Pharmacology Quiz Questions

A client is to receive an intravenous (IV) antibiotic in 50 mL of 0.9% sodium chloride to be administered over 20 minutes. At what rate should the nurse set the infusion pump? Record your answer using a whole number. ___ mL/hr

150 mL/hr

Nitrofurantoin 0.1 g is prescribed for a client with a urinary tract infection. Each tablet contains 50 mg. How many tablets will the nurse administer? Record your answer using a whole number. ___

2

Cyanocobalamin (vitamin B12) 0.2 mg intramuscularly (IM) is prescribed for a client with pernicious anemia. A vial of the drug labeled "1 mL = 100 mcg" is available. How many milliliters should the nurse administer? Record your answer using a whole number. ___mL

2 mL

A transfusion of packed red blood cells is prescribed for a client with anemia. List the following actions in the order in which they should be performed by the nurse. A. Ensure that the client signed a consent for the transfusion. B. Run the transfusion slowly C. Compare the number on the blood product and laboratory record. D. Don a pair of clean gloves E. Determine the client's vital signs

1. (A) Ensure that the client signed a consent for the transfusion. 2. (E) Determine the client's vital signs. 3. (C) Compare the number on the blood product and laboratory record. 4. (D) Don a pair of clean gloves. 5. (B) Run the transfusion slowly. A client must sign a consent for the transfusion before the procedure; clients have the right to refuse. Vital signs should be obtained immediately before the transfusion to serve as a baseline for comparison if a reaction is suspected. Two nurses must verify that the numbers, ABO type, and Rh type on the blood label and laboratory record match before hanging the transfusion to minimize risk of transfusion reactions. Clean gloves must be worn before inserting the spike of the blood administration set. The transfusion is run slowly for the first 15 to 20 minutes, but only after other steps have been completed. Test-Taking Tip: Answer the question that is asked. Read the situation and the question carefully, looking for key words or phrases. Do not read anything into the question or apply what you did in a similar situation during one of your clinical experiences. Think of each question as being an ideal, yet realistic, situation.

A client is to receive 125 mL of intravenous (IV) fluid every hour. The drop factor of the IV tubing is 10 gtt/mL. How many drops per minute should the nurse administer? Record your answer using a whole number. ___ gtts/min

21

A client develops a seizure disorder as a result of a traumatic fall. When the client returns to the clinic for a routine visit, the client states, "I have not had a seizure in 2 years. When can I stop taking my antiseizure medications?" What is the nurse's best response? A. "A gradual reduction in seizure medication may be considered." B. "You will require medication for the rest of your life." C. "Enough time has passed since the last seizure. The medication probably will be discontinued at this visit." D. "A minimum of 10 years without seizures is necessary before discontinuation of medications is considered."

A. "A gradual reduction in seizure medication may be considered." Specific protocols are designed to gradually reduce the dosage of antiseizure medications after a client is seizure free, provided the electroencephalogram is within acceptable limits. The client is monitored for seizure activity because recurrence is greatest within the first year after drug withdrawal. Depending on the status of the client, antiseizure medications may not be necessary for life. Medications must be withdrawn slowly to prevent an abrupt reduction in serum drug levels, which may precipitate a seizure. The response "A minimum of 10 years without seizures is necessary before discontinuation of medications is considered" indicates too long a time.

A client with diabetes asks how exercise will affect insulin and dietary needs. What information does the nurse share about insulin and exercise? A. "Exercise increases the need for carbohydrates and decreases the need for insulin." B. "Exercise increases the need for insulin and increases the need for carbohydrates." C. "Regular physical activity decreases the need for insulin and decreases the need for carbohydrates." D. "Intensive physical activity decreases the need for carbohydrates but does not affect the need for insulin."

A. "Exercise increases the need for carbohydrates and decreases the need for insulin." Exercise increases the uptake of glucose by active muscle cells without the need for insulin; carbohydrates are needed to supply energy for the increased metabolic rate associated with exercise. The need for insulin is decreased. Test-Taking Tip: Being emotionally prepared for an examination is key to your success. Proper use of resources over an extended period of time ensures your understanding and increases your confidence about your nursing knowledge. Your lifelong dream of becoming a nurse is now within your reach! You are excited, yet anxious. This feeling is normal. A little anxiety can be good because it increases awareness of reality; but excessive anxiety has the opposite effect, acting as a barrier and keeping you from reaching your goal. Your attitude about yourself and your goals will help keep you focused, adding to your strength and inner conviction to achieve success.

A nurse teaches a client who is scheduled for a kidney transplant about the need for immunosuppressive medications. The nurse determines that the client understands the teaching when the client states that medications must be taken for what period of time? A. "For the rest of my life." B. "Until the surgery is over." C. "Until the surgery heals." D. "During the intraoperative period."

A. "For the rest of my life." These drugs must be taken continuously to prevent rejection of the transplanted organ. The danger of rejection always exists. The client must take the medications longer than after the surgery or until the anastomosis heals or during the intraoperative period.

The healthcare provider prescribes nitroglycerin ointment for a client who was admitted for chest pain and a myocardial infarction (MI). Which statement, if made by the client, would indicate understanding of the side effects of nitroglycerin ointment? A. "I may experience a headache." B. "Confusion is a common adverse effect." C. "A slow pulse rate in an expected side effect." D. "Increased blood pressure readings may occur initially."

A. "I may experience a headache." The most common side effect of nitroglycerin is a headache. Additional cardiovascular side effects are hypotension, not hypertension; tachycardia, not bradycardia; and dizziness, not confusion.

A primary health care provider prescribes 1000 mL total parenteral nutrition (TPN) to be infused over 12 hours via a central venous access device. What is most important for the nurse to obtain when preparing the equipment? A. An infusion pump B. A steady intravenous (IV) pole C. An infusion set delivering 60 gtts/mL D. A set of hemostats to be taped at the bedside

A. An infusion pump An infusion pump should be administered in a continuous and uniform infusion to prevent hyperosmolar diuresis. A steady IV pole is true for any intravenous infusion; this is not unique to total parenteral nutrition. Also, infusion pumps can be placed on the bedside table. The tubing set should be specific for the type of infusion pump. Hemostats (clamps) are not necessary when administering total parenteral nutrition; an infusion pump should be used.

When a client is receiving total parenteral nutrition, what is important for the nurse to assess? A. Blood glucose B. Occult blood in stool C. Urine specific gravity D. Presence of bowel sounds

A. Blood glucose Blood glucose that exceeds the renal threshold for glucose reabsorption in the kidney tubules (approximately 160 to 180 mg/dL) will cause cellular osmotic diuresis, resulting in dehydration. Stool for occult blood determines the presence of digested blood in the stool; it is unrelated to total parenteral nutrition. An altered specific gravity is nonspecific; increases can result from causes other than glycosuria. Abdomen for bowel sounds assesses for increased or decreased peristalsis; it is unrelated to total parenteral nutrition. STUDY TIP: Do not change your pattern of study. It obviously has contributed to your being here, so it worked. If you have studied alone, continue to study alone. If you have studied in a group, form a study group.

A client is scheduled to begin chemotherapy 2 weeks after surgery for colon cancer. What explanation does the nurse give to explain the delay following surgery? A. Chemotherapy interferes with cell growth and delays wound healing. B. Because chemotherapy causes vomiting, it endangers the integrity of the incisional area. C. Chemotherapy decreases red blood cell production, and the resultant anemia will add to postoperative fatigue. D. Chemotherapy increases edema in areas distal to the incision by blocking lymph channels with destroyed lymphocytes.

A. Chemotherapy interferes with cell growth and delays wound healing. Chemotherapeutic agents can attack healthy as well as malignant cells; they generally interfere with protein synthesis and cell division in all rapidly dividing cells, including those regenerating traumatized tissue (as in wound healing), bone marrow, and cutaneous and alimentary tract epithelial tissue. Vomiting should not disturb the integrity of the area. Decreased red blood cell levels caused by bone marrow depression can be corrected with transfusions. Chemotherapy should not cause a blockage of lymph channels, with destroyed lymphocytes increasing edema. STUDY TIP: Identify your problem areas that need attention. Do not waste time on restudying information you know.

A client diagnosed with asthma has received a prescription for an inhaler. The nurse teaches the client how to determine when the inhaler is empty, instructing the client to do what? A. Count the number of doses taken. B. Taste the medication when sprayed into the air. C. Shake the canister. D. Place the canister in water to see if it floats.

A. Count the number of doses taken. The only way to determine if the canister is empty is to count the number of doses taken. The client is tracking the number of daily doses. It is wasteful to spray medication into the air; tasting it from the air is not an effective method of determining if the canister is empty. Shaking the canister is not effective; even if there is no more medication, some propellant may be left. It is futile to place the canister in water; the flotation test is ineffective.

An ambulatory client with relapsing-remitting multiple sclerosis is to receive every-other-day injections of interferon beta-1a. What adverse effects does the nurse explain may occur when taking this medication? Select all that apply. A. Depression B. Constipation C. Flulike symptoms D. Increased heart rate E. Decreased perspiration

A. Depression B. Constipation C. Flulike symptoms D. Increased heart rate Central nervous system effects include depression that may lead to suicide attempts. Gastrointestinal side effects include constipation, diarrhea, vomiting, and abdominal pain. Interferon immune modifier causes flulike symptoms, such as fever, muscle aches, and lethargy. Drugs for increased heart rate include side effects such as tachycardia, palpitations, and hypertension. An integumentary response to this drug is sweating, not lack of perspiration (anhidrosis). STUDY TIP: Adverse effects are categorized as those that are predictable and those that are unpredictable. Predictable responses include augmented pharmacologic responses, toxic effects, and cumulative effects. Unpredictable responses include idiosyncratic reactions, pharmacogenetic reactions, allergic reactions, drug tolerance, and dependence.

Trimethoprim-sulfamethoxazole is prescribed for a client with cystitis. When teaching about the medication, what does the nurse instruct the client to do? A. Drink 8 to 10 glasses of water daily. B. Drink two glasses of orange juice daily. C. Take the medication with meals. D. Take the medication until symptoms subside.

A. Drink 8 to 10 glasses of water daily. A urinary output of at least 1500 mL daily should be maintained to prevent crystalluria (crystals in the urine). Orange juice produces an alkaline ash, which results in an alkaline urine that supports the growth of bacteria. Trimethoprim-sulfamethoxazole should be taken 1 hour before meals for maximum absorption. A prescribed course of antibiotics must be completed to eliminate the infection, which can exist on a subclinical level after symptoms subside. Test-Taking Tip: Never leave a question unanswered. Even if answering is no more than an educated guess on your part, go ahead and mark an answer. You might be right, but if you leave it blank, you will certainly be wrong and lose precious points.

A nurse is providing instructions for a client who is receiving phenytoin but has limited access to health care. What side effect is the basis for the nurse's emphasis on meticulous oral hygiene? A. Hyperplasia of the gums B. Alkalinity of the oral secretions C. Irritation of the gingiva and destruction of tooth enamel D. Promotion of plaque and bacterial growth at the gum line

A. Hyperplasia of the gums Gingival hyperplasia is an adverse effect of long-term phenytoin therapy; incidence can be decreased by maintaining therapeutic blood levels and meticulous oral hygiene. Alkalinity is not related to phenytoin or to gingival hyperplasia caused by phenytoin. Irritation of the gingiva and destruction of tooth enamel are not direct effects of phenytoin. Plaque and bacterial growth at the gum line are unrelated to phenytoin or to hyperplasia caused by it.

A nurse concludes that a client has a hypoglycemic reaction to insulin. Which clinical findings support this conclusion? Select all that apply. A. Irritability B. Glycosuria C. Dry, hot skin D. Heart palpitations E. Fruity odor of breath

A. Irritability D. Heart palpitations Irritability, a neuroglycopenic symptom, occurs when the glucose in the brain declines to a low level. Heart palpitations, a neurogenic symptom, occur when the sympathetic nervous system responds to a rapid decline in blood glucose. Because the blood glucose level is decreased, the renal threshold is not exceeded, and there is no glycosuria. Dry, hot skin is consistent with dehydration, which often is associated with hyperglycemic states. Fruity odor of the breath is associated with hyperglycemia; it is caused by the breakdown of fats as a result of inadequate insulin supply.

Which is an independent nursing action that should be included in the plan of care for a client after an episode of ketoacidosis? A. Monitoring for signs of hypoglycemia resulting from treatment B. Withholding glucose in any form until the situation is corrected C. Giving fruit juices, broth, and milk as soon as the client is able to take fluids orally D. Regulating insulin dosage according to the amount of ketones found in the client's urine

A. Monitoring for signs of hypoglycemia resulting from treatment During treatment for acidosis, hypoglycemia may develop; careful observation for this complication should be made by the nurse. Withholding all glucose may cause insulin coma. Whole milk and fruit juices are high in carbohydrates, which are contraindicated immediately following ketoacidosis. The regulation of insulin depends on the prescription for coverage; the prescription usually depends on the client's blood glucose level rather than ketones in the urine.

A client with anorexia nervosa is admitted to the critical care unit following a period of prolonged starvation. What signs or symptoms indicate to the nurse that the client may have hypokalemia? Select all that apply. A. Muscle weakness B. Metabolic alkalosis C. Cardiac dysrhythmias D. Respiratory rate of 24 or higher E. Serum potassium of 5.5 mEq/L (5.5 mmol/L)

A. Muscle weakness C. Cardiac dysrhythmias Potassium is a component of the sodium-potassium pump that is essential for cellular functioning, especially muscle contraction; a deficiency of either potassium or sodium results in weakness. Potassium is important for muscle contraction; the heart is a muscle, and hypokalemia causes dysrhythmias. Decreased functioning of respiratory muscles may result in respiratory acidosis, not metabolic alkalosis. A serum potassium level of 5.5 mEq/L (5.5 mmol/L) is within the upper range of normal. A low respiratory rate, not a rapid one, would be expected because of the weakened respiratory muscles. Test-Taking Tip: Eat breakfast or lunch before an exam. Avoid greasy, heavy foods and overeating. This will help keep you calm and give you energy.

A client with heart failure is receiving digoxin and hydrochlorothiazide. The nurse will assess for which signs and symptoms that indicate digoxin toxicity? Select all that apply. A. Nausea B. Yellow vision C. Irregular pulse D. Increased urine output E. Heart rate of 64 beats per minute

A. Nausea B. Yellow vision C. Irregular pulse Signs and symptoms of digoxin toxicity include bradycardia, headache, dizziness, confusion, nausea, and visual disturbances (blurred vision or yellow vision). In addition, ECG findings may include heart block, atrial tachycardia with block, or ventricular dysrhythmias, all causing an irregular pulse. Increased urine output is an expected effect of the diuretic furosemide; a pulse rate of 64 beats per minute is an acceptable rate when a client is receiving digoxin. Test-Taking Tip: Avoid spending excessive time on any one question. Most questions can be answered in 1 to 2 minutes.

A healthcare provider prescribes aspirin therapy for a client with arthritis and the nurse provides teaching about the undesirable side effects of this medication. What responses should the client identify as reasons to notify the healthcare provider? Select all that apply. A. Ongoing nausea B. Constipation C. Easy bruising D. Decreased pulse E. Ringing in the ears

A. Ongoing nausea C. Easy bruising E. Ringing in the ears Aspirin is a gastrointestinal irritant that can cause nausea, vomiting, and gastrointestinal bleeding. Salicylates decrease platelet aggregation, resulting in easy bruising and gastrointestinal bleeding. Tinnitus and hearing loss can occur as a result of the effects of the drug on the eighth cranial nerve. Salicylates may cause diarrhea, not constipation, because of gastrointestinal irritation. Salicylates may increase, not decrease, the heart rate.

A client steps on a rusty nail, and the puncture site becomes swollen and painful. Tetanus immune globulin is prescribed. What does the nurse identify as an action of this drug? A. Provides antibodies B. Stimulates plasma cells C. Produces active immunity D. Facilitates long-lasting immunity

A. Provides antibodies Tetanus immune globulin provides antibodies, which confer immediate passive immunity. It does not stimulate production of plasma cells, the precursors of antibodies. Passive, not active, immunity occurs. Passive immunity, by definition, is not long lasting.

A nurse has administered sublingual nitroglycerin. Which parameter should the nurse use to determine the effectiveness of sublingual nitroglycerin? A. Relief of anginal pain B. Improved cardiac output C. Decreased blood pressure D. Dilation of superficial blood vessels

A. Relief of anginal pain Cardiac nitrates relax smooth muscles of the coronary arteries; they dilate and deliver more blood to heart muscle, relieving ischemic pain. Although cardiac output may improve because of improved oxygenation of the myocardium, improved cardiac output is not a basis for evaluating the effectiveness of sublingual nitroglycerin. Although dilation of blood vessels and a subsequent drop in blood pressure is a reason why IV nitroglycerin may be administered, decreased blood pressure is not the basis for evaluating the effectiveness of sublingual nitroglycerin, which is indicated for pain relief. Although superficial vessels dilate, lowering the blood pressure and creating a flushed appearance, dilation of superficial blood vessels is not the basis for evaluating the drug's effectiveness.

A client is admitted to the coronary care unit complaining of "viselike" chest pain radiating to the neck. Assessment reveals a blood pressure of 124/64 mm Hg, an irregular apical pulse of 64 beats per minute, and diaphoresis. Cardiac monitoring is instituted, and morphine sulfate 4 mg intravenous (IV) push stat is prescribed. What is the priority nursing care for this client? A. Relief of pain B. Client teaching C. Cardiac monitoring D. Maintenance of bed rest

A. Relief of pain Unrelieved chest pain increases anxiety, fatigue, and myocardial oxygen consumption, with the possibility of extending the infarction. The client will not be ready for teaching until the chest pain is relieved. Cardiac monitoring is important, but it does not take priority over relieving the chest pain. Bed rest is necessary to decrease the workload of the heart, but decreasing the cardiac workload will be difficult to achieve unless the chest pain is relieved.

Carbidopa-levodopa is prescribed for a client with Parkinson disease. The nurse monitors the client for which side effects of the medication? Select all that apply. A. Vomiting B. Anorexia C. Slow heart rate D. Changes in mood E. Peripheral edema

A. Vomiting B. Anorexia D. Changes in mood Nausea and vomiting may occur; it reflects a central emetic reaction to levodopa. Anorexia may occur; decreased appetite results because of nausea and vomiting. Changes in affect, mood, and behavior are related to toxic effects of the drug. Tachycardia and palpitations, not bradycardia, occur. Peripheral edema is not a side effect of carbidopa-levodopa.

How should a nurse prepare an intravenous piggyback (IVPB) medication for administration to a client receiving an IV infusion? Select all that apply. A. Wear clean gloves to check the IV site. B. Rotate the bag after adding the medication to mix. C. Use 100 mL of fluid to mix the medication. D. Flush the IV insertion site with 2 mL saline. E. Place the IVPB at a lower level than the existing IV. F. Use a sterile technique when preparing the medication.

A. Wear clean gloves to check the IV site. B. Rotate the bag after adding the medication to mix. F. Use a sterile technique when preparing the medication. Clean gloves should be worn to check the IV site because there is a risk of coming into contact with the client's blood. Ensuring that the medication is mixed is important. Rotating the bag is one way, although there are others. Because IV solutions enter the body's internal environment, all solutions and medications using this route must be sterile to prevent the introduction of microbes. The amount and type of solution depend on the medication. The insertion site does not have to be flushed with an infusing IV. The IVPB should be hung higher, not lower, than the existing bag. Test-Taking Tip: The following are crucial requisites for doing well on the NCLEX exam: (1) A sound understanding of the subject; (2) The ability to follow explicitly the directions given at the beginning of the test; (3) The ability to comprehend what is read; (4) The patience to read each question and set of options carefully before deciding how to answer the question; (5) The ability to use the computer correctly to record answers; (6) The determination to do well; (7) A degree of confidence.

While receiving an adrenergic beta2 agonist drug for asthma, the client complains of palpitations, chest pain, and a throbbing headache. What is the most appropriate nursing action? A. Withhold the drug and notify the healthcare provider. B. Tell the client not to worry; these are expected side effects from the medicine. C. Give instructions to breathe slowly and deeply for several minutes. D. Explain that the effects are temporary and will subside as the body becomes accustomed to the drug.

A. Withhold the drug and notify the healthcare provider. These drugs cause increased heart contraction (positive inotropic effect) and increased heart rate (positive chronotropic effect). If toxic levels are reached, side effects occur, and the drug should be withheld until the healthcare provider is notified. Telling the client not to worry and that these are expected side effects from the medicine is false reassurance and a false statement. Controlled breathing may be helpful in allaying a client's anxiety; however, the drug may be producing adverse effects and should be withheld. Test-Taking Tip: Come to your test prep with a positive attitude about yourself, your nursing knowledge, and your test-taking abilities. A positive attitude is achieved through self-confidence gained by effective study. This means (a) answering questions (assessment), (b) organizing study time (planning), (c) reading and further study (implementation), and (d) answering questions (evaluation).

A client with a respiratory infection will be receiving ampicillin 250 mg per percutaneous endoscopic gastrostomy tube every 6 hours. The reconstituted medication suspension contains 125 mg per 5 mL. Which medication cup contains the correct amount of medication for the ordered dose? A. 5 mL B. 10 mL C. 15 mL D. 30 mL

B. 10 mL Set up the problem and solve. Using the ratio and proportion method: 125 mg : 5 mL = 250 mg : x mL (125)(x) = (5)(250); 125 x = 1250; divide both sides by 125. x = 1250/125 = 10 mL. Choose the medication cup that is shaded to the 10-mL mark. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.

Routine postoperative intravenous fluids are designed to supply hydration, electrolytes, and limited energy. One liter of 5% dextrose solution contains 50 grams of sugar. The nurse calculates that 3L solution/day will supply approximately how many kilocalories? A. 400 B. 600 C. 800 D. 1000

B. 600 Carbohydrates provide 4 kcal/g; therefore 3 L × 50 g/L × 4 kcal/g = 600 kcal, only about a third of the basal energy needed. Four hundred kilocalories is less than the kilocalories provided by the prescribed (IV) fluid. Eight hundred kilocalories and 1000 kilocalories are more than the kilocalories provided by the prescribed IV fluid.

Which interventions should the nurse anticipate will be prescribed initially for a client who had a hemorrhoidectomy? Select all that apply. A. Giving an enema B. Applying moist heat C. Administering stool softeners D. Encouraging showers as needed E. Providing occlusive dressings to the area

B. Applying moist heat C. Administering stool softeners Moist heat dilates the blood vessels, thereby increasing circulation to the area; this is soothing and promotes healing. Stool softeners are prescribed to avoid straining on defecation and constipation. Enemas may be prescribed several days after surgery if the client has not had a bowel movement. Baths, especially sitz baths, are advised to promote healing and cleaning of the area. Occlusive dressings are not used. Light applications of witch hazel may be used to promote drainage and healing. STUDY TIP: In the first pass through the exam, answer what you know and skip what you do not know. Answering the questions you are sure of increases your confidence and saves time. This is buying you time to devote to the questions with which you have more difficulty.

A healthcare provider recently made the diagnosis that a client has glaucoma. The nurse is preparing to administer eyedrops to the client. Which ophthalmic solution is contraindicated for this client? A. Timolol B. Atropine C. Pilocarpine D. Epinephrine

B. Atropine Atropine, a mydriatic ophthalmic solution, is contraindicated for clients with glaucoma because it dilates the pupil, increasing intraocular pressure. Timolol, a beta blocker, decreases aqueous humor production; beta blockers are the preferred initial medications given to reduce intraocular pressure. Pilocarpine, a cholinergic, constricts the pupil, thereby increasing aqueous humor outflow. Epinephrine, an adrenergic agent, enhances aqueous humor outflow, thereby reducing intraocular pressure.

A client with myasthenia gravis has been receiving neostigmine and asks about its action. What information about its action should the nurse consider when formulating a response? A. Stimulates the cerebral cortex B. Blocks the action of cholinesterase C. Replaces deficient neurotransmitters D. Accelerates transmission along neural sheaths

B. Blocks the action of cholinesterase Neostigmine, an anticholinesterase, inhibits the breakdown of acetylcholine, thus prolonging neurotransmission. Neostigmine's action is at the myoneural junction, not the cerebral cortex. Neostigmine prevents neurotransmitter breakdown, but it is not a neurotransmitter. Neostigmine's action is at the myoneural junction, not the sheath.

A client is to receive doxorubicin as part of a chemotherapy protocol. The nurse should assess for which major life-threatening adverse effect? A. Infiltration B. Cardiotoxicity C. Pulmonary fibrosis D. Ulcerative stomatitis

B. Cardiotoxicity Congestive heart failure and dysrhythmias are life-threatening toxic effects unique to doxorubicin. Infiltration can cause severe tissue damage; however, this is not typically life threatening. Pulmonary fibrosis is not a side effect of doxorubicin or of any of the other antineoplastic agents. Ulcerative stomatitis is a very uncomfortable side effect, but is not life threatening. STUDY TIP: Focus your study time on the common health problems that nurses most frequently encounter.

A nurse is evaluating the results of treatment with erythropoietin. Which assessment finding indicates an improvement in the underlying condition being treated? A. 2+ pedal pulses B. Decreased pallor C. Decreased jaundice D. 2+ deep tendon reflexes

B. Decreased pallor Erythropoietin stimulates red blood cell production, thereby decreasing the pallor that accompanies anemia. It would not have a role in alleviating jaundice. It would not have an appreciable effect on pulses or deep tendon reflexes. Test-Taking Tip: Pace yourself while taking a quiz or exam. Read the entire question and all answer choices before answering the question. Do not assume that you know what the question is asking without reading it entirely.

A healthcare provider prescribes morphine for a client being treated for myocardial infarction. What physiologic response will occur if the client experiences the intended therapeutic effect of morphine? A. Increased respiratory rate B. Decreased workload of the heart C. Reduced size of the clot blocking the coronary artery D. Diminished metabolites within the ischemic heart muscle

B. Decreased workload of the heart Morphine reduces pain and anxiety. This limits the response of the sympathetic nervous system, ultimately decreasing cardiac preload and the workload of the heart. Reduced respiratory rate is a side effect of morphine; it is not the intended therapeutic effect for a client being treated for myocardial infarction. Decreasing the size of the clot blocking the coronary artery is the action of antithrombolytic therapy. Decreasing metabolites within the ischemic heart muscle is not the action of morphine.

A client with stage III Hodgkin disease is started on ABVD therapy, a multiple-drug regimen. The client asks why so many drugs need to be given all at once. Which is the best response by the nurse? A. Using groups of drugs reduces the likelihood of serious side effects. B. Each drug destroys the cancer cell at a different time in the cell cycle. C. Several drugs are used to destroy cells that are not susceptible to radiation therapy. D. Because there are stages of Hodgkin disease, if one drug is ineffective, another will work.

B. Each drug destroys the cancer cell at a different time in the cell cycle. Cells are vulnerable to specific drugs through the stages of mitosis, and a combination bombards the malignant cells at various stages. The side effects of a drug are not ameliorated by a combination with others. Although the statement that several drugs are used to destroy cells that are not susceptible to radiation therapy is true, it is not the reason for using a combination of drugs. Although there is more than one stage of Hodgkin disease, this is not the reason for using a combination of drugs.

The nurse is caring for a client with type 1 diabetes. For which signs or symptoms of insulin-induced hypoglycemia should the nurse particularly be observant? Select all that apply. A. Excessive hunger B. Headache C. Diaphoresis D. Excessive thirst E. Deep respirations

B. Headache C. Diaphoresis Hypoglycemia affects the central nervous system, causing headache. Hypoglycemia affects the sympathetic nervous system, causing diaphoresis. Excessive hunger is associated with hyperglycemia because glucose is not being used for cellular metabolism. Excessive thirst is associated with hyperglycemia because fluid shifts, along with the excess glucose being excreted by the kidneys, result in polyuria. Deep respirations (Kussmaul respirations) are associated with hyperglycemia because the body is attempting to blow off carbon dioxide to compensate for the metabolic acidosis.

What are the desired outcomes that the nurse expects when administering ibuprofen? Select all that apply. A. Diuresis B. Pain relief C. Antipyresis D. Bronchodilation E. Anticoagulation F. Reduced inflammation

B. Pain relief C. Antipyresis F. Reduced inflammation Prostaglandins accumulate at the site of an injury, causing pain; nonsteroidal antiinflammatory drugs (NSAIDs) like ibuprofen inhibit COX-1 and COX-2 (both are isoforms of the enzyme cyclooxygenase), which inhibit the production of prostaglandins, thereby contributing to analgesia. NSAIDs inhibit COX-2, which is associated with fever, thereby causing antipyresis. NSAIDs inhibit COX-2, which is associated with inflammation, thereby reducing inflammation. NSAIDs do not cause diuresis; reversible renal ischemia and renal insufficiency in clients with heart failure, cirrhosis, or hypovolemia can be potential adverse effects of NSAIDs. NSAIDs do not cause bronchodilation. Anticoagulation is an adverse effect, not a desired outcome; NSAIDs can impair platelet function by inhibiting thromboxane, an aggregating agent, resulting in bleeding.

A nurse is caring for a client during the emergent phase of a severe burn injury. Which parenteral intervention prescribed by the healthcare provider should the nurse question? A. Colloids B. Potassium C. Hypertonic saline D. Lactated Ringer solution

B. Potassium Potassium replacement generally is not indicated in the initial management of burns because hyperkalemia results from the liberation of potassium ions from the injured cells. Colloids are given to draw fluid from edematous tissue back into the bloodstream. Hypertonic saline and lactated Ringer solution are given to replace fluid and electrolytes.

A client develops a maculopapular rash on the upper extremities and audible wheezing during the administration of intravenous vancomycin. To ensure the client's safety, which action would the nurse carry out first? A. Notify healthcare provider B. Stop infusion C. Decrease flow rate D. Reassess in 15 minutes

B. Stop infusion The first action the nurse should take is to stop the infusion immediately. The client may be experiencing an allergic reaction. The nurse should stop the medication infusion and then notify the healthcare provider. Decreasing the flow rate is not an appropriate action. Infusions must be stopped if allergic reaction is suspected. This could be an emergent situation, so reassessing in 15 minutes is not the most appropriate action. Test-Taking Tip: Because few things in life are absolute without exceptions, avoid selecting answers that include words such as always, never, all, every, and none. Answers containing these key words are rarely correct.

A nurse concludes that the simvastatin being administered to a client is effective. A decrease in what clinical finding supports this conclusion? A. Heart rate B. Triglycerides C. Blood pressure D. International normalized ratio (INR)

B. Triglycerides Therapeutic effects of simvastatin include decreased levels of serum triglycerides, low-density lipoprotein (LDL), and cholesterol. INR is not related to simvastatin; it is a measure used to evaluate blood coagulation. Heart rate and blood pressure are not related to simvastatin.

The healthcare provider prescribes enalapril maleate. Which instruction should the nurse include when educating the client about the new medication? A. Take the medication with orange juice. B. When standing up, change position slowly. C. Check your pulse before taking the medication. D. Use requires weekly basic metabolic panels to be drawn.

B. When standing up, change position slowly. Enalapril is an angiotensin-converting enzyme inhibitor and can cause postural hypotension. For safety purposes, the client should be instructed, when standing, to change positions slowly to avoid dizziness or fainting. Checking pulse rate is not indicated before administration; checking blood pressure is indicated. While electrolytes often are checked for clients with hypertension who are receiving medication therapy, weekly basic metabolic panels are not required while taking this medication. It is not necessary to take the medication with orange juice.

The healthcare provider prescribes isosorbide dinitrate 10 mg for a client with chronic angina pectoris. The client asks the nurse why the isosorbide dinitrate is prescribed. How will the nurse respond? A. "It prevents excessive blood clotting." B. "It suppresses irritability in the ventricles." C. "It improves oxygen supply to heart tissue." D. "The inotropic action increases the force of contraction of the heart."

C. "It improves oxygen supply to heart tissue." Isosorbide dinitrate dilates the coronary vasculature, improving the supply of oxygen to the hypoxic myocardium. Preventing blood from clotting is the action of anticoagulants. Suppressing irritability in the ventricles is the action of antidysrhythmics. Increasing the force of contraction of the heart is the action of cardiac glycosides.

A client with type 1 diabetes is placed on an insulin pump. What is the priority short-term goal when teaching this client to control the diabetes? A. "The client will adhere to the medical regimen." B. "The client will remain normoglycemic for 3 weeks." C. "The client will demonstrate correct use of the insulin pump." D. "The client will list three self-care activities that are necessary to control the diabetes."

C. "The client will demonstrate correct use of the insulin pump." Demonstrating the correct use of the administration equipment is a short-term goal, client oriented, necessary for the client to control the diabetes and measurable when the client performs a return demonstration for the nurse. Adhering to the medical regimen is not a short-term goal. Remaining normoglycemic for 3 weeks is measurable, but it is a long-term goal. Although listing three self-care activities that are necessary to control the diabetes is measurable and a short-term goal, it is not the one with the greatest priority when a client has an insulin pump that must be mastered before discharge. Test-Taking Tip: Avoid taking a wild guess at an answer. However, should you feel insecure about a question, eliminate the alternatives that you believe are definitely incorrect, and reread the information given to make sure you understand the intent of the question. This approach increases your chances of randomly selecting the correct answer or getting a clearer understanding of what is being asked. Although there is no penalty for guessing, the subsequent question will be based, to an extent, on the response you give to the question at hand; that is, if you answer a question incorrectly, the computer will adapt the next question accordingly based on your knowledge and skill performance on the examination up to that point.

A nurse is administering serum albumin intravenously to a client with ascites. In response to this therapy, what does the nurse expect to decrease? A. Confusion B. Urinary output C. Abdominal girth D. Serum ammonia level

C. Abdominal girth An increased serum albumin level increases the osmotic effect and pulls fluid back into the intravascular compartment. This will increase renal flow and urine output, with a resulting decrease in abdominal girth. Urinary output therapy will increase blood volume and blood flow to the kidney, thereby increasing urinary output. Albumin therapy has no effect on blood ammonia levels. An increased, not decreased, blood ammonia level causes hepatic encephalopathy

A client who has an adenocarcinoma of the descending colon with a partial obstruction is receiving doxorubicin intravenously (IV) to reduce the tumor mass. The nurse monitors the client for signs and symptoms of doxorubicin toxicity. What clinical finding indicates that toxicity has occurred? A. Minor skin rash B. Blue tinge to the urine C. Alteration in cardiac rhythm D. Increased feeling of nervousness

C. Alteration in cardiac rhythm Doxorubicin is cardiotoxic and causes dysrhythmias. Doxorubicin toxicity causes severe, not minor, dermatitis. Blue-tinged urine is a side effect of doxorubicin, not a toxic effect. Feelings of nervousness are a side effect of doxorubicin, not a toxic effect. Test-Taking Tip: A psychological technique used to boost your test-taking confidence is to look into a mirror whenever you pass one and say out loud, "I know the material, and I'll do well on the test." Try it; many students have found that it works because it reduces "test anxiety."

A client with Hodgkin disease is placed on an ABVD combination chemotherapy regimen. Because doxorubicin is part of this therapy, what education will the nurse provide about this drug? A. Cease taking any medication that contains vitamin D. B. Keep the doxorubicin in a dark place protected from light. C. Expect urine to turn red for a few days after taking this drug. D. Take the doxorubicin on an empty stomach with large amounts of fluids.

C. Expect urine to turn red for a few days after taking this drug. Doxorubicin causes the urine to turn red for a few days; the client should be informed of this expectation so as not to become alarmed when it occurs. Discontinuing the intake of vitamin D is true for plicamycin, not the drugs in this protocol. It is unnecessary to keep doxorubicin in a dark area, protected from light. Doxorubicin is not given orally, only via the intravenous route.

A client is scheduled for discharge following surgery. The medical record indicates that the client has not had a bowel movement since before surgery, which was 4 days ago. During the hospital stay, the client received a stool softener daily and an oral laxative the day before discharge. Which one of the prescribed medications should the nurse administer to ensure a bowel movement prior to discharge? A. Milk of magnesia 30 mL B. Docusate sodium 100 mg C. Bisacodyl 10-mg suppository D. Bisacodyl two enteric-coated 5-mg tablets

C. Bisacodyl 10-mg suppository A bisacodyl suppository should produce results before the client leaves the facility. The client already had an oral laxative the previous day, which was not effective at the time of discharge. The client already had stool softeners daily, which were not effective at the time of discharge. Test-Taking Tip: A psychological technique used to boost your test-taking confidence is to look into a mirror whenever you pass one and say out loud, "I know the material, and I'll do well on the test." Try it; many students have found that it works because it reduces "test anxiety."

Aspirin is prescribed for a client with rheumatoid arthritis. Which clinical indicators of aspirin toxicity should the nurse teach the client to report? Select all that apply. A. Bradycardia B. Joint pain C. Blood in the stool D. Ringing in the ears E. Increased urine output

C. Blood in the stool D. Ringing in the ears Blood in the stool indicates gastrointestinal irritation and may have resulted from the anticoagulant effect of aspirin. Salicylates, such as aspirin, can cause ototoxicity (affects eighth cranial nerve), which may manifest as ringing in the ears (tinnitus) or muffled hearing and it should be reported. Joint pain is not a symptom of salicylate toxicity; however, it is related to the disease process and should be minimized by the administration of aspirin. Bradycardia and increased urine output (polyuria) do not indicate salicylate toxicity. Test-Taking Tip: Become familiar with reading questions on a computer screen. Familiarity reduces anxiety and decreases errors.

The health care provider prescribes an oral hypoglycemic for the client with type 2 diabetes. What will the nurse need to consider when developing the teaching plan? A. Oral hypoglycemics work by decreasing absorption of carbohydrates. B. Oral hypoglycemics work by stimulating the pancreas to produce insulin. C. Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control. D. Clients with type 2 diabetes do not need to be concerned about serious adverse effects from oral hypoglycemics.

C. Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control. Taking a tablet may give the client a false sense that the disease is under control, and this can lead to dietary indiscretions. Some oral hypoglycemics work by stimulating the pancreas to produce insulin, others work by decreasing carbohydrate absorption, and others work in a variety of other ways; therefore teaching should be specific to the drug prescribed. Oral hypoglycemic drugs can have serious adverse effects.

Amlodipine is prescribed for a client with hypertension. Which response to the medication should the nurse instruct the client to report to the healthcare provider? A. Blurred vision B. Dizziness on rising C. Difficulty breathing D. Excessive urination

C. Difficulty breathing Dyspnea may indicate development of pulmonary edema, which is a life-threatening condition. Blurred vision may occur in some people, but it is not life threatening. Dizziness on rising and excessive urination are common side effects of this medication that are not life threatening. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.

A client sustains severe burns over 40% of the surface area of the body. The nurse is assigned to care for the client during the first 48 hours after the injury. What clinical finding does the nurse anticipate if the client develops water intoxication? A. Sooty-colored sputum B. Frothy, pink-tinged sputum C. Disorientation with twitching D. Urine output of 25 mL/hr

C. Disorientation with twitching Excess extracellular fluid moves into cells (water intoxication). Intracellular fluid excess in sensitive brain cells causes altered mental status; other signs include anorexia, nausea, vomiting, twitching, sleepiness, and convulsions. Sooty-colored sputum indicates inhalation of smoke or flames. Frothy, pink-tinged sputum is associated with pulmonary edema. Decreased urinary output indicates insufficient fluid replacement or dehydration. Test-Taking Tip: The presence of absolute words and phrases can also help you determine the correct answer to a multiple-choice item. If answer choices contain an absolute (e.g., none, never, must, cannot), be very cautious. Remember that there are not many things in the world that are absolute, and in an area as complex as nursing, an absolute may be a reason to eliminate it from consideration as the best choice. This is only a guideline and should not be taken to be true 100% of the time; however, it can help you reduce the number of choices.

A nurse identifies that a client receiving chemotherapy has lost weight. What are appropriate nursing interventions for this client? Select all that apply. A. Providing low-carbohydrate meals B. Explaining the effect of chemotherapy C. Encouraging the intake of preferred foods D. Promoting the intake of small, frequent meals E. Administering prescribed antiemetics before meals

C. Encouraging the intake of preferred foods D. Promoting the intake of small, frequent meals E. Administering prescribed antiemetics before meals Selecting preferred foods increases the likelihood of the client eating the food. Small, frequent feedings are better tolerated than large meals. Antiemetics should be administered prophylactically to decrease nausea and enhance appetite. The diet should provide maximum protein and carbohydrates to meet demands related to restoration of body cells and energy. Explaining the effect of chemotherapy will not alter the client's nutrition.

Before a client with syphilis can be treated, what should be determined? A. Portal of entry B. Size of chancre C. Existence of allergies D. Names of sexual contacts

C. Existence of allergies Although the treatment of choice is penicillin, clients who are allergic must be given other antimicrobial agents to avoid an anaphylactic reaction. The portal of entry does not influence treatment. The chancre is present only in the primary stage; it does not alter treatment. Although sexual contacts should be identified and notified, treatment should not be delayed. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Example: If the item relates to and identifies stroke rehabilitation as its focus and only one of the options contains the word stroke in relation to rehabilitation, you are safe in identifying this choice as the correct response.

A client is receiving furosemide to relieve edema. The nurse should monitor the client for which response to the medication? A. Hypernatremia B. Low blood urea nitrogen C. Hypokalemia D. Increase in the urine specific gravity

C. Hypokalemia Furosemide is a potent diuretic used to provide rapid diuresis; it acts in the loop of Henle and causes depletion of electrolytes, such as potassium and sodium. Furosemide inhibits the reabsorption, not retention, of sodium. Furosemide does not affect protein metabolism. With edema, the specific gravity of the fluid more likely will be low.

When obtaining a health history, the nurse is informed that a client has been taking digoxin. What therapeutic effect of digoxin does the nurse expect? A. Decreased cardiac output B. Decreased stroke volume of the heart C. Increased contractile force of the myocardium D. Increased electrical conduction through the atrioventricular (AV) node

C. Increased contractile force of the myocardium Digoxin produces a positive inotropic effect that increases the strength of myocardial contractions and thus cardiac output. The positive inotropic effect of digoxin increases, not decreases, cardiac output. Digoxin increases the strength of myocardial contractions (positive inotropic effect) and slows the heart rate (negative chronotropic effect); these effects increase the stroke volume of the heart. Digoxin decreases the refractory period of the AV node and decreases conduction through the sinoatrial (SA) and AV nodes. Test-Taking Tip: Do not select answers that contain exceptions to the general rule, controversial material, or responses that appear to be degrading.

A client is receiving penicillin G and probenecid for syphilis. What rationale should the nurse give for the need to take these two drugs? A. Each drug attacks the organism during different stages of cell multiplication. B. The penicillin treats the syphilis, whereas the probenecid relieves the severe urethritis. C. Probenecid delays excretion of penicillin, thus maintaining blood levels for longer periods. D. Probenecid decreases the potential for an allergic reaction to penicillin, which treats the syphilis.

C. Probenecid delays excretion of penicillin, thus maintaining blood levels for longer periods. Probenecid results in better use of penicillin by delaying the excretion of penicillin through the kidneys. Penicillin destroys Treponemapallidum during all stages of its development; probenecid delays the excretion of penicillin. Probenecid does not treat urethritis. Probenecid does not prevent allergic reactions

A client who is hospitalized after a myocardial infarction asks the nurse why morphine was prescribed. What will the nurse include in the reply? A. Decreases anxiety and promotes sleep B. Helps prevent development of atrial fibrillation C. Relieves pain and reduces cardiac oxygen demand D. Dilates coronary blood vessels to increase oxygen supply

C. Relieves pain and reduces cardiac oxygen demand Morphine is a specific central nervous system depressant used to relieve the pain associated with myocardial infarction; it also decreases apprehension and reduces cardiac oxygen demand by decreasing cardiac workload. Dilating coronary blood vessels is not the reason for the use of morphine. Decreasing anxiety and restlessness is not the primary reason for the use of morphine. Lidocaine is given intravenously to prevent fibrillation of the heart.

A client is diagnosed with Parkinson disease and receives a prescription for levodopa therapy. What does the nurse identify as the drug's mechanism of action? A. Blocks the effects of acetylcholine B. Increases the production of dopamine C. Restores the dopamine levels in the brain D. Promotes the production of acetylcholine

C. Restores the dopamine levels in the brain Levodopa is a precursor of dopamine, a catecholamine neurotransmitter; it increases dopamine levels in the brain that are depleted in Parkinson disease. Blocking the effects of acetylcholine is accomplished by anticholinergic drugs. Increasing the production of dopamine is ineffective because it is believed that the cells that produce dopamine have degenerated in Parkinson disease. Levodopa does not affect acetylcholine production. Test-Taking Tip: Being emotionally prepared for an examination is key to your success. Proper use of resources over an extended period of time ensures your understanding and increases your confidence about your nursing knowledge. Your lifelong dream of becoming a nurse is now within your reach! You are excited, yet anxious. This feeling is normal. A little anxiety can be good because it increases awareness of reality, but excessive anxiety has the opposite effect, acting as a barrier and keeping you from reaching your goal. Your attitude about yourself and your goals will help keep you focused, adding to your strength and inner conviction to achieve success.

Tissue plasminogen activator (t-PA) is to be administered to a client in the emergency department. Which is the priority nursing assessment? A. Apical heart rate B. Electrolyte levels C. Signs of bleeding D. Tissue compatibility

C. Signs of bleeding Assessment for bleeding is a priority when administering a thrombolytic agent because it may lead to hemorrhage. While it is important to assess the heart rate and other vital signs, a failure to do so would not be potentially life-threatening. Electrolyte levels are not affected. Tissue compatibility assessment is not necessary.

A client with gastric ulcer disease asks the nurse why the health care provider has prescribed metronidazole. What purpose does the nurse provide? A. To augment the immune response B. To potentiate the effect of antacids C. To treat Helicobacter pylori infection D. To reduce hydrochloric acid secretion

C. To treat Helicobacter pylori infection Approximately two thirds of clients with peptic ulcer disease are found to have Helicobacter pylori infecting the mucosa and interfering with its protective function. Antibiotics do not augment the immune response, potentiate the effect of antacids, or reduce hydrochloric acid secretion.

What client response indicates to the nurse that a vasodilator medication is effective? A. Absence of adventitious breath sounds B. Increase in the daily amount of urine produced C. Pulse rate decreases from 110 to 75 beats/min D. Blood pressure changes from 154/90 to 126/72 mm Hg

D. Blood pressure changes from 154/90 to 126/72 mm Hg Vasodilation will lower the blood pressure. The pulse rate is not decreased and may increase. Breath sounds are not directly affected by vasodilation, although vasodilator medications can decrease preload and afterload, which could indirectly affect breath sounds in heart failure. The urine output is not affected immediately, although control of blood pressure can help preserve renal function over time.

A client with type 2 diabetes is taking one glyburide tablet daily. The client asks whether an extra pill should be taken before exercise. What is the nurse's best reply? A. "You will need to decrease how much you are exercising." B. "An extra pill will help your body use glucose when exercising." C. "The amount of medication you need to take is not related to exercising." D. "Do not take an extra pill because you may become hypoglycemic when exercising."

D. "Do not take an extra pill because you may become hypoglycemic when exercising." Exercise improves glucose metabolism. Exercise is associated with a risk for hypoglycemia, not hyperglycemia; an additional antidiabetic agent is contraindicated. Exercise should not be decreased because it improves glucose metabolism. Also, this response does not answer the client's question. An extra tablet probably will result in hypoglycemia because exercise alone improves glucose metabolism. Control of glucose metabolism is achieved through balanced diet, exercise, and pharmacologic therapy. STUDY TIP: Begin studying by setting goals. Make sure they are realistic. A goal of scoring 100% on all exams is not realistic, but scoring an 85% may be a better goal.

A client with type 2 diabetes is taking one oral hypoglycemic tablet daily. The client asks whether an extra tablet should be taken before exercise. What is the best response by the nurse? A. "You will need to decrease your exercise." B. "An extra tablet will help your body use glucose correctly." C. "When taking medicine, your diet will not be affected by exercise." D. "No, but you should observe for signs of hypoglycemia while exercising."

D. "No, but you should observe for signs of hypoglycemia while exercising." Exercise improves glucose metabolism; with exercise there is a risk of developing hypoglycemia, not hyperglycemia. Exercise should not be decreased because it improves glucose metabolism. An extra tablet probably will result in hypoglycemia because exercise alone improves glucose metabolism. Control of glucose metabolism is achieved through a balance of diet, exercise, and pharmacologic therapy. Test-Taking Tip: Do not panic while taking an exam! Panic will only increase your anxiety. Stop for a moment, close your eyes, take a few deep breaths, and resume review of the question.

A client with type 1 diabetes receives regular insulin every morning at 8:00 AM. During what period of time does the nurse recognize the risk of hypoglycemia is greatest? A. 8:30 to 9:30 AM B. 8:00 PM to midnight C. 1:00 PM to 8:00 PM D. 10:00 AM to 1:00 PM

D. 10:00 AM to 1:00 PM Regular insulin peaks in 2 to 5 hours; therefore the greatest risk is between 10:00 AM and 1:00 PM. Although the onset of action occurs earlier, during the period from 8:30 to 9:30 AM, the level is not yet at its highest, so the risk of hypoglycemia is not at its greatest. NPH insulin's peak action is 4 to 12 hours; if hypoglycemia occurs, it will happen most likely between midnight and 8 PM.

A nurse prepares to administer extended-release metformin to an older adult who has asked that it be crushed because it is difficult to swallow. What will prompt the nurse to ask the provider for a different form of metformin? A. This drug has a wax matrix frame that is difficult to crush. B. The drug has an unpleasant taste, which most clients find intolerable if crushed. C. If crushed, this drug irritates mucosal tissue and can cause oral and esophageal ulcer formation. D. Extended-release formulations are designed to be released slowly, and crushing the tablet will prevent this from occurring.

D. Extended-release formulations are designed to be released slowly, and crushing the tablet will prevent this from occurring. The slow-release formulary will be compromised and the client will not receive the entire dose if it is chewed or crushed. The capsules are not difficult to crush. Irritation of the mucosal tissue is not the reason the medication should not be crushed; however, this drug should be given with meals to prevent gastrointestinal irritation. Although taste could be a factor, it is not the priority issue.

A nurse has provided teaching to a client with a newly prescribed proton pump inhibitor (PPI). The nurse determines that the teaching is effective when the client states that the medication is used for the treatment of which condition? A. Diarrhea B. Vomiting C. Cardiac dysrhythmias D. Gastroesophageal reflux disease (GERD)

D. Gastroesophageal reflux disease (GERD) PPIs are effective in decreasing the secretion of gastric acid, helping to alleviate symptoms of GERD. PPIs are not used for the treatment of diarrhea, vomiting, or cardiac dysrhythmias.

Famotidine (Pepcid) is prescribed for a client with peptic ulcer disease. The client asks the nurse what this medication does. Which action does the nurse mention when replying? A. Increases gastric motility B. Neutralizes gastric acidity C. Facilitates histamine release D. Inhibits gastric acid secretion

D. Inhibits gastric acid secretion Famotidine decreases gastric secretion by inhibiting histamine at H2 receptors. Increases gastric motility, neutralizes gastric acidity, and facilitates histamine release are not actions of famotidine. Test-Taking Tip: On a test day, eat a normal meal before going to school. If the test is late in the morning, take a high-powered snack with you to eat 20 minutes before the examination. The brain works best when it has the glucose necessary for cellular function.

A nurse administers several vitamins as part of a client's medical regimen. Which prescribed vitamin is essential for the synthesis of prothrombin by the liver? A. B12 B. C C. D D. K

D. K Prothrombin, which is present in the plasma, is synthesized in the liver in the presence of vitamin K from the amino acid glutamine; vitamin K initiates the vital process of coagulation. Vitamin B12 is needed for hemoglobin synthesis. Vitamin C plays a role in collagen formation. Vitamin D is involved in calcium absorption and metabolism. Test-Taking Tip: Prepare for exams when and where you are most alert and able to concentrate. If you are most alert at night, study at night. If you are most alert at 2 am, study in the early morning hours. Study where you can focus your attention and avoid distractions. This may be in the library or in a quiet corner of your home. The key point is to keep on doing what is working for you. If you are distracted or falling asleep, you may want to change when and where you are studying.

A healthcare provider prescribes furosemide for a client with hypervolemia. The nurse recalls that furosemide exerts its effects in what part of the renal system? A. Distal tubule B. Collecting duct C. Glomerulus of the nephron D. Loop of Henle

D. Loop of Henle Furosemide acts in the ascending limb of the loop of Henle in the kidney. Thiazides act in the distal tubule in the kidney. Potassium-sparing diuretics act in the collecting duct in the kidney. Plasma expanders, not diuretics, act in the glomerulus of the nephron in the kidney.

The nurse is caring for a client who is experiencing side effects from high doses of methotrexate. Leucovorin calcium is prescribed and is to be administered immediately after the infusion of methotrexate. What is the best indicator that leucovorin calcium is effective? A. Increased energy B. Decreased nausea C. Decreased white blood cell (WBC) level D. Methotrexate level less than 0.05 micromole

D. Methotrexate level less than 0.05 micromole The laboratory measurement of the client's methotrexate level is the most objective measure of leucovorin calcium's effectiveness. Leucovorin calcium is considered a "rescue" drug because it minimizes the effects of methotrexate on healthy cells by competing with methotrexate at the cellular level, thus neutralizing it and causing it to be excreted. Although nausea and vomiting should decrease, this is a subjective finding and not as accurate as an objective one. The client's WBC level should increase, not decrease. Although the client may report that there is an increase in energy, this is a subjective finding and not as accurate as an objective finding. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question.

A nurse is reviewing a plan of care for a client who was admitted with dehydration as a result of prolonged watery diarrhea. Which new prescription will the nurse question? A. Oral psyllium B. Oral potassium supplement C. Parenteral half-normal saline D. Parenteral albumin

D. Parenteral albumin Albumin is hypertonic and will draw additional fluid from the tissues into the intravascular space. Oral psyllium will absorb the watery diarrhea, giving more bulk to the stool. An oral potassium supplement is appropriate because diarrhea causes potassium loss. Parenteral half-normal saline is a hypotonic solution, which can correct dehydration.

A client with a head injury has been receiving dexamethasone. The health care provider plans to reduce the dosage gradually and to continue a lower maintenance dosage. Which effect associated with the gradual dosage reduction of the drug should the nurse explain to the client? A. Builds glycogen stores in the muscles B. Produces antibodies by the immune system C. Allows the increased intracranial pressure to return to normal D. Promotes return of cortisone production by the adrenal glands

D. Promotes return of cortisone production by the adrenal glands Hormone therapy must be withdrawn slowly to allow the adrenal glands to adjust and resume production of their hormone. Building glycogen stores in the muscles, producing antibodies by the immune system, and allowing the increased intracranial pressure to return to normal are not reasons for the gradual withdrawal of dexamethasone.

Which relationship does the nurse consider reflective of the relationship of naloxone to morphine sulfate? A. Aspirin to warfarin B. Amoxicillin to infection C. Enoxaparin to dalteparin D. Protamine sulfate to heparin

D. Protamine sulfate to heparin Protamine sulfate is the antidote for heparin overdose, and naloxone will reverse the effects of opioids such as morphine. Aspirin and warfarin both interfere with coagulation. While amoxicillin is used to treat some infections, an infection is not a medication, so amoxicillin cannot be considered an antidote. Both enoxaparin and dalteparin are low-molecular-weight heparins.

The nurse is caring for a client who is receiving azathioprine, cyclosporine, and prednisone before receiving a kidney transplant. What does the nurse identify as the purpose of these drugs? A. Stimulate leukocytosis B. Provide passive immunity C. Prevent iatrogenic infection D. Reduce antibody production

D. Reduce antibody production These drugs suppress the immune system, decreasing the body's production of antibodies in response to the new organ, which acts as an antigen. These drugs decrease the risk of rejection. These drugs inhibit leukocytosis. These drugs do not provide immunity; they interfere with natural immune responses. Because these drugs suppress the immune system, they increase the risk of infection. Test-Taking Tip: Have confidence in your initial response to an item because it more than likely is the correct answer.

A nurse administers carbidopa-levodopa to a client with Parkinson disease. Which therapeutic effect does the nurse expect the medication to produce? A. Increase in acetylcholine production B. Regeneration of injured thalamic cells C. Improvement in myelination of neurons D. Replacement of a neurotransmitter in the brain

D. Replacement of a neurotransmitter in the brain Carbidopa-levodopa is used because levodopa is the precursor of dopamine. It is converted to dopamine in the brain cells, where it is stored until needed by axon terminals; it functions as a neurotransmitter. Regeneration of injured thalamic cells is not an action of this drug; neurons do not regenerate. Increase in acetylcholine production and improvement in myelination of neurons are not actions of this drug.

A nurse administers the prescribed regular insulin to a client in diabetic ketoacidosis. In addition, an intravenous (IV) solution with potassium is prescribed even though the serum potassium level is within normal limits. What does the nurse recognize as the reason for potassium administration? A. Potassium loss occurs rapidly from diaphoresis present during coma. B. Potassium is carried with glucose to the kidneys to be excreted in the urine in increased amounts. C. Potassium is quickly used up during the rapid series of catabolic reactions stimulated by insulin and glucose. D. Serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment.

D. Serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment. Insulin stimulates cellular uptake of glucose and stimulates the sodium/potassium pump, leading to the influx of potassium into cells. The resulting hypokalemia is offset by parenteral administration of potassium. Potassium is not lost from the body by profuse diaphoresis. Potassium moves from the extracellular to the intracellular compartment rather than being excreted in the urine. Anabolic reactions are stimulated by insulin and glucose administration; potassium is drawn into the intracellular compartment, necessitating a replenishment of extracellular potassium.

A client with heart failure is to receive digoxin and asks the nurse why the medication is necessary. What physiologic response will the nurse include when answering the client's question? A. Reduces edema B. Increases cardiac conduction C. Increases rate of ventricular contractions D. Slows and strengthens cardiac contractions

D. Slows and strengthens cardiac contractions Digoxin increases the strength of myocardial contractions (positive inotropic effect) and, by altering the electrophysiological properties of the heart, slows the heart rate (negative chronotropic effect). Digoxin increases the strength of the contractions but decreases the heart rate. Although a reduction in edema may result from the increased blood supply to the kidneys, it is not the reason for administering digoxin. Digoxin decreases, not increases, cardiac impulses through the conduction system of the heart. Test-Taking Tip: A psychological technique used to boost your test-taking confidence is to look into a mirror whenever you pass one and say out loud, "I know the material, and I'll do well on the test." Try it; many students have found that it works because it reduces "test anxiety.

A nurse is caring for a client who has been taking several antibiotic medications for a prolonged time. Because long-term use of antibiotics interferes with the absorption of fat, what prescription does the nurse anticipate? A. High-fat diet B. Supplemental cod liver oil C. Total parenteral nutrition (TPN) D. Water-soluble forms of vitamins A and E

D. Water-soluble forms of vitamins A and E Vitamins A, D, E, and K are known as fat-soluble vitamins because bile salts and other fat-related compounds aid their absorption. A high-fat diet will not achieve the uptake of fat-soluble vitamins in this client. Supplemental cod liver oil will not achieve the uptake of fat-soluble vitamins in this client. TPN is unnecessary; a well-balanced diet is preferred. Water-miscible forms of vitamins A and E can be absorbed with water-soluble nutrients. Test-Taking Tip: Study wisely, not hard. Use study strategies to save time and be able to get a good night's sleep the night before your exam. Cramming is not smart, and it is hard work that increases stress while reducing learning. When you cram, your mind is more likely to go blank during a test. When you cram, the information is in your short-term memory so you will need to relearn it before a comprehensive exam. Relearning takes more time. The stress caused by cramming may interfere with your sleep. Your brain needs sleep to function at its best.

A client is admitted to the hospital with a diagnosis of acute pancreatitis. The health care provider's prescriptions include nothing by mouth and total parenteral nutrition (TPN). The nurse explains that the TPN therapy provides what benefit? A. Is the easiest method for administering needed nutrition B. Is the safest method for meeting the client's nutritional requirements C. Will satisfy the client's hunger without the discomfort associated with eating D. Will meet the client's nutritional needs without causing the discomfort precipitated by eating

D. Will meet the client's nutritional needs without causing the discomfort precipitated by eating Providing nutrients by the intravenous route eliminates pancreatic stimulation, therefore reducing the pain experienced with pancreatitis. TPN is used to meet the client's needs, not the nurse's needs. TPN creates many safety risks for the client. Hunger can be experienced with TPN therapy.