Pharm B

A nurse is providing teaching for a client who has multiple sclerosis and a new prescription for methylprednisone. Which of the following instructions should the nurse include? (select all)

"Blood glucose levels will be monitored during therapy" is correct. The nurse should instruct the client that their blood glucose levels will be monitored during therapy because corticosteroids, such as methylprednisolone, can raise blood glucose levels. "Avoid contact with persons who have known infections" is correct. The nurse should instruct the client to avoid contact with persons who have known infections because corticosteroids, such as methylprednisolone, suppress the immune response and mask manifestations of infection. "Take the medication 1 hr before a meal" is incorrect. The nurse should instruct the client to take the medication with food or milk to avoid gastrointestinal manifestations. "Decrease intake of foods containing potassium" is incorrect. Methylprednisolone decreases potassium levels through urinary excretion, so the nurse should instruct the client to increase intake of foods containing potassium. "Grapefruit juice can increase the blood levels of the medication" is correct. The nurse should instruct the client that grapefruit juice increases the absorption of the medication, which can lead to toxicity and adrenal suppression.

A nurse is caring for a client who is refusing to take their scheduled morning furosemide. Which of the following statements should the nurse make?

"By not taking your furosemide, you might retain fluid and develop swelling." The nurse should respect the client's right to refuse the medication and inform the client of the risks of not taking the medication, notify the provider, and document the refusal. Furosemide is a loop diuretic given to reduce edema. Wrong "You can double your dose of furosemide this evening if that would be better for you." The nurse should respect the client's right to refuse the medication and identify that the client should not double the medication dose if missed. "If you do not take your furosemide, we might get in trouble." The nurse should respect the client's right to refuse the medication and inform the client of the risks of not taking the medication, notify the provider, and document the refusal. This response uses nontherapeutic communication because the nurse is threatening the client. "I'll go ahead and mix the furosemide into your breakfast cereal." The nurse should respect the client's right to refuse the medication and inform the client of the risks of not taking the medication, notify the provider, and document the refusal. This response is dismissing the client's right to refuse a medication.

A nurse is planning discharge teaching for a client who has prescription for furosemide. The nurse should plan to include which of the following statements in the teaching?

"Drink a glass of milk with each dose of medication." The client should take furosemide with food or milk to reduce gastric irritation. Wrong "Take each dose of medication in the evening before bed." The client should take each dose of medication in the morning to avoid sleep disturbances from nocturia. "Avoid potassium-rich foods in your diet." The client who takes furosemide has an increased risk for potassium loss because of the diuretic effect of the medication that causes excretion of potassium through the kidneys. The client should increase their intake of potassium-rich foods. "This medication increases your risk for hypertension." The client who takes furosemide has an increased risk of hypotension due to fluid loss from the diuretic effect of the medication.

A nurse is teaching a client who is to start taking ranitidine for peptic ulcer disease. Which of the following client statements should the nurse identify as understand of the teaching?

"I know smoking makes ranitidine less effective." The nurse should instruct the client that smoking decreases the effectiveness of ranitidine by exacerbating the ulcer manifestations. Wrong "I will stop taking ranitidine when my stomach pain is gone." The nurse should instruct the client to take ranitidine on a continuous basis for the prescribed time. "I will take ranitidine anytime my stomach hurts." The nurse should instruct the client to take ranitidine on a continuous basis for the prescribed time. "I know that ranitidine will turn my stools black." Ranitidine does not cause stools to appear black. However, a bleeding peptic ulcer can cause a client's stools to turn black.

A nurse is providing teaching to a client who has depression and a new prescription for flouxetine. Which of the following statements by the client indicates an understanding of the teaching?

"I should take acetaminophen instead of ibuprofen for my headaches while taking this medication." Fluoxetine suppresses platelet aggregation, which increases the risk of bleeding when used concurrently with NSAIDs and anticoagulants. Therefore, clients who are taking fluoxetine should take acetaminophen for headaches or pain, since acetaminophen does not suppress platelet aggregation. Wrong "I will continue to take St. John's Wort to increase the effects of the medication." Concurrent use of St. John's Wort and fluoxetine can increase the client's risk for serotonin syndrome, a potentially life-threatening complication. Manifestations of serotonin syndrome include confusion, hallucinations, hyperreflexia, excessive sweating, and fever. "I will be sure to follow a strict diet to avoid foods with tyramine." Clients taking fluoxetine, a selective serotonin reuptake inhibitor, are not required to restrict their dietary intake of tyramine. A client who is taking an MAOI, such as selegiline, should avoid products containing tyramine. "I should start to feel better within 24 hours of starting this medication." The nurse should inform the client that the therapeutic levels of fluoxetine can take between 1 and 4 weeks to achieve desired effects. The client should take the medication as prescribed and use other strategies to manage depression in the interim.

A nurse is teaching a client who is starting to take diltiazem. Which of the following statements should the nurse identify as an indication that the client understands the teaching.

"I will check my heart rate before I take the medication." Diltiazem, a calcium channel blocker, has cardio-suppressant effects at the SA and AV nodes, which can lead to bradycardia. The client should check their heart rate before taking the medication and notify the provider if it falls below the expected reference range. Wrong "I should expect to gain weight while taking this medication." Diltiazem, a calcium channel blocker, can decrease myocardial contraction, which can lead to heart failure. If the client gains weight or develops shortness of breath, they should notify the provider. "I should not drink orange juice while taking this medication." The client should not drink grapefruit juice while taking diltiazem because it can interfere with metabolism of the medication by increasing the blood levels of diltiazem and leading to toxicity. "I will stop taking the medication if I get dizzy." Diltiazem is a calcium channel blocker that causes vascular dilation, which can result in orthostatic hypotension. The client should rise slowly when standing and avoid hazardous activities until there is a stabilization of the medication and dizziness no longer occurs.

A nurse is providing teaching to a client about the use of ethinyl estradiol/norelgestromin. The nurse should identify that which of the following statements by the client indicates an understanding of the teaching?

"I will fold the sticky sides of the old patch together before disposing it." The client should fold the sticky sides of the old patch together and then place it in a childproof container to ensure safe disposal of the patch. Wrong "I will apply the patch once a week for 2 weeks." The client should apply the patch once a week for 3 weeks and then go without the patch for 1 week to promote menstruation. "I will leave the existing patch on for 4 hours after applying the new patch." The client should remove and dispose the old patch before applying a new patch to prevent toxicity by combining the remaining medication on the old patch with the medication on the new patch. "I will apply the patch within 14 days of menses." The client should apply the patch within 7 days of menses to prevent ovulation and the need for another contraceptive method.

A nurse is teaching about self-administration of transdermal medication with a male client who has a new prescription for nitroglycerin. The nurse should identify that which of the following statements by the client indicated an understanding of the teaching?

"I will remove the patch after 14 hours." The client should remove the patch after 12 to 14 hr to prevent tolerance of the medication. Wrong "I need to apply a new patch to the same area every day." The client should rotate the location of the patch daily to avoid irritation of the skin. "I can take this medication while using an erectile dysfunction product." The client should not use erectile dysfunction products while taking nitroglycerin because this combination can cause severe hypotension and death. "I can apply the patch to a chest area that has hair." The client should apply the patch to an area of the skin that is hairless to enhance absorption of the medication.

A nurse is teaching about a new prescription for ciprofloxacin to a client who has a urinary tract infection. The nurse should identify which of the following statements as an indication that the client understands the teaching?

"I will report any signs of tendon pain or swelling." Ciprofloxacin, a fluoroquinolone, is associated with a risk of tendon rupture. This risk is increased in older adult clients, so the client should notify the provider at the onset of tendon pain or swelling. Wrong "I will take this medication with an antacid to prevent gastrointestinal upset." The client should avoid taking ciprofloxacin with an antacid containing aluminum, magnesium, or calcium because this can decrease the effectiveness of the medication. The nurse should instruct the client to take antacids 2 hr before or 6 hr after the ciprofloxacin. "I will stop taking this medication when I no longer have pain upon urination." The client should take the full course of ciprofloxacin to prevent reoccurring colonization of bacteria. "I will take this medication with milk." The client should take ciprofloxacin with water and increase fluids to 2 to 3 L daily to avoid the development of crystals in the kidneys. Milk products will decrease the absorption of the medication.

A nurse is providing discharge instructions to a client who is to self-administer insulin at home. Which of the following client statements should indicate to the nurse that the teaching is effective?

"I will store my unopened bottles of insulin in the refrigerator." The client should store unopened vials of insulin in the refrigerator to maintain medication viability. Once opened, the insulin can remain at room temperature for up to 1 month. Wrong "I should avoid getting rid of the air bubble in the syringe." The nurse should instruct the client to expel all air bubbles in the syringe to ensure an accurate dosage is delivered. "I should inject the insulin into my thigh for the fastest absorption." The nurse should instruct the client that the fastest absorption of insulin occurs with abdominal injections. Absorption is slowest when the injection is into the thigh. "I need to shake the insulin before using it to make sure it is well mixed." The nurse should instruct the client to mix insulin by rolling the insulin in the palm of their hand to prevent frothing, which can cause the drawing up of an inaccurate dose of insulin.

A nurse is teaching about zolpidem to a client who has insomnia. The nurse should identify that which of the following client statements indicates an understanding of the teaching?

"I will use this medication for a short period of time." Zolpidem is used for short-term treatment of insomnia. Therefore, the provider should reassess the client before refilling the prescription. Wrong I will need to get laboratory testing prior to a refill of this medication." Laboratory testing is not needed when taking this medication for sleep. "I will need to take this medication for 1 week before results are seen." The client who takes zolpidem should experience improved sleep within 2 days of starting this medication. "I will need to change the medications to prevent building up a tolerance." The client who takes zolpidem should not build up a tolerance to the medication with short-term use.

A nurse is providing discharge teaching to a client who has a new prescription for furosemide twice daily. The nurse should include which of the following instructions in the teaching? (select all that apply)

"Take the second dose at bedtime" is incorrect. Furosemide is a loop diuretic that causes diuresis. When taken twice daily, the client should take the second dose of furosemide by 1400 hr to prevent nocturia. "Increase intake of potassium-rich foods" is correct. Loop diuretics, such as furosemide, act at the loop of Henle by blocking the resorption of sodium, water, and potassium. An adverse effect of the medication is the development of electrolyte imbalances such as hyponatremia, hypochloremia, and hypokalemia. To prevent hypokalemia, the client should increase intake of potassium-rich foods, such as potatoes, spinach, dried fruit, and nuts. "Obtain your weight weekly" is incorrect. Loop diuretics cause an increase in fluid excretion and can cause dehydration. While manifestations of dehydration, such as increased thirst and decreased urine output, can assist in the diagnosis of dehydration, the most reliable method of identifying the onset of dehydration is by loss of weight. The client should obtain daily weights to monitor for the diuresis effect of the medication. "Monitor for muscle weakness" is correct. Furosemide, a loop diuretic, causes a loss of potassium, which can result in manifestations of hypokalemia such as difficulty concentrating, shallow respirations, hyporeflexia, and muscle weakness. The nurse should instruct the client to monitor for these manifestations and report them to the provider. "Dangle your legs from the side of the bed before standing" is correct. Loop diuretics, such as furosemide, reduce vascular tone and increase fluid excretion. These effects decrease blood return to the heart and can manifest as dizziness and lightheadedness when going from a lying to a standing position. The client should change positions slowly to minimize orthostatic hypotension.

A nurse is completing an incident report for a medication error. Which of the following information should the nurse include in the report?

Administered propranolol 80 mg PO at 1800 to the client who did not have a prescription for the medication. The incident report should clearly and thoroughly report the facts of the error. Wrong It was easy to get confused because another client is receiving a similar sounding medication. The incident report should clearly and thoroughly report the facts of the error. It should not include the nurse's opinion as to why the error might have occurred. This could have been avoided if I had double checked the medication administration record with the client's identification band. The incident report should clearly and thoroughly report the facts of the error. It should not include the nurse's opinion as to how the error might have been prevented. While I rarely make medication errors, the client was given 80 mg of propranolol by mistake at 1800. The incident report should clearly and thoroughly report the facts of the error. It should not include statements by the nurse regarding personal characteristics.

A nurse is precepting a newly licensed nurse who is caring for four clients. The nurse should complete an incident report for which of the following actions by the newly licensed nurse?

Administers isosorbide mononitrate to a client who has BP 82/60 mm Hg Isosorbide mononitrate is a nitrate used for clients with angina. Taking isosorbide mononitrate leads to vasodilation, which can result in hypotension. The nurse should withhold the medication and notify the provider if the client's systolic blood pressure is below the expected reference range of 120/80. Wrong Administers digoxin to a client who has a heart rate of 92/min Digoxin is a cardiac glycoside used for clients who have heart failure because it strengthens the contractility of the heart, increasing cardiac output. A slowing of the heart rate is an effect of digoxin, so it should be withheld if the client's heart rate is less than 60/min. Administers regular insulin to a client who has a blood glucose of 250 mg/dL Insulin is a hormone that promotes the uptake of glucose into the cells, thereby decreasing circulating glucose. A blood glucose value of 250 mg/dL is above the expected reference range, so the nurse should administer regular insulin. Administers heparin to a client who has an aPTT of 70 seconds Heparin is an anticoagulant that decreases the coagulability of the blood and is used for clients who have thrombus. Dosing of heparin is dependent upon achieving a therapeutic aPTT level. An aPTT of 70 seconds is within the expected reference range when administering heparin.

A nurse is caring for a client who is receiving haloperidol. The nurse should identify which of the following findings as an adverse effect of the medication?

Akathisia An adverse effect associated with haloperidol is the development of extrapyramidal manifestations such as dystonia, pseudoparkinsonism, and akathisia. Wrong Paresthesia Haloperidol, an antipsychotic neuroleptic medication, can cause CNS adverse effects such as seizures, confusion, and neuroleptic syndrome. However, paresthesia is not an adverse effect of haloperidol. Excess tear production Haloperidol has anticholinergic properties that can cause sensory adverse effects such as increased intraocular pressure, blurred vision, and dry eyes. Anxiety Haloperidol can be prescribed to treat severe agitation as well as psychotic manifestations.

A nurse is reviewing the medical record of a client who has hypertension. The nurse should identify which of the following findings as a contraindication for receiving propranolol?

Asthma Asthma is a contraindication for receiving propranolol. Propranolol is an adrenergic antagonist which blocks the beta2 receptors in the lungs, causing bronchoconstriction and leading to serious airway resistance and possibly respiratory arrest. Wrong Cholelithiasis Cholelithiasis is not a contraindication for receiving propranolol. Angina pectoris The client who has angina pectoris can receive propranolol to decrease heart rate and contractility, resulting in a reduction of oxygen demand. Propranolol is contraindicated for use when a client has vasospastic angina. Tachycardia Tachycardia is not a contraindication for receiving propranolol. Propranolol is administered to slow a client's heart rate and decrease oxygen demand.

A nurse is caring for a client who is recovering from deep-vein thrombosis and is to start taking warfarin. For which of the following findings should the nurse monitor as an adverse effect of warfarin?

Bleeding gums The nurse should monitor the client for bleeding gums, which is an adverse effect of warfarin, an anticoagulant. Wrong Constipation The nurse should monitor for gastrointestinal irritation, which can include diarrhea, nausea, and vomiting. Low INR The nurse should monitor the INR daily until it increases to a therapeutic level. Hypertension The nurse should monitor for hypotension, which can indicate bleeding.

A nurse is assessing a client who has received atropine eye drops during an eye examination. Which of the following findings should the nurse expect as an adverse effect of the medication?

Blurred vision Blurred vision is an expected finding following the administration of atropine eye drops. This is due to the cycloplegic effects of the medication, which cause near objects to appear blurry to the client. Wrong Pinpoint pupils Dilation of pupils, or mydriasis, is an expected finding following the administration of atropine eye drops. Difficulty seeing in the dark A client who has received atropine eye drops can experience photosensitivity, which causes difficulty seeing in brightly lit areas due to the muscarinic receptors causing mydriasis. Excessive tearing Excessive tearing is not an expected finding following the administration of atropine eye drops.

A nurse is caring for a client who has magnesium level of 3.1 mEq/L. The nurse should expect to administer which of the following medicaitons?

Calcium gluconate The nurse should expect to administer IV calcium gluconate to the client and prepare to provide ventilatory support. This client is at risk for respiratory depression and cardiac dysrhythmias because a magnesium level of 3.1 mEq/L is above the expected reference range of 1.3 to 2.1 mEq/L. Wrong Magnesium gluconate A magnesium level of 3.1 mEq/L is above the expected reference range of 1.3 to 2.1 mEq/L. Magnesium gluconate is administered to treat hypomagnesemia. Cinacalcet Cinacalcet is administered to treat hypercalcemia. Regular insulin Regular insulin is administered to treat hyperkalemia.

A nurse is reviewing laboratory results for a client who is to receive a dose of ceftazidime via intermittent IV bolus. Which of the following laboratory findings is the priority for the nurse to report to the provider before administering the medication?

Ceftazidime is excreted primarily by the renal system. A serum creatinine level above 1.3 mg/dL can indicate a kidney disorder requiring a reduction in the dose administered. The nurse should notify the provider, who is likely to prescribe a lowered dose of medication. Wrong Total bilirubin 0.4 mg/dL Ceftazidime, a cephalosporin, can cause elevated liver function tests, such as bilirubin. However, a total bilirubin value of 0.4 mg/dL is within the expected reference range. Alanine aminotransferase 26 units/L Ceftazidime can cause elevated liver function tests, such as alanine aminotransferase. However, an alanine aminotransferase value of 26 units/L is within the expected reference range. Platelet count 360,000/mm3 Ceftazidime can cause thrombocytopenia. However, a platelet count of 360,000/mm3 is within the expected reference range.

A nurse is providing teaching to a client who is to start taking sumatriptan. Which of the following adverse effects should the nurse instruct the client to monitor for and report to the provider?

Chest pressure Sumatriptan is an antimigraine agent which can cause coronary vasospasms, resulting in angina. The client should report chest pressure or heavy arms to the provider. Wrong White patches on the tongue White patches on the tongue can indicate a fungal infection, which is not an adverse effect of sumatriptan. Bruising Ecchymosis can indicate thrombocytopenia, which is not an adverse effect of sumatriptan. ​Insomnia Sumatriptan can cause drowsiness and sedation as an adverse effect of the medication.

A nurse is caring for a client who has hypocalcemia and is receiving calcium citrate. The nurse should identify that which of the following findings indicates a therapeutic response to the medication?

Client report of decreased paresthesia Paresthesia is a manifestation of hypocalcemia. A client report of a decrease in paresthesia is an indication of a therapeutic response to calcium citrate. The nurse should also monitor for a decrease in other manifestations of hypocalcemia, including muscle twitching and cardiac dysrhythmias. Wrong Positive Chvostek's sign A positive Chvostek's sign is a manifestation of hypocalcemia and does not indicate a therapeutic response to calcium citrate. Client report of increased thirst An increase in thirst is a manifestation of hypercalcemia and can be an indication of calcium toxicity. The nurse should monitor the client for other manifestations of hypercalcemia, such as nausea, vomiting, or anorexia. Calcium level of 8.8 mg/dL A calcium level of 8.8 mg/dL is below the reference range of 9.0 to 10.5 mg/dL and does not indicate a therapeutic response to calcium citrate.

A nurse is caring for a client who is taking atorvastatin for hyperlipidemia. Which of the following client laboratory values should the nurse monitor?

Creatinine kinase The client who is taking atorvastatin can develop an adverse effect called rhabdomyolysis, which causes muscle weakness or pain and can progress to myositis. Creatinine kinase levels rise in response to enzymes released with muscle injury. Wrong Erythrocyte sedimentation rate Erythrocyte sedimentation rates (ESR) evaluate the speed at which red blood cells settle in plasma over a set amount of time. The nurse should monitor ESR for clients who have multiple myeloma, rheumatoid arthritis, and systemic lupus erythematosus. However, ESR is not affected by statins, such as atorvastatin. International normalized ratio The international normalized ratio (INR) measures clotting abilities of the blood. The nurse should monitor INR for clients who are receiving warfarin therapy. Potassium Potassium is a major electrolyte that maintains acid-base balance, oncotic pressure, and cardiac rhythm. The nurse should monitor potassium levels in clients who are receiving loop diuretics, such as bumetanide.

A nurse is planning to teach about inhalant medications to a client who has a new diagnosis of exercise-induced asthma. Which of the following medications should the nurse plan to instruct the client to use prior to physical activity?

Cromolyn Cromolyn sodium stabilizes mast cells, which inhibit the release of histamine and other inflammatory mediators. The client should use cromolyn 10 to 15 min before planning to exercise to prevent bronchospasms. Wrong Beclomethasone Beclomethasone is a prophylactic glucocorticoid inhalant medication that suppresses the inflammatory and humoral immune responses. Beclomethasone should be administered with a fixed schedule, not for PRN use before physical exercise. Budesonide Budesonide is a glucocorticoid medication used to treat asthma as a long-term inhaled agent. This medication is administered by inhalation twice daily, not prior to physical activity. Tiotropium Tiotropium is an anticholinergic medication that decreases mucus production and produces bronchodilation. Tiotropium is used for maintenance therapy of bronchospasms and has a duration of 24 hr.

A nurse is administering baclofen for a client who has a spinal cord injury. Which of the following findings should the nurse document as a therapeutic outcome?

Decrease in flexor and extensor spasticity A client who has a spinal cord injury and takes baclofen can experience a decrease in the frequency and severity of muscle spasms and in flexor and extensor spasticity. Wrong Increase in seizure threshold A client who has a seizure disorder and takes baclofen can have a decrease in the seizure threshold, which can result in seizure activity. Increase in cognitive function A client who takes baclofen can experience the adverse effect of memory impairment and a decrease in cognitive function. Decrease in paralysis of the extremities A client who takes baclofen can experience the adverse effect of inhibited reflexes at the spinal level; however, this medication does not decrease the effects of paralysis.

A nurse is administering cefotetan via intermittent IV bolus to a client who suddenly develops dyspnea and widespread hives. Which of the following actions should the nurse take first?

Discontinue the medication IV infusion. The greatest risk to the client is respiratory arrest from anaphylaxis. Therefore, the first action the nurse should take is to discontinue the medication IV infusion to prevent the client from receiving more medication. However, the nurse should not remove the IV catheter. Instead, the nurse should change the tubing and administer 0.9% sodium chloride by continuous IV infusion. Wrong Administer epinephrine 0.5 mL via IV bolus. The nurse should administer epinephrine, which is a beta-adrenergic agonist that can stimulate the heart, cause vasoconstriction of blood vessels in the skin and mucous membranes, and cause bronchodilation in the lungs. However, there is another action the nurse should take first. Elevate the client's legs above the level of the heart. The nurse should elevate the client's legs and feet to a level above the client's heart to facilitate blood flow to the vital organs. However, there is another action the nurse should take first. Collect a blood specimen for ABGs. The nurse should collect a blood specimen for ABGs levels to evaluate the client's respiratory status. However, there is another action the nurse should take first.

A nurse is caring for a client who has developed hypomagnesemia due to long-term therapy with lansoprazole. The nurse should monitor the client for which of the following manifestations?

Disorientation The nurse should monitor the client for disorientation and confusion as manifestations of hypomagnesemia. The nurse should also assess the client for a positive Chvostek's and Trousseau's signs. Wrong Muscle weakness The nurse should monitor the client for neuromuscular irritability, such as tremors, as a manifestation of hypomagnesemia. Hypotension The nurse should monitor the client for hypertension as a manifestation of hypomagnesemia. Bradycardia The nurse should monitor the client for tachycardia as a manifestation of hypomagnesemia.

A nurse is teaching a client who has a new prescription for docustate sodium about the medication's mechanism of action. Which of the following information should the nurse include in the teaching?

Docusate sodium reduces the surface tension of the stools to change their consistency. Docusate sodium is a surfactant that softens stool by reducing surface tension, allowing water to penetrate more easily into the stool. Wrong Osmotic laxatives, such as glycerin suppositories, act by lubricating the lower colon and initiating reflex contractions of the rectum. Docusate sodium acts as a fiber agent, increasing bulk in the intestines. Bulk-forming laxatives, such as methylcellulose, mimic the action of dietary fiber, forming a viscous compound that softens the fecal mass and increases its bulk, which stimulates peristalsis. Docusate sodium stimulates the motility of the intestines. Stimulant laxatives, such as bisacodyl, stimulate the intestinal wall to cause peristalsis by pulling water into the intestines.

A nurse is caring for a client who has pneumonia. The client tells the nurse she is pregnant and that she has not told her provider yet. The nurse should identify that pregnancy is a contraindication for receiving which of the following medications?

Doxycycline Doxycycline is a tetracycline antibiotic. The nurse should identify that doxycycline can cause teratogenic effects such as staining of the infant's teeth when exposed to this medication. Therefore, this medication is contraindicated for the client. Wrong Benzonatate Benzonatate is a cough suppressant and is not contraindicated for a client who is pregnant. Ipratropium Ipratropium is a long-acting bronchodilator and is not contraindicated for a client who is pregnant. Acetaminophen Acetaminophen treats mild pain and is not contraindicated for the client at this time. Acetaminophen IV is used with caution among clients who are pregnant or lactating.

A nurse is teaching a client who is taking allopurinol for the treatment of gout. Which of the following information should the nurse include in the teaching?

Drink 2 L of water daily. The nurse should instruct the client to drink at least 2 L of water each day to prevent renal stone formation and kidney injury, because allopurinol is eliminated through the kidneys. Wrong Plan to increase the dosage each week by 200 mg increments. The nurse should instruct the client to increase the dosage each week by 50 to 100 mg until they experience relief or reach a maximum of 800 mg daily. Prolonged use of the medication can cause glaucoma. The nurse should instruct the client that the prolonged use of allopurinol can cause cataracts; therefore, the client should have periodic ophthalmic checkups. A fine red rash is transient and can be treated with antihistamines. The nurse should instruct the client to report a rash to the provider immediately as this can be an indication of hypersensitivity syndrome, a life-threatening toxicity. Treatment for allopurinol toxicity can require hemodialysis or the administration of glucocorticoid medications.

A nurse is providing teaching to a client who has a prescription for trimethoprim/sulfamethoxazole. Which of the following instructions should the nurse include in the teaching?

Drink 8 to 10 glasses of water daily. The nurse should instruct the client to increase water intake to 1,920 to 2,400 mL (65 to 81 oz) a day to decrease the chance of kidney damage from crystallization. Wrong Expect a fine, red rash as a transient effect. The nurse should instruct the client to notify the provider if a rash develops, because this can be an indication of Stevens-Johnson syndrome. However, the client should not expect to have a fine, red rash as a transient effect. Take the medication with food. The nurse should instruct the client to take the medication on an empty stomach either 1 hr before or 2 hr after meals. Store the medication in the refrigerator. The nurse should inform the client to store trimethoprim/sulfamethoxazole in a light-resistant container at room temperature.

A nurse is assessing a client who is taking amitriptyline for depression. Which of the following findings should the nurse identify as an adverse effect of the medication?

Dry mouth The nurse should expect the client to have a dry mouth due to the blocking of acetylcholine receptors that cause anticholinergic responses. Wrong Tinnitus Amitriptyline is a tricyclic antidepressant medication that has anticholinergic properties. The nurse should assess for sensory-neurologic adverse effects such as blurred vision or an increased sensitivity to light. However, tinnitus is not an expected finding. Urinary frequency The nurse should assess the client for genitourinary anticholinergic effects such as urinary hesitancy or retention due to the blocking of acetylcholine receptors that cause anticholinergic responses. However, urinary frequency is not an expected finding. Exopthalmos The nurse should assess the client for ophthalmic anticholinergic effects such as blurred vision and mydriasis, dilation of the pupil. However, exophthalmos, bulging of the eyes, is not an expected finding.

A nurse is administering diazepam to a client who is having a colonoscopy. Which of the following actions should the nurse take?

Ensure flumazenil is available to administer for toxicity management. The nurse should monitor the client for manifestations of diazepam toxicity, such as respiratory depression and hypotension. The nurse should be prepared to administer flumazenil to reverse the effects of diazepam. Wrong Monitor the client for an increase in blood pressure. The nurse should monitor the client for the adverse effect of hypotension. Expect the client to become unconscious within 30 seconds. When diazepam is administered IV for induction of anesthesia, the nurse should expect the client to develop the full effect of the medication in 2 min. Measure the capnography level every hour until the client is awake and oriented. The nurse should measure the capnography level every 15 to 30 min until the client is awake and oriented and vital signs have returned to baseline.

A nurse contacts a client's provider on the telephone to obtain a prescription for pain medication. Which of the following actions should the nurse take?

Have the provider spell out the unfamiliar medication names. The nurse should ask the provider to spell out the name of the medication if the stated name is one the nurse is not familiar with. Wrong Write the order on a prescription pad designated for the client's provider. The nurse should write the order on the provider's order form in the client's medical record or place the order into the computer on the provider's order form according to facility policy. Read the prescription back to the provider using abbreviations. The nurse should read the prescription back to the provider using words in place of abbreviations to reduce the risk of error. The nurse should ask the provider to acknowledge that the prescription is correct after having it read back. Consult with a second nurse for any questions regarding dosage. The nurse should consult the provider about any questions concerning the prescription.

A nurse is caring for a client who has sickle cell anemia and is taking hydroxyurea. Which of the following findings should the nurse report to the provider? (select all that apply)

Hemoglobin 7.0 g/dL is correct. A hemoglobin level of 7.0 g/dL indicates hydroxyurea toxicity. This hemoglobin level is below the expected reference range of 14 to 19 g/dL for a male client and 12 to 16 g/dL for a female client. Therefore, the nurse should report this finding to the provider. Creatinine 1 mg/dL is incorrect. A creatinine level of 1 mg/dL is within the expected reference range of 0.5 mg/dL to 1.2 mg/dL. RBC 4.7 million/mm3 is incorrect. An RBC count of 4.7 million/mm3 is within the expected reference range of 4.7 to 6.1 million/mm3 for a male client and 4.2 to 5.4 million/mm3 for a female client. Platelets 75,000/mm3 is correct. A platelet level of 75,000/mm3 indicates hydroxyurea toxicity. This platelet level is below the expected reference range of 150,00 to 400,000/mm3. Therefore, the nurse should report this finding to the provider. Potassium 5.2 mEq/L is correct. A potassium level of 5.2 mEq/L indicates tumor lysis syndrome. This potassium level is above the expected reference range of 3.5 to 5 mEq/L. Therefore, the nurse should report this finding to the provider.

A nurse is caring for a client who has heart failure and a prescription for enalapril. The nurse should monitor the client for which of the following findings as an adverse effect of the medication?

Hyperkalemia Enalapril improves cardiac functioning in clients who have heart failure and can cause hyperkalemia due to potassium retention by the kidneys. Wrong Bradycardia Enalapril is an ACE inhibitor that has several cardiovascular adverse effects including hypotension, tachycardia, and dysrhythmias. Loss of smell Enalapril can cause several sensory adverse effects such as a loss of taste. However, it does not cause a loss of smell. Hypoglycemia Enalapril does not cause hypoglycemia.

A nurse in a provider's office is assessing a client who has been taking aspirin daily for the past year. For which of the following findings should the nurse notify the provider immediately?

Hyperventilation When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is hyperventilation. This finding indicates the client might have acute salicylate poisoning, which causes respiratory alkalosis in the early stages. Wrong Heartburn Heartburn is nonurgent because the client who is taking aspirin can experience gastrointestinal distress. Therefore, there is another finding that is the nurse's priority. Anorexia Anorexia is nonurgent because the client who is taking aspirin can experience a decrease in appetite. Therefore, there is another finding that is the nurse's priority. Swollen ankles Swollen ankles are nonurgent because the client who is taking aspirin can experience sodium and fluid retention. Therefore, there is another finding that is the nurse's priority.

A nurse is assessing a client who is receiving epoetin alfa to treat anemia. Which of the following findings should the nurse monitor?

Increased blood pressure The therapeutic effect of epoetin alfa is an increase in hematocrit levels, which can result in an increase in a client's blood pressure. If the client's hematocrit level rises too rapidly, hypertension and seizures can result. The nurse should monitor the client's blood pressure and ensure hypertension is controlled prior to administering the medication. Wrong Paresthesia Epoetin alfa stimulates the bone marrow to increase production of red blood cells. Adverse effects include neurological manifestations such as seizures, headache, and dizziness. However, epoetin alfa does not cause paresthesia. Fever Adverse effects of epoetin alfa include neurological manifestations such as coldness and sweating. However, it does not cause fever. Respiratory depression Heart failure is an adverse effect of epoetin alfa. The nurse should monitor the client's respiratory status and notify the provider if the client develops crackles or rhonchi. However, epoetin alfa does not cause respiratory depression.

A nurse is caring for a client who has heart failure and is receiving an IV infusion of dopamine. Which of the following findings indicated that the medication is effective?

Increased cardiac output Dopamine is an adrenergic that causes a receptor specificity effect, which increases cardiac output and improves perfusion. Wrong Increased heart rate Tachycardia is an adverse effect of dopamine and does not indicate the medication's effectiveness. Decreased blood pressure Dopamine is an adrenergic that causes a receptor specificity effect, which increases blood pressure. Decreased serum potassium Dopamine does not affect serum potassium levels.

A nurse is assessing a client who is taking tamoxifen to treat breast cancer. Which of the following findings is the priority for the nurse report to the provider?

Leg tenderness The greatest risk to this client is the development of a thromboembolism, which is an adverse effect of tamoxifen. The nurse should also monitor the client for other manifestations of a thromboembolism, including leg tenderness, redness, swelling, and shortness of breath. Wrong Vaginal dryness The client is at risk for vaginal dryness as an adverse effect of tamoxifen; however, another finding is the priority to report to the provider. The nurse should encourage the client to use vaginal moisturizers if dryness occurs. Gastrointestinal irritation The client is at risk for gastrointestinal irritation (GI) as an adverse effect of tamoxifen; however, another finding is the priority to report to the provider. The nurse should administer the medication with food or fluids to reduce GI irritation. Hot flashes The client is at risk for hot flashes as an adverse effect of tamoxifen; however, another finding is the priority to report to the provider. The nurse should encourage the client to avoid caffeine and spicy foods to prevent hot flashes.

A nurse is caring for a client who is to receive treatment for opioid use disorder. Which of the following medications should the nurse expect to administer?

Methadone The nurse should expect to administer methadone for treatment of opioid use disorder. Methadone can be administered for withdrawal and to assist with maintenance and suppressive therapy. Wrong Disulfiram The nurse should administer disulfiram as an aversion therapy to assist with maintaining abstinence from alcohol. Bupropion The nurse should administer bupropion to assist the client with smoking cessation. Modafinil The nurse should administer modafinil to assist with the fatigue and prolonged sleep from methamphetamine withdrawal.

A nurse administered digoxin immune Fab to a client who received the incorrect dose of digoxin over a period of 3 days. The nurse should identify that which of the following findings indicates the antidote was effective?

Normal sinus rhythm Dysrhythmias are a life-threatening adverse effect of digoxin toxicity. The return of the heart to normal sinus rhythm indicates a therapeutic response to the antidote. Digoxin immune Fab is administered to a client who is experiencing severe digoxin toxicity. It binds with digoxin and works to reduce the client's blood digoxin level. Wrong Digoxin level of 2.5 ng/mL A digoxin level of 2.5 ng/mL is above the expected reference range of 0.8 to 2 ng/mL. Therefore, this finding does not indicate a therapeutic response to the antidote. Decrease in blood pressure A decrease in blood pressure is not an indication of a therapeutic response to the antidote. Potassium level of 3.2 mEq/L A potassium level of 3.2 mEq/L is below the expected reference range of 3.5 to 5.0 mEq/L. A decreased potassium level can lead to toxicity in a client who is taking digoxin. However, digoxin immune Fab is administered only for severe toxicity.

A nurse is caring for a client who reports lethargy and myalgia after taking clozapine for 6 months. Which of the following actions should the nurse plan to take?

Obtain WBC with absolute neutrophil count. The client who takes clozapine can develop lethargy and myalgia caused by the adverse effect of agranulocytosis. Therefore, monitoring the WBC with absolute neutrophil count weekly for the first 6 months of treatment is recommended. After 6 months, monitoring can occur every 2 weeks up to 1 year. Wrong Infuse 0.9% sodium chloride 1,000 mL IV fluid bolus. The client who is dehydrated can receive 0.9% sodium chloride IV bolus, but it is not used to treat the adverse effects of lethargy, myalgia, and weakness associated with clozapine. Schedule the client for an electroencephalogram. The client who develops seizures can have an electroencephalogram, but it is not used to treat or diagnose the client who has lethargy and myalgia. Place the client on a tyramine-free diet. The client can take clozapine with or without food and does not need to follow a tyramine-free diet. A client who is taking monoamine oxidase inhibitors should follow a tyramine-free diet.

A nurse is preparing to administer hydrochlorothiazide to a client. Which of the following actions should the nurse take prior to administering the medication?

Obtain the client's blood pressure. HCTZ is a thiazide diuretic administered to promote urine output and reduce blood pressure and edema. The nurse should obtain the client's blood pressure prior to administration of the medication. Wrong Determine if the client is allergic to NSAIDs. The nurse should assess the client for an allergy to sulfonamides due to the potential of cross-sensitivity with HCTZ. NSAIDs can decrease the effectiveness of HCTZ. Review the client's most recent Hgb level. HCTZ does not affect Hgb levels. The nurse should monitor the client's electrolytes, especially potassium, before and periodically while the client is taking this medication. Ask the client to drink 8 oz of water. HCTZ is a thiazide diuretic administered to promote urine output and reduce blood pressure and edema. The client does not need to drink 8 oz of water prior to taking the medication.

A nurse is providing teaching to a client who has a new prescription for ferrous sulfate. The nurse should instruct the client to take the medication with which of the following to promote absorption?

Orange juice The absorption of ferrous sulfate is enhanced by a vitamin C source, such as orange juice. Wrong Vitamin E Vitamin E has no effect on iron absorption. Milk Milk inhibits iron absorption. Antacids Antacids inhibit iron absorption.

A nurse is monitoring for adverse effects of hydrochlorothiazide after administering the medication to an older adult client who has heart failure. Which of the following findings should the nurse identify as an adverse effect of the medication?

Orthostatic hypotension The nurse should identify that hydrochlorothiazide is an antihypertensive thiazide diuretic medication, which can cause orthostatic hypotension and light headedness. Therefore, the nurse should instruct the client to rise slowly when moving from a recumbent to a standing position. Wrong Hypoglycemia Hydrochlorothiazide is an antihypertensive thiazide diuretic medication, which can cause hyperglycemia. Bradycardia The nurse should identify palpitations as an adverse effect of hydrochlorothiazide, which is an antihypertensive thiazide diuretic medication. Conjunctivitis The nurse should identify that hydrochlorothiazide is an antihypertensive thiazide diuretic medication and may have the adverse effects of blurred vision and xanthopsia, which causes objects to appear yellow. Conjunctivitis is not an adverse effect of this medication.

A nurse is caring for a client who has diabetes mellitus and is taking glyburide. The client reports feeling confused and anxious. Which of the following actions should the nurse take first?

Perform a capillary blood glucose test. The greatest risk to this client is injury from hypoglycemia. Therefore, the nurse should perform a capillary blood glucose test to determine the client's blood glucose status. Manifestations of hypoglycemia include weakness, anxiety, confusion, sweating, and seizures. Wrong Provide the client with a protein-rich snack. The nurse should provide the client with a protein-rich snack after determining the client's blood glucose value and providing a carbohydrate first. However, there is another action that the nurse should take first. Give the client 120 mL (4 oz) of orange juice. The nurse should give the client 10 to 15 g of carbohydrates, such as 4 oz of orange juice, to treat hypoglycemia. However, there is another action that the nurse should take first. Schedule an early meal tray. The nurse should schedule an early meal tray to maintain the client's blood glucose level following the initial interventions for hypoglycemia. However, there is another action the nurse should take first.

A circulating nurse is planning care for a client who is scheduled for surgery and has a latex allergy. Which of the following actions should the nurse include

Place monitoring cords and tubes in a stockinet. The nurse should place monitoring devices in a stockinet to prevent direct contact with the client's skin. Wrong Schedule the client for the last surgery of the day. The nurse should schedule the client for the first surgery of the day to minimize the client's exposure to latex, including latex dust. Choose rubber injection ports for fluid administration. The nurse should ensure that latex-free products are used in the care of this client. Rubber injection ports contain latex, which puts the client at risk for a severe allergic reaction. Ensure phenytoin IV is readily available. The nurse should ensure that epinephrine is readily available in the operating room in case of an anaphylactic reaction caused by an accidental exposure to latex.

A nurse is preparing to mix and administer dantrolene via IV bolus to a client who has developed malignant hyperthermia during surgery. Which of the following actions should the nurse take?

Reconstitute the initial dose with 60 mL of sterile water without a bacteriostatic agent. The nurse should dilute the medication with 60 mL of sterile water without a bacteriostatic agent and inject rapidly. Wrong Use the reconstituted medication within 12 hr. The nurse should use the reconstituted medication within 6 hr. Store the reconstituted medication in the refrigerator. The nurse should store the reconstituted medication at room temperature and protect it from light until use. Administer the reconstituted medication slowly over 5 min. The nurse should administer reconstituted dantrolene via IV bolus rapidly through a large bore IV or central line.

A nurse is caring for a client who is receiving end-of-life care and has a prescription for fentanyl patches. Which of the following information regarding the adverse effects of fentanyl should the nurse plan to give to the client and family?

Take a stool softener on a daily basis. Constipation is an adverse effect of opioid use. Stool softeners can decrease the severity of this adverse effect. Wrong Expect an increase in urinary output. Urinary retention is an adverse effect of opioids, including fentanyl. Remove the patch to reverse the adverse effects immediately. After removing the patch, the effects will persist for several hours due to the absorption of the residual medication on the skin. The provider will prescribe naloxone at home for respiratory depression. Naloxone is only for use in an acute care setting for the reversal of severe respiratory depression.

A nurse administers ceftazidime to a client who has severe penicillin allergy. The nurse should identify which of the following client findings as an indication that she should complete an incident report?

The client reports shortness of breath. A severe penicillin allergy is a contraindication for taking ceftazidime, a cephalosporin antibiotic, due to the potential for cross-sensitivity. Shortness of breath can indicate the client is developing anaphylaxis. Wrong The client is also taking lisinopril. Lisinopril is an ACE inhibitor medication that has no known interaction with cephalosporins. The client's pulse rate is 60/min. Cephalosporins do not affect the client's pulse rate. The client's pulse rate of 60/min is within the expected reference range. The client's WBC count is 14,000/mm3. An elevated WBC count is an indication the client has an infection and should receive antibiotic therapy.

A nurse in a clinic is caring for a client who is taking aspirin for the treatment of arthritis. The nurse should identify which of the following findings as an indication that the client is beginning to exhibit salicylism?

Tinnitus Tinnitus is a manifestation of aspirin toxicity, also called salicylism. Other manifestations include sweating, headache, and dizziness. Wrong Excessive bruising Excessive bruising is a possible adverse effect of aspirin therapy, caused by the antiplatelet effects of the medication. However, excessive bruising is not an indication of salicylism. Oliguria Kidney impairment is an adverse effect associated with aspirin use. Manifestations include reduced urinary output, weight gain, and elevated BUN and creatinine levels. However, oliguria is not an indication of salicylism. Gastric distress Gastric distress is a possible adverse effect of aspirin therapy, but it is not an indication of salicylism. Gastric distress can be minimized by taking aspirin with food or an enteric form of the medication.

A nurse is reviewing the medical record of a client who has schizophrenia and a prescription of clozapine. Which of the following laboratory tests should the nurse review before administering the medication.

Total cholesterol MY ANSWER The nurse should review the client's total cholesterol before administering clozapine, because this medication can cause hyperlipidemia.

A nurse is teaching a client who is starting to take amitriptyline. Which of the following findings should the nurse include in the teaching as an adverse effect of the medication?

Urinary retention The nurse should instruct the client that amitriptyline causes the anticholinergic effect of urinary retention. Wrong Cough Developing a cough is not an adverse effect of amitriptyline. Muscle twitching Muscle twitching is not an adverse effect of amitriptyline. Increased libido A decrease in libido is an adverse effect of amitriptyline.

A nurse is reviewing the laboratory results of a client who is taking carbamazepine for a seizure disorder. Which of the following findings should the nurse report to the provider?

WBC 3,500/mm3 A WBC count of 3,500/mm3 is below the expected reference range of 5,000 to 10,000/mm3. Leukopenia is an adverse effect of carbamazepine. The nurse should report this finding to the provider and monitor the client for manifestations of infection. Wrong Carbamazepine level 7 mcg/mL A carbamazepine level of 7 mcg/mL is within the expected reference range of 5 to 12 mcg/mL and is an expected finding. 24-hour urine glucose 300 mg/day A 24-hour urine glucose of 300 mg/day is within the expected reference range of 50 to 300 mg/day. The nurse should continue to monitor this value because carbamazepine can cause an elevation in urine glucose levels. Potassium 4.1 mEq/L A potassium level of 4.1 mEq/L is within the expected reference range of 3.5 to 5 mEq/L. The nurse does not need to monitor potassium levels for a client taking carbamazepine; however, the nurse should monitor sodium levels due to the potential adverse effect of hyponatremia.

A nurse is preparing to administer a new prescription of amoxicillin/clavulanic to a client. The client tells the nurse that they are allergic to penicillin. Which of the following actions should the nurse take first?

Withhold the medication. When using the urgent vs nonurgent approach to client care, the nurse should determine that the priority action is to withhold the medication to prevent injury to the client. Wrong Notify the provider. It is important to notify the provider because the client will need a new prescription; however, the nurse should take another action first. Update the client's medical record. It is important to update the client's medical record to have complete information available; however, the nurse should take another action first. Inform the pharmacist of the client's allergy to penicillin. It is important to inform the pharmacist of the allergy to promote continuity of care; however, the nurse should take another action first.

A nurse is providing teaching to a client who is to start therapy with digoxin. For which of the following effects should the nurse instruct the client to monitor and report to the provider?

Yellow-tinged vision The nurse should instruct the client to monitor for and report yellow-tinged vision, which is a sign of digoxin toxicity. Other manifestations of digoxin toxicity include nausea, vomiting, loss of appetite, and fatigue. As the digoxin levels increase, the client can experience cardiac dysrhythmias. Wrong Bruising Clients taking an anticoagulant, such as enoxaparin, might develop bruising and should report this adverse effect to the provider. However, hematologic adverse effects are not associated with digoxin. Pedal edema Clients taking a calcium channel blocker, such as verapamil, might develop pedal edema and should report this adverse effect to the provider. However, peripheral edema is not associated with digoxin. Dry cough Clients taking an ACE inhibitor, such as captopril, might develop a dry cough due to a buildup of bradykinin and should report this adverse effect to the provider. However, respiratory adverse effects are not associated with digoxin.

A nurse is preparing to teach a client who is to start a new prescription for extended release verapamil. Which of the following instruction should the nurse plan to include?

​Change positions slowly. The nurse should instruct the client to change positions gradually to prevent orthostatic hypotension and syncope. Wrong Discontinue the medication if palpitations occur. The nurse should instruct the client that verapamil can cause palpitations, which should be reported to the provider. The client should never discontinue the medication abruptly because the client might experience chest pain. ​Avoid crowds. Avoiding crowds is not necessary for the client who is taking verapamil because it does not cause an immunosuppression disorder. Take the medication on an empty stomach. The nurse should instruct the client to take extended release verapamil with food to minimize gastric distress.