Pharm II HESI

The nurse should withhold which medication if a client reports nausea, vomiting, and diarrhea? A. Colchicine (Colchicine). B. Erythromycin (E-Mycin). C. Naproxen (Aleve, Naprosyn). D. Labetolol (Normodyne).

A. Colchicine (Colchicine). Nausea, vomiting, and diarrhea are indicators of toxic effects of colchicine which can be life-threatening, and if present, this drug should be withheld and the healthcare provider notified.

The nurse is assessing a patient who is prescribed estrogen replacement therapy. A history of which medical condition would be a contraindication to this therapy? A. Deep vein thrombosis B. Vaginal bleeding C. Weight loss D. Dysmenorrhea

A. Deep vein thrombosis Increased coagulation and risk of deep vein thrombosis are side effects of hormone replacement therapy. A previous history would put the patient at increased risk.

What will the nurse monitor to evaluate the effectiveness of antiviral agents administered to treat human immunodeficiency virus infection? A. Megakaryocyte counts B. Lymphocyte counts C. Red blood cell counts D. Viral load

D. Viral load All antiretroviral agents work to reduce the viral load, which is the number of viral RNA copies per milliliter of blood.

What information will the nurse teach the patient who has been prescribed an alpha glucosidase inhibitor? A. "This medication will stimulate pancreatic insulin release." B. "This medication will increase the sensitivity of insulin receptor sites." C. "This medication will delay the absorption of carbohydrates from the intestines." D. "This medication cannot be used in combination with other antidiabetic agents."

C. "This medication will delay the absorption of carbohydrates from the intestines." Alpha glucosidase is an enzyme necessary for the absorption of glucose from the GI tract. Inhibiting this enzyme inhibits glucose absorption, delaying rises in postprandial serum glucose levels.

A patient has been taking metoprolol and tells the home care nurse, "I can't afford this medication any more, and I stopped it yesterday." What is the nurse's priority action? A. Refer the patient to the social worker. B. Call the drug company to ask for assistance. C. Assess the patient's blood pressure. D. Teach the patient that abrupt medication withdrawal may lead to a rebound hypertensive crisis.

C. Assess the patient's blood pressure. Abrupt withdrawal of a beta blocker can cause rebound hypertension. The nurse should immediately check the patient's blood pressure and then proceed with teaching and calling the health care provider.

A client is receiving metoprolol (Lopressor SR, Nu-Metop). What assessment is most important for the nurse to obtain? A. Temperature. B. Lung sounds. C. Blood pressure. D. Urinary output.

C. Blood pressure. It is most important to monitor the blood pressure of clients taking this medication because metoprolol is an antianginal, antiarrhythmic, antihypertensive agent.

The nurse notes that the health care provider is considering starting the patient on a selective serotonin reuptake inhibitor (SRRI) drug. The nurse recognizes that the health care provider will select which drug? A. Amitriptyline B. Doxepin C. Fluvoxamine D. Imipramine

C. Fluvoxamine

The nurse is instructing a group of patients about nutrition. The nurse is discussing vitamin deficiencies in this week's class. A patient asks if a B12 deficiency is a significant problem. The nurse explains that a B12 deficiency can result in which symptom? A. Dermatitis B. Blurred vision C. Gastrointestinal disorders D. Loss of appetite

C. Gastrointestinal disorders Vitamin B12 deficiency is known to produce symptoms such as gastrointestinal disorders, poor growth, and anemia. Dermatitis is symptomatic of a deficiency of vitamin B6; loss of appetite is symptomatic of vitamin B1 deficiency; blurred vision is symptomatic of deficiency of vitamin B2.

A medication that is classified as a beta-1 agonist is most commonly prescribed for a client with which condition? A. Glaucoma. B. Hypertension. C. Heart failure. D. Asthma.

C. Heart failure. Beta-1 agonists improve cardiac output by increasing the heart rate and blood pressure and are indicated in heart failure, shock, atrioventricular block dysrhythmias, and cardiac arrest. In contrast, glaucoma is managed using adrenergic agents and beta-adrenergic blocking agents. Beta-1 blocking agents are used in the management of hypertension. Medications that stimulate beta-2 receptors in the bronchi are effective for bronchoconstriction in respiratory disorders, such as asthma.

Which finding would indicate to the nurse that a medication has activated beta2 receptors? A. Uterine contractions B. Bronchiolar constriction C. Hyperglycemia D. Increased saliva production

C. Hyperglycemia When beta2 receptors are stimulated, the nurse will observe dilation of bronchioles; gastrointestinal and uterine relaxation; increases in blood glucose through glycogenolysis in the liver, and increases in blood flow in skeletal muscles.

The nurse is caring for a patient who describes symptoms indicative of narcolepsy. The nurse recognizes that the physician is most likely to order which medication for the patient? A. Phentermine-topiramate B. Diethylpropion HCl C. Modafinil D. Benzphetamine HCl

C. Modafinil Modafinil (Provigil) is indicated for treatment of narcolepsy.

The patient is caring for the patient receiving nitroprusside. Which interventions should be included in the nurse's plan of care? SATA A. Monitor for thiocyanate levels B. Protect fluid bag from light. C. Provide continuous blood pressure monitoring. D. Monitor potassium levels. E. Assess chest pain level.

A, B, C Nitroprusside is used for hypertensive emergencies as well as emergency management for heart failure. The drug can be administered over 24 h but decomposes in light, so the container must be wrapped in opaque material, such as aluminum foil. Discard drug if red, green, or blue. Measure cyanide and thiocyanate levels. May cause confusion, hypotension, bradycardia, tachycardia, dizziness, headache, palpitations, ataxia, seizures, cyanide or thiocyanate toxicity, and methemoglobinemia.

In which of the following groups would the use of tetracycline be contraindicated? A. Infants B. Pregnant women C. Older adults D. Adolescents. E. Breastfeeding mothers

A, B, D Women in the last trimester of pregnancy and children younger than 8 years of age should also not take tetracycline because it irreversibly discolors the permanent teeth.

The nurse is caring for a patient receiving androgen therapy. The nurse understands that androgen therapy is indicated for which conditions? A. Constitutional growth delay B. Endometriosis C. Hypergonadism D. Priapism E. Prostate cancer F. Refractory anemias

A, B, F Androgen therapy is indicated for the treatment of constitutional growth delay, endometriosis, refractory anemias, advanced breast cancer in women, hypogonadism, angioneurotic edema, and tissue wasting associated with severe or chronic illness.

The patient asks the nurse if there is anything that the physician could order that would function as an appetite suppressant. The nurse anticipates that the physician may order which medications? A. Phentermine-topiramate B. Caffeine citrate C. Diethylpropion HCl D. Benzphetamine HCl E. Armodafinil

A, C, D

Which side effects should the nurse monitor for a client who is receiving dexamethasone (Decadron) following neurosurgery? (Select all that apply.) A. Mood swings. B. Decreased appetite. C. Increased weight gain. D. Serum glucose level of 65 mg/dl. E. Delayed incisional wound healing. F. Serum hemoglobin level of 9 mg/dl.

A, C, E, F Dexamethasone (Decadron) is a long-acting glucocorticoid prescribed for neurosurgical procedures because it suppresses inflammation and has a low sodium-retaining ability, which is important in averting cerebral edema. However though the medication does produce the following side effects such as: mood swings; an increase in appetite, resulting in weight gain; hyperglycemia (serum glucose level above 120 mg/dl) which is related to the gluconeogenesis properties of corticosteroids; delayed in wound healing related to immune suppression properties; and complete blood count resulting in a decreased in WBC and hemoglobin (less than 12mg/dl). When a client is receiving dexamethasone, they should be monitor for these side effects.

The nurse should expect the healthcare provider to prescribed what treatment regimen for a client with peptic ulcer caused by Helicobacter pylori ? (Select all that apply.) A. Clarithromycin (Biaxin). B. Sulfisoxazole (Gantrisin). C. Misoprostol (Cytotec). D. Omeprazole (Prilosec). E. Metronidazole (Flagyl). F. Sucralfate (Carafate).

A, D, E Recommended medical treatment for Helicobacter pylori includes the use of at least 2 different antibiotics and a proton pump inhibitor to decrease the incidence of antibiotic resistance.

Which instruction(s) should the nurse give to a female client who just received a prescription for oral metronidazole (Flagyl) for treatment of trichomonas vaginalis? (Select all that apply.) A. Increase fluid intake, especially cranberry juice. B. Do not abruptly discontinue the medication; taper use. C. Check blood pressure daily to detect hypertension. D. Avoid drinking alcohol while taking this medication. E. Use condoms until treatment is completed. F. Ensure that all sexual partners are treated at the same time.

A, D, E Increased fluid intake and cranberry juice are recommended for prevention and treatment of urinary tract infections, which frequently accompany vaginal infections. It is not necessary to taper use of this drug or to check the blood pressure daily, as this condition is not related to hypertension. Flagyl can cause a disulfiram-like reaction if taken in conjunction with ingestion of alcohol, so the client should be instructed to avoid alcohol. All sexual partners should be treated at the same time and condoms should be used until after treatment is completed to avoid reinfection.

A patient is to be discharged with a transdermal nitroglycerin patch. Which instruction will the nurse include in the patient's teaching plan? A. "Apply the patch to a non-hairy area of the upper torso or arm." B. "Apply the patch to the same site each day." C. "If you have a headache, remove the patch for 4 hours and then reapply." D. "If you have chest pain, apply a second patch next to the first patch."

A. "Apply the patch to a non-hairy area of the upper torso or arm." A nitroglycerin patch should be applied to a non-hairy area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation. The drug should be continued if headache occurs, as tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain.

What is the primary information the nurse should teach a patient who has just started taking mephobarbital? A. "Do not drive until you determine how you react to the medication." B. "Take the medication on a full stomach." C. "Do not take any over-the-counter medications with this drug." D. "Take this medication for 1 month only and then stop."

A. "Do not drive until you determine how you react to the medication." This medication can cause drowsiness. The nurse must teach the patient to be safe while taking this medication. The drug does not need to be taken on a full stomach or to be taken for a limited period of time. The patient should be advised not to take any sedating medications that are available over the counter, but the patient does not need to discontinue all over-the-counter medications.

What is the most important information for the nurse to include in a teaching plan for the patient receiving allopurinol? A. "Do not take this medication during an acute attack of gout." B. "Include salmon and organ meats in your diet weekly." C. "Take the medication with an antacid to minimize gastrointestinal distress." D. "This medication may cause your urine to turn orange."

A. "Do not take this medication during an acute attack of gout." Allopurinol should not be taken during an acute attack because the initial response to allopurinol is an exacerbation of the symptoms. It is used prophylactically to prevent gout and treat hyperuricemia. It should not be taken with an antacid, will not be affected by the patient's usual diet, and will not result in a change in the color of the urine.

Which patient statement demonstrates understanding of the nurse's teaching for levothyroxine? A. "I will take this medication first thing in the morning." B. "I will double my dose if I gain more than 1 pound/day." C. "It is best to take the medication with food to prevent gastrointestinal upset." D. "I can expect to see relief of my symptoms within 1 week."

A. "I will take this medication first thing in the morning." Levothyroxine increases basal metabolism and thus wakefulness. It should be taken first thing in the morning. The patient should not increase the dose. The medication is absorbed best on an empty stomach. Depending on the symptoms, some symptoms may take weeks to improve.

The patient with type 1 diabetes mellitus asks, "Why can't I take a sulfonylurea like my friend who has diabetes?" What is the nurse's best response? A. "Sulfonylurea increases beta-cell stimulation to secrete insulin, and with your type of diabetes, the beta cells do not contain insulin. This medication will not work for you." B. "You must be mistaken. If your friend has diabetes mellitus, she is taking insulin." C. "Sulfonylurea will lower your blood sugar too much, and you will be hypoglycemic." D. "You are unable to store glucose, because you do not have insulin, and sulfonylurea helps with glucose storage."

A. "Sulfonylurea increases beta-cell stimulation to secrete insulin, and with your type of diabetes, the beta cells do not contain insulin. This medication will not work for you." Sulfonylurea agents reduce serum glucose levels by increasing beta-cell stimulation for insulin release, decreasing hepatic glucose production, and increasing insulin sensitivity. It is administered for type 2 diabetes mellitus but will not be effective in type 1.

The nurse is teaching a patient who has been prescribed repaglinide. Which information will the nurse include in the teaching plan? A. "You will need to be sure you eat as soon as you take this medication." B. "This medication is compatible with all of your cardiac medications." C. "This medication will not cause hypoglycemia." D. "This medication has no side effects."

A. "You will need to be sure you eat as soon as you take this medication." Repaglinide is short-acting. The drug's very fast onset of action allows patients to take the drug with meals and skip a dose when they skip a meal. Repaglinide interacts with beta-adrenergic blockers as well as other medications. Hypoglycemia is a side effect of this medication, and there are many other possible side effects of this medication.

The patient has recently been prescribed a sedative-hypnotic medication and reports experiencing a "hangover"-type effect upon awakening. What does this symptom indicate? A. A need to change to a different medication B. Toxicity level of the medication C. Allergic reaction to the medication D. Inadequate amount of the medication

A. A need to change to a different medication Some of the sedative-hypnotic drugs can produce a hangover-type effect; if this occurs, the patient should be changed to a different drug. Such a symptom is not indicative of overdosage, an allergic reaction, or inadequate dosage.

A patient's serum digoxin level is noted to be 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.

A. Administer ordered dose of digoxin. Therapeutic serum digoxin levels are 0.5-2 ng/mL. The patient should receive the next dose to bring the level into therapeutic range.

A patient newly diagnosed with myasthenia gravis (MG) is started on neostigmine. What is the most important nursing intervention for this patient? A. Administer the drug on time. B. Teach the patient to take the drug with food. C. Assess the patient's temperature daily. D. Teach the patient to rise slowly.

A. Administer the drug on time. Neostigmine is an acetylcholinesterase inhibitor with a short half-life. It is administered every 2 to 4 hours and must be given on time to prevent muscle weakness. It is not required to administer the drug with food, and the drug should not affect the patient's temperature nor result in orthostatic hypotension.

Methylphenidate is prescribed for daily administration to a 10-year-old child with attention-deficit/hyperactivity disorder (ADHD). In preparing a teaching plan for the parents of this child newly diagnosed with ADHD, which instruction is most important for the nurse to provide to the parents? A. Administer the medication in the morning before the child goes to school. B. Plan to implement periodic interruptions in the administration of the drug. C. Attempt to be consistent when setting limits on inappropriate behavior. D. Seek professional counseling if the child's behavior continues to be disruptive.

A. Administer the medication in the morning before the child goes to school. Methylphenidate is a central nervous system (CNS) stimulant. To be most effective in affecting the child's behavior, the dose of the drug should be administered in the morning before the child goes to school. Drug holidays are often prescribed to assess the child's degree of recovery; however, such interruptions are not conducted in the early phase of treatment and are usually implemented when side effects occur over a period of time. Options C and D are worthwhile instructions but do not have the priority of option A.

A female client who has started long-term corticosteroid therapy tells the nurse that she is careful to take her daily dose at bedtime with a snack of crackers and milk. Which is the best response by the nurse? A. Advise the client to take the medication in the morning, rather than at bedtime. B. Teach the client that dairy products should not be taken with her medication. C. Tell the client that absorption is improved when taken on an empty stomach. D. Affirm that the client has a safe and effective routine for taking the medication.

A. Advise the client to take the medication in the morning, rather than at bedtime. Daily doses of long-term corticosteroid therapy should be administered in the morning to coincide with the body's normal secretion of cortisol. Clients receiving long-term corticosteroids need to increase their intake of calcium, which generally means an increase in dairy products. Corticosteroids can often cause gastrointestinal distress and should be administered with meals. The client has established a safe routine by taking the medication with a snack, but the routine will be more effective if done in the morning.

What is a priority nursing diagnosis for a patient taking an antihypertensive medication? A. Alteration in cardiac output related to effects on the sympathetic nervous system B. Knowledge deficit related to medication regimen C. Fatigue related to side effects of medication D. Alteration in comfort related to nonproductive cough

A. Alteration in cardiac output related to effects on the sympathetic nervous system Circulation is always a priority over fatigue, pain, and knowledge deficit.

A patient has been prescribed celecoxib to treat arthritis. The nurse will contact the health care provider if the patient shows symptoms of which condition? A. Anemia B. Cataracts C. Glaucoma D. Hyperthyroidism

A. Anemia Celecoxib is a COX-2 inhibitor that is contraindicated in patients with anemia. Celecoxib can cause an increased risk of gastrointestinal adverse effects, including bleeding.

The nurse is caring for a patient who is starting clozapine. Which nursing intervention is a priority for this patient? A. Assess baseline white blood cell count and absolute neutrophil count. B. Evaluate suicidal tendencies. C. Take a baseline EEG. D. Evaluate creatinine clearance.

A. Assess baseline white blood cell count and absolute neutrophil count. Patients taking clozapine must be monitored for the life-threatening side effect of agranulocytosis. A baseline white blood cell count and absolute neutrophil count must be taken. Patients started on this medication are chronically and severely ill. Evaluation of suicidal tendencies would not need to happen before the patient started the medication. Patients on this medication may have an increased risk of seizures; however, a baseline EEG will not assist in predicting or preventing this side effect. This medication is metabolized before excretion. Evaluation of creatinine clearance is not a priority for the patient starting on the medication.

A client with Tourette syndrome takes haloperidol to control tics and vocalizations. The client has become increasingly drowsy over the past 2 days and reports becoming dizzy when changing from a supine to sitting position. Which action should the nurse take? A. Assess for poor skin turgor, sunken eyeballs, and concentrated urine output. B. Recognize that a sedative effect is expected and continue monitoring the client. C. Have the caregiver hold the next two doses of the medication to reduce the drug toxicity. D. Determine whether the client's urine is pink or reddish brown, and report findings to the health care provider.

A. Assess for poor skin turgor, sunken eyeballs, and concentrated urine output. Because haloperidol causes CNS effects of sedation and decreased thirst, the nurse should assess for signs of dehydration. Although sedation may occur with haloperidol administration, this side effect may signal an adverse CNS reaction; therefore, option B is not a sufficient intervention when client safety is threatened. Option C could precipitate withdrawal-emergent dyskinesia, which is potentially life threatening. Option D is expected.

A patient with cardiac decompensation is receiving dobutamine as a continuous infusion. The patient's blood pressure has increased from 100/80 mm Hg to 130/90 mm Hg. What is the nurse's priority action? A. Assess hourly blood pressure readings. B. Assess the patient's ECG and slow the infusion. C. Assess the patient's respiratory rate and measure ABGs. D. Assess the patient's I&O and decrease IV fluids.

A. Assess hourly blood pressure readings. The major therapeutic effect of dobutamine is to increase cardiac output. Cardiac output is reflected in the patient's heart rate, blood pressure, and urine output. An increase in blood pressure is the expected therapeutic effect.

Which is the priority intervention when the nurse is assessing a patient with a potassium level of 3.2 mEq/L? A. Attach telemetry leads for monitoring. B. Apply oxygen. C. Administer Kayexalate. D. Start IV fluids.

A. Attach telemetry leads for monitoring. The patient is high risk for cardiac dysrhythmias due to low potassium level. Oxygen and IV fluids are not a priority; Kayexalate is not used for low potassium level.

The nurse is providing discharge instructions to a client who has received a prescription for an antibiotic that is hepatotoxic. Which information should the nurse include in the instructions? A. Avoid ingesting any alcohol or acetaminophen. B. Schedule a follow-up visit for a liver biopsy in 1 month. C. Activities that are strenuous should be avoided. D. Notify the health care provider of any increase in appetite.

A. Avoid ingesting any alcohol or acetaminophen. Combining hepatotoxic drugs, such as acetaminophen and alcohol, increases the risk of liver damage, so option A is an important discharge instruction. Although clients who receive hepatotoxic drugs should be screened for any changes in serum liver function test (LFT) results, option B is not indicated. Rest is advantageous during an infectious process, but activity restriction is unnecessary. A client who is receiving a hepatotoxic drug should report any hepatotoxic symptoms, such as jaundice, dark urine, or light-colored stools, but an increased appetite does not need medical attention.

The mother of a newborn asks the nurse why her infant needs the vitamin K (AquaMEPHYTON) injection. What information should the nurse provide? A. Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract. B. Oral vitamin K impedes the synthesis of clotting factors in the liver. C. The maternal diet is often deficient in vitamin K, so the infant is deficient in the vitamin.aquamephyton D. The synthesis of vitamin K is inadequate for 3 to 4 months in the newborn.

A. Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract. Vitamin K is provided due to the fact the newborn does not have the intestinal flora to synthesize adequate vitamin K in the intestines at birth and vitamin K levels in breast milk are considered inadequate for the first 2-3 days of life. Vitamin K promotes the formation of clotting factors in the liver, and is routinely given by injection to prevention or treat hemorrhagic disease in the newborn.

Which assessment finding in a patient taking NSAIDs requires immediate intervention? A. Black, tarry stools B. Headache C. Nonproductive cough D. Palpitations

A. Black, tarry stools A major side effect of NSAID therapy is gastrointestinal (GI) distress with potential GI bleeding. Black, tarry stools are indicative of a GI bleed. Headaches, cough, and palpitations should not result from the use of NSAID medications.

A nurse is caring for a patient who is taking an angiotensin-converting enzyme inhibitor and develops a dry, nonproductive cough. What is the nurse's priority action? A. Call the health care provider to switch the medication. B. Assess the patient for other symptoms of upper respiratory infection. C. Instruct the patient to take antitussive medication until the symptoms subside. D. Tell the patient that the cough will subside in a few days.

A. Call the health care provider to switch the medication. Angiotensin-converting enzyme inhibitors prevent the breakdown of bradykinin, frequently causing a nonproductive cough. Angiotensin receptor blocking agents do not block this breakdown, thus minimizing this annoying side effect. The patient should be switched to a different medication if the side effect cannot be tolerated.

The nurse is developing a teaching plan for a patient prescribed carbidopa-levodopa. What information does the nurse use as a basis for the teaching plan? A. Carbidopa decreases levodopa's conversion in the periphery, increasing the amount of levodopa available to cross the blood-brain barrier. B. Carbidopa increases levodopa's conversion in the periphery, enhancing the amount of dopamine available to the brain. C. Giving both drugs together minimizes side effects. D. Carbidopa crosses the blood-brain barrier to increase the metabolism of levodopa to dopamine in the brain.

A. Carbidopa decreases levodopa's conversion in the periphery, increasing the amount of levodopa available to cross the blood-brain barrier. Adding carbidopa to levodopa decreases the breakdown of levodopa in the periphery, increasing the amount available to cross the blood-brain barrier and decreasing the extrapyramidal side effects caused by dopamine in the periphery.

When teaching a patient about the use of tricyclic antidepressants, what will the nurse emphasize? A. Common side effects can be relieved by increasing fluid and fiber intake and sucking hard candy. B. The patient should notify the health care provider if therapeutic effects are not noted within 10 days. C. The drugs are often given with monoamine oxidase inhibitors (MAOIs) for synergistic effect. D. Dietary restrictions of beer and chocolate are needed to prevent a hypertensive crisis.

A. Common side effects can be relieved by increasing fluid and fiber intake and sucking hard candy. Tricyclic antidepressants (TCAs) cause anticholinergic side effects, including constipation and dry mouth. The time period required to produce therapeutic effects ranges from 2 to 4 weeks. Concurrent use of MAOIs with amitriptyline may lead to cardiovascular instability and toxic psychosis. The patient does not need to avoid beer and chocolate to prevent a hypertensive crisis as the patient would need to with MAOIs, but beer would potentiate central nervous system depression when taken with TCAs.

Which intervention is most important for a nurse to implement prior to administering atropine PO? A. Determine the presence of 5 to 35 bowel sounds/min. B. Provide oral care prior to administration. C. Verify that the client's tendon reflexes are 2+. D. Have the client rate his or her pain on a 0-10 scale.

A. Determine the presence of 5 to 35 bowel sounds/min. Anticholinergic drugs, such as atropine, have antispasmodic and antisecretory properties, which relax the gastrointestinal tract, and are therefore contraindicated in a client with intestinal atony. Oral care may be required after administration since atropine can dry secretions. Option B (used to determine dehydration) or (C). Atropine itself has no analgesic effect; it is used with opioids to potentiate their effect.

The nurse is caring for a patient who is taking rifampin. The patient has a heart rate of 90 beats/min, blood pressure of 100/89 mm Hg, and red-orange urine. What is the nurse's best action? A. Document the findings and teach the patient. B. Call the health care provider. C. Collect a urine culture. D. Discard the first void and start a 24-hour urine collection.

A. Document the findings and teach the patient. Red-orange discoloration of body fluids is a common side effect of rifampin, but it is not harmful and does not indicate infection. There is no need to call the health care provider, collect a urine culture, or start 24-hour urine collection.

A patient is taking digoxin 0.25 mg and furosemide (Lasix) 40 mg. The patient tells the nurse, there are yellow halos around the lights. Which action will the nurse take? A. Evaluate digoxin levels. B. Withhold the furosemide. C. Administer potassium. D. Document the findings and reassess in 1 h.

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

A patient is admitted to the emergency department with an overdose of benzodiazepine. Which antidote will the nurse expect to administer? A. Flumazenil B. Naloxone C. Naltrexone D. Nalmefene

A. Flumazenil Flumazenil is the antidote for benzodiazepine overdoses. Naloxone, naltrexone, and nalmefene are used in opioid or narcotic overdose. Flumazenil should be used with caution when the patient is known to have an addiction to one of the benzodiazepine drugs because of the possibility of withdrawal seizures that may occur.

A client who is receiving chemotherapy is prescribed ondansetron (Zofran). What side effect should the nurse include in the teaching plan? A. Headache. B. Dry mouth. C. Impaired taste. D. Blurred vision.

A. Headache. Ondansetron (Zofran), a serotonin antagonist, is the most effective antiemetic in suppressing nausea and vomiting caused by cancer chemotherapy-induced emesis or emetogenic anticancer drugs. Common side effects include headache, diarrhea, dizziness, and fatigue.

A client who is HIV-positive is receiving epoetin alfa for the management of anemia secondary to zidovudine (AZT) therapy. Which laboratory finding is most important for the nurse to report to the health care provider? A. Hematocrit (HCT) of 58% B. Hemoglobin of 10.8 g/dL C. White blood cell count of 5000 mm3 D. Serum potassium level of 5 mEq/L

A. Hematocrit (HCT) of 58% Option A should be reported to the health care provider immediately because of the likelihood of a hypertensive crisis and because seizure activity increases with an increase in HCT of more than 4 points, or an HCT above 36%. Epoetin alfa stimulates erythropoiesis (production of red blood cells), thereby decreasing the need for blood transfusions. Uncontrolled hypertension can occur if erythropoietin levels are too high. Option B is the reason why the client is receiving epoetin alpha. Options C and D are within normal limits.

The nurse is caring for a patient who has been prescribed cefazolin sodium. Which nursing assessment is the priority? A. History, including allergies B. Cardiac assessment C. Neurological assessment D. History of immunizations

A. History, including allergies Antibiotic allergy is one of the most common drug allergies. These allergies also have the potential to cause severe anaphylaxis and death and, therefore, have more importance than the other assessments listed.

A client receives a prescription for theophylline PO to be initiated in the morning after the dose of theophylline IV is complete. The nurse determines that a theophylline level drawn yesterday was 22 mcg/mL. Based on this information, which action should the nurse implement? A. Hold the theophylline dose and notify the health care provider. B. Start the client on a half-dose of theophylline PO. C. The theophylline dose can be initiated as planned. D. The client is not ready to be weaned from the IV to the PO route.

A. Hold the theophylline dose and notify the health care provider. The therapeutic range for theophylline is 10 to 20 mcg/mL, so the theophylline dose should be held for fear of causing toxicity. Options B, C, and D are not indicated actions based on the reported theophylline level.

The nurse is reviewing a client's laboratory results before a procedure in which a neuromuscular blocking agent is prescribed. Which finding should the nurse report to the health care provider? A. Hypokalemia B. Hyponatremia C. Hypercalcemia D. Hypomagnesemia

A. Hypokalemia Low potassium levels enhance the effects of neuromuscular blocking agents, so the health care provider should be informed of the client's hypokalemia. Options B, C, and D are of concern but do not enhance the effects of neuromuscular blocking agents.

An older client is taking warfarin sodium (Coumadin) PO 2.5 mg twice a day. Which laboratory value should the nurse identify as a therapeutic response of the medication? A. INR of 2 to 3. B. PT of 4 seconds. C. PTT of 20 seconds. D. aPTT of 3 times normal.

A. INR of 2 to 3. Recommended INR ranges for clients on warfarin therapy is 2 to 3. Therapeutic anticoagulation using Coumadin should prolong the prothrombin time (PT) by 1.5 to 2 times the control value (a normal value is 10-20 seconds), (or 20% to 30% of the normal value, if percentages are used).

Which finding would indicate to the nurse that a medication has activated alpha1 receptors? A. Increase in blood pressure B. Pupillary constriction C. Bradycardia D. Increased saliva production

A. Increase in blood pressure When alpha1 receptors are stimulated, the nurse will see increases in force of heart contraction; vasoconstriction increases blood pressure; mydriasis (dilation of pupils) occurs; secretion in salivary glands decreases; urinary bladder relaxation and urinary sphincter contraction increases.

What is the effect of beta-blocking agents when used for treatment of glaucoma? A. Inhibiting aqueous humor production. B. Enhancing aqueous humor outflow. C. Increasing intraocular pressure. D. Preventing extraocular infection.

A. Inhibiting aqueous humor production. Beta-blockers are used to inhibit aqueous humor production, with the goal is to reduce intraocular pressure.

The nurse assesses a patient taking phenytoin and finds gingival hyperplasia. What is the nurse's priority action? A. Instruct the patient on oral hygiene. B. Call for a consult with a dentist. C. Call the health care provider. D. Hold the next dose of the drug.

A. Instruct the patient on oral hygiene. A side effect of phenytoin (Dilantin) is overgrowth of gum tissue. This can be minimized by frequent oral hygiene. If oral hygiene efforts do not improve gum condition, a consult with a dentist is recommended. Since this is an expected side effect, there is no indication to notify the health care provider or to hold the next dose.

Which assessment finding will alert the nurse to suspect early digitalis toxicity? A. Loss of appetite with slight bradycardia B. Blood pressure of 90/60 mm Hg C. Heart rate of 110 beats/min D. Confusion and diarrhea

A. Loss of appetite with slight bradycardia Early symptoms of digitalis toxicity include anorexia, nausea and vomiting, and bradycardia.

A client with rheumatoid arthritis is receiving a prescription for minocycline (Minocin). Which side effect is most important for the nurse to instruct the client to report? A. Loss of balance and dizziness. B. Nausea and vomiting. C. Headache and mouth sores. D. Abdominal pain and diarrhea.

A. Loss of balance and dizziness. Minocycline (Minocin), a tetracycline antibiotic, is used to treat mild cases of rheumatoid arthritis and can cause damage to the vestibular part of the inner ear, so the client should report dizziness or difficulty maintaining balance.

When prescribed for a client with hepatic encephalopathy, what is the therapeutic action of lactulose (Portalac)? A. Lowers the pH of the colon. B. Softens the stool. C. Increases glucose absorption. D. Stimulates peristalsis.

A. Lowers the pH of the colon. Colonic bacteria digest lactulose to create a drug-induced acidic and hyperosmotic environment that draws water and blood ammonia into the colon. The physiologic action of lactulose for the client with hepatic encephalopathy is to lower the pH of the colon which inhibits diffusion of ammonia into the bloodstream.

A pediatric client is discharged home with multiple prescriptions for medications. Which information should the nurse provide that is most helpful to the parents when managing the medication regimens? A. Maintain a drug administration record. B. Fill all prescriptions at one pharmacy. C. Allow one person to give the medications. D. Give all medications in small volumes.

A. Maintain a drug administration record. A written drug administration record provides a consistent plan to ensure safe adherence to multiple medication dosages and times. Although option B is an important safeguard to monitor for drug interactions, the parents should be given a tool to enhance their confidence and provide a mechanism to ensure accurate and timely medication administration without duplicating or omitting a dose. Using a written record to record medication administration allows more than one person to share the responsibility of giving medications to the child. Although smaller volumes ensure that all the medication is taken, it is more important to maintain an accurate administration schedule.

The nurse is caring for a patient who is experiencing a myasthenic crisis. What is the primary nursing intervention? A. Maintain the patient's airway. B. Administer atropine. C. Administer naloxone hydrochloride. D. Monitor muscle strength.

A. Maintain the patient's airway. Muscle weakness can affect the airway, and maintaining the airway is the primary priority. Asphyxiation is the primary threat to the patient's life; therefore, maintaining the airway is paramount. Neither atropine nor naloxone hydrochloride will alleviate the crisis.

A 4-year-old child is receiving chemotherapy for acute lymphocytic leukemia. Which laboratory result should the nurse examine to assess the child's risk for infection? A. Neutrophil count B. Platelet count C. Reticulocyte count D. Lymphocyte count

A. Neutrophil count During chemotherapy, granulocytes are significantly suppressed. Because neutrophils comprise 60% to 70% of the granulocyte count, these levels are the most useful laboratory results of the options presented to determine the child's risk for infection. Options B, C, and D are not as useful as option A in determining risk of infection.

A female client is receiving tetracycline for acne. Which client teaching should the nurse include? A. Oral contraceptives may not be effective. B. Drinking cranberry juice will promote healing. C. Breast tenderness may occur as a side effect. D. The urine will turn a red-orange color.

A. Oral contraceptives may not be effective. Certain antibiotics, such as tetracycline, decrease the effectiveness of oral contraceptives. Options B, C, and D do not convey accurate information related to client teaching about this medication.

A child with cystic fibrosis is receiving ticarcillin disodium for Pseudomonas pneumonia. For which adverse effect should the nurse assess and report promptly to the health care provider? A. Petechiae B. Tinnitus C. Oliguria D. Hypertension

A. Petechiae Adverse effects of ticarcillin disodium include hypothrombinemia and decreased platelet adhesion, which can result in the presence of petechiae. Options B, C, and D are not adverse effects primarily associated with the administration of ticarcillin disodium.

A client is taking sulfisoxazole (Gantrisin) for a urinary tract infection (UTI) and complains of nausea and gastric upset since starting the medication. Which additional adverse reaction should the nurse instruct the client to report? A. Rash. B. Diarrhea. C. Hematuria. D. Muscle cramping.

A. Rash. Side effects of sulfisoxazole (Gantrisin), a sulfonamide antibiotic, include possible allergic response, manifested by skin rash and itching, which can progress to Stevens-Johnson syndrome - erythema multiforme, a severe hypersensitivity reaction. Other gastrointestinal disturbances, such as diarrhea, crystalluria and photosensitivity are other side effects that commonly occur with "sulfa" agents, but do not indicate a discontinuation of the prescription.

The nurse receives a unit of blood from the blood bank for a postoperative client who is currently in the X-ray department. What action should the nurse implement? A. Return the blood to the blood bank for refrigeration within 30 minutes. B. Hang the blood transfusion as soon as the client returns to the unit. C. Store the blood bag in the nursing unit's refrigerator until the client returns. D. Take the unit of blood to the X-ray department to initiate the transfusion.

A. Return the blood to the blood bank for refrigeration within 30 minutes. A blood transfusion should be hung for administration within 30 minutes of its arrival from the blood bank. If it is not going to be used within that time frame, it must be returned to the blood bank for refrigeration. Waiting until the client returns to the

A client who takes a statin and gemfibrozil (Lopid) for hyperlipidemia reports onset of muscle pain and weakness. What additional assessment is most important for the nurse to obtain? A. Serum liver enzymes. B. T3 and T4 blood levels. C. Bowel function. D. Peripheral sensation.

A. Serum liver enzymes. Concomminent use of gemfibrozil and statins can cause muscle weakness and wasting known as myopathy, which is reflected in serum liver function enzymes, such as elevated serum aspartate aminotransferase (AST or SGOT) that is also found in skeletal muscle.

wo hours after taking the first dose of penicillin, a client arrives at the emergency department complaining of feeling ill, exhibiting hives, having difficulty breathing, and experiencing hypotension. These findings are consistent with which client response that requires immediate action? A. Severe acute anaphylactic response B. Side reaction that should resolve C. Idiosyncratic reaction D. Cumulative drug response

A. Severe acute anaphylactic response Anaphylaxis related to penicillin can cause a life-threatening allergic response characterized by bronchospasm, laryngeal edema, and a precipitous drop in blood pressure. This client's ingestion of penicillin and presenting clinical picture indicate the client is having an acute reaction with respiratory difficulty. Options B, C, and D are other physiologic responses to medications, but immediate action is required for a potential loss of airway, breathing, and circulation.

Which suggestion should the nurse provide to the parents of a child taking methylphenidate for attention-deficit/hyperactivity disorder to offset anticipated side effects? A. Suck on hard candy.Side effects of amphetamines include dry mouth. B. Increase vitamin C in the diet. C. Decrease fluid intake prior to bedtime. D. Take the medication with grapefruit juice.

A. Suck on hard candy. Side effects of amphetamines include dry mouth. Sucking on hard candy can help eliminate this effect. Vitamin loss does not accompany the use of amphetamines. Dehydration is not a common side effect, and grapefruit juice could alter the metabolism of the drug.

The nurse is assessing a patient who has been taking ferrous sulfate prophylactically during pregnancy. Which assessment finding will require an intervention from the nurse? A. The patient says she takes the ferrous sulfate with an antacid. B. The patient says she takes the ferrous sulfate with orange juice C. The patient says she has very dark stools. D. The patient states she has indigestion.

A. The patient says she takes the ferrous sulfate with an antacid. Iron supplementation should be administered 2 h before or 4 h after antacids. Absorption of ferrous sulfate is promoted when taken with orange juice or another vitamin C source, not with an antacid. Dark stools are to be expected with iron administration. Indigestion is very common during pregnancy.

The nurse plans to draw blood samples for the determination of peak and trough levels of gentamicin sulfate in a client receiving IV doses of this medication. When should the nurse plan to obtain the peak level? A. Thirty minutes after the dose is administered B. Immediately before giving the next dose C. When the next electrolyte levels are drawn D. Sixty minutes after the dose is administered

A. Thirty minutes after the dose is administered Peak drug serum levels are achieved 30 minutes after the IV administration of aminoglycosides, so option A is the optimum time to get a peak level. Options B, C, and D are not appropriate times associated with peak levels for gentamicin.

Which assessment finding in the patient receiving gentamicin would alert the nurse to a possible adverse reaction? A. Tinnitus B. Diarrhea C. Runny nose D. White flakey spots on the tongue

A. Tinnitus The aminoglycosides are ototoxic and the nurse must assess changes in patients' hearing, balance, and urinary output. Tinnitus may indicate ototoxicity. Diarrhea may occur but is not a sign of adverse reactions, nor is runny nose. White spots on the tongue may indicate suprainfection.

Which findings should the nurse identify in an adult client with possible chronic salicylate intoxication? A. Tinnitus and hearing loss. B. Photosensitivity and nervousness. C. Acute gastrointestinal bleeding and anorexia. D. Hyperventilation and central nervous system effects.

A. Tinnitus and hearing loss. The most frequent manifestations of chronic salicylate intoxication in adults are tinnitus and hearing loss.

A male client who is in the terminal stage of cancer is cared for at home by his family and receives a prescription for morphine at a rate to control intractable pain. When the hospice nurse visits, the client awakens, moans in severe pain, and asks for an increase in the morphine dosage. After determining the client's respirations are 10 per minute, what is the best action for the nurse to implement? A. Titrate the morphine dose upward until the client has adequate pain relief. B. Suggest to the family that they can also give the client ibuprofen, a non-narcotic analgesic. C. Hold additional morphine until the client's respirations are at least 16 per minute. D. Inform the client that an increased dose of morphine increases side effects without additional pain control.

A. Titrate the morphine dose upward until the client has adequate pain relief. Tolerance can occur in a client who requires large doses of opioids for intractable pain management, and an increased titration of the analgesic or an additional drug in the same or a different classification may provide more effective pain management. The client's basic need for comfort during the last stages of a terminal malignancy is the main priority for this hospice client.

The patient has been diagnosed with Alzheimer disease and has been forgetting the location of objects in addition to having difficulty finding the word to use in conversation. The patient has been started on donepezil. The patient is most likely in which stage of the disease process? A. Very mild B. Mild C. Moderate D. Moderately severe

A. Very mild Donepezil can be used in all stages of Alzheimer disease. The symptoms noted will occur in the very mild stage of Alzheimer disease.

The nurse is caring for an older adult patient who arrives at the health clinic complaining of fatigue, lack of appetite, and changes in his vision. The nurse suspects that the symptoms may be related to a vitamin deficiency. Based on the symptoms, the patient is most likely to be experiencing a deficiency of which vitamin? A. Vitamin B1 B. Vitamin B2 C. Vitamin B6 D. Vitamin B12

A. Vitamin B1 Vitamin B1 deficiency is characterized by sensory disturbances, retarded growth, fatigue, and anorexia.

The nurse assesses a patient receiving an adrenergic (sympathomimetic) agent. Which finding will be of greatest concern to the nurse? A. Weak peripheral pulses and decreased heart rate. B. Increased peripheral pulses and increased heart rate. C. Stable blood pressure and increased cardiac output. D. Heart rate of 95 beats per minute and strong peripheral pulses.

A. Weak peripheral pulses and decreased heart rate. Adrenergic agents stimulate the sympathetic nervous system, which increases heart rate (positive chronotropic effect), contractility (positive inotropic effect), and conductivity (positive dromotropic effect). The nurse would be most concerned that the pulses remain weak and heart rate decreased after receiving this drug, as the therapeutic effect is not being achieved.

A client who is diagnosed with methillicin-resistant Staphylococcus aureus receives a prescription for vancomycin (Vancocin). Which assessment should the nurse perform to identify a potential adverse effect? A. Whisper test. B. Romberg test. C. Tactile discrimination. D. Skin turgor.

A. Whisper test. The most serious adverse effect of vancomycin is ototoxicity, which often causes irreversible, permanent impairment. So, a whisper test determines the presence of early hearing impairment.

What information will the nurse teach the patient who is considering stopping the antiepileptic drug phenytoin? A. You may go into status epilepticus. B. You may have an acute withdrawal. C. You will have severe hypotension. D. You may become confused and delirious.

A. You may go into status epilepticus. Abrupt withdrawal of antiepileptic drugs can cause the development of status epilepticus. However, stopping phenytoin should not result in acute withdrawal, severe hypotension, or confusion.

The patient asks the nurse to explain the difference between carbidopa-levodopa and ropinirole. The nurse's best response is based on understanding that A. ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa. B. carbidopa-levodopa is less effective than ropinirole in treating the symptoms of Parkinson disease. C. both drugs have the same pharmacodynamic and side effect profiles. D. carbidopa-levodopa acts as a dopamine agonist, whereas ropinirole directly replaces dopamine.

A. ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa. Ropinirole is a newer antiparkinson drug that directly stimulates specific dopamine receptors. Because the drug itself is not dopamine, there are fewer side effects related to peripheral dopamine levels than are noted with carbidopa-levodopa.

Which following conditions would meet the medically approved criteria for use of CNS stimulants? A. Weight loss in the morbidly obese B. Attention-deficit/hyperactivity disorder in children C. Promotion of wakefulness in narcolepsy D. Reversal of respiratory distress E. Severe depressive states

B, C, D Medically approved use of CNS stimulants is limited to the treatment of attention-deficit/hyperactivity disorder in children, narcolepsy, and the reversal of respiratory distress. Although the drug has anorexiant properties, this is not its medically approved indication. It is not indicated for depression.

The nurse is teaching a patient who has been prescribed nitrofurantoin. The teaching plan for this patient will include which interventions? SATA. A. Swish and swallow this medication. B. Do not take the medication with an antacid. C. Shake the suspension before drinking. D. Increase fluids while on the medication. E. Take on an empty stomach.

B, C, D The medication should not be taken with an antacid, because they interfere with drug absorption. The medication should be shaken well before drinking, and the patient should increase fluids to help with nausea. This medication can stain the teeth, so swishing is not recommended. The medication can cause stomach upset and should be taken with food.

A patient has been prescribed nitroprusside for treatment of a hypertensive emergency. Which interventions will the nurse include when administering nitroprusside? A. Vigorously shake the mixture before administration. B. Place the bottle in an opaque bag. C. Closely monitor the patient's blood pressure. D. Monitor the patient's thiocyanate levels. E. Administer the solution slow IV push. F. Do not mix nitroprusside with other drugs.

B, C, D, F Nitroprusside will lower the patient's blood pressure owing to vasodilation. Thiocyanate toxicity is an adverse reaction, and levels should be monitored. To prevent drug interactions, nitroprusside should not be mixed with other drugs. The mixture should not be vigorously shaken. Nitroprusside sodium is rapidly inactivated by light; the IV bottle or bag must be wrapped with aluminum foil or another opaque material to protect the solution from degradation. The medication should not be administered IV push.

When titrating intravenous nitroglycerin for a patient, what is important for the nurse to monitor? A. Continuous oxygen saturation B. Continuous blood pressure C. Hourly electrocardiograms D. Presence of chest pain E. Serum nitroglycerin levels F. Visual acuity

B, D Intravenous nitroglycerin can cause hypotension and tachycardia. Relief of chest pain and systolic blood pressure <90 mm Hg are typical parameters used for titrating nitroglycerin. Pulse should also be monitored.

The nurse will hold the next dose of antipsychotic medication for which patients? SATA A. The patient with a sitting blood pressure of 130/90 mm Hg and 100/80 mm Hg when standing. B. The patient who presents with protrusion and rolling of the tongue and smacking movements of the lips. C. The patient who has pill-rolling motions of the hand. D. The patient who has a sudden high fever.

B, D The patient with protrusion and rolling of the tongue and smacking movements of the lips most likely is displaying symptoms of tardive dyskinesia. The medication should be stopped in any patient displaying these symptoms. A patient with a sudden high fever may be experiencing neuroleptic malignant syndrome; immediate withdrawal of the medication is needed. Orthostatic hypotension is a common occurrence with many antipsychotic medications and is not a reason to stop the medication. Pill-rolling motions of the hand may indicate Parkinson-like extrapyramidal side effects. This is not a reason to stop the medication. Treatment is aimed at controlling the side effects.

Which statement indicates that the patient understands the benefit of continuous administration of progestin with an estrogen regimen? A. "This regimen prevents ovarian cancer." B. "Endometrial cancer risk can be reduced with this regimen." C. "This regimen will prevent breast cancer." D. "Vaginal cancer is prevented with this regimen."

B. "Endometrial cancer risk can be reduced with this regimen." Estrogen, given alone, has been associated with an increased risk of endometrial hyperplasia, which can lead to endometrial cancer. Progestin reduces the incidence of endometrial hyperplasia.

A patient is being switched from amitriptyline to citalopram. Which statement made by the patient indicates understanding of medication instructions? A. "I can stop taking my amitriptyline and start taking the citalopram as ordered." B. "I can expect fewer cardiovascular side effects with the citalopram." C. "The doctor is switching me to this medication because it is less expensive but just as effective." D. "I will need to limit my intake of cheese when taking citalopram to prevent a rise in my blood pressure."

B. "I can expect fewer cardiovascular side effects with the citalopram." Citalopram, an SSRI, produces minimal anticholinergic and cardiovascular side effects. The patient will need to wait 14 days after stopping amitriptyline (Elavil) before starting the citalopram. The patient does not need to limit cheese intake with citalopram.

Which statement by a client warrants further instruction by the nurse about the changing insulin needs of a diabetic client during pregnancy? A. "Episodes of hypoglycemia are more likely to occur during the first 3 months." B. "I will increase my insulin dosage by 5 units each month during the first trimester." C. "Insulin dosage will likely need to be increased during the second and third trimesters." D. "Breastfeeding will decrease my insulin needs to lower than my prepregnancy levels."

B. "I will increase my insulin dosage by 5 units each month during the first trimester." Insulin needs during pregnancy are determined individually according to the client's glucose levels. Insulin needs in the first trimester may actually decrease, so the client's statement about increasing her insulin dose, indicates the need for reteaching.

The patient asks the nurse how nitroglycerin should be stored while traveling. What is the nurse's best response? A. "You can protect it from heat by placing the bottle in an ice chest." B. "It's best to keep it in its original container away from heat and light." C. "You can put a few tablets in a resealable bag and carry in your pocket." D. "It's best to lock them in the glove compartment to keep them away from heat and light."

B. "It's best to keep it in its original container away from heat and light." Although nitroglycerin needs to be kept in a cool, dry place, it should not be placed in an ice chest where it could freeze. It should also not be locked up and must be kept away from light, not in a clear plastic bag.

A patient receiving propylthiouracil asks the nurse how this medication will help relieve symptoms. Which statement is the nurse's best response? A. "Propylthiouracil inactivates any circulating thyroid hormone, thus decreasing signs and symptoms of hyperthyroidism." B. "This medication inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal." C. "Propylthiouracil helps the thyroid gland use iodine and synthesize hormones better." D. "This medication stimulates the pituitary gland to secrete thyroid-stimulating hormone, which inhibits the production of hormones by the thyroid gland."

B. "This medication inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal." Propylthiouracil is an antithyroid medication used to treat hyperthyroidism. It works by inhibiting the synthesis of new thyroid hormone. It does not inactivate hormone already present.

The nurse is teaching the patient on the use of beclomethasone. Which statement by the patient indicates an understanding of the teaching? A. "I will need to taper off the medication to prevent acute adrenal crisis." B. "This medication will help prevent the inflammatory response of my allergies." C. "I will need to monitor my blood sugar more closely because it may increase." D. "I need to take this medication only when my symptoms get bad."

B. "This medication will help prevent the inflammatory response of my allergies." Beclomethasone is a steroid spray administered nasally. It is used to prevent allergy symptoms. Its effect is localized, and therefore the patient does not have systemic side effects with normal use and does not have to worry about weaning off the medication as with oral corticosteroids. Because the medication has a localized effect, it will not produce the changes in blood sugar that would be generated by systemic steroids.

A patient taking oral contraceptives has developed an infection and is prescribed tetracycline. What information is essential for the nurse to teach the patient? A. "Do not drink grapefruit juice while on these medications." B. "Use an additional form of contraception while on these medications." C. "Use an alternative form of contraception while taking the antibiotic." D. "Do not drink milk while on this medication."

B. "Use an additional form of contraception while on these medications." Tetracycline interacts with oral contraceptives and decreases their effectiveness. An additional form of contraception is needed while taking tetracycline.

A pregnant patient who is in her first trimester states that she is constantly experiencing headaches. What is the nurse's best response? A. "Take low-dose aspirin each morning." B. "What have you tried to treat the headaches?" C. "I will call the health care provider for a prescription." D. "This is expected during the first trimester."

B. "What have you tried to treat the headaches?" The nurse should first assess to see what interventions, if any, the patient has attempted. There are several interventions that may help, such as relaxation therapy, ice packs, or heat. Nonpharmacologic interventions should be attempted first. If they are not effective, acetaminophen can be recommended.

The patient is receiving corticotropin for ACTH deficiency. Which statement by the patient indicates a need for further teaching? A. "I can administer the drug subcutaneously." B. "When my symptoms are resolved, I can discontinue the drug." C. "I need to eat foods high in potassium." D. "The drug may suppress symptoms of infection."

B. "When my symptoms are resolved, I can discontinue the drug." The patient should not discontinue the drug abruptly; the dose of the drug must be tapered over several days. Hypokalemia is possible, so eating foods high in potassium is correct. The drug can be administered subcutaneously.

Based on the condition of the patient, an intravenous fluid that is hypertonic will be ordered. Which intravenous fluid is most likely to be ordered by the health care provider? A. Normal saline B. 5% dextrose and normal saline C. 2.5% dextrose and water D. 0.33% NaCl

B. 5% dextrose and normal saline Of the fluids listed, the only one that is hypertonic is 5% dextrose and normal saline. Normal saline is isotonic, and both 2.5% dextrose and water and 0.33% NaCl are considered to be hypotonic.

When assessing an adolescent who recently overdosed on acetaminophen (Tylenol), it is most important for the nurse to assess for pain in which area of the body? A. Flank. B. Abdomen. C. Chest. D. Head.

B. Abdomen. Acetaminophen toxicity can result in liver damage; therefore, it is especially important for the nurse to assess for pain in the right upper quadrant of the abdomen, which might indicate liver damage, along with nausea and vomiting.

Discharge teaching for a patient receiving glucocorticoids will include the preferred use of which medication for pain management? A. Aspirin B. Acetaminophen C. Ibuprofen D. Naproxen sodium

B. Acetaminophen Acetaminophen does not cause gastric distress as do aspirin, ibuprofen, naproxen sodium, and glucocorticoids.

A pregnant patient is receiving magnesium sulfate to inhibit uterine contractions. The patient develops depressed reflexes and confusion. What is the nurse's priority action? A. Administer atropine IV. B. Administer calcium gluconate. C. Administer epinephrine. D. Administer protamine sulfate.

B. Administer calcium gluconate. Calcium gluconate is the antidote if magnesium toxicity (maternal neurologic, respiratory, or cardiac depression) is evidenced. Atropine will not reverse magnesium toxicity; it is used for insecticide intoxication or slow heart rates. Epinephrine will not reverse magnesium toxicity; it is used for the treatment of anaphylactic reactions. Protamine sulfate will not reverse magnesium toxicity; it is the antidote for heparin overdose.

What is the nurse's best action when finding a patient with type 1 diabetes mellitus unresponsive, cold, and clammy? A. Administer subcutaneous regular insulin immediately. B. Administer glucagon. C. Start an insulin drip.. D. Draw blood glucose level and send to the laboratory.

B. Administer glucagon. Glucagon stimulates glycogenolysis, raising serum glucose levels. The patient is showing signs of hypoglycemia.

The patient tells the nurse that she has a cold, is coughing, and feels like she has fluid in her lungs. What action will the nurse anticipate performing next? A. Administer dextromethorphan. B. Administer guaifenesin. C. Encourage the patient to drink fluids hourly. D. Administer fluticasone (Flonase).

B. Administer guaifenesin. The patient needs an expectorant. This medication will help the patient cough the fluid out of her lungs. Dextromethorphan and fluticasone will not help the patient expectorate. There is no information about the patient's fluid intake, so hourly fluids may be too much.

A patient is admitted for treatment of opioid addiction. Which intervention is a priority? A. Assess blood pressure every 8 hours. B. Administer methadone. C. Monitor temperature hourly. D. Administer naloxone.

B. Administer methadone. Methadone is a synthetic opioid analgesic with gentler withdrawal symptoms and is the drug of choice for detoxification treatment. The patient's blood pressure needs to be monitored more frequently than every 8 hours for a patient in withdrawal. The patient's temperature is not a concern. Narcan is not administered to the patient in withdrawal from narcotic addiction.

Given each of the following actions, the nurse would recognize which action has the highest priority for a patient admitted with glaucoma? A. Teach the patient to wear glasses at all times. B. Administer pilocarpine as prescribed. C. Teach patient to avoid bending at the waist. D. Administer atropine as prescribed.

B. Administer pilocarpine as prescribed. Pilocarpine is a direct-acting cholinergic drug that constricts the pupils of the eyes, thus opening the canal of Schlemm to promote drainage of aqueous humor (fluid). This drug is used to treat glaucoma by relieving fluid (intraocular) pressure in the eye.

Based on the blood culture and sensitivity results, the healthcare provider prescribes an IV aminoglycoside antibiotic and discontinues the current prescription for another broad spectrum antibiotic. The medication administration record indicates that the client received the broad spectrum antibiotic two hours ago. Which action should the nurse implement? A. Obtain peak and trough serum levels so the aminoglycoside antibiotic can be initiated. B. Administer the initial dose of the aminoglycoside antibiotic as soon as possible. C. Withhold antibiotic administration until the healthcare provider clarifies the prescriptions. D. Schedule the initial dose of the aminoglycoside antibiotic for the following day.

B. Administer the initial dose of the aminoglycoside antibiotic as soon as possible. Based on the blood culture and sensitivity results, the prescribed aminoglycoside antibiotic is the most effective in treating the client's infection, so it should be administered as soon as possible.

What is the priority nursing intervention when administering intravenous potassium replacement to the patient? A. Administer potassium as a bolus over 10 min. B. Administer the medication using an infusion device. C. Apply heat to the site of intravenous administration. D. Teach the patient and family the signs and symptoms of hypokalemia.

B. Administer the medication using an infusion device. Too rapid infusion of potassium can cause cardiac dysrhythmias; an intravenous infusion device must always be used. Potassium should not be bolused or pushed. Heat will not aid the infusion. Unless the patient is prone to constant hypokalemia, teaching the signs and symptoms is not a priority.

The nurse is assessing a patient taking antipsychotics and notes that he has difficulty sitting still. The patient states that he is feeling "restless" as he paces the floor. What is the nurse's primary intervention? A. Stop the medication immediately and notify the health care provider. B. Administer the prescribed benzodiazepine. C. Administer benztropine (Cogentin) as ordered. D. Stay with the patient and offer reassurance.

B. Administer the prescribed benzodiazepine. Akathisia presents with restlessness and trouble standing still. This side effect is best treated with a benzodiazepine such as lorazepam. The medication is not stopped if a patient exhibits this type of effect. Cogentin is administered for Parkinson-like side effects, which this patient is not exhibiting. The symptoms displayed are most likely not just typical nervousness. Staying with the patient will not change the symptoms.

Which class of antineoplastic chemotherapy agents resembles the essential elements required for DNA and RNA synthesis and inhibits enzymes necessary for cellular function and replication? A. Alkylating agents B. Antimetabolites C. Antitumor antibiotics D. Plant alkaloids

B. Antimetabolites Antimetabolites exert their action by inhibiting the enzymes necessary for cellular function and replication. Options A, C, and D have a different mechanism of action.

What instruction should the nurse provide to the patient who needs to apply nitroglycerin ointment? A. Use the fingers to spread the ointment evenly over a 3-inch area. B. Apply the ointment to a non-hairy part of the upper torso. C. Massage the ointment into the skin. D. Cover the application paper with ointment before use.

B. Apply the ointment to a non-hairy part of the upper torso. Absorption is best over a non-hairy portion of skin. The upper torso is the preferred site of application. The nurse should wear gloves and squeeze the ointment onto the application patch. Massaging in the ointment is not appropriate. The paper should not be covered with ointment. The ointment is measured as one straight line on the nitroglycerin paper and is then gently spread around and applied, but not rubbed, into the skin.

A patient taking methylphenidate is nauseous and vomiting. What is the nurse's best action? A. Monitor the patient's vital signs. B. Ask the patient if he or she has been taking the medication regularly. C. Assess the patient's temperature. D. Administer an antiemetic medication.

B. Ask the patient if he or she has been taking the medication regularly. Nausea, vomiting, and headache are symptoms of withdrawal. The nurse should find out if the patient has been taking the medication regularly.

When providing nursing care for a client receiving pyridostigmine bromide for myasthenia gravis, which nursing intervention has the highest priority? A. Monitor the client frequently for urinary retention. B. Assess respiratory status and breath sounds often. C. Monitor blood pressure each shift to screen for hypertension. D. Administer most medications after meals to decrease gastrointestinal irritation.

B. Assess respiratory status and breath sounds often. The client should be assessed often for signs of respiratory complications. The client with myasthenia gravis is at greatest risk for life-threatening respiratory complications because of the weakness of the diaphragm and ancillary respiratory muscles caused by the disease process. Cholinergic agents used to reduce muscle weakness can also cause hypersalivation, increased respiratory secretions, and possible bronchoconstriction. Although options A, C, and D reflect helpful interventions, they do not have the priority of option B in caring for the client with myasthenia gravis.

The nurse is administering hypertonic saline solution to treat a patient with severe hyponatremia. Which nursing intervention is the priority? A. Monitor urinary output. B. Assess skin for flushing and assess increased thirst. C. Monitor temperature. D. Administer antiemetic for vomiting.

B. Assess skin for flushing and assess increased thirst. Flushed skin and increased thirst are signs and symptoms of hypernatremia.

The healthcare provider prescribes digitalis (Digoxin) for a client diagnosed with heart failure. Which intervention should the nurse implement prior to administering the digoxin? A. Observe respiratory rate and depth. B. Assess the serum potassium level. C. Obtain the client's blood pressure. D. Monitor the serum glucose level.

B. Assess the serum potassium level. Hypokalemia (decreased serum potassium) will precipitate digitalis toxicity in persons receiving digoxin. The nurse should monitor the client's serum potassium levels. Blood pressure and respiratory rate will not inform the nurse about potential safety issues with digitalis.

The nurse is reviewing a patient's medication history and notes that the patient recently began taking lithium. What intervention is a priority for this patient? A. Monitoring for the recurrence of seizure activity B. Assessing lithium levels every other week C. Asking the patient if they have ringing in the ears D. Monitoring the patient's intake and output

B. Assessing lithium levels every other week Lithium is the drug of choice to treat manic episodes associated with bipolar disorders. It has a narrow therapeutic range, and levels should be monitored biweekly until the therapeutic level has been obtained and then monitored monthly on the maintenance dose.

A patient is prescribed a noncardioselective beta1 blocker. What nursing intervention is a priority for this patient? A. Assessment of blood glucose levels B. Auscultation of the lungs C. Orthostatic blood pressure assessment D. Teaching about potential tachycardia

B. Auscultation of the lungs Noncardioselective beta blockers can cause bronchospasms, and a respiratory assessment is indicated to check for potential respiratory side effects. Assessment of blood glucose and teaching about tachycardia will not be priorities.

A client with depression receives a prescription for amitriptyline (Elavil). Which instruction should the nurse include in the client's teaching? A. Do not ingest foods with tyramine. B. Avoid the consumption of alcohol. C. Obtain daily blood pressure readings. D. Take with a glass of orange juice.

B. Avoid the consumption of alcohol. Tricyclic antidepressants (TCAs) such as amitriptyline can cause sedation and should not be mixed with agents that depress the central nervous system, so the client should be instructed to avoid alcohol. The consumption of alcohol and TCAs interaction could worsen the client's depression; increased drunkenness and potentially cause death.

The patient has been ordered to receive a unit of packed red blood cells. What is the highest priority nursing action prior to initiating the infusion of the blood product? A. Verify that a large bore IV is in place. B. Confirm the identity of the patient. C. Collect the blood product from the blood bank. D. Verify that the permit for infusion was witnessed.

B. Confirm the identity of the patient. Although all of the actions listed are important, the highest priority one is confirmation of the identity of the patient. Failure to do this is a major safety violation.

A patient receiving intravenous nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's priority action? A. Assess the patient s lung sounds. B. Decrease the intravenous nitroglycerin by 10 mcg/min. C. Stop the nitroglycerin infusion for 1 h and then restart. D. Continue the infusion and recheck the patient's vital signs in 15 min.

B. Decrease the intravenous nitroglycerin by 10 mcg/min. Nitroglycerin, as a vasodilator, causes a decrease in blood pressure. Because it is short-acting, decreasing the infusion rate will allow the blood pressure to rise. The patient should be monitored every 10 min while changing the rate of the intravenous nitroglycerin infusion.

In addition to its benefit in reducing pain and anxiety in the patient with pulmonary edema, the nurse understands morphine produces which primary effect on the pathophysiology of pulmonary edema? A. Decreasing the conduction rate at the AV node B. Decreasing preload C. Increasing cerebral perfusion D. Increasing afterload

B. Decreasing preload Morphine sulfate is also indicated for acute pulmonary edema because it produces venous vasodilation that decreases cardiac preload, the amount of blood returning to the right ventricle. The net effect is a decrease in pulmonary venous congestion.

An older client is receiving a water-soluble drug that is more than the average dose for a young adult. Which action should the nurse implement first? A. Obtain a prescription for lower medication dosages. B. Determine the drug's serum levels for toxicity. C. Start IV fluids to decrease the serum drug levels. D. Hold the next dosage and notify the health care provider.

B. Determine the drug's serum levels for toxicity. Older clients usually have a decline in lean body mass and total body water that causes water-soluble drugs to become distributed in fluid compartments, resulting in an increased concentration, so determining the drug's serum level for toxicity should be implemented first. Although options A, C, and D may be indicated, an increased plasma drug level should be the determining factor to consider when water-soluble drugs warrant a reduced dosage in the older client.

A 28-week primipara is experiencing contractions on a regular basis. Vaginal examination assessment confirms early cervical dilation. The drug terbutaline is ordered. Given the fetus is at 28-week gestations, which additional drug would the nurse anticipate to be added to the mother's drug regimen? A. A cephalosporin B. Dexamethasone C. Aspirin D. Magnesium sulfate

B. Dexamethasone Patients at risk for preterm delivery (24-34 weeks' gestation) should receive antenatal corticosteroid therapy with betamethasone or dexamethasone. An off-label use, administration of antenatal corticosteroids accelerates lung maturation and lung surfactant development in the fetus in utero, decreasing the incidence and severity of respiratory distress syndrome (RDS) and increasing survival of preterm infants.

A 6-year-old child is admitted to the emergency department with status epilepticus. His parents report that his seizure disorder has been managed with phenytoin, 50 mg PO bid, for the past year. Which drug should the nurse plan to administer in the emergency department? A. Phenytoin B. Diazepam C. Phenobarbital D. Carbamazepine

B. Diazepam Diazepam is the drug of choice for treatment of status epilepticus. Options A, C, and D are used for the long-term management of seizure disorders but are not as useful in the emergency management of status epilepticus.

A client receives a prescription for sulfamethoxazole-trimethoprim (Septra) for a urinary tract infection (UTI). What instruction should the nurse provide the client? A. Ingest food prior to taking the antibiotic. B. Drink at least 8 glasses of water a day. C. Take the medication with grapefruit juice. D. Avoid prolonged exposure to sunlight.

B. Drink at least 8 glasses of water a day. To decrease the risk of renal damage due to crystalluria associated with sulfamethoxazole, the client should be instructed to consume at least 8 glasses of water a day. To increase absorption, sulfamethoxazole should be given on an empty stomach.

The healthcare provider prescribes a medication for an older adult client who is complaining of insomnia, and instructs the client to return in two weeks. The nurse should question which prescription? A. Zolpidem (Ambien) 10 milligrams orally at bedtime. B. Eszopiclone (Lunesta) 10 milligrams orally at bedtime. C. Temazepam (Restoril) 7.5 milligrams orally at bedtime. D. Ramelteon (Rozerem) 8 milligrams orally at bedtime.

B. Eszopiclone (Lunesta) 10 milligrams orally at bedtime. The prescription for eszopiclone (Lunesta) 10mg at bedtime is too high for this client. The dosing of this medication is usually a client is started off at 1mg at bedtime and may advance up to 3mg maximum if needed.

The nurse is providing patient teaching for the drug miglitol for the patient with a diagnosis of type 2 diabetes. Which group of side effects should the nurse include in the patient teaching? A. Dehydration, hypoglycemia, and thirst B. Flatulence, hypoglycemia, and diarrhea C. Hypoglycemia, diaphoresis, and hypokalemia D. Rash, gingivitis, and hypoglycemia.

B. Flatulence, hypoglycemia, and diarrhea Side effects of miglitol include flatulence, diarrhea, and abdominal pain.

The patient is suspected of having overdosed on a benzodiazepine medication. The nurse expects that the health care provider will prescribe which medication? A. Lorazepam B. Flumazenil C. Oxazepam D. Buspirone HCl

B. Flumazenil Of the medications listed, flumazenil is the only one that would be effective as a benzodiazepine antagonist.

In developing a nursing care plan for a 9-month-old infant with cystic fibrosis, the nurse writes a nursing diagnosis of alteration in nutrition: less than body requirements, related to inadequate digestion of nutrients. Which intervention would best meet this child's needs? A. Give aluminum hydroxide and magnesium hydroxide after meals. B. Give pancrelipase capsule mixed with applesauce before each meal. C. Administer cholestyramine resin before each meal and at bedtime. D. Administer omeprazole for gastroesophageal reflux.

B. Give pancrelipase capsule mixed with applesauce before each meal. Pancreatic enzyme replacement with pancrelipase is a major component of cystic fibrosis nutritional management. Aluminum hydroxide and magnesium hydroxide may be given before meals with enzymes to reduce gastric acidity and prevent enzyme destruction but are ineffective when used alone to promote enzyme replacement. Options C and D are used to treat steatorrhea in cystic fibrosis.

The nurse is working with a patient who is receiving haloperidol. Which finding in the patient's history would cause the nurse to question the use of this drug? A. Hypertension B. Glaucoma C. Irritable bowel disease D. Prostatic hypertrophy

B. Glaucoma A contraindication for the use of haloperidol is glaucoma. The other findings would not affect the use of this drug.

A child is being treated with mebendazole for pinworms. Which type of diet should the mother be instructed to feed the child while the child is receiving this medication? A. Lactose-free foods B. High-fat diet C. Vitamin C-enriched foods D. High-fiber diet

B. High-fat diet A high-fat diet increases the absorption of mebendazole, which boosts the effectiveness of the medication in eliminating the pinworms. Options A, C, and D are not related to the administration of this medication.

A client receives a prescription for esomeprazole (Nexium) for heartburn. Which finding in the client's history should the nurse report to the healthcare provider before administering the prescription? A. Eats spicy food three times a week. B. History of deep vein thrombosis. C. Drinks 2 alcoholic beverages on weekends. D. Family history of diabetes mellitus.

B. History of deep vein thrombosis. Esomeprazole (Nexium), a proton pump inhibitor (PPI), may increase the chance of bleeding in a client who is taking both a PPI and warfarin (Coumadin), which is used in the treatment of deep vein thrombosis (DVT). The healthcare provider should be informed of the client's recent history and treatment for DVT prior to giving Nexium.

The health care provider prescribes the H2 antagonist famotidine, 20 mg PO in the morning and at bedtime. Which statement regarding the action of H2 antagonists offers the correct rationale for administering the medication at bedtime? A. Gastric acid secreted at night is buffered, preventing pepsin formation. B. Hydrochloric acid secreted during the night is blocked. C. The drug relaxes stomach muscles at night to reduce acid. D. Ingestion of the medication at night offers a sedative effect, promoting sleep.

B. Hydrochloric acid secreted during the night is blocked. H2 antagonists act on the parietal cells to inhibit gastric secretion. Some gastric secretion occurs all the time, even when the stomach is empty, unless medications are taken to inhibit this action. Options C and D are not actions of famotidine. Option A is the action of antacids. Antacids do not affect healing or prevent the recurrence of ulcers; they merely provide symptomatic relief. Knowing the difference between H2 antagonists and antacids is important when teaching clients.

Dopamine is administered to a client who is hypotensive. Which finding should the nurse identify as a therapeutic response? A. Gain in weight B. Increase in urine output C. Improved gastric motility D. Decrease in blood pressure

B. Increase in urine output Intropin activates dopamine receptors in the kidney and dilates blood vessels to improve renal perfusion, so an increase in urine output indicates an increase in glomerular filtration caused by increased arterial blood pressure. Option A is related to fluid retention but is not an indicator of a therapeutic response to dopamine therapy. Option C is not related to the vasopressor effect of dopamine therapy. Dopamine increases cardiac output, which increases a client's blood pressure, not option D.

What assessment finding indicates to the nurse that vasopressin has been effective? A. Increased serum albumin levels B. Increased urine specific gravity C. Decreased adrenocorticotropic hormone levels D. Relief of pain

B. Increased urine specific gravity Vasopressin causes decreased water excretion in the renal tubule, thus increasing urine specific gravity. It is used to treat diabetes insipidus, which presents with a low urine specific gravity. This medication does not affect serum albumin, decrease adrenocorticotropic hormone levels, or decrease pain.

Which is the most appropriate action for the nurse who is told that a patient typically takes his glipizide with food? A. Immediately check the patient's blood glucose level. B. Inform the patient that it is better to take the medication 30 min before a meal. C. Inform the patient that the medication must be taken 15 min after a meal. D. Immediately call the health care provider.

B. Inform the patient that it is better to take the medication 30 min before a meal. Food inhibits the absorption of glipizide, the only sulfonylurea agent that should be given 30 min before a meal. The blood glucose level does not have to be taken right away. The medication is not to be taken after a meal. The health care provider does not have to be called; the nurse should intervene.

A client with a dislocated shoulder is being prepared for a closed manual reduction using conscious sedation. Which medication should the nurse explain as a sedative used during the procedure? A. Inhaled nitrous oxide B. Midazolam IV C. Ketamine IM D. Fentanyl and droperidol IM

B. Midazolam IV Conscious sedation uses sedative-hypnotics that do not compromise the airway, so IV midazolam, a short-duration benzodiazepine sedative, provides conscious sedation with local and regional anesthesia and has an amnestic effect. Option A is a weak anesthetic and is rarely used alone. Option C causes profound analgesia that causes a client to appear catatonic and amnestic. Fentanyl is an opioid more commonly used as an analgesic during anesthesia, whereas droperidol is a skeletal muscle anesthetic agent used to reduce spasticity to ensure a smooth induction under general anesthesia and requires intubation and ventilation during its onset and duration.

The nurse is caring for a patient who is taking levothyroxine and warfarin. Which intervention is a priority for the nurse? A. Monitor the patient for cardiac dysrhythmias. B. Monitor the patient for increased risk of bleeding. C. Weigh patient daily for excessive weight loss. D. Assess peripheral pulses and Homans sign daily.

B. Monitor the patient for increased risk of bleeding. Levothyroxine can compete with protein-binding sites of warfarin (Coumadin), allowing more warfarin to be unbound or free, thus increasing the effects of warfarin and the risk of bleeding. This combination does not place the patient at an increased risk of dysrhythmias, weight loss, or deep vein thrombosis.

What is a priority nursing action when taking care of a patient who is prescribed a central nervous system (CNS) stimulant? A. Keep the patient on bed rest. B. Monitor the patient for seizure activity. C. Continuously monitor the patient's pulse rate. D. Obtain a bedside commode for the patient.

B. Monitor the patient for seizure activity. Central nervous system (CNS) stimulation occurs when the amount and duration of action of excitatory neurotransmitters are increased. This can lead to the development of seizure activity in the patient who has received a central nervous system stimulant.

The nurse is caring for a patient who has been diagnosed with multiple sclerosis. The health care provider opts to include baclofen as part of this patient's treatment regimen. The nurse recognizes that this is an appropriate medication for this patient because the drug will treat which symptom? A. Muscle deterioration B. Muscle spasticity C. Muscle aching D. Muscle wasting

B. Muscle spasticity Baclofen is a muscle relaxant that is used to treat the spasticity of the muscles that occurs with multiple sclerosis. It does not specifically address muscle aching nor deterioration of muscle tissue.

A 19-year-old male client who has sustained a severe head injury is intubated and placed on assisted mechanical ventilation. To facilitate optimal ventilation and prevent the client from "fighting" the ventilator, the health care provider administers pancuronium bromide IV, with adjunctive opioid analgesia. What medication should be immediately accessible for a potential complication with this drug? A. Dantrolene sodium B. Neostigmine bromide C. Succinylcholine bromide D. Epinephrine

B. Neostigmine bromide Neostigmine bromide and atropine sulfate, both anticholinergic drugs, reverse the respiratory muscle paralysis caused by pancuronium bromide. Options A, C, and D are not antagonists to pancuronium bromide and would not be helpful in reversing the effects of the drug compared with the use of anticholinergics.

The nurse is preparing to administer an injection of morphine to a patient and notes a respiratory rate of 10 breaths/min. What is the nurse's best action? A. Administer a smaller dose and record the findings. B. Notify the health care provider and delay drug administration. C. Administer the prescribed dose and notify the health care provider. D. Hold the drug, record the assessment, and recheck in 1 hour.

B. Notify the health care provider and delay drug administration. Respiratory depression is a side effect of opioid analgesia. Therefore, since the patient's respiratory rate is below normal, the nurse should withhold the morphine and notify the health care provider. The drug should not be given while the respiratory rate is this much low, and the health care provider should be notified of the change in the patient's condition.

The patient taking methyldopa has elevated liver function tests. What is the nurse's best action? A. Document the finding and continue care. B. Notify the health care provider.This drug should not be used in patients with impaired liver function. C. Immediately stop the medication. D. Change the patient's diet.

B. Notify the health care provider. This drug should not be used in patients with impaired liver function. The nurse should notify the health care provider so that the patient can be tapered off the medication. The nurse should not immediately stop this medication, as the patient could have a hypertensive crisis. The patient's diet is not the cause of elevated liver enzymes and should not make a difference with therapy.

The apical heart rate of an infant receiving digoxin for congestive heart failure is 80 beats/min. Which intervention should the nurse implement first? A. Administer the next dose of digoxin as scheduled. B. Obtain a serum digoxin level. C. Administer a PRN dose of atropine sulfate. D. Assess for S3 and S4 heart sounds.

B. Obtain a serum digoxin level. Sinus bradycardia (rate <90 to 110 beats/min in an infant) is an indication of digoxin toxicity, so assessment of the client's digoxin level is the highest priority. Further doses of digoxin should be withheld until the serum level is obtained. Option C is not indicated unless the client exhibits symptoms of diminished cardiac output. Option D provides information about cardiac function but is of less priority than option B.

A client receives an antihypertensive agent daily. Which action is most important for the nurse to implement prior to administering the medication? A. Verify the expiration date. B. Obtain the client's blood pressure. C. Determine the client's history of adverse reactions. D. Review the client's medical record for a change in drug route.

B. Obtain the client's blood pressure. To determine the most accurate response to antihypertensive therapy, baseline blood pressures should be obtained before an antihypertensive drug is administered and should be compared with orthostatic vital signs to determine whether any side effects are occurring. Although options A, C, and D are required nursing actions prior to giving any drug, the therapeutic response should be determined before another dose is administered.

Which physiologic mechanism explains a drug's increased metabolism that is triggered by a disease process? A. Selectivity response B. Pharmacokinetics C. Pharmacodynamics D. Pharmacotherapeutics

B. Pharmacokinetics Pharmacokinetics describes the physiologic process of a drug's movement throughout the body and how the drug's interaction is affected by an underlying disease. Selectivity, or a selective drug, is defined as a drug that elicits only the response for which it is given. Pharmacodynamics is the impact of drugs on the body. Pharmacotherapeutics is defined as the use of drugs to diagnose, prevent, or treat disease or prevent pregnancy.

The nurse is providing medication teaching for a client who has recently received a prescription for clozapine (Clozaril). Which instruction should be included in this client's teaching plan? A. Avoid prolonged sun exposure. B. Rise slowly from a lying position. C. Do not eat any aged cheese. D. Take as needed for anxiety.

B. Rise slowly from a lying position. Orthostatic hypotension is a side effect of Clozaril, so the client should be instructed to rise slowly from a lying down or sitting position.

A 28-week primipara is experiencing contractions on a regular basis. Vaginal examination assessment confirms early cervical dilation. The drug terbutaline is ordered. Which maternal side effects would the nurse anticipate to observe in this patient? A. Hypoglycemia and thirst B. Tachycardia and palpitations C. Constipation and abdominal distention D. Hypocalcemia and muscle cramping

B. Tachycardia and palpitations Maternal side effects include tremors, dizziness, nervousness, tachycardia, hypotension, chest pain, palpitations, nausea, vomiting, hyperglycemia, and hypokalemia.

A client with angina pectoris is instructed to take sublingual nitroglycerin tablets PRN for chest pain. Which instruction should the nurse include in the client's teaching plan? A. Take one tablet every 3 minutes, up to five tablets. B. Take one tablet at the onset of angina and stop activity. C. Replace nitroglycerin tablets yearly to maintain freshness. D. Allow 30 minutes for a tablet to provide relief from angina.

B. Take one tablet at the onset of angina and stop activity. Nitroglycerin tablets should be taken at the onset of angina, and the client should stop activity and rest. One tablet can be taken every 5 minutes, up to three doses. Nitroglycerin should be replaced every 3 to 6 months, not every 12 months. Nitroglycerin should provide relief in 5 minutes, not 30 minutes.

The nurse is reviewing the use of the patient-controlled analgesia (PCA) pump with a client in the immediate postoperative period. The client will receive morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes per PCA to total 5 mg IV maximally per hour. What assessment has the highest priority before initiating the PCA pump? A. The expiration date on the morphine syringe in the pump. B. The rate and depth of the client's respirations. C. The type of anesthesia used during the surgical procedure. D. The client's subjective and objective signs of pain.

B. The rate and depth of the client's respirations. A life-threatening side effect of intravenous administration of morphine sulfate, an opiate narcotic, is respiratory depression. Prior to the initiation of the PCA pump, the nurse should assess the client's respirations to obtain a baseline of their respiratory rate and depth. Once the PCA pump is initiated and if the client's respiratory rate falls below 12 breaths per minute, the PCA pump should be stopped and the healthcare provider notified immediately.

A client with chronic gouty arthritis is talking allopurinol, 100 mg PO daily. Which laboratory serum level should the nurse report to the health care provider to determine the therapeutic outcome? A. Prothrombin time B. Uric acid level C. White blood cell count D. Creatinine level

B. Uric acid level The primary therapeutic outcome associated with allopurinol therapy is reduced serum uric acid levels with a lower frequency of acute gouty attacks, so option B should be reported to the health care provider. Options A, C, and D are not related to the effectiveness of allopurinol.

A psychiatric client is discharged from the hospital with a prescription for haloperidol. Which instruction should the nurse include in the discharge teaching plan for this client? A. Take with antacids to reduce gastrointestinal irritation. B. Use sunglasses and sunscreen when outdoors. C. Eat foods low in fiber and salt. D. Count the pulse before each dose.

B. Use sunglasses and sunscreen when outdoors. Photosensitivity is a common adverse effect of haloperidol (Haldol); therefore, the use of sunglasses and sunscreen should be included in the discharge teaching for this client. Options A, C, and D are not pertinent to client teaching regarding the use of haloperidol (Haldol).

The patient arrives at the health clinic complaining of experiencing numbness in his extremities. He also tells the nurse that the rash on his nose will not go away despite use of many home remedies. The nurse suspects that the patient is deficient in which vitamin? A. Vitamin B1 B. Vitamin B2 C. Vitamin B6 D. Vitamin B12

B. Vitamin B2 Evidence of a vitamin B2 deficiency includes visual defects such as blurred vision and photophobia, cheilosis, rash on nose, and numbness of the extremities.

What teaching should the nurse provide a client who has received a new prescription for sildenafil (Viagra)? (Select all that apply.) A. Frequent use can lead to the development of hypertension. B. Most effective if taken after at least 6 hours of REM sleep. C. Take within 30 to 60 minutes of sexual stimulation. D. Report rebound priapism that occurs for 4 hours or more. E. Can cause facial flushing and headache.

C, D, E Sildenafil (Viagra) enhances the natural response to sexual stimuli, so a client should be instructed to take Viagra within 30 to 60 minutes before sexual intercourse to provide adequate time to enhance penile erection. Sildenafil does not cause erection directly, but priapism can occur and should be reported to the healthcare provider if it persists. Common side effects include headaches, facial flushing, and diarrhea. Viagra can potentiate vasodilators, such as alpha-adrenergic blockers, nitroglycerin, and other nitrates used for angina pectoris, and may cause hypotension, which decreases perfusion to vital organs.

After administering corticotropin, what assessments are priorities for the nurse? A. Acid and alkaline phosphatase levels B. C-reactive protein levels C. Changes in vision D. Glucose levels E. Intake and output F. Serum sodium levels

C, D, E, F Corticotropin can cause cataracts and glaucoma, so the nurse needs to monitor for changes in vision. Corticotropin stimulates the release of adrenal hormones, which can lead to sodium and fluid retention as well as hyperglycemia. Corticotropin can cause sodium and fluid retention, so that intake and output should be monitored. Serum sodium levels should be monitored, as sodium retention can be a result of corticotropin administration.

The patient states that she has been prescribed prophylactic medication for tuberculosis for a period of 4 weeks. What is the nurse's best response? A. "Let me teach you about the medications." B. "We do not use medications prophylactically for tuberculosis." C. "You should be on the drugs for at least 6 months." D. "You should be on the medications for only 2 weeks."

C. "You should be on the drugs for at least 6 months." Between 6 months and 1 year is sufficient time for prevention of active tuberculosis. Because the tuberculosis mycobacterium is slow-growing, shorter lengths of time may not sufficiently eradicate the organism.

A patient has been admitted after overdosing on acetaminophen. The nurse plans to monitor this patient for development of which complication related to the overdose? A. Decreased urinary output B. Kidney stones C. Acute hepatic necrosis D. Metabolic alkalosis

C. Acute hepatic necrosis Acetaminophen in large doses is extremely hepatotoxic. Patients with normal hepatic function should receive no more than 4000 mg/day. An overdosage of acetaminophen should not result in decreased urinary output, kidney stones, or metabolic alkalosis.

During assessment of a patient diagnosed with pheochromocytoma, the nurse auscultates a blood pressure of 210/110 mm Hg. What is the nurse's best action? A. Ask the patient to lie down and rest. B. Assess the patient's dietary intake of sodium and fluid. C. Administer phentolamine. D. Administer nitroprusside.

C. Administer phentolamine. Phentolamine is a potent alpha-blocking agent specifically effective for treatment of hypertension associated with pheochromocytoma. The patient's blood pressure is elevated owing to tumor secretion. If the patient lies down, the blood pressure will not necessarily decrease. Increased fluid and sodium is not the cause of hypertension in this condition. Nipride is not the recommended treatment for this condition.

The nurse should instruct a client to avoid which product while taking carisoprodol (Soma) for muscle spasms? A. Aspirin products. B. Antacids. C. Alcoholic beverages. D. Dairy products.

C. Alcoholic beverages. Soma is a centrally-acting muscle relaxant that can cause CNS depression, and can have an additive effect when taken with other CNS depressants, such as alcohol.

Which drug of choice is indicated for acute ventricular dysrhythmias associated with myocardial infarction? A. Diltiazem. B. Bretylium. C. Amiodarone. D. Adenosine.

C. Amiodarone. Based on the Tachycardia Algorithm, amiodaroneis the drug of choice for acute ventricular dysrhythmias associated with myocardial infarction (C). (B) is not indicated. (A and D) are used for supraventricular tachyarrhythmias.

In monitoring a patient for adverse effects related to morphine sulfate, which is a priority assessment? A. Assess circulation. B. Assess cough reflex. C. Assess for nausea and vomiting. D. Assess lung sounds.

C. Assess for nausea and vomiting. Morphine sulfate can cause nausea and vomiting by stimulating the vomiting center in the brain.

A pregnant patient complains of constipation and has not had a bowel movement in 5 days. What is the nurse's first intervention? A. Administer Metamucil. B. Administer docusate sodium. C. Assess the patient's fluid intake. D. Increase the patient's dietary fiber.

C. Assess the patient's fluid intake. The pregnant patient is often nauseous and may not take in enough fluid, which can contribute to constipation. The nurse should first assess if this is the cause and increase fluid intake as appropriate.

A client with pneumonia receives a prescription for tetracycline (Sumycin). What precaution should the nurse include in this client's teaching? A. Take the medication with a glass of orange juice. B. Avoid over-the-counter medications containing alcohol. C. Avoid diary products for 2 hours after taking the medication. D. Do not use teeth whitening agents during the treatment regimen.

C. Avoid diary products for 2 hours after taking the medication. Dairy products should not be ingested until at least 2 hours after taking Sumycin because the calcium from the dairy binds with tetracycline and decreases the medication's absorption.

What will the nurse teach the patient who is prescribed a fentanyl transdermal delivery system? A. Change the patch when pain recurs. B. Change the patch every 24 hours. C. Change the patch every 72 hours. D. Change the patch once a week.

C. Change the patch every 72 hours. The fentanyl transdermal delivery system is designed to slowly release analgesic over a 72-hour period. It should not be changed every time that pain recurs, every 24 hours, or once a week.

To evaluate whether the administration of an antihypertensive medication has caused a therapeutic effect, which action should the nurse implement? A. Ask the client about the onset of any dizziness since taking the medication. B. Measure the client's blood pressure while the client is lying, sitting, and then standing. C. Compare the client's blood pressure before and after the client takes the medication. D. Interview the client about any past or recent history of high blood pressure.

C. Compare the client's blood pressure before and after the client takes the medication. Therapeutic effects are the expected or predictable physiologic responses to a medication. An antihypertensive medication is administered to lower blood pressure, so to determine if the therapeutic effect has been achieved, the nurse should compare the client's blood pressure before and after the client takes the medication. Options A and B provide data related to the side effect of hypotension, which may occur following the administration of an antihypertensive medication. Option D provides useful data but does not evaluate the medication's effectiveness.

A patient receiving finasteride has increased hair growth. What is the nurse's priority action? A. Hold the medication. B. Call the health care provider. C. Continue to assess. D. Measure testosterone levels.

C. Continue to assess. Increased hair growth is a therapeutic effect of this medication. The nurse should continue to assess.

A client is admitted for atrial fibrillation, and the healthcare provider prescribes disopyramide (Norpace). After explaining the action of this antidysrhythmic agent, which complaint should the nurse instruct the client to report? A. Joint pain. B. Dizziness or muscle weakness. C. Daily weight gain of 2 pounds. D. Dry mouth.

C. Daily weight gain of 2 pounds. Disopyramide (Norpace) is a Class IA antiarrhythmic (with similar actions as procainamide) used to suppress and prevent premature ventricular contractions, episodes of ventricular tachycardia, atrial flutter, and atrial fibrillation. The nurse should instruct the client to report any sudden weight gain that may indicate fluid retention related to poor cardiac output, which may be the result of ineffective management of the dysrhythmia.

The patient has been ordered lincomycin. The patient reports to the nurse that the patient has experienced reduced renal function in the past. The nurse anticipates that the health care provider will take which action? A. Place the medication on hold until renal function improves. B. Increase the original dosage of the medication. C. Decrease the original dosage of the medication. D. Continue with the medication as originally ordered.

C. Decrease the original dosage of the medication. Rather than place the medication on hold because of the patient's decreased renal function, the health care provider will likely opt to decrease the originally ordered dosage to accommodate the change in function.

What pathophysiological action supports the expected outcome for a client with chronic cancer pain who is treated with imipramine (Tofranil), a tricyclic antidepressant? A. Increases pain threshold by stimulating opiate receptors in the CNS to release of endogenous enkephalins. B. Decreases perception of pain by blocking opiate receptors in the brain and descending inhibitory nerves. C. Decreases transmission of pain impulses by altering serotonin and norepinephrine activity at nerve synapses. D. Increases pain tolerance through relief of depression by increasing the amounts of norepinephrine in the brain.

C. Decreases transmission of pain impulses by altering serotonin and norepinephrine activity at nerve synapses. Tricyclic antidepressants reduce neuropathic pain due to cancer invasion by blocking the reuptake of serotonin and norepinephrine in the CNS, and thereby inhibit pain transmission in the spinal cord dorsal horn, which are part of the descending pain-modulating system.

A client is experiencing an adverse effect of the gastrointestinal stimulant metoclopramide HCl. Which assessment finding would require immediate intervention by the nurse? A. Reports dizziness when first getting up. B. Describes an unpleasant metallic taste in the mouth. C. Demonstrates Parkinson-like symptoms, such as cogwheel rigidity. D. Refuses to drive after 6 pm because of an inability to see well at night.

C. Demonstrates Parkinson-like symptoms, such as cogwheel rigidity. Metoclopramide HCl blocks dopamine receptors in the brain, which can cause the extrapyramidal symptoms associated with Parkinson disease. Reglan has been associated with hypertension, not option A. Option B is often associated with metronidazole, not metoclopramide HCl. Option D, and other vision problems, have not been associated with metoclopramide HCl.

The nurse is assessing a patient with a history of chronic sedative use. The nurse notes the patient is exhibiting muscle twitching, tremors, and dizziness, especially on moving from sitting to standing. Which reaction is the patient experiencing? A. Tolerance to the sedative B. Underdosing of the sedative C. Dependence to the sedative D. An allergic response to the sedative

C. Dependence to the sedative Dependence is the result of chronic hypnotic use. Physical and psychological dependence can result. Physical dependence results in the appearance of specific withdrawal symptoms when a drug is discontinued after prolonged use. The severity of withdrawal symptoms depends on the drug and dosage. Symptoms may include muscular twitching and tremors, dizziness, orthostatic hypotension, delusions, hallucinations, delirium, and seizures.

A patient taking prazosin has a blood pressure of 140/90 mm Hg and is complaining of swollen feet. What is the nurse's best action? A. Hold the medication. B. Call the health care provider to change to an alternative medication. C. Determine the patient's drug history with this medication. D. Weigh the patient.

C. Determine the patient's drug history with this medication. The desired therapeutic effect of prazosin may not fully occur for 4 weeks. The nurse does not know how long the patient has been on this medication. There is no need to hold the medication. It is more important to determine the patient's history prior to weighing the patient or calling the health care provider, since symptoms may be the result of the medication not yet achieving the full therapeutic effect.

A patient receiving a unit of red blood cells suddenly develops shortness of breath, chills, and fever. What will the nurse do first? A. Reassure the patient that this is an expected reaction. B. Notify the health care provider while a peer monitors the blood transfusion. C. Discontinue the infusion. D. Decrease the infusion rate and reassess the patient in 15 min.

C. Discontinue the infusion. These are signs and symptoms of a blood transfusion reaction that could escalate to anaphylaxis; therefore, the blood transfusion should be stopped immediately.

The nursing student would be correct in identifying which microbe as the most common etiology of pyelonephritis? A. Klebsiella B. Psuedomonas C. E. Coli D. Staphylococcus

C. E. Coli Acute pyelonephritis, an upper UTI, is commonly seen in women of childbearing age, older women, and young girls. E. coli is the most common organism to cause pyelonephritis.

A patient complains of abdominal discomfort while taking nitrofurantoin. What will the nurse teach the patient? A. Take the medication with an antacid. B. Take the medication immediately before dinner. C. Eat when taking the medication. D. Discontinue the medication.

C. Eat when taking the medication. The drug is usually taken with food to decrease gastrointestinal distress. Antacids decrease the absorption of this medication. Taking the medication on an empty stomach will not help the gastric pain. Discontinuing the medication is not recommended for this side effect.

What nursing diagnosis is the highest priority for a patient receiving desmopressin (DDAVP)? A. Risk for injury B. Alteration in comfort C. Fluid volume excess D. Knowledge deficit

C. Fluid volume excess Desmopressin (DDAVP) is a form of antidiuretic hormone, which increases sodium and water retention, leading to an alteration in fluid volume. Although the other nursing diagnoses may be appropriate, they are not a priority using Maslow hierarchy of needs.

A 55-year-old client was diagnosed with schizophrenia 5 years earlier. Numerous hospitalizations have occurred since the diagnosis because of noncompliance with the prescribed medication regimen. Which drug might work best for this particular client? A. Chlorpromazine HCl B. Lithium carbonate C. Fluphenazine decanoate D. Diazepam

C. Fluphenazine decanoate Fluphenazine, an antipsychotic drug that can be given IM, has a rapid onset (1 to 2 hours) and a long duration of action (up to 3 or 4 weeks), so it would be the drug of choice for a noncompliant psychotic client. Option A is an antipsychotic drug used to treat schizophrenia and is usually administered PO (IM doses are short-acting). The client must be compliant in taking this drug for it to be effective. Option B is most effective with manic and depressive bipolar affective disorders. Option D is an antianxiety drug and would not be effective for a psychotic disorder.

A calcium channel blocker has been ordered for a patient. Which condition in the patient's history is a contraindication to this medication? A. Hypokalemia B. Dysrhythmias C. Hypotension D. Increased intracranial pressure

C. Hypotension Calcium channel blockers cause vasodilation and thus a drop in blood pressure. They are contraindicated in the presence of hypotension.

In developing a plan of care for a patient receiving morphine sulfate, which nursing diagnosis is a priority? A. Nausea B. Risk for injury related to central nervous system side effects C. Impaired gas exchange related to respiratory depression D. Constipation related to gastrointestinal side effects

C. Impaired gas exchange related to respiratory depression Using Maslow's hierarchy of needs and the ABCs of prioritization, impaired gas exchange is a priority.

When assessing a client prior to the administration of digoxin (Lanoxin, APO-Digoxin), which data is most important for the nurse to consider? A. Presence of a grade 2 murmur. B. Nailbed capillary refill of 5 seconds. C. Irregular apical pulse with a rate of 87. D. Bilateral lower extremity dependent rubor.

C. Irregular apical pulse with a rate of 87. The action of digoxin is to slow the heart rate and strengthen the force of contraction, so it is essential for the nurse to auscultate the apical pulse for a full minute and that the apical pulse is grater then 60 beats per minute for an adult or greater then 90 beats per minute for an infant prior to administration. If apical pulse is below the desired parameters, hold the dose and recheck the rate in one hour.

When caring for a client on digoxin therapy, the nurse knows to be alert for digoxin toxicity. Which finding would predispose this client to developing digoxin toxicity? A. Low serum sodium level B. High serum sodium level C. Low serum potassium level D. High serum potassium level

C. Low serum potassium level Hypokalemia predisposes the client on digoxin to digoxin toxicity, which usually presents as abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and atrioventricular (AV) dissociation. Assessment of serum potassium levels with prompt correction of hypokalemia is an important intervention for the client taking digoxin. Options A, B, and D are not relevant.

The nurse administers NPH insulin at 8 AM. What intervention is essential for the nurse to perform? A. Assess the patient for hyperglycemia by 10 AM. B. Monitor fingerstick at 2 PM. C. Make sure patient eats by 5 PM. D. Administer the insulin via IV pump.

C. Make sure patient eats by 5 PM. NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia. The patient needs to eat by 5 PM. The patient would not be at high risk for hypoglycemia at 10 AM. A fingerstick is not necessary at 2 PM. The insulin should not be routinely administered via IV.

A patient with type 1 diabetes mellitus has been ordered insulin aspart 10 units at 7:00 AM. What nursing intervention will the nurse perform after administering this medication? A. Perform a fingerstick blood sugar test. B. Have the patient void and dipstick the urine. C. Make sure the patient eats breakfast immediately. D. Flush the IV.

C. Make sure the patient eats breakfast immediately. Insulin aspart is a rapid-acting insulin that acts in 15 min or less. It is imperative that the patient eats as it starts to work. The patient should have had a fingerstick blood sugar test done before receiving the medication. There is no need to check the urine. This medication is given subcutaneously.

The patient has been diagnosed with candidiasis. The nurse recognizes that the patient is most likely to be ordered which drug? A. Sulconazole B. Haloprogin C. Miconazole nitrate D. Tolnaftate

C. Miconazole nitrate Miconazole nitrate can be ordered to treat candidiasis. The other drugs listed can be used to treat tinea pedis, corporis, and cruris.

The nurse is preparing to administer the morning medications, which includes a tetracycline. While preparing to administer the medication, the dietary staff delivers the patient's breakfast tray. Which item on the tray would most concern the nurse? A. Coffee B. Eggs C. Milk D. Whole wheat toast

C. Milk Milk and foods high in calcium can inhibit tetracycline absorption. To avoid drug interaction, these should be taken at least 2 hours apart from tetracycline.

A patient is being treated for short-term management of heart failure with milrinone. What is the primary nursing action? A. Administer digoxin via IV infusion with the milrinone. B. Administer furosemide (Lasix) via IV infusion after the milrinone. C. Monitor cardiac rhythm and blood pressure continuously. D. Maintain an infusion of lactated Ringer with milrinone infusion.

C. Monitor cardiac rhythm and blood pressure continuously. Milrinone lactate is a phosphodiesterase inhibitor administered intravenously for short-term treatment in patients with heart failure not responding adequately to digoxin, diuretics, or other vasodilators. Blood pressure and heart rate should be closely monitored. Digoxin is not administered with the milrinone but is usually tried before treatment with milrinone. Furosemide is not necessarily administered after the milrinone, although it could be. It is not, however, administered routinely via IV infusion. Lactated Ringer does not have to be administered with milrinone.

A nurse is caring for a patient prescribed neostigmine orally. Which instruction will the nurse include in the patient's plan of care? A. Administer neostigmine every 8 hours. B. Monitor for onset of action in 4 hours. C. Monitor the patient for respiratory depression. D. Make sure that naloxone hydrochloride is readily available.

C. Monitor the patient for respiratory depression. Neostigmine is a fast-acting AChE inhibitor that, when administered orally, has an onset of action of 0.5 to 1 hour; it is given every 2 to 4 hours. The nurse should monitor the patient for respiratory depression, which is a life-threatening adverse effect. Atropine is the antidote for a cholinergic crisis.

Which adverse reaction will the nurse monitor for in a patient taking bethanechol for treatment of urinary retention? A. Constipation B. Hypertension C. Muscle weakness D. Tachycardia

C. Muscle weakness Adverse reactions to bethanechol include abdominal cramps, diarrhea, orthostatic hypotension, bradycardia, and muscle weakness.

The nurse is caring for a patient who is taking ascorbic acid (vitamin C). The nurse plans to monitor the patient for which adverse effect of ascorbic acid? A. Frequent constipation B. Excessive bleeding tendencies C. Nausea, vomiting, heartburn D. Seizure activity

C. Nausea, vomiting, heartburn Adverse effects of ascorbic acid (vitamin C) include nausea and vomiting, headache, heartburn, and the development of kidney stones.

A client who has chronic back pain is on long-term pain medication management and asks the nurse why his pain relief therapy is not as effective as it was 2 months ago. How should the nurse respond? A. The phenomenon occurs when opiates are used for more than 6 months to relieve pain. B. Withdrawal occurs if the drug is not tapered slowly while being discontinued. C. Pharmacodynamic tolerance requires increased drug levels to achieve the same effect. D. A consistent dosage with around-the-clock administration is the most effective.

C. Pharmacodynamic tolerance requires increased drug levels to achieve the same effect. Pharmacodynamic tolerance explains the client's need for an increased drug level to produce effects that formerly occurred at lower drug levels. Tolerance can occur with opioids during shorter periods of use. Although a withdrawal syndrome can occur if the client develops a dependency, this does not address the client's immediate concern of drug effectiveness. Although a stable serum drug level provides effective pain management, the client's complaint is consistent with a tolerance to his current pain management regimen.

The healthcare provider has prescribed digoxin for a client who has been taking furosemide (Lasix) for six months. What laboratory serum levels should the nurse review before administering the digoxin? A. Calcium. B. Magnesium. C. Potassium. D. Furosemide.

C. Potassium. The client's serum potassium levels should be evaluated before giving the first dose of digoxin because Lasix is can cause hypokalemia which increases the risk of digoxin toxicity and cardiac arrhythmias.

A client is taking danazol (Danocrine) for endometriosis and calls the clinic nurse to complain of a dark, swollen, and painful leg. What instructions should the nurse provide the client? A. Wear support stockings. B. Elevate both legs and apply heat. C. Proceed to the closest emergency room. D. Walk for 20 to 30 minutes to reduce muscle cramps.

C. Proceed to the closest emergency room. A dark, swollen, and painful leg is consistent with deep vein thrombosis (DVT), an adverse effect of danazol, so the client should be instructed to seek immediate emergency care.

A client with chronic gouty arthritis takes allopurinol (Zyloprim) and experiences an acute attack of gouty arthritis. The healthcare provider prescribes concurrent low-dose colchicine. What information should the nurse provide the client that best explains the action of the colchicine? A. Acts like aspirin to relieve pain. B. Facilitates the excretion of uric acid. C. Reduces inflammation at the affected site. D. Prevents formation of uric acid crystals.

C. Reduces inflammation at the affected site. Allopurinol (Zyloprim) improves joint function in chronic gouty arthritis by reducing blood uric acid levels to prevent and promote regression of tophi. Low-dose colchicine, an antiinflammatory agent specific for gout, is used concurrently with allopurinol, which can precipitate an incident of acute gouty arthritis.

A client receives a new prescription for an angiotensin-converting enzyme (ACE) inhibitor. What client history contraindicates its use? A. Asthma. B. Heart failure. C. Renal artery stenosis. D. Coronary artery disease.

C. Renal artery stenosis. Angiotensin-converting enzyme (ACE) inhibitors can cause severe renal insufficiency in clients with bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney.

A client receives pancuronium, a long-acting, nondepolarizing neuromuscular blocker, during surgical anesthesia. Which client situation should alert the nurse to evaluate the client for a prolonged muscle relaxation response to this medication? A. Hepatitis B. Heart failure C. Renal insufficiency D. History of emphysema

C. Renal insufficiency Pancuronium is eliminated via the kidneys, so a client with renal failure is at risk for prolonged muscle relaxation. Although hepatitis can interfere with this drug's metabolism, it does not place a client at increased risk for prolonged muscle relaxation. Options B and D do not cause prolonged muscle relaxation in a client who receives pancuronium.

During administration of theophylline, the nurse should monitor for signs of toxicity. Which symptom would cause the nurse to suspect theophylline toxicity? A. Dry mouth B. Urinary retention C. Restlessness D. Sedation

C. Restlessness Restlessness is a sign of theophylline intoxication. Other signs of toxicity are anorexia, nausea, vomiting, insomnia, tachycardia, arrhythmias, and seizures. Options A, B, and D are common side effects of antihistamines but do not indicate theophylline intoxication.

A client who is HIV-positive is receiving combination therapy with the antiviral medication zidovudine. Which instruction should the nurse include in this client's teaching plan? A. Take the drug as prescribed to cure HIV infections. B. Use the drug to reduce the risk of transmitting HIV to sexual contacts. C. Return to the clinic every 2 weeks for blood counts. D. Report to the health care provider immediately if dizziness is experienced.

C. Return to the clinic every 2 weeks for blood counts. Bone marrow depression with granulocytopenia is a severe but common adverse effect of zidovudine. Careful monitoring of CBCs is indicated. Options A and B are not correct instructions related to use of this medication. Option D is an expected side effect. The client should be instructed to avoid driving until this reaction improves.

A client who arrives in the postanesthesia care unit (PACU) after surgery is not awake from general anesthesia. Which action should the nurse implement first? A. Assess for deep tendon reflexes. B. Observe urinary output. C. Review the medication administration record (MAR). D. Administer naloxone.

C. Review the medication administration record (MAR). Most general anesthetics produce cardiovascular and respiratory depression, so a review of the client's MAR identifies all the medications received during surgery and helps the nurse anticipate the client's response and emergence from anesthesia. Options A and B are ongoing postoperative assessments. Based on the medications that the client has received, naloxone may need to be administered if indicated by the client's vital signs and delayed spontaneous reactivity.

Which nursing diagnosis is important to include in the plan of care for a client receiving the angiotensin-2 receptor antagonist irbesartan (Avapro)? A. Fluid volume deficit. B. Risk for infection. C. Risk for injury. D. Impaired sleep patterns.

C. Risk for injury. Avapro is an antihypertensive agent, which acts by blocking vasoconstrictor effects at various receptor sites. This can cause hypotension and dizziness, placing the client at high risk for injury.

When assessing for potential side effects of fludrocortisone, what is a priority for the nurse to monitor? A. Serum sodium levels for potential hyponatremia B. Serum calcium levels for hypercalcemia C. Serum potassium levels for hypokalemia D. Intake and output for potential fluid volume deficit

C. Serum potassium levels for hypokalemia Fludrocortisone has mineralocorticoid properties, resulting in sodium and fluid retention along with potassium excretion.

An emergency department triage nurse is interviewing a female client who has a history of epilepsy with tonic-clonic seizures controlled by phenytoin (Dilantin). Which information is most significant in planning this client's care? A. She has missed 2 menstrual periods. B. She has had no dental care for several years. C. She ran out of her medication 4 days ago. D. She has smoked 3 packs of cigarettes a day for 10 years.

C. She ran out of her medication 4 days ago. Abruptly stopping anticonvulsant medications can precipitate seizures or the development of status epilepticus. Immediate seizure precautions and medication administration are necessary.

The health care provider has ordered 5% dextrose in water as a maintenance fluid for the patient. The nurse is assessing the patient at the beginning of the shift and observes the fluid hanging to be 50% dextrose in water (D50W). Which is the highest priority nursing action? A. Notify the health care provider of the error. B. Find out which nurse hung the D50W. C. Stop the infusion. D. Complete an incident report.

C. Stop the infusion. The patient's safety is always the primary concern; the fluid should be stopped and the correct fluid hung before other measures are taken such as notifying the health care provider.

The nurse is teaching a patient with decreased hepatic function about taking pain relievers. What is the most important information to teach this patient? A. Take COX-2 inhibitors every 8 hours. B. Do not take aspirin. C. Take no more than 2 grams of acetaminophen per day. D. Do not take narcotic pain relievers.

C. Take no more than 2 grams of acetaminophen per day. The patient with decreased hepatic function should decrease the dose of acetaminophen.

What plan is best for the patient beginning prednisone therapy? A. Administer the medication early evening to coincide with the natural secretion pattern of the adrenal cortex. B. Plan to keep a strict, unchanging schedule to prevent adverse reactions. C. Take the medication with food to diminish the risk of gastric irritation. D. Take the medication only every other day to decrease the risk of adrenal hyperplasia.

C. Take the medication with food to diminish the risk of gastric irritation. Glucocorticoids can cause gastric distress and should be administered with food. The normal circadian secretion of the adrenal cortex is early morning to wake the person up, not early evening. These medications should be tapered off slowly to prevent adrenal crisis. The patient takes the medication daily.

A patient taking amantadine complains of depression and dizziness. What intervention will the nurse perform first? A. Evaluate the patient for other central nervous system effects from the medication. B. Order a consult for counseling. C. Take the patient's blood pressure sitting and standing. D. Call the health care provider.

C. Take the patient's blood pressure sitting and standing. The side effects and adverse reactions to amantadine include central nervous system effects, such as insomnia, depression, anxiety, confusion, and ataxia; orthostatic hypotension; neurologic problems, such as weakness, dizziness, and slurred speech; and gastrointestinal disturbances, such as anorexia, nausea, vomiting, and diarrhea. The nurse should evaluate the patient for orthostatic hypotension first to address safety issues.

A client who is receiving chlorpromazine HCl to control his psychotic behavior also has a prescription for benztropine. When teaching the client and/or significant others about these medications, what should the nurse explain about the use of benztropine in the treatment plan for this client? A. This medication will reduce the side effect of urinary retention. B. This drug potentiates the effect of chlorpromazine HCl. C. The benztropine is used to control extrapyramidal symptoms. D. The combined effect of these drugs will modify psychotic behavior.

C. The benztropine is used to control extrapyramidal symptoms. Benztropine, an anticholinergic drug, is used to control extrapyramidal symptoms associated with chlorpromazine HCl (Thorazine) use. Options A, B, and D are not accurate statements regarding the use of benztropine for clients who are treated with chlorpromazine HCl for the control of psychosis.

The nurse is instructing a patient on the use of the contraceptive etonogestrel transvaginal ring. What information will the nurse include in the patient's teaching plan? A. The patient should eat a low-fiber diet to prevent diarrhea. B. The ring protects against sexually transmitted infections (STIs). C. The patient should insert the ring during the first 5 days of the menstrual cycle. D. Back-up contraception is not needed during the first 7 days after the first ring is placed.

C. The patient should insert the ring during the first 5 days of the menstrual cycle. The etonogestrel transvaginal ring should be inserted during the first 5 days of the menstrual cycle. Back-up contraception is recommended during the first 7 days after the first ring is placed, until hormones have had the opportunity to reach an appropriate level. The ring does not cause diarrhea and does not protect against STIs, including human immunodeficiency virus.

The nurse is caring for several patients who are all being treated for hypertension. Which patient will the nurse assess first? A. The patient who has been on beta blockers for 1 day B. The patient who is on a beta blocker and a thiazide diuretic C. The patient who has stopped taking a beta blocker due to cost D. The patient who is taking a beta blocker and Lasix (furosemide)

C. The patient who has stopped taking a beta blocker due to cost Abrupt discontinuation of the antihypertensive drug may cause rebound hypertension. The patient who has just been started on an antihypertensive drug and the patients who are on combinations of antihypertensive drugs will not be as high priorities for assessment since they seem to be complying with treatment. Abruptly discontinuing the drug indicates either a failure to understand the treatment or a noncompliance with the treatment.

What information will the nurse include on the care plan for a patient taking fluvoxamine? A. This medication must be given IV. B. This medication will interact with caffeine. C. This medication might not become therapeutic for 4 weeks. D. This medication is safe in those with liver disease, unlike other SSRIs.

C. This medication might not become therapeutic for 4 weeks. This medication takes between 1 and 4 weeks to be therapeutic. The patient must be encouraged to remain on the medication. This medication is given PO and does not interact with caffeine. Fluvoxamine should not be taken by those with hepatic disease.

A client is receiving fentanyl via an epidural infusion. Which side effect should the nurse anticipate in the first 24 hours of epidural analgesia? A. Headache. B. Agitation. C. Urinary retention. D. Abdominal cramping and diarrhea.

C. Urinary retention. Anticipated common side effects of epidural opioids include nausea, itching, and urinary retention which may require urinary catheterization.

The health care provider prescribes cisplatin to be administered in 5% dextrose and 0.45% normal saline with mannitol added. Which assessment parameters would be most helpful to the nurse in evaluating the effectiveness of the therapy? A. Oral temperature B. Blood cultures C. Urine output D. Liver enzyme levels

C. Urine output The effectiveness of the diuresis is best measured by urine output. Mannitol, an osmotic diuretic, is given during cisplatin therapy to promote diuresis and reduce the risk of nephrotoxicity and ototoxicity associated with this chemotherapeutic agent. Options A, B, and D do not provide information about the risk for nephrotoxicity and ototoxicity related to cisplatin administration.

Which common side effect should the nurse alert a female client about when medroxyprogesterone (Depo-Provera) is prescribed? A. Leg or calf pain. B. Headaches or visual changes. C. Vaginal bleeding after discontinuing the medication. D. Jaundice during the first 3 weeks of administration.

C. Vaginal bleeding after discontinuing the medication. Approximately 3 to 7 days after the last cyclic dose of medroxyprogesterone, a female client may experience withdrawal vaginal bleeding.

The nurse is caring for a patient who has been experiencing convulsions. The patient's laboratory results also show evidence of anemia. The nurse suspects that the patient may be experiencing a deficiency of which vitamin? A. Folic acid B. Vitamin A C. Vitamin B6 D. Vitamin B1

C. Vitamin B6 Vitamin B6 deficiency is characterized by neuritis, convulsions, dermatitis, anemia, and lymphopenia.

The nurse is caring for a patient with a diagnosis of acute alcohol toxicity. Which assessment finding requires immediate action? A. Decreased reflexes B. Headache C. Vomiting D. Tachycardia

C. Vomiting In acute alcohol toxicity, vomiting occurs frequently, and to the patient's semiconscious state, aspiration is a concern.

Which statement indicates to the nurse that the patient understands sublingual nitroglycerin medication instructions? A. "I will take up to five doses every 3 min for chest pain." B. "I can chew the tablet for the quickest effect." C. "I will keep the tablets locked in a safe place until I need them." D. "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."

D. "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness." Nitroglycerin is a vasodilator and can cause orthostatic hypotension, resulting in dizziness. Three doses can be taken 5 min apart. The tablet should be placed under the tongue to dissolve. The medication should be kept in a readily accessible location for immediate use should chest pain occur.

A male patient 24 h post-op tells the nursing student that his nurse "gave him an extra shot of insulin and there must be some mistake." The nursing student verifies the patient received a sliding scale dose of insulin. What information should the nursing student provide to the patient? A. "You received extra insulin today because you have not been eating." B. "The effects of surgery result in a decrease in your metabolic rate; this increases secretion of glucagon and increases your glucose levels." C. "Surgery often results in infection, and infection raises your glucose levels." D. "Surgery can produce stress, which can produce stress; an additional small amount of insulin helps provide a constant glucose level."

D. "Surgery can produce stress, which can produce stress; an additional small amount of insulin helps provide a constant glucose level." Insulin may be administered in adjusted sliding doses that depend on individual blood glucose test results. When the diabetic patient has extreme variances in insulin requirements—such as with stress from hospitalization, surgery, illness, or infection—adjusted dosing or sliding-scale insulin coverage provides a more constant blood glucose level. Blood glucose testing is performed several times a day at specified intervals, usually before meals. A preset scale usually involves directions for the administration of rapid- or short-acting insulin.

The patient newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine. What information is essential for the nurse to teach this patient? A. "This medication should be mixed with the regular insulin each morning." B. "This medication is very short acting. You must be sure you eat after injecting it." C. "This medication is very expensive, but you will be receiving it only a short time." D. "This medication has a duration of action of 24 h."

D. "This medication has a duration of action of 24 h." Insulin glargine has a duration of action of 24 h with no peaks, mimicking the natural, basal insulin secretion of the pancreas. This medication cannot be mixed with other insulins and is not a short-acting insulin. The patient may need to receive this medication for a long time.

The nurse is caring for a patient in the clinic who states that he is afraid of taking antihistamines because he is a truck driver. What is the best information for the nurse to give this patient? A. "Take the medication only when you are not driving." B. "Take a lower dose than normal when you have to drive." C. "You are correct; you should not take antihistamines." D. "You may be able to safely take a second-generation antihistamine."

D. "You may be able to safely take a second-generation antihistamine." Second-generation antihistamines are often called non-sedating antihistamines. These may be safer for the patient to take, but the patient should still monitor for signs of excessive sedation.

The patient is currently on a treatment regimen that includes selegiline therapy. What information is most important for the nurse to teach the patient about this medication? A. "This medication will cure your disease." B. "This medication is used when other drugs do not work." C. "This medication blocks breakdown of dopamine." D. "You will need to restrict your intake of certain foods and drinks."

D. "You will need to restrict your intake of certain foods and drinks." This medication may inhibit monoamine oxidase (MAO)-A, an enzyme that promotes metabolism of tyramine in the gastrointestinal tract. If not metabolized, ingestion of foods high in tyramine, such as aged cheese, red wine, and bananas, can cause a hypertensive crisis. This is the most important information the nurse needs to teach the patient.

A school-aged child is taking methylphenidate hydrochloride (Ritalin, Biphentin) for the treatment of attention-deficit hyperactivity disorder (ADHD). The mother tells the nurse that she gives the medication at bedtime so it is "working" during school the next morning. What modification to the administration plan should the nurse recommend to this mother? A. Continue administering the medication dose at bedtime. B. Give the medication when the child arrives at school. C. Take the medication with meals. D. Administer at least six hours before bedtime.

D. Administer at least six hours before bedtime. Central nervous system stimulants, such as Ritalin, should be taken at least six hours before bedtime to decrease insomnia.

Which intervention is most appropriate for a patient who needs treatment for acute postoperative pain? A. Administer allopurinol PO every 4 hours. B. Administer celecoxib PO every 6 hours. C. Administer indomethacin PO every 4 hours. D. Administer ketorolac IV every 4 hours PRN.

D. Administer ketorolac IV every 4 hours PRN. Ketorolac is the only NSAID that can be administered by injection (intramuscularly or intravenously) and is indicated for short-term use for severe to moderate pain. Acute postoperative pain cannot be effectively managed on oral medication.

A patient who has been taking morphine for pain is assessed by the nurse. The patient's respiratory rate is 7 per minute, and pupils are 1 mm and unreactive. What is the nurse's immediate action? A. Start rescue breathing. B. Call anesthesia. C. Call a code. D. Administer naloxone.

D. Administer naloxone. Morphine overdose can be indicated by unresponsive, pinpoint pupils and respiratory depression. Rescue breathing, calling anesthesia, or calling a code will not correct the underlying problem.

A patient is admitted to the emergency department with an expected cholinesterase inhibitor overdose. What is the nurse's primary action? A. Monitor urinary output. B. Insert a large-bore IV catheter. C. Attach patient to telemetry monitor. D. Administer ordered anticholinergic medication.

D. Administer ordered anticholinergic medication. An anticholinergic can act as an antidote to the toxicity caused by cholinesterase inhibitors and organophosphate ingestion.

The patient is being treated with intravenous amphotericin B. What is the nurse's primary intervention? A. Encourage the patient to drink at least a liter of fluid per shift. B. Assess the IV site for infiltration. C. Administer with dextrose. D. Assess blood urea nitrogen and creatinine.

D. Assess blood urea nitrogen and creatinine. Amphotericin B is considered highly toxic and can cause nephrotoxicity and electrolyte imbalance, especially hypokalemia and hypomagnesemia (low serum potassium and magnesium levels). Urinary output, blood urea nitrogen, and serum creatinine levels need to be closely monitored.

The nurse is caring for a patient who has been recently diagnosed with hypertension and is to receive an initial dose of atenolol. What is the nurse's primary intervention? A. Assess the patient's urinary output. B. Teach the change position slowly. C. Encourage increase in fluid intake. D. Assess for history of any respiratory disease.

D. Assess for history of any respiratory disease. At therapeutic dosages, atenolol selectively blocks only the beta1 receptors in the heart, not the beta2 receptors located in the lungs. However, the drug can lead to bronchospasm, so the assessment should focus on the lungs. It is a part of the plan to caution the patient about hypotension, but it is not the priority.

Which is a priority nursing action when assessing for side effects expected in a patient taking analeptics? A. Assessing heart rate for bradycardia B. Assessing patient for decreased mental alertness C. Assessing blood pressure for hypotension D. Assessing patient for nervousness

D. Assessing patient for nervousness Analeptics are CNS stimulants, which cause nervousness as a side effect. The stimulation effect can result in increased heart rate, increased mental alertness, and hypertension as well.

A client who has Trichomonas vaginalis receives a prescription for metronidazole (Flagyl). Which instruction should the nurse provide during client education? A. Do not ingest with diary products. B. Notify the clinic if the urine changes color. C. Obtain liver function tests every 3 months. D. Avoid over-the-counter antitussives.

D. Avoid over-the-counter antitussives. Flagyl can produce a disulfiram (Antabuse)-like reaction when combined with products containing alcohol, such as over-the-counter cough remedies, so the client should be informed to avoid ingesting any alcohol product during the use of Flagyl.

A male client with meningitis is prescribed cefotaxime (Claforan) IV and asks the nurse why he cannot receive an oral drug, such as cefaclor (Ceclor) or cefadroxil (Duricef), that he has taken before for infections.How should the nurse respond when considering the actions of cephalosporins? A. Cefazolin (Ancef) is another IV antibiotic that can be prescribed. B. Cefaclor (Ceclor) is a good alternative to suggest to the healthcare provider. C. Cefadroxil (Duricef) is usually prescribed when the IV is discontinued. D. Cefotaxime (Claforan) provides therapeutic CNS concentrations.

D. Cefotaxime (Claforan) provides therapeutic CNS concentrations. According to research studies, only third generation cephalosporins such as cefotaxime (Claforan), and ceftazidime have been shown effective in treating bacterial meningitis with the exception of cefuroxime, the only second generation cephalosporin shown to be effective. First generation cephalosporins have not been successful in the treatment of bacterial meningitis. IV administration of these antibiotics are preferred route of administration due to oral administration medication levels tend to be too low to be effective in comparison to parental administration.

The nurse is monitoring a patient during IV nitroglycerin infusion. Which assessment finding will cause the nurse to take action? A. Blood pressure 110/90 mm Hg B. Flushing C. Headache D. Chest pain

D. Chest pain The patient should not continue to have chest pain while on IV nitroglycerin. This would prompt the nurse to intervene. Blood pressure of 110/90 mm Hg is not cause for concern and is expected with nitroglycerin. Headache and flushing are common side effects of nitroglycerin.

A client who has trouble swallowing pills intermittently has been prescribed venlafaxine (XR) for depression. The medication comes in capsule form. What should the nurse include in the discharge teaching plan for this client? A. Capsule contents can be sprinkled on pudding or applesauce. B. Chew the medication thoroughly to enhance absorption. C. Take the medication with a large glass of water or juice. D. Contact the health care provider for another form of medication.

D. Contact the health care provider for another form of medication. Venlafaxine is administered PO in capsule form. Capsules that are extended-release (XR) or continuous-release (CR) contain delayed-release, enteric-coated granules to prevent decomposition of the drug in the acidic pH of the stomach. The client should notify the health care provider about the inability to swallow the capsule. This medication should not be chewed or opened so that the delayed-release, enteric-coated granules can remain intact. Water or juice will not affect the medication.

When developing a written nursing care plan for a client receiving chemotherapy for treatment of cancer, the nurse writes, "Assess each voiding for hematuria." The administration of which type of chemotherapeutic agent would prompt the nurse to add this intervention? A. Vincristine B. Bleomycin sulfate C. Chlorambucil D. Cyclophosphamide

D. Cyclophosphamide Hemorrhagic cystitis is the characteristic adverse reaction of cyclophosphamide. Administration of options A, B, and C does not typically cause hemorrhagic cystitis.

What action should the nurse implement to provide analgesic titration for a client in pain? A. Teach the client to increase the time range between doses of pain medication. B. Monitor the effects of continuous intravenous infusion of narcotic analgesics. C. Plan with the client how to use a specific total dose of analgesic over a 24-hour period. D. Determine the optimal analgesic dosage required that causes the least side effects.

D. Determine the optimal analgesic dosage required that causes the least side effects. No given dosage of an analgesic provides the same level of pain relief for every patient, and so titration upward or downward is determined based on the client's response, so that the optimal dosage achieves adequate pain relief with minimal side effects for the client. An individual's response to the medication dosage is the assessment for titration, and the titration dose should be implemented as long as analgesia is needed.

A female client with myasthenia gravis is taking a cholinesterase inhibitor and asks the nurse what can be done to remedy her fatigue and difficulty swallowing. What action should the nurse implement? A. Explore a plan for development of coping strategies for the symptoms with the client. B. Explain to the client that the dosage is too high, so she should skip every other dose of medication. C. Advise the client to contact her health care provider because of the development of tolerance to the medication. D. Develop a teaching plan for the client to self-adjust the dose of medication in response to symptoms.Explore a plan for development of coping strategies for the symptoms with the client.

D. Develop a teaching plan for the client to self-adjust the dose of medication in response to symptoms.Explore a plan for development of coping strategies for the symptoms with the client. Maintaining optimal dosage for cholinesterase inhibitors can be challenging for clients with myasthenia gravis. Clients should be taught to recognize signs of overmedication and undermedication so that they can modify the dosage themselves based on a prescribed sliding scale. Options A, B, and C do not adequately address the client's concerns.

Which medication is useful in treating digoxin toxicity? A. Atropine sulfate B. Isoproterenol C. Xylocaine D. Digoxin immune Fab

D. Digoxin immune Fab

Prior to administering a scheduled dose of digoxin, the nurse reviews the client's current serum digoxin level, which is 1.3 ng/dL. Which action should the nurse implement? A. Administer Digibind to counteract the toxicity. B. Withhold the drug and notify the health care provider immediately. C. Withhold the dose and notify the health care provider during rounds that the dose was held. D. Give the dose of digoxin if the client's heart rate is within a safe range.

D. Give the dose of digoxin if the client's heart rate is within a safe range. The client's digoxin level of 1.3 ng/dL is not above the upper range of its therapeutic index (toxic level is >2.0 ng/dL), so the dose should be administered after the client's heart rate is evaluated. Digibind is administered for toxic levels of digoxin, so option A is not indicated. Options B and C are not necessary.

A patient diagnosed with an atonic bladder and a peptic ulcer is prescribed bethanechol. What is the nurse's best intervention? A. Inform the patient that the medication must be taken on an empty stomach. B. Teach the patient to take the medication with a full glass of water. C. Administer the medication only after meals. D. Hold the medication and call the health care provider.

D. Hold the medication and call the health care provider. Bethanechol should not be taken if peptic ulcer is present. Bethanechol can cause epigastric distress, abdominal cramps, nausea, vomiting, diarrhea, and flatulence.

The nurse is caring for a patient who has just started taking levothyroxine. What assessment finding is a priority for the nurse to address? A. Heart rate 55 beats/min B. Intolerance to cold C. Weight gain of 3 pounds in the last week D. Irritability

D. Irritability Irritability is a symptom of hyperthyroidism. This could be a sign that the medication dose is too high. A lowered heart rate, weight gain, and intolerance to cold could be symptoms of hypothyroidism and are expected in this patient, who just began medication therapy.

A patient enters the emergency department with suspected influenza. Prior to starting the patient on the prescribed oseltamivir phosphate, what should the nurse determine? A. Allergies to antibiotics B. Over-the-counter medications taken in the last 48 hours C. Immunization history D. Length of time since onset of symptoms

D. Length of time since onset of symptoms Oseltamivir phosphate inhibits the replication and spread of influenza if given within 48 hours of symptoms.

The nurse is caring for a patient receiving testosterone therapy. For which assessment finding will the nurse intervene immediately? A. Abdominal pain B. Nausea C. Dizziness D. Lower extremity edema

D. Lower extremity edema Lower extremity edema is a sign of sodium and water retention and is an adverse reaction of administration of testosterone. Abdominal pain, nausea, and dizziness are side effects but do not require immediate attention.

The nurse is preparing to administer a transfusion of a blood product. What is the most appropriate intravenous fluid to hang as a maintenance infusion? A. Lactated Ringer B. 5% dextrose and water C. Ringer solution D. Normal saline

D. Normal saline Of the intravenous solutions listed, the only one that is compatible with blood products is normal saline.

The nurse notes that the hemoglobin level of a client receiving darbepoetin alfa has increased from 6 to 10 g/dL over the first 2 weeks of treatment. Which action should the nurse take? A. Encourage the client to continue the treatment, because it is effective. B. Advise the client that the dose will need to be increased. C. Assess the client's skin color for continued pallor or cyanosis. D. Notify the health care provider of the change in the client's laboratory values.

D. Notify the health care provider of the change in the client's laboratory values. Although an increase in the client's hemoglobin level is desired, a rapid increase (more than 1 g/dL in a 2-week period) may lead to hypertension, so the health care provider should be notified of this excessive increase. Options A and B may lead to a dangerous increase in blood pressure. Because the client's anemia has improved, option D is of greater priority than continuing to monitor for signs of anemia.

A patient has been taking aspirin for chronic pain. The patient states that the pain is not relieved with 650 mg of aspirin every 4 hours. What is the best instruction for the nurse to give the patient? A. Increase your dose to 1000 mg every 4 hours. B. Alternate aspirin and a narcotic analgesic every 4 hours. C. Take aspirin and a COX-1 inhibitor at the same time. D. Notify your health care provider that the medication is not effective.

D. Notify your health care provider that the medication is not effective. If pain persists, the best advice is for the patient to switch to another pain reliever, such as ibuprofen. Increasing the dose of aspirin may lead to gastric distress. Changing the medication regimen is outside of the nurse's scope of practice.

The nurse administers the initial dose of a fentanyl (Duragesic) transdermal patch to a client with chronic pain. When monitoring the client an hour later, which assessment is most important for the nurse to obtain? A. Level of consciousness. B. Moistness of mucosa. C. Bowel sound activity. D. Numeric pain scale.

D. Numeric pain scale. Transdermal fentanyl, an opioid analgesic, has an onset and peak of 6 to 12 hours after the initial dose, so it is most important to determine the client's level of pain, which can persist as breakthrough pain throughout the 72-hour duration of the patch.

The nurse admitting a patient with acromegaly anticipates administering which medication? A. Desmopressin B. Corticotropin C. Somatropin D. Octreotide

D. Octreotide Octreotide suppresses growth hormone that causes acromegaly.

The patient has been ordered a regimen to treat a urinary tract infection and notifies the nurse that the patient's urine has turned an orange color. The nurse recognizes that the patient is most likely being treated with which drug? A. Ciprofloxacin B. Bethanechol Cl C. Darifenacin hydrobromide D. Phenazopyridine HCl

D. Phenazopyridine HCl Of the drugs listed, phenazopyridine HCl (Pyridium) is known to turn the urine an orange color. It can cause staining of the underwear and should be included in the education of the patient.

The nurse is assessing a patient taking morphine sulfate. Which assessment requires immediate action? A. Decreased bowel sounds B. Nausea C. Delayed gastric emptying D. Pinpoint pupils

D. Pinpoint pupils Pinpoint pupils might be a sign of morphine overdose or toxicity. The nurse needs to act on this finding immediately. Decreased bowel sounds and constipation are expected. Nausea and delayed gastric emptying are expected side effects of morphine sulfate and do not require immediate action.

A client who is experiencing an acute attack of gouty arthritis is prescribed colchicine USP, 1 mg PO daily. Which information is most important for the nurse to provide the client? A. Take the medication with meals. B. Limit fluid intake until the attack subsides. C. Stop the medication when the pain resolves. D. Report any vomiting to the clinic.

D. Report any vomiting to the clinic. The client should be instructed to report signs of colchicine toxicity, such as nausea, diarrhea, vomiting, and/or abdominal pain, to the health care provider. Food inhibits the absorption of colchicine when ingested concurrently. Limited fluid intake decreases the excretion of the uric acid crystals, which contributes to painful attacks. Typically, a client should remain on a daily dose of colchicine to decrease the number and severity of acute attacks, so stopping the medication after the pain resolves is not indicated.

A resident of a long-term care facility is taking lithium carbonate (Eskalith) to treat bipolar disorder. Which instruction should the nurse provide to this client's caregivers? A. Offer the morning dose of the medicine before breakfast. B. Have the client chew the pill if it is difficult to swallow. C. Encourage high energy fluid intake by providing sports drinks or sodas. D. Report symptoms of hypothyroidism such as fatigue and constipation.

D. Report symptoms of hypothyroidism such as fatigue and constipation. Lithium carbonate (Eskalith) causes hypothyroidism in 1 to 4% of those clients receiving the medication, so caregivers should assess for signs of hypothyroidism, including fatigue and constipation (early signs) and myxedema or goiter (late symptoms).

An older client who had a colon resection yesterday is receiving a constant dose of hydromorphone via a patient-controlled analgesia (PCA) pump. Which assessment finding is most significant and requires that the nurse intervene? A. The client is drowsy and complains of pruritus. B. Pupils are 3 mm; PERRLA. C. The area around the sutures is reddened and swollen. D. Respirations decrease to 14 breaths/min.

D. Respirations decrease to 14 breaths/min. Hydromorphone is an opioid agonist-analgesic of opiate receptors that inhibits ascending pathways and can cause respiratory depression. Older adults are more sensitive to opioids so the "start low and go slow" approach should be taken. Option A lists common side effects of opioids, particularly the opiates, which are usually harmless and often transient. Option B is within the normal range (2 to 6 cm). The suture site may be red and swollen as an inflammatory response, but no action is required if the skin around the incision is a normal color and temperature.

A client receives a new prescription for pentazocine (Talwin), a mixed opioid agonist-antagonist, after an opioid agonist is discontinued. What is the advantage for the client when the new prescription is implemented? A. Tolerance does not occur. B. Less agitation is experienced. C. The analgesic ceiling is higher. D. Respiratory depression is less.

D. Respiratory depression is less. Mixed agonist-antagonists bind as an agonist at the Kappa receptor and as antagonists or partial agonists on the mu receptor, which produces less respiratory depression than opioid agonists that are pure mu agonists.

A 5-month-pregnant patient enters the clinic and states, "I have no money for any kind of vitamins, and I have never taken any." What is the nurse's primary intervention? A. Refer the patient to social services. B. Check the patient's hemoglobin and hematocrit. C. Start the patient on folic acid. D. Screen the patient for fetal neural tube defects.

D. Screen the patient for fetal neural tube defects. The development of neural tube defects occurs early in the pregnancy, so it would be appropriate to screen for this first. Folic acid ingestion improves the outcomes of pregnancy, as folic acid deficiency can lead to spontaneous abortion, neural tube defects, premature birth, low birth weight, and abruptio placentae.

When instructing a patient about antibiotic therapy, the nurse explains that which condition occurs when the normal flora are disturbed during antibiotic therapy? A. Hypersensitivity B. Rebound toxicity C. Organ toxicity D. Superinfection

D. Superinfection Antibiotic therapy can destroy the normal flora of the body, which typically inhibit the overgrowth of fungi and yeast. When the normal flora are decreased, these organisms can overgrow and cause infections.

A client with chronic pancreatitis receives a new prescription for pancrelipase (Pancrease). Which instruction is most important for the nurse to include in this client's teaching? A. Avoid prolonged exposure to direct sunlight. B. Stay away from products containing alcohol. C. Ingest 8 oz of grapefruit juice with the medication. D. Take the medication when consuming food.

D. Take the medication when consuming food. With the loss of exocrine function for a client with chronic pancreatitis, replacement of pancreatic enzymes using pancrelipase (Pancrease) becomes necessary. Diarrhea and steatorrhea (fatty stools) indicate insufficient pancreatic enzymes are present to digest dietary fats and other of nutrients, so pancrelipase, a fat-digesting enzyme, should be consumed with any type of food.

A client with giardiasis is taking metronidazole (Flagyl) 2 grams PO. Which information should the nurse include in the client's instruction? A. Notify the clinic of any changes in the color of urine. B. Avoid overexposure to the sun. C. Stop the medication after the diarrhea resolves. D. Take the medication with food.

D. Take the medication with food. Flagyl, an amoebicide and antibacterial agent, may cause gastric distress, so the client should be instructed to take the medication on a full stomach. Urine may be red-brown or dark from Flagyl, but this side effect is an expectant finding and not necessary to report tot he healthcare provider.

The nurse knows that certain antipsychotic drugs cause extrapyramidal symptoms. Which extrapyramidal symptom is a permanent and irreversible adverse effect of long-term phenothiazine administration? A. Dystonia B. Akathisia C. Pseudoparkinsonism D. Tardive dyskinesia

D. Tardive dyskinesia Tardive dyskinesia is a permanent effect of long-term phenothiazine administration. Options A, B, and C are side effects of phenothiazines but do not have the characteristics of being permanent and irreversible.

A female client receives a prescription for cefadroxil (Duricef) for a urinary tract infection. The client informs the nurse that she is currently taking oral contraceptives (OCP). What information is important for the nurse to share with the client? A. The antibiotic may be less effective while taking OCP. B. The medication combination potentiates the risk of adverse reactions. C. Avoid prolonged sun exposure while taking the antibiotic. D. Use an additional form of contraception until your menstrual cycle.

D. Use an additional form of contraception until your menstrual cycle. Cephlasporins such as cefadroxil can decrease the efficacy of oral contraceptives, so the client should be instructed to use an additional form of contraception.

A patient is prescribed an antitussive medication. What is the most important instruction for the nurse to include in the patient teaching? A. "This medication may cause drowsiness and dizziness." B. "Watch for diarrhea and abdominal cramping." C. "This medication may cause tremors and anxiety." D. "Headache and hypertension are common side effects."

A. "This medication may cause drowsiness and dizziness." Antitussive medications also affect the central nervous system, thus causing drowsiness and dizziness. There is no reason to anticipate that the medication will cause diarrhea, abdominal cramping, tremors and anxiety, or headache and hypertension.

A patient who has been taking sildenafil has developed angina. The health care provider has ordered isosorbide mononitrate. What is the nurse's primary intervention? A. Advise the patient not to take the sildenafil. B. Tell the patient to take the isosorbide before the sildenafil. C. Instruct the patient to take the medications on opposite days. D. Take the patient's blood pressure.

A. Advise the patient not to take the sildenafil. When taken in conjunction with nitrates, sildenafil can cause severe hypotension unresponsive to treatment. The patient should not take these medications together.

The therapeutic effect of insulin in treating Type 1 diabetes mellitus is based on which physiologic action? A. Facilitates transport of glucose into the cells. B. Stimulates function of beta cells in the pancreas. C. Increases intracellular receptor site sensitivity. D. Delays carbohydrate digestion and absorption.

A. Facilitates transport of glucose into the cells. Glucose moves across the cell membrane by using an active transport mechanism. Insulin acts as the carrier of glucose and is the only hormone that decreases blood glucose levels by facilitating transport of glucose into the cells.

The nurse expects that a newborn who is experiencing apnea is most likely to be ordered treatment with which medication? A. Diphenhydramine B. Caffeine citrate C. Benzphetamine HCl D. Diethylpropion HCl

B. Caffeine citrate Caffeine citrate can be used as a respiratory stimulant for newborns experiencing apnea.

Which statement made by the patient demonstrates a need for further instruction regarding the use of nitroglycerin? A. "If I get a headache, I should keep taking nitroglycerin and use Tylenol for pain relief." B. "I should keep my nitroglycerin in a cool, dry place." C. "I should change positions slowly to avoid getting dizzy." D. "I can take up to five tablets at 3-minute intervals for chest pain if necessary."

D. "I can take up to five tablets at 3-minute intervals for chest pain if necessary." Patients are taught to take up to three tablets every 5 min. If no relief from chest pain is obtained after one tablet, they should seek medical assistance and take up to two more tablets. All other responses demonstrate

Which response best supports the observations that the nurse identifies in a client who is experiencing a placebo effect? A. Beneficial response or cure for disease B. Behavioral or psychotropic responses C. Malingering or drug-seeking behaviors D. Psychological response to inert medication

D. Psychological response to inert medication

The nurse is caring for a patient who is taking barbiturate. Which assessment finding requires immediate action by the nurse? A. History of a sleep disorder B. +1 pitting edema of the lower extremities C. Urinary output of 10 mL/h D. Blood pressure of 140/95 mm Hg

C. Urinary output of 10 mL/h The patient's urinary output is insufficient and could result in toxicity. History of sleep disorder, +1 pitting edema, and a blood pressure of 140/95 do not require immediate intervention.

A client is diagnosed with peptic ulcer disease and receives a prescription for esomeprazole (Nexium) 20 mg capsule daily. When providing this client with discharge teaching, the nurse should include which instruction? A. Drink fluids between meals to relieve gastric distress. B. Monitor for an increase in blood pressure during therapy. C. Dissolve capsule contents in fruit juice for easier ingestion. D. Take at same time each day one hour before eating a meal.

D. Take at same time each day one hour before eating a meal. Nexium, a proton pump inhibitor (PPI), is a first-line agent for symptomatic GERD that poorly responds to other acid reducing drugs, such as H2 antagonists. Nexium is most effective when taken 30 to 60 minutes before a meal.

Based on the condition of the patient, an intravenous fluid that is hypotonic will be ordered. Which intravenous fluid is most likely to be ordered by the health care provider? A. Normal saline B. 5% dextrose and normal saline C. 5% dextrose and lactated Ringer D. 0.33% NaCl

D. 0.33% NaCl Of the fluids listed, the only one that is hypotonic is 0.33% NaCl. Normal saline is isotonic; both D5NS and D5LR are considered to be hypertonic solutions.

Upon admission to the emergency center, an adult client with acute status asthmaticus is prescribed this series of medications. In which order should the nurse administer the prescribed medications? (Arrange from first to last.) 1. Salmeterol (Serevent Diskus). 2. Albuterol (Proventil) puffs. 3. Prednisone (Deltasone) orally. 4. Gentamicin (Garamycin) IM.

1.Albuterol (Proventil) puffs 2.Salmeterol (Serevent Diskus) 3.Prednisone (Deltasone) orally 4.Gentamicin (Garamycin) IM Status asthmaticus is potentially a life-threatening respiratory event, so albuterol, a beta2 adrenergic agonist and short acting bronchodilator, should be administered by inhalation first to provide rapid and deep topical penetration to relieve bronchospasms, dilate the bronchioles, and increase oxygenation. In stepwise management of persistent asthma, a long-action bronchodilator, such as salmeterol (Serevent Diskus), with a 12-hour duration of action should be given next. Prednisone, an oral corticosteroid, provides prolonged anti-inflammatory effects and should be given after the client's respiratory distress begins to resolves. Gentamicin, an antibiotic, is given deep IM, which can be painful, and may require repositioning the client, so should be last in the sequence.

While instructing a patient about antibiotic therapy, the nurse explains to the patient that bacterial resistance to antibiotics can occur when what happens? A. Patients stop taking an antibiotic after they feel better. B. Environmental dispersion of antibiotic liquid occurs. C. Antibiotics are prescribed according to culture and sensitivity reports. D. Antibiotics are prescribed to treat a viral infection. E. Antibiotics are taken with water or juice. F. Antibiotics are taken with ascorbic acid (vitamin C).

A, B, D Not completing a full course of antibiotic therapy can allow bacteria that are not killed but have been exposed to the antibiotic to adapt their physiology to become resistant to that antibiotic. The same thing can occur when bacteria are exposed to antibiotics in the environment or when antibiotics are erroneously used to treat a viral infection.

A nurse is preparing to administer a beta blocker to a patient. The nurse recognizes that beta blockers are used to treat which conditions? A. Angina pectoris B. Cardiogenic shock C. Chronic obstructive pulmonary disease (COPD) D. Congestive heart failure (CHF) E. Hypertension F. Sinus bradycardia

A, D, E Beta blockers are effective in treating hypertension (secondary to negative inotropic effects) and angina pectoris (decreases cardiac workload when decreasing heart rate and contractility). Beta blockade has also been shown to reduce mortality in patients with CHF.

Which question should the nurse ask a client prior to the initiation of treatment with IV infusions of gentamicin sulfate? A. "Are you having difficulty hearing?" B. "Have you ever been diagnosed with cancer?" C. "Do you have any type of diabetes mellitus?" D. "Have you ever had anemia?"

A. "Are you having difficulty hearing?" Complications of gentamicin sulfate therapy include ototoxicity, nephrotoxicity, and neurotoxicity. Determining if the client is hard of hearing prior to initiation of this aminoglycoside will be helpful as the treatment progresses and ototoxicity is identified as a possible complication. Options B, C, and D are important elements of any medical history, but they do not have the priority of option A when assessing for complications of aminoglycoside therapy.

The nurse is caring for a patient who is taking a first-generation antihistamine. What is the most important information for the nurse to teach the patient? A. "Do not drive after taking this medication." B. "Make sure you drink a lot of liquids while on this medication." C. "Take this medication on an empty stomach." D. "Do not take this medication for more than 2 days."

A. "Do not drive after taking this medication." First-generation antihistamines cause drowsiness. There is no evidence to indicate that the patient should force fluids, take the medication on an empty stomach, or place the medication on hold for any period of time.

The nurse is teaching the patient how to administer insulin. What information is essential to include in the plan? A. "For the most consistent absorption, inject the insulin into the abdomen." B. "Avoid administering the insulin into your arm." C. "Inject the insulin at a 30-degree angle between the fat and muscle." D. "Do not mix any insulins in the same syringe."

A. "For the most consistent absorption, inject the insulin into the abdomen." The abdomen has the most consistent absorption because the blood flow to the subcutaneous tissue typically is not as affected by muscular movements as it could be in the arm or thigh. Insulin can be administered in the arm. The patient should be instructed to inject insulin at a 45- to 90-degree angle, not a 30-degree angle. Most insulins can be mixed.

A patient asks the nurse to explain the action of glucocorticoids. Which statement is the nurse's best response? A. "Glucocorticoids influence carbohydrate, lipid, and protein metabolism." B. "Glucocorticoids are produced in decreased amounts during times of stress." C. "Glucocorticoids decrease serum sodium and glucose levels." D. "Glucocorticoids stimulate defense mechanisms to produce immunity."

A. "Glucocorticoids influence carbohydrate, lipid, and protein metabolism." Glucocorticoids play a major role in carbohydrate, lipid, and protein metabolism within the body. They are produced in increasing amounts during stress. They increase sodium and glucose levels and suppress the immune system.

What statement indicates to the nurse that the patient needs additional instruction about antihypertensive treatment? A. "I will check my blood pressure daily and take my medication when it is over 140/90." B. "I will include rest periods during the day to help me tolerate the fatigue my medicine may cause." C. "I will change my position slowly to prevent feeling dizzy." D. "I will not mow my lawn until I see how this medication makes me feel."

A. "I will check my blood pressure daily and take my medication when it is over 140/90." Antihypertensive medications need to be taken routinely to maintain a normotensive state and prevent occurrence of complications. Many patients do not adhere to this regimen because hypertension itself does not cause symptoms, whereas the medication can cause some untoward effects. Patient teaching is essential. If the patient indicates that he will take rest periods and change positions slowly to avoid orthostatic hypotension, he is demonstrating compliance with the treatment regimen.

The nurse is preparing to discharge a patient who is receiving acebutolol HCl. Which instruction will the nurse include in the medication teaching plan for this patient? A. "If you take your pulse and it is less than 60, hold your medicine and call your health care provider for instructions." B. "If you become dizzy, do not take your medication for 2 days and then restart on the third day." C. "This medication may make you fatigued; increasing caffeine in your diet may help alleviate this problem." D. "Increase intake of green leafy vegetables to prevent bleeding problems that can be caused by this medication."

A. "If you take your pulse and it is less than 60, hold your medicine and call your health care provider for instructions." Acebutolol HCl, a beta blocker, has negative chronotropic effects and could cause symptomatic bradycardia and/or heart block. The health care provider should be consulted before acebutolol is administered to a patient with bradycardia (heart rate less than 60 beats/min).

A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse why she is receiving codeine when she is free of pain. What is the nurse's best response? A. "This medication will help decrease your coughing." B. "This medication will help you bring up sputum." C. "This medication will help increase lung volume." D. "This medication will strengthen your immune system."

A. "This medication will help decrease your coughing." Codeine provides both analgesic and antitussive therapeutic effects. It does not strengthen the immune system, increase lung volume, or help the patient expectorate sputum.

The patient has been taking phenobarbital to control seizures. The patient complains to the nurse of experiencing occasional stomach upset when taking the medication. What is the nurse's best response? A. "You can take the medication with food or milk." B. "You should take the medication on an empty stomach." C. "You should call your health care provider because the dose may need to be adjusted." D. "You should call your health care provider because the drug may need to be stopped."

A. "You can take the medication with food or milk." The medication can be taken with food or milk to minimize gastric distress, which is an expected side effect of the medication.

The nurse is administering the early morning dose of insulin aspart, 5 units subcutaneously, to a client with diabetes mellitus type 1. The client's fingerstick serum glucose level is 140 mg/dL. Considering the onset of insulin aspart, when should the nurse ensure that the client's breakfast be given? A. 5 minutes after subcutaneous administration B. 30 minutes after subcutaneous administration C. 1 to 2 hours after administration D. At any time because of a flat peak of action

A. 5 minutes after subcutaneous administration Insulin aspart is a very rapidly acting insulin, with an onset of 5 to 15 minutes. Insulin aspart should be administered when the client's tray is available. Insulin aspart peaks in 45 minutes to 1½ hours and has a duration of 3 to 4 hours. The client should have eaten to ensure absorption of the meal so that serum glucose levels will coincide with the peak. Insulin glargine has a flat peak of action and is usually given at bedtime.

Which patient is most likely to be treated with somatropin? A. A 7-year-old diagnosed with growth hormone deficiency B. A 10-year-old of short stature who has severe asthma C. An 8-year-old with Prader-Willi syndrome D. A 17-year-old who is 5 feet tall

A. A 7-year-old diagnosed with growth hormone deficiency For this medication to be used, the patient has to be diagnosed with a growth hormone deficiency, and the epiphyses must not be fused, so the child needs to be young. Severe respiratory conditions, Prader-Willi syndrome, and age of 17 years are contraindications to this medication

The nurse is caring for several patients, each of whom is being treated with anticonvulsants. Which patient will the nurse assess first? A. A patient started on valproic acid with a creatinine level of 3 B. A patient started on pregabalin who has partial seizures C. A patient taking tiagabine who has partial seizures D. A patient taking levetiracetam and is on multiple drug therapy

A. A patient started on valproic acid with a creatinine level of 3 As valproic acid is excreted by the kidneys, this level is cause for concern because the drug could become toxic. The other patients do not demonstrate any areas outside of the therapeutic range.

Which patient assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker? A. Absence of chest pain B. Decreased swelling in the ankles and feet C. Patient denies dizziness. D. Patient states that she feels stronger.

A. Absence of chest pain The workload in the heart should be decreased with the vasodilation from the calcium channel blocker. With less strain, the patient should have fewer incidences of angina as afterload is decreased.

The nurse is caring for a patient who has been diagnosed with genital herpes. Which medication is the drug of choice for this patient? A. Acyclovir B. Amantadine C. Ribavirin D. Zidovudine

A. Acyclovir Acyclovir is the drug of choice to treat herpes simplex infections. Ribavirin is effective against respiratory syncytial virus (RSV); zidovudine is effective against HIV; amantadine is effective against H. influenzae type A.

A patient taking pyridostigmine develops symptoms of a cholinergic crisis. What action does the nurse anticipate performing next? A. Administer atropine. B. Administer epinephrine. C. Increase the dose of pyridostigmine. D. Monitor the patient's blood pressure.

A. Administer atropine. Atropine is the antidote for treating a cholinergic crisis. Administering epinephrine will not be effective nor will increasing the dosage of the pyridostigmine. Monitoring the patient's blood pressure will not alleviate the cholinergic crisis.

A patient is complaining of urinary pain after being diagnosed with a urinary tract infection the previous day. What is the nurse's best action? A. Administer ordered phenazopyridine hydrochloride. B. Administer ordered trimethoprim. C. Administer ordered bethanechol. D. Administer ordered acetaminophen and a warm bath.

A. Administer ordered phenazopyridine hydrochloride. Phenazopyridine hydrochloride is a urinary analgesic prescribed to relieve the pain associated with urinary tract infections. The other drug options are antiinfective agents and antispasmodic drugs. Having the patient take a warm bath will not address the pain.

The patient has been ordered to be treated with alprazolam. The nurse recognizes that the patient is most likely experiencing which condition? A. Anxiety with depression B. Alcohol withdrawal C. Seizures D. Insomnia

A. Anxiety with depression Alprazolam is known to be effective in treating anxiety that is associated with depression. It is not considered a first-line treatment for alcohol withdrawal, seizures, or insomnia.

The nurse is reviewing a patient's medication history and notes that the patient is taking vitamin K. What is the highest priority for the nurse to assess? A. Coagulation studies B. Confusion C. Diarrhea D. Seizure activity

A. Coagulation studies Vitamin K is an essential nutrient for the synthesis of clotting factors. It is also the antidote for warfarin, an oral anticoagulant. The administration of vitamin K enhances the coagulation process, thus minimizing a patient's risk for excessive bleeding.

A pediatric client who has been diagnosed with partial seizures receives a prescription for topiramate (Topamax). What information should the nurse provide to the child's parents? A. Do not crush the tablet prior to administration. B. Give the medication with 8 oz of orange juice. C. Avoid prolonged exposure to direct sunlight. D. Administer the tablet an hour before meals.

A. Do not crush the tablet prior to administration. The tablet form of topiramate should be taken with adequate fluids and without breaking it because of its extremely bitter taste, so crushing the tablet should be avoided.

Which technique is most appropriate regarding mixing insulin when the patient must administer 30 units regular insulin and 70 units NPH insulin in the morning? A. Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. B. Draw the medication into two separate syringes but inject into the same spot. C. Administer these insulins at least 10 min apart, so that you will know when they are working. D. Use the Z-track method for administration.

A. Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could cause an alteration in the onset of action of the regular insulin. The medications do not have to be in separate syringes and can be administered together. Z-track is an IM technique.

Miotic drug therapy for the treatment of glaucoma is based chiefly upon which physiologic action? A. Enhancing aqueous humor outflow. B. Inhibiting aqueous humor production. C. Maintaining intraocular pressure. D. Preventing extraocular infection.

A. Enhancing aqueous humor outflow. Miotic drugs act to enhance aqueous outflow through papillary constriction with the goal to reduce intraocular pressure.

A client who is hypertensive receives a prescription for hydrochlorothiazide. When teaching about the side effects of this drug, which symptoms are most important for the nurse to instruct the client to report? A. Fatigue and muscle weakness B. Anxiety and heart palpitations C. Abdominal cramping and diarrhea D. Confusion and personality changes

A. Fatigue and muscle weakness Thiazide diuretics, such as HCTZ, cause potassium wasting in the urine, so the client should be instructed to report fatigue and muscle weakness, which are characteristic of hypokalemia. Although options B, C, and D should be reported, they are not indicative of hypokalemia, which is a side effect of hiazides that can cause cardiac dysrhythmias.

The nurse assesses a patient's laboratory results and finds a decreased white blood cell count as well as evidence of anemia. The nurse suspects that a vitamin deficiency is the source of the change in lab values. Based on the results, the patient is most likely to be experiencing a deficiency of which vitamin? A. Folic acid B. Vitamin A C. Vitamin B6 D. Vitamin B1

A. Folic acid Folic acid deficiency is characterized by decreased white blood cell count, decreased clotting factors, anemia, intestinal disturbances, as well as depression.

Which is a priority nursing diagnosis for a patient receiving an anticholinergic (parasympatholytic) medication? A. Impaired gas exchange related to thickened respiratory secretions B. Knowledge deficit related to pharmacologic regimen C. Risk for injury related to excessive CNS stimulation D. Urinary retention related to loss of bladder tone

A. Impaired gas exchange related to thickened respiratory secretions Although all of these nursing diagnoses are appropriate, the priority is determined by remembering the ABCs. Anticholinergic drugs decrease respiratory secretions, which could lead to mucous plugs and resultant impaired gas exchange.

The nurse is caring for a patient who is taking a cholinergic (parasympathomimetic) drug. Which assessment will indicate that the medication is having a desired effect? A. Increased gastrointestinal (GI) motility B. Mydriasis C. Urinary retention D. Vasoconstriction

A. Increased gastrointestinal (GI) motility Cholinergic effects mimic the parasympathetic nervous system (rest and digest) as opposed to the sympathetic nervous system (fight or flight). Increasing GI motility helps the digestive process

A client has a positive skin test for tuberculosis. Which prophylactic drug should the nurse expect to administer to this client? A. Isoniazid B. Carvedilol C. Acyclovir D. Griseofulvin

A. Isoniazid Isoniazid is the drug of choice for treatment of clients with positive skin tests for tuberculosis. Options B, C, and D are not the drugs used for treatment of TB.

During therapy with isoniazid, it is most important for the nurse to monitor which laboratory value closely? A. Liver enzyme levels B. Blood urea nitrogen (BUN) level C. Serum electrolyte levels D. Complete blood count (CBC)

A. Liver enzyme levels The client receiving isoniazid is at risk for the development of hepatitis; therefore, liver function test results should be monitored carefully during drug therapy. Options B, C, and D are not specific indicators of liver function, so they are not monitored closely during isoniazid therapy.

Which route should the nurse clarify with the healthcare provider prior to administering a drug with a high first-pass effect? A. Oral. B. Buccal. C. Sublingual. D. Intravenous.

A. Oral. The first-pass effect occurs when hepatic metabolism decreases the bioavailability of a drug. Oral forms of medications are processed through the GI tract, absorbed through the small intestines, and undergo the first-pass effect in the liver in which some of the active ingredients is removed from the drug before it reaches the intended site of action.

The nurse is caring for a patient who is taking oxybutynin. The nurse recognizes that the patient is most likely experiencing which condition? A. Overactive bladder B. Pain upon urination. C. Difficulty urinating D. Nighttime urination.

A. Overactive bladder

Which assessment finding indicates that the nonsteroidal anti-inflammatory drug has been effective? A. Pain has decreased from "a 6 to a 1" on a scale of 10. B. Patient's bleeding time is prolonged. C. Patient has increased circulation to his legs. D. PTT is 100 seconds.

A. Pain has decreased from "a 6 to a 1" on a scale of 10. Prostaglandins are produced in response to activation of the arachidonic acid pathway. Nonsteroidal anti-inflammatory drugs (NSAIDs) work by blocking cyclooxygenase, the enzyme responsible for conversion of arachidonic acid into prostaglandins. Decreasing the synthesis of prostaglandins results in decreased pain and inflammation. The length of the PTT, the bleeding time, and the increased extremity circulation will not necessarily be correlated with the effectiveness of the NSAID medication.

Which is the highest priority nursing intervention for a patient who is starting on metoprolol? A. Peripheral pulses B. Respiratory rate C. Urinary retention D. Lung sounds

A. Peripheral pulses Decreased cardiac output puts the patient at highest risk. This will be evident by the assessment of peripheral pulses.

What is the expected outcome of esomeprazole (Nexium) when prescribed for a client with gastroesophageal reflux disease (GERD)? A. Promotion of rapid tissue healing. B. Increased gastric emptying. C. Improved esophageal peristalsis. D. Neutralization of gastric secretions.

A. Promotion of rapid tissue healing. Proton pump inhibitors, such as esomeprazole (Nexium), act to inhibit gastric acid secretion and promote rapid healing of esophageal tissue.

Which electrolyte is the major cation of extracellular fluid? A. Sodium B. Potassium C. Chloride D. Phosphorus

A. Sodium

A client calls the clinic and states that she forgot to take her oral contraceptives for the past two days. Which instruction is best for the nurse to provide to this client? A. Take 2 pills a day for 2 days and use an alternate method of contraception for 7 days. B. Quit the pills for this cycle, use an alternate method of contraception, and resume pills on the fifth day of menstruation. C. Take one extra pill per day for the rest of this cycle, then resume taking pills as usual next cycle. D. Take 4 pills now and use an alternate method of contraception for the rest of this cycle.

A. Take 2 pills a day for 2 days and use an alternate method of contraception for 7 days. If two pills are missed in a roll, the client should take 2 pills a day for two days and used an alternative form of birth control for seven days.

The nurse is caring for several patients who will be receiving glucocorticoid therapy. Which patient should be assessed first? A. The patient with uncontrolled diabetes mellitus B. The patient with rheumatoid arthritis C. The patient with septic shock D. The patient experiencing an exacerbation of asthma

A. The patient with uncontrolled diabetes mellitus A common side effect of steroid therapy is hyperglycemia. The patient with uncontrolled diabetes mellitus could suffer a severe hyperglycemic episode. The risks and benefits should be considered.

A client asks the nurse to explain the meaning of a narrow therapeutic index of a medication. What information should the nurse use to answer the question? A. The onset of action for the medication occurs very quickly. B. A small margin exists between safe and toxic plasma levels. C. Bioavailability is significantly reduced by the first-pass effect. D. Minimum dosage is needed for the medication to be effective.

B. A small margin exists between safe and toxic plasma levels. A narrow therapeutic index means that there is a narrow difference between safe and toxic drug levels, so clients receiving these medications should be closely monitored.

The nurse is caring for a child taking methylphenidate (Ritalin). Assessment reveals a heart rate of 110, and the child is complaining of chest pain. What is the nurse's highest priority action? A. Administer an antianxiety agent. B. Assess for over-the-counter medication use. C. Stay with the child and use relaxation techniques. C. Hold the next dose of the medication.

B. Assess for over-the-counter medication use. Methylphenidate interacts with over-the-counter cold medication. The nurse should assess for the use of over-the-counter medication use.

A 22-year-old female patient is put on amoxicillin. Which is the most important intervention for this patient? A. Instruct the patient to not take the medication before meals. B. Assess if the patient is on oral contraceptives. C. Inform the patient about possible superinfections. D. Assess the patient for cross sensitivity. patient is sexually active.

B. Assess if the patient is on oral contraceptives. This medication may decrease the effectiveness of oral contraceptives. The nurse needs to assess whether or not the patient is on oral contraceptives and whether or not the patient is sexually active.

A client is receiving acyclovir sodium IV for a severe herpes simplex infection. Which intervention should the nurse implement during this drug therapy? A. Maintain respiratory isolation precautions. B. Increase daily fluids to 2000 to 4000 mL/day. C. Administer with meals to decrease gastric irritation. D. Assess for signs of severe liver dysfunction.

B. Increase daily fluids to 2000 to 4000 mL/day. Increasing fluid intake during treatment prevents precipitation of the drug in the renal tubules, which could lead to obstructive problems that impair kidney function. Acute glomerulonephritis is a possible complication of acyclovir sodium therapy. Options A, C, and D are unrelated interventions for treatment with acyclovir sodium.

What is the most important thing for the nurse to teach a patient who is switching allergy medications from diphenhydramine to loratadine? A. Loratadine can potentially cause dysrhythmias. B. Loratadine has fewer sedative effects. C. Loratadine has increased bronchodilating effects. D. Loratadine causes less gastrointestinal upset.

B. Loratadine has fewer sedative effects. Loratadine does not affect the central nervous system and therefore is non-sedating. There is insufficient evidence to indicate that loratadine can cause dysrhythmias, can act as a bronchodilator, or cause gastrointestinal upset than other comparable medications.

A mechanically ventilated patient receiving a neuromuscular blocking agent has tearing in the eyes and increased heart rate and blood pressure. What is the nurse's initial action? A. Stop the medication; the patient is having an adverse reaction to the medication. B. Notify the physician; patient's level of sedation is inadequate. C. Notify the physician; patient's dose of the neuromuscular blocking agent is too high. D. Document findings and monitor; these effects are expected.

B. Notify the physician; patient's level of sedation is inadequate. Tearing in eyes and increased heart rate and blood pressure are symptoms of increased anxiety and/or pain. A patient receiving a neuromuscular blocking agent cannot move or communicate; thus, the nurse must rely on subtle changes to assess adequate sedation. Simply documenting findings or monitoring will not relieve the patient's symptoms.

Which electrolyte is the major ion of the intracellular space? A. Sodium B. Potassium C. Chloride D. Phosphorous

B. Potassium

In teaching a client who had a liver transplant about cyclosporine (Sandimmune), the nurse should encourage the client to report which adverse response to the healthcare provider? A. Changes in urine color. B. Presence of hand tremors. C. Increasing body hirsutism. D. Nausea and vomiting.

B. Presence of hand tremors. Neurological complications, such as hand tremors, occur in about 50% of clients taking cyclosporine and should be reported. Although this drug can be nephrotoxic, changes in urine color typically does not occur. Nausea is a common side effects, but is not usually severe.

A client receiving a continuous infusion of heparin IV starts to hemorrhage from an arterial access site. Which medication should the nurse anticipate administering to prevent further heparin-induced hemorrhaging? A. Vitamin K1 B. Protamine sulfate C. Warfarin sodium D. Prothrombin

B. Protamine sulfate Protamine sulfate is the antagonist for heparin and is given for episodes of acute hemorrhage. Options A, C, and D are not heparin antagonists.

A 43-year-old female client is receiving thyroid replacement hormone following a thyroidectomy. What adverse effects associated with thyroid hormone toxicity should the nurse instruct the client to report promptly to the healthcare provider? A. Tinnitus and dizziness. B. Tachycardia and chest pain. C. Dry skin and intolerance to cold. D. Weight gain and increased appetite.

B. Tachycardia and chest pain. Thyroid replacement hormone increases the metabolic rate of all tissues, so common signs and symptoms of toxicity include tachycardia and chest pain.

The healthcare provider prescribes pyridostigmine bromide (Mestinon) tablets for a client with myasthenia gravis (MG). What instruction should the nurse provide this client? A. Increase activity in the afternoon when the medication is most effective. B. Take the medication 30 to 45 minutes before eating. C. Use a PRN dose for increasing muscular weakness or fasciculations. D. Give the client a dietary guide that describes low-protein foods.

B. Take the medication 30 to 45 minutes before eating. Mestinon, an acetylcholinesterase inhibitor, increases the amount of neuromuscular transmitters to promote muscular strength and swallowing, so the client should take the medication at least 30 minutes before meals.

The healthcare provider prescribes oral antifungal therapy for a client with onychomycosis. What information should the nurse tell the client? A. A single dose of the oral antifungal agent is usually sufficient to treat the infection. B. The infection is difficult to eradicate and requires prolonged therapy for 3 to 6 months. C. Complete eradicate is important because of the risk of a systemic infection. D. Prolonged therapy provides no benefit and increases the risk of adverse effects.

B. The infection is difficult to eradicate and requires prolonged therapy for 3 to 6 months. Treatment of onychomycosis, a fungal infection of the fingernails and toenails, is difficult to treat and requires prolonged therapy of 3 to 6 months for oral antifungal therapy.

The patient arrives at a local health clinic complaining of dry skin and not being able to see well in dim light. The nurse suspects that the patient is experiencing a vitamin deficiency. Based on the symptoms, the patient is most likely to be experiencing a deficiency of which vitamin? A. Folic acid B. Vitamin A C. Vitamin B6 D. Vitamin B1

B. Vitamin A Vitamin A deficiency is characterized by symptoms of dry skin and night blindness as well as poor tooth development.

Which symptoms are serious adverse effects of beta-adrenergic blockers such as propranolol (Inderal)? A. Headache, hypertension, and blurred vision. B. Wheezing, hypotension, and AV block. C. Vomiting, dilated pupils, and papilledema. D. Tinnitus, muscle weakness, and tachypnea.

B. Wheezing, hypotension, and AV block. Wheezing, hypotension, and AV block represents the most serious adverse effects of beta-blocking agents. AV block is generally associated with bradycardia and results in potentially life-threatening decreases in cardiac output. Additionally, wheezing secondary to bronchospasm and hypotension represent life-threatening respiratory and cardiac disorders.

A client is beginning therapy with montelukast (Singulair) PO 10 mg once a day in the evening. The client asks the nurse, "When should I begin to feel better?" How should the nurse respond? A. Immediately. B. Within 24 hours. C. In about 12 hours. D. 30 minutes to 1 hour.

B. Within 24 hours. Maximal effects of montelukast (Singulair) develop within 24 hours after initiating the first dose.

Which assessment datum indicates to the nurse that a dose of granisetron administered IV prior to chemotherapy has had the desired effect? A. Oral mucosa pink and intact B. Scalp intact without alopecia C. Client denies nausea D. Client denies pain

C. Client denies nausea Granisetron is an antiemetic administered before chemotherapy to prevent chemotherapy-induced nausea and vomiting. Chemotherapy can cause oral sores, but granisetron does not prevent this problem. Granisetron does not affect option B or D.

Which statement indicates that client teaching regarding the administration of the chemotherapeutic agent daunorubicin HCl has been effective? A. "I should use an astringent mouthwash after every meal." B. "I will eat high-fiber foods and drink lots of water." C. "I expect my urine to be red for the next few days." D. "I should use sunscreen when I spend time outdoors."

C. "I expect my urine to be red for the next few days." Daunorubicin HCl causes the urine to turn red in color. Option A is not recommended. Options B and D are interventions that promote general good health but are not specific to treatment with daunorubicin HCl.

Which statement indicates to the nurse that the patient needs additional teaching on oral hypoglycemic agents? A. "I will limit my alcohol consumption." B. "I will report symptoms of fatigue and loss of appetite." C. "I will take the medication only when I need it." D. "I will monitor my blood sugar daily."

C. "I will take the medication only when I need it." Oral hypoglycemic agents must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes. When alcohol is ingested with certain oral hypoglycemic drugs, the hypoglycemic effect can be intensified. The patient may experience fatigue and loss of appetite as side effects of the medication, and these should be reported to the health care provider. The patient needs to closely monitor blood sugar.

Which patient statement indicates to the nurse that the patient understands the discharge instructions regarding alendronate? A. "I need to decrease my intake of dairy products to prevent hypercalcemia." B. "I need to take this medication with food to prevent damage to my esophagus." C. "I will take the medication with 8 ounces of water and not lie down for 30 min." D. "This medication will help relieve the bone pain I have from my osteoporosis."

C. "I will take the medication with 8 ounces of water and not lie down for 30 min." Alendronate can cause erosive esophagitis. To prevent this side effect, it is important to take the medication with 8 ounces of water and to maintain an upright position for 30 min. These actions facilitate rapid absorption and prevent reflux into the esophagus.

The nurse is teaching a patient about the use of an expectorant. What is the most important instruction for the nurse to include in the patient teaching? A. "Restrict your fluids in order to decrease mucus production." B. "Take the medication once a day only, at bedtime." C. "Increase your fluid intake in order to decrease viscosity of secretions." D. "Increase your fiber and fluid intake to prevent constipation."

C. "Increase your fluid intake in order to decrease viscosity of secretions." Expectorant drugs are used to decrease viscosity of secretions and allow them to be more easily expectorated. Increasing fluid intake helps this action.

The nurse is preparing a teaching plan for a client who has received a new prescription for levothyroxine sodium. Which instruction should be included? A. "Take this medication with a high-protein snack at bedtime." B. "You may change at any time to a less expensive generic brand." C. "Take your pulse daily, and if it exceeds 100 beats/min, contact the health care provider." D. "Return to the clinic weekly for serum blood glucose testing."

C. "Take your pulse daily, and if it exceeds 100 beats/min, contact the health care provider." Levothyroxine sodium should be withheld if the pulse is over 100 beats/min. To prevent insomnia, the daily dose should be taken early in the morning before breakfast, not at bedtime. Product brands should not be changed without consulting the health care provider because the intended effects and side effects of different formulations of the medication can vary. The serum glucose level is not affected by thyroid preparations, so option D is not required.

The charge nurse is reviewing the admission history and physical data for four clients newly admitted to the unit. Which client is at greatest risk for adverse reactions to medications? A. 30-year-old man with a fracture B. 7-year-old child with an ear infection C. 75-year-old woman with liver disease D. 50-year-old man with an upper respiratory tract infection

C. 75-year-old woman with liver disease Impaired hepatic metabolic pathways for drug and chemical degradation place option C at greatest risk for adverse reactions to medications based on advancing age and liver disease. Options A and D have no predisposing factors, such as genetics, pathophysiologic dysfunction, or drug allergies, that would increase the risk for cumulative toxicity or adverse drug reactions. Option B is at risk for dose-related adverse reactions but is at less risk than option C.

The nurse is caring for several patients, each of whom has a history of seizure activity. Which patient will the nurse assess first? A. A patient who has absence seizures B. A patient who has sensory seizures C. A patient who is postictal D. A patient who is taking diazepam

C. A patient who is postictal The patient who is postseizure may be disoriented and not fully conscious. As safety is a primary concern, the nurse should assess this patient first. The patient with absence seizures, patient with sensory seizures, and patient who is taking Valium do not have the safety issues experienced by the postictal patient.

The patient is admitted with an acetaminophen overdose. In addition to monitoring liver function results, the nursing would anticipate administering which of the following? A. Naloxone B. Activated charcoal C. Acetylcysteine D. An antacid

C. Acetylcysteine

Which parameter is most important for the nurse to check prior to administering a subcutaneous injection of heparin? A. Heart rate B. Urinary output C. Activated partial thromboplastin time (aPTT) D. Prothrombin time (PT) and international normalized ratio (INR)

C. Activated partial thromboplastin time (aPTT) The laboratory value that measures heparin's therapeutic anticoagulation time is the aPTT. Option A should be checked before the administration of digoxin. Option B is valuable information but not a parameter measured for heparin therapy. Option D is evaluated during anticoagulation therapy using sodium warfarin.

Which food will the nurse teach the patient to avoid while taking a monoamine oxidase inhibitor (MAOI)? A. Coffee B. White bread C. Aged cheese D. White meat

C. Aged cheese Eating foods high in tyramine, including aged cheese, can cause a hypertensive crisis in patients taking MAOIs.

Which action is most important for the nurse to implement prior to the administration of the antiarrhythmic drug adenosine (Adenocard)? A. Assess pupillary response to light. B. Instruct the client that facial flushing may occur. C. Apply continuous cardiac monitoring. D. Request that family members leave the room.

C. Apply continuous cardiac monitoring. Adenosine (Adenocard) is an antiarrhythmic drug used to restore a normal sinus rhythm in clients with rapid supraventricular tachycardia. The client's heart rate should be monitored continuously for the onset of additional arrhythmias while receiving adenosine.

A nurse is monitoring a patient receiving atropine. Which finding requires nursing action? A. Heart rate of 60 beats/min B. Nasal congestion C. Blood pressure of 90/40 D. Dilated pupils

C. Blood pressure of 90/40 Atropine is an anticholinergic agent that blocks the effects of the parasympathetic nervous system, producing sympathetic nervous system effects. Adverse reactions include nasal congestion, tachycardia, hypotension, pupillary dilation, abdominal distention, and palpitations. This blood pressure is low enough that action is required.

The health care provider indicates that the patient will be ordered an opioid antitussive. Which medication does the nurse anticipate the provider will order? A. Promethazine with dextromethorphan B. Benzonatate C. Codeine D. Levocetirizine

C. Codeine Codeine is classified as an opioid antitussive. Promethazine with dextromethorphan and benzonatate are both non-opioid antitussives. Levocetirizine is an antihistamine.

The patient is receiving a selective serotonin reuptake inhibitor (SSRI). Which item on the patient's breakfast tray should the nurse remove? A. A carbonated soda B. Grapefruit juice C. Coffee D. Milk

C. Coffee Many SSRIs have an interaction with grapefruit juice that can lead to possible toxicity. It is recommended that daily intake be limited to 8 ounces of grapefruit juice or one half of a grapefruit.

A client is taking cyclosporine for renal allograft rejection prevention. After 9 months of drug therapy, the nurse reviews laboratory data and notes that the blood urea nitrogen level is 36 mg/dl. What additional finding should the nurse identify? A. Hypotension. B. White blood cell count 10,000. C. Creatinine 28 mg/dl. D. Anaphylactic reaction.

C. Creatinine 28 mg/dl. Acute organ rejection usually occurs in the first 3 months after transplantation or at any time if an infection develops. Cyclosporine (Sandimmune, Neoral, Gengraf), is a cytokine inhibitor used to prevent and treat organ rejection, which is manifested by elevated blood urea nitrogen (norm 10 to 20 mg/dl) and creatinine (norm 0.6 to 1.2 mg/dl).

The nurse is working with a patient who has recently been started on temazepam. The nurse recognizes that the patient is most likely experiencing which condition? A. Anxiety B. Seizures C. Insomnia D. Depression

C. Insomnia Temazepam is used to treat insomnia. It is not recommended for treatment of anxiety, seizures, or depression.

A 38-year-old gravida 2 para 2 is diagnosed with bacterial vaginosis 9-months postpartum. A prescription is written for metronidazole (Flagyl). Which information is most important for the nurse to obtain from the client before initiating treatment? A. Sexual history. B. Use of oral contraceptives. C. Method of infant feeding. D. Possibility of pregnancy.

C. Method of infant feeding. Flagyl is contraindicated if the woman is breastfeeding because high concentrations have been found in breast milk fed to infants. If Flagyl must be prescribed, the woman should be instructed to pump and discard the milk during treatment and for 48 to 72 hours after the last dose.

A client with metastatic cancer who has been receiving fentanyl for several weeks reports to the nurse that the medication is not effectively controlling the pain. Which intervention should the nurse initiate? A. Instruct the client about the indications of opioid dependence. B. Monitor the client for symptoms of opioid withdrawal. C. Notify the health care provider of the need to increase the dose. D. Administer naloxone per PRN protocol for reversal.

C. Notify the health care provider of the need to increase the dose. Clients can develop a tolerance to the analgesic effect of opioids and may require an increased dose for effective long-term pain relief. The client is not exhibiting indications of dependence, withdrawal, or toxicity.

What will the nurse teach a patient who is taking isoniazid (INH)? A. You will need to take vitamin C to potentiate the action of INH. B. You should not be on that drug. C. Pyridoxine (vitamin B6) will prevent numbness and tingling that can occur when taking isoniazid. D. Multidrug therapy is necessary to prevent the occurrence of resistant bacteria.

C. Pyridoxine (vitamin B6) will prevent numbness and tingling that can occur when taking isoniazid. Isoniazid can cause neurotoxicity. Pyridoxine (vitamin B6) is the drug of choice to prevent this adverse reaction. It is not an anti-infective agent and thus will work to destroy the mycobacterium or prevent drug resistance. Vitamin C is not taken with this drug; the drug is appropriate for most patients, and INH with pyridoxine is not multidrug therapy.

A client who is recently diagnosised with myasthenia gravis receives a prescription for pyridostigmine (Mestinon), a cholinergic agent. Which information should the nurse instruct the client to implement when taking this medication? A. Always take with meals to avoid gastrointestinal distress. B. Plan the doses close together for maximal therapeutic effect. C. Take the medication at least 30 minutes before eating meals. D. Avoid dairy products two hours before and after taking medications.

C. Take the medication at least 30 minutes before eating meals. The nurse should instruct the client to take the medication 30 minutes before meals with an empty stomach, which allows for the onset of action and therapeutic effects to be present during the meal to help improve swallowing and chewing. The doses should also be spaced evenly apart to optimize the effects of the medication.

A patient is diagnosed with an oral candidal infection. Which intervention is best? A. Start an IV so the patient does not have to eat by mouth. B. Instruct the patient to brush her teeth and gargle hourly. C. Teach the patient how to take nystatin. D. Administer valacyclovir hydrochloride and monitor lips and gums.

C. Teach the patient how to take nystatin. Nystatin is an antifungal ointment that is used for a variety of candidal infections. The patient needs to be taught how to "swish and swallow" to treat this infection. There is no need to brush the teeth hourly or administer Valtrex, and starting an IV is an extreme measure.

The healthcare provider discontinues prednisone, a glucocorticoid, for a client with chronic obstructive pulmonary disease. What instructions should the nurse give the client about the regimen to follow? A. Life-long treatment is common for chronic disease. B. The drug should be stopped immediately if no longer needed. C. The dose must be tapered over the course of 7 to 10 days. D. Another glucocorticoid should be used to prevent cross-tolerance.

C. The dose must be tapered over the course of 7 to 10 days. To minimize the impact of adrenal insufficiency, withdrawal of exogenous glucocorticoids should be done by gradually decreasing the dosage over several days because it can cause life-threatening adrenal insufficiency if abruptly terminated.

The patient has recently been prescribed a benzodiazepine and reports experiencing vivid dreams. What does this symptom indicate? A. Overdosage of the medication B. Allergic reaction to the medication C. Therapeutic effect of the medication D. Inadequate amount of the medication

C. Therapeutic effect of the medication The benzodiazepine medications are known to delay REM sleep and thus generate vivid dreams. Such a symptom is not indicative of overdosage, an allergic reaction, or inadequate dosage.

A client with metastatic cancer reports severe continuous pain. Which route of administration should the nurse use to provide the most effective continuous analgesia? A. Oral B. Intravenous C. Transdermal D. Intramuscular

C. Transdermal Continuous pain is best managed by maintaining a constant serum drug level. Transdermal drug administration of an analgesic provides around-the-clock, controlled release of the medication that is absorbed through intact skin into the bloodstream to provide continuous pain relief. Option A is convenient, but gastrointestinal variables affect the absorption rate of the drug, its onset and intensity, and duration of response and requires repeated doses around the clock. Option B provides immediate action because the drug is infused directly into the bloodstream and is quickly metabolized, and repeated IV doses are required to maintain a continuous blood level. Option D requires repeated injections at regular intervals, which are uncomfortable, and absorption rates vary between muscle sites.

A client with chronic schizophrenia illness is admitted after taking risperidone (Risperdal) 10 mg/day for three months. The nurse implements a daily assessment using the Abnormal Involuntary Movement Scale (AIMS). What findings should the nurse report to the healthcare provider? A. Cogwheel rigidity. B. Drowsiness and dizziness. C. Tremors and muscle twitching. D. Dry mouth, constipation, and blurred vision.

C. Tremors and muscle twitching. For a client with chronic mental illness, evidence-based pharmacological guidelines recommend first-line treatment using an atypical antipsychotic, such as risperidone (Risperdal), which can cause extrapyramidal symptoms (EPS) at dosages above 10 mg/day. The AIMS criteria measures tardive dyskinesia movements, such as facial, oral, tongue, teeth, and other akinesias of the trunk and extremity, such as tremors and muscle twitching, which should be reported.

Which assessment most assists the nurse in determining if bethanechol has had a therapeutic effect? A. Neurologic assessment B. Muscular assessment C. Urinary assessment D. Gastric assessment

C. Urinary assessment This medication increases the tone of the detrusor muscle and causes the patient to void.

The patient is receiving triazolam as part of treatment for insomnia. The patient complains of experiencing memory problems. The nurse recognizes this as A. evidence of an allergic response. B. an idiosyncratic effect. C. an adverse reaction to the drug. D. evidence of drug toxicity.

C. an adverse reaction to the drug. Memory issues may occur as an adverse reaction to triazolam.

An antacid (Maalox) is prescribed for a client with peptic ulcer disease. The nurse knows that the purpose of this medication is to A. decrease production of gastric secretions. B. produce an adherent barrier over the ulcer. C. maintain a gastric pH of 3.5 or above. D. decrease gastric motor activity.

C. maintain a gastric pH of 3.5 or above. The objective of antacids is to neutralize gastric acids and keep pH of 3.5 or above which is necessary for pepsinogen inactivity.

The nurse is teaching the patient being treated with an anticholinergic about dietary changes that might be necessary. What is the highest priority instruction for the patient? A. "Do not drink milk while on this medication." B. "Increase your intake of fatty foods while on this therapy." C. "Do not eat carbohydrates with this medication." D. "Increase your intake of fluids while on this medication."

D. "Increase your intake of fluids while on this medication." The patient should be encouraged to ingest foods high in fiber and increase fluid intake to prevent constipation. There is no need to restrict milk or carbohydrates or to increase the intake of fatty foods.

Which instruction should the nurse include in the teaching plan for a client who is receiving phenytoin for seizure control? A. Maintain consistent sodium intake. B. Use sunscreen when outdoors. C. Return for monthly urinalysis. D. Brush and floss teeth daily.

D. Brush and floss teeth daily. Brushing and flossing the teeth daily prevent gingival hyperplasia (gum disease) that is common with long-term phenytoin therapy. Options A, B, and C are not indicated for client instruction regarding phenytoin.

The nurse is caring for a patient diagnosed with heart failure and chronic obstructive pulmonary disease (COPD). The patient is ordered a nonselective beta blocker. What is the nurse's primary intervention? A. Assess the heart rate before administration. B. Maintain the patient on intake and output. C. Make sure the patient is on telemetry monitoring. D. Call the health care provider to request a different medication.

D. Call the health care provider to request a different medication. Nonselective beta blockers are used to treat supraventricular dysrhythmias secondary to their negative chronotropic effects (decreasing heart rate). They may exacerbate heart failure and COPD. The patient could receive a selective beta blocker instead. The nurse should make the health care provider aware of the patient's history of respiratory disease.

The nurse notes in the patient's chart that the health care provider is considering adding a tricyclic antidepressant to the patient's treatment regimen. The nurse recognizes that the health care provider will select which drug? A. Amoxapine B. Maprotiline. C. Trazodone D. Doxepin

D. Doxepin

A 48-year-old client is experiencing a severe anaphylactic reaction to an injection of contrast media. What pharmacologic agent is of greatest use in this situation? A. Dopamine (Intropin). B. Loratadine (Claritin). C. Nitroprusside (Nipride). D. Epinephrine (Adrenalin).

D. Epinephrine (Adrenalin). Epinephrine is the drug of choice in treating hypotension and circulatory failure associated with anaphylaxis because it is a potent vasoconstrictor. An anaphylactic reaction is an acute systemic hypersensitivity reaction that occurs within minutes of antigen exposure (such as with contrast material containing iodine) that can result in peripheral vascular collapse.

The nurse is caring for a patient with hypertension who is prescribed a clonidine transdermal patch. What is the correct information to teach this patient? A. Change the patch daily at the same time. B. Remove the patch before taking a shower or bath. C. Do not take other antihypertensive medications while on this patch. D. Get up slowly from a sitting to a standing position.

D. Get up slowly from a sitting to a standing position. This medication can cause dizziness. Patient safety is a priority. The patch is left on for 7 days and can be left on while bathing. This medication is often prescribed with other drugs.

What will the nurse teach the patient to minimize gastrointestinal (GI) side effects of opioid analgesics for chronic pain? A. Take diphenoxylate hydrochloride and atropine sulfate with each dose. B. Eat foods high in lactobacilli. C. Take the medication on an empty stomach.sics. D. Increase fluid and fiber in the diet.

D. Increase fluid and fiber in the diet. Opioid analgesics decrease intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can prevent this. Eating foods high in lactobacilli and taking the medication on an empty stomach will not minimize GI side effects and may intensify them. Lomotil is used to treat diarrhea rather than the constipation that would result from use of narcotic analgesics.

A client with Paget's disease is started on calcitonin (Calcimar) 500 mcg subcutaneously daily. During the initial treatment, what is the priority nursing action? A. Assess the injection site for inflammation. B. Evaluate the client's level of pain. C. Monitor the client's alkaline phosphatase levels. D. Observe the client for signs of hypersensitivity.

D. Observe the client for signs of hypersensitivity. Calcitonin is given to a client with Paget's disease to lower serum calcium levels. The nurse's highest priority is to observe for signs of hypersensitivity, such as skin rash, hives, or anaphylaxis. Upon initiation of treatment, emergency equipment should be readily available.

Alteration of which laboratory finding represents the achievement of a therapeutic goal for heparin administration? A. Prothrombin time (PT) B. Fibrin split products C. Platelet count D. Partial thromboplastin time (PTT)

D. Partial thromboplastin time (PTT) Heparin therapy is guided by changes in the partial thromboplastin time (PTT). Options A, B, and C are not used to track the therapeutic effect of heparin administration.

Which assessment is most important for the nurse to monitor in a patient receiving an opioid analgesic? A. Blood pressure B. Heart rate C. Mental status D. Respiratory rate

D. Respiratory rate The most serious side effect of narcotic analgesics is respiratory depression.

The patient is taking an antithyroid medication. Which foods will the nurse teach the patient to avoid eating? A. Chicken salad sandwich with mayonnaise, vegetable soup, milk B. Ham and cheese omelet, rye toast with butter, orange juice C. Hamburger on sesame roll, salad with French dressing, milk D. Shrimp cocktail, boiled lobster, spinach salad without dressing, water

D. Shrimp cocktail, boiled lobster, spinach salad without dressing, water Seafood contains high amounts of iodine. The other choices do not. The nurse instructs a patient taking an antithyroid medication to avoid foods high in iodine.

The nurse is reviewing a medication history on a patient taking an ACE inhibitor. The nurse plans to contact the health care provider if the patient is also taking which medication? A. Docusate sodium B. Furosemide C. Morphine sulfate D. Spironolactone

D. Spironolactone ACE inhibitors block the conversion of angiotensin I to angiotensin II, thus also blocking the stimulus for aldosterone production. Aldosterone is responsible for potassium excretion—decreased aldosterone can result in increased serum potassium levels. Spironolactone is a potassium-sparing diuretic and should not be administered with an ACE inhibitor.

A patient is receiving mannitol for treatment of cerebral edema. The nurse assesses a heart rate of 110 beats/min and rhonchi throughout the lung fields, and the patient complains of blurred vision. What will the nurse do? A. Continue to assess the patient. B. Encourage the patient to cough and deep breathe. C. Tell the patient to close her eyes and relax. D. Stop the infusion and call the health care provider.

D. Stop the infusion and call the health care provider. Pulmonary congestion, tachycardia, and blurred vision are symptoms of adverse effects of mannitol. The nurse should stop the infusion. Coughing and deep breathing will not assist the patient.

The nurse assesses the peripheral intravenous infusion site of a patient receiving intravenous dopamine and suspects extravasation. What is the nurse's primary action? A. Apply a cold pad to the site. B. Pull the IV immediately. C. Elevate the patient's extremity. D. Stop the infusion.

D. Stop the infusion. The nurse's first action is to stop the infusion, followed by infusing phentolamine into the area to counteract vasoconstrictive effects of the dopamine.

The nurse is caring for a patient who is prescribed propranolol. Which assessment finding will reveal if the medication is having a therapeutic effect? A. The patient's lung sounds are clear. B. The patient is in sinus rhythm. C. The patient has strong peripheral pulses. D. The patient's blood pressure is 130/75 mm Hg.

D. The patient's blood pressure is 130/75 mm Hg. Propranolol is nonselective—it blocks both beta1 and beta2 receptors at therapeutic doses. The medication is administered to treat hypertension. The patient's blood pressure is within normal limits, which indicates therapeutic effect.

A client receives a new prescription for ciprofloxacin (Cipro), a synthetic quinolone. When teaching about this drug, which information in the client's history requires special emphasis by the nurse? A. Snacks on dairy products such as yogurt or ice cream. B. Previously had a mild allergic reaction to a cephalosporin. C. Consumes alcoholic drinks occasionally on the weekends. D. Works twenty hours a week as a lifeguard at the local pool.

D. Works twenty hours a week as a lifeguard at the local pool. Cipro can cause both dizziness and photosensitivity. Since the client works as a lifeguard outdoors, measures related to these adverse effects should be addressed.

Minocycline, 50 mg PO every 8 hours, is prescribed for an adolescent girl diagnosed with acne. The nurse discusses self-care with the client while she is taking the medication. Which teaching points should be included in the discussion? (Select all that apply.) A. Report vaginal itching or discharge. B. Take the medication at 0800, 1500, and 2200 hours. C. Protect skin from natural and artificial UV light. D. Avoid driving until response to medication is known. E. Take with an antacid to prevent nausea. F. Use a nonhormonal method of contraception if sexually active.

A, C, D, F Adverse effects of tetracyclines include superinfections, photosensitivity, and decreased efficacy of oral contraceptives. Therefore, the client should report vaginal itching or discharge (A), protect the skin from ultraviolet light (C), and use a nonhormonal method of contraception (F) while on the medication. Minocycline is known to cause dizziness and ataxia, so until the client's response to the medication is known, driving (D) should be avoided. Tetracyclines should be taken around the clock (B) but exhibit decreased absorption when taken with antacids, so (E) is contraindicated.

Which instructions should the nurse provide to an adolescent female client who is initiating treatment with isotretinoin for acne vulgaris? (Select all that apply.) A. "Notify the health care provider immediately if you think you are pregnant." B. "If your acne gets worse, stop the medication and call the health care provider." C. "Take a daily multiple vitamin to prevent deficiencies and promote dermal healing." D. "Dermabrasion for deep acne scars should be postponed for 1 month after therapy is stopped." E. "If you begin crying more than usual and feel sad, stop the drug and call the health care provider." F. "Before, during, and after therapy, two effective forms of birth control must be used at the same time."

A, E, F Isotretinoin has been found to cause pregnancy category D drug-related birth defects, premature births, and fetal death (A), which necessitates the use of effective birth control methods before, during, and after therapy (F). Isotretinoin is associated with sadness (E), depression, suicidal ideations, and other serious mental health problems. An initial exacerbation of acne (B) is common when starting drug therapy. Isotretinoin is a retinoid related to vitamin A, and taking additional multivitamin supplements (C) can predispose the client to vitamin A toxicity. The client should stop taking isotretinoin at least 6 months before cosmetic procedures, such as dermabrasion (D), because the drug can increase the chances of scarring.

A client is receiving antiinfective drug therapy for a postoperative infection. Which complaint should alert the nurse to the possibility that the client has contracted a superinfection? A. "My mouth feels sore." B. "I have a headache." C. "My ears feel plugged up." D. "I feel constipated."

A. "My mouth feels sore." Stomatitis caused by a thrush infection, which can cause mouth pain, is a sign of superinfection. Options B, C, and D are more typical side effects, rather than symptoms, of a superinfection.

An adult client has prescriptions for morphine sulfate 2.5 mg IV q6h and ketorolac (Toradol) 30 mg IV q6h. Which action should the nurse implement? A. Administer both medications according to the prescription. B. Hold the ketorolac to prevent an antagonistic effect. C. Hold the morphine to prevent an additive drug interaction. D. Contact the healthcare provider to clarify the prescription.

A. Administer both medications according to the prescription. Morphine and ketorolac (Toradol) can be administered concurrently, and may produce an additive analgesic effect, resulting in the ability to reduce the dose of morphine, as seen in this prescription. Toradol is an anti inflammatory analgesic, and does not have an antagonistic effect with morphine.

An adult client is given a prescription for a scopolamine patch (Transderm Scop) to prevent motion sickness while on a cruise. Which information should the nurse provide to the client? A. Apply the patch at least 4 hours prior to departure. B. Change the patch every other day while on the cruise. C. Place the patch on a hairless area at the base of the skull. D. Drink no more than 2 alcoholic drinks during the cruise.

A. Apply the patch at least 4 hours prior to departure. Scopolamine, an anticholinergic agent, is used to prevent motion sickness and has a peak onset in 6 hours, so the client should be instructed to apply the patch at least 4 hours before departure on the cruise ship. The duration of the transdermal patch is 72 hours. Scopolamine blocks muscarinic receptors in the inner ear and to the vomiting center, so the best application site of the patch is behind the ear. Anticholinergic medications are CNS depressants, so the client should be instructed to avoid alcohol while using the patch

A 26-year-old primigravida client is experiencing increasing discomfort and anxiety during the active phase of labor. She requests something for pain. Which analgesic should the nurse anticipate administering? A. Butorphanol B. Hydromorphone C. Morphine sulfate D. Codeine sulfate

A. Butorphanol Butorphanol is a mixed agonist-antagonist analgesic resulting in good analgesia but with less respiratory depression, nausea, and vomiting compared with opioid agonist analgesics.

Following the administration of sublingual nitroglycerin to a client experiencing an acute anginal attack, which assessment finding indicates to the nurse that the desired effect has been achieved? A. Client states chest pain is relieved. B. Client's pulse decreases from 120 to 90. C. Client's systolic blood pressure decreases from 180 to 90. D. Client's SaO2 level increases from 92% to 96%.

A. Client states chest pain is relieved. Nitroglycerin reduces myocardial oxygen consumption which decreases ischemia and reduces chest pain.

The nurse is preparing a child for transport to the operating room for an emergency appendectomy. The anesthesiologist prescribes atropine sulfate, IM STAT. What is the primary purpose for administering this drug to the child at this time? A. Decrease the oral secretions. B. Reduce the child's anxiety. C. Potentiate the opioid effects. D. Prevent possible peritonitis.

A. Decrease the oral secretions. Atropine sulfate, an anticholinergic agent, is given to decrease oral secretions during a surgical procedure. Options B, C, and D are not actions of anticholinergic agents.

A chemotherapeutic regimen with doxorubicin HCl is being planned for a client recently diagnosed with cancer. What diagnostic test results should the nurse review prior to initiating this treatment? A. Electrocardiogram (ECG) B. Arterial blood gases (ABGs) C. Serum cholesterol level D. Pelvic ultrasound

A. Electrocardiogram (ECG) Baseline cardiac function studies are required to monitor the irreversible cardiotoxic effects of doxorubicin HCl. Option B assesses disturbances of acid-base balance. Option C is not affected by this chemotherapeutic agent. Option D is used to detect pelvic abnormalities such as tumors but is not specific for the administration of doxorubicin HCl.

A client with hyperlipidemia receives a prescription for niacin (Niaspan). Which client teaching is most important for the nurse to provide? A. Expected duration of flushing. B. Symptoms of hyperglycemia. C. Diets that minimize GI irritation. D. Comfort measures for pruritus.

A. Expected duration of flushing. Flushing of the face and neck, lasting up to an hour, is a frequent reason for discontinuing niacin. Inclusion of this effect in client teaching may promote compliance in taking the medication. While nutrition tips and managing pruritis are worthwhile instructions to help clients minimize or cope with normal side effects associated with niacin (Niaspan), flushing is intense and causes the most concern for the client.

A client is receiving digoxin for the onset of supraventricular tachycardia (SVT). Which laboratory finding should the nurse identify that places this client at risk? A. Hypokalemia. B. Hyponatremia. C. Hypercalcemia. D. Low uric acid levels.

A. Hypokalemia. Hypokalemia affects myocardial contractility and places this client at greatest risk for dysrhythmias that may be unresponsive to drug therapy. Although an imbalance of serum sodium and calcium can effect cardiac rhythm, the greatest risk for the client receiving digoxin is low potassium.

In addition to nitrate therapy, a client is receiving nifedipine, 10 mg PO every 6 hours. The nurse should plan to observe for which common side effect of this treatment regimen? A. Hypotension B. Hyperkalemia C. Hypocalcemia D. Seizures

A. Hypotension Nifedipine reduces peripheral vascular resistance and nitrates produce vasodilation, so concurrent use of nitrates with nifedipine can cause hypotension with the initial administration of these agents. Options B, C, and D are not side effects of this treatment regimen.

The nurse is assessing a stuporous client in the emergency department who is suspected of overdosing with opioids. Which agent should the nurse prepare to administer if the client becomes comatose? A. Naloxone hydrochloride B. Atropine sulfate C. Vitamin K D. Flumazenil

A. Naloxone hydrochloride Naloxone is an opioid antidote used in opioid overdose to reverse CNS and respiratory depression. Atropine is used for bradycardia, intestinal hypertonicity and hypermotility, muscarinic agonist poisoning, peptic ulcer disease, and biliary colic. Vitamin K is used to manage warfarin overdose and vitamin K deficiency in newborns. Flumazenil reduces the sedative effects of benzodiazepines following general anesthesia or overdose.

A client is admitted to the coronary care unit with a medical diagnosis of acute myocardial infarction. Which medication prescription decreases both preload and afterload? A. Nitroglycerin. B. Propranolol (Inderal). C. Morphine. D. Captopril (Capoten).

A. Nitroglycerin. Nitroglycerin is a nitrate that causes peripheral vasodilation and decreases contractility, thereby decreasing both preload and afterload.

Which method of medication administration provides the client with the greatest first-pass effect? A. Oral. B. Sublingual. C. Intravenous. D. Subcutaneous.

A. Oral. The first-pass effect is a pharmacokinetic phenomenon that is related to the drug's metabolism in the liver. After oral medications are absorbed from the gastrointestinal tract, the drug is carried directly to the liver via the hepatic portal circulation where hepatic inactivation occurs and reduces the bioavailability of the drug. Alternative method of administration, such as sublingual, IV, and subcutaneous routes, avoid this first-pass effect.

A client is receiving ampicillin sodium (Omnipen) for a sinus infection. The nurse should instruct the client to notify the healthcare provider immediately if which symptom occurs? A. Rash. B. Nausea. C. Headache. D. Dizziness.

A. Rash. Rash is the most common adverse effect of all penicillins, indicating an allergy to the medication which could result in anaphylactic shock, a medical emergency.

A client is receiving methylprednisolone (Solu-Medrol) 40 mg IV daily. The nurse anticipates an increase in which laboratory value as the result of this medication? A. Serum glucose. B. Serum calcium. C. Red blood cells. D. Serum potassium.

A. Serum glucose. Solu-Medrol is a corticosteroid with glucocorticoid and mineralocorticoid actions. These effects can lead to hyperglycemia which is reflected as an increase in the serum glucose value. The client taking Solu-Medrol is also at risk for hypocalcemia and hypokalemia which result in a decrease in the serum calcium and serum potassium levels. These medications also alter the some of the body's immune responses by suppressing the migration of white blood cells decreasing inflammation response

A 42-year-old client is admitted to the emergency department after taking an overdose of amitriptyline in a suicide attempt. Which drug should the nurse plan to administer to reverse the cardiac and central nervous system effects of amitriptyline? A. Sodium bicarbonate B. Naloxone C. Phentolamine mesylate D. Atropine sulfate

A. Sodium bicarbonate Sodium bicarbonate is an effective treatment for an overdose of tricyclic antidepressants such as amitriptyline to reverse QRS prolongation. Options B, C, and D are not the preferred agents for treating this drug overdose.

A client is being treated for osteoporosis with alendronate (Fosamax), and the nurse has completed discharge teaching regarding medication administration. Which morning schedule would indicate to the nurse that the client teaching has been effective? A. Take medication, go for a 30 minute morning walk, then eat breakfast. B. Take medication, rest in bed for 30 minutes, eat breakfast, go for morning walk. C. Take medication with breakfast, then take a 30 minute morning walk. D. Go for a 30 minute morning walk, eat breakfast, then take medication.

A. Take medication, go for a 30 minute morning walk, then eat breakfast. Alendronate (Fosamax) is best absorbed when taken thirty minutes before eating in the morning. The client should also be advised to remain in an upright position for at least thirty minutes after taking the medication to reduce the risk of esophageal reflux and irritation.

Methenamine mandelate is prescribed for a client with a urinary tract infection and renal calculi. Which finding indicates to the nurse that the medication is effective? A. The frequency of urinary tract infections decreases. B. The urine changes color and pain is diminished. C. The dipstick test changes from +1 to trace. D. The daily urinary output increases by 10%.

A. The frequency of urinary tract infections decreases. Mandelamine is prescribed to acidify the urine, decreasing the incidence of calcium phosphate calculi and urinary tract infections. Option B is related to the administration of pyridine. Mandelamine has no effect on option C or D.

After abdominal surgery, a male client is prescribed low molecular weight heparin (LMWH). During administration of the medication, the client asks the nurse why he is receiving this medication. Which is the best response for the nurse to provide? A. This medication is a blood thinner given to prevent blood clot formation. B. This medication enhances antibiotics to prevent infection. C. This medication dissolves any clots that develop in the legs. D. This abdominal injection assists in the healing of the abdominal wound.

A. This medication is a blood thinner given to prevent blood clot formation. Unfractionated heparin or low molecular weight heparin (LMWH) is an anticoagulant that inhibits thrombin-mediated conversion of fibrinogen to fibrin and is given prophylactically to prevent postoperative venous thrombosis in order to prevent pulmonary embolism or deep vein thrombosis following knee and abdominal surgeries.

A category X drug is prescribed for a young adult female client. Which instruction is most important for the nurse to teach this client? A. Use a reliable form of birth control. B. Avoid exposure to ultraviolet light. C. Refuse this medication if planning pregnancy. D. Abstain from intercourse while on this drug.

A. Use a reliable form of birth control. Drugs classified in the category X place a client who is in the first trimester of pregnancy at risk for teratogenesis, so women in the childbearing years should be counseled to use a reliable form of birth control during drug therapy. If the client is planning to become pregnant, she should be encouraged to discuss plans for pregnancy with the healthcare provider, so a safer alternative prescription can be provided if pregnancy occurs.

A female client with rheumatoid arthritis take ibuprofen (Motrin) 600 mg PO 4 times a day. To prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is prescribed. Which information is most important for the nurse to include in client teaching? A. Use contraception during intercourse. B. Ensure the Cytotec is taken on an empty stomach. C. Encourage oral fluid intake to prevent constipation. D. Take Cytotec 30 minutes prior to Motrin.

A. Use contraception during intercourse. Cytotec, a synthetic form of a prostaglandin, is classified as pregnancy Category X and can act as an abortifacient, so the client should be instructed to use contraception during intercourse to prevent loss of an early pregnancy. A common side effect of Cytotec is diarrhea, so constipation prevention strategies are usually not needed. Cytotec and Motrin should be taken together to provide protective properties against gastrointestinal bleeding.

The nurse is transcribing a new prescription for spironolactone (Aldactone) for a client who receives an angiotensin-converting enzyme (ACE) inhibitor. Which action should the nurse implement? A. Verify both prescriptions with the healthcare provider. B. Report the medication interactions to the nurse manager. C. Hold the ACE inhibitor and give the new prescription. D. Transcribe and send the prescription to the pharmacy.

A. Verify both prescriptions with the healthcare provider. The concomitant use of an angiotensin-converting enzyme (ACE) inhibitor and a potassium-sparing diuretic such as spironolactone, should be given with caution because the two drugs may interact to cause an elevation in serum potassium levels. Although the client is currently receiving an ACE inhibitor, verifying both prescriptions alerts the healthcare provider about the client's medication regimen and provides the safest action before administering the medication.

The nurse is preparing the 0900 dose of losartan (Cozaar), an angiotensin II receptor blocker (ARB), for a client with hypertension and heart failure. The nurse reviews the client's laboratory results and notes that the client's serum potassium level is 5.9 mEq/L. What action should the nurse take first? A. Withhold the scheduled dose. B. Check the client's apical pulse. C. Notify the healthcare provider. D. Repeat the serum potassium level.

A. Withhold the scheduled dose. The nurse should first withhold the scheduled dose of Cozaar because the client is hyperkalemic (normal range 3.5 to 5 mEq/l). Although hypokalemia is usually associated with diuretic therapy in heart failure, hyperkalemia is associated with several heart failure medications, including ARBs. Because hyperkalemia may lead to cardiac dysrhythmias, the nurse should check the apical pulse for rate and rhythm, and the blood pressure.

A client with a dysrhythmia is to receive procainamide (Pronestyl) in 4 divided doses over the next 24 hours. What dosing schedule is best for the nurse to implement? A. q6h. B. QID. C. AC and bedtime. D. PC and bedtime.

A. q6h. Pronestyl is a class 1A antidysrhythmic. It should be taken around-the-clock, so that a stable blood level of the drug can be maintained, thereby decreasing the possibility of hypotension (an adverse effect) occurring because of too much of the drug circulating systemically at any particular time of day. Pronestyl may be given with food if GI distress is a problem.

Which medications should the nurse caution the client about taking while receiving an opioid analgesic? A. Antacids. B. Benzodiazepines. C. Antihypertensives. D. Oral antidiabetics.

B. Benzodiazepines. Respiratory depression increases with the concurrent use of opioid analgesics and other central nervous system depressant agents, such as alcohol, barbiturates, and benzodiazepines. Antacids and antidiabetic agents do not interact with opiates to produce adverse effects. Antihypertensives may cause morphine-induced hypotension, but should not be withheld without notifying the healthcare provider.

While taking a nursing history, the client states, "I am allergic to penicillin." What related allergy to another type of anti infective agent should the nurse ask the client about when taking the nursing history? A. Aminoglycosides. B. Cephalosporins. C. Sulfonamides. D. Tetracyclines.

B. Cephalosporins. If a client has a history of being allergic to penicillin (PCN); there is appears to be a cross sensitivity between penicillins and 1st generation cephalosporins. According to research, there appears to be no cross sensitivity between PCN and 3rd or 4th generation cephalosporins.

A client is receiving pyridostigmine bromide to control the symptoms of myasthenia gravis. Which client behavior would indicate that the drug therapy is effective? A. Decreased oral secretions B. Clear speech C. Diminished hand tremors D. Increased ptosis

B. Clear speech Clear speech is the result of increased muscle strength. Muscle weakness characteristic of myasthenia gravis often first appears in the muscles of the neck and face. Options A and D are symptoms of multiple sclerosis that would persist if the medication was ineffective. Hand tremors are not typical symptoms of the disease.

The nurse is teaching a client with cancer about opioid management for intractable pain and tolerance related side effects. The nurse should prepare the client for which side effect that is most likely to persist during long-term use of opioids? A. Sedation. B. Constipation. C. Urinary retention. D. Respiratory depression.

B. Constipation. The client should be prepared to implement measures for constipation which is the most likely persistent side effect related to opioid use. Tolerance to opiate narcotics is common, and the client may experience less sedation and respiratory depression as analgesic use continues. Opioids increase the tone in the urinary bladder sphincter, which causes retention but may subside. The most likely persistent side effect is constipation.

A client with heart failure (HF) is being discharged with a new prescription for the angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten). The nurse's discharge instruction should include reporting which problem to the healthcare provider? A. Weight loss. B. Dizziness. C. Muscle cramps. D. Dry mucous membranes.

B. Dizziness. Angiotensin-converting enzyme (ACE) inhibitors are used in HF to reduce afterload by reversing vasoconstriction common in heart failure. This vasodilation can cause hypotension and resultant dizziness. Weight loss is desired if fluid overload is present, and may occur as the result of effective combination drug therapy such as diuretics with ACE inhibitors. It does not reuiqre reporting to the healthcare provider. Unlike ACE inhibitors, diuretics may result in hypokalemia and excessive diuretic administration may result in fluid volume deficit manifested by symptoms of dehydration.

The nitrate isosorbide dinitrate (Isordil) is prescribed for a client with angina. Which instruction should the nurse include in this client's discharge teaching plan? A. Quit taking the medication if dizziness occurs. B. Do not get up quickly. Always rise slowly. C. Take the medication with food only. D. Increase your intake of potassium-rich foods.

B. Do not get up quickly. Always rise slowly. An expected side effect of nitrates is orthostatic hypotension and the nurse should address how to prevent it--by rising slowly.

Which dosing schedule should the nurse teach the client to observe for a controlled-release oxycodone prescription? A. As needed. B. Every 12 hours. C. Every 24 hours. D. Every 4 to 6 hours.

B. Every 12 hours. A controlled-release oxycodone provides long-acting analgesia to relieve moderate to severe pain, so a dosing schedule of every 12 hours provides the best around-the-clock pain management. Controlled-release oxycodone is not prescribed for breakthrough pain on a PRN or as needed schedule. Using a schedule of every 4 to 6 hours may jeopardize patient safety due to cumulative effects.

A peak and trough level must be drawn for a client receiving antibiotic therapy. What is the optimum time for the nurse to obtain the trough level? A. Sixty minutes after the antibiotic dose is administered. B. Immediately before the next antibiotic dose is given. C. When the next blood glucose level is to be checked. D. Thirty minutes before the next antibiotic dose is given.

B. Immediately before the next antibiotic dose is given. Trough levels are drawn when the blood level is at its lowest, which is typically just before the next dose is given.

A client with osteoarthritis receives a new prescription for celecoxib (Celebrex) orally for symptom management. The nurse notes the client is allergic to sulfa. Which action is most important for the nurse to implement prior to administering the first dose? A. Review the client's hemoglobin results. B. Notify the healthcare provider. C. Inquire about the reaction to sulfa. D. Record the client's vital signs.

B. Notify the healthcare provider. Celebrex contains a sulfur molecule, which can lead to an allergic reaction in individuals who are sensitive to sulfonamides, so the healthcare provider should be notified of the client's allergies.

Following heparin treatment for a pulmonary embolism, a client is being discharged with a prescription for warfarin (Coumadin). In conducting discharge teaching, the nurse advises the client to have which diagnostic test monitored regularly after discharge? A. Perfusion scan. B. Prothrombin Time (PT/INR). C. Activated partial thromboplastin (APTT). D. Serum Coumadin level (SCL).

B. Prothrombin Time (PT/INR). When used for a client with pulmonary embolus, the therapeutic goal for warfarin therapy is a PT 1 to 2 times greater than the control, or an INR of 2 to 3.

A client with acute lymphocytic leukemia is to begin chemotherapy today. The health care provider's prescription specifies that ondansetron is to be administered IV 30 minutes prior to the infusion of cisplatin. What is the rationale for administering Zofran prior to the chemotherapy induction? A. Promotion of diuresis to prevent nephrotoxicity B. Reduction or elimination of nausea and vomiting C. Prevention of a secondary hyperuricemia D. Reduction in the risk of an allergic reaction

B. Reduction or elimination of nausea and vomiting Ondansetron is a type 3 receptor (5-HT3) antagonist that is recognized for improved control of acute nausea and vomiting associated with chemotherapy. 5-HT3 antagonists are most effective when administered IV prior to the induction of the chemotherapeutic agent(s). Options A, C, and D are not therapeutic actions of ondansetron.

A client with heart failure is prescribed spironolactone (Aldactone). Which information is most important for the nurse to provide to the client about diet modifications? A. Do not add salt to foods during preparation. B. Refrain for eating foods high in potassium. C. Restrict fluid intake to 1000 ml per day. D. Increase intake of milk and milk products.

B. Refrain for eating foods high in potassium. Spironolactone (Aldactone), an aldosterone antagonist, is a potassium-sparing diuretic, so a diet high in potassium should be avoided, along with table salt substitutes which are generally contain potassium chloride which can lead to hyperkalemia.

The nurse is preparing a plan of care for a client receiving the glucocorticoid methylprednisolone. Which nursing diagnosis reflects a problem related to this medication that should be included in the care plan? A. Ineffective airway clearance B. Risk for infection C. Deficient fluid volume D. Impaired gas exchange

B. Risk for infection Corticosteroids depress the immune system, placing the client at risk for infection. Although options A, C, and D reflect diagnostic statements that may be applicable to this client, only option B is directly related to the administration of this medication.

A 67-year-old client is discharged from the hospital with a prescription for digoxin, 0.25 mg daily. Which instruction should the nurse include in this client's discharge teaching plan? A. Take the medication in the morning before rising. B. Take and record radial pulse rate daily. C. Expect some vision changes caused by the medication. D. Increase intake of foods rich in vitamin K.

B. Take and record radial pulse rate daily. Monitoring pulse rate is very important when taking digoxin. The client should be further instructed to report pulse rates <60 or >110 beats/min and to withhold the dosage until consulting with the health care provider in such a case. Options A and D are not necessary. Option C is an indication of drug toxicity, and the client should be instructed to report this immediately.

In evaluating the effects of lactulose (Cephulac), which outcome would indicate that the drug is performing as intended? A. An increase in urine output. B. Two or three soft stools per day. C. Watery, diarrhea stools. D. Increased serum bilirubin.

B. Two or three soft stools per day. The medication lactulose can be administered for either chronic constipation or for portal-systemic encephalopathy in clients with hepatic disease. Two to three stools a day indicate that lactulose is performing as intended for chronic constipation. This would also indicate it should be effective for the clients with encephalopathy because the lactulose's action prevents absorption of ammonia in the colon as it increases water absorption and softens the stool. The efficacy of the use for ammonia absorption would have to be verified by a serum ammonia level and observation of clearing of the client's mental status.

The healthcare provider prescribes naloxone (Narcan) for a client in the emergency room. Which assessment data would indicate that the naloxone has been effective? The client's A. statement that the chest pain is better. B. respiratory rate is 16 breaths/minute. C. seizure activity has stopped temporarily. D. pupils are constricted bilaterally.

B. respiratory rate is 16 breaths/minute. Naloxone (Narcan) is a narcotic antagonist that reverses the respiratory depression effects of opiate overdose, so assessment of a normal respiratory rate would indicate that the respiratory depression has been reversed.

For which clients should the nurse withhold the initial dose of a cyclooxygenase 2 (COX-2) inhibitor until notifying the health care provider? (Select all that apply.) A. A middle-aged adult with history of tinnitus while taking aspirin B. A middle-aged adult with a history of polycystic ovarian disease C. An older adult with a history of a skin rash while taking glyburide (DiaBeta) D. An adolescent with a history of an anaphylactic reaction to penicillin E. An older adult with a history of gastrointestinal upset while taking naproxen sodium (Naprosyn) F. An adolescent at 34 weeks gestation experiencing 1+ pitting edema

C, D, F COX-2 inhibitors are contraindicated for those who are allergic to sulfa drugs (C), aspirin, and nonsteroidal antiinflammatory drugs (NSAIDs). Drug safety for adolescents (D and F) is not yet established, and COX-2 inhibitors, as well as NSAIDs, are contraindicated during the third trimester of pregnancy (F) because they can cause a premature closure of the patent ductus arteriosus. Tinnitus, an adverse reaction of aspirin (A), and ovarian disease (B) are not contraindications for the use of COX-2 inhibitors. Gastrointestinal upset is a common adverse reaction of NSAIDs (E) but is not a contraindication for the use of a COX-2 inhibitor.

A client asks the nurse if glipizide (Glucotrol) is an oral insulin. Which response should the nurse provide? A. "Yes, it is an oral insulin and has the same actions and properties as intermediate insulin." B. "Yes, it is an oral insulin and is distributed, metabolized, and excreted in the same manner as insulin." C. "No, it is not an oral insulin and can be used only when some beta cell function is present." D. "No, it is not an oral insulin, but it is effective for those who are resistant to injectable insulins."

C. "No, it is not an oral insulin and can be used only when some beta cell function is present." An effective oral form of insulin has not yet been developed because when insulin is taken orally, it is destroyed by digestive enzymes. Glipizide (Glucotrol) is an oral hypoglycemic agent that enhances pancreatic production of insulin.

A client is taking hydromorphone (Dilaudid) PO q4h at home. Following surgery, Dilaudid IV q4h PRN and butorphanol tartrate (Stadol) IV q4h PRN are prescribed for pain. The client received a dose of the Dilaudid IV four hours ago, and is again requesting pain medication. What intervention should the nurse implement? A. Alternate the two medications q4h PRN for pain. B. Alternate the two medications q2h PRN for pain. C. Administer only the Dilaudid q4h PRN for pain. D. Administer only the Stadol q4h PRN for pain.

C. Administer only the Dilaudid q4h PRN for pain. Dilaudid is an opioid agonist. Stadol is an opioid agonist-antagonist. Use of an agonist-antagonist for the client who has been receiving opioid agonists may result in abrupt withdrawal symptoms, and should be avoided.

A client's dose of isosorbide dinitrate (Imdur) is increased from 40 mg to 60 mg PO daily. When the client reports the onset of a headache prior to the next scheduled dose, which action should the nurse implement? A. Hold the next scheduled dose of Imdur 60 mg and administer a PRN dose of acetaminophen (Tylenol). B. Administer the 40 mg of Imdur and then contact the healthcare provider. C. Administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol). D. Do not administer the next dose of Imdur or any acetaminophen until notifying the healthcare provider.

C. Administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol). Imdur is a nitrate which causes vasodilation. This vasodilation can result in headaches, which can generally be controlled with acetaminophen until the client develops a tolerance to this adverse effect.

A client receiving albuterol (Proventil) tablets complains of nausea every evening with her 9:00 p.m. dose. What action can the nurse take to alleviate this side effect? A. Change the time of the dose. B. Hold the 9 p.m. dose. C. Administer the dose with a snack. D. Administer an antiemetic with the dose.

C. Administer the dose with a snack. Administering oral doses of albuterol with food helps minimize GI discomfort.

The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with osteoarthritis of the hands. The client tells the nurse that the drug does not seem to be effective after three weeks. Which is the best response for the nurse to provide? A. The frequency of the dosing is necessary to increase the effectiveness. B. Therapeutic blood levels of this drug are reached in 4 to 6 weeks. C. Another type of nonsteroidal antiinflammatory drug may be indicated. D. Systemic corticosteroids are the next drugs of choice for pain relief.

C. Another type of nonsteroidal antiinflammatory drug may be indicated. Individual responses to nonsteroidal antiinflammatory drugs are vary from person to person, so another nonsteroidal antiinflammatory drug (NSAID) may be indicated for this particular client.

The nurse is preparing to apply a surface anesthetic agent for a client. Which action should the nurse implement to reduce the risk of systemic absorption? A. Apply the anesthetic to mucous membranes. B. Limit the area of application to inflamed areas. C. Avoid abraded skin areas when applying the anesthetic. D. Spread the topical agent over a large surface area.

C. Avoid abraded skin areas when applying the anesthetic. To minimize systemic absorption of topical anesthetics, the anesthetic agent should be applied to the smallest surface area of intact skin. Application to the mucous membranes poses the greatest risk of systemic absorption because absorption occurs more readily through mucous membranes than through the skin. Inflamed areas generally have an increased blood supply, which increases the risk of systemic absorption, so option B should be avoided. A large surface area increases the amount of topical drug that is available for transdermal absorption, so the smallest area should be covered, not option D.

Which antidiarrheal agent should be used with caution in clients taking high dosages of aspirin for arthritis? A. Loperamide (Imodium). B. Probanthine (Propantheline). C. Bismuth subsalicylate (Pepto Bismol). D. Diphenoxylate hydrochloride with atropine (Lomotil).

C. Bismuth subsalicylate (Pepto Bismol). Bismuth subsalicylate (Pepto Bismol) contains a subsalicylate that increases the potential for salicylate toxicity when used concurrently with aspirin (acetylsalicylic acid, another salicylate preparation).

A postoperative client has been receiving a continuous IV infusion of meperidine (Demerol) 35 mg/hr for four days. The client has a PRN prescription for Demerol 100 mg PO q3h. The nurse notes that the client has become increasingly restless, irritable and confused, stating that there are bugs all over the walls. What action should the nurse take first? A. Administer a PRN dose of the PO meperidine (Demerol). B. Administer naloxone (Narcan) IV per PRN protocol. C. Decrease the IV infusion rate of the meperidine (Demerol) per protocol. D. Notify the healthcare provider of the client's confusion and hallucinations.

C. Decrease the IV infusion rate of the meperidine (Demerol) per protocol. The client is exhibiting symptoms of Demerol toxicity which is consistent with the large doses of Demerol received over four days. Decreasing the infusion rate of the Demerol as per protocol is the most effective action to immediately decrease the amount of serum Demerol. The next nursing action is for the nurse to notify the healthcare provider.

The health care provider prescribes the anticonvulsant carbamazepine for an adolescent client with a seizure disorder. The nurse should instruct the client to notify the health care provider if which condition occurs? A. Experiences dry mouth. B. Experiences dizziness. C. Develops a sore throat. D. Develops gingival hyperplasia.

C. Develops a sore throat. Blood dyscrasias (aplastic anemia, leukopenia, anemia, and thrombocytopenia) can be an adverse effect of carbamazepine. Flulike symptoms, such as pallor, fatigue, sore throat, and fever, are indications of such dyscrasias. Options A and B are expected reactions. Option D is a side effect of phenytoin, not carbamazepine.

The nurse is assessing a client who is experiencing anaphylaxis from an insect sting. Which prescription should the nurse prepare to administer this client? A. Dopamine. B. Ephedrine. C. Epinephrine. D. Diphenhydramine.

C. Epinephrine. Epinephrine is an adrenergic agent that stimulates beta receptors to increase cardiac automaticity in cardiac arrest and relax bronchospasms in anaphylaxis. On the ither hand, dopamine is a vasopressor used to treat clients with shock. Ephedrine causes peripheral vasoconstriction and is used in the treatment of nasal congestion. Diphenhydramine is an antihistamine decongestant used in the treatment of mild allergic reactions and motion sickness. Epinephrine is the medication of choice in treating anaphylaxis.

The nurse is preparing to administer the disease-modifying antirheumatic drug (DMARD) methotrexate to a client diagnosed with rheumatoid arthritis. Which intervention is most important to implement prior to administering this medication? A. Assess the client's liver function test results. B. Monitor the client's intake and output. C. Have another nurse check the prescription. D. Assess the client's oral mucosa.

C. Have another nurse check the prescription. Double-checking the prescription is an important intervention because death can occur from an overdose. This medication is administered weekly and in low doses for rheumatoid arthritis and should not be confused with administration of the drug as a chemotherapeutic agent. Options A and B are appropriate interventions for those who are receiving this drug, but they are not the most important interventions. Stomatitis is an expected side effect of this medication.

A client is prescribed a cholinesterase inhibitor, and a family member asks the nurse how this medication works. Which pharmacophysiologic explanation should the nurse use to describe this class of drug? A. Promotes excretion of neurotoxins. B. Slows nerve cell degeneration. C. Improves nerve impulse transmission. D. Stimulates nerve cell regeneration.

C. Improves nerve impulse transmission. Cholinesterase inhibitors work to increase the availability of acetylcholine at cholinergic synapses, which aids in neuronal transmission and assists in memory formation. Basing an explanation on this concept, option C should provide an accurate explanation that the family can understand. Options A, B, and D are incorrect.

Which nursing intervention is most important when caring for a client receiving the antimetabolite cytosine arabinoside (Arc-C) for chemotherapy? A. Hydrate the client with IV fluids before and after infusion. B. Assess the client for numbness and tingling of extremities. C. Inspect the client's oral mucosa for ulcerations. D. Monitor the client's urine pH for increased acidity.

C. Inspect the client's oral mucosa for ulcerations. Cytosine arabinoside (Arc-C) affects the rapidly growing cells of the body, therefore stomatitis and mucosal ulcerations are key signs of antimetabolite toxicity.

A client who was prescribed atorvastatin (Lipitor) one month ago calls the triage nurse at the clinic complaining of muscle pain and weakness in his legs. Which statement reflects the correct drug-specific teaching the nurse should provide to this client? A. Increase consumption of potassium-rich foods since low potassium levels can cause muscle spasms. B. Have serum electrolytes checked at the next scheduled appointment to assess hyponatremia, a cause of cramping. C. Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect. D. Be sure to consume a low-cholesterol diet while taking the drug to enhance the effectiveness of the drug.

C. Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect. Myopathy, suggested by the leg pain and weakness, is a serious, and potentially life-threatening, complication of Lipitor, and should be evaluated immediately by the healthcare provider.

The nurse is assessing the effectiveness of high dose aspirin therapy for an 88-year-old client with arthritis. The client reports that she can't hear the nurse's questions because her ears are ringing. What action should the nurse implement? A. Refer the client to an audiologist for evaluation of her hearing. B. Advise the client that this is a common side effect of aspirin therapy. C. Notify the healthcare provider of this finding immediately. D. Ask the client to turn off her hearing aid during the exam.

C. Notify the healthcare provider of this finding immediately. Tinnitus is an early sign of salicylate toxicity. The healthcare provider should be notified immediately, and the medication discontinued.

A client has myxedema, which results from a deficiency of thyroid hormone synthesis in adults. The nurse knows that which medication would be contraindicated for this client? A. Liothyronine (Cytomel) to replace iodine. B. Furosemide (Lasix) for relief of fluid retention. C. Pentobarbital sodium (Nembutal Sodium) for sleep. D. Nitroglycerin (Nitrostat) for angina pain.

C. Pentobarbital sodium (Nembutal Sodium) for sleep. Persons with myxedema are dangerously hypersensitive to narcotics, barbiturates and anesthetics.

A 45-year-old female client is receiving alprazolam for anxiety. Which client behavior would indicate that the drug is effective? A. Personal hygiene is maintained by the client for the first time in a week. B. The client has an average resting heart rate of 120 beats/min. C. The staff observes the client sitting in the day room reading a book. D. The nurse records that the client lost 2 lb of body weight in the past week.

C. The staff observes the client sitting in the day room reading a book. The ability to sit and concentrate on reading indicates decreased anxiety. Options A, B, and D are not related to the use of alprazolam for anxiety.

A client is taking famotidine. Which client statement should the nurse further assess because it may indicate that the client is experiencing a side effect of this drug? A. "I have heartburn whenever I lie down." B. "I am never hungry. I've lost weight in the past 2 weeks." C. "I have a funny metallic taste in my mouth." D. "I seem to be having difficulty thinking clearly."

D. "I seem to be having difficulty thinking clearly." A common side effect of of famotidine is confusion. Options A, B, and C are not side effects of this medication.

The nurse is evaluating a client's understanding of the prescribed antilipemic drug lovastatin. Which client statement indicates that further teaching is needed? A. "My bowel habits should not be affected by this drug." B. "This medication should be taken once a day only." C. "I will still need to follow a low-cholesterol diet." D. "I will take the medication every day before breakfast."

D. "I will take the medication every day before breakfast." The enzyme that helps metabolize cholesterol is activated at night, so this medication should be taken with the evening meal. Options A, B, and C reflect correct information about lovastatin.

The nurse has completed diabetic teaching for a client who has been newly diagnosed with diabetes mellitus. Which statement by this client would indicate to the nurse that further teaching is needed? A. "Regular insulin can be stored at room temperature for 30 days." B. "My legs, arms, and abdomen are all good sites to inject my insulin." C. "I will always carry hard candies to treat hypoglycemic reactions." D. "When I exercise, I should plan to increase my insulin dosage."

D. "When I exercise, I should plan to increase my insulin dosage." Exercise helps facilitate the entry of glucose into the cell, so increasing insulin doses with exercise would place the client at high risk for a hypoglycemic reaction. Options A, B, and C reflect accurate statements about the use of insulin and management of hypoglycemic reactions.

A client who has been taking levodopa PO TID to control the symptoms of Parkinson's disease has a new prescription for sustained release levodopa/carbidopa (Sinemet 25/100) PO BID. The client took his levodopa at 0800. Which instruction should the nurse include in the teaching plan for this client? A. "Take the first dose of Sinemet today, as soon as your prescription is filled." B. "Since you already took your levodopa, wait until tomorrow to take the Sinemet." C. "Take both drugs for the first week, then switch to taking only the Sinemet." D. "You can begin taking the Sinemet this evening, but do not take any more levodopa."

D. "You can begin taking the Sinemet this evening, but do not take any more levodopa." Carbidopa significantly reduces the need for levodopa in clients with Parkinson's disease, so the new prescription should not be started until eight hours after the previous dose of levodopa, but can be started the same day.

Which client should the nurse identify as being at highest risk for complications during the use of an opioid analgesic? A. An older client with Type 2 diabetes mellitus. B. A client with chronic rheumatoid arthritis. C. A client with a open compound fracture. D. A young adult with inflammatory bowel disease.

D. A young adult with inflammatory bowel disease. The principal indication for opioid use is acute pain, and a client with inflammatory bowel disease is at risk for toxic megacolon or paralytic ileus related to slowed peristalsis, a side effect of morphine. Adverse effects of morphine do not pose as great a risk for clients with diabetes or a fracture as for the client with bowel disease.

A mother brings her 18-month-old child to the community health center because the child has had "bad diarrhea" for the last 3 days. She states, "I bought some of this liquid at the pharmacy and gave my daughter a half-ounce." The nurse sees that the bottle contains loperamide. Which intervention is most important for the nurse to implement initially? A. Tell the mother never to give this drug to her toddler. B. Ask if any other siblings have experienced diarrhea. C. Take the child's oral and tympanic temperatures. D. Ask the mother when the child last voided.

D. Ask the mother when the child last voided. Determining when the child last voided is most important because urine output is decreased with dehydration and an 18-month-old with a 3-day history of diarrhea could be severely dehydrated. Although the manufacturer states that loperamide should not be given to a child younger than 2 years except under the direction of a health care provider, option A is not the best answer for this question. In addition, loperamide causes an anticholinergic effect of urinary retention. Data obtained in options B and C are not as high a priority as option D in this situation.

A client is receiving clonidine (Catapres) 0.1 mg/24hr via transdermal patch. Which assessment finding indicates that the desired effect of the medication has been achieved? A. Client denies recent episodes of angina. B. Change in peripheral edema from +3 to +1. C. Client denies recent nausea or vomiting. D. Blood pressure has changed from 180/120 to 140/70 mmHg.

D. Blood pressure has changed from 180/120 to 140/70 mmHg. Catapres acts as a centrally-acting analgesic and antihypertensive agent. A reduction of the blood pressure to 140/70 mmHg indicates a reduction in hypertension.

Which change in data indicates to the nurse that the desired effect of the angiotensin II receptor antagonist valsartan (Diovan) has been achieved? A. Dependent edema reduced from +3 to +1. B. Serum HDL increased from 35 to 55 mg/dl. C. Pulse rate reduced from 150 to 90 beats/minute. D. Blood pressure reduced from 160/90 to 130/80.

D. Blood pressure reduced from 160/90 to 130/80. Diovan is an angiotensin receptor blocker, prescribed for the treatment of hypertension. The desired effect is a decrease in blood pressure.

The health care provider has prescribed a low-molecular-weight heparin, enoxaparin prefilled syringe, 30 mg/0.3 mL IV every 12 hours, for a client following hip replacement. Prior to administering the first dose, which intervention is most important for the nurse to implement? A. Assess the client's IV site for signs of inflammation. B. Evaluate the client's degree of mobility. C. Instruct the client regarding medication side effects. D. Contact the health care provider to clarify the prescription.

D. Contact the health care provider to clarify the prescription. Enoxaparin is a low-molecular-weight heparin that should be administered subcutaneously when given as a prophylaxis for deep vein thrombosis, so the nurse should contact the health care provider to clarify the route of administration. Options A and B are important nursing interventions but not necessary to the administration of this medication. The client should be instructed about medication side effects, but this is of lower priority than obtaining a correct prescription.

A client is admitted to the hospital for diagnostic testing for possible myasthenia gravis. The nurse prepares for intravenous administration of edrophonium chloride (Tensilon). What is the expected outcome for this client following administration of this pharmacologic agent? A. Progressive difficulty with swallowing. B. Decreased respiratory effort. C. Improvement in generalized fatigue. D. Decreased muscle weakness.

D. Decreased muscle weakness. Administration of edrophonium chloride (Tensilon), a cholinergic agent, will temporarily reduce muscle weakness, the most common complaint of newly-diagnosed clients with myasthenia gravis. This medication is used to diagnose myasthenia gravis due to its short duration of action. This drug would temporarily reverse difficulty in swallowing and respiratory effort.

Which drug is used as a palliative treatment for a client with tumor-induced spinal cord compression? A. Morphine Sulfate (Duromorph). B. Ibuprofen (Advil). C. Amitriptyline (Amitril). D. Dexamethasone (Decadron).

D. Dexamethasone (Decadron). Dexamethasone is a palliative treatment modality to manage symptoms related to compression due to tumor growth ( the focus of this question). Morphine sulphate is an opioid analgesic used in oncology to manage severe or intractable pain. Ibuprofen, a nonsteroidal antiinflammatory drug (NSAID), provides relief for mild to moderate pain, suppression of inflammation, and reduction of fever. Amitriptyline, a tricyclic antidepressant, is often prescribed for pain related to neuropathic origin and provides a reduction in opioid dosage.

A client receiving Doxorubicin (Adriamycin) intravenously (IV) complains of pain at the insertion site, and the nurse notes edema at the site. Which intervention is most important for the nurse to implement? A. Assess for erythema. B. Administer the antidote. C. Apply warm compresses. D. Discontinue the IV fluids.

D. Discontinue the IV fluids. Doxorubicin is an antineoplastic agent that causes inflammation, blistering, and necrosis of tissue upon extravasation. First, all IV fluids should be discontinued at the site to prevent further tissue damage by the vesicant.

An older client with a decreased percentage of lean body mass is likely to receive a prescription that is adjusted based on which pharmacokinetic process? A. Absorption. B. Metabolism. C. Elimination. D. Distribution.

D. Distribution. A decreased lean body mass in an older adult affects the distribution of drugs which affects the pharmacokinetics of drugs. In contrast, decreased gastric pH, delayed gastric emptying, decreased splanchnic blood flow, decreased gastrointestinal absorption surface areas and motility affect absorption in the older adult population. Decreased hepatic blood flow, decreased hepatic mass, and decreased activity of hepatic enzymes affect metabolism in older adults. Decreased renal blood flow, decreased glomerular filtration rate, decreased tubular secretion, and decreased number of nephrons affects elimination in an older adult.

Dobutamine (Dobutrex) is an emergency drug most commonly prescribed for a client with which condition? A. Shock. B. Asthma. C. Hypotension. D. Heart failure.

D. Heart failure. Dobutamine is a beta-1 adrenergic agonist that is indicated for short term use in cardiac decompensation or heart failure related to reduced cardiac contractility due to organic heart disease or cardiac surgical procedures. On the other hand, alpha and beta adrenergic agonists, such as epinephrine and dopamine, are sympathomimetics used in the treatment of shock. Other selective beta-2 adrenergic agonists, such as terbutaline and isoproterenol, are indicated in the treatment of asthma. Although dobutamine improves cardiac output, it is not used to treat hypotension.

A client has a continuous IV infusion of dopamine (Intropin) and an IV of normal saline at 50 ml/hour. The nurse notes that the client's urinary output has been 20 ml/hour for the last two hours. Which intervention should the nurse initiate? A. Stop the infusion of dopamine. B. Change the normal saline to a keep open rate. C. Replace the urinary catheter. D. Notify the healthcare provider of the urinary output.

D. Notify the healthcare provider of the urinary output. The main effect of dopamine is adrenergic stimulation used to increase cardiac output, which should also result in increased urinary output. A urinary output of less than 20 ml/hour is oliguria and should be reported to the healthcare provider, so the dose of dopamine can be adjusted. Depending on the current rate of administration, the dose may need to be increased or decreased.

When providing client teaching about the administration of methylphenidate (Ritalin) to a parent of a child diagnosed with ADHD, which instruction should the nurse include in the teaching plan? A. The doses should be given exactly 12 hours apart to sustain a therapeutic serum level. B. Doses should be scheduled at midmorning and midafternoon to achieve optimal benefit. C. Give the medication only on school days and when the child appears to be anxious. D. Offer the child the medication with breakfast and after the child eats lunch.

D. Offer the child the medication with breakfast and after the child eats lunch. Administering the medication at breakfast and after lunch provides the correct spacing of the doses to maximize the child's attention span and helps prevent the appetite suppression associated with the drug. Doses should be spaced at 6-hour intervals, not option A. Option B is likely to increase insomnia. Option C disrupts the normal dosing schedule, resulting in ineffective treatment. Doses should be discontinued only for brief intervals (with the health care provider's approval) when the client's condition is being evaluated or if the client is being weaned from the medication entirely.

A male client asks the nurse why condoms should not be lubricated with the spermicide nonoxynol-9. Which response is best for the nurse to provide? A. The risk of female infertility and spontaneous abortion is linked with nonoxynol-9. B. Partners can develop intermittent interstitial cystitis if the spermicide is used after expiration date. C. Decreases the amount of vaginal and penile sensitivity for up to 8 to 12 hours. D. Provides no protection from STDs and has been linked to the transmission of HIV.

D. Provides no protection from STDs and has been linked to the transmission of HIV. The use of condoms and a water-based spermicide is recommended because nonoxynol-9 can cause a rash that allows viruses a portal of entry if the condom breaks, which increases the risk of transmission of sexually transmitted diseases (STDs), such as human immunodeficiency virus (HIV), herpes, human papillomavirus (HPV), or hepatitis B virus (HBV). Options A and B are inaccurate. Nonoxynol-9 may cause vaginal irritation, not option C.

A client with coronary artery disease who is taking digoxin (Lanoxin) receives a new prescription for atorvastatin (Lipitor). Two weeks after initiation of the Lipitor prescription, the nurse assesses the client. Which finding requires the most immediate intervention? A. Heartburn. B. Headache. C. Constipation. D. Vomiting.

D. Vomiting. Vomiting, anorexia and abdominal pain are early indications of digitalis toxicity. Since Lipitor increases the risk for digitalis toxicity, this finding requires the most immediate intervention by the nurse.

A client is being treated for hyperthyroidism with propylthiouracil (PTU). The nurse knows that the action of this drug is to A. decrease the amount of thyroid-stimulating hormone circulating in the blood. B. increase the amount of thyroid-stimulating hormone circulating in the blood. C. increase the amount of T4 and decrease the amount of T3 produced by the thyroid. D. inhibit synthesis of T3 and T4 by the thyroid gland.

D. inhibit synthesis of T3 and T4 by the thyroid gland. Rationale PTU is an adjunct therapy used to control hyperthyroidism by inhibiting production of thyroid hormones. It is often prescribed in preparation for thyroidectomy or radioactive iodine therapy