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The client receives diphenhydramine (Benadryl) to control allergic symptoms. Which common symptom does the nurse teach the client to report to the physician?

Urinary hesitancy Urinary hesitancy is an anticholinergic effect of diphenhydramine (Benadryl) and should be reported to the physician.

The nurse prepares to administer benztropine (Cogentin) to the patient. The nurse holds the dose and notifies the physician based on which assessment finding? 1. A respiratory rate of 14 2. A pulse of 102 3. Blood pressure of 88/60 mmHg 4. A temperature of 100.2°F

2. A pulse of 102

A 11-year-old client has been hospitalized on the adolescent psychiatry unit with severe depression. For the past several weeks, the client has been prescribed a selective serotonin reuptake inhibitor (SSRI). What is the priority nursing action? Assess for weight loss and difficulty sleeping. Monitor the client for migraines. Monitor food intake and eliminate potential sources of tyramine. Implement suicide precautions.

Implement suicide precautions.

Which of the following over-the-counter (OTC) antihistamine combinations contains an analgesic property?

Actifed Plus contains acetaminophen.

The patient tells the nurse, "I thought I was just depressed, but my doctor says I have bipolar disorder. What is that?" What is the best response by the nurse? 1. "Bipolar disorder is just another type of depression, except your depression occurs in cycles." 2. "Bipolar disorder is a type of depression that includes attention deficit disorder symptoms." 3. "Bipolar disorder just means that your mood alternates with the seasons, and it becomes worse in the winter." 4. "Bipolar disorder means you have cycles of depression as well as hyperactivity, or mania."

4. "Bipolar disorder means you have cycles of depression as well as hyperactivity, or mania."

A mother phones the clinic and tells the nurse, "My 5-year-old son had a febrile seizure this morning." She adds that this is the child's first seizure experience. The nurse responds by asking the mother to bring the child in to be seen today. What other information should the nurse offer? Select all that apply. 1. "Febrile seizures are uncommon in boys." 2. "High temperatures generally induce seizures." 3. "Five-year-olds are too old for febrile seizures." 4. "Febrile seizures occur in up to 5% of children." 5. "Seizure medications are usually not necessary for febrile seizures."

4. "Febrile seizures occur in up to 5% of children." 5. "Seizure medications are usually not necessary for febrile seizures."

The patient has been depressed and the physician plans to begin treatment with an antidepressant medication. In performing the initial assessment, what is the most important question for the nurse to ask? 1. "How much alcohol do you consume during the week?" 2. "Are you allergic to any medications?" 3. "How long have you been depressed?" 4. "Have you had any thoughts about killing yourself?"

4. "Have you had any thoughts about killing yourself?"

The nurse has taught the client about open-angle glaucoma. The nurse evaluates learning has occurred when the client makes which statement? 1. "The eyedrops only need to be used when my eyes hurt." 2. "I will need to continually increase the dose of my eyedrops." 3. "I can stop the eyedrops when the glaucoma has resolved." 4. "I must use my eyedrops as prescribed for the rest of my life."

4. "I must use my eyedrops as prescribed for the rest of my life."

The nursing instructor teaches the student nurses about intrinsic factor. The instructor evaluates that learning has occurred when the students make which response? 1. "Intrinsic factor is secreted by the chief cells of the stomach." 2. "Intrinsic factor is necessary for absorption of vitamin B6." 3. "Intrinsic factor aids in the secretion of mucus to protect the stomach." 4. "Intrinsic factor is necessary for absorption of vitamin B12."

4. "Intrinsic factor is necessary for absorption of vitamin B12."

The patient has generalized anxiety disorder. He asks the nurse, "Will I need medication for this? My neighbor is very nervous and he takes medication." What is the best response by the nurse? 1. "Medications are a way of life for patients with anxiety disorders." 2. "Medication is necessary initially; later we will try therapy." 3. "Probably not, but you shouldn't compare yourself to your neighbor." 4. "Medication is necessary when anxiety interferes with your quality of life."

4. "Medication is necessary when anxiety interferes with your quality of life."

The client receives chemotherapy as therapy for cancer. The physician orders epoetin alfa (Procrit) subcutaneously. The client asks the nurse if this drug is also chemotherapy. What is the best response by the nurse? 1. "No, but it works with your chemotherapy to make it more effective." 2. "No, this drug helps to counteract the nausea and vomiting caused by your chemotherapy." 3. "No, it will stimulate your immune system to help you battle the cancer." 4. "No, this drug will help prevent anemia that can be caused by your chemotherapy."

4. "No, this drug will help prevent anemia that can be caused by your chemotherapy."

The patient is receiving phenobarbital (Luminal) for seizure control. The patient asks the nurse how this little pill can stop his seizures. What is the best response by the nurse? 1. "Phenobarbital (Luminal) stops your seizures by decreasing the calcium in your brain which is responsible for the seizures." 2. "Phenobarbital (Luminal) stops your seizures by increasing a chemical called glutamate that calms down the excitability in your brain." 3. "Phenobarbital (Luminal) stops your seizures by decreasing the sodium in your brain which is responsible for the seizures." 4. "Phenobarbital (Luminal) stops your seizures by increasing a chemical called GABA that calms down the excitability in your brain."

4. "Phenobarbital (Luminal) stops your seizures by increasing a chemical called GABA that calms down the excitability in your brain."

The nurse is teaching a class on how red blood cell formation is regulated by the body to a group of clients who have AIDS. The nurse evaluates that learning has occurred when the clients make which statements? Select all that apply. 1. "Red blood cell formation is regulated through chemicals called colony-stimulating factors that come from white blood cells." 2. "Red blood cell formation is regulated through messages from the hormone, secretin, which is located in the kidney." 3. "Red blood cell formation is regulated through specific liver enzymes and a process called hemochromatosis." 4. "Red blood cell formation is regulated through messages from the hormone erythropoietin." 5. "Red blood cell formation is regulated through specific transporter proteins called apolipoprotein A and B."

4. "Red blood cell formation is regulated through messages from the hormone erythropoietin."

The client is prescribed a nasal decongestant spray. What information should the nurse include when educating the client about how to use this medication?

"Blow your nose immediately before using the medication." "Limit your use of this spray to no more than 5 days." "Since you are using more than one type of nasal spray, be sure to wait 5-10 minutes between administrations." "You should spit out any excess spray that drains into your mouth."

The physician has ordered ipratropium (Atrovent) for the client. What is a priority assessment question for the nurse to ask prior to administering this medication?

"Do you have glaucoma?" Anticholinergic drugs can worsen narrow angle glaucoma.

The elderly client receives diphenhydramine (Benadryl) for allergies. The nurse completes medication education and evaluates that learning has occurred when the client makes which statement?

"Drowsiness is common but should lessen within a few doses." Drowsiness is a common adverse effect of antihistamines. The client should develop a tolerance to this effect within a few doses.

A mother asks the nurse when she should give her child cough medicine. What is the best response by the nurse When he has a dry cough and cannot rest.

"Dry, hacking, and nonproductive cough is irritating to the membranes of the throat and deprives the client of much needed rest, so a cough medicine would be warranted in this case."

The nursing instructor teaches the student nurses about histamine receptors and evaluates that further instruction is needed when the students make which statement?

"H1-receptors are found in the stomach." H1-receptors are seen in inflammatory response and cause typical allergy symptoms. H2-receptors are found in the gastric mucosa and are responsible for peptic ulcers.

The client tells the nurse that her symptoms have become worse since she has been using oxymetazoline (Afrin) for nasal congestion. What is the best assessment question for the nurse to ask?

"How long have you been using the medication?" Oxymetazoline (Afrin) can cause rebound congestion if used for too long, so length of treatment is the best assessment question

A client diagnosed with COPD says, "I don't see why I need to stop smoking. The damage to my lungs is already done." How should the nurse respond to this statement?

"If you stop smoking now your COPD may not get worse as fast." Your symptoms might not be as bad if you aren't smoking."

The client receives beclomethasone (Beconase) intranasally as treatment for allergic rhinitis. He asks the nurse if this drug is safe because it is a glucocorticoid. What is the best response by the nurse?

"Intranasal glucocorticoids produce almost no serious adverse effects."

A patient is receiving lithium carbonate for treatment of bipolar disorder. Which of the following statements should be included in discharge education for this patient? "Keep your scheduled appointments for measurement of lithium levels." "Limit fluid intake to 500 mL daily." "Take this medication on an empty stomach." "Do not drive while on this medication."

"Keep your scheduled appointments for measurement of lithium levels."

A nurse is explaining the process of respiration to a client. Which information should be given?

"Moving air in and out of the lungs is really called ventilation." Exchange of oxygen and carbon dioxide occurs across a thin capillary membrane. Respiration is not effective without perfusion. Your basic respiratory drive is determined by your brain.

The nurse teaches the client about the difference between oral and nasal decongestants. The nurse evaluates that learning has been effective when the client makes which statement?

"Oral decongestants can cause hypertension."

A client has been prescribed the opioid combination drug Hycomine Compound for control of cough. This drug contains hydrocodone, phenylephrine, chlorpheniramine, and acetaminophen. Which instructions should the nurse provide as part of medication education?

"Take this drug exactly as indicated." Do not make important decisions or operate machinery while taking this drug." Taking too much of this drug can cause oversedation. It also contains acetaminophen which should be taken only as directed. The hydrocodone component of this drug will make the client drowsy and may impact the ability to make decisions.

A patient has been diagnosed with depression. The physician has ordered sertraline. The patient asks, "How soon will it be until I feel better?" What would be the best response? "The medication will start to work in as soon as 10 days, but it may take up to 4 weeks to be fully effective." "The medication will improve your energy in 1 to 2 days, but the symptoms of sadness will not improve for a week." "The medication will start to work immediately." "The medication will decrease only your visible symptoms of depression."

"The medication will start to work in as soon as 10 days, but it may take up to 4 weeks to be fully effective."

A new mother asks her nurse about the safety of taking St. John's wort for postpartum depression. What would be the nurse's best response? "Most experts agree that St. John's wort is effective in treating depression but that it can contribute to hypertension." "St. John's wort is a natural and safe alternative to prescription antidepressants." "There is insufficient evidence to support the use of St. John's wort, and drug interactions may be extensive." "It's not clear that St. John's wort is effective in treating depression, but it won't cause any harm."

"There is insufficient evidence to support the use of St. John's wort, and drug interactions may be extensive."

A physician has prescribed an antidepressant medication for a 15-year-old female patient. Which statement would be appropriate for inclusion in patient teaching? "Patients may lose all inhibitions while on this drug." "There may be an increased risk of suicide while taking this drug." "There may be an increased risk of socialization while taking this drug." "If you miss a dose of this drug, double the dose the next time you take it."

"There may be an increased risk of suicide while taking this drug."

A client with chronic bronchitis is to start receiving breathing treatments with Acetylcysteine (Mucomyst). Which information should the nurse include in teaching about this medication?

"This drug is designed to break down and thin the mucus in your lungs." "You might experience nausea while using this drug."

The client is very frustrated that pseudoephedrine is no longer stocked on pharmacy shelves. The client does not like to go the pharmacy counter to obtain the drug. What is the best response by the nurse?

"This is frustrating, but hopefully it will decrease the amount of methamphetamine being produced." Pseudoephedrine (Sudafed) is a major ingredient in the production of methamphetamine

The nurse completes medication education for the client receiving antihistamines. The nurse evaluates that learning has occurred when the client makes which statement?

"This medication could make me very sleepy." Sedation is a common side effect of antihistamines.

The client receives zafirlukast (Accolate) as treatment for asthma. The nurse has completed medication education and evaluates that learning has occurred when the client makes which statement?

"This medication decreases the inflammation in my lungs." Zafirlukast (Accolate) prevents airway edema and inflammation by blocking leukotriene receptors in the airways.

The client receives albuterol Proventil via inhaler. He asks the nurse why he can't just take a pill. What is the best response by the nurse?

"When you inhale the drug the blood supply in your lungs picks it up rapidly, resulting in quicker effects."

The client has allergic rhinitis and asks the nurse what causes this. How should the nurse respond?

"You inherited the predisposition for this." "It can occur after exposure to animal dander." "Tobacco smoke causes it in some people." "Exposure to pollens from weeds and grass cause an allergic response in some people."

A client is prescribed an intranasal corticosteroid. What should the nurse include in client education about this drug?

"You may feel a burning sensation when using this drug." "This medication may dry out your nasal passages enough to cause nosebleed." "Do not eat licorice while taking this drug."

The physician has prescribed sertraline (Zoloft) for the patient who is anxious and depressed. The patient calls the nurse to report that he has experienced delayed ejaculation since being on this medication. What is the best response by the nurse? 1. "I will let your doctor know, and he will most likely change your medication." 2. "This does happen, but treating your depression is a bigger priority." 3. "I am concerned that you will become suicidal if you stop the medication." 4. "Keep taking the medicine, as this usually goes away after a few months."

1. "I will let your doctor know, and he will most likely change your medication."

The nurse has completed education about peptic ulcer disease (PUD) with the client. The nurse evaluates that learning has occurred when the client makes which statement? 1. "I will limit my intake of caffeine products." 2. "I will take ibuprofen (Motrin) for my headaches." 3. "I will drink more milk and limit spicy foods." 4. "I will join a gym and increase my exercise."

1. "I will limit my intake of caffeine products."

A patient treated for bipolar disorder with lithium carbonate (Eskalith) is scheduled for a lithium blood level. What is the therapeutic serum lithium level? 2.7-2.9 milliequivalents per liter 2.75-3.25 milliequivalents per liter 0.5-1.2 milliequivalents per liter 1.5-2.0 milliequivalents per liter

0.5-1.2 milliequivalents per liter

The nurse is monitoring the client for early lithium carbonate (Eskalith) toxicity. Which symptoms, if manifested by the client, would indicate that toxicity may be developing? Select all that apply: 1. Persistent GI upset 2. Confusion 3. Polyuria 4. Convulsions 5. Ataxia

1 & 2: GI upset and confusion are signs of elevated lithium levels (1.5-2). Convulsions do occur at higher levels.

Which of the following assessment findings, if discovered in a client receiving verapamil (Calan) for angina, would be cause for the nurse to withhold the medication? Select all that apply: 1. Bradycardia: HR of 40bpm 2. Tachycardia: HR of 126bpm 3. Hypotension: BP 76-46 mmHg 4. Tinnitus with hearing loss 5. Hypertension: BP of 156/92 mmHg

1 & 3: If the HR and BP are too low the drug should not be administered. It is often used to treat tachycardia and hypertension.

When planning client education, the nurse knows that client adherence to beta blocker therapy in HF may be difficult to achieve despite the usefulness of the drugs. What will the nurse need to address in the teaching plan. Select all that apply: 1. The dosage must be gradually adjusted over time to a beneficial dose. 2. The client may not notice significant improvement early into therapy. 3. The drug may require changes to many other medications the client is taking. 4. The drug has significant benefit in reducing mortality from HF. 5. The drug will require extensive lifestyle changes.

1, 2, & 4: Beta blockers require gradual increase in dosage, a significant improvement may not be noticed due to small dosages early in therapy, although the therapy has proven to decrease the number of HF hospitalizing and mortalities.

A client will be receiving lepirudin (Refludan). Which of the following is true concerning this drug therapy? Select all that apply. 1. Ginger, garlic, and green tea may increase the risk of bleeding. 2. Vitamin B12 is used to augment this drug's response. 3. Refludan is used for heparin-induced thrombocytopenia 4. Activated partial thromboplastin time is monitored to determine effectiveness 5. This drug is contraindicated for clients with severe hypertension.

1, 3, 4, & 5: Ginger, garlic, and green tea may all increase risk of bleeding. Lepirudin is used for heparin-iduced thrombocytopenia and is monitored by aPTT., similar to heparin. The drug is contraindication in client with hypertension.

Which of the following should the nurse include in the teaching plan for a client receiving subcutaneous heparin? Select all that apply: 1. Inject medication in the deep fatty layer of the abdomen 2. When brushing your teeth, use a soft toothbrush 3. Hold direct pressure on any puncture sites for 15 minutes. 4. use dental floss daily after brushing 5. Take a daily aspirin tablet, 325 mg, to prevent inflammation at the injection site.

1,2, & 3: the client should be taught proper injecting technique including the need to inject the heparin not the deep, subcutaneous fat layer. A soft toothbrush would be most appropriate because heparin increases chance of bleeding which makes the gums very sensitive. Because heparin does increase bleeding time, it is important to put pressure on the site of injection to promote clotting.

The patient has epilepsy and receives phenytoin (Dilantin). The patient has been seizure-free, and asks the nurse why he still needs blood tests when he is not having seizures. What is the best response by the nurse? 1. "Because phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose." 2. "Because phenytoin (Dilantin) can cause blood-thinning in some patients." 3. "Because phenytoin (Dilantin) can cause Stevens-Johnson syndrome, which will show up in the blood tests." 4. "Because phenytoin (Dilantin) can deplete your system of potassium."

1. "Because phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose."

The nurse is conducting a group education session for patients who have been diagnosed with depression. The nurse evaluates the education as effective when a patient makes which comment(s) about the cause of depression? Select all that apply. 1. "Depression has many causes; they could include environmental as well as brain-based disorders." 2. "Depression includes impaired relationships, and is also an inherited illness." 3. "We really don't know what causes depression; it has not been studied very much." 4. "Depression results from unresolved conflicts in your childhood." 5. "Depression results from parents who are cold and distant and don't really care about their children."

1. "Depression has many causes; they could include environmental as well as brain-based disorders." 2. "Depression includes impaired relationships, and is also an inherited illness."

A client's blood work shows an anemia that was not present at the last clinic visit 6 months ago. Which questions should the nurse ask this client? Select all that apply. 1. "Have you had a significant dietary change in the last 6 months?" 2. "Do you handle chemicals in your new job?" 3. "Have your stools changed in appearance?" 4. "Have you been eating more carbohydrates than usual?" 5. "Are your menstrual periods heavier than normal for you?"

1. "Have you had a significant dietary change in the last 6 months?" 2. "Do you handle chemicals in your new job?" 3. "Have your stools changed in appearance?" 5. "Are your menstrual periods heavier than normal for you?"

The client asks the nurse how glaucoma develops. What is the best response by the nurse? Select all that apply. 1. "Having diabetes is a risk factor in the development of glaucoma." 2. "Glaucoma exists when the pressure in your eye is high enough to cause optic nerve damage." 3. "High blood pressure can certainly lead to the development of glaucoma." 4. "Having blue eyes is a risk factor in the development of glaucoma." 5. "Drugs like antihistamines and antidepressants can contribute to glaucoma."

1. "Having diabetes is a risk factor in the development of glaucoma." 2. "Glaucoma exists when the pressure in your eye is high enough to cause optic nerve damage." 3. "High blood pressure can certainly lead to the development of glaucoma." 5. "Drugs like antihistamines and antidepressants can contribute to glaucoma."

During a health history, the nurse wants to include an assessment of depression with an older patient. What statements will the nurse use to make this assessment? Select all that apply. 1. "How often do you go out to socialize with friends?" 2. "Explain your self-care activities." 3. "How much alcohol do you consume every day?" 4. "How is living with your oldest daughter and her family working out for you?" 5. "Are you feeling depressed?"

1. "How often do you go out to socialize with friends?" 2. "Explain your self-care activities." 3. "How much alcohol do you consume every day?" 4. "How is living with your oldest daughter and her family working out for you?"

The young child has absence seizures. The physician has prescribed valproic acid (Depakene) syrup. The nurse has completed medication education with the child's mother and determines that learning has occurred when the mother makes which statement? 1. "I should not mix this with carbonated beverages." 2. "If my child gets a headache from this, I can administer a baby aspirin." 3. "I can still give the clonazepam (Klonopin) prescribed by the psychiatrist for sleep." 4. "I can give this on a full stomach or an empty stomach."

1. "I should not mix this with carbonated beverages."

Which statement made by the client who is taking lithium carbonate indicates that further teaching is necessary? 1. "I will be sure to remain on a low sodium diet" 2. "I will have blood levels drawn every 2-3 months even if I have no symptoms" 3. "Lithium has a narrow margin of safety, so toxicity is a real concern" 4. "I will not be able to breastfeed by baby"

1. "I will be sure to remain on a low sodium diet": because lithium carbonate is a salt, if the body is low on sodium, it will replace it with lithium allowing it to stay in the body longer; could increase risk of toxicity.

The client receives timolol (Timoptic) eyedrops for glaucoma. The nurse has completed medication education and evaluates learning has occurred when the client makes which statement? 1. "I will discuss use of over-the-counter (OTC) medications with my physician." 2. "I will store my drops in the refrigerator to keep them fresh." 3. "I will restrict my caffeine to one cup of coffee per day." 4. "I will discontinue the drops if my eye looks red."

1. "I will discuss use of over-the-counter (OTC) medications with my physician."

The patient has been treated by the same physician for 2 years and has had insomnia the entire time. Many different medications have been tried with limited success. What should be the nurse's primary assessment at this time? 1. Assess for a primary sleep disorder such as sleep apnea. 2. Assess if the patient has been selling his medications to addicts. 3. Assess if the patient has an addictive personality disorder. 4. Assess the patient for a primary personality disorder.

1. Assess for a primary sleep disorder such as sleep apnea.

The patient has been receiving amitriptyline (Elavil) for 2 weeks. He tells the nurse he doesn't think this medicine is working, as he is still depressed. What is the best response by the nurse? 1. "It is working, but it can take several weeks to have an effect." 2. "You might still feel depressed, but you are looking much better." 3. "This may not be the best medicine for you; I'll call your doctor." 4. "It is working, but it can take several months to have an effect."

1. "It is working, but it can take several weeks to have an effect."

The client is receiving ferrous sulfate (Feosol) for the treatment of anemia. The nurse has taught the client about this drug and about anemia. The nurse evaluates that learning has occurred when the client makes which statement? 1. "My anemia was caused by blood loss from my ulcer, but there are other causes too." 2. "My anemia was caused by drinking too many carbonated beverages with caffeine." 3. "There are many causes for anemia; mine was caused by heart failure and fluid overload." 4. "I think my anemia occurred when I started that vegetarian diet."

1. "My anemia was caused by blood loss from my ulcer, but there are other causes too."

Which statements would the nurse interpret as indicating that the client understands the diagnosis of open-angle glaucoma? Select all that apply. 1. "My eye cannot drain the fluid that it produces." 2. "One of the first signs of this is pain behind my eyes." 3. "My type of glaucoma is a medical emergency." 4. "This is a gradual process; it may take years to develop." 5. "This is the most common kind of glaucoma."

1. "My eye cannot drain the fluid that it produces." 4. "This is a gradual process; it may take years to develop." 5. "This is the most common kind of glaucoma."

The patient tells the nurse that she has been taking phenytoin (Dilantin) for 2 years now and is still having too many side effects. She wants to stop taking it. What is the best response by the nurse? 1. "Please do not stop the medication abruptly, as you will have withdrawal seizures." 2. "Side effects are a problem, but they are not as bad as the seizures you were having." 3. "This is the best medication for you; we can add another medication to decrease side effects.". 4. "You have probably been on the medication long enough; I'll let your doctor know you are stopping it."

1. "Please do not stop the medication abruptly, as you will have withdrawal seizures."

The nurse has completed group education for patients with anxiety disorders. The education is evaluated as successful when the patients make which statements? Select all that apply. 1. "Relaxation techniques will often decrease anxiety." 2. "Antianxiety medicine should be used until our anxiety is gone." 3. "Antianxiety medicine should not be used indefinitely." 4. "We need therapy to learn where this anxiety comes from." 5. "We need different medicines for anxiety, and for difficulty in sleeping."

1. "Relaxation techniques will often decrease anxiety." 3. "Antianxiety medicine should not be used indefinitely." 4. "We need therapy to learn where this anxiety comes from."

The nurse has completed education to the parents of a child newly diagnosed with tonic-clonic seizures. Which comments made by the parents would the nurse evaluate as indicating need for further education? Select all that apply. 1. "Some of the times when I thought he was ignoring me may have actually been seizure activity." 2. "He just needs to focus more to prevent these attacks." 3. "I know he will outgrow these seizures with time." 4. "I hope we can help our son identify his seizure aura." 5. "We will watch for the development of status epilepticus."

1. "Some of the times when I thought he was ignoring me may have actually been seizure activity." 2. "He just needs to focus more to prevent these attacks." 3. "I know he will outgrow these seizures with time."

The patient tells the nurse that she is interested in the human brain, and questions which parts of the brain control anxiety and insomnia. What is the best reply by the nurse? 1. "The limbic system and reticular activating system control anxiety and insomnia." 2. "The frontal lobes and limbic system control anxiety and insomnia." 3. "The thalamus and reticular activating system control anxiety and insomnia." 4. "The limbic system and hypothalamus control anxiety and insomnia."

1. "The limbic system and reticular activating system control anxiety and insomnia."

The patient has been diagnosed with Alzheimer's disease. What is the best medication education the nurse gives to the patient's husband? 1. "The medication may help her symptoms for a little while." 2. "The medication has serious side effects if used for a long time." 3. "Her symptoms will improve as long as she takes the medication." 4. "Her symptoms should begin improving in a few days."

1. "The medication may help her symptoms for a little while."

The patient is receiving escitalopram (Lexapro) for treatment of generalized anxiety disorder. The patient asks the nurse, "I am just nervous, not depressed. Why am I taking an antidepressant medicine?" What is the best response by the nurse? 1. "The same brain chemicals are involved with anxiety as well as depression, and these medications are very safe." 2. "You are really depressed; it is just manifested as anxiety. These medications are safer than benzodiazepines." 3. "Your doctor thinks that this is the best treatment for your anxiety, and these medications are safer than benzodiazepines." 4. "The two disorders go together, and if you treat depression, the anxiety goes away."

1. "The same brain chemicals are involved with anxiety as well as depression, and these medications are very safe."

The client calls the nurse and is very frantic. "I think something is wrong! My stools are black and they have never been this color before!" The client is receiving ferrous sulfate (Feosol). What is the best response by the nurse? 1. "This is an expected side effect of ferrous sulfate (Feosol); it is okay." 2. "This sounds serious; you may have started bleeding again." 3. "Do you have hemorrhoids? That could be the problem." 4. "I will speak with your doctor and call you right back."

1. "This is an expected side effect of ferrous sulfate (Feosol); it is okay."

The client receives eyedrops as treatment for glaucoma. The client calls the clinic one day and tells the nurse that his eye color is changing. What is the best response by the nurse? 1. "This is an expected side effect of the medication." 2. "This is unusual; please come in for an evaluation." 3. "Are you sure that your eyes have changed color?" 4. "What do you mean that your eyes have changed color?"

1. "This is an expected side effect of the medication."

A patient whose spouse recently died is having difficulty falling asleep and does not want to take any prescription medications to induce sleep. How should the nurse respond? Select all that apply. 1. "Walking 2-3 miles or engaging in some other exercise every morning can enhance sleep." 2. "There are alternative methods to treat insomnia, such as yoga, meditation, and massage therapy." 3. "Eating a large meal at bedtime will help induce sleep." 4. "Avoid caffeinated beverages, nicotine, and alcohol immediately prior to bedtime." 5. "Count sheep after lying down in order to enhance sleep."

1. "Walking 2Â?3 miles or engaging in some other exercise every morning can enhance sleep." 2. "There are alternative methods to treat insomnia, such as yoga, meditation, and massage therapy." 4. "Avoid caffeinated beverages, nicotine, and alcohol immediately prior to bedtime."

The patient tells the nurse he worries about everything all day, feels confused, restless, and just can't stop worrying. What is the best response by the nurse? 1. "You have generalized anxiety; I will teach you some relaxation techniques." 2. "This sounds like social anxiety. You need to calm down and you'll be fine." 3. "You have posttraumatic stress disorder (PTSD), and it is time for your therapy session." 4. "This is called panic disorder; I'll get your medication for you."

1. "You have generalized anxiety; I will teach you some relaxation techniques."

The patient tells the nurse, "I am really confused after talking to my doctor. He said I would be taking different kinds of medications for my anxiety and insomnia. Will you please explain it?" What is the best response by the nurse? Select all that apply. 1. "You will be taking medications known as sedative-hypnotics." 2. "You will be taking medications known as antidepressants." 3. "You will be taking a medication known as paraldehyde." 4. "You will be taking medications known as barbiturates." 5. "You will be taking medications known as benzodiazepines."

1. "You will be taking medications known as sedative-hypnotics." 2. "You will be taking medications known as antidepressants." 5. "You will be taking medications known as benzodiazepines."

The client receives epoetin alfa (Epogen) subcutaneously, and says to the nurse, "My doctor said I have anemia. Are there little red blood cells in that shot?" What are the best responses by the nurse? Select all that apply. 1. "Your kidney makes more erythropoietin if it doesn't get enough oxygen." 2. "Erythropoietin also helps your body make hemoglobin." 3. "This stimulates your kidney to make more red blood cells." 4. "It is similar to a kidney hormone, erythropoietin, and helps your body make more red blood cells." 5. "Your kidney makes more erythropoietin when you have too much fluid in your body."

1. "Your kidney makes more erythropoietin if it doesn't get enough oxygen." 2. "Erythropoietin also helps your body make hemoglobin." 4. "It is similar to a kidney hormone, erythropoietin, and helps your body make more red blood cells."

The client with deep vein thrombosis is being treated with a heparin infusion. the nurse would monitor for the therapeutic effects by noticing which of the following: 1. Activated partial thromboplastin time aPTT 2. Prothrombin time (PT) 3. Platelet counts 4. Internation normalized ratio (INR)

1. Activated partial thromboplastin time (aPTT): an activated partial thromboplastin time is the appropriated lab vale that should be monitoring with heparin infusions.

The nurse works with a physician who frequently prescribes benzodiazepines. The use of benzodiazepines in which patient would cause the nurse the most concern? 1. An 87-year-old patient who uses a cane for ambulation 2. A 9-year-old child with panic attacks 3. A 42-year-old businessman who travels internationally 4. A 32-year-old mother of two preschool children

1. An 87-year-old patient who uses a cane for ambulation

The nurse teaches the patient with a neuromuscular disorder about nonpharmacological treatment of muscle spasms. What will the best information include? Select all that apply. 1. Application of heat or cold 2. Ultrasound 3. Massage 4. Relaxation techniques 5. Guided imagery

1. Application of heat or cold 2. Ultrasound 3. Massage

The physician has ordered intravenous (IV) diazepam (Valium) for the patient in status epilepticus. During administration, which assessment by the nurse is most important? 1. Assessing respirations every 5 to 15 minutes 2. Assessing level of consciousness 3. Assessing pulse for bradycardia 4. Assessing blood pressure for hypertension

1. Assessing respirations every 5 to 15 minutes

A patient who has been taking antidepressant medication for several months and is demonstrating an improvement in symptoms tells the nurse that counseling sessions might be helpful. Which types of therapies will the nurse review with the patient? Select all that apply. 1. Behavioral therapy 2. Interpersonal therapy 3. Cognitive-behavioral therapy 4. Psychodynamic therapy 5. Crisis therapy

1. Behavioral therapy 2. Interpersonal therapy 3. Cognitive-behavioral therapy 4. Psychodynamic therapy

The nurse expects that a client experiencing extrapyramidal symptoms during therapy with phenothiazines will be prescribed: 1. Benztropine (Cogentin) 2. Diazepam (Valium) 3. Haloperidol (Haldol) 4. Lorazepam (Ativan)

1. Benzotropine (Cogentin): is an anticholinergic agent which reverses the effects of extrapyramidal symptoms such as muscle rigidity and twitching.

A client is prescribed a beta-adrenergic blocker for treatment of glaucoma. The nurse provides specific information on administration technique to avoid which adverse effects? Select all that apply. 1. Bronchoconstriction 2. Cardiac dysrhythmias 3. Low blood pressure 4. Rash 5. Vomiting

1. Bronchoconstriction 2. Cardiac dysrhythmias 3. Low blood pressure

Spasticity is most commonly caused by damage to what area of the body? 1. Cerebral cortex 2. Peripheral nerves 3. Brainstem 4. Spinal cord

1. Cerebral cortex

A client who has overdosed on Adderall is admitted into the emergency department. The nurse should anticipate which medications to be administered to assist in counteracting the effects of the dosage? 1. Chloropromazine (Thorazine) 2. Phenytoin (Dilantin) 3. Propofol (Diprivan) 4. Dexamethasone (Decadron)

1. Chloropromazine (Thorzine): have alpha-adrenergic blocking abilities and is therefore the medication of choice when treating an OD with a CNS stimulant.

The nurse plans to teach a class about Alzheimer's disease to a caregiver's support group. What will the best plan by the nurse include? Select all that apply. 1. Depression and aggressive behavior are common with the disease. 2. Alzheimer's disease accounts for about 50% of all dementias. 3. Glutamergic inhibitors are the most common class of drugs for treating Alzheimer's disease. 4. Chronic inflammation of the brain may be a cause of the disease. 5. Memory difficulties are an early symptom of the disease.

1. Depression and aggressive behavior are common with the disease. 4. Chronic inflammation of the brain may be a cause of the disease. 5. Memory difficulties are an early symptom of the disease

The nurse is instructing a patient on the cause of bipolar disorder. What neurotransmitters will the nurse describe as contributing to the manic phase of this disorder? Select all that apply. 1. Excessive glutamate 2. Excessive norepinephrine 3. Deficiency of gamma-aminobutyric acid 4. Deficiency of dopamine 5. Excessive serotonin

1. Excessive glutamate 2. Excessive norepinephrine 3. Deficiency of gamma-aminobutyric acid

The nurse is evaluating the therapeutic effects of milrinone, a positive inotropic drug. The nurse knows that this drug is given to: 1. Increase the force of cardiac contractions and improve CO. 2. Decrease the volume of cardiac output to reduce hypertension. 3. Relax the myocardial muscle, decreasing myocardial oxygen requirements. 4. Inhibit cardiac irregularities, decreasing the sensation of palpitations.

1. Increase the force of cardiac contractions and improve CO: Because milrinone is a positive inotropic drug, its mechanism of action is to make the heart pump more forcefully.

The physician prescribes cyclobenzaprine (Flexeril) for the patient. When doing medication education, what will the best information of the nurse include? 1. Increase the intake of fiber while taking this medication. 2. Restrict the intake of sodium while taking this medication. 3. Increase the intake of protein while taking this medication. 4. Do not drink any caffeine while taking this medication.

1. Increase the intake of fiber while taking this medication.

The patient has been taking lorazepam (Ativan) for 2 years. The patient stopped this medication after a neighbor said the drug manufacturer's plant was contaminated with rat droppings. What best describes the nurse's assessment of the patient when seen 3 days after stopping his medication? 1. Increased heart rate, fever, and muscle cramps 2. Nothing different; it is safe to abruptly stop lorazepam (Ativan) 3. Pinpoint pupils, constipation, and urinary retention 4. A sense of calmness and lack of anxiety

1. Increased heart rate, fever, and muscle cramps

A client who is taking clopidogrel (Plavix) to prevent another stroke asks the nurse how the medication works. The nurse's response should based on an understanding that Plavix: 1. Inhibits platelet aggregation to prevent clot formation. 2. Activates antithrombin III and subsequently inhibits thrombin. 3. Inhibits enzymes involved in the formation of vitamin K. 4. Converts plasminogen to plasmin to dissolve fibrin clots.

1. Inhibits platelet aggregation to prevent clot formation: Clopidogrel is an anti platelet drug used to prevent blood clots from forming inside the arteries by inhibiting platelet aggregation.

From a pharmacology standpoint, which of the following best explains why levodopa is superior to dopamine? 1. It crosses the blood-brain barrier. 2. It has fewer adverse effects. 3. It has less risk for addiction. 4. It can be administered orally.

1. It crosses the blood-brain barrier

Which of the following best describes open-angle glaucoma? 1. It is bilateral with a slow onset. 2. It is less common than closed-angle glaucoma. 3. It is accompanied by eye pain. 4. It is unilateral with a rapid onset.

1. It is bilateral with a slow onset.

the client, who is receiving benzodiazepines, is a two-pack per day cigarette smoker. The nurse expects to administer a(n) ______ dose of this medication. 1. Larger 2. Smaller 3. Extra 4. Half

1. Larger: smoking enhances the metabolism of benzodiazepines because they are a CNS stimulant. Therefore a larger dose may be necessary in order to feel the same therapeutic effect.

The physician has ordered intravenous (IV) phenytoin (Dilantin). The nurse does not read the drug label and administers the medication intramuscularly (IM). What is the most likely response in the patient? 1. Local tissue damage following extravasation will most likely occur. 2. A phenomenon known as purple gluteus syndrome will most likely occur. 3. A marked decrease in serum glucose levels will most likely occur. 4. Nothing adverse, the medication may be administered intravenously (IV) or intramuscularly (IM).

1. Local tissue damage following extravasation will most likely occur.

A patient taking which of the following medications should avoid foods high in tyramine? 1. MAOIs 2. SSRIs 3. Beta blockers 4. Benzodiazepines

1. MAOIs

The client had stomach cancer and a surgical removal of his stomach several years ago. The physician prescribed cyanocobalamin (Crystamine). The client stopped this drug several months ago. What will the nurse most likely assess in this client? 1. Memory loss, numbness in the limbs, and depression 2. A gradual decrease in red blood cell counts 3. Jaundice, and tarry stools 4. Low hemoglobin and hematocrit counts

1. Memory loss, numbness in the limbs, and depression

A patient who has cerebral palsy is beginning to experience spasticity of the muscles in the upper arm. Which medications would the nurse question if prescribed for this patient? Select all that apply. 1. Metaxalone (Skelaxin) dosed three times a day 2. Chlorzoxazone (Parafon Forte) dosed four times a day 3. Carisoprodol (Soma) dosed three times a day 4. Intrathecal baclofen (Lioresal) 5. Tizanidine (Zanaflex) dosed twice a day

1. Metaxalone (Skelaxin) dosed three times a day 2. Chlorzoxazone (Parafon Forte) dosed four times a day 5. Tizanidine (Zanaflex) dosed twice a day

The nurse plans care for a patient with Parkinson's disease. What will the best plan by the nurse include? 1. Monitor the patient for the ability to chew and swallow. 2. Check peripheral circulation for thrombophlebitis. 3. Monitor the patient for psychotic symptoms. 4. Limit exercise to decrease the possibility of fractures.

1. Monitor the patient for the ability to chew and swallow.

A patient is diagnosed with multiple sclerosis. What symptoms will the nurse most likely assess in this patient? Select all that apply. 1. Muscle weakness 2. Difficulty maintaining balance 3. Atrophy of the hands and legs 4. Slow shuffling gait 5. Progressive chorea

1. Muscle weakness 2. Difficulty maintaining balance

The client is preparing for an eye examination. Which of the following classification of drugs will be used? 1. Mydriatics 2. Vasoconstrictors 3. Prostaglandins 4. Beta-adrenergic blockers

1. Mydriatics

A client is scheduled to have chemotherapy Thursday at 9 a.m. Filgrastim (Neupogen) has also been ordered. The nurse should plan which dosing time for the Neupogen? Select all that apply. 1. No later than 9 a.m. on Wednesday 2. At the time of the chemotherapy infusion 3. Immediately following the chemotherapy 4. No earlier than 9 a.m. Friday 5. Immediately before the chemotherapy

1. No later than 9 a.m. on Wednesday 4. No earlier than 9 a.m. Friday

The nurse is concerned that a patient is moving into the manic phase of bipolar disorder when what is assessed? Select all that apply. 1. Not sleeping 2. Losing weight 3. Sluggish activity 4. Complaints of muscle pain 5. Constant talking

1. Not sleeping 2. Losing weight 5. Constant talking

The nurse designs a plan of care for the client with peptic ulcer disease (PUD) who is taking omeprazole (Prilosec) for the management of his illness. What will the best plan by the nurse include? Select all that apply. 1. Omeprazole (Prilosec) should not be crushed or chewed. 2. Omeprazole (Prilosec) is best taken with yogurt. 3. Omeprazole (Prilosec) is recommended for long-term treatment of peptic ulcer disease (PUD). 4. Omeprazole (Prilosec) should be administered before meals. 5. Omeprazole (Prilosec) should be administered after meals.

1. Omeprazole (Prilosec) should not be crushed or chewed 4. Omeprazole (Prilosec) should be administered before meals.

Muscle stiffness, pill-rolling activity, and bradykinesia are symptoms most likely associated with which disorder? 1. Parkinson's disease 2. Multiple sclerosis 3. Alzheimer's disease 4. Amyotrophic lateral sclerosis

1. Parkinson's disease

The nurse observes a patient with Parkinson's disease having difficulty controlling hand movements. What did the nurse observe in this patient? Select all that apply. 1. Pill rolling 2. Tremor 3. Stooped posture 4. Lack of arm swing 5. Difficulty bending the arms

1. Pill rolling 2. Tremor

The physician has ordered filgrastim (Neupogen) intravenously for the client. What is a priority plan by the nurse prior to administering this drug? 1. Plan to monitor the client's ECG readings. 2. Plan to insert a Foley catheter and monitor urine output. 3. Plan to administer 10% oxygen during the infusion. 4. Plan to have a white blood cell (WBC) count drawn every 30 minutes.

1. Plan to monitor the client's ECG readings.

The nurse, who is monitoring a client taking phenytoin (Dilantin), has noted symptoms of nystagmus, confusion, and ataxia. Considering these findings, the nurse would suspect that the dose of the drug should be: 1. Reduced 2. Increased 3. Maintained 4. Discontinued

1. Reduced: Nystagmus, confusion, and ataxia are all signs that too much CNS depression is occurring. Therefore the drug should still be taken although at a reduce dosage.

The client wears contact lenses and has been prescribed eyedrops for glaucoma. What will the best education by the nurse include with regard to contact lenses? 1. Remove lenses before instilling eyedrops; do not reinsert lenses for 15 minutes. 2. Instill the drops with the contacts in as long as they are the hard kind of contacts. 3. Eyeglasses must be worn for as long as the client must have the eyedrops. 4. Instill the drops with the contacts in as long as they are the soft kind of contacts.

1. Remove lenses before instilling eyedrops; do not reinsert lenses for 15 minutes

Which area of the brain is primarily responsible for maintaining sleep and wakefulness? 1. Reticular activating system 2. Cerebral cortex 3. Limbic system 4. Cerebellum

1. Reticular activating system

A health care provider has ordered imipramine (Tofranil) for each of these clients. A nurse should question the order for the client with: 1. Seizure disorder 2. Depression 3. Enuresis 4. Neuropathic pain

1. Seizure disorder: mood stabilizers decrease the seizure threshold. It is effective in treating depression, enuresis, and neuropathic pain because it is not easily targeted.

A client will be taking carvedilol (Coreg) for heart failure. Before teaching the client about this drug, the nurse will discuss the strategy for drug dogs with the health care provider because of which recommended routine for beta-adrenergic0-blockers in heart failure? 1. Significantly lower dosages are used first and gradually increase to target dose. 2. A loading dose that is higher than the subsequent daily dose must be given. 3. The beta blocker dosage must be lowered if the client is also on ACE inhibitors. 4. Beta blockers are almost never used in heart failure and the order must be confirmed.

1. Significantly lower dosages are used first and gradually increase to target dose: Beta blockers are started at 1/10-1/20 of target dose in order to prevent the adverse effects associated with beta blockers.

A patient with Parkinson's disease is experiencing an increase in bradykinesia. What will the patient demonstrate with this manifestation? Select all that apply. 1. Slow speech 2. Difficulty chewing 3. Shuffling the feet when walking 4. Stooped posture 5. Lack of facial expression

1. Slow speech 2. Difficulty chewing 3. Shuffling the feet when walking

The client asks how atenolol (Tenormin) helps angina. The response provided by the nurse is based on which concept. This medication: 1. Slows the heart rate and reduces contractility 2. Increases the HR and diminishes contractility 3. Blocks sodium channels and elevates depolarization 4. Decreases BP and blocks the alpha2 receptors.

1. Slows the HR and reduces contractility: it is a beta block and therefore decreases the HR by blocking beta receptors.

The patient is diagnosed with post-traumatic stress disorder. What will the nurse assess in this patient? Select all that apply. 1. Tachycardia 2. Extreme nervousness or panic attacks 3. A fear of crowds 4. A fear of exposure to germs 5. Hallucinations, nightmares, or flashbacks

1. Tachycardia 2. Extreme nervousness or panic attacks 5. Hallucinations, nightmares, or flashbacks

A client comes to the clinic with report of intermittent epigastric pain that is associated with meals. The nurse would review the client's medical record and assess for the presence of which risk factors for peptic ulcer disease (PUD)? Select all that apply. 1. The client reports that his mother and grandfather both had ulcers. 2. The client has type AB blood. 3. The client reports drinking several cups of coffee every morning. 4. The client reports mild to moderate job and family stress. 5. The client tested positive for influenza A

1. The client reports that his mother and grandfather both had ulcers. 3. The client reports drinking several cups of coffee every morning.

The physician has prescribed epoetin alfa (Epogen) for the client. What is the priority assessment by the nurse? 1. The client's blood pressure 2. The client's report of a headache, indicating a stroke 3. The client's ability to use the proper injection techniques for self-administration 4. The client's hemoglobin and hematocrit levels

1. The client's blood pressure

A client has been treated with an erythropoiesis-stimulating factor. Which client assessment would the nurse interpret as indicating the goal of this treatment has been reached? Select all that apply. 1. The client's hemoglobin values have risen. 2. The client reports less shortness of breath on exertion. 3. The client has not had an episode of epistaxis in over three weeks. 4. The client reports enjoying a walk with family for the first time in months. 5. The client has not had a fever since treatment began.

1. The client's hemoglobin values have risen. 2. The client reports less shortness of breath on exertion. 4. The client reports enjoying a walk with family for the first time in months.

A client has been prescribed brinzolamide (Azopt). Which findings would the nurse discuss with the prescriber before administering this drug? Select all that apply. 1. The client's last potassium level was low. 2. The client is a vegetarian. 3. The client is allergic to sulfa. 4. The client has a history of atopic dermatitis. 5. The client's father had a myocardial infarction at age 35.

1. The client's last potassium level was low. 3. The client is allergic to sulfa

The nurse is planning educations sessions for a patient regarding use of a newly prescribed anti epileptic drug (AED). Which topics should be included in this session? Select all that apply. 1. The patient should take the medication at the same time every day. 2. If the patient forgets a dose of medication, wait until the next dose is due and take both doses together. 3. The patient should take an additional dose of medication upon experiencing a seizure aura. 4. If the patient experiences side effects of the medication, the patient should skip the next dose to see if the side effects lessen. 5. The patient should avoid using dietary supplements containing kava when on this medication.

1. The patient should take the medication at the same time every day. 5. The patient should avoid using dietary supplements containing kava when on this medication.

The nurse has been conducting medication education for a patient with epilepsy. What is the best outcome for this patient? 1. The patient will recognize that the antiseizure medication must be continued indefinitely. 2. The patient will recognize the need to be on a tyramine-free diet while on anti seizure medications. 3. The patient will recognize the need to be on a ketogenic diet in combination with antiseizure medications. 4. The patient will recognize the need to be on antiseizure medication for one year after the last seizure.

1. The patient will recognize that the antiseizure medication must be continued indefinitely.

The patient receives imipramine (Tofranil) as treatment for depression. He is admitted to the emergency department following an intentional overdose of this medication. What will the best assessment by the nurse include? 1. The patient's cardiac status 2. The patient's liver function 3. The patient's renal status 4. The patient's neurological function

1. The patient's cardiac status

Which statement about skeletal muscle relaxants is correct? 1. They inhibit upper motor neuron activity within the central nervous system. 2. They work primarily by stimulating the peripheral nervous system. 3. They increase the amount of neurotransmitter within the muscles. 4. They stimulate motor activity within the brainstem.

1. They inhibit upper motor neuron activity within the central nervous system.

The physician has ordered intravenous phenytoin (Dilantin). The patient is also receiving 5% dextrose in water (D5W) intravenously (IV). What will the nurse plan to do before administering this medication? Select all that apply. 1. Use a large vein for the infusion. 2. Use an intravenous (IV) line with a filter. 3. Flush the intravenous (IV) line with saline. 4. Monitor the patient for hypertension. 5. Monitor the patient for Stevens-Johnson Syndrome.

1. Use a large vein for the infusion. 2. Use an intravenous (IV) line with a filter. 3. Flush the intravenous (IV) line with saline.

A patient with depression does not want to take prescribed medication because of the side effects. What can the nurse suggest to help with medication adherence? Select all that apply. 1. Use ice chips to help alleviate dry mouth. 2. Chew gum or use hard candy to help alleviate dry mouth. 3. Avoid alcohol-based mouthwash to help alleviate dry mouth. 4. Use "dry eye" drops to help with eye dryness. 5. Take alcoholic beverages several times a week to help with unpleasant side effects.

1. Use ice chips to help alleviate dry mouth. 2. Chew gum or use hard candy to help alleviate dry mouth. 3. Avoid alcohol-based mouthwash to help alleviate dry mouth. 4. Use "dry eye" drops to help with eye dryness.

The patient receives dantrolene (Dantrium). Which medication would the nurse evaluate as being contraindicated with dantrolene (Dantrium)? 1. Verapamil (Calan) 2. Insulin 3. Clarithromycin (Biaxin) 4. Methylphenidate (Concerta)

1. Verapamil (Calan)

The nurse identifies a patient with a repeating pattern of muscle contraction of the leg for 5 seconds followed by 2 seconds of relaxation as experiencing 1. a clonic spasm. 2. a tonic spasm. 3. spasticity. 4. dystonia.

1. a clonic spasm.

The nurse is aware that antacids containing magnesium and aluminum can cause 1. diarrhea. 2. abdominal pain. 3. constipation. 4. indigestion.

1. diarrhea.

The mechanism of action of colony-stimulating factors, such as filgrastim (Neupogen), is to 1. increase neutrophil production. 2. supplement iron in the body. 3. replace vitamin B12 factor. 4. increase erythrocyte production.

1. increase neutrophil production.

Pharmacotherapy for Parkinson's disease is intended to 1. increase the amount of dopamine and reduce the amount of acetylcholine. 2. increase the amount of dopamine and acetylcholine. 3. reduce the amount of dopamine and increase the amount of acetylcholine. 4. reduce the amount of dopamine and acetylcholine.

1. increase the amount of dopamine and reduce the amount of acetylcholine.

The nurse, providing medications to a patient with multiple sclerosis, realizes that the goals of medication therapy for this patient include Select all that apply. 1. modifying the progression of the disease. 2. treating acute exacerbations. 3. managing symptoms. 4. curing the disease. 5. remyelinating nerve fibers.

1. modifying the progression of the disease. 2. treating acute exacerbations. 3. managing symptoms.

An individual who has difficulty sleeping due to two final examinations scheduled for the same day later in the week most likely would be suffering from 1. situational anxiety. 2. social anxiety. 3. obsessive-compulsive disorder. 4. performance anxiety.

1. situational anxiety

The pyloric sphincter regulates flow of food into the 1. small intestine. 2. stomach. 3. esophagus. 4. rectum

1. small intestine

During a health history, the nurse is concerned that a patient with depression is at risk for suicide when the patient Select all that apply. 1. states that "suicide is always an option." 2. describes a previous unsuccessful attempt at suicide by aspirin overdose. 3. states that the prescribed medication is not working and that feelings of depression are worse. 4. requests prescriptions for pain medication and a sleeping aid. 5. expresses interest in meeting with friends more often.

1. states that "suicide is always an option." 2. describes a previous unsuccessful attempt at suicide by aspirin overdose. 3. states that the prescribed medication is not working and that feelings of depression are worse. 4. requests prescriptions for pain medication and a sleeping aid.

It is important for the nurse to obtain a thorough history from a patient who is experiencing anxiety. This history will help to distinguish Select all that apply. 1. the best method of pharmacotherapy. 2. whether the patient might benefit from individual or group therapy. 3. the category of anxiety disorder. 4. the region of the brain that is causing the anxiety disorder. 5. substances that might worsen anxiety.

1. the best method of pharmacotherapy. 2. whether the patient might benefit from individual or group therapy. 5. substances that might worsen anxiety.

In monitoring clients receiving hematopoietic agents, it is most important for the nurse to monitor for 1. thromboembolus. 2. TIA (transient ischemic attack). 3. MI (myocardial infarction). 4. stroke

1. thromboembolus

Colony-stimulating factors (CSFs) are named according to 1. type of blood cell stimulated. 2. type of hormone secreted. 3. type of homeostatic control. 4. type of stem cell stimulated.

1. type of blood cell stimulated

A nurse is reviewing a client's serum lithium level. Which finding would indicate that the client is experiencing lithium toxicity? 0.6 mEq/L 1.2 mEq/L 0.8 mEq/L 1.8 mEq/L

1.8 mEq/L

How long does a patient need to wait after stopping a phenelzine (Nardil) before starting paroxetine (Paxil)? 14 days 10 days 1 day 7 days

14 days

A 17-year old client is started on fluoxetine (Prozac) for treatment of depression. When teaching the client and his family, what would the nurse include. Select all that apply: 1. Report any sedation to the provider and exercise caution with activities requiring mental alertness 2. Fluctuations in weight may be managed with a healthy diet and adequate amounts of exercise 3. Report any thoughts of suicide to the provider immediately, especially during early invitation of the drug. 4. The drug may be safely stopped if unpleasant side effects occur and reported to the provider at the next scheduled visit. 5. The drug may cause excessive thirst but dramatic increase in fluid intake should be avoided.

2 & 3: Weight loss and weight fluctuations are common; although they can be avoided with proper nutrition and exercise. Also, suicidal thoughts have been noted up to the age of 24 of which should be reported to the health care provider immediately.

The parents of a 2-year-old who has cerebral palsy are only now beginning to accept that their child will have a permanent disability. The nurse has been instructing the parents about the treatment for the spasticity their child is experiencing. Which statements by the parents indicate that the nurse should plan additional teaching sessions? Select all that apply. 1. "At some point, our child may require surgery to correct this spasticity." 2. "As long as we continue our child's medications, the spasticity can be controlled." 3. "Our physical therapy sessions should focus on flexing our child's muscles." 4. "We should repeat the exercises several times with each muscle group." 5. "It is best to give our child a rest from physical therapy by skipping 1 week a month."

2. "As long as we continue our child's medications, the spasticity can be controlled." 3. "Our physical therapy sessions should focus on flexing our child's muscles." 5. "It is best to give our child a rest from physical therapy by skipping 1 week a month."

The 10-year-old patient is receiving methylphenidate (Ritalin). The patient's mother tells the nurse he just won't sleep while on his medication. What is the best response by the nurse? 1. "You can give him a 25 mg diphenhydramine (Benadryl) tablet at bedtime." 2. "Do not give the medication after 4:00 p.m." 3. "Do not give the medication after 6:00 p.m." 4. "This is serious; you should ask the doctor about atomoxetine (Strattera)."

2. "Do not give the medication after 4:00 p.m."

The nurse is teaching a class for patients who have been recently diagnosed with epilepsy. The nurse determines that learning has occurred when the patients make which statements? Select all that apply. 1. "Excessive stress levels cause disruptions in how the brain receives oxygen, leading to epilepsy." 2. "Epilepsy may be caused by a head injury." 3. "Eating disorders, like anorexia nervosa, increase the risk for developing epilepsy." 4. "A stroke, or brain attack, could increase the risk for developing epilepsy." 5. "With some cases of epilepsy, the cause is never determined."

2. "Epilepsy may be caused by a head injury." 4. "A stroke, or brain attack, could increase the risk for developing epilepsy." 5. "With some cases of epilepsy, the cause is never determined."

The 8-year-old patient is receiving methylphenidate (Ritalin). The patient's mother tells the nurse that he won't eat while on his medication. What is the best response by the nurse? 1. "It sounds like he is becoming depressed. I will speak to the doctor about starting an antidepressant medication." 2. "Give the medication after meals and encourage him to have supplements between meals." 3. "You are right to be concerned. I will speak to the doctor about starting an appetite stimulant medication." 4. "This is a very serious concern; it would be best for him to see a nutritionist for counseling."

2. "Give the medication after meals and encourage him to have supplements between meals."

The nurse has completed medication education for the anxious patient who is receiving buspirone (BuSpar). The nurse determines that the patient needs additional instruction when the patient makes which statement? 1. "Side effects I might experience include dizziness, headache, and drowsiness." 2. "I can take this medication when I feel anxious and it will relax me." 3. "I have to take this medicine on a regular basis for it to help me." 4. "I don't need to worry about becoming dependent on this medication."

2. "I can take this medication when I feel anxious and it will relax me."

The nurse is talking with a patient who was just prescribed zonisamide (Zonegran). Which patient statement should the nurse immediately discuss with the patient's health care provider? Select all that apply. 1. "Did I mention that I used to take phenobarbital for my seizures?" 2. "I forgot to tell the doctor that I am allergic to sulfa drugs." 3. "I have lactose intolerance, so I can't drink milk." 4. "My husband and I plan to have a baby in a couple of years." 5. "My husband and I are leading a 20-mile bicycle tour next weekend for the company we have just started."

2. "I forgot to tell the doctor that I am allergic to sulfa drugs." 5. "My husband and I are leading a 20-mile bicycle tour next weekend for the company we have just started."

The patient receives levodopa (Larodopa). The nurse has completed medication education and determines that learning has occurred when the patient makes which statement? 1. "I need to increase my daily intake of protein." 2. "I must increase the fiber in my diet." 3. "I need to check my pulse before taking the medication." 4. "I must avoid yellow vegetables in my diet."

2. "I must increase the fiber in my diet."

The nurse has completed medication education for a patient prior to the patient receiving phenelzine (Nardil). The nurse evaluates the education as effective when the patient makes which statement(s)? Select all that apply. 1. "I am really going to miss my morning coffee and sweet roll." 2. "I'll have to give up my beer at the football games." 3. "I can't eat fried chicken and gravy." 4. "I am not supposed to have processed meats or cheese." 5. "I really shouldn't eat at a restaurant; too many foods are on my restricted list."

2. "I'll have to give up my beer at the football games." 4. "I am not supposed to have processed meats or cheese."

The patient tells the nurse that she awakens frequently during the night because of leg and foot cramps. What is the best response by the nurse? 1. "Ask your physician for a muscle relaxant." 2. "Increase your intake of calcium." 3. "Take a warm bath before going to bed." 4. "Apply heat to relieve the cramping."

2. "Increase your intake of calcium."

The client receives filgrastim (Neupogen). He asks the nurse, "That is such a funny name; where do you suppose it comes from?" What is the best response by the nurse? 1. "It comes from the interleukins it stimulates; this one stimulates neuocytes." 2. "It comes from the blood cell it stimulates; this one stimulates neutrophils." 3. "It comes from the stem cells it stimulates, such as filgrastims." 4. "It is a complicated process; the drug companies are secretive about it."

2. "It comes from the blood cell it stimulates; this one stimulates neutrophils."

The client receives esomeprazole (Nexium). He asks the nurse why that little purple pill is better than his cimetidine (Tagamet). What is the best response by the nurse? 1. "It is about the same, but a lot cheaper than your cimetidine (Tagamet)." 2. "It decreases acid in your stomach, better than cimetidine (Tagamet)." 3. "It is about the same, but has fewer side effects than your cimetidine (Tagamet)." 4. "It is not as effective as cimetidine (Tagamet), but kills bacteria better."

2. "It decreases acid in your stomach, better than cimetidine (Tagamet)."

The client receives misoprostol (Cytotec) for treatment of peptic ulcer disease (PUD). The client asks the nurse why he is receiving this medication. What is the best response by the nurse? 1. "It dissolves into a gel and sticks to your ulcer." 2. "It increases mucus production in your stomach." 3. "It inhibits bacterial growth." 4. "It neutralizes stomach acid."

2. "It increases mucus production in your stomach."

The client is pregnant and has been told by her physician that she needs cyanocobalamin (Nascobal). She asks the nurse, "Will this hurt my baby?" What is the best response by the nurse? 1. "No, this medication will not hurt your baby as long as you take it with ascorbic acid." 2. "No, this is safe as long as long as you take it in pill form; it is a Pregnancy Category A drug, which means it is safe for your baby." 3. "No, this medication will not hurt your baby as long as you take the pills only in the third trimester." 4. "No, this is safe in either pill or injectable form; it is a Pregnancy Category A drug which means it is safe for your baby."

2. "No, this is safe as long as long as you take it in pill form; it is a Pregnancy Category A drug, which means it is safe for your baby."

The patient is receiving Phenobarbital (Luminal) for control of seizures. The patient tells the nurse she plans to become pregnant. What is the best response of the nurse? 1. "Your medication dose will need to be decreased during your pregnancy." 2. "Please talk to your doctor; this drug is contraindicated in pregnancy." 3. "Your medication dose will need to be increased during your pregnancy." 4. "Please talk to your doctor; you will need a safer drug like valproic acid (Depakene)."

2. "Please talk to your doctor; this drug is contraindicated in pregnancy."

A client is to receive darbepoetin alfa (Aranesp) adjunctive medication during chemotherapy. The client says, "Not another drug. Why do I need this one?" How should the nurse respond? Select all that apply. 1. "I know you are tired of drugs, but this is just one more." 2. "This drug will help you grow red blood cells." 3. "This drug will help keep you from getting infections." 4. "This is an erythropoiesis-stimulating factor." 5. "This drug will help you get more oxygen around to your tissues so you feel better."

2. "This drug will help you grow red blood cells." 5. "This drug will help you get more oxygen around to your tissues so you feel better."

The client tells the nurse that when he uses his timolol (Timoptic) eyedrops, they sting his eyes. What is the best response by the nurse? 1. "Hold the next dose and contact your physician." 2. "This is a normal and expected effect of the drops." 3. "Your eyedrops may have expired; check the date." 4. "You should wash your eyes immediately with saline."

2. "This is a normal and expected effect of the drops."

The client is receiving chemotherapy for cancer. The physician has prescribed oprelvekin (Neumega). The nurse has completed medication education and evaluates it as effective when the client makes which statement? 1. "This medication will help my chemotherapy work better." 2. "This medication will help increase my platelet count." 3. "This medication will help me regain the weight I have lost." 4. "This medication will help increase my red blood cell count."

2. "This medication will help increase my platelet count."

The nurse completes medication education for the client receiving sucralfate (Carafate). The nurse evaluates that learning has occurred when the client makes which statement? 1. "This works by inhibiting bacterial growth in my stomach." 2. "This works by dissolving into a jelly and sticking to my ulcer." 3. "This works by decreasing the amount of acid in my stomach." 4. "This works by neutralizing the acid in my stomach."

2. "This works by dissolving into a jelly and sticking to my ulcer."

The client has chronic alcoholism. He asks the nurse why his doctor put him on folic acid (Folvite) since he promised the doctor that he would stop drinking. What is the best response by the nurse? 1. "You should ask your doctor since you promised him that you would not drink anymore." 2. "You have been drinking instead of eating, and alcohol interferes with folate metabolism in your liver." 3. "You need folic acid to make up for the vitamin B12 deficiency that was caused by your alcoholism." 4. "You need folic acid because you have not been compliant with taking your vitamins and attending Alcoholics Anonymous (AA) meetings."

2. "You have been drinking instead of eating, and alcohol interferes with folate metabolism in your liver."

The patient asks the nurse why she needs to continue using table salt because her prescribed lithium (Eskalith) is a salt. What is the best response by the nurse? 1. "You must continue to use salt to avoid lithium (Eskalith) toxicity. If you use sea salt, you don't need as much." 2. "You must use table salt or your kidneys will retain lithium (Eskalith), and you will become toxic." 3. "The amount is not important; just increase your table salt if you notice signs of lithium (Eskalith) toxicity." 4. "Salt is very important to avoid lithium (Eskalith) toxicity, but not as important as drinking 1 to 1.5 L of water per day."

2. "You must use table salt or your kidneys will retain lithium (Eskalith), and you will become toxic."

A parent says to the nurse, "The doctor prescribed ethosuximide (Zarontin) for my child, who has absence seizures. What does this mean?" What is the best response by the nurse? 1. "Absence seizures are basically the same kind of seizures as grand mal, but they are less frequent." 2. "Your daughter's seizures manifest as a staring into space for a few seconds. Ethosuximide (Zarontin) is a good medication for this type of seizure." 3. "Explaining the types of seizure activity is complicated. Have you spoken to your doctor about it?" 4. "Are you sure your doctor prescribed ethosuximide (Zarontin)? Phenobarbital (Luminal) is used much more frequently with children."

2. "Your daughter's seizures manifest as a staring into space for a few seconds. Ethosuximide (Zarontin) is a good medication for this type of seizure."

Which of the following patients suffering from muscle spasms should not receive the direct-acting antispasmodic medication dantrolene sodium (Dantrium)? 1. 20-year-old suffering from a spinal cord injury 2. 57-year-old suffering from congestive heart failure 3. 40-year-old suffering from multiple sclerosis 4. 65-year-old suffering from a cerebral vascular accident

2. 57-year-old suffering from congestive heart failure

Which statement best explains why a CNS stimulant helps a patient with attention-deficit hyperactivity disorder (ADHD)? 1. Neurotransmitters are blocked, limiting the effects they can produce within the PNS. 2. Activation of certain areas of the brain causes increased attention and ability to focus. 3. Neurotransmitter levels are reduced, which produces a calming effect within the CNS. 4. Certain areas of the brain are deactivated, resulting in a calming effect.

2. Activation of certain areas of the brain causes increased attention and ability to focus.

What is the correct administration technique for sucralfate (Carafate)? 1. Administer it after meals. 2. Administer it prior to meals. 3. Administer the drug once daily. 4. Administer it with milk.

2. Administer it prior to meals

Which statement regarding the use of zolpidem (Ambien) for insomnia is accurate? 1. Patients using Ambien should avoid foods that contain tyramine. 2. Ambien will take longer to produce an effect when taken with food. 3. Ambien is contraindicated during pregnancy, but can be taken by breastfeeding mothers. 4. Ambien is classified as a benzodiazepine.

2. Ambien will take longer to produce an effect when taken with food.

The client has gastroesophageal reflux disease (GERD) and has been receiving medication treatment for many years. What priority assessment findings associated with the medication must the nurse report to the physician? 1. Vomiting and mild upper mid-epigastric pain 2. Anemia, fatigue, and weakness 3. Hypotension and tachycardia 4. Diarrhea and soft stools

2. Anemia, fatigue, and weakness

Which statement is accurate regarding attention-deficit hyperactivity disorder (ADHD)? 1. ADHD is characterized by periods of mania and periods of depression. 2. Anxiety and social withdrawal are more frequently seen in girls than in boys. 3. Diagnosis is higher in girls than in boys. 4. ADHD is generally diagnosed later in life.

2. Anxiety and social withdrawal are more frequently seen in girls than in boys

Benzodiazepines are often the drug of choice for managing anxiety and insomnia. Which statement best explains why? 1. Benzodiazepines are the most effective. 2. Benzodiazepines have the lowest risk of dependency and tolerance. 3. Benzodiazepines are most likely to be covered under insurance premiums. 4. Benzodiazepines are the most affordable.

2. Benzodiazepines have the lowest risk of dependency and tolerance.

The nurse teaches a class about muscle movement to a group of patients who have neuromuscular disorders. What will the best plan of the nurse include? Select all that apply. 1. Body movement depends on an intact spinal cord. 2. Body movement depends on proper functioning of muscles. 3. Body movement depends on intact nerves. 4. Body movement depends on proper endocrine functioning. 5. Body movement depends on the level of consciousness.

2. Body movement depends on proper functioning of muscles. 3. Body movement depends on intact nerves.

A client is admitted for treatment of a duodenal ulcer. What will the nurse's admission assessment likely reveal? 1. Nausea and lower right quadrant abdominal pain 2. Burning pain several hours after eating a meal 3. Anorexia and weight loss 4. Low back pain radiating down the left leg

2. Burning pain several hours after eating a meal

The physician has ordered combination therapy for the client with peptic ulcer disease (PUD). The nurse plans to do medication education. What will the best plan by the nurse include? 1. Combination therapy has the best outcomes when antibiotics are used with antacids. 2. Combination therapy has the best outcomes when antibiotics are used with proton-pump inhibitors. 3. The use of sucralfate (Carafate) along with antibiotics is the best combination therapy for peptic ulcer disease (PUD). 4. Various antibiotics are used to eradicate the bacteria that are responsible for the development of peptic ulcer disease (PUD).

2. Combination therapy has the best outcomes when antibiotics are used with proton-pump inhibitors.

The nurse is discharging a 72-year-old man who was hospitalized after a muscle strain injury to his back. One of the discharge prescriptions for this patient is cyclobenzaprine (Flexeril) 10 mg three times per day with food. The prescription is written for 90 tablets and there are three refills available. Which information from this situation would alert the nurse for the need to collaborate with the patient's health care provider? Select all that apply. 1. The dosage amount is too low for the type of injury this patient sustained. 2. Cyclobenzaprine should be used with great caution in those over 65. 3. If taken as directed, the patient would be able to take the medication for 120 days. 4. Cyclobenzaprine is not effective for back pain. 5. Cyclobenzaprine should not be taken with food.

2. Cyclobenzaprine should be used with great caution in those over 65. 3. If taken as directed, the patient would be able to take the medication for 120 days.

Which therapeutic outcome would the nurse consider most significant in evaluating a client who started atomoxetine (Straterra), a non-stimulant, norepinephrine re-uptake inhibitor for ADHD about 6 months ago. 1. Decrease in attention 2. Decrease in hyperactivity 3. Development of mydriasis 4. Elevated liver enzymes

2. Decrease in hyperactivity: the intended use of ADHD drugs is to increase alertness and decrease hyperactivity.

A client newly diagnosed with heart failure following an acute MI has a prescription for enalapril. This class class is frequently used in early heart failure because of what clinical improvement? 1. It strengths the force of myocardial contraction to improve CO. 2. It decreases peripheral resistance, increasing cardiac output. 3. It slows the heart rate, improving filling time and increasing CO. 4. It has diuretic effects, decreasing peripheral edema and pulmonary congestion.

2. Decreases peripheral resistance, increasing cardiac output: Enalapril is an ACE inhibitor, which lowers peripheral resistance through the inhibition of angiotensin II. Blocks the kidneys from increasing BP which increases CO.

What will the nurse include when teaching a caregivers' support group about Alzheimer's disease? Select all that apply. 1. Glutamergic inhibitors are the most common class of drugs for treating Alzheimer's disease. 2. Depression and aggressive behavior are common with the disease. 3. Memory difficulties are an early symptom of the disease. 4. Chronic inflammation of the brain can be a cause of the disease. 5. Pharmacologic therapies are given to help improve memory in Alzheimer's disease.

2. Depression and aggressive behavior are common with the disease. 3. Memory difficulties are an early symptom of the disease. 4. Chronic inflammation of the brain can be a cause of the disease. 5. Pharmacologic therapies are given to help improve memory in Alzheimer's disease.

The patient's health care provider prescribed dantrolene sodium (Dantrium) 25 mg daily for the treatment of neck spasms secondary to spinal cord injury. The patient reports that the medication is "not working," even though it has been 45 days since the medication was started. What changes in this patient's plan of care would the nurse anticipate? Select all that apply. 1. Increase in the dosage frequency to twice a day 2. Discontinuation of the medication 3. Increase in the frequency of hepatic function tests 4. Change to a different medication 5. Addition of succinylcholine (Anectine) to the patient's medications

2. Discontinuation of the medication 4. Change to a different medication

The health care provider has ordered 5 mg of intravenous diazepam (Valium) to treat the patient in status epilepticus. The patient's IV bag is labeled "1,000 mL D5NS with 20,000 units Heparin." What nursing interventions are necessary to safely administer this diazepam (Valium)? Select all that apply. 1. Use a large bore needle to access the IV port. 2. Flush the intravenous (IV) line with saline. 3. Administer the diazepam (Valium) directly into a vein in the patient's hand. 4. Dilute the diazepam (Valium) with xylocaine prior to administration. 5. Observe the IV tubing for cloudiness while administering the diazepam (Valium).

2. Flush the intravenous (IV) line with saline. 5. Observe the IV tubing for cloudiness while administering the diazepam (Valium).

A client presents to the emergency department with symptoms of closed-angle glaucoma. Intraocular pressure is measured at 30 mmHg. Which assessment findings would the nurse anticipate? Select all that apply. 1. Absence of eye pain 2. Headache 3. Bloodshot eyes 4. Vomiting 5. Bruising around the orbit

2. Headache 3. Bloodshot eyes 4. Vomiting

The patient has bipolar disorder and is in a manic phase. The physician prescribes lithium (Eskalith). The patient's current lithium level is 0.4. What will the nurse expect to assess in this patient? 1. A return to baseline behavior, calm and rational 2. Hyperactivity and pressured speech 3. Signs and symptoms of depression 4. A decrease in manic behavior

2. Hyperactivity and pressured speech

In providing a client with heart failure information prior to discharge, the nurse will discuss digoxin therapy. Which point would the nurse include in the client's teaching? 1. Take the drug in the morning before rising 2. Monitor the pulse daily prior to taking the drug 3. Discontinue the drug if the pulse rate is 70 bpm 4. Eat a diet high in bran fiber and calcium

2. Monitor the pulse daily prior to taking the drug: if the pulse is <60bpm or >120bpm that client will contact health care provider and will not take the drug.

The nurse should question a health care provider's order of phenobarbital for the client with which condition? 1. Seizure disorder 2. Panic disorder 3. Prior to a bronchoscopy 4. Prior to receiving general anesthetic

2. Panic disorder: phenobarbital is not an appropriate drug for treating panic disorder, it is used to treat insomnia not anxiety related disorders, although it is also a strong sedative which is why it is used for various diagnostic testing, as a general anesthetic, and for seizure (CNS depressant).

Which of the following degenerative diseases of the central nervous system is the most common? 1. Amyotrophic lateral sclerosis 2. Parkinson's 3. Multiple sclerosis 4. Huntington's chorea

2. Parkinson's

Which of the following seizure drugs is most likely to be administered IV and result in soft tissue damage following extravasation? 1. Phenobarbital (Luminal) 2. Phenytoin (Dilantin) 3. Ethosuximide (Zarontin) 4. Clonazepam (Klonopin)

2. Phenytoin (Dilantin)

The physician has prescribed phenytoin (Dilantin) for a patient with type 1 diabetes mellitus. What does the nurse include in the plan of care for this patient? 1. Plan to discuss with the physician the need to decrease the patient's insulin based on serum glucose levels. 2. Plan to discuss with the physician the need to increase the patient's insulin based on serum glucose levels. 3. Plan to assess the patient for petechiae, epistaxis, and hematuria. 4. Plan to institute safety precautions, as the patient is at risk for dizziness and ataxia.

2. Plan to discuss with the physician the need to increase the patient's insulin based on serum glucose levels.

The client complains of constipation while receiving ferrous sulfate (Feosol). What is the best plan by the nurse to assist the client in resolving this common side effect? 1. Plan to teach the client about which laxatives are the safest to use. 2. Plan to teach the client to increase fluids and high-fiber foods in the diet. 3. Plan to teach the client to self-administer Fleets enemas. 4. Plan to teach the client to increase exercise.

2. Plan to teach the client to increase fluids and high-fiber foods in the diet.

A patient has been in the intensive care unit for a week receiving various procedures throughout the day and night. Currently the patient, though physiologically stable, is irritable and paranoid and complains of vivid dreams when dozing off to sleep. What are the best actions for the nurse to take at this time? Select all that apply. 1. Check the patient's oxygen status. 2. Request an order for sleep medication. 3. Assess the patient's vital signs. 4. Turn down the lights at night and reduce noise to a minimum. 5. Schedule all tests and procedures before 9 p.m. or after 7 a.m.

2. Request an order for sleep medication. 4. Turn down the lights at night and reduce noise to a minimum. 5. Schedule all tests and procedures before 9 p.m. or after 7 a.m

The client tells the nurse that he experiences frequent eye irritation even after using over-the-counter (OTC) medications. What is the best recommendation by the nurse? 1. Increase your fluid intake; you are probably dehydrated. 2. See your eye doctor for further evaluation. 3. This sounds like an allergic response; try an antihistamine. 4. Use normal saline rinses instead of over-the-counter (OTC) preparations

2. See your eye doctor for further evaluation.

Identify the correct statement regarding seizures. 1. Convulsions are a symptom of the underlying seizure disorder. 2. Seizures can be caused by bacterial infections of the nervous system. 3. Epilepsy is an acute disorder characterized by non-convulsive seizures. 4. All seizures are convulsions, but not all convulsions are seizures.

2. Seizures can be caused by bacterial infections of the nervous system

Prior to discharge, the nurse provides teaching related to adverse effects of phenothiazines to the client and caregivers. Which of the following should be included? 1. The client may experience social withdrawal and slowed activity. 2. Severe muscle spasms may occur early in therapy 3. Tardive dyskinesia is likely in early therapy 4. Medications should be taken as prescribed to prevent adverse effects

2. Sever muscles spasms may occur early in therapy: Within the first few days of therapy twitching in the face and neck are common although should be reported immediately. Social withdrawal is a symptom of a psychotic disorder. Tradeoff dyskinesia occurs late in therapy.

A client has been prescribed ranitidine (Zantac). The nurse plans to include which information in the teaching plan for this client? Select all that apply. 1. You should experience symptom relief in 10 to 15 minutes after taking this drug. 2. Take this medication after your meal. 3. Take this medication first thing in the morning, before breakfast. 4. This drug will not work as well if you continue smoking. 5. If you experience confusion, discontinue the drug and call for an appointment.

2. Take this medication after your meal. 4. This drug will not work as well if you continue smoking

A 23-year old patient has been taking gabapentin (Neurontin) for control of partial seizures. He is admitted to the energy department with slurred speech, dyspnea, reports of double vision, and sedation. The admitting nurse suspects the client has: 1. Not taken the drug for several days 2. Taken an OD of the drug, either accidental or deliberately. 3. Taken the drug with grapefruit or grapefruit juice 4. Continued to smoke despite prior client education that smoking interacts with the drug

2. Taken an OD of the drug, either accidental or deliberate: Slurred speech, dyspnea, double vision, and sedation are all signs of an OD of gabapentin. Remember a majority of seizure drugs cause a sedative effect by inhibiting CNS function.

An office worker has made an appointment with the provider for heart palpitations, dysarrythmias, and facial tingling. Which of the follow does the nurse note may explain the symptoms? 1. The client takes zolpidem (Ambien) for occasional insomnia 2. The client has been working late and frequently has relied on coffee to maintain alertness. 3. The client is taking gabapentin (Neurontin) for pain associated with herpes zoster. 4. The client has been under stress at work and has switched to using herbal teas.

2. The client has been working late and has frequently relied on coffee to maintain alertness: Palpitations, arrhythmia, and facial tingling area ll side effects of caffeine.

What should the nurse teach the client who is to receive alteplase (Activase) as part of the treatment for MI? 1. The drug will be given IV, and the client should be able to go home later day. 2. The client should remain quiet and lying down during drug administration and for up to 8 hours after infusion. 3. The risk of bleeding returns to normal within 24 hours after the drug has been infused. 4. An increase in vitamin-K rich foods or a supplement will be needed for the week following the treatment.

2. The client should remain quiet and laying down during drug administration and for up to 8 hours after infusion: Because of the risk of hemorrhaging, dysrhythmia, and hypotension, the client should remain supine during and for up to 8 hours after drug infusion.

A client has been diagnosed with closed-angle glaucoma. Which findings would the nurse interpret as indicating that the pharmacologic treatment regimen has been successful? Select all that apply. 1. The client reports being hungry. 2. The client's last two intraocular pressure readings have been 19 mmHg and 18 mmHg. 3. The client's eye is not as bloodshot. 4. The client reports a sensation of drainage down the nose. 5. The client's cough has diminished.

2. The client's last two intraocular pressure readings have been 19 mmHg and 18 mmHg. 3. The client's eye is not as bloodshot

The nurse has completed medication education with the patient who is receiving lithium (Eskalith). What is the best patient outcome? 1. The patient will be able to work a normal work schedule and will receive adequate sleep. 2. The patient will identify signs of lithium (Eskalith) toxicity and verbalize measures to avoid it. 3. The patient will engage in activities of daily living and report enjoyment with them. 4. The patient will report stabilization of mood, including absence of mania or depression.

2. The patient will identify signs of lithium (Eskalith) toxicity and verbalize measures to avoid it.

Which of the following common adverse effects of selective serotonin reuptake inhibitors (SSRIs) would be stressed by the nurse during patient discharge? 1. Drowsiness and coma 2. Weight gain and sexual dysfunction 3. Headache and nausea 4. Dry mouth and urine retention

2. Weight gain and sexual dysfunction

It is suspected that a client has developed peptic ulcer disease (PUD). Which information should the nurse provide this client regarding projected course of treatment? Select all that apply. 1. You will be started on an antibiotic. 2. You will be tested for the presence of H. pylori. 3. You may be directed to take Pepto-Bismol along with your other medications. 4. You should plan on taking medication for 4 to 8 weeks. 5. There are some lifestyle changes you can take to make therapy more successful.

2. You will be tested for the presence of H. pylori. 3. You may be directed to take Pepto-Bismol along with your other medications. 4. You should plan on taking medication for 4 to 8 weeks. 5. There are some lifestyle changes you can take to make therapy more successful.

The drug most likely to be used to soften or eliminate cerumen is 1. a steroid. 2. a wax softener. 3. an antifungal agent. 4. a local analgesic.

2. a wax softener.

The mechanism of action of proton pump inhibitors is to 1. neutralize acid. 2. reduce acid secretion in the stomach. 3. block H2 receptors in the stomach. 4. decrease infection.

2. reduce acid secretion in the stomach.

The physician orders misoprostol (Cytotec) for the female client with peptic ulcer disease (PUD). What is a priority question for the nurse to ask the client prior to administration of this medication? 1. "Do you plan on becoming pregnant?" 2. "Are you sexually active?" 3. "Are you pregnant?" 4. "Are your menstrual cycles irregular?"

3. "Are you pregnant?"

The physician has ordered bismuth (Pepto-Bismol) for the client with a peptic ulcer who is colonized with H. Pylori. The client asks the nurse why he is receiving this drug. What is the best response by the nurse? Select all that apply. 1. "Bismuth (Pepto-Bismol) increases stomach acid to help kill bacteria." 2. "Bismuth (Pepto-Bismol) helps prevent the side effects of antibiotics." 3. "Bismuth (Pepto-Bismol) is effective for inhibiting bacterial growth." 4. "Bismuth (Pepto-Bismol) keeps bacteria from sticking in your stomach." 5. "Bismuth (Pepto-Bismol) helps relieve ulcer-related constipation."

3. "Bismuth (Pepto-Bismol) is effective for inhibiting bacterial growth." 4. "Bismuth (Pepto-Bismol) keeps bacteria from sticking in your stomach."

A patient who has recently experienced the loss of a spouse asks the nurse if there are any over-the-counter herbs or nonprescription medications that can be used to improve insomnia. How should the nurse respond to this patient? Select all that apply. 1. "Ginger root is commonly taken to improve sleep." 2. "Ginkgo is an herb commonly taken to improve sleep." 3. "Diphenhydramine (Benadryl) and doxylamine are over-the-counter meds sometimes taken to produce drowsiness." 4. "Valerian and melatonin are herbs commonly taken to improve sleep." 5. "Kava is an herb taken to improve sleep."

3. "Diphenhydramine (Benadryl) and doxylamine are over-the-counter meds sometimes taken to produce drowsiness." 4. "Valerian and melatonin are herbs commonly taken to improve sleep."

The client receives latanoprost (Xalatan) and another eyedrop. The nurse has completed medication education and evaluates that learning has occurred when the client makes which statement? 1. "I will give two drops of one medication, wait one minute, and then give two drops of the other medication." 2. "I should lay the dropper against my eyelid for stability when putting in drops." 3. "I will remove my contact lens before instilling these eyedrops." 4. "I may notice that my eyelashes get thinner while I am using this medication."

3. "I will remove my contact lens before instilling these eyedrops."

Which of these statements, if made by a client, would indicate that further instruction is needed about alprazolam (Xanax)? 1. "I will stop smoking by undergoing hypnosis" 2. "I will not drive immediately after I take this medication" 3. "I will stop the medicine when I feel less anxious" 4. "I will take my medication with food if my stomach feels upset"

3. "I will stop the medicine when I feel less anxious": administration of the drug must be gradual and the patient must be weened off in order to avoid withdrawal symptoms.

The nurse determines that a client understand an important principle in administration of fluoxetine (Prozac) when the client makes which of the follow statements: 1. "I should not decrease my sodium or water intake" 2. "The drug can be taken concurrently with a MAOI" 3. "It may take up to a month to reach full therapeutic effects" 4. "There are no problems associated with concurrent use of other central nervous system depressants"

3. "It may take up to a month to reach full therapeutic effects": Because mood stabilizers generally impact neurotransmitter levels, the length of time it take to create the therapeutic effect can be 4-6 weeks. Although they should not be taken concurrently with other MAOI's or CNS depressants to avoid serious adverse effects with increase CNS depression.

A patient tells the nurse, "I have been reading about using castor oil as a treatment for muscle cramping. Do you know anything about that?" How should the nurse respond to this question? Select all that apply. 1. "Why don't you ask the doctor about whether it works or not?" 2. "I think you take a tablespoon twice a day." 3. "The castor oil should be warmed before use." 4. "Soak a flannel cloth with the castor oil and apply it to your muscle." 5. "You must wear gloves when handling castor oil."

3. "The castor oil should be warmed before use." 4. "Soak a flannel cloth with the castor oil and apply it to your muscle."

The client who has been taking venlafaxine (Effexor) for 2 weeks calls the nurse to report that there is no improvement in her depression. The nurse's best response is: 1. "Call your health care provider and see if he or she will change the order to a different medication" 2. "Are you sure that you are takin git as it is ordered? Perhaps you should consider increasing the dosage gradually" 3. "The medication may take up to 3 weeks or longer to be effective. Continue taking the medication as ordered" 4. "Add an over the counter anti-anxiety agent to your daily medications"

3. "The medication may take up to 3 weeks or longer to be effective. Continue taking the medication as ordered": Mood stabilizers take time to perform their desired effect, approximately 4-6 weeks. Therefore the time it take for it to produce it's therapeutic effect may be long; which can seem like forever if you have depression.

The nurse is teaching a class for caregivers of patients with Alzheimer's disease. The nurse determines that learning has occurred when the caregivers make which statement? 1. "There aren't any drugs that are effective in treating this disease." 2. "There are effective drugs, but they cannot be used over a long period." 3. "There are drugs that will help decrease symptoms for a little while." 4. "There are drugs that can control symptoms for many years."

3. "There are drugs that will help decrease symptoms for a little while."

The patient tells the nurse, "The doctor is going to start me on Botox for the muscle spasms in my neck. I've always wanted to try that. It will make me look younger." What information should the nurse provide to this patient regarding onabotulinumtoxinA (Botox)? Select all that apply. 1. "Once you start on the medication, it may take a week or so before you notice a change in your skin." 2. "Be certain you take the medication with a full glass of water because it can be hard on your kidneys." 3. "There are many different uses for that drug, depending on how it is administered." 4. "You may have to have additional treatments with the medication in a few months." 5. "You should be aware that side effects of the medication can occur hours or weeks after your treatment."

3. "There are many different uses for that drug, depending on how it is administered." 4. "You may have to have additional treatments with the medication in a few months." 5. "You should be aware that side effects of the medication can occur hours or weeks after your treatment."

The mother of a 7-year-old child says to the nurse, "My child is distractible in school, cannot complete assignments on time, and interrupts other children while they are speaking. What do you think?" What is the best response by the nurse? 1. "This sounds like your child is depressed; depression looks different in children and is very serious." 2. "This sounds like bipolar disorder; you might want to have your child tested by a child psychiatrist." 3. "This could be attention-deficit hyperactivity disorder (ADHD); you might want to have your child tested." 4. "This sounds like typical 7-year-old behaviors to me; if they do not resolve, have your child tested."

3. "This could be attention-deficit hyperactivity disorder (ADHD); you might want to have your child tested."

The patient has Parkinson's disease, and develops depression. What is the best education the nurse can give the patient's family? 1. "Anytime someone has a brain disease, depression will result." 2. "Depression is very easy to treat with medications we have available." 3. "This is a common problem with Parkinson's disease." 4. "This is a result of the medications taken for control of symptoms."

3. "This is a common problem with Parkinson's disease."

The patient is scheduled to have an EEG to confirm the presence of a sleep disorder. The patient asks the nurse to describe Stage IV NREM sleep. What is the best response by the nurse? 1. "This is the lightest stage of sleep, and is profoundly affected by anxiety." 2. "Dreaming occurs here; without dreams you will be irritable and paranoid." 3. "This is the deepest stage of sleep; without it you will be tired and depressed." 4. "This stage comprises the greatest amount of sleep time, and is important."

3. "This is the deepest stage of sleep; without it you will be tired and depressed."

The nurse teaches a class on iron-deficiency anemia to a group of pregnant clients who are all taking ferrous sulfate (Feosol). The nurse evaluates that additional learning is needed when the clients make which statement? 1. "Most iron in our bodies is stored on hemoglobin in the red blood cell." 2. "Transferrin is a protein that transports iron to places in our bodies where it is needed." 3. "We need extra iron because when our red blood cells die, all their iron is excreted from the body." 4. "The most common cause of nutritional anemia is iron deficiency."

3. "We need extra iron because when our red blood cells die, all their iron is excreted from the body."

The patient receives aspirin, a multivitamin, and an antihistamine every day. What is the best instruction by the nurse prior to administering levodopa (Larodopa)? 1. "You should not take the aspirin with your levodopa (Larodopa)." 2. "You should not take the antihistamine with your levodopa (Larodopa)." 3. "You should not take the multivitamin with your levodopa (Larodopa)." 4. "These medications are safe to take with levodopa (Larodopa)."

3. "You should not take the multivitamin with your levodopa (Larodopa)."

The patient who is prescribed valproic acid (Depakote) for seizure control would like to have a baby. Which statements should the nurse include in a discussion with this patient? Select all that apply. 1. "Since your epilepsy may flare up during pregnancy, your doctor will likely have you take a second antiepileptic medication." 2. "Thankfully, most modern antiepileptic medications will not interfere with you getting pregnant." 3. "Your current antiepileptic medication should not be used when you are pregnant." 4. "Folic acid supplementation is important for you." 5. "You should consider adopting a baby instead since there are so many problems associated with epilepsy and pregnancy."

3. "Your current antiepileptic medication should not be used when you are pregnant." 4. "Folic acid supplementation is important for you."

Which of the following symptoms experienced over 1 month would be most helpful to diagnose bipolar disorder? 1. Difficulty sleeping, obsession with death, hallucinations 2. Delusions, unkempt appearance, fatigue 3. Abnormal eating patterns, feelings of despair, flight of ideas 4. Increased goal-directed behavior and talkativeness, distractibility

3. Abnormal eating patterns, feelings of despair, flight of ideas

The nurse planning medication administration instruction for a client receiving antacids should consider including which information? 1. Antacids can be safely administered with H2-receptor medications. 2. Antacids can be safely administered with antibiotics. 3. Administer antacids at least 2 hours before other oral medications. 4. Lay down for 30 minutes after taking antacids.

3. Administer antacids at least 2 hours before other oral medications.

A high school student taking atomoxetine (Strattera) for ADHD visits the school office and confides, "I am so depressed. The world would be better off without me." Which action would the nurse take for this client? 1. Tell the client to stop taking atomoxetine immediately and not to take it until checking with the provider 2. Assure the client that these are normal symptoms because the drug may take 3-4 weeks to work 3. Alert the family or caregiver that immediate attention and treatment are needed for these symptoms 4. Have the client increase intake of caffeine by consuming cola products, coffee, or tea to counteract the depressive effect.

3. Alert the family or caregiver that immediately attention and treatment are needed for these symptoms: CNS stimulants should never be immediately discontinued although suicidal thoughts are a common adverse effect in children and adolescents, although they should be reported immediately.

Several senior citizens have asked the nurse to do a presentation on degenerative diseases. What does the nurse plan to teach as the most common degenerative diseases? Select all that apply. 1. Amyotrophic lateral sclerosis 2. Multiple sclerosis 3. Alzheimer's disease 4. Huntington's chorea 5. Parkinson's disease

3. Alzheimer's disease 5. Parkinson's disease

Which of the following lists of treatment options would be considered optimal for treating a muscle spasm with an unknown cause? 1. Anti-inflammatory agents, casting, and ultrasound 2. Analgesics, antibiotics, and heat application 3. Analgesics, muscle relaxants, and massage 4. Anti-inflammatory agents, immobilization, and fluid and electrolyte replacement

3. Analgesics, muscle relaxants, and massage

An elderly client comes to the emergency department with his wife. He has a history of peptic ulcer disease (PUD), and is currently experiencing confusion and severe headaches. What does the best plan by the nurse include? 1. Ask the client if he has experienced any head injuries recently. 2. Obtain a complete blood count (CBC), chemistry profile, and urine drug screen. 3. Ask the client's wife for a list of medications that the client has taken. 4. Obtain a magnetic resonance imaging (MRI) exam to assess if the client has experienced a stroke.

3. Ask the client's wife for a list of medications that the client has taken

A nurse should advise a client who is receiving lorazepam (Ativan) about the adverse effects of this medication, which include: 1. Tachypnea 2. Astigmatism 3. Ataxia 4. Euphoria

3. Ataxia: ataxia (lack of coordination and muscles weakness), weakness, restlessness, and dizziness as well as other motor problems can occur when taking lorazepam.

Vitamin D deficiency would most likely be seen in a patient with seizures who is being treated with which drug type? 1. Phenytoin-like agents 2. Benzodiazepines 3. Barbiturates 4. Hydantoins

3. Barbiturates

Which of the following adverse effects would most likely be associated with the use of phenytoin (Dilantin)? 1. Vitamin B deficiency 2. Leg edema 3. Bleeding 4. Hypoglycemia

3. Bleeding

Carbamazepine (Tegretol) has been prescribed for a patient to control partial seizures. The nurse will teach the client to immediately report: 1. Blurred vision 2. Leg cramps 3. Blister-like rash 4. Lethargy

3. Blister-like rash: Steven-Johnson's syndrome, a epidermal disease that results in clients who are genetically predisposed, results which caused necrosis of tissue. Skin becomes sensitive. Although blurred vision, cramps, and lethargy are all side effects of the drug, they are usually manageable.

The traditionally prescribed drug types used to treat attention-deficit hyperactivity disorder (ADHD) include 1. CNS depressants. 2. parasympathomimetics. 3. CNS stimulants. 4. sympathomimetics.

3. CNS stimulants

Which statement describes the primary difference between centrally acting muscle relaxants and direct-acting antispasmodics? 1. Centrally acting agents inhibit neurons of the central nervous system, while direct-acting agents stimulate neurons of central nervous system. 2. Centrally acting agents stimulate neurons of the central nervous system, while direct-acting agents stimulate neurons of the peripheral nervous system. 3. Centrally acting agents inhibit neurons of the central nervous system, while direct-acting agents work at the level of the neuromuscular junction and skeletal muscles. 4. Centrally acting agents stimulate the central nervous system, while direct-acting agents inhibit neuronal conduction of the central nervous system.

3. Centrally acting agents inhibit neurons of the central nervous system, while direct-acting agents work at the level of the neuromuscular junction and skeletal muscles

Which of the following food items should the nurse advise a patient taking a monoamine oxidase inhibitor (MAOI) to avoid? 1. Orange juice, cottage cheese, and turkey 2. Spring water, ice cream, and salmon 3. Chocolate, wine, and fava beans 4. Spinach, rice, and venison

3. Chocolate, wine, and fava beans

Which of the following best explains why structural changes occur within the brains of people with Alzheimer's disease? 1. Increased acetylcholine levels 2. Increases in blood pressure and cholesterol levels 3. Chronic inflammation and oxidate cellular damage 4. Cerebral bleeding and associated hypoxia

3. Chronic inflammation and oxidate cellular damage

Which of the following is a common adverse effect of cyclobenzaprine (Flexeril)? 1. Alopecia 2. Tongue swelling 3. Drowsiness 4. Hypotension

3. Drowsiness

The patient comes to the emergency department after an overdose of lorazepam (Ativan). The nurse will plan to administer which medication? 1. Pralidoxime (Protopam) 2. Naloxone (Narcan) 3. Flumazenil (Romazicon) 4. Nalmefene (Revex)

3. Flumazenil (Romazicon)

A nurse is preparing to administer ferrous sulfate IM to a client with anemia. What should the nurse consider when giving this injection? Select all that apply. 1. Give the injection in the deltoid muscle. 2. Iron is best absorbed if given subcutaneously. 3. Iron is irritating to the tissues. 4. The z-track method should be used. 5. Iron preparations should be administered through a needle gauge 16 or larger.

3. Iron is irritating to the tissues. 4. The z-track method should be used.

The nurse is caring for a client with chronic angina. The client is receiving isosorbide denigrate oral tablets. Which client manifestations would the nurse conclude are more common adverse effects for this medication? 1. Flushing and headache 2. Tremors and anxiety 3. Lightheadedness and dizziness 4. Sleepiness and lethargy

3. Lightheadedness and dizziness: isosorbide has hypotensive effects which could result in lightheadedness and dizziness. Flushing and headache is often a result of vasodilators.

A client who is taking Ritalin for ADHD reports having insomnia. Which interventions will assist in the promotion of sleep? 1. Have a glass of wine with dinner 2. Eat chocolate at bedtime 3. Take the drug before 4 P.M. 4. Switch to decaffeinated coffee

3. Take the drug before 4 P.M.: this gives the drug to be partially metabolized before sleep decreasing it's effects, which includes insomnia.

A client who is taking warfarin (Coumadin) states, "I wake up every morning with arthritis pain and I always take aspirin and ibuprofen." The nurse's response would be based on which physiological concepts? 1. Aspirin and ibuprofen will counteract the therapeutic effects of many anticoagulants. 2. Anticoagulation will reduce the half-life of drugs such as aspirin and ibuprofen 3. Many substances such as aspirin and ibuprofen will increase the risk of bleeding. 4. The combination of aspirin products with anticoagulants will worsen arthritis pain

3. Many substances such as aspirin and ibuprofen will increase the risk of bleeding: Aspirin and ibuprofen both have anti-aggregation properties and taking it concurrently with warfarin will increase the risk of bleeding even more.

A 10-year old child has been evaluated for a learning disability and has been diagnosed with absence seizures. Ethozuximide (Zarontin) has been ordered and the nurse is teaching the client and family about a drug. Because of the client's age, it is important to include instructions to: 1. Curtail after school sports activities because the drug's metabolism may be increased with physical activity. 2. Increase intake of calcium-rich foods and vitamin D to prevent bone loss 3. Monitor height and weight weekly to be sure GI side effects are not hindering nutrition and normal growth. 4. Increase fluid intake to prevent dehydration caused by the drug.

3. Monitor heigh and weight weekly to be sure GI side effects are not hindering nutrition and normal growth: One of the side effects of Zarontin (a CNS inhibitor) is nausea, vomiting, and anorexia therefore children might develop those side effects. If the child has poor nutritional status it could negatively impact growth, and therefore should be monitored regularly.

The elderly patient receives levodopa (Larodopa). The nurse is primarily concerned about which problem with this patient? 1. Hypertension 2. Diarrhea 3. Muscle twitching 4. Dark urine

3. Muscle twitching

Which sleep stage accounts for about one-half of total sleep? 1. NREM sleep stage 1 2. NREM sleep stage 3 3. NREM sleep stage 2 4. NREM sleep stage 4

3. NREM sleep stage 2

The patient receives dantrolene (Dantrium) for treatment of muscle spasms following a spinal cord injury. What is the best outcome for this patient? 1. Patient will have stabilized vital signs. 2. Patient will have and improved self-concept. 3. Patient will sleep without pain. 4. Patient will have increased bladder tone.

3. Patient will sleep without pain.

The client is to receive eyedrops for glaucoma. What is the correct method of administration? 1. Place the drop in the center of the eye. 2. Place the drop so it falls on the white part of the eye. 3. Place the drop in the conjunctival sac below the eye. 4. Turn the head to the side so that the drop flows to the outer corner.

3. Place the drop in the conjunctival sac below the eye

A patient who is complaining of anxiety and difficulty sleeping has asked what prescription medications would assist in getting to sleep. What would be appropriate responses? Select all that apply. 1. Diphenhydramine (Benadryl) 2. Valerian root 3. Ramelteon (Rozerem) 4. Flurazepam (Dalmane) 5. Zolpidem (Ambien)

3. Ramelteon (Rozerem) 4. Flurazepam (Dalmane) 5. Zolpidem (Ambien)

Nitroglycerin topical ointment is being initiated for a client with angina. Which health teaching would be most appropriate? 1. Keep the medication in the refrigerator 2. Only take this medication when chest pain is severe. 3. Remove the old paste before applying the next dose. 4. Apply the ointment on the chest wall only.

3. Remove the old paste before applying the next dose: the client should be taught to remove old paste before applying more in order to prevent adverse effects.

The patient receives dantrolene (Dantrium). A consulting physician orders hydroxyzine (Vistaril) for the patient and he begins taking it. What will the best assessment by the nurse reveal? 1. Confusion 2. Hypertension 3. Respiratory depression 4. Delirium

3. Respiratory depression

The elderly patient is taking phenobarbital (Luminal) for seizure control. What is most important for the nurse to assess in the patient? 1. Fluid intake 2. Electrolyte balance 3. Respiratory function 4. Nutritional status

3. Respiratory function

The nurse is caring for a client receiving a sedative-hypnotic. Which adverse effect associated with this drug therapy is the highest priority for the nurse? 1. Urinary incontinence 2. Activity intolerance 3. Risk for falls 4. Poor nutritional intake

3. Risk for falls: the clients safety is the major concern with sedative-hypnotics which is why they are contraindicated in older populations with ambulation issues. All the other options are possible to experiences although safety is the major issue.

Which drug category can be used for treating anxiety? 1. Antitussives 2. Anticoagulants 3. Seizure drugs 4. Antibiotics

3. Seizure drugs

The patient receives levodopa and carbidopa (Sinemet). What will the best teaching by the nurse include as relates to this medication? 1. Avoid drinking caffeinated beverages. 2. Take the medication with meals. 3. Take the medication on an empty stomach. 4. Take the medication with a protein food.

3. Take the medication on an empty stomach.

The client receives H2-receptor antagonists for treatment of peptic ulcer disease (PUD). Which assessment finding should be reported immediately to the physician? 1. The client reports he is constipated. 2. The client reports pain after 24 hours of treatment. 3. The client reports episodes of melana. 4. The client reports he took the antacid Tums with his H2-receptor antagonist

3. The client reports episodes of melana

What is the priority outcome for a 6-year-old patient who had been started on methylphenidate (Ritalin)? 1. The patient will avoid altercations with peers. 2. The patient will be able to complete age-appropriate chores at home. 3. The patient will use age-appropriate play with peers. 4. The patient will maintain weight within norms for this age group.

3. The patient will use age-appropriate play with peers.

A client has been prescribed aluminum hydroxide (AlternaGEL) for the treatment of heartburn. Which information should the nurse plan to teach this client? Select all that apply. 1. You should expect this medication to take up to two days to start taking effect. 2. Take this medication with a glass of milk. 3. You may notice constipation as an effect of this drug. 4. Take this medication at least 2 hours before or after any other medication you are taking. 5. This medication will reduce the acid your stomach produces.

3. You may notice constipation as an effect of this drug. 4. Take this medication at least 2 hours before or after any other medication you are taking.

Peptic ulcer disease is treated primarily with 1. pharmacotherapy. 2. exercise. 3. a combination of lifestyle changes and pharmacotherapy. 4. diet.

3. a combination of lifestyle changes and pharmacotherapy

A person who stops talking mid-sentence and has a blank stare for 5 seconds would most likely be experiencing 1. a partial seizure. 2. a grand mal seizure. 3. a petit mal seizure. 4. A convulsion.

3. a petit mal seizure.

A low-income patient without insurance has been prescribed several different medications over several months for seizure control without any improvement. The patient indicates she has not experienced any adverse effects. At this point the nurse should 1. recommend nontypical drug use. 2. inform the patient that it might take years for the medications to work. 3. assess for medication compliance. 4. advise the patient to double the current dose.

3. assess for medication compliance

The process for regulating hematopoiesis occurs via 1. white bone marrow. 2. hematopoietic stem cell. 3. hormones. 4. essential vitamins and nutrients.

3. hormones.

Per classification of anemias, the morphology for pernicious anemia or folate-deficiency anemia results in 1. hematocytic-hematochromic erythrocytes. 2. microcytic-hypochromic erythrocytes. 3. macrocytic-normochromic erythrocytes. 4. normocytic-normochromic erythrocytes

3. macrocytic-normochromic erythrocytes.

The primary goal in treatment of gastroesophageal reflux disease is to 1. promote ulcer healing. 2. prevent infection. 3. reduce gastric acid secretions. 4. decrease stomach pain.

3. reduce gastric acid secretions.

Depression that occurs during cold winter months would be classified as 1. baby blues. 2. bipolar disorder. 3. seasonal affective disorder. 4. obsessive-compulsive disorder.

3. seasonal affective disorder.

The primary treatment for mastoiditis is 1. topical antibiotics. 2. topical steroids. 3. systemic antibiotics. 4. Systemic steroids.

3. systemic antibiotics.

The patient is diagnosed with Parkinson's disease. The patient's wife asks the nurse how taking medicine will help her husband. What is the best response by the nurse? 1. "The medications will help prevent muscle wasting in your husband." 2. "The medications will boost your husband's appetite and energy." 3. "The medications will balance serotonin and acetylcholine in your husband's brain." 4. "The medications will help your husband to eat and walk."

4. "The medications will help your husband to eat and walk."

The patient says to the nurse, "My doctor said I have epilepsy and need to take medicine for those seizures I had. Do I really need medicine?" What is the best response by the nurse? 1. "Having epilepsy is the same as having a mental illness; the medications are very similar." 2. "You will need medicine for a little while to cure the seizures." 3. "You might not need medicine; you may be controlled by a ketogenic diet." 4. "Yes, you need to take medication on a continual basis to control the seizures."

4. "Yes, you need to take medication on a continual basis to control the seizures."

The patient receives dantrolene (Dantrium) for muscle spasticity. Which lab result is a priority for the nurse to assess? 1. Creatinine clearance 2. Serum amylase 3. Hemoglobin and hematocrit 4. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT)

4. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT)

The patient receives dantrolene (Dantrium) intravenously (IV). What will a priority assessment by the nurse include? 1. Assessing the patient's urinary output 2. Assessing the patient's blood glucose 3. Assessing the patient's breath sounds 4. Assessing the patient's intravenous (IV) site

4. Assessing the patient's intravenous (IV) sit

The patient is receiving valproic acid (Depakene) for treatment of seizures. The patient has also been taking a daily 81 mg aspirin tablet prophylactically for a cardiac condition. What would the nurse be most likely to observe? 1. An increase in seizure activity 2. Stevens-Johnson syndrome 3. Migraine headaches and generalized irritability 4. Bleeding from the gums and bruising of the skin

4. Bleeding from the gums and bruising of the skin

A clint with chest pain is receiving sublingual nitro. The nurse would include in the care plan to monitor the client for which adverse effect? 1. Photosensitivity 2. Elevated BP 3. Vomiting and diarrhea 4. Decreased BP

4. Decreased BP: Nitro is a vasodilator, therefore monitoring for hypotension is important; if it's too low it could be fatal.

The client is receiving hydrlazine with isosorbide for heart failure. The nurse should monitor the client for: 1. Bleeding and agitation 2. Bleeding 3. Tingling and cramping in the legs 4. Dizziness and rapid heart rate

4. Dizziness and rapid heart rate: the two are a diuretic and a positive inotropic drug. Concurrent use could result in hypotension and reflex tachycardia.

Which of the following would most likely be an initial treatment for a patient with Alzheimer's disease? 1. Levodopa (Larodopa) 2. Haloperidol (Haldol) 3. Benztropine mesylate (Cogentin) 4. Donepezil hydrochloride (Aricept)

4. Donepezil hydrochloride (Aricept)

Which of the following is an adverse effect of prostaglandins, such as latanoprost (Xaltan)? 1. Hypotension 2. Nausea 3. Tachycardia 4. Eye pain

4. Eye pain

Which statement is correct in regard to the muscle relaxant botulinum toxin type B (Myobloc)? 1. It can be classified as a cholinergic agonist. 2. Increased muscle strength is often seen within a couple of weeks. 3. It can take 6 months for the effects to be seen. 4. In high doses, it is poisonous, causing the same symptoms food poisoning does.

4. In high doses, it is poisonous, causing the same symptoms food poisoning does

The physician has ordered dantrolene (Dantrium) for a patient. What is a priority assessment by the nurse prior to administering this medication? 1. Does the patient have gastric ulcer disease? 2. Does the patient have cardiovascular disease? 3. Does the patient have gallbladder disease? 4. Is the patient pregnant or lactating?

4. Is the patient pregnant or lactating?

An elementary school teacher is providing education to the faculty on the use of central nervous system stimulants used to treat attention deficit/hyperactivity disorder. Of the following, which is the most important for the nurse to convey to the faculty? 1. Have the child bring the drug dose in a lunch bag and come to the office to take it to avoid being teased. 2. Request that the parents leave an extra copy of the prescription at the school in case the dose runs out. 3. Suggest that the parents have two prescriptions filled, one for home and one to keep at school. 4. Keep the drugs in a locked drawer, clearly labeled with the clients name and only the number of doses allowed by school policy.

4. Keep the drugs in a locked drawer labeled with the clients name and only the number of doses allowed by school policy: ADHD drugs are schedule II-IV drugs which require tight control due to high abuse potential. Minimal dosage allowance, according to school policy, should be the only dose allowed.

A 40-year-old patient experiencing periods of mania and periods of depression would most likely benefit from which of the following? 1. Atomoxetine (Strattera) 2. Amitriptyline (Elavil) 3. Methylphenidate (Ritalin) 4. Lithium (Eskalith)

4. Lithium (Eskalith)

The patient receives tacrine (Cognex) as treatment for Alzheimer's disease. Which laboratory test(s) will the nurse primarily assess? 1. Serum amylase levels 2. Complete blood count 3. Renal function tests 4. Liver function tests

4. Liver function tests

Which of the following drug types used to treat depression works by preventing enzymatic destruction of the neurotransmitter norepinephrine? 1. Beta-adrenergic blockers 2. Selective serotonin reuptake inhibitors (SSRIs) 3. Tricyclic antidepressants (TCAs) 4. Monoamine oxidase inhibitors (MAOIs)

4. Monoamine oxidase inhibitors (MAOIs)

An erosion of the mucosal layer of the stomach or duodenum describes a 1. diverticulum. 2. Crohn's lesion. 3. hiatal hernia. 4. Peptic ulcer.

4. Peptic ulcer

A client has had several measurements of intraocular pressure. Which measurements would the nurse interpret as indicating need for pharmacologic intervention? Select all that apply. 1. A single reading of 14 mmHg 2. A consistent reading trending between 15 and 16 mmHg. 3. A single reading of 19 mmHg. 4. Readings consistently higher than 21 mmHg. 5. A single reading of 32 mmHg.

4. Readings consistently higher than 21 mmHg. 5. A single reading of 32 mmHg.

The client has glaucoma. Which assessment finding indicates to the nurse that a client's medical regimen could have contributed to onset of glaucoma? 1. Taking a beta blocker to treat hypertension 2. Occasional use of antihistamines for allergies 3. Taking glucocorticoids to treat arthritis 4. Regular use of an antidepressant drug

4. Regular use of an antidepressant drug

An 80-year old client is prescribed carbamazepine (Tegretol) for a newly diagnosed seizure disorder. The nurse will implement safety measures because this client is at an increased risk for which adverse effect with the administration of this drug? 1. Dementia and confusion 2. Insomnia and forgetfulness related to sleep deprivation 3. Stroke and decrease monitor function 4. Sedation and falls

4. Sedation and falls: like CNS depressant (Barbiturates or benzodiazapines) Tegretol is a sedative and because the older population is at an increased risk of falls without medication, they need to be closely monitored while it is administered.

Which of the following drug types are often used as a first-line treatment for depression due to their side effect profile? 1. Monoamine oxidase inhibitors (MAOIs) 2. Beta-adrenergic blockers 3. Tricyclic antidepressants (TCAs) 4. Selective serotonin reuptake inhibitors (SSRIs)

4. Selective serotonin reuptake inhibitors (SSRIs)

The client states, "I always put my nitro patch in the same place so I do not forget to take it off." The nurse's response would be based on which of the following physiological concepts? 1. Clients are more likely to remember to apply the patch if the same site is used daily. 2. Repeated use of the same application site will enhance the medication absorption. 3. Rebound phenomena is likely to occur when the same site is used more than once. 4. Skin irritation due to the nitro ointment can occur if the same site is used repeatedly.

4. Skin irritation due to the nitro ointment can occur if the same site is used repeatedly

The client with insomnia is being treated with temazepam (Restoril). The nurse monitors for therapeutic effectiveness by noting which of the following? 1. Sleeping in 3-hour intervals, awaking for a short time. 2. Feeling less anxiety during activities of daily living. 3. Having fewer episodes of panic attacks when stressed. 4. Sleeping 7 hours without awakening.

4. Sleeping 7 hours without awakening: temazepam is used to treat insomnia specifically, which results in longer, more restful sleep. Other benzodiazepines are used to treat anxiety.

The patient is receiving zolpidem (Ambien) for treatment of short-term insomnia. What is the primary safety concern of the nurse when the patient takes this medication? 1. Dizziness and daytime sedation 2. Nausea and diarrhea 3. Nausea and gastrointestinal (GI) distress 4. Sleepwalking

4. Sleepwalking

The client states that he has not taken his antipsychotic drug for the past 2 weeks because it was causing sexual dysfunction. The nurse is aware that the name antipsychotic indicates that continuing the medication as prescribed is important because: 1. Hypertensive crisis may occur with abrupt withdrawal 2. Muscle twitching may occur with abrupt withdrawal 3. Parkinson-like symptoms will occur with withdrawal 4. Symptoms of psychosis are likely to return if the medication is withdrawn.

4. Symptoms of psychosis are likely to return if the medication is withdrawn: Antipsychotics are used to treat the symptoms of psychoses not get rid of the condition.

The client is scheduled for an eye exam. Prior to the exam the physician will put a cycloplegic drug, atropine sulfate (Isopto Atropine) eyedrops in the client's eyes. What will the nurse teach the client about these eyedrops? 1. The drugs will dilate the pupil and lubricate the eye to provide additional comfort during the examination. 2. The drops will paralyze the muscles that move the eye so that examination can take place. 3. The drops will dilate the pupil so that the physician can better visualize the retina during examination. 4. The drops dilate the pupil and paralyze the ciliary muscle to prevent the lens from moving during examination.

4. The drops dilate the pupil and paralyze the ciliary muscle to prevent the lens from moving during examination.

The patient has been receiving escitalopram (Lexapro) for treatment of obsessive-compulsive disorder. Unknown to the nurse, the patient has also been self-medicating with St. John's wort. The patient comes to the office with symptoms of hyperthermia and diaphoresis. Which statement best describes the result of the nurse's assessment? 1. The patient is experiencing symptoms of St. John's wort toxicity, as the medication was most likely outdated. 2. The patient has contracted a viral infection. Escitalopram (Lexapro) and St. John's wort are safe to take together. 3. The patient has not been taking escitalopram (Lexapro) and is experiencing withdrawal. 4. The patient has combined two antidepressant medications and is experiencing serotonin syndrome

4. The patient has combined two antidepressant medications and is experiencing serotonin syndrome

The patient is receiving clonazepam (Klonopin) for the treatment of panic attacks. What is an important medication outcome for this patient as it relates to safety? 1. The patient will verbalize the signs of developing Stevens-Johnson rash. 2. The patient will verbalize the importance of diet restrictions related to this drug. 3. The patient will verbalize the importance of having routine blood work done. 4. The patient will verbalize the consequences of stopping the drug abruptly

4. The patient will verbalize the consequences of stopping the drug abruptly

Which statement is the most accurate regarding acetylcholinesterase inhibitors when used for Alzheimer's disease? 1. They reverse the structural damage within the brain. 2. They increase synthesis of acetylcholine. 3. They increase enzymatic breakdown, leading to increased neuronal production. 4. They intensify the effect of acetylcholine at the receptor.

4. They intensify the effect of acetylcholine at the receptor.

Which explanation best indicates why barbiturates are rarely used to treat anxiety and insomnia? 1. They have a greater associated cost. 2. They have a high risk of producing an allergic response. 3. They are seldom effective. 4. They produce many serious adverse effects

4. They produce many serious adverse effects

The patient is started on a medication to treat a neuromuscular disorder. What does the nurse teach as the primary therapeutic goal of the medication? 1. To stop the patient's muscle spasms 2. To improve the patient's appearance 3. To promote exercise in the patient 4. To allow the patient increased independence

4. To allow the patient increased independence

The patient receives trihexyphenidyl (Artane) for Parkinson's disease. Which assessment data will the nurse report to the physician? 1. Dry mouth 2. Anorexia 3. Hypertension 4. Urinary retention

4. Urinary retention

The client has excess cerumen in his ears. What will the best plan by the nurse include as to the safe removal of the cerumen? 1. Use a sterile Q-tip to remove cerumen. 2. Instill 2% acetic acid in each ear. 3. Take hot showers to facilitate drainage. 4. Use warm water and a bulb syringe.

4. Use warm water and a bulb syringe.

The nurse is counseling a client with glaucoma. The nurse explains that, if left untreated, the condition can lead to 1. myopia. 2. nearsightedness. 3. diabetes mellitus. 4. blindness.

4. blindness.

The most productive way of managing stress would be to 1. use a combined approach (drug use and nonpharmacological strategies). 2. use anxiolytics. 3. practice meditation. 4. determine the cause and address it accordingly.

4. determine the cause and address it accordingly.

A drug that is used to treat petit mal seizures but not tonic-clonic seizures and works by decreasing neuronal activity in the motor cortex is 1. diazepam (Valium). 2. valproic acid (Depakote). 3. phenytoin (Dilantin). 4. ethosuximide (Zarontin).

4. ethosuximide (Zarontin).

To decrease gastric irritation, anti-anemia medications, such as ferrous sulfate (Ferosol), should be taken with 1. milk. 2. other medications, such as calcium. 3. orange juice. 4. food

4. food

The primary mechanism of action of beta-adrenergic blockers in the treatment of open-angle glaucoma is to 1. increase the outflow of aqueous humor. 2. constrict the pupil. 3. dilate the pupil to increase outflow. 4. reduce production of aqueous humor.

4. reduce production of aqueous humor.

Smoking cessation has been shown to result in fewer respiratory symptoms.Smoking cessation has been shown to slow the progression of COPD.

A client has been prescribed a leukotriene modifier. Which assessment finding would cause the nurse to question this prescription?

A nurse provides care on a psychiatric unit, and many of the clients on the unit take antidepressants. What client factor would the nurse have to consider when administering these medications? A client has a history of pulling out her IV cannula A client has an intense fear of injections A client actively resists IM injections A client has dysphagia

A client has dysphagia

The health care provider would not prescribe duloxetine (Cymbalta) for a client with a mood disorder if the client took which other medication? A medication for diabetes A medication for hypertension A medication for diarrhea. A medication for tonsillitis

A medication for hypertension

The client reports drinking two or three mixed alcohol drinks each day. The client has chronic hepatitis C.

An 8-year-old child was just diagnosed with asthma. Which assessment questions should the nurse ask the child and parents?

Venlafaxine (Effexor) is an antidepressant that has become more popular with adults in treating their depression. Why has it become more popular? It is an oral drug. It doesn't have side effects. An extended release form is available. It can be taken during pregnancy.

An extended release form is available.

Which of the following medications acts by blocking the reabsorption of sodium and chloride in Henle's loop? a. Furosemide (Lasix) b. Chlorothiazide (Diuril) c. Spironolactone (Aldactone) d. Metolazone (Zaroxolyn)

Answer: a. Furosemide (Lasix) Rationale: Furosemide (Lasix) is a loop diuretic that blocks the reabsorption of sodium and chloride in Henle's loop.

Which of the following actions by the nurse is the most important when caring for a client with renal disease who has an order for furosemide (Lasix)? 1. Assess urine output and renal laboratory values for signs of nephrotoxicity. 2. Check the specific gravity of the urine daily. 3. Eliminate potassium- rich foods from the diet. 4. Encourage the client to void every 4 hours.

Answer: 1 Rationale: Because the kidneys excrete most drugs, clients with renal failure may need a lower dosage of furosemide (Lasix) to prevent further damage to the kidneys. Options 2,3 and 4 are incorrect. Urine specific gravity will not adequately assess renal status and may be altered by the diuresis secondary to the furosemide. Potassium should be increased when furosemide, a potent loop diuretic, is ordered and not eliminated. If diuresis is occurring, the patient may need to void more often then every 4 hours.

31.6 The client has been running in a long-distance marathon on a very warm day. The client complains of dizziness and nausea, and is taken to the hospital where she becomes lethargic. The serum sodium level is 125 mEq/L. What will be the best plan of the nurse? 1.Prepare to administer normal saline intravenous (IV). 2.Prepare to administer 0.45% NaCl. 3.Prepare to encourage the client to drink fluids. 4.Prepare to provide a diet high in NaCl.

Answer: 1 Prepare to administer normal saline intravenous (IV). Rationale: Hyponatremia is a serum sodium level less the 135 mEq/L. Hyponatremia caused by sodium loss may be treated with intravenous (IV) fluids containing salt, such as normal saline. 0.45% NaCl is a hypotonic solution and will further lower the serum sodium. The client requires intravenous (IV) fluids at this point, not oral fluids. The client requires intravenous (IV) fluids at this point, not foods high in NaCl.

31.10 The physician orders potassium chloride (KCL) intravenous (IV) for the client. The nurse administers this drug intravenous (IV) push. What will be the most likely outcome for this client? 1.The client will most likely experience cardiac arrest. 2.The client will not experience adverse effects if the push was given slowly. 3.The client will most likely experience renal failure. 4.The client will most likely experience tissue necrosis at the injection site.

Answer: 1 The client will most likely experience cardiac arrest. Rationale: Potassium chloride (KCL) must never be administered intravenous (IV) push, as bolus injections can overload the heart and cause cardiac arrest. Potassium chloride must never be administered via intravenous (IV) push, even if slowly, as cardiac arrest may result. Cardiac failure, not renal failure, is the most likely outcome of administering potassium chloride intravenous (IV) push. Although tissue necrosis may occur, this is not the primary concern.

31.15 The nurse provides group education to active adolescents about sodium replacement after exercising outdoors. What is the best information to include? 1.Water is the best fluid replacement after exercising. 2.You should take one salt tablet for every two hours spent outside. 3.It is best to avoid exercising outdoors in the summer. 4.Have extra salt with your breakfast on days you exercise outdoors.

Answer: 1 Water is the best fluid replacement after exercising. Rationale: Heat-related problems can be best avoided by consuming adequate amounts of water. Salt tablets can increase the risk of hypernatremia. There is no need to avoid exercising as long as enough water is consumed to avoid dehydration. Increasing salt intake prior to exercising is not necessary.

Which of the following medications may be used to treat partial seizures? (Select all that apply) 1. Phenytoin (Dilantin) 2. Valproic acid (Depakene) 3. Diazepam (Valium) 4. Carbamazepine (Tegretol) 5. Ethosuximide (Zarontin)

Answer: 1, 2, 4; 1. Phenytoin (Dilantin); 2. Valproic acid (Depakene); 4. Carbamazepine (Tegretol) Rationale: The phenytoin-like drugs including phenytoin (Dilantin), Valproic acid (Depakene), and Carbamazepine (Tegretol) are used to treat partial seizures. Options 3 and 5 are incorrect. Diazepam (Valium) is a benzodiazepine that is used to treat tonic-clonic seizures and status epilepticus. Ethosuximide (Zarontin) is used in the control of generalized seizures such as absence seizures.

31.1 The nurse practitioner conducts education for home-health nurses who care for geriatric clients. Many of the clients abuse laxatives, so the nurse practitioner focuses the education on problems that can be caused by chronic laxative use. The nurse practitioner evaluates that learning has occurred when the nurses make which statement(s)? Select all that apply. 1. "Electrolytes carry electricity in the body and must stay in balance." 2. "The most important electrolytes are sodium, potassium, and magnesium." 3. "Laxatives can lower the level of potassium, necessary for proper heart function." 4. "The kidneys and GI tract keep electrolytes in narrow balance, where they must be." 5. "The electrolytes can be replaced by eating the right foods."

Answer: 1, 3, 4, 5 Rationale: Small, inorganic molecules possessing a positive or negative charge are called electrolytes. These ions are able to conduct electricity. Chronic use of laxatives can result in fluid imbalance and hypokalemia. Cardiac arrest is a possible consequence of hypokalemia. Levels of electrolytes in body fluids are maintained within very narrow ranges, primarily by the kidneys and GI tract. As electrolytes are lost due to normal excretory functions, they must be replaced by adequate intake, otherwise electrolyte imbalances will result. The most important electrolytes are sodium, potassium, and calcium, not magnesium.

Which of the following actions by the nurse is most important when caring for a client with renal disease? a. Identify medications that have the potential for nephrotoxicity. b. Check the specific gravity of the urine daily. c. Eliminate potassium-rich foods from the diet. d. Encourage the client to void every four hours.

Answer: a. Identify medications that have the potential for nephrotoxicity. Rationale: Since the kidneys excrete most drugs, clients with renal failure will need a significantly lower dosage in order to avoid fatal consequences.

The nurse is providing education for a 12-year-old client with partial seizures currently prescribed valproic acid (Depakene). The nurse will teach the client and the parents to immediately report which symptom? 1. Increasing or severe abdominal pain 2. Decreased or foul taste in the mouth 3. Pruritus and dry skin 4. Bone and joint pain

Answer: 1. Increasing or severe abdominal pain Rationale: Valporic acid may cause life threatening pancreatitis and any severe or increasing abdominal pain should be reported immediately. Options 2, 3, and 4 are in correct. The drug is not known to cause dysgeusia (altered sense of taste) or effects on bones or joints. Although pruritus is an adverse effect associated with valproic acid, it may be managed with simple therapies, and unless it progresses to a more serious rash, it does not need to be reported immediately.

The nurse is providing teaching to a client who has been prescribed furosemide (Lasix). Which of the following should the nurse teach the client? 1. Avoid consuming large amounts of kale, cauliflower, or cabbage. 2. Rise slowly from a lying or sitting position. 3. Count the pulse for one full minute before taking this medication. 4. Restrict fluid intake to no more than 1L per 24 hour period.

Answer: 2 Rationale: Loop diuretics such as furosemide (Lasix) may dramatically reduce a client's circulating blood volume from diuresis and may cause orthostatic hypotension. To minimize the chance for syncope and falls, the client should be taught to rise slowly from a lying or sitting position to standing. Options 1,3, and 4 are incorrect. Kale, cauliflower and cabbage contain vitamin K, which does not need to be restricted during diuretic therapy. Monitoring the pulse along with blood pressure to assess for tachycardia is advised, but the pulse does not need to be taken for 1 full minute before taking the drug. Fluids should not be restricted during diuretic therapy unless ordered by the provider.

31.13 The client receives normal serum albumin. What are the priority assessments by the nurse? 1.Blood pressure and level of pain. 2.Blood pressure and urinary output. 3.Urinary output and pupil response. 4.Urinary output and nausea or vomiting.

Answer: 2 Blood pressure and urinary output. Rationale: During fluid replacement therapy, the nurse must assess for fluid volume deficit and fluid volume excess. This is commonly done by assessment of blood pressure and urinary output. Level of pain is not a priority assessment. Pupil response is not a priority assessment. Nausea or vomiting are not the priority assessments.

31.8 The physician has ordered ammonium chloride for the client. What will be a primary assessment of the nurse during administration? 1. The client's blood pressure. 2. The client's renal status. 3. The client's liver status. 4. The client's level of orientation.

Answer: 2 The client's renal status. Rationale: The nurse must closely monitor the client's renal status during the administration of ammonium chloride, because the excretion of this drug depends on normal kidney function. Although important, blood pressure is not a primary assessment for a client receiving ammonium chloride. Although important, liver status is not a primary assessment for a client receiving ammonium chloride. Although important, the level of orientation is not a primary assessment for a client receiving ammonium chloride.

31.3 The nurse cares for a client in the critical care setting who was severely burned. The wife of the client asks the nurse, "Why does he need those intravenous infusions (IVs)?" What is (are) the best response(s) by the nurse that indicates the primary reason for intravenous infusions (IVs) with a burned client? Select all that apply. 1. "So he can receive his antibiotics." 2. "So we can be sure he keeps enough blood volume." 3. "So we have an open line for resuscitation in case his heart stops." 4. "So we can rapidly administer his pain medications." 5. "So we can keep his blood pressure stable."

Answer: 2, 5 Rationale: Net loss of fluids from the body can result in dehydration and shock. Intravenous (IV) fluid therapy is used to maintain blood volume and support blood pressure. Antibiotic therapy is not a primary reason for intravenous (IV) fluid replacement. Cardiac resuscitation is not a primary reason for intravenous (IV) fluid replacement. Administration of analgesics is not a primary reason for intravenous (IV) fluid replacement.

An 8-year-old boy is evaluated and diagnosed with absence seizures. He is started on ethosuximide (Zarontin). Which information should the nurse provide the parents? 1. After-school sports activities will need to be stopped because they will increase the risk of seizures. 2. Monitor height and weight to assess that growth is progressing normally 3. Fractures may occur, so increase the amount of vitamin D and calcium-rich foods in the diet. 4. Avoid dehydration with activities and increase fluid intake.

Answer: 2. Monitor height and weight to assess that growth is progressing normally Rationale: Because adverse drug effects such as nausea, anorexia, or abdominal pain may occur with ethossuximide (Zarontin), the parents should monitor the child's height and weight to access whether nutritional intake is sufficient for normal growth and development. Options 1, 3, and 4 are incorrect. Physical activity does not increase the risk of seizure activity or need to be curtailed, and the drug does not affect bone growth or require extra vitamin D or calcium in the diet. Dehydration is a condition to be avoided in all clients, although increasing fluid intake is not necessary related to the use of ethosuximide.

A client has been taking phenytoin (Dilantin) for control of generalized seizures, tonic-clonic type. The client is admitted to the medical unit with symptoms of nystagmus, confusion, and ataxia. What change in the phenytoin dosage does the nurse anticipate will be made based on these symptoms? 1. The dosage will be increased 2. The dosage will be decreased 3. The dosage will remain unchanged; these are symptoms unrelated to phenytoin 4. The dosage will remain unchanged but an additional antiseizure medication may be added

Answer: 2. The dosage will be decreased Rationale: Nystagmus, confusion and ataxia may occur with phenytoin, particularly with higher doses. The dosage is likely to be decreased. Options 1, 3, and 4 are incorrect. The dosage would not remain the same or be increased because these are adverse effects of phenytoin that are related to overdosage.

Which of the following manifestations may indicate the the client taking metolazone (Zaroxolyn) is experiencing hypokalemia? 1. Hypertension 2. Polydipsia 3. Cardiac dysrhythmias 4. Skin rash

Answer: 3 Rationale: Metolazone (Zaroxolyn) is a thiazide diuretic and causes potassium loss. Signs of hypokalemia include cardiac dysrhythmias, hypotension, dizziness and fainting. Options 1,2 and 4 are incorrect. Polydipsia is not associated with hypokalemia. Hypertension is a clinical indication for the use for diuretics. Skin rashes are an adverse effect of metolazone but are not a symptom of hypokalemia.

While planning for a client's discharge from the hospital, which of the following teaching points would be included for a client going home with a prescription for chlorothiazide (Diuril)? 1. Increase fluid and salt intake to make up for the losses caused by the drug. 2. Increase intake of vitamin C- rich foods such as grapefruit and oranges. 3. Report muscle cramping or weakness to the health care provider. 4. Take the drug at night because it may cause drowsiness.

Answer: 3 Rationale: Muscle cramping or weakness may indicate hypokalemia and should be reported to the health care provider. Options 1,2, and 4 are incorrect. Clients on diuretic therapy are taught to monitor sodium (salt) and water intake to maintain adequate, but not excessive, amounts. Vitamin C -rich foods do not need to be increased while a client is taking chlorothiazide (Diuril). The drug should be taken early in the day to avoid nocturia. It does not cause drowsiness.

31.11 The physician orders potassium chloride (KCL) for the client who has a nasogastric (NG) tube. What will the nurse plan to do prior to the administration of this drug? 1.There is no particular preparation prior to administration. 2.Flush the nasogastric (NG) tube with Coca-Cola before and after administration. 3.Dilute the drug prior to administration through the nasogastric (NG) tube. 4.Flush the nasogastric (NG) tube with normal saline before and after administration.

Answer: 3 Dilute the drug prior to administration through the nasogastric (NG) tube Rationale: Liquid forms of potassium chloride (KCL) must be diluted prior to administration through a nasogastric (NG) tube to decrease gastrointestinal (GI) distress. There is a preparation; the drug must be diluted to decrease gastrointestinal (GI) distress. Flushing the tube with Coca-Cola is an outdated practice, and should not be done. Flushing the tube before and after administration of the drug is important, but the drug must still be diluted to decrease gastrointestinal (GI) distress.

31.4 The physician orders a hypertonic crystalloid solution for the client in critical care who has cerebral edema. The nurse hangs a bag of a hypotonic solution. What will the priority assessment of the nurse include? 1.Confusion, hallucinations, and agitation 2.Hypertension, headache, and nausea 3.Headache, irritability, and decreasing level of consciousness 4.Nausea, projectile vomiting, and pinpoint pupils

Answer: 3 Headache, irritability, and decreasing level of consciousness Rationale: A hypotonic solution will cause a fluid shift out of the plasma into the tissues and cells in the intracellular compartment. This will increase cerebral edema. Headache, irritability, and decreasing level of consciousness are signs of cerebral edema. Confusion, hallucinations, and agitation are not classical signs of cerebral edema. Hypertension and nausea are not classical signs of cerebral edema. Projectile vomiting and pinpoint pupils are not classical signs of cerebral edema.

31.2 The client is receiving sodium bicarbonate intravenously (IV) for correction of acidosis secondary to diabetic coma. The nurse assesses cyanosis, slow respirations, and irregular pulse. What is the nurse's priority action? 1. Continue the infusion; the client is still in acidosis. 2. Increase the rate of the infusion and continue to assess the client for symptoms of acidosis. 3. Stop the infusion and notify the physician; the client is in alkalosis. 4. Decrease the rate of the infusion and continue to assess the client for symptoms of alkalosis.

Answer: 3 Increase the rate of the infusion and continue to assess the client for symptoms of acidosis. Rationale: The client receiving sodium bicarbonate is prone to alkalosis; monitor for cyanosis, slow respirations, and irregular pulse. The client's symptoms indicate alkalosis so infusion must be stopped and the physician notified. The client is not in acidosis, symptoms of acidosis include lethargy, confusion, CNS depression leading to coma, and a deep, rapid respiration rate that indicates an attempt by the lungs to rid the body of excess acid. The client is not in acidosis, so the infusion must be stopped, not increased. The infusion must be stopped, not decreased, as the client is in alkalosis.

31.14 What is a priority outcome when a client receives dextran 40 (Gentran 40)? 1.The client will immediately report any diarrhea. 2.The client will immediately report any ototoxicity. 3.The client will immediately report any itching or flushing. 4.The client will immediately report any hiccoughs.

Answer: 3 The client will immediately report any itching or flushing. Rationale: A small percentage of clients are allergic to dextran 40 (Gentran 40), with urticaria being the most common sign. The most important outcome is for the client to report any allergic symptoms. Diarrhea is not a sign of an allergic reaction so is not the priority. Ototoxicity is not a sign of an allergic reaction so is not the priority. Hiccoughs are not a sign of an allergic reaction so are not the priority.

The client admitted for heart failure (HF) has been receiving hydrochlorothiazide (Microzide). Which of the following laboratory levels should the nurse carefully monitor? (Select all that apply) 1. Platelet count 2. WBC count 3. Potassium 4. Sodium 5. Uric acid

Answer: 3,4,5 Rationale: Thiazide diuretics such as hydrochlorothiazide (Microzide) cause loss of sodium and potassium but may cause hyperuricemia. Options 1 and 2 are incorrect. Hydrochlorothiazide does not have a direct effect on blood cells.

31.7 The client has a potassium level of 5.9 mEq/L. The nurse is administering glucose and insulin. The client's wife says, "He doesn't have diabetes, why is he getting insulin?" What is the best response by the nurse? 1. "Insulin is safer than giving laxatives such as Kayexalate." 2. "Insulin will help his kidneys excrete the extra potassium." 3. "Insulin lowers his blood sugar levels and this is how the extra potassium is excreted." 4. "Insulin will cause his extra potassium to go into his cells and lower the blood level."

Answer: 4 "Insulin will cause his extra potassium to go into his cells and lower the blood level." Rationale: Serum potassium levels may be temporarily lowered by administering glucose and insulin, which cause potassium to leave the extracellular fluid and enter cells. Giving insulin to decrease serum potassium levels is not considered a safer method than giving Kayexalate. Insulin does not promote renal excretion of potassium. Serum potassium is lowered by entering the cells; this is not controlled by serum glucose.

The client admitted for congestive heart failure (CHF) is receiving digoxin (Lanoxin) and furosemide (Lasix). Which of the following laboratory findings should the nurse carefully monitor? a. Potassium b. Creatinine c. Calcium d. Sodium

Answer: a. Potassium Rationale: Potassium loss is a serious side effect of loop diuretics, and this is a serious concern to clients being treated with digoxin (Lanoxin).

31.12 The client has overdosed on aspirin. In the emergency department, the physician orders sodium bicarbonate. A family member says to the nurse, "I thought that was for stomach ulcers." What is the best response by the nurse? 1. "It will prevent excessive bleeding from the stomach." 2. "It will change the pH of the blood to neutralize the aspirin." 3. "It will help the liver break down the aspirin more quickly." 4. "It will change the urine so the kidneys can get rid of the aspirin quickly."

Answer: 4 "It will change the urine so the kidneys can get rid of the aspirin quickly." Rationale: Sodium bicarbonate makes the urine more basic, which aids in the renal excretion of acidic drugs such as aspirin. Sodium bicarbonate is not given to prevent bleeding when a client has overdosed on aspirin. Sodium bicarbonate is not given to neutralize blood pH when a client has overdosed on aspirin. Sodium bicarbonate is not given to enhance liver enzymes when a client has overdosed on aspirin.

31.9 The client receives dextran 40 (Gentran 40). The client experiences tachycardia, dyspnea, and a cough. What is the best evaluation by the nurse? 1. The client is allergic to the drug. 2. The drug caused an interaction with another drug the client receives. 3. The client experienced impending kidney failure. 4. The drug was infused too rapidly.

Answer: 4 The drug was infused too rapidly. Rationale: Fluid overload will be caused by a rate of infusion that is too rapid. Signs of fluid overload include tachycardia, peripheral edema, distended neck veins, dyspnea, and cough. An allergy would be manifested by urticaria. There is no information in the question that the client is receiving another drug. The client's symptoms do not indicate kidney failure.

31.5 The client is dehydrated, but has a normal blood pressure. The new medical intern orders normal serum albumin intravenously (IV) for this client. What is the best evaluation of the nurse regarding this order? 1.It is a correct and valid order. 2.The intern should have ordered 0.9% NaCl. 3.The intern should have ordered 5% dextrose in normal saline. 4.The intern should have ordered 0.45% NaCl.

Answer: 4 The intern should have ordered 0.45% NaCl. Rationale: 0.45% NaCl is a hypotonic solution. This will cause fluid to shift from plasma to the tissues and cells in the intravascular compartment. Hypotonic solutions are indicated for clients who are dehydrated with normal blood pressure. Normal serum albumin is a hypertonic solution; the client requires a hypotonic solution 5% dextrose in normal saline is a hypertonic solution; the client requires a hypotonic solution. 0.9% NaCl is an isotonic solution, the client requires a hypotonic solution.

Teaching for a client receiving carbamazepine (Tegretol) should include instructions that the client should immediately report which symptom? 1. Leg cramping 2. Blurred vision 3. Lethargy 4. Blister-like rash

Answer: 4. Blister-like rash Rationale: Carbamazepine (Tegretol) is associated with Stevens-Johnson Syndrome (SJS) and exfoliative dermatitis. A blister-like skin rash may indicate that these conditions are developing. Options 1, 2, and 3 are incorrect. Blurred vision, leg cramping , and drowsiness or lethargy are adverse effects of carbamazepine but do not require immediate reporting and may diminish over time.

The nurse is caring for a 72-year-old client taking gabapentin (Neurontin) for a seizure disorder. Because of this client's age, the nurse would establish which nursing diagnosis related to the drug's common adverse effects? 1. Risk for Deficient Fluid Volume 2. Risk for Impaired Verbal Communication 3. Risk for Constipation 4. Risk for Falls

Answer: 4. Risk for Falls Rationale: Common adverse effects to gabapentin (Neurontin) include CNS depression including dizziness and drowsiness. Because of this client's age, these effects may increase the risk of falls. Options 1, 2, and 3 are incorrect. The drug is not known to cause dehydration (fluid volume deficit) or constipation or impair the ability to communicate.

31.19 Hyponatremia is marked by a serum sodium level less than: a. 135 mEq/ml. b. 145 mEq/ml. c. 140 mEq/ml. d. 137 mEq/ml.

Answer: A 135 mEq/ml. Rationale: A. 135 indicates a hyponatremia state. B. Normal serum sodium range is 135‒145 mEq/L. C. 140 is normal. D. 137 is normal.

31.20 Which of the following is a sign of hypokalemia? a. Muscle weakness b. Hypertension c. Weight gain d. Constipation

Answer: A Muscle weakness Rationale: A. Muscle weakness can occur, since muscle fibers are very sensitive to changes in potassium. B. Hypertension is usually not a sign of hypokalemia. C. Weight gain is usually not a sign of hypokalemia. D. Diarrhea. not constipation, will occur.

31.22 Potential causes for respiratory alkalosis include: a. Hypoventilation. b. Hyperventilation. c. Hypertension. d. Hypotension.

Answer: B Hyperventilation. Rationale A. Hypoventilation is associated with respiratory acidosis. B. Hyperventilation occurs with respiratory alkalosis. C. Hypertension is unrelated. D. Hypotension is unrelated

31.16 Intravenous therapy would be indicated if: a. Fluid intake were greater than 2500 ml/day. b. Intake and output were deregulated. c. Hypertension were present. d. Constipation were present.

Answer: B Intake and output were deregulated. Rationale: A. Fluid intake of 2500 ml/day is the average intake for adults. B. Intake and output imbalance would require IV therapy to treat dehydration or shock and correct fluid imbalance. C. Hypertension would not require IV therapy. D. Constipation might indicate lack of fluid, but would not require IV.

31.21 Buffers are chemicals that help maintain normal body Ph. The two primary buffers in the body are: a. Sodium and bicarbonate ions. b. Potassium and phosphate ions. c. Bicarbonate and phosphate ions. d. Sodium and calcium ions.

Answer: C Bicarbonate and phosphate ions Rationale: A. Sodium is not a buffer in maintaining normal body Ph. B. Potassium and phosphate are not the two primary buffers. C. Bicarbonate and phosphate are the two primary buffers of Ph balances. D. Sodium and calcium are not buffers.

31.17 Osmolality and tonicity are not changed when movement of fluids and solution are: a. Hypertonic. b. Hypotonic. c. Isotonic. d. Oncotic.

Answer: C Isotonic. Rationale: A. Increased osmolity, water moves from cells is hypertonic. B. Decreased osmolity, waters moves to fluid and cells, hypotonics. C. Isotonic does not net fluid change. D. Oncotic refers to a blood product to treat shock.

31.18 Electrolytes are essential for many body functions, and require a: A. Wide level range. b. High level range. c. Narrow level range. d. Low level range.

Answer: C Narrow level range. Rationale: A. Levels of electrolytes are maintained within a very narrow range. B. Levels of electrolytes are maintained within a very narrow range. C. Levels of electrolytes are maintained within a very narrow range. D. Levels of electrolytes are maintained within a very narrow range.

Administration of potassium supplements is contraindicated in clients taking which of the following diuretics? a. Spironolactone (Aldactone) b. Furosemide (Lasix) c. Chlorothiazide (Diuril) d. Bumetanide (Bumex)

Answer: a. Spironolactone (Aldactone) Rationale: Unlike with loop and thiazide diuretics, clients taking potassium-sparing diuretics should not take potassium supplements, due to the increased risk of hyperkalemia.

Which of the following actions is dependent upon proper functioning of the kidneys or the administration of Epogen? a. Stimulates the production of RBCs. b. Inhibits the release of renin. c. Detoxifies drugs in the bloodstream. d. Secretes the hormone cortisol.

Answer: a. Stimulates the production of RBCs. Rationale: The kidney is responsible for the hormone erythropoietin, which stimulates the production of RBCs.

Client education as relates to loop diuretics should include goals of therapy and should include which of the following points? (Select all that apply.) a. Take in the morning to avoid nighttime urination that could result in increased risk of injury. b. Expect decreased urine output. c. Take potassium supplements, if ordered, and eat potassium-rich foods. d. Check weight daily, and report a weight gain of 2 pounds or greater in 24 hours. e. Report any change in hearing (deafness).

Answer: a. Take in the morning to avoid nighttime urination that could result in increased risk of injury.; c. Take potassium supplements, if ordered, and eat potassium-rich foods.; d. Check weight daily, and report a weight gain of 2 pounds or greater in 24 hours.; e. Report any change in hearing (deafness). Rationale: Client education should include reasons for obtaining baseline data such as vital signs and tests for renal disorders, and possible side effects.

Which of the following is an important point of emphasis the nurse should include when teaching a client with diabetes regarding thiazides? a. Hypocalcemia b. Hyperglycemia c. Urinary tract infections d. Anemia

Answer: b. Hyperglycemia Rationale: Some thiazide diuretics can cause hyperglycemia and glycosuria in diabetic patients. Thiazides do not affect calcium or red blood cell levels.

For which of the following disorders should the nurse assess before administering chlorothiazide (Diuril)? a. Chronic urinary tract infections b. Low blood pressure c. Congenital malformations d. Hyperkalemia

Answer: b. Low blood pressure Rationale: Thiazide diuretics reduce circulating blood volume, which can cause orthostatic hypotension.

Which of the following is the most important baseline value prior to initiation of diuretic therapy? a. Glucose level b. Amino acids c. Blood pressure d. Sodium bicarbonate

Answer: c. Blood pressure Rationale: Although many baseline values are important, blood pressure (sitting and supine) can indicate excessive diuresis, which can result in dehydration and hypovolemia.

Which of the following clinical manifestations might indicate that the client has excessive potassium loss? a. Hypertension; angina b. Excessive thirst; urination c. Low blood pressure; cardiac arrhythmias d. Pitting edema; weight gain

Answer: c. Low blood pressure; cardiac arrhythmias Rationale: Rapid excretion of large amounts of fluid predisposes the client to potassium deficits and is manifested by hypotension, dizziness, cardiac arrhythmias, and fainting.

A client with a history of HF will be started on spironolactone (Aldactone). Which of the following drug groups should not be used, or used with extreme caution in patients taking potassium-sparing diuretics? 1. NSAIDs 2. Corticosteroids 3. Loop diuretics 4. ACE inhibitors or ARBs

Answer:4 Rationale: ACE inhibitors and ARBs taken concurrently with potassium -sparing diuretics increase the risk of hyperkalemia. Options 1,2, and 3 are incorrect. NSAIDs are used cautiously with all diuretics because they are excreted through the kidney. Corticosteroids and loop diuretics may cause hypokalemia and may be paired with a potassium -sparing diuretic to reduce the risk of hypokalemia developing if a diuretic is needed.

The client receives beclomethasone (Beconase). What will the best assessment by the nurse include?

Assess the client's mouth for any sign of fungal infection. Assess if the client has blown his nose prior to administration of nasal spray. Assess if the client has had a change in taste. Assess the client for any hoarseness or change in voice.

Which of the following statements is true regarding asthma?It has both inflammatory and bronchoconstriction components

Asthma has an inflammatory and a bronchoconstriction component

A client says, "My doctor told me that I have COPD and might develop emphysema. I always thought I had chronic bronchitis." How should the nurse respond to this statement?

COPD is either asthma, chronic bronchitis, or emphysema, or a combination of those disorders. "As COPD progresses it becomes emphysema." "Both diagnoses are correct."

The physician has prescribed lithium to Mr. Johnson, a 34-year-old male with a history of obesity, cirrhosis of the liver secondary to alcohol abuse, diabetes, and hypertension. Which condition places him at highest risk of lithium toxicity? Cirrhosis of the liver Obesity Alcoholism Diabetes

Cirrhosis of the liver

A nurse should administer which of the following antidepressants in the morning as it has a great likelihood to cause insomnia? Select all that apply: Bupropion (Welbutrin) Amitiptyline (Elavil) Paroxetine (Paxil) Citalopram (Celexa) Sertraline (Zoloft)

Citalopram (Celexa) Paroxetine (Paxil) Sertraline (Zoloft)

The elderly client receives diphenhydramine (Benadryl) for allergies. The nurse completes medication education and evaluates that learning has occurred when the client makes which statement? 1. Drowsiness is common but should lessen within a few doses. 2. If this medication makes my nose run, I can use a nasal spray. 3. I need to watch my intake of sodium with this medication. 4. I cannot take this medication with pseudoephedrine (Sudafed).

Correct Answer: 1 Rationale 1: Drowsiness is a common adverse effect of antihistamines. The client should develop a tolerance to this effect within a few doses. Rationale 2: Antihistamines would dry the nasal secretions, not increase them. Rationale 3: Sodium intake is not related to antihistamines. Rationale 4: Pseudoephedrine (Sudafed) is commonly used with antihistamines.

The nursing instructor teaches the student nurses about histamine receptors and evaluates that further instruction is needed when the students make which statement? 1. H1-receptors are found in the stomach. 2. H1-receptors are responsible for allergic symptoms. 3. H2-receptors increase mucus secretion in the stomach. 4. H2-receptors are responsible for peptic ulcers.

Correct Answer: 1 Rationale 1: H2-receptors are found in the stomach. Rationale 2: The histamine receptors responsible for allergic symptoms are called H1 receptors. Rationale 3: H2-receptors increase mucus secretion in the stomach. Rationale 4: H2-receptors are responsible for peptic ulcers.

A patient is taking warfarin sodium. The nurse will reinforce teaching by telling the patient that he should watch for 1. bleeding. 2. pain. 3. headache. 4. rash.

Correct Answer: 1 Rationale 1: Increased risk for bleeding is the important adverse effect to teach to patients taking warfarin sodium. Rationale 2: Pain occurs with some antiplatelet drugs. Rationale 3: Headaches are not common. Rationale 4: Rash is not common.

The client receives beclomethasone (Beconase) intranasally as treatment for allergic rhinitis. He asks the nurse if this drug is safe because it is a glucocorticoid. What is the best response by the nurse? 1. Intranasal glucocorticoids produce almost no serious adverse effects. 2. Intranasal glucocorticoids are safe if you do not swallow any while using them. 3. Intranasal glucocorticoids are safe if they are not used too long. 4. Intranasal glucocorticoids are safe only if used once a day.

Correct Answer: 1 Rationale 1: Intranasal glucocorticoids produce almost no serious adverse effects. Rationale 2: Swallowing glucocorticoids used for intranasal application could potentially cause reactions, but large amounts would need to be swallowed. This option states they are dangerous if swallowed in any quantity. Rationale 3: There is no time frame for the use of intranasal glucocorticoids; they produce almost no serious adverse effects. Rationale 4: Intranasal glucocorticoids may be used more than once a day; they produce almost no serious adverse effects.

The physician has ordered ipratropium (Atrovent) for the client. What is a priority assessment question for the nurse to ask prior to administering this medication? 1. "Are you allergic to soy? 2. "Do you have diabetes mellitus?" 3. "Do you have seizures?" 4. "Do you have gout?

Correct Answer: 1 Rationale 1: Ipratropium (Atrovent) is contraindicated in patients with hypersensitivity to soy as soya lecithin is used as a propellant in the inhaler. Rationale 2: Anticholinergic drugs do not impact glucose levels, so having diabetes mellitus is not a concern. Rationale 3: Anticholinergic drugs do not affect seizure disorders; this is not a concern. Rationale 4: Anticholinergic drugs are not contraindicated in clients with gout.

The client calls the clinic and is frantic that her two children have been sent home from school with head lice. She has treated their scalps, but does not know what else to do. What will be the best teaching by the nurse? 1. Wash the bed linens and clothing that have come into contact with the children. 2. Just continue to apply the medication to their scalps as directed. 3. Do not let your children return to the school until it is fumigated. 4. Isolate the affected children from other family members for three days.

Correct Answer: 1 Rationale 1: Lice are spread by direct contact and can live many days on inanimate objects. The children could be re-infected if household items are not treated. Rationale 2: It is not necessary to continue applying medication to the childrens scalps. Rationale 3: Head lice are spread by direct contact; it is not necessary to fumigate the school. Rationale 4: It is not necessary to isolate the affected children.

Loop diuretics 1. inhibit reabsorption of sodium and chloride in the loop of Henle. 2. block sodium in the distal and proximal loops. 3. block aldosterone. 4. promote excretion of water by adding sodium to the filtrate.

Correct Answer: 1 Rationale 1: Loop diuretics inhibit sodium in the loop of Henle and increase urine output. Rationale 2: Thiazide diuretics block sodium in the distal tubule and nephron. Rationale 3: Potassium-sparing diuretics block aldosterone. Rationale 4: Some miscellaneous diuretics have this mechanism.

A client receives theophylline (Theo-Dur) and calls the clinic to say he has had nausea and vomiting for 2 days. What is the best action by the nurse? 1. Tell the client to come to the clinic for an assessment. 2. Ask the client if he has eaten at any unclean restaurants. 3. Ask the client if he has been exposed to anyone with the flu. 4. Recommend that the client begin a clear liquid diet

Correct Answer: 1 Rationale 1: Nausea and vomiting are symptoms of theophylline toxicity; the client needs to come to the clinic for an assessment. Rationale 2: Food poisoning could be the cause of the client's symptoms, but he needs to be assessed for theophylline toxicity. Rationale 3: Flu could be the cause of the client's symptoms, but he needs to be assessed for theophylline toxicity. Rationale 4: A clear-liquid diet might help, but the client needs to be assessed for theophylline toxicity.

The nurse teaches the client about the difference between oral and nasal decongestants. The nurse evaluates that learning has been effective when the client makes which statement? 1. Oral decongestants can cause hypertension. 2. Intranasal decongestants are safe to use for a month, if needed. 3. Oral and nasal decongestants can cause rebound congestion. 4. Oral decongestants are the most effective at relieving severe congestion.

Correct Answer: 1 Rationale 1: One of the side effects of oral decongestants is hypertension. Rationale 2: Intranasal decongestants should not be used for longer than 3 to 5 days. Rationale 3: Oral decongestants do not cause rebound congestion; nasal decongestants can cause rebound congestion. Rationale 4: Intranasal, not oral, decongestants are the most effective at relieving severe congestion.

The mother of a young child calls the clinic and tells the nurse that she has just discovered head lice in her daughters hair. What is the best instruction by the nurse? 1. Purchase an over-the-counter lice medication and follow the package directions exactly. 2. Take her to your beautician for treatment. 3. Bring her to the clinic for evaluation. 4. Be certain to eliminate all the lice with the first application of medication as treatment cannot be done again for a month.

Correct Answer: 1 Rationale 1: Package directions should be followed exactly. Rationale 2: Lice are easily spread. Exposing those in the beauty shop to lice is not the best plan. Rationale 3: It is easy to identify lice at home and instruction for treatment can be given over the telephone. Lice are easily spread, so it is not the best plan to have the child in the clinic waiting room. Rationale 4: Treatment can be repeated, usually in one week, if necessary.

The client is very frustrated that pseudoephedrine is no longer stocked on pharmacy shelves. The client does not like to go the pharmacy counter to obtain the drug. What is the best response by the nurse? 1. This is frustrating, but hopefully it will decrease the amount of methamphetamine being produced. 2. This is frustrating, but hopefully it will decrease the amount of inhaled heroin being produced. 3. This is frustrating, but hopefully it will decrease the amount of methylphenidate being produced. 4. This is frustrating, but hopefully it will decrease the amount of crack cocaine being produced.

Correct Answer: 1 Rationale 1: Pseudoephedrine (Sudafed) is a major ingredient in the production of methamphetamine.

Antihistamines block the actions of histamine at the 1. H1 receptor site. 2. B1 receptor site. 3. B2 receptor site. 4. C1 receptor site.

Correct Answer: 1 Rationale 1: The H1 receptor site is the site for blocking histamine with the use of antihistamines. Rationale 2: The B1 receptor site does not play a role in blocking histamine. Rationale 3: The B2 receptor site does not play a role in blocking histamine. Rationale 4: C1 is not a site of histamine release.

The client receives albuterol (Proventil) via inhaler. He asks the nurse why he can't just take a pill. What is the best response by the nurse? 1. "When you inhale the drug the blood supply in your lungs picks it up rapidly, resulting in quicker effects." 2. "Because pills cannot help your illness; you must have inhaled medications for relief of symptoms." 3. "Because pills would produce too many side effects; you will have very few side effects with inhaled medications." 4. "Because this medication cannot be absorbed from your GI tract; the acid in your stomach would destroy it."

Correct Answer: 1 Rationale 1: The respiratory system offers a rapid and efficient mechanism for delivering drugs. The enormous surface area of the bronchioles and alveoli, and the rich blood supply to these areas, results in an almost instantaneous onset of action for inhaled substances. Rationale 2: Albuterol (Proventil) can be given orally (PO) but has a faster onset of action if inhaled. Rationale 3: Inhaled medications also produce side effects. Rationale 4: Oral medications are effective with some symptoms of respiratory disorders, but inhaled medications work faster.

Laboratory studies related to heparin therapy include 1. aPTT. 2. serum heparin studies. 3. complete blood studies. 4. sedimentation rate.

Correct Answer: 1 Rationale 1: aPTT is the study of choice for heparin therapy. Rationale 2: These are not valid studies. Rationale 3: Complete blood studies can be done, but are not necessarily related to heparin. Rationale 4: Sedimentation rate is not needed for heparin therapy.

The nurse is managing care for a group of patients on a renal failure unit. What does the nurse recognize as the most important patient safety precaution with regard to medication administration? 1. Know that patients will require less-than-average doses of medications. 2. Know which drugs will increase fluid retention. 3. Ensure that each patients intake and output is measured precisely. 4. Be aware of what drugs are nephrotoxic.

Correct Answer: 1 Rationale: Administering the average dose of medication to a patient in severe renal failure can have mortal consequences. The consequences of recognizing that renal patients will require less-than-average doses of medications cannot be overemphasized. Recognizing which drugs are nephrotoxic is important, but not as important as knowing that patients will need less-than-average doses. Ensuring that each patients intake and output is measured precisely is important, but not as important as knowing that patients will need less-than-average doses. Knowing which drugs will increase fluid retention is important, but not as important as knowing that patients will need less-than-average doses.

The elderly patient is receiving chlorothiazide (Diuril). What does the best teaching by the nurse include with this medication? 1. Take the medication early in the morning. 2. Avoid foods that are high in potassium. 3. It is alright to have a glass of wine with this medication. 4. Take the medication on an empty stomach.

Correct Answer: 1 Rationale: Elderly patients should take diuretics early in the morning to avoid nocturia. Absorption of chlorothiazide (Diuril) is decreased when taken on an empty stomach. Chlorothiazide (Diuril) is a potassium excreting drug and foods high in potassium should be encouraged. Alcohol can potentiate the hypotensive effects of chlorothiazide (Diuril) and should be avoided, especially in the elderly.

The patient receives an appropriate dose of warfarin (Coumadin), but the international normalized ratio (INR) is in the high range. The patient denies taking any aspirin products. What is the best assessment question to ask the patient at this time? 1. Have you been eating much garlic? 2. Have you been eating a lot of salads and vegetables? 3. Have you been drinking too much milk? 4. Are you restricting your fluids too much?

Correct Answer: 1 Rationale: Garlic has been shown to decrease the aggregation of platelets, thus producing an anticoagulant effect. Patients taking anticoagulant medications should limit their intake of garlic. Salads and vegetables contain vitamin K, which is an antidote for warfarin (Coumadin). This would not impact the international normalized ratio (INR). Milk does not impact the international normalized ratio (INR) when a patient receives warfarin (Coumadin). Dehydration does not impact the international normalized ratio (INR) when a patient receives warfarin (Coumadin).

The patient is being discharged on warfarin (Coumadin) following a valve replacement. The nurse has completed medication education and determines that learning has occurred when the patient makes which statement? 1. I must wear a MedicAlert bracelet that says Im on warfarin (Coumadin). 2. If I notice any bruising or bleeding I will need to have lab work done. 3. I can take enteric-coated aspirin, but not plain aspirin for my arthritis. 4. I must limit my intake of vitamin C while Im on warfarin (Coumadin).

Correct Answer: 1 Rationale: Patients on anticoagulant therapy should wear a MedicAlert bracelet. Aspirin is not allowed when a patient is on anticoagulant therapy. Lab work must be done routinely, not just if the patient notices bruising or bleeding. The intake of Vitamin K, not Vitamin C must be limited when a patient receives warfarin (Coumadin).

The client asks the nurse how skin cells are replaced. What is the best response by the nurse? 1. The epidermis supplies new cells after older cells have been damaged or lost. 2. The dermis supplies new cells after older cells have been damaged or lost. 3. The stratum corneum supplies new cells after older cells have been damaged or lost. 4. The stratum germinativum supplies new cells after older cells have been damaged or lost.

Correct Answer: 1 Rationale: The deepest epidermal sublayer, the stratum basale, supplies the epidermis with new cells after older superficial cells have been damaged or lost through normal wear.

The patient receives warfarin (Coumadin). The nurse plans to teach the patient to avoid which foods that are served for lunch? 1. Tomato salad with basil 2. Whole-wheat bread with margarine 3. Salt substitute 4. Fettuccine Alfredo

Correct Answer: 1 Rationale: Tomatoes are high in vitamin K and must be avoided when a patient receives warfarin (Coumadin). Fettuccine Alfredo is not high in vitamin K so is not contraindicated when a patient receives warfarin (Coumadin). Salt substitute is not high in vitamin K so is not contraindicated when a patient receives warfarin (Coumadin). Whole-wheat bread with margarine is not high in vitamin K so is not contraindicated when a patient receives warfarin (Coumadin).

Which statement is true regarding asthma? 1. It has both inflammatory and bronchoconstriction components. 2. Asthma is caused by a virus. 3. Asthma cannot be treated. 4. Symptoms most often occur with rest

Correct Answer: 1 Rationale 1: Asthma has an inflammatory and a bronchoconstriction component. Rationale 2: Asthma is not caused by a virus, although a virus can be a trigger. Rationale 3: Asthma can be treated by several drug classes. Rationale 4: Symptoms occur with exposure to triggers or exertion.

The nurse is providing disease management education for a patient who has just been diagnosed with asthma. The nurse provides which information? (Select all that apply.) 1. Drink additional fluids. 2. Eat small, frequent meals. 3. Sleep in a warm room. 4. Do all activity early in the morning and rest in the afternoon. 5. Avoid foods high in protein

Correct Answer: 1,2 Rationale 1: Drinking sufficient fluids will help to liquefy and mobilize mucus. Rationale 2: Small, frequent meals of calorie and nutrient dense foods help to prevent fatigue and maintain nutrition. Rationale 3: Cooler room temperatures make breathing easier. Rationale 4: Activities and rest should be alternated and balanced. Rationale 5: There is no need to avoid foods high in protein.

The nurse is providing care for a patient who developed heparin-induced thrombocytopenia (HIT) during heparin therapy. The nurse is aware that lepirudin (Refludan) is often given to patients with this condition. Which assessment findings should the nurse report to the medical team? Select all that apply. 1. The most recent aPTT is 2.8. 2. The patients last stool tested positive for blood. 3. The patient is allergic to eggs. 4. The patients spleen was removed after a motor vehicle accident 3 years ago. 5. The patient drinks 5-6 cups of coffee daily.

Correct Answer: 1,2 Rationale 1: Lepirudin is contraindicated if the aPTT is above 2.5. Rationale 2: Lepirudin is contraindicated in patients who are actively bleeding. Rationale 3: There is no contraindication to the use of lepirudin in patients with egg allergy. Rationale 4: A surgery 3 years ago is not a contraindication to the use of lepirudin, nor is absence of the spleen. Rationale 5: There is no contraindication to the use of lepirudin in those who drink coffee.

Which substances enter the filtrate by active secretion? Select all that apply. 1. Hydrogen 2. Potassium 3. Phosphate 4. Chloride 5. Sodium

Correct Answer: 1,2,3 Rationale 1: Hydrogen is pumped into filtrate by molecular pumps. Rationale 2: Potassium is pumped into filtrate by molecular pumps. Rationale 3: Phosphate is pumped into filtrate by molecular pumps. Rationale 4: Chloride does not enter filtrate by active secretion. Rationale 5: Sodium does not enter filtrate by active secretion.

The physician orders pentoxifylline (Trental) for the patient with peripheral vascular disease. The nurse has completed medication education and determines that learning has occurred when the patient makes which statement(s)? Select all that apply. 1. It makes my red blood cells (RBCs) squishy so they can go into the little blood vessels. 2. It decreases my platelets so my blood is less likely to clot. 3. It decreases the stickiness of my blood. 4. It changes how my liver makes clotting factors. 5. It thins my blood so more can get to those little vessels.

Correct Answer: 1,2,3 Rationale: Pentoxifylline (Trental) acts on red blood cells (RBCs) to reduce their viscosity and increase their flexibility to allow them to enter partially occluded vessels. Pentoxifylline (Trental) also has antiplatelet action. Pentoxifylline (Trental) decreases the viscosity or stickiness of blood. Pentoxifylline (Trental) is not an anticoagulant. Pentoxifylline (Trental) does not interfere with the manufacture of clotting factors in the liver.

The patient has been diagnosed with chronic renal failure and is receiving hydrochlorothiazide (HCTZ). The nurse has taught the patient about the importance of kidney function, and evaluates that learning has occurred when the patient makes which statements? Select all that apply. 1. Kidneys help my heart by balancing potassium. 2. Kidneys balance the fluid and electrolytes in my body. 3. Kidneys keep blood pressure from getting too low. 4. Kidneys help decrease infections by excreting bacteria. 5. Kidneys help regulate the oxygen levels in my blood.

Correct Answer: 1,2,3 Rationale: The kidneys are the primary organs for regulating fluid and electrolyte balance. The kidneys are the primary organs for regulating potassium balance. They secrete rennin, which helps to regulate blood pressure. The kidneys do not affect serum oxygen levels. The kidneys do not have any impact on bacterial infections.

The client has allergic rhinitis and asks the nurse what causes this. How should the nurse respond? Select all that apply. 1. It can occur after exposure to animal dander. 2. Tobacco smoke causes it in some people. 3. Exposure to pollens from weeds and grass cause an allergic response in some people. 4. It is caused by asthma. 5. You inherited the predisposition for this.

Correct Answer: 1,2,3,5 Rationale 1: One of the causative factors for allergic rhinitis is animal dander. Rationale 2: Tobacco smoke causes the allergic rhinitis reaction in some people. Rationale 3: Allergic response to pollen can cause allergic rhinitis in some people. Rationale 4: Although associated with asthma, allergic rhinitis is not caused by asthma. Rationale 5: There is a strong genetic predisposition for allergic rhinitis.

A client calls the clinic and asks the nurse how to treat a skin injury. What questions should the nurse ask prior to formulating a response? Select all that apply. 1. How deep is the injury? 2. How large is the injured area? 3. How did the injury happen? 4. Did the injury happen over 3 hours ago? 5. Where is the injury?

Correct Answer: 1,2,3,5 Rationale 1: The depth of injury is important in determining if treatment should be topical, systemic, or both. Rationale 2: Size of skin injury is important in determining if the treatment should be topical, systemic, or both. Rationale 3: The mechanism of injury is important in determining the potential for the injury to become infected. Rationale 4: There is no specific length of time that would change therapy. Rationale 5: The position of the injury is important in determining potential for infection.

The nurse is caring for a patient who is experiencing acute renal failure. The nurse knows that this patient may experience problems regulating _________________. Select all that apply. 1. fluid balance. 2. electrolyte composition. 3. the pH of body fluids. 4. heart rate. 5. blood pressure.

Correct Answer: 1,2,3,5 Rationale 1: The kidneys are the primary organs for regulating fluid balance through filtration and urine output. Rationale 2: The kidneys are the primary organs for regulating electrolyte composition through filtration and urine output. Rationale 3: The kidneys are the primary organ for regulating the pH of body fluids through filtration and urine output. Rationale 4: The kidneys do not play a role in regulating heart rate. Rationale 5: The kidneys play a role in regulating blood pressure through the secretion of renin.

Oral decongestants differ from intranasal decongestants in that oral decongestants 1. are more effective at relieving severe congestion. 2. have more systemic effects. 3. can cause rebound congestion. 4. have high efficacy.

Correct Answer: 2 Rationale 1: Oral decongestants are less effective at relieving severe congestion. Rationale 2: Oral decongestants can have more systemic effects. Rationale 3: Intranasal decongestants can cause rebound congestion after more than 5 days of use. Rationale 4: Intranasal decongestants are higher in efficacy.

An 8-year-old child was just diagnosed with asthma. Which assessment questions should the nurse ask the child and parents? Select all that apply. 1. "Have you eaten any new foods?" 2. "Are you exposed to anyone who smokes?" 3. "Have you had your carpet cleaned lately?" 4. "Have you grown taller since last year?" 5. "Has there been a change in laundry products recently?

Correct Answer: 1,2,3,5 Rationale 1: Recent diet changes should be investigated as a potential source of asthma. Rationale 2: Cigarette smoke can trigger asthma. Rationale 3: Recent carpet cleaning may release substances that trigger asthma. Rationale 4: Growth rate would not likely be affected in the last year for a client with newly diagnosed asthma. Weight would be more likely to be affected than height. Rationale 5: Changes in household chemicals may be related to the onset of asthma.

A clients medical record reveals presence of an erythematous urticaric rash with pruritus. What assessment findings would the nurse expect? Select all that apply. 1. The area of the rash is red. 2. The area has a raised, bumpy texture. 3. The area involved is warm to the touch. 4. The area itches. 5. The area is scaly.

Correct Answer: 1,2,4 Rationale 1: Erythema refers to redness often associated with skin rashes. Rationale 2: Urticaria refers to hives which present as raised bumps. Rationale 3: This may be the case, but the nurse would not expect that from the description given. Rationale 4: Pruritus is itching. Rationale 5: While pruritus is often associated with scaly skin, there is nothing in the description that indicates the area is scaly.

The nurse is planning care for a patient receiving enoxaparin (Lovenox). Which interventions should be included? Select all that apply. 1. Teach the patient or family to give subcutaneous injections at home. 2. Monitor for development of deep vein thrombosis. 3. Monitor multiple lab tests. 4. Teach the patient signs of excessive bleeding. 5. Schedule administration times right before breakfast and the evening meal.

Correct Answer: 1,2,4 Rationale 1: Family and patients can be taught to give subcutaneous injections at home. Rationale 2: Lovenox is used to prevent DVTs. The nurse should observe for the development of DVTs. Rationale 3: Lovenox is a low-molecular-weight heparin (LMWH), and does not require multiple lab tests. Rationale 4: Although Lovenox is more predictable than are other anticoagulants and has fewer adverse effects, bleeding is still a possibility. Rationale 5: Lovenox is generally administered once daily, and administration time is not tied to mealtimes.

A home care nurse is instructing a patient with congestive heart failure on daily self-monitoring between home care visits. The nurse should instruct the patient to monitor and record _______________. Select all that apply. 1. weight. 2. pulse. 3. temperature. 4. blood pressure. 5. respiratory rate.

Correct Answer: 1,2,4 Rationale 1: It is essential that the patient measure and record weight daily to monitor for fluid loss or retention. Rationale 2: It is essential that the patient measure and record the pulse daily to determine the effectiveness of the medication therapy. Rationale 3: There is no need for the patient to measure and record a daily temperature while taking a diuretic. Rationale 4: It is essential that the patient measure and record daily blood pressure to determine the effectiveness of the medication therapy. Rationale 5: There is no need for the patient to measure and record a daily respiratory rate while taking a diuretic.

The nurse has provided medication education to a patient who was just diagnosed with asthma. The nurse would evaluate that additional teaching is necessary when the patient makes which statement? (Select all that apply.) 1. "My albuterol inhaler should be taken routinely to prevent asthma attacks." 2. "I should plan to take my corticosteroid for the rest of my life." 3. "My cromolyn inhaler (Intal) will help me prevent asthma attacks." 4. "I'll use my montelukast (Singulair) inhaler every day." 5. "My therapy will include both oral and inhaled drugs."

Correct Answer: 1,2,4 Rationale 1: Albuterol inhalers are used as rescue medications. Rationale 2: Corticosteroids are short-term drugs. Rationale 3: Cromolyn (Intal) is a mast cell stabilizer and will help prevent asthma attacks. Rationale 4: Montelukast (Singulair) is an oral drug. Rationale 5: Therapy will include both oral and inhaled drugs.

A nurse works in a clinic that sees both children and adults with asthma. Which assessments will the nurse routinely monitor on patients taking corticosteroids? (Select all that apply.) 1. Height measurement in children 2. Bone density test results in adults 3. IQ measurements in both adults and children 4. Weight measurements in children 5. EKGs on adults

Correct Answer: 1,2,4 Rationale 1: Corticosteroids can affect growth in children. Rationale 2: Corticosteroids can affect bone density in adults. Rationale 3: Corticosteroids do not affect IQ. Rationale 4: Corticosteroids can affect growth in children. Rationale 5: Corticosteroids do not affect EKG readings.

A patient presents to the emergency department with exacerbation of asthma that occurred while eating breakfast at a local buffet. The nurse would ask which assessment questions? (Select all that apply.) 1. "Did you eat bacon or sausage?" 2. "Did you have any dairy products?" 3. "Did you drink orange juice?" 4. "Did you have pastries with nuts?" 5. "Did you drink coffee?

Correct Answer: 1,2,4 Rationale 1: The nitrates in processed foods may trigger asthma. Rationale 2: Some people with asthma react to dairy products. Rationale 3: Orange juice is not a known trigger for asthma. Rationale 4: Nuts may trigger asthma in some people. Rationale 5: Coffee is not a known trigger for asthma.

A clinic nurse is developing a teaching handout for patients who are prescribed warfarin (Coumadin) therapy. Which statement should be included in this information? Select all that apply. 1. Tell your dentist you are taking warfarin prior to any procedures. 2. Report to the lab for testing of activated partial thromboplastin time (APTT). 3. Avoid strenuous activities. 4. Place ice at the injection site if stinging or burning occurs. 5. Take nonsteroidal anti-inflammatories (NSAIDs) for minor pain relief.

Correct Answer: 1,3 Rationale 1: Warfarin increases the risk of bleeding from dental procedures. Rationale 2: APTT is not used to monitor warfarin. Rationale 3: Strenuous or risky activities place the patient at risk for injury and bleeding. Rationale 4: Warfarin is not administered by injection. Rationale 5: NSAIDs can cause bleeding if taken concurrently with warfarin.

A patient with chronic kidney failure is taking a loop diuretic. The nurse will advise the patient to take the drug 1. with food. 2. in the morning. 3. at bedtime. 4. in the late afternoon.

Correct Answer: 2 Rationale 1: The medication does not need to be given with food. Rationale 2: It is best to take loop diuretics in the morning, since they increase urine flow, which could lead to injury. Rationale 3: Taking a loop diuretic at bedtime will cause nighttime urination and interfere with sleep. Rationale 4: Late afternoon is too late, since the drug will increase urine flow.

A client diagnosed with COPD says, "I don't see why I need to stop smoking. The damage to my lungs is already done." How should the nurse respond to this statement? Select all that apply. 1. "If you stop smoking now, your COPD may not get worse as fast." 2. "If you stop smoking, your lungs will get better pretty quickly." 3. "Your symptoms might not be as bad if you aren't smoking." 4. "You are probably correct, but you should at least try." 5. "If I were you, I would enjoy what time I have left."

Correct Answer: 1,3 Rationale 1: Smoking cessation has been shown to slow the progression of COPD. Rationale 2: Depending on the extent of damage, the client's lungs may not get better at all, but may just stop getting worse. Rationale 3: Smoking cessation has been shown to result in fewer respiratory symptoms. Rationale 4: It is not therapeutic to tell the client that he is correct with this statement. Rationale 5: The nurse should encourage the client to stop smoking.

The nurse is preparing to discharge a patient who has been placed on a loop diuretic for the treatment of congestive heart failure. Which foods should the nurse encourage the patient to consume to prevent serious adverse effects associated with the medication? Select all that apply. 1. Bananas 2. Red meat 3. Oranges 4. Dried dates 5. Green, leafy vegetables

Correct Answer: 1,3,4 Rationale 1: Bananas are a potassium-rich food. Patients on loop diuretics should eat foods rich in potassium. Rationale 2: Red meats are high in iron and would not be a good source of potassium for this patient. Rationale 3: Citrus fruits are a good source of potassium. Patients on loop diuretics should eat foods rich in potassium. Rationale 4: Dried dates are a good source of potassium. Patients on loop diuretics should eat foods rich in potassium. Rationale 5: Green, leafy vegetables are a good source of iron but not of potassium. Patients on loop diuretics should eat foods rich in potassium.

The client receives beclomethasone (Beconase). What will the best assessment by the nurse include? Select all that apply. 1. Assess the client's mouth for any sign of fungal infection. 2. Assess the client's blood glucose prior to administration of nasal spray. 3. Assess if the client has blown his nose prior to administration of nasal spray. 4. Assess if the client has had a change in taste. 5. Assess the client for any hoarseness or change in voice

Correct Answer: 1,3,4,5 Rationale 1: Clients may develop candidiasis so the mouth should be assessed. Rationale 2: There is no need to assess the client's blood glucose. Rationale 3: The client should gently blow the nose prior to use to clear the nasal passages. Rationale 4: Clients may experience a change in taste. Rationale 5: Clients may experience a change in voice as a local effect.

The client is prescribed a nasal decongestant spray. What information should the nurse include when educating the client about how to use this medication? Select all that apply. 1. Blow your nose immediately before using the medication. 2. Drink a full glass of water immediately before using this spray. 3. Limit your use of this spray to no more than 5 days. 4. Since you are using more than one type of nasal spray, be sure to wait 510 minutes between administrations. 5. You should spit out any excess spray that drains into your mouth.

Correct Answer: 1,3,4,5 Rationale 1: The nasal passages should be cleared by blowing the nose immediately before the medication is administered. Rationale 2: Fluids should be increased, but it is not necessary to drink a glass of water immediately before using the spray. Rationale 3: Nasal decongestant sprays should not be used for more that 35 days. Rationale 4: The client should wait 510 minutes between administering different nasal sprays to allow the first medication some time to work before the second one is used. Rationale 5: Excess spray should not be swallowed as systemic effects may occur.

A nurse is explaining the process of respiration to a client. Which information should be given? Select all that apply. 1. "Moving air in and out of the lungs is really called ventilation." 2. The smooth muscle in the alveoli helps to pull air into the lungs. 3. Exchange of oxygen and carbon dioxide occurs across a thin capillary membrane. 4. Respiration is not effective without perfusion. 5. Your basic respiratory drive is determined by your brain.

Correct Answer: 1,3,4,5 Rationale 1: Ventilation is the process of moving air into and out of the lungs. Rationale 2: There is no smooth muscle in the alveoli. Rationale 3: The blood stays in capillaries. A thin membrane separates airway from capillary. Rationale 4: Perfusion is the blood flow through the lungs. Without this blood flow, the oxygen-carbon dioxide exchange does not take place. Rationale 5: The rate is determined by neurons in the brainstem and can be affected by a number of factors.

The nursing instructor teaches the student nurses about the structure and function of the skin. What will the best teaching plan of the instructor include? Select all that apply. 1. The outermost layer of the epidermis serves as the major waterproof barrier to the environment. 2. The epidermis provides a foundation for the accessory structures such as hair and nails. 3. The amount of subcutaneous tissue varies, and is determined by nutritional status and heredity. 4. Most receptor nerve endings, oil glands, sweat glands, and blood vessels are found within the subcutaneous fat. 5. The deepest epidermal layer provides new cells.

Correct Answer: 1,3,5 Rationale 1: The outermost layer of the epidermis, or stratum coneum, forms an effective barrier. Most substances cannot penetrate this barrier. Rationale 2: The dermis, not the epidermis, provides a foundation for the accessory structures such as hair and nails. Rationale 3: The amount of subcutaneous tissue varies, and is determined by nutritional status and heredity. Rationale 4: Most receptor nerve endings, oil glands, sweat glands, and blood vessels are found within the dermis, not the subcutaneous fat. Rationale 5: The deepest epidermal sublayer supplies the epidermis with new cells after older superficial cells have been damaged or lost through normal wear.

A client has been prescribed tretinoin (Avita) for treatment of acne. Which medication information should the nurse provide? Select all that apply. 1. It will take several weeks for you to see improvement in your skin. 2. You should continue using your over-the-counter oil drying medication until you start to see effects from this medication. 3. Mild sun exposure will help this medication work more effectively. 4. You will likely notice redness and scaling of your skin while using this medication. 5. Continue to take the tetracycline previously prescribed for your cystic acne.

Correct Answer: 1,4 Rationale 1: Initial improvement may take 4-8 weeks, while maximum therapeutic benefit may take 5-6 months. Rationale 2: The client should avoid preparations that dry the skin. Rationale 3: The client should avoid direct exposure to sunlight while using this medication. Rationale 4: Redness and scaling are expected effects of this medication. Rationale 5: Additive phototoxicity can occur if tretinoin is used concurrently with tetracycline.

A client is prescribed an intranasal corticosteroid. What should the nurse include in client education about this drug? Select all that apply. 1. You may feel a burning sensation when using this drug. 2. This drug will be most effective if used only when symptoms are present. 3. Be careful of how hard you squeeze the container as you can inadvertently give yourself too much medication for one dose. 4. This medication may dry out your nasal passages enough to cause nosebleed. 5. Do not eat licorice while taking this drug.

Correct Answer: 1,4,5 Rationale 1: The most frequently reported adverse effect of this drug is an intense burning sensation in the nose occurring immediately after spraying. Rationale 2: The drug often takes 1 to 3 weeks to achieve peak response and should be started in advance of expected need. Rationale 3: The medications are provided in metered-spray devices. Rationale 4: Excessive drying of the nasal mucosa may occur, which leads to epistaxis. Rationale 5: Licorice may potentiate the effects of corticosteroids.

The patient has a deep vein thrombosis (DVT) and is admitted for initial heparin therapy. Which order(s) would the nurse want to validate with the physician? Select all that apply. 1. Heparin 1,000 units intravenous (IV) every 6 hours 2. Tylenol as needed (PRN) for headaches 3. Obtaining a daily weight on the patient 4. Advil as needed (PRN) for headaches 5. Low vitamin K diet

Correct Answer: 1,4,5 Rationale: Advil could increase the risk of bleeding. 1,000 units of heparin is a sub-therapeutic dose. Vitamin K is the antidote for warfarin (Coumadin) overdose, there is no need to restrict it with heparin therapy. Daily weights are necessary to determine medication dosage. There isnt any contraindication with heparin and Tylenol.

A client has psoriasis. Prior to beginning education, the nurse assesses the client. Which statement indicates the client has a correct knowledge base about his illness? 1. I wish there were some way besides medications to treat my psoriasis. 2. Treatment can help lessen the discomfort of my psoriasis. 3. Systemic medications are the only medications that are effective. 4. No medications are effective for treating my disorder.

Correct Answer: 2 Rationale 1: . Ultraviolet light is also effective as an alternative to medication. Rationale 2: There are some medications that are effective in treating psoriasis. Rationale 3: Topical medications are also effective for treating psoriasis. Rationale 4: At this time, treatment can help lessen the discomfort of psoriasis.

Anticoagulants are used to 1. increase the number of platelets. 2. prevent the formation of blood clots. 3. shorten the prothrombin time. 4. dissolve blood clots.

Correct Answer: 2 Rationale 1: Anticoagulants do not increase the number of platelets. Rationale 2: Anticoagulants do not prevent the formation of blood clots. Rationale 3: Anticoagulants are used to prevent the enlargement of clots and do not shorten the prothrombin time. Rationale 4: Thrombolytics are used to dissolve clots.

The nurse is preparing to administer beclomethasone (Beconase) to several clients. For which client would the nurse hold the drug and contact the physician? 1. The client who has had a myocardial infarction (MI) 2. The client who has methicillin resistant Staphylococcus aureus (MRSA) 3. The client who has diabetes mellitus 4. The client who has terminal cancer

Correct Answer: 2 Rationale 1: Beclomethasone (Beconase) is not contraindicated in clients who have had a myocardial infarction. Rationale 2: Glucocorticoids can mask the signs of infection and are contraindicated if active infection is present. Rationale 3: Beclomethasone (Beconase) is not contraindicated in clients who have diabetes mellitus. Rationale 4: Beclomethasone (Beconase) is not contraindicated in clients who have terminal cancer.

The most important food for a patient taking anticoagulants to avoid is 1. citrus fruits. 2. garlic. 3. honey. 4. meat.

Correct Answer: 2 Rationale 1: Citrus fruits overall do not impact these drugs. Rationale 2: Garlic does interact with anticoagulants to increase their effect. Rationale 3: Honey does not interact with anticoagulants. Rationale 4: Meat has no impact on these drugs.

The nurse will know that a client with head lice understands principles of scabicides when she can discuss 1. contraceptive measures. 2. proper application with gloves. 3. sun protection. 4. antifungal creams.

Correct Answer: 2 Rationale 1: Contraceptive measures are not necessary with the scabicides. Rationale 2: Proper application is important, as is the use of gloves. Rationale 3: Sun protection is no more necessary than usual. Rationale 4: Antifungal creams are not effective with scabies or lice.

Pharmacotherapy with diuretics can cause which of the following general adverse effects? 1. Constipation 2. Orthostatic hypotension 3. Weight gain 4. Hypertension

Correct Answer: 2 Rationale 1: Diarrhea, not constipation, might be a problem. Rationale 2: Orthostatic hypotension is a common adverse effect of all the prototype drugs. Rationale 3: Weight loss, not weight gain, will occur. Rationale 4: Hypertension usually does not occur.

The process of fibrinolysis is to 1. stop blood flow. 2. remove a blood clot. 3. promote enzymes. 4. increase blood flow.

Correct Answer: 2 Rationale 1: Fibrin stops blood. Rationale 2: Fibrinolysis is the removal of a clot in order to release plasminogen. Rationale 3: Hemostasis increases enzymes. Rationale 4: None of the clotting cascade leads to an increase in blood flow.

The client is recovering from a severe sunburn. What will the best teaching by the nurse include? 1. Apply lotion or oil to your skin the next time you go out into the sun. 2. Apply a sunscreen when you are going to be in the sun. 3. Do not go out into the sun again; you are more susceptible to burn again. 4. Use a water-soluble sunscreen the next time that you go out into the sun.

Correct Answer: 2 Rationale 1: Lotion or oil will keep the skin moist, but will not prevent another sunburn. Rationale 2: Sunscreens are used to protect the skin from excessive sun exposure. Rationale 3: It is not necessary to avoid the sun, but precautions should be taken. Rationale 4: Sunscreens should be water-resistant, not water-soluble.

The most appropriate food for the patient taking loop diuretics is 1. meat. 2. bananas. 3. cheese. 4. Yogurt.

Correct Answer: 2 Rationale 1: Meat provides protein, but not much potassium. Rationale 2: Bananas are great source of potassium. Other foods high in potassium are green leafy vegetables. Rationale 3: Cheese is a good source of calcium. Rationale 4: Yogurt is a good source of calcium.

The nurse teaches the client about the use of a metered-dose inhaler (MDI) and spacer. The nurse evaluates that additional teaching is required when the client makes which statement?

I should keep the spacer moist between uses by storing it in a plastic zipbag."The spacer and inhaler should be rinsed with water and allowed to air-dry.

The client asks the nurse why she must continue taking her asthma medication even though she has not had an asthma attack in several months. What is the best response by the nurse? 1. "The medication needs to be taken indefinitely according to your doctor, so you should discuss this with him." 2. "The medication is still needed to decrease inflammation in your airways and help prevent an attack." 3. "The medication needs to be taken or your lungs will be severely damaged, and we will not be able to stop an acute attack." 4. "The medication needs to be taken for at least a year; then, if you have not had an acute attack, you can stop it.

Correct Answer: 2 Rationale 1: The nurse is able to answer the client's question; it does not need to be referred to the physician. Rationale 2: Effective treatment of asthma includes long-term treatment to prevent attacks and decrease inflammation, as well as short-term treatment when an attack occurs. Rationale 3: Telling a client that his or her lungs will be severely damaged is non-therapeutic; the inability to prevent an acute attack in this client is not true. Rationale 4: Long-term treatment of asthma continues indefinitely, not for just 1 year.

The physician prescribes fluticasone (Flonase) for the client. The nurse would hold the drug and contact the physician with which assessment finding? 1. The client has diabetes mellitus. 2. The client is pregnant. 3. The client has glaucoma. 4. The client has hypertension.

Correct Answer: 2 Rationale 1: There is no contraindication for use of this drug in a client who has diabetes mellitus. Rationale 2: This is a class C drug so effects on pregnancy are not known; the client should not receive this drug. Rationale 3: There is no contraindication for use of this drug in a client diagnosed with glaucoma. Rationale 4: There is no indication that use of this drug is contraindicated in the client who is hypertensive.

The physician orders lindane (Kwell) for nursing home clients who have contracted head lice. The nurse will contact the physician when one of the clients has which medical diagnosis? 1. Diabetes mellitus 2. Seizures 3. Stroke 4. Hypothyroidism

Correct Answer: 2 Rationale 1: There is no contraindication to the use of lindane (Kwell) in a client with diabetes mellitus. Rationale 2: Lindane (Kwell) can cause serious nervous system toxicity and should not be used in clients with seizure disorder. Rationale 3: . There is no contraindication to the use of lindane (Kwell) in a client who has had a stroke. Rationale 4: There is no contraindication to the use of lindane (Kwell) in a client with hypothyroidism.

The patient receives heparin. During the morning assessment of the patient, the nurse notes that the patients blood pressure and red blood cell (RBC) count are low. There is no evidence of bleeding on the bed linen or the patients gown. What will the best assessment of this patient reveal? 1. The patient is dehydrated. 2. The patient may be bleeding internally. 3. The patients activated partial thromboplastin time (aPTT) is too low. 4. The patient has probably formed some clots.

Correct Answer: 2 Rationale: A low blood pressure and red blood cell (RBC) count in the patient could indicate internal bleeding. Internal bleeding, not the formation of clots, is most likely responsible for the low blood pressure and red blood cell (RBC) count. Internal bleeding, not a low activated partial thromboplastin time (aPTT), is most likely responsible for the low blood pressure and red blood cell (RBC) count. Internal bleeding, not dehydration, is most likely responsible for the low blood pressure and red blood cell (RBC) count.

The physician orders enoxaparin (Lovenox) for the postoperative patient. What is the best administration technique by the nurse? 1. Administer the medication in the upper arm, subcutaneously. 2. Administer the medication in the abdomen, subcutaneously. 3. Administer the medication via slow intravenous (IV) push in the patients Intravenous (IV) line. 4. Ask the patient where she would like the injection, and administer it subcutaneously.

Correct Answer: 2 Rationale: Administering the medication in the abdomen, subcutaneously, is the correct method of administration for enoxaparin (Lovenox). Administering the medication in the upper arm subcutaneously is not the correct method of administration of enoxaparin (Lovenox). Asking the patient where she would like the injection and administering subcutaneously is not the correct method of administration of enoxaparin (Lovenox). Administering the medication via slow intravenous (IV) push in the patients intravenous (IV) line is not the correct method of administration for enoxaparin (Lovenox).

The patient receives enoxaparin (Lovenox) postoperatively. The nurse teaches the patient about this medication and evaluates that learning has occurred when he makes which statement? 1. It inhibits the synthesis of prostaglandins. 2. It increases the time it takes for me to form a clot. 3. It dissolves small clots so I wont have a stroke. 4. It increases the flexibility of my blood cells.

Correct Answer: 2 Rationale: All anticoagulant drugs will increase the normal time the body takes to form clots. Enoxaparin (Lovenox) does not dissolve small clots. Enoxaparin (Lovenox) does not increase the flexibility of blood cells. Enoxaparin (Lovenox) does not inhibit the synthesis of prostaglandins.

The patient is receiving chlorothiazide (Diuril). The nurse suspects the patient is exhibiting side effects to the medication. What will the best assessment of the nurse include? 1. Ataxia and frequent diarrhea 2. Serum potassium level of 3.0 and low blood pressure 3. Serum sodium level of 160 and headaches 4. Mental confusion and dependent edema

Correct Answer: 2 Rationale: Hypokalemia and hypotension are serious side effects of diuretic therapy. Hypernatremia and headaches are not side effects of diuretic therapy. Ataxia and frequent diarrhea are not side effects of diuretic therapy. Mental confusion and dependent edema are not side effects of diuretic therapy.

The elderly patient is receiving ethacrynic acid (Edecrin) and tells the nurse he doesnt hear as well as he used to. What is the best response by the nurse? 1. You may be dehydrated; are you drinking enough fluid? 2. I will let your doctor know about this; it could be a side effect of your medication. 3. How long have you been having difficulty hearing? 4. I will schedule a hearing exam; this could be a side effect of your medication.

Correct Answer: 2 Rationale: Loop diuretics are ototoxic. Instruct the patient to report ringing in the ears or becoming hard of hearing and notify the physician. It is inappropriate to schedule a hearing exam unless drug toxicity has been ruled out. Asking the patient about how long he has had the hearing loss is a good question, but the nurse must always report suspected side effects to the physician. Ototoxicity is not related to dehydration.

The patient is receiving chlorothiazide (Diuril). The nurse assesses the patient for hypokalemia. What does the best assessment include? 1. Confusion and decreased urine output 2. Muscle weakness or cramps 3. General irritability and increased urine output 4. Diarrhea and projectile vomiting

Correct Answer: 2 Rationale: Muscle weakness or cramps are indications of hypokalemia. Diarrhea and projectile vomiting are not signs of hypokalemia. Confusion and decreased urine output are not signs of hypokalemia. General irritability and increased urine output are not signs of hypokalemia.

The patient is receiving spironolactone (Aldactone). The nurse has completed dietary education and evaluates that the patient needs additional education when the patient makes which statement? 1. I am really happy that I can have my cranberry juice. 2. Thank goodness I can still have my orange juice and bananas for breakfast. 3. I need an apple a day to stay regular; Im glad I can still have this. 4. I am German, so I could not give up my cabbage and mushrooms.

Correct Answer: 2 Rationale: Orange juice and bananas are high in potassium, and are contraindicated with a potassium-sparing diuretic. Cranberries are low in potassium and are not contraindicated with a potassium-sparing diuretic. Cabbage and mushrooms are low in potassium and are not contraindicated with a potassium-sparing diuretic. Apples are low in potassium and are not contraindicated with a potassium-sparing diuretic.

The patient is receiving chlorothiazide (Diuril). What is the best medication education by the nurse? 1. Avoid foods high in potassium, such as bananas. 2. Weigh yourself, and report a gain of more than 2 pounds in 24 hours. 3. Weigh yourself and report a gain of more than 0.5 pounds in 24 hours. 4. Report signs of hypokalemia, such as vomiting and diarrhea.

Correct Answer: 2 Rationale: Patients receiving thiazide diuretics should check weight daily and report a weight gain of 2 or more pounds in 24 hours. Patients receiving thiazide diuretics should consume foods high in potassium. Vomiting and diarrhea are not signs of hypokalemia. A weight gain of more than 2, not 0.5, pounds in 24 hours is considered the gold standard for fluid overload.

A new mother receives heparin. She asks the nurse if she can breastfeed her baby. What is the most therapeutic response by the nurse? 1. No, because it would be too difficult to regulate your heparin dose. 2. No, because this could cause your nipples to bleed. 3. No, because this could alter your international normalized ratio (INR) times too much. 4. No, because heparin will enter your breast milk.

Correct Answer: 2 Rationale: Use of heparin during breastfeeding can trigger bleeding from the nipples and should be avoided. Heparin does not enter the breast milk. Breastfeeding would not alter the international normalized ratio (INR). Breastfeeding would not make it difficult to regulate the heparin dose.

The patient has a routine urinalysis done, and the results show protein in the urine. What does the nurse correctly conclude about this result? 1. The patient is in acute renal failure, and needs to be hospitalized. 2. The patient probably has kidney damage; protein should not be present in the urine. 3. There could be a mistake with the results; the patient should have another test done. 4. The results probably mean nothing if the amount of protein is very small.

Correct Answer: 2 Rationale: When filtrate passes through Bowmans capsule, its composition is similar to plasma. Plasma proteins are too large to pass through the filter, and if they appear in the filtrate or urine, this indicates kidney pathology. There is no evidence to support a mistake with the results of the urinalysis. Any amount of protein in the kidney is considered abnormal. There is no evidence that this patient is in acute renal failure.

A patient who takes albuterol (Proventil) reports to the emergency department with reports of fatigue and palpitations. The nurse would closely assess which laboratory test? 1. Amylase 2. Electrolytes 3. Hemoglobin 4. Arterial blood gases

Correct Answer: 2 Rationale 1: Albuterol does not affect amylase. Rationale 2: Albuterol can cause hypokalemia. Potassium is an electrolyte. Rationale 3: Albuterol does not cause bleeding. Rationale 4: The patient may have ABGs drawn to check asthma status, but this test is not indicated by fatigue and palpitations.

The client receives a topical medication for treatment of an acne-like skin disorder. The nurse completes medication education and evaluates learning has occurred when the client makes which statements? Select all that apply. 1. My daughter has a similar problem so she can use this too. 2. I will call my doctor if I notice a change in my symptoms. 3. I will apply the medication only to the affected area. 4. I do not need to shower prior to using this medication. 5. My medication only needs to be applied once a day.

Correct Answer: 2,3 Rationale 1: Clients should not share medications; the daughter should have an evaluation herself. Rationale 2: The client must notify the physician if the symptoms change. Rationale 3: Medications can be irritating so they should be applied only to the affected area. Rationale 4: The medication should be applied to clean skin, so it is a good idea to shower prior to using this medication. Rationale 5: Some topical medications need to be applied more than once a day.

A patient has been started on ticlopidine (Ticlid) after a myocardial infarction and stent placement. How should the nurse explain the action of this medication to the patient? Select all that apply. 1. Ticlid will dissolve any clots that might form in your stent. 2. Ticlid will make the platelets in your blood less sticky. 3. Ticlid will change the way your platelets work their entire lives. 4. Ticlid decreases your bloods ability to clot. 5. Ticlid works just like the heparin you have been on in the hospital.

Correct Answer: 2,3,4 Rationale 1: Ticlid does not act to dissolve clots. Rationale 2: Ticlid is an adenosine diphosphate (ADP) receptor blocker that acts to make platelets unable to aggregate, thus rendering them less sticky. Rationale 3: Ticlid causes irreversible changes in platelet plasma membranes. Rationale 4: Ticlid does decrease the bloods ability to clot. Rationale 5: The mechanisms of action of Ticlid and heparin are not alike.

A teenager is taking isotretinoin (Accutane) for treatment of severe acne. The nurse has completed medication education with her mother, and evaluates additional learning is required when the mother makes which statement? 1. We can expect that her skin will be less oily. 2. She needs to be on a reliable method of birth control now. 3. At least I do not need to worry about her self-concept now. 4. I will pay particular attention to her mood now.

Correct Answer: 3 Rationale 1: Isotretinoin (Accutane) decreases oil production. Rationale 2: Isotretinoin (Accutane) is Pregnancy Category X. Rationale 3: Severe depression with resulting suicidal ideation can be caused by this drug; the mother must pay attention to her mood. Rationale 4: Isotretinoin (Accutane) can cause severe depression with resulting suicidal ideation; the mother needs to talk to her daughter about her self-concept.

The nursing instructor teaches the nursing students about the major functions of the upper respiratory tract. What will the best plan by the nursing instructor include? Select all that apply. 1. Inward airflow from the trachea branches off to the two bronchi. 2. The nose warms the air before it reaches the lungs. 3. The nasal mucosa is the first line of immunological defense. 4. Activation of the parasympathetic nervous system constricts arterioles in the nose. 5. Activation of the sympathetic nervous system constricts arterioles in the nose.

Correct Answer: 2,3,5 Rationale 1: The trachea and bronchi are part of the lower respiratory tract. Rationale 2: The nose warms the air before it reaches the lungs. Rationale 3: The nasal mucosa is the first line of immunological defense. Rationale 4: Activation of the sympathetic nervous system, not the parasympathetic nervous system, constricts arterioles in the nose. Rationale 5: Activation of the sympathetic nervous system constricts arterioles in the nose.

The nurse is assessing a patient prior to the administration of a diuretic. The nurse knows it is essential to assess which vital signs at this time? Select all that apply. 1. Temperature 2. Pulse 3. Respirations 4. Blood pressure 5. Pain

Correct Answer: 2,4 Rationale 1: It is not necessary to assess temperature prior to administering a diuretic. Rationale 2: The nurse must assess the patients pulse prior to administering a diuretic. Rationale 3: It is not necessary to assess respirations prior to administering a diuretic. Rationale 4: The nurse must assess the patients blood pressure prior to administering a diuretic. Rationale 5: It is not necessary to assess the patients pain prior to administering a diuretic.

A client has been prescribed permethrin (Nix) for the treatment of body mites. What medication information should the nurse provide? Select all that apply. 1. Make certain you get the 1% lotion. 2. You should leave the lotion on your body for 10 minutes. 3. You should expect almost immediate relief from the itching. 4. You may feel some stinging or tingling while the lotion is being used. 5. You should not use this medication if you are sensitive to chrysanthemums.

Correct Answer: 2,4,5 Rationale 1: The 1% lotion is for head lice. This client should obtain the 5% lotion. Rationale 2: The medication should be allowed to remain on the body for 10 minutes before removal. Rationale 3: Itching is caused by the penetration of the skin by the mites. It may persist up to 2 or 3 weeks. Rationale 4: Transient stinging or tingling is often noted with this medication. Rationale 5: Permethrin is obtained from chrysanthemums.

Lice and body mites have been discovered in an elementary school population. Which instructions should the school nurse send home to parents? Select all that apply. 1. Obtain over-the-counter antiparasitic lotion and apply to your children according to label directions. 2. Look for small bugs in your children's hair or small objects attached to the hair shaft. 3. Look for bugs between fingers, under the arms, and in the pubic area. 4. Open the windows and doors of your house and let fresh air blow through to eliminate lice and mites in the home. 5. If lice or mites are found, stuffed animals should be washed or sealed in an airtight bag for 2 weeks.

Correct Answer: 2,5 Rationale 1: If children do not have lice or mites treatment is not necessary. Rationale 2: Lice are small bugs that are found in the hair. The eggs or nits are small objects found attached to the hair shaft. Rationale 3: Mites are nearly invisible to the naked eye. The parents should look for signs of scratching or complaints of itching in these areas. Rationale 4: Fresh air will not eliminate the lice or mites. Rationale 5: Personal objects may harbor and spread the infestation to others or may re-infest the child. All objects should be washed, vacuumed, or sealed in plastic for 2 weeks.

Which assessment finding, by the nurse, is a priority concern when a client receives pseudoephedrine (Sudafed)? 1. Temperature of 100 F 2. Respiratory rate of 22 3. Heart rate 82 and irregular 4. Complaints of a dry mouth

Correct Answer: 3 Rationale 1: A temperature is possible with pseudoephedrine , but is not the primary concern. Rationale 2: A respiratory rate of 22 is possible with pseudoephedrine, but is not the primary concern. Rationale 3: Pseudoephedrine may cause dysrhythmias. Rationale 4: A dry mouth is possible with pseudoephedrine but is not the primary concern.

The nurse is aware that the drug that will most likely be used in the treatment of warfarin sodium overdose is 1. aspirin. 2. heparin. 3. vitamin K. 4. protamine sulfate.

Correct Answer: 3 Rationale 1: Aspirin is an antiplatelet, and would lead to more bleeding. Rationale 2: Heparin would not be used; it is another drug in the class. Rationale 3: Vitamin K is the drug for overdose; it helps to clot the blood. Rationale 4: Protamine sulfate is the antidote for heparin overdose.

The physician has prescribed cromolyn (Intal) for the client with asthma. The nurse plans to do medication education. What will the best plan by the nurse include? 1. This medication is indicated for acute asthma attacks. 2. This medication can affect blood glucose levels. 3. This medication will help prevent asthma attacks. 4. This medication can result in hypertension.

Correct Answer: 3 Rationale 1: Cromolyn (Intal) is ineffective for acute asthma attacks. Rationale 2: Cromolyn (Intal) does not affect blood glucose levels. Rationale 3: By reducing inflammation, cromolyn (Intal) is able to prevent asthma attacks. Rationale 4: Cromolyn (Intal) does not cause hypertension.

Centrally acting antitussives, such as opioids, are used to 1. decrease nasal congestion. 2. break down mucus. 3. relieve severe cough. 4. relieve mild cough.

Correct Answer: 3 Rationale 1: Decongestants decrease congestion. Rationale 2: Expectorants break down mucus. Rationale 3: Opioids relieve severe cough. Rationale 4: Non-opioid antitussives relieve mild cough.

The upper respiratory tract (URT) consists of the nose, nasal cavity, pharynx, and paranasal sinuses. It undergoes a process sometimes referred to as 1. filtering. 2. warm conditioning. 3. air conditioning. 4. absorbing.

Correct Answer: 3 Rationale 1: Filtering does not occur in this process. Rationale 2: It does not warm condition in this process. Rationale 3: It does undergo a process referred to as air conditioning. Rationale 4: Absorbing does not occur in this process.

Which of the following is a common adverse effect of furosemide (Lasix)? 1. Weight gain 2. Bradycardia 3. Hypotension 4. Vomiting

Correct Answer: 3 Rationale 1: Loop diuretics can produce dehydration and electrolyte imbalances. Signs of dehydration include thirst, dry mouth, weight loss, and headache. Hypotension, dizziness, and fainting can result from the rapid fluid loss. Rationale 2: Tachycardia when dehydrated is the cardiac systems response to fluid loss. Rationale 3: Hypotension results from large amounts of fluid being excreted. Rationale 4: Vomiting is not a common adverse effect.

A client has lice infestation of the eyelids. What instruction should the nurse provide? 1. Dilute the permethrin lotion with water before applying it to your eyelids. 2. These lice should be pulled off manually. 3. Apply a thin coat of petroleum jelly to your eyelashes once a day for a week. 4. The systemic effect of the lotion you are using on your hair will kill these lice, so no specific treatment is necessary.

Correct Answer: 3 Rationale 1: Permethrin should not be used on the eyelids. Rationale 2: While removing the lice manually will work, it is not the best solution to the problem. Rationale 3: The petroleum jelly will kill the lice which can then be removed by combing. Rationale 4: Specific treatment is necessary.

The client receives ipratropium (Atrovent). She tells the nurse she is going to stop it because of the bitter taste in her mouth after using the medication. What is the best response by the nurse? 1. "That is a good idea; you are experiencing a serious side effect." 2. "That is a common side effect; it will go away in time." 3. "You can decrease that side effect by rinsing your mouth after use." 4. "Are you sure you are using the medication properly?

Correct Answer: 3 Rationale 1: The client is not experiencing a serious side effect; there is no need to stop the medication. Rationale 2: The bitter taste will not go away in time; the client must rinse her mouth. Rationale 3: Ipratropium (Atrovent) produces a bitter taste, which may be relieved by rinsing the mouth after use. Rationale 4: Asking how the client uses the medication may be a good option but not with the common side effect of bitter taste

The primary functional unit of the kidney is the 1. loop of Henle. 2. Bowmans capsule. 3. nephron. 4. distal tubule.

Correct Answer: 3 Rationale 1: The loop of Henle filtrates. Rationale 2: The Bowmans capsule filters the blood. Rationale 3: The nephron is the functional unit which receives blood. Rationale 4: The distal tubule passes filtrate.

A client has been prescribed 0.1% tacrolimus (Protopic) for treatment of severe atopic dermatitis. The nurse would evaluate that medication teaching is successful when the client makes which statement? 1. I could use this for my 1-year-old who also has atopic dermatitis. 2. I can use this ointment on an as needed basis for as long as I wish. 3. I am at increased risk for skin cancer because I am using this drug. 4. I cannot use this ointment on my face.

Correct Answer: 3 Rationale 1: This medication is not approved for use in children under age 2. Rationale 2: This drug is generally used for short-term treatment of severe disease. Rationale 3: There is a small increase in risk of skin cancer when using this drug. Rationale 4: This medication can be used on the face and neck.

The client receives topical glucocorticoids for the treatment of dermatitis. The nurse has completed medication education and evaluates that learning has occurred when the client makes which statement? 1. A pill would be more effective than this messy lotion that I have to use. 2. If this medication doesn't help me, there is nothing left to try. 3. Use of this lotion is really a lot safer and more effective than a pill. 4. Long-term use of this lotion can lead to dependence on the drug.

Correct Answer: 3 Rationale 1: Topical agents, not oral agents, are the most effective treatment for dermatitis. Rationale 2: If topical medications are ineffective, they can be augmented with oral agents. Rationale 3: Topical agents are less likely to cause systemic effects than are oral medications, so they are safer and they are more effective. Rationale 4: Dependence does not occur with glucocorticoids.

The patient is receiving bumetanide (Bumex) and asks the nurse, What is all this about loops in my medicine? What is the best response by the nurse? 1. This medication reabsorbs potassium in the loop of Henle in your kidney. It is safer than other diuretics. 2. This is a loop diuretic, which means it works in the proximal loop of your kidney. Not all diuretics work the same way. 3. This is a loop diuretic, which refers to where it acts in your kidney. Not all diuretics work the same way. 4. This medication blocks sodium reabsorption in what is known as Bowmans capsule. Not all diuretics work the same way.

Correct Answer: 3 Rationale: Bumetanide (Bumex) is called a loop diuretic because it acts by preventing the reabsorption of sodium in the loop of Henle. Bumetanide (Bumex) blocks reabsorption of sodium in the loop of Henle, not in Bowmans capsule. Bumetanide (Bumex) is a potassium-excreting drug; it does not reabsorb potassium. Bumetanide (Bumex) works in the loop of Henle, not the proximal loop.

The hospitalized patient is receiving spironolactone (Aldactone). A consulting physician sees the patient and orders lisinopril (Prinivil). What will be the primary assessment by the nurse? 1. Decreased effect of spironolactone (Aldactone) 2. Hypokalemia 3. Hyperkalemia 4. Decreased effect of lisinopril (Prinivil)

Correct Answer: 3 Rationale: Concurrent use of spironolactone (Aldactone) and ACE inhibitors such as lisinopril (Prinivil), may predispose the patient to hyperkalemia. The patient will be at risk for hyperkalemia, not hypokalemia. Lisinopril (Prinivil) does not decrease the effect of spironolactone (Aldactone). Spironolactone (Aldactone) does not decrease the effect of spironolactone (Aldactone).

Four patients arrive at the emergency department. All have attempted suicide by overdosing on medication. Which patient will the nurse plan to transfer to the renal failure unit? 1. The patient who overdosed on lorazepam (Ativan) 2. The patient who overdosed on amitriptyline (Elavil) 3. The patient who overdosed on ibuprofen (Advil) 4. The patient who overdosed on quetiapine (Seroquel)

Correct Answer: 3 Rationale: NSAIDs, such as ibuprofen, are nephrotoxic drugs. Amitriptyline (Elavil) is cardiotoxic, not nephrotoxic. An overdose of lorazepam (Ativan) will result in CNS depression, not nephrotoxicity. An overdose of quetiapine (Seroquel) will result in CNS depression, not nephrotoxicity.

The patient is receiving hydrochlorothiazide (HCTZ). The patient asks the nurse what the best fluid to drink to avoid dehydration is. What is the best response by the nurse? 1. Iced teas, especially the green teas. 2. Any kind of fluid is okay, but avoid alcohol. 3. Plain water is really the best. 4. Electrolyte-replacement drinks like Gatorade.

Correct Answer: 3 Rationale: Plain water is the best fluid for the patient to consume while receiving diuretic therapy. Electrolyte-replacement drinks like Gatorade are not as good as plain water in avoiding dehydration. Iced teas, especially the green teas, are not as good as plain water in avoiding dehydration. Plain water is the best fluid for the patient to drink to avoid dehydration.

The nursing instructor is teaching student nurses about the process of hemostasis after an injury. What does the nursing instructor include as the initial event in this process? 1. Platelets become sticky. 2. Plasma proteins convert to active forms. 3. The vessel spasms. 4. Von Willebrands factor is activated.

Correct Answer: 3 Rationale: The blood vessel spasms, causing constriction during the initial event in the hemostasis process. Platelets do not become sticky during the initial event in the hemostasis process. Von Willebrands factor is not activated during the initial event in the hemostasis process. Plasma proteins do not convert to active forms during the initial event in the hemostasis process.

The nurse is managing care for a patient with cirrhosis of the liver. The nurse teaches the patient about how to avoid injury that may result in bleeding. The patient asks the nurse why he is at risk to start bleeding. What is the best response by the nurse? 1. Because your liver is injured and unable to manufacture platelets. 2. Because your liver thickens your blood so it is less likely to clot. 3. Because your liver is injured and cannot make clotting factors. 4. Because your liver is breaking down your clotting factors too quickly.

Correct Answer: 3 Rationale: The liver is responsible for the production of essential clotting factors necessary to prevent bleeding. The liver is not responsible for breaking down clotting factors. The liver is not responsible for making the blood thick. The liver is not responsible for manufacturing platelets.

Which condition is an adverse effect of a beta-adrenergic agonist? 1. Bradycardia 2. Constipation 3. Tachycardia 4. Runny nose

Correct Answer: 3 Rationale 1: Beta-adrenergic agonists cause tachycardia, not bradycardia. Rationale 2: Diarrhea can occur with some leukotrienes. Rationale 3: Tachycardia is common, along with restlessness. Rationale 4: Dry mucous membranes can occur

Which statement is true regarding dry powder inhalers (DPI)? 1. The medication is delivered by tablet orally. 2. The medication is delivered by fine mist. 3. The device is activated by inhalation. 4. The medication is applied topically.

Correct Answer: 3 Rationale 1: Inhalers are not oral tablets. Rationale 2: Nebulizers deliver medications in fine mist. Rationale 3: The client activates the device by inhaling. Rationale 4: Inhalers are not applied topically.

A patient is being treated for a thromboembolic disorder. If the goal is to prevent clot formation, the nurse anticipates the patient will be treated with which classification of drug? Select all that apply. 1. Hemostatics 2. Thrombolytics 3. Anticoagulants 4. Antiplatelet agents 5. Clotting factor concentrates

Correct Answer: 3,4 Rationale 1: Hemostatic drugs are given to inhibit fibrin destruction, thereby promoting clot formation. Rationale 2: Thrombolytic drugs are given to remove existing clots by dissolving them. Rationale 3: Anticoagulants inhibit specific clotting factors, thereby preventing clot formation. Rationale 4: Antiplatelet agents inhibit the action of platelets, thereby preventing clot formation. Rationale 5: Clotting factor concentrates replace missing clotting factors, thereby promoting clot formation.

A patient who has hemophilia A is scheduled for a minor surgical procedure. The patient states, Im worried about this surgery. My doctor told me I had to come to the hospital for some kind of treatment a week before it. What is that all about? How should the nurse respond? Select all that apply. 1. You must have misunderstood the directions. Let me check with the health care provider. 2. Blood will be taken and banked in case you need to have it retransfused on the day of surgery. 3. You will be given a test dose of a medication used to increase your clotting factors. 4. This visit is related to your hemophilia and keeping you safe during the surgery. 5. Dont be worried about the testing. Nothing will hurt.

Correct Answer: 3,4 Rationale 1: The patient has not misunderstood the directions provided by the health care provider. Rationale 2: Preparation for auto-transfusion is not the purpose of this visit. Rationale 3: Desmopressin therapy can cause an increase in Factor VIII levels. A test dose is given one week prior to minor surgery to determine if the patient is responsive to the drug. Rationale 4: Simple answers that assure the patient that his or her safety is being protected are useful when working with patients whose anxiety is elevated. Rationale 5: The nurse has not answered the patients concerns.

Several patients have been seen in the acute-care clinic. The nurse will plan to administer diuretic therapy to which patients? Select all that apply. 1. The patient experiencing visual and auditory hallucinations 2. The patient with confusion and ataxia 3. The patient with a blood pressure of 200/98 mmHg 4. The patient with generalized edema and decreased urine output 5. The patient with pinpoint pupils and extreme paranoia

Correct Answer: 3,4 Rationale: Diuretics are indicated for the treatment of renal failure, hypertension, and for the removal of edema fluid. Confusion and ataxia could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here. Visual and auditory hallucinations could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here. Pinpoint pupils and extreme paranoia could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here.

A client has been prescribed a leukotriene modifier. Which assessment finding would cause the nurse to question this prescription? Select all that apply. 1. The client is 54 years old. 2. The client reports frequent foot cramps. 3. The client reports drinking two or three mixed alcohol drinks each day. 4. The client has chronic hepatitis C. 5. The client has a history of a CVA 2 years ago.

Correct Answer: 3,4 Rationale 1: The concern would be for persons over age 65, who may experience increased frequency of infections. Rationale 2: There is no reason to avoid giving this medication to a client who has foot cramps. Rationale 3: Chronic alcohol users may not tolerate these medications as they are extensively metabolized by the liver. Rationale 4: Significant hepatic dysfunction is a contraindication to this medication as it is extensively metabolized by the liver. Rationale 5: There is no contraindication for the use of this medication in a client with history of CVA.

The nurse understands that one advantage of inhaled pulmonary drugs over oral drugs is that inhaled drugs 1. increase adverse effects. 2. allow for convenience to the client. 3. are delivered to systemic locations. 4. allow for quick absorption

Correct Answer: 4 Rationale 1: Inhaled drugs decrease adverse effects. Rationale 2: Inhaled drugs are not as convenient as oral. Rationale 3: Inhaled drugs are delivered to local sites. Rationale 4: Inhalation is the most common route of administration; it is rapid and allows for quick absorption to direct airway.

The client receives ipratropium (Atrovent) via inhalation for the treatment of chronic asthma. The nurse plans to do medication education with the client. What will the best plan by the nurse include? Select all that apply. 1. Wait 15 minutes before using any other inhaled medications. 2. The medication may also be used for acute asthma attacks. 3. Report any increased dyspnea. 4. Report any changes in urinary pattern. 5. Use the medication consistently, not occasionally.

Correct Answer: 3,4,5 Rationale 1: It is only necessary to wait 2-3 minutes, not 15 minutes, between inhaled medications. Rationale 2: Anticholinergic drugs will not terminate an acute asthma attack, as peak effects may take 1 to 2 hours. Rationale 3: The client should be advised to report any symptoms of deteriorating respiratory status such as increased dyspnea. Rationale 4: Anticholinergic drugs can result in urinary retention, and the client should report any changes in urinary patterns. Rationale 5: To get the most benefit from ipratropium (Atrovent), it must be used consistently.

A client says, "My doctor told me that I have COPD and might develop emphysema. I always thought I had chronic bronchitis." How should the nurse respond to this statement? Select all that apply. 1. "Are you certain he didn't say you have asthma?" 2. "Chronic bronchitis doesn't have anything to do with COPD." 3. "COPD is either asthma, chronic bronchitis, or emphysema, or a combination of those disorders." 4. "As COPD progresses, it becomes emphysema." 5. "Both diagnoses are correct."

Correct Answer: 3,4,5 Rationale 1: There would be no reason to ask this question. It is logical that a client with chronic bronchitis would have a COPD diagnosis. Rationale 2: The three specific COPD conditions are asthma, chronic bronchitis, and emphysema. Rationale 3: The three specific COPD conditions are asthma, chronic bronchitis, and emphysema. Rationale 4: COPD is progressive, with the terminal stage being emphysema. Rationale 5: Chronic bronchitis is a form of COPD, so both diagnoses are plausible

The nurse is providing discharge teaching regarding anticoagulant therapy. Which statements by the patient would the nurse evaluate as indicating the need for further instruction? Select all that apply. 1. Ill ask for an electric razor for my birthday next week. 2. I guess my trip to the amusement park is off for now. 3. I wont be able to cook anymore. 4. Ill get one of those new electric toothbrushes with the firm bristles. 5. I should make an appointment for a B12 injection monthly.

Correct Answer: 3,4,5 Rationale 1: Use of an electric razor is preferred for patients on anticoagulant therapy. Rationale 2: The patient should avoid situations in which jostling or violent bumping could occur. Rationale 3: The patient should be cautious when cutting food for preparation, but cooking is not prohibited. Rationale 4: The patient should use a soft-bristle toothbrush. Rationale 5: IM injections should be avoided.

The nurse is instructing a patient on the importance of eating foods rich in potassium while taking a diuretic that causes hypokalemia. Which diuretics do not require potassium supplements? Select all that apply. 1. Furosemide (Lasix) 2. Chlorothiazide (Diuril) 3. Amiloride (Midamor) 4. Mannitol (Osmitrol) 5. Spironolactone (Aldactone)

Correct Answer: 3,5 Rationale 1: Furosemide (Lasix) is a loop diuretic that often causes hypokalemia. Patients taking furosemide are encouraged to eat foods high in potassium or take a potassium supplement. Rationale 2: Chlorothiazide (Diuril) is a thiazide diuretic that often causes hypokalemia. Patients taking chlorothiazide are encouraged to eat foods high in potassium or take a potassium supplement. Rationale 3: Amiloride (Midamor) is a potassium-sparing diuretic; therefore, patients do not need to eat foods high in potassium or take a potassium supplement while on this medication. Rationale 4: Mannitol (Osmitrol) is an osmotic diuretic that causes hypokalemia. A patient should be instructed to take a potassium supplement. Rationale 5: Spironolactone (Aldactone) is a potassium-sparing diuretic. Patients on this medication are not required to eat foods high in potassium or take a potassium supplement.

A client has been prescribed the opioid combination drug Hycomine Compound for control of cough. This drug contains hydrocodone, phenylephrine, chlorpheniramine, and acetaminophen. Which instructions should the nurse provide as part of medication education? Select all that apply. 1. Drink a full glass of water when taking this medication. 2. Keep this medication at your bedside so you can take it as needed. 3. Take this drug exactly as indicated. 4. If you have head or body aches you may take any over-the-counter analgesic. 5. Do not make important decisions or operate machinery while taking this drug.

Correct Answer: 3,5 Rationale 1: The medication should be taken without water and the client should not drink anything for 3060 minutes. Rationale 2: Hydrocodone is an opioid with the adverse effect of drowsiness. The client may inadvertently overdose if taking as needed or if taking doses while drowsy. Rationale 3: Taking too much of this drug can cause oversedation. It also contains acetaminophen which should be taken only as directed. Rationale 4: The client should not take any other preparation that contains acetaminophen to avoid overdose. Rationale 5: The hydrocodone component of this drug will make the client drowsy and may impact the ability to make decisions.

The nurse completes medication education for the client receiving antihistamines. The nurse evaluates that learning has occurred when the client makes which statement? 1. I can still have my after-dinner drink. 2. I need to increase fluids while taking this medication. 3. This medication is safe because it is sold over-the-counter (OTC). 4. This medication could make me very sleepy.

Correct Answer: 4 Rationale 1: Alcohol will increase the sedative effects of antihistamines, so the client should not drink while taking antihistamines. Rationale 2: There is no need to increase fluids when taking antihistamines. Rationale 3: Just because a medicine is sold over-the-counter (OTC), does not mean it is safe. Rationale 4: Sedation is a common side effect of antihistamines.

The nurse is aware that the mechanism of action of anticoagulant drugs is to 1. alter plasma membrane and platelets. 2. convert plasminogen to plasmin. 3. prevent fibrin from dissolving. 4. inhibit clotting factors to prevent clot formation.

Correct Answer: 4 Rationale 1: Antiplatelet drugs alter plasma and platelet aggregation. Rationale 2: Thrombolytics convert plasminogen to plasmin. Rationale 3: Hemostats prevent fibrin from dissolving. Rationale 4: Anticoagulants inhibit the specific clotting factors and interfere with clotting cascade, and thereby prevent clots.

The nurse teaches a medication class on bronchodilators for clients with asthma. The nurse evaluates that learning has occurred when the clients make which statement? 1. "The medication widens the airways because it decreases the production of mucus that narrows them." 2. "The medication widens the airways because it decreases the production of histamine that narrows them." 3. "The medication widens the airways because it acts on the parasympathetic nervous system." 4. "The medication widens the airways because it stimulates the fight-or-flight response of the nervous system."

Correct Answer: 4 Rationale 1: Bronchodilators do not decrease the production of mucus. Rationale 2: Bronchodilators do not decrease the production of histamine. Rationale 3: Bronchodilators act on the sympathetic nervous system, not the parasympathetic nervous system. Rationale 4: During the fight-or-flight response, beta 2-adrenergic receptors of the sympathetic nervous system are stimulated, the bronchiolar smooth muscle relaxes, and bronchodilation occurs.

The diuretic drug that will most likely be used to reduce mortality in heart failure is 1. chlorothiazide (Diuril). 2. acetazolamide (Diamox). 3. furosemide (Lasix). 4. spironolactone (Aldactone).

Correct Answer: 4 Rationale 1: Chlorothiazide is a thiazide diuretic used primarily for hypertension. Rationale 2: Acetazolamide is a carbonic anhydrase inhibitor used primarily for patients with glaucoma. Rationale 3: Furosemide is used for hypertension and reduction of edema. Rationale 4: Spironolactone is used to reduce mortality in heart failure patients.

A laboratory test used to best measure the effectiveness of warfarin sodium therapy is known as 1. complete blood count. 2. platelet count. 3. aPTT. 4. international normalized ratio (INR).

Correct Answer: 4 Rationale 1: Complete blood count is not necessary for this drug. Rationale 2: Platelet count is not necessary for this drug. Rationale 3: aPTT is the best laboratory test for heparin therapy. Rationale 4: INR is the best and most effective for warfarin therapy.

The client takes diphenhydramine (Benadryl), but forgets to tell the physician about this drug when a monoamine oxidase inhibitor (MAOI) drug is prescribed for depression. What will the best assessment by the nurse reveal? 1. The depression will not subside. 2. The client may develop seizures. 3. The diphenhydramine (Benadryl) will not control allergies. 4. The client may develop a hypertensive crisis.

Correct Answer: 4 Rationale 1: Depression is not the concern with this combination. Rationale 2: Seizures are not the concern with this combination. Rationale 3: Control of allergies is not the concern with this combination. Rationale 4: The combination of diphenhydramine (Benadryl) and a monoamine oxidase inhibitor (MAOI) drug can result in a hypertensive crisis.

The nurses neighbor has a severe sunburn and cannot sleep. What is the best advice by the nurse? 1. Apply emollients to keep the skin moist until it heals. 2. Call your physician for a prescription for pain medication. 3. Take acetaminophen (Tylenol) or ibuprofen (Advil) for pain. 4. Apply a local anesthetic to the area that is sunburned.

Correct Answer: 4 Rationale 1: Emollients will not stop the pain of the sunburn. Rationale 2: The client does not need a prescription pain medication. Rationale 3: Acetaminophen (Tylenol) or ibuprofen (Advil) are good medications, but this is not the best answer. Rationale 4: A local anesthetic will relieve the pain and allow the neighbor to sleep.

The main classification for a prototype drug, such as fexofenadine (Allegra), is a/n 1. atypical second generation H2-receptor antagonist. 2. typical first-generation H1-receptor antagonist. 3. atypical first generation H1-receptor antagonist. 4. typical second-generation H1-receptor antagonist.

Correct Answer: 4 Rationale 1: Fexofenadine (Allegra) is not an atypical H2-receptor antagonist. Rationale 2: Fexofenadine (Allegra) is not a typical first-generation H1-receptor. Rationale 3: Fexofenadine (Allegra) is not an atypical H1-receptor antagonist. Rationale 4: Fexofenadine (Allegra) is a typical second-generation H1-receptor antagonist.

The nurse teaches the client about the use of a metered-dose inhaler (MDI) and spacer. The nurse evaluates that additional teaching is required when the client makes which statement? 1. "I need to follow the instructions about using the metered-dose inhaler (MDI)." 2. "I need to rinse my mouth each time after using the metered-dose inhaler (MDI)." 3. "I need to drink a lot of fluids while I am using the metered-dose inhaler (MDI)." 4. "I should keep the spacer moist between uses by storing it in a plastic zip bag.

Correct Answer: 4 Rationale 1: Following instructions indicates compliance with use of the metered-dose inhaler (MDI). Rationale 2: Rinsing the mouth after using the metered-dose inhaler (MDI) is correct; it will help reduce oral absorption of the drug. Rationale 3: Fluids are encouraged to liquefy pulmonary secretions when using the metered-dose inhaler (MDI). Rationale 4: The spacer and inhaler should be rinsed with water and allowed to air-dry.

A mother asks the nurse when she should give her child cough medicine. What is the best response by the nurse? 1. When he is coughing up green secretions. 2. When he has a temperature over 102F. 3. When he has bronchitis. 4. When he has a dry cough and cannot rest.

Correct Answer: 4 Rationale 1: If the client is coughing up green secretions, he needs to receive an antibiotic, not cough medicine. The child needs to clear these secretions so a cough suppressant would not be used. Rationale 2: If a client is febrile, he needs an assessment prior to receiving cough medication. Rationale 3: It is not desirable to suppress the cough reflex in a client with bronchitis; the child should not receive cough medicine. Rationale 4: Dry, hacking, and nonproductive cough is irritating to the membranes of the throat and deprives the client of much needed rest, so a cough medicine would be warranted in this case.

The nurse plans to teach an adolescent about inhalation therapy as part of the treatment plan for the client's asthma. What does the best plan by the nurse include? 1. Inhalation therapy is effective because it provides around-the-clock therapy, as opposed to oral medications. 2. Inhalation therapy is the preferred treatment for adolescents because it is easier for them to manage. 3. Inhalation therapy is effective because it provides systemic relief of symptoms as well as local relief. 4. Inhalation therapy is effective because it goes to the direct site of action in the respiratory tract.

Correct Answer: 4 Rationale 1: Inhalation therapy does not provide around-the-clock therapy. Rationale 2: Inhalation therapy is used for adolescents because it is effective, not because it is easier for them to manage. Rationale 3: Inhalation therapy does not provide systemic relief of symptoms. Rationale 4: The major advantage of aerosol therapy is that it delivers the drugs to their direct site of action.

The client has scabies. The nurse has taught the client about safety in using topical scabicide medications, and evaluates that teaching has been effective when the client makes which statement? 1. I should cover the area with a clean cloth. 2. I will need help in showering to remove the lotion. 3. I need to sign a consent for this medication. 4. I must avoid putting this lotion on my face.

Correct Answer: 4 Rationale 1: It is not necessary to cover the area with a cloth. Rationale 2: The client should not need assistance to shower. Rationale 3: A consent is not necessary for these medications. Rationale 4: These medications are irritating to sensitive skin and eyes, so the facial area should be avoided.

Bronchoconstriction in the airways is stimulated by 1. perfusion. 2. ventilation. 3. the sympathetic nervous system. 4. parasympathetic nervous system.

Correct Answer: 4 Rationale 1: Perfusion is the flow of blood in the lungs. Rationale 2: Ventilation moves air in and out. Rationale 3: The sympathetic nervous system stimulates dilation. Rationale 4: The parasympathetic nervous system stimulates bronchoconstriction

Dermatitis is characterized by 1. flaky, silver scales. 2. swelling of nasal tissues. 3. small papules. 4. pruritus.

Correct Answer: 4 Rationale 1: Psoriasis produces red plaques with silver scales. Rationale 2: Rosacea psoriasis causes swelling around the nasal tissue. Rationale 3: Rosacea produces small papules with no pus. Rationale 4: Dermatitis is characterized by redness, pain, and pruritus.

The client receives diphenhydramine (Benadryl) to control allergic symptoms. Which common symptom does the nurse teach the client to report to the physician? 1. Sedation 2. Diarrhea 3. Projectile vomiting 4. Urinary hesitancy

Correct Answer: 4 Rationale 1: Sedation is a common side effect, but does not need to be reported. Rationale 2: Diarrhea is not a common side effect. Rationale 3: Projectile vomiting is not a common side effect. Rationale 4: Urinary hesitancy is an anticholinergic effect of diphenhydramine (Benadryl) and should be reported to the physician.

Which of the following over-the-counter (OTC) antihistamine combinations contains an analgesic property? 1. Sudafed PE Nighttime Allergy 2. Triaminic Cold/Allergy 3. Tavist Allergy 12-hour 4. Actifed Plus

Correct Answer: 4 Rationale 1: Sudafed PE Nighttime Allergy contains diphenhydramine and phenylephrine. Rationale 2: Triaminic Cold/Allergy contains chlorpheniramine and phenylephrine. Rationale 3: Tavist Allergy 12-hour contains clemastine. Rationale 4: Actifed Plus contains acetaminophen.

The primary function of the epidermis is to 1. provide foundation for hair growth. 2. insulate the body. 3. provide a source of energy. 4. form a protective barrier to foreign matter.

Correct Answer: 4 Rationale 1: The dermis provides for hair growth. Rationale 2: The subcutaneous layer insulates the body. Rationale 3: The subcutaneous layer provides energy. Rationale 4: The epidermis is the outermost layer, and provides a protective barrier to foreign material and bacteria.

Skin cells in the epidermis are replaced and supplied by the 1. stratum lucidum. 2. dermis basale. 3. melanocytes. 4. stratum basale.

Correct Answer: 4 Rationale 1: The stratum lucidum is the middle layer. Rationale 2: This is not the layer that supplies new cells. Rationale 3: Melanocytes provide pigment. Rationale 4: The stratum basale is the deepest layer, and provides new skin cells.

The mother of a client with head lice has completed the applications of topical medication. What is the best instruction by the nurse at this time? 1. Keep your child's hair short so it will be easier to treat next time. 2. You are fine now; just watch your child for a re-infection. 3. Check the heads of your child's friends before allowing them to play together. 4. Remove all nits from the hair shaft with a nit comb or a fine-tooth comb.

Correct Answer: 4 Rationale 1: There is no need to cut the childs hair, just remove the nits from the childs hair shaft. Rationale 2: The treatment is not complete until the nits are removed from the hair shaft; the mother is not finished. Rationale 3: The mother does not need to check the friends hair. Rationale 4: After the shampoo treatment, the mother should remove all nits from the hair shaft with a nit comb or a fine-tooth comb.

Thrombolytic drugs are used to 1. convert plasmin to plasminogen. 2. prevent the liver from making fibrin. 3. prevent a thrombus from forming. 4. lyse a thrombus.

Correct Answer: 4 Rationale 1: Thrombolytics do not convert plasmin to plasminogen. Rationale 2: Thrombolytics do not prevent the liver from making fibrin. Rationale 3: Anticoagulants, not thrombolytics, prevent the formation of a clot. Rationale 4: Thrombolytics break up the clot.

A clients medical record reveals the diagnosis of tinea unguium. The nurse would assess which body part for this disorder? 1. The foot 2. The pubic area 3. The head 4. The nails

Correct Answer: 4 Rationale 1: Tinea pedis is athletes foot. Rationale 2: Tinea cruris or jock itch is located in the pubic area and groin. Rationale 3: Tinea capitis is ringworm of the scalp. Rationale 4: Tinea unguium is fungal infection of the nails.

The client tells the nurse that her symptoms have become worse since she has been using oxymetazoline (Afrin) for nasal congestion. What is the best assessment question for the nurse to ask? 1. How old is the bottle you are using? 2. May I take your temperature? 3. Are you using any other inhaled medications? 4. How long have you been using the medication?

Correct Answer: 4 Rationale 1: While it is possible that the client is using outdated medication, this is not the best question. Rationale 2: Asking to take the clients temperature is not the best question. Rationale 3: The use of other inhaled medications will not cause or prevent rebound congestion, so this question is unnecessary. Rationale 4: Oxymetazoline (Afrin) can cause rebound congestion if used for too long, so length of treatment is the best assessment question.

A woman brings her husband to the emergency department and tells the nurse that her husband just had a stroke. The physician verifies a thrombotic cerebral vascular accident (CVA) occurred and plans to use alteplase (Activase). What priority assessment question will the nurse ask the wife? 1. What other medications does your husband take? 2. Does your husband have hypertension? 3. What other medical illnesses does your husband have? 4. What time did your husband have the stroke?

Correct Answer: 4 Rationale: Alteplase (Activase) must be given within 3 hours of a thrombotic cerebro vascular accident (CVA) for maximum effectiveness. Asking about hypertension is a good question, but is not the priority. Asking about medications is a good question, but is not the priority. Asking about illnesses is a good question, but is not the priority.

The nurse is managing care for a patient with a DVT (deep vein thrombosis) of the right calf. The patient receives heparin intravenously (IV). What is the priority outcome for this patient? 1. The patient will comply with dietary restrictions. 2. The patient will keep the right leg elevated on two pillows. 3. The patient will not disturb the intravenous infusion. 4. The patient will not experience bleeding.

Correct Answer: 4 Rationale: An absence of bleeding is a priority outcome for any patient receiving anticoagulant therapy. Disturbing the intravenous (IV) could relate to bleeding, but this does not directly correlate with heparin. Dietary restrictions are important, but not as high of a priority as an absence of bleeding. Elevation of the affected extremity is important, but not as high of a priority as an absence of bleeding.

The patient receives warfarin (Coumadin) and becomes pregnant. The physician changes her anticoagulant to enoxaparin (Lovenox). She asks the nurse, Why did the doctor do that? What is the best rationale by the nurse? 1. Because it is easier to maintain your bleeding times in a therapeutic range. 2. Because warfarin (Coumadin) is known to cause serious cardiac defects. 3. Because you are less likely to have bleeding with enoxaparin (Lovenox). 4. Because enoxaparin (Lovenox) cannot get into your baby.

Correct Answer: 4 Rationale: Heparin and the low-molecular-weight heparin (LMWH) molecules are too large to cross the placental barrier. The patient would not be less likely to have bleeding with enoxaparin (Lovenox). Warfarin (Coumadin) is not known to cause serious cardiac defects. It is not easier to maintain bleeding times with enoxaparin (Lovenox) than with warfarin (Coumadin).

The patient receives warfarin (Coumadin). The nurse notes that the patients morning international normalized ratio (INR) is 7-. What are the priority nursing interventions at this time? 1. Hold the next dose of warfarin (Coumadin) and repeat the international normalized ratio (INR). 2. Administer protamine sulfate and hold the next dose of warfarin (Coumadin). 3. Hold the next dose of warfarin (Coumadin) and contact the physician. 4. Administer vitamin K and hold the next dose of warfarin (Coumadin).

Correct Answer: 4 Rationale: Vitamin K is the antidote for warfarin (Coumadin) overdose and its administration is warranted with an international normalized ratio (INR) of 7-. Repeating the international normalized ratio (INR) is appropriate, but the patient must receive vitamin K immediately. Protamine sulfate is the antidote for heparin, not warfarin. Consulting the physician is appropriate, but the patient must receive vitamin K immediately.

The physician has ordered hydrochlorothiazide (HCTZ) for the patient in chronic renal failure. The nurse suspects the patient is experiencing an ineffective response to the medication. Which assessment is a priority for this patient? 1. Reviewing the lab work for hypokalemia and hyponatremia 2. Assessing the vital signs for hypertension 3. Assessing the skin for moisture and turgor 4. Auscultating breath sounds for wheezes

Correct Answer: 4 Rationale: Wheezes are commonly auscultated with pulmonary edema, which can occur with chronic renal failure and fluid retention. This is a priority because pulmonary edema affects the patients oxygenation. Skin assessment is important, but is not the priority here. Vital sign assessment is important, but is not the priority here. Reviewing lab work is important, but is not the priority here.

Leukotriene modifiers are primarily used for 1. status asthmaticus. 2. infection. 3. bronchodilation in asthma. 4. prophylaxis of asthma symptoms.

Correct Answer: 4 Rationale 1: Leukotrienes are not used for treatment of status asthmaticus. Rationale 2: Leukotrienes do not reduce infection. Rationale 3: Anticholinergics are bronchodilators. Rationale 4: Leukotriene modifiers are used primarily for prophylaxis and reducing inflammatory components.

The nurse would observe for fungal infection of the throat with which class of medications? 1. Methylxanthines 2. Beta-adrenergic agonists 3. Mast cell inhibitors 4. Glucocorticoids

Correct Answer: 4 Rationale 1: Methylxanthines do not cause fungal infection. Rationale 2: Beta-adrenergic agonists can cause throat irritation, but not infection. Rationale 3: Mast cell inhibitors do not cause fungal infection. Rationale 4: Glucocorticoids weaken the immune system and cause candidiasis of the throat.

The client receives zafirlukast (Accolate) as treatment for asthma. The nurse has completed medication education and evaluates that learning has occurred when the client makes which statement? 1. "This medication activates my fight-or-flight response." 2. "This medication is good when I have an acute attack of asthma." 3. "This medication dilates my airways so I can breathe better." 4. "This medication decreases the inflammation in my lungs.

Correct Answer: 4 Rationale 1: Zafirlukast (Accolate) does not stimulate the sympathetic nervous system. Rationale 2: Zafirlukast (Accolate) is ineffective for acute asthma attacks. Rationale 3: Zafirlukast (Accolate) is not a bronchodilator. Rationale 4: Zafirlukast (Accolate) prevents airway edema and inflammation by blocking leukotriene receptors in the airways.

A client with chronic bronchitis is to start receiving breathing treatments with Acetylcysteine (Mucomyst). Which information should the nurse include in teaching about this medication? Select all that apply. 1. Your pharmacist can order this for you to purchase as an over-the-counter drug. 2. Stop the treatment if you start to cough. 3. This drug has a very short shelf-life, so if it smells bad do not use it. 4. This drug is designed to break down and thin the mucus in your lungs. 5. You might experience nausea while using this drug.

Correct Answer: 4,5 Rationale 1: This drug is by prescription only. Rationale 2: This medication is designed to thin mucus to make it easier to remove by coughing. Coughing is a desired effect. Rationale 3: Acetylcysteine has the odor of rotten eggs. This is not an indication that it is past the recommended use date or that it has gone bad. Rationale 4: This drug is a mucolytic and is designed to thin mucus by breaking down the chemical structure. Rationale 5: One of the adverse effects of acetylcysteine is nausea.

A nurse is caring for a patient with depression. Which symptom should the nurse closely monitor for in the patient? Dilated pupils Extreme sadness Drowsiness Severe headache

Extreme sadness

Mrs. Dermon has called to report that her husband, who is on SSRI therapy, appears to be overly stimulated, especially after breakfast and dinner. What is likely to have caused this effect? Drug interaction with nicotine Drug interaction with a monoamine oxidase inhibitor Drug interaction with a caffeinated beverage Drug interaction with a diet drug

Drug interaction with a caffeinated beverage

A patient with a severe depression has been hospitalized, and the physician has ordered amitriptyline. What common adverse effect might this patient have? Hypertension Fever Decreased B/P Dry mouth

Dry mouth

The medication is still needed to decrease inflammation in your airways and help prevent an attack."

Effective treatment of asthma includes long-term treatment to prevent attacks and decrease inflammation, as well as short-term treatment when an attack occurs.

The nurse recognizes that several chemicals inhibit neurotransmitter function in the brain. The primary inhibitory transmitter in the brain is _______________________.

GABA Rationale: GABA drugs mimic GABA by stimulating the influx of chloride ions into the neuron, leading to the suppression of neuron firing.

The nurse would observe for fungal infection of the throat with which class of medications? Glucocorticoids

Glucocorticoids weaken the immune system and cause candidiasis of the throat.

The client receives isoproterenol (Isuprel) via inhalation. The nurse determines that the client is experiencing a side effect of this medication when reviewing which laboratory test?

Glucose of 145

Oral decongestants differ from intranasal decongestants in that oral decongestants

Have more systemic effects

A client's depression is believed to exist because of a deficiency of biogenic amines in key areas of the client's brain. What phenomenon would be most likely to cause this deficiency? Increase in the number or sensitivity of postsynaptic receptors Depletion of norepinephrine because biogenic amines feed off of loose particles of the neurotransmitter. Monoamine oxidase (MAO) strengthening the impact of biogenic amines. A slowing of the action of the neurons may lead to their depletion.

Increase in the number or sensitivity of postsynaptic receptors

The nurse plans to teach an adolescent about inhalation therapy as part of the treatment plan for the client's asthma. What does the best plan by the nurse include?

Inhalation therapy is effective because it goes to the direct site of action in the respiratory tract.

Which of the following is true regarding dry powder inhalers (DPI)? The device is activated by inhalation

Leukotriene modifiers are primarily used for prophylaxis of asthma symptoms.Leukotriene modifiers are used primarily for prophylaxis and reducing inflammatory components.

Terry, age 46, has a history of bipolar disorder and has been taking lithium for the past 15 years. He recently began showing signs of low thyroid function and changes in his urinary output. Which adverse effect could be affecting Terry's kidneys? Lithium causes a decrease in the levels of antidiuretic hormones. Lithium impairs the ability of the kidneys to concentrate urine. Lithium causes a reduction in the glomerular filtration rate. Lithium causes renal insufficiency.

Lithium impairs the ability of the kidneys to concentrate urine.

A patient has been taking lithium carbonate (Eskalith) for many years to treat bipolar disorder. Which of the following diets will require the dose of lithium carbonate (Eskalith) be reduced? Low calorie Low residue Low carbohydrate Low sodium

Low sodium

A nurse is caring for a patient being treated for depression. Which of the following interventions should the nurse perform when the patient complains of dry mouth? Suggest intake of only fibrous food Suggest intake of only fluids Provide sugarless gum or hard candy Provide food rich in fiber

Provide sugarless gum or hard candy

Which assessment finding, by the nurse, is a priority concern when a client receives pseudo ephedrine (Sudafed)? Heart rate 82 and irregular

Pseudoephedrine may cause dysrhythmias

The client receives ipratropium Atrovent via inhalation for the treatment of chronic asthma. The nurse plans to do medication education with the client. What will the best plan by the nurse include?

Report any increased dyspnea. Report any changes in urinary pattern. Use the medication consistently, not occasionally.

Which class of antidepressants exerts its effects by inhibiting reuptake serotonin? Tricyclic antidepressants Monoamine oxidase inhibitors Selective serotonin reuptake inhibitors Atypical antidepressants

Selective serotonin reuptake inhibitors

Which herbal product should a nurse specifically question patients about due to the potential for adverse reactions when taken with antidepressants? St. John's wort Fever few Ginseng Eucalyptus

St. John's wort

Which of the following is an adverse effect of a beta-adrenergic agonist? Tachycardia

Tachycardia is common, along with restlessness.

A client receives theophylline Theo-Dur and calls the clinic to say he has had nausea and vomiting for two days. What is the best action by the nurse?

Tell the client to come to the clinic for an assessment.Nausea and vomiting are symptoms of theophylline toxicity; the client needs to come to the clinic for an assessment.

Antihistamines block the actions of histamine at the H1 receptor site.

The H1 receptor site is the site for blocking histamine with the use of antihistamines.

During the fight-or-flight response, beta2-adrenergic receptors of the sympathetic nervous system are stimulated, the bronchiolar smooth muscle relaxes, and bronchodilation occurs.

The client asks the nurse why she must continue taking her asthma medication even though she has not had an asthma attack in several months. What is the best response by the nurse?

A 79-year-old male client is brought to the emergency department by his family because he is "talking to people who aren't there." During the initial admission assessment, his daughter mentions that her mother died 4 months ago and "Dad just hasn't been the same. The doctor has even put him on antidepressant medication. I go by the house every day to make sure he takes his medication." What would the nurse suspect is happening to this client? The client probably has a urinary tract infection , caused by changes in pH from his antidepressant The client is having hallucinations as an adverse effect of antidepressant therapy The mental status change is due to the patient's age a paradoxical medication effect The client is having delusions because of his depression over the loss of his wife.

The client is having hallucinations as an adverse effect of antidepressant therapy

The physician prescribes fluticasone (Flonase) for the client. The nurse would hold the drug and contact the physician with which assessment finding?

The client is pregnant. This is a class C drug so effects on pregnancy are not known; the client should not receive this drug.

The client takes diphenhydramine (Benadryl), but forgets to tell the physician about this drug when a monoamine oxidase inhibitor drug is prescribed for depression. What will the best assessment by the nurse reveal?

The client may develop a hypertensive crisis. The combination of diphenhydramine (Benadryl) and a monoamine oxidase inhibitor (MAOI) drug can result in a hypertensive crisis.

The nurse is preparing to administer beclomethasone Beconase to several clients. For which client would the nurse hold the drug and contact the physician?

The client who has methicillin resistant Staphylococcus aureus (MRSA)Glucocorticoids can mask the signs of infection, and are contraindicated if active infection is present.

A female client has been diagnosed with depression. She also has a history of alcoholism. She has been sober now for 4 months, but at her last physical examination, the physician noted right-upper-quadrant tenderness and elevated liver enzyme levels. The physician has prescribed sertraline to treat Ms. Tooka's depression. Which factor would need to be considered prior to administering this medication to her? The patient should have monthly evaluation of liver function to monitor the disease progression. The patient should not take any medications because of her liver dysfunction. She should have an ultrasound of the liver to check for disease. The medication should be started at a lower dose due to liver dysfunction, and the patient should be monitored for side effects.

The medication should be started at a lower dose due to liver dysfunction, and the patient should be monitored for side effects.

The nurse teaches a medication class on bronchodilators for clients with asthma. The nurse evaluates that learning has occurred when the clients make which statement?

The medication widens the airways because it stimulates the fight-or-flight response of the nervous system."

Why are selective serotonin reuptake inhibitors considered the first line of drug therapy for patients with depression? The medications have no sexual side effects. The medications have fewer anticholinergic effects than alternatives. The medications eliminate the risk of suicide during treatment. The onset of action is sooner than with other medications.

The medications have fewer anticholinergic effects than alternatives.

The nursing instructor teaches the nursing students about the major functions of the upper respiratory tract. What will the best plan by the nursing instructor include?

The nose warms the air before it reaches the lungs. The nasal mucosa is the first line of immunological defense. Activation of the sympathetic nervous system constricts arterioles in the nose.

Bronchoconstriction in the airways is stimulated by parasympathetic nervous system.

The nurse understands that one advantage of inhaled pulmonary drugs over oral drugs is that inhaled drugs allow for quick absorption.

The physician has prescribed cromolyn (Intal) for the client with asthma. The nurse plans to do medication education. What will the best plan by the nurse include?

This medication will help prevent asthma attacks. By reducing inflammation, cromolyn (Intal) is able to prevent asthma attacks.

The adverse effects of selective serotonin reuptake inhibitors are less than other antidepressants. False True

True

The client receives ipratropium (Atrovent). She tells the nurse she is going to stop it because of the bitter taste in her mouth after using the medication. What is the best response by the nurse?

You can decrease that side effect by rinsing your mouth after use."Ipratropium (Atrovent) produces a bitter taste

A client receiving phenytoin (Dilantin) has been experiencing fluctuating serum blood levels of the medication. Development of which symptoms in the client should prompt the nurse to notify the primary health care provider immediately? (Select all that apply.) a. Migraine headaches and nausea b. Double vision and lethargy c. Dry skin and constipation d. GI cramping and diarrhea

a. Migraine headaches and nausea; b. Double vision and lethargy Rationale: Although all the symptoms should prompt further assessment by the nurse, dizziness, ataxia, diplopia, and lethargy are signs of hydantoin toxicity and should be reported

The nurse completes a history and physical on a client admitted with exacerbation of a seizure disorder. What datum collected by the nurse requires intervention? a. Use of herb Ginkgo biloba b. History of asthma c. Use of aspirin daily d. History of diabetes mellitus

a. Use of herb Ginkgo biloba Rationale: Ginkgo biloba decreases the effectiveness of anti-seizure medication.

The upper respiratory tract (URT) consists of the nose, nasal cavity, pharynx, and paranasal sinuses. It undergoes a process sometimes referred to as

air conditioning.

The nurse should question the use of barbiturates for the treatment of seizure activity if prescribed for which of the following clients? a. 24-year-old male with new diagnosis of seizures b. 30-year-old pregnant female c. 45-year-old male with history of hypertension d. 55-year-old female with history of diabetes mellitus

b. 30-year-old pregnant female Rationale: Barbiturates cross the placental barrier and are excreted in breast milk, and are not recommended for women who are pregnant or nursing. Folic acid absorption also is decreased, and congenital malformations can occur if barbiturates are taken during the first trimester.

A client asks if convulsions and seizures are the same. The nurse's response is based on the knowledge that: a. The terms can be used interchangeably. b. Convulsions always involve violent skeletal muscle activity. c. Seizures involve muscle spasms on one side only. d. Seizure activity is more harmful than are convulsions.

b. Convulsions always involve violent skeletal muscle activity. Rationale: Convulsions specifically refer to involuntary, violent spasms of the large muscles of the face, neck, arms, and legs. Seizure activity does not always involve these characteristics.

The client is prescribed clonazepam (Klonopin) for treatment of a seizure disorder. Appropriate nursing action includes: a. Maintaining available dose for treating status epilepticus. b. Determining the pregnancy status of the client. c. Administrating with other CNS depressants. d. Assuring the client that a history of glaucoma will not affect treatment.

b. Determining the pregnancy status of the client. Rationale: Benzodiazepines are Category D drugs, and are contraindicated during pregnancy. The question does not indicate that the client has status epilepticus. CNS depressants should not be given with benzodiazepines. The drug could produce changes in intraocular pressure and is contraindicated in narrow-angle glaucoma

The nurse evaluates teaching related to causes of seizures. Further teaching is needed if the client makes which of the following statements? a. "Seizures can be caused by inflammation of the brain." b. "Seizures can be caused by low blood sugar." c. "My relative had seizures because of a large tumor growing in his muscles." d. "Seizures can occur after a head injury."

c. "My relative had seizures because of a large tumor growing in his muscles." Rationale: Rapid-growing, space-occupying lesions in the brain, not muscles, that increase intracranial pressure can cause seizures. Seizures may be caused by inflammation of the brain, low blood sugar, and head injuries.

A client receiving digoxin (Lanoxin) therapy is being treated for status epilepticus with diazepam (Valium). The nurse places priority on: a. Holding the digoxin until the seizure has subsided. b. Keeping the client in a high Fowler's position. c. Monitoring the client for nausea and GI cramping. d. Instructing the client to eat foods high in potassium.

c. Monitoring the client for nausea and GI cramping. Rationale: Valium is a benzodiazepine, which can potentate the action of digoxin and raise blood levels. Nausea, vomiting, GI cramping, blurred vision, and bigeminy are signs of digoxin toxicity. The digoxin should not be held unless symptoms of toxicity are seen. Positioning should protect the client from injury during the seizure-most likely recumbent and on the side, if possible. Potassium is not indicated.

The nurse giving discharge teaching for a client receiving carbamazepine (Tegretol) should include: a. Monitor blood glucose, and report decreased levels. b. Expect a discoloration of the contact lenses. c. Report unusual bleeding or bruises to the health care provider immediately. d. Expect an orange discoloration of urine.

c. Report unusual bleeding or bruises to the health care provider immediately. Rationale: Carbamazepine affects vitamin K metabolism and can lead to blood dyscraisias and bleeding. It does not significantly lower blood sugar or change the color of body fluids.

The client, age 8, is prescribed valproic acid (Depokene) for treatment of a seizure disorder. The nurse should monitor the client closely for: a. Hyperthermia. b. Vitamin B deficiency. c. Restlessness and agitation. d. Respiratory distress.

c. Restlessness and agitation. Rationale: Valproic acid can produce an idiosyncratic response in children, including restlessness and psychomotor agitation.

Centrally acting antitussives, such as opioids, are used to

relieve severe cough.

The main classification for a prototype drug, such as fexofenadine (Allegra), is a/n

typical second-generation H1-receptor antagonist.

After teaching a client who is prescribed isocarboxazid, the nurse determines that additional teaching is needed when the client states a need to avoid what food? red wine. Parmesan cheese sausage. whole milk.

whole milk.