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a nurse is caring for a client who has osteoporosis and is taking a calcium supplement. When the client tells the nurse she has been having some flank pain. which of the following adverse effects should the nurse suspect?

Renal stones calcium supplements may cause renal stones. Indications for a hip fracture- pain in the hip or groin, inability to put weight on the injured side and bruising. indications for pancreatitis include upper abdominal pain and tenderness, nausea and vomiting.

A nurse is caring for a 2-year-old child who is receiving phenytoin (Dilantin) in suspension form. Which of the following actions* should the nurse take before administering each dose?

Shake the container vigorously. - it is important because the child can be under medicated if med is not evenly distributed

a nurse is teaching a client who has multiple sclerosis about starting therapy with baclofen (Lioresal) which of the following instructions should the nurse include?

" Avoid driving until the drugs effects are evident." Baclofen causes drowsiness, dizziness, headache and confusion. it causes nausea and GI distress- take it with meals or milk abrupt withdrawal of baclofen - cause seizures, fever, and hypotension it can cause constipation

A home health nurse is reviewing the medication list of an older adult client who reports falling a couple of times over the past week. Which of the following meds should the nurse suspect is contributing to the client's falls?

"Alprazolam"- CNS depressant- dizziness and lightheadedness causes sedation too

A nurse is caring for a client. The client states, " I don't want to take my medication." Which of the following actions should the nurse take?

"Document that the client refuses the medication" the client has the right to refuse the medication. it is appropriate for the nurse to document the client's wishes.

a nurse is assessing a client who has numerous bruises on his upper extremities. The client reports that he has taken warfarin (Coumadin) daily for the past 3 months. Which of the following statements by the client indicates the client needs further teaching?

"I have started taking ginger root to treat my joint stiffness." Ginger root can interfere with the blood clotting effect of warfarin and place the client at risk for bleeding. Clients who are taking warfarin can take acetaminophen for mild to mod pain relief. but no more tha 1g/day and no more than 2-3 days at a time. Green leafy veggies contain Vit K which can interfere with warfarin but pts do not need to constrict their intake of vit k but instead control it. Clients need their INR tested every 2-4 weeks.

A nurse is talking with a client who is about to start taking allopurinol (Zyloprim) to treat gout. Which of the following statements indicates that the client understands how to take this medication?

"I need to drink at least 3 quarts of water a day." Clients taking allopurinol must drink enough fluids to produce 2000 ml of urine per day. The pts need to report a rash or a fever to the provider immediately. Pts. need to take this after a meal.

A nurse is teaching a client about the side effects of taking tamoxifen (Nolvadex) to treat breast cancer. Which client statement indicates understanding of the possible effects?

"I will call my doctor if i notice any unusual menstrual bleeding" Tamoxifen, an estrogen receptor blocker can cause uterine cancer. The client should watch for abnormal uterine bleeding, pelvic pain or pressure and have regular gynecologic exams. - more likely to cause weight loss. more likely to cause vision loss. more likely to cause sleepiness and dizziness.

A nurse is teaching a client who is about to start therapy with alendronate (Fosamax) to treat osteoporosis. Which of the following adverse effects should the nurse instruct the client to report?

"Jaw pain, blurred vision, dysphagia" alendronate can cause osteonecrosis of the jaw= jaw pain - cause ocular inflammation= blurred vision. - cause headache - cause esophagitis- dysphagia

a nurse is caring for a client who has a diagnosis of diabetes mellitus and hypertension and recently began taking propanolol (Inderal) when the client reports dizziness upon standing. the nurse should perform which of the following actions?

"Monitor blood pressure lying, sitting and standing" One of the adverse rxns to beta-blockers is bronchospasm.

a nurse is caring for a client who has thrombophlebitis and is receiving continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin's effects?

"Protamine Sulfate" vitamin K is for warfarin by promoting the synthesis of coag factors VI, IX, and X and prothrombin

A nurse is caring for a client who is receiving a unit of packed RBC. The nurse notices the client's face is flushing and he begins to report low back pain. Which of the following actions is the nurse's priority?

"Stop the transfusion" the client will need antihistamines, will need vital signs to be monitored, will need the venous access maintained with 0.9% sodium chloride but these are all not priority action.

a nurse at a family practice clinic receives a call fro a client who is taking oral contraceptives but forgot to take one oral contraceptive pill. which of the following instructions should the nurse give her?

"Take the missed dose along with the next dose." If she misses two doses, she should take an additional dose each day for the next two days.

A nurse is caring for a client who is hospitalized with deep vein thrombosis and has been on IV heparin for 5 days. The provider prescribes warfarin without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following is an appropriate nursing response?

"The Coumadin takes several days to work so the IV heparin will be used until the coumadin reaches a therapeutic level." Heparin and warfarin are both anticoagulants. Warfarin takes 1-5 days for therapeutic levels to be reached.

A client is receiving pancreatic enzymes as a digestive aid. The nurse should tell the client expect which of the following gastrointestinal changes?

"decreased fat in stools" Clients who have CF or pancreatitis need to supplement meals with oral pancreatic enzymes to reduce the fat content in their stools.

a client who has angina pectoris is experiencing chest pain and has taken three nitroglycerin tablets sublingually. The client reports relief from the chest pain but now reports a headache. The nurse should explain that this symptom

"is an expected side effect of the med" the vasodilation nitroglycerin induces increases blood flow to the head and typically results in a headache

A nurse is caring for a preoperative client who is prescribed hydroxyzine (Vistaril). The nurse should know that which of the following are beneficial actions of hydroxyzine for the preoperative client? (Select all that apply.)

- Controlling emesis - Diminishing anxiety - Reducing the amount of narcotics needed for pain relief - Drying secretions

A nurse is caring for a client who is diagnosed with a urinary tract infection (UTI) and is taking ciprofloxacin (Cipro) 500 mg PO every 12 hr. Which of the following instructions should the nurse give to the client?

---"Drink at least 1 to 2 quarts of fluid each day while taking Cipro." it is excreted through kidneys if antacid is taken wait at least 2 hours before administering cipro best taken with an empty stomach and a full glass of water

A nurse is giving discharge instructions to a client who has asthma and is about to start taking zileuton (Zyflo). The nurse should tell the client to report which of the following adverse effects to the provider?

Abdominal pain Zileuton can cause liver damage and hepatitis. The client should report any signs of hepatic toxicity, such as abdominal pain or jaundice.

a nurse is caring for a client who has several environment allergies and was admitted in status asthmaticus. the provider prescribes cromolyn sodium via metered dose inhaler. to be added to the client's home management along with an albuterol MDI. When preforming discharge teaching the nurse should identify the need for additional teaching when the client states

I will be sure to take the intal four times a day before using proventil the client should always use the bronchodilator MDI prior to any other MDI. this helps to ensure that the maximum dose of med will get to to client's lungs. albuterol is a beta agonist bronchodilator but cromolyn is a mast cell inhibitor = albuterol should be used prior to cromolyn

a nurse is caring for a client who is taking naproxen (Naprosyn) following an exacerbation of rheumatoid arthritis. Which of the following comments by the client requires further discussion by the nurse?

I've been buying Tagamet to help with the indigestion I've had." nsaids like naproxen could cause severe GI rxns like bleeding ulceration and perforation. naproxen can be crushed or swallowed whole

A client is about to start using gentamicin (Garamycin) cream to treat a serious skin infection. Which of the following instructions should the nurse include when talking with the client about using this preparation?

Ill wash the area thorougly with water and soap

a nurse is preparing to administer an iv injection of phenytoin to a client. which of the following nursing actions is appropriate?

administer a saline solution after injection - helps to reduce and prevent venous irritation inject slowly over 1 min to reduce risk of hypotension

a nurse on a medical unit is caring for a client who has angina pectoris and reports chest pain with a severity of 6 on a 0 to 10 scale. the nurse administers sublingual nitroglycerin . after 5 min the client states that his chest pain is now a 2

administer another ntiroglycerin tablet - give another one 5 min after the first if client is still reporting pain

a nurse is assessing an older adult client who is receiving digoxin. to eval the client for digoxin tox. the nurse would check for which of the following manifestations?

anorexia- digoxin tox CM: anorexia, vomiting, confusion, H/A, vision changes - halos and lights NSAID tox= photosensitivity

a nurse is caring for a client who is HIV positive and is started on zidovudine. the nurse should monitor the client for which of the following life threatening side effects of this med?

aplastic anemia severe myelosuppression results in anemia, agranulocytosis also occurs, and thrombocytopenia results fever is a common side effect

a nurse is caring for a client treated with intermittent IV vancomycin. the client reports pain at the IV site when the nurse starts the infusion. which of the following nursing actions is appropriate at this time?

assess the patency of the IV site vanc is irritating to tissues and cause damage is allowed to infiltrate.

a nurse is educating a group of clients about contraindications of warfarin therapy. which of the folowing statements is appropriate to include in the teaching?

clients who are pregnant should not take coumadin it crosses the placenta and places fetus at risk

a nurse is caring for a client who is receiving mydriatic eye drops

constipation mydriatic eye drops cause constipation, dry mouth, photophobia, and tachycardia can cause resp depression, delirium and coma and can cause fever

a nurse is preparing to teach a client how to draw up regular insulin and neutral protamine hagedorn (NPH) insulin into the same syringe. Which of the following instructions is appropriate for the nurse to provide?

discard any regular insulin that appears cloudy regular insulin should be clear. NPH has a cloudy appearance

a nurse is monitoring a client who is receiving a parenteral lipid infusion. which of the following findings is the highest priority for the nurse to report to the provider?

elevated temp the nurse should immediately report an elevated temp = allergic reaction or a fat overload syndrome

a nurse is instructing a hospitalized client who has asthma about how to use an albuterol inhaler. the nurse should recognize that the client understands how to use the inhaler when the client demonstrates by

holding a breath for 10 seconds after inhaling the medication the med should be retained for a minimum of 10 sec the client should wait 1-2 min between inhalations for maximum benefits

a nurse is caring for a client who reports taking bisacodyl to promote a daily bowel movement which of the following should be the nurses priority response

how long have you been taking the ducolax? should only be used short term it begins to work within 6-12 hr of ingestion and shoud not be taken within 1 hr of milk or antacids

a nurse is teaching a client with MS who has a new presc for dantrolene.

i need to apply sunscreen when i go outside- photosensitivity it may take a week or more for the client to notice improvement with spasticity muscle strength may decline with med

a nurse is caring for a client who is receiving liothyronine for treatment of hypothyroidism. which of the following should the nurse recognize as a therapeutic response?

improvement of overall mood= depression, anorexia, cold and dry skin, pale and puffy face, brittle hair, decreased heart rate, decreased temp, weight gain, intolerance to cold, lethargy and fatigue= hypothyroidism

a client has developed agranulocytosis as a result of taking PTU to tx hyperthyroidism- client is at risk for what

infections

a nurse is preparing to administer a bisacodyl 10 mg suppository.

lubricate index fingerwith sterile water soluble lubricating jelly, position sims, insert just beyond the internal sphincter

a nurse is caring for aclient who is experiencing cushing's triad following a subdural hematoma. the client exhibits a widening pulse pressure, a decrease in HR, and altered RR. which of the following should the nurse administer?

mannitol 25%

A nurse is caring for a client who receives digoxin. before administering the med which of the following actions should the nurse take?

measure the apical pulse Digoxin reduces the HR so the nurse should measure it for at least 1 minute. Withhold the med if HR is less than 60/min

a nurse is caring for a client who has detached retina and is scheduled for surgical repair preoperatively the nurse should prepare to administer which of the following medications?

phenylephrine hydrochloride

A nurse is caring for a client who has a diagnosis of pulmonary embolism (PE). Which of the following should the nurse report to the provider?

platelets 74,000/mm3 stop heparin if less than 100,000/mm3 PTT= 40-75 sec or 1.5-2 x the normal value

spironolactone

potassium sparing diuretic increases sodium excretion

a nurse is preparing to administer lisinopril. Which of the following findings should be reported to the provider immediately?

swelling of the tongue an oral pharynx ANGIOEDEMA- giant wheals, edema of tongue, glottis, and pharynx,- tx with epinephrine

a nurse is caring for a client who asks how albuterol helps his breathing. which of the following should the nurse include in the response?

the med will prevent wheezing, will open airways and will decrease coughing episodes albuterol promotes bronchodilation does not reduce inflammation- steroids reduce inflammation

a nurse is caring for a client who has been on levothyroxine for several months. if the dose of this medication has been adequate the nurse should expect to see a decrease in the

thyroid stimulating hormone if the dose of the medications works, there should be an increase in T3, T4 and FT4

a nurse is talking with a client who is about to start taking the bile acid sequestrant colestipol to lower his LDL. if choosing tablet

will have to take up to 30 tablets per day comes in 1 g will need 15-30 g/day do not crush or chew take before meals and at bedtime

A client is receiving lithium carbonate (Eskalith) to treat manic behavior. The nurse caring for this client should use which of the following strategies to guide the administration of this medication?

​Maintaining a therapeutic dose of 900 mg TID ​Encouraging regular (serum lithium level) determination until stabilization of the maintenance dose= the ther dose is 300 mg TID ​---Telling the client to expect control of manic symptoms 7 to 10 days after starting lithium therapy ​Advising the client to report muscle weakness as it indicates severe toxicity- expected side effect not toxicity