NCLEX studies

A nurse is teaching a client about tricyclic antidepressants. Which potential side effects does the nurse include? Select all that apply.

Dry mouth,Drowsiness,Constipation,Orthostatic hypotension Rationale Dry mouth is a common anticholinergic side effect of tricyclic antidepressants. Drowsiness can be a common side effect of tricyclic antidepressants but usually decreases with continued treatment. Constipation is a common side effect of tricyclic antidepressants that can usually be managed with stool softeners and a high-fiber diet. Orthostatic hypotension is a common side effect of tricyclic antidepressants; the client should be instructed to rise slowly from a sitting to a standing position.

A nurse is providing instructions for a client who is receiving phenytoin but has limited access to health care. What side effect is the basis for the nurse's emphasis on meticulous oral hygiene?

Hyperplasia of the gums Rationale Gingival hyperplasia is an adverse effect of long-term phenytoin therapy; incidence can be decreased by maintaining therapeutic blood levels and meticulous oral hygiene.

A pregnant client with an infection tells the nurse that she has taken tetracycline for infections on other occasions and prefers to take it now. What does the nurse advise regarding the reason tetracycline is avoided during pregnancy?

It alters the development of fetal teeth buds. Rationale Tetracycline has an affinity for calcium; if used during tooth bud development it may cause discoloration of teeth

A client is scheduled to receive intravenous (IV) fluids to be delivered at 80 mL/hr. To adjust the drip rate when administering the IV via gravity, what must the nurse determine?

Drops per milliliter delivered by the infusion set

A lactating woman who reports a loss of interest in daily activities, loss of appetite, and sleeplessness is diagnosed with depression. What would be the drug of choice for this client if she wishes to continue breast-feeding?

Sertraline ,Rationale Sertraline is the drug of choice for lactating woman with depression because it does not cause any effects on breast-feeding infants

A client with depression is to be given fluoxetine (Prozac). What precaution should the nurse consider when initiating treatment with this drug?

The blood level may not be sufficient to cause noticeable improvement for 2 to 4 weeks.

A nurse administers trimethoprim-sulfamethoxazole (Bactrim) to a client diagnosed with a urinary tract infection. What should the nurse monitor to determine the therapeutic effectiveness of the drug?

White blood cell (WBC) count

A woman in the first trimester of pregnancy wants to terminate her pregnancy due to malformations in her fetus. Which oxytocic drug should be administered to the client?

Mifepristone, Rationale Mifepristone is a progesterone antagonist used to induce the voluntary termination of a pregnancy. Oxytocin is generally used to induce and enhance labor. Misoprostol and dinoprostone are given during the second trimester to induce an abortion.

A child who has been undergoing prolonged steroid therapy takes on a cushingoid appearance. What will the nursing evaluation probably reveal? Select all that apply.

Truncal obesity,Thin extremities Rationale An increase in appetite results in deposition of fat on the abdomen and trunk. Muscle wasting results in thin extremities. Increased excretion of calcium causes retardation of linear growth and a resulting short stature. Because of the excess production of androgens, virilization and hirsutism occur. Increased salt and water retention cause hypertension and hypernatremia.

A client receives information about rifampin for tuberculosis. Which statements indicate that the client understands this information? Select all that apply.

"This drug may be hard on my liver so I must avoid alcoholic drinks while taking it." This drug may reduce the effectiveness of the oral contraceptive I am taking." My health care provider must be called immediately if my eyes and skin become yellow."

What should the nurse assess to determine if a client is experiencing the therapeutic effect of valsartan (Diovan)?

Blood pressure Rationale Angiotensin II receptor blockers (ARBs) lower the blood pressure; they block the receptor sites in smooth muscles and adrenal glands so vasoconstriction is prevented

A nurse is providing discharge instructions about digoxin (Lanoxin). Which response should a nurse include as a reason for a client to withhold the digoxin?

Blurred vision,Visual disturbances, such as blurred or yellow vision.

A client reports nausea, vomiting, and seeing a yellow light around objects. A diagnosis of hypokalemia is made. Upon a review of the client's prescribed medication list, the nurse determines that what is the likely cause of the clinical findings?

Digoxin (Lanoxin) These are signs of digitalis toxicity, which is more likely to occur in the presence of hypokalemia.

A nurse is providing palliative care to a client with lung cancer. Which therapies does the nurse identify that will most likely provide palliation of distressing symptoms of the disease? Select all that apply.

Chemotherapy,Oxygen therapy , Radiation therapy Chemotherapy and radiation therapy can provide palliative relief from distressing symptoms of lung cancer. Oxygen therapy would likely relieve some of the dyspnea associated with lung cancer. Photochemotherapy is used in the management of psoriasis.

A nurse is caring for a patient who has been prescribed an atypical antipsychotic drug. The nurse knows that the patient needs to be monitored for hypotension, which can occur as a drug side effect. Which drug is most likely to have been prescribed to the patient?

Clozapine (Gen-Clozapine) Rationale Clozapine is an atypical antipsychotic drug that is highly hypotensive; a patient taking this drug needs to be monitored for hypotension. Asenapine is an atypical antipsychotic drug that is moderately hypotensive. Aripiprazole is an atypical antipsychotic drug that has low hypotensive effects. Fluphenazine is a typical antipsychotic drug that is mildly hypotensive.

A client is treated with lorazepam for status epilepticus. What effect of lorazepam does the nurse consider therapeutic?

Depresses the central nervous system (CNS). Rationale Lorazepam, an anxiolytic and sedative, is used to treat status epilepticus because it depresses the CNS.

The parents of a school-aged child with cystic fibrosis tell the nurse that they have changed to generic pancreatic enzymes because of money issues. What is an appropriate response by the nurse?

Generic enzymes are not as effective as the brand-name one. This is something you need to discuss with your healthcare provider." Generic pancreatic enzymes are not considered adequate in children with cystic fibrosis because of the bioavailability of the enzymes. Pancreatic enzyme supplementation is a lifelong treatment for cystic fibrosis.

A toddler with hemophilia A is receiving factor VIII. The mother asks the nurse, "If my son hurts himself, I'll give him 2 children's ibuprofen. Is that right?" How should the nurse respond?

Give him acetinophen. Ibuprofen may cause bleeding." Rationale The parent is asking a specific question that should be answered by the nurse. Ibuprofen (Advil) is contraindicated because it may cause more bleeding. Ibuprofen interferes with platelet function and may cause more bleeding; therefore an analgesic such as acetaminophen (Tylenol) should be administered, because it does not interfere with coagulation. Analgesics are permitted, provided they do not have anticoagulant effects.

An alcoholic mother gave birth to a baby who had alcohol dependency. Which nursing intervention would be helpful in managing alcohol dependency in the baby?

Give reduced doses of alcohol to overcome drug dependency Rationale The baby born to an alcoholic mother should be treated with reduced doses of alcohol to wean the baby from the alcohol dependency. Avoiding alcohol may cause withdrawal syndrome, and the baby may show symptoms of shrill crying and extreme irritability. Treatment to counter the alcohol abuse in the baby may not be effective. Alcohol should not be provided in normal doses to reduce the alcohol dependency or to prevent withdrawal symptoms.

A young adult client with schizophrenia is prescribed haloperidol (Haldol). When the nurse administers the medication, the client asks, "What's this for?" The nurse responds that the medication will do what?

Help him relax and think more clearly Rationale Stating that the medication will help the client to relax and think more clearly is an accurate and concise explanation of the effects of haloperidol (Haldol); it blocks postsynaptic dopamine receptors in the brain. Haloperidol lowers, not increases, the seizure threshold. Haloperidol is a neuroleptic; it does not alter mood.

An adolescent with type 1 diabetes who is admitted to the hospital with a blood glucose level of 700 mg/dL. A continuous insulin infusion is started. What complication should the nurse make a priority of detecting while the adolescent is receiving the infusion?

Hypokalemia Rationale Insulin causes potassium to move into the cells along with glucose, thereby reducing the serum potassium level. Hypokalemia can lead to lethal cardiac dysrhythmias. Insulin does not result in reduced blood volume, alter the sodium level directly, or affect calcium mobilization.

A nurse reinforces teaching a client about warfarin and concludes that the teaching is effective when the client makes which statement?

I should not drink cranberry juice." Antioxidants in cranberry juice may inhibit the mechanism that metabolizes warfarin (Coumadin), causing elevations in the international normalized ratio (INR), resulting in hemorrhage. Apple juice, grape juice, and orange juice are fine to drink.

A client with type 1 diabetes consistently has high glucose levels on awakening in the morning. What should the nurse instruct the client to do to differentiate between the Somogyi effect and the dawn phenomenon?

Measure the blood glucose level between 2 AM and 4 AM. Rationale During the hours of sleep, the Somogyi effect may be caused by a decline in the blood glucose level in response to too much insulin. The resulting hypoglycemia stimulates counter regulatory hormones, which precipitate lipolysis, gluconeogenesis, and glycogenolysis, which in turn produce rebound hyperglycemia and ketosis. Treatment involves decreasing the evening insulin. The dawn phenomenon is characterized by the release of counterregulatory hormones in the predawn hours, precipitating hyperglycemia on awakening. Treatment involves an increase in insulin. Eating a snack before going to bed should be done when insulin is taken before sleep, but it will not help to differentiate between the Somogyi effect and the dawn phenomenon. Administering the prescribed bedtime insulin immediately before going to bed depends on the insulin regimen prescribed by the health care provider and will not help to differentiate between the Somogyi effect and the dawn phenomenon. Both the Somogyi effect and the dawn phenomenon are characterized by hyperglycemia, not hypoglycemia.

A 5-year-old child is receiving dactinomycin (Cosmegen) and doxorubicin therapy after nephrectomy for Wilms tumor. What intervention should the nurse include when planning care?

Offering warm saline mouthwash Rationale The use of warm saline mouthwash will minimize oral discomfort; ulceration of the oral mucosa occurs as a result of the antineoplastic effect on the rapidly dividing gastrointestinal epithelium. Oral anesthetics may be prescribed by the health care provider.

A client with arthritis states that the prescribed aspirin (ASA) causes stomach irritation even when taken with food. When shoudl the nurse instruct the client to take the aspirin?

With a full glass of water Rationale A full glass of water helps to decrease gastric irritation by diluting the acidic substances in the stomach. If aspirin is taken on an empty stomach, gastric irritation is increased.