Pharm Final

Cyclophosphamide THINK

"Cystitis" cyclophosphamide

Filgrastim THINK

"Grow WBC"-grastim

16) A client receiving chemotherapy develops bone marrow suppression. The nurse will monitor for which thrombocytopenic effect? Select all that apply. One, some, or all responses may be correct. A. Deep vein thrombosis B. Melena C. Purpura D. Emboli E. Hematuria

B, C, E Rationale Black, tarry feces caused by the action of intestinal secretions on blood are associated with bleeding in the gastrointestinal tract; bleeding is related to a reduced number of thrombocytes, which are part of the coagulation process. Hemorrhages into the skin and mucous membranes (purpura) may occur with reduced numbers of thrombocytes, which are part of the coagulation process. Blood in the urine (hematuria) may occur with a reduced number of thrombocytes, which are part of the coagulation process. Deep vein thrombosis and emboli are effects of thrombocytosis.

Cimetidine (Tagamet), famotidine (Pepcid), ranitidine (Zantac), nizatidine THINK

"Acid Blocking"-tidine

Doxycycline, tetracycline THINK

"Anti-B" -cycline "My stained teeth and baby!"

Levofloxacin, ciprofloxacin THINK

"Anti-B" -floxacin , "Flex that tendon off!"

Vancomycin "Big Gun", gentamicin, erythromycin, streptomycin, azithromycin THINK

"Anti-B" -mycin -micin "I CAN'T HEAR" and "Mountains and Valleys"

Metronidazole, mebendazole (Flagyl) THINK

"Anti-B"-nidazole "A doozy against worms, but no beer please"

Trimethoprim and sulfamethoxazole THINK

"Anti-B"-prim & sulfa-"Biotic" ... "WATER!"

Valacyclovir, acyclovir, zanamivir THINK

"Anti-Virus" -vir

Metoclopramide (Reglan) THINK

"GI" -pramide

Mannitol THINK

"Man, Osmosis that Cerebral Edema"

Rifampin THINK

"PIN my TB"

Epoetin THINK

"RBC maker "-poetin

Alendronate THINK

"Stand Strong Bone on Empty"-dronate

Pantoprazole (Protonix), omeprazole (Prilosec) THINK

"Stop the Pump"-prazole

Sucralfate THINK

"coat my gut"

Nitrofurantoin (Macrobid) THINK

"nitro BIOTIC furantoin"

1) The nurse mixes a short-acting and an intermediate-acting (NPH) insulin in the same syringe. List the actions in the order the nurse will perform them. 1. Put air into the intermediate-acting (NPH) insulin vial. 2. Put air into the short-acting insulin vial. 3. Withdraw the prescribed amount of short-acting insulin. 4. Withdraw the prescribed amount of intermediate-acting insulin.

1, 2, 3, 4 Rationale Air should be injected into the air space of the intermediate-acting insulin vial before short-acting insulin is drawn into the syringe; the needle should not touch the insulin. The nurse should inject the amount of air into the short-acting insulin vial equivalent to the volume to be withdrawn to prevent negative pressure that can make withdrawal difficult. The short-acting insulin should be withdrawn first to prevent possible contamination of the vial with the intermediate-acting insulin, which would cause a delay in onset time of the short-acting insulin. The intermediate-acting insulin should be drawn up after the short-acting insulin to prevent contamination of the short-acting insulin.

6 ) The nurse is preparing to administer insulin to a client with diabetes. In which order will the nurse perform the actions associated with insulin administration? 1. Wash hands with soap and water. 2. Rotate the vial of insulin between the palms of the hands. 3. Wipe the top of the insulin vial with an alcohol swab. 4. Instill air into the vial of insulin equal to the desired dose. 5. Withdraw the correct amount of insulin from the inverted vial.

1, 2, 3, 4, 5 Rationale Washing the hands prevents cross-contamination. Rotating the insulin vial distributes the medication evenly throughout the vial. Wiping the seal on the insulin vial prevents contamination of the needle and the fluid. Instilling air into the vial increases the pressure in the closed space so that the correct amount of fluid finally can be withdrawn.

10) The nurse is caring for a client who reports sweating, tachycardia, and tremors. The laboratory report of the client reveals serum cortisol less than normal and a blood glucose level of 60 mg/dL. Which medication would be administered to this client? A. Glucagon B. Kayexalate C. Hydrocortisone D. Insulin with dextrose in normal saline

A Rationale A decrease in cortisol levels impairs the glucose metabolism. The client's blood glucose level is 60 mg/dL, which is indicative of hypoglycemia. The nurse should administer glucagon as per the prescription to manage the low glucose levels. Kayexalate is a potassium-binding resin that facilitates potassium excretion and is used to manage hyperkalemia. Intramuscular hydrocortisone is given concomitantly every 12 hours as part of hormone replacement in adrenal insufficiency. Insulin with dextrose in normal saline is given to manage hyperkalemia by causing an intracellular shift of potassium.

3) The nurse is caring for a female client who is requesting hormonal contraceptives. Which of the following questions should the nurse ask to assess for contraindications? A. "Have you ever had a blood clot?" B. "How many children do you have?" C. "Do you drink alcohol?" D. Did you experience acne in adolescence? =

A Rationale A history of thromboembolic disorders is a contraindication to hormonal contraceptives; therefore, any history of thrombus should be assessed. The number of children/pregnancies and use of alcohol are probable history questions but are not contraindications to this method. Acne is a side effect of oral contraceptives but not a contraindication.

2) Trimethoprim-sulfamethoxazole is prescribed for a client with cystitis. Which instruction would the nurse include when providing medication teaching? A. 'Drink eight to ten glasses of water daily.' B. 'Take this medication with orange juice.' C. 'Take the medication with meals.' D. 'Take the medication until symptoms subside.'

A Rationale A urinary output of at least 1500 mL daily should be maintained to prevent crystalluria (crystals in the urine). Taking the medication with orange juice provides no advantage. Also, orange juice produces an alkaline ash, which results in an alkaline urine that supports the growth of bacteria. Trimethoprim-sulfamethoxazole should be taken 1 hour before meals for maximum absorption. A prescribed course of antibiotics must be completed to eliminate the infection, which can exist on a subclinical level after symptoms subside.

1) A client is being treated for osteoporosis with alendronate (Fosamax), and the nurse has completed discharge teaching regarding medication administration. Which morning schedule would indicate to the nurse that the client teaching has been effective? A. Take medication, go for a 30 minute morning walk, then eat breakfast. B. Take medication, rest in bed for 30 minutes, eat breakfast, go for morning walk. C. Take medication with breakfast, then take a 30 minute morning walk. D. Go for a 30 minute morning walk, eat breakfast, then take medication.

A Rationale Alendronate (Fosamax) is best absorbed when taken thirty minutes before eating in the morning. The client should also be advised to remain in an upright position for at least thirty minutes after taking the medication to reduce the risk of esophageal reflux and irritation.

9) The nurse is providing medication teaching for a client who has been prescribed tetracycline. The client regularly takes calcium supplements to prevent osteoporosis. Which statement is appropriate for the nurse to make? A. Take your calcium two hours before you take the antibiotic B. You can take the calcium with the antibiotic to decrease an upset stomach C. Try taking the antibiotic and calcium with orange juice D. It is best to take the antibiotic and calcium on an empty stomach

A Rationale All tetracycline derivatives are bacteriostatics, and their concentration in serum should not fall during the therapy below the generally accepted minimum therapeutic concentration. Tetracyclines have a high affinity to form chelates with iron, aluminum, magnesium, and calcium. These complexes are poorly absorbed in the gastrointestinal tract; therefore, an interval between the ingestion of tetracyclines and cations is necessary. Taking tetracyclines with orange juice may increase irritation because the medication itself is also acidic. Additionally, orange juice may have added calcium, which would interact with the antibiotic. It is okay to take tetracyclines with food as long as it doesn't contain dairy. This may reduce stomach-related side effects.

1) How can the nurse prevent vomiting in a client who reports feeling nauseated after cataract surgery? A. Administer the prescribed antiemetic medication. B. Provide some dry crackers for the client to eat. C. Explain that this is expected after surgery. D. Teach how to breathe deeply until the nausea subsides.

A Rationale An antiemetic will prevent vomiting; vomiting increases intraocular pressure and should be avoided. Providing some dry crackers for the client to eat, explaining that this is expected after surgery, and teaching how to breathe deeply until the nausea subsides are unsafe; vomiting increases intraocular pressure, and aggressive intervention is required.

8) How will the nurse respond to a client with a new diagnosis of type 1 diabetes who becomes agitated and says, "I am scared of shots. If that is my only option, I'll just have to go into a coma and die!" when told that lifelong insulin will be needed? A. "Injections are not the only option available for insulin." B. "It won't be so bad; you will get used to it if you will only try." C. "This is one of those times when you need to act like an adult." D. "Clients have the right to refuse treatment, but I need you to sign this form that removes us from liability for your decision."

A Rationale An insulin nasal spray was approved by the Food and Drug Administration (FDA) in 2014 and is available for clients who do not want insulin injections. The nurse should use therapeutic communication in interacting with clients. Intimidating the client by suggesting that actions are childlike and suggesting that the client's concerns are not significant are not therapeutic responses. The nurse's primary concern should be for the client's well-being, not protection from liability.

4) A biphasic antiovulatory medication of combined progestin and estrogen is prescribed for a client. Which instruction would the nurse include when teaching about this oral contraceptive? A. 'Report irregular vaginal bleeding.' B. 'Restrict sexual activity temporarily.' C. 'Have regular bimonthly Pap smears.' D. 'Increase dietary intake of calcium.'

A Rationale Antiovulatory medications suppress menstruation. Breakthrough bleeding is not expected with biphasic medications and should be reported. The medication is given for 21 days, and menstrual flow does not occur during this time. Sexual activity is not restricted when one is taking oral contraceptives. There is no indication for increased frequency of Pap smears; one a year is sufficient. Increased calcium intake is not relevant to the administration of oral contraceptives.

4) Which essential test results will the nurse review before starting antitubercular pharmacotherapy when caring for a client with human immunodeficiency virus (HIV) infection who is diagnosed with tuberculosis? A. Liver function studies B. Pulmonary function studies C. Electrocardiogram and echocardiogram D. White blood cell counts and sedimentation rate

A Rationale Antitubercular medications, such as isoniazid (INH) and rifampin (RIF), are hepatotoxic; liver function should be assessed before initiation of pharmacological therapy. Pulmonary function studies, electrocardiogram, and echocardiogram might be done; the results of these tests are not crucial for the nurse to review before administering antitubercular medications. White blood cell counts and sedimentation will not provide information relative to starting antitubercular therapy or to its side effects.

5) Which laboratory test result would the nurse review before initiating a prescribed antitubercular pharmacotherapy for a client with tuberculosis associated with human immunodeficiency virus? A. Liver function studies B. Pulmonary function studies C. Electrocardiogram D. White blood cell (WBC) count

A Rationale Antitubercular medications, such as isoniazid and rifampin, are hepatotoxic. Pulmonary function studies and electrocardiograms are not related to the administration of antitubercular medications or to their side effects. The WBC count is expected to be higher in the presence of infection, but with acquired immunodeficiency syndrome, the WBC count will be less than 2500/cm 3 (2.5 × 10 9/L), and helper T cells will number less than 200 mm 3; the T4/T8 ratio will be 1:2. These tests will not provide information relative to starting antitubercular therapy or to its side effects.

3) The triage nurse at a health clinic receives a call from a client. The client states that they have been experiencing flu-like symptoms for the past 24 hours. The client asks for a prescription for zanamivir. How should the triage nurse respond? A. "Come in right away so we can start treating you." B. "Do you have trouble swallowing big pills?" C. "We will call your pharmacy for an antibiotic prescription for you." D. "Call back tomorrow when you are sure you have the flu."

A Rationale Antiviral influenza treatment with zanamivir should be initiated within 48 hours of onset of symptoms, thus it is important to get treatment started as soon as possible. The medication won't cure the disease, it will only shorten the time frame that someone is sick and may reduce the severity of the illness. It is administered by oral inhalation. Antibiotics are not an appropriate treatment for the flu.

4) Which side effect would the nurse anticipate in a child receiving chelation therapy? A. Hypocalcemia B. Hyperkalemia C. Hypoglycemia D. Hypernatremia

A Rationale Calcium EDTA removes calcium along with lead, so the serum calcium level should be checked periodically. Hyperkalemia, hypoglycemia, and hypernatremia do not occur with chelation therapy.

11) At 6 weeks' gestation a client is found to have gonorrhea. For which medication would the nurse anticipate preparing a teaching plan? A. Ceftriaxone B. Levofloxacin C. Sulfasalazine D. Trimethoprim/sulfamethoxazole

A Rationale Ceftriaxone, a broad-spectrum antibiotic, is preferred during pregnancy. Levofloxacin, although listed for unlabeled use against gonococcal infection, should not be prescribed during pregnancy. Sulfonamides, such as Sulfasalazone, may cause hemolysis in the fetus. Trimethoprim/sulfamethoxazole contains a sulfonamide and is contraindicated during pregnancy.

12) Which fact about ceftriaxone medication therapy will the nurse emphasize when teaching a client diagnosed with gonorrhea? A. Cures the infection B. Prevents complications C. Controls its transmission D. Reverses pathologic changes

A Rationale Ceftriaxone, followed by doxycycline, is specific for Neisseria gonorrhoeae and eradicates the microorganism; other treatment regimens are available for resistant strains. If the disease progresses before the diagnosis is made, complications such as sterility, heart valve damage, or joint degeneration may occur. Transmission is not controlled; the organism is eliminated. If tubal structures, heart valves, or joints degenerate, the pathologic changes will not be reversed by antibiotic therapy.

9) The nurse administers cimetidine to a 75-year-old client diagnosed with a gastric ulcer. The nurse should monitor the client for which adverse reaction? A. Mental status change B. Increased liver enzymes C. Constipation D. Hearing loss

A Rationale Cimetidine is a histamine H2-receptor antagonist used to treat gastric ulcers. It has been found to cause confusion in susceptible clients, such as the elderly and debilitated clients. Clients over age 50 or who are severely ill may become temporarily confused while taking H2 blockers, especially cimetidine.

8) A woman questions the nurse about the effectiveness of oral contraceptives. Which important factor about the effectiveness of oral contraceptives would the nurse include in the response? A. User motivation B. Simplicity of use C. Reliability record D. Identified risk factors

A Rationale Conception will not be prevented unless the user is motivated to use the method correctly and consistently. No matter how simple, the method must be used consistently. Reliability record is not relevant if the method is not used correctly and consistently by the woman. Risk factors have little influence on the effectiveness of the contraceptive method.

3) Which statement by the nurse is most appropriate regarding the greatest advantage of using an insulin pump? A. 'Independence is fostered.' B. 'Fear of daily injections is allayed.' C. 'Dietary restrictions are minimized.' D. 'Blood glucose monitoring can be eliminated.'

A Rationale Continuous insulin therapy allows the child to become independent of parental control and anxiety regarding insulin injections. The pump can be programmed to give a bolus of insulin, which corresponds to food eaten, rather than the child needing an injection because of a sudden increase in blood glucose. The pump requires a subcutaneous needle insertion site that needs periodic changing (e.g., every third day or as necessary). The child must still adhere to the recommended diet; dietary control minimizes the amount of exogenous insulin needed. Blood glucose monitoring is required regardless of the method of insulin administration.

2) A female client with rheumatoid arthritis takes ibuprofen (Motrin) 600 mg PO 4 times a day. To prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is prescribed. Which information is most important for the nurse to include in client teaching? A. Use contraception during intercourse. B. Ensure the Cytotec is taken on an empty stomach. C. Encourage oral fluid intake to prevent constipation. D. Take Cytotec 30 minutes prior to Motrin.

A Rationale Cytotec, a synthetic form of a prostaglandin, is classified as pregnancy Category X and can act as an abortifacient, so the client should be instructed to use contraception during intercourse to prevent loss of an early pregnancy. A common side effect of Cytotec is diarrhea, so constipation prevention strategies are usually not needed. Cytotec and Motrin should be taken together to provide protective properties against gastrointestinal bleeding.

2) A nurse is administering insulin glargine to a client with diabetes type I. The client asks the nurse why insulin is the only option for therapy. Which statement by the nurse is appropriate? A. Your body does not produce an adequate amount of insulin B. Insulin is better at controlling the disease than oral pills C. Your body has a resistance to insulin D. Oral pills take longer to produce therapeutic effects than insulin

A Rationale Diabetes mellitus type 1 is characterized by the inability of the beta cells to produce insulin. The disease is managed by implementing an insulin regimen. Oral hypoglycemic medications are not effective in treating diabetes type 1. The body's resistance to insulin is characteristic of diabetes mellitus type 2. The onset of oral hypoglycemic medications is not relevant to a client with diabetes mellitus type 1.

7) Which independent nursing action would be included in the plan of care for a client after an episode of ketoacidosis? A. Monitoring for signs of hypoglycemia resulting from treatment B. Withholding glucose in any form until the situation is corrected C. Giving fruit juices, broth, and milk as soon as the client is able to take fluids orally D. Regulating insulin dosage according to the client's urinary ketone levels

A Rationale During treatment for acidosis, hypoglycemia may develop; careful observation for this complication will be made by the nurse. Withholding all glucose may cause insulin coma. Whole milk and fruit juices are high in carbohydrates, which are contraindicated immediately following ketoacidosis. The regulation of insulin depends on the prescription for coverage; the prescription usually depends on the client's blood glucose level rather than ketones in the urine.

1) The nurse is preparing a client for discharge following inpatient treatment for pulmonary tuberculosis. Which instruction should be given to the client? A. Continue taking medications as prescribed. B. Continue taking medications until symptoms are relieved. C. Avoid contact with children, pregnant women or immunosuppressed persons. D. Take medication with aluminum hydroxide if epigastric distress occurs.

A Rationale Early cessation of treatment may lead to development of drug-resistant tuberculosis (TB). Active TB is usually treated with a combination of four different antibiotics (Isoniazid, rifampin, ethambutol and pyrazinamide) and can now take anywhere from 6-12 months to completely kill the bacteria. As with any antibiotics, clients should continue to take medications even after they begin to feel better. There is no reason to avoid contact with children, pregnant women or immunosuppressed persons once discharged from the hospital as long as the client is adhering to medication schedules. Isoniazid should be taken on an empty stomach; ethambutol can be taken with food to avoid stomach upset. If taken with TB medications, aluminum hydroxide will interfere with absorption of these medications.

5) A client is receiving epoetin for the treatment of anemia associated with chronic renal failure. Which client statement indicates to the nurse that further teaching about this medication is necessary? A. 'I realize it is important to take this medication because it will cure my anemia.' B. 'Because I am at risk for seizures, I need to avoid hazardous activities.' C. 'I recognize that I may still need blood transfusions if my hemoglobin is very low.' D. 'I understand that I will still have to take supplemental iron therapy with this medication.'

A Rationale Epoetin will increase a sense of well-being, but it will not cure the underlying medical problem; this misconception needs to be corrected. Seizures are a risk during the first 90 days of therapy, especially if the hematocrit increases more than 4 points in a 2-week period. A dose adjustment may be necessary. Blood transfusions may still be necessary when the client is severely anemic. Supplemental iron therapy is still necessary when receiving epoetin because the increased red blood cell production still requires iron.

5) A 5-year-old child is given fluoroquinolones. Which potential adverse effect unique to pediatric clients would the nurse anticipate? A. Tendon rupture B. Cartilage erosion C. Staining of developing teeth D. Central nervous system toxicity

A Rationale Fluoroquinolones may cause tendon rupture in children. Nalidixic acid can cause cartilage erosion, and tetracycline can cause staining of developing teeth. Hexachlorophene may cause central nervous system toxicity in infants.

1) Which mechanism of action explains how glyburide decreases serum glucose levels? A. Stimulates the pancreas to produce insulin B. Accelerates the liver's release of stored glycogen C. Increases glucose transport across the cell membrane D. Decreases absorption of glucose from the gastrointestinal system

A Rationale Glyburide, an antidiabetic sulfonylurea, stimulates insulin production by the beta cells of the pancreas. Accelerating the liver's release of stored glycogen occurs when serum glucose drops below normal levels. Increasing glucose transport across the cell membrane occurs in the presence of insulin and potassium. Antidiabetic medications of the biguanide chemical class improve sensitivity of peripheral tissue to insulin, which ultimately increases glucose transport into cells. Beta cells must have some function to enable this medication to be effective.

10) Oral contraceptives are prescribed for a client who smokes heavily. Which side effect would the nurse warn the client might occur? A. Blood clots B. Cervical cancer C. Ovarian cancer D. Risk of coronary heart disease later in life

A Rationale Heavy smoking is a major risk factor for an increased risk of thrombosis or blood clots. Cervical cancer is associated with human papillomavirus infection, not oral contraceptive use. Oral contraceptives have a protective effect against ovarian cancer. Although there is an increased risk of coronary heart disease while taking an oral contraceptive, this risk abates when it is no longer taken and does not carry over into later life.

6) The client is diagnosed with tuberculosis (TB). The nurse understands that the treatment plan for this client will involve what type of drug therapy? A. Administering two antituberculosis drugs B. Aminoglycoside antibiotics C. An anti-inflammatory agent D. High doses of B complex vitamins

A Rationale In order to prevent drug-resistant strains of TB, clients are always prescribed at least two different anti-tubercular medications. Rifampin and isoniazid are the most effective drugs used to treat TB and are always used together, for at least six months. Additional medications, such as pyrazinamide and either streptomycin or ethambutol, may also be prescribed. Vitamin B6 is usually prescribed to help prevent expected side effect of isoniazid.

6) An infant with congenital hypothyroidism receives levothyroxine for 3 months. Which finding would indicate to the nurse that the medication is effective? A. The infant is alert and interactive. B. The skin is cool to the touch. C. The baby's fine tremor has ceased. D. The baby's thyroid stimulating hormone level has increased.

A Rationale Infants with congenital hypothyroidism are lethargic, and may even need to be awakened and stimulated to nurse; therefore an infant who is alert and interacts appropriately for its age would demonstrate improvement. Cool skin is a clinical sign of hypothyroidism related to a slow basal metabolic rate. Fine hand tremor is related to hyperthyroidism and is not present in an infant with hypothyroidism, even one whose condition is being stabilized with levothyroxine. An increased thyroid stimulating hormone level would indicate inadequate treatment.

1) A child is prescribed insulin glargine before breakfast. Which instruction is most appropriate for the nurse to give the parents regarding a bedtime snack? A. 'Offer a snack to prevent hypoglycemia during the night.' B. 'Give the child a snack if signs of hyperglycemia are present.' C. 'Avoid a snack because the child is being treated with long-acting insulin.' D. 'Keep a snack at the bedside in case the child gets hungry during the night.'

A Rationale Insulin glargine is released continuously throughout the 24-hour period; a bedtime snack will prevent hypoglycemia during the night. Providing a snack when signs of hyperglycemia are present is unsafe because it intensifies hyperglycemia; if hyperglycemia is present, the child needs insulin. Because insulin glargine is a long-acting insulin, bedtime snacks are recommended to prevent a hypoglycemic episode during the night. When hypoglycemia develops, the child will be asleep; the child should eat the snack before going to bed.

5) An adolescent with type 1 diabetes mellitus is admitted to the intensive care unit in ketoacidosis with a blood glucose level of 170 mg/dL (9.4 mmol/L). A continuous insulin infusion is started. Which adverse reaction to the infusion is most important for the nurse to monitor? A. Hypokalemia B. Hypovolemia C. Hypernatremia D. Hypercalcemia

A Rationale Insulin moves potassium into the cells along with glucose, thus lowering the serum potassium level. Insulin does not lead to a reduced blood volume. Insulin does not directly alter the sodium levels. Insulin does not affect the calcium levels.

9) Which rationale accurately explains why insulin is prescribed for clients in acute renal failure? A. It promotes transfer of potassium into cells to lower serum potassium levels. B. Insulin is required because the alpha cells of the pancreas cease to function with renal failure. C. It is necessary to manage the elevated blood glucose levels that accompany renal failure. D. Insulin reduces the accumulated toxins by lowering the metabolic rate.

A Rationale Insulin promotes the transfer of potassium into cells, which reduces the circulating blood level of potassium. Renal failure does not cause pancreatic alpha cells to cease functioning. Blood glucose levels usually are not elevated in acute renal failure. Insulin will not lower the metabolic rate.

9) The nurse is caring for a client who is receiving isoniazid for tuberculosis (TB). Which assessment finding would indicate the client is having a possible adverse response to this medication? A. Yellowing of the sclera B. Tinnitus and decreased hearing C. Headache and sore throat D. Urinary frequency

A Rationale Isoniazid is a first-line anti-tuberculosis drug that is used as part of the combination therapy for treatment of tuberculosis. These first-line medications may be used up to 2 years in clients who are being treated for tuberculosis. The use of long-term combination treatment increases the effectiveness and decreases the occurrence of resistant strands. Clients receiving this medication are at risk for drug-induced hepatitis. The appearance of jaundice (yellowing of the sclera) may indicate an elevation of the client's serum bilirubin levels and liver enzymes (AST and ALT). A small number of clients taking isoniazid develop severe hepatitis that may progress to liver failure and death, unless the medication is stopped immediately. Other common side effects include nausea and peripheral neuropathy. This medication is not ototoxic and can occasionally cause urinary retention, not frequency.

1) Which condition contraindicates the use of ginseng herbal therapy? A. Pregnancy B. Schizophrenia C. Bipolar depression D. Alzheimer disease

A Rationale Pregnancy is contraindicated for ginseng herbal therapy. Schizophrenia, bipolar depression, and Alzheimer disease are contraindicated for St. John's Wort herbal therapy.

12) A parent of three young children has contracted tuberculosis. Which medication would the nurse anticipate being prescribed for members of the family who have been exposed? A. Isoniazid B. Multiple-puncture test C. Bacille Calmette-Guérin D. Tuberculin purified protein derivative

A Rationale Isoniazid is used as a prophylactic agent for people who have been exposed to tuberculosis; also, it is one of several medications used to treat the disease. Multiple-puncture tests, such as the tine test, are used to test for tuberculosis; these are no longer recommended. They are not a treatment for the prevention or cure of tuberculosis. Bacille Calmette-Guérin is a vaccine that provides limited immunity; it is not recommended for use in the United States. Tuberculin purified protein derivative, the Mantoux test, is a widely used skin test for detecting tuberculosis; it is not a treatment for the prevention or treatment of tuberculosis.

2) The nurse is caring for a 6-year-old child who has undergone craniotomy. The parents ask what effect mannitol has. Which response by the nurse is most appropriate? A. 'It relieves cerebral pressure.' B. 'It increases the bladder's filtration rate.' C. 'It reduces glucose excretion in the urine.' D. 'It decreases the peripheral retention of fluid.'

A Rationale Mannitol is an osmotic diuretic used to relieve cerebral edema. The bladder is a storage basin and is not involved with filtration; mannitol acts in the kidneys. Mannitol is an osmotic diuretic that affects neither the body's excretion of glucose nor peripheral edema.

9) Which therapy is indicated for a client admitted to the hospital after general paresis develops as a complication of syphilis? A. Penicillin therapy B. Major tranquilizers C. Behavior modification D. Electroconvulsive therapy

A Rationale Massive doses of penicillin may limit central nervous system damage if treatment is started before neural deterioration from syphilis occurs. Tranquilizers are used to modify behavior, not to treat general paresis. Behavior, not paresis, is treated with behavior modification. Electroconvulsive therapy is used to treat certain psychiatric disorders.

19) The health care provider prescribes peak and trough levels after initiation of intravenous antibiotic therapy. The client asks why these blood tests are necessary. Which reason would the nurse provide? A. 'They determine if the dosage of the medication is adequate.' B. 'They detect if you are having an allergic reaction to the medication.' C. 'The tests permit blood culture specimens to be obtained when the medication is at its lowest level.' D. 'These allow comparison of your fever to changes in the antibiotic level.'

A Rationale Medication dose and frequency are adjusted according to peak and trough levels to enhance efficacy by maintaining therapeutic levels. Peak and trough levels reveal nothing about allergic reactions. Blood cultures are obtained when the client spikes a temperature; they are not related to peak and trough levels of an antibiotic. A sustained decrease in fever is the desired outcome, not a reduction just at peak serum levels of the medication.

2) The nurse is providing teaching to the client taking metoclopramide. Serious side effects that should be reported to the provider are included in the teaching plan. Which of the following side effects is the priority? A. Involuntary muscle movements B. Report of increased fatigue C. Onset of headaches D. Difficulty with sleep

A Rationale Metoclopramide is a GI stimulant that is effective in reducing headache, nausea, and vomiting. Metoclopramide can cause a serious movement disorder called tardive dyskinesia (TD). This condition is often irreversible. TD is characterized by involuntary movements of the face, tongue, or extremities. The risk of developing TD is increased with longer treatment and increased dosage. To help prevent TD, this drug shouldn't be used for longer than 12 weeks. The more common side effects of metoclopramide can include headache, confusion, drowsiness, dizziness, restlessness, and insomnia.

15) Which are the characteristics of reactions associated with immunizations for a 2-month-old infant? A. Local or systemic and usually mild B. Often serious, possibly requiring hospitalization C. Sometimes causing ulceration at the injection site D. May be responsible for permanent neurological damage

A Rationale Mild reactions consist of redness and induration at the injection site, slight fever, and irritability. Serious reactions are not common. Induration at the injection site may occur, but not ulceration. Permanent brain damage is not likely after an immunization.

11) The nurse is counseling a client with gastroesophageal reflux disease (GERD) who has been taking prescribed famotidine for two days. Which statement would require immediate follow up by a healthcare provider? A. I take digoxin for my heart failure B. I use calcium carbonate if I have symptoms after meals C. I use alendronate for my osteoporosis D. I'm still having some symptoms of heartburn.

A Rationale Most medications for heartburn decrease stomach acid. Histamine blocking drugs such as famotidine (H2 receptor antagonist) are available as both prescription and over-the-counter. It is often advised to take an antacid with an H2RA to relieve pain. Symptoms should be improved after one week. Famotidine does not cause bone loss, unlike proton pump inhibitors, and is an acceptable choice for clients with osteoporosis. Famotidine is used cautiously in clients on digoxin as it decreases absorption. This client needs to have their digoxin level checked, and the dosage may need to be adjusted.

13) A client with tuberculosis takes combination therapy with isoniazid, rifampin, pyrazinamide, and streptomycin. The client says, 'I've never had to take so much medication for an infection before.' How would the nurse respond? A. 'The bacteria causing this infection are difficult to destroy.' B. 'Streptomycin prevents the side effects of the other medications.' C. 'You only need to take the medications for a couple of weeks.' D. 'Aggressive therapy is needed because the infection is well advanced.'

A Rationale Multiple medications are administered because of concerns regarding medication resistance. Streptomycin sulfate is an antibiotic; it does not prevent the side effects of other medications used in therapy. Multiple antitubercular medications are necessary for an extended period, approximately 6 to 8 months depending on the individual. Multiple dose therapy is needed regardless of whether the disease is advanced.

2) A client is prescribed ampicillin sodium (Omnipen) for a sinus infection. The nurse should instruct the client to notify the healthcare provider immediately if which symptom occurs? A. Rash. B. Nausea. C. Headache. D. Dizziness.

A Rationale Rash is the most common adverse effect of all penicillins, indicating an allergy to the medication that could result in anaphylactic shock, a medical emergency.

5) A nurse is preparing to withdraw insulin into a syringe in the medication room. The nurse notes an open, full vial of regular insulin with no labeled expiration date. Which action does the nurse take? A. Discard the vial and request a new one from the pharmacy B. Label the vial with the current date and withdraw the medication C. Withdraw the medication and discard the vial D. Store the medication in the refrigerator and notify the pharmacy

A Rationale Opened vials of medication should have a labeled expiration date. Multi-dose vials expire 28 days after being opened. The nurse should discard the vial and request a new one since there is no way of knowing when the vial was opened. Labeling the medication with the current date or withdrawing the medication are not safe practices. There is no way to verify how long the medication has been opened. The vial should not be stored without an expiration date label.

12) The nurse teaches a client about side effects that necessitate discontinuation of oral contraceptives. Which statement made by the client indicates that the teaching was effective? A. 'I'll stop taking the pills if I have chest pain.' B. 'I'll stop taking the pills if I start to retain fluid.' C. 'I'll stop taking the pills if I have white discharge from the vagina.' D. 'I'll stop taking the pills if I have pain during the middle of my cycle.'

A Rationale Oral contraceptives should be discontinued with any symptom that may be related to a pulmonary embolus. Fluid retention is a common side effect of increased estrogen and progestin; discontinuation of the contraceptive is unnecessary. Leukorrhea may be a sign of infection, not a side effect of oral contraceptives. Abdominal pain in the middle of the menstrual cycle is not expected while an oral contraceptive is being taken. Abdominal pain in the area of an ovary that occurs midway during the menstrual cycle (mittelschmerz) usually indicates ovulation.

4) A client with a history of tuberculosis reports difficulty hearing. Which medication would the nurse consider is causing this response? A. Streptomycin B. Pyrazinamide C. Isoniazid D. Ethambutol

A Rationale Ototoxicity is an adverse effect of aminoglycosides such as streptomycin. Ototoxicity is not an adverse effect of pyrazinamide, isoniazid, or ethambutol.

2) The nurse is reviewing discharge instructions with the parent of an infant with cystic fibrosis. Which statement indicates the parents know how to administer the pancreatic enzyme replacement? A. 'We should give the medication with feedings.' B. 'We should put crushed enteric-coated pills in the formula.' C. 'We need to give the medication every 6 hours, even during the night.' D. 'We should feed the granules from the capsule in applesauce every morning.'

A Rationale Pancreatic enzyme replacement is given just before or with every meal to aid digestion. Breaking up and dissolving the medication will hasten its degradation by gastric secretions and interfere with its efficiency. The medication must be given just before or with every meal, not every 6 hours or every morning, to aid digestion.

3) When would the nurse plan to administer pancrelipase to a child with cystic fibrosis? A. With meals and snacks B. In the morning and at bedtime C. On awakening and every 3 hours while the child is awake D. After each bowel movement and after postural drainage is performed

A Rationale Pancrelipase must be taken with food and snacks because it is essential for the digestion of nutrients. The enzyme is ineffective when taken without food; it is contraindicated at any other time.

5) A client who is taking isoniazid for tuberculosis asks the nurse about the possible side effects of this medication. The nurse informs the client to report which side effect of this medication to the primary health care provider (HCP)? A. Extremity tingling and numbness B. Confusion and light-headedness C. Double vision and visual halos D. Photosensitivity and photophobia

A Rationale Peripheral neuropathy is a common side effect of isoniazid and other anti-tubercular medications. Extremity tingling and numbness should be reported to the primary health care provider (HCP). Daily doses of pyridoxine (vitamin B6) may lessen or even reverse peripheral neuropathy due to isoniazid use.

3) A client who takes daily megadoses of vitamins is hospitalized with joint pain, loss of hair, yellow pigmentation of the skin, and an enlarged liver due to vitamin toxicity. Which type of toxicity would the nurse suspect? A. Retinol (vitamin A) B. Thiamine (vitamin B 1) C. Pyridoxine (vitamin B 6) D. Ascorbic acid (vitamin C)

A Rationale Retinol is lipid soluble and eliminated by the liver. Joint pain, hair loss, jaundice, anemia, irritability, pruritus, and enlarged liver and spleen are signs of vitamin A toxicity. Thiamine, pyridoxine, and ascorbic acid are water soluble, so they are typically excreted in the urine before toxic blood levels can be achieved. However, excess thiamine may elicit an allergic reaction in some individuals, excess vitamin C (ascorbic acid) may cause diarrhea or renal calculi, and ultrahigh doses (about 800 times the normal dose) of pyridoxine (vitamin B 6) can promote neuropathy. Remember that lipid-soluble vitamins normally take longer to eliminate and accumulate faster than water-soluble vitamins.

1) A client who takes rifampin tells the nurse, 'My urine looks orange.' Which action would the nurse take? A. Explain that this is expected. B. Check the liver enzymes. C. Ask the provider to order a urinalysis. D. Ask what foods were eaten.

A Rationale Rifampin causes a reddish-orange discoloration of secretions such as urine, sweat, and tears. Although liver enzymes should be monitored because of the risk of hepatitis, this action is not addressing the client's statement. A urinalysis is not indicated for an anticipated finding. The medication, not food, is responsible for the urine color.

1) A client who has a habit of smoking is on estrogen therapy. Which condition is the client at most risk of developing? A. Thrombosis B. Gastrointestinal upset C. Risk of developing cancer D. Decreased effectiveness of estrogen

A Rationale Smoking along with estrogen therapy may increase the risk of thrombosis. Estrogen taken on an empty stomach may cause gastrointestinal upset. Estrogen is not prescribed to clients with endometrial or breast cancer. The effectiveness of estrogen decreases with the use of anticoagulants, rifampicin, and St. John wort.

3) A client reports to the nurse, 'I've been using St. John's wort to try and feel more like myself again. I'm not sure whether it's going to work.' Which symptom would the nurse further assess? A. Depression B. Sleep disturbances C. Diminished cognitive ability D. Sensory-perceptual disturbances

A Rationale St. John's wort is an herb marketed as a natural way to improve mood and ease feelings of depression. Because St. John's wort is considered a dietary supplement, it is not regulated by the Food and Drug Administration as medications are. It has not been shown to exert positive effects in people with sleep disturbances, diminished cognitive abilities, or sensory-perceptual disturbances.

9) A 28-year-old woman who is a smoker seeks advice about oral contraceptives. Which response by the nurse is appropriate? A. 'Oral contraceptives can cause thrombophlebitis.' B. 'Oral contraceptives must be used with other methods.' C. 'Some oral contraceptives can be used without concern.' D. 'Some oral contraceptives are safe, but others are not safe.'

A Rationale Studies have shown that women who smoke at least a pack of cigarettes a day are more prone to cardiovascular problems such as thrombophlebitis. Using oral contraceptives with other methods of contraception is not necessary if there are no contraindications; oral contraceptives are effective used alone. There is no 'safe' oral contraceptive for all women or one that may be used without concern; any client at risk should be informed of the potential consequences of taking an oral contraceptive.

22) The nurse is providing education to the parent of a pediatric client receiving amoxicillin clavulanate suspension. Which of the following statements is appropriate? A. Use the measuring device provided by the pharmacy B. You should take this medication on an empty stomach C. Avoid shaking the medication before opening D. Take the medication with a glass of juice

A Rationale Take augmentin (amoxicillin clavulanate) with meals to increase absorption and decrease GI upset. Acidic fluids may destroy the drug, so avoid taking the medication with citrus juice. The client should be taught to shake liquid penicillins well as the medication tends to separate out of the suspension. Measure liquid doses carefully. Use the measuring device that comes with this drug. If there is none, ask the pharmacist for a device to measure this drug.

3) The nurse provides client teaching on the use of oral contraceptives. Which statement made by the client indicates to the nurse that teaching was effective? A. 'I will take my pill at the same time every day.' B. 'I can stop the pill and try to get pregnant right away.' C. 'I may miss two periods and not worry about being pregnant.' D. 'I am so glad we won't have to use condoms even if I miss just one pill during the month.'

A Rationale Taking the pill at the same time every day makes it more effective, and the client should be instructed to do so. A woman should wait 2 to 3 months after stopping the oral contraceptive pill before attempting to become pregnant. If two consecutive menstrual cycles are missed, the client should stop the contraceptive pill and perform a pregnancy test. The client should use a barrier method of contraception for the first month of pill use and when a pill is missed to help prevent conception.

6) Tetanus immune globulin is prescribed after a client steps on a rusty nail. Which action would the nurse associate with this medication? A. Provides antibodies B. Stimulates plasma cells C. Produces active immunity D. Facilitates long-lasting immunity

A Rationale Tetanus immune globulin provides antibodies, which confer immediate passive immunity. It does not stimulate production of plasma cells, the precursors of antibodies. Passive, not active, immunity occurs. Passive immunity, by definition, is not long lasting.

5) The nurse is preparing to administer doxycycline to a client to treat syphilis. Which lab results should the nurse review before administering this medication? A. Pregnancy test B. Hematocrit C. Sodium level D. Arterial blood gas

A Rationale Tetracyclines, such as doxycycline, may cause fetal harm and should not be administered during pregnancy. It is important to know the client's pregnancy status prior to administration. Reviewing hematocrit, serum sodium level, and ABGs may be a part of the client's assessment, but these do not affect the prescription for doxycycline.

8) A client is diagnosed with acute kidney failure secondary to dehydration. An intravenous (IV) infusion of 50% glucose with regular insulin is prescribed to address which purpose? A. To correct hyperkalemia B. To increase urinary output C. To prevent respiratory acidosis D. To increase serum calcium levels

A Rationale The 50% glucose and regular insulin infusion treats the hyperkalemia associated with kidney failure; it moves potassium from the intravascular compartment into the intracellular compartment. Insulin will not increase urinary output. Insulin is not a treatment for respiratory acidosis. Insulin and glucose do not increase serum calcium levels.

5) The nurse plans to teach a client with type 1 diabetes about the use of an insulin pump. Which information will the nurse include in client teaching? A. Insulin pumps mimic the way a healthy pancreas works. B. The insulin pump's needle should be changed every day. C. Pumps are implanted in a subcutaneous pocket near the abdomen. D. The insulin pump's advantage is that it only requires glucose monitoring once a day.

A Rationale The basal infusion rate mimics the low rate of insulin secretion during fasting, and the bolus before meals mimics the high output after meals. The subcutaneous needle may be left in place for as long as 3 days. Most insulin pumps are external to the body and access the body via a subcutaneous needle. Blood glucose monitoring is done a minimum of four times a day.

1) A nurse is assessing a client diagnosed with diabetic ketoacidosis. The client is on a prescribed regular insulin infusion at 0.1 units/kg/hr. The client appears restless and verbalizes tingling to the extremities. Which action does the nurse perform next? A. Check the client capillary blood glucose B. Stop the regular insulin infusion C. Increase the infusion to 0.15 units/kg/hr D. Give the client 4 oz of fruit juice

A Rationale The client is experiencing symptoms of hypoglycemia. Prior to decreasing the dose of the infusion, the nurse should assess the client's blood glucose level to confirm the hypoglycemia. Prior to stopping the infusion, the nurse needs to assess the client's blood sugar level and notify the healthcare provider of the results. Increasing the infusion will cause further hypoglycemia. Prior to performing an intervention to correct the hypoglycemia, the nurse needs to assess the blood glucose level first.

12 ) In addition to clients who are receiving insulin for type 1 diabetes, the nurse will assess for signs and symptoms of hypoglycemia in clients who have which diagnosis? A. Liver failure B. Anemia C. Hyperthyroidism D. Stage 3 hypertension

A Rationale The client with liver disease is at risk for hypoglycemia—40% of clients with liver failure develop hypoglycemia. This client is limited in mobilizing carbohydrates because of a decreased ability to form glycogen (glycogenesis) and to form glucose from glycogen (glycogenolysis). Anemia is not related to a decreased serum glucose level. Hyperthyroidism is not related to a decreased serum glucose level. Hypertension is not related to a decreased serum glucose level.

9) Which action would the nurse take when a client develops a maculopapular rash on the upper extremities and audible wheezing during the admistinration of intravenous vancomycin? A. Stop the infusion. B. Decrease the flow rate. C. Reassess in 15 minutes. D. Notify the health care provider.

A Rationale The first action the nurse would take is to stop the infusion immediately. The client may be experiencing an allergic reaction. Decreasing the flow rate is not an appropriate action. Infusions must be stopped if an allergic reaction is suspected. This could be an emergent situation, so reassessing in 15 minutes is not the most appropriate action. The nurse would stop the medication infusion and then notify the health care provider.

7) A client being discharged home is prescribed an antibiotic with a dosage three times higher than it was administered when the client was in the hospital (IV route). Which route of administration should the nurse anticipate will be prescribed for the greatest first-pass effect? A. Oral. B. Sublingual. C. Intravenous. D. Subcutaneous.

A Rationale The first-pass effect is a pharmacokinetic phenomenon that is related to the drug's metabolism in the liver. After oral medications are absorbed from the gastrointestinal tract, the drug is carried directly to the liver via the hepatic portal circulation, where hepatic inactivation occurs and reduces the bioavailability (strength/concentration) of the drug.

7) The nurse is educating a client prescribed metronidazole. Which of the following findings should the nurse include in the education as reportable to the healthcare provider? A. Pinpoint red spots on the skin B. Nausea after beginning the medication C. Metallic taste D. Occasional diarrhea

A Rationale The most common gastrointestinal effects of metronidazole are nausea, vomiting, diarrhea, and metallic taste. Drug-induced immune thrombocytopenia (DITP) is a rare, but serious, adverse effect where medications cause the body to produce antibodies to platelets. The medication must be stopped immediately because DITP can be life-threatening. Heparin-induced thrombocytopenia is one example. Metronidazole is associated with DITP. Petechiae are pinpoint, round spots that appear on the skin as a result of bleeding. The bleeding causes the petechiae to appear red, brown, or purple.

9) A nurse is preparing to administer intravenous mannitol to a client with increased intracranial pressure. Which action will the nurse perform prior to administering the medication? A. Connect an in-line filter to the infusion tubing B. Dilute the medication with lactated ringers C. Prepare an infusion warmer D. Ensure the client has a patent central line

A Rationale The nurse should connect a filter to the infusion tubing prior to administering mannitol. Mannitol is an osmotic diuretic that may contain crystals within the solution. The in-line filter prevents the administration of particulates into the bloodstream. Mannitol should be administered undiluted. An infusion warmer is not required for the administration of mannitol. Mannitol can be administered through a peripheral line.

5) Which statement by the client indicates to the nurse a need for further teaching on rifampin therapy? A. 'I can expect my skin to turn yellow.' B. 'I can expect my sweat to change color.' C. 'I can expect my urine to turn red-orange.' D. 'I can expect my contact lenses to stain orange.'

A Rationale The skin turning yellow indicates jaundice, a serious unexpected adverse effect of rifampin therapy that needs to be reported to the prescriber. Sweat, urine, saliva, and tears (which may stain contact lenses) may turn to a red-orange color during rifampin therapy, which is expected.

4) The nurse is educating an older adult client about newly prescribed levofloxacin for the treatment of pneumonia. The nurse should teach the client that which side effect is a priority for the client to report to the provider? A. Joint tenderness B. Diarrhea C. Dizziness D. Difficulty sleeping

A Rationale There is a black box warning for fluoroquinolones alerting health professionals not only to the increased disabling risk of tendinitis and tendon rupture but also to the significant risk of peripheral neuropathy, central nervous system and cardiac effects, and dermatologic and hypersensitivity reactions. Signs of tendonitis and tendon rupture include pain and tenderness in the affected limb or joint. The medication must be stopped immediately. The other options are common side effects and while reportable, are not a priority.

4) The nurse recognizes that hormonal therapy (HT) increases the risk of which condition in postmenopausal women? A. Breast cancer B. Rapid weight loss C. Accelerated bone loss D. Vaginal tissue atrophy

A Rationale There is a relationship between HT that combines estrogen and progesterone compounds and an increased incidence of invasive breast cancer. One side effect of HT is weight gain with ankle and foot edema. Bone loss is slowed with HT. Vaginal tissue maintains turgor and lubrication with HT.

3) Intravenous fluids and insulin are prescribed to treat a client's diabetic ketoacidosis. The client develops peripheral paresthesias and shortness of breath. The cardiac monitor shows the appearance of a U wave. Which complication would the nurse suspect? A. Hypokalemia B. Hypoglycemia C. Hypernatremia D. Hypercalcemia

A Rationale These are classic signs of hypokalemia that occur when potassium levels are reduced as potassium reenters cells with glucose. Symptoms of hypoglycemia are weakness, nervousness, tachycardia, diaphoresis, irritability, and pallor. Symptoms of hypernatremia are thirst, orthostatic hypotension, dry mouth and mucous membranes, concentrated urine, tachycardia, irregular heartbeat, irritability, fatigue, lethargy, labored breathing, and muscle twitching or seizures. Symptoms of hypercalcemia are lethargy, nausea, vomiting, paresthesias, and personality changes.

1) The nurse teaches a client who is scheduled for a kidney transplant about the need for immunosuppressive medications. The nurse determines that the client understands the teaching when the client says that medications must be taken for which period of time? A. 'For the rest of my life.' B. 'Until the surgery is over.' C. 'Until the surgery heals.' D. 'During the intraoperative period.'

A Rationale These medications must be taken continuously for life to prevent rejection of the transplanted organ.

1) Which medication will the nurse expect the health care provider to prescribe to a client who had a thyroidectomy and is pale with spasms of the hand when taking the blood pressure? A. Calcium B. Magnesium C. Bicarbonate D. Potassium chloride

A Rationale These signs may indicate calcium depletion as a result of accidental removal of parathyroid glands during thyroidectomy. Symptoms associated with hypomagnesemia include tremor, neuromuscular irritability, and confusion. Symptoms associated with metabolic acidosis include deep, rapid breathing, weakness, and disorientation. Symptoms associated with hypokalemia include muscle weakness and dysrhythmias.

1) Which body function maintained by thiamine (vitamin B 1) and niacin (vitamin B 3) will the nurse monitor when prescribed for a client with alcoholism? A. Neuronal activity B. Bowel elimination C. Efficient circulation D. Prothrombin development

A Rationale Thiamine and niacin help convert glucose for energy and influence nerve activity. These vitamins do not affect elimination. These vitamins are not related to circulatory activity. Vitamin K, not thiamine and niacin, is essential for the manufacturing of prothrombin.

1) A client has a prescription for nitrofurantoin 50 mg orally every evening to manage recurrent urinary tract infections. Which instruction would the nurse give to the client? A. 'Increase your intake of fluids.' B. 'Strain your urine for crystals and stones.' C. 'Stop taking the medication if your urinary output increases.' D. 'This may turn your urine green.'

A Rationale To prevent crystal formation, the client should have sufficient intake to produce 1000 to 1500 mL of urine daily while taking this medication. Straining urine is not indicated when the client is taking a urinary anti-infective. If fluids are encouraged, the client's output should increase. Nitrofurantoin turns urine dark yellow to brown, not green.

16) The nurse is caring for a client who is receiving intermittent intravenous piggyback (IVPG) doses of vancomycin every 12 hours. The primary health care provider prescribes trough levels of the antibiotic. The nurse schedules the blood sample to be obtained at which time? A. Just before the medication is administered B. Between 30 and 60 minutes after the infusion is completed C. Six hours after the dose is completely infused D. In the morning before the client eats breakfast

A Rationale Trough levels are measured in relation to the time a medication is administered. The trough level for a medication is drawn just before a medication is given, when the medication's level is at its lowest. Any other time would be inaccurate for a medication's trough level. The medication's peak level is drawn 30 to 60 minutes after the infusion is completed. Whether the client eats breakfast does not affect this medication's trough levels, because it is an intravenous infusion.

1) The nurse is teaching a client who has been diagnosed with recurrent genital herpes about newly prescribed valacyclovir. Which statement by the client indicates understanding? A. This medication is preferable because I can take it less often than other antivirals B. I will be free of outbreaks from now on C. This medication will prevent transmission of the virus to my partner D. Starting the medication now will not help speed up healing

A Rationale Valacyclovir has greater bioavailability than acyclovir does and is administered less frequently. It speeds up the healing process for lesions and reduces discomfort from the lesions, even if they've already developed. While antivirals do reduce the risk of transmitting herpes simplex to partners, it is not eliminated. The number of outbreaks may be reduced but also may not be completed eliminated.

18) The nurse is caring for a client who has been prescribed vancomycin intravenous infusion for the treatment of methicillin-resistant staphylococcus aureus. Which of the following laboratory values should be immediately reported to the healthcare provider? A. Vancomycin trough of 15 mcg/dl (normal less than 10 mcg/dl) B. Blood urea nitrogen level of 18 mg/dl (normal 6-24 mg/dl) C. Creatinine level of 1.1 mg d/l (normal 0.5 - 1.3 mg/dl) D. White blood cell count of 11,500 per microliter ( normal 4,500 - 11,000 per microliter)

A Rationale Vancomycin has a low therapeutic index, with nephrotoxicity and ototoxicity complicating therapy if toxicity develops. In contrast, underdosing (less than the minimum inhibitory concentration) can lead to treatment failure. Nephrotoxicity is associated with a trough level above 10 mcg/dl. The BUN and creatinine in this case are still within a normal range. While the WBC count is elevated, this is an expected finding.

11) The home health nurse is teaching a female client about self-administering vancomycin. Which statement by the client demonstrates understanding of the teaching? A. I need to call my provider if my urine changes B. Muscle tingling and weakness is an expected side effect of this medication C. Ringing in the ears is common when taking vancomycin D. I should avoid eating food with active cultures in it

A Rationale Vancomycin is commonly linked to nephrotoxicity, leading to the need for monitoring trough levels. Signs of kidney injury include decreased urination, blood in the urine, and other changes in urine color and clarity. Antibiotic-associated diarrhea (colitis) results from oral or parenteral antibiotic therapy. Another pathogen is Candida albicans, which results in vaginal yeast infection and oral thrush. Probiotics can reduce these risks. Antibiotic-induced neuropathy is a rare complication of several antimicrobial agents. Hypokalemia can result from vancomycin; therefore, muscle weakness and numbness or tingling should be reported. Ototoxicity is a serious complication from vancomycin due to vestibular damage.

8) Which action would the nurse take to avoid red man syndrome when preparing to administer a vancomycin infusion? A. Infuse slowly. B. Change the intravenous (IV) site. C. Reduce the dosage. D. Administer vitamin K.

A Rationale Vancomycin should be infused slowly to avoid the occurrence of the reaction known as 'red man syndrome.' Changing the IV site reduces the incidence of thrombophlebitis. Reducing the dosage is done in the setting of renal dysfunction. Administration of vitamin K is done to correct an elevated prothrombin time.

3) A mother complains that her child's teeth have become yellow in color. The nurse understands that with prolonged use, which medication may be responsible? A. Tetracycline B. Promethazine C. Chloramphenicol D. Fluoroquinolones

A Rationale When administered to neonates and infants, tetracycline may cause staining of developing teeth. Promethazine can cause respiratory depression in children under 2 years of age. Chloramphenicol can cause Gray baby syndrome, and fluoroquinolones may cause tendon rupture in pediatric clients.

4) The nurse is preparing to administer a client's prescribed insulins and needs to mix NPH and lispro. Which of the following actions should the nurse take first? A. Inject air into the long-acting insulin B. Draw up the short-acting insulin C. Draw up the long-acting insulin D. Inject air into the short-acting insulin

A Rationale When mixing insulins in the same vial, the process should be to inject air into the long-acting insulin, inject air into the short-acting insulin, draw up the short-acting insulin, and then draw up the long-acting insulin.

4) A nurse is administering an intravenous piggyback infusion of penicillin. Which client statement would require the nurse's immediate attention? A. "I am itching all over." B. "I have soreness and aching in my muscles." C. "I have cramping in my stomach." D. "I have a burning sensation when I urinate."

A Rationale: Allergic reactions to medications can include itching all over. This can be further supported by the presence of hives or welts. Abdominal pain or cramping could indicate a side effect of the penicillin. The other symptoms of muscle soreness and painful urination are not as urgent as the itching.

3) The nurse in an urgent care clinic is preparing discharge instructions for the parents of a 15-month-old child with a first episode of otitis media. Which information is the priority to include? A. Explain that the child should complete the full 10 days of antibiotics B. Describe the tympanocentesis most likely needed to clear the infection C. Offer information on recommended immunizations around the child's second birthday D. Provide a written handout describing the care of myringotomy tubes

A Rationale: Otitis media, an inner ear infection, commonly occurs in young children. Although not always caused by bacteria, many ear infections are treated with oral antibiotics. If a client is prescribed antibiotics, the priority is to make sure that they take the full prescription for the prescribed number of days to prevent recurrence or antibiotic resistance.

15) The nurse is caring for a client with sepsis receiving broad-spectrum antibiotics. Which finding might indicate to the nurse the need for a dosage adjustment? A. Elevated creatinine level B. Elevated heart rate C. Decreased white blood cell count D. Decreased platelet count

A Rationale: Septic shock is the most common type of distributive shock that threatens multi-system organ failure with a rapid onset, which is the leading cause of death in noncoronary ICU patients. Gram-negative bacteria have been the most implicated organism, and broad-spectrum antibiotics are given to help increase the likelihood of increasing tissue perfusion. The majority of broad-spectrum antibiotics are excreted through the kidneys, and an elevated creatine level will indicate the need for dosage adjustments. Elevated lactic acid levels, heart rate, and white blood cell (WBC) levels are all signs of sepsis and need to be monitored closely. Decreased platelet counts are seen when the condition is exacerbated with blood loss but does not affect the antibiotic dosage.

7) The nurse is teaching a client with diabetes about newly prescribed trimethoprim and sulfamethoxazole (TMP-SMX) to treat a urinary tract infection. Which statement by the client indicates understanding? A. I will stop taking this medication if I develop a rash." B. This antibiotic will kill mature bacteria in my urinary tract." C. I should avoid dairy products when taking this medication." D. "My blood sugar will not be affected by this medication."

A Rationale: TMP-SMX is a sulfonamide medication. These drugs are bacteriostatic and therefore, halt the multiplication of new bacteria, but do not kill mature bacteria. Clients using sulfonylureas for the management of diabetes should know that other sulfa drugs may increase the chances of hypoglycemia. The action of metformin is also enhanced. Dairy is avoided when clients are taking tetracyclines. TMP-SMX is the most common cause of erythema multiforme. Sulfonamides are also often implicated in cases of both toxic epidermal necrosis and Stevens-Johnson syndrome, which can be fatal.

8) A nurse is educating a client on insulin administration. Which statement made by the client indicates further teaching is required? A. I will inject the insulin in the same site every day B. The best injection area is around my abdomen C. I will squeeze my skin together to inject the medication D. Gentle pressure should be applied to the site after injection

A Rationale: The nurse should further educate the client on rotating injection sites to prevent lipohypertrophy. Lipohypertrophy is the development of scar tissue under the skin that prevents adequate absorption of the medication. The absorption rate is greater in the subcutaneous tissue of the abdomen. Squeezing or bunching the skin together ensures the medication is administered into the subcutaneous layer. Gentle pressure helps the medication to absorb better.

5) Which points would the nurse include when counseling a woman on hormone therapy? Select all that apply. One, some, or all responses may be correct. A. The client should use appropriate sun protection. B. The client should monitor any deviations in body weight. C. The client should take the medication on an empty stomach. D. The client should discontinue the medication if adverse effects occur. E. The client should alternate the time of day the medication is taken.

A, B Rationale Appropriate sun protection should be used because hormones make people sensitive to sunlight. The client's body weight should be monitored during hormonal therapy because abnormal bleeding can lead to weight loss and serious complications. Hormonal medications should be taken with food to reduce gastrointestinal upset. The client should report any side effects to the primary health care provider and seek his or her advice. Hormonal therapy should never be discontinued without the knowledge of the primary health care provider. Oral medications should be administered at the same time every day to maintain the appropriate concentration of serum medication levels.

7) Which conditions would the nurse identify as decreasing the effectiveness of estrogen therapy? Select all that apply. One, some, or all responses may be correct. A. Habit of smoking B. Use of anticoagulants C. Use of tricyclic antidepressants D. Presence of endometrial cancer E. Presence of thromboembolic disorders

A, B Rationale The effectiveness of estrogen therapy decreases with smoking and decreases with the use of anticoagulants. The use of tricyclic antidepressants along with estrogen may result in medication toxicity. Estrogen therapy is not recommended in clients with endometrial cancer and thromboembolic disorders because it may increase the risk of these complications.

3) The nurse is caring for a client with type 1 diabetes. Which signs or symptoms may indicate that the client has insulin-induced hypoglycemia? Select all that apply. One, some, or all responses may be correct. A. Excessive hunger B. Weakness C. Diaphoresis D. Excessive thirst E. Deep respirations

A, B, C Rationale Hypoglycemia affects the central nervous system, causing weakness. Hypoglycemia affects the sympathetic nervous system, causing diaphoresis. Excessive hunger is associated with hypoglycemia because the body needs glucose for cellular metabolism. Excessive thirst is associated with hyperglycemia because fluid shifts, along with the excess glucose being excreted by the kidneys, result in polyuria. Deep respirations (Kussmaul respirations) are associated with hyperglycemia because the body is attempting to blow off carbon dioxide to compensate for the metabolic acidosis.

13) Which medication is classified as an H 2 receptor antagonist? Select all that apply. One, some, or all responses may be correct. A. Nizatidine B. Ranitidine C. Famotidine D. Lansoprazole E. Metoclopramide

A, B, C Rationale Nizatidine, ranitidine, and famotidine are H 2 receptor antagonists that reduces gastric acid secretion and provide symptomatic improvement in GERD. Lansoprazole is a proton pump inhibitor that inhibits gastric secretion up to 90% with one dose daily and provides for symptomatic improvement in GERD. Metoclopramide is a prokinetic agent that increases the rate of gastric emptying; it has multiple side effects and is not appropriate for long-term treatment of GERD.

7) Which assessment findings during the administration of intravenous penicillin prompt the nurse to stop the infusion? Select all that apply. One, some, or all responses may be correct. A. Hives B. Itching and Nausea C. Skin rash D. Shortness of breath

A, B, C, D Rationale Penicillin administration carries a high rate of allergic reaction, so the nurse monitors the client for signs of allergy. Hives, itching, skin rash, and shortness of breath are all indications of allergic reaction and warrant cessation of the infusion and contact with the health care provider. Nausea is not an indication of allergic reaction.

17) Which substance history of a severe allergic reaction results in avoidance of the cephalosporins such as cefazolin, cefditoren, cefotetan, and ceftriaxone? Select all that apply. One, some, or all responses may be correct. A. Milk B. Aspirin C. Calcium D. Penicillin E. Strawberries

A, B, C, D Rationale Use of cephalosporins like cefazolin should be avoided in the client with a history of severe allergic reaction to penicillin because of the potential of cross-sensitivity. The cephalosporin cefditoren should not be administered to the client with a milk allergy because it contains the milk protein caseinate. Bleeding can be magnified with the use of aspirin and the use of the cephalosporins cefotetan or ceftriaxone. The cephalosporin ceftriaxone and calcium should not be administered together because they cause the formation of precipitates.

21) Which assessment would the nurse perform before administering a dose of vancomycin to a client? Select all that apply.One, some, or all responses may be correct. A. Creatinine B. Trough level C. Hearing ability D. Intravenous site E. Blood urea nitrogen

A, B, C, D, E Rationale ALL are correct. Two major adverse effects of vancomycin are nephrotoxicity and ototoxicity. The nurse would assess the client's creatinine and blood urea nitrogen levels to determine renal function. The nurse would also assess the vancomycin trough levels to determine if the client's kidneys are clearing the medication. The nurse would assess for changes in hearing as a result of ototoxicity. Vancomycin can cause phlebitis, so the nurse would assess the intravenous site before initiating the infusion.

1) Which finding in a client with hypothyroidism and hypertension who reports taking an extra dose of levothyroxine indicates the need to obtain a thyroid function panel? Select all that apply. One, some, or all responses may be correct. A. Tremors B. Diaphoresis C. Nervousness D. Temperature 101°F E. Heart rate 116 beats/min

A, B, C, D, E Rationale Clients with hypothyroidism can develop thyrotoxicosis from an acute overdose of thyroid hormone. Tremors, diaphoresis, and nervousness are all signs of thyrotoxicosis. Clients may also be hyperthermic and tachycardic.

2) Which finding would lead the nurse to recheck the blood glucose level of a diabetic client before administering a mealtime insulin dose? Select all that apply. One, some, or all responses may be correct. A. Confusion B. Drowsiness C. Diaphoresis D. Nervousness E. Heart rate 110 beats/min

A, B, C, D, E Rationale Signs of hypoglycemia include confusion, drowsiness, diaphoresis, nervousness, tachycardia, and headache. The nurse would recheck the blood glucose level of a diabetic client with these symptoms to avoid worsening hypoglycemia caused by administration of additional insulin.

11) Which information would the nurse provide to a client diagnosed with chlamydia and prescribed doxycycline? Select all that apply. One, some, or all responses may be correct. A. Report worsening symptoms. B. Refrain from sexual relations. C. Use barrier protection devices. D. Contact partners to be tested. E. Take the entire course of antibiotics.

A, B, C, D, E Rationale The nurse would instruct clients taking doxycycline for an STI to report worsening symptoms to the health care provider as it could indicate antibiotic resistance. Clients would also be instructed to refrain from sexual relations while the infection is being treated. If they do choose to have sexual relations, they would be instructed on the importance of using barrier protection. The nurse would also instruct clients to contact their sexual partners and inform them of the need to be tested and treated for the STI. Clients should take the entire prescribed course of antibiotics to prevent recurrence of the infection.

8) Which finding in a menopausal client's health history would prevent the health care provider from prescribing hormone replacement therapy? Select all that apply. One, some, or all responses may be correct. A. Smoking B. Cirrhosis C. Cholecystitis D. Breast cancer E. Deep vein thrombosis

A, B, C, D, E Rationale Use of estrogens can have major side effects, especially if the client smokes. The nurse would provide information to the client about smoking cessation. Clients with cirrhosis have a decreased ability to break down medications, especially estrogen. Cholecystitis can worsen in clients taking estrogen. Clients at risk for breast and endometrial cancer should not take estrogen because it can further increase the risk. Estrogens can lead to deep vein thrombosis.

1) Intravenous (IV) insulin is prescribed for a client in. Which insulin can be administered IV? Select all that apply. One, some, or all responses may be correct. A. Lispro insulin B. Aspart insulin C. Regular insulin D. Glargine insulin E. Glulisine insulin

A, B, C, E Rationale Four insulins are approved for IV administration: regular, aspart, lispro, and glulisine insulin can be administered intravenously. Glargine insulin is long-acting insulin; it is not approved for IV use.

8) During an assessment the client mentions taking cefotetan and drinking a few cocktails at dinner. Which symptoms might be explained by this medication-alcohol interaction? Select all that apply. One, some, or all responses may be correct. A. Pruritus B. Diaphoresis C. Hypotension D. Hypertension E. Stomach cramps F. Chest pain

A, B, C, E Rationale Individuals taking the antibiotic cefotetan need to avoid alcohol. Drinking alcohol while on this medication causes acute alcohol intolerance, resulting in pruritus, diaphoresis, hypotension, and stomach cramps. Hypertension and chest pain or pressure are not typical symptoms of acute alcohol intolerance and cannot be explained by this medication-alcohol interaction.

22) When the nurse is administering a course of aminoglycoside treatment to a client with Klebsiella infection, which adverse effects prompt the nurse to hold treatment and contact the health care provider? Select all that apply. One, some, or all responses may be correct. A. Vertigo B. Tinnitus C. Dizziness D. Heartburn E. Persistent headache

A, B, C, E Rationale The nurse monitors the client administered aminoglycosides for signs of ototoxicity, which include vertigo, tinnitus, dizziness, and persistent headache. Any sign of ototoxicity should result in holding the treatment and contacting the health care provider. Heartburn is not associated with ototoxicity.

10) Which statement indicates that a female client who is receiving rifampin for tuberculosis understands the teaching? Select all that apply. One, some, or all responses may be correct. A. "This medication may be hard on my liver, so I must avoid alcoholic drinks while taking it." B. "This medication may reduce the effectiveness of the oral contraceptive I am taking." C. "I cannot take an antacid within 2 hours before taking my medicine." D. "My health care provider must be called immediately if my eyes and skin become yellow."

A, B, D Rationale Alcohol may increase the risk of hepatotoxicity. Rifampin has teratogenic properties and may reduce the effectiveness of oral contraceptives. Yellowing of the eyes and skin are signs of hepatitis and should be reported immediately. An antacid may be taken 1 hour before taking the medication.

11) A client is taking an estrogen-progestin oral contraceptive. Which adverse effects from the contraceptive would the nurse teach the client to report to the primary health care provider? Select all that apply. One, some, or all responses may be correct. A. Dizziness B. Chest pain C. Bloating D. Nausea E. Calf tenderness F. Breast tenderness

A, B, E Rationale Early side effects of oral contraceptives include bloating, nausea, and breast tenderness. Although they may be bothersome enough to lead to discontinuation of the contraceptive, these side effects usually subside in several months. Dizziness is not a common side effect and should be reported to the provider. Contraceptives have been associated with thrombophlebitis; clinical manifestations of thrombophlebitis include calf tenderness and redness and heat over the affected area. If the clot travels, it could present as a pulmonary embolism, so chest pain should be reported as well.

5) Which medications would the nurse plan to use when administering chelation therapy to a toddler-age client to decrease the pain associated with intramuscular administration? Select all that apply. One, some, or all responses may be correct. A. LMX-4, analgesic cream B. Fentanyl C. Procaine/Lidocaine Intradermal Analgesic D. Ibuprofen E. Acetaminophen

A, C Rationale LMX-4 is a topical medication that can be applied to the skin to decrease the pain associated with chelation therapy. Procaine is a medication that can be mixed with chelation therapy to decrease the pain associated with chelation therapy. Fentanyl, ibuprofen, and acetaminophen are not medications used to decrease the pain associated with chelation therapy.

5) Which rationale will the nurse provide to a client with Crohn's disease who asks why the prescribed vitamins have to be given intravenously (IV) rather than by mouth? Select all that apply. One, some, or all responses may be correct. A. "They provide more rapid action results." B. "They decrease colon irritability." C. "Oral vitamins are less effective." D. "Intestinal absorption may be inadequate." E. "Allergic responses are less likely to occur."

A, C, D Rationale Absorption through the gastrointestinal (GI) tract is impaired, and parenteral administration goes directly into the intravascular compartment. Disease of the GI tract hampers absorption. Because the mucosa of the intestinal tract is damaged, its ability to absorb vitamins taken orally is greatly impaired. IV vitamins do not decrease colonic irritability. Route of administration does not affect allergic response.

2) A client has been prescribed alendronate for osteoporosis. Which statements indicate that the client understands how to safely take this medication? Select all that apply. A. "I will notify my doctor if I experience worsening heartburn." B. "I will take the pill with an antacid to prevent stomach upset." C. "I will swallow the pill with a full glass of water." D. "I will stand or sit quietly for 30 minutes after taking the pill." E. "I will always eat breakfast before taking the pill."

A, C, D Rationale Alendronate is a bisphosphonate used to treat osteoporosis. It can cause esophagitis or esophageal ulcers unless precautions are followed. The client must sit upright or stand for at least 30 minutes after taking the medication. The client should take the medication with a full glass of water, at least 30 minutes before eating or drinking anything or taking any other medication. Antacids will interfere with absorption and should not be taken at the same time.

2) Which manifestation would the nurse include when teaching a client about ketoacidosis? Select all that apply. One, some, or all responses may be correct. A. Confusion B. Hyperactivity C. Excessive thirst D. Fruity-scented breath E. Decreased urinary output

A, C, D Rationale Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. Diabetic ketoacidosis is a serious complication of diabetes that occurs when the body produces high levels of ketones (blood acids). Diabetic ketoacidosis develops when the body is unable to produce enough insulin. Without enough insulin, the body begins to break down fat as an alternative fuel. This process produces a buildup of ketones (toxic acids) in the bloodstream, eventually leading to diabetic ketoacidosis if untreated. Signs and symptoms include confusion, excessive thirst, fruity-scented breath, frequent urination, nausea and vomiting, abdominal pain, weakness or fatigue, and shortness of breath. Weakness or fatigue, not hyperactivity, is a symptom. Frequent urination, not decreased urination, is a symptom.

3) A client is taking thyroxine to manage hypothyroidism. Which developments indicate to the nurse that the dosage should be reduced? Select all that apply. One, some, or all responses may be correct. A. Diaphoresis B. Weight gain C. Tachycardia D. Nervousness E. Cold intolerance

A, C, D Rationale Diaphoresis, tachycardia, and nervousness are signs of hyperthyroidism, which indicate that too much medication is being taken. Weight gain and cold intolerance indicate that the medication has not yet been effective.

1) Several hours after administering insulin, the nurse assesses the client's response to the insulin. Which client responses are indicative of a hypoglycemic reaction? Select all that apply. One, some, or all responses may be correct. A. Tremors B. Anorexia C. Confusion D. Glycosuria E. Diaphoresis

A, C, E Rationale Confusion is typically the first sign of a hypoglycemic reaction. Tremors are a sympathetic nervous system response that occurs because circulating glucose in the brain decreases. Diaphoresis is a cholinergic response to hypoglycemia. Hypoglycemia causes hunger, not anorexia. Because blood glucose is low in hypoglycemia, the renal threshold is not exceeded and glycosuria does not occur.

2) Which clinical manifestation exhibited by a client taking levothyroxine for hypothyroidism for 3 months would cause a nurse to suspect that a decrease in dosage is needed? Select all that apply. One, some, or all responses may be correct. A. Tremors B. Bradycardia C. Somnolence D. Heat intolerance E. Decreased blood pressure

A, D Rationale Excessive levothyroxine produces adaptations similar to hyperthyroidism, including tremors, heat intolerance, tachycardia, hypertension, and insomnia. These adaptations are related to the increase in the metabolic rate associated with hyperthyroidism. Bradycardia is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Somnolence is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Hypotension is a sign of hypothyroidism and a need to increase the dose of levothyroxine.

4) The nurse concludes that a client has a hypoglycemic reaction to insulin. Which clinical findings support this conclusion? Select all that apply. One, some, or all responses may be correct. A. Irritability B. Glycosuria C. Dry, hot skin D. Heart palpitations E. Fruity odor of breath

A, D Rationale Irritability, a neuroglycopenic symptom, occurs when the glucose in the brain declines to a low level. Heart palpitations, a neurogenic symptom, occur when the sympathetic nervous system responds to a rapid decline in blood glucose. Because the blood glucose level is decreased, the renal threshold is not exceeded, and there is no glycosuria. Dry, hot skin is consistent with dehydration, which often is associated with hyperglycemic states. Fruity odor of the breath is associated with hyperglycemia; it is caused by the breakdown of fats as a result of inadequate insulin supply.

5) Which instruction should the nurse give to a female client who just received a prescription for oral metronidazole (Flagyl) for treatment of trichomonas vaginalis? (Select all that apply.) A. Increase fluid intake, especially cranberry juice. B. Do not abruptly discontinue the medication; taper use. C. Check blood pressure daily to detect hypertension. D. Avoid drinking alcohol while taking this medication. E. Use condoms until treatment is completed. F. Ensure that all sexual partners are treated at the same time.

A, D, E, F Rationale Increased fluid intake and cranberry juice are recommended for prevention and treatment of urinary tract infections, which frequently accompany vaginal infections. It is not necessary to taper use of this drug or to check the blood pressure daily, as this condition is not related to hypertension. Flagyl can cause a disulfiram-like reaction if taken in conjunction with ingestion of alcohol, so the client should be instructed to avoid alcohol. All sexual partners should be treated at the same time and condoms should be used until after treatment is completed to avoid reinfection.

7) A client is concerned about taking hormones for birth control. Which contraceptives, explained to the client by the nurse, have a hormonal component? Select all that apply. One, some, or all responses may be correct. A. Oral contraceptives B. Diaphragm C. Cervical cap D. Female condom E. Foam spermicide F. Transdermal agents

A, F Rationale Oral contraceptives have a hormonal component. Transdermal agents have a hormonal component. The diaphragm, cervical cap, and female condom act as barriers. Foam spermicides kill the sperm; there is no hormonal effect.

Vitamins: Fat Soluble Class Vitamin THINK

A,D,E,K

10) The nurse is providing instructions to a client with a new prescription for levothyroxine 50 mcg daily to treat hypothyroidism. Which of the following is important for the nurse to include in the discharge instructions? A. It can be taken with an antacid if stomach upset occurs. B. It should be taken in the morning. C. It must be stored in a dark container. D. It may decrease the client's energy level.

B Rationale A thyroid supplement should be taken in the morning on an empty stomach with 8 ounces of water to maximize effects. Also, the client should avoid foods high in fiber, iron or soybeans within four hours of taking this medication because they may interfere with this drug's absorption. The medication should not be given in the evening or prior to bedtime because it may cause insomnia. It is not necessary to keep in a dark container. As the medication replaces thyroid hormone the client's energy level should be improved not decreased.

9) The nurse is reinforcing teaching about levothyroxine for a client newly-diagnosed with hypothyroidism. Which information should the nurse make sure to reinforce about this medication? A. The medication must be stored in a dark container. B. The medication should be taken in the morning. C. The medication will decrease the client's heart rate. D. The medication may decrease the client's energy level.

B Rationale A thyroid supplement, such as levothyroxine, should be taken on an empty stomach in the morning. Morning dosing minimizes the side effect of insomnia and an empty stomach facilitates absorption. The medication does not need to be stored in a dark container. Levothyroxine will cause an increase in the client's energy level and heart rate.

18) While taking a medical history, the client states, "I am allergic to penicillin." What related allergy to another type of antiinfective agent should the nurse ask the client about when taking the nursing history? A. Aminoglycosides. B. Cephalosporins. C. Sulfonamides. D. Tetracyclines.

B Rationale According to research, there appears to be a cross sensitivity between penicillins and first generation cephalosporins; however, research shows there is no evidence of cross sensitivity between PCN and third or fourth generation cephalosporins.

2) Which nursing action is the priority when administering chelation therapy for a toddler? A. Assessing vital signs B. Monitoring urine output C. Conducting a behavioral assessment D. Providing education to reduce lead exposure

B Rationale Adequate urinary output must be ensured with administration of calcium EDTA, the medication used for chelation therapy. Children receiving the medication intramuscularly must be able to maintain adequate oral intake of fluids. Monitoring vital signs, conducting a behavioral assessment, and providing education to reduce lead exposure are not priority nursing actions when administering chelation therapy.

6) The nurse is teaching the client with bacterial vaginosis who has been prescribed metronidazole tablets. What statement is appropriate? A. You may continue to experience symptoms after you stop the medication B. You should avoid drinking alcohol while taking this medication C. Call your healthcare provider if you experience diarrhea D. Your sexual partner will need to be treated as well

B Rationale Alcohol should be avoided while on metronidazole to reduce the risk of a disulfiram reaction. Routine treatment of male sexual partners is not needed and does not affect re-infection rates. If the client experiences continued symptoms, this may indicate treatment failure and the need for follow-up may be required. Diarrhea is a common side effect of metronidazole and should subside once treatment ends.

4) The nurse is caring for a client with osteoporosis who has been prescribed alendronate. When providing care, which intervention would be a priority? A. Administer the alendronate 30 to 60 minutes before the client eats. B. Notify the health care provider if the client reports jaw pain. C. Encourage the client to increase their intake of vitamin D. D. Monitor the client's serum calcium levels.

B Rationale Alendronate is a bisphosphonate that helps slow down bone resorption, decreasing osteoporosis. Osteonecrosis of the jaw is a rare, adverse reaction to alendronate, and jaw pain can be a symptom of this. Therefore, notifying the health care provider of the jaw pain is the priority. The other interventions are also correct for a client with osteoporosis, but are not as important as reporting the potential adverse drug effect.

7) Which education would the nurse provide the parents of an infant receiving the first diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) at 2 months of age? A. Give the baby aspirin if there is pain. B. Call the clinic if marked drowsiness occurs. C. Apply ice to the injection site if there is swelling. D. Provide heat at the injection site if redness occurs.

B Rationale Altered level of consciousness (such as marked drowiness) and seizures are rare but serious complications of the pertussis vaccine. Aspirin should not be given to infants and children because it is associated with Reye syndrome. Infants are sensitive to the application of ice. Heat will cause an extension of the inflammatory response and should be avoided.

27) Which condition would the nurse monitor for in the client on aminoglycoside therapy (the "-mycin, micins") and skeletal muscle relaxants? A. Stroke B. Respiratory arrest C. Myocardial infarction D. Abdominal discomfort

B Rationale Aminoglycosides can intensify the effect of skeletal muscle relaxants, placing the client at risk for respiratory arrest. Aminoglycoside therapy with muscle relaxants does not increase the risk of stroke, myocardial infarction, or abdominal discomfort.

6) Which adverse response to isoniazid (INH) in a client with tuberculosis would cause the nurse to determine that prompt intervention is needed? A. Orange feces B. Yellow sclera C. Temperature of 96.8°F (36°C) D. Weight gain of 5 pounds (2.3 kilograms)

B Rationale An adverse reaction to isoniazid (INH) is hepatitis, resulting in jaundice. Rifampin, an antitubercular medication, can color excretions orange, which is not harmful. A temperature of 96.8°F (36°C) is within expected limits. Weight gain indicates improvement in the client's health status.

4) The nurse is evaluating the results of treatment with erythropoietin. Which assessment finding indicates an improvement in the underlying condition being treated? A. 2+ pedal pulses B. Decreased pallor C. Decreased jaundice D. 2+ deep tendon reflexes

B Rationale Erythropoietin stimulates red blood cell production, thereby decreasing the pallor that accompanies anemia. It would not have a role in alleviating jaundice. It would not have an appreciable effect on pulses or deep tendon reflexes.

2) A client comes in for a pregnancy test. She tells the nurse that pregnancy may have occurred because she missed her contraceptive pills for 1 week when she had the flu. Which response by the nurse is appropriate? A. 'That's the trouble with using contraceptive pills. People frequently forget to take them.' B. 'You may be correct. The effect of contraceptive pills depends on them being taken on a regular schedule.' C. 'Let's find out whether you really are pregnant. If you are, you may want to consider having an abortion.' D. 'Contraceptive pills are unpredictable. You could have become pregnant even if you had taken them regularly.'

B Rationale An oral contraceptive program requires the client to take one tablet daily from the fifth day of the cycle and continue taking tablets for 20 or 21 days. Interrupting the monthly dosage program may permit release of luteinizing hormone, resulting in ovulation and possibly pregnancy. Stating that people often forget to take oral contraceptive pills is judgmental; contraceptive practice is the client's choice. It is premature to discuss abortion. Oral contraceptives that are taken on an exact schedule have a very high rate of success.

1) Which therapeutic effect would the nurse expect to identify when mannitol is administered to a client? A. Improved renal blood flow B. Decreased intracranial pressure C. Maintenance of circulatory volume D. Prevention of the development of thrombi

B Rationale As an osmotic diuretic, mannitol helps reduce cerebral edema. Although there may be a transient increase in blood volume as a result of an increased osmotic pressure, which increases renal perfusion, this is not the therapeutic effect. Prevention of the development of thrombi is not the reason for giving this medication.

2) A client diagnosed with multiple sclerosis is prescribed baclofen. Which assessment finding would indicate to the nurse that the client is experiencing a therapeutic response from the medication? A. Decreased Nausea B. Decreased muscle spasms C. Increased muscle tone and strength D. Increased range of motion to all extremities.

B Rationale Baclofen is a skeletal muscle relaxant and acts at the spinal cord level to decrease the frequency and amplitude of muscle spasms in clients with spinal cord injuries or diseases, or multiple sclerosis. None of the other options are related to the effects of this medications.

20) When would the nurse have the laboratory obtain a blood sample to determine the peak level of an antibiotic administered by intravenous piggyback (IVPB)? A. Halfway between two doses of the medication B. Between 30 and 60 minutes after a dose C. Immediately before the medication is administered D. Anytime it is convenient for the client and the laboratory

B Rationale Because the medication was administered by IV, the blood level of the medication will be at its highest shortly after administration. A medication blood level measured halfway between two doses will not obtain the peak level. Immediately before the medication is administered is done for a trough level, when the medication level is at its lowest. Anytime it is convenient for the client and the laboratory will produce inaccurate results; peak and trough levels are measured in relation to the time a medication is administered.

1) Which vitamin would the nurse anticipate may become deficient in a client prescribed cholestyramine (fat binding drug) for the treatment of type II hyperlipoproteinemia? A. Niacin (vitamin B 3) B. Calciferol (vitamin D) C. Ascorbic acid (vitamin C) D. Cyanocobalamin (vitamin B 12)

B Rationale Bile acid sequestrants (also known as bile acid-binding resins) bind with bile acids to form an insoluble compound that is then excreted in the feces. These medications decrease the absorption of fat-soluble vitamins (A, D, E, K). Vitamins B 3, C, and B 12 are water-soluble vitamins and are not affected by the administration of this medication.

3) A child with plumbism is prescribed edetate calcium disodium (calcium EDTA). Which assessment would be the most appropriate for the nurse to conduct before administering EDTA? A. Reviewing laboratory results for hypocalcemia B. Checking for protein in the urine C. Looking for signs of bone marrow depression D. Monitoring for increased intracranial pressure

B Rationale Both lead toxicity and calcium EDTA damage the proximal renal tubules, resulting in increased excretion of protein and other substances. Hypocalcemia is attributable to only some chelating agents; however, it is not likely to occur with calcium EDTA, which replaces calcium. Bone marrow damage is caused by lead toxicity, not calcium EDTA. Lead encephalopathy, not calcium EDTA, causes an increase of intracranial pressure.

1) A client who has a long history of medication and alcohol abuse mentions taking ginkgo biloba. Which condition is this client taking ginkgo biloba to treat? A. Insomnia B. Depression C. Memory impairment D. Anxiety and nervousness

C Rationale Ginkgo biloba is an herb used to treat age-related memory impairment and dementia. It has not been shown to be effective in treating insomnia, depression, or anxiety.

1) The nurse is reviewing discharge instructions with a client who has been prescribed ciprofloxacin following a minor burn injury. Which statement by the client requires additional teaching? A. "I will protect my skin from the sun with sunscreen and clothing." B. "I will not take ciprofloxacin prior to sun exposure." C. "After healing, I should have no scarring from this burn." D. "I can take ibuprofen for the pain related to this burn."

B Rationale Ciprofloxacin is an antibiotic that is associated with causing photosensitivity. Clients should be instructed to protect their skin from sun exposure while taking this medication. Appropriate methods to protect the skin are to limit sun exposure and to wear sunscreen and protective clothing. For a superficial-thickness burn, no scarring will occur and healing should take 3 to 6 days. The client may take a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, to alleviate the pain associated with the burn. It is inappropriate for the client to stop taking their antibiotic. However, if the client cannot avoid sun exposure, the nurse may contact the health care provider and request that the antibiotic be changed to one that does not cause photosensitivity.

10) A client diagnosed with tuberculosis is taking isoniazid. To prevent a food and medication interaction, the nurse will advise the client to avoid which food item? A. Hot dogs B. Red wine C. Sour cream D. Grapefruit juice

B Rationale Clients taking isoniazid should avoid foods containing tyramine such as red wine, tuna fish, and hard cheese. Hot dogs, sour cream, and grapefruit juice do not contain tyramine and are not contraindicated. Grapefruit juice slows metabolism of many medications, but isoniazid is not one of them.

2) A client has received a prescription for nitrofurantoin to treat a urinary tract infection. Which of the following statements made by the client indicates the need for additional teaching about the medication? A. "I will be sure to finish taking the antibiotics, even if I start feeling better." B. "I will spend extra time in the sun to get plenty of vitamin D." C. "I'll call my primary health care provider immediately if I develop a rash after taking the medication." D. "I will take the medication with food."

B Rationale Clients taking nitrofurantoin should avoid exposure to sunlight while taking the medication. Exposure to sunlight while taking this medication can lead to damage to the skin. A client planning to spend extra time in the sun while taking nitrofurantoin should be informed of the dangers of sun exposure and counseled to avoid sun exposure while taking the medication.

6) A registered nurse teaches a nursing student about caring for a client prescribed estradiol to treat low estrogen levels. Which statement by the student indicates to the nurse a need for additional learning? A. 'I should apply the emulsion once a day on the thighs.' B. 'I should avoid covering the medication with clothing after it is dried.' C. 'I should educate the client about the pharmacokinetic effects of estradiol.' D. 'I should advise the client to avoid applying sunscreen at the same time as the medication intake.'

B Rationale Covering the medication with clothing after it is dried helps prevent the transfer of the medication to other individuals. The nurse would instruct the client to apply the emulsion once a day on the thighs. The nurse would educate the client about the pharmacokinetic properties of the medication to ensure the medication's safe and effective administration. The nurse would advise the client to not apply sunscreen products at the same time because this action may reduce the absorption of estradiol.

10) The nurse teaches an adolescent about the side effects of azithromycin. The nurse determines the teaching has been understood when the adolescent identifies which problem as the most common side effect of this medication? A. Tinnitus B. Diarrhea C. Dizziness D. Headache

B Rationale Diarrhea initially is related to gastrointestinal irritation; later it is related to loss of intestinal flora, which may lead to overgrowth of drug-resistant microbes, resulting in superinfection. This also causes diarrhea. Tinnitus, dizziness (vertigo), and headache all may occur, but none is the most common side effect.

1) An infant is prescribed an antibiotic after cardiac surgery. Which instruction would the nurse emphasize to the parents regarding administration of the medication? A. Give the antibiotic between feedings. B. Ensure that the antibiotic is administered as prescribed. C. Shake the bottle thoroughly before giving the antibiotic. D. Keep the antibiotic in the refrigerator after the bottle has been opened.

B Rationale Ensuring that the antibiotic is administered as prescribed is a priority because inadequate antibiotic therapy may predispose the infant to the development of bacterial endocarditis. Giving the antibiotic between feedings, shaking the bottle, and storing the medication in the refrigerator are not priority instructions because instructions often vary depending on the antibiotic.

1) A health care provider prescribes bed rest, loperamide, and esomeprazole for a client who just had major surgery. After several days of this regimen, the client complains of diarrhea. Which treatment strategy would the nurse conclude is the cause of the diarrhea? A. Loperamide B. Esomeprazole C. Bed rest D. Diet alteration

B Rationale Esomeprazole, a proton-pump inhibitor, may cause diarrhea. Loperamide, an antidiarrheal, may cause constipation, not diarrhea. Immobility causes constipation, not diarrhea. Although diet can affect elimination, no data are presented to support this conclusion.

6) Which advice will the nurse give the client to avoid lipodystrophy when self-administering insulin therapy? A. Exercise regularly. B. Rotate injection sites. C. Use the Z-track technique. D. Vigorously massage the injection site.

B Rationale Fibrous scar tissue can result from the trauma of repeated injections at the same site. Exercise reduces blood glucose but is unrelated to lipodystrophy. Insulin is given subcutaneously; the Z-track technique is used with some intramuscular injections. Gentle pressure applied over the injection site after insulin administration promotes absorption; it should not be vigorously massaged.

2) Use of which medication would the nurse identify as a potential risk for hearing impairment in a child? A. Amoxicillin B. Gentamicin C. Penicillin D. Ciprofloxacin

B Rationale Gentamicin can be ototoxic because of its effects on the eighth cranial nerve. Reactions to amoxicillin are usually allergic in nature. Impaired hearing does not occur with ciprofloxacin or with penicillin.

3) The nurse is preparing to administer a prescribed dose of lactulose to a client who has cirrhosis. Which lab value will the nurse monitor to evaluate the therapeutic effect of the medication? A. Glucose B. Ammonia C. Potassium D. Bicarbonate

B Rationale Hepatic encephalopathy is a manifestation of liver disease that has neurotoxic effects of ammonia. Lactulose acidifies feces in the intestines, which traps ammonia that can be then eliminated with defecation.

1) A health care provider prescribes oral antacids and intravenous ranitidine for a client with burns and crushing injuries caused by an accident. The client asks how these medications work. Which explanation would the nurse provide? A. 'These medications work together to decrease bowel irritability.' B. 'They limit acidity in the gastrointestinal tract.' C. 'They are very effective in clients with multiple trauma.' D. 'These medications decrease nausea and vomiting.'

B Rationale Increased acidity caused by the stress occurring with burns and crushing injuries contributes to the formation of Curling ulcer; ranitidine, an H 2 antagonist, decreases the formation of gastric acid, and an antacid neutralizes gastric acid once it is formed. These medications do not decrease irritability of the bowel; their purpose is to decrease gastrointestinal acidity. The response, 'They are very effective in clients with multiple trauma,' does not answer the client's question. Their purpose is not that of an antiemetic.

1) At 9 am, the nurse administers 10 units of insulin aspart subcutaneously to a client with a blood sugar of 322 mg/dL. At approximately what time should the nurse expect the insulin to peak? A. At 9:30 am B. At 10:00 am C. At noon D. This insulin does not peak because it acts over 24 hours.

B Rationale Insulin aspart is an analog of human insulin with a rapid onset (10 to 20 minutes), peak of 30 to 60 minutes and short duration (3 to 5 hours); therefore, the nurse should expect the insulin to peak at 10 am. The drug is structurally identical to human insulin. Insulin aspart (100 units/ mL) is supplied in 10 mL vials and 3 mL pre-filled pens and cartridges. Dosing is almost always done by subcutaneous injection or subcutaneous infusion with an insulin pump. Because insulin aspart acts rapidly, it is often used for sliding scale coverage and injections should be given 5 to 15 minutes before meals.

4) During a teaching session about insulin injections, a client asks the nurse, 'Why can't I take the insulin in pills instead of taking shots?' How will the nurse respond? A. 'Insulin cannot be manufactured in pill form.' B. 'Insulin is destroyed by gastric juices, rendering it ineffective.' C. 'Your health care provider decides the route of administration.' D. 'Your health care provider will prescribe pills when you are ready.'

B Rationale Insulin in tablet form is inactivated by gastric juices; insulin given by injection avoids exposure to digestive enzymes. Insulin is not given orally at this time because it is inactivated by digestive enzymes. The response, 'Your health care provider will prescribe pills when you are ready,' is incorrect information and provides false reassurance; the client currently is insulin dependent. The response, 'Your health care provider decides the route of administration,' does not answer the client's question; insulin is administered intravenously or subcutaneously, and the route depends on the client's needs.

4) Which insulin would the nurse conclude has the fastest onset of action? A. NPH insulin B. Insulin lispro C. Regular insulin D. Insulin glargine

B Rationale Insulin lispro has an onset of 0.25 hours, a peak action of 0.5 to 1.0 hours, and a duration of 3 to 4 hours. Neutral protamine Hagedorn (NPH) or intermediate-acting insulin has an onset of 1.5 hours, a peak action of 4 to 12 hours, and a duration of 18 to 24 hours. Regular insulin has an onset of 0.5 hours, a peak action of 1 to 5 hours, and a duration of 6 to 10 hours. Insulin glargine has an onset of 1 to 1.5 hours, no peak action, and a duration of 20 to 24 hours.

5) A client with diabetes mellitus is scheduled to receive an intravenous (IV) administration of 25 units of insulin in 250 mL normal saline. Which type of insulin would the nurse recognize as compatible with IV solutions? A. NPH insulin B. Insulin lispro C. Insulin detemir D. Insulin glargine

B Rationale Insulin lispro is compatible with IV solutions; it is a rapid-acting insulin. Insulin glargine is not compatible with IV solutions; it is a long-acting insulin. NPH insulin is not compatible with IV solutions; it is an intermediate-acting insulin.

2) A client states, 'I keep my insulin in the refrigerator because that is where my parents kept it.' Which reason will the nurse include when explaining why insulin should be stored at room temperature? A. Its potency and effectiveness are maximized. B. Absorption is enhanced and local irritation is decreased. C. It is more convenient and drawing insulin into the syringe is facilitated. D. Adherence of insulin to the syringe and resistance upon injection are decreased.

B Rationale Insulin that is close to body temperature prevents vasoconstriction at the site and decreases irritation of tissues. Insulin can be stored at room temperature for up to 1 month but must be kept away from heat or sunlight. Inappropriate storage of insulin can decrease its stability and decrease, not increase, its therapeutic action. Although it may be more convenient to keep insulin in the refrigerator, this is not a valid rationale; temperature of the solution does not increase the viscosity of insulin. Neither adherence of insulin to the syringe nor decreased resistance upon injection occurs.

4) Which topic will the nurse include in the discharge teaching of a client who has had a total gastrectomy? A. Daily use of a stool softener B. Injections of vitamin B 12 for life C. Monthly injections of iron dextran D. Replacement of pancreatic enzymes

B Rationale Intrinsic factor is lost with removal of the stomach, and vitamin B 12 is needed to maintain the hemoglobin level and prevent pernicious anemia. Adequate diet, fluid intake, and exercise should prevent constipation. Iron-deficiency anemia is not expected. Secretion of pancreatic enzymes should not be affected because this surgery does not alter this function.

2) The nurse administers lactulose to a client with cirrhosis of the liver. Which laboratory test change leads the nurse to determine that the lactulose is effective? A. Decreased amylase B. Decreased ammonia C. Increased potassium D. Increased hemoglobin

B Rationale Lactulose destroys intestinal flora that break down protein and, in the process, give off ammonia. In clients with cirrhosis, ammonia is inadequately detoxified by the liver and can build to toxic levels. Amylase levels are associated with pancreatic problems. Increased potassium levels are associated with kidney failure. Hemoglobin is increased when the body needs more oxygen-carrying capacity, such as in smokers, or in high altitudes.

5) A nurse is providing care to a client diagnosed with a myocardial infarction. The client has a history of hypothyroidism and hypertension. Which prescribed medication will the nurse clarify before administering it to the client? A. Morphine B. Levothyroxine C. Aspirin D. Labetalol

B Rationale Levothyroxine is a synthetic thyroid hormone used in the treatment of hypothyroidism. Levothyroxine can induce cardiac stimulant effects and is contraindicated in clients with a recent myocardial infarction (MI). Morphine and aspirin are commonly administered after a cardiac event. Morphine relieves pain associated with cardiac ischemia and aspirin decreases platelet aggregation that leads to blood clotting. Labetalol is a beta-blocker used in the treatment of hypertension. There is no known contraindication for the use of labetalol after an MI.

5) Which assessment would the nurse perform specific to the safe administration of intravenous mannitol? A. Body weight daily B. Urine output hourly C. Vital signs every 2 hours D. Level of consciousness every 8 hours

B Rationale Mannitol, an osmotic diuretic, increases the intravascular volume that must be excreted by the kidneys. The client's urine output should be monitored hourly to determine the client's response to therapy. Although mannitol results in an increase in urinary excretion that is reflected in a decrease in body weight (1 L of fluid is equal to 2.2 pounds [1 kg]), a daily assessment of the client's weight is too infrequent to assess the client's response to therapy. Urine output can be monitored hourly and is a more frequent, accurate, and efficient assessment than is a daily weight. Vital signs should be monitored every hour considering the severity of the client's injury and the administration of mannitol. Although the level of consciousness should be monitored with a head injury, conducting assessments every 8 hours is too infrequent to monitor the client's response to therapy.

10) Which parent education would the nurse give about why the MMR vaccine is administered at 12 to 15 months of age? A. There is an increased risk of side effects in infants. B. Maternal antibodies provide immunity for about 1 year. C. It interferes with the effectiveness of vaccines given during infancy. D. There are rare instances of these infections occurring during the first year of life.

B Rationale Maternal antibodies to measles, mumps, and rubella infection persist in the infant until approximately 15 months of age. Side effects are no more common among infants than in toddlers. The measles vaccination does not interfere with the effectiveness of other vaccines. Although the measles, mumps, and rubella do occasionally occur after the administration of the MMR vaccine during the first year of life, the vaccine is not given during this time because of the presence of maternal antibodies.

1) Which medication for treatment of gastroesophageal reflux disease would be contraindicated in the pregnant client? A. Ranitidine B. Misoprostol C. Esomeprazole D. Calcium carbonate

B Rationale Misoprostol is contraindicated in pregnancy because it can cause uterine contractions, expelling the developing fetus. Ranitidine, esomeprazole, and calcium carbonate are not contraindicated during pregnancy.

4) A child with type 1 diabetes is receiving 15 units of regular insulin and 20 units of NPH insulin at 7:00 AM each day. Which time would the nurse anticipate a hypoglycemic reaction from the NPH insulin to occur? A. Before noon B. In the afternoon C. Within 30 minutes D. During the late evening

B Rationale NPH insulin is an intermediate-acting insulin that peaks approximately 4 to 12 hours after administration. It was administered at 7:00 AM, so between 1:00 PM and 3:00 PM is when the nurse would anticipate that a hypoglycemic reaction would occur. Noon is when a reaction from a short-acting insulin is expected. Short-acting insulin peaks 2 to 4 hours after administration. Within 30 minutes of administration is when a reaction from a rapid-acting insulin is expected. Rapid-acting insulin peaks 30 to 60 minutes after administration. During the evening or nighttime is when a reaction from a long-acting insulin is expected. Long-acting insulin has a small peak 10 to 16 hours after administration.

8) Which response by the nurse would be most appropriate to promote a sense of control in a 6-year-old child who is about to receive an injection? A. 'This won't hurt, so you shouldn't cry.' B. 'Which arm should I use to give you the medicine?' C. 'I know you're grown up. You won't cry, will you?' D. 'Close your eyes. You won't even know what's happening.'

B Rationale Offering a choice and involving the child in decision-making gives the child a sense of control over the situation. Assuring the child that the injection will not hurt is not truthful and conveys an unrealistic expectation. Stating that the child is grown up and won't cry indicates an expectation that the child might not be able to meet. Instructing the child not to look negates the child's needs.

3) Which supplement would the nurse instruct a client taking oral contraceptives to increase? A. Calcium B. Vitamin C C. Vitamin E D. Potassium

B Rationale Oral contraceptives can affect the metabolism of certain vitamins, particularly vitamin C, and supplementation may be required. It is unnecessary to increase the intake of calcium when one is taking oral contraceptives. There is no clinical evidence linking oral contraceptives with a deficiency of vitamin E. There is no interrelationship between oral contraceptives and dietary intake of potassium.

7) A child is prescribed intravenous mannitol. The nurse understands mannitol belongs to which classification of diuretics? A. Loop B. Osmotic C. Potassium sparing D. Carbonic anhydrase inhibitor

B Rationale Osmotic diuretics, such as mannitol, increase the osmotic pressure of glomerular filtrate and thus decrease absorption of sodium; they are used to treat cerebral edema and increased intraocular pressure. Loop diuretics, such as furosemide, inhibit resorption of sodium and potassium in the loop of Henle; they are used for heart failure and pulmonary edema. Potassium-sparing diuretics, such as spironolactone, interfere with sodium resorption in the distal tubules, thus decreasing potassium excretion; they are used to treat cirrhotic ascites and pulmonary edema. Carbonic anhydrase inhibitors, such as acetazolamide, increase sodium excretion by decreasing sodium-hydrogen ion exchange. They are used to treat seizure disorders and open-angle glaucoma.

3) A client is experiencing both tingling of the extremities and tetany. The nurse will review the client's laboratory report to check for which electrolyte abnormality? A. Hypokalemia B. Hypocalcemia C. Hyponatremia D. Hypochloremia

B Rationale Paresthesias (tingling of the extremities) and tetany are signs of hypocalcemia. These are not expected findings for hypokalemia, hyponatremia, or hypochloremia.

1) When a female client with a new infant is prescribed amoxicillin for a urinary tract infection, which instruction would the nurse include when teaching about the use of this medication? A. 'Take this medication on an empty stomach.' B. 'Report signs of allergic reaction such as skin rash or itching.' C. 'Stop taking the medication as soon as you void without burning.' D. 'Breast-feeding should stop until you have finished with this medication.'

B Rationale Penicillin class medications have a high incidence of allergic reaction, so the client should monitor for allergy and report symptoms of an allergic reaction. Amoxicillin may be taken with food. The entire course of treatment should be completed, not stopped when symptoms are absent. It is safe to breast-feed with amoxicillin.

1) Which information would the nurse provide to a client with type 1 diabetes who requests information about the differences between penlike insulin delivery devices and syringes? A. "The penlike devices have a shorter injection time." B. "Penlike devices provide a more accurate dose delivery." C. "The penlike delivery system uses a smaller-gauge needle." D. "Penlike devices cost less by having reusable insulin cartridges."

B Rationale Penlike insulin delivery devices are more accurate because they are easy to use; also, they promote adherence to insulin regimens because the medication can be administered discreetly. One disadvantage of the penlike insulin delivery device is that the injection time will be longer; the device must remain in place for several seconds after the insulin is injected to ensure that no insulin leaks out. The penlike insulin delivery device has a larger-gauge needle that has a smaller diameter. The insulin cartridges of a penlike insulin delivery device are single use and disposable.

1) A client is to receive metoclopramide intravenously 30 minutes before initiating chemotherapy for cancer of the colon. The nurse explains that metoclopramide is given for which purpose? A. To stimulate production of gastrointestinal (GI) secretions B. To stimulate peristalsis of the upper gastrointestinal (GI) tract C. To prolong excretion of the chemotherapeutic medication D. To increase absorption of the chemotherapeutic medication

B Rationale Prokinetic medications such as metoclopramide stimulate peristalsis in the GI tract. This enhances the emptying of stomach contents into the duodenum to decrease gastroesophageal reflux and vomiting, all of which are precipitated by chemotherapeutic agents. Metoclopramide does not stimulate the production of gastrointestinal secretions. Metoclopramide has no effect on the excretion of chemotherapeutic medications. Metoclopramide has no effect on the absorption of chemotherapeutic medications.

6) Which information would the nurse include when teaching a client about the administration of ranitidine? A. Ranitidine increases gastrointestinal peristalsis. B. Ranitidine reduces gastric acidity in the stomach. C. Ranitidine neutralizes the acid that is present in the stomach. D. Ranitidine stops the production of hydrochloric acid in the stomach.

B Rationale Ranitidine inhibits histamine at H 2-receptor sites in the stomach, resulting in reduced gastric acid secretion. Ranitidine does not increase gastrointestinal peristalsis, and it does not completely stop the production of hydrochloric acid in the stomach. Ranitidine reduces, rather than neutralizes, gastric acidity.

5) Daily regular insulin has been prescribed for a client with type 1 diabetes. The nurse administers the insulin at 8 AM. When will the nurse monitor the client for a potential hypoglycemic reaction? A. At breakfast B. Before lunch C. Before dinner D. In the early afternoon

B Rationale Regular insulin is short acting and peaks in 2 to 4 hours, which in this case will be at or before lunch. Breakfast is too soon; regular insulin peaks in 2 to 4 hours. Before dinner is too late; regular insulin peaks in 2 to 4 hours. The early afternoon is too late; regular insulin peaks in 2 to 4 hours.

2) A client with tuberculosis is started on rifampin. The nurse evaluates that the teaching about rifampin is effective when the client makes which statement? A. 'I need to drink a lot of fluid while I take this medication.' B. 'My sweat will turn orange from this medication.' C. 'I should have my hearing tested while I take this medication.' D. 'Most people who take this medication develop a rash.'

B Rationale Rifampin causes body fluids, such as sweat, tears, and urine, to turn orange. It is not necessary to drink large amounts of fluid with this medication; it is not nephrotoxic. Damage to the eighth cranial nerve is not a side effect of rifampin; it is a side effect of streptomycin sulfate, which is sometimes used to treat tuberculosis. A skin rash is not a side effect of rifampin.

8) Which class is contraindicated in clients who take rifampin? A. Loop diuretics B. Oral contraceptives C. Proton pump inhibitor D. Intermediate-acting insulin

B Rationale Rifampin increases metabolism of oral contraceptives, which may result in an unplanned pregnancy. Rifampin does not interact with a loop diuretic, a proton pump inhibitor, or intermediate-acting insulin.

9) Clients who take rifampin should not take medications from which class? A. Loop diuretics B. Oral contraceptives C. Proton pump inhibitor D. Intermediate-acting insulin

B Rationale Rifampin increases metabolism of oral contraceptives, which may result in an unplanned pregnancy. Rifampin does not interact with a loop diuretic, a proton pump inhibitor, or intermediate-acting insulin.

3) Which B vitamin deficiency will result in Wernicke encephalopathy? A. B 3 (niacin) B. B 1 (thiamine) C. B 2 (riboflavin) D. B 6 (pyridoxine)

B Rationale Severe deficiency of thiamine will result in Wernicke encephalopathy. Niacin deficiency causes pellagra. Riboflavin deficiency can result in cutaneous, oral, and corneal changes. Pyridoxine deficiency can progress to sideroblastic anemia, neurological disturbances, and xanthurenic aciduria, among other problems.

1) Which information would be included in the teaching plan for the older adult client with peptic ulcer disease who is taking an antacid and sucralfate? A. Antacids should be taken 30 minutes before a meal. B. Sucralfate should be taken on an empty stomach 1 hour before meals. C. Sucralfate is prescribed for the long-term maintenance of peptic ulcer disease. D. Sodium bicarbonate is an inexpensive over-the-counter antacid with few adverse effects.

B Rationale Sucralfate works best in a low pH environment; therefore it should be given on an empty stomach either 1 hour before or 2 hours after meals. Sucralfate also should be administered no sooner than 30 minutes before or after an antacid. The acid-neutralizing effects of antacids last approximately 30 minutes when taken on an empty stomach and 3 to 4 hours when taken after meals. When sucralfate and an antacid are both prescribed, they are each most effective when the sucralfate is scheduled an hour before meals and the antacid is scheduled after meals. Sucralfate is prescribed for the short-term treatment of peptic ulcers. Its use is limited to 4 to 8 weeks. The client should follow the recommendations of the primary health care provider with regard to antacid selection. Sodium bicarbonate can produce acid-base imbalances, which could be harmful, especially in older adult clients.

6) The health care provider has prescribed tetracycline for a 28-year-old female client with severe acne. When teaching the client about this medication, which information is important for the nurse to include? A. It may cause staining of the teeth. B. It may decrease the effectiveness of oral contraceptives. C. It should be taken with food or milk. D. It may cause hearing loss.

B Rationale Tetracycline, a broad-spectrum antibiotic, can decrease the effectiveness of oral contraceptives; therefore, it is important to recommend use of an additional form of contraception such as a condom when taking this medication. Tetracycline should be taken on an empty stomach and never with milk. It is not given to children younger than 8 years old because it can stain developing teeth. Tetracycline is not known to cause hearing loss.

3) Which response would a nurse give to a client diagnosed with type 1 diabetes who states "I hate shots. Why can't I take the insulin in tablet form?"? A. "Your diabetic condition is too serious for oral insulin." B. "Insulin is poorly absorbed orally, so it is not available in a tablet." C. "Insulin by mouth causes a high incidence of allergic and adverse reactions." D. "Once your diabetes is controlled, your primary health care provider might consider oral insulin."

B Rationale The chemical structure of insulin is altered by gastric secretions, rendering it ineffective. There is no such thing as oral insulin; this comment about the seriousness of the diabetic condition may increase anxiety. There are no data to support the statement regarding allergic or adverse reactions, and insulin is given parenterally, not orally. Insulin is not absorbed but is destroyed by gastric secretions; there is no insulin that is effective if taken by mouth.

2) Which mineral deficiency would a nurse suspect in a client who reports tingling in the fingers and around the mouth and exhibits carpopedal spasm and tremors after a surgical thyroidectomy ? A. Potassium B. Calcium C. Magnesium D. Sodium

B Rationale The client is exhibiting signs and symptoms of hypocalcemia, which occurs with accidental removal of the parathyroid glands; calcium gluconate is administered to treat hypocalcemia. Deficits in potassium, magnesium, and sodium do not cause these classic manifestations.

13) Which statement by a client prescribed ampicillin indicates that teaching by the nurse was effective? A. "I will miss eating grapefruit." B. "I must increase my fluid intake." C. "I can stop taking this medication any time." D. "I should take this medication just after eating."

B Rationale The client should increase fluid intake when taking ampicillin to prevent nephrotoxicity; side effects include oliguria, hematuria, proteinuria, and glomerulonephritis. There are no restrictions on eating grapefruit when taking an antibiotic; this is contraindicated when taking some calcium channel blockers because grapefruit juice increases their serum level. An antibiotic should be continued until the entire prescription is completed; discontinuing before completion lowers its serum level, thereby decreasing its effectiveness. Ampicillin should be taken when the stomach is empty, either 1 to 2 hours before eating or 3 to 4 hours after eating.

11) The nurse administers a tube of glucose gel to a client who is hypoglycemic. Which explanation would the nurse share regarding the reversal of hypoglycemia? A. It liberates glucose from hepatic stores of glycogen. B. It provides a glucose source that is rapidly absorbed. C. Insulin action is blocked as it competes for tissue sites. D. Glycogen is supplied to the brain as well as other vital organs.

B Rationale The glucose gel provides a simple sugar for rapid use by the body. Liberating glucose from hepatic stores of glycogen is related to the action of glucagon. It is a medication that mobilizes glycogen storage in the liver, leading to an increased blood glucose level. Glucose does not compete with insulin. Glucose gel does not supply glycogen to the brain and other vital organs.

6) The nurse is caring for a client with diabetes mellitus. The client reports feeling hungry and thirsty. The client's most recent blood glucose level was 175 mg/dL. Which type of insulin should the nurse anticipate being prescribed for this client? A. Glucagon B. Lispro C. Exenatide D. Sitagliptin

B Rationale The inpatient client with an elevated blood sugar is usually prescribed a short-acting insulin such as lispro, aspart or regular (Humulin-R) insulin. Glucagon is a medication used to treat hypoglycemia, not hyperglycemia. Exenatide and sitagliptin are not insulins.

5) In evaluating the effects of lactulose (Cephulac), which outcome would indicate that the drug is performing as intended? A. An increase in urine output. B. Two or three soft stools per day. C. Watery, diarrhea stools. D. Increased serum bilirubin.

B Rationale The medication lactulose can be administered for either chronic constipation or for portal-systemic encephalopathy in clients with hepatic disease. Two to three stools a day indicate that lactulose is performing as intended for chronic constipation. This would also indicate it should be effective for the clients with encephalopathy because the lactulose's action prevents absorption of ammonia in the colon as it increases water absorption and softens the stool. The efficacy of the use for ammonia absorption would have to be verified by a serum ammonia level and observation of clearing of the client's mental status.

11) Which issue related to antibiotic use is an increased risk for the older adult? A. Allergy B. Toxicity C. Resistance D. Superinfection

B Rationale The older adult is at increased risk for toxicity related to antibiotic use because of reduced metabolism and excretion of medications. Allergy, resistance, and superinfection are a risk for all antibiotic recipients but not an increased risk in the older adult population.

3) At the client's request, the nurse performs a fingerstick to test the client's blood glucose and the results are 322 mg/dL (17.9 mmol/L). Following the insulin sliding scale orders, the nurse administers 3 units of insulin lispro at 11:00 AM. When does the nurse anticipate the insulin lispro will begin to act? A. 3:00 pm B. 11:15 am C. 1:00 pm D. 12:00 PM

B Rationale The onset of action for insulin lispro, which is a rapid acting insulin, is 10 to 15 minutes after administration. It was administered at 11:00 AM, so it will begin to act at 11:15 AM.

1) Which time for medication scheduling would a nurse teach to a client prescribed the oral pancreatic enzymes pancrelipase? A. At bedtime B. With meals C. One hour before meals D. On arising each morning

B Rationale The pancreatic enzymes (amylase, trypsin, and lipase) must be present when food is ingested for digestion to take place. At bedtime the food eaten for dinner has passed beyond the duodenum, so at bedtime the enzyme is given too late to aid digestion. Taking pancrelipase 1 hour before meals or on arising each morning will have no chyme in the duodenum on which the enzyme can act.

6) The nurse evaluates that teaching for the oral pancreatic enzymes pancrelipase is understood when the client identifies which time for medication scheduling? A. At bedtime B. With meals C. One hour before meals D. On arising each morning

B Rationale The pancreatic enzymes (amylase, trypsin, and lipase) must be present when food is ingested for digestion to take place. At bedtime the food eaten for dinner has passed beyond the duodenum, so at bedtime the enzyme is given too late to aid digestion. Taking pancrelipase 1 hour before meals or on arising each morning will have no chyme in the duodenum on which the enzyme can act.

8) Which purpose is served by an evening snack of milk, crackers, and cheese for a client who is receiving NPH insulin? A. Encouragement to stay on the diet B. Food to counteract late insulin activity C. Added calories to promote weight gain D. High carbohydrates to provide nourishment for immediate use

B Rationale The protein in milk and cheese is converted slowly to glucose (gluconeogenesis), providing the body with some glucose during sleep while the insulin is still acting. The purpose of an evening snack is to cover for insulin activity during sleep, not to encourage the client to stay on the diet. There are no data that indicate a need to gain weight. The foods chosen are rich in protein and are used slowly.

2) The nurse teaches an adolescent about administration of intermediate-acting insulin and regular insulin. Which response indicates the adolescent understands when to administer the second dose of NPH insulin? A. At lunch B. At dinnertime C. 1 hour after lunch D. 1 hour after dinner

B Rationale The second dose of the intermediate-acting insulin should be given at dinnertime. NPH insulin peaks in 4 to 12 hours. A second dose is often prescribed approximately 10 to 12 hours after the first dose. A blood glucose reading at bedtime will determine the evening dose of regular insulin. A dose given at lunch is too early because it may precipitate a hypoglycemic reaction. A dose given 1 hour after lunch is also too early because it may precipitate a hypoglycemic reaction. A dose given 1 hour after dinner is too late.

25) The clinic nurse is planning care for a client with chlamydia. Which treatment would the nurse anticipate implementing? A. Administration of 250 mg of acyclovir orally in a single dose B. Administration of 1 g of azithromycin orally in a single dose C. Administration of 250 mg of ceftriaxone intramuscularly in a single dose D. Administration of 2.4 million units of benzathine penicillin G intramuscularly in a single dose

B Rationale The treatment of choice for chlamydial infection is 1 g of azithromycin orally in a single dose. The one-dose course is preferred because of its ease of completion. Acyclovir may be prescribed in a 7-day course for a genital herpes outbreak. Administering 250 mg of ceftriaxone intramuscularly in a single dose is the medication therapy recommended for gonorrhea. Benzathine penicillin G given intramuscularly as a single 2.4 million-unit dose is the treatment for primary, secondary, and early latent syphilis.

7) Which response by the nurse is appropriate when a client asks what to expect when beginning treatment for tuberculosis? A. 'Therapy will last a few weeks.' B. 'Therapy will occur over two phases.' C. 'Therapy will involve one medication.' D. 'Therapy will require monitoring kidney function.'

B Rationale Therapy for tuberculosis occurs over two phases. The target of the induction phase is to achieve noninfectious sputum, and the target of the continuation phase is to eradicate the intracellular bacteria. Therapy for tuberculosis is prolonged, lasting 6 months to 2 years. Therapy for tuberculosis involves two to four medications. Therapy for tuberculosis requires monitoring liver, not kidney, function.

1) Trimethoprim/sulfamethoxazole is prescribed for a child with a urinary tract infection. Which statement by the parent indicates the nurse's instructions about administration have been understood? A. 'Mealtime is a good time to give the medication.' B. 'I'll make sure to give each pill with 6 to 8 oz of fluid.' C. 'It must be taken with orange juice to ensure acidity of urine.' D. 'The medication has to be taken every 4 hours to maintain a blood level.'

B Rationale This is a sulfa medication; water must be encouraged to prevent urine crystallization in the kidneys. This medication does not have to be given with meals; it is administered every 12 hours. Orange juice causes an alkaline urine; water is the best fluid to be administered with this medication. This medication maintains the blood level for 8 to 12 hours; it is an intermediate-acting medication.

4) A 43-year-old female client is prescribed thyroid replacement hormone following a thyroidectomy. Which adverse effects should the nurse instruct the client to report immediately to the healthcare provider? A. Tinnitus and dizziness. B. Tachycardia and chest pain. C. Dry skin and intolerance to cold. D. Weight gain and increased appetite.

B Rationale Thyroid replacement hormone increases the metabolic rate of all tissues. Common signs and symptoms of toxicity include tachycardia and chest pain and should be reported to the healthcare provider immediately.

6) A client with thyroid cancer is scheduled for a thyroidectomy. Which information will the nurse teach the client? A. The dietary intake of carbohydrates must be restricted. B. Thyroxine replacement therapy will be required indefinitely. C. Chemotherapy will be used in conjunction with the surgery. D. A tracheostomy is required for clients having this procedure.

B Rationale Thyroxine is given postoperatively to suppress thyroid-stimulating hormone (TSH) and prevent hypothyroidism. Increased intake of carbohydrates and proteins is needed because of the increased metabolic activity associated with hyperthyroidism. Chemotherapy is uncommon; radiation may be used to eradicate remaining tissue. A tracheostomy is not planned; it is needed only in an emergency related to respiratory distress.

6) A client with burns develops a wound infection. The nurse plans to teach the client that local wound infections are primarily treated with which antibiotic formulation? A. Oral B. Topical C. Intravenous D. Intramuscular

B Rationale Topical antibiotics are applied directly to the wound and are effective against many gram-positive and gram-negative organisms found on the skin. Although oral, intravenous, and intramuscular antibiotics may be administered, they are most effective for systemic rather than local infections; the vasculature in and around a burn is impaired, and the medication may not reach the organisms in the wound.

13) A hospitalized infant is receiving gentamicin. While monitoring for drug toxicity, the nurse should focus on which laboratory result? A. Platelet counts B. Serum creatinine C. Thyroxin levels D. Growth hormone levels

B Rationale Toxicity to the aminoglycoside antibiotic gentamicin is seen in increased BUN and serum creatinine levels. Kidney damage may be reversible if the drug is stopped at the first sign of toxicity. In addition to nephrotoxicity, this medication has a Black Box warning for neurotoxicity and ototoxicity.

17) A peak and trough level is prescribed for a client receiving antibiotic therapy. When should the nurse should obtain the trough level? A. Sixty minutes after the antibiotic dose is administered. B. Immediately before the next antibiotic dose is given. C. Upon completion of the prescribed antibiotic regime. D. An hour before the next antibiotic dose is given.

B Rationale Trough levels are drawn when the blood level is at its lowest, which is typically just before the next dose is given.

11) Which action would the nurse take when a client arrives for an influenza vaccination and reports a low-grade fever with a cough? A. Administer aspirin with the vaccine. B. Check the temperature and current history. C. Hold the vaccine and notify the health care provider. D. Reschedule administration of the vaccine for the next month.

B Rationale Vaccines may be administered during a mild febrile illness and upper respiratory infection, so the nurse would assess further. Administering aspirin is a dependent function of the nurse and requires a health care provider's prescription. Although holding the vaccine and administering it after the fever and cough are resolved is appropriate, notifying the health care provider is not necessary. Vaccinations should not be delayed unless the illness is moderate to severe.

1) To evaluate the effectiveness of antiretroviral therapy for a client infected with human immunodeficiency virus (HIV), which laboratory test result will the nurse plan to review? A. Western blot test B. Viral load test C. Nucleic acid amplification test D. Rapid HIV antibody test

B Rationale Viral load refers to the amount of HIV circulating in the blood. The effectiveness of antiretroviral therapy (ART) is measured by the decrease in the amount of HIV virus, i.e., viral load, detectable in the blood. The goal is for the viral load to be so low that it is deemed undetectable. An undetectable viral load does not mean that the client is cured or can no longer transmit the disease. The other tests are used to detect HIV antibodies, which remain positive even with effective ART. A nucleic acid amplification test (NAAT) is commonly used to diagnose a gonorrhea infection.

2) The nurse in an ambulatory clinic is speaking with the parents of a 2-year-old child diagnosed with acute otitis media. Which information is most important for the nurse to include in the instructions to the parents? A. The child may be given acetaminophen or ibuprofen drops for pain. B. The child must complete the entire course of the prescribed antibiotic. C. The child should return to the clinic to evaluate effectiveness of the treatment. D. The child may be given a decongestant to relieve pressure on the tympanic membrane.

B Rationale: Acute otitis media (AOM) is an inflammation of the middle ear space with a rapid onset of the signs and symptoms of acute infection, namely, fever and otalgia (ear pain). It is one of the most prevalent early childhood illnesses. Treatment for AOM is one of the most common reasons for antibiotic use in the ambulatory setting. When antibiotics are necessary, it is most important to complete the entire course to prevent antibiotic resistance. The child should be seen after antibiotic therapy is complete to ensure that the infection has resolved. Supportive care of AOM includes treating the fever and pain. Decongestants or antihistamines are not recommended for children with ear infections.

4) A nurse is assessing a 9-year-old child after several days of treatment for a documented strep throat. Which statement is incorrect and suggests that further teaching is needed? A. "Sometimes I take my medicine with fruit juice." B. "Sometimes I take the pills in the morning and other times at night." C. "I am feeling much better than I did last week." D. "My mother makes me take my medicine right after school."

B Rationale: Strep throat is a bacterial infection that is treated with antibiotics. It is important to take antibiotics on a regular schedule and at approximately the same time each day. Depending on the medication, it is OK to take it with food or juice. The client should be feeling better after several days of antibiotics —however should be cautioned to complete the prescribed amount.

4) A client is prescribed trimethoprim/sulfamethoxazole for recurrent urinary tract infections. Which information should the nurse include during client teaching? A. "A harmless skin rash may appear." B. "Drink at least eight large glasses of water a day." C. "Be sure to take the medication with food." D. "Stop the medication when your symptoms disappear."

B Rationale: Trimethoprim/sulfamethoxazole (Bactrim) is a highly insoluble drug that can cause crystalluria and clients should drink plenty of fluids while taking this medication to lower the risk of developing kidney stones. Increased fluid intake is also recommended with a UTI to promote the "flushing out" of bacteria. The drug may be taken with or without food. Clients should take the medication for the prescribed length of time. Sulfonamide-containing products should be discontinued at the first appearance of skin rash. In rare instances, a skin rash may be followed by a more severe reaction, such as Stevens-Johnson syndrome or toxic epidermal necrolysis.

9) The nurse is preparing to administer trimethoprim and sulfamethoxazole (TMP-SMX) to a client. When assessing client allergies, the client reports that they are allergic to glipizide. What action by the nurse is most appropriate? A. Prepare to administer the medication B. Report the allergies to the healthcare provider C. Review the health record to see if the client is on glipizide D. Assess the client blood sugar

B Rationale: While administering a sulfonamide with a sulfonylurea may increase the risk of a hypoglycemic reaction, the real concern is the potential allergy to TMP-SMX. It may be safe to administer the medication, but the healthcare provider should be notified first.

5) A client who is taking an oral hypoglycemic daily for type 2 diabetes develops an infection with anorexia. Which advice will the nurse provide to the client? Select all that apply. One, some, or all responses may be correct. A. Avoid solid food. B. Continue to take the oral medication. C. Drink fluids throughout the day. D. Monitor capillary glucose levels. E. Do not take medication until tolerating food.

B, C, D Rationale Physiological stress increases gluconeogenesis, requiring continued pharmacological therapy despite an inability to eat; fluids prevent dehydration; monitoring of glucose levels permits early intervention if necessary. Skipping the oral hypoglycemic agent may precipitate hyperglycemia. Food intake will be attempted to prevent acidosis. Delaying an oral hypoglycemic agent may precipitate hyperglycemia.

15) The nurse would instruct a client to stop taking an oral contraceptive and notify the health care provider immediately for the presence of which clinical findings? Select all that apply. One, some, or all responses may be correct. One, some, or all responses may be correct. A. Nausea B. Headaches C. Weight loss D. Visual disturbances E. Increased menstrual flow

B, D Rationale Headaches, either sudden or persistent, may indicate hypertension or a cardiovascular event. Visual disorders, such as partial or complete loss of vision or double vision, may indicate neuro-ocular lesions, which are associated with the use of some oral contraceptives. Nausea is a side effect that is not life threatening; the dose may need to be adjusted or the product changed to an alternative. Weight gain, not loss, may occur because of fluid retention. Menorrhagia is less likely to occur.

14) Which immunizations would the nurse determine are safe for a child who is receiving prednisone? Select all that apply. One, some, or all responses may be correct. A. Rubeola B. Pertussis C. Varicella D. Inactivated poliovirus E. Tetanus immune globulin

B, D, E Rationale Inactivated vaccines are safe for a child receiving prednisone. The pertussis (whooping cough) vaccine is made from inactivated toxins. It is safe to give the child the inactivated poliovirus vaccine; it is not a live attenuated virus vaccine. Tetanus immune globulin is an antitoxin that provides transient passive immunity; tetanus toxoid is contraindicated. Live attenuated virus vaccines are contraindicated for a child on prednisone. Both the rubeola (measles) and the varicella (chickenpox) vaccines are made live attenuated viruses.

8) A child infected with human immunodeficiency virus (HIV) is admitted with Pneumocystis jiroveci pneumonia and receives trimethoprim/sulfamethoxazole. Which common side effects would the nurse anticipate? Select all that apply. One, some, or all responses may be correct. A. Jaundice B. Vomiting C. Headache D. Crystalluria E. Photosensitivity

B, D, E Rationale Nausea and vomiting may occur as a result of gastrointestinal irritation. Crystalluria may occur with this medication, especially in the presence of restricted fluid intake secondary to nausea and vomiting. Skin reactions such as photosensitivity are also common. Hepatic side effects such as jaundice may occur but are not common. Central nervous system side effects such as headache are rare adverse reactions.

Vitamins: Water Soluble THINK

B1, B2, B12

Baclofen THINK

Bac "SLOW" fen

1) A client with type 1 diabetes mellitus has a finger-stick glucose level of 258 mg/dL (14.3 mmol/L) at bedtime. A prescription for sliding-scale regular insulin exists. Which would the nurse do? A. Call the health care provider. B. Encourage intake of fluids. C. Administer the insulin as prescribed. D. Give the client 4 ounces of orange juice.

C Rationale A value of 258 mg/dL (14.3 mmol/L) is above the expected range of 70 to 100 mg/dL (3.6-5.6 mmol/L); the nurse would administer the regular insulin as prescribed. Calling the health care provider is unnecessary; a prescription for insulin exists and should be implemented. Encouraging the intake of fluids is insufficient to lower a glucose level this high. Giving the client orange juice is contraindicated, because this will increase the glucose level further; orange juice, a complex carbohydrate, and a protein should be given if the glucose level is too low.

2) The nurse teaches a teenage client about the administration of levofloxacin to treat a sinus infection. The nurse concludes the teaching is effective when the client makes which statement? A. 'I should take the medication at mealtime.' B. 'I should take the medication just before a meal.' C. 'I should take the medication 1 hour before a meal.' D. 'I should take the medication 30 minutes after a meal.'

C Rationale Absorption of the oral solution levofloxacin is enhanced when the stomach is empty, and it should be taken 1 hour before meals or 2 hours after meals. Tablets can be taken without regard for food. Food in the stomach will interfere with absorption. If the medication is taken just before a meal, food in the stomach shortly afterward will interfere with absorption. If the medication is taken 30 minutes after a meal, food remaining in the stomach will interfere with absorption.

3) A client is prescribed alendronate. Which instruction should the nurse emphasize when teaching about this medication? A. "Take the medication with a full glass of milk two hours after meals." B. "It is recommended that you take this medication with calcium and a glass of juice." C. "Be sure to take this medication on an empty stomach." D. "You may take this medication after any meal, at the same time every day."

C Rationale Alendronate (Fosamax) is used to treat and prevent osteoporosis. It should be taken first thing in the morning with 6 to 8 ounces of plain water at least 30 minutes before other medication or food. Food and fluids (other than water) greatly decrease the absorption of this medication. The client must also be instructed to remain in the upright position for 30 minutes following the dose to facilitate passage into the stomach and minimize irritation of the esophagus.

4) A thin 24-year-old woman who runs 10 miles each week asks the nurse for advice about preventing osteoporosis. Which vitamin would the nurse recommend? A. Vitamin E B. Vitamin B C. Vitamin D D. Vitamin C

C Rationale All women, except those who are pregnant or lactating, should ingest between 1000 and 1300 mg of calcium daily; if the client is unable to ingest enough calcium in food, supplements of calcium and vitamin D are recommended. Vitamin C helps maintain cartilage and connective tissue integrity but does not help prevent osteoporosis. Vitamins E and B do not help prevent osteoporosis.

3) A client asks the nurse if glipizide (Glucotrol) is an oral insulin. Which response should the nurse provide? A. "Yes, it is an oral insulin and has the same actions and properties as intermediate insulin." B. "Yes, it is an oral insulin and is distributed, metabolized, and excreted in the same manner as insulin." C. "No, it is not an oral insulin and can be used only when some beta cell function is present." D. "No, it is not an oral insulin, but it is effective for those who are resistant to injectable insulins."

C Rationale An effective oral form of insulin has not yet been developed because when insulin is taken orally, it is destroyed by digestive enzymes. Glipizide (Glucotrol) is an oral hypoglycemic agent that enhances pancreatic production of insulin.

8) The nurse is administering a histamine H 2 antagonist to a client who has extensive burns. Which complication will it prevent? A. Colitis B. Gastritis C. Stress ulcer D. Metabolic acidosis

C Rationale An ulcer of the upper gastrointestinal tract is related to excessive secretion of stress-related hormones, which increases hydrochloric acid production. Histamine H 2 antagonists decrease acid secretion. Colitis is not a complication of burns. Gastritis is not a complication of burns. Metabolic acidosis is not a complication of burns unless hypermetabolism or renal failure occurs; metabolic acidosis is not treated with H 2 antagonists.

7) Which action would the nurse take when administering tetracycline? A. Administer the medication with meals or a snack. B. Provide orange or other citrus fruit juice with the medication. C. Administer the medication at least an hour before ingestion of milk products. D. Offer antacids 30 minutes after administration if gastrointestinal side effects occur.

C Rationale Any product containing aluminum, magnesium, or calcium ions should not be taken in the hour before or after an oral dose of tetracyclines (with the exception of doxycycline) because it decreases absorption by as much as 25% to 50%. Food interferes with absorption; it should be given 1 hour before or 2 hours after meals. Citrus juice does not improve absorption. Antacids will interfere with absorption.

3) Which explanation would the nurse provide to a client with gastric ulcer disease who asks the nurse why the health care provider has prescribed metronidazole? A. To augment the immune response B. To potentiate the effect of antacids C. To treat Helicobacter pylori infection D. To reduce hydrochloric acid secretion

C Rationale Approximately two-thirds of clients with peptic ulcer disease are found to have Helicobacter pylori infecting the mucosa and interfering with its protective function. Antibiotics do not augment the immune response, potentiate the effect of antacids, or reduce hydrochloric acid secretion.

3) A nurse is monitoring a pt receiving baclofen (Lioresal) for side effects related to the medication. Which of the following would indicate that the pt is experiencing a side effect? A. Polyuria B. Diarrhea C. Drowsiness D. Muscular excitability

C Rationale Baclofen slows the CNS system thus causing drowsiness. The other answers are not side effects of baclofen

7) The nurse is planning to teach an adolescent about diabetes and self-administration of insulin. Which would the nurse complete first? A. Establish realistic goals. B. Assess the adolescent's intellectual ability. C. Determine what the adolescent knows about diabetes. D. Gather the equipment that will be needed for the demonstration.

C Rationale Before developing and instituting a teaching plan, the nurse must assess the adolescent's attitudes, experience, knowledge, and understanding of the health problem. Before realistic goals can be set there must be an assessment. The adolescent's intellectual ability is only one aspect of the information the nurse must collect and can be assessed as the nurse is determining what the adolescent knows about diabetes. Performing a demonstration is premature until readiness for learning has been established.

3) A 6-month-old infant is to receive scheduled immunizations. The parents ask why two influenza vaccines are given: Haemophilus influenzae type B (Hib) and pneumococcal conjugate vaccine (PCV). Which response by the nurse is appropriate? A. 'PCV prevents influenza.' B. 'Hib is given to prevent pneumonia.' C. 'Hib and PCV prevent different bacterial diseases.' D. 'They are given together to protect against viral and bacterial diseases.'

C Rationale Both vaccines protect against bacterial infections. The PCV protects against bacterial pneumonia. The Hib vaccine protects against bacterial infections caused by Haemophilus influenzae type B; these include otitis media, meningitis, epiglottitis, septic arthritis, and sepsis. The PCV conjugate vaccine protects against infections caused by the Streptococcus pneumoniae bacterium (pneumococcal pneumonia).

19) The nurse is preparing to administer ceftriaxone to a client. Which of the following findings from the client's medical record should cause the nurse to question this prescription? A. White blood cells in the urine B. History of hypertension C. Allergy to cephalexin D. Current tobacco smoker

C Rationale Ceftriaxone and cephalexin are both cephalosporins; therefore, an allergy to cephalexin should cause the nurse to question any prescription for a cephalosporin. Hypertension and tobacco use do not affect the ability to take ceftriaxone. Elevated white blood counts (WBCs) in the urine indicate a possible infection and may be why antibiotics were prescribed, but this finding should not cause the nurse to be concerned about the medication.

10) A nurse administers cimetidine to a 79-year-old male with a gastric ulcer. Which parameter may be affected by this drug and should be closely monitored by the nurse? A. Blood pressure B. Liver enzymes C. Mental status D. Hemoglobin

C Rationale Cimetidine is an H2 receptor blocker used in treatment of gastric ulcers. Cimetidine should be used cautiously in the elderly, as it is known to cause a change in mental status such as confusion in the elderly population. Cimetidine does not impact the blood pressure, liver enzymes, or hemoglobin.

9) Which complication of diabetes would the nurse suspect when a health care provider prescribes one tube of glucose gel for a client with type 1 diabetes? A. Diabetic acidosis B. Hyperinsulin secretion C. Insulin-induced hypoglycemia D. Idiosyncratic reactions to insulin

C Rationale Glucose gel delivers a measured amount of simple sugars to provide glucose to the blood for rapid action. Acidosis occurs when there is an increased serum glucose level; therefore glucose gel is not indicated. Diabetes mellitus involves a decreased insulin production. Glucose gel is not indicated in idiosyncratic reactions to insulin.

2) Which is the priority short-term goal when teaching a client with type 1 diabetes who is placed on an insulin pump to control the diabetes? A. "The client will adhere to the medical regimen." B. "The client will remain normoglycemic for 3 weeks." C. "The client will demonstrate correct use of the insulin pump." D. "The client will list three self-care activities that are necessary to control the diabetes."

C Rationale Demonstrating the correct use of the administration equipment is a short-term, client-oriented goal that is necessary for the client to control the diabetes and is measurable when the client performs a return demonstration for the nurse. Adhering to the medical regimen is not a short-term goal. Remaining normoglycemic for 3 weeks is measurable, but it is a long-term goal. Although listing three self-care activities that are necessary to control the diabetes is measurable and a short-term goal, it is not the one with the greatest priority when a client has an insulin pump that must be mastered before discharge.

5) Which information would the nurse include in the teaching plan on ampicillin? A. 'Take the ampicillin with meals.' B. 'Store the ampicillin in a light-resistant container.' C. 'Notify the health care provider if diarrhea develops.' D. 'Continue the medication until a negative culture is obtained.'

C Rationale Diarrhea is a possible side effect that can be related to superinfection or to the destruction of bacterial flora in the intestine; it can lead to fluid and electrolyte imbalance. Ampicillin is absorbed best when taken with water on an empty stomach. Although storage in an airtight container is necessary, protection from light is not. A culture generally is not repeated unless the client's condition indicates that the medication was ineffective.

1) A nurse is providing instructions to a client receiving baclofen. Which of the following would be included in the teaching plan? A. Limit Fluid Intake B. Hold the medication if diarrhea occurs. C. Restrict alcohol intake. D. Notify the Physician if weakness occurs.

C Rationale Due to the depressive effects on the CNS, alcohol should be limited.

7) A client with diabetes asks how exercise will affect insulin and dietary needs. Which effects of exercise would the nurse share? A. Increases the amount of insulin needed and increases the need for carbohydrates B. Increases the amount of insulin needed and decreases the need for carbohydrates C. Decreases the amount of insulin needed and increases the need for carbohydrates D. Decreases the amount of insulin needed and decreases the need for carbohydrates

C Rationale Exercise increases the uptake of glucose by active muscle cells; carbohydrates are needed to supply energy for the increased metabolic rate associated with exercise. The need for insulin is decreased.

26) An older adult client is to receive intravenous (IV) gentamicin for urosepsis. Before administering the medication, for which finding should the nurse notify the health care provider (HCP)? A. The client has a history of acid reflux disease. B. The client has a history of retinopathy. C. The client has a history of chronic kidney disease. D. The client has a history of urinary retention.

C Rationale Gentamicin is an aminoglycoside antibiotic. Aminoglycosides are used to treat severe infections, such as septicemia, and are only given for a short period of time due to their toxic effects. They are not metabolized by the liver. Instead they are excreted by glomerular filtration. Aminoglycosides are nephrotoxic and requires close monitoring of renal function. A client with chronic kidney disease should not receive this medication. The other conditions do not represent a contraindication to gentamicin.

4) The nurse is providing medication teaching for a client prescribed famotidine for the treatment of gastroesophageal reflux disease (GERD). Which statement by the client indicates an understanding of the teaching? A. I will take this medication once a day in the morning B. I will no longer have discomfort at night once I begin this medication C. This medication will both prevent and treat heartburn D. My treatment will be done in one week

C Rationale H2 receptor blockers (antagonists) are used to prevent and treat conditions caused by too much acid being produced in the stomach. These conditions include gastric ulcers, duodenal ulcers, and GERD. Famotidine may be prescribed to take twice a day, in the morning and evening, or just once daily in the evening. Duration of treatment varies but is at a minimum two weeks.

6) A client has an anaphylactic reaction after receiving intravenous penicillin. Which would the nurse conclude is the cause of this reaction? A. An acquired atopic sensitization occurred. B. There was passive immunity to the penicillin allergen. C. Antibodies to penicillin developed after a previous exposure. D. Genes encoded for allergies cause a reaction on an initial penicillin exposure.

C Rationale Hypersensitivity results from the production of antibodies in response to exposure to certain foreign substances (allergens). Earlier exposure is necessary for the development of these antibodies. Hay fever and asthma, not penicillin allergy, are atopic conditions. The reaction is an active, not passive, immune response. Antibodies developed when there was a previous, not first, exposure to penicillin.

10) Which medication is considered first-line therapy for an infant with congenital syphilis? A. Vidarabine B. Pyrimethamine C. Intravenous (IV) penicillin D. Trimethoprim-sulfamethoxazole

C Rationale IV penicillin destroys the cell wall of Treponema pallidum, the causative organism of syphilis. Vidarabine is an antiviral medication; it does not treat congenital syphilis in an infant. Pyrimethamine and trimethoprim-sulfamethoxazole are ineffective in the treatment of syphilis.

2) Which insulin will the nurse prepare for the emergency treatment of ketoacidosis? A. Glargine B. NPH insulin C. Insulin aspart D. Insulin detemir

C Rationale Insulin aspart is a rapid-acting insulin (within 10-15 minutes) and is used to meet a client's immediate insulin needs. Glargine is a long-acting insulin, which has an onset of 1.5 hours; for diabetic acidosis, the individual needs rapid-acting insulin. NPH insulin is an intermediate-acting insulin, which has an onset of 1 to 2 hours; for diabetic acidosis, the individual needs rapid-acting insulin. Insulin detemir is a long-acting insulin; for diabetic acidosis, the individual needs rapid-acting insulin.

3) A nurse is preparing to administer insulin to a client with diabetes mellitus type 1. The client has regular insulin and insulin glargine prescribed. How will the nurse prepare these medications? A. Draw up the glargine insulin before the regular insulin B. Mix the insulins in a larger syringe C. Use a separate syringe for each insulin D. Draw up the regular insulin before the glargine insulin

C Rationale Insulin glargine is a clear, long-acting insulin that should not be mixed with other insulins. Mixing insulin glargine with other medications can cause precipitate formation. The insulins should be drawn up in separate syringes. Short-acting insulins should be drawn up before long-acting insulins. However, insulin glargine should not be combined with any other medication. A larger syringe does not address incompatibility issues.

13) A client with advanced cancer of the bladder is scheduled for a cystectomy and ileal conduit. Which intervention would the nurse anticipate the health care provider will prescribe to prepare the client for surgery? A. Intravesical chemotherapy B. Instillation of a urinary antiseptic C. Administration of an antibiotic D. Placement of an indwelling catheter

C Rationale Intestinal antibiotics and a complete cleansing of the bowel with enemas until returns are clear are necessary to reduce the possibility of fecal contamination when the bowel is resected to construct the ileal conduit. Intravesical chemotherapy is unnecessary because the urinary bladder is removed with this surgery. Instillation of a urinary antiseptic is not necessary. There is no evidence of a urinary tract infection. The urinary bladder will be removed, so there is no need for an indwelling urinary catheter. No data indicate that the client is experiencing urinary retention before surgery.

2) Which explanation would the nurse provide to a client with tuberculosis who asks why vitamin B 6 (pyridoxine) is given with isoniazid? A. "It will improve your immunologic defenses." B. "The tuberculostatic effect of isoniazid is enhanced." C. "Isoniazid interferes with the synthesis of this vitamin." D. "Destruction of the tuberculosis organisms is accelerated."

C Rationale Isoniazid often leads to vitamin B 6 (pyridoxine) deficiency because it competes with the vitamin for the same enzyme; this deficiency most often is manifested by peripheral neuritis, which can be controlled by the regular administration of vitamin B 6. Vitamin B 6 does not improve immune status. Pyridoxine does not enhance the effects of isoniazid. Pyridoxine does not destroy organisms.

16) The nurse provides teaching about ampicillin. Which client statement indicates that additional teaching is needed? A. 'I should take this on an empty stomach with a full glass of water.' B. 'This medicine will work best if I space the time out evenly.' C. 'I can stop this medication after I am symptom-free for 48 hours.' D. 'If I get worse, I will notify my primary health care provider.'

C Rationale It is most important for the client to complete the full antibiotic prescription to prevent the development of antibiotic-resistant bacteria. Ampicillin should be taken on an empty stomach with a full glass of water. If the medication is spaced out evenly, the ability to maintain a steady therapeutic serum medication level is increased. Because the client has an infection, it is important to report worsening because this may indicate antibiotic failure requiring alternative treatment.

1) Which nursing intervention is a priority for a school-age child with lead poisoning undergoing chelation therapy? A. Scrupulous skin care B. Provision of a high-protein diet C. Careful monitoring of intake and output D. Daily blood sampling for liver function tests

C Rationale Kidney function must be adequate to excrete the lead; if it is not adequate, nephrotoxicity or kidney damage may result. Skin breakdown is not associated with chelation therapy. A high-protein diet is not necessary. Liver damage does not occur with chelation therapy.

1) Why would lactulose be prescribed for a client with a history of cirrhosis of the liver? A. The desire to drink alcohol is decreased. B. Diarrhea is controlled and prevented. C. Elevated ammonia levels are lowered. D. Abdominal distension secondary to ascites is decreased.

C Rationale Lactulose is an ammonia detoxicant. It decreases serum ammonia concentration by preventing reabsorption of ammonia. Lactulose has been used to lower blood ammonia content in clients with portal hypertension and hepatic encephalopathy secondary to chronic liver disease. Lactulose has no effect on the craving for alcohol or reduction of ascites or abdominal distension. Lactulose is also used as a hyperosmotic laxative; therefore it will not relieve diarrhea.

7) The nurse understands that the prescribed levothyroxine is effective when the client with hypothyroidism makes which statement? A. "I still feel lethargic and fatigued." B. "I have to change my sheets in the morning because I sweat a lot at night." C. "I have been having daily, formed bowel movements." D. "I was reprimanded at work after becoming angry with my boss."

C Rationale Levothyroxine sodium is utilized to treat hypothyroidism. The nurse must first understand signs and symptoms of hypothyroidism, such as fatigue, lethargy, constipation, hypotension, anorexia and weight gain. In doing so, the nurse can identify that reports of having regular bowel movements is indicative of the levothyroxine working as intended, as constipation is a common symptom of hypothyroidism. Additionally, the nurse must also recognize symptoms of hyperthyroidism, as some clients on levothyroxine sodium may be receiving too high a dose, resulting in excess thyroid hormone and symptoms of hyperthyroidism, such as diaphoresis, irritability, heart palpitations, weight loss and diarrhea. The nurse should recognize that a client who sweats through the night or who is irritable and angry at work may be displaying symptoms of hyperthyroidism.

6) A health care provider prescribes mannitol for a client with a head injury. Which mechanism of action is responsible for therapeutic effects of this medication? A. Decreasing the production of cerebrospinal fluid B. Limiting the metabolic requirements of the brain C. Drawing fluid from brain cells into the bloodstream D. Preventing uncontrolled electrical discharges in the brain

C Rationale Mannitol, an osmotic diuretic, pulls fluid from the brain to relieve cerebral edema. Mannitol's diuretic action does not decrease the production of cerebrospinal fluid. Mannitol does not affect brain metabolism; rest and lowered body temperature reduce brain metabolism. Preventing uncontrolled electrical discharges in the brain is the action of phenytoin sodium, not mannitol.

3) The health care provider prescribes metformin as monotherapy for the client with type 2 diabetes. The nurse will teach the client to monitor for which adverse effect? A. Weight gain B. Constipation C. Lactic acidosis D. Hypoglycemia

C Rationale Metformin carries a black box warning regarding the possibility of lactic acidosis; clients must know how to monitor for this condition. An advantage of metformin over some other antidiabetic medications is that it does not cause weight gain and may actually result in weight loss for some clients. Constipation is not a problem, but many clients will develop diarrhea initially. Metformin does not increase pancreatic production of insulin and, when used without other antidiabetic medications, will not cause hypoglycemia.

24) Neomycin is prescribed preoperatively for a client with colon cancer. The client asks why this is necessary. Which response would the nurse provide? A. 'It kills cancer cells that may be missed during surgery.' B. 'This medication is helpful in decreasing the inflammatory response associated with surgical procedures.' C. 'It kills intestinal bacteria to decrease the risk for infection.' D. 'This medication alters the body flora to prevent the occurrence of superinfections.'

C Rationale Neomycin is an aminoglycoside antibacterial medication that provides preoperative intestinal antisepsis. Neomycin is not a cancer chemotherapeutic medication; therefore, it does not kill cancer cells. It is not an anti-inflammatory medication; therefore it is not given for that purpose. Antibiotic alteration of body flora increases the risk for superinfections, rather than preventing them.

2) A client prescribed omeprazole for gastroesophageal reflux disease reports a new occurrence of significant diarrhea. Which response by the nurse is most appropriate? A. 'Stop taking your omeprazole.' B. 'This is a normal side effect of omeprazole.' C. 'We are going to collect a stool sample for testing.' D. 'Antidiarrheal medication can be used to decrease this.'

C Rationale Omeprazole has been linked to an increased risk of diarrhea because of Clostridium difficile, so the stool should be tested. The nurse would not instruct the client to stop any medications without consulting the prescribing health care provider. Significant diarrhea in the setting of omeprazole is not a normal finding and should be investigated for Clostridium difficile. Antidiarrheal medication should not be recommended until Clostridium difficile infection is investigated and ruled out.

6) The nurse adds 20 mEq of potassium chloride to the intravenous solution of a client with diabetic ketoacidosis. Which purpose would this medication serve? A. Treats hyperpnea B. Prevents flaccid paralysis C. Prevents hypokalemia D. Treats cardiac dysrhythmias

C Rationale Once treatment with insulin for diabetic ketoacidosis is begun, potassium ions reenter the cell, causing hypokalemia; therefore potassium, along with replacement fluids, is needed to prevent hypokalemia. Potassium will not correct hyperpnea. Flaccid paralysis does not occur in diabetic ketoacidosis. There is no mention of dysrhythmias in the scenario; they are not a universal finding in diabetic ketoacidosis (and are commonly absent) and hypokalemia does not always cause these to occur.

3) Pyridoxine (vitamin B 6) and isoniazid (INH) are prescribed as part of the medication protocol for a client with tuberculosis. Which response indicates that vitamin B 6 is effective? A. Weight gain B. Improvement of stomatitis C. Absence of paresthesias D. Absence of night sweats

C Rationale One of the most common side effects of INH is peripheral neuritis due to vitamin B 6 deficiency, and vitamin B 6 will counteract this problem. Weight gain is not a therapeutic effect of this vitamin. Vitamin B 6 does not affect stomatitis and does not prevent night sweats.

14) The nurse is counseling a 34-year-old client who has requested a prescription for oral contraceptives. Which condition would warrant additional discussion? A. Anemia B. Depression C. Hypertension D. Dysmenorrhea

C Rationale One of the side effects of oral contraceptives is hypertension; therefore they are contraindicated for any woman who already has hypertension, particularly at the client's age or older. Anemia is not a contraindication for women who want to take oral contraceptives because oral contraceptives may help this condition by decreasing bleeding. Depression is not a contraindication for women who want to take oral contraceptives. Oral contraceptives may be prescribed for women with menstrual difficulties such as dysmenorrhea.

4) The nurse is administering an osmotic diuretic to a client with a traumatic brain injury. Which finding best indicates that the medication was effective? A. 250 mL clear, yellow urine output over four hours B. Clear bilateral lung sounds to posterior auscultation C. Intracranial pressure reading of 14 mmHg D. Bilateral ovoid pupils that are slow to constrict

C Rationale Osmotic diuretics, such as mannitol, are used to reduce intracranial or intraocular pressure. Intracranial pressure (ICP) for a client with a head injury should be less than 20 mmHg and the osmotic diuretic may be administered to reduce a high ICP. The osmotic diuretic will reduce the amount of water normally reabsorbed by the renal tubules and loop of Henle, so urinary output is increased, which is an expected occurrence, but does not indicate effectiveness of the medication. Ovoid pupils may indicate the presence of cerebral hypertension. An osmotic diuretic is not intended to reduce pulmonary edema, thus clear lung sounds are not an indicator for effectiveness of the diuretic for this particular client.

3) A client with pulmonary tuberculosis develops tinnitus and vertigo. Which antitubercular medication would the nurse suspect is causing these symptoms? A. Isoniazid B. Rifampin C. Streptomycin D. Ethambutol

C Rationale Streptomycin is ototoxic and can cause damage to the eighth cranial nerve, resulting in deafness. Assessment for ringing or roaring in the ears, vertigo, and hearing acuity should be made before, during, and after treatment. Isoniazid does not affect the ear; however, blurred vision and optic neuritis, as well as peripheral neuropathy, may occur. Rifampin does not affect hearing; however, visual disturbances may occur. Ethambutol does not affect hearing; however, visual disturbances may occur.

4) A 12-year-old child with cystic fibrosis is prescribed four pancrelipase capsules five times a day. The nurse explains to the child they would take the medication with meals and snacks to accomplish which goal? A. Enhance oxygenation B. Limit excretion of fats C. Facilitate nutrient utilization D. Prevent iron-deficiency anemia

C Rationale Pancreatic enzyme replacement is needed because children with cystic fibrosis cannot manufacture pancreatic enzymes that promote the digestion of food. This results in large amounts of fat in the stool, which can cause bloating and abdominal cramping. Increased oxygenation is not the effect of pancrelipase; pancrelipase contains enzymes to break down fats, proteins, and carbohydrates. Pancrelipase promotes the body's ability to metabolize and absorb fat rather than limit its excretion. The purpose of pancrelipase is not the prevention of anemia.

20) Which rationale will the nurse give for the need to take penicillin G and probenecid for syphilis? A. "Each medication attacks the organism during different stages of cell multiplication." B. "The penicillin treats the syphilis, and the probenecid relieves the severe urethritis." C. "Probenecid delays excretion of penicillin, thus maintaining blood levels for longer periods." D. "Probenecid decreases the potential for an allergic reaction to penicillin, which treats the syphilis."

C Rationale Probenecid results in better use of penicillin by delaying the excretion of penicillin through the kidneys. Penicillin destroys Treponema pallidum during all stages of its development; probenecid delays the excretion of penicillin. Probenecid does not treat urethritis. Probenecid does not prevent allergic reactions.

12) Which administration instruction would the nurse give a client prescribed ranitidine 150 mg daily to treat peptic ulcer disease (PUD)? A. As needed B. With meals C. At bedtime D. Before meals

C Rationale Ranitidine is typically administered in a single dose at bedtime. This medication is used for 4 to 6 weeks in combination with other therapy; it is not used as needed, with meals, or when indigestion occurs.

3) A client diagnosed with tuberculosis is prescribed rifampin and isoniazid. Which information should the nurse include when reinforcing information about these medications? A. "You can take the medication with food." B. "You may experience an increase in appetite." C. "You may notice an orange-red color to your urine." D. "You may have occasional problems sleeping."

C Rationale Rifampin can cause reddish-orange discoloration of the urine and other body fluids, including tears and sweat. This is harmless, but the client needs to be made aware of it. The nurse should caution the client not to wear soft contacts while taking this medication because they can become discolored. The other information does not apply to those two medications.

6) The nurse is assessing a client who is taking rifampin for the treatment of tuberculosis. Which finding reported by the client should the nurse immediately report to the healthcare provider? A. Blurred vision B. Orange-tinged tears C. Dark amber urine D. Diarrhea

C Rationale Rifampin causes a temporary yellow-orange discoloration of body fluids. Soft contact lenses may be permanently stained. Dark amber urine is an indication of liver dysfunction and should be reported. A major adverse effect of ethambutol, not rifampin, is optic neuritis. Diarrhea is a common side effect of antibiotics and is not the priority in this case.

3) A client with diabetes presents to the emergency department with a 3-hour history of profound weakness and nervousness. According to the spouse, the client became confused shortly after self-administering the morning dose of 10 units of regular insulin and 25 units of NPH insulin. The client had a light breakfast and no additional intake since that time. Which condition would the nurse identify as the likely cause of the client's signs and symptoms? A. Hyperglycemia B. Hyperinsulinemia C. Hypoglycemia D. Hypoinsulinemia

C Rationale Severe hypoglycemia is a finding in diabetic clients who take insulin and miss a meal. Signs and symptoms of hypoglycemia are nervousness, weakness, confusion, and disorientation. Hyperglycemia is rare in clients who are on insulin therapy and decrease their intake. Hyperinsulinemia is a condition where an excess of insulin is produced by the pancreas in response to conditions such as insulin resistance or insulinomas. Hypoinsulinemia refers to abnormally low levels of insulin in the blood.

1) The nurse is teaching a 12-year-old child about the action of insulin injections. Which statement indicates the child understands how insulin works in the body? A. 'Glucose is released as fats break down.' B. 'It keeps glucose from being stored in the liver.' C. 'Glucose is carried into cells where it is used for energy.' D. 'It stops the wasting of blood glucose by converting it to glycogen.'

C Rationale Specialized insulin receptors on insulin-sensitive cells transport glucose through cell membranes, making it available for use. Insulin does not break down fats to release glucose, prevent glucose from being stored in the liver, or convert glucose into glycogen.

1) Which condition is contraindicated for St. John's wort herbal therapy? A. Anxiety B. Seizures C. Dementia D. Cardiac disease

C Rationale St. John's wort is contraindicated for dementia; this herbal therapy is used to treat anxiety. Bupropion therapy is contraindicated for seizures. Valerian (Valeriana officinalis) is contraindicated for cardiac disease.

5) Which information will the nurse include when teaching about tetanus immune globulin prescribed to a client with a puncture wound? A. "It will take about a week to become effective." B. "Immune globulin provides lifelong passive immunity." C. "It provides immediate, passive, short-term immunity." D. "Immune globulins stimulate the production of antibodies."

C Rationale Tetanus immune globulin contains ready-made antibodies and provides immediate, short-term, passive immunity. Passive immunity lasts a short time, not throughout life. Immune globulins confer passive artificial immunity, not long-lasting active immunity. Immune globulins are antibodies; they do not stimulate the production of antibodies.

4) A teenager with a deep laceration of his leg does not remember the date of the last tetanus immunization received. The nurse explains that tetanus immunoglobulin and tetanus toxoid are required. Which explanation underlies the nurse's statement? A. Neither medication is effective alone. B. Both eliminate the need for additional medications. C. Antibodies provide protection, whereas the toxoid stimulates a response. D. Tetanus toxoid minimizes the risks related to the tetanus immunoglobulin.

C Rationale Tetanus immunoglobulin provides immediate protection, whereas the tetanus toxoid initiates an active immune response. Each is effective alone, but the combination is preferred. They do not confer lifelong immunity. After the initial routine immunizations and boosters, it is recommended that the tetanus toxoid be administered every 10 years. Tetanus immunoglobulin does not carry major side effects because it is derived from human serum.

4) A pregnant client with an infection tells the nurse that she has taken tetracycline for infections in the past and prefers to take it now. Which response would the nurse give regarding the avoidance of tetracycline administration during pregnancy? A. 'It affects breast-feeding adversely.' B. 'Tetracycline causes fetal allergies.' C. 'It alters the development of fetal teeth buds.' D. 'It increases fetal tolerance to the medication.'

C Rationale Tetracycline has an affinity for calcium; if used during tooth bud development it may cause discoloration of teeth. Tetracycline does not adversely affect breast-feeding, cause fetal allergies to the medication, or increase fetal tolerance of the medication.

2) The nurse is teaching parents about the side effects of immunization vaccines. Which expected side effect associated with the Haemophilus influenzae (Hib) vaccine would the nurse include in the teaching? A. Urticaria B. Lethargy C. Low-grade fever D. Generalized rash

C Rationale The Hib vaccine may cause a low-grade fever as the body reacts to the vaccine. Urticaria is more likely to occur with the tetanus and pertussis vaccines. Lethargy is not expected. There may be a mild reaction at the injection site, but a generalized rash is not expected. RN Focus: Patient Education - Given to for different bacteria (Hib & PCV)

9) Which vaccine is contraindicated for a child undergoing chemotherapy? A. Influenza (Hib) B. Hepatitis B (Hep B) C. Measles, mumps, rubella (MMR) D. Diphtheria, tetanus, acellular pertussis (DTaP)

C Rationale The MMR vaccine contains an attenuated live virus and should not be administered to a child undergoing chemotherapy because of the compromise to the child's immune system. There are no contraindications to administering the Hib, Hep B, or DTaP vaccines to a child who is immunosuppressed.

2) A nurse is educating a client with diabetes type 2 about newly prescribed glipizide. Which statement by the nurse best describes the action of glipizide? A. "This medication absorbs the excess carbohydrates from your intestinal tract." B. "This medication will inhibit the release of glucose stored in the liver." C. "This medication will stimulate your pancreas to release insulin." D. "This medication works by increasing the ability of the cells to uptake glucose."

C Rationale The action of sulfonylureas, such as glyburide, is to stimulate the pancreas to release insulin. Biguanides, such as metformin, work by decreasing the release of glucose from the liver and increasing the uptake of glucose into the cells. The action of a-glucosidase inhibitors is to decrease the absorption of carbohydrates in the gastrointestinal tract.

4) The nurse is teaching a school-age child how to use an insulin pump. Which instruction by the nurse is most important for the child to understand? A. The needle must be changed every day. B. A blood glucose check is necessary once a day. C. The pump is an attempt to mimic the way a healthy pancreas works. D. Subcutaneous pockets near the abdomen are used to implant the pump.

C Rationale The basal infusion rate mimics the low rate of insulin secretion during fasting, and the bolus before meals mimics the high output after meals. The subcutaneous needle and tubing may be left in place for as long as 3 days. Blood glucose monitoring is performed at least four times a day. Most insulin pumps are battery-driven syringes external to the body.

5) A client receiving intravenous vancomycin reports ringing in both ears. Which initial action would the nurse take? A. Notify the primary health care provider. B. Consult an audiologist. C. Stop the infusion. D. Document the finding and continue to monitor the client.

C Rationale The first action the nurse would take is to stop the infusion immediately. Vancomycin can cause temporary or permanent hearing loss. The nurse would stop the medication infusion and then notify the health care provider at once if a client reports any hearing problems or ringing in the ears. An audiologist may need to be consulted at a later date, but this is not the best first action. The nurse would document the findings; however, this is not the initial action.

7) Which nursing intervention would prevent stimulation of the pancreas in a client with acute pancreatitis? A. Maintain the gastric pH at a level of less than 3.5. B. Encourage the resumption of activities of daily living. C. Administer the histamine H 2-receptor antagonist as prescribed. D. Ensure that the nasogastric tube remains in the fundus of the stomach.

C Rationale The histamine H 2-receptor antagonist medication inhibits histamine at H 2-receptor sites in parietal cells, thus decreasing gastric secretion and preventing pancreatic stimulation. A lower pH will stimulate pancreatic secretion, which contains bicarbonate ions that neutralize the acid. The client should rest to decrease stimulation of the pancreas. The tube should be positioned nearer the pylorus for the removal of gastric contents.

1) A client with type 1 diabetes self-administers neutral protamine Hagedorn (NPH) insulin every morning at 8:00 AM. The nurse evaluates that the client understands the action of the insulin when the client identifies which time range as the highest risk for hypoglycemia? A. 9:00 AM to 10:00 AM B. 10:00 AM to 11:00 AM C. Noon to 8:00 PM D. 8:00 PM to midnight

C Rationale The time of greatest risk for hypoglycemia occurs when the insulin is at its peak. The action of intermediate-acting insulin peaks in 4 to 12 hours. Nine to 10:00 AM and 10:00 AM to 11:00 AM are too soon for NPH to produce a hypoglycemic response. NPH insulin will have produced a hypoglycemic response before 8:00 PM and after noon. A hypoglycemic response that occurs in 45 to 60 minutes after administration is associated with rapid-acting insulins.

8) A client has been diagnosed with hypothyroidism. Which medication should the nurse administer to treat the client's bradycardia? A. Epinephrine B. Adenosine C. Levothyroxine D. Atropine

C Rationale The treatment for bradycardia from hypothyroidism is to treat the hypothyroidism using levothyroxine sodium, a T4 replacement hormone. If the heart rate were so slow that it causes hemodynamic instability, then atropine or epinephrine might be an option for short-term management. Adenosine slows atrioventricular (AV) conduction in the heart and would be contraindicated for a client with bradycardia.

6) A client has type 2 diabetes controlled with oral antidiabetic medications. When admitted for elective surgery, the health care provider prescribes regular insulin. Which information would the nurse include when teaching the client about the addition of insulin? A. 'You will need a higher serum glucose level while on bed rest.' B. 'The stress of surgery may cause hypoglycemia.' C. 'With insulin, dosage can be adjusted to your changing needs during recovery from surgery.' D. 'The possibility of surgical complications is greater when a client takes oral hypoglycemics.'

C Rationale There is better control of blood glucose levels with short-acting (regular) insulin. The level of glucose must be maintained as close to normal as possible; elevated glucose levels are not desirable for clients on bed rest. The stress of surgery will precipitate hyperglycemia (not hypoglycemia), which is best controlled with exogenous insulin. Oral hypoglycemics do not increase surgical complications.

4) Which statement by a client who had a laminectomy and is receiving a skeletal muscle relaxant that will be continued after discharge indicates that teaching was effective? A. "I'm going to take the medication between meals." B. "If the medication makes me sleepy, I'll stop taking it." C. "If the medication upsets my stomach, I'll take it with milk." D. "I'll take an extra dose of the medication before I do anything active."

C Rationale These medications tend to irritate the gastric mucosa and should be taken with milk or food to limit gastrointestinal irritation. Drowsiness is an expected side effect; safety precautions are indicated, but the medication should not be discontinued. Taking an extra dose of the medication before activity can result in toxicity if the extra dose, in addition to the prescribed dose, exceeds the therapeutic range; the dosage prescribed by the health care provider should be followed.

5) A client with type 1 diabetes experiences tremors, pallor, and diaphoresis. These signs and symptoms are manifestations of which cause? A. Overeating B. Viral infection C. Aerobic exercise D. Missed insulin dose

C Rationale These responses are indicative of hypoglycemia, which can be caused by increased activity in clients who take insulin. Overeating causes hyperglycemia. Infections cause hyperglycemia because of the release of stress-related hormones. Missing an insulin dose causes hyperglycemia.

2) Which medication therapy is indicated for management of Wernicke encephalopathy associated with Korsakoff syndrome? A. Traditional phenothiazines B. Judicious use of antipsychotics C. Intramuscular injections of thiamine D. Oral administration of chlorpromazine

C Rationale Thiamine is a coenzyme necessary for the production of energy from glucose. If thiamine is not present in adequate amounts, nerve activity is diminished and damage or degeneration of myelin sheaths occurs. A traditional phenothiazine is a neuroleptic antipsychotic that should not be prescribed because it is hepatotoxic. Antipsychotics must be avoided; their use has a higher risk of toxic side effects in older or debilitated persons. Chlorpromazine, a neuroleptic, cannot be used because it is severely toxic to the liver.

12) The nurse is preparing to administer the next dose of prescribed vancomycin to the client being treated for sepsis. Which of the following laboratory results would be the priority for the nurse to review? A. Peak serum drug level B. Serum potassium level C. Serum creatinine level D. White blood cell count

C Rationale Vancomycin can lead to interstitial nephritis and therefore, serum creatinine should be monitored. Prior to a dose, a trough level would be drawn to help assess minimum inhibitory concentration; however, peak levels are not needed for this purpose and are drawn after administration. Do not hold the next vancomycin doses while waiting for the results of vancomycin levels unless there is a concern about renal function. Therefore, the priority is serum creatinine. While the treatment of infection is the goal, assessing white blood count (WBC) prior to administration is not necessary.

2) The nurse is caring for a client with diabetes type I who received a prescribed dose of regular insulin 30 minutes prior to the meal. The client reports nausea and vomiting. Which action should the nurse take? A. Administer another dose of regular insulin B. Encourage the client to eat a small amount of carbohydrates C. Assess blood glucose level D. Notify the healthcare provider

C Rationale When a client who has been administered a regular insulin injection vomits, the nurse should monitor blood glucose and frequently assess for signs of hypoglycemia. After 30 minutes, most of the medication would have been absorbed. Any food ingested may be lost, and repeating the dose would further lower glucose levels. Giving intravenous insulin would also lower glucose levels, causing further hypoglycemia. Before the nurse notifies the healthcare provider, the nurse should assess the client's blood glucose level.

2) The nurse is preparing to administer a client's prescribed NPH and regular insulins. Which action should the nurse take first when mixing the insulins in one syringe? A. Draw up the NPH B. Draw up the regular insulin C. Inject air into the NPH D. Inject air into the regular insulin

C Rationale When mixing insulins in the same vial, the process should be to inject air into the long-acting insulin, inject air into the short-acting insulin, draw up the short-acting insulin, and then draw up the long-acting insulin.

2) The nurse is reinforcing teaching to a 24-year-old woman receiving acyclovir for a Herpes Simplex Virus type 2 infection. Which instructions should the nurse provide the client with? A. Continue to take prophylactic doses for at least five years after the diagnosis B. Complete the entire course of the medication for an effective cure C. Begin treatment with acyclovir at the onset of symptoms of recurrence D. Stop treatment if she thinks she may be pregnant

C Rationale When the client is aware of early symptoms, such as pain, itching or tingling, treatment is very effective. Medications for herpes simplex do not cure the disease. They simply decrease the intensity of the symptoms. Acyclovir (Zovirax) is not known to have an impact on the fetus. Acyclovir should not be taken for preventive purposes, regardless of the date of diagnosis.

10) The nurse is assessing a client who is receiving antibiotic therapy for an infection. Which finding should indicate to the nurse that the client may be experiencing an allergic reaction to a medication? A. Xerostomia B. Hypertension C. Pruritus D. Lymphadenopathy

C Rationale: If the client experiences pruritus, the nurse should be concerned about the possibility of an allergic reaction. Xerostomia, or dry mouth, and lymphadenopathy are not signs of a hypersensitivity reaction. A client experiencing an allergic reaction will experience hypotension.

1) The nurse is caring for a client with osteomyelitis who is receiving IV infusion of prescribed vancomycin. Which statement by the client would be a priority for the nurse to report to the healthcare provider? A. I fell some burning at the catheter site B. I feel a little nauseous C. I have a ringing in my ears D. I have a headache

C Rationale: The nurse who is caring for a client with osteomyelitis who is receiving IV infusion of vancomycin should assess the client for toxicity. The client who reports ringing in the ear could be experiencing ototoxicity, which is an adverse effect of vancomycin and should be reported to the healthcare provider.Headache, nausea, and burning at the IV site are side effects of the medication but not a priority for the nurse to report to the healthcare provider.

14) Which client would benefit most from the administration of prophylactic antibiotics? Select all that apply. One, some, or all responses may be correct. A. Chickenpox infection B. Fever of unknown origin C. Preoperative hip replacement D. Congenital bicuspid aortic valve E. Current chemotherapy treatment

C, D, E Rationale Prophylactic antibiotics are indicated in the preoperative hip replacement client because this decreases the occurrence of infection postoperatively. Prophylactic antibiotics are indicated for the client with congenital bicuspid aortic valve disease because this decreases the risk of endocarditis with an invasive procedure. Prophylactic antibiotics are indicated for the current chemotherapy treatment client because this decreases the risk of infection due to neutropenia. A client with the chickenpox infection has a viral infection for which antibiotics are ineffective. A fever of unknown origin should not be treated with antibiotics because that may eliminate the ability to discover the causative organism, and a virus could be the cause of the fever.

11) Isoniazid (INH) is prescribed as a prophylactic measure for a client whose spouse has active tuberculosis (TB). Which statements made by the client indicate that there is a need for further teaching? Select all that apply. One, some, or all responses may be correct. A. 'I plan to start taking vitamin B 6 with breakfast.' B. 'I'll still be taking this medication 6 months from now.' C. 'I sometimes allow our children to sleep in our bed at night.' D. 'I know I also have tuberculosis because the skin test was positive.' E. 'I plan to attend a wine tasting event this evening.'

C, D, E Rationale The children are at an increased risk because the client's spouse has TB; the children should be screened as members of the household. The positive skin test indicates that the client has been exposed to the bacilli and developed antibodies, not necessarily the disease itself; further diagnostic studies are indicated. Wine contains tyramine and histamine, which when taken concurrently with INH can cause headache, flushing, and a drop in blood pressure; these should be avoided when taking INH. Pyridoxine (vitamin B 6) should be taken to prevent neuritis, which is associated with INH. The prophylactic medication therapy will be continued for 6 to 12 months.

Ampicillin, penicillin, cephalosporin, ceftriaxone THINK

Cef/Ceph- "biotic"-cillins ... "ITCH!"

Chelation THINK

Chelation (get them metals out) with EDTA

8) Which health history would the nurse consider a contraindication to administering the second diphtheria/tetanus/pertussis (DTaP) immunization to a 4-month-old infant? A. Allergy to eggs B. Lactose intolerance C. Infectious dermatitis D. High fever after the first dose

D Rationale A temperature of 105°F (40.6°C) or higher after a diphtheria/tetanus/pertussis (DTaP) immunization is a contraindication to further DTaP immunizations. An allergy to eggs is not a contraindication to the administration of the DTaP vaccine because eggs are not used in the production of the vaccine. Lactose intolerance is not a contraindication to the administration of DTaP vaccine, nor is infectious dermatitis.

Misoprostol (Cytotec) THINK

mis "with my preg" oprostol

2) A primary health care provider prescribes venlafaxine for a client with a diagnosis of major depressive disorder who has been taking herbal medications. Which herbal supplement is contraindicated when taking venlafaxine? A. Ginseng B. Valerian C. Kava-kava D. St. John's wort

D Rationale A client who takes venlafaxine, a selective serotonin reuptake inhibitor, and St. John's wort concurrently is at risk for serotonin syndrome, a medication-induced excess of intrasynaptic serotonin. Ginseng can precipitate a hypertensive crisis in clients taking a monoamine oxidase inhibitor. Valerian (valerian root) can enhance sedation in clients taking a tricyclic antidepressant. Kava-kava can increase the risk of dystonic reactions in clients taking an antipsychotic medication.

7) The nurse is planning an evening snack for a child receiving NPH insulin. The nurse offers a snack for which reason? A. It encourages the child to stay on the diet. B. Energy is needed for immediate utilization. C. Extra calories will help the child gain weight. D. Nourishment helps counteract late insulin activity.

D Rationale A bedtime snack is needed for the evening. NPH insulin is intermediate-acting insulin, which peaks 4 to 12 hours later and lasts for 18 to 24 hours. Protein and carbohydrate ingestion before sleep prevents hypoglycemia during the night when the NPH is still active. The snack is important for diet-insulin balance during the night, not encouragement. There are no data to indicate that extra calories are needed; a bedtime snack is routinely provided to help cover intermediate-acting insulin during sleep. The snack must contain mainly protein-rich foods, not simple carbohydrates, to help cover the intermediate-acting insulin during sleep.

7) An adolescent with diabetes had a 6:30 AM fasting blood glucose level of 180 mg/dL (10.0 mmol/L). Which nursing action is a priority? A. Encourage the adolescent to start exercising. B. Ask the adolescent to obtain an immediate glucometer reading. C. Inform the adolescent that a complex carbohydrate such as cheese should be eaten. D. Tell the adolescent that the prescribed dose of rapid-acting insulin should be administered.

D Rationale A blood glucose level of 180 mg/dL (10.0 mmol/L) is above the average range, and the prescribed rapid-acting insulin is needed. Although exercise does decrease insulin requirements and does lower the blood glucose level, the immediate action of insulin is needed. Asking the adolescent to obtain an immediate glucometer reading is an action that will not correct the problem; the blood glucose level is already known. Food intake at this time will increase the level of blood glucose.

6) A client is prescribed an oral contraceptive. As part of teaching, the nurse plans to inform the client of the possibility of which adverse effect? A. Cervicitis B. Ovarian cysts C. Fibrocystic breasts D. Breakthrough bleeding

D Rationale Breakthrough bleeding, or midcycle bleeding, commonly occurs when women start using oral contraceptives. If it persists, the dosage should be changed. There is no evidence that cervicitis, ovarian cysts, or fibrocystic breasts are related to the use of oral contraceptives.

2) The nurse is caring for a client who has a prescription for an insulin sliding scale to manage the client's hyperglycemia. At 11 am, the client's blood glucose level was 285 mg/dL (15.8 mmol/L). According to the following sliding scale parameters, how many units of insulin should the nurse administer? • For glucose less than 140, give 0 units of insulin aspart. • For glucose between 140 to 180, give 2 units of insulin aspart. • For glucose between 181 to 220, give 4 units of insulin aspart. • For glucose between 221 to 260, give 6 units of insulin aspart. • For glucose between 261 to 300, give 8 units of insulin aspart. • For glucose greater than 300, notify the health care provider. A. 2 units B. 4 units C. 6 units D. 8 units

D Rationale According to the prescribed sliding scale, for a blood glucose level of 285 mg/dL (15.8 mmol/L), the nurse should administer 8 units of insulin aspart.

7) A health care provider has prescribed isoniazid for a client. Which instruction will the nurse give the client about this medication? A. Prolonged use can cause dark, concentrated urine. B. The medication is best absorbed when taken on an empty stomach. C. Take the medication with aluminum hydroxide to minimize gastrointestinal (GI) upset. D. Drinking alcohol daily can cause medication-induced hepatitis.

D Rationale Alcohol may increase hepatotoxicity of the medication; instruct client to avoid drinking alcohol during treatment; monitor for signs of hepatitis before and while taking medication. Prolonged use does not cause dark, concentrated urine. The client should take isoniazid with meals to decrease GI upset. Clients should avoid taking aluminum antacids at the same time as this medication because it impairs absorption.

15) Which statement by a client prescribed ampicillin 250 mg by mouth every 6 hours indicates to the nurse that teaching has been effective? A. "I should drink a glass of milk with each pill." B. "I should drink at least six glasses of water every day." C. "The medicine should be taken with meals and at bedtime." D. "The medicine should be taken 1 hour before or 2 hours after meals."

D Rationale Ampicillin is a form of penicillin that should be given on an empty stomach; food delays absorption. The response "I should drink a glass of milk with each pill" is incorrect; opaque liquids, such as milk, delay the absorption of this medication. It is not necessary to drink at least six glasses of water every day; however, it is appropriate to prevent crystalluria when the client is prescribed sulfonamides. The response "The medicine should be taken with meals and at bedtime" is incorrect; food delays the absorption of this medication.

2) A client develops leukopenia 3 weeks after having a renal transplant. Which factor would the nurse conclude is the cause of the leukopenia? A. Bacterial infection B. High creatinine levels C. Rejection of the kidney D. Antirejection medications

D Rationale Antirejection medications alter the immune response by causing bone marrow suppression. The white blood cell (WBC) count drops precipitously. Leukocytosis, not leukopenia, occurs with an infection. High creatinine levels are related to kidney failure, but do not cause leukopenia. The WBC count is increased, not decreased, with kidney rejection.

14) The nurse is preparing a client for discharge from the emergency department. Which client statement provides evidence that the client understands medication teaching for high-dose ampicillin? A. 'I should take this medication with meals.' B. 'This medicine may cause constipation.' C. 'I must avoid dairy products while taking this medicine.' D. 'I must increase my intake of fluids while taking this medication.'

D Rationale Because penicillin in high doses is nephrotoxic, keeping hydrated maintains adequate renal perfusion for medication excretion. It should be taken on an empty stomach for best absorption. Dietary restrictions are not imposed while this medication is taken. It may cause diarrhea, but not constipation.

8) A 6-year-old child is receiving an intravenous solution of 10% glucose and mannitol to reduce cerebral edema. Which complication would the nurse monitor the child for? A. Overhydration B. Seizure activity C. Acute heart failure D. Hypovolemic shock

D Rationale Both hypertonic glucose and mannitol cause diuresis; the child should be monitored for excessive fluid loss. Hypertonic glucose and mannitol will cause fluid loss, not gain. Seizure activity is not anticipated as a result of this infusion. An increased fluid volume can lead to heart failure; however, hypertonic glucose and mannitol cause fluid loss, not gain.

21) A nurse receives a prescription to administer intravenous cefepime to a client with a bacterial infection. The client has a history of lung cancer and is on a continuous cisplatin infusion. How will the nurse administer the prescribed medication? A. Piggyback the cefepime onto the cisplatin infusion B. Wait for the cisplatin infusion to finish before administering cefepime C. Infuse the cefepime via IV push at the proximal port D. Initiate a new intravenous line for the cefepime infusion

D Rationale Cefepime is an antibiotic medication used to treat bacterial infections. Cisplatin is an antineoplastic medication used in the treatment of various cancers. Cefepime and cisplatin are not compatible and should not be mixed. The nurse should initiate a new intravenous line for the administration of cefepime. Piggybacking the cefepime will cause the medication to mix with cisplatin. The medications are not compatible. A continuous cisplatin infusion is administered over 24 hours to 5 days. The nurse should not wait to administer other medications. Cefepime should be administered as an infusion, not an IV push.

3) A client has been admitted for the second time to treat tuberculosis (TB). Which referral does the nurse initiate as a priority? A. Psychiatric nurse liaison to assess reasons for noncompliance B. Infection control nurse to arrange testing for drug resistance C. Social worker to see if the client can afford the medications D. Visiting nurses to arrange for directly observed therapy (DOT)

D Rationale Clients with TB must take multiple drugs for six months or longer, making adherence a very real problem. Non-adherence is the most common cause of treatment failure and relapse. This client has a risk of non-adherence, as evidenced because this is their second admission to treat TB. When the client is discharged, they most likely will need to be placed on DOT to ensure compliance. This is the priority referral in order to prevent transmission of TB to others in the community. The other referrals may also be appropriate depending on the client's needs.

7) The nurse is caring for a client who is prescribed erythromycin 500 mg orally every six hours for the treatment of pneumonia. The nurse should monitor the client for which common side effect? A. Esophagitis B. Tendon rupture C. Orange-red discoloration of urine D. Nausea and vomiting

D Rationale Erythromycin is a macrolide anti-infective medication used that interferes with protein synthesis in susceptible bacteria. Nausea, vomiting and gastrointestinal (GI) upset are common with erythromycin. The other side effects are not commonly seen with this drug.

2) A 25-year-old woman on estrogen therapy has a history of smoking. Which complication would the nurse anticipate in the client? A. Osteoporosis B. Hypermenorrhea C. Endometrial cancer D. Pulmonary embolism

D Rationale Estrogen therapy increases the risk of pulmonary embolism in clients who have a history of smoking because the medication affects blood circulation and hemostasis. Osteoporosis may be caused by reduced bone density observed in postmenopausal woman. Hypermenorrhea (excessive menstrual bleeding) is treated with estrogen therapy. Endometrial cancer is a complication of estrogen therapy seen in postmenopausal woman.

4) A client is admitted to the hospital for a subtotal thyroidectomy. When discussing postoperative medication therapy with the client, which advice will the nurse include in the teaching? A. 'You will be taking iodine daily to increase the formation of thyroid hormone.' B. 'After your body adjusts to postsurgical status, you will be weaned off this medication.' C. 'The propylthiouracil that is prescribed will stimulate the secretion of thyroid-stimulating hormone.' D. 'If you develop palpitations, nervousness, or tremors, the dose of thyroid hormone may need to be decreased.'

D Rationale Excessive thyroid hormone replacement may lead to signs and symptoms of hyperthyroidism. Iodine may be administered before, not after, surgery. Thyroid hormone replacement is required for life. Propylthiouracil blocks thyroid hormone synthesis; this often is administered before, not after, surgery.

4) A client with type 2 diabetes takes one glyburide tablet daily. The client asks whether an extra tablet should be taken before exercise. Which response will the nurse provide? A. 'You will need to decrease how much you are exercising.' B. 'An extra pill will help your body use glucose when exercising.' C. 'The amount of medication you need to take is not related to exercising.' D. 'Do not take an extra pill because you may become hypoglycemic when exercising.'

D Rationale Exercise improves glucose metabolism. Exercise is associated with a risk for hypoglycemia, not hyperglycemia; an additional antidiabetic agent is contraindicated. Exercise should not be decreased because it improves glucose metabolism. Also, this response does not answer the client's question. An extra tablet probably will result in hypoglycemia because exercise alone improves glucose metabolism. Control of glucose metabolism is achieved through balanced diet, exercise, and pharmacological therapy.

6) Which response would a nurse give to a client taking an oral hypoglycemic tablet daily who asks if an extra tablet should be taken before exercise? A. "You will need to decrease your exercise." B. "An extra tablet will help your body use glucose correctly." C. "When taking medicine, your diet will not be affected by exercise." D. "No, but you should observe for signs of hypoglycemia while exercising."

D Rationale Exercise improves glucose metabolism; with exercise, there is a risk of developing hypoglycemia, not hyperglycemia. Exercise should not be decreased because it improves glucose metabolism. An extra tablet probably will result in hypoglycemia because exercise alone improves glucose metabolism. Control of glucose metabolism is achieved through a balance of diet, exercise, and pharmacologic therapy.

8) The nurse is teaching a 10-year-old child with type 1 diabetes about insulin requirements. Which statement by the nurse correctly identifies when insulin needs decrease? A. 'Insulin needs often decrease when puberty is reached.' B. 'When there is an infection is present, the body requires less insulin.' C. 'Emotional stress can cause insulin needs to decrease.' D. 'Increased muscle activity such as exercise, cause insulin needs to decrease.'

D Rationale Exercise reduces the body's need for insulin. Increased muscle activity accelerates transport of glucose into muscle cells, thus producing an insulin like effect. With increased growth and associated dietary intake, the need for insulin increases during puberty. An infectious process may require increased insulin. Emotional stress increases the need for insulin.

3) Famotidine is prescribed for a client with peptic ulcer disease. Which mechanism of action is a characteristic of this medication? A. Increases gastric motility B. Neutralizes gastric acidity C. Facilitates histamine release D. Inhibits gastric acid secretion

D Rationale Famotidine decreases gastric secretion by inhibiting histamine at H 2 receptors. Increasing gastric motility, neutralizing gastric acidity, and facilitating histamine release are not actions of famotidine.

2) A health care provider prescribes famotidine for a client with dyspepsia. Which statement is important to include in a teaching session about famotidine? A. Lowers the stress level B. Neutralizes gastric acidity C. Reduces gastrointestinal peristalsis D. Decreases secretions in the stomach

D Rationale Famotidine inhibits histamine at H 2-receptor sites in the stomach, inhibiting gastric acid secretion. Famotidine does not affect stress levels. Famotidine inhibits, rather than neutralizes, gastric secretion. Famotidine inhibits gastric secretion, not peristalsis.

4) A client with giardiasis is taking metronidazole (Flagyl) 2 grams PO. Which information should the nurse include in the client's instruction? A. Notify the clinic of any changes in the color of urine. B. Encourage the use of over-the-counter cough/cold syrup when a cough/cold develops. C. Stop the medication after the diarrhea resolves. D. Take the medication with food.

D Rationale Flagyl, an amoebicide and antibacterial agent, may cause gastric distress, so the client should be instructed to take the medication on a full stomach. Urine may be red-brown or dark from Flagyl, but this side effect is an expectant finding and not necessary to report to the healthcare provider. The client should also avoid using alcohol-containing products such as cough or cold syrups or mouthwash while taking the medication and for at least three days after stopping it.

5) A sulfonamide preparation is prescribed for a child with a urinary tract infection. Which nursing responsibility is a priority when administering this medication? A. Weighing the child daily B. Giving the medication with milk C. Taking the child's temperature frequently D. Administering the medication at the prescribed times

D Rationale For the desired blood level to be maintained, the medication must be administered in the exact amount at the times directed. If the blood level of the medication falls, the microorganisms have an opportunity to build resistance to the medication. Weighing is important with medications that affect fluid balance, such as diuretics. Sulfa medications should be given on an empty stomach to promote absorption. Monitoring the temperature is important with antipyretic medications.

14) The nurse receives an order to administer intravenous gentamicin to a client. For which finding should the nurse contact the health care provider to clarify the order? A. Low serum albumin B. Low serum blood urea nitrogen C. High gastric pH D. High serum creatinine

D Rationale Gentamicin is an aminoglycoside antibiotic that is excreted primarily by the kidneys. If there is reduced renal function as evidenced by the elevated serum creatinine level, the client is at greater risk for drug toxicity and further renal damage.

6) A nurse is reviewing prescribed medications for a client diagnosed with diabetic ketoacidosis. Which medication will the nurse clarify with the healthcare provider? A. Regular insulin Your Answer B. Potassium C. 0.9% sodium chloride D. Glipizide

D Rationale Glipizide is an oral antidiabetic medication used in the treatment of type 2 diabetes mellitus. The intended effect of glipizide is to lower glucose levels and maintain adequate management of the disease. Oral antidiabetic agents are contraindicated in clients with diabetic ketoacidosis (DKA). Glucose levels must be carefully lowered and monitored following insulin therapy. Regular insulin, potassium, and 0.9% sodium.

11) When a female client becomes hypothyroid, levothyroxine is prescribed. The client asks whether she can become pregnant while taking levothyroxine. How will the nurse respond? A. 'If you become pregnant, thyroid abnormalities will develop in the fetus.' B. 'Yes, but you will have a high-risk pregnancy.' C. 'This medication causes infertility for the length of time that it is taken.' D. 'This medicine will not interfere with your ability to become pregnant.'

D Rationale Hormone replacement should stabilize the metabolic rate and should not interfere with the client's becoming pregnant. If thyroid function remains controlled, there is no reason why the client should not become pregnant. Because thyroid function will be normalized, the fetus will not be negatively affected, and pregnancy risk will not be increased.

3) The nurse is monitoring a client who received a first dose of intravenous ampicillin. Which finding should indicate to the nurse that the client may be experiencing an allergic reaction? A. Abdominal pain B. Increase in blood pressure C. Hypotensive bowel sounds D. Hives on the extremities

D Rationale If the client experiences an allergic reaction to medications they may display systemic signs such as hives, pruritus, dyspnea, etc. Abdominal pain, hypertension, and hyperactive bowel sounds do not indicate an allergic reaction.

4) Which rationale explain why intravenous (IV) potassium is prescribed in addition to regular insulin for clients in diabetic ketosis? A. Potassium loss occurs rapidly from diaphoresis present during coma. B. Potassium is carried with glucose to the kidneys to be excreted in the urine in increased amounts. C. Potassium is quickly used up during the rapid series of catabolic reactions stimulated by insulin and glucose. D. Serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment.

D Rationale Insulin stimulates cellular uptake of glucose and stimulates the sodium/potassium pump, leading to the influx of potassium into cells. The resulting hypokalemia is offset by parenteral administration of potassium. Potassium is not lost from the body by profuse diaphoresis. Potassium moves from the extracellular to the intracellular compartment rather than being excreted in the urine. Anabolic reactions are stimulated by insulin and glucose administration; potassium is drawn into the intracellular compartment, necessitating a replenishment of extracellular potassium.

8) When caring for a client on isoniazid therapy for tuberculosis, the nurse would focus on which diagnostic testing for this client? A. Creatinine B. Hearing tests C. Electrocardiogram D. Liver function tests

D Rationale Isoniazid can damage the liver enough to lead to death, so liver function should be monitored. Creatinine would be tracked for renal dysfunction, which is not a focus of isoniazid therapy because isoniazid is metabolized by the liver. Aminoglycosides can cause ototoxicity, causing hearing loss. Bedaquiline can cause prolonged QT, detected through electrocardiogram.

4) A client with cirrhosis of the liver asks the nurse about the purpose of taking lactulose. How should the nurse respond? A. "It is used to control portal hypertension." B. "It adds dietary fiber to your diet." C. "It helps to regenerate your liver." D. "It helps to reduce ammonia levels in your blood."

D Rationale Lactulose is a synthetic disaccharide that can be given orally or rectally. It blocks the absorption and production of ammonia from the gastrointestinal tract, reducing serum ammonia levels, and is used to treat hepatic encephalopathy. The other answers are incorrect.

10) The client is newly diagnosed with type 1 diabetes mellitus. Which of these approaches would be the best strategy for the nurse to use when teaching insulin injection techniques? A. Give written pre and post tests B. Allow another diabetic to assist C. Ask questions during practice D. Observe a return demonstration

D Rationale Learning to inject oneself is a challenging task and the nurse should first demonstrate the injection and then ask for a return demonstration from the client. Giving a written test is not appropriate for this teaching. Asking questions during practice is important, but the nurse still needs to see the client self-inject. Asking another diabetic to assist is not appropriate.

7) The nurse identifies a nontender 5-cm indurated region on the upper arm of a client with type 1 diabetes. The client says to the nurse, 'That is where I give myself insulin shots.' The nurse concludes that the nodule is a result of which condition? A. Callus B. An allergy C. An infection D. Lipodystrophy

D Rationale Lipodystrophy is a noninflammatory reaction causing localized atrophy or hypertrophy and a localized increase in collagen deposits. Injections of insulin will not cause a horny growth such as a wart or callus. An allergic response will precipitate a localized or systemic inflammatory response. Hyperthermia and localized heat, erythema, and pain are associated with an infection.

1) Which response will be given by a nurse caring for a client with chronic hepatitis B who asks "Are there any medications to help me get rid of this problem?"? A. "Sedatives can be given to help you relax." B. "We can give you immune serum globulin." C. "Vitamin supplements are frequently helpful and hasten recovery." D. "There are medications to help reduce viral load and liver inflammation."

D Rationale Medications are available to help reduce the viral load (antivirals), including lamivudine, ribavirin, and adefovir dipivoxil. Although sedatives can be given to help the client relax, sedatives are given only as needed and do not treat the hepatitis. The response "We can give you immune serum globulin" would be used only during the incubation period. Vitamins are used as adjunctive therapy and will not eliminate the hepatitis.

1) Which statement made by a client prescribed metformin extended release to control type 2 diabetes mellitus indicates the need for further education? A. "I will take the medication with food." B. "I must swallow my medication whole and not crush or chew it." C. "I will notify my doctor if I develop muscular or abdominal discomfort." D. "I will stop taking metformin for 24 hours before and after having a test involving dye."

D Rationale Metformin must be withheld for 48 hours before the use of iodinated contrast materials to prevent lactic acidosis. Metformin is restarted when kidney function has returned to normal. Metformin is taken with food to avoid adverse gastrointestinal effects. If crushed or chewed, metformin XL will be released too rapidly and may lead to hypoglycemia. Muscular and abdominal discomfort is a potential sign of lactic acidosis and must be reported to the health care provider.

2) The nurse is caring for a pregnant client who has contracted a trichomonal protozoan infection. For which oral medication would the nurse anticipate preparing to provide education? A. Penicillin G B. Acyclovir C. Nystatin D. Metronidazole

D Rationale Metronidazole is a potent amebicide that is safe in pregnancy. It is effective in eradicating the protozoan Trichomonas vaginalis. Penicillin is administered for its effect on bacterial, not protozoal, infections. Acyclovir is an antiviral medication; therefore, it would not be effective in treating protozoal infections such as trichomonas. Nystatin is an antifungal for infections caused by Candida albicans.

3) Levofloxacin is prescribed for a woman who has been experiencing urinary frequency and burning for the past 24 hours. The nurse concludes the teaching has been effective when the client states she will make which change in her routine? A. Limit her fluid intake. B. Strain her urine for calculi. C. Monitor her urine output. D. Take mineral supplements 2 hours before or after levofloxacin.

D Rationale Mineral substances taken within 2 hours of a levofloxacin dose decrease the medication's effectiveness. Fluid intake should be increased to prevent crystalluria. Although the urine should be inspected for crystals, straining is not necessary. It is unnecessary to monitor urine output.

3) The nurse teaches an adolescent with type 1 diabetes about peak action of NPH insulin and the risk for hypoglycemia. The nurse determines teaching has been effective when the adolescent identifies insulin peak action within which time frame? A. 1 to 2 hours B. 2 to 4 hours C. 5 to 10 hours D. 4 to 12 hours

D Rationale NPH insulin onset is 1.5 to 4 hours, peaks in 4 to 12 hours, and has a duration of 12 to 18 hours.

5) A client taking oral contraceptives for 3 months tells the nurse she has breakthrough bleeding between menstrual cycles. For which causative factor would the nurse first assess in the client? A. Illness B. Anorexia nervosa C. Ectopic pregnancy D. Nonadherence to protocol

D Rationale Nonadherence to the instructions for taking the oral contraceptive can alter hormone levels, and breakthrough bleeding may occur as a result. Illness and anorexia nervosa are more likely to cause amenorrhea, not breakthrough bleeding. If nonadherence is determined not to be a concern, then the nurse would assess for far less likely causes such as ectopic pregnancy.

3) The nurse is assessing a client who began taking omeprazole a month ago. Which finding by the nurse, indicates that the drug has had the desired effect? A. Blood pressure readings are lower B. Feelings of depression are not as severe C. Chronic pain level is markedly decreased D. Heartburn discomfort is lessened

D Rationale Omeprazole is a proton pump inhibitor used to decrease stomach acid and relieve symptoms of gastroesophageal reflux disorder (GERD), such as heartburn. Omeprazole is also used to treat gastric ulcers and esophagitis. Omeprazole does not affect blood administration of medication. Omeprazole is not indicated for depression. Although omeprazole can alleviate abdominal pain in an individual who has a gastric ulcer or suffers from gastric bleeding, the option does not specify what type of pain is being discussed. Secondly, omeprazole is not typically indicated for chronic pain. The desired outcome for this client is to have a decrease in symptoms of GERD within 4 weeks.

1) Which purpose would the nurse identify as the reason for prescribing vitamin B 6 when a chemotherapy protocol prescribed for a client with tuberculosis includes vitamin B 6 and isoniazid (INH)? A. To improve the nutritional status of the client B. To enhance the tuberculostatic effect of INH C. To accelerate the destruction of dormant tubercular bacilli D. To counteract the peripheral neuritis that INH may cause

D Rationale One of the most common side effects of INH is peripheral neuritis, and vitamin B 6 will counteract this problem. It does help nutrition, but that is not the specific reason it is given. It counters the side effects of isoniazid; it does not act to enhance its action. It does not speed the destruction of the causative organism.

4) The chemotherapy protocol prescribed for a client with tuberculosis includes vitamin B 6 and isoniazid (INH). Which would the nurse identify as the reason for prescribing vitamin B 6? A. To improve the nutritional status of the client B. To enhance the tuberculostatic effect of INH C. To accelerate the destruction of dormant tubercular bacilli D. To counteract the peripheral neuritis that INH may cause

D Rationale One of the most common side effects of INH is peripheral neuritis, and vitamin B 6 will counteract this problem. It does help nutrition, but that is not the specific reason it is given. It counters the side effects of isoniazid; it does not act to enhance its action. It does not speed the destruction of the causative organism.

13) A 31-year-old client is seeking contraceptive information. While obtaining the client's history, which factor indicates to the nurse that oral contraceptives are contraindicated? A. Older than 30 years B. Current hypothyroidism C. Two multiple pregnancies D. Blood pressure 162/110

D Rationale Oral contraceptives may cause or exacerbate hypertension; even borderline hypertension places the client at risk for a brain attack. Oral contraceptives are not contraindicated for women older than 30 years of age if there are no known risk factors. There is no relationship between oral contraceptives and multiple births. Contraceptives are not contraindicated in clients who have hypothyroidism.

3) A client is prepared for a supratentorial craniotomy with burr holes, and an intravenous infusion of mannitol is instituted. The nurse concludes that this medication is primarily given for which purpose? A. Lower blood pressure B. Prevent hypoglycemia C. Increase cardiac output D. Decrease fluid in the brain

D Rationale Osmotic diuretics remove excessive cerebrospinal fluid (CSF), reducing intracranial pressure. Osmotic diuretics increase, not decrease, the blood pressure by increasing the fluid in the intravascular compartment. Osmotic diuretics do not directly influence blood glucose levels. Although there is an increase in cardiac output when the vascular bed expands as CSF is removed, it is not the primary purpose of administering the medication.

4) Which condition is treated with a proton pump inhibitor (PPI)? A. Diarrhea B. Vomiting C. Cardiac dysrhythmias D. Gastroesophageal reflux disease (GERD)

D Rationale PPIs are effective in decreasing the secretion of gastric acid, helping alleviate the symptoms of GERD. PPIs are not used for the treatment of diarrhea, vomiting, or cardiac dysrhythmias.

5) The nurse is giving instructions to the parents of a child who has cystic fibrosis. Which information should the nurse emphasize about administration of pancreatic enzymes? A. Administer each time a high-carbohydrate meal is eaten B. Crush the tablet and sprinkle on food three times a day C. Dispense once daily with breakfast D. They are to be taken with every meal or snack

D Rationale Pancreatic enzymes are necessary for digesting fat, starch and protein. They should be taken with each meal and most snacks to allow for the proper digestion of the food. If taken on an empty stomach, they may cause gastric irritation and possibly ulcers. Enzyme capsules should be swallowed whole, not crushed or chewed, and the microspheres should not be sprinkled on or mixed with the whole meal.

1) A child with pinworms is prescribed mebendazole. Which expected response to the medication would the nurse teach the parents watch for? A. Blood B. Constipation C. Yellow stools D. Passage of worms

D Rationale Passage of worms is the expected response because the medication causes the death of the worms. Neither the medication nor the worms cause intestinal bleeding. Transient diarrhea, not constipation, may occur. The medication may color the stool red, not yellow.

13) The parent of a newborn asks the nurse why, except for hepatitis B vaccine, the immunization schedule does not start until the infant is 2 months old. Which response would the nurse provide? A. 'A newborn's spleen can't produce efficient antibodies.' B. 'Infants younger than 2 months are rarely exposed to infectious disease.' C. 'The immunization will attack the infant's immature immune system and cause the disease.' D. 'Maternal antibodies interfere with the development of active antibodies by the infant when immunized.'

D Rationale Passive antibodies received from the mother will be diminished by age 8 weeks and will no longer interfere with the development of active immunity to most communicable diseases. The spleen does not produce antibodies. Young infants often are exposed to infectious diseases. The viruses in immunizations are inactivated or attenuated; they may cause irritability and fever but will not cause the related disease.

7) A client is prescribed rifampin after being exposed to active tuberculosis. Which finding would the nurse immediately report to the health care provider? Select all that apply. One, some, or all responses may be correct. A. Reddish-orange color urine B. Yellow-colored teeth stains C. Orange-colored sweat and tears D. Small, red, pinpoint areas on the arms E. Numbness, tingling, and burning of extremities

D Rationale Pinpoint red areas that appear on the arms, legs, or trunk of the body are known as petechiae. The petechiae are tiny hemorrhages that occur under the skin as a result of a low circulating platelet count (thrombocytopenia). Thrombocytopenia occurs with liver stress or damage. As hepatotoxicity is a possible adverse reaction to rifampin, the health care provider must be notified of the appearance of petechiae. Reddish-orange colored urine or stool is a normal effect of the rifampin. Yellow-colored stains on the teeth are side effects that are not dangerous; however, there is no way to reverse the staining, and they may be permanent. Orange-colored sweat and tears are also normal side effects of rifampin, but they are not dangerous. Numbness, tingling, and burning of the extremities could indicate peripheral neuropathy, which can be treated with vitamin B 12, so this is not an immediate emergency.

1) Which purpose of insulin would a nurse identify when caring for a client prescribed insulin added to a solution of 10% dextrose in water after an intravenous solution containing potassium inadvertently was infused too rapidly? A. Glucose with insulin increases metabolism, which accelerates potassium excretion. B. Increased potassium causes a temporary slowing of the pancreatic production of insulin. C. Increased insulin accelerates the excretion of glucose and potassium, thereby decreasing the serum potassium level. D. Potassium follows glucose into the cells of the body, thereby raising the intracellular potassium level.

D Rationale Potassium follows glucose into the cells of the body, thereby raising the intracellular potassium level and preventing fatal dysrhythmias. Potassium is not excreted as a result of this therapy; it shifts into the intracellular compartment. The potassium level has no effect on pancreatic insulin production. Insulin does not cause the excretion of these substances.

9) The nurse plans to teach a fifth-grader with type 1 diabetes how to self-administer lispro and glargine insulin. Which action would the nurse include in the teaching plan? A. Alternate the sites until the best one to use is found. B. Self-administer the injections after being taught the technique. C. Draw up the insulin glargine and then draw up the insulin lispro. D. Learn to use the needle and syringe by practicing on an insulin pad first.

D Rationale Practice using a syringe builds confidence. The child's confidence, readiness, and skill for giving self-injections are essential for long-term management of diabetes. Injection sites must be rotated. Learning responsibility for injections should be a gradual process with continual support and guidance. Insulin glargine should not be mixed with other insulins; it should be prepared and administered separately.

5) Which mechanism is specifically responsible for the action of the medication ranitidine? A. Inhibiting proton pumps B. Promoting the release of gastrin C. Regenerating the gastric mucosa D. Inhibiting the histamine at H 2 receptors

D Rationale Ranitidine inhibits histamine at H 2 receptor sites in parietal cells, which limits gastric secretion. It does not inhibit proton pumps. Promoting the release of gastrin is undesirable; gastric hormones increase gastric acid secretion. Ranitidine does not regenerate the gastric mucosa; the medication prevents its erosion by gastric secretions.

23) Which reason will the nurse explain is the purpose for neomycin being prescribed to a client with cirrhosis? A. Prevents an infection B. Limits abdominal distention C. Minimizes intestinal edema D. Reduces the blood ammonia level

D Rationale Reducing the blood ammonia level decreases the effect of bacterial activity on blood and wastes in the gastrointestinal tract. Although neomycin is an aminoglycoside antimicrobial, it is not administered to prevent infection. Neomycin does not reduce abdominal distention. Neomycin has little or no effect on intestinal edema.

4) Which period of time would a nurse recognize as the greatest risk of hypoglycemia when caring for a client who receives regular insulin daily at 8:00 AM? A. 8:30 AM to 9:30 AM B. 8:00 PM to 12:00 AM C. 1:00 PM to 8:00 PM D. 10:00 AM to 1:00 PM

D Rationale Regular insulin peaks in 2 to 4 hours; therefore the greatest risk is between 10:00 AM and 1:00 PM. Although the onset of action occurs earlier, during the period from 8:30 AM to 9:30 AM, the level is not yet at its highest, so the risk of hypoglycemia is not at its greatest. NPH insulin's peak action is 4 to 12 hours; if hypoglycemia occurs, it will most likely happen between 12:00 PM and 8:00 PM.

4) A client begins treatment with rifampin for suspected pulmonary tuberculosis. Which information should the nurse include when teaching the client about this drug? A. "It is important to stay upright for 30 minutes after taking this drug." B. "Check your radial pulse before taking the drug." C. "Avoid prolonged exposure to the sun while taking this drug." D. "You may notice an orange-red color to your urine."

D Rationale Rifampin can cause a harmless reddish-orange discoloration of urine, feces, saliva, sweat, tears, and skin, even contact lenses. This effect can be very alarming for the client who may interpret it as some sort of bleeding. Understanding that this is a normal effect will promote adherence. The other instructions are not indicated when taking rifampin.

6) After receiving streptomycin sulfate for 2 weeks as part of the medical regimen for tuberculosis, the client reports feeling dizzy and having some hearing loss. Which part of the body is the medication affecting? A. Pyramidal tracts B. Cerebellar tissue C. Peripheral motor end plates D. Eighth cranial nerve's vestibular branch

D Rationale Streptomycin sulfate is ototoxic and may cause damage to auditory and vestibular portions of the eighth cranial nerve. Pyramidal tracts, cerebellar tissue, and peripheral motor end plates are not affected by streptomycin.

2) A child is prescribed tetracycline. The nurse understands which possible medication-related reaction is associated with this medication? A. Kernicterus B. Gray syndrome C. Reye syndrome D. Staining of teeth

D Rationale Tetracycline causes staining or discoloration of developing teeth in children. Sulfonamides may cause kernicterus in neonates. Chloramphenicol may cause Gray syndrome in infants. Aspirin may cause Reye syndrome in pediatric clients with a history of chickenpox or influenza.

1) Which effect has resulted in the avoidance of tetracycline use in children under 8 years old? A. Birth defects B. Allergic responses C. Severe nausea and vomiting D. Permanent tooth discoloration

D Rationale Tetracycline use in children under the age of 8 years has been discontinued because it causes permanent tooth discoloration. Birth defects, allergic responses, and severe nausea and vomiting are not prevalent reasons for the discontinuation of tetracycline medications in children under 8 years old.

8) How would the nurse reply when a client prescribed a tetracycline class medication asks why milk and antacids should be avoided before and after dosing? A. 'Taking these together can lead to kidney impairment.' B. 'The pairing of these substances leads to tooth staining.' C. 'Severe diarrhea can occur when taking these substances together.' D. 'This can lead to decreased absorption of the medication you need.'

D Rationale Tetracyclines chelate with calcium, iron, and magnesium, so substances containing these minerals are avoided to optimize absorption of the antimicrobial.

12) Which explanation would the nurse include when teaching a client scheduled for a bowel resection about the purpose of preoperative antibiotics? A. "They prevent incisional infection." B. "Antibiotics prevent postoperative pneumonia." C. "These medications limit the risk of a urinary tract infection." D. "They are given to eliminate bacteria from the gastrointestinal (GI) tract."

D Rationale The GI tract contains numerous bacteria; antibiotics are given to decrease the number of microorganisms in the bowel before surgery. Preventing incisional infection is a potential complication prevented by the use of sterile technique when changing the dressing. Avoiding postoperative pneumonia is a potential complication prevented by coughing, deep breathing, and early ambulation postoperatively. Limiting the risk of a urinary tract infection is a potential complication prevented by hygiene, meatal care, and increased hydration postoperatively.

1) Which education would the nurse provide parents about the side effects of the Haemophilus influenzae (Hib) vaccine? A. Lethargy B. Urticaria C. Generalized rash D. Low-grade fever

D Rationale The Hib vaccine may cause a low-grade fever. Lethargy is not expected. Urticaria is more likely to occur with the tetanus and pertussis vaccines. There may be a mild reaction at the injection site, but a generalized rash is not expected.

8) Which action will the nurse take after stopping the antibiotic infusion of a client who becomes restless and flushed, and begins to wheeze during the administration of an antibiotic? A. Check the client's temperature. B. Take the client's blood pressure. C. Obtain the client's pulse oximetry. D. Assess the client's respiratory status.

D Rationale The client is experiencing an allergic reaction that may progress to anaphylaxis. Anaphylactic shock can lead to respiratory distress as a result of laryngeal edema or severe bronchospasm. Assessing and maintaining the client's airway is the priority. Checking the client's temperature and taking the client's blood pressure are not the priority; vital signs should be obtained after airway patency is ensured and maintained. Pulse oximetry is only one portion of the needed respiratory status assessment.

9) The nurse is preparing to administer an intravenous piggyback antibiotic that has been newly prescribed. Shortly after initiation, the client becomes restless and flushed and begins to wheeze. After stopping the infusion, which priority action will the nurse take? A. Notify the primary health care provider immediately about the client's condition. B. Take the client's blood pressure. C. Obtain the client's pulse oximetry. D. Assess the client's respiratory status.

D Rationale The client is experiencing an allergic reaction. Severe allergic reactions commonly cause respiratory distress as a result of laryngeal edema or severe bronchospasm. Assessing and maintaining the client's airway is the priority. The nurse must determine the client's status before notifying the primary health care provider. Vital signs, including blood pressure and pulse oximetry, are obtained after airway patency is ensured and maintained.

1) A client asks the nurse what she should do if she forgets to take her contraceptive pill 1 day. Which response by the nurse is appropriate? A. 'Take your pills as instructed.' B. 'Call your primary health care provider immediately.' C. 'Continue as usual, and there shouldn't be a problem.' D. 'On the next day take 1 pill in the morning and 1 pill before bedtime.'

D Rationale The client should make up for the missed pill by taking 2 pills the next day; taking 1 pill in the morning and 1 pill in the evening decreases the chance of the client becoming nauseated. Telling the client to take her pills as instructed does not explain what is to be done if a pill is missed; missing 1 pill can alter hormone levels and predispose the client to becoming pregnant. It is unnecessary to call the primary health care provider unless other problems are identified. Telling the client that there should be no problem if she continues as usual is incorrect advice; again, missing 1 pill can alter hormone levels and predispose a woman to pregnancy.

11) A client is diagnosed with pulmonary tuberculosis, and the health care provider prescribes a combination of rifampin and isoniazid. The nurse evaluates that the teaching regarding the medications is effective when the client reports which action as most important? A. 'Report any changes in vision.' B. 'Take the medicine with my meals.' C. 'Call my doctor if my urine or tears turn red-orange.' D. 'Continue taking the medicine even after I feel better.'

D Rationale The medication should be taken for the full course of therapy; most regimens last from 6 to 9 months, depending on the state of the disease. Visual changes are not side effects of this medication. The medication should be taken 1 hour before meals or 2 hours after meals for better absorption. Urine or tears turning red-orange is a side effect of rifampin; although this should be reported, it is not an adverse side effect.

6) After teaching a client about sulfonamide use for a urinary tract infection, which client statement would the nurse review for correction? A. 'I will avoid the sunlight.' B. 'I will increase my fluid intake.' C. 'I will let my doctor know if I develop a rash.' D. 'I will stop taking the medication when my symptoms subside.'

D Rationale The nurse instructs the client to complete the entire course of treatment, not stop when symptoms subside. The client on sulfonamide therapy should avoid prolonged exposure to sun, increase fluid intake to support the kidneys, and report a rash to investigate possible hypersensitivity.

2) The nurse prepares to administer extended-release metformin to an older adult who has asked that it be crushed because it is difficult to swallow. Which rationale will prompt the nurse to ask the provider for a different form of metformin? A. This medication has a wax matrix frame that is difficult to crush. B. The medication has an unpleasant taste, which most clients find intolerable if crushed. C. If crushed, this medication irritates mucosal tissue and can cause oral and esophageal ulcer formation. D. Extended-release formulations are designed to be released slowly and crushing the tablet will prevent this from occurring.

D Rationale The slow-release formulary will be compromised, and the client will not receive the entire dose if it is chewed or crushed. The capsules are not difficult to crush. Irritation of the mucosal tissue is not the reason the medication should not be crushed; however, this medication should be given with meals to prevent gastrointestinal irritation. Although taste could be a factor, it is not the priority issue.

5) A client who receives NPH insulin every morning reports feeling nervous at 4:30 PM. The nurse observes that the client's skin is moist and cool. Which condition is the client likely experiencing? A. Hyperosmolar hyperglycemic nonketotic state B. Ketoacidosis C. Glycogenesis D. Hypoglycemia

D Rationale The time of the client's response corresponds to the expected peak action (4-12 hours after administration) of the intermediate-acting insulin that was administered in the morning, which can result in hypoglycemia. Hypoglycemia triggers the sympathetic nervous system; epinephrine causes diaphoresis and nervousness. Hyperosmolar hyperglycemic nonketotic state is a severe hyperglycemia state that occurs in clients with type 2 diabetes secondary to severe illness or stress. Warm, dry, flushed skin and lethargy are associated with hyperglycemia and ketoacidosis. Glycogenesis, the formation of glycogen in the liver, is unrelated to nervousness and cool, moist skin.

1) A breast-feeding mother asks the nurse if the use of herbal medicines will increase breast milk supply. Which nursing response is most appropriate? A. 'It may be safe if taken with lots of water.' B. 'It does not effectively increase breast milk supply.' C. 'It may cause iron deficiency anemia in the infant.' D. 'You should speak to your health care provider about this.'

D Rationale The use of herbs may increase breast milk supply, but research is limited, so the mother should consult with her health care provider. The herbs are safe for the mother with or without water. However, the priority in this case is to inform the parent of the adverse effects that can result in the infant. Early introduction of solids may increase the risk for iron deficiency anemia in the infant. The herbs increase breast milk supply.

6) A client with type 1 diabetes receives 30 units of neutral protamine Hagedorn (NPH) insulin at 7:00 AM. At 3:30 PM, the client becomes diaphoretic, weak, and pale. With which condition would the nurse determine that these physiological responses are associated? A. Diabetic coma B. Hyperosmolar hyperglycemic nonketotic syndrome C. Diabetic ketoacidosis D. Hypoglycemic reaction

D Rationale These are sympathetic nervous system responses to hypoglycemia; the peak action of NPH insulin is 8 to 12 hours after administration, and 8.5 hours have elapsed since it was given. The signs and symptoms of diabetic coma are dry mucous membranes; hot, flushed skin; deep, rapid respirations (Kussmaul breathing); acetone odor to the breath; nausea and vomiting; and, as with hypoglycemia, weakness. Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is a hyperglycemic state and this client has symptoms of a hypoglycemic state. Ketoacidosis results from excess use of fats for energy when carbohydrates cannot be used. Lipids are metabolized incompletely, and dehydration, acidosis (both ketotic and lactic), and electrolyte imbalance result. It is not the result of insulin administration.

3) The nurse is caring for a client who is receiving azathioprine, cyclosporine, and prednisone before receiving a kidney transplant. Which medication action would the nurse identify as the purpose of these medications? A. Stimulate leukocytosis B. Provide passive immunity C. Prevent iatrogenic infection D. Reduce antibody production

D Rationale These drugs suppress the immune system, decreasing the body's production of antibodies in response to the new organ, which acts as an antigen. These medications decrease the risk of rejection. These medications inhibit leukocytosis. These medications do not provide immunity; they interfere with natural immune responses. Because these medications suppress the immune system, they increase the risk of infection.

5) Which alteration is the likely cause of thyrotoxic crisis (thyroid storm) in a client who has had treatment with propylthiouracil for hyperthyroidism followed by thyroid ablation with 131I? A. Deficiency of iodine B. Decreased serum calcium C. Increased sodium retention D. Excessive hormone replacement

D Rationale Thyrotoxic crisis (thyroid storm) is the body's response to excessive circulating thyroid hormones. A deficiency of iodine results in a deficiency in thyroid hormone production. A decreased serum calcium causes tetany. Sodium retention is unrelated to thyrotoxic crisis; thyrotoxic crisis is caused by excessive circulating thyroid hormones.

2) The nurse provides discharge teaching to a client with tuberculosis. Which treatment measure would the nurse reinforce as the highest priority? A. Getting sufficient rest B. Getting plenty of fresh air C. Maintaining a healthy lifestyle D. Consistently taking prescribed medication

D Rationale Tubercle bacilli are particularly resistant to treatment and can remain dormant for prolonged periods; medication must be taken consistently as prescribed. Although getting sufficient rest, getting plenty of fresh air, and maintaining a healthy lifestyle are important, to heal the microorganisms must be eliminated with medication.

1) Which statement made by a client recently diagnosed with type 1 diabetes indicates that further education is necessary regarding the teaching plan? A. 'I will need to have my eyes and vision examined once a year.' B. 'I will need to check my blood sugar at home to evaluate my response to my treatment plan.' C. 'I can improve metabolic and cardiac risk factors of this disease if I follow a healthy diet and exercise routine.' D. 'Once I get my glucose levels under control, there is a good chance that I will be able to switch from insulin to an oral medication.'

D Rationale Type 1 diabetes mellitus (DM) is an autoimmune disorder in which beta cells are destroyed. No insulin or very little insulin is produced. A person with type 1 DM will need lifelong insulin injections to control blood sugar. Early detection of changes in the eye permits treatment plan adjustments that can slow or halt progression of retinopathy. Blood glucose monitoring should be done at home to evaluate the treatment plan. Disease risk factors can be improved with a healthy diet and exercise routine.

15) A client with an infection is receiving vancomycin. Which laboratory blood test result would the nurse report? A. Hematocrit: 45% B. Calcium: 9.0 mg/dL (2.25 mmol/L) C. White blood cells (WBC): 10,000 mm 3 (10 × 10 9/L) D. Blood urea nitrogen (BUN): 30 mg/dL (10.2 mmol/L)

D Rationale Vancomycin is a nephrotoxic medication. An elevated BUN can be an early sign of toxicity. The BUN of a healthy adult is 10 to 20 mg/dL (3.6-7.1 mmol/L). This hematocrit is expected in a healthy adult; the range is from 40 to 52. The expected range of the white blood cell (WBC) count is 5000 to 10,000 mm 3 (5 to 10 × 10 9/L) for a healthy adult. This calcium level is within the expected range of 9.0 to 10.5 (2.25-2.75 mmol/L) for a healthy adult.

2) Which prescription would the nurse anticipate for the client who takes a medication that interferes with fat absorption? A. High-fat diet B. Supplemental cod liver oil C. Total parenteral nutrition (TPN) D. Water-miscible forms of vitamins A and E

D Rationale Vitamins A, D, E, and K are known as fat-soluble vitamins because bile salts and other fat-related compounds aid their absorption. A high-fat diet will not achieve the uptake of fat-soluble vitamins in this client. Supplemental cod liver oil will not achieve the uptake of fat-soluble vitamins in this client. TPN is unnecessary; a well-balanced diet is preferred. Water-miscible forms of vitamins A and E can be absorbed with water-soluble nutrients.

10) The nurse in the urgent-care clinic is reviewing discharge instructions with a client who is prescribed doxycycline. Which statement by the client indicates understanding of the instructions? A. "I will not wear my contact lenses while taking this medication." B. "I will carry glucose tablets with me in case I experience low blood sugar." C. "I will take this medication with an antacid to prevent an upset stomach." D. "I will apply sunscreen when outside to prevent a sunburn."

D Rationale: Doxycycline is a tetracycline antibiotic. All tetracyclines can increase the sensitivity of the skin to ultraviolet light. The most common result is a sunburn. Clients on these types of medications should prevent sunburn by avoiding prolonged exposure to sunlight, wearing protective clothing and applying sunscreen to exposed skin while outdoors. This drug should be taken two hours before or after antacids, not with them. Hypoglycemia is not a common side effect of doxycycline. Wearing contact lenses is not contraindicated with this medication.

5) Which of the following instructions is most important for the nurse to include when discharging a client with an infection caused by staphylococcus? A. Schedule follow-up blood cultures B. Monitor for signs of recurrent infection C. Visit the provider in a few weeks D. Complete the full course of the antibiotic

D Rationale: Staphylococcus is a bacteria and to rid the body of the infection, it is most important to instruct the client to complete the full course of antibiotics. Not completing the full course of antibiotics can lead to antibiotic resistant infections. At this point, there is no indication for the need for blood cultures. The client will need a follow-up appointment with the provider, and will need to monitor for signs of recurrent infections, but these are not as high a priority as completing the full course of antibiotics.

6) A child is treated with succimer for lead poisoning. Which of these assessments is the priority? A. Check the client's serum potassium level. B. Check the client's blood calcium level. C. Test the client's deep tendon reflexes. D. Check the client's complete blood count with differential.

D Rationale: Succimer is used in the management of lead or other heavy metal poisoning. Although it is generally well-tolerated and has a relatively low toxicity, it may cause neutropenia. Succimer therapy should be withheld or discontinued if the absolute neutrophil count (ANC) is below 1,200/mm3. The normal range for an ANC is 1.5 to 8.0 (1,500 to 8,000/mm3). Therefore, the assessment priority in this scenario is checking the complete blood count (CBC) with differential which includes an ANC value.

3) A client is prescribed trimethoprim/sulfamethoxazole for recurrent urinary tract infections. Which statement by the nurse about this medication is correct? A. "You can stop the medication after five days." B. "Be sure to take the medication with food." C. "It is safe to take with oral contraceptives." D. "Drink at least eight glasses of water a day."

D Rationale: Trimethoprim/sulfamethoxazole is a highly insoluble medication and should be taken with a large volume of fluid. This medication can be taken with or without food. The full prescribed amount should be taken at evenly-spaced intervals until the medication is finished. Unlike many other antibiotics, trimethoprim/sulfamethoxazole does not seem to affect hormonal birth control such as the pill, the patch or ring.

9) A nurse receives a prescription to administer regular insulin U-500 to a client with diabetes mellitus. How will the nurse administer this medication? A. Intravenously using an infusion pump B. Subcutaneously using an insulin pump C. Intramuscularly using a U-100 syringe D. Subcutaneously using a U-500 syringe

D Rationale: Insulin U-500 is a highly concentrated form of insulin that is five times stronger than regular insulin. This medication should only be administered subcutaneously with a specialized U-500 syringe for accurate measurement. Concentrated insulin should not be administered intravenously, intramuscularly, or via an insulin pump due to the high risk of hypoglycemic episodes.

Glipizide (Glucotrol), glyburide THINK

Gli- Gly- "glide my glucose down"

Glargine (Lantus), detemir (Levemir) THINK

Good Looooong Acting Insulin (provide steady long continuous insulin coverage without peaks)

Isoniazid THINK

Iso "TB" niazid

Levothyroxine THINK

Levothy "roid" roxin

Metformin THINK

Met "can" form "lactic Acid" in Body

Glulisine, aspart, lispro THINK

Rapid Acting Insulin is G.A.L. Gadot "Wonder Woman"

Lactulose THINK

lactuLOSE "Ammonia"

Pumping Iron=

strong O2 on RBC

Double Feature: DKA and Renal Failure BOTH feature

using IV Insulin with IV Glucose to lower hyperkalemia

Vincristine/vinblastine THINK

"VINE to Wine with my Crabs/Cancer, but "crish/blasted" my nerves"

26) An adolescent is to begin a chemotherapeutic medication regimen. Which side effect of vincristine is most important for the nurse to prepare the adolescent to expect before treatment? A. Alopecia B. Mild Constipation C. Loss of appetite D. Peripheral neuropathy

A Rationale A side effect of vincristine is alopecia. To adolescents, who are very concerned with identity, hair loss represents a tremendous threat to self-image. Constipation, is not as important to the adolescent as a side effect that affects appearance. Although anorexia will be a concern while the adolescent is undergoing chemotherapy, it is not as important before the start of the regimen. Although neurologic side effects are serious, they are not as important to the adolescent before the start of chemotherapy.

27) Which anticipatory guidance would the nurse include when teaching an adolescent about side effects of dactinomycin and doxorubicin therapy? A. Wear a baseball cap. B. Eat three meals daily. C. Avoid dairy products. D. Dress in light clothing.

A Rationale Antineoplastic medications exert their effect on rapidly dividing tissues such as hair follicles, resulting in alopecia. Eating regular meals, avoiding dairy products, and wearing certain types of clothing are not related to the side effects of the antineoplastics that are being used.

31) A client is scheduled to begin chemotherapy 2 weeks after surgery for colon cancer. Which explanation would the nurse give to explain the delay after surgery? A. Chemotherapy interferes with cell growth and delays wound healing. B. Because chemotherapy causes vomiting, it endangers the integrity of the incisional area. C. Chemotherapy decreases red blood cell production, and the resultant anemia will add to postoperative fatigue. D. Chemotherapy increases edema in areas distal to the incision by blocking lymph channels with destroyed lymphocytes.

A Rationale Chemotherapeutic agents can attack healthy as well as malignant cells; they generally interfere with protein synthesis and cell division in all rapidly dividing cells, including those regenerating traumatized tissue (as in wound healing), bone marrow, and cutaneous and alimentary tract epithelial tissue. Vomiting should not disturb the integrity of the area. Decreased red blood cell levels caused by bone marrow depression can be corrected with transfusions. Chemotherapy should not cause a blockage of lymph channels, with destroyed lymphocytes increasing edema.

8) An adolescent who has been prescribed prednisone and vincristine for leukemia tells the nurse that he is constipated. Which reason would the nurse cite as the probable cause of the constipation? A. It is a side effect of the vincristine. B. The spleen is compressing the bowel. C. It is a toxic effect from the prednisone. D. The leukemic mass is obstructing the bowel.

A Rationale Constipation is a side effect of vincristine because it slows gastrointestinal motility. An enlarged spleen will put pressure on the stomach and diaphragm, not on the large bowel. Constipation is not a toxic effect of prednisone. It is unlikely that leukemia is causing an obstruction.

1) A client is prescribed epoetin injections. To ensure the client's safety, which laboratory value would the nurse assess before administration? A. Hematocrit B. Platelet count C. Prothrombin time D. Partial thromboplastin time

A Rationale Epoetin is used to treat anemia by increasing production of red blood cells. The laboratory value the nurse would assess before administration is the hematocrit because it measures the number of red blood cells. Erythropoietin is specific for increasing red blood cells and does not increase other blood components such as white blood cells or thrombocytes (platelets). The partial thromboplastin time and prothrombin time are measures of the effectiveness of anticoagulant therapy.

27) The nurse is caring for a child with an exacerbation of leukemia. The nurse would plan to administer the prescribed analgesic for bone pain at which time? A. At scheduled intervals B. When the child asks for it C. When pain becomes severe D. Before the pain becomes severe

A Rationale For maximal benefit, the analgesic should be administered at scheduled intervals that are individualized for the child; routine administration manages the pain before it becomes too intense. The goal is to keep the child pain free; by the time the child asks for the analgesic, the pain has returned. It is insensitive to allow the child to be in pain; there should be no pain.

3) An adolescent with leukemia is receiving vincristine. The mother reports that the child is complaining of feeling 'tingles' all over. Which response by the nurse is most appropriate regarding the effect of this medication? A. 'It is a neurological side effect.' B. 'It is caused by an autoimmune reaction.' C. 'The skin becomes sensitive with chemotherapy.' D. 'The central nervous system has become hyperactive.'

A Rationale Neurotoxicity is an anticipated side effect of vincristine sulfate. Some children report it as 'tingles' or feeling 'funny all over.' It is not usually permanent. Vincristine causes leukopenia, which increases susceptibility to infection; it does not cause an autoimmune reaction. Skin sensitivity is not the reason that the child feels tingly. Hyperactivity of the central nervous system is not a factor in the development of this neurological finding.

6) A client is receiving ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) therapy for Hodgkin's disease. When the client reports burning and tingling of the feet, which medication would the nurse determine is the likely cause? A. Neurotoxicity caused by vinblastine B. Hypersensitivity caused by dacarbazine C. Endocrine alterations caused by doxorubicin D. Peripheral vasoconstriction caused by bleomycin

A Rationale Neurotoxicity manifested by peripheral neuropathy (burning and tingling of the hands and/or feet) is a common and expected side effect of vinblastine. Dacarbazine and doxorubicin also cause peripheral neuropathy; however, the peripheral neuropathy does not occur as part of a hypersensitivity reaction, as was mentioned for dacarbazine, or due to endocrine function alterations, as was mentioned for doxorubicin. Bleomycin is not known to cause neurotoxicity and peripheral neuropathy.

11) The nurse is assessing a child receiving chemotherapy for treatment of leukemia. Which side effect would the nurse anticipate? A. Epistaxis B. Tachycardia C. Flushed skin D. Increased temperature

A Rationale Nosebleeds (epistaxis) are expected in a child with leukemia who is undergoing chemotherapy because the bone marrow is depressed and the number of platelets decreases substantially. Tachycardia is not expected unless there is severe anemia. Usually children with leukemia have pale skin. An increased temperature occurs only if there is an infection resulting from the leukemia.

1) Which toxic effect would a nurse monitor for in a client who is prescribed vincristine? A. Peripheral paresthesia B. Anginal-type chest pain C. Ophthalmic papilledema D. Bilateral crackles in the lung

A Rationale Peripheral paresthesia is an indication of toxicity from a plant alkaloid such as vincristine. Anginal-type chest pain, ophthalmic papilledema, and bilateral crackles in the lung are not side effects of this medication.

14) A client is admitted to the hospital with pancytopenia as a result of chemotherapy. Which information will the nurse provide to minimize the risk for complications? A. Avoid activities that risk traumatic injuries and exposure to infection. B. Perform frequent mouth care with a firm toothbrush. C. Increase oral fluid intake to a minimum of 3 L daily. D. Report any unusual muscle cramps or tingling sensations in the extremities. Rationale

A Rationale Reduced platelets increase the likelihood of uncontrolled bleeding; reduced lymphocytes increase susceptibility to infection. Aggressive oral hygiene can precipitate bleeding from the gums. Although fluids may be increased to flush out the toxic by-products of chemotherapy, this has no effect on pancytopenia. Muscle cramps or tingling sensations in the extremities are adaptations to hypocalcemia; hypocalcemia is unrelated to pancytopenia.

12) Parents of a child with sickle cell anemia ask about their child taking iron supplements to help treat the anemia. How will the nurse respond? A. Taking supplements will not help with this condition. B. It is advised that iron be taken with orange juice to aid in absorption. C. An over-the-counter multivitamin with iron should meet the needs of the child. D. It is advised that liquid iron supplements be given through a straw to prevent staining the teeth.

A Rationale Taking iron supplements will not help. Sickle cell anemia is not caused by too little iron in the blood; it is caused by destruction of red blood cells, which increases free iron. Taking iron supplements could cause harm, because the extra iron builds up in the body and can damage organs. Although iron is better absorbed when taken with orange juice, in the case of sickle cell anemia supplements are not given. Using a straw when giving liquid iron supplements does prevent staining of the teeth; however, giving iron to this child may be detrimental. A multivitamin may be beneficial for this child; however, the addition of iron could build up in the body.

15) A client with Hodgkin's disease is to receive the cyclic antineoplastic vincristine as part of a therapy protocol. Which mechanism of action would the nurse associate with this medication? A. Arresting mitosis in metaphase B. Inhibiting the synthesis of thymidine C. Alkylating nucleic acids needed for mitosis D. Inactivating DNA while inhibiting RNA synthesis

A Rationale Vincristine is a plant alkaloid that is cell-cycle specific. It affects cell division during metaphase by interfering with spindle formation and causing cell death. Inhibiting the synthesis of thymidine is the typical action of antimetabolites, not plant alkaloids. Alkylating nucleic acids needed for mitosis is typical of the action of alkylating agents, not plant alkaloids. Inactivating DNA and RNA synthesis is the typical action of antineoplastic antibiotics, not plant alkaloids.

6) A nurse is reviewing laboratory data prior to administering methotrexate to a client with breast cancer. Which clinical finding will the nurse report to the healthcare provider before administering the medication? A. ALT of 55 IU/mL B. WBC of 12,000/mm³ C. AST of 34 U/L D. HGB of 11.5 g/dL

A Rationale: Alanine transaminase (ALT) is a liver enzyme that is released into the bloodstream when liver damage is present (normal ALT is 4-36 IU/L). Methotrexate is an antineoplastic used in the treatment of various carcinomas. Methotrexate is contraindicated in clients with hepatic impairment. A higher than normal white blood cell (WBC) count is an expected finding in a client with carcinoma. Aspartate aminotransferase (AST) is a liver enzyme used to assess hepatic function. An AST level of 34 U/L is a normal finding. Anemia (low hemoglobin) is an expected finding in a client with carcinoma.

19) For which side effects will the nurse assess a client with cancer who is being treated with chemotherapeutic agents? Select all that apply. One, some, or all responses may be correct. A. Diarrhea B. Leukocytosis C. Bleeding tendencies D. Lowered sedimentation rate E. Increased hemoglobin levels

A, C Rationale Most chemotherapeutic agents interfere with mitosis. The rapidly dividing cells of the mucous membranes of the gastrointestinal tract are affected, causing stomatitis and diarrhea. Bone marrow depression often causes thrombocytopenia, resulting in bleeding tendencies. The bone marrow consists of rapidly dividing cells, and its activity is depressed. Leukopenia, not leukocytosis, can occur. The erythrocyte sedimentation rate generally increases in the presence of tissue inflammation or necrosis. Hemoglobin and hematocrit levels may decrease because of an inadequate number of red blood cells related to bone marrow depression.

20) The nurse is developing a plan of care for a client who has developed blisters and sores in the mouth after receiving chemotherapy. Which interventions should the nurse include? Select all that apply. A. Examine your mouth frequently. B. Use strong mouthwashes to kill bacteria. C. Drink 2 or more liters of water per day. D. Suck on ice chips during chemotherapy. E. Visit a dental hygienist weekly. F. Avoid spicy or acidic foods. Correct Answer (Blank)

A, C, D, F Rationale: Mucositis is a complex, multiphase process at the cellular level started in response to cytotoxic chemotherapy. The epithelial cells in the mouth are very sensitive to chemotherapy due to their high rate of cell turnover. Oral cryotherapy using ice water or ice chips can be used for the prevention of mucositis. It is believed that vasoconstriction caused by the cold temperature decreases exposure of the oral mucous membranes to the mucositis-causing agents. Frequent mouth assessment, and good and frequent oral hygiene are key in managing mucositis. The client should avoid the use of "strong" mouthwashes that often contain alcohol. Mucositis can be managed at home and does not require seeing a dental hygienist. Increased hydration is generally recommended.

30) A client is diagnosed at stage IV Hodgkin disease. Which therapy option is indicated? A. Radiation therapy B. Combination chemotherapy C. Radiation with chemotherapy D. Surgical removal of the affected nodes

B Rationale A protocol consisting of three or four chemotherapeutic agents that attack the dividing cells at various phases of development is the therapy of choice at this stage; alternating courses of different protocols generally are used. Radiation, alone or in combination with chemotherapy, is used in stages IA, IB, IIA, IIB, and IIIA. Radiation with chemotherapy is recommended for use in stage IIIA. Surgical removal of the affected nodes is not a therapy for Hodgkin disease at any stage. The nodes may be removed for biopsy or irradiated as part of therapy.

1) A client is receiving chemotherapy with doxorubicin. Which development will the nurse teach the client to report immediately? A. Nausea B. Sore throat C. Loss of hair D. Constipation

B Rationale A sore throat is indicative of a respiratory tract infection, which may be the first clinical sign of bone marrow suppression, which can be life-threatening. Nausea is an expected side effect of doxorubicin, but it is not life-threatening. Hair loss is not a side effect of doxorubicin but, regardless, is not life-threatening. Constipation is an expected side effect of doxorubicin, but it is not life-threatening.

12) The nurse observes bloody expectorant after a 4-year-old child with leukemia brushed his or her teeth. Which action should the nurse take next? A. Secure a smaller toothbrush for the child to use. B. Document and report the incident. C. Tell the child to be more careful when brushing the teeth. D. Rinse the child's mouth with half-strength hydrogen peroxide.

B Rationale Because of the increased capillary fragility and decreased platelet count that accompany leukemia, even the slightest trauma can cause hemorrhage. Brushing the teeth has caused gingival bleeding, and the incident should be documented; this information may also help define the treatment plan. It is wiser to eliminate a toothbrush and use a sponge-type applicator. It cannot be assumed that a 4-year-old child will or can follow a direction to be more careful when brushing. Rinsing the child's mouth with half-strength hydrogen peroxide could irritate the gums, causing more trauma. If oral ulcers develop, the mouth should be rinsed with an isotonic solution such as normal saline.

12) A client with stage III Hodgkin's disease is started on a multiple-drug regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine. Why are so many drugs necessary? A. Using smaller doses of several drugs reduces the likelihood of serious side effects. B. Each drug destroys the cancer cell at a different time in the cell cycle. C. Several drugs are used to destroy cells that are not susceptible to radiation therapy. D. Because there are stages of Hodgkin's disease, if one drug is ineffective, another will work.

B Rationale Cells are vulnerable to specific drugs through the stages of mitosis, and a combination bombards the malignant cells at various stages. The side effects of a drug are not ameliorated by a combination with others. Although the statement that several drugs are used to destroy cells that are not susceptible to radiation therapy is true, it is not the reason for using a combination of drugs. Although there is more than one stage of Hodgkin's disease, this is not the reason for using a combination of drugs.

1) The alkylating agent cyclophosphamide is prescribed for a school-age child with cancer. Which clinical manifestation would the nurse be alert for while the child is receiving this medication? A. Irritability B. Pain with urination C. Unpredictable nausea D. Hyperplasia of the gums

B Rationale Cystitis is a potentially serious adverse reaction to cyclophosphamide; it sometimes can be prevented by increasing hydration because the fluid flushes the bladder. Irritability may be present but is not a result of cyclophosphamide administration. Unpredictable nausea is an expected but manageable side effect of cyclophosphamide. Hyperplasia of the gums is unrelated to cyclophosphamide administration; it may occur with prolonged phenytoin therapy.

10) Which intervention would the nurse include in the plan of care for a client with breast cancer who received doxorubicin and cyclophosphamide 12 days ago and now has a white blood cell (WBC) count of 1.4 cells/mm 3 and reports shortness of breath and activity intolerance? Select all that apply. One, some, or all responses may be correct. A. Use an electric razor when shaving. B. Institute neutropenic precautions. C. Place client on airborne precautions. D. Transfuse two units of packed red blood cells (RBCs). E. Instruct nursing staff to wear a dosimeter badge.

B Rationale Doxorubicin and cyclophosphamide can lower the client's blood cell counts. Clients with low WBC counts need interventions to prevent infection, which include instituting neutropenic precautions. The nurse would instruct the client to use an electric razor if the platelet count was less than 50,000 cells/µL. Airborne precautions would be indicated if the client was ill with an infectious disease. The nurse would transfuse RBCs for a client with anemia (if prescribed by the health care provider). Nursing staff would wear dosimeter badges when caring for a client receiving internal radiation (brachytherapy).

2) The nurse administers erythropoietin three times a week to a client receiving chemotherapy for cancer. Which client response demonstrates a therapeutic effect? A. Increase in band cells B. Elevated hematocrit C. Normalization of platelets D. Increase in the white blood cell (WBC) count Rationale Erythropoietin stimulates red blood cell production, thereby increasing the hematocrit and hemoglobin level. Erythropoietin increases red blood cells (RBCs), not WBCs, not platelets, and not immature neutrophils (band cells).

B Rationale Erythropoietin stimulates red blood cell production, thereby increasing the hematocrit and hemoglobin level. Erythropoietin increases red blood cells (RBCs), not WBCs, not platelets, and not immature neutrophils (band cells).

4) A client receives doxorubicin as part of a chemotherapy protocol. The nurse would assess the client for signs and symptoms of which adverse effect? A. Toxic epidermal necrolysis B. Heart failure C. Pulmonary fibrosis D. Ototoxicity

B Rationale Heart failure and dysrhythmias are life-threatening toxic effects unique to doxorubicin. It is a vesicant that can cause severe tissue damage if the medication infiltrates; however, this is different from the tissue destruction associated with toxic epidermal necrolysis. Pulmonary fibrosis and ototoxicity are not adverse effects of doxorubicin.

3) A client is receiving doxorubicin as part of a chemotherapy protocol. The nurse will assess the client for which system toxicity? A. Neurotoxicity B. Cardiotoxicity C. Ototoxicity D. Nephrotoxicity

B Rationale Heart failure and dysrhythmias secondary to cardiotoxicity are the primary life-threatening toxic effects unique to doxorubicin. Neurotoxicity, nephrotoxicity, and ototoxicity are not associated with this medication.

17) A client with upper gastrointestinal (GI) bleeding develops mild anemia. Which agent is indicated for treatment of this condition? A. Dextran B. Iron salts C. Vitamin B 12 D. Erythropoietin

B Rationale Iron salts are needed in the formation of hemoglobin, so iron that is lost through bleeding must be replaced. Erythropoietin increases red blood cell (RBC) production, but the client's anemia is caused by GI bleeding, not impaired RBC production. Dextran is a plasma volume expander; it does not affect erythrocyte production. Vitamin B 12 is a water-soluble vitamin that must be used as a supplement when an individual has pernicious anemia.

4) A client with cancer is receiving leucovorin as part of a chemotherapy protocol. Which purpose does leucovorin serve? A. Potentiating the effect of alkylating agents B. Diminishing toxicity of folic acid antagonists C. Limiting vomiting associated with chemotherapy D. Preventing alopecia

B Rationale Leucovorin limits toxicity of folic acid antagonists, such as methotrexate sodium, by competing for transport into cells. Leucovorin does not potentiate the effect of alkylating agents. It does not have antiemetic properties. It will not prevent hair loss.

5) A client with multiple myeloma who is receiving the alkylating agent melphalan returns to the oncology clinic for a follow-up visit. For which adverse effect will the nurse monitor the client? A. Hirsutism B. Leukopenia C. Constipation D. Photosensitivity

B Rationale Melphalan depresses the bone marrow, causing a reduction in white blood cells (leukopenia), red blood cells (anemia), and thrombocytes (thrombocytopenia); leukopenia increases the risk of infection. Hirsutism occurs with the administration of androgens to women. Diarrhea, not constipation, occurs with melphalan. Photosensitivity occurs with 5-fluorouracil, floxuridine, and methotrexate, not with melphalan.

25) Which information will the nurse share about alopecia characteristics to a client who is to receive chemotherapy after surgery for cancer? A. Usually rare B. Not permanent C. Frequently prolonged D. Usually preventable

B Rationale Once the medications that interfere with cell division are stopped, the hair will grow back; sometimes the hair will be a different color or texture. Alopecia is a common side effect of chemotherapy. Hair loss persists while the medications are being received; once the medications are withdrawn, the hair grows back. Although ice caps on the head and rubber bands around the scalp have been used to try to limit alopecia, they have not been particularly effective.

22) Which nursing care will be included for a client who is receiving doxorubicin for acute myelogenous leukemia? A. Increasing citrus foods B. Providing frequent oral hygiene C. Encouraging activity D. Administering medications parenterally

B Rationale Stomatitis and hyperuricemia are possible complications of therapy; therefore oral care and hydration are important. A cidic foods such as citrus foods and fluids will cause pain for clients with stomatitis. Rest, not increased activity, is important for increased fatigability. Abnormal bleeding is a common problem; thus injections (administering medications parenterally) are contraindicated.

18) A client with Hodgkin's disease is started on chemotherapy. The nurse teaches the client to notify the health care provider for which adverse response to chemotherapy? A. Hair loss B. Sores in the mouth C. Moderate diarrhea after treatment D. Nausea for 6 hours after treatment

B Rationale Stomatitis is a common response to chemotherapy and should be brought to the health care provider's attention because a swish-and-swallow anesthetic solution can be prescribed to make the client more comfortable. Hair loss is also anticipated with some chemotherapeutic medications; the effects are temporary and reversible. Moderate diarrhea is expected and is not a cause for concern unless dehydration results. Nausea is expected but should be reported if it lasts more than 24 hours.

23) A 5-year-old child is receiving dactinomycin and doxorubicin therapy after nephrectomy for Wilms tumor. Which intervention would the nurse include when planning care? A. Adding citrus juices to meals B. Offering warm saline mouthwash C. Scheduling booster immunizations D. Reporting red-orange colored urine

B 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. Adding citrus juices to meals is contraindicated because it will aggravate the stomatitis that is a common side effect of both chemotherapeutic agents. Immunizations must be postponed because of the immunosuppressant effects of chemotherapy. Urine and other body fluids may become red-orange during the first 48 hours after doxorubicin is started; this is an expected response that need not be reported.

10) A 9-month-old infant with iron-deficiency anemia has been getting supplements but shows no improvement. The nurse recognizes which action by the parents as the reason for the lack of improvement? A. Administering iron supplements through a straw B. Administering iron supplements with whole cow's milk C. Administering iron supplements along with orange juice D. Administering iron supplements at the back of the mouth

B Rationale Whole cow's milk binds with free iron and reduces medication absorption. The infant has developed medication insufficiency for maximum therapeutic action. Administering iron supplements through a straw does not reduce medication absorption; it prevents the iron from staining the infant's teeth. Orange juice increases the absorption of iron supplements. Administering iron supplements at the back of the mouth does not reduce medication absorption; it prevents the iron from staining the infant's teeth.

2) The nurse is providing teaching to a client who has been prescribed cyclophosphamide for breast cancer treatment. Which of the following statements made by the client would indicate that additional teaching is needed? A. "I will probably need to plan on using a wig to cover my hair loss." B. "I should limit the amount of fluids I drink while taking this medication." C. "I will need to stay away from children when my white blood cell count is low." D. "I may have trouble getting pregnant due to the damaging effects of the medication."

B Rationale: Cyclophosphamide is a chemotherapeutic medication. Some of the side effects of this medication include hair loss, low white cell count and infertility. The client is encouraged to drink about 2 to 3 liters of fluid per day to aid in eliminating the chemotherapy from the body.

28) The hospice nurse is visiting a client diagnosed with end-stage lung cancer and metastases to the bone. What should the nurse keep in mind when planning for effective pain management? A. High doses of opioid analgesics will be required. B. Pain therapy is based on the client's report of pain. C. Relief of pain will be achieved quickly. D. The client will most likely become addicted.

B Rationale: Every person's pain experience is unique and should be treated based on the individual's goals for pain management. Therefore, the amount of medication needed is dependent on the client's needs and reports of pain relief. The nurse should not assume that high doses of analgesics will be needed to alleviate the client's pain. Immediate or quick pain relief might be difficult to achieve, especially in light of the client's type of cancer and bone metastases. Addiction is a psychological condition and not a concern for this client. However, the client may develop a physical dependence and tolerance to pain medications that may require an increase in dosage to manage pain effectively.

5) A client with anemia has a new prescription for ferrous sulfate. When teaching the client about diet and iron supplements, what should the nurse emphasize about taking an iron supplement? A. Lie down for about 10 minutes after taking the pill B. Take the iron tablet with a glass of orange juice C. Take an antacid with the iron supplement to reduce stomach upset D. Take the iron tablet with a glass of low-fat milk

B Rationale: Iron is best taken on an empty stomach, one hour before or two hours after meals, with a full glass of water or orange juice (ascorbic acid enhances the absorption of iron.) The client should not take the medication with antacids, dairy products, coffee or tea because these will decrease the effectiveness of the medicine. The client should not lie down for at least 10 minutes after taking the medicine.

14) The nurse receives an order to administer intravenous (IV) iron sucrose to a client with anemia. Which statement best describes the purpose of administering this medication using the IV route? A. To ensure that the entire dose of medication is given B. To prevent the drug from causing tissue irritation C. To provide more even distribution of the drug D. To enhance absorption of the medication

B Rationale: Iron sucrose is an iron supplement used to treat iron deficiency anemia. If given subcutaneously or intramuscularly, the tissue can become irritated and may result in bleeding into the muscle; therefore, the best route for this medication is intravenous (IV). The rate for administration will vary on the dosage but is typically at a slower rate due to the risk of adverse reactions. The other statements do not accurately describe the purpose for the IV route.

16) A nurse is administering vincristine to a client with cancer. The client asks the nurse how the medication works. Which statement by the nurse is appropriate? A. It stops the synthesis of proteins in cancer cells B. It prevents cell division of cancer cells C. It interrupts the S-phase of cancer cell reproduction D. It alters the DNA structure of cancer cells

B Rationale: Antimitotics, such as vincristine, kill cancerous cells by inhibiting cell division and mitosis. Stopping the synthesis of proteins in cancer cells is the expected action of antitumor antibiotics. Interruption of the S-phase of cell reproduction is the expected action of antimetabolites. Altering the DNA structure of cancer cells is the expected action of alkylating agents.

10) A nurse is preparing to administer doxorubicin to a client with bladder carcinoma. How will the nurse prepare this medication? A. While wearing sterile gloves B. In a biological safety cabinet C. Inside a temperature-controlled room D. By withdrawing into a syringe undiluted

B Rationale: Doxorubicin should be prepared in a biological safety cabinet. Doxorubicin is a high-risk medication whose fumes may cause health hazards. A biosafety cabinet controls the airflow while preparing this medication. Sterile gloves are not required. Standard gloves, a gown, and a mask should be worn when preparing this medication. The temperature of the room is not a specified guideline for preparing this medication. Doxorubicin should be diluted with normal saline before administration.

11) A nurse is preparing to administer reconstituted doxorubicin (Myocet) to a client with thyroid carcinoma. Nuclear medicine calls for the client, and the nurse is unable to administer the medication. Which action should the nurse perform with the medication? A. Save the medication in a syringe with an aluminum needle B. Store the medication in the refrigerator inside the syringe C. Discard the medication in the hazardous waste container D. Add the medication to the intravenous fluids in the client room

B Rationale: Doxorubicin that is stored in a refrigerator is stable for up to 48 hours. The medication remains stable at room temperature for up to 24 hours. Saving the medication with an aluminum needle will cause discoloration of the solution and form a dark precipitate. Discarding the medication is not necessary. The medication can be stored for 24-48 hours. Doxorubicin should not be added to intravenous fluids. The medication should be dissolved completely with a diluent.

2) The nurse is reviewing the laboratory results for a client with cancer who is being treated with chemotherapy and recently started prescribed filgrastim. Which laboratory value indicates the treatment is effective? A. Hemoglobin level of 9.8 g/dL B. White blood cell count (WBC) of 5,200/mm3 C. Platelet count of 200,000/mm D. Red blood cell count (RBC) of 4 million/mm

B Rationale: The client has a normal white blood cell count indicating that filgrastim has been effective. The action of filgrastim is to increase neutrophil production, thereby increasing the white blood cell (WBC) count. Decreased hemoglobin (Hgb) indicates anemia. The hemoglobin and red blood cell (RBC) count are below normal limits for an adult male. Epoetin alfa is used to treat low RBC counts (anemia) caused by chemotherapy. The platelet count is within normal limits for an adult client.

12) The oncology nurse is preparing to administer the initial dose of vincristine to a child diagnosed with acute lymphocytic leukemia. Which interventions should the nurse include in the plan of care? Select all that apply. A. Apply pressure to the injection site if extravasation occurs. B. Monitor liver function tests regularly. C. Monitor for numbness or tingling in the fingers and toes. D. Select the appropriate catheter for intrathecal administration. E. Verify blood return before, during and after intravenous administration.

B, C, E Rationale: Acute lymphocytic leukemia (ALL) is the most common type of cancer in children and treatment protocols include vincristine, an anticancer drug. Vincristine is for intravenous use only; intrathecal (i.e., spinal) administration can be fatal. Vincristine is a vesicant that can cause significant local damage if extravasation occurs; treatment includes subcutaneous injection of an antidote and warm compresses (topical cooling may worsen the effect). Peripheral neuropathy is a major side effect associated with vincristine. The nurse should monitor for decreased hepatic functioning because vincristine is metabolized in the liver.

14) The nurse is caring for a child who is receiving vincristine. Which body systems are most important for the nurse to assess after medication administration? Select all that apply. One, some, or all responses may be correct. A. Respiratory B. Neurological C. Reproductive D. Hematologic E. Gastrointestinal

B, D, E Rationale Vincristine is neurotoxic; therefore the child should be monitored for paresthesias, seizures, footdrop, bowel and bladder problems, and alterations in the function of cranial nerves. Hematologic problems such as anemia, thrombocytopenia, and leukopenia occur, although they are not as severe as with other chemotherapeutic agents, such as cyclophosphamide. Gastrointestinal adverse effects include severe constipation, intestinal necrosis, intestinal perforation, and paralytic ileus, in addition to nausea and vomiting. Respiratory problems are not associated with vincristine therapy. The reproductive system is not affected by vincristine therapy.

9) To minimize the side effects of the vincristine that a client is receiving, which diet would the nurse advise? A. Low in fat B. High in iron C. High in fluids D. Low in residue

C Rationale A common side effect of vincristine is a paralytic ileus that results in constipation. Preventative measures include high-fiber foods and fluids that exceed minimum requirements. These will keep the stool bulky and soft, thereby promoting evacuation. Dietary plans that are low in fat, high in iron, and low in residue will not provide the roughage and fluids needed to minimize the constipation associated with vincristine.

10) Which common side effect will the nurse address in the care plan of a client with cancer receiving the plant alkaloid vincristine? A. Color-blindness B. Anuria C. Constipation D. Hyperphosphatemia

C Rationale Although most chemotherapy causes diarrhea, vincristine can cause severe constipation, impaction, or paralytic ileus. Visual changes may occur, but color-blindness is not one of them. Polyuria, not anuria, is common. Hyperuricemia may occur, but hyperphosphatemia is not associated with this medication.

8) An adolescent is prescribed an antineoplastic agent. Which instruction would the nurse give to the parents before discharge? A. Limit contact with all peers and family members. B. Withhold medications when nausea occurs to prevent vomiting. C. Schedule laboratory blood tests to evaluate response to the medication. D. Return weekly for a bone marrow aspiration to monitor effectiveness of therapy.

C Rationale Blood tests indicate response to therapy; if the white blood cell count drops precipitously, therapy may be halted temporarily. Children undergo therapy for extended periods, and prolonged separation from their peers may lead to social isolation. Contact with children who have active infections should be avoided. Although nausea commonly occurs with this therapy, antiemetic measures are instituted; the medication is not withdrawn for this reason. A bone marrow aspiration is a painful procedure and is performed selectively (e.g., to confirm the diagnosis), not routinely.

7) A school-age child diagnosed with acute lymphocytic leukemia (ALL) becomes constipated after receiving induction therapy with prednisone, vincristine, and asparaginase. Which would the nurse suspect as the cause? A. Diet, which lacks bulk B. Inactivity, which results from illness C. Vincristine, which decreases peristalsis D. Prednisone, which causes gastric irritability

C Rationale Constipation, which may progress to paralytic ileus, is a side effect of vincristine. Lack of bulk and inactivity each may contribute to constipation, but neither is the primary cause of this child's constipation. Prednisone may cause nausea and vomiting, but it does not cause constipation.

28) Which concept is important to teach a client in relation to why medication cocktails are more effective than a single medication in cancer therapy? A. Medication resistance B. Tumor doubling time C. Cellular growth cycle D. Retained radioactive particles

C Rationale Different medications destroy cells at different stages of their replication; rapidly dividing cells not destroyed by one medication may be destroyed by another medication during a different stage of cell replication. Although certain tumors are medication resistant, it is not the reason for multiple chemotherapeutic medications; medication-resistant tumors may be treated with surgery, radiation therapy, or other methods. The doubling time of the tumor is a factor that influences the length of time chemotherapy will be given, but it is not the reason multiple medications are given. Retained radioactive particles can occur with internal radiation therapy, not chemotherapy.

8) A client with Hodgkin's disease adds doxorubicin to current therapy. Which advice will the nurse provide about this medication? A. Cease taking any medication that contains vitamin D. B. Keep the doxorubicin in a dark place protected from light. C. Expect urine to turn red for a few days after taking this medication. D. Take the doxorubicin on an empty stomach with large amounts of fluids.

C Rationale Doxorubicin causes the urine to turn red for a few days; the client should be informed of this expectation so as not to become alarmed when it occurs. Discontinuing the intake of vitamin D is true for plicamycin, not the medications in this protocol. It is unnecessary to keep doxorubicin in a dark area, protected from light. Doxorubicin is not given orally, only via the intravenous route.

6) A client diagnosed with breast cancer is prescribed doxorubicin. Which assessment finding would the nurse recognize as a toxic effect of this medication? A. Paralytic ileus B. Red-tinged urine C. Cardiac dysrhythmias D. Increased serum magnesium

C Rationale Doxorubicin has the potential for cardiac toxicity, including changes in heart rhythm. Paralytic ileus is a toxic effect of vincristine, not doxorubicin. Red-tinged urine is a benign side effect, the result of metabolism of the doxorubicin. The magnesium level is not influenced by doxorubicin.

1) Which clinical finding indicates that doxorubicin toxicity may have occurred? A. Fever B. Blue tinge to the urine C. Alteration in cardiac rhythm D. Increasing anxiety

C Rationale Doxorubicin is cardiotoxic and causes dysrhythmias. It increases the risk for infections secondary to myelosuppression, which may result in fever; however, this is not the result of toxicity. Blue-tinged urine is a side effect of doxorubicin, not a toxic effect. Feelings of nervousness are a side effect of doxorubicin, not a toxic effect.

5) A client with adenocarcinoma receives doxorubicin intravenously (IV) to reduce the tumor mass. Which clinical finding indicates that doxorubicin toxicity may have occurred? A. Fever B. Blue tinge to the urine C. Alteration in cardiac rhythm D. Increasing anxiety

C Rationale Doxorubicin is cardiotoxic and causes dysrhythmias. It increases the risk for infections secondary to myelosuppression, which may result in fever; however, this is not the result of toxicity. Blue-tinged urine is a side effect of doxorubicin, not a toxic effect. Feelings of nervousness are a side effect of doxorubicin, not a toxic effect.

11) A child with iron-deficiency anemia is prescribed oral iron therapy. Anticipatory guidance regarding which side effect would the nurse provide? A. Bloody stool B. Orange urine C. Greenish-black stool D. Staining of the mouth

C Rationale Iron is excreted in the feces, and the change in color results from the insoluble iron compound excreted in the stool. Blood in the stool is associated with lower intestinal bleeding, not supplemental iron ingestion. Orange urine is not associated with supplemental iron ingestion; it occurs with phenazopyridine hydrochloride or rifampin administration. Staining of the mucous membranes of the mouth should not occur with oral administration of iron if a straw is used and the teeth are brushed immediately after administration. The teeth, not the mucous membranes, may become stained if these precautions are not taken.

6) Which drink would the nurse instruct a client with iron deficiency anemia to choose to drink with the supplement for efficient absorption? A. Water B. Skim milk C. Orange juice D. A strawberry milkshake

C Rationale Iron should be taken before breakfast on an empty stomach to permit maximal absorption; the ascorbic acid in orange juice enhances the absorption of iron. Water does not provide the ascorbic acid necessary for absorption of iron. Iron should not be taken with milk or other dairy products, which may interfere with its absorption.

3) Which systemic side effect would the nurse monitor for in a client receiving combination chemotherapy for the treatment of metastatic carcinoma? A. Ascites B. Nystagmus C. Leukopenia D. Polycythemia

C Rationale Leukopenia, a reduction in white blood cells, is a systemic effect of chemotherapy as a result of myelosuppression. Ascites is not a side effect of chemotherapy. Chemotherapy does not affect the eyes; nystagmus is an involuntary, rapid rhythmic movement of the eyeballs. Also, nystagmus is a local, not a systemic, response. The red blood cells will be decreased, not increased.

7) A client is receiving combination chemotherapy for the treatment of metastatic carcinoma. For which systemic side effect would the nurse monitor the client? A. Ascites B. Nystagmus C. Leukopenia D. Polycythemia

C Rationale Leukopenia, a reduction in white blood cells, is a systemic effect of chemotherapy as a result of myelosuppression. Ascites is not a side effect of chemotherapy. Chemotherapy does not affect the eyes; nystagmus is an involuntary, rapid rhythmic movement of the eyeballs. Also, nystagmus is a local, not a systemic, response. The red blood cells will be decreased, not increased.

3) Which information would the nurse include when teaching parents about the side effects of iron supplements? A. The urine may turn red. B. The skin will turn yellow. C. The teeth may become stained. D. The stools will take on a clay color.

C Rationale Liquid oral iron supplements may stain the teeth; brushing the teeth after administration may limit the discoloration. There should be no change in the color of the urine. Yellowing of the skin is a sign of jaundice; it is not a side effect of an iron supplement. The stools will become black-green; clay-colored stools are a sign of biliary obstruction.

17) Which response would the nurse give to a client receiving chemotherapy who develops sores in the mouth and asks the nurse why this happened? A. "The sores occur because of the direct irritating effects of the medication." B. "These tissues are poorly nourished because you have a decreased appetite." C. "The frequently dividing cells of the gastrointestinal tract are damaged by the medication." D. "This side effect occurs because it targets the cells of the gastrointestinal system."

C Rationale Many chemotherapeutic agents function by interfering with the DNA replication associated with cellular reproduction (mitosis). Frequent cellular mitosis of the stratified squamous epithelium of the mouth and anus results in these areas being powerfully affected by the medications. The response "The sores occur because of the direct irritating effects of the medication" is inaccurate; most agents are administered parenterally. A decreased appetite (anorexia) does not cause stomatitis. Chemotherapeutic agents affect the most rapidly proliferating cells, which include not only the cells of the gastrointestinal epithelium but also those of the bone marrow and hair follicles.

24) A child is prescribed dactinomycin and doxorubicin therapy after a nephrectomy for Wilms tumor. Which intervention would the nurse include in the plan of care? A. Administering aspirin for pain B. Offering citrus juices with meals C. Ensuring meticulous oral hygiene D. Eliminating spicy foods from the diet

C Rationale Oral hygiene is essential, especially during the administration of medications that have a negative effect on the oral mucosa. Although pain may be present, aspirin is avoided because doxorubicin is also being used, and a side effect of this medication is thrombocytopenia. Aspirin is contraindicated for children because it is associated with Reye syndrome. Citrus juice will aggravate stomatitis, which is a common side effect of dactinomycin. Spicy foods may aggravate the stomatitis that occurs with chemotherapy. However, usually any food that the child requests is permitted.

6) A client receiving cancer chemotherapy asks the nurse why an antibiotic was prescribed. Which tissue affected by chemotherapy will the nurse consider when formulating a response? A. Liver B. Blood C. Bone marrow D. Lymph nodes

C Rationale Prolonged chemotherapy may slow production of leukocytes in bone marrow, thus suppressing the immune system. Antibiotics may be required to help counter infections that the body can no longer handle easily. The liver does not produce leukocytes. Although leukocytes are in both blood and lymph nodes, these cells are more mature than those found in the bone marrow and thus are more resistant to the effects of chemotherapy.

7) A child with Wilms tumor is prescribed doxorubicin hydrochloride. Which common side effect unique to doxorubicin would the nurse expect to observe in the child? A. Hair loss B. Vomiting C. Red urine D. Stomatitis

C Rationale Red urine is a common side effect of doxorubicin administration. The medication is not metabolized and is excreted in the urine. The genitourinary responses to vincristine are nocturia, oliguria, urine retention, and gonadal suppression. Hair loss, vomiting, and stomatitis occur with both medications.

15) Which action would the nurse take when administering iron dextran? A. Use a transdermal needle. B. Massage the injection site. C. Use the Z-track method. D. Apply a local anesthetic first.

C Rationale The Z-track injection method prevents seepage of iron dextran through the needle track, thereby limiting irritation of subcutaneous tissue and staining of the skin. The length of a transdermal needle is too short to reach a muscle; a 1.5-inch (3.8 cm) needle is required. Massage will force iron dextran into the subcutaneous tissue, causing irritation and staining. Although an injection may be uncomfortable, a local anesthetic is unnecessary.

13) Which laboratory test result would alert the nurse that fluid intake would need to be increased in a child receiving vincristine? A. Urine pH of 6, normal B. Urine specific gravity of 1.020, normal C. Blood uric acid level of 7.5 mg/dL, high D. Blood urea nitrogen level of 15 mg/dL, normal

C Rationale The normal blood uric acid level for children ranges from 2.5 to 5.5 mg/dL. An increase in the uric acid level caused by the destruction of cells may lead to renal problems; increased fluid intake helps dilute the urine. A urine pH of 6 is within the expected range of 4.5 to 8. A urine specific gravity of 1.020 is within the expected range of 1.005 to 1.030 (usually 1.010-1.025). A blood urea nitrogen level of 15 mg/dL is within the expected range of 5 to 18 mg/dL.

13) A client develops severe bone marrow suppression related to cancer treatment. Which instruction is important for the nurse to include in the client's teaching? A. Be prepared to experience alopecia. B. Increase fluids to at least 3 liters per day. C. Use a soft toothbrush for oral hygiene. D. Monitor your intake and output of fluids.

C Rationale Thrombocytopenia occurs with several cancer treatment programs; using a soft toothbrush helps prevent bleeding gums. Although alopecia does occur, it is not related to bone marrow suppression. Increasing fluids will neither reverse bone marrow suppression nor stimulate hematopoiesis. Monitoring intake and output of fluids is not related to bone marrow suppression.

1) A child receiving methotrexate and undergoing cranial radiation is very weak. The mother asks the nurse if she should give her child vitamins. Which response by the nurse is most appropriate? A. 'That's an excellent idea. I'll try to get a prescription for her.' B. 'Unfortunately, vitamins won't make her feel any better now.' C. 'That won't be possible. Vitamins interfere with the action of methotrexate.' D. 'After we receive the laboratory reports, your daughter will be getting vitamins.'

C Rationale Many vitamin supplements contain folic acid, which negates the action of methotrexate, a folic acid antagonist. Vitamin therapy is contraindicated, so the nurse would not try to obtain a prescription, and vitamins will not be prescribed after the laboratory reports have come back. Although vitamins contribute to well-being, stating that the client won't feel any better does not answer the question.

1) A nurse is teaching a parent how to administer oral iron supplements to a 2-year-old child. Which intervention should be included in the teaching? A. Stop the medication if the stools become tarry green B. Add the medicine to a bottle of formula C. Give the medicine with orange juice and through a straw D. Administer the iron with your child's meals

C Rationale: Absorption of iron is facilitated in an environment rich in vitamin C. Because liquid iron preparation will stain teeth, a straw should be used. Parents should be informed that dark, tarry stools are expected outcomes of taking iron supplements. Iron is best absorbed on an empty stomach (but it may be given after meals if the child experiences an upset stomach).

9) A client is being discharged with a prescription for an iron supplement. Which client statement indicates the need for further teaching by the nurse? A. "I will have greenish-black stools from the medication." B. "I will not take antacids with my iron supplement." C. "I will take the iron supplement with a full glass of milk." D. "I will take vitamin C along with the iron supplement."

C Rationale: Iron supplements should be taken along with Vitamin C, such as orange juice, because this increases the absorption. Conversely, antacids, milk, caffeinated beverages, and calcium supplements can decrease the absorption of iron. Iron should be taken one hour before or two hours after meals to enhance absorption, although clients who report gastrointestinal intolerance may take it with food. Iron will cause stool to turn greenish-black and tarry.

9) The nurse is caring for a client who recently received an allogeneic bone marrow transplant for the treatment of leukemia. Which nursing intervention is a priority for this client? A. Provide education on infection prevention in the community B. Assist the client with ambulation every 2 hours C. Monitor the client for signs of infection D. Introduce the client to another bone marrow recipient

C Rationale: Leukemia is cancer that results in the uncontrolled production of immature WBCs (" blast" cells) in the bone marrow. Hematopoietic stem cell transplantation (HSCT), also called bone marrow transplantation (BMT), is standard treatment for the patient with leukemia who has a closely matched donor, e.g., a sibling (allogeneic). The client has an impaired immune system due to the diagnosis of leukemia and the treatment related to the bone marrow transplant, placing the client at an increased risk for infections. The priority if for the nurse to monitor for signs of infection including a temperature above 100.5 °F (38 °C), chills and cough. The other options are also appropriate for this client; however, they are not the priority immediately following a bone marrow transplant.

16) A client with severe iron-deficiency anemia is prescribed a parenteral form of iron. Which intervention does the nurse prepare to implement before administering the medication? A. Obtain the client's vital signs. B. Use the Z-track administration method. C. Administer a small test dose. D. Obtain informed consent.

C Rationale: The most serious adverse effect of iron dextran is an anaphylactic reaction. Although anaphylactic reactions are rare, their possibility demands that iron dextran be used only when clearly required. To reduce this risk, each dose must be preceded by a small test dose and the client must be closely monitored while receiving the test dose. The nurse should be aware that even the test dose can trigger anaphylactic and other hypersensitivity reactions. In addition, even when the test dose is uneventful, patients can still experience anaphylaxis. The medication does not require informed consent and obtaining the client's vital signs does not prevent an anaphylactic reaction. If the medication is ordered to be administered intramuscularly, the Z-track technique should be used to minimize discomfort, leakage and surface discoloration.

13) Which instructions would the nurse include when teaching parents how to administer liquid iron to their child? Select all that apply. One, some, or all responses may be correct. A. Protect the child from sunlight. B. Administer the medication with food. C. Anticipate that stools tend to be blackish-green. D. Give the medication with a glass of orange juice. E. Have the child drink it through a straw.

C, D, E Rationale Iron thickens the consistency of stools and may turn stools a blackish-green color. Citrus juices contain vitamin C and are acidic, meaning that they increase the absorption of iron. Direct contact with iron stains the teeth. Use of a needleless syringe permits accurate dosing and limited exposure of the teeth to the medication when given to very young children, but adolescents can drink the medication through a straw, which deposits the medication behind the teeth. The child will not experience photosensitivity when undergoing iron therapy. The medication should be taken between meals because it is best absorbed in an environment that has a low pH.

21) Which intervention would the nurse take to improve nutrition after identifying that a client receiving chemotherapy has lost weight? Select all that apply. One, some, or all responses may be correct. A. Provide low-carbohydrate meals. B. Decrease fluid intake at mealtime. C. Encourage the intake of preferred foods. D. Promote the intake of small, frequent meals E. Administer prescribed antiemetics before meals

C, D, E Rationale Selecting preferred foods increases the likelihood of the client eating the food. Small, frequent feedings are better tolerated than large meals. Antiemetics should be administered prophylactically to decrease nausea and enhance appetite. The diet should provide maximum protein and carbohydrates to meet demands related to restoration of body cells and energy. Decreasing fluid intake may have deleterious effects.

15) A client who was admitted with a diagnosis of acute lymphoblastic leukemia is receiving chemotherapy. Which assessment findings would alert the nurse to the possible development of thrombocytopenia? Select all that apply. One, some, or all responses may be correct. A. Fever B. Diarrhea C. Melena D. Hematuria E. Ecchymosis

C, D, E Rationale Thrombocytopenia is a condition characterized by abnormally low levels of thrombocytes, also known as platelets, in the blood. This reduction in platelet activity impairs blood clotting, so any assessment finding associated with potentially abnormal bleeding would alert the nurse to the possibility of thrombocytopenia. This includes melena (digested blood in feces), hematuria (bleeding within the renal system), and ecchymosis (bleeding into skeletal soft tissue). Fever and diarrhea are common side effects of chemotherapy but are not findings specifically attributed to thrombocytopenia.

9) A client receiving doxorubicin (Adriamycin) intravenously (IV) complains of pain at the insertion site, and the nurse notes edema at the site. Which intervention is most important for the nurse to implement? A. Assess for erythema. B. Administer the antidote. C. Apply warm compresses. D. Discontinue the IV fluids.

D Doxorubicin is an antineoplastic agent that causes inflammation, blistering, and necrosis of tissue upon extravasation. First, all IV fluids should be discontinued at the site to prevent further tissue damage by the vesicant.

2) A 3-year-old child is prescribed a liquid iron preparation. The nurse would include which intervention when teaching the parent about the administration of this medication? A. 'Monitor the stools for diarrhea.' B. 'Administer with meals to improve absorption.' C. 'Avoid giving the child orange juice with the iron preparation.' D. 'Have the child drink the diluted iron preparation through a straw.'

D Rationale A liquid iron preparation may stain tooth enamel; therefore it should be diluted and administered through a straw. Constipation, rather than loose stools, often results from the administration of iron. Iron absorption is improved when taken on an empty stomach. The exception is acidic foods, such as citrus juices, which improve absorption.

26) Which mechanism of action explains the ability of nitrogen mustard to interfere with growth of cancer cells? A. Interference of the cellular protein synthesis B. Inhibition of the synthesis of purine and pyrimidine C. Binding with DNA to interfere with RNA production D. Combining with DNA strands and interfering with cell replication

D Rationale Alkylating agents such as nitrogen mustard combine with DNA strands and interfere with cell replication. Some chemotherapeutic medications are believed to act by interfering with cellular protein synthesis, but nitrogen mustard does not. Inhibiting the synthesis of purine and pyrimidine is the mechanism of action of antimetabolites. Antibiotics, not nitrogen mustard, used in cancer chemotherapy are believed to act by binding with DNA to interfere with RNA production.

2) A complete blood count is prescribed before each round of a client's cancer chemotherapy. Which component of the complete blood count is of greatest concern to the nurse? A. Platelets B. Hematocrit C. Red blood cells (RBCs) D. White blood cells (WBCs)

D Rationale Antineoplastic medications depress bone marrow, which causes leukopenia; the client must be protected from infection, which can be life-threatening. RBCs diminish slowly and can be replaced with a transfusion of packed RBCs. Platelets decrease as rapidly as WBCs, but complications can be limited with infusions of platelets.

4) A client with laryngeal cancer is receiving chemotherapy. Which laboratory report is most important for the nurse to monitor when considering the effects of chemotherapy? A. Platelets B. Hemoglobin level C. Red blood cell count D. White blood cell count

D Rationale Antineoplastic medications depress bone marrow, which results in leukopenia; the client must be protected from infection, which is a primary cause of death in the client with cancer. Platelets may decrease rapidly, but complications may be limited by infusions of platelets. Although the hemoglobin level diminishes, a transfusion with packed red blood cells (PRBCs) will alleviate the anemia. RBCs diminish slowly and may be replaced with a transfusion of PRBCs.

29) A client is diagnosed with multiple myeloma. Which intervention would the nurse expect the plan of care to include? A. Radiotherapy on an outpatient basis B. Human leukocyte interferon therapy C. Surgery to remove the invasive lesions D. Chemotherapy employing a combination of medications

D Rationale Chemotherapy employing a combination of drugs is the treatment of choice; a variety of chemotherapeutic medications affect rapidly dividing cells at different stages of cell division. Although radiotherapy on an outpatient basis may be used to alleviate pain and treat acute vertebral lesions, it is not the primary approach. Although human leukocyte interferon therapy may be done, it is not the primary treatment. Multiple myeloma is a diffuse disorder of the bone, and no single lesion can be removed.

2) A client receives doxorubicin infusions for treatment of acute lymphocytic leukemia. Which clinical finding indicates that toxicity has occurred? A. Alopecia B. Dyspnea C. Metallic taste to food D. Cardiac rhythm abnormalities

D Rationale Doxorubicin is cardiotoxic, which is manifested by transient electrocardiogram (ECG) abnormalities. Alopecia is an expected side effect of doxorubicin, not a toxic effect. Dyspnea and a metallic taste to food are not effects of doxorubicin.

3) Which step would the nurse include during the administration of epoetin prescribed to a client with acquired immunodeficiency syndrome (AIDS)? A. Administer the medication via the Z-track technique. B. Shake the vial before withdrawing the solution. C. Obtain the client's pulse rate before administration. D. Use a syringe that has a 1-inch (2.5-cm), 25-gauge needle.

D Rationale Epoetin is administered via the subcutaneous or intravenous route; a 1-inch (2.5-cm), 25-gauge needle is appropriate for either method of administration. Epoetin is not administered via the intramuscular route, so the Z-track technique is not used. Shaking the vial denatures the glycoprotein, making the medication biologically inactive and therefore ineffective. The client's vital signs, particularly the blood pressure, need to be monitored only routinely to determine the effectiveness of the medication.

1) A client who is immunosuppressed is receiving filgrastim. When monitoring effectiveness, the nurse will check for an increase in which blood component? A. Platelets B. Erythrocytes C. Lymphocytes D. White blood cells

D Rationale Filgrastim, a granulocyte colony-stimulating factor, increases the production of neutrophils with little effect on the production of other blood components. The production of platelets is not stimulated by filgrastim. The production of erythrocytes is not stimulated by filgrastim. Neutrophils, not lymphocytes, are the white blood cells whose production is stimulated by filgrastim.

3) Which nursing assessment is most important for a child receiving cyclophosphamide? A. Extent of alopecia B. Changes in appetite C. Hyperplasia of gums D. Daily intake and output

D Rationale Hemorrhagic cystitis is a potentially serious adverse reaction to cyclophosphamide that can sometimes be prevented with increased fluid intake because the fluid flushes the bladder. The extent of hydration can be measured with hourly documentation of intake and output. Alopecia is expected; however, it is a benign side effect, and the hair will regrow when therapy is completed. A change in appetite is expected but is not a serious side effect of cyclophosphamide administration. Hyperplasia of the gums is unrelated to cyclophosphamide administration.

7) The nurse instructs a postpartum client on the administration of an iron supplement. Which drink selected by the client indicates the teaching was effective? A. Milk B. Water C. Cream soda D. Cranberry juice

D Rationale Iron is absorbed best when given in an acidic medium. One cup of cranberry juice contains 90 mg of vitamin C (ascorbic acid). Milk, water, and cream soda will all decrease the acidity of the stomach.

8) The nurse would counsel a pregnant client to take her iron supplement at which time of the day for efficient absorption? A. Bedtime B. After lunch C. Dinnertime D. Before breakfast

D Rationale Iron should be taken before breakfast on an empty stomach to permit maximal absorption. Iron should not be taken at bedtime or with meals or after meals.

4) A client with leukemia who is receiving vincristine reports lower leg numbness. Which statement about vincristine explains this occurrence? A. Vincristine acts on enlarged lymph nodes in the groin. B. Vincristine affects peripheral vascular circulation. C. Vincristine increases the risk for vascular occlusion. D. Peripheral neuropathies can result from vincristine chemotherapy.

D Rationale Muscle weakness, tingling, and numbness are related to medications like vincristine; neuropathies usually are transient if the medication is stopped or reduced. Nodal enlargement produces vascular rather than neural side effects. Most chemotherapeutic regimens do affect the nervous or peripheral vascular system; neuropathies and peripheral vascular adaptations are potential side effects of chemotherapy. Tingling and numbness are characteristic of neuropathy, not vascular occlusion.

5) A school-age child with leukemia is receiving treatment with vincristine. Which toxic response would the nurse assess the child for? A. Diarrhea B. Alopecia C. Hemorrhagic cystitis D. Peripheral neuropathy

D Rationale Neurotoxicity is a specific response to vincristine; the child may become numb and ataxic. Vincristine causes adynamic ileus, resulting in constipation; diarrhea occurs with other antineoplastics and radiation therapy. Alopecia is an expected side effect rather than a toxic response; it is not considered serious, and hair will regrow after the treatment is completed. Hemorrhagic cystitis is a toxic response to cyclophosphamide, not vincristine.

5) The nurse considers that the safe administration of high-dose methotrexate therapy would include which intervention? A. Maintaining an acidic urine B. Restricting intravenous fluids C. Providing a diet high in folic acid D. Monitoring plasma levels of the medication

D Rationale Plasma levels indicate whether therapeutic or toxic levels are present. Methotrexate crystallizes in the kidneys if urine becomes acidic. The regimen would include hydration with a minimum of intravenous fluids of 125 mL/h 6 to 12 hours before and during therapy. The effectiveness of methotrexate, a folic acid antagonist, is minimized by a diet high in folic acid.

3) Leucovorin calcium is prescribed and is to be administered immediately after an infusion of methotrexate. Which result of laboratory testing indicates that leucovorin has been effective? A. Potassium level normalizes B. Folic acid level within normal limits C. Improved white blood cell count D. Decreased methotrexate level

D Rationale The laboratory measurement of the client's methotrexate level is the most objective measure of leucovorin calcium's effectiveness. Leucovorin calcium is considered a 'rescue' medication because it minimizes the effects of methotrexate on healthy cells by competing with methotrexate at the cellular level, thus neutralizing it and causing it to be excreted. Its purpose is not to affect folic acid levels nor to affect potassium or white blood cell counts.

29) An adolescent with leukemia is to be given a chemotherapeutic agent. Which time is best for the nurse to administer the prescribed antiemetic? A. As nausea occurs B. An hour before meals C. Just before each meal is eaten D. Before each dose of chemotherapy

D Rationale The purpose of an antiemetic before chemotherapy is to prevent the child from experiencing nausea during and after the administration of the medication. Waiting until nausea has occurred is too late; the medication should be given before nausea occurs. The meals are not causing the nausea; the nausea is caused by the chemotherapy, and if nausea is not prevented, the child will not eat.

4) Which technique would the nurse use to administer ferrous sulfate to a 12-month-old infant? A. Through a straw B. Crushed in applesauce C. In an intramuscular injection D. Syringe directed toward the back of the mouth

D Rationale Very young children should receive ferrous sulfate elixir through a syringe or medicine dropper placed in the back of the mouth; this limits staining of teeth by the ferrous sulfate. A 12-month-old infant may not be able to suck on a straw. A 12-month-old infant cannot swallow a tablet, and ferrous sulfate should not be crushed. Ferrous sulfate is not available in an injectable form.

2) Which side effect would the nurse assess for in a child receiving vincristine? A. Hemolytic anemia B. Irreversible alopecia C. Hyperglycemia D. Neurological complications

D Rationale Vincristine is highly neurotoxic, causing paresthesias, muscle weakness, ptosis, diplopia, paralytic ileus, vocal cord paralysis, and loss of deep tendon reflexes. Hematologic effects are rare; mild anemia may occur, but hemolytic anemia is not anticipated. Alopecia is reversible with cessation of the medication. Hyperglycemia is not an anticipated adverse effect.

2) The parent of a toddler taking methotrexate asks the nurse whether the child should be started on vitamin supplements. Which statement by the nurse is appropriate? A. 'That's a fine suggestion, and I'll ask for a prescription.' B. 'Vitamin supplements won't help him feel any better right now.' C. 'He'll benefit from a vitamin supplement and will be getting it soon.' D. 'Supplements that contain folic acid interfere with the effectiveness of chemotherapy.'

D Rationale Vitamins are contraindicated because methotrexate is a folic acid antagonist, and folic acid will counteract the effectiveness of methotrexate. Telling the parent that vitamins won't help his or her child feel better doesn't answer the question; the parent is asking about improving her child's strength, not well-being.

Doxorubicin THINK

Doxo "ruby hearted devil" rubicin

Methotrexate THINK

Metho "mess with folic" trexate