NCLEX Pharmacology

A client with a history of congestive heart failure (CHF) has been admitted with digoxin toxicity. After reviewing the initial laboratory results, the nurse knows what abnormal findings most likely contributed to the digoxin toxicity? Sodium: 146 mEq/L, Potassium 3.1 mEq/L, Calcium 9.9 mg/dL, Magnesium 1.2 mEq/L, Albumin 4.8 gm/dL Select all that apply 1. Sodium 2. Calcium 3. Albumin 4. Potassium 5. Magnesium

4. Potassium 5. Magnesium (4., & 5. Correct: Hypokalemia and hypomagnesemia both can increase the client's potential to develop digoxin toxicity. Digoxin and potassium both bind at the same location on the ATPase pump. When potassium levels are low, more digoxin will attach to the sites, leading to toxicity. Low magnesium levels sensitize the cardiovascular system to the toxic effects of digoxin. 1. Incorrect: The presence of digoxin in the body does slightly inhibit the activity of the Na/K⁺ pump. However, even though the sodium level is slightly elevated, there is no direct correlation between that increased sodium level and digoxin toxicity. 2. Incorrect: A calcium level of 9.9 is within the normal limits of 9.0 to 10.5 mg/dL (2.25-2.62 mmol/L). Calcium is controlled by the parathyroid glands, generally shifting between the bones and serum. A normal calcium level would not contribute to digoxin toxicity. 3. Incorrect: Albumin is a protein synthesized by the liver which helps to maintain fluid within the vascular spaces and transport soluble products throughout the body. This specific laboratory result is within normal limits. Nonetheless, albumin has no effect on digoxin levels in the body.)

The nurse instructs a client taking isoniazid for the treatment of tuberculosis (TB) regarding appropriate food choices. Which food choices indicate to the nurse that teaching has been successful? 1. Salad with bleu cheese dressing. 2. Smothered liver with onions. 3. Smoked salmon with crackers. 4. Pear salad with lettuce.

4. Pear salad with lettuce. (4. Correct: Pears are acceptable fruit. Foods high in tyramine can cause headaches, fast or irregular heartbeats, nausea and vomiting and sensitivity to light. Foods high in tyramine such as aged cheeses, certain meats, liver, moked fish, sour cream, raisins, bananas and avocados should not be eaten when taking isoniazid. 1. Incorrect: Avoid foods high in tyramine. Foods high in tyramine such as salad with bleu cheese dressing can result in severe reactions when client is taking isoniazid. 2. Incorrect: Avoid foods high in tyramine. Foods high in tyramine such as smothered liver with onions can result in severe reactions when client is taking isoniazid. 3. Incorrect: Avoid foods high in tyramine. Foods high in tyramine such as smoked salmon can result in severe reactions when client is taking isoniazid.)

An elderly client was admitted with a diagnosis of Type II diabetes. The primary healthcare provider initiated the Insulin Sliding Scale Protocol for Type II Diabetic Clients. The prescription regimen was to begin at the low dose regimen with regular insulin every 6 hours. The 2400 hours glucose level is 252 mg/dL. How much regular insulin should the nurse give the client at this time? Answer using numbers only. Sliding Scale Insulin Protocol: 1. If Potassium is < 3.5, call M.D. 2. Advance to the next higher dose regimen if glucose level is > 250 two (2) times in 24 hours and all readings were > 100. 3. Decrease to the next lower dose regimen if glucose level is between 60-100 twice in 24 hours. Glucose Level (mg/dL) → Low Dose Regimen → Medium Dose → High → Very High 60-150 → 0 → 0 → 0 → 0 150-200 → 0 → 2 → 4 → 6 201-250 → 3 → 6 → 8 → 10 251-300 → 4 → 8 → 12 → 14 301-350 → 6 → 10 → 14 → 18 351-400 → 9 → 12 → 16 → 22 > 400 → 351-400 dose & Call MD Glucose Flow Sheet: Date/Time → Glucose Level → Insulin Dose Regimen → Insulin Dose 0700 → 360 mg/dL → Low dose regimen → 9 units 1200 → 121 mg/dL → Low dose regimen → 3 units 1800 → 264 mg/dL → Low dose regimen → 4 units 2400 → 252 mg/dL → ______ → ______

8 (The prescription regimen was to begin at the low dose regimen with regular insulin every 6 hours using the Insulin Sliding Scale Protocol for Type II Diabetic Clients. The protocol states to advance to the next higher dose regimen if glucose level is greater than 250 two (2) times in 24 hours and all readings are greater than 100. All glucose readings were greater than 100 and greater than 250 at 1800 hours and 2400 hours, so the client should be moved to the medium dose regimen which indicates that 8 units of regular insulin should be given at 2400 hours.)

A client diagnosed with bipolar mania was prescribed lithium carbonate 2000 mg daily two months ago. What is the nurse's best action? Sodium - 143 mEq/L (143 mmol/L) Potassium - 4.5 mEq/L (4.5 mmol/L) Magnesium - 1.9 mEq/L (0.8 mmol/L) Serum Lithium - 1.8 mEq/L 1. Record the lab results in the chart and recheck in one month. 2. Inform the primary healthcare provider that the lithium level is too high. 3. Notify the primary healthcare provider because the sodium level is too high. 4. Let the primary healthcare provider know that the magnesium level is too low.

2. Inform the primary healthcare provider that the lithium level is too high. (2. Correct: The appropriate serum lithium level for acute mania is 1.0 to 1.5 mEq/L. For maintenance it is 0.6 to 1.2 mEq/L. Levels exceeding 1.5 to 2.5 mEq/L begin to produce toxicity. 1. Incorrect: All lab results should be documented; however, the lithium needs to be reported so that the dose can be adjusted. 3. Incorrect: The sodium level is normal: 135-145 mEq/L (135-145 mmol/l). 4. Incorrect: The magnesium level is normal: 1.3 - 2.1 mEq/L (0.65-1.05 mmol/l).)

The primary healthcare provider has prescribed KCl 20 mEq by mouth once a day. The pharmacy has dispensed KCl 8 mEq/5 mL. How many mL will the nurse administer? Round answer using one decimal point. Ans:______

12.5 (Rationale: (20 mEq ÷ 1) × (5 mL ÷ 8 mEq) = (100 ÷ 8) = 12.5 mL Ans: 12.5 mL)

The nurse is preparing to give a client's prescribed levothyroxine dose. How many tablets will the nurse give to the client? Answer with numbers only. Prescription: Levothyroxine 0.05 mg by mouth every morning. Synthroid Levothyroxine Sodium Tablets, USP 25 mcg (0.025 mg)

2 (Rationale: (0.05 mg ÷ 1) × (1 tab ÷ 0.025 mg) = (0.05 ÷ 0.025) = 2 tab Ans: 2 tab)

The nurse is preparing to administer Sunday's 1600 medications to a client. How many mg of Warfarin should the nurse administer? Answer using numbers only. Medication administration record: Warfarin 2 mg tab (take 1 tablet every morning Mon-Sat) Warfarin 2 mg tab (take ½ (1 mg) tablet every Sunday evening) Ans:______

1 (Warfarin 2 mg tab (take ½ (1 mg) tablet every Sunday evening))

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

10 (Rationale: (1,000 u ÷ 1 hr) × (1 mL ÷ 100 u) = (1,000 ÷ 100) = 10 mL/hr Ans: 10 mL/hr)

What side effects would the nurse expect to find in a client who has received too much levothyroxine? Select all that apply. 1. Angina 2. Bradycardia 3. Hypotension 4. Heat intolerance 5. Tremors

1. Angina 4. Heat intolerance 5. Tremors (1., 4., & 5. Correct: These are side effects of too much levothyroxine. Levothyroxine is the replacement hormone for clients with hypothyroidism, so if too much is given, they would exhibit symptoms just like someone with hyperthyroidism. These clients also tend to have coronary artery disease (CAD), which is why angina is a significant side effect. 2. Incorrect: Tachycardia rather than bradycardia will be seen with too much levothyroxine. 3. Incorrect: Hypertension rather than hypotension will be seen with too much levothyroxine.)

The primary healthcare provider prescribes 12,000 units of Heparin every 12 hours. The pharmacy dispensed a vial of heparin containing 40,000 units per mL. How many mL will the nurse administer? Round answer using one decimal point. Ans:______

0.3 (Rationale: (12,000 u ÷ 1) × (1 mL ÷ 40,000 u) = (12,000 ÷ 40,000) = 0.3 mL Ans: 0.3 mL)

The nurse is caring for a client who has hypercholesterolemia. When evaluating the effects of atorvastatin, the nurse should monitor the results of which laboratory tests? Select all that apply 1. AST 2. Alkaline phophatase 3. Complete blood count 4. Serum cholesterol levels 5. Serum triglyceride levels

1. AST 2. Alkaline phophatase 4. Serum cholesterol levels 5. Serum triglyceride levels (1., 2., 4. & 5. Correct: AST is a liver function test. Liver function tests including AST should be monitored before, at 12 weeks after initiation of therapy or after dose elevation, and then every 6 months. If AST levels increase to 3 times normal, atorvastatin should be reduced or discontinued. Atorvastatin may increase alkaline phosphatase and bilirubin levels. Atorvastatin is a lipid-lowering agent/HMG-CoA reductase inhibitor. The expected outcome of treatment with atorvastatin is lower serum cholesterol and triglycerides. 3. Incorrect: The CBC results would not be used to evaluate the effectiveness of treatment with atorvastatin. The CBC is used to evaluate your overall health and can be used to measure components and features of your blood such as RBC'c, WBC's, Hgb, Hct and platelets.)

The nurse is caring for a client admitted with heart failure. Which prescriptions would necessitate that the nurse seek clarification from the primary healthcare provider? Select all that apply 1. Furosemide 20.0 mg p.o. daily 2. Rosuvastatin 5 mg p.o hs 3. Digoxin 0.125 mg IVP every 8 hours for three doses 4. Folic acid 1 mg daily 5. Heparin 1000 IU subcutaneously daily

1. Furosemide 20.0 mg p.o. daily 4. Folic acid 1 mg daily 5. Heparin 1000 IU subcutaneously daily (1., 4. & 5. Correct: It is inappropriate to have a trailing zero after a decimal point for doses expressed in whole numbers. It can be mistaken as 200 if the decimal point is not seen. The folic acid order lacks a route, thus needs clarification. The Heparin order should be written as Heparin 1,000 units subcutaneously daily. Use commas for dosing units at or above 1,000 or use words such as one thousand to improve readability. Use units rather than IU (International units) as this can be mistaken as IV or 10. 2., & 3. Incorrect: This medication order is written correctly.)

On morning rounds, the nurse finds a somnolent client with a blood glucose of 89 mg/dL(4.9 mmol/L). A sulfonylurea and a proton pump inhibitor are scheduled to be administered. What is the nurse's best action? 1. Give the proton pump inhibitor and hold the sulfonylurea until the client eats. 2. Hold the medications and notify the primary healthcare provider. 3. Arouse the client and give some orange juice with sugar packets added. 4. Give the medications as prescribed and re-check the blood sugar in one hour.

1. Give the proton pump inhibitor and hold the sulfonylurea until the client eats. (1. Correct: Sulfonylureas are a class of oral hypoglycemics and should be held until after a meal in a client with a blood glucose of 89mg/dl. 2. Incorrect: It is not necessary to call the primary healthcare provider; you are just waiting until the client eats. Also, the proton pump inhibitor does not affect blood glucose levels and should be administered. 3. Incorrect: A blood glucose of 89mg/dl is not hypoglcemia, do not treat unless the blood glucose drops to or below the 70-80 range. 4. Incorrect: If you administer the sulfonylurea, you are going to cause the client to secrete insulin from their pancreas, causing the blood sugar to drop and cause hypoglycemia.)

A pregnant client who had been on a magnesium drip for severe pregnancy induced hypertension (PIH) has had an emergency cesarean section at 35 weeks. The nursery nurse should anticipate what findings in the newborn related to the magnesium therapy? Select all that apply 1. Hypotension 2. Hypoglycemia 3. Hyperreflexia 4. Flaccid muscle tone 5. Respiratory depression

1. Hypotension 4. Flaccid muscle tone 5. Respiratory depression (1., 4. & 5. Correct: When magnesium sulfate is administered to the mother for preeclampsia, the intent is to prevent seizures and decrease blood pressure by suppressing the central nervous system, thus preventing premature labor. The dose of this drug and the length of time administered will determine what side effects might be seen in the newborn, since magnesium crosses the placental barrier. The nurse will most likely note hypotension and some degree of respiratory depression in the newborn. Additionally, the newborn may have flaccid or weak muscles along with poor, or even absent reflexes. Treatment of the newborn will be based on the degree of depression. 2. Incorrect: The use of magnesium sulfate in the mother prior to delivery does not affect the blood glucose level of the fetus/newborn. Magnesium sulfate affects the central nervous system, not the pancreas, so blood sugar should be within normal limits. 3. Incorrect: Magnesium is a central nervous system depressant that crosses the placental barrier. Side effects to the newborn would be similar to those noted in the mother, including depressed or absent reflexes. The nurse would not find hyperreflexia.)

A client was prescribed a monoamine oxidase inhibitor (MAOI) for the treatment of depression. Which comment by the client indicates adequate understanding of the tyramine restrictions that apply? 1. I cannot eat avocados or smoked ham. 2. I can eat sausage for breakfast, but not bacon. 3. At least I can still have my beer. 4. I can have blue cheese on my salad but not ranch dressing.

1. I cannot eat avocados or smoked ham. (1. Correct. Clients taking MAOIs cannot consume foods containing large amounts of tyramine. MAOIs block monoamine oxidase which breakdown tyramine. Having a MAOI prescribed and eating a diet high in tyramine can cause a severe increase in blood pressure. Smoked ham and avocados are high in tyramine. 2. Incorrect. Clients taking these medications cannot eat the following foods: sausage, salami, liver, or bologna which have high levels of tyramine. 3. Incorrect. Clients taking these medications cannot consume beer, sherry, chianti wines, or ales due to their high tyramine levels. 4. Incorrect. Consuming blue cheese on a salad may result in a hypertensive crisis due to the presence of tyramine.)

The nurse is caring for a client diagnosed with alcohol dependence who is prescribed a benzodiazepine. Which potential side effect of benzodiazepine has a higher priority for the nurse to monitor? 1. Sedation 2. Drowsiness 3. Drug dependence 4. Impaired coordination

1. Sedation (1. Correct: Maintaining a client's airway is always a priority. The nurse should observe the client for excessive sedation. After a benzodiazepine is administered, the client may fall asleep, transition into respiratory depression and apnea. 2. Incorrect: A side effect of benzodiazepine is drowsiness. Though the actions of the client may be slower, and the client may feel drowsy, the nurse's priority is to assess the client's sedation level. 3. Incorrect: Benzodiazepine therapy can result in substance abuse which can result in physical dependence. Maintaining a client's airway or apnea is a life-threatening situation. The priority intervention is to monitor the client's sedation. 4. Incorrect: The client may experience impaired coordination when prescribed benzodiazepine. Benzodiazepine depresses the central nervous system (CNS). The nurse's priority is to monitor the sedation level of the client.)

A client who has been prescribed zolpidem for insomnia has received medication education. Which statement by the client indicates to the nurse that education was successful? 1. "There is a high potential for tolerance with this medication." 2. "I may do things in my sleep that I will not remember the next day." 3. "Daytime drowsiness is rare when taking this medication." 4. "The most common side effects of this medication are confusion and a bitter aftertaste."

2. "I may do things in my sleep that I will not remember the next day." (2. Correct: Zolpidem is a sedative, also called a hypnotic. It affects chemicals in the brain that may be unbalanced in people with sleep problems (insomnia). Zolpidem may impair the client's thinking or reactions. The cleint may still feel sleepy the morning after taking this medicine, especially if taking the extended-release tablet. Wait at least 4 hours or until fully awake before doing anything that requires being awake and alert. Some people using this medicine have engaged in activity such as driving, eating, walking, making phone calls, or having sex and later having no memory of the activity. 1. Incorrect: This is a schedule 4 substance. There is a low potential for tolerance, dependence, or abuse with this medication. 3. Incorrect: Daytime drowsiness and dizziness are common side effects. 4. Incorrect: Daytime drowsiness and dizziness are the most common side effects. Bitter aftertaste does not occur with this medication.)

The nurse is caring for a client taking lithium. Which comment by the client indicates lack of understanding of the therapeutic regimen? 1. "I must keep my sodium intake steady over time. " 2. "If I miss a dose of lithium, I should make it up with the next dose." 3. "I must check with my primary healthcare provider before changing my diet for weight loss." 4. "I must keep my exercise routine the same or discuss with my primary healthcare provider. "

2. "If I miss a dose of lithium, I should make it up with the next dose." (2. Correct: If a client misses a dose of lithium, the client should take the next dose as prescribed without doubling it. If the client adds the missed dose, toxicity may occur. If sodium intake is reduced or the body is depleted of its normal sodium (due to sweating, fever, diuresis), lithium is reabsorbed by the kidneys, increasing the possibility of toxicity. 1. Incorrect: This comment indicates understanding. The client should keep sodium levels the same over time as lithium and sodium are both excreted by the kidney. 3. Incorrect: This comment indicates understanding. Food intake should remain constant. Therapeutic levels should be monitored closely while the client is losing weight. Sodium reduction can lead to lithium reabsorption in the body causing toxicity. 4. Incorrect: This comment indicates that the client does understand the treatment regimen. Any changes that would change the concentration of the drug in the bloodstream should be discussed with the primary healthcare provider. Activities that cause excess sodium loss, such as heavy exertion, exercise in hot weather, or saunas should be avoided.)

The nurse is caring for a client admitted to rule out myocardial infarction. The nurse has administered sublingual nitroglycerin. What time frame should the nurse expect the earliest onset of effectiveness? 1. 15 seconds 2. 3 minutes 3. 5 minutes 4. 15 minutes

2. 3 minutes (2. Correct: The onset of action for nitroglycerin sublingual is 1 to 3 minutes. So the effectiveness can be assessed 3 minutes after the drug is administered. 1. Incorrect: This time frame is too short for the onset of action of nitroglycerin given sublingual. 3. Incorrect: Sublingual doses of nitroglycerin can be repeated every 5 minutes. The drug would start to be effective before 5 minutes. 4. Incorrect: Fifteen minutes would be to long to wait to assess the effectiveness of nitroglycerin sublingual, in a client suspected of a myocardial infarction.)

The nurse is assigned a group of clients. For which client would the use of acetaminophen pose a higher risk? 1. 42 year old female who abuses cocaine. 2. 54 year old male who abuses alcohol. 3. 23 year old female who has asthma. 4. 34 year old male with sickle cell anemia.

2. 54 year old male who abuses alcohol. (2. Correct: The use of acetaminophen poses a higher risk for the client who abuses alcohol due to its interaction with the liver. Clients should be educated to be cautious if using acetaminophen due to the hepatotoxicity that can occur with liver dysfunction and failure. 1. Incorrect: Clients who use cocaine do not carry a higher risk of hepatotoxicity with acetaminophen use. 3. Incorrect: Clients who have a history of asthma do not carry a higher risk of hepatotoxicity with acetaminophen use. 4. Incorrect: Pain management should follow the "analgesic ladder" recommended by the World Health Organization for the treatment of cancer-related pain. The choice of analgesic and the dosage should be based on the severity of pain in the individual client. The ladder starts with nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen for mild-to-moderate pain. Because clients with sickle cell disease have varying degrees of hepatic impairment, acetaminophen may be contraindicated. So, the alcoholic client is at greatest risk.)

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

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

The nurse is caring for a client who has the diagnosis of schizophrenia. The nurse enters the room to administer the morning dose of the prescribed antipsychotic medication. The client is drooling and has extreme muscular rigidity. After assessing the client for adequate respiratory effort, what is the nurse's priority? 1. Elevate HOB and give the medication as prescribed. 2. Hold the medication and call the primary healthcare provider. 3. Report the behaviors to the on-coming shift. 4. Hold the medication, and check the vital signs.

2. Hold the medication and call the primary healthcare provider. (2. Correct: The nurse should hold the medication, and report the symptoms to the primary healthcare provider. The client may be experiencing neuroleptic malignant syndrome. 1. Incorrect: The client is experiencing symptoms of possible neuroleptic malignant syndrome. The nurse should not give another dose of the medication without consultating with the primary healthcare provider. 3. Incorrect: The symptoms that the client has are very serious and should be reported to the primary healthcare provider immediately. 4. Incorrect: The client may be experiencing neuroleptic malignant syndrome. It is important to notify the primary healthcare provider immediately.)

What medications would the nurse anticipate for the treatment of hyperthyroidism? Select all that apply 1. Levothyroxine 2. Methimazole 3. Propranolol 4. Iodine compounds 5. Calcitonin

2. Methimazole 3. Propranolol 4. Iodine compounds (2., 3., & 4. Correct: Methimazole is correct because it decreases the production of thyroid hormones. It is an antithyroid drug and it is used to "stun" the thyroid pre-operatively. It makes the thyroid "freak out" and stop producing hormones temporarily. Propanolol is correct because it is a beta blocker and beta blockers decrease the heart rate and decrease anxiety. Why is this important? Because the heart rate and anxiety are going to be increased in the hyperthyroid client. Iodine compounds like Lugol's solution® are correct because these decrease the size and vascularity of the thyroid gland. Do you think this might be important pre-operatively? Yes, to decrease the likelihood of bleeding/hemorrhage. And we also, just learned that pharmacologic doses of iodine will also do what? That's right, large doses will decrease thyroid hormone production for a few weeks. So that's two reasons we might use an Iodine compound for Hyperthyroidism. 1. Incorrect: We are not going to give levothyroxine, that's just going to make the problem worse. Levothyroxine is the synthetic form of T4. 5. Incorrect: What about calcitonin? It is a thyroid hormone too, they don't need more. They are hyperthyroid.)

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

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

A client has recently been diagnosed with rheumatoid arthritis. The nurse anticipates which class of pharmacologic agents will likely be a part of the client's treatment regimen? 1. Mitotic inhibitors 2. Systemic glucocorticoids 3. Antifungals 4. Anticoagulants

2. Systemic glucocorticoids (2. Correct: Glucocorticoids (steroids) are an appropriate pharmacologic treatment for rheumatoid arthritis. Other treatment options include the use of NSAIDs, biologic and nonbiologic DMARDs (methotrexate and others). Remember, all the other problems associated with the use of steroids. 1. Incorrect: Mitotic inhibitors are a class of chemotherapeutic agents and are not indicated for the treatment of rheumatoid arthritis. Medications in this class include plant alkaloids (vincristine) and taxanes (paclitaxel). 3. Incorrect: Antifungals are not indicated for the treatment of rheumatoid arthritis. Rheumatoid arthritis is an autoimmune disease, not associated with a fungal disorders. 4. Incorrect: Anticoagulants are indicated for the treatment and prevention of thrombolytic disease and are not indicated for the treatment of rheumatoid arthritis. Salicylate (aspirin), an antiplatelets, may be used as an anti-inflammatory agent.)

The nurse is teaching a client diagnosed with asthma about using a peak expiratory flow meter. The nurse asks the client what action should be taken if the reading is 65% of the client's personal best value. What statement by the client indicates to the nurse that education was successful? 1. "This is a good reading for me, so I can go about my usual activities." 2. "I will administer my long-term inhaler medication." 3. "My as needed inhaler medication needs to be administered." 4. "I need to immediately call 911."

3. "My as needed inhaler medication needs to be administered." (3. Correct: Between 50% and 79% of the client's personal best value indicates asthma is getting worse and the client should immediately take the "as needed" medication which should be a short-acting bronchodilator. 1. Incorrect: 80% to 100% of a client's personal best value is considered "doing well" and is the range recommended that the client can do usual activities. However, a reading of 65% falls below this recommended level, so the client may not be able to perform usual activities. 2. Incorrect: 80% to 100% of a client's personal best value indicates continuation of long term inhaler medication each day. The level of 65% of the client's personal best value confirms the need for a rescue medication. 4. Incorrect: If the client is unresponsive to immediate therapy, emergency care may be required.)

A nurse is preparing to administer an insulin infusion to a client. The nurse calculates the infusion pump setting as 9 mL/hr. What should the nurse do next? 1. Administer the calculated medication dosage. 2. Call the primary healthcare provider to clarify the dosage. 3. Ask another nurse to calculate the dosage. 4. Notify pharmacy of the pump setting for the calculated dosage.

3. Ask another nurse to calculate the dosage. (3. Correct: Insulin is a high alert drug and must be double checked by another nurse before it is administered. High alert drugs that could have significant side effects if administered improperly. 1. Incorrect: Insulin is a high alert drug and must be double checked by another nurse before it is administered. High alert drugs that could have significant side effects if administered improperly. 2. Incorrect: Calling the primary healthcare provider is inappropriate. The nurses are trained to properly calculate this drug calculation problem. 4. Incorrect: The nurse will calculate the infusion rate and then have a second nurse verify the rate. There is no reason to notify pharmacy.)

The nurse is caring for a client diagnosed with deep vein thrombosis, who has been treated with intravenous heparin for one week. The primary healthcare provider plans to change the medication from heparin IV to warfarin sodium by mouth. The nurse understands which approach would be appropriate? 1. Begin the warfarin sodium and stop the heparin simultaneously. 2. Stop the heparin 24 hours, then begin the warfarin sodium. 3. Begin the warfarin sodium before stopping the heparin. 4. Stop the heparin, wait for the coagulation studies to reach the control value, and begin the warfarin sodium.

3. Begin the warfarin sodium before stopping the heparin. (3. Correct: Warfarin sodium is initiated while the client remains on heparin. This is done so that the client remains adequately anticoagulated during the transition from IV heparin to warfarin sodium. The onset of action of warfarin sodium is 36 hours to 3 days. 1. Incorrect: Warfarin sodium's onset of action is 36 hours to 3 days. If heparin were stopped and warfarin sodium initiated there would be a lag time when the client would be inadequately anticoagulated and at an increased risk for clotting. 2. Incorrect: Warfarin sodium's onset of action is 36 hours to 3 days. Stopping heparin 24 hours before administering warfarin sodium would cause a lag time and increased risk of clotting. 4. Incorrect: Waiting for coagulation studies before administering warfarin sodium would cause a lag time and put the client at increased risk for clotting. Additionally, heparin and warfarin are measured by different clotting lab tests. The aPTT can measure the effectiveness of heparin. The PT and INR can be used to measure the effectiveness of warfarin sodium.)

The nurse is caring for a client admitted with an episode of bleeding esophogeal varices. What should the nurse monitor for after administering propranolol to this client? Select all that apply 1. Increased systolic BP 2. Hypokalemia 3. Bradycardia 4. Wheezing 5. Decreased hematemesis

3. Bradycardia 4. Wheezing 5. Decreased hematemesis (3., 4., & 5. Correct: Propranolol is a beta blocker that affects the heart and circulation. It is used in the treatment of high blood pressure, irregular heartbeats and in the prevention of angina and headaches. This medication works by blocking epinephrine and reduces heart rate, blood pressure and strain on the heart. Decreasing the heart rate should decrease bleeding. Wheezing is an adverse reaction from propranolol and should be monitored for after administration. A decreased in heart rate and blood pressure will help to decrease bleeding. Hematemesis is vomiting blood. 1. Incorrect: Blood pressure is the force of blood flow against the walls of your arteries. Propranolol should decrease blood pressure, thus decreasing bleeding. 2. Incorrect: Beta blockers inhibit renin release which can decrease the release of aldosterone. We should monitor for hyperkalemia, rather than hypokalemia.)

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

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

The nurse is caring for a diabetic client. The client's glucose level at 0700 is 265. What is the nurse's best action? Perscription: 40 units NPH insulin every AM Regular Insulin per Sliding Scale both AC and HS Sliding Scale: Blood glucose < 200: 0 units Blood glucose 200-249: 2 units Blood glucose 250-299: 4 units Blood glucose 300-349: 6 units Blood glucose 350-399: 8 units Blood glucose 400 or >: Call primary healthcare provider 1. Hold the NPH and regular insulin 2. Give 8 units of regular insulin and hold the NPH 3. Give the NPH and 4 units of regular insulin 4. Give 40 units of NPH and hold the regular insulin

3. Give the NPH and 4 units of regular insulin (3. Correct: According to the prescription and sliding scale, the client will need 40 units of NPH and 4 units of regular insulin for a glucose level of 250-299. 1., 2., & 4. Incorrect: According to the prescription and sliding scale, the client will need 40 units of NPH and 4 units of regular insulin for a glucose level of 250-299.)

A community health nurse is reconciling medications of a client who was discharged from the hospital with a diagnosis of congestive heart failure, hypertension, and arthritis. After reviewing the client's medications, what action is most important for the nurse to take? Prescriptions: Furosemide 20 mg tablet by mouth every morning Carvedilol 6.25 mg one tablet by mouth twice daily Potassium Chloride 20 mEq one tablet by mouth every morning Current Medications: Saw palmetto one tablet by mouth every morning Adalimumab 40 mg subcutaneously every other week Captopril 25 mg one tablet by mouth every morning 1. Educate the client on the newly prescribed medications. 2. Inform the client to take the captopril at night. 3. Notify the primary healthcare provider that the client is receiving adalimumab. 4. Tell the client to stop taking saw palmetto.

3. Notify the primary healthcare provider that the client is receiving adalimumab. (3. Correct: This is the "most important" action for client safety. Medication reconciliation is "the process of comparing a client's medication prescriptions to all of the medications that the client has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. Transitions in care include changes in setting, service, practitioner or level of care. [Adalimumab can cause serious side effects, including heart failure (new or worsening).] 1. Incorrect: Although the nurse will need to teach the client about the new medications, the most important thing for the nurse to do is inform the HCP about the client taking adalimumab. 2. Incorrect: The nurse cannot change the primary healthcare providers RX. Most HF clients go home on an ACE inhibitor, beta blockers, or both (as in this case). Ceptopril is an ACE inhibtor used for the treatment of hypertension and heart failure, and is often prescribed as two -three times daily. 4. Incorrect: Saw palmetto is used as a traditional or folk remedy for urinary symptoms associated with an enlarged prostate gland (also called benign prostatic hyperplasia, or BPH), as well as for chronic pelvic pain, bladder disorders, decreased sex drive, hair loss, hormone imbalances, and prostate cancer. Not saw palmetto contraindicated with prescribed medications.)

Two nurses are checking a unit of packed red blood cells (PRBCs) for client compatibility prior to infusion. What action should the primary nurse take after completing this process? Unit of Packed Red Blood Cells: O Rh Positive CPDA-1 Red Blood Cells Volunteer Donor H708 202 417 336R Blood Compatibility Label: Last Name: Monty First Name: Mira DOB: 12/08/1959 Gender: Female Client Address: 22 Main Street, MyTown, USA Client Identity No: 600287J Component: Red Blood Cells Donation Number: H100 600 795 338R Client's Wristband: MIRA MONTY Hospital Number: 600287J DOB 12/08/1959 Sex: Female 1. Initiate the PRBCs transfusion at 25 mL/hour for the first 15 minutes. 2. Ask blood bank personnel to type and cross match for PRBCs sent to unit. 3. Send unit of PRBCs back to the blood bank. 4. Notify the primary healthcare provider.

3. Send unit of PRBCs back to the blood bank. (3. Correct: The blood compatibility label does not match the PRBC unit sent to the unit. Note that the donor numbers are not the same. So, this unit needs to be sent back to the blood bank and the correct unit needs to be obtained. 1. Incorrect: Do not give uncrossed matched blood. This unit is not the one that was cross matched to the client. The unit numbers are different. 2. Incorrect: It takes a while to cross match blood and the blood cannot stay out of the refrigerator that long. And what if it is not compatible. A unit of blood has been wasted. 4. Incorrect: The wrong unit of PRBCs has not been hung. There is no need to contact the primary healthcare provider.)

A nurse is caring for a client who has been prescribed sucralfate. Which client education intervention would the nurse include for the client prescribed sucralfate? 1. Take medication 1 hour after meals. 2. Crush tablets prior to taking medication. 3. Consume 1000 mL of fluid every 24 hours. 4. Avoid antacids 1 hour before and after this medication.

4. Avoid antacids 1 hour before and after this medication. (4. Correct: Sucralfate is absorbed more effectively in an acidic state. Since an antacid medication will increase the alkaline state, the client should avoid taking antacids within 1 hour before or after taking sucralfate to increase the absorption rate of sucralfate. 1. Incorrect: Sucralfate should not be taken 1 hour after a meal. To increase the absorption of sucralfate the medication should be taken on an empty stomach when the stomach is more acidic. 2. Incorrect: Clients should not crush, or chew sucralfate tablets. The outer layer of the tablet has specific formulated pharmacokinetic properties that should not be crushed or chewed. 3. Incorrect: A potential side effect of sucralfate is constipation. An increase of fluids during the medication therapy is recommended to decrease the side effect of constipation. An intake of 1000 mL of fluid per 24 hours intervention is not enough fluid to reduce the possibility of constipation.)

A new mother brings her infant to the clinic for a well-baby checkup. While at the clinic, the mother asks the nurse if there are any reasons why her infant should not have the measles, mumps, rubella (MMR) vaccine. The nurse's response is based on evidence that the MMR vaccine is contraindicated under which condition? 1. A known allergy to gelatin. 2. A family history of autism. 3. In infants with diarrhea. 4. A known allergy to sulfonamides.

1. A known allergy to gelatin. (1. Correct: The MMR vaccine is grown using chicken embryos and manufactured with the use of gelatin. Known allergies to gelatin would be a contraindication for administration. 2. Incorrect: The Centers for Disease Control does not recognize a link between the administration of the MMR vaccine and the development of autism. 3. Incorrect: Diarrhea is not a contraindication specifically for the MMR vaccine. Diarrhea may result in hypovolumia and electrolyte imbalance which need to be addressed. 4. Incorrect: Sulfonamides are not used in the development of the MMR vaccine. Neomycin is used in the development of the MMR vaccine. Neomycin is the only antibiotic allergy that would contraindicate the administration of the MMR vaccine.)

The unlicensed assistive personnel (UAP) reports to the nurse that a client who received morphine sulfate 4 mg IVP 30 minutes ago has a respiratory rate of 10 breaths/ minute. What is the nurse's priority intervention? 1. Administer naloxone 0.4 mg IVP. 2. Notify the primary healthcare provider of respiratory status. 3. Deliver breaths at 20 breaths/ minute via a bag-valve mask. 4. Instruct the UAP to ambulate the client.

1. Administer naloxone 0.4 mg IVP. (1. Correct: The problem is respiratory depression due to morphine sulfate IV. Giving naloxone will reverse the respiratory depression. 2. Incorrect: The primary healthcare provider needs to know what happened, however, fix the problem first if you can. And we can, by giving the naloxone. 3. Incorrect: Give naloxone first and the client may not even need ventilation with a bag-valve mask. 4. Incorrect: Ambulation will not reverse the effects of the narcotic. And this is a safety issue. The client could fall.)

The nurse is caring for a client taking a selective serotonin reuptake inhibitor (SSRI). The client tells the nurse "I am sweating more than ever!" What is the nurses best response? 1. This is a common side effect of antidepressant medications. Perhaps a different antidepressant would cause less side effects. 2. Excessive sweating can have many causes. 3. I think that you should report this side effect to your primary healthcare provider. 4. This symptom should go away within a few days.

1. This is a common side effect of antidepressant medications. Perhaps a different antidepressant would cause less side effects. (1. Correct: A common side effect of SSRIs is increased sweating. This option also gives the client an explanation. 2. Incorrect: This response shows a lack of understanding of the side effects of anti depressant medications. 3. Incorrect: This option does not acknowledge the client's problem and possible causes. 4. Incorrect: Increased sweating may continue throughout treatment with an antipsychotic medication.)

The nurse is preparing to give a client's prescribed nafcillin dose. How many mL will the nurse give to the client? Answer as a whole number. Perscription: Nafcillin 500 mg IM every 6 hours Nafcillin for Injection, USP 2 grams per vial Buffered for IV or IM Use Vial contains nafcillin sodium as the monohydrate, equivalent to 2g nafcilin. Each gram is buffered with 40 mg sodium citrate and contains 66.2 [2.9 mEq] sodium. Sterile, Nonpyrogenic, Preservative-free. When reconsitituted with 6.6 mL diluent, (SEE INSERT - INTRAMUSCULAR ROUTE), each vial contains 8 mL solution. Ans:______

2 (Rationale: (500 mg ÷ 1) × (1 g ÷ 1,000 mg) × (8 mL ÷ 2 g) = (4,000 ÷ 2,000) = 2 mL Ans: 2 mL)

Which prescription should the nurse question when a client is receiving spironolactone 25 mg by mouth daily? 1. Digoxin 0.125 mg by IVP daily 2. Potassium chloride 40 mEq orally t.i.d. 3. Cimetadine 200 mg IVPB q6h 4. Metoprolol 100 mg p.o. daily

2. Potassium chloride 40 mEq orally t.i.d. (2. Correct: Do not give potassium supplements, salt substitutes, or angiotensin-converting enzyme inhibitors to clients taking potassium sparing diuretics because these drugs can increase the risk of developing high to extremely high blood potassium levels. 1. Incorrect: This medication does not adversely interact with potassium sparing diuretics; however, the nurse should be on the alert for digoxin toxicity with hyper or hypokalemia. 3. Incorrect: Cimetadine is a H₂ receptor antagonist indicated for ulcers and GI complaints. It does not adversely interact with potassium sparing diuretics. 4. Incorrect: This medication is a beta blocker, which may be given in addition to a diuretic for hypertension control.

The nurse is preparing to hang an IV bottle of fat emulsions 20% on a client. How many mL should be delivered in 12 hours? Answer in numbers only. Fat emulsions 20% IV at 17 mL/hour to run for 12 hours Liposyn II 20% 500 mL Due 01/29 @ 1400 Ans:______

204 (Rationale: 17 mL/hr × 12 hr = 204 mL Ans: 204 mL)

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

0.5 (0.125 mg ÷ 1) × (2 mL ÷ 0.5 mg) = (0.25 ÷ 0.5) = 0.5 mL Ans: 0.5 mL)

Which medications, if prescribed to a client, should indicate to a nurse that retention of CO₂ is a possibility? Select all that apply 1. Narcotics 2. Diuretics 3. Glucocorticoid steroids 4. Antiemetics 5. Hypnotics

1. Narcotics 4. Antiemetics 5. Hypnotics (1., 4. & 5. Correct: Narcotics sedate and decrease the respiratory rate, which increases CO₂ retention. Always monitor respiratory rate. Some antiemetics (such as promethazine) are very sedating and will decrease the respiratory rate while increasing CO₂ retention. Sleeping pills can cause sedation to the point of hypoventilation, which leads to CO₂ retention. Always monitor respiratory rate. 2. Incorrect: Diuretics do not affect breathing patterns. 3. Incorrect: Steroids do not affect breathing patterns.)

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

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

A primary healthcare provider has prescribed chlorpromazine 150 mg by mouth twice a day. The pharmacy sends chlorpromazine oral concentration: 100 mg/mL. How many mL should the nurse administer for each dose? Round answer using one decimal point. Ans:______

1.5 (Rationale: (150 mg ÷ 1) × (1 mL ÷ 100 mg) = (150 ÷ 100) = 1.5 mL Ans: 1.5 mL)

The nurse is caring for a client that is receiving blood that was started 2 hours ago. The nurse observes that the client has flushed cheeks. What should the nurse do first? 1. Inform the primary healthcare provider. 2. Stop the blood infusion. 3. Obtain a blood sample from the client. 4. Take vital signs.

2. Stop the blood infusion. (2. Correct: Flushing is an adverse reaction to blood transfusion. Stop the infusion immediately, then notify primary healthcare provider. 1. Incorrect: Notify the primary healthcare provider after stopping the blood transfusion. 3. Incorrect: Blood samples will be collected from the client to evaluate the reaction, but stop the transfusion first. 4. Incorrect: Take vital signs after stopping the blood transfusion.)

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

200 ×÷≈ (Rationale: (100 mL ÷ 30 min) × (60 min ÷ 1 hr) = (6,000 mL÷ 30 hr) = 200 mL/hr Ans: 200 mL/hr)

The nurse is monitoring the IV medications that a client is receiving by an IV infusion pump. How many micrograms per min of dopamine should the nurse determine that the client is receiving? Use numbers only to answer. Height: 187 cm Weight: 75.2 kg Mix Dopamine 400 mg in 250 mL of NS to yield 1600 mcg/mL Dopamine Infusing 14.1 mL/hr 5.0 mcg/kg/min

376 (Rationale: 5.0 mcg/kg/min × 75.2 kg = 376 mcg/min Ans: 376 mcg/min)

The nurse is caring for a client on the medical unit. The primary healthcare provider prescribed Lactulose 30 gram orally once a day. Available is Lactulose labeled 10 g per 15 mL. How many mL will the nurse administer? Round answer to the nearest whole number. Ans:______

45 (Rationale: (30 g ÷ 1) × (15 mL ÷ 10 g) = (450 ÷ 10) = 45 mL Ans: 45 mL)

A client has been instructed not to take non-steroidal anti-inflammatory drugs (NSAIDs) post lumbar laminectomy with spinal fusion. The nurse knows that education was successul when the client identifies which medications should be avoided? Select all that apply 1. Celecoxib 2. Ibuprofen 3. Naproxen 4. Acetaminophen 5. Indomethacin

1. Celecoxib 2. Ibuprofen 3. Naproxen 5. Indomethacin (1., 2., 3. & 5. Correct: NSAIDs, such as celecoxib, ibuprofen, naproxen, and indomethacin prevent platelet aggregation. This can result in a tendency for bleeding that interferes with healing after a laminectomy with spinal fusion surgery. 4. Incorrect: Acetaminophen is a peripheral-acting analgesic and not a non-steroidal anti-inflammatory drug.)

The primary healthcare provider has prescribed 1000 mL of D5W to infuse over a 12 hour period. The drop factor is 20 gtt/mL. How many gtt/min should the nurse administer? Round answer to the nearest whole number. Ans:______

28 (Rationale: (1,000 mL ÷ 12 hr) × (20 gtt ÷ 1 mL) × (1 hr ÷ 60 min) = (20,000 ÷ 720) ≈ 28 gtt/min Ans: 28 gtt/min)

The nurse is preparing to give 250 mL D5W IV over 2.5 hours. How many gtts/min will the nurse need to set the IV rate at? Primary IV Set, Convertible Pin, 80 Inch With Backcheck Valve And 2 Injection Sites Piggyback 15 drops/mL Ans:______

25 (Rationale: (250 mL ÷ 2.5 hr) × (15 gtt ÷ 1 mL) × (1 hr ÷ 60 min) = (3,750 ÷ 150) = 25 mL/hr Ans: 25 mL/hr)

The nurse is preparing to administer 500 mL Normal Saline to a client over the next two hours per infusion pump. What number should the nurse set the pump at to deliver the prescribed amount per hour? Ans:______

250 (Rationale: (500 mL ÷ 2 hr) = (500 ÷ 2) = 250 mL/hr Ans: 250 mL/hr)

The nurse is preparing to give a client's prescribed ceftazidime dose. How many mL will the nurse give to the client? Answer to the first decimal place. Answer with numbers and decimal only. Perscription: Ceftazidime 1 gm IM every 6 hours Tazicef Ceftazidime For Injection, USP For IM injection, IV direct (bolus) injection, or IV infusion, reconstitute with Sterile Water for injection according to the following information. The vacuum may assist entry of the diluent. SHAKE WELL. Vial Size → Diluent to Be Added → Approx. Avail. Volume Intramuscular or Intravenous Direct (bolus) Injection: 1 gram → 3.0 mL → 3.6 mL Intravenous Infusion: 1 gram → 10 mL → 10.6 mL 2 gram → 10 mL → 11.2 mL Ans:______

3.6 (Rationale: Prescription: Ceftazidime 1 gm IM every 6 hours Available: Ceftazidime 1 gm in 3.6 mL Step 1: The instructions say to add 3.0 mL sterile water for injection to the vial. Volume yields 3.6 mL.)

Shortly after being admitted to the cardiac unit, a client reports shortness of breath. The nurse prepares to administer the prescribed morphine. How many mL should the nurse administer? Use numbers and decimals only to answer. Physician Orders: Admit to cardiac stepdown unit with telemetry monitoring. Oxygen at 2 L/min. Monitor oxygen saturation. Morphine IV 2 mg every 2 hours prn shortness of breath. Furosemide IV 40 mg every 6 hours. Dobutamine 5 mcg/kg/min IV. 0.9% normal saline solution IV at 150 mL/hr. Maintain bedrest except for ambulation to bathroom. Elevate head of bed 30 degrees. Monitor vital signs hourly. Morphine Sulfate Injection, USP 5 mg/mL For SC, IM, or slow IV use not for epidural or intrathecal use 25 x 1 mL DOSETTE vials Ans:______

0.4 (Rationale: (2 mg ÷ 1) × (1 mL ÷ 5 mg) = (2 ÷ 5) = 0.4 mL Ans: 0.4 mL)

The nurse is caring for a client on the medical unit. The client has an IV of 1000 mL D5W with 50,000 units heparin. The infusion is to run at 60 mL per hour. How many units/hour is the client receiving? Round answer to the nearest whole number. Ans:______

3,000 (Rationale: (60mL ÷ 1) × (50,000 u ÷ 1,000 mL) = (3,000,000 ÷ 1,000) = 3,000 u/hr Ans: 3,000 u/hr)

The nurse is caring for a client in the emergency department. The primary healthcare provider prescribed 1,000 mL of D₅½ NS. The IV is infusing at 25 gtt/min. (Drop factor is 60 gtt/mL). What is the infusion time in hours? Round your answer to the nearest whole number. Ans:______

40 (Rationale: ×÷ (25 gtt ÷ 1 min) × (1 mL ÷ 60 gtt) × (60 min ÷ 1 hr) = (1,500 ÷ 60) = 25 mL/hr 1,000 mL ÷ 25 mL/hr = 40 hr Ans: 40 hr)

A client who has been admitted to the intensive care unit with malignant hypertension has been prescribed nitroprusside IV. BP on admit is 210/112. Weight - 56 kg. Based on the prescription, what should the flow rate for a volumetric pump be set at initially? Round to the whole number. Titrate nitroprusside 50 mg in 250 mL D5W at 3 to 6 mcg/kg/min to maintain client's systolic blood pressure below 140 mm Hg. Ans:______

50 (Rationale: Always start with the lowest dosage when beginning nitropusside. 3 mcg/kg × 56 kg = 168 mcg/min (168 mcg ÷ 1 min) × (1 mg ÷ 1,000 mcg) × (250 mL ÷ 50 mg) × (60 min ÷ 1 hr) = (2,520,000 ÷ 50,000) = 50 mL/hr Ans: 50 mL/hr)

A client has a prescription for digoxin 0.125 mg IV push every morning. Prior to administering digoxin, the nurse notes that the digoxin level drawn this morning was 0.9 ng/mL. Which action would be most important for the nurse to take? 1. Administer the digoxin. 2. Hold the digoxin. 3. Notify the primary healthcare provider. 4. Repeat the digoxin level.

1. Administer the digoxin. (1. Correct: This is a normal digoxin level. The nurse would administer the prescribed digoxin. The therapeutic serum levels of digoxin range from 0.5 to 2 ng/mL. 2. Incorrect: This is a normal digoxin level. The nurse would administer the prescribed digoxin. 3. Incorrect: There is no need to notify the primary healthcare provider of a normal digoxin level. 4. Incorrect: There is no need to repeat a normal laboratory value.)

The nurse is caring for a client taking digoxin. Which electrolyte imbalance should be of most concern? 1. Hypokalemia 2. Hyponatremia 3. Hypomagnesemia 4. Hypocalcemia

1. Hypokalemia (1. Correct: The serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity could occur. 2., 3., & 4. Incorrect: Hyponatremia, hypomagnesemia, and hypocalcemia do not interfere with digoxin. Any electrolyte imbalance can predispose the client to digoxin toxicity, but hypokalemia is the imbalance that can potentiate digoxin toxicity the most.)

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

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

After the nurse administers ear drops to an adult client, it is important for the nurse to implement which action? 1. Leave the client lying with the unaffected ear facing up. 2. Place a cotton ball firmly into the affected ear for 15 minutes. 3. Pull the pinna of the ear down and back. 4. Gently massage the tragus of the ear.

4. Gently massage the tragus of the ear. (4. Correct: This is a correct nursing measure that will facilitate the flow of medication in the auditory canal. 1. Incorrect: The client can remain on the side for 5 to 10 minutes with the affected ear up to help distribute the medication and prevent the medication from escaping the ear canal. 2. Incorrect: The cotton ball is placed loosely at the opening of the auditory canal for 15 minutes to prevent the medication from escaping the canal when the client changes positions. 3. Incorrect: The pinna is pulled up and back on an adult client when instilling the ear drops to straighten the ear canal.)

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

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

Which comment made by a new nurse regarding calcium gluconate 1000 mg (10 mL) IV indicates to the charge nurse that further education is needed? 1. "Infusion rate should be 5 mL/minute." 2. "Calcium gluconate will counteract the effects of the client's hyperkalemia." 3. "I will monitor for hypophosphatemia after administering this medication." 4. "This medication is given to reverse the effects of hypermagnesemia."

1. "Infusion rate should be 5 mL/minute." (1. Correct: Calcium gluconate is administered IVP very slowly. Rapid injection may cause vasodilation, decreased blood pressure, bradycardia, cardiac arrhythmias and even cardiac arrest. The max rate is 1.5- 2 mL/min. Administration at a faster rate would indicate further education is needed. 2. Incorrect: This is a correct statement by the new nurse, indicating that the nurse understands the use of this medication. It counteracts the effects of hyperkalemia on cardiac excitability. 3. Incorrect: This is a correct statement. Calcium and phosphorus have an inverse relationship to each other. As calcium goes up, phosphorus goes down. Hypophosaphetemia may occur after administration. 4. Incorrect: This is a correct statement. Calcium gluconate is used to treat calcium deficiencies as well as magnesium sulfate overdose.)

A client has been given information about several complementary therapies for the treatment of anxiety disorder. Which therapy selected by the client would require the nurse to check for allergies? 1. Aromatherapy 2. Biofeedback 3. Guided Imagery 4. Acupuncture

1. Aromatherapy (1. Correct: Aromatherapy is the use of essential oils from plants and herbs in the form of baths, inhalation, or compresses applied directly to the skin to promote relaxation, decrease depression and enhance sleep. Because these oils come in contact with the client's skin, or by inhalation, it would be important to verify any allergies the client may have prior to initiating therapy. 2. Incorrect: Biofeedback is progressive muscle relaxation with the use of electrodes placed on the client's skin. This therapy has been used to treat medical issues such as migraines or chronic pain. Allergies would not be a concern with this complementary therapy. 3. Incorrect: Guided Imagery, also called "visualization", uses words or sounds to direct the client on an imaginary journey within the mind. This technique for dealing with anxiety would not present any concerns about allergies. 4. Incorrect: Acupuncture is a complementary therapy that entails stimulating certain areas of the body by penetrating the skin with a variety of tiny needles in order to treat a variety of physical and emotional disorders.The nurse would not be concerned about allergies with this therapeutic treatment.)

When administering an intravenous push (IVP) medication through a continuous intravenous infusion, which intervention is most important for the nurse to take? 1. Assess for drug and solution compatibility. 2. Clamp the tubing of the large volume infusion above the injection port. 3. Stop the large volume infusion and flush the tubing . 4. Use the port nearest the client to administer the IVP medication.

1. Assess for drug and solution compatibility. (1. Correct: This would have the most life threatening affect on a client if it is not done and an incompatibility exists. Checking for incompatibility between the large volume solution and the medication is a safety issue. 2. Incorrect: This is an action that can be taken when administering an IVP medication; however, clamping the tubing does not have to be done. If the tubing is not clamped when administering the IVP medication, the medication would first go up the tubing toward the large volume container, then go toward the client when the pressure from the push is stopped. 3. Incorrect: This needs to be done if the large volume infusion solution is incompatible with the IVP medication. The action would not have to be implemented when administering all IVP medications. If incompatible, then it should be flushed. 4. Incorrect: This is recommended when administering IVP medication, but would not cause the greatest life-threatening consequences. Using the port closest to the client minimizes the distance the medication must travel, so that the medication gets to the client's circulation faster.)

A school nurse is planning a session on the effects of cannabis use for a high school health class. Which information does the nurse need to include? Select all that apply 1. Cannabis ingestion can cause tachycardia. 2. Inhaled cannabis produces a greater amount of tar than tobacco. 3. Cannabis smoke contains more carcinogens than tobacco smoke. 4. Cannabis ingestion reduces the risk for heart disease 5. Orthostatic hypotension can be caused by cannabis ingestion.

1. Cannabis ingestion can cause tachycardia. 2. Inhaled cannabis produces a greater amount of tar than tobacco. 3. Cannabis smoke contains more carcinogens than tobacco smoke. 5. Orthostatic hypotension can be caused by cannabis ingestion. (1., 2., 3. & 5. Correct: Tetrahydrocannabinol (THC) is the chemical compound in cannabis. THC enters the blood stream quickly and is transported to the brain and other organs. Within minutes, the heart rate may increase by 20-50 bpm and last for up to 3 hours. Cannabis ingestion may cause tachycardia and orthostatic hypotension. Cannabis smoke contains more carcinogens and tar than tobacco. Lowering of blood pressure during use is common and can lead to orthostatic hypotension. 4. Incorrect: Research has indicated that the ingestion of cannabis increases the risk for heart disease.)

A client diagnosed with rheumatoid arthritis has been prescribed celecoxib. What should the nurse include in the client's education regarding this medication? Select all that apply. 1. Do not take celecoxib with ibuprofen. 2. GI complaints and headache are among the most common side effects. 3. Drink a lot of water to offset the dehydration that may occur. 4. Notify the healthcare provider immediately if black stools are noted. 5. This medication provides relief of pain and swelling so you can perform normal daily activities.

1. Do not take celecoxib with ibuprofen. 2. GI complaints and headache are among the most common side effects. 4. Notify the healthcare provider immediately if black stools are noted. 5. This medication provides relief of pain and swelling so you can perform normal daily activities. (1., 2., 4., & 5. Correct: Concomitant use of celecoxib with aspirin or other NSAIDs (for example, ibuprofen, naproxen, etc.) may increase the occurrence of stomach and intestinal ulcers. This would increase the risk of GI bleeders. GI complaints and headache are two of the most common side effects. The client should stop taking celecoxib and get medical help right away if the client notices bloody or black/tarry stools. This would be an indication of GI bleeding. This medication is a nonsteroidal anti-inflammatory drug (NSAID), which relieves pain and swelling. It is used to treat arthritis. The pain and swelling relief provided by this medication should help the client perform normal daily activities. 3. Incorrect: The client may develop fluid retention while taking this medication. They should decrease the intake of sodium to decrease fluid retention.)

A nurse is planning care for a laboring client who is about to be started on oxytocin. What interventions should the nurse include in this plan of care? Select all that apply 1. Piggy back oxytocin into main IV fluid. 2. Monitor for early decelerations. 3. Discontinue if contractions last longer than 90 seconds. 4. Maintain one on one care. 5. Check fetal heart tones hourly.

1. Piggy back oxytocin into main IV fluid. 3. Discontinue if contractions last longer than 90 seconds. 4. Maintain one on one care. (1., 3., & 4. Correct: The oxytocin is piggy backed into the main IV fluid, so when the nurse discontinues the medication, the main IV fluid is quickly resumed. Contractions should be at a rate of 1 every 2-3 minutes with each lasting no more than 90 seconds. Hyperstimulation of the uterus can occur and result in fetal distress. One on one care is needed since complications such as fetal distress and uterine rupture can occur. 2. Incorrect: External continuous fetal monitoring should begin prior to oxytocin administration. A reactive fetal heart rate tracing should be obtained over 30 minutes. 5. Incorrect: Continuous fetal monitoring is must be maintained during oxytocin administration to fetus is not experiencing distress in utero with contractions.)

A client receiving torsemide 20 mg every day reports an onset of cramping in the lower extremities. Based on this report, what current lab finding would the nurse expect? 1. Potassium level of 3.1 mEq/L (3.1 mmol/L) 2. Calcium level of 11 mg/dL (2.75 mmol/L) 3. Sodium level of 140 mEq/L (140 mmol/L) 4. pH level of 7.40

1. Potassium level of 3.1 mEq/L (3.1 mmol/L) (1. Correct: Torsemide is a loop diuretic, which causes the excretion of K⁺. Hypokalemia can result from use of this diuretic. Normal range for potassium is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). Therefore the level of 3.1 mEq/L (3.1 mmoL/L) is hypokalemia, and a common sign and symptom includes muscle cramps. 2. Incorrect: Normal calcium levels in the serum are 9.0-10.5 mg/dL (2.25-2.62 mmol/L). The level of 11 mg/dL (2.75 mmol/L) is hypercalcemia. Calcium acts like a sedative, so you would expect the client's muscle tone to be weak and flaccid rather than experiencing muscle cramping. 3. Incorrect: The normal sodium level is 135 to 145 mEq/L (135 to 145 mmol/L). Therefore, a level of 140 mEq/L (140 mmol/L) is WNL and would not be a factor in the client's report of muscle cramping. 4. Incorrect: The pH level of 7.40 is also WNL and is not a lab finding that would be consistent with muscle cramping.)

What information should a nurse include when educating a client regarding buccal administration of a medication? Select all that apply. 1. This route allows the medication to get into the blood stream faster than the oral route. 2. Stinging may occur after placing the medication in the cheek. 3. If swallowed, the medication may be inactivated by gastric secretions. 4. The buccal dose of medication will need to be increased from the oral dose. 5. Remove the tablet from buccal area after 15 seconds.

1. This route allows the medication to get into the blood stream faster than the oral route. 2. Stinging may occur after placing the medication in the cheek. 3. If swallowed, the medication may be inactivated by gastric secretions. (1., 2., & 3. Correct: These are correct statements about buccal administration of medication. Buccal administration involves the medication being placed between the gums and cheek, where it dissolves and becomes absorbed into the bloodstream. The cheek area has many capillaries that allow the medication to be absorbed quickly without having to pass through the digestive system. The degree of stinging experienced depends on the medication being administered. Some effects of certain medications can be lessened by digestive processes. 4. Incorrect: When given by the buccal route, the medication does not go through the digestive system. This means that the medication is not metabolized through the liver, and thus a lower dose can be used. 5. Incorrect: Placement should be maintained until the tablet is dissolved in order to get the dosage and effects desired.)

The home health nurse is preparing to hang an IV bag of total parenteral nutrition (TPN) on a client. At what rate should the nurse set the IV infusion pump? Round to the nearest whole number. Answer in numbers and decimals only. TPN Formula (per bag): Amino Acids 5.5%: 400 mL Dextrose 10%: 350 mL Lipids 10%: 200 mL Sterile water for injection: 400 mL Final Volume: 1,350 mL Add: Calcium gluconate: 5 mEq Magnesium sulfate: 10 mEq Potassium chloride: 20 mEq Infuse 1 bag of TPN over 12 hours. Ans:______

113 (Rationale: 1,350 mL ÷ 12 hr ≈ 113 mL/hr Ans: 113 mL/hr)

The primary healthcare provider has prescribed phenytoin 100 mg intravenous push (IVP) stat for an adult client. What is the least amount of time that the nurse can safely administer this medication? 1. 1 minute 2. 2 minutes 3. 5 minutes 4. 10 minutes

2. 2 minutes (2. Correct: The rate of IV administration should not exceed 50 mg/min. for adults and 1-3 mg/kg/min (or 50 mg/min, whichever is slower) in pediatric clients because of the risk of severe hypotension and cardiac arrhythmias. So 100 mg can safely be delivered over a period of at least 2 minutes. 1. Incorrect: The rate of IV administration should not exceed 50 mg/min. for adults and 1-3 mg/kg/min (or 50 mg/min, whichever is slower) in pediatric clients because of the risk of severe hypotension and cardiac arrhythmias. So 100 mg can safely be delivered over a period of at least 2 minutes. Giving this dose over only one minute could lead to these or other potential harmful effects. 3. Incorrect: The rate of IV administration should not exceed 50 mg/min. for adults and 1-3 mg/kg/min (or 50 mg/min, whichever is slower) in pediatric clients because of the risk of severe hypotension and cardiac arrhythmias. So 100 mg can safely be delivered over a period of at least 2 minutes. Five minutes would be longer than required to be able to safely administer the medication. 4. Incorrect: The rate of IV administration should not exceed 50 mg/min. for adults and 1-3 mg/kg/min (or 50 mg/min, whichever is slower) in pediatric clients because of the risk of severe hypotension and cardiac arrhythmias. So 100 mg can safely be delivered over a period of at least 2 minutes. Ten minutes is much longer than required to be able to safely administer the medication.)

A client who is 20 weeks pregnant and diagnosed with pelvic inflammatory disease is given a prescription for metronidazole. What should the nurse inform the client to avoid in order to prevent an interaction with metronidazole? 1. Furosemide 2. Alcohol 3. Doxycycline 4. St. John's Wort

2. Alcohol (Rationale Strategies 2. Correct: Metronidazole is an antibiotic used for the treatment of vaginal infections. Metronidazole and alcohol can interact with each other, causing severe nausea and vomiting as well as cramping and flushed appearance. 1. Incorrect: Furosemide is a diuretic and does not interact with metronidazole. 3. Incorrect: Doxycycline is a tetracycline antibiotic and does not interact with metroindazole. 4. Incorrect: St. John's wort is an herbal supplement and does not interact with metronidazole.)

A client diagnosed with a deep venous thrombosis (DVT) has been prescribed warfarin. Which of the client's current medications would the nurse notify the primary healthcare provider related to the prescribed warfarin? Select all that apply 1. Metformin 2. Aspirin 3. Ginkgo 4. Amlodipine 5. Hydrochlorothiazide

2. Aspirin 3. Ginkgo (2., & 3. Correct: Aspirin's chemical classification is a salicylate. One of the actions of aspirin is to reduce platelet aggregation. Aspirin's action of reducing platelet aggregation if taken with warfarin will also increase the client's risk of bleeding. Ginkgo, a herb, has properties which will increases the risk of bleeding if prescribed in conjunction with the administration of warfarin. Gingko's properties improve blood circulation. 1. incorrect: Metformin's functional classification is an oral antidiabetic medication. Metformin is not listed as a medication that causes either an increase or decrease in the actions of warfarin. 4. Incorrect: Amlodipine's functional class is a calcium channel blocker. The interaction of warfarin and amlodipine does not result in an increase or decrease in the actions of warfarin. 5. Incorrect: Hydrochlorothiazide's functional class is a thiazide diuretic. Hydrochlorothiazide does not have any properties that will interact with warfarin to decrease or increase warfarin's actions.)

The family member of a schizophrenic client asks the nurse why the client is receiving chlorpromazine and benztropine. What is the best response by the nurse? 1. The chlorpromazine makes the benztropine more effective so a smaller dose of both drugs can be used. 2. Benztropine is given to treat the side effects produced by the chlorpromazine. 3. Chlorpromazine is used for severe hiccups that can occur with the use of benztropine. 4. Chlorpromazine is used for psychosis and benztropine is used for preventing agranulocytosis.

2. Benztropine is given to treat the side effects produced by the chlorpromazine. (2. Correct: Benztropine is used to treat parkinsonism of various causes and drug-induced extrapyramidal reactions seen with chlorpromazine, which is an antipsychotic agent. Extrapyramidal symptoms are neurologic disturbances in the area of the brain that controls motor coordination. This disruption can cause symptoms that mimic Parkinson's disease, including stiffness, rigidity, tremor, drooling and the classic "mask like" facial expression. These symptoms can be treated and are reversible using such medications as benztropine. 1. Incorrect: Chlorpromazine does not potentiate the effects of benztropine, so dosage regulation is not appropriate. 3 Incorrect: Chlorpromazine can be used for severe hiccups, but the hiccups are not the result of using benztropine. Chlorpromazine is also used for psychosis in the schizophrenic client. 4. Incorrect: Benztropine is not used to prevent agranulocytosis.)

A nurse is caring for a client who has been prescribed metoprolol. What education should the nurse provide to the client? Select all that apply 1. Information on skin turgor. 2. Check for edema in lower extremities. 3. Take medication 30 minutes prior to a meal. 4. Do not use over the counter (OTC) nasal decongestants. 5. Notify primary healthcare provider if the pulse is < 60 beats per minute.

2. Check for edema in lower extremities. 4. Do not use over the counter (OTC) nasal decongestants. 5. Notify primary healthcare provider if the pulse is < 60 beats per minute. (2., 4., & 5. Correct: Heart failure is one of the diagnoses that is an indication for the prescription on metoprolol. If the client is experiencing swelling of the lower extremities, the primary healthcare provider should be notified to evaluate the prescription of metoprolol. The client should avoid taking over the counter (OTC) nasal decongestants because they contain alpha-adrenergic stimulants, when metoprolol is prescribed. The combination of taking both medications can increase the client's risk for orthostatic hypertension. The primary healthcare provider should be notified if the client's pulse rate is < 60 beats per minute. Bradycardia is a cardiovascular side effect of metoprolol. 1. Incorrect: Skin turgor reflects the presence of dehydration. Since dehydration is not a side effect of metoprolol, the technique of monitoring skin turgor is not included in the client's medication education. 3. Incorrect: Metoprolol should be taken right after meals, and not taken prior to the meal. There is a decreased absorption rate of metoprolol with increased stomach contents.)

In which situations should the nurse notify the primary healthcare provider of a medication incident? Select all that apply. 1. Every occurrence. 2. Client is harmed or dies. 3. Medication incident is a near miss. 4. Nurse administers an incorrect dosage. 5. Client questions the medication color.

2. Client is harmed or dies. 4. Nurse administers an incorrect dosage. (2. & 4. Correct: The primary healthcare provider should be notified if harm is brought to the client or death occurs as a result of the medication incident. The primary healthcare provider should be notified if the nurse administers an incorrect dosage to the client, and an incident report needs to be completed in this situation. 1. Incorrect: The primary healthcare provider should be notified if harm is brought to the client but not for all events with medications. An incident report should be completed so the hospital can track incident patterns for quality improvement. 3. Incorrect: Near misses do not need to be reported to the primary healthcare provider. Following the rights of medication administration every time ensures medication error prevention. 5. Incorrect: The nurse should answer questions regarding medication color. Depending on the manufacturer, the shape and color of the medication can vary.)

Which signs and symptoms would the nurse expect to see in a client who has taken prednisone for two months? Select all that apply. 1. Weight loss 2. Decreased wound healing 3. Hypertension 4. Decreased facial hair 5. Moon face

2. Decreased wound healing 3. Hypertension 5. Moon face (2., 3. & 5. Correct: Decreased wound healing is a side effect with prolonged steroid use due to the immunosuppressive effects. All steroid medications, such as prednisone, can lead to sodium retention which then leads to dose related fluid retention. Hypertension is seen due to this fluid and sodium retention. Cushingoid appearance (moon face) is a side effect that is created from the abnormal redistribution of fat from prolonged steroid use. 1. Incorrect: Within one month after corticosteroid administration, weight gain is seen rather than weight loss. 4. Incorrect: Facial and body hair increase with prolonged steroid use. This excessive growth of body hair, known as hirsutism, is one of the numerous potential side effects of prednisone.)

The nurse is caring for a client with Addison's disease that is taking fludrocortisone 0.1mg/day. What assessment data by the nurse would suggest that the client's dose is too high? Select all that apply 1. Weight loss of 2 lbs (0.907 kg)/24 hours 2. Elevated serum sodium level 3. Bilateral pedal edema 4. Crackles in the lung fields bilaterally 5. Elevated blood pressure

2. Elevated serum sodium level 3. Bilateral pedal edema 4. Crackles in the lung fields bilaterally 5. Elevated blood pressure (2., 3., 4., & 5. Correct: Now, remember that with Addison's disease the client does not have enough steroids, so we have to ADD steroids. All of these options indicate the client is holding onto fluid, and we would expect the client to hold onto fluid when their steroid dose is too high. 1. Incorrect: We would expect weight gain with this client, and what is the amount of weight gain we worry about? That's right, anything over 2-3 lbs (0.907 - 1.360 kg) in 24 hours.

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

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

What is the primary electrolyte imbalance that the nurse should monitor for in a client who is receiving an insulin infusion? 1. Hypernatremia 2. Hypokalemia 3. Hypocalcemia 4. Hypophosphatemia

2. Hypokalemia (2. Correct: Insulin causes movement of potassium into the cells, which can lead to a severe reduction in serum potassium if not regulated appropriately. A severe decrease in serum potassium could be fatal. 1. Incorrect: Although insulin has been shown to increase sodium reabsorption in the kidneys, the change is not as rapid and not as life threatening as the change in potassium. 3. Incorrect: A significant change in the calcium level is not anticipated with the insulin infusion. 4. Incorrect: A significant change in the phosphorus level is not anticipated with the insulin infusion.)

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

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

A client calls the clinic to ask the nurse if it would be okay to take the herbal medication kava-kava to help reduce anxiety. What is the nurse's best response? 1. "Why do you want to take kava-kava?" 2. "I really doubt your primary healthcare provider will approve you taking kava-kava." 3. "Kava-kava can cause liver damage, so we need to consult your healthcare provider." 4. "Do not take Kava-kava for more than a year without a primary healthcare provider's supervision."

3. "Kava-kava can cause liver damage, so we need to consult your healthcare provider." (3. Correct: Kava-kava can cause liver damage. It is recommended that if if taking kava-kava the client should be under the direct supervision of a primary healthcare provider. 1. Incorrect: The client has already answered that: anxiety. This question will put the client on the defensive. This is an example of nontherapeutic communication technique asking for explanations. 2. Incorrect: Judgmental response. This will put the client on the defensive. This is an example of the nontherapeutic communication technique of an aggressive response. 4. Incorrect: You should not take this drug for longer than 3 months without a primary healthcare provider's supervision. There have been recent reports that kava-kava causes liver damage.)

A client is given an intramuscular injection of morphine following a laparoscopic cholecystectomy four hours ago. What client data would best indicate to the nurse that the medication has been effective? 1. Rates pain as 6 on 1-10 scale. 2. Heart rate is within normal limits. 3. Ambulates with assistance of one. 4. Voided 250 mL in 4 hours.

3. Ambulates with assistance of one. (3. Correct: The client's ability to ambulate with one assistant indicates that pain is controlled enough to get out of bed. Even a laparoscopic procedure can cause extreme discomfort in the immediate post-op period. This action is the best indicator the client has experienced some pain relief. 1. Incorrect: Although a baseline pain measurement is not noted, a level of 6 on the 1-10 scale is still very elevated. This client response indicates the morphine was not effective. 2. Incorrect: Many clients do become tachycardic in response to pain; however, with no baseline to compare, a heart rate within normal levels is not the best indicator of effective pain medication. 4. Incorrect: The amount and ability to void does not provide evidence of successful pain control. The voiding instinct is rarely affected by pain.)

A client is admitted with new onset hyperthyroidism. Which medication is of concern to the nurse while reviewing the client's routine medications? 1. Ranitidine 2. Furosemide 3. Amiodarone 4. Propranolol

3. Amiodarone (3. Correct: Amiodarone, a class III anti-arrhythmic drug, has multiple effects on myocardial depolarization and repolarization that make it an extremely effective antiarrhythmic drug. However, amiodarone is associated with a number of side effects, including thyroid dysfunction (both hypo- and hyperthyroidism), which is due to amiodarone's high iodine content and its direct toxic effect on the thyroid. 1. Incorrect: Ranitidine has not been found to contribute to the development of hyperthyroidism or hypothyroidism. 2. Incorrect: Furosemide has not been found to affect the thyroid. 4. Incorrect: Beta blockers are given to hyperthyroid clients to decrease myocardial contractility BP, and HR. It also decreases anxiety. This will help the hyperthyroid client.)

Donepezil has been prescribed to a client with cognitive impairment. Which statement by the family member indicates understanding of the nurse's instructions on this medication? 1. This medicine will control agitation and aggression. 2. This medication should be given at bedtime since it is for insomnia. 3. Notify the primary healthcare provider if the client is vomiting coffee ground material. 4. This drug is given as needed for confusion.

3. Notify the primary healthcare provider if the client is vomiting coffee ground material. (3. Correct: A rare but very serious side effect that can occur: black stools, vomit that looks like coffee grounds, severe stomach/abdominal pain. Notify the primary healthcare provider immediately. 1. Incorrect: An antipsychotic medication such as risperidone is used for agitation, aggression, hallucinations, thought disturbances, and wandering. Donepezil helps to decrease the symptoms of dementia (impairment of memory, judgment, abstract thinking and personality changes) in client's with Alzheimer disease. 2. Incorrect: Donepezil should be given in the evening just before bedtime, however, it is not for insomnia. Sedative/hypnotics such as zolpidem and temzaepam are given for insomnia. 4. Incorrect: Donepezil should be given regularly in order to get the most benefit from it. Do not stop taking it or increase the dosage unless the primary healthcare provider changes the dose. It may take a few weeks before the full benefit of this drug takes effect.)

A client was prescribed thioridazine hcl five days ago and presents to the emergency department with a shuffling gait, tremors of the fingers, drooling, and muscle rigidity. Which adverse reaction to this medication does the nurse suspect? 1. Akinesia 2. Neuroleptic malignant syndrome 3. Pseudoparkinsonism 4. Oculogyric crisis

3. Pseudoparkinsonism (3. Correct: Pseudoparkinsonism may appear 1 to 5 days following initiation of antipsychotic medications: occurs most often in women, the elderly, and dehydrated clients. Symptoms include tremor, shuffling gait, drooling, and rigidity. 1. Incorrect: Akinesia is defined as muscle weakness. This client is not presenting with this symptom. 2. Incorrect: Neuroleptic malignant syndrome is a rare, but fatal complication of neuroleptic drugs. Symptoms include hyperpyrexia up to 107 degrees, tachycardia, tachypnea, fluctuations in BP, diaphoresis, coma. 4. Incorrect: Oculogyric crisis is uncontrolled rolling back of the eyes and may appear as part of dystonia (involuntary muscular movements of face, arms, legs, and neck). Oculogyric crisis is not a side effect of thioridazine.)

The nurse is preparing to administer 0800 medications to a client. How many mg of Citalopram should the nurse administer? Aspirin 325 mg tab: 0800 Citalopram 20 mg (Take 1 tablet daily (with 10 mg = 30 mg)): 0800 Citalopram 10 mg (Take 1 tablet daily (with 20 mg = 30 mg)): 0800 Divalproex 250 tab (Take 1 tablet 3 times daily): 0800 Diagnosis: CHF, A-Fib, Seizures, HTN Allergies: Cephalosporins, Penicillin, Sulfa

30 (Look at the medical record for medications. There are two doses of citalopram written: Citalopram 10 mg 1 tablet daily with a 20 mg tab totaling 30 mg. Citalopram 20 mg 1 tablet daily with a 10 mg tab totaling 30 mg. So, the nurse will administer 30 mg of citalopram.)

A nurse is teaching a client about the prescription aripiprazole discmelt. The nurse documents that teaching has been effective when the client makes which statement? 1. "If I start to have shakiness and sweating I need to call my primary healthcare provider at once." 2. "I must be certain to take this medication with food to eliminate vomiting." 3. "If I miss a dose of medication, I need to take an extra dose to make up for the missed dose." 4. "I will allow the tablet to dissolve in my mouth."

4. "I will allow the tablet to dissolve in my mouth." (4. Correct: Discmelt is an orally disintegrating tablet. Since this tablet is formulated to dissolve on the tongue, the tablet should not be swallowed. 1. Incorrect: Hyperglycemia can occur. Signs/symptoms include polydipsia, polyphasia, polyuria. Hyperglycemia is a potential adverse reaction of aripiprazole discmelt. The symptoms listed are indicative of hypoglycemia. 2. Incorrect: Can be taken with or without food. Aripiprazole can be taken with or without food. Taking the medication with food does not increase or decrease side effects. 3. Incorrect: Skip the missed dose if it is almost time for the next scheduled dose. Do not take extra medication to make up for missed dose.)

The nurse is caring for a client who is wheezing and struggling to breathe. Which inhaled medications might be indicated at this time? Select all that apply 1. Fluticasone 2. Salmeterol 3. Theophylline 4. Albuterol 5. Levalbuterol

4. Albuterol 5. Levalbuterol (4., & 5. Correct: Albuterol and levalbuterol are both rapid acting bronchodilators, that will quickly relieve shortness of breath, chest tightness and wheezing. This client is in distress now. Either medication would be indicated. 1. Incorrect: Fluticasone is a corticosteroid that is used regularly to receive the most benefit. It does not work immediately but may take 12 hours to several days to get the full benefit. Steroid use is for control of symptoms. This client is having symptoms now. 2. Incorrect: Long acting bronchodilators are not for use in an emergency. Salmeterol is an inhaled corticosteroid. It will not stop an asthma attack or breathing problem once it has begun. 3. Incorrect: Theophylline is inexpensive but it is often not utilized as a first line treatment. Takes a long time for this to work, and its purpose is to prevent frequency of attacks, not for emergency use.)

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

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

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

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

The nurse is caring for a client on the pediatric unit. The primary healthcare provider prescribes phenytoin 30 mg by mouth every 8 hours for a client weighting 18 kg. The recommended dosage is 5 mg/kg/day. What does the nurse determine is the safe dosage for the child in mg/day? Round your answer to the nearest whole number. Ans:______

90 (Rationale: 5 mg × 18 kg = 90 kg/day Ans: 90 kg/day)

The nurse is monitoring the IV medications that a client is receiving by an IV infusion pump. How many milligrams per hour of epinephrine should the nurse determine that the client is receiving? Round to the second decimal place. Use numbers only to answer. IV Infusion Pump: Infusing 15.0 mL/h 1.0 mcg/min Epinephrine Infusing 14.1 mL/h 5.0 mcg/kg/min Dopamine Infusing 3.0 mL/h 10.0 mcg/min Nitroglycerin Ans:______

0.06 (Rationale: (1 mcg ÷ 1 min) × (1 mg ÷ 1,000 mcg) × (60 min ÷ 1 hr) = (60 ÷ 1,000) = 0.06 mg/hr Ans: 0.06 mg/hr)

The primary healthcare provider prescribes an intravenous infusion of D5W at 125 mL per hour. The tubing has a drop factor of 20 gtt/mL. How many drops per minute should the nurse administer? Round answer to the nearest whole number. Ans:______

42 (Rationale: (125 mL ÷ 1 hr) × (20 gtt ÷ 1 mL) × (1 hr ÷ 60 min) = (2,500 ÷ 60) ≈ 42 gtt/min Ans: 42 gtt/min)

The nurse is caring for a client in the emergency department. In what order would a nurse correctly administer an intravenous push (IVP) medication through a continuous IV infusion of normal saline? Check medication label with healthcare provider's prescription Adminisiter medication while assessing IV site Restart IV pump Stop IV pump Cleanse port closest to IV insertion site with an alcohol wipe. Draw up ordered dose of medication aseptically.

Check medication label with healthcare provider's prescription Draw up ordered dose of medication aseptically. Stop IV pump Cleanse port closest to IV insertion site with an alcohol wipe. Adminisiter medication while assessing IV site Restart IV pump (First, check medication label with healthcare provider's prescription. Second, draw up ordered dose of medication aseptically. Third, stop the infusion pump. Fourth, cleanse the port closest to the IV insertion site with an alcohol wipe. Fifth, administer medication while assessing IV site. Sixth, restart IV pump.)

The nurse is preparing to give a client's prescribed glargine dose. How many mL will the nurse give to the client? Answer to the second decimal place. Answer with numbers and decimal only. Glargine 35 units SQ every morning Lantus 100 units/mL Insulin glargine (rDNA origin) 10 mL Multiple-dose vial Ans:______

0.35 ×÷ (Rationale: (35 u ÷ 1) × (1 mL × 100 u) = (35 ÷ 100) = 0.35 mL Ans: 0.35 mL)

The nurse is preparing to give a client's prescribed azithromycin dose. How many tablets will the nurse give to the client? Answer with numbers only. Azithromycin 1 gram by mouth times one dose now Zithromax (azithromycin) tablets 500 mg* Store between 15° to 30°C (50° to 86°F). Dispense in tight (USP), child-resistant containers. *Each tablet contains azithromycin dihydrate equivalent to 500 mg of azithromycin. Ans:______

2 (Rationale: (1g ÷ 1) × (1,000 mg ÷ 1 g) × (1 tab ÷ 500 mg) = (1,000 ÷ 500) = 2 tab Ans: 2 tab)

The primary healthcare provider prescribes nafcillin 0.6 gram every 12 hours IM. Available is a vial labeled 200 mg per 1 mL. How many mL should the nurse give? Round your answer to the nearest whole number. Ans:______

3 (Rationale: (0.6 g ÷ 1) × (1,000 mg ÷ 1g) × (1 mL ÷ 200 mg) = (600 ÷ 200) = 3 mL Ans: 3 mL)

The nurse is caring for a client who is to receive an antibiotic in 50 mL of D5W over 30 minutes using an infusion pump. The nurse will set the infusion pump to deliver how many mL per hour? Round answer to the nearest whole number. Ans:______

100 (Rationale: ×÷ (50 mL ÷ 30 min) × (60 min ÷ 1 hr) = (3,000 ÷ 30) = 100 mL/hr Ans: 100 mL/hr)

A client has a prescription for nitroglycerin gr 1/400 SL prn for angina pain. How many tablets should the nurse give the client? Use numbers and decimals only. Nitroglycerin tablets, USP Rx Only 0.3 mg (1/200 gr) 100 Sublingual Tablets Ans:______

0.5 (Rationale: (0.0025 gr ÷ 1) × (0.3 mg ÷ 0.005 gr) × (1 tab ÷ 0.3 mg) = (0.00075 ÷ 0.0015) = 0.5 tab Ans: 0.5 tab)

A client has sublingual (SL) nitroglycerin prn added to their medication regimen. Which statements made by this client indicates teaching has been effective? Select all that apply 1. "I will take this medication if I have an episode of chest pain." 2. "I will wait at least 1 hour after I take my erection agent before using Nitroglycerin." 3. "I can take up to 3 tablets every 10 minutes if my angina occurs." 4. "I know that I must put this tablet under my tongue for it to work." 5. "I will keep my medication handy, in a pocket."

1. "I will take this medication if I have an episode of chest pain." 4. "I know that I must put this tablet under my tongue for it to work." (1. & 4. Correct: Nitroglycerin should be used for chest pain and sublingual should be placed under the tongue. 2. Incorrect: Nitroglycerin should not be used with erection agents, as extreme hypotension may occur. 3. Incorrect: Take one tablet every 5 minutes x 3 doses. 5. Incorrect: Nitroglycerin should be keep in a cool, dark place.)

The nurse is caring for a client with chronic renal failure who receives dialysis treatment. Which findings would indicate to the nurse that the client's AV shunt is patent? Select all that apply. 1. A bruit is heard with a stethoscope. 2. A thrill is felt on palpation. 3. There is a blood return on the venous side of the shunt. 4. Urine output greater than 30 mL/hr. 5. There is a strong radial pulse in the arm with the AV shunt.

1. A bruit is heard with a stethoscope. 2. A thrill is felt on palpation. (1, & 2. Correct: AV shunts should have the presence of a bruit and a thrill which indicates patency. 3. Incorrect: IV sticks should not be performed on the shunt or the extremity where the shunt is placed except for initiating dialysis. 4. Incorrect: This is not related to patency of AV shunt. This would be related to assessing the patency of an indwelling catheter. 5. Incorrect: Radial pulse does not determine patency of AV shunt. Only the confirmation of a bruit and a thrill ensure patency.)

A client weighing 155 pounds (70 kg) is admitted to the burn unit with second and third degree burns covering 40% total body surface area. Normal Saline IV fluid resuscitation is ordered at 4 mL/kg per percentage of total body surface area burned over the first 24 hours. How much fluid does the nurse calculate the client will receive in 24 hours? Provide your answer using numbers and decimal points only. Ans:______

11,200 (Rationale: 4 mL × 70 kg × 40 = 11,200 Ans: 11,200)

Two days after being prescribed enoxaparin the nurse notes hematemesis. Lab work has been obtained. Based on this data what action is most important for the nurse to take? Hemaglobin: 10.0 g/dL Hematocrit: 40% RBCs: 4.5 Platelets: 90,000 Guaiac stool: + for occult blood 1. Administer protamine sulfate. 2. Administer the next dose of enoxaparin. 3. Obtain vital signs. 4. Insert a nasogastric tube.

1. Administer protamine sulfate. (1. Correct: This client has a low hgb, hct, and platelet count and is actively bleeding. Protamine sulfate is the antidote for enoxaparin. 2. Incorrect: Administering another dose of enoxaparin would make the problem worse. The client is actively bleeding and has a low platelet count. 3. Incorrect: The client is actively bleeding. Obtaining vital signs is delaying treatment. The client needs protamine sulfate. 4. Incorrect: The client needs protamine sulfate to correct the problem.)

The client has been taking divalproex for the management of bipolar disorder. The nurse should give priority to monitoring which laboratory test? 1. Alanine aminotransferase (ALT) 2. Serum glucose 3. Serum creatinine 4. Serum electrolytes

1. Alanine aminotransferase (ALT) (1. Correct: ALT levels will increase primarily in liver damage/disorders. A side effect of administering divalproex is drug-induced hepatitis. 2. Incorrect: Divalproex is not expected to alter glucose metabolism. 3. Incorrect: Divalproex should not cause a change in renal function. 4. Incorrect: Divalproex should not interfere with electrolytes balance.)

What is the best instruction the nurse should provide when administering acetylsalicylic acid 81 mg to a client experiencing severe, crushing chest pain radiating up the left jaw? 1. Chew the acetylsalicylic acid prior to swallowing. 2. Place the acetylsalicylic acid under the tongue so that it can dissolve. 3. Swallow the acetylsalicylic acid tablet. 4. Insert the acetylsalicylic acid between the cheek and gum for greater absorption.

1. Chew the acetylsalicylic acid prior to swallowing. (1. Correct: Acetylsalicylic acid has been shown to decrease mortality and re-infarction rates after MI. The fastest way to get the aspirin into the circulatory system is to have the client chew the acetylsalicylic acid prior to swallowing. 2. Incorrect: Nitroglycerin is administered sublingual (SL) or buccal. Initially acetylsalicylic acid is administered by chewing the tablet or swallowing the tablet. 3. Incorrect: If a solid dose pill is prescribed, the pill should be chewed. Faster absorption is obtained from chewing, rather than swallowing acetylsalicylic acid. 4. Incorrect: Nitroglycerin is administered SL or buccal. Initially acetylsalicylic acid would be chewed to increase the absorption rate.)

While in the emergency department, a 68 year old client being treated for flu symptoms, became symptomatic with an episode of atrial tachycardia which was successfully treated with cardioversion. After stabilization, the client was admitted to the telemetry unit with a diagnosis of the flu, and a history of angina. Primary healthcare provider prescriptions were received. What is most important for the nurse to ensure prior to administering Peramivir? Prescriptions: Bedrest with bathroom privileges. Continuous cardiac monitoring. ½ Normal Saline at 75 mL/hour. 2 gm Low sodium diet. Peramivir 600 mg IVPB times one dose. ECG every 8 hours times three. Lab: CBC, sodium, potassium, BNP, Troponin, Creatinine clearance, Urinalysis 1. Creatinine clearance is greater than 50 mL/min. 2. Pulse greater than 70 beats/min. 3. Cardiac rhythm showing normal sinus rhythm. 4. Oral temperature less than 101° F (38.3° C)

1. Creatinine clearance is greater than 50 mL/min. (1. Correct: The dose of this medication needs to be decreased if the creatinine clearance of a client is less than 50 mL/min, so the nurse must know the prescribe creatine clearance level of this client prior to administering peramivir. 2. Incorrect: Few side effects or adverse reactions are noted with peramivir. There is no need to monitor the heart rate prior to administration. 3. Incorrect: Few side effects or adverse reactions are noted with peramivir. There is no need to monitor the cardiac rhythm prior to administration. 4. Incorrect: Few side effects or adverse reactions are noted with peramivir. There is no need to monitor the temperature prior to administration.)

The drug nadolol is prescribed for a client with stable angina. Which findings would indicate to the nurse that the drug is effective? Select all that apply. 1. Decreased anxiety 2. Relief of chest pain 3. Bounding pulses 4. Lowered blood pressure 5. Bradycardia

1. Decreased anxiety 2. Relief of chest pain 4. Lowered blood pressure (1., 2., & 4. Correct: Nadolol is a beta-blocking agent. Beta-blockers block the beta 1 adrenergic receptor cells in the heart, thereby decreasing heart rate, contractility, and blood pressure. These effects decrease the workload on the heart. With decreased oxygen demand (workload on the heart), chest pain is relieved. Beta-blockers decrease cardiac contractility, thereby decreasing cardiac output. Beta blockers also relieve anxiety. 3. Incorrect: Bounding pulses would indicate fluid volume excess, thus making the problem worse. 5. Incorrect: Nadolol is a beta-blocking agent, which blocks the beta 1 adrenergic receptor cells in the heart, thereby decreasing heart rate; however, decreasing the heart rate to the point of bradycardia would be an adverse effect.)

The nurse is preparing to administer 0900 medications. Which medications should the nurse include? Overdue Medications: Heparin 5,000 units SC Q8H Medications Due: Escitalopram 10 mg PO Daily Conjugated Estrogens 0.625 mg PO Daily Omeprazole 20 mg PO BID Lopressor 25 mg PO TID (Hold if Sys BP <90, HR <55) Magnesium Gluconate PO 1 tab daily (Sliding Scale) Labs: Creatinine 0.77 mg/dL Magnesium 2.0 mg/dL Temp 98.8 (37.1), HR 60, RR 22, BP 88/60 Sliding Scale for Magnesium Gluconate: For Magnesium lab value less than 1.8, give one tablet daily. For Magnesium lab value within normal limits, hold magnesium. For Magnesium lab value greater than 2.5, notify the primary healthcare provider. Select all that apply 1. Heparin 2. Escitalopram 3. Conjugated estrogens 4. Omeprazole 5. Lopressor 6. Magnesium gluconate

1. Heparin 2. Escitalopram 3. Conjugated estrogens 4. Omeprazole 1., 2., 3., & 4. Correct: Heparin was due at 0800 and is now overdue, so the nurse needs to administer this medication now. The other three medications are scheduled for 0900. 5. Incorrect: Lopressor needs to be held based on the prescription to hold the medication for a systolic BP below 90. This clients current BP is 88 systolic. 6. Incorrect: The latest magnesium lab value is within normal limits. Based on the prescription, this medication should be held.)

The nurse is teaching the client about benzodiazepines. Which comments by the client indicate adequate understanding of the drug effects/side effects? Select all that apply. 1. I should not drive my car until I see how the medication affects me. 2. I can expect my reaction time to be slowed in the beginning. 3. I may need to double the dose if I continue to be anxious. 4. I must be careful to take the medication for a limited time. 5. There is a risk for dependence on this medication.

1. I should not drive my car until I see how the medication affects me. 2. I can expect my reaction time to be slowed in the beginning. 4. I must be careful to take the medication for a limited time. 5. There is a risk for dependence on this medication. (1., 2., 4. & 5. Correct: Benzodiazepines slow reaction time and may affect general alertness. The client should not operate machinery until effects of the medication are observed, and client can drive safely. Benzodiazepine medications are usually prescribed for short periods of time. Benzodiazepines are frequently abused. Clients develop tolerance and dependence on the drugs. 3. Incorrect: The client should not self-regulate dosage. There is a potential for tolerance and dependence to develop. Dosage should be monitored carefully by the primary healthcare provider.)

The nurse has been educating a client on a new prescription for amitriptyline 25 mg PO twice a day. The nurse recognizes that teaching has been successful when the client makes which statement? 1. I will wear long sleeves and a hat when I go for my afternoon walks. 2. I will limit my alcohol intake to one glass of red wine with supper. 3. I need to limit my fluid intake in order to avoid fluid retention. 4. I need to maintain a high calorie diet and eat 6-8 small meals a day.

1. I will wear long sleeves and a hat when I go for my afternoon walks. (1. Correct: When taking tricyclic antidepressants such as amitriptyline, the skin may be sensitive to sunburn. Use sunscreens, wear protective clothing and sunglasses. 2. Incorrect: Alcohol should be avoided while taking antidepressant medications. These drugs potentiate the effects of each other. 3. Incorrect: An increase in fluid intake (unless contraindicated) is recommended along with foods high in fiber and exercise to avoid constipation. 4. Incorrect: Weight gain is common. Provide instructions for reduced calorie diet. Encourage increased level of activity if appropriate.)

A 9 month old with asthma symptomology has montelukast sodium oral granules prescribed. What is the most appropriate way for the nurse to instruct the parent on how to administer the medication? 1. Mix the granules with a spoonful of baby food such as applesauce. 2. Pour the granules directly on the back of the infant's tongue. 3. Dissolve the granules in an 8 ounce (240 mL)bottle of juice. 4. Administer the medication in the morning mixed in a bowl of rice cereal.

1. Mix the granules with a spoonful of baby food such as applesauce. (1. Correct: Applesauce is an appropriate baby food for a 9 month old infant. The medication is being mixed with a very small amount of baby food to facilitate all of the medication being consumed. 2. Incorrect: Although the medication can be administered directly into the mouth, a 9 month old is not likely to tolerate medication granules being placed in the back of the mouth and would likely spit the medication out or gag when the medication is placed in the back of the mouth, 3. Incorrect: The medication is being placed in too much juice. The infant might not drink this amount and would not receive all of the medication ordered. 4. Incorrect: If the child does not eat the entire amount of the cereal, the child would not receive the prescribed dose of the medication.)

Which signs and symptoms would indicate to the nurse that the client is having an anaphylactic response after receiving penicillin? Select all that apply 1. Reports a scratchy throat 2. Faint expiratory wheeze on auscultation. 3. Client statement, "I feel like something is wrong." 4. Bounding radial pulse rate of 100/min 5. BP 100/70

1. Reports a scratchy throat 2. Faint expiratory wheeze on auscultation. 3. Client statement, "I feel like something is wrong." (1., 2. & 3. Correct: Swelling of face, mouth, throat, and a scratchy throat are indicative of an inflammatory response that could obstruct the airway. Wheezes and stridor are indicators of breathing difficulties seen with anaphylactic reaction. A sense that something bad is happening should serve as a warning that something bad is really going on. Suspect anaphylactic response. 4. Incorrect: The pulse rate would be increased, but the client would have a thready, weak pulse, not bounding. The pulse may also be irregular. 5. Incorrect: This blood pressure is not below 90 systolic which could indicate shock. Although on the low side, simply getting this BP reading does not tell you if perfusion is adequate. Once blood pressure decreases, other symptoms may appear such as dizziness, blurred vision and loss of bladder/bowel control.)

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

150 (Physician Order: 0.9% Normal Saline Solution IV at 150 mL/hour.)

The son of a client diagnosed with Alzheimer's Disease who is listed as a person who has access to the client's health information asks the nurse why his father has been prescribed donepezil. What response should the nurse make? 1. "Depression is often treated with this medication." 2. "This medication is used to treat confusion." 3. "Behavioral problems are diminished when the client receives this medication." 4. "This medication will address sleep disturbances."

2. "This medication is used to treat confusion." (2. Correct: Donepezil is a cholinesterase inhibitor. It improves the function of nerve cells in the brain. It works by preventing the breakdown of acetylcholine. People with dementia usually have lower levels of this chemical, which is important for the processes of memory, thinking, and reasoning. Donepezil is used to treat mild to moderate dementia caused by Alzheimer's disease. 1. Incorrect: Common antidepressant medications used for treating depression related to Alzheimer's are the selective serotonin reuptake inhibitors (SSRIs). 3. Incorrect: Antipsychotics and Benzodiazepines are used for behavioral problems such as agitation, physical aggression, and disinhibition. 4. Incorrect: Zolpidem is the most common prescription used to help with sleep disturbance found in the client diagnosed with Alzheimer's Disease.)

The nurse is caring for a client diagnosed with herpes varicella zoster. What pharmacologic agent should the nurse anticipate the primary healthcare provider will prescribe? 1. Metronidazole 2. Acyclovir 3. Ceftriaxone 4. Ampicillin

2. Acyclovir (2. Correct: Herpes varicella zoster is a virus that causes chickenpox in children and shingles in adults. An antiviral such as acyclovir, is indicated. 1. Incorrect: Herpes varicella zoster is a virus; an antiviral is indicated, not a nitromodazole antimicrobial, such as metronidazole. Metronidazole may have additional classifications such as: amebecide, antibiotic, antibacterial, etc. 3., & 4. Incorrect: Herpes varicella zoster is a virus; an antiviral is indicated, not an antibiotic.)

A client comes into the clinic for a routine check-up during the second trimester of pregnancy. The client reports gastrointestinal (GI) upset and constipation. The nurse reviews the client's medications. Which client medication is most commonly associated with GI upset and constipation? 1. Calcium supplement 2. Ferrous sulfate 3. Folic acid 4. Cetirizine

2. Ferrous sulfate (2. Correct: Ferrous sulfate commonly causes constipation and GI upset. These side effects can be diminished with proper teaching regarding diet and taking medication with food. 1. Incorrect: Calcium may cause constipation but generally relieves symptoms associated with gastric acid indigestion. Calcium is often used for the treatment of transient acid indigestion and heartburn. 3. Incorrect: Constipation and GI upset are not generally associated with folic acid administration. 4. Incorrect: Constipation is an adverse effect associated with cetirizine administration, since it is an antihistamine.)

Which nursing intervention should the nurse implement when administering a medication through a nasogastric (NG) tube? 1. Place the client in a high-Fowler's position for medication administration. 2. Flush the tubing between administering medications 3. Turn the client onto their left side after medication administration. 4. Mix the medication directly into the tube feeding

2. Flush the tubing between administering medications (2. Correct: The NG tube should be flushed with appropriate facility approved amount of fluid between medications. The amount of the flushing solution should be added to the intake amount. 1. Incorrect: Semi-Fowler's position is the position of choice for administering tube feedings. This position helps prevent aspiration and promotes digestion. The volume of fluid administered with medication administration is usually much smaller than with tube feedings, so high-Fowler's is not required. 3. Incorrect: The left side position slows gastric emptying, which could lead to aspiration. The right side is the position that best promotes gastric emptying. 4. Incorrect: Do not mix medications in the enteral feeding solution. The tube feeding rate may be prescribed at different rates or the tube feeding can be held for a designated time. The proper administration of the medication could not be determined.)

A postpartum client is receiving methylergonovine maleate 0.2 mg by mouth three times a day. What is most important for the nurse to monitor with this client? 1. Dizziness 2. Hypertension 3. Nausea and vomiting 4. Headache

2. Hypertension (2. Correct: Methylergonovine affects smooth muscle of a woman's uterus. It improves muscle tone and strength. It is used after childbirth to help deliver the placenta. Cardiovascular side effects have included palpitations, hypertension, hypotension, acute myocardial infarction, transient chest pains, arterial spasm (coronary and peripheral), bradycardia, and tachycardia. These need to be reported to the primary healthcare provider. 1. Incorrect: Dizziness is a rare side effect and not as life threatening as hypertension. 3. Incorrect: Nausea and vomiting are minor signs and symptoms and not as life threatening as hypertension. 4. Incorrect: Headache is a minor symptom and not as life threatening as hypertension.)

A client has been prescribed levothyroxine sodium. What should the nurse teach the client about this medication? Select all that apply 1. Treatment will last for one year. 2. Notify the primary healthcare provider of chest pain. 3. Take medication ½ hour before breakfast. 4. Take calcium supplements 4 hours after taking levothyroxine. 5. Improvement of symptoms will occur within 2 days.

2. Notify the primary healthcare provider of chest pain. 3. Take medication ½ hour before breakfast. 4. Take calcium supplements 4 hours after taking levothyroxine. (2., 3. & 4. Correct: Levothyroxine is a replacement for a hormone normally produced by the thyroid gland to regulate the body's energy and metabolism. It is given when the thyroid does not produce enough of this hormone on its own. Levothyroxine treats hypothyroidism and is also used to treat or prevent goiter, which can be caused by hormone imbalances, radiation treatment, surgery, or cancer. Chest pain is a rare but serious side effect of levothyroxine and must be reported immediately. Levothyroxine works best if taken on an empty stomach, at least 30 minutes before breakfast. The client should follow dosing instructions and try to take the medicine at the same time each day. Certain medicines can make levothyroxine less effective if taken at the same time. Iron, calcium and antacids decrease absorption of levothyroxine sodium. If using any of the following drugs, avoid taking them within 4 hours before or 4 hours after taking levothyroxine: calcium carbonate, cholestyramine, colestipol, ferrous sulfate iron supplement, sucralfate, sodium polystyrene sulfonate, antacids that contain aluminum or magnesium. 1., & 5. Incorrect: It may take several weeks before the body starts to respond to levothyroxine. The client should keep using this medicine even if feeling well. This medication may need to be taken for the rest of the client's life to replace the thyroid hormone the body cannot produce.)

The nurse is preparing to discharge a client who has been placed on tranylcypromine. The nurse teaches the client about food to avoid while taking this medication. What food choice by the client confirms appropriate understanding of the teaching? 1. Cottage cheese 2. Salami 3. Baked chicken 4. Potatoes

2. Salami (2. Correct: The client taking a monoamine oxidase inhibitor (MAOI) such as tranylcypromine should avoid foods rich in tyramine or tryptophan. These include: cured foods, those that have been aged, pickled, fermented, or smoked. These can precipitate a hypertensive crisis. 1. Incorrect: Clients taking MAOIs can eat cottage cheese in reasonable amounts. 3. Incorrect: Clients taking MAOIs can eat baked chicken. 4. Incorrect: Clients taking MAOIs can eat potatoes.)

The primary healthcare provider prescribed diazepam 12.5 mg IM to a client. The pharmacy dispenses diazepam 5 mg/mL. How many mL will the nurse administer? Round answer using one decimal point. Ans:______

2.5 (Rationale: (12.5 mg ÷ 1) × (1 mL ÷ 5 mg) = (12.5 ÷ 5) = 2.5 mL Ans: 2.5 mL)

The nurse is caring for a heart failure client taking spironolactone. Which snack choices would indicate to the nurse that the client understands proper dietary choices while on this medication? Select all that apply 1. Bananas 2. Cheese and crackers 3. Apples 4. Sweet potatoes 5. Grapes

3. Apples 5. Grapes (3. & 5. Correct: Apples and grapes are low in sodium and potassium. Spironolactone is a potassium sparing diuretic. The client with heart failure needs to limit sodium and potassium. 1. Incorrect: The action of spironolactone is to inhibit the reabsorption of sodium in the kidney while saving potassium. It is a diuretic so the client will lose water. Bananas are high in potassium. 2. Incorrect: Cheese and crackers are high in sodium. Spironolactone is given to lower BP and decrease fluid. Foods high in sodium should be limited. 4. Incorrect: The action of spironolactone is to inhibit the reabsorption of sodium in the kidney while saving potassium. It is a diuretic so the client will lose water. Sweet potatoes are high in potassium.)

The primary healthcare provider prescribes a combination of pyrazinamide and isoniazid to treat a client with tuberculosis. The client asks the nurse, "Why am I taking two drugs?" Which explanation should the nurse give the client? 1. One diminishes the side effects of the other. 2. Hepatoxicity is reduced. 3. Bacterial resistance is decreased. 4. One kills the live bacteria, and the other the spores.

3. Bacterial resistance is decreased. (3. Correct: The CDC says that the initial phase of treatment for newly diagnosed cases of pulmonary TB should consist of a multiple-medication regimen because many cases of TB are caused by strains of the bacteria that are resistant to isoniazid or rifampin. This client has been prescribed the multiple medication regimen of pyrazinamide and isoniazid. 1. Incorrect: These drugs do not diminish the side effects of each other. In fact, they potentiate them. 2. Incorrect: Both drugs can cause hepatoxicity. 4. Incorrect: Isoniazid is bacteriostatic or bactericidal against susceptible bacteria. Pyrazinamide is also bacteriostatic against susceptible bacteria.)

One hour after administering pyridostigmine, the nurse notes increased salivation, lacrimation, and urination in the client. What initial action should the nurse take? 1. Administer a second dose of pyridostigmine. 2. Place client in side lying position. 3. Notify the primary healthcare provider. 4. Prepare for intubation and mechanical ventilation.

3. Notify the primary healthcare provider. (3. Correct: Anticholinesterase drugs are aimed at enhancing function of the neuromuscular junction. Acetylcholinesterase is the enzyme that breaks down acetylcholine. Thus inhibition of this enzyme by an anticholinesterase inhibitor will prolong the action of acetylcholine and facilitate transmission of impulses at the neuromuscular junction. Pyridostigmine is the most successful drug of this group in long-term treatment of myasthenia gravis. Cholinergic crisis happens when too much cholinergic medications are taken and, if not treated accordingly, respiratory failure and hypotension might happen. When cholinergic crisis takes place, the muscles cannot react to the inflow of acetylcholine so symptoms usually follow. Symptoms may include salivation, lacrimation, urination, and defecation. Failure of the respiratory system occurs due to the insufficient gas exchange. Flaccid paralysis, too much sweating, bronchial secretions, and miosis develop. 1. Incorrect: Giving an additional dose of pyridostigmine will make the client worse. 2. Incorrect: For better respiratory effort the client should be placed in a semi fowler's position. 4. Incorrect: This can be done after notifying the primary healthcare provider.)

The nurse is caring for a preoperative client who received intravenous lorazepam 5 minutes ago and is now requesting to void. What is the appropriate nursing action? 1. Ask the unlicensed assistive personnel to assist the client to the bathroom. 2. Insert a indwelling urinary catheter since the client is going to surgery. 3. Place the client on a bedpan. 4. Allow the client to go to the bathroom.

3. Place the client on a bedpan. (3. Correct: Placing the client on a bedpan is the safest and least invasive choice. Lorazepam can cause drowsiness and the client should not be allowed to ambulate. 1. Incorrect: The client does not need to get up after receiving lorazepam because it can cause drowsiness. The client might fall. Think safety. 2. Incorrect: Not all surgical clients require a indwelling urinary catheter. This is not the least invasive choice. 4. Incorrect: Lorazepam can cause drowsiness and the client should not be allowed to ambulate. The risks of falls, especially alone, is too great.)

The nurse is caring for a client receiving an intravenous infusion of normal saline that is prescribed at 150 milliliters per hour. Using a tubing that has a drop factor of 15, how many drops per minute should the nurse deliver? Round answer to the nearest whole number. Ans:______

38 (Rationale: (150 mL ÷ 1 hr) × (15 gtt ÷ 1 mL) ÷ (1 hr ÷ 60 min) = (2,250 ÷ 60) ≈ 38 gtt/min Ans: 38 gtt/min)

Which statement made by a client prescribed naproxen for rheumatoid arthritis would require further investigation by the nurse? 1. "I signed up for swimming classes at the local recreation center." 2. "I take acetaminophen when I have a headache." 3. "I have lost 2 pounds in the past 2 weeks." 4. "I am taking an antacid to help with indigestion."

4. "I am taking an antacid to help with indigestion." (4. Correct: ​Naproxen is a nonsteroidal anti-inflammatory drug (NSAID). It works by reducing hormones that cause inflammation and pain in the body. So what do we know is a concern about NSAIDs? They may cause GI bleeding and dyspepsia. This client might be experiencing these symptoms if they are taking an antacid for indigestion. Follow-up is required. 1. Incorrect: There is nothing wrong with the client taking swimming classes. This form of aerobic exercise can help decrease pain and improve strength. 2. Incorrect: Acetaminophen is not considered an NSAID. It can be taken for a headache while taking an NSAID. It is best to stagger the acetamenophen between naproxen doses if needed for headache. 3. Incorrect: There is nothing unusual or worrisome about a 1 to 2 pound (0.45 - 0.9 kg) weight loss a week. This weight loss would not be related to the medication.)

Which statement by a client would indicate to the nurse that education about alendronate has been successful? 1. "It is recommended that I recline for 15 minutes after taking my medication." 2. "Food should be eaten immediately after taking alendronate." 3. "My medication tablet should be chewed for rapid absorption." 4. "I should drink a full 8 ounce glass of water with my medication."

4. "I should drink a full 8 ounce glass of water with my medication." (4. Correct: Alendronate is a biophosphonate drug used in the treatment of osteoporosis and other bone diseases. The client should take each tablet in the morning with a full glass of water (6-8 ounces or 180-240 ml) at least 30 to 60 minutes before the first food, beverage or medication of the day, to increase absorption. 1. Incorrect: After taking alendronate, the client should remain upright (sitting or standing) for 30-60 minutes. The client should not lie down until after eating. These actions help to decrease the likelihood of esophageal and GI associated side effects. 2. Incorrect: The client should wait at least 30-60 minutes before eating, drinking or taking any other medication, to increase absorption. 3. Incorrect: The client should not chew the medication tablet, mouth ulcers can occur when alendronate is chewed or dissolved in the mouth.)

What medication should the nurse anticipate giving to a client in preterm labor to stimulate maturation of the baby's lungs? 1. Magnesium sulfate 2. Terbutaline 3. Methotrexate 4. Betamethasone

4. Betamethasone (4. Correct: Betamethasone is used to stimulate maturation of the baby's lungs in case preterm birth occurs. This medication is given to help prevent respiratory distress syndrome (RDS) by improving storage and secretion of surfactant that helps to keep the alveoli from collapsing. 1. Incorrect: Magnesium sulfate is given to stop preterm labor, however, if delivery is imminent, then Betamethasone should be given to stimulate maturation of the baby's lungs. 2. Incorrect: Terbutaline is contraindicated in preterm labor, however, if delivery is imminent, then Betamethasone should be given to stimulate maturation of the baby's lungs. 3. Incorrect: Methotrexate is used to stop the growth of the embryo in ectopic pregnancy so that the fallopian tube can be saved. It is not an agent used in the management of preterm labor.)

A client experiencing chest pain is prescribed an intravenous infusion of nitroglycerin. After the infusion is initiated, the occurrence of which symptom would prompt the nurse to discontinue the nitroglycerin? 1. Frontal headache 2. Orthostatic hypotension 3. Decrease in intensity of chest pain 4. Cool, clammy skin

4. Cool, clammy skin (4. Correct: This assessment finding of cool, clammy skin is an indication of decreased cardiac output that could be the result of too much vasodilatation. Cardiac output could continue to decrease if the nitroglycerin is not discontinued. 1. Incorrect: A headache is an expected common side effect of nitroglycerin administration. The headache is treated with medication. 2. Incorrect: A decrease in blood pressure when rising from a supine or sitting position is a common effect of the vasodilatation that occurs with the administration of nitroglycerin. The client should be advised to change positions slowly. 3. Incorrect: The decrease in the intensity of the client's chest pain is the desired outcome of the nitroglycerin administration.)

A client who is occasionally confused states that the medication is the wrong color when the nurse hands it to the client. What action should the nurse take? 1. Encourage the client to take the medication. 2. Tell the client that the medication is correct. 3. Explain that generic medications may be different colors. 4. Double check the medication before administering.

4. Double check the medication before administering. (4. Correct: The nurse cannot assume that the client is confused. Assessing orientation, LOC and asking client to state his/her name would help identify if the client is confused. The nurse must double-check. An error may be prevented by doing this. Seeking clarification is the safest option. 1. Incorrect: The nurse may make a medication error if she/he encourages the client to take the medication without double checking. To prevent errors, the nurse must adhere to the five rights of medication administration: right drug, right dose, right time, right route and right patient. 2. Incorrect: The client may be identifying an error. The nurse should double check that this is the correct medication. Determine if the client understands the purpose of the medication. 3. Incorrect: This statement is true; however, to maintain safety of the client, the medication should be checked again. Seeking clarification is the safest option.)

The nurse is caring for a poorly controlled type 2 diabetic client. Lab results include a BUN of 22mg/dL (7.85 mmol/L) and a creatinine of 1.9 mg/dL (0.67 mmol/L). The nurse checks the client's blood sugar and it is 218mg/dL (12.09 mmol/L). Current medications include metformin and exenatide. What is the priority concern with this client taking metformin? 1. Inadequate blood glucose control 2. Concomitant administration of metformin and exenatide 3. Reports of headache 4. Renal function impairment

4. Renal function impairment (4. Correct: This is the priority response. Why? Because metformin is eliminated primarily by the kidneys, and if the kidneys are not working properly, as evidenced by the elevated BUN and creatinine levels, administration of metformin can lead to toxicity and increased lactic acidosis risk. 1. Incorrect: The glucose is not where I want it to be, but is a blood sugar of 218 mg/dL going to kill me? No. 2. Incorrect: Exenatide and metformin are commonly prescribed together to control a client's glucose level, so this should not be a concern. 3. Incorrect: Headache is a side effect of metformin and the primary healthcare provider may be notified. However, this is not the priority.)

Based on the Parkland formula, the primary healthcare provider has determined that a burn victim needs 9,250 mL of LR intravenously over the first 24 hours. How many milliliters of LR should the nurse administer over the first eight hours? Round answer to the nearest whole number. Ans:______

4625 (Based on the Parkland formula the fluid resuscitation of a burn victim means that ½ of the fluid should be given within the first 8 hours. For this client 4,625 mL needs to be administered within the first 8 hours. The remaining ½ of the fluid is divided over the remaining 16 hours.)

A three year old weighing 13.6 kg is scheduled to receive a dose of digoxin elixir. The prescribed dose is 25 micrograms/kg How many mL will the nurse administer to the child? Round to 1 decimal place. Use numbers and decimals only. Lanoxin (digoxin) Elixir Pediatric Each mL contains 50 µg (0.05 mg) Pleasantly flavored Ans:______

6.8 (Rationale: ×÷ 25 µg × 13.6 kg = 340 µg (340 µg ÷ 1) × (1 mL ÷ 50 µg) = (340 ÷ 50) = 6.8 mL Ans: 6.8 mL)

The nurse is preparing to administer a unit of packed red blood cells (PRBCs) using a blood administration set. During the first 15 minutes of administration, the unit is to run at 25 mL / hour. How many gtts/min will the nurse need to set the IV rate at? Round to the nearest whole number. Use numbers only. Blood Administration Set (Single Chamber) In-Line Filter No. 5966 20 Drops/mL Ans:______

8 (Rationale: (25 mL ÷ 1 hr) × (20 gtt ÷ 1 mL) × (1 hr ÷ 60 min) = (500 ÷ 60) ≈ 8 gtt/min Ans: 8 gtt/min)

The primary healthcare provider has prescribed phenytoin 100 mg intravenous push (IVP) stat through a non-tunneled central venous catheter lumen with no other medication or fluid infusing. In what order should the nurse administer this prescription? Flush with normal saline, then with heparin Gently aspirate for blood Flush saline using push-pause method Cleanse access port Connect 10 mL normal saline to access port Administer phenytoin

Cleanse access port Connect 10 mL normal saline to access port Gently aspirate for blood Flush saline using push-pause method Administer phenytoin Flush with normal saline, then with heparin (Proper administration of medication through a non-tunneled central venous catheter: First, cleanse the access port. Failure to cleanse the port first would increase the risk of infection from contamination when the port is accessed. Second, connect 10 mL normal saline to access port. This 10 mL syringe will be connected to first check patency and then for flushing prior to medication administration. At least 10 mL of normal saline is used to flush central lines. Third, gently aspirate for blood. Fourth, flush saline using push-pause method. This method is utilized to help clear the catheter of blood or drugs that could potentially adhere to the internal surface of the central line catheter. This creation of turbulent flow from pausing then pushing causes swirling of the fluid and theoretically removes blood and medications from the walls of the catheter, which reduces the risk of occlusion in the catheter. Fifth, administer phenytoin. Sixth, flush with normal saline, then with heparin. Standard flushing solutions used most frequently for central venous access devices include normal saline and/or heparinized sodium chloride. Low dose heparin flushes are generally used to fill the lumen of the central line between use in order to prevent thrombus formation and maintain patency of the catheter for a longer period of time.)

Place the steps in order that the nurse should take to administer a subcutaneous injection. Dispose the syringe in sharps container Remove the needle cap by pulling it straight off Perform hand hygiene Hold syringe and pinch the skin with nondominant hand Inject the needle and administer the medication Cleanse site with antiseptic swab Apply gloves and locate the injection site

Perform hand hygiene Apply gloves and locate the injection site Cleanse site with antiseptic swab Remove the needle cap by pulling it straight off Hold syringe and pinch the skin with nondominant hand Inject the needle and administer the medication Dispose the syringe in sharps container (First perform hand hygiene. Then apply gloves and locate injection site using anatomical landmarks. Start at the center of the site and rotate outward in a circular direction to cleanse the site. Remove the needle cap by pulling the cap straight off. Next, hold the syringe and pinch the skin with nondominant hand. Inject the needle quickly then administer the medication slowly. Finally, dispose of the syringe in the sharps container.)

The nurse is preparing to hang an IV bottle of fat emulsions 20% on a client. At what rate should the nurse set the IV infusion pump? Answer in numbers only. Perscription: 200 mL fat emulsion 20% IV at 17 mL/hour. *CHANGE TUBING/BOTTLE EVERY 12 HOURS. Liposyn II 20% 500 mL Intravenous Fat Emulsion Ans:______

17 (Perscription: 200 mL fat emulsion 20% IV at 17 mL/hr.)

The primary healthcare provider has prescribed hydromorphone 2 mg intravenously (IV) every 4 hours as needed for pain. When should the nurse plan to administer the medication to the client? 1. Only when requested. 2. Prior to onset of intense pain. 3. With reports of acute pain lasting for at least one hour. 4. Continuously every 4 hours to keep the client pain free.

2. Prior to onset of intense pain. (2. Correct: Pain is best managed before acute pain has developed. If the client waits until the pain is intense, the pain medication may not work as effectively or not at all. 1. Incorrect: Clients sometimes need pharmacologic treatment for pain even if not requested. Nurses should monitor the client for physical signs of pain. Vital sign changes and facial grimacing may be signs of pain. The word "only" is too limiting. 3. Incorrect: Clients should be treated for pain before acute pain develops when possible. The client should be educated to report pain prior to experiencing it for at least one hour. 4. Incorrect: The order is as needed, not continuously. Also, the goal of being pain free may be unrealistic. The nurse wants to keep the client's pain at a tolerable level. Always measure pain on a pain scale such as 0-10.)

The nurse is preparing to give a client's prescribed furosemide dose. How many mL will the nurse give to the client? Answer to the first decimal place. Answer with numbers and decimal only. Perscription: Furosemide 25 mg by mouth daily Furosemide Oral Solution USP 10 mg per mL Each mL contains 10 mg furosemide USP. SUGAR FREE Ans:______

2.5 (Rationale: (25 mg ÷ 1) × (1 mL ÷ 10 mg) = (25 ÷ 10) = 2.5 mL Ans: 2.5 mL)

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

20 (Rationale: (10 mg ÷ 1) × (5 mL ÷ 2.5 mg) = (50 ÷ 2.5) = 20 mL Ans: 20 mL)

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

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

A client weighing 140 pounds (63.64 kg) has been admitted to the telemetry unit with a diagnosis of Class III pulmonary hypertension. The primary healthcare provider prescribes digoxin. How many micrograms should the nurse administer now? Round to the whole number. Loading dose of digoxin - 15 micrograms/kg. Give ½ of the dose now, Then ¼ the loading dose every 8 hours times 2 doses. Ans:______

477 (Rationale: (63.64 kg ÷ 1) × (15 mcg ÷ 1 kg) = (954.6 ÷ 1) = 954.6 mcg 954.6 × ½ = 477.3 ≈ 477 mcg Ans: 477 mcg)

A client was admitted with a diagnosis of Type II diabetes. The primary healthcare provider initiated the Insulin Sliding Scale Protocol for Type II Diabetic Clients. The prescription regimen was to begin at the high dose regimen with regular insulin AC & HS. How much insulin should the nurse administer at 2100 hours? Glucose Flow Sheet Time → BG Level → Dose 0730 → 168 mg/dL → 4 units 1130 → 156 mg/dL → 4 units 1700 → 264 mg/dL → 12 units 2100 → 298 mg/dL → ______ Protocol: 1. If potassium is < 3.5, call M.D. 2. Add two (2) additional insulin units to total units if glucose level is > 250 two (2) times in 24 hours and all readings were > 100. 3. Subtract two (2) insulin units from total units to give if glucose level is between 60-100 twice in 24 hours. BG < 60: hypoglycemia protocol & call MD 60-150: 0 units 150-200: 4 units 201-250: 8 units 251-300: 12 units 351-400: 16 units > 400: 16 units & call MD Ans:______

10 (Prescription: The prescription regimen was to begin at the high dose regimen with regular insulin AC & HS using the Insulin Sliding Scale Protocol for Type II Diabetic Clients. The protocol states to add two (2) additional insulin units to total units if glucose level is greater than 250 two (2) times in 24 hours and all readings are greater than 100. All glucose readings were greater than 100, and the readings were greater than 250 three times. So, the client should receive an additional two units which indicates that 10 units of regular insulin should be given at 2100 hours for a glucose of 298.)

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

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

The nurse is teaching a client regarding herbal therapy. What is the main goal of herbal therapy? 1. To treat a specific disease or symptom by taking prescription medications. 2. To restore balance within the body by supporting the client's self-healing ability. 3. To avoid the use of toxic chemicals within the body. 4. To incorporate Eastern healing practices into Western medicine.

2. To restore balance within the body by supporting the client's self-healing ability. (2. Correct: The main goal of herbal therapy is to restore balance within the body by supporting the client's self-healing ability. When teaching clients, the main goal should always be included. 1. Incorrect: The main goal of drug therapy is the treatment of a specific disease or symptom. Herbal therapy should not treat diseases. They are for support only. 3. Incorrect: The main goal of herbal therapy is to restore balance and support healing. Many times herbal therapy is considered less toxic but the question is asking for the main goal of herbal therapy. 4. Incorrect: Not the main goal of herbal therapy. This is not the main goal of herbal therapy. The main goal is to restore balance within the body by supporting the client's self-healing ability.)

The nurse is caring for a client with a diagnosis of major depression. The client began taking a selective serotonin reuptake inhibitor (SSRI) three days ago. The client says, "I am just not feeling well. My medicine is not working." Which reply by the nurse indicates adequate understanding of treatment? 1. "I agree, your medication is not working." 2. "Your treatment may have to be changed." 3. "Most SSRIs take about 5 days to work." 4. "You should reach the desired effect in 1-3 weeks."

4. "You should reach the desired effect in 1-3 weeks." (4. Correct: Therapeutic effect is usually reached in one to three weeks, or longer. Encourage the client to continue taking the medication as prescribed. Provide supportive care and reassurance during this time. 1. Incorrect: This response demonstrates that the nurse is not familiar with the time for therapeutic onset. This response would discourage the client. 2. Incorrect: It is too soon to determine if treatment should be changed. It may take several weeks to reach therapeutic effects. 3. Incorrect: While some clients may be more calm within a short period of time, therapeutic effect cannot be evaluated at this point. Initial effects may be seen in as little as 1-3 weeks, while full therapeutic effects may fake up to 4-6 weeks.)

The nurse is caring for a client in the emergency department. The primary healthcare provider prescribed penicillin 100,000 units IM. The drug label reads penicillin 300,000 units/mL. The nurse would administer how many mL of this medication? Round answer using two decimal points. Ans:______

0.33 (Rationale: (100,000 u ÷ 1) × (1 mL ÷ 300,000 u) = (100,000 ÷ 300,000) ≈ 0.33 mL Ans: 0.33 mL)

The nurse is preparing to give a client's prescribed ampicillin dose. How many mL will the nurse give to the client? Answer to the first decimal place. Answer with numbers and decimal only. Perscription: Ampicillin 200 mg IM every 8 hours AMPicillin IM Injection (Sandoz) 1 g / 4 mL (250 mg / mL) Ingredient (DRUG): AMPicillin 1 g (1 vial) Ingredient (DILUENT): Sterile Water for Injection 10 mL (1 vial) Procedure: 1. Withdraw 3.4 mL of Sterile Water for Injection 2. Inject the 3.4 mL of Sterile Water for Injection into a 1 g vial of AMPicillin. Shake well to dissolve drug. 3. Concentration: 1 g / 4 mL - 250 mg / mL Dose: 200 mg Dose Volume: 0.8 mL IM INJECTION Only Ans:______

0.8 (Rationale: (200 mg ÷ 1) × (1 mL ÷ 250 mg) = (200 ÷ 250) = 0.8 mL Ans: 0.8 mL NOTE: The information tells you that 200 mg is in 0.8 mL in the bottom left corner but it is always good to double check the dose.)

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

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

Which assessment finding by the nurse is likely to be the result of long-term corticosteroid use in a client? Select all that apply 1. Occasional nausea that occurs after eating the evening meal. 2. A wound that is slow to heal. 3. Weight loss of 15 pounds (6.8 kg) over a 6 week period. 4. The appearance of acne on the forehead and cheeks. 5. Vertebral compression fracture.

2. A wound that is slow to heal. 4. The appearance of acne on the forehead and cheeks. 5. Vertebral compression fracture. (2., 4., & 5. Correct: Suppression of the immune system occurs with long-term steroid use. This leads to slow wound healing. Acne is sometimes seen with steroid use due to oily skin and overproduction of the acne bacterium. Osteoporosis risk is increased with long-term use of steroids. Remember steroids pull calcium from the bone and place it in the blood. 1. Incorrect: Nausea is not commonly seen with steroid use. 3. Incorrect: Changes in metabolism usually lead to weight gain, not weight loss.)

The nurse is discharging a client who had a kidney transplant and the primary healthcare provider has prescribed mycophenolate. Which nursing instruction is priority regarding this medication? 1. Take the medication with food 2. Notify primary healthcare provider at first signs of an infection 3. Nausea, vomiting, and diarrhea are common side effects 4. Use sunscreen when planning to be outdoors

2. Notify primary healthcare provider at first signs of an infection (2. Correct: Calling the primary healthcare provider at the first signs of an infection is priority because mycophenolate is an immunosuppressant. It diminishes the body's ability to identify and eliminate pathogens. 1. Incorrect: It is recommended the client take the medication on an empty stomach but the drug may be taken with food if the client experiences stomach upset. This is not the priority teaching point. 3. Incorrect: These side effects may be experienced but this is not the priority teaching point. 4. Incorrect: Sun exposure should be avoided and clients should be advised to use sunscreen because it can make the client more prone to sunburn but this is not the priority teaching point.)

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

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

The nurse is reinforcing the dietary discharge instruction for a client prescribed warfarin. Which food choices should be avoided on the warfarin dietary instruction plan? Select all that apply 1. Corn 2. Carrot 3. Spinach 4. Broccoli 5. Watermelon

3. Spinach 4. Broccoli (3. & 4. Correct: Clients prescribed warfarin will need to reduce the intake of food sources with high levels of vitamin K. High levels of vitamin K interfere with warfarin by decreasing the effectiveness of warfarin to prevent blood clots. The vitamin K level of 1 cup of raw spinach is 144.87 mcg. The vitamin K level of 1 cup of raw broccoli is 92.46 mcg. Because spinach and broccoli are high in vitamin K, the client should eat sparingly or refrain from eating spinach, and broccoli. 1. Incorrect: There is 0.31 mcg of Vitamin K in 1.0 ear, medium (6-3/4" to 7-1/2" long) of corn. This level of vitamin K in the corn can be consumed with warfarin. The vitamin K level of corn will not interfere with the action of warfarin. 2. Incorrect: The level of vitamin K in a cup of raw carrots is 16.9 mcg. Carrots will not reduce the action of warfarin, due to the low level of vitamin K in corn. 5. Incorrect: The content of vitamin K in a cup of watermelon is 0.15 mcg. Due to the low level of vitamin K in watermelon. Watermelon will not lower the effectiveness of warfarin.

What would the nurse include when teaching a client newly prescribed timolol maleate eyedrops for glaucoma? 1. The medication works by causing the pupils to constrict 2. The medication will dilate the canals of Schlemm 3. This medication decreases the production of aqueous humor 4. The medication improves ciliary muscle contraction

3. This medication decreases the production of aqueous humor (3. Correct: timolol decreases aqueous humor formation; therefore decreasing IOP. 1. Incorrect: timolol does not constrict pupils​. 2. Incorrect: timolol does not dilate the canals of Schlemm​. 4. Incorrect: timolol does not cause ciliary muscle contraction​.)

A nurse is providing education to a client regarding the use of an inhaler for acute asthma symptoms. Which statement made by the client would indicate the need for further teaching? 1. "I should shake the inhaler well before use." 2. "I should breathe out slowly and completely through my mouth before placing the mouthpiece of the inhaler in my mouth." 3. "I should hold my breath for approximately 8-10 seconds before exhaling slowly." 4. "I should administer the two puffs that are ordered in rapid sequence."

4. "I should administer the two puffs that are ordered in rapid sequence." (4. Correct: Rapid sequencing of the puffs is not a correct measure for using an inhaler. The client should wait 1 minute between puffs. This statement indicates the need for further teaching. 1. Incorrect: This is a correct measure that should be followed when using an inhaler. Clients are instructed to shake the inhaler well before use. 2. Incorrect: This is a correct measure that should be followed when using an inhaler. Clients are instructed to exhale slowly before bringing the inhaler to the mouth. 3. Incorrect: This is a correct measure that should be followed when using an inhaler. After removing the inhaler from the mouth, clients are instructed to hold their breath for 10 seconds, then breath out slowly.)

The nurse is preparing to administer 1000 mL D5W with 40 mEq KCl IV over 12 hours. How many gtts/min will the nurse need to set the IV rate at? Primary I.V. Set, Convertible Pin, 80 Inch With Backcheck Valve And 2 Injection Sites Piggyback No. 5966 10 Drops/mL Ans:______

14 (Rationale: (1,000 mL ÷ 12 hr) × (10 gtt ÷ 1 mL) × (1 hr ÷ 60 min) = (10,000 ÷ 720) ≈ 14 gtt/min Ans: 14 gtt/min)

The nurse is preparing to administer subcutaneous injection. At which angle should the syringe enter the client's skin? 1. 90° 2. 45° 3. 25° 4. 10-15°

2. 45° (2. Correct: SQ injections are delivered at a 45 degree angle to get the medication into the subcutaneous tissue. 1: Incorrect: IM injections are delivered at a 90 degree angle. 3: Intravenous lines are inserted at a 25 degree angle. 4. Intradermal medications are delivered at a 10-15 degree angle.)

What should the nurse teach a client who has been prescribed sertraline 100 mg PO daily? 1. Kidney function must be monitored regularly 2. Decrease the dose of the prescribed MAO inhibitor 3. Do not stop taking medication abruptly 4. Expect weight loss

3. Do not stop taking medication abruptly (3. Correct: We do not abruptly stop a medication that is being used for depression, plus sudden withdrawal may cause flu symptoms or thought disturbances. 1. Incorrect: No, you should monitor liver function regularly, not kidney function. 2. Incorrect: Again, no. Sertraline is an SSRI (selective serotonin reuptake Inhibitor) and should not be given with MAO inhibitors. Do you know why? Because both SSRIs and MAO inhibitors increase the levels of serotonin in the brain, we don't want to give both and double dose them. 4. Incorrect: Antidepressants usually cause weight gain.)

What should the nurse include when teaching a client diagnosed with Grave's disease who is scheduled to receive radioactive iodine? Select all that apply 1. Stay 6 feet from people for 2 weeks. 2. This medication is given intravenously as a one-time dose. 3. Radioactive iodine will leave the body in urine and saliva within a few days. 4. You cannot receive radioactive iodine if you are pregnant. 5. Radioactive iodine is absorbed by the parathyroid glands.

3. Radioactive iodine will leave the body in urine and saliva within a few days. 4. You cannot receive radioactive iodine if you are pregnant. (3., & 4. Correct: Within a few days after treatment, the radioactive iodine will leave the body in urine and saliva. If the client is pregnant, she should not receive radioactive iodine treatment. This kind of treatment can damage the fetus's thyroid gland or expose the fetus to radioactivity. Women should wait a year before conceiving if they have been treated with radioactive iodine. 1. Incorrect: Stay away from babies for 1 week and do not kiss anyone for 1 week. 2. Incorrect: Radioactive iodine is given in a capsule or liquid form. One dose is usually all that is needed. 5. Incorrect: Radioactive iodine is absorbed by the thyroid gland. It destroys the thyroid. So now the client becomes hypothyroid.)

The nurse is caring for a client diagnosed with pneumonia. The primary healthcare provider has prescribed erythromycin ER. What teaching points should the nurse plan to teach the client regarding this medication? Select all that apply 1. Crush the medication if unable to swallow capsule. 2. Take erythromycin 1 hour after eating. 3. Report clay-colored stools. 4. Do not take erythromycin with grapefruit juice. 5. Keep capsules in bathroom cabinet.

3. Report clay-colored stools. 4. Do not take erythromycin with grapefruit juice. (3., & 4. Correct: The client should be taught signs and symptoms of liver problems such as nausea, increased stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, or jaundice. Grapefruit juice can interfere with absorption of this medication. 1. Incorrect: Do not crush, chew, or break a delayed release capsule or tablet. Swallow it whole. 2. Incorrect: This medication should be taken 1 hour before or 2 hours after a meal. 5. Incorrect: Keep at room temperature, away from excess heat and moisture (not in bathroom).)

A post-operative client has received morphine for pain. The nurse re-assesses the client 10 minutes later. Which assessment data warrants further action by the nurse? B/P 110/76, Pulse 68, Respirations 8, Pain level of 5, dressing dry and intact. 1. Blood pressure 94/60 2. Pulse rate 72/min 3. Pain level 3/10 4. Respiratory rate at 8/min

4. Respiratory rate at 8/min (4. Correct: Normal respiratory rate is 12-20 per minute. The respiratory rate indicates respiratory depression following administration of an opioid. Care should be taken to titrate the dose so that the patients pain is controlled without depressing the respiratory function. 1. Incorrect: Respiratory rate warrants immediate action. However, blood pressure will continue to be monitored. 2. Incorrect: Pulse rate warrants no further action. Pulse rate is normal. 3. Incorrect: The pain level is expected following surgery. The client should continue to have a reduction on pain, as 10 minutes is not long enough to fully evaluate.)

While reviewing the prescriptions written by a primary healthcare provider, the nurse notes that ibuprofen 30 mg by mouth every 6 hours is prescribed for a child weighing 6 kg. The drug information book states that the appropriate dosage range is 20-30 mg/kg/24 hours. What action should the nurse take? 1. Administer the ibuprofen at 30 mg by mouth every 6 hours. 2. Contact the nursing supervisor regarding the prescription. 3. Ask the pharmacist to calculate the appropriate dose. 4. Notify the primary healthcare provider.

1. Administer the ibuprofen at 30 mg by mouth every 6 hours. (1. Correct: The appropriate range is 120 (20 mg × 6 kg) to 180 (30 mg × 6 kg) per 24 hours. Appropriate range per 6 hours is 30 (120 ÷ 4) to 45 (180 ÷ 4). 30 mg every 6 hours is appropriate. 2. Incorrect: The nursing supervisor does not need to be notified. This is a safe dose. 3. Incorrect: The nurse can calculate the appropriate dose based on the information provided. The primary healthcare provider does not need to be notified. The prescription is within the safe range. 4. Incorrect: The primary healthcare provider does not need to be notified since the prescription is written within the safe range.)

Which comment made by a new nurse regarding sodium polystyrene sulfonate indicates to the charge nurse that the new nurse understands the effects of this medication? 1. "Sodium is exchanged for potassium in the blood." 2. "Fluids will need to be encouraged after administration." 3. "This medication will increase potassium and decrease sodium." 4. "Sodium polystyrene sulfate is only given as an enema."

2. "Fluids will need to be encouraged after administration." (2. Correct: Sodium polysterene sulfonate (kayexalate) is used to treat hyperkalemia, and it works by helping your body get rid of the extra potassium by exchanging sodium ions for potassium ions in the intestines. Sodium level increases after administration and this increase causes some dehydration. Pushing fluids will offset the dehydration. 1. Incorrect: This is an incorrect statement by the new nurse. Sodium is exchanged for potassium in the GI tract, and the majority of the exchange occurs in the large intestine where potassium ions are excreted in larger amounts. 3. Incorrect: Potassium will decrease and sodium will increase. Remember, this medication is used for hyperkalemia. 4. Incorrect: Sodium polystyrene sulfonate can be given as a liquid by mouth, through a stomach feeding tube, or as a rectal enema.)

The nurse recognizes that Rho(D) immune globulin would be indicated for which Rh negative client? Select all that apply 1. Elective abortion at sixteen weeks gestation 2. Involved in a major car accident 3. Requires amniocentesis 4. Diagnosed with an ectopic pregnancy 5. Forty-eight hours post delivery of term Rh positive baby 6. Twenty weeks gestatation

1. Elective abortion at sixteen weeks gestation 2. Involved in a major car accident 3. Requires amniocentesis 4. Diagnosed with an ectopic pregnancy 5. Forty-eight hours post delivery of term Rh positive baby (1., 2., 3., 4. & 5. Correct: All of these clients may need to receive the Rho(D) immune globulin because they could have some bleeding and therefore develop antibodies against a Rh positive fetus. 6. Incorrect: An optional Rho(D) immune globulin dose may have been given during pregnancy by the practitioner, but it is 28 weeks, not 20 weeks.)

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

4. Cefotaxime intravenous piggyback to the newly admitted client with a diagnosis of pneumonia and a white blood cell count (WBC) of 12,000 mm³ (4. Correct: The first dose of intravenous antibiotic medication is the priority since the WBCs are elevated and the antibiotic should be administered first. 1. Incorrect: The TSH is normal so the thyroid medication is not the priority. 2. Incorrect: Amlodipine is for high blood pressure and is important but the antibiotic is the priority. 3. Incorrect: It is important to administer the regular insulin but it is not priority over initiating the intravenous antibiotic medication.)

What information should the nurse include in teaching an oncology client the purpose of taking epoetin? 1. Emergency treatment of anemia. 2. Improves quality of life. 3. Used for the prevention of pure red cell aplasia (PRCA). 4. Decreases the need for transfusion.

4. Decreases the need for transfusion. (4. Correct: Epoetin is prescribed to treat a lower than normal number of red blood cells (anemia) caused by chronic kidney disease in clients on dialysis, in HIV clients receiving zidovudine and in cancer clients receiving chemotherapy that develop anemia. Epoetin stimulates the bone marrow to produce more RBCs. 1. Incorrect: Epoetin does not work raoidly enough to be used for the emergency treatment of anemia (RBC transfusion). 2. Incorrect: Epoetin has not been proven to improve quality of life, fatigue, or sense of well-being in clients with cancer. 3. Incorrect: Pure red cell aplasia (PRCA) is a type of anemia that starts after treatment with epoetin or other erythropoetin medications.)

A client has been started on intravenous gentamicin for osteomyelitis. The nurse informs the client frequent blood work will be done to monitor the amount of medication in the body. The nurse knows what labs are a priority to check every three days for the client? 1. BUN and creatinine. 2. Liver function studies. 3. Hemoglobin and hematocrit. 4. Peak and trough levels.

4. Peak and trough levels. (4. Correct: Peak and trough levels help to determine the amount of medication in the body system at specific times. Gentamicin is a very potent antibiotic; therefore, it is crucial to keep track of blood levels of this medication. Too low a level of this drug would be ineffective against the bacteria while too high a level increases the potential for severe side effects or toxicity from this antibiotic. 1. Incorrect: Because aminoglycosides such as gentamicin can lead to nephrotoxicity, checking BUN and creatinine levels periodically is important. However, it would not be necessary to check those values every three days. 2. Incorrect: Aminoglycosides like gentamicin rarely affect the liver; therefore, liver function studies would not be needed frequently. 3. Incorrect: Hemoglobin and hematocrit levels are rarely impacted by aminoglycosides such as gentamicin. Although an initial level may be obtained prior to treatment, additional levels are not necessary.)

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

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

The nurse is assessing the injection site of a healthy client who received a Mantoux skin test 48 hours ago. Which finding at the injection site indicates a need for further evaluation? 1. 16 mm induration 2. 4 mm erythrokeratodemia 3. 0.1 mL bluish colored hard wheal 4. Multiple fluid-filled vesicles

1. 16 mm induration (1. Correct: An induration of 15 mm or greater is usually considered positive in people who have normal or mildly impaired immunity. A client with a positive reaction of 15mm or greater will need further evaluation by a primary healthcare provider. 2. Incorrect: This is a small, red, hard area that is smaller than 10 mm. Therefore the size is not considered significant. Induration is roughness, not hardness. The induration is what nurses assess to determine significance. 3. Incorrect: When administering a Mantoux skin test, 0.1 mL of solution is injected under the top layer of the skin to produce a wheal. The presence of the 0.1 mL wheal is not expected at this time. 4. Incorrect: This is the significant reaction that one would find with a multiple puncture tine, which is sometimes used with mass screening for TB. This is not expected with a Mantoux skin test.)

The nurse is caring for a client on the cardiac unit. Which assessments are most important for the nurse to perform prior to the administration of diltiazem? Select all that apply 1. Note the rate and character of the apical pulse. 2. Ausculate the anterior and posterior breath sounds. 3. Check the morning results of serum calcium. 4. Review the last 24 hour urine output. 5. Monitor blood pressure. 6. Assess for chest pain.

1. Note the rate and character of the apical pulse. 5. Monitor blood pressure. 6. Assess for chest pain. (1., 5., & 6. Correct: Diltiazem is a calcium channel blocker. It works by relaxing the muscles of the heart and blood vessels. Monitor blood pressure and pulse before and frequently during administration of diltiazem, as it causes systemic vasodilation and suppresses arrhythmias. Diltiazem is used to treat angina, so the nurse should assess for anginal pain. 2. Incorrect: Breath sounds need to be assessed to monitor for signs of heart failure, this would be a complication after diltiazem administration. Breath sounds are not necessarily assessed just prior to administration. 3. Incorrect: Diltiazem is a calcium channel blocker, but the total serum calcium concentration is not affected by it. Calcium channel blockers affect the flow of calcium into muscle cells. 4. Incorrect: A decrease in output would be an indicator of heart failure, which is a complication of diltiazem administration. This would be assessed after giving the medication.)

A teenager leaves class in the middle of an exam to go to the school nurse's office. The student reports difficulty sleeping for several days, increasing nervousness, irritability, and palpitations. The nurse notes flushing of the skin, and an irregular heartbeat. What would be the best question for the nurse to ask this client? 1. "Do you feel this way because you are afraid that you are failing the exam?" 2. "Have you been drinking energy drinks while studying for your exam?" 3. "What drugs are you taking?" 4. "Do you want me to call your mother?"

2. "Have you been drinking energy drinks while studying for your exam?" (2. Incorrect: Caffeine is a stimulant used to keep people awake and increase energy. It is found in many OTC medications and in many soft drinks and energy drinks. The student is exhibiting all the signs/symptoms of ingesting too much caffeine. 1. Incorrect: This is not addressing the problem. These are physical symptoms of a problem. 3. Incorrect: This is confrontational and will put the student on the defensive. Caffeine is not generally thought of as a drug by clients, so might not even be considered in the first place. 4. Incorrect: This might be done later, but this question does not help to determine what is going on with the student.)

A child diagnosed with acute lymphocytic leukemia (ALL) is receiving vincristine sulfate during the induction phase of chemotherapy. What client side effect should the nurse report immediately to the primary healthcare provider? 1. Anemia 2. Paresthesia 3. Nosebleeds 4. Alopecia

2. Paresthesia (2. Correct: Paresthesia is an uncommon but serious reaction to chemotherapy, particularly vinca alkaloids like vincristine sulfate. The abnormal tingling or pins and needles sensation is caused by pressure or damage to peripheral nerves which may include both motor and sensory sensations. The nurse should immediately notify the primary healthcare provider of this critical side effect of vincristine therapy. 1. Incorrect: Anemia is an expected side effect of many types of chemotherapy, including vincristine sulfate. Chemotherapy drugs attack rapidly dividing cells, including those that create red blood cells. Anemia contributes to fatigue, shortness of breath and lack of energy. This should definitely be evaluated, but is not the most urgent concern for the nurse at this time. 3. Incorrect: Vincristine sulfate has many side effects, including depletion of platelets which are responsible for blood clotting. When platelets are depleted, the client can experience nose bleeds, bruising, or bleeding gums. While this is of concern, it is not the side effect which needs to be reported immediately to the doctor. 4. Incorrect: Alopecia is a very common, expected side effect of chemotherapy. Damage to hair follicles commonly occurs after the first two treatments. While this side effect can impact the client psychologically, it is not an issue that the nurse must immediately report.)

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

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

What nursing intervention takes priority for the client one day postoperative bowel resection reporting pain of a 6 on a 0 to 10 pain scale? 1. Assist the client in changing positions. 2. Use a distraction technique. 3. Administer the prescribed analgesic. 4. Encourage the client to walk.

3. Administer the prescribed analgesic. (3. Correct: Rating pain a 1-3 is a mild pain. This pain is nagging, annoying, interfering little with the client's activities of daily living. This is when repositioning, alternative therapies, and distraction techniques are beneficial. Pain rated between 4-6 is considered to be moderate in severity and interferes significantly with activities of daily living. This is the time to give pain medication in an attempt to lessen the severity of the pain. A score of 7-10 is severe pain that is disabling. The client is unable to perform activities of daily living. Pain medication is often delayed in helping at this point. We want to give pain medication before it reaches this intense level. 1. Incorrect: There is no information to indicate repositioning may be effective. 2. Incorrect: Distraction is not an effective strategy for severe pain. 4. Incorrect: There is no information to indicate walking would be effective.)

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

4. Heart rate 56/min (4. Correct: This is a beta blocker. If a client's heart rate is less than 60 beats per minute, notify the primary healthcare provider and ask if the client should receive this medication. You can identify that nadolol is a beta blocker because it ends in "lol". 1. Incorrect: Beta blocker are prescribed to lower BP. When the baseline BP is not known, worry about a BP of 90/60 or below. If the client's BP drops below 90/60, this beta blocker should be held and the primary healthcare provider notified. 2. Incorrect: This is a normal glucose level. If the client is a diabetic, beta blockers can mask the signs of hypoglycemia. 3. Incorrect: Urinary output is adequate. Beta blockers do not alter renal function.)

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

1. Chlordiazepoxide 10 mg p.o. q 4h p.r.n. for agitation 4. Cefepime 1 gram IVPB every 8 hours 5. Diphenhydramine 25 mg p.o. hour of sleep for three nights (1., 4. & 5. Correct: These medication prescriptions are correctly written following approved Joint Commission abbreviations. 2. Incorrect: The "U" can be mistaken for "0" (zero), the number "4" (four) or "cc". Units should be written out completely. 3. Incorrect: MS can mean morphine sulfate or magnesium sulfate. Write "morphine sulfate". Write "magnesium sulfate".)

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

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

The nurse is assisting with a client who will receive electroconvulsive therapy (ECT). The anesthesiologist administers succinylcholine chloride intravenously. What adverse effects should the nurse monitor for post procedure? Select all that apply 1. Malignant hyperthermia 2. Hypokalemia 3. Apnea 4. Tetany 5. Arrhythmias

1. Malignant hyperthermia 3. Apnea 4. Tetany 5. Arrhythmias (1., 3., 4. & 5. Correct: Succinylcholine is a paralytic used to relax the muscles to prevent severe muscle contractions during the seizure, thereby reducing the possibility of fracture or dislocated bones. Adverse effects include malignant hyperthermia, apnea, and arrhythmias. It causes paralysis of the muscles of the face and those used to breath, so monitoring for apnea is very important. Tetany, spasms or stiffness in the jaw would be adverse effects and can indicate malignant hyperthermia. 2. Incorrect: Hyperkalemia can occur. Succinylcholine is a depolarizing muscle relaxant which means during prolonged muscle depolarization, the muscle may release large amounts of potassium into the blood.)

The nurse is developing a teaching plan for a female client who is taking one of the thiazolidinediones for the treatment of type 2 diabetes. What instruction should be included in the teaching plan? 1. Make sure that you use effective contraception while taking this drug. 2. The drug may lead to weight loss. 3. Therapeutic effect is reached within one to two weeks. 4. Therapeutic effect is reached within one month.

1. Make sure that you use effective contraception while taking this drug. (1. Correct: Thiazolidinediones may reduce the plasma concentration of the contraceptives. Additionally, post-menopausal women may resume ovulation. 2. Incorrect: Thiazolidinediones may lead to weight gain and exacerbate congestive heart failure. 3. Incorrect: With thiazolidinediones therapy, therapeutic effect may not be reached until 8 to 12 weeks of treatment. 4. Incorrect: With thiazolidinediones therapy, therapeutic effect may not be reached until 2 to 3 months of treatment.)

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

1. "I must get my blood levels checked regularly." 2. "I shouldn't change my diet to include a lot of foods containing vitamin K without supervision." 4. "I should report this medication to any primary healthcare provider that I see." 5. "I should not change the dosage without talking with my primary healthcare provider." (1., 2., 4. & 5. Correct: The client should comply with regular follow up visits for checks of INR level. INR is the international normalization ratio and is used for clients taking anticoagulants (blood thinning medications). The client should eat a normal healthy diet, but should not increase foods containing high amounts of vitamin K. The client should report using warfarin to any primary healthcare provider, as treatment may be changed due to this medication. The client should not manipulate the dosage unless instructed by the primary healthcare provider. An identification card or bracelet may also be recommended in case of emergencies. Clients should inform dentists and other healthcare providers especially before a medical procedure. The anticoagulant effect must be closely monitored. 3. Incorrect: Vitamin K reverses the anticoagulant effects of warfarin, so instruct the client to avoid foods high in vitamin K (examples are green leafy vegetables, brussels sprouts, prunes, cucumbers and cabbage).)

A nurse is planning to teach a group of men about their sildenafil prescription. What information should the nurse include? Select all that apply. 1. Notify primary healthcare provider if prescribed an alpha-adrenergic blocker. 2. This medication protects against sexually transmitted diseases. 3. Sildenafil should be taken only once per day if needed. 4. This medication is most effective if taken with grapefruit juice. 5. The most common side effects are flushing, headache, and dyspepsia.

1. Notify primary healthcare provider if prescribed an alpha-adrenergic blocker. 3. Sildenafil should be taken only once per day if needed. 5. The most common side effects are flushing, headache, and dyspepsia. (1., 3., & 5. Correct: Alpha-adrenergic blockers action is to dilate small muscles. The action of sildenafil is also to dilate specific small muscles. The combination of these medications can cause a hypotension event. Sildenafil is usually taken only when needed, 30 minutes to 1 hour before sexual activity. Do not take sildenafil more than once per day. The most common side effects are flushing, headache, and dyspepsia. 2. Incorrect: This medication does not protect against sexually transmitted diseases. Safe sex practices should be followed, such as use of latex condoms. 4. Incorrect: Grapefruit and grapefruit juice may interact with sildenafil and lead to unwanted side effects. Avoid the use of grapefruit products while taking sildenafil.)

The charge nurse is observing a new nurse administer cortisporin otic to the left ear of a 2 year old child. What action by the new nurse would indicate that the charge nurse needs to intervene? Select all that apply 1. Position the client prone, with affected ear up. 2. Pull pinna down and back. 3. Administers medication at room temperature. 4. Allow child to sit up once medication is instilled. 5. Educate parents that the medication may burn when instilled.

1. Position the client prone, with affected ear up. 4. Allow child to sit up once medication is instilled. (1., & 4. Correct: The charge nurse needs to intervene if the new nurse does not position the client supine, with affected ear up. The child may lie in a parents lap to decrease anxiety and increase cooperation. The child should remain supine for 5 minutes after medication is instilled to assure medication remains in ear canal. Remaining supine for several minutes permits to fluid to be absorbed and not drain back out of the ear canal. 2. Incorrect: The charge nurse does not need to intervene if the new nurse pulls the pinna down and back. For children 3 years of age and younger, pull pinna down and back. For adults, pull pinna up and back for medication administration or otoscopic exam. 3. Incorrect: The charge nurse does not need to intervene if the new nurse administers the medication at room temperature. It should not be placed in the ear cold as it can cause nausea/vomiting and dizziness. 5. Incorrect: The charge nurse does not need to intervene if the new nurse teaches the parents that generally mild adverse reactions include ear irritation, local stinging or burning, and/or dizziness.)

The nurse is caring for a client on the surgical unit. The primary healthcare provider prescribed morphine sulfate 20 mg IM one time dose. The nurse has available: morphine sulfate in a 20 mL vial, labeled 15 mg per mL. How many mL should the nurse administer? Record answer using one decimal place. Ans:______

1.3 (Rationale: (20 mg ÷ 1) × (1 mL ÷ 15 mg) = (20 ÷ 15) ≈ 1.3 mL Ans: 1.3 mL

A client diagnosed with systemic lupus erythematosus (SLE) has been started on hydroxychloroquine sulfate to decrease joint pain and swelling. What statement by the client indicates to the nurse the medication teaching has been effective? 1. "I will be prone to infections while on this medication." 2. "I need to see my eye doctor at least once every year." 3. "I might develop a red rash on my nose and cheeks." 4. "I can stop this medicine after my symptoms are gone."

2. "I need to see my eye doctor at least once every year." (2. Correct: Hydroxychloroquine sulfate(Plaquenil) is in the category of DMARDs (disease modifying anti-rheumatic drug) and was originally developed to treat or prevent malaria. When taken once or twice daily, this medication reduces swelling and joint pain while also decreasing skin problems in Lupus clients. Though there are relatively few side effects, the most serious is retinal toxicity which requires treatment by an ophthalmologist. It is imperative for clients on this medication to have an eye examination every 6 to 12 months. 1. Incorrect: This medication is an antimalarial which has been shown to decrease pain from arthralgia in clients with SLE. Minimal side effects are generally limited to gastrointestinal disturbances such as nausea or diarrhea. This medication does not increase the client's risk of infection at all. 3. Incorrect: Clients with SLE frequently develop the classic red "butterfly rash" across the nose and cheeks which becomes worse when exposed to the sunlight. This symptom occurs because of the disease process and is not related to any medications the client may be taking. 4. Incorrect: There are several categories of medications used to treat SLE; however, none of them should be stopped suddenly. The disappearance of symptoms generally indicates the medication regime is working well, and the client should never suddenly discontinue any medicine unless instructed to do so. Abruptly stopping this drug increases the risk of an exacerbation of symptoms such as nephritis or vasculitis.)

A client who has developed hypovolemic shock is receiving albumin. What assessment finding by the nurse indicates that the albumin has been effective? 1. Swelling in the legs 2. Increase in uninary output 3. Proteinuria 4. Increase in waist measurement

2. Increase in uninary output (2. Correct: The action of albumin is to increase the serum albumin level. When the albumin level increases there is a shift of fluid from extracellular to intracellular. This action will result in an increase in urinary output. 1. Incorrect: This is a symptom of hypoalbuminemia. There is a shift in the fluid from intracellular to extracellular. This results in the swelling of the legs. 3. Incorrect: Hypoalbuminemia may cause damage to the kidneys. Proteinuria is indicative of renal disease or damage. 4. Incorrect: There may be a increased accumulation of fluid in the abdomen. The ascites is due to the decreased albumin level in the vascular space, which also causes damage to the liver.)

A nurse is teaching a group of expectant parents about epidural anesthesia. What information should the nurse include? Select all that apply 1. Contraindications for an epidural include a previous cesarean section. 2. Post procedure position should be side lying. 3. Headache is a post procedure side effect. 4. The major complication is hypotension. 5. Usually administered at 3-4 cm dilation.

2. Post procedure position should be side lying. 4. The major complication is hypotension. 5. Usually administered at 3-4 cm dilation. (2., 4., & 5. Correct: The client should not lie supine but should position self in a side-lying position. This will prevent compression on the vena cava. The major complication of epidural anesthesia is hypotension and supine position increases the risk. If this occurs, a bolus with 1000 mL of NS or LR to increase blood pressure by increasing vascular volume. Epidurals are usually placed during stage 1 at 3-4 cm dilation. 1. Incorrect: Previous C-sections do not eliminate the ability to have an epidural. Epidurals are commonly utilized for anesthesia during a cesarean birth. 3. Incorrect: A sterile guide needle and a small epidural catheter is placed between the spinal cord and the outer membrane. There is usually no headache since the needle does not enter the spinal column but rather the epidural space.)

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

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

The family of a client recently placed on antipsychotic medications for the treatment of schizophrenia calls the nursing hot line and reports that the client's temperature is 105.1ºF (40.6ºC), and that the client's muscles are stiff. What should the nurse tell the family? 1. Continue to monitor for signs and symptoms of infection. 2. Transport the client to the emergency room. 3. The signs and symptoms will subside within a day or so. 4. They should call the primary healthcare provider tomorrow.

2. Transport the client to the emergency room. (2. Correct. The client may be experiencing neuroleptic malignant syndrome, a potentially life threatening adverse reaction. Symptoms include high fever, unstable blood pressure and myoglobinemia. The client should be taken to the ER. 1. Incorrect. The client may be developing neuroleptic malignant syndrome. This high fever is not associated with infection. Immediate treatment is necessary. 3. Incorrect. The symptoms will progress and may lead to death. Remember, do not delay treatment. 4. Incorrect. The symptoms will progress and the client may die without treatment. Do not delay treatment.

A hospitalized client has developed diabetes insipidus and is given desmopressin. The nurse is aware which laboratory result indicates an improvement in the client's condition? 1. White blood cells of 7,000 mm³ (7 × 10⁹) 2. Urine specific gravity of 1.010 3. Hemoglobin of 22 g/dL (220 g/L) 4. Serum sodium of 148 mEq/L (148 mmol/L)

2. Urine specific gravity of 1.010 (2. Correct: In diabetes insipidus, the kidneys excrete huge amounts of urine, causing the specific gravity to decrease from normal levels of 1.010 to 1.030, which would have been verified by urinalysis. The client's lab result indicates specific gravity within normal limits, evidence the desmopressin has begun to correct the client's condition. 1. Incorrect: The white blood cell count is not affected by diabetes insipidus. This laboratory result is within normal limits of 5,000 to 10,000 mm³ (5-10 × 10⁹) and would not reflect any changes from desmopressin. 3. Incorrect: Diabetes insipidus causes loss of the water component of serum, leaving blood very concentrated and electrolyte levels elevated. A hemoglobin level of 22 g/dL (220 g/L) is elevated for both male and female clients. This result does not indicate any improvement in the client from desmopressin. 4. Incorrect: A sodium level of 148 mEq/L (148 mmol/L) is elevated from the normal levels of 135-145 mEq/L (135-145 mmol/L). A concentrated level of sodium does not suggest improvement in the client's status yet.)

The nurse is caring for a client who is taking an antipsychotic medication for the treatment of schizophrenia. The nurse is told in report that the client has akathisia, as a side effect of their antipsychotic medication. What symptom should the nurse expect this client to have? 1. Upward gaze of the eyes. 2. Involuntary movement of the tongue. 3. Reports of restlessness. 4. Lack of movement or slowed movement.

3. Reports of restlessness. (3. Correct: Reports of restlessness, inability to sit still, and nervous energy indicate akathisia. These symptoms respond poorly to treatment. If possible, the dose of the medication may be reduced. 1. Incorrect: Upward gaze of the eyes indicates dystonia, a possible adverse reaction to the antipsychotic medications. 2. Incorrect: Tardive dyskinesia has the symptoms of involuntary movement of the tongue, chewing movements of the mouth, and lip smacking. These symptoms may be irreversible. 4. Incorrect: Slowed movement refers to the side effect of bradykinesia. Lack of movement is referred to as akinesia.)

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

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

A client taking phenelzine is admitted to the hospital. Which healthcare provider prescription should the nurse question? 1. Take blood pressure lying, sitting, and standing once per shift. 2. Order a complete blood count and liver profile studies. 3. Eliminate foods containing tyramine from diet. 4. Discontinue phenelzine. Begin fluoxetine 20 mg by mouth at bedtime.

4. Discontinue phenelzine. Begin fluoxetine 20 mg by mouth at bedtime. (4. Correct: Phenelzine is a non-selective monamine oxidase inhibitor (MAOI). Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). Both of these medications are antidepressants, but are in different drug classifications. They should not be taken in combination due to the risk of serotonin syndrome. Additionally 2 weeks should be allowed for phenelzine to be cleared from the body before starting a different classification of antidepressant. There should be at least two weeks between giving phenelzine and fluoxetine. 1., 2., 3. Incorrect: These are correct prescriptions/interventions for this client. Clients taking antidepressants can have a sudden drop in blood pressure upon rising. Instruct them to rise slowly. The liver can be affected by these drugs so routine liver screening is acceptable. Foods containing tyramine can lead to hypertensive crisis when ingested while taking a monoamine oxidase inhibitor (MAOI).)

What instruction is most important to include when teaching a child how to self administer a combined dose of isophane suspension and regular insulin subcutaneously? 1. Alternate the injection sites from one body area to another with each dose. 2. Draw up the isophane suspension insulin first and then regular insulin into the same insulin syringe. 3. Massage the injection site after the medication is injected. 4. Insulin syringes should be stored at room temperature.

4. Insulin syringes should be stored at room temperature. (4. Correct: Insulin syringes and needles should be stored at room temperature. The potential benefits or risks of refrigerating the syringe are unknown. 1. Incorrect: Insulin injection sites are rotated, but within a chosen site e.g., the abdomen. Once all the sites in that area are used, then another area of the body is selected e.g., the arm. 2. Incorrect: As a rule, remember clear before cloudy; that is, draw up the regular (clear) insulin first, and then draw up the long acting insulin, isophane suspension (cloudy). 3. Incorrect: Gently blot any blood with a gauze pad. Do not massage the site. Massaging or rubbing the site will alter the rate of absorption of the medication.)

What action is most important for the nurse to take when a client receiving a cephalosporin develops abdominal cramping and diarrhea? 1. Administer antidiarrheal medication. 2. Increase fluid intake. 3. Provide food with the medication. 4. Notify the healthcare provider.

4. Notify the healthcare provider. (4. Correct: Notify the healthcare provider if diarrhea occurs as it can promote the development of Clostridium difficile infection. Cephalosporin difficile is a toxin producing bacteria that causes antibiotics-associated colitis, and can occur with antibiotic therapy. Cephalosporin is one of the most common antibiotics that cause clostridium difficile. 1. Incorrect: Taking a probiotic, stopping the antibiotic or switching to another antibiotic are standard treatments for antibiotic induced diarrhea. Administering an anti-diarrheal is not recommended for antibiotic induced diarrhea. 2. Incorrect: Increasing fluid intake will help with the associated dehydration seen with diarrhea, but will not correct the problem or decrease the risk of clostridium difficile. 3. Incorrect: If the client has GI upset, then cephalosporin may be given with food, however, the most important thing to worry about is the development of Clostridium difficile infection. So notifying the healthcare provider is the most important action.)

A client comes into the clinic reporting muscle pain and tenderness but denies previous injury. Based on data gathered by the nurse, what client medication does the nurse suspect is causing this problem? CPK: 300 U/L ALT: 38 U/L AST: 42 U/L Alert, oriented client with general weakness and muscle tenderness noted. Reports myalgia, muscle weakness, fatigue, and joint pain. Urine sample obtained; urine cola-colored. 1. Captopril 2. Furosemide 3. Nadolol 4. Rosuvastatin

4. Rosuvastatin (4. Correct: Rosuvastatin is a lipid-lowering agent. All lab work is abnormal and indicates muscle and liver damage. Lipid-lowering drugs can cause liver damage. The assessment of the lab values reveals muscle damage and could indicate rhabdomyolysis development. Creatine phosphokinase: males 55-170 u/L and females 30-135 u/L; Alanine aminotransferase (ALT): 4-36 u/L; Aspartate aminotransferase (AST): 0-35 u/L. 1. Incorrect: Captopril does not affect the liver or muscle. Captopril is an angiotensin-converting enzyme (ACE) prescribed for treatment of hypertension. 2. Incorrect: Furosemide does not affect the liver or muscle. Furosemide is a loop diuretic which promotes diuresis. 3. Incorrect: Nadolol does not affect the liver or muscle. Nadolol is a non-selective beta blocker. The action of nadolol is to treat arterial fibrillation, hypertension, migraines and chest pain.)

The client's EEG revealed epileptiform abnormalities predictive of seizure activity and was started on valproic acid 500 mg PO twice a day. What nursing interventions should the nurse include in this client's plan of care? Select all that apply. 1. Assess for changes in mood. 2. Check for upper stomach pain and jaundice. 3. Monitor ALT and AST. 4. Teach client not to discontinue medication abruptly. 5. Instruct client to take acetaminophen for mild pain.

1. Assess for changes in mood. 2. Check for upper stomach pain and jaundice. 3. Monitor ALT and AST. 4. Teach client not to discontinue medication abruptly. (1., 2., 3., & 4. Correct: Valproic acid may cause agitation, irritability, or other abnormal behavior. Some clients have suicidal thoughts when first taking this medication. Upper stomach pain and jaundice could be signs of liver or pancreas problems. ALT and AST are your liver enzymes and you better be watching those because valproic acid can cause serious, even fatal hepatotoxicity. Clients should never discontinue anti-seizure meds abruptly. 5. Incorrect: False because acetaminophen metabolism occurs primarily in the liver. Let's pick another pain reliever since we know valproic acid can be hepatotoxic.)

What should the nurse include when educating a client about the use of nitroglycerin sublingual. Select all that apply. 1. Do not swallow nitroglycerin. 2. Keep the medication is a moist, warm place. 3. The medication may burn when taken. 4. Sit or lie down when taking this medication. 5. The most common side effect is vomiting.

1. Do not swallow nitroglycerin. 3. The medication may burn when taken. 4. Sit or lie down when taking this medication. (1., 3., & 4. Correct: Nitroglycerin is to be taken sublingually. Do not swallow because this will decrease the effectiveness of the medication. The medication may or may not burn or fizz when placed under the tongue. Because hypotension occurs due to vasodilation, the client should sit or lie down when taking to prevent injuries from falls. 2. Incorrect: Keep nitroglycerin in a dark, glass bottle and a dry and cool place to maintain the effectiveness of the medication. 5. Incorrect: The most common side effect is a headache and should be taught to the client as an expected side effect that does not have to be reported to the primary healthcare provider.)

In which client should the nurse question the prescribed medication levofloxacin? 1. History of myasthenia gravis. 2. Has a prescription for verapamil. 3. Thrombocytopenic 4. Admitted with renal arterial stenosis.

1. History of myasthenia gravis. (1. Correct: Levofloxacin is contraindicated in clients with a history of myasthenia gravis because it may cause the condition to become worse. Myasthenia gravis results in a breakdown in the communication between muscles and nerves and is characterized by muscle weakness. The most commonly affected muscles are those of the eye, face, throat, neck and limbs. 2. Incorrect: Levofloxacin and verapamil are not known to be incompatible. Levofloxacin is a quinolone antibiotic and there are no contraindications for use with verapamil, a calcium channel blocker. 3. Incorrect: You would worry about thrombocytopenia in clients taking anticoagulants. Thrombocytopenia is a decrease in platelets in the blood. 4. Incorrect: ACE inhibitors are contraindicated with renal arterial stenosis. There are no contraindications of using levofloxacin with renal arteral stenosis.)

The nurse is caring for an adolescent client diagnosed with depression. The client is prescribed fluoxetine. What is the best response by the nurse when the client says, "What will this medicine do to me?" 1. It will increase the level of serotonin in the brain. 2. It will decrease the production of noradrenaline. 3. It will lower your level of the brain hormone norepinephrine. 4. It will balance blood glucose and dopamine levels in your head.

1. It will increase the level of serotonin in the brain. (1. Correct: The action of fluoxetine is to increase the level of serotonin in the central nervous system. There is a correlation between a low level of serotonin and depression. The action of the drug should be explained to the adolescent in a manner that will be understood. 2. Incorrect: Fluoxetine does not selectively decrease the production of noradrenaline in the brain. 3. Incorrect: This action does not relate to fluoxetine. Fluoxetine may actually increase the level of norepinephrine in the brain. 4. Incorrect: This action does not relate to fluoxetine. Fluoxetine does not effect the balance of blood glucose and dopamine in the brain.)

The nurse is preparing to initiate a dopamine infusion per protocol. The primary healthcare provider prescription: Dopamine 5 mcg/kg/min IV per infusion pump. At what rate should the nurse set the pump? Use numbers only. Height - 187 cm Weight - 80 kg A mixture of 400 mg Dopamine in 250 mL = 1,600 mcg/mL Rate for 20kg client → 40kg → 60 → 80 → 100 2 mcg dose: 2 → 3 → 5 → 6 → 8 5 mcg dose: 4 → 8 → 11 → 15 → 19 10 mcg dose: 8 → 15 → 23 → 30 → 38 15 mcg dose: 11 → 23 → 34 → 45 → 56 20 mcg dose: 15 → 30 → 45 → 60 → 75 Ans:______

15 (Rationale: 5 mcg/kg × 80 kg = 400 mcg/min (400 mcg ÷ 1 min) × (1 mL × 1600 mcg) × (60 min × 1 hr) = (24,000 ÷ 1,600) = 15 mL/hr Ans: 15 mL/hr Always double check with the chart)

The nurse is teaching a newly diagnosed diabetic client about self-injection of insulin. Which statement made by the client indicates to the nurse that teaching has been effective? Select all that apply 1. "The abdominal site is best because it is closest to the pancreas." 2. "I can reach my thigh the best, so I will use different areas of the same thigh." 3. "By rotating the sites within one area, my chances of having tissue changes are less." 4. "If I change injection sites from the thigh to the arm, the rate of absorption will be different." 5. "I should inject at least 1-2 inches away from the last injection site."

2. "I can reach my thigh the best, so I will use different areas of the same thigh." 3. "By rotating the sites within one area, my chances of having tissue changes are less." 4. "If I change injection sites from the thigh to the arm, the rate of absorption will be different." 5. "I should inject at least 1-2 inches away from the last injection site." (2., 3., 4., & 5. Correct: To promote consistency in insulin absorption, the client should systematically rotate injection sites within an anatomic area to prevent lipodystrophy. Four main areas for injection are the abdomen, upper arms, thighs and hips. The client should try not to use the exact same site more than once in 2 to 3 weeks. If insulin is injected where there is more fat underneath the skin, insulin may be absorbed more slowly. Also, insulin should not be injected into the limb that will be exercised; absorption will be faster, increasing risk of hypoglycemia. The client should avoid using the exact same site more than once in 2 to 3 weeks. 1. Incorrect: The diabetic client should rotate sites within the same area before moving to a new area. This will assist in preventing lipodystrophy. Use of the abdominal site has nothing to do with being close to the pancreas. The abdomen is the preferred site because it provides the most rapid insulin absorption.)

The nurse is teaching a client regarding buspirone. The nurse recognizes that teaching has been effective when the client makes which statements? Select all that apply. 1. "I should start feeling better in two or three days." 2. "I should not drink alcohol while taking this medication." 3. "I will rise slowly from lying to sitting or standing." 4. "I will notify my primary healthcare provider of any unusal facial movements." 5. "I need to keep the medication in a closed container in the refrigerator."

2. "I should not drink alcohol while taking this medication." 3. "I will rise slowly from lying to sitting or standing." 4. "I will notify my primary healthcare provider of any unusal facial movements." (2., 3., & 4. Correct: These are correct statements that indicate that the client understands the teaching about this medication. Combined with alcohol use, the client may develop dizziness or drowsiness. Buspirone may cause orthostatic hypotension, so position changes are made slowly. The primary healthcare provider should be notified of any abnormal facial movements. The therapeutic effect occurs in 3-4 weeks. 1. Incorrect: Buspirone has a lag time of 10-14 days between start of therapy and subsiding of symptoms. The client must take the medication regularly, as ordered, so that it has sufficient time to take effect. 5. Incorrect: Store this medication in a container at room temperature below 86°F (30°C). The container should be kept away from light and moisture.)

The nurse is administering the prescribed Mantoux tuberculin skin test to a client. The nurse does not observe the tense blister-like formation at the injection site. Which action should the nurse take? 1. Chart the injection site response as the only action. 2. Administer another Mantoux tuberculin skin test at a different site. 3. Circle the area, wait 48 to 72 hours, and assess for a reaction. 4. Call the primary healthcare provider.

2. Administer another Mantoux tuberculin skin test at a different site. (2. Correct: If there is not a wheal of at least 6 mm in diameter after the solution is injected , the test should be administered again. The nurse would need to administer another Mantoux tuberculin skin test in another area about 5-6 cm from the original injection site. 1. Incorrect: The Mantoux tuberculin skin test is an intradermal injection. The expected outcome after the injection of the medication is a tense blister-like formation at the injection site. The absence of the tense blister-like formation is an indicator that the injection was given too deep. 3. Incorrect: The Mantoux tuberculin skin test was not administered correctly. A wheal of 5-6 cm did not occur after injection was given. The test would need to be done again. 4. Incorrect: There is no need to call the primary healthcare provider. The primary healthcare provider prescribed the test. The injection should be administered to create a 5-6 cm wheal.)

A client is admitted to the intensive care unit after overdosing on meperidine. What is the nurse's first priority? 1. Maintain continuous cardiac monitoring. 2. Administer naloxone hydrochloride 0.4 mg IV every 2-3 minutes prn. 3. Provide alprazolam 0.25 mg PO PRN. 4. Initiate intravenous fluid resuscitation with lactated ringers at 125 mL/hr.

2. Administer naloxone hydrochloride 0.4 mg IV every 2-3 minutes prn. (2. Correct: The respiratory status of the client takes priority. The administration of naloxone will block the opioid, initiating a reversal of the central nervous system (CNS) and respiratory depression. 1. Incorrect: Continuous cardiac monitoring is appropriate, however, airway takes priority. 3. Incorrect: Alprazolam will worsen respiratory depression. Alprazolam is a benzodiazepine. The action of this drug may depress the CNS. 4. Incorrect: IV fluids will be initiated, but airway takes priority.)

The nurse is caring for a client who is receiving a prostaglandin agonist for the treatment of glaucoma. Which comment by the client indicates a lack of understanding of the treatment regimen? 1. I must only use the drops in the eye with the increased pressure. 2. My eyes may be different colors, so I will use the drops in both eyes. 3. I must be careful not to overmedicate even if it is just an eye drop. 4. The eyelashes in the eye with the higher pressure may get longer.

2. My eyes may be different colors, so I will use the drops in both eyes. (2. Correct: The color of the iris may darken in the eye being treated; however, it is important that the client understand that drops should not be placed in the unaffected eye. Prostaglandins cause increased permeability in the sclera to aqueous fluid. So, as the prostaglandin agonist increases this activity, the outflow of aqueous fluid increases and the ocular pressure decreases. Administering the drops in the unaffected eye may result in a subnormal intraocular pressure. 1. Incorrect: This comment shows adequate understanding. The client should only treat the eye with the increased pressure. 3. Incorrect: This comment demonstrates that the client does understand the treatment regimen. Overmedicating the affected eye could reduce the intraocular pressure too much. 4. Incorrect: This comment shows understanding. The lashes in the eye being treated will lengthen as opposed to the untreated eye. The changes of the eyelashes (increased length, thickness, pigmentation and number of lashes) are typical with these eye drops and are viewed as a benefit by many clients.)

Which assessment finding by a nurse would best indicate a positive Mantoux tuberculin skin test in a client? 1. Formation of a vesicle that is 4 mm in diameter 2. A sharply demarcated region of erythema of 10 mm 3. A central area of induration of 15 mm surrounded by erythema 4. A circle of blanched skin surrounding the injection site

3. A central area of induration of 15 mm surrounded by erythema (3. Correct: The basis of reading the skin test is the presence or absence of induration, which is a hard, dense, raised formation. This is the area that is measured. Sometimes the site has erythema, a reddening of the skin that can also have swelling. The erythema should not be measured. Reactions to the skin test will vary. Measure only the induration. An induration of 15 mm or more is positive in persons with no known risk factors of TB. Reactions larger than 15 mm are unlikely to be due to previous BCG vaccination or exposure to environmental mycobacteria. 1. Incorrect: The basis of reading the skin test is the presence or absence of induration, which is a hard, dense, raised formation. This is the area that is measured. Sometimes the site has erythema, a reddening of the skin that can also have swelling. The erythema should not be measured. Reactions to the skin test will vary. For example, this is a very large reaction with blistering, swelling, and redness. Make sure to record blistering, even if no induration is present. Palpate this induration gently, as it may be painful. Measure only the induration. The vesicle may have a different underlying cause. 2. Incorrect: The basis of reading the skin test is the presence or absence of induration, which is a hard, dense, raised formation. This is the area that is measured. Sometimes the site has erythema, a reddening of the skin that can also have swelling. The erythema should not be measured. Doing so would result in a false positive test for the client. 4. Incorrect: The basis of reading the skin test is the presence or absence of induration, which is a hard, dense, raised formation. This is the area that is measured. Sometimes the site has erythema, a reddening of the skin that can also have swelling. The erythema should not be measured. Reactions to the skin test will vary. The area around the injection site may appear blanched initially, but should resolve. However, blanching should not be measured.)

The nurse is caring for a client prescribed vancomycin for Methicillin-Resistant Staphylococcus Aureus (MRSA) infection. What nursing intervention is appropriate? 1. Provide the client food or a snack to take with the medication 2. Verify that the client's BUN and creatinine are within normal range 3. Administer an antiemetic prior to vancomycin administration 4. Request the placement of a PICC line for IV administration

2. Verify that the client's BUN and creatinine are within normal range (2. Correct: Vancomycin is nephrotoxic, caution should be exercised in clients with impaired renal function. BUN and creatinine are specific diagnostic tests that indicate appropriate renal function. 1. Incorrect: Vancomycin is not effective via the oral route for systemic infections. It is taken orally only for the treatment of Clostridium difficile colitis. It does not need to be administered with food when taken orally. 3. Incorrect: Nausea and vomiting are not common side effects of vancomycin administration. 4. Incorrect: Vancomycin may be administered via a peripheral IV line; however, the IV access should be monitored closely due to the risk of necrosis and tissue sloughing with extravasation.)

What should the nurse instruct a client to avoid when prescribed digoxin? 1. Corn 2. Apples 3. Black licorice 4. Milk

3. Black licorice (1. Correct: Digoxin is derived from the leaves of a digitalis plant. It helps make the heart beat stronger and with a more regular rhythm. Digoxin is used to treat heart failure and atrial fibrillation. Foods and other drugs may interact with digoxin, including prescription and over-the-counter medicines, vitamins, and herbal products. Insoluble fiber such as wheat bran, can slow down the absorption of digoxin and lessen its effectiveness. To prevent this, clients should take digoxin at least one hour before or two hours after eating a meal. Herb use can also affect digoxin. Black licorice contains a natural ingredient called glycyrrhiza, which can deplete the body of potassium while causing an increased retention of sodium. When the body is depleted of potassium, the action of digoxin can be greatly enhanced, resulting in digoxin toxicity. 2., 3., & 4. Incorrect: Corn, apples, and milk do not interfere with the action of digoxin.)

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

4. Heart rate 56/min (4. Correct: This is a beta blocker. It slows the heart rate. If a client's heart rate is less than 60 beats per minute, notify the primary healthcare provider and ask if the client should receive this medication. Administering a beta blocker to a client who has a heart rate less than 60 could possibly cause the client to develop symptomatic bradycardia and hypotension. 1. Incorrect: If the client's BP drops below 90/60, this beta blocker should be held and the primary healthcare provider notified. The BP in this option is high enough to administer the medication, but the BP in clients on beta blockers should be monitored and the client should be taught about signs and symptoms of hypotension. 2. Incorrect: This is a normal glucose level. If the client is a diabetic, beta blockers can mask the signs of hypoglycemia. There diabetics on beta blockers should monitor their blood sugar carefully. 3. Incorrect: Urinary output is adequate. Beta blockers do not alter renal function. However, if pulse and BP are reduced too much, renal perfusion could ultimately be affected.)

A client diagnosed with a duodenal ulcer is prescribed lansoprazole and sucralfate. What should the nurse teach the client about how to take these medications? 1. Take together immediately before meals. 2. Take together immediately after meals. 3. Take the sucralfate first, wait at least 30 minutes, then take the lansoprazole. 4. Take the lansoprazole first, wait at least 30 minutes, then take the sucralfate.

4. Take the lansoprazole first, wait at least 30 minutes, then take the sucralfate. (4. Correct: When prescribed any medication along with sucralfate, the client should avoid taking the medication at the same time with sucralfate. Sucralfate can make it harder for the body to absorb lansoprazole because it forms a "coating" or "barrier" on the stomach lining. Therefore, the client should wait at least 30 minutes after taking the lansoprazole before taking sucralfate. 1. Incorrect: Taking sucralfate and lansoprazole at the same time will decrease the effects of lansoprazole because the sucralfate coats the stomach lining and reduces the absorption of the lansoprazole. 2. Incorrect: Taking sucralfate and lansoprazole at the same time will decrease the effects of lansoprazole because the sucralfate coats the stomach lining and reduces the absorption of the lansoprazole.. 3. Incorrect: Sucralfate can make it harder for your body to absorb lansoprazole because of the barrier created on the stomach lining.)

What should the chemotherapy infusion nurse recognize as the major barrier of chemotherapy success in treating cancer clients? 1. Inadequate knowledge of the side effects of chemotherapy 2. Difficulty obtaining an IV access 3. The development of alopecia 4. Toxicity to normal tissues

4. Toxicity to normal tissues (4. Correct: Chemotherapy is toxic to both cancerous and non-cancerous cells. Widespread destruction of non-concancerous "normal" cells can limit the use of chemotherapeutic agents. 1. Incorrect: Inadequate knowledge can be addressed and is not considered a major barrier for chemotherapy treatment. 2. Incorrect: Implantable ports are most often used for chemotherapy administration and eliminate the difficulty of obtaining a repeated peripheral IV site. 3. Incorrect: Alopecia is an adverse effect of chemotherapy but does not affect the success of chemotherapeutic agents.)

A nurse instructs a client diagnosed with asthma on the use of a metered dose inhaler (MDI). Prioritize the nurse's teaching by placing each instruction in the correct order. Shake the MDI Breathe out slowly, expelling all air from lungs Breathe in slowly over the course of 3 to 5 seconds Insert mouth piece and firmly press down on the MDI Hold your breath for 10 seconds Wait 1 minute and administer an additional puff as directed

Shake the MDI Breathe out slowly, expelling all air from lungs Insert mouth piece and firmly press down on the MDI Breathe in slowly over the course of 3 to 5 seconds Hold your breath for 10 seconds Wait 1 minute and administer an additional puff as directed (The correct sequencing when using an MDI begins with shaking the medication. Second, have the client breathe out to prepare to breathe in the medication. Third, inserting the mouthpiece, the nurse should instruct the client to firmly press down on the MDI. The fourth step will include pressing down on the delivery device of the inhaler, while the client slowly inhales for 3 to 5 seconds. Step five is having the client hold the breath to allow the medication to act on the lung tissue for a longer period of time. Finally, step six would be to administer an additional puff, if prescribed, after 1 minute. By waiting, especially in the case of a bronchodilator, the bronchioles will be even more open for the next dose of medication. If multiple inhaled medications are required, the client should always start with the bronchodilator for this reason.)

The nurse is caring for a client post heart transplant who is being discharged on cyclosporine and azathioprine. Which precautions would be important for the nurse to teach the client? Select all that apply 1. Avoid crowds. 2. Do not obtain live vaccinations. 3. Drink at least 3 liters of fluids per day and watch the urine for sediment. 4. Use a soft-bristled brush to clean your teeth. 5. Advise to use contraceptive measures during treatment.

1. Avoid crowds. 2. Do not obtain live vaccinations. 4. Use a soft-bristled brush to clean your teeth. 5. Advise to use contraceptive measures during treatment. (1., 2., 4., & 5. Correct: Both cyclosporine and azathioprine are immunosuppressants. Clients should be taught to protect themselves from sources of infection. Vaccinations are not given to immunocompromised clients. Avoidance of crowds will decrease the client's chance of contact with infections, especially those spread by droplets. As a general rule, significantly immunosuppressed clients should not receive live vaccines. Cyclosporine may cause growth of extra tissue in your gums so use a dentist regularly. These drugs are teratogenic. Clients should avoid pregnancy while on these medications. 3. Incorrect: Drinking 3 liters of fluids per day will not prevent renal impairment.)

The nurse is reviewing medications for a client who is being treated for major depression. The client is prescribed a selective serotonin reuptake inhibitor (SSRI). Which over the counter medication/supplement taken by the client should be reported to the primary healthcare provider immediately? 1. Daily intake of St. John's Wort. 2. Daily intake of a multi-vitamin. 3. Occasional use of ibuprofen. 4. Twice daily intake of an antacid.

1. Daily intake of St. John's Wort. (1. Correct: St. John's Wort is an herbal supplement often used in the treatment of mild depression. It should not be taken in combination with a selective serotonin reuptake inhibitor due to the risk of serotonin syndrome, which can be fatal. 2. Incorrect: A multi-vitamin taken with an SSRI poses no risk. 3. Incorrect: This medication taken with the SSRI would not warrant immediate reporting to the primary healthcare provider. 4. Incorrect: Antacids would not require immediate reporting.)

A client newly diagnosed with insulin dependent diabetes mellitus is started on insulin aspart protamine suspension/insulin aspart solution mixture. The nurse would teach the client that the insulin should start to lower the blood sugar within how many minutes? 1. 15 2. 30 3. 45 4. 90

1. 15 (1. Correct: Insulin aspart mixture is a rapid-acting insulin and starts to work within 15 minutes after given subcutaneously. 2. Incorrect: Regular insulin has an onset of 30 minutes to 1 hour. Aspart is a rapid-acting insulin, and begins to work within 15 mnutes. 3. Incorrect: Long acting insulin has an onset of 45-48 minutes. An example of long acting insulin would be lantus. 4. Incorrect: Intermediate acting insulin such as NPH insulin has an onset of 90 minutes.)

An elderly client receives instructions regarding the use of warfarin sodium. Which statement indicates to the nurse that the client understands the possible food interactions which may occur with this medication? 1. "I'm going to miss having my evening glass of wine now." 2. "I told my daughter to buy spinach for me. I'll have to eat more servings now." 3. "I will have to watch my intake of salads, something that I really love." 4. "I am going to begin eating more fish and pork and leave beef alone now."

3. "I will have to watch my intake of salads, something that I really love." (3. Correct: Clients taking warfarin sodium must watch their intake of vitamin K, which is present in leafy green vegetables and tomatoes. 1. Incorrect: Wine does not affect the use of warfarin sodium. 2. Incorrect: These clients need to monitor their intake of spinach, which is a source of vitamin K. 4. Incorrect: These clients need to monitor their intake of fish, which is a source of vitamin K.)

A woman, diagnosed with an ectopic pregnancy, asks the nurse the purpose of receiving methotrexate. What is the best reply for the nurse to make? 1. "Methotrexate will stop your bleeding." 2. "It will destroy fetal cells that got into your blood so that antibodies will not be formed." 3. "This medication will stop the growth of the embryo to save your fallopian tube." 4. "Cervical dilation is expected after receiving this medication."

3. "This medication will stop the growth of the embryo to save your fallopian tube." (3. Correct: The medical management of an ectopic pregnancy is to prescribe methotrexate. The action of methotrexate is to stop the growth of the embryo in the fallopian tube. The embryo is reabsorbed and the fallopian tube can be saved. 1. Incorrect: Methotrexate does not stop bleeding. It will stop the growth of the embryo so that the fallopian tube can be saved. 2. Incorrect: RhoGam is given to destroy fetal cells that got into mom's blood so that antibodies are not formed. This is done when mom is Rh negative. 4. Incorrect: Methotrexate does not cause cervical dilation. This medication will prevent damage to the fallopian tube by halting the growth of the embryo.)

A child was diagnosed with attention-deficit/hyperactivity disorder (ADHD) in the clinic one week ago. Today the child's mother calls the clinic to tell the nurse, "My child has not been able to sleep since being put on methyphenidate." What is the best response for the nurse to make? 1. "I will discuss this with the primary healthcare provider. A different medication may be prescribed." 2. "The insomnia will get better over time. Just wait it out." 3. "To prevent insomnia, give your child the last daily dose at least 6 hours before bedtime." 4. "Your child may have overdosed on the medication. Go to the emergency department now."

3. "To prevent insomnia, give your child the last daily dose at least 6 hours before bedtime." (3. Correct: The last dose should be at least 6 hours before bedtime. This will decrease the child's difficulty in falling asleep. If the medication is sustained-released, administer the dose in the morning. 1. Incorrect: This is premature. The nurse should identify the problem and suggest an alternative response. Try changing the time to help with sleep. 2. Incorrect: The child may adjust to the medication, but this will not correct the problem of insomnia. An alternative intervention should be recommended. 4. Incorrect: The client has not overdosed based on the data presented. Telling the mother to take the child to the emergency room is not needed.)

The nurse is teaching the client with asthma on proper use of an inhaler. Which statements by the client indicates that teaching has been successful? Select all that apply. 1. "Exhale completely before using my inhaler." 2. "Use my steroid inhaler before the bronchodilator." 3. "Inhale slowly and push down firmly on the inhaler." 4. "Rinse my mouth with water after using my inhaler." 5. "Wait 5 minutes between puffs."

1. "Exhale completely before using my inhaler." 3. "Inhale slowly and push down firmly on the inhaler." 4. "Rinse my mouth with water after using my inhaler." (1., 3. & 4. Correct: The client should exhale completely before using the inhaler; this response indicates the teaching was effective. The client should inhale slowly and push down firmly on the inhaler when administering the medication; therefore, the teaching was effective. The client should rinse the mouth after using the inhaler to prevent thrush. 2. Incorrect: The client should use the bronchodilator before the steroid inhaler. This response indicates the need for further teaching. 5. Incorrect: For inhaled quick-relief medication (beta2-agonists), wait about one minute between puffs. There is no need to wait between puffs for other medications.)

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

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

A female client with a history of frequent exacerbations of asthma asks the nurse to explain to her why she is at greater risk for fractures than other women her age. What is the nurse's best response? 1. "The steroids you are taking decrease calcium in the bone by sending it to the blood." 2. "Taking steroids causes bone calcium to increase, thus causing osteoporosis." 3. "Clients who have asthma are not able to exercise enough to prevent fractures from occurring." 4. "Asthma should not put you at increased risk for fractures but you are at risk for decreased blood glucose levels."

1. "The steroids you are taking decrease calcium in the bone by sending it to the blood." (1. Correct: Long term use of steroids decreases serum calcium, so the body takes calcium from the bone and puts it in the blood in order to bring the serum calcium back to a normal level. Every time a steroid is given, calcium is removed from the bone, thus leading to a greater risk for osteoporosis and fractures. 2. Incorrect: Osteoporosis is a decrease in bone calcium not an increase. 3. Incorrect: There are many types of exercise that asthma clients may participate in, including walking at short intervals. 4. Incorrect: Drug therapy for asthma (not asthma itself) may put a client at risk for osteoporosis, but not hypoglycemia.)

A client has been taking enoxaparin 40 mg subcutaneous once a day for 1 week. Which action should the nurse take? Lab Results: Hgb - 15 g/dl (2.3 mmol/l) Hct - 42% Platelets - 110,000/mm³ aPTT - 110 seconds INR - 1.2 1. Administer protamine sulfate 50 mg over 10 minutes. 2. Type and cross match for 2 units PRBCs 3. Increase enoxaparin dose to increase INR 4. Give the scheduled dose of enoxaparin

1. Administer protamine sulfate 50 mg over 10 minutes. (1. Correct: Protamine sulfate is given for heparin overdose. It is a heparin antagonist. Overdose is seen with a aPTT of 110 seconds. Depending on therapeutic intent, a client's aPTT levels should be between 60-80 seconds. (Normal aPTT for a client not on an anticoagulant is 25-35 seconds). 2. Incorrect: RBC, Hgb, Hct are normal. Blood transfusion is not indicated. 3. Incorrect: PT is not used to measure the therapeutic effect of enoxaparin, but rather aPTT. PT and INR are used for warfarin. 4. Incorrect: aPTT is too long at 110 seconds. Therapeutic level is 60-80 seconds.)

The nurse is assessing a client who is being treated with a non-steroidal anti-inflammatory medication (NSAID) for an acute flare-up of gout. Which finding is expected in the assessment? 1. Dramatic decrease in pain after beginning medications. 2. Severe abdominal pain following medication administration. 3. Decreased plasma uric acid levels. 4. Low-grade fever and rash.

1. Dramatic decrease in pain after beginning medications. (1. Correct: The client usually experiences dramatic improvement within 24 hours after beginning NSAIDs. 2. Incorrect: Most clients can tolerate NSAIDs fairly well. If severe pain in experienced, the primary healthcare provider should be notified immediately. 3. Incorrect: NSAIDs do not reduce plasma uric acid levels. 4. Incorrect: This is not an adverse effect of NSAIDs, in fact, most NSAIDs are also antipyretics and would prevent fever.)

A client diagnosed with serotonin syndrome is admitted to the unit. The nurse is familiar with this adverse reaction to the serotonin reuptake inhibitors. Which symptoms can the nurse expect on assessment? Select all that apply. 1. Fever and shivering 2. Agitation 3. Decreased body temperature 4. Constipation 5. Increased heart rate

1. Fever and shivering 2. Agitation 5. Increased heart rate (1., 2. & 5. Correct: Serotonin syndrome is a group of symptoms that can result from the use of certain serotonin reuptake inhibitors. These symptoms can range from mild to severe and include high body temperature, agitation, increased reflexes, diaphoresis, tremors, dilated pupils and diarrhea. The client is likely to experience shivering with fever. Increased heart rate and blood pressure are also commonly experienced. More severe symptoms, including muscle rigidity and seizures, can occur. If not treated, serotonin syndrome can be fatal. 3. Incorrect: Increased body temperature is expected as is increased diaphoresis. 4. Incorrect: Diarrhea, not constipation, is a symptom of serotonin syndrome.)

The nurse is caring for a client in an outpatient clinic. The client is being treated with warfarin for prevention of a stroke due to atrial fibrillation. The international normalized ratio (INR) was noted to be 4.6. What should the nurse do? Select all that apply. 1. Inform the primary healthcare provider immediately. 2. Instruct the client to continue medication as ordered. 3. Inform the client to watch for signs of bleeding. 4. Inform the client to return to the clinic per routine monitoring schedule. 5. Take no action as this value is within target range.

1. Inform the primary healthcare provider immediately. 3. Inform the client to watch for signs of bleeding. (1. & 3. Correct: The primary healthcare provider should be notified. The value of 4 is above the usual target range of 2-3. The client has a potential for decreased clotting and bleeding. The client should be told to watch for signs of bleeding. 2. Incorrect: The medication dosage is likely to be reduced. 4. Incorrect: The client should not leave the clinic until the primary healthcare provider has been notified. Further action is indicated and may include changing the usual warfarin dosage. 5. Incorrect: The normal range for a INR is 2-3. When a client is prescribed warfarin, the INR should increase to a therapeutic target range. The value of 4.6 is greater than the usual target range.)

The nurse is caring for a client who has just arrived at the emergency department with suspected acute myocardial infarction. Which medications should the nurse administer immediately? Select all that apply. 1. Oxygen 2. Heparin 3. Morphine 4. Sublingual nitroglycerin 5. Furosemide

1. Oxygen 3. Morphine 4. Sublingual nitroglycerin (1., 3., & 4. Correct: Initial management should take place immediately. According to the American Heart Association/Heart & Stroke Foundation of Canada and the American College of Cardiology, oxygen, SL nitroglycerin, morphine, and aspirin should be administered immediately. The initial goal of therapy for clients with an acute MI is to restore perfusion to the myocardium as soon as possible. Oxygen is appropriate and advisable when hypoxia is present. Pain from acute MI's may be intense and requires prompt administration of analgesia. Morphine sulfate is the medication of choice (2-4 mg every 5-15 minutes). Reducing the myocardial ischemia also helps reduce pain, so oxygen therapy and nitrates are main components of the therapy. The vasodilation effects of morphine and the nitroglycerin improve coronary blood flow and reduce myocardial ischemia. 2. Incorrect: Heparin is not part of the protocol within the guidelines and is not recommended at this time. 5. Incorrect: Furosemide is not part of the protocol within the guidelines and is not indicated at this time.)

A client has been prescribed sodium polystyrene sulfonate 30 grams rectally every 6h times 2. Which laboratory value would indicate that the prescribed sodium polystyrene sulfonate has been effective? 1. Potassium 4.8 mEq/L (4.8 mmol/L) 2. Sodium 148 mEq/L (148 mmol/L) 3. Calcium 8.9 mg/dL (2.2207 mmol/L) 4. Magnesium 1.2 mEq (0.6 mmol/L)

1. Potassium 4.8 mEq/L (4.8 mmol/L) (1. Correct: Sodium polystyrene sulfonate's action is to reduce the serum potassium level. The normal range for potassium is 3.5 - 5.0 mEq/L (3.5 - 5.0 mmol/L). The potassium level is 4.8 mEq/L (4.8 mmol/L) which is within the normal range. The potassium level would indicate that the prescribed sodium polystyrene has been effective. 2. Incorrect: A side effect of sodium polystyrene sulfonate is sodium retention. The normal range for sodium is 135 - 145 mEq/L (135-145 mmol/L). The client's sodium level of 148 mEq/L (148 mmol/L) indicates sodium retention. This is not the desired outcome of sodium polystyrene sulfonate. 3. Incorrect: The normal range of calcium is 9.0-10.5 mg/dL (2.25 - 2.62 mmol/L). The calcium level of 8.9 mg/dL (2.2207 mmol/L) indicates hypocalcemia. This is a side effect of sodium polystyrene sulfonate. 4. Incorrect: The magnesium level of Magnesium 1.2 mEq (0.6 mmol/L) indicates hypomagnesemia. This is a side effect of sodium polystyrene sulfonate. The normal range of magnesium is 1.3-2.1 mEq/L (0.65-1.05 mmol/L).)

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

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

The nurse is teaching a newly diagnosed diabetic about the action of regular insulin. The nurse verifies that teaching has been successful when the client verbalizes being at greatest risk for developing hypoglycemia at what time following the 8:00 a.m. dose of regular insulin? 1. 8:30 AM 2. 11:00 AM 3. 1:30 PM 4. 4:00 PM

2. 11:00 AM (2. Correct: 11:00 AM: Regular insulin peaks 2-3 hours after administration. Clients are at greatest risk for hypoglycemia when insulin is at its peak. 1. Incorrect: 8:30 AM: Rapid acting insulin will begin peaking in 30 minutes. 3. Incorrect: 1:30 PM: Intermediate acting insulin begins peaking at 4 hours. So at 1:30 PM this would be a time of worry. 4. Incorrect: 4:00 PM: At 4 PM you would still be worried about intermediate acting insulin. But you would also be worried about long acting insulin as well. Which starts to peak at 6 hours.)

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

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

A client is admitted to the surgical unit with cholelithiasis and a history of psychosis and a known allergy to phenothiazines. Which prescription should the nurse discuss with the primary healthcare provider? Perscriptions: Clear liquid diet Gallbladder ultrasound today IV of LR with KCL 20 mEq at 125 ml/hr Thioridazine 50 mg PO TID ​Ciprofloxicin 200 mg IVPB every 12 hours Haloperidol 5 mg by mouth twice daily Ondansetron 4 mg IM as needed for nausea or vomiting Allergies: Phenothiazines, ​Penicillin 1. Thioridazine 50 mg PO tid 2. Ciprofloxicin 200 mg IVPB every 12 hours 3. Haloperidol 5 mg PO bid 4. Ondansetron 4 mg IM prn nausea or vomiting

1. Thioridazine 50 mg PO tid (1. Correct: The client is allergic to phenothiazines. Thioridazine is a phenothiazine and should not be given to this client. 2. Incorrect: Ciprofloxicin is an antibiotic but is not a penicillin drug; therefore, it can be administered to this client. 3. Incorrect: Haloperidol is an antipsychotic medication. The classification is butyrophenone, not a phenothiazine. 4. Incorrect: Ondansetron is an antiemetic and is an appropriate drug for this client.)

A client diagnosed Alzheimer's disease has been prescribed memantine. What should the nurse teach the caregiver about this medication? Select all that apply 1. When beginning this medication provide ambulatory assistance. 2. This medication is prescribed to help improve mild dementia. 3. This medication must be taken without food. 4. If a dose is missed, double the next dose. 5. If the client cannot swallow the capsule you sprinkle on applesauce.

1. When beginning this medication provide ambulatory assistance. 5. If the client cannot swallow the capsule you sprinkle on applesauce. (1. & 5. Correct: This medication can cause dizziness, so safety precautions should be taught to the caregiver. Extended release caps should not be crushed, chewed, or divided. If the client cannot swallow it whole, it can be opened and sprinkled on a small amount of applesauce. 2. Incorrect: Memantine is used for moderate to severe dementia associated with Alzheimer's disease. 3. Incorrect: Memantine can be taken with or without food. 4. Incorrect: If the client misses a single dose of memantine, that client should not double up on the next dose. The next dose should be taken as scheduled.)

The night nurse has reported to the day nurse that a client has not had a bowel movement in 2 consecutive days. What actions should the day nurse take? Bowel Protocol: 1. When no BM has been recorded in two (2) consecutive days; On the 3rd Day 2. Write an interim order to "Initiate Bowel Protocol per Standing Order;" 3. Nurse initiates per-printed Bowel Protocol Administration Record; 4. Document on 24 hour report NIGHT SHIFT NURSE: Review all BM records and list names of clients who have not had DM for two (2) consecutive days. Give list to day shift nurse next morning. DAY SHIFT NURSE: 1. Offer 120 mL prune juice to client and ask UAP to inform nurse if client does not have BM by end of shift. 2. Document on 24 hour report. EVENING SHIFT NURSE: 1. If no BM on day shift, give client Milk of Magnesia 30 mL at 2000 hours. Ask UAP to inform nurse if client does not have BM by end of shift. 2. Document on 24 hour report. NIGHT SHIFT NURSE: 1. If no BM on evening shift, administer one Bisacodyl suppository by rectum at 0600. Ask UAP to inform nurse if client does not have BM by end of shift. 2. Document on 24 hour report. DAY SHIFT NURSE: 1. If no results from suppository, administer sodium phosphate enema at 1100 and ask UAP to inform nurse if client does not have BM by end of shift. 2. Document on 24 hour report. THE PRIMARY HEALTHCARE PROVIDER IS TO BE CALLED IF NO RESULT FROM ENEMA. Select all that apply 1. Write prescription to initiate "Bowel Protocol" per standing order. 2. Offer client 120 mL prune juice. 3. Give Milk of Magnesia (MOM) 30 mL po. 4. Administer bisacodyl suppository. 5. Provide sodium phosphate enema.

1. Write prescription to initiate "Bowel Protocol" per standing order. 2. Offer client 120 mL prune juice. (1., & 2. Correct: Look at the standing orders for Bowel Protocol. It states that if the client has not had a bowel movement in 2 consecutive days, the day shift nurse should write an order to initiate bowel protocol per standing order, and then offer 120 mL prune juice to the client. 3. Incorrect: The bowel protocol states to give MOM at 8 pm if there was no bowel movement on the day shift after giving prune juice. 4. Incorrect: The night nurse should give the suppository at 5 AM if there was no bowel movement prior to this time. 5. Incorrect: The day shift nurse on day 2 gives the enema at 11 AM if there has been no bowel movement.)

The nurse in the outpatient clinic performs an assessment on a client who takes propranolol for management of palpitations associated with mitral valve prolapse. Which statement by the client should be reported immediately to the primary healthcare provider? 1. "My resting pulse was 60 this morning." 2. "I feel a little short of breath when walking." 3. "I have lost 5 pounds in the last 2 weeks." 4. "My blood pressure (BP) was lower this visit than last time."

2. "I feel a little short of breath when walking." (2. Correct: Propranolol is a non-selective beta blocker so it blocks sites in the heart and in the lungs. The shortness of breath could be the result of the adverse reactions of bronchospams or heart failure. This statement requires immediate investigation by the primary healthcare provider. 1. Incorrect: A side effect of propranolol is bradycardia. The client should be taught to contact their primary healthcare provider if their pulse is <50 beats per minute (bpm). A pulse rate of 60 bpm is acceptable. 3. Incorrect: Losing weight is not a side effect of propranolol. Weight loss regimen may be encouraged for hypertension. Losing 5 pounds in 2 weeks is within the acceptable range. 4. Incorrect: The therapeutic effect of propranolol is to reduce BP. If the client is asymptomatic, decreased BP is no big deal.)

A client diagnosed with Addison's disease has been prescribed prednisolone. Which statement by the client indicates that the client's medication instructions for prednisolone have been effective? 1. "I should avoid foods high in protein." 2. "I will take prednisolone in the morning." 3. "I need to schedule an eye examination every 2 years." 4. "Infections will be reduced while taking prednisolone."

2. "I will take prednisolone in the morning." (2. Correct: If prednisolone is prescribed once a day, the medication should be taken in the morning. The body's production of cortisone is at a higher level in the morning. The cortisone prescription if taken in the morning will affect the pituitary-adrenal feedback less. 1. Incorrect: Side effects of corticosteroid therapy include decreased muscle mass and wound healing. Clients should be encouraged to consume a diet high in protein. Protein aids the body in repairing damaged tissues. 3. Incorrect: Yearly eye examinations are recommended. Prolonged prescription of prednisolone can result in cataracts and glaucoma. The yearly eye examination is necessary to monitor the client's eyes for any vision changes. 4. Incorrect: Infections will not be reduced while taking prednisolone. Prednisolone is an anti-inflammatory and immune system suppressant. There will be a decrease client's immune system and increase in masking infection symptoms.)

A client is being treated in the emergency department for dehydration. Which central venous pressure (CVP) reading would the nurse identify as the desired response to treatment? 1. -1 mm Hg 2. 4 mm Hg 3. 10 mm Hg 4. 15 mm Hg

2. 4 mm Hg (2. Correct: This CVP reading is indicative of a normal fluid volume state. This would be the desired response of treatment for dehydration. 1. Incorrect: This CVP reading is indicative of fluid volume deficit. The normal CVP reading is 2-6 mm Hg. 3. Incorrect: The normal CVP reading is 2-6 mm Hg. This CVP reading is high and indicative of fluid volume excess. This is not the desired outcome of treatment for dehydration. 4. Incorrect: The normal CVP reading is 2-6 mm Hg. This CVP reading is high and indicative of fluid volume excess. This is not the desired outcome of treatment for dehydration.)

During a physical assessment of a client who was started on haloperidol 5 days ago, the nurse notes restlessness, muscle weakness, drooling, and a shuffling gait. What should be the nurse's first action? 1. Hold the next haloperidol dose. 2. Administer the prn benztropine mesylate. 3. Notify the primary healthcare provider to discontinue the haloperidol. 4. Draw a blood sample for drug level.

2. Administer the prn benztropine mesylate. (2. Correct: Benztropine mesylate is an anticholinergic that counteracts the extrapyramidal symptoms (EPS) seen with the use of haloperidol. 1. Incorrect: Holding a single dose of haloperidol does not correct the extrapyramidal symptoms. 3. Incorrect: The primary healthcare provider has prescribed benztropine mesylate to combat the side effects of the haloperidol. There is no need to notify the primary healthcare provider, which will delay treatment. 4. Incorrect: The client is showing extrapyramidal symptoms associated with haloperidol therapy. Benztropine mesylate is an anticholinergic agent that can be used to treat the extrapyramidal effects that may be seen as a side effect of haloperidol therapy.)

The nurse is teaching a group of clients about selective serotonin reuptake inhibitors (SSRI). Which comment by a client in the group indicates adequate understanding of the effects/side effects of the medications? 1. My weight may decrease while taking this drug. 2. I may expect increased sweating while taking this drug. 3. I may actually feel more depressed while taking this medication. 4. I should feel better within a couple of days after beginning the medication.

2. I may expect increased sweating while taking this drug. (2. Correct. The drug causes temperature dysregulation, with increased sweating in some clients. 1. Incorrect. The medications may cause weight gain in some clients. 3. Incorrect. The client should have a lessening of depressive symptoms within a few weeks. This is one of the primary indications for taking this classification of medications. 4. Incorrect. The lag time for antidepressants to reach therapeutic effect is usually two to four weeks before the therapeutic effect is reached. The client's comment indicates lack of understanding of the medication effects and side effects.)

A client with a history of adrenal insufficiency is placed on fludrocortisone. Which value is most important for the nurse to monitor? 1. Magnesium 2. Weight 3. Pain 4. Glucose

2. Weight (2. Correct: Weight is monitored daily to assess for sudden increases which would indicate fluid retention. Fludrocortisone is a man made glucocorticoid and is used to treat low glucocorticoid levels caused by diseases of the adrenal gland. Glucocorticoids are important in maintaining salt and water balance in the body and normalizing blood pressure. 1. Incorrect: No, monitor for lowered serum potassium instead of magnesium because fludrocortisone causes the body to retain sodium, and excrete calcium and potassium. 3. Incorrect: Adrenal insufficiency and steroid therapy are not precursors of pain. 4. Incorrect: Glucose may increase as a result of steroid therapy as glucocorticoids inhibit insulin. But, weight is the critical value to monitor for dosing, as treatment may be discontinued with a sudden weight increase.)

An occupational health nurse is reviewing the current medications of a client who has recently been prescribed propranolol for hypertension. Which current medication taken with propranolol by the client should be of concern to the nurse? 1. Cyanocobalamin 2. Melatonin 3. Cetirizine 4. Esomeprazole

2. Melatonin (2. Correct: Melatonin is a manmade form of the hormone that is key in regulation your body's internal clock. It is often used in treating sleep disorders. Melatonin can raise blood pressure in people who are taking beta blockers to control blood pressure. Avoid using it in conjunction with propanolol or any other beta blockers. 1. Incorrect: There are no known interactions between propranolol and Vitamin B12 (cyanocobalamin). Vitamin B12 is one of the essential vitamins and can be found in meat, fish and dairy. 3. Incorrect: There are no known interactions between propranolol and Zyrtec (Cetirizine). Cetirizine is an antihistamine used to treat cold or allergy symptoms. This medication may cause severe drowsiness. 4. Incorrect: There are no known interactions between propranolol and Nexium (esomeprazole). Esomeprazole is a proton inhibitor that decreases stomach acid, and remember, it is not used for immediate relief of heartburn symptoms.)

A nurse is planning an educational session on fluticasone/salmeterol for a group of clients who have been prescribed this medication. What teaching points should the nurse include? Select all that apply 1. Swallow the capsule when having an acute asthma episode. 2. Rinse mouth after medication administration to decrease infection. 3. Take this medication every day, even on days when breathing fine. 4. Administer by HandiHaler DPI, twice daily. 5. Carry a rescue inhaler, such as albuterol, when leaving home.

2. Rinse mouth after medication administration to decrease infection. 3. Take this medication every day, even on days when breathing fine. 4. Administer by HandiHaler DPI, twice daily. 5. Carry a rescue inhaler, such as albuterol, when leaving home. (2., 3., 4., & 5. Correct: This medication contains a steroid which can increase the risk of oropharyngeal fungal infections. Rinsing will also decrease mouth and throat irritation. Medication should be taken every day as directed, even on days when client feels they are breathing better. This is a preventative medication not a rescue medication. This medication is administered by an inhaler. It is not given orally. A rescue inhaler, such as albuterol, is needed when the client leaves home. Fluticasone/salmeterol is not a rescue inhaler but for long term control and maintenance treatment for the prevention of bronchospasm and airway inflammation associated with asthma, chronic bronchitis, and COPD. 1. Incorrect: Medication must be taken with an inhaler. Capsules and tablets are not to be swallowed. Teach client how to use a DPI for medication administration.)

A client with chronic alcoholism has been admitted to the intensive care unit after overdosing on alcohol. Which medication should the nurse prepare to administer? 1. Disulfiram 250 mg po daily 2. Thiamine 100 mg IV twice a day 3. Naloxone 0.4 mg IV prn 4. Clonidine TTS patch 2.5 mg per week

2. Thiamine 100 mg IV twice a day (2. Correct: Prescribing of thiamine action is to alleviate dehydration, prevent delirium and precaution treatment for vitamin B complex deficiency. Thiamine 50-100 mg IV or IM is indicated twice a day for clients with chronic alcoholism. It is usually given for several days, followed by 10-20 mg once a day until a therapeutic response is obtained. 1. Incorrect: Disulfuram is an aid in the management of selected chronic alcohol clients who want to remain in a state of enforced sobriety so that supportive and psychotherapeutic treatment may be applied. It is not a cure for alcoholism. Without proper motivation and supportive therapy, it is unlikely that it will have any substantive effect on the drinking pattern of the chronic alcoholic. 3. Incorrect: Naloxone prevents or blocks the action of narcotics (opioid medication). Naloxone is indicated for opioid overdose. Naloxone is sometimes prescribed to verify whether the client has overdosed with an opioid. 4. Incorrect: Clonidine is used to suppress opiate withdrawal symptoms. Serves effectively as a bridge to enable the client to stay opiate-free long enough to facilitate termination of methadone maintenance.)

The nurse is teaching a client about foods containing tyramine which should be avoided while taking a monoamine oxidase inhibitor (MAOI). Which meal selection by the client would indicate understanding of an acceptable food to eat? 1. Smoked turkey and dressing, sweet peas and carrots and milk. 2. Baked chicken over pasta with parmesan sauce, baked potato and tea. 3. Fried catfish, French fries, coleslaw and apple juice. 4. Liver smothered in gravy and onions, rice, squash and water.

3. Fried catfish, French fries, coleslaw and apple juice. (3. Correct: These foods are not high in tyramine. Tyramine is an amino acid that helps in the regulation of blood pressure. MAOIs block the enzyme monoamine oxidase which is responsible for breaking down excess tyramine in the body. Eating foods high in tyramine while on MAOIs can result in dangerously high levels of tyramine in the body. This can lead to a serious rise in blood pressure, creating an emergency situation. Tyramine is found in protein-containing foods and the levels increase as these foods age. Food such as strong or aged cheese, cured meats, smoked or process meats, liver (especially aged liver), pickled or fermented foods, sauces, soybeans, dried or overripe fruits, meat tenderizers, brewer's yeast, alcoholic beverages and caffeine- such as in tea, cokes and coffee are considered to be high in tyramine and should be avoided in clients taking MAOIs. 1., 2., & 4. Incorrect: The following foods in the options listed above contain moderate to high levels of tyramine and should be avoided while taking MAOIs: smoked turkey, parmesan cheese, tea and liver.)

A client is to undergo an endoscopy in the client's room. The gastroenterologist gives a verbal prescription to the general floor nurse to prepare and administer propofol 10 mL slow IVP until sedation is achieved. What action should the nurse take? 1. Administer the propofol as prescribed. 2. Draw up the propofol and give it to the gastroenterologist to administer. 3. Inform the gastroenterologist that giving propofol is outside the nurse's scope of practice. 4. Request the gastrointerologist write the prescription.

3. Inform the gastroenterologist that giving propofol is outside the nurse's scope of practice. (3. Correct. Propofol administration is outside the scope of practice for general floor nurses. The gastroenterologist cannot monitor the client adequately while performing the procedure. A nurse anesthetist or anesthesiologist should be present. 1. Incorrect. Propofol administration is outside the scope of practice for general floor nurses. 2. Incorrect. The nurse should not draw up a medication and hand it to someone else to administer. Additionally, propofol should not be administered on a general unit without an anesthesiologist, or nurse anesthetist in attendance. 4. Incorrect. Prescriptions should be written rather than given verbally. However, the RN cannot administer propofol.)

Which findings would indicate to the nurse that a client with Addison's disease has received too much glucocorticoid replacement? Select all that apply. 1. Dry skin and hair 2. Hypotension 3. Rapid weight gain 4. Decreased blood glucose level 5. Increased cholesterol

3. Rapid weight gain 5. Increased cholesterol (3, & 5. Correct: Excessive drug therapy with glucocorticoids will cause rapid weight gain, round face, and fluid retention. Cholesterol and triglycerides in the blood are also increased by glucocorticoids. Long term use of high steroid doses can lead to symptoms such as thinning skin, easy bruising, changes in the shape or location of body fat (especially in your face, neck, back, and waist), increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex. 1. Incorrect: Dry skin and hair would be seen with a decrease in sex hormones, not with a increase in glucocorticoids. An increase in glucocorticoids will result in an increase in oil production in the skin. 2. Incorrect: Hypotension is a sign of Addison's disease. The client loses sodium and water, causing the client's blood pressure to drop. This loss of sodium and water would come from a decrease in mineralocorticoids. This would have nothing to do with glucocorticoids. 4. Incorrect: An increase in glucocorticoids will result in glucose intolerance. The client will become resistive to insulin production. This will result in an increase in the serum blood glucose.)

The nurse has initiated instruction for an 11 year old child newly diagnosed with diabetes mellitus. The child indicates anxiety about the need for daily insulin injections. What nursing action would best address this issue? 1. Tell the child it only hurts for a moment. 2. Have the parents administer the shots. 3. Show the child how to give self injections. 4. Provide toy syringe for the client to play with.

3. Show the child how to give self injections. (3. Correct: A school age child needs a sense of achievement and control of the situation. Because diabetes will be a life-long disease, it is important for the child to begin learning about self-care which includes daily insulin injections. Age eleven is not too young to begin administering self injections. 1. Incorrect: This is a false statement, considering the fact that pain perception varies. Minimizing the amount of potential discomfort will instill distrust in the child, decreasing compliance with the health regimen. This is false assurance. 2. Incorrect: While parents may administer injections for much younger children, school aged children are capable of becoming independent with all aspects of diabetes. Additionally, an 11 year old client needs to develop a sense of mastery and achievement to accomplish this stage successfully. 4. Incorrect: The client is too old for pretend play with imitation syringes. That process is more appropriate for a preschool child. It would be beneficial to allow this child to handle regular syringes without a needle initially, and then add all the necessary equipment when the client feels more comfortable handling everything.)

What action by a new nurse who is drawing up a medication from an ampule would require intervention by the supervising nurse? 1. Taps the top of the ampule to remove medication trapped in the top of the ampule. 2. Snaps the neck of ampule away from the body when breaking the top off. 3. Withdraws medication using a 22 gauge needle. 4. Inverts ampule, places needle tip in liquid, and withdraws all of the medication.

3. Withdraws medication using a 22 gauge needle. (3. Correct: This action should be corrected by the supervising nurse. Because tiny pieces of glass could have gotten into the medication, the nurse should attach a filter straw to a syringe. If the syringe has a needle in place, the nurse should remove both the needle and the cap and place it on a sterile surface (e.g., a newly unwrapped alcohol pad still in the open wrapper), and then attach filter straw. 1. Incorrect: This is a correct action by the new nurse. Alternatively, the new nurse can flick the top or shake the ampule by quickly turning and "snapping" the wrist. 2. Incorrect: This is a correct action by the new nurse. This will prevent shattering of class toward the hand or face. 4. Incorrect: This is a correct action by the new nurse. Two techniques can be used to withdraw medication from an ampule. The nurse can invert the ampule, place the filter straw tip in the liquid, and withdraw all of medication. The nurse does not insert the filter straw through the medication into the air at the top of the inverted ampule. This will result in medication leaking out of the ampule. Alternatively, the nurse can tip the ampule, place the filter in the liquid, and withdraw all of the medication.)

A nurse is caring for a client who has been prescribed clonazepam for 6 months. What education should the nurse provide to the client? 1. "Your glucose level should be monitored while prescribed clonazepam." 2. "You may experience dry skin periodically while prescribed clonazepam." 3. "Schedule appointments to have clonazepam administered intravenously." 4. "A long-term prescription of clonazepam should be discontinued gradually."

4. "A long-term prescription of clonazepam should be discontinued gradually." (4. Correct: Client's on an extended prescription of clonazepam will precipitate physical withdrawal symptoms, if the prescription is abruptly discontinued. The physical symptoms can include nausea, feeling tired, and headache. 1. Incorrect: The action of clonazepam does not result in a negative feedback in the endocrine system. The glucose level does not need to be monitored while prescribed clonazepam. 2. Incorrect: Dry skin is not a side effect related to the actions of clonazepam. The integumentary system side effects related to the actions of clonazepam include rash, alopecia, and hirsutism. 3. Incorrect: The route of administration for clonazepam is by mouth, tablet and disintegrating tablet. Clonazepam is not approved to be administered by the intravenous route.)

A female client taking captopril for hypertension tells the clinic nurse that she is planning to get pregnant. What recommendation should the nurse make? 1. "Captopril can be taken safely during pregnancy, but we will need to decrease your dose so you do not become hypotensive." 2. "We will need to increase your dose of captopril once you become pregnant." 3. "In order to prevent neural tube defects, start taking folic acid." 4. "Captopril can cause serious harm to an unborn baby, so you must prevent pregnancy while taking this medication. "

4. "Captopril can cause serious harm to an unborn baby, so you must prevent pregnancy while taking this medication. " (4. Correct: Captopril should not be taken during pregnancy because serious harm (possibly fatal) to the unborn baby can result when taken during pregnancy. 1., & 2. Incorrect: Captopril should not be taken during pregnancy because serious harm (possibly fatal) to the unborn baby can result when taken during pregnancy. 3. Incorrect: Captopril should not be taken during pregnancy because serious harm (possibly fatal) to the unborn baby can result when taken during pregnancy. The problem being presented in the stem is not related to general prevention of neural tube defects. Folic acid would not prevent the harm to the fetus caused by catopril.)

A client, admitted in Sickle Cell Crisis, is started on oxygen at 2L/NC and given a narcotic analgesic for pain control. What additional prescription is a priority for the nurse to initiate? 1. A high protein, low fat diet 2. Administration of a thrombolytic, such as streptokinase 3. Implementation of bleeding precautions 4. Administration of IV fluids for hydration

4. Administration of IV fluids for hydration (4. Correct: Increasing hydration status via the administration of IV fluids is indicated in sickle cell crisis to increase that volume in the vascular space and subsequently decrease the vaso-occlusion from the sickling effects of the RBCs. The increased volume separates the sickled cells to reduce the clumping together of the cells. 1. Incorrect: While beneficial for many clients, a high protein, low fat diet provides no benefit during the crisis phase of sickle cell disease. Hydration to improve circulation is a priority due to the impairment or obstruction of blood flow caused by the sickled cells clumping together. 2. Incorrect: Thrombolytics are indicated for the lysis of existing clots and do not have a primary role in the treatment or management of sickle cell disease. The issue in sickle cell crisis is not clot formation but rather a clumping together of sickled cells that impairs or blocks circulation. 3. Incorrect: Sickle cell disease is characterized by sickling of RBCs, causing them to clump together and obstruct capillary blood flow, causing ischemia and possible tissue infarction. Increased risk of bleeding is not a concern.)

A client is scheduled for an inguinal hernia repair. Routine medications for the client include valproic acid, glyburide, and diclofenac. What pre-op prescription should the nurse question? 1. Stop taking diclofenac 2 days prior to surgery. 2. Complete shave prep of groin. 3. Start IV of NS at 50/mL per hr. 4. Hold all morning medications day of surgery.

4. Hold all morning medications day of surgery. (4. Correct: Valproic acid is a synthetic anticonvulsant that is used for seizure disorders and is usually prescribed once or twice daily. The most concerning issue is that seizure medication should not be stopped suddenly for any reason. The nurse should call the primary healthcare provider and ask if the client could take the valproic acid with a little sip of water. This would not interfere with the surgery. However, the client is on an oral antidiabetic agent (glyburide) which would need to be held. 1. Incorrect: Diclofenac is a non-steroidal antiinflammatory drug (NSAID). It is appropriate to withhold NSAIDS several days to a week before surgery to reduce the risk of bleeding. 2. Incorrect: This order is appropriate for a client having an inguinal hernia repair. There is no need to question this order. 3. Incorrect: When a client is NPO for surgery, dehydration can quickly become an issue. Therefore, a basic IV solution, such as normal saline, running at 50 mL/hour is considered a KVO (keep vein open) rate and is appropriate. This is enough to supply minimum body fluid needs until client goes to surgery.)

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

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

A client has an order for two units of packed red blood cells (PRBCs) to be administered. The current IV prescribed is D5LR with 20 mEq KCL at 125 mL/hr infusing through a 22 gauge needle to the left hand. What action should the nurse take? 1. Piggyback the PRBCs to the current IV fluid at the lowest port on the tubing. 2. Change the current IV fluid to NS so the blood can infuse through the IV tubing. 3. Disconnect the current IV fluid and connect NS with a y-tubing blood administration set. 4. Start another IV with an 18 gauge needle to the right arm.

4. Start another IV with an 18 gauge needle to the right arm. (4. Correct: Blood should be administered through a large bore IV needle such as an 18 gauge, but no smaller than a 20 gauge. Smaller needles can cause the PRBCs to lyse. 1. Incorrect: The PRBCs must be administered through a y-tubing blood administration set that has a filter. Do not infuse through a normal IV tubing. The current IV that is infusing has 20 mEq KCL added. PRBCs should not be infused with KCL. Also the current IV was initiated with a 22 gauge needle, and the PRBCs should be infused with a needle no smaller than 20 gauge. 2. Incorrect: The IV needle is too small, and the client has an order for the IV fluids and potassium. It is out of the scope of the RN to change the prescription for the D5LR with 20 mEq KCL. Also the client requires additional KCL. 3. Incorrect: The problem here is that the IV needle is too small.

After reviewing the nursing notes on a client receiving a unit of packed red blood cells, what action should the charge nurse take? 1200: NS hung to y-tubing for administration of one unit of PRBCs. Initial vital signs taken. Afebrile. Client informed of signs/symptoms of reactions to report. Informed client that vital signs will be taken every 15 minutes for 1 hour. 1205: Unit of PRBCs checked with M. Nurse, RN as compatible. Unit #12345 hung via pump at 25 mL per hour. 1220: No signs/symptoms of reaction to blood transfusion. Vital signs stable. Afebrile. IV rate increased to 50 mL per hour. 1620: PRBCs continue to infuse. IV rate increased to 125 mL per hour. 1. Decrease the transfusion rate to 50 mL/hour. 2. Assess the client for a transfusion reaction. 3. Check primary healthcare provider prescription for prescribed administration time. 4. Stop the transfusion and send blood bag to the lab.

4. Stop the transfusion and send blood bag to the lab. (4. Correct: All blood from each unit of packed red blood cells must be completed within a 4 hour time frame due to risk of hemolysis and bacterial invasion. If the unit of blood is not completed in a 4 hour time frame, the blood must be sent to the lab to be discarded. Keep in mind that the time frame for administering platelets and fresh frozen plasma differs (20-30 min). 1. Incorrect: This blood has been hanging for 4 hours and must be discontinued. 2. Incorrect: The problem is that the blood has been hanging too long. It must be taken down. There is no indication that a transfusion reaction is occurring. Transfusion reaction symptoms include back pain, dark urine, chills, fainting or dizziness, fever, flank pain, skin flushing, shortness of breath. 3. Incorrect: The problem is that the blood has been hanging too long. It must be taken down. It cannot be hung for a longer period of time due to risk of hemolysis and bacterial invasion.)

A client who has chronic renal failure has been prescribed synthetic erythropoietin for the prevention of anemia. Which assessment finding should be reported to the primary healthcare provider? 1. Hemoglobin level of 10 g/dl (1.6 mmol/L) 2. Blood pressure of 120/84 3. Constipation 4. Swelling of feet and ankles

4. Swelling of feet and ankles (4. Correct: Erythropoietin is generally well tolerated. Swelling of feet and ankles may indicate the beginning of a cardiovascular problem. Clients taking this drug are at risk for myocardial infarctions and risk of blood clots. 1. Incorrect: The purpose of this drug is to increase hemoglobin levels. A level of 10g/dL (1.6 mmol/L) would be considered favorable even though still low. The client would still need the medication since anemia still exists. If hgb is above 12 g/dl (1.9 mmol/l), the level should be reported as the client does not need the med any longer. 2. Incorrect: An elevated blood pressure is one of the more common and major side effects. If elevated it should be reported, but this blood pressure is within normal limits. 3. Incorrect: Constipation may be caused by iron preparations. Increasing fiber in the diet may improve that symptom. A common side effect of synthetic erythropoietin is diarrhea.)

The nurse is caring for a client receiving total parenteral nutrition (TPN). Which assessment would require the nurse to intervene? 1. TPN has been hanging for 12 hours 2. Central venous catheter's dressing is clean and dry 3. TPN fluid is room temperature when beginning administration 4. TPN appears oily in consistency

4. TPN appears oily in consistency (4. Correct: Do not use TPN if it looks curdled, oily, or has particles in it. This is an indication that something is wrong with the solution and could harm the client if given. 1. Incorrect: This TPN does not need to be replaced at 12 hours. It can infuse for 24 hours. 2. Incorrect: This is a description of an occlusive clean dressing at the insertion site. This description would not require intervention. 3. Incorrect: TPN should be at room temperature when beginning administration. Solutions that is too cold could cause vasoconstriction and undue harm to the client.)

A client with nausea, vomiting, and diarrhea for the past three days has been prescribed one liter of normal saline with 40 mEq (40 mmol/L) of potassium chloride to infuse at 250 mL per hour. Which assessment would the nurse report to the primary healthcare provider prior to initiating the infusion? 1. Blood pressure of 106/54 2. Apical pulse of 112 per minute 3. Tenting of the skin over the sternum 4. Urinary output of 148 mL for the past 6 hours

4. Urinary output of 148 mL for the past 6 hours (4. Correct: The client's output is below normal. This could indicate a problem with renal perfusion. Potassium is excreted through the kidneys, so if the kidneys are not being perfused, the client would retain potassium. The healthcare provider would need to be aware of the client's low urine output. 1. Incorrect: A client in fluid volume deficit would have a low blood pressure. This is an expected assessment prior to fluid resuscitation. 2. Incorrect: A client in fluid volume deficit would have a fast pulse rate. This is an expected assessment prior to fluid resuscitation. 3. Incorrect: A client in fluid volume deficit would have tenting of skin. This is an expected assessment prior to fluid resuscitation.)

A client with diabetes mellitus has a newly prescribed insulin pump. Which statements made by the client indicate understanding of an insulin pump? Select all that apply 1. "I will attach the pump to my waistband or wear it in the pocket of my pants." 2. "I can eat whatever I want as long as I cover the calories with sufficient insulin." 3. "I may take my insulin pump off when I exercise." 4. "I need to check my blood glucose level several times a day." 5. "I have to change the catheter at the end of the pump every week."

1. "I will attach the pump to my waistband or wear it in the pocket of my pants." 3. "I may take my insulin pump off when I exercise." 4. "I need to check my blood glucose level several times a day." (1., 3. & 4. Correct: Insulin pumps are externally worn on clothing or in a pocket. Pumps can be easily disconnected for limited periods such as for showering, exercise, and sexual activity. Clients must assess their blood glucose level several times daily. 2. Incorrect: Clients are prescribed a specific caloric intake and insulin regimen, and maintaining as much consistency as possible in the amount of calories and carbohydrates is essential. 5. Incorrect: The needle or catheter attached at the end is changed at least every three days.)