ATI Pharmacology Practice A, ATI PHARM: practice B

A nurse is caring fo a client whho is refusing to take her schedueled moring furosemide. Which of the following statments shoulf the nurse make?

"By not taking your furosemide, you might retain fluid and develop swelling." The nurse should respect the client's right to refuse the medication and inform the client of the risks of not taking the medication, notify the provider, and document the refusal. Furosemide is a loop diuretic given to reduce edema.

A nurse is planning discharge teaching for a client who has a prescription for hurosemide. the nurse should plan to include which of the following statments in the teaching.

"Drink a glass of milk with each dose of medication." The client should take furosemide with food or milk to reduce gastric irritation.

A nurse is providing teaching for a client who has multiple sclerosis and a new prescription for methylprednisolone. Which of the following instructoins should the nurse include?

-"Blood glucose levels will need to be monitored during therapy." -"Avoid contact with persons who have known infections." -"Grapefruit juice can increase the blood levels of the medication."

A nurse is providing teaching to a client who has depression and a new prescription for fluoxentine. Which of the following statments by the client indicates an understanding of the teaching?

"I should take acetaminophen instead of ibuprofen for my headaches while taking this medication." Fluoxetine suppresses platelet aggregation, which increases the risk of bleeding when used concurrently with NSAIDs and anticoagulants. Therefore, clients who are taking fluoxetine should take acetaminophen for headaches or pain, since acetaminophen does not suppress platelet aggregation.

A nurse is teaching a client who is starting to take diltiazem. Which of the following statments should the nurse id as an indication that the client understands the teaching?

"I will check my heart rate before I take the medication." "I will check my heart rate before I take the medication."

A nurse is providing teaching to a client about the use of ethinyl estradiol/norelfestromin. the nurse should id that which of the following statments by the client indicates an understanding of the testing?

"I will fold the sticky sides of the old patch together before disposing it." The client should fold the sticky sides of the old patch together and then place it in a childproof container to ensure safe disposal of the patch.

A nurse is providing discharge instructions to a client who is to self-administer insuling at home. Which of the following client statments should indicate to the nurse that the teaching is effective?

"I will store my unopened bottles of insulin in the refrigerator." The client should store unopened vials of insulin in the refrigerator to maintain medication viability. Once opened, the insulin can remain at room temperature for up to 1 month.

A nurse is providing discharge teaching to a client who has a new prescription for furosemide twice daily. the nurse should include which of the following instructions in the teaching?

"Increase intake of potassium-rich foods" is correct. "Monitor for muscle weakness" is correct. "Dangle your legs from the side of the bed before standing" is correct

.9 sodium chloride 1500ml

188ml

.9 sodium chloride 1000ml IV over 8hr

31gtt/min

A nurse is assessing a client who has schizophrenia and is taking haloperidol. The nurse should report which of the following findings to the provider as a manifestation of neuroleptic malignant syndrome (NMS)? A. Temperature of 39.7° C (103.5° F) B. Urinary retention C. Heart rate 56/min D. Muscle flaccidity

Answer: A A. The nurse should report fever to the provider as an indication of NMS, an acute life-threatening emergency. Other manifestations can include respiratory distress, diaphoresis, and either hyper- or hypotension. B. The nurse should report incontinence as a manifestation of NMS. C. The nurse should report tachycardia as a manifestation of NMS. D. The nurse should report severe muscle rigidity as a manifestation of NMS.

A nurse is precepting a newly licensed nurse who is caring for four clients. the nurse should complete an incident report for which of the following actions by the newly licensed nurse?

Administers isosorbide mononitrate to a client who has BP 82/60 mm Hg Isosorbide mononitrate is a nitrate used for clients with angina. Taking isosorbide mononitrate leads to vasodilation, which can result in hypotension. The nurse should withhold the medication and notify the provider if the client's systolic blood pressure is below the expected reference range of 120/80.

nurse is caring for a client who is receiving haloperidol. the nurse should id which of the following findings as an adverse effect of the medication?

Akathisia An adverse effect associated with haloperidol is the development of extrapyramidal manifestations such as dystonia, pseudoparkinsonism, and akathisia.

A nurse is assesing a client who has received atropine eye drops during an eye examination. which of the following findings should the nurse expect as an effect of the medication.

Blurred vision Blurred vision is an expected finding following the administration of atropine eye drops. This is due to the cycloplegic effects of the medication, which cause near objects to appear blurry to the client.

A nurse is caring for a client who has a magnesium level of 3.1 meq. The nurse should expect to administer which of the following medications?

Calcium gluconate The nurse should expect to administer IV calcium gluconate to the client and prepare to provide ventilatory support. This client is at risk for respiratory depression and cardiac dysrhythmias because a magnesium level of 3.1 mEq/L is above the expected reference range of 1.3 to 2.1 mEq/L.

A nurse is profiding teaching to a client who to start taking sumatriptan. Which if the following adverse effects should the nurse instruct the client to monitor for and report to the provider?

Chest Pressure Sumatriptan is an antimigraine agent which can cause coronary vasospasms, resulting in angina. The client should report chest pressure or heavy arms to the provider.

A nurse is reviewing lab results for a client who is to receive a dose of ceftazidme cia IV bolus. Which of the following lab findings is the priority for the nurse to report to the provider before admin of the meds?

Creatinine 2.6 mg/dL Ceftazidime is excreted primarily by the renal system. A serum creatinine level above 1.3 mg/dL can indicate a kidney disorder requiring a reduction in the dose administered. The nurse should notify the provider, who is likely to prescribe a lowered dose of medication.

A nurse is caring for a client who is taking atorvastatin for hyperlipidemia. which of the following client laboratory values should the nurse monitor?

Creatinine Kinase The client who is taking atorvastatin can develop an adverse effect called rhabdomyolysis, which causes muscle weakness or pain and can progress to myositis. Creatinine kinase levels rise in response to enzymes released with muscle injury.

A nurse is planning to teach about inhalant medications to a client who has a new diagnosis of exercise-induced asthma. which of the following medications should the nurse plan to instruct the client to use prior to physical activity?

Cromolyn Cromolyn sodium stabilizes mast cells, which inhibit the release of histamine and other inflammatory mediators. The client should use cromolyn 10 to 15 min before planning to exercise to prevent bronchospasms.

A nurse is administering baclofen for a client who has a spinal cord injurt. which of the following findings should the nurse document as a therapuic outcome?

Decrease in flexor and extensor spasticity A client who has a spinal cord injury and takes baclofen can experience a decrease in the frequency and severity of muscle spasms and in flexor and extensor spasticity.

A nurse is administering cefotetan via intermittent IV bolus to a client who suddenly developed dyspnea and widespread hives. Which of the following actions should the nurse take first?

Discontinue the medication IV infusion. The greatest risk to the client is respiratory arrest from anaphylaxis. Therefore, the first action the nurse should take is to discontinue the medication IV infusion to prevent the client from receiving more medication. However, the nurse should not remove the IV catheter. Instead, the nurse should change the tubing and administer 0.9% sodium chloride by continuous IV infusion.

A nurse is caring for a client who has developed hypomagnesemia due to longterm therapy with lansoprazole. The nurse should monitor the client for which of the following manifestations.

Disorientation The nurse should monitor the client for disorientation and confusion as manifestations of hypomagnesemia. The nurse should also assess the client for a positive Chvostek's and Trousseau's signs.

A nurse is teaching a client who has a new prescription for docuste sodium about the medication's mechanism of action. Which of the following information should the nurse include in the teaching.

Docusate sodium reduces the surface tension of the stools to change their consistency. Docusate sodium is a surfactant that softens stool by reducing surface tension, allowing water to penetrate more easily into the stool.

A nurse is caring for a client who has pneumonia. The client tells the nurse she is pregnant and that she has not told her provider yet. The nurse should id that the pregnancy is a contraindication for receiving which of the following medications?

Doxycycline Doxycycline is a tetracycline antibiotic. The nurse should identify that doxycycline can cause teratogenic effects such as staining of the infant's teeth when exposed to this medication. Therefore, this medication is contraindicated for the client.

A nurse is teaching a client who is taking allopurinol for the treatment of gout. Which of the following information should the nurse include in the teaching?

Drink 2 L of water daily The nurse should instruct the client to drink at least 2 L of water each day to prevent renal stone formation and kidney injury, because allopurinol is eliminated through the kidneys.

A nurse is providing teaching to a client who has a prescription for trimethoprimsulfamethoxazole. Which of the following instructions should the nurse include in the teaching?

Drink 8 to 10 glasses of water daily. The nurse should instruct the client to increase water intake to 1,920 to 2,400 mL (65 to 81 oz) a day to decrease the chance of kidney damage from crystallization.

A nurse is assessing a client who is taking amitriptyline for depression. Which of the following findings should the nurse id as an adverse effect of the medication?

Dry mouth The nurse should expect the client to have a dry mouth due to the blocking of acetylcholine receptors that cause anticholinergic responses.

A nurse is administering diazepam to a client who is having a clonoscopy. which of the following actions should the nurse take?

Ensure flumazenil is available to administer for toxicity management. The nurse should monitor the client for manifestations of diazepam toxicity, such as respiratory depression and hypotension. The nurse should be prepared to administer flumazenil to reverse the effects of diazepam.

A nurse contacts a client's provider on the telephone to obtain a prescription for pain medication. Which of thee following actions should the nurse take?

Have the provider spell out the unfamiliar medication names The nurse should ask the provider to spell out the name of the medication if the stated name is one the nurse is not familiar with.

A nurse is caring for a client who has sickle cell anemia and is taking hydroxyurea. which of the following findings should the nrse report to a provider?

Hemoglobin 7.0 g/dL is correct. Platelets 75,000/mm3 is correct. Potassium 5.2 mEq/L is correct.

A nurse is caring for a client who has heart failure and a prescription for enalapril. The nurse should monitor the client for which of the following findings as an adverse effect of the medication?

Hyperkalemia Enalapril improves cardiac functioning in clients who have heart failure and can cause hyperkalemia due to potassium retention by the kidneys.

A nurse in a providers office is assessing a client who has been taking. asprin daily for the past year. For which of the following findings should the nurse notify the provider immediately?

Hyperventilation When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is hyperventilation. This finding indicates the client might have acute salicylate poisoning, which causes respiratory alkalosis in the early stages.

A nurse is teaching a client who is to start taking ranitidine for peptic ulcer disease. which of the following client statments should the nurse id as understanding of the teaching?

I know smoking makes ranitidine less effective." The nurse should instruct the client that smoking decreases the effectiveness of ranitidine by exacerbating the ulcer manifestations.

A nurse is teaching about self administration of transdermal medication with a male client who has a new prescription for nitroglycerin. The nurse should id that which of the following statments by the client indicates an understanding of the teaching?

I will remove the patch after 14 hr

A nurse is assessing a client who is receiving epoetin alfa to treat anemia. Which of the following findings should the nurse monitor?

Increased blood pressure The therapeutic effect of epoetin alfa is an increase in hematocrit levels, which can result in an increase in a client's blood pressure. If the client's hematocrit level rises too rapidly, hypertension and seizures can result. The nurse should monitor the client's blood pressure and ensure hypertension is controlled prior to administering the medication.

A nurse is caring for a client who has heart failure and is receiving an IV infusion if dopamine. Which of the following indicates that the medication is effective?

Increased cardiac output Dopamine is an adrenergic that causes a receptor specificity effect, which increases cardiac output and improves perfusion.

A nurse is caring for a client who is to receive treatment for opioid use disorder. Which of teh following medications should the nurse expect to administer.

Methadone The nurse should expect to administer methadone for treatment of opioid use disorder. Methadone can be administered for withdrawal and to assist with maintenance and suppressive therapy.

A nurse is administered dogoxin immune fab to a client who received the incorrect dose of digoxin over a period of 3 days the nurse should id that which of the following findings indicates the antidote was effective?

Normal sinus rhythm Dysrhythmias are a life-threatening adverse effect of digoxin toxicity. The return of the heart to normal sinus rhythm indicates a therapeutic response to the antidote. Digoxin immune Fab is administered to a client who is experiencing severe digoxin toxicity. It binds with digoxin and works to reduce the client's blood digoxin level.

A nurse is preparing to administer HCTZ to a client. Which of the following actions should the nurse take prior to administering the medication?

Obtain clients blood pressure. HCTZ is a thiazide diuretic administered to promote urine output and reduce blood pressure and edema. The nurse should obtain the client's blood pressure prior to administration of the medication.

A nurse is providing teaching to a client who has a new prescription for ferrous sulfate. the nurse should instruct the client to take medication with which of the following to promote absorbtion.

Orange juice The absorption of ferrous sulfate is enhanced by a vitamin C source, such as orange juice.

A nurse is caring for a client who has diabetes mellitus and is taking glyburide. the client reports feeling confused and anxious. Which of the following actions should the nurse take first?

Perform a capillary blood glucose test. The greatest risk to this client is injury from hypoglycemia. Therefore, the nurse should perform a capillary blood glucose test to determine the client's blood glucose status. Manifestations of hypoglycemia include weakness, anxiety, confusion, sweating, and seizures.

A circulatory nurse is planning care for a client who is scheduled for a surgery and has a latex allergy. Which of the following actions should the nurse include in the plan?

Place monitoring cords and tubes in a stockinet. The nurse should place monitoring devices in a stockinet to prevent direct contact with the client's skin.

A nurse is preparing to mix and administer dantroline via IV bolus to a client who has developed malignent hyperthermia duting surgery. which og the the following actions should the nurse take?

Reconstitute the initial dose with 60 mL of sterile water without a bacteriostatic agent. The nurse should dilute the medication with 60 mL of sterile water without a bacteriostatic agent and inject rapidly

A nurse is caring for a client who is receiving end-of-life care and has a prescription for fentanyl patches. Which of the following information regarding the adverse effects of fentanyl should the nurse plan to gice to the client and fam?

Take a stool softener on a daily basis. Constipation is an adverse effect of opioid use. Stool softeners can decrease the severity of this adverse effect.

A nurse administers ceftazidime to a client who has a severe penicillin allergy. The nurse should id which of the following client findings as an indication that she should complete an incident report?

The client has shortness of breath A severe penicillin allergy is a contraindication for taking ceftazidime, a cephalosporin antibiotic, due to the potential for cross-sensitivity. Shortness of breath can indicate the client is developing anaphylaxis.

A nurse is caring for a client who repors lethargy and myalgia after taking clozapine for 6 months. Which of the followong actions should the nurse plan to take?

The client who takes clozapine can develop lethargy and myalgia caused by the adverse effect of agranulocytosis. Therefore, monitoring the WBC with absolute neutrophil count weekly for the first 6 months of treatment is recommended. After 6 months, monitoring can occur every 2 weeks up to 1 year.

A nurse is reviewing the laboratory results of a client who is taking carbamazepide for a seizure disorder. Which if the following findings should the nurse report to the provider?

WBC 3,500/mm3 MY ANSWER A WBC count of 3,500/mm3 is below the expected reference range of 5,000 to 10,000/mm3. Leukopenia is an adverse effect of carbamazepine. The nurse should report this finding to the provider and monitor the client for manifestations of infection.

A nurse is caring for a client who is receiving filgrastim. Which of the following findings should the nurse document to indicate the effectiveness of the therapy? A. Increased neutrophil count B. Increased RBC count C. Decreased prothrombin time D. Decreased triglycerides

Answer A: A. Filgrastim stimulates the bone marrow to produce neutrophils. For clients receiving chemotherapy, the risk of infection is minimized. B. Filgrastim stimulates the bone marrow to produce neutrophils and has no effect on a client's RBC count. C. Prothrombin time measures the effectiveness of warfarin therapy. Filgrastim therapy does not cause a decrease in prothrombin time. D. Triglycerides are a form of lipids found in the blood stream. Increased levels are associated with an increased risk for heart disease. Decreased levels can occur in clients who have malnutrition or malabsorption disorders. Filgrastim is used to treat chemotherapy-induced neutropenia and has no effect on a client's triglyceride levels.

A nurse is reviewing the medical record of a client who has hypertension. The nurse should id which of teh following findings as a contraindication for receiving propranolol.

Asthma Asthma is a contraindication for receiving propranolol. Propranolol is an adrenergic antagonist which blocks the beta2 receptors in the lungs, causing bronchoconstriction and leading to serious airway resistance and possibly respiratory arrest.

A nurse is caring for a client who is recovering from a deep-vein thrombosis and is to start taking warfarin. For whih of the following findings should the nurse monitor as a n adverse effect of warfarin?

Bleeding gums The nurse should monitor the client for bleeding gums, which is an adverse effect of warfarin, an anticoagulant.

A nurse is prping to teach a client who is to start a new prescription for ectended esease verapamiil. which of the following instructions should the nurse plan to include?

Change positions slowly. The nurse should instruct the client to change positions gradually to prevent orthostatic hypotension and syncope.

A nurse is teaching about a new prescription for ciprofloxacin to a client who has a urinary tract infection. the nurse should ID which of the following statments as an indication that the client understands the teaching.

I will report any signs of tendon swelling or pain. Ciprofloxacin, a fluoroquinolone, is associated with a risk of tendon rupture. This risk is increased in older adult clients, so the client should notify the provider at the onset of tendon pain or swelling.

A nurse is teaching about Zoolpidem to a client who has insomnia. the nurse should identify that which of the following client statements indicates an understanding of the teaching?

I will use this medication for a short period of time." Zolpidem is used for short-term treatment of insomnia. Therefore, the provider should reassess the client before refilling the prescription.

A nurse is completing an incident report for a med error. Which of the following info should the nurse include in the report.

It was easy to get confused because another client is receiving a similar sounding medication. The incident report should clearly and thoroughly report the facts of the error. It should not include the nurse's opinion as to why the error might have occurred.

A nurse in a clinic is caring for a client who is taking aspirin for the treatment of arthritis. The nurse should id which of the following findings as an indication that the client is beginning to exhibit salicylism?

Tinnitus (ringing in ears) Tinnitus is a manifestation of aspirin toxicity, also called salicylism. Other manifestations include sweating, headache, and dizziness.

A nurse is reviewing the medical record of a client who has schizophrenia and a prescription for clozapine. Which of the following laboratory tests should the nurse review before administering the medication?

Total Cholesterol The nurse should review the client's total cholesterol before administering clozapine, because this medication can cause hyperlipidemia

A nurse is teaching a client who is starting amtiriptyline. Which of the following findings should the nurse include in the teaching as an adverse effect of the med?

Urinary retention The nurse should instruct the client that amitriptyline causes the anticholinergic effect of urinary retention.

A nurse is preping to administer a new prescription of amoxicillin/Clavulanic to a client. The client tells the nurse that they are allergic to penicillin. which of the following actions should the nurse take first.

Withhold the medication. When using the urgent vs nonurgent approach to client care, the nurse should determine that the priority action is to withhold the medication to prevent injury to the client.

A nnurse is providing teaching to a client who is to start therapy with digoxin. for which of the following adverse effects should the nurse instruct the client to monitor and report to the provider.

Yellow-tinged vision The nurse should instruct the client to monitor for and report yellow-tinged vision, which is a sign of digoxin toxicity. Other manifestations of digoxin toxicity include nausea, vomiting, loss of appetite, and fatigue. As the digoxin levels increase, the client can experience cardiac dysrhythmias.

A nurse is caring for a client who has hypoclcemia and is receiving calcium citrate. the nurse should id that which of the following findings indicates a theraputic response to the meds?

client report of decreased paresthesia Paresthesia is a manifestation of hypocalcemia. A client report of a decrease in paresthesia is an indication of a therapeutic response to calcium citrate. The nurse should also monitor for a decrease in other manifestations of hypocalcemia, including muscle twitching and cardiac dysrhythmias

A nurse is assessing a client who is taking tamoxifen to treat breast cancer. Which of the following findings is the priority fir the nurse to report to the provider

Leg tenderness The greatest risk to this client is the development of a thromboembolism, which is an adverse effect of tamoxifen. The nurse should also monitor the client for other manifestations of a thromboembolism, including leg tenderness, redness, swelling, and shortness of breath.

A nurse is monitoring for adverse effects of hydrochlorothiazide after administering the medication to an older adult client who has heart failure. Which of the following findings should the nurse id as an adverse effect of the med?

Orthostatic hypotension The nurse should identify that hydrochlorothiazide is an antihypertensive thiazide diuretic medication, which can cause orthostatic hypotension and light headedness. Therefore, the nurse should instruct the client to rise slowly when moving from a recumbent to a standing position.

A nurse is preparing to administer dextrose 5% in water (D5W) 400 mL IV to infuse over 1 hr. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Answer: 100 gtt/min Step 1: What is the unit of measurement the nurse should calculate? (Place the unit of measure being calculated on the left side of the equation.) Step 2: Determine the ratio that contains the same unit as the unit being calculated. (Place the ratio on the right side of the equation, ensuring that the unit in the numerator matches the unit being calculated.) Step 3: Place any remaining ratios that are relevant to the item on the right side of the equation, along with any needed conversion factors, to cancel out unwanted units of measurement. Step 4: Solve for X. Step 5: Round if necessary. Step 6: Determine whether the amount to administer makes sense. If the prescription reads D5W 400 mL IV to infuse over 60 min with a drop factor of 15 gtt/mL, it makes sense to administer 100 gtt/min. The nurse should set the manual IV infusion to deliver D5W IV at 100 gtt/min.

A nurse is preparing to administer ciprofloxacin 15 mg/kg PO every 12 hr to a child who weighs 44 lb. How many mg should the nurse administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Answer: 300 mg Step 1: What is the unit of measurement the nurse should calculate? (Place the unit of measure being calculated on the left side of the equation.) Step 2: Determine the ratio that contains the same unit as the unit being calculated. (Place the ratio on the right side of the equation, ensuring that the unit in the numerator matches the unit being calculated.) Step 3: Place any remaining ratios that are relevant to the item on the right side of the equation, along with any needed conversion factors, to cancel out unwanted units of measurement. Step 4: Solve for X. Step 5: Round if necessary. Step 6: Determine whether the amount to administer makes sense. If the prescription reads 15 mg/kg every 12 hr and the child weighs 20 kg, it makes sense to give 300 mg/dose every 12 hr.

A nurse is reviewing the medication list of a client who wants to begin taking oral contraceptives. The nurse should identify that which of the following client medications will interfere with the effectiveness of oral contraceptives? A. Carbamazepine B. Sumatriptan C. Atenolol D. Glipizide

Answer: A A. Carbamazepine causes an accelerated inactivation of oral contraceptives because of its action on hepatic medication-metabolizing enzymes. B. There is no medication interaction between oral contraceptives and sumatriptan, which is a medication to treat migraines. C. There is no medication interaction between oral contraceptives and atenolol, a beta blocker. D. There is no medication interaction between oral contraceptives and glipizide, an antidiabetic medication.

A nurse is caring for a client who has cancer and is taking oral morphine and docusate sodium. The nurse should instruct the client that taking the docusate sodium daily can minimize which of the following adverse effects of morphine? A. Constipation B. Drowsiness C. Facial flushing D. Itching

Answer: A A. Constipation is a common adverse effect of morphine that can be minimized by taking docusate sodium, a stool softener that promotes easier evacuation of stool by increasing water and fat in the intestine. B. Drowsiness is not an adverse effect of morphine that can be minimized by taking docusate sodium. C. Facial flushing is not an adverse effect of morphine that can be minimized by taking docusate sodium. D. Itching is not an adverse effect of morphine that can be minimized by taking docusate sodium.

A nurse is planning to teach about the use of a spacer to a child who has a new prescription for a fluticasone inhaler to treat chronic asthma. The nurse should include that the spacer decreases the risk for which of the following adverse effects of the medication? A. Oral candidiasis B. Headache C. Joint pain D. Adrenal suppression

Answer: A A. Dysphonia and oral candidiasis are adverse effects of inhaled corticosteroids. Using a spacer and rinsing the mouth after inhalation will minimize the amount of medication remaining in the oropharynx, preventing the development of these adverse effects. B. Fluticasone can cause neurologic adverse effects such as dizziness, fatigue, nervousness, and headaches. However, the use of a spacer will not decrease systemic adverse effects of fluticasone, such as headaches. C. Fluticasone can cause musculoskeletal adverse effects such as bone loss, muscle aches, and joint pain. However, the use of a spacer will not decrease systemic adverse effects of fluticasone, such as joint pain. D. Fluticasone is a glucocorticoid mediation that decreases bronchoconstriction. Inhaled glucocorticoids can cause adrenal suppression, although this occurs more often with oral glucocorticoids. The nurse should monitor the client for manifestations of adrenal suppression such as weakness, fatigue, hypotension, and hypoglycemia. However, the use of a spacer will not decrease systemic adverse effects of fluticasone, such as adrenal suppression.

A nurse is teaching a client who is to begin taking tamoxifen for the treatment of breast cancer. Which of the following adverse effects should the nurse include in the teaching? A. Hot flashes B. Urinary retention C. Constipation D. Bradycardia

Answer: A A. The estrogen receptor blocking action of tamoxifen commonly results in the adverse effect of hot flashes. B. Tamoxifen can cause genitourinary adverse effects such as vaginal discharge and uterine cancer. However, urinary retention is not an expected adverse effect of tamoxifen. C. Gastrointestinal adverse effects of tamoxifen include nausea and vomiting. However, constipation is not an expected adverse effect of tamoxifen. D. Tamoxifen is an antiestrogen medication that works by blocking estrogen receptors. Cardiovascular adverse effects of the medication include chest pain, flushing, and the development of thrombus. However, bradycardia is not an expected adverse effect of tamoxifen.

A nurse is caring for a client who is in labor. The client is receiving oxytocin by continuous IV infusion with a maintenance IV solution. The external FHR monitor indicates late decelerations. Which of the following actions should the nurse take first? A. Turn the client to a side-lying position. B. Disconnect the client's oxytocin from the maintenance IV. C. Apply oxygen to the client by face mask. D. Increase the client's maintenance IV infusion rate.

Answer: A A. The greatest risk to the fetus experiencing late decelerations is injury from uteroplacental insufficiency. Therefore, the priority action the nurse should take is to place the client in a lateral position. B. The nurse should discontinue the oxytocin to reduce uterine contractions. However, another action is the nurse's priority. C. The nurse should apply oxygen by face mask to provide supplemental oxygen to the fetus. However, another action is the nurse's priority. D. The nurse should increase the client's maintenance IV infusion rate to maintain adequate blood flow and promote placental perfusion. However, another action is the nurse's priority.

A nurse is preparing to administer medications to a client who tells the nurse, "I don't want to take my fluid pill until I get home today." Which of the following actions should the nurse take? A. Document the refusal and inform the client's provider. B. File an incident report with the risk manager. C. Contact the pharmacist to pick up the medication. D. Give the client the medication to take at home and document that it was administered.

Answer: A A. The nurse has the responsibility to verify that the client understands the risks of refusing the medication so that an informed decision can be made. The nurse should then document the refusal in the client's medical record and notify the health care provider. B. The nurse does not need to complete an incident report if a client refuses to take a medication. An incident report is necessary for a medication error. C. The nurse should follow facility protocols for discarding the medication. It is not the role of the pharmacist to retrieve medications that a client refuses to take. D. The nurse should not give the client a scheduled medication to take at home and then document that it was administered, because this violates the ethical principle of accountability.

A nurse is preparing to administer heparin subcutaneously to a client. Which of the following actions should the nurse plan to take? A. Administer the medication outside the 5-cm (2-in) radius of the umbilicus. B. Aspirate for blood return before injecting. C. Rub vigorously after the injection to promote absorption. D. Place a pressure dressing on the injection site to prevent bleeding.

Answer: A A. The nurse should administer the heparin by subcutaneous injection to the abdomen in an area that is above the iliac crest and at least 5 cm (2 in) away from the umbilicus. B. The nurse should not aspirate by pulling back on the plunger of the heparin syringe to check for a blood return, because this will cause the injection site to bruise. C. The nurse should apply firm pressure to the injection site for 1 to 2 min after the administration of the heparin to prevent bruising. D. The nurse does not need to apply a dressing over the injection site if pressure is held for at least 1 min to prevent bleeding.

A nurse is assessing a client who is postoperative following an outpatient endoscopy procedure using midazolam. The nurse should monitor for which of the following findings as an indication that the client is ready for discharge? A. The client's capnography has returned to baseline. B. The client can respond to their name when called. C. The client is passing flatus. D. The client is requesting oral intake.

Answer: A A. The nurse should identify that the client is ready for discharge when the capnography level indicates that gas exchange is adequate. B. The client is considered ready for discharge when the state of arousal is at the preprocedure level. C. The nurse should monitor for the passing of flatus for a client who received general anesthesia. D. A request for oral intake does not indicate the client is ready for discharge. The nurse should assess for a return of the gag reflex for a client who is postoperative following an endoscopy.

A nurse is caring for a client who is taking acetazolamide for chronic open-angle glaucoma. For which of the following adverse effects should the nurse instruct the client to monitor and report? A. Tingling of fingers B. Constipation C. Weight gain D. Oliguria

Answer: A A. The nurse should instruct the client to report the adverse effect of paresthesia, a tingling sensation in the extremities, when taking acetazolamide. B. Diarrhea is an adverse effect of acetazolamide due to gastrointestinal disturbances. C. Weight loss is an adverse effect of acetazolamide due to gastrointestinal disturbances causing reduced appetite. D. Polyuria, rather than oliguria, is an adverse effect of acetazolamide.

A nurse is preparing to administer medication to a client who has gout. The nurse discovers that an error was made during the previous shift and the client received atenolol instead of allopurinol. Which of the following actions should the nurse take first? A. Obtain the client's blood pressure. B. Contact the client's provider. C. Inform the charge nurse. D. Complete an incident report.

Answer: A A. When using the nursing process, the first action the nurse should take to prevent injury to the client is to assess the client for adverse effects of atenolol, such as hypotension. B. The nurse should contact the provider, who can provide direction to the nurse to prevent injury to the client. However, there is another action the nurse should take first. C. The nurse should alert the charge nurse about the medication error. However, there is another action the nurse should take first. D. The nurse should complete an incident report, which is used as part of a facility's quality assurance program. However, there is another action the nurse should take first.

A nurse is developing a teaching plan for a client who has a new prescription for simvastatin. Which of the following instructions should the nurse include in the teaching plan? (Select all that apply.) A. Report muscle pain to the provider. B. Avoid taking the medication with grapefruit juice. C. Take the medication in the early morning. D. Expect a flushing of the skin as a reaction to the medication. E. Expect therapy with this medication to be lifelong.

Answer: A, B, E A. Myopathy is an adverse effect of simvastatin that can lead to rhabdomyolysis. The nurse should instruct the client to report this to the provider. B. When taken with grapefruit juice, simvastatin increases the risk of muscle injury from elevations in creatine kinase. C. This medication is most effective when taken in the evening because cholesterol production generally increases overnight. D. The nurse should identify flushing of the skin as an adverse effect of the medication niacin, which can be used to decrease the client's triglyceride levels. E. If medication therapy is discontinued, cholesterol levels will return to their pretreatment range within several weeks to months.

A nurse on the acute care unit is caring for a client who is receiving gentamicin IV. The nurse should report which of the following findings to the provider as an adverse effect of the medication? A. Constipation B. Tinnitus C. Hypoglycemia D. Joint pain

Answer: B A. Gentamicin, an aminoglycoside used to treat serious infections, can cause several gastrointestinal adverse effects, such as inflammation of the liver and spleen. However, it does not cause constipation. B. Aminoglycosides, such as gentamicin, are ototoxic, which can manifest as tinnitus and deafness. The nurse should monitor the client for high-pitched ringing in the ears and headaches and should notify the provider if these occur. C. Gentamicin, an aminoglycoside used to treat serious infections, can cause alternations in the functions of the liver and spleen. However, pancreatic function, mainly insulin production, is not affected by this medication. D. Aminoglycosides, such as gentamicin, can result in neuromuscular adverse effects such as twitching or flaccid paralysis. However, joint pain is not an adverse effect of gentamicin.

A nurse is providing teaching to a client who has multiple sclerosis and a new prescription for methylprednisolone. Which of the following instructions should the nurse include? (Select all that apply.) A. Blood glucose levels will be monitored during therapy. B. Avoid contact with people who have known infections. C. Take the medication 1 hr before breakfast. D. Decrease dietary intake of foods containing potassium. E. Grapefruit juice can increase the effects of the medication.

Answer: A, B, E A. The nurse should monitor the client for hyperglycemia while providing methylprednisolone to the client. Glucocorticoids, such as methylprednisolone, increase serum glucose levels and can require management with insulin or antihyperglycemics. B. The nurse should instruct the client to avoid exposure to infectious agents, such as contact with those who have active infections or illnesses. Glucocorticoids, such as methylprednisolone, depress the immune system, placing the client at an increased risk for developing an infection. C. The nurse should instruct the client to take the medication with food or milk to decrease gastrointestinal upset. D. The nurse should instruct the client to increase dietary intake of potassium-rich foods while taking this medication. Glucocorticoids, such as methylprednisolone, deplete potassium in the body, which manifests as hypokalemia. E. The nurse should instruct the client that grapefruit and grapefruit juice can increase the level of methylprednisolone in the body.

A nurse is providing teaching to a client who is to begin taking oxybutynin for urinary incontinence. Which of the following adverse effects should the nurse include in the teaching? (Select all that apply.) A. Dry mouth B. Tinnitus C. Blurred vision D. Bradycardia E. Dry eyes

Answer: A, C, E A. Oxybutynin is an anticholinergic agent that can cause dry mouth. B. Oxybutynin can cause several sensory adverse effects including increased intraocular pressure. The nurse should instruct the client to report eye pain, seeing colored halos around lights, and a decreased ability to perceive light changes. However, tinnitus is not an adverse effect associated with oxybutynin administration. C. Oxybutynin is an anticholinergic agent that can cause blurred vision due to an increase in intraocular pressure. D. Oxybutynin can cause several cardiovascular adverse effects such as a prolongation of the QT interval, palpitations, hypertension, and tachycardia. E. Oxybutynin is an anticholinergic agent that can cause dry eyes and mydriasis, or pupil dilation.

A nurse is caring for the parent of a newborn. The parent asks the nurse when their newborn should receive the first diphtheria, tetanus, and pertussis vaccine (DTaP). The nurse should instruct the parent that their newborn should receive the immunization at which of the following ages? A. At birth B. 2 months C. 6 months D. 15 months

Answer: B A. According to the current recommended immunization schedule, only the hepatitis B vaccine is given at birth. B. The CDC recommends that newborns receive the first dose of the five-dose series of the DTaP immunization at 2 months of age. C. The CDC recommends that newborns receive the third dose of the five-dose series of the DTaP immunization at 6 months of age. D. The CDC recommends that newborns receive the fourth dose of the five-dose series of the DTaP immunization between 15 to 18 months of age.

A nurse is teaching a client about warfarin. The client asks if they can take aspirin while taking the warfarin. Which of the following responses should the nurse make? A. "It is safe to take an enteric-coated aspirin." B. "Aspirin will increase the risk of bleeding." C. "Acetaminophen may be substituted for aspirin." D. "The INR lab work must be monitored more frequently if aspirin is taken."

Answer: B A. Although it is common for clients to consider an occasional aspirin harmless, salicylates inhibit platelet aggregation and increase the potential for hemorrhage. Therefore, the client should avoid taking enteric-coated aspirin. B. Aspirin inhibits platelet aggregation and can potentiate the action of the anticoagulant warfarin. Therefore, the client should avoid taking aspirin because it increases the risk for bleeding. C. Acetaminophen, an analgesic, can potentiate the action of the anticoagulant warfarin when administered in high doses and is not a safe substitute for aspirin. D. The client should continue to follow the provider's prescription for monitoring the PT and INR levels to adjust warfarin dosages. However, the nurse should discourage the client from using aspirin products because these medications increase the antiplatelet action of the warfarin and can result in bleeding.

A nurse is collecting a medication history from a client who has a new prescription for lithium. The nurse should identify that the client should discontinue which of the following over-the-counter medications? A. Aspirin B. Ibuprofen C. Ranitidine D. Bisacodyl

Answer: B A. Although most NSAIDs interact with lithium to increase lithium levels, aspirin does not interact with lithium. B. Most NSAIDs can significantly increase lithium levels. Therefore, the client should not take ibuprofen and lithium concurrently. C. There are no known medication interactions between ranitidine and lithium. D. There are no known medication interactions between bisacodyl and lithium.

A nurse is providing teaching to a client who has a prescription for ergotamine sublingual to treat migraine headaches. Which of the following information should the nurse include in the instructions? A. "Take one tablet three times a day before meals." B. "Take one tablet at onset of migraine." C. "Take up to eight tablets as needed within a 24-hour period." D. "Take one tablet every 15 minutes until migraine subsides."

Answer: B A. Ergotamine, an alpha-adrenergic blocking medication, is not used prophylactically because this can result in ergotamine dependence. B. The client should take one tablet immediately after the onset of aura or headache. C. The client can take up to a maximum of three tablets in a 24-hr period. Excessive dosing can lead to ergotism, which can cause peripheral gangrene due to vasoconstriction and ischemia. D. The client can take one sublingual tablet every 30 min for a maximum of three tablets in a 24-hr period to manage a migraine.

A nurse at a clinic is providing follow-up care to a client who is taking fluoxetine for depression. Which of the following findings should the nurse identify as an adverse effect of the medication? A. Tingling toes B. Sexual dysfunction C. Absence of dreams D. Pica

Answer: B A. Fluoxetine is an SSRI that can cause muscle twitching. However, distorted sensations in the extremities are not adverse effects of fluoxetine. B. Sexual dysfunction, including a decreased libido, impotence, and delayed orgasm, or anorgasmia, is a common adverse effect of fluoxetine and occurs in about 70% of clients who take this SSRI antidepressant. C. Fluoxetine can cause CNS adverse effects including abnormal dreaming, sedation, delusions, hallucinations, and psychosis. However, an absence of dreams is not associated with fluoxetine. D. Fluoxetine can cause neurologic adverse effects such as agitation, euphoria, and sedation. However, an eating disorder such as pica is not associated with fluoxetine.

A nurse is planning care for a client who is prescribed metoclopramide following bowel surgery. For which of the following adverse effects should the nurse monitor? A. Muscle weakness B. Sedation C. Tinnitus D. Peripheral edema

Answer: B A. Metoclopramide is a central dopamine receptor antagonist that increases gastrointestinal motility and prevents nausea. Tardive dyskinesia is an adverse effect of metoclopramide. However, metoclopramide does not cause muscle weakness. B. Metoclopramide has multiple CNS adverse effects, including dizziness, fatigue, and sedation. C. Metoclopramide does not cause ringing in the ears. D. Metoclopramide does not cause peripheral edema.

A nurse is instructing a client on the application of nitroglycerin transdermal patches. Which of the following statements by the client indicates an understanding of the teaching? A. "I should apply a patch every 5 minutes if I develop chest pain." B. "I will take the patch off right after my evening meal." C. "I will leave the patch off at least 1 day each week." D. "I should discard the used patch by flushing it down the toilet."

Answer: B A. Nitroglycerin sublingual tablets are used to treat new onset of angina pain. A client who uses sublingual tablets should place one tablet under their tongue at the onset of angina pain and continue taking a tablet every 5 min for a total of three doses of nitroglycerin. The effects of a nitroglycerin patch will take 30 to 60 min to occur and are not useful to prevent an ongoing angina attack. B. Clients should remove the patch each evening for a medication free time of 12 to 14 hr before applying a new patch to avoid developing a tolerance to the medication's effects. C. Nitroglycerin is an antianginal medication that results in dilation of the coronary vessels. Clients should apply the patch daily to sustain prophylaxis. D. Medication remains in the transdermal patch after removing it from the body and must be discarded safely. The nurse should instruct the client to fold the patch ends together with the medication on the inside and place the discarded patch in a closed container so that children and pets cannot gain access to the medication.

A nurse is caring for a 20-year-old female client who has a prescription for isotretinoin for severe nodulocystic acne vulgaris. Before the client can obtain a refill, the nurse should advise the client that which of the following tests is required? A. Serum calcium B. Pregnancy test C. 24-hr urine collection for protein D. Aspartate aminotransferase level

Answer: B A. The client does not need to have a laboratory test for serum calcium levels while taking isotretinoin. B. The nurse should instruct the client that isotretinoin has teratogenic effects; therefore, pregnancy must be ruled out before the client can obtain a refill. The client must provide two negative pregnancy tests for the initial prescription and one negative test before monthly refills. C. The client does not need to have a 24-hr urine test for protein levels when taking isotretinoin. D. The client should have a laboratory test for aspartate aminotransferase levels prior to starting isotretinoin, 1 month after starting the medication, and periodically thereafter. However, a laboratory test for aspartate aminotransferase is not required to renew a prescription for isotretinoin.

A nurse in an emergency department is caring for a client who has heroin toxicity. The client is unresponsive with pinpoint pupils and a respiratory rate of 6/min. Which of the following medication should the nurse plan to administer? A. Methadone B. Naloxone C. Diazepam D. Bupropion

Answer: B A. The nurse should administer methadone, an opioid agonist, to a client who has heroin toxicity to decrease manifestations of opioid withdrawal and suppress the euphoria the client feels when using heroin. However, the client should not receive methadone in an emergency. B. The nurse should administer naloxone, an opioid antagonist, to a client who has heroin toxicity to reverse the respiratory depressive effects of the heroin. However, the nurse should not administer naloxone too quickly because naloxone can cause hypertension, tachycardia, nausea, vomiting, and might cause the client to enter a state of opioid withdrawal. C. The nurse should administer diazepam, a benzodiazepine, to a client who has alcohol toxicity to decrease the manifestations of alcohol withdrawal and prevent withdrawal seizures. D. The nurse should administer bupropion, an atypical antidepressant, to a client who is trying to quit nicotine to decrease the manifestations of nicotine withdrawal and ease the client's cravings for nicotine.

A nurse is reviewing the ECG of a client who is receiving IV furosemide for heart failure. The nurse should identify which of the following findings as an indication of hypokalemia? A. Tall, tented T-waves B. Presence of U-waves C. Widened QRS complex D. ST elevation

Answer: B A. The nurse should identify tall, tented T-waves as a manifestation of hyperkalemia. Flattened or inverted T-waves are a manifestation of hypokalemia. B. The nurse should identify the presence of U-waves as a manifestation of hypokalemia, an adverse effect of furosemide. C. The nurse should identify a widened QRS complex as a manifestation of hyperkalemia. D. The nurse should identify ST elevation is an indication of ischemia. ST depression is a manifestation of hypokalemia.

A nurse is caring for a client who received 0.9% sodium chloride 1 L over 4 hr instead of over 8 hr as prescribed. Which of the following information should the nurse enter as a complete documentation of the incident? A. IV fluid infused over 4 hr instead of the prescribed 8 hr. Client tolerated fluids well, provider notified. B. 0.9% sodium chloride 1 L IV infused over 4 hr. Vital signs stable, provider notified. C. 1 L of 0.9% sodium chloride completed at 0900. Client denies shortness of breath. D. IV fluid initiated at 0500. Lungs clear to auscultation.

Answer: B A. The nurse should only chart factual information in the client's medical record without indicating the error that occurred. B. The nurse should document the type and amount of fluid, how long it took to infuse, provider notification, and the client's physical status. C. This documentation is not complete because it does not include the amount of fluid that was infused over the amount of time. D. This documentation is not complete because it does not include the amount of fluid that was infused over the amount of time.

A nurse is assessing a client who has myasthenia gravis and is taking neostigmine. Which of the following findings should indicate to the nurse that the client is experiencing an adverse effect? A. Tachycardia B. Oliguria C. Xerostomia D. Miosis

Answer: D A. Neostigmine can cause bradycardia, rather than tachycardia, due to the excessive muscarinic stimulation. B. Neostigmine can cause urinary urgency, rather than decreased urinary output, due to the excessive muscarinic stimulation. C. Neostigmine can cause increased salivation, rather than dry mouth, due to the excessive muscarinic stimulation. D. Miosis, which is pupillary constriction, is a common adverse effect of neostigmine due to the excessive muscarinic stimulation that causes difficulty with visual accommodation.

A nurse is planning care for a client who has hypertension and is to start taking metoprolol. Which of the following interventions should the nurse include in the plan of care? A. Weigh the client weekly. B. Determine apical pulse prior to administering. C. Administer the medication 30 min prior to breakfast. D. Monitor the client for jaundice.

Answer: B A. The nurse should weigh the client daily to monitor for the development of heart failure and weight gain. B. Life-threatening bradycardia is an adverse effect that might affect this client. Therefore, the nurse should assess the client's apical pulse prior to administering the medication. If the client's pulse rate is less than 60/min, the nurse should withhold the medication and notify the provider. C. The nurse should administer metoprolol following meals or at bedtime if orthostatic hypotension occurs. D. The nurse should monitor the client for adverse effects such as hypotension. However, jaundice is not associated with this medication.

A nurse receives a verbal order from the provider to administer morphine five milligrams every 4 hours subcutaneously for severe pain as needed. The nurse should identify which of the following entries as the correct format for the medication administration record (MAR)? A. MSO4 5 mg subcut every 4 hr PRN severe pain B. Morphine 5 mg subcut every 4 hr PRN severe pain C. MSO4 5 mg SQ every 4 hr PRN severe pain D. Morphine 5.0 mg subcutaneously every 4 hr PRN severe pain

Answer: B A. The use of the abbreviation MSO4 is prohibited by The Joint Commission. The medication name of morphine must be spelled out to reduce the risk for error. B. The nurse should identify this entry as the correct format for the MAR. The medication name is spelled out and there are not any abbreviations from The Joint Commission's "Do Not Use" list included in the transcription. C. The use of the abbreviations MSO4 and SQ are prohibited by The Joint Commission. The abbreviation SQ can be mistaken for SL and, therefore, this route should be written as subcut, subq, or subcutaneously. D. The trailing zero on 5.0 can be mistaken for 50 if the decimal point is missed. Therefore, the dosage should be written as 5 mg without a trailing zero.

A nurse is caring for a client who has acute acetaminophen toxicity. The nurse should anticipate administering which of the following medications? A. Vitamin K B. Acetylcysteine C. Benztropine D. Physostigmine

Answer: B A. Vitamin K is used to treat increased warfarin serum levels, indicated by elevated levels of PT/INR. B. Acetylcysteine is a specific antidote for acetaminophen toxicity. It can prevent severe injury when given orally or by IV infusion within 8 to 10 hr. C. Benztropine is an anticholinergic medication used to treat adverse effects of Parkinson's disease by reducing rigidity and tremors. D. Physostigmine is an effective antidote for antimuscarinic poisoning from medications such as atropine, scopolamine, some antihistamines, phenothiazines, and tricyclic antidepressants. It has no effect on acetaminophen toxicity.

A nurse is caring for a client who is receiving heparin therapy via continuous IV infusion to treat a pulmonary embolism. Which of the following findings should the nurse identify as an adverse effect of the medication and report to the provider? A. Vomiting B. Blood in the urine C. Positive Chvostek's sign D. Ringing in the ears

Answer: B A. Vomiting is not an expected adverse effect of heparin therapy. The nurse should assess the client for other causes for vomiting. B. The nurse should report blood in the urine to the provider because this can be a manifestation of heparin toxicity. Other manifestations can include bruising, hematomas, hypotension, and tachycardia. C. A Chvostek's sign is seen in clients who have hypocalcemia or hypomagnesemia. D. Ringing in the ears is not an expected adverse effect of heparin therapy. Aminoglycosides, such as vancomycin, are medications that cause ringing in the ears.

A nurse is reviewing the medication administration record of a client who has hypocalcemia and a new prescription for IV calcium gluconate. The nurse should identify that which of the following medications can interact with calcium gluconate? A. Felodipine B. Guaifenesin C. Digoxin D. Regular insulin

Answer: C A. Calcium gluconate does not interact with felodipine. B. Calcium gluconate does not interact with guaifenesin. C. The nurse should identify that calcium gluconate can cause hypercalcemia, which increases the risk of digoxin toxicity. D. Calcium gluconate does not interact with insulin.

A nurse is assessing a client's vital signs prior to the administration of PO digoxin. The client's BP is 144/86 mm Hg, heart rate is 55/min, and respiratory rate is 20/min. The nurse should withhold the medication and contact the provider for which of the following findings? A. Diastolic BP B. Systolic BP C. Heart rate D. Respiratory rate

Answer: C A. Digoxin increases cardiac output and reduces the heart rate. A diastolic BP of 86 mm Hg is not a cause for withholding the medication and contacting the provider. B. Digoxin increases cardiac output and reduces the heart rate. A systolic BP of 140 mm Hg is not a cause for withholding the medication and contacting the provider. C. Digoxin slows the conduction rate through the SA and AV nodes, thereby decreasing the heart rate. The nurse should withhold the medication and notify the provider for a heart rate of 55/min because this is an early indication of digoxin toxicity. D. Digoxin increases cardiac output and reduces heart rate. A respiratory rate of 20/min is not a cause for withholding the medication and contacting the provider.

A nurse in an emergency department is caring for a client whose family reports the client has taken large amounts of diazepam. Which of the following medications should the nurse anticipate administering? A. Ondansetron B. Magnesium sulfate C. Flumazenil D. Protamine sulfate

Answer: C A. Ondansetron is an antiemetic that is used to treat nausea and vomiting. B. Magnesium sulfate is an electrolyte replacement that is used to treat clients who are at risk for seizure activity. C. The nurse should anticipate administering flumazenil, an antidote used to reverse benzodiazepines such as diazepam. D. Protamine sulfate is an antidote for heparin and is used to reverse an elevated aPTT caused by taking heparin.

A nurse is providing teaching to a client who has peptic ulcer disease and is to start a new prescription for sucralfate. Which of the following actions of sucralfate should the nurse include in the teaching? A. Decreases stomach acid secretion B. Neutralizes acids in the stomach C. Forms a protective barrier over ulcers D. Treats ulcers by eradicating H. pylori

Answer: C A. Peptic ulcer disease manifests as an erosion of the gastric or duodenal mucosa. The acid production in the stomach causes further irritation and pain. H2 receptor antagonists, such as famotidine, decrease stomach acid secretion. B. Acid production in the stomach causes further irritation and pain to a client who has a peptic ulcer. Antacids, such as aluminum hydroxide, neutralize acids in the stomach and prevent pepsin formation, a digestive enzyme that can further damage the eroded epithelium. C. Secretions by the parietal and chief cells, hydrochloric acid and pepsin, can further irritate the ulcerated areas. Sucralfate, a mucosal protectant, forms a gel-like substance that coats the ulcer, creating a barrier to hydrochloric acid and pepsin. D. A common cause of peptic ulcers is a bacterial infection with Helicobacter pylori. Treatment of the ulcer includes a combination of antibiotics, such as metronidazole, tetracycline, clarithromycin, or amoxicillin, to eradicate the H. pylori infection.

A nurse in an emergency department is caring for a client who has myasthenia gravis and is in a cholinergic crisis. Which of the following medications should the nurse plan to administer? A. Potassium iodide B. Glucagon C. Atropine D. Protamine

Answer: C A. Potassium iodide is a thyroid hormone antagonist used in the treatment of radioactive iodine exposure. B. Glucagon is an antihypoglycemic medication used in the treatment of low blood glucose levels. C. A cholinergic crisis is caused by an excess amount of cholinesterase inhibitor, such as neostigmine. The nurse should plan to administer atropine, an anticholinergic agent, to reverse cholinergic toxicity. D. Protamine is a heparin antagonist that is administered to reverse heparin toxicity evidenced by an aPTT greater than 70 seconds.

A nurse is providing teaching to a client who has a gastric ulcer and a new prescription for ranitidine. Which of the following instructions should the nurse include? A. "Take the medication on an empty stomach for full effectiveness." B. "You may discontinue this medication when stomach discomfort subsides." C. "Report yellowing of the skin." D. "Store the medication in the refrigerator."

Answer: C A. The client can take ranitidine with or without food because food does not affect the medication's effectiveness. B. For clients who have a gastric ulcer, ranitidine is prescribed to inhibit gastric secretion and must be taken for the full course of therapy to be effective. C. Ranitidine can be hepatotoxic and cause jaundice. The nurse should instruct the client to monitor for and report yellowing of the skin or eyes to the provider. D. The client should store ranitidine at room temperature.

A nurse is providing discharge instructions to a client who has heart failure and a new prescription for captopril. Which of the following client statements indicates an understanding of the teaching. A. "I should take the medication with food." B. "I should take naproxen if I develop joint pain." C. "I should tell my provider if I develop a sore throat." D. "I should expect the medication to cause my urine to look orange."

Answer: C A. The client should take captopril on an empty stomach because food reduces absorption of the medication. The nurse should instruct the client to take the medication 1 hr before or 2 hr after a meal. B. Naproxen and other NSAIDs can interact with captopril, which can decrease the effect of the antihypertensive and increase the risk of kidney dysfunction. C. The client should report a sore throat to the provider because this can indicate neutropenia, a serious adverse effect of captopril. Neutropenia can be reversed if it is identified early and the medication is promptly discontinued. D. Captopril affects the urinary system by causing dysuria, urinary frequency, and changes in the normal amount of urine. However, captopril does not affect the color of the urine.

A nurse is teaching a client about cyclobenzaprine. Which of the following client statements should indicate to the nurse that the teaching is effective? A. "I will have increased saliva production." B. "I will continue taking the medication until the rash disappears." C. "I will taper off the medication before discontinuing it." D. "I will report any urinary incontinence."

Answer: C A. The client should use gum or sip on water to prevent dry mouth, which is an adverse effect of cyclobenzaprine. B. The client should take cyclobenzaprine for treatment of muscle spasms. This medication does not affect skin rashes. C. The client should taper off cyclobenzaprine before discontinuing it to prevent abstinence syndrome or rebound insomnia. D. The client should report any urinary retention because of the anticholinergic effects caused when taking cyclobenzaprine.

A nurse is teaching a group of unit nurses about medication reconciliation. Which of the following information should the nurse include in the teaching? A. The client's provider is required to complete medication reconciliation. B. Medication reconciliation at discharge is limited to the medication ordered at the time of discharge. C. A transition in care requires the nurse to conduct medication reconciliation. D. Medical reconciliation is limited to the name of the medications that the client is currently taking.

Answer: C A. The nurse or a member of the health care team, such as the pharmacist, is required to complete medication reconciliation. B. Medication reconciliation at discharge includes medications ordered at the time of discharge, over-the-counter medications, vitamins, herbal supplements, nutritional supplements, and other medications the client is taking. C. The nurse should conduct medication reconciliation anytime the client is undergoing a change in care such as admission, transfer from one unit to another, or discharge. A complete listing of all prescribed and over-the-counter medications should be reviewed. D. The name of the current medication and new medication, over-the-counter medications, vitamins, herbal supplements, and nutritional supplements are included at the medication reconciliation. The indication, route, dosage size, and dosing interval are also required.

A nurse is assessing a client after administering a second dose of cefazolin IV. The nurse notes the client has anxiety, hypotension, and dyspnea. Which of the following medication should the nurse administer first? A. Diphenhydramine B. Albuterol inhaler C. Epinephrine D. Prednisone

Answer: C A. The nurse should administer diphenhydramine, an antihistamine, as a second-line medication to decrease angioedema and urticaria following anaphylaxis. However, evidence-based practice indicates that administering another medication is the priority. B. The nurse should administer albuterol, a bronchodilator, for a client who has dyspnea from bronchospasms during anaphylaxis. However, evidence-based practice indicates that administering another medication is the priority. C. According to evidence-based practice, the nurse should administer epinephrine first to induce vasoconstriction and bronchodilation during anaphylaxis. D. The nurse should plan to administer prednisone, a glucocorticoid, for the urticaria following anaphylaxis and to prevent a delayed anaphylactic reaction from occurring. However, evidence-based practice indicates that administering another medication is the priority.

A nurse is preparing to administer a scheduled antibiotic at 0800 to a client and discovers the antibiotic is not present in the client's medication drawer. The nurse should identify that administration of the medication can occur at which of the following time periods without requiring an incident report? A. 1000 B. 0900 C. 0830 D. 1200

Answer: C A. The nurse should identify that administering an antibiotic 2 hr after the scheduled time is too late and requires filing an incident report. B. The nurse should identify that administering an antibiotic 1 hr after the scheduled time is too late and requires filing an incident report. C. The nurse should identify that an antibiotic can be administered 30 min before or after the scheduled time to maintain therapeutic blood levels without requiring an incident report. D. The nurse should identify that administering an antibiotic 4 hr after the scheduled time is too late and requires filing an incident report.

A nurse administers a dose of metformin to a client instead of the prescribed dose of metoclopramide. Which of the following actions should the nurse take first? A. Report the incident to the charge nurse. B. Notify the provider. C. Check the client's blood glucose. D. Fill out an incident report.

Answer: C A. The nurse should report the incident to the charge nurse to protect the client from injury. However, there is another action the nurse should take first. B. The nurse should notify the provider to protect the client from injury. However, there is another action the nurse should take first. C. The first action the nurse should take using the nursing process is to assess the client. The client is at risk for hypoglycemia. The nurse should monitor the client's blood glucose and provide the client with a snack to reduce the risk for hypoglycemia. D. The nurse should fill out an incident report to document the incident. However, there is another action the nurse should take first. The incident report alerts the risk manager to the incident, who then determines the cause and a plan of action to reduce the risk of reoccurrence.

A nurse is reviewing the laboratory results of a client who is taking digoxin for heart failure. Which of the following results should the nurse report to the provider? A. Calcium level 9.2 mg/dL B. Magnesium level 1.6 mEq/L C. Digoxin level 1.1 ng/mL D. Potassium level 2.8 mEq/L

Answer: D A. A calcium level of 9.2 mg/dL is within the expected reference range of 9.0 to 10.5 mg/dL. The nurse should report a calcium level that is outside the expected reference range to the provider. B. A magnesium level of 1.6 mEq/L is within the expected reference range of 1.3 to 2.1 mEq/L. The nurse should report a magnesium level that is outside the expected reference range to the provider. C. A digoxin level of 1.1 ng/mL is within the expected reference range of 0.8 to 2 ng/mL. The nurse should report a digoxin level that is outside the expected reference range to the provider for a dosage adjustment. D. A potassium level of 2.8 mEq/L is below the expected reference range of 3.5 to 5 mEq/L. The nurse should notify the provider if a client has hypokalemia prior to administration of digoxin due to the increased risk of developing digoxin toxicity and cardiac dysrhythmias.

A nurse is reviewing the laboratory results for a client who is receiving heparin via continuous IV infusion for deep-vein thrombosis. The nurse should discontinue the medication infusion for which of the following client findings? A. Potassium 5.0 mEq/ L B. aPTT 2 times the control C. Hemoglobin 15 g/dL D. Platelets 96,000/mm3

Answer: D A. Although heparin can cause an increase in potassium levels, the client's potassium level is within the expected reference range of 3.5 to 5 mEq/L. B. This is a therapeutic aPTT level for a client receiving heparin and is not an indication to stop the heparin infusion. C. An Hgb of 15 g/dL is within the expected reference range of 14 to 18 g/dL for a male and 12 to 16 g/dL for a female and is not an indication to stop the heparin infusion. D. A platelet count of 96,000/mm3 is below the expected range of 150,000 to 400,000/mm3. A platelet count less than 100,000/mm3 while receiving heparin can indicate heparin-induced thrombocytopenia, a potentially fatal condition that requires stopping the infusion.

A nurse is providing teaching to a client who is taking bupropion as an aid to quit smoking. Which of the following findings should the nurse identify as an adverse effect of the medication? A. Cough B. Joint pain C. Alopecia D. Insomnia

Answer: D A. Bupropion, an atypical antidepressant, does not cause coughing. B. Bupropion can cause neurologic adverse effects such as bradykinesia. However, it does not cause joint pain. C. Bupropion can cause sensory adverse effects such as changes in vision and hearing. However, it does not cause alopecia. D. Bupropion, an atypical antidepressant, has stimulant properties, which can result in agitation, tremors, mania, and insomnia.

A nurse is planning care for a client who is receiving mannitol via continuous IV infusion. The nurse should monitor the client for which of the following adverse effects? A. Weight loss B. Increased intraocular pressure C. Auditory hallucinations D. Bibasilar crackles

Answer: D A. Mannitol is an osmotic diuretic used to promote diuresis, decrease intracranial pressure, and improve renal function. An expected therapeutic effect of mannitol is weight loss resulting from diuresis. B. An indication for the use of mannitol is increased intraocular pressure. Mannitol decreases the intraocular pressure by creating an osmotic gradient between the intraocular fluid and the plasma. C. Mannitol has several neurologic adverse effects, including increased intracranial pressure, seizures, confusion, and headaches. However, it does not cause auditory hallucinations. D. Mannitol, an osmotic diuretic, can precipitate heart failure and pulmonary edema. Therefore, the nurse should recognize lung crackles as an indicator of a potential complication and stop the infusion.

A nurse is assessing a client who is taking propylthiouracil for the treatment of Graves' disease. Which of the following findings should the nurse identify as an indication that the medication has been effective? A. Decrease in WBC count B. Decrease in amount of time sleeping C. Increase in appetite D. Increase in ability to focus

Answer: D A. Propylthiouracil is a thyroid hormone antagonist used in the treatment of hyperthyroidism, or thyroid storms. A decreased WBC count is an adverse effect of propylthiouracil, which can cause myelosuppression. Therefore, a decrease in WBC count indicates the medication has not been effective. B. Graves' disease, a form of hyperthyroidism, has neurologic manifestations, including insomnia. Therefore, a decrease in the amount of time sleeping indicates the medication has not been effective. C. Graves' disease can result in gastrointestinal manifestations such as increased appetite, weight loss, and increased gastrointestinal motility. Therefore, an increase in appetite indicates the medication has not been effective. D. A client who has Graves' disease can experience psychological manifestations such as difficulty focusing, restlessness, and manic-type behaviors. Propylthiouracil is a thyroid hormone antagonist that decreases the circulating T4 hormone, reducing the manifestations of hyperthyroidism. An increased ability to focus indicates that the medication has been effective.

A nurse is providing teaching to a client who is to start treatment for asthma with beclomethasone and albuterol inhalers. Which of the following instructions should the nurse include in the teaching? A. "Take beclomethasone to avoid an acute attack." B. "Use beclomethasone 5 minutes before using albuterol." C. "Limit your calcium and vitamin D intake when taking beclomethasone." D. "Rinse your mouth after inhaling the beclomethasone."

Answer: D A. The client should take albuterol, a short-acting beta2-adrenergic agonist, to avoid an acute asthma attack. B. The client should use the bronchodilator, albuterol, prior to taking beclomethasone, a glucocorticoid inhaler, to enhance its absorption. C. The client should increase the intake of calcium and vitamin D to minimize bone loss while taking beclomethasone, a glucocorticoid inhaler. D. The client should rinse their mouth after using beclomethasone, a glucocorticoid inhaler, to prevent oropharyngeal candidiasis and hoarseness.

A nurse is caring for a client who is experiencing acute alcohol withdrawal. For which of the following client outcomes should the nurse administer chlordiazepoxide? A. Minimize diaphoresis B. Maintain abstinence C. Lessen craving D. Prevent delirium tremens

Answer: D A. The client should take clonidine or a beta-adrenergic blocker, such as atenolol, to minimize autonomic components, such as diaphoresis, during alcohol withdrawal. B. The client should take acamprosate to help maintain abstinence from alcohol by decreasing anxiety and other uncomfortable manifestations. C. The client should take propranolol to decrease cravings during alcohol withdrawal. D. The client should take chlordiazepoxide to prevent delirium tremens during acute alcohol withdrawal.

A nurse is teaching a client who is to start taking hydrocodone with acetaminophen tablets for pain. Which of the following information should the nurse include in the teaching? A. The medication should be taken 1 hr prior to eating. B. It takes 48 hr for therapeutic effects to occur. C. Tablets should not be crushed or chewed. D. Decreased respirations might occur.

Answer: D A. The client should take hydrocodone and acetaminophen with food or milk to decrease gastric irritation. B. The nurse should instruct the client that they should experience the effects of hydrocodone with acetaminophen within 20 min of administration and that pain relief should last for 4 to 6 hr. C. The client should avoid crushing, chewing, or breaking the extended release or immediate release hydrocodone tablets to prevent an immediate increase in CNS effects. Hydrocodone with acetaminophen tablets can be crushed if needed. D. The nurse should instruct the client that hydrocodone with acetaminophen might cause respiratory depression, which is an adverse effect of the medication. The client should avoid taking over-the-counter medications or newly prescribed medications without consulting their provider to avoid increased respiratory depression.

A nurse is preparing to administer PO sodium polystyrene sulfonate to a client who has hyperkalemia. Which of the following actions should the nurse plan to take? A. Hold the client's other oral medications for 8 hr post administration. B. Inform the client that this medication can turn stool a light tan color. C. Keep the client's solution in the refrigerator for up to 72 hr. D. Monitor the client for constipation.

Answer: D A. The nurse should hold the client's other oral medications for 6 hr before and after administration of sodium polystyrene sulfonate. B. Sodium polystyrene sulfonate will not alter the color of the client's stool. C. Sodium polystyrene sulfonate solution is stable for 24 hr when refrigerated. D. The nurse should monitor the client for the adverse effect of constipation and report it to the provider because this can lead to fecal impaction.

A nurse is providing discharge teaching about handling medication to a client who is to continue taking oral transmucosal fentanyl raspberry-flavored lozenges on a stick. Which of the following information should the nurse include in the teaching? A. Chew on the medication stick to release the medication. B. Leave the medication stick in one location of the mouth until melted. C. Allow the medication 1 hr for analgesia effects to begin. D. Store unused medication sticks in a storage container.

Answer: D A. The nurse should instruct the client to place the fentanyl stick between their cheek and lower gum and actively suck it for increased absorption of the medication. B. The nurse should instruct the client to periodically move the medication stick to a different location in the mouth for best absorption. C. The nurse should instruct the client to expect the medication's analgesia effects to begin within 10 to 15 min. D. The nurse should instruct the client to store unused, used, or partially used medication sticks in the safe storage container that comes in the kit when the medication is initially prescribed.

A nurse is teaching a client about the use of risedronate for the treatment of osteoporosis. The nurse should identify which of the following statements as an indication that the client understands the teaching? A. "I will drink a glass of milk when I take the risedronate." B. "I will take the risedronate 15 minutes after my evening meal." C. "I should take an antacid with the risedronate to avoid nausea." D. "I should sit up for 30 minutes after taking the risedronate."

Answer: D A. The nurse should reinforce that risedronate should be taken with a full glass of water, rather than any other liquid. B. Although the delayed release form of the medication can be taken after eating, the immediate release form of the medication should be taken at least 30 min prior to consuming food or other liquids. Both forms of medication should be taken in the morning. C. The absorption of risedronate, a bisphosphonate, will be reduced if it is taken with antacids containing calcium, aluminum, or magnesium. The nurse should instruct the client to take the antacid 2 hr after taking risedronate. D. Sitting upright for at least 30 min after taking risedronate will reduce the adverse gastrointestinal effects of esophagitis and dyspepsia. Risedronate is contraindicated for a client who cannot sit or stand upright for this length of time.

A nurse is administering donepezil to a client who has Alzheimer's disease. Which of the following findings should the nurse report to the provider immediately? A. Dyspepsia B. Diarrhea C. Dizziness D. Dyspnea

Answer: D A. The nurse should report dyspepsia to the provider because dyspepsia can cause discomfort and irritation to the esophageal tissues. However, the nurse should report another finding first. B. The nurse should report diarrhea to the provider because diarrhea can result in electrolyte and fluid imbalances. However, the nurse should report another finding first. C. The nurse should report dizziness to the provider because dizziness can place the client at an increased risk for falls. However, the nurse should report another finding first. D. When using the airway, breathing, circulation approach to client care, the nurse should report the adverse effect of dyspnea, caused by bronchoconstriction, to the provider first. Bronchoconstriction, dyspepsia, diarrhea, and dizziness are caused by the increase in acetylcholine levels, which is a primary effect of donepezil.

A nurse is assessing a client 1 hr after administering morphine for pain. The nurse should identify which of the following findings as the best indication that the morphine has been effective? A. The client's vital signs are within normal limits. B. The client has not requested additional medication. C. The client is resting comfortably with eyes closed. D. The client rates pain as 3 on a scale from 0 to 10.

Answer: D A. Vital signs can be within normal limits for clients who have pain. B. Clients often do not request medicine even when they are experiencing pain. C. The client might rest with their eyes closed as a method to try to manage pain. However, this does not indicate that the pain is controlled. D. The client's description of the pain is the most accurate assessment of pain.

A nurse at an urgent care clinic is collecting a history from a female client who has a urinary tract infection. The nurse anticipates a prescription for ciprofloxacin. The nurse should identify that which of the following client statements indicates a contraindication for administering this medication? A. "I have tendonitis, so I haven't been able to exercise." B. "I take a stool softener for chronic constipation." C. "I take medicine for my thyroid." D. "I am allergic to sulfa."

Answer; A A. The nurse should identify tendonitis as a contraindication for taking ciprofloxacin due to the risk of tendon rupture. B. Ciprofloxacin is not contraindicated for the client who takes a stool softener for chronic constipation. Diarrhea is an adverse effect of the medication. C. Ciprofloxacin does not affect thyroid function and is not contraindicated for the client who takes thyroid medication. D. Ciprofloxacin is a quinolone antibiotic. Therefore, the client who has a sulfa allergy can take this medication.