N316B Final Exam Qs

Question 6 A client is prescribed trimethoprim/sulfamethoxazole for recurrent urinary tract infections. Which statement by the nurse about this medication is correct? A"You can stop the medication after five days." B"Be sure to take the medication with food." C"It is safe to take with oral contraceptives." "D"Drink at least eight glasses of water a day."

"D"Drink at least eight glasses of water a day." Rationale: Trimethoprim/sulfamethoxazole is a highly insoluble medication and should be taken with a large volume of fluid. This medication can be taken with or without food. The full prescribed amount should be taken at evenly-spaced intervals until the medication is finished. Unlike many other antibiotics, trimethoprim/sulfamethoxazole does not seem to affect hormonal birth control such as the pill, the patch or ring.

352) Which statement made by a client prescribed metformin extended release to control type 2 diabetes mellitus indicates the need for further education? "I will take the medication with food." "I must swallow my medication whole and not crush or chew it." "I will notify my doctor if I develop muscular or abdominal discomfort." "I will stop taking metformin for 24 hours before and after having a test involving dye."

"I will stop taking metformin for 24 hours before and after having a test involving dye." Rationale Metformin must be withheld for 48 hours before the use of iodinated contrast materials to prevent lactic acidosis. Metformin is restarted when kidney function has returned to normal. Metformin is taken with food to avoid adverse gastrointestinal effects. If crushed or chewed, metformin XL will be released too rapidly and may lead to hypoglycemia. Muscular and abdominal discomfort is a potential sign of lactic acidosis and must be reported to the health care provider.

350) Which response would a nurse give to a client diagnosed with type 1 diabetes who states "I hate shots. Why can't I take the insulin in tablet form?"? "Your diabetic condition is too serious for oral insulin." "Insulin is poorly absorbed orally, so it is not available in a tablet." "Insulin by mouth causes a high incidence of allergic and adverse reactions." "Once your diabetes is controlled, your primary health care provider might consider oral insulin."

"Insulin is poorly absorbed orally, so it is not available in a tablet." Rationale The chemical structure of insulin is altered by gastric secretions, rendering it ineffective. There is no such thing as oral insulin; this comment about the seriousness of the diabetic condition may increase anxiety. There are no data to support the statement regarding allergic or adverse reactions, and insulin is given parenterally, not orally. Insulin is not absorbed but is destroyed by gastric secretions; there is no insulin that is effective if taken by mouth.

467) Which explanation would the nurse provide to a client with tuberculosis who asks why vitamin B 6 (pyridoxine) is given with isoniazid? "It will improve your immunologic defenses." "The tuberculostatic effect of isoniazid is enhanced." "Isoniazid interferes with the synthesis of this vitamin." "Destruction of the tuberculosis organisms is accelerated." Rationale

"Isoniazid interferes with the synthesis of this vitamin." Isoniazid often leads to vitamin B 6 (pyridoxine) deficiency because it competes with the vitamin for the same enzyme; this deficiency most often is manifested by peripheral neuritis, which can be controlled by the regular administration of vitamin B 6. Vitamin B 6 does not improve immune status. Pyridoxine does not enhance the effects of isoniazid. Pyridoxine does not destroy organisms.

349) Which response would a nurse give to a client taking an oral hypoglycemic tablet daily who asks if an extra tablet should be taken before exercise? "You will need to decrease your exercise." "An extra tablet will help your body use glucose correctly." "When taking medicine, your diet will not be affected by exercise." "No, but you should observe for signs of hypoglycemia while exercising."

"No, but you should observe for signs of hypoglycemia while exercising." Rationale Exercise improves glucose metabolism; with exercise, there is a risk of developing hypoglycemia, not hyperglycemia. Exercise should not be decreased because it improves glucose metabolism. An extra tablet probably will result in hypoglycemia because exercise alone improves glucose metabolism. Control of glucose metabolism is achieved through a balance of diet, exercise, and pharmacologic therapy.

888) A client with type 2 diabetes takes one glyburide tablet daily. The client asks whether an extra tablet should be taken before exercise. Which response will the nurse provide? 'You will need to decrease how much you are exercising.' 'An extra pill will help your body use glucose when exercising.' 'The amount of medication you need to take is not related to exercising.' 'Do not take an extra pill because you may become hypoglycemic when exercising.'

'Do not take an extra pill because you may become hypoglycemic when exercising.' Rationale Exercise improves glucose metabolism. Exercise is associated with a risk for hypoglycemia, not hyperglycemia; an additional antidiabetic agent is contraindicated. Exercise should not be decreased because it improves glucose metabolism. Also, this response does not answer the client's question. An extra tablet probably will result in hypoglycemia because exercise alone improves glucose metabolism. Control of glucose metabolism is achieved through balanced diet, exercise, and pharmacological therapy.

328) Which statement indicates that a female client who is receiving rifampin for tuberculosis understands the teaching? Select all that apply. One, some, or all responses may be correct. "This medication may be hard on my liver, so I must avoid alcoholic drinks while taking it." "This medication may reduce the effectiveness of the oral contraceptive I am taking." "I cannot take an antacid within 2 hours before taking my medicine." "My health care provider must be called immediately if my eyes and skin become yellow."

"This medication may be hard on my liver, so I must avoid alcoholic drinks while taking it." "This medication may reduce the effectiveness of the oral contraceptive I am taking." "My health care provider must be called immediately if my eyes and skin become yellow." Rationale Alcohol may increase the risk of hepatotoxicity. Rifampin has teratogenic properties and may reduce the effectiveness of oral contraceptives. Yellowing of the eyes and skin are signs of hepatitis and should be reported immediately. An antacid may be taken 1 hour before taking the medication.

662) Trimethoprim-sulfamethoxazole is prescribed for a client with cystitis. Which instruction would the nurse include when providing medication teaching? 'Drink eight to ten glasses of water daily.' 'Take this medication with orange juice.' 'Take the medication with meals.' 'Take the medication until symptoms subside.'

'Drink eight to ten glasses of water daily.' Rationale A urinary output of at least 1500 mL daily should be maintained to prevent crystalluria (crystals in the urine). Taking the medication with orange juice provides no advantage. Also, orange juice produces an alkaline ash, which results in an alkaline urine that supports the growth of bacteria. Trimethoprim-sulfamethoxazole should be taken 1 hour before meals for maximum absorption. A prescribed course of antibiotics must be completed to eliminate the infection, which can exist on a subclinical level after symptoms subside.

1011) Which statement by the client indicates to the nurse a need for further teaching on rifampin therapy? 'I can expect my skin to turn yellow.' 'I can expect my sweat to change color.' 'I can expect my urine to turn red-orange.' 'I can expect my contact lenses to stain orange.'

'I can expect my skin to turn yellow.' Rationale The skin turning yellow indicates jaundice, a serious unexpected adverse effect of rifampin therapy that needs to be reported to the prescriber. Sweat, urine, saliva, and tears (which may stain contact lenses) may turn to a red-orange color during rifampin therapy, which is expected.

516) Trimethoprim/sulfamethoxazole is prescribed for a child with a urinary tract infection. Which statement by the parent indicates the nurse's instructions about administration have been understood? 'Mealtime is a good time to give the medication.' 'I'll make sure to give each pill with 6 to 8 oz of fluid.' 'It must be taken with orange juice to ensure acidity of urine.' 'The medication has to be taken every 4 hours to maintain a blood level.'

'I'll make sure to give each pill with 6 to 8 oz of fluid.' Rationale This is a sulfa medication; water must be encouraged to prevent urine crystallization in the kidneys. This medication does not have to be given with meals; it is administered every 12 hours. Orange juice causes an alkaline urine; water is the best fluid to be administered with this medication. This medication maintains the blood level for 8 to 12 hours; it is an intermediate-acting medication.

1045) Isoniazid (INH) is prescribed as a prophylactic measure for a client whose spouse has active tuberculosis (TB). Which statements made by the client indicate that there is a need for further teaching? Select all that apply. One, some, or all responses may be correct. 'I plan to start taking vitamin B 6 with breakfast.' 'I'll still be taking this medication 6 months from now.' 'I sometimes allow our children to sleep in our bed at night.' 'I know I also have tuberculosis because the skin test was positive.' 'I plan to attend a wine tasting event this evening.'

'I sometimes allow our children to sleep in our bed at night.' 'I know I also have tuberculosis because the skin test was positive.' 'I plan to attend a wine tasting event this evening.' Rationale The children are at an increased risk because the client's spouse has TB; the children should be screened as members of the household. The positive skin test indicates that the client has been exposed to the bacilli and developed antibodies, not necessarily the disease itself; further diagnostic studies are indicated. Wine contains tyramine and histamine, which when taken concurrently with INH can cause headache, flushing, and a drop in blood pressure; these should be avoided when taking INH. Pyridoxine (vitamin B 6) should be taken to prevent neuritis, which is associated with INH. The prophylactic medication therapy will be continued for 6 to 12 months.

659) A client has a prescription for nitrofurantoin 50 mg orally every evening to manage recurrent urinary tract infections. Which instruction would the nurse give to the client? 'Increase your intake of fluids.' 'Strain your urine for crystals and stones.' 'Stop taking the medication if your urinary output increases.' 'This may turn your urine green.'

'Increase your intake of fluids.' Rationale To prevent crystal formation, the client should have sufficient intake to produce 1000 to 1500 mL of urine daily while taking this medication. Straining urine is not indicated when the client is taking a urinary anti-infective. If fluids are encouraged, the client's output should increase. Nitrofurantoin turns urine dark yellow to brown, not green.

588) An adolescent with leukemia is receiving vincristine. The mother reports that the child is complaining of feeling 'tingles' all over. Which response by the nurse is most appropriate regarding the effect of this medication? 'It is a neurological side effect.' 'It is caused by an autoimmune reaction.' 'The skin becomes sensitive with chemotherapy.' 'The central nervous system has become hyperactive.'

'It is a neurological side effect.' Rationale Neurotoxicity is an anticipated side effect of vincristine sulfate. Some children report it as 'tingles' or feeling 'funny all over.' It is not usually permanent. Vincristine causes leukopenia, which increases susceptibility to infection; it does not cause an autoimmune reaction. Skin sensitivity is not the reason that the child feels tingly. Hyperactivity of the central nervous system is not a factor in the development of this neurological finding.

667) A client with tuberculosis is started on rifampin. The nurse evaluates that the teaching about rifampin is effective when the client makes which statement? 'I need to drink a lot of fluid while I take this medication.' 'My sweat will turn orange from this medication.' 'I should have my hearing tested while I take this medication.' 'Most people who take this medication develop a rash.'

'My sweat will turn orange from this medication.' Rationale Rifampin causes body fluids, such as sweat, tears, and urine, to turn orange. It is not necessary to drink large amounts of fluid with this medication; it is not nephrotoxic. Damage to the eighth cranial nerve is not a side effect of rifampin; it is a side effect of streptomycin sulfate, which is sometimes used to treat tuberculosis. A skin rash is not a side effect of rifampin.

544) A child is prescribed insulin glargine before breakfast. Which instruction is most appropriate for the nurse to give the parents regarding a bedtime snack? 'Offer a snack to prevent hypoglycemia during the night.' 'Give the child a snack if signs of hyperglycemia are present.' 'Avoid a snack because the child is being treated with long-acting insulin.' 'Keep a snack at the bedside in case the child gets hungry during the night.'

'Offer a snack to prevent hypoglycemia during the night.' Rationale Insulin glargine is released continuously throughout the 24-hour period; a bedtime snack will prevent hypoglycemia during the night. Providing a snack when signs of hyperglycemia are present is unsafe because it intensifies hyperglycemia; if hyperglycemia is present, the child needs insulin. Because insulin glargine is a long-acting insulin, bedtime snacks are recommended to prevent a hypoglycemic episode during the night. When hypoglycemia develops, the child will be asleep; the child should eat the snack before going to bed.

879) Which statement made by a client recently diagnosed with type 1 diabetes indicates that further education is necessary regarding the teaching plan? 'I will need to have my eyes and vision examined once a year.' 'I will need to check my blood sugar at home to evaluate my response to my treatment plan.' 'I can improve metabolic and cardiac risk factors of this disease if I follow a healthy diet and exercise routine.' 'Once I get my glucose levels under control, there is a good chance that I will be able to switch from insulin to an oral medication.'

'Once I get my glucose levels under control, there is a good chance that I will be able to switch from insulin to an oral medication.' Rationale Type 1 diabetes mellitus (DM) is an autoimmune disorder in which beta cells are destroyed. No insulin or very little insulin is produced. A person with type 1 DM will need lifelong insulin injections to control blood sugar. Early detection of changes in the eye permits treatment plan adjustments that can slow or halt progression of retinopathy. Blood glucose monitoring should be done at home to evaluate the treatment plan. Disease risk factors can be improved with a healthy diet and exercise routine.

1500) The parent of a toddler taking methotrexate asks the nurse whether the child should be started on vitamin supplements. Which statement by the nurse is appropriate? 'That's a fine suggestion, and I'll ask for a prescription.' 'Vitamin supplements won't help him feel any better right now.' 'He'll benefit from a vitamin supplement and will be getting it soon.' 'Supplements that contain folic acid interfere with the effectiveness of chemotherapy.'

'Supplements that contain folic acid interfere with the effectiveness of chemotherapy.' Rationale Vitamins are contraindicated because methotrexate is a folic acid antagonist, and folic acid will counteract the effectiveness of methotrexate. Telling the parent that vitamins won't help his or her child feel better doesn't answer the question; the parent is asking about improving her child's strength, not well-being.

596) A child receiving methotrexate and undergoing cranial radiation is very weak. The mother asks the nurse if she should give her child vitamins. Which response by the nurse is most appropriate? 'That's an excellent idea. I'll try to get a prescription for her.' 'Unfortunately, vitamins won't make her feel any better now.' 'That won't be possible. Vitamins interfere with the action of methotrexate.' 'After we receive the laboratory reports, your daughter will be getting vitamins.'

'That won't be possible. Vitamins interfere with the action of methotrexate.' Rationale Many vitamin supplements contain folic acid, which negates the action of methotrexate, a folic acid antagonist. Vitamin therapy is contraindicated, so the nurse would not try to obtain a prescription, and vitamins will not be prescribed after the laboratory reports have come back. Although vitamins contribute to well-being, stating that the client won't feel any better does not answer the question.

653) A client with tuberculosis takes combination therapy with isoniazid, rifampin, pyrazinamide, and streptomycin. The client says, 'I've never had to take so much medication for an infection before.' How would the nurse respond? 'The bacteria causing this infection are difficult to destroy.' 'Streptomycin prevents the side effects of the other medications.' 'You only need to take the medications for a couple of weeks.' 'Aggressive therapy is needed because the infection is well advanced.'

'The bacteria causing this infection are difficult to destroy.' Rationale Multiple medications are administered because of concerns regarding medication resistance. Streptomycin sulfate is an antibiotic; it does not prevent the side effects of other medications used in therapy. Multiple antitubercular medications are necessary for an extended period, approximately 6 to 8 months depending on the individual. Multiple dose therapy is needed regardless of whether the disease is advanced.

1010) Which response by the nurse is appropriate when a client asks what to expect when beginning treatment for tuberculosis? 'Therapy will last a few weeks.' 'Therapy will occur over two phases.' 'Therapy will involve one medication.' 'Therapy will require monitoring kidney function.'

'Therapy will occur over two phases.' Rationale Therapy for tuberculosis occurs over two phases. The target of the induction phase is to achieve noninfectious sputum, and the target of the continuation phase is to eradicate the intracellular bacteria. Therapy for tuberculosis is prolonged, lasting 6 months to 2 years. Therapy for tuberculosis involves two to four medications. Therapy for tuberculosis requires monitoring liver, not kidney, function.

1054) A health care provider prescribes oral antacids and intravenous ranitidine for a client with burns and crushing injuries caused by an accident. The client asks how these medications work. Which explanation would the nurse provide? 'These medications work together to decrease bowel irritability.' 'They limit acidity in the gastrointestinal tract.' 'They are very effective in clients with multiple trauma.' 'These medications decrease nausea and vomiting.'

'They limit acidity in the gastrointestinal tract.' Rationale Increased acidity caused by the stress occurring with burns and crushing injuries contributes to the formation of Curling ulcer; ranitidine, an H 2 antagonist, decreases the formation of gastric acid, and an antacid neutralizes gastric acid once it is formed. These medications do not decrease irritability of the bowel; their purpose is to decrease gastrointestinal acidity. The response, 'They are very effective in clients with multiple trauma,' does not answer the client's question. Their purpose is not that of an antiemetic.

996) A client prescribed omeprazole for gastroesophageal reflux disease reports a new occurrence of significant diarrhea. Which response by the nurse is most appropriate? 'Stop taking your omeprazole.' 'This is a normal side effect of omeprazole.' 'We are going to collect a stool sample for testing.' 'Antidiarrheal medication can be used to decrease this.'

'We are going to collect a stool sample for testing.' Rationale Omeprazole has been linked to an increased risk of diarrhea because of Clostridium difficile, so the stool should be tested. The nurse would not instruct the client to stop any medications without consulting the prescribing health care provider. Significant diarrhea in the setting of omeprazole is not a normal finding and should be investigated for Clostridium difficile. Antidiarrheal medication should not be recommended until Clostridium difficile infection is investigated and ruled out.

909) A client has type 2 diabetes controlled with oral antidiabetic medications. When admitted for elective surgery, the health care provider prescribes regular insulin. Which information would the nurse include when teaching the client about the addition of insulin? 'You will need a higher serum glucose level while on bed rest.' 'The stress of surgery may cause hypoglycemia.' 'With insulin, dosage can be adjusted to your changing needs during recovery from surgery.' 'The possibility of surgical complications is greater when a client takes oral hypoglycemics.'

'With insulin, dosage can be adjusted to your changing needs during recovery from surgery.' Rationale There is better control of blood glucose levels with short-acting (regular) insulin. The level of glucose must be maintained as close to normal as possible; elevated glucose levels are not desirable for clients on bed rest. The stress of surgery will precipitate hyperglycemia (not hypoglycemia), which is best controlled with exogenous insulin. Oral hypoglycemics do not increase surgical complications.

764) A client is diagnosed with pulmonary tuberculosis, and the health care provider prescribes a combination of rifampin and isoniazid. The nurse evaluates that the teaching regarding the medications is effective when the client reports which action as most important? 'Report any changes in vision.' 'Take the medicine with my meals.' 'Call my doctor if my urine or tears turn red-orange.' 'Continue taking the medicine even after I feel better.'

*'Continue taking the medicine even after I feel better.' Rationale The medication should be taken for the full course of therapy; most regimens last from 6 to 9 months, depending on the state of the disease. Visual changes are not side effects of this medication. The medication should be taken 1 hour before meals or 2 hours after meals for better absorption. Urine or tears turning red-orange is a side effect of rifampin; although this should be reported, it is not an adverse side effect.

1085) A client is admitted to the hospital for a subtotal thyroidectomy. When discussing postoperative medication therapy with the client, which advice will the nurse include in the teaching? 'You will be taking iodine daily to increase the formation of thyroid hormone.' 'After your body adjusts to postsurgical status, you will be weaned off this medication.' 'The propylthiouracil that is prescribed will stimulate the secretion of thyroid-stimulating hormone.' 'If you develop palpitations, nervousness, or tremors, the dose of thyroid hormone may need to be decreased.'

*'If you develop palpitations, nervousness, or tremors, the dose of thyroid hormone may need to be decreased.' Rationale Excessive thyroid hormone replacement may lead to signs and symptoms of hyperthyroidism. Iodine may be administered before, not after, surgery. Thyroid hormone replacement is required for life. Propylthiouracil blocks thyroid hormone synthesis; this often is administered before, not after, surgery.

538) A 3-year-old child is prescribed a liquid iron preparation. The nurse would include which intervention when teaching the parent about the administration of this medication? 'Monitor the stools for diarrhea.' 'Administer with meals to improve absorption.' 'Avoid giving the child orange juice with the iron preparation.' Have the child drink the diluted iron preparation through a straw.'

*Have the child drink the diluted iron preparation through a straw.' Rationale A liquid iron preparation may stain tooth enamel; therefore it should be diluted and administered through a straw. Constipation, rather than loose stools, often results from the administration of iron. Iron absorption is improved when taken on an empty stomach. The exception is acidic foods, such as citrus juices, which improve absorption.

53) Which finding in a client with hypothyroidism and hypertension who reports taking an extra dose of levothyroxine indicates the need to obtain a thyroid function panel? Select all that apply. One, some, or all responses may be correct. Tremors Diaphoresis Nervousness Temperature 101°F Heart rate 116 beats/min

*Tremors *Diaphoresis *Nervousness *Temperature 101°F *Heart rate 116 beats/min Rationale Clients with hypothyroidism can develop thyrotoxicosis from an acute overdose of thyroid hormone. Tremors, diaphoresis, and nervousness are all signs of thyrotoxicosis. Clients may also be hyperthermic and tachycardic.

496) Which purpose of insulin would a nurse identify when caring for a client prescribed insulin added to a solution of 10% dextrose in water after an intravenous solution containing potassium inadvertently was infused too rapidly? -Glucose with insulin increases metabolism, which accelerates potassium excretion. -Increased potassium causes a temporary slowing of the pancreatic production of insulin. -Increased insulin accelerates the excretion of glucose and potassium, thereby decreasing the serum potassium level. -Potassium follows glucose into the cells of the body, thereby raising the intracellular potassium level.

-Potassium follows glucose into the cells of the body, thereby raising the intracellular potassium level. Rationale Potassium follows glucose into the cells of the body, thereby raising the intracellular potassium level and preventing fatal dysrhythmias. Potassium is not excreted as a result of this therapy; it shifts into the intracellular compartment. The potassium level has no effect on pancreatic insulin production. Insulin does not cause the excretion of these substances.

970) Which rationale explain why intravenous (IV) potassium is prescribed in addition to regular insulin for clients in diabetic ketosis? -Potassium loss occurs rapidly from diaphoresis present during coma. -Potassium is carried with glucose to the kidneys to be excreted in the urine in increased amounts. -Potassium is quickly used up during the rapid series of catabolic reactions stimulated by insulin and glucose. -Serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment.

-Serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment. Rationale Insulin stimulates cellular uptake of glucose and stimulates the sodium/potassium pump, leading to the influx of potassium into cells. The resulting hypokalemia is offset by parenteral administration of potassium. Potassium is not lost from the body by profuse diaphoresis. Potassium moves from the extracellular to the intracellular compartment rather than being excreted in the urine. Anabolic reactions are stimulated by insulin and glucose administration; potassium is drawn into the intracellular compartment, necessitating a replenishment of extracellular potassium.

459) Which period of time would a nurse recognize as the greatest risk of hypoglycemia when caring for a client who receives regular insulin daily at 8:00 AM? 8:30 AM to 9:30 AM 8:00 PM to 12:00 AM 1:00 PM to 8:00 PM 10:00 AM to 1:00 PM

10:00 AM to 1:00 PM Rationale Regular insulin peaks in 2 to 5 hours; therefore the greatest risk is between 10:00 AM and 1:00 PM. Although the onset of action occurs earlier, during the period from 8:30 AM to 9:30 AM, the level is not yet at its highest, so the risk of hypoglycemia is not at its greatest. NPH insulin's peak action is 4 to 12 hours; if hypoglycemia occurs, it will most likely happen between 12:00 PM and 8:00 PM.

1525) The nurse teaches an adolescent with type 1 diabetes about peak action of NPH insulin and the risk for hypoglycemia. The nurse determines teaching has been effective when the adolescent identifies insulin peak action within which time frame? 1 to 2 hours 2 to 4 hours 5 to 10 hours 4 to 12 hours

4 to 12 hours Rationale NPH insulin onset is 1.5 to 4 hours, peaks in 4 to 12 hours, and has a duration of 12 to 18 hours.

The nurse is preparing to administer doxycycline to a client to treat syphilis. Which lab results should the nurse review before administering this medication? A Pregnancy test B Hematocrit C Sodium level D Arterial blood gas

A Pregnancy test Rationale: Tetracyclines, such as doxycycline, may cause fetal harm and should not be administered during pregnancy. It is important to know the client's pregnancy status prior to administration. Reviewing hematocrit, serum sodium level, and ABGs may be a part of the client's assessment, but these do not affect the prescription for doxycycline.

A client is prescribed ampicillin sodium (Omnipen) for a sinus infection. The nurse should instruct the client to notify the healthcare provider immediately if which symptom occurs? A. Rash. B. Nausea. C. Headache. D. Dizziness.

A. Rash. Rash is the most common adverse effect of all penicillins, indicating an allergy to the medication that could result in anaphylactic shock, a medical emergency.

A female client with rheumatoid arthritis takes ibuprofen (Motrin) 600 mg PO 4 times a day. To prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is prescribed. Which information is most important for the nurse to include in client teaching? A. Use contraception during intercourse. B. Ensure the Cytotec is taken on an empty stomach. C. Encourage oral fluid intake to prevent constipation. D. Take Cytotec 30 minutes prior to Motrin.

A. Use contraception during intercourse. Cytotec, a synthetic form of a prostaglandin, is classified as pregnancy Category X and can act as an abortifacient, so the client should be instructed to use contraception during intercourse to prevent loss of an early pregnancy. A common side effect of Cytotec is diarrhea, so constipation prevention strategies are usually not needed. Cytotec and Motrin should be taken together to provide protective properties against gastrointestinal bleeding.

A nurse is reviewing laboratory data prior to administering methotrexate to a client with breast cancer. Which clinical finding will the nurse report to the healthcare provider before administering the medication? AALT of 55 IU/mL BWBC of 12,000/mm³ C AST of 34 U/L DHGB of 11.5 g/dL

AALT of 55 IU/mL Rationale: Alanine transaminase (ALT) is a liver enzyme that is released into the bloodstream when liver damage is present. Methotrexate is an antineoplastic used in the treatment of various carcinomas. Methotrexate is contraindicated in clients with hepatic impairment. A higher than normal white blood cell (WBC) count is an expected finding in a client with carcinoma. Aspartate aminotransferase (AST) is a liver enzyme used to assess hepatic function. An AST level of 34 U/L is a normal finding. Anemia (low hemoglobin) is an expected finding in a client with carcinoma.

The client is diagnosed with tuberculosis (TB). The nurse understands that the treatment plan for this client will involve what type of drug therapy? AAdministering two antituberculosis drugs BAminoglycoside antibiotics CAn anti-inflammatory agent DHigh doses of B complex vitamins

AAdministering two antituberculosis drugs Rationale: In order to prevent drug-resistant strains of TB, clients are always prescribed at least two different anti-tubercular medications. Rifampin and isoniazid are the most effective drugs used to treat TB and are always used together, for at least six months. Additional medications, such as pyrazinamide and either streptomycin or ethambutol, may also be prescribed. Vitamin B6 is usually prescribed to help prevent expected side effect of isoniazid.

A nurse is assessing a client diagnosed with diabetic ketoacidosis. The client is on a prescribed regular insulin infusion at 0.1 units/kg/hr. The client appears restless and verbalizes tingling to the extremities. Which action does the nurse perform next? ACheck the client capillary blood glucose BStop the regular insulin infusion CIncrease the infusion to 0.15 units/kg/hr DGive the client 4 oz of fruit juice

ACheck the client capillary blood glucose Rationale: The client is experiencing symptoms of hypoglycemia. Prior to decreasing the dose of the infusion, the nurse should assess the client's blood glucose level to confirm the hypoglycemia. Prior to stopping the infusion, the nurse needs to assess the client's blood sugar level and notify the healthcare provider of the results. Increasing the infusion will cause further hypoglycemia. Prior to performing an intervention to correct the hypoglycemia, the nurse needs to assess the blood glucose level first. Question 1

The nurse is preparing a client for discharge following inpatient treatment for pulmonary tuberculosis. Which instruction should be given to the client? AContinue taking medications as prescribed. BContinue taking medications until symptoms are relieved. CAvoid contact with children, pregnant women or immunosuppressed persons. DTake medication with aluminum hydroxide if epigastric distress occurs.

AContinue taking medications as prescribed. Rationale: Early cessation of treatment may lead to development of drug-resistant tuberculosis (TB). Active TB is usually treated with a combination of four different antibiotics (Isoniazid, rifampin, ethambutol and pyrazinamide) and can now take anywhere from 6-12 months to completely kill the bacteria. As with any antibiotics, clients should continue to take medications even after they begin to feel better. There is no reason to avoid contact with children, pregnant women or immunosuppressed persons once discharged from the hospital as long as the client is adhering to medication schedules. Isoniazid should be taken on an empty stomach; ethambutol can be taken with food to avoid stomach upset. If taken with TB medications, aluminum hydroxide will interfere with absorption of these medications.

A client who is taking isoniazid for tuberculosis asks the nurse about the possible side effects of this medication. The nurse informs the client to report which side effect of this medication to the primary health care provider (HCP)? AExtremity tingling and numbness BConfusion and light-headedness CDouble vision and visual halos DPhotosensitivity and photophobia

AExtremity tingling and numbness Rationale: Peripheral neuropathy is a common side effect of isoniazid and other anti-tubercular medications. Extremity tingling and numbness should be reported to the primary health care provider (HCP). Daily doses of pyridoxine (vitamin B6) may lessen or even reverse peripheral neuropathy due to isoniazid use.

The nurse is counseling a client with gastroesophageal reflux disease (GERD) who has been taking prescribed famotidine for two days. Which statement would require immediate follow up by a healthcare provider? AI take digoxin for my heart failure BI use calcium carbonate if I have symptoms after meals CI use alendronate for my osteoporosis DIm still having some symptoms of heartburn."

AI take digoxin for my heart failure Rationale: Most medications for heartburn decrease stomach acid. Histamine blocking drugs such as famotidine (H2 receptor antagonist) are available as both prescription and over-the-counter. It is often advised to take an antacid with an H2RA to relieve pain. Symptoms should be improved after one week. Famotidine does not cause bone loss, unlike proton pump inhibitors, and is an acceptable choice for clients with osteoporosis. Famotidine is used cautiously in clients on digoxin as it decreases absorption. This client needs to have their digoxin level checked, and the dosage may need to be adjusted.

The nurse is teaching a client with diabetes about newly prescribed trimethoprim and sulfamethoxazole (TMP-SMX) to treat a urinary tract infection. Which statement by the client indicates understanding? AI will stop taking this medication if I develop a rash." BThis antibiotic will kill mature bacteria in my urinary tract." CI should avoid dairy products when taking this medication." D"My blood sugar will not be affected by this medication."

AI will stop taking this medication if I develop a rash." Rationale: TMP-SMX is a sulfonamide medication. These drugs are bacteriostatic and therefore, halt the multiplication of new bacteria, but do not kill mature bacteria. Clients using sulfonylureas for the management of diabetes should know that other sulfa drugs may increase the chances of hypoglycemia. The action of metformin is also enhanced. Dairy is avoided when clients are taking tetracyclines. TMP-SMX is the most common cause of erythema multiforme. Sulfonamides are also often implicated in cases of both toxic epidermal necrosis and Stevens-Johnson syndrome, which can be fatal.

The nurse is providing teaching to the client taking metoclopramide. Serious side effects that should be reported to the provider are included in the teaching plan. Which of the following side effects is the priority? AInvoluntary muscle movements BReport of increased fatigue COnset of headaches DDifficulty with sleep

AInvoluntary muscle movements Rationale: Metoclopramide is a GI stimulant that is effective in reducing headache, nausea, and vomiting. Metoclopramide can cause a serious movement disorder called tardive dyskinesia (TD). This condition is often irreversible. TD is characterized by involuntary movements of the face, tongue, or extremities. The risk of developing TD is increased with longer treatment and increased dosage. To help prevent TD, this drug shouldn't be used for longer than 12 weeks. The more common side effects of metoclopramide can include headache, confusion, drowsiness, dizziness, restlessness, and insomnia.

The nurse administers cimetidine to a 75-year-old client diagnosed with a gastric ulcer. The nurse should monitor the client for which adverse reaction? AMental status change BIncreased liver enzymes CConstipation DHearing loss .

AMental status change Rationale: Cimetidine is a histamine H2-receptor antagonist used to treat gastric ulcers. It has been found to cause confusion in susceptible clients, such as the elderly and debilitated clients. Clients over age 50 or who are severely ill may become temporarily confused while taking H2 blockers, especially cimetidine

The nurse is educating a client prescribed metronidazole. Which of the following findings should the nurse include in the education as reportable to the healthcare provider? APinpoint red spots on the skin Pinpoint red spots on the skin BNausea after beginning the medication Nausea after beginning the medication CMetallic taste Metallic taste DOccasional diarrhea Occasional diarrhea

APinpoint red spots on the skin Pinpoint red spots on the skin Rationale: The most common gastrointestinal effects of metronidazole are nausea, vomiting, diarrhea, and metallic taste. Drug-induced immune thrombocytopenia (DITP) is a rare, but serious, adverse effect where medications cause the body to produce antibodies to platelets. The medication must be stopped immediately because DITP can be life-threatening. Heparin-induced thrombocytopenia is one example. Metronidazole is associated with DITP. Petechiae are pinpoint, round spots that appear on the skin as a result of bleeding. The bleeding causes the petechiae to appear red, brown, or purple.

The nurse is caring for a client who is receiving isoniazid for tuberculosis (TB). Which assessment finding would indicate the client is having a possible adverse response to this medication? AYellowing of the sclera BTinnitus and decreased hearing CHeadache and sore throat DUrinary frequency

AYellowing of the sclera Rationale: Isoniazid is a first-line anti-tuberculosis drug that is used as part of the combination therapy for treatment of tuberculosis. These first-line medications may be used up to 2 years in clients who are being treated for tuberculosis. The use of long-term combination treatment increases the effectiveness and decreases the occurrence of resistant strands. Clients receiving this medication are at risk for drug-induced hepatitis. The appearance of jaundice (yellowing of the sclera) may indicate an elevation of the client's serum bilirubin levels and liver enzymes (AST and ALT). A small number of clients taking isoniazid develop severe hepatitis that may progress to liver failure and death, unless the medication is stopped immediately. Other common side effects include nausea and peripheral neuropathy. This medication is not ototoxic and can occasionally cause urinary retention, not frequency.

1060) Pyridoxine (vitamin B 6) and isoniazid (INH) are prescribed as part of the medication protocol for a client with tuberculosis. Which response indicates that vitamin B 6 is effective? Weight gain Improvement of stomatitis Absence of paresthesias Absence of night sweats

Absence of paresthesias Rationale One of the most common side effects of INH is peripheral neuritis due to vitamin B 6 deficiency, and vitamin B 6 will counteract this problem. Weight gain is not a therapeutic effect of this vitamin. Vitamin B 6 does not affect stomatitis and does not prevent night sweats.

1483) A 9-month-old infant with iron-deficiency anemia has been getting supplements but shows no improvement. The nurse recognizes which action by the parents as the reason for the lack of improvement? Administering iron supplements through a straw Administering iron supplements with whole cow's milk Administering iron supplements along with orange juice Administering iron supplements at the back of the mouth

Administering iron supplements with whole cow's milk Rationale Whole cow's milk binds with free iron and reduces medication absorption. The infant has developed medication insufficiency for maximum therapeutic action. Administering iron supplements through a straw does not reduce medication absorption; it prevents the iron from staining the infant's teeth. Orange juice increases the absorption of iron supplements. Administering iron supplements at the back of the mouth does not reduce medication absorption; it prevents the iron from staining the infant's teeth.

1117) A client with type 1 diabetes experiences tremors, pallor, and diaphoresis. These signs and symptoms are manifestations of which cause? Overeating Viral infection Aerobic exercise Missed insulin dose

Aerobic exercise Rationale These responses are indicative of hypoglycemia, which can be caused by increased activity in clients who take insulin. Overeating causes hyperglycemia. Infections cause hyperglycemia because of the release of stress-related hormones. Missing an insulin dose causes hyperglycemia.

1123) A client with adenocarcinoma receives doxorubicin intravenously (IV) to reduce the tumor mass. Which clinical finding indicates that doxorubicin toxicity may have occurred? Fever Blue tinge to the urine Alteration in cardiac rhythm Increasing anxiety

Alteration in cardiac rhythm Rationale Doxorubicin is cardiotoxic and causes dysrhythmias. It increases the risk for infections secondary to myelosuppression, which may result in fever; however, this is not the result of toxicity. Blue-tinged urine is a side effect of doxorubicin, not a toxic effect. Feelings of nervousness are a side effect of doxorubicin, not a toxic effect.

452) Which clinical finding indicates that doxorubicin toxicity may have occurred? Fever Blue tinge to the urine Alteration in cardiac rhythm Increasing anxiety

Alteration in cardiac rhythm Rationale Doxorubicin is cardiotoxic and causes dysrhythmias. It increases the risk for infections secondary to myelosuppression, which may result in fever; however, this is not the result of toxicity. Blue-tinged urine is a side effect of doxorubicin, not a toxic effect. Feelings of nervousness are a side effect of doxorubicin, not a toxic effect.

1523) Which instructions would the nurse include when teaching parents how to administer liquid iron to their child? Select all that apply. One, some, or all responses may be correct. Protect the child from sunlight. Administer the medication with food. Anticipate that stools tend to be blackish-green. Give the medication with a glass of orange juice. Have the child drink it through a straw.

Anticipate that stools tend to be blackish-green. Give the medication with a glass of orange juice. Have the child drink it through a straw. Rationale Iron thickens the consistency of stools and may turn stools a blackish-green color. Citrus juices contain vitamin C and are acidic, meaning that they increase the absorption of iron. Direct contact with iron stains the teeth. Use of a needleless syringe permits accurate dosing and limited exposure of the teeth to the medication when given to very young children, but adolescents can drink the medication through a straw, which deposits the medication behind the teeth. The child will not experience photosensitivity when undergoing iron therapy. The medication should be taken between meals because it is best absorbed in an environment that has a low pH.

1524) The nurse teaches an adolescent about administration of intermediate-acting insulin and regular insulin. Which response indicates the adolescent understands when to administer the second dose of NPH insulin? At lunch At dinnertime 1 hour after lunch 1 hour after dinner

At dinnertime Rationale The second dose of the intermediate-acting insulin should be given at dinnertime. NPH insulin peaks in 4 to 12 hours. A second dose is often prescribed approximately 10 to 12 hours after the first dose. A blood glucose reading at bedtime will determine the evening dose of regular insulin. A dose given at lunch is too early because it may precipitate a hypoglycemic reaction. A dose given 1 hour after lunch is also too early because it may precipitate a hypoglycemic reaction. A dose given 1 hour after dinner is too late.

Question 12 A client is prescribed trimethoprim/sulfamethoxazole for recurrent urinary tract infections. Which information should the nurse include during client teaching? A"A harmless skin rash may appear." B"Drink at least eight large glasses of water a day." C"Be sure to take the medication with food." D"Stop the medication when your symptoms disappear."

B"Drink at least eight large glasses of water a day." Rationale: Trimethoprim/sulfamethoxazole (Bactrim) is a highly insoluble drug that can cause crystalluria and clients should drink plenty of fluids while taking this medication to lower the risk of developing kidney stones. Increased fluid intake is also recommended with a UTI to promote the "flushing out" of bacteria. The drug may be taken with or without food. Clients should take the medication for the prescribed length of time. Sulfonamide-containing products should be discontinued at the first appearance of skin rash. In rare instances, a skin rash may be followed by a more severe reaction, such as Stevens-Johnson syndrome or toxic epidermal necrolysis.

The nurse is providing teaching to a client who has been prescribed cyclophosphamide for breast cancer treatment. Which of the following statements made by the client would indicate that additional teaching is needed? A"I will probably need to plan on using a wig to cover my hair loss." B"I should limit the amount of fluids I drink while taking this medication." C"I will need to stay away from children when my white blood cell count is low." D"I may have trouble getting pregnant due to the damaging effects of the medication."

B"I should limit the amount of fluids I drink while taking this medication." Rationale: Cyclophosphamide is a chemotherapeutic medication. Some of the side effects of this medication include hair loss, low white cell count and infertility. The client is encouraged to drink about 2 to 3 liters of fluid per day to aid in eliminating the chemotherapy from the body.

Question 16 A client has received a prescription for nitrofurantoin to treat a urinary tract infection. Which of the following statements made by the client indicates the need for additional teaching about the medication? A"I will be sure to finish taking the antibiotics, even if I start feeling better." B"I will spend extra time in the sun to get plenty of vitamin D." C"I'll call my primary health care provider immediately if I develop a rash after taking the medication." D"I will take the medication with food."

B"I will spend extra time in the sun to get plenty of vitamin D." Rationale: Clients taking nitrofurantoin should avoid exposure to sunlight while taking the medication. Exposure to sunlight while taking this medication can lead to damage to the skin. A client planning to spend extra time in the sun while taking nitrofurantoin should be informed of the dangers of sun exposure and counseled to avoid sun exposure while taking the medication.

A client is prescribed morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes per patient-controlled analgesia (PCA) pump for a total of 5 mg IV maximally per hour. Which nursing action has the highest priority before initiating the PCA pump? A. Assessment of the expiration date on the morphine syringe in the pump. B. Assessment of the rate and depth of the client's respirations. C. Assessment of the type of anesthesia used during the surgical procedure. D. Assessment of the client's subjective and objective signs of pain.

B. Assessment of the rate and depth of the client's respirations. A life-threatening side effect of intravenous administration of morphine sulfate is respiratory depression. Prior to the initiation of the patient-controlled analgesia (PCA) pump, the nurse should assess the client's respirations to obtain a baseline of the client's respiratory rate and depth. Once the PCA pump is initiated, and if the client's respiratory rate falls below 12 breaths per minute, the PCA pump should be stopped and the healthcare provider notified immediately.

While taking a medical history, the client states, "I am allergic to penicillin." What related allergy to another type of antiinfective agent should the nurse ask the client about when taking the nursing history? A. Aminoglycosides. B. Cephalosporins. C. Sulfonamides. D. Tetracyclines.

B. Cephalosporins. According to research, there appears to be a cross sensitivity between penicillins and first generation cephalosporins; however, research shows there is no evidence of cross sensitivity between PCN and third or fourth generation cephalosporins.

The nurse is preparing an education session for a client prescribed opioids for intractable cancer pain. The nurse should include strategies to help prevent which common side effect associated with long-term use of opioids? A. Sedation. B. Constipation. C. Urinary retention. D. Respiratory depression.

B. Constipation. The client should be prepared to implement measures for constipation, which is the most likely persistent side effect related to opioid use. Tolerance to opiate narcotics is common, and the client may experience less sedation and respiratory depression as analgesic use continues. Opioids increase the tone in the urinary bladder sphincter, which causes retention but may subside. The most likely persistent side effect is constipation.

The healthcare provider prescribes naloxone (Narcan) for a client in the emergency room. Which assessment data would indicate that the naloxone has been effective? A. A client's statement that the chest pain is better. B. Respiratory rate is 16 breaths/minute. C. Seizure activity has stopped temporarily. D. Pupils are constricted bilaterally.

B. Respiratory rate is 16 breaths/minute. Naloxone (Narcan) is a narcotic antagonist that reverses the respiratory depression effects of opiate overdose, so assessment of a normal respiratory rate would indicate that the respiratory depression has been reversed.

A 43-year-old female client is prescribed thyroid replacement hormone following a thyroidectomy. Which adverse effects should the nurse instruct the client to report immediately to the healthcare provider? A. Tinnitus and dizziness. B. Tachycardia and chest pain. C. Dry skin and intolerance to cold. D. Weight gain and increased appetite.

B. Tachycardia and chest pain. Thyroid replacement hormone increases the metabolic rate of all tissues. Common signs and symptoms of toxicity include tachycardia and chest pain and should be reported to the healthcare provider immediately.

In evaluating the effects of lactulose (Cephulac), which outcome would indicate that the drug is performing as intended? A. An increase in urine output. B. Two or three soft stools per day. C. Watery, diarrhea stools. D. Increased serum bilirubin.

B. Two or three soft stools per day. The medication lactulose can be administered for either chronic constipation or for portal-systemic encephalopathy in clients with hepatic disease. Two to three stools a day indicate that lactulose is performing as intended for chronic constipation. This would also indicate it should be effective for the clients with encephalopathy because the lactulose's action prevents absorption of ammonia in the colon as it increases water absorption and softens the stool. The efficacy of the use for ammonia absorption would have to be verified by a serum ammonia level and observation of clearing of the client's mental status.

At the client's request, the nurse performs a fingerstick to test the client's blood glucose and the results are 322 mg/dL (17.9 mmol/L). Following the insulin sliding scale orders, the nurse administers 3 units of insulin lispro at 11:00 AM. When does the nurse anticipate the insulin lispro will begin to act? A3:00 pm B11:15 am C1:00 pm D12:00 PM

B11:15 am Rationale: The onset of action for insulin lispro, which is a rapid acting insulin, is 10 to 15 minutes after administration. It was administered at 11:00 AM, so it will begin to act at 11:15 AM.

The nurse is preparing to administer a prescribed dose of lactulose to a client who has cirrhosis. Which lab value will the nurse monitor to evaluate the therapeutic effect of the medication? AGlucose BAmmonia CPotassium DBicarbonate

BAmmonia Rationale: Hepatic encephalopathy is a manifestation of liver disease that has neurotoxic effects of ammonia. Lactulose acidifies feces in the intestines, which traps ammonia that can be then eliminated with defecation.

At 9 am, the nurse administers 10 units of insulin aspart subcutaneously to a client with a blood sugar of 322 mg/dL. At approximately what time should the nurse expect the insulin to peak? At 9:30 am BAt 10:00 am CAt noon DThis insulin does not peak because it acts over 24 hours.

BAt 10:00 am Rationale: Insulin aspart is an analog of human insulin with a rapid onset (10 to 20 minutes), peak of 40 to 60 minutes and short duration (3 to 5 hours); therefore, the nurse should expect the insulin to peak at 10 am. The drug is structurally identical to human insulin. Insulin aspart (100 units/ mL) is supplied in 10 mL vials and 3 mL pre-filled pens and cartridges. Dosing is almost always done by subcutaneous injection or subcutaneous infusion with an insulin pump. Because insulin aspart acts rapidly, it is often used for sliding scale coverage and injections should be given 5 to 15 minutes before meals.

The nurse is providing instructions to a client with a new prescription for levothyroxine 50 mcg daily to treat hypothyroidism. Which of the following is important for the nurse to include in the discharge instructions? AIt can be taken with an antacid if stomach upset occurs. BIt should be taken in the morning. CIt must be stored in a dark container. DIt may decrease the client's energy level.

BIt should be taken in the morning. Rationale: A thyroid supplement should be taken in the morning on an empty stomach with 8 ounces of water to maximize effects. Also, the client should avoid foods high in fiber, iron or soybeans within four hours of taking this medication because they may interfere with this drug's absorption. The medication should not be given in the evening or prior to bedtime because it may cause insomnia. It is not necessary to keep in a dark container. As the medication replaces thyroid hormone the client's energy level should be improved not decreased.

A nurse is providing care to a client diagnosed with a myocardial infarction. The client has a history of hypothyroidism and hypertension. Which prescribed medication will the nurse clarify before administering it to the client? AMorphine BLevothyroxine CAspirin DLabetalol

BLevothyroxine Rationale: Levothyroxine is a synthetic thyroid hormone used in the treatment of hypothyroidism. Levothyroxine can induce cardiac stimulant effects and is contraindicated in clients with a recent myocardial infarction (MI). Morphine and aspirin are commonly administered after a cardiac event. Morphine relieves pain associated with cardiac ischemia and aspirin decreases platelet aggregation that leads to blood clotting. Labetalol is a beta-blocker used in the treatment of hypertension. There is no known contraindication for the use of labetalol after an MI.

The nurse is caring for a client with diabetes mellitus. The client reports feeling hungry and thirsty. The client's most recent blood glucose level was 175 mg/dL. Which type of insulin should the nurse anticipate being prescribed for this client? AGlucagon BLispro CExenatide DSitagliptin

BLispro Rationale: The inpatient client with an elevated blood sugar is usually prescribed a short-acting insulin such as lispro, aspart or regular (Humulin-R) insulin. Glucagon is a medication used to treat hypoglycemia, not hyperglycemia. Exenatide and sitagliptin are not insulins.

The nurse is preparing to administer trimethoprim and sulfamethoxazole (TMP-SMX) to a client. When assessing client allergies, the client reports that they are allergic to glipizide. What action by the nurse is most appropriate? APrepare to administer the medication BReport the allergies to the healthcare provider CReview the health record to see if the client is on glipizide DAssess the client blood sugar

BReport the allergies to the healthcare provider Rationale: While administering a sulfonamide with a sulfonylurea may increase the risk of a hypoglycemic reaction, the real concern is the potential allergy to TMP-SMX. It may be safe to administer the medication, but the healthcare provider should be notified first.

Question 12 The nurse is teaching the client with bacterial vaginosis who has been prescribed metronidazole tablets. What statement is appropriate? AYou may continue to experience symptoms after you stop the medication BYou should avoid drinking alcohol while taking this medication CCall your healthcare provider if you experience diarrhea DYour sexual partner will need to be treated as well

BYou should avoid drinking alcohol while taking this medication Rationale: Alcohol should be avoided while on metronidazole to reduce the risk of a disulfiram reaction. Routine treatment of male sexual partners is not needed and does not affect re-infection rates. If the client experiences continued symptoms, this may indicate treatment failure and the need for follow-up may be required. Diarrhea is a common side effect of metronidazole and should subside once treatment ends.

1218) The nurse would counsel a pregnant client to take her iron supplement at which time of the day for efficient absorption? Bedtime After lunch Dinnertime Before breakfast

Before breakfast Rationale Iron should be taken before breakfast on an empty stomach to permit maximal absorption. Iron should not be taken at bedtime or with meals or after meals.

1096) Daily regular insulin has been prescribed for a client with type 1 diabetes. The nurse administers the insulin at 8 AM. When will the nurse monitor the client for a potential hypoglycemic reaction? At breakfast Before lunch Before dinner In the early afternoon

Before lunch Rationale Regular insulin is short acting and peaks in 2 to 4 hours, which in this case will be at or before lunch. Breakfast is too soon; regular insulin peaks in 2 to 4 hours. Before dinner is too late; regular insulin peaks in 2 to 4 hours. The early afternoon is too late; regular insulin peaks in 2 to 4 hours.

522) Which laboratory test result would alert the nurse that fluid intake would need to be increased in a child receiving vincristine? Urine pH of 6 Urine specific gravity of 1.020 Blood uric acid level of 7.5 mg/dL Blood urea nitrogen level of 15 mg/dL

Blood uric acid level of 7.5 mg/dL Rationale The normal blood uric acid level for children ranges from 2.5 to 5.5 mg/dL. An increase in the uric acid level caused by the destruction of cells may lead to renal problems; increased fluid intake helps dilute the urine. A urine pH of 6 is within the expected range of 4.5 to 8. A urine specific gravity of 1.020 is within the expected range of 1.005 to 1.030 (usually 1.010-1.025). A blood urea nitrogen level of 15 mg/dL is within the expected range of 5 to 18 mg/dL.

A nurse is educating a client with diabetes type 2 about newly prescribed glipizide. Which statement by the nurse best describes the action of glipizide? A "This medication absorbs the excess carbohydrates from your intestinal tract." B "This medication will inhibit the release of glucose stored in the liver." C "This medication will stimulate your pancreas to release insulin." D "This medication works by increasing the ability of the cells to uptake glucose."

C "This medication will stimulate your pancreas to release insulin." Rationale: The action of sulfonylureas, such as glyburide, is to stimulate the pancreas to release insulin. Biguanides, such as metformin, work by decreasing the release of glucose from the liver and increasing the uptake of glucose into the cells. The action of a-glucosidase inhibitors is to decrease the absorption of carbohydrates in the gastrointestinal tract.

Question 17 The nurse understands that the prescribed levothyroxine is effective when the client with hypothyroidism makes which statement? A"I still feel lethargic and fatigued." B"I have to change my sheets in the morning because I sweat a lot at night." C"I have been having daily, formed bowel movements." D"I was reprimanded at work after becoming angry with my boss."

C"I have been having daily, formed bowel movements." Rationale: Levothyroxine sodium is utilized to treat hypothyroidism. The nurse must first understand signs and symptoms of hypothyroidism, such as fatigue, lethargy, constipation, hypotension, anorexia and weight gain. In doing so, the nurse can identify that reports of having regular bowel movements is indicative of the levothyroxine working as intended, as constipation is a common symptom of hypothyroidism.

Question 12 A client is being discharged with a prescription for an iron supplement. Which client statement indicates the need for further teaching by the nurse? A"I will have greenish-black stools from the medication." B"I will not take antacids with my iron supplement." C"I will take the iron supplement with a full glass of milk." D"I will take vitamin C along with the iron supplement."

C"I will take the iron supplement with a full glass of milk." Rationale: Iron supplements should be taken along with Vitamin C, such as orange juice, because this increases the absorption. Conversely, antacids, milk, caffeinated beverages, and calcium supplements can decrease the absorption of iron. Iron should be taken one hour before or two hours after meals to enhance absorption, although clients who report gastrointestinal intolerance may take it with food. Iron will cause stool to turn greenish-black and tarry.

A client diagnosed with tuberculosis is prescribed rifampin and isoniazid. Which information should the nurse include when reinforcing information about these medications? Question 11 Answer Choices A"You can take the medication with food." B"You may experience an increase in appetite." C"You may notice an orange-red color to your urine." D"You may have occasional problems sleeping."

C"You may notice an orange-red color to your urine." Rationale: Rifampin can cause reddish-orange discoloration of the urine and other body fluids, including tears and sweat. This is harmless, but the client needs to be made aware of it. The nurse should caution the client not to wear soft contacts while taking this medication because they can become discolored. The other information does not apply to those two medications.

A client asks the nurse if glipizide (Glucotrol) is an oral insulin. Which response should the nurse provide? A. "Yes, it is an oral insulin and has the same actions and properties as intermediate insulin." B. "Yes, it is an oral insulin and is distributed, metabolized, and excreted in the same manner as insulin." C. "No, it is not an oral insulin and can be used only when some beta cell function is present." D. "No, it is not an oral insulin, but it is effective for those who are resistant to injectable insulins."

C. "No, it is not an oral insulin and can be used only when some beta cell function is present." An effective oral form of insulin has not yet been developed because when insulin is taken orally, it is destroyed by digestive enzymes. Glipizide (Glucotrol) is an oral hypoglycemic agent that enhances pancreatic production of insulin.

The nurse is assessing the effectiveness of high dose aspirin therapy for an 88-year-old client with arthritis. The client reports hearing non-stop ringing in the ears. Which action should the nurse implement? A. Refer the client to an audiologist for evaluation of her hearing. B. Advise the client that this is a common side effect. C. Notify the healthcare provider of the finding immediately. D. Face the client directly and speak in a low, monotone voice.

C. Notify the healthcare provider of the finding immediately. Tinnitus (ringing in the ears) is an early sign of salicylate toxicity. The healthcare provider should be notified immediately, and the medication discontinued.

1072) A client is receiving doxorubicin as part of a chemotherapy protocol. The nurse will assess the client for which system toxicity? Neurotoxicity Cardiotoxicity Ototoxicity Nephrotoxicity

Cardiotoxicity Rationale Heart failure and dysrhythmias secondary to cardiotoxicity are the primary life-threatening toxic effects unique to doxorubicin. Neurotoxicity, nephrotoxicity, and ototoxicity are not associated with this medication.

The nurse is assessing a client who is taking rifampin for the treatment of tuberculosis. Which finding reported by the client should the nurse immediately report to the healthcare provider? ABlurred vision BOrange-tinged tears CDark amber urine DDiarrhea

CDark amber urine Rationale: Rifampin causes a temporary yellow-orange discoloration of body fluids. Soft contact lenses may be permanently stained. Dark amber urine is an indication of liver dysfunction and should be reported. A major adverse effect of ethambutol, not rifampin, is optic neuritis. Diarrhea is a common side effect of antibiotics and is not the priority in this case.

The nurse is caring for a client with osteomyelitis who is receiving IV infusion of prescribed vancomycin. Which statement by the client would be a priority for the nurse to report to the healthcare provider? AI fell some burning at the catheter site BI feel a little nauseous CI have a ringing in my ears DI have a headache

CI have a ringing in my ears Rationale: The nurse who is caring for a client with osteomyelitis who is receiving IV infusion of vancomycin should assess the client for toxicity. The client who reports ringing in the ear could be experiencing ototoxicity, which is an adverse effect of vancomycin and should be reported to the healthcare provider. Headache, nausea, and burning at the IV site are side effects of the medication but not a priority for the nurse to report to the healthcare provider.

A client has been diagnosed with hypothyroidism. Which medication should the nurse administer to treat the client's bradycardia? A Epinephrine BAdenosine CLevothyroxine DAtropine

CLevothyroxine Rationale: The treatment for bradycardia from hypothyroidism is to treat the hypothyroidism using levothyroxine sodium, a T4 replacement hormone. If the heart rate were so slow that it causes hemodynamic instability, then atropine or epinephrine might be an option for short-term management. Adenosine slows atrioventricular (AV) conduction in the heart and would be contraindicated for a client with bradycardia.

A nurse administers cimetidine to a 79-year-old male with a gastric ulcer. Which parameter may be affected by this drug and should be closely monitored by the nurse? ABlood pressure BLiver enzymes CMental status DHemoglobin

CMental status Rationale: Cimetidine is an H2 receptor blocker used in treatment of gastric ulcers. Cimetidine should be used cautiously in the elderly, as it is known to cause a change in mental status such as confusion in the elderly population. Cimetidine does not impact the blood pressure, liver enzymes, or hemoglobin.

Question 11 The nurse is providing medication teaching for a client prescribed famotidine for the treatment of gastroesophageal reflux disease (GERD). Which statement by the client indicates an understanding of the teaching? Question 11 Answer Choices AI will take this medication once a day in the morning BI will no longer have discomfort at night once I begin this medication CThis medication will both prevent and treat heartburn DMy treatment will be done in one week

CThis medication will both prevent and treat heartburn Rationale: H2 receptor blockers (antagonists) are used to prevent and treat conditions caused by too much acid being produced in the stomach. These conditions include gastric ulcers, duodenal ulcers, and GERD. Famotidine may be prescribed to take twice a day, in the morning and evening, or just once daily in the evening. Duration of treatment varies but is at a minimum two weeks.

A nurse is preparing to administer insulin to a client with diabetes mellitus type 1. The client has regular insulin and insulin glargine prescribed. How will the nurse prepare these medications? ADraw up the glargine insulin before the regular insulin Draw up the glargine insulin before the regular insulin BMix the insulins in a larger syringe Mix the insulins in a larger syringe CUse a separate syringe for each insulin Use a separate syringe for each insulin DDraw up the regular insulin before the glargine insulin Draw up the regular insulin before the glargine insulin

CUse a separate syringe for each insulin Use a separate syringe for each insulin Rationale: Insulin glargine is a clear, long-acting insulin that should not be mixed with other insulins. Mixing insulin glargine with other medications can cause precipitate formation. The insulins should be drawn up in separate syringes. Short-acting insulins should be drawn up before long-acting insulins. However, insulin glargine should not be combined with any other medication. A larger syringe does not address incompatibility issues.

109) Which medication will the nurse expect the health care provider to prescribe to a client who had a thyroidectomy and is pale with spasms of the hand when taking the blood pressure? Calcium Magnesium Bicarbonate Potassium chloride

Calcium These signs may indicate calcium depletion as a result of accidental removal of parathyroid glands during thyroidectomy. Symptoms associated with hypomagnesemia include tremor, neuromuscular irritability, and confusion. Symptoms associated with metabolic acidosis include deep, rapid breathing, weakness, and disorientation. Symptoms associated with hypokalemia include muscle weakness and dysrhythmias.

991) A client receives doxorubicin infusions for treatment of acute lymphocytic leukemia. Which clinical finding indicates that toxicity has occurred? Alopecia Dyspnea Metallic taste to food Cardiac rhythm abnormalities

Cardiac rhythm abnormalities Rationale Doxorubicin is cardiotoxic, which is manifested by transient electrocardiogram (ECG) abnormalities. Alopecia is an expected side effect of doxorubicin, not a toxic effect. Dyspnea and a metallic taste to food are not effects of doxorubicin.

46) Which finding would lead the nurse to recheck the blood glucose level of a diabetic client before administering a mealtime insulin dose? Select all that apply. One, some, or all responses may be correct. Confusion Drowsiness Diaphoresis Nervousness Heart rate 110 beats/min

Confusion Drowsiness Diaphoresis Nervousness Heart rate 110 beats/min Rationale Signs of hypoglycemia include confusion, drowsiness, diaphoresis, nervousness, tachycardia, and headache. The nurse would recheck the blood glucose level of a diabetic client with these symptoms to avoid worsening hypoglycemia caused by administration of additional insulin.

747) The nurse provides discharge teaching to a client with tuberculosis. Which treatment measure would the nurse reinforce as the highest priority? Getting sufficient rest Getting plenty of fresh air Maintaining a healthy lifestyle Consistently taking prescribed medication

Consistently taking prescribed medication Rationale Tubercle bacilli are particularly resistant to treatment and can remain dormant for prolonged periods; medication must be taken consistently as prescribed. Although getting sufficient rest, getting plenty of fresh air, and maintaining a healthy lifestyle are important, to heal the microorganisms must be eliminated with medication.

245) Which common side effect will the nurse address in the care plan of a client with cancer receiving the plant alkaloid vincristine? Color-blindness Anuria Constipation Hyperphosphatemia

Constipation Rationale Although most chemotherapy causes diarrhea, vincristine can cause severe constipation, impaction, or paralytic ileus. Visual changes may occur, but color-blindness is not one of them. Polyuria, not anuria, is common. Hyperuricemia may occur, but hyperphosphatemia is not associated with this medication.

1373) The nurse instructs a postpartum client on the administration of an iron supplement. Which drink selected by the client indicates the teaching was effective? Milk Water Cream soda Cranberry juice

Cranberry juice Rationale Iron is absorbed best when given in an acidic medium. One cup of cranberry juice contains 90 mg of vitamin C (ascorbic acid). Milk, water, and cream soda will all decrease the acidity of the stomach.

A client begins treatment with rifampin for suspected pulmonary tuberculosis. Which information should the nurse include when teaching the client about this drug? A"It is important to stay upright for 30 minutes after taking this drug." B"Check your radial pulse before taking the drug." C"Avoid prolonged exposure to the sun while taking this drug." D"You may notice an orange-red color to your urine."

D"You may notice an orange-red color to your urine." Rationale: Rifampin can cause a harmless reddish-orange discoloration of urine, feces, saliva, sweat, tears, and skin, even contact lenses. This effect can be very alarming for the client who may interpret it as some sort of bleeding. Understanding that this is a normal effect will promote adherence. The other instructions are not indicated when taking rifampin.

A client with giardiasis is taking metronidazole (Flagyl) 2 grams PO. Which information should the nurse include in the client's instruction? A. Notify the clinic of any changes in the color of urine. B. Encourage the use of over-the-counter cough/cold syrup when a cough/cold develops. C. Stop the medication after the diarrhea resolves. D. Take the medication with food.

D. Take the medication with food. Flagyl, an amoebicide and antibacterial agent, may cause gastric distress, so the client should be instructed to take the medication on a full stomach. Urine may be red-brown or dark from Flagyl, but this side effect is an expectant finding and not necessary to report to the healthcare provider. The client should also avoid using alcohol-containing products such as cough or cold syrups or mouthwash while taking the medication and for at least three days after stopping it.

A nurse is reviewing prescribed medications for a client diagnosed with diabetic ketoacidosis. Which medication will the nurse clarify with the healthcare provider? ARegular insulin BPotassiumC C0.9% sodium chloride DGlipizide

DGlipizide Rationale: Glipizide is an oral antidiabetic medication used in the treatment of type 2 diabetes mellitus. The intended effect of glipizide is to lower glucose levels and maintain adequate management of the disease. Oral antidiabetic agents are contraindicated in clients with diabetic ketoacidosis (DKA). Glucose levels must be carefully lowered and monitored following insulin therapy. Regular insulin, potassium, and 0.9% sodium.

The nurse is assessing a client who began taking omeprazole a month ago. Which finding by the nurse, indicates that the drug has had the desired effect? ABlood pressure readings are lower BFeelings of depression are not as severe CChronic pain level is markedly decreased DHeartburn discomfort is lessened

DHeartburn discomfort is lessened Rationale: Omeprazole is a proton pump inhibitor used to decrease stomach acid and relieve symptoms of gastroesophageal reflux disorder (GERD), such as heartburn. Omeprazole is also used to treat gastric ulcers and esophagitis. Omeprazole does not affect blood pressure. A lower blood pressure reading in this client would not be related to administration of medication. Omeprazole is not indicated for depression. Although omeprazole can alleviate abdominal pain in an individual who has a gastric ulcer or suffers from gastric bleeding, the option does not specify what type of pain is being discussed. Secondly, omeprazole is not typically indicated for chronic pain. The desired outcome for this client is to have a decrease in symptoms of GERD within 4 weeks.

The nurse is monitoring a client who received a first dose of intravenous ampicillin. Which finding should indicate to the nurse that the client may be experiencing an allergic reaction? AAbdominal pain BIncrease in blood pressure CHypotensive bowel sounds DHives on the extremities

DHives on the extremities Rationale: If the client experiences an allergic reaction to medications they may display systemic signs such as hives, pruritus, dyspnea, etc. Abdominal pain, hypertension, and hyperactive bowel sounds do not indicate an allergic reaction.

Question 4 The nurse is caring for a client who is prescribed erythromycin 500 mg orally every six hours for the treatment of pneumonia. The nurse should monitor the client for which common side effect? AEsophagitis BTendon rupture COrange-red discoloration of urine DNausea and vomiting

DNausea and vomiting Rationale: Erythromycin is a macrolide anti-infective medication used that interferes with protein synthesis in susceptible bacteria. Nausea, vomiting and gastrointestinal (GI) upset are common with erythromycin. The other side effects are not commonly seen with this drug.

The nurse is teaching a client about an oral hypoglycemic medication. The nurse should place priority emphasis on which of the following points? AConsulting with the health care provider about dose changes based on blood glucose BDistinguishing signs and symptoms of hypoglycemia and hyperglycemia CAdherence with recommended diet plan DTaking the medication at specified times

DTaking the medication at specified times Rationale: A regular interval between doses should be maintained because oral hypoglycemics stimulate the islets of Langerhans to produce insulin. If doses are not spaced correctly, insulin levels may increase, causing hypoglycemia or decrease, causing hyperglycemia. The other actions are important and would be discussed after this initial point.

A client has been admitted for the second time to treat tuberculosis (TB). Which referral does the nurse initiate as a priority? APsychiatric nurse liaison to assess reasons for noncompliance BInfection control nurse to arrange testing for drug resistance CSocial worker to see if the client can afford the medications DVisiting nurses to arrange for directly observed therapy (DOT)

DVisiting nurses to arrange for directly observed therapy (DOT) Rationale: Clients with TB must take multiple drugs for six months or longer, making adherence a very real problem. Non-adherence is the most common cause of treatment failure and relapse. This client has a risk of non-adherence, as evidenced because this is their second admission to treat TB. When the client is discharged, they most likely will need to be placed on DOT to ensure compliance. This is the priority referral in order to prevent transmission of TB to others in the community. The other referrals may also be appropriate depending on the client's needs.

570) Which nursing assessment is most important for a child receiving cyclophosphamide? Extent of alopecia Changes in appetite Hyperplasia of gums Daily intake and output

Daily intake and output Rationale Hemorrhagic cystitis is a potentially serious adverse reaction to cyclophosphamide that can sometimes be prevented with increased fluid intake because the fluid flushes the bladder. The extent of hydration can be measured with hourly documentation of intake and output. Alopecia is expected; however, it is a benign side effect, and the hair will regrow when therapy is completed. A change in appetite is expected but is not a serious side effect of cyclophosphamide administration. Hyperplasia of the gums is unrelated to cyclophosphamide administration.

1075) The nurse administers lactulose to a client with cirrhosis of the liver. Which laboratory test change leads the nurse to determine that the lactulose is effective? Decreased amylase Decreased ammonia Increased potassium Increased hemoglobin

Decreased ammonia Rationale Lactulose destroys intestinal flora that break down protein and, in the process, give off ammonia. In clients with cirrhosis, ammonia is inadequately detoxified by the liver and can build to toxic levels. Amylase levels are associated with pancreatic problems. Increased potassium levels are associated with kidney failure. Hemoglobin is increased when the body needs more oxygen-carrying capacity, such as in smokers, or in high altitudes.

1081) Leucovorin calcium is prescribed and is to be administered immediately after an infusion of methotrexate. Which result of laboratory testing indicates that leucovorin has been effective? Potassium level normalizes Folic acid level within normal limits Improved white blood cell count Decreased methotrexate level

Decreased methotrexate level Rationale The laboratory measurement of the client's methotrexate level is the most objective measure of leucovorin calcium's effectiveness. Leucovorin calcium is considered a 'rescue' medication because it minimizes the effects of methotrexate on healthy cells by competing with methotrexate at the cellular level, thus neutralizing it and causing it to be excreted. Its purpose is not to affect folic acid levels nor to affect potassium or white blood cell counts.

1098) A health care provider prescribes famotidine for a client with dyspepsia. Which statement is important to include in a teaching session about famotidine? Lowers the stress level Neutralizes gastric acidity Reduces gastrointestinal peristalsis Decreases secretions in the stomach

Decreases secretions in the stomach Rationale Famotidine inhibits histamine at H 2-receptor sites in the stomach, inhibiting gastric acid secretion. Famotidine does not affect stress levels. Famotidine inhibits, rather than neutralizes, gastric secretion. Famotidine inhibits gastric secretion, not peristalsis.

1084) A client with cancer is receiving leucovorin as part of a chemotherapy protocol. Which purpose does leucovorin serve? Potentiating the effect of alkylating agents Diminishing toxicity of folic acid antagonists Limiting vomiting associated with chemotherapy Preventing alopecia

Diminishing toxicity of folic acid antagonists Rationale Leucovorin limits toxicity of folic acid antagonists, such as methotrexate sodium, by competing for transport into cells. Leucovorin does not potentiate the effect of alkylating agents. It does not have antiemetic properties. It will not prevent hair loss.

866) A health care provider has prescribed isoniazid for a client. Which instruction will the nurse give the client about this medication? Prolonged use can cause dark, concentrated urine. The medication is best absorbed when taken on an empty stomach. Take the medication with aluminum hydroxide to minimize gastrointestinal (GI) upset. Drinking alcohol daily can cause medication-induced hepatitis.

Drinking alcohol daily can cause medication-induced hepatitis. Rationale Alcohol may increase hepatotoxicity of the medication; instruct client to avoid drinking alcohol during treatment; monitor for signs of hepatitis before and while taking medication. Prolonged use does not cause dark, concentrated urine. The client should take isoniazid with meals to decrease GI upset. Clients should avoid taking aluminum antacids at the same time as this medication because it impairs absorption.

705) Why would lactulose be prescribed for a client with a history of cirrhosis of the liver? The desire to drink alcohol is decreased. Diarrhea is controlled and prevented. Elevated ammonia levels are lowered. Abdominal distension secondary to ascites is decreased.

Elevated ammonia levels are lowered. Rationale Lactulose is an ammonia detoxicant. It decreases serum ammonia concentration by preventing reabsorption of ammonia. Lactulose has been used to lower blood ammonia content in clients with portal hypertension and hepatic encephalopathy secondary to chronic liver disease. Lactulose has no effect on the craving for alcohol or reduction of ascites or abdominal distension. Lactulose is also used as a hyperosmotic laxative; therefore it will not relieve diarrhea.

541) A child is prescribed dactinomycin and doxorubicin therapy after a nephrectomy for Wilms tumor. Which intervention would the nurse include in the plan of care? Administering aspirin for pain Offering citrus juices with meals Ensuring meticulous oral hygiene Eliminating spicy foods from the diet

Ensuring meticulous oral hygiene Rationale Oral hygiene is essential, especially during the administration of medications that have a negative effect on the oral mucosa. Although pain may be present, aspirin is avoided because doxorubicin is also being used, and a side effect of this medication is thrombocytopenia. Aspirin is contraindicated for children because it is associated with Reye syndrome. Citrus juice will aggravate stomatitis, which is a common side effect of dactinomycin. Spicy foods may aggravate the stomatitis that occurs with chemotherapy. However, usually any food that the child requests is permitted.

900) A health care provider prescribes bed rest, loperamide, and esomeprazole for a client who just had major surgery. After several days of this regimen, the client complains of diarrhea. Which treatment strategy would the nurse conclude is the cause of the diarrhea? Loperamide Esomeprazole Bed rest Diet alteration

Esomeprazole Rationale Esomeprazole, a proton-pump inhibitor, may cause diarrhea. Loperamide, an antidiarrheal, may cause constipation, not diarrhea. Immobility causes constipation, not diarrhea. Although diet can affect elimination, no data are presented to support this conclusion.

1058) The nurse is caring for a client with type 1 diabetes. Which signs or symptoms may indicate that the client has insulin-induced hypoglycemia? Select all that apply. One, some, or all responses may be correct. Excessive hunger Weakness Diaphoresis Excessive thirst Deep respirations

Excessive hunger Weakness Diaphoresis Rationale Hypoglycemia affects the central nervous system, causing weakness. Hypoglycemia affects the sympathetic nervous system, causing diaphoresis. Excessive hunger is associated with hypoglycemia because the body needs glucose for cellular metabolism. Excessive thirst is associated with hyperglycemia because fluid shifts, along with the excess glucose being excreted by the kidneys, result in polyuria. Deep respirations (Kussmaul respirations) are associated with hyperglycemia because the body is attempting to blow off carbon dioxide to compensate for the metabolic acidosis.

822) A client with Hodgkin's disease adds doxorubicin to current therapy. Which advice will the nurse provide about this medication? Cease taking any medication that contains vitamin D. Keep the doxorubicin in a dark place protected from light. Expect urine to turn red for a few days after taking this medication. Take the doxorubicin on an empty stomach with large amounts of fluids.

Expect urine to turn red for a few days after taking this medication. Rationale Doxorubicin causes the urine to turn red for a few days; the client should be informed of this expectation so as not to become alarmed when it occurs. Discontinuing the intake of vitamin D is true for plicamycin, not the medications in this protocol. It is unnecessary to keep doxorubicin in a dark area, protected from light. Doxorubicin is not given orally, only via the intravenous route.

655) A client who takes rifampin tells the nurse, 'My urine looks orange.' Which action would the nurse take? Explain that this is expected. Check the liver enzymes. Ask the provider to order a urinalysis. Ask what foods were eaten.

Explain that this is expected. Rationale Rifampin causes a reddish-orange discoloration of secretions such as urine, sweat, and tears. Although liver enzymes should be monitored because of the risk of hepatitis, this action is not addressing the client's statement. A urinalysis is not indicated for an anticipated finding. The medication, not food, is responsible for the urine color.

119) Which purpose is served by an evening snack of milk, crackers, and cheese for a client who is receiving NPH insulin? Encouragement to stay on the diet Food to counteract late insulin activity Added calories to promote weight gain High carbohydrates to provide nourishment for immediate use

Food to counteract late insulin activity Rationale The protein in milk and cheese is converted slowly to glucose (gluconeogenesis), providing the body with some glucose during sleep while the insulin is still acting. The purpose of an evening snack is to cover for insulin activity during sleep, not to encourage the client to stay on the diet. There are no data that indicate a need to gain weight. The foods chosen are rich in protein and are used slowly.

640) A client receives doxorubicin as part of a chemotherapy protocol. The nurse would assess the client for signs and symptoms of which adverse effect? Toxic epidermal necrolysis Heart failure Pulmonary fibrosis Ototoxicity

Heart failure Rationale Heart failure and dysrhythmias are life-threatening toxic effects unique to doxorubicin. It is a vesicant that can cause severe tissue damage if the medication infiltrates; however, this is different from the tissue destruction associated with toxic epidermal necrolysis. Pulmonary fibrosis and ototoxicity are not adverse effects of doxorubicin.

771) To minimize the side effects of the vincristine that a client is receiving, which diet would the nurse advise? Low in fat High in iron High in fluids Low in residue

High in fluids Rationale A common side effect of vincristine is a paralytic ileus that results in constipation. Preventative measures include high-fiber foods and fluids that exceed minimum requirements. These will keep the stool bulky and soft, thereby promoting evacuation. Dietary plans that are low in fat, high in iron, and low in residue will not provide the roughage and fluids needed to minimize the constipation associated with vincristine.

910) A client who receives NPH insulin every morning reports feeling nervous at 4:30 PM. The nurse observes that the client's skin is moist and cool. Which condition is the client likely experiencing? Hyperosmolar hyperglycemic nonketotic state Ketoacidosis Glycogenesis Hypoglycemia

Hypoglycemia Rationale The time of the client's response corresponds to the expected peak action (4-12 hours after administration) of the intermediate-acting insulin that was administered in the morning, which can result in hypoglycemia. Hypoglycemia triggers the sympathetic nervous system; epinephrine causes diaphoresis and nervousness. Hyperosmolar hyperglycemic nonketotic state is a severe hyperglycemia state that occurs in clients with type 2 diabetes secondary to severe illness or stress. Warm, dry, flushed skin and lethargy are associated with hyperglycemia and ketoacidosis. Glycogenesis, the formation of glycogen in the liver, is unrelated to nervousness and cool, moist skin.

973) A client with type 1 diabetes receives 30 units of neutral protamine Hagedorn (NPH) insulin at 7:00 AM. At 3:30 PM, the client becomes diaphoretic, weak, and pale. With which condition would the nurse determine that these physiological responses are associated? Diabetic coma Hyperosmolar hyperglycemic nonketotic syndrome Diabetic ketoacidosis Hypoglycemic reaction

Hypoglycemic reaction Rationale These are sympathetic nervous system responses to hypoglycemia; the peak action of NPH insulin is 8 to 12 hours after administration, and 8.5 hours have elapsed since it was given. The signs and symptoms of diabetic coma are dry mucous membranes; hot, flushed skin; deep, rapid respirations (Kussmaul breathing); acetone odor to the breath; nausea and vomiting; and, as with hypoglycemia, weakness. Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is a hyperglycemic state and this client has symptoms of a hypoglycemic state. Ketoacidosis results from excess use of fats for energy when carbohydrates cannot be used. Lipids are metabolized incompletely, and dehydration, acidosis (both ketotic and lactic), and electrolyte imbalance result. It is not the result of insulin administration.

1515) An adolescent with type 1 diabetes mellitus is admitted to the intensive care unit in ketoacidosis with a blood glucose level of 170 mg/dL (9.4 mmol/L). A continuous insulin infusion is started. Which adverse reaction to the infusion is most important for the nurse to monitor? Hypokalemia Hypovolemia Hypernatremia Hypercalcemia

Hypokalemia Rationale Insulin moves potassium into the cells along with glucose, thus lowering the serum potassium level. Insulin does not lead to a reduced blood volume. Insulin does not directly alter the sodium levels. Insulin does not affect the calcium levels.

963) Intravenous fluids and insulin are prescribed to treat a client's diabetic ketoacidosis. The client develops peripheral paresthesias and shortness of breath. The cardiac monitor shows the appearance of a U wave. Which complication would the nurse suspect? Hypokalemia Hypoglycemia Hypernatremia Hypercalcemia

Hypokalemia Rationale These are classic signs of hypokalemia that occur when potassium levels are reduced as potassium reenters cells with glucose. Symptoms of hypoglycemia are weakness, nervousness, tachycardia, diaphoresis, irritability, and pallor. Symptoms of hypernatremia are thirst, orthostatic hypotension, dry mouth and mucous membranes, concentrated urine, tachycardia, irregular heartbeat, irritability, fatigue, lethargy, labored breathing, and muscle twitching or seizures. Symptoms of hypercalcemia are lethargy, nausea, vomiting, paresthesias, and personality changes.

1528) A child with type 1 diabetes is receiving 15 units of regular insulin and 20 units of NPH insulin at 7:00 AM each day. Which time would the nurse anticipate a hypoglycemic reaction from the NPH insulin to occur? Before noon In the afternoon Within 30 minutes During the evening

In the afternoon Rationale NPH insulin is an intermediate-acting insulin that peaks approximately 6 to 8 hours after administration. It was administered at 7:00 AM, so between 1:00 PM and 3:00 PM is when the nurse would anticipate that a hypoglycemic reaction would occur. Noon is when a reaction from a short-acting insulin is expected. Short-acting insulin peaks 2 to 4 hours after administration. Within 30 minutes of administration is when a reaction from a rapid-acting insulin is expected. Rapid-acting insulin peaks 30 to 60 minutes after administration. During the evening or nighttime is when a reaction from a long-acting insulin is expected. Long-acting insulin has a small peak 10 to 16 hours after administration.

1157) A client who had an organ transplant is receiving cyclosporine. The nurse would monitor for which serious adverse effect of cyclosporine? Hirsutism Constipation Dysrhythmias Increased creatinine level

Increased creatinine level Rationale A life-threatening effect of cyclosporine is nephrotoxicity. Creatinine and blood urea nitrogen levels should be monitored. Although abnormal hairiness (hirsutism) is an effect of cyclosporine, it is not life threatening. Diarrhea, not constipation, is a response to cyclosporine. Cyclosporine does not cause life-threatening cardiovascular effects.

243) Which mechanism is specifically responsible for the action of the medication ranitidine? Inhibiting proton pumps Promoting the release of gastrin Regenerating the gastric mucosa Inhibiting the histamine at H 2 receptors

Inhibiting the histamine at H 2 receptors Rationale Ranitidine inhibits histamine at H 2 receptor sites in parietal cells, which limits gastric secretion. It does not inhibit proton pumps. Promoting the release of gastrin is undesirable; gastric hormones increase gastric acid secretion. Ranitidine does not regenerate the gastric mucosa; the medication prevents its erosion by gastric secretions.

1121) Famotidine is prescribed for a client with peptic ulcer disease. Which mechanism of action is a characteristic of this medication? Increases gastric motility Neutralizes gastric acidity Facilitates histamine release Inhibits gastric acid secretion

Inhibits gastric acid secretion Rationale Famotidine decreases gastric secretion by inhibiting histamine at H 2 receptors. Increasing gastric motility, neutralizing gastric acidity, and facilitating histamine release are not actions of famotidine.

915) Which insulin will the nurse prepare for the emergency treatment of ketoacidosis? Glargine NPH insulin Insulin aspart Insulin detemir

Insulin aspart Rationale Insulin aspart is a rapid-acting insulin (within 10-20 minutes) and is used to meet a client's immediate insulin needs. Glargine is a long-acting insulin, which has an onset of 1.5 hours; for diabetic acidosis, the individual needs rapid-acting insulin. NPH insulin is an intermediate-acting insulin, which has an onset of 1 to 2 hours; for diabetic acidosis, the individual needs rapid-acting insulin. Insulin detemir is a long-acting insulin; for diabetic acidosis, the individual needs rapid-acting insulin.

1073) A client with diabetes mellitus is scheduled to receive an intravenous (IV) administration of 25 units of insulin in 250 mL normal saline. Which type of insulin would the nurse recognize as compatible with IV solutions? NPH insulin Insulin lispro Insulin detemir Insulin glargine

Insulin lispro Rationale Insulin lispro has an onset of 0.25 hours, a peak action of 0.5 to 1.5 hours, and a duration of 3 to 4 hours. Neutral protamine Hagedorn (NPH) or intermediate-acting insulin has an onset of 1.5 hours, a peak action of 4 to 12 hours, and a duration of 18 to 24 hours. Regular insulin has an onset of 0.5 hours, a peak action of 1 to 5 hours, and a duration of 6 to 10 hours. Insulin glargine has an onset of 1 to 1.5 hours, no peak action, and a duration of 20 to 24 hours.

111) Which complication of diabetes would the nurse suspect when a health care provider prescribes one tube of glucose gel for a client with type 1 diabetes? Diabetic acidosis Hyperinsulin secretion Insulin-induced hypoglycemia Idiosyncratic reactions to insulin

Insulin-induced hypoglycemia Rationale Glucose gel delivers a measured amount of simple sugars to provide glucose to the blood for rapid action. Acidosis occurs when there is an increased serum glucose level; therefore glucose gel is not indicated. Diabetes mellitus involves a decreased insulin production. Glucose gel is not indicated in idiosyncratic reactions to insulin.

930) The nurse concludes that a client has a hypoglycemic reaction to insulin. Which clinical findings support this conclusion? Select all that apply. One, some, or all responses may be correct. Irritability Glycosuria Dry, hot skin Heart palpitations Fruity odor of breath

Irritability Heart palpitations Rationale Irritability, a neuroglycopenic symptom, occurs when the glucose in the brain declines to a low level. Heart palpitations, a neurogenic symptom, occur when the sympathetic nervous system responds to a rapid decline in blood glucose. Because the blood glucose level is decreased, the renal threshold is not exceeded, and there is no glycosuria. Dry, hot skin is consistent with dehydration, which often is associated with hyperglycemic states. Fruity odor of the breath is associated with hyperglycemia; it is caused by the breakdown of fats as a result of inadequate insulin supply.

1489) A parent of three young children has contracted tuberculosis. Which medication would the nurse anticipate being prescribed for members of the family who have been exposed? Isoniazid Multiple-puncture test Bacille Calmette-Guérin Tuberculin purified protein derivative

Isoniazid Rationale Isoniazid is used as a prophylactic agent for people who have been exposed to tuberculosis; also, it is one of several medications used to treat the disease. Multiple-puncture tests, such as the tine test, are used to test for tuberculosis; these are no longer recommended. They are not a treatment for the prevention or cure of tuberculosis. Bacille Calmette-Guérin is a vaccine that provides limited immunity; it is not recommended for use in the United States. Tuberculin purified protein derivative, the Mantoux test, is a widely used skin test for detecting tuberculosis; it is not a treatment for the prevention or treatment of tuberculosis.

589) An adolescent who has been prescribed prednisone and vincristine for leukemia tells the nurse that he is constipated. Which reason would the nurse cite as the probable cause of the constipation? It is a side effect of the vincristine. The spleen is compressing the bowel. It is a toxic effect from the prednisone. The leukemic mass is obstructing the bowel.

It is a side effect of the vincristine. Rationale Constipation is a side effect of vincristine because it slows gastrointestinal motility. An enlarged spleen will put pressure on the stomach and diaphragm, not on the large bowel. Constipation is not a toxic effect of prednisone. It is unlikely that leukemia is causing an obstruction.

735) Which rationale accurately explains why insulin is prescribed for clients in acute renal failure? It promotes transfer of potassium into cells to lower serum potassium levels. Insulin is required because the alpha cells of the pancreas cease to function with renal failure. It is necessary to manage the elevated blood glucose levels that accompany renal failure. Insulin reduces the accumulated toxins by lowering the metabolic rate.

It promotes transfer of potassium into cells to lower serum potassium levels. Rationale Insulin promotes the transfer of potassium into cells, which reduces the circulating blood level of potassium. Renal failure does not cause pancreatic alpha cells to cease functioning. Blood glucose levels usually are not elevated in acute renal failure. Insulin will not lower the metabolic rate.

916) The nurse administers a tube of glucose gel to a client who is hypoglycemic. Which explanation would the nurse share regarding the reversal of hypoglycemia? It liberates glucose from hepatic stores of glycogen. It provides a glucose source that is rapidly absorbed. Insulin action is blocked as it competes for tissue sites. Glycogen is supplied to the brain as well as other vital organs.

It provides a glucose source that is rapidly absorbed. Rationale The glucose gel provides a simple sugar for rapid use by the body. Liberating glucose from hepatic stores of glycogen is related to the action of glucagon. It is a medication that mobilizes glycogen storage in the liver, leading to an increased blood glucose level. Glucose does not compete with insulin. Glucose gel does not supply glycogen to the brain and other vital organs.

1116) The health care provider prescribes metformin as monotherapy for the client with type 2 diabetes. The nurse will teach the client to monitor for which adverse effect? Weight gain Constipation Lactic acidosis Hypoglycemia

Lactic acidosis Rationale Metformin carries a black box warning regarding the possibility of lactic acidosis; clients must know how to monitor for this condition. An advantage of metformin over some other antidiabetic medications is that it does not cause weight gain and may actually result in weight loss for some clients. Constipation is not a problem, but many clients will develop diarrhea initially. Metformin does not increase pancreatic production of insulin and, when used without other antidiabetic medications, will not cause hypoglycemia.

1059) Intravenous (IV) insulin is prescribed for a client in. Which insulin can be administered IV? Select all that apply. One, some, or all responses may be correct. Lispro insulin Aspart insulin Regular insulin Glargine insulin Glulisine insulin

Lispro insulin Aspart insulin Regular insulin Glulisine insulin Rationale Four insulins are approved for IV administration: regular, aspart, lispro, and glulisine insulin can be administered intravenously. Glargine insulin is long-acting insulin; it is not approved for IV use. Test-Taking Tip: What happens if you find yourself in a slump over the examination? Take a time-out to refocus and reenergize! Talk to friends and family who support your efforts in achieving one of your major accomplishments in life. This effort will help you regain confidence in yourself and get you back on track toward the realization of your long-anticipated goal.

143) Which essential test results will the nurse review before starting antitubercular pharmacotherapy when caring for a client with human immunodeficiency virus (HIV) infection who is diagnosed with tuberculosis? Liver function studies Pulmonary function studies Electrocardiogram and echocardiogram White blood cell counts and sedimentation rate

Liver function studies Rationale Antitubercular medications, such as isoniazid (INH) and rifampin (RIF), are hepatotoxic; liver function should be assessed before initiation of pharmacological therapy. Pulmonary function studies, electrocardiogram, and echocardiogram might be done; the results of these tests are not crucial for the nurse to review before administering antitubercular medications. White blood cell counts and sedimentation will not provide information relative to starting antitubercular therapy or to its side effects.

342) Which laboratory test result would the nurse review before initiating a prescribed antitubercular pharmacotherapy for a client with tuberculosis associated with human immunodeficiency virus? Liver function studies Pulmonary function studies Electrocardiogram White blood cell (WBC) count

Liver function studies Rationale Antitubercular medications, such as isoniazid and rifampin, are hepatotoxic. Pulmonary function studies and electrocardiograms are not related to the administration of antitubercular medications or to their side effects. The WBC count is expected to be higher in the presence of infection, but with acquired immunodeficiency syndrome, the WBC count will be less than 2500/cm 3 (2.5 × 10 9/L), and helper T cells will number less than 200 mm 3; the T4/T8 ratio will be 1:2. These tests will not provide information relative to starting antitubercular therapy or to its side effects.

1009) When caring for a client on isoniazid therapy for tuberculosis, the nurse would focus on which diagnostic testing for this client? Creatinine Hearing tests Electrocardiogram Liver function tests

Liver function tests Rationale Isoniazid can damage the liver enough to lead to death, so liver function should be monitored. Creatinine would be tracked for renal dysfunction, which is not a focus of isoniazid therapy because isoniazid is metabolized by the liver. Aminoglycosides can cause ototoxicity, causing hearing loss. Bedaquiline can cause prolonged QT, detected through electrocardiogram.

997) Which medication for treatment of gastroesophageal reflux disease would be contraindicated in the pregnant client? Ranitidine Misoprostol Esomeprazole Calcium carbonate

Misoprostol Rationale Misoprostol is contraindicated in pregnancy because it can cause uterine contractions, expelling the developing fetus. Ranitidine, esomeprazole, and calcium carbonate are not contraindicated during pregnancy.

The oncology nurse is preparing to administer the initial dose of vincristine to a child diagnosed with acute lymphocytic leukemia. Which interventions should the nurse include in the plan of care? Select all that apply. Apply pressure to the injection site if extravasation occurs. Monitor liver function tests regularly. Monitor for numbness or tingling in the fingers and toes. Select the appropriate catheter for intrathecal administration. Verify blood return before, during and after intravenous administration.

Monitor liver function tests regularly. Monitor for numbness or tingling in the fingers and toes. Verify blood return before, during and after intravenous administration. Rationale: Acute lymphocytic leukemia (ALL) is the most common type of cancer in children and treatment protocols include vincristine, an anticancer drug. Vincristine is for intravenous use only; intrathecal (i.e., spinal) administration can be fatal. Vincristine is a vesicant that can cause significant local damage if extravasation occurs; treatment includes subcutaneous injection of an antidote and warm compresses (topical cooling may worsen the effect). Peripheral neuropathy is a major side effect associated with vincristine. The nurse should monitor for decreased hepatic functioning because vincristine is metabolized in the liver.

929) Which independent nursing action would be included in the plan of care for a client after an episode of ketoacidosis? Monitoring for signs of hypoglycemia resulting from treatment Withholding glucose in any form until the situation is corrected Giving fruit juices, broth, and milk as soon as the client is able to take fluids orally Regulating insulin dosage according to the client's urinary ketone levels

Monitoring for signs of hypoglycemia resulting from treatment Rationale During treatment for acidosis, hypoglycemia may develop; careful observation for this complication will be made by the nurse. Withholding all glucose may cause insulin coma. Whole milk and fruit juices are high in carbohydrates, which are contraindicated immediately following ketoacidosis. The regulation of insulin depends on the prescription for coverage; the prescription usually depends on the client's blood glucose level rather than ketones in the urine.

738) The nurse considers that the safe administration of high-dose methotrexate therapy would include which intervention? Maintaining an acidic urine Restricting intravenous fluids Providing a diet high in folic acid Monitoring plasma levels of the medication

Monitoring plasma levels of the medication Rationale Plasma levels indicate whether therapeutic or toxic levels are present. Methotrexate crystallizes in the kidneys if urine becomes acidic. The regimen would include hydration with a minimum of intravenous fluids of 125 mL/h 6 to 12 hours before and during therapy. The effectiveness of methotrexate, a folic acid antagonist, is minimized by a diet high in folic acid.

574) The nurse is caring for a child who is receiving vincristine. Which body systems are most important for the nurse to assess after medication administration? Select all that apply. One, some, or all responses may be correct. Respiratory Neurological Reproductive Hematologic Gastrointestinal

Neurological Hematologic Gastrointestinal Rationale Vincristine is neurotoxic; therefore the child should be monitored for paresthesias, seizures, footdrop, bowel and bladder problems, and alterations in the function of cranial nerves. Hematologic problems such as anemia, thrombocytopenia, and leukopenia occur, although they are not as severe as with other chemotherapeutic agents, such as cyclophosphamide. Gastrointestinal adverse effects include severe constipation, intestinal necrosis, intestinal perforation, and paralytic ileus, in addition to nausea and vomiting. Respiratory problems are not associated with vincristine therapy. The reproductive system is not affected by vincristine therapy.

580) Which side effect would the nurse assess for in a child receiving vincristine? Hemolytic anemia Irreversible alopecia Hyperglycemia Neurological complications

Neurological complications Rationale Vincristine is highly neurotoxic, causing paresthesias, muscle weakness, ptosis, diplopia, paralytic ileus, vocal cord paralysis, and loss of deep tendon reflexes. Hematologic effects are rare; mild anemia may occur, but hemolytic anemia is not anticipated. Alopecia is reversible with cessation of the medication. Hyperglycemia is not an anticipated adverse effect.

426) Which medication is classified as an H 2 receptor antagonist? Select all that apply. One, some, or all responses may be correct. Nizatidine Ranitidine Famotidine Lansoprazole Metoclopramide

Nizatidine Ranitidine Famotidine Rationale Nizatidine, ranitidine, and famotidine are H 2 receptor antagonists that reduces gastric acid secretion and provide symptomatic improvement in GERD. Lansoprazole is a proton pump inhibitor that inhibits gastric secretion up to 90% with one dose daily and provides for symptomatic improvement in GERD. Metoclopramide is a prokinetic agent that increases the rate of gastric emptying; it has multiple side effects and is not appropriate for long-term treatment of GERD.

1022) A client with type 1 diabetes self-administers neutral protamine Hagedorn (NPH) insulin every morning at 8:00 AM. The nurse evaluates that the client understands the action of the insulin when the client identifies which time range as the highest risk for hypoglycemia? 9:00 AM to 10:00 AM 10:00 AM to 11:00 AM Noon to 8:00 PM 8:00 PM to midnight

Noon to 8:00 PM Rationale The time of greatest risk for hypoglycemia occurs when the insulin is at its peak. The action of intermediate-acting insulin peaks in 4 to 12 hours. Nine to 10:00 AM and 10:00 AM to 11:00 AM are too soon for NPH to produce a hypoglycemic response. NPH insulin will have produced a hypoglycemic response before 8:00 PM and after noon. A hypoglycemic response that occurs in 45 to 60 minutes after administration is associated with rapid-acting insulins.

569) The nurse is planning an evening snack for a child receiving NPH insulin. The nurse offers a snack for which reason? It encourages the child to stay on the diet. Energy is needed for immediate utilization. Extra calories will help the child gain weight. Nourishment helps counteract late insulin activity.

Nourishment helps counteract late insulin activity. Rationale A bedtime snack is needed for the evening. NPH insulin is intermediate-acting insulin, which peaks 4 to 12 hours later and lasts for 18 to 24 hours. Protein and carbohydrate ingestion before sleep prevents hypoglycemia during the night when the NPH is still active. The snack is important for diet-insulin balance during the night, not encouragement. There are no data to indicate that extra calories are needed; a bedtime snack is routinely provided to help cover intermediate-acting insulin during sleep. The snack must contain mainly protein-rich foods, not simple carbohydrates, to help cover the intermediate-acting insulin during sleep. Test-Taking Tip: Make educated guesses when necessary.

513) A 5-year-old child is receiving dactinomycin and doxorubicin therapy after nephrectomy for Wilms tumor. Which intervention would the nurse include when planning care? Adding citrus juices to meals Offering warm saline mouthwash Scheduling booster immunizations Reporting red-orange colored urine

Offering warm saline mouthwash Rationale The use of warm saline mouthwash will minimize oral discomfort; ulceration of the oral mucosa occurs as a result of the antineoplastic effect on the rapidly dividing gastrointestinal epithelium. Oral anesthetics may be prescribed by the health care provider. Adding citrus juices to meals is contraindicated because it will aggravate the stomatitis that is a common side effect of both chemotherapeutic agents. Immunizations must be postponed because of the immunosuppressant effects of chemotherapy. Urine and other body fluids may become red-orange during the first 48 hours after doxorubicin is started; this is an expected response that need not be reported.

1134) Clients who take rifampin should not take medications from which class? Loop diuretics Oral contraceptives Proton pump inhibitor Intermediate-acting insulin

Oral contraceptives Rationale Rifampin increases metabolism of oral contraceptives, which may result in an unplanned pregnancy. Rifampin does not interact with a loop diuretic, a proton pump inhibitor, or intermediate-acting insulin.

430) Which class is contraindicated in clients who take rifampin? Loop diuretics Oral contraceptives Proton pump inhibitor Intermediate-acting insulin

Oral contraceptives Rationale Rifampin increases metabolism of oral contraceptives, which may result in an unplanned pregnancy. Rifampin does not interact with a loop diuretic, a proton pump inhibitor, or intermediate-acting insulin.

1214) Which drink would the nurse instruct a client with iron deficiency anemia to choose to drink with the supplement for efficient absorption? Water Skim milk Orange juice A strawberry milkshake

Orange juice Rationale Iron should be taken before breakfast on an empty stomach to permit maximal absorption; the ascorbic acid in orange juice enhances the absorption of iron. Water does not provide the ascorbic acid necessary for absorption of iron. Iron should not be taken with milk or other dairy products, which may interfere with its absorption.

1492) The alkylating agent cyclophosphamide is prescribed for a school-age child with cancer. Which clinical manifestation would the nurse be alert for while the child is receiving this medication? Irritability Pain with urination Unpredictable nausea Hyperplasia of the gums

Pain with urination Rationale Cystitis is a potentially serious adverse reaction to cyclophosphamide; it sometimes can be prevented by increasing hydration because the fluid flushes the bladder. Irritability may be present but is not a result of cyclophosphamide administration. Unpredictable nausea is an expected but manageable side effect of cyclophosphamide. Hyperplasia of the gums is unrelated to cyclophosphamide administration; it may occur with prolonged phenytoin therapy.

971) A client with leukemia who is receiving vincristine reports lower leg numbness. Which statement about vincristine explains this occurrence? Vincristine acts on enlarged lymph nodes in the groin. Vincristine affects peripheral vascular circulation. Vincristine increases the risk for vascular occlusion. Peripheral neuropathies can result from vincristine chemotherapy.

Peripheral neuropathies can result from vincristine chemotherapy. Rationale Muscle weakness, tingling, and numbness are related to medications like vincristine; neuropathies usually are transient if the medication is stopped or reduced. Nodal enlargement produces vascular rather than neural side effects. Most chemotherapeutic regimens do affect the nervous or peripheral vascular system; neuropathies and peripheral vascular adaptations are potential side effects of chemotherapy. Tingling and numbness are characteristic of neuropathy, not vascular occlusion.

1514) A school-age child with leukemia is receiving treatment with vincristine. Which toxic response would the nurse assess the child for? Diarrhea Alopecia Hemorrhagic cystitis Peripheral neuropathy

Peripheral neuropathy Rationale Neurotoxicity is a specific response to vincristine; the child may become numb and ataxic. Vincristine causes adynamic ileus, resulting in constipation; diarrhea occurs with other antineoplastics and radiation therapy. Alopecia is an expected side effect rather than a toxic response; it is not considered serious, and hair will regrow after the treatment is completed. Hemorrhagic cystitis is a toxic response to cyclophosphamide, not vincristine.

258) Which toxic effect would a nurse monitor for in a client who is prescribed vincristine? Peripheral paresthesia Anginal-type chest pain Ophthalmic papilledema Bilateral crackles in the lung

Peripheral paresthesia Rationale Peripheral paresthesia is an indication of toxicity from a plant alkaloid such as vincristine. Anginal-type chest pain, ophthalmic papilledema, and bilateral crackles in the lung are not side effects of this medication.

1042) The nurse adds 20 mEq of potassium chloride to the intravenous solution of a client with diabetic ketoacidosis. Which purpose would this medication serve? Treats hyperpnea Prevents flaccid paralysis Prevents hypokalemia Treats cardiac dysrhythmias

Prevents hypokalemia Rationale Once treatment with insulin for diabetic ketoacidosis is begun, potassium ions reenter the cell, causing hypokalemia; therefore potassium, along with replacement fluids, is needed to prevent hypokalemia. Potassium will not correct hyperpnea. Flaccid paralysis does not occur in diabetic ketoacidosis. There is no mention of dysrhythmias in the scenario; they are not a universal finding in diabetic ketoacidosis (and are commonly absent) and hypokalemia does not always cause these to occur.

62) Which nursing care will be included for a client who is receiving doxorubicin for acute myelogenous leukemia? Increasing citrus foods Providing frequent oral hygiene Encouraging activity Administering medications parenterally

Providing frequent oral hygiene Rationale Stomatitis and hyperuricemia are possible complications of therapy; therefore oral care and hydration are important. A cidic foods such as citrus foods and fluids will cause pain for clients with stomatitis. Rest, not increased activity, is important for increased fatigability. Abnormal bleeding is a common problem; thus injections (administering medications parenterally) are contraindicated.

382) Which information would the nurse include when teaching a client about the administration of ranitidine? Ranitidine increases gastrointestinal peristalsis. Ranitidine reduces gastric acidity in the stomach. Ranitidine neutralizes the acid that is present in the stomach. Ranitidine stops the production of hydrochloric acid in the stomach.

Ranitidine reduces gastric acidity in the stomach. Rationale Ranitidine inhibits histamine at H 2-receptor sites in the stomach, resulting in reduced gastric acid secretion. Ranitidine does not increase gastrointestinal peristalsis, and it does not completely stop the production of hydrochloric acid in the stomach. Ranitidine reduces, rather than neutralizes, gastric acidity.

510) The nurse is caring for a client who reports sweating, tachycardia, and tremors. The laboratory report of the client reveals serum cortisol less than normal and a blood glucose level of 60 mg/dL. Which medication would be administered to this client? Glucagon Kayexalate Hydrocortisone Insulin with dextrose in normal saline

Rationale A decrease in cortisol levels impairs the glucose metabolism. The client's blood glucose level is 60 mg/dL, which is indicative of hypoglycemia. The nurse should administer glucagon as per the prescription to manage the low glucose levels. Kayexalate is a potassium-binding resin that facilitates potassium excretion and is used to manage hyperkalemia. Intramuscular hydrocortisone is given concomitantly every 12 hours as part of hormone replacement in adrenal insufficiency. Insulin with dextrose in normal saline is given to manage hyperkalemia by causing an intracellular shift of potassium.

966) The nurse prepares to administer extended-release metformin to an older adult who has asked that it be crushed because it is difficult to swallow. Which rationale will prompt the nurse to ask the provider for a different form of metformin? This medication has a wax matrix frame that is difficult to crush. The medication has an unpleasant taste, which most clients find intolerable if crushed. If crushed, this medication irritates mucosal tissue and can cause oral and esophageal ulcer formation. Extended-release formulations are designed to be released slowly and crushing the tablet will prevent this from occurring.

Rationale The slow-release formulary will be compromised, and the client will not receive the entire dose if it is chewed or crushed. The capsules are not difficult to crush. Irritation of the mucosal tissue is not the reason the medication should not be crushed; however, this medication should be given with meals to prevent gastrointestinal irritation. Although taste could be a factor, it is not the priority issue.

515) A child with Wilms tumor is prescribed doxorubicin hydrochloride. Which common side effect unique to doxorubicin would the nurse expect to observe in the child? Hair loss Vomiting Red urine Stomatitis

Red urine Rationale Red urine is a common side effect of doxorubicin administration. The medication is not metabolized and is excreted in the urine. The genitourinary responses to vincristine are nocturia, oliguria, urine retention, and gonadal suppression. Hair loss, vomiting, and stomatitis occur with both medications.

1026) A client diagnosed with tuberculosis is taking isoniazid. To prevent a food and medication interaction, the nurse will advise the client to avoid which food item? Hot dogs Red wine Sour cream Grapefruit juice

Red wine Rationale Clients taking isoniazid should avoid foods containing tyramine such as red wine, tuna fish, and hard cheese. Hot dogs, sour cream, and grapefruit juice do not contain tyramine and are not contraindicated. Grapefruit juice slows metabolism of many medications, but isoniazid is not one of them.

840) The nurse is caring for a client who is receiving azathioprine, cyclosporine, and prednisone before receiving a kidney transplant. Which medication action would the nurse identify as the purpose of these medications? Stimulate leukocytosis Provide passive immunity Prevent iatrogenic infection Reduce antibody production

Reduce antibody production Rationale These drugs suppress the immune system, decreasing the body's production of antibodies in response to the new organ, which acts as an antigen. These medications decrease the risk of rejection. These medications inhibit leukocytosis. These medications do not provide immunity; they interfere with natural immune responses. Because these medications suppress the immune system, they increase the risk of infection.

960) A client takes an oral hypoglycemic agent daily. For which condition is an oral hypoglycemic agent indicated? Ketosis Obesity Pancreatitis Reduced insulin production

Reduced insulin production Rationale Oral hypoglycemics may be helpful when some functioning of the beta cells exists, as in type 2 diabetes. Rapid-acting regular insulin is needed to reverse ketoacidosis. Obesity does not offer enough information to determine the status of beta cell function. Oral hypoglycemics are not routinely indicated for the treatment of pancreatitis.

1540) A client is prescribed rifampin after being exposed to active tuberculosis. Which finding would the nurse immediately report to the health care provider? Select all that apply. One, some, or all responses may be correct. Reddish-orange color urine Yellow-colored teeth stains Orange-colored sweat and tears Small, red, pinpoint areas on the arms Numbness, tingling, and burning of extremities

Small, red, pinpoint areas on the arms Rationale Pinpoint red areas that appear on the arms, legs, or trunk of the body are known as petechiae. The petechiae are tiny hemorrhages that occur under the skin as a result of a low circulating platelet count (thrombocytopenia). Thrombocytopenia occurs with liver stress or damage. As hepatotoxicity is a possible adverse reaction to rifampin, the health care provider must be notified of the appearance of petechiae. Reddish-orange colored urine or stool is a normal effect of the rifampin. Yellow-colored stains on the teeth are side effects that are not dangerous; however, there is no way to reverse the staining, and they may be permanent. Orange-colored sweat and tears are also normal side effects of rifampin, but they are not dangerous. Numbness, tingling, and burning of the extremities could indicate peripheral neuropathy, which can be treated with vitamin B 12, so this is not an immediate emergency.

927) Parents of a child with sickle cell anemia ask about their child taking iron supplements to help treat the anemia. How will the nurse respond? Taking supplements will not help with this condition. It is advised that iron be taken with orange juice to aid in absorption. An over-the-counter multivitamin with iron should meet the needs of the child. It is advised that liquid iron supplements be given through a straw to prevent staining the teeth.

Taking supplements will not help with this condition. Rationale Taking iron supplements will not help. Sickle cell anemia is not caused by too little iron in the blood; it is caused by destruction of red blood cells, which increases free iron. Taking iron supplements could cause harm, because the extra iron builds up in the body and can damage organs. Although iron is better absorbed when taken with orange juice, in the case of sickle cell anemia supplements are not given. Using a straw when giving liquid iron supplements does prevent staining of the teeth; however, giving iron to this child may be detrimental. A multivitamin may be beneficial for this child; however, the addition of iron could build up in the body.

566) An infant with congenital hypothyroidism receives levothyroxine for 3 months. Which finding would indicate to the nurse that the medication is effective? The infant is alert and interactive. The skin is cool to the touch. The baby's fine tremor has ceased. The baby's thyroid stimulating hormone level has increased.

The infant is alert and interactive. Rationale Infants with congenital hypothyroidism are lethargic, and may even need to be awakened and stimulated to nurse; therefore an infant who is alert and interacts appropriately for its age would demonstrate improvement. Cool skin is a clinical sign of hypothyroidism related to a slow basal metabolic rate. Fine hand tremor is related to hyperthyroidism and is not present in an infant with hypothyroidism, even one whose condition is being stabilized with levothyroxine. An increased thyroid stimulating hormone level would indicate inadequate treatment.

554) Which information would the nurse include when teaching parents about the side effects of iron supplements? The urine may turn red. The skin will turn yellow. The teeth may become stained. The stools will take on a clay color.

The teeth may become stained. Rationale Liquid oral iron supplements may stain the teeth; brushing the teeth after administration may limit the discoloration. There should be no change in the color of the urine. Yellowing of the skin is a sign of jaundice; it is not a side effect of an iron supplement. The stools will become black-green; clay-colored stools are a sign of biliary obstruction.

1109) A client is diagnosed with acute kidney failure secondary to dehydration. An intravenous (IV) infusion of 50% glucose with regular insulin is prescribed to address which purpose? To correct hyperkalemia To increase urinary output To prevent respiratory acidosis To increase serum calcium levels

To correct hyperkalemia Rationale The 50% glucose and regular insulin infusion treats the hyperkalemia associated with kidney failure; it moves potassium from the intravascular compartment into the intracellular compartment. Insulin will not increase urinary output. Insulin is not a treatment for respiratory acidosis. Insulin and glucose do not increase serum calcium levels.

1175) The chemotherapy protocol prescribed for a client with tuberculosis includes vitamin B 6 and isoniazid (INH). Which would the nurse identify as the reason for prescribing vitamin B 6? To improve the nutritional status of the client To enhance the tuberculostatic effect of INH To accelerate the destruction of dormant tubercular bacilli To counteract the peripheral neuritis that INH may cause

To counteract the peripheral neuritis that INH may cause Rationale One of the most common side effects of INH is peripheral neuritis, and vitamin B 6 will counteract this problem. It does help nutrition, but that is not the specific reason it is given. It counters the side effects of isoniazid; it does not act to enhance its action. It does not speed the destruction of the causative organism.

355) Which purpose would the nurse identify as the reason for prescribing vitamin B 6 when a chemotherapy protocol prescribed for a client with tuberculosis includes vitamin B 6 and isoniazid (INH)? To improve the nutritional status of the client To enhance the tuberculostatic effect of INH To accelerate the destruction of dormant tubercular bacilli To counteract the peripheral neuritis that INH may cause

To counteract the peripheral neuritis that INH may cause Rationale One of the most common side effects of INH is peripheral neuritis, and vitamin B 6 will counteract this problem. It does help nutrition, but that is not the specific reason it is given. It counters the side effects of isoniazid; it does not act to enhance its action. It does not speed the destruction of the causative organism.

905) A client is to receive metoclopramide intravenously 30 minutes before initiating chemotherapy for cancer of the colon. The nurse explains that metoclopramide is given for which purpose? To stimulate production of gastrointestinal (GI) secretions To stimulate peristalsis of the upper gastrointestinal (GI) tract To prolong excretion of the chemotherapeutic medication To increase absorption of the chemotherapeutic medication

To stimulate peristalsis of the upper gastrointestinal (GI) tract Rationale Prokinetic medications such as metoclopramide stimulate peristalsis in the GI tract. This enhances the emptying of stomach contents into the duodenum to decrease gastroesophageal reflux and vomiting, all of which are precipitated by chemotherapeutic agents. Metoclopramide does not stimulate the production of gastrointestinal secretions. Metoclopramide has no effect on the excretion of chemotherapeutic medications. Metoclopramide has no effect on the absorption of chemotherapeutic medications.

969) Several hours after administering insulin, the nurse assesses the client's response to the insulin. Which client responses are indicative of a hypoglycemic reaction? Select all that apply. One, some, or all responses may be correct. Tremors Anorexia Confusion Glycosuria Diaphoresis

Tremors Confusion Diaphoresis Rationale Confusion is typically the first sign of a hypoglycemic reaction. Tremors are a sympathetic nervous system response that occurs because circulating glucose in the brain decreases. Diaphoresis is a cholinergic response to hypoglycemia. Hypoglycemia causes hunger, not anorexia. Because blood glucose is low in hypoglycemia, the renal threshold is not exceeded and glycosuria does not occur.

620) A school-age child diagnosed with acute lymphocytic leukemia (ALL) becomes constipated after receiving induction therapy with prednisone, vincristine, and asparaginase. Which would the nurse suspect as the cause? Diet, which lacks bulk Inactivity, which results from illness Vincristine, which decreases peristalsis Prednisone, which causes gastric irritability

Vincristine, which decreases peristalsis Rationale Constipation, which may progress to paralytic ileus, is a side effect of vincristine. Lack of bulk and inactivity each may contribute to constipation, but neither is the primary cause of this child's constipation. Prednisone may cause nausea and vomiting, but it does not cause constipation.

616) A child infected with human immunodeficiency virus (HIV) is admitted with Pneumocystis jiroveci pneumonia and receives trimethoprim/sulfamethoxazole. Which common side effects would the nurse anticipate? Select all that apply. One, some, or all responses may be correct. Jaundice Vomiting Headache Crystalluria Photosensitivity

Vomiting Crystalluria Photosensitivity Rationale Nausea and vomiting may occur as a result of gastrointestinal irritation. Crystalluria may occur with this medication, especially in the presence of restricted fluid intake secondary to nausea and vomiting. Skin reactions such as photosensitivity are also common. Hepatic side effects such as jaundice may occur but are not common. Central nervous system side effects such as headache are rare adverse reactions.

347) Which adverse response to isoniazid (INH) in a client with tuberculosis would cause the nurse to determine that prompt intervention is needed? Orange feces Yellow sclera Temperature of 96.8°F (36°C) Weight gain of 5 pounds (2.3 kilograms)

Yellow sclera Rationale An adverse reaction to isoniazid (INH) is hepatitis, resulting in jaundice. Rifampin, an antitubercular medication, can color excretions orange, which is not harmful. A temperature of 96.8°F (36°C) is within expected limits. Weight gain indicates improvement in the client's health status.

413) Which client statement indicates that teaching about acetaminophen is effective? "I can drink beer with this but not wine." "I need to limit my intake of acetaminophen to 650 mg a day." "I should take an emetic if I accidentally overdose on acetaminophen." "I have to be careful about which over-the-counter cold preparations I take."

"I have to be careful about which over-the-counter cold preparations I take." Many over-the-counter cold preparations contain acetaminophen; the amount of acetaminophen in cold preparations must be taken into consideration when the total amount of acetaminophen taken daily is calculated. Alcohol of any type increases the risk of liver injury when taken with acetaminophen. A typical single dose is 650 mg for adults. Acetaminophen should not exceed 3 to 4 g a day. An emetic is contraindicated because it may reduce the client's ability to tolerate oral acetylcysteine, the antidote for acetaminophen toxicity.

302) Which response would the nurse give to a client taking ibuprofen for rheumatoid arthritis who asks the nurse if acetaminophen can be substituted? "Yes, both are antipyretics and have the same effect." "Acetaminophen irritates the stomach more than ibuprofen does." "Acetaminophen is the preferred treatment for rheumatoid arthritis." "Ibuprofen has anti-inflammatory properties, and acetaminophen does not."

"Ibuprofen has anti-inflammatory properties, and acetaminophen does not." Ibuprofen has an anti-inflammatory action that relieves the inflammation and pain associated with arthritis. Ibuprofen is not an antipyretic. Acetaminophen does not cause gastritis; this is an effect of aspirin. Acetaminophen is not a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs are preferred for the treatment of rheumatoid arthritis.

625) After surgery, an adolescent has a patient-controlled analgesia (PCA) pump that is set to allow morphine delivery every 6 minutes. Which statement indicates to the nurse that the family understand instructions about the PCA pump? 'I'll make sure that she pushes the PCA button every 6 minutes.' 'She needs to push the PCA button whenever she needs pain medication.' 'I'll have to wake her up on a regular basis so she can push the PCA button.' 'I'll press the PCA button every 6 minutes so she gets enough pain medication while she's sleeping.'

'She needs to push the PCA button whenever she needs pain medication.' Rationale Morphine, an opioid analgesic, relieves pain; when control of pain is given to the adolescent, anxiety and pain are usually diminished, resulting in a decreased need for the analgesic; only the adolescent should press the PCA button. Having the adolescent press the PCA button every 6 minutes is unnecessary. Although pain medication can be delivered as often as every 6 minutes, it should be used only if necessary. If the adolescent is sleeping, the pain is under control; waking the adolescent will interfere with rest. If the adolescent is sleeping, the pain is under control; also, this will result in an unnecessary and excessive dosage of the opioid.

1005) How would the nurse reply when a client prescribed a tetracycline class medication asks why milk and antacids should be avoided before and after dosing? 'Taking these together can lead to kidney impairment.' 'The pairing of these substances leads to tooth staining.' 'Severe diarrhea can occur when taking these substances together.' 'This can lead to decreased absorption of the medication you need.'

'This can lead to decreased absorption of the medication you need.' Rationale Tetracyclines chelate with calcium, iron, and magnesium, so substances containing these minerals are avoided to optimize absorption of the antimicrobial.

170) Which statement by a client prescribed ampicillin indicates that teaching by the nurse was effective? "I will miss eating grapefruit." "I must increase my fluid intake." "I can stop taking this medication any time." "I should take this medication just after eating."

*"I must increase my fluid intake." Rationale The client should increase fluid intake when taking ampicillin to prevent nephrotoxicity; side effects include oliguria, hematuria, proteinuria, and glomerulonephritis. There are no restrictions on eating grapefruit when taking an antibiotic; this is contraindicated when taking some calcium channel blockers because grapefruit juice increases their serum level. An antibiotic should be continued until the entire prescription is completed; discontinuing before completion lowers its serum level, thereby decreasing its effectiveness. Ampicillin should be taken when the stomach is empty, either 1 to 2 hours before eating or 3 to 4 hours after eating.

621) The nurse teaches a teenage client about the administration of levofloxacin to treat a sinus infection. The nurse concludes the teaching is effective when the client makes which statement? 'I should take the medication at mealtime.' 'I should take the medication just before a meal.' 'I should take the medication 1 hour before a meal.' 'I should take the medication 30 minutes after a meal.'

*'I should take the medication 1 hour before a meal.' Rationale Absorption of the oral solution levofloxacin is enhanced when the stomach is empty, and it should be taken 1 hour before meals or 2 hours after meals. Tablets can be taken without regard for food. Food in the stomach will interfere with absorption. If the medication is taken just before a meal, food in the stomach shortly afterward will interfere with absorption. If the medication is taken 30 minutes after a meal, food remaining in the stomach will interfere with absorption.

790) A client has an anaphylactic reaction after receiving intravenous penicillin. Which would the nurse conclude is the cause of this reaction? An acquired atopic sensitization occurred. There was passive immunity to the penicillin allergen. Antibodies to penicillin developed after a previous exposure. Genes encoded for allergies cause a reaction on an initial penicillin exposure.

*Antibodies to penicillin developed after a previous exposure. Rationale Hypersensitivity results from the production of antibodies in response to exposure to certain foreign substances (allergens). Earlier exposure is necessary for the development of these antibodies. Hay fever and asthma, not penicillin allergy, are atopic conditions. The reaction is an active, not passive, immune response. Antibodies developed when there was a previous, not first, exposure to penicillin.

1484) Which medication is considered first-line therapy for an infant with congenital syphilis? Vidarabine Pyrimethamine Intravenous (IV) penicillin Trimethoprim-sulfamethoxazole

*Intravenous (IV) penicillin Rationale IV penicillin destroys the cell wall of Treponema pallidum, the causative organism of syphilis. Vidarabine is an antiviral medication; it does not treat congenital syphilis in an infant. Pyrimethamine and trimethoprim-sulfamethoxazole are ineffective in the treatment of syphilis.

A nurse is reviewing prescriptions for a client with a history of rheumatoid arthritis and peptic ulcer disease. The client has prescriptions for ibuprofen and ranitidine. Which action will the nurse perform? AClarify the prescription for ibuprofen BAdminister the ibuprofen 30 minutes before the ranitidine CHold the ranitidine for 1 hour after meals DQuestion the prescription for ranitidine

AClarify the prescription for ibuprofen Rationale: Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that can cause gastrointestinal (GI) bleeding. The client has a history of peptic ulcer disease. The nurse should clarify the prescription for ibuprofen. Administering the ibuprofen before the ranitidine does not address the issue of possible GI bleeding. Ranitidine can be administered without regard to meals. The prescription for ranitidine is appropriate for the client's condition and does not need to be questioned.

A client recovering from hip replacement surgery is taking acetaminophen with codeine every three hours for pain. For which side effect should the nurse monitor the client? AConstipation BWheezing CDiffuse rash DHyperglycemia

AConstipation Rationale: Codeine is an opioid analgesic and antitussive (cough suppressant). For analgesic use, codeine is formulated alone and in combination with non-opioid analgesics (either aspirin or acetaminophen). Because codeine and non-opioid analgesics relieve pain by different mechanisms, the combination can produce greater pain relief than either agent alone. Opioids such as codeine slow down the function of the central nervous system. This can affect involuntary movements in the body, such as peristalsis. As the movement of food through the intestinal tract is slowed down, the walls of the intestine absorb more fluid. With less fluid in the intestines, stool becomes hard and constipation develops. The other side effects are not usually seen with codeine.

A postoperative client has a prescription for acetaminophen with codeine for pain relief. The nurse understands which action to be the primary purpose of this drug combination? AEnhanced pain relief BFaster onset of action CPrevents tolerance DMinimized side effects

AEnhanced pain relief Rationale: Codeine is an opioid analgesic. It is considered a moderate opioid, similar to morphine in most respects. It is used for relief of mild to moderate pain. Codeine is formulated alone and in combination with non-opioid analgesics such as aspirin or acetaminophen. Because codeine and non-opioid analgesics relieve pain by different mechanisms, the combinations can produce greater (enhanced) pain relief than either agent alone. The onset of action, risk of tolerance and side effects are the same as with other oral, opioid medications.

Question 5 The home health nurse is teaching a female client about self-administering vancomycin. Which statement by the client demonstrates understanding of the teaching? AI need to call my provider if my urine changes BMuscle tingling and weakness is an expected side effect of this medication CRinging in the ears is common when taking vancomycin DI should avoid eating food with active cultures in it

AI need to call my provider if my urine changes Rationale: Vancomycin is commonly linked to nephrotoxicity, leading to the need for monitoring trough levels. Signs of kidney injury include decreased urination, blood in the urine, and other changes in urine color and clarity. Antibiotic-associated diarrhea (colitis) results from oral or parenteral antibiotic therapy. Another pathogen is Candida albicans, which results in vaginal yeast infection and oral thrush. Probiotics can reduce these risks. Antibiotic-induced neuropathy is a rare complication of several antimicrobial agents. Hypokalemia can result from vancomycin; therefore, muscle weakness and numbness or tingling should be reported. Ototoxicity is a serious complication from vancomycin due to vestibular damage.

A nurse has removed a 2 ml vial of fentanyl from the medication dispensing system. After dosage calculations, the nurse determines only 1 ml will be administered to the client. Which action will the nurse perform with the remainder of the medication? ARequest another nurse to witness wasting of the unused medication BDispose of the unused medication in the sink CStore the unused of the medication in the medication cart DReturn the unused medication to the dispensing system

ARequest another nurse to witness wasting of the unused medication Rationale: Unused controlled substances such as fentanyl should be wasted. The waste of narcotics requires a witness. The nurse should request another licensed nurse to witness the waste of the additional 1 ml of medication. Disposal of controlled substances should be witnessed. Unused controlled substances should be wasted, not stored or returned to the dispensing system.

Question 5 The nurse is providing medication teaching for a client who has been prescribed tetracycline. The client regularly takes calcium supplements to prevent osteoporosis. Which statement is appropriate for the nurse to make? ATake your calcium two hours before you take the antibiotic BYou can take the calcium with the antibiotic to decrease an upset stomach CTry taking the antibiotic and calcium with orange juice DIt is best to take the antibiotic and calcium on an empty stomach

ATake your calcium two hours before you take the antibiotic Rationale: All tetracycline derivatives are bacteriostatics, and their concentration in serum should not fall during the therapy below the generally accepted minimum therapeutic concentration. Tetracyclines have a high affinity to form chelates with iron, aluminum, magnesium, and calcium. These complexes are poorly absorbed in the gastrointestinal tract; therefore, an interval between the ingestion of tetracyclines and cations is necessary. Taking tetracyclines with orange juice may increase irritation because the medication itself is also acidic. Additionally, orange juice may have added calcium, which would interact with the antibiotic. It is okay to take tetracyclines with food as long as it doesn't contain dairy. This may reduce stomach-related side effects.

The nurse educating a client who is postpartum about the use of ibuprofen for uterine cramping. Which statement should the nurse include in the teaching? AThis medication could cause gastrointestinal discomfort BYou may experience decreased vaginal discharge with this medication CTaking this medication could decrease your breast milk production DYou could experience dizziness while taking this medication

AThis medication could cause gastrointestinal discomfort Question Explanation Rationale: Ibuprofen, which is an NSAID, can cause gastrointestinal upset, especially if taken frequently without food. Ibuprofen can increase the risk for bleeding, so the client should monitor vaginal discharge. Ibuprofen does not affect breast milk production. Medications that cause vasodilation, such as beta-blockers, could cause dizziness.

The nurse is caring for a client who has been prescribed vancomycin intravenous infusion for the treatment of methicillin-resistant staphylococcus aureus. Which of the following laboratory values should be immediately reported to the healthcare provider? AVancomycin trough of 15 mcg/dl BBlood urea nitrogen level of 18 mg/dl CCreatinine level of 1.1 mg d/l DWhite blood cell count of 11,500 per microliter

AVancomycin trough of 15 mcg/dl Rationale: Vancomycin has a low therapeutic index, with nephrotoxicity and ototoxicity complicating therapy if toxicity develops. In contrast, underdosing (less than the minimum inhibitory concentration) can lead to treatment failure. Nephrotoxicity is associated with a trough level above 10 mcg/dl. The BUN and creatinine in this case are still within a normal range. While the WBC count is elevated, this is an expected finding.

732) Which medication is safest to take for pain in the week before a surgical procedure? Naproxen Aspirin Ketorolac Acetaminophen

Acetaminophen Rationale Acetaminophen is a nonopioid analgesic that inhibits prostaglandins, which serve as mediators for pain; it does not affect platelet function. Naproxen, aspirin, and ketorolac are nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) that are contraindicated for clients undergoing surgery; nonselective NSAIDs have an inhibitory effect on thromboxane, a strong aggregating agent, and can result in bleeding.

422) Which action would the nurse take when administering tetracycline? Administer the medication with meals or a snack. Provide orange or other citrus fruit juice with the medication. Administer the medication at least an hour before ingestion of milk products. Offer antacids 30 minutes after administration if gastrointestinal side effects occur.

Administer the medication at least an hour before ingestion of milk products. Rationale Any product containing aluminum, magnesium, or calcium ions should not be taken in the hour before or after an oral dose of tetracyclines (with the exception of doxycycline) because it decreases absorption by as much as 25% to 50%. Food interferes with absorption; it should be given 1 hour before or 2 hours after meals. Citrus juice does not improve absorption. Antacids will interfere with absorption.

44) A client who is addicted to opioids undergoes emergency surgery. During the postoperative period, the health care provider decreases the previously prescribed methadone dosage. Which clinical manifestations will the nurse monitor for when assessing this client? Constipation and lack of interest in surroundings Agitation and attempts to escape from the hospital Skin dryness and scratching under the incision dressing Lethargy and refusal to participate in therapeutic exercises

Agitation and attempts to escape from the hospital Rationale When the methadone dosage is reduced, a craving for opioids may occur, anxiety will increase, and the client will become agitated and may try to leave the hospital to secure drugs. Constipation and lack of interest in surroundings and skin dryness and itching under the incision dressing are not related to methadone dosage reduction. Lethargy and refusal to participate in therapeutic exercises may occur with methadone overdose.

801) A client has been given a prescription for acetylsalicylic acid. The nurse recalls that this medication has which property? Sedative Hypnotic Analgesic Antibiotic

Analgesic Rationale Acetylsalicylic acid (aspirin) acts as an analgesic by inhibiting production of inflammatory mediators. Acetylsalicylic acid does not act as a sedative to calm individuals. Acetylsalicylic acid does not act as a hypnotic to induce sleep. Acetylsalicylic acid does not destroy or control microorganisms.

796) Aspirin is prescribed on a regular schedule for a client with rheumatoid arthritis. The nurse understands that the medication is being used primarily for which property? Analgesic Antipyretic Anti-inflammatory Antiplatelet

Anti-inflammatory Rationale The anti-inflammatory action of aspirin reduces joint inflammation. Aspirin reduces fever, but this is not the rationale for prescribing it for clients with rheumatoid arthritis. It can relieve pain and prevent abnormal clotting; however, although these effects can be beneficial, these are not the primary reasons that it is prescribed for rheumatoid arthritis.

712) Which medication would the nurse anticipate the health care provider will prescribe to relieve the pain experienced by a client with rheumatoid arthritis? Aspirin Hydromorphone Meperidine Alprazolam

Aspirin Rationale Because of its anti-inflammatory effect, acetylsalicylic acid is useful in treating arthritis symptoms. Opioids such as hydromorphone and meperidine should be avoided because they promote medication dependency and do not affect the inflammatory process. Alprazolam is an antianxiety, not an anti-inflammatory, agent.

237) Which medication increases the risk for upper gastrointestinal (GI) bleeding? Select all that apply. One, some, or all responses may be . Aspirin Ibuprofen Ciprofloxacin Acetaminophen Methylprednisolone

Aspirin Ibuprofen Methylprednisolone Rationale Nonsteroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid and ibuprofen, and corticosteroids such as methylprednisolone are known causes of medication-induced gastrointestinal (GI) bleeding by causing irritation and erosion of the gastric mucosal barrier. Ciprofloxacin, an antibiotic, has not been associated with GI bleeding. Acetaminophen is a safe alternative to NSAIDs to reduce the risk of GI bleeding.

The nurse is reviewing discharge instructions with a client who has been prescribed ciprofloxacin following a minor burn injury. Which statement by the client requires additional teaching? A"I will protect my skin from the sun with sunscreen and clothing." B"I will not take ciprofloxacin prior to sun exposure." C"After healing, I should have no scarring from this burn." D"I can take ibuprofen for the pain related to this burn."

B"I will not take ciprofloxacin prior to sun exposure." Rationale: Ciprofloxacin is an antibiotic that is associated with causing photosensitivity. Clients should be instructed to protect their skin from sun exposure while taking this medication. Appropriate methods to protect the skin are to limit sun exposure and to wear sunscreen and protective clothing. For a superficial-thickness burn, no scarring will occur and healing should take 3 to 6 days. The client may take a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, to alleviate the pain associated with the burn. It is inappropriate for the client to stop taking their antibiotic. However, if the client cannot avoid sun exposure, the nurse may contact the health care provider and request that the antibiotic be changed to one that does not cause photosensitivity.

Question 16 The health care provider has prescribed tetracycline for a 28-year-old female client with severe acne. When teaching the client about this medication, which information is important for the nurse to include? AIt may cause staining of the teeth. BIt may decrease the effectiveness of oral contraceptives. CIt should be taken with food or milk. DIt may cause hearing loss.

BIt may decrease the effectiveness of oral contraceptives. Rationale: Tetracycline, a broad-spectrum antibiotic, can decrease the effectiveness of oral contraceptives; therefore, it is important to recommend use of an additional form of contraception such as a condom when taking this medication. Tetracycline should be taken on an empty stomach and never with milk. It is not given to children younger than 8 years old because it can stain developing teeth. Tetracycline is not known to cause hearing loss.

The nurse is assessing a client who is taking prescribed opioids for pain. Which finding should indicate to the nurse that the client is having a side effect of the medication? ADecreased skin turgor BNo bowel movement for four days CHypertension DIncreased respiratory effort

BNo bowel movement for four days Rationale: A side effect is a mild, predictable response to a medication. Opioids slow down processes in the body, including gastrointestinal motility, so a possible side effect of this medication would be constipation. Skin turgor is not directly affected by opioids. A client who is having side effects of opioids will have hypotension and decreased respiratory effort.

Question 4 The nurse is caring for a client with acute pain and realizes a medication error has occurred. The client received twice the ordered dose of morphine an hour ago. Which nursing problem is the priority at this time? AChronic pain BRespiratory depression CConstipation DTolerance

BRespiratory depression Rationale: Opioids (e.g., morphine) are indicated for the treatment of moderate to severe pain. An opioid is a medication that relieves pain by binding to receptors in the nervous system. Respiratory depression is a life-threatening risk in an opioid overdose. The priority problem is ineffective respirations/respiratory depression due to central nervous system depression.

595) A child with juvenile idiopathic arthritis is prescribed nonsteroidal anti-inflammatory drug (NSAID) therapy at home. Which important toxic effect of NSAIDs would the nurse include in discharge instructions to the child and family? Diarrhea Hypothermia Blood in the urine Increased irritability

Blood in the urine Rationale Hematuria may result from the use of NSAIDs because they may cause nephrotoxicity. Diarrhea can occur but is not a sign of toxicity. Hypothermia does not occur with NSAIDs. Drowsiness, not hyperactivity, may occur.

A client with an infection is receiving vancomycin. Which laboratory blood test result would the nurse report? Hematocrit: 45% Calcium: 9.0 mg/dL (2.25 mmol/L) White blood cells (WBC): 10,000 mm 3 (10 × 10 9/L) Blood urea nitrogen (BUN): 30 mg/dL (10.2 mmol/L)

Blood urea nitrogen (BUN): 30 mg/dL (10.2 mmol/L) Rationale Vancomycin is a nephrotoxic medication. An elevated BUN can be an early sign of toxicity. The BUN of a healthy adult is 10 to 20 mg/dL (3.6-7.1 mmol/L). This hematocrit is expected in a healthy adult; the range is from 40 to 52. The expected range of the white blood cell (WBC) count is 5000 to 10,000 mm 3 (5 to 10 × 10 9/L) for a healthy adult. This calcium level is within the expected range of 9.0 to 10.5 (2.25-2.75 mmol/L) for a healthy adult.

957) Which response to morphine would need to be reported immediately to the health care provider? Nausea Headache Drowsiness Bradycardia

Bradycardia Rationale Because morphine is a central nervous system depressant, it may cause bradycardia, shock, and cardiac arrest. Although headache, drowsiness, and nausea may be a response to morphine, they do not have to be reported.

1029) Which therapeutic outcomes are expected after administering ibuprofen? Select all that apply. One, some, or all responses may be . Diuresis Pain relief Temperature reduction Bronchodilation Anticoagulation Reduced inflammation

Pain relief Temperature reduction Reduced inflammation Rationale Prostaglandins accumulate at the site of an injury, causing pain; nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen inhibit COX-1 and COX-2 (both are isoforms of the enzyme cyclooxygenase), which inhibit the production of prostaglandins, thereby contributing to analgesia. NSAIDs inhibit COX-2, which is associated with fever, thereby causing the temperature to decline. NSAIDs inhibit COX-2, which is associated with inflammation, thereby reducing inflammation. NSAIDs do not cause diuresis; reversible renal ischemia and renal insufficiency in clients with heart failure, cirrhosis, or hypovolemia can be potential adverse effects of NSAIDs. NSAIDs do not cause bronchodilation. Anticoagulation is an adverse effect, not a desired outcome; NSAIDs can impair platelet function by inhibiting thromboxane, an aggregating agent, resulting in bleeding.

169) Which therapy is indicated for a client admitted to the hospital after general paresis develops as a complication of syphilis? Penicillin therapy Major tranquilizers Behavior modification Electroconvulsive therapy

Penicillin therapy Rationale Massive doses of penicillin may limit central nervous system damage if treatment is started before neural deterioration from syphilis occurs. Tranquilizers are used to modify behavior, not to treat general paresis. Behavior, not paresis, is treated with behavior modification. Electroconvulsive therapy is used to treat certain psychiatric disorders.

1004) Which effect has resulted in the avoidance of tetracycline use in children under 8 years old? Birth defects Allergic responses Severe nausea and vomiting Permanent tooth discoloration

Permanent tooth discoloration Rationale Tetracycline use in children under the age of 8 years has been discontinued because it causes permanent tooth discoloration. Birth defects, allergic responses, and severe nausea and vomiting are not prevalent reasons for the discontinuation of tetracycline medications in children under 8 years old.

857) A client who had a myocardial infarction receives 15 mg of morphine sulfate for chest pain. Fifteen minutes after receiving the medication, the client complains of feeling dizzy. Which action will the nurse take? Determine if this is an allergic reaction. Elevate the client's head and keep the extremities warm. Place the client in the supine position and take the vital signs. Tell the client that this is not a typical sensation after receiving morphine sulfate.

Place the client in the supine position and take the vital signs. Rationale Dizziness is a symptom of hypotension, a side effect of morphine sulfate. The supine position increases venous return, cardiac output, and blood flow to the brain. Dizziness is a symptom of hypotension that is a side effect, not an allergic response, to morphine sulfate. Raising the client's head may aggravate dizziness. Dizziness is a typical side effect of morphine sulfate.

697) The nurse is caring for a client who is receiving aspirin therapy. Which clinical indicator would be related to this therapy? Urinary calculi Atrophy of the liver Prolonged bleeding time Premature erythrocyte destruction

Prolonged bleeding time Rationale Aspirin interferes with platelet aggregation, thereby lengthening bleeding time. Urate excretion is enhanced by high doses of aspirin. Aspirin does not cause atrophy of the liver; it is readily broken down in the gastrointestinal tract and liver. Aspirin does not destroy erythrocytes.

479) Which information would the nurse include in the teaching plan on ampicillin? 'Take the ampicillin with meals.' 'Store the ampicillin in a light-resistant container.' 'Notify the health care provider if diarrhea develops.' 'Continue the medication until a negative culture is obtained.' .

Rationale Diarrhea is a possible side effect that can be related to superinfection or to the destruction of bacterial flora in the intestine; it can lead to fluid and electrolyte imbalance. Ampicillin is absorbed best when taken with water on an empty stomach. Although storage in an airtight container is necessary, protection from light is not. A culture generally is not repeated unless the client's condition indicates that the medication was ineffective

539) A child with pinworms is prescribed mebendazole. Which expected response to the medication would the nurse teach the parents watch for? Blood Constipation Yellow stools Passage of worms

Rationale Passage of worms is the expected response because the medication causes the death of the worms. Neither the medication nor the worms cause intestinal bleeding. Transient diarrhea, not constipation, may occur. The medication may color the stool red, not yellow.

646) A client with pulmonary tuberculosis develops tinnitus and vertigo. Which antitubercular medication would the nurse suspect is causing these symptoms? Isoniazid Rifampin Streptomycin Ethambutol

Rationale Streptomycin is ototoxic and can cause damage to the eighth cranial nerve, resulting in deafness. Assessment for ringing or roaring in the ears, vertigo, and hearing acuity should be made before, during, and after treatment. Isoniazid does not affect the ear; however, blurred vision and optic neuritis, as well as peripheral neuropathy, may occur. Rifampin does not affect hearing; however, visual disturbances may occur. Ethambutol does not affect hearing; however, visual disturbances may occur.

645) Which adverse effect of morphine indicates the need for naloxone administration? Blurred vision Urinary retention Mental confusion Respiratory depression

Respiratory depression Rationale Because morphine is a central nervous system depressant, it affects the medulla, the respiratory center in the brain. Respiratory depression may progress to respiratory arrest and death. Naloxone will reverse the effects of an opioid. Although blurred vision, urinary retention, and mental confusion are adverse effects of morphine, they do not require opioid reversal.

657) A client takes morphine sulfate for severe metastatic bone pain. The nurse will assess the client for which adverse effect? Diarrhea Addiction Respiratory depression Diuresis

Respiratory depression Rationale Morphine sulfate is a central nervous system depressant that commonly decreases the respiratory rate, which can lead to respiratory arrest. Morphine, an opioid, will cause constipation, not diarrhea. Addiction is not a concern for a terminally ill client. Urinary retention, not diuresis, is a common side effect of morphine.

1048) Aspirin is prescribed for a client with rheumatoid arthritis. Which clinical indicators of aspirin toxicity will the nurse teach the client to report? Select all that apply. One, some, or all responses may be . Bradycardia Joint pain Blood in the stool Ringing in the ears Increased urine output

Ringing in the ears Rationale Blood in the stool indicates gastrointestinal irritation and may have resulted from the anticoagulant effect of aspirin. Salicylates, such as aspirin, can cause ototoxicity (affects eighth cranial nerve), which may manifest as ringing in the ears (tinnitus) or muffled hearing and it should be reported. Joint pain is not a symptom of salicylate toxicity; however, it is related to the disease process and should be minimized by the administration of aspirin. Bradycardia and increased urine output (polyuria) do not indicate salicylate toxicity.

776) A client who takes four 325-mg tablets of buffered aspirin four times a day for severe arthritis complains of dizziness and ringing in the ears. Which complication would the nurse conclude that the client probably is experiencing? Salicylate toxicity Allergic reaction Withdrawal symptoms Aspirin tolerance

Salicylate toxicity Rationale Aspirin is a salicylate; excessive aspirin ingestion can influence the vestibulocochlear nerve (cranial nerve VIII), causing tinnitus and dizziness. The client is experiencing symptoms of toxicity, not an allergic response. Withdrawal symptoms occur when a medication is no longer being administered. Tolerance describes a condition in which additional medication is needed to achieve an effect; it is not associated with the development of new symptoms.

1536) A child is prescribed tetracycline. The nurse understands which possible medication-related reaction is associated with this medication? Kernicterus Gray syndrome Reye syndrome Staining of teeth

Staining of teeth Rationale Tetracycline causes staining or discoloration of developing teeth in children. Sulfonamides may cause kernicterus in neonates. Chloramphenicol may cause Gray syndrome in infants. Aspirin may cause Reye syndrome in pediatric clients with a history of chickenpox or influenza.

759) A client receiving intravenous vancomycin reports ringing in both ears. Which initial action would the nurse take? Notify the primary health care provider. Consult an audiologist. Stop the infusion. Document the finding and continue to monitor the client.

Stop the infusion. Rationale The first action the nurse would take is to stop the infusion immediately. Vancomycin can cause temporary or permanent hearing loss. The nurse would stop the medication infusion and then notify the health care provider at once if a client reports any hearing problems or ringing in the ears. An audiologist may need to be consulted at a later date, but this is not the best first action. The nurse would document the findings; however, this is not the initial action.

702) A client with a history of tuberculosis reports difficulty hearing. Which medication would the nurse consider is causing this response? Streptomycin Pyrazinamide Isoniazid Ethambutol

Streptomycin Rationale Ototoxicity is an adverse effect of aminoglycosides

238) A client who is addicted to heroin has major surgery. Afterward, the client receives methadone. Which purpose does the methadone serve? Allows symptom-free termination of opioid addiction Switches the user from illicit opioid use to use of a legal drug Provides postoperative pain control without causing opioid dependence Counteracts the depressive effects of long-term opioid use on thoracic muscles

Switches the user from illicit opioid use to use of a legal drug Rationale Methadone may be dispensed legally; the strength of this medication is controlled and remains constant from dose to dose, unlike illicit drugs. Methadone is used in the medically supervised withdrawal period to treat physical dependence on opiates; methadone therapy substitutes a legal drug for an illegal one. Methadone may be administered over the long term to replace illegal opioid use. If methadone treatment is abruptly stopped, there will be withdrawal symptoms. It is a synthetic opioid and can cause dependence; it is used in the treatment of heroin addiction but also may be prescribed for people who have chronic pain syndromes. It is not used for acute postoperative pain. Methadone is not known to counteract the depressive effects of long-term opioid use on thoracic muscles.

1374) Levofloxacin is prescribed for a woman who has been experiencing urinary frequency and burning for the past 24 hours. The nurse concludes the teaching has been effective when the client states she will make which change in her routine? Limit her fluid intake. Strain her urine for calculi. Monitor her urine output. Take mineral supplements 2 hours before or after levofloxacin.

Take mineral supplements 2 hours before or after levofloxacin. Rationale Mineral substances taken within 2 hours of a levofloxacin dose decrease the medication's effectiveness. Fluid intake should be increased to prevent crystalluria. Although the urine should be inspected for crystals, straining is not necessary. It is unnecessary to monitor urine output.

781) A health care provider prescribes aspirin for a client with severe arthritis. Which advice will the nurse provide to the client? Take the medicine with meals. See a dentist if bleeding gums develop. Switch to acetaminophen if tinnitus occurs. Avoid spicy foods while taking the medication.

Take the medicine with meals. Rationale Acetylsalicylic acid is irritating to the stomach lining and can cause ulceration; the presence of food, fluid, or antacids decreases this response. Bleeding gums should be reported to the health care provider, not the dentist. Acetaminophen does not contain the anti-inflammatory properties present in aspirin; tinnitus should be reported to the health care provider. Avoiding spicy foods is unnecessary as long as aspirin is taken with food.

1526) A mother complains that her child's teeth have become yellow in color. The nurse understands that with prolonged use, which medication may be responsible? Tetracycline Promethazine Chloramphenicol Fluoroquinolones

Tetracycline Rationale When administered to neonates and infants, tetracycline may cause staining of developing teeth. Promethazine can cause respiratory depression in children under 2 years of age. Chloramphenicol can cause Gray baby syndrome, and fluoroquinolones may cause tendon rupture in pediatric clients.

1028) A client receiving morphine is being monitored by the nurse for adverse effects of the medication. Which clinical findings warrant immediate follow up by the nurse? Select all that apply. One, some, or all responses may be . Polyuria Unconsciousness Bradycardia Dilated pupils Bradypnea

Unconsciousness Bradycardia Bradypnea Rationale The central nervous system (CNS) depressant effect of morphine, if severe, can cause unconsciousness. The CNS depressant effect of morphine causes bradycardia and bradypnea. Morphine does not increase urine output. Morphine causes constriction of pupils.

1043) After surgery the client has a prescription for morphine sulfate via intravenous (IV) route every 3 hours as needed for pain. The client's preoperative blood pressure was 128/76 mm Hg. Postoperative assessments reveal that the client's blood pressure ranges between 90/60 mm Hg and 100/70 mm Hg. Which action will the nurse take if the client requests medication for pain? Administer morphine as prescribed. Obtain a prescription for a vasoconstrictor. Give half the prescribed amount of morphine. Withhold morphine until the blood pressure stabilizes.

Withhold morphine until the blood pressure stabilizes. Rationale Morphine is an opioid analgesic that may decrease the blood pressure further. It should be withheld and not administered at this time. It is not unusual for blood pressure to be lowered after surgery, plus a vasoconstrictor may not be the best option to increase blood pressure; if obtaining a prescription, a better option would be to have an alternative for pain. Administration of a medication dosage other than that prescribed is not an independent nursing function.

A client who recently had a heart attack has been prescribed low-dose (81 mg) aspirin at bedtime. The client states "Why am I supposed to take a 'baby aspirin' instead of a regular 325 mg tablet?" Which statement represents the nurse's best response? A"Taking a higher dose will affect your hearing." B"The higher dose will cause you to have heartburn." C"Taking 325 mg of aspirin daily will increase your risk of bleeding." D"The higher doses may interfere with your normal sleep patterns."

C"Taking 325 mg of aspirin daily will increase your risk of bleeding." Rationale: Aspirin is a nonsteroidal anti-inflammatory drug and is prescribed to help keep blood clots from forming after a heart attack. Lower-dose aspirin therapy is just as effective in reducing the risk of secondary heart attacks as higher doses of aspirin, but with less risk of bleeding (including gastrointestinal bleeding.) This is especially important for the client to understand since he will may also be prescribed an anticoagulant after his heart attack. Common side effects of aspirin therapy include rash, upset stomach, heartburn, drowsiness, and headache. Many drugs, including aspirin, can affect hearing; usually much larger daily doses would be needed to affect hearing.

Question 12 The nurse is preparing to administer the next dose of prescribed vancomycin to the client being treated for sepsis. Which of the following laboratory results would be the priority for the nurse to review? APeak serum drug level BSerum potassium level CSerum creatinine level DWhite blood cell count

CSerum creatinine level Rationale: Vancomycin can lead to interstitial nephritis and therefore, serum creatinine should be monitored. Prior to a dose, a trough level would be drawn to help assess minimum inhibitory concentration; however, peak levels are not needed for this purpose and are drawn after administration. Do not hold the next vancomycin doses while waiting for the results of vancomycin levels unless there is a concern about renal function. Therefore, the priority is serum creatinine. While the treatment of infection is the goal, assessing white blood count (WBC) prior to administration is not necessary.

The nurse is teaching a group of clients diagnosed with arthritis about the use of non-steroidal anti-inflammatory agents (NSAIDs). In order to minimize side effects of these drugs, which action should the nurse emphasize? AEat a diet high in fiber BLimit foods high in Vitamin K CTake the medication with food DTake the drug with an antacid

CTake the medication with food Rationale: A common side effect of NSAIDs is gastrointestinal distress including heartburn, nausea, and stomach pain. Taking the medication with food will decrease this side effect. The other actions are not appropriate or indicated when taking NSAIDs.

The nurse is caring for a client that is taking prednisone and aspirin for rheumatoid arthritis. Which action by the nurse is appropriate for this client? AAssess the client's pain level once a shift BMonitor the client's temperature every two hours CTest the client's stool for occult blood DApply a hot pack to a warm, acutely inflamed joint

CTest the client's stool for occult blood Rationale: Rheumatoid arthritis is a chronic, progressive immunologic disorder. This type of arthritis is associated with progressive inflammation of joints and pain. The client's pain level should be assessed more often than once a shift. However, the client's temperature does not need to be measured every two hours. The client is at risk for gastrointestinal bleeding with the use of these two medications. The nurse should anticipate checking the stool for occult blood and monitor the client for signs and symptoms of anemia. When joints are acutely inflamed and warm on palpitation, the nurse should apply an ice pack, not heat.

The nurse is educating a client about the use of fentanyl citrate via a patient-controlled analgesia pump. Which of the following statements should be included in the teaching? AYou cannot breastfeed your baby while using a patient controlled analgesia pump BYou may get drowsy if you press the administration button too many times CThe administration button should not be pressed by anyone other than you DA patient controlled analgesia pump reduces the risk of post-partum hemorrhage

CThe administration button should not be pressed by anyone other than you Rationale: A patient-controlled analgesia (PCA) pump is a device that the client can use to self-administer medication. The client is the only person who should press the administration button. These devices have a "lockout" that prevents the client from administering too many doses. The PCA pump does not affect the likelihood of hemorrhage, and clients may breastfeed while using the device.

A nurse is preparing to administer morphine to a client with chronic pain. Which assessment finding would prompt the nurse to withhold the medication? AHeart rate of 117 beats/min BUrine output of 35 ml/hr COxygen saturation of 92% DRespiratory rate of 11 breaths/min

DRespiratory rate of 11 breaths/min Rationale: The nurse should withhold the medication if the respiratory rate is 11 breaths/min. Opioid medications, such as morphine, can cause respiratory depression. A respiratory rate of 11 breaths/min increases the risk of respiratory depression and arrest. The normal respiratory rate is 12-20 breaths/min. A heart rate of 117 beats/min (tachycardia) is not contraindicated with the use of morphine. Morphine can cause the opposite effect, bradycardia. Morphine can cause urinary retention; however, a urine output of 35 ml/hr is a normal finding. Oxygen saturation of 92% is a low-normal finding. The nurse should administer the medication and monitor the client's respiratory status.

A nurse is preparing to discontinue a client's fentanyl patient-controlled analgesia infusion. Which priority action will the nurse take before discontinuing the infusion? AAssess the client pain level BDocument the frequency of doses on the medication administration record CTake the client vital signs DVerify the infusion record with another registered nurse

DVerify the infusion record with another registered nurse Rationale: The nurse should verify the infusion record with another licensed healthcare provider before discontinuation. Fentanyl is a controlled substance that requires recordkeeping of its usage. Assessing the client's pain level and checking vital signs are important assessments; however, these actions are not specific to patient-controlled analgesia with a controlled substance. Documenting the frequency of doses is important but must be verified with another licensed provider.

1041) A health care provider prescribes morphine for a client being treated for myocardial infarction. Which physiological response will occur if the client experiences the intended therapeutic effect of morphine? Increased respiratory rate Decreased workload of the heart Dilation of coronary arteries Diminished metabolites within the ischemic heart muscle

Decreased workload of the heart Rationale Morphine reduces pain and anxiety. This limits the response of the sympathetic nervous system, ultimately decreasing cardiac preload and the workload of the heart. Reduced respiratory rate is a side effect of morphine; it is not the intended therapeutic effect for a client being treated for myocardial infarction. Morphine causes peripheral vasodilation but not coronary artery dilation. Decreasing metabolites within the ischemic heart muscle is not the action of morphine.

1518) The nurse teaches an adolescent about the side effects of azithromycin. The nurse determines the teaching has been understood when the adolescent identifies which problem as the most common side effect of this medication? Tinnitus Diarrhea Dizziness Headache

Diarrhea Rationale Diarrhea initially is related to gastrointestinal irritation; later it is related to loss of intestinal flora, which may lead to overgrowth of drug-resistant microbes, resulting in superinfection. This also causes diarrhea. Tinnitus, dizziness (vertigo), and headache all may occur, but none is the most common side effect.

708) A client with arthritis takes large doses of aspirin. Which symptom would the nurse include when teaching the client about the clinical manifestations of aspirin toxicity? Feelings of drowsiness Disturbances in hearing Intermittent constipation Metallic taste in the mouth

Disturbances in hearing Rationale Ringing in the ears occurs because of aspirin's effect on the eighth cranial nerve and is a classic symptom of aspirin toxicity. Feelings of drowsiness are not side effects of aspirin; aspirin promotes comfort, which may permit rest. Aspirin may cause diarrhea, nausea, and vomiting, not intermittent constipation. A metallic taste in the mouth is not a side effect of salicylates such as aspirin.

893) After receiving streptomycin sulfate for 2 weeks as part of the medical regimen for tuberculosis, the client reports feeling dizzy and having some hearing loss. Which part of the body is the medication affecting? Pyramidal tracts Cerebellar tissue Peripheral motor end plates Eighth cranial nerve's vestibular branch

Eighth cranial nerve's vestibular branch Rationale Streptomycin sulfate is ototoxic and may cause damage to auditory and vestibular portions of the eighth cranial nerve. Pyramidal tracts, cerebellar tissue, and peripheral motor end plates are not affected by streptomycin.

787) Which life-threatening complication may occur in clients taking high-dose or long-term ibuprofen? Anaphylaxis Gastrointestinal (GI) bleeding Cardiac dysrhythmia Disulfiram reaction

Gastrointestinal (GI) bleeding Rationale Ibuprofen irritates the GI mucosa and can cause mucosal erosion while decreasing platelet activity, which can result in GI hemorrhage. Cardiac dysrhythmias and anaphylaxis are not typically associated with high-dose or long-term administration of ibuprofen. Disulfiram reactions are associated with alcohol intake, not ibuprofen.

1495) Use of which medication would the nurse identify as a potential risk for hearing impairment in a child? Amoxicillin Gentamicin Clindamycin Ciprofloxacin

Gentamicin Rationale Gentamicin can be ototoxic because of its effects on the eighth cranial nerve. Reactions to amoxicillin are usually allergic in nature. Impaired hearing does not occur with ciprofloxacin or with clindamycin.

142) Which characteristic identifies the reason that methadone is useful in the treatment of opioid addiction? Is a nonaddictive medication Has an effect of longer duration Does not produce a cumulative effect Carries little risk of psychological dependence

Has an effect of longer duration Rationale Methadone's duration of effect is 12 to 24 hours, compared with other opioids, which have a 3- to 6-hour duration of effect. It is just as addictive but controls the addiction and keeps the client out of the illicit drug market. Methadone does produce a cumulative effect. Physical and psychological dependence is possible, just as with other opioids.

1000) Which assessment findings during the administration of intravenous penicillin prompt the nurse to stop the infusion? Select all that apply. One, some, or all responses may be correct. Hives ItchingNausea Skin rash Shortness of breath

Hives ItchingNausea Skin rash Shortness of breath Rationale Penicillin administration carries a high rate of allergic reaction, so the nurse monitors the client for signs of allergy. Hives, itching, skin rash, and shortness of breath are all indications of allergic reaction and warrant cessation of the infusion and contact with the health care provider. Nausea is not an indication of allergic reaction.

761) The nurse is caring for a client who is receiving intermittent intravenous piggyback (IVPG) doses of vancomycin every 12 hours. The primary health care provider prescribes trough levels of the antibiotic. The nurse schedules the blood sample to be obtained at which time? Just before the medication is administered Between 30 and 60 minutes after the infusion is completed Six hours after the dose is completely infused In the morning before the client eats breakfast

Just before the medication is administered Rationale Trough levels are measured in relation to the time a medication is administered. The trough level for a medication is drawn just before a medication is given, when the medication's level is at its lowest. Any other time would be inaccurate for a medication's trough level. The medication's peak level is drawn 30 to 60 minutes after the infusion is completed. Whether the client eats breakfast does not affect this medication's trough levels, because it is an intravenous infusion.

789) Which member of the health care team would the nurse ask to serve as a witness when wasting unused morphine? Nursing supervisor Licensed practical nurse (LPN) Client's health care provider Designated nursing assistant

Licensed practical nurse (LPN) Rationale The wasting of controlled substances should be witnessed by two licensed personnel according to federal regulations; this can be done by a registered nurse (RN) or LPN. Although the nursing supervisor is licensed and may perform this function, it is not an efficient use of this individual's expertise. Federal regulations do not require the participation by the client's health care provider in this situation. A nursing assistant is not a licensed person who can take responsibility for the wasting of controlled substances.

1208) The nurse is caring for a pregnant client who has contracted a trichomonal protozoan infection. For which oral medication would the nurse anticipate preparing to provide education? Penicillin G Acyclovir Nystatin Metronidazole

Metronidazole Rationale Metronidazole is a potent amebicide that is safe in pregnancy. It is effective in eradicating the protozoan Trichomonas vaginalis. Penicillin is administered for its effect on bacterial, not protozoal, infections. Acyclovir is an antiviral medication; therefore, it would not be effective in treating protozoal infections such as trichomonas. Nystatin is an antifungal for infections caused by Candida albicans.

883) A client receives intrathecal morphine to control severe postoperative pain. Which action will the nurse include as part of the client's initial 24-hour postoperative care plan? Monitoring of respiratory rate hourly Assessing the client for tachycardia Administering naloxone every 3 to 4 hours Observing the client for signs of central nervous system (CNS) excitement

Monitoring of respiratory rate hourly Rationale Intrathecal morphine can depress respiratory function depending on the level it reaches within the spinal column; hourly assessments during the first 12 to 24 hours will allow for early intervention with an antidote if respiratory depression needs to be ed. Bradycardia, not tachycardia, and hypotension occur. Administering naloxone every 3 to 4 hours is too infrequent if the client's respirations are depressed. The recommended adult dosage usually is 0.4 to 2 mg every 2 to 3 minutes, if indicated. CNS depression occurs secondary to hypoxia.

955) The nurse is caring for a client hospitalized with a myocardial infarction. Which analgesic is the medication of choice for this client? Ketorolac Meperidine Flurazepam Morphine sulfate

Morphine sulfate Rationale For myocardial infarction, morphine sulfate is the medication of choice because it relieves pain quickly and reduces anxiety while decreasing cardiac workload. Diazepam is a muscle relaxant that may be used for its sedative effect; it is not effective for the pain of a myocardial infarction. Although ketorolac and meperidine relieve pain, they do not offer all the additional benefits of morphine. In addition, meperidine has additional adverse effects. Flurazepam is a hypnotic that may be used to reduce fear and restlessness; it is not effective for the pain of a myocardial infarction.

825) A client, admitted to the cardiac care unit with a myocardial infarction, complains of chest pain. Which intervention will be most effective in relieving the client's pain? Nitroglycerin sublingually Oxygen per nasal cannula Lidocaine hydrochloride 50-mg intravenous (IV) bolus Morphine sulfate 2 mg IV

Morphine sulfate 2 mg IV Rationale Morphine is an opioid analgesic that acts on the central nervous system by a sympathetic mechanism. Morphine decreases systemic vascular resistance, which decreases left ventricular afterload, thus decreasing myocardial oxygen consumption. Nitroglycerin sublingually relieves anginal pain, not myocardial infarction pain. Oxygen administration elevates arterial oxygen tension, potentially improving tissue oxygenation; however, oxygen administration will not relieve the pain. Lidocaine is an antidysrhythmic, not an analgesic.

180) Which rationale will the nurse give for the need to take penicillin G and probenecid for syphilis? "Each medication attacks the organism during different stages of cell multiplication." "The penicillin treats the syphilis, and the probenecid relieves the severe urethritis." "Probenecid delays excretion of penicillin, thus maintaining blood levels for longer periods." "Probenecid decreases the potential for an allergic reaction to penicillin, which treats the syphilis."

"Probenecid delays excretion of penicillin, thus maintaining blood levels for longer periods." Rationale Probenecid results in better use of penicillin by delaying the excretion of penicillin through the kidneys. Penicillin destroys Treponema pallidum during all stages of its development; probenecid delays the excretion of penicillin. Probenecid does not treat urethritis. Probenecid does not prevent allergic reactions.

628) The mother of a toddler with hemophilia A asks the nurse, 'Can I give my child ibuprofen for fever or pain?' How will the nurse respond? 'Ibuprofen is a good choice for fever or pain.' 'Give your child acetaminophen. Ibuprofen may cause bleeding.' 'No. I'll explain why your child isn't allowed pain medications.' 'You seem concerned about giving medications to your child.'

'Give your child acetaminophen. Ibuprofen may cause bleeding.' Rationale The parent is asking a specific question that should be answered by the nurse. Ibuprofen is contraindicated because it interferes with platelet function and may cause more bleeding; therefore an analgesic such as acetaminophen should be administered because it does not interfere with coagulation. Analgesics are permitted, provided they do not have anticoagulant effects.

670) The nurse is preparing a client for discharge from the emergency department. Which client statement provides evidence that the client understands medication teaching for high-dose ampicillin? 'I should take this medication with meals.' 'This medicine may cause constipation.' 'I must avoid dairy products while taking this medicine.' 'I must increase my intake of fluids while taking this medication.'

'I must increase my intake of fluids while taking this medication.' Rationale Because penicillin in high doses is nephrotoxic, keeping hydrated maintains adequate renal perfusion for medication excretion. It should be taken on an empty stomach for best absorption. Dietary restrictions are not imposed while this medication is taken. It may cause diarrhea, but not constipation.

803) A client with rheumatoid arthritis is to begin taking ibuprofen 800 mg by mouth three times a day. The nurse provides education about the medication's side effects. The nurse concludes that the teaching was effective when the client makes which statements? Select all that apply. One, some, or all responses may be . 'I need to report any dark tarry stools.' 'I will need to stop taking this medication before any scheduled surgery.' 'I should change positions slowly.' 'I will take the medication on an empty stomach.' 'I need to stop taking low-dose aspirin while I take this medication.'

'I need to report any dark tarry stools.' 'I will need to stop taking this medication before any scheduled surgery.' Rationale Ibuprofen increases the risk for bleeding, so clients need to report any signs or symptoms of bleeding such as dark tarry stools. They also will need to stop taking this medication before scheduled surgery to prevent excessive bleeding. Ibuprofen does not cause postural hypotension, so there is no need to change positions slowly. Ibuprofen may cause epigastric distress; it should be taken with meals or milk to reduce this adverse effect. Clients should continue to take low-dose aspirin to reduce myocardial infarction or stroke risk; however, they will need to take this 2 hours before taking ibuprofen because ibuprofen can reduce the antiplatelet effects of aspirin by blocking access of aspirin to COX-1 in platelets.

1210) A pregnant client with an infection tells the nurse that she has taken tetracycline for infections in the past and prefers to take it now. Which response would the nurse give regarding the avoidance of tetracycline administration during pregnancy? 'It affects breast-feeding adversely.' 'Tetracycline causes fetal allergies.' 'It alters the development of fetal teeth buds.' 'It increases fetal tolerance to the medication.'

'It alters the development of fetal teeth buds.' Rationale Tetracycline has an affinity for calcium; if used during tooth bud development it may cause discoloration of teeth. Tetracycline does not adversely affect breast-feeding, cause fetal allergies to the medication, or increase fetal tolerance of the medication.

1522) The nurse administers acetaminophen to a child who complains of pain after abdominal surgery. The mother asks the nurse why her child isn't being given ibuprofen. Which response by the nurse is most appropriate? 'It could prolong bleeding time.' 'It's contraindicated for young children.' 'It can suppress the healing of the incision.' 'It becomes ineffective when given for long periods.'

'It could prolong bleeding time.' Rationale Acetaminophen is not associated with bleeding complications like ibuprofen is, but if used long term, it can result in liver toxicity. Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID) prolongs bleeding time; in the postoperative period, medications that interfere with clotting and prolong bleeding are contraindicated. Ibuprofen is safe for young children when administered in appropriate doses. Ibuprofen exerts an anti-inflammatory action; it does not interfere with the healing process. Tolerance for ibuprofen does not develop.

The nurse is caring for a post-surgical client who is using patient-controlled analgesia (PCA) with morphine for pain management. The client reports that the pain is severe and does not get better, even after "pushing the PCA button". Place each step in the order by entering the numbers in order. Only enter numbers, no spaces or commas. 1. Consult with the health care provider 2. Check the MAR for adjuvant medications prescribed 3. Verify that the client is using the PCA equipment ly 4. Confirm that the pump is working and the tubing is patent 5. Offer non-pharmacological interventions

3. Verify that the client is using the PCA equipment ly 4. Confirm that the pump is working and the tubing is patent 2. Check the MAR for adjuvant medications prescribed 5. Offer non-pharmacological interventions 1. Consult with the health care provider Rationale: The nurse should implement the interventions/actions in the following order: Verify that the client understands how to use the PCA equipment ly, assess if the PCA pump is functioning properly and medication is being delivered, determine if the client is able to receive additional or adjuvant medication for pain management, offer non-pharmacological interventions such as repositioning, diversional activities and rest. Lastly, the nurse should notify the health care provider if the client's pain level does not improve.

The nurse is educating an older adult client about newly prescribed levofloxacin for the treatment of pneumonia. The nurse should teach the client that which side effect is a priority for the client to report to the provider? A Joint tenderness B Diarrhea C Dizziness D Difficulty sleeping

A Joint tenderness Rationale: There is a black box warning for fluoroquinolones alerting health professionals not only to the increased disabling risk of tendinitis and tendon rupture but also to the significant risk of peripheral neuropathy, central nervous system and cardiac effects, and dermatologic and hypersensitivity reactions. Signs of tendonitis and tendon rupture include pain and tenderness in the affected limb or joint. The medication must be stopped immediately. The other options are common side effects and while reportable, are not a priority.

A nurse is administering an intravenous piggyback infusion of penicillin. Which client statement would require the nurse's immediate attention? A"I am itching all over." B"I have soreness and aching in my muscles." C"I have cramping in my stomach." D"I have a burning sensation when I urinate."

A"I am itching all over." Rationale: Allergic reactions to medications can include itching all over. This can be further supported by the presence of hives or welts. Abdominal pain or cramping could indicate a side effect of the penicillin. The other symptoms of muscle soreness and painful urination are not as urgent as the itching.

The nurse is providing care for a client after surgery. The client has an order for acetaminophen with codeine. The client asks the nurse what to expect after taking this medication. Which is the best response by the nurse? A"This combination medication will better help to manage your pain." B"The combination medication will reduce the chance of addiction." C"This medication will minimize any side effects from the codeine." D"This medication combination will allow healing to occur faster."

A"This combination medication will better help to manage your pain." Rationale: A post-operative client experiencing pain may receive opioid or non-opioid pain medication, in addition to non-pharmacologic comfort measures. The use of acetaminophen with codeine potentiates the effect of the codeine, thus providing greater/better pain relief. The presence of codeine doesn't alter the chance of addiction or reduce the chances of side effects. The medication will not affect healing.

Which instruction) should the nurse give to a female client who just received a prescription for oral metronidazole (Flagyl) for treatment of trichomonas vaginalis? (Select all that apply.) A. Increase fluid intake, especially cranberry juice. B. Do not abruptly discontinue the medication; taper use. C. Check blood pressure daily to detect hypertension. D. Avoid drinking alcohol while taking this medication. E. Use condoms until treatment is completed. F. Ensure that all sexual partners are treated at the same time.

A. Increase fluid intake, especially cranberry juice. D. Avoid drinking alcohol while taking this medication. E. Use condoms until treatment is completed. F. Ensure that all sexual partners are treated at the same time. Increased fluid intake and cranberry juice are recommended for prevention and treatment of urinary tract infections, which frequently accompany vaginal infections. It is not necessary to taper use of this drug or to check the blood pressure daily, as this condition is not related to hypertension. Flagyl can cause a disulfiram-like reaction if taken in conjunction with ingestion of alcohol, so the client should be instructed to avoid alcohol. All sexual partners should be treated at the same time and condoms should be used until after treatment is completed to avoid reinfection.

810) A client is receiving patient-controlled analgesia (PCA) after surgery. Which benefit would this type of therapy provide? Select all that apply. One, some, or all responses may be . Client is able to self-administer pain-relieving medications as necessary Amount of medication received is determined entirely by the client Decreases client dependency Relieves the nurse of monitoring the client Increases client sense of autonomy

Client is able to self-administer pain-relieving medications as necessary Decreases client dependency Increases client sense of autonomy Rationale The purpose of patient-controlled analgesia is to give the client the ability to self-administer pain-relieving medications as necessary; usually smaller amounts of analgesics are used with self-administration. The amount and dosage of the medication are programmed to prevent accidents or abuse. Medication levels are kept in a maintenance range, and pain relief is achieved without extreme fluctuations. The client isn't dependent on the nurse availability to administer medication. This increases the client's sense of autonomy. The nurse is not absolved of responsibility when PCA is used; monitoring the client for effectiveness, refilling the apparatus with the prescribed narcotic, and charting the amount administered and the client's response are required.

194) Which mechanism of action explains why naloxone is administered for a heroin overdose? Competition with opioids for occupancy of opioid receptors Blunts severity of withdrawal symptoms as heroin wears off Accelerated metabolism of heroin and stimulation of respiratory centers Stimulation of cortical sites that control consciousness and cardiovascular function

Competition with opioids for occupancy of opioid receptors Rationale Naloxone is used to treat opioid-induced apnea. It competes with the opioid for central nervous system receptor sites and thus acts as an opioid antagonist. Preventing excessive withdrawal symptoms as heroin wears off is not the specific action of this medication. Naloxone does not accelerate the metabolism of heroin. Stimulating cortical sites that control consciousness and cardiovascular function also is not the action of naloxone. One adverse reaction of naloxone is cardiovascular irritability.

51) Which assessment would the nurse perform before administering a dose of vancomycin to a client? Select all that apply.One, some, or all responses may be correct. Creatinine Trough level Hearing ability Intravenous site Blood urea nitrogen

Creatinine Trough level Hearing ability Intravenous site Blood urea nitrogen Rationale ALL are correct. Two major adverse effects of vancomycin are nephrotoxicity and ototoxicity. The nurse would assess the client's creatinine and blood urea nitrogen levels to determine renal function. The nurse would also assess the vancomycin trough levels to determine if the client's kidneys are clearing the medication. The nurse would assess for changes in hearing as a result of ototoxicity. Vancomycin can cause phlebitis, so the nurse would assess the intravenous site before initiating the infusion.

1552) Which assessment would the nurse perform before administering a dose of vancomycin to a client? Select all that apply.One, some, or all responses may be correct. Creatinine Trough level Hearing ability Intravenous site Blood urea nitrogen

Creatinine Trough level Hearing ability Intravenous site Blood urea nitrogen Rationale Two major adverse effects of vancomycin are nephrotoxicity and ototoxicity. The nurse would assess the client's creatinine and blood urea nitrogen levels to determine renal function. The nurse would also assess the vancomycin trough levels to determine if the client's kidneys are clearing the medication. The nurse would assess for changes in hearing as a result of ototoxicity. Vancomycin can cause phlebitis, so the nurse would assess the intravenous site before initiating the infusion.

The nurse in the urgent-care clinic is reviewing discharge instructions with a client who is prescribed doxycycline. Which statement by the client indicates understanding of the instructions? A"I will not wear my contact lenses while taking this medication." B"I will carry glucose tablets with me in case I experience low blood sugar." C"I will take this medication with an antacid to prevent an upset stomach." D"I will apply sunscreen when outside to prevent a sunburn."

D"I will apply sunscreen when outside to prevent a sunburn." Rationale: Doxycycline is a tetracycline antibiotic. All tetracyclines can increase the sensitivity of the skin to ultraviolet light. The most common result is a sunburn. Clients on these types of medications should prevent sunburn by avoiding prolonged exposure to sunlight, wearing protective clothing and applying sunscreen to exposed skin while outdoors. This drug should be taken two hours before or after antacids, not with them. Hypoglycemia is not a common side effect of doxycycline. Wearing contact lenses is not contraindicated with this medication.

The client is using nonsteroidal anti-inflammatory drugs (NSAIDs) to manage arthritis pain. The nurse should caution the client about which potential side effect? AUrinary incontinence BNystagmus CConstipation DOccult bleeding

DOccult bleeding Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) taken for long periods of time may cause serious side effects, including bleeding in the gastrointestinal tract. Clients should be instructed to take the medication with meals if stomach upset occurs. To avoid esophageal irritation, the client should take the drug with a full glass of water and to avoid lying down for 30 to 60 minutes after taking a dose.