pharm.

2

Alprazolam is prescribed for a client with the diagnosis of panic disorder. The client refuses to take the medication because of fears of addiction. What should the nurse do initially? 1 Provide the client information about alprazolam. 2 Assess the client's feelings about alprazolam further. 3 Ask the practitioner about changing the client's medication. 4 Have the practitioner speak with the client about the safety of this medication

3

A client is treated with lorazepam for status epilepticus. What effect of lorazepam does the nurse consider therapeutic? 1 Slows cardiac contractions 2 Dilates tracheobronchial structures 3 Depresses the central nervous system (CNS) 4 Provides amnesia for the convulsive episode

3

A healthcare provider prescribes aripiprazole 15 mg by mouth once a day for a client with the diagnosis of schizophrenia. The hospital pharmacy sends aripiprazole 5 mg/tablet. How many tablets will the nurse administer? Record your answer as a whole number. ____ tablet(s)

2 (Vaccines may be administered during a mild febrile illness and upper respiratory infection, so the nurse should assess further. Administering an aspirin is a dependent function of the nurse and requires a healthcare provider's prescription. Although holding the vaccine and administering it after the fever and cough are resolved is appropriate, notifying the healthcare provider is not necessary. Vaccinations should not be delayed unless the illness is moderate to severe.)

A client arrives for a vaccination at an influenza prevention clinic. The client reports a low-grade fever with a cough. What should the nurse do? 1 Administer aspirin with the vaccine. 2 Check the temperature and current history. 3 Hold the vaccine and notify the healthcare provider. 4 Reschedule administration of the vaccine for the next month.

4 (After administration of certain antihypertensives or opioids, a client's neurocirculatory reflexes may have some difficulty adjusting to the force of gravity when an upright position is assumed. Postural or orthostatic hypotension occurs, and blood supply to the brain is temporarily decreased. Abdominal pain, respiratory distress, and sudden hemorrhage will not be prevented by the intervention described.)

A client with a history of heart disease has been receiving a calcium channel blocker and morphine sulfate for pain from abdominal surgery. When getting the client out of bed, the nurse first should have the client sit on the edge of the bed with feet on the floor. What untoward client response can be prevented by this nursing action? 1 Abdominal pain 2 Respiratory distress 3 Sudden hemorrhage 4 Postural hypotension

1 (If the client will be taking the medication long term, periodic diagnostic tests are necessary because ibuprofen is nephrotoxic, is hepatotoxic, and prolongs the bleeding time. Balancing exercise with rest is important for all clients with arthritis; it is not related to ibuprofen. Ibuprofen does not cause postural hypotension. Ibuprofen causes epigastric distress and occult bleeding; it should be taken with meals or milk to reduce these adverse reactions.)

A client with rheumatoid arthritis is to begin taking ibuprofen 800 mg by mouth three times a day. The nurse provides education about the medication's side effects. The nurse concludes that the teaching was effective when the client makes which statement? 1 "I need to have my blood work checked periodically." 2 "I need to balance exercise with rest." 3 "I need to change positions slowly." 4 "I need to take the medication between meals.

3 (Cisplatin is nephrotoxic and can cause kidney damage unless the client is adequately hydrated to flush the kidneys. Leucovorin, a form of folic acid, is used to combat toxic effects of methotrexate; cisplatin does not interfere with folic acid metabolism. Gentle, not vigorous, oral care is needed to cleanse the mouth without further aggravating the expected stomatitis. A low-residue diet is unnecessary. Prolonged gastrointestinal irritation is not the major concern; nausea and vomiting last about 24 hours, and although diarrhea may occur and last longer, it is not the primary concern.)

The healthcare provider prescribes cisplatin for a client with metastatic cancer. What will the nurse do to prevent toxic effects? 1 Ask the client's healthcare provider about prescribing leucovorin. 2 Encourage regular vigorous oral care. 3 Increase hydration to promote diuresis. 4 Assist the client in selecting foods appropriate for a high-protein, low-residue diet.

3 (Tamoxifen is an estrogen antagonist antineoplastic medication that has been found to be effective in 50% to 60% of women with estrogen receptor-positive cancer of the breast. After 5 years of administration there is an increased risk of complications, and the drug is discontinued. Tamoxifen usually is prescribed for 5 years after initiation of therapy, not for the rest of the client's life; this duration will not produce positive effects for the client. Tamoxifen usually is prescribed for 5 years after initiation of therapy, not just for 10 days. Tamoxifen may cause the adverse effect of bone pain, which indicates the drug's effectiveness. Medication is given to manage the pain and the drug is continued.)

A 63-year-old woman with the diagnosis of estrogen receptor-positive cancer of the breast undergoes lumpectomy and radiation therapy, and tamoxifen is prescribed. The client asks the nurse how long she will have to take the medication. How will the nurse respond? 1 "You'll have to take it for the rest of your life." 2 "You'll need to take it for 10 days, like an antibiotic." 3 "You'll need to take it for 5 years, after which it will be discontinued." 4 "You'll need to take it for several months, until the bone pain subsides."

4 (Although the exact mechanism is unknown, clinical improvements have been reported with sympathomimetic amines such as methylphenidate. After the purpose and action of the drug are explained, the nurse should review side effects with the parent. The appetite of a child taking methylphenidate usually diminishes. The child should be medicated for as short a period as possible. Each child is evaluated individually. The duration of methylphenidate is 3 to 6 hours, or 8 hours with the extended-release form.)

A 7-year-old boy with a diagnosis of attention deficit-hyperactivity disorder (ADHD) is receiving methylphenidate. His mother asks about its action and side effects. What is the nurse's initial response? 1 "This medicine increases the appetite." 2 "This medicine must be continued until adulthood." 3 "It is a short-acting medicine that must be given with each meal." 4 "It is a stimulant that has a calming effect on children with your son's disorder."

2.4

A child is to receive 60 mg of phenytoin. The medication is available as an oral suspension that contains 125 mg/5 mL. How many milliliters should the nurse administer? Record your answer using one decimal place. ____ mL

1 (It usually takes 1 to 4 weeks to attain a therapeutic blood level of escitalopram. Waiting 6 to 8 weeks is too long. The client needs more time, not an increased dosage, to see an effect of the medication. There is no need for the nurse to notify the primary healthcare provider yet. )

A client has been taking escitalopram for treatment of a major depressive episode. On the fifth day of therapy the client refuses the medication, stating, "It doesn't help, so what's the use of taking it?" What is the best response by the nurse? 1 "It can take 1 to 4 weeks to see an improvement." 2 "It takes 6 to 8 weeks for this medication to have an effect." 3 "I'll talk to your primary healthcare provider about increasing the dosage. That may help." 4 "You should have felt a response by now. I'll notify the primary healthcare provider right now.

1

A client is diagnosed as having the hepatitis B virus (HBV). The nurse reviews the client's health history for possible situations in which exposure may have occurred. Which event does the nurse determine is most likely the source of this infection? 1 Had a small tattoo on the arm three months ago 2 Assisted in the emergency birth of a baby two weeks ago 3 Worked for a month in an undeveloped area in Mexico four months ago 4 Attended an ecologic conference in a large urban center two months ago

2 (Administering the next dose of the medication as prescribed is within the therapeutic range of 10 to 20 mg/L (40 to 80 mcmol/L); the nurse should administer the drug as prescribed. The phenytoin level is within the therapeutic range of 10 to 20 mg/L (40-80 mcmol/L); there is no need to hold the dose and notify the healthcare provider. Holding the next dose and then resuming administration as prescribed is unsafe and will reduce the therapeutic blood level of the drug. Calling the healthcare provider to obtain a prescription with an increased dose is unnecessary; the blood level is within the therapeutic range.)

A client is taking phenytoin to treat clonic-tonic seizures. The client's phenytoin level is 16 mg/L. Which action should the nurse take? 1 Hold the medication and notify the healthcare provider. 2 Administer the next dose of the medication as prescribed. 3 Hold the next dose and then resume administration as prescribed. 4 Call the healthcare provider to obtain a prescription with an increased dose

1 (The medication should be stopped immediately, because jaundice indicates possible liver damage, which prolongs elimination of the drug and may result in toxic accumulation. Milk does not change the effect of the drug. The drug must be stopped, not reduced. The drug is available only in an oral form; in addition, the route of administration will not influence the occurrence of toxic accumulation.)

A client receiving the medication buspirone is admitted to the hospital with the diagnosis of possible hepatitis. The nurse identifies that the client's sclerae look yellow. What will be the nurse's initial action? 1 Withhold the medication. 2 Give the buspirone with milk. 3 Reduce the dosage of the medication. 4 Ensure that the medication can be given parenterally.

4 (A life-threatening effect of cyclosporine is nephrotoxicity. Therefore creatinine and blood urea nitrogen levels should be monitored. Although abnormal hairiness (hirsutism) is an effect of cyclosporine, it is not life threatening. Diarrhea, not constipation, is a response to cyclosporine. Cyclosporine does not cause cardiovascular life-threatening effects. )

A client who had an organ transplant is receiving cyclosporine. The nurse should monitor for what serious adverse effect of cyclosporine? 1 Hirsutism 2 Constipation 3 Dysrhythmias 4 Increased creatinine level

3 (Ibuprofen has an antiinflammatory action that relieves the inflammation and pain associated with arthritis. Acetaminophen is not a nonsteroidal antiinflammatory drug (NSAID). NSAIDs are preferred for the treatment of rheumatoid arthritis. Acetaminophen does not cause gastritis; this is an effect of aspirin. Ibuprofen is not an antipyretic. )

A client who has been taking ibuprofen for rheumatoid arthritis asks the nurse if acetaminophen can be substituted instead. What is the appropriate nursing response? 1 "Acetaminophen is the preferred treatment for rheumatoid arthritis." 2 "Acetaminophen irritates the stomach more than ibuprofen does." 3 "Ibuprofen has antiinflammatory properties and acetaminophen does not." 4 "Yes, both are antipyretics and have the same effect.

1 (Seizure disorders usually are associated with marked changes in the electrical activity of the cerebral cortex, requiring prolonged or lifelong therapy. Seizures may occur despite drug therapy; the dosage may need to be adjusted. A therapeutic blood level must be maintained through consistent administration of the drug irrespective of emotional stress. Absence of seizures will probably result from medication effectiveness rather than from correction of the pathophysiologic condition)

A client who is receiving phenytoin to control a seizure disorder questions the nurse regarding this medication after discharge. How will the nurse respond? 1 Antiseizure drugs will probably be continued for life." 2 "Phenytoin prevents any further occurrence of seizures." 3 "This drug needs to be taken during periods of emotional stress." 4 "Your antiseizure drug usually can be stopped after a year's absence of seizures.

4 (Symptoms of infection are suggestive of agranulocytosis, an adverse effect that can occur with clozapine therapy and can cause death. Remaining in bed, drinking fluids, taking aspirin, and asking the primary healthcare provider to decrease the dose of clozapine is unsafe, because agranulocytosis may be developing, and this life-threatening side effect requires immediate treatment. Also, prescribing medications is outside the legal role of the nurse. Only a certified nurse practitioner or other licensed healthcare provider can prescribe medications. Although discontinuing the medication is acceptable advice, delaying a primary healthcare provider's evaluation is unsafe. Continuing the medication, drinking fluids, taking aspirin, and seeing the primary healthcare provider in a few days if the condition does not improve is unsafe, because agranulocytosis may be developing.)

A client who is taking clozapine calls the nurse in the psychiatric clinic to report the sudden development of a sore throat and a high fever. What will the nurse instruct the client to do? 1 Stay in bed, drink fluids, take a dose of aspirin, and ask the primary healthcare provider to reduce the dosage of clozapine. 2 Discontinue the medication immediately and see the primary healthcare provider as soon as an appointment becomes available. 3 Continue the medication, drink fluids, take aspirin, and see the primary healthcare provider in a few days if the symptoms do not improve. 4 Discontinue the medication and, if the primary healthcare provider is unavailable today, go to the emergency department for evaluation

3 (Sudden withdrawal of antiepileptic medication can cause status epilepticus. It is important to take medication as prescribed to lessen the frequency of seizures; there is no guarantee that seizures will stop. Medication may or may not eliminate the seizures; stress may precipitate a seizure. Antiepileptics are not prescribed to prevent falls and injury. Although seizures may occur while the client is taking the medications, the medications do not stop postseizure confusion.)

A client with a seizure disorder is receiving phenytoin and phenobarbital. What client statement indicates that the instructions regarding the medications are understood? 1 "I will not have any seizures with these medications." 2 "These medicines must be continued to prevent falls and injury." 3 "Stopping the drugs can cause continuous seizures and I may die." 4 "By my staying on the medicines I will prevent postseizure confusion."

4 (Albumin is an essential component of the bloodstream that helps maintain both osmotic pressure and fluid and electrolytes. This is not a cause of hemorrhage. Blood components such as platelets, thrombin, and erythrocytes are involved in the prevention of hemorrhage or anemia. Diminished resistance to bacterial insult is not involved directly with immunity and resistance. Blood components, such as T and B lymphocytes, are involved in this process; the liver synthesizes specific proteins intrinsic to the function of antibodies. The serum albumin level is not related to nutrition of cells.)

A client with hepatitis B (HBV) develops cirrhosis and is hospitalized. One potential sequela of chronic liver disease is fluid and electrolyte imbalance. The nurse determines that this may be attributed to a decrease in serum albumin level. Which of these conditions results from this imbalance? 1 Hemorrhage with subsequent anemia 2 Diminished resistance to bacterial insult 3 Malnutrition of cells, especially hepatic cells 4 Reduction of colloidal osmotic pressure in the blood

3 (Allopurinol decreases serum uric acid levels before and during chemotherapy; increased fluid intake aids in the increased excretion of uric acid. Allopurinol and increased fluids help prevent renal tubular impairment and kidney failure because of hyperuricemia. The client should be encouraged to follow a diet that promotes urine alkalinity. If the oral route is used, administering the methotrexate after providing an antacid will limit gastric irritation, not uric acid nephropathy. Fluid intake should be increased to 2 to 3 liters per day to prevent urate deposits and calculus formation. )

A client with lymphosarcoma is receiving allopurinol and methotrexate. The nurse can help the client prevent complications related to uric acid nephropathy by administering which drug in relation to fluid intake? 1 Allopurinol and restricting the fluid intake 2 Methotrexate and restricting fluid intake 3 Allopurinol and encouraging increased fluid intake 4 Methotrexate and encouraging increased fluid intake

1 (The anticholinergic activity of each drug is magnified, and adverse effects such as paralytic ileus may occur. Hypotension, not hypertension, occurs with anticholinergic medications. Dryness of the mouth, not increased salivation, occurs with anticholinergic medications. Decreased, not increased, perspiration occurs with anticholinergic medications)

A client with schizophrenia who is receiving an antipsychotic medication begins to exhibit a shuffling gait and tremors. The primary healthcare provider prescribes the anticholinergic medication benztropine, 2 mg daily. What will the nurse assess the client for daily when administering these medications together? 1 Constipation 2 Hypertension 3 Increased salivation 4 Excessive perspiration

3 (Informing the client about the expected response to the medication is factual information that may decrease the client's sense of hopelessness. Although empathic responses may be helpful, at this time the client needs information and reassurance based on fact. Citalopram hydrobromide does not work more slowly in some people.)

A depressed client is prescribed citalopram hydrobromide. Six days later the client tearfully says to the nurse, "I'm taking an antidepressant, but it's not working. I'm hopeless." What is the best response by the nurse? 1 "You feel hopeless." 2 "It's easy to get discouraged." Correct3 "It takes 2 or 3 weeks before it begins to relieve depression." 4 "Give it a little more time; it works more slowly in some people."

2 (Midazolam, a benzodiazepine, depresses subcortical levels in the central nervous system and acts on the limbic system and reticular formation; it reduces anxiety and induces sedation. Analgesics are given to reduce pain. Although it induces amnesia, this is not the primary reason for its administration. Atropine, an anticholinergic, is given to decrease oral and respiratory secretions.)

A healthcare provider informs a client that midazolam will be administered preoperatively. Later, the client asks the nurse why this medication is given. What primary reason should the nurse consider when formulating a response? 1 Reduces pain 2 Induces sedation 3 Produces amnesia 4 Limits oral secretions

4 (Hospice clients with severe pain need increasing levels of analgesics and should be maintained at a pain-free level, even if addiction occurs. Pain management, not the prevention of addiction, is the priority. The client has severe pain, and the priority is to relieve the pain. Comfort measures should augment, not be substitutes for, pharmacologic interventions when clients are experiencing severe pain.)

A hospice client who has severe pain asks for another dose of oxycodone. What is the nurse's primary consideration when responding to the client's request? 1 Prevent addiction 2 Determine why the drug is needed 3 Provide alternative comfort measures 4 Reduce the client's pain

3 (Hard candy may produce salivation, which helps alleviate the anticholinergic-like side effect of dry mouth that is experienced with some psychotropics. Dry mouth increases the risk for cavities; candy with sugar adds to this risk. Fluids should be encouraged, not discouraged; fluids may alleviate the dry mouth. A diet high in carbohydrates and avoiding aspirin are unnecessary. )

Considering the anticholinergic-like side effects of many of the psychotropic drugs, the nurse will encourage clients taking these drugs to take which action? 1 Restrict their fluid intake. 2 Eat a diet high in carbohydrates. 3 Suck on sugar-free hard candies. 4 Avoid products that contain aspirin.

2 (All Rh-negative mothers with Rh-positive infants are candidates for Rho(D) immune globulin; a negative Coombs test result verifies an absence of Rh antibodies, indicating that the Rho(D) immune globulin will be effective in preventing antibody formation during the client's next pregnancy. A positive Coombs result indicates the presence of circulating antibodies; therefore Rho(D) immune globulin (RhoGAM) is of no use. An Rh negative newborn with a positive Coombs result is not possible; if both mother and newborn are Rh negative, there are no circulating antibodies and the Coombs result must be negative. When mother and newborn both have Rh-negative blood, Rho(D) immune globulin is not required.)

Rho(D) immune globulin (RhoGAM) is prescribed for an Rh-negative client who has just given birth. Before giving the medication, the nurse verifies the newborn's Rh factor and reaction to the Coombs test. Which combination of newborn Rh factor and Coombs test result confirms the need to give Rho(D) immune globulin? 1 Rh positive with a positive Coombs result 2 Rh positive with a negative Coombs result 3 Rh negative with a positive Coombs result 4 Rh negative with a negative Coombs result

4

The healthcare provider prescribes epoetin for a client who has acquired immunodeficiency syndrome (AIDS). What step will the nurse include during administration of this drug? 1 Administer the drug via the Z-track technique. 2 Shake the vial before withdrawing the solution. 3 Obtain the client's pulse rate before administration. 4 Use a syringe that has a 1-inch (2.5-cm), 25-gauge needle

1 (Atgam is a lymphocyte immune globulin, which is administered as an induction therapy or to treat acute rejection in organ transplant individuals. The purpose of induction therapy is to severely immunosuppress individuals immediately after transplantation to prevent early rejection in a client who has had an organ transplant. Mycophenolate has been shown to decrease the incidence of late graft loss; side effects include gastrointestinal toxicities. Acetaminophen and diphenhydramine are administered to treat headache, myalgias, and rigors that may occur with muromonab-CD3. )

The nurse is providing induction therapy to a client to prevent rejection after an organ transplant. Which medication will the nurse most likely to administer? 1 Atgam 2 Mycophenolate 3 Acetaminophen 4 Diphenhydramine

2 (Elastic stockings help decrease venous pooling of blood and help maintain systemic blood pressure when the client stands up. Orthostatic hypotension occurs on rising to an upright position. Gait training should not be postponed; safety measures, such as permitting adequate time for the blood pressure to adjust to the client moving to the sitting or standing position, should be implemented. An alteration in dosage may be prescribed, but sudden withdrawal is dangerous and unwarranted. Increasing fluid intake may increase the intravascular fluid volume temporarily but will not affect reflexes involved in orthostatic hypotension. )

The practitioner prescribes a regular diet, gait training, elastic stockings, and benztropine mesylate for a client. The client experiences orthostatic hypotension, a side effect of benztropine mesylate. What should the nurse anticipate as the priority nursing action? 1 Postpone gait training 2 Apply elastic stockings 3 Withhold the next dose 4 Increase the fluid intake

1 (Carbamazepine is administered to control pain by reducing transmission of nerve impulses in clients with trigeminal neuralgia. Liver function is monitored to detect adverse reactions to carbamazepine, not to determine therapeutic effectiveness. Carbamazepine is not given to influence cardiac output. Carbamazepine is not administered to clients with trigeminal neuralgia (tic douloureux) for its anticonvulsant properties because seizures are not present with this disorder.)

What should the nurse monitor to evaluate the effectiveness of carbamazepine in the management of a client's trigeminal neuralgia? 1 Pain intensity 2 Liver function 3 Cardiac output 4 Seizure activity

2 (The client should be encouraged to follow the medical regimen to maximize the response to drug therapy. The client asked a direct question; stating "You're concerned about taking this medication" does not answer the question. The healthcare provider should be notified of side effects. Legally it is the healthcare provider who is responsible for discontinuing a medication or adjusting a medication dosage.)

An older client who is hospitalized for depression is receiving citalopram. During discharge teaching, the client asks the nurse whether there is anything that should be known about taking this medication. What is the nurse's reply? 1 "You're concerned about taking this medication." 2 "You should take each dose of medication as prescribed." 3 "You must discontinue the medication if side effects occur." 4 "You may find it necessary to adjust the dosage if side effects occur.

2 (Duloxetine is an antidepressant drug used in the treatment of generalized anxiety disorder. A contraindication is that it can worsen uncontrolled angle-closure glaucoma. Lithium carbonate is used to treat manic episodes but is contraindicated in clients with renal disease. Buspirone is an antidepressant drug contraindicated in clients with known allergic reactions to this drug. Chlorpromazine is an antipsychotic drug contraindicated in clients with blood dyscrasias. )

Which drug worsens uncontrolled angle-closure glaucoma when used for the treatment of generalized anxiety disorder? 1 Buspirone 2 Duloxetine 3 Chlorpromazine 4 Lithium carbonate

4 (Vincristine is highly neurotoxic, causing paresthesias, muscle weakness, ptosis, diplopia, paralytic ileus, vocal cord paralysis, and loss of deep tendon reflexes. Hematologic effects are rare; mild anemia may occur, but hemolytic anemia is not anticipated. Alopecia is reversible with cessation of the drug. Hyperglycemia is not an anticipated adverse effect. )

A combination of drugs, including vincristine and prednisone, is prescribed for a child with leukemia. For which adverse effect of vincristine will the nurse assess the child? 1 Hemolytic anemia 2 Irreversible alopecia 3 Hyperglycemia 4 Neurologic complications

2 (Adequate dental hygiene is essential to control or prevent the common side effect of hypertrophy of the gums. The medication should be taken with food or milk to decrease gastrointestinal side effects. The healthcare provider should be consulted before the drug is discontinued or the dosage is adjusted; usually in this situation, a gradual dosage reduction is prescribed. Changes in pulse and respiratory rates are unrelated to phenytoin therapy.)

A client who had a tonic-clonic seizure of unknown etiology is to begin taking phenytoin. What instructions will the nurse give to the client? 1 Take the medication on an empty stomach. 2 Brush the teeth and gums three times daily. 3 Stop taking the drug if abdominal pain occurs. 4 Note any change in pulse and respiratory rates

4 (Very young children should receive ferrous sulfate elixir through a syringe or medicine dropper placed in the back of the mouth; this limits staining of teeth by the ferrous sulfate. A 12-month-old infant may not be able to suck on a straw. A 12-month-old infant cannot swallow a tablet, and ferrous sulfate should not be crushed. Ferrous sulfate is not available in an injectable form. )

A 12-month-old infant is to receive ferrous sulfate for iron-deficiency anemia. How will the nurse administer the medication? 1 Through a straw 2 Crushed in applesauce 3 4 In a syringe directed toward the back of the mouth

4 (Numbness, a sensory deficit, is inconsistent with parkinsonism; further medical evaluation is necessary. Numbness, even in the absence of other problems, may be indicative of an impending brain attack (cerebrovascular accident, CVA). This symptom is not caused by parkinsonism; increasing the dosage of the anticholinergic medication will not be helpful. Stressing the importance of having the client call the primary healthcare provider as soon as possible can cause a delay in the client's receiving immediate medical attention. )

A client with parkinsonism is taking an anticholinergic medication for morning stiffness and tremors in the right arm. During a visit to the clinic, the client complains of some numbness in the left hand. What is the nurse's priority intervention? 1 Refer the client to the primary healthcare provider only if other neurologic deficits are present. 2 Ask the primary healthcare provider to increase the client's dosage of the anticholinergic medication. 3 Stress the importance of having the client call the primary healthcare provider as soon as possible. 4 Make arrangements immediately for further medical evaluation by the client's primary healthcare provider.

4 (The therapeutic level of lithium carbonate is very close to the toxic level. Therefore it is vital that blood levels of the drug be checked twice a week during the acute phase and bimonthly once the client is on a maintenance dosage. Lithium does cause some weight gain, but daily weights are not necessary. Although psychomotor activity assessment should be done, it is not the priority. Lithium does not affect red blood cells.)

A nurse is counseling a client who is taking lithium carbonate. What is the priority nursing assessment when a client is taking this medication? 1 Daily weights 2 Psychomotor activity 3 Red blood cell counts 4 Blood level of the drug

4 (Acetaminophen is a nonopioid analgesic that inhibits prostaglandins, which serve as mediators for pain; it does not affect platelet function. Naproxen, aspirin, and ketorolac are nonselective nonsteroidal antiinflammatory drugs (NSAIDs) that are contraindicated for clients undergoing surgery; nonselective NSAIDs have an inhibitory effect on thromboxane, a strong aggregating agent, and can result in bleeding)

A nurse is taking the health history of a client who is to have surgery in one week. The nurse identifies that the client is taking ibuprofen for discomfort associated with osteoarthritis and notifies the healthcare provider. Which drug does the nurse expect will most likely be prescribed instead of the ibuprofen? 1 Naproxen 2 Aspirin 3 Ketorolac 4 Acetaminophen

1 (When nurses make judgmental remarks and client needs are not placed first, the standards of care are violated and quality of care is compromised. Assessments should be objective, not subjective and biased. There is no information about the client's acuity to come to this conclusion regarding priorities. The statement does not reflect information about complexity of care.)

A nurse on the medical-surgical unit tells other staff members, "That client can just wait for the lorazepam; I get so annoyed when people drink too much." What does this nurse's comment reflect? 1 Demonstration of a personal bias 2 Problem solving based on assessment 3 Determination of client acuity to set priorities 4 Consideration of the complexity of client care

2 (If the areas that cause stress can be identified and avoided, the client should be better able to control the acting-out behavior. These clients may be confused or disoriented, but they usually do not experience an altered level of consciousness; an altered level of consciousness is associated with delirium, not dementia. Although the client's performance of activities of daily living may be observed, this is only one area of function that should be assessed. Although monitoring the side effects associated with the client's medications is important, it is not the priority.)

A nursing home resident with dementia of the Alzheimer type, stage 2, who has been receiving donepezil is engaging in numerous acting-out behaviors. On what should the nurse base the initial plan of care? 1 Assessing the client's level of consciousness 2 Identifying the stressors that precipitate the client's behavior 3 Observing the client's performance of activities of daily living 4 Monitoring the side effects associated with the client's medications

1,2,4 (Nausea and vomiting may occur; it reflects a central emetic reaction to levodopa. Anorexia may occur; decreased appetite results because of nausea and vomiting. Changes in affect, mood, and behavior are related to toxic effects of the drug. Tachycardia and palpitations, not bradycardia, occur. Peripheral edema is not a side effect of carbidopa-levodopa.)

Carbidopa-levodopa is prescribed for a client with Parkinson disease. The nurse monitors the client for which side effects of the medication? Select all that apply. 1 Vomiting 2 Anorexia 3 Slow heart rate 4 Changes in mood 5 Peripheral edema

3 (Yellow sclerae is a sign of jaundice, indicating an increase of liver enzymes, which may be irreversible even if drug therapy is discontinued. Although grimacing may be a sign of a serious side effect, it may also just be a behavioral response of the disorder; the nurse should notify the primary healthcare provider rather than withhold the drug. Shuffling gait is a parkinsonian symptom that can be reversed with treatment; continuation of the medication is permitted. Photosensitivity is not a problem as long as the client is cautioned to stay out of the sun.)

Which assessment finding alerts the nurse to stop administering haloperidol to a client until further laboratory work is done? 1 Grimacing 2 Shuffling gait 3 Yellow sclerae 4 PhotosensitivitY

4 (These drugs suppress the immune system, decreasing the body's production of antibodies in response to the new organ, which acts as an antigen. These drugs decrease the risk of rejection. These drugs inhibit leukocytosis. These drugs do not provide immunity; they interfere with natural immune responses. Because these drugs suppress the immune system, they increase the risk of infection. )

The nurse is caring for a client who is receiving azathioprine, cyclosporine, and prednisone before receiving a kidney transplant. What does the nurse identify as the purpose of these drugs? 1 Stimulate leukocytosis 2 Provide passive immunity 3 Prevent iatrogenic infection 4 Reduce antibody production

3 (The response "I've been on the medication for 8 days now, and I don't feel any better" indicates that the client has not been taking the drug long enough to expect a therapeutic response; clients who begin taking antidepressants usually begin to feel a lightening of depression in approximately 14 to 20 days, with the full antidepressant effects being felt between 3 and 4 weeks. Drowsiness, fatigue, and insomnia are common side effects. Medication alone may not be effective; some form of psychotherapy often is needed. Clients usually remain on these medications for several months.)

When talking with a client who has been receiving paroxetine, the nurse determines that more clarification is needed when the client makes which statement? 1 "I'll be a little drowsy in the mornings." 2 "I'm expecting to feel somewhat better, but I may need other therapy." 3 "I've been on the medication for 8 days now, and I don't feel any better." 4 "I know that I'll probably have to take this medication for several months."

3 (In addition to promoting therapeutic cerebral vasoconstriction, sumatriptan promotes undesirable coronary artery vasoconstriction. Coronary vasoconstriction may cause harm to the client with coronary artery disease. For maximum effectiveness, sumatriptan should be administered at the onset of migraine headache. Sumatriptan may be given orally, subcutaneously, or as a nasal spray. The maximum adult dose of sumatriptan is two 6-mg doses in a 24-hour period for a total of 12 milligrams. The two doses must be separated by at least an hour. The second dose should not be administered unless some response was observed with the first dose.)

Which information does the nurse include in the teaching plan for the client who is prescribed sumatriptan for migraine headache? 1 Should be administered when headache is at its peak 2 Should be administered by deep intramuscular injection 3 Is contraindicated in people with coronary artery disease 4 Injectable sumatriptan may be administered every 6 hours as needed

1 (These drugs cause increased heart contraction (positive inotropic effect) and increased heart rate (positive chronotropic effect). If toxic levels are reached, side effects occur, and the drug should be withheld until the healthcare provider is notified. Telling the client not to worry and that these are expected side effects from the medicine is false reassurance and a false statement. Controlled breathing may be helpful in allaying a client's anxiety; however, the drug may be producing adverse effects and should be withheld. )

While receiving an adrenergic beta2 agonist drug for asthma, the client complains of palpitations, chest pain, and a throbbing headache. What is the most appropriate nursing action? 1 Withhold the drug and notify the healthcare provider. 2 Tell the client not to worry; these are expected side effects from the medicine. 3 Give instructions to breathe slowly and deeply for several minutes. 4 Explain that the effects are temporary and will subside as the body becomes accustomed to the drug