MEDSURG3- MEDICATIONS
A client, who weighs 165 lb (75 kg), with a pulmonary embolus, is ordered to receive heparin 20 units/kg/hr by IV infusion. How many units of heparin should the client receive each hour? 1,700 1,000 1,500 1,200
,500 Explanation: A 165 lb client weighs 75 kg (2.2 lb = 1 kg): 20 units?(kg?hr) x 75 kg=1,500 units?hr
A nurse is providing instruction to a 38-year-old male client undergoing treatment for anxiety and insomnia. The practitioner has prescribed lorazepam 1 mg/po/tid. The nurse determines that teaching has been effective when the client states:
"I'll avoid coffee." Explanation: Lorazepam is a benzodiazepine used to treat various forms of anxiety and insomnia. Caffeine is contraindicated because it is a stimulant and increases anxiety. A client taking lorazepam should avoid alcoholic beverages. Clients taking certain antipsychotic medications should avoid sunlight. Salt intake has no effect on lorazepam.
A client, with new onset of atrial fibrillation, is receiving warfarin to help prevent thromboemboli. The client will be discharged when the warfarin reaches therapeutic levels, and when the international normalized ratio (INR) ranges from: 0.5 to 1 INR 1.25 to1.75 INR 3.5 to 4 INR 2 to 3 INR
2 to 3 INR In a client with atrial fibrillation, the warfarin is at a therapeutic level when the INR ranges from 2 to 3. A range of 3.5 to 4 is too high, and increases the risk of hemorrhage. Discharge would be considered when the INR is within the therapeutic range.
Which client would be most at risk for secondary Parkinson's disease caused by pharmacotherapy? A 30-year-old client with schizophrenia who is taking chlorpromazine A 50-year-old client taking nitroglycerin tablets for angina A 60-year-old client who is taking prednisone for chronic obstructive pulmonary disease A 75-year-old client using naproxen for rheumatoid arthritis
A 30-year-old client with schizophrenia who is taking chlorpromazine Explanation: Phenothiazines such as chlorpromazine deplete dopamine, which may lead to extrapyramidal effects. The other drugs don't place the client at a greater risk for developing Parkinson's disease.
The nurse has provided teaching for a client who will be taking lorazepam upon discharge. The nurse determines that teaching was effective when the client states the need to avoid:
alcohol. Alcohol should be avoided because of the added depressive effects. Ingestion of shellfish, coffee, and cheese is not problematic.
What is the most appropriate action for a nurse to take when administering a new blood pressure medication to a client? Administer the medication to the client without explanation Inform the client of the new drug only if he asks about it Inform the client of the new medication, its name and use, and the reason for the medication Administer the medication, and inform the client that the provider will later explain the medication
inform the client of the new medication, its name and use, and the reason for the medication Explanation: Informing the client of the medication, its use, and the reason for the medication change is important information for the client. Teaching the client about his treatment regimen promotes compliance. The other responses are inappropriate.
A child with diabetic ketoacidosis is being treated for a blood glucose level of 738 mg/dl (41.0 mmol/L). The nurse should anticipate an order for:
normal saline with regular insulin. Explanation: Short-acting regular insulin is the only insulin used for insulin infusions. Initially, normal saline is used until blood glucose levels are reduced, then a dextrose solution may be used to prevent hypoglycemia. Ultralente, NPH, and PZI insulins have a longer duration of action and shouldn't be used for continuous infusions.
client with a subarachnoid hemorrhage is prescribed a 1,000 mg loading dose of IV phenytoin. What information is most important when administering this dose? Therapeutic drug levels should be maintained between 20 and 30 mg/ml. Phenytoin should be administered through an IV catheter in the client's hand. Rapid phenytoin administration can cause cardiac arrhythmias. Phenytoin should be mixed in dextrose in water before administration. SUBMIT ANSWER
rapid phenytoin administration can cause cardiac arrhythmias. Explanation: Intravenous phenytoin should not exceed 50 mg/min, as rapid administration can depress the myocardium, causing lethal dysrhythmias. Therapeutic drug levels range from 10 to 20 mg/ml. Phenytoin is only compatible with normal saline, not dextrose in water. Phenytoin is very irritating to the blood vessels, and may cause purple glove syndrome when administered IV into a hand.
A client with acute pulmonary edema has been taking an angiotensin-converting enzyme (ACE) inhibitor. The nurse explains that this medication has been ordered to: promote diuresis. increase cardiac output. decrease contractility. reduce blood pressure.
reduce blood pressure. Explanation: ACE inhibitors are given to reduce blood pressure by inhibiting aldosterone production, which in turn decreases sodium and water reabsorption. ACE inhibitors also reduce production of angiotensin II, a potent vasoconstrictor. Diuretics are given to increase urine production. Vasodilators increase cardiac output. Negative inotropic agents decrease contractility.
A client with chronic alcohol use is admitted to the hospital for detoxification. Later that day, the client's blood pressure increases and the client is given lorazepam to prevent: fainting. anxiety reaction. seizure. stroke.
seizure. Explanation: During detoxification from alcohol, changes in the client's physiological status, especially an increase in blood pressure, may indicate a possible seizure. Clients are treated with benzodiazepines to prevent this. Stroke, fainting, and anxiety aren't the primary concerns when withdrawing from alcohol.
A nurse is teaching a client diagnosed with a pulmonary embolism about the prescribed heparin therapy. The nurse determines that teaching has been effective when the client states heparin is given to: dissolve the clot. break up the pulmonary embolism. slow the development of other clots. prevent clots from traveling to the lung.
slow the development of other clots. Explanation: Heparin slows the development of other clots. It doesn't break up pulmonary embolisms or dissolve existing clots. Heparin doesn't stop clots from traveling to the lungs.
A primipara who is Rho(D) negative has just given birth to a Rh-positive baby. The nurse is developing a plan of care. How should Rho(D) immune globulin be administered? To the neonate within three days To the client within three days To the client at her first postpartum visit in six weeks To the neonate at the first well-baby visit
the client within three days Administering Rho(D) immune globulin to the client within 72 hours of birth prevents antibodies from forming that can destroy fetal blood cells in the next pregnancy. Rho(D) immune globulin isn't given to the baby. The client should not wait six weeks to receive Rho(D) immune globulin as antibodies will already have formed.
A client with type 2 diabetes mellitus is prescribed capsaicin cream 0.075% What should the nurse include in a teaching plan for this medication? "This cream should be applied to open sores to prevent infection." "This cream should be applied to necrotic areas of ulcers to aid in debridement." "Apply capsaicin cream four times daily to decrease neuropathic pain sensations." "This cream should be applied daily to prevent dry skin."
Apply capsaicin cream four times daily to decrease neuropathic pain sensations."
A neonate is admitted to the neonatal intensive care unit with persistent pulmonary hypertension. Which medication should the nurse anticipate for this neonate? Prostaglandin E2 Inhaled nitric oxide Isoproterenol Dobutamine
inhaled nitric oxide Explanation: Inhaled nitric oxide is a potent selective pulmonary vasodilator. Dobutamine is a vasopressor, not a vasodilator. Isoproterenol dilates pulmonary arteries but does not decrease pulmonary vascular resistance. Prostaglandin E2 is an oxytocic substance used to induce labor and does not affect pulmonary vasodilation.
Which statement best describes the action of furosemide for the treatment of hypertension? It inhibits reabsorption of sodium and water in the loop of Henle. It inhibits the angiotensin-converting enzyme. It dilates peripheral blood vessels. It decreases sympathetic cardioacceleration.
it inhibits reabsorption of sodium and water in the loop of Henle. Explanation: Furosemide is a loop diuretic that inhibits sodium and water reabsorption in the loop of Henle, thereby causing a decrease in blood pressure. Vasodilators cause dilation of peripheral blood vessels, directly relaxing vascular smooth muscle and decreasing blood pressure. Adrenergic blockers decrease sympathetic cardioacceleration and decrease blood pressure. Angiotensin-converting enzyme inhibitors decrease blood pressure due to their action on angiotensin.
The nurse understands that certain medications protect the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation. Which class of medications serve this function? Opioids Calcium channel blockers Beta-adrenergic blockers Nitrates
Beta-adrenergic blockers Explanation: Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve stimulation. They protect the myocardium, and help reduce the risk of another infarction by decreasing the workload of the heart and decreasing myocardial oxygen demand. Calcium channel blockers reduce the workload of the heart by reducing contractility and vasodilatation; thus, lowering afterload. Opioids reduce myocardial oxygen demand, promote vasodilation, and decrease anxiety. Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure and systemic vascular resistance.
Which medication would the nurse expect the provider to prescribe as prophylaxis against Pneumocystis carinii pneumonia for a client with leukemia? Vincristine Co-trimoxazole Prednisone Oral nystatin suspension
Co-trimoxazole Explanation: The most common cause of death from leukemia is overwhelming infection. P. carinii infection is lethal to a child with leukemia. As prophylaxis against P. carinii pneumonia, continuous low dosages of co-trimoxazole are typically prescribed. Oral nystatin suspension would be indicated for the treatment of thrush. Prednisone isn't an antibiotic, and increases susceptibility to infection. Vincristine is an antineoplastic agent.
A client is taking fluphenazine. The nurse understands that teaching and discharge instructions are understood when the client states: "I can't eat cheese or eggs." "I need to stay out of the sun." "I need to plan frequent naps." "I need to double my fluids."
"I need to stay out of the sun." Explanation: Fluphenazine is an antipsychotic drug that can cause photosensitivity and sunburn. Clients taking this drug don't need to increase fluid intake, avoid cheese or eggs, or plan rest periods.
A nurse is teaching a client with glaucoma the proper technique for instilling eye drops "I should instill the drop directly onto the cornea." "I should instill the drop in the outer canthus." "I should instill the drop near the opening of the lacrimal duct." "I should instill the drop in the lower conjunctival sac."
"I should instill the drop in the lower conjunctival sac." Explanation: Eye drops should be placed in the lower conjunctival sac starting at the inner, not outer, canthus. Placing eye drops on the cornea causes discomfort and should be avoided. Eye drops shouldn't be placed by the opening of the lacrimal ducts to avoid systemic absorption.
A nurse is about to give a client with type 2 diabetes mellitus her insulin before breakfast on her first day postpartum. Which client statement indicates an understanding of insulin requirements immediately postpartum? "I will need less insulin now than during my pregnancy." "I will need more insulin now than during my pregnancy." "I will probably be able to control my diabetes with diet and exercise now." "I will need more insulin now than before I was pregnant."
"I will need less insulin now than during my pregnancy." Explanation: Postpartum insulin requirements are usually significantly lower than requirements during pregnancy. Occasionally, clients may require little or no insulin during the first 24 to 48 hours postpartum. Management of type 2 diabetes includes: healthy eating, regular exercise, possibly diabetes medication or insulin therapy, and blood sugar monitoring. However, there is not way of knowing if the client will now be able to control her diabetes without insulin.
A nurse is teaching a client about tricyclic antidepressants. The nurse determines that teaching has been effective when the client states: "This drug causes weight loss so I need to eat properly." "I should avoid all milk and dairy products." "I need to call the prescriber if I get a sore throat." "Improvement in my mood will take up to 28 days."
"Improvement in my mood will take up to 28 days." Explanation: The client's mood may not improve until the third or fourth week of tricyclic antidepressant therapy. The client needs to be reassured that the drug works slowly. The drug does not cause weight loss. It does not interact with milk and dairy products. Tricyclic antidepressants do not cause symptoms of infection.
2/10/2017 1800 19 year old male with mild concussion after slipping in school parking lot three hours prior. No loss of consciousness. No appreciable neurological deficits. CT scan normal. Client was preparing for discharge. Now reports a 5/10 headache. Acetaminophen PO ordered. When offered acetaminophen, the client's mother tells the nurse that she would like her son to have something stronger. What is the nurse's best response? "Acetaminophen is strong enough for your son's mild concussion." "We avoid giving aspirin to children and young adults because of the danger of Reye's syndrome." "Opioids are avoided following a head injury because they may hide a deteriorating condition." "Stronger medications may lead to vomiting, which increases the intracranial pressure (ICP)."
"Opioids are avoided following a head injury because they may hide a deteriorating condition." Explanation: Opioids may mask changes in the level of consciousness (LOC) that indicate increased ICP, and shouldn't be given as a first-line drug. Stating that acetaminophen is strong enough ignores the mother's question and isn't appropriate. Aspirin is contraindicated in conditions that include bleeding, and for children or young adults with viral illnesses due to the danger of Reye's syndrome. Stronger medications may not necessarily lead to vomiting, but will sedate the client, thereby masking changes in his LOC.
The nurse is teaching a client newly diagnosed with type 1 diabetes mellitus about the rotation of insulin injection sites. The nurse determines that teaching was effective when the client states: "Rotate injection sites within one anatomical region." "Rotate injection sites from one anatomic region to another." "Rotation of injection sites does not affect speed of absorption." "Rotation of injection sites does not prevent lipohypertrophy."
"Rotate injection sites within one anatomical region." Explanation: Rotation of insulin injections within one anatomic site is preferred to prevent day-to-day changes in absorption. Speed of absorption is affected by choice of site. Lipohypertrophy can be prevented by rotation of sites.
The home health nurse is speaking to the wife of a client with neurocognitive disorder due to Alzheimer's disease. The client has been taking donepezil. The nurse is most concerned when the caregiver states: "In the last few days, the main thing that my husband wants to eat is bread." "Somehow, this medication has been making my husband sleep longer in the morning." "My husband no longer has any interest in listening to the radio with me." "Yesterday, I managed to weigh my husband, and he has lost 8 lbs this month."
"Yesterday, I managed to weigh my husband, and he has lost 8 lbs this month. "A side effect of donepezil is weight loss, and it would be important to discuss the weight loss with the primary care provider. The desire to eat bread, the ability to sleep longer, and the lack of interest in listening to the radio are not changes related to the use of donepezil.
The provider has ordered an IV of 5% dextrose in lactated Ringer's solution at 125 ml/hr. The IV tubing delivers 10 gtts/ml. How many gtts/min should fall into the drip chamber? 12 to 13 10 to 11 20 to 21 22 to 24
20 to 21 Multiply the number of ml to be infused by the drop factor: (125 ml/hr x 10 gtts/ml) =1,250 gtts/hr 1,250 gtts/hr ÷60 min/hr=20.83 gtts/min or 20 to 21 gtts/min.
After a thyroidectomy, the cline develops a positive Trousseau's sign. What is the nurse's priority action?
Administer calcium.gluconate Explanation: Damage to the parathyroid glands can inadvertently occur during a thyroidectomy. This may cause a decrease in serum calcium, which causes muscle hyperexcitability and tetany. The treatment for a client who develops hypocalcemia and tetany following a thyroidectomy is calcium gluconate. Hypokalemia does not cause a positive Trousseau's sign. Decreased thyroid hormones will not cause tetany, however, the client will have to take thyroid replacement therapy following a thyroidectomy.
A client in labor is receiving magnesium sulfate to treat hypertension of pregnancy. How should this drug be administered? As a loading dose of 4 g in Lactated ringers, followed by a continuous infusion of 1 to 2 g/hr As a loading dose of 2 g in normal saline solution, followed by a continuous infusion of 2 g/hr As a loading dose of 4 g in dextrose 5% in water (D5W), followed by a continuous infusion of 1 to 2 g/hr As a loading dose of 4 g in dextrose 5%, followed by a continuous infusion of 4 g/hr
As a loading dose of 4 g in dextrose 5% in water (D5W), followed by a continuous infusion of 1 to 2 g/hr Explanation: A loading dose of magnesium sulfate should be given as a 4 g bolus, followed by a continuous infusion of 1 to 2 g/hr in D5W for maintenance. Magnesium sulfate shouldn't be administered in normal saline solution.
A depressed client, who is taking fluoxetine, tells the nurse that he has difficulty sleeping at night, is often sleepy during the day, and does not feel like doing anything. What is the nurse's best response?
Ask the prescriber whether the medication can be given early in the day Explanation: A common side effect of fluoxetine is insomnia, which is best addressed by administering this medication early in the day. It is inappropriate for the nurse to tell the client to stop taking the drug, to continue taking it until the undesired effects wear off, or to seek a second opinion.
The nurse is planning discharge teaching for a client who will continue taking the prescribed warfarin sodium at home. What is the priority teaching?
Avoid injury and watch for signs of bleeding Explanation: Coumadin is an anticoagulant, so the priority teaching would include watching for signs of hemorrhage and to prevent bleeding. Warfarin is administered orally. The client should have scheduled blood tests for prothrombin time. Consumption of leafy green vegetables should be limited.
A client is receiving spironolactone to treat hypertension. Which instruction should the nurse provide? Eat foods high in potassium Take daily potassium supplements Discontinue sodium restrictions Avoid salt substitutes
Avoid salt substitutes Explanation: Because spironolactone is a potassium-sparing diuretic, the client should avoid salt substitutes because of their high potassium content. The client should also avoid potassium-rich foods and potassium supplements. To reduce fluid volume overload, sodium restrictions should continue.
During a home health visit, a nurse assesses a client's medication and notes that the client has two prescriptions for fluid retention. One prescription reads, "Lasix, 40 milligrams one tablet daily." The next prescription reads, "Furosemide, 40 milligrams one tablet daily." Which instruction should be given to the client?
Call the health care provider for verification Explanation: The nurse understands that Lasix and furosemide are the same drug. Calling the health care provider to determine the correct dosage and frequency the nurse's role as a client advocate. Setting up medications in a medication tray, using only one pharmacy to dispense medications, and using all medications until the bottle is emptied will reduce medication errors. However, it is a priority to verify the medication orders first.
A client with terminal cancer is receiving large doses of opioids for pain control. He becomes agitated and continues trying to get out of bed but can't stand without the assistance of two people. To reduce the client's risk of falling, which type of restraint should the nurse request for this client? Leg restraints Mechanical restraints Chemical restraints Jacket restraint
Chemical restraints Explanation: Antianxiety medication can be used to calm the client. Chemical restraints are effective, especially with highly agitated clients receiving large doses of opioids. Other forms of restraint will increase the client's agitation and hostility, thus increasing the risk of injury.
Which assessment findings demonstrate an effective outcome of levodopa-carbidopa medication therapy for a client with Parkinson's disease? Select all that apply. Reduced rigidity and tremor Less frequent "freezing" Decreased dyskinesia Reduction in short-term memory Improved visual acuity
Decreased dyskinesia Reduced rigidity and tremor levodopa-carbidopa will increase the amount of dopamine in the central nervous system, allowing for more smooth and purposeful movements. The drug doesn't affect visual acuity, and should improve dyskinesia and short-term memory. It does not affect "freezing" or problems with autonomic functions, such as constipation, urinary problems, impotence, or pain.
The nurse is teaching the family of a client with a psychiatric disorder about traditional antipsychotic drugs and their effect on symptoms. Which symptom would be most responsive to these types of drugs? Apathy Delusions Social withdrawal Attention impairment
Delusions Explanation: Positive symptoms, such as delusions, hallucinations, thought disorder, and disorganized speech, respond to traditional antipsychotic drugs. The other options belong in a category of negative symptoms, including affective flattening, restricted thought and speech, apathy, anhedonia, asociality, and attention impairment. Negative symptoms are more responsive to the new atypical antipsychotics, such as clozapine risperidone, and olanzapine
Which instruction should the nurse give to a client with prostatitis who is receiving double strength co-trimoxazole? Don't expect improvement of symptoms for 7 to 10 days Drink six to eight glasses of fluid daily while taking this medication If a sore mouth or throat develops, take the medication with milk or an antacid Use a sunscreen of at least SPF-15 with para-aminobenzoic acid (PABA)
Drink six to eight glasses of fluid daily while taking this medication Explanation: Six to eight glasses of fluid daily are needed to prevent renal problems, such as crystalluria and stone formation. The symptoms should improve in a few days if the drug is effective. Sore throat and sore mouth are adverse effects that should be reported right away. The drug causes photosensitivity, but a PABA-free sunscreen should be used because PABA can interfere with the drug's action
Which instruction should the nurse give to a client with prostatitis who is receiving double strength co-trimoxazole? Drink six to eight glasses of fluid daily while taking this medication Use a sunscreen of at least SPF-15 with para-aminobenzoic acid (PABA) If a sore mouth or throat develops, take the medication with milk or an antacid Don't expect improvement of symptoms for 7 to 10 days
Drink six to eight glasses of fluid daily while taking this medication Explanation: Six to eight glasses of fluid daily are needed to prevent renal problems, such as crystalluria and stone formation. The symptoms should improve in a few days if the drug is effective. Sore throat and sore mouth are adverse effects that should be reported right away. The drug causes photosensitivity, but a PABA-free sunscreen should be used because PABA can interfere with the drug's action.
A client with sickle cell disease is discussing his therapeutic regimen. Which statement by the client indicates further teaching is needed? "I should drink 4 to 6 L of fluid each day." "Cigarette smoking can cause a sickle cell crisis." "I should avoid vacationing or traveling in areas of high altitude." "I should take one baby aspirin daily to help prevent sickle cell crisis."
I should take one baby aspirin daily to help prevent sickle cell crisis." Explanation: Aspirin inhibits platelet aggregation and won't help prevent sickle cell crisis. Hydroxyurea is prescribed for some people to help prevent sickle cell crisis. High altitude increases oxygen demand and therefore can also precipitate a crisis. Tobacco, alcohol, and dehydration can precipitate a sickle cell crisis and should be avoided.
A nurse is providing instruction to a 38-year-old male client undergoing treatment for anxiety and insomnia. The practitioner has prescribed lorazepam 1 mg/po/tid. The nurse determines that teaching has been effective when the client states: "I must eat enough salt." "I can drink red wine." "I'll avoid sunlight." "I'll avoid coffee."
I'll avoid coffee." Explanation: Lorazepam is a benzodiazepine used to treat various forms of anxiety and insomnia. Caffeine is contraindicated because it is a stimulant and increases anxiety. A client taking lorazepam should avoid alcoholic beverages. Clients taking certain antipsychotic medications should avoid sunlight. Salt intake has no effect on lorazepam.
A client with a large cerebral intracranial hemorrhage was given mannitol to decrease intracranial pressure (ICP). What therapeutic effect should the nurse anticipate from mannitol? Evidence of rebound cerebral hypertension Increased urine output Normal blood urea nitrogen (BUN) and creatinine levels Pupils that are bilaterally 7 mm and nonreactive
Increased urine output Explanation: Mannitol promotes osmotic diuresis by increasing the pressure gradient in the renal tubules, thus increasing urine output. Fixed and dilated pupils are symptoms of increased ICP or cranial nerve damage, seen in herniation associated with a deteriorating cerebellar hemorrhage. No information is given about abnormal BUN and creatinine levels, or that mannitol is being given for renal dysfunction. Rebound cerebral hypertension is an adverse and undesired complication from ongoing mannitol use.
The nurse is providing discharge instructions for a client who is receiving chemotherapeutic medications. Which intervention is most important to prevent hemorrhagic cystitis? Increasing fluid intake Administering antacids Increasing calcium intake Administering antibiotics
Increasing fluid intake Explanation: Sterile hemorrhagic cystitis is an adverse effect of chemical irritation of the bladder from cyclophosphamide. It can be prevented by liberal fluid intake (at least one-and-a-half times the recommended daily fluid requirement). Antibiotics do not aid in the prevention of sterile hemorrhagic cystitis. Increasing calcium intake does not alter the risk of developing cystitis. Antacids would not be indicated for treatment.
A team of nurses is preparing a trauma room for the arrival of a child with partial-thickness burns to both lower extremities and portions of the trunk. Which intravenous fluid should the nurse be prepared to administer to this client? Dextrose 5% and half-normal saline Albumin Lactated Ringer's solution Normal saline with 2 mEq KCl/100 ml
Lactated Ringer's solution
Which antiparkinsonian drug can cause drug tolerance or toxicity if taken for too long? Levodopa-carbidopa Pergolide Amantadine Selegiline
Levodopa-carbidopa Explanation: Long-term therapy with levodopa-carbidopa can result in drug tolerance or toxicity manifested by confusion, hallucinations, or decreased drug effectiveness. The other drugs listed don't require the client to take a drug holiday.
A client with type 1 diabetes mellitus often skips his ordered dose of insulin. What priority information should the nurse give to this client regarding the omission of insulin doses? May lead to ketoacidosis May cause hypoglycemic coma May lead to pancreatitis May cause diabetes insipidus
May lead to ketoacidosis Explanation: A client who fails to regularly take insulin is at risk for hyperglycemia, which could lead to diabetic ketoacidosis. Hypoglycemia would not occur because the lack of insulin would lead to increased levels of sugar in the blood. A client with chronic pancreatitis may develop diabetes, but insulin-dependent diabetes mellitus does not lead to pancreatitis. Diabetes insipidus isn't caused by alteration in insulin levels.
a client with joint pain, tenderness and swelling has been admitted to the hospital. A disease modifying anti-rheumatic drug (DMARD) is prescribed by the health care provider. Which medication should the nurse expect to administer? Aspirin Methotrexate Ferrous sulfate Prednisone
Methotrexate Explanation: Methotrexate is considered a first-line DMARD for most clients with rheumatoid arthritis (RA). NSAIDs, such as aspirin, cannot be tolerated. Ferrous sulfate is not used to treat RA. Prednisone may be used to control inflammation when NSAIDs cannot be used.
What is the nurse's priority action when administering phenytoin to a client intravenously? Administer rapidly Withhold other anticonvulsants Mix phenytoin with saline solution only Use only dextrose solution when flushing the IV catheter
Mix phenytoin with saline solution only Explanation: Phenytoin is only compatible with saline solutions. Dextrose will cause an insoluble precipitate to form. Phenytoin should be administered at a rate of less than 50 mg/min. There is no need to withhold additional anticonvulsants.
What is the most important information for the nurse to include when teaching a client about metronidazol? Mixing this drug with alcohol causes severe nausea and vomiting. Urine may develop a greenish tinge while the client is taking this drug. Heart palpitations may occur and should be immediately reported. Breathlessness and cough are common adverse effects. SUBMIT ANSWER
Mixing this drug with alcohol causes severe nausea and vomiting. Explanation: When mixed with alcohol, metronidazole causes a disulfiram-like effect involving nausea, vomiting, and other unpleasant symptoms. Urine may turn reddish brown, not greenish, from the drug. Cardiovascular or respiratory effects are not associated with this drug.
The nurse makes initial rounds for his clients. Five medication are scheduled for administration at the same time to five different clients. Which medication should the nurse administer first after initial rounds?
Morphine sulfate to a client with a myocardial infarction reporting chest pain Explanation: Morphine sulfate relieves pain which immediately decreases myocardial oxygen demand and decreases preload and afterload pressure. The digoxin is a maintenance dose and does not elicit an immediate reaction. Though administration of naproxen and ondansetron are next in the order urgency, they are not the priority.
A client reports pain one day after a colostomy. The nurse administers four milligrams morphine IV, and reassesses the client 30 minutes later. The following is noted: Respiratory rate at 8 breaths/min. Nasal cannula on floor. Arterial blood gas (ABG) results are: pH, 7.23; PaO2, 58 mmHg; PaCO2, 61 mmHg; HCO3 24 mEq/l. Which factors most likely contribute to this client's ABG results? Colostomy, pain, and morphine Morphine, respiratory rate of 8 breaths/min, and the nasal cannula on the floor Morphine, the nasal cannula on the floor, and the colostomy Pain, respiratory rate of 8 breaths/min, and the nasal cannula on the floor SUBMIT ANSWER
Morphine, respiratory rate of 8 breaths/min, and the nasal cannula on the floor Explanation: This client has respiratory acidosis. Opioids can suppress respirations, causing retention of carbon dioxide. A PaO2 of 58 mmHg indicates hypoxemia caused by the removal of the client's supplementary oxygen and decreased respiratory rate. Pain increases the rate of respirations, which causes a decrease in PaCO2. Colostomy drainage doesn't start until 2 to 3 days postoperatively, and this drainage would contribute to metabolic alkalosis.
The nurse is caring for a newborn with unrepaired transposition of the great vessels. Which medication should the nurse anticipate giving first for treatment of this defect? Digoxin Furosemide Enalapril Prostaglandin E1
Prostaglandin E1 Explanation: Prostaglandin E1 is necessary to maintain patency of the patent ductus arteriosus, and improve systemic arterial flow in children with inadequate intracardiac mixing. Digoxin, furosemide, and enalapril will treat heart failure when present.
The nurse is performing discharge teaching for a school-aged child who experienced an asthma attack. What is the most important information the nurse can provide this client about the prescription for budesonide? Use the medication before using a bronchodilator. This medication is used for acute asthma attacks. There is no need to use a spacer when taking this medication. Rinse the mouth after using this medication.
Rinse the mouth after using this medication. Explanation: Oral candidiasis or thrush (a fungal infection of the throat) may occur in 1 in 25 persons who use budesonide without a spacer device on the inhaler. The risk is even higher with large doses, but is less in children than in adults. The child should be instructed to rinse the mouth after use and parents should be instructed to monitor the child's mouth for this. The medication should be given after using a bronchodilator to ensure maximum effectiveness. Corticosteroids should not be used for acute asthma attacks.
The nurse is instructing a client who will be discharged on anticoagulant therapy. What is the most important instruction for this nurse to include? Do not shave with an electric razor Take ibuprofen or aspirin for pain Take the anticoagulant at the same time each day Eat green, leafy vegetables and salad daily SUBMIT ANSWER
Take the anticoagulant at the same time each day Explanation: It is important to take the anticoagulant at the same time each day to maintain an adequate blood level. An electric razor reduces the risk of cutting the skin. Avoid the use of standard razors. Avoid taking aspirin or ibuprofen because these drugs decrease clotting time. Eating a large amount of green, leafy vegetables that contain vitamin K will increase clotting time, thus requiring more anticoagulants.
A five-year-old child, diagnosed with cerebral palsy, has just been prescribed oral baclofen. Which assessment finding, by the nurse, would indicate effective drug therapy? The child no longer sleeps during the daytime. The child is exhibiting less spasticity. The child has less frequent seizures. The child is better able to concentrate on mental activities.
The child is exhibiting less spasticity. Explanation: Baclofen is a skeletal muscle relaxant that is effective in reducing overall spasticity. It is not an anti-seizure drug. Significant side effects of this drug are drowsiness and confusion, so this child would not be sleeping less, nor demonstrating a better ability to concentrate on mental activities.
The client tells the nurse that she frequently experiences nausea and vomiting after receiving radiation and chemotherapy. The nurse adapts the plan of care to include antiemetics. What is the most appropriate time for the administration of the medication? Thirty minutes before therapy begins When therapy is completed Immediately after nausea begins At the same time as therapy
Thirty minutes before therapy begins Explanation: Antiemetics are most beneficial if given before the onset of nausea and vomiting. To calculate the optimum time for administration, the first dose is given 30 minutes to one hour before nausea is expected, and then every two, four, or six hours for approximately 24 hours after chemotherapy. If the antiemetic was given with the medication, or after the medication, it could lose its maximum effectiveness when needed.
A mother asks why she can't use 2.5% hydrocortisone cream prescribed for eczema for longer than one week. What is the nurse's best response? The drug loses its efficacy after prolonged use. This reduces adverse effects, such as skin atrophy and fragility. If no improvement is seen, a stronger concentration will be prescribed. If no improvement is seen after one week, an antibiotic will be prescribed.
This reduces adverse effects, such as skin atrophy and fragility. Explanation: Hydrocortisone cream should be used for brief periods to decrease adverse effects such as skin atrophy. The drug doesn't lose efficacy after prolonged use. A stronger concentration may not be prescribed if no improvement is seen, and an antibiotic would be inappropriate.
The nurse receives an order to administer morphine to a client with an acute myocardial infarction. What is the purpose of this medication? To decrease cardiac output To increase myocardial oxygen demand To increase preload and afterload To decrease myocardial oxygen demand SUBMIT ANSWER
To decrease myocardial oxygen demand Explanation: Morphine will calm and relax the client and decrease respiratory rate, anxiety, and stress, thus decreasing myocardial oxygen demand. It doesn't have any effect on cardiac output or preload or afterload.
The family of a client in rehabilitation following heroin withdrawal asks a nurse why the client is receiving naltrexone. What is the nurse's best response? To help reverse withdrawal symptoms To keep the client sedated during withdrawal To take the place of detoxification with methadone To decrease the client's memory of the withdrawal experience
To help reverse withdrawal symptoms Explanation: Naltrexone is an opioid antagonist and helps the client stay drug free. Keeping the client sedated during withdrawal isn't the reason for giving this drug. The drug doesn't decrease the client's memory of the withdrawal experience, and isn't used in place of detoxification with methadone.
The nurse is preparing to administer vasopressin to a client who has undergone a hypophysectomy. What is the purpose of the medication? To treat growth failure To prevent syndrome of inappropriate antidiuretic hormone (SIADH) To reduce cerebral edema and lower intracranial pressure To replace antidiuretic hormone (ADH) normally secreted from the pituitary
To replace antidiuretic hormone (ADH) normally secreted from the pituitary Explanation: After hypophysectomy, or removal of the pituitary gland, the body can't synthesize ADH; therefore, vasopressin is administered. Somatropin or growth hormone is used to treat growth failure. SIADH results from excessive ADH secretion. Vasopressin is not used to treat cerebral edema.
How should the nurse proceed when instilling neomycin and polymyxin B sulfates and hydrocortisone optic suspension, two drops in the right ear? Position the client in the semi-Fowler's position Verify the proper client and route Warm the solution to prevent dizziness Hold an emesis basin under the client's ear
Verify the proper client and route Explanation: When giving medications, a nurse should follow the five "Rs" of medication administration: right client, right drug, right dose, right route, and right time. The drops may be warmed to prevent pain or dizziness, but this action isn't essential. An emesis basin would be used for irrigation of the ear. The client should be placed in the lateral position for five minutes, not semi-Fowler's position, to prevent the drops from draining.
Which physical assessment data would alert the nurse to a possible mild toxic reaction in a client receiving lithium? Vomiting and diarrhea Hypotension Seizures Increased appetite
Vomiting and diarrhea Explanation: Vomiting and diarrhea are signs of mild to moderate lithium toxicity. Hypotension and seizures occur with moderate to severe toxic reactions. Anorexia occurs with mild toxic reactions.
Which oral medication would the nurse anticipate being prescribed to prevent further thrombus formation? Warfarin Heparin Furosemide Metoprolol
Warfarin Explanation: Warfarin prevents vitamin K from synthesizing certain clotting factors. This oral anticoagulant can be given long term. Heparin is a parenteral anticoagulant that interferes with coagulation by readily combining with antithrombin. It cannot be administered orally. Neither furosemide nor metoprolol affects anticoagulation.
Five days after running out of medication, a client taking clonazepam tells the nurse, "I know I shouldn't have just stopped the drug like that, but I'm OK." What is the nurse's most appropriate response? "You have handled your anxiety, and now you know how to cope with stress." "You could go through withdrawal symptoms for up to two weeks." "If you're fine now, chances are you won't experience withdrawal symptoms." "Let's monitor you for problems, in case something else happens."
You could go through withdrawal symptoms for up to two weeks." Explanation: Withdrawal symptoms can appear after one or two weeks because the benzodiazepine has a long half-life. Looking for another problem unrelated to withdrawal isn't the nurse's best strategy. The act of discontinuing an antianxiety medication doesn't indicate that a client has learned to cope with stress. Every client taking medication needs to be monitored for withdrawal symptoms when the medication is abruptly stopped.
The nurse has provided teaching for a client who will be taking lorazepam upon discharge. The nurse determines that teaching was effective when the client states the need to avoid: coffee. shellfish. cheese. alcohol.
alcohol. Explanation: Alcohol should be avoided because of the added depressive effects. Ingestion of shellfish, coffee, and cheese is not problematic.
A child with diabetes insipidus will be receiving injectable vasopressin when discharged from the hospital. What is the most important step when teaching injection techniques? Teach injection techniques to the primary caregiver Teach injection techniques to anyone who will provide care for the child Provide information about the nearest home health agency so the parents can arrange for the home health nurse to give the injection Teach injection techniques to anyone who will provide care for the child as well as to the child if he's old enough to understand
each injection techniques to anyone who will provide care for the child as well as to the child if he's old enough to understand Explanation: The most important step is to teach all those who provide care for the child. The child should be included if age-appropriate. It's unrealistic to arrange for a home health nurse to give injections that are required throughout the child's life.
A definitive diagnosis of pulmonary embolism has been made for a client. Which medication would the nurse anticipate for this client? Streptokinase Heparin Acyclovir Warfarin
heparin
A child with diabetic ketoacidosis is being treated for a blood glucose level of 738 mg/dl (41.0 mmol/L). The nurse should anticipate an order for: normal saline with regular insulin. normal saline with ultralente insulin. 5% dextrose in water with NPH insulin. 5% dextrose in water with PZI insulin.
normal saline with regular insulin. Explanation: Short-acting regular insulin is the only insulin used for insulin infusions. Initially, normal saline is used until blood glucose levels are reduced, then a dextrose solution may be used to prevent hypoglycemia. Ultralente, NPH, and PZI insulins have a longer duration of action and shouldn't be used for continuous infusions.
The nurse is providing education to a client diagnosed with hyperparathyroidism. The nurse determines further teaching is necessary when the client states that they will continue to take: acetaminophen. aspirin. potassium-wasting diuretics. thiazide diuretics.
thiazide diuretics. Explanation: Thiazide diuretics shouldn't be taken by a client with hyperparathyroidism as they decrease renal excretion of calcium, and increase serum calcium levels. There are no contraindications to acetaminophen or aspirin for clients with hyperparathyroidism. Potassium loss is not a concern for clients with hyperparathyroidism.