Pharmacology Final Exam

An overweight client taking warfarin (Coumadin) has dry skin due to decreased arterial blood flow. What should the nurse instruct the client to do? Select all that apply. 1. Apply lanolin or petroleum jelly to intact skin. 2. Follow a reduced-calorie, reduced-fat diet. 3. Inspect the involved areas daily for new ulcerations. 4. Instruct the client to limit acti vi lies of daily living (ADLs). 5. Use an electric razor to shave.

1, 2, 3, 5. Maintaining skin integrity is important in preventing chronic ulcers and infections. The client should be taught to inspect the skin on a daily basis. The client should reduce weight to promote circulation; a diet lower in calories and fat is appropriate. Because the client is receiving Coumadin, the client is at risk for bleeding from cuts. To decrease the risk of cuts, the nurse should suggest that the client use an electric razor. The client with decreased arterial blood flow should be encouraged to participate in ADLs. In fact, the client should be encouraged to consult an exercise physiologist for an exercise program that enhances the aerobic capacity of the body.

The nurse administers two 325 mg aspirin every 4 hours to a client with pneumonia. The nurse should evaluate the outcome of administering the drug by assessing which of the following? Select all that apply. 1. Decreased pain when breathing. 2. Prolonged clotting Lime. 3. Decreased temperature. 4. Decreased respiratory rate. 5. Increased ability to expectorate secretions.

1, 3. Aspirin is administered to clients with pneumonia because it is an analgesic that helps control chest discomfort and an antipyretic that helps reduce fever. Aspirin has an anticoagulant effect, but that is not the reason for prescribing it for a client with pneumonia, and the use of the drug will be short term. Aspirin docs not affect the respiratory rate and does not facilitate expectoration of secretions.

A client with acute chest pain is receiving IV morphine sulfate. Which of the following results are intended effects of morphine? Select all that apply. 1. Reduces myocardial oxygen consumption. 2. Promotes reduction in respiratory rate. 3. Prevents ventricular remodeling. 4. Reduces blood pressure and heart rate. 5. Reduces anxiety and fear.

1, 4, 5. Morphine sulfate acts as an analgesic and sedative. It also reduces myocardial oxygen consumption, blood pressure, and heart rate. Morphine also reduces anxiety and fear due to its sedative effects and by slowing the heart rate. It can depress respirations; however, such an effect may lead to hypoxia, which should be avoided in the treatment of chest pain. Angiotensin-converting enzymeinbibitor drugs, not morphine, may help to prevent ventricular remodeling.

The physician has prescribed ciprofloxacin (Cipro) for a client who takes warfarin (Coumadin). The nurse should instruct the client to do which of the following while taking this drug? Select all that apply. 1. Split the tablets and stir them in food. 2. Avoid exposure to sunlight. 3. Eliminate caffeine from the diet. 4. Report unusual bleeding. 5. Increase fluid intake to 3,000 mL/day.

2, 4. A Black Box Warning for ciprofloxacin (Cipro) is that ciprofloxacin (Cipro) may increase the anticoagulant effects of warfarin (Coumadin). The nurse should instruct the client to report increased bleeding and to monitor the prothrombin time (PT) and the international normalized ratio (INR) closely. Although there is a drug-food interaction and taking ciprofloxacin (Cipro) may increase the stimulatory effect of caffeine, the client does not need to eliminate caffeine, but should report signs of stimulant effect. Ciprofloxacin (Cipro) may cause photosensitivity reactions; the nurse must advise the client to avoid excessive sunlight or artificial ultraviolet light during therapy. Clients must be advised not to crush, split, or chew the extended-release tablets. It is not necessary to increase the amount of fluids.

The nurse is evaluating the client's learning about combination chemotherapy. Which of the following statements by the client about reasons for using combination chemotherapy indicates the need for further explanation? 1. "Combination chemotherapy is used to interrupt cell growth cycle at different points." 2. "Combination chemotherapy is used to destroy cancer cells and treat side effects simultaneously." 3. "Combination chemotherapy is used to decrease resistance." 4. "Combination chemotherapy is used to minimize the toxicity from using high closes of a single agent."

2. Combination chemotherapy does not mean two groups of drugs, one to kill the cancer cells and one to treat the adverse effects of the chemotherapy. Combination chemotherapy means that multiple drugs are given to interrupt the cell growth cycle at different points, decrease resistance to a chemotherapy agent, and minimize the toxicity associated with use of a high dose of a single agent (ie, by using multiple agents with different toxicities).

A client has a history of heart failure and has been furosemide (Lasix), digoxin (Lanoxin). and potassium chloride. The client has nausea, blurred vision, headache, and weakness. The nurse notes that the client is confused. The telemetry strip shows first-degree atrioventricular block. The nurse should assess the client for signs of which of the following? 1. Hyperkalemia. 2. Digoxin toxicity. 3. Fluid deficit. 4. Pulmonary edema.

2. Early symptoms of digoxin toxicity include anorexia, nausea, and vomiting. Visual disturbances can also occur, including double or blurred vision and visual halos. Hypokalemia is a common cause of digoxin toxicity associated with anhythmias because low serum potassium can enhance ectopic pacemaker activity. Although vomiting can lead to fluid deficit, given the client's history, the vomiting is likely due to the adverse effects of digoxin toxicity. Pulmonary edema is manifested by dyspnea and coughing.

An elderly client with diabetes who has been maintained on metformin (Glucophage) has been scheduled for a cardiac catheterization. The nurse should verify that the physician has written a prescription to: 1. Limit the amount of protein in the diet prior to the cardiac cath. 2. Withhold the Glucophage prior to the cardiac catheterization. 3. Administer the Glucophage with only a sip of water prior to the cardiac catheterization. 4. Give the Glucophage before breakfast.

2. The nurse should verify that the physician has requested to withhold the Glucophage prior to any procedure requiring dye such as a cardiac catheterization clue to the increased risk of lactic acidosis. Acid i tionally, the drug will usually be withheld for up to 48 hours following a procedure involving dye while it clears the client's system. The physician may prescribe sliding scale insulin during

The physician prescribes sulfasalazine for the client with ulcerative colitis. Which instruction should the nurse give the client about taking this medication? 1. Avoid taking it with food. 2. Take the total dose at bedtime. 3. Take it with a full glass (240 mL) of water. 4. Stop taking it if urine turns orange-yellow.

3. Adequate fluid intake of at least eight glasses a day prevents crystalluria and stone formation during sulfasalazine therapy. Sulfasalazine can cause gastrointestinal distress and is best taken after meals and in equally divided doses. Sulfasalazine gives alkaline urine an orange-yellow color, but it is not necessary to slop the drug when this occurs.

A client is admitted with acute necrotizing pancreatitis. Lab results have been obtained, and a peripheral IV has been inserted. Which of the following prescriptions from a health care provider should the nurse question? 1. Infuse a 500-mL normal saline bolus. 2. Calcium gluconate 90 mg in 100 mL NS. 3. Total parnnteral nutrition (TPN) at 72 mL/h. 4. Placement of a Foley catheter.

3. Clients with acute necrotizing pancreatitis should remain nothing by mouth (NPO) with early enteral feeding via the jejunum to maintain bowel integrity and immune function. TPN is considered if enteral feedings are contraindicated. Access is also needed for TPN, preferably via a central line. Hemodynamic instability can result from fluid volume loss and bleeding and requires fluid and electrolyte replacement. Fat necrosis occurring with acute pancreatitis can cause hypocalcemia requiring calcium replacement. A Foley catheter provides accurate output assessment to monitor for prerenal acute renal failure that can occur from hypovolemia.

A client with chronic heart failure has atrial fibrillation and a left ventricular ejection fraction of 15%. The client is taking warfarin (Coumadin). The expected outcome of this drug is to: 1. Decrease circulatory overload. 2. Improve the myocardial workload. 3. Prevent thrombus formation. 4. Regulate cardiac rhythm.

3. Coumadin is an anticoagulant, which is used in the treatment of atrial fibrillation and decreased left ventricular ejection fraction (less than 20%) to prevent thrombus formation and release of emboli into the circulation. The client may also take other medication as needed to manage the heart failure. Coumadin does not reduce circulatory load or improve myocardial workload. Coumadin does not affect cardiac rhythm.

As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3 mg given sublingually. This drug's principal effects are produced by: 1. Antispasmodic effects on the pericardium. 2. Causing an increased myocardial oxygen demand. 3. Vasodilation of peripheral vasculature. 4. Improved conductivity in the myocardium.

3. Nitroglycerin produces peripheral vasodi lation, which reduces myocardial oxygen consumption and demand. Vasodilation in coronary arteries and collateral vessels may also increase blood flow to the ischemic areas of the heart. Nitroglycerin decreases myocardial oxygen demand. Nitroglycerin does not have an effect on pericardia I spasticity or conductivity in the myocardium.

A client is to be discharged on prednisone. Which of the following statements indicates that the client understands important concepts about the medication therapy? 1. "I need to take the medicine in divided doses at morning and bedtime." 2. "I am to take 40 mg of prednisone for 2 months and then stop." 3. "I need to wear or carry identification that I am taking prednisone." 4. "Prednisone will give me extra protection from colds and flu."

3. The client needs to wear or carry information containing the name of the drug, dosage, physician and contact information, and emergency instructions because additional corticosteroid drug therapy would be needed during emergency situations. Prednisone should be taken in the morning because it can cause insomnia and because exogenous corticosteroid suppression of the adrenal cortex is less when it is administered in the morning. Preclnisone must never be stopped suddenly. It must be tapered off to allow for the adrenal cortex to recover from drug-induced atrophy so that it can resume its function. Prednisone suppresses the immune response and masks infections. ll does not provide extra protection against infection.

The nurse is to administer ampicillin 500 mg orally to a client with a ruptured appendix. The nurse checks the capsule in the client's medication box, which is located inside of the client's room. The dosage of the medication is not labeled, but the nurse recognizes the color and shape of the capsule. The nurse should next: 1. Administer the medication to maintain blood levels of the drug. 2. Ask another registered nurse to verify that the capsule is ampicillin. 3. Contact the pharmacy to bring a properly labeled medication. 4. Notify the unit manager to report the problem.

3. The nurse should contact the pharmacy directly and request that a properly labeled medication be provided. The nurse should not administer any drug that is not properly labeled, even if the nurse or another nurse recognizes the medication. It is not necessary to notify the unit manager at this point because the client needs to receive the antibiotic as soon as possible.

A client diagnosed with a deep vein thrombosis has heparin sodium infusing at 1,500 units/h. The concentration of heparin is 25,000 units/500 mL. If the infusion remains at the same rate for a full 12-hour shift, how many milliliters of fluid will infuse? __________________________________________mL.

360 mL

The client with peripheral vascular disease has been prescribed diltiazem (Cardizem). The nurse should determine the effectiveness of this medication by assessing the client for: 1. Relief of anxiety. 2. Sedation. 3. Vasoconstriction. 4. Vasodilation.

4. Diltiazem is a calcium channel blocker that blocks the influx of calcium into the cell. In this situation, the primary use of diltiazem is to promote vasodilation and prevent spasms of the arteries. As a result of the vasodilation, blood, oxygen, and nutrients can reach the muscle and tissues. Diltiazem is not an antianxiety agent and does not promote sedation. It also does not cause vasoconstriction which would be contraindicated for the client with peripheral vascular disease.

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? 1. Floor exercises. 2. Stretching. 3. Running. 4. Walking.

4. The best exercise for females who am on long-term corticosteroid therapy is a low-impact, weightbearing exercise such as walking or weight lifting. Floor exercises do not provide for the weightbearing. Stretching is appropriate but does not offer sufficient weightbearing. Running provides for weightbearing but is hard on the joints and may cause bleeding.

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

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

A client has a new prescription for metoclopramide (Reglan). On review of the chart, the nurse identifies that this medication can be safely administered with which condition? 1. Intestinal obstruction 2. Peptic ulcer with melena 3. Diverticulitis with perforation 4. Vomiting following cancer chemotherapy

Answer: 4 Rationale: Metoclopramide is a gastrointestinal stimulant and antiemetic. Because it is a gastrointestinal stimulant, it is contraindicated with gastrointestinal obstruction, hemorrhage, or perforation. It is used in the treatment of emesis after surgery, d1emotherapy, and radiation.

A client l with chest pain is prescribed intravenous nitroglycerin. Which assessment is of greatest concern for the nurse initiating the nitroglycerin drip? 1. Serum potassium is 3.5 mEq/L (3.5 mmol/L). 2. Blood pressure is 88/46. 3. ST elevation is present on the electrocardiogram. 4. Heart rate is 61.

2. Nitroglycerin is a vasodilator that will lower blood pressure. The client is having chest pain and the ST elevation indicates injury to the myocardium, which may benefit from nitroglycerin. The potassium and heart rate are within normal range.

Intravenous heparin therapy is prescribed for a client. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit? 1. Vitamin K 2. Protamine sulfate 3. Potassium chloride 4. Aminocaproic acid (Amicar)

Answer: 2 Rationale: The antidote to heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin sodium. Potassium cl1loride is administered for a potassium deficit. Aminocaproic acid is the antidote for thrombolytic therapy.

A client is taking the prescribed dose of phenytoin (Dilantin) to control seizures. Results of a phenytoin blood level study reveal a level of 35 mcg/mL. Which finding would be expected as a result of this laboratory result? 1. Hypotension 2. Tachycardia 3. Slurred speech 4. No abnormal finding

Answer: 3 Rationale: The therapeutic phenytoin level is 10 to 20 mcg/ mL. At a level higher than 20 mcg/mL, involuntary movements of the eyeballs (nystagmus) occur. At a level higher than 30 mcg/mL, ataxia and slurred speech occur.

The nurse should report which assessment finding to the health care provider (HCP) before initiating thrombolytic therapy in a client with pulmonary embolism? 1. Adventitious breath sounds 2. Temperature of 99.4 ° F orally 3. Blood pressure of 198/110 mm Hg 4. Respiratory rate of 28 breaths/minute

Answer: 3 Rationale: Thrombolytic therapy is contraindicated in a number of preexisting conditions in which there is a risk of uncontrolled bleeding. similar to the case in anticoagulant therapy. Thrombolytic therapy also is contraindicated in severe uncontrolled hypertension because of the risk of cerebral hemorrhage. Therefore the nurse would report the results of the blood pressure to the HCP before initiating therapy.

A client with tuberculosis is being started on antituberculosis therapy with isoniazid. Before giving the client the first close, the nurse should ensure that which baseline study has been completed? 1. Electrolyte levels 2. Coagulation times 3. Liver enzyme levels 4. Serum creatinine level

Answer: 3 Rationale: lsoniazid therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 or abuses alcohol. The laboratory tests in options 1, 2, and 4 are not necessary.

A client who underwent a left lower lobectomy has been out of surgery for 48 hours. The client is receiving morphine sulfate via a patient controlled analgesia (PCA) system and reports having pain in the left thorax that worsens when coughing. The nurse should: 1. Let the client rest, so that the client is not stimulated to cough. 2. Encourage the client to take deep breaths to help control the pain. 3. Check that the PCA device is functioning properly, and then reassure the client that the machine is working and will relieve the pain. 4. Obtain a more detailed assessment of the client's pain using a pain scale.

4. Systematic pain assessment is necessary for adequate pain management in the postoperative client. Guidelines from a variety of health care agencies and nursing groups recommend that institutions adopt a pain assessment scale to assist in facilitating pain management. Even though the client is receiving morphine sulfate by PCA, assessment is needed if she is experiencing pain. The concern is not to eliminate coughing but to control pain adequately. Coughing is necessary to prevent postoperative atelectasis and pneumonia. Breathing exercises may help control pain in some circumstances; however, most clients with thoracic surgery require parenteral opioid analgesics in the early postoperative period. Although it is necessary that the PCA device be checked periodically to ensure that it is functioning properly, if the machine is functional and the client's pain is not relieved, further intervention, beginning with a pain assessment, is indicated.

What is the rationale that supports multidrug treatment for clients with tuberculosis? 1. Multiple drugs potentiate the drugs' actions. 2. Multiple drugs reduce undesirable drug adverse effects. 3. Multiple drugs allow reduced drug dosages to be given. 4. Multiple drugs reduce development of resistant strains of the bacteria.

4. Use of a combination of anti tuberculosis drugs slows the rate at which organisms develop drug resistance. Combination therapy also appears to be more effective than single-drug therapy. Many drugs potentiate (or inhibit) the actions of other drugs; however, this is not the rationale for using multiple drugs to treat tuberculosis. Treatment with multiple drugs does not reduce adverse effects and may expose the client to more adverse effects. Combination therapy may allow some medications (eg, antihypertensives) to be given in reduced dosages; however, reduced dosages are not prescribed for antibiotics and antitubercuIosis drugs.

Amoxicillin trihydrate (Amoxil) 300 mg PO has been prescribed for a client with an oral infection. The medication is available in a liquid suspension that is available as 250 mg/5 mL. How many milliliters should the nurse administer? _____________________________________ mL.

6 mL. To administer 300 mg PO, the nurse will need to administer 6 mL. The following formula is used to calculate the correct dosage: 300 mg/X mL = 250 mg/5 mL.

The nurse provides discharge instructions to a client who is taking warfarin sodium (Coumadin). Which statement, by the client, reflects the need for further teaching? 1. "I will avoid alcohol consumption." 2. "I will take my pills every day at the same time." 3. "I have already called my family to pick up a Medic-Alert bracelet."

Answer: 4 Rationale: Ecotrin is an aspirin-containing product and should be avoided. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking prescribed medication at the same time each day increases client compliance. The Medic-Alert bracelet provides health care personnel emergency information.

The nurse is caring for a client in the emergency department who has been diagnosed with Bell's palsy. The client has been taking acetaminophen (Tylenol), and acetaminophen overdose is suspected. Which antidote should me nurse anticipate to be prescribed? 1. Pentostatin (Nipent) 2. Auranofin (Ridaura) 3. Fludarabine (Fludara) 4. Acetylcysteine (Mucomyst)

Answer: 4 Rationale: The antidote for acetaminophen is acetylcysteine (Mucomyst). The normal therapeutic serum level of acetaminophen is 10 to 20 mcg/mL. A toxic level is higher than 50 mcg/mL, and levels higher than 200 mcg/mL could indicate hepatotoxicity. Auranofin (Ridaura) is a gold preparation used to treat rheumatoid arthritis. Pentostatin (Nipent) and fludarabine (Fludara) are anti neoplastic agents.

A client who weighs 187 lb (85 kg) has a prescription to receive enoxaparin (Lovenox) 1 mg/kg. This drug is available in a concentration of 30 mg/0.3 mL. What dose would the nurse administer in milliliters? ________________________mL.

0.85 mL The physician's prescription is for the client to receive enoxaparin (Lovenox) 1 mg/kg. Therefore, the client is lo receive 85 mg. The desired dose in milliliters then can be calculated by using the formula of desired dose (D) divided by dose or strength of dose on hand (H) times volume (V).

The client with chronic obstructive pulmonary disease (COPD) is taking theophylline. The nurse should instruct the client to report which of the following signs of theophylline toxicity? Select all that apply. 1. Nausea. 2. Vomiting. 3. Seizures. 4. Insomnia. 5. Vision changes.

1, 2, 3, 4. The therapeutic range for serum theophylline is 10 to 20 mcg/mL (55.5 to 111 umol/L). Al higher levels, the client will experience signs of toxicity such as nausea, vomiting, seizure, and insomnia. The nurse should instruct the client to report these signs and to keep appointments to have theophylline blood levels monitored. If the theophylline level is below the therapeutic range, the client may be at risk for more frequent exacerbations of the disease.

A client diagnosed with primary (essential) hypertension is taking chlorothiazide (Diuril). The nurse determines teaching about this medication is effective when the client makes the following statement. "I will (Select all that apply.) 1. take my weight daily at the same time each day." 2. not drink alcoholic beverages while on this medication." 3. reduce salt intake in my diet." 4. reduce my dosage if I have severe dizziness." 5. use sunscreen if I have prolonged exposure to sunlight." 6. take the drug late in the evening."

1, 2, 3, 5. Chlorothiazide (Diuril) causes increased urination and decreased swelling (if there is edema) and weight loss. It is important to check and record weight two to three times per 1 week at same time of day with similar amount of clothing. Clients should not drink alcoholic beverages or take other medications without the approval of the health care provider. Reducing sodium intake in the diet helps diuretic drugs lo be more effective and allows smaller doses to be taken. Smaller doses are less likely to cause adverse effects and hence excessive table salt as well as salty foods should be avoided. Chlorothiazide (Diuril) is a diuretic that is prescribed for lower blood pressure and may cause dizziness and faintness when the patient stands up suddenly. This can be prevented or decreased by changing positions slowly. lf dizziness is severe, the health care provider must be notified. Diuretics may cause sensitivity to sunlight, hence the need to avoid prolonged exposure to sunlight, use sunscreens, and wear protective clothing. Chlorothiazide (Diuril) causes increased urination and must be taken early in the day to decrease nighttime trips to the bathroom. fewer bathroom trips mean less interference with sleep and less risk of falls.

Which instructions should the nurse include when developing a teaching plan for a client being discharged from the hospital on anticoagulant therapy after having deep vein thrombosis (DVT)? Select all that apply. 1. Checking urine for bright blood and a dark smoky color. 2. Walking daily as a good exercise. 3. Using garlic and ginger, which may decrease bleeding time. 4. Performing foot/leg exercises and walking around the airplane cabin when on long flights. 5. Preventing DVT because of risk of pulmonary emboli. 6. Avoiding surface bumps because the skin is prone lo injury.

1, 2, 4, 5, 6. Clients with resolving DVT being sent home on anticoagulant therapy need instructions about assessing and preventing bleeding episodes and preventing a recurrence of DVT. Blood in the urine (hematuria) is often one of the first symptoms of anticoagulant overdose. fresh blood in the urine is red; however, blood in the urine may also be a dark smoky color. Daily ambulation is an excellent activity lo keep the venous blood circulating and thus to prevent blood clots from forming in the lower extremities. Garlic and ginger increase the bleeding time and should not be used when a client is on anticoagulant therapy. Clients who have had previous DVTs should avoid activities that cause stagnation and pooling of venous blood. Prolonged sitting coupled with change of air pressure without fool or leg exercises or ambulation in the cabin are activities that prevent venous return. Instructing the client about prevention measures is important because clients with DVT are at high risk for pulmonary emboli (PE), which can be fatal. The client can be taught risk factors for DVT and PE. In addition, recommendations for prevention of these events also are standard protocol in practice and should be shared with the client for home care purposes. Older adults should be monitored closely for bleeding because the skin becomes thinner and the capillaries become more fragile with the aging process.

A client with ulcerative colitis is to take sulfasalazine. Which of the following instructions should the nurse provide for the client about taking this medication at home? Select all that apply 1. Drink enough fluids to maintain a urine output of at least 1,200 to 1,500 mL/day. 2. Discontinue therapy if symptoms of acute intolerance develop and notify the health care provider. 3. Stop taking the medication if the urine turns orange-yellow. 4. Avoid activities that require alertness. 5. f dose is missed, skip and continue with the next dose.

1, 2, 4. Sulfasalazine may cause dizziness, and the nurse should caution the client to avoid driving or other activities that require alertness until response to medication is known. If symptoms of acute intolerance (cramping, acute abdominal pain, bloody diarrhea, fever, headache, rash) occur, the client should discontinue therapy and notify the health care provider immediately. Fluid intake should be sufficient to maintain a urine output of at least 1,200 to 1,500 mL daily to prevent crystalluria and stone formation. The nurse can also inform the client that this medication may cause orange-yellow discoloration of urine and skin, which is not significant and does not require the client to stop taking the medication. The nurse should instruct the client lo take missed doses as soon as remembered unless i l is a I most time for the next close.

The nurse is to administer subcutaneous heparin to an older adult. What facts should the nurse keep in mind when administering this dose? Select all that apply. 1. It should be administered in the anterior area of the iIiac crest. 2. The onset is immediate. 3. Use a 27G, 5/8" (1.6-cm) needle. 4. Cephalosporin potentiates the effects of heparin. 5. Double check the dose with another nurse.

1, 3, 4, 5. Older adults may have little subcutaneous tissue, so the area around the anterior iliac crest is a suitable site for these clients. The nurse should use a 27G, 5/8" (1.6-cm) needle. Cephalosporin and penicillin potentiate the effects of heparin. Two nurses should check the dose because a dose error could cause hemorrhage. The onset of heparin is not immediate when given subcutaneously.

The nurse is providing follow-up care to a client with tuberculosis who does not regularly take the prescribed medication. Which nursing action would be most appropriate for this client? 1. Ask the client's spouse to supervise the daily administration of the medications. 2. Visit the client weekly to verify compliance with taking the medication. 3. Notify the physician of the client's noncompliance and request a different prescription. 4. Remind the client that tuberculosis can be fatal if it is not treated promptly.

1. Directly observed therapy (DOT) can be implemented with clients who are not compliant with drug therapy. In DOT, a responsible person, who may be a family member or a health care provider, observes the client taking the medication. Visiting the client, changing the prescription, or threatening the client will not ensure compliance if the client will not or cannot follow the prescribed treatment.

Which of the following medications would the nurse question for a client with acute pancreatitis? 1. Furosemide (Lasix) 20 mg IV push. 2. Imipenem (Primaxin) 500 mg IV. 3. Morphine sulfate 2 mg IV push. 4. Famotidine (Pepcicl) 20 mg IV push.

1. Furosemide (Lasix) can cause pancreatitis. Additionally, hypovolemia can develop with acute pancreatitis and Lasix will further delete fluid volume. Imipenem is indicated in the treatment of acute pancreatitis with necrosis and infection. Research no longer supports Meperidine (Demerol) over other opiates. Morphine and Dilaudid are opiates of choice in acute pancreatitis to get pain w1der control. Famotidine is a Histamine 2 receptor antagonist used to decrease acid secretion and prevent stress or peptic ulcers.

For a client with rib fractures and a pneumothorax, the physician prescribes morphine sulfate, 1 to 2 mg/h, given IV as needed for pain. The nursing care goal is to provide adequate pain control so that the client can breathe effectively. Which of the following outcomes would indicate successful achievement of this goal? 1. Pain rating of O on a scale of O to 10 by the client. 2. Decreased client anxiety. 3. Respiratory rate of 26 breaths/min. 4. Pa02 of 70 mm Hg (9.31 kPa).

1. If the client reports no pain, then the objective of adequate pain relief has been met. Decreased anxiety is not related only to pain control; it could also be related to other factors. A respiratory rate of 26 breaths/min is not within normal limits, nor is the PaO., of 70 mm Hg (9.31 kPa). but these values are not measures of pain relief.

When teaching the client older than age 50 who is receiving long-term prednisone therapy, the nurse should recommend which of the following? 1. Take the prednisone with food. 2. Take over-the-counter drugs as needed. 3. Exercise three to four times a week. 4. Eat foods that are low in potassium.

1. Nausea, vomiting, and peptic ulcers are gastrointestinal adverse effects of prednisone, so it is recommended that clients take the prednisone with food. In some instances, the client may be advised to take a prescribed antacid prophylactically. The client should never take over-the-counter drugs without notifying the physician who prescribed the prednisone. The client should ask the physician about the amount and kind of exercise because of the need to establish baseline physical values before starling an exercise program and because of the increased potential for comorbidity with increasing age. The client should eat foods that are high in potassium to prevent hypokalemia.

A client with tuberculosis is taking Isoniazid (INH). To help prevent development of peripheral neuropathies, the nurse should instruct the client to: 1. Adhere to a low-cholesterol diet. 2. Supplement the diet with pyricloxine (vitamin BJ 3. Get extra rest. 4. Avoid excessive sun exposure.

2. A positive Mantox skin test indicates that the client has been exposed to tubercle bacilli. Exposure does not necessarily mean that active disease exists. A positive Mantoux test does not mean that the client has developed resistance. Unless involved in treatment, the client may still develop active disease at any time. Immunity to tuberculosis is not possible.

A client has received numerous different antibiotics and now is experiencing diarrhea. The physician has prescribed a transmission based precaution. Which of the following types of precautions wouId be most appropriate for all personnel to use? 1. Airborne precautions. 2. Contact precautions. 3. Droplet precautions. 4. Needlestick precautions.

2. Airborne precautions are required for clients with presumed or proven pulmonary tuberculosis (TB), chickenpox, or other airborne pathogens. Contact precautions are used for organisms that are spread by skin-to-skin contact, such as antibioticresistant organisms or Clostridium difficile. Droplet precautions are used for organisms such as influenza or meningococcus that can be transmitted by close respiratory or mucous membrane contact with respiratory secretions. The most important aspect of reducing the risk of bloodborne infection is avoidance of percutaneous injury. Extreme care is essential when needles, scalpels, and other sharp objects are handled.

A client with heart failure is receiving digoxin intravenously. The nurse should determine the effectiveness of the drug by assessing which of the following? 1. Dilated coronary arteries. 2. Increased myocardial contractility. 3. Decreased cardiac arrhythmias. 4. Decreased electrical conductivity in the heart.

2. Digoxin is a cardiac glycoside with positive inotropic activity. This inotropic activity causes increased strength of myocardial contractions and thereby increases output of blood from the left ventricle. Digoxin does not dilate coronary arteries. Although digoxin can be used to treat arrhythmias and does decrease the electrical conductivity of the myocardium, these are not primary reasons for its use in clients with heart failure and pulmonary edema.

A client has been placed on long-term sulfasalazine therapy for treatment of ulcerative colitis. The nurse should encourage the client to eat which of the following foods to help avoid the nutrient deficiencies that may develop as a result of this medication? 1. Citrus fruits. 2. Green, Leafy vegetables. 3. Eggs. 4. Milk products.

2. In long-term sulfasalazine therapy, the client may develop folic acid deficiency. The client can take folic acid supplements, but the nurse should also encourage the client to increase the intake of folic acid in his diet. Green, leafy vegetables are a good source of folic acid. Citrus fruits, eggs, and milk products are not good sources of folic acid.

A hospitalized client who is being treated for hypertension with furosemide (Lasix), atenolol (Tenormin), and ramipril (Altace) develops a second-degree heart block Mobitz type 1. Which of the following actions should the nurse take? 1. Administer a 250-mL fluid bolus. 2. Withhold the atenolol. 3. Prepare for cardioversion. 4. Set up for an arterial line.

2. The client may be asymptomatic and the underlying cause should be assessed. Drugs that block the AV node should be avoided, such as beta blockers (Atenolol), calcium channel blockers, digoxin, and amiodarone. Symptomatic clients are treated with atropine and transcutaneous pacing. There is no indication for a fluid bolus, cardioversion, or arterial line.

A client with deep vein thrombosis has been receiving warfarin (Coumadin) for 2 months. The client reports bleeding gums, increased bruising, and dark stools. These symptoms indicate that the medication: 1. Does not need to be changed. 2. Needs to be decreased. 3. Needs to be increased. 4. Is not being taken as prescribed.

2. These symptoms suggest that the client is receiving too much Coumadin. Coumadin hinders the hepatic synthesis of vitamin K-dependent clotting factors and prolongs the clotting time. Because many factors influence the effectiveness of Coumadin, the dosage is monitored closely. Signs and symptoms of blood loss include bleeding gums, petechiae, bruises, dark stools, and dark urine.

A client with Raynaud's phenomenon is prescribed diltiazem (Cardizem). An expected outcome is: 1. Decreased heart rate. 2. Conversion to normal sinus rhythm. 3. Reduced episodes of finger numbness. 4. Increased Sp0

3. Calcium channel blockers are first-line drug therapy for the treatment of vasospasms with Raynaud's phenomenon when other therapies are ineffective. Cardizem relaxes smooth muscles and improves peripheral perfusion, therefore reducing finger numbness. Cardizem decreases heart rate and is used to treat atrial fibrillation, but these are not associated with Raynaud's. When vasospasms are prevented, an accurate Sp0 can be measured in the affected extremity; however, Sp0 is a measurement of systemic oxygenation not influenced by Cardizem.

The nurse should caution sexually active female clients taking isoniazicl (INH) that the drug has which of the following effects? 1. Increases the risk of vaginal infection. 2. Has mutagenic effects on ova. 3. Decreases the effectiveness of hormonal contraceptives. 4. Inhibits ovulation.

3. INH interferes with the effectiveness of hormonal contraceptives, and female clients of childbearing age should be counseled to use an alternative form of birth control while taking the drug. INH does not increase the risk of vaginal infection, nor does it affect the ova or ovulation.

The nurse should teach the client who is receiving warfarin sodium that: 1. Partial thromboplastin time values determine the dosage of warfarin sodium. 2. Protamine sulfate is used to reverse the effects of warfarin sodium. 3. International Normalized Ratio (INR) is used to assess effectiveness. 4. Warfarin sodium v,,ill facilitate clotting of the blood.

3. INR is the value used to assess effective ness of the warfarin sodium therapy. INR is the prothrombin time ratio that would be obtained if the thromboplastin reagent from the World Health Organization was used for the plasma test. It is now the recommended method to monitor effectiveness of warfarin sodium. Generally, the INR for clients administered warfarin sodium should range from 2 to 3. In the past, prothrombin time was used to assess effectiveness of warfarin sodium and was maintained at 1.5 to 2.5 times the control value. Partial thromboplastin time is used to assess the effectiveness of heparin therapy. Fresh frozen plasma or vitamin K is used to reverse warfarin sodium's anticoagulant effect, whereas protamine sulfate reverses the effects of heparin. Warfarin sodium will help to prevent blood clots.

A client with a history of hypertension and peripheral vascular disease underwent an aortobifemoral bypass graft. Preoperative medications included pentoxifylline (Trental), metoprolol (Toprol XL), and furosemide (Lasix). On postoperative day 1, the 12 noon vital signs are: Temperature 37.2°C; heart rate 132 bpm; respiratory rate 20; blood pressure 126/78. Urine output is 50 to 70 mL/h. The hemoglobin and the hematocrit are stable. Using the SBAR (Situation-BackgroundAssessment-Recommendation) technique for communication, the nurse recommends that the primary care provider: 1. Continues the pentoxifylline. 2. Increases the IV fluids. 3. Restarts the metoprolol. 4. Resumes the furosemide.

3. The client is experiencing a rebound tachycardia from abrupt withdrawal of the beta blocker. The beta blocker should be restarted clue to the tachycardia, history of hypertension, and the desire to reduce the risk of postoperative myocardial morbidity. The bypass surgery should correct the claudication and need for pentoxifylline. The furosemide and increase in fluids are not indicated since the client's urine output and blood pressure are satisfactory and there is no indication of bleeding. The potassium should also be assessed prior to starting the furosemide.

Penicillin has been prescribed for a client admitted to the hospital for treatment of pneumonia. Prior to administering the first dose of penicillin, the nurse should ask the client: 1. "Do you have a history of seizures?" 2. "Do you have any cardiac history?" 3. "Have you had any recent infections?" 4. "Have you had a previous allergy to penicillin?"

4. The nurse should determine if the client is allergic to penicillin prior to administering the drug. History of seizures, recent infections, and a cardiac history are not contraindications to for this client for receiving penicillin. While important to know, recent infections will not preclude this client receiving penicillin at this time.

How should the nurse instruct the client with unstable angina to use sublingual nitroglycerin tablets when chest pain occurs? "Sit clown and then 0 1. take one tablet every 2 to 5 minutes until the pain stops." 2. take one tablet and rest for 15 minutes. Call the physician if pain persists after 15 minutes." 3. take one tablet, then if the pain persists take additional two tablets in 5 minutes. Call the physician if pain persists after 15 minutes." 4. take one tablet. If pain persists after 5 minutes call 911."

4. The nurse should instruct the client that correct protocol for using sublingual nitroglycerin involves immediate administration when chest pain occurs. Sublingual nitroglycerin appears in the bloodstream within 2 to 3 minutes and is metabolized within about 10 minutes. The client should sit down and place the tablet under the tongue. If the chest pain is not relieved within 5 minutes, the client should call 911. Although some physicians may recommend taking a second or third tablet spaced 5 minutes apart and then calling for emergency assistance, it is not appropriate to take two tablets at once. Nitroglycerin acts within 2 to 3 minutes and the client should not wait 15 minutes to take further action. The client should call 911 to obtain emergency help rather than calling the physician.

Alteplase recombinant, or tissue plasminogen activator (l-PA), a thrombolytic enzyme, is administered during the first 6 hours after onset of myocardial infarction (MI) to: 1. Control chest pain. 2. Reduce coronary artery vasospasm. 3. Control the arrhythmias associated with Ml. 4. Revascularize the blocked coronal'y artery.

4. The thrombolytic agent t-PA, administered intravenously, lyses the clot blocking the coronary artery. The drug is most effective when administered within the first 6 hours after onset of MI. The drug does not reduce coronary artery vasospasm; nitrates are used to promote vasodilation. Arrhythmias are managed by antiarrhythmic drugs. Surgical approaches are used to open the coronary artery and re-establish a blood supply to the area.

A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hour. The nurse determines that the client is receiving the therapeutic effect based on which results? 1. Prothrombin time of 12.5 seconds 2. Activated partial thromboplastin time of 60 seconds 3. Activated partial thromboplastin time of 28 seconds 4. Activated partial thromboplastin time longer than 120 seconds

Answer: 2 Rationale: Common laboratory ranges for activated partial thromboplastin time are 20 to 36 seconds. Because the activated partial thromboplastin time should be 1.5 to 2.5 times the normal value, the client's activated partial thromboplastin time would be considered therapeutic if it was 60 seconds.

A client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to teach the client to take which action? 1. Use alcohol in small amounts only. 2. Report yellow eyes or skin immediately. 3. Increase intake of Swiss or aged cheeses. 4. Avoid vitamin supplements during therapy.

Answer: 2 Rationale: Isoniazid is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately, which include yellow skin and sclera. For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating. tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B) during the course of isoniazid therapy.

A client with atrial fibrillation secondary to mitral stenosis is receiving a heparin sodium infusion at 1000 units/hour and warfarin sodium (Coumadin) 7.5 mg at 5:001',\I daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT) = 32 seconds; internationalized normalized ratio (INR) = 1.3. The nurse should plan to take which action based on the client's laboratory results? 1. Collaborate with the health care provider (HCP) to discontinue the heparin infusion and administer the warfarin sodium as prescribed. 2. Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed. 3. Collaborate with the HCP to withhold the warfarin sodium since the client is receiving a heparin infusion and the aPTT is within the therapeutic range. 4. Collaborate with the HCP to continue the heparin infusion at the same rate and to discuss use of dabigatran etexilate (Pradaxa) in place of warfarin sodium.

Answer: 2 Rationale: When a client is receiving warfarin {Coumadin) for clot prevention due 10 atrial fibrillation, an INR of 2 to 3 is appropriate for most clients. Until the INR has achieved a therapeutic range the client should be maintained on a continuous heparin infusion with the aPTT ranging between 60 and 80 seconds. Therefore, the nurse should collaborate with the health care provider to obtain a prescription to increase the heparin infusion and to administer the warfarin as prescribed.

A client has been taking isoniazid for 1.5 months. The client complains to the nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing which problem? 1. Hypercalcemia 2. Peripheral neuritis 3. Small blood vessel spasm 4. Impaired peripheral circulation

Answer: 2 Rationale: lsoniazid is an antitubercular medication. A common side effect of isoniazid is peripheral neuritis, manifested by numbness, tingling. and paresthesias in the extremities. This can be minimized with pyridoxine (vitamin 86) intake. Options 1, 3, and 4 are incorrect.

The nurse has given medication instructions to a client receiving phenytoin (Dilantin). Which statement indicates that the client has an adequate understanding of the instructions? l. "Alcohol is not contraindicated while taking this medication." 2. "Good oral hygiene is needed, including brushing and flossing." 3. "The medication dose may be self-adjusted, depending on side effects." 4. "The morning dose of the medication should be taken before a serum drug level is drawn."

Answer: 2 Rntionale: Typical amiconvulsant medication instructions include taking the prescribed daily dosage to keep the blood level of the drug constant and having a sample drawn for serum drug level determination before taking the morning dose. The client is taught not to stop the medication abruptly, to avoid alcohol, to check with a health care provider before taking over-the-counter medications, to avoid activities in which alertness and coordination are required until medication effects are known, to provide good oral hygiene, and to obtain regular dental care. The client should also wear a Medic-Alert bracelet.

The nurse is monitoring a client who is taking digoxin (Lanoxin) for adverse effects. Which findings are characteristic of digoxin toxicity? Select all that apply. 1. Tremors 2. Diarrhea 3. Irritability 4. Blurred vision 5. Nausea and vomiting

Answer: 2, 4, 5 Rationale: Digoxin (Lanoxin) is a cardiacglycoside. The risk of toxicity can occur with the use of this medication. Toxicity can lead to life-threatening events and the nurse needs to monitor the client closely for signs of toxicity. Early signs of toxicity include gastrointestinal manifestations such as anorexia, nausea, vomiting, and diarrhea. Subsequent manifestations include headache; visual disturbances such as diplopia, blurred vision, yellow-green halos, and photophobia; drowsiness; fatigue; and weakness. Cardiac rhythm abnormalities can also occur. The nurse also monitors the digoxin level. Therapeutic levels for digoxin range from 0.5 to 2 ng/mL.

A client with trigeminal neuralgia tells the nurse that acetaminophen (Tylenol) is taken daily for the relief of generalized discomfort. Which laboratory value would indicate toxicity associated with the medication? 1. Sodium level of 140mEq/L 2. Prothrombin time of 12 seconds 3. Direct bilirubin level of 2 mg/dL 4. Platelet count of 400,000 cells/mm3

Answer: 3 Rationale: In adults, overdose of acetaminophen causes liver damage. The correct option is an indicator of liver function and is the only option that indicates an abnormal laboratory value. The normal direct bilirubin level is O to 0.3 mg/dL. The normal sodium level is 135 to 145 mEq/L. The normal prothrombin time is 10 to 13 seconds. The normal platelet count is 150,000 to 400,000 cells/mm'.

The home health nurse visits a client who is taking phenytoin (Dilantin) for control of seizures. During the assessment, the nurse notes that the client is taking birth control pills. Which information should the nurse include in the teaching plan? l. Pregnancy should be avoided while taking phenytoin. 2. The client may stop the medication if it is causing severe gastrointestinal effects. 3. There is the potential of decreased effectiveness of birth control pills while taking phenytoin. 4. There is the increased risk of thrombophlebitis while taking phenytoin and birth control pills together.

Answer: 3 Rationale: Phenytoin enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. Options 1, 2, and 4 are inappropriate instructions.

A client receiving thrombolytic therapy with a continuous infusion of alteplase (Activase) suddenly becomes extremely anxious and complains of itching. The nurse hears stridor and notes generalized urticaria and hypotension. Which nursing action is the priority? 1. Administer oxygen and protamine sulfate. 2. Cut the infusion rate in half and sit the client up in bed. 3. Stop the infusion and call the health care provider (HCP). 4. Administer diphenhydramine (Benadryl) and continue the infusion.

Answer: 3 Rationale: The client is experiencing an anaphylactic reaction. Therefore, the priority action is to stop the infusion and notify the I ICP. The client may be treated with epinephrine, antihistamines, and corticosteroids as prescribed.

A client is diagnosed with an ST-segment elevation myocardial infarction (STEM1) and is receiving tissue plasminogen activator, alteplase (Activase, tPA). Which action is a priority nursing intervention? 1. Monitor for kidney failure. 2. Monitor psychosocial status. 3. Monitor for signs of bleeding. 4. I lave heparin sodium available.

Answer: 3 Rationale: Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychosocial status are important but are not the most critical interventions. Heparin may be administered after thrombolytic therapy, but the question is not asking about follow-up medications.

A client with a peptic ulcer is diagnosed with a Helicobaccer pylori infection. The nurse is teaching the client about the medications prescribed, including clarithromycin (Biaxin), esome-prazole (Nexium), and amoxicillin (Amoxil). Which statement by the client indicates the best understanding of the medication regimen? 1. "My ulcer will heal because these medications will kill the bacteria." 2. "These medications are only taken when I have pain from my ulcer." 3. "The medications will kill the bacteria and stop the acid production." 4. "These medications will coat the ulcer and decrease the acid production in my stomach."

Answer: 3 Rationale: Triple therapy for /-lelicobncter pylori infection usually includes two antibacterial medications and a proton pump inhibitor. Clarithromycin and amoxicillin are antibacterials. Esomeprazole is a proton pump inhibitor. These medications will kill the bacteria and decrease acid production.

A client with a peptic ulcer is diagnosed with a Helicobaterpylori infection. The nurse is teaching the client about the medications prescribed, including clarithromycin (Biaxin), esomeprazole (Nexium), and amoxicillin (Amoxil). Which Statement by the client indicates the best understanding of the medication regiment? 1. "My ulcer will heal because these medications will kill the bacteria." 2. "These medications are only taken when I have pain from my ulcer." 3. "The medications will kill the bacteria and stop the acid production." 4. "Theses medications will coat the ulcer and decrease the acid production in my stomach."

Answer: 3 Rationale: Triple therapy for Helicobacter pylori infection usually includes two antibacterial medications and a proton pump inhibitor. Clarithromycin and amoxicillin are antibacterials. Esomepraxole is a proton pump inhibitor. These medications will kill the bacteria and decrease acid production.

Trimethoprim-sulfamethoxazole(TMP-SMZ;Bactrim) is prescribed for a client. The nurse should instruct the client to report which symptom if it develops during the course of this medication therapy? 1. Nausea 2. Diarrhea 3. Headache 4. Sore throat

Answer: 4 Rationale: Clients taking trimethoprim (TMP)-sulfamethoxazole (SMZ) should be informed about early signs/ symptoms of blood disorders that can occur from this medication. These include sore throat, fever, and pallor, and the client should be instructed to notify the health care provider (HCP) if these occur. The other options do not require HCP notification.

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? ___________________________ mL.

0.4 mL

A nurse is lo administer 10 mg of morphine sulfate to a client with three fractured ribs. The available concentration for this drug is 15 mg/mL. How many milliliters should the nurse administer'? Round to one decimal point. _____________________________________ mL.

0.7 mL

A client who has diabetes is taking metoprolol (Lopressor) for hypertension. Which of the following information should the nurse include in the teaching plan? Select all that apply 1. These tablets should be taken with food at same time each day. 2. Do not crush or chew the tablets. 3. Notify the heal the care provider if pulse is 82 per minute. 4. Have a blood glucose level drawn every 6 to 12 months during therapy. 5. Use an appropriate decongestant if needed. 6. Report any fainting spells to the health care provider.

1, 2, 4, 6. Metoprolol (Lopressor) is a beta adrenergic blocker indicated for hypertension, angina, and myocardial infarction. The tablets should be taken with food at same time each day; they should not be chewed or crushed. The health care provider should be notified if pulse falls below 50 for several days. Blood glucose should be checked regularly during therapy since increased episodes of hypoglycemia may occur. It may mask evidence of hypoglycemia such as palpitations, tachycardia, and tremor. Use of any OTC decongestants, asthma and cold remedies, and herbal preparations must be avoided. Fainting spells may occur due to exercise or stress, and the dosage of the drug may need to be reduced or discontinued.

A client who weighs 207 lb (94.1 kg) is to receive 1.5 mg/kg of gentamicin sulfate (Garamycin) [V three Li mes each day. How many milligrams of medication should the nurse administer for each dose? Round lo the nearest whole number. _____________________________mg.

141 mg

Nitrofurantoin, 75 mg four times per day, has been prescribed for a client with a lower urinary tract infection. The medication comes in an oral suspension of 25 mg/5 mL. How many milliliters should the nurse administer for each dose? _________________________________mL.

15 mL

The client with type 2 insulin-requiring diabetes asks the nurse about having alcoholic beverages. Which of the following is the best response by the nurse? 1. "You can have one or two drinks a day as long as you have something to eat with them." 2. "Alcohol is detoxified in the liver, so it is not a good idea for you to drink anything with alcohol." 3. "If you are going to have a drink, it is best to consume alcohol on an empty stomach." 4. "If you do have a drink, the blood glucose value may be elevated at bedtime, and you should skip having a snack."

1. A modest alcohol intake (1 to 2 drinks/day) may be incorporated into the nutrition plan for individuals who choose to drink. Alcohol is detoxified in the liver where glycogen reserves are stored and normally released in case of hypoglycemia. At the time alcohol is consumed, glucose values will likely rise because of the carbohydrate in the beer, wine or mixed drinks; however, the later and more dangerous effect of alcohol is a hypoglycemic effect. Alcohol should be consumed with food; even if blood glucose values are elevated, the bedtime snack should not be skipped.

An adult client with type 2 diabetes is taking metformin (Glucophage) 1,000 mg two times every day. After the nurse provides instructions regarding the interaction of alcohol and metformin, the nurse evaluates that the client understands the instructions when the client says: 1. "If I know I'll be having alcohol, I must not take metformin; I could develop lactic acidosis." 2. "If my physician approves, I may drink alcohol with my metformin." 3. "Adverse effects I should watch for are feeling excessively energetic, unusual muscle stiffness, low back pain, and a rapid heartbeat." 4. "If I feel bloated, I should call my physician."

1. A rare but serious adverse effect of metformin (Glucophage) is lactic acidosis; half the cases are fatal. Ideally, one should stop metformin for 2 days before and 2 days after drinking alcohol. Signs and symptoms of lactic acidosis are weakness, fatigue, unusual muscle pain, dyspnea, unusual stomach discomfort, dizziness or light-headedness, and braclycardia or cardiac arrhythmias. Bloating is not an adverse effect of metformin.

Furosemide is administered intravenously to a client with heart failure. How soon after administration should the nurse begin to see evidence of the drug's desired effect? 1. 5 to 10 minutes. 2. 30 to 60 minutes. 3. 2 to 4 hours. 4. 6 to 8 hours.

1. After intravenous injection of furosemide, diuresis normally begins in about 5 minutes and reaches its peak within about 30 minutes. Medication effects last 2 to 4 hours. When furosemide is given intramusculmly or orally, drug action begins more slowly and lasts longer than when it is given intravenously.

A client has acute arterial occlusion. The physician has prescribed IV heparin. Before starting the medication, the nurse should: 1. Review the blood coagulation laboratory values. 2. Test the client's stools for occult blood. 3. Count the client's apical pulse for 1 minute. 4. Check the 24-hour urine output record.

1. Before starting a heparin infusion, it is essential for the nurse to know the client's baseline blood coagulation values (hematocrit, hemoglobin, and red blood cell and platelet counts). In addition, the partial thromboplastin time should be monitored closely during the process. The client's stools would be tested only if internal bleeding is suspected. Although monitoring vital signs such as apical pulse is important in assessing potential signs and symptoms of hemorrhage or potential adverse reactions to the medication, vital signs are not the most important data to collect before administering the heparin. Intake and output are not important assessments for heparin administration unless the client has fluid and volume problems or kidney disease.

When monitoring a client who is receiving tissue plasminogen activator (t-PA). the nurse should have resuscitation equipment available because reperfusion of the cardiac tissue can result in which of the following? 1. Cardiac arrhythmias. 2. Hypertension. 3. Seizure. 4. Hypothermia.

1. Cardiac arrhythmias are commonly observed with administration of t-PA. Cardiac arrhythmias are associated with reperf-usion of the cardiac tissue. Hypotension is commonly observed with administration of t-PA. Seizures and hypothermia are not generally associated with reperfusion of the cardiac tissue.

The nurse is teaching the client who is receiving chemotherapy and the family how to manage possible nausea and vomiting at home. The nurse should include information about: 1. Eating frequent, small meals throughout the day. 2. Eating three normal meals a day. 3. Eating only cold foods with no odor. 4. Limiting the amount of fluid intake.

1. Dietary suggestions to reduce adverse effects of cancer and cancer therapies include a soft, bland diet low in fat and sugar. Frequent, small meals are usually better tolerated. It is not necessary to restrict the diet to cold foods. Fluid intake should be encouraged to avoid dehydration.

Which of the following is the most reliable early indicator of infection in a client who is neutropenic? 1. Fever. 2. Chills. 3. Tachycardia. 4. Dyspnea.

1. Fever is an early sign requiring clinical intervention to identify potential causes. Chills and dyspnea may or may not be observed. Tachycardia can be an indicator in a variety of clinical situations when associated with infection; it usually occurs in response to an elevated temperature or change in cardiac function.

The nurse is discussing medications with a client with hypertension who has a prescription for fmosemide (Lasix) daily. The client needs further education when the client states which of the following? 1. "I know I should not drive after taking my Lasix." 2. "I should be careful not to stand up too quickly when taking Lasix." 3. "I should take the Lasix in the morning instead of before bed." 4. "I need to be sure to also take the potassium supplement that the doctor prescribed along with my Lasix."

1. Furosemide (Lasix) is a diuretic often prescribed for clients with hypertension or heart fail me; the drug should not affect a client's ability to drive safely. Lasix may cause orthostatic hypotension and clients should be instructed to be careful when changing from supine to sitting to standing position. Diuretics should be taken in the morning if possible to prevent sleep disturbance due to the need to get up to void. Lasix is a loop diuretic that is not potassium sparing; clients should take potassium supplements as prescribed and have their serum potassium levels checked at prescribed intervals.

The physician prescribes continuous IV nitroglycerin infusion for the client with myocardial infarction. The nurse should: 1. Obtain an infusion pump for the medication. 2. Take the blood pressure every 4 hours. 3. Monitor urine output hourly. 4. Obtain serum potassium levels daily.

1. IV nitroglycerin infusion requires an infusion pump for precise control of the medication. Blood pressure monitoring would be done with a continuous system, and more frequently than every 4 hours. Hourly urine outputs are not always required. Obtaining serum potassium levels is not associated with nitroglycerin infusion.

A 62-year-old female is taking long-acting morphine 120 mg every 12 hours for pain from metastatic breast cancer. She can have 20 mg of immediate-release morphine every 3 to 4 hours as needed for breakthrough pain. The physician should be notified if the client uses more than how many breakthrough doses of morphine in 24 hours? 1. Seven. 2. Four. 3. Two. 4. One.

1. If the maximum dose specified by the physician's prescription is required every 3 to 4 hours for breakthrough pain, the physician should be notified to increase the long-acting medication or rotate to another type of opioid. Around-the-clock closing is mandatory to achieve a steady state of analgesia. The rescue dose for breakthrough pain is administered over and above the regularly scheduled medication. If three to four analgesic doses are required every 24 hours, the sustained-release around-the-clock dose should be increased to include the amount used for previous breakthrough pain while maintaining a dose for future breakthrough pain.

Which of the following physician prescriptions is written correctly on the chart? 1. Fentanyl 50 mcg given IV every 2 hours as needed for pain greater than 6/10. 2. Give 4 U regular insulin IV now. 3 . .5 mg MS given IM for c/o pain. 4. 60.0 mg Toradol given IM for c/o pain.

1. Prescriptions should be written clearly to avoid confusion or misinterpretation. Clearly written prescriptions do not use a "trailing" zero (a zero following a decimal point) and do use a "leading" zero (a zero preceding a decimal point). Additionally, the prescribed medication should be written in full and avoid abbreviations of the drug and the dosage, for example "morphine sulfate" (avoiding use of "MS"). "ml" instead of "cc," and "micrograms" instead of "mcg."

A client is receiving an IV infusion of heparin sodium at 1,200 units/h. The dilution is 25,000 units/500 mL. Hm,v many milliliters per hour will this client receive? _______________ mL/h.

24 mL/h

The laboratory notifies the nurse that a client who had a total knee replacement 3 days ago and is receiving heparin has an activated partial thromboplastin time (aPTT) of 75 seconds. After verifying the values, the nurse calls the physician. The nurse should anticipate receiving a prescription for: 1. Protamine sulfate. 2. Vitamin K. 3. Warfarin (Coumadin). 4. Packed reel blood cells.

1. The aPTT is at a critical value, and the client should receive protamine sulfate as the antidote for heparin. Vitamin K is the antidote for warfarin. Packed red blood cells are administered to increase the hematocrit.

An older adult has chest pain and shortness of breath. The health care provider prescribes nitroglycerin tablets. What should the nurse instruct the client to do? 1. Put the tablet under the tongue until it is absorbed. 2. Swallow the tablet with 120 mL of water. 3. Chew the tablet until it is dissolved. 4. Place the tablet between the cheek and gums

1. The client is having symptoms of a myocardial infarction. The first action is to prevent platelet formation and block prostaglandin synthesis. The client should place the tablet under the tongue and wait until it is absorbed. Nitroglycerin tablets are not effective if chewed, swallowed, or placed between the cheek and gums.

Metoprolol (Toprol XL) is added to the pharmacologic therapy of a diabetic female diagnosed with stage 2 hypertension initially treated with Furosemide (Lasix) and Ramipril (Altace). An expected therapeutic effect is: 1. Decrease in heart rate. 2. Lessening of fatigue. 3. Improvement in blood sugar levels. 4. Increase in urine output.

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

A client diagnosed with cancer is receiving chemotherapy. The nurses should assess which of the following diagnostic values while the client is receiving chemotherapy? 1. Bone marrow cells. 2. Liver tissues. 3. Heart tissues. 4. Pancreatic enzymes.

1. The fast-growing, normal cells most likely to be affected by certain cancer treatments are blood-forming cells in the bone marrow, as well as cells in the digestive track, reproductive system, and hair follicles. Fortunately, most normal cells recover quickly when treatment is over. Bone marrow suppression (a decreased ability of the bone marrow to manufacture blood cells) is a common side effect of chemotherapy. A low white blood cell count (neutropenia) increasing the risk of infection during chemotherapy, but other blood cells made in the bone marrow can be affected as well. Most cancer agents do not affect tissues and organs, such as heart, liver, and pancreas.

Prior to administering tissue plasminogen activator (t-PA). the nurse should assess the client for which of the following contradictions to administering the drug? 1. Age greater than 60 years. 2. History of cerebral hemorrhage. 3. History of heart failure. 4. Cigarette smoking.

2. A history of cerebral hemorrhage is a contraindication to administration of t-PA because the risk of hemorrhage may be further increased. Age greater than 60 years, history of heart failure, and cigarette smoking are not contraindications.

An older adult with a history of hypertension is admitted with a diagnosis of dehydration. The client is becoming increasingly confused and weak. The client reports taking one tablet of hydrochlorothiazide (HydroDIURlL) daily, and the prescription is written for 1/2 tablet. The nurse should obtain additional information about: 1. Decreased drug half-life of the HydroDIURlL. 2. Decreased hepatic blood flow. 3. Increased GI activity. 4. Increased urinary elimination.

2. Aging causes decreased hepatic blood flow. Decreased drug metabolism, which occurs \<\rith aging, along with more drug in circulation means the drug will remain in the body longer and produce greater drug effects. The client has also taken more drug than prescribed increasing the opportunity for more drug action to occur. When there is decreased metabolism of drugs, an increase in the half-life will occur most especially in the older adult. In older adults transit time (GI motility) is slower, allowing more drug to be absorbed. Increased urinary elimination would mean that drug elimination could be higher not lower and accumulating in the body.

Which of the following is an expected outcome when a client is receiving an IV administration of furosemide? 1. Increased blood pressure. 2. Increased urine output. 3. Decreased pain. 4. Decreased premature ventricular contractions.

2. Furosemicle is a loop diuretic that acts to increase urine output. Furosemide does not increase blood pressure, decrease pain, or decrease arrhythmias.

Metoclopramide is prescribed as a premedication for a client about to undergo a gastroduodenoscopy. Which of the following is the expected therapeutic effect? 1. Increased gastric pH. 2. Increased gastric emptying. 3. Reduced anxiety. 4. Inhibited respiratory secretions.

2. Metoclopramide is an antiemetic given because of its gastric emptying ability, which is necessary in gastrointestinal procedures. It does not increase gastric pH, reduce anxiety, or inhibit respiratory secretions.

The nurse assesses a client who has just received morphine sulfate. The client's blood pressure is 90/50 mm Hg; pulse rate, 58 bpm; respiration rate, 4 breaths/min. The nurse should check the client's chart for a prescription to administer: 1. Flumazenil (Romazicon). 2. Naloxone hydrochloride (Narcan). 3. Doxacurium (Nuromax). 4. Remifentanil (Ultiva).

2. Naloxone hydrochloride is the antidote for morphine sulfate. The signs of overdose on morphine sulfate are a respiration rate of 2 to 4 breaths/ min, bradycardia, and hypotension. Flumazenil is the antidote for midazolam. Doxacurium is a nondepolarizing muscle relaxant. Remifentanil is an opioid used as an anesthetic adjunct.

A nurse is assessing a client with lymphoma who reports distress 9 days after chemotherapy. Because of the risk for septic shock, the nurse should assess the client for which cluster of symptoms? 1. Flushing, decreased oxygen saturation, mild hypotension. 2. Low-grade fever, chills, tachycardia. 3. Elevated temperature, oliguria, hypotension. 4. High-grade fever, normal blood pressure, increased respirations.

2. Nine days after chemotherapy, it is expected for the client to be immunocompromised. The clinical signs and symptoms of shock reflect changes in cardiac function, vascular resistance, cellular metabolism, and capillary permeability. Low grade fever, tachycardia, and chills may be early signs of shock. The client with signs and symptoms of impending septic shock may not have decreased oxygen saturation levels. Oliguria and hypotension are late signs of shock. Urine output can be initially normal or increased.

The nurse is administering the initial dose of a rapid-acting insulin to a client with type 1 diabetes. The nurse should assess the client for hypoglycemia within: 1. 0.5 hours. 2. 1 hour. 3. 2 hours. 4. 3 hours.

2. Rapid-acting insulin has an onset in 15 minutes, peaks at 1 hour, and lasts for 3 to 4 hours. Rapid-acting insulin is administered right before or right after a meal. The nurse should assess the client for hypoglycemia 1 hour following administration of the drug.

A client is to receive enoxaparin (Lovenox) 6 hours before the scheduled time of laparoscopic vaginal assisted hysterectomy. Which of the following effects does the nurse recognize as an intended therapeutic action of the enoxaparin? 1. Increase in red blood cell production. 2. Reduction of postoperative thrombi. 3. Decrease in postoperative bleeding. 4. Promotion of tissue healing.

2. Research findings have shown that enoxaparin and low-dose heparin given 6 to 12 hours preoperatively reduce the incidence of deep vein thrombosis and pulmonary emboli by 60% in clients who are at risk for deep vein thrombosis, such as those who are placed in the lithotomy position. Lovenox has no effect on red blood cell production, postoperative bleeding, or tissue healing.

A client with chronic cancer pain has been receiving opiates for 4 months. She rated the pain as an 8 on a 10-point scale before starting the opioid medication. Following thorough examination, there is no new evidence of increased disease, yet the pain is close to 8 again. The most likely explanation for the increasing pain is: 1. Development of an addiction to the opioids. 2. Tolerance to the opioid. 3. Withdrawal from the opioid. 4. Placebo effect has decreased.

2. Tolerance to an opioid occurs when a larger dose of the analgesic is needed to provide the same level of pain control. The risk of addiction is low with opioids to treat cancer pain. There are no data to support that this client is experiencing withdrawal. Although the client may have experienced a placebo effect at one time, placebo effects tend to diminish over time, especially in regard to chronic cancer pain.

Which clinical manifestation is a typical reaction to long-term phenytoin sodium (Dilantin) therapy? 1. Weight gain. 2. Insomnia. 3. Excessive growth of gum tissue. 4. Deteriorating eyesight.

3. A common adverse effect of long-term phenytoin therapy is an overgrowth of gingival tissues. Problems may be minimized with good oral hygiene, but in some cases, overgrown tissues must be removed surgically. Phenytoin does not cause weight gain, insomnia, or deteriorating eyesight.

Lasix [furosemide) 40 mg intravenous push (IVP) is prescribed. Lasix 10 mg/mL is available. The nurse should administer ________________________ mL.

4 mL. Desired amount (DJ divided by what is available (H), times quantity (Q) = amount to administer. D = 40 mg divided by H = 10 mg/mL; equals 40 divided by 10 = 4 mL.

The nurse has a prescription to administer sulfasalazine 2 g. The medication is available in 500-mg tablets. How many tablets should the nurse administer? ________________ tablets.

4 tablets To administer 2 g sulfasalazine, the nurse will need to administer four tablets.

The nurse should teach the client that signs of digoxin toxicity include which of the following? 1. Rash over the chest and back. 2. Increased appetite. 3. Visual clistmbances such as seeing yellow spots. 4. Elevated blood pressure.

3. Colored vision and seeing yellow spots are symptoms of cligoxin toxicity. Abdominal pain, anorexia, nausea, and vomiting me other common symptoms of digoxin toxicity. Additional signs of toxicity include arrhythmias, such as atrial fibrillation or braclycardia. Rash, increased appetite, and elevated blood pressure are not associated with digoxin toxicity.

Interferon alfa-2b (Intron A) has been prescribed to treat a client with chronic hepatitis B. The nurse should assess the client for which of the following adverse effects? 1. Retinopathy. 2. Constipation. 3. Flu like symptoms. 4. Hypoglycemia.

3. Interferon alfa-2b (Intron A) most commonly causes flu like adverse effects, such as myalgia, arthralgia, headache, nausea, fever, and fatigue. Retinopathy is a potential adverse effect, but not a common one. Diarrhea may develop as an adverse effect. Clients are advised to administer the drug at bedtime and get adequate rest. Medications may be prescribed Lo treat the symptoms. The drug may also cause hematologic changes; therefore, laboratory tests such as a complete blood count and differential should be conducted monthly during drug therapy. Blood glucose laboratory values should be monitored for the development of hyperglycemia.

A client who is recovering from a bilateral adrenalectomy has a patient-controlled analgesia (PCA) system with morphine sulfate. Which of the following actions is a priority nursing intervention for the client? 1. Observing the client at regular intervals for opioid addiction. 2. Encouraging the client to reduce analgesic use and tolerate the pain. 3. Evaluating pain control at least every 2 hours. 4. Increasing the amount of morphine if the client does not administer the medication.

3. Pain control should be evaluated at least every 2 hours for the client with a PCA system. Addiction is not a common problem for the postoprative client. A client should not be encouraged to tolerate pain; in fact, other nursing actions besides PCA should be implemented to enhance the action of opioids. One of the purposes of PCA is for the client to determine frequency of administering the medication; the nurse should not interfere unless the client is not obtaining pain relief. The nurse should ensure that the client is instructed on the use of the PCA control button and that the button is always within reach.

The nurse is instructing the client on insulin administration. The client is performing a return demonstration for preparing the insulin. The client's morning dose of insulin is 10 units of regular and 22 units of NPH. The nurse checks the dose accuracy with the client. The nurse determines that the client has prepared the correct dose when the syringe reads how many units? ___________________________ units.

32 units Clients commonly need to mix insulin, requiring careful mixing and calculation. The total dosage is 10 units plus 22 units, for a total of 32 units.

The nurse administers theophylline to a client. When evaluating the effectiveness of this medication, the nurse should assess the client for which of the following? 1. Suppression of the client's respiratory infection. 2. Decrease in bronchial secretions. 3. Less difficulty breathing. 4. Thinning of tenacious, purulent sputum.

3. Theophylline is a bronchodilator that is administered to relax airways and decrease dyspnea. Theophylline is not used to treat infections and does not decrease or thin secretions.

The nurse should caution the client with diabetes mellitus who is taking a sulfonylurea that alcoholic beverages should be avoided while taking these drugs because they can cause which of the following? 1. Hypokalemia. 2. Hyperkalemia. 3. Hypocalcemia. 4. Disulfiram (Antabuse)-like symptoms.

4. A client with diabetes who takes any first- or second-generation sulfonylmea should be advised to avoid alcohol intake. Sulfonylmeas in combination with alcohol can cause serious disulfiram (Antabuse)-like reactions, including flushing, angina, palpitations, and vertigo. Serious reactions, such as seizures and possibly death, may also occur. Hypokalemia, hyperkalemia, and hypocalcemia do not result from taking sulfonylureas in combination with alcohol.

The nurse should assess the client for digoxin toxicity if serum levels indicate that the client has a: 1. Low sodium level. 2. High glucose level. 3. High calcium level. 4. Low potassium level.

4. A low serum potassium level (hypoka lemia) predisposes the client to digoxin toxicity. Because potassium inhibits cardiac excitability, a low serum potassium level would mean that the client would be prone to increased cardiac excitability. Sodium, glucose, and calcium levels do not affect digoxin or contribute to digoxin toxicity.

Which of the following represents the most appropriate nursing intervention for a hospitalized client with pruritus caused by medications used to treat cancer? 1. Administration of antihistamines. 2. Steroids. 3. Silk sheets. 4. Medicated cool baths.

4. Nursing interventions to decrease the discomfort of pruritus include those that prevent vasodilation, decrease anxiety, and maintain skin integrity and hydration. Medicated baths with salicylic acid or colloidal oatmeal can be soothing as a temporary relief. The use of antihistamines or topical steroids depends on the cause of the pruritus, and these agents should be used with caution. Using silk sheets is not a practical intervention for the hos pi tali zed client with pruritus.

A client who is taking acetylsalicylic acid (ASA) caplets develops prolonged bleeding from a superficial skin injury on the forearm. The nurse should tell the client to do which of the following first? 1. Place the forearm under a running stream of lukewarm water. 2. Pat the injury with a dry washcloth. 3. Wrap the entire forearm from the wrist to the elbow. 4. Apply an ice pack for 20 minutes.

4. Aspirin has an antiplatelet effect, and bleeding time can consequently be prolonged. Intermittent use of ice packs to the site may stop the bleeding; ice causes blood vessels to vasoconstrict. Use of lukewarm water, patting the injury, and wrapping the entire forearm do not promote vasoconstriction to stop bleeding.

A client is receiving chemotherapy that has the potential to cause pulmonary toxicity. Which of the following symptoms indicates a toxic response to the chemotherapy? 1. Decrease in appetite. 2. Drowsiness. 3. Spasms of the diaphragm. 4. Cough and shortness of breath.

4. Cough and shortness of breath are significant symptoms because they may indicate decreasing pulmonary function secondary to drug toxicity. Decrease in appetite, difficulty in thinking clearly, and spasms of the diaphragm may occur as a result of chemotherapy; however, they are not indicative of pulmonary toxicity.

A client is to receive glargine insulin in addition to a dose of aspart. When the nurse checks the blood glucose level at the bedside, it is greater than 200 mg/dL (11.1 mmol/L). How should the nurse administer the insulins? 1. Put air into the glargine insulin vial, and then air into the aspart insulin vial, and draw up the correct close of aspart insulin first. 2. Roll the glargine insulin vial, then roll the aspart insulin vial. Draw up the longer-acting glargine insulin first. 3. Shake both vials of insulin before drawing up each close in separate insulin syringes. 4. Put air into the glargine insulin vial, and draw up the correct dose in an insulin syringe; then, with a different insulin syringe, put air into the aspart vial and draw up the correct dose.

4. Glargine is a long-acting recombinant human insulin analog. Glargine should not be mixed with any other insulin product. Insulins should not be shaken; instead, if the insulin is cloudy, roll the vial or insulin pen between the palms of the hands.

A client is admitted with a diagnosis of thrombophlebitis and deep vein thrombosis of the right leg. A loading dose of heparin has been given in the emergency room, and IV heparin will be continued for the next several days. The nurse should develop a plan of care for this client that will involve: 1. Administering aspirin as prescribed. 2. Encouraging green leafy vegetables in the diet. 3. Monitoring the client's prothrombin time (PT). 4. Monitoring the client's activated partial thromboplastin time (aPTT) and International Normalized Ratio (INR).

4. Heparin dosage is usually determined by the physician based on the client's aPTT and INR laboratory values. Therefore, the nurse monitors these values to prevent complications. Administering aspirin when the client is on heparin is contraindicated. Green leafy vegetables are high in vitamin Kand therefore are not recommended for clients receiving heparin. Monitoring of the client's PT is done when the client is receiving warfarin sodium (Coumadin).

A client has renal colic due to renal lithiasis. What is the nurse's first priority in managing care for this client? 1. Do not allow the client to ingest fluids. 2. Encourage the client to drink at least 500 mL of water each hour. 3. Request the central supply department to send supplies for straining urine. 4.Administer an opioid analgesic as prescribed.

4. If infection or blockage caused by calculi is present, a client can experience sudden severe pain in the flank area, known as renal colic. Pain from a kidney stone is considered an emergency situation and requires analgesic intervention. Withholding fluids will make urine more concentrated and stones more difficult to pass naturally. Forcing large quantities of fluid may cause hydronephrosis if urine is prevented from flowing past calculi. Straining urine for small stones is important, but does not take priority over pain management.

The nurse should instruct the client to avoid which of the following drugs while taking metoclopramide hydrochloride? 1. Antacids. 2. Antihypertensives. 3. Anticoagulants. 4. Alcohol.

4. Metoclopramide hydrochloride can cause sedation. Alcohol and other central nervous system depressants acid to this sedation. A client who is taking this drug should be cautioned to avoid driving or performing other hazardous activities for a few hours after taking the drug. Clients may take antacids, antihypertensives, and anticoagulants while on metoclopramide.

A client with peripheral vascular disease, coronary artery disease and chronic obstructive pulmonary disease takes theophylline 200 mg twice daily every day, and digoxin 0.5 mg once a day. The physician now prescribes pentoxifylline. To prevent problematic adverse effects, the nurse should monitor the client's: 1. Digoxin level. 2. Partial thromboplastin time (PTT) . 3. Serum cholesterol level. 4. Theophylline level.

4. Pentoxifylline can potentiate the effects of theophylline and increase the risk of theophylline toxicity. Therefore, the nurse should monitor the client's theophylline level. Pentoxifylline does not interact with digoxin. Pentoxifylline can interact with heparin, and the client's PTT would need to be monitored closely if the client were taking heparin. It does not affect cholesterol levels.

The nurse teaches a client with heart failure to take oral furosemide in the morning. The primary reason for this is to help: 1. Prevent electrolyte imbalances. 2. Retard rapid drug absorption. 3. Excrete excessive fluids accumulated during the night. 4. Prevent sleep disturbances during the night.

4. When diuretics are given early in the clay, the client will void frequently during the daytime hours and will not need to void frequently during the night. Therefore, the client's sleep will not be disturbed. Taking furosemide in the morning has no effect on preventing electrolyte imbalances or retarding rapid drug absorption. The client should not accumulate excessive fluids throughout the night.

A client has begun therapy with theophylline (Theo-24). The nurse should plan to teach the client to limit the intake of which items while taking this medication? 1. Coffee, cola, and chocolate 2. Oysters, lobster, and shrimp 3. Melons, oranges, and pineapple 4. Cottage cheese, cream cheese, and dairy creamers

Answer: 1 Rationale: Theophylline (Theo-24) is a methylxanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These foods include coffee, cola, and chocolate.

A client who is receiving digoxin (lanoxin) daily has a serum potassium level of 3 mEq/L and is complaining of anorexia. The health care provider prescribes determination of the serum digoxin level to rule out digoxin toxicity. The nurse checks the results, knowing that which value is the therapeutic serum level (range) for digoxin? 1. 0.5 to 2ng/ml 2. 1.2 to 2.8 ng/mL 3. 3.0 lo 5.0 ng/ml 4. 3.5 to 5.5 ng/ml

Answer: 1 Rationale: Therapeutic levels for digoxin range from 0.5 to 2 ng/ml. The ranges in the remaining options are incorrect. Test-Tailing Strategy: Focus on the subject, therapeutic serum digoxin level. It is necessary Lo remember that the therapeutic range is 0.5 to 2 ng/mL to answer correctly.

Prior to administering a client's daily close of digoxin, the nurse reviews the client's laboratory data and notes the following results: serum calcium, 9.8 mg/dl; serum magnesium, 1.2 mg/dl; serum potassium, 4.1 mEq/L; serum creatinine, 0.9 mg/dL. Which result should alert the nurse that the client is at risk for digoxin toxicity? 1. Serum calcium level 2. Serum potassium level 3. Serum creatinine level 4. Serum magnesium level

Answer: 4 Rationale: An increased risk of toxicity exists in clients with hypercalcemia, hypokalemia, hypomagnesemia, hypothyroidism, and impaired renal function. The calcium, creatinine, and potassium levels are all within normal limits. The normal range for magnesium is 1.6 to 2.6 mg/dL and the results in the correct option are reflective of hypomagnesemia.

The nurse is teaching the client to administer enoxaparin (Lovenox) following a total hip replacement. The nurse should instruct the client about which of the following? Select all that apply. 1. Report promptly any difficulty breathing, rash, or itching. 2. Notify the health care provider of unusual bruising. 3. Avoid all aspirin-containing medications. 4. Wear or carry medical identification. 5. Expel the air bubble from the syringe before the injection. 6. Remove needle immediately after medication is injected.

1, 2, 3, 4. Client/family teaching should include advising the client to report any symptoms of unusual bleeding or bruising, dizziness, itching, rash, fever, swelling, or difficulty breathing to health care provider immediately. Instruct the client not to take aspirin or nonsteroidal anti-inflammatory drugs without consulting the health care provider while on therapy. A low-molecular-weight heparin is considered to be a high-risk medication and the client should wear or carry medical identification. The air bubble should not be expelled from the syringe because the bubble ensures the client receives the full dose of the medication. The client should allow 5 seconds to pass before withdrawing the needle to prevent seepage of the medication out of the site.

When developing a teaching plan for a client who is proscribed acetaminophen (Tylenol) for muscle pain, which information should the nurse expect to include? Select all that apply. 1. The drug can be used if the person is allergic to aspirin. 2. Acetaminophen does not affect platelet aggregation. 3. This drug causes little or no gastric distress. 4. Acetaminophen exerts a strong anti-inflammatory effect. 5. The client should have Lhe international normalized ratio (INR) checked regularly.

1, 2, 3. Acetaminophen is an alternative for a client who is allergic to aspirin. It does not affect platelet aggregation and the client does not need to have coagulation studies (such as INR). Acetaminophen causes little or no gastric distress. Acetaminophen exerts no anti-inflammatory effects.

Benzathine penicillin G, 2.4 million units IM, is prescribed as treatment for an adult client with primary syphilis. The nurse should administer the injection in the: 1. Deltoid. 2. Upper outer quadrant of the buttock. 3. Quadriceps lateralis of the thigh. 4. Mid lateral aspect of the thigh.

2. Because of the large dose, the upper outer quadrant of the buttocks is the recommended site. The deltoid and the q uaclriceps lateralis of the thigh are not large enough for the recommended dose. In infants and small children, the midlateral aspect of the thigh may be preferred.

The physician has prescribed 5 mg Coumadin (warfarin) orally for a hospitalized client. In planning care for this client, the nurse should verify that which of the following services have been contacted'? Check all that apply. 1. Pharmacy. 2. Dietary. 3. Laboratory. 4. Discharge planning. 5. Chaplain

1, 2, 3. To assure client safety when using anticoagulants, the nurse should coordinate care at this lime with the pharmacist, dietitian, and laboratory. The pharmacist will collaborate in teaching the client about using the drug; dietary services will plan a diet that limits foods that have high amounts of vitamin K (spinach, cabbage, blueberries) that will interfere with anticoagulation, and the laboratory will draw daily INR levels to assure accurate dosing. Although the nurse coordinates discharge planning at the time of admission lo the hospital, at this point it is too soon for discharge planning services lo be involved because it is not known if the client will continue to take the Coumadin when discharged. There is no indication a chaplain is needed at this time.

A client has been prescribed allopurinol (Zyloprim) for renal calculi that are caused by high uric acid levels. Which of the following indicate the client is experiencing adverse effect(s) of this drug'? Select all that apply. 1. Nausea. 2. Rash. 3. Constipation. 4. Flushed skin. 5. Bone marrow depression.

1, 2, 5. Common adverse effects of allopurinol (Zyloprim) include gastrointestinal distress, such as anorexia, nausea, vomiting, and diarrhea. A rash is another potential adverse effect. A potentially life-threatening adverse effect is bone marrow depression. Constipation and flushed skin are not associated with this drug.

After the administration of t-PA, the nurse should: 1. Observe the client for chest pain. 2. Monitor for fever. 3. Review the 12-lead electrocardiogram (ECG). 4. Auscultate breath sounds.

1. Although monitoring the 12-lead ECG andmonitoring breath sounds are important, observing the client for chest pain is the nursing assessment priority because closme of the previously obstructed coronary artery may recur. Clients who receive t-PA frequently receive heparin to prevent closure of the artery after administration of t-PA. Careful assessment for signs of bleeding and monitoring of partial thromboplastin time are essential to detect complications. Administration of t-PA should not cause fever.

A client with diabetes is taking insulin lispro (Humalog) injections. The nurse should advise the client to eat: 1. Within 10 to 15 minutes after the injection. 2. 1 hour after the injection. 3. At any time, because timing of meals with lispro injections is unnecessary. 4. 2 hours before the injection.

1. Insulin lispro (Humalog) begins to act within 10 to 15 minutes and lasts approximately 4 hours. A major advantage of Humalog is that the client can eat almost immediately after the insulin is administered. The client needs to be instructed regarding the onset, peak, and duration of all insulin, as meals need to be timed with these parameters. Waiting 1 hour to eat may precipitate hypoglycemia. Eating 2 hours before the insulin lispro could cause hyperglycemia if the client does not have circulating insulin to metabolize the carbohydrate.

A client taking oral contraceptives is placed on a 10-day course of antibiotics for an infection. Which of the following instructions should the nurse include in the teaching plan? 1. "Use a barrier method of birth control for the rest of your cycle." 2. "You should stop taking the oral contraceptives while taking the antibiotic." 3. "Call your health care provider for increased hunger or fluid retention." 4. "Take the antibiotics 2 hours after the oral contraceptive."

1. Antibiotics may decrease the effectiveness of oral contraceptives. The client should be instructed to continue the contraceptives and use a barrier method as a backup method of birth control until the next menstrual cycle. The client should not stop taking her oral contraceptives and there is no indication for or benefit to taking the antibiotic 2 hours after the contraceptive. There is no incidence of the adverse effects of increased hunger and fluid retention with the interaction of antibiotic therapy and oral contraceptives.

A nurse is reviewing the chart of an adult male with cancer. The health care provider has prescribed filgrastim 400 mcg, subcutaneously once daily. The nurse reviews the laboratory report and determines treatment has been effective when: 1. Hemoglobin is 16 g/dL (160 g/L). 2. WBC count is 3,500/mm3 (3.5 x 10^9/L). 3. Platelet count is 200,000/mm3 (200 x 10^9/L). 4. RBC count is 4.3 million/mm3 (4.3 x 10^12/L).

1. Chemotherapy may cause suppression of the immune system, resulting in a reduction in the WBC count and placing the client at risk for infection. Decreased hemoglobin (Hgb) indicates anemia. The Hgb is within normal limits for an adult male. A decreased platelet count would indicate lhrombocytopenia, and platelets would be pre scribed. The platelet count is within normal limits for an adult male. Epoetin alfa is used to treat low red blood cell counts (anemia) caused by chemotherapy.

A client has a throbbing headache when nitroglycerin is taken for angina. The nurse should instruct the client that: 1. Acetaminophen (Tylenol) or Ibuprofen (Advil) can be taken for this common side effect. 2. Nitroglycerin should be avoided if the client is experiencing this serious side effect. 3. Taking the nitroglycerin with a few glasses of water will reduce the problem. 4. The client should lie in a supine position to alleviate the headache.

1. Headache is a common side effect of nitroglycerin that can be alleviated with aspirin, acetaminophen, or ibuprofen. The sublingual nitroglycerin needs to be absorbed in the mouth, which will be disrupted with drinking. Lying flat will increase blood flow to the head and may increase pain and exacerbate other symptoms, such as shortness of breath.

The physician prescribes rnetoclopramide hydrochloride for the client with hiatal hernia. This drug is used in hiatal hernia therapy to accomplish which of the following objectives? 1. Increase tone of the esophageal sphincter. 2. Neutralize gastric secretions. 3. Delay gastric emptying. 4. Reduce secretion of digestive juices.

1. Metoclopramicle hydrochloride increases esophageal sphincter tone and facilitates gastric emptying; both actions reduce the incidence of reflux. Other drugs, such as antacids or histamine receptor antagonists, may also be prescribed to help control reflux and esophagitis and to decrease or neutralize gastric secretions. Reglan is not effective in decreasing or neutralizing gastric secretions.

Assessment of a client taking a nonsteroidal anti-intlammatory drug (NSAID) for pain management should include specific questions regarding which of the following systems? 1. Gastrointestinal. 2. Renal. 3. Pulmonary. 4. Cardiac.

1. The most common toxicities from NSAIDs are gastrointestinal disorders (nausea, epigastric pain, ulcers, bleeding, diarrhea, and constipation). Renal dysfunction, pulmonary complications, and cardiovascular complications from NSAIDs are much less common.

Two days after surgery, a client continues to take hydrocodone 7.5 mg and acetaminophen 500 mg (Lortab 7.5/500). What should the nurse ask the client before administering the pain medication? 1. "Where is your pain located?" 2. "Have you emptied your bladder?" 3. "How long has it been since your last dose?" 4. "ls your pain better than before you had surgery?"

1. The nurse should ask the location of the client's pain because Lortab is an opioid, which can be constipating. By the third day, many clients become constipated and are feeling distended, with sharp, cramping pain due to gas, which is treated with ambulation, not more opioids. The client's emptying the bladder should not affect the pain level. The nurse should look at the client's chart to determine when the client's last dose of pain medication was administered, rather than asking the client. The client's statement regarding the pain level before the surgery is not relevant to whether the nurse should administer the Lortab.

The nurse in the emergency department is administering a prescription for 20 mg intravenous furosemide (Lasix) which is to be given immediately. The nurse scans the client's identification band and the medication barcode. The medication administration system does not verify that furosemide is prescribed for this client; however, the furosemide is prepared in the accurate unit dose for intravenous infusion. The nurse should do which of the following next? 1. Contact the pharmacist immediately to check the prescription and the barcode label for accuracy. 2. Administer the medication now, knowing the medication is labeled and the client is identified. 3. Report the problem to the information technology team to have the barcode system recalibrated. 4. Ask another nurse to verify the medication and the client so the medication can be given now.

1. The nurse should contact the pharmacist first to be sure the medication is labeled for administration to this client. The nurse should not administer the drug until all safety precautions have been observed; the nurse should also not ask another nurse to verify the medication or client. Later, if the problem cannot be resolved with relabeling the medication, the nurse or pharmacist can contact the information technology team to check the barcode system.

An elderly client on steroids has secondary diabetes and chronic kidney disease (CKD) and takes insulin. The client has had episodes of hypoglycemia. The nurse should: 1. Continue to monitor the client's blood glucose values. 2. Contact the dietitian to request that one additional serving of protein be added to each meal. 3. Restrict ambulation so there will be less of a chance for hypoglycemia. 4. Contact the physician and recommend that the closes of insulin be evaluated.

1. The nurse should continue to monitor glucose in the blood to prevent the client from continuing to experience hypoglycemia. One of the risk factors for hypoglycemia is decreased insulin clearance as with impaired kidney function and/or renal failure. Another risk factor for hypoglycemia is increased glucose utilization when there is too much activity or exercise without enough food. Protein is digested slower than carbohydrate, but with chronic kidney disease (CKD), it is more difficult for the kidneys to rid the body of metabolic waste products.

A male client reports having impotence. The nurse examines the client's medication regimen and is aware that a contributing factor to impotence could be: 1. Aspirin. 2. Antihypertensives. 3. Nonsteroidal anti-inflammatory drugs. 4. Anticoagulants.

2. Antihypertensives, especially beta-blockers such as propranolol (Inderal), can cause impotence. When a male client has impotence, the nurse should always examine his medication regimen as a potential contributing factor. Aspirin, nonsteroidal anti-inflammatory drugs, and anticoagulants do not cause erectile dysfunction.

The best indicator that the client has learned how to give an insulin self-injection correctly is when the client can: 1. Perform the procedure safely and correctly. 2. Critique the nurse's performance of the procedure. 3. Explain all steps of the procedure correctly. 4. Correctly answer a posttest about the procedure.

1. The nurse should judge that learning has occurred from the evidence of a change in the client's behavior. A client who performs a procedure safely and correctly demonstrates that he has acquired a skill. Evaluation of this skill acquisition requires performance of that skill by the client with observation by the nurse. The client must also demonstrate cognitive understanding, as shown by the ability to critique the nurse's performance. Explaining the steps demonstrates acquisition of knowledge at the cognitive level only. A posttest does not indicate the degree to which the client has learned a psychomotor skill.

A client has had a stasis ulcer of the left ankle with 2+ pitting edema for 2 years. The client is taking chlorothiazide. The expected outcome of this drug is: 1. Improved capillary circulation. 2. Decreased blood pressure. 3. Wound healing. 4. Absence of infection.

1. The result of chronic venous stasis is swelling and edema and superficial varicose veins. Diuretics will help reduce the swelling, thus improving capillary circulation. Although diuretics may decrease blood pressure, that is not the intended outcome of this drug. The nurse should teach the client to prevent infection and monitor wound healing, but these are not the primary outcomes of chlorothiazide.

A client is using a herbal therapy while receiving chemotherapy. The nurse should: 1. Determine what substances the client is using, and make sure that the physician is aware of all therapies the client is using. 2. Guide the client in the decision-making process to select either Western or alternative medicine. 3. Encourage the client to seek alternative modalities that do not require the ingestion of substances. 4. Recommend that the client stop using the alternative medicines immediately.

1. The role of the nurse is to assess what substances or medications the client is using and to document and inform other members of the health care team. It is very important to encourage the client to keep the physician informed of all therapeutic agents, medications, and supplements she is using, to avoid adverse interactions. It is not appropriate for the nurse to suggest that the client choose either Western or alternative therapies or to discourage the client's use of alternative therapies. The nurse should remain objective about the client's treatment choices and respect her autonomy.

A client requests a narcotic analgesic shortly after the oncoming nurse receives change-of-shift report. The nurse who is leaving reported that the client had received morphine 10 mg (IM) within the past hour. In what order from first to last should the oncoming registered nurse (RN) do the following actions? 1. Validate with the outgoing RN that morphine 10 mg (IM) had been administered. 2. Assess the client for manifestations of pain. 3. Check the medication documentation as to when morphine 10 mg (IM) was dispensed and to whom. 4. Check to ascertain if any discrepancy had been documented with accompanying reason/s.

2, 3, 1, 4. The oncoming nurse should first assess the client for pain. Next, the nurse should check the documentation and then validate with the nurse who reported giving the medication that the medication had been given. Finally, the nurse should determine if there is a discrepancy between administration and documentation.

A physician has prescribed amoxicillin (Ampicillin) 100 PO b.i.d. The nurse should teach the client to do which of the following? Select all that apply. 1. Drink 300 to 500 mL of fluids daily. 2. Void frequently, at least every 2 to 3 hours. 3. Take time to empty the bladder completely. 4. Take the last dose of the antibiotic for the day at bedtime. 5. Take the antibiotic with or without food.

2, 3, 4, 5. Ampicillin may be given with or without food, but the nurse should instruct the client to obtain an adequate lluicl intake (2,500 to 3,000 mL) to promote urinary output and to flush out bacteria from the urinary tract. The nurse should also encourage the client to void frequently (every 2 to 3 hours) and empty the bladder completely. Taking the antibiotic at bedtime, after emptying the bladder, helps to ensure an adequate concentration of the drug during the overnight period.

Which clinical manifestations should the nurse expect to assess in a client diagnosed with an overdose of a cholinergic agent? Select all that apply. 1. Dry mucous membranes. 2. Urinary incontinence. 3. Central nervous system (CNS) depression. 4. Seizures. 5. Skin rash.

2, 3, 4. An excess of cholinergic agents produces urinary and fecal incontinence, increased salivation, diarrhea, and diaphoresis. In a severe overdose, CNS depression, seizures and muscle fasciculations, bradycardia or tachycardia, weakness, and respiratory arrest due to respiratory muscle paralysis occur. Anticholinergics produce dry mucous membranes. Skin rash is not a sign of overdose with a cholinergic agent.

A client receiving a loop diuretic should be encouraged to eat which of the following foods? Select all that apply. 1. Angel food cake. 2. Banana. 3. Dried fruit. 4. Orange juice. 5. Peppers.

2, 3, 4. Hypokalemia is a side effect of loop diuretics. Bananas, dried fruit, and oranges are examples of food high in potassium. Angel food cake, yellow cake, and peppers are low in potassium.

The nurse is teaching a client about taking prophylactic warfarin sodium (Coumadin). Which statement indicates that the client understands how lo Lake the drug? Select all that apply. 1. "The drug's action peaks in 2 hours." 2. "Maximum dosage is not achieved until 3 to 4 days after starting the medication." 3. "Effects of the drug continue for 4 to 5 days after discontinuing the medication." 4. "Protamine sulfate is the antidote for warfarin." 5. "I should have my blood levels tested periodically."

2, 3, 5. The maximum dosage of warfarin sodium (Coumadin) is not achieved until 3 lo 4 days after starting the medication, and the effects of the drug continue for 4 to 5 days after discontinuing the medication. The client should have blood levels tested periodically to make sure that the desired level is maintained. Warfarin has a peak action of 9 hours. Vitamin K is the antidote for warfarin; prolamine sulfate is the antidote for heparin.

When teaching the client with a urinary tract infection about taking a prescribed antibiotic for 7 days, the nurse should tell the client to report which of the following to the health care provider? Select all that apply. 1. Cloudy urine for the first few days. 2. Blood in the urine. 3. Rash. 4. Mild nausea. 5. Fever above 100°F (37.8°C) 6. Urinating every 3 to 4 hours

2, 3, 5. The nurse should instruct the client to report signs of adverse reaction to the antibiotic or indications that the urinary tract infection is not clearing. Blood in the urine is not an expected outcome, rash is an adverse response to the antibiotic, and an elevated temperature indicates a persistent infection. These signs should be reported to the health care provider. Cloudy urine can be expected during the first few days of antibiotic treatment. Mild nausea is a side effect of antibiotic therapy, but can be managed with eating small, frequent meals. Urinating every 3 to 4 hours or more is expected, particularly if the client is increasing the fluid intake as directed.

A client has been prescribed nitrofurantoin for treatment of a lower urinary tract infection. Which of the following instructions should the nurse include when teaching the client about this medication? Select all that apply. 1. "Take the medication on an empty stomach." 2. "Your urine may become brown in color." 3. "Increase your fluid intake." 4. "Take the medication until your symptoms subside." 5. "Take the medication with an antacid to decrease gastrointestinal distress."

2, 3. Clients who are taking nilrofurantoin should be instructed to take the medication with meals and lo increase their fluid intake to minimize gastrointestinal distress. The urine may become brown in color. Although this change is harmless, clients need lo be prepared for this color change. The client should be instructed to take the full prescription and not to stop taking the drug because symptoms have subsided. The medication should not be taken with antacids as this may interfere with the drug's absorption.

A client has been on long-term prednisone therapy. The nurse should instruct the client to consume a diet high in which of the following? Select all that apply. 1. Carbohydrate. 2. Protein. 3. Trans fat. 4. Potassium. 5. Calcium. 6. Vitamin D.

2, 4, 5, 6. Adverse effects of prednisone are weight gain, retention of sodium and fluids with hypertension and cushingoid features, a low serum albumin level, suppressed inflammatory processes with masked symptoms, and osteoporosis. A diet high in protein, potassium, calcium, and vitamin Dis recommended. Carbohydrate would elevate glucose and further compromise a client's immune status. Trans fat does not counteract the adverse effects of steroids such as prednisone.

A client is receiving monthly doses of chemotherapy for treatment of stage Ill colon cancer. The nurse should report which of the following laboratory results to the oncologist before the next dose of chemotherapy is administered? Select all that apply. 1. Hemoglobin of 14.5 g/dL (145 g/L). 2. Platelet count of 40,000/mm3 (40 x 10g/L). 3. Blood urea nitrogen (BUN) level of 12 mg/dL (4.28 mmol/L). 4. White blood cell count of 2,300/mm3 (2.3x10/L) 5. Temperature of 101.2F(38.4C) 6. Urine specific gravity of 1.020

2, 4, 5. Chemotherapy causes bone marrow suppression and risk of infection. A platelet count of 40,000/mm3 (40 x 109/L) and a white blood cell count of 2,300/mm3 (2.3 x 10!1/LJ are low. A temperature of 101.2°F (38.4°CJ is high and could indicate an infection. Further assessment and examination should be performed lo rule out infection. The BUN, hemoglobin, and specific gravity values are normal.

A client with bacterial pneumonia is to be started on IV antibiotics. Which of the following diagnostic tests must be completed before antibiotic therapy begins? 1. Urinalysis. 2. Sputum culture. 3. Chest radiograph. 4. Red blood cell count.

2. A sputum specimen is obtained for culture to determine the causative organism. After the organism is identified, an appropriate antibiotic can be prescribed. Beginning antibiotic therapy before obtaining the sputum specimen may alter the results of the test. Urinalysis, a chest radiograph, and a red blood cell count do not need to be obtained before initiation of antibiotic therapy for pneumonia.

Allopurinol (Zyloprim), 200 mg/day, is prescribed for the client with renal calculi to take at home. The nurse should teach the client about which of the following adverse effects of this medication? 1. Retinopathy. 2. Maculopapular rash. 3. Nasal congestion. 4. Dizziness.

2. Allopurinol (Zyloprim) is used to treat renal calculi composed of uric acid. Adverse effects of allopurinol include drowsiness, maculopapular rash, anemia, abdominal pain, nausea, vomiting, and bone marrow depression. Clients should be instructed to report rashes and unusual bleeding or bruising. Retinopathy, nasal congestion, and dizziness are not adverse effects of allopurinol.

A client undergoing chemotherapy tells the nurse, "I do not want to get out of bed in the morning because I am so tired." The nursing plan of care should include: 1. Education on the use of filgrastim. 2. Individually tailored exercise program. 3. Weight lifting when not experiencing fatigue. 4. Bed rest until chemotherapy is completed.

2. An individualized exercise program will increase stamina and endurance. Weight lifting may be too vigorous. Filgrastim is used to increase white blood cells and is not applicable in this situation. Decreased hemoglobin and hematocrit predisposes the client to fatigue due lo decreased oxygen availability. Bed rest causes muscle atrophy, adding to fatigue, and promotes DVT formation.

When preparing to teach a client about phenytoin sodium (Dilantin) therapy, the nurse should urge the client not to stop the drug suddenly because: 1. Physical dependency on the drug develops over time. 2. Status epilepticus may develop. 3. A hypoglycemic reaction develops. 4. Heart block is likely to develop.

2. Anticonvulsant drug therapy should never be stopped suddenly; doing so can lead to life threatening status epilepticus. Phenytoin sodium does not carry a risk of physical dependency or lead to hypoglycemia. Phenytoin has antianhythmic properties, and discontinuation does not cause heart block.

A nurse is assessing a female who is receiving her second administration of chemotherapy for breast cancer. When obtaining this client's health history, what is the most important information the nurse should obtain? 1. "Has your hair been falling out in clumps?" 2. "Have you had nausea or vomiting?" 3. "Have you been sleeping at night?" 4. "Do you have your usual energy level?"

2. Chemotherapy agents typically cause nausea and vomiting when not controlled by antiemetic drugs. Antineoplastic drugs attack rapidly growing normal cells, such as in the gastrointestinal tract. These drugs also stimulate the vomiting center in the brain. Hair loss, loss of energy, and sleep are important aspects of the health history, but not as critical as the potential for dehydration and electrolyte imbalance caused by nausea and vomiting.

A client with cervical cancer is undergoing internal radium implant therapy. A lead-lined container and a pair of long forceps are kept in the client's hospital room for: 1. Disposal of emesis or other bodily secretions. 2. Handling of a dislodged radiation source. 3. Disposal of the client's eating utensils. 4. Storage of the radiation close.

2. Dislodged radioactive materials should not be touched with bare or gloved hands. Forceps are used to place the material in the lead-lined container, which shields the radiation. Exposure lo radiation can occur only by direct exposure lo the encased radioactive substance; it cannot result from contact with emesis or urine or from touching the client. Disposal of eating utensils cannot lead to radiation exposure. Radioactive dose materials are kept only in the radiation department.

A 75-year-old client who has been taking furosemide (Lasix) regularly for 4 months tells the nurse that he is having trouble hearing. What would be the nurse's best response to this statement? 1. Tell the client that because he is 75 years old it is inevitable that his hearing should begin to deteriorate. 2. Have the client immediately report the hearing loss to his physician. 3. Schedule the client for audiometric testing and a hearing aid. 4. Tell the client that the hearing loss is only temporary; when his system adjusts to the furosemide, his hearing will improve.

2. Furosemide may cause ototoxicity. The nurse should tell the client to promptly report the hearing loss, dizziness, or tinnitus to help prevent permanent ear damage. Hearing loss is not inevitable, and it is inappropriate to make assumptions about the cause of symptoms without a thorough evaluation. The client's system will not "adjust," and hearing loss will not resolve.

A client with Parkinson's disease is prescribed levodopa (L-dopa) therapy. Improvement in which of the following indicates effective therapy? 1. Mood. 2. Muscle rigidity. 3. Appetite. 4. Alertness.

2. Levodopa is prescribed to decrease severe muscle rigidity. Levodopa does not improve mood, appetite, or alertness in a client with Parkinson's disease.

Which of the following statements is most accurate regarding the long-term toxic effects of cancer treatments on the immune system? 1. Clients with persistent immunologic abnormalities after treatment are at a much greater risk for infection than clients with a history of splenectomy. 2. The use of radiation and combination chemotherapy can result in more frequent and more severe immune system impairment. 3. Long-term immunologic effects have been studied only in clients with breast and lung cancer. 4. The helper T cells recover more rapidly than the suppressor T cells, which results in positive helper cell balance that can last 5 years.

2. Studies of long-term immunologic effects in clients treated for leukemia, Hodgkin's disease, and breast cancer reveal that combination treatments of chemotherapy and radiation can cause overall bone marrow suppression, decreased leukocyte counts, and profound immunosuppression. Persistent and severe immunologic impairment may follow radiation and chemotherapy (especially multiagent therapy). There is no evidence of greater risk of infection in clients with persistent immunologic abnormalities. Suppressor T cells recover more rapidly than the helper T cells.

The nurse is planning care for a client with osteomyelitis. The client is taking an antibiotic, but the infection has not resolved. The nurse should advise the client to do which of the following? 1. Use herbal supplements. 2. Eat a diet high in protein and vitamins C and D. 3. Ask the health care provider for a change of antibiotics. 4. Encourage frequent passive range of motion to the affected extremity.

2. The goal of ca.re for this client is healing and tissue growth while the client continues on long-term antibiotic therapy to clear the infection. A diet high in protein and vitamins C and D promotes healing. Herbal supplement may potentiate bleeding (eg, ginkgo, ginger, tumeric, chamomile,. kelp, horse chestnut, garlic, and dong quail and have not been proven through research to promote healing. Frequent passive motion will increase circulation but may also aggravate localized bone pain. It is not appropriate to advise the client to change antibiotics as treatment may take time.

A 48-year-old client with cancer has been receiving 10 mg of IV morphine while hospitalized. Which of the following is an equivalent close of oral morphine? 1. 20 mg. 2. 30 mg. 3. 40 mg. 4. 50 mg.

2. There is a 1:3 ratio with equianalgesic dosing of IV to oral morphine; therefore, the physician should prescribe three times the IV dose.

The client has been recently diagnosed with type 2 diabetes, and is taking metformin [Glucophage) two times per day, 1,000 mg before breakfast and 1,000 mg before supper. The client is experiencing diarhea, nausea, vomiting, abdominal bloating, and anorexia on admission to the hospital. The admission prescriptions include metformin [Glucophage). The nurse should do which of the following? Select all that apply. 1. Discontinue the metformin (Glucophage). 2. Administer glargine [Lantus) insulin rather than the metformin (Glucophage). 3. Inform the client that the adverse effects of diarrhea, nausea, and upset stomach gradually subside over time. 4. Assess the client's renal function. 5. Monitor the client's glucose value prior to each meal.

3, 4, 5. The nurse may not discontinue a medication without a physician's prescription, and the nurse may not substitute one medication for another. Maximum doses may be better tolerated if given with meals. Before therapy begins, and at least annually thereafter, assess the client's renal function; if renal impairment is detected, a different antidiabelic agent may be indicated. To evaluate the effectiveness of therapy, the client's glucose value must be monitored regularly. The prescriber must be notified if the glucose value increases, despite therapy.

A health care provider has prescribed carbidopa-levodopa (Sinemet) four times per clay for a client with Parkinson's disease. The client wants "to end it all now that the Parkinson's disease has progressed." What should the nurse do? Select all that apply. 1. Explain that the new prescription for Sinemet will treat tho depression. 2. Encourage the client to discuss feelings as the Sinemet is being administered. 3. Contact the health care provider before administering the Sinemet. 4. Determine if the client is on antidepressants or monoamino oxiclase (MAO) inhibitors. 5. Determine if the client is at risk for suicide.

3, 4, 5. The nurse should contact the health care provider before administering Sinemet because this medication can cause further symptoms of depression. Suicide threats in clients with chronic illness should be taken seriously. The nurse should also determine if the client is on an MAO inhibitor because concurrent use with Sinemet can cause a hypertensive crisis. Sinemet is not a treatment for depression. Having the client discuss feelings is appropriate when the prescription is finalized.

A client is brought to the emergency department unconscious. An empty bottle of aspirin was found in the car, and a drug overdose is suspected. Which of the following medications should the nurse have available for further emergency treatment? 1. Vitamin K. 2. Dextrose 50%. 3. Activated charcoal powder. 4. Sodium thiosulfate.

3. Activated charcoal powder is administered to absorb remaining particles of salicylate. Vitamin K is an antidote for warfarin sodium (Coumadin). Dextrose 50% is used to treat hypoglycemia. Sodium thiosulfate is an antidote for cyanide.

A client had a craniotomy for removal of a malignant brain tumor in the occipital region. The nurse should question a prescription for which of these drugs? 1. Ibuprofen (Motrin). 2. Naproxen (Naprosyn). 3. Morphine sulfate. 4. Acetaminophen (Tylenol).

3. Administration of morphine sulfate is contraindicated because morphine causes respiratory depression. It may also increase intracranial pressure if the client is not ventilating properly, which could result in an accumulation of CO2, a potent vasodilator. Ibuprofen, naproxen, and acetaminophen are not likely to mask symptoms of increased intracranial pressure or impact respiratory status.

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? 1. "You can wait and take the next dose when it is due." 2. "Double the amount prescribed with your next dose." 3. "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." 4. "Take a lot of water with a double amount of your prescribed dose."

3. Antibiotics have the maximum effect when the level of the medication in the blood is maintained. However, because nitrofurantoin is readily absorbed from the gastrointestinal tract and is primarily excreted in urine, toxicity may develop by doubling the dose. The client should not skip a dose, if one dose is missed. Additional fluids, especially water, should be encouraged, but not forced to promote elimination of the antibiotic from the body. Adequate fluid intake aids in the prevention of urinary tract infections, in addition to an acidic urine.

A young adult client who has been diagnosed with type 1 diabetes has an insulin drip to aid in lowering the serum blood glucose level of 600 mg/dL (33.3 mmol/L). The client is also receiving ciprofloxacin IV. The physician prescribes discontinuation of the insulin drip. The nurse should next? 1. Discontinue the insulin drip, as prescribed. 2. Hang the next IV dose of antibiotic before discontinuing the insulin drip. 3. Inform the physician that the client has not received any subcutaneous insulin yet. 4. Add glargine to the insulin drip before discontinuing it.

3. Because subcutaneous administration of insulin has a slower rate of absorption than IV insulin, there must be an adequate level of insulin in the bloodstream before discontinuing the insulin drip; otherwise, the glucose level will rise. Adding an IV antibiotic has no influence on the insulin drip; it should not be piggy-backed into the insulin drip. Glargine cannot be administered IV, and should not be mixed with other insulins or solutions.

The client who is receiving chemotherapy is not eating well but otherwise feels healthy. Which meal suggestion would be best for this client? 1. Creal with milk and strawberries. 2. Toast, gelatin dessert, and cookies. 3. Broiled chicken, green beans, and cottage cheese. 4. Steak and french fries

3. Carbohydrates are the first substance used by the body for energy. Proteins are needed lo maintain muscle mass, repair tissue, and maintain osmotic pressure in the vascular system. Fats, in a small amount, are needed for energy production. Chicken, green beans, and cottage cheese are the best selection to provide a nutritionally wellbalanced diet of carbohydrate, protein, and a small amount of fat. Cereal with milk and strawberries as well as toast, gelatin dessert, and cookies have a large amount of carbohydrates and not enough protein. Steak and french fries provide some carbohydrates and a good deal of protein; however, they also provide a large amount of fat.

During the first 24 hours after thrombolytic treatment for an ischemic stroke, the primary goal is to control the client's: 1. Pulse. 2. Respirations. 3. Blood pressure. 4. Temperature.

3. Control of blood pressure is critical during the first 24 hours after treatment because an intracerebral hemorrhage is the major adverse effect of thrombolytic therapy. Vital signs are monitored, and blood pressure is maintained as identified by the physician and specific to the client's ischemic tissue needs and risk of bleeding from treatment. The other vital signs are important, but the priority is to monitor blood pressure.

Glulisine (Apidra) insulin is prescribed to be administered to a client before each meal. To assist the day-shift nurse who is receiving the report, the night-shift nurse gives the morning dose of glulisine. When the day-shift nurse goes to the room of the client who requires glulisine, the nurse finds that the client is not in the room. The client's roommate tells the nurse that the client "went for a test." What should the nurse do next? 1. Bring a small glass of juice, and locate the client. 2. Call the client's physician. 3. Check the computerized care plan to determine what test was scheduled. 4. Send the nurse's assistant to the x-ray department to bring the client back to his room.

3. Glulisine (Apidra) is a rapid-acting insulin with an action onset of 15 minutes. The client could experience hypoglycemia with the insulin in the bloodstream and no breakfast. It is not necessary to call the client's physician; the nurse should determine what test was scheduled and then locate the client and provide either breakfast or 4 oz (120 mL) of fruit juice. To bring the client back to the room would be wasting valuable time needed to prevent or correct hypoglycemia.

A client who has been taking hydrocodone with acetaminophen at home for 6 weeks following a fractured tibia is admitted with a blood pressure of 80/50 mm Hg, a pulse rate of 115 bpm, and respirations of 8 breaths per minute and shallow. The nurse interprets these findings as indicating which of the following? 1. Expected common adverse effects of the hydrocodone. 2. Hypersensitivity reaction to the acetaminophen. 3. Possible habituating effect of the long-term drug use. 4. Hemorrhage from gastrointestinal irritation associated with the pain medication

3. Hypotension and depressed respirations are signs of high levels of ingestion of hydrocodone, and the client may be developing a habit of taking this drug for a prolonged period. Expected common adverse effects of hydrocodone and acetaminophen would include drowsiness, confusion, blurred vision, and constipation. Hemorrhage from gastrointestinal irritation is not associated with this drug. Hypersensitivity reactions would be manifested by pruritus and rashes.

A nurse is teaching a client with type 1 diabetes mellitus who jogs daily about the preferred sites for insulin absorption. What is the most appropriate site for a client who jogs? 1. Arms. 2. Legs. 3. Abdomen. 4. Iliac crest.

3. If the client engages in an activity or exercise that focuses on one area of the body, that area may cause inconsistent absorption of insulin. A good regimen for a jogger is to inject the abdomen for 1 week and then rotate to the buttock. A jogger may have inconsistent absorption in the legs or arms with strenuous running. The iliac crest is not an appropriate site due to a lack of loose skin and subcutaneous tissue in that area.

The client is scheduled to receive phenytoin (Dilantin) through a nasogastric tube (NGT) and has a tube-feeding supplement running continuously. The head of the bed is elevated to 30 degrees. Prior to administering the medication, the nurse should: 1. Elevate the head of the bed to 60 degrees. 2. after Draw giving blood to the morning determine dose the in Dilantin order to level determine if client has toxic blood level. 3. Stop Dilantin the and tube hold feeding tube 1 hour feeding before for 1 giving Dilantin and hold tube fooding for 1 hour after giving Dilantin. 4. Flush the NGT with the 150 mL of water before and after giving the Dilantin.

3. In order for Dilantin to be properly absorbed and provide maximum benefit to the client, nutritional supplements must be stopped before and after delivery. The head of the bed is elevated 30 degrees since this client has a tube feeding infusing; it is not necessary to elevate the bed any further. Blood levels are usually drawn before giving a dose of Dilantin, not after. It is not necessary to flush with such a large amount of water (150 mL) before and after Dilantin.

When caring for the client who is receiving an aminoglycoside antibiotic, the nurse should monitor which of the following laboratory values? 1. Serum sodium. 2. Serum potassium. 3. Serum creatinine. 4. Serum calcium.

3. It is essential to monitor serum creatinine in the client receiving an aminoglycoside antibiotic because of the potential of this type of drug to cause acute tubular necrosis. Aminoglycoside antibiotics do not affect serum sodium, potassium, or calcium levels.

The client with a fractured tibia has been taking methocarbamol (Robaxin). Which of the following indicate that the drug is having the intended effect? 1. Lack of infection. 2. Reduction in itching. 3. Relief of muscle spasms. 4. Decrease in nervousness.

3. Methocarbamol is a muscle relaxant and acts primarily to relieve muscle spasms. It has no effect on microorganisms, does not reduce itching, and has no effect on nervousness.

A client arrives in the emergency department with an ischemic stroke and receives tissue plasminogen activator (t-PA) administration. The nurse should first: 1. Ask what medications the client is taking. 2. Complete a history and health assessment. 3. Identify the time of onset of the stroke. 4. Determine if the client is scheduled for any surgical procedures.

3. Studies show that clients who receive recombinant t-PA treatment within 3 hours after the onset of a stroke have better outcomes. The time from the onset of a stroke to t-PA treatment is critical. A complete health assessment and history is not possible when a client is receiving emergency care. Upcoming surgical procedures may need to be delayed because of the administration of t-PA, which is a priority in the immediate treatment of the current stroke. While the nurse should identify which medications the client is taking, it is more important to !mow the time of the onset of the stroke to determine the course of action for administering t-PA.

After completing client teaching on the use of patient-controlled analgesia (PCA), the nurse determines that the client understands the use of the PCA when the client stales: 1. "It is OK for my family to press the button for me if I'm too tired to do it myself." 2. "I should wait until the pain is really bad before I push the button to get more pain medicine." 3. "The machine will only give me the prescribed amount of pain medication even if I push the button too soon." 4. "I have to be careful about pushing the button too many times or I will overdose myself."

3. The client must be able to verbalize under standing about receiving no more pain medication than is prescribed no matter how many times the button is pushed. Only the client should press the button for the PCA. The client should administer the pain medication when the pain is first noticed, well before the pain is out of control. One of the advantages of the PCA is that the amount of pain medication is controlled; therefore overdosing is not a client concern when using a PCA.

After treatment with radioactive iodine (RAJ) in the form of sodium iodide (I131), the nurse teaches the client to: 1. Monitor for signs and symptoms of hyperthyroidism. 2. Rest for 1 week to prevent complications of the medication. 3. Take thyroxine replacement for the remainder of the client's life. 4. Assess for hypertension and tachycardia resulting from altered thyroid activity.

3. The client needs to be educated about the need For lifelong thyroid hormone replacement. Permanent hypothyroidism is the major complication of RAI treatment. Lifelong medical follow-up and thyroid replacement are warranted. The client needs to monitor for signs and symptoms of hypothyroidism, not hyperthyroidism. Resting for 1 week is not necessary. Hypertension and tachycardia are signs of hyperthyroidism, not hypothyroidism.

The client with first-time bacterial cystitis is being treated with an antibiotic to be taken for 7 days. The nurse should instruct the client to: 1. Limit fluids to 1,000 mL/day. 2. Notify the health care provider when the urine is clear. 3. Take the entire prescription as ordered. 4. Use condoms if having sex.

3. The client should take the prescription as ordered. The client should increase fluid intake to 3,000 mL/day to increase urination. Even though the urine may become clear in a short period, it is not necessary to notify the health care provider. The client should continue to take the entire prescription of antibiotics. Cystitis is not sexually transmitted, so protection by using a condom is not necessary.

A client had a colectomy 8 1/2 hours ago and has received 1,500 mL of dextrose 5% in water with normal saline solution. The client has just used a patient-controlled analgesia pump to administer morphine for pain, has been re-positioned for comfort, and has stable pulse rate, respirations, and blood pressure. What should the nurse do next? 1. Check that the family is comfortable. 2. Assess vital signs following the use of morphine. 3. Dim the lights in the room. 4. Increase nasal oxygen from 2 to 3 L.

3. The nurse is helping the client manage pain and comfort level. The nurse has completed the assessment of the client and should now dim the lights and create a quiet environment. Such nonpharmacologic measures as adjusting the light level in the room facilitate pain management. Decreasing stimulation from the environment, such as brightness to the optic nerve, promotes the client's ability to relax skeletal muscles and fall asleep. It is too soon to reassess vital signs. Checking that the family is comfortable is important but is not the next thing to do for this client. Increasing the oxygen flow rate is not indicated, and, if needed, should have been clone before repositioning the client.

A nurse is reviewing the physician's admitting prescriptions for a 52-year-old client scheduled for a dilatation and curettage. The nurse is unable to decipher the handwriting but thinks the medication prescription reads either metoprolol or topiramate. What should the nurse do next? 1. Ask the client if she has hypertension. 2. Ask the client if she has migraines. 3. Call the physician to clarify the prescription. 4. Ask the pharmacist to interpret the prescription.

3. The nurse must clarify this prescription with the admitting physician to ensure medication accuracy and client safety. In health care settings without computerized medical records or computer prescribing, misinterpretation of handwriting remains a leading cause of medication errors. It is not safe practice to question the client regarding a diagnosis and assume the medication is correctly prescribed. The pharmacist will need clarification of the prescription as well. It is not the role of the pharmacist to interpret the prescription.

A nurse on the gynecologic surgery unit observes a respiratory therapist (RT) take a medication cup with pills that was sitting in the medication room. What course of action should the nurse take? 1. Report the situation to the supervisor of respiratory therapy. 2. Tell the RT that you saw her take the pills from the medication room. 3. Report the situation to the nursing supervisor. 4. Tell the nurse who was administering medications not to leave pills out.

3. The nurse should follow the line of authority or chain of command by reporting the observation immediately to the nursing supervisor. The nurse should not confront the person or the medication nurse because the line of authority for reporting incidents should be followed. The RT supervisor may subsequently be involved in the incident, but the nursing supervisor should initiate and follow the policy and procedure.

The nurse learns that a client who is scheduled for a tonsillectomy has been taking 40 mg of oral prednisone daily for the last week for poison ivy on the leg. What is the nurse's best action? 1. Document the prednisone with current medications. 2. Notify the surgeon of the poison ivy. 3. Notify the anesthesiologist of the prednisone administration. 4. Send the client to surgery.

3. The nurse should notify the anesthesiologist because supplemental prednisone suppresses the adrenal cortex's natural ability to produce increased corticosteroids in times of stress such as surgery. The anesthesiologist may need to prescribe supplemental steroid coverage during the perioperative period. The nurse should document the prednisone with current medications, but it is a priority to inform the anesthesiologist. Because the poison ivy is not in the surgical field, the surgeon does not need to be called regarding the skin disruption.

On the day of surgery, a client with diabetes who takes insulin on a sliding scale is to have nothing by mouth and all medications withheld. The client's 6 AM glucose level is 300 mg/dL (16.7 mmol/L). The nurse should: 1. Withhold all medications. 2. Administer the insulin dose dictated by the sliding scale. 3. Call the physician for specific prescriptions based on the glucose level. 4. Notify the surgery department.

3. The nurse should notify the physician directly for specific prescriptions based on the client's glucose level. The nurse cannot ignore the elevated glucose level. The surgical experience is stressful, and the client needs specific insulin coverage during the perioperative period. The nurse should not administer the insulin without checking with the surgeon because there are specific prescriptions to withhold all medications. It is not necessary to notify the surgery department unless the physician cancels the surgery.

A client had a total abdominal hysterectomy and bilateral oophorectomy for ovarian carcinoma yesterday. She received 2 mg of morphine sulfate IV by patient-controlled analgesia (PCA) 10 minutes ago. The nurse was assisting her from the bed to a chair when the client felt dizzy and fell into the chair. The nurse should: 1. Discontinue the PCA pump. 2. Administer oxygen. 3. Take the client's blood pressure. 4. Assist the client back to bed.

3. The nurse should take the client's blood pressure. She is likely experiencing orthostatic hypotension. The PCA pump does not need to be discontinued because, as soon as the blood pressure stabilizes, the pain medication can be resumed. Administering oxygen is not necessary w1less the oxygen saturation also drops. The client should sit in the chair until the blood pressure stabilizes.

The mother of a client who has a radium implant asks why so many nurses are involved in her daughter's care. She states, "The doctor said I can be in the room for up to 2 hours each day, but the nurses say they're restricted to 30 minutes." The nurse explains that this variation is based on the fact that nurses: 1. Touch the client, which increases their exposure to radiation. 2. Work with many clients and could carry infection to a client receiving radiation therapy, if exposure is prolonged. 3. Work with radiation on an ongoing basis, while visitors have infrequent exposure to radiation. 4. Are at greater risk from the radiation because they are younger than the mother.

3. The three factors related to radiation safety are time, distance, and shielding. Nurses on radiation oncology units work with radiation frequently and so must limit their contact. Nurses are physically closer to clients than are visitors, who are often asked to sit 6 feet (182.9 cm) away from the client. Touching the client does not increase the amount of radiation exposure. Aseptic technique and isolation prevent the spread of infection. Age is a risk factor for people in their reproductive years.

What is the expected outcome of thrombolytic drug therapy for stroke? 1. Increased vascular permeability. 2. Vasoconstriction. 3. Dissolved emboli. 4. Prevention of hemorrhage.

3. Thrombolytic enzyme agents are used for clients with a thrombotic stroke to dissolve emboli, thus reestablishing cerebral perfusion. They do not increase vascular permeability, cause vasoconstriction, or prevent further hemorrhage.

A client with pancreatic cancer has been receiving morphine via a subcutaneous pump for 2 weeks. The client is requiring an increased dose of the morphine to manage the pain. The nurse should document that the client is: 1. Tolerating the medication well. 2. Showing addiction to morphine. 3. Developing a tolerance for the medication. 4. Experiencing physical dependence.

3. Tolerance develops from taking opioids over an extended period. It is characterized by the need for an increased dose to achieve the same degree of analgesia. Addiction is characterized by a drive to take the medication for the psychic effect rather than the therapeutic effect. Physical dependence is a response to ongoing exposure to a medication manifested by withdrawal symptoms when discontinued abruptly.

A client is being switched from levodopa (L-dopa) to carbidopa-levodopa (Sinemet). The nurse should monitor for which of the following possible complications during medication changes and dosage adjustment? 1. Euphoria. 2. Jaundice. 3. Vital sign fluctuation. 4. Signs and symptoms of diabetes.

3. Vital signs should be monitored, especially during periods of adjustment. Changes, such as orthostatic hypotension, cardiac irregularities, palpitations, and light-headedness, should be reported immediately. The client may actually experience suicidal or paranoid ideation instead of euphoria. The nurse should monitor the client for elevated liver enzyme levels, such as lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, and alkaline phosphatase, but the client should not be jaundiced. The client should not experience signs and symptoms of diabetes or a low serum glucose level, but the nurse should check the hemoglobin and hematocrit levels.

A client with human immunodeficiency virus (HIV) infection is taking zidovucline (AZT). The expected outcome of AZT is to: 1. Destroy the virus. 2. Enhance the body's antibody production. 3. Slow replication of the virus. 4. Neutralize toxins produced by the virus.

3. Zidovudine (AZT) interferes with replication of HIV and thereby slows progression of HIV infection to acquired immunodeficiency syndrome (AIDS). There is no known cure for HIV infection. Today, clients are not treated with monotherapy but are usually on triple therapy due to a much improved clinical response. Decreased viral loads with the drug combinations have improved the longevity and quality of life in clients with HIV/AIDS. AZT does not destroy the virus, enhance the body's antibody production, or neutralize toxins produced by the virus.

A male client is diagnosed with a chlamydia infection. Azithromycin (Zithromax) 1 g is prescribed. The supply of azithromycin is in 250-mg tablets. How many tablets should the nurse administer? ________________________________tablets.

4 tablets

A client who has been taking warfarin has been admitted with severe acute rectal bleeding and the following laboratory results: International Normalized Ratio (INR), 8; hemoglobin, 11 g/dL (110 g/1); and hematocrit, 33% (0.33). In which order should the nurse implement the following physician prescriptions? 1. Give 1 unit fresh frozen plasma (FFP). 2. Administer vitamin K 2.5 mg by mouth. 3. Schedule client for sigmoidoscopy. 4. Administer IV dextrose 5% in 0.45% normal saline solution.

4, 1, 2, 3 Analysis of the client's laboratory results indicate that an INR of 8 is increased beyond therapeutic ranges. The client is also experiencing severe acute rectal bleeding and has a hemoglobin level in the low range of normal and a hernatocrit reflecting fluid volume loss. The nurse should first establish an IV line and administer the dextrose in saline. Next the nurse should administer the FFP. FFP contains concentrated clotting factors and provides an immediate reversal of the prolonged INR. Vitamin K 2.5 mg PO should be given next because it reverses the warfarin by returning the PT to normal values. However, the reversal process occurs over 1 to 2 hours. Last, the nurse can schedule the client for the sigmoidoscopy.

The nurse ascertains that there is a discrepancy in the records of use of a controlled substance for a client who is taking large doses of narcotic pain medication. The nurse should do which of the following next'? 1. Notify the police. 2. Contact the hospital's administration or legal department. 3. Notify the pharmacy technician who delivered the controlled substance. 4. Notify the nursing supervisor of the clinical unit.

4. All health earn facilities in which controlled medications are stored for dispensing and/or administration to clients are required to follow procedures for the proper maintenance of narcotic inventory. Narcotic inventory maintenance includes, but is not limited lo, all discrepancies will have thorough and appropriate documentation with accompanying reasons (ie, tablet/amp/vial breakage, additional medication volume, etc.), timely resolution of inventory discrepancies, and timely notification regarding cont.rolled substance inventory discrepancies of persons in oversight areas (ie, Pharmacy, Security, Nursing House Supervisor). In the event of a significant incident, the proper external authorities will be notified by the Quality and Risk Management/Legal Department.

Atropine sulfate is included in the preoperative prescriptions for a client undergoing a modified radical mastectomy. The expected outcome is to: 1. promote general muscular relaxation. 2. decrease pulse and respiratory rates. 3. decrease nausea. 4. inhibit oral and respiratory secretions.

4. Atropine sulfate, a cholinergic blocking agent, is given preoperatively to reduce secretions in the mouth and respiratory tract, which assists in maintaining the integrity of the respiratory system during general anesthesia. Atropine is not used to promote muscle relaxation, decrease nausea and vomiting, or decrease pulse and respiratory rates. It causes the pulse to increase.

A client is to receive belladonna and opium suppositories, as needed, postoperatively after transurethral resection of the prostate (TURF). The nurse should give the client these drugs when he demontrates signs of: 1. A urinary tract infection. 2. Urine retention. 3. Frequent urination. 4. Pain from bladder spasms.

4. Belladonna and opium suppositories are prescribed and administered to reduce bladder spasms that cause pain after TURP. Bladder spasms frequently accompany urologic procedures. Antispasmodics offer relief by eliminating or reducing spasms. Antimicrobial drugs are used to treat an infection. Belladonna and opium do not relieve urine retention or urinary frequency.

Which of the following should be included in the nursing care for a client with cervical cancer who has an internal radium implant in place? 1. Offer the bedpan every 2 hours. 2. Provide perinea] care t\.vice daily. 3. Check the position of the applicator hourly. 4. Offer a low-residue diet.

4. Bowel movements can be difficult with the radium applicator in place. The purpose of the low-residue diet is to decrease bowel movements. The bowel is cleaned before therapy, and the woman is maintained on a low-residue diet during treatment to prevent bowel distention and defecation. To prevent dislodgment of the applicator, the client is maintained on strict bed rest and allowed only to turn from side to side. Perinea! care is omitted during radium implant therapy, although any vaginal discharge should be reported to the physician. ll is rare for the applicator to extrude, so this does not need to be checked every hour.

The nurse is reviewing laboratory reports for a client who is taking allopurinoI (Zyloprim). Which of the following indicate that the drug has had a therapeutic effect? 1. Decreased urine alkaline phosphatase level. 2. Increased urine calcium excretion. 3. Increased serum calcium level. 4. Decreased serum uric acid level.

4. By inhibiting uric acid synthesis, allopurinol (Zyloprim) decreases its excretion. The drug's effectiveness is assessed by evaluating for a decreased serum uric acid concentration. Allopurinol does not alter the level of alkaline phosphatase, nor does it affect urine calcium excretion or the serum, calcium level.

A client is prescribed oral metronidazole (Flagyl) for treatment of bacterial vaginosis. What should the nurse instruct the client to avoid during treatment and for 24 hours thereafter? 1. Douching. 2. Sexual intercourse. 3. Hot tub baths. 4. Alcohol consumption.

4. Metronidazole (Flagyl) interacts with alcohol and can cause a serious disulfiram (Antabuse)-type reaction, with severe, prolonged vomiting. The client should not douche unless following a medical prescription, but douching does not interact with Flagyl. Sexual intercourse and hot tub baths are not known to affect the incidence or treatment of bacterial vaginosis.

A 52-year-old male was discharged from the hospital for cancer-related pain. His pain appeared to be well controlled on the IV morphine. He was switched to oral morphine when discharged 2 days ago. He now reports his pain as an 8 on a 10-point scale and wants the IV morphine. Which of the following represents the most likely explanation for the client's reports of inadequate pain control? 1. He is addicted to the IV morphine. 2. He is going through withdrawal from the IV opioid. 3. He is physically dependent on the IV morphine. 4. He is undermedicated on the oral opioid.

4. Most clients with cancer who are experienc.ing inadequate pain control while taking an oral opioid after being switched from IV administration have been undermedicated. Equianalgesic conversions should be made to provide estimates of the equivalent close needed for the same level of relief as provided by the IV dose. There is research to suggest that cancer clients do not become addicted to opioids when dosed adequately. There is no evidence to suggest that the client is physically addicted or is having withdrawal symptoms.

The nurse should carefully observe a client with internal radium implants for typical adverse effects associated with radiation therapy to the cervix. These effects include: 1. Severe vaginal itching. 2. Confusion. 3. High fever in the afternoon or evening. 4. Nausea and a foul vaginal discharge.

4. Nausea, vomiting, and a foul vaginal discharge are common adverse effects of internal radiation therapy for cervical cancer. A foul-smelling discharge may develop from the destruction and sloughing of cells. Vaginal discharge may persist for some time. General signs and symptoms of radiation syndrome include nausea, vomiting, anorexia, and malaise. Vaginal itching, confusion, and high fever are not typical adverse effects of radiation therapy for cervical cancer.

A client with Graves' disease is treated with radioactive iodine (RAJ) in the form of sodium iodide (I131). Which of the following statements by the nurse will explain to the client how the drug works? 1. "The RAI stabilizes the thyroid hormone levels before a thyroidectomy." 2. "The RAI reduces uptake of thyroxine and thereby improves your condition." 3. "The RAI lowers the levels of thyroid hormones by slowing your body's production of them." 4. "The RAI destroys thyroid tissue so that thyroid hormones are no longer produced."

4. Sodium iodide (I131) destroys the thyroid follicular cells, and thyroid hormones are no longer produced. RAI is commonly recommended for clients vvith Graves' disease, especially the elderly. The treatment results in a "medical thyroidectomy." RAI is given in lieu of surgery, not before surgery. RAI does not reduce uptake of thyroxine. The outcome of giving RAI is the destruction of the thyroid follicular cells. It is possible to slow the production of thyroid hormones with RAT.

A client is receiving chemotherapy for the diagnosis of brain cancer. When teaching the client about contamination from excretion of the chemotherapy drugs within the first 48 hours, the nurse should instruct the client that: 1. A bathroom can be shared with an adult who is not pregnant. 2. Urinary and bowel excretions are not considered contaminated. 3. Disposable plates and plastic utensils must be used during the entire course of chemotherapy. 4. Any contaminated linens should be washed separately and then washed a second time, if necessary.

4. The client may excrete the chemotherapeutic agent for 48 hours or more after administration. Blood, emesis, and excretions may be considered contaminated during this time, and the client should not share a bathroom vvith children or pregnant women. Any contaminated linens or clothing should be washed separately and then washed a second time, if necessary. All contaminated disposable items should be sealed in plastic bags and disposed of as hazardous waste.

The client with type 1 diabetes mellitus is taught to take isophane insulin suspension NPH (Humulin N) at 5 PM each day. The client should be instructed that the greatest risk of hypoglycemia will occur at about what time? 1. 11 AM, shortly before lunch. 2. 1 PM, shortly after lunch. 3. 6 PM, shortly after dinner. 4. 1 AM, while sleeping.

4. The client with diabetes mellitus who is taking NPH insulin (Humulin NJ in the evening is most likely to become hypoglycemic shortly after midnight because this insulin peaks in 6 to 8 hours. The client should eat a bedtime snack to help prevent hypoglycemia while sleeping.

A client with advanced ovarian cancer takes 150 mg of long-acting morphine orally every 12 hours for abdominal pain. When the client develops a small bowel obstruction, the physician discontinues the oral morphine and begins morphine 6 mg/h IV. After calculating the equianalgesic conversion from oral to intravenous morphine, the nurse should: 1. Continue the oral morphine for one more dose after the IV morphine is started. 2. Contact the physician to suggest a higher equianalgesic dose of IV morphine. 3. Administer the morphine IV as prescribed. 4. Clarify the prescription to recommend the initial morphine dose of 4 mg/h.

4. The conversion ratio for morphine is 10 mg IV equals 30 mg oral, or 1:3. The client is receiving 300 mg orally per 24 hours, which is equivalent to 100 mg of IV morphine. Morphine 100 mg IV /24 hours= approximately 4 mg/h IV. The effect of the IV morphine is quick and the oral morphine should be discontinued prior to starting the IV morphine.

A nurse is checking the laboratory results of a client with colon cancer admitted for further chemotherapy. The client has lost 30 lb (13.6 kg) since initiation of the treatment. Which laboratory result should be reported to the health care provider? 1. Blood glucose level of 95 mg/dL (5.5mmol/L) 2. Total cholesterol level of 182 mg/dL (10.1 mmol/L). 3. Hemoglobin level of 12.3 mg/dL (123 g/L). 4. Albumin level of 2.8 g/dL (28 g/L).

4. The nurse must recognize that an albumin level of 2.8 g/dL (28 g/L) indicates catabolism and polential for malnutrition. Normal albumin is 3.5 to 5.0 g/dL (35 to 50 g/L); less than 3.5 (35 g/L) indicates malnutrition. The other laboratory results are normal.

The nurse is planning care for a client with severe postoperative pain. There is a prescription for morphine written as "10 mg MSO/ on the chart. Which of the following should the nurse do first? 1. Obtain an intravenous infusion system. 2. Prepare the medication for administration. 3. Contact the Pharmacy Department. 4. Contact the physician who prescribed the medication.

4. The nurse should first contact the physician because the prescription for the morphine is not complete. The Joint Commission of the United States and the Institute for Safe Medication Practices Canada recommend not to use MS0. because it can 1 apply to morphine as well as to magnesium sulfate. There is no mention of an IV system being needed. The morphine should not be in the medication cabinet because the prescription is not complete. Although pharmacy may offer a suggestion as to what the medication prescribed is, the best means to confirm the intent of the prescription is to contact the physician who wrote the prescription.

A young female client is receiving chemotherapy and mentions to the nurse that she and her husband are using a diaphragm for birth control. Which of the following is most important for the nurse to discuss? 1. Inconvenience of the diaphragm. 2. Transmission of sexually transmitted diseases. 3. Body changes related to hormones. 4. Infection control.

4. The risk of becoming neutropenic during chemotherapy is very high. Therefore, an inserted foreign object such as a diaphragm may be a nidus for infection. Although the nurse may wish to inform the client about the ease with which various contraceptive modalities may be used, the focus of this discussion should be on preventing an infection, which can be fatal for the neutropenic client. There are no data to suggest the client is at risk for acquiring a sexually transmitted disease. The client will not be experiencing body changes directly related to hormonal changes.

An older adult takes two 81-mg aspirin tablets daily to prevent a heart attack. The client reports having a constant "ringing" in both ears. How should the nurse respond to the client's comment? 1. Tell the client that "ringing" in the ears is associated with the aging process. 2. Refer the client to have a Weber test. 3. Schedule the client for audiometric testing. 4. Explain to the client that the "ringing" may be related to the aspirin.

4. Tinnitus (ringing in the ears) is an adverse effect of aspirin. Aspirin contains salicylate, which is an ototoxic drug that can induce reversible hearing loss and tinnitus. The nurse should encourage the client to inform the physician of the symptom. Tinnitus is not a function of aging. The Weber test and audiometric testing are useful for determining hearing loss but are not necessarily helpful in the management or diagnosis of drug-induced tinnitus.

A client receiving chemotherapy has pruritus. In order to develop a care plan, the nurse should ask if the client has been: 1. Wearing clothes made from 100% cotton. 2. Sleeping in a cool, humidified room. 3. Increasing fluid intake to at least 3,000 mL/day. 4. Taking daily baths with a deodorant soap.

4. Use of deodorant or fragrant soaps is drying to the skin. Cotton clothing gives the least irritation to skin. A cool, humidified environment adds to the client's comfort as well as providing hydration for skin comfort. Fluid intake of 3,000 mL/day is recommended for adequate hydration.

A new medication regimen is prescribed for a client with Parkinson's disease. At which time should the nurse make certain that the medication is taken? 1. At bedtime. 2. All at one time. 3. Two hours before mealtime. 4. At the time scheduled.

4. While the client is hospitalized for adjustment of medication, it is essential that the medications be administered exactly at the scheduled time, for accurate evaluation of effectiveness. For example, levodopa-carbidopa (Sinemet) is taken in divided doses over the day, not all at one time, for optimum effectiveness.