Pharm

Question 1 See full question 47s A client who gave birth 24 hours ago continues to experience urine retention after several catheterizations. The physician orders bethanechol, 10 mg by mouth three times per day. The client asks, "How does bethanechol act on the bladder?" How should the nurse respond? You Selected: "It stimulates the smooth muscle of the bladder." Correct response: "It stimulates the smooth muscle of the bladder." Explanation: Bethanechol stimulates the smooth muscle of the bladder, causing it to release retained urine. Bethanechol doesn't act on the urinary sphincter or dilate the urethra. The bladder contains smooth muscle, not skeletal muscle. Add a Note Question 2 See full question 1m 7s A client has just given birth to her first child, a healthy, full-term girl. The client is Rho(D)-negative and her neonate is Rh-positive. What intervention will be performed to reduce the risk of Rh incompatibility? You Selected: Administration of Rho(D) immune globulin I.M. to the mother within 72 hours Correct response: Administration of Rho(D) immune globulin I.M. to the mother within 72 hours Explanation: When a mother is Rho(D)-negative and a neonate is Rh-positive, the mother forms antibodies against the D antigen. Most of the antibodies develop within the first 72 hours after she has given birth as a result of the exchange of maternal and fetal blood during birth. If the mother becomes pregnant again, she'll have a high antibody D level that may destroy fetal blood cells during the second pregnancy. However, if the mother receives an injection of Rho(D) immune globulin within 72 hours, no antibodies will be formed. Rho(D) immune globulin may also be given to the mother during pregnancy, if the neonate is Rh-positive. The neonate isn't given Rho(D) immune globulin. Add a Note Question 3 See full question 42s After instructing a 20-year-old nulligravid client about adverse effects of oral contraceptives, the nurse determines that further instruction is needed when the client states which as an adverse effect? You Selected: ovarian cancer Correct response: ovarian cancer Explanation: The nurse determines that the client needs further instruction when the client says that one of the adverse effects of oral contraceptive use is ovarian cancer. Some studies suggest that ovarian and endometrial cancers are reduced in women using oral contraceptives. Other adverse effects of oral contraceptives include weight gain, nausea, headache, breakthrough bleeding, and monilial infections. The most serious adverse effect is thrombophlebitis. Add a Note Question 4 See full question 42s Which laboratory test should the nurse monitor when the client is receiving warfarin sodium therapy? You Selected: prothrombin time (PT) Correct response: prothrombin time (PT) Explanation: Warfarin sodium interferes with clotting. The nurse should monitor the PT and evaluate for the therapeutic effects of coumadin. A therapeutic PT is between 1.5 and 2.5 times the control value; the PT should be established by the health care provider (HCP). It may also be reported as an International Normalized Ratio, a standardized system that provides a common basis for communicating and interpreting PT results. The PTT is monitored in clients who are receiving heparin therapy. Serum potassium levels and ABG values are not affected by coumadin. Add a Note Question 5 See full question 22s The nurse is evaluating the client's learning about combination chemotherapy. Which statement by the client about reasons for using combination chemotherapy indicates the need for further explanation? You Selected: "Combination chemotherapy is used to destroy cancer cells and treat side effects simultaneously." Correct response: "Combination chemotherapy is used to destroy cancer cells and treat side effects simultaneously." Explanation: Combination chemotherapy does not mean two groups of drugs, one to kill the cancer cells and one to treat the adverse effects of the chemotherapy. Combination chemotherapy means that multiple drugs are given to interrupt the cell growth cycle at different points, to decrease resistance to a chemotherapy agent, and to minimize the toxicity associated with use of a high dose of a single agent (i.e., by using multiple agents with different toxicities). Add a Note Question 6 See full question 24s A client is receiving cilostazol for intermittent claudication. What should the nurse ask the client to determine the effectiveness of the drug? You Selected: "Do you have less pain in the legs?" Correct response: "Do you have less pain in the legs?" Explanation: Cilostazol improves blood flow, and the client should have improved circulation in the legs as evident by less pain. The client does not have nerve impairment and should be able to wiggle the toes. Urination is not improved by taking cilostazol. Dizziness is a side effect of the drug, not an intended outcome. Add a Note Question 7 See full question 8s When administering an IM injection to a neonate, which muscle should the nurse consider as the best injection site? You Selected: vastus lateralis Correct response: vastus lateralis Explanation: The vastus lateralis muscle of the thigh is preferred for administering IM injections to infants because there is less danger of injuring nerves, blood vessels, or bony structures at this site. The deltoid muscle is used for IM injections only when other areas are unavailable. The dorsogluteal site has long been contraindicated for use in children who have not been walking for at least 1 year and is seldom used in other clients because of the risk of sciatic nerve. The ventrogluteal site is relatively free of major nerves and blood vessels, but the vastus lateralis remains the preferred IM injection site in infants. Add a Note Question 8 See full question 1m 27s An 80-year-old client is admitted with nausea and vomiting. The client has a history of heart failure and is being treated with digoxin. The client has been nauseated for a week and began vomiting 2 days ago. Laboratory values indicate hypokalemia. Because of these clinical findings, the nurse should assess the client carefully for: You Selected: digoxin toxicity. Correct response: digoxin toxicity. Explanation: Nausea and vomiting, along with hypokalemia, are likely indicators of digoxin toxicity. Hypokalemia is a common cause of digoxin toxicity; therefore, serum potassium levels should be carefully monitored if the client is taking digoxin. The earliest clinical signs of digoxin toxicity are anorexia, nausea, and vomiting. Bradycardia, other dysrhythmias, and visual disturbances are also common signs. Chronic renal failure usually causes hyperkalemia. With persistent vomiting, the client is more likely to develop metabolic alkalosis than metabolic acidosis. Add a Note Question 9 See full question 29s Which of the following indicates that the client with Addison's disease is receiving too much glucocorticoid replacement? You Selected: Rapid weight gain. Correct response: Rapid weight gain. Explanation: Rapid weight gain, because it reflects excess fluids, is a warning sign that the client is receiving too much hormone replacement. It may be difficult to individualize the correct dosage for a client taking glucocorticoids, and the therapeutic range between underdosage and overdosage is narrow. Maintaining the client on the lowest dose that provides satisfactory clinical response is always the goal of pharmacotherapeutics. Fluid balance is an important indicator of the adequacy of hormone replacement. Anorexia is not present with glucocorticoid therapy because these drugs increase the appetite. Dizziness is not specific to the effects of glucocorticoid therapy. Poor skin turgor is a late sign of fluid volume deficit. Add a Note Question 10 See full question 1m 5s A nurse working on a new unit is required to administer an unfamiliar medication to a client. How should the nurse proceed with the medication administration? You Selected: Consult a formulary or drug handbook to learn about the medication. Correct response: Consult a formulary or drug handbook to learn about the medication. Explanation: Before administering a medication, the nurse must be knowledgeable of the action, distribution, metabolism, expected response, and any side or adverse effects of the drug. A formulary guide or drug handbook can provide the necessary information. The other answers do follow the guidelines for administering medication safely.

LvL 0 to 1

Question 1 The administration of medications during infancy is often necessary. The nurse needs to be concerned about the metabolism of these drugs. What concern regarding metabolism should the nurse consider when administering medications to an infant? You Selected: Inefficient liver function Correct response: Inefficient liver function Explanation: Inefficient liver function will most likely decrease drug metabolism during infancy. As the liver matures during the first year of life, drug metabolism improves. Decreased glomerular filtration and increased tubular secretion may affect drug excretion rather than metabolism; reduced protein-binding ability may affect drug distribution but not metabolism. Add a Note Question 2 See full question 50s The nurse is checking the client's chart for possible contraindications, before administering meperidine, 50 mg I.M., to a client with pain after an appendectomy. The nurse should hold the meperidine when she sees an order for what type of drug? You Selected: A monoamine oxidase (MAO) inhibitor Correct response: A monoamine oxidase (MAO) inhibitor Explanation: The nurse should hold the meperidine if she sees an order for an MAO inhibitor because MAO inhibitors increase the effects of meperidine and can cause rigidity, hypotension, and excitation. The client shouldn't receive meperidine within 14 days after administration of an MAO inhibitor. Antibiotics, antiemetics, and loop diuretics don't cause significant drug interactions when administered concurrently with meperidine. Add a Note Question 3 See full question 26s The nurse hands the medication cup to a client who is psychotic and exhibiting concrete thinking, and tells the client to take his medicine. The client takes the cup, holds it in his hand, and stares at it. What should the nurse do next? You Selected: Tell the client to put the medicine in his mouth and swallow it with some water. Correct response: Tell the client to put the medicine in his mouth and swallow it with some water. Explanation: The nurse instructs the client clearly and directly to put the medication in the mouth and then to swallow it with some water. Clear, step-by-step directions assist the client to process what the nurse is saying. Telling the client to sit in the dayroom and wait, asking another staff member to stay with the client, or saying nothing is not helpful. Add a Note Question 4 See full question 42s The antidote for heparin is: You Selected: protamine sulfate. Correct response: protamine sulfate. Explanation: The antidote for heparin is 1% protamine sulfate. Vitamin K is the antidote for warfarin, an oral anticoagulant. Thrombin is a topical anticoagulant. Add a Note Question 5 See full question 29s A client with human immunodeficiency virus (HIV) infection is taking zidovudine (AZT). The expected outcome of AZTis to: You Selected: slow replication of the virus. Correct response: slow replication of the virus. Explanation: Zidovudine (AZT) interferes with replication of HIV and thereby slows progression of HIV infection to acquired immunodeficiency syndrome (AIDS). There is no known cure for HIV infection. Today, clients are not treated with monotherapy but are usually on triple therapy due to a much-improved clinical response. Decreased viral loads with the drug combinations have improved the longevity and quality of life in clients with HIV/AIDS. AZT does not destroy the virus, enhance the body's antibody production, or neutralize toxins produced by the virus. Add a Note Question 6 See full question 21s A 20-year-old client visiting the clinic requests the use of oral contraceptives. When reviewing the client's history, which finding would alert the nurse to a possible contraindication to using these agents? You Selected: thrombophlebitis Correct response: thrombophlebitis Explanation: Oral contraceptives are contraindicated for clients with a history of thrombophlebitis because a serious side effect of oral contraceptives is thrombus formation. Other contraindications include stroke and liver disease. Oral contraceptives are used cautiously in clients with hypertension or diabetes. Close follow-up of these clients is essential. Urinary tract infections (UTIs) do not contraindicate the use of oral contraceptives. If the client is suffering from UTIs, the nurse can instruct her to increase her fluid intake and wipe from front to back after urinating or defecating. Ulcerative colitis does not contraindicate using oral contraceptives. Menorrhagia is typically reduced through the use of oral contraceptives. Add a Note Question 7 See full question 41s The nurse teaches a client taking desmopressin nasal spray about how to manage treatment. The nurse determines that the client needs additional instruction when the client says: You Selected: "I should use the same nostril each time I take the medicine." Correct response: "I should use the same nostril each time I take the medicine." Explanation: The client who is taking desmopressin nasal spray should not use the same nares for administration each time. The client should alternate nares every dose. The client should observe for and report promptly signs and symptoms of nasal ulceration, congestion, or respiratory infection. Add a Note Question 8 See full question 21s A client's diagnosis of pneumonia requires treatment with antibiotics. The corresponding order in the client's chart should be written as: You Selected: Moxifloxacin 400 mg daily. Correct response: Moxifloxacin 400 mg daily. Explanation: Among the Joint Commission's list of "do not use" abbreviations are Q.D., qd, and OD when denoting a once-per-day drug administration. Because of the potential for misinterpretation and consequent drug errors, the Joint Commission recommends writing "daily" in the order. Add a Note Question 9 See full question 35s The nurse is aware that a client receiving morphine sulfate intravenously post-surgical repair of a hip fracture may exhibit which of the following outcomes when getting out of bed for the first time? You Selected: Postural or orthostatic hypotension Correct response: Postural or orthostatic hypotension Explanation: After the administration of certain antihypertensives or narcotics, the client's neurocirculatory reflexes may have some difficulty adjusting to the force of gravity when he/she assumes an upright position. Postural or orthostatic hypotension may then occur, causing a temporarily decreased blood supply to the brain. The client received analgesia, so pain should be controlled and the client's blood pressure should be within normal range or slightly lower. Pain should not be acute. Add a Note Question 10 See full question 35s A client's glucose level is 365 mg/dL (365 mmol/dL). The physician orders 10 units of regular insulin to be administered. The bottle of regular insulin is labeled 100 units/ml. How many milliliters of insulin should the nurse administer? Record your answer using one decimal place. Your Response: 0.1 Correct response: 0.1 Explanation: To find the correct administration amount, use the cross-product principle to set up the following equation: X/10 units = 1 ml/100 units Next, cross-multiply: 100 x X units = 10 units x 1 ml. Then divide both sides of the equation by 100 units to solve for X: X = 0.1 ml.

LvL 1 to 2

Question 1 See full question 33s Which finding is the best indication that fluid replacement for the client in hypovolemic shock is adequate? You Selected: urine output greater than 30 ml/hour Correct response: urine output greater than 30 ml/hour Explanation: Urine output provides the most sensitive indication of the client's response to therapy for hypovolemic shock. Urine output should be consistently greater than 35 mL/h. Blood pressure is a more accurate reflection of the adequacy of vasoconstriction than of tissue perfusion. Respiratory rate is not a sensitive indicator of fluid balance in the client recovering from hypovolemic shock. Add a Note Question 2 See full question 1m 3s Which observation by the nurse indicates that the mother of a child receiving home IV nafcillin therapy requires further teaching? The mother: You Selected: flushes the venous access site with heparin 20 minutes after giving the antibiotic. Correct response: flushes the venous access site with heparin 20 minutes after giving the antibiotic. Explanation: When administering IV antibiotics, heparin or saline should be used to flush the IV line as soon as the infusion is completed so that the line remains patent. Waiting for 20 minutes is too long. Although nafcillin can be given as a slow IV push, it is usually infused over 30 minutes to decrease inflammation of the vein. The infusion should be stopped if there is any question about whether the fluid is entering a vein or subcutaneous tissue, evidenced by hardening or reddening of the site. If the IV access is not allowing infusion of the medication, the mother should call the nurse. Add a Note Question 3 See full question 36s The nurse notes grapefruit juice on the breakfast tray of a client who is taking repaglinide. What should the nurse do next? You Selected: Remove the grapefruit juice from the client's tray and bring another juice of the client's preference. Correct response: Remove the grapefruit juice from the client's tray and bring another juice of the client's preference. Explanation: There is a drug-food interaction between repaglinide and grapefruit juice that may inhibit metabolism of repaglinide; the fresh grapefruit also interacts with repaglinide. It is not necessary that the dietitian inform the client of the drug-food interaction first. To contact the manager of the Food and Nutrition Department is not an intervention that will bring about prompt removal of the juice. Add a Note Question 4 See full question 57s A client is prescribed warfarin sodium. The nurse has prepared 1 tablet of 5 mg, 1 tablet of 2 mg, and 1/2 tablet of 3 mg. What is the dose that the nurse will be administering? Record your answer using one decimal place. Your Response: 8.5 Correct response: 8.5 Explanation: Calculations must be done to ensure accuracy of the dosage. Results of the prothrombin times and INR will determine the amount of warfarin to be administered on a daily basis while in the hospital. Add a Note Question 5 See full question 30s A child has been prescribed a 3-day treatment of gentamicin sulfate. Which of the following manifestations would indicate that the child is developing toxicity? Correct response: Decreased renal output Explanation: Gentamicin sulfate is an antibiotic that can cause ototoxicity and nephrotoxicity. Therefore, a decrease in renal output would be concerning. Electrolyte and visual disturbances and joint discomfort would not be indicative of gentamicin toxicity.

LvL 2 to 3

Question 1 See full question 26s Most oral pediatric medications are administered: You Selected: on an empty stomach. Correct response: on an empty stomach. Explanation: Most oral pediatric medications are administered on an empty stomach. They aren't usually administered with milk or formula because these can affect gastric pH and alter drug absorption. Because a child's meals usually contain milk or a milk product, the nurse wouldn't administer the drugs with meals or even ½ hour after meals. Add a Note Question 2 See full question 1m 28s A school-age child diagnosed with attention deficit hyperactivity disorder is prescribed methylphenidate. What finding should alert the school nurse to the possibility that the child is experiencing a common side effect of the drug? You Selected: loss of appetite Correct response: loss of appetite Explanation: Loss of appetite is one of the more common adverse effects associated with methylphenidate. Although nausea is associated with this drug, vomiting is not. Photosensitivity is not associated with this drug. Because of decreased appetite, the client will not gain more weight. Add a Note Question 3 See full question 7m 35s After the nurse teaches a client and family about lithium therapy, which client statements indicates the need for further teaching? Correct response: "I need to eliminate salt in my diet." Explanation: Clients receiving lithium need to have a consistent dietary intake of sodium to maintain a therapeutic serum lithium level of 0.6 to 1.2. A decrease in salt intake decreases lithium elimination, causing an increase in the serum lithium level. The client who is taking lithium needs to ingest adequate amounts of fluid, from 2,400 to 3,000 mL per day. Drinking 10 to 12 glasses of water each day would aid in achieving this goal. Because drowsiness and dizziness can occur with this drug, the client should avoid driving until the effects of the drug are known and the client is stabilized. Calling the healthcare provider if vomiting, diarrhea, blurred vision, or weakness occurs is important because these symptoms may indicate lithium toxicity. Add a Note Question 4 See full question 1m 10s The nurse is discussing medications with a client with hypertension who has a prescription for furosemide daily. Which comment by the client indicates the client needs further education? Correct response: "I know I shouldn't drive after taking my furosemide." Explanation: Furosemide is a diuretic often prescribed for clients with hypertension or heart failure; the drug should not affect a client's ability to drive safely. Furosemide may cause orthostatic hypotension, and clients should be instructed to be careful when changing from supine to sitting to standing position. Diuretics should be taken in the morning if possible to prevent sleep disturbance due to the need to get up to void. Furosemide is a loop diuretic that is not potassium sparing; clients should take potassium supplements as prescribed and have their serum potassium levels checked at prescribed intervals. Add a Note Question 5 See full question 1m 49s The nurse is preparing a client for an ileostomy. Two weeks before the surgery, what should the nurse instruct the client to do? You Selected: Stop taking drugs that will interfere with clotting. Correct response: Stop taking drugs that will interfere with clotting. Explanation: The nurse should instruct the client to stop taking drugs that would interfere with clotting, such as aspirin or ibuprofen. The client should follow a high-fiber diet with increased fluids during the 2-week preoperative period. It is not necessary to limit fluids. The client does not need to report having a temperature above 99° F (37.2° C) to the health care provider (HCP) as this is within normal limits; however, if the temperature is higher, this could indicate an infection, and the client should notify the HCP. Question 1 See full question 48s A client with rheumatoid arthritis has been on aspirin therapy for an extended time. Which assessment is the most important for the nurse to obtain? You Selected: Hearing Correct response: Hearing Explanation: Prolonged use of aspirin and other salicylates sometimes causes bilateral hearing loss of 30 to 40 decibels. Usually, this adverse effect resolves within 2 weeks after the therapy is discontinued. Aspirin doesn't lead to weight gain, gait problems, or changes in muscle mass. Add a Note Question 2 See full question 2m 16s A client with diabetes insipidus is receiving vasopressin. Which sign indicates that the drug is having the intended effect? You Selected: concentration of urine Correct response: concentration of urine Explanation: The major characteristic of diabetes insipidus is decreased tubular reabsorption of water due to insufficient amounts of antidiuretic hormone (ADH). Vasopressin is administered to the client with diabetes insipidus because it has pressor and ADH activities. Vasopressin works to increase the concentration of the urine by increasing tubular reabsorption, thus preserving up to 90% water. Vasopressin is administered to the client with diabetes insipidus because it is a synthetic ADH. The administration of vasopressin results in increased tubular reabsorption of water, and it is effective for emergency treatment or daily maintenance of mild diabetes insipidus. Vasopressin does not decrease blood pressure or affect insulin production or glucose metabolism, nor is insulin production a factor in diabetes insipidus. Add a Note Question 3 See full question 46s The nurse is administering packed red blood cells (PRBCs) to a client. What should the nurse do first? You Selected: Stay with the client during the first 15 minutes of infusion. Correct response: Stay with the client during the first 15 minutes of infusion. Explanation: The most likely time for a blood transfusion reaction to occur is during the first 15 minutes or first 50 ml of the infusion. If a blood transfusion reaction does occur, it is imperative to keep an established I.V. line so that medication can be administered to prevent or treat cardiovascular collapse in case of anaphylaxis. PRBCs should be administered through a 19-gauge or larger needle; a peripherally inserted central catheter line is not recommended, in order to avoid a slow flow. RBCs will hemolyze in dextrose or lactated Ringer's solution and should be infused with only normal saline solution. Add a Note Question 4 See full question 1m 2s A client is receiving an IV infusion of heparin sodium at 1,200 units/h. The dilution is 25,000 units/500 mL. How many milliliters per hour will this client receive? Record your answer using a whole number. Your Response: 24 Correct response: 24 Explanation: First, calculate how many units are in each milliliter of the medication. 25,000 units/500 mL = 50 units/1 mL. Next, calculate how many milliliters the client receives per hour. 1,200 units/1 hour divided by 50 units/1 mL = 1,200 units/1 hour X 1 mL/50 units = 24 mL/h. Add a Note Question 5 See full question 1m 57s Which technique is correct when the nurse administers a subcutaneous injection? You Selected: Insert the needle at a 45-degree angle to the skin. Correct response: Insert the needle at a 45-degree angle to the skin. Explanation: Subcutaneous injections are administered at an angle of 45 to 90 degrees, depending on the size of the client. Subcutaneous needles are typically ? to ? inches in length. The skin should be pinched up at the injection site to elevate the subcutaneous tissue. Air is not drawn into the syringe for a subcutaneous injection. Question 1 See full question 1m 38s How should a nurse prepare a suspension before administration? You Selected: By shaking it so that all the drug particles are dispersed uniformly Correct response: By shaking it so that all the drug particles are dispersed uniformly Explanation: The nurse should shake a suspension before administration to disperse drug particles uniformly. Diluting the suspension and crushing particles aren't recommended for this drug form. Add a Note Question 2 See full question 1m 20s After receiving an oral dose of codeine for an intractable cough, a client asks the nurse, "How long will it take for this drug to work?" How should the nurse respond? You Selected: 30 minutes Correct response: 30 minutes Explanation: Codeine's onset of action is 30 minutes. Its peak concentration occurs in about 1 hour; its half-life, in 2.5 hours; and its duration of action is 4 to 6 hours. Add a Note Question 3 See full question 1m 29s The nurse is preparing to administer erythromycin ophthalmic ointment to a neonate soon after birth. The nurse should explain to the parents that this medication, in addition to preventing blindness caused by gonococcal organisms, also prevents neonatal blindness caused by which organism? You Selected: chlamydia trachomatis Correct response: chlamydia trachomatis Explanation: The use of erythromycin ophthalmic ointment prevents blindness from gonococcal organisms and C. trachomatis. This ointment usually is less expensive than tetracycline. Beta-hemolytic streptococcus, E. coli, and S. aureus can cause a generalized infection in the neonate. However, these organisms typically are not responsible for causing neonatal blindness. Add a Note Question 4 See full question 23s When teaching a client when to take glipizide in order to maximize the effectiveness of the drug, the nurse should instruct the client to: You Selected: take glipizide 30 minutes before breakfast. Correct response: take glipizide 30 minutes before breakfast. Explanation: Glipizide is most effective when taken 30 minutes before breakfast. The duration of action is 10 to 24 hours. If the drug needs to be taken more than once a day, the dosage may be divided and taken twice a day before meals. It is not as effective to take the drug after meals. Although blood glucose levels will be monitored, the values do not dictate when the drug should be taken. Add a Note Question 5 See full question 1m 19s Because of a shortage of IV infusion pumps, a nurse must regulate a client's IV by gravity flow. The client has an order for 1000 mL of 0.9 NSS to infuse at 100 mL/hr. The tubing drip factor is 10 drops/mL. What is the appropriate rate for the nurse to set the IV infusion? You Selected: 17 drops per minute Correct response: 17 drops per minute Explanation: The accurate formula used to calculate drip rate of the IV is volume per hour, divided by infusion time in minutes, multiplied by the drip factor of the tubing. The other options are calculated incorrectly.``````

LvL 3 to 4

LvL 1 to 2] [LvL 0 to 1] Question 1 See full question 47s A client who gave birth 24 hours ago continues to experience urine retention after several catheterizations. The physician orders bethanechol, 10 mg by mouth three times per day. The client asks, "How does bethanechol act on the bladder?" How should the nurse respond? You Selected: "It stimulates the smooth muscle of the bladder." Correct response: "It stimulates the smooth muscle of the bladder." Explanation: Bethanechol stimulates the smooth muscle of the bladder, causing it to release retained urine. Bethanechol doesn't act on the urinary sphincter or dilate the urethra. The bladder contains smooth muscle, not skeletal muscle. Add a Note Question 2 See full question 1m 7s A client has just given birth to her first child, a healthy, full-term girl. The client is Rho(D)-negative and her neonate is Rh-positive. What intervention will be performed to reduce the risk of Rh incompatibility? You Selected: Administration of Rho(D) immune globulin I.M. to the mother within 72 hours Correct response: Administration of Rho(D) immune globulin I.M. to the mother within 72 hours Explanation: When a mother is Rho(D)-negative and a neonate is Rh-positive, the mother forms antibodies against the D antigen. Most of the antibodies develop within the first 72 hours after she has given birth as a result of the exchange of maternal and fetal blood during birth. If the mother becomes pregnant again, she'll have a high antibody D level that may destroy fetal blood cells during the second pregnancy. However, if the mother receives an injection of Rho(D) immune globulin within 72 hours, no antibodies will be formed. Rho(D) immune globulin may also be given to the mother during pregnancy, if the neonate is Rh-positive. The neonate isn't given Rho(D) immune globulin. Add a Note Question 3 See full question 42s After instructing a 20-year-old nulligravid client about adverse effects of oral contraceptives, the nurse determines that further instruction is needed when the client states which as an adverse effect? You Selected: ovarian cancer Correct response: ovarian cancer Explanation: The nurse determines that the client needs further instruction when the client says that one of the adverse effects of oral contraceptive use is ovarian cancer. Some studies suggest that ovarian and endometrial cancers are reduced in women using oral contraceptives. Other adverse effects of oral contraceptives include weight gain, nausea, headache, breakthrough bleeding, and monilial infections. The most serious adverse effect is thrombophlebitis. Add a Note Question 4 See full question 42s Which laboratory test should the nurse monitor when the client is receiving warfarin sodium therapy? You Selected: prothrombin time (PT) Correct response: prothrombin time (PT) Explanation: Warfarin sodium interferes with clotting. The nurse should monitor the PT and evaluate for the therapeutic effects of coumadin. A therapeutic PT is between 1.5 and 2.5 times the control value; the PT should be established by the health care provider (HCP). It may also be reported as an International Normalized Ratio, a standardized system that provides a common basis for communicating and interpreting PT results. The PTT is monitored in clients who are receiving heparin therapy. Serum potassium levels and ABG values are not affected by coumadin. Add a Note Question 5 See full question 22s The nurse is evaluating the client's learning about combination chemotherapy. Which statement by the client about reasons for using combination chemotherapy indicates the need for further explanation? You Selected: "Combination chemotherapy is used to destroy cancer cells and treat side effects simultaneously." Correct response: "Combination chemotherapy is used to destroy cancer cells and treat side effects simultaneously." Explanation: Combination chemotherapy does not mean two groups of drugs, one to kill the cancer cells and one to treat the adverse effects of the chemotherapy. Combination chemotherapy means that multiple drugs are given to interrupt the cell growth cycle at different points, to decrease resistance to a chemotherapy agent, and to minimize the toxicity associated with use of a high dose of a single agent (i.e., by using multiple agents with different toxicities). Add a Note Question 6 See full question 24s A client is receiving cilostazol for intermittent claudication. What should the nurse ask the client to determine the effectiveness of the drug? You Selected: "Do you have less pain in the legs?" Correct response: "Do you have less pain in the legs?" Explanation: Cilostazol improves blood flow, and the client should have improved circulation in the legs as evident by less pain. The client does not have nerve impairment and should be able to wiggle the toes. Urination is not improved by taking cilostazol. Dizziness is a side effect of the drug, not an intended outcome. Add a Note Question 7 See full question 8s When administering an IM injection to a neonate, which muscle should the nurse consider as the best injection site? You Selected: vastus lateralis Correct response: vastus lateralis Explanation: The vastus lateralis muscle of the thigh is preferred for administering IM injections to infants because there is less danger of injuring nerves, blood vessels, or bony structures at this site. The deltoid muscle is used for IM injections only when other areas are unavailable. The dorsogluteal site has long been contraindicated for use in children who have not been walking for at least 1 year and is seldom used in other clients because of the risk of sciatic nerve. The ventrogluteal site is relatively free of major nerves and blood vessels, but the vastus lateralis remains the preferred IM injection site in infants. Add a Note Question 8 See full question 1m 27s An 80-year-old client is admitted with nausea and vomiting. The client has a history of heart failure and is being treated with digoxin. The client has been nauseated for a week and began vomiting 2 days ago. Laboratory values indicate hypokalemia. Because of these clinical findings, the nurse should assess the client carefully for: You Selected: digoxin toxicity. Correct response: digoxin toxicity. Explanation: Nausea and vomiting, along with hypokalemia, are likely indicators of digoxin toxicity. Hypokalemia is a common cause of digoxin toxicity; therefore, serum potassium levels should be carefully monitored if the client is taking digoxin. The earliest clinical signs of digoxin toxicity are anorexia, nausea, and vomiting. Bradycardia, other dysrhythmias, and visual disturbances are also common signs. Chronic renal failure usually causes hyperkalemia. With persistent vomiting, the client is more likely to develop metabolic alkalosis than metabolic acidosis. Add a Note Question 9 See full question 29s Which of the following indicates that the client with Addison's disease is receiving too much glucocorticoid replacement? You Selected: Rapid weight gain. Correct response: Rapid weight gain. Explanation: Rapid weight gain, because it reflects excess fluids, is a warning sign that the client is receiving too much hormone replacement. It may be difficult to individualize the correct dosage for a client taking glucocorticoids, and the therapeutic range between underdosage and overdosage is narrow. Maintaining the client on the lowest dose that provides satisfactory clinical response is always the goal of pharmacotherapeutics. Fluid balance is an important indicator of the adequacy of hormone replacement. Anorexia is not present with glucocorticoid therapy because these drugs increase the appetite. Dizziness is not specific to the effects of glucocorticoid therapy. Poor skin turgor is a late sign of fluid volume deficit. Add a Note Question 10 See full question 1m 5s A nurse working on a new unit is required to administer an unfamiliar medication to a client. How should the nurse proceed with the medication administration? You Selected: Consult a formulary or drug handbook to learn about the medication. Correct response: Consult a formulary or drug handbook to learn about the medication. Explanation: Before administering a medication, the nurse must be knowledgeable of the action, distribution, metabolism, expected response, and any side or adverse effects of the drug. A formulary guide or drug handbook can provide the necessary information. The other answers do follow the guidelines for administering medication safely.Question 1 The administration of medications during infancy is often necessary. The nurse needs to be concerned about the metabolism of these drugs. What concern regarding metabolism should the nurse consider when administering medications to an infant? You Selected: Inefficient liver function Correct response: Inefficient liver function Explanation: Inefficient liver function will most likely decrease drug metabolism during infancy. As the liver matures during the first year of life, drug metabolism improves. Decreased glomerular filtration and increased tubular secretion may affect drug excretion rather than metabolism; reduced protein-binding ability may affect drug distribution but not metabolism. Add a Note Question 2 See full question 50s The nurse is checking the client's chart for possible contraindications, before administering meperidine, 50 mg I.M., to a client with pain after an appendectomy. The nurse should hold the meperidine when she sees an order for what type of drug? You Selected: A monoamine oxidase (MAO) inhibitor Correct response: A monoamine oxidase (MAO) inhibitor Explanation: The nurse should hold the meperidine if she sees an order for an MAO inhibitor because MAO inhibitors increase the effects of meperidine and can cause rigidity, hypotension, and excitation. The client shouldn't receive meperidine within 14 days after administration of an MAO inhibitor. Antibiotics, antiemetics, and loop diuretics don't cause significant drug interactions when administered concurrently with meperidine. Add a Note Question 3 See full question 26s The nurse hands the medication cup to a client who is psychotic and exhibiting concrete thinking, and tells the client to take his medicine. The client takes the cup, holds it in his hand, and stares at it. What should the nurse do next? You Selected: Tell the client to put the medicine in his mouth and swallow it with some water. Correct response: Tell the client to put the medicine in his mouth and swallow it with some water. Explanation: The nurse instructs the client clearly and directly to put the medication in the mouth and then to swallow it with some water. Clear, step-by-step directions assist the client to process what the nurse is saying. Telling the client to sit in the dayroom and wait, asking another staff member to stay with the client, or saying nothing is not helpful. Add a Note Question 4 See full question 42s The antidote for heparin is: You Selected: protamine sulfate. Correct response: protamine sulfate. Explanation: The antidote for heparin is 1% protamine sulfate. Vitamin K is the antidote for warfarin, an oral anticoagulant. Thrombin is a topical anticoagulant. Add a Note Question 5 See full question 29s A client with human immunodeficiency virus (HIV) infection is taking zidovudine (AZT). The expected outcome of AZTis to: You Selected: slow replication of the virus. Correct response: slow replication of the virus. Explanation: Zidovudine (AZT) interferes with replication of HIV and thereby slows progression of HIV infection to acquired immunodeficiency syndrome (AIDS). There is no known cure for HIV infection. Today, clients are not treated with monotherapy but are usually on triple therapy due to a much-improved clinical response. Decreased viral loads with the drug combinations have improved the longevity and quality of life in clients with HIV/AIDS. AZT does not destroy the virus, enhance the body's antibody production, or neutralize toxins produced by the virus. Add a Note Question 6 See full question 21s A 20-year-old client visiting the clinic requests the use of oral contraceptives. When reviewing the client's history, which finding would alert the nurse to a possible contraindication to using these agents? You Selected: thrombophlebitis Correct response: thrombophlebitis Explanation: Oral contraceptives are contraindicated for clients with a history of thrombophlebitis because a serious side effect of oral contraceptives is thrombus formation. Other contraindications include stroke and liver disease. Oral contraceptives are used cautiously in clients with hypertension or diabetes. Close follow-up of these clients is essential. Urinary tract infections (UTIs) do not contraindicate the use of oral contraceptives. If the client is suffering from UTIs, the nurse can instruct her to increase her fluid intake and wipe from front to back after urinating or defecating. Ulcerative colitis does not contraindicate using oral contraceptives. Menorrhagia is typically reduced through the use of oral contraceptives. Add a Note Question 7 See full question 41s The nurse teaches a client taking desmopressin nasal spray about how to manage treatment. The nurse determines that the client needs additional instruction when the client says: You Selected: "I should use the same nostril each time I take the medicine." Correct response: "I should use the same nostril each time I take the medicine." Explanation: The client who is taking desmopressin nasal spray should not use the same nares for administration each time. The client should alternate nares every dose. The client should observe for and report promptly signs and symptoms of nasal ulceration, congestion, or respiratory infection. Add a Note Question 8 See full question 21s A client's diagnosis of pneumonia requires treatment with antibiotics. The corresponding order in the client's chart should be written as: You Selected: Moxifloxacin 400 mg daily. Correct response: Moxifloxacin 400 mg daily. Explanation: Among the Joint Commission's list of "do not use" abbreviations are Q.D., qd, and OD when denoting a once-per-day drug administration. Because of the potential for misinterpretation and consequent drug errors, the Joint Commission recommends writing "daily" in the order. Add a Note Question 9 See full question 35s The nurse is aware that a client receiving morphine sulfate intravenously post-surgical repair of a hip fracture may exhibit which of the following outcomes when getting out of bed for the first time? You Selected: Postural or orthostatic hypotension Correct response: Postural or orthostatic hypotension Explanation: After the administration of certain antihypertensives or narcotics, the client's neurocirculatory reflexes may have some difficulty adjusting to the force of gravity when he/she assumes an upright position. Postural or orthostatic hypotension may then occur, causing a temporarily decreased blood supply to the brain. The client received analgesia, so pain should be controlled and the client's blood pressure should be within normal range or slightly lower. Pain should not be acute. Add a Note Question 10 See full question 35s A client's glucose level is 365 mg/dL (365 mmol/dL). The physician orders 10 units of regular insulin to be administered. The bottle of regular insulin is labeled 100 units/ml. How many milliliters of insulin should the nurse administer? Record your answer using one decimal place. Your Response: 0.1 Correct response: 0.1 Explanation: To find the correct administration amount, use the cross-product principle to set up the following equation: X/10 units = 1 ml/100 units Next, cross-multiply: 100 x X units = 10 units x 1 ml. Then divide both sides of the equation by 100 units to solve for X: X = 0.1 ml. [LvL 2 to 3] Question 1 See full question 33s Which finding is the best indication that fluid replacement for the client in hypovolemic shock is adequate? You Selected: urine output greater than 30 ml/hour Correct response: urine output greater than 30 ml/hour Explanation: Urine output provides the most sensitive indication of the client's response to therapy for hypovolemic shock. Urine output should be consistently greater than 35 mL/h. Blood pressure is a more accurate reflection of the adequacy of vasoconstriction than of tissue perfusion. Respiratory rate is not a sensitive indicator of fluid balance in the client recovering from hypovolemic shock. Add a Note Question 2 See full question 1m 3s Which observation by the nurse indicates that the mother of a child receiving home IV nafcillin therapy requires further teaching? The mother: You Selected: flushes the venous access site with heparin 20 minutes after giving the antibiotic. Correct response: flushes the venous access site with heparin 20 minutes after giving the antibiotic. Explanation: When administering IV antibiotics, heparin or saline should be used to flush the IV line as soon as the infusion is completed so that the line remains patent. Waiting for 20 minutes is too long. Although nafcillin can be given as a slow IV push, it is usually infused over 30 minutes to decrease inflammation of the vein. The infusion should be stopped if there is any question about whether the fluid is entering a vein or subcutaneous tissue, evidenced by hardening or reddening of the site. If the IV access is not allowing infusion of the medication, the mother should call the nurse. Add a Note Question 3 See full question 36s The nurse notes grapefruit juice on the breakfast tray of a client who is taking repaglinide. What should the nurse do next? You Selected: Remove the grapefruit juice from the client's tray and bring another juice of the client's preference. Correct response: Remove the grapefruit juice from the client's tray and bring another juice of the client's preference. Explanation: There is a drug-food interaction between repaglinide and grapefruit juice that may inhibit metabolism of repaglinide; the fresh grapefruit also interacts with repaglinide. It is not necessary that the dietitian inform the client of the drug-food interaction first. To contact the manager of the Food and Nutrition Department is not an intervention that will bring about prompt removal of the juice. Add a Note Question 4 See full question 57s A client is prescribed warfarin sodium. The nurse has prepared 1 tablet of 5 mg, 1 tablet of 2 mg, and 1/2 tablet of 3 mg. What is the dose that the nurse will be administering? Record your answer using one decimal place. Your Response: 8.5 Correct response: 8.5 Explanation: Calculations must be done to ensure accuracy of the dosage. Results of the prothrombin times and INR will determine the amount of warfarin to be administered on a daily basis while in the hospital. Add a Note Question 5 See full question 30s A child has been prescribed a 3-day treatment of gentamicin sulfate. Which of the following manifestations would indicate that the child is developing toxicity? Correct response: Decreased renal output Explanation: Gentamicin sulfate is an antibiotic that can cause ototoxicity and nephrotoxicity. Therefore, a decrease in renal output would be concerning. Electrolyte and visual disturbances and joint discomfort would not be indicative of gentamicin toxicity. Question 1 See full question 1m 38s How should a nurse prepare a suspension before administration? You Selected: By shaking it so that all the drug particles are dispersed uniformly Correct response: By shaking it so that all the drug particles are dispersed uniformly Explanation: The nurse should shake a suspension before administration to disperse drug particles uniformly. Diluting the suspension and crushing particles aren't recommended for this drug form. Add a Note Question 2 See full question 1m 20s After receiving an oral dose of codeine for an intractable cough, a client asks the nurse, "How long will it take for this drug to work?" How should the nurse respond? You Selected: 30 minutes Correct response: 30 minutes Explanation: Codeine's onset of action is 30 minutes. Its peak concentration occurs in about 1 hour; its half-life, in 2.5 hours; and its duration of action is 4 to 6 hours. Add a Note Question 3 See full question 1m 29s The nurse is preparing to administer erythromycin ophthalmic ointment to a neonate soon after birth. The nurse should explain to the parents that this medication, in addition to preventing blindness caused by gonococcal organisms, also prevents neonatal blindness caused by which organism? You Selected: chlamydia trachomatis Correct response: chlamydia trachomatis Explanation: The use of erythromycin ophthalmic ointment prevents blindness from gonococcal organisms and C. trachomatis. This ointment usually is less expensive than tetracycline. Beta-hemolytic streptococcus, E. coli, and S. aureus can cause a generalized infection in the neonate. However, these organisms typically are not responsible for causing neonatal blindness. Add a Note Question 4 See full question 23s When teaching a client when to take glipizide in order to maximize the effectiveness of the drug, the nurse should instruct the client to: You Selected: take glipizide 30 minutes before breakfast. Correct response: take glipizide 30 minutes before breakfast. Explanation: Glipizide is most effective when taken 30 minutes before breakfast. The duration of action is 10 to 24 hours. If the drug needs to be taken more than once a day, the dosage may be divided and taken twice a day before meals. It is not as effective to take the drug after meals. Although blood glucose levels will be monitored, the values do not dictate when the drug should be taken. Add a Note Question 5 See full question 1m 19s Because of a shortage of IV infusion pumps, a nurse must regulate a client's IV by gravity flow. The client has an order for 1000 mL of 0.9 NSS to infuse at 100 mL/hr. The tubing drip factor is 10 drops/mL. What is the appropriate rate for the nurse to set the IV infusion? You Selected: 17 drops per minute Correct response: 17 drops per minute Explanation: The accurate formula used to calculate drip rate of the IV is volume per hour, divided by infusion time in minutes, multiplied by the drip factor of the tubing. The other options are calculated incorrectly.

repeat question

Question 1 See full question 55s A nurse is preparing to administer a sustained-release capsule to a client. Which is an appropriate nursing intervention? You Selected: Administering the capsule whole with a glass of water Correct response: Administering the capsule whole with a glass of water Explanation: Sustained-release capsules should never be split open, crushed, or chewed because doing so may alter the drug's absorption rate, causing adverse reactions or subtherapeutic activity. Sustained-released capsules should be swallowed whole. Add a Note Question 2 See full question 1m 9s A client's medication order reads, "Thioridazine 200 mg P.O. q.i.d. and 100 mg P.O. p.r.n." A nurse should: You Selected: question the physician about the order. Correct response: question the physician about the order. Explanation: The nurse must question this order immediately. Thioridazine has an absolute dosage ceiling of 800 mg/day. Any dosage above this level places the client at high risk for toxic pigmentary retinopathy, which can't be reversed. As written, the order allows for administering more than the maximum 800 mg/day; it should be corrected immediately, before the client's health is jeopardized. Add a Note Question 3 See full question 1m 7s One hour before a client is to undergo abdominal surgery, the physician orders atropine, 0.6 mg I.M. The client asks the nurse why this drug must be administered. How should the nurse respond? You Selected: "Atropine decreases salivation and gastric secretions." Correct response: "Atropine decreases salivation and gastric secretions." Explanation: The nurse should tell the client that, when used as preanesthesia medication, atropine and other cholinergic blocking agents reduce salivation and gastric secretions, thus helping to prevent aspiration of secretions during surgery. Atropine increases the heart rate and cardiac contractility, decreases bronchial secretions, and causes bronchodilation. No evidence indicates that the drug enhances the effect of anesthetic agents. Add a Note Question 4 See full question 1m 10s The nurse is reviewing the laboratory report with the client's lithium level prior to administering the 1700 hours dose. The lithium level is 1.8 mEq/L (1.8 mmol/L). The nurse should: You Selected: hold the 1700 hours dose of lithium. Correct response: hold the 1700 hours dose of lithium. Explanation: The nurse should hold the 1700 hour dose of lithium because a level of 1.8 mEq/L (1.8 mmol/L) can cause adverse reactions, including diarrhea, vomiting, drowsiness, muscle weakness, and lack of coordination, which are early signs of lithium toxicity. The nurse should report the lithium level to the health care provider (HCP) , including any symptoms of toxicity. Administering the 1700 hour dose of lithium, giving the client the lithium with 240mL of water, or giving it after supper would result in an increase of the lithium level, thus increasing the risk of lithium toxicity. Add a Note Question 5 See full question 1m 22s The health care provider (HCP) prescribes mirtazapine 30 mg PO at bedtime for a client diagnosed with depression. The nurse should: Correct response: give the medication as prescribed. Explanation: The nurse should give the medication as prescribed. Mirtazapine is given once daily, preferably at bedtime to minimize the risk of injury resulting from postural hypotension and sedative effects. The usual dosage ranges from 15 to 45 mg. There is no reason to question the HCP's prescriptions. The nurse should administer the medication as prescribed. Requesting to give the medication in three divided doses is inappropriate and demonstrates the nurse's lack of knowledge about the drug. Question 1 See full question 3m 5s A dystonic reaction can be caused by which medication? You Selected: Haloperidol Correct response: Haloperidol Explanation: Haloperidol is a phenothiazine and is capable of causing dystonic reactions. Diazepam and clonazepam are benzodiazepines, and amitriptyline is a tricyclic antidepressant. Benzodiazepines don't cause dystonic reactions; however, they can cause drowsiness, lethargy, and hypotension. Tricyclic antidepressants rarely cause severe dystonic reactions; however, they can cause a decreased level of consciousness, tachycardia, dry mouth, and dilated pupils. Add a Note Question 2 See full question 31s A nurse is administering daunorubicin to a patient with lung cancer. Which situation requires immediate intervention? You Selected: The I.V. site is red and swollen. Correct response: The I.V. site is red and swollen. Explanation: A red, swollen I.V. site indicates possible infiltration. Daunorubicin is a vesicant chemotherapeutic agent and can be very damaging to tissue if it infiltrates. The nurse should immediately stop the medication, apply ice to the site, and notify the physician. Although nausea, WBC count of 1,000/mm3, and shivering require interventions, these findings aren't a high priority at this time. Question 3 While receiving disulfiram therapy, the client becomes nauseated and vomits severely. Which question should the nurse ask first? Correct response: "How much alcohol did you drink today?" Explanation: The first question should be to ask the client how much alcohol she has had today because nausea with severe vomiting is a sign of an alcohol-disulfiram reaction. Asking the client whether she feels like she has flu symptoms is important after inquiring about alcohol intake. Foods cooked in an alcoholic beverage, such as wine, could also cause a reaction, but the reaction would be less severe because the alcohol dissipates with cooking. Asking how long the client has been taking disulfiram would be least important at this time. Question 4 A breastfeeding primiparous client with a midline episiotomy is prescribed ibuprofen orally. When does the nurse instruct the client to take the medication? Correct response: immediately after a feeding Explanation: Taking ibuprofen 200 mg orally immediately after breastfeeding helps minimize the neonate's exposure to the drug because drugs are most highly concentrated in the body soon after they are taken. Most mothers breastfeed on demand or every 2 to 3 hours, so the effects of the ibuprofen should be decreased by the next breastfeeding session. Taking the medication before going to bed is inappropriate because, although the mother may go to bed at a certain time, the neonate may wish to breastfeed soon after the mother goes to bed. If the mother takes the medication midway between feedings, then its peak action may occur midway between feedings. Breast milk is sufficient for the neonate's nutritional needs. Most breastfeeding mothers should not be encouraged to provide supplemental feedings to the infant because this may result in nipple confusion. Question 5 The nurse must administer ferrous sulfate to an infant who weighs 8 lb 13 oz (4 kg). The dosage prescribed is 6 mg/kg/day to be given in three doses. What would be the correct amount to be administered for each dose? Record your answer using a whole number. = Correct response: 8 Explanation: 6 mg × 4 kg = 24 mg/24 hours. The dose is to be administered three times every 24 hours, resulting in 24 mg/3doses = 8 mg/dose.

LvL 6 to 7

Question 1 See full question 4m 37s A client with refractory angina pectoris is scheduled for a percutaneous transluminal coronary angioplasty (PTCA). The cardiologist orders an infusion of abciximab. Before beginning the infusion, the nurse should ensure the client has: You Selected: up-to-date partial thromboplastin time (PTT) result in his record. Correct response: up-to-date partial thromboplastin time (PTT) result in his record. Explanation: Clients undergoing PTCA receive abciximab because it inhibits platelet aggregation and, thereby, reduces cardiac ischemic complications. Before abciximab is administered, the client should have an up-to-date PTT result available. The drug isn't contraindicated in clients with a seizure history. Abciximab isn't an opioid; therefore, an opioid antagonist doesn't need to be at the bedside. Any client with refractory angina should be on continuous ECG monitoring; however, monitoring isn't a requirement for administering abciximab. Add a Note Question 2 See full question 1m 7s A client with acquired immunodeficiency syndrome is receiving zidovudine. Which laboratory value indicates an adverse reaction to zidovudine? You Selected: Red blood cell (RBC) count of 1.8 million/μl (1.8 million x 10 to the 12th/L) Correct response: Red blood cell (RBC) count of 1.8 million/μl (1.8 million x 10 to the 12th/L) Explanation: Because anemia (characterized by a decrease in RBCs below 4.0 million/μl) (4.0 million x 10 to the 12th/L) is a major adverse effect of zidovudine, the nurse should monitor the client's RBC count and assess for signs and symptoms of decreased cellular oxygenation. Zidovudine doesn't affect the blood glucose level, serum calcium level, or platelet count and the values listed are within normal limits. Add a Note Question 3 See full question 1m 7s A client comes into the emergency department with severe back pain radiating to the left lower groin region. Morphine sulfate 10 mg IV is administered as ordered. One hour later the client states that the pain is still at 8 of 10. Which actions would the nurse take? You Selected: Contact the physician and explain that the pain is still at 8 of 10 one hour after the morphine has been administered and request a higher dosage. Correct response: Contact the physician and explain that the pain is still at 8 of 10 one hour after the morphine has been administered and request a higher dosage. Explanation: Renal colic can be one of the most severe pain experiences. The ordered dosage of analgesic has not provided relief, so additional intervention is appropriate. Because of the severity of the pain, it is not appropriate for the client to wait until the next dose is due. Although the client is receiving a therapeutic dose, it is not effective. The interval between doses of the analgesic is too great. There may be a tolerance to the analgesic if the client has routinely taken painkillers; however, relief is still needed now. Add a Note Question 4 See full question 1m 23s A client has a patient-controlled analgesia (PCA) pump with morphine after a bowel resection. What are the nursing responsibilities after the client has self-administered a bolus of medication? You Selected: Encourage ambulation and deep breathing and coughing exercises to counteract respiratory depression. Correct response: Ensure that the client understands that a bolus may take up to 15 minutes to alleviate the pain. Explanation: Clients on a PCA pump will receive pain medication continuously; however, they can adjust the amount of medication they receive by self-administering a bolus. Clients need to be informed regarding self-administration of pain medication, and that the effects can be expected in 15 minutes. The client is concerned about pain relief, so reducing the side effects and counteracting respiratory depression are secondary in importance. Add a Note Question 5 See full question 2m 7s During the intravenous administration of a chemotherapeutic vesicant drug, the nurse observes that there is a lack of blood return from the intravenous catheter. The nurse should first: You Selected: stop the administration of the drug. Correct response: stop the administration of the drug. Explanation: An intravenous catheter with no blood return is most likely occluded and not patent. A chemotherapeutic vesicant drug extravasates into the surrounding skin tissue and causes tissue necrosis. The nurse stops administration of the drug immediately. Repositioning the arm does not improve patency. Irrigating the catheter may cause the medication to enter tissue. It is inappropriate to wait and see if the arm becomes edematous because of the vesicant action of the drug. Question 1 See full question 2m 15s A client diagnosed with schizophrenia is brought to the hospital from a group home where he became agitated, threw a chair at another client, and has been refusing medication for 8 weeks. The client exhibits a flat affect, is not caring for his hygiene, and has become increasingly withdrawn and asocial. The health care provider (HCP) prescribes treatment with risperidone to improve the client's negative and positive symptoms of schizophrenia. When evaluating the drug's effectiveness on the client's negative symptoms, the nurse should expect improvement in which symptom? You Selected: apathy, affect, social isolation Correct response: apathy, affect, social isolation Explanation: When determining the effectiveness of risperidone, the nurse would expect improvement in the client's negative symptoms of apathy, flat affect, and social withdrawal. Delusions, hallucinations, illusions, and ideas of reference are positive symptoms of schizophrenia. Agitation, hostility, and aggression are also the result of the positive symptoms. Add a Note Question 2 See full question 1m 27s A client admitted with a diagnosis of schizoaffective disorder, manic phase, who is currently taking fluoxetine, valproic acid, and olanzapine as prescribed, has had an increase in manic symptoms in the past week. The health care provider (HCP) prescribes a valproic acid blood level to be drawn at once. What does the nurse understand is the rationale for this prescription? You Selected: A decrease in the level of valproic acid could explain the increase in manic symptoms. Correct response: A decrease in the level of valproic acid could explain the increase in manic symptoms. Explanation: Add a Note Question 3 See full question 3m 17s A client with hypertensive emergency is being treated with sodium nitroprusside. In a dilution of 50 mg/250 mL, how many micrograms of nitroprusside are in each milliliter? Record your answer using a whole number. Your Response: 200 Correct response: 200 Explanation: First, calculate the number of milligrams per milliliter: 50 mg/250 mL = 1 mg/5 mL = 0.2 mg/1 mL Next, calculate the number of micrograms in each milligram: 0.2 mg × 1,000 mcg = 200 mcg. Add a Note Question 4 See full question 1m 10s A client is started on sulfamethoxazole-trimethoprim for reports of severe burning on urination and frequent, urgent voiding of small amounts of urine. As the nurse explains the medication, the client requests something to relieve the painful urination. Which treatment order would the nurse anticipate for the client's discomfort? You Selected: phenazopyridine Correct response: phenazopyridine Explanation: Phenazopyridine may be ordered in conjunction with an antibiotic for painful bladder infections to promote comfort. Because of its local anesthetic action on the urinary mucosa, phenazopyridine specifically relieves bladder pain. Nitrofurantoin is another choice for antibiotic treatment and would not be recommended in conjunction with trimethoprim-sulfamethoxazole. Although ibuprofen is an analgesic, phenazopyridine has more direct effect on urinary tract infections. Add a Note Question 5 See full question 2m 15s A client who is receiving doxorubicin should have a plan of care for reducing the risk for which of the following complications? Select all that apply. You Selected: Cardiac toxicity Correct response: Cardiac toxicity Pulmonary toxicity Explanation: Doxorubicin is an antitumor antibiotic that can cause toxicity to the heart and lungs. This medication does not cause toxicity to the nervous system or the ears or eyes.

LvL 7 to 8

Question 1 See full question 1m 42s A client has a heart rate of 170 beats/minute. The physician diagnoses ventricular tachycardia and orders lidocaine hydrochloride, an initial I.V. bolus of 50 mg followed in 5 minutes by a second 50-mg bolus, then continuous I.V. infusion at 2 mg/minute. The nurse can expect the client to begin experiencing an antiarrhythmic effect within: Correct response: 1 to 2 minutes after I.V. bolus administration. Explanation: Lidocaine exerts its antiarrhythmic effect in 1 to 2 minutes after I.V. bolus administration. A continuous I.V. infusion will maintain lidocaine's antiarrhythmic effect for as long as the drip is used. Lidocaine provides antiarrhythmic effects for only 15 minutes after the I.V. infusion is stopped. Add a Note Question 2 See full question 1m 34s An auto mechanic accidentally has battery acid splashed in his eyes. His coworkers irrigate his eyes with water for 20 minutes, then take him to the emergency department of a nearby hospital, where he receives emergency care for corneal injury. The physician orders dexamethasone, two drops of 0.1% solution to be instilled initially into the conjunctival sacs of both eyes every hour; and polymyxin B sulfate, 0.5% ointment to be placed in the conjunctival sacs of both eyes every 3 hours. The nurse knows that dexamethasone exerts its therapeutic effect by: Correct response: decreasing leukocyte infiltration at the site of ocular inflammation. Explanation: Add a Note Question 3 See full question 1m 12s If a client's central venous catheter accidentally becomes disconnected, what should a nurse do first? You Selected: Clamp the catheter. Correct response: Clamp the catheter. Explanation: Add a Note Question 4 See full question 1m 30s After evaluating a client for hypertension, a physician orders atenolol, 50 mg P.O. daily. Which therapeutic effect should atenolol have? Correct response: Decreased cardiac output and decreased systolic and diastolic blood pressure Explanation: Add a Note Question 5 See full question 1m 35s A client who had a total hip placement at 0900 is receiving an autologous blood transfusion that was started at 1100. At the change of shift (1500), the nurse working on the day shift reports that there is 50 mL of the unit of blood remaining to be infused. Which is a priority action for the nurse working on the evening shift? Correct response: Discontinue the blood transfusion at the beginning of the shift. Explanation: In most agencies, it is a policy to discard the autologous blood after 4 hours of transfusing, due to an increased risk of infection. Increasing the infusion rate could cause fluid overload. Monitoring blood transfusions is a serious nursing responsibility, and because it is the change of shift, there is increased risk of error.

LvL 5 to 6