#5

The nurse is caring for a client who has a order for 1000 mL of IV fluid every 8 hours. When the nurse's shift began at 8 pm, there was 500 mL remaining in the IV fluid bag. How many mL would the nurse expect to be in the bag at midnight?

0

The nurse is administering the initial dose of a rapid-acting insulin to a client with type 1 diabetes. At what time should the nurse assess the client for hypoglycemia?

1 hour

The health care provider (HCP) has prescribed guaifenesin 300 mg four times a day. The dosage strength of the liquid is 200 mg/5 mL. How many milliliters should the nurse administer for each dose? Record your answer using one decimal place.

7.5

A client is taking fluphenazine. The nurse understands that teaching and discharge instructions are understood when the client states:

"I need to stay out of the sun."

A client who is using a patient-controlled analgesia (PCA) pump after bowel surgery states, "I'm afraid that I'll become addicted if I use too much morphine." Which would be the best response by the nurse?

"When morphine is used to alleviate severe pain for 2 to 3 days, there is little likelihood of becoming addicted."

A 12-year-old child sustains a moderate burn injury. The parent reports that the child last received a tetanus injection at 5 years of age. Which immunization would the nurse anticipate for this child?

0.5 ml of tetanus toxoid I.M.

A child is to receive dexamethasone intravenously at the ordered dosage of 7.6 mg. The drug concentration in the vial is 4 mg/ml. How many milliliters should the nurse administer? Record the answer using one decimal place. Your Response: 1.9

1.9

The nurse is preparing to administer propranolol to a client for control of migraine headaches. The client also has a prescription for sumatriptan as needed for a headache. The client's pulse rate is 56 bpm. What should the nurse do next?

Assess blood pressure.

A nurse caring for an infant with neonatal bronchopulmonary dysplasia (chronic lung disease) administers furosemide. What is the priority intervention following the administration of this medication?

Monitor electrolyte status.

The nurse is evaluating a client who received tissue plasminogen activator (t-PA) following a myocardial infarction (MI). What is the expected outcome of this drug?

Revascularize the blocked coronary artery.

Which assessment finding supports the administration of protamine sulfate?

aPTT 3.5-5 times normal

When teaching the client with a urinary tract infection about taking a prescribed antibiotic for 7 days, the nurse should tell the client to report which symptoms to the health care provider (HCP)? Select all that apply.

blood in the urine rash fever above 100° F (37.8° C)

A multiparous client tells the nurse that she is using medroxyprogesterone injections for contraception. The nurse should instruct the client to increase her intake of which nutrient?

calcium

A client is admitted to the neurologic intensive care unit for an intracranial hemorrhage. Which medication prescription should the nurse question for this client?

enoxaparin

The nurse is caring for a client with toxic epidermal necrolysis. When reviewing the client's medical record, the nurse would suspect which medication to be a probable cause of this disorder?

phenytoin Explanation: Antiseizure medications are often the cause of toxic epidermal necrolysis. Other common medications that may cause toxic epidermal necrolysis include antibiotics, NSAIDs (nonsteroidal anti-inflammatory drugs), and sulfa medications.

To determine the I.V. drip rate, a nurse must know the drip factor, which is

the number of drops in one milliliter.

The physician orders 250 mg of a drug. The drug vial reads 500 mg/ml. How much of the drug should the nurse give?

½ ml

Which statement by a student nurse demonstrates that further instruction about cytotoxic drugs is needed?

"Nurses who are pregnant must wear gloves during administration of cytotoxic drugs."

Which technique is appropriate when the nurse is irrigating an adult client's ear to move cerumen?

Allow the irrigating solution to run down the wall of the ear canal.

A nurse is caring for a client with a urinary tract infection. The client is anemic and has a hemoglobin count of 8 mg/dL. Taking into consideration that the client is from a Mediterranean country, what should the nurse's most appropriate action be?

Ensure that drugs exacerbating anemia are not given.

What nursing action is appropriate when caring for a child receiving steroids in therapeutic doses over a long period of time?

Monitor the child's serum glucose level.

The administration of medications during infancy is often necessary. The nurse needs to be concerned about the metabolism of these drugs. What concern regarding metabolism should the nurse consider when administering medications to an infant?

inefficient liver function

The nurse is to administer chloramphenicol 50 mg IV in 100 mL of dextrose 5% in water over 30 minutes. The infusion set administers 10 gtt/mL. At what flow rate (in drops per minute) should the nurse set the infusion? Round to the nearest whole number.

33

The nurse is instructing the client who is taking gentamicin to monitor renal function. The nurse determines that the client needs additional instruction when the client makes which statement? "I should call you if:

I have a fever.

Ear drops have been prescribed to be instilled in the adult client's left ear to soften cerumen. To position the client, what should the nurse do?

Pull the auricle lobe up and back

Ear drops have been prescribed to be instilled in the adult client's left ear to soften cerumen. To position the client, what should the nurse do?

Pull the auricle lobe up and back.

A client with gestational hypertension receives magnesium sulfate 50% 4 g in 250 mL D5W over 20 minutes. What priority assessment should the nurse perform when administering this drug?

deep tendon reflexes

A 10-year-old child is taking high doses of aspirin. Which finding indicates the child is experiencing early salicylate toxicity?

dizziness

A nurse is caring for a child taking prednisone following a heart transplant. The child's pre-surgical weight was 25.6 lb (11.6 kg). The practitioner orders the child to receive 2 mg/kg/day divided every six hours. The oral solution comes prepared as 5 mg/5ml. How many milliliters will the child receive with each dose? Record your answer using one decimal place.

5.8

The health care provider prescribes 30 mg of methylphenidate to a child with autism. The methylphenidate is to be given in two divided doses. The concentration is 10 mg/5 mL. How many mL of methylphenidate should the nurse give per dose? Record the answer with one decimal place.

7.5

A 5-year-old child who weighs 44 lb (20 kg) is given penicillin V suspension for a throat culture positive for streptococcus. The dose is 40 mg/kg/day, divided into two doses. The pharmacy supplies penicillin V in a concentration of 250 mg/5 mL. The nurse should administer how many milliliters for each dose? Record your answer using a whole number.

8

The nurse assesses a client who has just received morphine sulfate. The client's blood pressure is 90/50 mm Hg; pulse rate, 58 bpm; and respiration rate, 4 breaths/min. What should the nurse do first?

Administer naloxone hydrochloride

The client has just undergone abdominal surgery and returned from the post-anesthesia care unit (PACU) with a patient-controlled analgesia (PCA) pump. Which interventions should the nurse implement? Select all that apply.

Assess the IV insertion site. Tell the client to push the button when in pain. Check the patient-controlled analgesia (PCA) settings with another nurse.

A nurse preparing to administer a scheduled dose of phenytoin intravenous (I.V.) push verifies that the client has a patent venous access site in the right hand with an infusion of dextrose solution at a rate of 50 mL/hour. In addition to following the rights of medication administration, which actions will the nurse take to give this drug safely? Select all that apply.

Calculate the I.V. rate. Initiate a new I.V. site in the forearm. Dilute the drug with sterile water.

On the day of surgery, a client with diabetes who takes insulin on a sliding scale is to have nothing by mouth and all medications withheld. The client's 0600 glucose level is 300 mg/dL (16.7 mmol/L). What should the nurse do?

Call the health care provider (HCP) for specific prescriptions based on the glucose level.

To give a Z-track injection, a nurse measures the correct medication dose and then changes the needle on the syringe. What is the rationale for this action?

Changing the needle makes the injection less painful.

A client has been taking imipramine, 125 mg by mouth daily, for a week. The client reports having a sore throat and a low-grade fever. What is the nurse's best action?

Collaborate with the doctor for a complete blood count.

A primigravid client who was successfully treated for preterm labor at 30 weeks' gestation had a history of mild hyperthyroidism before becoming pregnant. What instructions should the nurse include in the plan of care?

Continue taking low-dose oral propylthiouracil as ordered.

The nurse is caring for a client with a double lumen tunneled central catheter with ordered bloodwork and intermittent I.V. medications. What is the correct action by the nurse?

Dedicate the largest lumen for blood draws.

The client has been prescribed lisinopril to treat hypertension. The nurse should assess the client for which electrolyte imbalance?

Explanation: Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. Hyperkalemia can be a side effect of ACE inhibitors. Because of this side effect, ACE inhibitors should not be administered with potassium-sparing diuretics.

A school-age child was recently hospitalized at a child psychiatric unit for inattention and acting out behavior at school and home. His provider prescribed the methylphenidate patch to control his attention deficit hyperactivity disorder symptoms, and inpatient unit staff worked with him on behavioral control measures. During his first office visit after his discharge from the hospital, the office nurse discovers that the boy has been taking off his patch during the day, which is causing problems at school and at home. In which order of priority from first to last should the nurse take the actions? All options must be used.

Explore the child's reasons for removing the patch during the day rather than at the end of the day. Explore the parents' attitudes about the medication administration in general and their child's medication in particular. Explain to the family, in terms the child can understand, the benefits of his medication in dealing with school and home problems he is experiencing. Have the provider discuss with the child and parents a trial of a different medication.

A nurse is teaching a client about taking antihistamines. Which information should the nurse include in the teaching plan? Select all that apply.

Increase fluid intake to 2,000 mL/day. Operating machinery and driving may be dangerous while taking antihistamines. Do not use alcohol with antihistamines.

The nurse is planning discharge teaching for a client who will continue taking the prescribed warfarin at home. What early symptoms of occult blood loss should the nurse teach the client?

Increasing fatigue and shortness of breath.

When preparing the teaching plan for a client about lithium therapy, the nurse should provide which instruction to the client concerning sodium?

Maintain an adequate sodium intake

A client taking tranylcypromine sulfate for depression was treated in the emergency department for a headache, vomiting, and blood pressure of 190/100 mm/Hg following dinner at a restaurant. At discharge, the nurse evaluated the client's understanding of diet instructions. For what menu choice will the nurse provide further education?

Mexican sausage soup with guacamole and chips

A client develops hepatic encephalopathy 1 week after portal caval shunt surgery. The client's physician orders neomycin, 4 g by mouth daily in four divided doses. The client's partner asks how neomycin decreases the serum ammonia concentration. How should the nurse respond?

Neomycin decreases the amount of ammonia-producing bacteria in the GI tract.

Upon entering the room, a nurse notes that there is a cap missing on the central venous access device. The client is experiencing shortness of breath, coughing, and chest pain. What would the nurse do first after replacing the cap on the open port?

Notify the health care provider (HCP) of the incident. Explanation: The client has signs of an air embolus. An air embolism occurs when a bolus of air enters the client's body through an open access in the venous system. Once the cap has been replaced, no more air will enter. The HCP should be informed immediately. The chest pain will not resolve on its own, and an EKG would be obtained immediately after notifying the HCP. Having the client sit in the low Fowler's position will not improve oxygenation.

The nurse understands that assessment of blood pressure in clients receiving antipsychotic drugs is important. What is a reason for this assessment?

Orthostatic hypotension is a common side effect.

The nurse notes grapefruit juice on the breakfast tray of a client who is taking repaglinide. What should the nurse do next?

Remove the grapefruit juice from the client's tray and bring another juice of the client's preference.

A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication?

Serum potassium level of [2.6 mEq/L (2.6 mmol/L)}

Which instructions should the nurse include in the teaching plan for a 30-year-old multiparous client who will be using an intrauterine device (IUD) for family planning?

Severe cramping may occur when the IUD is inserted.

The nurse just started an infusion of blood on a client. A few minutes pass and the client develops a sudden fever. What are the priority interventions by the nurse? Select all that apply.

Start the normal saline infusion. Continue to monitor vital signs. Stop the blood infusion. Notify the health care provider

The nurse just started an infusion of blood on a client. A few minutes pass and the client develops a sudden fever. What are the priority interventions by the nurse? Select all that apply.

Stop the blood infusion. Continue to monitor vital signs. Notify the health care provider. Start the normal saline infusion.

A client receiving a blood transfusion calls the nurse to the room and reports feeling hot and itchy. The client's temperature is 101.4°F (38.6°C) after 100 mL of the blood is infused. What are the priority actions for the nurse?

Stop the blood transfusion and maintain the intravenous site with normal saline.

The nurse hands the medication cup to a client who is psychotic and exhibiting concrete thinking, and tells the client to take his medicine. The client takes the cup, holds it in his hand, and stares at it. What should the nurse do next?

Tell the client to put the medicine in his mouth and swallow it with some water.

The client, who is taking fluoxetine 20 mg at bedtime, tells the nurse the drug is interfering with his sleep. What conclusion should the nurse make?

The client should take fluoxetine in the morning.

The nurse is teaching the client how to use a metered-dose inhaler (MDI) to administer a corticosteroid. Which observations indicates that the client is using the MDI correctly? Select all that apply.

The inhaler is held upright. The client rinses the mouth with water following administration.

A client who has glaucoma has been prescribed timolol eye drops. The nurse should give which instructions about the administration of the eye drops?

The medication may cause some transient eye discomfort.

Sodium polystyrene sulfonate is prescribed for a client following a crush injury. Which finding indicates the drug has been effective?

The serum potassium is 4.0 mEq/L (4.0 mmol/L).

Why are antacids administered regularly, rather than as needed, in peptic ulcer disease?

To keep gastric pH at 3.0 to 3.5

When preparing to give a child with insulin-dependent diabetes his dose of regular insulin and isophane insulin suspension, which of the following actions is most appropriate?

Withdrawing the regular insulin first, then withdrawing the isophane insulin suspension into one syringe.

What liquid does the nurse recommend the parents of a 1½-month-old infant with hypothyroidism use to administer levothyroxine with?

You Selected: small amount of formula or breast milk

Which assessment finding supports the administration of protamine sulfate?

aPTT 3.5-5 times normal Explanation: Protamine sulfate is the antidote specific to heparin. The RBC, and platelet levels are normal. Normal aPTT in heparinized clients is 2-2.5 times normal. INR measurement relates to therapy with warfarin, not heparin. An INR value of 8 is abnormally high and would likely require administration of vitamin K, the antidote for warfarin.

The client is having mild pain and inquires about what medications they can use. Which analgesic will the nurse teach the client to use for mild pain? Select all that apply.

acetaminophen naproxen ibuprofen

A nurse is caring for a 3-year-old child admitted to the pediatric unit with acetaminophen poisoning. The nurse administers acetylcysteine every 4 hours for 72 hours. Which laboratory findings confirm the effectiveness of the drug therapy?

alanine aminotransferase and aspartate aminotransferase

The client visits the health care provider reporting a red, swollen, and painful right great toe and is subsequently diagnosed with gouty arthritis. Which drug does the nurse anticipate the healthcare provider to order?

allopurinol

A client being treated for iron deficiency anemia with ferrous sulfate continues to be anemic despite treatment. The nurse should assess the client for use of which medication?

aluminum hydroxide Explanation: The nurse should assess the client for possible use of antacids such as aluminum hydroxide. Clients should take ferrous sulfate and an antacid at least 2 hours apart because antacids bind with iron in the GI tract, decreasing the rate or extent of iron absorption.

The nurse is preparing to administer medications to a group of clients. Which client does the nurse prioritize as being at greatest risk for adverse drug effects

an 85-year-old female client with arthritis, diabetes, and heart disease

The nurse should warn a client who is taking a benzodiazepine about using which medication in combination with his current medication?

antacids

A nurse in a psychiatric inpatient unit is caring for a client with generalized anxiety disorder. As part of the client's treatment, the psychiatrist orders lorazepam, 1 mg by mouth three times per day. During lorazepam therapy, the nurse should remind the client to

avoid caffeine.

A client with newly diagnosed type 1 diabetes is scheduled to receive regular insulin 10 units and NPH insulin 20 units every morning. When should the nurse schedule the administration of these medications?

both insulins 0.5 hours before breakfast

Atropine sulfate is contraindicated as a preoperative medication for which client?

client with glaucoma

During an assessment of a neonate born at 33 weeks' gestation, a nurse finds and reports a heart murmur. An echocardiogram reveals patent ductus arteriosis, for which the neonate received indomethacin. What is the expected outcome after the administration of indomethacin to a neonate with patent ductus arteriosis?

closure of a patent ductus arteriosus

A nurse should expect to administer which medication to a client with gout?

colchicine

Which performance improvement strategy helps prevent adverse reactions to blood products?

confirming client identification with two qualified health professionals

The health care provider (HCP) has prescribed intravenous mannitol for a child with a head injury. The best indicator that the drug has been effective is which assessment finding?

decreased intracranial pressure.

A child has been prescribed a 3-day course of treatment with gentamicin sulfate while recovering from surgery. Which assessment of the child causes the nurse to be the most concerned?

decreased urine output

An auto mechanic accidentally has battery acid splashed in their eyes. The coworkers irrigate the eyes with water for 20 minutes, then take the mechanic to the emergency department of a nearby hospital, where the mechanic receives emergency care for corneal injury. The physician orders dexamethasone, two drops of 0.1% solution to be instilled initially into the conjunctival sacs of both eyes every hour; and polymyxin B sulfate, 0.5% ointment to be placed in the conjunctival sacs of both eyes every 3 hours. The nurse knows that dexamethasone exerts its therapeutic effect by

decreasing leukocyte infiltration at the site of ocular inflammation.

A client with chronic schizophrenia receives 20 mg of fluphenazine decanoate by I.M. injection. Three days later, muscle contractions that contort the client's neck. This client is exhibiting which extrapyramidal reaction?

dystonia

Which clinical manifestation is a typical reaction to long-term phenytoin sodium therapy?

excessive growth of gum tissue

A nurse is caring for a young child who is experiencing verbal tics and motor tics such as eye blinking and protruding the tongue. Based on this assessment, which medication would the nurse consider administering?

haloperidol

A client with multiple sclerosis is taking baclofen. Which sign indicates the drug is having the intended outcome? The client:

has relief from muscle spasms

Which assessment finding is expected in a client receiving bicalutamide and leuprolide for advanced prostate cancer?

hot flashes

A nurse is reviewing the healthcare provider's orders for a client admitted with systemic lupus erythematosus (SLE). Which medication would the nurse expect to find in this client's plan of care?

hydroxychloroquine

A client rates the pain level of a migraine an 8 on a scale of 1-10. How would the nurse administer the medication to give the client the quickest relief?

intravenous (IV)

A multigravid client at 34 weeks' gestation with premature rupture of the membranes tests positive for group B streptococcus. The client is having contractions every 4 to 6 minutes. Her vital signs are as follows: blood pressure, 120/80 mm Hg; temperature, 100°F (37.8°C); pulse, 100 bpm; respirations, 18 breaths/minute. Which medication would the nurse expect the primary health care provider (HCP) to prescribe?

intravenous penicillin

At what time should the blood be drawn in relation to the administration of the IV dose of gentamicin sulfate?

just before the administration of the next IV dose

A physician orders lithium carbonate for a client who has just been diagnosed with bipolar disorder. The nurse is teaching the client about signs and symptoms of lithium toxicity, which include:

lethargy, vomiting, and diarrhea.

A client is receiving methotrexate, 12 g/m2 I.V., to treat osteogenic carcinoma. During methotrexate therapy, the nurse expects the client to receive which other drug to protect normal cells?

leucovorin (citrovorum factor or folinic acid)

A multigravid client is admitted to the hospital with a diagnosis of ectopic pregnancy. The nurse anticipates that, because the client's fallopian tube has not yet ruptured, which medication may be prescribed?

methotrexate Explanation: Because the fallopian tube has not yet ruptured, methotrexate may be given, followed by leucovorin. This chemotherapeutic agent attacks the fast-growing zygote and trophoblast cells. RU-486 is also effective. A hysterosalpingogram is usually performed after chemotherapy to determine whether the tube is still patent. Progestin-only contraceptives and medroxyprogesterone are ineffective in clearing the fallopian tube. Dyphylline is a bronchodilator and is not used.

What is the nurse's priority action when administering phenytoin to a client intravenously?

mix phenytoin with saline solution only

Which nursing intervention takes highest priority when caring for a client who's receiving a blood transfusion? You Selected: monitoring the client for itching, swelling, or dyspnea

monitoring the client for itching, swelling, or dyspnea

A client is born with severe tetralogy of Fallot and transferred to a pediatric hospital. The nurse caring for the client anticipates administering which medications during, or to prevent, a "tet spell?" Select all that apply.

morphine sulfate propranolol hydrochloride

What is the priority symptom to assess for in the client who is taking risperidone 1 mg, orally twice a day?

orthostatic hypotension

A nurse is caring for a client in addisonian crisis. Which medication order should the nurse question?

potassium chloride Explanation: Since addisonian crisis results in hyperkalemia, administering potassium chloride is contraindicated. Therefore, the nurse should question the order for potassium chloride, making this the correct choice for this question. Because the client is hyponatremic, an order for normal saline solution is appropriate. Hydrocortisone and fludrocortisone are used to replace deficient adrenal cortex hormones

Which oral contraceptive is considered safe for use while breastfeeding because it will not affect the breast milk supply once breastfeeding has been well established?

progestin

A client is being given naltrexone as part of an alcohol treatment program. When the client asks the nurse to explain the intended effects of the drug, the nurse should state that the drug:

reduces compulsions to drink.

A neonate weighing 1,870 g with a respiratory rate of 46 breaths/minute, a pulse rate of 175 bpm, and a serum pH of 7.11 has received sodium bicarbonate intravenously. The drug has been effective if the neonate exhibits which finding?

resolves the metabolic acidosis

A client is scheduled for cardiac catheterization the next morning. The physician ordered temazepam, 30 mg by mouth at bedtime, for sedation. Before administering the drug, the nurse should know that:

sedatives reduce excitement; hypnotics induce sleep.

A client was discharged from an alcohol rehabilitation program on clonazepam 0.5 mg three times a day. Several months later, the client reports having insomnia, shakiness, sweating, and one seizure. The nurse should first assess the client for which possible symptoms cause?

stopping the clonazepam suddenly

The nurse is caring for a client with gastroesophageal reflux disease (GERD). The nurse knows that breakfast is served for clients at 0800. Which prescribed medication will the nurse administer at 0730?

sucralfate

A nurse is monitoring a client for adverse reactions to atropine eyedrops. Systemic absorption of atropine sulfate through the conjunctiva can cause which adverse reaction?

tachycardia

A client's intravenous catheter has become occluded. The nurse knows that the reason for the occlusion is:

thrombosis at the site.

A client takes diazepam while establishing a therapeutic dose of antidepressants for generalized anxiety disorder. Which instruction should the nurse give to this client? Select all that apply

to consult with his health care provider before he stops taking the drug to stop taking the drug if he experiences swelling of the lips and face and difficulty breathing not to use alcohol while taking the drug

Lorazepam is commonly given along with a neuroleptic agent. What is the purpose of administering the drugs together?

to reduce anxiety and potentiate the neuroleptic's sedative action

The nurse is preparing to administer vasopressin to a client who has undergone a hypophysectomy. What is the purpose of the medication?

to replace antidiuretic hormone (ADH) normally secreted from the pituitary

The RN is administering intravenous chemotherapy to a client with cancer. Which precautions are necessary when administering chemotherapy? Select all that apply.

wearing gloves when handling the client's urine disposing of chemotherapy waste as hazardous material wearing a long-sleeved gown when administering chemotherapy

A client is prescribed buspirone 5 mg two times a day. Which statements indicate that the client has understood the nurse's teaching about this drug? Select all that apply.

"Buspirone will help me not to worry so much." "I'll be able to focus better."

The client was diagnosed with hypertension 7 years ago. In the last 6 months, after diet and exercise, the client's blood pressure has consistently ranged around 160/95. What should the nurse include in the client's teaching about the side effects of clonidine? Select all that apply.

"Clonidine may cause low blood pressure when you stand up." "Clonidine may cause dry mouth." "Clonidine may cause fatigue."

The client was diagnosed with hypertension 7 years ago. In the last 6 months, after diet and exercise, the client's blood pressure has consistently ranged around 160/95. What should the nurse include in the client's teaching about the side effects of clonidine? Select all that apply.

"Clonidine may cause low blood pressure when you stand up." "Clonidine may cause fatigue." "Clonidine may cause dry mouth."

The nurse teaches a client taking desmopressin nasal spray about how to manage treatment. The nurse determines that the client needs additional instruction when the client makes which comment?

"I should use the same nostril each time I take the medicine."

The nurse is caring for a client taking risperidone 2 mg daily. It is most important for the nurse to follow up on which client statement?

"I'm constantly sick and feel like I always have a fever."

Which statement by an adolescent receiving gentamicin should the nurse interpret as indicating drug toxicity?

"I'm feeling dizzy."

After being hospitalized for status asthmaticus, a child is discharged with prednisone and other oral medications. Two weeks later, when the child comes to the clinic for a checkup, the nurse instructs the parent to gradually decrease the dosage of prednisone, which will be discontinued. The parent asks why prednisone must be discontinued. How should the nurse respond?

"Long-term steroid therapy may interfere with a child's growth."

A 2-year-old child is prescribed cyclosporine. The parent says the child doesn't like taking the liquid medication. Which statement by the nurse is most appropriate?

"Offer the medication diluted with chocolate milk or orange juice to make it more palatable."

A client with rheumatoid arthritis reports gastrointestinal irritation after taking piroxicam. To prevent gastrointestinal upset, the nurse should provide which instruction?

"Take piroxicam with food or an antacid."

Which statement by the client indicates an understanding of teaching regarding use of corticosteroids during preterm labor?

"The corticosteroids may help my baby's lungs mature."

Which statement by a client who has been taking buspirone as prescribed for 2 days indicates the need for further teaching?

"This medication will help my tight, aching muscles."

The parent of a child who is taking an antibiotic for bilateral otitis media tells the nurse that he has stopped the medicine since the child is better and is saving the rest of the medication to use the next time the child gets sick. What should the nurse tell the parent?

"Your child needs all of the medicine so that the infection clears."

The health care provider orders ibuprofen for a client reporting pain. What should the nurse include in the client's teaching concerning ibuprofen? Select all that apply.

-Do not take aspirin concurrently with ibuprofen. -Notify the health care provider immediately of dark tarry stools. -Notify the health care provider of skin rash or jaundice immediately.

The clinic nurse is teaching caregivers of a 6-year-old client how to administer eye drops for bacterial conjunctivitis. Which will the nurse include in the plan of care? Select all that apply.

-Remove any drainage from the eye prior to administration of the eye drops. -After administration of the eye drops, keep the eye lid closed for several seconds.

The client was found not breathing and was transported to the hospital. A family member states the client may have taken too much pain medication because the client frequently forgets if the medication was taken. Which observation(s) by the nurse indicates therapeutic effect of naloxone hydrochloride in the client? Select all that apply.

-Reverses decreased respiratory rate of 10. -Reverses decreased level of consciousness. -Reverses blood pressure of 90/58.

The neonate has a prescribed IV rate of 8 mL/h. Fluid totals are recorded every 2 hours on the even hours. There is a new prescription written at 1030 to decrease the IV rate to 6 mL/h. How many mL will be added to the recorded total at 1200? Record your answer using a whole number.

13

An infusion of lidocaine hydrochloride is running at 30 mL/hour. The dilution is 1,000 mg/250 mL. What dosage is the client receiving per minute? Record your answer using a whole number.

2

The client is ordered oxycodone/acetaminophen 20mg tablets, one or two prn pain. The client rates the pain as a 7 on the numeric scale of 0/10. How many tablets of oxycodone/acetaminophen should the nurse administer?

2

A client with deep vein thrombosis has an I.V. infusion of heparin infusing at 1,500 units/hour. The concentration in the bag is 25,000 units/500 ml. How many milliliters of solution should the nurse document as intake from this infusion for an 8-hour shift? Record your answer using a whole number.

240

A child with osteomyelitis is to receive nafcillin IV every 6 hours. Before administering the drug, the nurse calculates the appropriate dosage. The recommended dosage is 50 to 100 mg/kg daily; the child weighs 22 lb (10 kg). Which dosage is acceptable?

250 mg every 6 hours

The nurse reviews information about how to take the prescribed tetracycline. Which statement by the client allows the nurse to determine that the client understands the information?

"I can take tetracycline 1 hour before or 2 hours after meals with plenty of water."

The nurse instructs the client in mixing and administering regular and NPH insulin. Which statement indicates that the client needs additional instruction?

"I shake the bottle of NPH insulin before drawing it up."

Which statement indicates that the client needs further teaching about taking medication to control cancer pain?

"I should skip doses periodically so I don't get hooked on my drugs."

The client was recently diagnosed with a hiatal hernia. The healthcare provider orders an antacid that has reduced adverse effects. What should the nurse include in the client's teaching about the side effects of antacids?

"The major side effect of an antacid is diarrhea."

The client with rapid-cycling bipolar disorder who is about to receive his 1700 hours dose of carbamazepine tells the nurse he has a sore throat and chills. What should the nurse do next?

Call the health care provider (HCP) immediately to report changes.

When assessing a client's I.V. insertion site, a nurse notes normal color and temperature at the site and no swelling. However, the I.V. solutions haven't infused at the ordered rate; the flow rate is slow even with the roller clamp wide open. When the nurse lowers the I.V. fluid bag, no blood returns to the tubing. What should the nurse do first?

Check the tubing for kinks and reposition the client's wrist and elbow

A client is taking doxorubicin and is distressed about hair loss. What should the nurse do?

Provide resources for a wig selection before hair loss begins.

A client takes isosorbide dinitrate as an antianginal medication. Which statement indicates that the client understands the adverse effects of the drug?

"I'll need to change positions slowly so I won't get dizzy."

A client with bipolar disorder has been taking lithium carbonate for the past 2 years. Recently, the client has been experiencing a recurrence of manic symptoms approximately once a month. The client's psychiatrist has added clonazepam to help manage the client's mood swings. Which statement should the nurse include in medication teaching?

"This medication will help steady your moods by reducing the overstimulation of chemical messengers in your brain."

A client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should the nurse provide?

"You may not be able to use desmopressin nasally if you have nasal discharge or blockage."

The health care provider prescribes 0.4 mg of atropine sulfate and 75 mg of meperidine hydrochloride to be given intramuscularly to a client 1 hour before surgery. The stock ampule of atropine contains 0.8 mg/mL, and the stock ampule of meperidine contains 100 mg/mL. The two drugs are compatible and can be drawn up in one syringe. What is the combined volume of medication in the syringe?

1.25 mL

A physician prescribes penicillin potassium oral suspension 56 mg/kg/day in four divided doses for a client with anorexia nervosa who weighs 25 kg. The medication dispensed by the pharmacy contains a dosage strength of 125 mg/5 mL. How many milliliters of solution should the nurse administer with each dose? Record your answer using a whole number.

14

The nurse is preparing to administer vitamin B12 intramuscularly (IM). Which nursing intervention is appropriate? Administer using z-track technique.

Administer using z-track technique

A client with obesity presents to the emergency department (ED) with reports of RUQ pain and pressure, and is subsequently diagnosed with cholecystitis. The client is being prepped for a cholecystectomy, what priority teachings will the nurse provide? Select all that apply.

how to use the numeric 0/10 pain scale types of pain medications and how they will be used

A client is receiving total parenteral nutrition (TPN) solution. The nurse should assess a client's ability to metabolize the TPN solution adequately by monitoring the client for which sign?

hyperglycemia

A client with cirrhosis begins to develop ascites. Spironolactone is prescribed to treat the ascites. The nurse should monitor the client closely for which drug-related adverse effect? You Selected: hyperkalemia

hyperkalemia

A breastfeeding primiparous client with a midline episiotomy is prescribed ibuprofen orally. When does the nurse instruct the client to take the medication?

immediately after a feeding

A client with quadriplegia is experiencing severe muscle spasms. To relieve them, a physician orders baclofen, 5 mg P.O. three times daily. What is the principal indication for baclofen?

muscle spasms with paraplegia or quadriplegia from spinal cord lesions

A physician orders acetaminophen elixir, 160 mg every 4 hours, for a 14-month-old client who weighs 20 lb (9.08 kg). This drug, supplied in a bottle labeled 160 mg/tsp, has a safe dosage of 10 mg/kg/dose. The nurse should administer how many milliliters?

none because this isn't a safe dose

After returning home, a client who has had cataract surgery will need to continue to instill eye drops in the affected eye. The client is instructed to apply slight pressure against the nose at the inner canthus of the eye after instilling the eye drops. What is the expected outcome of applying pressure? Pressure:

prevents the medication from entering the tear duct.

The laboratory notifies the nurse that a client who had a total knee replacement 3 days ago and is receiving heparin has an activated partial thromboplastin time (aPTT) of 95 seconds. After verifying the values, the nurse calls the health care provider (HCP). What prescription for the client should the nurse recommend the HCP consider?

protamine sulfate

A primigravid client at 32 weeks' gestation with ruptured membranes is prescribed to receive betamethasone 12 mg intramuscularly for two doses 24 hours apart. When teaching the client about the medication, what should the nurse include as the purpose of this drug?

to accelerate fetal lung maturity

The nurse is preparing a client for a cardiac catheterization. Which client statement would the nurse need to report to the healthcare provider immediately?

"I took my metformin this morning."

A client newly diagnosed with ulcerative colitis who has been placed on steroids asks the nurse why steroids are prescribed. What should the nurse tell the client?

"Steroids are used in severe flare-ups because they can decrease the incidence of bleeding."

Which action(s) should the nurse take prior to administering an oral medication to an infant? Select all that apply.

-Verify the infant's name. -Verify that it is the correct dose. -Ensure that it is the correct medication

A healthcare provider orders 500 mg of oxacillin sodium for intramuscular administration. One gram of powdered oxacillin sodium is available. Directions for reconstitution are to add 5.7 mL of sterile water to yield 1 g in 4 mL. How many milliliters should a nurse withdraw from the vial after reconstituting the drug as directed? Record your answer using a whole number.

2

A client with deep vein thrombosis (DVT) has an IV infusion of heparin sodium infusing at 1,500 units/hr. The concentration in the bag is 25,000 units/500 ml. How many milliliters should the nurse document as intake from this infusion following an 8-hr shift? Record your answer using a whole number.

240 Explanation: The solution has 25,000 units of medication in every 500 ml of solution, and 1,500 units are infusing each hour over 8 hours. There are several paths to finding the intake, or amount of solution, infused. Here is one approach. Calculate how many units are in each milliliter by reducing the ratio given: 25,000 units/500 ml = 50 units/1 ml. Calculate how many milliliters the client receives each hour. Multiply known ratios so that units cancel out, leaving ml/hr, and then reduce:1 ml/50 units × 1,500 units/1 hr = 1,500 ml/50 hr = 30 ml/1 hr. Multiply the hourly rate by 8 hours: 30 ml/1 hr × 8 hr = 240 ml. The intake is 240 ml of solution.

A client who is recovering from gastric surgery is receiving IV fluids to be infused at 100 mL/hour. The IV tubing delivers 15 gtt/mL. The nurse should infuse the solution at a flow rate of how many drops per minute to ensure that the client receives 100 mL/hour? Record your answer using a whole number.

25

A physician orders phenytoin 150 mg by mouth twice per day for a child. The strength of the oral suspension on hand is 30 mg/5 mL. How many milliliters of suspension should the nurse administer with each dose? Record your answer using a whole number.

25

A physician orders gentamicin sulfate, 80 mg I.V. every 8 hours for a client with Pseudomonas aeruginosa. The nurse should infuse this drug over at least:

30 minutes.

A client receiving an intravenous infusion states that, "My arm is feeling cool." Which priority action should be taken?

Assess the intravenous site.

A nurse is administering an IV antineoplastic agent when the client says, "My arm is burning by the IV site." What should the nurse do first?

Stop infusing the medication

A client receiving a blood transfusion experiences an acute hemolytic reaction. Which nursing intervention is the most important? You Selected: Stop the transfusion, infuse normal saline solution, and call the physician.

Stop the transfusion, infuse normal saline solution, and call the physician.

After a period of unsuccessful treatment with amitriptyline, a woman diagnosed with depression is switched to tranylcypromine. Which statement by the client indicates the client understands the side effects of tranylcypromine?

You Selected: "I must refrain from eating aged cheese or yeast products."

A client is brought to the emergency department unconscious. An empty bottle of aspirin was found in the car, and a drug overdose is suspected. Which medication should the nurse have available for further emergency treatment?

activated charcoal powder

Which factor is most important for the nurse to consider when determining the angle at which to insert the needle for a subcutaneous injection?

amount of subcutaneous tissue

The client has been managing angina episodes with nitroglycerin. Which finding indicates that the therapeutic effect of the drug has been achieved?

decreased chest pain

An auto mechanic accidentally has battery acid splashed in their eyes. The coworkers irrigate the eyes with water for 20 minutes, then take the mechanic to the emergency department of a nearby hospital, where the mechanic receives emergency care for corneal injury. The physician orders dexamethasone, two drops of 0.1% solution to be instilled initially into the conjunctival sacs of both eyes every hour; and polymyxin B sulfate, 0.5% ointment to be placed in the conjunctival sacs of both eyes every 3 hours. The nurse knows that dexamethasone exerts its therapeutic effect by

decreasing leukocyte infiltration at the site of ocular inflammation