YOU'RE SCREWED!

A client with phosphate-based urinary calculi asks why aluminum hydroxide gel has been prescribed. The nurse explains that the medication decreases serum phosphorus by which action? A. Binding with phosphorus in the intestine B. Preventing absorption of phosphorus in the stomach C. Promoting excretion of excessive urinary phosphorus D. Dissolving stones as they pass through the urinary tract

ANS: A Aluminum hydroxide binds phosphorus in the intestine, preventing its absorption; this decreases serum phosphorus.

A client with Addison disease is receiving cortisone therapy. What complications does the nurse expect if the client abruptly stops the medication? Select all that apply. A. Diplopia B. Dysphagia C. Tachypnea D. Bradycardia E. Hypotension

ANS: C, E Tachypnea occurs with addisonian crisis because inadequate circulating corticosteroids cause hypotension, pallor, weakness, tachycardia, and tachypnea.

A nurse administers carbidopa-levodopa to a client with Parkinson disease. Which therapeutic effect does the nurse expect the medication to produce? A. Increase in acetylcholine production B. Regeneration of injured thalamic cells C. Improvement in myelination of neurons D. Replacement of a neurotransmitter in the brain

ANS: D Carbidopa-levodopa is used because levodopa is the precursor of dopamine. It is converted to dopamine in the brain cells, where it is stored until needed by axon terminals; it functions as neurotransmitter.

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

ANS: D A life-threatening effect of cyclosporine is nephrotoxicity. Therefore creatinine and BUN levels should be monitored. Hirsutism is an effect, diarrhea is a response, and it does not cause cardiovascular life-threatening effects.

A client with human immunodeficiency virus (HIV) infection is diagnosed with tuberculosis. Before starting antitubercular pharmacotherapy, what essential test results should the nurse review? A. Liver function studies B. Pulmonary function studies C. Electrocardiogram and echocardiogram D. WBC counts and sedimentation rate

ANS: A

A nurse is caring for a client with diabetes who is scheduled for a radiographic study requiring contrast. Which should the nurse expect the health care provider to prescribe? A. Acetylcysteine before the test B. Renal-friendly contrast medium for the test C. Forced diuresis with mannitol after the test D. Hydration with dextrose and water throughout the test.

ANS: A Acetylcysteine is an antioxidant that scavenges free radicals, which are released when contrast medium causes cell death to renal tubular tissue; it also induces slight vasodilation. Contrast that is renal friendly does not exist.

A healthcare provider prescribes a vitamin tablet that contains vitamin B complex. What should the nurse teach the client? A. It may turn the urine bright yellow. B. The daily fluid intake should be increased C. The drug should be taken on an empty stomach. D. It may accumulate in the body if an excessive amount is taken.

ANS: A Bright yellow urine is expected, insignificant side effect of vitamin B complex.

A client who is receiving hydrochlorothiazide asks what this drug actually does. What information about the drug's therapeutic action will the nurse consider when formulating a response? A. Increases the excretion of sodium B. Increases the glomerular filtration rate C. Decreases the reabsorption of potassium D. Decreases the amount of fluid reabsorption in the loop of Henle

ANS: A Hydrochlorothiazide inhibits sodium reabsorption in the nephrons, causing increased excretion of sodium and chloride. The GFR is not affected. The loss of potassium is a side effect, not a therapeutic effect. Loop diuretics inhibit reabsorption of sodium and chloride at the ascending loop of Henle.

A client who takes daily megadoses of vitamins is hospitalized with joint pain, loss of hair, yellow pigmentation of the skin, and an enlarged liver due to vitamin toxicity. What type of toxicity does the nurse suspect? A. Retinol (vitamin A) B. Thiamine (vitamin B1) C. Pyridoxine (vitamin B6) D. Ascorbic acid (vitamin C)

ANS: A Joint pain, hair loss, jaundice, anemia, irritability, pruritus, and enlarged liver and spleen are signs of vitamin A toxicity. Remember that lipid-soluble vitamins normally take longer to eliminate and accumulate faster than water-soluble vitamins.

Which medication does the nurse anticipate will be prescribed to relieve anxiety and apprehension in a client with pulmonary edema? A. Morphine B. Phenobarbital C. Hydroxyzine D. Chloral hydrate

ANS: A Morphine binds with the same receptors as natural opioids. However it has a rapid onset, lowers the blood pressure, decreases pulmonary reflexes, and produces sedation. Phenobarbital has slower onset than morphine and does not affect respirations and BP to same extent as morphine. Hydroxyzine generally is used to control anxiety associated with less acute situations.

A client is admitted to the coronary care unit complaining of "viselike" chest pain radiating to the neck. Assessment reveals a blood pressure of 124/64 mm Hg, an irregular apical pulse of 64 beats per minute, and diaphoresis. Cardiac monitoring is instituted, and morphine sulfate 4 mg intravenous (IV) push stat is prescribed. What is the priority nursing care for this client? A. Relief of pain B. Client teaching C. Cardiac monitoring D. Maintenance of bed rest

ANS: A Unrelieved chest pain increases anxiety, fatigue, and myocardial oxygen consumption, with the possibility of extending the infarction.

A client is receiving furosemide to relieve edema. The nurse will monitor the client for which responses? Select all that apply. A. Weight loss B. Negative nitrogen balance C. Increased urine specific gravity D. Excessive loss of potassium ions E. Pronounced retention of sodium ions

ANS: A, D Furosemide is a potent diuretic that is used to provide rapid diuresis in clients with pulmonary edema; it acts in the loop of Henle and causes depletion of electrolytes, such as potassium and sodium. With increased fluid loss, the specific gravity is likely to be lowered.

After a short hospitalization for an episode of a transient ischemic attack (TIA) related to hypertension, a client is discharged on a regimen that includes chlorothiazide. What will the nurse instruct the client to do regarding nutrition? Select all that apply. A. Eat more dark green leafy vegetables such as spinach. B. Eat more vitamin-enriched products. C. Return to previous eating habits. D. Increase intake of dairy products E. Increase intake of beans

ANS: A, E The client should increase the intake of dietary potassium because of potassium loss associated with chlorothiazide.

A client is scheduled to receive an intravenous (IV) infusion of potassium chloride (KCl) 40 mEq in 100 mL of 5% dextrose and water to be infused over 2 hours. Before administering this IV medication, it is a priority for the nurse to assess which of the following? Select all that apply. A. Urinary output B. Deep tendon reflexes C. Last bowel movement D. Arterial blood gas results E. Last serum potassium level F. Patency of the IV access

ANS: A, E, F Before administering IV potassium, the urinary output must be normal. If the urine output is low, a potassium infusion may damage renal cells. The last serum potassium level should also be checked to ensure potassium replacement is appropriate.

A nurse is caring for a client during the emergent phase of a severe burn injury. Which parenteral intervention prescribed by the healthcare provider should the nurse question? A. Colloids B. Potassium C. Hypertonic saline D. Lactated Ringer solution

ANS: B Potassium replacement generally is not indicated in the initial management of burns because hyperkalemia results from the liberation of potassium ions from the injured cells. Colloids are given to draw fluid from the edematous tissue back into the blood stream. Hypertonic saline and lactated RInger solution given to replace fluid and electrolytes.

A healthcare provider prescribes selegiline 5 mg twice a day for a client with a diagnosis of Parkinson disease. What is most important for the nurse to teach the client? A. Eat food high in tyramine B. Ensure that an opioid is not taken currently. C. Take the medication in the morning and evening. D. Monitor for signs of hypoglycemia and hyperglycemia.

ANS: B Selegiline concurrently used with an opioid analgesic can result in fatal reaction (e.g., excitation, rigidity, hypertension, hypotension, coma). Foods high in tyramine should be avoided. The effects are more apparent when awake, take at breakfast and lunch.

A nurse is caring for a client who is receiving a unit of packed red blood cells. Which findings lead the nurse to suspect a transfusion reaction caused by incompatible blood? Select all that apply. A. Cyanosis B. Backache C. Shivering D. Bradycardia E. Hypertension

ANS: B, C Mismatched blood cells are attacked by antibodies, and the hemoglobin released from ruptured erythrocytes plugs the kidney tubules; this kidney involvement results in backache. Shivering occurs as part of the inflammatory response associated with transfusion reaction. Cyanosis is not commonly associated with transfusion reaction. Tachycardia and hypotension are associated with transfusion reaction.

The nurse provides medication discharge instructions to a client who received a prescription for digoxin following the client's myocardial infarction. Which statement by the client leads the nurse to conclude that the teaching was effective? A. "I will avoid foods high in potassium." B. "I must increase my intake of vitamin K." C. "I should adjust the dosage according to my activities." D. "It will be important to check my radial pulse rate daily."

ANS: D

Which interventions should the nurse anticipate will be prescribed initially for a client who had a hemorrhoidectomy? Select all that apply. A. Giving an enema B. Applying moist heat C. Administering stool softeners D. Encouraging showers as needed E. Providing occlusive dressings to the area

ANS: B, C Moist heat dilates the blood vessels, thereby increasing circulation to the area; this is soothing and promotes healing. Stool softeners are prescribed to avoid straining on defecation and constipation. Enemas may be prescribed several days after surgery if the client has not had a bowel movement. Baths, especially sitz baths, are advised to promote healing and cleaning of the area. Occlusive dressings are not used. light applications of witch hazel amy be used to promote drainage and healing.

To minimize the side effects of the vincristine that a client is receiving, what does the nurse expect the dietary prescription to include? A. Low in fat B. High in iron C. High in fluids D. Low is residue

ANS: C A common side effect of vincristine is a paralytic ileus that results in constipation. Preventative measures include high-fiber foods and fluid that exceed minimum requirements. These will keep the stool bulky and soft, thereby promoting evacuation.

A nurse explains to a client with trigeminal neuralgia that a treatment is effective on a temporary (6 to 18 months) basis. The nurse is referring to which treatment? A. Weekly IV injections of cobra venom B. A lidocaine injection of the ventral root of the eleventh spinal nerve C. Microvascular decompression of the blood vessels at the nerve root. D. An alcohol injection of the peripheral branch of the fifth cranial nerve

ANS: D A nerve block of the trigeminal (fifth cranial) nerve with alcohol is a conservative approach that lasts 6 to 18 months. Weekly IV injections of cobra venom have been tried but provide little, if any, relief.

A primary health care provider prescribes total parenteral nutrition for a client with cancer of the pancreas. A central venous access device is inserted. What does the nurse identify as the most important reason for using this type of access? A. Infection is uncommon. B. It permits free use of the hands. C. The chance of the infusion infiltrating is decreased. D. The amount of blood in a major vein helps to dilute the solution.

ANS: D Unless diluted, the highly concentrated solution can cause vein irritation or occlusion.

A healthcare provider prescribes digoxin for a client. The nurse teaches the client to be alert for which common early indication of digoxin toxicity? A. Nausea B. Urticaria C. Photophobia D. Yellow vision

ANS: A Nausea and loss of appetite are the first indications of toxicity in approximately 50% of clients who take a cardiac glycoside, such as digoxin.

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

ANS: C 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 %.

The nurse prepares an intravenous solution of lactated Ringer solution to replace the T-tube output of a client who had a cholecystectomy and common bile duct exploration. Which condition will improve if the administration of lactated Ringer solution is effective? A. Urinary stasis B. Paralytic ileus C. Metabolic acidosis D. Increased potassium level

ANS: C Lactated Ringer solution is an alkaline solution that replaces bicarbonate ions lost from T-tube bile drainage, thus preventing/treating acidosis.

A client is scheduled to have a thyroidectomy. Which medication does the nurse anticipate the health care provider will prescribe to decrease the size and vascularity of the thyroid gland before surgery? A. Vasopressin B. Levothyroxine C. Propylthiouracil D. Potassium iodide

ANS: D Potassium iodide adds iodine to the body fluids, exerting negative feedback on the thyroid tissue and decreasing its metabolism and vascularity.

A nurse is planning care for a client with cancer who is receiving the plant alkaloid vincristine. In contrast to the side effects of most chemotherapeutic agents, what is a common side effect of vincristine that the nurse must address in the client's care plan? A. Nausea B. Alopecia C. Constipation D. Hyperuricemia

ANS: C Although most chemotherapy causes diarrhea, vincristine can cause severe constipation, impaction, or paralytic ileus. Nausea, alopecia, and hyperuricemia are side effects shared with most other chemotherapeutic agents.

An older adult with cerebral arteriosclerosis is admitted with atrial fibrillation and is started on a continuous heparin infusion. What clinical finding enables the nurse to conclude that the anticoagulant therapy is effective? A. A reduction of confusion B. An absence of ecchymotic areas C. A decreased viscosity of the blood D. An activated partial thromboplastin twice the usual value

ANS: D Desired anticoagulant effect is achieved when the activated partial thromboplastin time is 1.5 to 2 times normal.

What should the nurse monitor to evaluate the effectiveness of carbamazepine in the management of a client's trigeminal neuralgia? A. Pain intensity B. Liver function C. Cardiac output D. Seizure activity

ANS: A Carbamazepine is administered to control pain by reducing transmission of nerve impulses in clients with trigeminal neuralgia. Liver function is monitored to detect adverse reactions to carbamazepine, not to determine therapeutic effectiveness. Carbamazepine is not given to influence cardiac output.

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

ANS: A Epoetin is used to treat anemia by increasing production of RBCs.

A client is scheduled for a craniotomy to remove a brain tumor. To prevent the development of cerebral edema after surgery, the nurse anticipates the use of drugs from which class? A. Steroids B. Diuretics C. Anticonvulsants D. Antihypertensives

ANS: A Glucocorticoids are used for their antiinflammatory action, which decreases the development of cerebral edema. Diuretics may be used in conjunction with steroids; they reduce edema after it is present.

A client's cardiac monitor indicates ventricular tachycardia. The nurse assesses the client and identifies an increase in apical pulse rate from 100 to 150 beats per minute. What is an appropriate treatment plan? A. Amiodarone bolus B. Intracardiac epinpehrine C. Insertion of a pacemaker D. Cardiopulmonary resuscitation (CPR)

ANS: A Amiodarone suppresses ventricular activity; therefore, it is used for treatment of premature ventricular complexes (PVCs) and ventricular tachycardia. It works directly on the heart tissue and slows the nerve impulses in the heart. A pace maker is used for symptomatic bradycardia nad heart blocks.

A nurse is giving an educational program to paramedics who have volunteered to give the smallpox vaccine in a community vaccination drive. Which type of needle and method of administration should the nurse teach the volunteers to use when administering the smallpox vaccine? A. Bifurcated needle for 15 injections within 5 mm B. Intradermal needle for 15 injections within 5 mm C. Bifurcated needle for 10 dermal injections within 5 mm D. Double lumen needle for 10 dermal injections within 5 mm

ANS: A Bifurcated needle for 15 injections within 5 mm

Which instructions should the nurse include in the teaching plan for a client with hyperlipidemia who is being discharged with a prescription for cholestyramine? A. "Increase your intake of fiber and fluid." B. "Take the medication before you go to bed." C. "Check your pulse before taking the medication." D. "Contact your healthcare provider if your skin or sclera turn yellow."

ANS: A Fiber and fluids help prevent the most common adverse effect of constipation and its complication: fecal impaction. The medication should be taken with meals. The pulse is not affected. It reduces the incidence of jaundice.

A client is admitted for chest pain and a myocardial infarction. The nurse caring for the client is preparing to apply nitroglycerin ointment. Before applying the ointment, what action will the nurse take? A. Assess the client's pulse rate. B. Prepare the site with an alcohol swab. C. Shave the client's chest in the area for application. D. Use the dose measuring application paper and spread the ointment in a thin layer to the prescribed amount.

ANS: D The nurse should assess blood pressure reading, not pulse rate.

For which side effects should a nurse assess a client with cancer who is being treated with chemotherapeutic agents? Select all that apply. A. Diarrhea B. Leukocytosis C. Bleeding tendecies D. Lowered sedimentation rate E. Increased hemoglobin levels

ANS: A, C Most chemotherapeutic agents interfere with mitosis.

A client is diagnosed with Crohn disease, and parenteral vitamins are prescribed. The client asks why the vitamins have to be given intravenously (IV) rather than by mouth. What rationales for this route should the nurse include in a response to the question? Select all that apply. A. More rapid action results. B. They decrease colon irritability. C. Oral vitamins are less effective. D. Intestinal absorption may be inadequate E. Allergic responses are less likely to occur.

ANS: A, C, D Absorption through the GI tract is impaired, and parenteral administration goes directly into the intravascular compartment. Disease of the GI tract hampers absorption.

A nurse is caring for a female client who is receiving rifampin for tuberculosis. Which statements indicate that the client understands the teaching about rifampin? Select all that apply. A. "This drug may be hard on my liver so I must avoid alcoholic drinks while taking it." B. "This drug may reduce the effectiveness of the oral contraceptive I am taking." C. "I cannot take an antacid within 2 hours before taking my medicine." D. "My HCP must be called immediately if my eyes and skin become yellow."

ANS: A, B, D An antacid may be taken 1 hour before taking this medication.

A healthcare provider prescribes dexamethasone for a client with head trauma. A family member asks why this medication is being given. The nurse explains that it reduces swelling in the brain by what process? A. Acts as a hyperosmotic diuretic B. Increases tissue resistance to infection C. Reduces the inflammatory response of tissues D. Decreases the formation of cerebrospinal fluid

ANS: C Corticosteroids act to decrease inflammation, which decreases edema.

The nurse administers 2 units of salt-poor albumin to a client with portal hypertension and ascites. What does the nurse explain to the client regarding the purpose of the albumin? A. It provides nutrients B. It increases protein stores. C. Albumin elevates the circulating blood volume. D. Albumin temporarily diverts blood flow away from the liver.

ANS: C Increasing oncotic pressure increases the client's circulating blood volume; salt-poor albumin pulls interstitial fluid into the blood vessels, restoring blood volume and limiting ascites.

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

ANS: A If the client will be taking the medication long-term, periodic diagnostic tests are necessary because ibuprofen is nephrotoxic, is hepatotoxic, and prolongs the bleeding time.

A nurse recalls that the shift of body fluids associated with the intravenous administration of albumin occurs by which process? A. Osmosis B. Diffusion C. Active transport D. Hydrostatic pressure

ANS: A Osmosis is the movement of fluid from an area of lesser solute concentration to an area of greater solute concentration. Diffusion is the movement of particles across a semipermable membrane from an area of greater concentration of particles to an area of lesser concentration.

A client is discharged with a prescription for sustained-release nitroglycerin. What should the nurse teach the client about sustained-release nitroglycerin? A. Swallow the capsule whole. B. Take milk with the medication C. Hold the tablet under the tongue D. Anticipate a stinging feeling when the drug is under the tongue.

ANS: A The sustained-release capsule should be swallowed whole on an empty stomach.

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. A. Constipation B. Hypokalemia C. Irregular pulse rate D. Changes in visual acuity E. Orthostatic hypotension

ANS: C, E Dysrhythmias, including second-degree heart block, are cardiovascular effects of valsartan. It also may precipitate angina pectoris, MI, and CVA. Diarrhea, not constipation, may occur. Hyperkalemia may occur.

A client who is receiving phenytoin asks why folic acid (Folate) was prescribed. What is the best explanation by the nurse? A. Absorption of folate from foods is inhibited. B. The action of phenytoin is potentiated. C. Absorption of iron from foods is improved. D. Neuropathy caused by phenytoin is prevented.

ANS: A Phenytoin inhibits folic acid absorption and potentiates the effect of folic acid antagonists. Folic acid is helpful in correcting certain anemias that can result from administration of phenytoin. The dosages must be carefully adjusted because folic acid diminishes the effect of phenytoin.

An intravenous solution containing potassium inadvertently has infused too rapidly. The healthcare provider prescribes insulin added to a 10% dextrose in water solution. What does the nurse identify as the purpose of the insulin? A. Potassium follows insulin and glucose into the cells of the body, thereby raising the intracellular potassium level. B. Increased insulin accelerates excretion of glucose and potassium, thereby decreasing the serum potassium level. C. Glucose with insulin increases metabolism, which accelerates potassium excretion. D. Increased potassium causes a temporary slowing of pancreatic production of insulin.

ANS: A Potassium follows insulin into the cells of the body, thereby raising the intracellular potassium level and preventing fatal dysrhythmias.

A client steps on a rusty nail, and the puncture site becomes swollen and painful. Tetanus immune globulin is prescribed. What does the nurse identify as an action of this drug? A. Provides antibodies B. Stimulates plasma cells C. Produces active immunity D. Facilitates long-lasting immunity

ANS: A Tetanus immune globulin provides antibodies, which confer immediate passive immunity.

A client reports nausea, vomiting, and seeing a yellow light around objects. A diagnosis of hypokalemia is made. Upon a review of the client's prescribed medication list, the nurse determines that what is the likely cause of the clinical findings? A. Digoxin B. Furosemide C. Propranolol D. Spironolactone

ANS: A These are signs of digitalis toxicity, which is more likely to occur in the presence of hypokalemia. Although furosemide most likely contributed to the hypokalemia, the client's symptoms are consistent with digitalis toxicity.

Ten minutes after the initiation of a blood transfusion, a client reports lumbar pain. What is the next nursing action? A. Stop the transfusion. B. Obtain the vital signs. C. Assess the pain further D. Increase the flow of normal saline.

ANS: A This is a sign of acute hemolytic transfusion reaction, indicating the the recipient's blood is incompatible with the transfused blood; pain is caused by hemolysis, agglutination, and capillary plugging in the kidneys.

What potentially dangerous adverse effect of an intravenous titrated drip of lidocaine should the nurse immediately report to the healthcare provider? A. Tremors B. Anorexia C. Tachycardia D. Hypertension

ANS: A Tremors are a precursor to the major adverse effects of seizures. Although anorexia may occur, it is not a dangerous side effect. Bradycardia, which may lead to heart bock, may occur. Hypotension may occur.

An ambulatory client with relapsing-remitting multiple sclerosis is to receive every-other-day injections of interferon beta-1a. What adverse effects does the nurse explain may occur when taking this medication? Select all that apply. A. Depression B. Constipation C. Flulike symptoms D. Increased heart rate E. Decreased perspiration

ANS: A, B, C, D CNS effects include depression that may lead to suicide attempts. GI side effects include constipation, diarrhea, vomiting, and abdominal pain. Interferon immune modifier causes flulike symptoms, such as fever, muscle aches, and lethargy. Drugs for increased heart rate include side effects such as tachycardia, palpitations, and hypertension. An integumentary response to this drug is sweating, not lack of perspiration (anhidrosis).

Carbidopa-levodopa is prescribed for a client with Parkinson disease. The nurse monitors the client for which side effects of the medication? Select all that apply. A. Vomiting B. Anorexia C. Slow heart rate D. Changes in mood E. Peripheral edema

ANS: A, B, D N/V may occur; it reflects a central emetic reaction to levodopa. Anorexia may occur; decreased appetite results because of N/V. Tachycardia and palpitations occur.

The nurse is monitoring a client who is having a third transfusion of packed red blood cells. Which of these may be evident if the client is experiencing a febrile transfusion reaction? Select all that apply . A. Chills B. Urticaria C. Hypotension D. Tachycardia E. Bronchospasm F. Sense of impending doom

ANS: A, C, D Febrile transfusion reactions occur most often in patients who have had multiple transfusions. Symptoms include chills, hypotension, tachycardia, tachypnea, and fever. Urticaria and bronchospasm occur with allergic transfusion reactions. Feeling a sense of impending doom occurs with hemolytic transfusion reactions.

The nurse is providing postoperative care for a client who has received a prescription for nalbuphine for pain. What side effects or adverse reactions does the nurse anticipate after administering this medication? Select all that apply. A. Nausea B. Oliguria C. Sedation D. Dry mouth E. Flushed skin F. Orthostatic hypotension

ANS: A, C, D, F

A client with metastatic breast cancer is started on a multiple drug regimen that includes docetaxel. The nurse assesses the client for which nontherapeutic effects of docetaxel? Select all that apply. A. Alopecia B. Constipation C. Febrile neutropenia D. Increased BP E. Hypersensitivity reaction

ANS: A, C, E Alopecia is a nontherapeutic response to docetaxel.

A hospitalized client is receiving pyridostigmine for control of myasthenia gravis. In the middle of the night, the nurse finds the client weak and barely able to move. Which additional clinical findings support the conclusion that these responses are related to pyridostigmine? Select all that apply. A. Respiratory depression B. Distention of the bladder C. Decreased blood pressure D. Fine tremor of the fingers E. High-pitched gurgling bowel sounds

ANS: A, C, E Anticholinergic effects of pryidostigmine can cause life-threatening respiratory depression, bronchospasm, laryngospasm, and respiratory arrest. Anticholinergic effects of pyridostigmine can cause hypotension, tachycardia, bradycardia, dysrhythmias, and cardiac arrest. Pyridostigmine is an anticholinergic that increases the peristaltic activity of the intestines. The result is hyperactive bowel sounds. Bladder distention is not associated with pyridostigmine.

Carbidopa-levodopa is prescribed for a client with Parkinson disease. The nurse assesses for which adverse responses that are associated with this medication? Select all that apply. A. Nausea B. Lethargy C. Bradycardia D. Polycythemia E. Emotional changes

ANS: A, E Nausea and vomiting may occur; this reflects a central emetic reaction to levodopa. Changes in affect, mood, and behavior are related to toxic effects of carbidopa-levodopa. Insomnia, tremors, and agitation are side effects, not lethargy. Tachycardia and palpitations occur. anemia and leukopenia are adverse reactions.

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

ANS: B Acetazolamide is a carbonic anhydrase inhibitor that decreases inflow of aqueous humor and controls intraocular pressure in acute angle-closure glaucoma attack. Methazolamide lowers ocular pressure but does decrease the inflow of aqueous humor.

When a client exhibits severe bradycardia, which type of drug should the nurse be prepared to administer? A. Cardiac nitrate B. Anticholinergic C. Antihypertensive D. Cardiac glycoside

ANS: B An anticholinergic drug will block parasympathetic effects, causing an increased heart rate. Cardiac nitrate will dilate coronary arteries. Both antihypertensive drugs and cardiac glycosides will decrease the heart rate.

A nurse administers beclomethasone by inhalation to a client with asthma, and the client asks why this medication is necessary. What should the nurse explain is the purpose of this pharmacologic therapy? A. Promotes comfort B. Decreases inflammation C. Stimulates smooth muscle relaxation D. Reduces bacteria in the respiratory tract

ANS: B Beclomethasone reduces the inflammatory response in bronchial walls by suppression of polymorphonuclear leukocytes and fibroblasts and the reversal of capillary permeability. Beclomethasone does not directly promote comfort.

A client's medication history includes a cholinergic medication. The client states, "I take that for some kind of urinary problem." The nurse recalls that cholinergic medications are prescribed primarily for what type of urinary condition? A. kidney stones B. Urine retention C. Spastic bladder D. UTIs

ANS: B Cholinergics intensify and prolonged the action of acetylcholine, which increases the tone in the genitourinary tract, preventing urinary retention. Anticholinergics are prescribed for frequency and urgency associated with spastic bladder.

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

ANS: B Elastic stockings help decrease venous pooling of blood and help maintain systemic BP when the client stands up.

When a client has gluteal edema, why should the nurse avoid using the gluteus maximus muscle for administration of intramuscular medications? A. Deposition of an injected drug causes pain B. Blood supply is likely insufficient for adequate absorption C. Fluid leaks from the site for a long time after the injection D. Tissue fluid dilutes the drug before it enters the circulation

ANS: B Fluid in interstitial spaces impairs circulation, leading to slowed absorption of drugs as well as an increased risk for skin breakdown.

A nurse in the surgical intensive care unit is caring for a client with a large surgical incision. The nurse reviews a list of vitamins and expects that which medication may be prescribed because of its major role in wound healing? A. Vitamin A (retinol) B. Vitamin K (phytonadione) C. Vitamin C (ascorbic acid) D. Vitamin B12 (cyanocobalamin)

ANS: C

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? A. Milk of magnesia 30 mL B. Docusate sodium 100 mg C. Bisacodyl 10-mg suppository D. Bisacodyl two enteric-coated 5-mg tablets

ANS: C 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.

A healthcare provider prescribes dexamethasone for a client with head trauma. A family member asks why this medication is being given. The nurse explains that it reduces swelling in the brain by what process? A. Acts as a hyperosmotic diuretic B. Increases tissue resistance to infection C. Reduces the inflammatory responses o tissues D. Decreases the formation of cerebrospinal fluid

ANS: C Corticosteroids acts to decrease inflammation, which decreases edema.

When obtaining a health history, the nurse is informed that a client has been taking digoxin. What therapeutic effect of digoxin does the nurse expect? A. Decreased cardiac output B. Decreased stroke volume of the heart C. Increased contractile force of the myocardium D. Increased electrical conduction through the AV node

ANS: C Digoxin produces a positive inotropic effect that increases the strength of the myocardial contractions and thus cardiac output. The positive inotropic effect of digoxin increases cardiac output. Digoxin increases the strength of myocardial contractions and slows the heart rate; these effects increase the stroke volume of the heart. Dixgoin decreases the refractory period of the AV node and decreases conduction through the SA and AV nodes.

A client receiving chemotherapy for cancer develops sores in the mouth and asks the nurse why this happened. What is the nurse's best response? A. "The sores occur because of the direct irritation effects of the drug." B. "These tissues are poorly nourished because you have a decreased appetite." C. "The frequently dividing cells of the GI tract are damaged by the drug." D. "This side effect occurs because it targets the cells of the GI system."

ANS: C Many chemotherapeutic agent function by interfering with DNA replication associated with cellular reproduction (mitosis).

A client who is hospitalized after a myocardial infarction asks the nurse why morphine was prescribed. What will the nurse include in the reply? A. Decreases anxiety and promotes sleep B. Helps prevent development of atrial fibrillation C. Relieves pain and reduces cardiac oxygen demand D. Dilates coronary blood vessels to increase oxygen supply.

ANS: C Morphine is a specific CNS depressant used to relieve the pain associated with myocardial infarction; it also decreases apprehension and reduces cardiac oxygen by decreasing cardiac workload.

A client with human immunodeficiency virus (HIV)-associated Pneumocystis jiroveci pneumonia is to receive pentamidine isethionate intravenously (IV) once daily. The nurse should monitor the client for what adverse effect? A. Hypertension B. Hypokalemia C. Hypoglycemia D. Hypercalcemia

ANS: C Pentamidine isethionate can cause either hypoglycemia or hyperglycemia even after therapy is discontinued, and therefore blood glucose levels should be monitored. Hypotension occurs. Hyperkalemia occurs. Hypocalcemia occurs.

A client is scheduled to receive phenytoin 100 mg orally at 6 PM but is having difficulty swallowing capsules. What method should the nurse use to help the client take the medication? A. Sprinkle the powder from the capsule into a cup of water. B. Insert a rectal suppository containing 100 mg of phenytoin. C. Administer 4 mL of phenytoin suspension containing 125 mg/5 mL. D. Obtain a change in the administration route to allow an intramuscular injection.

ANS: C When an oral medication is available in suspension form, the nurse can use it for clients who cannot swallow capsules.

A client who takes high-dose aspirin for arthritis has an acute episode of right ventricular heart failure. The healthcare provider prescribes furosemide and lowers the client's usual dosage of aspirin. The client asks the nurse the reason for the lower dose. On what principle does the nurse base a response? A. Aspirin accelerates metabolism of furosemide and decreases the diuretic effect. B. Aspirin in large doses after an acute stress episode increases the bleeding potential. C. Competition for renal excretion sites by the drugs causes increased serum levels of aspirin. D. Use of furosemide and aspirin concomitantly increases formation of uric acid crystals in the nephron.

ANS: C Because furosemide and aspirin compete for the same renal excretory sites, salicylate toxicity may occur even with lower dosages.

A nurse is reviewing a plan of care for a client who was admitted with dehydration as a result of prolonged watery diarrhea. Which new prescription will the nurse question? A. Oral psyllium B. Oral potassium supplement C. Parenteral half-normal saline D. Parenteral albumin

ANS: D Albumin is hypertonic and will draw additional fluid from the tissues into the intravascular space. Oral psyllium will absorb the water diarrhea, giving more bulk to the stool. An oral potassium supplement is appropriate because diarrhea causes potassium loss.

The healthcare provider prescribes finasteride for a client with benign prostatic hyperplasia. What information does the nurse provide to the client? A. Male pattern baldness can occur. B. Results can be expected in 4 to 6 weeks. C. The medication relaxes the muscles in the blood neck, making it easier to urinate. D. Protection should be worn during intercourse with a pregnant female.

ANS: D Contact with the semen of a client taking finasteride can adversely affect a developing male fetus in a pregnant woman. Finasteride helps prevent male pattern baldness. Results may take 6 to 12 months. Finasteride is used to shrink the enlarged prostate. Other medications, such as tumsulosin, relaxes muscles in the prostate and bladder neck making it easier to urinate.

A client, admitted to the cardiac care unit with a myocardial infarction, complains of chest pain. What intervention will be most effective in relieving the client's pain? A. Nitroglycerin sublingually B. Oxygen per nasal cannula C. Lidocaine hydrochloride 50 mg IV bolus D. Morphine sulfate 2 mg intravenously (IV)

ANS: D Morphine is an opioid analgesic that actson the CNS by a sympathetic mechanism. Morphine decreases systemic vascular resistance, which decreases left ventricular afterload, thus decreasing myocardial oxygen consumption. Nitroglycerin sublingually relieves anginal pain, not myocardial infarction pain. Oxygen administration elevates arterial oxygen tension, potentially improving tissue oxygenation, however, oxygen adminstration will not relieve pain.

Neomycin is prescribed for a client with cirrhosis. What should the nurse explain is the reason for taking this medication? A. Prevents an infection B. Limits abdominal distention C. Minimizes intestinal edema D. Reduces the blood ammonia level

ANS: D Reducing the blood ammonia level decreases the effect of bacterial activity on blood and wastes in the GI tract. Although neomycin is an aminoglycoside antimicrobial, it is not administered to prevention infection.

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? A. Take the medication with breakfast B. Have liver function tests every 6 months C. Wear sunscreen to prevent photosensitivity reactions D. Inform the HCP if the client wishes to become pregnant

ANS: D Simvastatin is contraindicated in pregnancy because it is capable of causing fetal damage. It is a pregnancy category X teratogen. It 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.

A health care provider prescribes sodium biphosphate for a client before a colonoscopy. How does the drug accomplish its therapeutic effect? A. Irritates the intestinal mucosa B. Provides water-absorbing bulk C. Softens stool by exerting a detergent effect D. Increases osmotic pressure in the intestines

ANS: D Sodium biphosphate is a saline (hypertonic) cathartic that increases osmotic pressure within the intestine so that body fluids are drawn into the bowel, stimulating bowel stretching, peristalsis, and defecation.

Steroid therapy is prescribed for a client with common signs and symptoms of multiple sclerosis. In response to the steroid therapy, what symptom does the nurse expect to decrease? A. Emotional lability B. Muscular contractions C. Pain in the extremities D> Episodes of vision loss

ANS: D Steroids decrease the inflammatory process around the optic nerve, thus improving vision; visual impairment is the most common physiologic manifestation of multiple sclerosis. Steroids are associated with increased emotional lability. Steroids are not effective in easing muscle contractions.

Sublingual nitroglycerin is prescribed for a client with a history of a myocardial infarction and atrial tachycardia. The nurse instructs the client about the prophylactic use of these tablets. Which statement by the client indicates the teaching was effective? A. "I should take the medicine three times a day." B. "I will be sure to take my pulse after I have exercised." C. "It will be important to avoid activities that are too strenuous." D. "I should take one tablet before attempting to climb two flights of stairs."

ANS: D Taking nitroglycerin tablet before such an activity probably will prevent an episode of angina. Blood pressure, not pulse, is the parameter most effected by nitroglycerin.

A health care provider prescribes daily docusate sodium for a client. The nurse explains to the client that this drug has what action? A. Lubricates the feces B. Creates an osmotic effect C. Stimulates motor activity D. Lowers the surface tension of feces

ANS: D The detergent action of docusate sodium promotes the drawing of fluid into the stool, which softens the feces.

A client with hyperthyroidism is treated initially with propylthiouracil (PTU). What should the nurse include when teaching the client about this medication? A. This medication will have to be taken for the remainder of the client's life. B. Milk should be taken with the medication so that gastric irritation does not occur. C. The medication should be taken between meals so that it is more readily absorbed. D. Symptoms may not subside until the client has taken the medication for several weeks.

ANS: D The drug does not interfere with thyroxine already stored in the gland; symptoms remain until the hormone is depleted.

A healthcare provider prescribes doxorubicin for a client with acute myelogenous leukemia. Which specific interventions should the nurse implement? 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

ANS:, A, B, C, E 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.