*HURST REVIEW Qbank/Customize Quiz - Pharmacology

A client diagnosed with hypertension has been prescribed metoprolol. Which statement by the client indicates that the client's medication instruction for metoprolol has been effective? 1. "I should not stop taking this drug immediately." 2. "I will need to rinse my mouth with water 3 times a day." 3. "I can decrease my aerobic exercises from 3 to 2 times per week." 4. "I will report irregular heartbeats, if they continue for more than 3 days."

1. Correct: Metoprolol, a beta-adrenergic antagonist, should not be discontinued abruptly. This action may have the serious result of precipitating angina. Metoprolol should be gradually discontinued. 2. Incorrect: Dry mouth is not a side effect of metoprolol. This drug does not stimulate anticholinergics to block acetylcholine from binding to its receptors on certain nerve cells. 3. Incorrect: Lifestyle modifications by the client should be continued. The client should not reduce the number of aerobic exercises after metoprolol has been prescribed. 4. Incorrect: The client should monitor their pulse rate, quality and rhythm daily. If changes in the quality and rhythm of the pulse occur, the primary healthcare provider should be notified immediately. A cardiovascular side of effect of metoprolol is bradycardia.

The nurse is reviewing the medication prescriptions with a client for which English is a second language (ESL). Which nursing intervention most likely will prevent a medication error with this client? 1. Use the teach-back method so that client is repeating the instructions back to the nurse. 2. Give printed information to the client. 3. Ask the client if they have questions before the client leaves the healthcare setting. 4. Refer medication questions to the pharmacist.

1. Correct: The teach-back method of asking the client to repeat the teaching instructions to the nurse will most likely reveal any misunderstanding. This allows the nurse to reinforce any areas where clarification is needed. 2. Incorrect: Printed information may or may not be helpful, depending on the client's level of understanding. 3. Incorrect: The client may not know which questions to ask regarding the medication, particularly if there is a language barrier. 4. Incorrect: The client may not ask another person for help. There has been no relationship established with the pharmacist since the nurse has been providing the teaching. The nurse should not put this responsibility on someone else in the interdisciplinary team.

The nurse has been teaching the parents of a child taking methylphenidate for the treatment of attention deficit hyperactivity disorder (ADHD). Which comments by the parents indicate adequate understanding of the important considerations for methylphenidate? Select all that apply 1. "I know that I need to monitor weight." 2. "I am supposed to call if my child has decreased attentiveness." 3. "This medication may cause increased drowsiness." 4. "I know that I need to monitor my childs height." 5. "If my child can't sleep, the dosage may need to be increased."

1., 2. & 4. Correct: Continued use of the medication may cause delays in growth and loss of appetite. Lack of appetite may cause weight loss. This drug may affect child's growth rate. The child's attentiveness should increase with this medication and if there is no improvement in attentiveness with this medication then notify the primary healthcare provider. 3. Incorrect: The medication is more likely to cause insomnia especially if administered late in the day. If this medication can cause insomnia. 5. Incorrect: If the client cannot sleep, it is likely that the afternoon dose will be decreased or omitted.

After obtaining vital signs, which prescribed medication should the nurse hold when caring for a client on the cardiac unit? Exhibit Vital Signs: T - 98 F (36.7C) P - 74 R- 20 BP - 88/50 1. Rosuvastatin 2. Enalapril 3. Digoxin 4. Clopidogrel

2. Correct: Enalapril is an angiotensin converting enzyme (ACE) inhibitor. An ACE inhibitor will lower the client's blood pressure. The blood pressure in the stem's exhibit is low. Lowering the client's blood pressure more could have a negative effect on the client's condition. 1. Incorrect: Rosuvastatin is a lipid lowering medication. The client's blood pressure has no bearing on whether or not to administer the medication. 3. Incorrect: Digoxin is an antiarrhythmic/inotropic agent. It will slow the heart rate and increase the force of myocardial contraction. This action could actually increase the blood pressure. 4. Incorrect: Clopidogrel is an antiplatelet agent. The client's blood pressure would not have a bearing on whether or not to administer the medication.

A nurse notes redness, warmth, and pain at a client's intravenous (IV) insertion site. What does the nurse suspect? 1. Colonization 2. Phlebitis 3. Infectious disease 4. Bacteremia

2. Correct: Phlebitis refers to inflammation of a vein and it can be caused by any insult to the blood vessel wall, impaired venous flow, or coagulation abnormality. Clinical evidence includes redness, heat and pain. These signs and symptoms show that the client is experiencing a localized inflammation such as phlebitis. 1. Incorrect: Colonization is used to describe microorganisms present without host interference or interaction. There is an absence of tissue invasion or damage. 3. Incorrect: Infectious disease is the state in which the infected host displays a decline in wellness due to the infection. Clinical signs and symptoms may or may not be present. 4. Incorrect: Bacteremia is determined by presence of bacteria in the bloodstream. Bacteremia can lead to sepsis and signs and symptoms such as fever, hypothermia, tachycardia, tachypnea and inadequate blood flow to internal organs.

A client in the third trimester of pregnancy arrives at the emergency room reporting general illness. The client is noted to have a blood glucose level of 390 mg/dL and is diagnosed with gestational diabetes. The primary healthcare provider prescribes 30 units of NPH insulin subcutaneously stat. What is the nurse's priority action? 1. Administer the dose of insulin immediately. 2. Question the type of insulin prescribed. 3. Insert an IV for an insulin infusion. 4. Question the dose of the insulin.

2. Correct: The client's blood glucose is extremely high and needs to be quickly reduced. The prescription given by the primary healthcare provider is for 30 units of NPH insulin, an intermediate acting insulin whose onset is about 1 ½ hours. That is too long to wait to start reducing this elevated glucose. This client should have been prescribed regular insulin. 1. Incorrect: While this client should indeed receive insulin immediately to start reducing the blood glucose, there is a problem with the prescription that the nurse must address before implementing. 3. Incorrect: Even though the primary healthcare provider has not prescribed an insulin drip, an IV would be an important intervention with a pregnant female whose blood sugar is very high. However, there is another problem that takes priority first. 4. Incorrect: Thirty units of insulin is not an unreasonable dose for a blood glucose level of 390 mg/dL. However, the amount of insulin is not the problem here. There is another issue of greater concern for the nurse.

The nurse is caring for a client taking enoxaparin. Which group of symptoms should be reported to the primary healthcare provider? 1. AST of 12 U/L and ALT 20 U/L 2. Hematocrit of 46% decreased to 35% and blood pressure decreases from 122/78 to 108/54 3. Ecchymosis around the abdominal subcutaneous injection site and platelet count of 200,000. 4. Hemoglobin of 14.5 g/dL (2.3 mmol/L) increased to 16 g/dL (2.5 mmol/L) and increased erythema of oral mucus membranes.

2. Correct: These values indicate a drop in hematocrit and drop in blood pressure. Both of these could represent bleeding. These would be important to report to the primary healthcare provider. 1. Incorrect: The nurse would need to watch and report any signs of liver complications due to the use of enoxaparin. The AST and ALT are two liver enzyme values that would increase with liver complications. These two values represent normal AST (8-40 U/L) and ALT (10-30 U/L) values. 3. Incorrect: Bruising (ecchymosis) at the injection site is a frequent occurrence with administration of enoxaparin. This platelet count is within the normal range. 4. Incorrect: The Hgb and color of oral mucous membranes indicate an increase in Hgb. This would not indicate bleeding.

A nurse is to administer a time release capsule to a client who has difficulty swallowing. Which intervention would be the best course of action for the nurse to take? 1. Open the capsule and sprinkle it on applesauce. 2. Melt the capsule in juice or water. 3. Call the primary healthcare provider to change the order. 4. Break the capsule in half using a pill splitter.

3. Correct: If the client has difficulty swallowing a capsule or tablet, ask the primary healthcare provider to substitute a liquid medication if possible. 1. Incorrect: Sprinkling the medication over applesauce or pudding may be the only option the nurse has if there is no other form, but since this medication is time-released, the best answer and priority would be to get a liquid form, if available, for the drug. 2. Incorrect: Never melt a time release capsule or tablet as this would release the medication all at once. 4. Incorrect: Breaking or splitting would also release the medication in boluses and could cause harm to the client.

A child with acute lymphocytic leukemia (ALL) is receiving chemotherapy through a single lumen Groshong catheter. During the infusion, the child reports nausea and has vomited. The primary healthcare provider has prescribed ondansetron IV. What action should the nurse take? 1. Ask primary healthcare provider for an oral antiemetic. 2. Give ondansetron IVPB with the chemotherapy. 3. Wait until chemotherapy is complete to infuse ondansetron. 4. Stop chemotherapy temporarily and flush line to give ondansetron.

4. Correct: A Groshong catheter is implanted when other venous access sites are no longer useable. The child has begun to react to the chemotherapy and needs medicated now. Because this implanted device has only one lumen, the nurse must stop the chemotherapy infusion temporarily, flush the port, administer the ondansetron, flush again and restart the chemotherapy infusion. 1. Incorrect: Because this client is vomiting, changing the medication to the oral route would not be effective. The medication takes longer to work if given orally, which means the client may vomit again before the medication activates, losing part of the dose. 2. Incorrect: Chemotherapy infusions should not be mixed with other categories of drugs, such as an antiemetic, because of the possibility of drug interactions. Certain chemical mixtures could also cause precipitates to form in the tubing, which is dangerous to the child. 3. Incorrect: The child is experiencing nausea and vomiting at this time. Waiting to give the antiemetic until after the chemotherapy is completed causes the child to suffer needlessly. The nurse should take action immediately to alleviate symptoms.

The primary healthcare provider has prescribed ampicillin and ciprofloxacin piggyback in the same hour, every 6 hours. How will the nurse administer these medications? 1. Administer one of the medications every 4 hours and the other every 6 hours. 2. Administer the medications by combining them into 150 mL of normal saline (NS). 3. Administer the medications at the same time by connecting the secondary tubing to two separate ports on the primary tubing. 4. Administer the medications separately, flushing with normal saline (NS) between medications.

4. Correct: Even though two IV piggyback medications have been ordered at the same time, they can both be infused separately on time. It just takes planning. The nurse must follow the medication rights (right client, right medication, right route, right dose, right time). The antibiotics need to be administered one at a time and normal saline is used to flush the remaining medication of the first antibiotic before the second is administered. 1. Incorrect: The primary healthcare provider will prescribe the dosing schedule. Its beyond the scope of practice for the nurse to independently the dosing schedule. 2. Incorrect: The properties of each antibiotic are different. The two different antibiotics cannot be mixed together. 3. Incorrect: Administering the antibiotic into different parts of the IV tubing is the same as mixing the IVs together. Only one antibiotic should be administered at a time.

The nurse is caring for a client with tuberculosis receiving isoniazid therapy. Because of the possible peripheral neuropathy that can occur, which supplementary nutritional agents would the nurse expect to administer? 1. Cyanocobalamin 2. Vitamin D 3. Ascorbic acid 4. Pyridoxine

4. Correct: Isoniazid interferes with vitamin B6 (pyridoxine) metabolism by inhibiting the formation of the active form of vitamin B6. This interference often results in peripheral neuropathy. 1. Incorrect: Vitamin B12 (Cyanocobalamin) is not given to prevent peripheral neuropathy caused from isoniazid therapy. It is used to treat vitamin B12 deficiency often caused by pernicious anemia. It may be given in client's with peripheral neuropathy, but is not beneficial in clients whose neuropathy is due to isoniazid therapy. 2. Incorrect: Vitamin D is not given to prevent peripheral neuropathy. It is used in the treatment of weak bones, bone pain and/or bone loss. 3. Incorrect: Vitamin C is not given to prevent peripheral neuropathy cause from isoniazid therapy. It's use can be beneficial in clients with diabetic peripheral neuropathy.

Which medication should the nurse administer first after receiving the morning shift report? 1. Levothyroxine to the client with hypothyroidism and a thyroid stimulating hormone (TSH) level of 2.8 mU/L 2. Amlodipine to the client with hypertension and a blood pressure of 150/86 3. Regular insulin sliding scale dose to the client with diabetes and a 210 blood glucose level. 4. Cefotaxime intravenous piggyback to the newly admitted client with a diagnosis of pneumonia and a white blood cell count (WBC) of 12,000mm3

4. Correct: The first dose of intravenous antibiotic medication is the priority since the WBCs are elevated and the antibiotic should be administered first. 1. Incorrect: The TSH is normal so the thyroid medication is not the priority. 2. Incorrect: Amlodipine is for high blood pressure and is important but the antibiotic is the priority. 3. Incorrect: It is important to administer the regular insulin but it is not priority over initiating the intravenous antibiotic medication.

A client was admitted with a diagnosis of Type II diabetes. The primary healthcare provider initiated the Insulin Sliding Scale Protocol for Type II Diabetic Clients. The prescription regimen was to begin at the high dose regimen with regular insulin AC & HS. How much insulin should the nurse administer at 2100 hours? Exhibit: Glucose flow sheet: Date/Time: 1/19 @ 0730, Glucose Level: 368 mg/dL, Insulin Dose Regimen: High dose regimen, Insulin Dose: 16 units regular insulin Date/Time: 1/19 @ 1130, Glucose Level: 256 mg/dL, Insulin Dose Regimen: High dose regimen, Insulin Dose: 12 units regular insulin Date/Time: 1/19 @ 1700, Glucose Level: 164 mg/dL, Insulin Dose Regimen: High dose regimen, Insulin Dose: 4 units regular insulin Date/Time: 1/19 @ 2100, Glucose Level: 248 mg/dL, Insulin Dose Regimen: ___________, Insulin Dose: ___________ Sliding Scale Insulin Protocol: Regimens: Low Dose Regimen: Suggested as starting for the thin and elderly. Medium Dose Regimen: Suggested as starting point for average weight. High Dose Regimen: Suggested as starting point for overweight clients. Very High Dose Regimen: Suggested as starting point for clients with infections or receiving steroids. Insulin Type: Regular Insulin Frequency of Monitoring: ACHS Protocol: 1. If Potassium is <3.5, call M.D. 2. Advance to the next higher dose regimen if glucose level is >250 two (2) times in 24 hours and all readings were > 100. 3. Decrease to the next lower dose regimen if glucose level is between 60-100 twice in 24 hours. Glucose Level (mg/dL): FSBS < 60, Low Dose Regimen: Hypoglycemia Protocol and Call MD, Medium Dose Regimen: Hypoglycemia Protocol and Call MD, High Dose Regimen: Hypoglycemia Protocol and Call MD, Very High Dose Regimen: Hypoglycemia Protocol and Call MD Glucose Level (mg/dL): 60-150, Low Dose Regimen: 0, Medium Dose Regimen: 0, High Dose Regimen: 0, Very High Dose Regimen: 0 Glucose Level (mg/dL): 150-200, Low Dose Regimen: 0, Medium Dose Regimen: 2, High Dose Regimen: 4, Very High Dose Regimen: 6 Glucose Level (mg/dL): 201-250, Low Dose Regimen: 3, Medium Dose Regimen: 6, High Dose Regimen: 8, Very High Dose Regimen: 10 Glucose Level (mg/dL): 251-300, Low Dose Regimen: 4, Medium Dose Regimen: 8, High Dose Regimen: 12, Very High Dose Regimen: 14 Glucose Level (mg/dL): 301-350, Low Dose Regimen: 6, Medium Dose Regimen: 10, High Dose Regimen: 14, Very High Dose Regimen: 18 Glucose Level (mg/dL): 351-400, Low Dose Regimen: 9, Medium Dose Regimen: 12, High Dose Regimen: 16, Very High Dose Regimen: 22 Glucose Level (mg/dL): > 400, Low Dose Regimen: 9 units and Call MD, Medium Dose Regimen: 12 units and Call MD, High Dose Regimen: 16 units and Call MD, Very High Dose Regimen: 22 units and Call MD

Answer: 10 Rationale: Prescription: The prescription regimen was to begin at the high dose regimen with regular insulin AC & HS using the Insulin Sliding Scale Protocol for Type II Diabetic Clients. The protocol states to advance to the next higher dose regimen if glucose level is greater than 250 two (2) times in 24 hours and all readings are greater than 100. All glucose readings were greater than 100, and the readings were greater than 250 three times. So, the client should move to the next highest dose regimen which indicates that 10 units of regular insulin should be given at 2100 hours for a glucose of 248.

The nurse is caring for a client on the psychiatric unit. The client is prescribed fluphenazine 10 mg. The drug is available as an elixir: 2.5 mg / 5 mL. How many mL will the nurse give to the client? ______mL. Round answer to the nearest whole number.

2.5 mg : 5 mL : 10 mg : x mL 2.5 mg/x mL = 50 mg/mL 2.5 mg/x mL = 50 mg/mL x = 20 mL

After drawing up insulin for subcutaneous administration, the nurse receives a return phone call from a primary healthcare provider who wants to give prescription orders on a new admit. The nurse asks a new nurse to administer the insulin dose. What action should the new nurse take? 1. Administer the insulin dose to the client. 2. Consult with the charge nurse about administering the insulin dose to the client. 3. Tell the nurse that whoever draws up the medication has to administer that medication. 4. Offer to take the call from the primary healthcare provider so the nurse can administer the insulin.

3. Correct: A nurse can only administer medication that has been drawn up by that nurse. It is not acceptable practice to administer a medication drawn up by another nurse. 1. Incorrect: The nurse who gives this medication does not really know what was drawn up. It could be the wrong medication, the wrong dose, the wrong time. A nurse can only administer medication that has been drawn up by that nurse. 2. Incorrect: There is no need to consult the charge nurse because the new nurse should not administer the medication that has been drawn up by another nurse. 4. Incorrect: The nurse should first take the return phone call from the primary healthcare provider and then administer the insulin yourself.

Which side effect of vincristine should the nurse immediately report to the primary healthcare provider? 1. Nausea 2. Fatigue 3. Paresthesia 4. Anorexia

3. Correct: Paresthesia is a side effect of some chemotherapeutic medications and if it occurs, the primary healthcare provider needs to modify the dosage or discontinue. 1. Incorrect: Nausea and vomiting are common side effects of many chemotherapeutic medications. 2. Incorrect: Fatigue is a common side effect of many chemotherapeutic medications. 4. Incorrect: Anorexia is a common side effect of many chemotherapeutic medications.

The nurse is preparing to administer nadolol to a hospitalized client. Which client data would indicate to the nurse that the medication should be held and the primary healthcare provider notified? 1. Blood pressure 102/68 2. Glucose 118 mg/dL 3. UOP 440 mL over previous 8 hour shift. 4. Heart rate 56/min

4. Correct: This is a beta blocker. If a client's heart rate is less than 60 beats per minute, notify the primary healthcare provider and ask if the client should receive this medication. You can identify that nadolol is a beta blocker because it ends in "lol". 1. Incorrect: Beta blocker are prescribed to lower BP. When the baseline BP is not known, worry about a BP of 90/60 or below. If the client's BP drops below 90/60, this beta blocker should be held and the primary healthcare provider notified. 2. Incorrect: This is a normal glucose level. If the client is a diabetic, beta blockers can mask the signs of hypoglycemia. 3. Incorrect: Urinary output is adequate. Beta blockers do not alter renal function.

A three year old weighing 13.6 kg is scheduled to receive a dose of digoxin elixir. The prescribed dose is 25 micrograms/kg How many mL will the nurse administer to the child? Round to 1 decimal place. Use numbers and decimals only. Exhibit Medicine Cart Drug Availability: Lanoxin (digoxin) Elixir Pediatric Each mL contain 50 mcg (0.05 mg)

Answer: 6.8 Rationale: Prescribed: Digoxin elixir 25 micrograms/kg Step 1: Determine how many micrograms per kg should be given. 25 mcg/kg x 13.6 kg = 340 mcg Step 2: Think: You will want to give less than 7 mL, since one mL is 50 mcg. Step 3: D/H x Q = 340 mcg/50 mcg x 1 mL = 34/5 = 6 4/5 = 6.8 mL

The nurse is preparing to administer 1000 mL D5W with 40 mEq KCL IV over 12 hours. How many gtts/min will the nurse need to set the IV rate at? Exhibit IV Tubing: 10 Drops/mL

Answer: 14 Rationale: Prescription: 1000 mL D5W with 40 mEq KCL IV over 12 hours. Step 1: Determine what the drop factor is on the IV tubing. The one shown in the exhibit has a drop factor of 10 drops/mL. Step 2: Remember the formula for gtts/min = mL/hr x drop factor/time in minutes = gtts/min Step 3: 1000 ml/12 hours x 10 gtts/1 mL x 1 hour/60 min = 1000/12 x 10/1 x 1/60 = 10000/720 = 13.8 or 14 gtts/min

Which action by the nurse administering intravenous ciprofloxacin would require intervention by the charge nurse? 1. Sets IV pump to administer ciprofloxacin over a period of 30 minutes. 2. Educates client that medication may cause dizziness. 3. Instructs client to notify nurse for any tendon pain. 4. Administers ciprofloxacin through 20 gauge catheter into the cephalic vein.

1. Correct: Cipro IV should be administered to by intravenous infusion over a period of 60 minutes. Slow infusion of a dilute solution into a larger vein will minimize client discomfort and reduce the risk of venous irritation. 2. Incorrect: This action does not require intervention by the charge nurse as dizziness is a side effect of this medication. 3. Incorrect: This is a correct action. Fluoroquinolones, including Cipro IV, are associated with an increased risk of tendinitis and tendon rupture in all ages. This adverse reaction most frequently involves the Achilles tendon, and rupture of the Achilles tendon may require surgical repair. Tendinitis and tendon rupture in the rotator cuff (the shoulder), the hand, the biceps, the thumb, and other tendon sites have also been reported. 4. Incorrect: Slow infusion of a dilute solution into a larger vein will minimize client discomfort and reduce the risk of venous irritation.

The primary healthcare provider prescribes an intravenous infusion of D5 W at 125 mL per hour. The tubing has a drop factor of 20 gtt/mL. How many drops per minute should the nurse administer? Round answer to the nearest whole number.

125 x 20 / 60 = 41.666 = 42 Since partial drops cannot be counted, always round to the nearest whole number which, is 42.

A client is prescribed phenobarbital to control seizures. Which medication prescribed for the client would the nurse recognize interacts with phenobarbital? 1. Lovastatin 2. Loratadine 3. Lansoprazole 4. Lactulose

2. Correct: Both of these drugs can cause CNS depression. There is a drug to drug interaction between antiseizure medications and antihistamines. Loratadine is the only medication in the answer options that can cause CNS depression. 1. Incorrect: Lovastatin is indicated for the treatment of increased cholesterol and triglyceride levels. There is no drug to drug interaction that exists between phenobarbital and lovastatin. 3. Incorrect: Lansoprazole is a proton-pump inhibitor indicated for the treatment of stomach ulcers and GI complaints. There is no drug to drug interaction that exists between phenobarbital and lansoprazole. 4. Incorrect: Lactulose is an ammonia reducer and laxative. It is indicated for the treatment of constipation and to decrease the ammonia level in the treatment of client's with liver disease. There is no drug to drug interaction that exists between phenobarbital and lactulose.

The nurse is monitoring the IV medications that a client is receiving by an IV infusion pump. How many milligrams per hour of epinephrine should the nurse determine that the client is receiving? Round to the second decimal place. Use numbers only to answer. Exhibit IV Infusion Pump: Infusing 15.0 mL/h (1.0 mcg/min) Epinephrine

Answer: 0.06 Rationale: Step 1: Determine how many micrograms there are in 1 hour. 1.0 mcg/ min x 60 minutes = 60 mcg/hour. Step 2: Convert micrograms to milligrams. There are 1000 mcg in 1 mg. Step 3: Calculate micrograms There are 1000 mcg in 1 mg. How many mg are in 60 mcg? 1000 mcg/1 mg = 60 mcg/x mg 1000x = 60 1000x/1000 = 60/1000 x = 0.06 mg/hour

The nurse is preparing to administer cefazolin 0.5 grams in 100 mL D5W IVPB over 30 minutes. How many mL/hour will the nurse need to set the IV infusion pump at? Round to the nearest whole number.

Answer: 200 Rationale: Prescription: Cefazolin 0.5 grams in 100 mL D5W IVPB over 30 minutes. Step 1: Determine what the drop factor is on the IV tubing. IV infusion pumps have a drop factor of 60 gtts/min. Step 2: Remember the formula to regulate an IV by infusion pump- Total mL prescribed/Total hr prescribed Step 3: 100 ml/30 x 60 gtts/1 mL = 100/30 x 60/1 = 200 mL/hr

What actions should the nurse take when administering fentanyl? Select all that apply 1. Remove old fentanyl patch prior to applying new patch. 2. Cleanse area of old fentanyl patch. 3. Shave hair where fentanyl patch will be applied. 4. Place fentanyl patch over dry skin. 5. Apply adhesive dressing over the fentanyl patch. 6. Dispose of fentanyl patch in trash.

1., 2., & 4. Correct: These are correct actions. Apply patch to dry, hairless area of subcutaneous tissue, preferably the chest, abdomen, or upper back. The old patch should be removed prior to applying a new patch so that too much medication is not given. This is also why the old site should be cleaned. The patch should be placed on dry skin. Do not place over emaciated skin, irritated or broken skin, or edematous skin. 3. Incorrect: Do not shave area where patch will be applied and do not apply over dense hair areas. If there is hair on the skin, clip the hair as close to the skin as possible, but do not shave. 5. Incorrect: Do not apply adhesive dressing over patch. It can interfere with absorption. If the patch comes loose, you may tape the edges and remove and apply a new patch. 6. Incorrect: Dispose of fentanyl patch in sharps container. Fentanyl patches that have been worn 3 days still contain enough medication to cause serious harm to adults and children.

A nurse is teaching a client the advantages of having a PICC line inserted rather than a peripheral IV. What information should the nurse include? Select all that apply 1. TPN may be infused using a PICC line. 2. Use of a PICC can allow for early client discharge. 3. PICC lines do not have to be replaced as often as a peripheral IV line. 4. PICC lines have the same risk of infection as a peripheral IV line. 5. PICC lines do not need to be flushed as frequently. 6. PICC placement decreases the need for skin puncture when blood sampling is needed.

1., 2., 3., & 6. Correct: Peripheral IV lines must be changed every 72-96 hours. PICC lines may remain in place for extended periods of time. A PICC can be cared for at home by home care nurses, family members, or in outpatient clinics. TPN cannot be administered via a peripheral line since it is hypertonic. PICC lines offer a lower chance for infection than a peripheral line. As long as the PICC is functioning and there is no evidence of infection, the PICC line can remain in place until it is no longer needed. 4. Incorrect: PICC lines are long lasting, so the risk of infection from changing sites is eliminated. Additionally, sterile technique is used for insertion, with sterile dressing changes. Precautions should still be taken to prevent complications. 5. Incorrect: Both peripheral and central lines need to be flushed to maintain patency.

The nurse has been teaching the client about warfarin for prevention of pulmonary emboli. Which comments by the client indicate understanding of the medication? Select all that apply 1. "I must get my blood levels checked regularly." 2. "I shouldn't change my diet to include a lot of foods containing vitamin K without supervision." 3. "I should eat lots of foods containing vitamin K." 4. "I should report this medication to any primary healthcare provider that I see." 5. "I should not change the dosage without talking with my primary healthcare provider."

1., 2., 4. & 5. Correct: The client should comply with regular follow up visits for checks of INR level. INR is the international normalization ratio and is used for clients taking anticoagulants (blood thinning medications). The client should eat a normal healthy diet, but should not increase foods containing high amounts of vitamin K. The client should report using warfarin to any primary healthcare provider, as treatment may be changed due to this medication. The client should not manipulate the dosage unless instructed by the primary healthcare provider. An identification card or bracelet may also be recommended in case of emergencies. Clients should inform dentists and other healthcare providers especially before a medical procedure. The anticoagulant effect must be closely monitored. 3. Incorrect: Vitamin K reverses the anticoagulant effects of warfarin, so instruct the client to avoid foods high in vitamin K (examples are green leafy vegetables, brussels sprouts, prunes, cucumbers and cabbage).

What medications should the nurse anticipate the primary healthcare provider prescribing for the client with portal hypertension and bleeding esophageal varices associated with advanced cirrhosis? Select all that apply 1. Oxygen 2. Clopidogrel 3. Propranolol 4. Vitamin K 5. Lactulose

1., 3., 4., & 5. Correct: We know that they need oxygen because they may have been bleeding. Propranolol acts to reduce portal venous pressure and reduce esophageal varices bleeding. Vitamin K is a clotting factor and helps to correct clotting abnormalities because of the damaged liver. Lactulose decreases what? Ammonia, which is elevated with cirrhosis. 2. Incorrect: You don't want to give them a platelet aggregation inhibitor. They are already bleeding.

A client diagnosed with new onset atrial fibrillation has been prescribed dabigatran. What should the nurse teach this client? Select all that apply 1. Place medication in a weekly pill organizer so that medication is not forgotten. 2. Do not take with clopidogrel. 3. Dabigatran decreases the risk of stroke associated with atrial fibrillation. 4. Take this medication with food. 5. aPTT and INR levels will be drawn monthly.

2., 3., & 4. Correct: Do not take dabigatran with any other anticoagulants, including clopidogrel due to increased bleeding risk. Dabigatran decreases the risk of stroke and systemic embolism in clients with atrial fibrillation that is not associated with a cardiac valve problem. Take this medication with food to decrease gastric side effects such as dyspepsia and gastritis. Proton pump inhibitors and histamine 2 receptor blockers may also decrease gastric side effects. 1. Incorrect: After container is opened, medication should be used within 30 days. It is sensitive to moisture and should not be stored in weekly pill organizers. To maintain efficacy, keep medication in manufacturer- supplied bottle. 5. Incorrect: This medication does not require monitoring of INR levels. However, the client should be informed about the risk of bleeding and to monitor for signs of bleeding.

A factory employee is brought to the emergency room on first shift with a severe hand laceration occurring at work. The employee is quite upset, indicating previous competency on the machine. When reviewing medications, the nurse notes the client has recently started alprazolam at bedtime. What vital information about this medication should the nurse provide to the client? 1. Consider getting new glasses. 2. Stand up slowly when sitting. 3. Do not operate dangerous machines. 4. Instructions for taking medication appropriately.

3. CORRECT: The vital information provided when a client starts any benzodiazepine includes no driving and no operating heavy machinery. The major side effects of this category of drugs include trouble concentrating, impaired coordination, drowsiness and fatigue, all of which may have contributed to this client's accident. The fact the client uses this drug for sleep and then goes to work indicates a lack of comprehension about side effects. 1. INCORRECT: There is no indication the client even wears glasses; however, glasses would not address the problem of slowed reflexes or poor coordination when working around even familiar machinery. 2. INCORRECT: Although standing up slowly is an important safety issue of which the client should be aware, this is not the most vital teaching the nurse should present. 4. INCORRECT: The question does not indicate the client's present dose of alprazolam nor the frequency. It is impossible to determine whether the client is taking the medication correctly.

A client with the diagnosis of mild anxiety asks the nurse why the primary healthcare provider switched medications from lorazepam to buspirone. What should the nurse tell the client? 1. "Lorazepam takes longer to start working than buspirone so the primary healthcare provider decided to switch medications." 2. "Buspirone can be stopped quickly if necessary." 3. "Buspirone does not depress the central nervous system like lorazepam does, so you should not have as much sedation." 4. "You need to ask your primary healthcare provider why the medication was changed from lorazepam to buspirone."

3. Correct: Buspirone does not depress the CNS system and is believed to produce the desired effects through interaction with serotonin, dopamine, and other neurotransmitter receptors. 1. Incorrect: Buspirone takes 1-2 weeks to take effect and can take up to 4-6 weeks to achieve full clinical benefits. Lorazepam is a benzodiazepine and begins to work within a few hours to 1-2 days. 2. Incorrect: The client should not stop taking any anti anxiety medications abruptly. Serious withdrawal symptoms can occur: depression, insomnia, anxiety, abdominal and muscle cramps, tremors, vomiting, sweating, convulsions, delirium. 4. Incorrect: The nurse should be able to discuss medication administration with the primary healthcare provider.

The nurse is caring for a client on the oncology unit. The client asks, "Why do I need this LifePort to receive my chemotherapy?" What evidence should the nurse consider when answering? 1. IV infusions can be more rapidly administered via an implantable IV port 2. Implantable IV ports are kept sterile and therefore do not become infected 3. Chemotherapeutic agents are more readily absorbed from implantable IV ports 4. Implantable ports are beneficial when long-term and/or multiple IV therapy is indicated.

4. Correct: Clients requiring long-term and/or multiple IV therapy benefit from implantable ports, because they reduces the number of IV sticks, preserve the integrity of peripheral veins, and provide a vessel with adequate blood flow. The part allows chemotherapy agents to be given in a larger vein, decreasing risk of tissue damage that can occur with peripheral administration. 1. Incorrect: Rate of administration is not an indicator for an implantable port, and chemotherapeutic agents are administered at a slower rate than most IV medications. Chemo agents should be given at the prescribed rate. 2. Incorrect: Infection is a concern for any implantable device. Sterile technique is used when accessing port. Inspection of the site is essential, in addition to monitoring vital signs and WBCs. 3. Incorrect: Rate of absorption is not affected by the type of central line or implantable IV port. Implantable ports promote safety and reduce problems during medication administration.

A client has been prescribed a decongestant. The nurse identifies that the client has a diagnosis of glaucoma. Which nursing intervention would the nurse implement after identifying the client's diagnosis of glaucoma? 1. Administer the decongestant. 2. Reassess the client in 4 hours. 3. Identify when the client was diagnosed with glaucoma. 4. Notify the primary healthcare provider regarding the glaucoma diagnosis.

4. Correct: The primary healthcare provider should be notified of the client's diagnosis of glaucoma. Glaucoma is the result of elevated eye pressure due to a buildup of aqueous humor that flows throughout the inside of your eye. Decongestants can cause the pupil to dilate. This response can result in an acute glaucoma attack in a client diagnosed with narrow-angle glaucoma or angle-closure glaucoma. 1. Incorrect: The primary healthcare provider should be notified of the client's diagnosis of glaucoma and the prescription for a decongestant. The medication should not be administered until the primary healthcare provider is consulted. 2. Incorrect: Continual assessment of the client is recommended, but the nurse should not delay consulting with the primary healthcare provider. The primary healthcare provider should be notified of the client's diagnosis of glaucoma and the prescription for a decongestant. 3. Incorrect: The nurse needs to determine whether to administer the decongestant due to the client's diagnosis of glaucoma. The nurse does not need to identify when the client was diagnosed with glaucoma.

The nurse is preparing to hang an IV bottle of fat emulsions 20% on a client. At what rate should the nurse set the IV infusion pump? Answer in numbers only. Exhibit Primary Healthcare Provider Prescription: 200 mL fat emulsion 20% IV at 17 mL/hour. Fat Emulsion 20%: Fat Emulsions 20% 200 mL

Answer: 17 Rationale: Prescription: 200 mL fat emulsions 20% IV at 17 mL/hour. Think, when an infusion pump is used, the flow rate is prescribed by the primary healthcare provider and programmed by the nurse by setting the device for milliliters per hour (mL/h). Rule - To regulate an IV by infusion pump, Total mL prescribed/Total hr prescribed = mL/hr If you forgot that, then work the formula for gtts/min - mL/hr x drop factor/time in minutes = gtts/min The drop factor for the infusion pump is 60. 17 mL x 60 / 60 minutes = 17 Therefore, the pump should be set at 17 mL per hour

The nurse is caring for a client prescribed ondansetron due to postoperative nausea. Which side effect is the nurse most worried about the client experiencing with administration of this medication? 1. Respiratory depression 2. Hyperglycemia 3. Malignant hypertension 4. Torsades de pointes

4. Correct: Torsades de pointes is a life threatening dysrhythmia which can occur with administration of ondansetron. Clients who are at increased risk for Torsades de pointes are those with underlying heart conditions and those with hypomagnesemia or hypokalemia. 1. Incorrect: Respiratory depression is not a common side effect of ondansetron. Headache and drowsiness are more common. 2. Incorrect: Hyperglycemia is also not a side effect of ondansetron. Hyperglycemia is high blood sugar and may produce symptoms of urinary frequency, increased thirst and increased appetite. Hyperglycemia is not related to ondansetron. 3. Incorrect: Malignant hypertension is extremely high blood pressure that develops rapidly and causes some type of organ damage. Although it is a serious condition this is not a side effect of ondansetron.

A client has a prescription for nitroglycerin gr 1/400 SL prn for angina pain. How many tablets should the nurse give the client? Use numbers and decimals only. Exhibit Medication Cart Drug Availability: Nitroglycerin Tablets USP 0.3 mg (1/200 gr)

Answer: 0.5 Rationale: Prescribed: nitroglycerin gr 1/400 Step 1 is to convert grains to mg (gr 1 = 60 mg) 1/400 = 1/400 x 60/1 = 60/400 = 3/20 = 0.15 mg Step 2: Think - 0.15 is ½ of 0.30. You want to give the equivalent of ½ tablet as needed. Step 3: D/H x Q = X 0.15/0.3 x 1 tablet = 0.5 tablet nitroglycerin SL

The nurse is preparing to hang an IV bag of Heparin after receiving a prescription from a client's primary healthcare provider: Heparin IV to infuse at 1000 U/h. What flow rate should the nurse set the IV infusion pump rate at? Round to the nearest whole number. Exhibit IV Heparin Infusion Label: Heparin Sodium 25,000 USP Units Added to 0.45% Sodium Chloride 250 mL Bag (100 USP units/mL)

Answer: 10 Rationale: Prescription: Heparin IV to infuse at 1000 U/h. Available: Heparin 25,000 units in NS 250 mL Use ratio-proportion to calculate flow rate in mL/h which will administer 1000 units/hour. 25,000 units/250 mL = 1000 units/X mL 25,000X = 250,000 X = 10 mL/hr

Shortly after admitting a client to the unit, the nurse prepares to start an IV and hang 0.9% normal saline solution. At what rate should the nurse set the IV infusion pump? Answer using numbers only. Exhibit Primary Healthcare Provider Prescriptions: Physician Orders: 1. Admit to Cardiac Stepdown Unit with telemetry monitoring. 2. Oxygen at 2 L/min. 3. Monitor oxygen saturation. 4. Morphine IV 2 mg every 2 hours PRN shortness of breath. 5. Furosemide IV 40 mg every 6 hours. 6. Dobutamine 5 mcg/kg/min IV. 7. 0.9% Normal Saline Solution IV at 150 mL/hour. 8. Maintain bedrest except for ambulation to bathroom. 9. Elevate head of bed 30 degrees. 10. Monitor vital signs hourly.

Answer: 150 Rationale: Prescription: 0.9% normal saline solution IV at 150 mL/hour. Think, when an infusion pump is used, the flow rate is prescribed by the primary healthcare provider and programmed by the nurse by setting the device for milliliters per hour (mL/h). Rule - To regulate an IV by infusion pump, Total mL prescribed/Total hr prescribed = mL/hr If you forgot that, then work the formula for gtts/min - mL/hr x drop factor/time in minutes = gtts/min The drop factor for the infusion pump is 60. 150 mL x 60 / 60 minutes = 150 Therefore, the pump should be set at 150 mL per hour

The nurse is preparing to give a client's prescribed azithromycin dose. How many tablets will the nurse give to the client? Answer with numbers only. Exhibit Primary Healthcare Provider Prescription: Azithromycin 1 gram by mouth times one dose now Medication Cart Drug Availability: Zithromax (azithromycin) tablets 500 mg

Answer: 2 Rationale: Prescription: Azithromycin 1 gram by mouth times one dose now Available: Azithromycin 500 mg/tablet Step 1 is to convert grams to mg (1 gram = 1000 mg) Step 2: Think, 1 tablet is 500 mg and you need to give 1000 or twice the amount that is available. Step 3: D/H x Q = X 1000mg/500 mg x 1 tablet = 2/1 = 2 tablets

The nurse is preparing to give 250 mL D5W IV over 2.5 hours. How many gtts/min will the nurse need to set the IV rate at? Exhibit IV Tubing: 15 Drops/mL

Answer: 25 Rationale: Prescription: 250 mL D5W IV over 2.5 hours. Step 1: Determine what the drop factor is on the IV tubing. The one shown in the exhibit has a drop factor of 15 drops/mL. Step 2: Remember the formula for gtts/min - mL/hr x drop factor/time in minutes = gtts/min Step 3: 250 ml/2.5 hours x 15 gtts/1 mL x 1 hour/60 min = 250/2.5 x 15/1 x 1/60 = 3750/150 = 25 gtts/min

The primary healthcare provider's prescription for a client instructs the nurse to give digoxin 0.125 mg intravenously as a one-time dose. The available medication is in a concentration of 0.5 mg/2 mL. How many milliliters should the nurse give? Round answer using one decimal point.

____ mL= 2 mL x 0.125 mg / 0.5 mg = 0.5 mL

A client who has been taking phenytoin for several years arrives to the clinic for follow-up care. During the nurse's history and physical of the client, which findings indicate a possible side effect to the phenytoin? Select all that apply 1. Skin rash 2. Reports fatigue 3. Dyspnea on exertion 4. Pale conjunctiva 5. Heart rate 60/min

1., 2., 3.,& 4. Correct: An adverse effect of phenytoin is aplastic anemia. Phenytoin is an anticonvulsant. Aplastic anemia is a blood disorder where not enough new blood cells are produced in the bone marrow. The blood cells include red blood cells, white blood cells and platelets. The most common symptom of decreased RBC's is fatigue and dyspnea upon exertion because RBC's are responsible for oxygen transport throughout the body. A common sign/symptom of aplastic anemia is also skin rashes. Collectively, these are signs/symptoms of aplastic anemia caused by this medication. 5. Incorrect: This is a normal heart rate, and there is no concern for vital signs within normal limits.

A client with asthma uses a corticoid inhaler. What teaching should the nurse provide to decrease the risk of an oral fungal infection? 1. Lessen the exposure of the oral mucosa to the ICS by exhaling rapidly. 2. Rinse the mouth completely and brush teeth following the use of the ICS. 3. Use alcohol based mouth rinses with ICS. 4. Drink water prior to using the ICS.

2. Correct: Thrush, is an oral fungal infection, which is one of the most common side effects of ICS. Up to 1/3 of all clients on ICS develop this infection. Rinsing and brushing helps to remove the medication residual from the oral mucosa and upper pharyngeal area. 1. Incorrect: This is not appropriate because exhaling rapidly would result in a loss of the medication and reduce the effectiveness. 3. Incorrect: This is not accurate because alcohol based mouth rinses have not been shown to reduce the risk of thrush. Alcohol based mouthwash can be drying to the oral mucosa. 4. Incorrect: Drinking water, prior to using the ICS is not an effective means of preventing thrush.

The staff nurse is caring for a 3-month old client receiving potassium IV therapy. Which actions indicate to the charge nurse that the staff nurse understands IV management? Select all that apply 1. Uses a 15 gtt factor drip chamber when changing the IV tubing. 2. Applies elbow restraints to prevent dislodgement of the IV catheter. 3. Checks the IV site for blood return hourly. 4. Instructs unlicensed assistive personnel (UAP) to count drip rate hourly. 5. Attaches a volume-controlled IV administration set to IV bag prior to beginning IV therapy.

2., 3. & 5. Correct: Young children and infants usually must be restrained to some degree to prevent accidental dislodging of the needle. Elbow restraints can prevent an infant with a scalp IV from rubbing or touching the IV site. When a foot, leg, or arm is used, limb motion must be limited. IV potassium is an irritant. When the fluid being infused is a known irritant or vesicant, the nurse should check the IV site for blood return and possible infiltration hourly. Infants and young children have a narrow range of normal fluid volume, and the risk for fluid overload is great, especially in an infant. Always use a volume-controlled IV administration set with an infant or small child. These sets hold no more than 100-150 mL of fluid, so the maximum amount that could accidentally be infused is limited. 1. Incorrect: Always use microdrip tubing which is a 60 gtt chamber. Micro Drip chambers are used for children and for clients who can not tolerate a fast infusion rate or large volumes. 4. Incorrect: This intervention is beyond the scope of a UAP. The UAP may assist with activities of daily living and bedside care under the supervision of a registered nurse or other healthcare professional. The nurse is responsible for monitoring the IV flow rate.

The charge nurse is observing a new nurse administer a Mantoux test. The new nurse demonstrates accurate knowledge of the procedure by completing what steps? Select all that apply 1. Administers 0.1 ml of PPD to upper outer arm. 2. Inserts needle under dermis with the bevel up. 3. Uses tuberculin syringe with 27-gauge needle. 4. Wraps site with gauze to prevent leaking. 5. Assesses the injection site after 48 hours.

2., 3., & 5. Correct: The Mantoux test is standardly used to test individuals for immunity to tuberculosis by giving an intradermal injection of tuberculin. This intradermal test uses 0.1 millimeter of solution given with a tuberculin syringe and 27 gauge needle, injected with bevel pointed upward into the inner surface of the forearm. The test must be read between 48 and 72 hours for accuracy. 1. Incorrect: PPD stands for "purified protein derivative", which is the solution injected for this test. The upper outer surface of the arm is just below the deltoid muscle area and is not suitable for an intradermal injection. 4. Incorrect: If the solution is injected properly, a small wheal, or bubble, will appear on the skin which should not be compressed in anyway, particularly with gauze wrap.

A client with recurrent angina and hypertension has been started on new medications. When reviewing the admission forms, the nurse should immediately question which prescription? Exhibit Primary Healthcare Provider Prescription: Spironolactone 50 mg. PO once daily Metoprolol 25 mg. PO once daily Diltiazem 120 mg. PO once daily Potassium 10 meq PO once daily 2 gm. sodium diet 1. 2 gm sodium diet 2. Metoprolol 25 mg PO once daily 3. Potassium 10 meq PO once daily 4. Diltiazem 120 mg PO once daily

3. Correct: This client is being treated for recurrent angina with hypertension. The admission prescription includes spironolactone daily, which is a potassium-sparing diuretic; therefore, the client should NOT be taking a daily dose of potassium. 1. Incorrect: A 2 gram sodium diet is considered a low salt diet, which would be appropriate for a client with hypertension. Excessive dietary salt leads to water retention and increased blood pressure. This prescription is appropriate for the client and does not need to be questioned. 2. Incorrect: Metoprolol is a beta-blocker used to decrease preload, which will also decrease pulse and blood pressure. The dose is appropriate for this client and does not need to be questioned. 4. Incorrect: Diltiazem is a calcium channel blocker which vasodilates the arterial system and reduces recurrent angina by decreasing afterload. Additionally, calcium channel blockers help to decrease blood pressure. This medication and dose are appropriate for this client.

Labetalol has been prescribed for a client in the emergency room. Prior to administering this medication, what assessment should the nurse perform? 1. Listen to the client's breath sounds. 2. Check the client's temperature. 3. Monitor for peripheral edema. 4. Auscultate the apical pulse rate.

4. Correct: The therapeutic effect of labetalol, which is a beta blocker, is to lower the blood pressure and decrease the heart rate. Apical pulse should be assessed for 1 full minute. If pulse is less than 60 the medication is held and the healthcare provider should be notified. 1. Incorrect: Indirectly a beta blocker could affect breath sounds but assessing breath sounds is not as important as taking the client's apical pulse. Beta blockers should be used cautiously in clients with a history of COPD or asthma these could cause airways to constrict. 2. Incorrect: Labetalol does not affect the client's temperature. This is not a side effect of labetalol. 3. Incorrect: Indirectly a beta blocker could affect the amount of peripheral edema, however, assessing for peripheral edema is not as important as taking the client's apical pulse.

The client diagnosed with active tuberculosis has been prescribed isoniazid 300 mg by mouth every day. What should the nurse teach this client? Select all that apply 1. "Notify your healthcare provider if your urine turns dark." 2. "Your healthcare provider has prescribed B6 along with the isoniazid to prevent neuritis." 3. "You should avoid eating aged cheeses and smoked fish." 4. "Eat foods such as tuna twice a week." 5. "Rise slowly from lying to sitting, or sitting to standing."

1., 2., 3., & 5 Correct: Signs of hepatotoxicity from this medication include dark urine, jaundice, and clay-colored stool. Isoniazid- induced pyridoxine (Vitamin B6) depletion causes neurotoxic effects. Vitamin B6 supplementation of 10-50 mg usually accompanies isoniazid use. Aged cheeses and smoked fish are high in tyramine which may cause palpitations, flushing, and blood pressure elevation while taking isoniazid. Avoid these foods during treatment. Isoniazid should be taken on an empty stomach, one hour before or two hours after food. Some clients experience orthostatic hypotension while taking isoniazid, so caution against rapid positional changes. 4. Incorrect: Histamine containing foods such as tuna and yeast extracts may cause exaggerated drug response (H/A, hypotension, palpitations sweating, itching, flushing, diarrhea).

The nurse is caring for a client on the surgical unit. Which prescriptions could the nurse safely administer to the client? Select all that apply 1. Chlordiazepoxide 10 mg p.o. q 4h p.r.n. for agitation 2. Regular insulin 10 U stat 3. MS 2 mg IVP every 2 hours as needed for pain 4. Cefepime 1 gram IVPB every 8 hours 5. Diphenhydramine 25 mg p.o. hour of sleep for three nights

1., 4. & 5. Correct: These medication prescriptions are correctly written following approved Joint Commission abbreviations. 2. Incorrect: The "U" can be mistaken for "0" (zero), the number "4" (four) or "cc." Units should be written out completely. 3. Incorrect: MS can mean morphine sulfate or magnesium sulfate. Write "morphine sulfate." Write "magnesium sulfate."

A client who has Parkinson's disease has a new prescription for benztropine. What should the nurse include when teaching the client and spouse about this medication? Select all that apply 1. This medication blocks dopamine in the brain to decrease tremors and muscle stiffness. 2. Notify your primary healthcare provider if you develop urinary retention. 3. Benztropine can reduce the ability to sweat, so do not become overheated. 4. No lab tests are needed while taking this medication. 5. Sit up or stand up slowly to prevent lightheadedness.

2., 3., & 5. Correct: Urinary retention is a side effect of benztropine. Benztropine can reduce the ability to sweat and cause the body to overheat. Do not become overheated in hot weather or while you are being active because heat stroke may occur. Benztropine may cause dizziness, lightheadedness, or fainting. Alcohol, hot weather, exercise, or fever may increase these effects. To prevent these negative effects, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects. 1. Incorrect: Benztropine is an anticholinergic. It works by decreasing the effects of acetylcholine, a chemical in the brain. This results in decreased tremors or muscle stiffness, and helps improve walking ability for clients with Parkinson's disease. 4. Incorrect: Lab tests, including liver function, kidney function, lung function, blood pressure, fasting blood glucose, and blood cholesterol, may be performed while using benztropine. These tests may be used to monitor the client's condition or check for side effects.