PHARM ATI PRACTICE
A nurse is caring for a client who is receiving 0.9% sodium chloride 1,000 mL to infuse over 8 hr. The drop factor on the manual IV tubing is 15 gtt/mL. The nurse should ensure that the manual infusion is set to deliver how many gtt/min? (round to nearest whole number, no trailing zero)
1 hr_. = 8hr___ 1,000 mL x 15 gtt = X gtt = 31.25 gtt/min 60min 480min. 480min 1 mL min = 31 gtt/min Step 1: What is the unit of measurement the nurse should calculate? (Place the unit of measure being calculated on the left side of the equation.) X gtt/min = Step 2: Determine the ratio that contains the same unit as the unit being calculated. (Place the ratio on the right side of the equation, ensuring that the unit in the numerator matches the unit being calculated.) X gtt/min = 15 gtt/1 mL Step 3: Place any remaining ratios that are relevant to the item on the right side of the equation, along with any needed conversion factors, to cancel out unwanted units of measurement. X gtt/min = 15 gtt/1 mL × 1,000 mL/8 hr × 1 hr/60 min Step 4: Solve for X. X gtt/min = 31.25 gtt/min Step 5: Round if necessary. 31.25 = 31 gtt/min Step 6: Determine whether the amount to administer makes sense. If the prescription reads 0.9% sodium chloride 1,000 mL IV to infuse 8 hr and the drop factor on the manual IV tubing is 15 gtt/mL, it makes sense to administer 31 gtt/min. The nurse should set the manual IV infusion to deliver 0.9% sodium chloride 1,000 mL IV at 31 gtt/min over 8 hr.
At 0800 a nurse assists with initiating a 1,000 mL IV infusion for a client, which is running 125 mL/hr. How much fluid is left in the IV bag at 1300? (Round to nearest whole number)
Step 1: What is the unit of measurement the nurse should calculate? mL Step 2: What is the total volume to be infused? Total volume = 1,000 mL Step 3: What is the rate of infusion? Rate = 125 mL/hr Step 4: What is the total infusion time so far? Time = 5 hr Step 5: Should the nurse convert the units of measurement? No Step 6: Set up an equation and solve for X. Rate (mL/hr) x Time (hr) = Volume infused (X mL) 125 mL/hr x 5 hr = X mL Volume infused = 625 mL Total volume (mL) - Volume infused (mL) = Volume remaining (mL) 1,000 mL - 625 mL = 375 mL Volume remaining = 375 mL Step 7: Round if necessary. Step 8: Determine whether the amount remaining makes sense. If the rate of the IV infusion is 125 mL/hr, with a total volume of 1,000 mL, it makes sense that after 5 hr there are 375 mL of IV fluid remaining to infuse. 125mL. x 5 hr = X mL. Volume infused 625 mL, Total vol. - Vol. infused = Vol. remaining Hr 1,000 mL - 625 mL = 375 mL volume remaining
A nurse is reinforcing teaching with a female client who has a new prescription for isotretinoin. Which of the following information should the nurse include in the teaching? a. "You will need to have your liver enzymes monitored after 1 month." b. "You can have nosebleeds while taking this medication." c. "You should report any thoughts of harming yourself." d. "You will need to have two negative pregnancy tests prior to starting this medication." e. "You will need to take a vitamin A supplement twice daily.
a. "You will need to have your liver enzymes monitored after 1 month." · The client should have their liver enzymes monitored 1 month after therapy and periodically thereafter because isotretinoin is metabolized in the liver. b. "You can have nosebleeds while taking this medication." · Due to the drying effects of isotretinoin, nosebleeds are very common. c. "You should report any thoughts of harming yourself." Isotretinoin can cause depression, which can lead to suicide. The client or clients family should report these thoughts to the provider. d. "You will need to have two negative pregnancy tests prior to starting the medication." · Due to the potential for severe birth defects. It is important to confirm the client is not pregnant. e. IS INCORRECT. Vitamin A enhances the risk of isotretinoin toxicity. The client should avoid taking vitamin A supplements because isotretinoin is a derivative of vitamin A.
A nurse is planning to reinforce teachings about newborn immunizations with a client who is 24 hours postpartum. Which of the following information should the nurse plan to include? a. "Your baby will receive their first hepatitis B vaccine before discharge" b. "Your baby will receive the rotavirus vaccine if your blood titer is too low." c. "Your baby will receive their first influenza vaccine at the 4-week checkup." d. "Your baby will receive the varicella vaccine if you have a history of chickenpox."
a. "Your baby will receive their first hepatits B vaccine before discharge." -The newborn should receive the first hepatitis B vaccine at birth, with the next dose at age 1 to 2 months. -The blood titer of a newborn's mother does not determine the need for a rotavirus vaccine. The rotavirus vaccine is administered in 2 to 3 doses starting at age 2 months. -Children should receive an annual influenza vaccine starting at age 6 months. -Children should receive the first of two doses of the varicella vaccine between 12 and 15 months.
A nurse is reinforcing teaching with a client who has seizures and a new prescription for valproic acid. The nurse should instruct the client to report which of the following adverse effects of valproic acid to the provider immediately? a. Abdominal pain b. Hair loss c. Weight gain
a. Abdominal Pain The greatest risk to the client is hepatotoxicity and pancreatitis, which can cause abdominal pain. Therefore, the client should notify the provider immediately if experiencing a decrease in appetite, nausea, abdominal pain, or yellowing of the skin -The client is at risk for hair loss (and ataxia and weight gain) because they are adverse effects of taking valproic acid. However, another adverse effect is the priority to report to the provider.
a nurse is reinforcing teaching with a client who has a new prescription for colchicine to treat g gouty arthritis. Which of the following manifestations should the nurse include as an adverse effect of this medication? a. Abdominal pain b. Wheezing c. Excessive urination d. Tinnitus
a. Abdominal pain Abdominal pain indicates cellular damage to the gastrointestinal tract. The nurse should notify the provider, and the client should discontinue the medication immediately
A nurse is reinforcing teaching with a client who has a new prescription for colchicine to manage gouty arthritis. Which of the following manifestations should the nurse include as an adverse effect of this medication? a. Abdominal pain b. Wheezing c. Excessive urination
a. Abdominal pain · Abdominal pain indicates cellular damage to the gastrointestinal tract. The nurse should notify the provider, and the client should discontinue the medication immediately
A nurse is collecting data from a client who is receiving digoxin for treatment of heart failure. The nurse should identify which of the following adverse effects of this medication. a. Blurred vision b. Nausea c. Hyperactivity d. Increased appetite e. Dysrhythmia
a. Blurred vision, b. Nausea, e. Dysrhythmia. -Blurred vision is correct. The nurse should identify visual changes such as blurred vision, halos, and a yellow or green tinge to vision, nausea and vomiting and dysrhythmia as adverse effects of this medication. -Dysrhythmia is correct. -Hyperactivity is incorrect. The nurse should identify that fatigue and weakness are adverse effects of digoxin. -Increased appetite is incorrect. The nurse should identify that anorexia is an adverse effect of digoxin.
A nurse is collecting data from a client who has Parkinson's disease and is taking levodopa/carbidopa. The nurse should identify which of the following findings as an adverse effect of this medication. a. Dark urine b. Hypertension c. Increased salivation d. Bradycardia
a. Dark urine The nurse should identify that carbidopa/levodopa can cause a darkening of the clients urine, sweat and saliva, and can cause orthostatic hypotension and dry mouth.
The nurse is caring for a client who has multiple sclerosis and a new prescription fro baclofen. Which of the following findings indicates to the nurse that the medication is having a therapeutic effect? a. Decreased muscle spasticity b. Increased urinary output c. Increased mental alertness
a. Decreased muscle spasticity -The nurse should ID that baclofen is an antispasmodic that decreases muscle spasticity in a client who has multiple sclerosis. -Urinary frequency is an adverse effect of baclofen, rather than therapeutic effect. -Baclofen is an antispasmodic that can cause CNS adverse effects, such as drowsiness, fatigue, and confusion, and does not produce an increase in the clients mental alertness as a therapeutic effect.
A nurse is caring for a client who has tuberculosis and will begin taking isoniazid. Which of the following actions should the nurse take? a. Determine the client's daily alcohol intake b. Tell the client to expect red-orange colored urine. c. Reinforce teaching about a low-calorie diet.
a. Determine the client's daily alcohol intake. The nurse should instruct the client to reduce or avoid all use of alcohol because isoniazid can cause liver damage, therefore it is important for the nurse to determine the clients daily alcohol intake. Isoniazid does not cause red-orange colored urine. Rifampin is a med used to treat tuberculosis and cause the client's sweat, urine, saliva, and tears to appear red-orange in color. The client is at risk for losing weight, therefore, the nurse should reinforce how the client can maintain their weight with good nutrition.
A nurse is reinforcing teaching with a client who has a new prescription for theophylline. The nurse should instruct the client that which of the following is an expected outcome of this medication? a. Dilates bronchioles b. Reduces inflammation c. Loosens secretions
a. Dilates bronchioles · Theophylline is a bronchodilator, which affects the smooth muscle relaxation and leads to open airways · Glucocorticoids are anti-inflammatory agents · Expectorants help the flow of secretions
A nurse is reinforcing teaching to a client about Etanercept to treat rheumatoid arthritis. Which of the following instructions should the nurse include? a. Discard any solutions that are cloudy, b. Attach a 21-gauge needle to the syringe for injection. c. Self-administer on alternate days.
a. Discard any solutions that are cloudy The client should discard any vials or pre-filled syringes that contain solutions that are discolored, cloudy or have any sediment in them. The client should attach a 27-gauge needle to the syringe for injecting the medication subcutaneously and should self-admin the medication once per week.
A nurse is collecting data from a parent of a toddler who is about to receive the varicella immunization. The nurse should identify that an anaphylactic reaction to which of the following substances is a contraindication for receiving this immunization? a. Gelatin b. Penicillin c. Sulfa d. Eggs
a. Gelatin. The nurse should identify a hypersensitivity reaction to either gelatin or neomycin is a contraindication for receiving the varicella vaccine because it contains both these substances.
A nurse is caring for a client who has a history of psychosis and is taking chlorpromazine. Which of the following actions should the nurse take to counteract the adverse effects of this medication? a. Suggest that the client apply antiperspirant deodorant more frequently b. Inform the client to apply sunblock before going outside c. Give the client a list of over-the-counter antidiarrheal medications d. Recommend that the client take the medication on an empty stomach
a. Inform the client to apply sunblock before going outside -which will counteract the adverse effects of photosensitivity. -Chlorpromazine increases sensitivity to ultraviolet light causing temporary pigmentation changes and increases the risk of sunburns. -The anticholinergic properties of antipsychotic drugs cause constipation, not diarrhea.
A nurse is instilling Timolol eye drops for a client who has glaucoma. Which of the following actions should the nurse take after instilling the eye drops? a. Press the nasolacrimal duct. b. Apply pressure to the upper eyelid c. Ask the client to blink their eyes several times
a. Press the nasolacrimal duct. The nurse should press the client's nasolacrimal duct to prevent the medication from absorbing into systemic circulation Avoid applying pressure to clients upper eyelid because it might force the medication out of the conjunctival sac
A nurse is reinforcing teaching with a client who has a new omeprazole prescription. Which of the following instructions should the nurse include? a. Swallow the medication whole. b. Take the medication with food. c. Take the medication at bedtime.
a. Swallow the medication whole. The nurse should instruct to swallow whole and not chew or crush. Omeprazole, a Protein Pump inhibitor blocks secretion of gastric acid in a delayed-release capsule/tablet, as well as suspensions and powders.
A nurse is teaching a client about the adverse effects of simvastatin. For which of the following adverse effects should the nurse inform the client to notify the provider? a. Muscle pain b. Fine hand tremors c. Urinary retention
a. muscle pain The nurse should instruct the client to notify the provider if muscle pain or tenderness develops because this can indicate the client is developing rhabdomyolysis
A nurse is caring for a client with a new prescription for sumatriptan. The nurse notes that the client takes fluoxetine. The nurse should notify the provider that the combination of these medications will place the client at risk for which of the following adverse effects? a. tremors b. renal calculi c. dysphagia
a. tremors concurrent use of sumatriptan and fluoxetine can lead to excessive stimulation of serotonin receptors, placing the client at risk for serotonin syndrome. The client can experience tremors, confusion, and hallucinations
A nurse is caring for a client who has a prescription for an IM injection of penicillin G benzathine. The client asks why the injection must be given IM instead of through the IV line. Which of the following responses should the nurse make? a. "The medication is more rapidly absorbed when giving IM." b. "Your medication can't be given IV because it is not water-soluble." c. "You will experience less discomfort with an IM injection."
b. "Your medication can't be given IV because it is not water-soluble." · The nurse should inform the client this type of penicillin has poor water solubility and is never administered intravenously. · The nurse should inform the client that IM injections of this medication can cause discomfort at the injection site. · The nurse should inform the client that this type of penicillin is absorbed slowly over several weeks, maintaining a continuous low blood level. Medications given intravenously are absorbed faster than IM medications.
A client comes to an urgent care clinic and announces with great enthusiasm, "I am an expert at all things medical as they apply to me, and I require zolpidem." The client's pupils are dilated, along with an elevated heart rate and blood pressure level. The nurse should suspect intoxication with which of the following substances? a. Alcohol b. Cocaine c. Barbiturates
b. Cocaine A client who has cocaine toxicity typically has tachycardia, elevated blood pressure, dilated pupils, and displays delusions. This client's behavior and physiological data indicate cocaine intoxication. · A client who has barbiturate toxicity typically has respiratory depression, constricted pupils, drowsiness, impaired judgement, irritability, and decreased blood pressure. · A client who has alcohol toxicity typically has slurred speech, drowsiness, impaired judgement, irritability, and decreased blood pressure.
A nurse is reviewing medication prescriptions for a group of clients. The nurse should recognize that which of the following prescriptions can result in a medication administration error? a. Penicillin G benzathine 1.2 million units IM daily. b. Furosemide 10.0mg PO daily c. Albuterol 2.5mg 2 inhalations every 6 hours as needed for shortness of breath. d. Insulin glargine 15 units subcutaneous daily at bedtime.
b. Furosemide 10.0mg PO daily The nurse should avoid using zero following a whole number. The prescription can result in a medication error because the nurse can mistake the dosage as 100 mg instead of 10 mg because the decimal point is not always recognized.
A nurse is collecting data from a client who is postoperative and taking morphine for pain. Which of the following findings is the priority for the nurse to report to the provider? a. Constipation b. Oxygen saturation 87% c. Vomiting
b. Oxygen saturation 87% When using the airway, breathing, and circulation approach to client care, the nurse determines that the priority finding is an oxygen saturation of 87%, which is a manifestation of respiratory depression and should be reported to the provider. The nurse should monitor and treat the client for constipation and vomiting, however there is another finding that is the priority for the nurse to report.
A nurse is collecting data from a female client who has been taking propylthiouracil (PTU) for 2 months to treat Graves' disease. Which of the following findings should the nurse recognize as an indication that the medication is effective? a. Weight loss b. Pulse 82/min c. Respiratory rate 22/min d. Decreased menstrual flow.
b. Pulse 82/min Tachycardia is a manifestation of hyperthyroidism. The nurse should identify that a pulse of 82/min is within the expected reference range of 60-100/min indicating the medication is effective. -a. The nurse should identify that weight loss is a manifestation of hyperthyroidism which indicates the medication is not effective. -c. The nurse should identify that tachypnea is a manifestation of hyperthyroidism, which indicates the medication is not effective. -d. The nurse should identify that amenorrhea is a manifestation of hyperthyroidism, which indicates the medication is not effective.
A nurse is reinforcing teaching with a client who has hypertension and a new prescription of spironolactone. Which of the following instructions should the nurse include in the teaching? a. Increase foods high in zinc b. Restrict foods high in potassium c. Restrict foods high in vitamin K
b. Restrict foods high in potassium. The nurse should instruct the client that spironolactone is a potassium-sparing diuretic, which can cause hyperkalemia. Therefore, the client should restrict foods that are high in potassium and salt substitutes that contain potassium.
A Nurse is reinforcing teaching about comfort measures with a parent of a 10-year-old child who has a viral infection. The nurse should plan to tell the parent that aspirin is contraindicated because of the risk of which of the following conditions? a. Juvenile idiopathic arthritis b. Reye syndrome c. Glomerulonephritis.
b. Reye syndrome Aspirin is contraindicated for children and adolescents who have a viral illness because it increases the risk fro the development of Reye syndrome.
A nurse is caring for a client who is taking phenylephrine. The nurse should plan to monitor the client for which of the following manifestations as an adverse effect to this medication? a. Increased drowsiness b. Increased heart rate c. Decreased blood pressure d. Decreased WBC Count
b. increased heart rate Due to cardiac effects, phenylephrine can cause tachycardia and other cardiac dysrhythmias, an increase in blood pressure, and insomnia.
A nurse is reinforcing teaching with a client who is using phenylephrine nasal spray three times daily and reports rebound congestion. Which of the following instructions should the nurse include to reduce the effects of rebound congestion? a. "Decrease the frequency to twice daily" b. "Continue use for one more week" c. "Discontinue use in the left nostril, then in the right nostril." d. "Add oxymetazoline nasal spray to relieve symptoms. "
c. "Discontinue use in the left nostril, then in the right nostril." -Discontinuing the medication one nostril at a time can overcome rebound congestion
A nurse is reinforcing teaching with the parent of a preschooler who has otitis media. The child has a low-grade fever and irritability for 2 days. Which of the following instructions should the nurse include in the teaching? a. "Administer amoxicillin twice a day for 3 days." b. "Apply cold packs every 4 hours for relief of pain" c. "Give acetaminophen as needed for discomfort and fever." d. "Return to the office in 72 hours for a follow-up appointment"
c. "Give acetaminophen as needed for discomfort and fever." · The nurse should instruct the parent to administer analgesics such as acetaminophen or ibuprofen to decrease discomfort and fever related to otitis media. · The nurse should instruct the parent to have the child lie on the affected side and apply heat to their ear to reduce discomfort. This position promotes drainage of exudate. · The nurse should instruct the parent to administer the full course of antibiotics, which is expected to be 5-7 days for mild and moderate infection and 10 days for severe infection.
A nurse is reinforcing a teaching with a client who has HIV and a new prescription for zidovudine. Which of the following client statements indicate to the nurse an understanding of the teaching? a. I can have unprotected sex 6 months after taking this medication b. I can expect to have constipation while taking this medication c. I will be sure to have my blood tested for anemia. d. My fingers might feel number after I start therapy. Zidovudine can cause severe anemia and neutropenia.
c. "I will be sure to have my blood tested for anemia." · Zidovudine can cause severe anemia and neutropenia. The client should have blood tests performed before treatment begins and have continued monitoring during the course of treatment. · Numbness and tingling are not adverse effects of Zidovudine. The clients nail beds might have changes to pigmentation while taking this medication · Zidovudine can cause gastrointestinal disturbances, such as diarrhea, abdominal pain, nausea, and vomiting. · The client should continue to use protection during sexual activity, even in the plasma HIV RNA is undetectable after taking zidovudine.
A nurse is reinforcing teaching with a client who has a new prescription for ethinyl estradiol norethindrone, an oral contraceptive. Which of the following client statements should indicate to the nurse an understanding of the teaching? a. "I should expect my menstrual flow to increase." b. "I should monitor my blood pressure for hypotension while on this medication." c. "I will take the medication at the same time every day." d. "This type of medication is the most effective because it only contains estrogen."
c. "I will take the medication at the same time every day." · The client should take this medication at the same time each day to maintain a consistent level to reduce fertility and the chance of pregnancy. · The nurse should reinforce with the client that ethinyl estradiol/norethindrone is a combination oral contraceptive, with each tablet containing both estrogen and progestin. · The nurse should reinforce with the client that menstrual flow volume will decrease, as well as the number of days of menses. · The client should monitor their blood pressure for hypertension because the medication causes increased secretion of aldosterone and angiotensin.
A nurse is reinforcing teaching with a newly licensed nurse about using metoprolol to treat hypertension. Which of the following conditions should the nurse include as a contraindication for this medication? a. Peripheral vascular disease b. Diabetes mellitus c. Bradycardia d. Chronic Kidney Disease
c. Bradycardia · Metoprolol is a beta blocker that slows conduction through the AV node. Therefore, it is contraindicated for clients who have bradycardia, or a heart rate that is consistently less than 60/min. · Metoprolol is not contraindicated for clients who have peripheral vascular disease. · Clients who have diabetes mellitus should use caution when taking metoprolol because it can mask the manifestations of hypoglycemia. · Metoprolol can cause the adverse effect of urinary frequency; however, it is not contraindicated for clients who have chronic kidney disease
A nurse is reinforcing teaching with a client following placement of a cast for a fractured ankle. The client is to take oxycodone for pain management. The nurse should instruct the client that which of the following over-the-counter medications is contraindicated while taking oxycodone? a. Docusate sodium b. Famotidine c. Diphenhydramine d. Ibuprofen
c. Diphenhydramine. -Both diphenhydramine, an antihistamine, and oxycodone, an opioid analgesic, can cause CNS depression. Therefore, when a client uses the two medications together, the client is at increased risk for sedation, respiratory depression, and injury. -The use of oxycodone can result in constipation. The client can take a stool softener, such as docusate sodium, to manage this adverse effect. -There are no known interactions between famotidine and oxycodone, and no indication for the client to avoid the use of famotidine while taking oxycodone. -Clients who have a musculoskeletal injury will benefit from using ibuprofen, an NSAID, in conjunction with an opioid analgesic.
A nurse is caring for a client with chronic kidney disease and has been receiving epoetin for 2 weeks. Which of the following findings indicate to the nurse that the clients medication is having the desired therapeutic effect? a. Albumin is within the expected range. b. Urine output increases to 60 mL/hr c. Hemoglobin rises 0.5g/dL d. Blood urea nitrogen level is within the expected reference range
c. Hemoglobin rises 0.5g/dL Initial therapeutic effects such as hemoglobin rising 0.5g/dL can occur within the first two weeks of therapy. The client's hemoglobin should reach target levels of 10 to 11 g/dL in 2-3 months. Epoetin does not affect the client's urine output or albumin level.
A nurse is collecting data from a client who is asking about taking celecoxib for treatment of joint pain. The nurse should identify that which of the following findings is a contraindication to receiving celecoxib? a. Hyperglycemia b. Allergy to penicillin c. History of myocardial infarction d. Peptic ulcer disease
c. History of myocardial infarction.. Celecoxib increases the risk of myocardial infarction caused by the increased vasoconstriction and unimpeded platelet aggregation. It is contraindicated for a client who has a history of myocardial infarction or heart disease.
A nurse is caring for a client who has a new prescription for eplerenone to treat hypertension. For which of the following adverse effects should the nurse monitor? a. Hematuria b. Hypernatremia c. Hyperkalemia d. Constipation
c. Hyperkalemia The client is at risk for increased potassium levels because eplerenone can cause potassium retention.
A nurse is caring for a client who has a new prescription for eplerenone to treat hypertension. The nurse should monitor for which of the following adverse effects. a. Hematuria b. Hypernatremia c. Hyperkalemia d. Constipation
c. Hyperkalemia The nurse should identify that eplerenone can place the client at risk for increased potassium levels because eplerenone can cause potassium retention. The nurse should identify that eplerenone · can cause increased sodium not decreased sodium · can cause diarrhea, not constipation · can cause vaginal bleeding not blood in the urine
A nurse is assisting with the care of a client who has a methicillin-resistant Staphylococcus aureus (MRSA) infection and is receiving vancomycin via IV infusion. Which of the following changes in the clients condition should the nurse identify as the priority finding to report to the provider? a. Nausea b. Back pain c. Hypotension d. Chills
c. Hypotension When using the urgent vs nonurgent approach to client care, the nurse determines that the priority finding to report to the provider is hypotension. -If the client's vancomycin infusion is too rapid, it can cause red main syndrome, which is a group of adverse effects that include tachycardia, hypotension, flushing and urticaria. · Although the nurse should report nausea/backpain for a client receiving vancomycin therapy, there is another finding that is the nurse's priority to report.
A nurse is reinforcing a teaching with a client who has a new prescription for regular insulin. Which of the following statements by the client indicates an understanding of the teaching? a. I should eat right before I give myself an insulin injection b. I should shake the vial gently prior to drawing up the insulin. c. I should ensure that the insulin is clear prior to drawing it up. d. I should inject the insulin deep into a muscle.
c. I should ensure that the insulin is clear prior to drawing it up. · Regular insulin is clear in appearance. Clients should discard the vial and use a new vial if the insulin appears cloudy. · Clients should administer insulin subcutaneously. An intramuscular injection will accelerate absorption. · The onset of regular insulin, a short-acting insulin, is 30-60 minutes. Therefore, clients should self-administer the insulin at least 15 to 30 minutes before eating. Clients should eat within 15 minutes of taking insulin lispro, a rapid-acting insulin. · Clients should gently roll a vial of insulin to ensure a uniform solution.
A nurse is reinforcing teaching with a client who has a new prescription for propranolol. Which of the following information should the nurse include in the teaching? a. If you miss a dose, double your next scheduled dose. b. Discontinue the medication if lightheadedness occurs. c. If your pulse rate is less than 50 BPM, notify your provider d. This medication can cause heat intolerance.
c. If your pulse rate is less than 50 BPM, notify your provider · The nurse should instruct the client to check their pulse before taking the medication and to withhold the medication if their pulse is less than 50/min. The client should also notify their provider. Bradycardia is a common adverse effect of beta blockers. · The nurse should instruct the client that lightheadedness and dizziness are adverse effects of this medication, and the client should avoid driving or other hazardous activities until the effects of the medication are known. · The nurse should instruct the client to avoid driving or other hazardous activities until the effects of the medication are known. · The nurse should instruct the client to avoid abrupt discontinuation of the medication because this can cause life-threatening dysrhythmias. · The nurse should instruct the client that beta blockers such as propranolol can cause cold intolerance.
A nurse is monitoring a client who is receiving a transfusion of packed RBC's. The clients temperature increases to 39.1 C (102.4 F). Which of the following actions should the nurse take first? a. Obtain a urine specimen b. Administer diphenhydramine c. Stop the transfusion d. Notify the charge nurse
c. Stop the transfusion -The greatest risk to this client is injury from transfusion reaction that can cause acute intravascular hemolysis or anaphylaxis. Therefore, the first action the nurse should take is to stop the transfusion. - The nurse should obtain a urine specimen to determine the extent of the reaction, however, this is not the first action the nurse should take. -The nurse might need to administer diphenhydramine as an emergency medication, however this is not the first action the nurse should take.
A nurse is reinforcing a teaching for a client who has a prescription for alendronate. Which of the following client responses indicates to the nurse an understanding of the teaching? a. "I will take the medication with my breakfast" b. " I will take the medication with 1 tablespoon of antacid." c. " I will lie down for 30 minutes after taking the medication." d. "I will take the medication with 8 ounces of water"
d. "I will take the medication with 8 ounces of water" ·The client should take alendronate upon arising on an empty stomach with 240 mL (8 oz) of water and sit upright for 30 minutes before eating or drinking liquids other than water to ensure it does not lodge in the esophagus, which can result in esophageal erosion/ulcerations. · The client should avoid taking alendronate with antacids because they can decrease absorption of alendronate
A nurse is preparing to administer a PRN medication to a group of clients. Which of the following clients should the nurse administer medication to first? a. A client who has GERD and requests an antacid. b. A client who reports constipation for 3 days and requests a stool softener c. A client who has mild generalized anxiety disorder and requests an antianxiety medication d. A client who is attending postoperative physical therapy and requests pain medication.
d. A client who is attending postoperative physical therapy and requests pain medication. When using urgent vs nonurgent approach to client care, the nurse should determine that the client who is postoperative and going to physical therapy should receive medication first. Administering medication to the client can reduce the clients pain during and after therapy
A nurse is preparing to administer diphenhydramine 50mg PO at 2200 to a client who has difficulty swallowing pills and capsules. Available is a diphenhydramine 12.5mg/5mL PO. Which of the following nursing actions requires the completion of an incident report. a. Giving the medication at 2140 b. Administering the medication with grapefruit juice. c. Giving the medication when the clients apical pulse is 58/min. d. Administering 25 mL of the syrup.
d. Administering 25 mL of the syrup. The dose is higher than the client should receive. The correct dosage is 20 mL. Administering an incorrect amount of medication to a client requires completion of an incident report. · The nurse can administer diphenhydramine if the clients heart rate is below 60/min because this medication can cause palpations. · Although grapefruit juice can alter the action of a number of other medications, it does not affect diphenhydramine · Administering the medication at 2140 is within the acceptable time frame of 1-2 hours before or after their scheduled time for medications that are not time critical.
A nurse is contributing to the plan of care for a client who has schizophrenia and a new prescription for clozapine. The nurse should include in the plan to monitor the client for which of the following adverse effects of this medication. a. Hypoglycemia b. Iron-deficiency anemia c. Serotonin syndrome d. Agranulocytosis
d. Agranulocytosis -The nurse should monitor the clients WBC count and notify the provider for a value below the expected reference range of 5,000 to 10,000/mm^3 -The nurse should monitor the client for tardive dyskinesia, rather than serotonin syndrome. -The nurse should monitor the client for hyperlipidemia, rather than iron-deficiency anemia. -The nurse should monitor for hyperglycemia, rather than hypoglycemia
A nurse is caring for a client who has hyperthyroidism and has been taking methimazole. Which of the following findings should indicate to the nurse that the medication has a therapeutic effect? a. Decreased blood glucose level b. Increased Hgb c. Increased platelets d. Decreased T4
d. Decreased T4 • The nurse should identify that methimazole inhibits the synthesis of thyroid hormone, reducing levels to provide a euthyroid state. Therefore, a decreased level of T4 is an indication of a therapeutic effect. • The nurse should identify that methimazole can cause agranulocytosis as an adverse effect. Increased platelets do not indicate therapeutic effect. • The nurse should identify that methimazole does not affect the client's blood glucose level/Hgb level. Therefore, these findings do not indicate a therapeutic debate.
A nurse is monitoring a client who has type 2 diabetes mellitus and is receiving repaglinide. Which of the following laboratory tests should the nurse plan to review to obtain information about the long-term therapeutic effect of this medication? a. Fasting blood glucose level b. 1-hr oral glucose tolerance test c. Urinary ketones d. Glycosylated HbA1c
d. Glycosylated HbA1c · The clients HbA1c value measures the average of blood glucose levels over the past 2 to 3 months. Therefore, the nurse should review this laboratory test to obtain information about the long-term therapeutic effect of repaglinide. · The fasting blood glucose indicates the clients current status, not the long-term therapeutic effect of repaglinide. · The 1-hr oral glucose tolerance test evaluates the clients response to a carbohydrate challenge. The client can undergo this test to determine if they have gestational diabetes · The presence of urinary ketones indicates diabetic ketoacidosis, not the long-term therapeutic effect of repaglinide.
A nurse is collecting data from a client who is taking ferrous sulfate orally. Which of the following findings reported by the client should indicate to the nurse that the medication is having a therapeutic effect? a. Passing of a soft, formed stool daily. b. Decreased number of viral illnesses c. Improved ability to fall asleep. d. Increased tolerance to exercise.
d. Increased tolerance to exercise. The client who takes ferrous sulfate, which is used to treat iron-deficiency anemia, can have fatigue and shortness of breath due to a low hemoglobin level. An increased tolerance to exercise occurs when the hemoglobin level increases, allowing more oxygen to be carried to the vital organs and tissues.
A Nurse is reinforcing teaching with a client who has bipolar disorder and a new prescription for lithium. Which of the following instructions should the nurse include in the teaching? a. Take the medication on an empty stomach. b. Monitor for signs of hyperthyroidism. c. Watch for signs of urinary retention d. Maintain a consistent sodium intake.
d. Maintain a consistent sodium intake. The client should maintain a consistent sodium intake while taking lithium. Decreased serum sodium levels cause lithium excretion to decline, which can lead to toxicity. The nurse should instruct the patient that polyuria hypothyroidism can occur when taking lithium and that they should take lithium with meals or milk to reduce gastrointestinal upset.
A nurse is reviewing the history of a client who is to start taking cefotetan to treat a bacterial infection. Which of the following information from the client's medical record should the nurse report to the provider before the client begins receiving this medication? a. Hearing impairment b. Milk-protein allergy c. Tendon pain d. Penicillin allergy
d. Penicillin allergy Cefotetan is a cephalosporin, an antibiotic structurally similar to penicillin. A client who has a severe allergy to penicillin can develop cross-reactivity and have an allergic reaction to cephalosporins. Therefore, the nurse should report this information to the provider before the client starts taking the medication. • Hearing loss is a contraindication to certain antibiotics, such as aminoglycosides, due to their ototoxic effects. • Cefditoren, a cephalosporin can cause an allergic reaction to clients who have a milk-protein hypersensitivity. • Clients who have tendon pain should use fluroquinolone antibiotics with caution due to the possible adverse effect of tendon rupture
A nurse is reinforcing teaching to a client who is starting therapy using a nitroglycerin transdermal patch. Which of the following instructions should the nurse include? a. Cover the patch with a dry dressing. b. Apply another patch if experiencing chest pain. c. Leave each patch in place for 24 hours. d. Place the patch on a different site for each application.
d. Place the patch on a different site for each application. The client should place the patch on a different site for each application to prevent skin irritation. To prevent tolerance, the client should remove the patch after 12-14 hours with a 10-12 hour break before applying a new patch. The client should not use a transdermal patch to treat acute chest pain. The client should cover nitroglycerin ointment with plastic dressing, but it is not necessary to cover a commercially prepared patch with a dressing.
A nurse is planning to administer metoprolol to a client who has heart failure and a heart rate of 48/min. Which of the following actions should the nurse take? a. Encourage the client to ambulate b. Request a different beta blocker medication to administer c. Administer one-half of the clients prescribed dose d. Withhold the client's medication
d. Withhold the client's medication The nurse should identify that metoprolol, (and all other beta blocker medications), results in decrease in heart rate and should withhold the medication for a heart rate less than 50/min. The nurse should also notify the clients provider of the client's heart rate. · A client who has a heartrate of 50/min or below can become hypotensive. Therefore, ambulating can increase the client's risk of falling. However, the nurse should not administer this medication because of the client's bradycardia. · Adjusting the client's medication dosage is outside the scope of practice for a nurse.
