Pharm b

A nurse is caring for a client who is taking atorvastatin for hyperlipidemia. Which of the following client laboratory values should the nurse monitor? A) Creatinine kinase B) Erythrocyte sedimentation rate C) International normalized ratio D) Potassium

A) Creatinine kinase The client can develop an adverse effect called rhabdomyolysis, which causes muscle weakness or pain and can progress to myositis. Creatinine kinase (CK) levels rise in response to enzymes released with muscle injury.

A nurse is providing follow up care to a client who is taking lisinopril. Which of the following manifestations should the nurse instruct the client to report as an adverse effect of lisinopril? A) Drowsiness B) Hallucinations C) Persistent cough D) Weight gain

C) Persistent cough Lisinopril is an ACE inhibitor that can cause a persistent, dry, irritating, nonproductive cough from an excessive buildup of bradykinin. The client should report this adverse effect to the provider.

A nurse is teaching a client about the use of risedronate for the treatment of osteoporosis. The nurse should identify which of the following statements as an indication that the client understands the teaching? A) "I will drink a glass of milk when I take the risedronate." B) "I will take the risedronate 15 minutes after my evening meal." C) "I should take an antacid with the risedronate to avoid nausea." D) "I should sit up for 30 minutes after taking the risedronate."

D) "I should sit up for 30 minutes after taking the risedronate." Sitting upright for at least 30 min after taking risedronate will reduce the adverse gastrointestinal effects of esophagitis and dyspepsia. Risedronate is contraindicated for a client who cannot sit or stand upright for this length of time. The absorption of risedronate, a bisphosphonate, will be reduced if it is taken with antacids containing calcium, aluminum, or magnesium. The nurse should instruct the client to take the antacid 2 hr after taking risedronate. Although the delayed release form of the medication can be taken after eating, the immediate release form of the medication should be taken at least 30 min prior to consuming food or other liquids. Both forms of medication should be taken in the morning upon arising.

A nurse is caring for a client in the emergency department following a diazepam overdose. Which of the following medications should the nurse anticipate administering to the client? A) Naloxone B) Leucovorin C) Neostigmine D) Flumazenil

D) Flumazenil Flumazenil is a benzodiazepine receptor antagonist that can decrease the sedative effects of benzodiazepines, such as diazepam. The nurse should administer the medication via IV bolus, titrating doses as needed, for a maximum of 3 mg. However, the medication can precipitate seizures and might not reverse respiratory depression, so airway support may be necessary.

A nurse is caring for a client who is receiving cefazolin IV. The nurse should identify that which of the following medications can potentiate nephrotoxicity if administered concurrently? A) Famotidine B) Levofloxacin C) Metoclpramide D) Gentamicin

D) Gentamicin Gentamicin, an aminoglycoside antibiotic, can damage renal function. When combined with a penicillin or cephalosporin, such as cefazolin, the client is at increased risk for nephrotoxicity.

A nurse is providing teaching to a client who is taking bupropion as an aid to quit smoking. which of the following finding should the nurse identify as an adverse effect of the medication? A) Cough B) Joint pain C) Alopecia D) Insomnia

D) Insomnia Bupropion, an atypical antidepressant, has stimulant properties, which can result in agitation, tremors, mania, and insomnia. Bupropion can cause neurologic adverse effects such as bradykinesia. However, it does not cause joint pain. Bupropion can cause sensory adverse effects such as changes in vision and hearing. However, it does not cause alopecia.

A nurse is providing teaching for a client who has multiple sclerosis and a new prescription for methylprednisolone. Which of the following instructions should the nurse include? A) "Blood glucose levels will need to be monitored during therapy." B) "Avoid contact with persons who have known infections." C) "Take the medication 1 hour before a meal." D) "Decrease intake of foods containing potassium. " E) "Grapefruit juice can increase the blood levels of the medication."

A) "Blood glucose levels will need to be monitored during therapy.": The nurse should instruct the client that his blood glucose levels will be monitored during therapy because corticosteroids, such as methylprednisolone, can raise blood glucose levels B) "Avoid contact with persons who have known infections.": 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. E) "Grapefruit juice can increase the blood levels of the medication.": The nurse should instruct the client that grapefruit juice increases the absorption of the medication leading to toxicity and adrenal suppression.

A nurse is caring for a client who is receiving haloperidol. The nurse should observe for which of the following findings as an adverse effect of the medication? A) Akathisia B) Paresthesia C) Excess tear production D) Anxiety

A) Akathisia A significant adverse effect associated with haloperidol is the development of extrapyramidal symptoms such as dystonia, pseudoparkinsonism, and akathisia. Haloperidol, an antipsychotic neuroleptic medication, can cause a number of CNS adverse effects including seizures, confusion, and neuroleptic syndrome. However, paresthesia is not an adverse effect of haloperidol.

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 o use prior to physical activity? A) Cromolyn B) Beclomethasone C) Budesonide D) Tiotropium

A) 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. - 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 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 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 teaching a client who has a new prescription for docusate sodium about the medications mechanism of action. Which of the following information should the nurse include in the teaching? A) Docusate sodium reduces the surface tension of the stools to change their consistency. B) Docusate sodium causes rectal contractions. C) Docusate sodium acts as a fiber agent, increasing bulk in the intestines. D) Docusate sodium stimulates the motility of the intestines.

A) 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.

A nurse is providing teaching to a client who is to begin taking oxybutynin for urinary incontinence. The nurse should instruct the client to report which of the following findings as an adverse effect of the medication? (Select all that apply) A) Dry mouth B) Tinnitus C) Blurred vision D) Bradycardia E) Dry eyes

A) Dry mouth: Oxybutynin is an anticholinergic agent that can cause dry mouth. C) Blurred vision: Oxybutynin is an anticholinergic agent that can cause blurred vision due to an increase in intraocular pressure. E) Dry eyes: Oxybutynin is an anticholinergic agent that can cause dry eyes and mydriasis, or pupil dilation.

A nurse is teaching about neural tube defects to a client who is planning a pregnancy. Which of the following vitamins should the nurse instruct the client to start taking before becoming pregnant? A) Folic acid B) Thiamine C) Pyridoxine D) Riboflavin

A) Folic acid The nurse should instruct all female clients who could become pregnant to take at least 400 mcg of folic acid daily in addition to foods containing folic acid to prevent neural tube defects in the developing fetus. Enriched rice and breakfast cereals are good sources of folic acid but might not provide enough folic acid without supplements.

A nurse is teaching a client who is to begin taking tamoxifen for the treatment of breast cancer. Which of the following adverse effects should the nurse include in the teaching? A) Hot flashes B) Urinary retention C) Constipation D) Bradycardia

A) Hot flashes The estrogen receptor blocking action of tamoxifen commonly results in the adverse effect of hot flashes. Tamoxifen can cause genitourinary adverse effects such as vaginal discharge and uterine cancer. However, urinary retention is not an expected adverse effect of tamoxifen. Cardiovascular adverse effects of the medication include chest pain, flushing, and the development of thrombus. However, bradycardia is not an expected adverse effect of tamoxifen.

A nurse is caring for a client who is receiving oprelvekin. Which of the following findings should the nurse document to indicate the effectiveness of the therapy? A) Increased platelet count B) Increased RBC count C) Decreased prothrombin time D) Decreased triglycerides

A) Increased platelet count Oprelvekin stimulates the bone marrow to produce platelets. For clients receiving chemotherapy, thrombocytopenia is minimized so these clients will require fewer platelet transfusions.

A nurse is instructing a client on the application of nitroglycerin transdermal patches. Which of the following statements by the client indicates an understating of the teaching? A) "I should apply a patch every 5 minutes if I develop chest pain." B) "I will take the patch off right after my evening meal." C) "I will leave the patch off at least 1 day each week." D) "I should discard the used patch by flushing it down the toilet."

B) "I will take the patch off right after my evening meal." Clients should remove the patch each evening for a medication free time of 12 to 14 hr before applying a new patch to avoid developing a tolerance to the medication's effects.

A nurse is providing discharge teaching to a a client who has a new prescription for furosemide twice daily. The nurse should include which of the following instructions in the teaching? A) "Take the second dose at bedtime." B) "Increase intake of potassium-rich foods." C) "Obtain your weight weekly." D) "Monitor for muscle weakness." E) "Dangle your legs from the side of the bed before standing."

B) "Increase intake of potassium-rich foods.": 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. D) "Monitor for muscle weakness.": 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. E) "Dangle your legs from the side of the bed before standing.": 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 positon. The client should change positions slowly to minimize orthostatic hypotension.

A nurse is providing teaching to a client who has a prescription for ergotamine sublingual to treat migraine headaches. Which of the following information should the nurse include in her instructions? A) "Take one tablet three times a day before meals." B) "Take one tablet at onset of migraine." C) "Take up to eight tablets as needed within a 24-hour period." D) "Take one tablet every 15 minutes until migraine subsides."

B) "Take one tablet at onset of migraine." The client should take one tablet immediately after the onset of aura or headache. Ergotamine, an alpha-adrenergic blocking medication, is not used prophylactically as this can result in ergotamine dependence. The client can take up to a maximum of three tablets in a 24-hr period. Excessive dosing can lead to ergotism, which can cause peripheral gangrene due to vasoconstriction and ischemia. The client can take one sublingual tablet every 30 min for a maximum of three tablets in a 24 hr period to manage a migraine.

A nurse is caring for a client who has acute acetaminophen toxicity. The nurse should anticipate administering which of the following medications? A) Vitamin K B) Acetylcysteine C) Benztrophine D) Physostigmine

B) Acetylcysteine Acetylcysteine is a specific antidote for acetaminophen. It can prevent severe injury when given orally or by IV infusion within 8 to 10 hr of overdose. Physostigmine is an effective antidote for antimuscarinic poisoning, that is, toxic overdoses of atropine, scopolamine, some antihistamines, phenothiazines, and tricyclic antidepressants. It has no effect on acetaminophen overdose. Benztrophine is an anticholinergic medication used to treat Parkinsonian adverse effects of antipsychotic medications.

A nurse is caring for a client who is receiving heparin therapy via continuous IV infusion to treat a pulmonary embolism. Which of the following findings should the nurse identify as an adverse effect of the medication and report to the provider? A) Vomiting B) Blood in the urine C) Positive Chvostek's sign D) Ringing in the ears

B) Blood in the urine The nurse should report blood in the urine to the provider because this can be a manifestation of heparin overdose. Other manifestations can include bruising, hematomas, hypotension, and tachycardia.

A nurse is planning care for a client who has hypertension and is to start taking metoprolol. Which of the following interventions should the nurse include in the plan of care? A) Weigh the client weekly. B) Determine apical pulse prior to administering. C) Administer the medication 30 min prior to breakfast. D) Monitor the client for jaundice.

B) Determine apical pulse prior to administering. An adverse effect for this client is life-threatening bradycardia. Therefore, the nurse should assess the client's apical pulse prior to administering the medication. If the pulse rate is less than 60/min, the nurse should withhold the medication and notify the provider.

A nurse is caring for a client who has heart failure and is prescribed enalapril. The nurse should monitor the client for which of the following findings as an adverse effect of the medication? A) Bradycardia B) Hyperkalemia C) Loss of smell D) Hypoglycemia

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

A nurse is collecting a medication history from a client who has a new prescription for lithium. The nurse should identify that the client should discontinue which of the following over-the-counter medications? A) Aspirin B) Ibuprofen C) Ranitidine D) Bisacodyl

B) Ibuprofen Most NSAIDs can significantly increase lithium levels. Therefore, the client should not take ibuprofen and lithium concurrently. Although most NSAIDs interact with lithium to increase lithium levels, aspirin and sulindac do not interact with lithium.

A nurse is assessing a client who is receiving epoetin alfa to treat anemia. Which of the following findings should the nurse monitor? A) Paresthesia B) Increased blood pressure C) Fever D) Respiratory depression

B) 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. 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, it does not cause paresthesia.

A nurse is planning care for a client who is prescribed metoclopramide following bowel surgery. For which of the following adverse effects should the nurse monitor? A) Muscle weakness B) Sedation C) Tinnitus D) Peripheral edema

B) Sedation Metoclopramide has multiple effects on the CNS, including dizziness, fatigue, and sedation. Metoclopramide is a central dopamine receptor antagonist that increases gastrointestinal motility and prevents nausea. An adverse effect of metoclopramide is tardive dyskinesia. However, metoclopramide does not cause muscle weakness.

A nurse is teaching about a new prescription for ciprofloxacin to an older adult 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? A) "I will take this medication with an antacid to prevent gastrointestinal upset." B) "I will stop taking this medication when I no longer have pain upon urination." C) "I will report any signs of tendon pain or swelling." D) "I will take this medication with milk."

C) "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. The client should avoid taking the ciprofloxacin with an antacid containing aluminum, magnesium, or calcium because the effectiveness of the medication could be decreased. The nurse should instruct the client to take antacids 2 hr before or 6 hr after the ciprofloxacin. 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 teaching to a client who has a gastric ulcer and a new prescription for ranitidine. which of the following instructions should the nurse include? A) "Take the medication on an empty stomach for full effectiveness." B) "You may discontinue this medication when stomach discomfort subsides." C) "Report yellowing of the skin." D) "Store the medication in the refrigerator."

C) "Report yellowing of the skin." Ranitidine can be hepatotoxic and cause jaundice. The nurse should instruct the client to monitor for and report yellowing of the skin or eyes to the provider. The client can take ranitidine with or without food because the medication's effectiveness is the same with or without food. For clients who have a gastric ulcer, ranitidine is prescribed to inhibit gastric secretion and must be taken for the full course of therapy in order to be effective. The client should store ranitidine at room temperature.

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? A) Plan to increase the dosage each week by 200 mg increments. B) Prolonged use of the medication can cause glaucoma. C) Drink 2 L of water daily. D) A fine red rash is transient and can be treated with antihistamines.

C) 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. The nurse should instruct the client to increase the dosage each week by 50 to 100 mg until he experiences relief or reaches a maximum of 800 mg daily. The nurse should teach that prolonged use of allopurinol can cause cataracts. Therefore, the client should have periodic ophthalmic check-ups. 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 peptic ulcer disease and is to start a new prescription for sucralfate. Which of the following actions of sucralfate should the nurse include in the teaching? A) Decreases stomach acid secretion B) Neutralizes acids in the stomach C) Forms a protective barrier over ulcers D) Treats ulcers by eradicating H. pylori

C) Forms a protective barrier over ulcers Secretions by the parietal and chief cells, hydrochloric acid and pepsin, can further irritate the ulcerated areas. Sucralfate, a mucosal protectant, forms a gel-like substance that coats the ulcer, creating a barrier to hydrochloric acid and pepsin. Peptic ulcer disease manifests as an erosion of the gastric or duodenal mucosa. The acid production in the stomach causes further irritation and pain. H2 receptor antagonists, such as famotidine, decrease stomach acid secretion. Acid production in the stomach causes further irritation and pain to a client who has a peptic ulcer. Antacids, such as aluminum hydroxide, neutralize acids in the stomach and prevent pepsin formation, a digestive enzyme that can further damage the eroded epithelium. A common cause of peptic ulcers is a bacterial infection with Helicobactor pylori. Treatment of the ulcer includes a combination of antibiotics, such as metronidazole, tetracycline, clarithromycin, or amoxicillin, to eradicate the H. pylori infection.

A nurse is preparing to administer a new prescription of amoxicillin/clavulanic to a client. The client tells the nurse that he is allergic to penicillin. Which of the following actions should the nurse take first? A) Update the client's medical record. B) Notify the provider. C) Withhold the medication. D) Inform the pharmacist of the client's allergy to penicillin.

C) 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 in order to prevent injury to the client.

A nurse is teaching a client who has tuberculosis about the adverse effects of isoniazid. The nurse should instruct the client to report to the provider which of the following finding as an adverse effect of the medication? A) Reddish-orange urine B) Photosensitivity C) Yellowish skin tones D) Headache

C) Yellowish skin tones Isoniazid is a hepatotoxic medication that can cause hepatitis. The nurse should instruct the client to monitor for and report signs of hepatitis, such as malaise, nausea, and yellowish skin tones, to the provider. Rifampin, another antituberculosis medication, can cause body fluids to take on a reddish-orange color. However, isoniazid does not alter urine color. Isoniazid can cause sensory adverse effects including blurred vision and optic neuritis. However, photosensitivity is not an adverse reaction of isoniazid. Isoniazid is associated with a number of CNS adverse effects including dizziness, memory impairment, seizures, and psychosis. However, it does not cause headaches.

A nurse is providing teaching to a client who has depression and has a new prescription for fluoxetine. Which of the following statements by the client indicates an understanding of the teaching? A) "I should start to feel better within 24 hours of starting this medication." B) "I will be sure to follow a strict diet to avoid foods with tyramine." C) "I will continue to take St. John's Wort to increase the effects of the medication." D) "I should take acetaminophen instead of ibuprofen for my headaches while taking this medication."

D) "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.

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? A) "I will stop taking the medication if I get dizzy." B) "I should not drink orange juice while taking this medication." C) "I should expect to gain weight while taking this medication." D) "I will check my heart rate before I take the medication."

D) "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 her heart rate before taking the medication and notify the provider if it falls below the expected reference range. --- 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, she should notify the provider. 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. 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 teaching a client who is to start taking hydrocodone with acetaminophen tablets for pain. Which of the following information should the nurse include in the teaching? A) The medication should be taken 1 hr prior to eating. B) It takes 48 hr for therapeutic effects to occur. C) Tablets should not be crushed or chewed. D) Decreased respirations might occur.

D) Decreased respirations might occur. The nurse should instruct the client that hydrocodone with acetaminophen might cause respiratory depression, which is an adverse effect of the medication. The client should avoid taking over-the-counter medications or newly prescribed medications without consulting her provider to avoid increased respiratory depression.

A nurse is administering donepezil to a client who has Alzheimer's disease. Which of the following findings should the nurse report to the provider immediately? A) Dyspepsia B) Diarrhea C) Dizziness D) Dyspnea

D) Dyspnea The first action the nurse should take when using the airway, breathing, circulation approach to client care is to report the adverse effect of dyspnea, caused by bronchoconstriction, to the provider. Bronchoconstriction, dyspepsia, diarrhea, and dizziness are caused by the increase in acetylcholine levels, which is a primary effect of donepezil.

A nurse is preparing to mix and administer dantrolene via IV bolus to a client who has developed malignant hyperthermia during therapy. Which of the following actions should the nurse take? A) Administer the reconstituted medication slowly over 5 min. B) Store the reconstituted medication in the refrigerator. C) Use the reconstituted medication within 12 hr. D) Reconstitute the initial dose with 60 mL of sterile water without a bacteriostatic agent.

D) 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.

A nurse is assessing a client 1 hr after administering morphine for pain. The nurse should identify which of the following findings as the best indication the morphine has been effective? A) The client's vital signs are within normal limits. B) The client has not requested additional medication. C) The client is resting comfortably with eyes closed. D) The client rates the pain at a 3 on a scale from 0 to 10.

D) The client rates the pain at a 3 on a scale from 0 to 10. The client's description of the pain is the most accurate assessment of pain.

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? A) Gastric distress B) Oliguria C) Excessive bruising D) Tinnitus

D) Tinnitus Tinnitus is a manifestation of aspirin toxicity, also called salicylism. Other manifestations include sweating, headache, and dizziness.

A nurse is providing teaching to a client who is to start therapy with digoxin. For which of the following adverse effects should the nurse instruct the client to monitor and report to the provider? A) Dry cough B) Pedal edema C) Bruising D) Yellow-tinged vision

D) Yellow-tinged vision The nurse should instruct the client to monitor for and report yellow-tinged vision, which is a sign of digoxin toxicity and should be reported to the provider. Other manifestations of digoxin toxicity include nausea, vomiting, loss of appetite, and fatigue. As the digoxin levels increase, the client can experience cardiac dysrhythmias.

A nurse is providing care for a client who is postoperative following an open cholecystectomy with the placement of a closed suction drain and is receiving morphine via patient controlled analgesia for pain. Which of the following assessments is the nurse's priority? A) Respiratory rate B) Bowel sounds C) Drainage amounts D) Wound appearance

A) Respiratory rate When using the airway, breathing, circulation approach to client care, the nurse should determine that the priority assessment is the client's respiratory rate due to the risk of respiratory depression. Morphine and other opioid medication can cause respiratory depression, constipation, and urinary retention.

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? A) Administers isosorbide mononitrate to a client who has BP 82/60 mm Hg B) Administers digoxin to a client who has a heart rate of 92/min C) Administers regular insulin to a client who has a blood glucose of 250 mg/dL D) Administers heparin to a client who has an aPTT of 70 seconds

A) 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. An aPTT of 70 seconds is within the expected reference range when administering heparin.

A nurse is planning care for a clienct who is receiving mannitol via continuous IV infusion. The nurse should monitor the client for which of the following adverse effects? A) Weight loss B) Increased intraocular pressure C) Auditory hallucinations D) Bibasilar crackles

D) Bibasilar crackles Mannitol, an osmotic diuretic, can precipitate heart failure and pulmonary edema. Therefore, the nurse should recognize lung crackles as an indicator of a potential complication and stop the infusion.

A nurse has administered 2 doses of betamethasone to a client in preterm labor. After delivery of the newborn, the nurse understands the medication was effective when she observes which of the following? A) The newborn is free of infection. B) The newborn has normal respiratory patterns. C) Mother's blood pressure is within the expected reference range. D) Mother's postpartum bleeding is minimal.

B) The newborn has normal respiratory patterns. The newborn having a normal respiratory pattern is an indication that the administration of betamethasone was effective. This medication stimulates surfactant production, which improves oxygenation and lung compliance in neonates.

A nurse is reviewing laboratory results for a client who is to receive a dose of ceftazadime via intermittent IV bolus. Which of the following laboratory finding is the priority for the nurse to report to the provider before administering the medication? A) Total bilirubin 0.4 mg/dL B) Alanine aminotransferase 26 units/L C) Platelet count 360,000/mm3 D) Creatinine 2.6 mg/dL

D) Creatinine 2.6 mg/dL Ceftazadime 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 dosage administered. The nurse should notify the provider, who is likely to prescribe a lowered dose of medication.

A nurse is reviewing laboratory results for a client who is receiving heparin via continuous IV infusion for deep-vein thrombosis. The nurse should discontinue the medication infusion for which of the following client findings? A) Potassium 5.0 mEq/ L B) aPTT 2 times the control C) Hemoglobin 15 g/dL D) Platelets 96,000/mm3

D) Platelets 96,000/mm3 A platelet count less than 100,000/mm3 while receiving heparin can indicate heparin-induced thrombocytopenia, a potentially fatal condition, which requires stopping the infusion.

A nurse is teaching a client about warfarin. The client asks if she can take aspirin while taking the warfarin. Which of the following responses should the nurse make? A) "It is safe to take an enteric-coated aspirin." B) "Aspirin will increase the risk of bleeding." C) "Acetaminophen may be substituted for aspirin." D) "The INR lab work must be monitored more frequently if aspirin is taken."

B) "Aspirin will increase the risk of bleeding." Aspirin inhibits platelet aggregation and can potentiate the action of the anticoagulant warfarin. Therefore, it increases the risk for bleeding, so the client should avoid taking aspirin.

A nurse is preparing to administer dextrose 5% in water (D5W) 400 mL IV to infuse over 1 hr. The drop factor of the manual IV tubing is 15gtt/mL. The nurse should set the manual IV infusion to deliver how many gatt/min?

100 gtt/min

A nurse is preparing to administer 0.9% sodium chloride (NaCl) 1,500 mL to infuse over 8 hr to a client who is postoperative. The nurse should set the IV pump to deliver how many mL/hr?

188 mL/hr

A nurse is preparing to administer Ciprofloxacin 15mg/kg PO every 12 hr to a child who weighs 44lbs. how many mg should the nurse administer per dose?

300 mg/dose

A nurse is reviewing the health history of a client who has diabetes mellitus and will begin taking insulin. Which of the following dings should the nurse identify as a fact that might cause the client to have difficulty safely self administering insulin? A) Macular degeneration B) Right-sided heart failure C) Hyperlipidemia D) Stage II chronic kidney disease

A) Macular degeneration A client who has macular degeneration loses central vision, making it difficult to accurately draw up insulin for self-administration or dial the insulin pen to the appropriate dosage. The nurse should determine that adaptive equipment is necessary for the client who has macular degeneration.

A nurse is planning to teach about the use of a spacer to a child who has a new prescription for a fluticasone inhaler to treat chronic asthma. the nurse should include that the spacer deceases the risk for which of the following adverse effect of the medication? A) Oral candidiasis B) Headache C) Joint pain D) Adrenal suppression

A) Oral candidiasis The adverse effects of inhaled corticosteroids can include dysphonia and oral candidiasis. Using a spacer and rinsing the mouth after inhalation will minimize the amount of medication remaining in the oropharynx, preventing the development of these adverse effects.

A nurse is caring for a client who recently began taking oral amoxicillin/clavulanate and reports urticaria. Which of the following actions should the nurse take? A) Request a change in the type of the antibiotic. B) Ask for a change in the route of the administration. C) Check for pitting edema. D) Check the client's WBC count.

A) Request a change in the type of the antibiotic. Manifestations of urticaria after taking a penicillin-based medication indicate a mild allergic reaction. Therefore, it is appropriate for the nurse to request a change in the type of antibiotic.

A nurse at a clinic is providing follow-up care to a client who is taking fluoxetine for depression. Which of the following findings should the nurse identify as an adverse effect of the medication? A) Tingling toes B) Sexual dysfunction C) Absence of dreams D) Pica

B) Sexual dysfunction Sexual dysfunction, including a decreased libido, impotence, and delayed orgasm, or anorgasmia, is a common adverse effect of fluoxetine and occurs in about 70% of clients who take this SSRI antidepressant. Fluoxetine is an SSRI that can cause muscle twitching. However, distorted sensations in the extremities are not adverse effects of fluoxetine. Fluoxetine can cause a number of CNS adverse effects including sedation, delusions, hallucinations, and psychosis. However, an absence of dreams is not associated with fluoxetine.

A nurse on the acute care unit is caring for a client who is receiving gentamicin IV. The nurse should report which of the following findings to the provider as an adverse effect of the medication? A) Constipation B) Tinnitus C) Hypoglycemia D) Joint pain

B) Tinnitus Aminoglycosides, such as gentamicin, are ototoxic, which can manifest as tinnitus and deafness. The nurse should monitor the client for high pitched ringing in the ears and headaches and should notify the provider if these occur.

A nurse is teaching a group of unit nurses about medication reconciliation. Which of the following information should the nurse include in the teaching? A) The client's provider is required to complete medication reconciliation. B) Medication reconciliation at discharge is limited to the medication ordered at the time of discharge. C) A transition in care requires the nurse to conduct medication reconciliation. D) Medical reconciliation is limited to the name of the medications that the client is currently taking.

C) A transition in care requires the nurse to conduct medication reconciliation. The nurse should conduct medication reconciliation anytime the client is undergoing a change in care (admission, transfer from one unit to another, discharge). A complete listing of all prescribed and over-the-counter medications should be reviewed.

A nurse in the emergency department is caring for a client who has myasthenia gravis and is in a cholinergic crisis. Which of the following medications should the nurse plan to administer? A) Potassium iodide B) Glucagon C) Atropine D) Protamine

C) Atropine A cholinergic crisis is caused by an excess amount of cholinesterase inhibitor, such as neostigmine. The nurse should plan to administer atropine, an anticholinergic agent, to reverse cholinergic toxicity. Protamine is a heparin antagonist that is administered to reverse heparin toxicity evidenced by an aPTT greater than 70 seconds.

A nurse is providing discharge instructions to a client who has heart failure and a new prescription for captopril. Which of the following client statements indicates an understanding of the teaching? A) "I should take the medication with food." B) "I should take naproxen if I develop joint pain." C) "I should tell my provider if I develop a sore throat." D) "I should expect the medication to cause my urine to look orange."

C) "I should tell my provider if I develop a sore throat." The client should report a sore throat to the provider because this can indicate neutropenia, a serious adverse effect of captopril. Neutropenia can be reversed if it is recognized early and the medication is promptly discontinued.

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? A) Tinnitus B) Urinary frequency C) Dry mouth D) Diarrhea

C) Dry mouth The nurse should expect the client to have a dry mouth due to the blocking of acetylcholine receptors that cause anticholinergic responses.

A nurse is assessing a client after administering a second dose of cefazolin IV. The nurse notes the client has anxiety, hypotension, and dyspnea. Which of the following medications should the nurse administer first? A) Diphenhydramine B) Albuterol inhaler C) Epinephrine D) Prednisone

C) Epinephrine According to evidence-based practice, the nurse should first administer epinephrine to induce vasoconstriction and bronchodilation during anaphylaxis.

A nurse is assessing a client who is taking propylthiouracil for the treatment of Graves disease. Which of the following findings should the nurse identify as as an indication of the medication has been effective? A) Decrease in WBC count B) Decrease in amount of time sleeping C) Increase in appetite D) Increase in ability to focus

D) Increase in ability to focus A client who has Graves' disease can experience psychological manifestations such as difficulty focusing, restlessness, and manic-type behaviors. Propylthiouracil is a thyroid hormone antagonist that decreases the circulating T4 hormone, reducing the manifestations of hyperthyroidism. An increased ability to focus indicates that the medication is effective.

A nurse is caring for a client who is experiencing acute alcohol withdrawal. For which of the following client outcomes should the nurse administer chlordiazepoxide? A) Minimize diaphoresis B) Maintain abstinence C) Lessen craving D) Prevent delirium tremens

D) Prevent delirium tremens The client should take chlordiazepoxide to prevent delirium tremens during acute alcohol withdrawal. The client should take clonidine or a beta-adrenergic blocker, such as atenolol, to minimize autonomic components, such as diaphoresis, during alcohol withdrawal. The client should take acamprosate to help maintain abstinence from alcohol by decreasing anxiety and other uncomfortable manifestations. The client should take propranolol to decrease craving during alcohol withdrawal.