neclex pharm

pharm endocrine question: the clinic nurse is teaching a client about levothyroxine. which the health care provider has prescribed for newly diagnosed hypothyroidism. which statement made by the client indicate the further teaching is needed? a. I will need to get my blood drawn to see if I am taking the right dose b. I will probably need to take this the rest of my life c. I will take this once a day in the morning d. If this makes my stomach upset, I will take it with an antacid

correct answer: rational: 1. several medication impair the absorption of levothyroxine (Synthroid), common offenders are antacids, calcium, and iron preparations. 1) some of these could be present in several over-the-counter multivitamin and mineral tablets. 2) therefore, clients with hypothyroidism should be instructed to take levothyroxine on an empty stomach, preferably in the morning, separately from other medications 3) the most common reason for inadequately treated hypothyroidism is deficiency knowledge related to the medication regimen (eg, not taking daily, taking with other medications) 2. 1) about a: levothyroxine dosing is adjusted based on blood tests for thyroid-stimulating hormones or other thyroids hormones level 2) about b: thyroid supplement with levothyroxine usually required lifelong therapy 3) about c: levothyroxine has a long half-life, so dosing is once daily educational objective: levothyroxine should be taken on an empty stomach, preferably in the Moring, separately from other medications

question the nurse in an outpatient clinic is caring for a client with Addison disease who has ben taking hydrocortisone 20 mg daily for the last 8 years. which client data is most important to report the HCP? a. blood pressure of 140/90 mm Hg b. low grade fever of 100.4 c. mild increase in fasting blood glucose d. weight gain of 6 lb in 3 months

correct answer rational 1. Addison disease: 1) primary adrenocortical insufficiency; characterized by a deficiency in all three types of adrenal steroids (ie, glucocorticoids, androgens, mineralocorticoids) are most commonly caused by an autoimmune response. 2) corticosteroid therapy (eg, hydrocortisone, dexamethasone, prednisone) is the primary treatment of Addison disease 2. long-term use of corticosteroids can cause immunosuppression, and the anti-inflammatory effects may also mask signs of infection (eg, inflammation, redness, tenderness, heat, fever, edema) 1) signs and symptoms of infection (eg, low grade fever) should be reported to the HCP as infection can develop quickly and spread rapidly 2) in addition, physiological stress such as infection can trigger Addisonian crisis, a life-threatening complication of Addisonian disease that could require an increase in the corticosteroid dose 3. about acd: 1) side effect of long-term corticosteroid therapy mimics the signs and symptoms of Cushing syndrome, including buffalo hump, moon-shaped face, and hypokalemia. 2) increased weight, blood pressure, and blood glucose levels can also occur; however, these effect are not as life-threatening as infection educational objective: 1. in clients taking corticosteroids, it is imperative to notify the health care provider of signs and symptoms of infection, even a low-grade fever 2. the anti-inflammatory properties of corticosteroids can mask signs of infection, and their immunosuppressive effects can cause the infection to develop and spread quickly

question the clinic nurse is instructing a client who is newly prescribed transdermal scopolamine to prevent sickness during an upcoming vacation on a cruise ship. which of the following statements made by the nurse are appropriate? select all that apply a. apply the patch when the ship starts moving and not before b. dispose of the patch out of children and pets c. make sure to remove the old patch before applying a new one d. place the patch on a hairless, clean, dry area behind the ear e. wash your hand with soap and water handing the patch

correct answer:rational1. scopolamine is an anticholinergic medication used to prevent nausea and vomiting from motion sickness and as an adjunct to anesthesia to control secretions 1) scopolamine transdermal is placed on a hairless, clean, dry area behind the ear of the proper absorption 2) apply the patch >=4 hours before starting travel to allow for absorption and medication onset. transdermal patches have a slower onset but a longer duration of action 3) replace the patch every 72 hours as prescribed to ensure continuous medication delivery 4) remove and discard the old patch before placing a new one to prevent accidental overdose 5) dispose of the old patch out of reach of children and pets to avoid accidental ingestion 6) wash hands with soap and water after handling the patch to avoid inadvertent drug absorption or contact with the eyes educational objective: 1. to prevent motion sickness, transdermal scopolamine should be applied to a hairless, dry area behind the ear >=4 hours prior to travel. 2. clients should change the patch every 72 hours, discard old patches out of reach of children and pets, and wash hands after handling patches 3. the old patch must be removed before a new one is placed

question a client has a serum potassium level 2.8 mEq/L, and the health care provider prescribed intravenous potassium chloride. the nurse administers 10 mEq/100 mL 5% dextrose in water at 100 mL/hr through the client's peripheral iv line using infusion pump. shortly after initiation of the infusion, the client reports feeling burning and discomfort at the IV site. what is the nurse's priority action? a. notify hcp to request a peripheral inserted central catheter b. notify hcp to request an oral preparation c. slow the rate of kcl infusion d. shop the infusion of kcl immediately

correct answer rational 1. KCL an electrolyte replacement to correct hypokalemia, is a high-alert drug that is never administered by the iv push, intramuscular, or subcutaneous routes. 1) the peripheral infusion rate s 5-10 mEq/L, however, the nurse should always follow institution IV guidelines and produce procedure for administering KCL 2) the nurse's priority is to slow the infusion rate if the client feels a burning discomfort at the IV sites shortly after initiation of the infusion 3) KCL initiates the veins, and irritation and discomfort at the site is expected. slowing the infusion rate is effective in alleviating discomfort. 2. 1) about a: KCL in concentrations 20-40 mEq/L at maximum rate of 40 mEq/L should be administered through a central venous access device (eg, PICC, centrally inserted catheter) to prevent postinduction phlebitis. a concentration of 10 mEq KCL/100 mL can be administered through a peripheral vein at the recommended infusion rate 2) about b: the iv infusion is preferred over the oral preparation to decrease the risk for dysrhythmias when hypokalemia must be corrected quickly. some clients may need both oral and IV forms if the serum potassium levels are markedly low. however, this action is not a priority 3) about d: 1. rapid correction of this client's hypokalemia is necessary due to risk for hypokalemia-associated dysrhythmias. stopping the infusion when not necessarily further increase risk 2. the nurse assesses the sit at least every hour for adverse reactions (eg, redness, pain, swelling, phlebitis, thrombosis, extravasation, or infiltration), and stop the infusion if any occur educational objective: 1. potassium chloride administered by the iv route is prescribed for rapid correction of hypokalemia. it is irritating to the vein but can be administered slowly through a peripheral vein at recommended infusion rates (5-10) 2. KCL concentrations 20-40 at maximum rate of 40 should be administered through a CVAD to prevent post infusion phlebitis or infiltration

question a client is receiving scheduled dose of carbidopa-levodopa. the nurse evaluates the medication as having the intended effect if which finding is noted? a. improvement in short-term memory b. improvement in spontaneous activity c. reduction in number of visual hallucinations d. reduction of dizziness with standing

correct answer rational 1. Parkinson disease is caused by low levels of dopamine in the brain. 1) levodopa is converted to dopamine in the brain, but much of this drug is metabolized before reaching the brain. 2) carbidopa helps prevent the breakdown of levodopa before it can reach the brain and take effect 3) this combination medication is particularly effective in treating bradykinesia (generalized slowing of movement). tremor and rigidity may also improve to some extent. 2. carbidopa-levodopa (Sinemet) once started should never be stopped suddenly as this can lead to akinetic crisis (complete loss of movement) however, prolonged use can also result in dyskinesias (spontaneous involuntary movements) and on/off periods when the medication will start or stop working unpredictably 3. 1) about a: carbidopa-levodopa does not improve memory. medications for the treatment of Alzheimer disease, such as donepezil and rivastigmine, are used to improve cognitive and memory. 1. Donepezil: brand name: Aricept. use to improve mental function in people with Alzheimer's disease 2. Rivastigmine: brand name: Exelon. use to treat mild to moderate dementia caused by Alzheimer's or Parkinson's disease 2) about a&d: orthostatic hypotension and neuropsychiatric (eg, confusion, hallucination, delusion, agitation, psychosis) are serious and important adverse effect of carbidopa-levodopa. health care providers usually start the medications at low doses and gradually increase them to prevent these effects educational objective: 1. the combination medication carbidopa-levodopa is most helpful for treating bradykinesia in Parkinson disease and can also improve tremor and rigidity to some extent 2. it is started in lower doses to prevent orthostatic hypotension and neuropsychiatric adverse effects 3. carbidopa-levodopa once started never being stopped suddenly as doing so can lead to akinetic crisis

question a client with Parkinson disease is prescribed carbidopa-levodopa, which of the following instructions should the nurse include with the client's discharge teaching? a. change positions slowly, and sit on the side of the bed before standing b. this medication takes several weeks to reach maximum benefit c. you may experience some facial and eye twitching, but this is not harmful d. your tremors should disappear completely while on this medication e. your urine and saliva may turn reddish-brown, but this is not harmful

correct answer rational 1. Parkinson disease is characterized by decreased dopamine levels, uncontrolled acetylcholine [ˌæsətɪlˈkolin], and formation of abnormal protein clusters (Lewy bodies) in the brain. 1) Parkinson disease causes with physical and neurological (eg, mood alterations, dementia) symptoms 2) carbidopa-levodopa is a combination antiparkinsonian medication used to reduce physical symptoms of Parkinson disease by increasing dopamine levels in the brain 3) carbidopa does not have a therapeutic effect on PD but prevent breakdown of levodopa before reaching the brain, which makes levodopa more effective 2. clients teaching for carbidopa-levodopa: 1) implementing fall precautions (eg, changing positions slowly, removing rugs) as orthostatic hypotension is a common side effect 2) knowing that carbidopa-levodopa takes several weeks to reach its maximum effectiveness 3) understanding that harmless discoloration (eg, red, brown, black) of secretions (eg, urine, perspiration, saliva) may occur while taking carbidopa-levodopa 4) avoiding high-protein meals, which interfere with the absorption of carbidopa-levodopa 3. 1) about c: dyskinesia (eg, facial or eyelid twitching, tongue protrusion, facial grimacing) may indicate overdose or toxicity of carbidopa-levodopa and should be reported immediately to the health care provider 2) about d: carbidopa-levodopa often decreases, but does not eliminate, tremor and rigidity educational objective: 1. carbidopa-levodopa is a medication used to reduce symptoms of tremors and rigidity in clients with Parkinson disease. 2. teach clients that the medication takes several to become effective; urine, perspiration, or saliva discoloration is a common side effect; and fall precautions should be implemented for client safety

urinary/renal question the health care provider prescribed phenazopyridine hydrochloride for a client with a urinary tract infection. what would the office nurse teach the client to expect while taking this medication? a. constipation b. difficulty sleeping c. discoloration of urine d. dry mouth

correct answer rational 1. Phenazopyridine hydrochloride (Pyridium): 1) a urinary analgesic prescribed to relieve the pain and burning associated with a urinary tract infection. 2) the urine will turn bright red-orange while on this medication; other body fluids can be discolored as well. because staining of underwear, clothing, bedding, and contact lenses can occur, the nurse should suggest that the client use sanitary napkins and wear eyeglasses while taking the medication. 3) phenazopyridine hydrochloride provides symptomatic relief but no antibiotic actions, and so it is important that the client take full course of antibiotic 2. about abd: constipation, difficulty sleeping, and dry mouth are not common adverse effects of phenazopyridine educational objective: 1. phenazopyridine hydrochloride (Pyridium) is a urinary analgesic prescribed to relieve symptoms of dysuria associated with a urinary tract infection 2. an expected side effect of the drug is orange-red discoloration of urine

question: the office nurse, while reviewing a client's health information, notices that the client has recently started taking St. John's wort for symptoms of depression. what additional information is most important for the nurse to obtain? a. ask if the client is currently taking any prescription antidepressant medication b. ask if the client has been diagnosed with depression by a mental health care provider c. ask if the client takes a multivitamin with iron d. ask if the client uses tanning beds

correct answer rational 1. St John's wort is an herbal product commonly used by many clients to treat depression. 1) however, it may interact with some medications used to treat depression or other mood disorders, including tricyclic antidepressants, selective serotonin and/or norepinephrine receptor inhibitors (SSRIs/SNRIs), and monoamine oxidase inhibitors (MAOIs). 2) taking St. John's wort with this medication tends to increase side effects and could potentially lead to a dangerous condition called serotonin syndrome 2. serotonin is a chemical produced by the body that is needed for the nerve cells and brain to function. 1) excessive serotonin causes symptoms that can range from mild (shivering and diarrhea) to severe (muscle rigidity, fever, and seizures) 2) severe serotonin syndrome can be fatal if it is not treated 3. 1) about b: the nurse can ask the client if a diagnosis of depression has been made by an HCP, but inquiring about possible medications that can interact with St. John's is more important at this time 2) about c: St. John's wort may interfere with the absorption of iron and other minerals, this is a teaching point, but it is not the highest priority question to ask the client 3) about d: St. John's wort can cause photosensitivity which could be exacerbated by use of tanning beds. however, this is not the highest priority question to ask the client educational objective: 1. St. John's wort interferes with many prescription medications. 2. it is a priority for the nurse to assess for concomitant use of St. John's wort with prescriptions SSRIs, MAOIs, or tricyclic antidepressants as such combinations can cause serotonin syndrome

question the nurse is administering medications to a client who is being evaluated for a brain malignancy. the client is scheduled for a CT scan with IV iodinated contrast the next morning. which medication should the nurse clarify the health care provider? a. amlodipine b. gabapentin c. metformin d. phenytoin

correct answer rational 1. a computed tomography (CT) scan is a noninvasive procedure that provides detailed x-ray images of the body. 1) in some cases, iodinated contrast (eg, IV PO) is administered during the CT scan to enhance visualization of blood vessels or certain organs. 2) for clients with renal impairment, a potential complicated of IV iodinated contrast is acute kidney injury (ie, contrast-induced nephropathy) 2. lactic acidosis is a severe complication of metformin, an antidiabetic medication. 1) administration of IV iodinated contrast to a client who takes metformin can cause an accumulation of metformin in the bloodstream, which increase the risk for lactic acidosis. 2) as a result, many HCP discontinue metformin 24-48 hours before administration of IV contrast and restart the medication after 48 hours, when stable renal function is confirmed. 3. about abd: 1) amlodipine is a calcium channel blocker commonly used to treat hypertension 2) gabapentin is an anticonvulsant that is also used for neuropathic pain 3) phenytoin is an anticonvulsant. 4) none of these medications are known to interact with the iodinated contrast or worsen kidney injury. therefore, these medications can be safely administered to the client who is scheduled to received IV iodinated contrast educational objective: 1. iodinated contrast is commonly administered during CT scans to enhance visualization of certain body structures. 2. clients who receive IV iodinated contrast while taking metformin are at increased risk for lactic acidosis. 3. therefore, the HCP may discontinue metformin 24-48 hours before administration of IV. contrast and restart the medication after 48 hours.

question the nurse reviews the analgesia prescriptions for assigned clients. the nurse should question the hcp about which prescription? a. lidocaine 5% patch over intact skin for a client for chronic postherpetic neuralgia who reports intolerable, persistent, burning pain b. hydromorphone iv for a client who has a fractured femur, is a known iv heroin abuser, and rates pain as 9 on 0-10 scale c. tramadol for client who is being prepared for discharge following a laparoscopic cholecystectomy and rates abdominal pain as 6 on a 0-10 scale d. transdermal fentanyl patch for a client who is 1 day postoperative above the knee amputation and reports intermittent throbbing stump pain

correct answer rational 1. a transdermal fentanyl patch is prescribed for clients suffering from moderate to severe chronic pain. the patch provides continues analgesia for up to 72 hours. however, the drug is absorbed slowly through the skin into the systemic circulation and can take up to 17 hours to reach its full analgesic effect. therefore, it is not recommended for treating acute postoperative, temporary or intermittent pain as it does not provide immediate analgesia when applied. 2. 1) about a: a lidocaine 5% transdermal patch provides a localized, topical anesthetic to intact skin. it is commonly prescribed for clients with chronic postherpetic neuralgia, a painful debilitating condition that can develop following a herpes zoster 2) about b: the client with opioid abuse history would be experiencing the same type of degree of pain as other clients with a fractured femur. however, a higher dose or a stronger opioid analgesic is needed for pain relief due to the client's increased opioid tolerance 3) about c: tramadol is a synthetic opioid analgesic prescribed to treat moderate to severe postoperative pain. it is appropriate to prescribe at discharge as it has fewer complications related to respiratory depression compared with another opioid educational objective: 1. a transdermal fentanyl patch is indicated to treat moderate to severe chronic pain 2. it is not recommended for treating acute postoperative, temporary, or intermittent pain as it does not provide immediate analgesia when applied.

question the nurse is caring for a client who is taking riluzole for amyotrophic lateral sclerosis (ALS). The client asks, there is no cure for ALS, so why should I keep taking this expensive drug? a. it may be able to slow the progressive of ALS b. It reduces the amount of glutamate in your brain c. the case manager may be able to find a program to assist with cost d. you have the right to refuse the medication

correct answer rational 1. amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig disease, is a debilitating, progressive neurodegenerative disease with no cure. 1) clients develop fatigue and muscle weakness that progressive to paralysis, dysphagia, difficulty speaking, and respiratory failure 2) most clients diagnosed with ALS survive only 3-5 years 2. Riluzole (Rilutek) is the only medication approved for ALS treatment. 1) riluzole, a glutamate anragonist, is thought to slow neuron degeneration by decreasing the production and activity of the neurotransmitter glutamate in the brain and spinal cord 2) in some clients, rilizole may slow disease progression and prolong survival by 3-6 months. the nurse should provide teaching about the purpose of the medication so that the client can make an informed decision about taking it 3. 1) about b: explaining the pharmacology of riluzole is not the best response for helping the client understand the purpose of taking the medication 2) about c: it would be appropriate to consult the case manager if the client expresses concern about not having the appropriate resources to acquire a costly medication, but the nurse should first ensure that the client understands the medication's purpose 3) the client has the right to refuse any medication, but the nurse should first ensure that the client is informed and understand the purpose of the medication educational objective: although there is no cure for amyotrophic lateral sclerosis, the medication riluzole may slow disease progression and prolong survival

question a client with type 1 diabetes mellitus is prescribed an insulin pump. the nurse reinforces the diabetic educator's teaching regarding transitioning from multiple daily injections to continuous subcutaneous insulin infusion (CSII) therapy. which statement indicates that the client understands the advantage of using this therapy? a. I wont need to bolus of insulin before may meals anymore b. I am glad my blood sugars wont go way up and down, like they did before c. I am so glad I do not have to stick my finger 4 times a day to test my sugar anymore d. It finally be easier for me to lose some weight

correct answer rational 1. an insulin pump is a small, battery-operated device about the size of paper. 1) the infusion set holds a syringe (reservoir) filled with raid-insulin (175-315) and delivers the drug from the pump to the client through a needle or catheter that is usually secured to the abdomen with an adhesive patch. 2) the pump delivers insulin in 2ways: a. as a steady, measured, and continuous dose (basal rate) 24 hours a day b. as an intermittent dose (bolus) administered manually at mealtime to cover carbohydrate intake and as a supplemental dose to correct pre-or postprandial hyperglycemia 3) CSII therapy delivers the insulin more accurately than injections, so the client experiences fewer swings in blood glucose levels and hypoglycemia episodes, as compared with the administration of insulin using a needle and syringe, or pen. 2. 1) about a: although the pump can calculate and deliver a more precise dose to regulate in client's glucose level more effectively, a bolus dose must be administered manually at mealtime to cover carbohydrate intake 2) about c: pumps used most (open loop) cannot respond to changes in the client's glucose level. the American diabetes association recommend that clients using CSII to check their blood glucose levels 4-8 times a day: fasting, pre-meal, 2-hours postcranial, bedtime, 3am weekly, when experiencing symptoms of hypoglycemia, after treating low blood sugar. and before exercise ---some insulin pumps (closed-loop system) are required with continuous blood glucose monitoring system, which can detect blood glucose levels without a fingerstick. however, CBDM does not eliminate the need to test blood sugar because some machine must be calibrated every day to validate accuracy 3) about d: use of the insulin pump facilitates tighter glucose control, leading to more normal metabolism. however, if the client continues to take in more calories than needed for a given amount of activity or exercise, glucose that is not used by the cells accumulates as fat and results in weight gain. educational objective: 1. a client prescribed CSII is taught how to self-manage the insulin pump. 2. key points include importance of checking blood glucose levels at least 4 times a day, how to administer a bolus dose at mealtime to cover carbohydrate intake, how to administer a supplemental bolus dose to correct pre-and postprandial hyperglycemia, and the important of balancing diet and exercise to avoid excess weight gain

question a client suffering from chronic kidney disease is scheduled to receive recombinant human erythropoietin and iron serous. the client's hemoglobin is 9.7 and hematocrit is 29%. wha ti s the appropriate nursing action? a. administer the erythropoietin in the client's ventrogluteal muscle b. check blood pressure prior to administering the erythropoietin c. hold the client's next scheduled iron sucrose dose d. hold the erythropoietin and inform the health care provider

correct answer rational 1. anemia associated with chronic kidney disease is treated with recombinant human erythropoietin (Epogen/Procrit, epoetin) 1) therapy is initiated when hemoglobin is <10 g/dL to alleviate the symptoms of anemia (eg, fatigue) and blood for transfusions 2) therapy should be discontinued or the dose reduced for hemoglobin >11 g/dL to prevent venous thromboembolism and adverse cardiovascular outcomes from blood thickened by high concentrations of RBCs 2. hypertension is a major adverse of erythropoietin administration. therefore, uncontrolled hypertension is a contraindication to recombinant erythropoietin therapy. ------blood pressure should be well controlled prior to administering erythropoietin 3. 1) about a: erythropoietin is administered intravenously or in any subcutaneous area (not intramuscularly) 2) about c: iron in the form of iron sucrose (Venofer) or ferric gluconate (Ferrlecit) may be prescribed to promote an adequate response to erythropoietin. adequate stores of iron, vitamin B12, and folic acid are required for the erythropoietin to work 3) about d: the dose should be held if the client has a hemoglobin level >11 g/dL or uncontrolled hypertension. educational objective: 1. anemia of chronic kidney disease is treated with recombinant human erythropoietin for hemoglobin <10 g/dL. 2. hemoglobin levels >11 is associated with thromboembolic and cardiovascular events.' 3. uncontrolled hypertension is a contraindication to recombinant human erythropoietin therapy

question the nurse performs medication reconciliation for a 94 year old client who has type 2 diabetes, hypothyroidism, and heart failure caused by previous myocardial infarction. due to risks outweighing benefits, the nurse plans to tale with the health care provider about discontinuing which medication? a. aspirin 81 mg PO once a day b. furosemide 40 mg PO once a day c. glyburide 10 mg PO once a day d. Levothyroxine 50 mcg PO once a day

correct answer rational 1. beer criteria list medications that maybe inappropriate for the geriatric population due to risks outweighing benefits. the nurse collaborates the health care provider to minimize polypharmacy and reduce adverse effects (eg, falls, confusion) 2. sulfonylureas (eg, glyburide) stimulate insulin release via the pancreases and carry a risk for severe and prolonged hypoglycemia in the geriatric population due to delayed elimination. 3. avoidance of these drug is recommended by the Beers criteria. instead, other medications that are at lower risk for hypoglycemia should be used (eg, melformin) 4. 1) about a: aspirin is used to prevent platelet aggression in clients with a history of stroke or myocardial infarction. 1. aspirin and other nonsteroidal anti-inflammatory medication (eg, ibuprofen) have an increased risk of gastrointestinal bleeding. 2. therefore, aspirin is used cautiously in the older adult population, and doses should not exceed 325 mg/day 2) about b: furosemide is a loop diuretic used to treat fluid overload in heart failure, making it an important part of symptom management. this drug may cause dehydration if the client is not ingesting food and fluid well; it should be continued. 3) about d: levothyroxine is required to maintain thyroid hormone levels in clients with hypothyroidism. major side effect typically occur only with improper dosing (eg, elevated levels) educational objective: 1. the beer criteria can be used to identify potentially inappropriate drugs that contribute to adverse events (falls, confusion) and drug toxicity in older adult 2. sulfonylureas (eg, glyburide) should be avoided due to potential delayed elimination causing risk for prolonged hypoglycemic

question a hospitalized client with thyrotoxicosis receives atenolol 50 mg PO daily, which statement by the nurse accurately reinforces the client's understanding this medication's purpose? a. atenolol is an iodine-based medication that blocks the release of thyroid hormone b. it is used to treat some of the symptoms of hyperthyroidism, such as increased heart rate c. this drug is radioactive and damages or destroys the thyrohyoid issues d. this first-line antithyroid drug inhibits the synthesis of thyroid hormone

correct answer rational 1. beta-adrenergic blockers (atenolol, metoprolol, and propranolol) are used to relieve some of the symptoms of thyrotoxicosis (thyroid storm), a complication of hyperdorism in which excessive thyroid hormones are released into the circulation. 1) beta blockers block the effect of the sympathetic nervous system 2) and treat symptoms such as tachycardia, hypertension, irritability, tremors, and nervousness in the hyperthyroidism 2. 1) about a: atenolol is not iodine based. 1. iodine is used to treat thyrotoxicosis or to prepare the client for a thyroidectomy. 2. in large dose, iodine quickly blocks the release of T4 & T3 from the gland within hours. 3. in addition, iodine decreases thyroid gland vascularity and is helpful when preparing the client for a thyroidectomy 2) about c: atenolol does not contain radioactive iodine, the primary treatment for hyperthyroidism. it damages or destroys the thyroid tissue, therefore, limiting thyroid secretion and eventually making the client hypothyroid 3) about d: Propylthiocutscil and Methimazole (Topazole) are first line antithyroid drugs used to inhibit thyroid hormone synthesis educational objective 1. beta-adrenergic blockers (atenolol, metoprolol, and propranolol) are given to relieve some of the symptoms of thyrotoxicosis. 2. they block the effect of the sympathetic nervous system and treat symptoms such as tachycardia, hypertension, irritability, tremors, and nervousness in hyperthyroidism

question an elderly client with type 2 diabetes is admitted to the medical unit du to urosepsis. the client is wearing an insulin pump for continuous subcutaneous infusion therapy. the client's significant other reports that the client self-manages the insulin pump extremely well and keep blood glucose in the specified target range. what is the admitting nurse's priority action? a. assess the client's level of orientation b. assess the insulin pump infusion size c. check the prescribed insulin pump settings d. consult the diabetic resources nurse or educator

correct answer rational 1. change in mental status and confusion is a common presenting symptom of sepsis in the elderly. 1) the nurse should assess the client's cognitive status and level of orientation and consciousness. 2) diminished mental acuity, side effect of medication, and impairment related to a medical condition during hospitalization affect the client's ability to manage the insulin pump safely. 2. mental status is the key to safe insulin pump use, so if the client is not competent to operate the pump, 1) the nurse should notify the HCP and document the finding in the client's electronic medical record. 2) the HCP will determine if continuing the use of the pump during hospitalization is appropriate 3. 1) about a: assessing the infusion pump site for signs of infection and intactness of the insulin set is important, but it is not the priority action 2) about b: the HCP prescribed the basal insulin along with the parameters for bolus and correction doses while the client is hospitalized. 1. the nurse should check and document the make and model, pump setting, type of insulin, and the date that the infusion site and set were changed. 2. however, this is not the priority action 3) about d: consulting with the diabetic resource nurse or educator to determine the client's competency and ability to manage a specific type of pump and provide ongoing client education is an appropriate action. however, this is not the priority educational objective: when caring for a hospitalized client wearing an insulin pump, the priority nursing action is to assess the client's capacity to determine the ability to self-manage the pump safely

question a nurse is caring for a client with an exacerbation of chronic obstructive pulmonary disease and a history of type 2 diabetes mellites requiring insulin. the client has been prescribed prednisone; the nurse anticipates which need? a. close monitoring for hypotension b. gradually increasing the prednisone dose c. increasing the insulin dose d. monitoring and recording intake and output

correct answer rational 1. corticosteroids (eg, methylprednisolone, prednisone, dexamethasone) are given to combat inflammation in the lung in clients with COPD exacerbation. all glucocorticoids can cause an increase in blood sugar. this may lead to the need for a higher dose of insulin based on the client's blood sugar level 2. 1) about a: most glucocorticoids have some mineralocorticoid activity, causing fluid retention and worsening hypertension 2) about b: prednisone is started at a higher dose and then gradually decreased for COPD exacerbation and most other conditions. a slow taper will prevent adrenal crisis 3) about d: intake and output are not affected by corticosteroid educational objective: 1. corticosteroids commonly cause hypoglycemia and worsen hypertension 2. when taken in combination with NSAIDs, they can increase the risk of peptic ulcer disease. 3. corticosteroids in general are started at high dose and slowly tapered to reduce the risk of sudden adrenal crisis.

question the nurse is speaking to a client who takes desmopressin nasal spray for diabetes insipidus. which statement by the client is most important for the nurse to report to the HCP? a. I am tired of restricting my fluids but know I need to b. I feel like I am beginning to get sick with a bad cold c. I have been getting a lot of nasal pain with this spray d. I have recently started to experience frequent headache

correct answer rational 1. desmopressin is the medication often used to treat central diabetes insipidus, a disease characterized by reduced antidiuretic hormone (ADH) level that may result in dehydrated and hypernatremia. 1) desmopressin mimics the effect of naturally occulting ADH, which increase renal water resorption and concentrates urine. 2) however, this effect also increase the risk for water intoxication from decreased urine output. 2. clients receiving desmopressin must have their fluid and electrolyte status closely monitored for symptoms of water intoxication/hyponatremia (eg, headache, mental status changes, weakness). ---the nurse should immediately notify the HCP of client reports of water intoxication symptoms, as severe hyponatremia may progress to seizure, neurologic damage, or death 3. 1) about a: clients on desmopressin are often on fluid restriction as part of therapy. frequent reinforcement may be necessary 2) about b: rhinitis and upper respiratory infection (eg, cold) can decrease the effectiveness of desmopressin nasal spray therapy and may require dosage adjustments by the HCP. however, dosage adjustment can be addressed after symptoms of water intoxication 3) about c: side effective of desmopressin nasal spray include nasal irritation, congestion and pain. if the client cannot tolerate side effect of nasal spray, oral dosing may be prescribed by the HCP educational objective: 1. clients taking desmopressin for diabetes insipidus are at risk for water intoxication and hyponatremia. 2. clients report headaches, mental status change, and/or muscle weakness may indicate hyponatremia from water intoxication and should be reported to the health care provider immediately

question the nurse evaluated the effectiveness of desmopressin use for diabetes insipidus in a client with a pituitary tumor. which client assessment finding indicates that the medication is having the desired effect? a. appetite has improved b. blood glucose is 110 c. urine output has decreased d. urine specific gravity is lower

correct answer rational 1. diabetes insipidus (DI) results in low levels of antidiuretic hormone (ADH), which is produced by the hypothalamus and stored in the pituitary gland. 1) the function of ADH is to concentrate urine by signaling the kidney to retain water in the setting of thirst. 2) when ADH level are insufficient, the kidney excretes large quantities of very dilute urine (polyuria). this causes hypernatremia (elevated serum sodium due to deficit of free water) and increased serum osmolality, which lead to excessive thirst (polydipsia) 2. desmopressin acetate (DDAVP) is a synthetic form of ADH, which can be administered intravenously, orally, or via nasal spray. ----effectiveness of therapy desmopressin would be manifested by decreased urinary output and increased urine specific gravity as the urine becomes less dilute 3. 1) about a: a client's thirst, not appetite, is affected by DI 2) about b: DI is related to water balance, but not to the diabetes mellitus (a disorder of glucose metabolism) 3) about d: if desmopressin therapy is effective, the client's urine specific gravity will be higher due to the urine decreasing and becoming less dilute educational objective: use of desmopressin acetate (DDAVP) in clients with diabetes insipidus will lower urinary output and cause the urine specific gravity to increase

question a nurse is preparing an educational presentation on herbal supplements for the local community center. saw palmetto is one herbal medicine being discussed. which audience participants would find this information beneficial? a. clients diagnosed with heart failure b. clients experiencing major depressive disorder c. elderly clients with benign prostatic hyperplasia d. perimenopausal clients experiencing hot flashes

correct answer rational 1. herbal preparations are not regulated by governmental agencies and are generally classified as food or dietary supplements 1) manufactures are therefore able to avoid the scientific scrutiny exercised when prescription drugs are readied for the market 2) saw palmetto is one such preparation, and clients most often use it to treat benign prostatic hyperplasia 2. 1) about a: hawthorn extract is used to treat heart failure and in some countries is an approved treatment for this purpose 2) about b: st john's wort has been used for centuries to treat depression. it may cause hypertension and serotonin syndrome when used with another antidepressant 3) about d: black cohosh is an herbal supplement often used by perimenopausal clients experiencing hot flashes

question the nurse is providing education to a pregnant client diagnosed with symptomatic hypothyroidism regarding levothyroxine therapy during pregnancy. which is appropriate teaching for the nurse to include? a. after symptoms resolve, levothyroxine may be discontinued b. levothyroxine should be taken in the evening with a prenatal vitamin c. medication dose will remain the same throughout pregnancy d. symptoms should begin improving within 4 weeks of starting levothyroxine

correct answer rational 1. hypothyroidism during pregnancy places clients at increased risk for other complications of pregnancy (eg, preeclampsia, placental abruption, preterm labor) 1) symptoms of hypothyroidism may include fatigue, cold intolerance, constipation, dry skin, and brittle hair/nails. 2) levothyroxine (Synthroid) is the first-line medication for treatment of hypothyroidism during pregnancy. the client may experience some relief of symptom beginning approximately 3-4 weeks after initiating levothyroxine therapy. hormone levels are usually rechecked every 4-6 weeks until normal thyroid hormone levels are achieved. it may take up to 8 weeks after initiation to see the full therapeutic effect 2. 1) about a: adequate levels of maternal thyroid hormone are important for fetal brain development, particular during the first trimester. levothyroxine should not be stopped during pregnancy, even if symptoms resolve. 2) about b: prenatal vitamins containing iron can affect the absorption of levothyroxine and decrease its effectiveness. the nurse should instruct the client to take levothyroxine in the morning on an empty stomach, at least 4 hours before or after taking a prenatal vitamin 3) about c: as the pregnancy advances, the client's dose of levothyroxine may need to be increased. thyroid stimulating hormone (TSH) levels are closely monitored during pregnancy, and the client's dose as needed to maintain normal levels educational objective: 1. levothyroxine is the first-line treatment for hypothyroidism during pregnancy to maintain adequate levels of maternal thyroid hormones, which are critical for fetal brain development 2. symptoms of hypothyroidism typically begin to improve approximately 3-4 weeks after initiating levothyroxine. 3. therapy should not be stopped, even if symptoms resolve

question the nurse administers 8 units of regular insulin subcutaneously at 11:30 am to a client with type 1 diabetes and severe the client lunch 30 minutes later. the client eats a few bites, become nauseated nauseas, and is unable to finish the meal. when is the client at highest risk for experiencing an insulin-related hypoglycemia reaction? a. 12:30 pm b. 2:00 pm c. 5:00 pm d. 6:00 pm

correct answer rational 1. insulin is a medication commonly used to control and lower blood glucose levels in clients with diabetes mellites. the nurse must be familiar with the various insulin types and their times of peak effect, which are the periods of highest risk for hypoglycemic events 2. regular insulin is a short-acting insulin that reaches the peak effect within 2-5 hours after subcutaneous administration. therefore, clients who receive regular insulin subcutaneously at 11:30 am are at highest risk for hypoglycemia between 11:30 pm and 4:30 pm 3. 1) about a: rapid-acting insulin (eg, lispro, aspart) take peak effect in 30 minutes to 3 hours. clients who receive rapid-acting insulin at 11:30 am would be most at risk for hypoglycemia from 12-2:30 pm 2) about cd: both insulin NPH, an intermediate-acting insulin, and insulin detemir, a long-acting insulin, have peak effect time that may cause hypoglycemia at 5-6 pm in clients who receives the medication at 11:30 am educational objective 1. insulin is a medication used to control and lower blood glucose levels with diabetes mellites. 2. peak effect times vary according to insulin type and represent the time of highest risk for hypoglycemic events. 3. regular insulin, a short acting insulin, reaches peak effect 2-5 hours after subcutaneous administration

question a client with chronic heart failure is being discharged home on furosemide and sustained-release potassium chloride tablets. which instructions related to the potassium supplement should the nurse give to the client? a. a diet rich in protein and vitamin D will help with absorption b. if the tablet is too large to swallow, crush and mix it with applesauce or pudding c. potassium tablets should be taken on an empty stomach d. take it with a full glass of water and stay sitting upright afterward

correct answer rational 1. loop diuretics (eg, furosemide, bumetanide) are "potassium-wasting" diuretics, meaning that clients may experience potassium loss and hypokalemia. 1) hypokalemia in a client with heart failure creates a risk for life-threatening cardiac dysrhythmias. 2) therefore, clients taking loop diuretics usually require potassium supplements 2. potassium is an erosive substance that can cause pill-induced esophagitis. 1) to prevent esophageal erosion, the client should take potassium tablets with plenty of water (at least 4 oz) and remain sitting upright for >=30 minutes after ingestion. 2) this prevents the tablets from becoming lodged in the esophagus or refluxing from the stomach 3) pill-induced esophagitis is also common with tetracyclines and bisphosphonates (Dronates: alendronate, ibandronate, pamidronate, risedronate), so clients taking these medications should be given similar instructions 3. 1) about a: a diet rich in protein and vitamin d helps with calcium-supplement, not potassium, absorption 2) about b: sustained-release medications should never be crushed as this would cause the client to absorb the medication too rapidly 3) about c: potassium should be taken during or immediately following meals to prevent gastric upset educational objective 1. the nurse should teach the client to take potassium tablets with plenty of water (>4oz) and to sit upright after injection to prevent pill-induced esophagitis. 2. potassium should be taken during or immediately following meals to prevent gastric upset. 3. sustained-release tablets should not be crushed

question the nurse in the same day surgery unit admits a client who will receive general anesthesia. the client has never had surgery before, which question is most critical for the nurse to ask the client during the preoperative assessment and health history? a. has any family member ever had a bad reaction to general anesthesia? b. have you ever experienced low back pain? c. have you ever had an anaphylactic reaction to a bee sting? d. have you ever received opioid pain medication?

correct answer rational 1. malignant hyperthermia is rare but life-threatening inherited muscle abnormally that is triggered by specific, inhaled anesthetic agents and the depolarizing muscle relaxant succinylcholine (Anectine) used to induce general anesthesia 2. in malignant hyperthermia susceptible client, the triggering agent leads to excessive release of calcium from the muscle, leading to sustained muscle contraction and rigidity (usually of the jaw and upper body (early sign)), increased oxygen demand and metabolism, and dangerously high temperature (later signs) 3. as malignant hyperthermia is an inherited condition, can help proper screening and a thorough preoperative nursing assessment and health history minimize the client's risk 4. 1) about b: cervical spine problems should be assessed before the intubation; low back pain history is not a priority for general anesthesia 2) about c: it would be appropriate to ask about allergies (eg, drug, latex). however, asking about an anaphylactic reaction to a bee sting is not the most critical question 3) history of prior opioid intake may be helpful, but the most important question is to ask about side effects and allergies. educational objective 1. malignant hyperthermia (MH) is a rate, life-threatening inherited muscular abnormality that is triggered by specific drugs used to induce general anesthesia. 2. therefore, it is critical for the perioperative nurse to screen for MH susceptibility by asking if any of the client's blood relatives had ever experienced an adverse reaction to general anesthesia, including unexplained death.

question a nurse is preparing for a medical relief trip to west Africa and is concerned about a disruption in circadian rhythm from traveling across several time zones. which herbal supplemental might help synchronize the body to environmental time? a. evening promise b. ginseng c. melatonin d. St. john's wort

correct answer rational 1. melatonin supplements are thought to help the body adjust to new surroundings and time zones (jet lag). 1) most practitioners agree that the lowest possible dose should be used and should be taken only for a short time 2) there are no long-term studies on the safety of melatonin. higher doses may cause side effect such as vivid dreams and nightmares 3) research suggest that taking melatonin once a person has reached the travel destination is sufficient and that starting it prior to or during air travel may slow the recovery of jet lag, energy, and alternes. 2. 1) about a: evening primrose may be used for eczema or skin irritation 2) about b: ginseng is used to promote mental alertness and enhance the immune system 3) about d: st. john's wort is used for treatment of depression. it has many interactions with other prescription medications educational objective: short-term use of low-dose melatonin may be considered to treat jet lag and fatigue from traveling across time zones

question a client is admitted to the ambulatory care unit for an endoscopic procedure. the GI md administers midazolam 1 mg intravenously for sedation and titrates the dosage upward to 3.5 mg. the client become hypotensive (86/60), develop severe respiratory depression (SpO2 86%), and has periods of apnea. the nurse anticipates the administration of which antidote drug? a. Benztropine b. flumazenil c. naloxone d. phentolamine

correct answer rational 1. midazolam (versed) is a benzodiazepine commonly used to induce conscious sedation in clients undergoing endoscopic procedures. 1) the initial dose is 1mg and is titrated up slowly (eg, 2 minutes before each 1 mg increment) until speech becomes slurred. usually no more than 3.5 mg is necessary to induce conscious sedation. 2) it is commonly administered with an opioid analgesic (eg, morphine, fentanyl) because of their synergistic effect. 3) side effect can include airway occlusion, apnea, hypotension (especially in the presence of an opioid), and oxygen desaturation with resultant respiratory arrest. 4) flumazenil (Romazicon) is the antidote drug used to reverse the sedative effect of benzodiazepine 2. 1) about a: benztropine (Cogentin) is used in the treatment of extrapyramidal side effects associated with antipsychotic medications or metoclopramide 2) about c: naloxone (Narcan) is the antidote drug to reverse the effect of opioid 3) about d: phentolamine (Regitine) is the antidote drug used to treat a norepinephrine (Levophed) extravasation educational objective: flumazenil is a drug used to reverse the sedative effects of benzodiazepines such as midazolam

question during shift report it was noted that the off-going nurse had given the client a PRN dose of morphine 2 mg 2 hours for incisional pain. what current client assessment would most likely affect the oncoming nurse's decision to discontinue the administration every 2 hours? a. client reports burning during injection into the IV line b. clients report dizziness when getting up to use the bathroom c. client's blood pressure is 106/68 d. client's respiratory rate is 11

correct answer rational 1. morphine is an opioid analgesic that can be given intravenously for moderate to severe pain. an adverse reaction to morphine administration is respiratory depression 1) a respiratory rate <12 would be a reason to hold morphine administration the nurse should perform a more in-depth assessment of the client's pain and causes. 2) the morphine dose may need to be decreased or the time between administration may need to be increased. 3) the nurse should not administer additional doses until the respiratory rate increases 2. 1) about a: morphine can cause burning during IV administration. this can be reduced by diluting the morphine with normal saline and administering it slowly over 4-5 minutes 2) about b: the nurse should instruct the client to call for help before getting up to go to use the bathroom to avoid falls caused by dizziness from the morphine 3) about c: morphine can lower blood pressure, and clients receiving it should have blood pressure monitored. this blood pressure reading is not severely low and is not a priority over the respiratory depression educational objective: morphine administration can cause respiratory depression. the nurse should hold the dose of morphine for a client whose respiratory rate is <12

question a client was prescribed phenytoin a month ago, today, the client has a serum phenytoin level 32. the nurse notifies the health care provider and expects which prescription? a. continue phenytoin as prescribed b. describe phenytoin daily nose c. increase phenytoin daily dose d. repeat serum phenytoin level in 2 hours

correct answer rational 1. phenytoin (Dilantin) is an anticonvulsant drug used to treat generalized tonic-clonic seizure. 1) the therapeutic serum phenytoin range: 10-20. in the presence of an elevated phenytoin level, the nurse anticipates that the health care provider will prescribe a decreased daily dose 2) the nurse should continue to monitor for sign of toxicity, typically presenting as neurological manifestations (eg, ataxia共济失调, nystagmus, slurred speech, decreased mentation) 2. about d: repeating the serum phenytoin level in 2 hours will not result in a significant change because the average half-life of the drug is 22 hours educational objective: 1. phenytoin (Dilantin) is used to treat generalized tonic-clonic seizures. 2. common symptoms of phenytoin toxicity involve the central nervous system (eg, nystagmus, ataxia, slurred speech, decreased mentation) and can occur when serum phenytoin level exceed the therapeutic range

question the nurse prepares to administer a prescribed dose of sodium polystyrene sulfonate to a client with hyperkalemia. which action by the nurse is most important prior to administering the dose? a. assessing the client's abdomen and reviewing the medical record for frequency of stools b. assisting the client onto a bedside commode c. teaching the client, the importance of frequency assessment of potassium and sodium levels d. verifying that the client had a daily weight assessment

correct answer rational 1. sodium polystyrene sulfonate (kayexalate) is used to treat mild to moderate hyperkalemia 1) potassium is exchanged for sodium in the intestines and excreted in the stool, thereby lowering the serum potassium 2) in clients without normal bowel function (eg, post-surgery, constipation, fecal impaction), there is a risk for intestinal necrosis 3) during sodium polystyrene sulfonate therapy, severe hypokalemia (palpitations, lethargy cramping) can develop. frequent monitoring of electrolyte status is required. 4) because potassium exchanges with sodium content of the resin, excess sodium absorption could put clients at risk of developing volume overload (water follows sodium). the client should be monitored for signs of fluid overload (eg, crackle, jugular venous distension, edema) and have daily weights and intake and output assessment. 2. 1) about a: the client will experience frequent, loose stools at the beginning of therapy. some clients may be more comfortable with a bedside commode. assisting the client onto the commode is important, but assuring normal bowel function is the priority 2) about c: clients teaching about necessary lab testing is important but assessing normal bowel function is priority. 3) about d: daily weights are important in the evaluation of potential edema from the medication's sodium content, but assuring normal bowel function is the priority educational objective: 1. clients receiving sodium polystyrene sulfonate must have bowel function to avoid the risk of intestinal necrosis. 2. the nurse must assess for constipation, sign of impaction, and recent bowel patterns

question the nurse should call the primary health care provider to obtain a new prescription prior to administering which medication to a client with type 1 diabetes mellitus? a. 10 units regular insulin IV push for blood glucose >250 b. 14 units glargine insulin subcutaneous injection every night at 8 pm c. 18 units aspart insulin subcutaneous injection 15 minutes before breakfast d. 20 units NPH insulin IV push administered every morning at 7 pm

correct answer rational 1. subcutaneous injection is the indicated route for NPH insulin administration; it should never be administered via IV push. 2. regular insulin is the only insulin that can be administered via IV push; this is typically performed only in an acute care facility under close observation by the nurse 3. 1) about a: administration of 10 units insulin IV push for blood glucose >250 is appropriate and a new prescription is not required 2) about b: administration of 14 units glargine insulin subcutaneous injection every night at 8 pm is appropriate and a new prescription is not required 3) about c: administration of 18 units aspart insulin subcutaneous injection 15 minutes before breakfast is appropriate and a new prescription is not required education objective: subcutaneous injection is the indicated route for NPH insulin administration, it should never be administrated IV PUSH, regular insulin is the only insulin that can be administered IV push

question the clinic nurse prepares to administer a newly prescribed dose of sumatriptan to a client with a migraine headache. which item in the client's history would cause the nurse to question the prescription? a. blood urea nitrogen of 12 b. BMI of 34 recorded during today's examination c. past medical history of uncontrolled hypertension d. takes alprazolam as prescribed for anxiety

correct answer rational 1. sumatriptan is a severe serotonin agonist prescribed to treat migraine headaches, which are thought to be caused by dilated cranial blood vessels. 1) triptan drugs, like sumatriptan, work by constricting cranial blood vessels, and clients should be instructed to take a dose at the first sign of migraine to help prevent and relieve symptoms 2) sumatriptan is contraindicated in clients with coronary artery disease and uncontrolled hypertension because its vasoconstrictive prosperities increase the risk of angina, hypertensive urgency, decreased cardiac perfusion, and acute myocardial infarction 3) the nurse should question the client about a past medical history of uncontrolled hypertension and report this to the health care provider 2. 1) about a: a blood urea nitrogen level of 12 is a normal value (normal 6-20) 2) about b: sumatriptan is not contraindicated for underweight or overweight 3) about d: sumatriptan is not contraindicated with alprazolam therapy. however, because of its serotonergic effects, clients already taking selective serotonin reuptake inhibitors (eg, sertraline, paroxetine) or selective norepinephrine reuptake inhibitors (eg, venlafaxine, duloxetine) should be monitored for signs of serotonin syndrome educational objective: 1. sumatriptan relieves migraines by constricting dilated cranial blood vessels. 2. sumatriptan is contraindicated in clients with coronary artery disease and uncontrolled hypertension because the vasoconstrictive effects can cause hypertensive urgency, angina, decreased cardiac perfusion, and acute myocardial infarction

question the health care provider is starting an elderly client on terazosin to treat prostatic hyperplasia (BPH) which information should be included when teaching this client about the new medication? a. change position slowly when going from lying to standing b. do not drink grapefruit when taking this drug c. take this medication first thing in the morning, before breakfast d. your stool may become darker and that's normal

correct answer rational 1. terazosin is an alpha-adrenergic blocker that can relieve urinary retention in client with BPH. 1) it relaxes the smooth muscle in the bladder neck and prostate gland. 2) however, it also relaxes smooth muscle in the peripheral vasculature, which can cause orthostatic hypotension, syncope (blacking out) and falls. this is particularly common when the drug is stated (first-dose hypotension) or when the dosage is increased. 3) the serious effect can be avoided by instructing the client to take the medication at bedtime, change position slowly when going from lying to standing, and avoid an medications that also increases smooth muscle relaxation (eg, phosphodiestwease-5 inhibitors) (sildenafil or vardenafil used to treat erectile dysfunction) 4) some clients may also experience ejaculatory dysfunction (decreased or absent ejaculation) 2. 1) about b: grapefruit juice can cause significant interaction with drugs such as calcium channel blockers and sildenafil. however, it does not appear to interact with alpha blockers such as terazosin 2) alpha-1 adrenergic antagonists (eg, terazosin, doxazosin, tamsulosin, alfuzosin) should be taken at bedtime, not in the morning, to avoid orthostatic hypotension 3) about d: oral iron tablets and bismuth salts (Pepto-Bismol) can turn stools dark, an expected side effect. this can be confused with upper gastriinsterinal bleeding, which can also cause melena. educational objective: 1. alpha blockers are commonly used to treat symptoms of urinary retention in clients with BPH 2. orthostatic hypotension is a common side effect that can be avoided by teaching the client to take the medication at bedside, avoid abrupt position changes, and avoid medication for erectile dysfunctions, which can worsen hypotension

question lab: creatinine: 4.5; potassium: 5.9 calcium: 6.3 phosphate: 5.2 a client with a chronic kidney disease has blood lab values as shown in the exhibit. the nurse administers sodium polystyrene sulfonate by mouth per the hcp prescription. the nurse evaluates the therapy is effective when which value is noted on the follow-up? a. calcium 7.4 b. creatinine 4 c. phosphorous 3.9 d. potassium 4.9

correct answer rational 1. the client with kidney disease is at risk for both hyperkalemia and hyperphosphatemia due to reduced glomerular filtration rate. 1) untreated hyperkalemia may cause life-threatening cardiac arrythmias. 2) sodium polystyrene sulfonate (kayexalate) can be used to treat hyperkalemia. it works in the GI tract to trade sodium for potassium, thereby eliminating excess potassium through the stool and reducing the serum potassium level 2. 1) about a: serum calcium level may decrease with diminished renal function due to lower activation of vitamin D and subsequent impaired gut absorption of calcium. calcium supplements are used to increase the serum calcium level. sodium polystyrene sulfonate does not affect the serum calcium level 2) sodium polystyrene sulfonate dose not affect serum creatinine level. creatinine level may decrease after dialysis 3) phosphorous is also not filtered with kidney injury and the level increase. phosphate binders administered orally eliminate phosphorous through stool, sodium polystyrene sulfonate does not bind phosphate educational objective: 1. clients with kidney disease are at risk for hyperkalemia. 2. sodium polystyrene sulfonate (kayexalate) works in the GI to trade sodium for potassium, thereby eliminating excess through the stool and reducing the serum potassium level

question the nurse reviews the laboratory results of several clients. which findings should the nurse report to the health care provider? a. clients who is receiving tube feeding and has a phenytoin level of 8 b. clients with a heart rate of 62 who has a digoxin level of 1.3 c. clients with a new prosthetic aortic valve who has an INR of 3 d. clients with a poor appetite and lithium level of 0.8

correct answer rational: 1. narrow therapeutic index medications have a higher chance of producing adverse effects due to a very small difference between therapeutic and toxic levels. 1) these medications require close monitoring of serum drug level for adequate, but not toxic dosing 2) clients should also be monitored for signs of toxicity, which are specific to each medication 2. phenytoin (Dilantin) is an antiseizure medication with a therapeutic index 10-20 1) tube feeding decrease phenytoin absorption, which reduces serum drug concentration and may precipitates seizures. the nurse should pause tube feeding for 1-2 hours before and after phenytoin administration to ensure adequate absorption 2) phenytoin toxicity produces nystagmus, dysarthria, ataxia, and encephalopathy 3. 1) about b: a heart rate of 62 is expected in a client taking digoxin (therapeutic index 0.5-2). digoxin toxicity produces GI symptoms (nausea, vomiting, diarrhea), bradycardia, and casual disturbances (blurred vision, yellow green halos) 2) about c: the therapeutic INR for a client with a mechanical valve is 2.5-3.5 3) about d: anorexia is a common side effect lithium (therapeutic index 0.6-1.2). lithium toxicity produces nausea, vomiting, ataxia, and tremors educational objective: 1. tube feeding decrease phenytoin (Dilantin) absorption, which reduces serum drug concentration (therapeutic index 10-20) and may precipitate seizures. 2. the nurse should pause tube feeding for 1-2 hours before and after phenytoin administration to ensure adequate absorption

question the client nurse evolute a client's response to levothyroxine after 8 weeks of treatment. what therapeutic response to the medication should the nurse expect? select all that apply a. apical heart rate of 88 b. elevation of mood c. improved energy level d. skin is cool and dry e. slight weigh gain

correct answer rational 1. the client's therapeutic response to levothyroxine (Synthroid) is emulated by resolution of hypothyroidism syndrome. the expected response includes improves well-being with elevated mood, higher energy level, and a heart rate that is within normal limits. 1) the nurse should consult the health care provider if the heart rate is >100, or if the client reports chest pain, nervousness, or tremors; this may indicate the dose is higher than necessary. 2) pharmacological therapy manages the symptoms of hypothyroidism, but is takes up 8 weeks after initiation to see the full therapeutic effect 2. 1) about d: in hypothyroidism, the skin is cool, pale, and rough (due to dryness). these characteristics result from decreased blood flow. a therapeutic response to levothyroxine would the skin that is normal. 2) about e: the client experiencing a therapeutic response to levothyroxine would experience weight loss due to the increased metabolic rate. however, the client with untreated hypothyroidism would experience weight gain. educational objective: the expected therapeutic response to levothyroxine (Synthroid) includes an increased sense of well-being with elevated mood, greater energy levels, and a heart rate within normal limits. it takes up 8 weeks to see the full effect of pharmacological therapy.

condition question the nurse teaches a client about the use of regular and neutral protamine Hagedorn (NPH). which statement by the client indicates that further teaching is needed? a. I will always check my blook glucose prior to using the sliding scale b. I will eat breakfast 30 minutes after taking my morning NPH and regular insulin c. I will use a new insulin syringe each time I give myself an injection d. I will use the sliding to determine my NPH dose 4 times a day

correct answer rational 1. the institute for safe medication practice has labeled insulin a high-alert medication. these types of medication can be safe and effective when administration or taken according to recommendation. however, errors in administration may cause death or serious illness 2. NPH is an intermediate-acting insulin with a duration of 12-18 hours; it is generally prescribed 2 time daily (morning and evening); acting time within 1-3 hours; so the patient need to eat the meal in 30 minutes. means c is correct 3. regular insulin and other rapid-acting insulin (Lispro, Aspart, Glusine) are typically used with a sliding scale for tighter control of blood glucose throughout the day. these are generally taken before meals and at bedtime. 4. about abc: there are correct statement and indicate the teaching objective was complete successfully educational objective: NPH is an intermediate-acting insulin with a duration of 12-18 hours and typically prescribed twice a day

question a client has a follow up checkup in the urology clinic, six months ago, the client started taking tolterodine, what data collected from the client should the nurse report to the HCP? a. client excitedly report being able to go an entire workday without having to urinate b. client is using an oct artificial saliva product for dry mouth c. clients report occasional dizziness in the morning and when changing positions d. client reports symptom of constipation

correct answer rational 1. tolterodine (Detrol LA), oxybutynin (Ditropan), and Solifenacin (VESIcare) are antimuscarinic/anticholinergic medications used for overactive bladder and urge urinary incontinence. 1) they decrease urinary urgency and frequency 2) the most common side effect is anticholinergic (eg, dry mouth, constipation, cognitive dysfunction) 3) the client's report of not urinating the entire day while at work may indicate that the dosage is too high and is causing urinary retention. 4) urinary retention can lead to bladder infections and distension, this information should be reported to the HCP 2. 1) about b: artificial saliva products and sugar-free candy and gum are acceptable ways to manage dry mouth caused by anticholinergics medication 2) about c: occasional dizziness is a side effect of tolterodine. the client should rise and change position slowly. however, if this client is receiving too high dose, reduction of the dosage may alleviate the dizziness, severe dizziness should be reported to the HCP 3) about d: constipation can be managed with increased fiber in the diet, fluids, stool softeners, or laxatives educational objective: 1. anticholinergics medications (eg, tolterodine, oxybutynin, solifenacin) are commonly used for overactive bladder. 2. the client should experience a reduction in the number of times needed to urinate, but the number should no decrease below typical urination frequency. 3. the nurse should also teach the client how to manage the common side effects of dry mouth, constipation , and mild dizziness

question the nurse is preparing medication scheduled at 8 am for a client with type 1 diabetes mellitus. after reviewing the client's prescription and morning laboratory results. which action by the nurse is most appropriate? a. administer insulin lispro per protocol and 75 units NPH b. contact the health care provider c. obtain a urine specimen to check for ketonuria d. recheck the client's blood glucose

correct answer rational 1. type 1 diabetes mellitus is an endocrine disorder characterized by the absence of insulin production in the pancreas, causing hyperglycemia and intracellular energy deficit. clients with type 1 diabetes mellitus require regular administration of insulin to prevent hyperglycemia and provide energy to the cells 2. insulin shifts glucose and potassium from the intravascular to the intracellular space. this shift of potassium into cells may cause or worsen hypokalemia and place the client at risk for life-threatening dysrhythmias (eg, ventricular tachycardia, ventricular fibrillation) the nurse should notify the hcp before administering insulin to clients with hypokalemia, as supplemental potassium may be required to prevent cardiac dysrhythmias 3. 1) about a: the nurse should notify the hcp of the client's hypokalemia before administering insulin, as such administration may worsen the hypokalemia and result in potentially fatal cardiac dysrhythmias. -----once supplemental potassium is administered, insulin should be administered to address the client's hyperglycemia and prevent diabetic ketoacidosis 2) about c&d: assessing for ketonuria and rechecking the client's blood glucose are appropriate but do not address the potentially life-threatening hypokalemia caused by insulin administration. these checks can occur after potassium has been replaced. educational objective: 1. clients with diabetes mellitus receiving insulin therapy should be monitored for electrolyte shifts, especially of potassium 2. the nurse should clarify the prescription for insulin with the health care provider if the client is hypokalemia and should seek a prescription for supplemental potassium before giving more insulin

question the nurse provides medication teaching to a client with primary adrenal insufficiency (Addison's disease) who is prescribed hydrocortisone 10 mg by mouth 3 times a day. which instructions should be included in the client's teaching plan? selecta all that apply a. discontinue hydrocortisone if you note mood changes or disruptions in behavior b. make an appointment with an optometrist yearly to assess for cataracts c. report even a low-grade fever to the hcp immediately d. report sign of hyperglycemia, including increased urine, hunger, and thirst e. take the medication on an empty stomach f. the dose of hydrocortisone may need to be decreased during times of stress

correct answer rational clients taking long-term corticosteroid therapy should be taught the following: 1. do not discontinue glucocorticoid therapy abruptly. abruptly discontinuation could lead to Addisonian crisis (life-threatening complication) 2. report any signs and symptoms of infection to the HCP immediately (because corticosteroid use can cause immunosuppression, and infection can develop quickly and spread rapidly) (corticosteroids' anti-inflammatory effects may also mask signs of infection such as inflammation, redness, tenderness, heat, fever, and edema) 3. stay attuned to signs and symptoms of stress and increase dose of corticosteroid during the time of stress. a stress response (surgery/trauma) can cause a sudden decrease in cortisol level, triggering Addisonian crisis 4. a side effect of corticosteroid therapy is hyperglycemia. report signs of hyperglycemia, including increased urine, hunger, and thirst. clients with diabetes mellitus must be vigilant in checking blood glucose levels 5. corticosteroids are catabolic to bone (osteoporosis) and muscle (muscle weakness). a diet high in calcium (at least 1500 mg/day) and protein (1.5 g/kg/day) but low in fat and simple carbohydrates is recommend 6. cataracts are a side effect of corticosteroid, particularly glucocorticoid therapy. make an appointment with an optometrist yearly to assess for cataract 7. corticosteroid medication can cause gastric irritation and should not be taken on an empty stomach 8. recognize signs and symptoms of Cushing syndrome and report to the PHCP 9. develop a regular HCP-approved exercise program educational objective: 1. corticosteroids are the primary drugs used to treat Addison's disease. 2. it is imperative that the nurse teach about the medication, including points such as never to stop it abruptly, notify the HCP of signs and symptoms of infection, and monitor blood glucose closely if diabetes is a comorbid condition

question the health care provider has prescribed amitriptyline 25 mg orally every morning for an elderly client with recent herpes zoster infection (shingles) and severe postherpetic neuralgia. what is the priority nursing action? a. encourage increased fluid intake b. provide frequent rest periods c. teach the client to get up slowly from bed or getting position d. tell the client to wear sunglasses when outdoors

correct answer rational1. tricyclic antidepressants (eg, amitriptyline, nortriptyline, desipramine, imipramine) are commonly used for neuropathic pain, side effects are especially in elderly clients 1) cardiovascular: dizziness, orthostatic hypotension: increased risk of failing, tachycardia: ------teach client to change positions slowly, avoid hot bath/showers, and avoid alcohol and sedative. obtain baseline electrocardiogram on elderly clients, monitor blood pressure and pulse 2) anticholinergic: dry mouth; constipation, urinary retention and/or difficulty initiating a urinary stream, blurred vision --------teach client to drink sips of water, suck on ice chips, chew sugarless gum; teach client to consume a high-fiber diet and large amounts of fluids; contact hcp if urinary problems persist or cause pain; report changes in vision to the hcp; reassure client that blurred vision is temporary 3) neurological: drowsiness, confusion --------teach client to use caution when driving or engaging in other activities requiring close concentration; ask hcp if medication can be administered prior to bedtime rather than in morning 4) dermatological: photosensitivity ------teach client to wear sunscreen, sunglasses, and protective clothing when outdoors educational objective: 1. the most common side effects experienced by clients taking tricyclic antidepressants include dizziness, drowsiness, dry mouth, constipation, photosensitivity, urinary retention, and blurred vision 2. the priority nursing action is to teach causation in changing position due to the increased risk for falls from dizziness and orthostatic, hypotension, especially in elderly clients

neurologic question: the nurse is reinforcing education to a client newly prescribed levetiracetam for seizure. which statement made by the client indicates a need for further instruction? a. drowsiness is a common side effect of the medication and will improve over time b. I can begin driving again after I have been on this medication for a few weeks c. I need to immediately report any new or increased anxiety when on this medication d. I need to immediately report any new rash when on this medication

correct answer rational: 1. Levetiracetam (Keppra) is an anticonvulsant prescribed for seizure disorder. 1) as with other antiseizure medications, levetiracetam has a depressing effect on the central nervous system, which may cause drowsiness, somnolence, and fatigue as clients adjust to the medication. ----clients should be assured that this common and typically improves within 4-6 weeks 2) however, the CNS-depressing effects of levetiracetam may be enhanced if taken with other CNS-depressing substances (eg, alcohol) or medications 3) new or increased agitation, anxiety, and/or depression or mood changes should be reported immediately as levetiracetam is associated with suicidal ideation 4) like other anticonvulsants, levetiracetam can trigger Stevens-Johnson syndrome, a rare but life-threatening blistering reaction of the skin, rash, blistering, muscle/joint pain, or conjunctivitis should be reported and assessed immediately 2. about b: clients with seizure disorders should avoid driving or operating heavy machinery until they have permission from their health care provider and have met the requirements of their department of transportation. ----typically, the client must be free from seizures for an allotted period educational objective: 1. levetiracetam is an anticonvulsant prescribed for seizure disorders. it may have depressing effects on the central nervous system (eg, drowsiness) as the body adjusts to therapy. 2. seizures adverse effects include suicidal ideation and stevens-Johnson syndrome. 3. clients with seizure disorders must meet the guidelines of their department of transportation and receive permission from their health care provider prior to legally operating a motor vehicle

question the nurse is providing discharge. instructions to a client receiving oxybutynin for overactive bladder, which client statement indicates that further teaching is required? a. I am looking forward to our summer vacation at the beach b. I plan to eat more fruits and vegetables to prevent constipation c. I should not drive until know how this drug affects me d. I will drink at least 6-8 glasses of water daily

correct answer rational: 1. Oxybutynin (Ditropan) is an anticholinergics medication that infrequently used to treat overactive bladder. 2. common side effects include new-onset constipation; dry mouth; flushing; heat intolerance; blurred vision; drowsiness 3. decreased sweat production may lead to hyperthermia. the nurse should instruct the clinet to be cautions in hot weather and during physical activity 4. 1) about b&d: increasing dietary intake of fluids and bulk-forming foods (eg, fruits veg) promotes normal bowel function during physical activity 2) about c: sedation is a common side effect of anticholinergic drugs. clients should be taught not to drive or operate heavy machinery until they know how the drug affects them educational objective: 1. anticholinergic medications are commonly associated with constipation, urinary retention, flushing, dry mouth, and heat intolerance 2. clients should be taught to prevent these side effect by increasing intake of fluids and bulk-forming foods (prevents dry mouth and constipation) and by avoiding locations or activities that may lead to hyperthermia

question the home health nurse prepares to give benztropine to 70-year-old with Parkinson disease. which client statement is most concerning and would warrant health care provider? a. I am going for repeat testing to confirm glaucoma b. I am not able to exercise as much as I used to c. I started taking esomeprazole for heartburn d. my bowel movements are not regular

correct answer rational: 1. Parkinson disease is a progressive neurological disorder characterized by bradykinesia (loss of autonomic movements), rigidity, and tremors. 1) clients with Parkinson disease have an imbalance between dopamine and acetylcholine in which dopamine is not produced in high enough quantities to inhibit acetylcholine 2) anticholinergic medications (eg, benztropine, trihexyphenidyl) are commonly used to treat tremor in these clients 3) however, in clients with benign prostatic hyperplasia or glaucoma, caution must be taken as anticholinergic drugs can precipitate urinary retention and an acute glaucoma episode. as a result, such medications are contraindicated in these clients. 2. 1) about b: decreased ability to exercise is common in clients with PD due to tremors and bradykinesia, and they require physical and occupational therapy consultations. however acute glaucoma can be sight threatening and is the priority 2) about c: esomeprazole is safe to take with benztropine and will not cause an adverse reaction 3) about d: constipation is a common side effect of benztropine, due to characteristic decreased mobility, parkin disease can also cause constipation. the client should be instructed to increase dietary fiber intake and drink plenty of water. however, this is not the most concerning issue educational objective: 1. anticholinergics medications (eg, benztropine, trihexyphenidyl) are ised to treat Parkinson disease tremors. 2. however, they can precipitate acute glaucoma and urinary retention and are therefore contraindicated in susceptible clients (eg, those with glaucoma or bph)

question a nurse is assessing a client with type 2 diabetes mellites who was recently started on pioglitazone. which client data obtained by the nurse is most important to bring to the attention of the health care provider? a. bilateral pitting edema in ankles b. blood pressure is 140/88 mm Hg c. most recent HbA1c is 6.7% d. retinal photocoagulation in right eye

correct answer: rational 1. thiazolidinediones (rosiglitazone and pioglitazone) are used to treat type 2 diabetes mellites. 1) these agents improve insulin sensitivity but do not release excess insulin, leading to a low risk for hypoglycemia (similar to metformin) 2) worsen hearth failure (causing fluid retention and increase the risk of bladder cancer); heart failure or volume overload is a contraindication to thiazolidinedione use 3) increase the risk of cardiovascular events such as myocardial infarction 2. 1) about b: the target pressure for a client with diabetes <140/90 2) about c: the goal HbA1c for diabetic client <7% 3) about d: diabetic retinopathy, a condition treated with retinal photocoagulation, is unrelated to thiazolidinedione use. if the client has a history of bladder cancer, then it should be reported educational objective: 1. thiazolidinediones (rosiglitazone and pioglitazone) increase the risk of cardiovascular event and bladder cancer. 2. thiazolidinedione uses increased insulin sensitivity but carries a low risk for hypoglycemia

question the home health nurse reviews the serum lab test results for a client with seizures. the phenytoin level is 27. the client makes which statement that may indicate the presence of dose-related drug toxicity and prompt the nurse to notify health care provider? a. I am feeling unsteady when I walk b. I am getting up to urinate about 4 times during the night c. I have a metallic taste in my mouth when I eat d. my gums are getting so puffy and red

correct answer rational: 1. Phenytoin (Dilantin) is an anticonvulsant drug used to treat generalized tonic-clonic seizures. the therapeutic serum phenytoin reference range is between 10-20. 1) level is measured when therapy is initiated, periodically throughout treatment to guide dosing until a steady state is attained, and if seizure activity increase 2) early sign of toxicity horizontal nystagmus and gait unsteadiness. these may be followed by slurred speech, lethargy, confusion, and even coma. 3) bradyarrhythmia's and hypotension are usually seen with intravenous phenytoin 2. 1) about b: nocturia is an expected side effect of diuretic but not phenytoin. nocturia is also seen with diabetes mellites and benign prostatic hyperplasia 2) about c: metallic taste in the mouth is often seen with metronidazole but not with phenytoin 3) about d: gingival hyperplasia is a common expected side effect of phenytoin and does not indicate drug toxicity. it occurs more often in clients <23 years of age who are prescribed > 500 mg/day. good oral hygiene can limit symptoms educational objective 1. phenytoin, an anticonvulsant drug, is used to treat generalized tonic-clonic seizure. 2. common symptoms of phenytoin drug-induced toxicity involve the central nervous system and include ataxia, nystagmus, slurred speech, and decreased alertness

question a client with type 1 diabetes has a prescription for 30 units of insulin glargine at bedtime. fingerstick blood glucose measurements are prescribed before meals and at bedtime with regular insulin based on a sliding scale. at 9 am, the client's blood glucose measurement is 180 mg/dL. what action should the nurse take? a. administer 30 units of glargine; give the client a snack, then administer 2 units of regular insulin b. administer 30 units of glargine; give and 2 units of regular insulin in 2 different injections c. mix 30 units of glargine with 2 units of regular insulin in the same syringe, drawing up the glargine first d. mix 30 units of glargine with 2 units of regular insulin in the same syringe. drawing up the regular insulin first

correct answer rational: 1. insulin is a medication commonly used to control and lower blood glucose levels in clients with diabetes mellitus. clients may require a combination of long-acting insulin (eg, glargine) with rapid (eg, lispro) or short-acting (eg, regular) insulin to manage glucose levels 1) the different onsets, peaks, and durations mimic the body's natural insulin levels and enhance glycemic control. 2) insulin glargine, a long-acting (basal) insulin, has no peak and may last 24 hours or longer. short-acting insulins peak 2-5 hours after administering and last approximately 5-8 hours 3) regular or rapid acting may be given on a sliding scale at prescribed intervals (eg, before meals and at bedtime) and are dosed based on the client's blood glucose measurement. 4) insulin glargine and regular insulin may be safely given concurrently due to the difference in onset, peak, and duration 2. 1) about a: insulin glargine has no peak effect and should not potentiate hypoglycemia, whereas regular insulin may cause hypoglycemia. concurrent administration of regular insulin with insulin glargine will not increase the risk of hypoglycemia as each medication has a differential onset, peak, and duration; therefore, a snack is not required 2) about c&d: insulin glargine should not be mixed in a single syringe with any other insulin as the mixture may alter the pharmacodynamic of the drugs educational objective: 1. sliding-scale insulin can be administered safely with scheduled insulin glargine without potentiating hypoglycemia if both medications are properly dosed and administered as separate injections 2. insulin glargine should not be mixed in syringe with any other insulin

question the nurse administers 15 units of aspart insulin subcutaneously to a hospitalized client with type 1 diabetes mellitus at 7 am for a fasting blood glucose of 180. which nursing action is a priority? a. ensure that the client continues to fast for at least 30 minutes b. give the client breakfast within 15 minutes c. recheck the blood glucose in 1 hour d. teach the client about the signs and symptoms of hyperglycemia

correct answer rational: 1. insulin type: 1) basal long acting: glargine; detemir; degludec-------once daily 2) basal intermediate-acting: NPH-------twice daily 3) postprandial short-acting: regular (peak 2-5 hrs best for IV use); lispro/aspart/glulisine (peak 0.5-3 hours; best option for post meal hyperglycemia) 2. Aspart (NocoLOG) is a rapid-acting insulin with an onset of 10-15 minutes (onset is the time it tales for the insulin to enter the circulation and begin to lower blood glucose) 1) the peak effect takes 30 minutes -3 hours, and the duration of action is 3-5 hours. 2) it is important for the nurse to ensure that the client eats within 15 minutes of administration/glulisine to prevent an insulin-related hypoglycemic reaction 3. 1) about a: the client is at risk for hypoglycemic reaction if breakfast is delayed for 30 minutes 2) about c: rechecking the blood glucose in 1 hour is not indicated unless hypoglycemia is suspected 3) about d: teaching is vital, but it is most important to ensure that the client eat breakfast to prevent a hypoglycemic reaction at drug onset educational objective: it is important for the nurse to ensure that the client eats within 15 minutes of administration of rapid-acting insulin such as aspart (novolog), lispro (humalog); and glulisine (apidra) to prevent an insulin-related hypoglycemia reaction.

question the nurse obtains a health history from a client who states, I skip dinner most nights to lose weight, I do not want to get low blood sugar, so I do not take my evening dose of metformin when I skip dinner. which response by the nurse is appropriate? a. have your blood sugar been in the desired range when you skip doses? b. take half of the evening dose to prevent a low blood sugar level c. the risk of low blood sugar is minimal when metformin is taken without food d. why are you skipping meals? that is not a healthy weight loss strategy

correct answer rational: 1. metformin is an oral antidiabetic medication used to manage hyperglycemia in clients with type 2 diabetes. 1) metformin increases the sensitivity of insulin receptors in cell and reduce glucose production by the liver. 2) these actions increase the efficacy of insulin present in the body and prevent large rises in blood glucose after meals. 3) because metformin dose not stimulate insulin secretion by the pancreas, the risk of hyperglycemia is minimal. although skipping meals would cause a drop in blood glucose, metformin would not cause further hypoglycemia 2. 1) about a: investigating the effect that skipping meals and medication has on the client's blood glucose levels my imply affirmation of the incorrect action. the nurse should provide education about the drug action and appropriate means of weight loss 2) about b: instructing the client to alter the frequency or dose of prescribed medication is outside of the nurse's scope of practice. altercation to treatment plans require the prescriptive authority of health care provider 3) about d: skipping meals to lose weight is not a healthy weight-loss strategy as it causes cellular energy deficits and may lead to hypoglycemia. 1. educating the client to take medications as prescribed remains the priority. 2. furthermore why questions are not appropriate forms of therapeutic communication educational objective: 1. metformin is an oral antidiabetic medication that increase insulin sensitivity and inhibit liver glucose production 2. metformin does not increase insulin secretion, so the risk of hypoglycemia is minimal even when meals are skipped

question a client with seizure activity is receiving a continuous tube feeding via a small-bore enteral tube. the nurse prepares to administer phenytoin oral suspension via the enteral route. what is the nurse's priority action before administering this medication? a. check renal function lab results b. flush tube with normal saline, not water c. stop the feeding for 1 to 2 hours d. take the blood pressure

correct answer rational: 1. phenytoin (Dilantin) is an anticonvulsant drug commonly used to treat seizure disorders. steady absorption is necessary to maintain a therapeutic dosage range and drug level to control seizure activity. 2. the nurse's priority action is to stop the feeding for 1 to 2 hours before and after administering phenytoin as products containing calcium (eg, antacids, calcium supplements) and/or nutritional enteral tube feeding can decrease the absorption and the serum level of this drug. 3. 1) about a: unless clients have renal insufficiency, renal function tests are not routinely monitored during prescribed phenytoin therapy. 2) about b: flushing the tube with 30-50 mL of water before and after administering phenytoin is recommended to minimize drug loss and drug-drug incompatibility. flushing with normal saline before and after drug administration is recommended in clients receiving intravenous phenytoin 3) about d: blood pressure is not usually affected in clients prescribed oral phenytoin therapy for seizure disorders. however, IV phenytoin can cause hypotension and arrhythmias educational objective: 1. phenytoin is an anticonvulsant drug commonly used to treat seizure disorders 2. steady absorption is necessary to maintain a therapeutic dosage range and drug level to control seizure activity 3. administration of phenytoin concurrent with certain drugs (eg, antacids, calcium) and/or enteral feedings can affect the absorption of phenytoin.

question the nurse administers a dose of radioactive iodine to a female client for treatment of hyperthyroidism. which of the following precautions should the nurse teach the client to follow on discharge? select all that apply a. avoid close contact with pregnant women, infants, and children b. if applicable, you may resume breastfeeding when you return home c. if possible, use a separate toilet from you family, and flush 2 to 3 times after each use d. use disposable cups, plates, and utensils, and do not share food items with others e. wash your clothing and towels separately from the rest of the laundry in your home

correct answer rational: 1. radioactive iodine (RAI) treats hyperthyroidism by partially damaging or destroying the thyroid gland. 1) RAI has a delayed response, requiring up to 3 months for maximal effect. 2) after treatment, the client emits radiation, and excreted bodily fluids are radioactive. 3) the nurse teaches home precautions to potent those who meet the client. depending on the dosage, clients should use the following precautions for up to 1 week" 1. limit close contact and time spent with pregnant women and children 2. do not sit near others for a prolonged time (eg, train, or flight travel) 3. sleep in a separate bed from others 4. use a separate toilet, and flush 2 or 3 times after each use to remove urine residue 5. use disposable cups, plates, and utensils, and do not share foods that could transfer saliva 6. isolate personal laundry (eg, clothing, linens) and wash it separately 2. about b: after RAI therapy, breast milk excreted by the client is radioactive and can permanently damage an infant's thyroid. 1) breastfeeding should be stopped 6 weeks before treatment to prevent RAI from accumulating in the breast after treatment. 2) breastfeeding is not resumed with the current child but can be resumed with further pregnancies educational objective: 1. radioactive iodine treats hyperthyroidism by damaging or destroying the thyroid gland. 2. after ingesting radioactive iodine, clients and their bodily secretions are radioactive. 3. they should avoid pregnant women and children, use a separate toilet, disposable tableware, sleep in separate bed, and isolate personal laundry

question the nurse is preparing to administer a sodium polystyrenes sulfonate retention enema. which explanation by the nurse best describes the purpose of this type of enema? a. a contrast modicum is administered to visualize the colon via x-ray b. bedridden clients receive this enema to stimulate defecation and relieve constipation c. this enema assists the large intestine in removing excess potassium from the body d. this enema is administered before bowel surgery to decrease bacteria in the colon

correct answer rational: 1. sodium polystyrene sulfonate (kayexalate) retention enema is a medicated enema administered to clients with high serum potassium levels. 1) the resin in kayexalate replace sodium irons for potassium ions in the large intestine and promotes evacuation of potassium-rich waste from the body, thereby lowering the serum potassium level. 2) kayexalate can also be given orally and is much more effective. 3) kayexalate can rarely be associated with intestinal necrosis 2. 1) about a: a barium enema use contrast medium (barium) administered rectally to visualize the colon using fluoroscopic x-ray 2) about b: a fleet enema relieves constipation by infusing a hypertonic solution into the bowel, pulling fluid into the colon, and causing distension and then defecation. 3) about d: a neomycin enema is a medicated enema that reduces the number of bacteria in the bacteria in the intestine in preparation for colon surgery education objective: 1. kayexalate retention enemas are mediated enemas administered to clients with high serum potassium levels. 2. the resin in kayexalate replaces sodium ions for potassium ions in the large intestine and promotes evacuation of potassium-rich waste from the body, thereby lowering the serum potassium level

question the nurse is caring for a client with diabetes who is being discharged with a prescribed for glyburide. which statement by the client indicates a need for further instruction? a. I should avoid alcohol intake with this new medication b. I should call my primary health care provider if my monitoring glucose is below 60 mg/dL c. I should read the labels on all foods I eat, including those that say sugarless d. this medication will help me lose weight

correct answer rational: 1. the major adverse effects of sulfonylurea medications (eg, glyburide, glipizide, glimepiride) are hypoglycemia and weight gain. 1) weight gain should be assessed. 2) clients taking glyburide should be taught to use sunscreen and protective clothing as serious sunburns can occur 2. 1) about a: clients talking sulfonylureas should avoid alcohol as it lowers blood glucose and can lead to sever hypoglycemia 2) hypoglycemia (serum glucose <70) is a major side effect of sulfonylurea medications. a fasting blood glucose <60 indicate moderate to sever hypoglycemia and the medication needs to be reassessed 3) about c: even food labeled diabetic sugar free, sugarless may contain carbohydrate such as honey, brown sugar, and corn syrup all of which can evolute blood sugar educational objective: 1. the major adverse effects of sulfonylurea medications are hypoglycemia and weight gain. 2. alcohol must be avoided while taking these medications due to the risk of severe hypoglycemia. 3. glyburide can also make clients sunburn easily

question the nurse is reviewing new prescription for assigned clients. which prescription would require further clarification from the health care provider? a. alteplase for an ischemic stroke in a client with a blood pressure of 192/112 b. amoxicillin for a respiratory infection in a client who is 20 weeks pregnant c. fentanyl for moderate to severe pain in a client post appendectomy with an allergy to codeine d. sodium chloride 3% infusion for a client with syndrome of inappropriate antidiuretic hormone

correct answer rational: 1. thrombolytic agents 溶栓药物(eg, alteplase, Tenecteplase, reteplase) are often prescribed to resolve acute thrombotic events (eg, ischemic stroke, myocardial infraction, massive pulmonary embolism). they are recombinant plasminogen activators that activate the blood fibrinolytic system and dissolve thrombi 2. thrombolytic agents are contraindicated in clients with active bleeding, recent trauma, aneurysm动脉瘤, arteriovenous malformation, history of hemorrhagic stroke, and uncontrolled hypertension (blood pressure >180/110) 1) therefore, the health care provider should be consulted for classification. 2) administering alteplase in the presence of these conditions can cause hemorrhage, including life-threatening intracerebral hemorrhage 3. 1) about b: most penicillin derivates (eg, ampicillin, amoxicillin) and cephalosporins (eg, cephalexin, ceftriaxone [seftraɪˈæksn]) are generally considered safe for use by women who are pregnant or lactating 2) about c: fentanyl is appropriate in postoperative clients with moderate to severe pain, even those with a history of allergies to codeine. both drugs have opiate agonist effect but are chemically different. ---codeine is a derivative of natural opiates (eg. morphine); where fentanyl is completely synthetic 3) about d: syndrome of inappropriate antidiuretic hormone (SIADH) secretion results in water retention and dilutional hyponatremia. clients with SIADH often require hypertonic saline for sodium repletion to increase serum sodium level with a minimal infused volume of water educational objective: thrombolytic agents (eg, alteplase, Tenecteplase, reteplase) place clients at risk for bleeding. therefore, they are contraindicated in clients with active bleeding, recent trauma, aneurysm, arteriovenous malformation, history of hemorrhagic stroke, and uncontrolled hypertension

question a client having an ischemic stroke arrives at the emergency department. the health care provider prescribes tissue plasminogen activator (tPA). which client statement would be the most important to clarify before administering tPA? a. I can't believe this is happening right after my stomach surgery b. I had a concussions after a car accident a year ago c. I started noticing my right arm becoming weak approximately an hour ago d. I stopped taking my warfarin 4 weeks ago

correct answer rational: 1. tissue plasminogen activator (tPA) dissolves clot and restores perfusion in client with ischemic stroke. 1) it must be administered within a 3-4 1/2 hour window from onset of symptoms for full effectiveness. 2) the nurse assesses for contraindications to tPA due to the risk of hemorrhages 2. the client should not have a history of intracranial hemorrhage or be actively bleeding. 1) surgery within the last 2 weeks is a contraindication as tPA dissolves all clots in the body and may disrupt the surgical site. 2) this client indicates a recent stomach surgery, which would need further clarification to determine eligibility to receive tPA 3. 1) about b: a client's history of stoke or head trauma in the last three months could exclude tPA use 2) about c: the nurse should determine when the client first developed stroke symptoms. tPA can be administered if symptoms started within the last 3 to 4/1/2 hours or based on facility guidelines 3) about d: current anticoagulant use may exclude a client from receiving tPA. the duration of action for warfarin is 2- 5 days; this client can safely receive tPA as warfarin was discontinued 4 weeks ago. -----however, if pending coagulation studies dawn prior to tPA administration are elevated, the infusion may be discontinued. educational objective: 1. tissue plasminogen activator (tPA) dissolves clot in an ischemic stroke and must be administered within 3-4 1/2-hour window from onset of symptom 2. the nurse assesses for contraindications to tPA due to the risk of hemorrhage

question a client diagnosed with trigeminal neuroglia is give a prescription of carbamazepine by the hcp. which intervention does the nurse add to the client's care plan? a. encourage client to drink cold beverage b. encourage client to eat a high fiber diet c. encourage client to perform facial massage d. encourage client to report any fever or sore throat

correct answer rational: 1. trigeminal neuralgia: sudden, sharp pain along the distribution of the trigeminal nerve. the symptoms are usually unilateral and primary in the maxillary and mandibular branches. 1) clients may experience chronic pain with periods of less severe pain or cluster attacks 2) triggers can include washing the face, chewing food, brushing teeth, yawning, or talking. pain is severe, intense, burning, or electric shock like. 3) the primary intervention for trigeminal neuralgia is consistent pain control with medications and lifestyle changes. the drug of choice is carbamazepine. it is a seizure medication but is highly effective for neuropathic pain. 4) carbamazepine is associated with agranulocytosis (leukopenia) and infection risk. clients should be advised to report any fever or sore throat. 2. behavioral interventions include: 1) oral care: use a small soft bristled toothbrush or a warm mouth wash 2) use lukewarm water; avoid beverage or food that are too hot or cold 3) room should be kept an even and moderate temperature 4) avoid rubbing or facial massage. use cotton pads to wash the face if necessary 5) have a soft diet with high calories content, avoid foods that are difficult to chew. chew on the unaffected side of the mouth 6) have a soft diet with high calorie content; avoid foods that are difficult to chew. chew on the unaffected side of the mouth. 3. 1) about b: a high-fiber is not required for a client with trigeminal neuralgia, and the additional chewing with high-fiber foods may be severe as a pain trigger 2) about c: clients with trigeminal neuralgia are encourage not to massage the face as this can trigger pain educational objective: 1. the primary intervention for trigeminal neuralgia includes pain control and limiting pain triggers 2. triggers can include washing the face, chewing food, brushing teeth, yawning, or talking. 3. carbamazepine is associated with agranulocytosis [eɪˌɡrænjəloʊsaɪˈtoʊsɪs] (leukopenia) and infection risk. 4. clients should be advised to report any fever or sore throat

uestion a client with seizure disorder is prescribed a moderately high dose of phenytoin. which teaching topic should the nurse discuss with this client? a. diet high in iron b. good oral care and dental follow up c. shaving with an electric razor d. use of sunglasses for eye protection

correct answer: rational 1. the nurse should discuss the need to perform good oral hygiene with a soft-bristle toothbrush and to visit the dentist regularly as phenytoin can cause gingival hyperplasia (overgrowth of the gum tissue or reddened gums that bleed easily), especially in high doses. 2. folic acid supplementation can also reduce this side effect 3. the other major site of phenytoin use are an increase in body hair, rash, folic acid depletion, and decreased bone density (osteoporosis) 4. 1) about a: long-term use of phenytoin can cause folic acid deficiency and decreased bone density. therefore, a diet high in folic acid and calcium should be recommended 2) about c: clients who use anticoagulants (eg, warfarin, rivaroxaban, apixaban) should avoid cuts and preferably use an electric razor for shaving 3) about d: exposure of the eyes to ultraviolet light and use of corticosteroids are risk factoes for cataract development educational objective 1. the nurse should encourage the client taking phenytoin to perform good oral hygiene and visit dentist regularly to prevent gingival hyperplasia 2. the other major side effect of phenytoin use are an increase in body hair, folic acid depletion, and decreased bone density (osteoporosis)

question a client with primary hypothyroidism has been taking levothyroxine for a year. laboratory results today show high levels of TSH. which statement by the nurse to the client is appropriate? a. a new prescription will likely be issued for a decreased dose of levothyroxine b. dosage of levothyroxine may need to be increased to improve TSH level c. levothyroxine should be held, and TSH levels will be reassessed in 3 months d. start taking your levothyroxine with dietary fiber or calcium to increase its effectiveness

correct answer: rational 1. thyroid-stimulating hormone (TSH) is released from the pituitary gland to stimulate the thyroid to secrete hormone (T3 T4). when sufficient thyroid hormone is circulating, negative feedback causes a normally function pituitary to slow or stop the release of THS 1) in primary hypothyroidism, the thyroid is unable to synthesize enough T3 or T4, slowing the metabolic rate. in response to low circulating thyroid hormones, the pituitary continues to release TSH, resulting in high TSH 2) levothyroxine (Synthroid) a thyroid hormone replacement drug, is commonly used to treat hypothyroidism. levothyroxine dosing is adjusted to regulate circulating thyroid hormone levels; this creates a euthyroid (normal) state and TSH level are decreased 2. 1) about a&c: decreasing the dose or discontinuing levothyroxine would lead to increased TSH and worsening hypothyroidism as the amount of circulating thyroid hormone decreases 2) about d: levothyroxine should be taken on a consistent morning schedule, at least 30 minutes before a meal. food containing certain ingredients (eg, walnut, soy products, dietary fiber, calcium) can decrease drug absorption educational objective: 1. in primary hypothyroidism, the thyroid does not produce enough hormone (T3 T4) 2. In response to low circulating thyroid hormones, the pituitary continues to release TSH, resulting in high levels of circulating TSH. 3. Levothyroxine is usually started or increased to lead to a euthyroid (normal) state

question a client with a brain tumor is admitted for surgery. the health care provider prescribes levetiracetam. the client asks why, what is the nurse's response? a. it destroys tumor cells and helps shrink the tumor b. it prevents seizure development c. it prevents blood clots in legs d. it reduces swelling around the tumor

correct answer: rational: 1. Levetiracetam (Keppra) is a medication often used to treat seizures in various settings. it has minimal drug-drug interactions compared to phenytoin and is often the preferred antiepileptic medication 2. 1) about a: chemotherapy and radiation therapy would kill tumor cells and reduce tumor size 2) about c: hospitalized clients and clients with malignancy are at higher risk for venous thromboembolism. these clients would benefit from anticoagulation (eg, heparin, enoxaparin, rivaroxaban, apixaban) 3) about d: Dexamethasone, a corticosteroid, is used to treat cerebral edema associated with a brain injury/tumor by decreasing inflammation educational objective 1. Levetiracetam (Keppra) is a medication often used to treat seizures in various settings. 2. corticosteroids are used to reduce inflammation and cerebral edema in clients with brain injury and tumors

question the nurse plans teaching for a client who was newly prescribed levothyroxine sodium after thyroid removal. which instruction will the nurse include in the teaching plan? select all that apply a. drowsiness is a common side effect; taking the dose at bedtime will make this less noticeable b. notify the HCP if you become pregnant as the medication is harmful to the fetus c. notify the HCP if you feel a fluttering or rapid heartbeat d. take the medication with a meal to prevent stomach upset e. you will need to take this medication for the rest of the life

correct answer: rational: 1. levothyroxine sodium (eg, levoxyl, levothroid, Synthroid) is used to replace thyroid hormone in clients with hypothyroidism (inadequate thyroid hormone) and for those who have had their thyroid hormone such as heart palpitations/tachycardia, weight loss and insomnia. 2. 1) about a: clients with hypothyroidism experience lethargy and somnolence. hormone replacement will increase metabolic activity and alertness 2) about b: this medication is a hormone that is normally present in the body, so it is safe to take during pregnancy. the dose may need to alter due to the metabolic demands of pregnancy, but the drug will not harm the fetus. 3) about d: it is best to take this medication first thing in the morning as it is best absorbed on an empty stomach (1 hour before or 2 hours after a meal) educational objective: 1. clients receiving thyroid hormone replacement therapy (levothyroxine sodium) should understand that treatment is lifelong and be taught the signs of excess hormone (eg, tachycardia/palpitations, weight loss, insomnia). 2. the medication is best absorbed on an empty stomach and is safe to take during pregnancy

question the nurse is administering medications to a client experiencing heart palpitations who is scheduled to receive a dose of furosemide. based on the client's lab results. what is the nurse's priority action? potassium: 2.9 a. calculate total urinary output b. hold the medication c. notify the health care provider d. obtain a 12-lead electrocardiogram

correct answer:rational 1. furosemide (Lasix) is a potassium-depleting loop diuretics, and this client's potassium level is low. 1) hypokalemia can lead to heart palpitation and/or dysrhythmias. 2) the nurse should initially hold the client's scheduled dose of furosemide. 3) if furosemide is administered, the client's potassium level could further decrease, leading to worsening cardiac symptoms 2. 1) about a: a brief, focused assessment, including calculating intake and output, maybe important before notifying the HCP. however, the first action is to hold the scheduled dose of furosemide based on the lab results. a low potassium level is justification for not administering the furosemide regardless of intake and output 2) about c: the priority action is to hold the dose of furosemide (Lasix); after assessing the client, the nurse should notify the HCP of the potassium level and report heart palpitation 3) about d: a 12-lead ECG may be ordered when notifying the HCP; however, the priority action is to first hold the dose of furosemide. educational objective: 1) furosemide is a potassium-depleting loop diuretic. the nurse should assess the client's potassium level before administration and be aware of signs of hypokalemia such as palpitations and dysrhythmias 2) furosemide should be held and the HCP notified if the potassium level is low