Module 8: Pharmacology and Intravenous Therapies
A nurse instructs a client with myxedema about the dosage, method of administration, and side effects of levothyroxine sodium (Synthroid). Which statement by the client indicates an understanding of the nurse's instructions? A "I should take the medication in the evening." B "I need to report any episodes of palpitations, chest pain, or dyspnea." C "I can expect diarrhea, insomnia, and excessive sweating." D "If I feel nervous or have tremors, I should only take half the dose."
B "I need to report any episodes of palpitations, chest pain, or dyspnea."
A nurse has just received a prescription to transfuse a unit of packed red blood cells for an assigned client. For how long does the nurse plan to stay with the client after the unit of blood is hung? A 5 minutes B 15 minutes C 45 minutes D 60 minutes
B 15 minutes
A client has been given a prescription to begin using nitroglycerin transdermal patches for the management of angina pectoris. The nurse tells the client to: A Place the patch in the area of a skin fold to promote adherence B Apply the patch at the same time each day and leave it in place for 12 to 16 hours as directed C If the patch becomes dislodged, do not reapply and wait until the next day to apply a new patch. D Alternate daily dose times between the morning and the evening to prevent the development of tolerance to the medication
B Apply the patch at the same time each day and leave it in place for 12 to 16 hours as directed
A nurse is teaching a client how to mix regular and NPH insulin in the same syringe. The nurse tells the client to: A Shake the NPH insulin bottle before mixing the two types B Draw the regular insulin into the syringe first C Remove all of the air from the bottle before mixing the two types D Keep insulin refrigerated at all times
B Draw the regular insulin into the syringe first
A client is taking a folic acid supplement (Folate). Which of the following laboratory parameters does the nurse use to evaluate the effectiveness of this therapy? Select all that apply. A Magnesium B Hemoglobin C Blood glucose D Hematocrit E Alkaline phosphatase
B Hemoglobin D Hematocrit
Fluoxetine hydrochloride (Prozac) is prescribed for a client, and the nurse provides instruction regarding the use of the medication. The nurse tells the client that it is best to take the medication: A At lunchtime B In the morning C With the evening meal D Midafternoon, with an antacid
B In the morning
Baclofen (Lioresal) is prescribed for a client with a spinal cord injury who is experiencing muscle spasms. While providing instructions to the client, which of the following side effects does the nurse tell the client is possible? A Photosensitivity B Nasal congestion C Increased appetite D Increased salivation
B Nasal congestion
A nurse is to administer a dose of digoxin (Lanoxin) to a client with atrial fibrillation. The client has a potassium level of 4.6 mEq/L. The nurse determines that the dose: A Should be withheld that day B Should be administered as prescribed C Should be withheld and the physician notified D Should be preceded with a dose of potassium
B Should be administered as prescribed
A client who has undergone adrenalectomy is prescribed prednisone. Which of the following findings indicates that the client is experiencing an adverse effect of the medication? A Dry mouth B Tarry stools C Hypotension D Hypoglycemia
B Tarry stools
Intravenous tobramycin sulfate (Tobrex) is prescribed for a client with a respiratory tract infection. For which of the following symptoms, indicative of an adverse effect, does the nurse monitor the client? A Nausea B Vertigo C Vomiting D Hypotension
B Vertigo
A nurse has obtained a unit of blood from the blood bank and properly checked the blood bag with another nurse. Which of the following parameters does the nurse assess just before hanging the transfusion? A Skin color B Vital signs C Latest platelet count D Urine output over the last 24 hours
B Vital signs
A nurse is caring for a group of adult clients on an acute care nursing unit. Which of the following clients does the nurse recognize as the least likely candidate for parenteral nutrition (PN)? A 61-year-old client with pancreatitis B 52-year-old client with severe sepsis C 45-year-old client who has undergone repair of a hiatal hernia D 24-year-old client with a severe exacerbation of ulcerative colitis
C 45-year-old client who has undergone repair of a hiatal hernia
A client who needs to receive a blood transfusion has experienced a pruritic rash during previous transfusions. The client asks the nurse whether it is safe to receive the transfusion. Which of the following medications does the nurse remember will likely be prescribed before the transfusion? A Ibuprofen (Motrin) B Acetaminophen (Tylenol) C Diphenhydramine (Benadryl) D Acetylsalicylic acid (ASA, aspirin)
C Diphenhydramine (Benadryl)
A client has been taking metoprolol (Lopressor, Toprol-XL). Which of the following findings indicates to the clinic nurse that the medication is effective? A The client's ankles are swollen. B The client's weight has increased. C The client's blood pressure has decreased. D The client has wheezes in the lower lobes of the lungs.
C The client's blood pressure has decreased.
A nurse is preparing a plan of care for a pregnant client who will be given oxytocin (Pitocin) to induce labor. Which of the following occurrences does the nurse include in the plan of care as a reason for immediate discontinuation of the oxytocin infusion? A Uterine atony B Severe drowsiness C Uterine hyperstimulation D Early decelerations of the fetal heart rate
C Uterine hyperstimulation
The emergency department staff prepares for the arrival of a child who has ingested a bottle of acetaminophen (Tylenol). Which medication does the nurse ensure is available? A Pancreatin B Protamine sulfate C Phytonadione (vitamin K) D Acetylcysteine (Mucomyst)
D Acetylcysteine (Mucomyst)
A client has a prescription for short-term therapy with enoxaparin (Lovenox). The nurse explains to the client that this medication is being prescribed to: A Prevent pain B Relieve back spasms C Increase the client's energy level D Reduce the risk of deep vein thrombosis
D Reduce the risk of deep vein thrombosis
A nurse is monitoring a client who is receiving a continuous intravenous infusion of morphine sulfate. Which finding should cause the nurse to contact the physician? A Temperature of 97.6° F B Urine output of 30 mL/hr C Blood pressure of 100/60 mm Hg D Respiratory rate of 10 breaths/min
D Respiratory rate of 10 breaths/min
The nurse is preparing to change the solution bag and intravenous tubing of a client receiving parenteral nutrition (PN) through a left subclavian central venous line. Which essential action does the nurse ask the client to perform just before switching the tubing? A Turn the head to the left B Turn the head to the right C Exhale slowly and evenly D Take a deep breath and hold it
D Take a deep breath and hold it
A client taking metronidazole (Flagyl) for the treatment of trichomoniasis vaginalis calls the clinic nurse to express concern because her urine has turned dark. The nurse should tell the client: A To increase her fluid intake B To discontinue the medication C To report to the clinic to see the physician D That darkening of the urine is a harmless side effect
D That darkening of the urine is a harmless side effect
Zidovudine (AZT) is prescribed for an adult client with HIV infection. The nurse, while providing instructions to the client, should tell the client: A That the medication must be taken with milk B That aspirin can be taken to treat headache C To discontinue the medication if nausea occurs D To space the doses evenly around the clock
D To space the doses evenly around the clock
Methylergonovine (Methergine) intramuscularly is prescribed for a postpartum client. Before administering the medication, the nurse explains to the client that the medication will:
Prevent postpartum bleeding
A physician s prescription reads, Phenytoin (Dilantin) 0.1 g by mouth twice daily. The medication label indicates that the bottle contains 100-mg capsules. How many capsules does the nurse prepare for administration of one dose?
1
A client has a prescription for a unit of packed red blood cells (RBCs). Which of the following IV solutions should the nurse obtain to hang with the blood product at the client's bedside? A 0.9% sodium chloride B Lactated Ringer's solution (LR) C 5% dextrose in 0.9% sodium chloride D 5% dextrose in water in 0.45% sodium chloride
A 0.9% sodium chloride
A client with schizophrenia has been taking an antipsychotic medication for 2 months. For which adverse effect should the nurse monitor the client closely? A Akathisia B Pelvic thrusts C Athetoid limbs D Protruding tongue
A Akathisia
A nurse has taught a client taking a methylxanthine bronchodilator about beverages that must be avoided. Which beverage choices by the client indicate to the nurse that the client needs further education? Select all that apply. A Cocoa B Coffee C Lemonade D Orange juice E Chocolate milk
A Cocoa B Coffee E Chocolate milk
Metoprolol (Lopressor) has been prescribed for a client with hypertension. For which common side effects of the medication does the nurse monitor the client? Select all that apply. A Fatigue B Dry eyes C Weakness D Impotence E Nightmares
A Fatigue C Weakness D Impotence/Erectile dysfunction
Phenelzine sulfate (Nardil) is being administered to a client with depression. The client suddenly complains of a severe frontally radiating occipital headache, neck stiffness and soreness, and vomiting. On further assessment, the client exhibits signs of hypertensive crisis. Which of the following medications should the nurse prepare to administer, anticipating that it will be prescribed as the antidote to treat phenelzine-induced hypertensive crisis? A Phentolamine B Protamine sulfate C Calcium gluconate D Acetylcysteine (Mucomyst)
A Phentolamine
A nurse is assessing a peripheral intravenous (IV) site and notes blanching, coolness, and edema at the insertion site. What should the nurse do first? A Remove the IV B Apply a warm compress C Check for blood return D Measure the area of infiltration
A Remove the IV Rationale: Blanching, coolness, and edema of the IV site are all signs of infiltration. Because infiltration may result in damage to the surrounding tissue, the nurse must first remove the IV cannula to prevent any further damage. The nurse should not depend solely on the blood return for assurance that the cannula is in the vein, because blood return may be present even if the cannula is only partially in the vein. Compresses may be used, but the compress (warm or cool) depends on the type of solution infusing and health care provider preference. The nurse should measure the area of infiltration after the IV has been removed so that further tissue damage is prevented.
A physician s prescription reads, Clindamycin phosphate (Cleocin Phosphate) 0.3 g in 50 mL NS, to be administered IV over 30 minutes. The medication label reads, Clindamycin phosphate (Cleocin Phosphate) 150 mg/mL. How many milliliters of medication does the nurse prepare to ensure that the correct dose is administered?
2
A nurse discontinues infusion of a unit of blood after the client experiences a transfusion reaction. Once the incident has been documented appropriately, where does the nurse send the blood transfusion bag? A Blood bank B Risk management C Microbiology laboratory D Infection-control department
A Blood bank
Packed red blood cells have been prescribed for a client with low hemoglobin and hematocrit values. The nurse takes the client's temperature orally before hanging the blood transfusion and notes that it is 100.0° F. What should the nurse do next? A Call the healthcare provider B Begin the transfusion as prescribed C Administer an antihistamine and begin the transfusion D Administer 2 tablets of acetaminophen (Tylenol) and begin the transfusion
A Call the healthcare provider
A physician prescribes an intramuscular dose of 200,000 units of penicillin G benzathine (Bicillin) for an adult client. The label on the 10-mL ampule sent from the pharmacy reads, Penicillin G benzathine (Bicillin), 300,000 units/mL. How many milliliters of medication does the nurse prepares to ensure administration of the correct dose? (Round your answer to the nearest tenth.)
.7
A nurse notes that the site of a client's peripheral IV catheter is reddened, warm, painful, and slightly edematous in the area of the insertion site. After taking appropriate steps to care for the client, the nurse documents in the medical record that the client has experienced: A Phlebitis of the vein B Infiltration of the IV line C Hypersensitivity to the IV solution D An allergic reaction to the IV catheter material
A Phlebitis of the vein
A physician prescribes 1000 mL of normal saline 0.45% for infusion over 8 hours. The drop factor is 10 gtt/mL. At how many drops per minute does the nurse set the flow rate? (Round your answer to the nearest whole number).
11
A physician s prescription for an adult client reads, Potassium chloride 15 mEq by mouth. The label on the medication bottle reads, 20 mEq potassium chloride/15 mL. How many milliliters of KCl does the nurse prepare to ensure administration of the correct dose of medication? (Round your answer to the nearest whole number.)
11
A nurse is assessing a client who is being hospitalized with a diagnosis of pneumonia. The client's husband tells the nurse that the client is taking donepezil hydrochloride (Aricept). The nurse should ask the husband about the client's history of which disorder? A Dementia B Seizure disorder C Diabetes mellitus D Posttraumatic stress disorder
A Dementia
The serum theophylline level of a client who is taking the medication (Theo-24) is 16 mcg/mL. On the basis of this result, the nurse will initially: A Document the normal value on the chart B Call the healthcare provider immediately C Call the rapid response team to help with the emergency D Call the pharmacy to alert the pharmacist regarding the client's theophylline level
A Document the normal value on the chart
Carbamazepine (Tegretol) is prescribed for a client with trigeminal neuralgia. Which of the following side effects does the nurse instruct the client to report to the physician? Select all that apply. A Fever B Nausea C Headache D Sore throat E Mouth sores Rationale: Drowsiness, headache, nausea, and vomiting are frequent side effects of carbamazepine. Adverse reactions include blood dyscrasias; fever, sore throat, mouth ulcerations, unusual bleeding or bruising, or joint pain may be indicative of a blood dyscrasia, and the physician should be notified.
A Fever D Sore throat E Mouth sores
A client taking hydrochlorothiazide reports to the clinic for follow-up blood tests. For which side effect of the medication does the nurse monitor the client's laboratory results? A Hypokalemia B Hypocalcemia C Hypernatremia D Hypermagnesemia
A Hypokalemia
A nurse is preparing a plan of care for a client with renal colic who is receiving meperidine hydrochloride (Demerol) for pain. Which side effects does the nurse make a note of needing to be alert to in the plan of care? Select all that apply. A Hypotension B Constipation C Bradycardia D Urine retention E Respiratory depression
A Hypotension B Constipation D Urine retention E Respiratory depression
A nurse suspects that a client receiving parenteral nutrition (PN) through a central line has an air embolism. The nurse immediately positions the client on the: A Left side with the head lower than the feet B Left side with the head higher than the feet C Right side with the head lower than the feet D Right side with the head higher than the feet
A Left side with the head lower than the feet
A client with tuberculosis is being started on isoniazid (INH), and the nurse stresses the importance of returning to the clinic for follow-up blood testing. Which blood test will be performed? A Liver enzymes B Serum creatinine C Blood urea nitrogen D Red blood cell count
A Liver enzymes
A physician prescribes 1000 mL of 5% dextrose in water to be infused over 8 hours. The drop factor is 15 gtt/mL. At how many drops per minute does the nurse set the flow rate? (Round your answer to the nearest whole number).
31
A nurse is developing a plan of care for a client, hospitalized with heart failure, who has a history of Parkinson disease and is taking benztropine mesylate (Cogentin) daily. Which intervention does the nurse identify as a priority in the plan? A Monitoring intake and output B Monitoring the client's pupillary response C Placing the client in a right side-lying position D Checking the client's hemoglobin level daily
A Monitoring intake and output
A nurse is reading the medical record of a client receiving haloperidol (Haldol). The nurse notes that the physician has documented that the client is experiencing signs of akathisia. On the basis of the physician's note, which clinical manifestation would the nurse expect to find during assessment of the client? A Motor restlessness B Puffing of the cheeks C Puckering of the mouth D Protrusion of the tongue
A Motor restlessness
A nurse is caring for a client with myasthenia gravis who is exhibiting signs of cholinergic crisis. Which medication does the nurse ensure is available to treat this crisis? A Atropine sulfate B Protamine sulfate C Acetylcysteine (Mucomyst) D Pyridostigmine bromide (Mestinon)
A Atropine sulfate
A physician prescribes 1000 mL of 5% dextrose in water, to be infused over 24 hours. The drop factor is 60 gtt/mL. At how many drops per minute does the nurse set the flow rate? (Round your answer to the nearest whole number).
42
A client with heart failure being discharged home will be taking furosemide (Lasix). Which of the following statements by the client indicates to the nurse that the teaching has been effective? A "I'll weigh myself every day." B "I'll take my pulse every day." C "I'll measure my urine output." D "I'll check my ankles every day for swelling."
A "I'll weigh myself every day."
A client with a thoracic spinal cord injury is receiving dantrolene sodium (Dantrium). Which statement by the client indicates to the nurse that the client is experiencing an undesired effect of the medication? A "I'm feeling really drowsy." B "My legs are very relaxed." C "I can't seem to get enough to eat." D "I urinate about the same amount as I always did."
A "I'm feeling really drowsy."
Disulfiram (Antabuse) is prescribed for a client. Which questions does the nurse make a priority of asking the client before administering this medication? Select all that apply. A "When did you have your last full meal?" B "Do you have a history of diabetes insipidus?" C "When was your last drink of alcohol?" D "Do you have a history of thyroid problems?" E "Do you have a history of cancer in your family?"
C "When was your last drink of alcohol?" D "Do you have a history of thyroid problems?"
A physician prescribes 2000 mL of 5% dextrose and normal saline 0.45% for infusion over 24 hours. The drop factor is 15 gtt/mL. At how many drops per minute does the nurse set the flow rate? (Round to the nearest whole number).
21
Erythromycin is prescribed for a client with a respiratory tract infection. The nurse provides instructions to the client regarding the administration of the oral medication and tells the client to take the medication: A With juice B With a meal C On an empty stomach D At bedtime, with a snack
C On an empty stomach
A client is receiving heparin sodium by way of continuous IV infusion. For which adverse effects of the therapy does the nurse assess the client? Select all that apply. A Tinnitus B Tarry stools C Slowed pulse D Bleeding from the gums E Increased blood pressure
B Tarry stools D Bleeding from the gums
A nurse is providing instructions to a client regarding quinapril hydrochloride (Accupril). The nurse teaches the client: A To take the medication with meals B To rise slowly from a lying to a sitting position C To discontinue the medication if nausea occurs D That a therapeutic effect will be felt immediately
B To rise slowly from a lying to a sitting position
A client who is taking bupropion (Wellbutrin) in an attempt to stop smoking tells a nurse that he has been doubling the daily dose to make it easier to resist smoking. The nurse warns the client that doubling the daily dosage is dangerous. Of which adverse effect of the medication does the nurse warn the client? A Insomnia B Seizures C Weight gain D Orthostatic hypotension
B Seizures
A client is receiving parenteral nutrition (PN) with fat emulsion (lipids) piggybacked to the PN solution. For which signs of an adverse reaction to the fat emulsion should the nurse monitor the client? Select all that apply. A Chills B Pallor C Headache D Chest and back pain E Nausea and vomiting F Subnormal temperature
A Chills C Headache D Chest and back pain E Nausea and vomiting Rationale: Signs of an adverse reaction to fat emulsion include chest and back pain, chills, fever, dyspnea, cyanosis, diaphoresis, flushing, headache, nausea and vomiting, pressure over the eyes, vertigo, and thrombophlebitis at the infusion site.
A nurse is caring for a client with histoplasmosis who is receiving intravenous amphotericin B (Fungizone). What should the nurse do while the medication is being administered? A Monitor the client's urine output B Monitor the client for hypothermia C Check the client's neurological status D Check the client's blood glucose level
A Monitor the client's urine output
Risperidone (Risperdal) is prescribed for a client with a diagnosis of schizophrenia. Which laboratory study does the nurse expect to see among the physician's prescriptions? A Platelet count B Creatinine level C Sedimentation rate D Red blood cell count
A Platelet count
At 1300, the nurse is documenting the receipt of a unit of packed blood cells at the hospital blood bank. The nurse calculates that the transfusion must be started by: A 1315 B 1330 C 1345 D 1400
B 1330
A nurse is providing instruction to a client who is taking codeine sulfate for severe back pain. The nurse should tell the client to: A Decrease fluid intake B Maintain a high-fiber diet C Avoid all exercise to help prevent lightheadedness D Avoid the use of stool softeners to help prevent diarrhea
B Maintain a high-fiber diet
A nurse has just hung a transfusion of packed red blood cells and stayed with the client for the appropriate amount of time. Before leaving the room, the nurse tells the client that it is most important to immediately report which specific sign if it occurs? Select all that apply. A Rash B Chills C Fatigue D Backache E Tiredness
A Rash B Chills D Backache
A nurse provides instructions to a client who will be taking furosemide (Lasix). Which of the following statements by the client indicates to the nurse that the client needs additional instruction? A "I need to sit or stand up slowly." B "I should expect to have ringing in my ears." C "I need to maintain my fluid intake." D "This medication will make me urinate."
B "I should expect to have ringing in my ears."
A client with rheumatoid arthritis is taking high doses of acetylsalicylic acid (aspirin, ASA). While assessing the client for aspirin toxicity, which question should the nurse ask the client? A "Are you constipated?" B "Are you having any diarrhea?" C "Do you have any double vision?" D "Do you have any ringing in the ears?"
D "Do you have any ringing in the ears?"
A nurse is making initials rounds on a group of assigned clients. Which of the following clients should the nurse see first? A A client receiving parenteral nutrition (PN) at a rate of 50 mL/hr for the last 24 hours B A client receiving PN at a rate of 50 mL/hr whose temp was 99° F on the previous shift C A client receiving PN at a rate of 100 mL/hr who has complained of needing frequent trips to the bathroom to void D A client whose PN solution was decreased to a rate of 25 mL/hr who is now complaining of weakness, headache, and sweating
D A client whose PN solution was decreased to a rate of 25 mL/hr who is now complaining of weakness, headache, and sweating
A nurse is reviewing the laboratory results of a client receiving intravenous chemotherapy. Which of the following laboratory findings prompts the nurse to initiate neutropenic precautions? A A clotting time of 10 minutes B An ammonia level of 20 mcg/dL C A platelet count of 100,000 cells/mm3 D A white blood cell (WBC) count of 2000 cells/mm3
D A white blood cell (WBC) count of 2000 cells/mm3 A white blood cell (WBC) count of 2.0 × 103/μL (2.0 × 109/L
A nurse is preparing a plan of care for a client with a diagnosis of cancer who is receiving morphine sulfate for pain. Which of the following actions does the nurse identify as a priority in the plan of care for this client? A Monitoring urine output B Encouraging increased fluids C Monitoring the client's temperature D Monitoring the client's respiratory rate
D Monitoring the client's respiratory rate
A nurse has a written prescription to remove an intravenous (IV) line. Which of the following items should the nurse obtain from the unit supply area for use in applying pressure to the site after removing the IV catheter? A Adhesive bandage B Alcohol swab C Povidone-iodine (Betadine) swab D Sterile 2 × 2 gauze
D Sterile 2 × 2 gauze
A nurse is changing the central line dressing of a client receiving total parenteral nutrition (TPN). The nurse notes moisture under the dressing covering the catheter insertion site. What should the nurse assess next? Temperature Time of the last dressing change Expiration date on the infusion bag Tightness of the tubing connections
Tightness of the tubing connections Rationale: A loose tubing connection — the most obvious cause of the moisture that could be readily detected and fixed by the nurse — is the first thing the nurse should look for. The client's temperature would be assessed if the nurse were looking for signs of infection. The expiration date on the infusion bag and the time of the last dressing change are routine observations but have nothing to do with the subject of the question.
A nurse notes that the site of a client's peripheral intravenous (IV) catheter is reddened, warm, painful, and slightly edematous near the insertion point of the catheter. On the basis of this assessment, the nurse first: A Removes the IV catheter B Slows the rate of infusion C Notifies the healthcare provider D Checks for loose catheter connections
A Removes the IV catheter Rationale: Phlebitis is an inflammatory process in the vein. Phlebitis at an IV site may be indicated by client discomfort at the site or by redness, warmth, and swelling in the area of the catheter. The IV catheter should be removed and a new IV line inserted at a different site. Slowing the rate of infusion and checking for loose catheter connections are not correct responses. The health care provider would be notified if phlebitis were to occur, but this is not the initial action.
A client rings the call bell and complains of pain at the site of an IV infusion. The nurse assesses the site and determines that phlebitis has developed. Which of the following actions should the nurse take? Select all that apply. A Removing the IV catheter at that site B Applying warm, moist compresses to the IV site C Notifying the healthcare provider about the finding D Encouraging the client to scrub the site while in the shower E Starting a new IV line in a proximal portion of the same vein
A Removing the IV catheter at that site B Applying warm, moist compresses to the IV site C Notifying the healthcare provider about the finding
A client who has been taking lisinopril (Prinivil) complains to the nurse of a persistent dry cough. The nurse tells the client that: A This is a side effect of therapy B He probably has an upper respiratory infection C He needs to have his blood counts checked D A chest x-ray is required because the cough is a sign of heart failure
A This is a side effect of therapy
A client with schizophrenia who has been taking an antipsychotic medication calls the clinic nurse and says, "I need to cancel my appointment with the psychiatrist again, because I still have this awful sore throat. It's so bad that my mouth has a sore." How does the nurse respond to the client? A "I wouldn't be upset. It happens when you aren't drinking enough water." B "I think you need to come in for blood work today, because this may be a side effect of your medicine." C "Do you remember when you started this medication? Your psychiatrist told you how important it is to keep your appointments with him." D "You probably have a simple flu, but it might help if you gargle with some antiseptic mouthwash every 2 hours or so and drink plenty of water."
B "I think you need to come in for blood work today, because this may be a side effect of your medicine."
Warfarin sodium (Coumadin) has been prescribed, and the nurse teaches the client about the medication. Which statement by the client indicates that further teaching is necessary? A "I won't play football anymore." B "I won't take any over-the-counter medications except aspirin." C "I'll use an electric shaver until the doctor stops the Coumadin prescription." D "I'll buy one of those medication alert tags that tells people I'm taking an anticoagulant."
B "I won't take any over-the-counter medications except aspirin."
A young female client with schizophrenia says to the nurse, "Since I started on Zyprexa [olanzapine] last year, I'm doing well in school and all, but I've gained so much weight, and it's really bothering me. What can I do about this?" Which response by the nurse would be therapeutic? A "Well, I think you're overreacting. Today people think they should be skinny-minnies, even though it's not healthy." B "Weight gain can be a side effect of the medication, so you need to watch your diet and exercise. How much weight have you gained?" C "That medication isn't any more likely to cause weight gain than the others you're taking. Perhaps we could go over your diet and exercise habits." D "I want you to stop taking this medication immediately, and I'm calling the doctor, because this is a very serious side effect and you may need dialysis."
B "Weight gain can be a side effect of the medication, so you need to watch your diet and exercise. How much weight have you gained?"
A nurse answers a call bell and finds that the parenteral nutrition (PN) solution bag of an assigned client is empty. The new prescription was written for a new bag at the beginning of the shift, but it has not yet arrived from the pharmacy. Which of the following actions should the nurse take first? A Calling the healthcare provider B Calling the pharmacy for further instructions C Hanging a solution of 10% dextrose in water D Hanging a solution of 5% dextrose in 0.9% sodium chloride
C Hanging a solution of 10% dextrose in water
A nurse is providing dietary instructions to a client taking spironolactone (Aldactone). Which of the following foods does the nurse instruct the client to avoid? Select all that apply. A Rice B Cereal C Carrots D Bananas E Citrus fruits
D Bananas E Citrus fruits
A client with heart failure is being given furosemide (Lasix) and digoxin (Lanoxin). The client calls the nurse and complains of anorexia and nausea. Which action should the nurse take first? A Administering an antiemetic B Administering the daily dose of digoxin C Discontinuing the morning dose of furosemide D Checking the result of laboratory testing for potassium on the sample drawn 3 hours ago
D Checking the result of laboratory testing for potassium on the sample drawn 3 hours ago Rationale: Anorexia and nausea are symptoms commonly associated with digoxin toxicity, which is compounded by hypokalemia. Early clinical manifestations of digoxin toxicity include anorexia and mild nausea, but they are frequently overlooked or not associated with digoxin toxicity. Hallucinations and any change in pulse rhythm, color vision, or behavior should be investigated and reported to the health care provider. The nurse should first check the results of the potassium level, which will provide additional when the nurse calls the health care provider,an important follow-up action. The nurse should also check the digoxin reading if one is available. The nurse would not administer an antiemetic without further investigating the client's problem. Because digoxin toxicity is suspected, the nurse would withhold the digoxin until the health care provider has been consulted. The nurse would not discontinue a medication without a prescription to do so.
A client with HIV infection has been started on therapy with zidovudine (AZT, Retrovir). The nurse tells the client to report to the laboratory in 3 months for testing to detect adverse effects of the therapy. Which of the following laboratory tests is most important in light of the therapy that has been prescribed for this client? A Creatinine B Serum potassium C Blood urea nitrogen (BUN) D Complete blood count (CBC)
D Complete blood count (CBC)
A nurse has taught a client who is taking lithium carbonate (Lithobid) about the medication. The nurse determines that the client needs additional teaching if the client states that: A The medication should be taken with meals B The lithium blood levels must be monitored very closely C It is important to decrease fluid intake while taking the medication to avoid nausea D The physician must be called if excessive diarrhea, vomiting, or diaphoresis occurs
C It is important to decrease fluid intake while taking the medication to avoid nausea
A home care nurse has been assigned a client who has been discharged home with a prescription for parenteral nutrition (PN). Which of the following parameters does the nurse plan to check at each visit as a means of identifying complications of the PN therapy? Select all that apply. A Weight B Glucose test C Temperature D Peripheral pulses E Hemoglobin and hematocrit
A Weight B Glucose test C Temperature Rationale: When a client is receiving TPN therapy, the nurse monitors the client's weight to determine the effectiveness of the therapy. The nurse should weigh the client at each visit to make sure that the client has not gained or lost an excessive amount of weight. Because the formula contains a large amount of dextrose, the health care provider should check the client's glucose level frequently. The nurse caring for a client receiving TPN at home should also monitor the temperature to detect infection, which is a potential complication of this therapy. An infection in the intravenous line could result in sepsis, because the catheter is in a blood vessel. The peripheral pulses and hemoglobin and hematocrit readings may provide data but are unrelated to complications associated with TPN therapy.
At 1600 the nurse checks a client's parenteral nutrition (PN) infusion bag and finds 1100 mL remaining in the 3000-mL bag. The solution is running at a rate of 100 mL/hr. The bag was hung the previous day at 1800. The nurse plans to change the infusion bag and tubing this evening at: A 1700 B 1800 C 2000 D 2100
B 1800 Rationale: The TPN solution should be changed every 24 hours as a means of helping prevent infection. Infection is also prevented with the use of aseptic technique during bag and tubing changes. Most agencies recommend that tubing be changed every 24 hours along with the TPN infusion bag. Specific agency policies should always be followed. Therefore the remaining options are incorrect.
A physician prescribes the administration of parenteral nutrition (PN), to be started at a rate of 50 mL/hr by way of infusion pump through an established subclavian central line. After the first 2 hours of the PN infusion, the client suddenly complains of difficulty breathing and chest pain. The nurse immediately: A Obtains blood for culture B Clamps the PN infusion line C Obtains a sample for blood glucose testing D Obtains an electrocardiogram (ECG)
B Clamps the PN infusion line Rationale: One complication of a subclavian central line is embolism, caused by air or thrombus. Sudden onset of chest pain shortly after the initiation of TPN may mean that this complication has developed. The infusion is clamped (the line should not be discontinued, however), the client turned on the left side with the head down, and the HCP notified immediately. Depending on agency protocol, the rapid response team would also be called. Blood cultures are not necessary in this situation, because infection is not the concern. Likewise, there is no useful reason for checking the blood glucose level. An ECG may be obtained, but this is not the immediate priority. If the client shows signs of an air embolism, the nurse should examine the catheter to determine whether an open port has allowed air into the circulatory system.
A nurse discontinues infusion of a unit of packed red blood cells (RBCs) because the client is experiencing a transfusion reaction. After discontinuing the transfusion, which of the following actions does the nurse take next? A Removing the IV catheter B Contacting the healthcare provider C Changing the solution to 5% dextrose in water D Obtaining a culture of the tip of the catheter device removed from the client
B Contacting the healthcare provider Rationale: If the nurse suspects a transfusion reaction, the transfusion is stopped and normal saline solution infused at a keep-vein-open rate pending further health care provider prescriptions. The nurse then contacts the health care provider.. Dextrose in water is not used, because it may cause clotting or hemolysis of blood cells. Normal saline solution is the only type of IV fluid that is compatible with blood. The nurse would not remove the IV catheter, because then there would be no IV access route through which to treat the reaction. There is no reason to obtain a culture of the catheter tip; this is done when an infection is suspected.
A nurse is caring for a client with a diagnosis of chronic renal failure who is receiving dialysis. Epoetin alfa (Epogen), to be administered subcutaneously, has been prescribed, and the nurse is drawing the medication from a single-use vial. The nurse should prepare the medication by: A Shaking the vial before drawing up the medication B Drawing up the medication and discarding the unused portion C Obtaining the medication from the medication freezer and allowing it to thaw D Mixing the medication with 0.1 mL of heparin before administration to prevent clotting
B Drawing up the medication and discarding the unused portion
A home health nurse provides instructions to a client who is taking allopurinol (Zyloprim) for the treatment of gout. The nurse should tell the client to: A Place an ice pack on the lips if they swell B Drink at least 8 glasses of fluid every day C Take the medication on an empty stomach 2 hours before meals D Use an over-the-counter (OTC) antihistamine lotion if a rash develops
B Drink at least 8 glasses of fluid every day
A nurse is caring for a client who has been taking acetazolamide (Diamox) for glaucoma. Which of the following, documented in the assessment data, indicates to the nurse that the client may be experiencing an adverse effect of the medication? A Tinnitus B Jaundice C No change in peripheral vision D Pupillary constriction in response to light
B Jaundice
A client is receiving intravenous bleomycin sulfate. During administration of the chemotherapy, which of the following nursing assessments is of the highest priority? A Heart rate B Lung sounds C Peripheral pulses D Level of consciousness
B Lung sounds
A client with a peripheral intravenous (IV) line in place has a new prescription for infusion of parenteral nutrition (PN), a solution containing 25% glucose. Which of the following actions should be taken by the nurse? A Hanging the IV solution as prescribed B Questioning the healthcare provider about the prescription C Hanging the IV solution but setting the infusion at just half the prescribed rate D Diluting the solution with sterile water to half-strength
B Questioning the healthcare provider about the prescription Rationale: TPN solutions containing as much as 10% glucose can be infused through peripheral vessels. A TPN solution containing 25% glucose is hypertonic. The nurse should question the prescription in the absence of a central venous catheter or a peripherally inserted central catheter. Diluting the solution with sterile water to half-strength and hanging the IV solution as prescribed are both inappropriate. The nurse must not alter a prescribed solution independently.
A client receiving parenteral nutrition (PN) requires fat emulsion (lipids), which will be piggybacked to the PN solution. On obtaining a bottle of fat emulsion, the nurse notes that fat globules are floating at the top of the solution. Which of these actions should the nurse take? A Shaking the bottle vigorously B Requesting a new bottle from the pharmacy C Rotating the bottle gently back and forth to mix the globules D Running the bottle under warm water until the globules disappear
B Requesting a new bottle from the pharmacy Rationale: The nurse should not hang a fat emulsion that contains visible fat globules. Another bottle of solution should be obtained and used in its place. When TPN is combined with fat emulsion, the solution should not be used if there is a visible "ring" noted in the container of solution. The actions in the other options are incorrect.
A pregnant client is receiving magnesium sulfate for the management of preeclampsia. Which of the following assessment findings indicates to the nurse that the client is experiencing magnesium toxicity? A Proteinuria of +3 B Sudden drop in fetal heart rate C Presence of deep tendon reflexes D Serum magnesium level of 6 mEq/L
B Sudden drop in fetal heart rate
The first bag of parenteral nutrition (PN) solution has arrived on the clinical unit for a client beginning this nutritional therapy. The solution is to be infused by way of a central line. Which of the following essential pieces of equipment does the nurse obtain before hanging the solution? A Pulse oximeter B Blood glucose meter C Electronic infusion device D Noninvasive blood pressure monitor
C Electronic infusion device Rationale: The nurse obtains an electronic infusion device before hanging a TPN solution. Because of the high glucose load, it is necessary to use an infusion device to ensure that the solution does not infuse too rapidly or fall too far behind. Because the client's blood glucose is checked every 6 to 8 hours during administration of PN, a blood glucose meter will also be needed, but it is not essential before the solution is hung. A noninvasive blood pressure cuff is unnecessary for this procedure. Although oxygen saturation is important, in this situation, it is not the most important equipment to use at this time
A nurse is monitoring a client who is receiving parenteral nutrition (PN). Which of the following signs and symptoms causes the nurse to suspect that the client is experiencing hyperglycemia as a complication? A Pallor, weak pulse, and anuria B Nausea, vomiting, and oliguria C Nausea, thirst, and increased urine output D Sweating, chills, and decreased urine output
C Nausea, thirst, and increased urine output Rationale: The high glucose concentration in TPN puts the client at risk for hyperglycemia. Signs of hyperglycemia include polyuria, polydipsia, polyphagia, blurred vision, nausea and vomiting, and abdominal pain. The nurse checks the blood glucose level immediately if these symptoms develop. The signs and symptoms identified in the other options are unrelated to hyperglycemia.
A client has just undergone insertion of a central venous catheter by the healthcare provider at the bedside. Which of the following results would the nurse be sure to check before initiating infusion of the IV solution that the healthcare provider has prescribed? A Serum osmolality B Serum electrolytes C Portable chest x-ray D Intake and output record
C Portable chest x-ray
A nurse hangs a 500-mL bag of intravenous (IV) fluid for an assigned client. One hour later the client complains of chest tightness, is dyspneic and apprehensive, and has an irregular pulse. The IV bag has 100 mL remaining. Which of the following actions should the nurse take first? A Removing the IV B Sitting the client up in bed C Shutting off the IV infusion D Slowing the rate of infusion
C Shutting off the IV Rationale: The client's symptoms are indicative of speed shock, which results from the rapid infusion of drugs or a bolus infusion. In this case, the nurse would note that 400 mL has infused over 60 minutes. The first action on the part of the nurse is shutting off the IV infusion. Other actions may follow in rapid sequence: The nurse may elevate the head of the bed to aid the client's breathing and then immediately notify the health care provider. Slowing the infusion rate is inappropriate because the client will continue to receive fluid. The IV does not need to be removed. It may be needed to manage the complication.
Betaxolol (Betoptic) eye drops have been prescribed for the treatment of a client's glaucoma. The nurse tells the client to return to the clinic: A To have her weight checked B To give a sample for urinalysis C To have the blood glucose level checked D For measurement of blood pressure and apical pulse
D For measurement of blood pressure and apical pulse
A nurse is preparing a client for the insertion of a central intravenous line into the subclavian vein by the healthcare provider. The nurse gathers the equipment, places it at the bedside, and prepares to assist the healthcare provider with the procedure. As further preparation for the procedure, the nurse places the client: A Flat on the left side B In the prone position C In the supine position D In a slight Trendelenburg position
D In a slight Trendelenburg position Rationale: Unless contraindicated, the client is placed in a slight Trendelenburg position. This position is used to increase dilation of the veins and positive pressure in the central veins, reducing the risk of air embolus during insertion. Note that Trendelenburg position is contraindicated in clients with head injuries, increased intracrainial pressure, certain respiratory conditions, and spinal cord injuries. If the client had any of these conditions then an alternative position as prescribed would need to be used for insertion. The other options are incorrect because they will not achieve this goal.
A client with newly diagnosed angina pectoris has taken 2 sublingual nitroglycerin tablets for chest pain. The chest pain is relieved, but the client complains of a headache. The nurse tells the client that: A This is an indication that the medication should not be used again B Headache indicates medication tolerance, and the dosage must be increased C This may be an allergic reaction to the nitroglycerin, and the physician must be notified D This is an expected side effect of the nitroglycerin, and the client can relieve it by taking acetaminophen (Tylenol)
D This is an expected side effect of the nitroglycerin, and the client can relieve it by taking acetaminophen (Tylenol)
Cyclophosphamide has been prescribed for a client with a diagnosis of breast cancer, and the nurse is providing instructions to the client. The nurse should tell the client: A To avoid salt while taking this medication B That it is best to take the medication with food C To drink at least 2 glasses of orange juice every day D To increase fluid intake to 2000 mL to 3000 mL/day
D To increase fluid intake to 2000 mL to 3000 mL/day
A nurse is caring for a group of adult clients on an acute care nursing unit. Which clients does the nurse recognize as the most likely candidates for total parenteral nutrition (TPN)? Select all that apply. A client with pancreatitis A client with severe sepsis A client with renal calculi A client who has undergone repair of a hiatal hernia A client with a severe exacerbation of ulcerative colitis
A client with pancreatitis A client with severe sepsis A client with a severe exacerbation of ulcerative colitis Rationale: TPN is indicated in the client whose gastrointestinal tract is not functional or who cannot tolerate an enteral diet for extended periods. The client with sepsis is very ill and may require TPN. Other candidates include clients who have undergone extensive surgery, sustained multiple fractures, or have advanced cancer or AIDS. The client who has undergone hiatal hernia repair is not a candidate, because this client would resume a normal diet within a relatively short period after the hernia repair. The client with renal calculi also is not a candidate because the client would be able to eat.
