NCLEX pharmacology 5 of 5

Metronidazole / flagyl

Antimicrobial

What drug interaction is important to know about Lithium Carbonate?

DO NOT give Lithium with diuretics, as it can cause the kidney to retain too much lithium, resulting in subsequent toxicity.

What suffix is typically associated with 2nd generation antihistamines?

"adine", for example: loratadine (Claritin) fexofenadine (Allegra) desloratadine (Clarinex) cetirizine (ZyrTEC)

IM Syringe Sizes

1-1.5 inches long 19-22 gauge

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

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

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

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

Macrodrip

10-20 gtt/ml

How long does it take Insulin Lispro (Humalog) to begin acting?

15 minutes; peak 30-90 minutes; duration of activity is less than 5 hours

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

2 tablets

Intradermal Syring Sizes

5-15 degree angle 1/4-5/8 Inch 25-29 gauge

the appropriate size needle for subcutaneanous injections

25 gauge, 5/8 inch needle

Subq Syringe Sizes

3/8 inch 1/2 inch 5/8 inch

When do the primitive reflexes like the tonic neck, Moro, and palmar grasp reflexes disappear in newborn development?

6 months

a. Perform pregnancy test.

A 20-year-old client is starting isotretinoin (Accutane) therapy. What is an essential nursing intervention for this client? a. Perform pregnancy test. b. Assess sputum cultures. c. Make sure IV is patent. d. Force fluids.

d. finasteride

A 55-year-old man has a chief complaint: "I'm going bald." Which drug is used to treat male pattern baldness? a. dexamethasone b. PABA c. minoxidil d. finasteride

decadron

A drug in the steriod family that is used to decrease swelling in the brain.

synthroid

A medication used to treat hypothyroidism

tigan

A medication used to treat nausea and vomiting

Morphine

A respiratory depressant. It should be withheld if the respirations are below 10

What ECG change is suggestive of hyperkalemia?

A tall peaked T wave is a finding in hyperkalemia.

ace inhibitors

ACTION: prevent the conversion of angiotensin I to angiotensin II in the lungs USES: CHF, HTN , usually end in PRIL

Lidocaine / lidoderm (patch), xylocaine (injection)

Anesthetic

Glimepiride / amaryl

Antidiabetic

Glyburide + Metformin / glucovance

Antidiabetic

Glyburide / diabeta, glynase, micronase

Antidiabetic

Metformin / glucophage

Antidiabetic

Diphenoxylate, Atropine / lomotil

Antidiarrheal

Vitamin K

Antidote for Coumadin

Fluconazole / diflucan

Antifungal

Ketoconazole / nizoral

Antifungal

Ezetimibe / zetia

Antihyperlipidemic

Ezitimibe, Simvastatin / vytorin

Antihyperlipidemic

Fenofibrate / tricor

Antihyperlipidemic

Gemfibrozil / lopid

Antihyperlipidemic

Omega-3/Fish Oil / lovaza

Antihyperlipidemic

Rosuvastatin / crestor

Antihyperlipidemic

Benazepril / lotensin

Antihypertensive

Bisoprolol / zebeta

Antihypertensive

Carisoprodol / vasotec

Antihypertensive

Diltiazem / cardizem

Antihypertensive

Doxazosin / cardura

Antihypertensive

Enalapril / vasotec

Antihypertensive

Losartan/HCTZ / Hyzaar

Antihypertensive

Nifedipine / adalat, procardia

Antihypertensive

Olmesartan/HCTZ / benicar HCT

Antihypertensive

Subq Injection Sites

Abdomen Upper Hips Upper Back Lateral Thighs Lateral Upper Arm

Diovan (HCTZ & Valsortan)

ARBS Combo is used to treat HBP.

When would you instill saline for tracheostomy suctioning?

According to evidence-based practice, the use of saline is no longer recommended during routine suctioning. However, if a client is suspected to have a mucous plug in the larger bronchials or in an artificial airway (such as a tracheostomy tube), the nurse can instill sterile normal saline to thin and loosen the plug or viscous secretions.

Enalopril (Vasotec)

Ace Inhibitor-pril Treat HBP (HTN) and CHF

Captopril (Capoten

Ace Inhibitor-pril Used to treat HBP (HTN), CHF, kidney problems caused by diabetes and to imrpove survival after a heart attack.

Why do newborns born to diabetic mothers sometimes experience hypoglycemia?

After delivery, high glucose levels which crossed the placenta to the fetus are suddenly stopped. The newborn continues to secrete insulin in anticipation of the glucose. When oral feedings begin, the newborn will adjust insulin production within a day or two.

Ramipril / altace

Antihypertensive

HOw long after surgery can a gastronomy tube be used to instill feedings?

After surgery for gastrostomy tube placement, the catheter is left open and attached to gravity drainage of air & stomach contents for 24 hours or more.

Terazosin / hytrin

Antihypertensive

What is Propecia typically prescribed for?

Allopecia Benign Prostatic Hypertrophy Agent

Minipress (Prazosin)

Alpha Adrenergic Blocker Relaxes your veins and arteries so that blood can more easily pass through them. Treat HBP and HTN.

Triamterene + HCTZ / dyazide (capsule), maxzide (tablet)

Antihypertensive

Valsartan / diovan

Antihypertensive

Verapamil / verelan, calan, isoptin

Antihypertensive

Lisinopril / prinivil, zestril

Antihypertensive (ACE inhibitor)

Why is Aluminum hydroxide (Amphojel) given?

Aluminum binds phosphates that tend to accumulate in the client with chronic renal failure due to decreased filtration capacity of the kidney. Antacids such as Amphojel or Basogel are commonly used to accomplish a decreased serum phosphate.

What is cloNIDine (Catapres) ?

An anti-hypertensive

Acetaminophen (APAP) / tylenol

Analgesic

Aspirin (ASA) / ecotrin, bayer

Analgesic

Butalbital + APAP + Caffeine / fioricet

Analgesic

Meperdine / demerol

Analgesic

Tramadol + APAP / ultracet

Analgesic

Tramadol / ultram

Analgesic

Fentanyl / duragesic

Analgesic (Topical)

Phenazepyridine / pyridium, AZO standard (OTC)

Analgesic (Urinary)

Hydrocodone + Acetaminophen / lortab, vicodin, lorcet

Analgesic, Opiate

Maalox

Anatacids

Ativan

Anti anxiety

Equanil

Anti anxiety

Librium

Anti anxiety

Vistaril

Anti anxiety

Tiotropium / spiriva

Anticholinergic

Warfarin / coumadin

Anticoagulant (Blood Thinner)

Divalproex / depakote

Anticonvulsant

Gabapentin / neurontin

Anticonvulsant

Lamotrigene / lamictal

Anticonvulsant

Levetiracetam / keppra

Anticonvulsant

Azithromycin / zithoromax, zmax

Antiobiotic (Macrolides)

Ciprofloxaxin / cipro

Antiobiotic (Quinolone)

Olanzapine / zyprexa

Antipsychotic

Ibandronate / boniva

Antiresorptive

Risedronate / actonel

Antiresorptive

Meclizine / antivert

Antivertigo

Acyclovir / zovirax

Antiviral

The nurse takes a medication to a client, and the client tells the nurse to take it away because she is not going to take it. The nurse's first action should be to:

Ask the client's reason for refusal

The nurse is administering a sustained-release capsule to a new client. The client insists that he cannot swallow pills. The best course of action for the nurse is to:

Ask the physician to change the order

Atropine: What checks do you do before giving this drug ?

BP

Metoprolol (Lopressor)

Beta Blocker-olol Treat angina, HTN, prevent and treat heart attack

Atenolol (Tenormin)

Beta Blocker-olol Used to treat angina, HTN, and treat/prevent heart attack

Coreg (Carvedilol)

Beta Blocker-olol Used to treat heart failure, HTN, post heart attack.

Inderal (Propranolol)

Beta Blocker-olol Used to treat tremors-angina, HTN, heart rhythm disorders, open heart circulatory conditions, prevent heart attack and reduce sensitivity and frequency of migraine H/A.

Norvasc (Amlodipine)

CCB (-pine) Relaxes (widens) blood vessels and improves blood flow. Treat HBP, chest pain, and other conditions caused by coronary artery disease. Used for adults and children > 6 y.o.

Cardizem (Dilitazem)

CCB (-pine) Relaxes muslces of heart and blood vessels. Treat HTN, angina, and certain heart rhythm disorders.

Amlodipine / norvasc

Calcium channel blocker

The nurse is having difficulty reading a physician's order for a medication. The nurse knows the physician is very busy and does not like to be called. The nurse should

Call the physician to have the order clarified

Diamox (Acetazolamide)

Carbonic Anhydrase Inhibitor Used to treat altitude sickness, CHF, and seizures.

Clonidine / catapres

Cardiovascular

Clopidogrel / plavix

Cardiovascular

Digoxin / lanoxin, digotek

Cardiovascular

Isosorbide Mononitrate / imdur, ISMO

Cardiovascular

Nitroglycerin / NitroStat

Cardiovascular

Carvedilol / coreg

Cardiovascular (Beta blocker)

Aldoment (Methyldopa) & Catapres (Clonidine)

Central Acting Lowers BP by decreasing levels of certain chemicals in blood. Allows blood vessels to relax and heart to beat more slowly and easily.

cefaclor (Ceclor)

Cephalosporins

cefazolin (Ancef)

Cephalosporins

cefoxitin (Mefoxin)

Cephalosporins

ceftriaxone (Rocephin)

Cephalosporins

cephalexin (Keflex)

Cephalosporins

ANTI-PARKINSONIAN

Cogentin: Sinemet:

Anticholinergics contraindication

Contraindicated with glaucoma, paralytic ileus, BPH

Clobestasol / Temovate

Corticosteroid

Dexamethasone / decadron

Corticosteroid

Mometasone / nasonex

Corticosteroid

Beta Blockers

Decrease the activity of the heart. They block sympathetic stimulation of the heart and reduce systolic pressure, heart rate, cardiac contractility and output, so decrease myocardial oxygen demand and increase exercise tolerance. -Used to treat angina, control abnormal heart rhythms an to reduce HBP. -"olol"

Absorption Rates

Deltoid, and vastus lateralis- 2mL Gluteal- up to 5mL

CARDIOVASCULAR

Digoxin (Lanoxin): Signs of toxicity: Pt will complain of visual change in colors. They would also complain of loss of appetite.

ANTI-CONVULSANTS:

Dilantin: Causes gum hyperplasia. Advice client to visit dentist frequently

d. Tachycardia

Discharge teaching to a client receiving a beta-agonist bronchodilator should emphasize reporting which side effect? a. Hypoglycemia b. Nonproductive cough c. Sedation d. Tachycardia

Aspirin

Do not give together with other anticoagulants. Stop taking Aspirin some days before surgery. Do not give to children with viral infection(Reye syndrome)

MAOIs Nursing Considerations

Do not take with cold medications or CNS stimulates

Anticonvulsants Nursing Considerations

Don't d/c abruptly, Caution with use of meds that lower seizure thresholds (ex. MOAIs, antipyscotic) No alcohol Urine is pink/reddish

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

Dorsogluteal

Sinemet:

Drug is effective when tremors are not observed

ANALGESICS

Drugs used to relieve or eliminate pain: Aspirin NSAID's e.g. Ibuprofen— Morphine

If a patient has thrombophlebitis on one leg, what should your immediate action be for the leg?

Elevate it on a pillow

What are your most common ACE Inhibitors? What is the most common side effect of these medications? How should the pills be taken?

Enalapril & Lisinopril SE: cough Take on an empty stomach 1 hour prior to a meal or 2 hours after a meal

A client is transitioning from the hospital to the home environment. A home care referral is obtained. What is a priority, in relation to safe medication administration, for the discharge nurse?

Ensure the home care agency is aware of medication and health teaching needs.

Sildenafil / viagra

Erectile Dysfunction

Tadalifil / cialis

Erectile Dysfunction

Varedenfil / levitra

Erectile Dysfunction

Most medication errors occur when the nurse:

Fails to follow routine procedures

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

Follow facility policy or drug manufacturer's directions

Metoclopramide / reglan

Gastrointestinal

IM Injection Sites

Glueteal (Buttocks), Deltoid, Vastus Lateralis (thigh)

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

Go recheck the medication order, taking along the medication.

MAOI inhibitors:

Have dangerous food-drug interactions. Food with Tyramine should be avoided. For example: aged cheese, wine etc.

Angiotensin 2 receptor blockers (ARBS)

Help relax blood vessels which lowers BP and makes it easier for your heart to pump blood.

Angiotensin-Converting Enzyme (ACE) Inhibitors

Help relax blood vessels.

Conjugated Estrogen / premarin

Hormone Replacement

Levothyroxine / synthroid, levoxyl, levothroid

Hormone Replacement

DIURETICS

Hydrochlothiazide Lasix Aldactone

Zolpidem / ambien

Hypnotic (sleep aid)

Eszopiclone / lunesta

Hyponotic

WHat lab value should be monitored for patients taken Warfarin?

INR and Prothrombin time

When should the nurse know to hold a dose of Digoxin?

If the patient's HR is <60bpm

Cyclosporine / restasis

Immunosuppressant

b. Fluid volume deficit related to nausea and vomiting

In developing a plan of care for a client receiving an antihistamine antiemetic agent, which nursing diagnosis would be of highest priority? a. Knowledge deficit regarding medication administration b. Fluid volume deficit related to nausea and vomiting c. Risk for injury related to side effects of medication d. Alteration in comfort related to nausea and vomiting

What is perhaps the most dangerous complication of unfractionated heparin therapy?

Life-threatening thrombocytopenia

Anticoagulant Coumadin Nursing Considerations

Monitor PT Normal 9-12 sec Therapeutic level 1.5 times control Antagonist- Vit K vitC dec coumadin, vitE inc. Monitor for bleeding Give PO

Antacids Nursing Consideration

Interferes with absorption of antibiotics, iron preps, INH, oral contraceptives Monitor bowel functions

How does Robitussin work? How should you give it?

It liquifies secretions in the respiratory tract by decreasing the surface tension. Give with plenty of water, and tell the pt. to avoid dairy and caffeine while On the med.

When identifying a new client before administering medications, the nurse asks the client to state his name. The client does not state the correct name. The nurse asks again, and the client states still another name. What is the nurse's next action?

Investigate the client's mental status before administering any further medications.

What is Ethambutol prescribed for and what is a danger of taking this med?

It is a drug prescribed in combination with Isoinazid and Rifampin (and Streptomycin) for TB treatment. It can adversely affect the eyes, and patients on this med should get regular eye exams.

The nurse is administering an intramuscular (IM) injection. The Z-track method is recommended for IM injections because:

It minimizes local skin irritation by sealing the medication in muscle tissue.

What is keratitis and how do you prevent it?

Keratitis is eye inflammation from a corneal ulcer or abrasion. Keratitis is caused by exposure to the air without the normal blink. It requires regular applications of moisturizing ointment to the exposed cornea and a plastic bubble shield or eye patch.

Lithium Carbonate:.

Know therapeutic range (0.8 to 1.2mEq). Also know symptoms of toxicity. Adequate fluid and salt intake is important

Distinguish between low molecular weight heparin and unfractionated heparin?

LMWH action: blocks action of Factors Xa and Ila without appreciably affecting thrombin or prothrombin Un-fractionated heparin: inhibits conversion of prothrombin to thrombin thus preventing fibrin formation

Docusate Sodium / colace

Laxative (stool softener)

PSYCHOTROPICS

Lithium Carbonate:. MAOI inhibitors: Disulfiram (Antabuse)

What type of diet should patients on a glucocorticoid be on?

Low-sodium, possibly calorie restricted.

Marplan

MAOIs hypertensive crisis when taken with tyramine

Nardil

MAOIs hypertensive crisis when taken with tyramine

Parnate

MAOIs hypertensive crisis when taken with tyramine (stiff neck, HA, palpatation, sweating)

clindamycin (Cleocin)

Macrolides (hepatotoxicity), confusion

erythromycin

Macrolides (hepatotoxicity), confusion

ANTIHYPERTENSIVE (PRE-ECLAMPSIA)

Magnesium Sulfate: Monitor for deep tendon reflex and respiratory depression

Folic Acid / folvite

Mineral supplement

Mineral/Electrolyte

Mineral/Electrolyte Potassium Chloride -Tx of hypokalemia Beating of the heart Don't stop abruptly Dilute

Anticoagulant Heparin Nursing Considerations

Monitor clotting time or PTT Normal 20-45 sec Therapeutic level 1.5-2.5 times control Antagonist- protmaine sulfate Give SC or IV - Do NOT aspirate or Massage!

Hydrochlothiazide

Monitor potassium levels

Lasix

Monitor potassium levels

Heparin:

Monitor pt's lab work-PTT. Antidote is protamine sulfate

Carisoprodol / soma

Muscle Relaxant

Celecoxib / celebrex

NSAID

Diclofenac / cataflam

NSAID

Ibuprofen / motrin, advil

NSAID

Meloxicam / mobic

NSAID

Nabumetone Relafen

NSAID

Naproxen / aleve, naprosyn, anaprox

NSAID

To what medication class does Procainamide belong to? What foods should be avoided while taking this medication?

Na-channel blocking agents. These drugs are "antidysrhythmics" AVOID citrus juices, antacids, and milk products

ANTIDOTES

Narcan Calcium Gluconate Vitamin K

Amphetamine + Dextroamphetamine / adderall

Neurologic / ADHD

Atometine / strattera

Neurologic / ADHD

Lisdexamfetamine / vyvanse

Neurologic / ADHD

Methylphenidate / concerta, ritalin

Neurologic / ADHD

Isosorbide

Nitrates Dilates blood vessels. Treatment of angina. Sublingual tablets

Can patients take Nitro 24 hours a day?

No. They must maintain a 6 to 8 hour nitrate-free period every 24 hours after acute episode to avoid tolerance.

a. Avoid sunlight. c. Monitor CBC, glucose, and lipids. d. Do not breastfeed or give blood.

Nursing implications for health teaching with clients taking isotretinoin include which implications? (Select all that apply.) a. Avoid sunlight. b. Monitor weight c. Monitor CBC, glucose, and lipids. d. Do not breastfeed or give blood.

Raloxifene / evista

Osteoporitic

Alendronate / fosamax

Osteoporitic

-mycin AE

Ototoxicity, nephrotoxicity

MATERNITY DRUGS

Oxytocin: Assess uterus frequently for tetanic contraction.

Ropinirole / Requip

Parkinsons

Penicillin

Pen-VK

Amoxicillin (Amoxil)

Penicillin (AE: stomatitis)

Amoxicillin/clavulanate (Augmentin)

Penicillin (AE: stomatitis)

Ampicillin

Penicillin (AE: stomatitis)

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

Phlebitis

Kcl

Potassium chloride, it is often given to cardiac patients whose potassium is depleted by diuretic medications, such as Lasix.

Aldactone

Potassium sparing

Aldactone is often prescribed for children with CHF because

Potassium sparing diuretic

ANTIINFLAMMATORY

Predisone: Causes Cushing like symptoms. Common side effects are immunosupression(monitor client for infection), hyperglycemia

What is the antidote to Heparin?

Protamine sulfate

182.) A client with angina pectoris is experiencing chest pain that radiates down the left arm. The nurse administers a sublingual nitroglycerin tablet to the client. The client's pain is unrelieved, and the nurse determines that the client needs another nitroglycerin tablet. Which of the following vital signs is most important for the nurse to check before administering the medication? 1. Temperature 2. Respirations 3. Blood pressure 4. Radial pulse rate

Rationale: Nitroglycerin acts directly on the smooth muscle of the blood vessels, causing relaxation and dilation. As a result, hypotension can occur. The nurse would check the client's blood pressure before administering the second nitroglycerin tablet. Although the respirations and apical pulse may be checked, these vital signs are not affected as a result of this medication. The temperature also is not associated with the administration of this medication.

134.) A nurse reinforces instructions to a client who is taking levothyroxine (Synthroid). The nurse tells the client to take the medication: 1. With food 2. At lunchtime 3. On an empty stomach 4. At bedtime with a snack

Rationale: Oral doses of levothyroxine (Synthroid) should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast. **Note that options 1, 2, and 4 are comparable or alike in that these options address administering the medication with food.**

Anti-Platelet

Reduce blood clotting in an artery, vein, or heart.

Alpha-Adrenergic Blockers

Relax certain muslces and help small blood vessels remain open. They work by keeping the hormone norepinephrine from tightening the muscles in the walls of smaller arteries and veins. Blocking that effect causes the vessels to remain open and relaxed. This imporves blood flow and lowers BP.

Albuterol Ipratropium / combivent

Respiratory

Chlorpheniramine + / tussionex

Respiratory

Fluticasone / flonase

Respiratory

Fluticasone, Salmeterol / advair

Respiratory

Montlukast / singulair

Respiratory

Albuterol / ventolin, ProAir, proventil

Respiratory (Bronchodilator)

Guaifenesin / robitussin, mucinex, cheritussin

Respiratory (Expectorant)

Insulin Rotation Sites

Rotate clockwise

Paxil

SSRI (AE: anxiety, GI upset, change in appetite and bowel function, urinary retention)

Diazepam / valium

Sedative / Antianxiety (Benzodiazepine)

Temazepam / restoril

Sedative / Sleep Aid (Benzodiazepine)

In order to prevent aspirin toxicity, what lab value should be monitored?

Serum albumin. When highly protein-bound drugs are administered to clients with low serum albumin (protein) levels, excess free (unbound) drug can cause exaggerated and dangerous effects. Aspirin is a protein-bound drug.

Central Acting

Signal your brain and nervous system to relax blood vessels.

Carbonic Anhydrase Inhibitor

Similar to diuretic.

How long should a client with GERD sit upright following a meal? How long before going to bed should the client eat?

Sit upright 2 hours post-meal (allows the stomach to empty) don't eat 2 hours prior to bedtime

Anti-Arrythmic

Slow electrical impulses in the heart so that it can resume its normal rhythm and conduction patterns.

Varenicline / chantix

Smoking Cessation

What are some examples of thrombolytic agents? What problems are these used for?

Streptokinase Urokinase Used in case of clots associated with : myocardial infarction deep venous thrombosis pulmonary embolism thrombosed intravenous catheters

A nursing student takes a client's antibiotic to his room. The client asks the nursing student what it is and why he should take it. The nursing student's reply includes the following information:

The name of the medication and a description of its desired effect

acetyl sulfisoxazole (Gantrisin)

Sulfonamides (AE: peripheral neuropathy, crystalluria)

co-trimoxazole (Bactrim)

Sulfonamides (AE: peripheral neuropathy, crystalluria)

sulfasalazine (Azulfidine)

Sulfonamides (AE: peripheral neuropathy, crystalluria)

NSAID's e.g. Ibuprofen

Take with food; contraindicated for people with GI ulcers

doxycycline (Vibramycin)

Tetracyclines (AE: phototoxic reaction)

tetracycline (Panmycin)

Tetracyclines (AE: phototoxic reaction)

The nurse selects the route for administering medication according to:

The prescriber's orders

Where would the nurse palpate the uterine fundus during the period 1-24 hours following delivery?

The uterus should be felt at the level of the umbilicus from about 1 to 24 hours after birth. The fundus (top of the uterus) will fall approximately 1 centimeter (or 1 fingerbreadth) each day for the next 10 days.

RESPIRATORY

Theophylline/Aminophylline: Side effects--Tachycardia

What lab values, following overdose with Tylenol would the nurse expect to follow closely?

Those that indicate liver damage, such as Bilirubin, ALT, and AST.

How many expiratory efforts should the client using a peak flow meter put forth, and which reading do they record?

Three times, record the highest reading of the three.

Why would you take a bile acid sequestrant agent? Name an example.

To increase lipid excretion in stool, and thus lower serum lipids. ex: Questran

amitriptyline (Elavil)

Tricyclics

desipramine (Norpramin)

Tricyclics

imipramine (Tofranil)

Tricyclics

The client is a 40-year-old man who weighs 160 lb and is 5 feet 9 inches tall. The order is for 5 ml of a medication to be given as a deep intramuscular (IM) injection. What size of syringe and gauge and length of needle should the nurse use for best practice?

Two 3-ml syringes, 20- to 23-gauge, 1½-inch needle

What is tylenol #3?

Tylenol + Codeine

Furadantin (nitrofurantoin)

UTI (AE: asthma attacks, diarrhea);

Pyridium

UTI, urinary track analgesic AE: HA, vertigo, change urine color to orange

Tolterodine / detrol

Urinary Anti-Spasmotic

Dutasteide / avodart

Urinary Tract Agent

Finastreride / proscar

Urinary Tract Agent

Disulfiram (Antabuse)

Used for alcohol aversion therapy. Clients started on Disulfiram must avoid any form of alcohol or they would develop a severe reaction. Teach pt to avoid some over-the-counter cough preparations, mouthwash etc.

Anti-Anginal

Used in the treatment of angina pectoris,a s/s of ischemic heart disease.

Epogen:

Used in treating anemia because it increases RBC production.

Amiodarone (Cordanone)

Used to help keep the heart beating normally in people with life threatening heart rhythm disorders of the ventircles. Also used to treat V tach and V fib.

Cogentin:

Used to treat EPS

the antidote for anticoagulants

VITAMIN K

What medication interaction can cause profound hypotension if taken with Nitro?

Viagra Cialis

How exactly does Vitamin C interfere with a Hematest?

Vitamin C interferes with the chemical reaction of the reagent and causes a false negative response, i.e., the test results come back negative even when blood is present in the stool sample.

What is the antidote for warfarin?

Vitamin K

a. Assess for metabolic alkalosis.

What assessment has the highest priority for a client using sodium bicarbonate to treat gastric hyperacidity? a. Assess for metabolic alkalosis. b. Assess for fluid volume deficit. c. Assess for hyperkalemia. d. Assess for hypercalcemia.

a. Administer just before meals.

What is a priority nursing intervention when administering ranitidine (Zantac)? a. Administer just before meals. b. Administer right after eating. c. Administer 1 to 2 hours after meals. d. Administer during meals.

c. Alcohol

When metoclopramide (Raglan) is given for nausea, the client is cautioned to avoid which substance? a. Milk b. MAOIs c. Alcohol d. Carbonated beverages

c. "I should rinse the eye dropper with tap water after each use."

Which statement, made by a client, indicates to the nurse a need for further client teaching regarding proper administration of eye drops? a. "I will put pressure on the inside corner of my eye after I administer the drops." b. "I will be careful not to touch my eye with the dropper." c. "I should rinse the eye dropper with tap water after each use." d. "I will turn my head slightly toward the outside of the eye I am putting the drops in."

What is the antidote for un-fractionated heparin?

protamine sulfate

What is hyrdALAZINE (Apresoline)??

a "centrally acting vasodilator" directly relaxes arteriolar vascular smooth muscle resulting in lowered peripheral vascular resistance and reflex tachycardia

theophylline

a bronchodilator used to treat asthma and bronchitis and emphysema

What is Ewing's sarcoma and what age group does it usually affect? How do you treat it?

a rare disease in which cancer cells are found in the bone or in soft tissue. The most common areas in which it occurs are the pelvis, the femur, the humerus, the ribs and clavicle (collar bone). Usually treated with multi-drug chemo. Ewing's sarcoma occurs most frequently in teenagers and young adults, with a male/female ratio of 1.6:1

What is one of the major contraindications to Isoinazid therapy for TB? What foods should patients avoid on this drug?

acute liver dysfunction Avoid foods with a) histamine (sauerkraut, jack-tuna, yeast) b) tyramine (aged cheese, cured meat, smoked fish)

when should coumadin be administered

afternoon

histamine

amine formed from histidine that stimulates gastric secretions and dilates blood vessels, a regulating body substance released in excess during allergic reactions causing swelling and inflammation of tissues

parnate

an MAOI usually usedin treating severe depression in patients who have failed to respond to other treatments

silvadene

an antibiotic used topically in burn treatment

coumadin

an anticoagulant use to prevent and treat a thrombus or embolus

glucophage

an antidiabetic drug prescribed to treat type II diabetes the action: decreases cellular resistance to insulin

thorazine

an antipsychotic agen used in treating manic-depression and hallucination

mellaril

an antipsychotic agent used in treating psychotic and severe depression

Atropine

an antispasmodic that may be administered preoperattively to relax smooth muscles

acyclovir

an oral antiviral drug (trade name Zovirax) used to treat genital herpes

zocor

an oral lipid-lowering medicine administered to reduce blood cholesterol levels

Hydromorphone / dilaudid

analgesic

Acyclovir:

anti-viral medication used in treating shingles.

Atropine

anticholingergic

propanthekine (Pro-Banthine)

anticholingergic

scopolamine (Scopace)

anticholingergic

Mirtazapine / remeron

antidepressant

adrenergic stimulants adverse reactions

anxiety apprehension headache cerebral hemorrhage

antitussive

any medicine used to suppress or relieve coughing

lipitor is best given

at night this is when the body makes the most cholesterol

terbutaline

beta1 direct agonist. Reduces premature uterine contractions

adequate folic acid will helop to prevent

birth defects

adverse reactions to hyperthyroid medications

bronchospasms, iodism, weight gain and sleeping patterns increase

angina pectoris

chest pain, which may radiate to the left arm and jaw, that occurs when there is an insufficient supply of blood to the heart muscle

tetracycline

comonly prescribed for acne vuglgaris • Dental staining in children

neupogen

stimulates the production of neutraphils

boniva

maintain adequate intake of calcium and vit. d

specificgravity

measures a patients hydration status

electrolyte laboratory test measures?

measures potassium

sublingual nitroglycerine

dilate blood vessels and increase circulation

Anticholinergics Actions

dilates pupil, causes bronchodialtion and decreased secretions, decreases mobility and GI secretions (urinary retention)

Spironolactone / aldactone

diuretic

What is diplopia?

double vision

adverse reactions to skeletal muscle relaxants

drowsiness, incoordination, GI upset

expectorant

drug that breaks up mucus and promotes coughing

cromolyn

drug used to prevent asthma attacks or decrease in allergic response

why do we give a client who is being treated for CHFa loading dose of digoxin

gives the patient an adequate blood level to achieve therapeutic relief as quick as possible

What is the antidote for beta-blockers?

glucagon

glucose laboratory test measures?

glucose

food have vitK

green veg, pork, rice, yogurt, fish, milk, cheese

sign of digoxin toxicity

green yellow vision

adverse reactions to hypothroid

headache and insominia

patients who are receiving vancomycin by IV infusion should be assessed before administration and during for

hearing damage; this drug is both ototoxic and nephrotoxic

adverse reactions of uterine relaxants

heart palpitations, nausea, vomiting, headache

lasix

helps decrease edema in the body

epinepherine

hormone that speeds up heart

benadryl

is an anti-hystemine that decreases itching

apresoline

is an antihypertensive medication

gantrisin

is the most common anti-biotic to treat UTI's

imodium

is used to treat diarrhea

admininster eye drops by dropping

lower conjuctiva

streptase

lysis of thrombi in acute myocardial infarction

Tegretol:

mood stabilizer - bipolar / anticonvulsant - carbamezepine

Anti Impotence Contraindications

nitrates, alpha blockers

Anticholinergics

o Anticholinergic: • Mad as a hatter = cognitive dysfunction (drowsiness, confusion, agitation) • Blind as a bat = blurred vision (mydriasis/pupils dilate), intraocular pressure, photophobia • Red as a beet = vasodilation, tachycardia & BP followed by BP • Dry as a bone = sweating, bronchial secretions (respiratory depression), dry mouth, GI motility/constipation, < urine output

lovenox is contraindicated in clients

on a kosher diet due to the pork content

protease inhibitor is best taken

on an empty stomach 1hr b4 or 2hrs. after a meal

Anticholinergics Uses

opthalmic exam, motion sickness, pre-operative

arterial blood gases lab test measures what?

oxygen and pH levels

the desired effect of morphine is

pain relief

patient on lasix may need

potassium supplements, to weigh self each wk. and change positions slowly to prevent dizziness, orthrostatic hypotension is a side effect of diuretic

heparin

prevents blood clotting

hemoglobin laboratory test measures?

rbc's and other things

the type of insulin used in an emergency situation is

regular

narcoan is given to overcome a narcotic overdose by

reverse CNS and respiratory depression

a patient with hyperthyroidism is given phenobarbital to achieve what?

sedation

antihistamines adverse reactions

sedation, dry mouth, blurred vision, urinary retention

characteristics of mild CNS depression

slow in initiating conversation

What is a 'dystonic reaction' and what drug class does this sometimes occur with?

symptoms of dystonia include stiffness and muscle rigidity, difficulty speaking, internal agitation and may progress to oculogyric crisis and hypertensive crisis. Typical antipsychotic drugs can cause this, such as Haldolperidol.

an adverse reaction to atropine sulfate

tachycardia

carafate

the action of this drrug is to line and protect the stomach, it is better able to do so if the medication can come in contact with the stomach

troche

throat lozenger

vistaril

tused as an antiemetic or in higher doses as a tranquilizer

avandia

type 2 diabetes mellitus , oral diabetic drug doesn't produce more insulin, only gets glucose level to norm

What are some of the serious side effects of anti-seizure medications that should be reported

unsteady gait, slurred speech, extreme fatigue, blurred vision, or feelings of suicide. Increased hunger, increased thirst, or increased urination are additional serious side effects.

aminophylline

used in bronchoconstriction broncial asthma and chronic obstructive pulmonary disease, and congestive heart failure, relaxes smooth muscle of the respiratory tract

gantrinsin

used in urinary tract infections

What are the symptoms of seratonin syndrome?

**confusion, nausea, palpitations, increased muscle tone with twitching muscles, and agitation. (The most common drug combinations associated with serotonin syndrome involve the MAOIs, SSRIs, and the tricyclic antidepressants)

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

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

Five Rights

1-Right Patient 2-Right Drug 3-Right Dose 4-Right Route 5-Right Time

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

what size needle would you use to administer vit. b12 to an average size person

22 gauge 1inch needle

the appropriate size needle for intradermal injection

27 gauge 1/2 inch needle

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

1 Pint

= 500ml or 16 fl oz

b. A review of iPLEDGE educational materials c. That a negative pregnancy test is required before each monthly refill

A 20-year-old woman comes to the clinic for follow-up related to isotretinoin use. The nurse reviews the iPLEDGE program, which includes which important information? (Select all that apply.) a. That an effective method of contraception must be used throughout treatment b. A review of iPLEDGE educational materials c. That a negative pregnancy test is required before each monthly refill d. That informed consent is not required

What is amnioderone?

A K-CHANNEL blocking agent, an antidysrhythmic medication

b. Lack of exercise

A client complains of constipation and requires a laxative. In providing teaching to the client, the nurse reviews the common causes of constipation, including which cause? a. Motion sickness b. Lack of exercise c. Food intolerance d. Bacteria (Escherichia coli)

b. "Overuse of nasal decongestants results in rebound congestion."

A client complains of worsening nasal congestion despite the use of oxymetazoline (Afrin) nasal spray every 2 hours. What is the nurse's best response? a. "Oxymetazoline is not an effective nasal decongestant." b. "Overuse of nasal decongestants results in rebound congestion." c. "Oxymetazoline should be administered every hour for severe congestion." d. "You are probably displaying an idiosyncratic reaction to oxymetazoline."

b. Avoid driving a motor vehicle until stabilized on the drug.

A client tells the nurse that he has started to take an OTC antihistamine, diphenhydramine. In teaching him about side effects, what is most important for the nurse to tell the client? a. Do not to take this drug at bedtime to avoid insomnia. b. Avoid driving a motor vehicle until stabilized on the drug. c. Nightmares and nervousness are more likely in an adult. d. Limit use to 1 to 2 puffs/sprays 4 to 6 times per day to avoid rebound congestion.

a. Acts on smooth intestinal muscle to gently increase peristalsis

A client who has constipation is prescribed a bisacodyl suppository. The nurse explains that bisacodyl does what? a. Acts on smooth intestinal muscle to gently increase peristalsis b. Absorbs water into the intestines to increase bulk and peristalsis c. Lowers surface tension and increases water accumulation in the intestines d. Pulls hyperosmolar salts into the colon and increases water in the feces to increase bulk

b. epinephrine (Adrenalin)

A client with COPD has an acute bronchospasm. The nurse knows that which is the best medication for this emergency situation? a. zafirlukast (Accolate) b. epinephrine (Adrenalin) c. dexamethasone (Decadron) d. oxtriphylline-theophyllinate (Choledyl)

a. Maintenance treatment of asthma

A client with COPD is taking a leukotriene antagonist, montelukast (Singulair). The nurse is aware that this medication is given for which purpose? a. Maintenance treatment of asthma b. Treatment of an acute asthma attack c. Reversing bronchospasm associated with COPD d. Treatment of inflammation in chronic bronchitis

When is the level of forced expiratory volume of concern?

A forced expiratory volume is of a concern if it is 50% or less.

c. Electrolytes

An 85-year-old client is taking acetazolamide, a carbonic anhydrase inhibitor. A nursing intervention associated with clients receiving this drug is to monitor what? a. Weight b. Complete blood count c. Electrolytes d. Urine output

Oxycodone / oxycontin

Analgesic, Opiate

Oxycodone + APAP / percocet, endocet, rocicet, tylox (capsule)

Analgesic, Opiate (Pain Relief)

Codeine + APAP / Tylenol 3

Analgesic- CIII

Aluminum hydroxide

Anatacids

Milk of Magnesia

Anatacids

Memantin / namenda

Anti-Alzheimer's

Promethazine / phenergan

Anti-Nausea/ Anti-emetic

Topiramate / topamax

Anti-convulsant

Plavix (Clopidogrel)

Anti-platelet Keeps the platelets in your blood from coagulating (clotting) to prevent unwanted blood clots that can occur with certain heart or blood vessel conditions.

Aspirin (Salicylate)

Anti-platelet Reduces substances in the body that cuase pain, fever, and inflammation. Sometimes used to treat or prevent heart attacks, strokes, and chest pain.

Aripirazole / abilify

Anti-psychotic

Quetiapine / seroquel

Anti-psychotic

Risperidone / risperdal

Anti-psychotic

Mupirocin / bactroban

Antibacteria; (Topical)

Cefuroxime / ceftin

Antibiotic

Pregabalin / lyrica

Anticonvulsant / Neurologic

carbamazepine (Tegretol)

Anticonvulsants (CNS depressant)aplastic anemia, gingival hypertrophy, ataxia

clonazepam (Klonopin)

Anticonvulsants (CNS depressant)aplastic anemia, gingival hypertrophy, ataxia

phenytoin (Dilantin)

Anticonvulsants (CNS depressant)aplastic anemia, gingival hypertrophy, ataxia; if give too quickly IV, can cause cardiac arrest. Have to give it alone

Amitriptyline / elavil

Antidepressant

Bupropion / wellbutrin, zyban, budeprion

Antidepressant

Duloxetine / cymbalta

Antidepressant

Nortriptyline / pamelor, aventyl

Antidepressant

Trazodone / desyrel

Antidepressant

Venlafaxine / effexor

Antidepressant

Citalopram / celexa

Antidepressant (SSRI)

Valacyclovir / valtrex

Antiviral

Oseltamivir / tamiflu

Antiviral (Flu)

Buspirone / buspar

Anxiolytic / Hypnotic

Phentermine / adipex, fastin

Appetitie Suppressant

Why would you position a client in left trendelenberg position if you suspected an air emboli?

Because it traps the air in the right side of the heart

d. Dry nasal mucosa

Beclomethasone (Beconase) has been prescribed for a client with allergic rhinitis. The nurse teaches the client that which is the most common side effect from continuous use? a. Dizziness b. Rhinorrhea c. Hallucinations d. Dry nasal mucosa

c. Evaluate renal function.

Before administering a stimulant laxative to a client, which nursing intervention is the priority? a. Obtain a history of constipation and causes. b. Record baseline vital signs. c. Evaluate renal function. d. Assess fluid and electrolyte balance.

d. Ask client if he or she has any allergies.

Before applying povidone-iodine (Betadine) to a client's skin, what is a primary nursing intervention? a. Apply a cortisone cream. b. Wash the skin. c. Shave and prepare the area. d. Ask client if he or she has any allergies.

The following orders were written by a prescriber (physician, advanced practice nurse, physician's assistant). Which order is written correctly?

CORRECT ANSWER IS C A) Aspirin 2 tablets prn B) Haloperidol (Haldol) ½ tablet at bedtime C) Zolpidem (Ambien) 5 mg PO at bedtime prn D) Levothyroxine (Synthroid) 0.05 mg 1 tablet

Prednisolone / prelone, pred forte (opthalmic)

Corticosteroid

Prednisone / sterapred, orasone, deltasone

Corticosteroid

Triamcinoline / nasacort, kenalog, aristocort

Corticosteroid

Benzonatate / tessalon perles

Cough Suppressant

Anti-Coagulant

Coumadin-Antedote=Vitamin K Reduces the formation of blood clots, Never take double dose. Performe regualr monitoring of INR (>4.0 great risk for bleeding, Target-2.0-3.0) Heparin- Antedote=Protamine Sulfate Only IV

Calcium Channel Blockers

Disrupts the movement of calcium through calcium channels. Are used as anti-hypertensive drugs tot decrease BP.

Hydrochlorothiazide (HCTZ) / Microzide

Diuretic (Thiazide)

ANTI-COAGULANTS

Heparin: Coumadin:

Coumadin:

Monitor pt's lab work—PT. Antidote is Vitamin K

Baclofenac / lioresal

Musculoskeletal

Hydroxychlorquine / plaquenil

Musculoskeletal

Methocarbamol / robaxin

Musculoskeletal

Tizanidine / zanaflex

Musculoskeletal

Cyclobenzaprine / fexeril

Musculoskeletal (Muscle Relaxant)

Potassium Chloride / micro-k (capsule), k-dur (tablet), klor-con (tablet & liquid)

Potassium supplement

206.) A client is receiving baclofen (Lioresal) for muscle spasms caused by a spinal cord injury. The nurse monitors the client, knowing that which of the following is a side effect of this medication? 1. Muscle pain 2. Hypertension 3. Slurred speech 4. Photosensitivity

Rationale: Side effects of baclofen include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesia of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion. Paradoxical central nervous system excitement and restlessness can occur, along with slurred speech, tremor, dry mouth, nocturia, and impotence. **Option 3 is most closely associated with a neurological disorder**

Narcan:

Reverses the effects of narcotics

a. Hydrogen peroxide

The camp nurse reviews the "shopping list" of supplies needed for the upcoming camping season. What product is recommended to prevent and treat chronic impaction of cerumen? a. Hydrogen peroxide b. Rubbing alcohol c. Charcoal d. Salt solution

c. Acute pharyngitis.

The client complains of a sore throat and has been told it is due to beta-hemolytic streptococcal infection. The nurse realizes this condition is called what? a. Acute rhinitis. b. Acute sinusitis. c. Acute pharyngitis. d. Acute rhinorrhea.

a. Metabolic acidosis c. Respiratory alkalosis

The client has second- and third-degree burns over 25% of his body. Mafenide acetate has been ordered. What acid-base imbalance can result from its use? (Select all that apply.) a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory alkalosis d. Respiratory acidosis

c. Cyclopentolate

The client is being prepared for an eye examination. When the nurse takes the health history, the client says that she is sensitive to atropine sulfate. What drug might be used instead for the examination? a. Diclofenac b. Suprofen c. Cyclopentolate d. Betaxolol HCl

Administer guaifenesin.

The client tells the nurse that she has a bad cold, is coughing, and feels like she has "stuff" in her lungs. What should the nurse do? a. Administer dextromethorphan. b. Administer guaifenesin. c. Encourage the client to drink fluids hourly. d. Administer fluticasone (Flonase).

b. Administer the albuterol first, wait 5 minutes, and administer ipratropium bromide, followed by beclomethasone several minutes later.

The health care provider orders ipratropium bromide (Atrovent), albuterol (Proventil), and beclomethasone (Vanceril) inhalers for a client. What is the nurse's best action? a. Question the order; three inhalers should not be given at one time. b. Administer the albuterol first, wait 5 minutes, and administer ipratropium bromide, followed by beclomethasone several minutes later. c. Administer each inhaler at 30-minute intervals. d. Administer beclomethasone first, wait 2 minutes, and administer ipratropium bromide, followed by the albuterol several minutes later.

c. The client has no throat pain.

The health care provider prescribes lansoprazole (Prevacid) to a client. Which assessment indicates to the nurse that the medication has had a therapeutic effect? a. The client has no diarrhea. b. The client has no gastric pain. c. The client has no throat pain. d. The client is able to eat.

d. Client's pupils are constricted to 2 mm.

The nurse administers pilocarpine (Pilocar) to a client with glaucoma. Which assessment finding would indicate a therapeutic effect of the medication? a. Client's eyes appear clear, without drainage. b. Client states that her eyes feel very dry. c. Client's pupils are dilated to 4 mm. d. Client's pupils are constricted to 2 mm.

What is the best nursing practice for administrating a controlled substance if part of the medication must be discarded?

The nurse documents on the medication administration record and the control inventory form, and has a second nurse witness the medication being discarded.

b. Instruct the client that one drop is optimal.

The nurse evaluates the client using eyedrops. The client puts two drops into his eye. What is the nurse's best action? a. Continue to observe the client. b. Instruct the client that one drop is optimal. c. Have the client irrigate his eye to remove excess medication. d. Have the client close his eye and rub to assist in absorption.

d. St. John's wort

The nurse instructs the client to avoid which over-the-counter products when taking theophylline (Theo-Dur)? a. acetaminophen (Tylenol) b. echinacea c. diphenhydramine (Benadryl) d. St. John's wort

b. Gastric assessment

The nurse is administering loperamide (Imodium) to a client with diarrhea. What assessment is essential for this client? a. Vascular assessment b. Gastric assessment c. Hourly blood pressure measurements d. White blood count

a. Warn the client to avoid laxative abuse. b. Record the frequency of bowel movements. c. Warn the client against taking sedatives concurrently. d. Encourage the client to increase fluids. e. Instruct the client to avoid this drug if he or she has narrow-angle glaucoma.

The nurse is administering opium tincture (paregoric) to a client. Which should be included in the client teaching regarding this medication? (Select all that apply.) a. Warn the client to avoid laxative abuse. b. Record the frequency of bowel movements. c. Warn the client against taking sedatives concurrently. d. Encourage the client to increase fluids. e. Instruct the client to avoid this drug if he or she has narrow-angle glaucoma. f. Teach the client that the drug acts by drawing water into the intestine.

b. Absent bowel sounds, hard abdomen

The nurse is caring for a client who is taking sucralfate (Carafate, Sulcrate) for treatment of a duodenal ulcer. Which assessment requires action by the nurse? a. Sodium level 140 mEq/L b. Absent bowel sounds, hard abdomen c. Urinary output 30 mL/hr d. Calcium level 8.5 mg/dL

c. Continue to assess the client's oxygenation.

The nurse is caring for a client with a theophylline level of 14 mcg/mL. What is the priority nursing intervention? a. Increase the IV drip rate. b. Monitor the client for toxicity. c. Continue to assess the client's oxygenation. d. Stop the IV for an hour then restart at lower rate.

d. Teach the child to use a spacer.

The nurse is caring for a young child who has been prescribed an inhaler for control of her asthma. The child is having difficulty using the inhaler. What is the nurse's best action? a. Tell the parent to hold the inhaler for the child. b. Ask the health care provider to switch to oral medications. c. Tell the parent that young children should not use inhalers. d. Teach the child to use a spacer.

d. The client with atrial fibrillation with a rate of 100

The nurse is caring for clients on the pulmonary unit. Which client should not receive epinephrine if ordered? a. The client with a history of emphysema b. The client with a history of type 2 diabetes c. The client who is 16 years old d. The client with atrial fibrillation with a rate of 100

c. Assess lesions

The nurse is doing health teaching with a client with psoriasis. Which is a nursing implication of the new biologic agents for the management of psoriasis? a. Daily weight b. Monitor electrolytes c. Assess lesions d. Monitor CBC and T-cell count

b. Warm the eardrops to room temperature before administration.

The nurse is planning to administer eardrops. Which intervention is essential to include in the plan of care? a. Eardrops should be cool when being administered. b. Warm the eardrops to room temperature before administration. c. The pinna of an adult should be held down and back to administer eardrops. d. Eardrops may be warmed in the microwave before administration.

c. Administer 30 minutes before meals and at bedtime.

The nurse is planning to administer metoclopramide (Reglan). What is a primary intervention? a. Administer with food to decrease gastrointestinal upset. b. Administer every 6 hours around the clock. c. Administer 30 minutes before meals and at bedtime. d. Give with a full glass of water first thing in the morning.

a. Take medication with food to decrease gastric distress. b. Avoid alcohol and other central nervous system depressants. c. Notify the health care provider if confusion or hypotension occurs. d. Take sugarless candy, gum, or ice chips for temporary relief of dry mouth. e. Avoid handling dangerous equipment or performing dangerous activities until stabilized on the drug.

The nurse is teaching a client about diphenhydramine (Benadryl). Which are topics to include? (Select all that apply.) a. Take medication with food to decrease gastric distress. b. Avoid alcohol and other central nervous system depressants. c. Notify the health care provider if confusion or hypotension occurs. d. Take sugarless candy, gum, or ice chips for temporary relief of dry mouth. e. Avoid handling dangerous equipment or performing dangerous activities until stabilized on the drug.

a. Instruct the client to report changes in vision and breathing. b. Maintain sterile technique and prevent dropper

The nurse prepares a health teaching plan for the client with glaucoma. Which important nursing intervention are included for this client? (Select all that apply.) a. Instruct the client to report changes in vision and breathing. b. Maintain sterile technique and prevent dropper contamination during administration of eyedrops. c. Include return demonstration only with geriatric clients. d. Wait 10 minutes to instill the second eye medication to be given at the same time.

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

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

Oxybutynin / ditropan

Urinary Tract Agent

Tamsulin / flomax

Urinary Tract Agent

b. This medication has fewer sedative effects.

What is the most important thing for the nurse to teach a client who is switching allergy medications from diphenhydramine (Benadryl) to loratadine (Claritin)? a. This medication can potentially cause dysrhythmias. b. This medication has fewer sedative effects. c. This medication has increased bronchodilating effects. d. This medication causes less gastrointestinal upset.

c. Monitor blood glucose levels every 4 hours when taking albuterol.

What is the most important thing for the nurse to teach the client with a history of diabetes and asthma who has started on albuterol PRN? a. Take Tylenol for headaches when taking albuterol. b. Monitor for orthostatic hypotension every 2 hours when taking albuterol. c. Monitor blood glucose levels every 4 hours when taking albuterol. d. An antianxiety agent may be prescribed to help with nervousness.

c. Liquefying and loosening of bronchial secretions

What will the nurse expect to find that would indicate a therapeutic effect of acetylcysteine (Mucomyst)? a. Decreased cough reflex b. Decreased nasal secretions c. Liquefying and loosening of bronchial secretions d. Relief of bronchospasms

c. Combination therapy blocks different vomiting pathways.

What will the nurse teach the client about the reason for administering multiple medications for relief of nausea and vomiting? a. Combination therapy decreases the risk of constipation. b. Combination therapy is more cost-effective. c. Combination therapy blocks different vomiting pathways. d. Combination therapy decreases side effects due to lower doses of each drug.

d. Antacids neutralize HCl and reduce pepsin activity.

When a client complains of pain accompanying a peptic ulcer, why should an antacid be given? a. Antacids decrease GI motility. b. Antacids decrease gastric acid secretion. c. Aluminum hydroxide is a systemic antacid. d. Antacids neutralize HCl and reduce pepsin activity.

d. To combine with protein to form a viscous substance that forms a protective covering of ulcer

When a client is given sucralfate (Carafate), the nurse knows that its mode of action is what? a. To neutralize gastric acidity b. To inhibit gastric acid secretion by inhibiting histamine at H2 receptors in parietal cells c. To suppress gastric acid secretion by inhibiting the hydrogen/potassium ATPase enzyme d. To combine with protein to form a viscous substance that forms a protective covering of ulcer

c. Allow the tablet to dissolve in water before administering.

When administering sucralfate (Carafate) to a client with a nasogastric tube, what is an essential intervention? a. Crush the tablet into a fine powder before mixing it with water. b. Administer with a bolus tube feeding. c. Allow the tablet to dissolve in water before administering. d. Administer with an antacid for maximum benefit.

a. Client has not had a bowel movement in 3 days.

Which assessment finding will need intervention and is related to the client's use of aluminum hydroxide (Amphojel)? a. Client has not had a bowel movement in 3 days. b. Client has had one loose stool this week. c. Client is complaining of gastric upset. d. Client has trace edema in feet.

c. Monitor signs and symptoms of fluid and electrolyte imbalance.

Which assessment is most important for the client who is taking stimulant laxatives? a. Monitor bowel elimination daily. b. Monitor intake and output. c. Monitor signs and symptoms of fluid and electrolyte imbalance. d. Monitor heart rate and blood pressure every 4 hours.

c. Client taking magnesium-containing antacids who has renal failure.

Which client needs immediate intervention? a. Client taking aluminum-containing antacids with complaints of reflux. b. Client taking calcium-containing antacids who is hypocalcemic. c. Client taking magnesium-containing antacids who has renal failure. d. Client taking antacids who is older than 70 years.

c. "I will apply the scopolamine patches to rotating sites on my arms."

Which client statement indicates that further teaching is needed? a. "I will not drive while I am taking these medications because they may cause drowsiness." b. "I may take Tylenol to treat the headache caused by ondansetron (Zofran)." c. "I will apply the scopolamine patches to rotating sites on my arms." d. "I should take my prescribed antiemetic before receiving my chemotherapy dose and continue afterwards."

c. "Hold your breath for 10 seconds if you can after you inhale the medication."

Which instruction will the nurse include when teaching a client about the proper use of metered-dose inhalers? a. "After you inhale the medication once, repeat until you obtain relief." b. "Make sure that you puff out air repeatedly after you inhale the medication." c. "Hold your breath for 10 seconds if you can after you inhale the medication." d. "Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler."

d. Silver sulfadiazine cream

Which intervention is most appropriate for the client with second-degree burns? a. IV antibiotics b. Isolation c. IV dextrose infusion d. Silver sulfadiazine cream

c. Increase fluid intake in order to decrease viscosity of secretions.

Which is the best instruction for the nurse to include when teaching a client about the use of expectorants? a. Restrict fluids in order to decrease mucus production. b. Take the medication once a day only, at bedtime. c. Increase fluid intake in order to decrease viscosity of secretions. d. Increase fiber and fluid intake to prevent constipation.

b. Potential risk for bleeding related to thrombocytopenia

Which nursing diagnoses is appropriate for a client receiving famotidine (Pepcid)? a. Increased risk for infection related to immunosuppression b. Potential risk for bleeding related to thrombocytopenia c. Alteration in urinary elimination related to retention d. Alteration in tissue perfusion related to hypertension

c. Decrease in gastric motility

Which outcome assessment is essential to monitor for the client taking diphenoxylate (Lomotil)? a. Increase in bowel sounds b. Increase in number of bowel movements c. Decrease in gastric motility d. Decrease in urination

b. "Smoking decreases the effects of this medication, so I should look into cessation programs."

Which statement demonstrates to the nurse that the client understands instructions regarding the use of histamine2-receptor antagonists? a. "Since I am taking this medication, it is all right for me to eat spicy foods." b. "Smoking decreases the effects of this medication, so I should look into cessation programs." c. "I should take this medication 1 hour after each meal in order to decrease gastric acidity." d. "I should decrease bulk and fluids in my diet to prevent diarrhea."

b. "This medication will help prevent the inflammatory response of my allergies."

Which statement indicates that the client understands the teaching about beclomethasone diproprionate (Beconase)? a. "I will need to taper off the medication to prevent acute adrenal crisis." b. "This medication will help prevent the inflammatory response of my allergies." c. "I will need to monitor my blood sugar more closely because it may increase." d. "I need to take this medication only when my symptoms get bad."

clomid

a fertility drug that is used to stimulate ovulation and that has been associated with multiple births

lithium

a medication used to treat bi-polar disorders

fosamax

a medication used to treat osteoporosis, limit dairy products while taking this med

What is trigeminal neuralgia?

a nerve disorder that causes a stabbing or electric-shock-like pain in parts of the face.

cbc

a test ordered for suspected bleeding disorders

Blood glucose

a test ordered for suspected diabetes

BUN

a test ordered for suspected renal disease

valium

a tranquilizer used to relieve anxiety and relax muscles

what medication would be given fo an overdose of a cholinergic drug

atropine anticholenergic

digoxin is given to treat

elevated heart rate in chf client

the antidote for heparin

protamine sulfate

oxytocin

stimulates uterine contraction

cumulative

the drug is not completly metabolized and is excreted before the next dose is given

the antidote for coumadin

vit k

Define hemiparesis

weakness on one side of the body. It is less severe than hemiplegia — the total paralysis of the arm, leg, and trunk on one side of the body. Thus, the patient can move the impaired side of his body, but with reduced muscular strength.

an important nursing interverntion while taking lasix

weights and vital signs. baseline is needed to determine the effectiveness of therapy

decadron is best given

with a glass of milk to decrease gastric distress

corticosteriods is taken

with or after meals

Atropine sulfate

Antidysrhythmics

Isuprel (Isoproterenol)

Antidysrhythmics

Lidocaine

Antidysrhythmics

Pronestyl (procainamide)

Antidysrhythmics

Quinidine

Antidysrhythmics

Prochlorperazine / compazine

Antiemetic

Dimenhydrinate / dramamine

Antiemetics

Clotrimazole + Bethamethasone / lotrisone

Antifungal / Steroid

Latanoprost / Xalatan

Antiglaucoma (Opthalmic)

Allopurinol / zyloprim

Antigout

Cetirizine / zyrtec

Antihistamine

Diphenhydramine / benadryl

Antihistamine

Fexofenadine / allegra

Antihistamine

Hydroxyzine HCL / atarax

Antihistamine

Hydroxyzine Pamoate / vistaril

Antihistamine

Lovastatin / mevacor

Antihyperlipidemic

Nicin / niaspan

Antihyperlipidemic

Pravastatin / pravachol

Antihyperlipidemic

Atorvastatin / lipitor

Antihyperlipidemic (Statin)

Simvastatin / zocor

Antihyperlipidemic (Statin)

Hydralazine / apresoline

Antihypertensive

Irbesartan / avapro

Antihypertensive

Irbesartan/HCTZ / avalide

Antihypertensive

Losartan / cozaar

Antihypertensive

Propanolol / inderall

Antihypertensive

Quinapril / Accupril

Antihypertensive

Atenolol / tenormin

Antihypertensive Beta Blocker (B1)

Metoprolol Succinate / Toprol XL

Antihypertensive Beta Blocker (B1)

Metoprolol Tartrate / lopressor

Antihypertensive Beta Blocker (B1)

Furosemide / lasix

Antihypertensive Diuretic

Clindamycin / cleocin

Antimicrobial

Nitropfurantoin / furadantin

Antimicrobial

Sumatriptan / imitrex

Antimigraine

prilosec

antacid that suppresses acid secretion in the stomach best given on empty stomach

208.) A client with myasthenia gravis verbalizes complaints of feeling much weaker than normal. The health care provider plans to implement a diagnostic test to determine if the client is experiencing a myasthenic crisis and administers edrophonium (Enlon). Which of the following would indicate that the client is experiencing a myasthenic crisis? 1. Increasing weakness 2. No change in the condition 3. An increase in muscle spasms 4. A temporary improvement in the condition

auto-define "A client with myasthen..." Rationale: Edrophonium (Enlon) is administered to determine whether the client is reacting to an overdose of a medication (cholinergic crisis) or to an increasing severity of the disease (myasthenic crisis). When the edrophonium (Enlon) injection is given and the condition improves temporarily, the client is in myasthenic crisis. This is known as a positive test. Increasing weakness would occur in cholinergic crisis. Options 2 and 3 would not occur in either crisis.

d. "You may be able to safely take a second-generation antihistamine."

The nurse is caring for a client in the clinic who states that he is afraid of taking antihistamines because he is a truck driver. What is the best information for the nurse to give this client? a. "Take the medication only when you are not driving." b. "Take a lower dose than normal when you have to drive." c. "You are correct, you should not take antihistamines." d. "You may be able to safely take a second-generation antihistamine."

b. Administer misoprostol. d. Instruct the client to take omeprazole with the aspirin.

The nurse is caring for a client who is experiencing gastric distress from the long-term use of aspirin for treatment of arthritis. What is the best intervention for this client? (Select all that apply.) a. Stop all aspirin therapy. b. Administer misoprostol. c. Instruct the client to take the aspirin with milk. d. Instruct the client to take omeprazole with the aspirin.

a. "Do not drive after taking this medication."

The nurse is caring for a client who is taking a first-generation antihistamine. What is the most important fact for the nurse to teach the client? a. "Do not drive after taking this medication." b. "Make sure you drink a lot of liquids while on this medication." c. "Take this medication on an empty stomach." d. "Do not take this medication for more than 2 days."

b. Dizziness d. Headaches f. Decreased libido

A client is taking famotidine (Pepcid) to inhibit gastric secretions. What are the side effects of famotidine? (Select all that apply.) a. Diarrhea b. Dizziness c. Dry mouth d. Headaches e. Blurred vision f. Decreased libido

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

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

b. Block serotonin receptors in the CTZ

A client has nausea and is taking ondansetron (Zofran). The nurse explains that the action of this drug is what? a. Stimulate the CTZ b. Block serotonin receptors in the CTZ c. Block dopamine receptors in the CTZ d. Coat the wall of the GI tract and absorb bacteria

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

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

a. Monitor for heart rate >100 beats/min.

A client has taken metaproterenol. What is the nurse's priority action? a. Monitor for heart rate >100 beats/min. b. Tell the client not to drive for 2 hours. c. Monitor for sedation. d. Assess for elevated blood pressure.

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

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

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

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

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

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

b. carbamide peroxide

A client is complaining of excessive earwax that diminishes hearing ability. What medication will the nurse use to assist the client? a. acetic acid b. carbamide peroxide c. hydrocortisone d. glycerin

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What are perhaps the most common side effects of anticholinergics?

dry mouth, constipation, and blurred vision,

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

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

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

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

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

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

cogentin

medication used to treat parkinson's disease

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

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

a. Asthma

A client is diagnosed with a pulmonary disorder that causes COPD. Lungs tissue changes are normally reversible with this condition. The nurse understands that which is the client's most likely diagnosis? a. Asthma b. Emphysema c. Bronchiectasis d. Chronic bronchitis

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

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

a. Helicobacter pylori

A client is diagnosed with peptic ulcer disease. The nurse realizes that which factor is a predisposing factor for this condition? a. Helicobacter pylori b. hyposecretion of pepsin c. decreased hydrochloric acid d. decreased number of parietal cells

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

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

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

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

d. Administer the medications and assess the client for relief.

A client is prescribed Lorazepam (Ativan) and a glucocorticoid during chemotherapy treatments. What is the nurse's best action? a. Call the health care provider and question the order. b. Only administer the Ativan if the client seems anxious. c. Administer the two medications at least 12 hours apart. d. Administer the medications and assess the client for relief.

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

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

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

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

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

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

a. "This medication may cause drowsiness and dizziness."

A client is prescribed an antitussive medication. What is the most important thing for the nurse to teach the client? a. "This medication may cause drowsiness and dizziness." b. "Watch out for diarrhea and abdominal cramping." c. "This may cause tremors and anxiety." d. "Headache and hypertension are common side effects."

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

a. Calcium 12 mg/dL

A client is prescribed calcipotriene (Dovonex) for treatment of psoriasis. Which assessment finding requires immediate intervention by the nurse? a. Calcium 12 mg/dL b. Potassium 3.8 meq/L c. Sodium 135 mmol/L d. Phosphorus 2.5 mg/dL

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

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

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

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

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

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

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

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

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

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

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

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

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

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

b. Weigh the client before chemotherapy.

A client is prescribed granisetron (Kytril) IV for relief of nausea and vomiting caused by cancer chemotherapy. What intervention is most appropriate for this client? a. Administer the medication at least 12 hours before the start of chemotherapy. b. Weigh the client before chemotherapy. c. Assess baseline vital signs and monitor for tachycardia. d. Teach the client about the possibility of rebound nausea and vomiting once the drug is discontinued.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

b. "Take the ipratropium at least 5 minutes before the cromolyn."

A client is prescribed ipratropium and cromolyn sodium. What will the nurse teach the client? a. "Do not take these medications within 4 hours of each other." b. "Take the ipratropium at least 5 minutes before the cromolyn." c. "Administer both medications together in a metered-dose inhaler." d. "Take the ipratropium only in the mornings."

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

b. Call the health care provider if you have muscle weakness.

A client is prescribed isotretinoin (Accutane). What is the most important instruction to teach the client before beginning this medication? a. Do not go out in the sun while on this medication. b. Call the health care provider if you have muscle weakness. c. Increase fluid intake while on this medication. d. Do not take aspirin while on this medication.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

d. "After 3 days, switch patch to alternate ear." e. "Apply patch 4 hours before effect is desired." f. "Drowsiness is a concern while on this medication."

A client is prescribed scopolamine. What information will the nurse include on the teaching plan for this client? (Select all that apply.) a. "Do not take this medication if you are dizzy." b. "Do not use laxatives while on this medication." c. "Do not use this medication for longer than a day." d. "After 3 days, switch patch to alternate ear." e. "Apply patch 4 hours before effect is desired." f. "Drowsiness is a concern while on this medication."

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

30 mL

Ranitidine / zantac

Antacid / Antiulcer

Esomeprazole / nexium

Antacid / Antiulcer (PPI)

Lansoprazole / prevacid

Antacid / Antiulcer (PPI)

Omeprazole / prilosec

Antacid / Antiulcer (PPI)

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

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

d. Limit the drug to 5 days of use to prevent rebound nasal congestion.

A client is prescribed the decongestant oxymetazoline (Afrin) nasal spray. What should the nurse teach the client? a. Take this drug at bedtime as a sleep aid. b. Directly spray away from the nasal septum and gently sniff. c. This drug may be used in maintenance treatment for asthma. d. Limit the drug to 5 days of use to prevent rebound nasal congestion.

Pantoprazole / protonix

Antacid / Antiulcer (PPI)

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

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

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

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

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

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

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

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

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

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

b. 10 to 20 mcg/mL

A client is prescribed theophylline to relax the smooth muscles of the bronchi. The nurse monitors the client's theophylline serum levels to maintain which therapeutic range? a. 1 to 10 mcg/mL b. 10 to 20 mcg/mL c. 20 to 30 mcg/mL d. 30 to 40 mcg/mL

Rabeprazole / aciphex

Antacid / Antiulcer (PPI)

Xanax

Anti anxiety

Donepezil / aricept

Anti-Alzheimer's

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

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

Methotrexate / Rheumatrex

Anti-Rheumatic

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

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

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

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

Anti-arrhthymic

Anti-arrhythmic, Antedote-Digimmune Fab Digoxin (Lanoxin) Helps make the heart beat stornger and with a more regular rhythm. Used to treat heart failure, A fib, don't stop abruptly. Side effects-uneven heart rate, tarry stools, blurred vision, confusion, hallucinations. Dont give <60, >100 BP

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

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

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

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

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

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

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

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

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

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

vancomycin

Anti-infective given for potentially life threatening infections(MRSA)

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

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

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

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

b. Administer ondansetron HCL (Zofran) 30 minutes before therapy and two doses after therapy.

A client is starting cisplatin therapy for cancer. What intervention is appropriate for this client? a. Administer granisetron (Kytril) 60 minutes before therapy and for several days after surgery. b. Administer ondansetron HCL (Zofran) 30 minutes before therapy and two doses after therapy. c. Administer palonosetron (Aloxi) IV push. d. Administer metoclopramide (Reglan) PO.

Methylorednisolone / medrol (tablets), depo-medrol (injection), solu-medrol (injection)

Anti-inflammatory

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

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

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

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

Dicyclomine / bentyl

Anti-spasmotic

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

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

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

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

Ferrous Sulfate / feosol

Antianemics

Alprazolam / xanax

Antianxiety (Benzodiazepine)

Clonazepam / klonopin

Antianxiety (Benzodiazepine)

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

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

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

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

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

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

Lorazepam / ativan

Antianxiety (Benzodiazepine)

Minocycline HCI / minocin

Antibiotic

c. Increased heart rate

A client is taking aminophylline-theophylline ethylenediamine (Somophyllin). For what should the nurse monitor the client? a. Drowsiness b. Hypoglycemia c. Increased heart rate d. Decreased white blood cell count

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

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

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

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

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

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

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

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

b. "I will drink 2 ounces of water after taking aluminum hydroxide."

A client has just been prescribed aluminum hydroxide (Amphojel, ALternaGEL, Alu-Tab) for peptic ulcer pain. The nurse has provided instructions to the client. Which statement by the client indicates to the nurse that the client understands the instructions? a. "I will take aluminum hydroxide at mealtime." b. "I will drink 2 ounces of water after taking aluminum hydroxide." c. "I will take aluminum hydroxide within 30 minutes of my other medications." d. "I will take a laxative if I develop constipation."

Sulfamethoxazole/trimethoprim / septra, bactrim

Antibiotic

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

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

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

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

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

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

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

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

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

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

the most common angle for an intramuscular injection

90 degrees

NURSING IMPLICATIONSof ace inhibitors

: Administer 1 hr before meals to increase absorption

1 Quart

= 2 pints or 1 liter

b. Rinse his mouth with water after each use.

A client demonstrates understanding of flunisolide (AeroBid) by saying that he will do what? a. Take two puffs to treat an acute asthma attack. b. Rinse his mouth with water after each use. c. Immediately stop taking his oral prednisone when he starts using AeroBid. d. Not use his albuterol inhaler while he is taking AeroBid.

b. To loosen bronchial secretions so they can be eliminated by coughing

A client has been prescribed guaifenesin (Robitussin). The nurse realizes that the purpose of the drug is to accomplish what? a. To treat allergic rhinitis and prevent motion sickness b. To loosen bronchial secretions so they can be eliminated by coughing c. To compete with histamine for receptor sites, thus preventing a histamine response d. To stimulate alpha-adrenergic receptors, thus producing vascular constriction of capillaries in nasal mucosa

c. The drug must be administered separate from an antacid by at least 1 hour e. Smoking should be avoided while taking this drug f. Foods high in vitamin B12 should be increased in diet

A client is taking ranitidine (Zantac). The nurse who is teaching the client about this drug should include which information? (Select all that apply.) a. Drug-induced impotence is irreversible b. The drug must be administered 30 minutes before meals c. The drug must be administered separate from an antacid by at least 1 hour d. The drug must always be administered with magnesium hydroxide e. Smoking should be avoided while taking this drug f. Foods high in vitamin B12 should be increased in diet

d. Dry mouth

A client is using the scopolamine patch to prevent motion sickness. The nurse teaches the client that which is a common side effect of this drug? a. Diarrhea b. Vomiting c. Insomnia d. Dry mouth

c. Hold the next dose of theophylline.

A client taking an oral theophylline preparation is due for her next dose and has a blood pressure of 100/50 mm Hg and a heart rate of 110. The client is irritable. What is the best action for the nurse to take? a. Continue to monitor the client. b. Call the health care provider. c. Hold the next dose of theophylline. d. Administer oxygen 2 lpm via nasal cannula.

c. Administer a beta2 adrenergic agonist.

A client with a history of asthma is short of breath and says, "I feel like I'm having an asthmatic attack." What is the nurse's best action? a. Call a code. b. Ask the client to describe the symptoms. c. Administer a beta2 adrenergic agonist. d. Administer a long-acting glucocorticoid.

side effects of ace inhibitors

A dry, hacking cough is COMMON. Hyperkalemia, renal tubular damage, decreased B/P, dizziness, nausea & diarrhea

d. pantoprazole (Protonix)

A nurse is caring for a client who is unable to tolerate oral medications. The nurse anticipates that the client may be prescribed which proton pump inhibitor to be administered intravenously? a. esomeprazole (Nexium) b. lansoprazole (Prevacid) c. omeprazole (Prilosec) d. pantoprazole (Protonix)

a. Monitor client for potential chest pain.

A nurse reviews a client's medication history and notes that the client is taking a nonselective adrenergic agonist bronchodilator and has a history of coronary artery disease. What is a priority nursing intervention? a. Monitor client for potential chest pain. b. Monitor blood pressure continuously. c. Assess daily for hyperkalemia. d. Assess 12-lead ECG each shift.

Cefdinir / omnicef

Antibiotic (Cephalosporin)

Cephalexin / keflex

Antibiotic (Cephalosporin)

Clarithromycin / biaxin

Antibiotic (Macrolide)

Amoxicillin + Clavulanate / augmentin

Antibiotic (Penicillin)

Amoxicillin / amoxil

Antibiotic (Penicillin)

Levofloxacin / levaquin

Antibiotic (Quinolone)

Moxifloxacin HCI / vigamox (opthalmic), avelox (tablets), avelox IV (injection)

Antibiotic (Quinolone)

Doxycycline / vibramycin

Antibiotic (Tetracycline)

Phenytoin / dilantin

Anticonvulsant

divalproex sodium (Depakote)

Anticonvulsants (CNS depressant)aplastic anemia, gingival hypertrophy, ataxia

phenabarbital (Luminal)

Anticonvulsants (CNS depressant)aplastic anemia, gingival hypertrophy, ataxia

Escitalopram / lexapro

Antidepressant (SSRI)

Fluoxetine / prozac

Antidepressant (SSRI)

Paroxetine / paxil

Antidepressant (SSRI)

Sertraline / zoloft

Antidepressant (SSRI)

Glipizide / glucotrol

Antidiabetic

Pioglitazone / actos

Antidiabetic

Cozar (Iosartan)

ARBS Keeps blood vessels from narrowing which lowers BP and improves blood flow. USed to treat HBP, also lower the risk of stroke, slow long term kidney damage in people with type 2 diabetes who also have HBP.

Sitagliptin / januvia

Antidiabetic

Calcium Gluconate:

Antidote for magnesium sulfate

What is Fluphenazine (Prolixin)

An antipsychotic medication

Famotidine / pepcid

Antacid / Antiulcer

c. "This medication will prevent the inflammation that causes your asthma attack."

Client teaching regarding the use of antileukotriene agents such as zafirlukast (Accolate) should include which statement? a. "Take the medication as soon as you begin wheezing." b. "It will take about 3 weeks before you notice a therapeutic effect." c. "This medication will prevent the inflammation that causes your asthma attack." d. "Increase fiber and fluid in your diet to prevent the side effect of constipation."

Anticonvulsants Side Effects

Respiratory depression, aplastic anemia, gingival hypertrophy, ataxia

d. Salmeterol has a longer duration of action.

The nurse is instructing a client about the advantages of salmeterol (Serevent) over other beta2 agonists such as albuterol (Proventil). How will the nurse explain to the client the difference in these two medications? a. Salmeterol has a shorter onset of action. b. Salmeterol does not have any side effects. c. Albuterol has a longer onset of action. d. Salmeterol has a longer duration of action.

d. travoprost

The nurse reviews the African-American client's list of medications. It is important for the nurse to be aware that the prostaglandin analogue more effective in African Americans than in non-African Americans is wha? a. latanoprost b. bimatoprost c. unoprostone d. travoprost

a. Dehydration

The nurse reviews the client's list of medication, which includes mannitol. The nurse must be aware that which condition is a contraindication for use of this drug? a. Dehydration b. Kidney stones c. Eczema d. Gout

b. A horny layer of epidermis

The nurse reviews the client's list of medications and recalls that the purpose of keratolytic agents is to remove what? a. A horny layer of dermis b. A horny layer of epidermis c. Erythematous lesions d. Hair follicles

b. Thinning of the skin d. Purpura

The nurse reviews the client's medication history. Based on the client's prolonged use of glucocorticoids, what does the assessment include? (Select all that apply.) a. Obesity b. Thinning of the skin c. Erythematous lesions d. Purpura

a. School-aged children may need only one drug, not a combination.

The school nurse is preparing a presentation for the parent-teacher association meeting on medications commonly used in school-aged children. It is important to note what primary disadvantage of the use of combination products such as Cortisporin Otic? a. School-aged children may need only one drug, not a combination. b. Combination products may not have the desired dose for school-aged children. c. There is increased cost in using combination products for school-aged children. d. Combination products are less effective for school-aged children.

a. Sunscreen products should contain information about UVA and UVB SPF protection. b. UVB radiation is greatest between 10 AM and 4 PM. d. SPF should be at least 15 in sunscreen products.

The school nurse prepares a program for junior high school students on sun safety. What is important information to include? (Select all that apply.) a. Sunscreen products should contain information about UVA and UVB SPF protection. b. UVB radiation is greatest between 10 AM and 4 PM. c. Clouds block radiation, so sunscreen is not needed on cloudy days. d. SPF should be at least 15 in sunscreen products.

c. "This medication will form a protective barrier over the gastric mucosa."

What information should the nurse include in a teaching plan for the client who is prescribed sucralfate (Carafate)? a. "This medication will neutralize gastric acid." b. "This medication will enhance gastric absorption of meals." c. "This medication will form a protective barrier over the gastric mucosa." d. "Your gastric acid will be inhibited."

c. "Brush your teeth and gargle to help with dryness in your mouth."

What instruction is most important for the nurse to teach a client who is taking an anticholinergic agent to treat nausea and vomiting? a. "Assess your stools for dark streaks." b. "Do not take more than two doses of this medication." c. "Brush your teeth and gargle to help with dryness in your mouth." d. Check your heart rate and call the health care provider if it gets below 50 beats/min.

zoloft

considered the first line of treatment in panic-anxiety disorders and mild to moderate depresssion

decongestant

decrease the amount of mucus secreation from the bronchi ,reduces congestion and swelling of membranes, such as those of the nose and eustachian tube in an infection

beta-antagonist

decreases contraction of smooth muscle

the drug of choice treating pancreatitis

demeral

barbituates

drugs that depress the activity of the central nervous system, reducing anxiety but imparing memory and judgement induces sleepiness

synergistic

drugs that work together so the total effect is greater than if given seperatly

side effects would be expected with elderly patients taking barbiturates

excitement confusion depression

Antidepressants: MAOIs Side Effects

hypertensive crisis when taken with tyramine-containing foods (aged cheese, liver, beer, wine, bananas), photosensitivity

cipro

medication given for UTI, bone, joint, skin infectons

tolerance

the diminishing effect with regular use of the same dose of a drug, requiring the user to take larger and larger doses before experiencing the drug's effect

inderal

the first beta blocker (trade name Inderal) used in treating hypertension and angina pectoris and essential tremor

absorption

the time it take the drug to be taken into the body to the time it enters the blood stream

distribution

the transport of drugs into the body

What is the therapeutic range for Digoxin?

therapeutic range 0.8 - 2 ng /mL (toxic: greater than 2.4 ng/mL)

urecholine

this drug produces smooth muscle contraction(bladder tone) and is used for abdominal and urinary retention

brevicon

this medication is a contraceptive agent

depo-provera

this medication suppresses endometrial bleeding

leukine

useful in treating patients with bone marrow transplant

whats the medication of choice for an alcoholic going through withdrawls

valium vit b1 and b12 and folic acid

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

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

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

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

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

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

Microdrip

60 gtt/ml

Insulin Injection Areas

Abdomen (2 inches from navel) Upper arms Thighs Buttocks

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

1 Inch

= 2.5 centimeters

1 Cup

= 240ml or 8 fl oz

1 Gallon

= 4 quarts

Total volume X drop factor / Time in mins

= gtt/ min

Total volume to infuse / ml/ hour being infused

= infusion time

Total volume in mL / Number of hours

= number of mL/hr

1 Tbsp

=15 ml or 0.5 fl oz or 3 tsp or 75 gtts

1 Tsp

=5 ml or 25 gtts