Pharm 3.0 Final with rationales

A nurse is providing teaching to a client who has postmenopausal osteoporosis and a new prescription for intranasal calcitonin-salmon. Which of the following statements by the client indicates an understanding of the teaching? "I will administer a spray into each nostril daily." "I should expect nasal bleeding for the first week." "I will need to depress the side arms to activate the pump." "I should expect to take this medication for a short-term course of treatment."

I will need to depress the side arms to activate the pump "I will administer a spray into each nostril daily."The nurse should instruct the client to administer calcitonin-salmon to one nostril daily, alternating nostrils. "I should expect nasal bleeding for the first week."The nurse should instruct the client that nasal bleeding, or ulcerations, are indications to discontinue the medication and to notify the provider if nasal bleeding occurs. I will need to depress the side arms to activate the pump."MY ANSWERThe nurse should instruct the client to activate the pump on the initial use by holding the bottle upright and depressing the two white side arms toward the bottle six times. "I should expect to take this medication for a short-term course of treatment."Calcitonin-salmon is a long-term treatment therapy for postmenopausal osteoporosis. The medication has no documented long-term adverse effects.

A nurse is preparing to administer Digoxin 0.2 mg via IV bolus to a client. The amount available is Digoxin 0.25 mg/1ml. How many ml should the nurse administer?

0.8 ml

A nurse is administering insulin glulisine 10 units subcutaneously at 0720 to an adolescent client who has type 1 diabetes mellitus. The nurse should anticipate onset of action of the insulin at which of the following times? 0800 0745 0900 1030

0745 0745 MY ANSWER Insulin glulisine has a very short onset of action of 15 min. The nurse should expect the onset of action around 0745 and ensure the client eats breakfast immediately following administration of the insulin. The onset of action for regular insulin is 30 to 60 min; however, insulin glulisine has a different onset of action. NPH insulin has an onset of action of 1 to 2 hr; however, insulin glulisine has a different onset of action.

A nurse is preparing to administer codeine 30 mg PO every 4 hr. PRN to a client for pain. The amount available is codeine oral solution 15 mg/5 ml. How many ml should the nurse plan to administer per does?

10 ml

A nurse is preparing a discharge teaching plan for a 6-year-old client who has asthma and several prescription medications using metered dose inhalers [MDIs]. Which of the following interventions should the nurse include in the plan? Add a spacer to each MDI. Instruct the child to inhale more rapidly than usual when using an MDI. Request that the provider change the child's medications from inhaled to oral formulations. Administer oxygen by facemask along with the MDI.

Add a spacer to the MDI Add a spacer to each MDI.MY ANSWERMDIs are difficult to use correctly and, even when properly used, only a portion of the medication is delivered to the lungs. A spacer applied to an MDI can make up for lack of hand-lung coordination by increasing the amount of medication delivered to the lungs. Instruct the child to inhale more rapidly than usual when using an MDI.The client who uses an inhaler should be taught to inhale the medication slowly over 3 to 5 seconds for maximum effectiveness. Request that the provider change the child's medications from inhaled to oral formulations.There are advantages to delivering medications for asthma by inhalation, including enhanced therapeutic effects, decreased systemic adverse effects, and quick relief when short-acting bronchodilators are used. Changing the child's medications to oral formulations is not an effective intervention. Administer oxygen by facemask along with the MDI.Administering oxygen along with inhaled medications does not increase the amount of medication reaching the lungs. In addition, oxygen therapy should be administered on the basis of low oxygen saturation and other assessments. It is not appropriate to administer oxygen by facemask along with the MDI.

A nurse is preparing to administer iron dextran IV to a client. Which of the following actions should the nurse plan to take? Administer a small test dose before giving the full dose. Infuse the medication over 30 seconds. Monitor the client closely for hypertension after the infusion. Administer cyanocobalamin as an antidote if iron dextran toxicity occurs.

Administer a small test dose before giving the full dose A serious adverse effect of iron dextran is anaphylaxis caused by hypersensitivity to the medication. It is recommended that a small test dose be administered over 5 min before giving the full dose. The client should be monitored carefully for an allergic reaction during and for a period of time following the test dose. Iron dextran should be administered slowly. An IV bolus dose should be administered over at least 1 min and an IV infusion dose should be given over 10 to 15 min. The nurse should monitor the client for hypotension and other manifestations of anaphylaxis following the infusion of iron dextran. Administer cyanocobalamin as an antidote if iron dextran toxicity occurs. Deferoxamine is an antidote for iron toxicity. Cyanocobalamin, or vitamin B12, is administered to clients who have megaloblastic anemia.

A nurse is providing teaching to the parents of a school-age child who has asthma about medications for bronchospasm. Which of the following inhaled medications should the nurse instruct the parents to use to relieve and acute asthma attack? Salmeterol Cromolyn Fluticasone Albuterol

Albuterol SalmeterolSalmeterol is a long-acting beta2-adrenergic agonist that is used for prophylaxis of asthma. The child should use salmeterol prior to planned exercise, but it is not effective in relieving an acute asthma attack. CromolynCromolyn is a mast cell stabilizer with anti-inflammatory action that is designed for prophylaxis of asthma. It should be used on a fixed schedule. The child should use cromolyn prior to planned exercise, but it is not effective in relieving an acute asthma attack. FluticasoneThe client should use fluticasone propionate, a glucocorticoid medication, for long-term prophylaxis of asthma, but it is not effective in relieving an acute asthma attack. ANSWERAlbuterol is a short-acting beta2-adrenergic agonist that is used to provide immediate relief for an acute asthma attack. One or two puffs every 4 to 6 hr PRN is the usual prescribed dose for a school-age child. If higher or more frequent doses are needed, the provider should evaluate the client for worsening asthma.

A nurse is planning to administer Diphenhydramine 50 mg via IV bolus to a client who is having an allergic reaction. The client has an IV infusion containing a medication that is incompatible with diphenhydramine in solution. Which of the following actions should the nurse take? Choose an IV port for IV bolus injection of the diphenhydramine as near as possible to the client's hanging IV bag. Flush the IV tubing with 2 mL of 0.9% sodium chloride before and after administering diphenhydramine. Allow the IV infusion to keep running while administering the diphenhydramine via IV bolus. Aspirate to check for IV patency before administering the diphenhydramine.

Aspirate to check for IV patency before administering the Diphenhydramine Choose an IV port for IV bolus injection of the diphenhydramine as near as possible to the client's hanging IV bag.The nurse should choose the injection port that is nearest to the client to administer an IV bolus injection. Flush the IV tubing with 2 mL of 0.9% sodium chloride before and after administering diphenhydramine.When IV medications are incompatible in solution, the nurse should flush the IV tubing with 10 mL of 0.9% sodium chloride before and after administering the diphenhydramine. Allow the IV infusion to keep running while administering the diphenhydramine via IV bolus.When medications are incompatible, the infusing IV fluids should be stopped by clamping the IV just above the chosen injection port. Aspirate to check for IV patency before administering the diphenhydramine.MY ANSWERIt is important to confirm IV patency prior to administering an IV bolus. Some medications cause severe tissue damage when inadvertently administered into tissue rather than into a vein.

A nurse is providing teaching to a client who has hypertension and a new prescription for oral Clonidine. Which of the following instructions should the nurse include in the teaching? Discontinue the medication if a rash develops. Expect increased salivation during the first few weeks of therapy. Minimize fiber intake to prevent diarrhea. Avoid driving until the client's reaction to the medication is known.

Avoiding driving until the client's reaction to the medication is known -Clonidine can cause drowsiness, weakness, sedation, and other CNS effects. Until the client's response to the medication is known, the nurse should instruct the client to avoid driving or handling other potentially hazardous equipment. Over time, these effects are likely to decrease. Clonidine should not be discontinued abruptly due to the risk of hypertensive crisis. The client should report the rash to the provider. Dry mouth is an expected finding of clonidine therapy, especially during the first few weeks. The nurse should instruct the client to suck hard candy and take sips of water to relieve this manifestation. Clonidine can cause constipation. The nurse should instruct the client to increase fiber intake.

A nurse is planning to administer epoetin alfa to a client who has chronic kidney failure. Which of the following data should the nurse plan to review prior to administration of this medication? Blood pressure Temperature Blood glucose levels Total protein level

Blood pressure Epoetin alfa often causes hypertension, which can lead to stroke or other cardiovascular complications. The nurse should monitor the client's blood pressure and notify the provider about increases. The client who receives epoetin alfa frequently requires concurrent use of antihypertensive medication.

A nurse is planning discharge teaching for a client who has Major Depressive Disorder and a new prescription for Phenelzine. Which of the following foods should the nurse include in the plan as safe for the client to consume while taking Phenelzine? Broiled beef steak Macaroni and cheese Pepperoni pizza Smoked salmon

Broiled beef steak Phenelzine, an MAOI, is an antidepressant. This medication interacts with a variety of foods to produce a hypertensive crisis. Beef steak and other meats that are fresh do not interact with phenelzine and are safe to consume. Macaroni and cheese, Most cheeses, except for cottage cheese and cream cheese, interact with MAOIs, such as phenelzine, and can cause hypertensive crisis. Pepperoni, salami, and other dried or cured meats interact with MAOIs, such as phenelzine, and can cause hypertensive crisis. Smoked salmon; Fish that has been cured or dried interacts with MAOIs, such as phenelzine, and can cause hypertensive crisis.

A nurse is providing discharge teaching to a client who has venous thrombosis and a prescription for warfarin. Which of the following instructions should the nurse include in the teaching? Take ibuprofen as needed for headache or other minor pains. Carry a medic alert ID card. Report to the laboratory weekly to have blood drawn for aPTT. Increase intake of dark green vegetables.

Carry a medic alert ID card Take ibuprofen as needed for headache or other minor pains.Clients who are taking warfarin should avoid aspirin and ibuprofen due to antiplatelet effects, which place the client at greater risk for bleeding. Because warfarin interacts with a wide variety of substances, the nurse should instruct the client to check with the provider before taking any medication or herbal substance. Carry a medic alert ID card.MY ANSWERA client who is taking warfarin is at increased risk for bleeding. In the case of an emergency, it is important that any medical personnel are aware of the client's medication history. Report to the laboratory weekly to have blood drawn for aPTT.The aPTT is used to monitor heparin therapy rather than warfarin therapy. Warfarin therapy is evaluated by PT and the INR, which is drawn daily for the first 5 days, then twice weekly for the next 1 to 2 weeks. Increase intake of dark green vegetables.Dietary vitamin K has the potential to reduce the anticoagulant effects of warfarin. Green leafy vegetables are a rich dietary source of vitamin K; therefore, the nurse should not instruct the client to increase the intake of dark green vegetables.

A nurse is caring for a client who has congestive heart failure and is taking digoxin. The client reports nausea and refused to eat breakfast. Which of the following actions should the nurse take first Encourage the client to eat the toast on the breakfast tray. Administer an antiemetic. Inform the client's provider. Check the client's apical pulse.

Check the client's apical pulse Encourage the client to eat the toast on the breakfast tray.The nurse should encourage the client to eat the toast on the breakfast tray because it is an easily digested carbohydrate and can sometimes relieve simple nausea; however, there is another action the nurse should take first. Administer an antiemetic.The nurse can administer an antiemetic to decrease nausea; however, there is another action the nurse should take first. Inform the client's provider.The nurse should notify the client's provider because nausea is a possible finding in digoxin toxicity; however, there is another action the nurse should take first. Check the client's apical pulse.MY ANSWERNausea, anorexia, fatigue, visual effects, and cardiac dysrhythmias, often caused by a slow pulse rate, are possible findings in digoxin toxicity. Caring for this client requires application of the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with assessment. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify the provider about a change in the client's status, she must first collect adequate data from the client. Assessing will provide the nurse with knowledge to make an appropriate decision.

A nurse is caring for a client who has alcohol use disorder and is admitted with lower extremity fractures following a motor-vehicle crash. A few hours after admission, the client develops restlessness and tremors. Which of the following medications should the nurse anticipate administering to the client first? Acamprosate Naltrexone Chlordiazepoxide Disulfiram

Chlordiazepoxide AcamprosateAcamprosate is a medication that is used to maintain abstinence in clients who have alcohol use disorder, but another medication is the priority during acute withdrawal. NaltrexoneNaltrexone is a medication that can decrease the client's cravings for alcohol, but another medication is the priority during acute withdrawal. ChlordiazepoxideMY ANSWERChlordiazepoxide, a long-acting oral benzodiazepine, is a first-line medication to use for a client who is experiencing manifestations of acute alcohol withdrawal. For clients who are nauseated or vomiting, another benzodiazepine, such as lorazepam, can be administered via IV. The nurse should apply the acute versus chronic priority-setting framework when caring for this client. Using this framework, acute needs (manifestations of acute alcohol withdrawal) are typically the priority need because they pose more of a threat to the client. Because chronic needs usually develop over a period of time, the client has more of an opportunity to adapt to the alteration in health. DisulfiramDisulfiram helps clients who have alcohol use disorder avoid drinking, but another medication is the priority during acute withdrawal.

A nurse is administering Adenosine via IV bolus for a client who has developed paroxysmal atrial tachycardia. For which of the following findings should the nurse assess the client during administration of Adenosine? Seizures Cinchonism Dyspnea Transient pallor of the face

Dyspnea Seizures Seizures are not an adverse effect of administration of adenosine. Cinchonism Cinchonism, manifested by tinnitus, headache, vertigo, and visual disturbances, occurs after administration of quinidine, another anti-dysrhythmic medication. Cinchonism is not seen in clients who receive adenosine. Dyspnea MY ANSWER Dyspnea can occur during administration of adenosine due to bronchoconstriction. Since adenosine has a very short half-life of about 10 seconds, this effect should be short-lived. Transient pallor of the face Flushing of the face and a feeling of warmth are transient findings that occur during administration of adenosine. Pallor is not an adverse effect seen with administration of this medication.

A nurse is providing discharge teaching about lithium toxicity to a client who has a new prescription for lithium. Which of the following statements by the client indicates an understanding of the teaching? "I should take naproxen if I have a headache because aspirin can cause lithium toxicity." "I can develop lithium toxicity if I eat foods with lots of sodium." "I can develop lithium toxicity if I experience vomiting or diarrhea." "I might need to take a daily diuretic along with my lithium to prevent lithium toxicity."

I can develop lithium toxicity if i experience vomiting or diarrhea -Vomiting or diarrhea can cause electrolyte imbalances. If serum sodium decreases, lithium is retained by the kidneys and the risk for lithium toxicity increases. NSAIDs, such as naproxen and ibuprofen, increase renal reabsorption of sodium and lithium, which causes an increase in lithium levels and possible toxicity. Acetylsalicylic acid and sulindac are NSAIDS that do not affect lithium levels. When sodium levels are low, lithium excretion by the kidneys is increased. Therefore, eating foods with larger amounts of sodium reduces, rather than increases, the risk for lithium toxicity. Increased sodium intake can lead to excretion of lithium and a decrease in the lithium level. It is important for clients to eat normal and consistent amounts of sodium to maintain lithium levels. Diuretics decrease kidney excretion of lithium, which causes lithium levels to rise and increases the potential for toxicity.

A nurse is providing teaching to a client who has heart failure and is taking Spironolactone. Which of the following statements by the client indicates an understanding of the teaching?

I will watch for increased breast tissue growth while taking this medication

A nurse is providing teaching to a client who has type 2 Diabetes Mellitus and a new prescription for Metformin. Which of the following adverse effects of Metformin should the nurse instruct the client to watch for and report to the provider? Weight gain Myalgia Hypoglycemia Severe constipation

Myalgia Myalgia, malaise, somnolence, and hyperventilation are manifestations of lactic acidosis, which rarely occur while taking metformin due to blockage of lactic acid oxidation. The nurse should instruct the client to report these findings promptly to the provider. Weight loss, rather than weight gain, is a common finding when beginning metformin. The sulfonylurea medications for type 2 diabetes, such as glipizide and tolbutamide, are very likely to cause weight gain. Other medications for type 2 diabetes, such as sulfonylureas and glitazones, can cause severe hypoglycemia, and when used in combination with metformin might cause this adverse effect. Metformin can cause nausea, vomiting, and diarrhea. Constipation is not an adverse effect of metformin.

A nurse is caring for a client who was brought to the emergency department by friends who report the client has overdosed on heroin. Which of the following findings should the nurse expect to assess? Temperature 39.2° C (102.6° F) Respiratory rate 30/min Pinpoint pupils Severe abdominal cramping

Pinpoint pupils Temperature 39.2° C (102.6° F)Extreme changes in body temperature are not seen in heroin (opioid) toxicity. Hyperpyrexia, a greatly increased body temperature, occurs in cocaine overdose and opioid withdrawal. Respiratory rate 30/minA greatly decreased respiratory rate (8/min) is an expected finding in opioid toxicity. Increased respiratory rate is seen in cocaine toxicity. Pinpoint pupilsMY ANSWERPinpoint pupils are an expected finding in opioid toxicity. Increased pupil size is seen in opioid withdrawal. Severe abdominal crampingSevere abdominal cramping, muscle spasms, and bone pain are seen in opioid withdrawal. Euphoria, relaxation, and freedom from pain are manifestations of opioid toxicity.

A home health nurse is visiting an older adult client who has Alzheimer's disease. His caregiver tells the nurse she has been administering prescribed Lorazepam, 1 mg three times per day, to the client for restlessness and anxiety during the past few days. For which of the following adverse effects should the nurse assess the client?

Sedation Lorazepam is a benzodiazepine with anti-anxiety and sedative effects. Older adult clients, especially, are at risk for central nervous system depression even with low doses of benzodiazepines. Clients who are 50 years or older can have a more profound and prolonged sedation than younger clients. -is a benzodiazepine with ant seizure effects

A nurse is planning care for a female client who has severe irritable bowel syndrome with diarrhea [IBS-D] and a new prescription for Alosetron. Which of the following interventions should the nurse include in the plan of care? The client must sign an agreement with the provider before beginning alosetron. The client must stop taking alosetron if diarrhea continues 1 week after beginning the medication. The client should expect to have a slower heart rate while taking alosetron. The client should use a barrier birth control method because alosetron interacts with oral contraceptives.

The client must sign an agreement with the provider before beginning alosetron Alosetron has potentially fatal adverse effects associated with constipation and bowel obstruction. The FDA has allowed alosetron to be placed on the market only if clients sign and adhere to a risk management program, which includes signing a client-provider agreement before starting alosetron. The client should notify the provider about tachydysrhythmia, which is an adverse effect of alosetron. The client should be taught to notify the provider and stop the medication if diarrhea is not controlled after 1 month of starting alosetron.

A nurse is providing teaching to a client who is to start taking Hydrochlorothiazide for hypertension. The nurse instructs the client to eat foods rich in potassium. Which of the following statements by the client indicates an understanding of the teaching?

This medication can cause a loss of potassium Hydrochlorothiazide can result in hypokalemia caused by excessive potassium excretion by the kidneys. The client should supplement his diet with potassium-rich foods to avoid the occurrence of hypokalemia. Foods that are high in potassium include bananas, raisins, baked potatoes, pumpkins, and milk.

A nurse is caring for a client who has heart failure and is taking oral furosemide 40 mg daily. For which of the following adverse effects should the client be taught to monitor and notify the provider if it occurs?

Tinnitus

A nurse is assessing a client who has oral Theophylline for relief of chronic bronchitis. The nurse should recognize that which of the following findings indicates toxicity to Theophylline?

Tremors Theophylline is a xanthine derivative bronchodilator. An early manifestation of toxicity is CNS stimulation, often seen as tremors. Seizures can occur if blood levels continue to rise. Theophylline Toxicity: diarrhea restlessness & irritability tachycardia

A nurse is preparing to administer an IV fluid bolus of 1 L 0.9% sodium chloride over 2 hr. to a client who is dehydrated. The nurse should set the IV pump to deliver how many ml/hr.?

500 ml/hr

A nurse is preparing to administer ampicillin 50 mg/kg/day PO divided into 4 equal doses for a toddler who weighs 33 lbs. available is ampicillin 125 mg/5ml oral solution. How many ml should the nurse administer per dose?

7.5 ml

A nurse is assessing a client who has hypothyroidism and takes Levothyroxine. Which of the following findings should alert the nurse that the client is experiencing acute Levothyroxine overdose?

tremors Tremor and anxiety are expected findings in acute levothyroxine overdose. These findings are similar to those seen in hyperthyroidism. THINK: hyperthyroidism -hyperthermia -tachycardia -heat intolerance

A nurse is preparing to administer heparin 900 units/hr. via IV infusion. The amount available is heparin 25, 000 units in 500 mL 5% dextrose in water. The nurse should set the IV pump to deliver how many mL/hr.?

18 ml/hr

A nurse is providing discharge teaching to a client who has angina pectoris and a new prescription for verapamil. The client tells the nurse, "My brother takes verapamil for high blood pressure. Do you think the provider made a mistake?" Which of the following responses should the nurse make? "Verapamil is used to treat both high blood pressure and angina." "You should talk to your provider to make sure the prescription is correct for you." "Are you concerned that you might have high blood pressure?" "Your provider has prescribed verapamil so that you will not develop high blood pressure."

"Verapamil is used to treat both high blood pressure and angina. Verapamil is a calcium channel blocker that is used for both hypertension and anginal pain because of its ability to dilate arteries and decrease afterload. "You should talk to your provider to make sure the prescription is correct for you."Telling the client to speak to the provider prolongs concern about the medication. The nurse should deal with the client's concern directly with specific information about the medication. "Are you concerned that you might have high blood pressure?"This response does not address the client's concerns directly. The nurse should give the client specific information about the medication rather than minimizing or making assumptions about the client's concerns. "Your provider has prescribed verapamil so that you will not develop high blood pressure."Verapamil is not prescribed to prevent hypertension. This statement is not correct.

A nurse is providing discharge teaching to a client who has been hospitalized for major depressive disorder and has a prescription or Amitriptyline. Which of the following statements by the client indicates an understanding of the teaching? "I will take amitriptyline in the morning because I'm likely to have trouble falling asleep if I take it in the evening." "I will move slowly when I stand up because amitriptyline can cause my blood pressure to decrease." "I can drink a glass of beer or wine with my evening meal because amitriptyline doesn't interact with alcohol." "I will avoid foods high in fiber because amitriptyline can cause diarrhea."

***I will move slowly when I stand up because amitriptyline can cause my blood pressure to decrease Amitriptyline can cause orthostatic hypotension. The nurse should instruct the client to take precautions to prevent injury due to falls while taking amitriptyline. Amitriptyline should not be taken with other CNS depressants, such as alcohol and sedatives, because these substances can enhance the adverse effects of amitriptyline. Amitriptyline and other tricyclic antidepressants have an anticholinergic action and can cause severe constipation as well as adverse effects such as dry mouth, blurred vision, and urinary retention. Amitriptyline is a tricyclic antidepressant that has a sedative effect. This medication is often prescribed three times daily until a therapeutic dose has been achieved and then the entire dose is prescribed at bedtime to help the client sleep at night and prevent daytime drowsiness.

A nurse is preparing to administer Chlorothiazide 20 mg/kg/day PO divided equally and administered twice daily for a toddler who weighs 28.6 lb. The amount available is Chlorothiazide oral suspension 250 mg/5ml. how many ml should the nurse administer per dose?

2.6 ml

A nurse is preparing to administer ampicillin 500 mg in 50 ml of dextrose 5% in water [D5W] to infuse over 15 minutes. The drop factor of the manual IV tubing is 10 gtt./ml. The nurse should set the manual IV infusion to deliver how many gtt./min?

33 gtt/min

A nurse is preparing to administer dextrose 5& in 0.45% sodium chloride 400 ml IV to an older adult client over 8 hr. The nurse should set the IV pump to deliver how many ml/hr.?

50 ml/hr

A nurse is caring for a client who has a positive tuberculin skin test and is beginning a prescription for Isoniazid. The nurse should teach the client that which of the following laboratory values should be monitored while taking Isoniazid?

Aspartate Aminotrasnferase [AST] Isoniazid can be toxic to the liver. Therefore, it is important to monitor liver enzymes, such as AST, during therapy with isoniazid. In addition, the nurse should instruct the client to notify the provider of jaundice, nausea, dark-colored urine or other findings indicating hepatitis.

A nurse is caring for a client and realizes after administering the 0900 medications that she administered digoxin 0.25 mg PO to the client instead of the prescribed digoxin 0.125 mg PO. Which of the following actions should the nurse take first? Notify the provider. Contact the nursing supervisor. Assess the client's apical pulse. Complete an incident report.

Assess the client's apical pulse Caring for this client requires application of the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with assessment. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify a provider about a change in the client's status, she must first collect adequate data from the client. Assessing will provide the nurse with knowledge to make an appropriate decision. Therefore, the first action the nurse should take is to assess the client.

A nurse is administering Ciprofloxacin and Phenazopyridine to a client who has a severe urinary tract infection [UTI]. The client asks why both medications are needed. Which of the following responses should the nurse make? "Phenazopyridine decreases adverse effects of ciprofloxacin hydrochloride." "Combining phenazopyridine with ciprofloxacin hydrochloride shortens the course of therapy." "The use of phenazopyridine allows for a lower dosage of ciprofloxacin hydrochloride." "Ciprofloxacin hydrochloride treats the infection, and the phenazopyridine treats pain."

Ciprofloxacin hydrochloride treats the infection, and the phenazopyridine treats pain. Ciprofloxacin hydrochloride is a broad-spectrum quinolone antibiotic and phenazopyridine is a bladder analgesic/anesthetic that relieves burning and pain in the bladder mucosa caused by bladder spasm and inflammation.

A nurse is administering oral hydroxyzine to a client. Which of the following adverse effects should the nurse instruct the client to expect? Diarrhea Anxiety Nausea and vomiting Dry mouth

Dry mouth DiarrheaDiarrhea is not an expected adverse effect of hydroxyzine. AnxietyHydroxyzine, an H1 receptor antagonist, is sometimes used to treat anxiety. Anxiety is not an expected adverse effect of the medication. Nausea and vomitingHydroxyzine has antiemetic properties, thereby reducing the occurrence of nausea and vomiting. Dry mouthMY ANSWERHydroxyzine has anticholinergic properties. Dry mouth is a common adverse effect of this medication. The nurse should instruct the client to take sips of water or suck hard candies to minimize this effect.

A nurse is planning to administer Diltiazem via IV bolus to a client who has atrial fibrillation. When assessing the client, the nurse should recognize that which of the following findings is a contraindication to administration of Diltiazem.

Hypotension Diltiazem can be a treatment option for essential hypertension. This medication will lower blood pressure and is contraindicated for a client who is hypotensive. The nurse should teach the client to self-monitor blood pressure and keep a record of the readings.

A nurse is providing discharge teaching to a client who had a kidney transplant and has a prescription for oral cyclosporine. Which of the following statements by the client indicates an understanding of the teaching?

I am likely to develop higher blood pressure while taking this medication

A nurse is providing teaching to a client who has hypertension and type 1 diabetes mellitus and a new prescription for metoprolol. Which of the following statements by the client indicates an understanding of the teaching? "I might have difficulty recognizing when my blood sugar is low." "I will have less risk for developing an infection while I take this medication." "I should be concerned about losing excess weight while I take this medication." "I could have more problems with high blood sugars while taking this medication."

I might have difficulty recognizing when my blood sugar is low Metoprolol, a beta-adrenergic blocker, is used to treat hypertension. Because it decreases heart rate, this common manifestation of hypoglycemia can be masked and hypoglycemia might become more difficult to recognize. The client should be taught to recognize hypoglycemia by other manifestations, such as hunger, nausea, and sweating. Metoprolol does not cause weight loss, although it can cause weight gain due to fluid retention. The client should be taught to report unexpected weight gain, edema, and cough while taking beta-adrenergic blockers.

A nurse is caring for a client who is in preterm labor and has a new prescription for Nifedipine. The client states she is concerned because her father takes Nifedipine for his angina pectoris. The nurse should explain to the client that Nifedipine works for clients who are pregnant by which of the following mechanisms? It decreases the incidence of bacterial vaginosis, thus preventing uterine contractions. It inhibits uterine contractions by blocking entry of calcium into uterine cells. It decreases the activity within the CNS, which regulates all smooth muscle. It stimulates beta2 receptors in the uterus, which results in decreased frequency of contractions.

It inhibits uterine contractions by blocking entry of calcium into uterine cells Nifedipine, a calcium channel blocker, causes uterine relaxation by blocking the flow of calcium to the myometrial cells of the uterus. It stimulates beta2 receptors in the uterus, which results in decreased frequency of contractions.......This describes the mechanism of terbutaline to suppress preterm labor. Terbutaline has more adverse effects affecting the health of the client than nifedipine.

A hospice nurse is caring for a client who has cancer and is taking naproxen 250 mg three times daily PO and gabapentin 1,800 mg three times daily PO to manage pain. The client tells the nurse, "I'm having pain that keeps me from doing what I'd like most of the time." Which of the following additions should the nurse anticipate to the client's medication regimen?

Oral Oxycodone The client's current pain regimen consists of a nonopioid analgesic, naproxen, and an adjuvant medication for neuropathic pain, gabapentin. According to the WHO analgesic ladder for cancer pain management, the next addition to the pain regimen is an opioid for moderate pain. Oxycodone is an oral opioid that relieves moderate to moderately severe pain; therefore, it is an appropriate choice to add to the client's pain regimen. Diazepam has no analgesic effects and can cause sedation, which will interfere with the client's daily activities. Naloxone is an opioid antagonist, which is not indicated for a client who has cancer pain and is not taking opioids. Naloxone is administered to clients who have opioid overdose. Meperidine, an opioid analgesic, is not indicated for cancer pain because it can cause severe toxic effects when given for more than a few doses.

A nurse is monitoring laboratory values for a male client who has leukemia and is receiving weekly chemotherapy with methotrexate via IV infusion. Which of the following laboratory values should the nurse report to the provider?

Platelets 78,000/mm The nurse should monitor the platelet count of a client who is taking methotrexate because the medication can cause thrombocytopenia. This client's platelet count is very low and puts the client at risk for severe bleeding. The nurse should report this finding promptly to the provider. The nurse should monitor the BUN of a client who is taking methotrexate because the medication can cause kidney injury. The nurse should monitor the hemoglobin of a client who is taking methotrexate because the medication can cause bone marrow suppression. The nurse should monitor the AST of a client who is taking methotrexate because the medication can cause liver damage

A nurse is preparing a discharge teaching plan for a client who is to being long-term oral prednisone for asthma. Which of the following instructions should the nurse include in the plan?

Schedule the medication on alternate days to decrease adverse effects AE long-term glucocorticoid therapy are suppression of the adrenal gland, can be avoided by alternating days. -rash not a side effect -DO NOT STOP abruptly, if taken longer than 10 days. dosage must be decreased gradually to prevent withdrawal syndrome -DO NOT take on an empty stomach; gastro distress and ulcer formation

A nurse is teaching a client who has chronic stable angina pectoris and a prescription for sublingual nitroglycerin tablets. Identify the sequence of instructions that the nurse should tell the client to use if he experiences chest pain?

Stop activity, place a tablet under the tongue, wait 5 minutes, call 911 if the pain is not relieved

A nurse is assessing a client who reports using several herbal and vitamin supplements daily, including saw palmetto. The nurse should recognize that saw palmetto is a supplement used by clients to elicit which of the following therapeutic effects

Urinary health promotion Saw palmetto is used primarily for manifestations related to prostatic conditions, such as benign prostatic hypertrophy (BPH). Its effectiveness has not been scientifically proven, however. The nurse should teach the client to check with the provider about interactions between saw palmetto and other medications. Ginkgo Biloba for improved leg pain; and other peripheral arterial disorders and cognitive function. Ginger root- prevent and tx nausea Echinacea- immune system, reduce manifestations and duration of colds and flu-like illness

A nurse in an outpatient facility is assessing a client who is prescribed furosemide 40 mg daily, but the client reports that she has been taking extra doses to promote weight loss. Which of the following findings should indicate to the nurse that the client is dehydrated? Urine specific gravity 1.035 Distended neck veins BUN 18 mg/dL Bounding radial pulses

Urine specific gravity 1.035 Urine specific gravity 1.035MY ANSWER Oliguria, increased urine concentration, and an increase in urine specific gravity greater than 1.030 are expected findings in clients who are dehydrated. Distended neck veins Distended neck veins are indicators of fluid volume excess, not dehydration or fluid volume deficit. BUN 18 mg/dL Elevations in laboratory values such as BUN, hematocrit, and others, can be seen in a client who is dehydrated. A BUN of 18 mg/dL is within the expected reference range. Bounding radial pulses Full, bounding radial pulses are an indicator of fluid volume excess, not dehydration or fluid volume deficit.

A nurse is providing discharge teaching to a client who had a bleeding duodenal ulcer and is prescribed Omeprazole. Which of the following statements should the nurse include in the teaching?

You should take this medication before breakfast every day Clients who have active duodenal ulcer or gastric reflux disease should take omeprazole once daily before a meal (usually breakfast) because the medication is less effective when taken with food. Omeprazole should be used for no more than 1 to 2 months due to long-term adverse effects, which include increased risk for fractures and hypomagnesemia. When used as prescribed, adverse effects of omeprazole are infrequent, including diarrhea, nausea/vomiting and headache. The nurse should instruct the client to report severe diarrhea to the provider.

A nurse is providing discharge teaching to a client who has heart failure and a prescription for Digoxin 0.125 mg PO daily and Furosemide 20 mg PO daily. Which of the following statements by the client indicates an understanding of the teaching?

i will eat fruits and vegetables that high potassium content every day -hypokalemia is an AE of diuretic therapy potassium level between 3.5-5.0 to avoid digoxin toxicity -Digoxin Toxicity= visual disturbances (blurred vision, yellow vision) report to provider immediately AND HR below 60/min -homecare: instruct client to weigh themselves daily at the same time and record it. Acute setting... measuring I&O

A nurse is preparing to administer oxytocin to a client who is at 41 weeks of gestation and is experiencing ineffective labor. Which of the following actions should the nurse plan to take? Place the oxytocin from a pre-filled syringe into the posterior fornix of the vagina every 10 min until effective labor occurs. Check the client's blood pressure and pulse every 15 min while induction of labor is occurring. Stop the oxytocin for contractions that continue longer than 30 seconds. Increase the dose of oxytocin to obtain uterine contractions that occur every 2 to 3 min.

increase the dose of Oxytocin to obtain uterine contractions that occur every 2-3 minutes Place the oxytocin from a pre-filled syringe into the posterior fornix of the vagina every 10 min until effective labor occurs.Oxytocin is administered via IV infusion when used for labor induction. Some other medications used for cervical ripening prior to oxytocin administration (dinoprostone and misoprostol) are administered vaginally. Oxytocin can be administered IM to decrease postpartum bleeding. Check the client's blood pressure and pulse every 15 min while induction of labor is occurring. The client's blood pressure and pulse should be continually monitored during labor induction with oxytocin. Stop the oxytocin for contractions that continue longer than 30 seconds.The goal during oxytocin therapy is for the client to experience contractions that last from 45 to 60 seconds. If prolonged contractions occur, administration should be stopped. Increase the dose of oxytocin to obtain uterine contractions that occur every 2 to 3 min.MY ANSWEREffective uterine contractions should occur every 2 to 3 min.