ATI MISTAKES REVIEW

A nurse is assessing a client who is taking varenicline for smoking cessation. Which of the following findings is the nurse's priority? A. Mood changes B. Nausea C. Altered sense of taste D. Skin rash

1 The greatest risk to the client is the development of neuropsychiatric effects that can progress to depression and suicide. Therefore, the highest priority is a change in the client's mood. NOT B. NV are common adverse effects of varenicline; however, there is another finding that is the priority. C. An altered sense of taste is an adverse effect of varenicline; however, there is another finding that is the priority. D. A skin rash is an adverse effect of varenicline; however, there is another finding that is the priority.

A nurse is teaching to a client who has systemic lupus erythematosus about a new prescription for oral glucocorticoid therapy. Which of the following client statements indicates an understanding of the teaching? a. "I should take a calcium supplement while on this medication." b. "Regular liver function studies will have to be done while I am taking this medication." c. "I can take NSAIDs to treat mild pain while using this medication." d. "I will be sure to eat 6 small meals a day to prevent hypoglycemia from this medication."

1. An adverse effect of systemic glucocorticoid therapy is osteoporosis. Increasing calcium-rich foods in the diet and adding calcium and vitamin D supplements should be encouraged to prevent osteoporosis and decrease the risk of fractures. NOT 2. Does not affect liver function 3. NSAIDs should be avoided while undergoing systemic glucocorticoid therapy due to the increased risk of gastric ulceration. Combining these medications increases the risk of GI bleeding. The client should be instructed to check for GI bleeding and report black, tarry stools to the provider 4. hyperglycemia is a SE

A nurse is providing teaching to a newly licensed nurse about administering morphine via IV bolus to a client. Which of the following pieces of information should the nurse include in the teaching? A. Respiratory depression can occur 7 min after the morphine is administered. B. The morphine will peak in 10 min. C. Withhold the morphine if the client has a respiratory rate of <16/min. D. Administer the morphine over 2 min.

1. Respiratory depression can occur within 7 minutes of the administration of IV bolus morphine. The nurse should monitor the client's respirations and have naloxone available to reverse the effects of the morphine. NOT B. IV morphine peaks in 20 minutes. C. The nurse should withhold the morphine if the client has a respiratory rate of <12/minute. D. The nurse should administer morphine via IV bolus slowly over 4 to 5 minutes to prevent hypotension and respiratory depression.

A nurse is caring for a client who has asthma and a prescription for Zileuton. Which of the following laboratory values should the nurse monitor while the client is taking this medication? 1 ALT 2 WBC 3 Potassium 4 Chloride

1. The nurse should identify that ALT is a liver function test. Zileuton is a leukotriene modifier that can affect the liver, causing increased ALT levels. The nurse should monitor this laboratory value closely while the client is taking the medication.

A nurse is caring for a client who has bronchitis and a prescription for a mucolytic agent. Which of the following findings should the nurse identify as an adverse effect of this type of medication? A. Fluid overload B. Bronchospasm C. Electrolyte imbalance D. Tachycardia

2. The nurse should identify that bronchospasm is an adverse reaction to a mucolytic agent. Mucolytic agents such as a hypertonic saline solution or acetylcysteine can irritate the airways, resulting in bronchospasm while producing a cough and thinning mucus secretions

A nurse is caring for a client who has cystic fibrosis (CF) and has a prescription for high-dose ibuprofen daily. The nurse should identify that which of the following is an expected outcome for the client receiving this medication? A. Thinned pulmonary secretions that are retained in the airways B. Slowed progression of pulmonary damage C. Potentiated action of bronchodilator therapy D. Decreased risk of fevers associated with CF

2. The nurse should identify that clients who have CF are prescribed high-dose Ibuprofen, which is an NSAID, to slow the progression of pulmonary damage by suppressing the inflammatory response that causes pulmonary damage. NOT 1. Mucolytic 3. Can be prescribed together but do not potentiate each other 4. Ibuprofen can be used to treat a client who has a fever. However, high-dose ibuprofen is not used to treat fevers for clients who have CF.

A nurse is reviewing the medical record of a client who has a prescription for a combination oral contraceptive. The nurse should identify that which of the following findings is a contraindication to receiving this medication? A. High cholesterol levels B. Liver disease C. Family history of ovarian cancer D. Client report of hypermenorrhea

2. The nurse should identify that liver disease or abnormal liver function is a contraindication to receiving a combination oral contraceptive. Therefore, the nurse should notify the client's provider. Other contraindications include thrombophlebitis or breast cancer. NOT 1. Combo OCP does not affect cholesterol levels, therefore not contraindicated 3. Combo OCP protect against ovarian cancer 4. Excessive bleeding during menses can be corrected with combo OCP

A nurse is reviewing the medical record of a client who is receiving hydrochlorothiazide (HCTZ). The nurse should expect to find an improvement in which of the following conditions as a result of this medication? A. Gouty arthritis B. Dehydration C. Diabetes insipidus D. Hypokalemia

3. A thiazide diuretic such as HCTZ is administered to treat diabetes insipidus. Diabetes insipidus is a condition in which there is an overproduction of urine. Thiazides reduce urine production by 30% to 50% NOT A. Gouty arthritis can be an adverse effect of HCTZ due to the retention of uric acid. The nurse should periodically monitor the client's plasma levels of uric acid. B. Dehydration can be an adverse effect of thiazide medications such as HCTZ due to the loss of water, sodium, and chlorite. The nurse should weigh the client on a regular basis to monitor for dehydration. D. Hypokalemia can be an adverse effect of taking HCTZ due to excessive potassium excretion. The nurse should monitor the client's potassium levels and encourage the client to eat potassium-rich foods.

A nurse is caring for a client who has a prescription for chlorothiazide to treat HTN. The nurse should plan to monitor the client for which of the following adverse effects? a. Thrombophlebitis b. Hyperactive reflexes c. Muscle weakness d. Hypoglycemia

3. Chlorothiazide is used to tx HTN and CHF. It promotes excretion of water, sodium, and potassium and cause hypokalemia. Manifestations of hypokalemia include muscle weakness, muscle cramps, and dysrhythmias NOT 1. Can cause hypercalcemia not Thrombophlebitis 2. Can cause hypoactive reflexes 4. Can cause hyperglycemia

A nurse is administering adenosine via IV bolus for a client who has developed paroxysmal atrial tachycardia. For which of the following findings should the nurse assess the client during the administration of adenosine? A. Seizures B. Cinchonism C. Dyspnea D. Transient pallor of the face

3. Dyspnea can occur during the administration of adenosine due to bronchoconstriction. Since adenosine has a short half-life of about 10 seconds, this effect should be short-lived. NOT A. not an adverse effect of administration of adenosine. B. Cinchonism (manifested by tinnitus, headache, vertigo, and visual disturbances) occurs after the administration of quinidine, another anti-dysrhythmic medication. Cinchonism is not seen in clients who receive adenosine. D. Flushing of the face and a feeling of warmth are transient findings that occur during the administration of adenosine. Pallor is not an adverse effect of this medication.

A nurse is providing teaching to a client who has hypertension and a new prescription for oral clonidine. Which of the following instructions should the nurse include in the teaching? A. Discontinue the medication if a rash develops. B. Expect increased salivation during the first few weeks of therapy. C. Minimize fiber intake to prevent diarrhea. D. Avoid driving until the client's reaction to the medication is known.

4. Clonidine can cause drowsiness, weakness, sedation, and other CNS effects. Until the client's response to the medication is known, the nurse should instruct the client to avoid driving or handling other potentially hazardous equipment. Over time, these effects are likely to decrease. NOT 1. Clonidine should not be discontinued abruptly due to the risk of hypertensive crisis. The client should report the rash to the provider 2. Dry mouth is expected 3. Can cause constipation

Detrimental inhibitory interaction

A detrimental inhibitory interaction can occur with the concurrent use of propranolol and albuterol. When a client takes propranolol and albuterol together, propranolol can interfere with albuterol's therapeutic effects.

A nurse is preparing to administer iron dextran IV to a client. Which of the following actions should the nurse plan to take? A. Administer a small test dose before giving the full dose. B. Infuse the medication over 30 seconds. C. Monitor the client closely for hypertension after the infusion. D. Administer cyanocobalamin as an antidote if iron dextran toxicity occurs.

A. A serious adverse effect of iron dextran is anaphylaxis caused by hypersensitivity to the medication. A small test dose should be administered over 5 minutes before giving the full dose. The client should be monitored carefully for an allergic reaction during and for a period of time following the test dose.

A nurse is preparing to administer amlodipine to a client who has hypertension. The nurse should plan to monitor the client for which of the following adverse effects of the medication? (Select all that apply.) A. Dizziness B. Pale appearance C. Palpitations D. Abdominal pain E. Peripheral edema

A. C. E. The nurse should monitor this client who is taking amlodipine for dizziness, palpitations (fast heartbeat as response from dropped BP), and peripheral edema as adverse effects of the medication. The nurse should advise the client to avoid activities that require alertness until the effect of the medication is known and to notify the provider if any of these adverse effects occur. Incorrect Answers: B. monitor a client for flushing as an adverse effect of the medication. D. monitor a client for headaches, not abdominal pain

A nurse is teaching a client about the adverse effects of omeprazole. Which of the following client statements indicates an understanding of the teaching? A. "If I experience severe diarrhea, I will call my doctor." B. "Pneumonia is associated with long-term use of this medication." C. "I will need to take this medication with food." D. "I should take vitamin B12 while using this medication."

A. Clients who experience diarrhea while taking omeprazole or other (PPIs) should report this finding to the provider immediately. Omeprazole and other PPIs are associated with a dose-related increase in the risk of infection with C. diff, which is a bacterium that can cause severe diarrhea. Incorrect Answers: B. The client's risk of PNA is limited to the first few days of using PPIs. After that period, the risk of PNA is no higher than in clients who do not use the medication. C. The nurse should instruct the client to take this medication AC and preferably AM for absorption. D. Omeprazole does not cause a deficiency in vitamin B12. However, this medication can cause a deficiency in magnesium, especially with long-term use

A nurse is providing teaching to a female client who has a new prescription for pravastatin to treat hyperlipidemia. Which of the following pieces of information should the nurse include in the teaching? A. Pravastatin can be taken with grapefruit juice. B. Pravastatin can be continued during pregnancy. C. Pravastatin should be taken with the morning meal. D. Laboratory testing to monitor the client's WBC count is required.

A. Pravastatin, unlike other statins, such as lovastatin, simvastatin, and atorvastatin, is not affected by CYP3A4 inhibitors. It is safe for the client to consume grapefruit juice if desired. NOT B. Can cause fetal abnormalities C. Evening is preferred D. WBCs not affected

A nurse is caring for a client who has a prescription for subdermal etonogestrel. The nurse should alert the provider about which of the following findings in the client's medical history? A. Takes St. John's wort B. Breastfeeds a 6-month-old infant C. Has a parent with hypertension D. Has a positive human papillomavirus (HPV) test result

A. St. John's wort can reduce the effects of subdermal etonogestrel because it stimulates hepatic drug-metabolizing enzymes. Therefore, the nurse should alert the provider about the client's use of St. John's wort, and it should be discontinued. Incorrect Answers: B. Subdermal etonogestrel is safe to use during breastfeeding after postpartum day 21 because minimal etonogestrel is excreted in breastmilk. C. A family history of HTN is not a contraindication for using subdermal etonogestrel and does not impact the medication's effectiveness. Subdermal etonogestrel can raise the client's blood pressure, but the risk with a low-estrogen preparation is minimal. D. + HPV test result does not impact the effectiveness of the subdermal etonogestrel.

A charge nurse is teaching a newly licensed nurse about a client who has severe allergy-related asthma and a new prescription for omalizumab. Which of the following pieces of information should the charge nurse include to describe the medication's mechanism of action? A. It reduces the number of immunoglobulin E (IgE) molecules on mast cells. B. It stabilizes the cellular membrane of mast cells. C. It decreases the synthesis and release of inflammatory mediators. D. It relaxes the smooth muscles by blocking adenosine receptors. Check Answer P

A. The charge nurse should include in the teaching that the MOA of omalizumab reduces the number of IgE molecules on mast cells. This limits the ability of allergens to trigger immune mediators that cause bronchospasm. NOT B. Stabilizing the cellular membrane of mast cells is the mechanism of action of mast cell stabilizers. C. Decreasing the synthesis and release of inflammatory mediators is the mechanism of action of glucocorticoids. D. Relaxing smooth muscle by blocking adenosine receptors is the mechanism of action of methylxanthines.

A nurse is assessing a client who began taking clozapine 3 weeks ago. Which of the following findings should the nurse report to the provider immediately? A. Tachypnea and tachycardia B. Abdominal pain and constipation C. Enuresis and polyuria D. Dry mouth and blurred vision

A. The greatest risk to the client is the development of myocarditis, a potentially fatal adverse effect of clozapine. Myocarditis is an inflammation of the heart muscle that typically occurs within 30 days of starting the medication. Manifestations of myocarditis include chest pain, palpitations, tachycardia, cardiac arrhythmias, dyspnea, tachypnea, a fever, peripheral edema, and unexplained fatigue. Clozapine should be discontinued if a client develops myocarditis, and its use should be avoided in the future.

An 18-month-old toddler who has Kawasaki disease (KD). The child is receiving intravenous immune globulin (IVIG). The guardian asks the nurse to administer the child's scheduled measles, mumps, and rubella (MMR) vaccine before discharge. Which of the following responses should the nurse provide? A. "Your child will not be able to receive the MMR vaccine for at least 3 months after discharge." B. "I cannot administer routine vaccines to children while they are in the hospital." C. "Your child can receive the MMR vaccine once his fever is gone." D. "I can administer the measles and rubella vaccines, but I cannot administer the mumps vaccine."

A. The nurse should explain to the guardian that IVIG given for the treatment of KD contains antibodies that can interfere with the action of live-virus vaccines like MMR. The MMR immunization should be postponed for 3 to 6 months.

A nurse is teaching a client who has chemotherapy-induced anemia and a prescription for epoetin alfa. The nurse should instruct the client to report which of the following findings as an adverse effect of epoetin alpha? A. Hypertension B. Leukocytosis C. Bone pain D. Neutropenia

A. The nurse should instruct the client to report hypertension, which is an adverse effect of epoetin alfa. Other adverse effects can include headaches, seizures, heart failure, and thromboembolic events related to increased hemoglobin levels. NOT B. C. Epoetin alfa is a growth factor that is used to stimulate the production of red blood cells in the bone marrow. It can cause polycythemia vera, not leukocytosis or bone pain. D. Clients who are receiving chemotherapy have decreased neutrophil counts as a result of the treatment. Therefore, epoetin alfa is used to stimulate the production of red blood cells in the client's bone marrow.

A nurse is planning care for a client who is receiving gentamicin IM and has a new prescription to obtain gentamicin peak and trough levels. At which of the following times should the nurse plan to obtain a blood sample to evaluate the gentamicin peak? A. 1 hour after administering the IM injection B. Just before administering the IM injection C. 12 hours after the last IM injection D. 30 minutes after administering the IM injection

A. The nurse should obtain blood samples for peak levels 1 hour after administering an IM injection or 30 minutes after completing an IV infusion. NOT 2. Done for trough levels 3. will not give accurate gentamicin peak or trough levels because some of the medication will have already metabolized 4. For clients who are receiving gentamicin via IM injection, it is important to wait for 1 hour after administration to obtain blood for testing peak levels. This allows the medication to be absorbed into the bloodstream and provides an accurate peak level.

A nurse is providing discharge teaching to a client who has a bacterial infection about adverse effects of imipenem to report to the provider. Which of the following pieces of information should the nurse include? A. "Seizures can occur with this medication." B. "You should observe for manifestations of bleeding." C. "Check your hands and feet for sensory dysfunction." D. "This medication can increase the risk of ototoxicity."

A. The nurse should tell the client that seizures can occur when receiving imipenem. The client should notify HCP immediately if these occur. Incorrect Answers: B. Imipenem does not increase the client's risk of bleeding. However, other antibiotics can increase the risk of bleeding such as some cephalosporins. C. Imipenem does not cause sensory dysfunction. However, sensory dysfunction is an adverse effect of penicillin G intramuscular injections as a result of accidental injection of the medication into a peripheral nerve. D. Imipenem does not have an adverse effect of ototoxicity. However, aminoglycosides antibiotics can cause this adverse effect.

A nurse is assessing a client who has a new prescription for chlorpromazine to treat schizophrenia. The client has a mask-like facial expression and is experiencing involuntary movements and tremors. Which of the following medications should the nurse anticipate administering? A. Amantadine B. Bupropion C. Phenelzine D. Hydroxyzine

A. This client is experiencing Parkinsonism, which is an adverse effect of the antipsychotic medication chlorpromazine. Amantadine is an antiparkinsonian medication used to treat the extrapyramidal manifestations that can occur with chlorpromazine therapy. Incorrect Answers: B. Bupropion is an atypical antidepressant. It is not used to treat Parkinsonism adverse effects caused by chlorpromazine. C. Phenelzine is an MAOI antidepressant. It is not used to treat Parkinsonism adverse effects caused by chlorpromazine. D. Hydroxyzine is an antihistamine used to treat mild to moderate anxiety. It is not used to treat Parkinsonism adverse effects caused by chlorpromazine.

Neomycin

Aminoglycoside

A nurse is planning care for a client who has a seizure disorder and a new prescription for valproic acid. Which of the following laboratory values should the nurse plan to monitor? (Select all that apply.) A. BUN B. PTT C. Aspartate aminotransferase (AST) D. Urinalysis E. Alanine aminotransferase (ALT)

B. C. E. Valproic acid can alter coagulation; therefore, PT and PTT should be monitored. It also can cause life-threatening hepatotoxicity; the client should have baseline liver function tests (LFTs) before starting this medication, and LFTs should be repeated at regular intervals during therapy. ALT is a liver enzyme that is measured as a component of liver function tests. Levels of the enzyme identify liver damage. Incorrect Answers: A. D. Valproic acid has no effect on kidney function.

A nurse is caring for a client who is receiving cefotetan 1 g via intermittent IV bolus every 12 hr to treat a postoperative infection. Which of the following manifestations should the nurse monitor for as an adverse effect of the medication? x A. Disorientation B. Epistaxis C. Constipation D. Jaundice

B. Cefotetan is an antibiotic that affects vitamin K levels, which can result in bleeding and epistaxis. The nurse should monitor the client for bleeding and notify the provider if this manifestation occurs so the medication can be discontinued. Incorrect Answers: A. Cefotetan is a 2nd gen cephalosporin, a class of antibiotics that does not manifest disorientation as an adverse effect. C. The nurse should monitor this client for diarrhea. D. Cefotetan does not manifest jaundice as an adverse effect.

A nurse is caring for a client who is taking selegiline. The nurse should monitor the client for which of the following adverse effects of selegiline and notify the provider if it occurs? A. Bruising B. Drowsiness C. Coughing D. Constipation

B. Drowsiness can be an adverse effect of selegiline and a manifestation of serotonin syndrome. The nurse should notify the provider about this finding immediately. Incorrect Answers: A. Bruising is an adverse effect of NSAIDs (e.g. ibuprofen prescribed for arthritic pain). C. A cough can be an adverse effect of an ACE inhibitor prescribed for hypertension. D. Diarrhea is an adverse effect of selegiline

A nurse is reviewing the laboratory results for a client who has a prescription for filgrastim. An increase in which of the following values indicates a therapeutic effect of this medication? A. Erythrocyte count B. Neutrophil count C. Lymphocyte count D. Thrombocyte count

B. Filgrastim increases neutrophil production. It is given to treat neutropenia and reduce the risk of infection in clients who are receiving chemotherapy for cancer or who have undergone bone marrow transplant. Incorrect Answers: A. Filgrastim does not increase erythrocyte production and can cause anemia. C. Filgrastim does not increase lymphocytes. D. Filgrastim does not increase thrombocytes.

A nurse is caring for a client who has atrial fibrillation and is scheduled for cardioversion. The nurse should anticipate a prescription from the provider for which of the following medications for this procedure? A. Amlodipine B. Diltiazem C. Nifedipine D. Lidocaine

B. The nurse should anticipate a prescription for diltiazem, which blocks calcium channels in the heart and blood vessels, thereby lowering blood pressure. Also, it is an antiarrhythmic medication that is used during cardioversion to treat atrial fibrillation. NOT 1.3. Nifedipine / Amldipine is a calcium channel blocker that minimally blocks calcium channels in the heart and is not used to treat arrhythmias. It is indicated for hypertension or angina pectoris. 4. Lidocaine is an antidysrhythmic medication used to treat ventricular dysrhythmias.

A nurse is caring for a client who has a suspected adrenal insufficiency. Which of the following medications should the nurse anticipate the provider using to determine the presence of adrenal insufficiency? A. Prednisone B. Cosyntropin C. Dexamethasone D. Ketoconazole

B. The nurse should expect the provider to use cosyntropin. The client is monitored after the provider injects cosyntropin to see if the cortisol level rises above 20 mcg/dL. If the adrenal response causes the cortisol level to elevate, the response is considered to be within the expected reference range. If the cortisol level does not elevate, the provider should determine that the client has adrenal insufficiency.

A nurse is caring for a client who has rheumatoid arthritis and a new prescription for etanercept. Which of the following values should the nurse review prior to the administration of the medication? A. Ability to swallow B. Results of last purified protein derivative (PPD) test C. Serum creatinine level D. Blood glucose level

B. The nurse should identify that a client who is taking etanercept is at risk for infections such as (TB). To reduce this risk, the client should be tested for latent TB; if the test is positive, the client should undergo TB treatment before receiving etanercept. During treatment with etanercept, the client should be monitored closely for the development of TB. NOT A. Can be given parenterally C. Hepatotoxic not nephrotoxic D. Does not affect blood glucose level

A nurse is preparing to administer the influenza vaccine to a client. Which of the following allergies should the nurse identify as a contraindication to the client receiving this vaccine? A. Gelatin B. Chicken eggs C. Neomycin D. Prednisone

B. The nurse should identify that an allergy to chicken eggs is a contraindication to receiving the influenza vaccine. Clients who have this allergy can experience angioedema and severe respiratory distress if this vaccine is administered Incorrect Answers: A. Clients who are allergic to gelatin should not receive the varicella vaccine because it contains gelatin. C. Clients who are allergic to neomycin should not receive the varicella vaccine because it contains neomycin. D. An allergy to prednisone is not a contraindication to receiving the influenza vaccine.

A nurse is teaching the guardian of an infant about the diphtheria, tetanus, and pertussis (DTaP) vaccine. Which of the following pieces of information should the nurse include in the teaching? A. "Routine immunization for DTaP consists of 3 injections." B. "The first immunization for DTaP in the series is given at 2 months." C. "DTaP immunization has been replaced with DTP." D. "This immunization is administered subcutaneously."

B. The nurse should tell the guardian that the first immunization of DTaP is given at 2 months, with the rest of the vaccinations occurring at 4 months, 6 months, 15 to 18 months, and 4 to 6 years of age. NOT A. The nurse should inform guardian that routine immunization for DTaP consists of 5 injections, with the first at 2 months, the second at 4 months, the third at 6 months, the fourth between 15 and 18 months, and the fifth between 4 and 6 years of age. C. The nurse should tell the guardian that DTP immunization is a product that was once used, but is no longer available. Children who began the series with DTP should complete it with DTaP to ensure they are up to date on the current immunization. D. The nurse should tell the guardian that DTaP vaccine is injected intramuscularly into the deltoid muscle or the thigh. These locations offer larger muscles in the body to diffuse the immunization and limit inflammation.

A nurse is evaluating how a client who is pregnant is responding to a medication. Which of the following physiological effects of pregnancy should the nurse take into consideration? A. Increased intestinal transit rate B. Accelerated excretion of fluids C. Reduced renal blood flow D. Decreased hepatic metabolism

B. There are physiological changes in the kidneys with pregnancy, including accelerated excretion from increased renal blood flow. This results in increased glomerular filtration. To compensate for accelerated excretion, dosages of medications that glomerular filtration eliminates must be increased to achieve a comparable therapeutic effect. Incorrect Answers: A. Pregnancy reduces the tone and motility of the intestines, which decreases the intestinal transit rate. This allows more time for the absorption of medications, which could increase the levels of medications that would otherwise have poor absorption. C. Renal blood flow doubles during pregnancy, which increases the glomerular filtration rate. This accelerates the clearance of medications that glomerular filtration eliminates. D. Pregnancy causes physiological changes in the liver. Liver metabolism can increase during pregnancy for some medications (e.g. antiseizure medications like phenytoin, carbamazepine, and valproic acid).

A nurse is assessing an infant who is scheduled to receive the rotavirus vaccine. Which of the following criteria should the nurse identify as a potential contraindication for administering this vaccine? A. The infant is teething. B. The infant has a history of intussusception. C. The infant has been constipated for 3 days. x D. The infant is 9 weeks old.

B. You should identify that the rotavirus vaccine is contraindicated for infants who have a history of intussusception. The rotavirus vaccine is also contraindicated for infants who have an uncorrected GI congenital malformation that could result in intussusception. Incorrect Answers: A. not a contraindication for receiving the rotavirus vaccine (it is safe) C. Infants who have moderate to severe diarrhea or vomiting should not receive the vaccine until they recover. Therefore, constipation is not a contraindication for the administration of this vaccine. D. Recommended that all infants receive the rotavirus vaccine beginning around the age of 8 weeks (not contraindicated for a 9-week-old infant)

A nurse is reviewing the medical record of a client who has been taking a vitamin D supplement. Which of the following findings from the client's record should the nurse identify as a risk factor for developing vitamin D deficiency? A. Middle-age B. Obesity C. Dark-colored eyes D. Light-pigmented skin

B. probably due to volumetric dilution into the greater volumes of fat, serum, liver, and muscle

Black cohosh

Black cohosh is an herb that is used for the treatment of menopausal symptoms such as hot flashes, vaginal dryness, irritability, and sleep disturbance.

A nurse is caring for an older adult client who has a new prescription for amitriptyline to treat depression. Which of the following diagnostic tests should the nurse plan to perform prior to starting the client on this medication? A. Hearing examination B. Glucose tolerance test C. Electrocardiogram D. Pulmonary function tests

C. Amitriptyline can cause tachycardia and ECG changes. An older adult client is at risk for CV effects while using amitriptyline; therefore, an ECG should be performed prior to the start of therapy to obtain a baseline of the client's cardiovascular status. Incorrect Answers: A. Amitriptyline can cause blurred vision; however, it does not affect hearing. B. Amitriptyline does not cause hyperglycemia or alter glucose tolerance. D. Amitriptyline does not affect pulmonary function.

A nurse is caring for a client who is experiencing cycloplegia following the administration of atropine eye drops during an eye examination. Which of the following findings should the nurse expect as a result of cycloplegia? A. Inability to tolerate bright lights B. Pinpoint pupils C. Blurred vision D. Inability to perform an upward gaze

C. Assessment findings of cycloplegia include blurred vision because focusing for near vision is impaired. This action occurs following the administration of atropine because the paralysis of the ciliary muscle prevents near-vision focus. Accommodation, or looking from far to near and vice-versa, is also temporarily impaired. NOT A. The inability to tolerate bright lights is photophobia, not cycloplegia. Photophobia is an adverse effect of topical anticholinergics, such as atropine. B. Dilated pupils result from atropine administration. Dilation of the eye, or mydriasis, allows the provider to examine the inside of the eye. D. The inability to perform an upward gaze can occur with some types of head or facial trauma involving muscle entrapment. This does not occur with administering anticholinergic eye drops.

A nurse is preparing a discharge teaching plan for a client who is scheduled to begin long-term oral prednisone for asthma. Which of the following instructions should the nurse include in the plan? A. Stop taking the medication if a rash occurs. B. Take the medication on an empty stomach to enhance absorption. C. Schedule the medication on alternate days to decrease adverse effects. D. Treat shortness of breath with an extra dose of the medication. Check Answer P

C. Some of the adverse effects caused by long-term glucocorticoid therapy (e.g. suppression of the adrenal gland) can be avoided by using alternate-day therapy. NOT A. A rash is not an expected adverse effect of oral glucocorticoids like prednisone. A client should not stop taking prednisone or other glucocorticoids abruptly if taking the medication for more than 10 days. The dosage should be decreased gradually to prevent withdrawal syndrome during long-term therapy. B. Glucocorticoids can cause significant GI distress and lead to ulcer formation. The client should not take steroids on an empty stomach. D. Oral glucocorticoids are not used as rescue medications. The client might need a SABA if acute distress occurs.

A nurse is teaching a client about the use of a dinoprostone vaginal insert pouch to stimulate labor. Which of the following statements should the nurse include in the teaching? A. "It is inserted using a catheter." B. "One pouch is given every 4 hours until labor occurs." C. "Lie on your back for at least 2 hours without getting up." D. "If labor doesn't occur within 6 hours, a second dose can be administered." Check Answer

C. The client should remain supine for at least 2 hours after the dinoprostone vaginal pouch is inserted to allow a slow release of the medication from the pouch to stimulate labor. Incorrect Answers: A. Dinoprostone gel, not the vaginal insert pouch, is administered by endocervical catheter. To prevent leakage when using the gel, the client should remain supine for at least 30 minutes. B. The dinoprostone vaginal insert pouch releases the medication slowly until active labor occurs or is removed after 12 hours. D. The dinoprostone vaginal insert pouch lasts for up to 12 hours and is removed when active labor occurs or after 12 hours have elapsed. Dinoprostone gel, not the vaginal insert, often requires 2 to 3 doses during the 12-hour timeframe.

A nurse is teaching a group of nurses about the effects of a client receiving spinal anesthesia. Which of the following pieces of information should the nurse include in the teaching? A. Lidocaine toxicity will cause the client to develop tachycardia. B. Most clients develop a headache from spinal anesthesia. C. Hypotension is an adverse effect of spinal anesthesia. D. Urinary urgency occurs when the client has spinal anesthesia.

C. The local anesthetic can cause the client's BP to decrease due to venous dilation secondary to a sympathetic nervous system response. If hypotension occurs, the nurse should lower the HOB, increase fluids if applicable, and administer vasoconstrictive medication as indicated by the provider NOT A. Bradycardia is a manifestation of lidocaine toxicity when used with spinal anesthetic. B. Clients who receive spinal anesthesia rarely experience spinal HA, which are caused by a nick in the dura when trying to locate the subarachnoid space. A client who has a spinal headache should remain flat in bed until the area has sealed over. At times, a blood patch might need to be injected by an anesthesiologist to cover the affected area. D. Spinal anesthesia can cause an autonomic blockage, resulting in urinary retention and distention. Monitor the client's output and alert the provider if the client has not voided within 8 hours of the surgery.

A nurse is teaching a female client who has a new prescription for misoprostol to treat peptic ulcer disease. Which of the following client statements should indicate to the nurse that the teaching was effective? A. "I should avoid taking NSAIDs while using this medication." B. "Misoprostol is used to treat stress-induced gastric ulcers." C. "I should avoid becoming pregnant while taking this medication." D. "This medication is also used to treat dysmenorrhea."

C. The nurse should identify that misoprostol is contraindicated during pregnancy and is classified as pregnancy risk category X by the Food and Drug Administration (FDA). It has the potential to stimulate uterine contractions, and the use of misoprostol during pregnancy has been known to cause partial or complete expulsion of the developing fetus. NOT A. Misoprostol is an analog of prostaglandin E. (NSAIDs) and aspirin can cause gastric ulcers by inhibiting prostaglandin synthesis. This makes misoprostol an ideal antiulcer medication for clients who frequently take NSAIDs. B. misoprostol's only approved GI indication is for the prevention of gastric ulcers. It is not approved for ulcer treatment. D. Misoprostol has an adverse effect of dysmenorrhea and should not be given to treat this condition.

A nurse is providing teaching to a client who has tuberculosis (TB) and a prescription for isoniazid. Which of the following instructions should the nurse include? A. "You'll need to take this medication for the rest of your life to prevent recurrence." B. "Your provider will monitor your thyroid function while you are taking this medication." C. "You should take this medication on an empty stomach." D. "You should take this medication with an antacid."

C. The nurse should instruct the client to take isoniazid on an empty stomach to improve absorption of the medication. To ensure the stomach is empty, the client should take the medication either 1 hour before or 2 hours after a meal

A nurse is caring for a client with a pseudomonas infection who has a new prescription for ticarcillin-clavulanate. Which of the following data should the nurse collect before administering this medication? A. Indications of superinfection B. Peak and trough medication levels C. Baseline BUN and creatinine D. History of allergy to aminoglycoside antibiotics

C. Ticarcillin-clavulanate is a penicillin antibiotic and is excreted by the kidneys. Therefore, any renal impairment could result in a toxic level of the medication. The nurse should assess baseline BUN and creatinine levels and monitor these values throughout therapy. NOT A. A superinfection occurs when the normal flora is eliminated following the administration of a broad-spectrum antibiotic. Superinfections are caused by drug-resistant microbes and would not be seen until ticarcillin-clavulanate had been administered for several days. B. Peak and trough levels are not monitored for penicillin antibiotics. Peak and trough levels are monitored for aminoglycoside antibiotics. D. Ticarcillin-clavulanate does not have cross-sensitivity with aminoglycoside antibiotics; therefore, assessing for an allergy to these antibiotics should not be necessary. Penicillin and aminoglycosides should not be infused through the same IV line.

A nurse is providing teaching to a client who has a prescription for famotidine to treat a gastric ulcer. Which of the following statements should the nurse include in the teaching? A. "This medication is more effective when taken on an empty stomach." B. "You should take this medication with an antacid for pain control." C. "This medication is less effective for people who smoke." D. "You should expect to experience dizziness when taking this medication."

C. instruct the client that smoking interferes with the effectiveness of famotidine. If a client taking famotidine smokes, the nurse should encourage the client to quit smoking or, if unable quit, to avoid smoking after the last dose of the day. Incorrect Answers: A. food does not affect the absorption of famotidine. the client is able to take the medication without regard to food intake. B. instruct the client to take antacids at least 30 to 60 min after taking famotidine. D. instruct the client that dizziness is an adverse effect of famotidine and to contact her provider if she experiences this manifestation.

Cardioversion

Cardioversion is a medical procedure that restores a normal heart rhythm in people with certain types of abnormal heartbeats (arrhythmias). Cardioversion is usually done by sending electric shocks to your heart through electrodes placed on your chest. It's also possible to do cardioversion with medications

Warfarin and NSAIDs interaction

Clients who are taking warfarin should avoid aspirin and ibuprofen due to antiplatelet effects, which place the client at a greater risk of bleeding. Because warfarin interacts with a wide variety of substances, the nurse should instruct the client to check with the provider before taking any medication or herbal substance

Cycloplegia

Cycloplegia is paralysis of the ciliary muscle of the eye, resulting in a loss of accommodation. Because of the paralysis of the ciliary muscle, the curvature of the lens can no longer be adjusted to focus on nearby objects

A nurse is assessing a client who is receiving clozapine to treat schizophrenia. The nurse should identify an increase in which of the following parameters as an early indication of an adverse effect of this medication? A. Urine specific gravity B. Urine output C. Blood pressure D. Temperature

D. Antipsychotic medications such as clozapine can cause agranulocytosis, which is the depletion of WBCs. This increases the client's risk of infection. A fever is an early indication to check the client's WBC count to detect agranulocytosis. Incorrect Answers: A. Antipsychotic medications do not typically affect fluid balance, although they can cause urinary retention. B. Clozapine causes urinary retention, not polyuria. C. Clozapine is unlikely to cause hypertension; however, it can cause orthostatic hypotension

A nurse is preparing to administer oxytocin to a client who is at 41 weeks gestation and is experiencing ineffective labor. Which of the following actions should the nurse plan to take? A. Place the oxytocin from a pre-filled syringe into the posterior fornix of the vagina every 10 min until effective labor occurs B. Check the client's blood pressure and pulse every 15 min while induction of labor is occurring C. Stop oxytocin for contractions that continue for more than 30 sec D. Increase the dose of oxytocin to obtain uterine contractions that occur every 2 to 3 min

D. Effective uterine contractions should occur every 2 - 3 minutes. Incorrect Answers: A. B. The client's BP and pulse should be continually monitored during labor induction with oxytocin. C. The goal of oxytocin therapy is for the client to experience contractions that last from 45 to 60 seconds. If prolonged contractions occur, the administration should be stopped

A nurse is assessing a client who has multidrug-resistant tuberculosis and takes ethambutol. The nurse should identify which of the following findings as an adverse effect of this medication? A. Mottling of the extremities B. Orange-red urine and bodily secretions C. Yellowing of the sclera D. Loss of red/green color discrimination

D. Ethambutol is an antitubercular medication that impairs ribonucleic acid synthesis. A common adverse reaction is the loss of red/green color discrimination due to optic neuritis. The nurse should notify the provider of this finding and expect to discontinue the medication. 1. Not related 2. Rifampin (another antitubercular medication) changes the color of bodily secretions to red-orange 3. Taking isoniazid (another antitubercular medication) can lead to hepatotoxicity and peripheral neuropathy. Yellowing of the sclera is an indication of jaundice, which accompanies liver failure

A nurse is teaching the guardian of a school-aged child about growth hormone therapy. Which of the following statements should the nurse include in the teaching? A. "Your child will grow an extra 4 to 6 inches while receiving hormone therapy." B. "Hormone injection therapy will occur for 2 to 3 years." C. "Your child will receive hormone injections no more often than 1 to 2 times each week." D. "The hormone injections are administered subcutaneously."

D. It is the preferred route of administration since the injections are more painful when administered intramuscularly NOT A. While receiving growth hormone therapy, the child will grow an extra 2.54 to 7.62 cm (1 to 3 in). B. Growth hormone therapy will last for 4 to 6 years in order to achieve the desired height for the child. C. Growth hormone therapy is administered 6 to 7 times each week

A nurse suspects that a client is having an allergic reaction to a medication. Which of the following factors should the nurse identify as increasing the likelihood of an allergic reaction to the medication? A. This is the client's initial dose of the current prescription. B. The client received a large dosage. C. The route of administration was oral. D. The client has had previous exposure to the medication. Check Answer I

D. Once the immune system has developed sensitization to a medication, a subsequent exposure to that same medication can result in an allergic response. The more exposure the client has to the medication, the more intense the reaction will likely be. Incorrect Answers: A. Since an allergic reaction is an immune response, an initial dosage rarely causes an allergic reaction. B. The intensity of allergic reactions does not depend of the dosage. As a result, a dose that provokes a strong reaction in a client might trigger a very mild reaction in another client. A client's sensitivity to a medication can also vary with time. A dose that results in a mild reaction soon after starting treatment can provoke an intense reaction with a later dose. C. A client can have an allergic reaction following any route of administration.

A nurse is caring for a female client who has osteoporosis and is taking raloxifene. Which of the following findings should indicate to the nurse that the client is experiencing an adverse effect of this medication? A. Severe leg cramps B. Urinary frequency C. Jaw pain D. Sudden onset of dyspnea

D. The nurse should identify that raloxifene is a selective estrogen receptor modulator (SERM), which can have estrogenic effects in some tissues and anti-estrogenic effect in other tissues. Clients who are taking raloxifene have an increased risk of thromboembolic events such as deep-vein thrombosis, pulmonary embolism, or stroke. Therefore, the nurse should notify the provider if the client is experiencing this adverse effect of raloxifene.

A nurse is teaching a client who has severe chronic gout and a new prescription for pegloticase. The client has been taking allopurinol for 1 month. Which of the following instructions should the nurse include about pegloticase? A. "You will take this medication along with allopurinol." B. "You will take this medication by mouth." C. "There are very few adverse effects of this medication." D. "If you experience a flare-up, you can take an NSAID while receiving this medication."

D. The nurse should instruct this client who has chronic gout that, during the first few months of treatment, an increase in gout manifestations is expected. To reduce the intensity of these manifestations, clients are instructed to take an NSAID such as Naproxen

Red Man's Syndrome

Dermatitis from infusing the medication too rapidly. Manifestations of this condition can include flushing, rash, pruritus, urticaria, tachycardia, and hypotension

Detrimental potentiative interactions

Detrimental potentiative interactions worsen adverse effects. An example of this effect is warfarin and aspirin, which increase the risk of bleeding when used together.

Dinoprostone

Dinoprostone is an oxytocic medication that is used to stimulate uterine contractions for clients who are at term and to control postpartum hemorrhage. It is contraindicated for clients who are experiencing preterm labor.

Diphenoxylate-atropine

Diphenoxylate-atropine is an opioid used to treat diarrhea. The therapeutic response of this medication is a decrease in the frequency of watery stools due to reduced motility of the intestinal lining.

Flaxseed

Flaxseed is used to relieve constipation and to reduce high cholesterol.

Ginkgo biloba

Ginkgo biloba improves blood flow and can reduce pain related to peripheral arterial disease.

Is spotting between periods normal while on birth control?

Hormones in different birth control methods, like the pill, patch, or shot, may cause spotting instead of a normal period. Estrogen helps to stabilize the lining in the uterus. It may shed irregularly if you're on a method that's low in this hormone.

How should levothyroxine be taken?

Levothyroxine should be taken in the morning on an empty stomach, and the calcium supplement should be taken at least 4 hours later. Food or supplements containing iron, magnesium, or zinc also bind to levothyroxine and prevent complete absorption of the medication

Manifestations of hypokalemia

Manifestations of hypokalemia include muscle weakness, muscle cramps, and dysrhythmias

Misoprostol

Misoprostol is a prostaglandin that is used to promote ripening of the cervix and to induce labor. It causes a higher incidence of uterine tachysystole. Therefore, it is contraindicated in clients who have a history of major uterine surgery or cesarean delivery with past pregnancies because of the risk of uterine rupture.

Polycythemia Vera (PV)

Neoplastic proliferation of mature myeloid (r/t bone marrow) cells, especially RBCs

Niacin

Niacin (B3) is used to reduce cholesterol levels or correct a deficiency.

Nifedipine & labor

Nifedipine is a tocolytic medication that is administered to stop preterm labor

Aminoglycosides adverse effects

Ototoxicity, balance issues, possible permanent deafness in older adults w/ hearing impairment Nephrotoxicity neuromuscular blockade, hypersensitivity (rash, urticaria).

Pyridoxine

Parental pyridoxine is used to treat a vitamin B6 deficiency. Manifestations of a vitamin B6 deficiency include peripheral neuritis and neuropathy, which is numbness and tingling of the extremities.

Preeclampsia & Eclampsia

Preeclampsia is a condition that can develop during pregnancy characterized by high blood pressure (hypertension) and protein in the urine (proteinuria). If not properly recognized and managed, preeclampsia can progress to eclampsia, which is defined as the development of seizures in a woman with preeclampsia

Raloxifene indication

Prevention of osteoporosis in patients at risk. Decreased risk of breast cancer

Riboflavin

Riboflavin tablets are used to treat a deficiency of vitamin B2 in its early manifestations, which can cause a sore throat and cracks in the skin at the corners of the mouth. Later manifestations include painful cracks in the lips, inflammation of the tongue, and itchy dermatitis of the scrotum or vulva.

Risk factors for vitamin D deficiency

Risk factors for vitamin D deficiency include pregnancy, obesity, and dark-pigmented skin. Older adult clients can be at increased risk for vitamin D deficiency, not middle-aged clients.

Methylxanthines MOA

Smooth muscle relaxation/bronchodilation via inhibition of phosphodiesterase (Theophylline)

Toxicity-reducing inhibitory interaction

Some medications reduce the effects of or block the action of another, with a beneficial interaction to reduce toxicity. An example of this effect is the use of naloxone to reverse the effects of an opioid overdose.

Intussusception

Telescoping (part of the intestine slides into an adjacent part of the intestine) of the intestines This telescoping action often blocks food or fluid from passing through. Intussusception also cuts off the blood supply to the part of the intestine that's affected

Chlordiazepoxide

The nurse should expect to administer chlordiazepoxide to a client who is experiencing manifestations of acute alcohol withdrawal. Chlordiazepoxide is a benzodiazepine; this class of medications is often used to facilitate withdrawal. Chlordiazepoxide assists with decreasing withdrawal manifestations, stabilizing vital signs, and preventing seizures and delirium tremens.

Disulfram

The nurse should expect to administer disulfiram to assist a client with maintaining abstinence from alcohol. This medication will not help a client who is experiencing acute alcohol withdrawal. The client should check all products for the presence of alcohol when taking disulfiram. The nurse should inform the client that 7 mL of alcohol is needed to precipitate adverse effects of the medication. Alcohol can be found in cough syrups, vinegar, and sauces. It might also be applied to the skin in aftershave and cologne.

Varenicline

The nurse should expect to administer varenicline to assist a client with smoking cessation. This medication can promote dopamine release, diminish nicotine cravings, and decrease the intensity of nicotine withdrawal manifestations.

Thiamine

The nurse should identify that a client who has a history of alcohol use disorder and displays ataxia, an altered level of consciousness, and nystagmus is exhibiting manifestations of Wernicke-Korsakoff syndrome due to a thiamine deficiency. Therefore, the nurse should anticipate administering parenteral thiamine (B1)

Potentiative interactions

When a client takes 2 medications, a medication might potentiate the effects of the other. Potentiative interactions can be helpful in increasing or prolonging a medication's therapeutic effects. However, this would not explain a decrease in the effectiveness of a medication.

A nurse is monitoring a client who has diabetes insipidus and was administered desmopressin. Which of the following findings should indicate to the nurse the client is experiencing an adverse effect of this medication? A. Thirst B. Nocturia C. Headache D. Heart palpitations

c. Headaches are an indicator of the adverse effect of water intoxication, which can occur as a result of taking desmopressin. This medication causes fluid retention and places the client at risk of water intoxication. Incorrect Answers: A. A client who has diabetes insipidus will report frequent thirst due to a lack of (ADH). Desmopressin is administered to stop the manifestations of diabetes insipidus such as thirst by improving the reabsorption of water in the kidneys. B. A client who has diabetes insipidus will report nocturia and excessive urination due to a lack of (ADH). Desmopressin is administered to stop the manifestations of diabetes insipidus (e.g. nocturia and excessive urination) by improving the reabsorption of water in the kidneys. D. A client who has diabetes insipidus is at risk for dehydration. As the body attempts to compensate, the HR increases, causing heart palpitations. Desmopressin is administered to stop these manifestations of diabetes insipidus by improving the reabsorption of water in the kidneys.

A nurse is providing teaching to a client who has postmenopausal osteoporosis and a new prescription for intranasal calcitonin-salmon. Which of the following statements by the client indicates an understanding of the teaching? A. "I will administer a spray into each nostril daily." B. "I should expect nasal bleeding for the first week." C. "I will need to depress the side arms to activate the pump." D. "I should expect to take this medication for a short-term course of treatment."

c. The nurse should instruct the client to activate the pump for the initial use by holding the bottle upright and depressing both white side arms toward the bottle 6 times. NOT A. The nurse should instruct the client to administer calcitonin-salmon to a single nostril daily, alternating nostrils. B. The nurse should instruct the client that nasal bleeding or ulcerations are indications to discontinue the medication and to notify HCP if nasal bleeding occurs. D. Calcitonin-salmon is a long-term treatment therapy for postmenopausal osteoporosis. The medication has no documented long-term adverse effects.

Cinchonism

quinidine toxicity or poisoning