Pharmacology- Adaptive Quiz

The healthcare provider prescribes nitroglycerin ointment for a client who was admitted for chest pain and a myocardial infarction (MI). Which statement, if made by the client, would indicate understanding of the side effects of nitroglycerin ointment? A. "I may experience a headache." B. "Confusion is a common adverse effect." C. "A slow pulse rate in an expected side effect." D. "Increased blood pressure readings may occur initially."

A. "I may experience a headache" Rationale The most common side effect of nitroglycerin is a headache. Additional cardiovascular side effects are hypotension, not hypertension; tachycardia, not bradycardia; and dizziness, not confusion.

A client with Hodgkin disease is to receive the cyclic antineoplastic vincristine as part of a therapy protocol. The client asks how this medication works. What mechanism of action does the nurse consider when responding to the client's question? A. Arresting mitosis in metaphase B. Inhibiting the synthesis of thymidine C. Alkylating nucleic acids needed for mitosis D. Inactivating DNA while inhibiting RNA synthesis

A. Arresting mitosis in metaphase Rationale Vincristine is a plant alkaloid that is cell-cycle specific. It affects cell division during metaphase by interfering with spindle formation and causing cell death. Inhibiting the synthesis of thymidine is the typical action of antimetabolites, not plant alkaloids. Alkylating nucleic acids needed for mitosis is typical of the action of alkylating agents, not plant alkaloids. Inactivating DNA and RNA synthesis is the typical action of antineoplastic antibiotics, not plant alkaloids.

A client is admitted to the emergency department with crushing chest pain. A diagnosis of acute coronary syndrome is suspected. The nurse expects that the client's initial treatment will include which medication? A. Aspirin B. Midazolam C. Gabapentin D. Alprazolam

A. Aspirin ationale Early administration of aspirin in the setting of acute myocardial infarction (MI) has been demonstrated to significantly reduce mortality. Aspirin inhibits the action of platelets, preventing their ability to clump together and form clots. The mechanism of acute coronary syndrome usually is ruptured plaque in one of the coronary arteries with clot formation obstructing blood flow. Prompt administration of an antiplatelet agent, such as aspirin, significantly reduces damage and can be lifesaving, the earlier the better; hence the reason why it is part of emergency management treatment. Gabapentin is an anticonvulsant and is not the drug of choice to relieve the pain associated with an MI. Midazolam HCl is a sedative-hypnotic that is used for its calming effect, but it will not relieve the pain of an MI. Alprazolam is an anxiolytic that is used for its calming effect, but it will not relieve the pain of an MI.

A client is receiving hydrochlorothiazide. What should the nurse monitor to best determine the effectiveness of the client's hydrochlorothiazide therapy? A. Blood pressure B. Decreasing edema C. Serum sodium level D. Urine specific gravity

A. Blood pressure Rationale Diuretics promote urinary excretion, which reduces the volume of fluid in the intravascular compartment, thus lowering blood pressure. Edema reflects multiple physiologic processes including venous competence, gravity, and disuse. The serum sodium level remains stable unless the dosage is excessive; an altered sodium level is not a therapeutic response. Although specific gravity decreases with increased urinary output, this does not reflect the desired reduction in intravascular pressure.

A client with left ventricular heart failure is taking digoxin 0.25 mg daily. What changes does the nurse expect to find if this medication is therapeutically effective? Select all that apply. Select all that apply A. Diuresis B. Tachycardia C. Decreased edema D. Decreased pulse rate E. Reduced heart murmur F. Jugular vein distention

A. Diuresis C. Decreased edema D. Decreased pulse rate Rationale Digoxin increases kidney perfusion, which results in urine formation and diuresis. The urine output increases because of improved cardiac output and kidney perfusion, resulting in a reduction in edema. Because of digoxin's inotropic and chronotropic effects, the heart rate will decrease. Digoxin increases the force of contractions (inotropic effect) and decreases the heart rate (chronotropic effect). Digoxin does not affect a heart murmur. Jugular vein distention is a specific sign of right ventricular heart failure; it is treated with diuretics to reduce the intravascular volume and venous pressure.

A client is prescribed epoetin injections. To ensure the client's safety, which lab value should the nurse assess before administration? A. Hemoglobin B. Platelet count C. Prothrombin time D. Partial thromboplastin time

A. Hemoglobin Rationale Epoetin is used to treat anemia by increasing production of red blood cells. The lab value the nurse should assess before administration is the hemoglobin because it measures the number of red blood cells. Erythropoietin is specific for increasing red blood cells and does not have an effect on other blood components such as white blood cells or thrombocytes (platelets). The partial thromboplastin time and prothrombin time are measures of the effectiveness of anticoagulant therapy.

In the postanesthesia care unit a client received intrathecal morphine intraoperatively to control pain. Considering the administration of this medication, what should the nurse include as part of the client's initial 24-hour postoperative care? A. Monitoring of respiratory rate hourly B. Assessing the client for tachycardia C. Administering naloxone every 3 to 4 hours D. Observing the client for signs of central nervous system (CNS) excitement

A. Monitoring the respiratory rate hourly Rationale Intrathecal morphine can depress respiratory function depending on the level it reaches within the spinal column; hourly assessments during the first 12 to 24 hours will allow for early intervention with an antidote if respiratory depression needs to be corrected. Bradycardia, not tachycardia, and hypotension occur. Administering naloxone every 3 to 4 hours is too infrequent if the client's respirations are depressed. The recommended adult dosage usually is 0.4 to 2 mg every 2 to 3 minutes, if indicated. CNS depression occurs secondary to hypoxia.

A client with anorexia nervosa is admitted to the critical care unit following a period of prolonged starvation. What signs or symptoms indicate to the nurse that the client may have hypokalemia? Select all that apply. Select all that apply A. Muscle weakness B. Metabolic alkalosis C. Cardiac dysrhythmias D. Respiratory rate of 24 or higher E. Serum potassium of 5.5 mEq/L (5.5 mmol/L)

A. Muscle weaknesss C. Cardiac dysrhythmias Rationale Potassium is a component of the sodium-potassium pump that is essential for cellular functioning, especially muscle contraction; a deficiency of either potassium or sodium results in weakness. Potassium is important for muscle contraction; the heart is a muscle, and hypokalemia causes dysrhythmias. Decreased functioning of respiratory muscles may result in respiratory acidosis, not metabolic alkalosis. A serum potassium level of 5.5 mEq/L (5.5 mmol/L) is within the upper range of normal. A low respiratory rate, not a rapid one, would be expected because of the weakened respiratory muscles

A healthcare provider prescribes two units of blood for a client who is bleeding. Which nursing interventions are necessary before the blood transfusion is administered? Select all that apply. Select all that apply A. Obtain the client's vital signs. B. Monitor hemoglobin and hematocrit levels. C. Allow the blood to reach room temperature. D. Determine typing and crossmatching of blood. E. Use a Y-type infusion set to initiate 0.9% normal saline.

A. Obtain the client's vital signs. D. Determine type and crossmatching of blood. E. Use a Y-type infusion set to initiate 0.9% normal saline. Rationale Obtaining the client's vital signs provides a baseline and should be done before the transfusion is initiated. Prior to beginning the transfusion, the nurse and another hospital-approved personnel should double-check client identification and blood product identification (blood unit number, blood type and crossmatch data like Rh factor along with expiration date) with another licensed nurse. Using a Y-type infusion set with 0.9% saline on one side of the Y is necessary to prevent an acute immunologic reaction if the donated blood is not compatible with the client's blood. A Y-type infusion set is specific for blood administration. It has a special blood filter, the drop factor is different, and it allows for quick shutoff and the administration of normal saline in the event of a transfusion reaction. The laboratory results for hemoglobin and hematocrit levels were part of the data used to determine the need for blood initially and do not need to be performed again until after the transfusion is completed. Blood must be kept cold until ready for use; if blood is kept at room temperature for 30 minutes before administration, it should be returned to the blood bank; after it is started, blood must be administered within four hours.

A client with a partial occlusion of the left common carotid artery is to be discharged while still receiving warfarin. Which clinical adverse effect should the nurse identify as a reason for the client to seek medical consultation? Select all that apply. Select all that apply A. Presence of blood in urine (hematuria). B. Bruising noted at various stages of healing. C. Delayed clotting from minor cuts and scrapes. D. Bleeding from gums when brushing teeth. E. Vomiting coffee-ground emesis.

A. Presence of blood in urine E. Vomiting coffee-ground emesis Rationale Warfarin causes an increase in the prothrombin time and international normalized ratio (INR) level, leading to an increased risk for bleeding. Any abnormal or prolonged bleeding must be reported, because it may indicate an excessive level of the drug. Common side effects including bruising, delayed clotting and bleeding gums do not require immediate intervention. However, hematuria and hemoptysis are evidence of more serious bleeding and require immediate attention. Coffee-ground emesis is a sign of gastric bleeding. Even though the emesis is not bright red, it still requires immediate attention by a healthcare provider.

The nurse prepares to give a prescribed capsule of hydroxyzine to a client. The client begins to vomit, so the nurse holds the oral medication. The nurse has not opened the medication package. What does proper and safe disposal of the capsule of hydroxyzine require the nurse to do? A. Return the capsule to the pharmacy. B. Drop the capsule into the sharps container. C. Place the capsule into a red biohazard bag and tie it shut. D. Have another nurse witness the disposal of the medication.

A. Return the capsule to the pharmacy. Rationale Medication taken from a stock supply cannot be returned; it should be returned to the pharmacy for safe disposal. The purpose of a sharps container is for safe disposal of sharp objects; a tablet dropped into a sharps container can be retrieved. Nonopioid medications do not require a witness for disposal. Placing the tablet into a biohazard bag does not render it unusable.

What should the nurse keep in mind when administering a benzodiazepine to a client? A. The medication can cause rebound insomnia if it is discontinued abruptly. B. The medication should be administered cautiously for infants less than 6 months old. C. The medication should be administered in higher dosage if the client becomes incontinent. D. The medication can cause fewer problems with dependence and abuse than does a nonbenzodiazepine.

A. The medication can cause rebound insomnia if it discontinued abruptly. Rationale Benzodiazepine often leads to tolerance and withdrawal; therefore, it can cause rebound insomnia when discontinued abruptly. Benzodiazepine is contraindicated for infants less than 6 months old. Benzodiazepine should be discontinued if the client becomes incontinent. Nonbenzodiazepines cause fewer problems with dependence and abuse than do benzodiazepines.

A client is prescribed albuterol to relieve severe asthma. What adverse effect will the nurse instruct the client to anticipate? Select all that apply. Select all that apply A. Tremors B. Lethargy C. Palpitations D. Visual disturbances E. Decreased pulse rate

A. Tremors C. Palpitations Rationale Albuterol's sympathomimetic effect causes central nervous stimulation, precipitating tremors, restlessness, and anxiety. Albuterol's sympathomimetic effect causes cardiac stimulation that may result in tachycardia and palpitations. Albuterol may cause restlessness, irritability, and tremors, not lethargy. Albuterol may cause dizziness, not visual disturbances. Albuterol will cause tachycardia, not bradycardia.

A healthcare provider prescribes doxorubicin for a client with acute myelogenous leukemia. Which specific interventions should the nurse implement? Select all that apply. Select all that apply A. Monitor for jaundice B. Increase fluids by mouth C. Provide frequent oral care D. Increase physical activities E. Assess vital signs routinely F. Serve hot liquids with meals

A. monitor for jaundice B. increase fluids by mouth C. provide frequent oral care E. assess vital signs routinely Rationale Doxorubicin is hepatotoxic; the client should be assessed for jaundice. Hyperuricemia is a possible complication of therapy; therefore, adequate hydration is important. Stomatitis is a possible complication of therapy; therefore, oral care is important to help maintain the integrity of the oral mucous membranes. Hypertension, sinus tachycardia, bradycardia, premature ventricular complexes, and asystole may occur with therapy. Leukopenia may make the client vulnerable to infection, with an associated increase in temperature. Anemia is a common side effect of therapy; rest is important because of the increased fatigability associated with therapy. Extremes in temperature should be avoided when administering fluids and food because of the common occurrence of stomatitis.

Which drug does a nurse anticipate may be prescribed to produce diuresis and inhibit formation of aqueous humor for a client with glaucoma? A. Chlorothiazide B. Acetazolamide C. Methazolamide D. Aclidinium bromide

B. Acetazolamide Rationale Acetazolamide is a carbonic anhydrase inhibitor that decreases inflow of aqueous humor and controls intraocular pressure in acute angle-closure glaucoma attack. Chlorothiazide has no effect on the eye. Methazolamide lowers ocular pressure but does not decrease the inflow of aqueous humor. Aclidinium bromide is a bronchodilator.

A client is admitted to the hospital with a diagnosis of heart failure and acute pulmonary edema. The healthcare provider prescribes furosemide 40 mg intravenous (IV) stat to be repeated in 1 hour. What nursing action will best evaluate the effectiveness of the furosemide in managing the client's condition? A. Perform daily weights B. Auscultate breath sounds C. Monitor intake and output D. Assess for dependent edema

B. Auscultate breath sounds Rationale Maintaining adequate gas exchange and minimizing hypoxia with pulmonary edema are critical; therefore, assessing the effectiveness of furosemide therapy as it relates to the respiratory system is most important. Furosemide inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule, causing diuresis; as diuresis occurs fluid moves out of the vascular compartment, thereby reducing pulmonary edema and the bilateral crackles. Although a liter of fluid weighs approximately 2.2 pounds (1 kilogram) and weight loss will reflect the amount of fluid lost, it will take time before a change in weight can be measured. Although identifying a greater output versus intake indicates the effectiveness of furosemide, it is the client's pulmonary status that is most important with acute pulmonary edema. Although the lessening of a client's dependent edema reflects effectiveness of furosemide therapy, it is the client's improving pulmonary status that is most important.

A nurse assesses a client's intravenous site. What clinical finding, unique to infiltration, leads the nurse to conclude that the intravenous (IV) site has infiltrated, rather than become inflamed? A. Pain B. Coolness C. Localized swelling D. Cessation in flow of solution

B. Coolness Rationale When an IV infiltrates, the IV solution entering the interstitial space is at room temperature (approximately 75° F [23.9° C]), whereas body temperature is approximately 98.6° F (37° C); therefore, the client's skin will feel cool to the touch at the site of an IV infiltration. The site of an inflammation will feel warm to the touch because of vasodilation and hyperemia. Pain may occur with both an inflammation and an infiltration. The pain of an inflammation is related to the pressure of edema on nerve endings. The pain of an infiltration is related to the IV solution in the interstitial compartment pressing on nerve endings. An increase in interstitial fluid occurs with both an inflammation and an infiltration. With an inflammation there is increased vascular permeability at the site; fluid, proteins, and leukocytes then move from the intravascular compartment into the interstitial compartment. With an infiltration the IV solution enters the interstitial compartment rather than the intravascular compartment. A cessation in flow of solution occurs with both an inflammation and an infiltration. An inflammation in the vein at the insertion site may close the lumen of the vessel, interfering with the flow of solution. An infiltration will cause excess fluid in the interstitial compartment to the extent that it will not accommodate more solution, interfering with the flow of the solution.

A nurse inspects a two-day-old intravenous (IV) site and identifies erythema, warmth, and mild edema. The client reports tenderness when the area is palpated. What should the nurse do first? A. Irrigate the IV tubing B. Discontinue the infusion C. Slow the rate of the infusion D. Obtain a prescription for an analgesic

B. Discontinue the infusion Rationale The clinical findings indicate the presence of inflammation. The IV catheter should be removed to prevent the development of thrombophlebitis. Irrigating the IV tubing and slowing the rate of the infusion do not address the underlying problem and may further irritate the vein and precipitate a thrombophlebitis. Although an analgesic may relieve the discomfort, it is not an intervention that will resolve the problem.

What should the nurse monitor when a client is receiving a platelet aggregation inhibitor such as clopidogrel? A. Nausea B. Epistaxis C. Chest pain D. Elevated temperature

B. Epistaxis Rationale The high vascularity of the nose, combined with its susceptibility to trauma (e.g., sneezing, nose blowing), makes it a frequent site of hemorrhage. Nausea, chest pain, and elevated temperature usually are not associated with anticoagulant therapy.

When reviewing a drug to be administered, the nurse identifies that the package insert indicates that the Z-track injection technique should be used. Under what circumstance does the nurse expect that this technique will be necessary? A. Volume of medication to be administered is large. B. Medication is irritating to subcutaneous tissue and skin. C. Injection site must be massaged after it is administered. D. Procedure requires an air bubble to be drawn into the syringe.

B. Medication is irritating to subcutaneous tissue and skin. Rationale The Z-track method seals the puncture at the intramuscular level, preventing seepage of injected medication up the needle track and thereby avoiding injury to subcutaneous tissue and skin. The Z-track technique is unrelated to the volume of medication to be administered. When the volume of medication is large, it should be administered into a large muscle or divided into two syringes. Massage is avoided with the Z-track technique to help prevent the injected medication from flowing back up the needle track. Administration of a small air bubble at the completion of injection of medication into a muscle (air-lock technique) is no longer recommended because it does not increase the likelihood that medication will remain in the muscle without flowing back up the needle track.

A client reports fatigue and dyspnea and appears pale. The nurse questions the client about medications currently being taken. In light of the symptoms, which medication causes the nurse to be most concerned? A. Famotidine B. Methyldopa C. Levothyroxine D. Ferrous sulfate

B. Methyldopa Rationale Methyldopa is associated with acquired hemolytic anemia and should be discontinued to prevent progression and complications. Famotidine will not cause these symptoms; it decreases gastric acid secretion, which will decrease the risk of gastrointestinal bleeding. Ferrous sulfate is an iron supplement to correct, not cause, symptoms of anemia. Levothyroxine is not associated with red blood cell destruction.

What should the nurse include in a teaching plan for a client taking calcium channel blockers such as nifedipine? Select all that apply. Select all that apply A. Reduce calcium intake. B. Report peripheral edema. C. Expect temporary hair loss. D. Avoid drinking grapefruit juice. E. Change to a standing position slowly.

B. Report peripheral edema. D. Avoid drinking grapefruit juice. E. Change to a standing position slowly. Rationale Changing positions slowly helps reduce orthostatic hypotension. Peripheral edema may occur as a result of heart failure and must be reported. Grapefruit juice affects the metabolism of calcium channel blockers and should be avoided. Reducing calcium intake is unnecessary because calcium levels are not affected. Hair loss does not occur.

A nurse is teaching a client about ampicillin that has been prescribed for a severe infection. Which statement indicates to the nurse that the client needs further teaching? A. "I should report any problems with my hearing." B. "I may be required to get additional blood tests." C. "It is okay for me to stop taking this medication after I improve." D. "If I develop a fever, I will notify my primary healthcare provider."

C. "It is okay for me to stop taking this medication after I improve." Rationale It is most important for the client to complete the antibiotic prescription to prevent the development of antibiotic-resistant bacteria. Ototoxicity is an adverse effect of aminoglycoside antibiotics such as gentamicin. Blood tests for toxicity may be required. Because the client has an infection, it is important to report temperature elevation.

An older client develops hypokalemia, and an intravenous infusion containing 40 mEq of potassium is instituted. The client tells the nurse that the IV stings a little. What is the nurse's best reply? A. "I'll restart the IV in a different vein. This may help to relieve the pain." B. "Try to imagine a sunny beach with gentle waves, and soon you won't notice the discomfort." C. "You are receiving a large dose of potassium, and unfortunately it often causes a stinging sensation." D. "Some people are more sensitive to pain than others. I'll get a prescription for pain medication for you."

C. "You are receiving a large dose of potassium, and unfortunately it often causes a stinging sensation." Rationale The response "You are receiving a large dose of potassium, and unfortunately it often causes a stinging sensation" validates the client's concerns and provides information. The potassium solution will be irritating to other peripheral veins as well. Although imagery may help to distract the client from discomfort, this response provides no information as to why the stinging sensation is occurring. The response "Some people are more sensitive to pain than others. I'll get a prescription for pain medication for you" belittles the client and implies that the client is intolerant of pain. Also, pain medication is not needed in this situation.

What effect of povidone-iodine does a nurse consider when using it on the client's skin before obtaining a specimen for a blood culture? A. Avoids drying the skin B. Makes the skin more supple C. Eliminates surface bacteria that may contaminate the culture D. Provides a cooling agent to diminish the feeling from the puncture wound

C. Eliminates surface bacteria that may contaminate the culture. Rationale Povidone-iodine exerts bactericidal action that helps eliminate surface bacteria that will contaminate culture results. Povidone-iodine does not make the skin more supple. It does dry the skin. Although povidone-iodine may provide a cool feeling, this is not a reason for its use.

A client hospitalized for uncontrolled hypertension and chest pain was started on a daily diuretic 2 days ago upon admission, with prescriptions for a daily basic metabolic panel. The client's potassium level this morning is 2.7 mEq/L (2.7 mmol/L). Which action should the nurse take next? A. Send another blood sample to the lab to retest the serum potassium level B. Notify the healthcare provider that the potassium level is above normal C. Notify the healthcare provider that the potassium level is below normal D. No action is required because the potassium level is within normal limits

C. Notify the HCP that the potassium level is below normal Rationale The healthcare provider should be notified immediately because the client's potassium is below normal. The normal potassium level range is 3.5 mEq/L to 5.0 mEq/L (3.5 mmol/L to 5.0 mmol/L). Clients on diuretic therapy require close monitoring of their electrolytes because supplemental potassium may be needed. Retesting the serum potassium level is unnecessary and will delay the treatment required by the client.

A nurse is providing discharge medication teaching to a client who will be taking furosemide and digoxin after discharge from the hospital. What information is most important for the nurse to include in the teaching plan? A. Maintenance of a low-potassium diet B. Avoidance of foods high in cholesterol C. Signs and symptoms of digoxin toxicity D. Importance of an adequate intake and output

C. Signs and symptoms of digoxin toxicity Rationale The risk of digoxin toxicity increases when the client is receiving digoxin and furosemide, a loop diuretic; loop diuretics can cause hypokalemia, which potentiates the effects of digoxin, leading to toxicity. Digoxin toxicity can result in dysrhythmias and death. When a client is receiving a loop diuretic, the diet should be high in potassium. Although teaching the need to avoid foods high in cholesterol may be included in the teaching plan, it is not the priority. Although it is important to maintain adequate intake and output because potassium chloride should not be taken when there is a decreased urinary output, the priority is monitoring for signs of digoxin toxicity.

Which medication requires the nurse to monitor the client for signs of hyperkalemia? A. Furosemide B. Metolazone C. Spironolactone D. Hydrochlorothiazide

C. Spironolactone Rationale Spironolactone is a potassium-sparing diuretic; hyperkalemia is an adverse effect. Furosemide, metolazone, and hydrochlorothiazide generally cause hypokalemia.

A client who is receiving atenolol for hypertension frequently reports feeling dizzy. What effect of atenolol should the nurse consider may be responsible this response? A. Depleting acetylcholine B. Stimulating histamine release C. Blocking the adrenergic response D. Decreasing adrenal release of epinephrine

C. blocking the adrenergic response Rationale The beta adrenergic blocking effect of atenolol decreases the heart's rate and contractility; it may result in orthostatic hypotension and decreased cerebral perfusion, causing dizziness. Depleting acetylcholine is not an action of atenolol. Stimulating histamine release is not an action of atenolol. Decreasing adrenal release of epinephrine is not an action of atenolol.

A client with type 2 diabetes is taking one glyburide tablet daily. The client asks whether an extra pill should be taken before exercise. What is the nurse's best reply? A. "You will need to decrease how much you are exercising." B. "An extra pill will help your body use glucose when exercising." C. "The amount of medication you need to take is not related to exercising." D. "Do not take an extra pill because you may become hypoglycemic when exercising."

D. "Do not take an extra pill because you may become hypoglycemic when exercising." Rationale Exercise improves glucose metabolism. Exercise is associated with a risk for hypoglycemia, not hyperglycemia; an additional antidiabetic agent is contraindicated. Exercise should not be decreased because it improves glucose metabolism. Also, this response does not answer the client's question. An extra tablet probably will result in hypoglycemia because exercise alone improves glucose metabolism. Control of glucose metabolism is achieved through balanced diet, exercise, and pharmacologic therapy.

A nurse prepares to administer intravenous (IV) albumin to a client with ascites. What effect does the nurse anticipate? A. Ascites and blood ammonia levels will decrease. B. Decreased capillary perfusion and blood pressure. .C. Venous stasis and blood urea nitrogen level will increase. D. As extravascular fluid decreases, the hematocrit will decrease.

D. As extravascular fluid decreases, the hematocrit will decrease. Rationale Serum albumin is administered to maintain blood volume and normal oncotic (osmotic) pressure; it does this by pulling fluid from the interstitial spaces into the intravascular compartment. Serum albumin does affect blood ammonia levels; fluid accumulated in the abdominal cavity is removed via a paracentesis. The administration of albumin results in a shift of fluid from the interstitial to the intravascular compartment, which probably will increase the blood pressure. Albumin administration does not affect venous stasis or the blood urea nitrogen level.

A client with an intractable infection is receiving vancomycin. Which laboratory blood test result should the nurse report? A. Hematocrit: 45% B. Calcium: 9.0 mg/dL (2.25 mmol/L) C. White blood cells (WBC): 10,000 mm 3 (10 X 10 9/L) D. Blood urea nitrogen (BUN): 30 mg/dL (10.2 mmol/L)

D. BUN: 30 mg/dL Rationale Vancomycin is a nephrotoxic medication. An elevated BUN can be an early sign of toxicity. The BUN of a healthy adult is 10 to 20 mg/dL (3.6-7.1 mmol/L). This hematocrit is expected in a healthy adult; the range is from 40 to 52. The expected range of the WBC count is 5,000 to 10,000 mm 3 (5-10 X 10 9/L) for a healthy adult. This calcium level is within the expected range of 9.0 to 10.5 (2.25-2.75 mmol/L) for a healthy adult.

A healthcare provider prescribes tissue plasminogen activator (t-PA) to be administered intravenously over 1 hour for a client experiencing a myocardial infarction. What is the nurse's priority assessment that is specific to this medication's effect? A. Respiratory rate B. Peripheral pulses C. Level of consciousness D. Intravenous insertion site

D. Intravenous insertion site Rationale The most common adverse effect of a tissue plasminogen activator is bleeding because of the thrombolytic action of the drug. Sites of invasive procedures, such as IV sites, have an increased tendency to bleed. Although respiratory rate, peripheral pulses, and level of consciousness are important for any client with a decreased cardiac output, they are not specific to the administration of a tissue plasminogen activator.

A client using fentanyl transdermal patches for pain management in late-stage cancer dies. What should the hospice nurse who is caring for this client do about the patch? A. Tell the family to remove and dispose of the patch. B. Leave the patch in place for the mortician to remove. C. Have the family return the patch to the pharmacy for disposal. D. Remove and dispose of the patch in an appropriate receptacle.

D. Remove and dispose of the patch in an appropriate receptacle. Rationale The nurse should remove and dispose of the patch in a manner that protects self and others from exposure to the fentanyl. This involves folding the patch so that adhesive edges are together. The nurse should flush the patch down toilet or place it in a proper disposal receptacle following the institutional policy. Having the family remove and dispose of the patch or having the mortician remove the patch is not safe. It is not the responsibility of nonprofessionals because they do not know how to protect themselves and others from exposure to the fentanyl. It is unnecessary to return a used fentanyl patch to the pharmacy.

A client takes isosorbide dinitrate daily. The client states, "I would like to start taking sildenafil for erectile dysfunction." The nurse explains that taking both of these medications concurrently may result in which complication? A. Constipation B. Protracted vomiting C. Respiratory distress D. Severe hypotension

D. Severe hypotension Rationale Concurrent use of sildenafil and a nitrate, which causes vasodilation, may result in severe, potentially fatal hypotension. Protracted vomiting and respiratory distress are not adverse effects associated with concurrent use of sildenafil and a nitrate. Sildenafil may cause diarrhea; adding a nitrate will not constipation.

A client with chronic liver disease reports, "My gums have been bleeding spontaneously." The nurse identifies small hemorrhagic lesions on the client's face. The nurse concludes that the client needs which additional supplement? A. Bile salts B. Folic acid C. Vitamin A D. Vitamin K

D. Vitamin K Rationale Fat-soluble vitamin K is essential for synthesis of prothrombin by the liver; a lack results in hypoprothrombinemia, inadequate coagulation, and hemorrhage. Although cirrhosis may interfere with production of bile, which contains the bilirubin needed for optimum absorption of vitamin K, the best and quickest manner to counteract the bleeding is to provide vitamin K intramuscularly. Folic acid is a coenzyme with vitamins B 12 and C in the formation of nucleic acids and heme; thus, a deficiency may lead to anemia, not bleeding. Vitamin A deficiency contributes to the development of polyneuritis and beriberi, not hemorrhage.

A client is taking lithium sodium. The nurse should notify the healthcare provider for which laboratory value? A. Negative protein in the urine B. Prothrombin of 12.0 seconds C. Blood urea nitrogen (BUN) of 20 mg/dL (7.1 mmol/L) D. White blood cell (WBC) count of 15,000 mm 3 (15 X 10 9/L)

D. WBC Count of 15,000 Rationale White cell counts can increase with this drug. The expected range of the WBC count is 5000 to 10,000 mm 3 (5-10 X 10 9/L) for a healthy adult. Urinalysis, BUN, and prothrombin are not necessary, and these are normal values.

After thoracic surgery for removal of a cancerous lesion in the lung, the client is drowsy, complains of pain when awakened, and then falls asleep. The client has a prescription for morphine sulfate via IV every 3 hours as needed for pain. The client's preoperative blood pressure was 128/76 mm Hg. Postoperative assessments reveal that the client's blood pressure ranges between 90/60 and 100/70 mm Hg. What is the nurse's best initial action? A. Administer morphine as prescribed. B. Obtain a prescription for a vasoconstrictor. C. Give half the prescribed amount of morphine. D. Withhold morphine until the blood pressure stabilizes.

D. Withhold morphine until the BP stabilizes Rationale Morphine is an opioid analgesic that may decrease the blood pressure further. It should be withheld and not administered at this time. A vasoconstrictor will not relieve the pain. Administration of a medication dosage other than that prescribed is not an independent nursing function.

A client admitted for uncontrolled hypertension and chest pain was prescribed a low-sodium diet and started on furosemide. The nurse should instruct the client to include which foods in the diet? A. Liver B. Apples C. Cabbage D. Bananas

D. bananas Rationale Furosemide is a loop diuretic that eliminates potassium by preventing renal absorption. Bananas have a significant amount of potassium. Bananas: 450 mg; cabbage: 243 mg; liver: 73.6 mg; apples: 100-120 mg.

Enoxaparin 40 mg subcutaneously daily is prescribed for a client who had abdominal surgery. The nurse explains that the medication is given for what purpose? A. Control postoperative fever B. Provide a constant source of mild analgesia C. Limit the postsurgical inflammatory response D. Provide prophylaxis against postoperative thrombus formation

D. provide prophylaxis against postoperative thrombus formation Rationale Enoxaparin, a low-molecular-weight heparin, prevents the conversion of fibrinogen to fibrin and of prothrombin to thrombin by enhancing the inhibitory effects of antithrombin III. Enoxaparin is not an antipyretic. Enoxaparin is not an analgesic. Enoxaparin is not an antiinflammatory drug.