Elsevier Saunders NCLEX PN - 8th Edition - Pharmacology

A client is taking Humulin NPH insulin daily every morning. The nurse reinforces instructions to the client and would tell the client that which is the most likely time for a hypoglycemic reaction to occur? a) 2 to 4 hours after administration b) 6 to 14 hours after administration c) 16 to 18 hours after administration d) 18 to 24 hours after administration

b) 6 to 14 hours after administration Rationale: Humulin NPH is an intermediate-acting insulin. The onset of action is 1 to 2 hours, it peaks in 6 to 14 hours, and its duration of action is 16 to 24 hours. Hypoglycemic reactions most likely occur during peak time. Test-Taking Strategy(ies): Note the strategic words, most likely, and focus on the subject, peak time of NPH insulin. Use knowledge regarding the onset, peak, and duration of action for NPH insulin. Remember that NPH peaks in 4 to 12 hours.

The client has an as-needed prescription for loperamide hydrochloride. For which condition would the nurse administer this medication? a) Constipation b) Abdominal pain c) An episode of diarrhea d) Hematest-positive nasogastric tube drainage

c) An episode of diarrhea Rationale: Loperamide is an antidiarrheal agent. It is used to manage acute and also chronic diarrhea in conditions such as inflammatory bowel disease. Loperamide also can be used to reduce the volume of drainage from an ileostomy. It is not used for the conditions in options 1, 2, and 4. Test-Taking Strategy(ies): Focus on the subject, the intended use of loperamide. Recalling that this medication is an antidiarrheal agent will direct you to option 3.

Desmopressin acetate is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response? a) Decreased urinary output b) Decreased blood pressure c) Decreased peripheral edema d) Decreased blood glucose level

a) Decreased urinary output Rationale: Desmopressin promotes renal conservation of water. The hormone carries out this action by acting on the collecting ducts of the kidney to increase their permeability to water, which results in increased water reabsorption. The therapeutic effect of this medication would be manifested by a decreased urine output. Options 2, 3, and 4 are unrelated to the effects of this medication. Test-Taking Strategy(ies): Note the subject, therapeutic response of DDAVP. Focus on the diagnosis in the question to assist in answering the question. Recalling the signs and symptoms related to the loss of large volumes of urine in this disorder will help direct you to the option describing decreased urine output.

The client who frequently uses nonsteroidal antiinflammatory drugs (NSAIDs) has been taking misoprostol. The nurse determines that this medication is having the intended therapeutic effect if which is noted? a) Resolved diarrhea b) Relief of epigastric pain c) Decreased platelet count d) Decreased white blood cell count

b) Relief of epigastric pain Rationale: The client who frequently uses nonsteroidal antiinflammatory drugs (NSAIDs) is prone to gastric mucosal injury. Misoprostol is a gastric protectant and is given specifically to prevent this occurrence. Diarrhea can be a side effect of the medication, but it is not an intended effect. Options 3 and 4 are incorrect. Test-Taking Strategy(ies): Note the subject, intended therapeutic effect of this medication. This tells you that the medication is being given to prevent the occurrence of specific symptoms. Recalling that NSAIDs can cause gastric mucosal injury will direct you to the correct option.

The client with acute myelocytic leukemia is being treated with busulfan. Which laboratory value would the nurse specifically monitor during treatment with this medication? a) Clotting time b) Uric acid level c) Potassium level d) Blood glucose level

b) Uric acid level Rationale: Busulfan can cause an increase in the uric acid level because of massive cell death of malignant cells. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute kidney injury. Clotting time, potassium, and glucose blood levels are not specifically related to this medication. Test-Taking Strategy(ies): Focus on the subject, the laboratory value to monitor for busulfan. It is necessary to know the adverse effects associated with this medication. Recalling that busulfan increases the uric acid level will direct you to the correct option.

The nurse is preparing a list of client care activities to be done during the shift. For which of the following clients would the nurse instruct the assistive personnel (AP) to use an electric razor for shaving? Select all that apply. a) A client with leukocytosis b) A client with thrombocytosis c) A client with thrombocytopenia d) A client receiving an antiplatelet medication* e) A client receiving acetaminophen as needed for mild pain

c) A client with thrombocytopenia Rationale: Electric razors need to be used for clients that are at risk for bleeding, which include clients with thrombocytopenia (a low platelet level), clients with bleeding or clotting disorders and clients taking certain medications, such as antiplatelet and anticoagulation medications. Therefore, options 3 and 4 are correct. Leukocytosis is not related to bleeding risk, as this indicates an elevated white blood cell count. Thrombocytosis indicates a higher-than-normal platelet level, which increases the risk for clotting. Finally, acetaminophen is not a medication that increases the client's risk for bleeding. Test-Taking Strategy(ies): Focus on the subject, clients that need to be shaven with an electric razor. Remember electric razors are used for clients that are at an increased risk for bleeding. Then, determine which client factors increase the risk for bleeding, which include thrombocytopenia and certain medications, such as antiplatelet medications and anticoagulants.

An older client has recently been taking cimetidine. The nurse would monitor the client for which most frequent central nervous system side effect of this medication? a) Tremors b) Dizziness c) Confusion d) Hallucinations

c) Confusion Rationale: Cimetidine is a histamine 2 (H2)-receptor antagonist. Older clients are especially susceptible to the central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations. Test-Taking Strategy(ies): Note the strategic word, most. Use knowledge of the older client and medication effects to direct you to the correct option.

A client with severe acne is seen in the clinic and the primary health care provider (PHCP) prescribes isotretinoin. The nurse reviews the client's medication record and would contact the PHCP if the client is also taking which medication? a) Digoxin b) Phenytoin c) Vitamin A d) Furosemide

c) Vitamin A Rationale: Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements should be discontinued before isotretinoin therapy. There are no contraindications associated with digoxin, phenytoin, or furosemide. Test-Taking Strategy(ies): Focus on the subject, the need to contact the PHCP to ensure client safety. Recall that isotretinoin is a metabolite of vitamin A. Vitamin A is a fat-soluble vitamin; therefore, it is possible to develop toxic levels. This will direct you to the correct option.

The client has an as-needed prescription for ondansetron. For which condition would the nurse administer this medication? a) Paralytic ileus b) Incisional pain c) Urinary retention d) Nausea and vomiting

d) Nausea and vomiting Rationale: Ondansetron is an antiemetic used to treat postoperative nausea and vomiting, as well as nausea and vomiting associated with chemotherapy. The other options are incorrect. Test-Taking Strategy(ies): Focus on the subject, the intended effect of ondansetron. Recalling that this medication is an antiemetic will direct you to the correct option.

The nurse is monitoring a client receiving levothyroxine sodium for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply. a) Insomnia b) Weight loss c) Bradycardia d) Constipation e) Mild heat intolerance

a) Insomnia b) Weight loss e) Mild heat intolerance Rationale: Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication, but rather are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat. Test-Taking Strategy(ies): Focus on the subject, side effects of levothyroxine. Thinking about the pathophysiology of hypothyroidism and the action of the medication will assist you with determining that insomnia, weight loss, and mild heat intolerance are side effects of thyroid hormones.

Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed? a) Potassium level b) Triglyceride level c) Hemoglobin A1c d) Total cholesterol level

b) Triglyceride level Rationale: Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before treatment and periodically thereafter until the effect on triglycerides has been evaluated. There is no indication that isotretinoin affects potassium, hemoglobin A1c, or total cholesterol levels. Test-Taking Strategy(ies): Note the subject, laboratory values that should be monitored specifically for the client taking isotretinoin. Recall that the medication can affect triglyceride levels in the client.

1. Morphine sulfate, 2.5 mg, is prescribed for a child. The safe pediatric dose is 0.05 mg/kg/dose to 0.1 mg/kg/dose. The child weighs 50 kg. Which statement accurately describes the prescribed dosage for this child? a) The dose is too low. b) The dose is too high. c) The dose is within the safe dosage range. d) There is not enough information to determine the safe dosage range

c) The dose is within the safe dosage range. Rationale: Use the formula for calculating a safe dosage range. Dosage parameters: 0.05mg/kg/dose x 50kg = 2.5 mg/dose 0.1mg/kg/dose x 50kg = 5 mg/dose The dose is within the safe dosage range. Test-Taking Strategy(ies): Focus on the subject, the safe dosage range of the medication. Calculate the dosage parameters with the use of the safe dosage range identified in the question and the child's weight in kilograms. Verify the answer with the use of a calculator.

A client is receiving acetylcysteine, 20% solution diluted in 0.9% normal saline by nebulizer. The nurse would have which item available for a possible adverse event after giving this medication? a) Ambu bag b) Intubation tray c) Nasogastric tube d) Suction equipment

d) Suction equipment Rationale: Acetylcysteine can be given orally or by nasogastric tube to treat acetaminophen overdose, or it may be given by inhalation for use as a mucolytic. The nurse administering this medication as a mucolytic should have suction equipment available in case the client cannot manage to clear the increased volume of liquefied secretions. Test-Taking Strategy(ies): Focus on the subject, equipment necessary in the administration of acetylcysteine. To answer this question, it is necessary to know that acetylcysteine may be given for either acetaminophen overdose or as a mucolytic agent. It is also necessary to know that the inhalation route is only used for mucolytic effects. With this in mind, options 1 and 2 are eliminated because the client does not need resuscitation. Option 3 is eliminated as well because a nasogastric tube may be used in the client with acetaminophen overdose but is not necessary when used as a mucolytic.

Silver sulfadiazine is prescribed for a client with a burn injury. Which laboratory finding requires the need for monitoring by the nurse? a) Glucose level of 99 mg/dL2 b) Platelet level of 300,000 mm33 c) Magnesium level of 1.5 mEq/L4 d) White blood cell count of 3000 mm3

d) White blood cell count of 3000 mm3 Rationale: Silver sulfadiazine is used for the treatment of burn injuries. Adverse effects of this medication include rash and itching, blue-green or gray skin discoloration, leukopenia, and interstitial nephritis. The nurse should monitor a complete blood count, particularly the white blood cells, frequently for the client taking this medication. If leukopenia develops, the PHCP is notified and the medication is usually discontinued. The white blood cell count noted in option 4 is indicative of leukopenia. The other laboratory values are not specific to this medication, and are also within normal limits. Test-Taking Strategy(ies): Note the words, need for monitoring. Eliminate options 1, 2, and 3 because they are comparable or alike and are within normal limits. In addition, recall that leukopenia is an adverse effect requiring discontinuation of the medication.

The home care nurse visits a client at home who has been prescribed prednisone 5 mg orally daily. The nurse reinforces teaching for the client about the medication. Which statement made by the client indicates a need for further teaching? a) "I can take aspirin or my antihistamine if I need it." b) "I need to take the medication every day at the same time." c) "I need to avoid coffee, tea, cola, and chocolate in my diet." d) "If I gain more than 5 pounds a week, I will call my doctor."

a) "I can take aspirin or my antihistamine if I need it." Rationale: Aspirin and other over-the-counter medications should not be taken unless the client consults with the PHCP. The client needs to take the medication at the same time every day and should be instructed not to stop. A slight weight gain as a result of an improved appetite is expected, but after the dosage is stabilized, a weight gain of 5 lb or more weekly should be reported to the PHCP. Caffeine-containing foods and fluids need to be avoided because they may contribute to steroid-ulcer development. Test-Taking Strategy(ies): Note the strategic words, need for further teaching. This indicates a negative event query and a need to select the incorrect statement as the answer. Remember that a client should not take other medications, especially over-the-counter medications, without first consulting with his or her PHCP.

Glimepiride is prescribed for a client with diabetes mellitus. The nurse reinforces instructions for the client and tells the client to avoid which while taking this medication? a) Alcohol b) Organ meats c) Whole-grain cereals d) Carbonated beverages

a) Alcohol Rationale: When alcohol is combined with glimepiride, a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol consumption while taking this medication. The items in options 2, 3, and 4 do not need to be avoided. Test-Taking Strategy(ies): Focus on the subject, the substance to avoid. Eliminate organ meats, whole-grain cereals, and carbonated beverages because these food items are allowed in a diabetic diet. Remembering that alcohol can affect the action of many medications will assist with directing you to the correct option.

The nurse is applying a topical corticosteroid to a client with eczema. The nurse would apply the medication to which body areas? Select all that apply. a) Back b) Axilla c) Eyelids d) Soles of the feet e) Palms of the hands

a) Back d) Soles of the feet e) Palms of the hands Rationale: Topical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions where permeability is poor (back, palms, soles). The nurse should avoid areas of higher absorption to prevent systemic absorption. Test-Taking Strategy(ies): Focus on the subject, permeability and the potential for increased systemic absorption. Eliminate options 2 and 3 because these body areas are comparable or alike in terms of skin substance. From the remaining options, think about permeability of the skin area. This should direct you to the correct options.

The client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed? Select all that apply. a) Chest x-ray b) Echocardiography c) Electrocardiography d) Cervical radiography e) Pulmonary function studies

a) Chest x-ray e) Pulmonary function studies Rationale: Bleomycin is an antineoplastic medication that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. During pulmonary fibrosis, the lung tissue becomes very scarred and hard. Pulmonary fibrosis is not reversible and the client is continuously short of breath. Pulmonary function studies and chest x-ray, along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and adventitious sounds, which could indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Cardiac studies such as an echocardiogram and electrocardiogram, and a cervical radiograph are unrelated to the specific use of this medication. Test-Taking Strategy(ies): Focus on the subject, considerations when administering the medication bleomycin. Eliminate options 2 and 3 first because they are cardiac-related and are therefore comparable or alike. From the remaining options, use the ABCs—airway, breathing, and circulation—to direct you to the correct option the studies related to lung function.

The home care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client, prescribed repaglinide and metformin, asks the nurse to explain these medications. The nurse would reinforce which instructions to the client? Select all that apply. a) Diarrhea can occur secondary to metformin. b) The repaglinide is not taken if a meal is skipped. c) The repaglinide is taken 30 minutes before eating. d) Candy or another simple sugar is carried and used to treat mild hypoglycemia episodes. e) Muscle pain is an expected side effect of metformin and may be treated with acetaminophen. f) Metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide.

a) Diarrhea can occur secondary to metformin. b) The repaglinide is not taken if a meal is skipped. c) The repaglinide is taken 30 minutes before eating. d) Candy or another simple sugar is carried and used to treat mild hypoglycemia episodes. Rationale: Repaglinide is a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin secretion that should be taken before meals and that should be withheld if the client does not eat. Hypoglycemia is a side effect of repaglinide, and the client should always be prepared by carrying a simple sugar with her or him at all times. Metformin is an oral hypoglycemic given in combination with repaglinide and works by decreasing hepatic glucose production. A common side effect of metformin is diarrhea. Muscle pain may occur as an adverse effect from metformin, but it also might signify a more serious condition that warrants PHCP notification, not the use of acetaminophen. Test-Taking Strategy(ies): Focus on the subject, client teaching points related to repaglinide and metformin. Also focus on the data in the question and the client's diagnosis to assist in answering the question. Recalling the actions and effects of these medications will assist with answering correctly.

A burn client is receiving treatments of topical mafenide acetate to the site of injury. The nurse monitors the client, knowing that which finding indicates the occurrence of a systemic effect? a) Hyperventilation b) Elevated blood pressure c) Local rash at the burn site d) Local pain at the burn site

a) Hyperventilation Rationale: Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal excretion of acid, thereby causing acidosis. Clients receiving this treatment should be monitored for signs of an acid-base imbalance (hyperventilation). If this occurs, the medication will probably be discontinued for 1 to 2 days. Options 3 and 4 describe local rather than systemic effects. An elevated blood pressure may be expected from the pain that occurs with a burn injury. Test-Taking Strategy(ies): Note the words, systemic effect. Options 3 and 4 can be eliminated because they are comparable or alike and are local rather than systemic effects. From the remaining options, recall that the client in pain would likely have an elevated blood pressure. This should direct you to the correct option.

The clinic nurse is performing an admission assessment on a client and notes that the client is taking azelaic acid. The nurse determines that which client complaint may be associated with the use of this medication? a) Itching b) Euphoria c) Drowsiness d) Frequent urination

a) Itching Rationale: Azelaic acid is a topical medication used to treat mild to moderate acne. Adverse effects include burning, itching, stinging, redness of the skin, and hypopigmentation of the skin in clients with a dark complexion. The effects noted in the other options are not specifically associated with this medication. Test-Taking Strategy(ies): Focus on the subject, the purpose and use of azelaic acid. Focusing on the name of the medication and recalling that acne medications commonly cause local irritation will direct you to the correct option.

An opioid analgesic is administered to a client in labor. The nurse assigned to care for the client ensures that which medication is readily available if respiratory depression occurs? a) Naloxone b) Morphine sulfate c) Betamethasone d) Meperidine hydrochloride

a) Naloxone Rationale: Opioid analgesics may be prescribed to relieve moderate to severe pain associated with labor. Opioid toxicity can occur and cause respiratory depression. Naloxone is an opioid antagonist, which reverses the effects of opioids and is given for respiratory depression. Morphine sulfate and meperidine hydrochloride are opioid analgesics. Betamethasone is a corticosteroid administered to enhance fetal lung maturity. Test-Taking Strategy(ies): Focus on the subject of the question, the antidote for respiratory depression. Eliminate options 2 and 4 first because they are comparable or alike and are opioid analgesics. Next, eliminate option 3, knowing that this medication is a corticosteroid.

A histamine (H2)-receptor antagonist will be prescribed for a client. The nurse understands that which medications are H2-receptor antagonists? Select all that apply. a) Nizatidine b) Ranitidine c) Famotidine d) Cimetidine e) Esomeprazole f) Lansoprazole

a) Nizatidine b) Ranitidine c) Famotidine d) Cimetidine Rationale: H2-receptor antagonists suppress secretion of gastric acid, alleviate symptoms of heartburn, and assist with preventing complications of peptic ulcer disease. These medications also suppress gastric acid secretions and are used in active ulcer disease, erosive esophagitis, and pathological hypersecretory conditions. The other medications listed are proton pump inhibitors. Test-Taking Strategy(ies): Focus on the subject, H2-receptor antagonists. Recalling that these medication names end with -dine will assist in answering this question. Also, recall that proton pump inhibitor medication names end with -zole.

The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase, an antineoplastic agent. The nurse consults with the registered nurse regarding the administration of the medication if which is documented in the client's history? a) Pancreatitis b) Diabetes mellitus c) Myocardial infarction d) Chronic obstructive pulmonary disease

a) Pancreatitis Rationale: Asparaginase is a antineoplastic enzyme that is contraindicated if hypersensitivity exists in the case of pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function, and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between the administration of doses. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. The medication may be used for clients with a history of diabetes mellitus, myocardial infarction, or chronic obstructive pulmonary disease. Test-Taking Strategy(ies): Focus on the subject, a contraindication for asparaginase. It is necessary to know the contraindications associated with this medication. Recall that the exocrine pancreatic cells produce enzymes lipase and amylase; "ase" is the suffix designating an enzyme. Recalling that this medication affects pancreatic function will direct you to the correct option.

Rifabutin is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. The nurse would monitor for which side/adverse effects of the medication? Select all that apply. a) Signs of hepatitis b) Flu-like syndrome c) Low neutrophil count d) Vitamin B6 deficiency e) Ocular pain or blurred vision f) Tingling and numbness of the fingers

a) Signs of hepatitis b) Flu-like syndrome c) Low neutrophil count e) Ocular pain or blurred vision Rationale: Rifabutin may be prescribed for a client with active MAC disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis. Side effects include rash, GI disturbances, neutropenia (low neutrophil count), red-orange body secretions, uveitis (blurred vision and eye pain), myositis, arthralgia, hepatitis, chest pain with dyspnea, and flu-like syndrome. Vitamin B6 deficiency and numbness and tingling in the extremities are associated with the use of isoniazid. Ethambutol also causes peripheral neuritis. Test-Taking Strategy(ies): Focus on the subject, side and adverse effects of rifabutin. Note the name of the medication to assist in answering the question. Recalling that vitamin B6 deficiency and numbness and tingling in the extremities are associated with the use of isoniazid, not rifabutin, will assist in answering.

The nurse is assisting with caring for a client with cancer who is receiving cisplatin. Which adverse effects are associated with this medication? Select all that apply. a) Tinnitus b) Ototoxicity c) Hyperkalemia d) Hypercalcemia e) Nephrotoxicity f) Hypomagnesemia

a) Tinnitus b) Ototoxicity e) Nephrotoxicity f) Hypomagnesemia Rationale: Cisplatin is an alkylating medication. Alkylating medications are cell cycle phase nonspecific and affect the synthesis of DNA by causing its cross-linking to inhibit cell reproduction. Cisplatin may cause ototoxicity, tinnitus, hypokalemia, hypocalcemia, hypomagnesemia, and nephrotoxicity. Amifostine may be administered before cisplatin to reduce the potential for renal toxicity. Test-Taking Strategy(ies): Note the subject, the adverse effects of cisplatin. Recall that most antineoplastic medications affect the bone marrow and the hematological system. This concept will assist you with determining that hypo- rather than hyper- conditions would occur. In addition, recall that this medication affects the ears (ototoxicity and tinnitus) and the kidneys (nephrotoxicity).

A client is receiving digoxin daily. The nurse suspects digoxin toxicity after noting which signs and symptoms? Select all that apply. a) Visual disturbances b) Nausea and vomiting c) Apical pulse rate of 63 beats per minute d) Serum digoxin level of 2.3 ng/mL (2.93 nmol/L) e) Serum potassium level of 3.9 mEq/L (3.9 mmol/L)

a) Visual disturbances b) Nausea and vomiting d) Serum digoxin level of 2.3 ng/mL (2.93 nmol/L) Rationale: Signs and symptoms of digoxin toxicity include gastrointestinal signs, bradycardia, visual disturbances, and hypokalemia. A therapeutic serum digoxin level ranges from 0.8 to 2.0 ng/mL (1.02 to 2.56 nmol/L). The serum potassium level should be between 3.5 mEq/L (3.5 mmol/L) and 5.0 mEq/L (5.0 mmol/L). The apical pulse must be greater than or equal to 60 beats per minute. Test-Taking Strategy(ies): Focus on the subject, digoxin toxicity. Knowledge of the signs and symptoms of digoxin toxicity is needed to answer correctly.

The nurse is reinforcing teaching for a client regarding how to mix regular insulin and NPH insulin in the same syringe. Which action performed by the client indicates the need for further teaching? a) Withdraws the NPH insulin first b) Withdraws the regular insulin first c) Injects air into NPH insulin vial first d) Injects an amount of air equal to the desired dose of insulin into the vial

a) Withdraws the NPH insulin first Rationale: When preparing a mixture of regular insulin with another insulin preparation, the regular insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of regular insulin with insulin of another type. Options 2, 3, and 4 identify the correct actions for preparing NPH and regular insulin. Test-Taking Strategy(ies): Note the strategic words, need for further teaching. These words indicate a negative event query and ask you to select an option that is an incorrect action. Remember RN—draw up the Regular insulin before the NPH insulin.

A client has a prescription to take guaifenesin every 4 hours, as needed. The nurse determines that the client understands the most effective use of this medication if the client makes which statement? a) "I will watch for irritability as a side effect." b) "I will take the tablet with a full glass of water." c) "I will take an extra dose if the cough is accompanied by fever." d) "I will crush the sustained-release tablet if immediate relief is needed."

b) "I will take the tablet with a full glass of water." Rationale: Guaifenesin is an expectorant. It should be taken with a full glass of water to decrease the viscosity of secretions. Sustained-release preparations should not be broken open, crushed, or chewed. The medication may occasionally cause dizziness, headache, or drowsiness. The client should contact the PHCP if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache. Test-Taking Strategy(ies): Note the strategic words, most effective. Begin to answer this question by eliminating option 4 first. Sustained-release preparations are not crushed or broken. Option 3 is eliminated next because fever indicates infection, and an "extra dose" of an expectorant is not helpful in treating infection. From the remaining options, recalling that increased fluids help liquefy secretions for more effective coughing will direct you to the correct option.

A licensed practical nurse is caring for a postoperative client who is receiving demand-dose hydromorphone via a patient-controlled analgesia (PCA) pump for pain control. The nurse enters the client's room and finds the client drowsy and records the following vital signs: temperature 36.2° C (97.2° F) orally, pulse 52 beats per minute, blood pressure 101/58 mm Hg, respiratory rate 11 breaths per minute, and SpO2 of 93% on 3 liters of oxygen via nasal cannula. Which action would the nurse take first? a) Document the findings. b) Attempt to arouse the client. c) Contact the registered nurse immediately. d) Check the medication administration history on the PCA pump.

b) Attempt to arouse the client. Rationale: The primary concern with opioid analgesics is respiratory depression and hypotension. Based on the findings, the nurse should suspect opioid overdose. The nurse should first attempt to arouse the client and then reassess the vital signs. The vital signs may begin to normalize once the client is aroused because sleep can also cause decreased heart rate, blood pressure, respiratory rate, and oxygen saturation. The nurse should also check to see how much medication has been taken via the PCA pump and should continue to monitor the client closely to determine whether further action is needed. The nurse should notify the registered nurse as the next step after attempting to arouse the client. The nurse would also then document the findings after all data is collected, the client is stabilized, and if an abnormality still exists after arousing the client. Test-Taking Strategy(ies): First, focus on the data in the question and determine whether an abnormality exists. It is clear that an abnormality exists because the client is drowsy and the vital sounds are outside of the normal range. Next, note the strategic word, first. Recall that attempting to arouse the client should come before further checking the pump. The client should always be checked before the equipment and before documentation.

A client in preterm labor (31 weeks) who is dilated to 4 cm has been started on magnesium sulfate and her contractions have stopped. If the client's labor can be inhibited for the next 48 hours, the nurse anticipates a prescription for which medication? a) Nalbuphine b) Betamethasone c) Rho(D) immune globulin d) Dinoprostone vaginal insert

b) Betamethasone Rationale: Betamethasone, a glucocorticoid, is given to increase the production of surfactant to stimulate fetal lung maturation. It is administered to clients in preterm labor at 28 to 32 weeks of gestation if the labor can be inhibited for 48 hours. Nalbuphine is an opioid analgesic. Rho(D) immune globulin is given to Rh-negative clients to prevent sensitization. Dinoprostone vaginal insert is a prostaglandin given to ripen and soften the cervix and to stimulate uterine contractions. Test-Taking Strategy(ies): Focus on the subject, a client at 31 weeks' gestation. Recall that the preterm infant is at risk for respiratory distress syndrome because of immaturity and the inability to produce surfactant. Next, recalling the actions of the medications in the options and that betamethasone is used to increase the production of surfactant will direct you to the correct option.

The client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication? a) Glucose level b) Calcium level c) Potassium level d) Prothrombin time

b) Calcium level Rationale: Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium levels should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain. Tamoxifen does not increase glucose or potassium levels, or increase the prothrombin time. Test-Taking Strategy(ies): Focus on the subject, the laboratory value to monitor for tamoxifen. It is necessary to know the adverse effects associated with this medication. Recalling that this medication causes hypercalcemia will direct you to the correct option.

The client has been taking omeprazole for 4 weeks. The nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom? a) Diarrhea b) Heartburn c) Flatulence d) Constipation

b) Heartburn Rationale: Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called "heartburn" by clients. Omeprazole is not used to treat the conditions identified in options 1, 3, and 4. Test-Taking Strategy(ies): Focus on the subject, the optimal intended effect of omeprazole. Recalling that this medication is a proton pump inhibitor will direct you to the correct option.

A client has been taking isoniazid for 2 months. The client complains to the nurse about numbness, paresthesia, and tingling in the extremities. The nurse interprets that the client is experiencing which problem? a) Hypercalcemia b) Peripheral neuritis c) Small blood vessel spasm d) Impaired peripheral circulation

b) Peripheral neuritis Rationale: A common adverse effect of isoniazid is peripheral neuritis. This is manifested by numbness, tingling, and paresthesias in the extremities. This adverse effect can be minimized by pyridoxine intake. Options 1, 3, and 4 are incorrect. Test-Taking Strategy(ies): Focus on the subject, a problem associated with isoniazid. Options 3 and 4 would not cause the symptoms presented in the question but instead would cause pallor and coolness. From the remaining options, you should know either that peripheral neuritis is an adverse effect of the medication or that the data in the question do not correlate with hypercalcemia.

A client with diabetes mellitus visits a healthcare clinic. The client's diabetes mellitus previously had been well controlled with glyburide daily, but recently the fasting blood glucose level has been 180 mg/dL to 200 mg/dL (10.2 mmol/L to 11.4 mmol/L). Which medication, added to the client's regimen, may have contributed to the hyperglycemia? a) Atenolol b) Prednisone c) Phenelzine d) Allopurinol

b) Prednisone Rationale: Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 1, a ß-blocker and option 3, a monoamine oxidase inhibitor, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia. Test-Taking Strategy(ies): Focus on the subject, medications that cause an increase in the blood glucose level. Recalling that prednisone decreases the effects of oral hypoglycemics will direct you to the correct option.

The nurse has given a client taking ethambutol information about the medication. The nurse determines that the client understands the instructions if the client states to report which occurrence immediately? a) Impaired sense of hearing b) Problems with visual acuity c) Gastrointestinal (GI) side effects e) Red-orange discoloration of body secretions

b) Problems with visual acuity Rationale: Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client is also taught to take the medication with food if GI upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Red-orange discoloration of secretions occurs with rifampin. Test-Taking Strategy(ies): Focus on the subject, client understanding of instructions given regarding ethambutol. Also note the strategic word, immediately. Option 3 is the least likely symptom to report; rather, it should be managed by taking the medication with food. To select from the other options, it is necessary to know that this medication causes optic neuritis, resulting in difficulty with red-green discrimination.

The home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse would provide which information? a) Freeze the insulin. b) Refrigerate the insulin. c) Store the insulin in a dark, dry place. d) Keep the insulin at room temperature.

b) Refrigerate the insulin. Rationale: Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be frozen because freezing affects the chemical composition of the insulin. When stored unopened under refrigeration, insulin can be used up to the expiration date on the vial. Freezing insulin, storing insulin in a dark, dry place and keeping the insulin at room temperature are all incorrect actions. Test-Taking Strategy(ies): Focus on the subject, how to store unopened vials of insulin. Remembering that insulin should not be frozen will assist in eliminating this option. The options for storing insulin at room temperature or in a dark, dry place are comparable or alike and should be eliminated.

The client is to begin a 6-month course of therapy with isoniazid. The nurse would plan to provide which information to the client? a) Drink alcohol in small amounts only. b) Report yellow eyes or skin immediately. c) Increase intake of Swiss or aged cheeses. d) Avoid vitamin supplements during therapy.

b) Report yellow eyes or skin immediately. Rationale: Isoniazid is hepatotoxic, and therefore the client is taught to report signs/symptoms of hepatitis immediately (which include yellow skin and sclera). For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine during the course of isoniazid therapy. Test-Taking Strategy(ies): Focus on the subject, signs/symptoms to report associated with use of isoniazid. Alcohol intake is avoided when the client is taking a prescribed medication, so option 1 should be eliminated first. Because the client receiving this medication typically is supplemented with vitamin B6, option 4 is incorrect and is eliminated next. From the remaining options, recalling that the medication is hepatotoxic will direct you to the correct option.

The nurse is monitoring a client who is taking propranolol. Which data collection finding would indicate a potential serious complication associated with propranolol? a) The development of complaints of insomnia b) The development of audible expiratory wheezes c) A baseline resting heart rate of 88 beats/min followed by a resting heart rate of 72 beats/min after two doses of the medication d) A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after two doses of the medication

b) The development of audible expiratory wheezes Rationale: Audible expiratory wheezes may indicate a serious adverse reaction: bronchospasm. ß-Blockers may induce this reaction particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored. Test-Taking Strategy(ies): Note the subject, a potential serious complication. Eliminate options 3 and 4 because these are expected effects from the medication. Next, focusing on the subject will direct you to the correct option.

Cycloserine is added to the medication regimen for a client with tuberculosis. Which instruction would the nurse reinforce in the client-teaching plan regarding this medication? a) To take the medication before meals b) To return to the clinic weekly for serum drug-level testing c) It is not necessary to restrict alcohol intake with this medication. d) It is not necessary to call the primary health care provider (PHCP) if a skin rash occurs.

b) To return to the clinic weekly for serum drug-level testing Rationale: Cycloserine is an antitubercular medication that requires weekly serum drug level determinations to monitor for the potential of neurotoxicity. Serum drug levels lower than 30 mcg/mL reduce the incidence of neurotoxicity. The medication must be taken after meals to prevent GI irritation. The client must be instructed to notify the PHCP if a skin rash or signs of central nervous system (CNS) toxicity are noted. Alcohol must be avoided because it increases the risk of seizure activity. Test-Taking Strategy(ies): Focus on the subject, client teaching regarding the use of cycloserine. Eliminate options 3 and 4 first, using guidelines related to general medication administration principles. From this point, knowing that the medication level needs to be monitored will assist with selecting the correct option.

Methylergonovine is prescribed for a woman to treat postpartum hemorrhage. Before administration of methylergonovine, what is the priority nursing assessment? a. Uterine tone b. Blood pressure c. Amount of lochia d. Deep tendon reflexes

b. Blood pressure Rationale: Methylergonovine, an ergot alkaloid, is used to prevent or control postpartum hemorrhage by contracting the uterus. Methylergonovine causes continuous uterine contractions and may elevate the blood pressure. A priority assessment before the administration of the medication is to check the blood pressure. The primary health care provider should be notified if hypertension is present. Although options 1, 3, and 4 may be components of the postpartum assessment, the correct option, blood pressure, is related specifically to the administration of this medication. Test-Taking Strategy(ies): Note the strategic word, priority. Eliminate options 1 and 3 first because they are comparable or alike and related to one another. To choose from the remaining options, use the ABCs—airway, breathing, and circulation. Blood pressure is a method of assessing circulation.

Silver sulfadiazine is prescribed for a client with a partial-thickness burn and the nurse provides teaching about the medication. Which statement made by the client indicates a need for further teaching about the treatments? a) "The medication is an antibacterial." b) "The medication will help heal the burn." c) "The medication is likely to cause stinging initially." d) "The medication should be applied directly to the wound."

c) "The medication is likely to cause stinging initially." Rationale: Silver sulfadiazine is an antibacterial that has a broad spectrum of activity against gram-negative bacteria, gram-positive bacteria, and yeast. It is applied directly to the wound to assist in healing. It does not cause stinging when applied. Test-Taking Strategy(ies): Note the strategic words, need for further teaching. These words indicate a negative event query and ask you to select an option that is an incorrect statement. Recall the characteristics of this medication.

A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is reinforcing teaching for the client about the medications prescribed, including clarithromycin, esomeprazole, and amoxicillin. Which statement by the client indicates the best understanding of the medication regimen? a) "My ulcer will heal because these medications will kill the bacteria." b) "These medications are only taken when I have pain from my ulcer." c) "The medications will kill the bacteria and stop the acid production." d) "These medications will coat the ulcer and decrease the acid production in my stomach."

c) "The medications will kill the bacteria and stop the acid production." Rationale: Triple therapy for Helicobacter pylori infection usually includes two antibacterial drugs and a proton pump inhibitor. Clarithromycin and amoxicillin are antibacterials. Esomeprazole is a proton pump inhibitor. These medications will kill the bacteria and decrease acid production. Test-Taking Strategy(ies): Note the strategic word, best, and focus on the subject, the name of the medications and their actions. Eliminate option 1 because the medications do more than kill the bacteria. These medications are taken not only when there is pain but continually until pain is gone, usually for 1 to 2 weeks. This will eliminate option 2. These medications do not coat the ulcer, eliminating option 4.

A client has been started on long-term therapy with rifampin. Which information about this medication would the nurse provide to the client? a) Should always be taken with food or antacids b) Should be double-dosed if one dose is forgotten c) Causes red-orange discoloration of sweat, tears, urine, and feces d) May be discontinued independently if symptoms are gone in 3 months

c) Causes red-orange discoloration of sweat, tears, urine, and feces Rationale: Rifampin should be taken exactly as directed. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a primary health care provider (PHCP). The medication should be administered on an empty stomach unless it causes GI upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin causes red-orange discoloration of body secretions and will permanently stain soft contact lenses. Test-Taking Strategy(ies): Focus on the subject, client teaching associated with rifampin. Use of general medication administration principles will assist with eliminating options 2 and 4. Eliminate option 1 next because of the closed-ended word "always."

A hospitalized client with coronary artery disease complains of substernal chest pain. After checking the client's heart rate and blood pressure, the nurse administers nitroglycerin, 0.4 mg, sublingually. After 5 minutes, the client states, "My chest still hurts." Which appropriate actions would the nurse take? Select all that apply. a) Call a code blue. b) Contact the client's family. c) Check the client's pain level. d) Check the client's blood pressure. e) Administer a second nitroglycerin, 0.4 mg, sublingually.

c) Check the client's pain level. d) Check the client's blood pressure. e) Administer a second nitroglycerin, 0.4 mg, sublingually. Rationale: The usual guideline for administering nitroglycerin tablets for a hospitalized client with chest pain is to administer one tablet every 5 minutes as needed (PRN) for chest pain for a total dose of 3 tablets. The registered nurse is notified immediately if a client complains of chest pain. In this situation, because the client is still complaining of chest pain, the nurse would administer a second nitroglycerin tablet. The nurse would check the client's pain level and the client's blood pressure before administering each nitroglycerin dose. There are no data in the question that indicate the need to call a code blue. In addition, it is not necessary to contact the client's family unless the client has requested this. Test-Taking Strategy(ies): Focus on the data in the question. Use the steps of the nursing process to determine that checking the client's pain level and the client's blood pressure are appropriate actions. Next, recalling the usual guidelines for administering nitroglycerin tablets will assist with determining that an appropriate action is to administer a second nitroglycerin, 0.4 mg, sublingually.

A client with tuberculosis is being started on antituberculosis therapy with isoniazid. Before giving the client the first dose, the nurse ensures that which baseline study has been completed? a) Electrolyte levels b) Coagulation times c) Liver enzyme levels d) Serum creatinine level

c) Liver enzyme levels Rationale: Isoniazid therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is greater than age 50 or abuses alcohol. Test-Taking Strategy(ies): Focus on the subject, laboratory monitoring associated with isoniazid. In order to answer this question correctly, it is necessary to know that this medication can be toxic to the liver.

A client is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase. Which action is a priority nursing intervention? a) Monitor for kidney failure. b) Monitor psychosocial status. c) Monitor for signs of bleeding. d) Have heparin sodium available.

c) Monitor for signs of bleeding. Rationale: Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychosocial status are important but are not the most critical interventions. Heparin is given after thrombolytic therapy, but the question is not asking about follow-up medications. Test-Taking Strategy(ies): Note the strategic word, priority. Think about the action of the medication and remember that bleeding is a priority.

The client has begun medication therapy with pancrelipase. The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed? a) Weight loss b) Relief of heartburn c) Reduction of steatorrhea d) Absence of abdominal pain

c) Reduction of steatorrhea Rationale: Pancrelipase is a pancreatic enzyme used in clients with pancreatitis as a digestive aid. The medication should reduce the amount of fatty stools (steatorrhea). Another intended effect could be improved nutritional status. It is not used to treat abdominal pain or heartburn. Its use could result in weight gain but should not result in weight loss if it is aiding in digestion. Test-Taking Strategy(ies): Focus on the subject, optimal intended effect of the medication as well as the name of the medication. Use knowledge of physiology of the pancreas to assist with directing you to the correct option.

A postoperative client has received a dose of naloxone hydrochloride for respiratory depression shortly after transfer to the nursing unit from the postanesthesia care unit. After administration of the medication, the nurse would check the client for which sign/symptom? a) Pupillary changes b) Scattered lung wheezes c) Sudden increase in pain d) Sudden episodes of diarrhea

c) Sudden increase in pain Rationale: Naloxone hydrochloride is an antidote to opioids and may also be given to the postoperative client to treat respiratory depression. When given to the postoperative client for respiratory depression, it may also reverse the effects of analgesics. Therefore, the nurse must check the client for a sudden increase in the level of pain experienced. Options 1, 2, and 4 are not associated with this medication. Test-Taking Strategy(ies): Focus on the subject, the purpose and effect of administering naloxone hydrochloride. Recalling that this medication is an antidote to opioid analgesics will assist with directing you to option 3. Remember that this medication will cause sudden pain in the postoperative client or return of pain in the client who received opioid analgesics.

Isosorbide mononitrate is prescribed for a client with angina pectoris. The client tells the nurse that the medication is causing a chronic headache. Which action would the nurse suggest to the client? a) Cut the dose in half. b) Discontinue the medication. c) Take the medication with food. d) Contact the primary health care provider (PHCP).

c) Take the medication with food. Rationale: Isosorbide mononitrate is an antianginal medication. Headache is a frequent side effect of isosorbide mononitrate and usually disappears during continued therapy. If a headache occurs during therapy, the client should be instructed to take the medication with food or meals. It is not necessary to contact the PHCP unless the headaches persist with therapy. It is not appropriate to instruct the client to discontinue therapy or adjust the dosages. Test-Taking Strategy(ies): Focus on the subject, isosorbide mononitrate and a headache. Eliminate options 1 and 2 first because it is not within the scope of nursing practice to instruct a client to discontinue or adjust dosages. From the remaining options, recalling that the headache can be relieved with the administration of food with the medication will assist in directing you to option 3.

The nurse reinforces discharge instructions to a postoperative client who is taking warfarin sodium. Which statement made by the client reflects the need for further teaching? a) "I will take my pills every day at the same time." b) "I will be certain to avoid alcohol consumption." c) "I have already called my family to pick up a Medic-Alert bracelet." d) "I will take enteric-coated aspirin for my headaches because it is coated."

d) "I will take enteric-coated aspirin for my headaches because it is coated." Rationale: Aspirin-containing products should be avoided while taking this medication. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking prescribed medication at the same time each day increases client compliance. The Medic-Alert bracelet provides health care personnel with emergency information. Test-Taking Strategy(ies): Note the strategic words, need for further teaching. These words indicate a negative event query and ask you to select an option that is an incorrect statement. Recalling that warfarin is an anticoagulant and that aspirin is an aspirin-containing product will direct you to the correct option.

The home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL (9.95 mmol/L). The client is taking cholestyramine. Which statement made by the client indicates the need for further teaching? a) "Constipation and bloating might be a problem." b) "I'll continue to watch my diet and reduce my fats." c) "Walking a mile each day will help the whole process." d) "I'll continue my nicotinic acid from the health food store."

d) "I'll continue my nicotinic acid from the health food store." Rationale: Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid-lowering medications can also cause liver abnormalities so a combination of nicotinic acid and cholestyramine resin is to be avoided. Constipation and bloating are the two most common side effects. Walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels. Test-Taking Strategy(ies):Note the strategic words, need for further teaching. These words indicate a negative event query and ask you to select an option that is an incorrect statement. Remembering that over-the-counter medications should be avoided when a client is taking a prescription medication will direct you to the correct option.

A client is taking nicotinic acid for hyperlipidemia, and the nurse reinforces instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions? a) "It is not necessary to avoid the use of alcohol." b) "The medication should be taken with meals to decrease flushing." c) "Clay-colored stools are a common side effect and should not be of concern." d) "Ibuprofen taken 30 minutes before the nicotinic acid should decrease the flushing."

d) "Ibuprofen taken 30 minutes before the nicotinic acid should decrease the flushing." Rationale: Flushing is a side effect of this medication. Aspirin or a nonsteroidal antiinflammatory drug can be taken 30 minutes before taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this side effect. The medication should be taken with meals; this will decrease gastrointestinal upset. Taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be immediately reported to the PHCP. Test-Taking Strategy(ies): Focus on the subject, niacin and flushing. Option 1 can be eliminated because alcohol must be abstained from. Option 2 can be eliminated because taking the medication with meals helps decrease the gastrointestinal symptoms. The clay-colored stools in option 3 are a sign of hepatic dysfunction and should be immediately reported to the PHCP.

Heparin sodium is prescribed for the client. Which laboratory result indicates that the heparin is prescribed at a therapeutic level? a) Thrombocyte count of 100,000 mm3 b) Prothrombin time (PT) of 21 seconds c) International normalized ratio (INR) of 2.3 d) Activated partial thromboplastin time (aPTT) of 55 seconds

d) Activated partial thromboplastin time (aPTT) of 55 seconds Rationale: The aPTT will assess the therapeutic effect of heparin sodium. The normal aPTT is 30 to 40 sec. To maintain a therapeutic level, the aPTT should be 1.5 to 2.5 times the normal value. The PT and INR will assess for the therapeutic effect of warfarin sodium. A decreased thrombocyte count can cause bleeding. Test-Taking Strategy(ies): Note the subject, laboratory values for heparin and warfarin. Eliminate options 2 and 3 because these laboratory values are related to warfarin sodium. Note that option 1 is an unrelated test for monitoring therapeutic values of both heparin sodium and warfarin sodium.

Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse understands that which is the primary action of this medication? a) Increase DNA and RNA synthesis. b) Promote the biosynthesis of nucleic acids. c) Increase estrogen concentration and estrogen response. d) Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors.

d) Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Rationale: Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen reduces DNA synthesis and estrogen response. Test-Taking Strategy(ies): Note the strategic word, primary, and focus on the subject, the action of tamoxifen. Eliminate options 1 and 2 first because they are comparable or alike. Nucleic acids include DNA and RNA. Eliminate option 3 because it is unlikely that treatment of metastatic breast carcinoma would focus on increasing estrogen concentration and estrogen response.

The client with ovarian cancer is being treated with vincristine. The nurse monitors the client, knowing that which adverse effect is specific to this medication? a) Diarrhea b) Hair loss c) Chest pain d) Extremity numbness

d) Extremity numbness Rationale: Vincristine is a vinca alkaloid antineoplastic (miotic inhibitor) medication that has an adverse effect, specifically peripheral neuropathy. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation, rather than diarrhea, is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all the antineoplastic medications. Chest pain is unrelated to this medication. Test-Taking Strategy(ies): Focus on the subject, an adverse effect of vincristine. Eliminate options 1 and 2 first because these effects are associated with many of the antineoplastic agents. Note that the question asks for the adverse effect specific to this medication. Correlate peripheral neuropathy with vincristine.

The client with a gastric ulcer has a prescription for sucralfate 1 g by mouth four times daily. The nurse would schedule the medication to be administered at which times? a) With meals and at bedtime b) Every 6 hours around the clock c) One hour after meals and at bedtime d) One hour before meals and at bedtime

d) One hour before meals and at bedtime Rationale: Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation. The other options are incorrect. Test-Taking Strategy(ies): Focus on the subject, scheduling of sucralfate. Focusing on the client's diagnosis and thinking about the pathophysiology associated with a gastric ulcer will assist in directing you to the correct option.

The client with small cell lung cancer is being treated with etoposide and the nurse is assisting with caring for the client during administration. The client gets up to use the bathroom and is dizzy and very weak. The nurse understands these symptoms are likely as a result of which side/adverse effect that is specifically associated with this medication? a) Alopecia b) Chest pain c) Pulmonary fibrosis d) Orthostatic hypotension

d) Orthostatic hypotension Rationale: A side effect specific to etoposide is orthostatic hypotension. The client's blood pressure is monitored during the infusion. Hair loss occurs with nearly all antineoplastic medications. Chest pain and pulmonary fibrosis are unrelated to this medication. Test-Taking Strategy(ies): Focus on the subject, a side/adverse effect of etoposide. Note the data in the question describes the client as weak and dizzy when getting up. These are symptoms associated with orthostatic hypotension. Eliminate option 1 first because this side effect is associated with many antineoplastic agents. Note that the question asks for the side/adverse effect specific to this medication. Correlate hypotension with etoposide.

1. Methylergonovine is prescribed for a client with postpartum hemorrhage. Before administering the medication, the nurse contacts the primary health care provider (PHCP) who prescribed the medication if which condition is documented in the client's medical history? a) Hypotension b) Hypothyroidism c) Diabetes mellitus d) Peripheral vascular disease

d) Peripheral vascular disease Rationale: Methylergonovine is an ergot alkaloid used to treat postpartum hemorrhage. Ergot alkaloids are contraindicated in clients with significant cardiovascular disease, peripheral vascular disease, hypertension, preeclampsia, or eclampsia. These conditions are worsened by the vasoconstrictive effects of the ergot alkaloids. Options 1, 2, and 3 are not contraindications related to the use of ergot alkaloids. Test-Taking Strategy(ies): Focus on the subject, the purpose, action, and contraindications of methylergonovine. Recalling that ergot alkaloids produce vasoconstriction will direct you to the correct option.