HESI Review

Define and give an example of an agonist.

'Agonist' = the drug binds with a receptor to cause an effect E.g: Salbutamol binds with β2 receptors to cause bronchodilation

Define and give an example of an antagonist.

'Antagonist' = the drug binds with a receptor to prevent an agonist having an effect. AKA a 'blocker' E.g: Bisoprolol binds with β1 receptors to block the effects of noradrenaline

Pleural effusion typical fidings

(abnormal accumulation of fluid in the pleural spaces of the lungs) -dyspnea that usually occurs with exertion and a dry nonproductive cough

A nurse is assisting with admitting a client to the hospital who recently had a bilateral adrenalectomy. Which intervention is essential for the nurse to suggest to include in the client's plan of care?

...

If you are the one preparing the medication then...

...only you can administer the medication.

AST

0 - 35 units/L

ESR

0-30mm/hr *rate at which erythrocytes settle out of anticoagulated blood in 1 hour. Abnormal values: mild 30-40 moderate 40-70 severe 70-150

Basophils

0.3% 0-200 cells/mm3

Therapeutic Range Dig

0.5-2 ng/mL

3.) Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which of the following would indicate the presence of systemic toxicity from this medication? 1. Tinnitus 2. Diarrhea 3. Constipation 4. Decreased respirations

1. Tinnitus Rationale: Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can result. Symptoms include tinnitus, dizziness, hyperpnea, and psychological disturbances. Constipation and diarrhea are not associated with salicylism.

110.) A client taking lithium carbonate (Lithobid) reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is checked as a part of the routine follow-up and the level is 3.0 mEq/L. The nurse knows that this level is: 1. Toxic 2. Normal 3. Slightly above normal 4. Excessively below normal

1. Toxic Rationale: The therapeutic serum level of lithium is 0.6 to 1.2 mEq/L. A level of 3 mEq/L indicates toxicity.

79.) Ibuprofen (Advil) is prescribed for a client. The nurse tells the client to take the medication: 1. With 8 oz of milk 2. In the morning after arising 3. 60 minutes before breakfast 4. At bedtime on an empty stomach

1. With 8 oz of milk Rationale: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs should be given with milk or food to prevent gastrointestinal irritation. Options 2, 3, and 4 are incorrect.

Normal INR

1.00-1.30

Urine SG

1.016-1.022

Therapeutic PT

1.5-2x normal (Coumadin/Warfarin)

IV Hypotonic Solutions

1/2 NS (.45%)

Lipase

10-140 units/L

Therapeutic Range Phenytoin (Dilantin)

10-20 mcg/mL

Serum Salicylates (treatment for RA - aspirn)

10-20 mg/dL

Ammonia

10-80 mcg/dL

BUN-Creatinine Ratio

10:1 - 15:1

PLT

150,000 - 400,000

Platelets

150,000-400,000

Fibrinogen

180-340 mg/dL

228.) A client receiving an anxiolytic medication complains that he feels very "faint" when he tries to get out of bed in the morning. The nurse recognizes this complaint as a symptom of: 1. Cardiac dysrhythmias 2. Postural hypotension 3. Psychosomatic symptoms 4. Respiratory insufficiency

2. Postural hypotension Rationale: Anxiolytic medications can cause postural hypotension. The client needs to be taught to rise to a sitting position and get out of bed slowly because of this adverse effect related to the medication. Options 1, 3, and 4 are unrelated to the use of this medication.

Therapeutic INR

2.0-3.0 standard warfarin 3.0-4.5 high dose warfarin sodium tx

aPTT

20-36 sec

139.) Prednisone is prescribed for a client with diabetes mellitus who is taking Humulin neutral protamine Hagedorn (NPH) insulin daily. Which of the following prescription changes does the nurse anticipate during therapy with the prednisone? 1. An additional dose of prednisone daily 2. A decreased amount of daily Humulin NPH insulin 3. An increased amount of daily Humulin NPH insulin 4. The addition of an oral hypoglycemic medication daily

3. An increased amount of daily Humulin NPH insulin Rationale: Glucocorticoids can elevate blood glucose levels. Clients with diabetes mellitus may need their dosages of insulin or oral hypoglycemic medications increased during glucocorticoid therapy. Therefore the other options are incorrect.

96.) The nurse is caring for a postrenal transplant client taking cyclosporine (Sandimmune, Gengraf, Neoral). The nurse notes an increase in one of the client's vital signs, and the client is complaining of a headache. What is the vital sign that is most likely increased? 1. Pulse 2. Respirations 3. Blood pressure 4. Pulse oximetry

3. Blood pressure Rationale: Hypertension can occur in a client taking cyclosporine (Sandimmune, Gengraf, Neoral), and because this client is also complaining of a headache, the blood pressure is the vital sign to be monitoring most closely. Other adverse effects include infection, nephrotoxicity, and hirsutism. Options 1, 2, and 4 are unrelated to the use of this medication.

111.) A client arrives at the health care clinic and tells the nurse that he has been doubling his daily dosage of bupropion hydrochloride (Wellbutrin) to help him get better faster. The nurse understands that the client is now at risk for which of the following? 1. Insomnia 2. Weight gain 3. Seizure activity 4. Orthostatic hypotension

3. Seizure activity Rationale: Bupropion does not cause significant orthostatic blood pressure changes. Seizure activity is common in dosages greater than 450 mg daily. Bupropion frequently causes a drop in body weight. Insomnia is a side effect, but seizure activity causes a greater client risk.

K+

3.5-5.1 mEq/L

The client has an order for 2 tablespoons of Milk of Magnesia. The nurse converts this dose to the metric system and gives the client:

30 mL

223.) A client with a psychotic disorder is being treated with haloperidol (Haldol). Which of the following would indicate the presence of a toxic effect of this medication? 1. Nausea 2. Hypotension 3. Blurred vision 4. Excessive salivation

4. Excessive salivation Rationale: Toxic effects include extrapyramidal symptoms (EPS) noted as marked drowsiness and lethargy, excessive salivation, and a fixed stare. Akathisia, acute dystonias, and tardive dyskinesia are also signs of toxicity. Hypotension, nausea, and blurred vision are occasional side effects.

2.) Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia. The nurse instructs the mother to administer the iron with which best food item? 1. Milk 2. Water 3. Apple juice 4. Orange juice

4. Orange juice Rationale: Vitamin C increases the absorption of iron by the body. The mother should be instructed to administer the medication with a citrus fruit or a juice that is high in vitamin C. Milk may affect absorption of the iron. Water will not assist in absorption. Orange juice contains a greater amount of vitamin C than apple juice.

Hct

42-52% males 35-47% females

Neutrophils

56% of WBC CDC 1800-7800 cells/mm3

Normal PAWP

6-12mmHg

Protein level

6.0-8.0 g/dL

Parameter

A characteristic or constant factor, limit.

Deficit

A deficiency or lack of something.

What are the effects of β-blockers?

All β-blockers cause decreased heart rate, contractility, automaticity and conduction velocity Non-selective β-blockers also cause vasoconstriction and bronchoconstriction

Preexisting

Already present

When opening a mental health clinic...

American Nursing Association.

Define Tincture

An alcohol or water-alcohol medication solution.

Define Adverse effect

An effect of a drug which may be unfavorable to the patient's health; an action or effect, other than that which is desired, such as an allergic reaction.

Affect

Appearance of observable emotions.

Define Aerosol

Aqueous medication sprayed and absorbed in the mouth and upper airways, not meant for ingestion.

A nurse observes a client in the dayroom talking to himself. What should the nurse do first?

Ask the client if they are currently hearing voices?

When performing a MSE on a client which assessment intervention would best assist the nurse?

Ask the client to interpret the proverb a stitch in time saves nine.

A nurse is to remove staples from an abdominal incision, the client is very anxious. What is the most important intervention?

Attempt to distract the client with general conversation.

A nurse is assisting with admitting a client to the hospital who recently had a bilateral adrenalectomy. Which intervention is essential for the nurse to suggest to include in the client's plan of care?

Avoid stress-producing situations and procedures Rationale: A bilateral adrenalectomy involves removal of the adrenal glands. This surgical procedure can lead to adrenal insufficiency. Adrenal hormones are essential in maintaining homeostasis in response to stressors.

What lab values reflect renal function?

BUN and Cr

Paroxysmal

Beginning suddenly or abruptly; convulsive

Angina Drugs that Decrease Myocardial Oxygen Demand

Beta adrenergic blockers

Which drug group is known as 'the -lols'?

Beta-Blockers

Other Drugs to Reduce LDLs

Bile-acid sequestrants Nicotinic acid (niacin) Fibrates (reduce triglycerides) Lovaza Fish oil Plant stanol & sterol esters

Testicular activity is under the control of which hormone(s)?

Both FSH and LH

pulmonary embolism symptoms

CHEST PAIN, dyspnea, tachypnea others: tachycardia, diaphoresis, cough, hemopytosis,fever, andsyncope

List the different types of β-blockers (3) and provide examples.

Cardioselective (block β1 receptors): Bisoprolol, Atenolol, Metoprolol Non-selective (block both β1 and β2 receptors): Sotalol, Propranolol Combined alpha and beta blockers: Carvedilol, Labetalol

What is the basic unit of life and the building block of tissues and organs?

Cell

Occleded

Closed or obstructed

Adverse Effects of Statins

Common: headache, rash, GI disturbances Rare: myopathy/rhabdomyolysis, hepatotoxicity, peripheral neuropathy

Which tissue serves as the framework of the body by providing support and structure for the organs?

Connective

A client with hyperthroidism has just discussed an upcoming thyroidectomy with the physician. The client tells the nurse that it is frightening to think about someone cutting into the neck. The nurse should make which response to the client?

Correct Answer is "Can you describe a little more about what you are frigthening you?' Rationale: Focusing on the client helps promote effective communications within a therapeutic relationship.

IV Hypertonic Solutions

D5NS **Pulls fluid into intravascular space for excretion**

Consistency

Degree of viscosity; how thick or thin a fluid is.

What are the side effects of Lithium?

Dehydration, diarrhea, and thirstiness.

A site that was a traditional location for intramuscular (IM) injections in the past is no longer recommended because its use carries the risk of striking the underlying sciatic nerve or major blood vessel. What is the name of this site?

Dorsogluteal

Motor or ______ neurons transmit nerve impulses away from the CNS.

Efferent

Children & Cholesterol

Elevated cholesterol in pediatric pts is a growing concern Screen high risk children at age 2, consider use of statins at age 8 Nutritional counseling, increase activity, weight reduction

Distended

Enlarged or expanded from pressure.

vital

Essential

Most medication errors occur when the nurse:

Fails to follow routine procedures

Who is most prone to being abused (elder abuse)?

Females over 75 living with their families. or mentally or physically handicapped

What are the side effects of Risperdal?

Fever, tachycardia, and sweating.

Define Suspension

Finely divided drug particles dispersed in liquid medium; when suspension is left standing, particles settle to bottom of container, must be shaken prior to use, commonly given orally and should not be given intravenously.

A client is receiving an IV push medication. If this type of drug infiltrates into the outer tissues, the nurse will:

Follow facility policy or drug manufacturer's directions

Anticoagulants

For thromboembolic disorders Reduce formation of fibrin by inhibiting synthesis of clotting factors & activity of clotting factors

Arterial Thrombosis

Formed when platelets adhere to the arterial wall, continued aggregation leads to occlusion of the artery, localized harmful results

A client taking Meth and Benzo's, what would the nurse prepare to do for overdose?

Give Narcan.

Oral

Given through or affecting the mouth

Define Vial

Glass or plastic container that has a self-sealing rubber stopper.

A client in the dayroom had tripped over a table and is escalating and has picked up a chair which he is threatening to throw at another client. What should the nurse do first?

Go and get more staff assistance.

While the nurse is administering medication, the client says, "This pill looks different from what I usually take." What is the nurse's best action?

Go recheck the medication order, taking along the medication.

Statins

HMG-CoA Reductase Inhibitors Atorvastatin (Lipitor) Elevates HDLs, reduces triglycerides Reduce risk of stroke, cardiac events, peripheral vascular disease, protects pts with normal LDLs & diabetes

What would be proper teaching for a client who is to start taking Antabuse?

Has not had anything alcoholic to drink for the last 48 hours.

What position should you have the patient in when applying ophthalmic medication?

Have the patient in either the supine or the sitting position with the head tilted back and to the side.

What is a common side effect of cocaine use.

Heart attack.

What are the uses and side effects associated with aldosterone blockers?

Heart failure and reduced EF with normal renal function and K+ levels Side effects of Spironolactone are significant: -Blocks androgen and stimulates progesterone -Causes gynecomastia, breast pain, sexual dysfunction and menstrual problems Eplerenone has less side effects since less binding to androgen and progesterone receptors

In what area of the body would you expect to find an especially thick stratum corneum?

Heel of the foot

Warfarin Adverse Effects

Hemorrhage (vit. K for toxicity) Fetal hemorrhage & teratogenesis from use during pregnancy Monitor prothrombin time (PT) & INR

Heparin Hypersensitivity Reactions

Heparin extracted from animal tissues, some preparations can be contaminated with antigens that can cause allergic rxn.

A nurse is assisting to prepare a plan of care for a client with hyperthyroidism and is instructed the client regarding dietary measures. Which of the following foods are included in the plan of care

High calories Rationale: Hyperthyroidism is a condition characterized by hyperactivity of the thyroid gland. The client with hyperthyroidism is usually extremely hungry because of increased metabolism. The client should be instructed to consume a high-calorie diet with six full meals a day. The client should be instructed to eat foods that are nutritious and contain ample amounts of protein, carbohydrates, fats, and minerals. Clients should be discouraged from eating foods that increase peristalsis and thus result in diarrhea, such as highly seasoned, bulky, and fibrous foods.

What are chemical messengers that control growth, differentiation, and the metabolism of specific target cells called?

Hormones

Define Excretion

How the drug and metabolites are eliminated from the body through the kidney, liver, lungs and GI tract. Example: Do not give NSAIDS (Motrin, ASA) to renal failure/transplant patient. It is excreted through kidneys and can possibly worsen the problem.

Define Distribution

How the drug is transported by the blood to the site of action. It requires adequate cardiac output and tissue perfusion.

A woman is just told of her husband's dx of terminal cancer. What would the nurse offer for the spouse (wife)?

How would you like to be involved with your husband's care?

Contraindications for Angina Drugs

Hypotension: all HF: beta blockers, Ca channel blockers

When must you report medication errors?

Immediately

A man who was stranded on the roof of his house for two days after a natural disaster, months later ...

Implement anxiety control strategies.

pr interval

Impulse travel time through the AV node, Bundle of His, and Purkinje Fibers. Normal length is 0.12 to 0.20 seconds. (Impulse longer than .20 seconds indicates a block in the impulse transmission in the AV node) (Impulse less than .12 seconds indicates the initiation of the electrical impulse form a source other than the AV node.)

What is Subcutaneous (Sub Q)

Injection of medication into subcutaneous tissue.

What is Intramuscular (IM)

Injection of sterile medication into a muscle.

What is Intravenous (IV)

Injection of sterile medication into the vein.

A Client is admitted to the hospital with severe Hypoparathyroidism. The nurse should do which of the following activities to promote client safety

Institute seizure precautions- Rationale: Hypoparathyroidism results from insufficient parathyroid hormone, leading to low serum calcium levels. Hypocalcemia can cause tetany, which, if untreated, can lead to seizures. The nurse should institute seizure precautions to maintain a safe environment. The other options do nothing to help this health problem or promote a safe environment for this client.

To promote a successful postoperative recovery for a client who had one adrenal gland removed, the nurse plans to reinforce which of the following instructions?

Instructions about early signs of a wound infection Rationale: A client who is undergoing a unilateral adrenalectomy will be placed on corticosteroids temporarily to avoid a cortisol deficiency. These medications will be gradually weaned in the postoperative period until discontinued. Because of the antiinflammatory properties of corticosteroids, clients who undergo adrenalectomies are at increased risk of developing wound infections. Because of this increased risk of infection, it is important for the client to know measures to prevent infection, early signs of infection, and what to do if an infection seems to be present.

Explain how warfarin is used.

Interferes with Vitamin K needed for making prothrombin Taken orally Good for long-term anti-coagulation Takes ~3 days to become effective Patients often prescribed Heparin acutely to cover this period Effectiveness is altered by lots of things (food, alcohol etc.) so patients have to be monitored carefully

Alzheimer's patient-nurse goes to do dressing change and the client refuses. What should the nurse do?

Leave and come back 30 minutes later.

A business man is stressed about his finances, has anxiety and sleeplessness.

Limit intake of sugar and caffeine.

Flaccid

Limp, lacking tone.

All the nutrients that enter the hepatic portal vein are routed where for decontamination?

Liver

A woman who is psychotic is carrying all of her belongings around with her because she is afraid that someone will steal it. What is the best way to establish trust?

Make brief contact with the client throughout the day.

Hgb

Males = 14-16.5 g/dL Females = 12-15 g/dL

Which of the following bones is the only moveable bone of the skull?

Mandible

What is Buccal?

Medication placed in the mouth against the mucous membranes of the cheek.

What is 'OP'?

Medication taken Orally.

Which type of cell division takes place in the gonads?

Meiosis

Angina Drugs that Increase Efficiency of ATP Production & Inhibit Fatty Acid Oxidation

Metabolic modulators

A patient has stopped taking Depakote six months ago, what would the nurse assess?

Mood.

Warfarin Uses

Not useful in emergencies Prevention of venous thrombosis & PE Prevention of thromboembolism (pts w/ prosthetic heart valves) Prevention of thrombosis during A-fib

Overt

Obvious, easily observed

Incidence

Occurrence

Compensatory

Offsetting or making up for something.

Organic Nitrates for Chronic Angina

Patches/ointment (upper arms/chest, avoid hairy areas), oral Tolerance develops w/in 24-48 hrs.

What is the correct fomula to convert lbs to kg?

Patient's weight in pounds ---------------------------------- 2.2

What is the correct formula for "Body Weight"

Patient's weight in pounds Dose ---------------------------------- X ------- 2.2 pounds/kilograms 1

To Reduce MI Risk With Angina

Patients should receive 1) antiplatelet drug & 2) cholesterol-lowering drug

In which of the following locations would the urinary bladder and internal reproductive organs be found?

Pelvic cavity

If a client who is receiving IV fluids develops tenderness, warmth, erythema, and pain at the site, the nurse suspects:

Phlebitis

During pregnancy, what organ produces the hormones that maintain the endometrium and prepare the breasts for milk production?

Placenta

What is the most important intervention for a client with bulimia?

Plan scheduled meals.

Heparin-Induced Thrombocytopenia (HIT)

Potentially fatal immune mediated disorder characterized by reduced platelet counts (monitor)

Latent

Present, but not active or visible

Depress

Press downward.

Low-Molecular-Weight Heparins Uses

Prevention of DVT after surgery, treatment of DVT, prevention of ischemic complications Administered subQ based on body weight Expensive, can be given at home

Pathology

Processes, causes, and effects of a disease; abnormality

What is a writen order?

Provider writes the drug order in the patient's chart

How will you straighten the auditory canal for a child?

Pull on the lower half down and back

PADP

Pulmonary Artery Diastolic Pressure 4-12 mmHg

Flushed

Reddened or ruddy appearance.

Inflamed

Reddened, swollen, warm and often tender

Vasodilation and vasoconstriction result from which of the following?

Relaxation and contraction of smooth muscle in the arterial wall

An alcoholic father tells his wife and children to stay away from him. What is the most important nursing dx?

Risk for injury.

Concave

Rounded inward.

A client who is refusing to take his medication is wandering on the unit and going in and out of resident's rooms. What is the priority?

Safety* deal with the wandering in and out of other client's rooms.

A flutter

Saw tooth P wave. Rhythm: regular. no atrial kick that helps ventricles. Blood pools=clotting=MI or stroke. Use CCB, beta blockers, DIg.

Define Toxicology

Scientific study of the nature and effects of toxic substances.

In men, spermatozoa develop within the _______ of each testis.

Seminiferous tubules

If an impulse is traveling from a sense receptor toward the spinal cord, it is traveling along what type of neuron?

Sensory neuron

Contour

Shape or outline of a shape.

Statin Dosing

Should be once daily in the evening, have the greatest impact when given in the evening Endogenous cholesterol synthesis increases during the night

What kind of medication order is "Stat"

Single dose of medication administered immediately.

A client with anger management issues uses belt making and bangs the leather heavily. What defense mechanisms is being used?

Sublimation.

Which of the following are functions of the skeletal system? (Select all that apply)

Support the body Hemopoiesis (process by which new blood cells are formed; bone marrow) Provide protection

How does the trachea remain open like a hollow tube?

Supporting cartilaginous rings keep it open

Antiplatelet Drugs

Suppress platelet aggregation Prevention of thrombosis in arteries Aspirin (ASA), Ticlopidine (Ticlid), Clopidogrel (Plavix)

Fondaparinux

Synthetic anticoagulant Prevention of DVT after surgery, treatment of acute PE (w/ warfarin) & acute DVT (w/ warfarin)

supplement

TO TAKE IN ADDITION TO OR TO COMPLETE

An elderly woman is brought to the ER with multiple stages of healing bruises. What should the nurse do?

Take the woman aside and ask her about abuse.

What would be the nurse's highest priority for a newly admitted depressed client upon admission?

The nurse should go through the client's belongings.

Define Absorption

The passage of medication molecules into the blood from the site of administration.

The nurse selects the route for administering medication according to:

The prescriber's orders

A nurse administering medications has many responsibilities. Among these responsibilities is a knowledge of pharmacokinetics. Which statement is the best description of pharmacokinetics?

The study of how medications enter the body, reach their site of action, metabolize, and exit the bod

Rationale

The underlying reason

Initiate

To begin or put into practice

A client with dementia uses the defense mechanism of confabulation. What is the reasoning?

To decrease anxiety.

Constrict

To draw together or become smaller.

Contract

To draw together, to reduce in size.

alleviate

To ease a pain or burden

Dilate

To enlarge or expand.

Adhere

To hold fast or stick together.

Retain

To hold or keep

Dilute

To make a liquid less concentrated.

Exacerbate

To make worse or more severe.

suppress

To stop or subdue

Abstain

To voluntarily refrain from something.

transmission

Transfer, such as of a disease, from one person to another

Adverse

Undesired, possibly harmful.

What lab values reflect kidney regulation of fluid balance?

Urine SG

A nurse is caring for a client with a diagnosis of thyroid crisis (thyroid storm). Which of the following should the nurse included in the plan of care for this client

Use of a hypothermic Blanket Rational: Thyroid crisis is a potentially fatal acute episode of thyroid overactivity characterized by high fever, severe tachycardia, delirium, dehydration, and extreme irritability. Because thyroid storm is an emergency, it requires immediate interventions for control. The high fever is treated with hypothermic blankets, and dehydration is reversed with intravenous fluids. Hypothyroidism a nurse shoudl restrict fluid intake, Administration of levothyroxine (Snythroid), and Administration of enemas and stool softeners.

How do you measure the effect of warfarin?

Use the International Normalisation Ratio (INR) Actual time for prothrombin to form / expected or control time Therapeutic range varies according to indication, typically 2.0-3.0 Important to know the INR before any invasive procedure in these patients due to risk of excessive bleeding

Very-Low-Density Lipoproteins

VLDLs Triglycerides-core lipid

What kind of order will a Corpsman not take?

Verbal Orders

The parents of a teenager who has overdosed what is the first question to ask?

What drug did the client ingest?

A client is told to come in by friends, clients complaints include losing his job, just got a divorce, single dad with two kids, what would be the best question for nurse to ask?

What is troubling you the most?

Define Medication interaction

When a medication may potentiate or diminish the actions of other medications.

Gaping

Wide open.

When giving the patient a sublingual medication, where will you place the medicine and what should you instruct the patient to do?

You will place the medication underneath the tongue and you should instruct the patient to not swallow the medication, eat, drink, chew or smoke until the medication is dissolved.

A client with Alzheimer's keeps asking for his mother. What is the nurses appropriate response?

Your mothers not here but you are safe.

Laceration

a cut, tear

Precaution

a measure taken in advance to prevent harm

transdermal

a method of administering medication through the unbroken skin via patch or ointment

Prognosis

a prediction of the outcome of a disease; any forecast or prediction

wall sunction pressure : Adults children

adults: 80-120 children: 60-110

untoward

adverse or negative,unseemly

continous bubbling in the water-seal compartment during inspiration and expiration indicates ___

air is leaking into the drainage system or pleural cavity

...

always remove the oxygen just before the ABG levels are drawn

Define Therapeutic effect

an expected or predictable physiological response to medication.

a client being weaned from a mechanical ventilator

antianxiety medications and opioid analgesics

CPT or chest physicay therapy

assist in mobilizing secretions to enhance more effective breathing -will indirectly assist the pt with coughing

P wave

atrium firing (depolarization)

silicosis

avoid exposure to sands, quarzes, flints and many other stones.. also soaps, polishes and filters may contant silica

symmetric

being equal or the same size shape and position

cardiac tamponade

compression of the heart produced by the accumulation of fluid in the pericardial sac as results from pericarditis or trauma, causing rupture of a blood vessel within the heart (tampon = a plug)

drainage system bubbling

continous bubbling in the water seal chamber X suction control chamber

3 types of shock

defib, cardioversion, medication

Lethargic

difficult to arouse

low pressure alarm on the ventilator sounds indicates

disconnection of the ventilation tubing

incentive spirometry

dont breath through nose

late sign of laryngeal tumor

dyspnea

ravenous

extremely hungry

Dysfunction

impaired or abnormal functioning

Tracheostomy care

insert catheter until pt coughs or resistance is felt then withdraw 1 cm to move away from mucosa -hyperoxygenate the client before and after suctioning -use intermittent suction in the airway ( not constant) for 10-15 sec

gallium scan

iv injection -to differentiate a tumor from a pulmonary embolus when xray is unclear -no iodine all metal must be removed

high pressure alarm on the ventilator sounds indicates

kinks, breathng out of phase, valvasalva, increased airway resistance, bronchospam etc

chest tube:____ indicates that the lung has reexpanded

lack of fluctuation in the water seal chamber

Impending

likely to occur soon

what does echocardiogram record?

low ejection fraction= not enough lood forward

respiratory acidosis , appropriate oxygen

low flow oxygen...

COPD foods to stay away from

milk (thickens secretions) cabbages and broccoli or high bulk and high fiber foods (may produce intestinal bloating that reduces lung expansion)

chest physiotherapy

mobilizing secretions to make them easier to expectorate

tacheostomy suctioning

mouth should be suctioned last allow 30 sec intervals b/w suctioning do not apply suction more than 120 mm hg suction cath shouldnt be left in trachea for more than 15 secs

what aggreviates acute bronchitis

moving from an area of warm air to cold

flail chest

multiple chest fractures -apply firm but gentle pressure inward in inspiration, outward in expiration

nasal polyp

nasal obstruction

kaposi's sarcoma (pts with AIDS)

neoplasm of reticuloendothelial cells

V fib

no QRS with saw tooth pattern, ventricular fibrillation, Rate: Fast Rhythm: Irregular P waves: None or not measureable QRS duration: QRS fibrillation waves No cardiac output b/c ventricles are not pumping. Tx: cpr then defib

Troponin I

normal <= 0.6 ng/mL MI = >1.5 ng/mL

BNP

normal = 100pg/mL *anything over 100 = dypnea b/c of CHF, if BNP is normal = dyspnea d/t pulmonary problem

PCWP,

obtained during momentary balloon inflation of a pulmonary artery catheter, is reflective of left ventricular end diastolic pressure. PCWP normally ranges between 6 and 12 mm Hg.

pt w/ sucutaneous emphysema/ crepitus. . complication of tracheostomy

occurs when air escapes from the tracheostomy incision into the tissues, dessects fascial planes under the skin and accumulates around the face, neck and upper chest ... )a puffy or crackling sensation on palpitation

Patent

open

The epidermis is classified as a(n):

organ

pulmunary sarcoidosis

should have follow up chest films every 6 months

Bell of the stetoscope

should not be used in auscultating lung sounds

Ominous

significantly important and dangerous

Which of the following is true of skeletal muscle?

skeletal muscle attaches to bones by tendons muscle contraction helps keep the body warm skeletal muscles continuously contract to maintain posture

bradycardia

slow HB. common in athletes

Bile is secreted into which organ?

small intestine

triage

sorting and allocating aid on the basis of need for or likely benefit from medical treatment or food

Pleurisy

splint the chest during coughing and deep breathing to prevent atelectasis -lie on the affected side to minimize movement on the affected chest wall

SV

stroke volume = amt of blood ejected from L. ventricle.

manifestation of esophegeal

substernal chest pain

inserting an artificial oral airway the correctway to det the size of the airway is to ___

supine measure from the corner of the mouth to the angle of the jaw, just below the ear

oropharyngeal airway insertion

supine the tip facing upward then rotated downward after the flange has reached the clients teeth-dentures should be removed -cuction every 1 hr

SVT

supraventricular tachycardia; rapid heartbeats arising from the atria and causing palpitations, SOB, and dizziness

c/i of radical neck dissection and laryngectomy

swimming...

western blot

test to conform HIV

volume

the amount of space an object takes up

Infection

the invasion of the body by pathogenic microorganisms and their multiplication which can lead to tissue damage and disease

quotient

the number obtained by division

milieu

the setting, surroundings, environment

Restrict

to limit

Predispose

to make more susceptible or more likely to occur

Recur

to occur again

Normal Lipids: Total Cholesterol Cholesterol LDL HDL Triglycerides

total cholesterol, 200 mg/dL cholesterol, 140-199 mg/dL LDL, < 130 mg/dL HDL, 30-70 mg/dL triglycerides < 200 mg/dL.

If you wanted to separate the abdominal cavity from the thoracic cavity, which plan would you use?

transverse

after thoracentesis u must lie on the___

unaffected side

to prevent nosebleeds during winter

use humidifier

QRS

ventricular depolarization, narrow, .04 - .12

V tach

ventricular tachycardia. medication and O2

complication of empysema

carbon monoxide narcosis: s/s occipital headache, drowsiness and inability to concentrate, bounding pulse, co2 of >75 mm hg, confusion, coma, asterixis

Where are the pressoreceptors and chemoreceptors located?

carotid body

Pathogenic

causing or able to cause disease

Going from superior to inferior, the sequence of the vertebral column is:

cervical, thoracic, lumbar, sacral, and coccyx

pleur-evac c/i

clamping for any reason unless ordered

You have been given a sample of tissue that has pillar-shaped cells arranged tightly together. The tissue you have is:

columnar epithelium

Docile

compliant

volatile

(adj.) highly changeable, fickle; tending to become violent or explosive; changing readily from the liquid to the gaseous state

What are some syringe sizes?

-3mL -U-100 -1mL

Routes of medication administration depends on :

-Condition of the patient -Nature of the drug - taste, stability, etc -Rate of absorption via one route vs. another

Always ____ hands and ___ gloves before any ______ ________ medication administration.

-Wash -Don -Mucous Membrane

Cr

0.6-1.3 mg/dL

18.) The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse consults with the registered nurse regarding the administration of the medication if which of the following is documented in the client's history? 1. Pancreatitis 2. Diabetes mellitus 3. Myocardial infarction 4. Chronic obstructive pulmonary disease

1. Pancreatitis Rationale: Asparaginase (Elspar) is contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between administration of the doses. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. The conditions noted in options 2, 3, and 4 are not contraindicated with this medication.

152.) Intravenous heparin therapy is prescribed for a client. While implementing this prescription, a nurse ensures that which of the following medications is available on the nursing unit? 1. Protamine sulfate 2. Potassium chloride 3. Phytonadione (vitamin K ) 4. Aminocaproic acid (Amicar)

1. Protamine sulfate Rationale: The antidote to heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrhage occurs. Potassium chloride is administered for a potassium deficit. Vitamin K is an antidote for warfarin sodium. Aminocaproic acid is the antidote for thrombolytic therapy.

102.) A client with human immunodeficiency virus is taking nevirapine (Viramune). The nurse should monitor for which adverse effects of the medication? Select all that apply. 1. Rash 2. Hepatotoxicity 3. Hyperglycemia 4. Peripheral neuropathy 5. Reduced bone mineral density

1. Rash 2. Hepatotoxicity Rationale: Nevirapine (Viramune) is a non-nucleoside reverse transcriptase inhibitors (NRTI) that is used to treat HIV infection. It is used in combination with other antiretroviral medications to treat HIV. Adverse effects include rash, Stevens-Johnson syndrome, hepatitis, and increased transaminase levels. Hyperglycemia, peripheral neuropathy, and reduced bone density are not adverse effects of this medication.

114.) A postoperative client requests medication for flatulence (gas pains). Which medication from the following PRN list should the nurse administer to this client? 1. Ondansetron (Zofran) 2. Simethicone (Mylicon) 3. Acetaminophen (Tylenol) 4. Magnesium hydroxide (milk of magnesia, MOM)

2. Simethicone (Mylicon) Rationale: Simethicone is an antiflatulent used in the relief of pain caused by excessive gas in the gastrointestinal tract. Ondansetron is used to treat postoperative nausea and vomiting. Acetaminophen is a nonopioid analgesic. Magnesium hydroxide is an antacid and laxative.

Bands

3% 0-700 cells/mm3

148.) A client is taking cetirizine hydrochloride (Zyrtec). The nurse checks for which of the following side effects of this medication? 1. Diarrhea 2. Excitability 3. Drowsiness 4. Excess salivation

3. Drowsiness Rationale: A frequent side effect of cetirizine hydrochloride (Zyrtec), an antihistamine, is drowsiness or sedation. Others include blurred vision, hypertension (and sometimes hypotension), dry mouth, constipation, urinary retention, and sweating.

PCO2

35-45 mmHg

159.) A nurse is caring for a client receiving morphine sulfate subcutaneously for pain. Because morphine sulfate has been prescribed for this client, which nursing action would be included in the plan of care? 1. Encourage fluid intake. 2. Monitor the client's temperature. 3. Maintain the client in a supine position. 4. Encourage the client to cough and deep breathe.

4. Encourage the client to cough and deep breathe. Rationale: Morphine sulfate suppresses the cough reflex. Clients need to be encouraged to cough and deep breathe to prevent pneumonia. **ABCs—airway, breathing, and circulation**

36.) The client has a PRN prescription for ondansetron (Zofran). For which condition should this medication be administered to the postoperative client? 1. Paralytic ileus 2. Incisional pain 3. Urinary retention 4. Nausea and vomiting

4. Nausea and vomiting Rationale: Ondansetron is an antiemetic used to treat postoperative nausea and vomiting, as well as nausea and vomiting associated with chemotherapy. The other options are incorrect.

143.) A client has just taken a dose of trimethobenzamide (Tigan). The nurse plans to monitor this client for relief of: 1. Heartburn 2. Constipation 3. Abdominal pain 4. Nausea and vomiting

4. Nausea and vomiting Rationale: Trimethobenzamide is an antiemetic agent used in the treatment of nausea and vomiting. The other options are incorrect.

Ca+ level

8.6-10mg/dL *eat 800mg / day of Ca+

A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breaths/min. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which of the following? 1) A decreased pH and an increased CO2 2) An increased pH and a decreased Co2 3) A decreased pH and a decreased HCO3- 4) An increased pH with an increased HCO3-

Answer: 4 Rational: Clients experiencing nausea and vomiting would most likely present with metabolic alkalosis resulting from loss of gastric acid, thus causing the pH and HCO3- to increase. Symptoms experienced by the client would include hypventilation and tachycardia. Option 2 reflects a respiratory acidotic condition. Option 2 reflects a respiratory alkalotic condition. Option 3 reflects a metabolic acidotic condition.

A client with type 1 diabetes mellitus takes NPH insulin every morning and checks the blood glucose level four times per day. The client tells the nurse in the physician's off that yesterday the late afternoon blood glucose level was 60mg/dL and that he felt funny. Which client statement would indicate an understanding of this occurrence 1. My blood glucose is running low because I am tired 2. I forgot to take my usual afternoon snack yesterday 3. I took less insulin this morning so I won't feel funny today 4. I don't know why I have to check my blood glucose four times a day that seems too often

Correct Answer is "I forgot to take my usual afternoon snack yesterday" Rationale: Hypoglycemia is a blood glucose of 60 mg/dL or less. The causes are multiple, but in this case omitting the afternoon snack would lead to hypoglycemia. Fatigue and self-adjustment of the insulin dose are incorrect options. Recommended frequency of blood glucose testing is four times a day.

A licensed practical nurse LPN is caring for an older client who has hyperparathyroidism with severe osteoporosis. The LPN plans to address which nursing diagnosis formulated by the registered nurse as the highest priority for this client?

Correct Answer is Risk of Injury related to demineralization of bone that can result in pathological fractures. Rationale: The individual with hyperparathyroidism with severe osteoporosis is at risk for pathological fractures because of bone demineralization. Thus home safety is a priority.

A Client has received instructions about postoperative care after a parathyroidectomy. Which client action would indicate to the nurse that the client understood the instructions? 1. The client places the hands at the back of the head when moving the neck 2. The client speaks frequently to exercise the vocal cords 3. The client splints the chest when deep breathing and coughing 4. The client drinks nothing by mouth for 24 to 48 hours.

Correct Answer is The client places the hands at the back of the head when moving the neck Rationale: The weight of the client's head must be supported when the client flexes the neck or moves the head. This decreases the stress on the suture line, which prevents bleeding. Options 2 and 4 are inaccurate and actually could be harmful to the client. Option 3 is not necessary, as the client has an incision in the neck, not the chest.

A nurse reinforces home care instructions to a client with a diagnosis of primary hyperparathyroidism. Which client statement indicates that the client has a knowledge deficit about treatment of the condition? 1. I take the diuretic every day because it helps get rid of the extra calcium in my blood 2. I won't feel so sad now that I take this medication 3. I urinate frequently, so I take only half of my fluid pill 4. I love milk shakes with ice cream, but I guess I can't have them as much now.

Correct answer is "I urinate frequently, so I take only half of my fluid pill" Rationale: Medical management of hyperparathyroidism includes increasing urinary calcium excretion with diuretics. High-calcium foods should be limited. The psychosocial manifestations associated with the disorder diminish as serum calcium levels are lowered with treatment.

What is the exchange of gases between the atmosphere and the blood through the alveoli called?

External respiration

Invasive

Inserting or entering into a body part

Angina Drugs that Improve Myocardial Blood Flow

Nitrates & Calcium Channel Blockers

Deteriorating

Worsening.

A Client with Cushing's syndrome is being instructed by the nurse about follow-up care. Which statement by the client indicates a need for further instruction?

"I should avoid food rich in Potassium" Rationale: Cushing's syndrome is a metabolic disorder resulting from the chronic and excessive production of cortisol by the adrenal cortex. Hypokalemia is associated with this condition, and the client should consume foods high in potassium. Clients experience activity intolerance, osteoporosis, and frequent bruising. Fluid volume excess results from water and sodium retention. Hyperglycemia is caused by an increased cortisol secretion.

virus

(virology) ultramicroscopic infectious agent that replicates itself only within cells of living hosts

What are the classification of drugs?

-Antidysrhythmics -Prevents Irregular Heart Rhythms -Antihypertensives -Controls high blood pressure -Anticoagulants -Inhibits clotting of the blood -Antacids -Used to neutralize acidity in the digestive system -Antiflatulants -Used for excess gas in the intestinal tract; acts on the surface of bubbles by reducing the surface tension and thereby disrupting or breaking the bubble -Nonopioid Analgesics (Non-Narcotic) -Relieves pain and inflammation -Nonsteriodal anti-inflammation (NSAIDS) -Counteraction of body tissue inflammation -Anti-infectives (antibiotics) -Inhibits growth of or destroys microorganisms -Vaccines and Toxoids -Artificially induced immunity to a specific disease or toxin -Local Anesthetic Agents -Produce numbness in local area -Antipsychotic Agents -Improves or moderates mental symptoms ranging from anxiety to psychosis -Insulin -Decreases blood sugar by transport of glucose into the body tissue and cells -Oral Hypoglycemics -Regulates amount of glucose in the blood (various ways this happens, depending on the drug) -Cathartics -Acts as a cleanser that produces watery evacuation of intestinal contents through increased peristalsis; aka Cleans you out -Stool Softeners -Promotes bowel movement by adding water and/or bulk to stool. (It makes you regular) -Antiemetics -Prevention or relief of nausea/vomiting

Heparin Adverse Effects

-Hemorrhage, reduced BL, increased HR, bruises, petechiae, hematomas, red/black stools, cloudy/discolored urine, pelvic pain, headaches/faintness, Heparin-induced thrombocytopenia (HIT), hypersensitivity rxns.

What are the six rights of a patient?

-Right Medication/Drug -Right dose -Right route -RIght time -RIght patient -Right documentation

What are two ways to administer oral medication?

-Solids; i.e. in form of tablets, capsules or lozenges. -Liquids; i.e. in form of syrup, elixir or suspension

Drugs are administered for the purpose of achieving...

...the desired effect.

Serum Cratinine

0.6-1.3 mg/dL

Therapeutic Range Lithium

0.6-1.4 mEq/L

Normal "bleeding time"

1-9 min

Stages of Hemostasis

1. Formation of platelet plug 2. Coagulation: prod. of fibrin 3. Physiologic removal of clots by fibrin

125.) A nurse is preparing to administer digoxin (Lanoxin), 0.125 mg orally, to a client with heart failure. Which vital sign is most important for the nurse to check before administering the medication? 1. Heart rate 2. Temperature 3. Respirations 4. Blood pressure

1. Heart rate Rationale: Digoxin is a cardiac glycoside that is used to treat heart failure and acts by increasing the force of myocardial contraction. Because bradycardia may be a clinical sign of toxicity, the nurse counts the apical heart rate for 1 full minute before administering the medication. If the pulse rate is less than 60 beats/minute in an adult client, the nurse would withhold the medication and report the pulse rate to the registered nurse, who would then contact the health care provider.

Therapeutic Range Theophylline (Theobid)

10-20 mcg/mL

227.) When teaching a client who is being started on imipramine hydrochloride (Tofranil), the nurse would inform the client that the desired effects of the medication may: 1. Start during the first week of administration 2. Not occur for 2 to 3 weeks of administration 3. Start during the second week of administration 4. Not occur until after a month of administration

2. Not occur for 2 to 3 weeks of administration Rationale: The therapeutic effects of administration of imipramine hydrochloride may not occur for 2 to 3 weeks after the antidepressant therapy has been initiated. Therefore options 1, 3, and 4 are incorrect.

174.) A client with portosystemic encephalopathy is receiving oral lactulose (Chronulac) daily. The nurse assesses which of the following to determine medication effectiveness? 1. Lung sounds 2. Blood pressure 3. Blood ammonia level 4. Serum potassium level

3. Blood ammonia level Rationale: Lactulose is a hyperosmotic laxative and ammonia detoxicant. It is used to prevent or treat portosystemic encephalopathy, including hepatic precoma and coma. It also is used to treat constipation. The medication retains ammonia in the colon (decreases the blood ammonia concentration), producing an osmotic effect. It promotes increased peristalsis and bowel evacuation, expelling ammonia from the colon.

A PT > __________ makes a person a bleeding risk

30sec

Lymphocytes

34% 1000-4800 cells/mm3

HR X SV= CO

4 - 8 L/min 750 ml/min, require for brain

Monocytes

4% 0-800 cells/mm3

WBC

4,500-11,000

syndrome

A group of symptoms or signs that collectively characterize or indicate a disease, disorder, abnormality, etc.

High PCWP = Low PCWP =

An increased PCWP indicates hypervolemia, left ventricular failure, or mitral regurgitation. A decreased PCWP indicates hypovolemia.

symptom

An indication of a problem

Manifestation

An indication or sign of something

Complication

An undesired problem that is the result of some other event.

Beta Adrenergic Blockers Mechanism

Angina prevention Propranolol, Metoprolol Decrease cardiac O2 demand, sympathetic response, heart rate, & force of contraction

Drugs for Thromboembolic Disorders

Anticoagulants Antiplatelets Thrombolytics

What are the side effects of taking β-blockers?

Bradycardia / AV block Heart failure Hypotension Bronchoconstriction Pulmonary oedema Vasoconstriction Sexual dysfunction Fatigue / Sleep disturbances

Beta Adrenergic Blockers Adverse Effects

Bradycardia, decreased AV conduction & contractility, asthmatic effects, insomnia, depression, bizarre dreams, sexual dysfunction Use caution in pts w/ diabetes

A client is seen in the health care clinic, and a diagnosis of hypothyroidism is suspected. Which finding does the nurse expect to note in the client?

Bradycardia- Rationale: Hypothyroidism is a condition characterized by decreased activity of the thyroid gland. Clinical manifestations associated with hypothyroidism include bradycardia; obesity; dry, sparse hair; flaky, dry, inelastic skin; and a lowered basal body temperature. The client's ability to sweat also diminishes. Constipation and fecal impaction occur, and the client has an increased susceptibility to infection. The blood pressure may be normal or slightly elevated, and the temperature is normal to subnormal. Options 2, 3, and 4 are findings noted in hyperthyroidism.

Potential

Capable of occurring or likely to occur

A client with myxedema has developed impaired memory, inattentiveness, and lethargy. The family is distraught about the decline in the client's intellectual functioning. Which appropriate statement should the nurse make?

Correct Answer is "It is obvious to me that you are concerned but these symptoms occur with myxedema and should improve with treatment" Rationale: The appropriate response acknowledges the family's concerns and provides accurate information about the neurological manifestations of myxedema. With thyroid hormone replacement therapy, the symptoms should decrease, with mentation returning to normal in about 2 weeks.

A client is admitted to the hospital with severe hypoparathyriodism. The nurse plans to do which of the following to promote client safety? 1. Use waist restraints continuously 2. Institute seizure precautions 3. Keep the room slightly cool 4. Keep the head of the bed slightly lowered

Correct Answer is Institute Seizure precautions Rationale: Hypoparathyroidism results from insufficient parathyroid hormone, leading to low serum calcium levels. Hypocalcemia can cause tetany, which can lead to seizures if untreated. The nurse should institute seizure precautions to maintain a safe environment. Options 1, 3, and 4 are unrelated to the client's diagnosis.

A nurse is caring for a client with diabetic ketoacidosis (DKA) who has been placed on an intravenous insulin infusion. The nurse reviews the plan of care and prepares to monitor which serial laboratory result as it becomes available? 1. Calcium Level 2. Sodium Level 3. Potassium Level 4. Serum Osmolarity

Correct Answer is Potassium Level Rationale: The client with DKA becomes hyperkalemic initially as potassium leaves the cells in response to a lowered pH. However, the potassium level drops quickly once the client is treated with fluid replacement and insulin therapy. This is because potassium is carried into the cells along with glucose and insulin and also because potassium is excreted in the urine once rehydration has occurred. Thus the nurse must plan to carefully monitor the results of serum potassium levels. Options 1, 2, and 4 are unrelated to the client's diagnosis.

A licensed practical nurse is caring for an older client with diabetic retinopathy secondary to type 2 diabetes mellitus. The LPN plans to address which nursing diagnosis formulated by the registered nurse as the highest priority for client? 1. Disturbed Body Image related to perceived negative effect of visual changes 2. Acute Pain related to degeneration of the retina 3. Situational Low Self-Esteem related to perceived loss of independence 4. Risk of injury related to decreased visual acuity

Correct Answer is Risk of injury related to decreased visual acuity Rationale: The individual with retinopathy suffers from varying degrees of visual impairment. Thus falls are a major concern, especially for the older client. Safety takes precedence over self-esteem and body image, thus eliminating options 1 and 3. Option 2 is incorrect because retinopathy is a painless pathological condition of diabetes mellitus.

A nurse reinforces instructions about the signs of addisonian crisis to client with Addison's disease. The nurse determines that teaching was effective when the client states that which of the following is a sign of this crisis? 1. Profuse diaphoresis 2. Severe agitation 3. Malignant hypertension 4. Sudden, profound weakness

Correct Answer is Sudden, profound weakness Rationale: Addisonian crisis is a serious, life-threatening response to acute adrenal insufficiency that is most commonly precipitated by a major stressor. The client with addisonian crisis may have any of the symptoms of Addison's disease, but the primary problems are sudden, profound weakness; severe abdominal, back, and leg pain; hyperpyrexia followed by hypothermia; peripheral vascular collapse; coma; and renal shutdown.

A nurse visits a community half way house with one bathroom. The nurse notices urine all over the walls of the bathroom. The toilet is clogged with feces and paper towels.

Infection control.

Nerve tissue is composed of neurons and connective tissue cells that are referred to as which of the following?

Neuroglia

All actions of the nervous system depend on the transmission of nerve impulses over which of the following?

Neurons

Side Effects of Organic Nitrates

Reflex tachycardia, hypotension, flushing, headache Contraindicated w/ anti-impotence meds (intensify vasodilation)

Define Reconstitution

Restoring a dehydrated substance to its previous liquid form by adding lidquid.

Define Hub

The wide base portion of the needle that fits over the syringe tip.

Why are skeletal muscles also called voluntary muscles?

They are under conscious control

A man dx with bipolar disorder states, "I don't understand, I believe in God and have not done anything to deserve this". What is the nurse's best response?

You didn't do anything wrong. You have a chemical imbalance in your brain.

List the side effects of anti-platelets and anti-coagulants.

!! Bleeding !! Higher risk of bleeding if >65yrs, history of stroke or GI bleed Aspirin carries particular risk of GI bleeding as damages lining of stomach Warfarin also carries a risk of skin necrosis within 1 week of starting

The nurse is caring for a client after thyroidectomy and is monitoring for complications. Which of the following, if noted in the client, indicates a need for physician notification?

Numbness and Tingling around the mouth. Rationale: Thyroidectomy is the surgical removal of the thyroid gland. Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed or traumatized during surgery. The physician should be called immediately if the client develops numbness and tingling around the mouth or in the fingertips or toes, muscle spasms, or twitching. A hoarse or weak voice may occur temporarily if there has been unilateral injury to the laryngeal nerve during surgery. Pain is expected in the postoperative period. Calcium gluconate ampules should be available at the bedside, and the client should have a patent intravenous line in the event that hypocalcemic tetany occurs.

L sided heart failure

O2 blood going backwards into the lungs, SOB, Crackles, fatigue, weakness, tachy,

Hematologic

OF OR RELATING TO BLOOD

A nursing is caring for a hospitalized older client with diabetes mellitus who is diagnosed with dehydration. The Client is alert but disoriented, pale, and slightly diaphoretic; and the nurse suspects that the client is hypoglycemic. The initial nursing intervention is to:

Obtain a fingerstick blood sample and test the glucose level. Rationale: The nurse should confirm that the client is hypoglycemic by checking the blood glucose. Option 1 is incorrect because the hypoglycemia has not been determined. More information should be gathered before calling the physician

Cushing syndrome

Occurs when your body is exposed to high levels of the hormone cortisol for a long time. The most common cause of Cushing syndrome, sometimes called hypercortisolism, is the use of oral corticosteroid medication. The condition can also occur when your body makes too much cortisol. Too much cortisol can produce some of the hallmark signs of Cushing syndrome — a fatty hump between your shoulders, a rounded face, and pink or purple stretch marks on your skin. Cushing syndrome can also result in high blood pressure, bone loss and, on occasion, diabetes. Treatments for Cushing syndrome can return your body's cortisol production to normal and noticeably improve your symptoms. The earlier treatment begins, the better your chances for recovery

Warfarin

Oral anticoagulant Also used as rat poison Delayed onset, Vit. K antagonist, blocks biosynthesis of factors VII,IX,X, & prothrombin

What is the slowest mode of transportation?

Orally is the slowest because the medication has to be digested and must cross the stomach/intestinal lining before it is absorbed into the bloodstream.

Skin aids in maintaining the calcium and phosphate levels of the body by participating in the production of which of the following?

Vitamin D

What should the patient take with the medication?

Water or other acceptable liquids

A nurse has taught the principles of foot care to a client with diabetes mellitus. The nurse determines that the client understood the information if the client states to:

Wear shoes that are closed toe and heal. Rationale: The client should wear shoes that are closed at the heel and toe to prevent injury to the feet. The client should avoid other potential sources of injury to the feet. Application of direct heat to the feet could cause burns, and application of lotion between the toes could cause skin breakdown. Toenails should be cut straight across at the level of the contour of the toe. Other general foot care measures include inspecting the feet daily, cleaning them with mild soap, rinsing and drying them well, and using lanolin-based lotions, except between the toes.

Treatment of High LDLs

Weight control, exercise, smoking cessation, TLC (therapeutic lifestyle changes) diet

A nurse is explaining a fire drill routine to a group of clients. A client becomes disruptive and continually interrupts the group. What is the nurse's best response?

When you interrupt, I cannot explain what to do to the group.

(cuffed tracheostomy tube) the nurse checks which critical occurence before plugging the tracheostomy

the cuff must be deflated before a cuffed tracheostomy tube is plugged

Describe the effect of calcium (and of blocking calcium channels) on the heart and blood vessels.

Needed for contraction of myocytes and for constriction of smooth muscle in blood vessels Depolarisation of intrinsic pacemaker cells is also affected by T-type calcium channels Blocking calcium channels can: -Decrease heart rate, slow conduction through AV node, decrease contractility -Promote coronary vasodilation and peripheral vasodilation (reduce afterload)

Which are the functional units of the kidney?

Nephrons

client with endotracheal tube

cannot talk so use 'pictures or word board' to communicate

PVC

premature ventricular contraction, possible elctrolyte imbalance. Most common ectopic beat seen as wide, bizarre QRS treated with lidocaine and antiarrhythmics (Toprol) Rate: normal, slow, or fast, Irregular P waves: P waves may be present but absent before PVC PR interval: not able to measure due to no P wave. QRS is wider and bizarre. T wave is opposite from QRS. Be careful of to much lasix.

WBC with a shift to the left

proliferation of WBCs

128.) A nurse is providing instructions to an adolescent who has a history of seizures and is taking an anticonvulsant medication. Which of the following statements indicates that the client understands the instructions? 1. "I will never be able to drive a car." 2. "My anticonvulsant medication will clear up my skin." 3. "I can't drink alcohol while I am taking my medication." 4. "If I forget my morning medication, I can take two pills at bedtime."

3. "I can't drink alcohol while I am taking my medication." Rationale: Alcohol will lower the seizure threshold and should be avoided. Adolescents can obtain a driver's license in most states when they have been seizure free for 1 year. Anticonvulsants cause acne and oily skin; therefore a dermatologist may need to be consulted. If an anticonvulsant medication is missed, the health care provider should be notified.

106.) Fluoxetine (Prozac) is prescribed for the client. The nurse reinforces instructions to the client regarding the administration of the medication. Which statement by the client indicates an understanding about administration of the medication? 1. "I should take the medication with my evening meal." 2. "I should take the medication at noon with an antacid." 3. "I should take the medication in the morning when I first arise." 4. "I should take the medication right before bedtime with a snack."

3. "I should take the medication in the morning when I first arise." Rationale: Fluoxetine hydrochloride is administered in the early morning without consideration to meals. **Eliminate options 1, 2, and 4 because they are comparable or alike and indicate taking the medication with an antacid or food.**

The stomach muscle churns and mixes food, turning the mass into a soupy substance called which of the following?

Chyme

Symptoms of Angina

Classic: chest pain (constricting, squeezing, suffocating) May radiate to jaw, neck, shoulder, back, down the arm(s) Women: epigastric or back discomfort Older adults: atypical symptoms Persons w/ diabetes: not classic

histoplamosis infection (fungus)

from contaminated moist soil bird droppings floors of chicken houses bat caves mushroom cellars

to minimize exposure to environmental pollutants

remove carpeting from the living area whenever possible -remove allergens

ARDS manifestations

restlessness, tachypnea, dyspnea (early signs) blood tinged fronthy sputum bronchial breath sounds

A Client with type 2 diabetes mellitus was recently hospitalized for hyperglycemic hyperosmolar nonketotic syndrome (HHNS). On discharge from the hospital, the client expresses concern about the recurrence of HHNS. Which statement by the nurse is therapeutic?

"You have concerns about the treatment for your condition" Rationale: The nurse should provide time and listen to the client's concerns. In option 4 the nurse is attempting to clarify the client's feelings. Options 1 and 2 provide inappropriate false reassurance. In addition, the nurse does not tell the client not to worry. Option 3 is not an appropriate nursing response. It disregards the client's concerns and gives advice.

Define and give an example of an inhibitor.

'Inhibitor' = refers to a drug that interferes with an enzyme E.g: Lisinopril inhibits the angiotensin converting enzyme to prevent formation of angiotensin II

3 sputum cultures are negative

- Pt is considered noninfectious at this point - it is performed 2-4 weeks after TB therapy

What must a provider's orders contain?

-Drug Name -Amount of drug per dose -Number of doses -Route of administration -Frequency or number of times per day the drug is to be taken -Signature of ordering provider

Injections are given for the following purposes:

-Patient cannot take medication by mouth -Hasten the action of the drug -Digestive juices would counteract the effect of the drug given PO (orally)

When do most errors occur?

-When we fail to follow routine procedures -When we do not follow the six rights -When we miscalculate dosages

What are two ways that orders may be initiated?

-Written -Verbal/Telephone

TB private room description

-at least 6 air exchange per hour -venting to the outside - have contravention lights installed

TB

-droplet -well ventelated room with fresh air exchange (respiratory isolation) -hepa respirator for health care workers

spacer

-reduces the incidence of yeast infections -dispensed more deeply and uniformly than whan w/o it -there is less need to coordinate the effort of inhalation with pressing on the canister of the inhaler -decrease either the no. or volume of puffs taken

pneumonectomy

-removal of the entire lung temporary numbless and tendernes in the surgical sight

chronic airflow limitation (cal)

-should alternate periods of activity with rest periods to conserve energy -sit when performing activities -limit activities that involve arm movements -avoid raising the arms above the head

When administering medications, it is essential for the nurse to have an understanding of basic arithmetic to calculate doses. The physician has ordered 250 mg of a medication that is available in 1-g amount. The vial reads 2 ml = 1 g. What dose would be given by the nurse?

0.5 ml = 250 mg of this medication. (Dose ordered/dose on hand) × amount on hand = amount administered [250 mg/1000 mg (1 g)] × 2 ml = 500/1000 = ½ ml or, in decimals, 0.5 ml

1 toxoplasmosis 2 cryptosporydiosis 3 malignant lymphoma 4 pneumocystis pneumonia

1 changes in mental status, neurological deficits, headaches, fever 2 mild diarrhea to cholera-like syndrome with body wasting and electrolyte imbalances (15-20 L/day) 3 weight loss, fever and night sweats 4 fungal infection of the lung (usually seen with HIV) fever, dyspnea, tachypnea, persistent dry cough, crackles

Describe the process of blood clotting.

1) Endothelial damage exposes collagen to platelets 2) Triggers platelet aggregation at injury site 3) Platelets become activated, releasing their granular stores (includes Thomboxane A2) 4) Activates more platelets and starts cascade that results in platelet shape change which helps the platelets stick together (involves Glycoprotein IIb-IIIa) 5) Endothelial injury also triggers a tissue factor pathway that results in prothrombin changing to thrombin 6) Primary role of thrombin is to convert fibrinogen to fibrin (the building block of the clot)

Which drugs are commonly prescribed for each of the following? 1) Hypertension 2) Heart failure 3) Stable angina 4) Acute unstable angina/NSTEMI 5) Secondary prevention of events following MI

1) β-blockers, calcium-channel blockers 2) ACE Inhibitors, β-blockers 3) β-blockers, calcium channel blockers 4) β-blockers 5) ACE Inhibitors

173.) A nurse reviews the medication history of a client admitted to the hospital and notes that the client is taking leflunomide (Arava). During data collection, the nurse asks which question to determine medication effectiveness? 1. "Do you have any joint pain?" 2. "Are you having any diarrhea?" 3. "Do you have frequent headaches?" 4. "Are you experiencing heartburn?"

1. "Do you have any joint pain?" Rationale: Leflunomide is an immunosuppressive agent and has an anti-inflammatory action. The medication provides symptomatic relief of rheumatoid arthritis. Diarrhea can occur as a side effect of the medication. The other options are unrelated to medication effectiveness.

127.) The nurse provides medication instructions to an older hypertensive client who is taking 20 mg of lisinopril (Prinivil, Zestril) orally daily. The nurse evaluates the need for further teaching when the client states which of the following? 1. "I can skip a dose once a week." 2. "I need to change my position slowly." 3. "I take the pill after breakfast each day." 4. "If I get a bad headache, I should call my doctor immediately."

1. "I can skip a dose once a week." Rationale: Lisinopril is an antihypertensive angiotensin-converting enzyme (ACE) inhibitor. The usual dosage range is 20 to 40 mg per day. Adverse effects include headache, dizziness, fatigue, orthostatic hypotension, tachycardia, and angioedema. Specific client teaching points include taking one pill a day, not stopping the medication without consulting the health care provider (HCP), and monitoring for side effects and adverse reactions. The client should notify the HCP if side effects occur.

31.) A community health nurse visits a client at home. Prednisone 10 mg orally daily has been prescribed for the client and the nurse reinforces teaching for the client about the medication. Which statement, if made by the client, indicates that further teaching is necessary? 1. "I can take aspirin or my antihistamine if I need it." 2. "I need to take the medication every day at the same time." 3. "I need to avoid coffee, tea, cola, and chocolate in my diet." 4. "If I gain more than 5 pounds a week, I will call my doctor."

1. "I can take aspirin or my antihistamine if I need it." Rationale: Aspirin and other over-the-counter medications should not be taken unless the client consults with the health care provider (HCP). The client needs to take the medication at the same time every day and should be instructed not to stop the medication. A slight weight gain as a result of an improved appetite is expected, but after the dosage is stabilized, a weight gain of 5 lb or more weekly should be reported to the HCP. Caffeine-containing foods and fluids need to be avoided because they may contribute to steroid-ulcer development.

179.) A nurse provides medication instructions to a client who had a kidney transplant about therapy with cyclosporine (Sandimmune). Which statement by the client indicates a need for further instruction? 1. "I need to obtain a yearly influenza vaccine." 2. "I need to have dental checkups every 3 months." 3. "I need to self-monitor my blood pressure at home." 4. "I need to call the health care provider (HCP) if my urine volume decreases or my urine becomes cloudy."

1. "I need to obtain a yearly influenza vaccine." Rationale: Cyclosporine is an immunosuppressant medication. Because of the medication's effects, the client should not receive any vaccinations without first consulting the HCP. The client should report decreased urine output or cloudy urine, which could indicate kidney rejection or infection, respectively. The client must be able to self-monitor blood pressure to check for the side effect of hypertension. The client needs meticulous oral care and dental cleaning every 3 months to help prevent gingival hyperplasia.

77.) Phenytoin (Dilantin), 100 mg orally three times daily, has been prescribed for a client for seizure control. The nurse reinforces instructions regarding the medication to the client. Which statement by the client indicates an understanding of the instructions? 1. "I will use a soft toothbrush to brush my teeth." 2. "It's all right to break the capsules to make it easier for me to swallow them." 3. "If I forget to take my medication, I can wait until the next dose and eliminate that dose." 4. "If my throat becomes sore, it's a normal effect of the medication and it's nothing to be concerned about."

1. "I will use a soft toothbrush to brush my teeth." Rationale: Phenytoin (Dilantin) is an anticonvulsant. Gingival hyperplasia, bleeding, swelling, and tenderness of the gums can occur with the use of this medication. The client needs to be taught good oral hygiene, gum massage, and the need for regular dentist visits. The client should not skip medication doses, because this could precipitate a seizure. Capsules should not be chewed or broken and they must be swallowed. The client needs to be instructed to report a sore throat, fever, glandular swelling, or any skin reaction, because this indicates hematological toxicity.

220.) A adult client with muscle spasms is taking an oral maintenance dose of baclofen (Lioresal). The nurse reviews the medication record, expecting that which dose should be prescribed? 1. 15 mg four times a day 2. 25 mg four times a day 3. 30 mg four times a day 4. 40 mg four times a day

1. 15 mg four times a day Rationale: Baclofen is dispensed in 10- and 20-mg tablets for oral use. Dosages are low initially and then gradually increased. Maintenance doses range from 15 to 20 mg administered three or four times a day.

115.) A client received 20 units of NPH insulin subcutaneously at 8:00 AM. The nurse should check the client for a potential hypoglycemic reaction at what time? 1. 5:00 PM 2. 10:00 AM 3. 11:00 AM 4. 11:00 PM

1. 5:00 PM Rationale: NPH is intermediate-acting insulin. Its onset of action is 1 to 2½ hours, it peaks in 4 to 12 hours, and its duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.

10.) The clinic nurse is performing an admission assessment on a client. The nurse notes that the client is taking azelaic acid (Azelex). Because of the medication prescription, the nurse would suspect that the client is being treated for: 1. Acne 2. Eczema 3. Hair loss 4. Herpes simplex

1. Acne Rationale: Azelaic acid is a topical medication used to treat mild to moderate acne. The acid appears to work by suppressing the growth of Propionibacterium acnes and decreasing the proliferation of keratinocytes. Options 2, 3, and 4 are incorrect.

A nurse prepares to administer digoxin (Lanoxin) to a 3-year-old with a diagnosis of congestive heart failure and notes that the apical heart rate is 120 beats per minute. Which nursing action is appropriate? 1. Administer the digoxin. 2. Recheck the apical heart rate in 15 minutes. 3. Notify the registered nurse. 4. Hold the medication.

1. Administer the digoxin. Rationale: The normal apical heart rate for a 3-year-old is 80 to 125 beats per minute. Because the apical heart rate is within normal range, options 2, 3, and 4 are inappropriate.

145.) A nurse has a prescription to give a client albuterol (Proventil HFA) (two puffs) and beclomethasone dipropionate (Qvar) (nasal inhalation, two puffs), by metered-dose inhaler. The nurse administers the medication by giving the: 1. Albuterol first and then the beclomethasone dipropionate 2. Beclomethasone dipropionate first and then the albuterol 3. Alternating a single puff of each, beginning with the albuterol 4. Alternating a single puff of each, beginning with the beclomethasone dipropionate

1. Albuterol first and then the beclomethasone dipropionate Rationale: Albuterol is a bronchodilator. Beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

26.) Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. A nurse reinforces instructions for the client and tells the client to avoid which of the following while taking this medication? 1. Alcohol 2. Organ meats 3. Whole-grain cereals 4. Carbonated beverages

1. Alcohol Rationale: When alcohol is combined with glimepiride (Amaryl), a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol consumption while taking this medication. The items in options 2, 3, and 4 do not need to be avoided.

142.) A health care provider has written a prescription for ranitidine (Zantac), once daily. The nurse should schedule the medication for which of the following times? 1. At bedtime 2. After lunch 3. With supper 4. Before breakfast

1. At bedtime Rationale: A single daily dose of ranitidine is usually scheduled to be given at bedtime. This allows for a prolonged effect, and the greatest protection of the gastric mucosa. **recall that ranitidine suppresses secretions of gastric acids**

100.) Saquinavir (Invirase) is prescribed for the client who is human immunodeficiency virus seropositive. The nurse reinforces medication instructions and tells the client to: 1. Avoid sun exposure. 2. Eat low-calorie foods. 3. Eat foods that are low in fat. 4. Take the medication on an empty stomach.

1. Avoid sun exposure. Rationale: Saquinavir (Invirase) is an antiretroviral (protease inhibitor) used with other antiretroviral medications to manage human immunodeficiency virus infection. Saquinavir is administered with meals and is best absorbed if the client consumes high-calorie, high-fat meals. Saquinavir can cause photosensitivity, and the nurse should instruct the client to avoid sun exposure.

A 15-year-old child is scheduled to receive a series of the hepatitis B vaccine. The child arrives at the clinic for the first dose. The nurse collects data on the child before administering the vaccine and asks the child about a history of an allergy to: 1. Baker's yeast 2. Eggs 3. Penicillin 4. Sulfonamides

1. Baker's yeast Rationale: A contraindication to receiving the hepatitis B vaccine is a previous anaphylactic reaction to common baker's yeast. An allergy to eggs, penicillin, and sulfonamides is unrelated to the contraindication to receiving this vaccine.

202.) A nurse is collecting data from a client about medications being taken, and the client tells the nurse that he is taking herbal supplements for the treatment of varicose veins. The nurse understands that the client is most likely taking which of the following? 1. Bilberry 2. Ginseng 3. Feverfew 4. Evening primrose

1. Bilberry Rationale: Bilberry is an herbal supplement that has been used to treat varicose veins. This supplement has also been used to treat cataracts, retinopathy, diabetes mellitus, and peripheral vascular disease. Ginseng has been used to improve memory performance and decrease blood glucose levels in type 2 diabetes mellitus. Feverfew is used to prevent migraine headaches and to treat rheumatoid arthritis. Evening primrose is used to treat eczema and skin irritation.

156.) A nurse is reviewing the laboratory results for a client receiving tacrolimus (Prograf). Which laboratory result would indicate to the nurse that the client is experiencing an adverse effect of the medication? 1. Blood glucose of 200 mg/dL 2. Potassium level of 3.8 mEq/L 3. Platelet count of 300,000 cells/mm3 4. White blood cell count of 6000 cells/mm3

1. Blood glucose of 200 mg/dL Rationale: A blood glucose level of 200 mg/dL is elevated above the normal range of 70 to 110 mg/dL and suggests an adverse effect. Other adverse effects include neurotoxicity evidenced by headache, tremor, insomnia; gastrointestinal (GI) effects such as diarrhea, nausea, and vomiting; hypertension; and hyperkalemia.

32.) Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response? 1. Decreased urinary output 2. Decreased blood pressure 3. Decreased peripheral edema 4. Decreased blood glucose level

1. Decreased urinary output Rationale: Desmopressin promotes renal conservation of water. The hormone carries out this action by acting on the collecting ducts of the kidney to increase their permeability to water, which results in increased water reabsorption. The therapeutic effect of this medication would be manifested by a decreased urine output. Options 2, 3, and 4 are unrelated to the effects of this medication.

105.) A nurse is collecting data from a client and the client's spouse reports that the client is taking donepezil hydrochloride (Aricept). Which disorder would the nurse suspect that this client may have based on the use of this medication? 1. Dementia 2. Schizophrenia 3. Seizure disorder 4. Obsessive-compulsive disorder

1. Dementia Rationale: Donepezil hydrochloride is a cholinergic agent used in the treatment of mild to moderate dementia of the Alzheimer type. It enhances cholinergic functions by increasing the concentration of acetylcholine. It slows the progression of Alzheimer's disease. Options 2, 3, and 4 are incorrect.

33.) The home health care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client is prescribed repaglinide (Prandin) and metformin (Glucophage) and asks the nurse to explain these medications. The nurse should reinforce which instructions to the client? Select all that apply. 1. Diarrhea can occur secondary to the metformin. 2. The repaglinide is not taken if a meal is skipped. 3. The repaglinide is taken 30 minutes before eating. 4. Candy or another simple sugar is carried and used to treat mild hypoglycemia episodes. 5. Metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide. 6. Muscle pain is an expected side effect of metformin and may be treated with acetaminophen (Tylenol).

1. Diarrhea can occur secondary to the metformin. 2. The repaglinide is not taken if a meal is skipped. 3. The repaglinide is taken 30 minutes before eating. 4. Candy or another simple sugar is carried and used to treat mild hypoglycemia episodes. Rationale: Repaglinide is a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin secretion that should be taken before meals, and that should be withheld if the client does not eat. Hypoglycemia is a side effect of repaglinide and the client should always be prepared by carrying a simple sugar with her or him at all times. Metformin is an oral hypoglycemic given in combination with repaglinide and works by decreasing hepatic glucose production. A common side effect of metformin is diarrhea. Muscle pain may occur as an adverse effect from metformin but it might signify a more serious condition that warrants health care provider notification, not the use of acetaminophen.

A child is hospitalized with Rocky Mountain spotted fever (RMSF). The health record reveals documentation that the child was bitten by a tick 2 weeks ago. The child presents with complaints of headache, fever, and anorexia, and the nurse notes a rash on the palms of the hands and soles of the feet. The nurse reviews the health care provider's prescriptions and anticipates that which of the following will be prescribed? 1. Doxycycline (Vibramycin) 2. Amphotericin B 3. Ganciclovir (Cytovene) 4. Amantadine (Symmetrel)

1. Doxycycline (Vibramycin) Rationale: The care of a child with RMSF caused by the bacterium Rickettsia rickettsii will include the administration of the antibacterial, doxycycline. Amphotericin B is used for fungal infections. Ganciclovir is used to treat cytomegalovirus. Amantadine is used to treat influenza A virus.

116.) A nurse administers a dose of scopolamine (Transderm-Scop) to a postoperative client. The nurse tells the client to expect which of the following side effects of this medication? 1. Dry mouth 2. Diaphoresis 3. Excessive urination 4. Pupillary constriction

1. Dry mouth Rationale: Scopolamine is an anticholinergic medication for the prevention of nausea and vomiting that causes the frequent side effects of dry mouth, urinary retention, decreased sweating, and dilation of the pupils. The other options describe the opposite effects of cholinergic-blocking agents and therefore are incorrect.

193.) Sodium hypochlorite (Dakin's solution) is prescribed for a client with a leg wound containing purulent drainage. The nurse is assisting in developing a plan of care for the client and includes which of the following in the plan? 1. Ensure that the solution is freshly prepared before use. 2. Soak a sterile dressing with solution and pack into the wound. 3. Allow the solution to remain in the wound following irrigation. 4. Apply the solution to the wound and on normal skin tissue surrounding the wound.

1. Ensure that the solution is freshly prepared before use. Rationale: Dakin solution is a chloride solution that is used for irrigating and cleaning necrotic or purulent wounds. It can be used for packing necrotic wounds. It cannot be used to pack purulent wounds because the solution is inactivated by copious pus. It should not come into contact with healing or normal tissue, and it should be rinsed off immediately if used for irrigation. Solutions are unstable and the nurse must ensure that the solution has been prepared fresh before use. **Eliminate options 2 and 3 first because they are comparable or alike. It makes sense to ensure that the solution is freshly prepared; therefore, select option 1**

A nurse is monitoring a hospitalized client with diabetes mellitus for signs of hyperglycemia.

1. Excessive thirst 2. Increased urine output 3. Kussmaul's respiration Rationale: Signs of hyperglycemia include excessive thirst, fatigue, restlessness, confusion, weakness, Kussmaul's respirations, diuresis, and coma, when severe. If the client presents with these symptoms, the blood glucose level should be checked immediately. Hunger, sweating, and diaphoresis are signs of hypoglycemia.

112.) A hospitalized client is started on phenelzine sulfate (Nardil) for the treatment of depression. The nurse instructs the client to avoid consuming which foods while taking this medication? Select all that apply. 1. Figs 2. Yogurt 3. Crackers 4. Aged cheese 5 Tossed salad 6. Oatmeal cookies

1. Figs 2. Yogurt 4. Aged cheese Rationale: Phenelzine sulfate (Nardil) is a monoamine oxidase inhibitor(MAOI). The client should avoid taking in foods that are high in tyramine. Use of these foods could trigger a potentially fatal hypertensive crisis. Some foods to avoid include yogurt, aged cheeses, smoked or processed meats, red wines, and fruits such as avocados, raisins, and figs.

93.) The client who is human immunodeficiency virus seropositive has been taking stavudine (d4t, Zerit). The nurse monitors which of the following most closely while the client is taking this medication? 1. Gait 2. Appetite 3. Level of consciousness 4. Hemoglobin and hematocrit blood levels

1. Gait Rationale: Stavudine (d4t, Zerit) is an antiretroviral used to manage human immunodeficiency virus infection in clients who do not respond to or who cannot tolerate conventional therapy. The medication can cause peripheral neuropathy, and the nurse should monitor the client's gait closely and ask the client about paresthesia. Options 2, 3, and 4 are unrelated to the use of the medication.

91.) Cyclobenzaprine (Flexeril) is prescribed for a client to treat muscle spasms, and the nurse is reviewing the client's record. Which of the following disorders, if noted in the client's record, would indicate a need to contact the health care provider regarding the administration of this medication? 1. Glaucoma 2. Emphysema 3. Hyperthyroidism 4. Diabetes mellitus

1. Glaucoma Rationale: Because this medication has anticholinergic effects, it should be used with caution in clients with a history of urinary retention, angle-closure glaucoma, and increased intraocular pressure. Cyclobenzaprine hydrochloride should be used only for short-term 2- to 3-week therapy.

158.) A client with chronic renal failure is receiving epoetin alfa (Epogen, Procrit). Which laboratory result would indicate a therapeutic effect of the medication? 1. Hematocrit of 32% 2. Platelet count of 400,000 cells/mm3 3. White blood cell count of 6000 cells/mm3 4. Blood urea nitrogen (BUN) level of 15 mg/dL

1. Hematocrit of 32% Rationale: Epoetin alfa is used to reverse anemia associated with chronic renal failure. A therapeutic effect is seen when the hematocrit is between 30% and 33%. The laboratory tests noted in the other options are unrelated to the use of this medication.

167.) A nurse prepares to reinforce instructions to a client who is taking allopurinol (Zyloprim). The nurse plans to include which of the following in the instructions? 1. Instruct the client to drink 3000 mL of fluid per day. 2. Instruct the client to take the medication on an empty stomach. 3. Inform the client that the effect of the medication will occur immediately. 4. Instruct the client that, if swelling of the lips occurs, this is a normal expected response.

1. Instruct the client to drink 3000 mL of fluid per day. Rationale: Allopurinol (Zyloprim) is an antigout medication used to decrease uric acid levels. Clients taking allopurinol are encouraged to drink 3000 mL of fluid a day. A full therapeutic effect may take 1 week or longer. Allopurinol is to be given with or immediately following meals or milk to prevent gastrointestinal irritation. If the client develops a rash, irritation of the eyes, or swelling of the lips or mouth, he or she should contact the health care provider because this may indicate hypersensitivity.

HCO3

22-27 mEq/L

A client with multiple sclerosis is receiving dantrolene (Dantrium) for relief of muscle spasticity. The nurse checks the results of which laboratory value periodically prescribed while the client is taking this medication? 1. Liver function studies 2. Creatinine 3. Blood urea nitrogen 4. Hematocrit level

1. Liver function studies (LFT's) Rationale: Dantrolene can cause liver damage, and the nurse should monitor the results of liver function studies. Baseline liver function studies are done before therapy starts, and regular liver function studies are performed throughout therapy. Dantrolene is discontinued if no relief of spasticity is achieved in 6 weeks.

113.) A nurse is reinforcing discharge instructions to a client receiving sulfisoxazole. Which of the following would be included in the plan of care for instructions? 1. Maintain a high fluid intake. 2. Discontinue the medication when feeling better. 3. If the urine turns dark brown, call the health care provider immediately. 4. Decrease the dosage when symptoms are improving to prevent an allergic response.

1. Maintain a high fluid intake. Rationale: Each dose of sulfisoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Some forms of sulfisoxazole cause the urine to turn dark brown or red. This does not indicate the need to notify the health care provider.

43.) A histamine (H2)-receptor antagonist will be prescribed for a client. The nurse understands that which medications are H2-receptor antagonists? Select all that apply. 1. Nizatidine (Axid) 2. Ranitidine (Zantac) 3. Famotidine (Pepcid) 4. Cimetidine (Tagamet) 5. Esomeprazole (Nexium) 6. Lansoprazole (Prevacid)

1. Nizatidine (Axid) 2. Ranitidine (Zantac) 3. Famotidine (Pepcid) 4. Cimetidine (Tagamet) Rationale: H2-receptor antagonists suppress secretion of gastric acid, alleviate symptoms of heartburn, and assist in preventing complications of peptic ulcer disease. These medications also suppress gastric acid secretions and are used in active ulcer disease, erosive esophagitis, and pathological hypersecretory conditions. The other medications listed are proton pump inhibitors. H2-receptor antagonists medication names end with -dine. Proton pump inhibitors medication names end with -zole.

109.) A client taking buspirone (BuSpar) for 1 month returns to the clinic for a follow-up visit. Which of the following would indicate medication effectiveness? 1. No rapid heartbeats or anxiety 2. No paranoid thought processes 3. No thought broadcasting or delusions 4. No reports of alcohol withdrawal symptoms

1. No rapid heartbeats or anxiety Rationale: Buspirone hydrochloride is not recommended for the treatment of drug or alcohol withdrawal, paranoid thought disorders, or schizophrenia (thought broadcasting or delusions). Buspirone hydrochloride is most often indicated for the treatment of anxiety and aggression.

12.) A nurse is caring for a client who is receiving an intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. During an inspection of the site, the nurse notes redness and swelling and that the rate of infusion of the medication has slowed. The nurse should take which appropriate action? 1. Notify the registered nurse. 2. Administer pain medication to reduce the discomfort. 3. Apply ice and maintain the infusion rate, as prescribed. 4. Elevate the extremity of the IV site, and slow the infusion.

1. Notify the registered nurse. Rationale: When antineoplastic medications (Chemotheraputic Agents) are administered via IV, great care must be taken to prevent the medication from escaping into the tissues surrounding the injection site, because pain, tissue damage, and necrosis can result. The nurse monitors for signs of extravasation, such as redness or swelling at the insertion site and a decreased infusion rate. If extravasation occurs, the registered nurse needs to be notified; he or she will then contact the health care provider.

235.) A tricyclic antidepressant is administered to a client daily. The nurse plans to monitor for the common side effects of the medication and includes which of the following in the plan of care? 1. Offer hard candy or gum periodically. 2. Offer a nutritious snack between meals. 3. Monitor the blood pressure every 2 hours. 4. Review the white blood cell (WBC) count results daily.

1. Offer hard candy or gum periodically. Rationale: Dry mouth is a common side effect of tricyclic antidepressants. Frequent mouth rinsing with water, sucking on hard candy, and chewing gum will alleviate this common side effect. It is not necessary to monitor the blood pressure every 2 hours. In addition, it is not necessary to check the WBC daily. Weight gain is a common side effect and frequent snacks will aggravate this problem.

171.) A nurse is preparing to administer furosemide (Lasix) to a client with a diagnosis of heart failure. The most important laboratory test result for the nurse to check before administering this medication is: 1. Potassium level 2. Creatinine level 3. Cholesterol level 4. Blood urea nitrogen

1. Potassium level Rationale: Furosemide is a loop diuretic. The medication causes a decrease in the client's electrolytes, especially potassium, sodium, and chloride. Administering furosemide to a client with low electrolyte levels could precipitate ventricular dysrhythmias. Options 2 and 4 reflect renal function. The cholesterol level is unrelated to the administration of this medication.

30.) A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia? 1. Prednisone 2. Phenelzine (Nardil) 3. Atenolol (Tenormin) 4. Allopurinol (Zyloprim)

1. Prednisone Rationale: Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 2, a monoamine oxidase inhibitor, and option 3, a β-blocker, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

72.) Cinoxacin (Cinobac), a urinary antiseptic, is prescribed for the client. The nurse reviews the client's medical record and should contact the health care provider (HCP) regarding which documented finding to verify the prescription? Refer to chart. 1. Renal insufficiency 2. Chest x-ray: normal 3. Blood glucose, 102 mg/dL 4. Folic acid (vitamin B6) 0.5 mg, orally daily

1. Renal insufficiency Rationale: Cinoxacin should be administered with caution in clients with renal impairment. The dosage should be reduced, and failure to do so could result in accumulation of cinoxacin to toxic levels. Therefore the nurse would verify the prescription if the client had a documented history of renal insufficiency. The laboratory and diagnostic test results are normal findings. Folic acid (vitamin B6) may be prescribed for a client with renal insufficiency to prevent anemia.

90.) A nurse is reviewing the record of a client who has been prescribed baclofen (Lioresal). Which of the following disorders, if noted in the client's history, would alert the nurse to contact the health care provider? 1. Seizure disorders 2. Hyperthyroidism 3. Diabetes mellitus 4. Coronary artery disease

1. Seizure disorders Rationale: Clients with seizure disorders may have a lowered seizure threshold when baclofen is administered. Concurrent therapy may require an increase in the anticonvulsive medication. The disorders in options 2, 3, and 4 are not a concern when the client is taking baclofen.

53.) Rifabutin (Mycobutin) is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. The nurse monitors for which side effects of the medication? Select all that apply. 1. Signs of hepatitis 2. Flu-like syndrome 3. Low neutrophil count 4. Vitamin B6 deficiency 5. Ocular pain or blurred vision 6. Tingling and numbness of the fingers

1. Signs of hepatitis 2. Flu-like syndrome 3. Low neutrophil count 5. Ocular pain or blurred vision Rationale: Rifabutin (Mycobutin) may be prescribed for a client with active MAC disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis. Side effects include rash, gastrointestinal disturbances, neutropenia (low neutrophil count), red-orange body secretions, uveitis (blurred vision and eye pain), myositis, arthralgia, hepatitis, chest pain with dyspnea, and flu-like syndrome. Vitamin B6 deficiency and numbness and tingling in the extremities are associated with the use of isoniazid (INH). Ethambutol (Myambutol) also causes peripheral neuritis.

92.) In monitoring a client's response to disease-modifying antirheumatic drugs (DMARDs), which findings would the nurse interpret as acceptable responses? Select all that apply. 1. Symptom control during periods of emotional stress 2. Normal white blood cell counts, platelet, and neutrophil counts 3. Radiological findings that show nonprogression of joint degeneration 4. An increased range of motion in the affected joints 3 months into therapy 5. Inflammation and irritation at the injection site 3 days after injection is given 6. A low-grade temperature upon rising in the morning that remains throughout the day

1. Symptom control during periods of emotional stress 2. Normal white blood cell counts, platelet, and neutrophil counts 3. Radiological findings that show nonprogression of joint degeneration 4. An increased range of motion in the affected joints 3 months into therapy Rationale: Because emotional stress frequently exacerbates the symptoms of rheumatoid arthritis, the absence of symptoms is a positive finding. DMARDs are given to slow progression of joint degeneration. In addition, the improvement in the range of motion after 3 months of therapy with normal blood work is a positive finding. Temperature elevation and inflammation and irritation at the medication injection site could indicate signs of infection.

149.) A client taking fexofenadine (Allegra) is scheduled for allergy skin testing and tells the nurse in the health care provider's office that a dose was taken this morning. The nurse determines that: 1. The client should reschedule the appointment. 2. A lower dose of allergen will need to be injected. 3. A higher dose of allergen will need to be injected. 4. The client should have the skin test read a day later than usual.

1. The client should reschedule the appointment. Rationale: Fexofenadine is an antihistamine, which provides relief of symptoms caused by allergy. Antihistamines should be discontinued for at least 3 days (72 hours) before allergy skin testing to avoid false-negative readings. This client should have the appointment rescheduled for 3 days after discontinuing the medication.

221.) A nurse is reviewing the health care provider's prescriptions for an adult client who has been admitted to the hospital following a back injury. Carisoprodol (Soma) is prescribed for the client to relieve the muscle spasms; the health care provider has prescribed 350 mg to be administered four times a day. When preparing to give this medication, the nurse determines that this dosage is: 1. The normal adult dosage 2. A lower than normal dosage 3. A higher than normal dosage 4. A dosage requiring further clarification

1. The normal adult dosage Rationale: The normal adult dosage for carisoprodol is 350 mg orally three or four times daily.

21.) A nurse is assisting with caring for a client with cancer who is receiving cisplatin. Select the adverse effects that the nurse monitors for that are associated with this medication. Select all that apply. 1. Tinnitus 2. Ototoxicity 3. Hyperkalemia 4. Hypercalcemia 5. Nephrotoxicity 6. Hypomagnesemia

1. Tinnitus 2. Ototoxicity 5. Nephrotoxicity 6. Hypomagnesemia Rationale: Cisplatin is an alkylating medication. Alkylating medications are cell cycle phase-nonspecific medications that affect the synthesis of DNA by causing the cross-linking of DNA to inhibit cell reproduction. Cisplatin may cause ototoxicity, tinnitus, hypokalemia, hypocalcemia, hypomagnesemia, and nephrotoxicity. Amifostine (Ethyol) may be administered before cisplatin to reduce the potential for renal toxicity.

213.) A client is admitted to the hospital with complaints of back spasms. The client states, "I have been taking two or three aspirin every 4 hours for the past week and it hasn't helped my back." Aspirin intoxication is suspected. Which of the following complaints would indicate aspirin intoxication? 1. Tinnitus 2. Constipation 3. Photosensitivity 4. Abdominal cramps

1. Tinnitus Rationale: Mild intoxication with acetylsalicylic acid (aspirin) is called salicylism and is commonly experienced when the daily dosage is higher than 4 g. Tinnitus (ringing in the ears) is the most frequently occurring effect noted with intoxication. Hyperventilation may occur because salicylate stimulates the respiratory center. Fever may result because salicylate interferes with the metabolic pathways involved with oxygen consumption and heat production. Options 2, 3, and 4 are incorrect.

8.) A client with severe acne is seen in the clinic and the health care provider (HCP) prescribes isotretinoin. The nurse reviews the client's medication record and would contact the (HCP) if the client is taking which medication? 1. Vitamin A 2. Digoxin (Lanoxin) 3. Furosemide (Lasix) 4. Phenytoin (Dilantin)

1. Vitamin A Rationale: Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements should be discontinued before isotretinoin therapy. Options 2, 3, and 4 are not contraindicated with the use of isotretinoin.

Amylase

25-151 units/L

239.) Which of the following precautions will the nurse specifically take during the administration of ribavirin (Virazole) to a child with respiratory syncytial virus (RSV)? 1. Wearing goggles 2. Wearing a gown 3. Wearing a gown and a mask 4. Handwashing before administration

1. Wearing goggles Rationale: Some caregivers experience headaches, burning nasal passages and eyes, and crystallization of soft contact lenses as a result of administration of ribavirin. Specific to this medication is the use of goggles. A gown is not necessary. A mask may be worn. Handwashing is to be performed before and after any child contact.

A nurse notes that a client in a long-term care facility is receiving a daily dose of furosemide (Lasix). The nurse writes in the care plan to monitor which of the following parameters on a daily basis? 1. Weight 2. Radial pulse 3. Hemoglobin 4. Serum creatinine clearance

1. Weight Rationale: Daily weight should be monitored because this reflects the fluid status of the client who is receiving a diuretic. Option 2 is a general assessment and does not relate directly to fluid balance. Options 3 and 4 are laboratory measurements that are not prescribed routinely by the nurse and would not be done on a daily basis in a long-term care facility.

24.) A nurse is reinforcing teaching for a client regarding how to mix regular insulin and NPH insulin in the same syringe. Which of the following actions, if performed by the client, indicates the need for further teaching? 1. Withdraws the NPH insulin first 2. Withdraws the regular insulin first 3. Injects air into NPH insulin vial first 4. Injects an amount of air equal to the desired dose of insulin into the vial

1. Withdraws the NPH insulin first Rationale: When preparing a mixture of regular insulin with another insulin preparation, the regular insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of regular insulin with insulin of another type. Options 2, 3, and 4 identify the correct actions for preparing NPH and regular insulin.

195.) A nurse is caring for a client who is taking metoprolol (Lopressor). The nurse measures the client's blood pressure (BP) and apical pulse (AP) immediately before administration. The client's BP is 122/78 mm/Hg and the AP is 58 beats/min. Based on this data, which of the following is the appropriate action? 1. Withhold the medication. 2. Notify the registered nurse immediately. 3. Administer the medication as prescribed. 4. Administer half of the prescribed medication.

1. Withhold the medication. Rationale: Metoprolol (Lopressor) is classified as a beta-adrenergic blocker and is used in the treatment of hypertension, angina, and myocardial infarction. Baseline nursing assessments include measurement of BP and AP immediately before administration. If the systolic BP is below 90 mm/Hg and the AP is below 60 beats/min, the nurse should withhold the medication and document this action. Although the registered nurse should be informed of the client's vital signs, it is not necessary to do so immediately. The medication should not be administered because the data is outside of the prescribed parameters for this medication. The nurse should not administer half of the medication, or alter any dosages at any point in time.

234.) A hospitalized client is started on phenelzine sulfate (Nardil) for the treatment of depression. At lunchtime, a tray is delivered to the client. Which food item on the tray will the nurse remove? 1. Yogurt 2. Crackers 3. Tossed salad 4. Oatmeal cookies

1. Yogurt Rationale: Phenelzine sulfate is a monoamine oxidase inhibitor (MAOI). The client should avoid taking in foods that are high in tyramine. These foods could trigger a potentially fatal hypertensive crisis. Foods to avoid include yogurt, aged cheeses, smoked or processed meats, red wines, and fruits such as avocados, raisins, or figs.

Mg+

1.6-2.6 mg/dL

6.) The burn client is receiving treatments of topical mafenide acetate (Sulfamylon) to the site of injury. The nurse monitors the client, knowing that which of the following indicates that a systemic effect has occurred? 1.Hyperventilation 2.Elevated blood pressure 3.Local pain at the burn site 4.Local rash at the burn site

1.Hyperventilation Rationale: Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal excretion of acid, thereby causing acidosis. Clients receiving this treatment should be monitored for signs of an acid-base imbalance (hyperventilation). If this occurs, the medication should be discontinued for 1 to 2 days. Options 3 and 4 describe local rather than systemic effects. An elevated blood pressure may be expected from the pain that occurs with a burn injury.

Therapeutic Range Theophylline (Aminophylline)

10-20 mcg/mL

Tracheostamy wall suction maintained between _________ mm hg of pressure

120-180 (one question said 100-150) 80-100 for infants 100-120 for children

Na+ level

135-145 mEq/L

A client is to receive cephalexin (Keflex) 500 mg PO. The pharmacy has sent 250-mg tablets. The nurse gives:

2 tablets

RA psi

2-8 mmHg

CVP

2-8mmHg

176.) A nurse notes that a client is taking lansoprazole (Prevacid). On data collection, the nurse asks which question to determine medication effectiveness? 1. "Has your appetite increased?" 2. "Are you experiencing any heartburn?" 3. "Do you have any problems with vision?" 4. "Do you experience any leg pain when walking?"

2. "Are you experiencing any heartburn?" Rationale: Lansoprazole is a gastric acid pump inhibitor used to treat gastric and duodenal ulcers, erosive esophagitis, and hypersecretory conditions. It also is used to treat gastroesophageal reflux disease (GERD). It is not used to treat visual problems, problems with appetite, or leg pain. **NOTE: "-zole" refers to gastric acid pump inhibitors**

183.) A client who received a kidney transplant is taking azathioprine (Imuran), and the nurse provides instructions about the medication. Which statement by the client indicates a need for further instructions? 1. "I need to watch for signs of infection." 2. "I need to discontinue the medication after 14 days of use." 3. "I can take the medication with meals to minimize nausea." 4. "I need to call the health care provider (HCP) if more than one dose is missed."

2. "I need to discontinue the medication after 14 days of use." Rationale: Azathioprine is an immunosuppressant medication that is taken for life. Because of the effects of the medication, the client must watch for signs of infection, which are reported immediately to the HCP. The client should also call the HCP if more than one dose is missed. The medication may be taken with meals to minimize nausea.

194.) A nurse provides instructions to a client regarding the use of tretinoin (Retin-A). Which statement by the client indicates the need for further instructions? 1. "Optimal results will be seen after 6 weeks." 2. "I should apply a very thin layer to my skin." 3. "I should wash my hands thoroughly after applying the medication." 4. "I should cleanse my skin thoroughly before applying the medication."

2. "I should apply a very thin layer to my skin." Rationale: Tretinoin is applied liberally to the skin. The hands are washed thoroughly immediately after applying. Therapeutic results should be seen after 2 to 3 weeks but may not be optimal until after 6 weeks. The skin needs to be cleansed thoroughly before applying the medication.

78.) A client is taking phenytoin (Dilantin) for seizure control and a sample for a serum drug level is drawn. Which of the following indicates a therapeutic serum drug range? 1. 5 to 10 mcg/mL 2. 10 to 20 mcg/mL 3. 20 to 30 mcg/mL 4. 30 to 40 mcg/mL

2. 10 to 20 mcg/mL Rationale: The therapeutic serum drug level range for phenytoin (Dilantin) is 10 to 20 mcg/mL. ** A helpful hint may be to remember that the theophylline therapeutic range and the acetaminophen (Tylenol) therapeutic range are the same as the phenytoin (Dilantin) therapeutic range.**

215.) A client with rheumatoid arthritis is taking acetylsalicylic acid (aspirin) on a daily basis. Which medication dose should the nurse expect the client to be taking? 1. 1 g daily 2. 4 g daily 3. 325 mg daily 4. 1000 mg daily

2. 4 g daily Rationale: Aspirin may be used to treat the client with rheumatoid arthritis. It may also be used to reduce the risk of recurrent transient ischemic attack (TIA) or brain attack (stroke) or reduce the risk of myocardial infarction (MI) in clients with unstable angina or a history of a previous MI. The normal dose for clients being treated with aspirin to decrease thrombosis and MI is 300 to 325 mg/day. Clients being treated to prevent TIAs are usually prescribed 1.3 g/day in two to four divided doses. Clients with rheumatoid arthritis are treated with 3.6 to 5.4 g/day in divided doses. **Eliminate options 1 and 4 because they are alike**

29.) A client is taking Humulin NPH insulin daily every morning. The nurse reinforces instructions for the client and tells the client that the most likely time for a hypoglycemic reaction to occur is: 1. 2 to 4 hours after administration 2. 4 to 12 hours after administration 3. 16 to 18 hours after administration 4. 18 to 24 hours after administration

2. 4 to 12 hours after administration Rationale: Humulin NPH is an intermediate-acting insulin. The onset of action is 1.5 hours, it peaks in 4 to 12 hours, and its duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.

64.) Nalidixic acid (NegGram) is prescribed for a client with a urinary tract infection. On review of the client's record, the nurse notes that the client is taking warfarin sodium (Coumadin) daily. Which prescription should the nurse anticipate for this client? 1. Discontinuation of warfarin sodium (Coumadin) 2. A decrease in the warfarin sodium (Coumadin) dosage 3. An increase in the warfarin sodium (Coumadin) dosage 4. A decrease in the usual dose of nalidixic acid (NegGram)

2. A decrease in the warfarin sodium (Coumadin) dosage Rationale: Nalidixic acid can intensify the effects of oral anticoagulants by displacing these agents from binding sites on plasma protein. When an oral anticoagulant is combined with nalidixic acid, a decrease in the anticoagulant dosage may be needed.

A client receiving therapy with carbidopa/levodopa (Sinemet) is upset and tells the nurse that his urine has turned a darker color since he began to take the medication. The client wants to discontinue its use. In formulating a response to the client's concerns, the nurse interprets that this change is: 1. Indicative of developing toxicity 2. A harmless side effect of the medication 3. A result of taking the medication with milk 4. A sign of interaction with another medication

2. A harmless side effect of the medication Rationale: With carbidopa/levodopa therapy, a darkening of the urine or sweat may occur. The client should be reassured that this is a harmless effect of the medication, and its use should be continued. **Eliminate options 1 and 4 first because they are comparable or alike.**

88.) Dantrolene sodium (Dantrium) is prescribed for a client experiencing flexor spasms, and the client asks the nurse about the action of the medication. The nurse responds, knowing that the therapeutic action of this medication is which of the following? 1. Depresses spinal reflexes 2. Acts directly on the skeletal muscle to relieve spasticity 3. Acts within the spinal cord to suppress hyperactive reflexes 4. Acts on the central nervous system (CNS) to suppress spasms

2. Acts directly on the skeletal muscle to relieve spasticity Rationale: Dantrium acts directly on skeletal muscle to relieve muscle spasticity. The primary action is the suppression of calcium release from the sarcoplasmic reticulum. This in turn decreases the ability of the skeletal muscle to contract. **Options 1, 3, and 4 are all comparable or alike in that they address CNS suppression and the depression of reflexes. Therefore, eliminate these options.**

74.) A client with myasthenia gravis is receiving pyridostigmine (Mestinon). The nurse monitors for signs and symptoms of cholinergic crisis caused by overdose of the medication. The nurse checks the medication supply to ensure that which medication is available for administration if a cholinergic crisis occurs? 1. Vitamin K 2. Atropine sulfate 3. Protamine sulfate 4. Acetylcysteine (Mucomyst)

2. Atropine sulfate Rationale: The antidote for cholinergic crisis is atropine sulfate. Vitamin K is the antidote for warfarin (Coumadin). Protamine sulfate is the antidote for heparin, and acetylcysteine (Mucomyst) is the antidote for acetaminophen (Tylenol).

86.) A nurse is reinforcing discharge instructions to a client receiving baclofen (Lioresal). Which of the following would the nurse include in the instructions? 1. Restrict fluid intake. 2. Avoid the use of alcohol. 3. Stop the medication if diarrhea occurs. 4. Notify the health care provider if fatigue occurs.

2. Avoid the use of alcohol. Rationale: Baclofen is a central nervous system (CNS) depressant. The client should be cautioned against the use of alcohol and other CNS depressants, because baclofen potentiates the depressant activity of these agents. Constipation rather than diarrhea is an adverse effect of baclofen. It is not necessary to restrict fluids, but the client should be warned that urinary retention can occur. Fatigue is related to a CNS effect that is most intense during the early phase of therapy and diminishes with continued medication use. It is not necessary that the client notify the health care provider if fatigue occurs.

9.) The nurse is applying a topical corticosteroid to a client with eczema. The nurse would monitor for the potential for increased systemic absorption of the medication if the medication were being applied to which of the following body areas? 1. Back 2. Axilla 3. Soles of the feet 4. Palms of the hands

2. Axilla Rationale: Topical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions in which permeability is poor (back, palms, soles).

199.) A nurse is applying a topical glucocorticoid to a client with eczema. The nurse monitors for systemic absorption of the medication if the medication is being applied to which of the following body areas? 1. Back 2. Axilla 3. Soles of the feet 4. Palms of the hands

2. Axilla Rationale: Topical glucocorticoids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axillae, face, eyelids, neck, perineum, genitalia), and lower from regions where penetrability is poor (back, palms, soles). **Eliminate options 3 and 4 because these body areas are similar in terms of skin characteristics**

A client has been given a prescription for gemfibrozil (Lopid). The nurse plans to instruct the client to limit intake of which of the following foods while taking this medication? 1. Fish 2. Beef 3. Spicy foods 4. Citrus products

2. Beef Rationale: Gemfibrozil is a lipid-lowering agent. It is given as part of a therapeutic regimen that also includes dietary counseling, specifically, the limitation of saturated and other fats in the diet. Therefore the intake of red meats is limited. Fish, foods that are spicy, and citrus products will not affect the cholesterol level.

The nurse has taught a client newly diagnosed with diabetes mellitus about blood glucose monitoring. The nurse determines that the client understand the information client states to report blood glucose levels that exceed:

250 mg/dL. Rationale" It is standard practice to teach the client to report blood glucose levels that exceed 250 mg/dL unless otherwise instructed by the physician.

123.) A nurse is planning to administer amlodipine (Norvasc) to a client. The nurse plans to check which of the following before giving the medication? 1. Respiratory rate 2. Blood pressure and heart rate 3. Heart rate and respiratory rate 4. Level of consciousness and blood pressure

2. Blood pressure and heart rate Rationale: Amlodipine is a calcium channel blocker. This medication decreases the rate and force of cardiac contraction. Before administering a calcium channel blocking agent, the nurse should check the blood pressure and heart rate, which could both decrease in response to the action of this medication. This action will help to prevent or identify early problems related to decreased cardiac contractility, heart rate, and conduction. **amlodipine is a calcium channel blocker, and this group of medications decreases the rate and force of cardiac contraction. This in turn lowers the pulse rate and blood pressure.**

224.) Neuroleptic malignant syndrome is suspected in a client who is taking chlorpromazine. Which medication would the nurse prepare in anticipation of being prescribed to treat this adverse effect related to the use of chlorpromazine? 1. Protamine sulfate 2. Bromocriptine (Parlodel) 3. Phytonadione (vitamin K) 4. Enalapril maleate (Vasotec)

2. Bromocriptine (Parlodel) Rationale: Bromocriptine is an antiparkinsonian prolactin inhibitor used in the treatment of neuroleptic malignant syndrome. Vitamin K is the antidote for warfarin (Coumadin) overdose. Protamine sulfate is the antidote for heparin overdose. Enalapril maleate is an antihypertensive used in the treatment of hypertension.

20.) The client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication? 1. Glucose level 2. Calcium level 3. Potassium level 4. Prothrombin time

2. Calcium level Rationale: Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium levels should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain.

170.) Atenolol hydrochloride (Tenormin) is prescribed for a hospitalized client. The nurse should perform which of the following as a priority action before administering the medication? 1. Listen to the client's lung sounds. 2. Check the client's blood pressure. 3. Check the recent electrolyte levels. 4. Assess the client for muscle weakness.

2. Check the client's blood pressure. Rationale: Atenolol hydrochloride is a beta-blocker used to treat hypertension. Therefore the priority nursing action before administration of the medication is to check the client's blood pressure. The nurse also checks the client's apical heart rate. If the systolic blood pressure is below 90 mm Hg or the apical pulse is 60 beats per minute or lower, the medication is withheld and the registered nurse and/or health care provider is notified. The nurse would check baseline renal and liver function tests. The medication may cause weakness, and the nurse would assist the client with activities if weakness occurs. **Beta-blockers have "-lol" at the end of the medication name**

34.) A client with Crohn's disease is scheduled to receive an infusion of infliximab (Remicade). The nurse assisting in caring for the client should take which action to monitor the effectiveness of treatment? 1. Monitoring the leukocyte count for 2 days after the infusion 2. Checking the frequency and consistency of bowel movements 3. Checking serum liver enzyme levels before and after the infusion 4. Carrying out a Hematest on gastric fluids after the infusion is completed

2. Checking the frequency and consistency of bowel movements Rationale: The principal manifestations of Crohn's disease are diarrhea and abdominal pain. Infliximab (Remicade) is an immunomodulator that reduces the degree of inflammation in the colon, thereby reducing the diarrhea. Options 1, 3, and 4 are unrelated to this medication.

146.) A client has begun therapy with theophylline (Theo-24). The nurse tells the client to limit the intake of which of the following while taking this medication? 1. Oranges and pineapple 2. Coffee, cola, and chocolate 3. Oysters, lobster, and shrimp 4. Cottage cheese, cream cheese, and dairy creamers

2. Coffee, cola, and chocolate Rationale: Theophylline is a xanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These include coffee, cola, and chocolate.

63.) A client with coronary artery disease complains of substernal chest pain. After checking the client's heart rate and blood pressure, a nurse administers nitroglycerin, 0.4 mg, sublingually. After 5 minutes, the client states, "My chest still hurts." Select the appropriate actions that the nurse should take. Select all that apply. 1. Call a code blue. 2. Contact the registered nurse. 3. Contact the client's family. 4. Assess the client's pain level. 5. Check the client's blood pressure. 6. Administer a second nitroglycerin, 0.4 mg, sublingually.

2. Contact the registered nurse. 4. Assess the client's pain level. 5. Check the client's blood pressure. 6. Administer a second nitroglycerin, 0.4 mg, sublingually. Rationale: The usual guideline for administering nitroglycerin tablets for a hospitalized client with chest pain is to administer one tablet every 5 minutes PRN for chest pain, for a total dose of three tablets. The registered nurse should be notified of the client's condition, who will then notify the health care provider as appropriate. Because the client is still complaining of chest pain, the nurse would administer a second nitroglycerin tablet. The nurse would assess the client's pain level and check the client's blood pressure before administering each nitroglycerin dose. There are no data in the question that indicate the need to call a code blue. In addition, it is not necessary to contact the client's family unless the client has requested this.

84.) Baclofen (Lioresal) is prescribed for the client with multiple sclerosis. The nurse assists in planning care, knowing that the primary therapeutic effect of this medication is which of the following? 1. Increased muscle tone 2. Decreased muscle spasms 3. Increased range of motion 4. Decreased local pain and tenderness

2. Decreased muscle spasms Rationale: Baclofen is a skeletal muscle relaxant and central nervous system depressant and acts at the spinal cord level to decrease the frequency and amplitude of muscle spasms in clients with spinal cord injuries or diseases and in clients with multiple sclerosis. Options 1, 3, and 4 are incorrect.

A client with a history of spinal cord injury is receiving baclofen (Lioresal) for muscle spasms. The nurse determines that the client is experiencing a side effect of this medication if the client experiences: 1. Photosensitivity 2. Drowsiness 3. Hypertension 4. Muscle pain

2. Drowsiness Rationale: Baclofen is a centrally acting skeletal muscle relaxant. Side effects of baclofen include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesias of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion. Options 1, 3, and 4 are incorrect.

209.) A client with multiple sclerosis is receiving diazepam (Valium), a centrally acting skeletal muscle relaxant. Which of the following would indicate that the client is experiencing a side effect related to this medication? 1. Headache 2. Drowsiness 3. Urinary retention 4. Increased salivation

2. Drowsiness Rationale: Incoordination and drowsiness are common side effects resulting from this medication. Options 1, 3, and 4 are incorrect.

133.) A nurse is monitoring a client receiving desmopressin acetate (DDAVP) for adverse effects to the medication. Which of the following indicates the presence of an adverse effect? 1. Insomnia 2. Drowsiness 3. Weight loss 4. Increased urination

2. Drowsiness Rationale: Water intoxication (overhydration) or hyponatremia is an adverse effect to desmopressin. Early signs include drowsiness, listlessness, and headache. Decreased urination, rapid weight gain, confusion, seizures, and coma also may occur in overhydration. **Recall that this medication is used to treat diabetes insipidus to eliminate weight loss and increased urination.**

240.) A client with Parkinson's disease has been prescribed benztropine (Cogentin). The nurse monitors for which gastrointestinal (GI) side effect of this medication? 1. Diarrhea 2. Dry mouth 3. Increased appetite 4. Hyperactive bowel sounds

2. Dry mouth Rationale: Common GI side effects of benztropine therapy include constipation and dry mouth. Other GI side effects include nausea and ileus. These effects are the result of the anticholinergic properties of the medication. **Eliminate options 1 and 4 because they are comparable or alike. Recall that the medication is an anticholinergic, which causes dry mouth**

108.) A nurse is performing a follow-up teaching session with a client discharged 1 month ago who is taking fluoxetine (Prozac). What information would be important for the nurse to gather regarding the adverse effects related to the medication? 1. Cardiovascular symptoms 2. Gastrointestinal dysfunctions 3. Problems with mouth dryness 4. Problems with excessive sweating

2. Gastrointestinal dysfunctions Rationale: The most common adverse effects related to fluoxetine include central nervous system (CNS) and gastrointestinal (GI) system dysfunction. This medication affects the GI system by causing nausea and vomiting, cramping, and diarrhea. Options 1, 3, and 4 are not adverse effects of this medication.

136.) A nurse performs an admission assessment on a client who visits a health care clinic for the first time. The client tells the nurse that propylthiouracil (PTU) is taken daily. The nurse continues to collect data from the client, suspecting that the client has a history of: 1. Myxedema 2. Graves' disease 3. Addison's disease 4. Cushing's syndrome

2. Graves' disease Rationale: PTU inhibits thyroid hormone synthesis and is used to treat hyperthyroidism, or Graves' disease. Myxedema indicates hypothyroidism. Cushing's syndrome and Addison's disease are disorders related to adrenal function.

41.) The client has been taking omeprazole (Prilosec) for 4 weeks. The ambulatory care nurse evaluates that the client is receiving optimal intended effect of the medication if the client reports the absence of which symptom? 1. Diarrhea 2. Heartburn 3. Flatulence 4. Constipation

2. Heartburn Rationale: Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called heartburn by clients. Omeprazole is not used to treat the conditions identified in options 1, 3, and 4.

131.) The nurse is reinforcing medication instructions to a client with breast cancer who is receiving cyclophosphamide (Neosar). The nurse tells the client to: 1. Take the medication with food. 2. Increase fluid intake to 2000 to 3000 mL daily. 3. Decrease sodium intake while taking the medication. 4. Increase potassium intake while taking the medication.

2. Increase fluid intake to 2000 to 3000 mL daily. Rationale: Hemorrhagic cystitis is a toxic effect that can occur with the use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal (GI) upset occurs. Hyperkalemia can result from the use of the medication; therefore the client would not be told to increase potassium intake. The client would not be instructed to alter sodium intake.

101.) Ketoconazole is prescribed for a client with a diagnosis of candidiasis. Select the interventions that the nurse includes when administering this medication. Select all that apply. 1. Restrict fluid intake. 2. Instruct the client to avoid alcohol. 3. Monitor hepatic and liver function studies. 4. Administer the medication with an antacid. 5. Instruct the client to avoid exposure to the sun. 6. Administer the medication on an empty stomach.

2. Instruct the client to avoid alcohol. 3. Monitor hepatic and liver function studies. 5. Instruct the client to avoid exposure to the sun. Rationale: Ketoconazole is an antifungal medication. It is administered with food (not on an empty stomach) and antacids are avoided for 2 hours after taking the medication to ensure absorption. The medication is hepatotoxic and the nurse monitors liver function studies. The client is instructed to avoid exposure to the sun because the medication increases photosensitivity. The client is also instructed to avoid alcohol. There is no reason for the client to restrict fluid intake. In fact, this could be harmful to the client.

162.) Carbamazepine (Tegretol) is prescribed for a client with a diagnosis of psychomotor seizures. The nurse reviews the client's health history, knowing that this medication is contraindicated if which of the following disorders is present? 1. Headaches 2. Liver disease 3. Hypothyroidism 4. Diabetes mellitus

2. Liver disease Rationale: Carbamazepine (Tegretol) is contraindicated in liver disease, and liver function tests are routinely prescribed for baseline purposes and are monitored during therapy. It is also contraindicated if the client has a history of blood dyscrasias. It is not contraindicated in the conditions noted in the incorrect options.

89.) A nurse is reviewing the laboratory studies on a client receiving dantrolene sodium (Dantrium). Which laboratory test would identify an adverse effect associated with the administration of this medication? 1. Creatinine 2. Liver function tests 3. Blood urea nitrogen 4. Hematological function tests

2. Liver function tests Rationale: Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, liver function tests should be performed before treatment and periodically throughout the treatment course. It is administered in the lowest effective dosage for the shortest time necessary. **Eliminate options 1 and 3 because these tests both assess kidney function.**

65.) A nurse is reinforcing discharge instructions to a client receiving sulfisoxazole. Which of the following should be included in the list of instructions? 1. Restrict fluid intake. 2. Maintain a high fluid intake. 3. If the urine turns dark brown, call the health care provider (HCP) immediately. 4. Decrease the dosage when symptoms are improving to prevent an allergic response.

2. Maintain a high fluid intake. Rationale: Each dose of sulfisoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Some forms of sulfisoxazole cause urine to turn dark brown or red. This does not indicate the need to notify the HCP.

161.) A nurse is caring for a client with severe back pain, and codeine sulfate has been prescribed for the client. Which of the following would the nurse include in the plan of care while the client is taking this medication? 1. Restrict fluid intake. 2. Monitor bowel activity. 3. Monitor for hypertension. 4. Monitor peripheral pulses.

2. Monitor bowel activity. Rationale: While the client is taking codeine sulfate, an opioid analgesic, the nurse would monitor vital signs and monitor for hypotension. The nurse should also increase fluid intake, palpate the bladder for urinary retention, auscultate bowel sounds, and monitor the pattern of daily bowel activity and stool consistency (codeine can cause constipation). The nurse should monitor respiratory status and initiate breathing and coughing exercises. In addition, the nurse monitors the effectiveness of the pain medication.

204.) A client receives a dose of edrophonium (Enlon). The client shows improvement in muscle strength for a period of time following the injection. The nurse interprets that this finding is compatible with: 1. Multiple sclerosis 2. Myasthenia gravis 3. Muscular dystrophy 4. Amyotrophic lateral sclerosis

2. Myasthenia gravis Rationale: Myasthenia gravis can often be diagnosed based on clinical signs and symptoms. The diagnosis can be confirmed by injecting the client with a dose of edrophonium . This medication inhibits the breakdown of an enzyme in the neuromuscular junction, so more acetylcholine binds to receptors. If the muscle is strengthened for 3 to 5 minutes after this injection, it confirms a diagnosis of myasthenia gravis. Another medication, neostigmine (Prostigmin), also may be used because its effect lasts for 1 to 2 hours, providing a better analysis. For either medication, atropine sulfate should be available as the antidote.

169.) Insulin glargine (Lantus) is prescribed for a client with diabetes mellitus. The nurse tells the client that it is best to take the insulin: 1. 1 hour after each meal 2. Once daily, at the same time each day 3. 15 minutes before breakfast, lunch, and dinner 4. Before each meal, on the basis of the blood glucose level

2. Once daily, at the same time each day Rationale: Insulin glargine is a long-acting recombinant DNA human insulin used to treat type 1 and type 2 diabetes mellitus. It has a 24-hour duration of action and is administered once a day, at the same time each day.

47.) A client has been taking isoniazid (INH) for 2 months. The client complains to a nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing: 1. Hypercalcemia 2. Peripheral neuritis 3. Small blood vessel spasm 4. Impaired peripheral circulation

2. Peripheral neuritis Rationale: A common side effect of the TB drug INH is peripheral neuritis. This is manifested by numbness, tingling, and paresthesias in the extremities. This side effect can be minimized by pyridoxine (vitamin B6) intake. Options 1, 3, and 4 are incorrect.

50.) A nurse has given a client taking ethambutol (Myambutol) information about the medication. The nurse determines that the client understands the instructions if the client states that he or she will immediately report: 1. Impaired sense of hearing 2. Problems with visual acuity 3. Gastrointestinal (GI) side effects 4. Orange-red discoloration of body secretions

2. Problems with visual acuity Rationale: Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client is also taught to take the medication with food if GI upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin (Rifadin).

25.) A home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse tells the client to: 1. Freeze the insulin. 2. Refrigerate the insulin. 3. Store the insulin in a dark, dry place. 4. Keep the insulin at room temperature.

2. Refrigerate the insulin. Rationale: Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be frozen. When stored unopened under refrigeration, insulin can be used up to the expiration date on the vial. Options 1, 3, and 4 are incorrect.

186.) A nurse prepares to administer sodium polystyrene sulfonate (Kayexalate) to a client. Before administering the medication, the nurse reviews the action of the medication and understands that it: 1. Releases bicarbonate in exchange for primarily sodium ions 2. Releases sodium ions in exchange for primarily potassium ions 3. Releases potassium ions in exchange for primarily sodium ions 4. Releases sodium ions in exchange for primarily bicarbonate ions

2. Releases sodium ions in exchange for primarily potassium ions Rationale: Sodium polystyrene sulfonate is a cation exchange resin used in the treatment of hyperkalemia. The resin either passes through the intestine or is retained in the colon. It releases sodium ions in exchange for primarily potassium ions. The therapeutic effect occurs 2 to 12 hours after oral administration and longer after rectal administration.

40.) The client who chronically uses nonsteroidal anti-inflammatory drugs has been taking misoprostol (Cytotec). The nurse determines that the medication is having the intended therapeutic effect if which of the following is noted? 1. Resolved diarrhea 2. Relief of epigastric pain 3. Decreased platelet count 4. Decreased white blood cell count

2. Relief of epigastric pain Rationale: The client who chronically uses nonsteroidal anti-inflammatory drugs (NSAIDs) is prone to gastric mucosal injury. Misoprostol is a gastric protectant and is given specifically to prevent this occurrence. Diarrhea can be a side effect of the medication, but is not an intended effect. Options 3 and 4 are incorrect.

168.) Colcrys (colchicine) is prescribed for a client with a diagnosis of gout. The nurse reviews the client's medical history in the health record, knowing that the medication would be contraindicated in which disorder? 1. Myxedema 2. Renal failure 3. Hypothyroidism 4. Diabetes mellitus

2. Renal failure Rationale: Colchicine is contraindicated in clients with severe gastrointestinal, renal, hepatic or cardiac disorders, or with blood dyscrasias. Clients with impaired renal function may exhibit myopathy and neuropathy manifested as generalized weakness. This medication should be used with caution in clients with impaired hepatic function, older clients, and debilitated clients. **Note that options 1, 3, and 4 are all endocrine-related disorders: Myxedema=Hypothyroidism**

48.) A client is to begin a 6-month course of therapy with isoniazid (INH). A nurse plans to teach the client to: 1. Drink alcohol in small amounts only. 2. Report yellow eyes or skin immediately. 3. Increase intake of Swiss or aged cheeses. 4. Avoid vitamin supplements during therapy.

2. Report yellow eyes or skin immediately. Rationale: INH is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately (which include yellow skin and sclera). For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of INH therapy for TB.

23.) A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which information should the nurse teach when carrying out plans for discharge? 1. Keep insulin vials refrigerated at all times. 2. Rotate the insulin injection sites systematically. 3. Increase the amount of insulin before unusual exercise. 4. Monitor the urine acetone level to determine the insulin dosage.

2. Rotate the insulin injection sites systematically. Rationale: Insulin dosages should not be adjusted or increased before unusual exercise. If acetone is found in the urine, it may possibly indicate the need for additional insulin. To minimize the discomfort associated with insulin injections, the insulin should be administered at room temperature. Injection sites should be systematically rotated from one area to another. The client should be instructed to give injections in one area, about 1 inch apart, until the whole area has been used and then to change to another site. This prevents dramatic changes in daily insulin absorption.

216.) A nurse is caring for a client with gout who is taking Colcrys (colchicine). The client has been instructed to restrict the diet to low-purine foods. Which of the following foods should the nurse instruct the client to avoid while taking this medication? 1. Spinach 2. Scallops 3. Potatoes 4. Ice cream

2. Scallops Rationale: Colchicine is a medication used for clients with gout to inhibit the reabsorption of uric acid by the kidney and promote excretion of uric acid in the urine. Uric acid is produced when purine is catabolized. Clients are instructed to modify their diet and limit excessive purine intake. High-purine foods to avoid or limit include organ meats, roe, sardines, scallops, anchovies, broth, mincemeat, herring, shrimp, mackerel, gravy, and yeast.

172.) A nurse provides dietary instructions to a client who will be taking warfarin sodium (Coumadin). The nurse tells the client to avoid which food item? 1. Grapes 2. Spinach 3. Watermelon 4. Cottage cheese

2. Spinach Rationale: Warfarin sodium is an anticoagulant. Anticoagulant medications act by antagonizing the action of vitamin K, which is needed for clotting. When a client is taking an anticoagulant, foods high in vitamin K often are omitted from the diet. Vitamin K-rich foods include green, leafy vegetables, fish, liver, coffee, and tea.

188.) The nurse should anticipate that the most likely medication to be prescribed prophylactically for a child with spina bifida (myelomeningocele) who has a neurogenic bladder would be: 1. Prednisone 2. Sulfisoxazole 3. Furosemide (Lasix) 4. Intravenous immune globulin (IVIG)

2. Sulfisoxazole Rationale: A neurogenic bladder prevents the bladder from completely emptying because of the decrease in muscle tone. The most likely medication to be prescribed to prevent urinary tract infection would be an antibiotic. A common prescribed medication is sulfisoxazole. Prednisone relieves allergic reactions and inflammation rather than preventing infection. Furosemide promotes diuresis and decreases edema caused by congestive heart failure. IVIG assists with antibody production in immunocompromised clients.

147.) A client with a prescription to take theophylline (Theo-24) daily has been given medication instructions by the nurse. The nurse determines that the client needs further information about the medication if the client states that he or she will: 1. Drink at least 2 L of fluid per day. 2. Take the daily dose at bedtime. 3. Avoid changing brands of the medication without health care provider (HCP) approval. 4. Avoid over-the-counter (OTC) cough and cold medications unless approved by the HCP.

2. Take the daily dose at bedtime. Rationale: The client taking a single daily dose of theophylline, a xanthine bronchodilator, should take the medication early in the morning. This enables the client to have maximal benefit from the medication during daytime activities. In addition, this medication causes insomnia. The client should take in at least 2 L of fluid per day to decrease viscosity of secretions. The client should check with the physician before changing brands of the medication. The client also checks with the HCP before taking OTC cough, cold, or other respiratory preparations because they could cause interactive effects, increasing the side effects of theophylline and causing dysrhythmias.

45.) A client has a prescription to take guaifenesin (Humibid) every 4 hours, as needed. The nurse determines that the client understands the most effective use of this medication if the client states that he or she will: 1. Watch for irritability as a side effect. 2. Take the tablet with a full glass of water. 3. Take an extra dose if the cough is accompanied by fever. 4. Crush the sustained-release tablet if immediate relief is needed.

2. Take the tablet with a full glass of water. Rationale: Guaifenesin is an expectorant. It should be taken with a full glass of water to decrease viscosity of secretions. Sustained-release preparations should not be broken open, crushed, or chewed. The medication may occasionally cause dizziness, headache, or drowsiness as side effects. The client should contact the health care provider if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache.

214.) A health care provider initiates carbidopa/levodopa (Sinemet) therapy for the client with Parkinson's disease. A few days after the client starts the medication, the client complains of nausea and vomiting. The nurse tells the client that: 1. Taking an antiemetic is the best measure to prevent the nausea. 2. Taking the medication with food will help to prevent the nausea. 3. This is an expected side effect of the medication and will decrease over time. 4. The nausea and vomiting will decrease when the dose of levodopa is stabilized.

2. Taking the medication with food will help to prevent the nausea. Rationale: If carbidopa/levodopa is causing nausea and vomiting, the nurse would tell the client that taking the medication with food will prevent the nausea. Additionally, the client should be instructed not to take the medication with a high-protein meal because the high-protein will affect absorption. Antiemetics from the phenothiazine class should not be used because they block the therapeutic action of dopamine. **eliminate options 3 and 4 because they are comparable or alike**

57.) A nurse is monitoring a client who is taking propranolol (Inderal LA). Which data collection finding would indicate a potential serious complication associated with propranolol? 1. The development of complaints of insomnia 2. The development of audible expiratory wheezes 3. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after two doses of the medication 4. A baseline resting heart rate of 88 beats/min followed by a resting heart rate of 72 beats/min after two doses of the medication

2. The development of audible expiratory wheezes Rationale: Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. β-Blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored.

28.) The health care provider (HCP) prescribes exenatide (Byetta) for a client with type 1 diabetes mellitus who takes insulin. The nurse knows that which of the following is the appropriate intervention? 1. The medication is administered within 60 minutes before the morning and evening meal. 2. The medication is withheld and the HCP is called to question the prescription for the client. 3. The client is monitored for gastrointestinal side effects after administration of the medication. 4. The insulin is withdrawn from the Penlet into an insulin syringe to prepare for administration.

2. The medication is withheld and the HCP is called to question the prescription for the client. Rationale: Exenatide (Byetta) is an incretin mimetic used for type 2 diabetes mellitus only. It is not recommended for clients taking insulin. Hence, the nurse should hold the medication and question the HCP regarding this prescription. Although options 1 and 3 are correct statements about the medication, in this situation the medication should not be administered. The medication is packaged in prefilled pens ready for injection without the need for drawing it up into another syringe.

165.) The client has been on treatment for rheumatoid arthritis for 3 weeks. During the administration of etanercept (Enbrel), it is most important for the nurse to assess: 1. The injection site for itching and edema 2. The white blood cell counts and platelet counts 3. Whether the client is experiencing fatigue and joint pain 4. A metallic taste in the mouth and a loss of appetite

2. The white blood cell counts and platelet counts Rationale: Infection and pancytopenia are adverse effects of etanercept (Enbrel). Laboratory studies are performed before and during treatment. The appearance of abnormal white blood cell counts and abnormal platelet counts can alert the nurse to a potential life-threatening infection. Injection site itching is a common occurrence following administration of the medication. In early treatment, residual fatigue and joint pain may still be apparent. A metallic taste and loss of appetite are not common signs of side effects of this medication.

83.) The client has been on treatment for rheumatoid arthritis for 3 weeks. During the administration of etanercept (Enbrel), it is most important for the nurse to check: 1. The injection site for itching and edema 2. The white blood cell counts and platelet counts 3. Whether the client is experiencing fatigue and joint pain 4. A metallic taste in the mouth, with a loss of appetite

2. The white blood cell counts and platelet counts Rationale: Infection and pancytopenia are side effects of etanercept (Enbrel). Laboratory studies are performed before and during drug treatment. The appearance of abnormal white blood cell counts and abnormal platelet counts can alert the nurse to a potentially life-threatening infection. Injection site itching is a common occurrence following administration. A metallic taste with loss of appetite are not common signs of side effects of this medication.

126.) A nurse is caring for a client who has been prescribed furosemide (Lasix) and is monitoring for adverse effects associated with this medication. Which of the following should the nurse recognize as a potential adverse effect Select all that apply. 1. Nausea 2. Tinnitus 3. Hypotension 4. Hypokalemia 5. Photosensitivity 6. Increased urinary frequency

2. Tinnitus 3. Hypotension 4. Hypokalemia Rationale: Furosemide is a loop diuretic; therefore, an expected effect is increased urinary frequency. Nausea is a frequent side effect, not an adverse effect. Photosensitivity is an occasional side effect. Adverse effects include tinnitus (ototoxicity), hypotension, and hypokalemia and occur as a result of sudden volume depletion.

51.) Cycloserine (Seromycin) is added to the medication regimen for a client with tuberculosis. Which of the following would the nurse include in the client-teaching plan regarding this medication? 1. To take the medication before meals 2. To return to the clinic weekly for serum drug-level testing 3. It is not necessary to call the health care provider (HCP) if a skin rash occurs. 4. It is not necessary to restrict alcohol intake with this medication.

2. To return to the clinic weekly for serum drug-level testing Rationale: Cycloserine (Seromycin) is an antitubercular medication that requires weekly serum drug level determinations to monitor for the potential of neurotoxicity. Serum drug levels lower than 30 mcg/mL reduce the incidence of neurotoxicity. The medication must be taken after meals to prevent gastrointestinal irritation. The client must be instructed to notify the HCP if a skin rash or signs of central nervous system toxicity are noted. Alcohol must be avoided because it increases the risk of seizure activity.

82.) A client is receiving meperidine hydrochloride (Demerol) for pain. Which of the following are side effects of this medication. Select all that apply. 1. Diarrhea 2. Tremors 3. Drowsiness 4. Hypotension 5. Urinary frequency 6. Increased respiratory rate

2. Tremors 3. Drowsiness 4. Hypotension Rationale: Meperidine hydrochloride is an opioid analgesic. Side effects include respiratory depression, drowsiness, hypotension, constipation, urinary retention, nausea, vomiting, and tremors.

135.) A nurse reinforces medication instructions to a client who is taking levothyroxine (Synthroid). The nurse instructs the client to notify the health care provider (HCP) if which of the following occurs? 1. Fatigue 2. Tremors 3. Cold intolerance 4. Excessively dry skin

2. Tremors Rationale: Excessive doses of levothyroxine (Synthroid) can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, heat intolerance, and sweating. The client should be instructed to notify the HCP if these occur. Options 1, 3, and 4 are signs of hypothyroidism.

7.) Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed? 1. Platelet count 2. Triglyceride level 3. Complete blood count 4. White blood cell count

2. Triglyceride level Rationale: Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before treatment and periodically thereafter until the effect on the triglycerides has been evaluated. Options 1, 3, and 4 do not need to be monitored specifically during this treatment.

14.) The client with acute myelocytic leukemia is being treated with busulfan (Myleran). Which laboratory value would the nurse specifically monitor during treatment with this medication? 1. Clotting time 2. Uric acid level 3. Potassium level 4. Blood glucose level

2. Uric acid level Rationale: Busulfan (Myleran) can cause an increase in the uric acid level. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute renal failure. Options 1, 3, and 4 are not specifically related to this medication.

A client is taking trihexyphenidyl for the treatment of Parkinson's disease. The nurse would monitor for which adverse effect of this medication? 1. Diarrhea 2. Urinary retention 3. Urinary incontinence 4. Excessive perspiration

2. Urinary retention Rationale: Trihexyphenidyl is an anticholinergic medication. Because of this, it can cause urinary hesitancy and retention, constipation, dry mouth, and decreased sweating as side effects.

68.) Bethanechol chloride (Urecholine) is prescribed for a client with urinary retention. Which disorder would be a contraindication to the administration of this medication? 1. Gastric atony 2. Urinary strictures 3. Neurogenic atony 4. Gastroesophageal reflux

2. Urinary strictures Rationale: Bethanechol chloride (Urecholine) can be harmful to clients with urinary tract obstruction or weakness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract could rupture the bladder in clients with these conditions.

A nurse has given medication instructions to a client beginning anticonvulsant therapy with carbamazepine (Tegretol). The nurse determines that the client understands the use of the medication if the client knows to: 1. Drive as long as it is not at night. 2. Use sunscreen when outsides. 3. Discontinue the medication if fever or sore throat occurs. 4. Keep tissues handy because of excess salivation that may occur.

2. Use sunscreen when outsides. Rationale: Carbamazepine acts by depressing synaptic transmission in the central nervous system (CNS). Because of this, the client should avoid driving or doing other activities that require mental alertness until the effect on the client is known. The client should use protective clothing and sunscreen to avoid photosensitivity reactions. The medication may cause dry mouth (not excessive salivation), and the client should be instructed to provide good oral hygiene and use sugarless candy or gum as needed. The medication should not be abruptly discontinued because it could cause return of seizures or status epilepticus. Fever and sore throat (leukopenia) should be reported to the health care provider (HCP).

238.) Ribavirin (Virazole) is prescribed for the hospitalized child with respiratory syncytial virus (RSV). The nurse prepares to administer this medication via which of the following routes? 1. Orally 2. Via face mask 3. Intravenously 4. Intramuscularly

2. Via face mask Rationale: Ribavirin is an antiviral respiratory medication used mainly in hospitalized children with severe RSV and in high-risk children. Administration is via hood, face mask, or oxygen tent. The medication is most effective if administered within the first 3 days of the infection.

55.) A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3.0 mEq/L and is complaining of anorexia. A health care provider prescribes a digoxin level to rule out digoxin toxicity. A nurse checks the results, knowing that which of the following is the therapeutic serum level (range) for digoxin? 1. 3 to 5 ng/mL 2. 0.5 to 2 ng/mL 3. 1.2 to 2.8 ng/mL 4. 3.5 to 5.5 ng/mL

2.) 0.5 to 2 ng/mL Rationale: Therapeutic levels for digoxin range from 0.5 to 2 ng/mL. Therefore, options 1, 3, and 4 are incorrect.

Eosinophils

2.7% 0-450 cells/mm3

PO4

2.7-4.5 mg/dL

Serum Phosphate

2.7-4.5 mg/dL

197.) Collagenase (Santyl) is prescribed for a client with a severe burn to the hand. The nurse provides instructions to the client regarding the use of the medication. Which statement by the client indicates an accurate understanding of the use of this medication? 1. "I will apply the ointment once a day and leave it open to the air." 2. "I will apply the ointment twice a day and leave it open to the air." 3. "I will apply the ointment once a day and cover it with a sterile dressing." 4. "I will apply the ointment at bedtime and in the morning and cover it with a sterile dressing."

3. "I will apply the ointment once a day and cover it with a sterile dressing." Rationale: Collagenase is used to promote debridement of dermal lesions and severe burns. It is usually applied once daily and covered with a sterile dressing.

164.) A client receives a prescription for methocarbamol (Robaxin), and the nurse reinforces instructions to the client regarding the medication. Which client statement would indicate a need for further instructions? 1. "My urine may turn brown or green." 2. "This medication is prescribed to help relieve my muscle spasms." 3. "If my vision becomes blurred, I don't need to be concerned about it." 4. "I need to call my doctor if I experience nasal congestion from this medication."

3. "If my vision becomes blurred, I don't need to be concerned about it." Rationale: The client needs to be told that the urine may turn brown, black, or green. Other adverse effects include blurred vision, nasal congestion, urticaria, and rash. The client needs to be instructed that, if these adverse effects occur, the health care provider needs to be notified. The medication is used to relieve muscle spasms.

11.) The health care provider has prescribed silver sulfadiazine (Silvadene) for the client with a partial-thickness burn, which has cultured positive for gram-negative bacteria. The nurse is reinforcing information to the client about the medication. Which statement made by the client indicates a lack of understanding about the treatments? 1. "The medication is an antibacterial." 2. "The medication will help heal the burn." 3. "The medication will permanently stain my skin." 4. "The medication should be applied directly to the wound."

3. "The medication will permanently stain my skin." Rationale: Silver sulfadiazine (Silvadene) is an antibacterial that has a broad spectrum of activity against gram-negative bacteria, gram-positive bacteria, and yeast. It is applied directly to the wound to assist in healing. It does not stain the skin.

42.) A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is reinforcing teaching for the client about the medications prescribed, including clarithromycin (Biaxin), esomeprazole (Nexium), and amoxicillin (Amoxil). Which statement by the client indicates the best understanding of the medication regimen? 1. "My ulcer will heal because these medications will kill the bacteria." 2. "These medications are only taken when I have pain from my ulcer." 3. "The medications will kill the bacteria and stop the acid production." 4. "These medications will coat the ulcer and decrease the acid production in my stomach."

3. "The medications will kill the bacteria and stop the acid production." Rationale: Triple therapy for Helicobacter pylori infection usually includes two antibacterial drugs and a proton pump inhibitor. Clarithromycin and amoxicillin are antibacterials. Esomeprazole is a proton pump inhibitor. These medications will kill the bacteria and decrease acid production.

141.) The nurse has reinforced instructions to a client who has been prescribed cholestyramine (Questran). Which statement by the client indicates a need for further instructions? 1. "I will continue taking vitamin supplements." 2. "This medication will help lower my cholesterol." 3. "This medication should only be taken with water." 4. "A high-fiber diet is important while taking this medication."

3. "This medication should only be taken with water." Rationale: Cholestyramine (Questran) is a bile acid sequestrant used to lower the cholesterol level, and client compliance is a problem because of its taste and palatability. The use of flavored products or fruit juices can improve the taste. Some side effects of bile acid sequestrants include constipation and decreased vitamin absorption. **Note the closed-ended word "only" in option 3**

A client is receiving a maintenance dose of oral dantrolene sodium (Dantrium) for the treatment of spasticity. The nurse reviews the medication record, expecting that which of the following doses would be prescribed? 1. 50 mg daily 2. 100 mg daily 3. 100 mg twice daily 4. 200 mg four times daily

3. 100 mg twice daily Rationale: For treatment of spasticity, dantrolene is administered orally. The initial dosage in adults is 25 mg once daily. The usual maintenance dosage is 100 mg two to four times daily. If beneficial effects do not develop within 45 days, dantrolene therapy should be discontinued.

A nurse is caring for a client with myasthenia gravis who has received edrophonium (Enlon) intravenously to test for myasthenic crisis. The client asks the nurse how long the improvement in muscle strength will last. The nurse's response is based on the understanding that the effects have a duration of approximately: 1. 5 minutes 2. 15 minutes 3. 30 minutes 4. 60 minutes

3. 30 minutes Rationale: Edrophonium may be given to test for myasthenic crisis. If the client is in myasthenic crisis, muscle strength improves after administration of the medication and lasts for about 30 minutes.

219.) A health care provider instructs a client with rheumatoid arthritis to take ibuprofen (Motrin). The nurse reinforces the instructions, knowing that the normal adult dose for this client is which of the following? 1. 100 mg orally twice a day 2. 200 mg orally twice a day 3. 400 mg orally three times a day 4. 1000 mg orally four times a day

3. 400 mg orally three times a day Rationale: For acute or chronic rheumatoid arthritis or osteoarthritis, the normal oral adult dose is 400 to 800 mg three or four times daily.

A nurse is caring for a child receiving carbamazepine (Tegretol) who has a carbamazepine level drawn. Which of the following results indicates a therapeutic level? 1. 1 mcg/mL 2. 3 mcg/mL 3. 6 mcg/mL 4. 15 mcg/mL

3. 6 mcg/mL Rationale: When carbamazepine is administered, blood levels need to be drawn periodically to check for the child's absorption of the medication. The amount of the medication prescribed is based on the blood level achieved. The therapeutic serum level for this medication is 4 to 12 mcg/mL.

191.) A child is brought to the emergency department for treatment of an acute asthma attack. The nurse prepares to administer which of the following medications first? 1. Oral corticosteroids 2. A leukotriene modifier 3. A β2 agonist 4. A nonsteroidal anti-inflammatory

3. A β2 agonist Rationale: In treating an acute asthma attack, a short acting β2 agonist such as albuterol (Proventil HFA) will be given to produce bronchodilation. Options 1, 2, and 4 are long-term control (preventive) medications.

120.) A client is taking lansoprazole (Prevacid) for the chronic management of Zollinger-Ellison syndrome. The nurse advises the client to take which of the following products if needed for a headache? 1. Naprosyn (Aleve) 2. Ibuprofen (Advil) 3. Acetaminophen (Tylenol) 4. Acetylsalicylic acid (aspirin)

3. Acetaminophen (Tylenol) Rationale: Zollinger-Ellison syndrome is a hypersecretory condition of the stomach. The client should avoid taking medications that are irritating to the stomach lining. Irritants would include aspirin and nonsteroidal antiinflammatory drugs (ibuprofen). The client should be advised to take acetaminophen for headache. **Remember that options that are comparable or alike are not likely to be correct. With this in mind, eliminate options 1 and 2 first.**

233.) Diphenhydramine hydrochloride (Benadryl) is used in the treatment of allergic rhinitis for a hospitalized client with a chronic psychotic disorder. The client asks the nurse why the medication is being discontinued before hospital discharge. The nurse responds, knowing that: 1. Allergic symptoms are short in duration. 2. This medication promotes long-term extrapyramidal symptoms. 3. Addictive properties are enhanced in the presence of psychotropic medications. 4. Poor compliance causes this medication to fail to reach its therapeutic blood level.

3. Addictive properties are enhanced in the presence of psychotropic medications. Rationale: The addictive properties of diphenhydramine hydrochloride are enhanced when used with psychotropic medications. Allergic symptoms may not be short term and will occur if allergens are present in the environment. Poor compliance may be a problem with psychotic clients but is not the subject of the question. Diphenhydramine hydrochloride may be used for extrapyramidal symptoms and mild medication-induced movement disorders.

35.) The client has a PRN prescription for loperamide hydrochloride (Imodium). The nurse understands that this medication is used for which condition? 1. Constipation 2. Abdominal pain 3. An episode of diarrhea 4. Hematest-positive nasogastric tube drainage

3. An episode of diarrhea Rationale: Loperamide is an antidiarrheal agent. It is used to manage acute and also chronic diarrhea in conditions such as inflammatory bowel disease. Loperamide also can be used to reduce the volume of drainage from an ileostomy. It is not used for the conditions in options 1, 2, and 4.

207.) A client is suspected of having myasthenia gravis, and the health care provider administers edrophonium (Enlon) to determine the diagnosis. After administration of this medication, which of the following would indicate the presence of myasthenia gravis? 1. Joint pain 2. A decrease in muscle strength 3. An increase in muscle strength 4. Feelings of faintness, dizziness, hypotension, and signs of flushing in the client

3. An increase in muscle strength Rationale: Edrophonium is a short-acting acetylcholinesterase inhibitor used as a diagnostic agent. When a client with suspected myasthenia gravis is given the medication intravenously, an increase in muscle strength would be seen in 1 to 3 minutes. If no response occurs, another dose is given over the next 2 minutes, and muscle strength is again tested. If no increase in muscle strength occurs with this higher dose, the muscle weakness is not caused by myasthenia gravis. Clients receiving injections of this medication commonly demonstrate a drop of blood pressure, feel faint and dizzy, and are flushed.

A 6-month-old infant receives a diphtheria, tetanus, and pertussis (DTaP) immunization at the well-baby clinic. The mother returns home and calls the clinic to report that the infant has developed swelling and redness at the site of injection. The appropriate suggestion to the mother should be to: 1. Apply a warm pack to the injection site. 2. Bring the infant back to the clinic. 3. Apply an ice pack to the injection site. 4. Monitor the infant for a fever.

3. Apply an ice pack to the injection site. Rationale: Occasionally, tenderness, redness, or swelling may occur at the site of the injection. This can be relieved with ice packs for the first 24 hours followed by warm compresses if the inflammation persists. It is not necessary to bring the infant back to the clinic. Option 4 may be an appropriate intervention but is not specific to the subject of the question.

107.) A client receiving a tricyclic antidepressant arrives at the mental health clinic. Which observation indicates that the client is correctly following the medication plan? 1. Reports not going to work for this past week 2. Complains of not being able to "do anything" anymore 3. Arrives at the clinic neat and appropriate in appearance 4. Reports sleeping 12 hours per night and 3 to 4 hours during the day

3. Arrives at the clinic neat and appropriate in appearance Rationale: Depressed individuals will sleep for long periods, are not able to go to work, and feel as if they cannot "do anything." Once they have had some therapeutic effect from their medication, they will report resolution of many of these complaints as well as demonstrate an improvement in their appearance.

153.) A client is diagnosed with pulmonary embolism and is to be treated with streptokinase (Streptase). A nurse would report which priority data collection finding to the registered nurse before initiating this therapy? 1. Adventitious breath sounds 2. Temperature of 99.4° F orally 3. Blood pressure of 198/110 mm Hg 4. Respiratory rate of 28 breaths/min

3. Blood pressure of 198/110 mm Hg Rationale: Thrombolytic therapy is contraindicated in a number of preexisting conditions in which there is a risk of uncontrolled bleeding, similar to the case in anticoagulant therapy. Thrombolytic therapy also is contraindicated in severe uncontrolled hypertension because of the risk of cerebral hemorrhage. Therefore the nurse would report the results of the blood pressure to the registered nurse before initiating therapy. The findings in options 1, 2, and 4 may be present in the client with pulmonary embolism.

69.) A nurse who is administering bethanechol chloride (Urecholine) is monitoring for acute toxicity associated with the medication. The nurse checks the client for which sign of toxicity? 1. Dry skin 2. Dry mouth 3. Bradycardia 4. Signs of dehydration

3. Bradycardia Rationale: Toxicity (overdose) produces manifestations of excessive muscarinic stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension. Treatment includes supportive measures and the administration of atropine sulfate subcutaneously or intravenously.

154.) A nurse is reinforcing dietary instructions to a client who has been prescribed cyclosporine (Sandimmune). Which food item would the nurse instruct the client to avoid? 1. Red meats 2. Orange juice 3. Grapefruit juice 4. Green, leafy vegetables

3. Grapefruit juice Rationale: A compound present in grapefruit juice inhibits metabolism of cyclosporine. As a result, the consumption of grapefruit juice can raise cyclosporine levels by 50% to 100%, thereby greatly increasing the risk of toxicity. Grapefruit juice needs to be avoided. Red meats, orange juice, and green leafy vegetables are acceptable to consume.

1) A nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13 mg/dL. Which medication should the nurse prepare to administer as prescribed to the client? 1. Calcium chloride 2. Calcium gluconate 3. Calcitonin (Miacalcin) 4. Large doses of vitamin D

3. Calcitonin (Miacalcin) Rationale: The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing hypercalcemia. Calcium gluconate and calcium chloride are medications used for the treatment of tetany, which occurs as a result of acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided. Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration.

49.) A client has been started on long-term therapy with rifampin (Rifadin). A nurse teaches the client that the medication: 1. Should always be taken with food or antacids 2. Should be double-dosed if one dose is forgotten 3. Causes orange discoloration of sweat, tears, urine, and feces 4. May be discontinued independently if symptoms are gone in 3 months

3. Causes orange discoloration of sweat, tears, urine, and feces Rationale: Rifampin should be taken exactly as directed as part of TB therapy. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a health care provider. The medication should be administered on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin causes orange-red discoloration of body secretions and will permanently stain soft contact lenses.

38.) An older client recently has been taking cimetidine (Tagamet). The nurse monitors the client for which most frequent central nervous system side effect of this medication? 1. Tremors 2. Dizziness 3. Confusion 4. Hallucinations

3. Confusion Rationale: Cimetidine is a histamine 2 (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations.

16.) The clinic nurse is reviewing a teaching plan for the client receiving an antineoplastic medication. When implementing the plan, the nurse tells the client: 1. To take aspirin (acetylsalicylic acid) as needed for headache 2. Drink beverages containing alcohol in moderate amounts each evening 3. Consult with health care providers (HCPs) before receiving immunizations 4. That it is not necessary to consult HCPs before receiving a flu vaccine at the local health fair

3. Consult with health care providers (HCPs) before receiving immunizations Rationale: Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without a HCP's approval. Clients also need to avoid contact with individuals who have recently received a live virus vaccine. Clients need to avoid aspirin and aspirin-containing products to minimize the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity and side effects.

150.) A client complaining of not feeling well is seen in a clinic. The client is taking several medications for the control of heart disease and hypertension. These medications include a β-blocker, digoxin (Lanoxin), and a diuretic. A tentative diagnosis of digoxin toxicity is made. Which of the following assessment data would support this diagnosis? 1. Dyspnea, edema, and palpitations 2. Chest pain, hypotension, and paresthesia 3. Double vision, loss of appetite, and nausea 4. Constipation, dry mouth, and sleep disorder

3. Double vision, loss of appetite, and nausea Rationale: Double vision, loss of appetite, and nausea are signs of digoxin toxicity. Additional signs of digoxin toxicity include bradycardia, difficulty reading, visual alterations such as green and yellow vision or seeing spots or halos, confusion, vomiting, diarrhea, decreased libido, and impotence. **gastrointestinal (GI) and visual disturbances occur with digoxin toxicity**

85.) A nurse is monitoring a client receiving baclofen (Lioresal) for side effects related to the medication. Which of the following would indicate that the client is experiencing a side effect? 1. Polyuria 2. Diarrhea 3. Drowsiness 4. Muscular excitability

3. Drowsiness Rationale: Baclofen is a central nervous system (CNS) depressant and frequently causes drowsiness, dizziness, weakness, and fatigue. It can also cause nausea, constipation, and urinary retention. Clients should be warned about the possible reactions. Options 1, 2, and 4 are not side effects.

138.) A daily dose of prednisone is prescribed for a client. A nurse reinforces instructions to the client regarding administration of the medication and instructs the client that the best time to take this medication is: 1. At noon 2. At bedtime 3. Early morning 4. Anytime, at the same time, each day

3. Early morning Rationale: Corticosteroids (glucocorticoids) should be administered before 9:00 AM. Administration at this time helps minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenal glands each morning. **Note the suffix "-sone," and recall that medication names that end with these letters are corticosteroids.**

71.) After kidney transplantation, cyclosporine (Sand immune) is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication? 1. Decreased creatinine level 2. Decreased hemoglobin level 3. Elevated blood urea nitrogen level 4. Decreased white blood cell count

3. Elevated blood urea nitrogen level Rationale: Nephrotoxicity can occur from the use of cyclosporine (Sandimmune). Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen (BUN) and serum creatinine levels. Cyclosporine is an immunosuppressant but does not depress the bone marrow.

244.) A client has a prescription for valproic acid (Depakene) orally once daily. The nurse plans to: 1. Administer the medication with an antacid. 2. Administer the medication with a carbonated beverage. 3. Ensure that the medication is administered at the same time each day. 4. Ensure that the medication is administered 2 hours before breakfast only, when the client's stomach is empty.

3. Ensure that the medication is administered at the same time each day. Rationale: Valproic acid is an anticonvulsant, antimanic, and antimigraine medication. It may be administered with or without food. It should not be taken with an antacid or carbonated beverage because these products will affect medication absorption. The medication is administered at the same time each day to maintain therapeutic serum levels. **Use general pharmacology guidelines to assist in eliminating options 1 and 2. Eliminate option 4 because of the closed-ended word "only."**

Therapeutic Range Vancomycin

30-40 mcg/mL

97.) Amikacin (Amikin) is prescribed for a client with a bacterial infection. The client is instructed to contact the health care provider (HCP) immediately if which of the following occurs? 1. Nausea 2. Lethargy 3. Hearing loss 4. Muscle aches

3. Hearing loss Rationale: Amikacin (Amikin) is an aminoglycoside. Adverse effects of aminoglycosides include ototoxicity (hearing problems), confusion, disorientation, gastrointestinal irritation, palpitations, blood pressure changes, nephrotoxicity, and hypersensitivity. The nurse instructs the client to report hearing loss to the HCP immediately. Lethargy and muscle aches are not associated with the use of this medication. It is not necessary to contact the HCP immediately if nausea occurs. If nausea persists or results in vomiting, the HCP should be notified. **(most aminoglycoside medication names end in the letters -cin)**

60.) A nurse is planning to administer hydrochlorothiazide (HydroDIURIL) to a client. The nurse understands that which of the following are concerns related to the administration of this medication? 1. Hypouricemia, hyperkalemia 2. Increased risk of osteoporosis 3. Hypokalemia, hyperglycemia, sulfa allergy 4. Hyperkalemia, hypoglycemia, penicillin allergy

3. Hypokalemia, hyperglycemia, sulfa allergy Rationale: Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.

A client is receiving diazepam (Valium) for its skeletal muscle relaxant effects. The nurse should monitor this client for which side effect of this medication? 1. Urinary retention 2. Headache 3. Incoordination 4. Increased salivation

3. Incoordination Rationale: Diazepam is a centrally acting skeletal muscle relaxant. Incoordination and drowsiness are common side effects resulting from this medication. The other options are incorrect.

130.) The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the nurse specifically note as a result of the massive cell destruction that occurred from the chemotherapy? 1. Anemia 2. Decreased platelets 3. Increased uric acid level 4. Decreased leukocyte count

3. Increased uric acid level Rationale: Hyperuricemia is especially common following treatment for leukemias and lymphomas because chemotherapy results in a massive cell kill. Although options 1, 2, and 4 also may be noted, an increased uric acid level is related specifically to cell destruction.

A client with diabetes mellitus has a foot infection and is to be started on antibiotic therapy with an aminoglycoside. The nurse collects data from the client and notes that the client has a hearing loss. The nurse should take which of the following actions next? 1. Suggest a peak and trough to ensure safe medication administration. 2. Have the client drink extra water to avoid toxic side effects. 3. Inform the registered nurse (RN) about the hearing loss. 4. Give the medication but at half the prescribed dose.

3. Inform the registered nurse (RN) about the hearing loss. Rationale: A preexisting hearing loss is a contraindication for the administration of aminoglycosides because these medications can cause ototoxicity and irreversible hearing loss. The nurse should report the findings to the RN to protect the client's safety. The RN will in turn notify the health care provider. Options 1 and 2 are not beneficial because hearing loss has already occurred in this client. Nurses do not change medication prescriptions independently.

122.) A client who has begun taking fosinopril (Monopril) is very distressed, telling the nurse that he cannot taste food normally since beginning the medication 2 weeks ago. The nurse provides the best support to the client by: 1. Telling the client not to take the medication with food 2. Suggesting that the client taper the dose until taste returns to normal 3. Informing the client that impaired taste is expected and generally disappears in 2 to 3 months 4. Requesting that the health care provider (HCP) change the prescription to another brand of angiotensin-converting enzyme (ACE) inhibitor

3. Informing the client that impaired taste is expected and generally disappears in 2 to 3 months Rationale: ACE inhibitors, such as fosinopril, cause temporary impairment of taste (dysgeusia). The nurse can tell the client that this effect usually disappears in 2 to 3 months, even with continued therapy, and provide nutritional counseling if appropriate to avoid weight loss. Options 1, 2, and 4 are inappropriate actions. Taking this medication with or without food does not affect absorption and action. The dosage should never be tapered without HCP approval and the medication should never be stopped abruptly.

5.) Mafenide acetate (Sulfamylon) is prescribed for the client with a burn injury. When applying the medication, the client complains of local discomfort and burning. Which of the following is the most appropriate nursing action? 1. Notifying the registered nurse 2. Discontinuing the medication 3. Informing the client that this is normal 4. Applying a thinner film than prescribed to the burn site

3. Informing the client that this is normal Rationale: Mafenide acetate is bacteriostatic for gram-negative and gram-positive organisms and is used to treat burns to reduce bacteria present in avascular tissues. The client should be informed that the medication will cause local discomfort and burning and that this is a normal reaction; therefore options 1, 2, and 4 are incorrect

243.) A hospitalized client is having the dosage of clonazepam (Klonopin) adjusted. The nurse should plan to: 1. Weigh the client daily. 2. Observe for ecchymosis. 3. Institute seizure precautions. 4. Monitor blood glucose levels.

3. Institute seizure precautions. Rationale: Clonazepam is a benzodiazepine used as an anticonvulsant. During initial therapy and during periods of dosage adjustment, the nurse should initiate seizure precautions for the client. Options 1, 2, and 4 are not associated with the use of this medication.

230.) A client is placed on chloral hydrate (Somnote) for short-term treatment. Which nursing action indicates an understanding of the major side effect of this medication? 1. Monitoring neurological signs every 2 hours 2. Monitoring the blood pressure every 4 hours 3. Instructing the client to call for ambulation assistance 4. Lowering the bed and clearing a path to the bathroom at bedtime

3. Instructing the client to call for ambulation assistance Rationale: Chloral hydrate (a sedative-hypnotic) causes sedation and impairment of motor coordination; therefore, safety measures need to be implemented. The client is instructed to call for assistance with ambulation. Options 1 and 2 are not specifically associated with the use of this medication. Although option 4 is an appropriate nursing intervention, it is most important to instruct the client to call for assistance with ambulation.

Therapeutic aPTT

30-90 sec (Heparin)

A nurse is reviewing medications with the client receiving colchicine for the treatment of gout. The nurse determines that the medication is effective if the client reports a decrease in: 1. Blood glucose 2. Blood pressure 3. Joint inflammation 4. Headaches

3. Joint inflammation Rationale: Colchicine is classified as an antigout agent. It interferes with the ability of the white blood cells to initiate and maintain an inflammatory response to monosodium urate crystals. The client should report a decrease in pain and inflammation in the affected joints, as well as a decrease in the number of gout attacks. Colchicine has no effect on the client's blood glucose or blood pressure; it is not used to treat a headache.

241.) A client with a history of simple partial seizures is taking clorazepate (Tranxene), and asks the nurse if there is a risk of addiction. The nurse's response is based on the understanding that clorazepate: 1. Is not habit forming, either physically or psychologically 2. Leads to physical tolerance, but only after 10 or more years of therapy 3. Leads to physical and psychological dependence with prolonged high-dose therapy 4. Can result in psychological dependence only, because of the nature of the medication

3. Leads to physical and psychological dependence with prolonged high-dose therapy Rationale: Clorazepate is classified as an anticonvulsant, antianxiety agent, and sedative-hypnotic (benzodiazepine). One of the concerns with clorazepate therapy is that the medication can lead to physical or psychological dependence with prolonged therapy at high doses. For this reason, the amount of medication that is readily available to the client at any one time is restricted. **Eliminate options 2 and 4 first because of the closed-ended word "only"**

A nurse has provided instructions to a client regarding the method for instilling eye drops into the left eye. The nurse determines that the client needs further instruction if the client does which of the following during a return demonstration? 1. Lies with the head to one side, puts the drop in the inner canthus, and slowly turns to the other side while blinking 2. Lies supine, pulls down on the lower lid, and puts the drop in the lower lid 3. Lies supine, pulls up on the upper lid, and puts the drop in the upper lid 4. Tilts the head back, pulls down on the lower lid, and puts the drop in the lower lid

3. Lies supine, pulls up on the upper lid, and puts the drop in the upper lid Rationale: It is correct procedure for the client to either lie down or sit with the head tilted back. The thumb or finger is used to pull down on the lower lid. The client holds the bottle like a pencil (tip facing downward) and squeezes the bottle so that the drop falls into the sac. The client then gently closes the eye. An alternative method for clients who blink very easily is to place the client in the supine position with the head turned to one side. The eye to be used is uppermost. The client squeezes the drop onto the inner canthus. The client turns from this side to the other while blinking. Surface tension and gravity then cause the drop to move into the conjunctival sac.

52.) A client with tuberculosis is being started on antituberculosis therapy with isoniazid (INH). Before giving the client the first dose, a nurse ensures that which of the following baseline studies has been completed? 1. Electrolyte levels 2. Coagulation times 3. Liver enzyme levels 4. Serum creatinine level

3. Liver enzyme levels Rationale: INH therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is greater than age 50 or abuses alcohol.

210.) Dantrolene (Dantrium) is prescribed for a client with a spinal cord injury for discomfort resulting from spasticity. The nurse tells the client about the importance of follow-up and the need for which blood study? 1. Creatinine level 2. Sedimentation rate 3. Liver function studies 4. White blood cell count

3. Liver function studies Rationale: Dantrolene can cause liver damage, and the nurse should monitor liver function studies. Baseline liver function studies are done before therapy starts, and regular liver function studies are performed throughout therapy. Dantrolene is discontinued if no relief of spasticity is achieved in 6 weeks.

A nurse is caring for a client with glaucoma who is receiving acetazolamide (Diamox Sequels) daily. Which of the following indicates to the nurse that the client is experiencing an adverse effect related to the medication? 1. Diarrhea 2. Lacrimation 3. Low back pain and dysuria 4. Irritability

3. Low back pain and dysuria Rationale: Acetazolamide is a carbonic anhydrase inhibitor. Nephrotoxicity and hepatotoxicity can occur and are manifested by dark urine and stools, jaundice, pain in the lower back, dysuria, crystalluria, renal colic, and calculi. Bone marrow depression also may occur. The remaining options are not adverse effects of the medication.

59.) A client is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase (Activase, tPA). Which action is a priority nursing intervention? 1. Monitor for renal failure. 2. Monitor psychosocial status. 3. Monitor for signs of bleeding. 4. Have heparin sodium available.

3. Monitor for signs of bleeding. Rationale: Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychosocial status are important but are not the most critical interventions. Heparin is given after thrombolytic therapy, but the question is not asking about follow-up medications.

151.) A client is being treated for acute congestive heart failure with intravenously administered bumetanide. The vital signs are as follows: blood pressure, 100/60 mm Hg; pulse, 96 beats/min; and respirations, 24 breaths/min. After the initial dose, which of the following is the priority assessment? 1. Monitoring weight loss 2. Monitoring temperature 3. Monitoring blood pressure 4. Monitoring potassium level

3. Monitoring blood pressure Rationale: Bumetanide is a loop diuretic. Hypotension is a common side effect associated with the use of this medication. The other options also require assessment but are not the priority. **priority ABCs—airway, breathing, and circulation**

To better control the client's blood glucose level, the physician orders a high regular insulin dosage of 20 units of U-500 insulin. The nurse has only a U-100 syringe. How many units will be given

4 U-500 insulin is 5 times as strong as U-100 insulin. Therefore the amount of U-500 insulin should be divided by 5; 20 units ÷ 5 = 4 units.

A nurse is caring for a hospitalized child with a history of seizures who is receiving oral phenytoin sodium (Dilantin). Which of the following should be included in the plan of care for this child? 1. Monitoring intake and output 2. Checking the heart rate before administering the phenytoin 3. Providing oral hygiene especially care of the gums 4. Administering medications 1 hour before food intake

3. Providing oral hygiene especially care of the gums Rationale: Phenytoin sodium causes gum bleeding and hypertrophy, and therefore oral hygiene is important. Soft toothbrushes and gum massage should be instituted to reduce the risk of complications and prevent further trauma. Options 1 and 2 are incorrect because the intake and output as well as heart rate are not affected by this medication. Option 4 is incorrect because directions for administration of this medication include administering with food to minimize gastrointestinal upset.

201.) A nurse is preparing to administer eardrops to an infant. The nurse plans to: 1. Pull up and back on the ear and direct the solution onto the eardrum. 2. Pull down and back on the ear and direct the solution onto the eardrum. 3. Pull down and back on the ear and direct the solution toward the wall of the canal. 4. Pull up and back on the ear lobe and direct the solution toward the wall of the canal.

3. Pull down and back on the ear and direct the solution toward the wall of the canal. Rationale: When administering eardrops to an infant, the nurse pulls the ear down and straight back. In the adult or a child older than 3 years, the ear is pulled up and back to straighten the auditory canal. The medication is administered by aiming it at the wall of the canal rather than directly onto the eardrum.

37.) The client has begun medication therapy with pancrelipase (Pancrease MT). The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed? 1. Weight loss 2. Relief of heartburn 3. Reduction of steatorrhea 4. Absence of abdominal pain

3. Reduction of steatorrhea Rationale: Pancrelipase (Pancrease MT) is a pancreatic enzyme used in clients with pancreatitis as a digestive aid. The medication should reduce the amount of fatty stools (steatorrhea). Another intended effect could be improved nutritional status. It is not used to treat abdominal pain or heartburn. Its use could result in weight gain but should not result in weight loss if it is aiding in digestion.

A client began taking amantadine (Symmetrel) approximately 2 weeks ago. The nurse would evaluate that the medication was having a therapeutic effect if the client exhibited decreased: 1. Voiding 2. Blood pressure 3. Rigidity and akinesia 4. White blood cell count

3. Rigidity and akinesia Rationale: Amantadine is an antiparkinson agent that potentiates the action of dopamine in the central nervous system. The expected effect of therapy is a decrease in akinesia and rigidity. Leukopenia, urinary retention, and hypotension are all adverse effects of the medication.

137.) A nurse is reinforcing instructions for a client regarding intranasal desmopressin acetate (DDAVP). The nurse tells the client that which of the following is a side effect of the medication? 1. Headache 2. Vulval pain 3. Runny nose 4. Flushed skin

3. Runny nose Rationale: Desmopressin administered by the intranasal route can cause a runny or stuffy nose. Headache, vulval pain, and flushed skin are side effects if the medication is administered by the intravenous (IV) route.

95.) The nurse is reviewing the results of serum laboratory studies drawn on a client with acquired immunodeficiency syndrome who is receiving didanosine (Videx). The nurse interprets that the client may have the medication discontinued by the health care provider if which of the following significantly elevated results is noted? 1. Serum protein 2. Blood glucose 3. Serum amylase 4. Serum creatinine

3. Serum amylase Rationale: Didanosine (Videx) can cause pancreatitis. A serum amylase level that is increased 1.5 to 2 times normal may signify pancreatitis in the client with acquired immunodeficiency syndrome and is potentially fatal. The medication may have to be discontinued. The medication is also hepatotoxic and can result in liver failure.

98.) The nurse is assigned to care for a client with cytomegalovirus retinitis and acquired immunodeficiency syndrome who is receiving foscarnet. The nurse should check the latest results of which of the following laboratory studies while the client is taking this medication? 1. CD4 cell count 2. Serum albumin 3. Serum creatinine 4. Lymphocyte count

3. Serum creatinine Rationale: Foscarnet is toxic to the kidneys. Serum creatinine is monitored before therapy, two to three times per week during induction therapy, and at least weekly during maintenance therapy. Foscarnet may also cause decreased levels of calcium, magnesium, phosphorus, and potassium. Thus these levels are also measured with the same frequency.

211.) A client with epilepsy is taking the prescribed dose of phenytoin (Dilantin) to control seizures. A phenytoin blood level is drawn, and the results reveal a level of 35 mcg/ml. Which of the following symptoms would be expected as a result of this laboratory result? 1. Nystagmus 2. Tachycardia 3. Slurred speech 4. No symptoms, because this is a normal therapeutic level

3. Slurred speech Rationale: The therapeutic phenytoin level is 10 to 20 mcg/mL. At a level higher than 20 mcg/mL, involuntary movements of the eyeballs (nystagmus) appear. At a level higher than 30 mcg/mL, ataxia and slurred speech occur.

187.) A clinic nurse prepares to administer an MMR (measles, mumps, rubella) vaccine to a child. How is this vaccine best administered? 1. Intramuscularly in the deltoid muscle 2. Subcutaneously in the gluteal muscle 3. Subcutaneously in the outer aspect of the upper arm 4. Intramuscularly in the anterolateral aspect of the thigh

3. Subcutaneously in the outer aspect of the upper arm Rationale: The MMR vaccine is administered subcutaneously in the outer aspect of the upper arm. The gluteal muscle is most often used for intramuscular injections. The MMR vaccine is not administered by the intramuscular route.

46.) A postoperative client has received a dose of naloxone hydrochloride for respiratory depression shortly after transfer to the nursing unit from the postanesthesia care unit. After administration of the medication, the nurse checks the client for: 1. Pupillary changes 2. Scattered lung wheezes 3. Sudden increase in pain 4. Sudden episodes of diarrhea

3. Sudden increase in pain Rationale: Naloxone hydrochloride is an antidote to opioids and may also be given to the postoperative client to treat respiratory depression. When given to the postoperative client for respiratory depression, it may also reverse the effects of analgesics. Therefore, the nurse must check the client for a sudden increase in the level of pain experienced. Options 1, 2, and 4 are not associated with this medication.

58.) Isosorbide mononitrate (Imdur) is prescribed for a client with angina pectoris. The client tells the nurse that the medication is causing a chronic headache. The nurse appropriately suggests that the client: 1. Cut the dose in half. 2. Discontinue the medication. 3. Take the medication with food. 4. Contact the health care provider (HCP).

3. Take the medication with food. Rationale: Isosorbide mononitrate is an antianginal medication. Headache is a frequent side effect of isosorbide mononitrate and usually disappears during continued therapy. If a headache occurs during therapy, the client should be instructed to take the medication with food or meals. It is not necessary to contact the HCP unless the headaches persist with therapy. It is not appropriate to instruct the client to discontinue therapy or adjust the dosages.

245.) A client taking carbamazepine (Tegretol) asks the nurse what to do if he misses one dose. The nurse responds that the carbamazepine should be: 1. Withheld until the next scheduled dose 2. Withheld and the health care provider is notified immediately 3. Taken as long as it is not immediately before the next dose 4. Withheld until the next scheduled dose, which should then be doubled

3. Taken as long as it is not immediately before the next dose Rationale: Carbamazepine is an anticonvulsant that should be taken around the clock, precisely as directed. If a dose is omitted, the client should take the dose as soon as it is remembered, as long as it is not immediately before the next dose. The medication should not be double dosed. If more than one dose is omitted, the client should call the health care provider.

229.) A client who is taking lithium carbonate (Lithobid) is scheduled for surgery. The nurse informs the client that: 1. The medication will be discontinued a week before the surgery and resumed 1 week postoperatively. 2. The medication is to be taken until the day of surgery and resumed by injection immediately postoperatively. 3. The medication will be discontinued 1 to 2 days before the surgery and resumed as soon as full oral intake is allowed. 4. The medication will be discontinued several days before surgery and resumed by injection in the immediate postoperative period.

3. The medication will be discontinued 1 to 2 days before the surgery and resumed as soon as full oral intake is allowed. Rationale: The client who is on lithium carbonate must be off the medication for 1 to 2 days before a scheduled surgical procedure and can resume the medication when full oral intake is prescribed after the surgery. **lithium carbonate is an oral medication and is not given as an injection**

80.) A nurse is caring for a client who is taking phenytoin (Dilantin) for control of seizures. During data collection, the nurse notes that the client is taking birth control pills. Which of the following information should the nurse provide to the client? 1. Pregnancy should be avoided while taking phenytoin (Dilantin). 2. The client may stop taking the phenytoin (Dilantin) if it is causing severe gastrointestinal effects. 3. The potential for decreased effectiveness of the birth control pills exists while taking phenytoin (Dilantin). 4. The increased risk of thrombophlebitis exists while taking phenytoin (Dilantin) and birth control pills together.

3. The potential for decreased effectiveness of the birth control pills exists while taking phenytoin (Dilantin). Rationale: Phenytoin (Dilantin) enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. Options 1, 2, are 4 are not accurate.

129.) Megestrol acetate (Megace), an antineoplastic medication, is prescribed for the client with metastatic endometrial carcinoma. The nurse reviews the client's history and contacts the registered nurse if which diagnosis is documented in the client's history? 1. Gout 2. Asthma 3. Thrombophlebitis 4. Myocardial infarction

3. Thrombophlebitis Rationale: Megestrol acetate (Megace) suppresses the release of luteinizing hormone from the anterior pituitary by inhibiting pituitary function and regressing tumor size. Megestrol is used with caution if the client has a history of thrombophlebitis. **megestrol acetate is a hormonal antagonist enzyme and that a side effect is thrombotic disorders**

22.) A nurse is caring for a client after thyroidectomy and notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed to: 1. Treat thyroid storm. 2. Prevent cardiac irritability. 3. Treat hypocalcemic tetany. 4. Stimulate the release of parathyroid hormone.

3. Treat hypocalcemic tetany. Rationale: Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed or injured during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes or muscle spasms or twitching, the health care provider is notified immediately. Calcium gluconate should be kept at the bedside.

27.) Sildenafil (Viagra) is prescribed to treat a client with erectile dysfunction. A nurse reviews the client's medical record and would question the prescription if which of the following is noted in the client's history? 1. Neuralgia 2. Insomnia 3. Use of nitroglycerin 4. Use of multivitamins

3. Use of nitroglycerin Rationale: Sildenafil (Viagra) enhances the vasodilating effect of nitric oxide in the corpus cavernosum of the penis, thus sustaining an erection. Because of the effect of the medication, it is contraindicated with concurrent use of organic nitrates and nitroglycerin. Sildenafil is not contraindicated with the use of vitamins. Neuralgia and insomnia are side effects of the medication.

103.) A nurse is caring for a hospitalized client who has been taking clozapine (Clozaril) for the treatment of a schizophrenic disorder. Which laboratory study prescribed for the client will the nurse specifically review to monitor for an adverse effect associated with the use of this medication? 1. Platelet count 2. Cholesterol level 3. White blood cell count 4. Blood urea nitrogen level

3. White blood cell count Rationale: Hematological reactions can occur in the client taking clozapine and include agranulocytosis and mild leukopenia. The white blood cell count should be checked before initiating treatment and should be monitored closely during the use of this medication. The client should also be monitored for signs indicating agranulocytosis, which may include sore throat, malaise, and fever. Options 1, 2, and 4 are unrelated to this medication.

81.) A client with trigeminal neuralgia is being treated with carbamazepine (Tegretol). Which laboratory result would indicate that the client is experiencing an adverse reaction to the medication? 1. Sodium level, 140 mEq/L 2. Uric acid level, 5.0 mg/dL 3. White blood cell count, 3000 cells/mm3 4. Blood urea nitrogen (BUN) level, 15 mg/dL

3. White blood cell count, 3000 cells/mm3 Rationale: Adverse effects of carbamazepine (Tegretol) appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia, cardiovascular disturbances, thrombophlebitis, dysrhythmias, and dermatological effects. Options 1, 2, and 4 identify normal laboratory values.

ALT

4-6 units/L

Therapeutic Range Magnesium Sulfate

4-8 mEq/L

118.) A nurse is caring for an older client with a diagnosis of myasthenia gravis and has reinforced self-care instructions. Which statement by the client indicates that further teaching is necessary? 1. "I rest each afternoon after my walk." 2. "I cough and deep breathe many times during the day." 3. "If I get abdominal cramps and diarrhea, I should call my doctor." 4. "I can change the time of my medication on the mornings that I feel strong."

4. "I can change the time of my medication on the mornings that I feel strong." Rationale: The client with myasthenia gravis should be taught that timing of anticholinesterase medication is critical. It is important to instruct the client to administer the medication on time to maintain a chemical balance at the neuromuscular junction. If not given on time, the client may become too weak to swallow. Options 1, 2, and 3 include the necessary information that the client needs to understand to maintain health with this neurological degenerative disease.

54.) A nurse reinforces discharge instructions to a postoperative client who is taking warfarin sodium (Coumadin). Which statement, if made by the client, reflects the need for further teaching? 1. "I will take my pills every day at the same time." 2. "I will be certain to avoid alcohol consumption." 3. "I have already called my family to pick up a Medic-Alert bracelet." 4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated."

4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated." Rationale: Ecotrin is an aspirin-containing product and should be avoided. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking prescribed medication at the same time each day increases client compliance. The Medic-Alert bracelet provides health care personnel emergency information.

61.) A home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine (Questran). Which of the following statements, if made by the client, indicates the need for further education? 1. "Constipation and bloating might be a problem." 2. "I'll continue to watch my diet and reduce my fats." 3. "Walking a mile each day will help the whole process." 4. "I'll continue my nicotinic acid from the health food store."

4. "I'll continue my nicotinic acid from the health food store." Rationale: Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid-lowering medications also can cause liver abnormalities, so a combination of nicotinic acid and cholestyramine resin is to be avoided. Constipation and bloating are the two most common side effects. Walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels.

62.) A client is on nicotinic acid (niacin) for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client would indicate an understanding of the instructions? 1. "It is not necessary to avoid the use of alcohol." 2. "The medication should be taken with meals to decrease flushing." 3. "Clay-colored stools are a common side effect and should not be of concern." 4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing."

4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing." Rationale: Flushing is a side effect of this medication. Aspirin or a nonsteroidal anti-inflammatory drug can be taken 30 minutes before taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this side effect. The medication should be taken with meals, this will decrease gastrointestinal upset. Taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be immediately reported to the health care provider (HCP).

A transcutaneous electrical nerve stimulation (TENS) is prescribed for a client with pain, and the nurse provides information to the client about TENS unit. Which statement by the client indicates the need for further information? 1. "Electrodes are attached to the skin." 2. "The unit relieves pain." 3. "The unit will reduce the needs for analgesics." 4. "Needles are inserted in the subcutaneous tissue to stimulate the nerve."

4. "Needles are inserted in the subcutaneous tissue to stimulate the nerve." Rationale: The TENS unit is a portable unit, and the client controls the system for relieving pain and reducing the need for analgesics. It is attached to the skin of the body by electrodes. Needles are not used.

218.) A film-coated form of diflunisal has been prescribed for a client for the treatment of chronic rheumatoid arthritis. The client calls the clinic nurse because of difficulty swallowing the tablets. Which initial instruction should the nurse provide to the client? 1. "Crush the tablets and mix them with food." 2. "Notify the health care provider for a medication change." 3. "Open the tablet and mix the contents with food." 4. "Swallow the tablets with large amounts of water or milk."

4. "Swallow the tablets with large amounts of water or milk." Rationale: Diflunisal may be given with water, milk, or meals. The tablets should not be crushed or broken open. Taking the medication with a large amount of water or milk should be tried before contacting the health care provider.

198.) Coal tar has been prescribed for a client with a diagnosis of psoriasis, and the nurse provides instructions to the client about the medication. Which statement by the client indicates a need for further instructions? 1. "The medication can cause phototoxicity." 2. "The medication has an unpleasant odor." 3. "The medication can stain the skin and hair." 4. "The medication can cause systemic effects."

4. "The medication can cause systemic effects." Rationale: Coal tar is used to treat psoriasis and other chronic disorders of the skin. It suppresses DNA synthesis, mitotic activity, and cell proliferation. It has an unpleasant odor, can frequently stain the skin and hair, and can cause phototoxicity. Systemic toxicity does not occur. **The name of the medication will assist in eliminating options 2 and 3**

87.) A client with acute muscle spasms has been taking baclofen (Lioresal). The client calls the clinic nurse because of continuous feelings of weakness and fatigue and asks the nurse about discontinuing the medication. The nurse should make which appropriate response to the client? 1. "You should never stop the medication." 2. "It is best that you taper the dose if you intend to stop the medication." 3. "It is okay to stop the medication if you think that you can tolerate the muscle spasms." 4. "Weakness and fatigue commonly occur and will diminish with continued medication use."

4. "Weakness and fatigue commonly occur and will diminish with continued medication use." Rationale: The client should be instructed that symptoms such as drowsiness, weakness, and fatigue are more intense in the early phase of therapy and diminish with continued medication use. The client should be instructed never to withdraw or stop the medication abruptly, because abrupt withdrawal can cause visual hallucinations, paranoid ideation, and seizures. It is best for the nurse to inform the client that these symptoms will subside and encourage the client to continue the use of the medication.

226.) A client receiving lithium carbonate (Lithobid) complains of loose, watery stools and difficulty walking. The nurse would expect the serum lithium level to be which of the following? 1. 0.7 mEq/L 2. 1.0 mEq/L 3. 1.2 mEq/L 4. 1.7 mEq/L

4. 1.7 mEq/L Rationale: The therapeutic serum level of lithium ranges from 0.6 to 1.2 mEq/L. Serum lithium levels above the therapeutic level will produce signs of toxicity.

A client with Parkinson's disease has begun therapy with carbidopa/levodopa (Sinemet). The nurse determines that the client understands the action of the medication if the client verbalizes that results may not be apparent for: 1. 24 hours 2. 1 week 3. 2 to 3 days 4. 2 to 3 weeks

4. 2 to 3 weeks Rationale: Signs and symptoms of Parkinson's disease usually begin to resolve within 2 to 3 weeks of starting therapy, although in some clients marked improvement may not be seen for up to 6 months. Clients need to understand this concept to aid in compliance with medication therapy. Options 1, 2, and 3 are incorrect because of the short time frames.

163.) A client with trigeminal neuralgia tells the nurse that acetaminophen (Tylenol) is taken on a frequent daily basis for relief of generalized discomfort. The nurse reviews the client's laboratory results and determines that which of the following indicates toxicity associated with the medication? 1. Sodium of 140 mEq/L 2. Prothrombin time of 12 seconds 3. Platelet count of 400,000 cells/mm3 4. A direct bilirubin level of 2 mg/dL

4. A direct bilirubin level of 2 mg/dL Rationale: In adults, overdose of acetaminophen (Tylenol) causes liver damage. Option 4 is an indicator of liver function and is the only option that indicates an abnormal laboratory value. The normal direct bilirubin is 0 to 0.4 mg/dL. The normal platelet count is 150,000 to 400,000 cells/mm3. The normal prothrombin time is 10 to 13 seconds. The normal sodium level is 135 to 145 mEq/L.

75.) A client with myasthenia gravis becomes increasingly weak. The health care provider prepares to identify whether the client is reacting to an overdose of the medication (cholinergic crisis) or increasing severity of the disease (myasthenic crisis). An injection of edrophonium (Enlon) is administered. Which of the following indicates that the client is in cholinergic crisis? 1. No change in the condition 2. Complaints of muscle spasms 3. An improvement of the weakness 4. A temporary worsening of the condition

4. A temporary worsening of the condition Rationale: An edrophonium (Enlon) injection, a cholinergic drug, makes the client in cholinergic crisis temporarily worse. This is known as a negative test. An improvement of weakness would occur if the client were experiencing myasthenia gravis. Options 1 and 2 would not occur in either crisis.

181.) A client is taking ticlopidine hydrochloride (Ticlid). The nurse tells the client to avoid which of the following while taking this medication? 1. Vitamin C 2. Vitamin D 3. Acetaminophen (Tylenol) 4. Acetylsalicylic acid (aspirin)

4. Acetylsalicylic acid (aspirin) Rationale: Ticlopidine hydrochloride is a platelet aggregation inhibitor. It is used to decrease the risk of thrombotic strokes in clients with precursor symptoms. Because it is an antiplatelet agent, other medications that precipitate or aggravate bleeding should be avoided during its use. Therefore, aspirin or any aspirin-containing product should be avoided.

56.) Heparin sodium is prescribed for the client. The nurse expects that the health care provider will prescribe which of the following to monitor for a therapeutic effect of the medication? 1. Hematocrit level 2. Hemoglobin level 3. Prothrombin time (PT) 4. Activated partial thromboplastin time (aPTT)

4. Activated partial thromboplastin time (aPTT) Rationale: The PT will assess for the therapeutic effect of warfarin sodium (Coumadin) and the aPTT will assess the therapeutic effect of heparin sodium. Heparin sodium doses are determined based on these laboratory results. The hemoglobin and hematocrit values assess red blood cell concentrations.

242.) A client who was started on anticonvulsant therapy with clonazepam (Klonopin) tells the nurse of increasing clumsiness and unsteadiness since starting the medication. The client is visibly upset by these manifestations and asks the nurse what to do. The nurse's response is based on the understanding that these symptoms: 1. Usually occur if the client takes the medication with food 2. Are probably the result of an interaction with another medication 3. Indicate that the client is experiencing a severe untoward reaction to the medication 4. Are worse during initial therapy and decrease or disappear with long-term use

4. Are worse during initial therapy and decrease or disappear with long-term use Rationale: Drowsiness, unsteadiness, and clumsiness are expected effects of the medication during early therapy. They are dose related and usually diminish or disappear altogether with continued use of the medication. It does not indicate that a severe side effect is occurring. It is also unrelated to interaction with another medication. The client is encouraged to take this medication with food to minimize gastrointestinal upset. **Eliminate options 2 and 3 first because they are comparable or alike and because of the word "severe" in option 3**

4.) The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied: 1. Immediately before swimming 2. 15 minutes before exposure to the sun 3. Immediately before exposure to the sun 4. At least 30 minutes before exposure to the sun

4. At least 30 minutes before exposure to the sun Rationale: Sunscreens are most effective when applied at least 30 minutes before exposure to the sun so that they can penetrate the skin. All sunscreens should be reapplied after swimming or sweating.

A health care provider is planning to administer a skeletal muscle relaxant to a client with a spinal cord injury. The medication is going to be administered intrathecally. Which of the following medications should the nurse expect to be prescribed and administered by this route? 1. Cyclobenzaprine hydrochloride (Flexeril) 2. Chlorzoxazone (Paraflex) 3. Dantrolene sodium (Dantrium) 4. Baclofen (Lioresal)

4. Baclofen (Lioresal) Rationale: Baclofen is the only skeletal muscle relaxant that can be administered intrathecally. Therefore options 1, 2, and 3 are incorrect.

178.) Methylergonovine (Methergine) is prescribed for a client with postpartum hemorrhage caused by uterine atony. Before administering the medication, the nurse checks which of the following as the important client parameter? 1. Temperature 2. Lochial flow 3. Urine output 4. Blood pressure

4. Blood pressure Rationale: Methylergonovine is an ergot alkaloid used for postpartum hemorrhage. It stimulates contraction of the uterus and causes arterial vasoconstriction. Ergot alkaloids are avoided in clients with significant cardiovascular disease, peripheral disease, hypertension, eclampsia, or preeclampsia. These conditions are worsened by the vasoconstrictive effects of the ergot alkaloids. The nurse would check the client's blood pressure before administering the medication and would follow agency protocols regarding withholding of the medication. Options 1, 2, and 3 are items that are checked in the postpartum period, but they are unrelated to the use of this medication.

A client on the nursing unit has a prescription for dextroamphetamine (Dexedrine) orally daily. The nurse collaborates with the dietitian to limit the amount of which of the following items on the client's dietary trays? 1. Fat 2. Protein 3. Starch 4. Caffeine

4. Caffeine Rationale: Dextroamphetamine is a central nervous system (CNS) stimulant. Caffeine is a stimulant also and should be limited in the client taking this medication. The client should be taught to limit caffeine intake as well.

237.) A client who is on lithium carbonate (Lithobid) will be discharged at the end of the week. In formulating a discharge teaching plan, the nurse will instruct the client that it is most important to: 1. Avoid soy sauce, wine, and aged cheese. 2. Have the lithium level checked every week. 3. Take medication only as prescribed because it can become addicting. 4. Check with the psychiatrist before using any over-the-counter (OTC) medications or prescription medications.

4. Check with the psychiatrist before using any over-the-counter (OTC) medications or prescription medications. Rationale: Lithium is the medication of choice to treat manic-depressive illness. Many OTC medications interact with lithium, and the client is instructed to avoid OTC medications while taking lithium. Lithium is not addicting, and, although serum lithium levels need to be monitored, it is not necessary to check these levels every week. A tyramine-free diet is associated with monoamine oxidase inhibitors.

19.) Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse understands that the primary action of this medication is to: 1. Increase DNA and RNA synthesis. 2. Promote the biosynthesis of nucleic acids. 3. Increase estrogen concentration and estrogen response. 4. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors.

4. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Rationale: Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy. Tamoxifen reduces DNA synthesis and estrogen response.

217.) A health care provider prescribes auranofin (Ridaura) for a client with rheumatoid arthritis. Which of the following would indicate to the nurse that the client is experiencing toxicity related to the medication? 1. Joint pain 2. Constipation 3. Ringing in the ears 4. Complaints of a metallic taste in the mouth

4. Complaints of a metallic taste in the mouth Rationale: Ridaura is the one gold preparation that is given orally rather than by injection. Gastrointestinal reactions including diarrhea, abdominal pain, nausea, and loss of appetite are common early in therapy, but these usually subside in the first 3 months of therapy. Early symptoms of toxicity include a rash, purple blotches, pruritus, mouth lesions, and a metallic taste in the mouth.

A client is receiving anticonvulsant therapy with phenytoin (Dilantin). The nurse plans to monitor the results of which laboratory test closely? 1. Serum sodium 2. Serum potassium 3. Blood urea nitrogen 4. Complete blood cell count

4. Complete blood cell count Rationale: The nurse would monitor the client's complete blood cell counts because hematological side effects of this therapy include aplastic anemia, agranulocytosis, leukopenia, and thrombocytopenia. Other values that warrant monitoring include serum calcium levels and the results of urinalysis, hepatic, and thyroid function tests.

94.) The client with acquired immunodeficiency syndrome has begun therapy with zidovudine (Retrovir, Azidothymidine, AZT, ZDV). The nurse carefully monitors which of the following laboratory results during treatment with this medication? 1. Blood culture 2. Blood glucose level 3. Blood urea nitrogen 4. Complete blood count

4. Complete blood count Rationale: A common side effect of therapy with zidovudine is leukopenia and anemia. The nurse monitors the complete blood count results for these changes. Options 1, 2, and 3 are unrelated to the use of this medication.

124.) A client with chronic renal failure is receiving ferrous sulfate (Feosol). The nurse monitors the client for which common side effect associated with this medication? 1. Diarrhea 2. Weakness 3. Headache 4. Constipation

4. Constipation Rationale: Feosol is an iron supplement used to treat anemia. Constipation is a frequent and uncomfortable side effect associated with the administration of oral iron supplements. Stool softeners are often prescribed to prevent constipation. **Focus on the name of the medication. Recalling that oral iron can cause constipation will easily direct you to the correct option.**

119.) A client with diabetes mellitus who has been controlled with daily insulin has been placed on atenolol (Tenormin) for the control of angina pectoris. Because of the effects of atenolol, the nurse determines that which of the following is the most reliable indicator of hypoglycemia? 1. Sweating 2. Tachycardia 3. Nervousness 4. Low blood glucose level

4. Low blood glucose level Rationale: β-Adrenergic blocking agents, such as atenolol, inhibit the appearance of signs and symptoms of acute hypoglycemia, which would include nervousness, increased heart rate, and sweating. Therefore, the client receiving this medication should adhere to the therapeutic regimen and monitor blood glucose levels carefully. Option 4 is the most reliable indicator of hypoglycemia.

155.) Mycophenolate mofetil (CellCept) is prescribed for a client as prophylaxis for organ rejection following an allogeneic renal transplant. Which of the following instructions does the nurse reinforce regarding administration of this medication? 1. Administer following meals. 2. Take the medication with a magnesium-type antacid. 3. Open the capsule and mix with food for administration. 4. Contact the health care provider (HCP) if a sore throat occurs.

4. Contact the health care provider (HCP) if a sore throat occurs. Rationale: Mycophenolate mofetil should be administered on an empty stomach. The capsules should not be opened or crushed. The client should contact the HCP if unusual bleeding or bruising, sore throat, mouth sores, abdominal pain, or fever occurs because these are adverse effects of the medication. Antacids containing magnesium and aluminum may decrease the absorption of the medication and therefore should not be taken with the medication. The medication may be given in combination with corticosteroids and cyclosporine. **neutropenia can occur with this medication**

A client with vascular headaches is taking ergotamine (Ergomar). The nurse would monitor the client for: 1. Constipation 2. Hypotension 3. Dependent edema 4. Cool, numb fingers and toes

4. Cool, numb fingers and toes Rationale: Ergotamine produces vasoconstriction, which suppresses vascular headaches when given at a therapeutic dose range. The nurse monitors for hypertension; cool, numb fingers and toes; muscle pain; and nausea and vomiting. **first recall that vascular headaches are caused by vasodilatation of the blood vessels in the head. Following this train of thought, you then recall that this medication must cause vasoconstriction. The only side effect consistent with vasoconstriction is option 4, the cool, numb fingers and toes.**

157.) A client receiving nitrofurantoin (Macrodantin) calls the health care provider's office complaining of side effects related to the medication. Which side effect indicates the need to stop treatment with this medication? 1. Nausea 2. Diarrhea 3. Anorexia 4. Cough and chest pain

4. Cough and chest pain Rationale: Gastrointestinal (GI) effects are the most frequent adverse reactions to this medication and can be minimized by administering the medication with milk or meals. Pulmonary reactions, manifested as dyspnea, chest pain, chills, fever, cough, and the presence of alveolar infiltrates on the x-ray, would indicate the need to stop the treatment. These symptoms resolve in 2 to 4 days following discontinuation of this medication. **Eliminate options 1, 2, and 3 because they are similar GI-related side effects. Also, use the ABCs— airway, breathing, and circulation**

132.) The client with non-Hodgkin's lymphoma is receiving daunorubicin (DaunoXome). Which of the following would indicate to the nurse that the client is experiencing a toxic effect related to the medication? 1. Fever 2. Diarrhea 3. Complaints of nausea and vomiting 4. Crackles on auscultation of the lungs

4. Crackles on auscultation of the lungs Rationale: Cardiotoxicity noted by abnormal electrocardiographic findings or cardiomyopathy manifested as congestive heart failure is a toxic effect of daunorubicin. Bone marrow depression is also a toxic effect. Nausea and vomiting are frequent side effects associated with the medication that begins a few hours after administration and lasts 24 to 48 hours. Fever is a frequent side effect, and diarrhea can occur occasionally. The other options, however, are not toxic effects. **keep in mind that the question is asking about a toxic effect and think: ABCs—airway, breathing, and circulation**

117.) A nurse has given the client taking ethambutol (Myambutol) information about the medication. The nurse determines that the client understands the instructions if the client immediately reports: 1. Impaired sense of hearing 2. Distressing gastrointestinal side effects 3. Orange-red discoloration of body secretions 4. Difficulty discriminating the color red from green

4. Difficulty discriminating the color red from green Rationale: Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when driving a motor vehicle. The client is taught to report this symptom immediately. The client is also taught to take the medication with food if gastrointestinal upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin (Rifadin).

190.) A child is hospitalized with a diagnosis of lead poisoning. The nurse assisting in caring for the child would prepare to assist in administering which of the following medications? 1. Activated charcoal 2. Sodium bicarbonate 3. Syrup of ipecac syrup 4. Dimercaprol (BAL in Oil)

4. Dimercaprol (BAL in Oil) Rationale: Dimercaprol is a chelating agent that is administered to remove lead from the circulating blood and from some tissues and organs for excretion in the urine. Sodium bicarbonate may be used in salicylate poisoning. Syrup of ipecac is used in the hospital setting in poisonings to induce vomiting. Activated charcoal is used to decrease absorption in certain poisoning situations. Note that dimercaprol is prepared with peanut oil, and hence should be avoided by clients with known or suspected peanut allergy.

203.) A nurse is preparing to give the postcraniotomy client medication for incisional pain. The family asks the nurse why the client is receiving codeine sulfate and not "something stronger." In formulating a response, the nurse incorporates the understanding that codeine: 1. Is one of the strongest opioid analgesics available 2. Cannot lead to physical or psychological dependence 3. Does not cause gastrointestinal upset or constipation as do other opioids 4. Does not alter respirations or mask neurological signs as do other opioids

4. Does not alter respirations or mask neurological signs as do other opioids Rationale: Codeine sulfate is the opioid analgesic often used for clients after craniotomy. It is frequently combined with a nonopioid analgesic such as acetaminophen for added effect. It does not alter the respiratory rate or mask neurological signs as do other opioids. Side effects of codeine include gastrointestinal upset and constipation. The medication can lead to physical and psychological dependence with chronic use. It is not the strongest opioid analgesic available.

231.) A client admitted to the hospital gives the nurse a bottle of clomipramine (Anafranil). The nurse notes that the medication has not been taken by the client in 2 months. What behaviors observed in the client would validate noncompliance with this medication? 1. Complaints of hunger 2. Complaints of insomnia 3. A pulse rate less than 60 beats per minute 4. Frequent handwashing with hot, soapy water

4. Frequent handwashing with hot, soapy water Rationale: Clomipramine is commonly used in the treatment of obsessive-compulsive disorder. Handwashing is a common obsessive-compulsive behavior. Weight gain is a common side effect of this medication. Tachycardia and sedation are side effects. Insomnia may occur but is seldom a side effect.

236.) A client is being treated for depression with amitriptyline hydrochloride. During the initial phases of treatment, the most important nursing intervention is: 1. Prescribing the client a tyramine-free diet 2. Checking the client for anticholinergic effects 3. Monitoring blood levels frequently because there is a narrow range between therapeutic and toxic blood levels of this medication 4. Getting baseline postural blood pressures before administering the medication and each time the medication is administered

4. Getting baseline postural blood pressures before administering the medication and each time the medication is administered Rationale: Amitriptyline hydrochloride is a tricyclic antidepressant often used to treat depression. It causes orthostatic changes and can produce hypotension and tachycardia. This can be frightening to the client and dangerous because it can result in dizziness and client falls. The client must be instructed to move slowly from a lying to a sitting to a standing position to avoid injury if these effects are experienced. The client may also experience sedation, dry mouth, constipation, blurred vision, and other anticholinergic effects, but these are transient and will diminish with time.

196.) A client has been prescribed amikacin (Amikin). Which of the following priority baseline functions should be monitored? 1. Apical pulse 2. Liver function 3. Blood pressure 4. Hearing acuity

4. Hearing acuity Rationale: Amikacin (Amikin) is an antibiotic. This medication can cause ototoxicity and nephrotoxicity; therefore, hearing acuity tests and kidney function studies should be performed before the initiation of therapy. Apical pulse, liver function studies, and blood pressure are not specifically related to the use of this medication.

175.) A nurse notes that a client is receiving lamivudine (Epivir). The nurse determines that this medication has been prescribed to treat which of the following? 1. Pancreatitis 2. Pharyngitis 3. Tonic-clonic seizures 4. Human immunodeficiency virus (HIV) infection

4. Human immunodeficiency virus (HIV) infection Rationale: Lamivudine is a nucleoside reverse transcriptase inhibitor and antiviral medication. It slows HIV replication and reduces the progression of HIV infection. It also is used to treat chronic hepatitis B and is used for prophylaxis in health care workers at risk of acquiring HIV after occupational exposure to the virus. **Note the letters "-vir" in the trade name for this medication**

192.) A nurse is collecting medication information from a client, and the client states that she is taking garlic as an herbal supplement. The nurse understands that the client is most likely treating which of the following conditions? 1. Eczema 2. Insomnia 3. Migraines 4. Hyperlipidemia

4. Hyperlipidemia Rationale: Garlic is an herbal supplement that is used to treat hyperlipidemia and hypertension. An herbal supplement that may be used to treat eczema is evening primrose. Insomnia has been treated with both valerian root and chamomile. Migraines have been treated with feverfew.

73.) A client with myasthenia gravis is suspected of having cholinergic crisis. Which of the following indicate that this crisis exists? 1. Ataxia 2. Mouth sores 3. Hypotension 4. Hypertension

4. Hypertension Rationale: Cholinergic crisis occurs as a result of an overdose of medication. Indications of cholinergic crisis include gastrointestinal disturbances, nausea, vomiting, diarrhea, abdominal cramps, increased salivation and tearing, miosis, hypertension, sweating, and increased bronchial secretions.

76.) Carbidopa-levodopa (Sinemet) is prescribed for a client with Parkinson's disease, and the nurse monitors the client for adverse reactions to the medication. Which of the following indicates that the client is experiencing an adverse reaction? 1. Pruritus 2. Tachycardia 3. Hypertension 4. Impaired voluntary movements

4. Impaired voluntary movements Rationale: Dyskinesia and impaired voluntary movement may occur with high levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia (the temporary muscle weakness that lasts 1 minute to 1 hour, also known as the "on-off phenomenon") are frequent side effects of the medication.

212.) Mannitol (Osmitrol) is being administered to a client with increased intracranial pressure following a head injury. The nurse assisting in caring for the client knows that which of the following indicates the therapeutic action of this medication? 1. Prevents the filtration of sodium and water through the kidneys 2. Prevents the filtration of sodium and potassium through the kidneys 3. Decreases water loss by promoting the reabsorption of sodium and water in the loop of Henle 4. Induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes

4. Induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes Rationale: Mannitol is an osmotic diuretic that induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes. It is used to reduce intracranial pressure in the client with head trauma.

225.) A nursing student is assigned to care for a client with a diagnosis of schizophrenia. Haloperidol (Haldol) is prescribed for the client, and the nursing instructor asks the student to describe the action of the medication. Which statement by the nursing student indicates an understanding of the action of this medication? 1. It is a serotonin reuptake blocker. 2. It inhibits the breakdown of released acetylcholine. 3. It blocks the uptake of norepinephrine and serotonin. 4. It blocks the binding of dopamine to the postsynaptic dopamine receptors in the brain.

4. It blocks the binding of dopamine to the postsynaptic dopamine receptors in the brain. Rationale: Haloperidol acts by blocking the binding of dopamine to the postsynaptic dopamine receptors in the brain. Imipramine hydrochloride (Tofranil) blocks the reuptake of norepinephrine and serotonin. Donepezil hydrochloride (Aricept) inhibits the breakdown of released acetylcholine. Fluoxetine hydrochloride (Prozac) is a potent serotonin reuptake blocker.

200.) A client is seen in the clinic for complaints of skin itchiness that has been persistent over the past several weeks. Following data collection, it has been determined that the client has scabies. Lindane is prescribed, and the nurse is asked to provide instructions to the client regarding the use of the medication. The nurse tells the client to: 1. Apply a thick layer of cream to the entire body. 2. Apply the cream as prescribed for 2 days in a row. 3. Apply to the entire body and scalp, excluding the face. 4. Leave the cream on for 8 to 12 hours and then remove by washing.

4. Leave the cream on for 8 to 12 hours and then remove by washing. Rationale: Lindane is applied in a thin layer to the entire body below the head. No more than 30 g (1 oz) should be used. The medication is removed by washing 8 to 12 hours later. Usually, only one application is required.

205.) A nurse is assisting in preparing to administer acetylcysteine (Mucomyst) to a client with an overdose of acetaminophen (Tylenol). The nurse prepares to administer the medication by: 1. Administering the medication subcutaneously in the deltoid muscle 2. Administering the medication by the intramuscular route in the gluteal muscle 3. Administering the medication by the intramuscular route, mixed in 10 mL of normal saline 4. Mixing the medication in a flavored ice drink and allowing the client to drink the medication through a straw

4. Mixing the medication in a flavored ice drink and allowing the client to drink the medication through a straw Rationale: Because acetylcysteine has a pervasive odor of rotten eggs, it must be disguised in a flavored ice drink. It is consumed preferably through a straw to minimize contact with the mouth. It is not administered by the intramuscular or subcutaneous route. **Knowing that the medication is a solution that is also used for nebulization treatments will assist you to select the option that indicates an oral route**

17.) The client with ovarian cancer is being treated with vincristine (Oncovin). The nurse monitors the client, knowing that which of the following indicates a side effect specific to this medication? 1. Diarrhea 2. Hair loss 3. Chest pain 4. Numbness and tingling in the fingers and toes

4. Numbness and tingling in the fingers and toes Rationale: A side effect specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation rather than diarrhea is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all the antineoplastic medications. Chest pain is unrelated to this medication.

39.) The client with a gastric ulcer has a prescription for sucralfate (Carafate), 1 g by mouth four times daily. The nurse schedules the medication for which times? 1. With meals and at bedtime 2. Every 6 hours around the clock 3. One hour after meals and at bedtime 4. One hour before meals and at bedtime

4. One hour before meals and at bedtime Rationale: Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation. The other options are incorrect.

15.) The client with small cell lung cancer is being treated with etoposide (VePesid). The nurse who is assisting in caring for the client during its administration understands that which side effect is specifically associated with this medication? 1. Alopecia 2. Chest pain 3. Pulmonary fibrosis 4. Orthostatic hypotension

4. Orthostatic hypotension Rationale: A side effect specific to etoposide is orthostatic hypotension. The client's blood pressure is monitored during the infusion. Hair loss occurs with nearly all the antineoplastic medications. Chest pain and pulmonary fibrosis are unrelated to this medication.

222.) A nurse has administered a dose of diazepam (Valium) to a client. The nurse would take which important action before leaving the client's room? 1. Giving the client a bedpan 2. Drawing the shades or blinds closed 3. Turning down the volume on the television 4. Per agency policy, putting up the side rails on the bed

4. Per agency policy, putting up the side rails on the bed Rationale: Diazepam is a sedative-hypnotic with anticonvulsant and skeletal muscle relaxant properties. The nurse should institute safety measures before leaving the client's room to ensure that the client does not injure herself or himself. The most frequent side effects of this medication are dizziness, drowsiness, and lethargy. For this reason, the nurse puts the side rails up on the bed before leaving the room to prevent falls. Options 1, 2, and 3 may be helpful measures that provide a comfortable, restful environment, but option 4 is the one that provides for the client's safety needs.

184.) A nurse preparing a client for surgery reviews the client's medication record. The client is to be nothing per mouth (NPO) after midnight. Which of the following medications, if noted on the client's record, should the nurse question? 1. Cyclobenzaprine (Flexeril) 2. Alendronate (Fosamax) 3. Allopurinol (Zyloprim) 4. Prednisone

4. Prednisone Rationale: Prednisone is a corticosteroid that can cause adrenal atrophy, which reduces the body's ability to withstand stress. Before and during surgery, dosages may be temporarily increased. Cyclobenzaprine is a skeletal muscle relaxant. Alendronate is a bone-resorption inhibitor. Allopurinol is an antigout medication.

189.) Prostaglandin E1 is prescribed for a child with transposition of the great arteries. The mother of the child asks the nurse why the child needs the medication. The nurse tells the mother that the medication: 1. Prevents hypercyanotic (blue or tet) spells 2. Maintains an adequate hormone level 3. Maintains the position of the great arteries 4. Provides adequate oxygen saturation and maintains cardiac output

4. Provides adequate oxygen saturation and maintains cardiac output Rationale: A child with transposition of the great arteries may receive prostaglandin E1 temporarily to increase blood mixing if systemic and pulmonary mixing are inadequate to maintain adequate cardiac output. Options 1, 2, and 3 are incorrect. In addition, hypercyanotic spells occur in tetralogy of Fallot. **Use the ABCs—airway, breathing, and circulation—to answer the question. The correct option addresses circulation**

13.) The client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed? 1. Echocardiography 2. Electrocardiography 3. Cervical radiography 4. Pulmonary function studies

4. Pulmonary function studies Rationale: Bleomycin is an antineoplastic medication (Chemotheraputic Agents) that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to the specific use of this medication.

144.) A client is taking docusate sodium (Colace). The nurse monitors which of the following to determine whether the client is having a therapeutic effect from this medication? 1. Abdominal pain 2. Reduction in steatorrhea 3. Hematest-negative stools 4. Regular bowel movements

4. Regular bowel movements Rationale: Docusate sodium is a stool softener that promotes the absorption of water into the stool, producing a softer consistency of stool. The intended effect is relief or prevention of constipation. The medication does not relieve abdominal pain, stop gastrointestinal (GI) bleeding, or decrease the amount of fat in the stools.

70.) Oxybutynin chloride (Ditropan XL) is prescribed for a client with neurogenic bladder. Which sign would indicate a possible toxic effect related to this medication? 1. Pallor 2. Drowsiness 3. Bradycardia 4. Restlessness

4. Restlessness Rationale: Toxicity (overdosage) of this medication produces central nervous system excitation, such as nervousness, restlessness, hallucinations, and irritability. Other signs of toxicity include hypotension or hypertension, confusion, tachycardia, flushed or red face, and signs of respiratory depression. Drowsiness is a frequent side effect of the medication but does not indicate overdosage.

66.) Trimethoprim-sulfamethoxazole (TMP-SMZ) is prescribed for a client. A nurse should instruct the client to report which symptom if it developed during the course of this medication therapy? 1. Nausea 2. Diarrhea 3. Headache 4. Sore throat

4. Sore throat Rationale: Clients taking trimethoprim-sulfamethoxazole (TMP-SMZ) should be informed about early signs of blood disorders that can occur from this medication. These include sore throat, fever, and pallor, and the client should be instructed to notify the health care provider if these symptoms occur. The other options do not require health care provider notification.

44.) A client is receiving acetylcysteine (Mucomyst), 20% solution diluted in 0.9% normal saline by nebulizer. The nurse should have which item available for possible use after giving this medication? 1. Ambu bag 2. Intubation tray 3. Nasogastric tube 4. Suction equipment

4. Suction equipment Rationale: Acetylcysteine can be given orally or by nasogastric tube to treat acetaminophen overdose, or it may be given by inhalation for use as a mucolytic. The nurse administering this medication as a mucolytic should have suction equipment available in case the client cannot manage to clear the increased volume of liquefied secretions.

166.) Alendronate (Fosamax) is prescribed for a client with osteoporosis. The client taking this medication is instructed to: 1. Take the medication at bedtime. 2. Take the medication in the morning with breakfast. 3. Lie down for 30 minutes after taking the medication. 4. Take the medication with a full glass of water after rising in the morning.

4. Take the medication with a full glass of water after rising in the morning. Rationale: Precautions need to be taken with administration of alendronate to prevent gastrointestinal side effects (especially esophageal irritation) and to increase absorption of the medication. The medication needs to be taken with a full glass of water after rising in the morning. The client should not eat or drink anything for 30 minutes following administration and should not lie down after taking the medication.

67.) Phenazopyridine hydrochloride (Pyridium) is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. The nurse reinforces to the client: 1. To take the medication at bedtime 2. To take the medication before meals 3. To discontinue the medication if a headache occurs 4. That a reddish orange discoloration of the urine may occur

4. That a reddish orange discoloration of the urine may occur Rationale: The nurse should instruct the client that a reddish-orange discoloration of urine may occur. The nurse also should instruct the client that this discoloration can stain fabric. The medication should be taken after meals to reduce the possibility of gastrointestinal upset. A headache is an occasional side effect of the medication and does not warrant discontinuation of the medication.

177.) A nurse is assisting in caring for a pregnant client who is receiving intravenous magnesium sulfate for the management of preeclampsia and notes that the client's deep tendon reflexes are absent. On the basis of this data, the nurse reports the finding and makes which determination? 1. The magnesium sulfate is effective. 2. The infusion rate needs to be increased. 3. The client is experiencing cerebral edema. 4. The client is experiencing magnesium toxicity.

4. The client is experiencing magnesium toxicity. Rationale: Magnesium toxicity can occur as a result of magnesium sulfate therapy. Signs of magnesium sulfate toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression; loss of deep tendon reflexes; sudden decrease in fetal heart rate or maternal heart rate, or both; and sudden drop in blood pressure. Hyperreflexia indicates increased cerebral edema. An absence of reflexes indicates magnesium toxicity. The therapeutic serum level of magnesium for a client receiving magnesium sulfate ranges from 4 to 7.5 mEq/L (5 to 8 mg/dL).

232.) A client in the mental health unit is administered haloperidol (Haldol). The nurse would check which of the following to determine medication effectiveness? 1. The client's vital signs 2. The client's nutritional intake 3. The physical safety of other unit clients 4. The client's orientation and delusional status

4. The client's orientation and delusional status Rationale: Haloperidol is used to treat clients exhibiting psychotic features. Therefore, to determine medication effectiveness, the nurse would check the client's orientation and delusional status. Vital signs are routine and not specific to this situation. The physical safety of other clients is not a direct assessment of this client. Monitoring nutritional intake is not related to this situation.

99.) The client with acquired immunodeficiency syndrome and Pneumocystis jiroveci infection has been receiving pentamidine isethionate (Pentam 300). The client develops a temperature of 101° F. The nurse does further monitoring of the client, knowing that this sign would most likely indicate: 1. The dose of the medication is too low. 2. The client is experiencing toxic effects of the medication. 3. The client has developed inadequacy of thermoregulation. 4. The result of another infection caused by leukopenic effects of the medication.

4. The result of another infection caused by leukopenic effects of the medication. Rationale: Frequent side effects of this medication include leukopenia, thrombocytopenia, and anemia. The client should be monitored routinely for signs and symptoms of infection. Options 1, 2, and 3 are inaccurate interpretations.

A client has been prescribed cyclobenzaprine (Flexeril) in the treatment of painful muscle spasms accompanying a herniated intervertebral disk. The nurse would withhold the medication and question the prescription if the client had concurrent prescriptions to take: 1. Ibuprofen (Advil) 2. Furosemide (Lasix) 3. Valproic acid (Depakene) 4. Tranylcypromine (Parnate)

4. Tranylcypromine (Parnate) Rationale: The client should not receive cyclobenzaprine if the client has taken monoamine oxidase inhibitors (MAOIs) such as tranylcypromine (Parnate) or phenelzine (Nardil) within the past 14 days. Otherwise, the client could experience hyperpyretic crisis, seizures, or death.

121.) A client who is taking hydrochlorothiazide (HydroDIURIL, HCTZ) has been started on triamterene (Dyrenium) as well. The client asks the nurse why both medications are required. The nurse formulates a response, based on the understanding that: 1. Both are weak potassium-losing diuretics. 2. The combination of these medications prevents renal toxicity. 3. Hydrochlorothiazide is an expensive medication, so using a combination of diuretics is cost-effective. 4. Triamterene is a potassium-sparing diuretic, whereas hydrochlorothiazide is a potassium-losing diuretic.

4. Triamterene is a potassium-sparing diuretic, whereas hydrochlorothiazide is a potassium-losing diuretic. Rationale: Potassium-sparing diuretics include amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium). They are weak diuretics that are used in combination with potassium-losing diuretics. This combination is useful when medication and dietary supplement of potassium is not appropriate. The use of two different diuretics does not prevent renal toxicity. Hydrochlorothiazide is an effective and inexpensive generic form of the thiazide classification of diuretics. **It is especially helpful to remember that hydrochlorothiazide is a potassium-losing diuretic and triamterene is a potassium-sparing diuretic**

160.) Meperidine hydrochloride (Demerol) is prescribed for the client with pain. Which of the following would the nurse monitor for as a side effect of this medication? 1. Diarrhea 2. Bradycardia 3. Hypertension 4. Urinary retention

4. Urinary retention Rationale: Meperidine hydrochloride (Demerol) is an opioid analgesic. Side effects of this medication include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention.

140.) The client has a new prescription for metoclopramide (Reglan). On review of the chart, the nurse identifies that this medication can be safely administered with which condition? 1. Intestinal obstruction 2. Peptic ulcer with melena 3. Diverticulitis with perforation 4. Vomiting following cancer chemotherapy

4. Vomiting following cancer chemotherapy Rationale: Metoclopramide is a gastrointestinal (GI) stimulant and antiemetic. Because it is a GI stimulant, it is contraindicated with GI obstruction, hemorrhage, or perforation. It is used in the treatment of emesis after surgery, chemotherapy, and radiation.

104.) Disulfiram (Antabuse) is prescribed for a client who is seen in the psychiatric health care clinic. The nurse is collecting data on the client and is providing instructions regarding the use of this medication. Which is most important for the nurse to determine before administration of this medication? 1. A history of hyperthyroidism 2. A history of diabetes insipidus 3. When the last full meal was consumed 4. When the last alcoholic drink was consumed

4. When the last alcoholic drink was consumed Rationale: Disulfiram is used as an adjunct treatment for selected clients with chronic alcoholism who want to remain in a state of enforced sobriety. Clients must abstain from alcohol intake for at least 12 hours before the initial dose of the medication is administered. The most important data are to determine when the last alcoholic drink was consumed. The medication is used with caution in clients with diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, nephritis, and hepatic disease. It is also contraindicated in severe heart disease, psychosis, or hypersensitivity related to the medication.

180.) A health care provider (HCP) writes a prescription for digoxin (Lanoxin), 0.25 mg daily. The nurse teaches the client about the medication and tells the client that it is important to: 1. Count the radial and carotid pulses every morning. 2. Check the blood pressure every morning and evening. 3. Stop taking the medication if the pulse is higher than 100 beats per minute. 4. Withhold the medication and call the HCP if the pulse is less than 60 beats per minute.

4. Withhold the medication and call the HCP if the pulse is less than 60 beats per minute. Rationale: An important component of taking this medication is monitoring the pulse rate; however, it is not necessary for the client to take both the radial and carotid pulses. It is not necessary for the client to check the blood pressure every morning and evening because the medication does not directly affect blood pressure. It is most important for the client to know the guidelines related to withholding the medication and calling the HCP. The client should not stop taking a medication.

185.) Which of the following herbal therapies would be prescribed for its use as an antispasmodic? Select all that apply. 1.Aloe 2.Kava 3.Ginger 4.Chamomile 5.Peppermint oil

4.Chamomile 5.Peppermint oil Rationale: Chamomile has a mild sedative effect and acts as an antispasmodic and anti-inflammatory. Peppermint oil acts as an antispasmodic and is used for irritable bowel syndrome. Topical aloe promotes wound healing. Aloe taken orally acts as a laxative. Kava has an anxiolytic, sedative, and analgesic effect. Ginger is effective in relieving nausea.

Blood pH

7.35-7.45

Normal fasting glucose

70-110 mg/dL *cap blood 60-110

BUN

8-25 mg/dL

PO2

80-100mmHg

PT

9.6-11.8 Male 9.5-11.3 Female * w/in 2 sec is considered "normal"

HbA1c Normal fair control poor control

<7% fair = 7-8% poor >8%

Positive Urine Culture

>100,000 colony forming units

Access

A means to obtain entry or a means of approach.

Contraindication

A reason why something is not advisable or why it should not be done.

Define Ointment

A sem-solid, externally applied preparation, usually containing one or more medication.

Define Suppository

A solid dosage form mixed with gelatin and shaped in pellet form for insertion into a body cavity; melts when it reaches body temperature, releasing medication for absorption.

Coronary Heart Disease Risk Factors

Age (men >45, women >55), family history of premature heart disease, hypertension, cigarette smoking, low HDL

Addison's disease

Addison's disease is a disorder that occurs when your body produces insufficient amounts of certain hormones produced by your adrenal glands. In Addison's disease, your adrenal glands produce too little cortisol and often insufficient levels of aldosterone as well. Also called adrenal insufficiency, Addison's disease occurs in all age groups and affects both sexes. Addison's disease can be life-threatening. Treatment for Addison's disease involves taking hormones to replace the insufficient amounts being made by your adrenal glands, in order to mimic the beneficial effects produced by your naturally made hormones.

A client comes into the ED with DTs. What should the nurse do first?

Administer Ativan.

What kind of medication order is "Single"

Administered once at a specified time.

What kind of medication order is "PRN"

Administered when the patient requires it.

A client becomes upset when the nurse he requests is not assigned to him, what is the nurse's best response?

Advise the client that nursing assignments are not based on client requests.

Which drug group is known as 'the -ones'?

Aldosterone Blockers E.g: Spironolactone (non-selective), Eplerenone (selective)

Actions of Drugs for Angina

All 4 categories relieve the pain of angina by decreasing cardiac O2 demand Provide symptomatic relief Do not affect underlying pathology

Who might benefit from calcium-channel blockers?

Angina: Coronary vasodilation so increased supply, decreased demand by reducing HR, contractility and afterload (Verapamil and Diltiazem) Hypertension: BP =CO x SVR. CO decreased by reduced HR and contractility, SVR decreased by vasodilation Arrhythmia: Slows AV conduction in AF/flutter, may help terminate AVNRT/AVRT (Verapamil and Diltiazem)

Who might benefit from β-blockers? (6)

Angina: decreased myocardial oxygen demand by reduced HR and contractility, decreased afterload secondary to reduced cardiac output, improved oxygen supply by increased filling time Hypertension: BP = CO x SVR, decreased HR and contractility leads to decreased CO and therefore BP ACS: reduced automaticity means lower risk of VF during event, preserves myocardium by reducing oxygen demand, improves survival rates Heart failure: reduce risk of SCD and AF Arrhythmia: decreased automaticity reduces risk of ectopics, VT, VF. Decreased conduction speed may slow rate in AF/flutter, may terminate SVT HCM: decreased contractility means reduced LVOTO. Decreased HR means longer filling time

What drug group is known as 'the -prils'?

Angiotensin Converting Enzyme (ACE) Inhibitors E.g: Lisinopril, Ramipril, Enalapril

Which drug group is commonly known as 'the -sartans'?

Angiotensin Receptor Blockers (alternatives to ACE inhibitors) E.g: Losartan, Irbesartan, Valsartan

A nurse reviews the blood gas results of a client with atelectasis. The nurse analyzes the results and determines that the client is experiencing respiratory acidosis. Which of the following validates the nurse's findings? 1) pH 7.25, Pco2 50, 2) pH 7.35, Pco2 40 3) pH 7.50, Pco2 52 4) pH 7.52, Pco2 28

Answer: 1 Rational: Atelectasis is a condition characterized by the collapse of alveoli, preventing the respiratory exchange of oxygen and carbon dioxide in a part of the lungs. The normal pH is 7.35-7.45. The normal Pco2 is 32-48. In respiratory acidosis, the pH is decreased and the Pco2 is elevated. Option 2 identifies normal values. Option 3 identifies an alkalotic condition. Option 4 identifies respiratory alkalosis.

A nurse caring for a client with an ileostomy understands the the client is most at risk for developing which acid-base disorder? 1) Metabolic Acidosis 2) Metabolic Alkalosis 3) Respiratory Acidosis 4) Respiratory Alkalosis

Answer: 1 Rational: Metabolic Acidosis is defined as total concentration of buffer base that is lower than normal, with a relative increase in the hydrogen ion concentration. This results from loss of buffer bases or the retention of too many acids without sufficient bases, and occurs in conditions such as renal failure, diabetic ketoacidosis, from the production of lactic acid, from the ingestion of toxins (such as acetylsalicylic acid -aka- aspirin), malnutrition, or severe diarrhea. Intestinal secretions are high in bicarbonate and may e lost through enteric drainage tubes or an ileostomy, or with diarrhea. These conditions result in metabolic acidosis. Options 2, 3, & 4 are incorrect interpretations and do not occur in the client with an ileostomy. **(Base/Bicarbonate is lost through an ileostomy)

A nurse notes that a client's arterial blood gas reults reveal a pH of 7.50 and a Pco2 of 30. The nurse monitors the client for which clinical manifestations associated with these arterial blood gas results? Select all the apply: 1) Nausea 2) Confusion 3) Bradypnea 4) Tachycardia 5) Hyperkalemia 6) Lightheadedness

Answer: 1, 2, 4, 6 Rational: Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentrations that results from the accumulations of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions that cause overstimulation of the respiratory system. Clinical manifestations of repirtory alkalosis include lethargy, lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemai, nausea, vomiting, epigastric pain, and numbness and tingling of the extremities. Hyperventilation (tachypnea) occurs.

A nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client, knowing that the client is at risk for which acid-base disorder? 1) Metabolic Acidosis 2) Metabolic Alkalosis 3) Respiratory Acidosis 4) Respiratory Alkalosis

Answer: 2 Rational: Metabolic Alkalosis is defined as a deficit or loss of hydrogen ions or acids or an excess of base (bicarbonate) that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions resulting in hypovolemia, the loss of gastric fluid, excessive bicarbonate intake, the massive transfusion of whole blood, and hyperaldosteronism. Loss of gastric fluid via nasogastric suction or vomiting causes Metabolic Alkalosis as a result of the loss of hydrochloric acid. Options 1, 3, & 4 are incorrect interpretations.

A nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicated a pH of 7.50 and a Pco2 of 30. The nurse has determines that the client is experience respiratory alkalosis. Which laboratory value would most likely be noted in this condition? 1) Sodium level of 145 2) Potassium level of 3 3) Magnesium level of 2 4) Phosphorus level of 4

Answer: 2 Rational: Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentrations that results from the accumulations of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions that cause overstimulation of the respiratory system. Clinical manifestations of repiratory alkalosis include headache, tachypnea, paresthesias, tetany, vertigo, convusions, hypkalemia, and hypocalcemia. Options 1, 3, & 4 identify normal laboratory values. Option 2 identifies the presence of hypokalemia.

A nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, Pco2 of 30, and HCO3- of 22. The nurse analyzes these results as indicating which condition? 1) Metabolic Acidosis, compensated 2) Respiratory Alkalosis, compensated 3) Metabolic Alkalosis, compensated 4) Respiratory Acidosis, compensated

Answer: 2 Rational: The normal pH is 7.3-7.45. In a respiratory condition, an opposite effect will be seen between the pH and the Pco2. In this condition, the pH is a the high end of normal and the Pco2 is low. In an alkalotic condition, the pH is elevated. Therefore the values identified in the question indicated a respiratory alkalosis. When the pH returns to a normal value, compensation has occurred.

The nurse plans care for a client with chronic obstructive pulmonary disease (COPD), understanding that the client is most likely to experience what type of acid-bases imbalance: 1) Metabolic Acidosis 2) Metabolic Alkalosis 3) Respiratory Acidosis 4) Respiratory Alkalosis

Answer: 3 Rational: Respiratory Acidosis is most often caused by hypoventilation in a client with COPD. Other acid-base disturbances can occur in a client with COPD during exacerbation of the disease but the most likely imabalance is respiratory acidosis. Option 1, 2,& 4 are incorrect options.

A nurse is caring for a client with diabetic ketoacidosis and documents the the client is experiencing Kussmaul's respirations. Based on this documentation, which of the following did the nurse observe? 1) Respirations that cease for several seconds 2) Respirations that are regular but abnormally slow 3) Respirations that are labored and increased in depth and rate 4) Respirations that are abnormally deep, regular, and increased in rate

Answer: 4 Rational: Kussmal's respirations are abnormally deep, regular, and increased in rate. Apnea is described as repirations that cease for several seconds. In bradypnea, respirations are regular but abnormally slow. In hyperpnea, respirations are labored and increased in depth and rate.

A client who is found unresponsive has arterial blood gases drawn and the results indicate dthe following: pH is 7.12, Pco2 is 90, and HCO3- is 22. the nurse interprets the results as indicating which condition? 1) Metabolic Acidosis with compensation 2) Respiratory Acidosis with compensation 3) Metabolic Acidosis without compensation 4) Respiratory Acidosis without compensation

Answer: 4 Rational: The acid-base disturbance is respiratory acidosis without compensation. The normal pH is 7.35-7.45. The normal Pco2 is 32-48. In respiratory acidosis the pH is decreased and the pco2 is elevated. The normal bicarbonate (HCO3-) level is 22-27. Because the bicarbonate is still within normal limits, the kidneys have not had time to adjust for this acid-base disturbance. Additionally, the pH is not within normal limits. Therefore the condition is without compensation. Options 1, 2, & 3 are incorrect interpretations.

The nurse takes a medication to a client, and the client tells the nurse to take it away because she is not going to take it. The nurse's first action should be to:

Ask the client's reason for refusal

The nurse is administering a sustained-release capsule to a new client. The client insists that he cannot swallow pills. The best course of action for the nurse is to:

Ask the physician to change the order

Which drugs/drug groups are used as anti-platelets? (3)

Aspirin GPIIb-IIIa inhibitors :Abciximab (ReoPro), Eptifibatide, Tirofiban The '-grels': Clopidogrel (Plavix), Prasugrel, Ticagrelor

After returning to work after a weekend off the nurse gets report that a depressed client has been in bed all weekend. What should the nurse to first?

Assist the client out of bed and involve in activity.

Who might require anti-platelets or anti-coagulants?

At risk of MI/stroke, or Post-MI/stroke Post DVT/PE (or at high risk) Mechanical heart valves Dilated cardiomyopathy Ventricular aneurysm Atrial fibrillation After orthopaedic surgery Those having PCI

A man comes into the ER after being in a car accident with a blood alcohol level greater than 2.0, what should the nurse prepare to administer?

Ativan or Librium per facility policy

A fib

Atrial Fibriallation, irregularly irregular rhythm with no distinct P waves between random QRS complexes; can lead to atrial stasis and stroke; Tx cardioverrsion, digoxin, and propanol, pridaxa, Ca channel blockers, cardezam

Explain how heparin is used.

Binds to the enzyme inhibitor antithrombin III Inactivates thrombin and other clotting substances Is not absorbed from the gut so given intravenously or subcutaneous injection (IV more rapid effects) Prescribed to lots of very immobile hospital patients who are at risk of DVT 2 forms: Unfractionated and Low-molecular weight (LMWH) LMWH is newer form and carries less risk of significant bleeding

Aspirin (ASA) Adverse Effects

Bleeding GI bleeding & hemorrhagic stroke Enteric-coated tabs may not reduce risk for GI bleeding

Low-Molecular-Weight Heparins Adverse Effects

Bleeding (less than unfractioned heparin) Toxicity antidote: protamine sulfate

Calcium Channel Blockers & Angina

Block Ca channels in vascular smooth muscle, dilate coronary & peripheral arteries, decrease myocardial contractility Adverse effects: tachycardia/bradycardia, hypotension, HF

Describe the effects of ARBs.

Block the effects of angiotensin II at receptor sites Works like an ACE inhibitor but no effect on bradykinin Less side effects

Explain how abciximab is used.

Blocks GPIIb-IIIa receptors Inhibits platelet aggregation Used in catheter lab alongside aspirin and heparin when patient is undergoing PCI or for UA patients who are about to go for PCI Given as an IV bolus followed by IV infusion

Thrombus

Blood clot formed within blood vessel or within the heart 1. Arterial thrombosis 2. Venous thrombosis

The reviews the client's laboratory results and reports which abnormal value to the physician? Client's Chart Calcium 9mg/dL Magnesium 2mg/dL Potassium 4mEq/L Blood urea nitrogen 45mg/dL

Blood urea nitrogen Rationale: The normal calcium level is 8.6 to 10 mg/dL. The normal magnesium level is 1.8 to 3 mg/dL. The normal potassium level is 3.5 to 5.1 mEq/L. The normal blood urea nitrogen is 5 to 20 mg/dL.

Concise

Brief, to the point.

The following orders were written by a prescriber (physician, advanced practice nurse, physician's assistant). Which order is written correctly?

CORRECT ANSWER IS C A) Aspirin 2 tablets prn B) Haloperidol (Haldol) ½ tablet at bedtime C) Zolpidem (Ambien) 5 mg PO at bedtime prn D) Levothyroxine (Synthroid) 0.05 mg 1 tablet

What does the parathyroid hormone regulate?

Calcium

What mineral is responsible for muscle contractions?

Calcium

The nurse is having difficulty reading a physician's order for a medication. The nurse knows the physician is very busy and does not like to be called. The nurse should

Call the physician to have the order clarified

Which of the following is the blood vessel where exchanges take place between blood and the cells of the body?

Capillary

A Nurse is monitoring a client with Addison's disease for signs of hyperkalemia. The nurse expects to note which of the following if hyperkalemia is present?

Cardiac dysrhythmias Rationale: Addison's disease is a condition caused by partial or complete failure of adrenocortical function. The inadequate production of aldosterone in Addison's disease causes inadequate excretion of potassium and results in hyperkalemia. The clinical manifestations of hyperkalemia are the result of altered nerve transmission. The most harmful consequence of hyperkalemia is its effect on cardiac function. Options 1, 3, and 4 are not manifestations associated with Addison's disease or hyperkalemia.

Labile

Changing rapidly and often

What should you advise a patient on a MAOI not to eat?

Cheese, beer, and avocado.

early onset of cough (before dyspnea), copious, purulent mucus production, minimal weight loss, milder severity of dyspnea

Chronic bronchitis

A client needs to wash her hands for two hours before able to go on with her morning. She doesn't want to sit on the chairs in the dayroom for fear of getting dirty. What is this mechanism?

Compulsion.

A mother comes into the clinic with her son who is being accused of a crime. She is worried her son will go to jail. What should the nurse say to the mother?

Consequences of enabling behaviors.

A woman calls the crisis hotline and says she has a loaded gun and is going to kill herself. To maintain patient confidentiality what would the nurse do?

Contact the person the client chooses to go to the home and remove the weapon.

Exposure

Contact.

Ongoing

Continuous

In order for inhalation to occur, what must happen?

Contraction of the diaphragm, which enlarges the chest cavity and draws air into the lungs

A nurse is assisting in the care of a client with hyperparathyroidism. The nurse does which of the following to help safely minimize effects of the disease process? 1. Restrict fluids to 1000 mL per day 2. Explains the benefits of diet high in milk products 3. Encourages the liberal use of calcium carbonate (Tums) antacids 4. Assists the client to ambulate in the hall 3 times a day for 15 minutes

Correct Answer Assist the client to ambulate in the hall 3 times a day for 15 minutes Rationale: The client with hyperparathyroidism is predisposed to hypercalcemia and renal calculi formation; therefore ambulation is important. A diet high in milk products would add to the client's calcium load. Calcium carbonate contains calcium and is therefore not the best choice as an antacid. Fluids should not be restricted because fluids aid in excreting calcium via the kidneys and prevent the formation of calcium-containing renal stones.

A client with diabetes mellitus has had insulin added to the treatment regimen. The nurse determines that the dose of insulin is optimal if the client has a random blood glucose level of 1. 75mg/dL 2. 115mg/dL 3. 140mg/dL 4. 200mg/dL

Correct Answer is 115mg/dL Rationale: The normal random blood glucose level is 80 to 120 mg/dL, but may vary, depending on the time of the last meal. Options 3 and 4 are incorrect because they exceed the normal range. Option 1 is slightly lower than normal and places the client at risk for hypoglycemia.

A Client with diabetes mellitus tells the nurse that she has cut the blood glucose monitoring strips in half lengthwise to save money. The nurse should make which response to the client?

Correct Answer is A lot of times the blood glucose value is underestimated with such a small area to read Rationale: Visual interpretation of blood glucose monitoring strips by clients can be difficult because of decreased visual acuity levels. Tearing the strips in half may affect the accuracy in reading. Option 1 is inappropriate according to this rationale. Option 2 places a demand on the client. Asking a client "why" needs to be avoided because it requires an explanation from the client and may cause the client to become defensive.

A nurse is providing instructions to a client who is schedule for a glucose tolerance test. Which instruction will the nurse provide to the client in preparation for the test. 1. Take insulin as scheduled on the day of the test. 2. Eat a normal breakfast on the day of the test 3. Avoid alcohol, coffee, or tea for 12 hours before testing. 4. Eat a low-carbohydrate diet for at least 3 days before the test

Correct Answer is Avoid alcohol, coffee, or tea for 12 hours before testing. Rationale: The nurse instructs the client to consume a high-carbohydrate diet for at least 3 days before the test and to discontinue oral contraceptives, corticosteroids, salicylates, and thiazide derivatives 3 days before the test. The client is told to withhold administration of insulin or oral hypoglycemic agents on the day of the test. Fasting is necessary from midnight before the test and during the test, although water is permitted. Alcohol, coffee, and tea should be avoided for 12 hours before the test.

A client with Addison's disease has been instructed to follow up care to avoid complications. The nurse determines that teaching was effective when the client verbalizes that she will avoid: 1. Salty food 2. Snacks between meals 3. Taking corticosteroids 4. Becoming dehydrated

Correct Answer is Becoming dehydrated Rationale: Addison's disease is a life-threatening condition caused by partial or complete failure of adrenocortical function. Decreased aldosterone secretion results in fluid volume deficit. Clients are encouraged to maintain an oral intake of 3000 mL/day to avoid dehydration. Clients require a high-sodium diet to replace losses. Snacks between meals are encouraged to prevent hypoglycemia. Clients with Addison's disease require hormone replacement therapy with corticosteroids.

A LPN checks the vitals signs of a client who just underwent parathyroidectomy while the registered nurse takes report from the postanesthesia care unit nurse. The client's blood pressure is 90/60 mm Hg, and the apical pulse is 102 beats/min

Correct Answer is Check the back of the dressing for bleeding Rationale: A decrease in blood pressure and tachycardia could indicate postoperative bleeding, which is a complication of a parathyroidectomy. Because blood often trickles around the neck to the back, it cannot be observed on the front of the dressing. Thus the first action of the nurse should be to check the front, sides, and back of the dressing and the sheets underneath the neck. The nurse would then report all of the data collected to the RN for further action.

A licensed practical nurse enters the room of a client with Diabetes mellitus and finds the client difficult to arouse, with warm flushed skin. The pulse and respiratory rate are elevated from the clients baseline. The LPN reports the findings to the registered nurse and prepares to assist in implementing which action first? 1. Preparing for an insulin drip 2. Give the client a glass of OJ 3. Administering a bolus does of 50% dextrose 4. Checking the client's capillary blood glucose

Correct Answer is Checking the client's capillary blood glucose Rationale: The client's signs and symptoms are consistent with hyperglycemia. The nurse must first obtain a blood glucose reading and then report it to the physician for subsequent orders. The physician orders an insulin drip if needed. Options 2 and 3 are implemented as needed in the treatment of hypoglycemia.

A Client is being treated with Levothyroxine Sodium (Synthroid). The nurse tells the client that which of the following is a possible medication side effect 1. Weight Gain 2. Constipation 3. Chest pain 4. Sleepiness

Correct Answer is Chest Pain Rationale: Levothyroxine sodium (Synthroid) is a synthetic thyroid preparation. Thyroid preparations increase metabolic rate, oxygen demands, and heart burden, which can result in angina pectoris. Options 1, 2, and 4 result from a deficit of thyroid hormone.

A nurse is assisting in planning care for the client with aldosteronism. The nurse should plan to monitor for which of the following? 1. Gastrointestinal (GI) bleeding 2. Hypoglycemia 3. Fluid overload 4. Urinary retention

Correct Answer is Fluid Overload Rationale: Aldosterone plays a major role in fluid and electrolyte balance. Hypersecretion of aldosterone causes sodium and water retention, which can lead to fluid overload. The other options are not part of the clinical picture of aldosteronism.

List the side effects associated with ACE inhibitors.

Cough (in up to 20%): increases bradykinin production which is thought to make the cough reflex more sensitive Hypotension Hyperkalaemia: due to decreased aldosterone and increased potassium reabsorption Impaired kidney function (especially in those with renal disease or HF)

A husband states to the nurse that his wife is not sleeping, buying impulsively, taking last minute trips, and has lost 22 pounds one month. What is an appropriate nursing dx?

Disturbed thought process.

A nurse is reinforcing teaching with a client newly diagnosed with diabetes mellitus who is taking NPH insulin daily in the morning. The nurse tells the client to self-monitor for which of the following signs and symptoms in the late afternoon? 1. Nausea, vomiting and abdominal pain 2. Drowsiness, red dry skin and fruity breath odor 3. Hunger, Shakiness and cool clammy skin 4. Increased urination, thirst and rapid deep breathing.

Correct Answer is Hunger, Shakiness and cool clammy skin Rationale: The client taking NPH insulin experiences peak effects of the medication from 6 to 12 hours after administration. The client is at risk for hypoglycemia at the time the medication peaks if food intake is insufficient. The nurse tells the client to watch for signs and symptoms of hypoglycemia during this time, including anxiety, confusion, difficulty concentrating, blurred vision, cold sweats, headache, increased pulse, shakiness, and hunger. The other options list signs and symptoms of hyperglycemia.

A client suspected of having Cushing's syndrome is scheduled for adrenal venography, and the nurse has provided instructions to the client about the test. Which client statement indicates a need for further instructions 1. I may feel a burning sensation after the dye is injected 2. The insertion site will be locally anesthetized 3. I should sign an informed consent 4. I will be placed in a high sitting position for the test.

Correct Answer is I will be placed in a high sitting position for the test. Rationale: The client is informed that the test aids in determining whether symptoms are caused by abnormalities in the adrenal gland. The nurse assesses the client for allergies to iodine before the test. The client is told that a transient burning sensation may be experienced after the dye is injected, that the client will be placed in a supine position, and that the insertion site will be locally anesthetized. An informed consent form is required.

A nurse is reinforcing medication instructions for a client with hypothyroidism. The nurse reminds the client that levothryoxine sodium (Synthroid) will result in: 1. Decreased body temperature 2. Reduced gastric acid production 3. Increased energy level 4. Faster weight gain

Correct Answer is Increased energy level Rationale: Levothyroxine sodium is a synthetically prepared thyroid hormone that increases body metabolism and the client's energy level. It promotes weight loss and increases body temperature. It does not affect gastric acid production.

A nurse is monitoring a hospitalized client with diabetes mellitus for signs of hyperglycemia. Select all signs of hyperglycemia 1. Hunger 2. Kussmaul's respirations 3. Sweating 4. Excessive thirst 5. Diaphoresis 6. Increased urine output

Correct Answer is Kussmaul's respiration, Excessive thirst and Increased urine output Rationale: Signs of hyperglycemia include excessive thirst, fatigue, restlessness, confusion, weakness, Kussmaul's respirations, diuresis, and coma, when severe. If the client presents with these symptoms, the blood glucose level should be checked immediately. Hunger, sweating, and diaphoresis are signs of hypoglycemia.

A Client experienced an acetylsalicylic (Aspirin) acid overdose 24 hours before being admitted to the hospital. The nurse monitors the client for signs and symptoms of which of the following acid-base imbalances? 1. Respiratory acidosis 2. Respiratory alkalosis 3. Metabolic acidosis 4. Metabolic alkalosis

Correct Answer is Metabolic acidosis Rationale: Acetylsalicylic acid is aspirin, which leads to metabolic acidosis as a late complication. In the early phase after aspirin overdose, the client may experience respiratory alkalosis as a compensatory mechanism as the body tries to combat the developing metabolic acidosis. Options 1, 2, and 4 are incorrect.

A nurse is preparing to administer medications to a client with hypoparathyroidism who has hypocalcemia. The nurse avoids giving the client a vitamin and calcium supplement with which of the following liquids? 1. Fruit juice 2. Iced Tea 3. Water 4. Milk

Correct Answer is Milk Rationale: The client with hypoparathyroidism should avoid milk products, which are high in phosphates. Options 1, 2, and 3 are appropriate liquids to administer with a vitamin and calcium supplement.

A nurse is caring for a client with Addison's Disease and reviews the plan of care. Which intervention will assist in preventing disease compilations? 1. Restrict fluids 2. Offer foods high in potassium 3. ID support system 4. Monitor Blood glucose

Correct Answer is Monitor Blood glucose Rationale: The decrease in cortisol secretion that characterizes Addison's disease can result in hypoglycemia. Therefore monitoring the blood glucose will assist in identifying the potential for this complication. Fluid intake should be encouraged to compensate for dehydration. Potassium intake should be restricted because of the hyperkalemia that occurs in this condition. Option 3 is not a priority for this client.

A Client has recently undergone bilateral adrenalectomy. The nurse assigned to this client should take which action as part of nursing care? 1. Encourage calcium intake 2. Observe color of the stools 3. Restrict fluid intake 4. Monitor for signs of hypoglycemia

Correct Answer is Monitor for signs of hypoglycemia Rationale: Adrenal insufficiency can lead to hypoglycemia. Adrenal insufficiency can result in hypovolemia; thus fluid intake should be encouraged, not restricted. Options 1 and 2 are unrelated to the problem of adrenal insufficiency.

An older client with diabetes mellitus has difficulty seeing the calibration marks on a syringe and cannot accurately draw up the daily NPH insulin dose. The client is expressing doubt about self-management of this disorder, and client's only close relative lives 30 minutes away. The LPN reports the client's concern to the RN and suggests a plan to investigate which option before the client's discharge from the hospital?

Correct Answer is Obtain a referral to a home health agency for pre-filling syringes and on going support Rationale: The strategic information in this question includes the client's physical inability to draw up the medication, the self-doubt about the ability to manage the diabetes mellitus, and the unavailability of the family member.

A registered nurse tells a licensed practical (LPN) nurse that a client with diabetes mellitus who is taking insulin is beginning to have hypoglycemic reaction and that the nurse should get the client a snack. Which food item would be the best choice? 1. 4-oz orange juice 2. Toast with peanut butter 3. 4-oz diet ginger ale 4. 8-oz coffee with half teaspoon sugar

Correct Answer is Orange Juice Rationale: A 10- to 15-g simple carbohydrate snack works quickly to increase the blood glucose level. The incorrect options do not provide sufficient simple carbohydrates to produce a quick rise in the blood glucose level. Solid foods take more time to digest than a liquid. Diet ginger ale does not contain sugar. Orange juice contains more sugar than ½ teaspoon sugar.

Which of the following diagnostic tests would best indicate a reduction in thyroid hormone secretion and synthesis in the client who is in thyroid storm and is being treated with propylthiouracil (PTU) 1. Serum thyroid antibodies 2. Thyroid Scan 3. Serum T3 and T4 4. Thyroid stimulation test

Correct Answer is Serum T3 and T4 Rationale: Propylthiouracil (PTU) is administered to clients in thyroid storm to block thyroid hormone synthesis of T3 and T4. Serum thyroid antibodies indicate whether an autoimmune disease is causing the client's symptoms. A thyroid scan provides information about whether excessive or diminished activity is present in the gland but does not provide information about the degree of hormone synthesis. The thyroid stimulation test differentiates primary from secondary hypothyroidism.

A nurse is reviewing assessment findings and laboratory data of a client with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Select the clinical manifestations of this disorder. 1. Signs of water intoxication 2. Hypernatremia 3. High urine osmolality 4. Low serum osmolality 5. Weight loss 6. Gastrointestinal disturbances

Correct Answer is Signs of water intoxication, High urine osmolality, Low serum osmolality and Gastrointestinal disturbances Rationale: SIADH is characterized by inappropriate continued release of antidiuretic hormone (ADH). This results in water intoxication characterized by fluid volume expansion, weight gain, hypotonicity of body fluids, and hyponatremia as a result of the high urine osmolality and low serum osmolality. Gastrointestinal disturbances such as anorexia, nausea, and vomiting occur as early manifestations.

A licensed practical nurse is caring for a client with myxedema. The LPN notes that the registered nurse has identified a nursing diagnosis of Imbalanced Nutrition. Which food sources are appropriate to include in the client's dietary plan? 1. Peanut Butter, Avocado and red meat 2. Skim milk, apples, whole grain bread and cereal 3. Organ meat, carrots and skim milk 4. Seafood, spinach and cream cheese

Correct Answer is Skim milk, apples, whole grain bread and cereal Rationale: Myxedema is the most severe form of hypothyroidism. A client with myxedema experiences an alteration in nutrition related to a decreased metabolic need. This client should consume low-calorie foods from all food groups to provide the necessary nutrients. Only option 2 identifies food choices low in calories.

A client recently diagnosed with type 1 diabetes mellitus tells the nurse that he is anxious about proper diabetic self-management during an upcoming 6-hour airplane flight. Which piece of information should the nurse give the client to help allay the anxiety about traveling?

Correct answer is Keep snacks in a carry-on luggage to prevent hypoglycemia during flight. Rationale: One of the biggest concerns for persons with diabetes during air travel, especially for long distance flights, is the availability of food at times that correspond with the timing and peak action of the client's insulin. For this reason the nurse may suggest that the client have carbohydrate snacks on hand for use as needed. Insulin equipment and supplies should always be placed in carry-on luggage (not stowed). This provides ready access to treat hyperglycemia, if needed, and also prevents loss of equipment if luggage is lost.

A woman is being abused by her husband, the abuse is escalating. What would the nurse ask first?

Do you have a plan in place when you are not safe? (SAFETY!!!)

Venous Thrombosis

Develop where blood flow is slow & blood stagnates. Fibrin produced, RBCs & platelets get caught in fibrin to develop an embolus. Emboli travel w/in vascular system & cause distant injury.

Bilateral Adrenalectomy

Definition Adrenalectomy is the surgical removal of one or both of the adrenal glands. The adrenal glands are paired endocrine glands, one located above each kidney, that produce hormones such as epinephrine, norepinephrine, androgens, estrogens, aldosterone, and cortisol. Adrenalectomy is usually performed by conventional (open) surgery, but in selected patients surgeons may use laparoscopy. With laparoscopy, adrenalectomy can be accomplished through four very small incisions. Purpose Adrenalectomy is usually advised for patients with tumors of the adrenal glands. Adrenal gland tumors may be malignant or benign, but all typically excrete excessive amounts of one or more hormones. A successful procedure will aid in correcting hormone imbalances, and may also remove cancerous tumors that can invade other parts of the body. Occasionally, adrenalectomy may be recommended when hormones produced by the adrenal glands aggravate another condition such as breast cancer. Precautions The adrenal glands are fed by numerous blood vessels, so surgeons need to be alert to extensive bleeding during surgery. In addition, the adrenal glands lie close to one of the body's major blood vessels (the vena cava), and to the spleen and the pancreas. The surgeon needs to remove the gland(s) without damaging any of these important and delicate organs.

A client is confused in an acute care hospital setting. What would support the dx of delirium instead of dementia?

Delerium: Started in hospital.

Contingent

Dependent.

Define Chemical Name

Describes the chemical make-up of a drug.

Define Generic name

Describes the principle ingredients; the formal name of the drug.

What is the correct formula for "Liquid and Weight"

Desired Dose Vehicle ------------------ X --------- = Dosage to be administered Dosage on hand 1

Normal Billi: Direct Indirect Total

Direct = 0.0-0.3 mg/dL Indirect = 0.1-1.0 mg/dL Total <1.5 mg/dL

Discrete

Distinct, separate.

A client with diabetes mellitus is brought to the urgent care center by the family. The client is lethargic and complains of a dry mouth and thirst. The skin is warm and dry, skin turgor is poor, and the client has deep respiration and a fruity odor to the breath. The nurse concludes that the client is experiencing which complication of diabetes mellitus?

Diabetic Ketoacidosis Rationale: Diabetic ketoacidosis is a complication of uncontrolled diabetes mellitus and is characterized by signs of dehydration such as dry mouth, thirst, and poor skin turgor. The client's neurological status declines as the serum glucose level rises. The pulse becomes rapid and weak, whereas the respirations become deep. The breath has a fruity or acetone odor to it. The client also may complain of abdominal pain, nausea, and vomiting.

What separates the thoracic cavity from the abdominal cavity?

Diaphragm

The orthopedic surgeon informs you that you have broken the middle region of the humerus. What area is he describing?

Diaphysis

The orthopedic surgeon informs you that you have broken the middle region of the humerus. What is he describing?

Diaphysis

Organic Nitrates for Acute Angina/Protection

Dilate peripheral & coronary blood vessels, decrease blood return, decrease preload Sublingual tabs or spray (don't chew or swallow) Large first-pass effect

List the side effects associated with calcium-channel blockers.

Diltiazem and Verapamil: Bradycardia, AV block, heart failure All: Hypotension, flushing, headaches, peripheral oedema

Impaired

Diminished or lacking some usual quality or level

Define Desired Dose

Dosage the Doctor has ordered

Warfarin Drug Interactions

Drugs that increase anticoagulant effects Drugs that promote bleeding Drugs that decrease anticoagulant effects Heparin, Aspirin, Acetaminophen

artifact

EKG craziness due to pt. movemen. It means nothing

What is a Verbal/Telephone Order?

EMERGENCIES ONLY

What are the glands of skin that produce a thin, watery secretion?

Eccrine glands

Hicg PADP Low PADP

Elevations in PAWP may indicate left ventricular failure, hypervolemia, mitral regurgitation, or intracardiac shunt decreases may indicate hypovolemia or afterload reduction.

-abnormal condution of the pulmonary system, overinfiltration and destructive changes in alveolar wall -dyspnea , late cough (after the onset of dyspnea), scant mucus production, weight loss

Emphysema

A Client has been diagnosed with goiter. The nurse should expect to note which of the following documented in the client's record?

Enlarged Thyroid Gland Rationale: Goiter is an enlargement of the thyroid gland. Enlargement occurs in an attempt to compensate for hormone deficiency. Heart damage, chronic fatigue, and decreased wound healing are not specifically associated with goiter.

A client is transitioning from the hospital to the home environment. A home care referral is obtained. What is a priority, in relation to safe medication administration, for the discharge nurse?

Ensure the home care agency is aware of medication and health teaching needs.

Angina Pectoris

Episodes of chest pain caused by deficits in myocardial O2 supply in regard to O2 demand May progress to MI

A tissue examined under the microscope exhibits the following characteristics: cells found on internal surface of stomach, no extracellular matrix, cells tall and thin, no blood vessels in the tissue. What type of tissue is this?

Epithelial

Defecate

Expel feces.

Which hormone initiates the preparation of the endometrium of the uterus for pregnancy?

Estrogen

Cholesterol Screening

Every 5 yrs. for those over 20 yrs. HDLs <40 low to undesirable LDLs <100 desirable

A nurse is planning to care for a client with Cushing's syndrome. The nurse plans care knowing that that condition is caused by:

Excessive amounts of Cortisol Rationale: Cushing's syndrome is caused by excessive amounts of cortisol. The average age of onset is between 20 and 40 years, and it occurs more commonly in women than in men.

urinate

Excrete or expel urine

void

Excrete, or expel urine

Fatigue

Extreme tiredness, exhaustion.

A nurse is assisting in planning care for the client with aldosteronism. The nurse plans to monitor for which of the following in the client

Fluid overload Rationale: Aldosteronism is a condition characterized by hypersecretion of aldosterone. Aldosterone plays a major role in fluid and electrolyte balance. Hypersecretion of aldosterone leads to sodium and water retention, which can lead to fluid overload. The other options are not part of the clinical picture that occurs with this health problem.

A client with hyperaldosteronism has undergone unilateral adrenalectomy. The nurse includes which of the following items in postoperative teaching?

Glucocorticoids will be needed temporaily Rationale: The client who has undergone unilateral adrenalectomy must take replacement corticosteroids for up to 2 years after surgery. This allows the remaining gland to resume function after being suppressed by the excessive hormone production of the diseased gland. Diuretics and a low-sodium diet are used in the preoperative period to manage hypertension. Once surgery has been performed, these measures are no longer required.

High-Density Lipoproteins

HDLs Cholesterol-core lipid Promote removal of cholesterol

Define Ampule

Made of glass with restricted neck that is pre-scored to be broken easily; contains sterile solution.

hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

Hyperosmolar Hyperglycemic Nonketotic Syndrome, or HHNS, is a serious condition most frequently seen in older persons. HHNS can happen to people with either type 1 or type 2 diabetes that is not being controlled properly, but it occurs more often in people with type 2. HHNS is usually brought on by something else, such as an illness or infection. In HHNS, blood sugar levels rise, and your body tries to get rid of the excess sugar by passing it into your urine. You make lots of urine at first, and you have to go to the bathroom more often. Later you may not have to go to the bathroom as often, and your urine becomes very dark. Also, you may be very thirsty. Even if you are not thirsty, you need to drink liquids. If you don't drink enough liquids at this point, you can get dehydrated. If HHNS continues, the severe dehydration will lead to seizures, coma and eventually death. HHNS may take days or even weeks to develop. Know the warning signs of HHNS. What are the Warning Signs? * Blood sugar level over 600 mg/dl * Dry, parched mouth * Extreme thirst (although this may gradually disappear) * Warm, dry skin that does not sweat * High fever (over 101 degrees Fahrenheit, for example) * Sleepiness or confusion * Loss of vision * Hallucinations (seeing or hearing things that are not there) * Weakness on one side of the body

Who might benefit from ACE inhibitors?

Hypertension: first line medication for those <55yrs Heart Failure: reduces myocardial workload, improves exercise capacity and survival, reduces symptoms, reduces hospitalisation Secondary Prevention Post-MI: reduces myocardial workload, improves survival

A nurse is providing dietary instructions to a client with a diagnosis of hyperparathyroidism. Which statement by the client indicates a need for further instructions?

I should consume foods high in Vitamin Rationale: Hyperparathyroidism is an abnormal endocrine condition characterized by hyperactivity of any of the four parathyroid glands with excessive secretion of parathyroid hormone. The client with hyperparathyroidism should consume at least 3000 mL of fluid per day. Dehydration is dangerous because it increases the serum calcium levels and promotes the formation of renal stones. Cranberry and prune juices help make the urine more acidic. A high urinary acidity helps prevent renal stone formation because calcium is more soluble in an acidic than in an alkaline urine. Clients should maintain a low-calcium, low-vitamin D diet. High-fiber foods are important to prevent constipation and fecal impaction resulting from the hypercalcemia that occurs with this disorder.

A nurse is providing home care instruction to a client with a diagnosis of Addison's disease. Which client statement indicates a need for further instruction?

I should daily medication for a limited period Rationale: Addison's disease is a life-threatening condition caused by partial or complete failure of adrenocortical function. Client education includes the need for lifelong daily medications. The client is also instructed to carry or wear a Medic-Alert card or bracelet. Increased glucocorticoid dosage during stressful minor illnesses is necessary. A travel kit needs to be purchased that contains oral cortisone along with intramuscular preparations for self-injection and intravenous vials for emergency injection by a physician.

Allen's test

In medicine, Allen's test, also Allen test, 1) The hand is elevated and the patient/person is asked to make a fist for about 30 seconds. 2) Pressure is applied over the ulnar and the radial arteries so as to occlude both of them. 3) Still elevated, the hand is then opened. It should appear blanched (pallor can be observed at the finger nails). 4) Ulnar pressure is released and the colour should return in 7 seconds. Inference: Ulnar artery supply to the hand is sufficient and it is safe to cannulate/prick the radial If color does not return or returns after 7-10 seconds, the test is considered positive and the ulnar artery supply to the hand is not sufficient. The radial artery therefore cannot be safely pricked/cannulated.

Homan's Sign

In medicine, Homans' sign was used as a sign of deep vein thrombosis (DVT). A positive sign is present when there is pain in the calf on dorsiflexion of the patient's foot at the ankle while the knee is fully extended.

Intact

In place, unharmed, whole

ST segment

Indicates that ventricle depolarization is complete and that repolarization is about to begin. Also called early ventricle repolarization. The ST Segment is measured from the end of the QRS to the beginning of the T wave, and represents a portion of ventricular repolarization. The normal segment is usually flat, or isoelectric. The absolute measurement of this segment is not as clinically important as is the configuration, whether depressed or elevated.

A client with a hx of depression and abusing alcohol with their depression getting worse. What is the most important nursing dx?

Ineffective coping.

A bipolar client comes into the clinic and tells the nurse that the next time she sees her sister I'm going to kill her. What should the nurse do?

Inform the sister.

What is the action of an ACE inhibitor?

Inhibits the conversion of Angiotensin I into Angiotensin II

Which of the following laboratory data indicate a potential complication associated with type 1 diabetes mellitus? A. Ketonuria B. Potassium 4.2m Eq C. Blood Glucose 112mg/dL D. Blood urea nitrogen (BUN) 18mg/dL

Ketonuria is an abnormal finding in the diabetic client that indicates ketosis. Ketosis is a metabolic effect from the lack of insulin on fat metabolism and occurs in type 1 diabetes mellitus. It is associated with severe complications of diabetic ketoacidosis (hyperglycemia, ketosis, and acidosis).

Cholesterol

Made primarily in liver Comes from dietary sources In all cell/organelle membranes, required for synthesis of certain hormones & bile salts, deposited in stratum corneum of skin

A nurse is collecting data from a male client with diabetes mellitus who has been taking insulin for many years. The client states that currently he is experiencing periods of hypoglycemia. The nurse determines that the most likely cause for this occurrence is

Injection insulin at the site of lipodystrophy Rationale: Tissue hypertrophy (lipodystrophy) involves thickening of the subcutaneous tissue at the injection sites. This can interfere with the absorption of insulin, resulting in erratic blood glucose levels. Because the client has been on insulin for many years, this is the most likely cause of poor control.

What is Mucous membrane medication administration?

Installation of fluid into the a body cavity such as eye, ear or nose drops.

Excess

More than what is needed or usual.

When identifying a new client before administering medications, the nurse asks the client to state his name. The client does not state the correct name. The nurse asks again, and the client states still another name. What is the nurse's next action?

Investigate the client's mental status before administering any further medications.

Kussmaul respiration

Is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also renal failure. It is a form of hyperventilation, which is any breathing pattern that reduces carbon dioxide in the blood due to increased rate or depth of respiration. In metabolic acidosis, breathing is first rapid and shallow[1] but as acidosis worsens, breathing gradually becomes deep, labored and gasping. It is this latter type of breathing pattern that is referred to as Kussmaul breathing.

Aspirin (ASA)

Ischemic stroke, TIA, angina, acute MI, previous MI, prevention of MI 81 mg dose

What is the function of aldosterone?

It conserves sodium in the body

Most of the carbon dioxide in the blood does which of the following?

It is converted to bicarbonate ions by carbonic anhydrase within red blood cells

The nurse is administering an intramuscular (IM) injection. The Z-track method is recommended for IM injections because:

It minimizes local skin irritation by sealing the medication in muscle tissue.

Low-Density Lipoproteins

LDLs Cholesterol-core lipid Greatest contributor to coronary heart disease

Lovenox, Fragmin, Innohep

Low-molecular-weight heparins

Creatinine Kinase (CK) MM = MB = BB =

MM = Skeletal Tissues MB = Myocardial Tissues BB = Brain Tissues

A client comes in after being in a car accident and is experiencing alcohol withdrawal, magnesium level of 1.1, cardiac dysthrythmias. What would you give first?

Magnesium.

A client comes to the nurses' station and told the nurse that her roommate had cut her wrists in the bathroom. After assessing and dressing the wounds, what should the nurse do next?

Move the client to a private room by the nurse's station.

Which leukocytes are correctly matched with their function or description? (Select all that apply)

Monocytes - become macrophages Lymphocytes - important in immune response Neutrophils - phagocytize microorganisms

Atherosclerosis

More than just deposit of lipids A chronic inflammatory process Infiltration of macrophages, T lymphocytes, & other inflammatory agents

What kind of medication order is "Standing"

Multiple doses.

IV Isotonic Solutions

NS (.9%) Lactate Ringers

What type of drug is kept in a locked drawer, compartment or automated dispensing unit?

Narcotics

Drugs for Angina

Organic nitrates Beta adrenergic blockers Calcium channel blockers Metabolic modulators

A nurse is assisting in monitoring a client for signs of hypocalcemia. Which of the following should the nurse note on data collection if hypocalcemia is present

Positive Trousseau's Sign Rationale: Hypocalcemia is a deficiency of calcium in the serum. Data collection findings from the client who is hypocalcemic include a positive Chvostek's sign and Trousseau's sign, hyperactive deep tendon reflexes, circumoral paresthesia, and numbness and tingling of the fingers. A positive Homans' sign is noted in thrombophlebitis.

Heparin Uses

Preferred anticoagulant in pregnancy & when rapid action is required Pulmonary embolism, stroke evolving, massive deep vein thrombosis

Explain how aspirin is used.

Prevents formation of thromboxane A2 so interferes with this cause of platelet aggregation Taken orally Low-dose, long term use frequently prescribed post MI

Exogenous

Produced outside of the body.

Endogenous

Produced within the body.

Potent

Producing a strong effect

What are the two functions of the male and female sex organs?

Production of gametes and production of hormones

How will you straighten the auditory canal for an adult?

Pull on the top of the ear up and back

PAP Systolic Diastolic

Pulmonary Artery Pressure Sys = 15-26 mmmHg Dia = 5-15 mmHg

PAWP

Pulmonary Artery Wedge Pressure (PAWP) aka Pulmonary Artery Occlusive Pressure (PAOP)

Metabolic Modulator

Ranolazine (Ranexa), new drug For chronic angina that has not responded to traditional drugs, in combination w/ amlodipine, beta blockers, & nitrates Inhibits fatty acid oxidation, increases efficiency of ATP production, decreases ischemia

Heparin (Unfractioned)

Rapid-acting anti-coagulant administered by injection only

A client with narcolepsy has been prescribed dextroamphetamine (Dexedrine). The client complains to the nurse that he cannot sleep well anymore at night and does not want to take the medication any longer. Before making any specific comment, the nurse plans to investigate whether the client takes the medication at which of the following proper time schedules? 1. After dinner each day 2. Just before going to bed 3. Two hours before bedtime 4. At least 6 hours before bedtime

Rationale: Dextroamphetamine is a central nervous system (CNS) stimulant, which acts by releasing norepinephrine from nerve endings. The client should take the medication at least 6 hours before going to bed at night to prevent disturbances with sleep. Taking the medication at the time frames indicated in options 1, 2, and 3 will prevent the client from sleeping because of the stimulant properties of the medication.

A nurse prepares to administer a measles, mumps, and rubella (MMR) vaccine to a 5-year-old child. The nurse plans to administer this vaccine: 1. Intramuscularly in the anterolateral aspect of the thigh 2. Intramuscularly in the deltoid muscle 3. Subcutaneously in the outer aspect of the upper arm 4. Subcutaneously in the gluteal muscle

Rationale: MMR is administered subcutaneously in the outer aspect of the upper arm. Each child should receive two vaccinations, the first between 12 and 15 months of age and the second between 4 and 6 years or 11 and 12 years. **Knowledge that MMR is administered subcutaneously will assist in eliminating options 1 and 2. Knowing that the gluteal muscle is not incorporated in the subcutaneous tissue will eliminate option 4.**

182.) A client with angina pectoris is experiencing chest pain that radiates down the left arm. The nurse administers a sublingual nitroglycerin tablet to the client. The client's pain is unrelieved, and the nurse determines that the client needs another nitroglycerin tablet. Which of the following vital signs is most important for the nurse to check before administering the medication? 1. Temperature 2. Respirations 3. Blood pressure 4. Radial pulse rate

Rationale: Nitroglycerin acts directly on the smooth muscle of the blood vessels, causing relaxation and dilation. As a result, hypotension can occur. The nurse would check the client's blood pressure before administering the second nitroglycerin tablet. Although the respirations and apical pulse may be checked, these vital signs are not affected as a result of this medication. The temperature also is not associated with the administration of this medication.

134.) A nurse reinforces instructions to a client who is taking levothyroxine (Synthroid). The nurse tells the client to take the medication: 1. With food 2. At lunchtime 3. On an empty stomach 4. At bedtime with a snack

Rationale: Oral doses of levothyroxine (Synthroid) should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast. **Note that options 1, 2, and 4 are comparable or alike in that these options address administering the medication with food.**

206.) A client is receiving baclofen (Lioresal) for muscle spasms caused by a spinal cord injury. The nurse monitors the client, knowing that which of the following is a side effect of this medication? 1. Muscle pain 2. Hypertension 3. Slurred speech 4. Photosensitivity

Rationale: Side effects of baclofen include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesia of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion. Paradoxical central nervous system excitement and restlessness can occur, along with slurred speech, tremor, dry mouth, nocturia, and impotence. **Option 3 is most closely associated with a neurological disorder**

In adolescent group discussing a handout on anger management, a client is becoming increasingly interruptive and talking about his home and pets. What is the nurse's most appropriate response?

Redirect the the handout.

Describe the effects of ACE inhibitors.

Reduced vasoconstriction, so: -Lower BP and therefore reduced afterload -Lower myocardial oxygen demand (limits remodelling) -Improved endothelial function Reduced fluid reabsorption so: -Lower preload (reduces diastolic pressure and wall stress) -Lower BP

Define Shaft

The long, cylindrical hollow tube of the needle

T wave

Repolarization of the ventricles. If bigger than QRS could meann hyperkalemia.

A client in group is talking about her prostitution, the nurse asks her if she was abused by her parents. She states "my mother ran my father out when I was young". What defense mechanism was used?

Repression.

Which of the followingepithelial types is correctly matchedwith its major function?

Simple columnar epithelium - secretion or absorption

The heart has an intrinsic beat that is initiated by which of the following?

Sinoatrial node

Insidious

So gradual as to not become apparent for a long time

At what temperature will the medication be administered in otic?

Should be room temperature.

Drug Therapy for Plasma Lipid Levels

Should not be the first line treatment Should only be used if TLCs fail

Plasma Lipoproteins

Six major classes, but 3 are relevant to coronary atherosclerosis 1. Very-low-density lipoproteins (VLDLs) 2. Low-density lipoproteins (LDLs) 3. High-density lipoproteins (HDLs)

A nurse is monitoring a client with hypothyroidism for neurological manifestations. Which of the following does the nurse expect to note in the client?

Slow, deliberate speech Rationale: Hypothyroidism is a condition characterized by decreased activity of the thyroid gland. In hypothyroidism the client's neurological manifestations include decreased deep tendon reflexes, muscle sluggishness, fatigue, slow and deliberate speech, apathy, depression, impaired short-term memory, and lethargy. Options of Fine Tremors, Restlessness, and Increased deep tendon reflexes are signs of hyperthyroidism.

Which mineral is responsible for regulating fluid in the body?

Sodium

Which of the following are tropic hormones? (Select all that apply)

Somatotropin Follicle-stimulating hormone Thyroid-stimulating hormone

You have been given a sample of tissue that has open spaces partially filled by an assemblage of needlelike structures. What is the tissue?

Spongy bone

What is the role of progesterone in the female reproductive system?

Stimulates the development of the endometrium

Explain how clopidogrel is used.

Stops ADP binding with platelet receptors so reduces expression of GPIIb-IIIa receptors Irreversibly interferes with platelet activation and aggregation (lasts lifetime of platelet ~10 days) Can be used in place of aspirin in those who are intolerant Usually given as a loading dose of 300-600mg Followed by 75mg daily for up to 1 year after stent, or medically treated UA/NSTEMI

Strict

Stringent, exact, complete

A client becomes agitated when the nurse is talking to his wife. He has not eaten in 3 days. What should the nurse do?

Take to quiet room and give PB crackers.

A client on LSD comes into the ER. How do you approach the client?

Talk calmly and soothing to the client.

Which two drug groups act as calcium-channel blockers?

The '-dipines' (Dihydropyridines) are potent vasodilators, e.g: Nifedipine, Felodipine, Amlodipine The non-dihydropyradines have greater cardiac effects, e.g: Verapamil (predominantly cardiac) and Diltiazem (mixed cardiac and vascular)

Which drugs/drug groups are used as anti-coagulants? (3)

The '-parins': Heparin, Enoxaparin (Clexane), Tinzaparin Warfarin Newer drugs: Dabigatran (direct thrombin inhibitor)

Chvostek's Sign

The Chvostek sign is one of the signs of tetany seen in hypocalcemia. It refers to an abnormal reaction to the stimulation of the facial nerve. When the facial nerve is tapped at the angle of the jaw (i.e. masseter muscle), the facial muscles on the same side of the face will contract momentarily (typically a twitch of the nose or lips) because of hypocalcemia (i.e. from hypoparathyroidism, pseudohypoparathyroidism, hypovitaminosis D) with resultant hyperexcitability of nerves. Though classically described in hypocalcemia, this sign may also be encountered in respiratory alkalosis, such as that seen in hyperventilation, which actually causes decreased serum Ca2+ with a normal calcium level due to a shift of Ca2+ from the blood to albumin which has become more negative in the alkalotic state.

What must you, as the Corpsman, pay close attention to ensure you are administering the specified form requested?

The Medication Order

A nurse who is caring for a client with Graves' disease notes a nursing diagnosis of Imbalanced Nutrition: Less Then Body Requirements related to the effects of the hypercatabolic state in the care plan. Which of the following indicates a successful outcome for this diagnosis?

The client maintains his or her normal weight or gradually gains weight if it is below normal. Rationale: Graves' disease is characterized by hyperthyroidism. It causes a state of chronic nutritional and caloric deficiency as a result of the metabolic effects of excessive T3 and T4. Clinical manifestations are weight loss and increased appetite. Therefore it is a nutritional goal that the client will not lose additional weight and will gradually return to the ideal body weight if necessary. To accomplish this, the client must be encouraged to eat frequent high-calorie, high-protein, and high-carbohydrate meals and snacks. The relationship between mealtime and the blood glucose level is unrelated to the subject of the question.

What is the fastest mode of transportation?

The closer the route is to major blood vessels, the quicker it is absorbed.

Define Metabolism

The conversion of the drug to an inactive and harmless for that can be excreted through the lungs, kidneys, and liver, GI tract. Example: Do not give Tylenol to a liver failure or transplant or alcoholic patient. It is metabolized in liver and can possibly worsen the problem.

Define Meniscus

The curved upper surface of a liquid in a container.

When are the three medication checks done?

The first two are completed during medication preparation and the third is completed just before administration.

Define Barrel

The graduated tubular outer portion of the syringe; the outer wall of the barrel has a scale calibrated in mL's or minims and the inner wall must remain sterile.

Which of the following statements is anatomically correct?

The hip is proximal to the knee

Define Lumen

The hollow inside diameter of the shaft of a needle.

Jeff has contracted bulbar poliomyelitis, and it has affected the medulla oblongata. The doctors warned the family that his condition is grave and death may be imminent. What functions of the medulla oblongata have warrated such a dire prognosis?

The medulla oblongata contains vital centers that control heart action, blood vessel diameter, and respiration

A nursing student takes a client's antibiotic to his room. The client asks the nursing student what it is and why he should take it. The nursing student's reply includes the following information:

The name of the medication and a description of its desired effect

What is the best nursing practice for administrating a controlled substance if part of the medication must be discarded?

The nurse documents on the medication administration record and the control inventory form, and has a second nurse witness the medication being discarded.

A nurse is planning to reinforce teaching to a client with diabetes mellitus with hypertension about "sick day management". Which carbohydrate-containing beverage should the nurse avoid putting on a list of beverages for use when the client cannot tolerate solid food orally?

Tomato Juice Rationale: Diabetic clients should take in approximately 15 g of carbohydrate every 1 to 2 hours when unable to tolerate food because of illness. The beverages listed in options 1, 2, and 3 provide approximately 13 to 15 g of carbohydrate in a ½-cup serving. Tomato juice is incorrect for two reasons. First, it is high in sodium and should not be used by the client with hypertension. In addition, it is a lower source of carbohydrate, providing only 5 g per ½ cup.

Trousseau's Sign

Trousseau sign of latent tetany is a medical sign observed in patients with low calcium.[1] This sign may become positive before other gross manifestations of hypocalcemia such as hyperreflexia and tetany, as such it is generally believed to be more sensitive (94%) than the Chvostek sign (29%) for hypocalcemia.[2][3] To elicit the sign, a blood pressure cuff is placed around the arm and inflated to a pressure greater than the systolic blood pressure and held in place for 3 minutes. This will occlude the brachial artery. In the absence of blood flow, the patient's hypocalcemia and subsequent neuromuscular irritability will induce spasm of the muscles of the hand and forearm. The wrist and metacarpophalangeal joints flex, the DIP and PIP joints extend, and the fingers adduct. The sign is also known as main d'accoucheur

A nurse is monitoring a client with hypoparathyroidism for signs of hypocalcemia. The nurse wraps a blood pressure (BP) cuff around the clients upper arm, fills the cuff, and monitors for spasms of the wrist and the hand. The nurse document the findings, kowning that this technique checks for the presence of which of the following?

Trousseau's Sign Rationale: Hypocalcemia is a deficiency of calcium in the serum. Trousseau's sign occurs when spasms of the wrist and hand occur after compression of the upper arm by a BP cuff. Homans' sign is the presence of pain in the calf area when the foot is dorsiflexed. Chvostek's sign is present when spasms of the facial muscles occur after a tap over a facial nerve, signifying facial hyperirritability. The Allen's test indicates adequate circulation to the hand before arterial blood gases are obtained.

The client is a 40-year-old man who weighs 160 lb and is 5 feet 9 inches tall. The order is for 5 ml of a medication to be given as a deep intramuscular (IM) injection. What size of syringe and gauge and length of needle should the nurse use for best practice?

Two 3-ml syringes, 20- to 23-gauge, 1½-inch needle

A client is diagnosed with hyperparathyroidism. The nurse plans to tell the client to limit which of the following foods in the diet?

Yogurt Rationale: The client with hyperparathyroidism is likely to have elevated calcium levels. This client should reduce intake of dairy products such as milk, cheese, ice cream, or yogurt. Apples, bananas, chicken, oatmeal, and pasta are low-calcium foods.

manifestation of pneumothorax: rhonchi sound

a rattling or gurgling sound heard on expiration (may clear with coughing) -dry, low-pitched snore like sound

208.) A client with myasthenia gravis verbalizes complaints of feeling much weaker than normal. The health care provider plans to implement a diagnostic test to determine if the client is experiencing a myasthenic crisis and administers edrophonium (Enlon). Which of the following would indicate that the client is experiencing a myasthenic crisis? 1. Increasing weakness 2. No change in the condition 3. An increase in muscle spasms 4. A temporary improvement in the condition

auto-define "A client with myasthen..." Rationale: Edrophonium (Enlon) is administered to determine whether the client is reacting to an overdose of a medication (cholinergic crisis) or to an increasing severity of the disease (myasthenic crisis). When the edrophonium (Enlon) injection is given and the condition improves temporarily, the client is in myasthenic crisis. This is known as a positive test. Increasing weakness would occur in cholinergic crisis. Options 2 and 3 would not occur in either crisis.

wheezing sound

continous musical or hissing noise that results from the passage of air through a narrowed airway

pleural friction rub

creaking or grating noise (2 leather rubbing)

febrile

fever

AIDS pneumocystis carinii pneumonia (fungus)

fever dyspnea, non productive cough...

psychosocial needs

helping the client deal with his or her own feelings

removal of chest tube, instruct pt to:

hold the breath

risk for pulmonary embolism

hypotension shortness of breath cough hemoptysis tachypnea chestpain

side effects of suctioning

hypoxemia cardiac irregularities resulting from vagal stimulation mucosal trauma paraxysmal coughing

1st action of chest tube accidentally disconnects from thechest drainage system

place the chest tube ie in a container of sterile water or saline

indigent

poor enough to need help from others

PPD 10 mm or more is considered as _____

positive

Precipitous

rapid, uncontrolled

peak flow meter for asthma

record the final position of the indicator

therapeutic

relating to the treatment of a disease; contributing to general well-being

96 (sata)ABG: info the nurse should write on lab requisition

ventilation client temperature date and time specimen was drawn details about any supplemental oxygen that the client is receiving x client allergies x extremity from whuch the specimen was obtained

chest drainage (95 read more)

when the lung has completely expanded, there is no longer air of=r fluid in the pleural space to be drained into the water seal chamber

trauma

wound or injury

chest tube drainage system: water-seal chamber should be filled to the 2cm mark to provide an adequate water seal between external env'l and the clients pleural cavity

yes

fluid in the water-seal compartment should rise with inspiration and fall with expiration (tidaling)

yes

gastric pH less than 5 should be treated with antacid

yes

tidal stops when the lung has reexpanded or if the chest drainage tubes are kinked or obstructed

yes

Describe the mechanism of action for each of the β-blockers.

β1 receptors -in cardiac conduction tissue and ventricular myocytes β2 receptors - arteries, veins, lungs Sympathetic nervous stimulation results in noradrenaline (and adrenaline) binding with β receptors: -Increased HR, contractility, automaticity, conduction velocity (β1) -Vasodilation, bronchodilation (β2) Beta blockers competitively bind with receptors, blocking these effects