Pharm Exam 1: Class NCLEX questions

1.) The nurse is caring for a patient admitted with emphysema, angina, and hypertension. Before administering the prescribed daily dose of atenolol 100 mg PO, the nurse assesses the patient carefully. Which of the following adverse effects is this patient at risk for given the patient's health history? A) Hypocapnia B) Tachycardia C) Bronchospasm D) Nausea and vomiting

1.) C. Bronchospasm

2) A nurse has an order to give a client salmeterol (Serevent Diskus), two puffs, and beclomethasone dipropionate (Qvar), two puffs, by metered-dose inhaler. The nurse administers the medication by giving the: 1) Beclomethasone first and then the salmeterol 2) Salmeterol first and then the beclomethasone 3) Alternating a single puff of each, beginning with the salmeterol 4) Alternating a single puff of each, beginning with the beclomethasone

2) Salmeterol first and then the beclomethasone Rationale: Salmeterol (Serevent Diskus) is an adrenergic type bronchodilator and beclomethasone dipropionate is a glucocorticoids. Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

2.) A patient is taking atenolol. When monitoring for adverse effects, you are looking for all of the following except? A) heart failure B) bradycardia C) bronchospasm D) hypertension

2.) D. hypertension

1. A client with heart failure was experiencing difficulty breathing and increased pulmonary congestion. The physician prescribed furosemide (Lasix) 40mg to be given intravenously and it was given an hour ago by the nurse. Which indicates the therapy has been effective? 1. The lungs are now clear to auscultation 2. The urine output has increased by 400mL 3. The serum potassium has decreased from 4.7mEq to 4.1mEq 4. The blood pressure has decreased from 118/64mmHg to 106/62mmHg

1. Furosemide (Lasix) is a diuretic. In this situation, it was given to decrease preload and reduce the pulmonary congestion and associated difficulty in breathing. Although all options may occur, option 1 is the reason furosemide was administered.

A nurse is preparing to administer digoxin (Lanoxin), 0.125 mg orally, to a client with heart failure. Which vital sign is most important for the nurse to check before administering the medication? 1. Heart rate 2. Temperature 3. Respirations 4. Blood pressure

1. Heart rate Rationale: Digoxin is a cardiac glycoside that is used to treat heart failure and acts by increasing the force of myocardial contraction. Because bradycardia may be a clinical sign of toxicity, the nurse counts the apical heart rate for 1 full minute before administering the medication. If the pulse rate is less than 60 beats/minute in an adult client, the nurse would withhold the medication and report the pulse rate to the registered nurse, who would then contact the health care provider.

2) The nurse is providing teaching to a client who has a new prescription for digoxin. The nurse should instruct the client to monitor and report which of the following adverse effects that is a manifestation of digoxin toxicity? (Select all that apply) A. Fatigue B. Constipation C. Anorexia D. Rash E. Diplopia

2) A, C, E Rationale: Fatigue and weakness are early CNS findings that can indicate digoxin toxicity. GI disturbances, such as anorexia, are manifestations of digoxin toxicity. Visual changes, such as diplopia and yellow-tinged vision, are manifestations of digoxin toxicity.

Question 2: A nurse in a provider's office is monitoring serum electrolytes for 4 older adult clients who take digoxin. which of the following electrolyte values increases a client's risk for digoxin toxicity ? A) Calcium 9.2 mg/dL B) Calcium of 10.3 mg/dL C) Potassium 3.4 mEq/L D) Potassium 4.8 mEq/L

2. C Potassium 3.4 mEq/L is below the expected reference range and puts a client at risk for digoxin toxicity. Low potassium can cause fatal dysrhythmias, especially in older patients who take digoxin. The nurse should notify the provider, who may prescribe the potassium supplement or a potassium sparing diuretic for the client.

2. A nurse is teaching a client who has a new prescription for digoxin to treat heart failure. Which of the following instructions should the nurse include in the teaching? A. Contact provider if heart rate is less than 60/min B. Check pulse rate for 30 seconds and multiply results by 2 C. Increase intake of sodium D. Take with food if nausea occurs

2. A - The client should contact the provider for a heart rate less than 60/min

2. A child with asthma is being discharged to home and has an order for Albuterol to be administered via a metered dose inhaler. Which point should a nurse address for appropriate administration of this medication? a. When administering medication via a MDI, avoid shaking the canister before discharging the medication. b. Medication is ordered in two "puffs"; press on the canister twice in succession to discharge the medication c. There should be a tight seal around the mouthpiece of the inhaler before discharging the medication d. There should be a 2-3 inch spacer (or spacer device) between the inhaler and the open mouth of the child

2. D, Children often have difficulty learning to depress and inhale their medications at the same time, and holding the MDI 2-3 inches away from the mouth or utilizing the "spacer" improves the effects of the medication.

A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3.0 mEq/L and is complaining of anorexia. A health care provider prescribes a digoxin level to rule out digoxin toxicity. A nurse checks the results, knowing that which of the following is the therapeutic serum level (range) for digoxin? 1. 3 to 5 ng/mL 2. 0.8 to 2 ng/mL 3. 1.2 to 2.8 ng/mL 4. 3.5 to 5.5 ng/mL

2.) 0.8 to 2 ng/mL Rationale: Therapeutic levels for digoxin range from 0.8 to 2 ng/mL. Therefore, options 1, 3, and 4 are incorrect.

A patient on several medications is being cared for on a medical/surgical unit by the nurse. Which of the following laboratory values, if reported to the nurse, would require follow-up? (Select all that apply) 1. Calcium 8.5 mg/dL 2. Lithium level of 1.3 mEq/L 3. Digoxin level of 2.4 mEq/L 4. Urine specific gravity of 1.016 5. Blood sugar of 103 mg/dL 6. Potassium level of 5.5 mEq/L

3,6. These are the only abnormal labs- digoxin should be between 1 and 2 mEq/L, while potassium should never stray from between 3.5-5.0 mEq/L.

A nurse is planning to administer hydrochlorothiazide (HydroDIURIL) to a client. The nurse understands that which of the following are concerns related to the administration of this medication? 1. Hypouricemia, hyperkalemia 2. Increased risk of osteoporosis 3. Hypokalemia, hyperglycemia, sulfa allergy 4. Hyperkalemia, hypoglycemia, penicillin allergy

3. Hypokalemia, hyperglycemia, sulfa allergy Rationale: Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.

A health care professional is caring for a patient who is hospitalized with chest pain. Patient instruction about drugs and discharge planning should begin A) as soon as possible. B) on the day of discharge. C) when family members are present. D) after the patient has a definitive diagnosis.

Ans: A

1.) The unresponsive client with Diabetes Mellitus is admitted to the ED with a serum glucose level of 35mg/dL. Which medication should the nurse plan to administer? a.) Exenatide b.) Pramlinitide c.) Miglitol d.) Glucagon

Answer: d Rationale: The nurse should plan to administer glucagon (GlucaGen). Glucagon, administered intramuscularly, intravenously, or subcutaneously, is used in unconscious clients with diabetes to reverse severe hypoglycemia from insulin overdose. Normal serum glucose is 70-110 mg/dL.

A patient has been prescribed the medication spironolactone (aldasterone). When preparing the patient for discharge, the nurse should include which of the following instructions? 1. "Be sure to take this with meals." 2. "Do not take this medication before bedtime." 3. "Remember to eat salt substitutes instead of actual sodium." 4. "This medication will make you urinate more often." 5. "It is important to increase your intake of dark leafy greens." 6. "Check your weight daily and keep a record to bring with you to your next appointment."

Answer:1,2,4,6 Rationale: This patient should be avoiding salt substitutes because they are generally made of potassium. Spironolactone is a potassium-sparing diuretic. Therefore, the patient should eat a normal potassium diet and regular salt intake. The other four answers are correct.

A patient with Asthma has been prescribed Montelukast (Singulair). The nurse is educating the patient on its use. Which statement by the nurse constitutes correct teaching? A. Keep this medication close by you at all times because it is a rescue medication. B. You should take this medication in the evening or at bed time. C. Be sure to check your blood sugar when taking this medication because it masks the effects of Hypoglycemia. D. This drug has a black box warning and I would advise you to not attempt pregnancy while taking the medication.

B Using this medication in the evening or before bedtime provides high concentration during night and early morning which alleviates nighttime symptoms that often occur or worsen.

1) The nurse acknowledges that beta blockers are as effective as antianginals because they do what? a. Increase oxygen to the systemic circulation. b. Maintain heart rate and blood pressure. c. Decrease heart rate and decrease myocardial contractility. d. Decrease heart rate and increase myocardial contractility.

C

A nurse is providing instructions to a client who has a new prescription for albuterol and beclomethasone inhalers for the control of asthma. Which of the following instructions should the nurse include in the teaching? A) take the albuterol at the same time each day B) administer the albuterol inhaler prior to using the beclomethasone inhaler C) use beclomethasone if experiencing an acute episode D) avoid shaking the beclomethasone before use

CORRECT ANSWER: B A. albuterol is a short acting inhaled beta2 agonist and used for short term relief of bronchospasm B. CORRECT. when a client is prescribed an inhaled beta2 agonist (such as albuterol) and an inhaled glucocorticoid (such as beclomethasone), the client should take the beta2 agonist first. The beta2 agonist promotes bronchodilation and enhances absorption of the glucocorticoid C. beclomethasone is administered on a fixed schedule. It is not used to treat an acute attack D. The client should shake the metered dose inhaler well before administration

A nurse is monitoring a client who is receiving spironolactone. Which of the following findings should the nurse report to the provider? A) Serum sodium 144 mEq/L B) Urine output 120 mL in 4 hrs C) Serum potassium 5.2 mEq/L D) Blood pressure 140/90 mm Hg

Correct answer: C A. serum sodium of 144 mEq/L is within the expected reference range B. urine output of 30 mL/hr or 120 mL in 4 hr is within the expected reference range C. CORRECT. serum potassium of 5.2 mEq/L indicates hyperkalemia because spironolactone causes potassium retention, the nurse should withhold the medication and notify the provider D. a blood pressure of 140/90 mm Hg is with the expected reference range

Prior to administrating digoxin 0.125 mg PO to a client in chronic heart failure, the nurse determines that the apical pulse is 56. Which of the following should the nurse do first? 1. Administer the drug and recheck the pulse in one hour 2. Withhold the drug and notify the physician 3. Obtain an EKG 4. Send a blood sample to the laboratory for a digoxin level

Correct Answer is 2: Unless the physician's order specifies otherwise, when the client's apical pulse drops below 60, the nurse should hold the dose and notify the physician

Question 2: A patient with emphysema is prescribed beclomethasone, an inhaled corticosteroid. Which of the following side effects should the nurse instruct the patient about in the discharge instructions? (Select all that apply) a.Cough b.Dry Mouth c.Fatigue d.Hoarseness e.Oral candidiasis

Correct Answer: A, B, D, E Rationale: Common side effects of beclomethasone and other inhaled corticosteroids include dry mouth, cough, hoarseness, sore throat, nausea and upset stomach. Local immunosuppression can cause oral candidiasis.

Question 1: A patient in severe respiratory distress is prescribed continuous albuterol nebulizers. Which of the following side effects should the nurse expect? (Select all that apply) a.Bradycardia b.Dizziness c.Excessive Salivation d.Hyperkalemia e.Tachycardia f.Tremors g.Urticara

Correct Answer: B, E, F Rationale: Side effects of albuterol are related to stimulation of the sympathetic nervous system and include tachycardia, palpitations, tremors, dizziness, anxiety, headache and dry mouth. High doses can cause hypokalemia.

Cyanide Toxicity is a potential side effect of which medication? A. Digoxin B. Succinylcholine C. Albuterol D. Nitroprusside

D

A patient is prescribed a calcium channel blocker to treat primary hypertension. When teaching the patient about the medication, which of these foods will the healthcare provider advise the patient to avoid? A. Eggs B. Bananas C. Oranges D. Grapefruit

Correct answer: D. Because thiazide diuretics produce an increase in urine output, the patient should avoid taking the medication in the evening. Potassium is lost in the urine along with sodium and chloride, so the patient should be instructed to include potassium-rich foods in the diet to avoid hypokalemia.

A patient is prescribed a thiazide diuretic for the treatment of hypertension. When teaching the patient about the medication, which of the following will the healthcare provider include? A. "Take this medication each day with a large glass of water after your evening meal." B. "I'll teach you how to take your radial pulse before taking the medication." C. "Stop taking this medication if you notice changes in how much you urinate." D. "Be sure to include a number of foods that are rich in potassium in your diet."

Correct answer: D. Because thiazide diuretics produce an increase in urine output, the patient should avoid taking the medication in the evening. Potassium is lost in the urine along with sodium and chloride, so the patient should be instructed to include potassium-rich foods in the diet to avoid hypokalemia.

A nurse admits a client who is 28 weeks pregnant and experiencing congestive heart failure. When initiating a healthcare provider's admissions orders for the client, which order should the nurse question? 1. Furosemide (Lasix) 40 mg IV bid 2. Captopril (Capoten) 25 mg PO daily 3. Digoxin (Lanoxin) 0.125 mg IV daily 4. Metoprolol sustained release (Toprol XL) 50 mg PO daily

Correct: Answer 2 Captopril is an angiotensin-converting enzyme (ACE) inhibitor. ACE inhibitors are contraindicated in the second and third trimester did pregnancy. They can cause oligohydramnios, intrauterine growth retardation, congenital structural defects, and renal failure. Digoxin, furosemide, and metoprolol are all Catergoty C medications but have not been shown to cause fetal harm.

A client with acute asthma is prescribed short-term corticosteroid therapy. Which is the expected outcome for the use of steroids in clients with asthma? Act as an expectorant. Have an anti-inflammatory effect. Prevent development of respiratory infections. Promote bronchodilation.

HAVE AN ANTI-INFLAMMATORY EFFECT. Rationale: Corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial airways and decrease mucus secretion. Corticosteroids do not have a bronchodilator effect, act as expectorants, or prevent respiratory infections.

1. A nurse, checking newly written physician orders, determines that which orders require the nurse to contact the physician to clarify the order? SELECT ALL THAT APPLY. a. Aspirin 325 mg orally qd b. MS 4 mg IV q1hr prn c. Furosemide (Lasix) 40 mg IV now d. D5W with 20 mEq KCL IV at 125 mL/hr e. Heparin 5,000 u subcutaneously bid

Integrated Processes: Analysis answers a,b,e Rational: The abbreviations "qd," "MS," and "u" are disallowed by Joint Commission. Answers c and d are incorrect because they include components of DRTIM

1) A type I diabetic patient comes to the clinic for a follow-up appointment. The patient is taking NPH insulin, 30 units every day. A nurse notes that the patient is also taking metoprolol (Lopressor). What education should the nurse provide to the patient? A) "You need to increase your insulin to allow for the agonist effects of metoprolol." B) "Metoprolol may potentiate the effects of the insulin, so the dose should be reduced." C) "Metoprolol has no effects on diabetes mellitus or on your insulin requirements." D) "Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely."

Questioin #1: D) "Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely."

Which of the following is a contraindication for digoxin administration? A.Blood pressure of 140/90 B.Heart rate above 80 C.Heart rate below 60 D.Respiratory rate above 20

Question 2: C. Heart rate below 60 Rationale: The apical heart rate must be monitored during therapy with digoxin, and the drug held for pulse below 60 and above 120. Remember that digoxin lowers the heart rate; therefore, the choice that reflects a low heart rate is the best selection.

A client has +3 pitting edema in their legs and a potassium of 2.3 mEq/L, the nurse knows which of the following diuretic is likely to be ordered? 1. Spironlactone (Aldactone) 2. Furosemide (Lasix) 3. Bumetamide (Bumex) 4. Ethacrynic Acid (Edecrin)

1 - Spironlactone (Aldactone) - is a potassium sparing diuretic

A patient with hypertension is started on a new medication for treatment and is reporting a continuous dry cough. Which of the following medications do you suspect is causing this problem? A. Lisinopril B. Labetalol C. Losartan D. Hydrochlorothiazide

A

Which statement by the patient demonstrates successful teaching regarding their new medication, Isotretinoin (Accutane)? A) "I should stop taking my vitamin A supplement" B) "I should scrub my face every night to help fight the acne" C) "I should start to see results in a few days" D) "I should take my medication before meals"

A, Vitamin A can increase the toxicity effects of accutane. Accutane should be taken with or after meals, scrubbing the patient's face will not help the acne and will likely cause the drying side-effect to be worse, and accutane takes longer than days to start show results (generally 2+ months).

2. A nurse is teaching a client who has a new prescription for beclomethasone. Which of the following instructions should the nurse include? A. "Rinse your mouth after each use of this medication" B. "Limit fluid intake while taking this medication" C. "Increase your intake of vitamin B12 while taking this medication" D. "You can take the medication as needed"

A. "Rinse your mouth after each use of this medication" is CORRECT: The client should rinse her mouth after each use to reduce the risk of oral fungal infections.

A client with acute asthma showing inspiratory and expiratory wheezes and a decreased expiratory volume should be treated with which of the following classes of medication right away? a. Beta-adrenergic blockers b. Bronchodilators c. Inhaled steroids d. Oral steroids

ANSWER B. Bronchodilators are the first line of treatment for asthma because bronchoconstriction is the cause of reduced airflow. Beta-adrenergic blockers aren't used to treat asthma and can cause bronchoconstriction. Inhaled or oral steroids may be given to reduce the inflammation but aren't used for emergency relief.

The client admitted with fluid volume overload is being treated with a loop diuretic. Serum potassium levels are being monitored as illustrated below. Which day is BEST for the nurse to consult with the HCP regarding initiating potassium replacement? Day 1 Day 2 Day 3 Day 4 5.6 mEq/L 4.4 mEq/l 3.5 mEq/L 3.1 mEq/L a. Day 1 b. Day 2 c. Day 3 d. Day 4

ANSWER: c. Day 3 Rationale: The nurse should consult the HCP on day 3, when the client's level is at the low end of normal. The client's serum potassium level is decreasing, and the client is taking a diuretic. Supplementation is needed to prevent a reduction of serum potassium level below normal.

1. Your patient is currently taking captopril and hydrochlorothiazide. As a nurse, you know the Hydrochlorothiazide is working as a diuretic by increasing excretion of Sodium. Other than sodium levels what will you be monitoring? A. Magnesium and Calcium levels B. Ototoxicity C. ALt and AST levels D. Flu-like symptoms

Answer: C. Alt, Ast Rational: Thiazide diuretics may cause hepatic impairment. Alt and Ast liver enzymes are important to monitor. Thiazide does not excrete Magnesium and Calcium the electrolyte excreted is Sodium. Furosemide may cause ototoxicity, not hydrochlorothiazide, and digoxin will cause toxicity resulting in flu-like symptoms.

2.) The client with COPD is prescribed salmeterol diskus inhaler and fluticasone Rotadisk inhaler. Which instruction should the nurse include to prevent the client from developing oropharyngeal candidiasis? a.) "Drink a glass of water before taking your medications." b.) "Rinse your mouth after using your inhaler medications." c.) "Wait at least one minute before taking the next medication." d.) "Close your mouth tightly around the inhaler mouthpiece."

Answer: b Rationale: Oropharyngeal candidiasis is a yeast infection that occurs in the mouth due to destruction of the normal flora with the use of a glucocorticoid inhaler (fluticasone [Advair]). The nurse should instruct the client to rinse the mouth after using the glucocorticoid inhaler to prevent its occurrence.

The nurse is talking to patient who is prescribed to Montelukast (Singulair). Which statement by the patient indicates to the nurse that they are experiencing adverse side effects of the medication? A. I feel like I can do anything I set my mind to. I just can't stop smiling. B. I just can't get rid of this dry cough and nothing comes up it's irritating. C. Don't tell anyone but sometimes I imagine ending it all. D. Oh so you're a nurse? Can you look at this rash under my armpit?

C The most important adverse effects of Montelukast to look out for is suicidal ideations. If the nurse assesses these side effects the medication should be discontinued immediately.

What would the nurse stress to the 17-year-old girl who has been prescribed Accutane for her acne? A. Avoid alcoholic beverages B. Drink at least 1000mL of fluid daily C. Use dependable birth control to avoid pregnancy D. Avoid exposure to the sun

C. Use dependable birth control to avoid pregnancy Rationale: Accutane has a destructive effect on fetal development. Dependable birth control is important to avoid a pregnancy.

Metoprolol is added to the pharmacologic therapy of a diabetic female diagnosed with stage 2 hypertension initially treated with Furosemide and Ramipril. An expected therapeutic effect is: Decrease in heart rate. Improvement in blood sugar levels. Increase in urine output. Lessening of fatigue.

DECREASE IN HEART RATE. Rationale: The effect of a beta blocker is a decrease in heart rate, contractility, and afterload, which leads to a decrease in blood pressure. The client at first may have an increase in fatigue when starting the beta blocker. The mechanism of action does not improve blood sugar or urine output.

1. A nurse is assessing a client who is taking dioxin to treat heart failure. Which of the following findings is a manifestation of Digoxin toxicity? A. Bruising B. Report of metallic taste C. Muscle pain D. Report of anorexia

Answer: D. Anorexia, blurred vision, stomach pain, and diarrhea are manifestations of digoxin toxicity. Incorrect: A. Bruising is an adverse effect of anticoagulants and antiplatelet medications. B. Metallic taste is an adverse effect of captopril and certain antibiotics E. Weakness is a manifestation of digoxin toxicity, not muscle pain.

1. A client is taking digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 40 mg. When the nurse enters the room, the client states, "There are yellow halos around the lights." Which action will the nurse take? A) a. Evaluate digoxin levels. B) b. Withhold the furosemide C) c. Administer potassium. D) d. Document the findings and reassess in 1 hour.

Answer: A. Seeing yellow or green halos around lights is a symptom of digoxin toxicity. The nurse should evaluate the client's digoxin levels.

2. A client's serum digoxin level is drawn, and it is 0.4 ng/mL. What is the nurse's priority action? a. Administer ordered dose of digoxin. b. Hold future digoxin doses. c. Administer potassium. d. Call the health care provider.

Answer: a. Administer ordered dose of digoxin.

2. The client is admitted to hospital with a hypertensive crisis. Diazoxide (Hyperstat) is ordered. During administration the nurse should: A. Utilize an infusion pump. B. Check the blood glucose level. C. Place the client in trendelenburg position. D. Cover the solution with foil.

Answer B is correct. Hyperstat is given IV push for hypertensive crisis. It often causes hyperglycemia. The glucose level will drop rapidly after the medication is administered.

The physician orders lisinopril (Zentril) and furosemide (lasix) to be administered concomitantly to the clientwith hypertention. The nurse should: A. Question the order. B. Administer the medication. C. Administer them separately. D. Contact the pharmacy.

Answer B is correct. Zentril is an ACE Inhibitor and is frequently used with a diuretic such as lasix. There is no need to question the order, give the drugs separately, or contact the pharmacy so answers A,C and D are incorrect.

A nurse had previously administered spironolactone (Aldactone) to a patient and is about to perform an assessment to evaluate the medication's effectiveness. Which assessment findings verify that the medication is working effectively? A) Patient reports sleeping well during their afternoon nap. B) Patient denies having any pain. C) Decreased peripheral edema, decreased shortness of breath, weight loss. D) Decreased urine output, decreased shortness of breath, increased fatigue.

Answer C: A nurse would assess the fluid status of the patient to see if it has the desired effect. The nurse would check for decreased peripheral edema, decreased SOB and a decrease in weight as signs that spironolactone is working effectively for the patient. This medication should increase urinary output, not decrease it. This medication does not have anything to do with pain relief or helping with sleep at night.

A patient with heart failure is admitted to the hospital's emergency room for a hypertensive crisis, with a blood pressure reading of 206/112 mmHg. Which medication would the nurse likely be administering first? A) captopril B) hydrochlorothiazide C) nitroprusside D) spironolactone

Answer C: Nitroprusside is a fast-acting vasodilator, administered intravenously, and is the drug of choice during a hypertensive crisis. The other medications are used in the treatment of hypertension, but are maintenance medications.

A client reports frequent use of sodium bicarbonate to relieve heartburn after meals. The nurse interprets that the client is at risk for which of the following conditions with long-term frequent use of this medication? A. Urinary Calculi B. Metabolic Alkalosis C. Chronic Bronchitis D. Respiratory Acidosis

Answer is B: Sodium bicarbonate is an electrolyte modifier and antacid. With large doses or long-term use, it can cause metabolic alkalosis.

A staff educator is reviewing medications dosages and factors that influence medication metabolism with a group of nurses at an in-service presentation. Which of the following factors should the educator include as a reason to administer lower medication dosages? (Select all that apply) a. Increased renal excretion b. Increased medication-metabolizing enzymes c. Liver failure d. Peripheral vascular disease e. Concurrent use of medication that the same pathway metabolizes

Answer: C- liver failure decreased metabolism and thus increases the concentration of medication. E- When the same pathway metabolizes two medications, they compete for metabolism, thereby increasing the concentration of one or both medications.

During your morning assessment of a patient with heart failure, the patient complains of sudden vision changes that include seeing a yellowish-green halo around the lights. Which of the following medications do you suspect is causing this issue? a. Lisinopril b. Losartan c. Lasix d. Digoxin

Answer: D- yellow green halos/vision changes are signs of Digoxin toxicity

An an opioid analgesic is administered to a client in labor. The nurse assigned to care for the client ensures that which medication is readily accessible should respiratory depression occur? 1. Naloxone 2. Morphine sulfate 3. Betamethasone 4. Hydromorphone hydrochloride

Answer: 1 Rationale: Opioid analgesics may be prescribed to relieve moderate to severe pain associated with labor. Opioid toxicity can occur and cause respiratory depression. Naloxone is an opioid antagonist, which reverses the effects of opioids and is given for respiratory depression. Morphine sulfate and hydromorphone hydrochloride are opioid analgesics. Betamethasone is a corticosteroid administered to enhance fetal lung maturity.

Question 1: Which prescribed drugs would a nurse most likely give the client for respiratory stridor, with wheezing, and hypotension after a bee sting? Select all that apply. 1. Epinephrine 2. Diphenhydramine (Benadryl) 3. Corticosteroid (Solu-Medrol) 4. Furosemide (Lasix) 5. Acetaminophen (Tylenol) 6. Ranitidine (Zantac)

Answer: 1, 2, 3 Reason: Answer 1 is correct because subcutaneous epinephrine is the first line of treatment. Clients with bee sting allergies should carry an EpiPen. Answer 2 is correct because Benadryl is a standard treatment for an allergic reaction. The client should chew the tablets. Answer 3 is correct because Solu-Medrol is a standard anti-inflammatory drug for anaplyaxis or an allergic reaction. Answer 4 is incorrect because the diuretic effects of Lasix will not help anaphylaxis. Answer 5 is incorrect because the analgesic or antipyretic effects of Tylenol will not help anaphylaxis. Answer 6 is incorrect because a histamine2 (H2) blocker such as Zantac is not a first line of defense, although the drug may be given. Test Taking Tip: Anaphylaxis is the concern here. Know the first line drugs for anaphylaxis. Eliminate the drugs used for diuretic and antipyretic effects.

1. A client beginning medication therapy with Montelukast (Singulair) asks the nurse how the medication is helping his symptoms. Which is the best response? A. "Singulair decreases inflammation and mucous production." B. "Singulair increases mucous secretion and bronchodilation." C." Singulair prevents smooth muscle contraction by nervous system stimulation." D. "Singulair increases the inflammatory response and mucous secretion."

1. A Rationale: Leukotrienes are released when a client is exposed to an allergen. Leukotrienes cause inflammation, bronchoconstriction, and mucous production. Leukotriene modifiers such as Montelukast block the action of leukotrienes and therefore decrease mucous secretion and reduce inflammation, which prevents bronchoconstriction.

1. A nurse is caring a client who is taking digoxin (Lanoxin) 0.25mcg tab once a day. The client suddenly complaints of anorexia, nausea, vomiting, and diarrhea. The physician is ruling a digoxin toxicity. As a nurse, you know the therapeutic digoxin rate is? A. 0.25-0.5 ng/ml. B. 0.5-2 ng/ml. C. 1.5-3 ng/ml. D. 3.5-4.5 ng/ml.

1. Answer: B. 0.5-2 ng/ml. The therapeutic level of digoxin is 0.5-2 ng/ml.

Question 1: A nurse is providing teaching for a client who has a new diagnosis of hypertension and a new prescription for spironolactone 25mg/day. Which of the following statement by the client indicate an understanding of the teaching? A) "I should eat a lot of fruits and vegetables, especially bananas and potatoes" B) "I will report any changes in heart rate to my provider" C) "I should replace the salt shaker on my table with a salt substitute." D) "I will decrease the dose of this medication when I no longer have headaches and facial redness."

1. B The nurse should teach the client to monitor her heart rate and report any changes to her provider. Spironolactone is a Potassium sparing diuretics, changing in HR may indicate hyperkalemia.

A client experiencing a severe asthma attack has the following arterial blood gas results: pH 7.33; Pco2 48 mm Hg; Po2 58 mm Hg; HCO3 26 mEq/L . Which prescriptions should the nurse implement first? 1) albuterol nebulizer 2) chest x-ray 3) ipratropium inhaler 4) sputum culture

A, the arterial blood gas reveals a respiratory acidosis with hypoxia. A quick acting bronchodilator, albuterol, should be administered via nebulizer to improve gas exchange. Ipratropium is a maintenance treatment for bronchospasm that can be used with albuterol. A chest x-ray and sputum sample can be obtained once the client is stable.

Question 2: The HCP prescribes a second antihypertensive medication for the client who has poorly controlled BP on one medication. if prescribed, which medication combination should the nurse question? 1. Atenolol and metoprolol 2. Metolazone and valsartan 3. Captopril and furosemide 4. Bumetanide and diltiazem

ANSWER: option 1, the nurse should question this medication combination. When two medications are used to treat hypertension, each should be from different drug classifications. Atenolol(tenormin) and metoprolol(Lopressor) are both beta-adrenergic blockers and have the same general mechanism of action.

Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed? 1. Potassium level 2. Triglyceride level 3. Hemoglobin A1C 4. Total Chloesterol level

Answer: 2 Rationale: Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before treatment and periodically thereafter until the effect on the triglycerides has been evaluated. There is no indication that isotretinoin affects potassium, hemoglobin A1C, or total cholesterol.

Question 2: A client is being discharged and instructed to take furosemide (Lasix) every morning. A nurse tells the client to notify the health provider in the event of: 1. Increased appetite. 2. Discruption in sleep patterns. 3. Increased urinary frequency. 4. Leg cramps.

Answer: 4 Reason: Answer 4 is correct because leg cramps could indicate excessive loss of potassium. Answer 1 is incorrect because this loop diuretic does not affect appetite. Answer 2 is incorrect because taking the diuretic in the morning should not increase nighttime urination, with sleep disturbances. Answer 3 is incorrect because this is a desired outcome of the drug, not an adverse effect. Test Taking Tip: Choose an option that has potentially the greatest risk if not corrected. Eliminate options that involve the GI (Answer 1) and urinary (Answer 3) systems because, in this case, they do not cause at-risk effects.

2) When administering a beta blocker the nurse should be aware that this drug masks signs of which of the following conditions? A)hypoglycemia B) asthma C) pulmonary embolism D) tachycardia

Answer: A. Rationale: Metoprolol masks signs of hypoglycemia. It should not be taken by patients with COPD or asthma.

A client with severe acne is seen in the clinic and the health care provider prescribes isotretinoin. The nurse reviews the client's medication record and would contact the HCP if the client is also taking with medication? A). Digoxin B). Phenytoin C). Vitamin A D). Furosemide

Answer: C Rationale: Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of isotretinoin toxicity.

2. The nurse is caring for a patient admitted with emphysema, angina, and hypertension. Before administering the prescribed daily dose of atenolol 100 mg PO, the nurse assesses the patient carefully. Which of the following adverse effects is this patient at risk for given the patient's health history? A) Hypocapnia B) Tachycardia C) Bronchospasm D) Nausea and vomiting

Answer: C) Bronchospasm Rationale: Atenolol is a cardioselective β1-adrenergic blocker that reduces blood pressure and could affect the β2-receptors in the lungs with larger doses or with drug accumulation. Although the risk of bronchospasm is less with cardioselective β-blockers than nonselective β-blockers, atenolol should be used cautiously in patients with COPD.

1) A nurse is assessing a patient with pulmonary edema. The nurse auscultates their lung sounds and hears crackles. What would be the best medication to administer to the patient? a) albuterol b) spironolactone c) furosemide d) hydrochlorothiazide

Answer: C) furosemide Rationale: C is correct because it gets rid of fluid from the body faster than other diuretics like b and d. A is a bronchodilator which opens your airway when the patient is having trouble breathing.

All potassium-sparing diuretics (such as spironlactone): A. Are required supplements during blood transfusions. B. Enhance aldosterone action. C. Cause hypokalemia. D. Are weak diuretics.

Answer: D Rationale: Potassium-sparing diuretics are not potent diuretics when used alone. They are used as adjunctive therapy with other diuretics to minimize potassium loss. Potassium-sparing diuretics given during blood transfusions tend to cause hyperkalemia because potassium is present in the transfusion. These drugs block aldosterone's effects. These drugs cause hyperkalemia, not hypokalemia.

An elderly resident of a longterm care facility requires regular administration of an inhaled corticosteroid for the treatment of COPD. In order to reduce this resident's chance of developing oral candidiasis, the nurse should perform what action? a. Administer prophylactic antifungal medications b. Have the resident gargle with normal saline prior to administering the drug c. Have the resident rinse her mouth after each dose of the drug d. Encourage the resident not to deeply inhale the medication.

Answer: c Rationale: Rinsing may reduce a person's risk of developing oral candidiasis during treatment with inhaled corticosteroids. It would be incorrect to discourage deep inhalation of the medication. Gargling prior to administration is ineffective, and prophylactic medications are not used.

2. A patient admitted to the procedure center for a colonoscopy is ordered propofol for sedation. Which of the following food allergies should the nurse report to the anesthesia provider? a). peanuts b). seafood products c). eggs d). milk

Answer: c- eggs. Patients who are allergic to soybean, soybean products, eggs, or egg products should not receive propofol.

Routine laboratory monitoring in clients taking Beta Blockers should include: 1. Sodium 2. Glucose 3. Thyrotropin 4. Creatine Phosphokinase

Answer= 2 Glucose-beta blockers influence glucose metabolism. Although 1, 3, and 4 are nice to have, there is no indication that routine assessment of thyrotopin, sodium, or creatine phosphokinase is needed.

A client is ordered furosemide (Lasix) to be given via intravenous push. What interventions should the nurse perform? (Select all that apply.) a. Administer at a rate no faster than 20 mg/min. b. Assess lung sounds before and after administration. c. Assess blood pressure before and after administration. d. Maintain accurate intake and output record. e. Monitor ECG continuously. f. Insert an arterial line for continuous blood pressure monitoring.

Answers : A,C,D. Lasix pulls fluid out of the body so it is important to assess lung sounds after the administration of Lasix for absence of crackles. Assessing for a reduce in Blood Pressure due to decrease in fluids and maintain accurate intake and output accurately are important to make sure the medication is working and the patient is not dehydrated or hypokalemic.

1. The nurse is monitoring a client who is taking digoxin for adverse affects. Which findings are characteristic of digoxin toxicity? Select all that apply. a. Tremors b. Diarrhea c. Irritability d. Blurred vision e. Nausea and vomiting.

Answers: B (diarrhea), D (blurred vision), E (nausea and vomiting) Rationale: Digoxin is a cardiac glycoside. The risk of toxicity can occur with the use of this medication. Toxicity can lead to life-threatening events and the nurse needs to monitor the client closely for signs of toxicity. Early signs of toxicity include GI manifestations such as anorexia, nausea, vomiting, and diarrhea. Subsequent manifestations include headache; visual disturbances such as diplopia, blurred vision, yellow-green halos, and photophobia; drowsiness; fatigue; and weakness. Cardiac rhythm abnormalities can also occur. The nurse also monitors the digoxin level. The optimal therapueatic range for digoxin is 0.5 to 0.8 ng/ml.

A nurse is providing health education to a patient who has recently been diagnosed with asthma and prescribed albuterol and ipratropium (atrovent). Which of the patient's statements suggest a need for clarification by the nurse? "I'll try to make sure that i drink plenty of fluids each ay." "I'll make sure I don't take my inhalers more often than they've been prescribed." "I'll keep taking my medications until I'm not experiencing any more symptoms." "I'm a heavy coffee drinker, but I know now that I need to cut down on this."

C- Anti-asthma medications should normally be taken on a regular schedule, not solely on the basis of immediate symptoms. They should not be discontinued in the absence of symptoms. Increasing fluid intake, limiting caffeine, and adhering to the administration schedule are correct actions.

2. A patient in the intensive care unit has been receiving nitroprusside for 2 days. The nurse needs to monitor for which of the following? A. thiocyanate toxicity B. hyperglycemia C. hyperkalemia D. Metabolic alkalosis

ANSWER: A. Nitroprusside is metabolized to thiocyanate. It has a therapeutic level of 12mg/dL.

2. The nurse is caring for a client receiving digoxin (Lanoxin). Which of the following manifestations correlate with possible digoxin toxicity? (select all that apply) 1. Nausea 2. Drowsiness 3. Photophobia 4. Increased appetite 5. Increased energy level 6. Seeing halos around bright objects

Answer: 1, 2, 3, 6. Digoxin is a cardiac glycoside used to manage and treat heart failure, control ventricular rate in patients with atrial fibrillation, and treat and prevent recurrent paroxysmal atrial tachycardia. Signs of toxicity include GI disturbance including anorexia, nausea and vomiting, neurological abnormalities such as fatigue, headache, depression, weakness, drowsiness, confusion and nightmares; facial pain; personality changes; and ocular disturbances such as photophobia, halos around bright lights, and yellow or green color perception.

2) A nurse is planning care for a client who is receiving furosemide IV for peripheral edema. Which of the following interventions should the nurse include in the plan of care? (Select all that apply) A. Assess for tinnitus B. Report urine output 50mL/hr C. Monitor serum potassium levels D. Elevate the head of the bed slowly before ambulation E. Recommend eating a banana daily

Correct: A. An adverse effect of furosemide is ototoxicity. Manifestations of tinnitus should be reported to the provider C. A decrease in serum potassium levels is an adverse effect of furosemide, the nurse should notify the provider. D. Slowly elevating th head of the bed will prevent the client from developing orthostatic hypotension, which is a manifestation of hypovolemia. E. A banana is high in potassium. The nurse should encourage the client to eat foods high in potassium to prevent hypokalemia. Incorrect: B. A urine output of 50 mL/hr is within the expected reference range. A urine output less than 30 mL/hr is a manifestation of dehydration and the nurse should notify the provider.

1.The nurse acknowledges that which condition could occur when taking furosemide? a. Hypokalemia b. Hyperkalemia c. Hypoglycemia d. Hypermagnesemia

1. A- hypokalemia

The term "blue bloater" refers to which of the following conditions? A. Adult respiratory distress syndrome (ARDS) b. Asthma c. Chronic obstructive bronchitis d. Emphysema

ANSWER C. Clients with chronic obstructive bronchitis appear bloated; they have large barrel chests and peripheral edema, cyanotic nail beds and, at times, circumoral cyanosis. Clients with ARDS are acutely short of breath and frequently need intubation for mechanical ventilation and large amounts of oxygen. Clients with asthma don't exhibit characteristics of chronic disease, and clients with emphysema appear pink and cachectic (a state of ill health, malnutrition, and wasting).

Which of the following is a potential adverse side effect of furosemide (Lasix)? A. Drowsiness B. Hearing loss C. Diarrhea D. Cystitis

Answer: B. Rationale: Patients receiving large doses of loop diuretics are at risk for developing ototoxicity.

1. The nurse circulating in the operating room when the anesthesia provider declares a malignant hyperthermia emergency. Which of the following symptoms are indicative of malignant hyperthermia? Select all that apply. a). Tachycardia b). hypokalemia c). Increased temperature d). hypertension e). muscle rigidity

Answer: a, c, and e. Signs of malignant hyperthermia include tachycardia, elevated temperature, body rigidity, mixed metabolic and respiratory acidosis, sweating, rigid jaw, hyperkalemia, elevated creatine kinase, myoglobinuria, and renal failure.

2. A patient with asthma is prescribed beclomethasone. Which of the following side effects should the nurse instruct the patient about in the discharge instructions? Select all that apply. A) Cough B) Dry Mouth C) Fatigue D) Hoarseness E) Oral Candidiasis

Answers: Cough, Dry Mouth, Hoarseness, Oral Candidiasis

Question 1: A hypotensive patient with heart failure is admitted to the hospital. They physician prescribes digoxin anticipating which effects on the patient's hemodynamics? (Select all that apply) A) Decreased blood pressure B) Decreased heart rate C) Increased blood pressure D) Increased heart rate

Correct answer: B) decreased heart rate & C) Increased blood pressure Rationale: Digoxin has a positive inptropic effect and a negative chronological effect, producing Increased contracility and cardiac output while decreasing the heart rate.

1. Which client assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker? a. Client states that she has no chest pain. b. Client states that the swelling in her feet is reduced. c. Client states the she does not feel dizzy. d. Client states that she feels stronger.

Answer: a. Client states that she has no chest pain.

1) A nurse is teaching a client who has a new prescription for beclomethasone. Which of the following instructions should the nurse include? A: "Rinse your mouth after each use of this medication" B: "Limit fluid intake while taking this medication" C: " Increase your intake of vitamin B12 while taking this medication" D: "You can take the medication as needed"

#1 CORRECT ANSWER AND RATIONALE: A-the client should rinse her mouth after each use to reduce the risk of oral fungal infection

Prior to administering digoxin to the 6 year old child with HF, the nurse reviews the child's serum laboratory report. Which value should concern the nurse and be reported to the HCP? 1. Potassium 3.2 mEq/L 2. Hemoglobin 10 g/L 3. Digoxin level 1.8 ng/mL 4. Creatinine 0.3 mg/dL

1

2. Montelukast (Singulair) is prescribed to a client with asthma. During the medication therapy, which of the following laboratories should be monitored? A. Complete blood count (CBC). B. Sodium and Potassium. C. Calcium and Platelet count. D. ALT and AST.

2. Answer: D. ALT and AST. Montelukast (Singulair) is a leukotriene receptor and is used with caution in clients with impaired renal function. Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST) should be monitor while taking this medication.

1) Zafirlukast (Accolate) is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication? 1) Platelet count 2) Neutrophil count 3) Liver function tests 4) Complete blood count

3) Liver function tests Rationale: Zafirlukast (Accolate) is a leukotriene receptor antagonist used in the prophylaxis and long-term treatment of bronchial asthma. Zafirlukast is used with caution in clients with impaired hepatic function. Liver function laboratory tests should be performed to obtain a baseline, and the levels should be monitored during administration of the medication.

An elderly resident of a long-term care facility requires regular administration of an inhaled corticosteroid for the treatment of COPD. ?In order to reduce this resident's chance of developing oral candidiasis, the nurse should perform what action? Have the resident rinse her mouth after each dose of the drug. Encourage the resident not to deeply inhale the medication. Administer prophylactic antifungal medications. Have the resident gargle with normal saline prior to administering the drug.

A- Rinsing may reduce a person's risk of developing oral candidiasis during treatment with inhaled corticosteroids. It would be incorrect to discourage deep inhalation of the medication. Gargling prior to administration is ineffective, and prophylactic medications are not used.

2. Prior to administering digoxin to the 50-year-old with HF, the nurse reviews the patients serum laboratory report. Which value should concern the nurse and be reported to the HCP? A. Potassium 3.2 mEq/L B. Hemoglobin 10 g/dL C. Digoxin level 1.8 ng/mL D. Creatinine 0,3 mg/dL

ANSWER: A- The low serum potassium level should concern the nurse and be reported to the HCP. A low serum potassium level would increase the risk of digoxin toxicity B. Although the Hgb level is a little low, this is not most concerning C. The digoxin level is on the high side of normal. Thus, administering digoxin while the serum potassium level is low increases the risk further. D. The serum creatinine level is a measure of renal function. It is WNL and not concerning.

1. A patient is taking digoxin (Lanoxin) for atrial fibrillation. Which of the following assessment findings would indicate that the digoxin should be held and the health care provider should be notified? A. Respiratory rate of 20 breaths/min B. Pulse rate of 80 bpm C. Respiratory rate of 12 breaths/min D. Pulse rate of 52 bpm

ANSWER: D. The nurse should take the patients apical pulse for 1 minute and hold the medication if it is below 60bpm.

The nurse suspects a patient is experiencing digoxin toxicity. Which of the following symptoms did the patient report to make the nurse suspicious of a toxic reaction? A. insatiable hunger B. constipation C. halo in vision field D. muscle cramping

C

1. A nurse is monitoring a client who is recieving spironlactone. Which of the following findings should the nurse report to the provider? A. Serum Sodium 144 mEq/L B. Urine output 120 mL in 4 hr C. Serum Potassium 5.2 mEq/L D. Blood Pressure 140/90 mm Hg

C. "Serum Potassium 5.2 mEq/L" is CORRECT: Serum potassium of 5.2 mEq/L indicates hyperkalemia. Because spironlactone causes potassium retention, the nurse should withhold the medication and notify the provider.

2) An intubated, mechanically ventilated patient in the intensive care unit is becoming increasingly restless and anxious. The nurse expects to administer which intravenous anesthetic drug? A) Isoflurane (Forane) B) nitrous oxide C) propofol (Diprivan) D) halothane (Fluothane

Question #2: C) propofol (Diprivan) Propofol is an intravenous sedative-hypnotic drug used for induction and maintenance of anesthesia as well as controlled sedation in patients who are intubated and mechanically ventilated in the intensive care unit. It has a rapid onset and short duration of action, allowing for easy titration and maintenance of the patient's level of consciousness.

1. Before administering oral digoxin to the adult client, the nurse assesses that the adult has bradycardia and mild vomiting. Which is the nurses most appropriate action? A. Explain to the patient that bradycardia is an expected effect of the digoxin B. Give digoxin, document the observations, and reevaluate after the next dose C. Withhold digoxin and notify the HCP, as these signs indicate toxicity D. Give both the oral beta blocker that is prescribed now and the digoxin

Question 1. answer with rationale A- Digoxin slows and strengthens the heart. Digoxin should not be given if the HR is too low. B. Digoxin should be held if the HR is slow. Continuing to administer the medication would be unsafe ANSWER: C- the nurse should withhold digoxin (Lanoxin) and immediately notify the HCP because bradycardia and mild vomiting are signs of digoxin toxicity D. A beta-blocking agent should not be administered because it may further slow the rate

2) A nurse is planning care for a client who is receiving furosemide IV for peripheral edema. Which of the following interventions should the nurse include in the pain of care? (select all that apply) A: assess for tinnitus B: report urine output 50 ml/hr C: monitor serum potassium levels D: elevate the head of bed slowly before ambulation E: recommend eating a banana daily

#2 CORRECT ANSWER AND RATIONALE: A- an adverse effect of furosemide is ototoxicity. manifestations of tinnitus should be reported to the provider C- a decrease in serum potassium levels is an adverse effect of furosemide, and the nurse should notify the provider D: slowly elevating the head of the bed will prevent the client from developing orthostatic hypotension, which is a manifestation of hypovolemia E: a banana is high in potassium. The nurse should encourage the client to eat foods high in potassium to prevent hypokalemia

The nurse is managing the care of the pediatric client in CHF. Which medically delegated interventions should the nurse expect to include in the child's plan of care? Select all that apply. 1. Oral positive inotropic agents 2. Diuretic medications 3. ACE inhibitor medications 4. Hypolipidemic medications 5. Oral positive chronotropic agents 6. Beta blocker medications

1,2,3 & 6.

A woman presents to a clinic with shortness of breath, wheezing, but no pain upon breathing. The most appropriate recommendation that the nurse would give the provider to help the women would be? A. Oxygen B. Albuterol C. Atrovent D. Digoxin

Answer: B. Although oxygen would be a good idea to order for someone who is short of breath it won't properly address the wheezing. Atrovent is not fast acting enough and digoxin is used to treat heart failure.

1. A nurse admits a client who is 28 weeks pregnant and experiencing congestive heart failure. When initiating a health care providers admission orders for the client which order should the nurse question? a. Furosemide 40 mg IV bid b. Captopril 25 mg PO daily c. Digoxin 0.125 mg IV daily d. Metoprolol sustained release 50 mg PO daily

1. B, Captopril is an angiotensin-converting enzyme (ACE) inhibitor. ACE inhibitors are contraindicated in the second and third trimesters of pregnancy. They can cause oligohydramnios, intrauterine growth retardation, congenital structural defects, and renal failure.

1. A nurse in a provider's office is monitoring serum electrolytes for an older adult client who is taking digoxin. Which of the following electrolyte values increases a client's risk for digoxin toxicity? A. Calcium 9.2 mg/dL B. Calcium 10.3 mg/dL C. Potassium 3.1 mEq/L D. Potassium 4.8 mEq/L

1. C - Potassium 3.1 mEq/L is below the expected reference range and puts a client at risk for digoxin toxicity. Low potassium can cause fatal dysrhythmias, especially in older clients who take digoxin.

7. While providing home care to a client with congestive heart failure, the nurse is asked how long diuretics must be taken. The BEST response to this client should be: A. "As you urinate more, you will need less medication to control fluid." B. "You will have to take this medication for about a year." C. "The medication must be continued so the fluid problem is controlled." D. "Please talk to your physician about medications and treatments.

Answer C. "The medication must be continued so the fluid problem is controlled." This is the most therapeutic response and gives the client accurate information.

An albuterol nebulizer treatment is ordered for a 6-month old infant hospitalized with Laryngotraceobronchitis (LTB). The nurse understands that albuterol, when used as a nebulizer treatment, does what? a. Relaxes smooth muscles in the airways b. Removes excess fluid from the lungs c. Loosens and thins pulmonary secretions d. Reduces inflammation and mucus from airways

ANSWER: a. Relaxes smooth muscles in the airways Rationale: Albuterol (Proventil, Ventolin) binds to beta-2 adrenergic receptors in the airway's smooth muscles, and cellular actions decrease intracellular calcium. Decreased intracellular calcium relaxes smooth muscle in the airways.

The client who is to receive a scheduled dose of digoxin has an irregular apical pulse at 92 BPM and a serum potassium of 3.9 mEq/L. Which nursing documentation reflects the most appropriate action? 1. serum potassium level WNL. Digoxin given for rapid apical pulse. 2. Digoxin withheld because the clients apical heart rate is irregular. 3. Digoxin withheld to prevent toxicity due to the low potassium level. 4. HCP informed of irregular heart rate and low serum potassium level.

ANSWER: option 1, a normal serum potassium level is 3.5 to 5.0 mEq/L. Digoxin (Lanoxin), a cardiac glycoside, slows and strengthens the heart. It is used for rate control in clients with atrial fibrillation, which often produces an irregular rhythm.

2. You are assessing a patient with type 1 diabetes and high blood pressure which blood pressure medication would you expect to see on a list of current medications. A. Spironolactone B. Losartan C. Metoprolol D. Captopril

Answer: D. Captopril Rational: Captopril is best for type on diabetes whereas Losartan is best for type 2 diabetes. Metoprolol my mask hypoglycemia and spironolactone had no indication regarding diabetes.

Which of the following describes drugs that are in pregnancy risk category D? (Select all that apply.) A) Are safe to take during the first trimester of pregnancy B) Require the use of contraception by women of childbearing age C) Can cause fetal malformation D) Can pass through the umbilical cord or the placenta to the fetus E) Require weighing potential benefits against possible risks

Ans: B,C,D,E

1) The patient's serum potassium is taken before administering a loop diuretic and is 3.0. The nurse should include which of the following in her recommendation in his/her SBAR to the physician? a) A baseline ECG b) A potassium wasting diuretic c) Potassium supplements d) A call to the physician is not necessary

Answer: C Rationale: While getting a baseline ECG is necessary, it is more important to administer a potassium supplement to the patient receiving Lasix, because they already have a potassium level below the normal range (3.5-5.3). A potassium wasting diuretic will cause the patient to lose more potassium, and a call to the physician is necessary.

Prior to administering a client's daily dose of digoxin, the nurse reviews the client's laboratory data and notes the following results: serum calcium, 9.8 mg/dL (2.45 mmol/L); serum magnesium, 1.0 mEq/L (0.5 mmol/L); serum potassium, 4.1 mEq/L (4.1 mmol/L); serum creatinine, 0.9 mg/dL (79.5mcmol/L). Which result should alert the nurse that the client is at risk for digoxin toxicity? A). Serum calcium level B). Serum potassium level C). Serum creatinine level D). Serum magnesium level

Answer: D Rationale: An increased risk of toxicity exists in clients with hypercalcemia, hypokalemia, hypomagnesemia, hypothyroidism, and impaired renal function. The calcium, creatinine, and potassium levels are all within normal limits. The normal range for magnesium is 1.3 to 2.1 mEq/L [note: CENTURY COLLEGE LAB VALUES HAVE Mg 1.5-2.5 mEq/L] and the results in the correct option are reflective of hypomagnesemia.

Montelukast (Singulair) is prescribed to a client with asthma. During the medication therapy, which of the following laboratories should be monitored? A. Complete Blood count (CBC). B. Sodium and Potassium. C. Calcium and Platelet count. D. ALT and AST.

Answer: D. ALT and AST. Montelukast (Singulair) is a leukotriene receptor and is used with caution in clients with impaired renal function. Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST) should be monitor while taking this medication.

A 70- year old male presented to the Emergency Department with shortness of breath, crackles in the base and middle of the lung fields bilaterally, +2 pitting edema bilaterally of the lower extremities, and a weight increase of 6 lbs in one week. His heart rate is 82 and his blood pressure is 162/90. Per physician's order, the nurse administers 40 mg of furosemide intravenously. The nurse knows that which of the following indicates effectiveness of the medication? 1. A heart rate of 58 2. A blood pressure of 100/52 3. Urine output increase of 200 mls over the next hour 4. Diminished lung sounds bilaterally with crackles in the bases

Correct Answer is 3: The nurse would expect an increase in urine output after the administration of furosemide. The client presented with sighs and symptoms of hypervolemia or fluid overload, including shortness of breath, crackles in lung base, and edema. Weight gain and hypertension can also be indicative of hypervolemia. The goal of treatment using furosemide is diuresis, with care not to send the client into hypovolemia

A nurse is administering an antidepressant medication. The nurse knows which of the following types of antidepressant medications have adverse effects when combined with foods containing tyramine? 1. Monoamine oxidase inhibitors (MAOIs) 2. Selective serotonin reuptake inhibitors (SSRIs) 3. Heterocyclics 4. Tricyclics

1 - MAOIs block the monoamine oxidase enzyme in the body, causing the body to not breakdown Tyramine. Tyramine is an amino acid that helps regulate blood pressure, if the levels of tyramine become too high, a client can become very hypertensive and require emergency medical attention.

14. A 25-year-old woman is in her fifth month of pregnancy. She has been taking 20 units of NPH insulin for diabetes mellitus daily for six years. Her diabetes has been well controlled with this dosage. She has been coming for routine prenatal visits, during which diabetic teaching has been implemented. Which of the following statements indicates that the woman understands the teaching regarding her insulin needs during her pregnancy? A. "Are you sure all this insulin won't hurt my baby?" B. "I'll probably need my daily insulin dose raised." C. "I will continue to take my regular dose of insulin." D. "These finger sticks make my hand sore. Can I do them less frequently?"

14. Answer B. "I'll probably need my daily insulin dose raised." The client starts to need increased insulin in the second trimester. This statement indicates a lack of understanding. As a result of placental maturation and placental production of lactogen, insulin requirements begin increasing in the second trimester and may double or quadruple by the end of pregnancy. The client starts to need increased insulin in the second trimester. This statement indicates a lack of understanding. Insulin doses depend on blood glucose levels. Finger sticks for glucose levels must be continued.

2) A patient with hypertension is started on a new medication for treatment and is reporting a continuous dry cough. Which of the following medications do you suspect is causing this problem? a. Lisinopril b. Losartan c. Labetalol d. Humalog

A- lisinopril, ACE inhibitors have a common side effect of a continuous "nagging" cough

A nurse applies a fentanyl (Sublimaze) transdermal patch to a client for the first time. Shortly after application, the client is experiencing pain. Which nursing action is most appropriate? 1. Remove the transdermal patch and apply a new one. 2. Administer a short-acting opioid analgesic. 3. Rub the transdermal patch to enhance absorption of the medication. 4. Call the physician to request a fentanyl transdermal patch with a higher dosage.

Answer: 2 Rationale: When the first fentanyl transdermal patch is applied, effective analgesia may take 12 to 24 hours to develop because absorption is slow. Removing the patch is unnecessary. Transdermal patches should not be rubbed to enhance absorption because it can cause the delivery of the medication to fluctuate. It is premature to request a higher dose of fentanyl.

The nurse is reviewing the chart of a client with a diagnosis of stage II heart failure: Admitting History & Physical Experiencing dyspnea on exertion Lung sounds: crackles in bilateral bases Reports seeing yellow halo when visualizing objects Serum Laboratory Data BNP: 886 ng/L aPTT: 55 sec K+: 2.9 mEq/L Diagnostic Data Results 12-lead ECG results: Atrial fibrillation with frequent PVCs Chest x-ray: Pulmonary infiltrated bilateral bases. Cardiomegaly Medications Buffered aspirin 325 mg oral daily Digoxin 0.25 mg oral daily Furosemide 40 mg oral daily Atenolol 25 mg oral Heparin intravenous infusion per protocol The data should suggest to the nurse that: 1. Medications should be administered as ordered. 2. The client may be experiencing digoxin toxicity. 3. Hyperkalemia likely caused the client's cardiac dysrhythmias. 4. The client's visual disturbance likely resulted from the atrial fibrillation rhythm or effects of the anticoagulants.

Answer: 2 Rationale: Signs of digoxin toxicity include yellow vision and dysrhythmias. The furosemide diuretic increases urinary excretion of potassium and can cause hypokalemia. A low serum potassium level can contribute to both cardiac dysrhythmias and digoxin toxicity. The digoxin should be held until a serum digoxin level is determined. A serum potassium level of 2.9 mEq/L indicates hypokalemia, not hyperkalemia. The yellow vision is a characteristic sign of digoxin toxicity and not a sign of cerebral damage from an infarct or bleeding. Question 2:

The nurse works on a medical/surgical unit and cares for a patient receiving Lanoxin (Digoxin) and Furosemide (Lasix). The nurse knows that which of the following, if reported by the patient, must be assessed IMMEDIATELY? 1. Night sweats and headache. 2. Vomiting and halos around lights. 3. Low blood pressure and dark urine. 4. Stomach upset and headache.

Answer: 2 Rationale: Lasix causes the patient to lose potassium. Digoxin, if taken with a low potassium level, can become toxic and show signs/symptoms of nausea, vomiting, and halos around lights.

An albuterol nebulizer treatment is ordered for a 6-month old infant hospitalized with LTB. The nurse understands that albuterol, when used as a nebulizer treatment, does what? A) relaxes smooth muscles in the airways B) removes excess fluid from the lungs C) loosens and thins pulmonary secretions D) reduces inflammation and mucus from airways

Answer: A

The nurse is teaching the client about using the plastic attachment (spacer) to the meter-dose inhaler. The nurse should explain that this attachment is used for what purpose? A) allows for a greater amount of medication to be delivered B) permits visualization of the medication to be delivered C) maintains the sterility of the mouthpiece and medication D) used for activating the medication canister by simply inhaling

Answer: A

Which is the MOST appropriate action for the nurse to take before administering digoxin? A. Monitor potassium level B. Assess blood pressure C. Evaluate urinary output D. Avoid giving with thiazide diuretic

Answer: A. Monitor potassium level Monitoring potassium is especially important because hypokalemia potentiates digoxin toxicity. B and C are incorrect because these data reflect overall CV status but are not specific for digoxin. Choice D are drugs usually administered with digoxin.

2. The nurse is monitoring a client taking digoxin (Lanoxin) for treatment of heart failure. Which assessment finding indicates a therapeutic effect of the drug? a. Heart rate 110 beats per minute b. Heart rate 58 beats per minute c. Urinary output 40 mL/hr d. Blood pressure 90/50 mm Hg

2. B- Heart rate 58 beats per minute - Digoxin increases contractility therefore decreasing HR

A patient is being discharged home on Hydrochlorothiazide (HCTZ) for treatment of hypertension. Which of the following statements by the patient indicates they understood your discharge teaching about this medication? A. I will make sure I consume foods high in potassium. B. I will only take this medication if my blood pressure is high. C. I understand a dry cough is a common side effect with this medication. D. I will monitor my glucose levels closely because this medication may mask symptoms of hypoglycemia.

A

2. The nurse receives an order to administer a loop diuretic IV push to the adolescent client with hydronephrosis. The nurse should monitor for which adverse effects? Select all that apply. a. Ototoxicity b. Hypertension c. Hypoglycemia d. Electrolyte abnormalities e. Orthostatic hypotension

Answer: A, D, E: Ototoxicity is a side effect of loop diuretics. Electrolyte abnormalities can occur with the use of loop diuretics from potassium and sodium excretion. Orthostatic hypotension is a common side effect of loop diuretic therapy due to fluid volume loss with diuresis.

2. A nurse is caring for a pediatric client who has congestive heart failure (CHF). The client is receiving digoxin therapy. Which laboratory result is most important to evaluate when preparing to administer digoxin? A. Serum potassium levels B. Serum magnesium levels C. Serum sodium levels D. Serum chloride levels

Answer: A. The serum potassium level is the most important result when preparing to administer digoxin. Hypokalemia increases the risk of digoxin toxicity and life-threatening dysrhythmias.

1. An albuterol nebulizer treatment is ordered for the 6-month-old infant hospitalized with Laryngotracheobronchitis (LTB). The nurse understands that albuterol when used as a nebulizer treatment, does what? a. Relaxes smooth muscles in the airways b. Removes excess fluid from the lungs c. Loosens and thins pulmonary secretions d. Reduces inflammation and mucous from airway

Answer: A: Albuterol binds to beta-2 receptors in the airway's smooth muscles, and cellular actions decrease intracellular calcium. Decreased intracellular calcium relaxes smooth muscle in the airways.

1) A nurse is reviewing the health record of a client who asks about using propranolol to treat hypertension. The nurse should recognize which of the following conditions is contraindicated for taking propranolol? A. Asthma B. Glaucoma C. Hypertension D. Tachycardia

1) A. asthma Rationale: Propranolol is a nonselective beta adrenergic blocker that blocks both beta1 and beta 2 receptors. Blockade of beta2 receptors in the lungs causes bronchoconstriction, so it is contraindicated in clients who have asthma.

The nurse provides medication instructions to an older hypertensive client who is taking 20 mg of lisinopril (Prinivil, Zestril) orally daily. The nurse evaluates the need for further teaching when the client states which of the following? 1. "I can skip a dose once a week." 2. "I need to change my position slowly." 3. "I take the pill after breakfast each day." 4. "If I get a bad headache, I should call my doctor immediately."

1. "I can skip a dose once a week." Rationale: Lisinopril is an antihypertensive angiotensin-converting enzyme (ACE) inhibitor. The usual dosage range is 20 to 40 mg per day. Adverse effects include headache, dizziness, fatigue, orthostatic hypotension, tachycardia, and angioedema. Specific client teaching points include taking one pill a day, not stopping the medication without consulting the health care provider (HCP), and monitoring for side effects and adverse reactions. The client should notify the HCP if side effects occur.

1. The nurse is monitoring a patient taking digoxin (Lanoxin) for treatment of heart failure. Which assessment finding indicates a therapeutic effect of the drug? a. Heart rate of 110 beats per minute b. Heart rate of 58 beats per minute c. Urinary output of 40 mL/hr d. Blood pressure of 90/50 mmHg

1. b. Digoxin works to increase the contractility of the heart, slowing the pulse.

Question 1 The nurse is reviewing the client's medications and noticed a prescription for Versed. Which medication is important to have available for clients who have received Versed? 1. flumazenil (Romazicon) 2. diazepam (valium) 3. florinef (Fludrocortisone) 4. naloxone (Narcan)

1. flumazenil (Romazicon) is the antidote for Versed. Versed is used for conscious sedation and is an antianxiety agent.

2. A client who has just been diagnosed with hypertension also smokes and has diabetes mellitus. The nurse would question an order for which of the following antihypertensive medications? A. Diltiazem (Cardizem) B. Propranolol (Inderal) C. Prazosin (Minipress) D. Furosemide (Lasix)

2. B Rationale: Adverse effects of beta-adrenergic blockers such as propranolol include their potential cause of bronchospasm and to mask hypoglycemia attacks. Therefore, the clients who are at risk for these conditions should not utilize beta-blockers as antihypertensive medications. Calcium channel blockers, alpha blockers, and diuretics do not directly effect these conditions.

A nurse is caring for a client who has been prescribed furosemide (Lasix) and is monitoring for adverse effects associated with this medication. Which of the following should the nurse recognize as a potential adverse effect Select all that apply. 1. Nausea 2. Tinnitus 3. Hypotension 4. Hypokalemia 5. Photosensitivity 6. Increased urinary frequency

2. Tinnitus 3. Hypotension 4. Hypokalemia Rationale: Furosemide is a loop diuretic; therefore, an expected effect is increased urinary frequency. Nausea is a frequent side effect, not an adverse effect. Photosensitivity is an occasional side effect. Adverse effects include tinnitus (ototoxicity), hypotension, and hypokalemia and occur as a result of sudden volume depletion.

2. Captopril has been ordered for a patient. The nurse teaches the patient that ACE inhibitors have which common side effect(s)? a. Nausea and vomiting b. Dizziness and headaches c. Bronchospasms d. Constant, irritating cough

2. d. ACE inhibitors have a common side effect of a constant, irritating cough. Patients experiencing this symptom may be switched to an Angiotensin II- Receptor Blocker (ARB) instead (such as Losartan).

1. A patient with hypertension and asthma is taking propranolol, a non selective betablocker. Which of the following side effects is the patient most at risk to develop? a. Alopecia b. Insomnia c. Bronchospasm d. Hypoglycemia

Answer is C. As a non-selective beta blocker, propranolol inhibits beta-2 receptors in the lungs, leading to brochoospasm and bronchoconstriction. Asthma places the patient at an increased risk for bronchospasm and constriction.

A client has +3 pitting edema in their legs and a potassium level of 2.3 mEq/L, the nurse knows which of the following diuretic is likely to be ordered? a. Bumetamide (Bumex) b. Ethacrynic Acid (Edecrin) c. Spironlactone (Aldactone) d. Furosemide (Lasix)

Answer is C. Spironlactone is a potassium sparing diuretic.

Which is the MOST appropriate action for the nurse to take before administering Digoxin? 1. Monitor potassium level 2. Assess blood pressure. 3. Evaluate urinary output. 4. Avoid giving with thiazide diuretic.

Answer: 1-Monitoring potassium level is especially important because hypokalemia potentiates digoxin toxicity. 2 and 3 are incorrect because these data reflect overall CV status but are not specific for digoxin. D are drugs usually administered with digoxin.

Question 2:The health care provider orders ipratropium bromide (Atrovent), albuterol (Proventil), and beclomethasone (Vanceril) inhalers for a client. What is the nurse's best action? a. Question the order; three inhalers should not be given at one time. b. Administer the albuterol first, wait 5 minutes, and administer ipratropium bromide, followed by beclomethasone several minutes later. c. Administer each inhaler at 30-minute intervals. d. Administer beclomethasone first, wait 2 minutes, and administer ipratropium bromide, followed by the albuterol several minutes later.

Answer: B. Albuterol is bronchodilator and it is should be given first to dilates the bronchi and bronchioles, decreasing resistance in the respiratory airway and increasing airflow to the lungs. There is a 5 minute wait after the administration of Albuterol before the nurse administers other inhalers to the patient

2. A client with severe acne is seen in the clinic and the health care provider prescribes Isotretinoin ( Accutane). The nurse reviews the clients medication record and would contact the health care provider if the client is also taking which medication? A. Digoxin B. Phenytoin C. Vitamin A D. Furosemide

Answer: C Rationale: Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of Isotrention toxicity. Because of the potential for increased toxicity, vitamin A supplements should be discontinued before Isotretinoin therapy. There are no contradictions associated with digoxin, phenytoin, or furosemide.

1. The nurse is planning to administer hydrochlorothiazide to a client. The nurse should monitor for which adverse effects related to the administration of this medication? A. Hypouricemia, hyperkalemia B. Increases risk of osteoporosis C. Hypokalemia, hyperglycemia, sulfa allergy D. Hyperkalemia, hypoglycemia, penicillin allergy

Answer: C Rationale: Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia and hyperuricemia.

2. A client with severe acne is seen in the clinic and the health care provider (HCP) prescribes isotretinoin. The nurse reviews the client's medication record and would contact the HCP if the client is also taking which medication? a. Digoxin b. Phenytoin c. Vitamin A d. Furosemide

Answer: C (vitamin A) Rationale: Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements should be discontinued before isotretinoin therapy. There are no contraindications associated with digoxin, phenytoin, or furosemide.

A 5 year old boy is brought to the ED with an asthma exacerbation. Those who have asthma chronically present with what signs, even when they may appear symptom free? Select all that apply. a. Bradycardia b. Damaged airway mucosa c. Elevated temperature d. Airway inflammation

Answer: b, d Rationale: Inflammation and damaged airway mucosa are chronically present in asthma, even when patients appear symptom free.

A patient as been taking beclomethasone for the treatment of asthma. Which statements by the patient indicate the need for further instruction? Select all that apply: A) "I should stay alert to symptoms of a high blood sugar." B) "I will continue my blood pressure medication." C) "I will immediately discontinue this medication if I experience skin thinning." D) "I will use this inhaler as needed for wheezing." E) "If I want to get pregnant, I should talk to my physician first."

Answers: C, D C) Corticosteroids should not be suddenly discontinued due to the risk of adrenal insufficiency. They should be tapered gradually. Skin atrophy is a common side effect and does not warrant the discontinuation of beclomethasone. D) Corticosteroids are maintenance therapy for asthma and will not resolve acute episodes of wheezing.

Question 2: A patient with congestive heart failure is prescribed lisinopril 10mg PO daily. The nurse should inform the patient about which common side effect? A) Confusion B) Dry cough C) Dry eyes D) Weight gain

Correct answer: B) Dry cough Rationale: Dry cough and hypotension are the most common side effects accompanied with ACE inhibitors such as lisinopril. Many patients cannot tolerate the dry cough and must be switched to an angiotensin 2 receptor blocker (ARB) for the management of congestive heart failure.

A child with asthma is being discharged to home and has an order for a bronchodilator (albuterol) to be administered via a metered dose inhaler (MDI). Which point should a nurse address for appropriate administration of this medication? 1. When administering medication via MDI, avoid shaking the canister before discharging the medication. 2. Medication is ordered in two "puffs"; press the canister twice in succession to discharge the medication. 3. There should be a tight seal around the mouthpiece of the inhaler before discharging the medication. 4. There should be a 2- to 3-inch space (or spacer device) between the inhaler and the open mouth of the child.

Correct: Answer 4. Children often have difficulty learning to depress and inhale their medications at the same time, and holding the MDI 2 to 3 inches away from the mouth or utilizing a "spacer" improves the effects of the medication. MDI canisters should be shaken before use. waiting 1 minute between puffs allows better absorption of the inhaled medication. Wrapping lips tightly around the mouthpiece consolidates the medication in the buccal cavity and decreases the effectiveness of inhaled medications.

2. A client is to receive a scheduled dose of digoxin (Lanoxin). A nurse determines that the clients apical pulse is irregular at 92 beats per minute and that the client's serum potassium level is 3.9 mEq/L. Which documentation by the nurse reflects the most appropriate action based on this information? a. Serum potassium level within normal limits. Digoxin administered for rapid apical pulse. b. Digoxin withheld because the client's heart rate is irregular. c. Digoxin withheld to prevent toxicity due to the low serum potassium level. d. Physician notified to report the irregular heart rate and low potassium level.

Integrated Processes: Communication and Documentation Answer: A Rational: Digoxin is a cardiac glycoside, slows and strengthens the heart. It is used for rate control in clients with atrial fibrillation, Atrial fibrillation produces an irregular rhythm. A normal serum potassium level 3.8 to 5.5 mEq/L (Century College 3.5-5.3). Dysrhythmias can occur if digoxin is administered when serum potassium is low, serum potassium level is within normal range. Withholding or notifying the physician is unnecessary.