Medsurg2 prep u Pharmacology and Medication Management

2/10 1800 19-year-old client with mild concussion after slipping in school parking lot three hours prior. No loss of consciousness. No appreciable neurological deficits. CT scan normal. Client was preparing for discharge. Now reports a 5/10 headache. Acetaminophen PO prescribed. When offered acetaminophen, the client's parents tell the nurse that they would like their child to have something stronger. What is the nurse's best response?

"Opioids are avoided following a head injury because they may hide a deteriorating condition."

A client has just received a renal transplant, and has started cyclosporine therapy. What is the most important information for the nurse to share with this client?

"Report any fever, a flushed feeling, or lethargy."

The nurse has taught a family about the medication donepezil. The nurse determines that teaching has been successful when the family states

"This drug may slow their pulse, since they have pre-existing heart disease."

A nurse is talking to a client with bulimia nervosa about the complications of laxative abuse. Which client statement indicates an understanding of the risks?

"Using laxatives prevents the absorbtion of essential nutrients."

The home health nurse is speaking to the wife of a client with neurocognitive disorder due to Alzheimer's disease. The client has been taking donepezil. The nurse is most concerned when the caregiver states

"Yesterday, I managed to weigh my husband, and he has lost 8 lbs this month."

Five days after running out of medication, a client taking clonazepam tells the nurse, "I know I shouldn't have just stopped the drug like that, but I'm OK." What is the nurse's most appropriate response?

"You could go through withdrawal symptoms for up to two weeks."

A nurse is administering vitamin K to a preterm neonate following delivery. The medication comes in a concentration of 2 mg/ml, and the ordered dose is 0.5 mg to be given subcutaneously. How many milliliters should the nurse administer? Record your answer using two decimal places.

0.25

A 13-year-old client admitted with a fractured femur had an open reduction and internal fixation (ORIF) 12 hours ago. The client is reporting pain 8 out of 10 on the numeric pain scale. The provider has ordered ketorolac 20 mg to be administered I.V. every 6 hours. The pharmacy sends over ketorolac 50 mg/1 ml. How many milliliters will the nurse administer for the correct dosage? Record your answer using one decimal place.

0.4

Treatment for a child with symptomatic bradycardia includes atropine 0.02 mg/kg/dose. If the child weighs 44.1 lb (20 kg), how much should be given per dose?

0.4 mg

A 12-year-old child sustains a moderate burn injury. The parent reports that the child last received a tetanus injection at 5 years of age. Which immunization would the nurse anticipate for this child?

0.5 ml of tetanus toxoid I.M.

A client with a spinal cord injury has dexamethasone 16 mg ordered .IV. The drug vial contains 24 mg/ml. The nurse plans to use a tuberculin syringe to measure the dose. How much should the nurse draw up to give to this client? Record your answer using two decimal places.

0.67

The healthcare provider orders heparin, 7,500 units subcutaneous, for a client who had a left total hip replacement secondary to osteoarthritis. The pharmacy sent heparin 5,000 units/0.5 ml to the unit. How many milliliters should the nurse administer to this client? Record your answer using two decimal places?

0.75

The healthcare provider orders 2 g of ampicillin in 50 ml of D5W, to infuse I.V. piggyback (IVPB) over 30 minutes, for a client who had a right total knee replacement secondary to osteoarthritis. At what rate would the nurse set the I.V. infusion pump in milliliters per hour? Record your answer using a whole number.

100

A pediatric client is to receive furosemide 4 mg/kg/day in 1 daily dose. The client weighs 20 kg. The oral solution comes as 8mg/ml. How many teaspoons should be administered in each dose? Record your answer using a whole number.

2

A 10-year-old child is admitted with asthma. The health care provider orders a methylprednisolone loading dose of 3 mg/kg. The child weighs 30 kg. It comes as a solution of 40 mg/ml. How many milliliters should the child receive? Record your answer using two decimal places.

2.25

The nurse prepares to give penicillin to a client with osteomyelitis. The healthcare provider has ordered 700 mg IM. The vial is a mix-o-vial containing drug powder and sterile water for injection. When mixed together the vial contains 1 g/3.4 ml. How much should the nurse draw up to give this client? Record your answer using one decimal place.

2.4

A child is given 0.5 mg/kg/day of prednisone divided into two doses. The child weighs 22 lb (10 kg). How much is given in each dose?

2.5 mg

A 22 lb (10 kg) child is diagnosed with Kawasaki disease and started on gamma globulin therapy. The provider orders an I.V. infusion of gamma globulin, 2 g/kg, to run over 12 hours. What is the correct dose? Record your answer using a whole number.

20

The provider has ordered an I.V. of 5% dextrose in lactated Ringer's solution at 125 ml/hr. The I.V. tubing delivers 10 gtts/ml. How many gtts/min should fall into the drip chamber?

20 to 21

An infant who weighs 17.6 lb (8 kg) is to receive ampicillin 25 mg/kg IV q6h. How many milligrams should the nurse administer per dose? Record your answer using a whole number.

200

An unconscious client with moderate hyperkalemia is prescribed 50 grams of sodium polystyrene sulfonate rectally. The medication is supplied as a 15 g/60 mL suspension. How many milliliters of sodium polystyrene sulfonate should the nurse administer? Record your answer as a whole number.

200

A nurse is verifying a medication calculation completed by a nursing student prior to administration. The adult client is to receive ampicillin 150 mg/kg/day I.V. divided in 6 even doses with a maximum dose of 12 g/day. The client's weight is 80 kg. How many mg/dose will the client receive? Record your answer using whole number.

2000

A child is receiving I.V. gamma globulin for treatment of Kawasaki disease. The order is for 8 g over 12 hours. The concentration is 8 g in 300 ml of normal saline. How many milliliters per hour will this child receive? Record your answer using a whole number.

25

A client, with heart failure, is receiving furosemide, 40 mg IV. The provider orders 40 mEq of potassium chloride in 100 ml of dextrose 5% in water, to infuse over four hours. The client's most recent serum potassium level is 3.0 mEq/L. At which infusion rate should the nurse set the IV pump? Record your answer using a whole number.

25

The nurse administers 1500 ml of lactated Ringers over 6 hours to a 12-year-old child with partial and full thickness burns over 40% of the body. How many milliliters per hour should this child receive? Record your answer using a whole number.

250

A client who weighs 165 lb (75 kg) with a pulmonary embolus is prescribed heparin 18 units/kg/hr by IV infusion. The heparin is supplied as 25,000 units in a 500-ml bag. At what hourly rate should the pump be running to deliver the prescribed amount of heparin each hour? Record your answer using a whole number.

27

A client with a history of hypertension has just had a total hip replacement. The provider orders hydrochlorothiazide 35 mg oral solution po/day. The label on the solution reads hydrochlorothiazide 50 mg/5 ml. How many milliliters should the nurse pour to administer the correct dose? Record your answer using one decimal place.

3.5

Which client would be most at risk for secondary Parkinson's disease caused by pharmacotherapy?

30-year-old client with schizophrenia who is taking chlorpromazine

A child is prescribed high-dose aspirin as part of the therapy for Kawasaki disease. The order is for 80 mg/kg/day PO in four divided doses until the child is afebrile. The child weighs 33.1 lb (15 kg). How many milligrams is given in one dose? Record your answer using a whole number.

300

A child undergoing chemotherapy is clinically dehydrated. The provider orders a 200 ml of I.V. fluid to be administered over 2 hours. The drop factor is 20. At what flow rate should the pump be set? Record your answer as a whole number.

33

A client, weighing 132 lb (60 kg), is to receive phenobarbital 2mg/kg/day to be given in a divided into three equal doses. How many milligrams of phenobarbital will the client receive in each dose? Record your answer using a whole number?

40

A 65-year-old client, who is experiencing a stroke, has been ordered alteplase. The order is for 0.9 mg/kg over one hour. The client weighs 110 lb (50 kg). What is the total dose in milligrams (mg) that the client will receive? Record your answer using a whole number.

45

A client is admitted with a diagnosis of diabetic ketoacidosis. An insulin drip is initiated with 50 units of insulin in 100 ml of normal saline solution. The I.V. is being infused via an infusion pump, and the pump is currently set at 10 ml/hr. How many units of insulin each hour is this client receiving? Record your answer using whole number.

5

A nurse is caring for a child taking prednisone following a heart transplant. The child's pre-surgical weight was 25.6 lb (11.6 kg). The practitioner orders the child to receive 2 mg/kg/day divided every six hours. The oral solution comes prepared as 5 mg/5ml. How many milliliters will the child receive with each dose? Record your answer using one decimal place.

5.8

After undergoing small-bowel resection, a client is prescribed metronidazole 500 mg I.V. The mixed I.V. solution contains 100 milliliters. A nurse is to run the drug over 30 minutes. The drip factor of the available I.V. tubing is 15 gtt/ml. What is the drip rate? Record your answer using a whole number.

50

A client with symptoms of acute asthma is ordered I.V. aminophylline 350 mg in 100 ml to be administered over 30 minutes. The nurse has vials of I.V. aminophylline labeled 250 mg/5 ml. How many milliliters of fluid contain the dose ordered? Record your answer using a whole number.

7

The nurse receives an order to administer 350 mg of amoxicillin to a toddler po/q6h. The pharmacy supplies the amoxicillin with a concentration of 250 mg/5 ml. How many milliliters would the nurse give for each dose? Record the answer using a whole number:

7

A client calls the clinic worried about experiencing new symptoms after taking antipsychotic medicine. The client reports persistent, uncontrollable restlessness of the limbs and head despite improvement in psychotic symptoms. What is the most appropriate intervention by the nurse?

Direct the client to see the provider for medication to address these side effects.

A nurse is caring for a 7-year-old client receiving cyclophosphamide. In addition to administering mesna, which action should the nurse take?

Encourage the child to void frequently.

A client who received massive packed red blood cell (PRBC) blood transfusions due to trauma has a potassium level of 7.1 mEq/L (7.1 mmol/L). Which medication should the nurse expect to administer?

I.V. insulin

The nurse is planning discharge teaching for a client who will continue taking the prescribed warfarin at home. What early symptoms of occult blood loss should the nurse teach the client?

Increasing fatigue and shortness of breath.

The nurse and occupational therapist are planning an outdoor volleyball game and picnic for eight mental health clients. What action should the nurse take for the two clients taking nortriptyline for depression?

Provide protective clothing and apply sunscreen before going out.

A 20-month-old toddler has been treated with permethrin for scabies. The toddler's parent asks, "Is this medication working? My child is still itching." Which response by the nurse is most appropriate?

Pruritus can be present for weeks after treatment.

A nurse is teaching a client who received a dose of Rho(D) immune globulin at 28 weeks' gestation to prevent Rh isoimmunization. Which statement most accurately describes isoimmunization?

Rh-positive fetal blood crosses into maternal blood, stimulating maternal antibodies.

The nurse is performing discharge teaching for a school-aged child who experienced an asthma attack. What is the most important information the nurse can provide this client about the prescription for budesonide?

Rinse the mouth after using this medication.

The nurse is providing information to a client who is taking chlorpromazine. What is the most important information for the nurse to provide?

Schedule routine medication checks.

A client has been receiving oxytocin to augment her labor. The nurse notes that contractions are lasting 100 seconds. Which immediate action should the nurse take?

Stop the oxytocin infusion.

One hour after receiving pyridostigmine bromide for myasthenia gravis, a client reports difficulty swallowing and excessive respiratory secretions. What medication would the nurse anticipate to reverse the effects of pyridostigmine bromide?

atropine

A client is taking finasteride. The nurse is most concerned when this client manifests

azotemia.

A client, recovering from a spinal cord injury, has a great deal of spasticity. Which medication would the nurse anticipate to relieve spasticity?

baclofen

A nurse administers oxytocin to a client to induce labor. Which finding would indicate to the nurse that this client requires an immediate intervention?

contractions longer than 70 seconds, occurring every 2 minutes or less

The nurse notes an infant client with tetralogy of Fallot developed cyanosis and applies supplemental oxygen. What assessment finding should the nurse document as evidence of a positive response to oxygen therapy?

decreased agitation and restlessness

The nurse is teaching the family of a client with a psychiatric disorder about traditional antipsychotic drugs and their effect on symptoms. Which symptom would be most responsive to these types of drugs?

delusions

An adolescent client ingests a large number of acetaminophen tablets in an attempt to commit suicide. Which laboratory result is most consistent with acetaminophen overdose?

elevated liver enzyme levels

A nurse is reviewing the healthcare provider's orders for a client admitted with systemic lupus erythematosus (SLE). Which medication would the nurse expect to find in this client's plan of care?

hydroxychloroquine

One hour after I.V. furosemide has been administered to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which electrolyte imbalance should the nurse suspect?

hypokalemia

A nurse is assessing a client with bipolar disorder. The client tells the nurse that the family health care provider prescribed lithium. Which symptom would indicate that the client is developing lithium toxicity?

lethargy

A laboring client in the latent stage of labor begins reporting pain in the epigastric area, blurred vision, and a headache. Which medication would the nurse anticipate for these symptoms?

magnesium sulfate

A client being treated for an asthma attack is not responding and deemed to be in status asthmaticus. The nurse administers the prescribed treatments to accomplish what primary goal?

maintenance of independent ventilation

A client with joint pain, tenderness and swelling has been admitted to the hospital. A disease modifying anti-rheumatic drug (DMARD) is prescribed by the healthcare provider. Which medication should the nurse expect to administer?

methotrexate

What is the nurse's priority action when administering phenytoin to a client intravenously?

mix phenytoin with saline solution only

A client reports pain one day after a colostomy. The nurse administers 4 milligrams morphine I.V., and reassesses the client 30 minutes later. The following is noted: Respiratory rate at 8 breaths/min. Nasal cannula on floor. Arterial blood gas (ABG) results are: pH, 7.23; PaO2, 58 mm Hg; PaCO2, 61 mm Hg; HCO3 24 mEq/l. Which factors most likely contribute to this client's ABG results?

morphine, respiratory rate of 8 breaths/min, and the nasal cannula on the floor

A child with diabetic ketoacidosis is being treated for a blood glucose level of 738 mg/dl (41.0 mmol/L). The nurse should anticipate an order for:

normal saline with regular insulin.

A client reports a dry mouth two days after starting therapy with trihexyphenidyl for Parkinson's disease. What is the best action by the nurse?

offer the client ice chips and frequent sips of water

Which medication would the nurse anticipate as the provider's treatment of choice for scarlet fever?

penicillin

A nurse is preparing to instill ear drops in a 28-year-old client with otitis externa. What is the correct procedure for instillation?

pull the pinna up and back

A client with acute pulmonary edema has been taking an angiotensin-converting enzyme (ACE) inhibitor. The nurse explains that this medication has been ordered to

reduce blood pressure.

A client who is receiving acetaminophen for osteoarthritis reports continuing pain. The healthcare provider prescribes celecoxib. What important information regarding this medication, should the nurse share with this client?

report black and tarry stools to the health care provider

The nurse is caring for a client admitted for a herniated nucleus pulposus. The client reports a pain level of 7 out of 10 and is currently using the ordered morphine sulfate patient-controlled analgesia pump for pain management. What is the priority nursing assessment for this client?

respiratory system

A client with chronic alcohol use is admitted to the hospital for detoxification. Later that day, the client's blood pressure increases and the client is given lorazepam to prevent:

seizure.

A nurse is teaching a client diagnosed with a pulmonary embolism about the prescribed heparin therapy. The nurse determines that teaching has been effective when the client states heparin is given to

slow the development of other clots.

An unemployed client without health insurance has not filled their prescription. Which assessment finding indicates that this client is not taking their levothyroxine as prescribed?

temperature of 94° F (34.4° C)

The nurse is aware that antihypertensives should be used cautiously in clients already taking

thioridazine.

The family of a client in rehabilitation following heroin withdrawal asks a nurse why the client is receiving naltrexone. What is the nurse's best response?

to help reverse withdrawal symptoms

A primipara who is Rho(D) negative has just given birth to a Rh-positive baby. The nurse is developing a plan of care. How should Rho(D) immune globulin be administered?

to the client within 3 days

Before starting treatment for leukemia, a client receives I.V. fluids and allopurinol. These interventions reduce the risk for

tumor lysis syndrome.

How should the nurse proceed when instilling neomycin and polymyxin B sulfates and hydrocortisone optic suspension, two drops in the right ear?

verify the proper client and route

Which physical assessment data would alert the nurse to a possible mild toxic reaction in a client receiving lithium?

vomiting and diarrhea

A client was admitted to the hospital because of a transient ischemic attack (TIA) secondary to atrial fibrillation. The nurse anticipates that the provider will prescribe

warfarin.

A two-year-old child is showing signs of shock. A 10 ml/kg bolus of normal saline solution is ordered. The child weighs 40 lb (18.18 kg). How many milliliters should be administered? Round your answer using a whole number.

182

A client with type 2 diabetes mellitus is prescribed capsaicin cream 0.075% What should the nurse include in a teaching plan for this medication?

"Apply capsaicin cream four times daily to decrease neuropathic pain sensations."

A nurse is about to give a client with type 2 diabetes mellitus the prescribed insulin before breakfast on the first day postpartum. Which client statement indicates an understanding of insulin requirements immediately postpartum?

"I will need less insulin now than during my pregnancy."

The nurse is teaching a client with iron-deficiency anemia about ferrous gluconate therapy. Which statement, if made by the client, would indicate a correct understanding of the teaching?

"I will take the medication on an empty stomach with orange juice."

A nurse is providing instruction to a client undergoing treatment for anxiety and insomnia. The practitioner has prescribed lorazepam 1 mg/po/tid. The nurse determines that teaching has been effective when the client states

"I'll avoid coffee."

A nurse is teaching a client about tricyclic antidepressants. The nurse determines that teaching has been effective when the client states

"Improvement in my mood will take up to 28 days."

Which instruction should the nurse give to a client with prostatitis who is receiving double strength co-trimoxazole?

drink six to eight glasses of fluid daily while taking this medication

A depressed client, who is taking fluoxetine, tells the nurse that they have difficulty sleeping at night, is often sleepy during the day, and does not feel like doing anything. What is the nurse's best response?

Ask the prescriber whether the medication can be given early in the day

A toddler taking penicillin for acute otitis media developed a maculopapular rash 24 hours ago after 3 days of therapy. The parents report no other abnormal symptoms. The nurse takes what initial action?

Assess chest sounds and oxygen saturation.

A newly admitted client diagnosed with delirium has a history of hypertension and anxiety. The client had been taking digoxin, furosemide, and diazepam. The nurse suspects that this client's impairment may be the result of:

drug intoxication.

Clients with schizophrenia often experience nonadherence to prescribed medication protocols. Nurses collaborate with these clients to develop a program of successful adherence. How are long-acting decanoate injections a helpful treatment option for these clients?

Decanoate injections improve adherence and sustained therapeutic drug levels despite possible client ambivalence.

The nurse is planning to administer morphine 1 mg I.V. to a client who is reporting pain. The available vial is morphine 2 mg/1 ml. What is the most appropriate action by the nurse?

Draw 0.5 ml of medication into a syringe and ask another nurse to witness the waste of 0.5 ml of medication.

What is the most important information for the nurse to include when teaching a client about metronidazol?

Mixing this drug with alcohol causes severe nausea and vomiting.

A depressed client has been taking a selective serotonin reuptake inhibitor (SSRI) in the evening, and is upset because he cannot perform sexually due to erectile problems. What is the nurse's best response?

engage in sexual activity prior to taking the drug

A client with bipolar disorder tells the nurse that she just found out she is pregnant, and is concerned because she takes lithium. What is the most important information for the nurse to provide to this client?

Use of lithium usually results in serious congenital problems.

Alprazolam has been prescribed for a client who has been experiencing panic attacks. The nurse reviews the client's records and determines further intervention is needed when the health history includes

acute-angle glaucoma.

After a thyroidectomy, the client develops a positive Trousseau's sign. What is the nurse's priority action?

administer calcium.gluconate

The nurse is caring for a client postoperatively after having a low anterior resection of the colon 6 hours prior. The client rates incisional pain 6/10. The prescribed orders include morphine 1 to 2 mg IV every hour as needed for pain. The client is alert with vital signs within normal limits. How will the nurse best manage the client's pain?

administer morphine 1 mg IV and reassess pain level in 20 minutes

In order for pravastatin to have maximum effect, the nurse should administer this medication:

at bedtime.

Where is the best site for the nurse to assess a client's pulse prior to administering digoxin?

at the left fifth intercostal space, midclavicular line

A client is receiving spironolactone to treat hypertension. Which instruction should the nurse provide?

avoid salt substitutes