Pharm Elevate

he nurse is planning to teach a group of young women who want to become pregnant. What information should be included as recommendations to increase the chances of having a healthy baby? Select all that apply 1. Take 400 micrograms of folic acid every day. 2. Limit alcohol to 1 glass per day. 3. Avoid smoking. 4. Take the flu vaccine during flu season. 5. Start prenatal care by 3 months of pregnancy

1., 3., & 4. Correct: Folic acid is a B vitamin. If a woman has enough folic acid in her body at least a month before and during pregnancy, it can help prevent neural tube defects. Smoking can lead to premature birth, cleft lip or cleft palate, and infant death. The flu shot given during pregnancy has been shown to protect mom and baby (up to 6 months old) from flu. 2. Incorrect: When a woman drinks alcohol, so does her unborn baby. This can cause the baby to be born with fetal alcohol spectrum disorder.5. Incorrect: A woman should be certain to see her healthcare provider when planning pregnancy and start prenatal care as soon as she thinks she is pregnant.

An elderly client diagnosed with Alzheimer's disease has become combative, restless and wanders at night. The nurse contacts the primary healthcare provider for medication to help the client rest. The nurse knows the best choice for this client is what medication? 1. Chlorpromazine 2. Hydroxyzine 3. Haloperidol 4. Diazepam

3. CORRECT: Haloperidol is a mild antipsychotic used to treat either mental or mood disorders, including uncontrollable movements and emotional outbursts. This drug is relatively safe for elderly clients and can be used at bedtime to enhance rest. 1. INCORRECT: Chlorpromazine is a low-potency, antipsychotic medication with both sedative and anticholinergic properties. However, this drug works best with consistent multiple daily doses rather than a once time dose and has too many side effects for this elderly client. 2. INCORRECT: Hydroxyzine is an antihistamine occasionally used as an antianxiety or for sedation; however, hydroxyzine has no real effect on combative or agitated behavior. 4. INCORRECT: Diazepam is an antianxiety medication but is not appropriate for elderly clients because of the potential for paradoxical response, such as excitation or delirium.

What actions should the nurse take when administering fentanyl? Select all that apply 1. Remove old fentanyl patch prior to applying new patch. 2. Cleanse area of old fentanyl patch. 3. Shave hair where fentanyl patch will be applied. 4. Place fentanyl patch over dry skin. 5. Apply adhesive dressing over the fentanyl patch. 6. Dispose of fentanyl patch in trash.

1., 2., & 4. Correct: These are correct actions. Apply patch to dry, hairless area of subcutaneous tissue, preferably the chest, abdomen, or upper back. The old patch should be removed prior to applying a new patch so that too much medication is not given. This is also why the old site should be cleaned. The patch should be placed on dry skin. Do not place over emaciated skin, irritated or broken skin, or edematous skin. 3. Incorrect: Do not shave area where patch will be applied and do not apply over dense hair areas. If there is hair on the skin, clip the hair as close to the skin as possible, but do not shave. 5. Incorrect: Do not apply adhesive dressing over patch. It can interfere with absorption. If the patch comes loose, you may tape the edges and remove and apply a new patch. 6. Incorrect: Dispose of fentanyl patch in sharps container. Fentanyl patches that have been worn 3 days still contain enough medication to cause serious harm to adults and children.

A client who has been taking phenytoin for several years arrives to the clinic for follow-up care. During the nurse's history and physical of the client, which findings indicate a possible side effect to the phenytoin? Select all that apply 1. Skin rash 2. Reports fatigue 3. Dyspnea on exertion 4. Pale conjunctiva 5. Heart rate 60/min

1., 2., 3.,& 4. Correct: An adverse effect of phenytoin is aplastic anemia. Phenytoin is an anticonvulsant. Aplastic anemia is a blood disorder where not enough new blood cells are produced in the bone marrow. The blood cells include red blood cells, white blood cells and platelets. The most common symptom of decreased RBC's is fatigue and dyspnea upon exertion because RBC's are responsible for oxygen transport throughout the body. A common sign/symptom of aplastic anemia is also skin rashes. Collectively, these are signs/symptoms of aplastic anemia caused by this medication. 5. Incorrect: This is a normal heart rate, and there is no concern for vital signs within normal limits.

A client diagnosed with Addison's disease has been prescribed prednisolone. Which statement by the client indicates that the client's medication instructions for prednisolone have been effective? 1. "I should avoid foods high in protein." 2. "I will take prednisolone in the morning." 3. "I need to schedule an eye examination every 2 years." 4. "Infections will be reduced while taking prednisolone."

2. Correct: If prednisolone is prescribed once a day, the medication should be taken in the morning. The body's production of cortisone is at a higher level in the morning. The cortisone prescription if taken in the morning will affect the pituitary-adrenal feedback less. 1. Incorrect: Side effects of corticosteroid therapy include decreased muscle mass and wound healing. Clients should be encouraged to consume a diet high in protein. Protein aids the body in repairing damaged tissues. 3. Incorrect: Yearly eye examinations are recommended. Prolonged prescription of prednisolone can result in cataracts and glaucoma. The yearly eye examination is necessary to monitor the client's eyes for any vision changes. 4. Incorrect: Infections will not be reduced while taking prednisolone. Prednisolone is an anti-inflammatory and immune system suppressant. There will be a decrease client's immune system and increase in masking infection symptoms.

The nurse is caring for a client diagnosed with Addison's disease. Which finding would indicate to the nurse that a client has received excessive mineralocorticoid replacement? Select all that apply 1. Oily skin 2. Weight gain of 4 pounds in one week 3. Loss of muscle mass in extremities 4. Blood glucose of 58 mg/dL 5. Serum potassium of 3.2 mEq

2., & 5. Correct: Remember that aldosterone is a mineralocorticoid, which causes the client to retain sodium and water. Retaining sodium and water will cause the client's weight to increase. Also remember, any sudden gain in weight is due to water retention. Too much aldosterone makes you retain too much sodium and water and lose potassium. Normal potassium is 3.5-5.0 mEq/L, so a lowering of potassium could indicate high levels of aldosterone.1. Incorrect: Oily skin would be seen with an increase in sex hormones such as testosterone and estrogen. Oily skin is not common with mineralocorticoids like aldosterone.3. Incorrect: Too many glucocorticoids will cause the breakdown of protein and fat but muscular weakness and increased fatigue is seen with too little mineralocorticoids.4. Incorrect: Too many glucocorticoids will inhibit insulin, causing the serum blood glucose level to go up. Normal blood glucose is 70-110.

The nurse is caring for a heart failure client taking spironolactone. Which snack choices would indicate to the nurse that the client understands proper dietary choices while on this medication? Select all that apply 1. Bananas 2. Cheese and crackers 3. Apples 4. Sweet potatoes 5. Grapes

3. & 5. Correct: Apples and grapes are low in sodium and potassium. Spironolactone is a potassium sparing diuretic. The client with heart failure needs to limit sodium and potassium. 1. Incorrect: The action of spironolactone is to inhibit the reabsorption of sodium in the kidney while saving potassium. It is a diuretic so the client will lose water. Bananas are high in potassium.2. Incorrect: Cheese and crackers are high in sodium. Spironolactone is given to lower BP and decrease fluid. Foods high in sodium should be limited. 4. Incorrect: The action of spironolactone is to inhibit the reabsorption of sodium in the kidney while saving potassium. It is a diuretic so the client will lose water. Sweet potatoes are high in potassium.

The nurse is caring for a client admitted with an episode of bleeding esophogeal varices. What should the nurse monitor for after administering propranolol to this client? Select all that apply 1. Increased systolic BP 2. Hypokalemia 3. Bradycardia 4. Wheezing 5. Decreased hematemesis

3., 4., & 5. Correct: Propranolol is a beta blocker that affects the heart and circulation. It is used in the treatment of high blood pressure, irregular heartbeats and in the prevention of angina and headaches. This medication works by blocking epinephrine and reduces heart rate, blood pressure and strain on the heart. Decreasing the heart rate should decrease bleeding. Wheezing is an adverse reaction from propranolol and should be monitored for after administration. A decreased in heart rate and blood pressure will help to decrease bleeding. Hematemesis is vomiting blood.1. Incorrect: Blood pressure is the force of blood flow against the walls of your arteries. Propranolol should decrease blood pressure, thus decreasing bleeding.2. Incorrect: Beta blockers inhibit renin release which can decrease the release of aldosterone. We should monitor for hyperkalemia, rather than hypokalemia.

A client arrives at the crisis center and reports stopping daily lithium because of pregnancy. What response by the nurse is most accurate? 1. "Are you positive that you are actually pregnant?" 2. "Lithium is perfectly safe throughout pregnancy." 3. "The psychiatrist can change you to another medication that is safe." 4. "It may be worse to suddenly stop the medication than to take the medication."

4. CORRECT: Lithium is most often used to treat manic-depression. Suddenly stopping the medication could cause the client to relapse, experiencing worse symptoms than previously. It may also be more difficult to get those symptoms under control again if the client has stopped this drug suddenly. The client and primary healthcare provider would need to weigh the benefits of the medication vs the possible birth defects attributed to the use of lithium during pregnancy. 1. INCORRECT: While this is a valid question by the nurse, there is a greater concern at this point. The client's pregnancy status can be verified at any time. 2. INCORRECT: This statement by the nurse is not correct. Specific birth defects have been attributed to the use of lithium during pregnancy. 3. INCORRECT: The psychiatrist would need to be notified that client has stopped the medication. However, there are very few medications for bipolar disorder that would also be completely safe during pregnancy.

The nurse is caring for a client with tuberculosis receiving isoniazid therapy. Because of the possible peripheral neuropathy that can occur, which supplementary nutritional agents would the nurse expect to administer? 1. Cyanocobalamin 2. Vitamin D 3. Ascorbic acid 4. Pyridoxine

4. Correct: Isoniazid interferes with vitamin B6 (pyridoxine) metabolism by inhibiting the formation of the active form of vitamin B6. This interference often results in peripheral neuropathy. 1. Incorrect: Vitamin B12 (Cyanocobalamin) is not given to prevent peripheral neuropathy caused from isoniazid therapy. It is used to treat vitamin B12 deficiency often caused by pernicious anemia. It may be given in client's with peripheral neuropathy, but is not beneficial in clients whose neuropathy is due to isoniazid therapy. 2. Incorrect: Vitamin D is not given to prevent peripheral neuropathy. It is used in the treatment of weak bones, bone pain and/or bone loss.3. Incorrect: Vitamin C is not given to prevent peripheral neuropathy cause from isoniazid therapy. It's use can be beneficial in clients with diabetic peripheral neuropathy.

The nurse is reviewing medications for a client who is being treated for major depression. The client is prescribed a selective serotonin reuptake inhibitor (SSRI). Which over the counter medication/supplement taken by the client should be reported to the primary healthcare provider immediately? 1. Daily intake of St. John's Wort. 2. Daily intake of a multi-vitamin. 3. Occasional use of ibuprofen. 4. Twice daily intake of an antacid.

1. Correct: St. John's Wort is an herbal supplement often used in the treatment of mild depression. It should not be taken in combination with a selective serotonin reuptake inhibitor due to the risk of serotonin syndrome, which can be fatal.2. Incorrect: A multi-vitamin taken with an SSRI poses no risk.3. Incorrect: This medication taken with the SSRI would not warrant immediate reporting to the primary healthcare provider.4. Incorrect: Antacids would not require immediate reporting.

A client diagnosed Alzheimer's disease has been prescribed memantine. What should the nurse teach the caregiver about this medication? Select all that apply 1. When beginning this medication provide ambulatory assistance. 2. This medication is prescribed to help improve mild dementia. 3. This medication must be taken without food. 4. If a dose is missed, double the next dose. 5. If the client cannot swallow the capsule you sprinkle on applesauce.

1. & 5. Correct: This medication can cause dizziness, so safety precautions should be taught to the caregiver. Extended release caps should not be crushed, chewed, or divided. If the client cannot swallow it whole, it can be opened and sprinkled on a small amount of applesauce. 2. Incorrect: Memantine is used for moderate to severe dementia associated with Alzheimer's disease. 3. Incorrect: Memantine can be taken with or without food. 4. Incorrect: If the client misses a single dose of memantine, that client should not double up on the next dose. The next dose should be taken as scheduled.

The client has been taking divalproex for the management of bipolar disorder. The nurse should give priority to monitoring which laboratory test? 1. Alanine aminotransferase (ALT) 2. Serum glucose 3. Serum creatinine 4. Serum electrolytes

1. Correct: ALT levels will increase primarily in liver damage/disorders. A side effect of administering divalproex is drug-induced hepatitis. 2. Incorrect: Divalproex is not expected to alter glucose metabolism. 3. Incorrect: Divalproex should not cause a change in renal function. 4. Incorrect: Divalproex should not interfere with electrolytes balance.

A client has been instructed not to take non-steroidal anti-inflammatory drugs (NSAIDs) post lumbar laminectomy with spinal fusion. The nurse knows that education was successul when the client identifies which medications should be avoided? Select all that apply 1. Celecoxib 2. Ibuprofen 3. Naproxen 4. Acetaminophen 5. Indomethacin

1., 2., 3. & 5. Correct: NSAIDs, such as celecoxib, ibuprofen, naproxen, and indomethacin prevent platelet aggregation. This can result in a tendency for bleeding that interferes with healing after a laminectomy with spinal fusion surgery. 4. Incorrect: Acetaminophen is a peripheral-acting analgesic and not a non-steroidal anti-inflammatory drug.

The nurse is caring for a client on the cardiac unit. Which assessments are most important for the nurse to perform prior to the administration of diltiazem? Select all that apply 1. Note the rate and character of the apical pulse. 2. Ausculate the anterior and posterior breath sounds. 3. Check the morning results of serum calcium. 4. Review the last 24 hour urine output. 5. Monitor blood pressure. 6. Assess for chest pain.

1., 5., & 6. Correct: Diltiazem is a calcium channel blocker. It works by relaxing the muscles of the heart and blood vessels. Monitor blood pressure and pulse before and frequently during administration of diltiazem, as it causes systemic vasodilation and suppresses arrhythmias. Diltiazem is used to treat angina, so the nurse should assess for anginal pain.2. Incorrect: Breath sounds need to be assessed to monitor for signs of heart failure, this would be a complication after diltiazem administration. Breath sounds are not necessarily assessed just prior to administration.3. Incorrect: Diltiazem is a calcium channel blocker, but the total serum calcium concentration is not affected by it. Calcium channel blockers affect the flow of calcium into muscle cells. 4. Incorrect: A decrease in output would be an indicator of heart failure, which is a complication of diltiazem administration. This would be assessed after giving the medication.

The nurse educates a client that the prescribed medication indomethacin is used to manage which symptoms? Select all that apply 1. Pain 2. Inflammation 3. Fever 4. Cough 5. Urticaria

1.,2., & 3. Correct: Indomethacin is a non-steroidal anti-inflammatory agent used to treat pain, inflammation, and fever. 4. Incorrect: Indomethacin does not have any cough suppressant actions.5. Incorrect: Urticaria is a side-effect associated with indomethacin use.

During a physical assessment of a client who was started on haloperidol 5 days ago, the nurse notes restlessness, muscle weakness, drooling, and a shuffling gait. What should be the nurse's first action? 1. Hold the next haloperidol dose. 2. Administer the prn benztropine mesylate. 3. Notify the primary healthcare provider to discontinue the haloperidol. 4. Draw a blood sample for drug level.

2. Correct: Benztropine mesylate is an anticholinergic that counteracts the extrapyramidal symptoms (EPS) seen with the use of haloperidol. 1. Incorrect: Holding a single dose of haloperidol does not correct the extrapyramidal symptoms. 3. Incorrect: The primary healthcare provider has prescribed benztropine mesylate to combat the side effects of the haloperidol. There is no need to notify the primary healthcare provider, which will delay treatment. 4. Incorrect: The client is showing extrapyramidal symptoms associated with haloperidol therapy. Benztropine mesylate is an anticholinergic agent that can be used to treat the extrapyramidal effects that may be seen as a side effect of haloperidol therapy.

A client diagnosed with new onset atrial fibrillation has been prescribed dabigatran. What should the nurse teach this client? Select all that apply 1. Place medication in a weekly pill organizer so that medication is not forgotten. 2. Do not take with clopidogrel. 3. Dabigatran decreases the risk of stroke associated with atrial fibrillation. 4. Take this medication with food. 5. aPTT and INR levels will be drawn monthly.

2., 3., & 4. Correct: Do not take dabigatran with any other anticoagulants, including clopidogrel due to increased bleeding risk. Dabigatran decreases the risk of stroke and systemic embolism in clients with atrial fibrillation that is not associated with a cardiac valve problem. Take this medication with food to decrease gastric side effects such as dyspepsia and gastritis. Proton pump inhibitors and histamine 2 recepter blockers may also decrease gastric side effects. 1. Incorrect: After container is opened, medication should be used within 30 days. It is sensitive to moisture and should not be stored in weekly pill organizers. To maintain efficacy, keep medication in manufacturer- supplied bottle. 5. Incorrect: This medication does not require monitoring of INR levels. However, the client should be informed about the risk of bleeding and to monitor for signs of bleeding.

The nurse is caring for a trauma client who is receiving a unit of whole blood. The client begins to experience lower back pain. What actions should the nurse take? Select all that apply 1. Administer diphenhydramine. 2. Collect a urine specimen. 3. Stop the transfusion. 4. Take the client's vital signs. 5. Change the IV tubing

2., 3., 4., & 5. Correct: Assume the worst, and stop the transfusion first, then continue with the assessment. Low back pain is a sign of an acute hemolytic reaction. This is the most dangerous and potentially life-threatening type of transfusion reaction. It occurs when the donor blood is incompatible with that of the recipient. Get lab tests such as a urinalysis to check for presence of hemoglobin, which indicates hemolytic reaction. Take vital signs. Change IV tubing to remove all blood and maintain the IV line with normal saline solution, with new IV tubing, at a slow rate. 1. Incorrect: Diphenhydramine is indicated for an allergic reaction to the blood component being transfused. It is not indicated for a hemolytic reaction.

A psychiatric nurse is completing an assessment on an elderly client being started on a tricyclic antidepressant. The nurse is aware the most crucial aspect of this assessment is evaluating what body system? 1. Endocrine 2. Nervous 3. Circulatory 4. Digestive

3. CORRECT: Tricyclic antidepressants can cause arrhythmias, changes in heart rate, and blood pressure fluctuations including orthostatic hypotension. A client's cardiovascular status should always be evaluated prior to starting this category of medication to determine the presence of pre-existing cardiac conditions. 1. INCORRECT: Blood glucose levels may become elevated while using this category of antidepressants, but hyperglycemia can be treated and controlled if the client responds well to the medication. This is not of greatest concern to the nurse. 2. INCORRECT: Tricyclics increase body levels of norepinephrine and serotonin, and the client may experience drowsiness or even blurred vision. The nurse will teach the client about safety precautions prior to discharge, but this is not the chief concern. 4. INCORRECT: Although tricyclic antidepressant medication may increase appetite, cause constipation and weight gain, these are expected side effects and not of major concern.

A nurse is preparing to administer an insulin infusion to a client. The nurse calculates the infusion pump setting as 9 mL/hr. What should the nurse do next? 1. Administer the calculated medication dosage. 2. Call the primary healthcare provider to clarify the dosage. 3. Ask another nurse to calculate the dosage. 4. Notify pharmacy of the pump setting for the calculated dosage.

3. Correct: Insulin is a high alert drug and must be double checked by another nurse before it is administered. High alert drugs that could have significant side effects if administered improperly. 1. Incorrect: Insulin is a high alert drug and must be double checked by another nurse before it is administered. High alert drugs that could have significant side effects if administered improperly. 2. Incorrect: Calling the primary healthcare provider is inappropriate. The nurses are trained to properly calculate this drug calculation problem. 4. Incorrect: The nurse will calculate the infusion rate and then have a second nurse verify the rate. There is no reason to notify pharmacy.

What action by a new nurse who is drawing up a medication from an ampule would require intervention by the supervising nurse? 1. Taps the top of the ampule to remove medication trapped in the top of the ampule. 2. Snaps the neck of ampule away from the body when breaking the top off. 3. Withdraws medication using a 22 gauge needle. 4. Inverts ampule, places needle tip in liquid, and withdraws all of the medication.

3. Correct: This action should be corrected by the supervising nurse. Because tiny pieces of glass could have gotten into the medication, the nurse should attach a filter straw to a syringe. If the syringe has a needle in place, the nurse should remove both the needle and the cap and place it on a sterile surface (e.g., a newly unwrapped alcohol pad still in the open wrapper), and then attach filter straw. 1. Incorrect: This is a correct action by the new nurse. Alternatively, the new nurse can flick the top or shake the ampule by quickly turning and "snapping" the wrist. 2. Incorrect: This is a correct action by the new nurse. This will prevent shattering of class toward the hand or face. 4. Incorrect: This is a correct action by the new nurse. Two techniques can be used to withdraw medication from an ampule. The nurse can invert the ampule, place the filter straw tip in the liquid, and withdraw all of medication. The nurse does not insert the filter straw through the medication into the air at the top of the inverted ampule. This will result in medication leaking out of the ampule. Alternatively, the nurse can tip the ampule, place the filter in the liquid, and withdraw all of the medication.

What should the nurse include when teaching a client diagnosed with Grave's disease who is scheduled to receive radioactive iodine? Select all that apply 1. Stay 6 feet from people for 2 weeks. 2. This medication is given intravenously as a one-time dose. 3. Radioactive iodine will leave the body in urine and saliva within a few days. 4. You cannot receive radioactive iodine if you are pregnant. 5. Radioactive iodine is absorbed by the parathyroid glands.

3., & 4. Correct: Within a few days after treatment, the radioactive iodine will leave the body in urine and saliva. If the client is pregnant, she should not receive radioactive iodine treatment. This kind of treatment can damage the fetus's thyroid gland or expose the fetus to radioactivity. Women should wait a year before conceiving if they have been treated with radioactive iodine. 1. Incorrect: Stay away from babies for 1 week and do not kiss anyone for 1 week. 2. Incorrect: Radioactive iodine is given in a capsule or liquid form. One dose is usually all that is needed. 5. Incorrect: Radioactive iodine is absorbed by the thyroid gland. It destroys the thyroid. So now the client becomes hypothyroid.

A child with acute lymphocytic leukemia (ALL) is receiving chemotherapy through a single lumen Groshong catheter. During the infusion, the child reports nausea and has vomited. The primary healthcare provider has prescribed ondansetron IV. What action should the nurse take? 1. Ask primary healthcare provider for an oral antiemetic. 2. Give ondansetron IVPB with the chemotherapy. 3. Wait until chemotherapy is complete to infuse ondansetron. 4. Stop chemotherapy temporarily and flush line to give ondansetron.

4. Correct: A Groshong catheter is implanted when other venous access sites are no longer useable. The child has begun to react to the chemotherapy and needs medicated now. Because this implanted device has only one lumen, the nurse must stop the chemotherapy infusion temporarily, flush the port, administer the ondansetron, flush again and restart the chemotherapy infusion. 1. Incorrect: Because this client is vomiting, changing the medication to the oral route would not be effective. The medication takes longer to work if given orally, which means the client may vomit again before the medication activates, losing part of the dose. 2. Incorrect: Chemotherapy infusions should not be mixed with other categories of drugs, such as an antiemetic, because of the possibility of drug interactions. Certain chemical mixtures could also cause precipitates to form in the tubing, which is dangerous to the child. 3. Incorrect: The child is experiencing nausea and vomiting at this time. Waiting to give the antiemetic until after the chemotherapy is completed causes the child to suffer needlessly. The nurse should take action immediately to alleviate symptoms.

What information should the nurse include in teaching an oncology client the purpose of taking epoetin? 1. Emergency treatment of anemia. 2. Improves quality of life. 3. Used for the prevention of pure red cell aplasia (PRCA). 4. Decreases the need for transfusion.

4. Correct: Epoetin is prescribed to treat a lower than normal number of red blood cells (anemia) caused by chronic kidney disease in clients on dialysis, in HIV clients receiving zidovudine and in cancer clients receiving chemotherapy that develop anemia. Epoetin stimulates the bone marrow to produce more RBCs. 1. Incorrect: Epoetin does not work raoidly enough to be used for the emergency treatment of anemia (RBC transfusion). 2. Incorrect: Epoetin has not been proven to improve quality of life, fatigue, or sense of well-being in clients with cancer. 3. Incorrect: Pure red cell aplasia (PRCA) is a type of anemia that starts after treatment with epoetin or other erythropoetin medications.

The nurse is caring for a client with a diagnosis of major depression. The client began taking a selective serotonin reuptake inhibitor (SSRI) three days ago. The client says, "I am just not feeling well. My medicine is not working." Which reply by the nurse indicates adequate understanding of treatment? 1. "I agree, your medication is not working." 2. "Your treatment may have to be changed." 3. "Most SSRIs take about 5 days to work." 4. "You should reach the desired effect in 1-3 weeks."

4. Correct: Therapeutic effect is usually reached in one to three weeks, or longer. Encourage the client to continue taking the medication as prescribed. Provide supportive care and reassurance during this time. 1. Incorrect: This response demonstrates that the nurse is not familiar with the time for therapeutic onset. This response would discourage the client. 2. Incorrect: It is too soon to determine if treatment should be changed. It may take several weeks to reach therapeutic effects. 3. Incorrect: While some clients may be more calm within a short period of time, therapeutic effect cannot be evaluated at this point. Initial effects may be seen in as little as 1-3 weeks, while full therapeutic effects may fake up to 4-6 weeks.

The nurse is caring for a client prescribed ondansetron due to postoperative nausea. Which side effect is the nurse most worried about the client experiencing with administration of this medication? 1. Respiratory depression 2. Hyperglycemia 3. Malignant hypertension 4. Torsades de pointes

4. Correct: Torsades de pointes is a life threatening dysrhythmia which can occur with administration of ondansetron. Clients who are at increased risk for Torsades de pointes are those with underlying heart conditions and those with hypomagnesemia or hypokalemia. 1. Incorrect: Respiratory depression is not a common side effect of ondansetron. Headache and drowsiness are more common. 2. Incorrect: Hyperglycemia is also not a side effect of ondansetron. Hyperglycemia is high blood sugar and may produce symptoms of urinary frequency, increased thirst and increased appetite. Hyperglycemia is not related to ondansetron. 3. Incorrect: Malignant hypertension is extremely high blood pressure that develops rapidly and causes some type of organ damage. Although it is a serious condition this is not a side effect of ondansetron.

The nurse is assessing the injection site of a healthy client who received a Mantoux skin test 48 hours ago. Which finding at the injection site indicates a need for further evaluation? 1. 16 mm induration 2. 4 mm erythrokeratodemia 3. 0.1 mL bluish colored hard wheal 4. Multiple fluid-filled vesicles

1. Correct: An induration of 15 mm or greater is usually considered positive in people who have normal or mildly impaired immunity. A client with a positive reaction of 15mm or greater will need further evaluation by a primary healthcare provider. 2. Incorrect: This is a small, red, hard area that is smaller than 10 mm. Therefore the size is not considered significant. Induration is roughness, not hardness. The induration is what nurses assess to determine significance. 3. Incorrect: When administering a Mantoux skin test, 0.1 mL of solution is injected under the top layer of the skin to produce a wheal. The presence of the 0.1 mL wheal is not expected at this time. 4. Incorrect: This is the significant reaction that one would find with a multiple puncture tine, which is sometimes used with mass screening for TB. This is not expected with a Mantoux skin test.

A female client with a history of frequent exacerbations of asthma asks the nurse to explain to her why she is at greater risk for fractures than other women her age. What is the nurse's best response? 1. "The steroids you are taking decrease calcium in the bone by sending it to the blood." 2. "Taking steroids causes bone calcium to increase, thus causing osteoporosis." 3. "Clients who have asthma are not able to exercise enough to prevent fractures from occurring." 4. "Asthma should not put you at increased risk for fractures but you are at risk for decreased blood glucose levels."

1. Correct: Long term use of steroids decreases serum calcium, so the body takes calcium from the bone and puts it in the blood in order to bring the serum calcium back to a normal level. Every time a steroid is given, calcium is removed from the bone, thus leading to a greater risk for osteoporosis and fractures. 2. Incorrect: Osteoporosis is a decrease in bone calcium not an increase. 3. Incorrect: There are many types of exercise that asthma clients may participate in, including walking at short intervals. 4. Incorrect: Drug therapy for asthma (not asthma itself) may put a client at risk for osteoporosis, but not hypoglycemia.

While in the emergency department, a 68 year old client being treated for flu symptoms, became symptomatic with an episode of atrial tachycardia which was successfully treated with cardioversion. After stabilization, the client was admitted to the telemetry unit with a diagnosis of the flu, and a history of angina. Primary healthcare provider prescriptions were received. What is most important for the nurse to ensure prior to administering Peramivir? 1. Creatinine clearance is greater than 50 mL/min. 2. Pulse greater than 70 beats/min. 3. Cardiac rhythm showing normal sinus rhythm. 4. Oral temperature less than 101° F (38.3° C)

1. Correct: The dose of this medication needs to be decreased if the creatinine clearance of a client is less than 50 mL/min, so the nurse must know the prescribe creatine clearance level of this client prior to administering peramivir. 2. Incorrect: Few side effects or adverse reactions are noted with peramivir. There is no need to monitor the heart rate prior to administration. 3. Incorrect: Few side effects or adverse reactions are noted with peramivir. There is no need to monitor the cardiac rhythm prior to administration. 4. Incorrect: Few side effects or adverse reactions are noted with peramivir. There is no need to monitor the temperature prior to administration.

The nurse is caring for a client taking digoxin. Which electrolyte imbalance should be of most concern? 1. Hypokalemia 2. Hyponatremia 3. Hypomagnesemia 4. Hypocalcemia

1. Correct: The serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity could occur. 2. Incorrect: Hyponatremia, hypomagnesemia, and hypocalcemia do not interfere with digoxin. Any electrolyte imbalance can predispose the client to digoxin toxicity, but hypokalemia is the imbalance that can potentiate digoxin toxicity the most. 3. Incorrect:Hyponatremia, hypomagnesemia, and hypocalcemia do not interfere with digoxin. Any electrolyte imbalance can predispose the client to digoxin toxicity, but hypokalemia is the imbalance that can potentiate digoxin toxicity the most. 4. Incorrect: Hyponatremia, hypomagnesemia, and hypocalcemia do not interfere with digoxin. Any electrolyte imbalance can predispose the client to digoxin toxicity, but hypokalemia is the imbalance that can potentiate digoxin toxicity the most.

The nurse is developing a teaching plan for a female client who is taking one of the thiazolidinediones for the treatment of type 2 diabetes. What instruction should be included in the teaching plan? 1. Make sure that you use effective contraception while taking this drug. 2. The drug may lead to weight loss. 3. Therapeutic effect is reached within one to two weeks. 4. Therapeutic effect is reached within one month.

1. Correct: Thiazolidinediones may reduce the plasma concentration of the contraceptives. Additionally, post-menopausal women may resume ovulation.2. Incorrect: Thiazolidinediones may lead to weight gain and exacerbate congestive heart failure.3. Incorrect: With thiazolidinediones therapy, therapeutic effect may not be reached until 8 to 12 weeks of treatment.4. Incorrect: With thiazolidinediones therapy, therapeutic effect may not be reached until 2 to 3 months of treatment.

When administering an intravenous push (IVP) medication through a continuous intravenous infusion, which intervention is most important for the nurse to take? 1. Assess for drug and solution compatibility. 2. Clamp the tubing of the large volume infusion above the injection port. 3. Stop the large volume infusion and flush the tubing . 4. Use the port nearest the client to administer the IVP medication.

1. Correct: This would have the most life threatening affect on a client if it is not done and an incompatibility exists. Checking for incompatibility between the large volume solution and the medication is a safety issue.2. Incorrect: This is an action that can be taken when administering an IVP medication; however, clamping the tubing does not have to be done. If the tubing is not clamped when administering the IVP medication, the medication would first go up the tubing toward the large volume container, then go toward the client when the pressure from the push is stopped.3. Incorrect: This needs to be done if the large volume infusion solution is incompatible with the IVP medication. The action would not have to be implemented when administering all IVP medications. If incompatible, then it should be flushed.4. Incorrect: This is recommended when administering IVP medication, but would not cause the greatest life-threatening consequences. Using the port closest to the client minimizes the distance the medication must travel, so that the medication gets to the client's circulation faster.

The client diagnosed with active tuberculosis has been prescribed isoniazid 300 mg by mouth every day. What should the nurse teach this client? Select all that apply 1. "Notify your healthcare provider if your urine turns dark." 2. "Your healthcare provider has prescribed B6 along with the isoniazid to prevent neuritis." 3. "You should avoid eating aged cheeses and smoked fish." 4. "Eat foods such as tuna twice a week." 5. "Rise slowly from lying to sitting, or sitting to standing."

1., 2., 3., & 5 Correct: Signs of hepatotoxicity from this medication include dark urine, jaundice, and clay-colored stool. Isoniazide- induced pyridoxine (Vitamin B6) depletion causes neurotoxic effects. Vitamin B6 supplementation of 10-50 mg usually accompanies isoniazid use. Aged cheeses and smoked fish are high in tyramine which may cause palpitations, flushing, and blood pressure elevation while taking isoniazid. Avoid these foods during treatment. Isoniazid should be taken on an empty stomach, one hour before or two hours after food. Some clients experience orthostatic hypotension while taking isoniazid, so caution against rapid positional changes. 4. Incorrect: Histamine containing foods such as tuna and yeast extracts may cause exaggerated drug response (H/A, hypotension, palpitations sweating, itching, flushing, diarrhea).

A nurse is teaching a client the advantages of having a PICC line inserted rather than a peripheral IV. What information should the nurse include? Select all that apply 1. TPN may be infused using a PICC line. 2. Use of a PICC can allow for early client discharge. 3. PICC lines do not have to be replaced as often as a peripheral IV line. 4. PICC lines have the same risk of infection as a peripheral IV line. 5. PICC lines do not need to be flushed as frequently. 6. PICC placement decreases the need for skin puncture when blood sampling is needed.

1., 2., 3., & 6. Correct: Peripheral IV lines must be changed every 72-96 hours. PICC lines may remain in place for extended periods of time. A PICC can be cared for at home by home care nurses, family members, or in outpatient clinics. TPN cannot be administered via a peripheral line since it is hypertonic. PICC lines offer a lower chance for infection than a peripheral line. As long as the PICC is functioning and there is no evidence of infection, the PICC line can remain in place until it is no longer needed. 4. Incorrect: PICC lines are long lasting, so the risk of infection from changing sites is eliminated. Additionally, sterile technique is used for insertion, with sterile dressing changes. Precautions should still be taken to prevent complications. 5. Incorrect: Both peripheral and central lines need to be flushed to maintain patency.

The nurse has been teaching the client about warfarin for prevention of pulmonary emboli. Which comments by the client indicate understanding of the medication? Select all that apply 1. "I must get my blood levels checked regularly." 2. "I shouldn't change my diet to include a lot of foods containing vitamin K without supervision." 3. "I should eat lots of foods containing vitamin K." 4. "I should report this medication to any primary healthcare provider that I see." 5. "I should not change the dosage without talking with my primary healthcare provider."

1., 2., 4. & 5. Correct: The client should comply with regular follow up visits for checks of INR level. INR is the international normalization ratio and is used for clients taking anticoagulants (blood thinning medications). The client should eat a normal healthy diet, but should not increase foods containing high amounts of vitamin K. The client should report using warfarin to any primary healthcare provider, as treatment may be changed due to this medication. The client should not manipulate the dosage unless instructed by the primary healthcare provider. An identification card or bracelet may also be recommended in case of emergencies. Clients should inform dentists and other healthcare providers especially before a medical procedure. The anticoagulant effect must be closely monitored.3. Incorrect: Vitamin K reverses the anticoagulant effects of warfarin, so instruct the client to avoid foods high in vitamin K (examples are green leafy vegetables, brussels sprouts, prunes, cucumbers and cabbage).

The nurse is caring for a client post heart transplant who is being discharged on cyclosporine and azathioprine. Which precautions would be important for the nurse to teach the client? Select all that apply 1. Avoid crowds. 2. Do not obtain live vaccinations. 3. Drink at least 3 liters of fluids per day and watch the urine for sediment. 4. Use a soft-bristled brush to clean your teeth. 5. Advise to use contraceptive measures during treatment.

1., 2., 4., & 5. Correct: Both cyclosporine and azathioprine are immunosuppressants. Clients should be taught to protect themselves from sources of infection. Vaccinations are not given to immunocompromised clients. Avoidance of crowds will decrease the client's chance of contact with infections, especially those spread by droplets. As a general rule, significantly immunosuppressed clients should not receive live vaccines. Cyclosporine may cause growth of extra tissue in your gums so use a dentist regularly. These drugs are teratogenic. Clients should avoid pregnancy while on these medications.3. Incorrect: Drinking 3 liters of fluids per day will not prevent renal impairment.

An alcoholic client has agreed to take disulfiram 250 mg PO daily. The nurse recognizes that education has been successful when the client makes which statements? Select all that apply 1. "If I decide to stop taking disulfiram, I should not ingest any alcohol for at least 2 weeks or I will have a reaction." 2. "I must read labels carefully so that I know that alcohol is not an ingredient." 3. "I am allowed to eat chili made with beer since the alcohol evaporates from the chili with prolonged cooking." 4. "This medication is not a cure. I still need to attend therapy sessions." 5. "I should avoid eating a lot of chocolate while on this medication."

1., 2., 4., & 5. Correct: Disulfiram works by reacting with alcohol to produce negative side effect which may last up to two weeks after discontinuation of the drug.The client should not consume any alcohol including hidden alcohol such as mouthwash and cough syrups. Disulfiram is not a cure for alcoholism. It is used in combination with supportive care and psychotherapy. Disulfiram can increase the side effects of caffeine, so avoid chocolate and other caffeine containing substances.3. Incorrect: Not even a small amount of alcohol can be ingested. This includes sauces and foods made with alcohol vinegar and vanilla extract. Meat holds on to alcohol, so chili with beer in the sauce should not be consumed. Additionally, do not use after shave, cough mixtures, or rubbing alcohol.

A nurse is caring for a client who has been prescribed prednisone. What education should the nurse provide to the client? Select all that apply 1. Avoid crossing legs. 2. Eat a low calcium diet. 3. Take prednisone with food. 4. Taper prednisone dose prior to completion. 5. Instruct the client to use arm rests when rising from a chair.

1., 3, 4, & 5. Correct: A potential side effect of prednisone is thromboembolism. An intervention to decrease thromboembolism is to avoid crossing legs. When the client crosses their legs, the client is decreasing the blood flow in the lower extremities. To decrease irritation of the lining of your stomach prednisone should always be taken with a meal. The food covers the surface of the stomach which can reduce irritation so eat before taking the prednisone. Client's on an extended prescription of prednisone will precipitate possible dangerous side effects, if the prescription is abruptly discontinued. The adrenal glands will have to adjust to the abrupt reduction of the prednisone. Gradually reducing the dosage of prednisone before discontinuing the drug allows the normal production of cortisol to reoccur. Osteoporosis is a possible side effect of extended prescription of prednisone. The client should be instructed to use arm rests when rising from a chair to prevent falling. The client could also experience falling due to postural hypotension. 2. Incorrect: A musculoskeletal side effect of prednisone is osteoporosis. Osteoporosis is a decrease in bone mass and density. To promote bone growth the client is encouraged to consume a diet high in calcium.

A nurse is planning care for a laboring client who is about to be started on oxytocin. What interventions should the nurse include in this plan of care? Select all that apply 1. Piggy back oxytocin into main IV fluid. 2. Monitor for early decelerations. 3. Discontinue if contractions last longer than 90 seconds. 4. Maintain one on one care. 5. Check fetal heart tones hourly.

1., 3., & 4. Correct: The oxytocin is piggy backed into the main IV fluid, so when the nurse discontinues the medication, the main IV fluid is quickly resumed. Contractions should be at a rate of 1 every 2-3 minutes with each lasting no more than 90 seconds. Hyperstimulation of the uterus can occur and result in fetal distress. One on one care is needed since complications such as fetal distress and uterine rupture can occur. 2. Incorrect: External continuous fetal monitoring should begin prior to oxytocin administration. A reactive fetal heart rate tracing should be obtained over 30 minutes. 5. Incorrect: Continuous fetal monitoring is must be maintained during oxytocin administration to fetus is not experiencing distress in utero with contractions.

The nurse is assisting with a client who will receive electroconvulsive therapy (ECT). The anesthesiologist administers succinylcholine chloride intravenously. What adverse effects should the nurse monitor for post procedure? Select all that apply 1. Malignant hyperthermia 2. Hypokalemia 3. Apnea 4. Tetany 5. Arrhythmias

1., 3., 4. & 5. Correct: Succinylcholine is a paralytic used to relax the muscles to prevent severe muscle contractions during the seizure, thereby reducing the possibility of fracture or dislocated bones. Adverse effects include malignant hyperthermia, apnea, and arrhythmias. It causes paralysis of the muscles of the face and those used to breath, so monitoring for apnea is very important. Tetany, spasms or stiffness in the jaw would be adverse effects and can indicate malignant hyperthermia.2. Incorrect: Hyperkalemia can occur. Succinylcholine is a depolarizing muscle relaxant which means during prolonged muscle depolarization, the muscle may release large amounts of potassium into the blood.

The nurse is caring for a client admitted with heart failure. Which prescriptions would necessitate that the nurse seek clarification from the primary healthcare provider? Select all that apply 1. Furosemide 20.0 mg p.o. daily 2. Rosuvastatin 5 mg p.o hs 3. Digoxin 0.125 mg IVP every 8 hours for three doses 4. Folic acid 1 mg daily 5. Heparin 1000 IU subcutaneously daily

1., 4. & 5. Correct: It is inappropriate to have a trailing zero after a decimal point for doses expressed in whole numbers. It can be mistaken as 200 if the decimal point is not seen. The folic acid order lacks a route, thus needs clarification. The Heparin order should be written as Heparin 1,000 units subcutaneously daily. Use commas for dosing units at or above 1,000 or use words such as one thousand to improve readability. Use units rather than IU (International units) as this can be mistaken as IV or 10.2. Incorrect: This medication order is written correctly.3. Incorrect: This medication order is written correctly.

Which medications, if prescribed to a client, should indicate to a nurse that retention of CO2 is a possibility? Select all that apply 1. Narcotics 2. Diuretics 3. Glucocorticoid steroids 4. Antiemetics 5. Hypnotics

1., 4. & 5. Correct: Narcotics sedate and decrease the respiratory rate, which increases CO2 retention. Always monitor respiratory rate. Some antiemetics (such as promethazine) are very sedating and will decrease the respiratory rate while increasing CO2 retention. Sleeping pills can cause sedation to the point of hypoventilation, which leads to CO2 retention. Always monitor respiratory rate. 2. Incorrect: Diuretics do not affect breathing patterns. 3. Incorrect: Steroids do not affect breathing patterns.

What actions would be appropriate for a nurse who is administering ear drops to a six year old child? Select all that apply 1. Position supine with affected ear up. 2. Administer ear drops immediately upon removing from the refrigerator. 3. Open ear canal by drawing back on the pinna and slightly downward. 4. Allow prescribed number of drops to fall along inside of ear and flow into ear by gravity. 5. Have client remain supine for several minutes.

1., 4., & 5. Correct: Supine with affected ear up allows for proper administration of medication. Never attempt to put drops directly on the eardrum. Administer along inside of ear so that drops flow by gravity into ear. Remaining supine for several minutes permits the fluid to be absorbed. 2. Incorrect: If medication is not instilled at room temperature, the client may experience vertigo, dizziness, pain, and nausea. Additionally, cold ear drops cause discomfort. 3. Incorrect: This is the method for a child less than 3 years of age. For older than 3 years, open canal of ear by drawing back on the pinna and slightly upward.

A client has recently been diagnosed with rheumatoid arthritis. The nurse anticipates which class of pharmacologic agents will likely be a part of the client's treatment regimen? 1. Mitotic inhibitors 2. Systemic glucocorticoids 3. Antifungals 4. Anticoagulants

2. Correct: Glucocorticoids (steroids) are an appropriate pharmacologic treatment for rheumatoid arthritis. Other treatment options include the use of NSAIDs, biologic and nonbiologic DMARDs (methotrexate and others). Remember, all the other problems associated with the use of steroids.1. Incorrect: Mitotic inhibitors are a class of chemotherapeutic agents and are not indicated for the treatment of rheumatoid arthritis. Medications in this class include plant alkaloids (vincristine) and taxanes (paclitaxel).3. Incorrect: Antifungals are not indicated for the treatment of rheumatoid arthritis. Rheumatoid arthritis is an autoimmune disease, not associated with a fungal disorders. 4. Incorrect: Anticoagulants are indicated for the treatment and prevention of thrombolytic disease and are not indicated for the treatment of rheumatoid arthritis. Salicylate (aspirin), an antiplatelets, may be used as an anti-inflammatory agent.

How should a nurse prepare to administer a Measles, Mumps, Rubella (MMR) vaccination to a 6 year old child? 1. 3 mL syringe with 23 gauge, 1" needle for IM injection 2. Use a 25 gauge, ¾" needle for subcutaneous (Sub-Q) injection. 3. Prime intranasal spray for administration. 4. Tuberculin (TB) syringe with 28 gauge, 3/8" needle for intradermal injection.

2. Correct: MMR is given Sub-Q. Subcutaneous injections are administered in the fat layer, underneath the skin. When administering SQ injections use a 23-25 gauge needle, needle length for infants (1- 12 months) is 5/8", children 12 months and older 5/8" - ¾". 1. Incorrect: MMR is given Sub-Q. An intramuscular injection is used to deliver medication deep into the muscles. 3. Incorrect: MMR is given Sub-Q. The intranasal spray is given by nasal delivery route. 4. Incorrect: MMR is given Sub-Q. Intradermal injections are given into the dermis, just below the epidermis and commonly used for tuberculin and allergy tests.

An occupational health nurse is reviewing the current medications of a client who has recently been prescribed propranolol for hypertension. Which current medication taken with propranolol by the client should be of concern to the nurse? 1. Cyanocobalamin 2. Melatonin 3. Cetirizine 4. Esomeprazole

2. Correct: Melatonin is a manmade form of the hormone that is key in regulation your body's internal clock. It is often used in treating sleep disorders. Melatonin can raise blood pressure in people who are taking beta blockers to control blood pressure. Avoid using it in conjuction with propanolol or any other beta blockers. 1. Incorrect: There are no known interactions between propranolol and Vitamin B12 (cyanocobalamin). Vitamin B12 is one of the essential vitamins and can be found in meat, fish and dairy. 3. Incorrect: There are no known interactions between propranolol and Zyrtec (Cetirizine). Cetirizine is an antihistamine used to treat cold or allergy symptoms. This medication may cause severe drowsiness. 4. Incorrect: There are no known interactions between propranolol and Nexium (esomeprazole). Esomeprazole is a proton inhibitor that decreases stomach acid, and remember, it is not used for immediate relief of heartburn symptoms.

Which comment made by a new nurse regarding sodium polystyrene sulfonate indicates to the charge nurse that the new nurse understands the effects of this medication? 1. "Sodium is exchanged for potassium in the blood." 2. "Fluids will need to be encouraged after administration." 3. "This medication will increase potassium and decrease sodium." 4. "Sodium polystyrene sulfate is only given as an enema."

2. Correct: Sodium polysterene sulfonate (kayexalate) is used to treat hyperkalemia, and it works by helping your body get rid of the extra potassium by exchanging sodium ions for potassium ions in the intestines. Sodium level increases after administration and this increase causes some dehydration. Pushing fluids will offset the dehydration. 1. Incorrect: This is an incorrect statement by the new nurse. Sodium is exchanged for potassium in the GI tract, and the majority of the exchange occurs in the large intestine where potassium ions are excreted in larger amounts. 3. Incorrect: Potassium will decrease and sodium will increase. Remember, this medication is used for hyperkalemia. 4. Incorrect: Sodium polystyrene sulfonate can be given as a liquid by mouth, through a stomach feeding tube, or as a rectal enema.

A client diagnosed with bipolar mania was prescribed lithium carbonate 2000 mg daily two months ago. What is the nurse's best action? Lithium level: 1.8 1. Record the lab results in the chart and recheck in one month. 2. Inform the primary healthcare provider that the lithium level is too high. 3. Notify the primary healthcare provider because the sodium level is too high. 4. Let the primary healthcare provider know that the magnesium level is too low.

2. Correct: The appropriate serum lithium level for acute mania is 1.0 to 1.5 mEq/L. For maintenance it is 0.6 to 1.2 mEq/L. Levels exceeding 1.5 to 2.5 mEq/L begin to produce toxicity. 1. Incorrect: All lab results should be documented; however, the lithium needs to be reported so that the dose can be adjusted. 3. Incorrect: The sodium level is normal: 135-145 mEq/L (135-145 mmol/l). 4. Incorrect: The magnesium level is normal: 1.3 - 2.1 mEq/L (0.65-1.05 mmol/l).

The nurse is caring for a client admitted to rule out myocardial infarction. The nurse has administered sublingual nitroglycerin. What time frame should the nurse expect the earliest onset of effectiveness? 1. 15 seconds 2. 3 minutes 3. 5 minutes 4. 15 minutes

2. Correct: The onset of action for nitroglycerin sublingual is 1 to 3 minutes. So the effectiveness can be assessed 3 minutes after the drug is administered.1. Incorrect: This time frame is too short for the onset of action of nitroglycerin given sublingual.3. Incorrect: Sublingual doses of nitroglycerin can be repeated every 5 minutes. The drug would start to be effective before 5 minutes.4. Incorrect: Fifteen minutes would be to long to wait to assess the effectiveness of nitroglycerin sublingual, in a client suspected of a myocardial infarction.

he nurse is caring for a client taking enoxaparin. Which group of symptoms should be reported to the primary healthcare provider? 1. AST of 12 U/L and ALT 20 U/L 2. Hematocrit of 46% decreased to 35% and blood pressure decreases from 122/78 to 108/54 3. Ecchymosis around the abdominal subcutaneous injection site and platelet count of 200,000. 4. Hemoglobin of 14.5 g/dL (2.3 mmol/L) increased to 16 g/dL (2.5 mmol/L) and increased erythemia of oral mucus membranes.

2. Correct: These values indicate a drop in hematocrit and drop in blood pressure. Both of these could represent bleeding. These would be important to report to the primary healthcare provider.1. Incorrect: The nurse would need to watch and report any signs of liver complications due to the use of enoxaparin. The AST and ALT are two liver enzyme values that would increase with liver complications. These two values represent normal AST (8-40 U/L) and ALT (10-30 U/L) values.3. Incorrect: Bruising (ecchymosis) at the injection site is a frequent occurrence with administration of enoxaparin. This platelet count is within the normal range. 4. Incorrect: The Hgb and color of oral mucus membranes indicate an increase in Hgb. This would not indicate bleeding.

lient who has Parkinson's disease has a new prescription for benztropine. What should the nurse include when teaching the client and spouse about this medication? Select all that apply 1. This medication blocks dopamine in the brain to decrease tremors and muscle stiffness. 2. Notify your primary healthcare provider if you develop urinary retention. 3. Benztropine can reduce the ability to sweat, so do not become overheated. 4. No lab tests are needed while taking this medication. 5. Sit up or stand up slowly to prevent lightheadedness.

2., 3., & 5. Correct: Urinary retention is a side effect of benztropine. Benztropine can reduce the ability to sweat and cause the body to overheat. Do not become overheated in hot weather or while you are being active because heatstroke may occur. Benztropine may cause dizziness, lightheadedness, or fainting. Alcohol, hot weather, exercise, or fever may increase these effects. To prevent these negative effects, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects. 1. Incorrect: Benztropine is an anticholinergic. It works by decreasing the effects of acetylcholine, a chemical in the brain. This results in decreased tremors or muscle stiffness, and helps improve walking ability for clients with Parkinson's disease. 4. Incorrect: Lab tests, including liver function, kidney function, lung function, blood pressure, fasting blood glucose, and blood cholesterol, may be performed while using benztropine. These tests may be used to monitor the client's condition or check for side effects.

The nurse is teaching a newly diagnosed diabetic client about self-injection of insulin. Which statement made by the client indicates to the nurse that teaching has been effective? Select all that apply 1. "The abdominal site is best because it is closest to the pancreas." 2. "I can reach my thigh the best, so I will use different areas of the same thigh." 3. "By rotating the sites within one area, my chances of having tissue changes are less." 4. "If I change injection sites from the thigh to the arm, the rate of absorption will be different." 5. "I should inject at least 1-2 inches away from the last injection site."

2., 3., 4., & 5. Correct: To promote consistency in insulin absorption, the client should systematically rotate injection sites within an anatomic area to prevent lipodystrophy. Four main areas for injection are the abdomen, upper arms, thighs and hips. The client should try not to use the exact same site more than once in 2 to 3 weeks. If insulin is injected where there is more fat underneath the skin, insulin may be absorbed more slowly. Also, insulin should not be injected into the limb that will be exercised; absorption will be faster, increasing risk of hypoglycemia. The client should avoid using the exact same site more than once in 2 to 3 weeks.1. Incorrect: The diabetic client should rotate sites within the same area before moving to a new area. This will assist in preventing lipodystrophy. Use of the abdominal site has nothing to do with being close to the pancreas. The abdomen is the preferred site because it provides the most rapid insulin absorption.

Donepezil has been prescribed to a client with cognitive impairment. Which statement by the family member indicates understanding of the nurse's instructions on this medication? 1. This medicine will control agitation and aggression. 2. This medication should be given at bedtime since it is for insomnia. 3. Notify the primary healthcare provider if the client is vomiting coffee ground material. 4. This drug is given as needed for confusion.

3. Correct: A rare but very serious side effect that can occur: black stools, vomit that looks like coffee grounds, severe stomach/abdominal pain. Notify the primary healthcare provider immediately. 1. Incorrect: An antipsychotic medication such as risperidone is used for agitation, aggression, hallucinations, thought disturbances, and wandering. Donepezil helps to decrease the symptoms of dementia (impairment of memory, judgment, abstract thinking and personality changes) in client's with Alzheimer disease. 2. Incorrect: Donepezil should be given in the evening just before bedtime, however, it is not for insomnia. Sedative/hypnotics such as zolpidem and temzaepam are given for insomnia. 4. Incorrect: Donepezil should be given regularly in order to get the most benefit from it. Do not stop taking it or increase the dosage unless the primary healthcare provider changes the dose. It may take a few weeks before the full benefit of this drug takes effect.

The nurse is caring for a client who is receiving weekly infusions of Factor VIII for Hemophilia. What assessment finding by the nurse related to the client's skin is indicative of a therapeutic response? 1. An absence of jaundice 2. The presence of petechiae 3. A reduction of bruising 4. A capillary refill time of < 3 seconds

3. Correct: A reduction in bruising indicates an increase in circulating coagulating substances in the blood of hemophilia clients. Factor VIII is the clotting factor that is deficient in hemophilia clients. Administration of Factor VIII in these clients would result in a reduction of bleeding episodes and the s/s associated with them.1. Incorrect: Jaundice is an indicator of elevated unconjugated bilirubin levels. Elevated unconjugated bilirubin levels are seen with liver disease and/or rapid destruction of RBCs.2. Incorrect: Petechiae are commonly seen with thrombocytopenia and can be an indicator of decreased clotting capability of the blood. The treatment goal with hemophilia is to increase the blood's ability to clot.4. Incorrect: Capillary refill is an indicator of tissue perfusion and not the blood's ability to clot.

A client is admitted with new onset hyperthyroidism. Which medication is of concern to the nurse while reviewing the client's routine medications? 1. Ranitidine 2. Furosemide 3. Amiodarone 4. Propranolol

3. Correct: Amiodarone, a class III anti-arrhythmic drug, has multiple effects on myocardial depolarization and repolarization that make it an extremely effective antiarrhythmic drug. However, amiodarone is associated with a number of side effects, including thyroid dysfunction (both hypo- and hyperthyroidism), which is due to amiodarone's high iodine content and its direct toxic effect on the thyroid. 1. Incorrect: Ranitidine has not been found to contribute to the development of hyperthyroidism or hypothyroidism. 2. Incorrect: Furosemide has not been found to affect the thyroid. 4. Incorrect: Beta blockers are given to hyperthyroid clients to decrease myocardial contractility BP, and HR. It also decreases anxiety. This will help the hyperthyroid client.

A client with the diagnosis of mild anxiety asks the nurse why the primary healthcare provider switched medications from lorazepam to buspirone. What should the nurse tell the client? 1. "Lorazepam takes longer to start working than buspirone so the primary healthcare provider decided to switch medications." 2. "Buspirone can be stopped quickly if neccessary." 3. "Buspirone does not depress the central nervous system like lorazepam does, so you should not have as much sedation." 4. "You need to ask your primary healthcare provider why the medication was changed from lorazepam to buspirone."

3. Correct: Buspirone does not depress the CNS system and is believed to produce the desired effects through interaction with serotonin, dopamine, and other neurotransmitter receptors. 1. Incorrect: Buspirone takes 1-2 weeks to take effect and can take up to 4-6 weeks to achieve full clinical benefits. Lorazepam is a benzodiazepine and begins to work within a few hours to 1-2 days. 2. Incorrect: The client should not stop taking any antianxiety medications abruptly. Serious withdrawal symptoms can occur: depression, insomnia, anxiety, abdominal and muscle cramps, tremors, vomiting, sweating, convulsions, delirium.4. Incorrect: The nurse should be able to discuss medication administration with the primary healthcare provider.

When preparing an intramuscular injection for a neonate, which needle should a nurse select? 1. 18 G, 7/8 inch 2. 21 G, 1 inch 3. 25 G, 5/8 inch 4. 25 G, 1.5 inch

3. Correct: The most appropriate needle to select for use in administering IM injection to a neonate would be a 25 gauge, 5/8 inches long. Intramuscular injections are given in the vastus lateralis muscle of the thigh. 1. Incorrect: This needle is too large a diameter for a newborn infant. An 18 gauge needle is appropriate for the intravenous (IV) medication or blood administration in adults. 2. Incorrect: This needle would be too large for a newborn infant. A 21 gauge needle is typically used to draw up medication from vials or ampules (filtered needle required). 4. Incorrect: This needle would be far too long for a newborn infant and also for most children. A 1.5 inch needle is often needed to administer intramuscular injections to obese adults.

The nurse is caring for a client diagnosed with deep vein thrombosis, who has been treated with intravenous heparin for one week. The primary healthcare provider plans to change the medication from heparin IV to warfarin sodium by mouth. The nurse understands which approach would be appropriate? 1. Begin the warfarin sodium and stop the heparin simultaneously. 2. Stop the heparin 24 hours, then begin the warfarin sodium. 3. Begin the warfarin sodium before stopping the heparin. 4. Stop the heparin, wait for the coagulation studies to reach the control value, and begin the warfarin sodium.

3. Correct: Warfarin sodium is initiated while the client remains on heparin. This is done so that the client remains adequately anticoagulated during the transition from IV heparin to warfarin sodium. The onset of action of warfarin sodium is 36 hours to 3 days. 1. Incorrect: Warfarin sodium's onset of action is 36 hours to 3 days. If heparin were stopped and warfarin sodium initiated there would be a lag time when the client would be inadequately anticoagulated and at an increased risk for clotting. 2. Incorrect: Warfarin sodium's onset of action is 36 hours to 3 days. Stopping heparin 24 hours before administering warfarin sodium would cause a lag time and increased risk of clotting. 4. Incorrect: Waiting for coagulation studies before administering warfarin sodium would cause a lag time and put the client at increased risk for clotting. Additionally, heparin and warfarin are measured by different clotting lab tests. The aPTT can measure the effectiveness of heparin. The PT and INR can be used to measure the effectiveness of warfarin sodium.

Which statement by a client would indicate to the nurse that education about alendronate has been successful? 1. "It is recommended that I recline for 15 minutes after taking my medication." 2. "Food should be eaten immediately after taking alendronate." 3. "My medication tablet should be chewed for rapid absorption." 4. "I should drink a full 8 ounce glass of water with my medication."

4. Correct: Alendronate is a biophosphonate drug used in the treatment of osteoporosis and other bone diseases. The client should take each tablet in the morning with a full glass of water (6-8 ounces or 180-240 ml) at least 30 to 60 minutes before the first food, beverage or medication of the day, to increase absorption. 1. Incorrect: After taking alendronate, the client should remain upright (sitting or standing) for 30-60 minutes. The client should not lie down until after eating. These actions help to decrease the likelihood of esophageal and GI associated side effects. 2. Incorrect: The client should wait at least 30-60 minutes before eating, drinking or taking any other medication, to increase absorption. 3. Incorrect: The client should not chew the medication tablet, mouth ulcers can occur when alendronate is chewed or dissolved in the mouth.

What is most important for the nurse to monitor when administering intravenous erythromycin to a client? You answered this question Correctly 1. Nausea and vomiting. 2. Clotting studies. 3. Premature atrial contractions. 4. Prolonged QT interval.

4. Correct: Erythromycin is a macrolide antibiotic that is linked to QT prolongation. Pharmacologic agents capable of prolonging the QT interval are capable of causing ventricular tachyarrhythmias. 1. Incorrect: This is a side effect but not as life threatening as a prolonged QT. 2. Incorrect: This medication does not alter clotting factors unless there is liver dysfunction, which is a contraindication of the medication. 3. Incorrect: PACs are not a common problem with this medication but prolonged QT intervals are, and the associated ventricular tachyarrhythmias are more life-threatening.

A client who has chronic renal failure has been prescribed synthetic erythropoietin for the prevention of anemia. Which assessment finding should be reported to the primary healthcare provider? 1. Hemoglobin level of 10 g/dl (1.6 mmol/L) 2. Blood pressure of 120/84 3. Constipation 4. Swelling of feet and ankles

4. Correct: Erythropoietin is generally well tolerated. Swelling of feet and ankles may indicate the beginning of a cardiovascular problem. Clients taking this drug are at risk for myocardial infarctions and risk of blood clots.1. Incorrect: The purpose of this drug is to increase hemoglobin levels. A level of 10g/dL (1.6 mmol/L) would be considered favorable even though still low. The client would still need the medication since anemia still exists. If hgb is above 12 g/dl (1.9 mmol/l), the level should be reported as the client does not need the med any longer. 2. Incorrect: An elevated blood pressure is one of the more common and major side effects. If elevated it should be reported, but this blood pressure is within normal limits.3. Incorrect: Constipation may be caused by iron preparations. Increasing fiber in the diet may improve that symptom. A common side effect of synthetic erythropoietin is darrhea.

The primary healthcare provider has prescribed ampicillin and ciprofloxacin piggyback in the same hour, every 6 hours. How will the nurse administer these medications? 1. Administer one of the medications every 4 hours and the other every 6 hours. 2. Administer the medications by combining them into 150 mL of normal saline (NS). 3. Administer the medications at the same time by connecting the secondary tubing to two separate ports on the primary tubing. 4. Administer the medications separately, flushing with normal saline (NS) between medications.

4. Correct: Even though two IV piggyback medications have been ordered at the same time, they can both be infused separately on time. It just takes planning. The nurse must follow the medication rights (right client, right medication, right route, right dose, right time). The antibiotics need to be administered one at a time and normal saline is used to flush the remaining medication of the first antibiotic before the second is administered. 1. Incorrect: The primary healthcare provider will prescribe the dosing schedule. Its beyond the scope of practice for the nurse to independently the dosing schedule. 2. Incorrect: The properties of each antibiotic are different. The two different antibiotics cannot be mixed together. 3. Incorrect: Administering the antibiotic into different parts of the IV tubing is the same as mixing the IVs together. Only one antibiotic should be administered at a time.

What action is most important for the nurse to take when a client receiving a cephalosporin develops abdominal cramping and diarrhea? 1. Administer antidiarrheal medication. 2. Increase fluid intake. 3. Provide food with the medication. 4. Notify the healthcare provider.

4. Correct: Notify the healthcare provider if diarrhea occurs as it can promote the development of Clostridium difficile infection. Cephalosporin difficile is a toxin producing bacteria that causes antibiotics-associated colitis, and can occur with antibiotic therapy. Cephalosporin is one of the most common antibiotics that cause clostridium difficile. 1. Incorrect: Taking a probiotic, stopping the antibiotic or switching to another antibiotic are standard treatments for antibiotic induced diarrhea. Administering an anti-diarrheal is not recommended for antibiotic induced diarrhea. 2. Incorrect: Increasing fluid intake will help with the associated dehydration seen with diarrhea, but will not correct the problem or decrease the risk of clostridium difficile. 3. Incorrect: If the client has GI upset, then cephalosporin may be given with food, however, the most important thing to worry about is the development of Clostridium difficile infection. So notifying the healthcare provider is the most important action.

A nurse is caring for a client who has been prescribed sucralfate. Which client education intervention would the nurse include for the client prescribed sucralfate? 1. Take medication 1 hour after meals. 2. Crush tablets prior to taking medication. 3. Consume 1000 mL of fluid every 24 hours. 4. Avoid antacids 1 hour before and after this medication.

4. Correct: Sucralfate is absorbed more effectively in an acidic state. Since an antacid medication will increase the alkaline state, the client should avoid taking antacids within 1 hour before or after taking sucralfate to increase the absorption rate of sucralfate. 1. Incorrect: Sucralfate should not be taken 1 hour after a meal. To increase the absorption of sucralfate the medication should be taken on an empty stomach when the stomach is more acidic. 2. Incorrect: Clients should not crush, or chew sucralfate tablets. The outer layer of the tablet has specific formulated pharmacokinetic properties that should not be crushed or chewed. 3. Incorrect: A potential side effect of sucralfate is constipation. An increase of fluids during the medication therapy is recommended to decrease the side effect of constipation. An intake of 1000 mL of fluid per 24 hours intervention is not enough fluid to reduce the possibility of constipation.

Which action by the nurse administering intravenous ciprofloxacin would require intervention by the charge nurse? 1. Sets IV pump to administer ciprofloxacin over a period of 30 minutes. 2. Educates client that medication may cause dizziness. 3. Instructs client to notify nurse for any tendon pain. 4. Administers ciprofloxacin through 20 gauge catheter into the cephalic vein.

Correct: Cipro IV should be administered to by intravenous infusion over a period of 60 minutes. Slow infusion of a dilute solution into a larger vein will minimize client discomfort and reduce the risk of venous irritation. Incorrect: This action does not require intervention by the charge nurse as dizziness is a side effect of this medication. Incorrect: This is a correct action. Fluoroquinolones, including Cipro IV, are associated with an increased risk of tendinitis and tendon rupture in all ages. This adverse reaction most frequently involves the Achilles tendon, and rupture of the Achilles tendon may require surgical repair. Tendinitis and tendon rupture in the rotator cuff (the shoulder), the hand, the biceps, the thumb, and other tendon sites have also been reported. Incorrect: Slow infusion of a dilute solution into a larger vein will minimize client discomfort and reduce the risk of venous irritation.