Pharm 35B HESI Practice Exam #2

The nurse administers 30 mL of lactulose for a client with stage 2 hepatic encephalopathy. Which assessment finding would indicate the medication is being therapeuitc?

A decrease in blood ammonia levels Rationale: Colonic bacteria digest lactulose to create a drug-induced acidic and hyperosmotic environment that draws water and blood ammonia into the colon. The physiologic action of lactulose for the client with hepatic encephalopathy is to lower the pH of the colon which inhibits diffusion of ammonia into the bloodstream.

A client prescribed clindamycin hydrochloride intravenously asks the nurse why blood has to be drawn before the third dose and one hour after the completion of the administration of the medication. Which information should the nurse provide the client to answer the question?

A small margin exists between safe and toxic plasma levels Rationale: Clindamycin hydrochloride has a narrow therapeutic index which means there is a narrow difference between safe and toxic drug levels, so clients receiving this medications should be closely monitored. The drawing of the client's blood samples before and one hour after the completion of the administration of the medication is known as a peak and trough level of the medication to monitor the medication's plasma levels in the client's blood.

Based on the blood culture and sensitivity results, the healthcare provider prescribes an IV aminoglycoside antibiotic and discontinues the current prescription for another broad spectrum antibiotic. The medication administration record indicates that the client received the broad spectrum antibiotic two hours ago. Which action should the nurse implement?

Administer the initial dose of the aminoglycoside antibiotic as soon as possible Rationale: Based on the blood culture and sensitivity results, the prescribed aminoglycoside antibiotic is the most effective in treating the client's infection, so it should be administered as soon as possible.

A mother of a child prescribed methylphenidate hydrochloride for attention-deficit hyperactivity disorder (ADHD) informs the school nurse she administers the medication at bedtime. Which instructions should the nurse recommend?

Administer the medication at least six hours before bedtime Rationale: Central nervous system stimulants, such as methylphenidate hydrochloride for attention-deficit hyperactivity disorder (ADHD) should be taken at least six hours before bedtime to decrease the occurrence of insomnia.

The nurse is instructing a client to avoid which product while taking carisoprodol for muscle spasms. The client verbalizes an understanding of the instructions if they state they will not consume which type of product?

Alcoholic beverages Rationale: Soma is a centrally-acting muscle relaxant that can cause central nervous system (CNS) depression, and can have an additive effect when taken with other CNS depressants, such as alcohol.

A client experiencing ventricular dysrhythmias is admitted to the intensive care unit status post a myocardial infarction. The nurse should anticipate the healthcare provider to prescribe which medication?

Amiodarone Rationale: Amiodarone is the drug of choice for acute ventricular dysrhythmias associated with myocardial infarction.

A client receives a prescription for tetracycline (Sumycin). Which instruction should the nurse include in the client's teaching?

Avoid diary products for 2 hours after taking the medication Rationale: Dairy products should not be ingested until at least 2 hours after taking Sumycin because the calcium from the dairy binds with tetracycline and decreases the medication's absorption.

The nurse is planning discharge instructions for a client newly prescribed amitriptyline for depression. Which instruction is important for the nurse to include in the client's teaching?

Avoid the consumption of alcohol Rationale: Tricyclic antidepressants (TCAs) such as amitriptyline can cause sedation and should not be mixed with agents that depress the central nervous system, so the client should be instructed to avoid alcohol. The consumption of alcohol and TCAs interaction could worsen the client's depression; increased drunkenness and potentially cause death.

The mother of a newborn refuses to have her newborn administer the vitamin K injection. Which information should the nurse provide the mother?

Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract Rationale: Vitamin K is provided due to the fact the newborn does not have the intestinal flora to synthesize adequate vitamin K in the intestines at birth and vitamin K levels in breast milk are considered inadequate for the first 2-3 days of life. Vitamin K promotes the formation of clotting factors in the liver, and is routinely given by injection to prevention or treat hemorrhagic disease in the newborn.

A male client with meningitis is prescribed cefotaxime (Claforan) IV and asks the nurse why he cannot receive an oral drug, such as cefaclor (Ceclor) or cefadroxil (Duricef), that he has taken before for infections. How should the nurse respond when considering the actions of cephalosporins?

Cefotaxime (Claforan) provides therapeutic CNS concentrations Rationale: According to research studies, only third generation cephalosporins such as cefotaxime (Claforan), and ceftazidime have been shown effective in treating bacterial meningitis with the exception of cefuroxime, the only second generation cephalosporin shown to be effective. First generation cephalosporins have not been successful in the treatment of bacterial meningitis. IV administration of these antibiotics are preferred route of administration due to oral administration medication levels tend to be too low to be effective in comparison to parental administration.

A 48-year-old client is experiencing a severe anaphylactic reaction to an injection of contrast media. Which pharmacologic agent is of greatest use in this situation?

Epinephrine (Adrenalin) Rationale: Epinephrine is the drug of choice in treating hypotension and circulatory failure associated with anaphylaxis because it is a potent vasoconstrictor. An anaphylactic reaction is an acute systemic hypersensitivity reaction that occurs within minutes of antigen exposure (such as with contrast material containing iodine) that can result in peripheral vascular collapse.

While reviewing the client's electronic medical record (EMR), the nurse assesses a client who is at risk for a possible interaction with an over-the-counter (OTC) decongestant. Which client health history should the nurse report to the healthcare provider concerning the OTC medication? (Select all that apply.)

Chronic hypertension, Closed angle glaucoma Rationale: OTC decongestants can increase intraocular pressure and should be avoided in clients with closed angle glaucoma. Decongestants also can increase the heart rate and elevate blood pressure, which can impact the client's management of chronic hypertension.

The nurse should withhold which medication if a client reports nausea, vomiting, and diarrhea?

Colchicine (Mitigare, Colcrys) Rationale: Nausea, vomiting, and diarrhea are indicators of toxic effects of colchicine, which can be life-threatening, and if present, this drug should be withheld and the healthcare provider notified.

The nurse reviews the new prescription, phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI), for a client with depression on the psychiatric unit. Which information is most important for the nurse to assess?

Consumption of any alcohol or tyramine-rich foods Rationale: The consumption of any type foods containing tyramine such as aged cheeses, fermented fruits and vegetables, smoked or cured meats, dark wines and other alcoholic products should be avoided when a client is prescribed a MAOIs due to the a food-drug interaction causing a hypertensive crisis that can lead to a hemorrhagic stroke.

A client prescribed cyclosporine for the past nine months to prevent renal allograft rejection has a blood urea nitrogen level of 36 mg/dL. Which additional finding should the nurse notify the healthcare provider?

Creatinine level of 2.8 mg/dL Rationale: Acute organ rejection usually occurs in the first 3 months after transplantation or at any time if an infection develops. Cyclosporine (Sandimmune, Neoral, Gengraf), is a cytokine inhibitor used to prevent and treat organ rejection, which is manifested by elevated blood urea nitrogen (norm 10 to 20 mg/dL) and creatinine (norm 0.6 to 1.2 mg/dL).

A client is admitted for atrial fibrillation, and the healthcare provider prescribes disopyramide (Norpace). After explaining the action of this antidysrhythmic agent, which complaint should the nurse instruct the client to report?

Daily weight gain of 2 pounds Rationale: Disopyramide (Norpace) is a Class IA antiarrhythmic (with similar actions as procainamide) used to suppress and prevent premature ventricular contractions, episodes of ventricular tachycardia, atrial flutter, and atrial fibrillation. The nurse should instruct the client to report any sudden weight gain that may indicate fluid retention related to poor cardiac output, which may be the result of ineffective management of the dysrhythmia.

A client being treated with imipramine, an anti-depressant for chronic cancer pain asks the the nurse, "What is the reason for the antiepressant medication?" Which explanation should the nurse provide the client?

Decreases transmission of pain impulses by altering serotonin and norepinephrine activity at nerve synapses Rationale: Tricyclic antidepressants reduce neuropathic pain due to cancer invasion by blocking the reuptake of serotonin and norepinephrine in the central nervous system, therefore inhibiting the pain transmission in the spinal cord dorsal horn, which are part of the descending pain-modulating system.

Which side effects should the nurse monitor for a client who is receiving dexamethasone (Decadron) following neurosurgery? (Select all that apply.)

Delayed incisional wound healing, Increased weight gain, Mood swings, Serum hemoglobin level of 9 mg/dL Rationale: Dexamethasone (Decadron) is a long-acting glucocorticoid prescribed for neurosurgical procedures because it suppresses inflammation and has a low sodium-retaining ability, which is important in averting cerebral edema. The medication produces the following side effects: mood swings, increased appetite resulting in weight gain, hyperglycemia (serum glucose level above 120 mg/dL) that is related to the gluconeogenesis properties of corticosteroids, delayed wound healing related to immune suppression properties, and complete blood count resulting in a decreased in WBC and hemoglobin (less than 12 mg/dL). When a client is receiving dexamethasone, they should be monitored for these side effects.

The nurse should implement which action to provide analgesic titration for a client in pain?

Determine the optimal analgesic dosage required that causes the least side effects Rationale: No given dosage of an analgesic provides the same level of pain relief for every patient, and so titration upward or downward is determined based on the client's response, so that the optimal dosage achieves adequate pain relief with minimal side effects for the client. An individual's response to the medication dosage is the assessment for titration, and the titration dose should be implemented as long as analgesia is needed.

A pediatric client diagnosed with partial seizures receives a prescription for topiramate. Which information should the nurse provide to the child's parents?

Do not crush the tablet prior to administration Rationale: The tablet form of topiramate should be taken with adequate fluids and without breaking it because of its extremely bitter taste, so crushing the tablet should be avoided.

A client receives a prescription for sulfamethoxazole-trimethoprim (Septra) for a urinary tract infection (UTI). Which instruction should the nurse provide the client?

Drink at least 8 glasses of water a day Rationale: To decrease the risk of renal damage due to crystalluria associated with sulfamethoxazole, the client should be instructed to consume at least 8 glasses of water a day. To increase absorption, sulfamethoxazole should be given on an empty stomach.

The nurse is administering haloperidol 0.5 mg IM PRN to a client for the first time. What side effects should the nurse assess the client for during the initial dose?

Dystonia Rationale: Dystonia can be a sudden adverse reaction to this psychotropic medication, which should be discontinued to resolve dystonia, and the healthcare provider notified immediately.

The healthcare provider (HCP) prescribes a medication for an older adult client who is reporting insomnia, and the HCP instructs the client to return in two weeks. The nurse should question which prescription?

Eszopiclone (Lunesta) 10 milligrams orally at bedtime Rationale: The prescription for eszopiclone (Lunesta) 10 mg at bedtime is too high for this client. The dosing of this medication is usually a client is started off at 1 mg at bedtime and may advance up to 3 mg maximum if needed.

A client who is receiving chemotherapy is prescribed ondansetron (Zofran). Which side effect should the nurse include in the teaching plan?

Headache Rationale: Ondansetron, a serotonin antagonist, is the most effective antiemetic in suppressing nausea and vomiting caused by cancer chemotherapy-induced emesis or emetogenic anticancer drugs. Common side effects include headache, diarrhea, dizziness, and fatigue.

A client diagnosed with multiple sclerosis is experiencing profound weakness, blurry vision, and shooting pains in both legs. Which medication is considered the best course of treatment for the nurse to administer?

High dose methylprednisolone intravenously Rationale: Multiple sclerosis (MS) relapses are caused by inflammation in the central nervous system that damages the myelin coating around nerve fibers. The client is experience an acute exacerbation of MS, which is best managed with high dose steroids, such as methylprednisolone.

Which statement by a client warrants further instruction by the nurse about the changing insulin needs of a diabetic client during pregnancy?

I will increase my insulin dosage by 5 units each month during the first trimester Rationale: Insulin needs during pregnancy are determined individually according to the client's glucose levels. Insulin needs in the first trimester may actually decrease, so the client's statement about increasing her insulin dose, indicates the need for reteaching.

An older client is taking warfarin sodium (Coumadin) PO 2.5 mg twice a day. Which laboratory value should the nurse identify as a therapeutic response of the medication?

INR of 2-3 Rationale: Recommended INR ranges for clients on warfarin therapy is 2 to 3. Therapeutic anticoagulation using Coumadin should prolong the prothrombin time (PT) by 1.5 to 2 times the control value (a normal value is 10-20 seconds), (or 20% to 30% of the normal value, if percentages are used).

When assessing a client prior to the administration of digoxin (Lanoxin, APO-Digoxin), which data is most important for the nurse to consider?

Irregular apical pulse with a rate of 87 Rationale: The action of digoxin is to slow the heart rate and strengthen the force of contraction, so it is essential for the nurse to auscultate the apical pulse for a full minute and that the apical pulse is grater then 60 beats per minute for an adult or greater then 90 beats per minute for an infant prior to administration. If apical pulse is below the desired parameters, hold the dose and recheck the rate in one hour.

The nurse is teaching a client who is newly diagnosed with Type 1 diabetes about neutral protamine Hagedor (NPH) insulin. Which statement by the client indicates an understanding of how the medication works?

It facilitates the transport of glucose into the cells Rationale: Glucose moves across the cell membrane by using an active transport mechanism. Neutral protamine Hagedor (NPH), also known as isophane insulin, is classified as an intermediate-acting insulin that peaks 4 to 12 hours after the injection and is effective for 12 to 18 hours. The insulin acts as the carrier of glucose and is the only hormone that decreases blood glucose levels by facilitating transport of glucose into the cells.

A nurse is providing medication education for a client prescribed a beta-blocking agents for treatment of glaucoma. Which statement by the client demonstrates an understanding of the mechanism of the medication?

It inhibits the aqueous humor production Rationale: Beta-blockers are used to inhibit aqueous humor production, with the goal is to reduce intraocular pressure experience by clients diagnosed with glaucoma.

A client with chronic gouty arthritis prescribed allopurinol is experiencing an acute attack of gouty arthritis. The healthcare provider prescribes concurrent low-dose colchicine. Which information should the nurse provide the client that best explains the action of the colchicine?

It reduces inflammation at the affected site Rationale: Allopurinol (Zyloprim) improves joint function in chronic gouty arthritis by reducing blood uric acid levels to prevent and promote regression of tophi. Low-dose colchicine, an antiinflammatory agent specific for gout, is used concurrently with allopurinol, which can precipitate an incident of acute gouty arthritis.

A client newly prescribed esomeprazole for gastroesophageal reflux disease (GERD) asks the nurse how the medication will help. Which is the best explanation to provide the client?

It will promote rapid tissue healing Rationale: Esomeprazole is a proton pump inhibitor that inhibits gastric acid secretion and promotes the rapid healing of esophageal tissue.

A client with rheumatoid arthritis is receiving a prescription for minocycline (Minocin). Which side effect is most important for the nurse to instruct the client to report?

Loss of balance and dizziness Rationale: Minocycline (Minocin), a tetracycline antibiotic, is used to treat mild cases of rheumatoid arthritis and can cause damage to the vestibular part of the inner ear, so the client should report dizziness or difficulty maintaining balance.

A 38-year-old gravida 2 para 2 is diagnosed with bacterial vaginosis 9-months postpartum. A prescription is written for metronidazole (Flagyl). Which information is most important for the nurse to obtain from the client before initiating treatment?

Method of infant feeding Rationale: Flagyl is contraindicated if the woman is breastfeeding because high concentrations have been found in breast milk fed to infants. If Flagyl must be prescribed, the woman should be instructed to pump and discard the milk during treatment and for 48 to 72 hours after the last dose.

A client with Paget's disease is started on calcitonin (Calcimar) 500 mcg subcutaneously daily. During the initial treatment, what is the priority nursing action?

Observe the client for signs of hypersensitivity Rationale: Calcitonin is given to a client with Paget's disease to lower serum calcium levels. The nurse's highest priority is to observe for signs of hypersensitivity, such as skin rash, hives, or anaphylaxis. Upon initiation of treatment, emergency equipment should be readily available.

A client is diagnosed with peptic ulcer disease caused by Helicobacter pylori. Which medications should the nurse anticipate the healthcare provider to prescribe for the client? (Select all that apply.)

Omeprazole (Prilosec), Clarithromycin (Biaxin), Metronidazole (Flagyl) Rationale: Recommended medical treatment for a peptic ulcer caused by Helicobacter pylori includes the use of at least 2 different antibiotics and a proton pump inhibitor to decrease the incidence of antibiotic resistance.

A client experiencing pain from metastatic cancer is prescribed morphine. Which route of administration should the nurse clarify with the healthcare provider prior to administering the medication?

Oral Rationale: Morphine is a drug that has a first-pass effect occurs when hepatic metabolism decreases the bioavailability of a drug. Oral forms of medications are processed through the liver and undergo extensive biotransformation known as the first-pass effect in which some of the active ingredients is removed from the drug before it reaches the intended site of action.

A healthcare provider prescribes cefadroxil (Duricef) for a client with a postoperative infection. It is most important for the nurse to assess for what additional drug allergy before administering this prescription?

Penicillins Rationale: Cross-allergies exist between penicillins and cephalosporins, such as cefadroxil (Duricef), so checking for penicillin allergy is a wise precaution before administering this drug.

A client receives a new prescription for nitroglycerin (Nitrostat) tablets. Which instruction should the nurse include in this client's teaching?

Place under the tongue as needed every 5 minutes up to 3 times Rationale: The client should be instructed to place a tablet under the tongue every 5 minutes up to 3 times, and call 911 if the anginal pain is not relieved after the third tablet. Nitrostat tablets should be taken sublingually (SL), under the tongue, to avoid first-pass effect, and be taken at the onset of chest pain without delay to expedite oxygen flow to myocardial tissues.

A client prescribed furosemide for the past six months is scheduled to receive digoxin for heart failure. Which laboratory serum levels should the nurse review before administering the digoxin?

Potassium Rationale: The client's serum potassium levels should be evaluated before administered digoxin because furosemide can cause hypokalemia which increases the risk of digoxin toxicity and cardiac arrhythmias.

A client prescribed danazol (Danocrine) for endometriosis calls the clinic nurse and reports having a dark, swollen, and painful leg. Which instructions should the nurse provide the client?

Proceed to the closest emergency room Rationale: A dark, swollen, and painful leg is consistent with deep vein thrombosis (DVT), an adverse effect of danazol, so the client should be instructed to seek immediate emergency care.

A client prescribed sulfisoxazole for a urinary tract infection (UTI) reports nausea and gastric upset since starting the medication. Which additional assessment finding should the nurse report to the healthcare provider immediately?

Rash Rationale: Side effects of sulfisoxazole include possible allergic response manifested by skin rash and itching that can progress to Stevens-Johnson syndrome, erythema multiforme, a severe hypersensitivity reaction. Gastrointestinal disturbances such as diarrhea, crystalluria, and photosensitivity are additional side effects that commonly occur with "sulfa" agents, but do not indicate a discontinuation of the prescription.

A client receives a new prescription for an angiotensin-converting enzyme (ACE) inhibitor. Which client history contraindicates its use?

Renal artery stenosis Rationale: Angiotensin-converting enzyme (ACE) inhibitors can cause severe renal insufficiency in clients with bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney.

A resident of a long-term care facility is taking lithium carbonate (Eskalith) to treat bipolar disorder. Which instruction should the nurse provide to this client's caregivers?

Report symptoms of hypothyroidism such as fatigue and constipation Rationale: Lithium carbonate (Eskalith) causes hypothyroidism in 1 to 4% of those clients receiving the medication, so caregivers should assess for signs of hypothyroidism, including fatigue and constipation (early signs) and myxedema or goiter (late symptoms).

A client receives a new prescription for pentazocine (Talwin), a mixed opioid agonist-antagonist, after an opioid agonist is discontinued. What is the advantage for the client when the new prescription is implemented?

Respiratory depression is less Rationale: Mixed agonist-antagonists bind as an agonist at the Kappa receptor and as antagonists or partial agonists on the mu receptor, which produces less respiratory depression than opioid agonists that are pure mu agonists.

The nurse receives a unit of blood from the blood bank for a postoperative client who is currently in the X-ray department. Which action should the nurse implement?

Return the blood to the blood bank for refrigeration within 30 minutes Rationale: A blood transfusion should be hung for administration within 30 minutes of its arrival from the blood bank. If it is not going to be used within that time frame, it must be returned to the blood bank for refrigeration. Waiting until the client returns to the unit is unpredictable, and the delay to hang the blood within the 30 minutes can contribute to contamination and infection.

The nurse is providing medication teaching for a client who recently received a prescription for clozapine (Clozaril). Which instruction should be included in this client's teaching plan?

Rise slowly from a lying position Rationale: Orthostatic hypotension is a side effect of Clozaril, so the client should be instructed to rise slowly from a lying down or sitting position.

A client prescribed a statin and gemfibrozil (Lopid) for hyperlipidemia reports an onset of muscle pain and weakness. Which assessment is most important for the nurse to evaluate?

Serum liver enzymes Rationale: Concomminent use of gemfibrozil and statins can cause muscle weakness and wasting known as myopathy, which is reflected in serum liver function enzymes, such as elevated serum aspartate aminotransferase (AST or SGOT) that is also found in skeletal muscle.

An emergency department triage nurse is interviewing a female client who has a history of epilepsy with tonic-clonic seizures controlled by phenytoin (Dilantin). Which information is most significant in planning this client's care?

She ran out of her medication 4 days ago Rationale: Abruptly stopping anticonvulsant medications can precipitate seizures or the development of status epilepticus. Immediate seizure precautions and medication administration are necessary.

A client calls the clinic and states that she forgot to take her oral contraceptives for the past two days. Which instruction is best for the nurse to provide to this client?

Take 2 pills a day for 2 days and use an alternate method of contraception for 7 days Rationale: If two pills are missed in a roll, the client should take 2 pills a day for two days and used an alternative form of birth control for seven days.

A client is diagnosed with peptic ulcer disease and receives a prescription for esomeprazole (Nexium) 20 mg capsule daily. When providing this client with discharge teaching, the nurse should include which instruction?

Take at same time each day one hour before eating a meal Rationale: Nexium, a proton pump inhibitor (PPI), is a first-line agent for symptomatic GERD that poorly responds to other acid reducing drugs, such as H2 antagonists. Nexium is most effective when taken 30 to 60 minutes before a meal.

The nurse is planning discharge instructions for a client prescribed pyridostigmine bromide tablets for myasthenia gravis (MG). Which instruction should the nurse include in the instructions?

Take the medication 30 to 45 minutes before eating. Rationale: Mestinon, an acetylcholinesterase inhibitor, increases the amount of neuromuscular transmitters to promote muscular strength and swallowing, so the client should be instructed to take the medication at least 30 minutes before meals.

A client who is recently diagnosised with myasthenia gravis receives a prescription for pyridostigmine (Mestinon), a cholinergic agent. Which information should the nurse instruct the client to implement when taking this medication?

Take the medication at least 30 minutes before eating meals Rationale: The nurse should instruct the client to take the medication 30 minutes before meals with an empty stomach, which allows for the onset of action and therapeutic effects to be present during the meal to help improve swallowing and chewing. The doses should also be spaced evenly apart to optimize the effects of the medication.

A client with chronic pancreatitis receives a new prescription for pancrelipase (Pancrease). Which instruction is most important for the nurse to include in this client's teaching?

Take the medication when consuming food Rationale: With the loss of exocrine function for a client with chronic pancreatitis, replacement of pancreatic enzymes using pancrelipase (Pancrease) becomes necessary. Diarrhea and steatorrhea (fatty stools) indicate insufficient pancreatic enzymes are present to digest dietary fats and other of nutrients, so pancrelipase, a fat-digesting enzyme, should be consumed with any type of food.

What teaching should the nurse provide a client who has received a new prescription for sildenafil (Viagra)? (Select all that apply.)

Take within 30 to 60 minutes of sexual stimulation, Can cause facial flushing and headache, Report rebound priapism that occurs for 4 hours or more Rationale: Sildenafil (Viagra) enhances the natural response to sexual stimuli, so a client should be instructed to take Viagra within 30 to 60 minutes before sexual intercourse to provide adequate time to enhance penile erection. Sildenafil does not cause erection directly, but priapism can occur and should be reported to the healthcare provider if it persists. Common side effects include headaches, facial flushing, and diarrhea. Viagra can potentiate vasodilators, such as alpha-adrenergic blockers, nitroglycerin, and other nitrates used for angina pectoris, and may cause hypotension, which decreases perfusion to vital organs.

A client's prescription of prednisone for the management of asthma is to be discontinued. Which information is important for the nurse to give the client?

The dose of the medication should be tapered over the course of 7 to 10 days Rationale: To minimize the impact of adrenal insufficiency, withdrawal of exogenous glucocorticoids should be done by gradually decreasing the dosage over several days because it can cause life-threatening adrenal insufficiency if abruptly terminated.

The healthcare provider prescribes oral antifungal therapy for a client with onychomycosis. Which information should the nurse provide the client?

The infection is difficult to eradicate and requires prolonged therapy for 3 to 6 months Rationale: Treatment of onychomycosis, a fungal infection of the fingernails and toenails, is difficult to treat and requires prolonged therapy of 3 to 6 months for oral antifungal therapy.

A nurse is planning a teaching session for a client newly prescribed a miotic drug for the treatment of glaucoma. Which information should the nurse include in the teaching session?

The medication enhances the aqueous humor outflow Rationale: Miotic drugs act to enhance aqueous outflow through papillary constriction with the goal to reduce intraocular pressure experience by clients diagnosed with glaucoma.

A client at 30-weeks gestation in labor receives two 12 mg doses of betamethasone intramuscularly 12 hours apart. The client asks the nurse why she is receiving the betamethasone. Which explanation should the nurse give the client?

The medication stimulates fetal surfactant production Rationale: Antenatal glucocorticoids, such as betamethasone, are given IM to the mother to stimulate surfactant production in the fetus and accelerate fetal lung maturity, in the event the fetus is delivered prematurely to minimize respiratory distress syndrome associated with premature infants.

The nurse administers the initial dose of a fentanyl (Duragesic) transdermal patch to a client. Which assessment finding should the nurse use to evaluate the effectiveness of the medication?

The number on the numeric pain scale Rationale: Transdermal fentanyl is an opioid analgesic and has an onset and peak action of 6 to 12 hours after the initial dose. To evaluate the effectiveness of the medication the nurse should determine the client's level of pain before application and then throughout the next 12 hours for pain relief.

Which findings should the nurse identify in an adult client with possible chronic salicylate intoxication?

Tinnitus and hearing loss Rationale: The most frequent manifestations of chronic salicylate intoxication in adults are tinnitus and hearing loss.

An end-stage terminally ill client being cared for at home is receiving morphine via a patient-controlled pump for intractable cancer pain. When the hospice nurse visits, the client awakens, moans in severe pain, and asks for an increase in the morphine dosage. The client's heart rate is 80 beats/minute, respirations are 10 breaths/minute, and the blood pressure is 102/68 mmHg. Which is the best action for the nurse to implement?

Titrate the morphine dose upward until the client has adequate pain relief Rationale: Tolerance can occur in a client who requires large doses of opioids for intractable pain management, and an increased titration of the analgesic or an additional drug in the same or a different classification may provide more effective pain management. The client's basic need for comfort during the last stages of a terminal malignancy is the main priority for this hospice client.

The nurse is preparing to administer esomeprazole to a client for the management of gastroesophageal reflux disease (GERD). Which finding in the client's history should the nurse hold the medication and notify the healthcare provider?

Treatment for deep vein thrombosis Rationale: Esomeprazole, a proton pump inhibitor (PPI), may increase the chance of bleeding in a client who is taking both a PPI and warfarin (Coumadin), which is used in the treatment of deep vein thrombosis (DVT). The healthcare provider should be informed of the client's recent history and treatment for deep vein thrombosis (DVT) prior to giving Nexium.

A client prescribed risperidone 10 mg/day for the past three months is being admitted to the hospital. Which physical assessment findings should the nurse report to the healthcare provider?

Tremors and muscle twitching Rationale: For a client with chronic mental illness, evidence-based pharmacological guidelines recommend first-line treatment using an atypical antipsychotic, such as risperidone (Risperdal). Risperidone can cause extrapyramidal symptoms (EPS) with dosages at or above 10 mg/day. Tardive dyskinesia movements, include twitches and uncontrollable movement of the facial, oral, tongue, teeth, and other akinesias of the trunk and extremities, such as tremors and muscle twitching.

A client is beginning therapy with montelukast (Singulair) PO 10 mg once a day in the evening. The client asks the nurse, "When should I begin to feel better?" How should the nurse respond?

Within 24 hrs Rationale: Maximal effects of montelukast (Singulair) develop within 24 hours after initiating the first dose.

The nurse is performing a physical assessment for a client who received fentanyl via an epidural infusion eight hours ago. Which finding should the nurse anticipate?

Urinary retention Rationale: Anticipated common side effects of epidural opioids within th efirst 24 hours include nausea, itching, and urinary retention which may require urinary catheterization.

A client is prescribed cefadroxil (Duricef) for a urinary tract infection. The client informs the nurse that she is currently taking oral contraceptives (OCP). Which client information should the nurse provide?

Use an additional form of contraception until your menstrual cycle Rationale: Cephlasporins such as cefadroxil can decrease the efficacy of oral contraceptives, so the client should be instructed to use an additional form of contraception.

A client is administered an injection of medroxyprogesterone acetate (Depo-Provera). Which physical finding should the nurse instruct the client is an expected side effect of the medication?

Vaginal bleeding or spotting Rationale: Approximately 3 to 7 days after the last cyclic dose of medroxyprogesterone, a client may experience withdrawal vaginal bleeding or spotting.

A client who is diagnosed with methillicin-resistant Staphylococcus aureus receives a prescription for vancomycin (Vancocin). Which assessment should the nurse perform to identify a potential adverse effect?

Whisper test Rationale: The most serious adverse effect of vancomycin is ototoxicity, which often causes irreversible, permanent impairment. So, a whisper test determines the presence of early hearing impairment.

A client prescribed ipratropium reports nausea, blurred vision, headaches, and insomnia after using the inhaler. Which action should the nurse implement first?

Withhold medication and report symptoms and vital signs to healthcare provider Rationale: Headache, nausea, blurred vision, and insomnia are symptoms of excessive use of ipratropium. Withholding the medication until the healthcare provider is notified should be initiated to maintain client safety.

A client receives a new prescription for ciprofloxacin (Cipro), a synthetic quinolone. When teaching about this drug, which information in the client's history requires special emphasis by the nurse?

Works twenty hours a week as a lifeguard at the local pool Rationale: Cipro can cause both dizziness and photosensitivity. Since the client works as a lifeguard outdoors, measures related to these adverse effects should be addressed.