N664 - Exam 2 - Resp, GU, Neuro

A woman has chlamydial cervicitis. What will the nurse typically find upon assessment? A. Yellow mucopurulent discharge B. Buboes C. Thin, gray malodorous discharge D. Abnormal menses (increased flow or dysmenorrhea)

Answer A. RATIONALE: A. Yellow mucopurulent discharge. Women with chlamydial cervicitis may be asymptomatic or may have a yellow mucopurulent discharge from the cervical os. B Other signs of primary lymphogranuloma venereum include a large, tender lymphatic nodule or bubo, urethritis, and cervicitis. C. Bacterial vaginosis is characterized by a thin, gray, homogeneous, and malodorous discharge that adheres to the vaginal walls but is often copious enough to drain into the vulva. D. Symptoms of gonorrhea can include dysuria, increased vaginal discharge, abnormal menses (increased flow or dysmenorrhea), dyspareunia, lower abdominal/pelvic pain, and fever.

A client diagnosed with prostatic carcinoma is admitted for staging of the disease. What finding is associated with advanced disease? A. Enlarged prostate palpable on digital rectal examination. B. Malignant cells in trans-rectal needle core biopsy. C. Hesitancy and dribbling when urinating. D. Prostate specific antigen (PSA) >10 ng/mL.

Answer C: Prostate carcinoma typically develops in the posterior lobe of the prostate, far away from the urethra. (Note that benign prostatic hyperplasia develops in the prostatic tissue directly surrounding the urethra.) It is clinically silent and does not produce any urinary symptoms until the disease has advanced significantly. Hesistancy and dribbling when urinating suggest that the prostatic carcinoma has reached the periurethral area. Choice A, B and D are all findings that are consistent with the diagnosis of prostate carcinoma. They are present early in the disease process and do not indicate advanced disease.

The nurse is administering an injection of erythropoietin (Procrit) to a client with chronic renal failure. This medication aids in the prevention of which health problems? A. Hypertension B. Hypercalcemia C. Hyperphosphatemia D. Anemia

Answer D Rationale: Erythropoietin is produced by the kidneys and is needed to form red blood cells. In chronic renal failure, this hormone will not be produced. This can cause the client to develop anemia. Choices A, B, and C are incorrect because erythropoietin does not help hypertension, hypercalcemia, or hyperphosphatemia.

The nurse suspects that a client is developing renal failure. What symptom does the nurse realize is least likely associated with this disorder? A. Metabolic acidosis B. Hyperkalemia C. Hypertension D. Hypophosphatemia

Answer D Rationale: In healthy individuals, phosphate is excreted by the kidneys. Renal failure will lead to increased serum phosphate levels due to decreased excretion. Choices A, B and C are all symptoms of renal failure. The kidney plays an important role in acid-base balance. They reabsorb bicarbonate (HCO3-, base) and secrete hydrogen ions (H+, acid). Renal failure will decrease HCO3- reabsorption and H+ secretion, resulting in metabolic acidosis (A). The kidneys secrete potassium. Renal failure causes increased serum potassium levels or hyperkalemia (B). Renal failure causes water and sodium retention, which leads to hypertension (C).

When the nurse is teaching the staff about X-linked recessive disorders, which information should the nurse include? SATA (select all that apply) A. The trait is seen much more often in females than in males. B. The trait is never transmitted from father to son. C. The gene can be transmitted through a series of carrier females. D. The gene is passed from an affected father to all his daughters. E. The trait never skips generations.

Answer: B. The trait is never transmitted from father to son. C. The gene can be transmitted through a series of carrier females. D. The gene is passed from an affected father to all his daughters. Note: The trait can skip generations if the generation is ALL females who will be carriers only "NOT affected".

Which client should the nurse question when administering the muscarinic antagonists benztropine (Cogentin) and atropine? 1.The 69-year-old client diagnosed with glaucoma and benign prostate hypertrophy. 2.The 60-year-old client diagnosed with symptomatic sinus bradycardia. 3.The 55-year-old client being prepped for an abdominal surgery. 4.The 28-year-old client with severe diarrhea.

Answer: 1 Rationale: 1. Atropine is contraindicated in a client with glaucoma because atropine causes mydriasis and paralysis of the ciliary muscle, which would increase intraocular pressure and may cause blindness. 2.Atropine is the medication of choice for the client with lightheadedness and dizziness from sinus bradycardia manifested by low apical pulse rate; therefore, the nurse would not question administering this medication. 3.Preoperative treatment with atropine can prevent a dangerous reduction in heart rate, and it dries secretions, which is needed during surgery. The nurse should not question administering this medication. 4.By blocking the muscarinic receptors in the intestine, atropine can decrease both the tone and motility of intestinal smooth muscle, which will decrease episodes of diarrhea.

Which information should the nurse include in the teaching plan for the mother of a child diagnosed with cystic fibrosis (CF)? Select all that apply. 1. Perform postural drainage and percussion every four (4) hours. 2. Modify activities to accommodate daily physiotherapy. 3. Increase fluid intake to one (1) liter daily to thin secretions. 4. Recognize and report signs and symptoms of respiratory infections. 5. Avoid anyone suspected of having an upper respiratory infection.

Answer: 1. Perform postural drainage and percussion every four (4) hours. 2. Modify activities to accommodate daily physiotherapy. 4. Recognize and report signs and symptoms of respiratory infections. 5. Avoid anyone suspected of having an upper respiratory infection. Rationale: 1. Clients and family members should be taught chest physiotherapy, including postural drainage, chest percussion, and vibration and breathing techniques to keep the lungs clear of the copious secretions. 2. Daily activities should be modified to accommodate the client's treatments. 3. Clients should increase fluids up to 3,000 mL each day to thin secretions and ease expectoration. 4. Clients should be taught the signs and symptoms of infections to report to the health-care provider. 5. Clients with CF are susceptible to respiratory infections and should avoid anyone who is suspected of having an infection.

Which clinical manifestation indicates to the nurse the child has cystic fibrosis? 1. Wheezing with a productive cough. 2. Excessive salty sweat secretions. 3. Multiple vitamin deficiencies. 4. Clubbing of all fingers.

Answer: 2. Excessive salty sweat secretions. Rationale: 1. Wheezing and productive coughs are symptoms experienced by clients with respiratory diseases, but they are not specific to cystic fibrosis. 2. The excessive excretion of salt from the sweat glands is specific to cystic fibrosis. Repeated values greater than 60 mEq/L of sweat chloride is diagnostic for CF. 3. Multiple vitamin deficiencies are experienced with some pulmonary diseases, but they are not specific to cystic fibrosis. 4. Clubbing of the fingers is an indicator of chronic hypoxia, but it is not specific to the diagnosis of cystic fibrosis.

A man who was recently diagnosed with Huntington's disease asks the nurse if his adolescent son should be tested for the disease. What response is best for the nurse to provide? A.Autosomal dominant disorders, such as Huntington's, cannot be inherited from the parent. B.Testing is needed because there is a 50 percent risk of passing the gene to each offspring. C.Genetic counseling should be provided to ensure an informed decision by the family. D.Positive genetic testing may contribute to insurance discrimination that denies coverage.

Answer: B.Testing is needed because there is a 50 percent risk of passing the gene to each offspring. Rationale: Huntington's disease, a progressively incapacitating, fatal neuromuscular disease, is an autosomal dominant inherited disease that has a 50% risk of developing in each child of those who have the disorder. The risk of autosomal dominant inheritance should be explained and emphasized (B). (A) is inaccurate. Although the basic tenet of genetic counseling is to provide families with facts to assist them in making informed decisions (C), the basic laws of inheritance should be explained to direct the client to counseling. (D) provides information that does not address the client's question, and might be considered judgmental.

The client is prescribed sumatriptan (Imitrex), 6 mg subcutaneously, for a migraine headache. The medication comes 12 mg/mL. How many milliliters should the nurse administer?

Answer: 0.5 mL Rationale: 0.5 mL. To set this problem up algebraically, the first step is: 6 : X = 12 : 1 (or 6/X =12/1). Then cross-multiply 12 X = 6 to get: The next step is X = 6/12 to get the X by itself: Simplify: X = 1/2 or 0.5 mL

The father of a 23-month-old female child with acute otitis media calls the clinic and tells the nurse his daughter is crying and pulling at her ears. Which action should the nurse implement? 1. Instruct the father to give acetaminophen elixir as prescribed on the bottle. 2. Determine when the father gave the last dose of prescribed antibiotic. 3. Tell the father to administer two chewable baby aspirins every 6 hours. 4. Encourage the father to hold the child and rock her until she falls asleep.

Answer: 1 Rationale: 1. Acetaminophen (Tylenol) is the drug of choice to help relieve discomfort in children. 2. Determining the last dose of antibiotic will not help relieve the child's pain. 3. Aspirin should not be given to children because of the possibility of their developing Reye's syndrome. 4. This is a good action to take, but the child needs medication to help ease pain.

The nurse on a medical unit is administering 0900 medications. Which medication should the nurse question administering? 1. Acetylcysteine (Mucomyst), a mucolytic, to a client who is coughing forcefully. 2. Cefazolin (Ancef), an antibiotic, IVPB to a client diagnosed with the flu. 3. Diphenhydramine (Benadryl), an antihistamine, to a client who is congested. 4. Dextromethorphan (Robitussin), an antitussive, to a client who has pneumonia.

Answer: 1 Rationale: 1. An adverse effect of Mucomyst is bronchospasm. This client should be assessed for bronchospasm before administering a dose of Mucomyst. 2. Antibiotics are frequently administered to clients with viral infections to prevent secondary bacterial infections. This client is considered at risk or the client would not be in a hospital receiving care. There Is no reason to question this medication. 3. Antihistamines are prescribed for congestion; there is no reason to question this medication. 4. A symptom of pneumonia is a cough. There is no reason to question this medication.

The client diagnosed with Meniere's disease, also known as endolymphatic hydrops, is prescribed meclizine (Antivert), an anti-vertigo medication. Which statement best describes the scientific rationale for this medication? 1. It will help decrease the whirling sensation experienced in Meniere's disease. 2. It will help prevent an acute episode of nausea and vomiting. 3. It will help maintain a lower labyrinthine pressure in the ears. 4. It will help the ear canal vasoconstrict, reducing the pressure in the ears.

Answer: 1 Rationale: 1. Antivert helps prevent dizziness and the whirling sensation characteristic of Meniere's disease. 2. An antiemetic medication, not Antivert, would be prescribed to help prevent nausea and vomiting. 3. An oral diuretic, not Antivert, is prescribed for clients with Meniere's disease to help maintain a lower labyrinthine pressure. 4. Vasoconstriction should be avoided in clients with Meniere's disease because it may precipitate an attack. Tobacco products, alcohol, and caffeine should be avoided because they cause vasoconstriction.

The client diagnosed with adult respiratory distress syndrome (ARDS) has been found to have a disease-causing organism resistant to the antibiotics being given. Which intervention should the nurse implement? 1. Monitor for therapeutic blood levels of the aminoglycoside antibiotic prescribed. 2. Prepare to administer the glucocorticoid medication ordered intramuscularly. 3. Obtain an order for repeat cultures to confirm the identity of the resistant organism. 4. Place the client on airborne isolation precautions.

Answer: 1 Rationale: 1. Currently the medications used to treat resistant bacteria are the aminoglycoside antibiotics. Vancomycin is the drug of choice, but gentamycin may also be used. These medications can be toxic to the auditory nerve and to the kidneys. The therapeutic range is 10-20 mg/dL. The nurse should monitor the blood levels. 2. If ordered, the steroid would be given intravenously, not intramuscularly. 3. The culture does not need to be repeated; this would add unnecessary expense to the client. 4. The client should be placed on contact and possibly droplet precautions. Airborne Isolation is required for tuberculosis.

The client with glaucoma is prescribed epinephrine (Epitrate), mydriatic ophthalmic drops. Which statement indicates the client understands the client teaching? 1. "I will call my health-care provider if I start experiencing any eye pain." 2. "This medication does not interfere with any over-the-counter medication." 3. "I will probably experience anxiety, nervousness, and muscle tremors." 4. "After putting the medication in my eyes I must lie down for 1 hour."

Answer: 1 Rationale: 1. Eye pain may indicate an attack of angle-closure glaucoma and must be reported to the HCP immediately. 2. The client should avoid using any over-the-counter sinus and cold medications containing pseudoephedrine and phenylephrine, which may accentuate the side effects of epinephrine. 3. If the client experiences any central nervous system side effects, such as anxiety, nervous-ness, or muscle tremors, the client should notify the HCP. Depending on the severity of the side effects, the HCP may or may not discontinue the medication. 4. There is no reason the client must lie down for 1 hour after administering this medication.

Which information should the nurse teach the client who is prescribed a glucocorticoid inhaler? 1. Advise the client to gargle after each administration. 2. Instruct the client to use the inhaler on a PRN basis. 3. Encourage the client not to use a spacer when using the inhaler. 4. Teach the client to check his or her forced expiratory volume daily.

Answer: 1 Rationale: 1. Gargling after each administration will help decrease the development of oropharyngeal yeast infections. 2. Glucocorticoids are intended for preventive therapy, not for aborting an ongoing asthma attack, and they should not be taken on a PRN basis. 3. A spacer, a device that attaches directly to the metered-dose inhaler, should be used because a spacer increases the delivery of the drug to the lungs and decreases deposition of the drug on the oropharyngeal mucosa. 4. Forced expiratory volume is the single most useful test of lung function, but the instrument required is a spirometer, which is expensive, cumbersome, and not suited for home use.

The nurse is administering ophthalmic medication to the client. To which area should the nurse instruct the client to apply pressure for 1-2 minutes after instilling the medication? 1. A 2. B 3. C 4. D

Answer: 1 Rationale: 1. Gentle pressure should be applied to the inner canthus (lacrimal sac) for 1- 2 minutes to increase the local effect and decrease systemic absorption. 2. Gentle pressure to the eyelid is not helpful when instilling ophthalmic medication. 3. Gentle pressure to the lower conjunctival sac is not helpful when instilling ophthalmic medication. 4. Gentle pressure to the outer canthus is not helpful when instilling ophthalmic medication

The client diagnosed with the flu is prescribed the cough medication hydrocodone. Which information should the nurse teach the client regarding this medication? 1. Teach the client to monitor the bowel movements for constipation. 2. Driving or operating machinery is all right while taking this medication. 3. This medication usually causes insomnia, so plan for rest periods. 4. This medication is more effective when taken with a mucolytic.

Answer: 1 Rationale: 1. Hydrocodone is an opioid and can slow the peristalsis of the bowel, resulting in constipation. The client should be aware of this and increase the fluid intake and use bulk laxatives and stool softeners, if needed. 2. Opioids can cause drowsiness, so driving or operating machinery should be discouraged. 3. Opioids usually cause the client to be drowsy, not have insomnia. 4. Hydrocodone is a cough suppressant and a mucolytic is an expectorant. These are opposite-acting medications.

The client with the flu has been taking acetylcysteine (Mucomyst), a mucolytic. Which adverse effect should the nurse assess for? 1. Bronchospasm. 2. Nausea. 3. Fever. 4. Drowsiness.

Answer: 1 Rationale: 1. Mucomyst can cause bronchospasm, which will impair the client's breathing, not improve it. An adverse reaction is a reason to immediately discontinue the medication. 2. Nausea is a side effect of many medications and can usually be managed by taking the medication with food. A side effect is not an adverse effect. 3. Fever would result from the cold, flu, or infection, not from the medication. 4. Drowsiness is caused by some cold and flu preparations, usually the antihistamines. Mucomyst causes the client to expectorate secretions, which will keep the client awake.

The child with cystic fibrosis is taking high-dose intravenous antibiotic therapy, cephalosporin (Ancef), and is getting progressively worse. Which medication should the intensive care nurse anticipate being added to the medication regimen? 1. An intravenous corticosteroid. 2. An intravenous aminoglycoside antibiotic. 3. An oral proton-pump inhibitor. 4. An oral mucolytic agent.

Answer: 1 Rationale: 1. Steroids are sometimes prescribed when pulmonary symptoms are unresponsive to antibiotics because corticosteroids decrease inflammation in the lungs. 2. The child should have cultures and sensitivities to determine resistance and sensitivity to an antibiotic. Changing an antibiotic depends on C&S results. Based on the information provided, there is no need to change antibiotics. 3. A proton-pump inhibitor decreases gastric secretions, but it is not indicated to improve pulmonary symptoms. 4. The client will be receiving inhaled mucolytic therapy in the intensive care unit.There is no reason to add an oral agent.

The health-care provider has ordered theophylline 3 mg/kg/q 6 hours for a child who weighs 20 lb. How much medication would the nurse administer to the child in a 24-hour time period?

Answer: 108 mg/24 hours Rationale: 108 mg/24 hours.First, determine the child's weight in kilograms: 20 lb ÷ 2.2 kg =9.09 kg. Then, determine how many milligrams should be given with each dose:9.09 kg ×3 mg = 27.27 mg. Because it is below 0.5, the nurse should round down to 27. Because the dose is to be given every 6 hours, the child will be receiving 4 doses in 24-hour time period: 27 mg times 4 equals to 108 mg/per 24 hours.

The client diagnosed with a massive pulmonary embolus is ordered the thrombolytic streptokinase. The nurse notes on the medication administration record that the client is allergic to the "-mycin" medications, including streptomycin. Which intervention should the nurse implement? 1. Call the HCP to report the allergy. 2. Administer the medication as ordered. 3. Call the pharmacist to substitute medication. 4. Check the bleeding-time laboratory values.

Answer: 1 Rationale: 1. Streptokinase is a foreign protein extracted from the cultures of streptococci bacteria, and streptomycin is derived from Streptomyces. As a result, this could possibly cause the client to have an allergic reaction. The nurse should discuss this allergy with the HCP. 2. The nurse should not administer this medication until determining if the client is at risk for an allergic reaction. 3. The pharmacist is not licensed to change an HCP order. 4. Bleeding times could be assessed after it is determined that the streptokinase will not cause the client to have an allergic reaction.

Which assessment data indicates the client with reactive airway disease has "good" control with the medication regimen? 1. The client's peak expiratory flow rate (PEFR) is greater than 80% of his or her personal best. 2. The client's lung sounds are clear bilaterally, both anterior and posterior. 3. The client has only had three acute exacerbations of asthma in the last month. 4. The client's monthly serum theophylline level is 18 g/mL. 5. The client is taking the medication as directed by the health-care provider.

Answer: 1 Rationale: 1. The PEFR is defined as the maximal rate of airflow during expiration in a relatively inexpensive, handheld device. If the peak flow is less than 80% of personal best, more frequent monitoring should be done. The PEFR should be measured every morning. 2. A normal respiratory assessment does not indicate that the medication regimen is effective and has "good" control. 3. Three asthma attacks in the last month would not indicate the client has "good" control of the reactive airway disease. 4. A serum theophylline level between 10 and 20 fig/mL indicates the medication is within the therapeutic range, but it is not the best indicator of the client's control of the signs or symptoms. 5. Taking the medication as directed is appropriate for the client but it does not indicate the medication regimen is effective.

The client with renal calculi was prescribed allopurinol (Zyloprim) for uric acid stone calculi. Which medication teaching should the nurse discuss with the client? 1. Inform the client to report chills, fever, and muscle aches to the HCP. 2.Instruct the client to avoid driving or other activities that require alertness. 3.Tell the client that the medication must be taken on an empty stomach. 4.Explain the importance of not eating breads, cereals, and fruits.

Answer: 1 Rationale: 1. The client should notify the HCP if a skin rash or influenza symptoms(chills, fever, muscle aches and pain, nausea or vomiting) develop because these signs and symptoms may indicate hypersensitivity. 2.Allopurinol does not cause drowsiness, so the nurse does not need to tell the client to avoid activities that require alertness. 3.Allopurinol may be administered with milkor meals to minimize gastric irritation. 4. The client with uric acid should be eating a low-purine diet. A low-purine diet includes breads, cereals, cream-style soups made with low-fat milk, fruits, juices, low-fat cheeses, nuts, peanut butter, coffee, and tea.

The client with reactive airway disease is taking the oral sympathomimetic bronchodilator metaproterenol (Alupent) three times a day. Which intervention should the nurse implement? 1. Instruct the client to take the last dose a few hours before bedtime. 2. Teach the client to decrease the fluid intake when taking this medication. 3. Have the client demonstrate the correct way to use the inhaler. 4. Encourage the client to take the medication with an antacid.

Answer: 1 Rationale: 1. The client should take the last dose a few hours before bedtime so that the medication does not produce insomnia. 2. The client should increase fluid intake, especially water, because it will make the mucus thinner and help the medication work more effectively. 3. This medication is taken orally; therefore, there is no reason for the client to demonstrate the correct way to use an inhaler. 4. Antacids decrease the absorption of medication; therefore, the medication should not be taken with or within 2 hours of taking an antacid.

The client is having an acute exacerbation of asthma. The health-care provider has prescribed epinephrine (adrenaline) subcutaneously. Which intervention should the nurse implement when administering this medication? 1. Administer the medication using a tuberculin syringe. 2. Dilute the medication to a 5-mL bolus prior to administering. 3. Perform a complete respiratory assessment. 4. Monitor the client's serum epinephrine level.

Answer: 1 Rationale: 1. The medication is prescribed in very low doses of 0.2-1.0 mg for an adult. The dosage of a sympathomimetic must be carefully monitored to prevent tachycardia, decreased or increased blood pressure, nausea, headache, and other central nervous system symptoms. A tuberculin syringe should be used to help ensure accuracy of dosage administered. 2. The medication is being administered subcutaneously; therefore, the nurse will not dilute the medication. 3. The client is in distress with an acute exacerbation of asthma. Therefore, the nurse should not assess but should treat the client because delaying the medication may result in a respiratory arrest. 4. There is no such laboratory test as a serum epinephrine level.

The client diagnosed with moderate benign prostatic hypertrophy (BPH) is being treated with the alpha-adrenergic agonist tamsulosin (Flomax). Which intervention should the nurse implement? 1.Check the client's blood pressure. 2.Send a urinalysis to the laboratory. 3.Determine if the client has nocturia. 4.Plan a scheduled voiding pattern.

Answer: 1 Rationale: 1. The medications used to treat hyperplasia of the prostate were originally developed to treat high blood pressure. The client may develop hypotension when taking these medications. This Side effect makes them useful for clients who are also hypertensive. 2. The medication is not given for urinary tract infections; there is no need for a urinalysis to be done when administering this medication. 3. The client has symptoms of BPH, which could include nocturia, but this is not pertinent when administering the medication. 4. This is an intervention that assists clients who have incontinence, not BPH.

Which statement best indicates the scientific rationale for administering vitamin K (AquaMEPHYTON) to the newborn infant? 1.It promotes blood clotting in the infant. 2.It prevents conjunctivitis in the infant's eyes. 3.It stimulates peristalsis in the small intestines. 4.It helps the digestive process in the newborn.

Answer: 1 Rationale: 1. The newborn's gut is sterile and the liver cannot synthesize vitamin K from the food ingested until there are bacteria present in the gut. 2.Ophthalmic ointment is administered to prevent eye infections. 3.Routine medications administered to the newborn do not include medications to stimulate the small intestines. 4.Routine medications administered to the newborn do not include medications to stimulate the digestive process.

The 19-year-old client presents to the emergency department with trauma to the flank area resulting from a motor vehicle accident. The client's first urine specimen shows bright-red urine. Which intervention should the nurse implement first? 1.Initiate an 18-gauge angiocath with normal saline. 2.Send a sterile urine specimen to the laboratory. 3.Type and crossmatch for 2 units of blood. 4.Prepare the client for a CT scan of the abdomen.

Answer: 1 Rationale: 1. The nurse must first initiate steps to prevent the client from developing hypovolemic shock; therefore, the nurse should start a large-bore IV to infuse isotonic normal saline to maintain blood pressure. The nurse should anticipate the client receiving a blood transfusion, which supports the need for an 18-gauge catheter. 2.A urine specimen should be sent to the lab-oratory, but the client's safety and prevention of shock are the nurse's first priority. 3.Ordering blood is a priority but not a priority over caring for the client who maybe going into hypovolemic shock. 4.Determining the source of bleeding is important, but caring for the client is priority. MEDICATION MEMORY JOGGER: The nurse's first priority is always caring for the client, not a laboratory or diagnostic test.

The client who has undergone eye surgery is complaining of being nauseated. Which intervention should the PACU recovery room nurse implement? 1. Administer an intravenous antiemetic medication. 2. Determine if the client had anything to eat preoperatively. 3. Place a cold washcloth under the chin along the client's throat. 4. Put the client on the left side and insert a rectal antiemetic medication.

Answer: 1 Rationale: 1. The nurse must take action as soon as possible to prevent vomiting because vomiting will increase intraocular pressure. 2. Determining if the client had anything to eat preoperatively should have been done prior to the client having surgery. It is not pertinent information at this time. 3. A cold washcloth will not help prevent the client from vomiting. The client needs an antiemetic medication. 4. The client in the recovery room would have an intravenous route. The nurse should administer the antiemetic via the route that would decrease the nausea as fast as possible; that is the intravenous route.

The 3-year-old child with an eye infection has both an ophthalmic ointment and ophthalmic drops prescribed. Which action by the primary nurse warrants intervention by the charge nurse? 1. The primary nurse applies the ophthalmic ointment first. 2. The primary nurse instills the ophthalmic drops in the lower lid. 3. The primary nurse does not allow the dropper to touch the eye. 4. The primary nurse instills the ophthalmic drops first.

Answer: 1 Rationale: 1. The nurse should apply the drops first because if the drops are placed after the ointment, the ophthalmic drops will not be absorbed. This action would warrant intervention by the charge nurse. 2. This is the correct procedure to instill the ophthalmic drops; therefore, this intervention would not warrant intervention by the charge nurse. 3. This is the correct procedure; therefore, this intervention would not warrant intervention by the charge nurse. 4. The ophthalmic drops should be administered first because if the ointment is instilled first, the ophthalmic drops will not be absorbed. This action would not warrant intervention by the charge nurse.

The client diagnosed with glaucoma is prescribed oral acetazolamide (Diamox), a carbonic anhydrase inhibitor. Which information should the client discuss with the client? 1. Administer the medication in the morning. 2. Instill medication in the lower conjunctival sac. 3. Wash hands prior to administering medication. 4. Hold the eyes shut for 2 minutes after taking medication.

Answer: 1 Rationale: 1. The oral medication Diamox has a diuretic effect. Therefore, it should be taken in the morning to prevent sleep deprivation because of the need to get up to urinate during the night. 2. This is an oral medication that is used as adjunctive therapy for clients diagnosed with glaucoma. It is not instilled into the eye. 3. This is an oral medication that is used as adjunctive therapy for clients diagnosed with glaucoma. The client does not have to wash hands prior to taking an oral medication. 4. This is an oral medication that is used as adjunctive therapy for clients diagnosed with glaucoma. It is not instilled into the eye, and there is no reason for the client to hold the eyes shut.

Which statement indicates to the nurse that the 13-year-old child understands the zone system for monitoring the treatment of asthma? 1. "When I am in the green zone, it means good control and I do not need any medication." 2. "If I am in the black zone, it means I should go to the emergency department." 3. "If I am in the red zone, it means I should take my cromolyn and steroid inhaler." 4. "The yellow zone means I tell my mom so she can give me a nebulizer treatment."

Answer: 1 Rationale: 1. The zone system is used to help children monitor their treatment. The child uses a peak flow meter, which monitors breathing capacity and shows which zone—green, yellow,or red—the child's peak flow is in.Treatment, if needed, is then based on which zone the peak flow meter shows. Green zone means all clear; no asthma symptoms are present. 2. There is no such zone as the black zone. 3. The red zone indicates a medical alert—bronchodilator should be taken and the child should seek medical attention for acute severe asthma. The cromolyn and steroid inhaler are not used for an acute asthma attack. 4. The yellow zone indicates caution because an acute episode may be present. The control is insufficient. The child should inhale a short-acting beta2 agonist. If this fails to return the child to the green zone,a short course of oral glucocorticoids may be needed.

The client taking nitrofurantoin (Macrodantin) for a urinary tract infection calls the clinic and tells the nurse the urine has turned dark. Which statement is the nurse's best response? 1."This is a side effect of the medication and is not harmful." 2."This means that you have cystitis and should come in to see the HCP." 3."If you take the medication with food, it causes this reaction." 4."There must be some other problem going on that is causing this."

Answer: 1 Rationale: 1. This is a side effect of nitrofurantoin. The client should be warned that the urine might turn brown. This color will disappear when the client is no longer taking the medication. If the client is taking an oral suspension, the nurse should instruct to rinse the mouth after taking the medication to prevent staining of the teeth. 2. This does not indicate cystitis. 3. The client should be instructed to take the medication with food to avoid GI upset. 4. This is a side effect of the medication and does not indicate another problem.

The client diagnosed with renal calculi is being scheduled for surgery. The client is having epidural anesthesia. Which intervention should the circulating nurse implement? 1.Have the client lie on the side in the fetal position. 2.Determine if the client has an advance directive. 3.Assess the client's gag and swallowing reflex. 4.Ensure that the head of the client's stretcher is elevated 30 degrees.

Answer: 1 Rationale: 1. This is the correct position for the client when an epidural anesthesia is being inserted. 2. The nurse would determine if the client's operative permit is signed. The admission nurse is responsible for determining if the client has an advance directive. 3.A client's gag and swallowing reflexes are assessed postoperatively for the client who has had general anesthesia. 4. The client's stretcher should be flat so that the client can lie on the side in the fetal position.

The nurse is preparing to hang the next bag of heparin. The client's current laboratory values are as follows: PT 13.4 (Control 12.9); PTT 92 (Control 36); INR 1 1. Discontinue the heparin infusion. 2. Prepare to administer protamine sulfate. 3. Notify the health-care provider. 4. Assess the client for bleeding.

Answer: 1 Rationale: 1. This would be the first intervention because the client is above the therapeutic range. The therapeutic range for heparin is 1.5-2.0 times the control, or 54-72. The client's PTT of 92 places the client at risk for bleeding. Therefore, the nurse must prevent further infusion of medication. 2. This is the antidote for heparin, but the nurse would not administer this first. Discontinuing the infusion of heparin for a few hours may be sufficient to correct the overdose. 3. The HCP should be notified of the client's situation, but it is not the first intervention. 4. Assessment is the first step in the nursing process, but if the client is in "distress" or experiencing a complication, the nurse should first treat the client.

The client with tuberculosis is prescribed isoniazid (INH). Which diet selection indicates the client needs more teaching? 1. Tuna fish sandwich on white bread, potato chips, and iced tea. 2. Pot roast, mashed potatoes with brown gravy, and a light beer. 3. Fried chicken, potato salad, corn on the cob, and white milk. 4. Caesar salad with chicken noodle soup and water.

Answer: 1 Rationale: 1. Tuna, foods with yeast extracts, aged cheese, red wine, and soy sauce contain tyramine and histamine, which interact with INH and result in a headache,flushing, hypotension, lightheadedness,palpitations, and diaphoresis. 2. Red wine, not beer, can cause a reaction with INH. 3. Fried foods and whole milk may not be a healthy diet, but they are not contraindicated with INH. 4. Soup is high in sodium content, but it is not contraindicated in clients taking INH.

Which statement is the advantage of prescribing donepezil (Aricept) over the other cholinesterase inhibitors? 1.The dosing schedule for Aricept is only once a day. 2.Aricept is the only one that can be given with an NSAID. 3.Aricept enhances the cognitive protective effects of vitamin E. 4.There are no side effects of Aricept.

Answer: 1 Rationale: 1.An advantage of Aricept is once-a-day dosing. Research has proved that the more doses required to be taken each day, the less the actual compliance with the medication regimen. Additionally, Aricept is not hepatotoxic and is better tolerated than some of the cholinesterase inhibitors. 2.There is no contraindication to administering NSAIDs and cholinesterase inhibitors simultaneously. 3.Aricept does not enhance vitamin E. 4.There are side effects with any medications. The common side effects of Aricept are nausea, diarrhea, and bradycardia.

The client newly diagnosed with epilepsy is prescribed an anticonvulsant medication. Which information should the nurse tell the client? 1.The medication dosage will start low and gradually increase over a few weeks. 2.The dosage prescribed initially will be the dosage prescribed for the rest of your life. 3.The health-care provider will prescribe a loading dose and decrease dosage gradually. 4.The dose of medication will be adjusted monthly until a serum drug level is obtained.

Answer: 1 Rationale: 1.Anticonvulsant dosages usually start low and gradually increase over a period of weeks until the serum drug level is within therapeutic range or the seizures stop. 2.It is incorrect to state that the dosage prescribed will be the dosage for the rest of the client's life, but it is correct to state that the client will most likely be on the medication for the rest of his or her life. 3.This is incorrect information. The medication is started in low dosages and gradually increased. 4.The dose of medication will be adjusted until a serum drug level is reached but it will be more frequently than monthly.

The 14-year-old client is prescribed oral contraceptive medication for menstrual irregularity. Which assessment data indicates the medication is effective? 1.The client has a period every 28 days. 2.The client has a decrease in abdominal bloating. 3.The client has a negative pregnancy test. 4.The client reports a decrease in facial acne.

Answer: 1 Rationale: 1.Because the client is receiving the medication for menstrual irregularity itis effective when the menstrual cycle is regular, which is every 28 days. 2.A decrease in abdominal bloating may occur, but it does not indicate the medication is effective. 3. This should occur but this is not why the client is taking the medication; therefore, it cannot be used to indicate the medication is effective. 4.Birth control pills have a positive effect on acne, but this is not why the client is taking the medication; therefore, it cannot be used to indicate the medication's effectiveness.

The client who is pregnant asks the nurse, "What does category A mean if the doctor orders that medication for me?" Which statement best describes the scientific rationale for the nurse's response? 1.Category A is the safest medication a client can take when pregnant. 2.Category A medications are safe as long as the client does not take them during the first trimester. 3.Research has not determined if these medications are harmful to the fetus or not. 4.This category is dangerous to the fetus but could be prescribed in emergencies.

Answer: 1 Rationale: 1.Category A medications have a remote risk of causing fetal harm and are prescribed for clients who are pregnant. 2.Category B medications are associated with a slightly higher risk than are category A medications and are often prescribed for clients who are pregnant. These medications should not be taken during the first 3 months of pregnancy. 3.Category C medications pose a greater risk than category B medications and are cautiously prescribed for clients who are pregnant. Research on medications in this category has not been done or may showrisk in animal studies. 4.Category D medications have a proven risk of fetal harm and are not prescribed for clients who are pregnant unless the mother's life is in danger. Category X Medications have a definite risk of fetal abnormality or abortion.

The 17-year-old client is prescribed metronidazole (Flagyl) and erythromycin (E Mycin) for a persistent Chlamydia infection. Which statements by the client indicate the need for further teaching? Select all that apply. 1."I can have a beer or two while taking these medications." 2."My boyfriend will have to take the medications too." 3."I can develop more problems if I don't treat this disease." 4."My birth control pills may not work because of the medications." 5."Chlamydia is a sexually transmitted infection I got from my boyfriend."

Answer: 1 Rationale: 1.Consuming alcohol concurrently with Flagyl can cause a severe reaction. This statement indicates the need for more teaching. 2. The sexual partners must be treated simultaneously to prevent an infection from occurring. This statement indicates the client understands the teaching. 3.Untreated STIs can lead to pelvic inflammatory disease, scarred fallopian tubes, and infertility. This statement indicates the client understands the teaching. 4.Antibiotics may interfere with the effectiveness of some birth control pills. The client should use a supplemental form of birth control when taking birth control pills. This statement indicates the client understands the teaching. 5. This is a sexually transmitted infection that can be transmitted by any male partner; therefore, she understands the teaching.

The nurse in the long-term care facility is caring for a client with an indwelling catheter. Which preparation should the nurse order for the client? 1.Cranberry juice with breakfast daily. 2.Nitrofurantoin (Macrodantin), a sulfa drug. 3.Vitamin C, a vitamin supplement. 4.Goldenseal, an herbal preparation.

Answer: 1 Rationale: 1.Cranberry juice is acidic and will change the pH of the urine, making it harder for bacteria to survive in the environment. It can be used prophylactically to prevent urinary tract infections. It does not treat an infection. The nurse can arrange with the dietitian to include this in the client's dietary plan. 2. This is a prescription medication that is used to treat chronic urinary tract infections, but the nurse could not order this medication. 3.In a long-term care facility, this over-the-counter vitamin would require an HCP order. 4. This is an herb used for urinary tract infections, but in a long-term care facility it would require an HCP order.

The client diagnosed with chronic kidney disease is prescribed erythropoietin (Epogen), a biologic response modifier. Which statement best describes the scientific rationale for administering this medication? 1.This medication stimulates red blood cell production. 2.This medication stimulates white blood cell production. 3.This medication is used to treat thrombocytopenia. 4.This medication increases the production of urine.

Answer: 1 Rationale: 1.Epogen is a glycoprotein produced by the kidney that stimulates red blood cell production in response to hypoxia. A biological response modifier, Epogen, is prescribed to treat the anemia that occurs in clients with chronic kidney disease. 2.Filgrastim (Neupogen) is the biological response modifier that stimulates white blood cells and is not used in the treatment of chronic kidney disease. 3.Oprelvekin (Neumega) is the biological response modifier that stimulates megakaryocytes and thrombocyte production, which stimulates platelet production to prevent thrombocytopenia in clients receiving chemotherapy. 4.There is no medication that increases the production of urine. Diuretics increase the excretion of urine but do not affect the production of urine.

The client with a seizure disorder who is taking carbamazepine (Tegretol) tells the clinic nurse, "I am taking evening primrose oil for my premenstrual cramps and it is really working." Which statement is the nurse's best response? 1."You should inform your health-care provider about taking this herb." 2."It is very dangerous to take both the herb and Tegretol." 3."Herbs are natural substances and I am glad it is helping your PMS." 4."Are you sure you should be taking herbs along with Tegretol?"

Answer: 1 Rationale: 1.Evening primrose oil may lower the seizure threshold, and the Tegretol dose may need to be modified. There-fore, the client should notify the HCP. 2.Evening primrose oil is not dangerous, and the nurse should not scare the client. 3.Although the evening primrose oil may help the client's PMS, the nurse should inform the client that because she is also taking Tegretol, she should inform her HCP because the dose of Tegretol may need to be adjusted. 4.The nurse needs to give factual information to the client—not ask the client a question.

The client diagnosed with chronic hypertension is prescribed furosemide (Lasix), a loop diuretic, and enalapril (Vasotec), an ACE inhibitor. The client's blood pressures for the last 3 weeks have averaged 178/95, and the HCP has added atenolol (Tenormin), a beta blocker, to the client's current medication regimen. Which statement is the scientific rationale for including this medication in the client's regimen? 1.Achieving a lower average blood pressure will help to prevent a stroke. 2.The other medications are not effective without the addition of atenolol. 3.The atenolol will potentiate the effects of loop diuretics. 4.The HCP will taper off the ACE inhibitor and eventually discontinue it.

Answer: 1 Rationale: 1.Hypertension is a risk factor for developing a stroke. Some clients require multiple medications to control their hypertension. 2.If this were true, then atenolol would be the only medication the client needs. Beta Blockers are frequently used in combination with other antihypertensive medications to control a client's blood pressure. 3.Atenolol does not potentiate the effective-ness of loop diuretics. 4.Beta blockers, not ACE inhibitors, must be tapered off when discontinuing them to prevent rebound cardiac dysrhythmias. The HCP is adding the beta blocker to the current medications.

The client has been taking birth control pills for 5 weeks. Which statement from the client warrants intervention by the clinic nurse? 1."I stay nauseated and my breasts are very tender." 2."I have not had a period since I started the pill." 3."I make my boyfriend use a condom even though I am on the pill." 4."I took the pills for 3 weeks then stopped for 1 week."

Answer: 1 Rationale: 1.If signs of estrogen excess are apparent(nausea, edema, or breast discomfort),a preparation with lower estrogen content is needed. This statement therefore warrants the nurse to intervene. 2.Oral contraceptives may decrease or eliminate menstrual flow during the initial months of use; therefore, the nurse would not intervene based on this statement. 3. This statement would warrant praise from the clinic nurse because birth control pills do not protect the client from STIs. Only Condoms or abstinence can do that. 4. The birth control pill suppresses ovulation for 3 weeks; then, when the pill isn't taken, the client has her period. This statement indicates the client understands the teaching and does not warrant intervention.

Which statement is the scientific rationale for the combination drug carbidopa/levodopa (Sinemet) prescribed to a client diagnosed with Parkinson's disease? 1.The carbidopa delays the breakdown of the levodopa in the periphery, so more dopamine gets to the brain. 2.The medication is less expensive when combined, so it is more affordable to clients on a fixed income. 3.The carbidopa breaks down in the periphery and causes vasoconstriction of the blood vessels. 4.Carbidopa increases the action of levodopa on the renal arteries, increasing renal perfusion.

Answer: 1 Rationale: 1.In Parkinson's disease there is a decreased amount of dopamine in the brain. Carbidopa delays the breakdown of levodopa (dopamine) in the periphery so that more of the levodopa crosses the blood-brain barrier and reaches the brain. 2.The expense of the medication is not the reason for the combination of the drugs. Sinemet comes in only one strength com-bination, which is a disadvantage of the medication. 3.Levodopa breaking down in the periphery is the reason that the medications are combined. 4.Carbidopa does not increase the action of levodopa; it delays the breakdown of the compound in the periphery.

The 6-year-old client diagnosed with a brain tumor has returned from the post-anesthesia care unit to intensive care. Which medication should the nurse question? 1.Meperidine (Demerol), a narcotic analgesic, IVP every 2 hours. 2.Methylprednisolone (Solu-Medrol), a steroid, IVPB every 8 hours. 3.Acetaminophen (Tylenol), an antipyretic, PO or rectal PRN. 4.Promethazine (Phenergan), an antiemetic, IVP PRN.

Answer: 1 Rationale: 1.Meperidine metabolizes into normeperidine in the body, and accumulation of this substance in the body can cause seizures. It is not recommended to give Demerol to children, and the schedule may be excessive. The nurse should not automatically administer narcotics to a client who is neurologically impaired. The nurse should determine the neuro-logical status of the client before administering a medication that can mask symptoms. 2.There is no reason to question prescription of a steroid. 3.The client may need this medication to control mild pain or fever until the body has a chance to readjust its thermoregulatory mechanism. 4.An antiemetic can prevent the child from vomiting and increasing intracranial pressure during that activity. The vomiting center is in the brain and can become irritated as a result of increased intracranial pressure.

The client diagnosed with a brain tumor is undergoing radiation therapy. Which medication should the home health nurse suggest the health-care provider order to assist the client in managing the side effects of the radiation therapy? 1.An antiemetic to be taken before meals and as needed. 2.An increase in the narcotic pain medication. 3.A topical medicated lotion for the scalp. 4.An antianxiety medication to control anxiety during treatments.

Answer: 1 Rationale: 1.Radiation therapy may cause nausea. An antiemetic should be ordered so the client can maintain nutritional status and comfort. 2.As the tumor shrinks from the radiation, the pain associated with the tumor should decrease, not increase, so an increase in the medication is not needed. 3.The skin in the radiation field should be cleaned with mild soap and water, being careful not to obliterate the markings. Medicated lotions can irritate the skin. 4.The therapy sessions take from 5 to 10 minutes and do require the client to lie still, but usually antianxiety medications are not needed.

The nurse is completing an admission assessment on a client being admitted to a medical unit diagnosed with pneumonia. The client's list of home medications includes Lasix, a loop diuretic; Metamucil, a bulk laxative; and Reminyl, a cholinesterase inhibitor. Which intervention should the nurse implement first? 1.Make sure the client has a room near the nursing station. 2.Check the client's white blood cell count and potassium level. 3.Have the unlicensed assistant get ice chips for the client to suck on. 4.Determine the client's usual bowel elimination pattern.

Answer: 1 Rationale: 1.Reminyl is prescribed for mild to moderate AD, and the safety of the client should be the nurse's first concern. Moving the client to a room that can be observed more closely is one of the first steps in a falls prevention protocol. 2.This should be done, but it is not a priority over client safety. 3.The medications do not cause dry mouth. The unlicensed assistive personnel can provide water for the client, providing that there is no reason not to. Clients taking bulk laxatives should increase the fluid intake, but this is not the first intervention. 4.The nurse should assess for effectiveness of all medications, including laxatives, but this is not the first concern.

The male client with a renal stone is admitted to the medical department. The nurse administers intravenous morphine over 5 minutes. Which intervention should the nurse implement first? 1.Instruct the client to call for help before getting out of bed. 2. Tell the client to urinate into the urinal at all times. 3.Document the time in the MAR and the client's chart. 4.Reevaluate the client's pain within 30 minutes

Answer: 1 Rationale: 1.Safety of the client is priority. 2. This is an appropriate intervention, but it is not priority over safety. 3. The nurse must document the medication inthe MAR and the chart because it is a PRN medication, but it is not the first intervention after administering the medication. 4. The nurse must evaluate the client's pain to determine the effectiveness of the medication, but this is not the first intervention.

The client newly diagnosed with a seizure disorder also has type 2 diabetes. The health-care provider prescribes phenytoin (Dilantin) for the client. Which intervention should the nurse implement? 1.Instruct the client to monitor his or her blood glucose more closely. 2.Explain that the Dilantin will not affect the client's antidiabetic medication. 3.Discuss the need to discontinue oral hypoglycemic medication and take insulin. 4.Call the health-care provider to discuss prescribing the Dilantin.

Answer: 1 Rationale: 1.Serum glucose must be monitored more closely because phenytoin may inhibit insulin release, thus causing an increase in glucose level. 2.This is not a true statement. Dilantin may affect the client's antidiabetic medication. 3.This is not a true statement. The client can still take oral hypoglycemic medications. 4.The nurse should call and discuss any questionable medication with the HCP, but there is no reason to discuss Dilantin being prescribed for a client with type 2 diabetes.

The nurse is caring for a client diagnosed with a hemorrhagic stroke. Which medication should the nurse question administering? 1.Clopidogrel (Plavix), an antiplatelet. 2.Mannitol (Osmitrol), an osmotic diuretic. 3.Nifedipine (Procardia), a calcium channel blocker. 4.Dexamethasone (Decadron), a glucocorticoid.

Answer: 1 Rationale: 1.The client has experienced a bleed into the cranium. Plavix interferes with the client's clotting ability. This medication should be held and discussed with the HCP. 2.There is no reason to question giving a medication that will decrease intracranial pressure. Mannitol is the diuretic of choice for this client. 3.Procardia will decrease the client's blood pressure, which is elevated in clients with increased intracranial pressure. 4.Decadron will decrease edema, resulting in decreased intracranial pressure.

The client diagnosed with a migraine headache rates the pain at a 4 on a 1-10 scale. Which medication should the nurse administer? 1.Ibuprofen (Motrin) po, a nonsteroidal anti-inflammatory drug. 2.Butorphanol (Stadol) IM, an opioid analgesic. 3.Dihydroergotamine (D.H.E. 45), an ergot alkaloid, intranasally. 4.Sumatriptan (Imitrex), subcutaneous, a selective serotonin receptor agonist.

Answer: 1 Rationale: 1.The client rates the pain as a 4. NSAIDs are given for mild-to-moderate migraine pain. 2.An opioid analgesic should be given only if ergot alkaloids or selective serotonin receptor agonist medications (migraine-specific medications) are not effective in treating the pain. 3.The patient reports mild to moderate pain. A migraine-specific drug, such as an ergot alkaloid, should be given for moderate to severe pain. 4.The patient reports mild to moderate pain. A migraine-specific drug, such as a selective serotonin receptor agonist, should be given for moderate to severe pain.

The client is admitted into the emergency department complaining of profuse salivation, excessive tearing, and diarrhea. The client tells the nurse he had been camping and living off the land. Which medication should the nurse anticipate administering? 1. Atropine, a muscarinic antagonist. 2. Diphenhydramine (Benadryl), an antihistamine. 3. Magnesium/aluminum hydroxide (Maalox), an antacid. 4. Pantoprazole (Protonix), a proton-pump inhibitor.

Answer: 1 Rationale: 1.The client reports living off the land, and the symptoms reported are clinical manifestations of muscarinic poisoning from eating wild mushrooms. There-fore, the nurse should anticipate administering the antidote, which is atropine. 2.An antihistamine would be prescribed for an allergic reaction, not for muscarinic poisoning. 3.Maalox neutralizes gastric acid and would not be used for mushroom poisoning. 4.A proton-pump inhibitor decreases gastric acidity and would not be prescribed for muscarinic poisoning.

The client diagnosed with epilepsy has undergone a spontaneous remission of the epilepsy, a rare but occasional occurrence. What information should the nurse discuss with the client when discontinuing antiepileptic drugs? 1.Discuss the need to slowly taper off the antiepileptic drugs. 2.Explain the importance of getting routine serum levels. 3.Teach the client to continue taking the antiepileptic drugs. 4.Instruct the client to use a soft-bristled toothbrush.

Answer: 1 Rationale: 1.The most important rule in discontinuing antiepileptic drugs (AED) is that they be withdrawn over a period of 6 weeks to several months to avoid side effects. If the client is taking two AEDs, the drugs should be discontinued sequentially, not simultaneously. 2.There is no need to obtain serum levels when the medication is being discontinued. 3.When the epilepsy is in remission, the client should stop taking the AED because a client should not take medication if it is not necessary. 4.Soft-bristled toothbrushes are recommended for clients taking phenytoin (Dilantin) be-cause of gingival hyperplasia, but this client will stop taking an AED because of being in remission.

The client with increased intracranial pressure is receiving the osmotic diuretic mannitol (Osmitrol). Which data would cause the nurse to hold the administration of this medication? 1.The serum osmolality is 330 mOsm/kg. 2.The urine osmolality is 550 mOsm/kg. 3.The BUN level is 8 mg/dL. 4.The creatinine level is 1.8 mg/dL.

Answer: 1 Rationale: 1.The normal serum osmolality is 275-300mOsm/kg. Mannitol is held if the serum osmolality exceeds 310-320 mOsm/kg. 2.The normal urine osmolality is 250-900 mOsm/kg; therefore, the data is within normal limits. However, urine osmolality is not usually monitored when administering mannitol. 3.The normal BUN level is 8-21 mg/dL; therefore, the data is within normal limits. However, BUN is not monitored when administering mannitol. 4.The normal creatinine level is 0.7-1.4 mg/dL; therefore, the data indicates an elevated level. However, the creatinine level is not affected by the administration of mannitol; there must be another reason for the elevated creatinine level.

The client diagnosed with migraine headaches that occur every 2 to 3 days is placed on preventive therapy with the beta blocker propranolol (Inderal). Which data indicates the medication is effective? 1.The client has had only one headache in the past week. 2.The client's apical pulse is 78 beats per minute. 3.The client has developed orthostatic hypotension. 4.The client supplemented Inderal with Imitrex four times.

Answer: 1 Rationale: 1.This indicates an improvement in the number of headaches the client normally experiences and is the only option that indicates an improvement in a condition. 2.This client should be taught to take the radial pulse for 1 minute and to hold the Inderal if the pulse is less than 60 because beta blockers slow the heart rate. This does not indicate the medication is effective. 3. This may be a side effect of the medication because beta blockers are frequently prescribed for hypertension, but this effect does not indicate the medication's effectiveness in preventing migraine. 4.Supplementing the Inderal with an abortive medication four times indicates that the Inderal has not been effective in preventing the occurrence of the headaches.

The client who has been prescribed phenytoin (Dilantin) for epilepsy calls the clinic and reports a measles-like rash. Which intervention should the nurse implement? 1.Instruct the client to come to the clinic immediately. 2.Determine if the client is drinking grapefruit juice. 3.Encourage the client to apply a hydrocortisone cream to the rash. 4.Explain that this is a common side effect of this medication.

Answer: 1 Rationale: 1.This morbilliform (measles-like) rash may progress to a more serious reaction; therefore, the client should come to the clinic immediately and the medication should be stopped immediately. 2.Grapefruit does not cause a measles-like rash; therefore, the nurse should not ask this question. 3.This rash has potential life-threatening consequences, and hydrocortisone cream will not help the client. 4.This is not a normal side effect of the medication.

The client diagnosed with Alzheimer's disease (AD) is prescribed rivastigmine (Exelon), a cholinesterase inhibitor. Which medication should the nurse question administering to the client? 1.Amitriptyline (Elavil), a tricyclic antidepressant. 2.Warfarin (Coumadin), an anticoagulant. 3.Phenytoin (Dilantin), an anticonvulsant. 4.Prochlorperazine (Compazine), an antiemetic.

Answer: 1 Rationale: 1.Tricyclic antidepressants, first-generation antihistamines, and antipsychotics can reduce the client's response to cholinesterase inhibitors. Antipsychotics are useful for clients whose behavior is erratic and uncontrollable in the end stage of the disease. The cholinesterase inhibitor Exelon would not be useful in end-stage disease. 2.Coumadin interacts with several medications but not with cholinesterase inhibitors. 3.Cholinesterase inhibitors do not interact with Dilantin. 4.Compazine may be used to control the nausea produced by Exelon; there is no reason to question administering this medication.

Which male client should the nurse consider at risk for complications when taking sildenafil (Viagra), a sexual stimulant? 1.A 56-year-old client with unstable angina. 2.An 87-year-old client with glaucoma. 3.A 44-year-old client with type 2 diabetes. 4.A 32-year-old client with an L1 spinal cord injury (SCI).

Answer: 1 Rationale: 1.Viagra should be used cautiously in clients with coronary heart disease because duringsexual activity the client could have a myocardial infarction from the extra demands on the heart. Specifically, clients taking nitroglycerin or any nitrate medication should not take Viagra because the vasodilatation effect of Viagra may cause hypotension. A client with unstable angina would be taking a nitrate medication. 2.Viagra is not contraindicated for clients diagnosed with glaucoma. 3.Viagra is not contraindicated for clients diagnosed with Type 2 diabetes and may help erectile dysfunction. 4.Viagra is not contraindicated for clients with an SCI and may help erectile dysfunction.

The long-term-care facility nurse is caring for a client diagnosed with a cerebrovascular accident (CVA) 6 months ago who has residual cognitive deficits. The HCP has ordered alprazolam (Xanax), an antianxiety medication, to be administered at bedtime. Which interventions should the nurse initiate for this client? Select all that apply. 1.Offer toileting every 2 hours. 2.Move the client close to the nurse's station. 3.Administer the medication at 2100. 4.Administer the medication with a full glass of water. 5.Do not administer if the client's apical pulse is less than 60.

Answer: 1, 2, 3 Rationale: 1.This medication has a side effect of drowsiness, which is why the HCP chose this medication for the client—to help the client rest at night. The client has cognitive deficits and should be on fall precautions, so it is hoped that assisting the client to the bathroom every 2 hours will prevent the client from falling while trying to get to the bathroom. 2.The client at risk for falling should be as near the nursing station as possible. This allows the staff to keep a closer watch on the client. 3.The medication is ordered for bedtime, usually 2100, in most health-care facilities. 4.Giving the medication with a full glass of water would increase the client's need to get up during the night to use the bathroom, increasing the risk of falling. 5.This medication does not require the apical pulse being monitored prior to administering the medication.

The nurse is teaching the parents how to instill antibiotic otic drops to the 6-year-old child with otitis media. Which instruction should the nurse discuss with the parent? Select all that apply. 1. Insert the otic medication in the affected ear after pulling the earlobe upward and back. 2. After instilling medication gently massage the area immediately anterior to the ear. 3. Gently pull the pinna downward and straight back when inserting the eardrops. 4. Allow the child to lie quietly on the side after instilling the ear drops into the affected ear. 5. Insert the dropper with prescribed medication deep into the ear canal and instill drops.

Answer: 1, 2, 4 Rationale: 1. In children older than 3 years, the pinna should be pulled upward and back to straighten the eustachian tube. 2. Gentle massage of the area immediately anterior to the ear facilitates the entry of drops into the ear canal. 3. This should be done with children younger than 3 years of age because it will straighten the ear canal. In children older than age 3, the pinna should be pulled upward and back. 4. After installation of eardrops, the child should remain lying on the unaffected side for a few minutes. 5. The dropper should be held over the ear canal when instilling ear drops. Inserting the dropper deep into the ear could cause injury to the ear.

The nurse is caring for a client newly diagnosed with Parkinson's disease who is receiving the anti-Parkinson's disease medication levodopa (L-dopa). Which interventions should the nurse implement? Select all that apply. 1.Instruct the client to rise slowly from a seated or lying position. 2.Teach about on-off effects of the medication. 3.Discuss taking the medication with meals or snacks. 4.Tell the client that the sweat and urine may become darker. 5.Inform the client about having routine blood levels drawn.

Answer: 1, 2, 4 Rationale: 1.Initially levodopa can cause orthostatic hypotension. The client should be taught to rise slowly to prevent falls. 2.The client may experience an "on" effect of symptom control when the medication is effective and an "off" effect near the time for the next dose of medication. 3.Food can decrease the absorption of levodopa; administration with meals should be avoided, if possible. 4.Clients should be warned that darkening of the urine and sweat is a harmless side effect of this medication. 5.Routine blood levels of levodopa are not drawn.

The client diagnosed with bilateral conjunctivitis is prescribed antibiotic ophthalmic ointment. Which interventions should the nurse implement when discussing the medication with the client? Select all that apply. 1. Apply a thin line of ointment evenly along inner edge of lower lid margin. 2. Press the nasolacrimal duct after applying the antibiotic ointment. 3. Don nonsterile gloves prior to administering the medication. 4. Apply antibiotic ointment from the outer canthus to the inner canthus. 5. Instruct the client to sit with head slightly tilted back or lie supine.

Answer: 1, 2, 5 Rationale: 1. The client should instill eye ointment into the lower conjunctival sac, which is the inner edge of the lower lid margin. 2. Applying pressure to the nasolacrimal duct will prevent systemic absorption of the medication. 3. The client does not have to wear gloves when applying the ointment to his or her own eyes. The client should be instructed to wash hands prior to and after applying the ointment. 4. The antibiotic ointment should be applied from the inner canthus to the outer can-thus, from the nose side of the eye to the outer area. 5. The client should sit with the head slightly tilted back or lie supine when ap-plying ophthalmic ointment or drops to better access the lower conjunctival sac.

The client with a seizure disorder is prescribed the anticonvulsant fosphenytoin (Cerebyx). Which interventions should the nurse discuss with the client? Select all that apply. 1.Instruct the client to wear a Medic Alert bracelet and carry identification. 2.Tell the client to not self-medicate with over-the-counter medications. 3.Encourage the client to decrease drinking of any type of alcohol. 4.Discuss the importance of maintaining good oral hygiene. 5.Explain the importance of maintaining adequate nutritional intake.

Answer: 1, 2, 5 Rationale: 1.The client should wear a Medic Alert bracelet and carry identification so that an HCP and others possibly providing care know that the client has a seizure disorder. 2.The client should not take any over-the-counter medications without first consulting with the HCP or pharmacist because many medications interact with Cerebyx. 3.Alcohol and other central nerve depressants can cause an added depressive effect on the body and should be avoided, not just decreased. 4.Gingival hyperplasia (overgrowth of gums) is a side effect of Dilantin, not of Cerebyx. 5.Dilantin may cause anorexia, nausea, and vomiting; therefore, the client should maintain an adequate nutritional intake.

The client with a head injury is admitted into the intensive care unit (ICU). Which health-care provider medication order should the ICU nurse question? Select all that apply. 1.Morphine, a narcotic analgesic. 2.Osmitrol (mannitol), an osmotic diuretic. 3.Methylprednisolone (Solu-Medrol), a corticosteroid. 4.Phenytoin (Dilantin), an anticonvulsant. 5.Oxygen, 6 L via nasal cannula.

Answer: 1, 3 Rationale: 1.Administering narcotics to clients with head injuries may mask signs of increased intracranial pressure, so the nurse's questioning this medication would be appropriate. 2.An osmotic diuretic is the treatment of choice to help decrease intracranial pressure that occurs with a head injury. 3.Research supports the finding that clients with head injuries who are treated with anti-inflammatory corticosteroids are 20% more likely to die within 2 weeks after the head injury than those who aren't so treated. The nurse should question this medication. 4.Seizures are a common complication of head injuries; therefore, an order for an anticonvulsant medication would be appropriate. 5.There is no reason for the nurse to question an order for oxygen—which is considered a medication—for a client with a head injury.

Which intervention should the nurse implement when administering the biological response modifier erythropoietin (Epogen) subcutaneously? Select all that apply. 1.Do not shake the vial prior to preparing the injection. 2.Apply a warm washcloth after administering the medication. 3.Discard any unused portion of the vial after pulling up the correct dose. 4.Keep the medication vials in the refrigerator until preparing to administer. 5.Administer the medication intramuscularly in the deltoid muscle.

Answer: 1, 3, 4 Rationale: 1.Do not shake the vial because shaking may denature the glycoprotein, rendering it biologically inactive. 2. The nurse should apply ice to numb the injection site, not a warm washcloth after administration. 3. The nurse should only use the vial for one dose. The nurse should not reenter the vial and should discard any unused portion because the vial contains no preservatives. 4. The medication should be stored in the refrigerator and should be warmed to room temperature prior to its being administered. 5. This injection is administered subcutaneously or intramuscularly.

The client diagnosed with emphysema is admitted to the surgical unit for a cholecystectomy (gallbladder removal). Which postoperative interventions should the nurse implement? Select all that apply. 1. Have the patient turn, cough, and breathe deeply every 2 hours. 2. Administer oxygen to the client at 4 L/min. 3. Assess the surgical dressing every 4 hours. 4. Medicate frequently with morphine 15 mg IVP. 5. Use the incentive spirometer every 4 hours.

Answer: 1, 3, 5 Rationale: 1. Clients undergoing surgery are encouraged to turn, cough, and deep breathe (TC&DB) a minimum of every 2 hours. Clients with emphysema should TC&DB more often than every 2 hours. 2. The client should be administered oxygen at 1-3 L/min. Clients with chronic lung disease have developed carbon dioxide narcosis; high levels of carbon dioxide have destroyed the client's first stimulus for breathing. Oxygen hunger is the body's backup system for sustaining life. Administering oxygen at levels above 2 L/min at rest and 3 L/min during activity may cause the client to stop breathing. 3. Clients diagnosed with chronic lung disease are frequently prescribed long-term steroid therapy. Steroids delay wound healing. The nurse should assess the wound to determine that the surgical incision is healing as desired. 4. Morphine can cause respiratory compromise, especially when given frequently and in large doses. This client is already at risk for respiratory complications from the emphysema. 5. The client should use the incentive spirometer to help prevent pneumonia; every 4 hours is an appropriate time span.

The client diagnosed with cerebrovascular accident (CVA) is complaining of a headache. Which interventions should the rehabilitation nurse implement? Rank in order of priority. 1.Assess the client's neurological status. 2.Administer oral acetaminophen (Tylenol). 3.Have the client swallow a drink of water. 4. Ask the client to give his or her date of birth. 5.Ask the client to rate pain on a scale of 1-10.

Answer: 1, 5, 4, 3, 2 Rationale: 1.The nurse should apply the nursing process and always assess the client unless the client is in distress. The nurse must determine if this is routine pain for which the HCP has prescribed acetaminophen or if it is a complication that warrants medical intervention. 5.The nurse must then determine how much pain the client is in to determine which medication would be most appropriate. The pain scale will also help evaluate the effectiveness of the medication. 4.The nurse must identify the client prior to administering the medication. 3.Because the client has had a CVA, the nurse must determine if the client can swallow prior to administering medication. If the client has problems swallowing water, then the nurse should thicken liquids to help prevent aspiration. 2.The nurse should administer the medication after all the previous steps are completed.

The nurse in the emergency department is preparing to administer the thrombolytic medication alteplase (Activase) to a client whose initial symptoms of a stroke began 2 hours ago. Which interventions should the nurse implement? Select all that apply. 1.Check the client's armband for allergies. 2.Hang the medication via IVPB and infuse over 90 minutes. 3.Check the results of the client's CT scan of the brain. 4.Teach the client this medication dissolves clots. 5.Monitor the client's PTT during drug administration.

Answer: 1,2,3,4,5 Rationale: 1.The nurse should always check the client's armband prior to administering medication. 2.This is the correct procedure when hanging the medication. 3.There are three types of strokes: thrombotic, embolic, and hemorrhagic. The nurse must know that the client has not had a hemorrhagic stroke before hanging a medication that destroys clots. Administering a thrombolytic to a client who has had a hemorrhagic stroke can result in the client's death. 4.Teaching the client can be done after the medication has been administered. 5.The client will be receiving heparin to prevent re-clotting of the thrombus along with thrombolytic medication; therefore, the nurse should monitor the PTT.

The 19-year-old client diagnosed with a severe herpes simplex 2 viral infection is admitted to the medical floor. The HCP prescribes acyclovir (Zovirax), an antiretroviral medication, 10 mg/kg IVPB every 8 hours. The client weighs 220 pounds. How many milligrams will the nurse administer with each dose?

Answer: 1000 mg of medication will be administered with each dose. Rationale: The client weighs 220 pounds. Convert weight to kilograms by dividing 2.2 (220 /2.2 = 100 kg). To find the amount for each dose, multiply 100 kg times 10 mg, which equals 1000 mg per dose.

The client diagnosed with benign prostatic hypertrophy (BPH) has had a transurethral resection of the prostate. The client returns to the unit with a continuous bladder irrigation (Murphy drip) in place. The unlicensed assistive personnel records emptying the catheter bag of red drainage three times during the shift of 1500mL, 2100 mL, and 1950 mL. The nurse records infusing 4100 mL of normal saline irrigation fluid. Which is the client's corrected urinary output for the shift?

Answer: 1450 mL of corrected urinary output. Rationale: 1450 mL of corrected urinary output. The drainage in the catheter bag equals 5550 mL of drainage. 1500 mL + 2100 mL + 1950 mL = 5550 mL of drainage emptied for the shift. Subtract the 4100mL of normal saline irrigation fluid from the 5550 mL total drainage = 1450 mL of corrected urinary output.

The client is receiving an intravenous infusion of heparin. The bag hanging has 40,000 units of heparin in 500 mL of D 5 W. The HCP has ordered the medication to be delivered at 1200 units per hour. At what rate would the nurse set the intravenous pump?

Answer: 15 mL per hour.

The client is receiving an intravenous infusion of heparin. The bag hanging has 40,000 units of heparin in 500 mL of D5W. The HCP has ordered the medication to be delivered at 1200 units per hour. At what rate would the nurse set the intravenous pump?

Answer: 15 mL per hour. Rationale: 15 mL per hour. When setting the intravenous pump, the nurse must first determine the number of units per milliliter. 40,000 units = 80 units per mL 500 mL 1200 Units per hour = 15 mL 80 units per mL

The nurse is administering mannitol (Osmitrol) to the client with a head injury. The order reads 1000 mL intravenous piggyback over 6 hours. At which rate should the nurse administer the medication via a pump?

Answer: 167 mL/hr Rationale: 167 mL/hr. The nurse should divide the volume (1000 mL) by the number of hours (6); this equals 166.6666. The nurse should round up if the number is greater than 5; therefore, the nurse should set the pump at 167 mL/hr.

The nurse is reading this intradermal positive protein derivative (PPD) skin test 72 hours after it was administered and the result was 5 mm. What should the nurse document based on this result? 1. Significant but not at risk. 2. Not significant. 3. Undetermined reaction. 4. Significant and at risk.

Answer: 2 Rationale: 1. A wheal 5 mm or greater may be significant individuals who are considered at risk. 2. A wheal measuring 5 mm or less is considered not significant, and this client's reaction is less than 5 mm induration. 3. This would indicate the reaction is not readable and could result from poor administration technique of the intradermal injection. 4. A wheal of 10 mm or greater is significant in individuals with normal immunity.

The HCP prescribed amoxicillin/clavulanate (Augmentin), an antibiotic, for a client diagnosed with chronic obstructive pulmonary disease (COPD) who has a cold. Which intervention should the nurse implement? 1. Discuss the prescription with the HCP because antibiotics do not help viral infections. 2. Teach the client to take all the antibiotics as ordered. 3. Encourage the client to seek a second opinion before taking the medication. 4. Ask the client if he or she is allergic to sulfa drugs or shellfish.

Answer: 2 Rationale: 1. Antibiotics do not treat viral infections, but HCPs will frequently prescribe prophylactic antibiotics for clients with comorbid conditions (such as COPD) to prevent secondary bacterial infection. 2. Clients prescribed antibiotics should always be taught to take all the medication as ordered to prevent resistant strains of bacteria from developing. 3. There is no reason for a second opinion; this is standard medical practice. 4. This is a penicillin preparation, not a sulfa medication or iodine.

The HCP has ordered streptokinase (Streptase), a thrombolytic, intravenously for the client diagnosed with a pulmonary embolism. The client has intravenous heparin infusing at 1600 units per hour via a 20-gauge angiocath. Which intervention should the nurse implement? 1. Administer the streptokinase via a Y-tubing. 2. Start a second intravenous site to infuse the streptokinase. 3. Discontinue the heparin and infuse streptokinase via the 20-gauge angiocath. 4. Piggyback the streptokinase through the heparin line at the port closest to the client.

Answer: 2 Rationale: 1. Blood or blood products are the only fluids infused through Y-tubing. 2. Heparin and streptokinase cannot be administered in the same intravenous line because they are incompatible. The nurse must start a second line to administer the streptokinase simultaneously with the heparin. The nurse does not need an order to do this. 3. The client needs both of these medications; therefore, the nurse cannot discontinue the heparin. Streptokinase is a thrombolytic, which will dissolve the clot in the pulmonary artery, but heparin,an anticoagulant, is prescribed to prevent reformation of the clot. 4. Heparin and streptokinase cannot be administered in the same intravenous line because they are incompatible. The nurse must start a second line to administer the streptokinase simultaneously with the heparin. The nurse does not need an order to do this.

The 8-year-old male child diagnosed with reactive airway disease is prescribed a cromolyn (Intal) inhaler. The child shares with the nurse that he wants to play baseball but can't because of his asthma. Which intervention should the nurse discuss with the child and parents? 1. Instruct the child to take the medication as soon as shortness of breath starts. 2. Teach the child to take a puff of the cromolyn inhaler 15 minutes before playing ball. 3. Encourage the child to play another sport that does not require running outside. 4. Inform the parents to notify the pediatrician if the child complains of a yellow haze.

Answer: 2 Rationale: 1. Cromolyn is a safe and effective drug for prophylaxis of asthma, but it is not useful for aborting an ongoing attack. 2. Cromolyn can prevent bronchospasm in children subject to exercise-induced asthma. It should be administered 15 minutes prior to anticipated exertion. 3. The child with a chronic illness should be encouraged to live as normal a life as possible; therefore, encouraging the child not to play ball is not appropriate. 4. Cromolyn is devoid of significant adverse effects and drug interactions. A yellow haze is not an expected side effect or adverse effect of cromolyn.

The client with gestational diabetes asks the nurse, "Why do I have to take shots? Why can't I take a pill?" Which statement is the nurse's best response? 1."The shots will help keep your blood glucose level down better." 2."Pills may hurt the development of the baby in your womb." 3."Insulin will help prevent you from having the baby too early." 4."Pills for diabetes may delay the baby's lung development."

Answer: 2 Rationale: 1.Insulin may better help control the blood glucose level, but that is not the reason why it is used during pregnancy. 2.Oral hypoglycemics are not used during pregnancy because they cross the placental barrier; they stimulate fetal insulin production and may be teratogenic. 3.Insulin has no effect on preterm labor. 4.Oral hypoglycemics do not affect fetal lung development.

The client diagnosed with Meniere's disease is admitted with an acute attack and prescribed intravenous diazepam (Valium), a sedative-hypnotic. Which intervention should the nurse implement when administering this medication? 1. Dilute the Valium to a 10-mL bolus with normal saline. 2. Administer the diazepam undiluted via a saline lock 3. Infuse the diazepam via an IV piggyback over 1 hour. 4. Question the order because diazepam cannot be given IVP.

Answer: 2 Rationale: 1. Diazepam cannot be diluted because it is oil based and will not dissolve with normal saline. 2. Diazepam cannot be diluted because it is oil based and will not dissolve with nor-mal saline. Diazepam should be administered via a saline lock or at the port closest to the client if administered through an existing intravenous line. 3. Diazepam is administered via intravenous push over 2-5 minutes, but it is not administered via an intravenous piggyback over 30 minutes. 4. Diazepam can be administered via intravenous push.

The nurse is administering silver nitrate 1% (Dey-Drop), an antibiotic, to a 1-hour-old infant. Which statement is the scientific rationale for administering this medication? 1. It is used to prevent herpes simplex keratitis. 2. It is used to prevent ophthalmia neonatorum. 3. It is used to treat bacterial conjunctivitis. 4. It is used to treat a fungal infection of the eyes.

Answer: 2 Rationale: 1. Herpes simplex is a virus and is not treated with an antibiotic. 2. This antibiotic ointment is used to prevent an eye infection secondary to the mother having a sexually transmit-ted disease. It is administered to all newborns within 1 hour of birth. 3. A 1-hour-old infant would not have bacterial conjunctivitis; therefore, this is not the scientific rationale for administering this medication. 4. Antibiotics are not used to treat fungal infections.

The client reports having dry and irritated eyes to the clinic nurse. Which intervention should the nurse implement first? 1. Recommend the client use artificial tears in both eyes. 2. Assess the eyes for any redness or discharge. 3. Check the client's eyes using the ophthalmoscope. 4. Evaluate the client's cardinal fields of vision.

Answer: 2 Rationale: 1. If there is no redness, inflammation, or other signs of an infection, then the nurse could recommend using artificial tears, which is an over-the-counter medication, but this is not the first intervention. 2. The nurse should first assess the eyes for redness or inflammation to determine if there is any type of infection, which would need an HCP's prescription for antibiotics. 3. The nurse could use the ophthalmoscope to assess the client's eyes, but the first intervention is a visual inspection. 4. The nurse could evaluate the client's cardinal fields of vision, but the first intervention is a visual inspection.

The client who has been using oxymetazoline (Afrin) nasal spray for several weeks complains to the nurse that the spray no longer seems to work to clear the nasal passages. Which information should the nurse teach? 1. Increase the amount of sprays used until the desired effect has been reached. 2. This type of medication can cause rebound congestion if used too long. 3. Alternate the Afrin with a saline nasal spray every 2 hours. 4. Place the Afrin nasal spray in a vaporizer at night for the best results.

Answer: 2 Rationale: 1. Increasing the number of sprays will only increase the problem. This medication is for short-term use only (that is, a few days). Longer use can cause a rebound congestion that can be difficult to resolve. 2. Afrin is recommended for short-term relief of nasal congestion for clients older than the age of 6 years. Longer Use can cause a rebound congestion that can be difficult to resolve. 3. Afrin should be used every 10-12 hours only; using it more often increases the chance of developing a dependence on the medication and rebound congestion. 4. Afrin nasal spray is to be used intranasally; it is not an additive for a vaporizer.

Which statement best describes the scientific rationale for administering a mydriatic ophthalmic medication to a client diagnosed with glaucoma? 1. It constricts the pupil, which causes the pupil to dilate in low light. 2. It dilates the pupil to reduce the production of aqueous humor. 3. It decreases production of aqueous humor but does not affect the eye. 4. It is used as adjunctive therapy primarily to reduce intraocular pressure.

Answer: 2 Rationale: 1. Miotic medications, not mydriatic medications, constrict the pupil and block sympathetic nervous system input, which causes the pupil to dilate in low light and contracts the ciliary muscle. 2. Mydriatic medications dilate the pupil, reduce the production of aqueous humor, and increase the absorption effectiveness of aqueous humor, thus reducing intraocular pressure in open-angle glaucoma. 3. Beta-adrenergic blockers decrease the production of aqueous humor, which reduces intraocular pressure, but they do not affect pupil size and lens accommodation. 4. Carbonic anhydrase inhibitors are used as adjunctive therapy to reduce intraocular pressure.

Which statement by the nurse best describes the scientific rationale for how a non narcotic antitussive medication works in the body? 1. It suppresses the cough reflex by directly acting on the medulla of the brain. 2. It reduces the cough reflex by anesthetizing stretch receptors in the respiratory passages. 3. Non Narcotic antitussives slow down the destruction of sensitized mast cells. 4. It acts to block receptors for cysteinyl leukotrienes that prevent bronchoconstriction.

Answer: 2 Rationale: 1. Narcotic antitussives suppress the cough reflex by acting directly on the cough center in the medulla of the brain. 2. Non Narcotic antitussives reduce the cough reflex at its source by anesthetizing stretch receptors in the respiratory passages, lungs, and pleura and by decreasing their activity. 3. Slowing down the destruction of sensitized mast cells is the scientific rationale for administering Cromolyn, a mast cell inhibitor given to prevent asthma attacks. 4. Blocking receptors for cysteinyl leukotrienes is the scientific rationale for administering leukotrienes to reduce the symptoms of asthma.

The client with multiple mouth ulcers is prescribed Nystatin to swish and swallow. Which intervention should the nurse implement when administering this medication? 1. Instruct the client to swish the medication in the mouth and spit it out. 2. Encourage the client to swish the medication in the mouth for at least 2 minutes. 3. Tell the client to swish the mouth with normal saline after swallowing the medication. 4. Apply the Nystatin medication to the mouth ulcers with a sterile cotton swab.

Answer: 2 Rationale: 1. The client should swish the medication in the mouth for at least 2 minutes and then swallow the medication. 2. The client should swish the medication in the mouth for at least 2 minutes and then swallow the medication. 3. The client should not swish the mouth with normal saline because the medication should remain in the mouth even after the medication is swallowed. 4. This is not the correct procedure for administering this medication.

The client diagnosed with tuberculosis is administered rifampin (Rifadin), an antitubercular medication. Which information should the nurse discuss with the client? 1. Instruct the client to consume fewer dark-green, leafy vegetables. 2. Explain that the client's urine and other body fluids will turn orange. 3. Encourage the client to stop smoking cigarettes while taking this medication. 4. Tell the client to increase fluid intake to 3000 mL a day.

Answer: 2 Rationale: 1. The consumption of dark-green, leafy vegetables will not affect this medication. 2. The client should be informed that this medication turns the urine and body secretions orange and can dis-color contact lenses. This is not harmful to the client. 3. The client should be encouraged to stop smoking for general health reasons, but smoking will not affect this medication. 4. Increasing fluid intake has no bearing on taking this medication.

Which statement indicates that the mother understands the procedure for administering otic drops to the child who has otitis media? 1. "I should clean my child's ear canal very gently with cotton swabs." 2. "I will warm the drops to room temperature before instilling them." 3. "I can place a heating pad over my child's ear after putting in drops." 4. "I need to place the dropper gently into my child's ear canal."

Answer: 2 Rationale: 1. The mother should never attempt to place anything inside the ear to clean the canal because the risk of rupturing the tympanic membrane is high. 2. Cold otic drops cause pain when they come in contact with the tympanic membrane. Therefore, otic solutions should be allowed to warm to room temperature before being administered. 3. A heating pad could cause the tympanic membrane to rupture. The mother should not put heat or cold over the ear. 4. The dropper should not be placed in the ear canal; the dropper should be held over the canal when releasing the drops into the canal.

The client diagnosed with chronic obstructive pulmonary disease (COPD) is prescribed morphine sulfate (MS Contin). Which statement is the scientific rationale for prescribing this medication? 1. MS Contin will depress the respiratory drive. 2. Morphine dilates the bronchi and improves breathing. 3. MS Contin is not addicting, so it can be given routinely. 4. Morphine causes bronchoconstriction and decreased sputum.

Answer: 2 Rationale: 1. The nurse does not administer medications to decrease the respiratory drive for any client—especially not one diagnosed with pulmonary disease. 2. Morphine is a mild bronchodilator, and the continuous-release formulation provides a sustained effect for the client. 3. All forms of morphine can be addicting. 4. Bronchoconstriction would increase the client's difficulty in breathing and trap sputum below the constricted bronchi.

The client with nasal congestion is prescribed nasal solution. Which information should be included in the medication teaching? 1. Direct the solution toward the base of the nasal cavity. 2. Tell the client to blow the nose prior to instilling solution. 3. Replace remaining nasal solution in the dropper back into the bottle. 4. Have the client squeeze the nostrils shut after instilling nasal solution.

Answer: 2 Rationale: 1. The solution should be directed laterally toward the midline of the superior concha of the ethmoid bone, not at the base of the nasal cavity because then it will run down the throat and into the eustachian tube. 2. The client should blow his or her nose to clear the nasal passages prior to instilling the nasal solution. 3. The client should discard any solution remaining in the dropper. 4. The client should not squeeze the nostrils but should remain with the head tilted for5 minutes after instilling the nasal solution.

The nurse observes the unlicensed assistive personnel (UAP) performing delegated tasks. Which action by the UAP requires immediate intervention? 1.The UAP measures the output of a client who had a transurethral resection of the prostate. 2.The UAP tells the client whose urine is green that something must be wrong for the urine to be such an odd color. 3.The UAP encourages the client to drink a glass of water after the nurse administered the oral antibiotic. 4.The UAP assists the client diagnosed with a urinary tract infection to the bedside commode every 2 hours.

Answer: 2 Rationale: 1. The urinary output should be measured frequently in a client who has had a transurethral resection of the prostate. The client will have bladder irrigation and the indwelling catheter bag will need to be emptied frequently. The nurse would not intervene to stop this action. 2.A green-blue color indicates the client is taking bethanechol (Urecholine), urinary stimulant used for clients with neurogenic bladder. This is an expected color, and the UAP should not indicate that something is wrong with the client. 3. The client should be encouraged to drink fluids. The nurse would not intervene to stop this action. 4. This action encourages bowel and urine incontinence and is part of a falls prevention protocol. The nurse would not intervene to stop this action.

The client with chronic reactive airway disease is taking the leukotriene receptor inhibitor montelukast (Singulair). Which statement by the client warrants intervention by the nurse? 1. "I have been having a lot of headaches lately." 2. "I have started taking an aspirin every day." 3. "I keep this medication up on a very high shelf." 4. "I must protect this medication from extreme temperatures."

Answer: 2 Rationale: 1. These drugs are generally safe and well-tolerated, with a headache being the most common side effect; therefore, this statement would not warrant intervention by the nurse. 2. This medication interacts with aspirin, warfarin, erythromycin, and theophylline; therefore, this statement warrants further intervention by the nurse. 3. All medications should be kept out of the reach of children, and keeping the medication on a high shelf would not warrant intervention by the nurse. 4. This medication does not need to be kept from extreme temperatures; it is the anti-asthmatic zafirlukast (Accolate) that must be protected from extremes of temperature, light, and humidity.

The client's arterial blood gas results are pH 7.48, PaO2 98, PCO2 30, and HCO3 24.Which intervention is most appropriate for this client? 1. Administer oxygen 10 L/min via nasal cannula. 2. Administer an anti anxiety medication. 3. Administer 1 ampule of sodium bicarbonate IVP. 4. Administer 30 mL of an antacid.

Answer: 2 Rationale: 1. This client is in respiratory alkalosis, which is caused by hyperventilating. Oxygen would not be helpful in treating this client. 2. This client is in respiratory alkalosis, which is caused by hyperventilation and could be the result of anxiety, elevated temperature, or pain. The nurse should assess the cause and administer the appropriate medication. 3. Sodium bicarbonate is the drug of choice for metabolic acidosis and this is respiratory alkalosis. This medication is an alkaline substance and would increase the client's alkalosis. 4. An antacid would not help treat respiratory alkalosis because it is also an alkaline substance.

Which data indicates the antibiotic therapy has not been successful for a client diagnosed with a bacterial pneumonia? 1. The client's hematocrit is 45%. 2. The client is expectorating thick, green sputum. 3. The client's lung sounds are clear to auscultation. 4. The client has no complaints of pleuritic chest pain.

Answer: 2 Rationale: 1. This hematocrit is normal, but this does not indicate that the client is responding to the antibiotics. 2. Thick, green sputum is a symptom of pneumonia, which indicates the antibiotic therapy is not effective. If the sputum were changing from a thick, green sputum to a thinner, lighter-colored sputum, it would indicate an improvement in the condition. 3. The symptoms of pneumonia include crackles and wheezing in the lung fields. Clear lung sounds indicate an improvement in the pneumonia and that the medication is effective. 4. Pleuritic chest is a symptom of pneumonia, and no chest pain indicates the medication is effective.

The primary nurse is administering antibiotic otic drops to a 2-year-old child. Which action by the primary nurse warrants intervention by the charge nurse? 1. The primary nurse asks the mother if the child has any known allergies. 2. The primary nurse dons nonsterile gloves before inserting the otic drops. 3. The primary nurse washes his or her hands prior to administering medication. 4. The primary nurse gets assistance to restrain the child when giving otic drops.

Answer: 2 Rationale: 1. This indicates the nurse understands the correct procedure for administering otic drops; therefore, this does not warrant intervention by the charge nurse. 2. This procedure does not warrant wearing nonsterile gloves because the nurse will not come into contact with any blood or body fluids. The nurse should wash his or her hands and administer medication. This action warrants intervention by the charge nurse. 3. This is correct procedure prior to administering medications; therefore, this action does not warrant intervention by the charge nurse. 4. Assistance in restraining a young child might be necessary; therefore, this would not warrant intervention by the charge nurse.

The nurse is preparing to administer medications on a pulmonary unit. Which medication should the nurse administer first? 1. Prednisone, a glucocorticoid, for a client diagnosed with chronic bronchitis. 2. Oxygen via nasal cannula at 2 L/min for a client diagnosed with pneumonia. 3. Lactic acidophilus (Lactinex) to a client receiving IVPB antibiotics. 4. Cephalexin (Keflex), an antibiotic, to a client being discharged.

Answer: 2 Rationale: 1. This is an oral preparation and one that can be given daily; this is not the first medication to be administered. 2. Oxygen is considered a medication and should be a priority whenever it is ordered. A client diagnosed with pneumonia will have some amount of respiratory compromise, and the ordered 2 L/min indicates a client with a chronic lung disease. This is the priority medication. 3. Lactinex is administered to replace the good bacteria in the body destroyed by the antibiotic, but it does not need to be administered first. 4. Keflex is an oral antibiotic, but this client is being discharged, indicating the client's condition has improved. This client could wait until the oxygen is initiated. MEDICATION MEMORY JOGGER: Oxygen is a medication, and the nurse should remember basic principles that apply to oxygen administration. The test taker would choose the correct answer based on Maslow's Hierarchy of Needs and breathing/oxygen is the priority.

The child diagnosed with reactive airway disease is prescribed a cromolyn inhaler. The mother asks the nurse to explain how this medication helps control her child's asthma. Which statement is the best explanation to give to the mother? 1. This medication diminishes the mediator action of leukotrienes. 2. This medication blocks the release of mast cell mediators. 3. This medication causes relaxation of the bronchial smooth muscle. 4. This medication decreases bronchial airway inflammation.

Answer: 2 Rationale: 1. This is the explanation for administering leukotriene blockers. 2. This is the correct explanation for administering a cromolyn inhaler; it prevents the asthma attack by blocking the release of mast cell mediators. 3. This is the explanation for administering theophylline, a bronchodilator. 4. This is the explanation for administering glucocorticoids, such as prednisone.

Which statement best describes the scientific rationale for administering aluminum hydroxide (Amphojel), an antacid, to a client in chronic kidney disease (CKD)? 1.This medication neutralizes gastric acid production. 2.It binds to phosphorus to help decrease hyperphosphatemia. 3.The medication is administered to decrease the calcium level. 4.It will help decrease episodes of constipation in the client with CKD.

Answer: 2 Rationale: 1. This is the scientific rationale for administering antacids to clients with peptic ulcer disease or gastritis, not clients with chronic kidney disease. 2.Clients in CKD experience an increase in serum phosphorus levels (hyperphosphatemia), and aluminum hydroxide binds with phosphorus to be excreted in feces. 3.Amphojel does not affect the calcium level. 4.Aluminum hydroxide can cause constipation; it is not used to treat constipation.

The client diagnosed with a pulmonary embolus (PE) is receiving intravenous heparin, and the HCP prescribes 5 mg warfarin (Coumadin) orally once a day. Which statement best explains the scientific rationale for prescribing these two anticoagulants? 1. Coumadin interferes with production of prothrombin. 2. It takes 3-5 days to achieve a therapeutic level of Coumadin. 3. Heparin is more effective when administered with warfarin. 4. Coumadin potentiates the therapeutic action of heparin.

Answer: 2 Rationale: 1. This is the scientific rationale for why Coumadin is prescribed to prevent thrombus formation, but it is not the rationale for why the medications are administered together. 2. Heparin has a short half-life and is prescribed as soon as a PE is suspected. The client must go home having taken an oral anticoagulant such as Coumadin, which has a long half-life and needs at least 3-5 days to reach a therapeutic level. Discontinuing the heparin prior to achieving a therapeutic level of Coumadin places the client at risk for another PE. 3. Heparin and warfarin work in different steps in the bleeding cascade. 4. This is a false statement; heparin and warfarin work in different steps in the bleeding cascade.

A client is diagnosed with a pulmonary embolism. Which pathophysiological process can cause this client to develop right heart failure? a.Decrease in alveolar surfactant b.Bronchoconstriction in the affected area of the lung c.Neurohumoral reflexes increasing pulmonary vascular resistance d. Fibrinolytic system dissolving the clot

Answer: C Rationale: In pulmonary embolism, neurohumoral reflexes triggered by obstruction cause vasoconstriction that increases pulmonary vascular resistance. This can lead to pulmonary hypertension and right ventricular heart failure. Choice A can lead to atelectasis. Choice B can lead to dead spacing of the lung. Choice D is a process that can occur if a small embolism does not infarct lung tissue. The fibrinolytic system dissolves the clot and pulmonary function returns to normal.

The 3-year-old female child is diagnosed with acute otitis media. Which statement by the mother indicates the medication teaching has not been effective? 1. "I will be sure and take my daughter to her follow-up appointment with her doctor." 2. "My son starting pulling at his ears so I gave him some of my daughter's antibiotics." 3. "I will give my daughter all of the medication, even if she starts feeling better." 4. "If my daughter does not get better in 48 hours, I will call her health-care provider."

Answer: 2 Rationale: 1. This statement indicates the mother understands the medication teaching. Clients should keep all follow-up appointments. 2. Antibiotics are prescribed for a specific condition for a specific client. The mother should not give antibiotics prescribed for her daughter to her son. The mother does not understand the medication teaching. 3. The entire prescription of antibiotics should be taken whether the client is feeling better or not 4. After 2 days of antibiotic therapy, the child should start feeling better. This statement indicates the mother understands the medication teaching.

The nurse is administering medication to a client who has had a kidney transplant and is taking cyclosporine, anti rejection medication. Which medication should the nurse question administering? 1.The ACE inhibitor captopril (Capoten). 2.The antibiotic trimethoprim-sulfamethoxazole (Bactrim DS). 3.The analgesic acetaminophen (Tylenol). 4.The antiemetic prochlorperazine (Compazine).

Answer: 2 Rationale: 1.ACE inhibitors would not be questioned in clients with kidney transplants or taking cyclosporine. 2.Bactrim reduces cyclosporine levels, which can lead to organ rejection; therefore, the nurse should question administering this medication. 3.Tylenol is not contraindicated in clients with kidney transplants; it is contraindicated in clients with liver disorders. 4.Compazine is not contraindicated in clients with kidney transplants; it is contraindicated in clients with a liver disorder.

The client diagnosed with renal calculi is receiving pain medication via morphine patient-controlled analgesia (PCA). The client is still voicing excruciating pain and is requesting something else. Which intervention should the nurse implement first? 1.Administer the rescue dose of morphine intravenous push. 2.Check the client's urine for color, sediment, and output. 3.Determine the last time the client received PCA morphine. 4.Demonstrate how to perform guided imagery with the client.

Answer: 2 Rationale: 1.Administering the rescue of morphine is an appropriate intervention, but it is not the nurse's first action. 2.Assessing the client and ruling out any complications is the nurse's first intervention. 3. The nurse should determine the last time the client receives morphine and the amount of morphine the client has received, but it is not the first intervention. 4.Nonpharmacological interventions are appropriate to address the client's pain, but they should not be implemented first for a client with renal calculi.

Which statement made by the wife of a client diagnosed with Parkinson's disease(PD) indicates the medication teaching is effective? 1."The medications will control all the symptoms of the PD if they are taken correctly." 2."The medications provide symptom management, but the effects may not last." 3."The medications will have to be taken for about 6 months and then stopped." 4."The medications must be tapered off when he is better, or he will have a relapse."

Answer: 2 Rationale: 1.All the symptoms may not be controlled even if the client adheres to a strict medication regimen. 2.PD is treated with medications and surgery. The medications have side effects and adverse effects, and the effectiveness of the medications may be reduced over time. 3.The client diagnosed with PD will need to take the medications for life unless surgery is performed, and a significant improvement is achieved. 4.The medications do not have to be tapered when discontinued.

Which statement is the scientific rationale for prescribing and administering donepezil (Aricept), a cholinesterase inhibitor? 1.Aricept works to bind the dopamine at neuron receptor sites to increase ability. 2.Aricept increases the availability of acetylcholine at cholinergic synapses. 3.Aricept decreases acetylcholine in the periphery to increase movement. 4.Aricept delays transmission of acetylcholine at the neuronal junction.

Answer: 2 Rationale: 1.Aricept does not bind dopamine. 2.Cholinesterase inhibitors increase the availability of acetylcholine at cholinergic synapses, resulting in increased trans-mission of acetylcholine by cholinergic neurons that have not been destroyed by the Alzheimer's disease. 3.Aricept does not decrease acetylcholine in the periphery. 4.Aricept enhances the availability of acetyl-choline at the receptor sites.

The client diagnosed with late-stage Alzheimer's disease is agitated and having delusions. Which medication should the nurse anticipate the health-care provider prescribing? 1.The cholinesterase inhibitor donepezil (Aricept). 2.The antipsychotic medication haloperidol (Haldol). 3.The selective serotonin reuptake inhibitor fluoxetine (Prozac). 4.The tricyclic antidepressant amitriptyline (Elavil).

Answer: 2 Rationale: 1.Aricept is prescribed in the early stages of Alzheimer's disease but would not be effective in the late stages. 2.Delusions and agitation respond to antipsychotic medications. Haldol has been used and has proved to be effective in treating these symptoms, so the nurse should anticipate this prescription. 3.SSRIs are useful in treating the depression of Alzheimer's, but these symptoms do not indicate depression. 4.Tricyclic antidepressants have significant anticholinergic actions and may intensify the symptoms of Alzheimer's disease; therefore, the nurse would not anticipate this being prescribed.

The client diagnosed with Parkinson's disease is prescribed the antiviral drug amantadine (Symmetrel). Which information should the nurse teach the client? 1.Do not get the flu vaccine because there may be interactions. 2.If the symptoms return, the client should notify the HCP. 3.The dose should be decreased if taking other PD medications. 4.If a dry mouth develops, discontinue the medication immediately.

Answer: 2 Rationale: 1.Clients diagnosed with chronic illnesses should receive the flu vaccination. There is no reason not to get the flu vaccine when receiving amantadine. 2.The effectiveness of amantadine may diminish in 3-6 months. If signs and symptoms of Parkinson's disease recur, the client should notify the HCP. 3.Amantadine can enhance the response of the other PD medications and is given in the same dosage as if given alone. 4.A dry mouth is a side effect, not an adverse effect. The client should be taught to chew sugarless gum or hard candies to relieve the dry mouth.

When working with women who are taking hormonal birth control, what health promotion measures should the nurse teach to prevent possible pulmonary embolism (PE)? (Select all that apply.) a.Avoid drinking alcohol. b.Eat more omega-3 fatty acids. c. Exercise on a regular basis. d. Maintain a healthy weight. e.Stop smoking cigarettes.

Answer: C, D, E

The nurse is administering medications to clients on a urology floor. Which medication should the nurse question? 1. Ceftriaxone (Rocephin), a third-generation cephalosporin, to a client who is pregnant. 2. Cephalexin (Keflex), a cephalosporin, to a client who is allergic to penicillin. 3. Trimethoprim sulfa (Bactrim), a sulfa antibiotic, to a client post-prostate surgery. 4. Nitrofurantoin (Macrodantin), a sulfa antibiotic, to a client with urinary stasis.

Answer: 2 Rationale: 1.Rocephin is in the pregnancy risk category B. No research has shown harm to the fetus in humans or in animals. The nurse would not question this medication. 2.A cross-sensitivity exists in some clients between penicillin and the cephalosporins. The nurse should assess the type of reaction that the client experienced when taking penicillin. If The client indicates any symptom of anaphylactic reaction, the nurse would hold the medication and discuss the situation with the HCP. 3.There is no reason for the nurse to question Bactrim for a client who has had prostate surgery. 4.There is no reason for the nurse to question Macrodantin for a client who has urinary stasis. Macrodantin is used to prevent or treat chronic urinary tract infections.

The client diagnosed with a stroke has been prescribed phenytoin (Dilantin), an anticonvulsant. Which statement explains the scientific rationale for prescribing this medication? 1.The client's stroke was caused by some damage to cerebral tissue. 2.The stroke caused damage to the brain tissue that could result in seizures. 3.Hemorrhagic strokes leave residual blood in the brain that causes seizures. 4.This medication can help the client with cognitive deficits think more clearly.

Answer: 2 Rationale: 1.Strokes cause damage to the cerebral tissue; the brain does not cause the damage to itself. 2.Stroke-caused loss of function in areas of the brain leads to a problem with nerve impulse transmission; this blocked transmission can initiate a seizure. 3.If the client survives a hemorrhagic stroke, the body will reabsorb the blood. There should not be any residual blood. 4.Anticonvulsants do not increase cognitive ability.

The preterm infant is receiving synthetic surfactant. Which data indicates the medication is effective? 1.The infant's heel stick capillary blood glucose level is 90 mg/dL. 2.The infant's arterial blood gases are within normal limits. 3.The positive end-expiratory pressure (PEEP) on the ventilator is turned off. 4.The infant's pulse oximeter reading fluctuates between 90% and 92%.

Answer: 2 Rationale: 1.Synthetic surfactant does not affect the infant's blood glucose level. 2.Synthetic lung surfactant coats the alveoli and prevents collapse of the lung by reducing the surface tension of pulmonary fluids. Normal ABGs indicate the lungs are adequately oxygenating the body, which means the medication is effective. 3.PEEP cannot be used on a newborn because it increases intrathoracic pressure and increases the risk for pneumothorax. 4.Pulse oximeter readings measure peripheral oxygenation and should be greater than 93%, which indicates the client's arterial oxygen level would be above 80. A 90% to 92% pulse oximeter reading indicates hypoxia and that the medication is not effective.

The client diagnosed with a brain tumor is being admitted to the medical oncology unit at 2000. Which health-care provider's order should be implemented first? 1.Regular soft diet with between-meal snacks. 2.Dexamethasone (Decadron), a steroid, every 6 hours IVP. 3.Prochlorperazine (Compazine), an antiemetic, a.c. 4.CBC and chemistry panel laboratory tests.

Answer: 2 Rationale: 1.The diet is not a priority over preventing increased intracranial pressure resulting from the tumor. It is 2000, or 8 P.M., and meals are usually served in hospitals around 0800, 1200, and 1700. The next meal will be served at 0800. 2.Dexamethasone is the glucocorticoid of choice for brain swelling. The client is at risk for increased intracranial pressure as a result of the tumor and edema caused by the tumor. The nurse should administer the steroid first to initiate the positive effects of the medication. 3.This medication is ordered a.c., which means "before meals." The next dose of this medication is not until 0730. 4.These are routine laboratory tests and will not be drawn until the next morning.

The nurse is administering medications at 1600. Which medication should the nurse administer first? 1.Humalog insulin for a client with a blood glucose level of 200 mg/dL. 2.Meperidine (Demerol), a narcotic analgesic, for a client with a headache rated an 8. 3.Divalproex (Depakote ER) for a client diagnosed with migraine headaches. 4.Metoclopramide (Reglan), an antiemetic, for a client with gastric stasis.

Answer: 2 Rationale: 1.The meal trays are usually served between1630 and 1700 on most nursing units. Humalog has an onset of action of 5-7 minutes. The nurse should not administer this insulin until closer to the time for the meal to be served. 2.Demerol is used to treat severe migraine headaches when other measures have not been effective. This client needs the medication as soon as possible (pain is rated as 8), and this should be the first medication administered. 3.Depakote ER is used to prevent migraine headaches in the extended-release form. This medication would not be administered prior to treating a headache that is occurring. 4.Reglan is given for nausea and vomiting and to relieve gastric stasis in clients with a migraine headache. The option did not say that the client was vomiting at this time. A headache rated as an 8 would be priority.

The client diagnosed with Parkinson's disease has been on long-term levodopa (L-dopa), an anti-Parkinson's disease drug. Which data supports the rationale for placing the client on a "drug holiday"? 1.The medication is expensive and difficult to afford for clients on a fixed income. 2.The therapeutic effects of the drug have diminished, and the adverse effects have increased. 3.The client has developed hypertension that is uncontrolled by medication. 4.An overdose is being taken and the medication needs to clear the system.

Answer: 2 Rationale: 1.The medication is not interrupted for this reason. 2.With long-term use of levodopa, the adverse effects tend to increase, and the client may develop a drug tolerance where the therapeutic effects decrease. A short hiatus from the medication (10 days) may result in beneficial effects being achieved with lower doses. 3.Early in the treatment of PD with levodopa the client may have postural hypotension, but hypertension is not associated with levodopa. 4.An overdose is not being taken; the client's tolerance to the medication has changed.

A client is on intravenous heparin to treat a pulmonary embolism. The client's most recent partial thromboplastin time (PTT) was 25 seconds. What order should the nurse anticipate?

Answer: Increase the heparin rate.

The client diagnosed with Parkinson's disease who is taking selegiline (Eldepryl) has had hip surgery and is being admitted to the orthopedic department. The nurse is transcribing the postoperative orders. Which postoperative order should the nurse question? 1.The low-molecular-weight heparin enoxaparin (Lovenox). 2.The narcotic analgesic meperidine (Demerol). 3.The MAO-B inhibitor selegiline (Eldepryl). 4.The prophylactic broad-spectrum antibiotic cefazolin (Ancef).

Answer: 2 Rationale: 1.The nurse would expect the client to be taking a prophylactic anticoagulant to prevent deep-vein thrombosis secondary to bed rest. 2.Meperidine can cause a dangerous interaction with selegiline (Eldepryl), resulting in stupor, rigidity, agitation, and hyperthermia. The nurse would question administering meperidine because the client is receiving selegiline for the Parkinson's disease and it cannot be discontinued abruptly. 3.This is a medication routinely prescribed for the treatment of Parkinson's disease and the nurse should not question administering it because it cannot be discontinued abruptly. 4.Prophylactic antibiotics should be prescribed for a client undergoing surgery; therefore, the nurse would not question this medication.

The school nurse is teaching a class on sexually transmitted infections to a group of high school students. Which statement provides accurate information regarding treatment of sexually transmitted infections? 1.Medications are available to cure STIs if the client is not allergic. 2.Medications will not cure all sexually transmitted infections. 3.Medications that prevent pregnancy will prevent most STIs. 4.Medications that treat STIs enhance sexual libido.

Answer: 2 Rationale: 1.There are no medications, whether the client is allergic or not, available to cure the herpes simplex 2 virus and the human immunodeficiency virus (HIV). This is a false statement but one that teenagers would like to believe because of their feelings of invincibility. 2.There are no medications available to cure the herpes simplex 2 virus and the human immunodeficiency virus (HIV).There are many medications available to treat the problems associated with these STIs, and they provide hope for the client, but the students must be aware of the long-term ramifications of STIs. 3.Birth control medications provide no protection against an STI. They may increase the chance of acquiring an STI because the fear of pregnancy is removed, making sexual activity more likely. 4.Antibiotics have side effects and the medications for HIV infections have especially strong associated side effects and adverse reactions. The side effects and adverse reactions are more likely to decrease libido than to enhance it.

The nurse is preparing a care plan for a client diagnosed with Parkinson's disease. Which statement is the goal of medication therapy for the client diagnosed with Parkinson's disease? 1.The medication will cure the client of Parkinson's disease. 2.The client will maintain functional ability. 3.The client will be able to take the medications as ordered. 4.The medication will control all symptoms of Parkinson's disease.

Answer: 2 Rationale: 1.There is currently no cure for Parkinson's disease. 2.The goal for most clients diagnosed with a chronic disease is to maintain functional ability as long as possible. 3.Taking the medications as ordered does not guarantee a positive response by the client's body to the medication and thus is not a goal of the medication therapy. 4.All the symptoms may not be controlled; in fact, the medications may exacerbate the symptoms or create new symptoms.

The client with epilepsy is seen in the clinic and has a serum Dilantin level of 5.4 mg/dL. Which intervention should the nurse implement first? 1.Request that the laboratory verify the results of the test. 2.Ask the client when the dose was taken last. 3.Instruct the client to not take the Dilantin for 2 days. 4.Discuss the need to increase the dose of the medication.

Answer: 2 Rationale: 1.There is no indication of a reason for verifying the serum Dilantin level. 2.This level is below the therapeutic range of 10-20 mg/dL; therefore, the nurse should determine if the client is taking the medication as directed. 3.This is below the therapeutic range; there-fore, the medication should not be omitted. 4.Because this level is below therapeutic range, the nurse must determine how the medication is being taken before discussing the need to increase the dose.

The female client diagnosed with epilepsy tells the nurse, "I am very scared to get pregnant since I am taking medication for my epilepsy." Which statement is the nurse's best response? 1."You are scared because you take medication for your epilepsy." 2."Can you tell me more about what is concerning you?" 3."You should not get pregnant when you are taking anticonvulsants." 4."Have you discussed your concerns with your health-care provider?"

Answer: 2 Rationale: 1.This is a therapeutic response that is used to encourage the client to ventilate feelings, but the nurse should provide factual information to this client. 2.The nurse should explore the reasons for the client's fears in order to be able to give her information that would help her make a decision about becoming pregnant since many anticonvulsant medications have teratogenic properties. 3.A female client with epilepsy can give birth to a normal infant. 4.The client should discuss a potential pregnancy with the significant other, but this is not addressing the client's concerns.

The home health-care nurse is caring for a client taking donepezil (Aricept), a cholinesterase inhibitor. Which finding indicates the medication is effective? 1.The client is unable to relate his or her name or birth date. 2.The client is discussing an upcoming event with the family. 3.The client is wearing underwear on the outside of the clothes. 4.The client is talking on a telephone that is signaling a dial tone.

Answer: 2 Rationale: 1.This may not indicate a decrease in abilities, but it definitely does not indicate an improvement in cognitive abilities, which is what the question is asking. 2.Cholinesterase inhibitors are prescribed to increase cognitive ability for clients diagnosed with AD. Discussing an up-coming event indicates the client is able to focus on a topic and remember that something will happen in the future. 3.This may not indicate a decrease in abilities, but it definitely does not indicate an improvement in cognitive abilities, which is what the question is asking. 4.This may not indicate a decrease in abilities, but it definitely does not indicate an improvement in cognitive abilities, which is what the question is asking.

The client with a brain tumor is complaining of headache that is a 5 on a scale of 1-10. The client's medication administration record (MAR) has acetaminophen(Tylenol) 2 po PRN pain, hydrocodone (Vicodin) 2 po PRN pain, morphine 4 mgIVP PRN pain, and lorazepam (Ativan) 1 mg IVP PRN. Which medication should the nurse prepare to administer? 1.Tylenol 2 tablets. 2.Vicodin 2 tablets. 3.Morphine 4 mg IVP. 4.Ativan 1 mg IVP.

Answer: 2 Rationale: 1.Tylenol, a nonnarcotic analgesic, is useful in the relief of mild to moderate pain, 1-3 on the pain scale. 2.Vicodin, a narcotic analgesic, is equivalent to codeine. It is useful for the relief of moderate to severe pain, 4-6 on the pain scale. This client has a brain tumor, which would include increasing intracranial pressure and pain. Therefore, this would be the most appropriate medication at this time. 3.Morphine, a narcotic analgesic, IVP, is a potent analgesic and used to treat severe pain, 7-10 on the pain scale. 4.Ativan, an antianxiety medication, is not used to treat pain.

The client diagnosed with history of a gastric ulcer is having a transient ischemic attack (TIA) and is prescribed a daily 325-mg aspirin. Which information should the nurse to discuss with the client? Select all that apply. 1.Encourage the client to take aspirin with one glass of water. 2.Notify the health-care provider if ringing in the ears occurs. 3.Instruct the client to take an enteric-coated brand of aspirin. 4.Notify the health-care provider if the client has black, tarry stools. 5.Explain that gastrointestinal distress is expected when taking aspirin.

Answer: 2, 3, 4 Rationale: 1.Aspirin does not need to be taken with a glass of water; it should be taken with food if it is not enteric-coated. 2.Tinnitus, ringing in the ears, is a sign of aspirin toxicity, and the client should notify the HCP. 3.Because the client has a history of a gastric ulcer, the client should take an enteric-coated aspirin to ensure that the medication will not dissolve in the stomach and potentially cause gastric irritation leading to bleeding. 4.If the client has black, tarry stools the health-care provider should be notified because this is a sign of gastric bleeding. Gastrointestinal distress is not expected with taking aspirin and should be reported to the HCP. It is a serious side effect of aspirin. 5. Gastrointestinal distress is not expected with taking aspirin and should be reported to HCP. It is a serious side effect of aspirin.

The client with a head injury is ordered a CT scan of the head with contrast dye. Which statements by the client warrant immediate intervention? Select all that apply. 1."I take Tenormin for my high blood pressure." 2."I am allergic to many types of fish." 3."I get nauseated whenever I take aspirin." 4."I am taking Glucophage for my diabetes." 5."I had about three beers before I fell and hit my head."

Answer: 2, 4 Rationale: 1.Antihypertensive medication would not interfere with the contrast dye that is used when performing a CT scan. 2.The contrast dye used in a CT scan is iodine based, and an allergy to shellfish suggests an allergy to iodine and would warrant the nurse notifying the HCP to cancel the contrast part of the CT scan. Further assessment would be needed. 3.Aspirin would not interfere with the contrast dye that is used when performing a CT scan. 4.Metformin (Glucophage) must not be taken because the kidneys remove metformin; contrast medium can greatly increase the level of metformin in the blood because damaged kidneys are notes effective at removing metformin from the body. 5.Alcohol is not contraindicated when per-forming a CT scan.

The client diagnosed with benign prostatic hypertrophy has had a transurethral resection of the prostate (TURP). The client is complaining of lower abdominal pain. Which interventions should the nurse implement? Rank in order of performance. 1.Administer the prescribed morphine by slow IVP. 2.Check the urinary catheter for drainage and clots. 3.Determine if the client has a hard, rigid abdomen. 4.Adjust the saline irrigation to flush the bladder. 5.Dilute the morphine with several milliliters of normal saline.

Answer: 2, 4, 3, 5, 1 Rationale: 2. The most obvious reason for a client post-TURP to be having lower abdominal pain is that the bladder has blood clots that need to be flushed out. Clots that are not flushed from the bladder result in bladder spasms. Assessing the urinary drainage would be the first step. 4. The next step is to adjust the rate of the irrigation to ensure adequate drainage of blood and clots from the bladder. 3.Before administering a narcotic analgesic the nurse should rule out complication. Assessing for peritonitis(hard, rigid abdomen) is the next step in this situation. 5.Morphine and most other narcotic medications require a very slow intravenous rate, around 5 minutes, according to the manufacturer's recommendations. The morphine is dispensed in 1-mL tubex syringes or vials. It is difficult to maintain a steady, slow administration of the medication with only 1 mL over 5 minutes. If the medication is diluted to a total volume of 10 mL, then the nurse can administer the medication at a rate of 1 mL every 30 seconds. Dilution causes less pain for the client and helps decrease irritation to the vein. 1. The final step in this sequence is to actually administer the analgesic.

The nurse is preparing to administer an IVPB antibiotic to a client diagnosed with pneumonia; 10 mL of the medication is mixed in 100 mL of saline. At what rate would the nurse set the pump to infuse the medication in 30 minutes?

Answer: 220 mL/hour Rationale: 220 mL/hour. The nurse should set the pump at 220 mL/hour.Pumps are set at an hourly rate.60 minutes divided by 30 equals 2.100 + 10 = 110110 multiplied by 2 = 220.

The client calls the clinic and tells the nurse that a live insect is in the client's right ear. Which intervention should the clinic nurse implement? 1. Encourage the client to get someone to remove the insect. 2. Instruct the client to put water into the ear canal. 3. Have the client put mineral oil into the ear canal. 4. Tell the client to put a medicated cotton ball in the ear.

Answer: 3 Rationale: 1. A live insect cannot be removed from the ear; the insect must be killed prior to removing the insect. 2. Water should not be inserted into the ear canal because organic foreign bodies such as an insect or bean will swell when water is inserted into the ear canal, which makes removal more difficult. 3. Mineral oil or topical lidocaine drops are used to immobilize or kill insects prior to their removal from the ear. 4. There is no such thing as medicated cotton balls available over the counter; therefore, this is not an appropriate action.

The client diagnosed with rule-out deep vein thrombosis (DVT) is experiencing dyspnea and chest pain on inspiration. On assessment, the nurse finds a respiratory rate of 40. Which medication should the nurse anticipate the health-care provider ordering? 1. Warfarin (Coumadin), an oral anticoagulant. 2. Enoxaparin (Lovenox), a low-molecular-weight heparin. 3. Heparin, an intravenous anticoagulant. 4. Ticlopidine (Ticlid), an antiplatelet medication.

Answer: 3 Rationale: 1. An oral anticoagulant would not be prescribed in an acute situation. 2. Lovenox is prescribed prophylactically to prevent deep vein thrombosis. The client is currently experiencing a complication of DVT; therefore, the nurse should not anticipate an order for this medication. 3. Heparin is the medication of choice for treating a pulmonary embolism, which the nurse should suspect with these signs and symptoms. Intravenous Heparin will prevent further clotting. 4. Ticlid is a medication used to treat arterial, and venous, conditions. MEDICATION MEMORY JOGGER: Remember that antiplatelets work in the arteries and anticoagulants work in the veins.

The 4-year-old child with otitis media with effusion is not prescribed systemic antibiotics. The mother asks the nurse, "Why didn't the doctor order antibiotics for my child?" Which statement is the nurse's best response? 1. "Your child is too young to receive antibiotics." 2. "You should discuss this with your child's health-care provider." 3. "Because your child did not have a fever the doctor did not order antibiotics." 4. "Most pediatricians prescribe ear drops instead of antibiotics."

Answer: 3 Rationale: 1. Any age child can receive antibiotics. 2. This is "passing the buck," and the nurse should answer the mother's question 3. Otitis media with effusion differs from acute otitis media in that there are no signs of acute infection. If there are no signs of infection, such as fever or pain, the nurse should explain that, with the emergence of antimicrobial-resistant organisms, recent recommendations discourage antibiotic use for otitis media with effusion because 50% of effusions will resolve on their own. 4.Acute otitis media with symptoms is treated with 5-7 days of oral antibiotics.

The client diagnosed with glaucoma is prescribed betaxolol (Betoptic), a beta-adrenergic blocker, ophthalmic drops. Which information should the nurse discuss with the client? 1. Instruct the client to call the HCP if dizziness occurs when getting up too fast. 2. Discuss that the drops will cause the vision to get worse initially. 3. Teach the client how to prevent orthostatic hypotension. 4. Explain the importance of applying pressure at the outer canthus.

Answer: 3 Rationale: 1. Betoptic is a beta blocker that if absorbed systemically may cause bradycardia and hypotension. The nurse should discuss ortho-static hypotension with the client, but there is no need for the client to call the HCP. 2. If the vision gets worse, the client should call the HCP because this is an adverse reaction that warrants intervention. 3. This is a beta blocker that if absorbed systemically may cause bradycardia and hypotension. The nurse should discuss ways to prevent orthostatic hypotension. 4. The client should apply pressure at the inner canthus (closest to nose) to help prevent systemic absorption of the medication.

The client with asthma asks the nurse, "Why should I use the corticosteroid inhaler instead of prednisone?" Which statement by the nurse is most appropriate? 1. "The lungs are incapable of utilizing prednisone to decrease inflammation." 2. "The inhaler costs less than the prednisone, which is why it should be used." 3. "The inhaler will not cause the systemic problems that prednisone does." 4. "Prednisone is not on your insurance formulary and the inhaler is."

Answer: 3 Rationale: 1. Prednisone, frequently prescribed, is a systemic anti-inflammatory medication that has many side effects. The inhaler doesn't have systemic effects, which is why the inhaler is preferred. 2. The cost of the medication does not have a bearing on why one route of medication should be used instead of another. 3. The steroid inhaler does not cause the systemic problem of suppression of the adrenal gland and exposure of cells of the body to excess cortisol. The inhaler delivers the anti-inflammatory medication directly to the lungs, where effects are desired. 4. Insurance should not be the reason for deciding which route of medication a client should be prescribed.

The child with an acute asthma attack is prescribed a 7-day course of the systemic corticosteroid prednisolone. The mother asks the nurse, "Doesn't this medication cause serious side effects?" Which statement is the nurse's best response? 1."Yes, this medication does have serious side effects, but your child needs the medication." 2."The doctor would not have ordered a medication that has serious side effects." 3."A short-term course of steroids will not cause serious side effects." 4."There may be serious side effects if your child takes the medication for a long time."

Answer: 3 Rationale: 1. Prolonged glucocorticoid therapy can cause serious adverse effects such as adrenal suppression, osteoporosis, hyperglycemia, and peptic ulcer disease. Short-term use does not cause these adverse effects. 2. Doctors often order medications that have serious side effects, but it must be done to treat the client. This statement is false andis not appropriate. 3. This is a true statement and the nurse's best response. 4. This is not the best response to the mother's question about her son's use of the medication. Prolonged glucocorticoid therapy can cause serious adverse effects, but short-term use does not cause the adverse effects.

The nurse is teaching the mother of a 9-year-old child with severe reactive airway disease. The child is prescribed salmeterol (Serevent) by metered dose inhaler (MDI) every 12 hours. Which instruction should the nurse include when discussing the medication with the mother? 1. Instruct the mother to perform and record a daily salmeterol level. 2. Inform the mother to notify the HCP if the child vomits or becomes irritable. 3. Tell the mother to observe the child for a sore throat and respiratory infection. 4. Recommend that the medication be refrigerated at all times.

Answer: 3 Rationale: 1. Serum salmeterol levels are not obtained. 2. This would apply to theophylline, not salmeterol. 3. Salmeterol is used when the client has not been responsive to other medications; side effects include pharyngitis and upper respiratory tract infections. The parent should be aware of the side effects. 4. Salmeterol does not need to be refrigerated.

The male client is admitted to the medical floor at 1200 with a diagnosis of pyelonephritis. Which intervention should the nurse implement first? 1. Initiate an intravenous access with a 20-gauge catheter. 2. Administer the IV antibiotic within 2 hours of admission. 3. Obtain a urine specimen for culture and sensitivity. 4. Notify the dietary department to order the client a regular diet.

Answer: 3 Rationale: 1. The IV is important to initiate therapy, but the nurse should obtain a clean voided midstream urine for culture and sensitivity before initiating the treatment. If the culture is not obtained prior to initiating the antibiotic, the results of the laboratory test will be skewed. 2. This should definitely be done, but obtaining the culture is the first intervention. 3. The nurse should obtain a clean voided midstream specimen for culture and sensitivity before initiating the antibiotics. This is the first intervention to implement. 4.A diet order is not priority over getting the treatment started. Urinary tract infections in males are difficult to treat and can be life threatening. MEDICATION MEMORY JOGGER: The first step in initiating antibiotic therapy is to obtain any ordered culture. Then the nurse must place a priority on initiating IV antibiotic therapy in a timely manner, within 1-2 hours after the order is written, depending on the facility's standard protocol.

The nurse is administering alteplase (Activase), a thrombolytic, to a client diagnosed with massive pulmonary emboli (PE). Which data indicates the medication is effective? 1. The client's PTT level is within therapeutic range. 2. The client is able to ambulate to the bathroom. 3. The client denies chest pain on inspiration. 4. The client's chest x-ray is normal.

Answer: 3 Rationale: 1. The PTT test is used to monitor the anticoagulant heparin, not the thrombolytic Activase. 2. A client with a massive PE would be on bed rest; therefore, ambulating would not indicate the medication is effective. 3. To determine if the medication is effective, the nurse must assess for an improvement in the signs or symptoms for the condition for which the medication was ordered.Chest pain is one of the most common symptoms of PE; denial of chest pain would indicate the medication is effective. 4. In the client diagnosed with a PE the chest x-ray is usually normal; therefore, it would not be used to determine if the thrombolytic is effective.

Which instruction should the nurse discuss with the client who is prescribed oral contraceptives for birth control? 1.Never take more than one birth control pill a day. 2.If breakthrough bleeding occurs, discontinue the pill. 3.Take a missed pill as soon as you realize you have missed it. 4.Antibiotics will increase the ovulation suppression effect of the pill.

Answer: 3 Rationale: 1. The client should be instructed to take any missed pill as soon as the omission is recognized; therefore, the client could and should take more than one pill in a day. 2.Breakthrough bleeding may mean the dosage of the oral contraceptive is not appropriate, but this is not a reason to discontinue taking the medication. The Client should see the HCP. 3. The client should be instructed to take any missed pill as soon as the omission is recognized. Therefore, the client could and should take more than one pill in a day. To maintain ovulation suppression the client must take the medication routinely. 4.Antibiotics decrease the effectiveness of some oral contraceptives, and a secondary form of birth control should be used during antibiotic therapy.

The client is prescribed albuterol (Ventolin), a sympathomimetic bronchodilator, metered-dose inhaler. Which behavior indicates the teaching concerning the inhaler is effective? 1. The client holds his or her breath for 5 seconds and then exhales forcefully. 2. The client states the canister is full when it is lying on top of the water. 3. The client exhales and then squeezes the canister as the next inspiration occurs. 4. The client connects the oxygen tubing to the inhaler before administering the dose.

Answer: 3 Rationale: 1. The client should hold his or her breath as long as possible before exhaling to allow the medication to settle before administering another dose; 5 seconds is not long enough. 2. The client can check how much medication is in a metered-dose canister by placing the canister in a glass of water; if the canister stays under water, the canister is full, and if it floats on top of the water, is empty. 3. This is the correct way to use an inhaler because it will carry the medication down into the lung. 4. Oxygen is not used when using an inhaler; oxygen is used to deliver the medication when using an aerosol.

The client in chronic kidney disease is taking aluminum hydroxide (Amphojel), a liquid antacid. Which information should the nurse discuss with the client? 1.Drink at least 500 mL of water after taking the medication. 2.Do not drink any water for 1 hour after taking the medication. 3.Drink 2-4 ounces of water after taking the medication. 4.Eat 30 minutes prior to taking the aluminum hydroxide.

Answer: 3 Rationale: 1. The client should not drink more than 4 ounces of water because water quickens the gastric emptying time. 2. The client should drink some water to ensure the medication gets to the stomach. 3.Liquid antacids should be taken with 2.4 ounces of water to ensure that the medication reaches the stomach. 4.Antacids should be taken on an empty stomach and are effective for 30-60 minutes before passing into the duodenum.

The client with renal calculi was prescribed allopurinol (Zyloprim) for uric acid stone calculi. Which statement warrants intervention by the nurse? 1."I had to take two Tylenol because of my headache." 2."I drink at least eight glasses of water a day." 3."My joints ache so I take a couple of aspirins." 4."I do not drink wine or any type of alcoholic drinks."

Answer: 3 Rationale: 1. The client should take acetaminophen (Tylenol), instead of aspirin (salicylic acid), to reduce acidity of the urine. This statement does not warrant intervention by the nurse. 2. The client should increase fluid intake when taking allopurinol to prevent drug accumulation and toxic effects and to minimize the risk of kidney stone formation. Therefore, this statement does not warrant intervention by the nurse. 3.Salicylic acid (aspirin) increases the acidity of the urine, and the urine should be alkaline; therefore, this statement warrants intervention by the nurse. 4. The client should avoid high-purine foods (wine, alcohol, organ meats, sardines, salmon, gravy) to help keep the urine alkaline; therefore, this statement does not warrant intervention by the nurse.

Which information should the nurse discuss with the client diagnosed with reactive airway disease who is prescribed theophylline (Slo-Phyllin), a xanthine bronchodilator? 1. Instruct the client to take the medication on an empty stomach. 2. Explain that an increased heart rate and irritability are expected side effects. 3. Discuss the need to avoid large amounts of caffeine-containing drinks. 4. Tell the client to double the next dose if a dose is missed.

Answer: 3 Rationale: 1. The client should take the medication with a glass of water or with meals to avoid an upset stomach. 2. The client should notify the health-care provider of a rapid or irregular heart beat,v omiting, dizziness, or irritability because these are not expected side effects. 3. The client should avoid drinking large amounts of caffeine-containing drinks such as tea, coffee, cocoa, and cola. 4. If a dose is missed within an hour, the client should take the dose immediately, but if it is more than 1 hour, the client should skip the dose and stay on the original dosing schedule. The client should not double the dose.

The client diagnosed with open-angle glaucoma is prescribed pilocarpine (Isopto Carpine), miotic ophthalmic drops. The client is demonstrating instilling the medication. Which action by the client warrants intervention? 1. The client washes his or her hands prior to instilling the medication. 2. The client squeezes the bridge of the nose after administering the medication. 3. The client keeps the eyes open immediately after administering the medication. 4. The client does not touch the dropper to the eye when instilling the medication.

Answer: 3 Rationale: 1. The client should wash the hands prior to instilling medication to ensure that bacteria do not fall into the eye. This action does not warrant intervention. 2. The client should squeeze the bridge of the nose gently after administering the medication to prevent systemic absorption of the medication. This action does not warrant intervention. 3. The client should keep the eyes closed for 1-2 minutes after instilling the eyedrops to enhance the effectiveness of the medication. This action warrants the nurse correcting the behavior. 4. The client should not touch the eye with the dropper to help prevent trauma to the eye. This action does not warrant intervention.

The nurse and the unlicensed assistive personnel (UAP) are caring for a client diagnosed with chronic pulmonary disease (COPD). Which action by the UAP warrants immediate intervention by the nurse? 1. The UAP encourages the client to wear the nasal cannula at all times. 2. The UAP calculates the client's fluid intake after the lunch meal. 3. The UAP increases the oxygen to 5 L/min while ambulating the client. 4. The UAP obtains the client's pulse oximeter reading.

Answer: 3 Rationale: 1. The client should wear the nasal cannula at all times; therefore, the nurse would not need to intervene. 2. The UAP can calculate the fluid intake, but the nurse must evaluate it to determine if it is adequate for the client's disease process. 3. Long-term oxygen therapy has been shown to improve the client's quality of life and survival. The oxygen must be kept between 1 and 3 L/min to prevent respiratory failure, which occurs when the oxygen level is increased and the client's hypoxic drive is no longer active.Carbon dioxide narcosis occurs in clients with COPD and eliminates that stimulus for breathing. 4. The UAP can obtain a pulse oximeter reading, but the nurse must evaluate the results to determine if it is normal for the disease process.

The client diagnosed with mild benign prostatic hypertrophy (BPH) is prescribed the 5-alpha-reductase inhibitor finasteride (Proscar) to relieve symptoms of urinary frequency. Which intervention should the clinic nurse implement? 1.Tell the client to drink at least 8-10 glasses of water a day. 2.Schedule an appointment with the HCP for a 1-week follow-up examination. 3.Have the laboratory draw a prostate-specific antigen level. 4.Give the client a urinal to measure his daily output of urine.

Answer: 3 Rationale: 1. The client's intake of water will not affect the medication. Drinking this much water each day until the medication has had an opportunity to shrink the enlarged prostate tissue could cause the client to have a difficult time emptying an uncomfortably full bladder. 2. The medication takes 6-12 months to have a full effect. There is no reason for the client to be seen in 1 week. 3.Proscar decreases serum prostate-specific antigen (PSA) levels. The Client should have a PSA level drawn before beginning Proscar and a level drawn after 6 months. If the PSA level does not drop, the client should be assessed for cancer of the prostate. 4.Clients do not need to measure their urine output daily.

The 10-year-old child is being prescribed a cromolyn inhaler. Which statement indicates the child needs more teaching concerning the cromolyn inhaler? 1. "If I cannot take a deep breath, I will not use my cromolyn inhaler." 2. "I should not exhale into my inhaler after I have finished taking a puff." 3. "I should wait at least 1 hour to rinse my mouth after taking my inhaler." 4. "I should not stop taking my inhaler because I might have an asthma attack."

Answer: 3 Rationale: 1. The cromolyn inhaler should be taken routinely and is not used for an acute asthma attack; therefore, the child understands the teaching. 2. Moisture (from exhaled air) will interfere with proper use of the inhaler; therefore, the child understands the teaching. 3. The child should rinse the mouth with water immediately after using the inhaler to help prevent throat irritation,dry mouth, and hoarseness. 4. Discontinuing the medication quickly can cause the child to have an acute attack of asthma. The child understands this.

The nurse is discussing health-promotion activities with a client diagnosed with chronic obstructive pulmonary disease (COPD). What information should the nurse discuss with the client? 1. Instruct the client to get the influenza vaccine semi-annually. 2. Teach the client to continue taking low-dose antibiotics at all times. 3. Encourage the client to get the pneumococcal vaccine every 5 years. 4. Discuss the need to receive three doses of the hepatitis B vaccine.

Answer: 3 Rationale: 1. The influenza vaccine should be taken yearly, not semi-annually (every 6 months). 2. The client may develop resistance to antibiotics if they are taken all the time; antibiotics will be prescribed during times of infection. 3. The pneumococcal vaccine titers persisting most adults for 5 years; the vaccine protects against pneumonia and clients with COPD should receive it to prevent lung infections. 4. The hepatitis B vaccine is not specifically recommended to promote health in clients with COPD.

The nurse is preparing to administer ophthalmic medication to the client. To which area should the nurse administer the medication? 1. A 2. B 3. C 4. D

Answer: 3 Rationale: 1. The medication should not be administered in the inner canthus because it may increase systemic absorption of the medication. 2. The medication should not be administered on the pupil because the medication will not be retained in the eye. 3. The medication should be administered into the lower conjunctival sac. Then the client should close the eye for 1-2 minutes, which will help ensure the medication stays in the eye. 4. The medication should not be administered in the outer canthus because it will not be retained in the eye.

The 8-year-old male child diagnosed with asthma is prescribed albuterol (Proventil).The child tells the nurse that if he is good at the doctor's visit, his mom is going to get a hamburger, French fries, and a cola for him. Which intervention should the nurse implement? 1. Encourage the child to be good so he can go get his meal. 2. Tell the mother not to use food as a reward for visiting the doctor. 3. Suggest drinking a Sprite or 7-Up with his lunch instead of cola. 4. Explain that the child should not eat foods high in salt such as fries.

Answer: 3 Rationale: 1. The nurse should teach the child about food preferences because the child has a chronic disease; caffeine-containing drinks should be discouraged. 2. The nurse should not be judgmental about the mother's parenting skills. 3. The child should avoid drinking large amounts of caffeine-containing drinks such as tea, cocoa, and cola drinks;Sprite and 7-Up do not contain caffeine. 4. This is an untrue statement; children rarely have problems with sodium intake.

The nurse is preparing to insert an 18-gauge indwelling urinary catheter in a client who has a latex allergy. Which intervention is most important for the nurse to implement? 1.Use latex-free gloves when performing this procedure. 2. Insert a 16-gauge indwelling urinary catheter into the client. 3.Obtain an appropriate indwelling urinary catheter for the client. 4. Use povidone iodine solution to cleanse the perineal area.

Answer: 3 Rationale: 1. The nurse should use latex-free gloves when touching the client, but this is not the most important invention because this is a very short-term exposure to the latex for the client. 2.A smaller catheter does not address the material the catheter is made out of. 3. The most important intervention is for the client to have a latex-free Foley catheter because this will stay in the client for an extended period. 4. The solution used to clean the client would not have a bearing on the latex allergy.

The client admitted for an acute exacerbation of reactive airway disease is receiving intravenous aminophylline. The client's serum theophylline level is 28 g/mL. Which intervention should the nurse implement first? 1. Continue to monitor the aminophylline drip. 2. Assess the client for nausea and restlessness. 3. Discontinue the aminophylline drip. 4. Notify the health-care provider immediately.

Answer: 3 Rationale: 1. The therapeutic level for theophylline is10-20 fig/mL; therefore, the nurse should take action. 2. As the serum theophylline level rises above 20 fig/mL, the client will experience nausea, vomiting, diarrhea, insomnia, and restlessness. This theophylline level may result in serious effects, such as convulsions and ventricular fibrillation. Therefore, the client should not be assessed first. 3. The client has the potential for having convulsions and ventricular fibrillation because the theophylline level is too high; therefore, the nurse should discontinue the aminophylline drip first. 4. After discontinuing the aminophylline drip and then assessing the client for potential life-threatening complications, the nurse should notify the health-care provider.

The female client asks the nurse why her teenage child would have many boxes of Sudafed, an OTC cold and allergy medication, in her room. Which statement is the nurse's best response? 1. "Has your child always had allergy problems?" 2. "Teenagers will try to take care of their own health problems." 3. "Has the teenager's behavior at school or at home changed recently?" 4. "Remove the medication and say nothing to the teenager about it."

Answer: 3 Rationale: 1. These may be allergy medications when used legally, but they are also the ingredients in illegal methamphetamine production. Quantities of any medication in a teenager's room should be investigated. 2. Teenagers do try to develop independence, but it is always the parent or guardian's responsibility to monitor the child's health. 3. This situation could indicate the teenager is involved with the drug culture, taking for manufacturing drugs. The nurse should assess for signs of drug involvement. 4. The parent is responsible for determining the teenager's activities; the situation should be discussed with the teenager.

The male client experiencing infertility problems tells the clinic nurse that he is taking St. John's wort for his depression. Which statement is the nurse's best response? 1."This herb is useful for depression. I hope it will help." 2."Did you discuss taking this herb with your psychologist?" 3."This herb may cause more infertility problems." 4."Is your significant other taking any herbal medication?"

Answer: 3 Rationale: 1. This herb is taken to treat depression, but it can cause more infertility problems; therefore, the nurse should discuss this with the client. 2. The client should discuss taking herbs with all healthcare providers, but this isn't the nurse's best response. 3.St. John's wort may cause effects on sperm cells, decreased sperm motility, and decreased viability; therefore, this client should not take this herb. 4. The significant other taking herbs should not affect the client's fertility; therefore, this is not an appropriate response.

The client post birth via C-section is receiving epidural morphine. The unlicensed assistive personnel (UAP) tells the primary nurse the client has a pulse of 84, respirations of 10, and a blood pressure of 102/78. Which intervention should the nurse implement first? 1.Administer naloxone (Narcan), a central nervous system antagonist. 2.Assess the client's pain using the numerical (1-10) pain scale. 3.Check the client's respiratory rate and pulse oximeter reading. 4.Complete a neurovascular assessment of the client's lower extremities.

Answer: 3 Rationale: 1. This is the antidote for morphine overdose, but the nurse would not administer the medication without first assessing the client because these data were provided by the UAP. 2. The client's respiration is less than normal; therefore, the priority should be assessing the respiratory status, not the client's pain level. 3.Because the UAP provided the initial abnormal data, the nurse should first assess the client to determine and validate the client's respiratory status. 4. The client's neurovascular status should be assessed because of the epidural analgesia, but the client's respiratory status is priority.

The client with increased intracranial pressure is receiving the osmotic diuretic mannitol (Osmitrol). Which intervention should the nurse implement to evaluate the effectiveness of the medication? 1.Monitor the client's vital signs. 2.Maintain strict intake and output. 3.Assess the client's neurological status. 4.Check the client's serum osmolality level.

Answer: 3 Rationale: 1.The client's vital signs should be evaluated, but these readings are not the best indicators of the effectiveness of an osmotic diuretic. 2.Monitoring the client's intake and output evaluates the client's hydration status, but it does not determine the effectiveness of the medication. 3.Mannitol is administered to decrease intracranial pressure. Changes in intracranial pressure affect neurological status; therefore, the client's neuro-logical status should be evaluated to determine the effectiveness of the medication. 4.The client's osmolality serum level is assessed when administering mannitol, but this level does not evaluate the effectiveness of the medication.

The client with an acute exacerbation of reactive airway disease is prescribed a nebulizer treatment. Which statement best describes how a nebulizer works? 1. Nebulizers are small, handheld pressurized devices that deliver a measured dose of anti asthma drug with activation. 2. A nebulizer is an inhaler that delivers an antiasthma drug in the form of a dry, micronized power directly to the lungs. 3. A nebulizer is a small machine used to convert an antiasthma drug solution into a mist that is delivered through a mouthpiece. 4. Nebulizers are small devices that are used to crush glucocorticoids so that the client can place them under the tongue for better absorption.

Answer: 3 Rationale: 1. This is the description of how a metered-dose inhaler works. 2. This is the description of how a dry-powder inhaler works. 3. This is the description of how a nebulizer works. Nebulizers take several minutes to deliver the same amount of drug contained in one puff from inhaler. They are usually used at home but can be used in the hospital. 4. This is not the description of how a nebulizer works. Glucocorticoids are not used sublingually to treat acute or chronic asthma.

Which statement best indicates the scientific rationale for administering corticosteroid therapy to a client who is 30 weeks pregnant? 1.Steroids are administered to decrease uterine contractions in preterm labor. 2.Steroids will increase the analgesic effects of opioid narcotics. 3.Steroids accelerate lung maturation, resulting in fetal surfactant development. 4.Steroids will prevent the development of maternal antibodies to the fetus's blood.

Answer: 3 Rationale: 1. This is the scientific rationale for administering corticosteroids. A beta-adrenergic agonist, not a corticosteroid, is given to decrease uterine contractions in preterm labor. 2. This is not the reason why steroids are administered; it is not the rationale for any medication administered to the client who is pregnant. 3. This is the scientific rationale for administering corticosteroids. They are administered to a client who is in preterm labor because they accelerate lung maturation, resulting in surfactant development in the fetus. 4.Rho (D) immune globulin (RhoGAM) is administered to a mother who has Rh-negative blood and is pregnant with a Rh-positive fetus to prevent the development of maternal antibodies to the fetus's blood. Corticosteroids are not given for this reason.

The client diagnosed with chronic obstructive pulmonary disease is prescribed methylprednisolone (Solu-Medrol), a glucocorticoid, IVP. Which laboratory test should the nurse monitor? 1. The white blood cell (WBC) count. 2. The hemoglobin and hematocrit. 3. The blood glucose level. 4. The BUN and creatinine.

Answer: 3 Rationale: 1. White blood cells are monitored to detect the presence of an infection, not for steroids. 2. The hemoglobin and hematocrit are monitored to detect blood loss, not for steroid therapy. 3. Steroid therapy interferes with glucose metabolism and increases insulin resis -tance. The blood glucose levels should be monitored to determine if an intervention is needed. 4. The BUN and creatinine levels are monitored to determine renal status. The adrenal glands produce cortisol.

Which client diagnosed with Parkinson's disease should the nurse question administering the anticholinergic medication benztropine (Cogentin)? 1.The client diagnosed with congestive heart failure. 2.The client who has had a myocardial infarction. 3.The client diagnosed with glaucoma. 4.The client who is undergoing hip replacement surgery.

Answer: 3 Rationale: 1.Anticholinergic medications are not contraindicated in clients diagnosed with heart failure. 2.Anticholinergic medications are not contraindicated in clients who have had a myocardial infarction. 3.Anticholinergic medications block cholinergic receptors in the eye and may precipitate or aggravate glaucoma. 4.Anticholinergic medications are not contraindicated in clients undergoing surgery.

The client is prescribed meclizine (Antivert), an antihistamine, for vertigo. Which statement by the client warrants intervention by the nurse? 1."I have had someone drive my car because I have been getting dizzy." 2."I will tell my health-care providers about taking this medication." 3."I usually have one or two glasses of wine with my evening meal." 4."I will chew sugarless gum or suck on hard candy if my mouth is dry."

Answer: 3 Rationale: 1.Because of the illness and its drug treatment, the client should not be driving a car; therefore, this statement does not warrant immediate intervention by the nurse. 2.This client should make sure the HCP knows about this medication; therefore, this statement does not warrant intervention by the nurse. The client should avoid other central nervous system depressants, including alcohol. Therefore, this statement requires intervention and further teaching by the nurse. 3. The client should avoid other central nervous system depressants, including alcohol. Therefore, this statement requires intervention and further teaching by the nurse. 4.This medication may cause dryness of the mouth and chewing sugarless gum or sucking hard candy would be appropriate; therefore, this statement does not warrant intervention.

The client presents to the emergency department complaining of a migraine headache. The health-care provider prescribes sumatriptan (Imitrex), a serotonin receptor agonist. When the nurse enters the room to administer the medication, the client is laughing with his or her significant other. Which intervention should the nurse implement? 1.Notify the health-care provider of the client's drug-seeking behavior. 2.Ask the client how bad the headache is if he or she is able to laugh. 3.Administer the medication after checking for allergies and the ID bracelet. 4.Discharge the client and recommend taking over-the-counter medication.

Answer: 3 Rationale: 1.Clients experiencing chronic pain must adjust to living with the pain and do not always act as the nurse assumes they should. Imitrex is not a narcotic. There-fore, this is not drug-seeking behavior. 2.Laughing may be the client's way of dealing with the pain, and the nurse should not be judgmental. 3.The nurse must check two forms of identification and allergies prior to administering any medication. The nurse should not be judgmental when caring for any client. Pain is what the client states it is. 4.Over-the-counter medications are not effective in treating severe vasospasm headaches, which is what a migraine headache is.

The client diagnosed with Alzheimer's disease is taking vitamin E and Ginkgo biloba. Which information should the nurse teach the client? 1.Take the medications on an empty stomach. 2.Have regular blood tests to assess for toxic levels. 3.The medications only slow the progression of the disease. 4.Use a sunscreen of SPF 15 or greater when in the sun.

Answer: 3 Rationale: 1.The medications may be taken at any time. 2.There is no reason for routine blood tests to determine toxicity. 3.Medications used to treat AD only slow the progression of AD. Currently no medications, prescribed or over-the-counter, have been proved to reverse or permanently prevent progression of neuronal destruction. 4.The medications do not produce photo-sensitivity. The client should use sun-screen but not because of the medications.

The older adult client diagnosed with Parkinson's disease (PD) has been prescribed carbidopa/levodopa (Sinemet). Which data indicates the medication is effective? 1.The client has cogwheel motion when swinging the arms. 2.The client does not display emotions when discussing the illness. 3.The client is able to walk upright without stumbling. 4.The client eats 30%-40% of meals within 1 hour.

Answer: 3 Rationale: 1.Cogwheel motion is a symptom of PD. Displaying cogwheel motion does not indicate the medication is effective. 2.Sinemet is a combination medication designed to delay the breakdown of levodopa(dopamine) in the periphery. A flat affect or no emotions would not indicate the medication is effective. 3.One of the symptoms of PD is a forward shuffling gait, so being able to walk up-right without stumbling would indicate that the medication is effective. 4.The client should be encouraged to consume at least 50% of the meals provided. Meal times that last 1 hour are not encouraged because the client becomes fatigued and the food temperature changes. Hot foods become cold and cold foods become lukewarm. The client should be served frequent, small meals each day.

Which data should the nurse assess for the client with a seizure disorder who is taking valproate (Depakote)? 1.Creatinine and BUN. 2.White blood cell count. 3.Liver enzymes. 4.Red blood cell count.

Answer: 3 Rationale: 1.Depakote does not cause nephrotoxicity. 2.Depakote does not cause blood dyscrasia. 3.Hepatotoxicity is one of the possible adverse reactions to Depakote; there-fore, the liver enzymes should be monitored. 4.Depakote does not affect the red blood cell count.

The nurse is preparing to administer phenytoin (Dilantin) intravenous push. The client has an IV of D5W 0.45 NS at 50 mL/hr. Which intervention should the nurse implement? 1.Administer the Dilantin undiluted over 5 minutes via the port closest to the client. 2.Dilute the medication with normal saline (NS) and administer over 2 minutes. 3.Flush tubing with NS, administer diluted Dilantin, and then flush with NS. 4.Insert a saline lock in the other arm and administer the medication undiluted.

Answer: 3 Rationale: 1.Dilantin cannot be administered with dextrose because it will cause precipitation. 2.Dextrose solutions should be avoided because of drug precipitation. 3.Dilantin should be diluted in a saline solution and the IV tubing should be flushed before and after administration because a dextrose solution will cause drug precipitation. 4.There is no reason for the nurse to cause more pain to the client by starting a saline lock because the IV tubing is already in place and can be flushed before and after the administration of Dilantin. MEDICATION MEMORY JOGGER: Any time a nurse administers an intravenous push medication the nurse should dilute the medication. This causes less pain for the client, helps prevent infiltration of the vein, and allows the nurse to administer the medication over the correct amount of time if it is diluted to a 10-mL bolus.

The client with a seizure disorder is prescribed the anticonvulsant phenytoin (Dilantin). Which statement indicates the client understands the medication teaching? 1."If my urine turns a reddish-brown color, I should call my doctor." 2."I should take my medication on an empty stomach." 3."I will use a soft-bristled toothbrush to brush my teeth." 4."I may get a sore throat when taking this medication."

Answer: 3 Rationale: 1.Dilantin may cause the client's urine to turn a harmless pinkish-red or reddish-brown; therefore, the client does not need to call the health-care provider. 2.The client should take Dilantin at the same time every day with food or milk to prevent gastric upset. 3.The client should use a soft-bristled toothbrush to prevent gum irritation and bleeding. Gingival hyperplasia (overgrowth of gums) is a side effect of this medication. 4.A sore throat, bruising, or nosebleeds should be reported to the health-care provider because this may indicate a blood dyscrasia

Which statement indicates to the nurse the client using a vaginal contraceptive ring understands the birth control teaching? 1."If the ring falls out during intercourse, I should get a new ring." 2."I should insert the ring 30 minutes before having intercourse." 3."I will remove the ring 3 weeks after I have inserted it." 4."I am so glad that I will not have a period when using the ring."

Answer: 3 Rationale: 1.If the ring is expelled before 3 weeks have passed, it can be washed off in warm water and reinserted. A new one is reinserted only if the expelled ring cannot be used. 2. This statement is appropriate for using a diaphragm, not the ring. 3. The vaginal contraceptive ring work on the same principle that oral contraceptives work. It provides 21 days of hormone suppression, followed by 7 days to allow for menses. The ring slowly releases hormones that pene-trate the vaginal mucosa and are absorbed by the blood and distributed throughout the body. The contraception occurs from systemic effects, nonlocal effects in the vagina. 4. The client will have a period when using this form of birth control.

The client who is pregnant is prescribed ferrous sulfate (Feosol), an iron product. Which statement indicates to the nurse the client needs more teaching? 1."I should increase my fluid intake and fiber when taking this medication." 2."I will take a daily stool softener to prevent becoming constipated." 3."If I notice that my stool becomes black or dark, I will call my obstetrician." 4."I should take my iron tablet 2 hours after I eat."

Answer: 3 Rationale: 1.Iron causes constipation; therefore, the client should increase fluid and fiber to help decrease the possibility of becoming constipated. 2.Iron causes constipation; therefore, the client is instructed to take a daily stool softener to prevent constipation. 3. The iron preparation causes the stool become black and tarry; therefore, the client would not need to notify the obstetrician. 4.Iron should be taken between meals, 2 hours after a meal, because food decreases absorption of the medication by 50%-70%.

The client in chronic renal disease is receiving oral Kayexalate, a cation exchange resin. Which assessment data indicates the medication is effective? 1.The client's serum potassium level is 5.8 mEq/L. 2.The client's serum sodium level is 135 mEq/L. 3.The client's serum potassium level is 4.2 mEq/L. 4.The client's serum sodium level is 147 mEq/L.

Answer: 3 Rationale: 1.Kayexalate is a medication that is administered to decrease an elevated serum potassium level. Therefore, an elevated serum potassium (>5.5 mEq/L) would indicate the medication is not effective. 2.Kayexalate is not used to alter the serum sodium level. 3.Kayexalate is a medication that is administered to decrease an elevated serum potassium level. A potassium level within the normal range of 3.5-5.5 mEq/L indicates the medication is effective. 4.Kayexalate is not used to alter the serum sodium level.

The teenage client has just delivered a 7-pound baby. The girl has not received any prenatal care. Which medication is administered to the neonate to prevent complications related to sexually transmitted infections? 1.Zidovudine (Retrovir), a nucleoside reverse transcriptase inhibitor (NRTI). 2.Valacyclovir (Valtrex), an antiretroviral. 3.Erythromycin ophthalmic ointment, an antibiotic. 4.Metronidazole (Flagyl), a gastrointestinal anti-infective.

Answer: 3 Rationale: 1.NRTI medications are prescribed for clients who are HIV positive during pregnancy to prevent maternal transmission of the virus to the fetus. 2.Valtrex is prescribed to treat herpes simplex 2 viral infections, but it is not administered routinely to neonates at birth. 3.Erythromycin ophthalmic ointment is the medication of choice to prevent ophthalmia neonatorum (blindness caused by a gonorrhea infection acquired when passing through the birth canal or coming into contact with the mother's tissues). Because the client has had no prenatal care, this would be recommended procedure in case the infant has been exposed to gonorrhea. 4.Metronidazole is administered for some STIs, but it is not routinely administered to neonates.

The 16-year-old male client is diagnosed with pediculosis pubis and is prescribed permethrin (Nix), an ectoparasiticide cream rinse. Which data indicate the treatment has been effective? 1.There are no scratches on the client's penis. 2.The client shaved his head and his scalp is clear. 3.The client reports that the intense itching has abated. 4.The client has no visible lice or nits on his head.

Answer: 3 Rationale: 1.No scratch marks on the penis indicate the client has not scratched himself but does not indicate a lack of infestation in the pubic hair. 2.Pediculosis pubis is pubic lice, not head lice; a clear scalp would not indicate a lack of a pubic infestation. 3.Pediculosis causes intense itching. Lack of itching indicates the treatment is effective. A 16-year-old client is un-likely to submit to a visual inspection of his pubic area by the nurse. 4.Pediculosis pubis is pubic lice, not head lice,so no visible lice or nits on the head would not indicate a lack of a pubic infestation.

The client diagnosed with a bladder infection is prescribed phenazopyridine (Pyridium). Which statement is the scientific rationale for prescribing this medication? 1.Pyridium is used to treat gram-negative urinary tract infections. 2.Pyridium stimulates a hypotonic bladder to increase urine output. 3.Pyridium alleviates pain and burning during urination. 4.Pyridium decreases urinary frequency to control an overactive bladder.

Answer: 3 Rationale: 1.Pyridium is not an antibiotic; it will not treat an infection. 2.Pyridium is a urinary analgesic, not a urinary stimulant. It will not increase bladder tone. 3.Pyridium is a urinary analgesic. It is useful in treating the pain and burning associated with a urinary tract infection. 4.Antimuscarinic/anticholinergic medications control an overactive bladder; urinary analgesic medications do not. Pyridium Dose help control urinary frequency associated with a urinary tract infection.

The client with chronic kidney disease is admitted to the medical floor for pneumonia. The admission orders include Zithromax, cyclosporine, and Mylanta. Which question should the nurse ask the client? 1."Are you allergic to iodine or any type of shellfish?" 2."When is the last time you had your dialysis treatment?" 3."Have you had any type of organ transplant?" 4."Why don't you take Amphojel instead of Mylanta?"

Answer: 3 Rationale: 1.Questions about allergies to iodine or shellfish would be appropriate for a client undergoing a test with contrast dye. 2. The nurse should realize that a client taking cyclosporine has had some type of organ transplant because it is a major immunosuppressant drug. 3.Cyclosporine would not be an expected medication for a client diagnosed with pneumonia or chronic kidney disease unless the client has had a kidney transplant; therefore, asking this question is appropriate. 4.Because the client has functioning kidneys there is no need to take the Amphojel, which is a phosphate binder.

Which is the scientific rationale for administering the 5-alpha-reductase inhibitor dutasteride (AVODART) to a client diagnosed with benign prostatic hypertrophy(BPH)? 1.The medication elevates male testosterone levels and decreases impotence. 2.AVODART causes a rapid reduction in the size of the prostate and relief of symptoms. 3.The medication decreases the mechanical obstruction of the urethra by the prostate. 4.AVODART is as fast as surgery in reducing the obstructive symptoms of BPH

Answer: 3 Rationale: 1.Testosterone is converted to dihydrotestosterone (DHT) in the prostate; the 5-alpha-reductase inhibitors reduce DHT but not testosterone. With a reduction in DHT, the prostate tissue shrinks. The 5-alpha-reductase inhibitors do not elevate testosterone,nor do they improve impotence problems. 2. The 5-alpha-reductase inhibitors require 6-12 months for therapeutic relief of symptoms of BPH to occur. 3. The 5-alpha-reductase inhibitors work by reducing the size of the prostate gland, resulting in a relief of the obstructive symptoms of urgency, frequency, difficulty initiating a urine stream, and nocturia. 4.Surgery provides faster relief of symptoms after recovery has taken place. AVODART requires a lengthy time period for therapeutic effects of the medications and may not provide adequate relief of symptoms of the client has severe BPH.

The client presents to the emergency department complaining of a migraine headache and is prescribed medication. Which scientific rationale is most appropriate for administering the medication by the parenteral route? 1.The client requests the medication be given IVP. 2.Migraine headaches do not respond to oral medications. 3.Migraine headaches can cause nausea, vomiting, and gastric stasis. 4.The client is not as likely to develop an addiction to the medications.

Answer: 3 Rationale: 1.The client request is not a scientific rationale for prescribing the route of a medication. 2.Migraine headaches respond to oral medication when administered prophylactically, but the client is less likely to respond to oral medication after the attack has begun. 3.Because migraine headaches often cause nausea, vomiting, and gastric stasis, oral medications may not be tolerated or may not be effective once an attack has begun. 4.Addiction to medications depends on many factors. The parenteral, intramuscular, intravenous, or oral route may all be addicting, depending on the medication in question.

The client has increased intracranial pressure and the health-care provider orders a bolus of 0.5 g/kg IV of 25% osmotic diuretic solution. The client weighs 165 pounds. How much medication should the nurse administer to the client?

Answer: 37.5 g MEDICATION MEMORY JOGGER:The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication wasprescribed.10.37.5 g. To determine this, first find the client's weight in kilograms (165 pounds ÷2.2 = 75 kg). Then, multiply 0.5 g by weight in kilograms (0.5 ×75 kg = 37.5 kg).

The nurse is preparing to administer medications to the following clients. Which medication should the nurse question administering? 1.The loop diuretic furosemide (Lasix) to a client with a serum potassium level of 4.2 mEq/L. 2.The osmotic diuretic mannitol (Osmitrol) to a client with a serum osmolality of 280 mOsm/kg. 3.The cardiac glycoside digoxin (Lanoxin) to a client with a digoxin level of 2.4 mg/dL. 4.The anticonvulsant phenytoin (Dilantin) to a client with a Dilantin level of 14 μg/mL.

Answer: 3 Rationale: 1.The normal serum potassium level is 3.5-4.5 mEq/L. Because the client's potassium level is within normal range, the nurse has no reason to question this medication order. 2.The normal serum osmolality is 275-300 mOsm/kg. Because the client's level is within this range, the nurse would have no reason to question administering this medication. 3.The normal digoxin level is 0.8-2.0 mg/dL. A digoxin level of 2.4 mg/dL would warrant the nurse questioning the administration of this medication. 4.The therapeutic serum level of Dilantin is10-20 μg/mL. Because the client's level is within this range, the nurse should not question administering this medication.

The nurse is preparing to administer the following anticonvulsant medications. Which medication should the nurse question administering? 1.Carbamazepine (Tegretol) to the client who has a Tegretol serum level of 8 μg/mL. 2.Clonazepam (Klonopin) to the client who has a Klonopin serum level of 60 ng/mL. 3.Phenytoin (Dilantin) to the client who has a Dilantin serum level of 26 μg/mL. 4.Ethosuximide (Zarontin) to the client who has a Zarontin serum level of 45 μg/mL.

Answer: 3 Rationale: 1.The therapeutic serum level of Tegretol is 5-12 μg/mL. Because the client's level is within that range, the nurse has no reason to question administering the drug. 2.The therapeutic serum level of Klonopin is 20-80 ng/m. Because the client's level is within that range, the nurse has no reason to question administering the drug. 3.The therapeutic serum level of Dilantin is 10-20 µg/mL. Because the client's level is above that range, the nurse should question administering this medication. 4.The therapeutic serum level of Zarontin is40-100 μg/mL. Because the client's level is within that range, the nurse has no reason to question administering the drug.

The family member of a client diagnosed with early-stage Alzheimer's disease (AD)who was prescribed the cholinesterase inhibitor donepezil (Aricept) without improvement asks the nurse, "Can anything be done to slow the disease since this medication does not work?" Which statement is the nurse's best response? 1."I am sorry that the medication did not help. Would you like to talk about it?" 2."You need to prepare for long-term care because confusion is inevitable now." 3."Your loved one may respond to a different medication of the same type." 4."No, nothing is going to slow the disease now. Have the client make a will."

Answer: 3 Rationale: 1.There are three other medications in the classification of cholinesterase inhibitors that may be tried because the medications are not identical. Additionally, vitamin E in large doses, selegiline, and Gingko biloba have been shown to slow progression of AD. This answer on the part of the nurse is not providing information and is not directly answering the family member's question. 2.The progression of AD is inevitable at some point. Cholinesterase inhibitors are prescribed for clients with mild to moderate symptoms of AD, and they can delay the progression of AD. This is not the time to discuss long-term care. 3.If the client does not respond to one of the cholinesterase inhibitors, then another may be tried because the drugs are not identical. The client may be responsive to a different medication in the same classification. 4.There are more options to discuss regarding treatment of AD at this time.

The male client who is infertile asks the clinic nurse, "Is there anything I can take to increase my chances of fathering a child?" Which statement is the nurse's best response? 1."I am sorry, but there are no medications to help men with infertility." 2."Are you concerned about not being able to father a child?" 3."Testosterone therapy may help increase your sperm count." 4."You can take Clomid and it will help your partner get pregnant."

Answer: 3 Rationale: 1.There is no documented drug regimen that helps men achieve sperm levels, except possibly testosterone medications or supplements. 2. This is a therapeutic response and the client is asking for information; therefore, the nurse should provide the facts. 3.Administration of testosterone will improve hormonal levels, resulting in potential for increased spermatogenesis. 4.Clomid is an ovarian stimulant and will not help a male client.

The male client diagnosed with chronic migraine headaches, who has taken medications daily for years to prevent a migraine from occurring, tells the clinic nurse that now he has a headache "all the time, no matter what I take." Which situation should the nurse suspect is occurring? 1.The client has developed a resistance to pain medication. 2.The client is addicted and wants to get an increase in narcotics prescribed. 3.The client has developed medication overuse headaches. 4.The client may have a complication of therapy and has a brain tumor.

Answer: 3 Rationale: 1.These symptoms indicate the client is responding to the long-term use of headache medication, not developing a resistance to the medications. 2.Pain is whatever the client says it is and occurs whenever the client says it does. The client is reporting a subjective symptom and seeking help, not judgment. 3.Medication overuse headaches occur when clients take headache medication every day. These headaches are also known as rebound headaches or drug-induced headaches. The headache will persist for days to weeks after the medication has been discontinued. 4.The use of medications for migraine headaches does not cause brain tumors.

The daughter of a client diagnosed with Alzheimer's disease tells the home health nurse that she has been giving her mother Ginkgo biloba, an herbal medication. Which intervention should the nurse implement? 1.Tell her to stop giving her mother the herb because it will not help. 2.Teach her that herbs have many life-threatening adverse effects. 3.Explain that the effects may only last for 6-12 months. 4.Ask the HCP to prescribe tacrine (Cognex) instead of the herb.

Answer: 3 Rationale: 1.This herb is able to stabilize or improve cognitive performance and social behavior for 6-12 months; therefore, it does help the symptoms of uncomplicated Alzheimer's. 2.Most herbs do not have life-threatening adverse effects. Ginkgo biloba should be taken with caution when taking antiplatelets or anticoagulants because it will increase the risk of bleeding. 3.Research has determined that Ginkgo biloba has biologic activity in treating uncomplicated Alzheimer's disease for up to 12 months. At this time, medications for Alzheimer's disease result in temporary improvement of the symptoms. 4.Ginkgo biloba extract has proved to be as effective as tacrine, so there is no reason to change to this medication. Tacrine has a significant risk of liver damage and is avoided in favor of the other cholinesterase inhibitors.

The client diagnosed with a pituitary tumor has the pituitary hormone vasopressin (DDAVP) ordered. Which statement by the client indicates the medication is effective? 1."My headaches are much better since I have been on this medication." 2."My nasal drainage was initially worse, but now I don't have any." 3."I am not so thirsty when I take this medication." 4."My seizures have been eliminated."

Answer: 3 Rationale: 1.Vasopressin is the antidiuretic hormone produced by the pituitary gland that is instrumental in the body's ability to conserve water. It does not affect headaches or another type of pain. Diabetes insipidus is caused by a lack of vasopressin. 2.DDAVP is given intranasal, and the nurse should be alert to symptoms of rhinitis, but lack of nasal drainage does not indicate that the medication is effective. 3.DDAVP is a synthetic form of the antidiuretic hormone vasopressin. With-out vasopressin, the body does not conserve water and a large amount of very dilute urine is excreted. The body will attempt to have the client replace the fluid by producing the symptom of extreme thirst. Lack of thirst indicates the medication is effective. 4.DDAVP will not affect seizure activity.

The male client diagnosed with a brain tumor tells the clinic nurse that he has been having seizures more frequently. The client is taking the anticonvulsant phenytoin(Dilantin), the narcotic morphine sulfate (Roxanol), the analgesic acetaminophen(Tylenol), and the antianxiety medication alprazolam (Xanax). Which question should the nurse ask next about the client's medications? 1."How often do you need to take the Xanax?" 2."Do you take any vitamins that might cause the seizures?" 3."What was your last Dilantin level?" 4."Have you had any x-rays to determine the cause of the seizures?"

Answer: 3 Rationale: 1.Xanax does not cause seizures; the client has a brain tumor that is the most likely the cause of the seizures. 2.The client would not know if a vitamin were causing a seizure. The most probable cause of the seizure is the brain tumor. 3.Therapeutic levels of Dilantin are needed to control aberrant brain activity. The therapeutic level is 10-20 mg/dL. 4.The client may need a CT scan or MRI to determine if tumor growth is causing the increase in frequency of seizures, but the nurse should determine if a therapeutic level of Dilantin is being maintained first.

The nurse is administering otic drops to a 5-year-old child with acute otitis media. Which interventions should the nurse implement? Rank in order of performance. 1. Brace the administering hand against the child's head above the ear. 2. Insert the required number of drops and gently massage the tragus. 3. Explain the procedure to the child in developmentally appropriate terms. 4. Gently pull the top of the child's ear up and back. 5. Keep the child on the unaffected side for several minutes.

Answer: 3, 1, 4, 2, 5 Rationale: 3. The nurse should talk to the child and explain the procedure. This will help develop trust with the child. Many nurses talk to the parents and not the child. 1. Bracing the hand helps prevent the child from moving the head. 4. For children older than 3 years, the pinna should be pulled up and back to straighten the ear canal so that the drops get to the tympanic membrane. 2. After inserting the drops, massaging the tragus (anterior portion) ensures that the drops reach the tympanic membrane. 5. This prevents the medication from spilling out of the ear.

Which interventions should be included when the nurse is teaching the 28-year-old client diagnosed with external otitis how to instill otic drops? Rank in the order of performance. 1. Loosely place a small piece of cotton in the auditory meatus. 2. Demonstrate pulling the pinna of the ear up and back when inserting drops. 3. Warm the medication by holding the container in the hand for 5 minutes. 4. Tilt the head toward the unaffected side when in the sitting position. 5. Administer the prescribed number of drops into the ear canal.

Answer: 3, 4, 2, 5, 1 Rationale: 3. Warming the medications promotes com-fort when the eardrops are instilled. 4. Sitting with the head tilted toward the unaffected side allows gravity to assist inmoving the medication to the inner portion of the ear canal. 2. Pulling the pinna up and back straightens the ear canal in adults and allows the medication to travel along the length of the canal. 5. This ensures the full amount of prescribed medication will be administered to penetrate the length of the canal and achieve full effectiveness. Leaving a small piece of cotton in the auditory meatus for 15 to 20 minutes helps keep the medication in the canal.

The following clients have a head injury. Which clients should the nurse question administering the osmotic diuretic mannitol (Osmitrol)? Select all that apply. 1.The 34-year-old client who is HIV-positive. 2.The 84-year-old client who has glaucoma. 3.The 68-year-old client who has cor pulmonale. 4.The 16-year-old client who has cystic fibrosis. 5.The 58-year-old with congestive heart failure.

Answer: 3, 5 Rationale: 1.Mannitol would not be contraindicated in client who is HIV-positive. 2.Mannitol would not be contraindicated in client who has glaucoma. 3.Cor pulmonale is right-sided heart failure, often secondary to chronic obstructive pulmonary disease (COPD). Because mannitol pulls fluid off the brain, it may lead to a circulatory overload, which the heart with right-sided failure could not handle. This client would need an order for a loop diuretic to prevent serious cardiac complications. 4.The client is 16 years old, and, even with cystic fibrosis, the client's heart should be able to handle the fluid volume overload. 5.Because mannitol pulls fluid off the brain, it may lead to a circulatory over-load, which the client in congestive heart failure could not handle. This client would need an order for a loop diuretic to prevent serious cardiac complications.

The nurse is discussing how to instill nasal drops. Which instructions should the nurse discuss with the client? Rank in order of performance. 1. Discard any remaining solution that is in the dropper. 2. Instruct the client to remain in position for 5 minutes. 3. Instruct the client to open and breathe through the mouth. 4. Instill the solution laterally toward the nasal septum. 5. Hold the tip of the dropper just above the nostril without touching the nose.

Answer: 3, 5, 4, 2, 1 Rationale: 3. The client should first breathe through the mouth. 5. The tip of the dropper should not touch the nose because this could cause contamination of the dropper when being replaced into the bottle. 4. The solution should be inserted later-ally toward the midline of the superior concha of the ethmoid bone, not the base of the nasal cavity where it will run down the throat and into the eustachian tube. 2. The client should remain lying down for 5 minutes so that the solution will not run out of the nose. 1. The remaining solution should be discarded to prevent contamination of the bottle.

The client is diagnosed with acute bacterial conjunctivitis. The health-care provider prescribed erythromycin ophthalmic ointment. Which information should the nurse discuss with the client? 1. Apply a thick line of ointment in the upper lid margin of the eye. 2. Instruct the client to look downward when applying the ointment. 3. Instruct the client to clean the eye with antibiotic solution prior to applying ointment. 4. Apply the ophthalmic ointment from the inner to the outer canthus.

Answer: 4 Rationale: 1. A thin line of ointment should be applied evenly along the inner edge of the lower lid margin of the eye. 2. The client should look upward when applying the ointment. 3. The eye should be cleaned with warm water prior to applying antibiotic ointment. There is no antibiotic solution used prior to using ophthalmic ointment. 4.When applying ointment, a thin line of ointment should be applied evenly along the inner edge of the lower lid margin, from the inner canthus to the outer canthus.

The clinic nurse is teaching the parent of a child with reactive airway disease about nebulizer treatments. Which statement indicates the teaching has been effective? 1. "I will use half the medication in the nebulizer at each treatment." 2. "The nebulizer treatment will take about 30 minutes or longer." 3. "I will use a disinfectant solution weekly when cleaning the nebulizer." 4. "I will rinse the nebulizer in clean water after each breathing treatment."

Answer: 4 Rationale: 1. All the medication in the nebulizer should be used during the treatment; medication should not be stored in the nebulizer for later use. 2. The length of treatment is usually 10-15 minutes. If it takes longer, the parent should check the nebulizer equipment compressor for defects or problems. 3. The nebulizer should be cleaned daily (not weekly) using a disinfecting solution or a solution containing one-part white vinegar and four parts water. 4. The nebulizer should be cleaned with water after each treatment and allowed to air dry after loosely covering it with a clean paper towel. Storing the equipment wet promotes the growth of mold and bacteria.

The 6-year-old child is experiencing an acute exacerbation of reactive airway disease. The child passed out, and the parents brought the child to the emergency department. Which intervention should the nurse implement first? 1. Administer subcutaneous epinephrine via a tuberculin syringe. 2. Administer a beta2-adrenergic agonist, albuterol (Ventolin), via nebulizer. 3. Administer intravenous methylprednisolone, a glucocorticoid. 4. Administer oxygen to maintain oxygen saturation above 95%.

Answer: 4 Rationale: 1. Because the child is unconscious the nurse should prepare to administer epinephrine, a beta 2-adrenergic agonist, but this is not the first action. 2. The client is unconscious; therefore, a nebulizer could not be administered to the child. It would be administered as soon as the child is conscious. 3. If there is no response to the nebulizer, then the child should receive an intravenous glucocorticoid. 4. The first intervention should be administering oxygen to the child and then administering medication. Oxygen is considered a medication.

The client is diagnosed with Chlamydia trachomatis,a sexually transmitted infection, and asks the nurse, "Why must I take an antibiotic when I don't have any itching or pain?" Which statement is the nurse's best response? 1."The itching and pain will start within 2 or 3 days." 2."The antibiotics will prevent canker sores on your genitalia." 3."If you use a condom, then you don't have to take the antibiotic." 4."If it is not treated, you may never be able to have a baby."

Answer: 4 Rationale: 1. Chlamydia Is frequently asymptomatic andis diagnosed with an annual Pap smear. 2. Chlamydia Does not cause canker sores;these sores are caused by syphilis. 3. Chlamydia Is bacteria and must be treated with an antibiotic; condoms are used to prevent transmission to a partner. 4.Untreated Chlamydia Can lead to pelvic inflammatory disease and long-term effects, including chronic pain, increased risk for ectopic pregnancy, postpartum endometritis, and infertility.

The male client diagnosed with chronic obstructive pulmonary disease (COPD) tells the nurse that he has been expectorating "rusty-colored" sputum. Which medication should the nurse anticipate the HCP prescribing? 1. Prednisone, a glucocorticoid. 2. Habitrol, a transdermal nicotine system. 3. Dextromethorphan (Robitussin), an antitussive. 4. Ceftriaxone (Rocephin), a cephalosporin.

Answer: 4 Rationale: 1. Clients diagnosed with COPD are commonly prescribed a steroid (glucocorticoid)medication to decrease inflammation in the lungs. This client should already be taking this or a similar medication. The client's "rust-colored" sputum indicates an infection and an antibiotic should be ordered. 2. The client should quit smoking if still smoking, but the client's "rusty-colored" sputum indicates an infection and an antibiotic should be ordered. 3. The client may require an antitussive but more likely would require a mucolytic to help to expectorate the thick tenacious sputum associated with COPD. 4. The client's "rust-colored" sputum indicates an infection and an antibiotic should be ordered. Rocephin is a broad-spectrum antibiotic.

The client diagnosed with a pituitary tumor has acromegaly. The HCP has prescribed the hormone suppressant octreotide (Sandostatin). Which intervention should the nurse implement regarding this medication? 1.Implement fall precautions. 2.Administer calcium tablets to replace the lost calcium. 3.Have the client discuss acne-like skin problems with a dermatologist. 4.Contact the client's insurance provider to determine if the medication is covered.

Answer: 4 Rationale: 1. Octreotide does not increase the risk of falls. 2. Octreotide does not cause bone resorption, so calcium replacement is not needed. 3. Octreotide does not cause acne or acne-like problems. 4. Octreotide can cost thousands of dollars a year (about $8,000). Before beginning the treatment, the nurse and HCP must know that the client can afford the medication.

The 8-year-old male client has been determined to have a benign tumor in the anterior pituitary gland. Surgery has resulted in an inadequate production of growth hormone (GH). The nurse is teaching the parents about GH therapy. Which statement indicates the parent understands the medication? 1."If I give too much, then my child will grow to be a giant." 2."After a few months I can taper my child off the GH." 3."If I don't give the hormone, my child will become retarded." 4."I should monitor my child's blood glucose levels."

Answer: 4 Rationale: 1. The HCP will regulate the dose to achieve a normal growth rate for the child. Heights and weights are determined on a monthly basis to determine the effectiveness of the medication. This therapy is continued until the epiphyseal closure occurs or to about age 20-24 years. 2.Tapering is not needed. 3.Lack of growth hormone can result in dwarfism but will not cause mental retardation. 4.Human growth hormone is diabetogenic and can cause hyperglycemia.

The woman who is Rh-negative and a Jehovah's Witness delivers a baby who is Rh Positive. The HCP prescribed RhoGAM for the mother. Which intervention should the nurse implement first? 1.Administer the RhoGAM to the client within 72 hours. 2.Obtain a signed permit for administering this medication. 3.Confirm the infant's blood type with the laboratory. 4.Explain to the client that RhoGAM is a blood product.

Answer: 4 Rationale: 1. The RhoGAM prevents the formation of antibodies to the fetus Rh-positive blood in the mother, but this cannot be done first because the client is a Jehovah's Witness. 2. The mother must sign a permit when taking this medication, but this is not the nurse's first intervention because the client is a Jehovah's Witness. 3. The nurse can confirm the newborn's blood type, but this is not the first intervention because the client is a Jehovah's Witness. 4. The RhoGAM is derived from blood products; therefore, the nurse must explain this to the client whose faith prohibits the administration of blood or blood products.

The nurse is discharging the female client diagnosed with a pulmonary embolism (PE) who is prescribed the anticoagulant warfarin (Coumadin). Which statement indicates the client understands the medication teaching? 1. "I should use a straight razor when I shave my legs." 2. "I will use a hard-bristled toothbrush to clean my teeth." 3. "An occasional nosebleed is common with this drug." 4. "It will be important for me to have regular blood work done."

Answer: 4 Rationale: 1. The client is at risk for bleeding and should be encouraged to use an electric razor. 2. The client is at risk for bleeding, and a soft-bristled toothbrush should be used. 3. Any abnormal bleeding, such as a nosebleed, is not expected and should be reported to the HCP. Unexplained bleeding is a sign of toxicity. 4. The client's International Normalized Ratio (INR) is monitored at routine intervals to determine if the medication is within the therapeutic range, INR 2-3.

The client diagnosed with arterial hypertension develops a cold. Which information regarding over-the-counter medications should the nurse teach? 1. Try to find a medication that will not cause drowsiness. 2. Over-the-counter medications are not as effective as a prescription. 3. Over-the-counter medications are more expensive than prescriptions. 4. Do not take over-the-counter medication unless approved by the HCP.

Answer: 4 Rationale: 1. The client should be informed about the dangers of self-medicating with OTC medications. Many OTC meds work by causing vasoconstriction, which will increase the client's hypertension. 2.Efficacy of medications depends on the medication and strength. Most OTC meds were at one time prescription medications. There are many variables, and this statement is too general to be true. 3. The expense of the medications is not the relevant point for this client. The problem is to inform the client about the actions of any OTC medications and the effect on the client's hypertension. 4.Many OTC medications work by causing vasoconstriction, which will increase the client's hypertension; the client should only take medications (approved by the HCP) that will not affect the client's hypertension.

The client called the emergency department and told the nurse that bleach had splashed into both eyes. Which action should the nurse tell the client to perform first? 1. Come to the emergency department immediately. 2. Determine if the client has normal saline flush. 3. Apply antibiotic ointment and patch the eyes bilaterally. 4. Cleanse the eye continuously with tap water.

Answer: 4 Rationale: 1. The client should come to the emergency department to determine if permanent damage has occurred and to be seen by an ophthalmologist, but that is not the first intervention. 2. Normal saline flush would help cleanse the bleach from the eyes, but it is not the first intervention. 3. Regular antibiotic ointment should not be used in the eye, and bilateral patching is not appropriate for chemical irritation to the eye. 4. The nurse should instruct the client to rinse the eye with tap water for at least5 minutes in each eye and then to come to the emergency department. The bleach must be thoroughly removed from the eyes.

The client with active tuberculosis is prescribed antitubercular medications. Which intervention should the public health nurse implement? 1. Request the client come to the public health clinic weekly for sputum cultures. 2. Place the client and family in quarantine while the client takes the medication. 3. Inform the neighbors and coworkers that the client has been diagnosed with TB. 4. Arrange for a health-care professional to observe the client taking the medication daily.

Answer: 4 Rationale: 1. The client will not have to go to the clinic weekly. Sputum cultures are done to diagnose TB and to determine when the client's illness is no longer communicable.Three negative sputum cultures taken for 3 consecutive days 10-14 days after starting medication indicate the client's illness is no longer communicable. 2. This medication will be administered for 9-12 months, and the client is quarantined for 10-14 days until negative sputum cultures are obtained. Family members are not quarantined unless they have active TB. 3. The public health nurse will notify the people who have been in contact with the client during the infectious stage, but the nurse will not divulge the client's name, which would be a violation of HIPAA. The nurse will explain that the individual may have come into contact with a person recently diagnosed with TB and the person should receive a PPD skin test. 4.Tuberculosis is a communicable disease that is a detriment to the community; therefore, the client is mandated to take the antitubercular medication and will be observed daily for the duration of the regimen, which may be 9-12 months. The risk of drug resistance is extremely high if the regimen is not strictly and continuously followed. This will result in multidrug-resistant TB in the community.

The nurse is preparing to administer the following medications. Which client should the nurse question administering the medication? 1. The client receiving prednisone, a glucocorticoid, who has a glucose level of 140 mg/dL. 2. The client receiving ceftriaxone (Rocephin), an antibiotic, who has a white blood cell count of 15,000. 3. The client receiving heparin, an anticoagulant, who has a PTT of 68 seconds with a control of 0.35. 4. The client receiving cromolyn (Intal) inhaler who is having an asthma attack.

Answer: 4 Rationale: 1. This blood glucose is elevated, but this is an expected side effect of prednisone; therefore, the nurse would not question administering this medication. 2. A client receiving an antibiotic would be expected to have an elevated white blood cell count; therefore, the nurse would not question administering this medication. 3. A PTT of 68 seconds is within the range of 1.5 to 2 times the control; therefore, the nurse would not question administering this medication. 4. Cromolyn is for maintenance only; it does not work for an acute attack. The Nurse should administer a beta agonist inhaler for quick response.

The client diagnosed with benign prostatic hypertrophy (BPH) and congestive heart failure (CHF) is receiving furosemide (Lasix), a loop diuretic, daily. Which information provided by the unlicensed assistive personnel (UAP) best indicates to the nurse the medication is effective? 1.The UAP recorded the intake as 350 mL and the output as 450 mL. 2.The UAP stated that the client ambulated to the bathroom without dyspnea. 3.The UAP emptied a moderate amount of urine from the bedside commode. 4.The UAP reports that the client lost 1 pound of weight from the day before.

Answer: 4 Rationale: 1. The client's intake and output measurements are important, but even accurate intake and output recordings cannot mea -sure for insensible losses. An output of 100 mL over the intake may or may not be considered adequate to determine effectiveness of a diuretic. 2.Ambulating to the bathroom without dyspnea is an indicator that the client is not experiencing pulmonary complications related to excess fluid volume, but it is not the best indicator of the effectiveness of a diuretic. 3.Terminology such as small, moderate, and large are not objective words. To quantify the results the nurse should use objective data—in this situation, numbers. This Would provide an accurate comparison of data to determine the effectiveness of themedication. 4. The most reliable method of determining changes in fluid-volume status is to weigh a client in the same type of clothing at the same time each day.One liter (1000 mL) is approximately 0.9 kg, or 2 pounds. This client has lost approximately 500 mL more fluid than was taken in.

The client with otitis media is prescribed clarithromycin (Biaxin), an antibiotic, 500 mg PO every 12 hours for 10 days. Which medication teaching should the nurse discuss with the client? 1. Discuss the need to take medication with food. 2. Tell the client to wear sunglasses when going outdoors. 3. Instruct the client to get cultures after completing medications. 4. Encourage the client to eat yogurt or buttermilk daily.

Answer: 4 Rationale: 1. The medication can be taken with or without food. 2. This medication does not cause photosensitivity. 3. There is no need for the client to get a culture after antibiotic therapy; otitis media is not diagnosed with a culture but with a visual examination of the ear. 4. Yogurt and buttermilk will help to maintain the intestinal flora, which maybe destroyed when receiving antibiotic therapy. The destruction of intestinal flora will lead to a superinfection, resulting in diarrhea.

The client is undergoing eye surgery and the nurse is administering a cycloplegic, a ciliary paralytic ophthalmic medication. Which intervention should the nurse implement? 1. Don sterile gloves prior to administering medication. 2. Tape the client's eyelids shut with non-adhesive tape. 3. Place an eye catheter at the outer canthus to insert medication. 4. Explain that the eyes will be paralyzed for 24 to 48 hours.

Answer: 4 Rationale: 1. The nurse does not have to don sterile gloves when applying ophthalmic medication; nonsterile gloves can be used. 2. The client's eyelids should not be shut during surgery. This medication paralyzes the eye during surgery. 3. There is no such thing as an eye catheter that is inserted into the outer canthus of the eye. 4. Cycloplegic medication paralyzes the eye for 1 to 2 days and the client should be aware of this information because most ophthalmic surgery is performed in day surgery. Because the client will be at home, he or she needs to be knowledge-able about the medication.

The 2-year-old child has acute otitis media. Which intervention will help increase the mother's compliance with the medical regimen? 1. Instruct the parent verbally on how to use a calibrated measuring device. 2. Give the mother a sample of the antibiotic therapy to take home. 3. Make an appointment for a follow-up visit in 1 week. 4. Provide written and oral instructions about antibiotic therapy

Answer: 4 Rationale: 1. The nurse should have the mother demonstrate how to use the measuring device to ensure the mother knows how to use the device. Verbal instructions alone do not ensure that the mother knows how to administer medication correctly. 2. Providing the mother with a sample of antibiotics will not ensure compliance. 3. A follow-up visit will not ensure compliance with the medication regimen. 4. Many times in the HCP's office the mother may be nervous. The child is in the room, and there are many distractions. Therefore, verbal instructions alone may not be thoroughly under-stood. Written information may increase compliance with the medication regimen.

The teenage male client is diagnosed with herpes simplex 2 viral infection and is prescribed valacyclovir (Valtrex). Which information should the nurse teach? 1.The medication will dry the lesions within a day or two. 2.Valtrex may be taken once a week to control outbreaks. 3.The use of condoms will increase the spread of the herpes. 4.Even after the lesions have gone, it is still possible to transmit the virus.

Answer: 4 Rationale: 1. The time period for the lesions to heal depends on several factors, including the immune status of the infected individual and the amount of stress the individual is experiencing at the time. It usually requires several days to more than a week for an outbreak to be healed. 2.Suppressive therapy with Valtrex is once daily, every day. This is an advantage of Valtrex over other antiretroviral agents, which require twice-a-day dosing. 3. The use of condoms may prevent the spread of herpes infections; it does not increase the spread of the virus. 4.It is possible to transmit the virus to asexual partner with no visible signs of a lesion being present. Valtrex will not absolutely prevent the spread of the virus. It will treat an outbreak and decrease the risk of transmission.

The 17-year-old male athlete admits to the nurse he has been taking anabolic steroids to increase his muscle strength. Which action should the nurse implement? 1.Inform the client's parents about the illegal use of anabolic steroids. 2.Ask the client where he has been obtaining these anabolic steroids. 3. Assess the client for moon face, buffalo hump, and weight gain. 4.Explain that long-term effects of steroids may cause him to never father a baby.

Answer: 4 Rationale: 1. This action would break the nurse-client relationship. The nurse should encourage the client to tell his parents. 2. The nurse should not be concerned with where the medications are being obtained. The nurse should strongly discourage use of anabolic steroids because of the long-term effects, including psychological changes. 3.These are side effects of glucocorticoid steroids, not of anabolic steroids. 4.Anabolic steroids have serious side effects including low sperm counts and impotence in men, along with permanent liver damage and aggressive behavior. The use of anabolic steroids to improve athletic performance is illegal and strongly discouraged by HCPs and athletic associations.

The nurse is teaching a 50-year-old client to instill drops in her ear. The nurse explains that to give the ear drops correctly, the client needs to take which action? a.A b.B c.C d.D

Answer: A

The nurse is discharging a client diagnosed with chronic obstructive pulmonary disease (COPD). Which discharge instructions should the nurse provide regarding the client's prescription for prednisone, a glucocorticoid? 1. Take all the prednisone as ordered until the prescription is empty. 2. Take the prednisone on an empty stomach with a full glass of water. 3. Stop taking the prednisone if a noticeable weight gain occurs. 4. The medication should never be abruptly discontinued.

Answer: 4 Rationale: 1. This instruction is for an antibiotic. Prednisone is not abruptly discontinued because cortisol (a glucocorticoid) is necessary to sustain life and the adrenal glands will stop producing cortisol while the client is taking it exogenously. 2. Prednisone can produce gastric distress; it is given with food to minimize the gastric discomfort. 3. Weight gain is a side effect of steroid therapy, and the client should not stop taking the medication if this occurs. This medication must be tapered off if the client is to stop the medication—if the client is able to discontinue the medication at all. 4. Prednisone is not abruptly discontinued because cortisol (a glucocorticoid) is necessary to sustain life and the adrenal glands stop producing cortisol while the client is taking it exogenously. The medication must be tapered off to prevent a life-threatening complication.

The nurse is preparing the client for the placement of an indwelling urinary catheter. Which statement has priority for the nurse to ask the client? 1."Do you have a preference of which leg the tube is taped to?" 2."When did you last attempt to void?" 3."Do you feel the need to void?" 4."Are you allergic to iodine or Betadine?"

Answer: 4 Rationale: 1. This is not a priority; the tubing should be taped to the leg on the side of the bed the bag will be suspended from. 2. This could be asked, but it is not priority. 3. This could be asked, but it is not priority. 4.Indwelling catheter kits come prepackaged with povidone iodine (Betadine)to use for cleansing the perineal skin before inserting the catheter. The Nurse should assess for allergies to themedication before preparing to cleanse the perineum. Another type of skin cleanser may need to be used.

The client is prescribed a 28-day oral contraceptive pack. Which statement best describes the scientific rationale for this birth control product? 1.This causes longer intervals between menses. 2.A hormone pill daily decreases cramping during menses. 3.It is not as expensive as other birth control products. 4.This ensures that the client will take a pill every day.

Answer: 4 Rationale: 1. This is not a true statement. The client will have a normal 28-day cycle. 2.Birth control pills will decrease cramping, but 7 days out of the month the pill the client takes does not contain hormones; itis a placebo. 3. This product is not any more expensive or cheaper than a 21-day product. 4. This 28-day pack contains 21 days of the hormone and 7 days of placebos. The client takes a pill every day. This eliminates the need for the woman to remember which day to restart taking the pill, as she would have to with a 21-day pack, with which the woman takes a pill for 21 days and then no pill for 7 days and then restarts a new pack.

The 28-year-old female client with chronic reactive airway disease is taking the leukotriene receptor inhibitor montelukast sodium (Singulair). Which statement by the client indicates the client teaching is effective? 1. "I will not drink coffee, tea, or any type of cola drinks." 2. "I will take this medication at the beginning of an asthma attack." 3. "It is all right to take this medication if I am trying to get pregnant." 4. "I should not decrease the dose or suddenly stop taking this medication."

Answer: 4 Rationale: 1. This medication does not stimulate the central nervous system; therefore, the client does not need to avoid caffeine-containing products. This statement indicates that the teaching is not effective. 2. These medications are not used to treat an acute exacerbation of reactive airway disease. They are adjunctive drugs given as part of the asthma regimen. This statement indicates the teaching is not effective. 3. The safety of these drugs has not been established in pregnancy and breastfeeding. This statement indicates that the teaching has not been effective. 4. The client should not suddenly stop taking the medication or decrease the dose. This statement indicates the teaching has been effective. Singulair is used with other types of asthma medications and should be continued if the client has an acute asthma attack.

The 34-year-old female client who is para 2, gravida 1 is prescribed the narcotic antitussive hydrocodone (Hycodan). Which information should the nurse discuss with client? 1. Explain that this medication can be taken when pregnant. 2. Teach that this medication will not cause any type of addiction. 3. Instruct the client to take 1 teaspoon after every cough. 4. Discuss keeping the medication away from children.

Answer: 4 Rationale: 1. This medication is a pregnancy risk category C, which is questionable when administered to a client who is pregnant.Pregnancy risk category A is the least dangerous to the fetus; categories B, C, and D are progressively more dangerous than category A, and category X is known to cause harm to the fetus. 2. This cough syrup (antitussive) is similar to codeine and is a narcotic and has addictive properties. 3. This medication should be taken every 4-6 hours to help prevent coughing but should not be taken after every cough; the client could experience excessive drowsiness, constipation, and nausea. 4. This medication is a narcotic and, because the client is 34 years old and has at least one child, the nurse should discuss proper storage of the medication to prevent accidental poisoning of any children.

Which client should the nurse question administering the beta-adrenergic blocker betaxolol (Betoptic) ophthalmic drops? 1. The client diagnosed with open-angle glaucoma. 2. The client diagnosed with end-stage liver failure. 3. The client diagnosed with allergies to sulfa. 4. The client diagnosed with chronic obstructive pulmonary disease (COPD).

Answer: 4 Rationale: 1. This medication is prescribed for clients with open-angle glaucoma. 2. There is no contraindication to administering this eye drop to a client in liver failure because the medication should not be absorbed systemically. 3. There is no contraindication to administering this eye drop to a client who is allergic to sulfa. 4. Contraindications to using this medication include clients who may be receiving beta-blocker therapy, including clients diagnosed with COPD, asthma, heart block, and heart failure.

While taking the health history of a male adolescent client, the nurse learns that he is currently taking an anticonvulsant drug for a seizure disorder. He also tells the nurse "I am embarrassed by the appearance of my gums and I regret not brushing and flossing my teeth more frequently". Which drug is this client most likely taking? a.Phenytoin b.Carbamazepine c.Valproic acid d.Phenobarbital

Answer: A

The male client diagnosed with renal calculi is receiving pain medication via a morphine patient-controlled analgesia (PCA) pump. The health-care provider pre-scribed the nonsteroidal anti-inflammatory drug (NSAID) indomethacin (Indocin) in a rectal suppository. Which intervention should the nurse implement? 1.Question and clarify the prescription with the health-care provider. 2.Give the suppository to the client and allow the client to insert it into the rectum. 3.Administer a Fleet's enema to clear the bowel prior to administering the suppository. 4.Have the client lie on the side and insert the rectal suppository with nonsterile gloves.

Answer: 4 Rationale: 1. This prescription would not need to be clarified with the HCP. 2. The client should not administer the suppository to himself or herself. 3. The client does not need to have a clean bowel to receive a suppository. 4. This medication is prescribed because it may reduce the amount of narcotic analgesia required for acute renal colic.

Which medical treatment is recommended for the client who is diagnosed with mild intermittent asthma? 1. This classification of asthma requires a combination of long-term control medication plus a quick-relief medication. 2. Mild intermittent asthma needs a routine glucocorticoid inhaler and a sustained-relief theophylline. 3. This classification requires daily inhalation of an oral glucocorticoid and daily nebulizer treatments. 4. Mild intermittent asthma is treated on a PRN basis and no long-term control medication is needed.

Answer: 4 Rationale: 1. This type of medical treatment would be used for a client with mild persistent asthma. 2. This medical treatment would be prescribed for a client with moderate persistent asthma. 3. The most severe class, severe persistent asthma, is managed with daily inhalation of a glucocorticoid (high dose), plus salmeterol, a long-acting inhaled agent. 4. Mild intermittent asthma is treated on a PRN basis; long-term control medication is not needed. The occasional acute attack is managed by inhaling a short-acting beta2 agonist. If the client needs the beta2 agonist more than twice a week, moving to Step 2 (mild persistent asthma) may be indicated.

The client just diagnosed with glaucoma is prescribed pilocarpine, a miotic ophthalmic eye drop. Which statement indicates the client needs more teaching concerning the medication? 1. "I will use nightlights in the halls and in the bathroom." 2. "I will get my wife or son to drive me around at night." 3. "I will avoid doing tasks that require sharp vision." 4. "I will take the eye drops every time I have eye pain."

Answer: 4 Rationale: 1. Vision is reduced in dim lights; therefore, the client should use a nightlight to prevent falls. This statement indicates the client understands the teaching. 2. Vision is reduced in dim lights; therefore, the client should avoid night driving for the safety of himself and others. This statement indicates the client understands the teaching. 3. Visual acuity may be decreased during the initiation of therapy; therefore, the client should avoid tasks requiring sharp vision. This statement indicates the client understands the teaching. 4. This medication should be taken routinely every day to reduce intraocular pressure. Glaucoma is painless, so if the client experiences pain, the client should call the HCP immediately. This statement indicates the client needs more teaching.

Which statement is the scientific theory for prescribing zinc preparations for a client with a cold? 1. Zinc binds with the viral particle and reduces the symptoms of a cold. 2. Zinc decreases the immune system's response to a virus. 3. Zinc activates viral receptors in the body's immune system. 4. Zinc blocks the virus from binding to the epithelial cells of the nose.

Answer: 4 Rationale: 1. Zinc does not bind the viral particle. Symptoms are diminished by blocking the ability of the virus to bind with the nasal lining. 2. Zinc is a micronutrient found in the body that helps to increase the body's immune system. 3. Activating viral receptors would increase the symptoms of a cold. 4 . Theoretically, zinc blocks viral binding to nasal epithelium. Observation has shown that increased amounts of zinc can prevent the binding and prevent the development of symptoms of the rhinovirus.

The client diagnosed with glomerulonephritis is receiving trimethoprim sulfa (Bactrim DS). Which data indicates the medication is effective? 1.A urine specific gravity of 1.010. 2.WBC of 35/hpf on the urinalysis. 3.Urine pH of 6.9. 4.Negative urine leukocyte esterase.

Answer: 4 Rationale: 1.A urine specific gravity can indicate dehydration or water intoxication, but it will not provide information about a urinary tract infection. 2.A WBC of 35/hpf indicates a urinary tract infection—not that the antibiotic is effective.Normal is <5/hpf. 3.Normal urine pH is 5.0-9.0, but the pH does not evaluate a urinary tract infection. 4.A negative urine leukocyte esterase indicates the antibiotic is effective in treating the infection. Leukocytes and nitrates are used to determine bacteriuria and other sources of urinary tract infections.

The nurse is caring for a client diagnosed with migraine headaches. Which information should the nurse teach regarding abortive medication therapy? 1.Use the medication every day even if no headache. 2.Take the radial pulse for 1 minute prior to taking the medication. 3.The medications can cause severe hypertension. 4.Limit use of the medication to 1 or 2 days a week.

Answer: 4 Rationale: 1.Abortive therapy is used to treat an actual migraine headache in an effort to limit the intensity and duration of the headache. Using the medication more than 1-2 days per week can cause medication overuse headaches (MOH). 2.The client should take his or her radial pulse if receiving preventive therapy with a beta blocker medication—not for the medications used to abort a headache. 3.The common side effects of abortive medications are nausea, vomiting, and diarrhea. The development of hypertension is not associated with these medications. Care should be taken to ensure the patient is experiencing a migraine because a headache can also be caused by severe hypertension. 4.Use of abortive medications more than 1-2 days per week frequently results in a drug-induced headache, called MOH.

The 28-year-old client who is obese is complaining of nervousness, irritability, insomnia, and heart palpitations. Which question should the clinic nurse ask the client first? 1."How much weight have you gained or lost within the last 12 months?" 2."Do you make yourself vomit after eating large meals?" 3."Is there any history of you taking illegal drugs such as amphetamines?" 4."Have you been taking any over-the-counter appetite suppressants?"

Answer: 4 Rationale: 1.Asking about weight loss and weight gain is an appropriate question for a client who is obese, but this client's physiological signs/symptoms require a more specific question. 2.This is a question the nurse would ask a client who is suspected of having bulimia, which is not apparent with this client. 3.Asking the client about illegal drug use may be appropriate, but the nurse should first ask about prescribed medications or over-the-counter self-medications. This question likely will cause the client to become defensive. 4.These physiological signs/symptoms could indicate long-term use of anorexiants (appetite suppressants);therefore, the nurse should discuss this question with the client.

Which statement best describes the scientific rationale for administering calcitriol (Rocaltrol), a vitamin D analog, to a client in end-stage kidney disease? 1.This medication increases the availability of vitamin D in the intestines. 2.This medication stimulates excretion of calcium from the parathyroid gland. 3.The medication helps the body excrete calcium through the feces. 4.This medication increases serum calcium levels by promoting calcium absorption.

Answer: 4 Rationale: 1.Calcitriol does not affect the availability of vitamin D. 2.Calcitriol is used to treat hypoparathyroidism, but it does not stimulate excretion of calcium from the parathyroid gland. 3. The client in end-stage kidney disease has hypocalcemia, and hypercalcemia. 4. This is the scientific rationale for administering this medication to a client in chronic kidney disease. Calcitriol increases serum calcium levels by promoting calcium absorption and thereby helps to manage hypoglycemia, which is a symptom of CKD.

Which medication category is contraindicated in clients who are pregnant? 1.Pregnancy category A 2.Pregnancy category B 3.Pregnancy category C 4.Pregnancy category D

Answer: 4 Rationale: 1.Category A medications have a remote risk of causing fetal harm and are prescribed for clients who are pregnant. 2.Category B medications have a slightly higher risk of causing fetal abnormalities than do Category A medications, but they are often prescribed for clients who are pregnant. 3.Category C medications pose a greater risk than category B medications and are cautiously prescribed for clients who are pregnant. Medications in this category have either not yet been the subject of research may show a risk in animal studies. 4.Category D medications have a proven risk of fetal harm and are not prescribed for clients who are pregnant unless the mother's life is in danger. Category X medications have a definite risk of fetal abnormality or abortion.

The client diagnosed with renal calculi has just had an intravenous pyelogram (IVP).Which task is most appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP)? 1.Hang a new bag of intravenous fluid. 2.Discontinue the client's intravenous catheter. 3.Assist the client outside to smoke a cigarette. 4.Maintain the client's intake and output.

Answer: 4 Rationale: 1.Intravenous fluids are medications and the nurse cannot delegate medication administration to the UAP. 2. The UAP may be able to discontinue an IV, but the question asks which the most appropriate task and the nurse is should always delegate the least invasive and the simplest task. 3. The UAP should not be assigned to take a client outside to smoke. This is not in the job description of a hospital employee. After The nurse discourages the client from going downstairs to smoke, a family member or friend should escort the client outside. 4. The UAP can document the client's oral intake and urinary output, but the UAP cannot evaluate if the urine output is adequate and appropriate for the IVP procedure.

The nurse is caring for a client with a malignant brain tumor. Which medication should the nurse anticipate the health-care provider ordering? 1.Cyclophosphamide (Cytoxan), an alkylating agent, IVPB. 2.Octreotide (Sandostatin), a pituitary suppressant. 3.Erythropoietin (Epogen), a biological response modifier. 4.Phenytoin (Dilantin), an anticonvulsant.

Answer: 4 Rationale: 1.Most drugs do not cross the blood-brain barrier, so most antineoplastic agents are not effective against cancers in the brain. 2.Octreotide is a growth hormone suppressant and is useful in the treatment of acromegaly, not malignant tumors of the brain. 3.Brain tumors rarely metastasize outside of the skull cavity to cause systemic manifestations of disease such as anemia, for which erythropoietin would be prescribed. Brain tumors, malignant or benign, kill by occupying space and causing increased intracranial pressure. 4.A brain tumor has the potential to cause erratic stimulation of the neurons in the brain, resulting in seizures. The nurse should expect the HCP to order an anticonvulsant to prevent or control seizures.

The client in end-stage renal disease (ESRD) is taking calcitriol, a vitamin D analog. Which assessment data warrants intervention by the nurse? 1.The client complains of nausea. 2.The client has had two episodes of diarrhea. 3.The client has an increase in the serum creatinine level. 4.The client has blood in the urine.

Answer: 4 Rationale: 1.Nausea is a side effect of calcitriol and can also result from ESRD itself. 2.Diarrhea is an expected side effect of the medication; therefore, it would not warrant intervention from the nurse. 3. The client in ESRD would have an increased serum creatinine level; therefore, this would not warrant immediate intervention by the nurse. 4.Hematuria is an adverse effect of calcitriol and the nurse should notify the health-care provider. This would warrant taking the client off the medication. MEDICATION MEMORY JOGGER: Any time there is blood in the urine it is a cause for concern, and the nurse should intervene and investigate what is causing the hematuria.

The 16-year-old female client tells the public health nurse that she thinks her boyfriend gave her a sexually transmitted infection (STI). Which statement is the nurse's best response? 1."You will need parental permission to be seen in the clinic." 2."Be sure and get the proper medications so that you don't become pregnant." 3."How would you know that you have a sexually transmitted infection?" 4."You need to have tests so you can be started on medications now."

Answer: 4 Rationale: 1.Sexually transmitted infections are considered a public health hazard and the client can be treated without parental permission. 2.Pregnancy may be a concern, but the client is discussing sexually transmitted infection and the nurse should address the client's concerns. 3. This is a judgmental statement and the nurse should not impair communication with the client. 4.There are many different STIs. The client needs to have tests run based on her presenting symptoms so that appropriate treatment can be initiated.

The nurse in an HCP's office is assessing a female client with a tension headache. Which question should the nurse ask the client? 1."Have you been sunbathing recently?" 2."Do you eat shellfish or other iodine-containing foods?" 3."Is there a chance you might be pregnant?" 4."What over-the-counter medications have you tried?"

Answer: 4 Rationale: 1.Sunbathing does not affect a tension headache. Clients with migraine headaches may be sensitive to light. 2.Iodine will not affect a tension headache. Caffeine intake may prevent a headache for some clients. 3.This would be a good question if the client were suffering from a migraine headache because a drug commonly used to treat migraine—ergotamine—should not be taken by a pregnant woman because it may cause uterine contractions. However, this client has a tension headache, not a migraine. 4.Clients will attempt to self-treat with over-the-counter medications prior to seeking medical attention. The nurse should assess what the client has already tried for relief of the headache.

The client with a head injury is experiencing increased intracranial pressure. The neurosurgeon prescribes the osmotic diuretic mannitol (Osmitrol). Which intervention should the nurse implement when administering this medication? 1.Monitor the client's arterial blood gases during administration. 2.Do not administer if the client's blood pressure is less than 90/60. 3.Ensure that the client's cardiac status is monitored by telemetry. 4.Use a filter needle when administering the medication.

Answer: 4 Rationale: 1.The client's ABGs are not affected by the administration of mannitol; therefore, there is no need to monitor them. 2.The client's blood pressure does not affect the administration of mannitol. 3.The client with a head injury would be in the intensive care unit receiving telemetry, but mannitol does not affect cardiac status. 4.The nurse must use a filter needle when administering mannitol because crystals may form in the solution and syringe and be inadvertently injected into the client if a filter needle is not used.

The 55-year-old African American male client presents to the emergency department with blurred vision, slurred speech, and left-sided weakness. The client has a history of hypertension (HTN) and benign prostatic hypertrophy (BPH). Which statement regarding the client's medications should the nurse ask at this time? 1."Have you been taking over-the-counter herbs to treat the BPH?" 2."Do you take an aspirin every day to prevent heart attacks and strokes?" 3."Do you eat green, leafy vegetables frequently?" 4."Have you been taking medications routinely to control the HTN?"

Answer: 4 Rationale: 1.The nurse should ask all clients about taking over-the-counter preparations when being admitted, but this question would have no bearing on the client's presenting symptoms of a stroke. 2.The client has symptoms of a stroke. Whether he was taking an aspirin to prevent a potential problem is irrelevant. The client has a problem at this time. 3.Green, leafy vegetables are high in vitamin, the antidote for Coumadin. The client has no reason to be taking an anticoagulant this time. 4.Many medications for HTN have the adverse effect of causing erectile dysfunction, which many men are hesitant to discuss with their HCP, and the man may simply stop taking the medication to avoid this side effect. The nurse should assess how the client has been controlling his HTN and ask specifically about erectile dysfunction related to hypertensive medication. HTN is a risk factor for developing other cardiovascular diseases, including stroke. This client has two risk factors for developing a stroke: HTN and his racial background.

The client has an open laceration on the right temporal lobe secondary to being hit on the head with a baseball bat. The emergency department HCP sutures the laceration and the CT scan is negative. Which instruction should the nurse discuss with the client? 1.Do not put anything on the laceration for 72 hours. 2.Use hydrocortisone cream 0.5% on the laceration. 3.Cleanse the area with alcohol three times a day. 4.Apply Neosporin ointment to the sutured area.

Answer: 4 Rationale: 1.The sutured area may get infected; there-fore, the client should keep the wound clean and apply antibiotic ointment. 2.Hydrocortisone cream is an anti-inflammatory medication and would not be applied to a laceration. 3.Alcohol would be very painful and should not be used to clean the laceration. 4.The sutured area must be cleansed with soap and water and patted dry, and an antibiotic ointment, such as Neosporin, should be applied to prevent infection.

The female client is taking clomiphene (Clomid), an estrogen antagonist. Which statement indicates the client understands the risk of taking this medication? 1."The medication may cause my child to have Down syndrome." 2."There are very few risks associated with taking this medication." 3."I should stagger the times that I take this medication." 4."This medication may increase my chance of having twins."

Answer: 4 Rationale: 1.There is no increased risk of having a child with Down syndrome when taking this medication. 2.There are many risks associated with taking this fertility medication, including multiple fetuses, pain, visual disturbances,abnormal bleeding, and ovarian failure. 3. This medication should be taken at the same time every day to maintain a therapeutic drug level. 4.Clomid is an ovarian stimulant that promotes follicle maturation and ovulation. Many follicles can mature simultaneously, resulting in the increased possibility of multiple births.

The client with a severe head injury was exhibiting decorticate posturing during the nurse's assessment 2 hours ago. The client is receiving mannitol (Osmitrol), an osmotic diuretic. Which data indicates the medication is not effective? 1.The client pushes the nurse's hand away in response to pain. 2.The client's Glasgow Coma score is a 13. 3.The client is not able to state the day of the week. 4.The client exhibits flaccid paralysis to painful stimuli.

Answer: 4 Rationale: 1.This behavior indicates the client's neuro-logical status is improving; therefore, the medication is effective. 2.The highest possible score on the Glasgow Coma Scale is 15. Therefore, a 13 indicates the client is getting better and the medication is effective. 3.If the client is alert, even if unable to identify the day of the week, this indicates the client is getting better and the medication is effective. 4.Flaccid paralysis is the client's worst response to painful stimuli, equivalent to a 3 on the Glasgow Coma Scale. Decorticate posturing would receive a5 on the Glasgow Coma Scale. Therefore, flaccid paralysis indicates the medication is not effective.

The client diagnosed with Parkinson's disease has been taking amantadine (Symmetrel), an antiparkinsonian drug. The home health nurse notes a new finding of mottled discoloration of the skin. Which intervention should the nurse implement? 1.Ask the client if he or she has changed soap products. 2.Prepare the significant other for the client's imminent death. 3.Notify the health-care provider to discontinue the medication. 4.Explain that this is expected and document the finding.

Answer: 4 Rationale: 1.This change in status would not result from soaps. A rash or skin irritation would be expected with soap products. 2.Mottling of the skin is a sign of imminent death in some clients, but the nurse must be aware of potential side effects of medications. This client is not dying 3.This side effect is not life threatening, and as long as the medication is effective, there is no reason to discontinue the medication. 4.Clients taking amantadine for 1 month or longer often develop a mottled discoloration of the skin called livedo reticularis, a benign condition that will gradually disappear following discontinuation of the drug. This condition is not a reason to discontinue the medication as long as it is effective. The effectiveness of this medication begins to diminish within 3-6 months.

The elderly client diagnosed with a stroke is being discharged. When preparing the discharge instructions, the nurse notes many medications that are ordered to be taken at different times of the day. Which intervention should the nurse implement first? 1.Complete a comprehensive chart for the client to use. 2.Refer the client to a home health-care agency for follow-up. 3.Teach the client to return to the HCP office for follow-up. 4.Discuss the multiple medications and times with the HCP.

Answer: 4 Rationale: 1.This could be done if the nurse and HCP cannot simplify the medication routine. 2.This may need to be done based on the nurse's evaluation of the client's situation, but it is not the first intervention. 3.This should be done, but it is not the first intervention and does not address the problem of many medications and multiple administration times. 4.The client has had a stroke and may have difficulty complying with multiple medications and different administration times. Research (for all clients) indicates that the fewer medication administration times during the day, the better the compliance with taking the medication as ordered. The nurse should discuss simplifying the medication regimen with the HCP.

The client is going on a cruise and asks the clinic nurse, "I am worried about getting seasick. What should I do?" Which statement is the nurse's best response? 1."You are worried about getting seasick. Let's sit down and talk about it." 2."Take the motion sickness medication when you start getting nauseated." 3."If you get seasick, you should take an antacid to help with the nausea." 4."I would recommend taking Dramamine 30 minutes before your departure."

Answer: 4 Rationale: 1.This is a therapeutic response and the patient needs information. Therefore, it is not the nurse's best response. 2.Antivertigo or anti-motion-sickness medications are most effective when administered prophylactically, rather than after symptoms have begun. 3.Antacids neutralize the gastric acid and will not help the nausea experienced with motion sickness. 4.Dimenhydrinate (Dramamine) is the over-the-counter drug of choice for motion sickness. It should be taken 30-60 minutes before departure and 30 minutes before meals thereafter.

The nurse in the intensive care unit is caring for a client diagnosed with a left cerebral artery thrombotic stroke who received a thrombolytic medication in the emergency department. Which intervention should be implemented? 1.Administer the antiplatelet medication ticlopidine (Ticlid) po. 2.Place the client in the Trendelenburg position. 3.Keep the client turned to the right side and high Fowler's position. 4.Monitor the anticoagulant heparin infusion.

Answer: 4 Rationale: 1.Ticlid may be ordered in the future once the cause of the thrombus is determined, but this would not be ordered in the intensive care unit. 2.The Trendelenburg position is head down and would increase intracranial pressure. 3.There is no reason to restrict the client to lying on the right side, and high Fowler's is sitting upright. This would be a difficult position for the client to maintain. The client should have the head of the bed elevated approximately 30 degrees to decrease intracranial pressure by gravity drainage. 4.The anticoagulant heparin is administered to prevent clot reformation after lysis of the clot by the thrombolytic, and its infusion should be monitored.

The client is having status epilepticus and is prescribed intravenous diazepam (Valium). The client has an IV of D5W 75 mL/hr in the right arm and a saline lock in the left arm. Which intervention should the nurse implement? 1.Dilute the Valium and administer over 5 minutes via the existing IV. 2.Do not dilute the medication and administer at the port closest to the client. 3.Question the order because Valium cannot be administered with D5W. 4.Inject 3 mL of normal saline in the saline lock and administer Valium undiluted.

Answer: 4 Rationale: 1.Valium is oil based and should not be diluted. 2.Valium is oil based and should not be administered in an existing IV line if another option is available. 3.Valium should not be administered in an existing IV line, but the nurse does not need to question the order because there is an existing saline lock. 4.The nurse should administer the Valium undiluted through the saline lock.

The female client is being admitted to a medical unit with a diagnosis of pneumonia. Which intervention would the nurse implement? Rank in order of performance. 1. Start an intravenous access line. 2. Administer the IVPB antibiotic. 3. Teach to notify the nurse of any vaginal itching. 4. Obtain sputum and blood cultures. 5. Place an identity band on the client.

Answer: 5, 4, 1, 2, 3 Rationale: 5. The laboratory technician who will draw the blood cultures will need the band to identify the client before drawing the specimen, and the nurse will need the band before administering the medication. Checking for the right client is one of the five rights of medication administration. 4. Cultures are obtained prior to the initiation of antibiotics to prevent skewing of the results. 1. An intravenous line must be initiated before the nurse can administer IV medications. 2. Intravenous antibiotics should be administered within 1-2 hours of the order being written. This should always be considered a "now" medication. 3. Superinfections are a potential complication of antibiotic therapy. Vaginal yeast infections occur when the good bacteria are killed off by the antibiotic. Diarrhea from destruction of intestinal flora is also a possibility.

The client is receiving an intravenous infusion of heparin. The bag hanging has 25,000 units of heparin in 500 mL of D 5 W at 14 mL per hour via an intravenous pump. How many units of heparin is the client receiving every hour?

Answer: 700 units of heparin are being infused every hour.

The client is receiving an intravenous infusion of heparin. The bag hanging has 25,000 units of heparin in 500 mL of D5W at 14 mL per hour via an intravenous pump. How many units of heparin is the client receiving every hour?

Answer: 700 units of heparin are being infused every hour. Rationale: 700 units of heparin are being infused every hour. When determining the units, the nurse must first determine how many units are in each milliliter. 25,000 Units = 50 units per mL 500 mL 50 units per mL ×14 mL per hour = 700 mL per hour

The health-care provider has ordered theophylline 5 mg/kg/q 6 hours for a child who weighs 35 lb. How much medication would the nurse administer in each dose?

Answer: 79.5 mg Rationale: 79.5 mg. First, convert the child's weight to kilograms: 35 ÷ 2.2 = 15.9 kg. Then, determine how many milligrams should be given with each dose: 15.9 kg ×5 mg = 79.5 mg per dose.

A mydriatic medication has been prescribed for a client to prepare for an ophthalmic procedure and the client asks the nurse about the purpose of the medication. Which best response should the nurse provide to the client? a."The medication will help dilate the pupils" b."The medication will relax the muscles of the eyes to prevent blurred vision" c."The medication causes the pupil to constrict and will lower the pressure in the eye" d."The medication will help block the responses that are sent to the muscles in the eye"

Answer: A

A client is tested for tuberculosis with a PPD skin test. What immune reaction occurs with this test? a.CD4 T-cells mediated type IV hypersensitivity b.Complement mediated type III hypersensitivity c.Antibody mediated type II hypersensitivity d.Eosinophils mediated type I hypersensitivity

Answer: A Rationale: The tuberculin skin test (PPD) is an example of CD4 T-cell mediated delayed type hypersensitivity (type IV). Antigens of the tubercle bacillus are injected intradermally and phagocytized by Langerhans cells. If the client has been exposed to the tuberculin bacillus, specific memory CD4 T-cells are activated and initiate an inflammatory reaction that takes 48-72h to reach its peak. The result can be quantified by measuring the area of induration on the client's skin. Choice B is incorrect because type III hypersensitivity reactions are mediated by circulating antigen-antibody complexes. They are deposited in specific tissues where they mediate a local inflammatory reaction that causes tissue damage (e.g. IgA nephropathy.) Choice C is incorrect because type II hypersensitivity is mediated by circulating autoantibodies that bind fixed antigens in specific tissue ( e.g. Hashimoto thyroiditis)> Choice D is incorrect because type I hypersensitivity is also known as immediate hypersensitivity. This is an allergic reaction that starts within minutes of exposure to the antigen and last no longer than 24 hours. It is predominantly mediated by eosinophils.

A client, with acute respiratory distress syndrome (ARDS), is intubated and placed on mechanical ventilation. Currently, the client's PaO2 is 58. What intervention would be indicated for this client? a.Positive end-expiratory pressure b.Suctioning c.Increase oxygen to 10 liters d.Remove continuous positive airway pressure

Answer: A Rationale: When the PaO2 cannot be maintained, there is a risk that oxygen toxicity will accentuate the disease process. Often it is necessary to add positive end-expiratory (PEEP) to mechanical ventilation settings to maintain blood and tissue oxygenation. Choice B is incorrect because suctioning will not improve this client's oxygen saturation level. Choice C is incorrect since this amount of oxygen since the amount of oxygen could lead to oxygen toxicity. Choice D is incorrect because continuous positive airway pressure may need to be added to improve the client's oxygenation level.

The nurse is caring for a client s/p (status post) craniotomy for a brain tumor. Which of the following signs and symptoms of increased intracranial pressure should the nurse monitor? a.Confusion b.Nausea and projectile vomiting c.Hypotension d.Tachycardia e.Tachypnea

Answer: A, B

A provider has prescribed pilocarpine. The nurse understands that the drug stimulates muscarinic receptors and would expect the drug to have which action? a.Reduce excessive secretions in a postoperative patient b.Lower intraocular pressure in patients with glaucoma c.Inhibit muscular activity in the bladder d.Prevent hypertensive crisis

Answer: B

Following heparin treatment for a pulmonary embolism, a client is being discharged with a prescription for warfarin (Coumadin). In conducting discharge teaching, the nurse advises the client to have which diagnostic test monitored regularly after discharge? a.Perfusion scan. b.Prothrombin Time (PT/INR). c.Activated partial thromboplastin (APTT). d.Serum Coumadin level (SCL).

Answer: B

The nurse is observing a new nursing graduate who is administering Phenytoin IV push (bolus) for a client with a Dextrose in water (D5W) is running. Which procedure by the nursing graduate should indicate to the nurse an understanding of proper administration of this medication? a.Stop the D5W solution, administer the phenytoin slowly, and then run the D5W at the ordered rate b.Stop the D5W solution, flush with 0.9% sodium chloride (NS), administer the phenytoin slowly, flush again with NS, then run the D5W at the ordered rate c.Stop the D5W solution, flush with Lactated Ringer's (LR), administer the phenytoin slowly, flush again with LR, then run the D5W at the ordered rate d.Keep the D5W solution and hang another IV bag of NS to run simultaneously with D5W, administer the phenytoin slowly, and then run the D5W and NS infusions at the ordered rates

Answer: B

A client recovering from a kidney transplant has an 8 mm are of induration after an intradermal PPD tuberculin test. What will need be done prior to treating this client for active tuberculosis? a.Nothing since this is a diagnostic indication of active disease. b.Determine active disease present through a chest x-ray. c.Conduct a multiple-puncture tine test. d.Evaluate results of liver functions tests.

Answer: B Rationale: A positive tuberculin test alone does not indicate active disease. A chest x ray will be done to evaluate for the presence of dense lesions in the apical and posterior segments of the upper lobe and possible cavity formation. Choice A is incorrect because positive tuberculin skin test alone does not indicate active disease. Choice C is incorrect because a multiple-puncture tine test is less accurate than the PPD test. Choice D is incorrect because liver function tests are obtained prior to treating with isoniazid. The client needs to be diagnosed with active tuberculosis first.

A male client is receiving pilocarpine hydrochloride ophthalmic drops for glaucoma. He called the clinic asking the nurse why he has difficulty seeing at night. Which explanation should the nurse provide? a.The drops increases the fluid in the eyes and clouds the visual fields b.The drug dilates the pupils and can cause the lens to become more opaque c.The eye drop constrict the pupils and slows pupil response to accommodate for darkness d.The medication causes pupils to dilate, which reduces night vision

Answer: C

A patient with a form of epilepsy that may have spontaneous remission has been taking an antiepileptic drug (AED) for a year. The patient reports being seizure free for 6 months and that he will stop taking the drug. What would be the nurse's most appropriate response? a.A b.B c.C d.D

Answer: C

A client with acute respiratory distress (ARDS) is not responding to oxygen therapy via nasal cannula. What is causing this lack of response? a. Thick mucus secretions blocking the airways b.Inflammatory mediated bronchoconstriction c.Loss of surfactant production d.Destruction of alveolar walls by elastase activity

Answer: C Rationale: In ARDS inflammatory cytokines damage the capillary alveolar membrane, resulting in fluid accumulation in the alveolus and impairing surfactant production. As a result, the alveoli collapse, and gas exchanges is impeded. Because oxygen cannot be taken up by the capillaries, PO2 level drop and remains unaffected by oxygen therapy. Choice A describes the mechanism of pneumonia. Choice B describes mechanism of an acute asthma attack. Choice D describes the mechanism of emphysema.

The client who has had a transurethral resection of the prostate is complaining of bladder spasms. The HCP prescribed an opiate suppository, belladonna and opiate (B&O). Which interventions should the nurse implement when administering this medication? Select all that apply. 1.Obtain the correct dose of the medication. 2.Lubricate the suppository with K-Y jelly. 3.Wash hands and don non sterile gloves. 4.Check the client's armband for allergies. 5.Ask the client to lie on the left side.

Answers: 1 ,2, 3, 4, 5 Rationale: 1.B&O suppositories come in 15A (1/2 grain) and 16A (1 grain) formula-tions. When obtaining the medication from the narcotic cabinet the nurse should obtain the correct dose for the client. B&O suppositories are used to reduce bladder spasms for clients who have had bladder surgery. 2.Lubricating the suppository decrease the pain for the client when inserting a suppository. 3.Adhering to Standard Precautions is always an appropriate nursing intervention when caring for the client. 4. The nurse should check the armband before opening the medication and preparing to administer it. 5. The large intestine/rectum lies on the left side of the body, so placing the client on the left side makes insertion easier and reduces the chance of a ruptured bowel.

The client diagnosed with a brain tumor is ordered the osmotic diuretic mannitol (Osmitrol) to be given intravenously. Which interventions for this medication should the nurse implement? Select all that apply. 1.Inspect the bottle for crystals. 2.Record intake and output every 8 hours. 3.Auscultate the client's lung fields. 4.Perform a neurological examination. 5.Have calcium gluconate at the bedside.

Answers: 1, 2, 3 Rationale: 1.Mannitol can crystallize in the containers in which it is packaged, and the crystals must not be infused into the client. The nurse should inspect the bottle for crystals before beginning the administration. 2.Any client receiving a diuretic should be monitored for intake and output to determine if the client is excreting more than the intake. 3.Mannitol is an osmotic diuretic and works by pulling fluid from the tissues into the blood vessels. Clients diagnosed with heart failure or who may be at risk for heart failure may develop fluid volume overload. Therefore, the nurse should assess lung sounds before administering this medication. 4.The nurse does not have to perform a neurological examination for this medication. The nurse should do this for the disease diagnosis. 5.Calcium gluconate will not affect this medication, nor is it an antidote.

Which interventions should the nurse implement when the nurse anaesthetist is administering spinal anesthesia to a pregnant client in labor? Select all that apply. 1.Administer 500-1000 mL of intravenous fluid before inserting the spinal catheter. 2.Instruct the client to lie on the side in the fetal position when inserting the spinal catheter. 3.Perform a neurovascular assessment on the client's lower extremities. 4.Monitor the client's blood pressure, pulse, and respirations during spinal anesthesia. 5.Assist the client with pushing when instructed by obstetrician.

Answers: 1, 2, 3, 4, 5 Rationale: 1.Spinal anesthesia has been shown to be well tolerated by a healthy fetus when a maternal intravenous fluid preload in excess of 500-1000 mL precedes the administration of the spinal. 2. The client will be in the side-lying fetal position when the spinal anesthesia being administered. 3. This neurovascular assessment should be performed prior to and after the spinal anesthesia to determine the effectiveness of the anesthesia. 4.Baseline vital signs can be obtained 30 minutes to 1 hour prior to spinal anesthesia; post procedure vital signs are monitored every 1-2 minutes for the first 10 minutes and then every 5-10 minutes throughout the delivery. 5.Spinal anesthesia will cause the pregnant client not to feel the contractions ,so the nurse needs to assist the client with pushing.

The nurse is discussing how to instill artificial tears into the client's eyes. Which information should the nurse discuss with the client? Select all that apply. 1. Do not allow the artificial tear dropper to touch the eye. 2. Keep the eyes closed 1-2 minutes after instilling drops. 3. Apply pressure to the inner canthus after instilling eye drops. 4. Wash the hands prior to instilling the artificial tears into the eyes. 5. Lie in the prone position when instilling the eye drops.

Answers: 1, 2, 4 Rationale: 1. Not letting the dropper touch the eye ensures that the eye will not be injured during application of the artificial tears. 2. Keeping the eyes shut for a minute or two after instilling the drops will enhance the effectiveness of the medication. 3. Applying pressure to the inner canthus is not an appropriate intervention because this prevents systemic absorption of the medication and artificial tears are not a medication that would cause systemic effects. 4. Washing the hands is an appropriate intervention so that bacteria on the hands will not fall into the eye when instilling eye drops. 5. Lying on the stomach (prone position) is not an appropriate intervention to discuss with the client. This position would allow the drops to leak out of the eye. MEDICATION MEMORY JOGGER: "Select all that apply" questions require the test taker to view each option as a True/False question. One option cannot assist the test taker to eliminate another option.

Which interventions should the nurse implement when administering intravenous(IV) fluids to a 2-year-old diagnosed with acute epiglottitis? Select all that apply. 1. Label the IV fluid with the client's name. 2. Obtain the daily weight and post at the head of the bed. 3. Restrain the client's arm with a soft wrist restraint. 4. Assess the child's IV site for redness and warmth. 5. Administer the IV fluids with a volume-control chamber.

Answers: 1, 2, 4, 5 Rationale: 1. Medications should be labeled appropriately; IV fluids should be considered a medication. 2. The weight is important when administering IV fluids to a child to help prevent fluid volume overload. 3. The child may need an elbow restraint but the nurse should not restrain the child with wrist restraints because doing so will scare the child. 4. Redness and warmth at the IV site indicate phlebitis, which requires the IV to be discontinued. 5. A volume-control chamber (Buretrol)is a special IV tubing device that allows for 1 hour of fluid to potentially infuse at any one time. It is a safety device to prevent fluid overload in a child.

The nurse is preparing to administer warfarin (Coumadin), an anticoagulant. The client's current laboratory values are as follows: PT 22 (control 12.9), PT 39 (Control 36), INR 3.6. Which intervention should the nurse implement? Select all that apply. 1. Question administering the medication. 2. Prepare to administer AquaMEPHYTON (vitamin K). 3. Notify the health-care provider to increase the dose. 4. Administer the medication as ordered. 5. Assess the client for abnormal bleeding.

Answers: 1, 2, 5 Rationale: 1. The INR is above the therapeutic range; therefore, the nurse should question administering this medication. 2. Vitamin K is the antidote for Coumadin Toxicity, therefore the nurse may administer this with a HCP order. 3. There is no reason to notify the HCP to request an increase in the dose because the client is above the therapeutic range. 4. The INR is above therapeutic range therefore the nurse should not administer the medication. 5. The INR is above therapeutic range therefore the nurse should assess the client for bleeding. MEDICATION MEMORY JOGGER: When trying to remember which laboratory value correlates with which anticoagulant, here's a helpful hint: "PT boats go to war (warfarin), and if you cross the small 't's' in 'Ptt' with one line it makes an 'h'(heparin)."

The client diagnosed with a brain tumor has been placed on narcotic analgesic medications to control the associated headaches. Which interventions should the nurse implement? Select all that apply. 1.Instruct the client to increase fluids while taking the medication. 2.Talk to the client about taking bulk laxatives daily. 3.Teach the significant other to perform a neurological assessment. 4.Discuss limiting the amount of medication allowed per day. 5.Explain safety issues when taking narcotic medications.

Answers: 1, 2, 5 Rationale: 1.The client is at risk for constipation because of the effects of narcotics on the gastrointestinal tract. The client should be encouraged to increase the amount of fluid intake. 2.The client is at risk for constipation. A bowel regimen should be instituted, including bulk laxatives as part of the regiment. 3.The significant other does not need to be taught to perform a neurological assessment for this medication. He or she should be told that if the client becomes excessively drowsy, hold the next dose and notify the HCP. It may be necessary to allow the drowsiness to control the pain. 4.The medication may need to be increased, not limited, to control the pain. The amount of pain medication needed should be provided. 5. The client should not drive motor vehicles or use machinery, and should be careful ambulating and/or climbing stairs. These are safety issues.

Which discharge instructions should the emergency room nurse discuss with the client who has sustained a concussion? Select all that apply. 1.Do not drink any type of alcoholic beverage until allowed by HCP. 2.Take two acetaminophen (Tylenol) up to every 6 hours for a headache. 3.If experiencing a headache, take one hydrocodone (Vicodin) every 8 hours. 4.It is all right to take a couple of aspirin if experiencing a headache. 5.Notify the healthcare provider if medication does not relieve headache.

Answers: 1, 2, 5 Rationale: 1.Traumatic brain injuries can impair many brain functions that can be significantly worsened by alcohol, so the client should not drink alcoholic beverages until allowed by HCP. 2.Tylenol can be taken for a headache in a patient who has sustained a concussion. If the Tylenol does not relieve the headache, the client should contact the HCP. 3.Narcotic analgesics should not be taken after a head injury because such medications may further depress neurological status. 4.Aspirin could lead to bleeding, and a client with a concussion does not need a chance of increased bleeding. 5.If Tylenol does not relieve the client's headache then the client should notify the HCP since this may indicate a worsening condition such as increased intracranial pressure.

The nurse is preparing to administer an oral medication to a client diagnosed with a stroke. Which interventions should the nurse implement? Select all that apply. 1.Crush all oral medications and place them in pudding. 2.Elevate the head 30 degrees. 3.Ask the client to swallow a drink of water. 4.Have suction equipment at the bedside. 5.Insert a nasogastric tube to administer medications.

Answers: 1, 3 Rationale: 1.Some medications can be crushed and administered in pudding if the client has difficulty swallowing but the nurse needs to be aware that enteric-coated or timed-release medications should not be crushed. 2.The head of the bed should be elevated to90 degrees when the client is swallowing food or medications. 3.The client's ability to swallow must be assessed before attempting to administer any oral medication. Water is the best fluid to use because it will not damage the lungs if aspirated. 4.Equipment is usually charged to the client. The nurse should first determine if suction equipment is needed prior to setting it up. 5.The client's medications are being administered orally; therefore, the nurse should not insert a nasogastric tube.

The client is admitted to the surgical department diagnosed with renal calculi. The HCP prescribes a morphine patient-controlled analgesia (PCA). Which interventions should the nurse implement? Select all that apply. 1.Instruct the client to push the control button as often as needed. 2.Explain the medication will ensure the client has no pain. 3.Discuss that medication effectiveness is evaluated on a pain scale of 1-10. 4.Inform the client to obtain assistance when getting out of the bed. 5.Instruct the unlicensed assistive personnel to strain all the client's urine

Answers: 1, 3, 4, 5 Rationale: 1. The PCA pump automatically administers a specific amount and has a lock-out interval time in which the PCA pump cannot administer any morphine. The client can push the control button as often as needed and will not receive an overdose of pain medication. 2. The nurse should inform the client that the pain should be tolerable, not necessarily absent. 3.Adult clients use the 1-10 pain scale, with 0 being no pain and 10 being the worst pain. 4. The client receiving PCA morphine should be instructed not to ambulate without assistance due to the chance of falls. 5.All the client's urine should be strained by all staff members.

The couple has decided to use a spermicide for birth control. Which information should the nurse discuss with the female partner? Select all that apply. 1.Insert the spermicide prior to having sexual intercourse. 2.Douche with vinegar and water immediately after intercourse. 3.Apply spermicide in the woman's vagina. 4.Tell the couple spermicide is effective up to 3 times. 5.Explain this form of birth control will not prevent STIs.

Answers: 1, 3, 4, 5 Rationale: 1.Correct use of spermicide is required for contraceptive efficacy. The spermicide must be in place prior to intercourse, and the foam is immediately active. If a suppository or tablet is used, it must be inserted 10-15 minutes before intercourse to allow time for it to dissolve. 2.Douching is not allowed for at least 6 hours after intercourse; douching will remove the spermicide. 3. The spermicide must be inserted into the female's vagina. 4. The spermicide must be inserted prior to each sexual intercourse; it is only effective for one time. 5.Condoms or abstinence are the only two ways to prevent sexually transmitted infections.

The client who is 38 weeks pregnant and diagnosed with preeclampsia is admitted to the labor and delivery area. The HCP has prescribed intravenous magnesium sulfate, an anticonvulsant. Which data indicates the medication is effective? Select all that apply. 1.The client has no seizure activity. 2.The client's urine output is 45 mL/hour. 3.The client's blood pressure is 148/90. 4.The client's deep tendon reflexes are 2 to 3+. 5.The client's apical pulse is 70.

Answers: 1, 4 Rationale: 1. The medication is administered to prevent seizure activity so if no activity is occurring the medication is effective. 2. The client's urine output does not indicate the medication is effective. 3.Magnesium sulfate is not administered to treat the client's blood pressure; therefore, this data cannot be used to evaluate the effectiveness of the medication. 4.Magnesium sulfate is administered to prevent seizure activity and is determined to be effective and in the therapeutic range when the client's deep tendon reflexes are normal, which is 2 to 3+ on a 0-4+ scale. 5. The client's apical pulse does not determine effectiveness of magnesium sulphate.

Which interventions should the nurse discuss with the client who has calcium/oxalate renal calculi and has been prescribed a thiazide diuretic? Select all that apply. 1.Tell the client to increase the intake of fluids. 2.Discuss possible kidney stones caused by this diuretic. 3.Explain the need to check the potassium level daily. 4.Inform the client to check the blood pressure daily. 5.Instruct the client to take the diuretic in the morning.

Answers: 1, 5 Rationale: 1. The client should drink adequate fluids or increase fluids when taking a thiazide diuretic and to help prevent formation of renal calculi. 2.Thiazide diuretics will help prevent renal stones, not increase the chance of developing renal calculi. 3.Thiazide diuretics cause an increase in potassium loss in the urine but not as significant as loop diuretics. In any case, the client would not check the potassium level daily at home. 4. The thiazide diuretic is not being administered to decrease blood pressure; therefore, the blood pressure would not have to be checked daily to ensure the effectiveness of the medication. 5.Diuretics should be taken in the morning so that the client is not up all night urinating. Thiazide diuretics are prescribed because they decrease the amount of calcium released by the kidneys into the urine by favoring calcium retention in the bone. Most Kidney stones (75% to 80%) are calcium stones, composed of calcium.

The 18-year-old male client is diagnosed with gonorrhea of the pharynx. The HCP has prescribed ceftriaxone (Rocephin), a cephalosporin. Which interventions should the clinic nurse implement? Select all that apply. 1.Administer the medication intramuscularly in the ventral gluteal muscle. 2.Have the client drink a full glass of water with the pill. 3.Use a tuberculin syringe to draw up the medication. 4.Make sure the client has eaten before administering the drug. 5.Instruct the client to stay in the clinic for 30 minutes after medication.

Answers: 1, 5 Rationale: 1.Rocephin is administered IM or IV. There is no pill form of the medication. The medication burns when administered and should be administered in the large gluteus muscle. 2.There is no pill form of Rocephin, so drinking water will not affect the medication. 3.Rocephin is administered IM or IV. A tuberculin syringe is used to administer medications by the subcutaneous or intradermal route. 4.There is no pill form of the medication, so eating will not affect the medication. 5. The client should stay in the clinic to be observed in case of an allergic reaction to the medication. Note the stem states "clinic nurse." This tells the test taker that the client is in the clinic if a clinic nurse is caring for the client.

The nurse is administering the thiazide diuretic hydrochlorothiazide (HydroDIURIL)to a client diagnosed with chronic renal disease. Which assessment data should cause the nurse to question the administration of this medication? Select all that apply. 1.The client's skin turgor on the upper chest is tented. 2.The urine output was 90 mL for the last 8 hours. 3.The client's oral mucosa is moist and pink. 4.The client has 3+ sacral and peripheral edema. 5.The client's blood pressure is 90/60 in the left arm.

Answers: 1, 5 Rationale: 1.Tented skin turgor indicates the client is dehydrated and the nurse should question administering a loop diuretic. 2. The client in chronic renal disease would have a less than normal urine output, so the nurse would not question giving the client a diuretic. 3.A moist and pink mucosa indicates the client is hydrated; therefore, the nurse wouldn't question administering this medication. 4. The medication is being administered to help decrease the sacral edema; therefore, the nurse would not question administering this diuretic. 5.Diuretics reduce circulating blood volume, which may cause orthostatic hypotension. Because the client's blood pressure is low, the nurse should question administering this medication.

The client diagnosed with rule-out renal calculi is scheduled for an intravenous dye pyelogram (IVP). Which interventions should the nurse implement? Select all that apply. 1.Keep the client NPO. 2.Check the serum creatinine level. 3.Assess for an iodine allergy. 4.Obtain informed consent. 5.Insert an 18-gauge angiocatheter.

Answers: 2, 3, 4 Rationale: 1. The client does not need to be NPO for this procedure because it is used to diagnose renal abnormalities, not gastrointestinal abnormalities. 2. The client should not have this diagnostic test if the kidneys are not working properly. The intravenous dye could damage the kidneys if normal functioning is not present. 3. The nurse would assess for iodine allergy. The nurse should ask if the client is allergic to Betadine or shellfish. 4. This is an invasive procedure; therefore, the client must give informed consent. 5. This diagnostic test does not require blood administration; therefore, the nurse should start a smaller gauge intravenous catheter such as a 22- or 20-gauge angiocatheter.

The male client is diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) of the urine and urosepsis and is receiving vancomycin (IVPB). Which interventions should the nurse implement when administering this medication? Select all that apply. 1.Hold the medication if the trough level is 5 mg/dL. 2. Ask the client if he is allergic to any medication. 3. Administer the medication via an infusion pump. 4. Check the client's BUN and creatinine levels. 5. Assess the client's intravenous insertion site.

Answers: 2, 3, 4, 5 Rationale: 1. The therapeutic range of vancomycin is10-20 mg/dL. The nurse would not hold the medication because the client has not reached a therapeutic range. 2. The nurse should always ask the client if he/she is allergic to any medication prior to administering any medication, especially an antibiotic. 3.Vancomycin is administered over a minimum of 1 hour. The nurse should obtain an infusion pump to regulate the speed of administration. 4.Vancomycin is nephrotoxic. The nurse should monitor the BUN and creatinine levels, especially in children and the elderly. 5. The nurse should assess the intravenous insertion site to determine if there are any signs of infiltration or inflammation. The nurse should not administer vancomycin in an inflamed site.

The pediatric nurse is caring for a 7-year-old child with chronic reactive airway disease who is being discharged. The nurse must evaluate the breathing capacity of the child to determine the effectiveness of the medication regimen. Which interventions should the nurse implement when using the peak flow meter? Select all that apply. 1. Instruct the child to lie down in the bed in the supine position. 2. Tell the child to seal the lips tightly around the mouthpiece. 3. Note the number on the scale after the client gives a sharp, short breath. 4. Blow into the peak flow meter one time and obtain the results. 5. Move the pointer on the peak flow meter to zero.

Answers: 2, 3, 5 Rationale: 1. The child should be standing up at the bedside, not lying down. 2. This is the correct way to obtain the peak flow meter results. 3. This is the correct way to take a reading from the peak flow meter. 4. The peak flow meter should be repeated three times, waiting at least 10 seconds between each attempt. The highest reading of the three attempts is recorded. 5. The pointer should be at zero everytime the child attempts to blow into the peak flow meter.

The client with an acute exacerbation of asthma is being treated with asthma medications. Which assessment data indicates the medication is effective? Select all that apply. 1. The client has bilateral wheezing. 2. The client's lung sounds are clear. 3. The client's pulse oximeter reading is 96%. 4. The client has no peripheral clubbing. 5. The client has no shortness of breath.

Answers: 2, 3, 5 Rationale: 1. Wheezing, a musical respiratory sound made when air is forced out through the small, mucus-lined passages during respiration, does not indicate the medication is effective. 2. Clear lung sounds would indicate that the asthma medications are effective. 3. The client's pulse oximeter indicates the client is adequately being oxygenated and would indicate the medication is effective. 4. Clubbing does not occur with clients diagnosed with asthma. It occurs in clients with chronic hypoxia such as occurs with chronic obstructive pulmonary disease or cystic fibrosis. 5. No shortness of breath indicates the medication is effective.

The mother with preeclampsia has received magnesium sulfate, an anticonvulsant, during labor and delivery. Which interventions should the nursery nurse implement for the newborn? Select all that apply. 1.Assess the lungs for meconium aspiration. 2.Prepare to administer IV calcium gluconate. 3.Administer 2 ounces of glucose water. 4.Assess the infant's axillary temperature. 5.Stimulate the baby by tapping the feet.

Answers: 2, 5 Rationale: 1.There is no data in the stem that indicates that the baby is postmature; therefore, the nursery nurse would not assess for meconium aspiration. 2. The antidote for magnesium sulfate overdose is calcium gluconate; there-fore, the nurse should be prepared to administer it. 3.Glucose water is given to infants who are experiencing hypoglycemia. There is no indication that this infant is experiencing hypoglycemia, the mother does not have diabetes, and hypoglycemia in the infant does not occur as a result of preeclampsia. 4. The infant's respiratory status should be assessed, not the infant's temperature. 5. The baby is at risk for respiratory or neurological depression; therefore, the nurse should stimulate the baby until the effects of the magnesium sulfate have dissipated.

The nurse is preparing to administer the first dose of an aminoglycoside antibiotic to the client. Which interventions should the nurse implement? Select all that apply. 1. Check the client's peak and trough level. 2. Administer the medication via a subclavian line. 3. Determine if a C&S was obtained. 4. Check the client's identification band. 5. Teach the client about suprainfection.

Answers: 3, 4, 5 Rationale: 1. The peak and trough level should be monitored when the client is receiving aminoglycosides antibiotics but not prior to the first dose; it is usually checked at the 4th, 8th, and 12th doses. 2. The aminoglycoside antibiotic can b e administered peripherally and does not have to be administered via a subclavian line. 3. The culture and sensitivity (C&S) is obtained before the antibiotic is administered so the results will be skewed and useless. This is usually checked at the nurse's station before entering the client's room to give the medication. 4. This should be checked before administering any medication. It is one of the six rights in medication administration. 5. The nurse should teach about the antibiotic destroying the good flora, resulting in a suprainfection.

The nurse is preparing a client for cataract extraction surgery that will be accessed through the cornea, using eyelid retractors, while the client is awake. Which of the following classes of medication would the nurse expect the provider to prescribe preoperatively? SATA a.An anesthetic eye drop to anesthetize the corneal surface b.A cycloplegic eye drop that paralyzes the ciliary bodies c.A miotic eye drop to constrict the pupils d.A loop diuretic to decrease the intraocular pressure e.A nonsteroidal antiinflammatory drug to prevent infection during and after surgery f.A mydriatic eye drop to dilate the pupils and facilitate access to lens which lies behind iris posterior chamber

Answers: A, B, F

Which of the following are characteristics of Alzheimer disease? SATA a.Rapid onset b.Memory loss that affects job skills c.Increased irritability and changes in mood or behavior d.Anxiety, depression, and changes in personality e.Problems with abstract thinking but no problems with language

Answers: B, C, D

A client with a diagnosis of trigeminal neuralgia is started on a regimen of carbamazepine. The nurse provides instructions to the client about the side and adverse effects of the medication. Which client statement indicates an understanding of the side and adverse effects of the medication? 1. "I will report a fever or sore throat to my health care provider." 2. "I must brush my teeth frequently to avoid damage to my gums." 3. "If I notice ringing in my ears that doesn't stop, I'll seek medical attention." 4."If I notice a pink color to my urine, I will stop the medication and call my health care provider."

Correct answer: 1 Rationale: Agranulocytosis is an adverse effect of carbamazepine and places the client at risk for infection. If a fever or a sore throat develops, the health care provider should be notified. Gum damage, ringing in the ears, and pink-colored urine are not effects associated with this medication.

The nurse who is caring for a client with myasthenia gravis has a prescription to perform an edrophonium test. After obtaining edrophonium the nurse should be certain that which also is available at the bedside? 1. Atropine sulfate 2. Protamine sulfate 3. Calcium gluconate 4.Magnesium sulfate

Correct answer: 1 Rationale: An edrophonium test is performed to distinguish between myasthenic and cholinergic crisis. After administration of the edrophonium, if symptoms intensify, the crisis is cholinergic. Because the symptoms of cholinergic crisis will worsen with the administration of edrophonium, atropine sulfate should be available because it is the antidote. Protamine sulfate is the antidote for heparin. Calcium gluconate is the antidote for magnesium sulfate toxicity.

The home care nurse is reviewing the record of a client newly diagnosed with glaucoma who is scheduled for a home visit. The nurse notes that the health care provider (HCP) has prescribed atropine sulfate and pilocarpine hydrochloride eye drops. The nurse should contact the HCP before the home visit for which reason? 1. Clarify the prescription for the atropine sulfate. 2. Clarify the prescription for the pilocarpine hydrochloride. 3. Determine the date of the scheduled follow-up HCP visit. 4.Determine the extent of the intraocular pressure caused by the glaucoma.

Correct answer: 1 Rationale: Atropine sulfate is a mydriatic and cycloplegic medication that is contraindicated in clients with PRIMARY CLOSED ANGLE GLAUCOMA. Mydriatic medications dilate the pupil and cause increased intraocular pressure in the eye. Pilocarpine hydrochloride is a miotic agent used in the treatment of glaucoma. It is unnecessary to contact the HCP regarding the date for follow-up treatment. In fact, the client may know this date, which the nurse can ask about during the home care visit. It is unnecessary to know the extent of the intraocular pressure caused by the glaucoma in planning care for the client.

The nurse prepares a client for ear irrigation as prescribed by the health care provider. Which action should the nurse take when performing the procedure? 1. Warm the irrigating solution to 98.6°F (37.0°C). 2. Position the client with the affected side up following the irrigation. 3. Direct a slow, steady stream of irrigation solution toward the eardrum. 4.Assist the client to turn his or her head so that the ear to be irrigated is facing upward.

Correct answer: 1 Rationale: Before ear irrigation, the nurse should inspect the tympanic membrane to ensure that it is intact. The irrigating solution should be warmed to 98.6°F (37.0°C) because a solution temperature that is not close to the client's body temperature will cause ear injury, nausea, and vertigo. The affected side should be down following the irrigation to assist in drainage of the fluid. When irrigating, a direct and slow steady stream of irrigation solution is directed toward the wall of the canal, not toward the eardrum. The client is positioned sitting, facing forward with the head in a natural position; if the ear is faced upward, the nurse would not be able to visualize the canal.

Betaxolol eye drops have been prescribed for a client with glaucoma. The nurse monitoring this client for side/adverse effects of the medication would place highest priority on which assessment? 1. Pulse rate 2. Blood glucose 3. Respiratory rate 4.Oxygen saturation

Correct answer: 1 Rationale: Betaxolol is a beta-blocking agent as well as an antiglaucoma medication. Nursing assessments include monitoring the blood pressure for hypotension and assessing the pulse for strength, weakness, irregular rate, and bradycardia. The nurse also assesses for evidence of heart failure as manifested by dizziness, night cough, peripheral edema, and distended neck veins.

The nurse is administering a dose of a prescribed diuretic to an assigned client. The nurse should monitor the client for hypokalemia as a side effect of therapy if the client has been receiving which medication? 1. Bumetanide 2. Triamterene 3. Amiloride HCl 4.Spironolactone

Correct answer: 1 Rationale: Bumetanide is a loop diuretic that places the client at risk for hypokalemia. The nurse would monitor this client carefully for signs of hypokalemia, monitor serum potassium levels, and encourage intake of high-potassium foods. The other medications listed are potassium-retaining diuretics.

The nurse has given medication instructions to a client beginning carbamazepine. The nurse determines that the client understands the use of the medication if he makes which statement? 1. "I will use sunscreen when outdoors." 2. "I can drive a car as long as it is not at night." 3. "I will keep tissues handy because of excess salivation." 4.I will discontinue the medication if fever or sore throat occurs."

Correct answer: 1 Rationale: Carbamazepine is an anticonvulsant. The client should use protective clothing and sunscreen to avoid photosensitivity reactions. Carbamazepine acts by depressing synaptic transmission in the central nervous system (CNS). Because of this, the client should avoid driving at any time or doing other activities that require mental alertness until the effect of the medication on the client is known. The medication may cause dry mouth, and the client should be instructed to provide good oral hygiene and use sugarless candy or gum as needed. The medication should not be abruptly discontinued because this could lead to return of seizures or status epilepticus. Fever and sore throat (leukopenia) should be reported to the health care provider.

The nurse has completed discharge teaching for a client prescribed carbamazepine. Which statement by the client indicates that education about the main effect of the medication was effective? 1. "This medication has an anticonvulsant effect." 2. "This medication interferes with DNA production." 3. "The main effect is a decrease in intraocular pressure." 4."The main action of this medication is prevention of cellular division."

Correct answer: 1 Rationale: Carbamazepine is classified as an iminostilbene derivative and is used as an anticonvulsant, antineuralgic, antimanic, and antipsychotic. The remaining options are not actions or effects of this medication.

A client with a urinary tract infection is receiving ciprofloxacin by the intravenous (IV) route. The nurse appropriately administers the medication by performing which action? 1. Infusing slowly over 60 minutes 2. Infusing in a light-protective bag 3. Infusing only through a central line 4.Infusing rapidly as a direct IV push medication

Correct answer: 1 Rationale: Ciprofloxacin is prescribed for treatment of mild, moderate, severe, and complicated infections of the urinary tract, lower respiratory tract, and skin and skin structure. A single dose is administered slowly over 60 minutes to minimize discomfort and vein irritation. Ciprofloxacin is not light-sensitive, may be infused through a peripheral IV access, and is not given by IV push method.

A client who is scheduled for cataract surgery requires preoperative instillation of cyclopentolate eye drops as prescribed. The client asks the nurse why this medication is needed, and the nurse provides education. Which statement by the client indicates that teaching has been effective? 1. "The medication dilates the pupil of the operative eye." 2. "The medication constricts the pupil of the operative eye." 3. "The medication is needed for the initiation of miosis in the operative eye." 4."The medication provides the necessary lubrication to the nonoperative eye."

Correct answer: 1 Rationale: Cyclopentolate is a rapidly acting mydriatic and cycloplegic medication that is used preoperatively to dilate the eye. It is effective in 25 to 75 minutes, and accommodation returns in 6 to 24 hours. The statements in the other options are incorrect.

A client experiencing spasticity as a result of spinal cord injury has a new prescription for dantrolene. Before administering the first dose, the nurse checks to see if which baseline study has been done? 1. Liver function studies 2. Renal function studies 3. Otoscopic examination 4.Blood glucose measurements

Correct answer: 1 Rationale: Dantrolene is a skeletal muscle relaxant and can cause liver damage; therefore, the nurse should monitor the results of liver function studies. They should be done before therapy starts and periodically throughout therapy. Dantrolene is discontinued if no relief of spasticity is achieved in 6 weeks. The incorrect options are not specifically related to the administration of this medication.

The nurse has the following prescription for a postcraniotomy client: "dexamethasone 4 mg by the intravenous (IV) route now." How does the nurse administer the medication? 1. IV push over 1 minute 2. IV push over 4 minutes 3. IV piggyback in 100 mL of normal saline over 10 minutes 4.IV piggyback in 100 mL of normal saline over 30 minutes

Correct answer: 1 Rationale: Dexamethasone is an adrenocorticosteroid administered after craniotomy to control cerebral edema. It is given by IV push, and single doses are administered over 1 minute. Dexamethasone IV doses are changed to the oral route after 24 to 72 hours and are tapered until discontinued. In addition, IV fluids are administered cautiously after craniotomy to prevent increased cerebral edema.

Dexamethasone intravenously is prescribed for the client with cerebral edema. The nurse prepares the medication for administration and plans to perform which action? 1. Administer by direct injection 2. Mix the medication in 1000 mL of 5% dextrose. 3. Mix the medication in 100 mL of lactated Ringer's solution. 4.Dilute the medication in lactated Ringer's solution and administer as a direct injection.

Correct answer: 1 Rationale: Dexamethasone may be given by direct intravenous injection or intravenous infusion. Dexamethasone may be mixed with 0.9% sodium chloride or 5% dextrose. If administered as an infusion, a minimum amount of diluting solution is needed.

A client is receiving phenobarbital sodium. Which finding on the nursing assessment would indicate that the client is experiencing a common side or adverse effect of this medication? 1. Drowsiness 2. Hypocalcemia 3. Blurred vision 4.Seizure activity

Correct answer: 1 Rationale: Drowsiness is a common side or adverse effect of phenobarbital, which is a barbiturate and antiseizure medication. Hypocalcemia is a rare effect. Blurred vision is not an associated side effect of this medication. Seizure activity could occur from abrupt withdrawal of this medication therapy or as a toxic reaction.

The nurse is caring for a client with myasthenia gravis who has received edrophonium by the intravenous route to test for myasthenic crisis. The client asks the nurse how long the improvement in muscle strength will last. Which response should the nurse make to the client? 1. "It will last for 4 to 5 minutes." 2. "It will last for about 30 minutes." 3. "It will last longer than 60 minutes." 4."It will last approximately 10 minutes."

Correct answer: 1 Rationale: Edrophonium commonly is given to test for myasthenic crisis. If the client is in myasthenic crisis, muscle strength improves after administration of the medication. Within 30 to 60 seconds, most myasthenic clients show a marked improvement in muscle tone that lasts for 4 to 5 minutes. Options 2, 3 and 4 are incorrect.

Epoetin alfa is prescribed for a client diagnosed with chronic kidney disease. The client asks the nurse about the purpose of the medication. Which response by the nurse is most appropriate? 1. "It is used to treat anemia." 2. "It is used to lower your blood pressure." 3. "It will help to increase the potassium level in your body." 4."It is an anticonvulsant medication given to all clients after dialysis to prevent seizure activity."

Correct answer: 1 Rationale: Epoetin alfa is a medication that is used to treat anemia. It does not lower blood pressure or increase potassium. It is also not given after a dialysis treatment to prevent seizure activity. Hypertension is a side effect. Hyperkalemia and seizures are adverse effects of the medication.

A client with chronic kidney disease has a medication prescription for epoetin alfa. The nurse should plan to administer this medication by which method? 1. Subcutaneously 2. Intramuscularly 3. With a full glass of water 4.Diluted in juice to enhance taste

Correct answer: 1 Rationale: Epoetin alfa is erythropoietin that has been manufactured through the use of recombinant DNA technology. It is used to treat anemia in the client with chronic kidney disease. The medication may be administered subcutaneously or intravenously as prescribed.

A client has a prescription for valproic acid. To maximize the client's safety, the nurse should plan to monitor for which potential complications of this medication? Select all that apply. 1. Pancreatitis 2. Hypotension 3. Renal failure 4. Hepatotoxicity 5.Cardiotoxicity

Correct answer: 1, 4 Rationale: Valproic acid is an anticonvulsant that causes central nervous system depression. Although rare, this medication has caused pancreatitis and hepatoxicity. The nurse should monitor for these complications. The other complications noted in the options are not specifically associated with this medication.

A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication? 1. Hematocrit of 33% (0.33) 2. Platelet count of 400,000 mm3 (400 × 109/L) 3. White blood cell count of 6000 mm3 (6.0 × 109/L) 4.Blood urea nitrogen level of 15 mg/dL (5.25 mmol/L)

Correct answer: 1 Rationale: Epoetin alfa is synthetic erythropoietin, which the kidneys produce to stimulate red blood cell production in the bone marrow. It is used to treat anemia associated with chronic kidney disease. The normal hematocrit level is Male: 42% to 52% (0.42 to 0.52); Female: 37% to 47% (0.37 to 0.47). Therapeutic effect is seen when the hematocrit reaches between 30% and 33% (0.30 and 0.33). The normal platelet count is 150,000 to 400,000 mm3 (150 to 400 × 109/L). The normal blood urea nitrogen level is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). The normal white blood cell count is 5000 to 10,000 mm3 (5 to 10 × 109/L). Platelet production, white blood cell production, and blood urea nitrogen do not respond to erythropoietin.

A client is scheduled to begin medication therapy with valproic acid. The nurse looks for the results of which laboratory test(s) before administering the first dose? 1. Liver function tests 2. Renal function tests 3. Pulmonary function test 4.Pancreatic enzyme studies

Correct answer: 1 Rationale: Gastrointestinal effects from valproic acid are common and typically mild, but hepatotoxicity, although rare, is serious. To minimize the risk of fatal liver injury, liver function is evaluated before initiation of treatment and periodically thereafter. The other options are unrelated to the use of this medication.

A client has a medication prescription for phenytoin to be administered by the intravenous route. After drawing up the medication, the nurse notes the presence of precipitate in the syringe. Which action should the nurse take? 1. Discard the syringe and begin again. 2. Add sterile water to dissolve the precipitate. 3. Draw up an additional 1 mL of normal saline into the syringe. 4. Chart the medication as "not given," and write a note in the medical record.

Correct answer: 1 Rationale: If the injectable solution is not clear or if precipitate is present, the medication should not be used and should be discarded. The nurse may have to call the pharmacy department to obtain another vial of the medication.The remaining options are inaccurate actions.

A client being discharged to home with a prescription for eye drops to be given in the left eye has received instructions regarding self-administration of the drops. The nurse determines that the client needs further instruction if, on return demonstration, the client takes which action? 1.Lies supine, pulls up on the upper lid, and puts the drop in the upper lid 2.Lies supine, pulls down on the lower lid, and puts the drop in the lower lid 3.Tilts the head back, pulls down on the lower lid, and puts the drop in the lower lid 4.Lies with head to the right, puts the drop in the inner canthus, and slowly turns to the left while blinking

Correct answer: 1 Rationale: It is correct procedure for the client to lie down or sit with his or her head tilted back. The thumb or finger is used to pull down on the lower lid. The client holds the bottle like a pencil (tip facing downward) and squeezes the bottle so that one drop falls into the sac. The client then gently closes the eye. An alternative method for clients who blink very easily is to place the client in the supine position with the head turned to one side. The eye to be used is uppermost. With the eye closed, the client squeezes the drop onto the inner canthus of the eye. The client turns from this side to the other while blinking. Surface tension and gravity then cause the drop to move into the conjunctival sac.

The nurse is caring for a client diagnosed with bacterial meningitis. Which clinical manifestation should the nurse monitor for, indicating increased intracranial pressure? 1. Altered mental status 2. Decreased urinary output 3. Decreased peripheral sensation 4.Numbness and tingling in the fingers and toes

Correct answer: 1 Rationale: Meningitis is a bacterial infection of the meninges of the brain. A common complication of meningitis is increased intracranial pressure. Altered mental status can result from increased intracranial pressure. Decreased urinary output, decreased peripheral sensation, and numbness and tingling in the fingers and toes are not specifically associated with bacterial meningitis.

The client arrives at the emergency department complaining of back spasms. The client states, "I have been taking 2 to 3 aspirin every 4 hours for the last week, and it hasn't helped my back." Since acetylsalicylic acid intoxication is suspected, the nurse should assess the client for which manifestation? 1. Tinnitus 2. Diarrhea 3. Constipation 4. Photosensitivity

Correct answer: 1 Rationale: Mild intoxication with acetylsalicylic acid is called salicylism and is experienced commonly when the daily dosage is higher than 4 g. Tinnitus (ringing in the ears) is the most frequent effect noted with intoxication. Hyperventilation may occur because salicylate stimulates the respiratory center. Fever may result because salicylate interferes with the metabolic pathways coupling oxygen consumption and heat production. Options 2, 3, and 4 are not associated specifically with toxicity.

Phenytoin 100 mg to be given orally 3 times daily has been prescribed to a client. The home health nurse visits the client and provides instructions regarding the medication. Which statement, if made by the client, would indicate an understanding of the instructions? 1."I will use a soft toothbrush to brush my teeth." 2."It's okay to break the capsules to make it easier for me to swallow them." 3."If I forget to take my medication, I can wait until the next dose and eliminate that dose." 4."If my throat becomes sore, it's a normal effect of the medication, and it's nothing to be concerned about."

Correct answer: 1 Rationale: Phenytoin is an anticonvulsant used to treat seizure disorders. Gingival hyperplasia, bleeding, swelling, and tenderness of the gums can occur with the use of this medication. The client needs to be taught good oral hygiene, gum massage, and the need for regular dentist visits. Capsules should not be chewed or broken. The client should not skip medication doses because inadequate blood levels could precipitate a seizure. The client needs to be instructed to report a sore throat, fever, glandular swelling, or any skin reaction because such findings may indicate hematological toxicity.

A client is taking benztropine mesylate orally daily. In monitoring this client for medication side effects, the nurse should plan to focus the assessment on which item? 1. Pupil response 2. Voiding pattern 3. Prothrombin time 4.Muscle strength and mobility

Correct answer: 2 Rationale: Benztropine mesylate is an anticholinergic. Because urinary retention is a side effect of benztropine mesylate, the nurse must assess for dysuria, distended abdomen, infrequent voiding in small amounts, and overflow incontinence. Monitoring of the other options is not necessary with this medication.

A client with myasthenia gravis who is taking neostigmine is experiencing frequent exacerbations of myasthenic crisis and cholinergic crisis. The nurse teaches the client that it is most important that this medication be taken in which manner? 1. On time 2. On an empty stomach 3. Double-dosed if 1 dose is missed 4.Titrated for dosage, depending on symptoms

Correct answer: 1 Rationale: The client should take neostigmine exactly on time. Taking the medication early or late could result in myasthenic or cholinergic crisis. Taking the medication on time is especially important for the client with dysphagia because the client may not be able to swallow the medication if it is given late. These clients are taught to set an alarm clock to remind them of dosage times. The medication should be administered with food or milk to minimize side and adverse effects. The client should never skip or double up on missed doses or titrate the dose, depending on symptoms. The client needs to take the medication exactly as prescribed.

Betaxolol eye drops have been prescribed for a client with glaucoma. The home health nurse preparing to visit the client develops a plan of care that includes monitoring for the side/adverse effects of this medication by taking which assessment action? 1. Monitoring body weight 2. Assessing the glucose level 3. Assessing peripheral pulses 4.Monitoring body temperature

Correct answer: 1 Rationale: This medication is an antiglaucoma medication and a β-adrenergic blocker. The nurse assesses for evidence of heart failure manifested by dizziness, night cough, peripheral edema, and distended neck veins. Intake greater than output, weight gain, and decreased urine output also may indicate heart failure. Hypotension (manifested as dizziness), nausea, diaphoresis, headache, fatigue, and constipation or diarrhea also are potential systemic effects of the medication. Nursing interventions include monitoring body weight; periodically evaluating blood pressure for hypotension; and assessing the apical or radial pulse for strength, weakness, irregular heart rate, and bradycardia.

The nurse is reviewing the instillation technique for both eye ointment and eye drops with the parent of a pediatric client diagnosed with bacterial conjunctivitis. Which statement made by the parent would indicate that learning has taken place? 1. "I will be careful not to touch the eye or eyelid during administration." 2. "I will place my child on the left side to administer drops in the right eye." 3. "I will administer the eye ointment and then wait 5 minutes and administer the eye drops." 4."I will have my child blink after the instillation to encourage thorough distribution of the eye drops."

Correct answer: 1 Rationale: Touching the eye or eyelid during medication administration can contaminate the dropper and cause eye injury. The child should be placed in a supine position with the neck slightly hyperextended for administration. Eye drops should be administered before eye ointment is administered. Blinking will increase the loss of medication.

The nurse is caring for a client who is taking oral benztropine mesylate daily. What is the priority nursing assessment for the client? 1. Intake and output 2. The prothrombin time 3. The pupillary response 4.The partial thromboplastin time

Correct answer: 1 Rationale: Urinary retention is a side effect of benztropine mesylate. The nurse needs to observe for dysuria, distended abdomen, infrequent voiding of small amounts, and overflow incontinence. The remaining options are unrelated to the side effects of this medication.

A client has a prescription to receive valproic acid daily. To ensure the client's safety, when is the best time for the nurse to schedule the administration of this medication? 1. At bedtime 2. Mid-afternoon 3. Two hours after lunch 4.Two hours before breakfast

Correct answer: 1 Rationale: Valproic acid is an anticonvulsant that causes central nervous system (CNS) depression. For this reason, the side effects include sedation, dizziness, ataxia, and confusion. When the client is taking this medication as a single daily dose, administering it at bedtime negates the risk of injury from sedation and enhances client safety. The medication also should be administered at the same time each day.

A client is prescribed an eye drop and an eye ointment for the right eye. How should the nurse best administer the medications? 1. Administer the eye drop first, followed by the eye ointment. 2. Administer the eye ointment first, followed by the eye drop. 3. Administer the eye drop, wait 15 minutes, and administer the eye ointment. 4.Administer the eye ointment, wait 15 minutes, and administer the eye drop.

Correct answer: 1 Rationale: When an eye drop and an eye ointment are scheduled to be administered at the same time, the eye drop is administered first. The instillation of two medications is separated by 3 to 5 minutes.

The client with a head injury is experiencing signs of increased intracranial pressure (ICP), and mannitol is prescribed. The nurse administering this medication expects which as intended effects of this medication? Select all that apply. 1. Reduced ICP 2. Increased diuresis 3. Increased osmotic pressure of glomerular filtrate 4. Reduced tubular reabsorption of water and solutes 5.Reabsorption of sodium and water in the loop of Henle

Correct answer: 1, 2, 3, 4 Rationale: Mannitol is an osmotic diuretic that induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes. It is used to reduce intracranial pressure in the client with head trauma. The incorrect option would cause fluid retention through reabsorption, thereby increasing ICP.

The nurse is preparing to administer eye drops. Which interventions should the nurse take to administer the drops? Select all that apply. 1. Wash hands. 2. Put gloves on. 3. Place the drop in the conjunctival sac. 4. Pull the lower lid down against the cheekbone. 5. Instruct the client to squeeze the eyes shut after instilling the eye drop. 6.Instruct the client to tilt the head forward, open the eyes, and look down.

Correct answer: 1, 2, 3, 4 Rationale: To administer eye medications, the nurse should wash hands and put gloves on. The client is instructed to tilt the head backward, open the eyes, and look up. The nurse pulls the lower lid down against the cheekbone and holds the bottle like a pencil with the tip downward. Holding the bottle, the nurse gently rests the wrist of the hand on the client's cheek and squeezes the bottle gently to allow the drop to fall into the conjunctival sac. The client is instructed to close the eyes gently and not to squeeze the eyes shut to prevent the loss of medication.

The nurse has a prescription to administer diazepam 5 mg by the intravenous (IV) route to a client. The nurse should administer the medication over a period of at least how long? 1. 15 seconds 2. 30 seconds 3. 1 minute 4.5 minutes

Correct answer: 3 Rationale: The recommended rate of infusion of diazepam is to give each 5 mg of the medication over at least 1 minute. This will prevent adverse effects, including apnea, bradycardia, hypotension, and possibly cardiac arrest.

The nurse has a prescription to give dexamethasone by the intravenous (IV) route to a client with cerebral edema. How should the nurse prepare this medication? 1. Diluting the medication in 500 mL of 5% dextrose 2. Preparing an undiluted direct injection of the medication 3. Diluting the medication in 1 mL of lactated Ringer's solution for direct injection 4.Diluting the medication in 10% dextrose in water and administering it as a direct injection

Correct answer: 2 Rationale: Dexamethasone may be given by direct IV injection or IV infusion. For IV infusion, it may be mixed with 50 to 100 mL of 0.9% sodium chloride or 5% dextrose in water. It is not mixed with lactated Ringer's solution or 10% dextrose in water.

A client with chronic glaucoma is being started on medication therapy with acetazolamide. The nurse teaches the client that which can occur early with the use of this medication? 1. Fatigue 2. Diuresis 3. Headache 4.Loss of libido

Correct answer: 2 Rationale: Diuresis is an early side effect of acetazolamide that usually subsides with continued treatment. This is because the medication is also a weak diuretic, although it is no longer prescribed for that purpose. Fatigue, headache, and loss of libido are common side effects of therapy, but these may not subside spontaneously.

The nurse is providing discharge instructions to a client receiving trimethoprim-sulfamethoxazole. Which instruction should be included in the list? 1. Advise that sunscreen is not needed. 2. Drink 8 to 10 glasses of water per day. 3. If the urine turns dark brown, call the health care provider (HCP) immediately. 4.Decrease the dosage when symptoms are improving to prevent an allergic response.

Correct answer: 2 Rationale: Each dose of trimethoprim-sulfamethoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake to avoid crystalluria. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Clients should be advised to use sunscreen since the skin becomes sensitive to the sun. Some forms of trimethoprim-sulfamethoxazole cause urine to turn dark brown or red. This does not indicate the need to notify the HCP.

The nurse is preparing an intravenous (IV) infusion of phenytoin as prescribed by the health care provider for the client with seizures. Which solution should the nurse plan to use to dilute this medication? 1. Dextrose 5% 2. Normal saline solution 3. Lactated Ringer's solution 4.Dextrose 5% and half-normal saline (0.45%)

Correct answer: 2 Rationale: IV infusion of phenytoin should be administered by injection into a large vein. The medication may be diluted in normal saline solution; however, dextrose solution should be avoided because of medication precipitation.The medication is administered as intermittent doses. Continuous IV infusions should not be used. Infusion rates of more than 50 mg/minute may cause hypotension or cardiac dysrhythmias, especially in older and debilitated clients.

The nurse is observing a new nursing graduate who is preparing an intermittent intravenous (IV) infusion of phenytoin for a client with a diagnosis of seizures. Which solution used by the nursing graduate should indicate to the nurse an understanding of proper preparation of this medication? 1. 5% dextrose in water 2. 0.9% sodium chloride 3. Lactated Ringer's solution 4.5% dextrose and 0.45% sodium chloride

Correct answer: 2 Rationale: Intermittent IV infusion of phenytoin is administered by injection into a large vein, using normal saline solution. Dextrose solutions are avoided because the medication will precipitate in these solutions. Therefore, the options containing dextrose identify incorrect solutions for IV administration with this medication. In addition, lactated Ringer's solution contains electrolytes that can interfere with phenytoin administration.

A client is receiving levofloxacin for treatment of urinary tract infection. Which finding warrants an immediate call to the health care provider (HCP)? 1. Client complaint of constipation 2. Prolonged QT interval on electrocardiogram 3. Client will not take the levofloxacin without food 4.The client's culture shows Staphylococcus aureus

Correct answer: 2 Rationale: Levofloxacin can prolong the client's QT interval, which would be noted on electrocardiogram. This warrants a call to the HCP because a prolongation in the QT interval can lead to torsades de pointes, a lethal dysrhythmia. The client may complain of diarrhea, not constipation, as a side or adverse effect. The medication can be taken with or without food and is effective against Staphylococcus aureus.

Nitrofurantoin is prescribed for a client with urinary tract infection. The nurse is instructing the client regarding the administration of the medication. Which information about the best time to take this medication should be included in the client's education? 1. At bedtime 2. With meals 3. One hour before the dinner meal 4.In the morning 2 hours after breakfast

Correct answer: 2 Rationale: Nitrofurantoin is an antibacterial used to treat urinary tract infections. The nurse would instruct the client to take the medication with food to reduce any gastrointestinal upset that the medication can cause. Therefore, the best time to take the medication is with meals.

Nitrofurantoin is prescribed for the client. The nurse checks the client's record, knowing that this medication is contraindicated in which disorder? 1. Heart failure 2. Renal disease 3. Hepatic disease 4.Diabetes insipidus

Correct answer: 2 Rationale: Nitrofurantoin is contraindicated in clients with renal impairment. The disorders in the other options are not a concern with the use of this medication.

The nurse would question the health care provider if which medication were prescribed for a client with glaucoma? 1. Carbachol 2. Atropine sulfate 3. Pilocarpine nitrate 4.Pilocarpine hydrochloride

Correct answer: 2 Rationale: Pilocarpine and carbachol are examples of miotic agents used in the treatment of glaucoma. Atropine sulfate is a mydriatic and cycloplegic medication that is contraindicated for use in clients with glaucoma. Mydriatic medications dilate the pupil and can cause an increase in intraocular pressure in the eye.

The home health nurse is caring for a client who is taking probenecid. The client has been instructed to restrict the diet to low-purine foods. Which food item should the nurse instruct the client to avoid? 1. Spinach 2. Scallops 3. Potatoes 4.Ice cream

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

The nurse teaches the wife of a client who is receiving levodopa/carbidopa to avoid pyridoxine medications. Which statement by the wife indicates an understanding of the instructions? 1."Vitamin B6 will change perspiration and urine to a dark color, which may stain clothing." 2."Vitamin B6 reverses the effectiveness of the medication, meaning a higher dose is needed." 3."The medication competes with vitamin B6 for absorption in the intestine, blocking absorption." 4."The two medications in combination will cause the blood sugar to drop, causing hypoglycemia."

Correct answer: 2 Rationale: Pyridoxine (vitamin B6) reverses the therapeutic effects of levodopa. Dietary restrictions are not necessary, but ingredients of multivitamins should be assessed. Many multivitamins contain pyridoxine and should be avoided. Careful reading of over-the-counter vitamin labeling is necessary to avoid increasing pyridoxine in the diet. The statements in the remaining options are incorrect.

Pilocarpine hydrochloride is prescribed for a client with glaucoma. The nurse checks the medication supply room to ensure that atropine sulfate is available for administration in the event that systemic toxicity occurs from the use of pilocarpine hydrochloride. The nurse also monitors for which sign of systemic toxicity? 1. Anorexia 2. Bradycardia 3. Tachycardia 4.Hypertension

Correct answer: 2 Rationale: Systemic absorption of pilocarpine hydrochloride can produce toxicity, manifested as vertigo, bradycardia, tremors, hypotension, syncope, cardiac dysrhythmias, and seizures. Atropine sulfate is the antidote for systemic reactions that occur with pilocarpine.

Aluminum hydroxide is prescribed for a client with chronic kidney disease (CKD). The nurse should instruct the client to take this medication at what time? 1. At bedtime 2. With meals 3. On an empty stomach 4.In the morning on arising

Correct answer: 2 Rationale: The client who is receiving aluminum hydroxide should take the medication with meals. The phosphate-binding effect of this medication is most effective when it is taken with food. If tablets are used, they should be chewed well before swallowing.

A client who has been taking phenytoin for seizure control has a serum phenytoin level of 8 mcg/mL (35.71 mmol/L). On the basis of this finding, which note should the nurse enter in the client's health record? 1. Client is experiencing a toxic level. 2. Client has an inadequate medication level. 3. Client's result is at the low end of therapeutic range. 4.Client's result is at the high end of therapeutic range.

Correct answer: 2 Rationale: The therapeutic serum level range for phenytoin is 10 to 20 mcg/mL (40 to 79 mmol/L). A laboratory value of 8 mcg/mL is below the therapeutic range, indicating an inadequate medication level, so this should be noted in the health record and the health care provider should be notified.

A client has been prescribed benztropine. The nurse should assess for which gastrointestinal (GI) problems as a side or adverse effect of this medication? 1. Diarrhea 2. Dry mouth 3. Increased appetite 4.Hyperactive bowel sounds

Correct answer: 2 Rationale: This medication is classified as an anticholinergic medication and is used to treat Parkinson's disease. Common GI side effects of benztropine therapy include constipation, dry mouth, and nausea. An adverse effect is ileus. These effects are the result of the anticholinergic properties of the medication.

Trimethoprim-sulfamethoxazole is prescribed to be administered by intravenous infusion to a client with a recurrent urinary tract infection. How should the nurse administer this medication? 1. Over 30 minutes 2. Over 60 to 90 minutes 3. Piggybacked into the peripheral line containing parenteral nutrition 4.Piggybacked into the existing infusion of normal saline and potassium chloride

Correct answer: 2 Rationale: Trimethoprim-sulfamethoxazole may be administered by intravenous infusion but should not be mixed with any other medications or solutions. Trimethoprim-sulfamethoxazole is infused over 60 to 90 minutes, and bolus infusions or rapid infusions must be avoided.

The nurse has given medication instructions to a client receiving phenytoin. Which statement indicates that the client has an adequate understanding of the instructions? 1."Alcohol is not contraindicated while taking this medication." 2."Good oral hygiene is needed, including brushing and flossing." 3."The medication dose may be self-adjusted, depending on side effects." 4."The morning dose of the medication should be taken before a serum medication level is drawn."

Correct answer: 2 Rationale: Typical antiseizure medication instructions include taking the prescribed daily dosage to keep the blood level of the medication constant and having a sample drawn for serum medication level determination before taking the morning dose. The client is taught not to stop the medication abruptly, to avoid alcohol, to check with a health care provider before taking over-the-counter medications, to avoid activities in which alertness and coordination are required until medication effects are known, to provide good oral hygiene, and to obtain regular dental care. The client should also wear a MedicAlert bracelet.

The nurse is told that the result of a serum carbamazepine level for a client who is receiving the medication for the control of seizures is 13 mcg/mL (55.03 mmol/L). Based on this laboratory result, the nurse anticipates that the health care provider (HCP) will document which prescription? 1. Discontinuation of the medication 2. A decrease of the dosage of the medication 3. An increase of the dosage of the medication 4.Continuation of the presently prescribed dosage

Correct answer: 2 Rationale: When carbamazepine is administered, blood levels need to be monitored periodically to check for the child's absorption of the medication. The amount of the medication prescribed is based on the blood level achieved. The therapeutic serum range of carbamazepine is 8 to 12 mcg/mL (34 to 51). The nurse would anticipate that the HCP will decrease the dosage of the medication.

The nurse is caring for a client with chronic back pain. Codeine has been prescribed for the client. Specific to this medication, which intervention should the nurse include in the plan of care while the client is taking this medication? 1. Monitor radial pulse. 2. Monitor bowel activity. 3. Monitor apical heart rate. 4.Monitor peripheral pulses.

Correct answer: 2 Rationale: While the client is taking codeine, the nurse would monitor vital signs and assess for hypotension. The nurse also should increase fluid intake, palpate the bladder for urinary retention, auscultate bowel sounds, and monitor the pattern of daily bowel activity and stool consistency because the medication causes constipation. The nurse should monitor respiratory status and initiate deep-breathing and coughing exercises. In addition, the nurse monitors the effectiveness of the pain medication.

A client receiving therapy with carbidopa/levodopa is upset and tells the home health nurse that his urine has turned a darker color since he started taking this medication. The client wants to discontinue its use. In formulating a response to the client's concerns, the nurse interprets that this change is indicative of which condition? 1. Developing toxicity 2. A harmless side effect of the medication 3. A result of taking the medication with milk 4.A sign of interaction with another medication

Correct answer: 2 Rationale: With carbidopa/levodopa therapy, a darkening of the urine or sweat may occur. The client should be reassured that this is a harmless effect of the medication, and its use should be continued. Darkened urine is not indicative of carbidopa/levodopa toxicity, the result of taking the medication with milk, or a sign of interaction with another medication.

Meperidine has been prescribed for a client to treat pain. Which side and adverse effects should the nurse monitor for? Select all that apply. 1. Diarrhea 2. Tremors 3. Drowsiness 4. Hypotension 5. Urinary frequency 6.Increased respiratory rate

Correct answer: 2, 3, 4 Rationale: Meperidine is an opioid analgesic. Side and adverse effects include respiratory depression, drowsiness, hypotension, constipation, urinary retention, nausea, vomiting, and tremors.

The health care provider is preparing to administer edrophonium to the client with myasthenia gravis. In planning care, the nurse understands which about the administration of edrophonium? Select all that apply. 1.Edrophonium is a long-acting cholinesterase inhibitor. 2.Atropine is used to reverse the effects of edrophonium. 3.If symptoms worsen following administration of edrophonium, the crisis is cholinergic. 4.Edrophonium is used to distinguish between a myasthenic crisis and a cholinergic crisis. 5.An improvement in symptoms following administration of edrophonium indicates myasthenic crisis.

Correct answer: 2, 3, 4, 5 Rationale: Edrophonium(Tensilon)is an ultra-short-acting reversible cholinesterase inhibitor that can be used to distinguish between a cholinergic and a myasthenic crisis. To distinguish between overtreatment (cholinergic crisis) and undertreatment (myasthenic crisis), edrophonium is administered; this is often referred to as a Tensilon test. Overtreatment of myasthenia gravis with reversible cholinesterase inhibitors results in a cholinergic crisis. Undertreatment can result in a myasthenic crisis. Both cholinergic and myasthenic crises result in increased muscle weakness or paralysis. If symptoms improve after the administration of edrophonium, the crisis is myasthenic; if symptoms worsen, the crisis is cholinergic. Atropine must be readily available so that edrophonium can be reversed if the symptoms worsen.

The nurse is assisting in the care of a client being discharged on phenytoin 100 mg three times daily. When providing client teaching about this medication, the nurse should be sure to include which points? Select all that apply. 1. Break the capsules so they are easier to swallow. 2. Use a soft toothbrush while taking this medication. 3. If a dose is missed, just wait until the next one is due. 4. The medication may turn the urine pink, red, or brown. 5. Alcohol should be avoided while taking this medication. 6.Sore throat is a common side effect of the medication and is nothing to worry about.

Correct answer: 2, 4, 5 Rationale: Phenytoin is an anticonvulsant that can cause gingival hyperplasia, as well as bleeding, swelling, and tenderness of the gums. The client should use good oral hygiene and gum massage and have regular dental checkups. Alcohol interferes with the absorption of phenytoin, so it should be avoided. Change in the color of the urine is a normal reaction. A sore throat, fever, glandular swelling, or any skin reaction indicates hematological toxicity and needs to be reported.

The nurse is providing dietary instructions to a client who has been prescribed cyclosporine. Which food item should the nurse instruct the client to exclude from the diet? 1. Red meats 2. Orange juice 3. Grapefruit juice 4.Green, leafy vegetables

Correct answer: 3 Rationale: A compound present in grapefruit juice inhibits metabolism of cyclosporine through the cytochrome P450 system. As a result, consumption of grapefruit juice can raise cyclosporine levels by 50% to 100%, thereby greatly increasing the risk of toxicity. Red meats, orange juice, and green, leafy vegetables do not interact with the cytochrome P450 system.

The nurse is reviewing the laboratory results for a client receiving tacrolimus. Which laboratory result would indicate to the nurse that the client is experiencing an adverse effect of the medication? 1. Potassium level of 3.8 mEq/L (3.8 mmol/L) 2. Platelet count of 300,000 mm3 (300 × 109/L) 3. Fasting blood glucose of 200 mg/dL (11.1 mmol/L) 4.White blood cell count of 6000 mm3 (6.0 × 109/L)

Correct answer: 3 Rationale: A fasting blood glucose level of 200 mg/dL (11.1 mmol/L) is significantly elevated above the normal range of 70 to 110 mg/dL (4 to 6 mmol/L) and suggests an adverse effect. Recall that fasting blood glucose levels are sometimes based on health care provider preference. Other adverse effects include neurotoxicity evidenced by headache, tremor, and insomnia; gastrointestinal effects such as diarrhea, nausea, and vomiting; hypertension; and hyperkalemia. The remaining options identify normal reference levels. The normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). The normal platelet count is 150,000 to 400,000 mm3 (150 to 400 × 109/L). The normal white blood cell count is 5000 to 10,000 mm3 (5 to 10 × 109/L).

A client with glaucoma is receiving acetazolamide. The nurse educator provides education to a group of nurses about the indications for and effect of this medication. Which statement by one of the nurses indicates that the teaching has been effective? 1. "This works to prevent hypertension." 2. "This works to prevent hyperthermia." 3. "This works to decrease intraocular pressure." 4."This works to maintain an adequate blood pressure for cerebral perfusion."

Correct answer: 3 Rationale: Acetazolamide is a carbonic-anhydrase inhibitor used to treat glaucoma. The medication decreases the formation of aqueous humor. The statements in the remaining options are not indicative of the purpose of this medication.

The nurse is reading the laboratory results for a client being treated with carbamazepine for prophylaxis of complex partial seizures. When evaluating the client's laboratory data, the nurse determines that which value is consistent with a side or adverse effect of this medication? 1. Sodium level, 136 mEq/L (136 mmol/L) 2. Platelet count, 350,000 mm3 (350 × 109/L) 3. White blood cell count, 3200 mm3 (3.2 × 109/L) 4.Blood urea nitrogen (BUN), 19 mg/dL (6.84 mmol/L)

Correct answer: 3 Rationale: Adverse effects of carbamazepine appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, and leukopenia. Other adverse effects include cardiovascular disturbances, thrombophlebitis, dysrhythmias, and dermatological effects.

A client with trigeminal neuralgia is being treated with carbamazepine, 400 mg orally daily. Which value indicates that the client is experiencing an adverse effect to the medication? 1. Sodium level, 140 mEq/L (140 mmol/L) 2. Uric acid level, 4.0 mg/dL (0.24 mmol/L) 3. White blood cell count, 3000 mm3 (3.0 × 109/L) 4.Blood urea nitrogen level, 10 mg/dL (3.6 mmol/L)

Correct answer: 3 Rationale: Adverse effects of carbamazepine {= Tegretol, an antiepileptic drug} appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, and leukopenia; cardiovascular disturbances, including thrombophlebitis and dysrhythmias; and dermatological effects. The low white blood cell count reflects agranulocytosis. The laboratory values in options 1, 2, and 4 are normal values.

A client was just admitted to the hospital to rule out a gastrointestinal (GI) bleed. The client has brought several bottles of medications prescribed by different specialists. During the admission assessment, the client states, "Lately, I have been hearing some roaring sounds in my ears, especially when I am alone." Which medication would the nurse identify as the cause of the client's complaint? 1. Doxycycline 2. Atropine sulfate 3. Acetylsalicylic acid 4.Diltiazem hydrochloride

Correct answer: 3 Rationale: Aspirin is contraindicated for GI bleeding and is potentially ototoxic. The client should be advised to notify the prescribing health care provider so the medication can be discontinued and/or a substitute that is less toxic to the ear can be taken instead. Options 1, 2, and 4 do not have effects that are potentially associated with hearing difficulties.

Benztropine mesylate is prescribed for a client. What statement by the client indicates that the client needs further teaching about the medication? 1. "I will avoid driving if I get drowsy or dizzy." 2. "I will watch my urinary output and look for signs of constipation." 3. "I will sit in the sun for an hour a day to enhance medication effectiveness." 4."I will call the health care provider if I have difficulty swallowing or if I start vomiting."

Correct answer: 3 Rationale: Benztropine mesylate is an anticholinergic that may be prescribed to treat Parkinson's disease. The client taking benztropine mesylate may have decreased tolerance to heat as a result of diminished ability to sweat and should plan rest periods in cool places during the day. The client is instructed to avoid driving or operating hazardous equipment if drowsy or dizzy. The client is also instructed to monitor urinary output and watch for signs of constipation. The client should be instructed to contact the health care provider if difficulty swallowing or speaking develops, vomiting occurs, or central nervous system effects occur. In addition, the use of anticholinergic medications should be avoided in older adults because they can cause confusion, urinary retention, constipation, dry mouth, and blurred vision.

A client taking carbamazepine asks the nurse what to do if a dose is inadvertently missed. The nurse responds that which action should be taken? 1. Withhold until the next scheduled dose. 2. Withhold and call the health care provider (HCP). 3. Take the dose as long as it is not close to the time for the next dose. 4.Withhold until the next scheduled dose, which should then be doubled.

Correct answer: 3 Rationale: Carbamazepine is an anticonvulsant that should be taken around the clock, precisely as directed. If a dose is omitted, the client should take the dose as soon as it is remembered, as long as it is not close to the time that the next dose is due. The medication should not be double-dosed. If more than 1 dose is omitted, the client should call the HCP.

The nurse is preparing to ambulate a client with Parkinson's disease who has recently been started on levodopa/carbidopa. Before performing this activity with the client, the nurse should include which most important assessment in the client's plan of care? 1. History of falls 2. Use of assistive devices 3. Postural (orthostatic) vital signs 4.Degree of exhibited intention tremor

Correct answer: 3 Rationale: Clients with Parkinson's disease are at risk for postural (orthostatic) hypotension from the disease. This problem is exacerbated with the introduction of levodopa/carbidopa, which also can cause postural hypotension and increase the client's risk for falls.Although knowledge of the client's use of assistive devices and history of falls is helpful, neither of these options is the most important element of the assessment, based on the wording of this question. Clients with Parkinson's disease generally have resting tremor, not intention tremor.

In preparation for cataract surgery, the nurse is to administer cyclopentolate eye drops at 0900 for surgery that is scheduled for 0915. What initial action should the nurse take in relation to the characteristics of the medication action? 1. Provide lubrication to the operative eye prior to giving the eye drops. 2. Call the surgeon, as this medication will further constrict the operative pupil. 3. Consult the surgeon, as there is not sufficient time for the dilative effects to occur. 4.Give the medication as prescribed; the surgeon needs optimal constriction of the pupil.

Correct answer: 3 Rationale: Cyclopentolate is a rapidly acting mydriatic and cycloplegic medication. Cyclopentolate is effective in 25 to 75 minutes, and accommodation returns in 6 to 24 hours. Cyclopentolate is used for preoperative mydriasis, not pupil constriction. The nurse should consult with the surgeon about the time of administration of the eye drops since 15 minutes is not adequate time for dilation to occur.

The preoperative medication sheet identifies that cyclopentolate is prescribed for a client before cataract surgery. The client asks the nurse what the medication is for, and the nurse provides education. Which statement by the client indicates that teaching has been effective? 1. "It lubricates the eye." 2. "It makes my pupils smaller." 3. "It paralyzes the muscles in my eye." 4."It causes me vessels to become smaller."

Correct answer: 3 Rationale: Cyclopentolate is used for preoperative mydriasis. It is a rapid-acting mydriatic and cycloplegic medication. Cycloplegics are medications that paralyze the ciliary muscle, and mydriatics are medications that dilate the pupil. Cyclopentolate becomes effective in 25 to 75 minutes, and the effects last for 6 to 24 hours. The statements in the remaining options are not actions of this medication.

After review of the client's laboratory values, the nurse notes that a phenytoin level for a client receiving phenytoin is 7 mcg/mL (27.78 mmol/L). The nurse makes which interpretation regarding this laboratory result? 1. The level is within the expected therapeutic range. 2. The level indicates the medication should be stopped. 3. The level is lower than the expected therapeutic range. 4.The level is higher than the expected therapeutic range.

Correct answer: 3 Rationale: The target range for a therapeutic serum level of phenytoin is between 10 and 20 mcg/mL (40 to 79 mmol/L). Levels below 10 mcg/mL are too low to control seizures. At levels above 20 mcg/mL (79 mmol/L), signs of toxicity begin to appear. This client has a low serum level, and the dosage is likely to be increased.

Following kidney transplantation, cyclosporine is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication? 1. Hemoglobin level of 14.0 g/dL (140 mmol/L) 2. Creatinine level of 0.6 mg/dL (53 mcmol/L) 3. Blood urea nitrogen level of 25 mg/dL (8.8 mmol/L) 4.Fasting blood glucose level of 99 mg/dL (5.5 mmol/L)

Correct answer: 3 Rationale: Cyclosporine is an immunosuppressant. Nephrotoxicity can occur from the use of cyclosporine. Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen and serum creatinine levels. The normal blood urea nitrogen level is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). The normal creatinine level for a male is 0.6 to 1.2 mg/dL (53 to 106 mcmol/L) and for a female 0.5 to1.1 mg/dL (44 to 97 mcmol/L). Cyclosporine can lower complete blood cell count levels. A normal hemoglobin is Male: 14 to 18 g/dL (140 to 180 mmol/L); Female: 12 to 16 g/dL (120 to 160 mmol/L). A normal hemoglobin is not an adverse effect. Cyclosporine does affect the glucose level. The normal fasting glucose is 70 to 110 mg/dL (4 to 6 mmol/L).

Dantrolene sodium has been administered to a client with a spinal cord injury. The nurse determines that the client is experiencing a side or adverse effect of the medication if which is noted? 1. Dizziness 2. Drowsiness 3. Abdominal pain 4.Lightheadedness

Correct answer: 3 Rationale: Dantrium is hepatotoxic. The nurse observes for indications of liver dysfunction, which include jaundice, abdominal pain, and malaise. The nurse notifies the health care provider if these occur. The signs and symptoms in the remaining options are expected side effects due to the central nervous system-depressant effects of the medication.

The nurse is assisting in the care of a client who is being evaluated for possible myasthenia gravis. The health care provider gives a test dose of edrophonium. Evaluation of the results indicates that the test is positive. Which would be the expected response noted by the nurse? 1. Joint pain for the next 15 minutes 2. An immediate increase in blood pressure 3. An increase in muscle strength within 1 to 3 minutes 4.Feelings of faintness or dizziness for 5 to 10 minutes

Correct answer: 3 Rationale: Edrophonium is a short-acting acetylcholinesterase inhibitor used to diagnose myasthenia gravis. An increase in muscle strength should be seen in 1 to 3 minutes following the test dose if the client does have the disease. If no response occurs, another dose is given over the next 2 minutes and muscle strength is tested again. If no increase in muscle strength occurs with this higher dose, the muscle weakness is not caused by myasthenia gravis. Clients who receive injections of this medication commonly demonstrate a drop in blood pressure, feel faint and dizzy, and are flushed.

The nurse preparing to administer carbamazepine notices a number of items on the client's breakfast tray. Which item should be a cause for concern and should be removed from the tray? 1. Carton of milk 2. Scrambled eggs 3. Grapefruit juice 4.Toast with honey

Correct answer: 3 Rationale: Grapefruit juice can increase peak and trough levels of carbamazepine. Accordingly, clients taking the medication should be advised to avoid grapefruit juice. The other foods can be taken with this medication.

Betaxolol hydrochloride eye drops have been prescribed for a client with glaucoma. Which nursing action is most appropriate related to monitoring for side and adverse effects of this medication? 1. Assessing for edema 2. Monitoring temperature 3. Monitoring blood pressure 4.Assessing blood glucose level

Correct answer: 3 Rationale: Hypotension, dizziness, nausea, diaphoresis, headache, fatigue, constipation, and diarrhea are side and adverse effects of the medication. Nursing interventions include monitoring the blood pressure for hypotension and assessing the pulse for strength, weakness, irregular rate, and bradycardia. Options 1, 2, and 4 are not specifically associated with this medication.

The nurse is assisting in the care of a client with myasthenia gravis who is receiving pyridostigmine. Which medication should the nurse plan to have readily available should the client develop cholinergic crisis because of excessive medication dosage? 1. Vitamin K 2. Acetylcysteine 3. Atropine sulfate 4.Protamine sulfate

Correct answer: 3 Rationale: If the client is in cholinergic crisis, the antidote for the medication would be a medication that is an anticholinergic. Thus, the antidote for cholinergic crisis is atropine sulfate. Vitamin K is the antidote for warfarin. Protamine sulfate is the antidote for heparin, and acetylcysteine is the antidote for acetaminophen.

Ear drops are prescribed for an infant with otitis media. Which is the most appropriate method to administer ear drops to an infant? 1. Pull up and back on the pinna, and direct the solution onto the eardrum. 2. Pull down and back on the pinna, and direct the solution onto the eardrum. 3. Pull down and back on the pinna, and direct the solution toward the wall of the canal. 4.Pull up and back on the pinna, and direct the solution toward the wall of the canal.

Correct answer: 3 Rationale: In a child younger than 3 years of age, the pinna is pulled down and straight back. The infant should be turned on the side with the affected ear uppermost. Using the nondominant hand, the person administering the ear drops pulls the pinna down and back. The medication is administered by aiming it at the wall of the canal rather than directly onto the eardrum. The infant should remain with the affected ear uppermost for 10 to 15 minutes to retain the solution. In an adult or a child older than 3 years of age, the pinna is pulled up and back to straighten the auditory canal.

A client with a urinary tract infection (UTI) is given a prescription for levofloxacin. The nurse should provide the client with which information about this medication? 1. "You may experience altered taste." 2. "You may get dizzy, so move around slowly." 3. "Pain in the back of the leg should be reported." 4."Your urine may become dark and if it does, you should call your health care provider."

Correct answer: 3 Rationale: Levofloxacin is a fluoroquinolone antibiotic and is used for a variety of infections, including UTI. Adverse effects include peripheral neuropathy, rhabdomyolysis, tendonitis, tendon rupture, Clostridium difficile infection, muscle weakness in clients with myasthenia gravis, and photosensitivity. Levofloxacin can also prolong the client's QT interval, leading to dysrhythmias. Pain in the back of the leg could be indicative of tendonitis and therefore risk for tendon rupture. The other adverse effects are associated with gemifloxacin, not levofloxacin.

A client is taking the prescribed dose of phenytoin to control seizures. Results of a phenytoin blood level study reveal a level of 35 mcg/mL (140 mcmol/L). Which finding would be expected as a result of this laboratory result? 1. Hypotension 2. Tachycardia 3. Slurred speech 4.No abnormal finding

Correct answer: 3 Rationale: The therapeutic phenytoin level is 10 to 20 mcg/mL (40 to 79 mcmol/L). At a level higher than 20 mcg/mL, involuntary movements of the eyeballs (nystagmus) occur. At a level higher than 30 mcg/mL (120 mcmol/L), ataxia and slurred speech occur.

A miotic medication has been prescribed for the client with glaucoma and the client asks the nurse about the purpose of the medication. Which response should the nurse provide to the client? 1. "The medication will help dilate the eye to prevent pressure from occurring." 2. "The medication will relax the muscles of the eyes and prevent blurred vision." 3. "The medication causes the pupil to constrict and will lower the pressure in the eye." 4."The medication will help block the responses that are sent to the muscles in the eye."

Correct answer: 3 Rationale: Miotics cause pupillary constriction and are used to treat glaucoma. They lower the intraocular pressure, thereby increasing blood flow to the retina and decreasing retinal damage and loss of vision. Miotics cause a contraction of the ciliary muscle and a widening of the trabecular meshwork. Options 1, 2, and 4 are incorrect.

The home health nurse visits a client who is taking phenytoin for control of seizures. During the assessment, the nurse notes that the client is taking birth control pills. Which information should the nurse include in the teaching plan? 1.Pregnancy must be avoided while taking phenytoin. 2.The client may stop the medication if it is causing severe gastrointestinal effects. 3.There is the potential of decreased effectiveness of birth control pills while taking phenytoin. 4.There is the increased risk of thrombophlebitis while taking phenytoin and birth control pills together.

Correct answer: 3 Rationale: Phenytoin enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. Options 1, 2, and 4 are inappropriate instructions. Pregnancy does not need to be "avoided" while taking phenytoin; however, because phenytoin may cause some risk to the fetus (Pregnancy Category D medication), consultation with the health care provider should be done if pregnancy is considered. Telling a client that there is an increased risk of thrombophlebitis is incorrect and inappropriate and could cause anxiety in the client. A client should not be instructed to stop antiseizure medication.

The nurse working in a long-term care facility notes that several clients are taking pilocarpine hydrochloride eye drops. The nurse ensures that which medication is available on the nursing unit for use if a client should develop systemic toxicity from pilocarpine hydrochloride? 1. Disulfiram 2. Cyclopentolate 3. Atropine sulfate 4.Naloxone hydrochloride

Correct answer: 3 Rationale: Pilocarpine hydrochloride is a cholinergic agent. Atropine sulfate must be available in the event of systemic toxicity from pilocarpine hydrochloride. Pilocarpine toxicity is manifested by vertigo, bradycardia, tremors, hypotension, syncope, cardiac dysrhythmias, and seizures. Disulfiram is an alcohol deterrent used in the management of alcoholism in selected clients. Cyclopentolate is a rapidly acting mydriatic and cycloplegic medication used preoperatively for surgical procedures on the eye. Naloxone hydrochloride is an opioid antagonist used to reverse opioid-induced respiratory depression.

The nursing student is assigned to care for a client with glaucoma for whom pilocarpine hydrochloride eye drops have been prescribed. The nursing instructor asks the student to describe the action of the eye medication. Which statement by the student indicates an understanding of the purpose of this medication? 1."The medication prevents blurred vision by relaxing the muscles of the eyes." 2."The medication dilates the eye to prevent increased pressure from occurring." 3."The medication increases the blood flow to the retina and also will lower the pressure in the eye." 4."The medication blocks responses that are sent to the brain that direct the actions of the muscles in the eye.

Correct answer: 3 Rationale: Pilocarpine hydrochloride is a miotic that is used to lower the intraocular pressure, thereby increasing blood flow to the retina and decreasing retinal damage and loss of vision. Miotics cause a contraction of the ciliary muscle and a widening of the trabecular meshwork. The statements in the remaining options are incorrect.

The nurse has a prescription to administer phenytoin 100 mg mixed in 5% dextrose in water by the intravenous (IV) route to a client. After reading this prescription, which action should the nurse take? 1. Prepare the solution for administration. 2. Contact the agency pharmacy to obtain the medication. 3. Contact the health care provider (HCP) to question the prescription. 4.Mix the medication in the prescribed solution and attach an in-line filter.

Correct answer: 3 Rationale: Precipitation will occur if phenytoin is mixed with any solution other than 0.9% (normal) saline. This is especially true with solutions containing dextrose. Therefore, the nurse would contact the HCP who prescribed the medication to change the prescription. Phenytoin is very irritating to the vein wall or other tissues and an in-line filter reduces the chance of precipitants entering the bloodstream. However, the prescription needs to be questioned and changed.

Tamsulosin hydrochloride is prescribed for a client. The nurse should suspect that this medication is prescribed to relieve which condition? 1. Constipation 2. Muscle spasms 3. Urinary obstruction 4. Respiratory congestion

Correct answer: 3 Rationale: Tamsulosin hydrochloride is used to relieve mild to moderate manifestations that occur in benign prostatic hypertrophy. The medication also improves urinary flow rates. This medication is not used to treat constipation, muscle spasms, or respiratory congestion.

The nurse is providing instructions to an adolescent prescribed phenytoin for the control of seizures. Which statement by the adolescent indicates a need for further teaching regarding the medication? 1. "The medication may cause acne or oily skin." 2. "Drinking alcohol may affect the medication." 3. "If my gums become sore and swollen, I need to stop the medication." 4."Birth control pills may not be effective when I take this medication."

Correct answer: 3 Rationale: The adolescent should not stop taking antiseizure medications suddenly or without discussing it with a health care provider (HCP) or nurse. Acne or oily skin may be a problem for the adolescent, and the adolescent is advised to call a HCP for skin problems. Alcohol will lower the seizure threshold, and it is best to avoid its use. Birth control pills may be less effective when the client is taking antiseizure medication.

A client has been prescribed codeine sulfate. The nurse has given the client instructions for its use. The nurse concludes that the client understands the instructions if the client verbalizes to self-assess for which side effect? 1. Excitability 2. Rapid pulse 3. Constipation 4.Excessive urination

Correct answer: 3 Rationale: The client is taught about side and adverse effects that could occur with the use of codeine sulfate. The most common side effects include drowsiness, confusion, hypotension, nausea and vomiting, and constipation. Adverse effects include bradycardia, respiratory depression, and urinary retention.

The nurse in the health care provider's office is reviewing the results of a client's phenytoin level determination performed that morning. The nurse identifies that a therapeutic medication level has been achieved if which result is noted? 1. 3 mcg/mL (11.9 mmol/L) 2. 8 mcg/mL (31.74 mmol/L) 3. 15 mcg/mL (59.52 mmol/L) 4.24 mcg/mL (95.23 mmol/L)

Correct answer: 3 Rationale: The therapeutic range for serum phenytoin levels is 10 to 20 mcg/mL (40 to 79 mmol/L) in clients with normal serum albumin levels and renal function. A level below this range indicates that the client is not receiving sufficient medication and is at risk for seizure activity. In this case, the medication dose should be adjusted upward. A level above this range indicates that the client is entering the toxic range and is at risk for toxic effects of the medication. In this case, the dose should be adjusted downward.

The nurse is planning to administer furosemide 40 mg by intravenous push (IVP) through an existing intravenous (IV) line. To deliver this medication safely, the nurse should perform which action? 1. Give the medication rapidly over 10 seconds. 2. Give the medication slowly, diluted in 100 mL of 5% dextrose in water. 3. Pinch the IV tubing above the injection port, and inject slowly over 1 to 2 minutes. 4.Pinch the IV tubing below the injection port, and inject slowly over 1 to 2 minutes.

Correct answer: 3 Rationale: To administer medication by IVP, the IV tubing must be pinched above the injection port so that the medication does not go back up the tubing during injection. Most IVP medications should be injected slowly. Considering the need for and action of the medication, it is not diluted unless prescribed.

In preparation for cataract surgery, the nurse is to administer prescribed eye drops. The nurse reviews the health care provider's prescriptions, expecting which type of eye drops to be prescribed? 1. A miotic agent 2. A thiazide diuretic 3. An osmotic diuretic 4.A mydriatic medication

Correct answer: 4 Rationale: A mydriatic medication produces mydriasis or dilation of the pupil. Mydriatic medications are used preoperatively in the client with a cataract. These medications act by dilating the pupils; they also constrict blood vessels. A miotic medication constricts the pupil. An osmotic diuretic may be used to decrease intraocular pressure. A thiazide diuretic is not likely to be prescribed for a client with a cataract.

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

Correct answer: 4 Rationale: An edrophonium injection makes the client in cholinergic crisis temporarily worse. An improvement in the weakness indicates myasthenia crisis. Muscle spasms are not associated with this test.

A client with myasthenia gravis becomes increasingly weaker. The health care provider injects a dose of edrophonium to determine whether the client is experiencing a myasthenic crisis or a cholinergic crisis. The nurse expects that the client will have which reaction if in cholinergic crisis? 1. No change in the condition 2. Complaints of muscle spasms 3. An improvement of the weakness 4.A temporary worsening of the condition

Correct answer: 4 Rationale: An edrophonium injection makes the client in cholinergic crisis temporarily worse. An improvement of the condition indicates myasthenic crisis. The other options are unrelated to the test.

The nurse is providing instructions to a client who will be self-administering eye drops. To minimize systemic absorption of the eye drops, the nurse should instruct the client to take which action? 1. Eat before instilling the drops. 2. Swallow several times after instilling the drops. 3. Blink vigorously to encourage tearing after instilling the drops. 4.Occlude the nasolacrimal duct with a finger after instilling the drops.

Correct answer: 4 Rationale: Applying pressure on the nasolacrimal duct prevents systemic absorption of the medication. Options 1, 2, and 3 will not prevent systemic absorption.

A client has been prescribed betaxolol eye drops for the treatment of glaucoma. The ambulatory care nurse determines that the client understands proper medication use if the client states the need to return to the office for monitoring of what item(s)? 1. Hearing acuity 2. Blood glucose level 3. Presence of calf pain 4.Blood pressure and apical pulse

Correct answer: 4 Rationale: Betaxolol is an antiglaucoma medication and a β-adrenergic blocker. Systemic effects of this medication are hypotension, dizziness, nausea, diaphoresis, headache, fatigue, constipation, and diarrhea. The client should have the blood pressure monitored for hypotension and the pulse assessed for strength, weakness, irregular rate, and bradycardia. Bowel activity and evidence of heart failure also should be assessed. The other options are incorrect and not associated with this medication.

The health care provider (HCP) writes a prescription for carbamazepine for a client who was admitted to the hospital. The nurse contacts the HCP to verify the prescription if which condition is noted in the assessment data? 1. Hypertension 2. Tonic-clonic seizures 3. Trigeminal neuralgia 4.Bone marrow depression

Correct answer: 4 Rationale: Carbamazepine is classified as an iminostilbene derivative and is used as an anticonvulsant, antineuralgic, antimanic, and antipsychotic. It is used to treat seizure disorders, trigeminal neuralgia, and diabetic neuropathy. The medication can cause blood dyscrasias (a diseased state of the blood, usually one in which the blood contains permanent abnormal cellular elements) as an adverse effect and is contraindicated if the client has a history of bone marrow depression, hypersensitivity to tricyclic antidepressants, or concurrent use of monoamine oxidase inhibitors.

Carbamazepine has been prescribed for a client. The nurse should tell the client that which blood test will be done periodically while the client is taking this medication? 1. Lipase level 2. Amylase level 3. Ammonia level 4.Complete blood cell (CBC) count

Correct answer: 4 Rationale: Carbamazepine is classified as an iminostilbene derivative and is used as an anticonvulsant, antineuralgic, antimanic, and antipsychotic. The medication can cause blood dyscrasias as an adverse effect, and the client should have a CBC count done before therapy and periodically during therapy. Additional laboratory tests that should be done include a serum iron determination, urinalysis, blood urea nitrogen determination, and carbamazepine level. The tests identified in the remaining options are unnecessary.

A client is scheduled to begin therapy with carbamazepine. The nurse should assess the results of which test(s) before administering the first dose of this medication to the client? 1. Liver function tests 2. Renal function tests 3. Pancreatic enzyme studies 4.Complete blood cell count

Correct answer: 4 Rationale: Carbamazepine may be used to treat a seizure disorder. It can cause leukopenia, anemia, thrombocytopenia, and, very rarely, fatal aplastic anemia. To reduce the risk of serious hematological effects, a complete blood cell count should be done before treatment and periodically thereafter. This medication should be avoided in clients with preexisting hematological abnormalities. The client also is told to report the occurrence of fever, sore throat, pallor, weakness, infection, easy bruising, and petechiae. The results of the remaining tests listed in the options are not associated with the use of this medication.

Trimethoprim-sulfamethoxazole is prescribed for a client. The nurse should instruct the client to report which symptom if it develops during the course of this medication therapy? 1. Nausea 2. Diarrhea 3. Headache 4.Sore throat

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

Carbidopa-levodopa is prescribed for a client with Parkinson's disease. The nurse monitors the client for side and adverse effects of the medication. Which finding indicates that the client is experiencing an adverse effect? 1. Pruritus 2. Tachycardia 3. Hypertension 4.Impaired voluntary movements

Correct answer: 4 Rationale: Dyskinesia and impaired voluntary movements may occur with high carbidopa-levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia are frequent side effects of the medication.

A client is suspected of having myasthenia gravis. Edrophonium is administered intravenously to determine the diagnosis. Which indicates that the client may have myasthenia gravis? 1.Joint pain following administration of the medication 2.Feelings of faintness, dizziness, hypotension, and signs of flushing in the client 3.A decrease in muscle strength within 30 to 60 seconds following administration of the medication 4.An increase in muscle strength within 30 to 60 seconds following administration of the medication

Correct answer: 4 Rationale: Edrophonium is a short-acting acetylcholinesterase inhibitor used as a diagnostic agent. When a client has suspected myasthenia gravis, the health care provider will administer an edrophonium test. When a dose is administered intravenously, an increase in muscle strength should be seen in 30 to 60 seconds. If no response occurs, another dose of edrophonium is given over the next 2 minutes, and muscle strength is tested again. If no increase in muscle strength occurs with this higher dose, the muscle weakness is not caused by myasthenia gravis. Clients receiving injections of this medication commonly demonstrate a drop in blood pressure, feel faint and dizzy, and are flushed.

The nurse is giving medication instructions to a client who is receiving phenytoin for epilepsy. Which instruction should the nurse include to promote adherence to the medication? 1. Discuss the self-limiting nature of epilepsy. 2. Explain how nonadherence does not account for treatment failure. 3. Involve one other person only in promoting adherence to prevent confusion. 4.Monitor plasma medication levels to provide information about compliance.

Correct answer: 4 Rationale: Epilepsy is a chronic disease that requires regular and continuous therapy. It is not self-limiting, and nonadherence to the medication regimen results in treatment failure. Family and friends should be involved in the treatment regimen to help promote compliance. Monitoring plasma medication levels helps to provide information about adherence and can promote coaching and enhance compliance.

A client with vascular headaches is taking ergotamine. The home health nurse should periodically assess him or her for which finding? 1. Hypotension 2. Constipation 3. Dependent edema 4.Cool, numb fingers and toes

Correct answer: 4 Rationale: Ergotamine can produce vasoconstriction. The nurse periodically assesses for hypertension; cool, numb fingers and toes; muscle pain; and nausea and vomiting. This medication does not cause hypotension, constipation, or dependent edema.

The nurse notes that a client taking ergotamine tartrate is having the intended effects of therapy if the client states relief from which symptom? 1. Cough 2. Diarrhea 3. Backache 4.Headaches

Correct answer: 4 Rationale: Ergotamine tartrate is used to stop an ongoing migraine attack; it also is used to treat cluster headaches. The other options are unrelated to the use of this medication.

A client with trigeminal neuralgia tells the nurse that acetaminophen is taken daily for the relief of generalized discomfort. Which laboratory value would indicate toxicity associated with the medication? 1. Sodium level of 140 mEq/L (140 mmol/L) 2. Platelet count of 400,000 mm3 (400 × 109/L) 3. Prothrombin time of 12 seconds (12 seconds) 4.Direct bilirubin level of 2 mg/dL (34 mcmol/L)

Correct answer: 4 Rationale: In adults, overdose of acetaminophen causes liver damage. The correct option is an indicator of liver function and is the only option that indicates an abnormal laboratory value. The normal direct bilirubin level is 0.1 to 0.3 mg/dL (1.7 to 5.1 mcmol/L). The normal sodium level is 135 to 145 mEq/L (135 to 145 mmol/L). The normal prothrombin time is 11 to 12.5 seconds (11 to 12.5 seconds). The normal platelet count is 150,000 to 400,000 mm3 (150 to 400 × 109/L).

A client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client should be questioned about the use of which medication? 1. Diuretics 2. Antibiotics 3. Antilipemics 4.Decongestants

Correct answer: 4 Rationale: In the client with benign prostatic hyperplasia, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. These medications lessen the voluntary ability to contract the bladder. The client should be questioned about the use of these medications if he has urinary retention. Diuretics increase urine output. Antibiotics and antilipemics do not affect ability to urinate.

The nurse is caring for a client with an exacerbation of multiple sclerosis. Which medication(s) will the nurse expect to be prescribed to hasten recovery from the exacerbation? 1. Carbamazepine and phenytoin by mouth 2. Lioresal by mouth and diazepam intravenously 3. Phenytoin intravenously, then tapered to oral route 4.Methylprednisolone and cyclophosphamide intravenously

Correct answer: 4 Rationale: Intravenous methylprednisolone or adrenocorticotropic hormone in combination with cyclophosphamide may be prescribed to accelerate recovery from an exacerbation of multiple sclerosis. Carbamazepine may be prescribed for trigeminal neuralgia, and phenytoin may be prescribed to control seizures. Lioresal and diazepam are used to treat muscle spasticity.

The nurse is performing an admission assessment on a client who has a history of glaucoma and uses latanoprost eye drops. Which assessment finding would indicate a side/adverse effect of these eye drops? 1. Irregular pulse 2. Periorbital edema 3. Elevated blood pressure 4.Brown pigmentation of the iris

Correct answer: 4 Rationale: Latanoprost is a topical medication used to lower intraocular pressure in clients with open-angle glaucoma and ocular hypertension. The most significant side/adverse effect is heightened brown pigmentation of the iris. Other side effects include blurred vision, burning, stinging, conjunctival hyperemia, and punctate keratopathy. The heightened pigmentation does not progress further once the medication is discontinued but does not regress. The other options are not noted with this medication.

When teaching a client with glaucoma about the effects of a miotic medication, the nurse should tell the client that the medication will produce which effect? 1. Reshape the lens to eliminate blurred vision 2. Dilate the pupil to reduce intraocular pressure 3. Interrupt the drainage of aqueous humor from the eye 4.Lower intraocular pressure and improve blood flow to the retina

Correct answer: 4 Rationale: Miotics are used to lower the intraocular pressure, which then increases blood flow to the retina. This in turn decreases retinal damage and loss of vision. Miotics cause a contraction or constriction of the ciliary muscle and widen the trabecular meshwork. The other options are incorrect.

Nitrofurantoin is prescribed for a client with a urinary tract infection. The client contacts the nurse and reports a cough, chills, fever, and difficulty breathing. The nurse should make which interpretation about the client's complaints? 1. The client may have contracted the flu. 2. The client is experiencing anaphylaxis. 3. The client is experiencing expected effects of the medication. 4.The client is experiencing a pulmonary reaction requiring cessation of the medication.

Correct answer: 4 Rationale: Nitrofurantoin can induce 2 kinds of pulmonary reactions: acute and subacute. Acute reactions, which are most common, manifest with dyspnea, chest pain, chills, fever, cough, and alveolar infiltrates. These symptoms resolve 2 to 4 days after discontinuing the medication. Acute pulmonary responses are thought to be hypersensitivity reactions. Subacute reactions are rare and occur during prolonged treatment. Symptoms (e.g., dyspnea, cough, malaise) usually regress over weeks to months following nitrofurantoin withdrawal. However, in some clients, permanent lung damage may occur. The remaining options are incorrect interpretations.

The ambulatory care nurse is providing instructions to a client with a urinary tract infection (UTI) being started on nitrofurantoin. The nurse should provide the client with which information? 1. It can cause urinary retention. 2. It will cause the urine to become clear. 3. The sun should be avoided because it is a sulfa-based medication. 4.If taken with meals, it will help decrease the risk for gastrointestinal (GI) upset.

Correct answer: 4 Rationale: Nitrofurantoin is a urinary antiseptic (not a sulfa-based medication) and should be taken with meals to decrease the incidence of GI side effects. Food or milk decreases the GI upset. The medication could cause the urine to turn rust yellow or brown. It does not cause urinary retention.

Which medication, if prescribed for the client with glaucoma, should the nurse question? 1. Betaxolol 2. Pilocarpine 3. Erythromycin 4.Atropine sulfate

Correct answer: 4 Rationale: Options 1 and 2 are miotic agents used to treat glaucoma. Option 3 is an antiinfective medication used to treat bacterial conjunctivitis. Atropine sulfate is a mydriatic and cycloplegic (also anticholinergic) medication, and its use is contraindicated in clients with glaucoma. Mydriatic medications dilate the pupil and can cause an increase in intraocular pressure in the eye.

The nurse is speaking with a client taking phenytoin for seizure control. The client states that she has started using birth control pills to prevent pregnancy. Which would be an important point for the nurse to emphasize to the client? 1.Oral contraceptives decrease the effectiveness of phenytoin. 2.Severe gastrointestinal side effects can occur when phenytoin and oral contraceptives are taken together. 3.There is an increased risk of thrombophlebitis when phenytoin and oral contraceptives are taken at the same time. 4.Phenytoin may decrease the effectiveness of birth control pills, and additional measures should be taken to avoid pregnancy.

Correct answer: 4 Rationale: Phenytoin enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. The nurse should tell the client to alert the health care provider about the use of birth control pills so that counseling may be provided about alternative birth control methods. The other options are incorrect.

A client is receiving phenytoin. To monitor for side and adverse effects of this medication, the nurse assesses the results of which laboratory test? 1. Serum sodium 2. Serum potassium 3. Blood urea nitrogen 4.Complete blood count (CBC)

Correct answer: 4 Rationale: Phenytoin is an anticonvulsant used to treat seizure disorders. The nurse monitors the CBC because hematological effects of this therapy include aplastic anemia, agranulocytosis, leukopenia, and thrombocytopenia. Other test results that warrant monitoring include serum calcium levels, urinalysis, and hepatic and thyroid function tests. Electrolyte results and renal function tests are not a concern with this medication.

Propofol is being administered to induce sedation in a client who is intubated and is being mechanically ventilated. The nurse should monitor for which adverse effect during infusion of the medication? 1. Itching 2. Skin redness 3. Elevated triglyceride levels 4.Signs of respiratory depression

Correct answer: 4 Rationale: Propofol is an anesthetic agent that is used to provide continuous sedation in a client receiving mechanical ventilation. Adverse effects include respiratory depression and cardiovascular depression. Itching, skin redness, and elevated triglyceride levels are possible side effects, not adverse effects.

A client with myasthenia gravis has difficulty chewing and has received a prescription for pyridostigmine. The nurse should check to see that the client takes the medication at what time? 1. With meals 2. Between meals 3. Just after meals 4.30 minutes before meals

Correct answer: 4 Rationale: Pyridostigmine is a cholinergic medication used to increase muscle strength in the client with myasthenia gravis. For the client who has difficulty chewing, the medication should be administered 30 minutes before meals to enhance the client's ability to eat. The times noted in the remaining options will not be helpful to the client.

A client with Parkinson's disease has begun therapy with levodopa/carbidopa. The nurse determines that the client understands the action of the medication if he or she verbalizes that results may not be apparent for how long? 1. 1 week 2. 24 hours 3. 2 to 3 days 4.2 to 3 weeks

Correct answer: 4 Rationale: Signs and symptoms of Parkinson's disease usually begin to resolve within 2 to 3 weeks of starting therapy, although in some clients marked improvement may not be seen for up to 6 months. The client needs to understand this concept to aid in compliance with medication therapy.

Tacrolimus is prescribed for a client who underwent a kidney transplant. Which instruction should the nurse include when teaching the client about this medication? 1. Eat at frequent intervals to avoid hypoglycemia. 2. Take the medication with a full glass of grapefruit juice. 3. Change positions carefully due to risk of orthostatic hypotension. 4.Take the oral medication every 12 hours at the same times every day.

Correct answer: 4 Rationale: Tacrolimus is a potent immunosuppressant used to prevent organ rejection in transplant clients. It is important that the medication be taken at 12-hour intervals to maintain a stable blood level to prevent organ rejection. Adverse effects include hyperglycemia and hypertension, so the client does not eat frequently to avoid hypoglycemia or use precautions to avoid orthostatic hypotension. Tacrolimus is metabolized through the cytochrome P450 system, so grapefruit juice is not allowed.

Tamsulosin hydrochloride has been prescribed for a client with benign prostatic hypertrophy (BPH). How should the nurse instruct the client to take the medication? 1. With breakfast 2. With a glass of milk 3. With the lunchtime meal 4.Thirty minutes after a meal

Correct answer: 4 Rationale: Tamsulosin hydrochloride is a medication that will relieve mild to moderate manifestations of BPH and improve urinary flow rates. The medication should be administered 30 minutes after meals because food decreases the peak plasma concentration and lengthens the time to achieve peak plasma medication concentrations. Therefore, options 1, 2, and 3 are incorrect.

The nurse is caring for a client in the emergency department who has been diagnosed with Bell's palsy. The client has been taking acetaminophen, and acetaminophen overdose is suspected. Which antidote should the nurse prepare for administration if prescribed? 1. Pentostatin 2. Auranofin 3. Fludarabine 4.Acetylcysteine

Correct answer: 4 Rationale: The antidote for acetaminophen is acetylcysteine. The normal therapeutic serum level of acetaminophen is 10 to 20 mcg/mL (40 to 79 mcmol/L). A toxic level is higher than 50 mcg/mL (200 mcmol/L), and levels higher than 100 mcg/mL (400 mcmol/L) could indicate hepatotoxicity. Auranofin is a gold preparation that may be used to treat rheumatoid arthritis. Pentostatin and fludarabine are antineoplastic agents.

The nurse teaching a mother how to administer ear drops to an infant tells the mother to pull the child's ear in which direction? 1. Up and back and direct the solution onto the eardrum 2. Down and forward and direct the solution onto the eardrum 3. Up and forward and direct the solution toward the wall of the canal 4.Down and back and direct the solution toward the wall of the canal

Correct answer: 4 Rationale: The ear is pulled down and straight back in a child younger than 3 years. The infant is turned onto the side, with the affected ear uppermost. The nurse pulls down and back on the earlobe with the nondominant hand while resting the wrist of the dominant hand on the infant's head. The medication is directed toward the wall of the canal rather than onto the eardrum. The infant should lie with the affected ear uppermost for 10 to 15 minutes to retain the solution. In an adult or a child older than 3 years, the ear is pulled up and back to straighten the auditory canal.

The nurse is providing teaching for a client prescribed ciprofloxacin for a urinary tract infection. Which statement made by the client indicates that there is a need for further teaching? 1."I can take the ciprofloxacin with or without food." 2."I'll need to wear sunscreen and protective clothing while taking ciprofloxacin." 3."I'll need to contact my health care provider if I develop any white patches in my mouth." 4."If I develop any tendon pain while taking ciprofloxacin, exercise should help to decrease the pain."

Correct answer: 4 Rationale: The health care provider should be contacted immediately if the client develops any tendon pain, swelling, or inflammation because of the risk of tendon rupture. Exercise is contraindicated until tendon rupture is ruled out. Fluorquinolones such as ciprofloxacin need to be discontinued at the first sign of any tendon pain, swelling, or inflammation. Ciprofloxacin can be taken with or without food, can cause photosensitivity, and can increase the risk for oral Candida infections.

The nurse is teaching a mother to instill drops in her infant's ear. The nurse explains that to give the ear drops correctly, the mother needs to take which action? 1. Pull up and back on the earlobe and direct the solution toward the eardrum. 2. Pull down and back on the auricle and direct the solution toward the eardrum. 3. Pull up and back on the auricle and direct the solution toward the wall of the canal. 4.Pull down and back on the earlobe and direct the solution toward the wall of the canal.

Correct answer: 4 Rationale: The infant should be turned onto the side, with the affected ear uppermost. With the wrist of the nondominant hand resting on the infant's head, the mother pulls down and back on the earlobe and aims the solution at the wall of the canal, rather than directly onto the eardrum. In the adult, the auricle is pulled up and back to straighten the auditory canal.

A client with glaucoma is given a prescription for a pilocarpine ocular system. The nurse plans to provide which instruction to the client on how to use the medication? 1. Apply ½ inch into the eye at bedtime. 2. Apply one drop of the solution four times a day. 3. Remove and replace the ocular system every 48 hours. 4.Check the eye each morning to make sure that the system is in place.

Correct answer: 4 Rationale: The pilocarpine ocular system has a bilayered membrane surrounding a reservoir of pilocarpine solution. The tiny unit, which is placed in the conjunctival sac, slowly releases medication. The unit should be changed once a week. Because the unit may fall out during sleep, the client should check the eye each morning for its presence.

The health care provider prescribes the instillation of mydriatic eye drops to both eyes of a client. The nurse administers the eye drops and monitors the client for an effective response from the medication, as indicated by which response? Click on the image to indicate your answer.

Correct answer: 4 Rationale: The top figure identifies unequal pupil size. This finding may be normal in some individuals, but the client with unequal pupil size should be assessed for central nervous system disease. The figure that is second from the top identifies constricted pupils. The third figure from the top identifies a unilateral dilated pupil, indicating cranial nerve III damage.

A client is prescribed trimethoprim-sulfamethoxazole for a recurrent urinary tract infection (UTI). The nurse should give the client which instruction regarding this medication? 1. Expect rashes or skin changes as a result of therapy. 2. Discontinue the medication when symptoms subside. 3. Take most doses early in the day when fluid intake is greatest. 4.Take each dose with 8 oz (235 mL) of water, and drink extra water each day.

Correct answer: 4 Rationale: Trimethoprim-sulfamethoxazole is a combination medication. The client takes each dose with 8 oz (235 mL) of water and drinks several extra glasses of water each day. The client should space doses evenly around the clock for stable blood levels and should take the medication for the full course of therapy. The client should report rashes or other skin changes, which could indicate an allergy to sulfa.

The nurse is reviewing the results of a test on a sample drawn from a child who is receiving carbamazepine for the control of seizures. The results indicate a serum carbamazepine level of 10 mcg/mL (42.33 mmol/L). The nurse analyzes the results and anticipates that the health care provider (HCP) will note which prescription? 1. Discontinuation of the medication 2. An increased dose of the medication 3. A decreased dose of the medication 4.Continuation of the presently prescribed dosage

Correct answer: 4 Rationale: When carbamazepine is administered, blood levels need to be tested periodically to check for the child's absorption of the medication. The amount of the medication prescribed is based on the blood level achieved. Carbamazepine's therapeutic serum range is 6 to 12 mcg/mL (34 to 51 mmol/L). Therefore, the nurse anticipates that the HCP will continue the presently prescribed dosage.