#3

A client is to be discharged with a prescription for an analgesic that is a controlled substance. Which comment by the client indicates to the nurse that further teaching is needed?

"I know I can titrate the dose according to the pain level."

The nurse is to administer ceftriaxone. The order reads: give 125 mg now. On hand is a ceftriaxone vial with a concentration of 250 mg/mL. How many milliliters will the nurse draw up to deliver 125 mg of ceftriaxone? Record your answer using one decimal place.

0.5

A physician prescribes penicillin potassium oral suspension 56 mg/kg/day in four divided doses for a client with anorexia nervosa who weighs 25 kg. The medication dispensed by the pharmacy contains a dosage strength of 125 mg/5 mL. How many milliliters of solution should the nurse administer with each dose? Record your answer using a whole number.

14

The nurse administers lactulose to a client with cirrhosis. What is the expected outcome from the administration of the lactulose?

Reduced serum ammonia levels.

The nurse is administering packed red blood cells (PRBCs) to a client. What should the nurse do first?

Stay with the client during the first 15 minutes of infusion.

A client has been prescribed digoxin. Which symptom should the nurse tell the client to report as a potential indication of digoxin toxicity?

visual disturbances

A client with heart failure is given a prescription for torsemide. Two days after the drug therapy is started, which sign indicates the drug is having the intended outcome? The client:

weighs 7 lb (3 kg) less than the client did 2 days ago.

While receiving disulfiram therapy, the client becomes nauseated and vomits severely. Which question should the nurse ask first?

"How much alcohol did you drink today?"

A client is receiving streptomycin to treat tuberculosis. What should the nurse evaluate to determine an adverse effect of the drug?

hearing loss

The client was admitted to the hospital with the diagnosis of iron overload. Over time, an excess of iron can damage the liver and cause heart problems. Which medication does the nurse anticipate the healthcare provider to order?

deferoxamine

A client who is receiving multiple medications for a myocardial infarction reports severe nausea. Assessments reveal that the heartbeat is irregular and slow. The nurse should recognize these symptoms as toxic effects of which medication?

digoxin

A client is receiving magnesium sulfate at 3 g/h intravenously. The bag of 1,000 mL normal saline contains 20 g of magnesium sulfate. At what rate (in mL/hour) should the nurse set the IV pump to deliver 3 g/h? Record your answer using a whole number.

150

A nurse is teaching a client about hormonal contraceptive therapy. If a client misses three or more pills in a row, the nurse should instruct the client to

discard the pack, use an alternative contraceptive method until her period begins, and start a new pack on the regular schedule.

A client with chronic renal failure who receives hemodialysis three times weekly has a hemoglobin (Hb) level of 7 g/dl (70mmol/L). The most therapeutic pharmacologic intervention would be to administer

epoetin alfa.

A client with quadriplegia is experiencing severe muscle spasms. To relieve them, a physician orders baclofen, 5 mg P.O. three times daily. What is the principal indication for baclofen?

muscle spasms with paraplegia or quadriplegia from spinal cord lesions

A client with a severe staphylococcal infection is receiving the aminoglycoside gentamicin sulfate by the I.V. route. The nurse should assess the client for which adverse reaction?

ototoxicity

After instructing a 20-year-old nulligravid client about adverse effects of oral contraceptives, the nurse determines that further instruction is needed when the client states which as an adverse effect?

ovarian cancer

The nurse has administered aminophylline to a client with emphysema. Which indicates the medication has been effective?

relaxation of smooth muscles in the bronchioles

A short time after cataract surgery, the client has nausea. What should the nurse do first?

Medicate the client with an antiemetic, as prescribed.

A graduate nurse is reviewing the procedure for removing a peripherally inserted central catheter (PICC) with the preceptor. Which planned action by the graduate nurse should the preceptor correct?

Discarding the catheter in a trash container

A physician orders several drugs for a client with hemorrhagic stroke. Which drug order should the nurse question?

heparin sodium

The nurse is educating a client who insists that the newly prescribed imipramine is not working for the client's feelings of depression. When evaluating the client's statement, which question is most important to ask first?

"How long have you been taking the medication?"

Which statement by a student nurse demonstrates that further instruction about cytotoxic drugs is needed?

"Nurses who are pregnant must wear gloves during administration of cytotoxic drugs."

The client is diagnosed with absence seizures and is prescribed pentobarbital sodium. What should the nurse include in the client's teaching concerning the administration of pentobarbital sodium?

"Pentobarbital sodium can cause confusion."

A client is taking lithium carbonate. The client asks for explanations of why regular blood tests are needed. The nurse explains that it is to detect lithium toxicity. Which statement, if made by the client, indicates to the nurse that the teaching about lithium toxicity has been effective?

"There may be too much medication in my bloodstream."

The client with heart failure asks the nurse about the reason for taking enalapril maleate. The nurse should tell the client:

"This drug will dilate your blood vessels and lower your blood pressure."

A child is to receive dexamethasone intravenously at the ordered dosage of 7.6 mg. The drug concentration in the vial is 4 mg/ml. How many milliliters should the nurse administer? Record the answer using one decimal place.

1.9

After laparoscopic cholecystectomy, a 43-year-old client reports pain and nausea. The nurse is preparing meperidine hydrochloride 75 mg and promethazine hydrochloride 12.5 mg to be administered I.M. in the same syringe. If the label on the meperidine reads 50 mg/ml and the label on the promethazine reads 25 mg/ml, how many milliliters should the nurse have in the syringe after the correct doses are drawn up? Record your answer using a whole number.

2

A client returns to the room from the postanesthesia care unit after undergoing a right hemicolectomy. The health care provider orders 1 L of dextrose 5% in half-normal saline solution to infuse at 125 ml/hour. The drop factor of the available intravenous tubing is 15 gtt/ml. What is the drip rate in drops per minute? Round your answer to the nearest whole number. (For example: 62)

31

The client with Alzheimer's disease has been prescribed donepezil 5 mg at bedtime. Which instructions should the nurse give to the client's caretaker?

Avoid suddenly stopping the medication.

A client is receiving total parenteral nutrition (TPN). The nurse notices that the bag of TPN solution has been infusing for 24 hours but has 300 mL of solution left. What should the nurse do?

Discontinue the current solution, change the tubing, and hang a new bag of TPN solution.

A client is using patient-controlled analgesia (PCA) to manage postoperative pain. What should the nurse do when assisting the client with the PCA?

Document the client's response to pain medication.

The nurse should seek clarification about which prescription?

Give 200,000 units heparin by IV drip, and infuse over 24 hours.

A client is typed and cross-matched for three units of packed cells. What are important precautions for the nurse to take before initiating the transfusion? Select all that apply.

Have two nurses check the blood type and identity. Initiate an IV with normal saline. Take baseline vital signs.

Which technique is correct when administering a subcutaneous injection?

Insert the needle at a 45-degree angle to the skin.

A client with depression states, "I'm still feeling nauseous after I take venlafaxine. Maybe I need something else." What should the nurse should tell the client to do?

Take the medication at mealtime.

Twenty-four hours after giving birth to a term neonate, a primipara receives acetaminophen with codeine for perineal pain. One hour after administering the medication, which finding should alert the nurse to the development of a possible side effect?

dizziness

The client with depression has been hospitalized for 3 days on the psychiatric unit. This is the second hospitalization during the past year. The healthcare provider prescribes tranylcypromine sulfate because the client did not respond positively to a tricyclic antidepressant. If the client's diet includes foods containing tyramine, the nurse should teach the client about which possible reaction?

hypertensive crisis

One hour after receiving nalbuphine for pain during labor, a primigravida gives birth to a full-term neonate with symptoms of respiratory depression. The nurse anticipates that the neonate will require the administration of which drug?

naloxone

The client with preeclampsia asks the nurse why she is receiving magnesium sulfate. The nurse's most appropriate response to is to tell the client that the priority reason for giving her magnesium sulfate is to

prevent seizures.

The nurse is caring for a client who has a new prescription for amitriptyline for depression and is preparing to be discharged. What assessment is the nurse's priority?

suicidal ideation

A client with lung cancer has developed an intractable, nonproductive cough that is unrelieved by nonopioid antitussive agents. The health care provider orders codeine, 10 mg PO every 4 hours. Which statement accurately describes codeine?

It's a centrally-acting antitussive and can cause dependence.

The nurse is preparing to administer vitamin B12 intramuscularly (IM). Which nursing intervention is appropriate?

Administer using z-track technique.

Prior to administering an opioid prescribed for pain management, the nurse assesses the client using the Pasero Opioid-Induced Sedation Scale (POSS) (see chart). The nurse assigns a score of 3 based on assessment criteria for the scale. What should the nurse do next?

Contact the health care provider (HCP) to request a decreased dose of the medication.

A client with hypothyroidism (myxedema) is receiving levothyroxine, 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug?

tachycardia

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

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

The parent of a young adult client diagnosed with schizophrenia is asking questions about his son's antipsychotic medication, ziprasidone. Which statement by the parent reflects a need for further teaching?

"I should give him benztropine to help prevent constipation from the ziprasidone."

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

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

A client who is recovering from gastric surgery is receiving IV fluids to be infused at 100 mL/hour. The IV tubing delivers 15 gtt/mL. The nurse should infuse the solution at a flow rate of how many drops per minute to ensure that the client receives 100 mL/hour? Record your answer using a whole number.

25

A client reports pain in the right heel and is requesting medication. The nurse assesses the client and administers an analgesic. The client experiences no pain relief and states that the heel pain is worse. What is an appropriate intervention by the nurse?

Call the physician to report the finding.

The nurse is reviewing the physician's order written for a postmenopausal client: "calcitonin salmon nasal spray 200 IU, one spray every day." What is the appropriate action to be taken by the nurse regarding this order?

Clarify with the physician that the spray should be given in only one nostril per day.

The nurse notes grapefruit juice on the breakfast tray of a client who is taking repaglinide. What should the nurse do next?

Remove the grapefruit juice from the client's tray and bring another juice of the client's preference.

A client has been taking 30 mg of duloxetine hydrochloride twice daily for 2 months because of depression and vague aches and pains. While interacting with the nurse, the client discloses a pattern of drinking a 6-pack of beer daily for the past 10 years to help with sleep. What should the nurse do first?

Report the client's beer consumption to the health care provider (HCP).

A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the physician immediately because the client probably is experiencing which problem?

a hemolytic allergic reaction caused by an antigen reaction

A nurse is caring for a client 1 hour post-laparotomy who reports abdominal pain rating 5/10. What will the nurse prioritize when administering the ordered morphine?

administer the medication before the pain becomes severe

A client comes to the clinic with back pain that has been unrelieved by continuous ibuprofen use over the past several days. Current prescription medications include captopril and hydrochlorothiazide. Which laboratory value should the nurse address?

blood urea nitrogen (BUN) of 26 mg/dL and serum creatinine of 2.35 mg/dL

A client has been taking prescribed aspirin in large doses and reports having stomach irritation, sometimes with vomiting. Which food or beverage noted from the client's diet history should the nurse suggest the client avoid?

glass of wine

An elderly client's lithium level is 1.4 mEq/L. The client complains of diarrhea, tremors, and nausea. The nurse should:

hold the lithium and notify the physician.

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

on the floor of the mouth.

The nurse is collaborating with the health care provider (HCP) to develop a care plan to help control chronic pain in a client with cancer who is receiving hospice home care. Which plan is most appropriate for preventing and reducing the client's pain?

Administer analgesics on a regular basis with administration of additional analgesics for breakthrough pain.

A physician orders an I.V. bolus injection of diltiazem hydrochloride for a client with uncontrolled atrial fibrillation. What should the nurse do before administering an I.V. bolus?

Gently aspirate the I.V. catheter to check for a blood return.

The physician's order reads "digoxin 0.075 mg." The pharmacy packaging contains three digoxin tablets labeled as 0.25 mg each. The packaging states to administer all 3 tablets to the client. What should the nurse do next?

Contact the pharmacist because the delivered dose is too high.

Which is the correct technique when the nurse is instilling eye drops for an adult who is alert? Select all that apply.

Hold the dropper over the eye, and instill the drops into the lower lid. Have the client tilt the head back and look up. Blot excess drops from the client's face.

A physician orders cefoxitin, 1 g in 100 ml of 5% dextrose in water, to be administered I.V. A nurse determines that the recommended infusion time is 15 to 30 minutes. The available infusion set has a calibration of 10 drops/ml. To infuse cefoxitin over 30 minutes, which drip rate should the nurse use?

33 drops/minute