HESI - NCLEX - RN

A client is receiving anti-infective drug therapy for a postoperative infection. Which complaint should alert the nurse to the possibility that the client has contracted a superinfection? A. "My mouth feels sore." B. "I have a headache." C. "My ears feel plugged up." D. "I feel constipated."

A. "My mouth feels sore."

In administering the antiinfective agent chloramphenicol IV to a client with bacterial meningitis, the nurse observes the client closely for signs of bone marrow depression. Which laboratory data would be most important for the nurse to monitor? A. Platelet count B. Blood urea nitrogen level C. Culture and sensitivity D. Serum calcium level

A. Platelet count (Chloramphenicol can cause irreversible, fatal bone marrow depression, so the nurse should monitor the client's platelet count. Options B, C, and D do not provide data related to bone marrow depression when monitoring a client who has been prescribed this medication.)

Which nursing intervention has the highest priority during IV administration of mechlorethamine HCl and actinomycin? A. Assess for extravasation at the IV site during infusion. B. Premedicate with antiemetics 30 to 60 minutes before infusion. C. Monitor cardiac rate and rhythm during the IV infusion. D. Check the granulocyte count daily for the presence of neutropenia.

A. Assess for extravasation at the IV site during infusion. (Mechlorethamine HCl and actinomycin are vesicants; therefore, assessment for blister formation and/or tissue sloughing that can occur with leakage of these agents into surrounding subcutaneous tissues is essential to ensure client safety during the IV infusion. Options B, C, and D do not have the priority of option A during the administration of vesicants.)

Which question should the nurse ask a client prior to the initiation of treatment with IV infusions of gentamicin sulfate? A. "Are you having difficulty hearing?" B. "Have you ever been diagnosed with cancer?" C. "Do you have any type of diabetes mellitus?" D. "Have you ever had anemia?"

A. "Are you having difficulty hearing?" Complications of gentamicin sulfate therapy include ototoxicity, nephrotoxicity, and neurotoxicity. Determining if the client is hard of hearing prior to initiation of this aminoglycoside will be helpful as the treatment progresses and ototoxicity is identified as a possible complication. Options B, C, and D are important elements of any medical history, but they do not have the priority of option A when assessing for complications of aminoglycoside therapy.

A client is receiving oral griseofulvin for a persistent tinea corporis infection. Which response by the client indicates an accurate understanding of the drug teaching conducted by the nurse? A. "I'll wear sunscreen whenever I mow the lawn." B. "This is the worse bacterial infection I've ever had." C. "I will need to take the medication for 7 days." D. "My urine will probably turn brown due to this drug."

A. "I'll wear sunscreen whenever I mow the lawn." Photosensitivity is a side effect of griseofulvin, so clients should be cautioned to wear protective sunscreen during sun exposure. Options B, C, and D are not accurate statements about side effects of this medication.

A client receives a prescription for theophylline PO to be initiated in the morning after the dose of theophylline IV is complete. The nurse determines that a theophylline level drawn yesterday was 22 mcg/mL. Based on this information, which action should the nurse implement? A. Hold the theophylline dose and notify the health care provider. B. Start the client on a half-dose of theophylline PO. C. The theophylline dose can be initiated as planned. D. The client is not ready to be weaned from the IV to the PO route.

A. Hold the theophylline dose and notify the health care provider. The therapeutic range for theophylline is 10 to 20 mcg/mL, so the theophylline dose should be held for fear of causing toxicity. Options B, C, and D are not indicated actions based on the reported theophylline level.

A client has a positive skin test for tuberculosis. Which prophylactic drug should the nurse expect to administer to this client? A. Isoniazid B. Carvedilol C. Acyclovir D. Griseofulvin

A. Isoniazid Isoniazid is the drug of choice for treatment of clients with positive skin tests for tuberculosis. Options B, C, and D are not the drugs used for treatment of TB.

A 4-year-old child is receiving chemotherapy for acute lymphocytic leukemia. Which laboratory result should the nurse examine to assess the child's risk for infection? A. Neutrophil count B. Platelet count C. Reticulocyte count D. Lymphocyte count

A. Neutrophil count During chemotherapy, granulocytes are significantly suppressed. Because neutrophils comprise 60% to 70% of the granulocyte count, these levels are the most useful laboratory results of the options presented to determine the child's risk for infection. Options B, C, and D are not as useful as option A in determining risk of infection.

The nurse is preparing to administer amphotericin B IV to a client. What laboratory data is most important for the nurse to assess before initiating an IV infusion of this medication? A. Serum potassium level B. Platelet count C. Serum creatinine level D. Hemoglobin level

A. Serum potassium level The nurse should obtain baseline potassium levels prior to beginning drug therapy because amphotericin B changes cellular permeability, allowing potassium to escape from the cell, which could lead to a decrease in the serum potassium level and severe hypokalemia. Options B, C, and D are helpful laboratory values, but they do not have the importance of option A in determining if amphotericin B can be administered safely via IV infusion.

During the initial nursing assessment history, a client tells the nurse that he is taking tetracycline hydrochloride for urethritis. The nurse is most concerned if the client reports taking which medication concurrently? A. Sucralfate B. Hydrochlorothiazide C. Acetaminophen D. Phenytoin

A. Sucralfate Sucralfate is used to treat duodenal ulcers and will bind with tetracycline hydrochloride, inhibiting this antibiotic's absorption. Options B, C, and D have no drug interaction properties that prohibit concurrent use with tetracycline hydrochloride.

The nurse plans to draw blood samples for the determination of peak and trough levels of gentamicin sulfate in a client receiving IV doses of this medication. When should the nurse plan to obtain the peak level? A. Thirty minutes after the dose is administered B. Immediately before giving the next dose C. When the next electrolyte levels are drawn D. Sixty minutes after the dose is administered

A. Thirty minutes after the dose is administered Peak drug serum levels are achieved 30 minutes after the IV administration of aminoglycosides, so option A is the optimum time to get a peak level. Options B, C, and D are not appropriate times associated with peak levels for gentamicin.

Which class of antineoplastic chemotherapy agents resembles the essential elements required for DNA and RNA synthesis and inhibits enzymes necessary for cellular function and replication? A. Alkylating agents B. Antimetabolites C. Antitumor antibiotics D. Plant alkaloids

B. Antimetabolites Antimetabolites exert their action by inhibiting the enzymes necessary for cellular function and replication. Options A, C, and D have a different mechanism of action.

When providing nursing care for a client receiving pyridostigmine bromide for myasthenia gravis, which nursing intervention has the highest priority? A. Monitor the client frequently for urinary retention. B. Assess respiratory status and breath sounds often. C. Monitor blood pressure each shift to screen for hypertension. D. Administer most medications after meals to decrease gastrointestinal irritation.

B. Assess respiratory status and breath sounds often. The client should be assessed often for signs of respiratory complications. The client with myasthenia gravis is at greatest risk for life-threatening respiratory complications because of the weakness of the diaphragm and ancillary respiratory muscles caused by the disease process. Cholinergic agents used to reduce muscle weakness can also cause hypersalivation, increased respiratory secretions, and possible bronchoconstriction. Although options A, C, and D reflect helpful interventions, they do not have the priority of option B in caring for the client with myasthenia gravis.

A client is receiving pyridostigmine bromide to control the symptoms of myasthenia gravis. Which client behavior would indicate that the drug therapy is effective? A. Decreased oral secretions B. Clear speech C. Diminished hand tremors D. Increased ptosis

B. Clear speech Clear speech is the result of increased muscle strength. Muscle weakness characteristic of myasthenia gravis often first appears in the muscles of the neck and face. Options A and D are symptoms of multiple sclerosis that would persist if the medication was ineffective. Hand tremors are not typical symptoms of the disease.

A client is experiencing an adverse effect of the gastrointestinal stimulant metoclopramide HCl. Which assessment finding would require immediate intervention by the nurse? A. Reports dizziness when first getting up. B. Describes an unpleasant metallic taste in the mouth. C. Demonstrates Parkinson-like symptoms, such as cogwheel rigidity. D. Refuses to drive after 6 pm because of an inability to see well at night.

B. Describes an unpleasant metallic taste in the mouth. (Metoclopramide HCl blocks dopamine receptors in the brain, which can cause the extrapyramidal symptoms associated with Parkinson disease. Reglan has been associated with hypertension, not option A. Option B is often associated with metronidazole, not metoclopramide HCl. Option D, and other vision problems, have not been associated with metoclopramide HCl.)

An older client is receiving a water-soluble drug that is more than the average dose for a young adult. Which action should the nurse implement first? A. Obtain a prescription for lower medication dosages. B. Determine the drug's serum levels for toxicity. C. Start IV fluids to decrease the serum drug levels. D. Hold the next dosage and notify the health care provider.

B. Determine the drug's serum levels for toxicity. Older clients usually have a decline in lean body mass and total body water that causes water-soluble drugs to become distributed in fluid compartments, resulting in an increased concentration, so determining the drug's serum level for toxicity should be implemented first. Although options A, C, and D may be indicated, an increased plasma drug level should be the determining factor to consider when water-soluble drugs warrant a reduced dosage in the older client.

A child is being treated with mebendazole for pinworms. Which type of diet should the mother be instructed to feed the child while the child is receiving this medication? A. Lactose-free foods B. High-fat diet C. Vitamin C-enriched foods D. High-fiber diet

B. High-fat diet (A high-fat diet increases the absorption of mebendazole, which boosts the effectiveness of the medication in eliminating the pinworms. Options A, C, and D are not related to the administration of this medication.)

A client with a dislocated shoulder is being prepared for a closed manual reduction using conscious sedation. Which medication should the nurse explain as a sedative used during the procedure? A. Inhaled nitrous oxide B. Midazolam IV C. Ketamine IM D. Fentanyl and droperidol IM

B. Midazolam IV Conscious sedation uses sedative-hypnotics that do not compromise the airway, so IV midazolam, a short-duration benzodiazepine sedative, provides conscious sedation with local and regional anesthesia and has an amnestic effect. Option A is a weak anesthetic and is rarely used alone. Option C causes profound analgesia that causes a client to appear catatonic and amnestic. Fentanyl is an opioid more commonly used as an analgesic during anesthesia, whereas droperidol is a skeletal muscle anesthetic agent used to reduce spasticity to ensure a smooth induction under general anesthesia and requires intubation and ventilation during its onset and duration.

A 19-year-old male client who has sustained a severe head injury is intubated and placed on assisted mechanical ventilation. To facilitate optimal ventilation and prevent the client from "fighting" the ventilator, the health care provider administers pancuronium bromide IV, with adjunctive opioid analgesia. What medication should be immediately accessible for a potential complication with this drug? A. Dantrolene sodium B. Neostigmine bromide C. Succinylcholine bromide D. Epinephrine

B. Neostigmine bromide Neostigmine bromide and atropine sulfate, both anticholinergic drugs, reverse the respiratory muscle paralysis caused by pancuronium bromide. Options A, C, and D are not antagonists to pancuronium bromide and would not be helpful in reversing the effects of the drug compared with the use of anticholinergics.

The apical heart rate of an infant receiving digoxin for congestive heart failure is 80 beats/min. Which intervention should the nurse implement first? A. Administer the next dose of digoxin as scheduled. B. Obtain a serum digoxin level. C. Administer a PRN dose of atropine sulfate. D. Assess for S3 and S4 heart sounds.

B. Obtain a serum digoxin level. Sinus bradycardia (rate <90 to 110 beats/min in an infant) is an indication of digoxin toxicity, so assessment of the client's digoxin level is the highest priority. Further doses of digoxin should be withheld until the serum level is obtained. Option C is not indicated unless the client exhibits symptoms of diminished cardiac output. Option D provides information about cardiac function but is of less priority than option B.

A 67-year-old client is discharged from the hospital with a prescription for digoxin, 0.25 mg daily. Which instruction should the nurse include in this client's discharge teaching plan? A. Take the medication in the morning before rising. B. Take and record radial pulse rate daily. C. Expect some vision changes caused by the medication. D. Increase intake of foods rich in vitamin K.

B. Take and record radial pulse rate daily. Monitoring pulse rate is very important when taking digoxin. The client should be further instructed to report pulse rates <60 or >110 beats/min and to withhold the dosage until consulting with the health care provider in such a case. Options A and D are not necessary. Option C is an indication of drug toxicity, and the client should be instructed to report this immediately.

A 3-year-old boy is admitted to the emergency department after ingesting an unknown amount of phenobarbital elixir prescribed for his brother's seizure disorder. Which nursing intervention should the nurse implement first? A. Administer syrup of ipecac. B. Take the child's vital signs. C. Draw a blood specimen for a phenobarbital level. D. Teach the mother safe medication storage practices.

B. Take the child's vital signs. Phenobarbital causes respiratory depression, so the priority intervention is assessment of vital signs. Options A, C, and D are actions that may all be used in the treatment of this child, but they do not have the priority of option B.

The nurse is preparing to apply a surface anesthetic agent for a client. Which action should the nurse implement to reduce the risk of systemic absorption? A. Apply the anesthetic to mucous membranes. B. Limit the area of application to inflamed areas. C. Avoid abraded skin areas when applying the anesthetic. D. Spread the topical agent over a large surface area.

C. Avoid abraded skin areas when applying the anesthetic. To minimize systemic absorption of topical anesthetics, the anesthetic agent should be applied to the smallest surface area of intact skin. Application to the mucous membranes poses the greatest risk of systemic absorption because absorption occurs more readily through mucous membranes than through the skin. Inflamed areas generally have an increased blood supply, which increases the risk of systemic absorption, so option B should be avoided. A large surface area increases the amount of topical drug that is available for transdermal absorption, so the smallest area should be covered, not option D.

To evaluate whether the administration of an antihypertensive medication has caused a therapeutic effect, which action should the nurse implement? A. Ask the client about the onset of any dizziness since taking the medication. B. Measure the client's blood pressure while the client is lying, sitting, and then standing. C. Compare the client's blood pressure before and after the client takes the medication. D. Interview the client about any past or recent history of high blood pressure.

C. Compare the client's blood pressure before and after the client takes the medication. Therapeutic effects are the expected or predictable physiologic responses to a medication. An antihypertensive medication is administered to lower blood pressure, so to determine if the therapeutic effect has been achieved, the nurse should compare the client's blood pressure before and after the client takes the medication. Options A and B provide data related to the side effect of hypotension, which may occur following the administration of an antihypertensive medication. Option D provides useful data but does not evaluate the medication's effectiveness.

The health care provider prescribes the anticonvulsant carbamazepine for an adolescent client with a seizure disorder. The nurse should instruct the client to notify the health care provider if which condition occurs? A. Experiences dry mouth. B. Experiences dizziness. C. Develops a sore throat. D. Develops gingival hyperplasia.

C. Develops a sore throat. Blood dyscrasias (aplastic anemia, leukopenia, anemia, and thrombocytopenia) can be an adverse effect of carbamazepine. Flulike symptoms, such as pallor, fatigue, sore throat, and fever, are indications of such dyscrasias. Options A and B are expected reactions. Option D is a side effect of phenytoin, not carbamazepine.

A client is taking famotidine. Which client statement should the nurse further assess because it may indicate that the client is experiencing a side effect of this drug? A. "I have heartburn whenever I lie down." B. "I am never hungry. I've lost weight in the past 2 weeks." C. "I have a funny metallic taste in my mouth." D. "I seem to be having difficulty thinking clearly."

D. "I seem to be having difficulty thinking clearly." A common side effect of of famotidine is confusion. Options A, B, and C are not side effects of this medication.

When caring for a client on digoxin therapy, the nurse knows to be alert for digoxin toxicity. Which finding would predispose this client to developing digoxin toxicity? A. Low serum sodium level B. High serum sodium level C. Low serum potassium level D. High serum potassium level

C. Low serum potassium level Hypokalemia predisposes the client on digoxin to digoxin toxicity, which usually presents as abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and atrioventricular (AV) dissociation. Assessment of serum potassium levels with prompt correction of hypokalemia is an important intervention for the client taking digoxin. Options A, B, and D are not relevant.

A client with metastatic cancer who has been receiving fentanyl for several weeks reports to the nurse that the medication is not effectively controlling the pain. Which intervention should the nurse initiate? A. Instruct the client about the indications of opioid dependence. B. Monitor the client for symptoms of opioid withdrawal. C. Notify the health care provider of the need to increase the dose. D. Administer naloxone per PRN protocol for reversal.

C. Notify the health care provider of the need to increase the dose. Clients can develop a tolerance to the analgesic effect of opioids and may require an increased dose for effective long-term pain relief. The client is not exhibiting indications of dependence, withdrawal, or toxicity.

A client who arrives in the postanesthesia care unit (PACU) after surgery is not awake from general anesthesia. Which action should the nurse implement first? A. Assess for deep tendon reflexes. B. Observe urinary output. C. Review the medication administration record (MAR). D. Administer naloxone.

C. Review the medication administration record (MAR). Most general anesthetics produce cardiovascular and respiratory depression, so a review of the client's MAR identifies all the medications received during surgery and helps the nurse anticipate the client's response and emergence from anesthesia. Options A and B are ongoing postoperative assessments. Based on the medications that the client has received, naloxone may need to be administered if indicated by the client's vital signs and delayed spontaneous reactivity.

A client with metastatic cancer reports severe continuous pain. Which route of administration should the nurse use to provide the most effective continuous analgesia? A. Oral B. Intravenous C. Transdermal D. Intramuscular

C. Transdermal Continuous pain is best managed by maintaining a constant serum drug level. Transdermal drug administration of an analgesic provides around-the-clock, controlled release of the medication that is absorbed through intact skin into the bloodstream to provide continuous pain relief. Option A is convenient, but gastrointestinal variables affect the absorption rate of the drug, its onset and intensity, and duration of response and requires repeated doses around the clock. Option B provides immediate action because the drug is infused directly into the bloodstream and is quickly metabolized, and repeated IV doses are required to maintain a continuous blood level. Option D requires repeated injections at regular intervals, which are uncomfortable, and absorption rates vary between muscle sites.

The nurse is evaluating a client's understanding of the prescribed antilipemic drug lovastatin. Which client statement indicates that further teaching is needed? A. "My bowel habits should not be affected by this drug." B. "This medication should be taken once a day only." C. "I will still need to follow a low-cholesterol diet." D. "I will take the medication every day before breakfast."

D. "I will take the medication every day before breakfast." The enzyme that helps metabolize cholesterol is activated at night, so this medication should be taken with the evening meal. Options A, B, and C reflect correct information about lovastatin.

A lidocaine IV infusion at 4 mg/min via infusion pump is prescribed for a client having premature ventricular contractions (PVCs). The available premixed infusion contains 2 mg/mL of D5W. How many milliliters per hour should the nurse program the pump to deliver to this client? A. 20 B. 24 C. 60 D. 120

D. 120 Option D is the correct calculation; 120 mL/hr = 1 mL/2 mg × 4 mg/min × 60 min/hr.

Dopamine, 5 mcg/kg/min, is prescribed for a client who weighs 105 kg. The nurse mixes 400 mg of dopamine in 250 mL D5W for IV administration via an infusion pump. What is the hourly rate that the nurse should set on the pump? A. 5 mL/hr B. 10 mL/hr C. 15 mL/hr D. 20 mL/hr

D. 20 mL/hr 400 mg/250 mL equals 1.6 mg/mL, or 1600 mcg/mL. The prescription for 5 mcg/kg/min would result in 31,500 mcg/hr. Delivery of that dose would be achieved by administering 20 mL/hr, which would deliver 5.07 mcg/kg/min. Options A, B, and C are not accurate hourly rates for this infusion.

The health care provider has prescribed a low-molecular-weight heparin, enoxaparin prefilled syringe, 30 mg/0.3 mL IV every 12 hours, for a client following hip replacement. Prior to administering the first dose, which intervention is most important for the nurse to implement? A. Assess the client's IV site for signs of inflammation. B. Evaluate the client's degree of mobility. C. Instruct the client regarding medication side effects. D. Contact the health care provider to clarify the prescription.

D. Contact the health care provider to clarify the prescription. Enoxaparin is a low-molecular-weight heparin that should be administered subcutaneously when given as a prophylaxis for deep vein thrombosis, so the nurse should contact the health care provider to clarify the route of administration. Options A and B are important nursing interventions but not necessary to the administration of this medication. The client should be instructed about medication side effects, but this is of lower priority than obtaining a correct prescription.

When providing client teaching about the administration of methylphenidate (Ritalin) to a parent of a child diagnosed with ADHD, which instruction should the nurse include in the teaching plan? A. The doses should be given exactly 12 hours apart to sustain a therapeutic serum level. B. Doses should be scheduled at midmorning and midafternoon to achieve optimal benefit. C. Give the medication only on school days and when the child appears to be anxious. D. Offer the child the medication with breakfast and after the child eats lunch.

D. Offer the child the medication with breakfast and after the child eats lunch. (Administering the medication at breakfast and after lunch provides the correct spacing of the doses to maximize the child's attention span and helps prevent the appetite suppression associated with the drug. Doses should be spaced at 6-hour intervals, not option A. Option B is likely to increase insomnia. Option C disrupts the normal dosing schedule, resulting in ineffective treatment. Doses should be discontinued only for brief intervals (with the health care provider's approval) when the client's condition is being evaluated or if the client is being weaned from the medication entirely.)

A client who is hypertensive receives a prescription for hydrochlorothiazide. When teaching about the side effects of this drug, which symptoms are most important for the nurse to instruct the client to report? A. Fatigue and muscle weakness B. Anxiety and heart palpitations C. Abdominal cramping and diarrhea D. Confusion and personality changes

A. Fatigue and muscle weakness (Thiazide diuretics, such as HCTZ, cause potassium wasting in the urine, so the client should be instructed to report fatigue and muscle weakness, which are characteristic of hypokalemia.)

A primigravida at 34 weeks of gestation is admitted to labor and delivery in preterm labor. She is started on a terbutaline sulfate continuous IV infusion via pump. This therapy is ineffective, and the baby is delivered vaginally. For which complication should the nurse monitor in this infant during the first few hours after delivery? A. Hypokalemia B. Hypermagnesia C. Hypoglycemia D. Hypernatremia

C. Hypoglycemia Hypoglycemia may occur in the neonate because a side effect of terbutaline sulfate is increased maternal serum glucose levels. Although monitoring for imbalances in options A, B, and D is important, option C is the priority following the maternal administration of terbutaline sulfate.

A client who is HIV-positive is receiving epoetin alfa for the management of anemia secondary to zidovudine (AZT) therapy. Which laboratory finding is most important for the nurse to report to the health care provider? A. Hematocrit (HCT) of 58% B. Hemoglobin of 10.8 g/dL C. White blood cell count of 5000 mm3 D. Serum potassium level of 5 mEq/L

A. Hematocrit (HCT) of 58% Option A should be reported to the health care provider immediately because of the likelihood of a hypertensive crisis and because seizure activity increases with an increase in HCT of more than 4 points, or an HCT above 36%. Epoetin alfa stimulates erythropoiesis (production of red blood cells), thereby decreasing the need for blood transfusions. Uncontrolled hypertension can occur if erythropoietin levels are too high. Option B is the reason why the client is receiving epoetin alpha. Options C and D are within normal limits.

The nurse is reviewing a client's laboratory results before a procedure in which a neuromuscular blocking agent is prescribed. Which finding should the nurse report to the health care provider? A. Hypokalemia B. Hyponatremia C. Hypercalcemia D. Hypomagnesemia

A. Hypokalemia (Low potassium levels enhance the effects of neuromuscular blocking agents, so the health care provider should be informed of the client's hypokalemia.)

In addition to nitrate therapy, a client is receiving nifedipine, 10 mg PO every 6 hours. The nurse should plan to observe for which common side effect of this treatment regimen? A. Hypotension B. Hyperkalemia C. Hypocalcemia D. Seizures

A. Hypotension

The health care provider prescribes cisplatin to be administered in 5% dextrose and 0.45% normal saline with mannitol added. Which assessment parameters would be most helpful to the nurse in evaluating the effectiveness of the therapy? A. Oral temperature B. Blood cultures C. Urine output D. Liver enzyme levels

C. Urine output (The effectiveness of the diuresis is best measured by urine output. Mannitol, an osmotic diuretic, is given during cisplatin therapy to promote diuresis and reduce the risk of nephrotoxicity and ototoxicity associated with this chemotherapeutic agent.)

A female client who has started long-term corticosteroid therapy tells the nurse that she is careful to take her daily dose at bedtime with a snack of crackers and milk. Which is the best response by the nurse? A. Advise the client to take the medication in the morning, rather than at bedtime. B. Teach the client that dairy products should not be taken with her medication. C. Tell the client that absorption is improved when taken on an empty stomach. D. Affirm that the client has a safe and effective routine for taking the medication.

A. Advise the client to take the medication in the morning, rather than at bedtime. (Daily doses of long-term corticosteroid therapy should be administered in the morning to coincide with the body's normal secretion of cortisol. Clients receiving long-term corticosteroids need to increase their intake of calcium, which generally means an increase in dairy products. Corticosteroids can often cause gastrointestinal distress and should be administered with meals. The client has established a safe routine by taking the medication with a snack, but the routine will be more effective if done in the morning.)

Which instructions should the nurse provide to an adolescent female client who is initiating treatment with isotretinoin for acne vulgaris? (Select all that apply.) A. "Notify the health care provider immediately if you think you are pregnant." B. "If your acne gets worse, stop the medication and call the health care provider." C. "Take a daily multiple vitamin to prevent deficiencies and promote dermal healing." D. "Dermabrasion for deep acne scars should be postponed for 1 month after therapy is stopped." E. "If you begin crying more than usual and feel sad, stop the drug and call the health care provider." F. "Before, during, and after therapy, two effective forms of birth control must be used at the same time."

A. "Notify the health care provider immediately if you think you are pregnant." E. "If you begin crying more than usual and feel sad, stop the drug and call the health care provider." F. "Before, during, and after therapy, two effective forms of birth control must be used at the same time." Isotretinoin has been found to cause pregnancy category D drug-related birth defects, premature births, and fetal death (A), which necessitates the use of effective birth control methods before, during, and after therapy (F). Isotretinoin is associated with sadness (E), depression, suicidal ideations, and other serious mental health problems. An initial exacerbation of acne (B) is common when starting drug therapy. Isotretinoin is a retinoid related to vitamin A, and taking additional multivitamin supplements (C) can predispose the client to vitamin A toxicity. The client should stop taking isotretinoin at least 6 months before cosmetic procedures, such as dermabrasion (D), because the drug can increase the chances of scarring.

The nurse is administering the early morning dose of insulin aspart, 5 units subcutaneously, to a client with diabetes mellitus type 1. The client's fingerstick serum glucose level is 140 mg/dL. Considering the onset of insulin aspart, when should the nurse ensure that the client's breakfast be given? A. 5 minutes after subcutaneous administration B. 30 minutes after subcutaneous administration C. 1 to 2 hours after administration D. At any time because of a flat peak of action

A. 5 minutes after subcutaneous administration (Insulin aspart is a very rapidly acting insulin, with an onset of 5 to 15 minutes. Insulin aspart should be administered when the client's tray is available. Insulin aspart peaks in 45 minutes to 1½ hours and has a duration of 3 to 4 hours. The client should have eaten to ensure absorption of the meal so that serum glucose levels will coincide with the peak. Insulin glargine has a flat peak of action and is usually given at bedtime.)

A male client with prostatic carcinoma has arrived for his scheduled dose of docetaxel chemotherapy. What symptom would indicate a need for an immediate response by the nurse prior to implementing another dose of this chemotherapeutic agent? A. A cough that is new and persistent B. Persistent nausea and vomiting C. Fingernail and toenail changes D. Increasing weakness and neuropathy

A. A cough that is new and persistent Option A is an adverse effect that is immediately life threatening. Severe fluid retention can cause pleural effusion (requiring urgent drainage), dyspnea at rest, cardiac tamponade, or pronounced abdominal distention (caused by ascites). Options B, C, and D are all adverse effects from chemotherapy and need to be monitored consistently.

Methylphenidate is prescribed for daily administration to a 10-year-old child with attention-deficit/hyperactivity disorder (ADHD). In preparing a teaching plan for the parents of this child newly diagnosed with ADHD, which instruction is most important for the nurse to provide to the parents? A. Administer the medication in the morning before the child goes to school. B. Plan to implement periodic interruptions in the administration of the drug. C. Attempt to be consistent when setting limits on inappropriate behavior. D. Seek professional counseling if the child's behavior continues to be disruptive.

A. Administer the medication in the morning before the child goes to school. Methylphenidate is a central nervous system (CNS) stimulant. To be most effective in affecting the child's behavior, the dose of the drug should be administered in the morning before the child goes to school. Drug holidays are often prescribed to assess the child's degree of recovery; however, such interruptions are not conducted in the early phase of treatment and are usually implemented when side effects occur over a period of time. Options C and D are worthwhile instructions but do not have the priority of option A.

The nurse performs a client assessment prior to the administration of a prescribed dose of dipyridamole and aspirin PO. The nurse notes that the client's carotid bruit is louder than previously assessed. Which action should the nurse implement? A. Administer the prescribed dose as scheduled. B. Hold the dose until the health care provider is contacted. C. Advise the client to take nothing by mouth until further assessment is completed. D. Elevate the head of the bed and apply oxygen by nasal cannula.

A. Administer the prescribed dose as scheduled. (A carotid bruit reflects the degree of blood vessel turbulence, which is typically the result of atherosclerosis. Aspirin is prescribed to reduce platelet aggregation and should be administered to this client, who is at high risk for thrombus occlusion. Options B, C, and D are not necessary interventions at this time.)

A client with Tourette syndrome takes haloperidol to control tics and vocalizations. The client has become increasingly drowsy over the past 2 days and reports becoming dizzy when changing from a supine to sitting position. Which action should the nurse take? A. Assess for poor skin turgor, sunken eyeballs, and concentrated urine output. B. Recognize that a sedative effect is expected and continue monitoring the client. C. Have the caregiver hold the next two doses of the medication to reduce the drug toxicity. D. Determine whether the client's urine is pink or reddish brown, and report findings to the health care provider.

A. Assess for poor skin turgor, sunken eyeballs, and concentrated urine output. Because haloperidol causes CNS effects of sedation and decreased thirst, the nurse should assess for signs of dehydration. Although sedation may occur with haloperidol administration, this side effect may signal an adverse CNS reaction; therefore, option B is not a sufficient intervention when client safety is threatened. Option C could precipitate withdrawal-emergent dyskinesia, which is potentially life threatening. Option D is expected.

A female client with trichomoniasis (Trichomonas vaginalis) receives a prescription for metronidazole. Which instruction is most important for the nurse to include in this client's teaching plan? A. Avoid alcohol consumption. B. Complete the medication regimen. C. Use a barrier contraceptive method. D. Treat partner(s) concurrently.

A. Avoid alcohol consumption. Clients should be instructed to avoid alcohol and products containing alcohol while taking metronidazole because of the possibility of a disulfiram-like reaction. Option B helps prevent the development of metronidazole-resistant T. vaginalis. To prevent reinfection, clients should abstain from sexual contact or use a barrier contraceptive while taking metronidazole, and their partner(s) should be treated concurrently. The most important instruction for client well-being is option A.

The nurse is providing discharge instructions to a client who has received a prescription for an antibiotic that is hepatotoxic. Which information should the nurse include in the instructions? A. Avoid ingesting any alcohol or acetaminophen. B. Schedule a follow-up visit for a liver biopsy in 1 month. C. Activities that are strenuous should be avoided. D. Notify the health care provider of any increase in appetite.

A. Avoid ingesting any alcohol or acetaminophen. (Combining hepatotoxic drugs, such as acetaminophen and alcohol, increases the risk of liver damage, so option A is an important discharge instruction. Although clients who receive hepatotoxic drugs should be screened for any changes in serum liver function test (LFT) results, option B is not indicated. Rest is advantageous during an infectious process, but activity restriction is unnecessary. A client who is receiving a hepatotoxic drug should report any hepatotoxic symptoms, such as jaundice, dark urine, or light-colored stools, but an increased appetite does not need medical attention.)

A 26-year-old primigravida client is experiencing increasing discomfort and anxiety during the active phase of labor. She requests something for pain. Which analgesic should the nurse anticipate administering? A. Butorphanol B. Hydromorphone C. Morphine sulfate D. Codeine sulfate

A. Butorphanol Butorphanol is a mixed agonist-antagonist analgesic resulting in good analgesia but with less respiratory depression, nausea, and vomiting compared with opioid agonist analgesics.

Following the administration of sublingual nitroglycerin, which assessment finding indicates that the medication was effective? A. Decrease in level of chest pain B. Clear bilateral breath sounds C. Increase in blood pressure D. Increase in urinary output

A. Decrease in level of chest pain Nitroglycerin reduces myocardial oxygen consumption, which decreases ischemia and reduces chest pain. Options B, C, and D are not expected outcomes of sublingual nitroglycerin.

The nurse is preparing a child for transport to the operating room for an emergency appendectomy. The anesthesiologist prescribes atropine sulfate, IM STAT. What is the primary purpose for administering this drug to the child at this time? A. Decrease the oral secretions. B. Reduce the child's anxiety. C. Potentiate the opioid effects. D. Prevent possible peritonitis.

A. Decrease the oral secretions. Atropine sulfate, an anticholinergic agent, is given to decrease oral secretions during a surgical procedure. Options B, C, and D are not actions of anticholinergic agents.

Which intervention is most important for a nurse to implement prior to administering atropine PO? A. Determine the presence of 5 to 35 bowel sounds/min. B. Provide oral care prior to administration. C. Verify that the client's tendon reflexes are 2+. D. Have the client rate his or her pain on a 0 to10 scale.

A. Determine the presence of 5 to 35 bowel sounds/min. Anticholinergic drugs, such as atropine, have antispasmodic and antisecretory properties, which relax the gastrointestinal tract, and are therefore contraindicated in a client with intestinal atony. Oral care may be required after administration since atropine can dry secretions. Option B (used to determine dehydration) or (C). Atropine itself has no analgesic effect; it is used with opioids to potentiate their effect.

A client experiencing dysrhythmias is given quinidine, 300 mg PO every 6 hours. The nurse plans to observe this client for which common side effect associated with the use of this medication? A. Diarrhea B. Hypothermia C. Seizures D. Dysphagia

A. Diarrhea The most common side effects associated with quinidine therapy are gastrointestinal complaints, such as diarrhea. Options B, C, and D are not usually associated with quinidine therapy.

A chemotherapeutic regimen with doxorubicin HCl is being planned for a client recently diagnosed with cancer. What diagnostic test results should the nurse review prior to initiating this treatment? A. Electrocardiogram (ECG) B. Arterial blood gases (ABGs) C. Serum cholesterol level D. Pelvic ultrasound

A. Electrocardiogram (ECG) Baseline cardiac function studies are required to monitor the irreversible cardiotoxic effects of doxorubicin HCl. Option B assesses disturbances of acid-base balance. Option C is not affected by this chemotherapeutic agent. Option D is used to detect pelvic abnormalities such as tumors but is not specific for the administration of doxorubicin HCl.

A female client is receiving tamoxifen following surgery for breast cancer. She reports the onset of hot flashes to the nurse. Which intervention should the nurse implement? A. Instruct the client that hot flashes are a side effect that often occurs with the use of this medication. B. Encourage the client to verbalize her feelings and fears about the recurrence of her breast cancer. C. Help the client schedule an appointment for evaluation of the need to increase the dose of medication. D. Notify the health care provider that the client needs immediate evaluation for medication toxicity.

A. Instruct the client that hot flashes are a side effect that often occurs with the use of this medication. Tamoxifen is an estrogen receptor blocker used to treat breast carcinoma. Hot flashes are a common side effect. If the hot flashes become bothersome, the client can be instructed in measures to reduce the discomfort. Hot flashes are not an indication of option B, C, or D.

During therapy with isoniazid, it is most important for the nurse to monitor which laboratory value closely? A. Liver enzyme levels B. Blood urea nitrogen (BUN) level C. Serum electrolyte levels D. Complete blood count (CBC)

A. Liver enzyme levels (The client receiving isoniazid is at risk for the development of hepatitis; therefore, liver function test results should be monitored carefully during drug therapy.)

A pediatric client is discharged home with multiple prescriptions for medications. Which information should the nurse provide that is most helpful to the parents when managing the medication regimens? A. Maintain a drug administration record. B. Fill all prescriptions at one pharmacy. C. Allow one person to give the medications. D. Give all medications in small volumes.

A. Maintain a drug administration record. A written drug administration record provides a consistent plan to ensure safe adherence to multiple medication dosages and times. Although option B is an important safeguard to monitor for drug interactions, the parents should be given a tool to enhance their confidence and provide a mechanism to ensure accurate and timely medication administration without duplicating or omitting a dose. Using a written record to record medication administration allows more than one person to share the responsibility of giving medications to the child. Although smaller volumes ensure that all the medication is taken, it is more important to maintain an accurate administration schedule.

The nurse is assessing a stuporous client in the emergency department who is suspected of overdosing with opioids. Which agent should the nurse prepare to administer if the client becomes comatose? A. Naloxone hydrochloride B. Atropine sulfate C. Vitamin K D. Flumazenil

A. Naloxone hydrochloride Naloxone is an opioid antidote used in opioid overdose to reverse CNS and respiratory depression. Atropine is used for bradycardia, intestinal hypertonicity and hypermotility, muscarinic agonist poisoning, peptic ulcer disease, and biliary colic. Vitamin K is used to manage warfarin overdose and vitamin K deficiency in newborns. Flumazenil reduces the sedative effects of benzodiazepines following general anesthesia or overdose.

A female client is receiving tetracycline for acne. Which client teaching should the nurse include? A. Oral contraceptives may not be effective. B. Drinking cranberry juice will promote healing. C. Breast tenderness may occur as a side effect. D. The urine will turn a red-orange color.

A. Oral contraceptives may not be effective. (Certain antibiotics, such as tetracycline, decrease the effectiveness of oral contraceptives. Options B, C, and D do not convey accurate information related to client teaching about this medication.)

A child with cystic fibrosis is receiving ticarcillin disodium for Pseudomonas pneumonia. For which adverse effect should the nurse assess and report promptly to the health care provider? A. Petechiae B. Tinnitus C. Oliguria D. Hypertension

A. Petechiae Adverse effects of ticarcillin disodium include hypothrombinemia and decreased platelet adhesion, which can result in the presence of petechiae. Options B, C, and D are not adverse effects primarily associated with the administration of ticarcillin disodium.

Minocycline, 50 mg PO every 8 hours, is prescribed for an adolescent girl diagnosed with acne. The nurse discusses self-care with the client while she is taking the medication. Which teaching points should be included in the discussion? (Select all that apply.) A. Report vaginal itching or discharge. B. Take the medication at 0800, 1500, and 2200 hours. C. Protect skin from natural and artificial ultraviolet light. D. Avoid driving until response to medication is known. E. Take with an antacid tablet to prevent nausea. F. Use a nonhormonal method of contraception if sexually active.

A. Report vaginal itching or discharge. C. Protect skin from natural and artificial ultraviolet light. D. Avoid driving until response to medication is known. F. Use a nonhormonal method of contraception if sexually active. (Adverse effects of tetracyclines include superinfections, photosensitivity, and decreased efficacy of oral contraceptives. Therefore, the client should report vaginal itching or discharge (A), protect the skin from ultraviolet light (C), and use a nonhormonal method of contraception (F) while on the medication. Minocycline is known to cause dizziness and ataxia, so until the client's response to the medication is known, driving (D) should be avoided. Tetracyclines should be taken around the clock (B) but exhibit decreased absorption when taken with antacids, so (E) is contraindicated.)

Two hours after taking the first dose of penicillin, a client arrives at the emergency department complaining of feeling ill, exhibiting hives, having difficulty breathing, and experiencing hypotension. These findings are consistent with which client response that requires immediate action? A. Severe acute anaphylactic response B. Side reaction that should resolve C. Idiosyncratic reaction D. Cumulative drug response

A. Severe acute anaphylactic response (Anaphylaxis related to penicillin can cause a life-threatening allergic response characterized by bronchospasm, laryngeal edema, and a precipitous drop in blood pressure. This client's ingestion of penicillin and presenting clinical picture indicate the client is having an acute reaction with respiratory difficulty.)

A 42-year-old client is admitted to the emergency department after taking an overdose of amitriptyline in a suicide attempt. Which drug should the nurse plan to administer to reverse the cardiac and central nervous system effects of amitriptyline? A. Sodium bicarbonate B. Naloxone C. Phentolamine mesylate D. Atropine sulfate

A. Sodium bicarbonate Sodium bicarbonate is an effective treatment for an overdose of tricyclic antidepressants such as amitriptyline to reverse QRS prolongation. Options B, C, and D are not the preferred agents for treating this drug overdose.

The health care provider prescribes oral contraceptives for a client who wants to prevent pregnancy. Which information is the most important for the nurse to provide to this client? A. Take one pill at the same time every day until all the pills are gone. B. Use condoms and foam instead of the pill while on any antibiotics. C. Limit sexual intercourse for at least one cycle after starting the pill. D. Use another contraceptive if two or more pills are missed in one cycle.

A. Take one pill at the same time every day until all the pills are gone. To maintain adequate hormonal levels for contraception and enhance compliance, oral contraceptives should be taken at the same time each day. There is no strong pharmacokinetic evidence that shows a relationship between the category of broad-spectrum antibiotic use and altered hormone levels in oral contraceptive users, so option B is not indicated at this time. Abstinence is the best method to prevent pregnancy during the first cycle. If a client misses two pills during the first week, the client should take two pills a day for 2 days and finish the package while using a backup method of birth control until her next menstrual cycle.

Methenamine mandelate is prescribed for a client with a urinary tract infection and renal calculi. Which finding indicates to the nurse that the medication is effective? A. The frequency of urinary tract infections decreases. B. The urine changes color and pain is diminished. C. The dipstick test changes from +1 to trace. D. The daily urinary output increases by 10%.

A. The frequency of urinary tract infections decreases. Mandelamine is prescribed to acidify the urine, decreasing the incidence of calcium phosphate calculi and urinary tract infections. Option B is related to the administration of pyridine. Mandelamine has no effect on option C or D.

A client receives an antihypertensive agent daily. Which action is most important for the nurse to implement prior to administering the medication? A. Verify the expiration date. B. Obtain the client's blood pressure. C. Determine the client's history of adverse reactions. D. Review the client's medical record for a change in drug route.

B. Obtain the client's blood pressure. (To determine the most accurate response to antihypertensive therapy, baseline blood pressures should be obtained before an antihypertensive drug is administered and should be compared with orthostatic vital signs to determine whether any side effects are occurring. Although options A, C, and D are required nursing actions prior to giving any drug, the therapeutic response should be determined before another dose is administered.)

A 6-year-old child is admitted to the emergency department with status epilepticus. His parents report that his seizure disorder has been managed with phenytoin, 50 mg PO bid, for the past year. Which drug should the nurse plan to administer in the emergency department? A. Phenytoin B. Diazepam C. Phenobarbital D. Carbamazepine

B. Diazepam (Diazepam is the drug of choice for treatment of status epilepticus. Options A, C, and D are used for the long-term management of seizure disorders but are not as useful in the emergency management of status epilepticus.)

In developing a nursing care plan for a 9-month-old infant with cystic fibrosis, the nurse writes a nursing diagnosis of alteration in nutrition: less than body requirements, related to inadequate digestion of nutrients. Which intervention would best meet this child's needs? A. Give aluminum hydroxide and magnesium hydroxide after meals. B. Give pancrelipase capsule mixed with applesauce before each meal. C. Administer cholestyramine resin before each meal and at bedtime. D. Administer omeprazole for gastroesophageal reflux.

B. Give pancrelipase capsule mixed with applesauce before each meal. (Pancreatic enzyme replacement with pancrelipase is a major component of cystic fibrosis nutritional management. Aluminum hydroxide and magnesium hydroxide may be given before meals with enzymes to reduce gastric acidity and prevent enzyme destruction but are ineffective when used alone to promote enzyme replacement. Options C and D are used to treat steatorrhea in cystic fibrosis.)

The health care provider prescribes the H2 antagonist famotidine, 20 mg PO in the morning and at bedtime. Which statement regarding the action of H2 antagonists offers the correct rationale for administering the medication at bedtime? A. Gastric acid secreted at night is buffered, preventing pepsin formation. B. Hydrochloric acid secreted during the night is blocked. C. The drug relaxes stomach muscles at night to reduce acid. D. Ingestion of the medication at night offers a sedative effect, promoting sleep.

B. Hydrochloric acid secreted during the night is blocked. H2 antagonists act on the parietal cells to inhibit gastric secretion. Some gastric secretion occurs all the time, even when the stomach is empty, unless medications are taken to inhibit this action. Options C and D are not actions of famotidine. Option A is the action of antacids. Antacids do not affect healing or prevent the recurrence of ulcers; they merely provide symptomatic relief. Knowing the difference between H2 antagonists and antacids is important when teaching clients.

A client is receiving acyclovir sodium IV for a severe herpes simplex infection. Which intervention should the nurse implement during this drug therapy? A. Maintain respiratory isolation precautions. B. Increase daily fluids to 2000 to 4000 mL/day. C. Administer with meals to decrease gastric irritation. D. Assess for signs of severe liver dysfunction.

B. Increase daily fluids to 2000 to 4000 mL/day. Increasing fluid intake during treatment prevents precipitation of the drug in the renal tubules, which could lead to obstructive problems that impair kidney function. Acute glomerulonephritis is a possible complication of acyclovir sodium therapy. Options A, C, and D are unrelated interventions for treatment with acyclovir sodium.

Dopamine is administered to a client who is hypotensive. Which finding should the nurse identify as a therapeutic response? A. Gain in weight B. Increase in urine output C. Improved gastric motility D. Decrease in blood pressure

B. Increase in urine output (Intropin activates dopamine receptors in the kidney and dilates blood vessels to improve renal perfusion, so an increase in urine output indicates an increase in glomerular filtration caused by increased arterial blood pressure. Option A is related to fluid retention but is not an indicator of a therapeutic response to dopamine therapy. Option C is not related to the vasopressor effect of dopamine therapy. Dopamine increases cardiac output, which increases a client's blood pressure, not option D.)

A client with HIV who was recently diagnosed with tuberculosis (TB) asks the nurse, "Why do I need to take all of these medications for TB?" What information should the nurse provide? A. Antiretroviral medications decrease the efficacy of the TB drugs. B. Multiple drugs prevent the development of resistant organisms. C. Duration of the medication regimen is shortened. D. Potential adverse drug reactions are minimized.

B. Multiple drugs prevent the development of resistant organisms. (A multidrug regimen is prescribed for a client with HIV and TB to prevent the development of resistance of the tubercle bacilli. Although antitubercular medications can inhibit some antiretrovirals, a multidrug regimen is needed to inhibit the proliferation of the virulent tubercle bacilli. The duration of antitubercular therapy is typically 6 to 9 months and is not shortened by the use of multiple medications. A client who is receiving HIV and TB therapy is at an increased risk of adverse reactions because of the complex medication regimens and complications secondary to immunosuppression.)

Which physiologic mechanism explains a drug's increased metabolism that is triggered by a disease process? A. Selectivity response B. Pharmacokinetics C. Pharmacodynamics D. Pharmacotherapeutics

B. Pharmacokinetics (Pharmacokinetics describes the physiologic process of a drug's movement throughout the body and how the drug's interaction is affected by an underlying disease. Selectivity, or a selective drug, is defined as a drug that elicits only the response for which it is given. Pharmacodynamics is the impact of drugs on the body. Pharmacotherapeutics is defined as the use of drugs to diagnose, prevent, or treat disease or prevent pregnancy.)

A client receiving a continuous infusion of heparin IV starts to hemorrhage from an arterial access site. Which medication should the nurse anticipate administering to prevent further heparin-induced hemorrhaging? A. Vitamin K1 B. Protamine sulfate C. Warfarin sodium D. Prothrombin

B. Protamine sulfate Protamine sulfate is the antagonist for heparin and is given for episodes of acute hemorrhage. Options A, C, and D are not heparin antagonists.

A client with acute lymphocytic leukemia is to begin chemotherapy today. The health care provider's prescription specifies that ondansetron is to be administered IV 30 minutes prior to the infusion of cisplatin. What is the rationale for administering Zofran prior to the chemotherapy induction? A. Promotion of diuresis to prevent nephrotoxicity B. Reduction or elimination of nausea and vomiting C. Prevention of a secondary hyperuricemia D. Reduction in the risk of an allergic reaction

B. Reduction or elimination of nausea and vomiting Ondansetron is a type 3 receptor (5-HT3) antagonist that is recognized for improved control of acute nausea and vomiting associated with chemotherapy. 5-HT3 antagonists are most effective when administered IV prior to the induction of the chemotherapeutic agent(s). Options A, C, and D are not therapeutic actions of ondansetron.

The nurse is preparing a plan of care for a client receiving the glucocorticoid methylprednisolone. Which nursing diagnosis reflects a problem related to this medication that should be included in the care plan? A. Ineffective airway clearance B. Risk for infection C. Deficient fluid volume D. Impaired gas exchange

B. Risk for infection Corticosteroids depress the immune system, placing the client at risk for infection. Although options A, C, and D reflect diagnostic statements that may be applicable to this client, only option B is directly related to the administration of this medication.

A client with angina pectoris is instructed to take sublingual nitroglycerin tablets PRN for chest pain. Which instruction should the nurse include in the client's teaching plan? A. Take one tablet every 3 minutes, up to five tablets. B. Take one tablet at the onset of angina and stop activity. C. Replace nitroglycerin tablets yearly to maintain freshness. D. Allow 30 minutes for a tablet to provide relief from angina.

B. Take one tablet at the onset of angina and stop activity. Nitroglycerin tablets should be taken at the onset of angina, and the client should stop activity and rest. One tablet can be taken every 5 minutes, up to three doses. Nitroglycerin should be replaced every 3 to 6 months, not every 12 months. Nitroglycerin should provide relief in 5 minutes, not 30 minutes.

A client being treated for an acute myocardial infarction is to receive the tissue plasminogen activator alteplase. The nurse would be correct in providing which explanation to the client regarding the purpose of this drug? A. This drug is a nitrate that promotes vasodilation of the coronary arteries. B. This drug is a clot buster that dissolves clots within a coronary artery. C. This drug is a blood thinner that will help prevent the formation of a new clot. D. This drug is a volume expander that improves myocardial perfusion by increasing output.

B. This drug is a clot buster that dissolves clots within a coronary artery. t-PA, or tissue plasminogen activator, is a coronary-specific fibrinolytic agent that dissolves clots within the coronary arteries. This drug is not a calcium channel blocker or nitrate, which would promote vasodilation of the coronary arteries. This medication is not an anticoagulant, such as warfarin or heparin, which would prevent new clot formation. Volume expansion is not provided by an infusion of t-PA and would not necessarily improve myocardial perfusion caused by an increased cardiac output in a client with coronary artery disease.

A client with chronic gouty arthritis is talking allopurinol, 100 mg PO daily. Which laboratory serum level should the nurse report to the health care provider to determine the therapeutic outcome? A. Prothrombin time B. Uric acid level C. White blood cell count D. Creatinine level

B. Uric acid level The primary therapeutic outcome associated with allopurinol therapy is reduced serum uric acid levels with a lower frequency of acute gouty attacks, so option B should be reported to the health care provider. Options A, C, and D are not related to the effectiveness of allopurinol.

A psychiatric client is discharged from the hospital with a prescription for haloperidol. Which instruction should the nurse include in the discharge teaching plan for this client? A. Take with antacids to reduce gastrointestinal irritation. B. Use sunglasses and sunscreen when outdoors. C. Eat foods low in fiber and salt. D. Count the pulse before each dose.

B. Use sunglasses and sunscreen when outdoors. Photosensitivity is a common adverse effect of haloperidol (Haldol); therefore, the use of sunglasses and sunscreen should be included in the discharge teaching for this client. Options A, C, and D are not pertinent to client teaching regarding the use of haloperidol (Haldol).

A 2-month-old infant is scheduled to receive the first DPT immunization. What is the preferred injection site to administer this immunization? A. Dorsal gluteal B. Vastus lateralis C. Ventral gluteal D. Deltoid

B. Vastus lateralis The preferred intramuscular site for children younger than 2 years is the vastus lateralis. Options A, C, and D are not preferred injection sites for the infant at 2 months of age.

Which statement indicates that client teaching regarding the administration of the chemotherapeutic agent daunorubicin HCl has been effective? A. "I should use an astringent mouthwash after every meal." B. "I will eat high-fiber foods and drink lots of water." C. "I expect my urine to be red for the next few days." D. "I should use sunscreen when I spend time outdoors."

C. "I expect my urine to be red for the next few days." Daunorubicin HCl causes the urine to turn red in color. Option A is not recommended. Options B and D are interventions that promote general good health but are not specific to treatment with daunorubicin HCl.

The nurse is preparing a teaching plan for a client who has received a new prescription for levothyroxine sodium. Which instruction should be included? A. "Take this medication with a high-protein snack at bedtime." B. "You may change at any time to a less expensive generic brand." C. "Take your pulse daily, and if it exceeds 100 beats/min, contact the health care provider." D. "Return to the clinic weekly for serum blood glucose testing."

C. "Take your pulse daily, and if it exceeds 100 beats/min, contact the health care provider." Levothyroxine sodium should be withheld if the pulse is over 100 beats/min. To prevent insomnia, the daily dose should be taken early in the morning before breakfast, not at bedtime. Product brands should not be changed without consulting the health care provider because the intended effects and side effects of different formulations of the medication can vary. The serum glucose level is not affected by thyroid preparations, so option D is not required.

Amoxicillin, 500 mg PO every 8 hours, is prescribed for a client with an infection. The drug is available in a suspension of 125 mg/5 mL. How many milliliters should the nurse administer with each dose? A. 10 B. 15 C. 20 D. 25

C. 20 500 mg/x mL = 125 mg/5 mL125x = 2500x = 20 mL

The charge nurse is reviewing the admission history and physical data for four clients newly admitted to the unit. Which client is at greatest risk for adverse reactions to medications? A. 30-year-old man with a fracture B. 7-year-old child with an ear infection C. 75-year-old woman with liver disease D. 50-year-old man with an upper respiratory tract infection

C. 75-year-old woman with liver disease (Impaired hepatic metabolic pathways for drug and chemical degradation place option C at greatest risk for adverse reactions to medications based on advancing age and liver disease. Options A and D have no predisposing factors, such as genetics, pathophysiologic dysfunction, or drug allergies, that would increase the risk for cumulative toxicity or adverse drug reactions. Option B is at risk for dose-related adverse reactions but is at less risk than option C.)

Which parameter is most important for the nurse to check prior to administering a subcutaneous injection of heparin? A. Heart rate B. Urinary output C. Activated partial thromboplastin time (aPTT) D. Prothrombin time (PT) and international normalized ratio (INR)

C. Activated partial thromboplastin time (aPTT) The laboratory value that measures heparin's therapeutic anticoagulation time is the aPTT. Option A should be checked before the administration of digoxin. Option B is valuable information but not a parameter measured for heparin therapy. Option D is evaluated during anticoagulation therapy using sodium warfarin.

For which clients should the nurse withhold the initial dose of a cyclooxygenase 2 (COX-2) inhibitor until notifying the health care provider? (Select all that apply.) A. A middle-aged adult with a history of tinnitus while taking aspirin B. A middle-aged adult with a history of polycystic ovarian disease C. An older adult with a history of a skin rash while taking glyburide (DiaBeta) D. An adolescent with a history of an anaphylactic reaction to penicillin E. An older adult with a history of gastrointestinal upset while taking naproxen sodium (Naprosyn) F. An adolescent at 34 weeks of gestation experiencing 1+ pitting edema

C. An older adult with a history of a skin rash while taking glyburide (DiaBeta) D. An adolescent with a history of an anaphylactic reaction to penicillin F. An adolescent at 34 weeks of gestation experiencing 1+ pitting edema (COX-2 inhibitors are contraindicated for those who are allergic to sulfa drugs (C), aspirin, and nonsteroidal antiinflammatory drugs (NSAIDs). Drug safety for adolescents (D and F) is not yet established, and COX-2 inhibitors, as well as NSAIDs, are contraindicated during the third trimester of pregnancy (F) because they can cause a premature closure of the patent ductus arteriosus. Tinnitus, an adverse reaction of aspirin (A), and ovarian disease (B) are not contraindications for the use of COX-2 inhibitors. Gastrointestinal upset is a common adverse reaction of NSAIDs (E) but is not a contraindication for the use of a COX-2 inhibitor.)

Which assessment datum indicates to the nurse that a dose of granisetron administered IV prior to chemotherapy has had the desired effect? A. Oral mucosa pink and intact B. Scalp intact without alopecia C. Client denies nausea D. Client denies pain

C. Client denies nausea (Granisetron is an antiemetic administered before chemotherapy to prevent chemotherapy-induced nausea and vomiting.)

Which factor is most important to ensure compliance when planning to teach a client about a drug regimen? A. Genetics B. Client age C. Client education D. Absorption rate

C. Client education (The client's educational level is the most important factor when planning teaching to ensure a client's compliance with taking a prescribed drug. Options A and D are physiologic responses that do not relate to a client's compliance. Although maturity level and age contribute to compliance, the client's basic understanding of instructions, which is best indicated by educational level, is more significant.)

A client with viral influenza is receiving vitamin C, 1000 mg PO daily, and acetaminophen elixir, 650 mg PO every 4 hours PRN. The nurse calls the health care provider to report that the client has developed diarrhea. Which change in prescriptions should the nurse anticipate? A. Change the acetaminophen to ibuprofen. B. Change the elixir to an injectable route. C. Decrease the dose of vitamin C. D. Begin treatment with an antibiotic.

C. Decrease the dose of vitamin C. (Diarrhea is an adverse effect of high doses of vitamin C, so the nurse should anticipate a reduction in the dose of vitamin C. Acetaminophen does not cause diarrhea and is not available in an injectable form. Because the client has a viral infection, option D will not be beneficial.)

A client with mild parkinsonism is started on oral amantadine. Which statement accurately describes the action of this medication? A. Viral organisms that provide the underlying pathophysiology for parkinsonism are eliminated. B. Acetylcholine in the myoneural junction is enhanced. C. Dopamine in the central nervous system is increased. D. Norepinephrine release is reduced within the peripheral system as the final step in dopamine uptake.

C. Dopamine in the central nervous system is increased. (Amantadine is a dopamine-releasing agent; therefore, this medication increases the amount of dopamine present in the central nervous system. Although this medication is also an antiviral agent, the antiviral effect is not significant in the treatment of parkinsonism. Options B and D are not affected by amantadine.)

A 55-year-old client was diagnosed with schizophrenia 5 years earlier. Numerous hospitalizations have occurred since the diagnosis because of noncompliance with the prescribed medication regimen. Which drug might work best for this particular client? A. Chlorpromazine HCl B. Lithium carbonate C. Fluphenazine decanoate D. Diazepam

C. Fluphenazine decanoate Fluphenazine, an antipsychotic drug that can be given IM, has a rapid onset (1 to 2 hours) and a long duration of action (up to 3 or 4 weeks), so it would be the drug of choice for a noncompliant psychotic client. Option A is an antipsychotic drug used to treat schizophrenia and is usually administered PO (IM doses are short-acting). The client must be compliant in taking this drug for it to be effective. Option B is most effective with manic and depressive bipolar affective disorders. Option D is an antianxiety drug and would not be effective for a psychotic disorder.

The nurse is preparing to administer the disease-modifying antirheumatic drug (DMARD) methotrexate to a client diagnosed with rheumatoid arthritis. Which intervention is most important to implement prior to administering this medication? A. Assess the client's liver function test results. B. Monitor the client's intake and output. C. Have another nurse check the prescription. D. Assess the client's oral mucosa.

C. Have another nurse check the prescription. (Double-checking the prescription is an important intervention because death can occur from an overdose. This medication is administered weekly and in low doses for rheumatoid arthritis and should not be confused with administration of the drug as a chemotherapeutic agent. Options A and B are appropriate interventions for those who are receiving this drug, but they are not the most important interventions. Stomatitis is an expected side effect of this medication.)

A client is prescribed a cholinesterase inhibitor, and a family member asks the nurse how this medication works. Which pharmacophysiologic explanation should the nurse use to describe this class of drug? A. Promotes excretion of neurotoxins. B. Slows nerve cell degeneration. C. Improves nerve impulse transmission. D. Stimulates nerve cell regeneration.

C. Improves nerve impulse transmission. Cholinesterase inhibitors work to increase the availability of acetylcholine at cholinergic synapses, which aids in neuronal transmission and assists in memory formation. Basing an explanation on this concept, option C should provide an accurate explanation that the family can understand. Options A, B, and D are incorrect.

A client taking linezolid at home for an infected foot ulcer calls the home care nurse to report the onset of watery diarrhea. Which intervention should the nurse implement? A. Schedule appointments to obtain blood samples for drug peak and trough levels. B. Reassure the client that this is an expected side effect that will resolve in a few days. C. Instruct the client to obtain a stool specimen to be taken to the laboratory for analysis. D. Advise the client to begin taking an over-the-counter antidiarrheal agent.

C. Instruct the client to obtain a stool specimen to be taken to the laboratory for analysis. (Antibiotics, such as linezolid, can cause pseudomembranous colitis, resulting in severe watery diarrhea. The prescriber should be notified, and a stool specimen should be obtained and analyzed for this complication. Severe diarrhea is not an indication of drug toxicity, so option A is not warranted. Although gastrointestinal disturbance can be an adverse effect of linezolid, a stool specimen should be obtained because the client reports the diarrhea is severe. Antidiarrheal medications are contraindicated in the presence of this colitis and should not be started until this potential complication is ruled out.)

The nurse is scheduling a client's antibiotic peak and trough levels with the laboratory personnel. What is the best schedule for drawing the trough level? A. Give the dose of medication, and call the laboratory to draw the trough STAT. B. Arrange for the laboratory to draw the trough 1 hour after the dose is given. C. Instruct the laboratory to draw the trough immediately before the next scheduled dose. D. Give the first dose of medication after the laboratory reports that the trough has been drawn.

C. Instruct the laboratory to draw the trough immediately before the next scheduled dose. The best time to draw a trough is the closest time to the next administration. Option A will provide a peak level. Option B will not provide the most accurate trough level. The medication is given before peak and trough levels are obtained.

The health care provider prescribes carbamazepine for a child whose tonic-clonic seizures have been poorly controlled. The nurse informs the mother that the child must have blood tests every week. The mother asks why so many blood tests are necessary. Which complication is assessed through frequent laboratory testing that the nurse should explain to this mother? A. Nephrotoxicity B. Ototoxicity C. Myelosuppression D. Hepatotoxicity

C. Myelosuppression Myelosuppression is the highest priority complication that can potentially affect clients managed with carbamazepine therapy. The client requires close monitoring for this condition by weekly laboratory testing. Hepatic function may be altered, but this complication does not have as great a potential for occurrence as option C. Options A and B are not typical complications of carbamazepine therapy.

A client who has chronic back pain is on long-term pain medication management and asks the nurse why his pain relief therapy is not as effective as it was 2 months ago. How should the nurse respond? A. The phenomenon occurs when opiates are used for more than 6 months to relieve pain. B. Withdrawal occurs if the drug is not tapered slowly while being discontinued. C. Pharmacodynamic tolerance requires increased drug levels to achieve the same effect. D. A consistent dosage with around-the-clock administration is the most effective.

C. Pharmacodynamic tolerance requires increased drug levels to achieve the same effect. Pharmacodynamic tolerance explains the client's need for an increased drug level to produce effects that formerly occurred at lower drug levels. Tolerance can occur with opioids during shorter periods of use. Although a withdrawal syndrome can occur if the client develops a dependency, this does not address the client's immediate concern of drug effectiveness. Although a stable serum drug level provides effective pain management, the client's complaint is consistent with a tolerance to his current pain management regimen.

A client receives pancuronium, a long-acting, nondepolarizing neuromuscular blocker, during surgical anesthesia. Which client situation should alert the nurse to evaluate the client for a prolonged muscle relaxation response to this medication? A. Hepatitis B. Heart failure C. Renal insufficiency D. History of emphysema

C. Renal insufficiency Pancuronium is eliminated via the kidneys, so a client with renal failure is at risk for prolonged muscle relaxation. Although hepatitis can interfere with this drug's metabolism, it does not place a client at increased risk for prolonged muscle relaxation. Options B and D do not cause prolonged muscle relaxation in a client who receives pancuronium.

During administration of theophylline, the nurse should monitor for signs of toxicity. Which symptom would cause the nurse to suspect theophylline toxicity? A. Dry mouth B. Urinary retention C. Restlessness D. Sedation

C. Restlessness Restlessness is a sign of theophylline intoxication. Other signs of toxicity are anorexia, nausea, vomiting, insomnia, tachycardia, arrhythmias, and seizures. Options A, B, and D are common side effects of antihistamines but do not indicate theophylline intoxication.

A client who is HIV-positive is receiving combination therapy with the antiviral medication zidovudine. Which instruction should the nurse include in this client's teaching plan? A. Take the drug as prescribed to cure HIV infections. B. Use the drug to reduce the risk of transmitting HIV to sexual contacts. C. Return to the clinic every 2 weeks for blood counts. D. Report to the health care provider immediately if dizziness is experienced.

C. Return to the clinic every 2 weeks for blood counts. Bone marrow depression with granulocytopenia is a severe but common adverse effect of zidovudine. Careful monitoring of CBCs is indicated. Options A and B are not correct instructions related to use of this medication. Option D is an expected side effect. The client should be instructed to avoid driving until this reaction improves.

A client who is receiving chlorpromazine HCl to control his psychotic behavior also has a prescription for benztropine. When teaching the client and/or significant others about these medications, what should the nurse explain about the use of benztropine in the treatment plan for this client? A. This medication will reduce the side effect of urinary retention. B. This drug potentiates the effect of chlorpromazine HCl. C. The benztropine is used to control extrapyramidal symptoms. D. The combined effect of these drugs will modify psychotic behavior.

C. The benztropine is used to control extrapyramidal symptoms. Benztropine, an anticholinergic drug, is used to control extrapyramidal symptoms associated with chlorpromazine HCl (Thorazine) use. Options A, B, and D are not accurate statements regarding the use of benztropine for clients who are treated with chlorpromazine HCl for the control of psychosis.

A 45-year-old female client is receiving alprazolam for anxiety. Which client behavior would indicate that the drug is effective? A. Personal hygiene is maintained by the client for the first time in a week. B. The client has an average resting heart rate of 120 beats/min. C. The staff observes the client sitting in the day room reading a book. D. The nurse records that the client lost 2 lb of body weight in the past week.

C. The staff observes the client sitting in the day room reading a book. (The ability to sit and concentrate on reading indicates decreased anxiety. Options A, B, and D are not related to the use of alprazolam for anxiety.)

Alteration of which laboratory finding represents the achievement of a therapeutic goal for heparin administration? A. Prothrombin time (PT) B. Fibrin split products C. Platelet count D. Partial thromboplastin time (PTT)

D. Partial thromboplastin time (PTT)

The nurse has completed diabetic teaching for a client who has been newly diagnosed with diabetes mellitus. Which statement by this client would indicate to the nurse that further teaching is needed? A. "Regular insulin can be stored at room temperature for 30 days." B. "My legs, arms, and abdomen are all good sites to inject my insulin." C. "I will always carry hard candies to treat hypoglycemic reactions." D. "When I exercise, I should plan to increase my insulin dosage."

D. "When I exercise, I should plan to increase my insulin dosage." Exercise helps facilitate the entry of glucose into the cell, so increasing insulin doses with exercise would place the client at high risk for a hypoglycemic reaction. Options A, B, and C reflect accurate statements about the use of insulin and management of hypoglycemic reactions.

A client is ordered 22 mg of gentamicin by IM injection. The drug is available in 20 mg/2 mL. How many milliliters should be administered? A. 1.8 B. 2.0 C. 2.4 D. 2.2

D. 2.2 ((22 mg/20 mg) × (x mL/2 mL) = 22x = 40x = 2.2 mL)

The nurse is preparing to administer a secondary infusion of a dobutamine solution to a client. The nurse notes that the solution is brown in color. Which action should the nurse implement? A. Verify the prescribed dose with the health care provider. B. Discard the solution and reorder from the pharmacy. C. Dilute the solution with more normal saline until it becomes lighter in color. D. Administer the drug if the solution's reconstitution time is <24 hours.

D. Administer the drug if the solution's reconstitution time is <24 hours.

A mother brings her 18-month-old child to the community health center because the child has had "bad diarrhea" for the last 3 days. She states, "I bought some of this liquid at the pharmacy and gave my daughter a half-ounce." The nurse sees that the bottle contains loperamide. Which intervention is most important for the nurse to implement initially? A. Tell the mother never to give this drug to her toddler. B. Ask if any other siblings have experienced diarrhea. C. Take the child's oral and tympanic temperatures. D. Ask the mother when the child last voided.

D. Ask the mother when the child last voided. Determining when the child last voided is most important because urine output is decreased with dehydration and an 18-month-old with a 3-day history of diarrhea could be severely dehydrated. Although the manufacturer states that loperamide should not be given to a child younger than 2 years except under the direction of a health care provider, option A is not the best answer for this question. In addition, loperamide causes an anticholinergic effect of urinary retention. Data obtained in options B and C are not as high a priority as option D in this situation.

The health care provider prescribes ipratropium for a client. An allergic reaction to which other medication would cause the nurse to question the prescription for? A. Albuterol B. Theophylline C. Metaproterenol D. Atropine sulfate

D. Atropine sulfate (Clients who have experienced allergic reactions to atropine sulfate and belladonna alkaloids may also be allergic to ipratropium, so the prescription for Atrovent should be questioned.)

Which instruction should the nurse include in the teaching plan for a client who is receiving phenytoin for seizure control? A. Maintain consistent sodium intake. B. Use sunscreen when outdoors. C. Return for monthly urinalysis. D. Brush and floss teeth daily.

D. Brush and floss teeth daily. Brushing and flossing the teeth daily prevent gingival hyperplasia (gum disease) that is common with long-term phenytoin therapy. Options A, B, and C are not indicated for client instruction regarding phenytoin.

A client who has trouble swallowing pills intermittently has been prescribed venlafaxine (XR) for depression. The medication comes in capsule form. What should the nurse include in the discharge teaching plan for this client? A. Capsule contents can be sprinkled on pudding or applesauce. B. Chew the medication thoroughly to enhance absorption. C. Take the medication with a large glass of water or juice. D. Contact the health care provider for another form of medication.

D. Contact the health care provider for another form of medication. Venlafaxine is administered PO in capsule form. Capsules that are extended-release (XR) or continuous-release (CR) contain delayed-release, enteric-coated granules to prevent decomposition of the drug in the acidic pH of the stomach. The client should notify the health care provider about the inability to swallow the capsule. This medication should not be chewed or opened so that the delayed-release, enteric-coated granules can remain intact. Water or juice will not affect the medication.

When developing a written nursing care plan for a client receiving chemotherapy for treatment of cancer, the nurse writes, "Assess each voiding for hematuria." The administration of which type of chemotherapeutic agent would prompt the nurse to add this intervention? A. Vincristine B. Bleomycin sulfate C. Chlorambucil D. Cyclophosphamide

D. Cyclophosphamide Hemorrhagic cystitis is the characteristic adverse reaction of cyclophosphamide. Administration of options A, B, and C does not typically cause hemorrhagic cystitis.

Which response best supports the observations that the nurse identifies in a client who is experiencing a placebo effect? A. Beneficial response or cure for disease B. Behavioral or psychotropic responses C. Malingering or drug-seeking behaviors D. Psychological response to inert medication

D. Psychological response to inert medication (The placebo effect is a response in the client that is caused by the psychological impact of taking an inert drug that has no biochemical properties. A placebo effect can be therapeutic, negative, or ineffective but provides no cure or benefit to the client's progress. The placebo effect may evoke behavioral changes but does not affect neurochemical psychotropic changes. Malingering and drug seeking are behaviors that a client exhibits to obtain treatment for nonexistent disorders or obtain prescription medications.)

A female client with myasthenia gravis is taking a cholinesterase inhibitor and asks the nurse what can be done to remedy her fatigue and difficulty swallowing. What action should the nurse implement? A. Explore a plan for development of coping strategies for the symptoms with the client. B. Explain to the client that the dosage is too high, so she should skip every other dose of medication. C. Advise the client to contact her health care provider because of the development of tolerance to the medication. D. Develop a teaching plan for the client to self-adjust the dose of medication in response to symptoms.

D. Develop a teaching plan for the client to self-adjust the dose of medication in response to symptoms. (Maintaining optimal dosage for cholinesterase inhibitors can be challenging for clients with myasthenia gravis. Clients should be taught to recognize signs of overmedication and undermedication so that they can modify the dosage themselves based on a prescribed sliding scale. Options A, B, and C do not adequately address the client's concerns.)

Which medication is useful in treating digoxin toxicity? A. Atropine sulfate B. Isoproterenol C. Xylocaine D. Digoxin immune Fab

D. Digoxin immune Fab Digibind is useful in treating this type of drug toxicity because it is an antibody that binds antigenically to unbound serum digoxin or digitoxin, resulting in renal excretion of the bound complex. Options A, B, and C are not used to treat digitoxin toxicity.

A client is being discharged with a prescription for sulfasalazine to treat ulcerative colitis. Which instruction should the nurse provide to this client prior to discharge? A. Maintain good oral hygiene. B. Take the medication 30 minutes before a meal. C. Discontinue use of the drug gradually. D. Drink at least eight glasses of fluid a day.

D. Drink at least eight glasses of fluid a day. (Adequate hydration is important for all sulfa drugs because they can crystallize in the urine. If possible, the drug should be taken after eating to provide longer intestinal transit time. Option A is important for other medications, such as phenytoin, because of the incidence of gingival hyperplasia, and option C is important for steroid administration, but option D is most important to stress with this client.)

Prior to administering a scheduled dose of digoxin, the nurse reviews the client's current serum digoxin level, which is 1.3 ng/dL. Which action should the nurse implement? A. Administer Digibind to counteract the toxicity. B. Withhold the drug and notify the health care provider immediately. C. Withhold the dose and notify the health care provider during rounds that the dose was held. D. Give the dose of digoxin if the client's heart rate is within a safe range.

D. Give the dose of digoxin if the client's heart rate is within a safe range. (The client's digoxin level of 1.3 ng/dL is not above the upper range of its therapeutic index (toxic level is >2.0 ng/dL), so the dose should be administered after the client's heart rate is evaluated. Digibind is administered for toxic levels of digoxin, so option A is not indicated. Options B and C are not necessary.)

A male client asks the nurse why condoms should not be lubricated with the spermicide nonoxynol-9. Which response is best for the nurse to provide? A. The risk of female infertility and spontaneous abortion is linked with nonoxynol-9. B. Partners can develop intermittent interstitial cystitis if the spermicide is used after the expiration date. C. The spermicide decreases the amount of vaginal and penile sensitivity for up to 8 to 12 hours. D. Nonoxynol-9 provides no protection from STDs and has been linked to the transmission of HIV.

D. Nonoxynol-9 provides no protection from STDs and has been linked to the transmission of HIV. (The use of condoms and a water-based spermicide is recommended because nonoxynol-9 can cause a rash that allows viruses a portal of entry if the condom breaks, which increases the risk of transmission of sexually transmitted diseases (STDs), such as human immunodeficiency virus (HIV), herpes, human papillomavirus (HPV), or hepatitis B virus (HBV). Options A and B are inaccurate. Nonoxynol-9 may cause vaginal irritation, not option C.)

The nurse notes that the hemoglobin level of a client receiving darbepoetin alfa has increased from 6 to 10 g/dL over the first 2 weeks of treatment. Which action should the nurse take? A. Encourage the client to continue the treatment, because it is effective. B. Advise the client that the dose will need to be increased. C. Assess the client's skin color for continued pallor or cyanosis. D. Notify the health care provider of the change in the client's laboratory values.

D. Notify the health care provider of the change in the client's laboratory values. Although an increase in the client's hemoglobin level is desired, a rapid increase (more than 1 g/dL in a 2-week period) may lead to hypertension, so the health care provider should be notified of this excessive increase. Options A and B may lead to a dangerous increase in blood pressure. Because the client's anemia has improved, option D is of greater priority than continuing to monitor for signs of anemia.

The nurse is reviewing prescribed medications with a female client who is preparing for discharge. The client asks the nurse why the oral dose of an opioid analgesic is higher than the IV dose that she received during hospitalization. Which response is best for the nurse to provide? A. A higher dose of analgesic medication may be needed after discharge. B. An error in the dose calculation may have occurred when the prescribed dose was converted. C. The doses should be the same unless the pain is not well controlled. D. Oral forms of drugs must pass through the liver first, where more of the dose is metabolized.

D. Oral forms of drugs must pass through the liver first, where more of the dose is metabolized. (Oral doses of medication are usually larger than parenteral doses to compensate for the first-pass effect in the liver after oral administration, which metabolizes more of the drug's dose before affecting its therapeutic response. Although recommended dose ranges for adults should be individualized, a client's pain should be controlled at discharge, not option A or C. Option B is inaccurate information to convey to the client.)

A client who is experiencing an acute attack of gouty arthritis is prescribed colchicine USP, 1 mg PO daily. Which information is most important for the nurse to provide the client? A. Take the medication with meals. B. Limit fluid intake until the attack subsides. C. Stop the medication when the pain resolves. D. Report any vomiting to the clinic.

D. Report any vomiting to the clinic. (The client should be instructed to report signs of colchicine toxicity, such as nausea, diarrhea, vomiting, and/or abdominal pain, to the health care provider. Food inhibits the absorption of colchicine when ingested concurrently. Limited fluid intake decreases the excretion of the uric acid crystals, which contributes to painful attacks. Typically, a client should remain on a daily dose of colchicine to decrease the number and severity of acute attacks, so stopping the medication after the pain resolves is not indicated.)

An older client who had a colon resection yesterday is receiving a constant dose of hydromorphone via a patient-controlled analgesia (PCA) pump. Which assessment finding is most significant and requires that the nurse intervene? A. The client is drowsy and complains of pruritus. B. Pupils are 3 mm; PERRLA. C. The area around the sutures is reddened and swollen. D. Respirations decrease to 14 breaths/min.

D. Respirations decrease to 14 breaths/min. Hydromorphone is an opioid agonist-analgesic of opiate receptors that inhibits ascending pathways and can cause respiratory depression. Older adults are more sensitive to opioids so the "start low and go slow" approach should be taken. Option A lists common side effects of opioids, particularly the opiates, which are usually harmless and often transient. Option B is within the normal range (2 to 6 cm). The suture site may be red and swollen as an inflammatory response, but no action is required if the skin around the incision is a normal color and temperature.

The nurse knows that certain antipsychotic drugs cause extrapyramidal symptoms. Which extrapyramidal symptom is a permanent and irreversible adverse effect of long-term phenothiazine administration? A. Dystonia B. Akathisia C. Pseudoparkinsonism D. Tardive dyskinesia

D. Tardive dyskinesia