pharmacology (eaq) (practice) 2

A healthcare provider prescribes a medication to be administered via a metered-dose inhaler (MDI) for a young adult with asthma. List in order the steps the nurse teaches the client to follow when using the inhaler. 1. Hold the inhaler upright in the mouth. 2. Shake the inhaler for 30 seconds. 3. Start breathing in and press down on the inhaler once. 4. Exhale slowly and deeply to empty the air from the lungs.

1. Shake the inhaler for 30 seconds. Correct 2. Exhale slowly and deeply to empty the air from the lungs. Correct 3. Hold the inhaler upright in the mouth. Correct 4. Start breathing in and press down on the inhaler once. When using an MDI, the medication should be shaken for 30 seconds to ensure that the medication is mixed. Exhaling completely maximizes emptying the lungs. The inhaler should be held upright in the mouth past the teeth with the lips closed around the mouthpiece (closed mouth method) or held upright 1 to 2 cm in front of the open mouth (open mouth method). Inhalation is begun at the same time that the device is compressed to ensure that maximum medication reaches the lungs.

The nurse is teaching a client about safe insulin administration. Which statement made by the client indicates the need for further education? 1 "I should see whether the insulin is expired." 2 "I should keep a daily logbook of times of insulin injection." 3 "I should keep my medication in its original labeled container." 4 "I should administer insulin only if there are any symptoms."

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A client is scheduled for discharge following surgery. The medical record indicates that the client has not had a bowel movement since before surgery, which was 4 days ago. During the hospital stay, the client received a stool softener daily and an oral laxative the day before discharge. Which one of the prescribed medications should the nurse administer to ensure a bowel movement prior to discharge? 1 Milk of magnesia 30 mL 2 Docusate sodium 100 mg 3 Bisacodyl 10-mg suppository 4 Bisacodyl two enteric-coated 5-mg tablets

A bisacodyl suppository should produce results before the client leaves the facility. The client already had an oral laxative the previous day, which was not effective at the time of discharge. The client already had stool softeners daily, which were not effective at the time of discharge. Test-Taking Tip: A psychological technique used to boost your test-taking confidence is to look into a mirror whenever you pass one and say out loud, "I know the material, and I'll do well on the test." Try it; many students have found that it works because it reduces "test anxiety."

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

A life-threatening effect of cyclosporine is nephrotoxicity. Therefore creatinine and blood urea nitrogen levels should be monitored. Although abnormal hairiness (hirsutism) is an effect of cyclosporine, it is not life threatening. Diarrhea, not constipation, is a response to cyclosporine. Cyclosporine does not cause cardiovascular life-threatening effects. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer.

The laboratory report of a client undergoing long-term treatment with lithium carbonate indicates a level of 1.5 mEq/L (1.5 mmol/L). What will the nurse do? 1 Watch for signs of lithium toxicity. 2 Expect an increase in manic behavior. 3 Administer the next dose of lithium as prescribed. 4 Ask the client whether he or she has been taking the medication.

A lithium plasma level of 0.8 to 1.2 mEq/L (0.8 to 1.2 mmol/L) is appropriate for mood stabilization; the client's level is above the recommended level. An increase in manic behavior is unexpected in this case. The client should be monitored for signs and symptoms of lithium toxicity, including nausea and vomiting, diarrhea, increased tremor, vertigo, and blurred vision. Administering another dose will further increase the plasma level of lithium, which is already increased beyond the therapeutic range. The client has obviously been taking the medication—the lithium level is too high. STUDY TIP: The old standbys of enough sleep and adequate nutritional intake also help keep excessive stress at bay. Although nursing students learn about the body's energy needs in anatomy and physiology classes, somehow they tend to forget that glucose is necessary for brain cells to work. Skipping breakfast or lunch or surviving on junk food puts the brain at a disadvantage.

Trimethoprim-sulfamethoxazole is prescribed for a client with cystitis. When teaching about the medication, what does the nurse instruct the client to do? 1 Drink 8 to 10 glasses of water daily. 2 Drink two glasses of orange juice daily. 3 Take the medication with meals. 4 Take the medication until symptoms subside.

A urinary output of at least 1500 mL daily should be maintained to prevent crystalluria (crystals in the urine). Orange juice produces an alkaline ash, which results in an alkaline urine that supports the growth of bacteria. Trimethoprim-sulfamethoxazole should be taken 1 hour before meals for maximum absorption. A prescribed course of antibiotics must be completed to eliminate the infection, which can exist on a subclinical level after symptoms subside. Test-Taking Tip: Never leave a question unanswered. Even if answering is no more than an educated guess on your part, go ahead and mark an answer. You might be right, but if you leave it blank, you will certainly be wrong and lose precious points.

A client with rheumatoid arthritis has been given a prescription for acetylsalicylic acid. The client asks the nurse, "What kind of drug is acetylsalicylic acid?" The nurse recalls that this drug has which property? 1 Sedative 2 Hypnotic 3 Analgesic 4 Antibiotic

Acetylsalicylic acid (aspirin) acts as an analgesic by inhibiting production of inflammatory mediators. Acetylsalicylic acid does not act as a sedative to calm individuals. Acetylsalicylic acid does not act as a hypnotic to induce sleep. Acetylsalicylic acid does not destroy or control microorganisms. Test-Taking Tip: Eat breakfast or lunch before an exam. Avoid greasy, heavy foods and overeating. This will help keep you calm and give you energy

A client is receiving warfarin for a pulmonary embolism. Which drug is often contraindicated when taking warfarin? 1 Atenolol 2 Ferrous sulfate 3 Chlorpromazine 4 Acetylsalicylic acid

Acetylsalicylic acid can cause decreased platelet aggregation, increasing the risk for undesired bleeding that may occur with administration of anticoagulants. It should not be administered unless specifically prescribed, usually by a cardiologist or other specialist, to manage serious risks of thrombosis. Ferrous sulfate does not affect warfarin; it is used for red blood cell synthesis. Atenolol is a beta-blocker that reduces blood pressure; it does not affect bleeding. Chlorpromazine is a neuroleptic; it does not affect bleeding.

A client with type 2 diabetes develops gout, and allopurinol is prescribed. The client is also taking metformin and an over-the-counter nonsteroidal antiinflammatory drug (NSAID). When teaching about the administration of allopurinol, what should the nurse instruct the client to do? 1 Decrease the daily dose of NSAIDs. 2 Limit fluid intake to one quart a day. Incorrect3 Take the medication on an empty stomach. Correct4 Monitor blood glucose levels more frequently.

Allopurinol can potentiate the effect of oral hypoglycemics, causing hypoglycemia; the blood glucose level should be monitored more frequently. NSAIDs can be taken concurrently with allopurinol. A daily fluid intake of 2500 to 3000 mL will limit the risk of developing renal calculi. Allopurinol should be taken with milk or food to decrease gastrointestinal irritation. Test-Taking Tip: Become familiar with reading questions on a computer screen. Familiarity reduces anxiety and decreases errors.

Which intravenous fluid should the nurse classify as hypertonic? 1 Ringer solution 2 5% dextrose in water 3 Lactated Ringer solution 4 5% dextrose in normal saline

An isotonic solution has the same osmolarity as body fluids. A hypertonic solution has a higher osmolarity than body fluids; it pulls fluid from cells, causing them to shrink and the extracellular space to expand. This hypertonic solution provides 586 mOsm/kg. This isotonic solution provides 309 mOsm/kg. The other isotonic solutions provide 278 mOsm/kg.

A healthcare provider prescribes famotidine and magnesium hydroxide/aluminum hydroxide antacid for a client with a peptic ulcer. The nurse should teach the client to take the antacid at what time? 1 Only at bedtime, when famotidine is not taken 2 Only if famotidine is ineffective 3 At the same time as famotidine, with a full glass of water 4 One hour before or 2 hours after famotidine

Antacids interfere with complete absorption of famotidine; therefore antacids should be administered at least 1 hour before or 2 hours after famotidine. Magnesium hydroxide/aluminum hydroxide usually is taken 1 hour after meals and at bedtime. Famotidine usually is prescribed once a day at bedtime. The client has received a prescription for both medications; the client should not be instructed to omit one of the medications without checking with the healthcare provider first.

A nurse teaches a client about Coumadin and concludes that the teaching is effective when the client agrees not to drink which juice? 1 Apple juice 2 Grape juice 3 Orange juice 4 Cranberry juice

Antioxidants in cranberry juice may inhibit the mechanism that metabolizes warfarin, causing elevations in the international normalized ratio, resulting in hemorrhage. Apple juice, grape juice, and orange juice are fine to drink.

A client is started on tetracycline antibiotic therapy. What should the nurse do when administering this drug? 1 Administer the medication with meals or a snack. 2 Provide orange or other citrus fruit juice with the medication. 3 Give the medication an hour before milk products are ingested. 4 Offer antacids 30 minutes after administration if gastrointestinal side effects occur.

Any product containing aluminum, magnesium, or calcium ions should not be taken in the hour before or after an oral dose of tetracyclines (with the exception of doxycycline) because it decreases absorption by as much as 25% to 50%. Food interferes with absorption; it should be given one hour before or two hours after meals. Citrus juice has no influence on this drug. Antacids will interfere with absorption.

The healthcare provider prescribes atenolol for a client with angina. What potential side effect will the nurse mention when instructing the client about this medication? 1 Headache 2 Tachycardia 3 Constipation 4 Hypotension

Atenolol competitively blocks stimulation of beta-adrenergic receptors within vascular smooth muscles, which lowers the blood pressure. This drug does not cause headaches; this drug may be used to relieve vascular headaches. This drug may cause bradycardia, not tachycardia. This drug may cause diarrhea, not constipation

While a pacemaker catheter is being inserted, the client's heart rate drops to 38 beats/min. What medication should the nurse expect the healthcare provider to prescribe? 1 Digoxin 2 Lidocaine 3 Amiodarone 4 Atropine sulfate

Atropine blocks vagal stimulation of the sinoatrial (SA) node, resulting in an increased heart rate. Digoxin slows the heart rate; hence it would not be indicated in this situation. Lidocaine decreases myocardial sensitivity and will not increase the heart rate. Amiodarone is an antidysrhythmic drug used for ventricular tachycardia; it will not stimulate the heart rate.

Which medication should the nurse anticipate the healthcare provider will prescribe to relieve the pain experienced by a client with rheumatoid arthritis? 1 Aspirin 2 Hydromorphone 3 Meperidine 4 Alprazola

Because of its antiinflammatory effect, acetylsalicylic acid is useful in treating arthritis symptoms. Opioids such as hydromorphone and meperidine should be avoided because they promote drug dependency and do not affect the inflammatory process. Alprazolam is an antianxiety, not an antiinflammatory, agent.

A nurse notes gentamycin in the prescription of an older adult with osteomyelitis. Which nursing interventions should be conducted before starting therapy? Select all that apply. Correct 1 Assessing renal function Correct 2 Assessing hydration status Incorrect 3 Checking the erythrocyte count 4 Checking the blood platelet count 5 Assessing serum thyroxin levels

Because gentamycin can increase the risk of nephrotoxicity, the nurse should assess a client's renal function before starting therapy. Dehydration can further increase the risk of nephrotoxicity; therefore the client's hydration status should also be checked before starting therapy. Gentamycin generally does not impact erythrocyte and blood platelet counts nor does it affect serum thyroxin levels.

A health care provider prescribes vancomycin peak and trough levels for a client who is receiving vancomycin intravenous piggyback (IVPB). When should the nurse have the laboratory obtain a blood sample to determine a peak level of the antibiotic? 1 Halfway between two doses of the drug 2 Between 30 and 60 minutes after a dose 3 Immediately before the medication is administered 4 Anytime it is convenient for the client and the laboratory

Because the drug was administered IV, the blood level of the drug will be at its highest shortly after administration. A drug blood level measured halfway between two doses will not obtain the peak level. Immediately before the medication is administered is done for a trough level, when the drug level is at its lowest. Anytime it is convenient for the client and the laboratory will produce inaccurate results; peak and trough levels are measured in relation to the time a drug is administered.

Which class of drugs is frequently prescribed for a client with bipolar disorder to induce sedation? 1 Antipsychotics 2 Antidepressants 3 Benzodiazepines 4 Mood stabilizers

Benzodiazepines are frequently used to sedate clients with bipolar disorder (BPD). BPD is treated with three major classes of drugs which include mood stabilizers, antipsychotics, and antidepressants.

Which drug is contraindicated in clients with eating and seizure disorders? 1 Bupropion 2 Trazodone 3 Amitriptyline 4 Lithium citrate

Bupropion is contraindicated in clients with eating and seizure disorders. Trazodone is contraindicated in clients with a known allergic reaction to this drug. Amitriptyline is contraindicated in clients who are pregnant and have known allergic reactions to this drug. Lithium citrate is contraindicated in clients with renal or cardiovascular disease.

A client is diagnosed with trigeminal neuralgia. Which medication should the nurse anticipate will be prescribed for this client? 1 Ascorbic acid (vitamin C) 2 Morphine 3 Allopurinol 4 Carbamazepine

Carbamazepine is an anticonvulsant, antineuraligic drug used to control pain in trigeminal neuralgia and to prevent future attacks. It sometimes eliminates the need for surgery. Ascorbic acid (vitamin C) may be used as an adjunct to the specific treatment for trigeminal neuralgia. Vitamin C is prescribed when the body is subject to stress, as occurs with pain. Morphine sulfate is an opioid analgesic that will relieve severe pain but will not prevent its recurrence; prolonged frequent use is contraindicated because of possible addiction. Allopurinol is used in the treatment of gout.

Carbidopa/levodopa is prescribed for a client with Parkinson disease. What will the nurse teach the client about this medication? 1 "Take this medication between meals." 2 "Blood levels of the drug should be monitored weekly." 3 "It can cause happy feelings followed by feelings of depression." 4 "You may experience dizziness when moving from sitting to standing."

Carbidopa/levodopa is a metabolic precursor of dopamine; it reduces sympathetic outflow by limiting vasoconstriction, which may result in orthostatic hypotension. Carbidopa/levodopa should be administered with food to minimize gastric irritation. Although periodic tests to evaluate hepatic, renal, and cardiovascular status are required for prolonged therapy, whether these tests should be done on a weekly basis has not been established. Carbidopa/levodopa may produce either happiness or depression, but no established pattern of such responses exists. STUDY TIP: Becoming a nursing student automatically increases stress levels because of the complexity of the information to be learned and applied and because of new constraints on time. One way to decrease stress associated with school is to become very organized so that assignment deadlines or tests do not come as sudden surprises. By following a consistent plan for studying and completing assignments, you can stay on top of requirements and thereby prevent added stress.

What should the nurse include in a teaching plan to help reduce the side effects associated with diltiazem? 1 Lie down after meals. 2 Avoid dairy products in diet. 3 Take the drug with an antacid. t4 Change slowly from sitting to standing.

Changing positions slowly will help prevent the side effect of orthostatic hypotension. Lying down after meals can relax the esophagus and lead to acid reflux. Avoiding dairy products and taking the drug with an antacid are not necessary. Test-Taking Tip: If you are unable to answer a multiple-choice question immediately, eliminate the alternatives that you know are incorrect and proceed from that point. The same goes for a multiple-response question that requires you to choose two or more of the given alternatives. If a fill-in-the-blank question poses a problem, read the situation and essential information carefully and then formulate your response.

Which is a second-generation antidepressant drug? 1 Doxepin 2 Citalopram 3 Protriptyline 4 Trimipramine

Citalopram is an example of a second-generation antidepressant drug. Doxepin, protriptyline, and trimipramine are examples of first-generation antidepressant drugs.

A client with supraventricular tachycardia (SVT) has a heart rate of 170 beats per minute. Following treatment with diltiazem hydrochloride, what assessment indicates to the nurse that the diltiazem hydrochloride is effective? 1 Increased urine output 2 Blood pressure of 90/60 mm Hg 3 Heart rate of 110 beats per minute 4 No longer complaining of heart palpations

Diltiazem hydrochloride's purpose is to slow down the heart rate. SVT has a heart rate of 150 to 250 beats per minute. A heart rate of 110 indicates that the diltiazem hydrochloride is having the desired effect. Hypotension is a side effect of diltiazem hydrochloride, not a desired effect. Heart palpations are experienced by some with various dysrhythmias. A decreased sensation of heart palpations is a positive finding but is not present in all clients. Increased urine output may occur over a period of time because of the increased ventricular filling time but would not occur until after the heart rate had stabilized. Test-Taking Tip: If you are unable to answer a multiple-choice question immediately, eliminate the alternatives that you know are incorrect and proceed from that point. The same goes for a multiple-response question that requires you to choose two or more of the given alternatives. If a fill-in-the-blank question poses a problem, read the situation and essential information carefully and then formulate your response.

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

Duloxetine is an antidepressant drug used in the treatment of generalized anxiety disorder. A contraindication is that it can worsen uncontrolled angle-closure glaucoma. Lithium carbonate is used to treat manic episodes but is contraindicated in clients with renal disease. Buspirone is an antidepressant drug contraindicated in clients with known allergic reactions to this drug. Chlorpromazine is an antipsychotic drug contraindicated in clients with blood dyscrasias. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect.

Valsartan, an angiotensin II receptor antagonist, is prescribed for a client. For which possible side effects should the nurse monitor the client? Select all that apply. 1 Constipation 2 Hypokalemia 3 Irregular pulse rate 4 Change in visual acuity 5 Orthostatic hypotension

Dysrhythmias, including second-degree heart block, are cardiovascular side effects of valsartan. It also may precipitate angina pectoris, myocardial infarction, and brain attack (cerebrovascular accident, CVA). Angiotensin II receptor antagonists, such as valsartan, block vasoconstrictor and aldosterone-producing effects of angiotensin II at receptor sites, including vascular smooth muscle, thus reducing the blood pressure; dizziness, orthostatic hypotension, and excessive hypotension may occur. Diarrhea, not constipation, may occur with valsartan. Hyperkalemia, not hypokalemia, may occur with valsartan. Valsartan does not cause altered visual acuity.

Potassium chloride effervescent tablets are prescribed for a client who is to be discharged from the emergency department. What information should the nurse include when teaching the client about this medication? 1 Chew the tablet completely. 2 Take the medication with food. 3 Take the medication at bedtime. 4 Use warm water to dissolve the tablet.

Eating food when taking the medication will decrease gastrointestinal irritation. Side effects of this medication include abdominal cramps, diarrhea, and ulceration of the small intestine. Chewing the tablet completely will cause oral mucosal irritation and is not the way the drug should be administered if it is to be most effective. Taking the medication at bedtime increases the possibility of mucosal irritation because the gastrointestinal tract is empty during the night. The tablet should be dissolved in cold water or juice to make it more palatable. STUDY TIP: Enhance your time-management abilities by designing a study program that best suits your needs and current daily routines by considering issues such as the following: (1) Amount of time needed; (2) Amount of time available; (3) "Best" time to study; (4) Time for emergencies and relaxation.

A healthcare provider prescribes enalapril for a client. Which is the most important nursing action? 1 Assess the client for hypokalemia. 2 Ensure that the medication is ingested with food. 3 Monitor the client's blood pressure during therapy. 4 Teach that a missed dose can be doubled at the next scheduled time.

Enalapril is an antihypertensive. A lowering of the client's blood pressure reflects a therapeutic response and needs to be monitored frequently. The client may be at risk for hyperkalemia, not hypokalemia. Enalapril may be taken without regard to meals. Doubling a dose is unsafe as it may cause an extreme lowering of blood pressure. A missed dose can be taken as long as it is not close to the next scheduled dose.

The nurse is preparing discharge instructions for a client who was prescribed enalapril for treatment of hypertension. Which instruction is appropriate for the nurse to include in the client's teaching? 1 Do not change to a standing position suddenly. 2 Lightheadedness is a common adverse effect that need not be reported. 3 The medication may cause a sore throat for the first few days. 4 Schedule blood tests weekly for the first 2 months.

Enalapril is classified as an angiotensin-converting enzyme (ACE) inhibitor. It is used to treat hypertension and congestive heart failure. It can also be used to treat a disorder of the ventricles. Angiotensin is a chemical that causes the arteries to become narrow. ACE inhibitors help the body produce less angiotensin, which helps the blood vessels relax and open up, which, in turn, lowers blood pressure. Clients should be advised to change positions slowly to minimize orthostatic hypotension. A healthcare provider should be notified immediately if the client is experiencing lightheadedness or feeling like he or she is about to faint, as this is a serious side effect. This medication does not cause a sore throat the first few days of treatment. Presently, there are no guidelines that suggest blood tests are required weekly for the first 2 months.

A client with a history of schizophrenia has recently begun reporting symptoms of depression and is now prescribed a selective serotonin reuptake inhibitor (SSRI). In light of the information in the client's chart, what is the nurse's priority? 1 Educating both the client and family on how to identify the early signs of extrapyramidal symptoms 2 Requesting a gastrointestinal consult to identify the cause of the client's need for frequent antacids 3 Stressing the importance of managing the client's diet while taking the prescribed antidepressant 4 Discussing the stressors that have developed since the client moved in with the sister and brother-in-law

Extrapyramidal symptoms can result from antipsychotic medication therapy, and the risk is increased when the treatment plan includes an SSRI antidepressant. The cause of the frequent use of antacids should be explored, but does not take priority in this situation. A well-balanced diet is always important, but the importance of diet management would still exist if the antidepressant were a monoamine oxidase inhibitor (MAOI) and not an SSRI. Identifying and addressing stressors is important, but it does not take priority in this situation.

A nurse is teaching the parents of an 8-year-old child who is taking a high dose of oral prednisone for asthma. What critical information about prednisone will be included? 1 It protects against infection. 2 It should be stopped gradually. 3 An early growth spurt may occur. 4 A moon-shaped face will develop.

Gradual weaning from prednisone is necessary to prevent adrenal insufficiency or adrenal crisis. Prednisone depresses the immune system, thereby increasing susceptibility to infection. The drug usually suppresses growth. A moon face may occur, but it is not a critical, life-threatening side effect. Test-Taking Tip: Come to your test prep with a positive attitude about yourself, your nursing knowledge, and your test-taking abilities. A positive attitude is achieved through self-confidence gained by effective study. This means (a) answering questions (assessment), (b) organizing study time (planning), (c) reading and further study (implementation), and (d) answering questions (evaluation)

Which client may benefit from the administration of the herbal preparation of Hypericum perforatum? 1 Client with dementia 2 Client with schizophrenia 3 Client with sleep disorder 4 Client with Alzheimer disease

Hypericum perforatum is an over-the-counter herbal preparation sold as a treatment for sleep disorders, depression, anxiety, and nervousness. It is contraindicated in clients with dementia, schizophrenia, and Alzheimer disease.

A healthcare provider prescribes transdermal fentanyl 25 mcg/hr every 72 hours. During the first 24 hours after starting the fentanyl, what is the most important nursing intervention? 1 Titrate the dose until pain is tolerable. 2 Manage pain with oral pain medication. 3 Assess the client for anticholinergic side effects. 4 Instruct the client to take the medication with food.

It takes 24 hours to reach the peak effect of transdermal fentanyl. Oral pain medication may be necessary to support client comfort until the fentanyl reaches its peak effect. The nurse needs to administer the dose of transdermal fentanyl exactly as prescribed by the healthcare provider. Anticholinergic side effects are associated with tricyclic antidepressants, not transdermal fentanyl. A transdermal medication is administered through the skin via a patch applied to the skin, not via the gastrointestinal tract. STUDY TIP: Rest is essential to the body and brain for good performance; think of it as recharging the battery. A run-down battery provides only substandard performance. For most students, it is better to spend 7 hours sleeping and 3 hours studying than to cut sleep to 6 hours and study 4 hours. The improvement in the rested mind's efficiency will balance out the difference in the time spent studying. Knowing your natural body rhythms is necessary when it comes to determining the amount of sleep needed for personal learning efficiency.

Which drug is used to counteract drug toxicity caused by magnesium sulfate in preterm labor management? 1 Nifedipine 2 Indomethacin 3 Dexamethasone 4 Calcium gluconate

Magnesium sulfate is used to treat pregnancy-induced hypertension. Calcium gluconate should be readily available to counter the drug toxicity caused by magnesium sulfate. Nifedipine is used to treat preterm labor by inhibiting myometrial activity by blocking the calcium reflex. Indomethacin is a nonsteroidal antiinflammatory drug used to treat preterm labor. Dexamethasone is given when delivery is proceeding to improve lung maturity in the fetus.

What assessment findings indicate that a client is experiencing an allergic reaction to antibiotic therapy? Select all that apply. 1 Pruritus 2 Confusion 3 Wheezing 4 Muscle aches 5 Bronchospasm

Manifestations of an allergic reaction to antibiotic therapy include pruritus, wheezing, and bronchospasm. Confusion and muscle aches are not specifically identified as being manifestations of an allergic reaction to antibiotic therapy.

The nurse is preparing a client who is on metformin therapy and is scheduled to undergo renal computed tomography with contrast dye. What does the nurse anticipate the primary healthcare provider to inform the client regarding the procedure? 1 "Discontinue metformin 1 day prior to procedure." 2 "Discontinue metformin a half-day prior to procedure." 3 "Discontinue metformin 3 days following the procedure." 4 "Discontinue metformin 7 days following the procedure."

Metformin can react with the iodinated contrast dye that is given for a renal computed tomography (CT) and cause lactic acidosis. Therefore the nurse anticipates an instruction that the client should discontinue the metformin 1 day before the procedure. Stopping the metformin a half-day before the renal CT may not reduce the risk of lactic acidosis. The client is advised to discontinue the metformin for at least 48 hours after the procedure. It is not necessary to discontinue metformin for 3 to 7 days after a renal CT with contrast media.

A client is prescribed metformin extended release to control type 2 diabetes mellitus. Which statement made by this client indicates the need for further education? 1 "I will take the drug with food." 2 "I must swallow my medication whole and not crush or chew it." 3 "I will notify my doctor if I develop muscular or abdominal discomfort." 4 "I will stop taking metformin for 24 hours before and after having a test involving dye."

Metformin must be withheld for 48 hours before the use of iodinated contrast materials to prevent lactic acidosis. Metformin is restarted when kidney function has returned to normal. Metformin is taken with food to avoid adverse gastrointestinal effects. If crushed or chewed, metformin XL will be released too rapidly and may lead to hypoglycemia. Muscular and abdominal discomfort is a potential sign of lactic acidosis and must be reported to the health care provider. Test-Taking Tip: Practicing a few relaxation techniques may prove helpful on the day of an examination. Relaxation techniques such as deep breathing, imagery, head rolling, shoulder shrugging, rotating and stretching of the neck, leg lifts, and heel lifts with feet flat on the floor can effectively reduce tension while causing little or no distraction to those around you. It is recommended that you practice one or two of these techniques intermittently to avoid becoming tense. The more anxious and tense you become, the longer it will take you to relax.

A client with hyperthyroidism is to receive methimazole. What instructions does the nurse provide? 1 Initial improvement will take several weeks. 2 There are few side effects associated with this drug. 3 This medication may be taken at any time during the day. 4 Large doses are used to quickly correct the functions of the thyroid.

Methimazole blocks thyroid hormone synthesis; it takes several weeks of medication therapy before the hormones stored in the thyroid gland are released and the excessive level of thyroid hormone in the circulation is metabolized. There are many common side effects that include nausea, vomiting, diarrhea, rash, urticaria, pruritus, alopecia, hyperpigmentation, drowsiness, headache, vertigo, and fever. Methimazole should be spaced at regular intervals because blood levels are reduced in approximately 8 hours. Large doses cause toxic side effects that can be life threatening, including nephritis, hepatitis, agranulocytosis, leukopenia, thrombocytopenia, hypothrombinemia, and lymphadenopathy.

A client diagnosed with depression is prescribed phenelzine. Which foods consumed along with this drug would cause a hypertensive crisis? Select all that apply. 1 Yogurt 2 Soy sauce 3 Cream cheese 4 Soybean paste 5 Over-ripened banana

Monoamine oxidase inhibitors (MAOIs) may cause hypertensive crisis if the client consumes foods rich in tyramine. Bananas, soy sauce, and soybean paste contain high amounts of tyramine. Yogurt and cream cheese do not contain tyramine.

A client with gastroesophageal reflux disease (GERD) receives a prescription for an H2 receptor antagonist. Which medications are within the classification of an H2 receptor antagonist? Select all that apply. 1 Nizatidine 2 Ranitidine 3 Famotidine 4 Lansoprazole 5 Metoclopramide

Nizatidine is an H2 receptor antagonist that reduces gastric acid secretion and provides for symptomatic improvement in GERD. Ranitidine is an H2 receptor antagonist that reduces gastric acid secretion and provides for symptomatic improvement in GERD. Famotidine is an H2 receptor antagonist that reduces gastric acid secretion and provides for symptomatic improvement in GERD. Lansoprazole is a proton pump inhibitor that inhibits gastric secretion up to 90% with one dose daily and provides for symptomatic improvement in GERD. Metoclopramide is a prokinetic agent that increases the rate of gastric emptying; it has multiple side effects and is not appropriate for long-term treatment of GERD.

Which medications are associated commonly with upper gastrointestinal (GI) bleeding? Select all that apply. 1 Aspirin 2 Ibuprofen 3 Ciprofloxacin 4 Acetaminophen 5 Methylprednisol

Nonsteroidal antiinflammatory drugs (NSAIDs), including acetylsalicylic acid and ibuprofen, and corticosteroids such as methylprednisolone, are known causes of drug-induced gastrointestinal (GI) bleeding by causing irritation and erosion of the gastric mucosal barrier. Acetaminophen is a safe alternative to NSAIDs to reduce the risk of GI bleeding. Ciprofloxacin, an antibiotic, has not been associated with GI bleeding. STUDY TIP: Record the information you find to be most difficult to remember on 3" × 5" cards and carry them with you in your pocket or purse. When you are waiting in traffic or for an appointment, just pull out the cards and review again. This "found" time may add points to your test scores that you have lost in the past.

Four clients with osteomyelitis are prescribed antibiotics. Which client is at risk for Achilles tendon rupture? 1 Client A 2 Client B 3 Client C 4 Client D

Osteomyelitis is a severe infection of the bone, bone marrow, and surrounding soft tissue. Tendon rupture can occur with use of the fluoroquinolones. Therefore client B, prescribed ciprofloxacin, is at risk for Achilles tendon rupture. Client A, prescribed gentamicin, is at risk for visual and hearing problems. Client C, prescribed cefazolin, is at risk for severe watery diarrhea and mouth sores. Client D, prescribed tobramycin, is at risk for nephrotoxicity. Test-Taking Tip: Chart/exhibit items present a situation and ask a question. A variety of objective and subjective information is presented about the client in formats such as the medical record (e.g., laboratory test results, results of diagnostic procedures, progress notes, healthcare provider orders, medication administration record, health history), physical assessment data, and assistant/client interactions. After analyzing the information presented, the test taker answers the question. These questions usually reflect the analyzing level of cognitive thinking. In a clinical exam, you may be expected to select instruments, arrange instruments, and/or perform some other task. Acquaint yourself with the physical facility. If the required procedures are not clear to you, ask for clarification.

A client is hospitalized with an overdose of benzodiazepines and presents with a respiratory rate less than 10 breaths per minute. Which nursing intervention should be provided as the first priority? 1 Give oxygen. 2 Secure airway. 3 Administer flumazenil. 4 Assess the intravenous site

Oxygen should be given as the first priority intervention for clients with a respiratory rate below 10 breaths per minute due to an overdose of benzodiazepines. Securing the airway is done before starting benzodiazepine antagonist therapy. Drugs such as flumazenil should be administered after providing the client with a sufficient oxygen supply. An intravenous site should be assessed because flumazenil can cause thrombophlebitis at the injection site. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options.

The health care provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. What is an action of PTU that the nurse will include in teaching? 1 Increases the uptake of iodine Incorrect2 Causes the thyroid gland to atrophy Correct3 Interferes with the synthesis of thyroid hormone 4 Decreases the secretion of thyroid-stimulating hormone (TSH)

PTU, used in the treatment of hyperthyroidism, blocks the synthesis of thyroid hormones by preventing iodination of tyrosine. Propylthiouracil does not increase the uptake of iodine. Iodine solutions reduce the size and vascularity of the thyroid gland. TSH, secreted by the anterior pituitary, is not affected by propylthiouracil.

A nurse considers that the safe administration of high-dose methotrexate therapy should include which intervention? 1 Maintaining an acidic urine 2 Restricting intravenous fluids 3 Providing a diet high in folic acid 4 Monitoring plasma levels of the medication

Plasma levels indicate whether therapeutic or toxic levels are present. Methotrexate (Rheumatrex) crystallizes in the kidneys if urine becomes acidic. The regimen should include hydration with a minimum of intravenous fluids of 125 mL/hr 6 to 12 hours before and during therapy. The effectiveness of methotrexate, a folic acid antagonist, is minimized by a diet high in folic acid.

A client with newly diagnosed hyperthyroidism is treated with propylthiouracil, an antithyroid drug, along with potassium iodide. What should the nurse take into consideration when caring for the client? 1 Iodide solutions must be diluted in water and taken on an empty stomach. 2 Monitoring for signs of infection or bleeding is necessary. 3 Postoperative hemorrhage is a common complication if these drugs are used before a thyroidectomy. 4 These drugs will be discontinued as soon as the temperature and pulse rate return to the expected range.

Propylthiouracil can cause depression of leukocytes and platelets. Propylthiouracil and potassium iodide should be given with milk, juice, or food to prevent gastric irritation. Drug therapy decreases the risk of postoperative hemorrhage because this drug regimen decreases the size and vascularity of the thyroid gland. Drug therapy is continued for at least 6 to 8 weeks, even if the client's temperature and pulse return to the expected range.

A nurse is administering 40 mg of furosemide (Lasix) intravenously. Which sensation reported by the client does the nurse consider when determining that it is being administered too quickly? 1 "Bladder feels full." 2 "Ears are buzzing." 3 "Heart is beating fast." 4 "Left arm feels numb."

Rapid administration of furosemide can cause tinnitus (a perceived ringing or buzzing in the ears), loss of hearing, and ear pain. Lasix has a diuretic effect; urinary retention does not occur. Lasix does not affect the heart rate. Lasix does not cause peripheral neuropathy.

A client develops a fever after surgery. Ceftriaxone is prescribed. For which potential adverse effect should the nurse monitor the client? 1 Dehydration 2 Heart failure 3 Constipation 4 Allergic response

Rash, urticaria, pruritus, angioedema, and other signs and symptoms of an allergic response may occur a few days after therapy is instituted. Ceftriaxone does not cause dehydration, does not affect the heart, and may cause diarrhea, not constipation.

A client with severe preeclampsia is receiving magnesium sulfate therapy. What is the priority nursing assessment as the nurse monitors this client's response to therapy? 1 Urine output 2 Respiratory rate 3 Deep tendon reflexes 4 Level of consciousness

Respiratory depression occurs with toxic levels of magnesium sulfate; calcium gluconate should be readily available to counteract toxicity. Although the other assessments (urine output, deep tendon reflexes, and level of consciousness) are important, none is the priority.

A client with arthritis is taking large doses of aspirin. What symptom does the nurse include when teaching the client about the clinical manifestations of aspirin toxicity? 1 Feelings of drowsiness 2 Disturbances in hearing 3 Intermittent constipation 4 Metallic taste in the mouth

Ringing in the ears occurs because of its effect on the eighth cranial nerve and is a classic symptom of aspirin toxicity. Feelings of drowsiness are not side effects of aspirin; aspirin promotes comfort, which may permit rest. Aspirin may cause diarrhea, nausea, and vomiting, not intermittent constipation. A metallic taste in the mouth is not a side effect of salicylates such as

Identify where selective serotonin reuptake inhibitors (SSRIs) act.

Selective serotonin reuptake inhibitors (SSRI) are antidepressant drugs. They block the reuptake pump for serotonin leading to the accumulation of serotonin in the synaptic space, thereby intensifying the effects of this neurotransmitter.

A healthcare provider prescribes simvastatin 20 mg daily for elevated cholesterol and triglyceride levels for a female client. Which is most important for the nurse to teach when the client initially takes the medication? 1 Take the medication with breakfast. Incorrect2 Have liver function tests every 6 months. 3 Wear sunscreen to prevent photosensitivity reactions. Correct4 Inform the healthcare provider if the client wishes to become pregnant.

Simvastatin is contraindicated in pregnancy because it is capable of causing fetal damage (teratogenic). It is a pregnancy category X teratogen. Simvastatin should be taken in the evening because most cholesterol is synthesized between midnight and 3:00 AM. Liver function tests should be done at 6 to 12 weeks initially and only then every 6 months. Although wearing sunscreen should be taught, sensitivity reactions are a rare occurrence and this is not as important.

A nurse gave a client the prescribed sodium polystyrene sulfonate. What assessment finding indicates that the drug has been effective? 1 The presence of diarrhea 2 A narrowing of the QRS complex 3 An increase in serum calcium level 4 A decrease in serum potassium level

Sodium polystyrene sulfonate is given to treat hyperkalemia. Therefore the effectiveness of the medication is determined by a decreasing serum potassium level. Sodium polystyrene sulfonate binds with the potassium in the gastrointestinal system and often causes diarrhea. Sodium polystyrene sulfonate has no effect on serum calcium levels. A wide QRS complex is a late finding in hyperkalemia. Sodium polystyrene sulfonate takes time to work and therefore would not be the drug of choice for hyperkalemia evidenced by a widening QRS complex. Test-Taking Tip: Anxiety leading to an exam is normal. Reduce your stress by studying often, not long. Spend at least 15 minutes every day reviewing the "old" material. This action alone will greatly reduce anxiety. The more time you devote to reviewing past material, the more confident you will feel about your knowledge of the topics. Start this review process on the first day of the semester. Don't wait until the middle to end of the semester to try to cram information.

A client with cirrhosis of the liver develops ascites, and the health care provider prescribes spironolactone. What should the nurse monitor the client for? 1 Bruising 2 Tachycardia 3 Hyperkalemia 4 Hypoglycemia

Spironolactone is a potassium-sparing diuretic that is used to treat clients with ascites; therefore the nurse should monitor the client for signs and symptoms of hyperkalemia. Bruising and purpura are associated with cirrhosis, not with the administration of spironolactone. Spironolactone does not cause tachycardia. Spironolactone does not cause hypoglycemia. STUDY TIP: Determine whether you are a "lark" or an "owl." Larks, day people, do best getting up early and studying during daylight hours. Owls, night people, are more alert after dark and can remain up late at night studying, catching up on needed sleep during daylight hours. It is better to work with natural biorhythms than to try to conform to an arbitrary schedule. You will absorb material more quickly and retain it better if you use your most alert periods of each day for study. Of course, it is necessary to work around class and clinical schedules. Owls should attempt to register in afternoon or evening lectures and clinical sections; larks do better with morning lectures and day clinical sections.

What dietary choices should the nurse instruct the client taking spironolactone to avoid increasing? Select all that apply. 1 Potatoes 2 Red meat 3 Cantaloupe 4 Wheat bread 5 Flavored yogurt

Spironolactone is potassium-sparing, and therefore beverages and foods containing potassium such as potatoes, cantaloupe, bananas, avocados, oranges, dates, apricots, and raisins should not be increased beyond the client's ordinary consumption to prevent hyperkalemia. Red meat may need to be limited for other reasons not related to spironolactone. Whole grains are associated with prevention of constipation and should not be avoided. Dairy products are rich in sodium and calcium; spironolactone may cause hyponatremia.

A client has an order for a sublingual nitroglycerin tablet. The nurse should teach the client to use what technique when self-administering this medication? 1 Place the pill inside the cheek and let it dissolve. 2 Place the pill under the tongue and let it dissolve. 3 Chew the pill thoroughly and then swallow it. 4 Swallow the pill with a full glass of water.

Sublingual medication is placed under the tongue and is quickly absorbed through the mucous membranes into blood. The buccal route requires placing medication between the cheek and gums. Chewing the pill and then swallowing it may be done for oral administration of some large size pills, but not with the sublingual route of administration. Taking the pill with water is required with the PO route of administration of medication, but not with sublingual. In addition, a full glass of water may be an excessive amount of fluid to swallow one pill. STUDY TIP: Becoming a nursing student automatically increases stress levels because of the complexity of the information to be learned and applied and because of new constraints on time. One way to decrease stress associated with school is to become very organized so that assignment deadlines or tests do not come as sudden surprises. By following a consistent plan for studying and completing assignments, you can stay on top of requirements and thereby prevent added stress.

The health care provider prescribes an oral hypoglycemic for the patient with type 2 diabetes. What will the nurse need to consider when developing the teaching plan? 1 Oral hypoglycemics work by decreasing absorption of carbohydrates. 2 Oral hypoglycemics work by stimulating the pancreas to produce insulin. 3 Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control. 4 Clients with type 2 diabetes do not need to be concerned about serious adverse effects from oral hypoglycemics.

Taking a tablet may give the client a false sense that the disease is under control, and this can lead to dietary indiscretions. Some oral hypoglycemics work by stimulating the pancreas to produce insulin, others work by decreasing carbohydrate absorption, and others work in a variety of other ways; therefore teaching should be specific to the drug prescribed. Oral hypoglycemic drugs can have serious adverse effects.

An older adult living in a long-term care facility has been receiving 600 mg of lithium twice a day for 3 weeks to ease manic behavior. The client is experiencing nausea and vomiting, diarrhea, thirst, polyuria, slurred speech, and muscle weakness. What is the most appropriate nursing intervention? 1 Withholding the next dose of lithium and drawing blood to test it for toxicity 2 Obtaining a prescription for the antidote to lithium and administering it immediately 3 Suggesting that the primary healthcare provider replace the lithium for an antiepileptic that will control the mania 4 Assessing the client for coarse hand tremor and, if it is present, giving the daily dose of lithium with a bit of water

The client is displaying signs and symptoms of early lithium toxicity; older clients should be monitored carefully and given smaller doses of lithium, because its excretion from the kidneys is slower than that in younger adults. There is no antidote to lithium. Coarse hand tremor is an indication of advanced lithium toxicity; the lithium should be withheld. Although antiepileptics are effective in 25% to 50% of clients with treatment-resistant bipolar disorder, this is not the appropriate treatment for lithium toxicity. STUDY TIP: Answer every question. A question without an answer is the same as a wrong answer. Go ahead and guess. You have studied for the test and you know the material well. You are not making a random guess based on no information. You are guessing based on what you have learned and your best assessment of the question.

A client receiving intravenous vancomycin reports ringing in both ears. Which initial action should the nurse take? 1 Notify the primary healthcare provider. 2 Consult an audiologist. Correct3 Stop the infusion. 4 Document the finding and continue to monitor the client.

The first action the nurse should take is to stop the infusion immediately. Vancomycin can cause temporary or permanent hearing loss. The nurse should stop the medication infusion and then notify the healthcare provider at once if a client reports any hearing problems or ringing in the ears. An audiologist may need to be consulted at a later date, but this is not the best first action. The nurse should document the findings; however, it is not the initial action. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question.

A client in labor is receiving an oxytocin (Pitocin) infusion. Which intervention is a priority for the nurse when repetitive late decelerations of the fetal heart rate are observed? 1 Administer oxygen. 2 Place the client on the left side. 3 Discontinue the oxytocin infusion. 4 Check the client's blood pressure.

The infusion should be stopped because it is the likely source of fetal compromise. Administering oxygen may not be necessary if late decelerations cease with other interventions. Placing the client on the left side should be done after the oxytocin infusion is discontinued. The client's blood pressure may be checked, but this is not the priority.

A client with hypertension is to take an angiotensin II receptor blocker (ARB). What should the nurse teach about this medication? Select all that apply. 1 Monitor the blood pressure daily. 2 Stop treatment if a cough develops. 3 Stop the medication if swelling of the mouth, lips, or face develops. 4 Have blood drawn for potassium levels 2 weeks after starting the medication. 5 Do not take nonsteroidal antiinflammatory drugs (NSAIDs) concurrently with this medication.

The medication should be stopped if angioedema occurs, and the healthcare provider should be notified. Electrolyte levels of potassium, sodium, and chloride should be obtained 2 weeks after the start of therapy and then periodically thereafter. Daily monitoring is not indicated. The blood pressure should be monitored at routine office visits. There is no need to avoid the use of NSAIDs while taking an ARB. A dry cough may occur during treatment with ARBs; however, it is not necessary to discontinue the medication because the cough usually resolves.

A nurse is teaching a client about the use of a metered-dose inhaler with a spacer. Which statement made by the client indicates the need for further teaching? 1 "I will wait for at least 1 minute between puffs." 2 "I will shake the whole unit vigorously one or two times." 3 "I will hold my breath for at least 10 seconds after removing the mouthpiece." 4 "I will insert the mouthpiece of the inhaler into the nonmouthpiece end of the spacer."

The metered-dose inhaler should be shaken vigorously for a minimum of three or four times for proper mixing of the content inside the inhaler. A minimum of a 1-minute gap should be given in between the puffs to ensure proper movement of the medications into the lungs. After removing the mouthpiece, the client should hold his/her breath for at least 10 seconds so that the drug does not escape with exhalation. Inserting the mouthpiece of the inhaler into the nonmouthpiece end of the spacer is the correct way of closing the inhaler.

The healthcare provider prescribes enoxaparin to be administered subcutaneously daily to a client who had a total knee replacement. To ensure client safety, which measure would the nurse take when administering this medication? 1 Remove air pocket from prepackaged syringe before administration. 2 Rub the injection site after administration for 30 seconds. 3 Administer medication over 2 minutes. 4 Administer in the abdomen area only.

The preferred site for enoxaparin administration is the abdomen. According to package directions, the air pocket in the prepackaged syringe should not be removed. Rubbing the injection site also is contraindicated. Subcutaneous injections should not be given over 2 minutes. STUDY TIP: Becoming a nursing student automatically increases stress levels because of the complexity of the information to be learned and applied and because of new constraints on time. One way to decrease stress associated with school is to become very organized so that assignment deadlines or tests do not come as sudden surprises. By following a consistent plan for studying and completing assignments, you can stay on top of requirements and thereby prevent added stress.

The nurse is caring for a client with a 30% total body surface area burn. Which assessment finding indicates to the nurse that the client's fluid replacement is adequate? 1 Increasing hematocrit level 2 Urinary output of 15 to 20 mL/hr Correct3 Slowing of a previously rapid pulse rate 4 Central venous pressure progressing from 5 to 1 mm Hg

The pulse rate is one indicator of optimum vascular fluid volume; the pulse rate decreases as intravascular volume normalizes. Increasing hematocrit level indicates hemoconcentration resulting from hypovolemia. Urinary output of 0.5 to 1 mL/kg/hr indicates inadequate kidney perfusion; if adequate, output should be greater than 30 mL/hr. Central venous pressure decreasing from 5 to 1 mm Hg indicates hypovolemia.

An adolescent with leukemia is to be given a chemotherapeutic agent that is known to cause nausea and vomiting. When is the best time for the nurse to administer the prescribed antiemetic? 1 Before each dose of chemotherapy 2 As nausea occurs 3 1 hour before meals

The purpose of an antiemetic before chemotherapy is to prevent the child from experiencing nausea during and after the administration of the medication. Waiting until nausea has occurred is too late; the medication should be given before nausea occurs. The meals are not causing the nausea; the nausea is caused by the chemotherapy, and if nausea is not prevented, the child will not eat.

A client with type 1 diabetes self-administers NPH insulin every morning at 8 am. The nurse evaluates that the client understands the action of the insulin when the client identifies which time range as the highest risk for hypoglycemia? 1 2 pm to 8 pm 2 8 pm to noon 3 9 am to 10 am 4 10 am to 11 am

The time of greatest risk for hypoglycemia occurs when the insulin is at its peak. The action of intermediate-acting insulins peaks in 6 to 12 hours. Nine to 10 am and 10 am to 11 am are too soon for NPH to produce a hypoglycemic response. NPH insulin will have produced a hypoglycemic response before 8 pm and noon. A hypoglycemic response that occurs in 45 to 60 minutes after administration is associated with rapid-acting insulins.

An older client with depression is prescribed a tricyclic antidepressant. What is the priority nursing intervention in this situation? 1 Providing psychotherapy to the client 2 Teaching strategies to overcome depression 3 Encouraging the client to walk for 30 minutes 4 Requesting that the physician change the drug

Tricyclic antidepressants have anticholinergic properties that can cause acute confusion, severe constipation, and urinary incontinence in older adults. Therefore the priority nursing care for an older client who is prescribed a tricyclic antidepressant is to request that the physician change the drug. Providing psychotherapy is an alternate treatment, which is of medium priority. Teaching strategies to overcome depression is of low priority. Encouraging the client to walk for 30 minutes overcomes the feelings of depression, but it is not the priority.

The nurse is caring for a client who is receiving intermittent intravenous piggyback doses of vancomycin every 12 hours. The primary healthcare provider prescribes trough levels of the antibiotic. The nurse schedules the blood sample to be obtained at what time? 1 Just before the medication is administered 2 Between 30 and 60 minutes after the infusion is completed 3 Six hours after the dose is completely infused 4 In the morning before the client eats breakfast

Trough levels are measured in relation to the time a drug is administered. The trough level for a drug is drawn just before a drug is given, when the drug's level is at its lowest. Any other time would be inaccurate for a drug's trough level. The drug's peak level is drawn 30 to 60 minutes after the infusion is completed. Whether the client eats breakfast does not affect this drug's trough levels, as it is an intravenous infusion. Test-Taking Tip: Look for options that are similar in nature. If all are correct, either the question is poor or all options are incorrect, the latter of which is more likely. Example: If the answer you are seeking is directed to a specific treatment and all but one option deal with signs and symptoms, you would be correct in choosing the treatment-specific option.

Which client statement indicates to the nurse that a client who is receiving cyanocobalamin (vitamin B12) therapy for an intrinsic factor deficiency understands the treatment? 1 "I should have a vitamin B12 injection every month." 2 "I'll take my B12 vitamin every morning with my breakfast." 3 "I'll have a salad every day because vitamin B12 is in green vegetables." 4 "I should feel better because my vitamin B12 treatments will improve my aplastic anemia."

Vitamin B12 is administered via injection on a weekly or monthly basis. Vitamin B12 is destroyed by stomach acid and therefore cannot be taken in pill form. Green vegetables are not an important source of vitamin B12. Vitamin B12 is found primarily in meat, fish, poultry, and eggs. Vitamin B12 is prescribed for pernicious, not aplastic, anemia.

A nurse is reviewing medication instructions with the parents of an infant who is receiving digoxin and spironolactone. What parental response concerning their infant's care indicates that the instructions have been understood? 1 Activity should be restricted. 2 Orange juice or other high-potassium drinks must be offered daily. Correct3 Vomiting should be reported to the healthcare provider. 4 Antiinflammatory drugs will not be given with spironolactone.

Vomiting is a classic sign of digoxin toxicity, and the healthcare provider must be notified. Infants regulate their own activity according to their energy level. Orange juice is rarely needed because spironolactone spares potassium. There is no restriction on antiinflammatory drugs with spironolactone.

Warfarin is prescribed for the client who takes phenytoin for a seizure disorder. Why must the nurse observe the client closely during the initial days of treatment with warfarin? 1 Warfarin affects the metabolism of phenytoin. 2 Phenytoin decreases warfarin's anticoagulant effect. 3 Warfarin's action is greater in clients with seizure disorders. 4 Seizures increase the metabolic degradation rate of warfarin.

Warfarin has been shown to inhibit metabolism of phenytoin, which results in an accumulation of phenytoin in the body. Warfarin potentiates the anticoagulant effect of heparin. That warfarin's action is greater in clients with seizure disorders is true only if the client is receiving phenytoin to control the seizure disorder. Seizures do not have a significant effect on the metabolism of warfarin. Test-Taking Tip: Look for options that are similar in nature. If all are correct, either the question is poor or all options are incorrect, the latter of which is more likely. Example: If the answer you are seeking is directed to a specific treatment and all but one option deals with signs and symptoms, you would be correct in choosing the treatment-specific option.

Why does the nurse question a prescription for a benzodiazepine for an individual experiencing acute grief? 1 The depression is magnified, and the risk of suicide increases. 2 Brain activity is suppressed, and the risk of depression increases. 3 Lethargy results, and it prevents the return to interpersonal activity. 4 The period of denial is extended, and the grieving process is suppressed.

With this sedating medication, the individual does not face the reality of the loss and merely delays the onset of the pain associated with it. Because most support is available at the time of the death and the funeral, a benzodiazepine at this time denies the individual the opportunity to use this assistance. This class of drugs does not magnify the risk of suicide or cause or prevent depression. Although sedation and muscle relaxation may initially occur with these drugs, these are not the reasons that they are not ordered.

A client is receiving clonidine for hypertension. What side effect of clonidine will the nurse include when providing drug education? 1 Xerostomia 2 Diarrhea 3 Euphoria 4 Photosensitivity

Xerostomia (dry mouth) is one of the common side effects of this drug. The reaction usually diminishes over the first 2 to 4 weeks of therapy. This drug causes constipation, not diarrhea. This drug may cause depression, anxiety, fatigue, and drowsiness, not euphoria. Photosensitivity is not a side effect of this medication.