Pharmacological and Parenteral Therapies Type: Client Needs Category: Pharmacological and Parenteral Therapies
After receiving an oral dose of codeine for an intractable cough, a client asks the nurse, "How long will it take for this drug to work?" How should the nurse respond?
30 minutes
A physician orders gentamicin sulfate, 80 mg I.V. every 8 hours for a client with Pseudomonas aeruginosa. The nurse should infuse this drug over at least:
30 minutes.
A client is taking spironolactone. Which change in the diet should the nurse teach the client to make when taking this drug?
Correct response: Avoid eating foods high in potassium.
A client takes prednisone, as ordered, for rheumatoid arthritis. During follow-up visits, the nurse should assess the client for common adverse reactions to this drug, such as
fluid retention and weight gain.
A client is receiving total parenteral nutrition (TPN) solution. The nurse should assess a client's ability to metabolize the TPN solution adequately by monitoring the client for which sign?
hyperglycemia
A client with impaired cardiac functioning is having abdominal surgery. Sodium thiopental is being used during anesthesia induction. What should the nurse monitor the client for during the surgery?
hypotension
A nurse knows that the major clinical use of dobutamine is to
increase cardiac output.
The health care provider (HCP) has prescribed nitroglycerin to a client with angina. The client also has closed-angle glaucoma. The nurse should contact the HCP to discuss the potential for which drug interaction?
increased intraocular pressure
The nurse should instruct a client who is taking dexamethasone and furosemide to report which symptom?
muscle weakness
A client with severe arthritis has been receiving maintenance therapy of prednisone 10 mg/day for the past 6 weeks. The nurse should instruct the client to immediately report which symptom?
respiratory infection
An elderly male client has been taking doxazosin 2 mg daily for 4 weeks for treatment of benign prostatic hypertrophy. The client reports feeling dizzy. The nurse should first:
take his blood pressure lying, standing, and sitting.
Which topic is most important to include in the teaching plan for a client newly diagnosed with Addison's disease who will be taking corticosteroids?
the importance of watching for signs of hyperglycemia
The nurse is preparing a teaching plan about increased exercise for a female client who is receiving long-term corticosteroid therapy. What type of exercise is most appropriate for this client?
walking
The nurse is calculating drug dosages for a child. What is the most important measurement for the nurse to consider?
weight in kilograms
The nurse reviews insulin administration with a client. Which statement best indicates that the client will continue to perform the procedure correctly?
Correct response: "I wrote down the steps in case I forget what to do."
The nurse should advise which client who is taking lithium to consult with the health care provider regarding a potential adjustment in lithium dosage?
a client who is beginning training for a tennis team
The health care provider (HCP) has prescribed insulin detemir for a client with type 2 diabetes requiring insulin. What should the nurse teach the client about this insulin?
"You do not mix insulin detemir; the solution is clear."
A nurse is providing health teaching about pediatric immunizations to the parents of a child. Which of the following is the most appropriate information for the nurse to give the parents about immunizations?
"Your child may need medication for a low-grade fever."
The client with type 1 diabetes mellitus is taught to take isophane insulin suspension NPH at 1700 each day. The client should be instructed that the greatest risk of hypoglycemia will occur at about what time?
0100, while sleeping.
A client with psychosis is prescribed quetiapine 400 mg by mouth daily in two divided doses. The pharmacy dispenses 200-mg tablets. How many tablets should the nurse administer with each dose? Record your answer using a whole number.
1
A 10-year-old child is admitted with asthma. The health care provider orders a methylprednisolone loading dose of 3 mg/kg. The child weighs 30 kg. It comes as a solution of 40 mg/ml. How many milliliters should the child receive? Record your answer using two decimal places.
2.25
A nurse is preparing to administer phenytoin to a 99-lb (45-kg) client with a seizure disorder. The medication administration record documents phenytoin 5 mg/kg/day to be administered in three divided doses. How many milligrams of phenytoin should be administered in the first dose? Record your answer as a whole number.
75
The nurse is preparing to administer propranolol to a client for control of migraine headaches. The client also has a prescription for sumatriptan as needed for a headache. The client's pulse rate is 56 bpm. What should the nurse do next?
Assess blood pressure
A client is using patient-controlled analgesia (PCA) to manage postoperative pain. What should the nurse do when assisting the client with the PCA?
Document the client's response to pain medication.
The nurse is assessing a client with chronic hepatitis B who is receiving lamivudine. What information about the client is most important to communicate to the health care provider?
a 3-kg weight gain over 2 days
A health care provider prescribes gentamicin for a client with peritonitis. The client has preexisting impaired vision and hearing. The nurse should:
question the prescription because gentamicin could cause further hearing impairment.
A client's caretaker calls the home care nurse and states accidentally puncturing the central venous catheter after discontinuing the total parenteral nutrition. What instructions should the nurse provide to the caretaker?
Correct response: Clamp the catheter.
An order has been written to discontinue an infusion of total parenteral nutrition (TPN) for a child. What is the priority nursing action?
Correct response: Gradually reduce the rate of the TPN per health care provider order.
A client with chest pain is prescribed intravenous nitroglycerin. Which finding is of greatest concern for the nurse initiating the nitroglycerin drip?
Correct response: Blood pressure is 88/46 mm Hg.
Which statement should be included when teaching clients about monoamine oxidase (MAO) inhibitors?
Correct response: Don't take any prescribed or over-the-counter medications without consulting a physician and pharmacist.
The nurse is administering packed red blood cells (PRBCs) to a client. What should the nurse do first?
Correct response: Stay with the client during the first 15 minutes of infusion.
A client is receiving spironolactone to treat hypertension. Which instruction should the nurse provide?
Correct response: avoid salt substitutes
The health care provider prescribes furosemide 40 mg intravenous push daily. The medication comes in a vial of 50 mg/mL. Mark on the syringe the dosage of medication the nurse would give.
Correct response: click on the .8
The nurse is instructing a sexually active female who is taking isoniazid (INH). What should the nurse tell the client?Isoniazid:
Correct response: decreases the effectiveness of hormonal contraceptives.
A nurse should assess the maturity of enzyme systems (kidney and liver) in which pediatric population before administering medications?
Correct response: premature infants
When the nurse is working in the mother-baby unit, which client would the nurse anticipate giving Rho(D) immune globulin (human) to?
Correct response: the Rh-negative mother with an Rh-positive baby
A short time after cataract surgery, the client has nausea. What should the nurse do first?
Correct response: Medicate the client with an antiemetic, as prescribed.
A client is ordered a dose of epoetin alfa to treat anemia related to chemotherapy. The recommended dose is 150 units/kg. The client weighs 60 kg. The vial is labeled 10,000 units/ml. How many milliliters of epoetin alfa would the nurse administer? Record your answer using one decimal place.
Correct response: 0.9
The nurse is flushing a peripheral intravenous access device. Place the steps in the order that the nurse should perform them. All options must be used.
Correct response: 1Cleanse the end cap with an antimicrobial swab. 2Insert the saline flush syringe into the cap on the extension tubing. 3Pull back on saline flush syringe to aspirate the catheter for blood return. 4Instill saline solution over 1 minute. 5Remove the syringe and reclamp the extension tubing. 6Remove gloves and perform hand hygiene.
An infant who weighs 17.6 lb (8 kg) is to receive ampicillin 25 mg/kg IV q6h. How many milligrams should the nurse administer per dose? Record your answer using a whole number.
Correct response: 200
A physician orders cefoxitin, 1 g in 100 ml of 5% dextrose in water, to be administered I.V. A nurse determines that the recommended infusion time is 15 to 30 minutes. The available infusion set has a calibration of 10 drops/ml. To infuse cefoxitin over 30 minutes, which drip rate should the nurse use?
Correct response: 33 drops/minute
Two days after a client undergoes repair of a ruptured cerebral aneurysm, a physician orders mannitol, 0.5 g/kg to be infused over 60 minutes. The client weighs 175 lb. The nurse should administer how many grams of mannitol? Record your answer using a whole number.
Correct response: 40
The nurse is reviewing an order for sliding scale insulin for a client with diabetes. Which parts of the order should the nurse question? Select all that apply.
Correct response: For blood glucose of 1-145 mg/dL (0-8 mmol/L): Give 3 units of regular insulin. For blood glucose of 162-216 mg/dL (9-12 mmol/L): Give 5 units of NPH insulin. For blood glucose greater than 360 mg/dL (20 mmol/L): Give 12 units of insulin glargine.
When preparing to draw up 8 units of a short-acting insulin and 20 units of a long-acting insulin in the same syringe, the nurse should use which technique?
Correct response: Inject air in the vial with the long-acting insulin first.
A school-age client with rheumatic fever is on long-term aspirin therapy. Which client statement most indicates that the client is experiencing a serious adverse reaction to aspirin?
Correct response: "I hear ringing in my ears."
A client receiving an intravenous infusion states that, "My arm is feeling cool." Which of the following priority actions should be taken?
Correct response:Assess the intravenous site.
The nurse receives an order to administer morphine to a client with an acute myocardial infarction. What is the purpose of this medication?
Correct response:to decrease myocardial oxygen demand
Which finding is the best indication that fluid replacement for the client in hypovolemic shock is adequate?
Correct response:urine output greater than 30 ml/hour
A client is to be discharged with a prescription for an analgesic that is a controlled substance. Which comment by the client indicates to the nurse that further teaching is needed
"I know I can titrate the dose according to the pain level."
A nurse is providing instruction to a client undergoing treatment for anxiety and insomnia. The practitioner has prescribed lorazepam 1 mg/po/tid. The nurse determines that teaching has been effective when the client states
"I'll avoid coffee."
The wife of a 67-year-old client who has been taking imipramine for 3 days asks the nurse why her husband is not better. The nurse should tell the wife:
"It takes 2 to 4 weeks before the full therapeutic effects are experienced."
The student nurse is learning how to administer medications. The nurse instructor asks, "What are the client's rights when administering medication?" What are the most appropriate response(s) by the student? Select all that apply.
"Right to refuse." "Right time or frequency." "Right assessment."
A client with chronic pancreatitis is discharged with a prescription for pancrelipase. Which instruction must the nurse include when providing discharge instructions regarding this medication?
"Swallow this medication whole. Do not chew it."
A client with pneumonia is ordered azithromycin 500 mg I.V. daily via a peripheral I.V. catheter. The medication is pre-mixed from the pharmacy in a 50 ml bag of solution to be infused over 30 minutes. The I.V. tubing delivers 15 gtts/ml. At what drip rate should the nurse set the infusion pump? Record your answer using a whole number
25
The nurse is administering an IV antibiotic to a client in the emergency department (ED). Within 15 minutes, the client reports itching, shortness of breath, and difficulty swallowing. Which interventions should the nurse implement? Select all that apply.
Administer epinephrine per order. Discontinue the medication. Apply oxygen.
A nurse obtained a client's fasting blood sugar (FBS) at 0700, which was 144 mg/dL (8 mmol/L). The client has an order for regular insulin 8 units every morning. What should the nurse do next?
Administer the insulin as ordered.
A client with acute pyelonephritis receives a prescription for co-trimoxazole P.O. twice daily for 10 days. Which finding best demonstrates that the client has followed the ordered regimen?
Bacteria are absent on urine culture.
A healthcare provider orders 500 mg of oxacillin sodium for intramuscular administration. One gram of powdered oxacillin sodium is available. Directions for reconstitution are to add 5.7 mL of sterile water to yield 1 g in 4 mL. How many milliliters should a nurse withdraw from the vial after reconstituting the drug as directed? Record your answer using a whole number.
Correct response: 2
A client is to receive 1 unit of packed red blood cells over 2 hours. There are 250 mL in the infusion bag. The IV administration infusion set delivers 10 gtt/mL. At what flow rate (in drops per minute) should the nurse run the infusion? Record your answer using a whole number.
Correct response: 21
The nurse is caring for a client with an order for an intravenous infusion of dextrose with 5% normal saline at 1500 mL over 8 hrs. The drip administration is set at 10 drops/mL. How fast will the IV infuse (drops/minute)? Record your answer using a whole number.
Correct response: 31
The nurse receives a physician's order to administer 1,000 mL of intravenous (I.V.) normal saline solution over 8 hours to a client who recently had a stroke. What should the drip rate be if the drop factor of the tubing is 15 gtt/mL? Record your answer using a whole number.
Correct response: 31
A child undergoing chemotherapy is clinically dehydrated. The provider orders a 200 ml of I.V. fluid to be administered over 2 hours. The drop factor is 20. At what flow rate should the pump be set? Record your answer as a whole number.
Correct response: 33
A client is admitted with a diagnosis of diabetic ketoacidosis. An insulin drip is initiated with 50 units of insulin in 100 ml of normal saline solution administered via an infusion pump set at 10 ml/hour. The nurse determines that the client is receiving how many units of insulin each hour? Record your answer using a whole number.
Correct response: 5
The client with glaucoma is scheduled for a hip replacement. Which prescription would require clarification before the nurse carries it out?
Correct response: Administer atropine sulfate
A client receiving 5-fluorouracil is experiencing nausea and vomiting. What is the nurse's best course of action?
Correct response: Administer odansetron prior to administering the 5-fluorouracil
The nurse is caring for an infant diagnosed with thrush. Which instruction would the nurse give to a client's mother who will be administering nystatin oral solution?
Correct response: Administer the drug right after meals by dabbing the solution to the sites.
The nurse is preparing the prescribed hydromorphone 1 mg I.V. After drawing up the prescribed dose from a 2 mg/ml vial, what is the next action by the nurse?
Correct response: Ask another nurse to witness the waste of 0.5 ml of medication into the sink.
The client is being treated for histoplasmosis and is prescribed amphotericin B. The nurse in charge asks the graduate nurse, "Which laboratory test is required while the client is receiving this medication?" What is the graduate nurse's most appropriate answer?
Correct response: BUN
A client reports pain in the right heel and is requesting medication. The nurse assesses the client and administers an analgesic. The client experiences no pain relief and states that the heel pain is worse. What is an appropriate intervention by the nurse?
Correct response: Call the physician to report the finding.
A nurse is caring for a client with a long-term central venous catheter. Which steps should the nurse include in teaching how to care for the catheter at home?
Correct response: Clean the port with an alcohol pad before administering I.V. fluid through the catheter.
The graduate nurse is preparing to hang a secondary medication. The preceptor reminds the graduate nurse that two different medications will be running at the same time. What should the graduate nurse do? Select all that apply.
Correct response: Confer with the preceptor in deciding if compatibility is an issue and what should be done. Refer to a compatibility chart.
A client with alcohol dependency is started on a regimen of disulfiram. Which statement should the nurse include when teaching the client about the intended effects of the drug?
Correct response: Disulfiram acts to deter alcohol consumption.
The client has just undergone abdominal surgery and returned from the post-anesthesia care unit (PACU) with a patient-controlled analgesia (PCA) pump. Which interventions should the nurse implement? Select all that apply.
Correct response: Tell the client to push the button when in pain. Check the patient-controlled analgesia (PCA) settings with another nurse. Assess the IV insertion site.
The nurse prepares to administer digoxin to a client. For which reason should the nurse question the prescribed dose?
Correct response: The client has chronic kidney disease (CKD).
A school-age child with cystic fibrosis (CF) is suddenly losing weight, despite having a voracious appetite. The child has large, foul-smelling stools, with excessive gas, distention, and bloating. Which is the nurse's best assessment of the etiology of this problem?
Correct response: The dose of pancreatic enzyme needs to be adjusted.
A client is given amiodarone in the emergency department for a dysrhythmia. Which finding indicates the drug is having the desired effect?
Correct response: The number of premature ventricular contractions is decreasing.
The nurse is administering newly ordered narcotic medication to a client. What safety steps are included in the process? Select all that apply.
Correct response: Verify the healthcare provider's order. Assess the client for allergies. Identify the client. Assess client's pain level.
On the second day following an abdominal hysterectomy, a client reports she has had three brown, loose stools in moderate amount. The morning medications include an order for 100 mg of docusate sodium daily or as needed. What should the nurse do next?
Correct response: Withhold the medication, and document the client's report of loose stools.
A nurse is caring for a client 1 hour post-laparotomy who reports abdominal pain rating 5/10. What will the nurse prioritize when administering the ordered morphine?
Correct response: administer the medication before the pain becomes severe
A 30-year-old multiparous client has been prescribed oral contraceptives as a method of birth control. The nurse instructs the client that decreased effectiveness may occur if the client is prescribed which drug?
Correct response: ampicillin
A client with diabetes has been diagnosed with hypertension, and the health care provider has prescribed atenolol, a beta-blocker. When teaching the client about the drug, what should the nurse tell the client about how it may interact with the client's diabetes? Atenol may cause:
Correct response: an increase in the hypoglycemic effects of insulin.
The client is admitted to the telemetry unit with atrial tachycardia and ordered propranolol. The nurse should monitor the client for which side effect while on propranolol therapy? Select all that apply.
Correct response: blood sugar of 65 mg/dL airway narrowing blood pressure of 90/60
A nurse is calculating the most accurate dosage of a medication for a child. What parameter should influence this calculation?
Correct response: body surface area in relation to weight
The client was admitted to the hospital with the diagnosis of iron overload. Over time, an excess of iron can damage the liver and cause heart problems. Which medication does the nurse anticipate the healthcare provider to order?
Correct response: deferoxamine
The nurse administers an intradermal injection to a client. Proper technique has been used if the injection site has which appearance?
Correct response: evidence of a bleb
A primigravid client in active labor has just received an epidural block for pain. After administration of the epidural block, the nurse should assess the client for which condition
Correct response: hypotension
A client's serum ammonia level is elevated, and the health care provider (HCP) prescribes 30 mL of lactulose. Which effect is common for this drug?
Correct response: increased bowel movements
An 18-year-old pregnant college student presented at the prenatal clinic for an initial visit at 14 weeks' gestation. The client's history revealed that she has taken fluoxetine 20 mg orally daily for posttraumatic stress disorder (PTSD) and depression. Her medication was recently increased to 40 mg daily because of reports of increased stress and suicide ideation. Which side effect of fluoxetine would the nurse judge to be the greatest risk for the client and her developing fetus at this stage in her pregnancy?
Correct response: nausea/anorexia
A full-term client is admitted for an induction of labor. The health care provider (HCP) has assigned a Bishop score of 10. Which drug would the nurse anticipate administering to this client?
Correct response: oxytocin 30 units in 500 ml D5W
A physician orders digoxin for a client with heart failure. During digoxin therapy, which laboratory value may predispose the client to digoxin toxicity?
Correct response: potassium level of 3.1 mEq/L (3.1 mmol/L)
The nurse administers fat emulsion solution during TPN to a malnourished client. What should the nurse tell the client about the purpose of this solution? Fat emulsion solution:
Correct response: provides essential fatty acids.
After undergoing a thoracotomy, a client is receiving epidural analgesia. Which assessment finding indicates that the client has developed the most serious complication of epidural analgesia?
Correct response: respiratory depression
A client experiences initial indications of dizziness after having an IV infusion of lidocaine hydrochloride started. The nurse should further assess the client for which symptoms?
Correct response: tinnitus
A client was discharged from the hospital for cancer-related pain. While in the hospital the pain was well controlled on patient-controlled administration (PCA) of IV morphine, and on discharge 2 days ago was taking oral morphine. The client now reports pain as an 8 on a 10-point scale and is asking the nurse about using PCA for the morphine at home. Which explanation is the most likely for the client's reports of inadequate pain control? The client is:
Correct response: undermedicated on the oral opioid.
A client has just begun treatment with busulfan, 4 mg by mouth daily, for chronic myelogenous leukemia. The client receives busulfan until their white blood cell (WBC) count falls to between 10,000/mm3 and 25,000/mm3. Then the drug is stopped. When should treatment resume?
Correct response: when the WBC count rises to 50,000/mm3
Which statement indicates that the client needs further teaching about taking medication to control cancer pain?
Correct response: "I should skip doses periodically so I don't get hooked on my drugs."
A client with a history of painful, continuous muscle spasms is prescribed diazepam, 2 mg P.O. twice daily. The client states the medication is effective and requests to use it long term. Which response by the nurse is most appropriate?
Correct response: "Long-term use of this medication may result in addiction."
A client with early acute renal failure has anemia, tachycardia, hypotension, and shortness of breath. The health care provider (HCP) has prescribed 2 units of packed red blood cells (RBCs). What should the nurse determine prior to initiating the blood transfusion? Select all that apply.
Correct response: 1 There is an IV access with the appropriate tubing and normal saline as the priming solution. 2 There is a signed informed consent for transfusion therapy. 3 Blood typing and cross-matching are documented in the medical record. 4 The vital signs have been taken and documented in accordance with facility policy and procedure. 5 The client has an identification bracelet.
The client with leukemia presents to the IV therapy clinic for chemotherapy. The nurse asks the client to roll up a sleeve to look for an IV access site. Which vein can the nurse access for this therapy? Select all that apply.
Correct response: cephalic, antebrachial, basilic
Hydrocodone with acetaminophen has been prescribed for a client with metastatic prostate cancer. What information is essential for the nurse to include in the teaching plan?
Correct response: "Constipation may develop with constant use."
The nurse is discussing medications with a client with hypertension who has a prescription for furosemide daily. Which comment by the client indicates the client needs further education?
Correct response: "I know I shouldn't drive after taking my furosemide."
The nurse is teaching a client with iron-deficiency anemia about ferrous gluconate therapy. Which statement, if made by the client, would indicate a correct understanding of the teaching?
Correct response: "I will take the medication on an empty stomach with orange juice."
A child newly diagnosed with rheumatic fever is to receive penicillin therapy. Which statement by the parents should lead the nurse to judge that the parents understand the teaching about penicillin as part of the treatment plan?
Correct response: "Our child should take the medication until the primary health care provider discontinues it."
Question A client taking oral contraceptives is placed on a 10-day course of antibiotics for an infection. Which instruction should the nurse include in the teaching plan?
Correct response: "Use a barrier method of birth control for the rest of your cycle."
The nurse is preparing a client's preoperative medication. The prescription reads atropine 0.6 mg and meperidine hydrochloride 50 mg IM. The dosage of available atropine is 0.8 mg/mL, and the dosage of available meperidine is 100 mg/mL. What will be the total volume of medication the nurse will administer? Record your answer using two decimal places.
Correct response: 1.25
A 5-year-old child has been placed on phenytoin for tonic-clonic seizures. The child weighs 42 lb (19.1 kg), and the maintenance dose prescribed for this child is 7.5 mg/kg/day. How many milligrams should the child receive each day? Record your answer using a whole number.
Correct response: 143
A client has an ordered intravenous infusion that is ordered to infuse at 3000 mL of D5W in a 24-hour period (drop factor of 10). Calculate the drops per minute. Record your answer using a whole number.
Correct response: 21
The physician has ordered an I.V. of 3000 mL of 0.9% sodium chloride to be infused over the next 24 hours. The nurse uses I.V. tubing that has a drip factor of 10. Calculate the drops per minute needed to deliver the correct amount of I.V. fluid. Record your answer using a whole number.
Correct response: 21
A client, undergoing treatment for active pulmonary tuberculosis, is prescribed isoniazid tablets. The order is written for the client to receive 5 mg/kg of body weight up to a maximum of 300 mg daily. Based on the client's body weight of 143 lb (65 kg), how many 100-mg tablets should the nurse administer? Record your answer using a whole number.
Correct response: 3
The nurse is calculating the digoxin dose for a pediatric client who weighs 11.36 kg (25 lb). The dose for the client is 30 mcg/kg. How many mcg will the client receive per dose? Record your answer using one decimal place.
Correct response: 340.8
A client is admitted with a diagnosis of diabetic ketoacidosis. An insulin drip is initiated with 50 units of insulin in 100 ml of normal saline solution. The I.V. is being infused via an infusion pump, and the pump is currently set at 10 ml/hr. How many units of insulin each hour is this client receiving? Record your answer using whole number.
Correct response: 5
A 3-year-old child is to receive 500 ml of dextrose 5% in normal saline (D5NSS) solution over 8 hours. At what rate (in milliliters/hour) would the nurse set the infusion pump? Record your answer using one decimal place.
Correct response: 62.5
A client with symptoms of acute asthma is ordered I.V. aminophylline 350 mg in 100 ml to be administered over 30 minutes. The nurse has vials of I.V. aminophylline labeled 250 mg/5 ml. How many milliliters of fluid contain the dose ordered? Record your answer using a whole number.
Correct response: 7
A registered nurse(RN) on the oncology floor is busy with another client, so the RN delegates care of a client to a coworker, a licensed practical nurse (LPN). The client that the LPN begins caring for requires a three-hour chemotherapy infusion. Which statement is in accordance with the Nurse Practice Act?
Correct response: A chemotherapy certified RN must begin the chemotherapy, then the LPN may monitor the client.
A client is receiving gentamicin sulfate intravenously. Before administering the next dose, the nurse reviews the peak and trough serum levels. The nurse uses this information to do what?
Correct response: Adjust the dosage to the therapeutic range.
A home health nurse visits a client who's taking pilocarpine, a miotic agent, to treat glaucoma. The nurse notes that the client's pilocarpine solution is cloudy. What should the nurse do first?
Correct response: Advise the client to discard the drug because it may have undergone chemical changes or become contaminated.
A client takes 30 ml of magnesium hydroxide and aluminum hydroxide with simethicone P.O. 1 hour and 3 hours after each meal and at bedtime for treatment of a duodenal ulcer. Why does the client take this antacid so frequently?
Correct response: It has a short duration of action.
The nurse understands that assessment of blood pressure in clients receiving antipsychotic drugs is important. What is a reason for this assessment?
Correct response: Orthostatic hypotension is a common side effect.
The nurse should dispose of a used needle and syringe by:
Correct response: Placing uncapped, used needles and syringes immediately in the universal precaution container in the client's room.
Which principle should a nurse consider when administering pain medication to a client?
Correct response: Sustained-release oral formulations should be given around the clock, if possible, for control of chronic pain.
A nurse is to administer several oral medications to a client at the same time. Which nursing instruction or action is appropriate in this situation?
Correct response: Tell the client the name and action or use of each medication before administering it.
Why are antacids administered regularly, rather than as needed, in peptic ulcer disease?
Correct response: To keep gastric pH at 3.0 to 3.5
A client is receiving total parenteral nutrition (TPN), and the nurse is concerned about the complication of fluid volume overload. Which nursing action is most appropriate in the administration of TPN to prevent this complication?
Correct response: Use an infusion pump to administer the TPN solution.
A nurse is caring for a client receiving chemotherapy. Which nursing action is most appropriate for handling chemotherapeutic agents?
Correct response: Wear protective clothing
The client has come to the hospital emergency room reporting lethargy and vomiting. The healthcare provider makes a tentative diagnosis of Reye's syndrome. The client's history reveals a recent acute viral infection and the use of several medications. The nurse suspects which medication to be implicated in the development of Reye's syndrome?
Correct response: aspirin
Where is the best site for the nurse to assess a client's pulse prior to administering digoxin?
Correct response: at the left fifth intercostal space, midclavicular line
Which adverse effect occurs when there is too rapid an infusion of TPN solution?
Correct response: circulatory overload
A nurse is teaching a client about hormonal contraceptive therapy. If a client misses three or more pills in a row, the nurse should instruct the client to
Correct response: discard the pack, use an alternative contraceptive method until her period begins, and start a new pack on the regular schedule.
The nurse is caring for a client in the intensive care unit. Which drug is most commonly used to treat cardiogenic shock?
Correct response: dopamine
A client with schizophrenia comes to the outpatient mental health clinic 5 days after being discharged from the hospital. The client was given a 1-week supply of clozapine. The client tells the nurse that she has too much saliva and frequently needs to spit. The nurse interprets the client's statement as being consistent with which factor?
Correct response: expected adverse effect of clozapine
Clients who are receiving parenteral nutrition (PN) are at risk for development of which complication?
Correct response: fluid imbalances
The nurse is reviewing the laboratory report with the client's lithium level prior to administering the 1700 hours dose. The lithium level is 1.8 mEq/L (1.8 mmol/L). The nurse should:
Correct response: hold the 1700 hours dose of lithium.
The sudden onset of which sign indicates a potentially serious complication for the client receiving an IV infusion?
Correct response: noisy respirations
A 2-year-old child has tested positive for tuberculosis (TB), and has been started on rifampin. The child's parents ask the nurse if there is any important information they should know about this medication. What important adverse effect should the nurse inform these parents about?
Correct response: orange body secretions
Which food should the nurse tell the client to avoid while taking phenelzine?
Correct response: salami
A nurse is administering two drugs to a client at the same time. The nurse knows the most probable reason for giving the drugs together is
Correct response: synergism
A client is brought to the ED with narcotic overdose and respiratory depression. The client is administered naloxone hydrochloride, and then asks the nurse, "What if I am allergic to what you gave me?" What adverse effects should the nurse communicate to the client? Select all that apply.
Correct response: tachycardia, tremors
When teaching a client when to take glipizide in order to maximize the effectiveness of the drug, the nurse should instruct the client to:
Correct response: take glipizide 30 minutes before breakfast.
A nurse is developing a teaching plan for a client who has just been diagnosed with breast cancer. The nurse should include information about
Correct response: tamoxifen.
The husband of a client who was diagnosed 6 years ago with Alzheimer's disease approaches the nurse and says, "I'm so excited that my wife is starting to use donepezil for her illness." What should the nurse tell the husband?
Correct response: the medication is effective mostly in the early stages of the illness.
Which statement indicates that a client understands discharge instructions about propranolol?
Correct response:"I will assess my heart rate before I take my medication."
After the nurse has taught the client who is being discharged on lithium about the drug, which client statement would indicate that the teaching has been successful?
Correct response:"I'll call my health care provider right away for any vomiting or muscle weakness."
A client who is incoherent and agitated comes to the emergency department. The client reports visual and auditory hallucinations. The healthcare provider orders haloperidol, 5 mg IM. When educating the client on this medication, which statement by the nurse is correct?
Correct response:"This medication will help decrease your tension and agitation."
A nurse is preparing to administer intravenous cefazolin 1 gram in 50 mL of normal saline over 30 minutes. How many mLs per hour will the client receive? Record your answer using a whole number.
Correct response:100
Chlorothiazide is ordered for a 1-year-old client with neonatal bronchopulmonary dysplasia (chronic lung disease). The dosage ordered is 30 mg/kg/day. The client weighs 10 kg. How much is given per dose when administered 2 times per day? Record your answer using a whole number.
Correct response:150
The nurse is preparing to administer 500 mL of whole blood to a client. The blood is to be infused over 4 hours. The infusion tubing delivers 10 gtt/mL. How many drops of blood per minute must the nurse infuse to complete the infusion in 4 hours? Record your answer using a whole number.
Correct response:21
A client who is recovering from gastric surgery is receiving IV fluids to be infused at 100 mL/hour. The IV tubing delivers 15 gtt/mL. The nurse should infuse the solution at a flow rate of how many drops per minute to ensure that the client receives 100 mL/hour? Record your answer using a whole number.
Correct response:25
Which client would be most at risk for secondary Parkinson's disease caused by pharmacotherapy?
Correct response:30-year-old client with schizophrenia who is taking chlorpromazine
A client returns to the room from the postanesthesia care unit after undergoing a right hemicolectomy. The health care provider orders 1 L of dextrose 5% in half-normal saline solution to infuse at 125 ml/hour. The drop factor of the available intravenous tubing is 15 gtt/ml. What is the drip rate in drops per minute? Round your answer to the nearest whole number. (For example: 62)
Correct response:31
A client who is experiencing an exacerbation of ulcerative colitis is receiving IV fluids that are to be infused at 125 mL/h. The IV tubing delivers 15 gtt/mL. How quickly should the nurse infuse the fluids in drops per minute to infuse the fluids at the prescribed rate? Record your answer using a whole number.
Correct response:31
A nurse is teaching a client how to take nitroglycerin to treat angina pectoris. What should the nurse include in the instructions?
Correct response:Call emergency medical services immediately if chest pain does not subside within 15 minutes.
The nurse observes the client instill eye drops. The client says, "I just try to hit the middle of my eyeball so the drops do not run out of my eye." What should the nurse tell the client about this method of instilling eye drops? This method may cause:
Correct response:corneal injury
A client is receiving an I.V. infusion of mannitol after undergoing intracranial surgery to remove a brain tumor. To determine whether this drug is producing its therapeutic effect, the nurse should consider which finding most significant?
Correct response:increased urine output
Immediately after a lumbar laminectomy, the nurse administers ondansetron hydrochloride to the client as prescribed. The nurse determines that the drug is effective when which sign is controlled?
Correct response:nausea
A primigravid client visits the clinic for a routine examination at 35 weeks' gestation. The client's blood pressure is near the baseline of 120/74 mm Hg with no proteinuria or evidence of facial edema. The client asks the nurse, "What should I take if I get an occasional headache after looking at my computer at work all day?" Which over-the-counter medicine does the nurse consider to be safest for occasional use by a pregnant client with no known risks?
acetaminophen
The home health nurse is speaking to the wife of a client with neurocognitive disorder due to Alzheimer's disease. The client has been taking donepezil. The nurse is most concerned when the caregiver states
Correct response: "Yesterday, I managed to weigh my husband, and he has lost 8 lbs this month."
Propranolol is ordered for a client that has Type 1 diabetes mellitus. Which client statement indicates understanding of a common side effect of this therapy?
Correct response: "I will check my blood glucose at least twice a day."
A client with a urinary tract infection is to take nitrofurantoin four times each day. The client asks the nurse, "What should I do if I forget a dose?" What should the nurse tell the client?
Correct response: "Take the prescribed dose as soon as you remember it, and if it is very close to the time for the next dose, delay that next dose."
Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"?
Correct response: "Test your blood glucose every 4 hours."
The client with breast cancer is prescribed tamoxifen 20 mg daily. The client states she does not like taking medicine and asks the nurse if the tamoxifen is really worth taking. What should the nurse tell the client?
Correct response: "This drug has been found to decrease metastatic breast cancer."
A client at 33 weeks' gestation is admitted in preterm labor. She is given betamethasone 12 mg IM q 24 hours × 2. What is the expected outcome of this drug therapy?
The neonate will be born with mature lungs.
A nurse suspects that a client has digoxin toxicity. The nurse should assess for
Correct response:vision changes.
A client presents with severe headache, blurred vision, anxiety and confusion. The client's blood pressure is 224/137 mm Hg. The family reports that the client has hypertension, but has not been taking the prescribed blood pressure medications. The nurse anticipates giving which medication?
Correct response: Labetalol
A client is taking phenelzine 15 mg PO three times a day. The nurse is about to administer the next dose when the client tells the nurse about having a throbbing headache. Which action should the nurse do first?
Correct response: Obtain the client's vital signs.
The health care provider (HCP) changes a client's current dose of IM meperidine hydrochloride to an oral dosage. The current IM dosage is 75 mg every 4 hours as needed. What dosage of oral meperidine will be required to provide an equivalent analgesic dose?
150 to 300 mg every 4 hour
One hour before a client is to undergo abdominal surgery, the physician orders atropine, 0.6 mg I.M. The client asks the nurse why this drug must be administered. How should the nurse respond?
"Atropine decreases salivation and gastric secretions."
The effectiveness of selective serotonin reuptake inhibitor (SSRIs) therapy, in a client with post traumatic stress disorder (PTSD), can be verified when the client states
"I'm sleeping better now."
The nurse is reconciling the prescriptions for a client diagnosed recently with pulmonary tuberculosis who is being admitted to the hospital for a total hip replacement (see medication prescription sheet). The client asks if it is necessary to take all of these medications while in the hospital. What should the nurse tell the client?
"It's important to continue to take the medications because the combination of drugs prevents bacterial resistance."
A nurse on the geropsychiatric unit receives a call from the son of a recently discharged client. He reports that his father just got a prescription for memantine to take "on top of his donepezil." The son then asks, "Why does he have to take extra medicines?" What should the nurse should tell the son?
"Memantine and donepezil are commonly used together to slow the progression of dementia."
A multigravid client admitted to the labor area is scheduled for a cesarean birth under spinal anesthesia. Which client statement indicates that teaching about spinal anesthesia has been understood?
"The anesthetic may cause a severe headache, which is treatable."
A multigravida with a history of cesarean birth due to fetal distress is admitted for a trial labor and possible vaginal birth. After several hours of active labor, the primary care provider prescribes nalbuphine. The nurse evaluates the drug as effective when the client makes which statement?
"The contractions don't seem as painful as before."
An infant who weighs 7.5 kg is to receive ampicillin 25 mg/kg intrvenously every 6 hours. How many milligrams would the nurse administer per dose? Record your answer using one decimal place
187.5
The health care provider (HCP) prescribes IV cefazolin 1 g for a client. In preparing to administer the cefazolin, the nurse notes that the client is allergic to penicillin. Based on this information, what is an appropriate action for the nurse to take?
Correct response: Notify the HCP of the client's allergy to penicillin.
A 7-year-old boy with a fractured right femur has been admitted to the pediatric unit following a car accident. The provider orders morphine 0.02 mg/kg I.V. for severe pain control. The client weighs 52 lb (23.6 kg) and is experiencing pain of 9 out of 10 on the pain scale. What dosage of morphine should the nurse will administer to this client? Record your answer using two decimal places.
0.47
The nurse has received a prescription to add 20 mEq of potassium chloride to a 1,000-mL bottle of IV fluid. The nurse has a 30-mL, multiple-dose vial of potassium chloride. The label reads 2 mEq/mL. How many milliliters should the nurse add to the IV fluid? Record your answer using a whole number.
10
The health care provider (HCP) prescribes ampicillin 100 mg/kg/dose for a newly admitted neonate. The neonate weighs 1,350 g. How many milligrams should the nurse administer? Record your answer using a whole number.
135
A client who has suffered a stroke is brought to the emergency department. The physician has ordered t-PA 0.9mg/kg for a client who weighs 198 lbs (90 kg). Directions for administration are to mix the 100 mg vial of t-PA with 100 ml of sterile water to yield 1 mg/ml. How many ml of t-PA should be removed from the vial and discarded before administration? Record your answer using a whole number.
19
A client is to receive 1 unit of packed red blood cells over 2 hours. There are 250 mL in the infusion bag. The IV administration infusion set delivers 10 gtt/mL. At what flow rate (in drops per minute) should the nurse run the infusion? Record your answer using a whole number.
21
An adolescent sustains a head injury and develops diabetes insipidus. The healthcare provider orders desmopressin, 10 mcg subcutaneously (SubQ). When does the nurse assess the client to determine the need for an addional dose?
4 to 7 hours
A client undergoing cancer chemotherapy has been prescribed epoetin alfa. The client is to receive 150 units/kg subcutaneously three times per week. The client weighs 90 kg. How many units will the nurse administer at each dose? Record your answer using a whole number.
Correct response: 13500
The nurse is preparing to administer erythromycin ophthalmic ointment to a neonate soon after birth. The nurse should explain to the parents that this medication, in addition to preventing blindness caused by gonococcal organisms, also prevents neonatal blindness caused by which organism?
Chlamydia trachomatis
The client has a history of hypertension and presents at the clinic reporting of dyspnea and a recent 7-pound weight gain. The client is diagnosed with congestive heart failure (CHF). The client is prescribed hydrochlorothiazide. What should the nurse include in the client's teaching about the side effects of hydrochlorothiazide? Select all that apply.
Correct response: "Hydrochlorothiazide can cause your eyes to be sensitive to light." "Hydrochlorothiazide can cause the sodium in your blood to be too low." "Hydrochlorothiazide can cause high blood sugar."
The client with heart failure asks the nurse about the reason for taking enalapril maleate. The nurse should tell the client:
Correct response: "This drug will dilate your blood vessels and lower your blood pressure."
A pediatric client has recently been diagnosed with asthma and is prescribed theophylline. What should the nurse include in the client's teaching concerning what to avoid when taking theophylline? Select all that apply.
Correct response: "You should avoid chocolate when taking theophylline." "You should avoid ice cream when taking theophylline." "You should avoid iced tea when taking theophylline." "You should avoid soft drinks when taking theophylline."
The nurse has an order to administer 1200 mg of an antibiotic. The drug is prepared as 6 grams of the drug in 2 ml of solution. The nurse should administer how many ml of the drug? Record your answer using one decimal place.
Correct response: 0.4
The nurse is to administer 1,200 mg of an antibiotic. The drug is prepared with 6 g of the drug in 2 mL of solution. The nurse should administer how many milliliters of the drug? Record your answer using one decimal place.
Correct response: 0.4
When administering flumazenil intravenously for reversal of sedation, what should the nurse do? Select all that apply.
Give the medication undiluted in incremental doses. Be alert for shivering and hypotension. Use only a free-flowing IV line in a large vein. Monitor the client's level of consciousness
A preterm neonate who has been stabilized is placed in a radiant warmer and is receiving oxygen via an oxygen hood. Which action should the nurse take while administering oxygen in this manner?
Humidify the air being delivered.
When preparing to draw up 8 units of a short-acting insulin and 20 units of a long-acting insulin in the same syringe, the nurse should use which technique?
Inject air in the vial with the long-acting insulin first.
An IV infusion is to be administered through a scalp vein on an infant's head. What should the nurse tell the parents to prepare them for the procedure?
It may be necessary to remove a small amount of hair from the infant's scalp.
The nurse is planning to teach the client how to properly use a metered-dose inhaler to treat asthma. The nurse should tell the client to use which procedure?
Rinse the mouth after each use of a steroid inhaler.
The nurse teaches the client how to instill nose drops. Which technique is correct?
The client blows the nose gently before instilling drops.
A nurse is caring for a client receiving morphine 4 mg I.V. every hour as needed to relieve pain. What teaching would the nurse provide?
The dose can be gradually decreased to avoid physical withdrawal symptoms
A physician orders prednisone to control inflammation in a client with interstitial lung disease. During client teaching, the nurse stresses the importance of taking prednisone exactly as ordered and cautions against discontinuing the drug abruptly. A client who discontinues prednisone abruptly may experience
acute adrenocortical insufficiency
A nurse is preparing a teaching plan for a male client newly prescribed atenolol. Which information is important for the nurse to teach this client?
causes and treatments for erectile dysfunction
The health care provider prescribes clomiphene citrate for a woman who has been having difficulty getting pregnant. When teaching the client about this drug, the nurse should discuss what potential adverse effects?
chance of multiple gestation.
Which performance improvement strategy helps prevent adverse reactions to blood products?
confirming client identification with two qualified health professionals
The plan of care for a client with hypertension taking propranolol hydrochloride should include:
instructing the client to notify the health care provider of irregular or slowed pulse rate.
A client rates the pain level of a migraine an 8 on a scale of 1-10. How would the nurse administer the medication to give the client the quickest relief?
intravenous (IV)
A client has been taking imipramine, 125 mg by mouth daily, for a week. The client reports having a sore throat and a low-grade fever. What is the nurse's best action?
Collaborate with the doctor for a complete blood count.
A client takes lithium carbonate daily, and their most recent lithium carbonate level is 1.8 mEq/L. What response by the nurse is best for this client?
Correct response: Tell the client to hold his/her intake of lithium and to call the physician.
Which instruction is most important for the nurse to include in the teaching plan for a client who is taking phenelzine?
Correct response: Avoid foods high in tyramine.
A nurse is caring for a woman receiving a lumbar epidural anesthetic block to control labor pain. What should the nurse do to prevent hypotension?
Correct response: Ensure adequate hydration before the anesthetic is administered.
An IV infusion is to be administered through a scalp vein on an infant's head. What should the nurse tell the parents to prepare them for the procedure?
Correct response: It may be necessary to remove a small amount of hair from the infant's scalp.
A nurse is preparing to administer digoxin elixir to a client. Which principle regarding this medication is correct?
Correct response: Liquid digoxin should be measured with a calibrated dropper or syringe.
Blood administration is ordered for a client receiving chemotherapy. The nurse is obtaining all supplies needed for infusion. Which intravenous solution is obtained?
Correct response: Look for 0.9% Sodium Chloride injection. REFL8002 NDC 0264-7800-20 DIN 01924303 HK 22617
A physician orders a tricyclic antidepressant for a client who has suffered an acute myocardial infarction (MI) within the previous 6 months. Which action should the nurse take?
Correct response: Question the physician about the order.
A client is to be discharged on prednisone. Which statement indicates that the client understands how to take the medication?
"I need to wear or carry identification that I am taking prednisone."
A client with marked oliguria is ordered a test dose of 0.2 g/kg of 15% mannitol solution intravenously over 5 minutes. The client weighs 132 lb (60 kg). How many grams would the nurse administer? Record your answer as a whole number.
Correct response: 12
The nurse is discontinuing a peripheral venous access device. Place the steps in the order that the nurse should perform them. All options must be used.
Correct response: Perform hand hygiene. Put on gloves. Remove tape and sterile dressing. Withdraw catheter. Apply pressure to area just above the insertion site. Apply an occlusive dressing to site.
A nurse is administering an IV antineoplastic agent when the client says, "My arm is burning by the IV site." What should the nurse do first?
Correct response: Stop infusing the medication.
A client with depression states, "I'm still feeling nauseous after I take venlafaxine. Maybe I need something else." What should the nurse should tell the client to do?
Correct response: Take the medication at mealtime.
A client calls the clinic and tells the nurse that she forgot to take her oral contraceptive this morning. What should the nurse tell the client to do?
Correct response: Take the medication immediately.
A nurse is preparing to administer 500 mL of an IV solution to a child over 12 hours via tubing that delivers microdrips at 60 gtt/mL. At what rate should the nurse infuse the solution? Record your answer using a whole number.
Correct response:42
The health care provider (HCP) prescribes an intravenous infusion of 5% dextrose in 0.45 normal saline to be infused at 2 mL/kg per hour in an infant who weighs 9 lb (4.1 kg). How many milliliters per hour of the solution should the nurse infuse? Round to one decimal place.
Correct response:8.2
Just prior to administering lorazepam 2 mg I.V. to an agitated client, the client knocks the medication to the floor. After retrieving the medication, what is the best action by the nurse?
Correct response:Ask another nurse to witness the waste of the medication.
After having a total hip replacement, a client receives morphine sulfate by patient-controlled analgesia (PCA) pump. The client says, "This pump doesn't help my pain at all." What should the nurse do in response to this statement?
Correct response:Assess the client's understanding of the PCA pump.
Which technique is correct when the nurse administers a subcutaneous injection?
Correct response:Insert the needle at a 45-degree angle to the skin.
Griseofulvin was ordered to treat a child's ringworm of the scalp. The nurse instructs the parents to use the medication for several weeks for which reason?
Correct response:The growth of the causative organism into new cells is prevented with long-term use.
A client with diabetes insipidus is receiving vasopressin. Which sign indicates that the drug is having the intended effect?
Correct response:concentration of urine
The client is receiving an IV infusion of 5% dextrose in normal saline running at 125 ml/h. When hanging a new bag of fluid, the nurse notes swelling and hardness at the infusion site. The nurse should first:
Correct response:discontinue the infusion.
A breastfeeding primiparous client with a midline episiotomy is prescribed ibuprofen orally. When does the nurse instruct the client to take the medication?
Correct response:immediately after a feeding
What adverse reaction might the nurse observe after administering enteric-coated erythromycin to a client?
Correct response:nausea and vomiting
A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The physician begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption?
intrinsic factor
A client who is experiencing alcohol withdrawal exhibits tremors, diaphoresis, and hyperactivity. Blood pressure is 190/87 mm Hg, and pulse is 92 bpm. Which medication should the nurse expect to administer?
lorazepam
During labor, a primigravid client receives an epidural anesthetic, and the nurse assists in monitoring maternal and fetal status. Which finding suggests an adverse reaction to the anesthesia?
maternal hypotension
A child is receiving total parenteral nutrition (TPN). During TPN therapy, the most important nursing action is:
monitoring the blood glucose level closely.
A nurse is planning to administer a sodium polystyrene sulfonate enema to a client with a potassium level of 6.2 mEq/L. Correct administration and the effects of this enema should include having the client
retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea.