Pharm FINAL study guide questions

Emergency medical personnel bring an unconscious patient to the emergency department. The patient's pupils are pinpoint and respirations are depressed. Intoxication of which of the following substances could contribute to these clinical signs? 1.Methamphetamine 2.Methadone 3.Cocaine 4.Ecstasy

-Methadone

When taking ondansetron, the nurse knows it is important to teach the client what? Select all that apply. 1. Gentle removal from the packaging is essential. 2.It may impair thinking and reaction time. 3. The dose needs to be increased when taking apomorphine 4. Diarrhea is a common side effect. 1, 2, and 4. Apomorphine is contraindicated when taking ondansetron.

1, 2, and 4. Apomorphine is contraindicated when taking ondansetron.

A adult client with muscle spasms is taking an oral maintenance dose of baclofen (Lioresal). The nurse reviews the medication record, expecting that which dose should be prescribed? 1. 15 mg four times a day 2. 25 mg four times a day 3. 30 mg four times a day 4. 40 mg four times a day

1. 15 mg four times a day Rationale: Baclofen is dispensed in 10- and 20-mg tablets for oral use. Dosages are low initially and then gradually increased. Maintenance doses range from 15 to 20 mg administered three or four times a day.

A nurse is reviewing the record of a client who has been prescribed baclofen (Lioresal). Which of the following disorders, if noted in the client's history, would alert the nurse to contact the health care provider? 1. Seizure disorders 2. Hyperthyroidism 3. Diabetes mellitus 4. Coronary artery disease

1. Seizure disorders Rationale: Clients with seizure disorders may have a lowered seizure threshold when baclofen is administered. Concurrent therapy may require an increase in the anticonvulsive medication. The disorders in options 2, 3, and 4 are not a concern when the client is taking baclofen.

An 80- year-old client has recently been started on cimetidine (Tagamet). The nurse monitors the client for which most frequent central nervous system (CNS) side effect of this medication? 1. Tremors 2. Dizziness 3. Confusion 4. Hallucination

3. confusion

What OTC medications should the nurse teach a patient taking ciprofloxacin to avoid? (Select all that apply.) Famotidine Aluminum- or magnesium-containing antacids Iron salts Calcium

Aluminum- or magnesium-containing antacids Iron salts Calcium

The nurse understands that the only stimulant laxative that works in the small bowel is what? Senna Castor oil Bisacodyl Phenolphthalein

Castor oil stimulates contractions during pregnancy

The nurse is caring for an older adult who has taken castor oil (chemical stimulant) every day of their life. The nurse does not instruct the patient to stop using the drug daily because the nurse suspects what condition has developed?

Cathartic dependence (seen frequently with laxative abuse)

A patient arrives in the emergency department complaining of back pain. He reports taking at least 3 acetaminophen tablets every three hours for the past week without relief. Which of the following symptoms suggest acetaminophen toxicity? A. Tinnitus B. Diarrhea C. Hypertension D. Hepatic Damage

D. Hepatic Damage

"What insulin type can be given by IV? Select all that apply": A. Glipizide (Glucotrol) B. Lispro (Humalog) C. NPH insulin D. Glargine (Lantus) E. Regular insulin

E) Regular insulin The only insulin that can be given by IV is regular insulin.

A pt on Clindamycin should avoid which other antibiotic during treatment?

Erythromycin

A pt is prophylactically receiving a medication to prevent opthalmia neonatorum. Which medication is being given and how is it administered?

Erythromycin (Illotycin), an antibiotic and macrolide eye ointment. Medication is administered 1-2 hours post birth to conjuctiva (with gloves). **FYI this medication in PO and IV form is also the top choice for bordatella pertussis treatment.

Which drug class is documented when a patient's medication history includes gemfibrozil (Lopid)?

Fibrate

What is the best choice of laxative for the nurse to administer to an infant or young child?

Glycerin suppositories

Which diuretic is a poor choice for a patient who has gout?

Hydrochlorothiazide (HydroDIURIL) Hydrochlorothiazide is a thiazide diuretic, which can cause an increased uric acid level, so it is a poor choice for a patient who has gout, because gout is a condition of impaired uric acid metabolism resulting in uric acid accumulation. Mannitol, acetazolamide, and spironolactone are better choices for this patient because they are less likely to increase the uric acid level.

The nurse monitors the patient receiving spironolactone (Aldactone) for which electrolyte imbalance? Hyperkalemia Hypernatremia Hyperglycemia Hypercalcemia

Hyperkalemia Spironolactone is a potassium-sparing diuretic, and use of this drug may lead to hyperkalemia.

The nurse admitting a patient with acromegaly anticipates administering which medication? A. desmopressin (DDAVP) B. corticotropin (Acthar) C. somatropin (Nutropin) D. octreotide (Sandostatin)

Octreotide (Sandostatin) Octreotide suppresses growth hormone, the culprit of acromegaly.

The nurse is caring for a patient in the emergency department who reports the onset of agitation, confusion, muscle twitching, diaphoresis, and fever about 12 hours after beginning a new prescription of escitalopram (Lexapro). Which is the most likely explanation for these symptoms?

Serotonin syndrome. This can occur within 2 to 72 hours after initiation of treatment with an SSRI. The symptoms include altered mental status, incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, and fever.

Which patient assessment will the nurse expect to observe when a patient has ingested alcohol while on disulfiram (Antabuse)?

Severe vomiting

What important point(s) of patient education should be included about disulfiram (Antabuse) therapy? (Select all that apply.)

The patient should return for liver function tests in 10 to 14 days following initiation of therapy. Headache, fatigue, and a metallic taste are common adverse effects that usually resolve. Avoid alcohol ingestion to prevent a reaction. Carefully read all labels for possible alcohol content, including perfumes, and over the counter (OTC) medications such as cough syrups.

Drugs that the nurse would anticipate administering to a client who has been admitted with acute alcohol intoxication include which drugs?

Thiamine, lorazepam (Ativan), intravenous glucose solution.

A patient is admitted to the emergency department with status epilepticus. Which drug should the nurse most likely prepare to administer to this patient? (Select all that apply.) a. diazepam (Valium) b. midazolam (Versed) c. gabapentin (Neurontin) d. levetiracetam (Keppra) e. topiramate (Topamax)

a. diazepam (Valium) b. midazolam (Versed)

The nurse is transcribing an order for disulfiram on a patient in alcohol rehabilitation. When planning the time of day to administer this medication the nurse will document that disulfiram be given:

at bedtime

A client is taking levothyroxine (Synthroid). The nurse should be aware that the client is taking the drug for? a) Addison's disease b) Hypothyroidism c) Cushing's syndrome d) Development of acromegaly

b) Hypothyroidism

Which of the following substances are growth hormone inhibiting hormones, or hyper pituitary drugs used to treat patients with pituitary giantism a) Somatotropin b) Somatostatin c) Somatrem d) Octreotide

b) Somatostatin d) Octreotide

During treatment for withdrawal from opioids, the nurse expects which medication to be ordered? a) amphetamine (Dexedrine) b) clonidine (Catapres) c) diazepam (Valium) d) disulfiram (Antabuse)

b) clonidine (Catapres)

Which assessment finding will alert the nurse to possible toxic effects of amiodarone? a. Heart rate 100 beats per minute b. Crackles in the lungs c. Elevated blood urea nitrogen d. Decreased hemoglobin

b. Crackles in the lungs

During an admission assessment, the client states that she takes amlodipine (Norvasc). The nurse wishes to determine whether or not the client has any common side effects of a calcium channel blocker. The nurse asks the client if she has which signs and symptoms? (Select all that apply.) a. Insomnia b. Dizziness c. Headache d. Angioedema e. Ankle edema f. Hacking cough

b. Dizziness c. Headache e. Ankle edema

When giving dronabinol (Marinol) to a patient with acquired immunodeficiency syndrome (AIDS), the nurse knows that this drug may also have what therapeutic effect in addition to reducing nausea? a. Euphoria b. Enhanced appetite c. Reduced pain d. Enhanced sleep

b. Enhanced appetite

The nurse notes third-degree heart block on the EKG of a client receiving diltiazem (Cardizem) for treatment of a supraventricular dysrhythmia. The appropriate action by the nurse is to: a. Administer the next dose as prescribed, and monitor the EKG. b. Hold the next dose, document the EKG finding, and notify the physician. c. Treat the heart block, and continue the Cardizem. d. Increase IV fluids, and administer half the dose of Cardizem.

b. Hold the next dose, document the EKG finding, and notify the physician. (Diltiazem (Cardizem) should never be given to clients with sick sinus syndrome, heart block, hypotension, cardiogenic shock, or severe HF. The drug can produce lethal ventricular dysrhythmias.)

A nurse is caring for a client who has been taking methotrexate (Rheumatrex) tablets for treatment of rheumatoid arthritis. Which assessment should the nurse conduct to determine whether the client is experiencing a serious adverse effect of the medication? a. Neurologic status b. Lung sounds c. Musculoskeletal function d. Sexual dysfunction

b. Lung sounds Pulmonary fibrosis and pneumonia are serious adverse effects of methotrexate; therefore, the nurse should obtain baseline and follow-up assessments of the client's lung sounds.

A client who will be traveling on a plane is prescribed dimenhydrinate (Dramamine) for management of motion sickness. Which instruction about administration of the drug should the nurse provide the client? a. Apply the patch behind the ear the day before travel. b. Take the medication by mouth 20-60 minutes prior to the trip. c. Take the medication by mouth at onset of motion sickness. d. Inject the medication on the thigh intramuscularly.

b. Take the medication by mouth 20-60 minutes prior to the trip. Drugs used to treat motion sickness, like dimenhydrinate, are most effective when taken 20-60 minutes before travel is expected. Dimenhydrinate is taken orally.

A nurse is caring for a client who is receiving cyanocobalamin injections once a month. For what should the nurse monitor while the client is on this drug? a. Bone marrow depression b. Lack of intrinsic factor c. Hypokalemia d. Hemorrhage

c. Hypokalemia Rationale: Hypokalemia is possible in patients receiving cyanocobalamin; thus, the nurse should monitor serum potassium levels periodically.

A patient receiving the drug somatotropin (Genotropin). The nurse understands that the action of this drug is to do what? a. Act as an antiinflammatory agent b. Increase metabolic rate and oxygen consumption c. Stimulate growth in long bones at epiphyseal plates d. Promote water reabsorption from the renal tubules

c. Stimulate growth in long bones at epiphyseal plates

The nurse is reviewing a patient's medication history for a patient who has just been prescribed cyclobenzaprine (Flexeril) for treatment of back spasms. The nurse plans to contact the health care provider if the patient is taking which medication? a. atorvastatin calcium (Lipitor) b. conjugated estrogen (Premarin) c. phenelzine (Nardil) d. penicillin G procaine (Crysticillin, Wycillin)

c. phenelzine (Nardil)

A nurse is planning to administer a first dose of captopril (Capoten) to a hospitalized client who has HT. Which of the following medications can intensify EARLY adverse effects of captopril? Select all that apply 1. Simvastatin (zocor) 2. HCTZ (hydrodiuril) 3. Phenytoin (dilantin) 4. clonidine (Catapress) 5. Aliskiren (Tekturna)

can intensify hypotension. 2. HCTZ (hydrodiuril) -- thiazide diuretic 4. clonidine (Catapress) -- central acting alpha2 agonist 5. Aliskiren (Tekturna) -- a direct renin inhibitor

A patient at a weight management clinic who was given a prescription for orlistat (Xenical) calls the clinic hotline complaining of a "terrible side effect." The nurse suspects that the patient is referring to which problem? a) nausea b) sexual dysfunction c) urinary incontinence d) fecal incontinence

d) fecal incontinence

A patient with constipation is prescibred psyllium (Metamucil) by his health care provider. What essential teaching will the nurse provide to the patient ? a. Take the drugs with meals and at bedtime b. Take the drug with minimal water so that it will not be diluted in the GI tract c. Avoid caffeine and chocolate while taking this medication d. Mix the product with a full glass of water and drink another glassful after taking

d. Mix the product with a full glass of water and drink another glassful after taking Toavoidesophagealorgastricob- struction, psyllium (Metamucil) should be mixed with a full glass of water or juice and followed by another full glass of liquid.

The nurse identifies ________ as an adverse effect of hydrochlorothiazide (HydroDIURIL). hyperuricemia hypernatremia hyperchloremia hypermagnesemia

hyperuricemia Thiazides such as hydrochlorothiazide cause increased uric acid retention, which can lead to an increased level of uric acid.

what precautions should be taken when taking other meds while taking bile acid sequestrants?

take other drugs one hour before or four hours after bile acid sequestrant

A client undergoing antineoplastic therapy is also prescribed Filgrastim. He asks the nurse why he is receiving this new medication. The best response by the nurse is that A. this drug works with you chemotherapy to attack cancer cells. B. this drug helps reduce nausea during chemotherapy. C. this drug helps your bone marrow build new blood cells. D. this drug will help prevent hair loss during chemotherapy

this drug helps your bone marrow build new blood cells.

The nurse recognizes that ________ is an example of an infection that a person may experience while taking ciprofloxacin. syphilis hairy tongue vaginal Candida Clostridium difficile

vaginal candida

The nurse recognizes that ______________ is necessary for synthesis of specific coagulation factors. vitamin A vitamin D vitamin E vitamin K

vitamin K

A patient is taking aspirin for arthritis. Which adverse reaction should the nurse teach the patient to report to the HCP? A) Tinnitus B) Seizures C) Sinusitis D) Palpitations

A) Tinnitus

Pt comes to the office with complaints of hair loss and peeling skin. Nurse notes that many vitamins and minerals are on the list of meds the pt reports using to treat liver disease. Pt's complaint may be caused by excess of what vitamin or mineral? A) vitamin A B) zinc C) vitamin C D) vitamin D

A) vitamin A

Which of the following would a nurse expect to be prescribed when providing care to a client with narcolepsy? Select all that apply. A) Methylphenidate B) Phentermine C) Modafinil D) Armodafinil E) Dextroamphetamine

A, C, D, E Feedback: A nurse caring for a client with narcolepsy may administer methylphenidate, modafinil, armodafinil, and dextroamphetamine.

A nurse is preparing to administer Baclofen to a patient with severe muscle spasms. What is the correct site of administration? A. Intrathecal B. Abdominal C. Thigh D. Gluteal maximus

A. Intrathecal

The nurse routinely includes teaching about vitamins to pts. Vitamin D has a major role in which process? A) ensuring night and color vision B) regulating calcium and phosphorus metabolism C) body growth D) DNA and prothrombin synthesis

B) regulating calcium and phosphorus metabolism

A nurse is caring for a client with cirrhosis who has a new prescription for cephulac (Lactulose). Following administration, the nurse will monitor the client for which adverse effect of this medication? A. Dry mouth B. Diarrhea C. Headache D. Peripheral edema

B. Diarrhea Rationale: The nurse will monitor for diarrhea, Lactulose is a synthetic disaccharide that the small intestine cannot utilize. It causes diarrhea by lowering the ph so that the bacterial flora are changed in the bowel

The nurse is caring for a patient with bipolar disorder treated with lithium (Eskalith). The patient has a new prescription for captopril (Capoten) for hypertension. The combination of these two drugs makes which assessment particularly important? A. Potassium level B. Lithium level C. Creatinine level D. Blood pressure

B. Lithium level

In the administration of a drug such as levothyroxine (Synthroid), the nurse should teach the client: A) That therapy typically lasts about 6 months. B) That weekly laboratory tests for T4 levels will be required. C) To report weight loss, anxiety, insomnia, and palpitations. D) That the drug may be taken every other day if diarrhea occurs.

C) To report weight loss, anxiety, insomnia, and palpitations.

A client who is allergic to penicillin is at increased risk for an allergy to which drug? A. Erythromycin (E-mycin) B. Gentamicin (Garamycin) C. Cefazolin sodium (Ancef) D. Demeclocycline (Declomycin)

C. Cefazolin sodium (Ancef)

When assessing a patient who has been taking amiodarone for 6 months, the nurse monitors for which potential adverse effect? A.) Hyperglycemia B.) Dysphagia C.) Photophobia D.) Urticaria

C.) Photophobia

Which drug should the nurse prepare to administer to prevent constipation in a client who had a surgical procedure? a. Docusate sodium (Colace) b. Prochlorperazine (Compazine) c. Loperamide (Imodium) d. Promethazine (Phenergan)

a. Docusate sodium (Colace)

A patient is given corticotropin (Acthar). The nurse knows to monitor the patient for which condition? a. Weight gain b. Hyperkalemia c. Hypoglycemia d. Dehydration

a. Weight gain

The nurse is reinforcing instructions to a client about the use of ceftriaxone, an antibiotic, for treating cervical gonorrhea. There is a need for further teaching if the client makes which statement? "I can expect to get this one shot." 2. "I will take the pills for 20 full days." 3. "I may experience some discomfort at the injection site." 4. "If I have a penicillin allergy, I may be allergic to this medication too."

"I will take the pills for 20 full days." Rationale: If the client indicates she will be taking pills for 20 days, further teaching is needed. Cervical gonorrhea is treated with one (125 mg) injection of ceftriaxone or one (400 mg) oral dose of cefixime (Suprax). Allergies to penicillin may contraindicate giving ceftriaxone, and slight discomfort at the injection site is common.

The nurse is teaching a patient about a new prescription for citalopram (Celexa). Which statement is appropriate to include in the teaching plan?

- "This medication may cause some sexual side effects. Let your healthcare provider know about this if it occurs." - "When you stop taking this medication you should not withdraw it abruptly." - "Let your family or your healthcare provider know if you experience a worsening mood, agitation, or increased anxiety."

The nurse has reinforced instructions to a client who has been prescribed cholestyramine (Questran). Which statement by the client indicates a need for further instructions? 1. "I will continue taking vitamin supplements." 2. "This medication will help lower my cholesterol." 3. "This medication should only be taken with water." 4. "A high-fiber diet is important while taking this medication."

3. "This medication should only be taken with water." Rationale: Cholestyramine (Questran) is a bile acid sequestrant used to lower the cholesterol level, and client compliance is a problem because of its taste and palatability. The use of flavored products or fruit juices can improve the taste. Some side effects of bile acid sequestrants include constipation and decreased vitamin absorption.

A client with trigeminal neuralgia tells the nurse that acetaminophen (Tylenol) is taken on a frequent daily basis for relief of generalized discomfort. The nurse reviews the client's laboratory results and determines that which of the following indicates toxicity associated with the medication? 1. Sodium of 140 mEq/L 2. Prothrombin time of 12 seconds 3. Platelet count of 400,000 cells/mm3 4. A direct bilirubin level of 2 mg/dL

4. A direct bilirubin level of 2 mg/dL Rationale: In adults, overdose of acetaminophen (Tylenol) causes liver damage. Option 4 is an indicator of liver function and is the only option that indicates an abnormal laboratory value. The normal direct bilirubin is 0 to 0.4 mg/dL. The normal platelet count is 150,000 to 400,000 cells/mm3. The normal prothrombin time is 10 to 13 seconds. The normal sodium level is 135 to 145 mEq/L.

When recording the administration of diphenoxylate for multiple loose stools: 1. Document the daily # of drugs given 2. Record all stools once each shift 3. Indicate all stools on the medication administration record next to the drug 4. Document each dose on the MAR

4. Document each dose on the MAR

The nurse is preparing to administer filgrastim. Which procedure indicates the correct administration of this medication? 1. Use a 3-mL syringe with a 11/2 inch needle and administer in the hip. 2. Mix the powder with sterile normal saline and administer within 1 hour. 3. Check the client's blood pressure and pulse prior to administration. 4. Hold the medication 24 hours before or after chemotherapy.

4.Hold the medication 24 hours before or after chemotherapy. RATIONALE: Neulasta stimulates the production of white blood cells. Cytotoxic chemotherapy acts on the bone marrow to decrease the production of white blood cells, an opposite response. The nurse should hold the medication and resume it 24 hours after the administration of the chemotherapy.

A physician prescribes levothyroxine sodium (Synthroid), 0.15 mg orally daily, for a client with hypothyroidism. The nurse will prepare to administer this medication: A) in the morning to prevent insomnia B) only when the client complains of fatigue and cold intolerance C) at various times during the day to prevent tolerance from occurring D) three times daily in equal doses of 0.5 mg each to ensure consistent serum drug levels

A) in the morning to prevent insomnia

The client is to begin taking atorvastatin (Lipitor) and the nurse is providing education about the drug. Which symptom related to this drug should be reported to the health care provider? 1. Constipation 2. Increasing muscle or joint pain 3. Hemorrhoids 4. Flushing or "hot flash"

Answer: 2 increasing muscle or joint pain Rationale: "Statins" (HMG-CoA reductase inhibitors) such as atorvastatin (Lipitor) may cause rhabdomyolysis, a rare but serious adverse effect. Options 1, 3, and 4 are incorrect. Constipation and hemorrhoids may result from bile acid sequestrants. A feeling of flushing or hot flash-type effects may result from nicotinic acid.

The nurse is teaching the patient about clonidine (Catapres), which the patient will begin taking for high blood pressure. What statement by the patient indicates understanding of why she should take her medication with food? A) "If I eat a big meal, I won't get diarrhea." B) "Having even something small to eat will prevent nausea and vomiting." C) "This medicine might make me get ulcers, so I have to eat it." D) "Lots of fiber in my diet will prevent constipation."

B) "Having even something small to eat will prevent nausea and vomiting."

A patient is experiencing diastolic heart failure. The nurse expects which beta-blocker to be ordered for this patient? A. atenolol (Tenormin) B. carvedilol (Coreg) C. acebutolol (Sectral) D. esmolol (Brevibloc)

B. carvedilol (Coreg)

Which drugs have an action similar to that of the naturally occurring hormone ADH? (Select all that apply) A. cosyntropin (Cortrosyn) B. desmopressin (DDAVP) C. somatropin (Humatrope) D. vasopressin (Pitressin) E. octreotide (Sandostatin)

B. desmopressin (DDAVP) D. vasopressin (Pitressin)

The nurse is assisting in monitoring a client who received hydralazine hydrochloride (Apresoline) to treat autonomic dysreflexia. Which finding accurately indicates that the medication is effective?

Blood pressure declines.

An example of a cardioselective beta-blocker includes A) propranolol (Inderal). B) labetalol (Normodyne). C) atenolol (Tenormin). D) sotalol (Betapace).

C) atenolol (Tenormin).

A client needing to evacuate the colon for endoscopy would likely be prescribed which medication?

Polyethylene glycol-electrolyte solution

Pts taking erythromycin may experience which adverse side effect as a result of the medication?

Possible hearing loss. Drug can also elevate liver enzymes.

A pt who is about to be given octreotide is also taking a diuretic, IV heparin, ciprofloxcin (Cipro), and an opioid as needed for pain. The nurse will monitor for what possible interaction? A. Hypokalemia due to an interaction with diuretic B. Decreased anticoagulation due to an interaction with the heparin C. Prolongation of the QT interval due to an interaction with cipro D. Increased sedation if the opioid is given

Prolongation of the QT interval due to an interaction with cipro

Related to its mechanism of action, what is an additive effect of lactulose (Enulose)? a. Reducing ammonia levels b. Decreasing cerebral edema c. Correcting sodium imbalances d. Alleviating galactose intolerance

Reducing ammonia levels Rationale: Lactulose draws water into the colon and produces a laxative effect. This drug-induced acidic environment also reduces blood ammonia levels by forcing ammonia from the blood into the colon. This effect is useful in treating clients with hepatic encephalopathy.

Sildenafil (Viagra) is prescribed to treat a client with erectile dysfunction. A nurse reviews the client's medical record and would question the prescription if which of the following is noted in the client's history? 1. Neuralgia 2. Insomnia 3. Use of nitroglycerin 4. Use of multivitamins

Use of nitroglycerin Rationale: Sildenafil (Viagra) enhances the vasodilating effect of nitric oxide in the corpus cavernosum of the penis, thus sustaining an erection. Because of the effect of the medication, it is contraindicated with concurrent use of organic nitrates and nitroglycerin. Sildenafil is not contraindicated with the use of vitamins. Neuralgia and insomnia are side effects of the medication.

A client is to receive a glycerin suppository. When inserting the suppository, the nurse should advance it approximately how far into the client's rectum?

3. 3" (7.5 cm)

A patient taking docusate asks the nurse how the medication works. The nurse knows that docusate: a. draws water into the intestinal lumen via osmosis b. is a stimulant laxative c. stimulates the myenteric plexus d. reduces surface tension by facilitating admixture of water and fat

Answer: D - Docusate is a surfactant laxative also known as a stool softener

What is the MOA of diphenoxylate? A.) It increases intestinal secretion and motility B.) It decreases peristalsis in the intestinal wall. C.) It inhibits intestinal excretion of water and sodium D.) It prevents the reabsorption of water in the bowel

B.) It decreases peristalsis in the intestinal wall.

A patient is taking levothyroxine (Synthroid). For which adverse effect would the nurse monitor this patient? a. Tachycardia b. Drowsiness c. Constipation d. Weight gain

a. Tachycardia

The nurse would question a prescription for somatropin (Genotropin) in a patient with which condition? A. Dwarfism B. Acromegaly C. Growth failure D. Hypopituitarism

B.acromegaly Somatropin is a synthetic form of human growth hormone. Acromegaly is caused by excessive growth hormone, and thus this drug would be contraindicated.

During therapy with the cytotoxic antibiotic bleomycin, the nurse will assess for a potentially serious adverse effect by monitoring . . . A. blood urea nitrogen and creatinine levels. B. cardiac ejection fraction. C. respiratory function. D. cranial nerve function.

C. respiratory function.

The nurse obtains these assessment data for a patient who has been taking orlistat (Xenical) for several months as part of a weight loss program. Which finding is most important to report to the health care provider? frequent liquid stools dark urine & light-colored stool weight loss has plateaued abdominal bloating after meals

dark urine & light-colored stool Feedback: Liver damage is a rare adverse reaction to orlistat. Symptoms include dark urine, light-colored stool as well as itching, vomiting, jaundice & anorexia. Abdominal bloating and liquid stools are common side effects of orlistat and indicate that the nurse should remind the patient that fat in the diet may increase these side effects. Weight loss plateaus are normal during weight reduction. See Lewis 953-954; Lehne pg 1040

While planning care for obese patients, two nurses are comparing the differences between orlistat (Xenical) and appetite suppressants. Which of the following statements best demonstrates how orlistat is different from appetite suppressing drugs? "Orlistat acts to reduce fat absorption in the intestines." suppress the appetite center in the brain." increase the metabolism to help burn calories."

reduce fat absorption in the intestines." RATIONALE: Unlike appetite suppresant drugs, which act in the brain to curb appetite, orlistat acts in the gastrointestinal (GI) tract to reduce absorption of fat. This is accomplished by inhibiting lipase, the enzyme responsible for breaking down fats. Orlistat does not act to increase metabolism, suppress appetite, or increase serotonin levels and improve mood. See Lehne p. 1039.

The client asks how atenolol (Tenormin) helps angina. The response provided by the nurse is based on which concept? This medication: 1. Slows the heart rate and reduces contractility. 2. Increases the heart rate and diminishes contractility. 3. Blocks sodium channels and elevates depolarization. 4. Decreases blood pressure and blocks alpha-2 receptors.

1. Slows the heart rate and reduces contractility.

Which of the following statements, if made by a patient receiving orlistat (Xenical), would indicate a need for further teaching? "I will be able to eat less because this drug will decrease my appetite." "Limiting the fat in my diet will decrease unpleasant adverse effects." "This drug may help reduce my bad cholesterol and increase my good cholesterol." "Unpleasant gas and oily bowel movements that are difficult to control may occur."

"I will be able to eat less because this drug will decrease my appetite." Orlistat does not work by reducing or suppressing appetite. Orlistat decreases fat absorption in the intestinal tract thereby causing the production of flatulence and bowel movements with increased fat content. Limiting dietary fat intake will decrease these symptoms. Patients in clinical trials experienced a decrease in total and LDL cholesterol and an increase in HDL cholesterol when orlistat was taken for 2 years. See Lehne pg. 1039-1040.

Which of the following medications is contraindicated with acetaminophen? A. Percocet B. furosemide C. phenytoin D. ampicillin

A. Percocet contains acetaminophen, and the two medications should not be administered together.

The nurse will question the use of a fluoroquinolone antibiotic in a client already prescribed which medication? A.) Furosemide B.) Omeprazole C.) Metoprolol D.) Amiodarone

D.) Amiodarone

A patient on chemotherapy is receiving ondansetron (Zofran) for treatment of nausea. The nurse will instruct the patient to watch for which adverse effect from this drug? a. Hiccups b. Headache c. Dry mouth d. Blurred vision

b. Headache

A patient is given desmopressin acetate. The nurse knows that this drug is used to treat which condition? a. Gigantism b. Diabetes mellitis c. Diabetes insipidus d. Adrenal insufficiency

c. Diabetes insipidus

After administering naloxone (Narcan), an opioid antagonist, the nurse should monitor the client carefully for which of the following? A Cerebral edema B Kidney failure C Seizure activity D Respiratory depression

d. respiratory depression (After administering naloxone, the nurse should monitor the client's respiratory statues carefully because the drug is short acting and respiratory depression may reoccur after its effects wear off. Cerebral edema, kidney failure, and seizure activity are not directly related to opioid overdose or naloxone therapy.)

The nurse is reviewing a medication history on a client taking an ACE inhibitor. The nurse plans to contact the health care provider if the client is also taking which medication? a. docusate sodium (Colace) b. furosemide (Lasix) c. morphine sulfate d. spironolactone (Aldactone)

d. spironolactone (Aldactone)

he nurse is providing patient education to a group of obese patients. To minimize the risk of vitamin deficiency in patients taking orlistat (Xenical), the nurse should instruct the patients to take Metamucil to reduce the unpleasant GI effects of orlistat. take a daily multivitamin 2 hours before or after taking orlistat. eat foods rich in vitamins A, D, E, and K at the same time orlistat is taken.

take a daily multivitamin 2 hours before or after taking orlistat. In reducing fat absorption, orlistat can reduce the absorption of fat-soluble vitamins (A, D, E. and K). To avoid deficiency, patients should take a daily multivitamin supplement 2 hours before or after taking orlistat. This timing will provide maximum absorption of the vitamins. If vitamin-rich foods are eaten at the same time orlistat is taken, those nutrients will not be absorbed. Taking a daily multivitamin at the same time as orlistat is not appropriate, because the fat-soluble vitamins would not be absorbed. Although it is true that Metamucil can reduce the GI effects of orlistat, this question asks about vitamin deficiency, not about the GI effects of the drug. See Lehne, p. 1040.

How is gemfibrozil (Lopid) taken with regard to meals?

30 minutes before meals

A client taking spironolactone (Aldactone) has been taught about the therapy. Which menu selection indicates that the client understands teaching related to this medication? a. Apricots b. Bananas c. Fish d. Strawberries

C. Fish

The home healthcare nurse is visiting a client who was recently diagnosed with type 2 DM. The client is prescribed repaglinide (Prandin) and metformin (Glucophage) and asks the nurse to explain these medications. the nurse should provide which instructions to the client? Select all that apply. 1.diarrhea may occur secondary to the metformin. 2.the repaglinide is not taken if the meal is skipped. 3.the repaglinide is taken 30 minutes before eating. 4.A simple sugar food item is carried and used to treat mild hypoglycemia episodes. 5.metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide. 6.muscle pain is an expected effect of metformin and maybe treated with acetaminophen (Tylenol).

1, 2, 3, 4 repaglinide, a rapid acting oral hypoglycemic agent that stimulates pancreatic insulin secretion, should be taken before meals (approximately 30 minutes before meals) and should be withheld if the client does not eat. Hypoglycemia is a side effect of repaglinide and the client should always be prepared by carrying a simple sugar with her or him at all times. Metformin is an oral hypoglycemic given in combination with repaglinide and works by decreasing hepatic glucose production. A common side effect of metformin is diarrhea. Muscle pain may occur as an adverse effect from metformin, but it might signify a more serious condition that warrants healthcare provider notification, not the use of acetaminophen.

A nurse provides medication instructions to a client who had a kidney transplant about therapy with cyclosporine (Sandimmune). Which statement by the client indicates a need for further instruction? 1. "I need to obtain a yearly influenza vaccine." 2. "I need to have dental checkups every 3 months." 3. "I need to self-monitor my blood pressure at home." 4. "I need to call the health care provider (HCP) if my urine volume decreases or my urine becomes cloudy."

1. "I need to obtain a yearly influenza vaccine." Rationale: Cyclosporine is an immunosuppressant medication. Because of the medication's effects, the client should not receive any vaccinations without first consulting the HCP. The client should report decreased urine output or cloudy urine, which could indicate kidney rejection or infection, respectively. The client must be able to self-monitor blood pressure to check for the side effect of hypertension. The client needs meticulous oral care and dental cleaning every 3 months to help prevent gingival hyperplasia.

A health care provider has written a prescription for ranitidine (Zantac), once daily. The nurse should schedule the medication for which of the following times? 1. At bedtime 2. After lunch 3. With supper 4. Before breakfast

1. At bedtime Rationale: A single daily dose of ranitidine is usually scheduled to be given at bedtime. This allows for a prolonged effect, and the greatest protection of the gastric mucosa.

What health teaching should the nurse provide for a client receiving diltiazem (Cardizem)? Select all that apply: 1. Avoid driving or performing other activities requiring mental alertness until the effects of the drug are known. 2. Maintain adequate fluid and fiber intake to facilitate stool passage. 3. Report weight gain of 2 kg per week. 4. Rise slowly from prolonged periods of sitting or lying down. 5. Immediately stop taking the medication if sexual dysfunction is notes.

1. Avoid driving or performing other activities requiring mental alertness until the effects of the drug are known. 2. Maintain adequate fluid and fiber intake to facilitate stool passage. 3. Report weight gain of 2 kg per week. 4. Rise slowly from prolonged periods of sitting or lying down.

Metoprolol (Toprol XL) is added to the pharmacologic therapy of a diabetic female diagnosed with stage 2 hypertension initially treated with Furosemide (Lasix) and Ramipril (Altace). An expected therapeutic effect is: 1. Decrease in heart rate. 2. Lessening of fatigue. 3. Improvement in blood sugar levels. 4. Increase in urine output.

1. Decrease in heart rate. The effect of a beta blocker is a decrease in heart rate, contractility, and afterload, which leads to a decrease in blood pressure. The client at first may have an increase in fatigue when starting the beta blocker. The mechanism of action does not improve blood sugar or urine output.

Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response? 1. Decreased urinary output 2. Decreased blood pressure 3. Decreased peripheral edema 4. Decreased blood glucose level

1. Decreased urinary output Rationale: Desmopressin promotes renal conservation of water. The hormone carries out this action by acting on the collecting ducts of the kidney to increase their permeability to water, which results in increased water reabsorption. The therapeutic effect of this medication would be manifested by a decreased urine output.

Cyclobenzaprine (Flexeril) is prescribed for a client to treat muscle spasms, and the nurse is reviewing the client's record. Which of the following disorders, if noted in the client's record, would indicate a need to contact the health care provider regarding the administration of this medication? 1. Glaucoma 2. Emphysema 3. Hyperthyroidism 4. Diabetes mellitus

1. Glaucoma Rationale: Because this medication has anticholinergic effects, it should be used with caution in clients with a history of urinary retention, angle-closure glaucoma, and increased intraocular pressure. Cyclobenzaprine hydrochloride should be used only for short-term 2- to 3-week therapy.

A client with chronic renal failure is receiving epoetin alfa (Epogen, Procrit). Which laboratory result would indicate a therapeutic effect of the medication? 1. Hematocrit of 32% 2. Platelet count of 400,000 cells/mm3 3. White blood cell count of 6000 cells/mm3 4. Blood urea nitrogen (BUN) level of 15 mg/dL

1. Hematocrit of 32% Rationale: Epoetin alfa is used to reverse anemia associated with chronic renal failure. A therapeutic effect is seen when the hematocrit is between 30% and 33%. The laboratory tests noted in the other options are unrelated to the use of this medication.

A client is taking Humulin NPH insulin and regular insulin every morning. The nurse should provide which instructions to the client? Select all that apply. 1. Hypoglycemia may be experienced before dinnertime. 2. The insulin dose should be decreased if illness occurs. 3. The insulin should be administered at room temperature. 4. The insulin vial needs to be shaken vigorously to break up the precipitates. 5. The NPH insulin should be drawn into the syringe first, then the regular insulin.

1. Hypoglycemia may be experienced before dinnertime. 3. The insulin should be administered at room temperature. Rationale: Humulin NPH is an intermediate-acting insulin. The onset of action is 1.5 hours, it peaks in 4 to 12 hours, and its duration of action is 24 hours. Regular insulin is a short-acting insulin. Depending on the type, the onset of action is 0.5 hour, it peaks in 2 to 5.5 hours, and its duration is 5 to 8 hours. Hypoglycemic reactions most likely occur during peak time. Insulin should be at room temperature when administered. Clients may need their insulin dosages increased during times of illness. Insulin vials should never be shaken vigorously. Regular insulin is always drawn up before NPH.

A client who is taking clopidogrel (Plavix) to prevent another stroke asks the nurse how the medication works. The nurse's response should be based on an understanding that Plavix: 1. Inhibits platelet aggregation to prevent clot formation. 2. Activates antithrombin III and subsequently inhibits thrombin. 3. Inhibits enzymes involved in formation of vitamin K. 4. Converts plasminogen to plasmin to dissolve fibrin

1. Inhibits platelet aggregation to prevent clot formation.

Which lab results will the nurse monitor to assess the therapeutic response for a patient receiving bile-acid sequestrants?

1. LDL (low density lipoproteins) 2. HDL (high density lipoproteins)

Intravenous heparin therapy is prescribed for a client. While implementing this prescription, a nurse ensures that which of the following medications is available on the nursing unit? 1. Protamine sulfate 2. Potassium chloride 3. Aminocaproic acid (Amicar) 4. Vitamin K (AquaMEPHYTON)

1. Protamine sulfate

A nurse is reviewing the health care provider's prescriptions for an adult client who has been admitted to the hospital following a back injury. Carisoprodol (Soma) is prescribed for the client to relieve the muscle spasms; the health care provider has prescribed 350 mg to be administered four times a day. When preparing to give this medication, the nurse determines that this dosage is: 1. The normal adult dosage 2. A lower than normal dosage 3. A higher than normal dosage 4. A dosage requiring further clarification

1. The normal adult dosage Rationale: The normal adult dosage for carisoprodol is 350 mg orally three or four times daily.

The nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. Which client complaint(s) would alert the nurse to the presence of a possible hypoglycemic reaction? Select all that apply. 1. Tremors 2. Anorexia 3. Irritability 4. Nervousness 5. Hot, dry skin 6. Muscle cramps

1. Tremors 3. Irritability 4. Nervousness Rationale: Decreased blood glucose levels produce autonomic nervous system symptoms, which are manifested classically as nervousness, irritability, and tremors. Option 5 is more likely to occur with hyperglycemia. Options 2 and 6 are unrelated to the signs of hypoglycemia. In hypoglycemia, usually the client feels hunger.

A client with severe acne is seen in the clinic and the health care provider (HCP) prescribes isotretinoin. The nurse reviews the client's medication record and would contact the (HCP) if the client is taking which medication? 1. Vitamin A 2. Digoxin (Lanoxin) 3. Furosemide (Lasix) 4. Phenytoin (Dilantin)

1. Vitamin A Rationale: Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements should be discontinued before isotretinoin therapy. Options 2, 3, and 4 are not contraindicated with the use of isotretinoin.

The client diagnosed with chronic kidney disease is prescribed erythropoietin (Procrit). Which intervention should the nurse implement? Select all that apply. 1. Administer it intramuscularly in the deltoid. 2. Have the client take Tylenol, an analgesic, for pain. 3. Monitor the client's complete blood count. 4. Teach the client to pace activities. 5. Inform the client not to drive for 90 days

2, 3, 4, 5 -Stimulation of blood cells in the bone can cause pain -CBC should be monitored to ensure RBC is not stimulated too quickly or too high -Pacing activities is important for any client with anemia -Potential for seizures exists with this drug, therefore no driving or operating heavy equipment should be done for 90 days

A client receiving Zyprexa (olanzapine) will most likely have another prescription of which medications? 1. Antihypertensives. 2. Antiparkinsonian drugs. 3. Antianxiety. 4. Anticholinergic.

2. Antiparkinsonian drugs. Olanzapine is an antipsychotic medication that decreases dopamine secretion. This decrease in dopamine can lead to development of extrapyramidal symptoms (EPS), including akathisia (inability to sit still, no pattern to movements), tardive dyskinesia (bizarre movements of jaw, mouth, tongue, extremities), and pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gait). These symptoms can be managed with the administration of antiparkinsonian drugs.

A nurse is planning to administer amlodipine (Norvasc) to a client. The nurse plans to check which of the following before giving the medication? 1. Respiratory rate 2. Blood pressure and heart rate 3. Heart rate and respiratory rate 4. Level of consciousness and blood pressure

2. Blood pressure and heart rate Rationale: Amlodipine is a calcium channel blocker. This medication decreases the rate and force of cardiac contraction. Before administering a calcium channel blocking agent, the nurse should check the blood pressure and heart rate, which could both decrease in response to the action of this medication. This action will help to prevent or identify early problems related to decreased cardiac contractility, heart rate, and conduction. *amlodipine is a calcium channel blocker, and this group of medications decreases the rate and force of cardiac contraction. This in turn lowers the pulse rate and blood pressure.*

Atenolol hydrochloride (Tenormin) is prescribed for a hospitalized client. The nurse should perform which of the following as a priority action before administering the medication? 1. Listen to the client's lung sounds. 2. Check the client's blood pressure. 3. Check the recent electrolyte levels. 4. Assess the client for muscle weakness.

2. Check the client's blood pressure Rationale: Atenolol hydrochloride is a beta-blocker used to treat hypertension. Therefore the priority nursing action before administration of the medication is to check the client's blood pressure. The nurse also checks the client's apical heart rate. If the systolic blood pressure is below 90 mm Hg or the apical pulse is 60 beats per minute or lower, the medication is withheld and the registered nurse and/or health care provider is notified. The nurse would check baseline renal and liver function tests. The medication may cause weakness, and the nurse would assist the client with activities if weakness occurs.

Which therapeutic outcome would the nurse consider more significant in evaluating a client who started atomoxetine (Strattera) 6 months ago? 1. Decrease in attention 2. Decrease in hyperactivity 3. Development of mydriasis 4. Elevated liver enzyme

2. Decrease in hyperactivity

A client with multiple sclerosis is receiving diazepam (Valium), a centrally acting skeletal muscle relaxant. Which of the following would indicate that the client is experiencing a side effect related to this medication? 1. Headache 2. Drowsiness 3. Urinary retention 4. Increased salivation

2. Drowsiness Rationale: Incoordination and drowsiness are common side effects resulting from this medication. Options 1, 3, and 4 are incorrect.

A patient has developed DI after a head injury. Which medication should the nurse anticipate to be prescribed for the management of DI? A. Corticotrophin (Acthar) B. Octreotide (Sandostatin) C. Somatropin (Genotropin) D. Desmopressin (DDAVP)

D. Desmopressin (DDAVP) Vasopressin (Pitressin) and desmopressin (DDAVP) are used to prevent or control polydipsia (excessive thirst), polyuria, and dehydration in patients with DI caused by a deficiency of endogenous antidiuretic hormone.

A nurse is reviewing the laboratory studies on a client receiving dantrolene sodium (Dantrium). Which laboratory test would identify an adverse effect associated with the administration of this medication? 1. Creatinine 2. Liver function tests 3. Blood urea nitrogen 4. Hematological function tests

2. Liver function tests Rationale: Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, liver function tests should be performed before treatment and periodically throughout the treatment course. It is administered in the lowest effective dosage for the shortest time necessary.

Insulin glargine (Lantus) is prescribed for a client with diabetes mellitus. The nurse tells the client that it is best to take the insulin: 1. 1 hour after each meal 2. Once daily, at the same time each day 3. 15 minutes before breakfast, lunch, and dinner 4. Before each meal, on the basis of the blood glucose level

2. Once daily, at the same time each day Rationale: Insulin glargine is a long-acting recombinant DNA human insulin used to treat type 1 and type 2 diabetes mellitus. It has a 24-hour duration of action and is administered once a day, at the same time each day.

A nurse prepares to administer sodium polystyrene sulfonate (Kayexalate) to a client. Before administering the medication, the nurse reviews the action of the medication and understands that it: 1. Releases bicarbonate in exchange for primarily sodium ions 2. Releases sodium ions in exchange for primarily potassium ions 3. Releases potassium ions in exchange for primarily sodium ions 4. Releases sodium ions in exchange for primarily bicarbonate ions

2. Releases sodium ions in exchange for primarily potassium ions Rationale: Sodium polystyrene sulfonate is a cation exchange resin used in the treatment of hyperkalemia. The resin either passes through the intestine or is retained in the colon. It releases sodium ions in exchange for primarily potassium ions. The therapeutic effect occurs 2 to 12 hours after oral administration and longer after rectal administration.

The nurse is instructing a client on home use of niacin and will include important instructions on how to take the drug and about its possible adverse effects. Which of the following may be expected adverse effects of this drug? (Select all that apply.) 1. Fever and chills 2. Intense flushing and hot flashes 3. Tingling of the fingers and toes 4. Hypoglycemia 5. Dry mucous membranes

2. intense flushing & hot flashes 3.tingling of the fingers and toes Rationale: Intense flushing and hot flashes occur in almost every client who is taking niacin. Tingling of the extremities may also occur. Options 1, 4, and 5 are incorrect. Fever, chills, or dry mucous membranes are not adverse effects associated with niacin. Niacin may cause an increase in blood glucose, especially in people with diabetes.

A client receives a prescription for methocarbamol (Robaxin), and the nurse reinforces instructions to the client regarding the medication. Which client statement would indicate a need for further instructions? 1. "My urine may turn brown or green." 2. "This medication is prescribed to help relieve my muscle spasms." 3. "If my vision becomes blurred, I don't need to be concerned about it." 4. "I need to call my doctor if I experience nasal congestion from this medication."

3. "If my vision becomes blurred, I don't need to be concerned about it." Rationale: The client needs to be told that the urine may turn brown, black, or green. Other adverse effects include blurred vision, nasal congestion, urticaria, and rash. The client needs to be instructed that, if these adverse effects occur, the health care provider needs to be notified. The medication is used to relieve muscle spasms.

A high school student taking atomoxetine (Strattera) for ADHD disorder visits the school nurse's office and confides "I am so depressed. The world would be better off without me." Which actions would the nurse take for this client. 1. Tell the client to stop taking atomoxetine immediately and not to take it until checking with the provider. 2. Assure the client that these are normal symptoms because the drug may 3 or 4 weeks to work. 3. Alert the family or caregiver that immediate attention and treatment are needed for these symptoms. 4. Have the client increase intake of caffeine by consuming cola products, coffee, or tea to counteract the depressive effect.

3. Alert the family or caregiver that immediate attention and treatment are needed for these symptoms.

A client is scheduled for a dose of ramipril. The nurse should check which measurement before administering the medication? 1. Weight 2. Apical pulse 3. Blood pressure 4. Potassium level

3. Blood pressure

A client with angina pectoris is experiencing chest pain that radiates down the left arm. The nurse administers a sublingual nitroglycerin tablet to the client. The client's pain is unrelieved, and the nurse determines that the client needs another nitroglycerin tablet. Which of the following vital signs is most important for the nurse to check before administering the medication? 1. Temperature 2. Respirations 3. Blood pressure 4. Radial pulse rate

3. Blood pressure Rationale: Nitroglycerin acts directly on the smooth muscle of the blood vessels, causing relaxation and dilation. As a result, hypotension can occur. The nurse would check the client's blood pressure before administering the second nitroglycerin tablet. Although the respirations and apical pulse may be checked, these vital signs are not affected as a result of this medication. The temperature also is not associated with the administration of this medication.

A nurse is planning to administer hydrochlorothiazide (HydroDIURIL) to a client. The nurse understands that which of the following are concerns related to the administration of this medication? 1. Hypouricemia, hyperkalemia 2. Increased risk of osteoporosis 3. Hypokalemia, hyperglycemia, sulfa allergy 4. Hyperkalemia, hypoglycemia, penicillin allergy

3. Hypokalemia, hyperglycemia, sulfa allergy Rationale: Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.

A nurse is caring for a client who is starting captopril (Capoten) for HT. For which of the following adverse effects should the nurse monitor the client? 1. Hypokalemia 2. Hypernatremia 3. Neutropenia 4. Anemia

3. Neutropenia Side effects --Hyperkalemia NOT hypo --cause excretion of sodium & water (expected)

A nurse reinforces instructions to a client who is taking levothyroxine (Synthroid). The nurse tells the client to take the medication: 1. With food 2. At lunchtime 3. On an empty stomach 4. At bedtime with a snack

3. On an empty stomach Rationale: Oral doses of levothyroxine (Synthroid) should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast.

A nurse is reinforcing instructions for a client regarding intranasal desmopressin acetate (DDAVP). The nurse tells the client that which of the following is a side effect of the medication? 1. Headache 2. Vulval pain 3. Runny nose 4. Flushed skin

3. Runny nose Rationale: Desmopressin administered by the intranasal route can cause a runny or stuffy nose. Headache, vulval pain, and flushed skin are side effects if the medication is administered by the intravenous (IV) route.

A client is receiving baclofen (Lioresal) for muscle spasms caused by a spinal cord injury. The nurse monitors the client, knowing that which of the following is a side effect of this medication? 1. Muscle pain 2. Hypertension 3. Slurred speech 4. Photosensitivity

3. Slurred speech Rationale: Side effects of baclofen include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesia of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion. Paradoxical central nervous system excitement and restlessness can occur, along with slurred speech, tremor, dry mouth, nocturia, and impotence.

A client is on nicotinic acid (niacin) for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client would indicate an understanding of the instructions? 1. "It is not necessary to avoid the use of alcohol." 2. "The medication should be taken with meals to decrease flushing." 3. "Clay-colored stools are a common side effect and should not be of concern." 4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing."

4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing." Rationale: Flushing is a side effect of this medication. Aspirin or a nonsteroidal anti-inflammatory drug can be taken 30 minutes before taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this side effect. The medication should be taken with meals, this will decrease gastrointestinal upset. Taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be immediately reported to the health care provider (HCP).

A client with peptic ulcer disease is taking ranitidine (Zantac). What is the expected outcome of this drug? 1. Heal the ulcer. 2. Protect the ulcer surface from acids. 3. Reduce acid concentration. 4. Limit gastric acid secretion.

4. Limit gastric acid secretion. Histamine-2 (H2) receptor antagonists, such as ranitidine, reduce gastric acid secretion. Antisecretory, or proton-pump inhibitors, such as omeprazole (Prilosec), help ulcers heal quickly in 4 to 8 weeks. Cytoprotective drugs, such as sucralfate (Carafate), protect the ulcer surface against acid, bile, and pepsin. Antacids reduce acid concentration and help reduce symptoms.

A nurse has administered a dose of diazepam (Valium) to a client. The nurse would take which important action before leaving the client's room? 1. Giving the client a bedpan 2. Drawing the shades or blinds closed 3. Turning down the volume on the television 4. Per agency policy, putting up the side rails on the bed

4. Per agency policy, putting up the side rails on the bed Rationale: Diazepam is a sedative-hypnotic with anticonvulsant and skeletal muscle relaxant properties. The nurse should institute safety measures before leaving the client's room to ensure that the client does not injure herself or himself. The most frequent side effects of this medication are dizziness, drowsiness, and lethargy. For this reason, the nurse puts the side rails up on the bed before leaving the room to prevent falls. Options 1, 2, and 3 may be helpful measures that provide a comfortable, restful environment, but option 4 is the one that provides for the client's safety needs.

A client is taking docusate sodium (Colace). The nurse monitors which of the following to determine whether the client is having a therapeutic effect from this medication? 1. Abdominal pain 2. Reduction in steatorrhea 3. Hematest-negative stools 4. Regular bowel movements

4. Regular bowel movements Rationale: Docusate sodium is a stool softener that promotes the absorption of water into the stool, producing a softer consistency of stool. The intended effect is relief or prevention of constipation. The medication does not relieve abdominal pain, stop gastrointestinal (GI) bleeding, or decrease the amount of fat in the stools.

Alendronate (Fosamax) is prescribed for a client with osteoporosis. The client taking this medication is instructed to: 1. Take the medication at bedtime. 2. Take the medication in the morning with breakfast. 3. Lie down for 30 minutes after taking the medication. 4. Take the medication with a full glass of water after rising in the morning.

4. Take the medication with a full glass of water after rising in the morning. Rationale: Precautions need to be taken with administration of alendronate to prevent gastrointestinal side effects (especially esophageal irritation) and to increase absorption of the medication. The medication needs to be taken with a full glass of water after rising in the morning. The client should not eat or drink anything for 30 minutes following administration and should not lie down after taking the medication.

A nurse is assisting in caring for a pregnant client who is receiving intravenous magnesium sulfate for the management of preeclampsia and notes that the client's deep tendon reflexes are absent. On the basis of this data, the nurse reports the finding and makes which determination? 1. The magnesium sulfate is effective. 2. The infusion rate needs to be increased. 3. The client is experiencing cerebral edema. 4. The client is experiencing magnesium toxicity.

4. The client is experiencing magnesium toxicity. Rationale: Magnesium toxicity can occur as a result of magnesium sulfate therapy. Signs of magnesium sulfate toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression; loss of deep tendon reflexes; sudden decrease in fetal heart rate or maternal heart rate, or both; and sudden drop in blood pressure. Hyperreflexia indicates increased cerebral edema. An absence of reflexes indicates magnesium toxicity. The therapeutic serum level of magnesium for a client receiving magnesium sulfate ranges from 4 to 7.5 mEq/L (5 to 8 mg/dL).

A client who is taking hydrochlorothiazide (HydroDIURIL, HCTZ) has been started on triamterene (Dyrenium) as well. The client asks the nurse why both medications are required. The nurse formulates a response, based on the understanding that: 1. Both are weak potassium-losing diuretics. 2. The combination of these medications prevents renal toxicity. 3. Hydrochlorothiazide is an expensive medication, so using a combination of diuretics is cost-effective. 4. Triamterene is a potassium-sparing diuretic, whereas hydrochlorothiazide is a potassium-losing diuretic.

4. Triamterene is a potassium-sparing diuretic, whereas hydrochlorothiazide is a potassium-losing diuretic. Rationale: Potassium-sparing diuretics include amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium). They are weak diuretics that are used in combination with potassium-losing diuretics. This combination is useful when medication and dietary supplement of potassium is not appropriate. The use of two different diuretics does not prevent renal toxicity. Hydrochlorothiazide is an effective and inexpensive generic form of the thiazide classification of diuretics.

Disulfiram (Antabuse) is prescribed for a client who is seen in the psychiatric health care clinic. The nurse is collecting data on the client and is providing instructions regarding the use of this medication. Which is most important for the nurse to determine before administration of this medication? 1. A history of hyperthyroidism 2. A history of diabetes insipidus 3. When the last full meal was consumed 4. When the last alcoholic drink was consumed

4. When the last alcoholic drink was consumed Rationale: Disulfiram is used as an adjunct treatment for selected clients with chronic alcoholism who want to remain in a state of enforced sobriety. Clients must abstain from alcohol intake for at least 12 hours before the initial dose of the medication is administered. The most important data are to determine when the last alcoholic drink was consumed. The medication is used with caution in clients with diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, nephritis, and hepatic disease. It is also contraindicated in severe heart disease, psychosis, or hypersensitivity related to the medication.

The nurse is drawing up a teaching plan for a patient who has type 1 diabetes. The doctor has ordered two types of insulin, 10 U of regular insulin and 35 U of NPH insulin. The proper procedure is to: 1. draw up the insulins in two separate syringes so that there can be no confusion. 2. draw up the regular insulin before drawing up the NPH insulin. 3. inject air into the NPH insulin, draw it up to 35 U, then inject air into the clear regular insulin and withdraw to 45 U. 4. inject 35 U air into the NPH insulin, inject 10 U air into the regular insulin, withdraw 10 U of the regular insulin, and withdraw 35 U of the NPH insulin.

4. inject 35 U air into the NPH insulin, inject 10 U air into the regular insulin, withdraw 10 U of the regular insulin, and withdraw 35 U of the NPH insulin. When drawing up two insulins, the vials are injected with air and the regular insulin is drawn first. This slow and time-consuming activity has been greatly reduced with the advent of premixed insulins.

Disulfiram (Antabuse) is prescribed for a client who is seen in the psychiatric health care clinic. The nurse is collecting data on the client and is providing instructions regarding the use of this medication. Which is most important for the nurse to determine before administration of this medication? 1. A history of hyperthyroidism 2. A history of diabetes insipidus 3. When the last full meal was consumed 4. When the last alcoholic drink was consumed

4.. When the last alcoholic drink was consumed Rationale: Disulfiram is used as an adjunct treatment for selected clients with chronic alcoholism who want to remain in a state of enforced sobriety. Clients must abstain from alcohol intake for at least 12 hours before the initial dose of the medication is administered. The most important data are to determine when the last alcoholic drink was consumed. The medication is used with caution in clients with diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, nephritis, and hepatic disease. It is also contraindicated in severe heart disease, psychosis, or hypersensitivity related to the medication.

A RN instructs a female patient with peptic ulcer disease who is to start a treatment regimen that includes ranitidine [Zantac] and bismuth subsalicylate [Pepto-Bismol]. Which statement by the patient indicates that the teaching has been effective? a) "While I'm taking these medications, my bowel movements could look black." b) "I have a medicine at home to take when I start having some loose diarrhea stools." c) "I'm so glad that my allergies will be helped while I'm taking these medications." d) "I'll include more calcium and vitamin D in my diet to prevent osteoporosis."

A "While I'm taking these medications, my bowel movements could look black." (Regimens for eradicating H. pylori include using two or three antibacterials with an antisecretory agent or histamine2 receptor antagonist. Bismuth acts topically to disrupt the cell wall of H. pylori. It can cause a harmless black stool discoloration. Loose stools are an adverse effect of systemic antibacterials such as amoxicillin [Amoxil]. Ranitidine [Zantac] produces selective blockade of H2 receptors, which inhibits gastric acid secretion only, not allergy symptoms. Osteoporosis is an adverse effect of omeprazole, a PPI.)

A patient is receiving acetaminophen for pain, the nurse knows the most common adverse effects are what? (select all) A- renal failure B- encephalopathy C- hepatotoxicity D- respiratory depression E- nephropathy

A- renal failure C- hepatotoxicity

A home care nurse is visiting an 88-year-old man, who is taking acetaminophen for arthritic pain in his knees. Which of the following patient teaching statements is most appropriate to implement? A. "Acetaminophen will only relieve pain but not the inflammation from arthritis." B. "Acetaminophen is appropriate for the treatment of inflammation from arthritis." C. "Your primary health care provider should consider a prescription of Vicodin (acetaminophen/hydrocodone)." D. "The acetaminophen should be administered on an empty stomach."

A. "Acetaminophen will only relieve pain but not the inflammation from arthritis." Acetaminophen is effective in reducing pain but not decreasing inflammation.

Which statement is the most appropriate to include in the teaching plan for a 30-year-old woman beginning a new prescription of clonidine (Catapres)? A. "If you stop taking this drug abruptly, your blood pressure might go up very high." B. "You will need to have your blood drawn regularly to check for anemia." C. "Take this medication first thing in the morning to reduce nighttime wakefulness." D. "This medication often is used to manage hypertension during pregnancy."

A. "If you stop taking this drug abruptly, your blood pressure might go up very high."

Humulin 70/30, Novolin 70/30, and Novolog 70/30 are combination insulins that have: A. 70% NPH and 30% regular insulin B. 70% regular insulin and 30% NPH

A. 70% NPH and 30% regular insulin

The nurse is reviewing the laboratory work for a patient who is taking atorvastatin (Lipitor). Which laboratory value is most useful for monitoring this drug? A. Aspartate aminotransferase (AST) B. Blood urea nitrogen (BUN) C. International normalized ratio (INR) D. C-reactive protein (CRP)

A. Aspartate aminotransferase (AST) AST is a liver enzyme that is helpful for monitoring liver function (hepatotoxicity). Lipitor, a lipid-lowering drug, is a commonly prescribed example of a hepatotoxic drug. The BUN is a measure of kidney function. The INR is a comparative rating of prothrombin time ratios that is used to monitor patients taking the anticoagulant agent warfarin. The CRP is elevated in inflammatory and neoplastic disease, myocardial infarction, and the third trimester of pregnancy. It is used as a cardiac risk marker.

The client admitted for heart failure (HF) has been receiving hydrochlorothiazide (Microzide). Which of the following laboratory levels should the nurse carefully monitor? (Select all that apply.) a. Platelet count b. WBC count c. Potassium d. Sodium e. Uric acid

Answer: c. Potassium d. Sodium e. Uric acid Rationale: Thiazide diuretics cause loss of sodium and potassium but may cause hypericemia.

The patient has been prescribed enalapril for hypertension. The patient asks the nurse how the medication lowers blood pressure. The nurse understands that ACE inhibitors lower blood pressure by...(select all that apply). a) Decreasing systematic vascular resistance b) Decreasing heart rate c) Inhibiting epinephrine d) Preventing sodium resorption e) Increasing vasoconstriction

A. Decreasing systematic vascular resistance D. Preventing sodium resorption Rationale: ACE inhibitors have potent effects on the renin angiotensin-aldosterone system (RAAS) which regulates water and sodium reabsorption and has an indirect effect on blood pressure. ACE inhibitors have cardiovascular and renal benefits and are often first-line agents for treating hypertension. ACE inhibitors block the action of angiotensin-converting enzyme and prevent the production of angiotensin II, which then inhibits the secretion of aldosterone and leads to the excretion of sodium and water (diuresis). Aldosterone is responsible for sodium and water retention in the kidneys. It is stimulated by angiotensin II-a potent vasoconstrictor. Blocking both through inhibition of the angiotensin-converting enzyme, leads to decreased systematic vascular resistance (SVR), decreased cardiac after load, and lower blood pressure.

A client with chronic renal failure receiving dialysis complains of frequent constipation. When performing discharge teaching, which over-the-counter products should the nurse instruct the client to avoid at home? A. Bisacodyl (Dulcolax) suppository B. Fiber supplements C. Docusate sodium D. Milk of magnesia

D. Milk of magnesia

When teaching a patient regarding desmopressin (DDAVP), the nurse will inform the patient to monitor for which potential side effects? (Select all that apply.) A. Headache B. Weight gain C. Nasal irritation D. Hyperglycemia E. Hypotension

A. Headache B. Weight gain C. Nasal irritation Desmopressin works to decrease urine output; thus the patient would retain fluid and gain weight. Headache may also occur as a sequela of fluid retention. Because it is administered intranasally, it can be irritating; thus nostrils should be rotated. Desmopressin does not affect serum glucose levels.

A client with a history of duodenal ulcer is taking calcium carbonate chewable tablets. The nurse determines that the client is experiencing optimal effects of the medication if: A. Heart burn is relieved B. Muscle twitching stops C. Serum calcium levels rise D. Serum phosphrous levels decrease

A. Heart burn is relieved

The nurse is preparing to administer dronabinol (Marinol) to a pt. Which statements about dronabinol therapy are true? A. It is approved for nausea and vomiting related to cancer chemotherapy B. It is approved for use with hyperemesis gravidarum (nausea and vomiting associated with pregnancy) C. It is approved to help stimulate the appetite in pts with nutritional wasting due to cancer or aids D. It may cause extrapyramidal symptoms E. It may cause drowsiness or euphoria

A. It is approved for nausea and vomiting related to cancer chemotherapy C. It is approved to help stimulate the appetite in pts with nutritional wasting due to cancer or aids E. It may cause drowsiness or euphoria

The nurse is preparing to administer a dose of clonidine (Catapres). Which is the best description of the action of this drug? A. It selectively activates alpha2 receptors in the central nervous system (CNS). B. It causes peripheral activation of alpha1 and alpha2 receptors. C. It depletes sympathetic neurons of norepinephrine. D. It directly blocks alpha and beta receptors in the periphery.

A. It selectively activates alpha2 receptors in the central nervous system (CNS).

The nurse has just administered the initial dose of enalapril (Vasotec) to a newly admitted patient. Which nursing intervention takes priority over the next several hours? A. Monitoring the blood pressure B. Measuring the heart rate C. Auscultating the lungs D. Drawing blood for potassium levels

A. Monitoring the blood pressure

Which are common side effects of fenofibrate (Tricor), a fibric acid derivative? (Select all that apply.) A. Nausea, vomiting, and abdominal pain B. Increase in gallstone formation C. Impotence D. Constipation E. Rash

A. Nausea, vomiting, and abdominal pain B. Increase in gallstone formation C. Impotence E. Rash

A patient is going home with a new prescription for the beta-blocker atenolol (Tenormin). The nurse should include which content when teaching the patient about this drug? A. Never stop taking this medication abruptly. B. The medication should be stopped once symptoms subside. C. If adverse effects occur, skip a dose for a "drug holiday."< /font> D. Be watchful for first-dose hypotension.

A. Never stop taking this medication abruptly.

A pt is experiencing severe diarrhea, flushing, and life threatening hypotension associated with carinoid crisis. The nurse will prepare to administer which drug? A. Octreotide (Sandostatin) B. Vasopressin (Pitressin) C. Somatropin (Humatrope) D. Cosyntropin (Cortrosyn)

A. Octreotide (Sandostatin)

Pramlintide (Symlin) is prescribed as a supplemental drug therapy to the treatment plan for a patient with type 1 diabetes mellitus. What information should the nurse include when teaching the patient about the action of this medication? A. Pramlintide slows gastric emptying. B. Pramlintide increases glucagon excretion. C. Pramlintide stimulates glucose production. D. Pramlintide corrects insulin receptor sensitivity.

A. Pramlintide slows gastric emptying.

A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting blood glucose level has been 180 to 200 mg/ dL. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia? a) Prednisone b) Phenelzine (Nardil) c) Atenolol (Tenormin) d) Allopurinol (Zyloprim)

A. Prednisone Rationale: Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option B, a monoamine oxidase inhibitor, and option C, a β-blocker, have their own intrinsic hypoglycemic activity. Option D decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

The nurse watches for which electrocardiogram changes in the patient receiving methadone? A. Prolonged QT interval B. Prolonged PR interval C. Increased heart rate D. Elevated T waves

A. Prolonged QT interval Methadone prolongs the QT interval and may pose a risk of potentially fatal dysrhythmias. Torsades de pointes has developed in patients taking 65 to 400 mg/day.

A patient is to receive conscious sedation for a minor surgical procedure. Which drug administration should the nurse expect? (Select all that apply) A. Propofol (Diprivan) to sustain natural sleep B. Lidocaine (Xylocaine) to provide local anesthesia C. Midazolam (Versed) to promote sedation and following of commands D. Ketamine (Ketalar) for rapid induction and prolonged duration of action E. Phenobarbital (Luminal) for short-acting duration of sleep

A. Propofol (Diprivan) to sustain natural sleep C. Midazolam (Versed) to promote sedation and following of commands

When ceftriaxone is administered intravenously, it is most important for the nurse to avoid mixing it with what? A. Ringer's lactate B. Normal saline C. Sterile water D. D5 0.45% NS

A. Ringer's lactate Correct Mixing ceftriaxone with calcium causes precipitates to form. Ringer's lactate contains calcium; therefore it should not be mixed with ceftriaxone. It is safe to mix normal saline, sterile water, and D5 0.45% NS with ceftriaxone.

In the administration of Levothyroxine(Synthroid), the nurse must teach the client: SELECT ALL THAT APPLY A. Therapy could take three weeks or longer B. Periodic lab tests for T4 are required C. Report weight loss, anxiety, insomnia, and palpatations. D. Jaundice

A. Therapy could take three weeks or longer B. Periodic lab tests for T4 are required C. Report weight loss, anxiety, insomnia, and palpatations.

The physician prescribes docusate sodium (Colace) fo the client. The client asks the nurse to explain why the medication is needed. Which explanation given by the nurse correctly states the purpose of medication? A. To ease bowel evacuation and its related discomfort B. To irriatate the bowel and promote stool elimination C. To stimulate peristalsis to remove wastes after the digestion D. To reduce intestinal activity and decrease stool size

A. To ease bowel evacuation and its related discomfort

Which is a priority nursing diagnosis for a patient receiving desmopressin (DDAVP)? A. Risk for injury B. Acute pain C. Excess fluid volume D. Deficient knowledge regarding medication

C. Excess fluid volume Desmopressin is a form of antidiuretic hormone, which increases sodium and water retention, leading to an alteration in fluid volume. Although the other nursing diagnoses may be appropriate, they are not a priority using Maslow's hierarchy of needs.

On discharge after treatment for alcoholism, a client plans to take disulfiram (Antabuse) as prescribed. When teaching the client about this drug, the nurse emphasizes the need to: A. avoid all products containing alcohol. B. adhere to concomitant vitamin B therapy. C. return for monthly blood drug level monitoring. D. limit alcohol consumption to a moderate level.

A. avoid all products containing alcohol. **Rationale: To avoid severe adverse effects, the client taking disulfiram must strictly avoid alcohol and all products that contain alcohol. Vitamin B therapy and blood monitoring aren't necessary during disulfiram therapy.

The nurse is providing care to a patient following a non-accidental traumatic brain injury. The patient has developed diabetes insipidus due to the injury. What medication is most often used in the management of diabetes insipidus? A. desmopressin (DDAVP) B. corticotrophin (Acthar) C. octreotide (Sandostatin) D. somatropin (Humatrope)

A. desmopressin (DDAVP) Vasopressin (Pitressin) and desmopressin (DDAVP) are used to prevent or control polydipsia (excessive thirst), polyuria, and dehydration in patients with diabetes insipidus caused by a deficiency of endogenous antidiuretic hormone.

After administering somatropin (Genotropin) to a patient, the nurse would assess for potential adverse effects of this medication by monitoring which laboratory test result? A. Glucose B. Platelets C. Potassium D. Magnesium

A. hyperglycemia Hyperglycemia and hypoglycemia are potential adverse effects of somatropin therapy.

The nurse is monitoring a client receiving levothyroxine sodium (Synthroid) for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply. a) Insomnia b) Weight loss c) Bradycardia d) Constipation e) Mild heat intolerance

A. insomnia B. weight loss E. mild heat intolerance - Rationale: Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication, and rather are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat.

Your client is dx with end stage liver failure and receiving lactulose/granulote. which lab test tells you it is effective? A. serum ammonia B. BUN C. sodium D. serum Creatinine

A. serum ammonia

A provider has ordered ceftriaxone 4 gm once daily for a patient with renal impairment. What will the nurse do? a. Administer the medication as prescribed. b. Contact the provider to ask about giving the drug in divided doses. c. Discuss increasing the interval between doses with the provider. d. Discuss reducing the dose with the provider.

ANS: A. Administer the medication as prescribed. Unlike other cephalosporins, ceftriaxone is eliminated largely by the liver, so dosage reduction is unnecessary in patients with renal impairment. Giving the drug in divided doses, increasing the interval between doses, and reducing the dose are not necessary

An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: "a. Gives small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal. b. Is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals. c. Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream. d. Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels"

ANSWER A. An insulin pump provides a small continuous dose of regular insulin subcutaneously throughout the day and night, and the client can self-administer a bolus with additional dosage from the pump before each meal as needed. Regular insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.

Ciprofloxacin (Cipro-XR) is prescribed for a client to treat a urinary tract infection. Which point should a nurse stress when teaching the client about the medication? 1. Avoid taking ciprofloxacin with milk or yogurt. 2. Treat diarrhea, a side effect of ciprofloxacin, with bismuth subsalicylate (Pepto-Bismol). 3. Avoid fennel because it will increase the absorption of the ciprofloxacin. 4. Take dietary calcium tablets 1 hour before or 2 hours after ciprofloxacin.

ANSWER: 1. Avoid taking ciprofloxacin with milk or yogurt RATIONALE: Ciprofloxacin is a fluoroquinolone antibiotic. Milk or yogurt decreases its absorption and should be avoided.

A client rates anxiety at 8 out of 10 on a scale of 1 to 10, is restless, and has narrowed perceptions. Which of the following medications would appropriately be prescribed to address these symptoms? Select all that apply. 1. Chlordiazepoxide (Librium). 2. Clonazepam (Klonopin). 3. Lithium carbonate (lithium). 4. Clozapine (Clozaril). 5. Oxazepam (Serax).

An anxiety rating of 8 out of 10, restlessness, and narrowed perceptions all are symptoms of increased levels of anxiety. 1. Chlordiazepoxide (Librium) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. 2. Clonazepam (Klonopin) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. 5. Oxazepam (Serax) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety.

In infants and children, the side effects of first generation over-the-counter (OTC) antihistamines, such as diphenhydramine (Benadryl) and hydroxyzine (Atarax) include: a. Reye's syndrome. b. Cholinergic effects. c. Paradoxical CNS stimulation. d. Nausea and diarrhea.

Answer C. Paradoxical CNS stimulation. Typically, first generation OTC antihistamines have a sedating effect because of passage into the CNS. However, in some individuals, especially infants and children, paradoxical CNS stimulation occurs and is manifested by excitement, euphoria, restlessness, and confusion. For this reason, use of first generation OTC antihistamines has declined, and second generation product usage has increased. Reye's syndrome is a systemic response to a virus. First generation OTC antihistamines do not exhibit a cholinergic effect. Nausea and diarrhea are uncommon when first generation OTC antihistamines are taken.

A client is receiving cholestyramine (Questran) for elevated low-density lipoprotein (LDL) levels. As the nurse completes the nursing care plan, which of the following adverse effects will be included for continued monitoring? 1. Abdominal pain 2. Orange-red urine and saliva 3. Decreased capillary refill time 4. Sore throat and fever

Answer: 1 abdominal pain Rationale: Obstruction of the GI tract is one of the most serious complications of bile acid sequestrants. Abdominal pain may signal the presence of obstruction. Options 2, 3, and 4 are incorrect. Cholestyramine (Questran) does not cause orange-red urine and saliva, sore throat, or fever, or affect capillary refill.

A client has been on long-term therapy with colestipol (Colestid). To prevent adverse effects related to the length of therapy and lack of nutrients, which of the following supplements may be required? (Select all that apply.) 1. Folic acid 2. Vitamins A, D, E, and K 3. Potassium, iodine, and chloride 4. Protein 5. B vitamins

Answer: 1, 2 Rationale: Long-term use of bile acid sequestrants such as colestipol (Colestid) may cause depletion or decreased absorption of folic acid and the fat-soluble vitamins. Options 3, 4, and 5 are incorrect. Decreases in protein, potassium, iodine, chloride, and the B vitamins are not a direct effect of bile acid sequestrant therapy.

An 80-year-old woman is receiving intravenous ciprofloxacin for the treatment of a urinary tract infection. What nursing assessment should the nurse prioritize in order to identify potential adverse effects of ciprofloxacin in an older patient? Blood Glucose monitoring Oxygen saturation monitoring Neurovital signs Daily weights

Answer: A Rationale: Fluoroquinolones are associated with hyperglycemia and hypoglycemia and older patients may be more at risk for these glucose disturbances. Alteration in LOC, oxygenation, and body weight are less likely.

An older adult patient with a urinary tract infection has been prescribed ciprofloxacin. What route of administration is most commonly used for the administration of ciprofloxacin? A) Oral B) Intravenous C) Subcutaneous D) Intramuscular

Answer: A) Oral cipro is typically administered by the PO or IV route. In most cases, oral administration is used

A patient is admitted to the hospital because of an acetaminophen (Tylenol) overdose. They could possibly display life-threatening abnormalities in which of the following organs? A. Liver B. Lungs C. Kidneys D. Spleen Answer: A, acetaminophen is extensively metabolized by the liver

Answer: A. Liver acetaminophen is extensively metabolized by the liver

1. A nurse is teaching a client who has a new prescription for baclofen (Lioresal) to treat muscle spasms. Which of the following statements by the client indicates an understanding of the teaching? (Select all that apply) A. "I will stop taking this medication right away if I develop dizziness." B. "I know the doctor will gradually increase my dose of this medication for a while." C. "I should increase fiber to prevent constipation from this medication." D. "I won't be able to drink alcohol while I'm taking this medication." E. "I should take this medication on an empty stomach each morning."

Answers: B, C and D The provider starts the client on a low dose and increases it gradually to prevent CNS depression. The client should increase fluids and fiber to reduce the risk for constipation. The intake of alcohol can exacerbate the CNS depressant effects of baclofen. Therefore, the client is instructed to avoid all CNS depressants while taking this medication. It is not "A" because abrupt withdrawal from baclofen can result in adverse effects including visual hallucinations and seizures. It is not "E" because the client should take baclofen with meals to prevent GI upset.

Ciprofloxacin is effective against which potential bioterrorism agent? Botulism Plague Anthrax Ebola

Anthrax

he mother of a child with attention deficit hyperactivity disorder (ADHD) who has been prescribed methylphenidate (Ritalin) expresses concern regarding the use of a controlled substance to treat her child and asks if there are any other options. The nurse's response is based on the knowledge that an option for treatment for ADHD might include which non-controlled central nervous system (CNS) stimulant?

Atomoxetine (Strattera) Atomoxetine (Strattera) is not a controlled substance as it lacks addictive properties, unlike amphetamines and phenidates.

A nurse assesses a patient who is taking pramlintide (Symlin) with mealtime insulin. Which of these findings should require immediate follow-up by the nurse? A) Skin rash B) Sweating C) Itching D) Pedal edema

B) Sweating Pramlintide is a new type of antidiabetic medication that is used as a supplement to mealtime insulin in type 1 and 2 diabetes. Hypoglycemia, which is manifested by sweating, tremors, and tachycardia, is the adverse reaction of most concern. Skin rash, itching, and edema are not adverse effects of pramlintide.

When teaching a patient about insulin glargine (Lantus), which statement by the nurse about this drug is correct? A. "You can mix this insulin with NPH insulin to enhance its effects on glucose metabolism." B. "You cannot mix this insulin with regular insulin and thus will have to take two injections." C. "It is often combined with regular insulin to decrease the number of insulin injections per day." D. "The duration of action for this insulin is 8 to10 hours, so you will need to take it twice a day."

B. "You cannot mix this insulin with regular insulin and thus will have to take two injections."

The nurse is caring for a patient with alcoholic hepatitis. The patient has PRN acetaminophen ordered. The nurse knows that the amount allowed daily of acetaminophen for this patient is A. 1000 mg B. 2000 mg C. 3000 mg D. 4000 mg

B. 2000 mg

Humulin 50/50 is a combination insulin that has: A. 50% regular insulin and 50% insulin lispro B. 50% NPH and 50% regular insulin

B. 50% NPH and 50% regular insulin

The nurse is caring for a client being treated for alcoholism. Before initiating therapy with disulfiram (Antabuse), the nurse teaches the client that he must read labels carefully on which of the following products? A. Carbonated beverages B. Aftershave lotion C. Toothpaste D. Cheese

B. Aftershave lotion **Rationale: Disulfiram may be given to clients with chronic alcohol abuse who wish to curb impulse drinking. Disulfiram works by blocking the oxidation of alcohol, inhibiting the conversion of acetaldehyde to acetate. As acetaldehyde builds up in the blood, the client experiences noxious and uncomfortable symptoms. Even alcohol rubbed onto the skin can produce a reaction. The client receiving disulfiram must be taught to read ingredient labels carefully to avoid products containing alcohol such as aftershave lotions. Carbonated beverages, toothpaste, and cheese don't contain alcohol and don't need to be avoided by the client.

After administering a dose of promethazine (Phenergan) to a patient with nausea and vomiting, what common temporary adverse effect of the medication does the nurse explain may be experienced? A. Tinnitus B. Drowsiness C. Reduced hearing D. Sensation of falling

B. Drowsiness Although being given to this patient as an antiemetic, promethazine also has sedative and amnesic properties. For this reason, the patient is likely to experience drowsiness as an adverse effect of the medication. Tinnitus, reduced hearing, and loss of balance are not side effects of promethazine.

The nurse is caring for a patient who has diabetes and hypertension. Which agent is most likely to be prescribed to treat this patient's hypertension? A. Hydrochlorothiazide (HCTZ) B. Enalapril (Vasotec) C. Propranolol (Inderal) D. Methyldopa (Aldomet)

B. Enalapril (Vasotec)

Methadone maintenance for heroin addiction is a harm reduction strategy because it reduces deviant behavior and introduces addicted persons to the health care system. What is a disadvantage to the use of Methadone? A. Methadone is inexpensive. B. Methadone carries a risk of overdose. C. Methadone prevents relapse. D. Methadone is long acting and effective orally.

B. Methadone carries a risk of overdose. Rationale: Methadone maintenance is a harm reduction intervention because it reduces deviant behavior (needle-sharing practices) and introduces addicted persons to the health care system. Methadone, when administered in moderate or high daily doses, produces a cross-tolerance to other narcotics, thereby blocking their effects and decreasing the craving for heroin. The advantages of methadone are that it is long-acting, effective orally, and inexpensive with few known side effects. However, there is a risk of overdose with the use of Methadone.

A client has been prescribed modafinil for the treatment of narcolepsy. The nurse would assess the client for which of the following as a common adverse reaction? A) Insomnia B) Nausea C) Urinary retention D) Tremors

B. Nausea Feedback: The nurse should monitor for nausea because it is one of the common adverse reactions associated with analeptics such as modafinil. Insomnia, urinary retention, and tremors are not reactions generally associated with analeptic drugs.

The nurse is caring for a patient receiving clopidogrel (Plavix) to prevent blockage of coronary artery stents. Which other drug on the patient's medication administration record may reduce the antiplatelet effects of clopidogrel? A. Aspirin (Bayer) B. Omeprazole (Prilosec) C. Acetaminophen (Tylenol) D. Warfarin (Coumadin)

B. Omeprazole (Prilosec) Omeprazole and other proton pump inhibitors may reduce the antiplatelet effects of clopidogrel. Patients sometimes take them to reduce gastric acidity and the risk of gastrointestinal (GI) bleeding.

Which cardiovascular finding does the nurse identify as a possible adverse effect of erythromycin (Ery-Tab) therapy? A. Heart rate of 52 beats per minute B. Prolonged QT interval C. Jugular vein distention D. Grade III diastolic murmur

B. Prolonged QT interval When present in high levels, erythromycin can prolong the QT interval, causing a potentially fatal ventricular dysrhythmia. It should be avoided by patients taking class IA or class III antidysrhythmic medications or others that inhibit metabolism.

Regular insulin (Humulin R, Novolin R) is a: A. Rapid-acting insulins B. Short-acting insulins C. Intermediate-acting insulins D. Long-acting insulins

B. Short-acting insulins

For patients prescribed amiodarone (Cordarone), the nurse should monitor for which potential adverse effects of this drug? (Select all that apply.) A. Diarrhea B. Visual halos C. Hypothyroidism D. Photosensitivity E. Overgrowth of gum tissue F. Blue gray skin discoloration

B. Visual halos C. hypothyroidism D. Photosensitivity F. Blue gray ski discoloration

Upon which patient finding would the nurse hold the ordered dose of filgrastim (Neupogen) and notify the provider? A. Fever of 99.5° F B. Absolute neutrophil count (ANC) count of 12,000 cells/mm3 C. White blood cell (WBC) count of 4.5/mm3 D.Blood pressure of 142/88 mm Hg

B. absolute neutrophil count (ANC) 12,000 cells/mm3 Filgrastim (Neupogen) is usually discontinued when a patient's ANC rises above 10,000 cells/mm3. However, some prescribers will stop it when the ANC is between 1000 and 2000 cells/mm3.

A teenage girl is suffering from migraine headaches. Her health care provider orders a combination of acetaminophen, aspirin, and caffeine. Prior to the administration of the medication, it is necessary to assess for which of the following? A. anxiety an depression B. history of smoking C. family history of migraines D. antacid use

B. history of smoking The administration of aspirin, acetaminophen, and caffeine in a patient who smokes decreases the effects of caffeine to treat the migraine pain.

A nurse is caring for a client who has been in the PACU for more than 1 hour and is difficult to arouse. The nurse should anticipate which of the following medication prescriptions? A. Pentazocine (Talwin) B. Naloxone (narcan) C. Naltrexone (Trexan) D. Butorphanol (Stadol)

B. naloxone (Naloxone displaces opiate medications from receptor sites, reversing the respiratory depression, sedation, hypertension, and analgesia opiates cause.)

A physician prescribes bisacodyl (Dulcolax) for a client in preparation for a diagnostic test and wants the client to achieve a rapid effect from the medication. The nurse then tells the client to take the medication: A. With a large meal B. On an empty stomach C. At bedtime with a snack D. With two glasses of juice

B. on an empty stomach, bisacodyl (Dulcolax) is a stool softner

A patient with renal impairment requires bowel cleansing before a diagnostic procedure. The RN prepares to administer which laxative? a) Mineral oil b) Polyethylene glycol-electrolyte solution c) Magnesium salts (magnesium citrate) d) Docusate sodium [Colace]

B.Polyethylene glycol-electrolyte solution (GoLYTELY, an osmotic laxative, produces a watery stool in 2 to 6 hours. It is isosmotic with body fluids, so it causes no fluid or electrolyte imbalance and thus can be used safely in patients with an electrolyte impairment. Magnesium salts are contraindicated in patients with renal dysfunction. Mineral oil is more useful when administered by enema for fecal impaction. Docusate sodium produces results in 1 to 3 days.)

A client has a PRN order for ondansetron (Zofran). The nurse would administer this medication to the postoperative client for relief of: A. paralytic ileus B. incisional pain C. urinary retention D. Nausea and vomiting

D. Nausea and vomiting, ondansetron (Zofran) is an antiemetic

The nurse is teaching a client about clopidogrel (Plavix). What is important information to include? a. Constipation may occur. b. Hypotension may occur. c. Bleeding may increase when taken with aspirin. d. Normal dose is 25 mg tablet per day.

Bleeding may increase when taken with aspirin.

The nurse recognizes that the therapeutic action of spironolactone (Aldactone) is what? Increased ADH secretion Decreased ADH secretion Blocked action of aldosterone Enhanced action of aldosterone

Blocked action of aldosterone Rationale: Aldosterone, a hormone secreted from the adrenal cortex, leads to sodium retention and potassium excretion. Spironolactone blocks the action of aldosterone, leading to sodium loss and potassium retention.

Which instruction about clopidogrel (Plavix) should be included in the discharge teaching for a patient who has received a drug-eluting coronary stent? A. "Constipation is a common side effect of clopidogrel, so take a stool softener daily." B. "If you see blood in your urine or black stools, stop the clopidogrel immediately." C. "Check with your healthcare provider before taking any over-the-counter medications for gastric acidity." D. "Keep the amounts of foods containing vitamin K, such as mayonnaise, canola and soybean oil, and green, leafy vegetables, consistent in your diet." .

C. "Check with your healthcare provider before taking any over-the-counter medications for gastric acidity." Proton pump inhibitors (PPIs), such as omeprazole (Prilosec), and CYP2C1 inhibitors, such as cimetidine (Tagamet), can be purchased over the counter to treat heartburn. However, patients taking clopidogrel should consult their healthcare provider before using them. PPIs and CYP2C1 inhibitors can reduce the antiplatelet effects of clopidogrel. Diarrhea (5% incidence), not constipation, is a side effect of clopidogrel. Patients should immediately contact the healthcare provider if signs of bleeding occur, such as bloody urine, stool, or emesis. The drug should not be stopped until the prescriber advises it, because this could lead to coronary stent restenosis. Consistency of vitamin K intake is indicated while taking warfarin (Coumadin)

Pramlintide (Symlin) is an oral anti-diabetic drug, classified as a/n: A. Biguanides B. Sulfonylureas- 1st gen C. Sulfonylureas- 2nd gen D. Meglitinides E. Thiazolidinediones F. Alpha-glucosidase inhibitors G. Amylin mimetics H. Incretin mimetics I. DPP-4 inhibitors

G. Amylin mimetics

"A nurse is caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). In the acute phase, the priority nursing action is to prepare to: "A. Correct the acidosis B. Administer 5% dextrose intravenously C. Administer regular insulin inraVenously D. Apply a monitor for an electrocardiogram."

C. Administer regular insulin inraVenously Lack (absolute or relative) of insulin is the primary cause of DKA. Treatment consists of insulin administration (regular insulin), intravenous fluid administration (normal saline initially), and potassium replacement, followed by correcting acidosis. Applying an electrocardiogram monitor is not a priority actio

The nurse receives an order for a parenteral dose of promethazine (Phenergan) and prepares to administer the medication to a 38-year-old male patient with nausea and repeated vomiting. Which action is most important for the nurse to take? a) Administer the medication subcutaneously for fast absorption. b) Administer the medication into an arterial line to prevent extravasation. c) Administer the medication deep into the muscle to prevent tissue damage. d) Administer the medication with 0.5 mL of lidocaine to decrease injection pain.

C. Administer the medication deep into the muscle to prevent tissue damage. Promethazine (Phenergan) is an antihistamine administered to relieve nausea and vomiting. Deep muscle injection is the preferred route of injection administration. This medication should not be administered into an artery or under the skin because of the risk of severe tissue injury, including gangrene. When administered IV, a risk factor is that it can leach out from the vein and cause serious damage to surrounding tissue.

Which statement by the nurse explains to the patient the action of cholestyramine (Questran) to decrease blood lipid levels? A. Inhibits absorption of dietary cholesterol in the small and large intestine. B. Stimulates the biliary system to increase excretion of dietary cholesterol. C. Binds to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces. D. Inhibits lipolysis in adipose tissue and decreases the hepatic synthesis of triglycerides in the liver.

C. Binds to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces.

Which medication combination is useful in the treatment of variant angina? A. Metoprolol (Lopressor) and ranozaline (Ranexa) B. Isosorbide dinitrate (Isordil) and metoprolol (Lopressor) C. Diltiazem (Cardizem) and isosorbide mononitrate (Imdur) D. Propranolol (Inderal) and diltiazem (Cardizem)

C. Diltiazem (Cardizem) and isosorbide mononitrate (Imdur)

The nurse is assessing a patient in a clinic who has been taking clonidine (Catapres) for hypertension. Which findings are most indicative of an adverse effect of this drug? A. Cough and wheezing B. Epigastric pain and diarrhea C. Drowsiness and dry mouth D. Positive Coombs' test result and anemia

C. Drowsiness and dry mouth

Which of the following interventions assists the patient in decreasing anticholinergic effects of cyclobenzaprine (Flexeril)? A. Have the patient void before the administration of cyclobenzaprine B. Give the patient lemon juice mixed with warm water to prevent constipation C. Give the patient hard candy to suck on D. Assess the patient's pulse and blood pressure

C. Give the patient hard candy to suck on Hard candy assists in relieving thirst related to anticholinergic effects of cyclobenzaprine

By which action does atorvastatin (Lipitor) decrease lipid levels? A. Stimulating the gallbladder and biliary system to increase excretion of dietary cholesterol B. Binding to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces C. Inhibiting HMG-CoA reductase, the enzyme responsible for the biosynthesis of cholesterol in the liver D. Decreasing the amount of triglycerides produced by the liver and increasing the removal of triglycerides by the liver

C. Inhibiting HMG-CoA reductase, the enzyme responsible for the biosynthesis of cholesterol in the liver

The nurse would anticipate administering which medication to patients receiving high-dose methotrexate (Trexall)? A. bleomycin B. cisplatin C. leucovorin D. dactinomycin

C. Leucovorin RATIONALE: Leucovorin is given to block the systemic toxic effect of high-dose methotrexate. It is a form of folic acid that does not require dihydrofolate reductase to produce folic acid. Therefore it is used to prevent or treat toxicity induced by methotrexate, a folic acid antagonist. All the other options are chemotherapeutic drugs, which are not specifically associated with methotrexate.

The physician ordered I.V. naloxone (Narcan) to reverse the respiratory depression from morphine administration. After administration of the naloxone the nurse should: A) Check Respirations in 5 minutes because naloxone is immediately effective in relieving respiratory depression. B) Check respirations in 30 minutes because the effects of morphine will have worn off by then. C) Monitor respirations frequently for 4 to 6 hours because the client may need repeated doses of naloxone D) Monitor respirations each time the client receives morphine sulfate 10 mg I.M.

C. Monitor respirations frequently for 4 to 6 hours because the client may need repeated doses of naloxone (Rationale: The nurse should monitor the clients respirations closely for 4 to 6 hours because naloxone has a shorter duration of action than opioids. The client may need repeated doses of naloxone to prevent or treat a recurrence of the respiratory depression. Naloxone is usually effective in a few minutes; however, its effects last only 1 to 2 hours and ongoing monitoring of the clients respiration's is necessary. )

A patient who is receiving cefotetan (Cefotan) has all of these medications ordered. The nurse monitors the patient for an adverse effect related to an interaction with which medication? A. Regular insulin B. Ampicillin (Polycillin) C. Naproxen (Naprosyn) D. Bisacodyl (Dulcolax)

C. Naproxen (Naprosyn) Three cephalosporins—cefmetazole (Zefazone), cefoperazone (Cefobid), and cefotetan (Cefotan)—cause bleeding tendencies. Caution should be used during concurrent use of anticoagulants and other nonsteroidal medications. Regular insulin, ampicillin, and bisacodyl are unrelated to adverse effects with cefotetan.

The nurse is caring for a patient prescribed amiodarone (Cordarone). The nurse knows the MOST serious adverse effect of this medication can occur in which body system? A. Nervous B. Immune C. Respiratory D. Gastrointestinal

C. Respiratory

A patient is given chlordiazepoxide (Librium) for acute alcohol withdrawal. During the interview with the patient's family, the nurse asks if the patient has taken which of the following herbal supplements? A. garlic B. ginger C. St. John's wart D. gingko bilbo

C. St. John's wort St. John's wort enhances central nervous system depression when combined with chlordiazepoxide (Librium).

For an overdose of morphine sulfate, which drug should the nurse have on hand as an antidote? A. phenytoin (Dilantin) B. tramadol (Ultram) C. naloxone (Narcan) D. atropine sulfate (Atropine)

C. naloxone (Narcan) (Naloxone (Narcan) is an opioid antagonist (blocks receptors. It counteracts the overdose. However, in conditions of extreme pain, Narcan should be given in small increments to avoid a complete loss of pain control. )

A client is prescribed modafinil as treatment for narcolepsy. When teaching the client about the drug, which of the following would the nurse include in the instructions for the client? A) Record any changes in weight. B) Avoid coffee or tea. C) Record number of periods of sleepiness. D) Take over-the-counter antidepressants for depression.

C. record number of sleepiness Feedback: The nurse should instruct the client to keep a record of the number of times per day that periods of sleepiness occur and to bring this record to each visit to the primary health care provider or clinic. There is no need to avoid tea or coffee or to record weight. The client should be instructed not to take antidepressants for the duration of the dosage regimen.

A patient is in the clinic for a follow-up visit. He has been taking amiodarone for almost a year and today he tells the nurse, "I am noticing some blue color around my face, neck and upper arms. Is that normal?" Which is the nurse's correct response? A.) "This is an expected side effect and should go away soon" B.) "This is a harmless effect. As long as the medication is working, we'll just monitor your skin." C.) "This can happen with amiodarone. I will let your doctor know about it right away." D.) "How much sun exposure have you had recently?"

C.) "This can happen with amiodarone. I will let your doctor know about it right away."

The patient is receiving hydrochlorothiazide (HydroDIURIL) as well as digoxin (Lanoxin). Which lab result would the nurse recognize as most significant? 1. ALT level of 35 units/L 2. Sodium level of 140 mEq/L 3. Potassium level of 2.9 mEq/L 4. BUN level of 20 mg/dl

Correct answer: 3. Potassium level of 2.9 mEq/L Rationale 1: The concern is hypokalemia, not liver damage, and this ALT level is within normal range. Rationale 2: The concern is hypokalemia, not sodium levels; this sodium level is within normal range. Rationale 3: Hypokalemia caused by hydrochlorothiazide (HydroDIURIL) may increase digoxin (Lanoxin) toxicity. The normal range for potassium is 3.5 to 5.2 mEq/L. Rationale 4: The concern is hypokalemia, not kidney function, and this BUN is within normal range.

Simethicone (Mylicon) is often combined with calcium carbonate antacids because: A) an increased antacid effect will result when these drugs are given in combination. B) simethicone helps to reduce the gas that is caused by the calcium antacids. C) simethicone reduces the diarrhea that is caused by the calcium. D) simethicone improves the taste of the calcium tablets, which must be chewed.

Correct answer: B. simethicone helps to reduce the gas that is caused by the calcium antacids. Rationale: Calcium carbonate neutralization will produce gas and possibly belching, so the addition of simethicone is intended to reduce this effect. Simethicone alters elasticity of mucus-coated gas bubbles, breaking them into smaller ones, resulting in decreased gas pain and increased expulsion via mouth or rectum.

A type I diabetic patient comes to the clinic for a follow-up appointment. The patient is taking NPH insulin, 30 units every day. A nurse notes that the patient is also taking metoprolol (Lopressor). What education should the nurse provide to the patient? A) "You need to increase your insulin to allow for the agonist effects of metoprolol." B) "Metoprolol may potentiate the effects of the insulin, so the dose should be reduced." C) "Metoprolol has no effects on diabetes mellitus or on your insulin requirements." D) "Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely."

D) "Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely."

The client taking Diltiazem Hydrochloride, a calcium channel blocker, is experiencing symptoms of toxicity. Which of the following assessments will be of highest priority for the nurse to make to assess the situation? A) The clients body temperature, looking for elevation B) The rate, depth and regularity of the client's respirations C) The client's daily weight, looking for weight loss D) The client's dietary intake of grapefruit juice

D) The client's dietary intake of grapefruit juice

When teaching a patient about beta-blockers such as atenolol (Tenormin) and metoprolol (Lopressor), it is important to inform the patient that A) these medications may be taken with antacids to minimize gastrointestinal distress. B) hot baths and showers will help enhance the therapeutic effects and are encouraged. C) alcohol intake is encouraged for its vasodilating effects. D) abrupt medication withdrawal may lead to a rebound hypertensive crisis.

D) abrupt medication withdrawal may lead to a rebound hypertensive crisis.

The patient is prescribed 30 units of regular insulin and 70 units of insulin isophane suspension (NPH insulin) subcutaneously every morning. The nurse should provide which instruction to the patient for insulin administration? A. "Inject the needle at a 30-degree angle." B. "Rotate sites at least once or twice a week." C. "Use a 23- to 25-gauge syringe with a 1-inch needle to increase insulin absorption." D. "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin."

D. "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin."

When monitoring for the therapeutic effects of intranasal desmopressin (DDAVP) in a patient who has diabetes insidious, which assessment finding will the nurse look for as an indication that the medication therapy is successful? A. Increased insulin levels B. Decreased diarrhea C. Improved nasal patency D. Decreased thirst

D. Decreased thirst

A nurse is providing teaching to a client who has a prescription for pramlintide (Symlin) for type 1 diabetes mellitus. Which of the following should the nurse include in the teaching? (Select all that apply) A. "Take oral medications 1 hr before injection" B. "Use upper arms as preferred injection sites" C. "Mix pramlintide with breakfast dose of insulin" D. "Inject pramlintide just before a meal" E. "Discard open vials after 28

D. "Inject pramlintide just before a meal" Pramlintide can cause hypoglycemia, especially when the client also takes insulin, so it is important to eat a meal after injecting this medication. E. "Discard open vials after 28 days" Unused mediation in the open pramlintide vial should be discarded after 28 days.

During discharge teaching, which statement by the nurse would be MOST appropriate for a patient prescribed a transdermal clonidine (Catapres)? A. "Occasional drooling is a common adverse effect of this medication." B. "Prolonged sitting or standing does not cause hypotension symptoms." C. "Your blood pressure should be checked by your health care provider two to three times a week." D. "The patch should be applied to a nonhairy site, and you should not suddenly stop using this drug."

D. "The patch should be applied to a nonhairy site, and you should not suddenly stop using this drug."

A client prescribed azithromycin (Zithromax) expresses concern regarding GI upset that was experienced when previously prescribed an erythromycin antibiotic. What is the nurse's best response? A. "Take an over-the-counter antiemetic to lessen the nausea." B. "Stop taking the drug if you experience heartburn and diarrhea." C. "I will call the health care provider and request a different antibiotic." D. "This drug is like erythromycin with less gastrointestinal adverse effects."

D. "This drug is like erythromycin with less gastrointestinal adverse effects."

The nurse would question the use of which cathartic agent in a patient with renal insufficiency? A. Bisacodyl (Dulcolax) B. Lubiprostone (Amitiza) C. Cascara sagrada (Senekot) D. Magnesium hydroxide (Milk of Magnesia)

D. Magnesium hydroxide (Milk of Magnesia) Milk of Magnesia may cause hypermagnesemia in patients with renal insufficiency. The nurse should question this order with the health care provider. Bisacodyl, lubiprostone, and cascara sagrada are safe to use in patients with renal insufficiency as long as the patient is not currently dehydrated.

A patient reports having a dry mouth and asks for something to drink. The nurse recognizes that this symptom can most likely be attributed to a common adverse effect of which medication that the patient is taking? A. Digoxin (Lanoxin) B. Cefotetan (Cefotan) C. Famotidine (Pepcid) D. Promethazine (Phenergan)

D. Promethazine (Phenergan) A common adverse effect of promethazine, an antihistamine/antiemetic agent, is dry mouth; another is blurred vision. Common side effects of digoxin are yellow halos and bradycardia. Common side effects of cefotetan are nausea, vomiting, stomach pain, and diarrhea. Common side effects of famotidine are headache, abdominal pain, constipation, or diarrhea.

A client who is postoperative has received 2 mg of hydromorphone (Dilaudid) IV bolus every 2 hr. The client continues to rate his pain at a 7 on a scale from 0 to 10. Which of the client findings should the nurse attend to first? -Constipation -Hypotension -Weakness -Nausea

Hypotension (According to the ABC priority-setting framework, this would be the first finding for the nurse to address.)

during patient education regarding own oral macrolide such as erythromycin the nurse will include which information? A. If GI upsets occur the drug will have to be stopped B. the drug needs to be taken with an antacid to avoid GI problems C. the patient needs to take each dose with a sip of water D. the patient may take the drug with a small snack to reduce GI irritation

D. the patient may take the drug with a small snack to reduce GI irritation

The nurse would question the prescription of bismuth subsalicylate as in antidiarrheal medication for a client prescribed aspirin daily because of which potential adverse effect? A.) Nausea B.) Constipation C.) Urinary retention D.) Increased bleeding

D.) Increased bleeding

A nurse is caring for a client who is taking levothyroxine (Synthroid) and has been prescribed cholestyramine (Questran). The nurse understands that the interaction between these two drugs: A: increases the risk of cardiac insufficiency B: accelerates levothyroxine metabolism C: decreases serum prothrombinemia levels D: reduces the absorption of levothyroxine

D: reduces the absorption of levothyroxine

The nurse is collecting a medication list upon admission and notes that the patient is taking a fibric acid derivative. What is the expected action of the drug?

Decrease in triglyceride levels

The nurse is administering alendronate (Fosamax) to a client. Which nursing intervention is most important for the nurse to consider when giving this medication? 1. Make sure the medication is taken on a full stomach. 2. Make sure this medication is always taken at bedtime. 3. Make sure the medication is taken with just a sip of water. 4. Make sure the client remains upright for 30 minutes after taking the medication.

Make sure the client remains upright for 30 minutes after taking the medication.

A postoperative client has received a dose of naloxone hydrochloride for respiratory depression shortly after transfer to the nursing unit from the postanesthesia care unit. After administration of the medication, the nurse checks the client for: 1. Pupillary changes 2. Scattered lung wheezes 3. Sudden increase in pain 4. Sudden episodes of diarrhea

Sudden increase in pain Rationale: Naloxone hydrochloride is an antidote to opioids and may also be given to the postoperative client to treat respiratory depression. When given to the postoperative client for respiratory depression, it may also reverse the effects of analgesics. Therefore, the nurse must check the client for a sudden increase in the level of pain experienced. Options 1, 2, and 4 are not associated with this medication.

The patient is taking ciprofloxacin and zinc salts. How should the patient be taught to take the medication? Take both medications with meals. Take the ciprofloxacin 30 minutes after taking the zinc salts. Take the ciprofloxacin 1 hour before or 2 hours after taking the zinc. Take the zinc salts 6 hours before the ciprofloxacin or 2 hours after the medication.

Take the zinc salts 6 hours before the ciprofloxacin or 2 hours after the medication.

The patient who is taking ciprofloxacin is complaining of lower leg pain or inflammation. What does the nurse suspect has happened? The patient has strained the ligaments in the leg. The patient has exercised at too high an intensity. The patient has overstretched the muscle in the calf. The patient has a tendon rupture.

The patient has a tendon rupture. Rationale: Ciprofloxacin and other fluoroquinolone antibiotics have a black box warning for the increased risk for tendon rupture. Patients usually experience pain and edema around tendons that may eventually lead to rupture. Patients should be instructed to rest if they experience tendon pain or edema while taking antibiotics in this class.

A teenaged boy will be receiving atomoxetine (Strattera) as part of treatment for attention deficit hyperactivity disorder (ADHD). Which statement about this drug therapy is accurate? 1.The patient should be monitored for possible suicidal thoughts and behavior. 2.Strattera is used to treat narcolepsy as well as ADHD. 3. Psychotherapy is rarely helpful in cases of ADHD. 4. Strattera is highly addictive.

The patient should be monitored for possible suicidal thoughts and behavior. Prescribers are advised to work with parents to monitor closely for suicidal thoughts and behavior. In addition, psychosocial problems within the patient's family should be addressed if needed. Strattera is not addictive, and it is not used to treat narcolepsy.

Meperidine hydrochloride (Demerol) is prescribed for the client with pain. Which of the following would the nurse monitor for as a side effect of this medication? 1. Diarrhea 2. Bradycardia 3. Hypertension 4. Urinary retention

Urinary retention Rationale: Meperidine hydrochloride (Demerol) is an opioid analgesic. Side effects of this medication include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention.

An atypical antipsychotic is prescribed for a patient with psychosis. The nurse understands that this category of medications includes which drugs? (Select all that apply.) a.clozapine (Clozaril) b.fluphenazine (Prolixin) c.haloperidol (Haldol) d.olanzapine (Zyprexa) e.aripiprazole (Abilify)

a.clozapine (Clozaril) d.olanzapine (Zyprexa) e.aripiprazole (Abilify)

Atenolol (Tenormin) is prescribed for a client. The nurse realizes that this drug is a beta-adrenergic blocker and that this drug classification is contraindicated for clients with which condition? a. Hypothyroidism b. Angina pectoris c. Cardiogenic shock d. Liver dysfunction

c. Cardiogenic shock

The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching? 1. Withdraws the NPH insulin first 2. Withdraws the regular insulin first 3. Injects air into NPH insulin vial first 4. Injects an amount of air equal to the desired dose of insulin into each vial

Withdraws the NPH insulin first Rationale: When preparing a mixture of short-acting insulin such as regular insulin with another insulin preparation, the short-acting insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of short-acting insulin with insulin of another type. Options 2, 3, and 4 identify correct actions for preparing NPH and short-acting insulin.

A middle-aged woman is experiencing severe vertigo. The nurse expects this patient will receive which drug, which is considered the most appropriate drug treatment for vertigo? a meclizine (Antivert) b prochlorperazine (Compazine) c metoclopramide (Reglan) d dronabinol (Marinol)

a meclizine (Antivert)

A nurse is teaching a female client who has a severe UTI about ciprofloxacin. Which of the following information about adverse reactions should the nurse include? (Select all that apply) a. Observe for pain and swelling of the Achilles tendon b. Watch for a vaginal yeast infection c. Expect excessive nighttime perspiration d. Inspect the mouth for cottage cheese-like lesions e. Take the medication with a dairy product

a, b, d are correct. RATIONALE: Pain and swelling of the Achilles tendon is an adverse reaction to this medication. A vaginal yeast infection and the cottage cheese-like lesions in the mouth both are caused by overgrowth of Candida albicans and are common reactions to the medication.Dairy products have calcium that reduces the effect of ciprofloxacin. Clients should take this medication 6 hours before or 2 hours after eating dairy products.

Which statement by the patient reflects the need for additional patient education about the calcium channel blocker diltiazem (Cardizem)? a. "I can take this drug to stop an attack of angina." b. "I understand that food and antacids alter the absorption of this oral drug." c. "When the long-acting forms are taken, the drug cannot be crushed." d. "This drug may cause my blood pressure to drop, so I need to be careful when getting up."

a. "I can take this drug to stop an attack of angina."

The nurse is providing medication instructions to a patient with acute muscle spasms who has been prescribed cyclobenzaprine (Flexeril). Which statement indicates to the nurse that the patient understands the instructions? a. "I plan to take this medication with a glass of milk." b. "Cyclobenzaprine should be taken once daily at bedtime." c. "I will only drink one glass of wine per day." d. "I will not be able to drink grapefruit juice while taking this drug."

a. "I plan to take this medication with a glass of milk."

A client who has constipation is prescribed a bisacodyl suppository. The nurse explains that bisacodyl does what? a. Acts on smooth intestinal muscle to gently increase peristalsis b. Absorbs water into the intestines to increase bulk and peristalsis c. Lowers surface tension and increases water accumulation in the intestines d. Pulls hyperosmolar salts into the colon and increases water in the feces to increase bulk

a. Acts on smooth intestinal muscle to gently increase peristalsis

What is a priority nursing intervention when administering ranitidine (Zantac)? a. Administer just before meals. b. Administer right after eating. c. Administer 1 to 2 hours after meals. d. Administer during meals.

a. Administer just before meals.

Cycobenzapine (Amrix, Flexural) is prescribed for a patient with muscle spasms of the lower back. Appropriate nursing interventions would include which of the following (select all that apply) a. Assessing the heart rate for tachycardia b. Assessing the home environment for patient safety concerns c. Encouraging frequent ambulation d. Providing oral suction for excessive oral secretions e. Providing assistance with activities of daily living such as reading

a. Assessing the heart rate for tachycardia b. Assessing the home environment for patient safety concerns e. Providing assistance with activities of daily living such as reading Adversereactionstocycloben- zaprine include drowsiness, dizziness, dry mouth, rash, blurred vision, and tachycardia. Because the medication can cause drowsiness and dizziness, ensuring patient safety must be a priority. The patient may need assis- tance with reading or other activities requiring visual acuity if blurred vision occurs.

Cyclobenzaprine (Flexeril) is prescribed for an older adult client experiencing muscle spasm of the lower back. Which nursing intervention should the nurse include in the client's plan of care? a. Assisting with patient repositioning b. Encouraging independent ambulation c. Assessing heart rate for bradycardia d. Providing oral suction for secretion

a. Assisting with patient repositioning Orthostatic hypotension is a possible adverse effect of cyclobenzaprine (Flexeril), so the nurse should include interventions to assist the patient with changing positions from lying to sitting or standing slowly to avoid dizziness or falls. In addition, muscles spasms, pain, or rigidity may increase the risk of falls or injury. The patient should be encouraged not to attempt standing or walking without assistance. Tachycardia and dry mouth are adverse effects of the medication.

A patient asks the nurse why the healthcare provider had advised against use of calcium carbonate as an antacid. What is the nurse's best response? a. Its use may result in kidney stones. b. It causes decreased gastric acid production. c. It often causes severe diarrhea. d. It may result in fluid retention and edema.

a. Its use may result in kidney stones. Antacids containing calcium can cause constipation and may cause or aggravate kidney stones. In addition, administering calcium carbonate antacids with milk or any items with vitamin D can cause milk-alkali syndrome to occur. Milk-alkali syndrome may result in permanent renal damage if the drug is continued at high doses.

A patient prescribed spironolactone (Aldactone) asks the nurse to assist with food choices that are low in potassium. The nurse would recommend which food choices? (Select all that apply.) a. Lean meat b. Winter squash c. Apples d.Bananas e. Pineapple

a. Lean meat c. Apples e. Pineapple Spironolactone is a potassium-sparing diuretic that could potentially cause hyperkalemia. Bananas and winter (not summer) squash are high in potassium and should be avoided in patients taking spironolactone.

Which of the following statements about promethazine are true? (Select all that apply.) a. The preferred route of parenteral dose is intramuscular. b. The medication should be administered through a large-bore IV. c. The medication should be given by IV push only. d. The medication should be given in a concentration of 25 mg/mL or less. e. This medication can cause severe tissue injury.

a. The preferred route of parenteral dose is intramuscular. b. The medication should be administered through a large-bore IV. d. The medication should be given in a concentration of 25 mg/mL or less. e. This medication can cause severe tissue injury. Parenteral promethazine can cause severe local tissue injury if an IV line becomes extravasated, or following inadvertent perivascular, intra-arterial, or intraneuronal dosing. Gangrene requiring amputation has developed. Accordingly, when parenteral dosing is needed, the preferred route is IM. If IV dosing cannot be avoided, promethazine should be administered through a large-bore, freely flowing line, in a concentration of 25 mg/mL or less at a rate of 25 mg/min or less.

A patient who has been prescribed baclofen (Lioresal) returns to the health care provider after a week of drug therapy, complaining of continued muscle spasms of the lower back. What further assessment data will the nurse gather? a. Whether the patient has been taking the medication consistently or only when the pain is severe b. Whether the patient has been consuming alcohol during this time c. Whether the patient has increased the dosage without consulting the health care provider d. Whether the patients log of symptoms indicates that the patient is telling the truth

a. Whether the patient has been taking the medication consistently or only when the pain is severe Muscle relaxers such as baclofen (Lioresal) work best when taken consistently and not prn. Noting consistency of dosing helps to determine the appropriateness of dose, frequency, and drug ef- fects.

The nurse is teaching a patient to self-administer medications. The nurse knows that which drug is used to treat narcolepsy? a. modafinil b. atomoxetine c. lisdexamfetamine d. methylphenidate

a. modafinil

A patient who is taking disulfiram as part of an alcohol treatment program accidentally takes a dose of cough syrup that contains a small percentage of alcohol. The nurse expects to see which symptom as a result of acetaldehyde syndrome? a) lethargy b) copious vomiting c) HTN d) no ill effect because of the small amount of alcohol in the cough syrup

b) copious vomiting

Which statement needs to be included when the nurse provides patient education for a patient with heart failure who is taking daily doses of spironolactone (Aldactone)? a. "Be sure to eat foods that are high in potassium." b. "Avoid foods that are high in potassium." c. "Avoid grapefruit juice while taking this medication." d. "A low-fiber diet will help prevent adverse effects of this medication."

b. "Avoid foods that are high in potassium."

A client who takes clonidine (Catapres) is to be discharged to home. Which instruction will the nurse include when teaching this client? a. "Your blood pressure should be checked by a health care provider at least once a year." b. "Increasing fluid and fiber in your diet can help prevent the side effect of constipation." c. "Intense exercise or prolonged standing is not a problem with clonidine as it can be with other antihypertensive agents." d. "If you are having difficulty with the common side effect of drooling, notify your health care provider so your dosage can be adjusted."

b. "Increasing fluid and fiber in your diet can help prevent the side effect of constipation."

What is the best information for the nurse to provide to the client who is receiving spironolactone (Aldactone) and furosemide (Lasix) therapy? a. "Moderate doses of two different diuretics are more effective than a large dose of one." b. "This combination promotes diuresis but decreases the risk of hypokalemia." c. "This combination prevents dehydration and hypovolemia." d. "Using two drugs increases the osmolality of plasma and the glomerular filtration rate."

b. "This combination promotes diuresis but decreases the risk of hypokalemia."

A patient asks the nurse about using potassium supplements while taking spironolactone (Aldactone). What is the nurse's best response? a. "I would recommend that you take two multivitamins every day." b. "This diuretic is potassium sparing, so there is no need for extra potassium." c. "I will call your health care provider and discuss your concern." d. "You will need to take potassium supplements for the medication to be effective."

b. "This diuretic is potassium sparing, so there is no need for extra potassium." Spironolactone is a potassium-sparing diuretic, and thus the patient does not need potassium supplementation. Intake of excess potassium may lead to hyperkalemia.

The nurse is teaching a patient about ranitidine (Zantac) prescribed for gastritis. Which statement by the patient indicates effective teaching by the nurse? a. "The drug will heal the areas of my stomach that are sore." b. "This drug will block the secretions of my stomach." c. "Zantac will coat the inside of my stomach to protect it from acid." d. "This pill kills the bacterial infection I have in my stomach."

b. "This drug will block the secretions of my stomach."

The nurse is preparing to administer chemotherapy to an oncology patient who also has an order for ondansetron (Zoran). When should the nurse administer the odansetron? a. Every time the patient complains of nausea b. 30 to 60 minutes before starting chemo c. Only if the patient complains of nausea d. When the patient begins to experience vomiting during chemo

b. 30 to 60 minutes before starting chemo To be most effective, ondansetron (Zofran) or other antiemetics should be administered 30 to 60 minutes before initiating the chemotherapy drugs.

A patient is receiving morphine sulfate and promethazine [Phenergan]. It is most important for the nurse to assess what? a. Heart rate b. Alertness c. Blood pressure d. Bowel sounds

b. Alertness Promethazine is a first-generation H1 blocker that binds selectively to H1 receptors, resulting in central nervous system (CNS) effects. The most common adverse effect of first-generation H1 blockers is sedation, and caution is advised, especially when these drugs are used in combination with other CNS depressants. The heart rate, blood pressure, and bowel sounds do not warrant more frequent monitoring.

The nurse is administering atenolol (Tenormin) to a patient. Which concurrent drugs does the nurse expect to most likely cause an interaction? (Select all that apply.) a. ginseng supplement b. An NSAID, such as aspirin c. atropine, an anticholinergic d. haloperidol (Haldol) e. methyldopa (Aldomet)

b. An NSAID, such as aspirin c. atropine, an anticholinergic

A client has nausea and is taking ondansetron (Zofran). The nurse explains that the action of this drug is what? a. Stimulate the CTZ b. Block serotonin receptors in the CTZ c. Block dopamine receptors in the CTZ d. Coat the wall of the GI tract and absorb bacteria

b. Block serotonin receptors in the CTZ

A patient is beginning to take cyclobenzaprine (Flexeril) for treatment of acute back spasms. Which interventions will the nurse include in the care of this patient? (Select all that apply.) a. Advise the patient to take this drug on an empty stomach. b. Inform the patient that muscular pain is usually relieved within 1 week. c. Tell the patient to report dizziness and double vision to the health care provider. d. Advise the patient to avoid alcohol. e. Taking narcotics at the same time can cause serious side effects.

b. Inform the patient that muscular pain is usually relieved within 1 week. c. Tell the patient to report dizziness and double vision to the health care provider. d. Advise the patient to avoid alcohol. e. Taking narcotics at the same time can cause serious side effects.

For the client taking a diuretic, a combination such as triamterene and hydrochlorothiazide may be prescribed. The nurse realizes that this combination is ordered for which purpose? a. To decrease the serum potassium level b. To increase the serum potassium level c. To decrease the glucose level d. To increase the glucose level

b. To increase the serum potassium level

Leuprolide (Lupron), an LH-RH Agonist, and bicalutamide (Casodex), an androgen receptor blocker, are prescribed for a patient with cancer of the prostate. In teaching the patient about these drugs, the nurse informs the patient that side effects may include a. low blood pressure. b. decreased sexual drive. c. urinary incontinence. d. frequent infections.

b. decreased sexual drive. Rationale: Hormonal therapy blocks the effects of testosterone and decreases libido. Hypotension is associated with the -blockers used for BPH. Urinary incontinence may occur after prostate surgery, but it is not an expected medication side effect. Risk for infection is increased in patients receiving chemotherapy.

Leuprolide (Lupron) is prescribed for a patient with cancer of the prostate. In teaching the patient about this drug, the nurse informs the patient that side effects may include a. dizziness. b. hot flashes. c. urinary incontinence. d. increased infection risk.

b. hot flashes. Hot flashes may occur with decreased testosterone production. Dizziness may occur with the -blockers used for benign prostatic hyperplasia (BPH). Urinary incontinence may occur after prostate surgery, but it is not an expected medication side effect. Risk for infection is increased in patients receiving chemotherapy.

The nurse should include which statement(s) when teaching a patient about the use of acetaminophen [Tylenol]? Select all that apply. a) "Use of this drug can prevent heart attack and stroke." b) "The most common side effect of treatment with this drug is kidney failure." c) "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." d) "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." e) "Acetaminophen is a useful drug for the treatment of inflammation such as rheumatoid arthritis."

c) "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." d) "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." Rationale: Acetaminophen [Tylenol] is used to treat fever and pain. It is not an antiinflammatory drug. The most serious side effect of acetaminophen therapy is liver failure; therefore, the healthcare provider should be notified if indications of jaundice are seen, such as yellowing of the skin or sclera. Acetaminophen therapy has no antiplatelet activity; therefore, it is not used to prevent heart attack or stroke. Routine use of acetaminophen may blunt the immune response to vaccines; therefore, it should be avoided as routine treatment for vaccine-associated fever and pain.

The nurse reviews the history for a client taking atorvastatin (Lipitor). What will the nurse act on immediately? a. Client takes medications with grape juice. b. Client takes herbal therapy including kava kava. c. Client is on oral contraceptives. d. Client was started on penicillin for a respiratory infection.

c. Client is on oral contraceptives. Atorvastatin (Lipitor) increases the estrogen levels of oral contraceptives. The client's oral contraceptive may need to be altered.

Which outcome assessment is essential to monitor for the client taking diphenoxylate (Lomotil)? a. Increase in bowel sounds b. Increase in number of bowel movements c. Decrease in gastric motility d. Decrease in urination

c. Decrease in gastric motility

A patient with severe diarrhea has an order for diphenoxylate with atropine (Lomotil). When assessing for therapeutic effects, which of the following will the nurse expect to find? a. Increased bowel sounds b. Decreased belching and flatus c. Decrease in loose, watery stools d. Decreased abdominal cramping

c. Decrease in loose, watery stools A decrease in the number and con- sistency of stools is a therapeutic effect of diphenoxylate with atropine (Lomotil). Options 1, 2, and 4 are incorrect. A decrease in bowel sounds rather than an increase would be noted if the drug is having therapeutic effects. The drug has no direct effect on the causes of belching or flatus. Al- though reduction in abdominal cramping may occur due to decreased peristalsis, it is not the therapeutic indication for the drug.

A client with hyperaldosteronism is prescribed spironolactone (Aldactone). What assessment finding would the nurse evaluate as a positive outcome? a. Decreased potassium level b. Decreased crackles in the lung bases c. Decreased aldosterone d. Decreased ankle edema

c. Decreased aldosterone

diltiazem (Cardizem) is Rx for a client with chronic, stable angina. Which statement by the client indicates to the clinic nurse that the client needs additional medication information? a. I will call the physician is SHOB occurs b. I will rise slowly when getting out of bed c. I will take the medication after meals d. I may notice changes in mental alertness until my dose is regulated

c. I will take the medication after measl rationale: administer before meals and at bedtime to increase absorption

A patient has been given PEG-3350 in a solution of polyethylene glycol (GoLYTELY) as a preparation for a colonoscopy. He started having diarrhea after about 45 minutes. Two hours later, he tells the nurse that "the diarrhea has not stopped yet." What will the nurse do? a. Give the patient an antidiarrheal drug, such as loperamide (Lomotil). b. Give the patient another dose of the GoLYTELY to finish cleansing the bowel. c. Remind the patient that it may take up to 4 hours to completely evacuate the bowel. d. Report this to the physician immediately.

c. Remind the patient that it may take up to 4 hours to completely evacuate the bowel.

A nurse is caring for a client with a spinal cord injury and is receiving baclofen (Lioresal) and clonazepam (Klonopin). For which adverse effect should the nurse monitor closely in this client? a. Insomnia b. Cardiac dysrhythmia c. Respiratory depression d. Hypertension

c. Respiratory depression Respiratory depression is a serious adverse effect of both baclofen (Lioresal) and clonazepam (Klonopin). Insomnia, cardiac dysrhythmia, and hypertension are not adverse effects associated with these medications.

When the nurse is checking the laboratory data for a patient taking spironolactone (Aldactone), which result would be a potential concern? a. Serum sodium level of 140 mEq/ L b. Serum calcium level of 10.2 mg/ dL c. Serum potassium level of 5.8 mEq/ L d. Serum magnesium level of 2.0 mg/ dL

c. Serum potassium level of 5.8 mEq/ L

A client is taking ranitidine (Zantac). The nurse who is teaching the client about this drug should include which information? (Select all that apply.) a. Drug-induced impotence is irreversible b. The drug must be administered 30 minutes before meals c. The drug must be administered separate from an antacid by at least 1 hour d. The drug must always be administered with magnesium hydroxide e. Smoking should be avoided while taking this drug f. Foods high in vitamin B12 should be increased in diet

c. The drug must be administered separate from an antacid by at least 1 hour e. Smoking should be avoided while taking this drug f. Foods high in vitamin B12 should be increased in diet

A patient is scheduled for a colonoscopy. Before the procedure, the nurse will anticipate administering: a. glycerin suppository b. magnesium hydroxide (MOM) c. polyethylene glycol and electrolytes d. lactulose

c. polyethylene glycol and electrolytes PEG plus electrolytes -large volume administered (4L) -commode near pt or close to bathroom

A patient with a history of chronic alcohol abuse has been admitted to the unit with hepatic encephalopathy. Upon review of the patient's laboratory test results, the nurse notes that the patient's ammonia level is elevated at 218 mcg/dL. What medication should the nurse anticpate will be included in the orders? a. 0.9% NS b. docusate sodium (Colace) c. lactulose d. polyethylene glycol (MiraLax)

c.lactulose lactulose (osmotic laxative) -colonic bacteria metabolizes to acid that produces osmotic state -draws in fluid and causes parastalsis -draws in ammonia -AE dehydration

A nurse is caring for a client receiving cyclobenzaprine (Flexeril) for management of acute back muscle spasms. Which evaluation data supports effective pharmacotherapy with cyclobenzaprine (Flexeril)? a. Muscle spasms occur only with exercise. b. Complaints of dry mouth have decreased. c. Reports episodes of dizziness or drowsiness. d. Ability to ambulate without complaint of pain

d. Ability to ambulate without complaint of pain Cyclobenzaprine relieves muscle spasms of local origin without interfering with general muscle function. Expected outcomes include relief of pain and spasms and increased range of motion of the affected body part.

A client is taking triazolam (Halcion). Which instructions about this drug are important for the nurse to include? a. It may be used as a barbiturate for only 4 weeks. b. Use as a nonbenzodiazepine to reduce anxiety. c. This drug does not lead to vivid dreams or nightmares. d. Avoid alcohol and smoking to prevent rebound insomnia.

d. Avoid alcohol and smoking to prevent rebound insomnia.

Captopril (Capoten) has been ordered for a client. The nurse teaches the client that ACE inhibitors have which common side effects? a. Nausea and vomiting b. Dizziness and headaches c. Upset stomach d. Constant, irritating cough

d. Constant, irritating cough

The nurse is caring for a client with hypertension who is prescribed Clonidine transdermal preparation. What is the correct information to teach this client? a. Change the patch daily at the same time. b. Remove the patch before taking a shower or bath. c. Do not take other antihypertensive medications while on this patch. d. Get up slowly from a sitting to a standing position.

d. Get up slowly from a sitting to a standing position.

To treat a patient diagnosed with primary hyperaldosteronism, the nurse would expect to administer which diuretic? a. Acetazolamide (Diamox) b. Furosemide (Lasix) c. Hydrochlorothiazide (HydroDIURIL) d. Spironolactone (Aldactone)

d. Spironolactone (Aldactone) Spironolactone is the direct antagonist for aldosterone.

A patient's chart includes an order that reads as follows: "Atenolol 25 mg once daily at 0900." Which action by the nurse is correct? a. The nurse gives the drug via the transdermal route. b. The nurse gives the drug orally. c. The nurse gives the drug intravenously. d. The nurse contacts the prescriber to clarify the dosage route.

d. The nurse contacts the prescriber to clarify the dosage route.

When reviewing the drugs used for nausea and vomiting, the nurse recalls that which drug is a synthetic derivative of the major active substance in marijuana? a. ondansetron (Zofran) b. metoclopramide (Reglan) c. prochlorperazine (Compazine) d. dronabinol (Marinol)

d. dronabinol (Marinol)

A patient with renal cancer needs an opiate for pain control. Which opioid medication would be the safest choice for this patient? a. fentanyl b. hydromorphone (Dilaudid) c. morphine sulfate d. methadone (Dolophine)

d. methadone (Dolophine)

When planning care for a patient who is receiving interferon therapy, the nurse must keep in mind that the major dose-limiting factor is . . . A. fatigue. B. bone marrow suppression. C. fever. D. nausea and vomiting.

A. fatigue.

In caring for a patient receiving therapy with a myelosuppressive antineoplastic drug, the nurse notes an order to begin filgrastim after the chemotherapy is completed. Which statement correctly describes when the nurse will begin the filgrastim therapy? A. It can be started during the chemotherapy. B. It will begin immediately after the chemotherapy is completed. C. It will be initiated 24 hours after the chemotherapy is completed. D. It will not be started until at least 72 hours after the chemotherapy is completed.

C. It will be initiated 24 hours after the chemotherapy is completed.

he expected outcome of administering epoetin afla (Epogen, Procrit) or darbepoetin alfa (Aranesp) to a patient with chronic renal failure is A. decreasing bleeding B. increased white blood cell production C. increased red blood cell production D. improved renal function

C. increased red blood cell production

A patient with a history of stroke and myocardial infarction (MI) is on a daily aspirin regimen. Which of the following would alert the nurse to contact the primary healthcare provider? a) temperature 97.9 F b) heart rate 99 beats/min c) blood glucose level 78 mg/dL d) blood pressure 160/94 mm Hg

D. blood pressure 160/94 mm Hg An elevated blood pressure over 150/90 mm Hg puts the patient at a greater risk for hemorrhagic stroke.

A patient who takes lisinopril (Zestril) for heart failure requires a diuretic to help prevent edema. Which is the best diuretic to administer to this patient?

Lisinopril with hydrochlorothiazide (Zestoretic) Lisinopril with hydrochlorothiazide is the best choice for this patient because it provides two important therapies in a single once-a-day pill—the best choice for this patient because the patient is much more likely to adhere to the therapeutic regimen if it involves taking just one pill once a day. Furosemide is a suitable diuretic for this patient, but combinations of lisinopril and furosemide are not marketed. Spironolactone is contraindicated because it is likely to lead to an increased potassium level.

The nurse administers filgrastim (Neupogen) to the client. The nurse explains that this drug is used in the treatment of: a) Acute lymphoblastic leukemia. b) Neutropenia, or neutropenia secondary to chemotherapy. c) Clients with Hodgkin's disease who are having bone marrow transplants. d) Hodgkin's lymphoma.

Neutropenia, or neutropenia secondary to chemotherapy. Rationale: Filgrastim is a colony-stimulating factor used primarily for chronic neutropenia, or neutropenia secondary to chemotherapy.

A nurse is caring for a client with chronic renal failure who is receiving epoetin alfa. Which health-promotion strategy should the nurse include in the client's plan of care? a. Encourage adequate dietary intake of iron and folic acid. b. Encourage frequent exercise or aerobic activity. c. Monitor for signs of cardiac adverse effects. d. Assess for symptoms of peripheral thrombosis.

a. Encourage adequate dietary intake of iron and folic acid. Rationale: The response to erythropoiesis-stimulating therapy may be decreased if blood levels of iron, folic acid, and vitamin B12 are deficient. Therefore, the nurse should encourage the client to maintain adequate dietary intake of iron, folic acid, and vitamin B12 (found in meats, dairy, eggs, fortified cereals and breads, leafy green vegetables, citrus fruits, dried beans, and peas). Provide dietary consult as needed and consider nutritional supplements of these nutrients if the diet is inadequate.

The client receiving filgrastim (Neupogen) should be monitored for common adverse effects, which include: a) Hypertension and skeletal pain. b) Elevated liver enzymes. c) Hypotension and hypoglycemia. d) Elevated BUN and creatinine.

a. Hypertension and skeletal pain. Rationale: The nurse should assess for both hypertension and skeletal pain, which are adverse effects of filgrastim therapy.

A nurse is caring for a 45-year-old female client with multiple sclerosis who is prescribed dantrolene sodium (Dantrium). For which adverse effect should the nurse monitor closely in this client? a. Constipation b. Hepatotoxicity c. Urinary obstruction d. Photosensitivity

b. Hepatotoxicity Women over the age of 35 taking dantrolene (Dantrium) are at greater risk for hepatotoxicity, so liver function should be monitored frequently. The older adult is at increased risk of constipation due to slowed peristalsis. The male older adult with an enlarged prostate is at higher risk for mechanical obstruction. Photosensitivity is an adverse effect of the drug that the nurse can expect, but not as significant as hepatotoxicity.

A client is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. What type of electrolyte imbalance does the nurse expect to occur? a. Hypocalcemia b. Hypokalemia c. Hyperkalemia d. Hypermagnesemia

b. Hypokalemia

A nurse teaching a client who has diabetes mellitus and is taking hydrochlorothiazide 50 mg/day. The teaching should include the importance of monitoring which levels? a. Hemoglobin and hematocrit b. Blood urea nitrogen (BUN) c. Arterial blood gases d. Serum glucose (sugar)

d. Serum glucose (sugar)

A nurse is monitoring a client receiving desmopressin acetate (DDAVP) for adverse effects to the medication. Which of the following indicates the presence of an adverse effect? 1. Insomnia 2. Drowsiness 3. Weight loss 4. Increased urination

2. Drowsiness Rationale: Water intoxication (overhydration) or hyponatremia is an adverse effect to desmopressin. Early signs include drowsiness, listlessness, and headache. Decreased urination, rapid weight gain, confusion, seizures, and coma also may occur in overhydration.

The order for enoxaparin (Lovenox) reads: "Give 1 mg/kg subcut every 12 hours. The patient weighs 242 lbs, and the medication is available in an injection form of 120 mg/0.8 mL. How many milliliters will the nurse draw up for the injection? (ROUND TO HUNDRETHS)

110 mg; 0.73 mL

A client with rheumatoid arthritis is taking acetylsalicylic acid (aspirin) on a daily basis. Which medication dose should the nurse expect the client to be taking? 1. 1 g daily 2. 4 g daily 3. 325 mg daily 4. 1000 mg daily

2. 4 g daily Rationale: Aspirin may be used to treat the client with rheumatoid arthritis. It may also be used to reduce the risk of recurrent transient ischemic attack (TIA) or brain attack (stroke) or reduce the risk of myocardial infarction (MI) in clients with unstable angina or a history of a previous MI. The normal dose for clients being treated with aspirin to decrease thrombosis and MI is 300 to 325 mg/day. Clients being treated to prevent TIAs are usually prescribed 1.3 g/day in two to four divided doses. Clients with rheumatoid arthritis are treated with 3.6 to 5.4 g/day in divided doses.

A nurse provides dietary instructions to a client who will be taking warfarin sodium (Coumadin). The nurse tells the client to avoid which food item? 1. Grapes 2. Spinach 3. Watermelon 4. Cottage cheese

2. Spinach Rationale: Warfarin sodium is an anticoagulant. Anticoagulant medications act by antagonizing the action of vitamin K, which is needed for clotting. When a client is taking an anticoagulant, foods high in vitamin K often are omitted from the diet. Vitamin K-rich foods include green, leafy vegetables, fish, liver, coffee, and tea.

A nurse reinforces medication instructions to a client who is taking levothyroxine (Synthroid). The nurse instructs the client to notify the health care provider (HCP) if which of the following occurs? 1. Fatigue 2. Tremors 3. Cold intolerance 4. Excessively dry skin

2. Tremors Rationale: Excessive doses of levothyroxine (Synthroid) can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, heat intolerance, and sweating. The client should be instructed to notify the HCP if these occur. Options 1, 3, and 4 are signs of hypothyroidism.

The client who received the hematopoietic growth factor ,filgrastim, calls the clinic nurse and reports aching in the back and legs. Which statement is the nurse's best response? 1. "This is unrelated to the medication. You may be getting the flu." 2. "You should come to the clinic immediately to see the HCP." 3. "This is an expected side effect of the medication and can be treated." 4. "Have you taken your blood pressure medication today?"

3. "This is an expected side effect of the medication and can be treated." hyperstimulation of the bone marrow is the probable cause of the aches and should be treated with over-the-counter pain medications before seeking a stronger analgesic from the HCP.

The nurse is caring for a postrenal transplant client taking cyclosporine (Sandimmune, Gengraf, Neoral). The nurse notes an increase in one of the client's vital signs, and the client is complaining of a headache. What is the vital sign that is most likely increased? 1. Pulse 2. Respirations 3. Blood pressure 4. Pulse oximetry

3. Blood pressure Rationale: Hypertension can occur in a client taking cyclosporine (Sandimmune, Gengraf, Neoral), and because this client is also complaining of a headache, the blood pressure is the vital sign to be monitoring most closely. Other adverse effects include infection, nephrotoxicity, and hirsutism. Options 1, 2, and 4 are unrelated to the use of this medication.

A nurse is monitoring a client receiving baclofen (Lioresal) for side effects related to the medication. Which of the following would indicate that the client is experiencing a side effect? 1. Polyuria 2. Diarrhea 3. Drowsiness 4. Muscular excitability

3. Drowsiness Rationale: Baclofen is a central nervous system (CNS) depressant and frequently causes drowsiness, dizziness, weakness, and fatigue. It can also cause nausea, constipation, and urinary retention. Clients should be warned about the possible reactions. Options 1, 2, and 4 are not side effects.

After kidney transplantation, cyclosporine (Sand immune) is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication? 1. Decreased creatinine level 2. Decreased hemoglobin level 3. Elevated blood urea nitrogen level 4. Decreased white blood cell count

3. Elevated blood urea nitrogen level Rationale: Nephrotoxicity can occur from the use of cyclosporine (Sandimmune). Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen (BUN) and serum creatinine levels. Cyclosporine is an immunosuppressant but does not depress the bone marrow.

A nurse is reinforcing dietary instructions to a client who has been prescribed cyclosporine (Sandimmune). Which food item would the nurse instruct the client to avoid? 1. Red meats 2. Orange juice 3. Grapefruit juice 4. Green, leafy vegetables

3. Grapefruit juice Rationale: A compound present in grapefruit juice inhibits metabolism of cyclosporine. As a result, the consumption of grapefruit juice can raise cyclosporine levels by 50% to 100%, thereby greatly increasing the risk of toxicity. Grapefruit juice needs to be avoided. Red meats, orange juice, and green leafy vegetables are acceptable to consume.

A home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine (Questran). Which of the following statements, if made by the client, indicates the need for further education? 1. "Constipation and bloating might be a problem." 2. "I'll continue to watch my diet and reduce my fats." 3. "Walking a mile each day will help the whole process." 4. "I'll continue my nicotinic acid from the health food store."

4. "I'll continue my nicotinic acid from the health food store." Rationale: Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid-lowering medications also can cause liver abnormalities, so a combination of nicotinic acid and cholestyramine resin is to be avoided. Constipation and bloating are the two most common side effects. Walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels.

A client with acute muscle spasms has been taking baclofen (Lioresal). The client calls the clinic nurse because of continuous feelings of weakness and fatigue and asks the nurse about discontinuing the medication. The nurse should make which appropriate response to the client? 1. "You should never stop the medication." 2. "It is best that you taper the dose if you intend to stop the medication." 3. "It is okay to stop the medication if you think that you can tolerate the muscle spasms." 4. "Weakness and fatigue commonly occur and will diminish with continued medication use."

4. "Weakness and fatigue commonly occur and will diminish with continued medication use." Rationale: The client should be instructed that symptoms such as drowsiness, weakness, and fatigue are more intense in the early phase of therapy and diminish with continued medication use. The client should be instructed never to withdraw or stop the medication abruptly, because abrupt withdrawal can cause visual hallucinations, paranoid ideation, and seizures. It is best for the nurse to inform the client that these symptoms will subside and encourage the client to continue the use of the medication.

A client with diabetes mellitus who has been controlled with daily insulin has been placed on atenolol (Tenormin) for the control of angina pectoris. Because of the effects of atenolol, the nurse determines that which of the following is the most reliable indicator of hypoglycemia? 1. Sweating 2. Tachycardia 3. Nervousness 4. Low blood glucose level

4. Low blood glucose level Rationale: β-Adrenergic blocking agents, such as atenolol, inhibit the appearance of signs and symptoms of acute hypoglycemia, which would include nervousness, increased heart rate, and sweating. Therefore, the client receiving this medication should adhere to the therapeutic regimen and monitor blood glucose levels carefully. Option 4 is the most reliable indicator of hypoglycemia.

A nurse is preparing to administer filgastim for the first time to a client who has just undergone a bone marrow transplant. Which of the following interventions is appropriate? a. Administer intramuscularly in a large muscle mass to prevent injury. b. Ensure that the medication is refrigerated until just prior to administration. c. Shake vial gently to mix well before withdrawing dose. d. Discard vial after removing one dose of the medication.

Answer is D, Discard vial after removing one dose of the medication. (Only one dose of filgrastim should be withdrawn from the vial and the vial should then be discarded)

The nurse is monitoring a client for adverse reactions to Dantrolene (Dantrium). Which adverse reaction is most common? A. Excessive Tearing B. Urine Retention C. Muscle Weakness D. Slurred Speech

Answer: C.muscle weakness Rational: The most common adverse reaction to Dantrolene is muscle weakness. The drug may also depress liver function. Muscle weakness is rarely severe enough to cause slurring of speech, drooling, or enuresis. Although excessive tearing and urine retention are adverse reactions to Dantrolene, they are not as common as muscle weakness

A nurse would monitor older adults who are prescribed a benzodiazepine for treatment of insomnia for which potential side effect? A. Hallucinations B. Ataxia C. Alertness D. Dyspnea

B. Ataxia

The nurse is administering methotrexate as part of treatment for a patient with rheumatoid arthritis and will monitor for which sign of bone marrow suppression? A. Edema B. Tinnitus C. Increased bleeding tendencies D. Tingling in the extremities

C. Increased bleeding tendencies

The nurse is reviewing cyclosporine and recognizes that this drug works by which mechanism of action? A. Suppressing viral replication. B. Enhancing the action of macrophages. C. Inhibiting activation of T-lymphocyte cells. D. Increasing the number of T-lymphocyte

C. Inhibiting activation of T-lymphocyte cells.

A patient is receiving instructions regarding warfarin therapy and asks the nurse about what medications she can take for headaches. The nurse will tell her to avoid which type of medication? A. Opioids B. acetaminophen (Tylenol) C. NSAIDs D. There are no restrictions while taking warfarin

C. NSAIDs

A client has been taking lorazepam (Ativan) for several weeks for treatment of anxiety. The nurse should plan to assess the client for potential development of what side effect? A. Tachypnea B. Astigmatism C. Ataxia D. Euphoria

C. ataxia When taken in high doses for a prolonged period of time, side effects for this medication include amnesia, weakness, disorientation, ataxia, blurred vision, diplopia, nausea, and vomiting.

When administering IV midazolam (Versed), the nurse should: 1. Obtain serial electrocardiograms (ECG) every hour until the client goes to surgery 2. Continuously monitor the patient's respiration after administration 3. Encourage the client to take quick, shallow breaths 4. Explain what will occur in the recovery room when the client awakens from anesthesia

Correct answer: 2 Continuously monitor the patient's respiration after administration Versed is a respiratory depressant which requires constant respiratory monitoring; instructing the client to take quick, shallow breaths is ill advised due to the potential for respiratory depression. Serial ECGs are not necessary. Versed causes amnesia, so the client is unlikely to remember explanations that occur around the same time as admin.

the nurse completed medication education with the patient who receives hydrochlorothiazide (HydroDIURIL). The nurse determines that teaching has been effective when the patient makes which statement? 1. I really need to avoid grapefruit juice when I take this medication. 2. I need to avoid salt substitutes and potassium-rich foods. 3. I take my medication early in the morning. 4. If I develop a cough, I should call my doctor.

Correct answer: 3. I take my medication early in the morning. Rationale 1: Grapefruit juice inhibits the metabolism of the calcium channel blockers. Rationale 2: Hydrochlorothiazide (HydroDIURIL) is a potassium-excreting diuretic and potassium supplementation is often necessary. Rationale 3: Taking hydrochlorothiazide (HydroDIURIL) early in the day will help prevent nocturia. Rationale 4: Development of a cough occurs with ACE Inhibitors, not diuretics.

A father presents to the emergency department with his 4-year-old son. The father explains that his son had a fever, so he gave the child baby aspirin to decrease the fever and it has not worked. What should concern the nurse about the 4-year-old receiving aspirin? A) Aspirin has the potential to cause gastrointestinal (GI) bleeding in children B) Aspirin has the potential to cause ringing in the ears in children C) Aspirin has the potential to cause hyperglycemia in children D) Aspirin has the potential to cause Reye's syndrome in children

D) Aspirin has the potential to cause Reye's syndrome in children

The nurse is teaching a client about taking aspirin. Which are important points for the nurse to include? (select all that apply): a. advising client to avoid alcohol while taking aspirin b. instructing client to take aspirin before meals on an empty stomach c. instructing client to inform dentist of aspirin dosage before any dental work d. instructing client to inform surgeon of aspirin dosage before any surgery e. suggesting that aspirin may be given to children for flu symptoms

a, c, d

A client who is prescribed dantrolene sodium (Dantrium) reports taking a calcium channel blocker for a heart condition. Which nursing action is most appropriate? a. Holding the drug until the healthcare provider arrives b. Monitoring the client's neurological status c. Encouraging the client to drink plenty of fluids d. Monitoring the client closely for cardiac dysrhythmias

d. Monitoring the client closely for cardiac dysrhythmias Verapamil is a calcium channel blocker and increases the risk for ventricular fibrillations and cardiovascular collapse when taken with dantrolene sodium (Dantrium).

Midazolam (Versed) has been ordered for a patient to be administered by injection 30 minutes prior to a colonoscopy. The nurse informs the patient that one of the most common side effects of this medication is which effect? A. Decreased heart rate B. Amnesia C. Constipation D. Dry mouth

B. amnesia Versed is known to cause amnesia and anxiolysis as well as sedation and is therefore commonly used prior to certain procedures.

Dantrolene sodium (Dantrium) is prescribed for a client experiencing flexor spasms, and the client asks the nurse about the action of the medication. The nurse responds, knowing that the therapeutic action of this medication is which of the following? 1. Depresses spinal reflexes 2. Acts directly on the skeletal muscle to relieve spasticity 3. Acts within the spinal cord to suppress hyperactive reflexes 4. Acts on the central nervous system (CNS) to suppress

2. Acts directly on the skeletal muscle to relieve spasticity Rationale: Dantrium acts directly on skeletal muscle to relieve muscle spasticity. The primary action is the suppression of calcium release from the sarcoplasmic reticulum. This in turn decreases the ability of the skeletal muscle to contract.

Baclofen (Lioresal) is prescribed for the client with multiple sclerosis. The nurse assists in planning care, knowing that the primary therapeutic effect of this medication is which of the following? 1. Increased muscle tone 2. Decreased muscle spasms 3. Increased range of motion 4. Decreased local pain and tenderness

2. Decreased muscle spasms Rationale: Baclofen is a skeletal muscle relaxant and central nervous system depressant and acts at the spinal cord level to decrease the frequency and amplitude of muscle spasms in clients with spinal cord injuries or diseases and in clients with multiple sclerosis. Options 1, 3, and 4 are incorrect.

A client who is receiving cyclosporine after a heart transplant exhibits a sore throat, fatigue, low-grade fever, and white blood count of 12,000 cells/mm3. The nurse should anticipate planning interventions for which client condition? a. Transplant rejection b. Heart failure c. Dehydration d. Infection

d. Infection. Rationale: Transplant patients on immunosuppressant therapy are at high risk for infections, and the client is exhibiting such symptoms. Therefore, the nurse should plan to implement interventions for treatment and management of an infection.

The nurse explains to a patient that aspirin suppresses blood clotting by a. inactivating thrombin b. promoting fibrin degradation c. decreasing synthesis of clotting factors d. decreasing platelet aggregation

d. decreasing platelet aggregation

The nurse is providing care to a patient prescribed aspirin. Which of the following prescribed drugs would alert the nurse that a possible drug interaction can occur? Select all that apply. a) insulin b) warfarin c) enalapril d) morphine e) naproxen

warfarin, elalapril, and naproxen aspirin suppresses platelet function and can decrease prothrombin production, which intensifies the effects of warfarin. aspirin and enalapril together can increase the risk of renal failure. Naproxen is a non steroidal anti-inflammatory drug (NSAID) which negates to the benefits of aspirin.

A patient has been given a new prescription for lorazepam (Ativan). Which of the following is considered an adverse effect of this drug? A. retrograde amnesia B. edema C. anxiety D. tachypnea

A. retrograde amnesia

A client with coronary artery disease complains of substernal chest pain. After checking the client's heart rate and blood pressure, a nurse administers nitroglycerin, 0.4 mg, sublingually. After 5 minutes, the client states, "My chest still hurts." Select the appropriate actions that the nurse should take. Select all that apply. 1. Call a code blue. 2. Contact the registered nurse. 3. Contact the client's family. 4. Assess the client's pain level. 5. Check the client's blood pressure. 6. Administer a second nitroglycerin, 0.4 mg, sublingually.

2. Contact the registered nurse. 4. Assess the client's pain level. 5. Check the client's blood pressure. 6. Administer a second nitroglycerin, 0.4 mg, sublingually. Rationale: The usual guideline for administering nitroglycerin tablets for a hospitalized client with chest pain is to administer one tablet every 5 minutes PRN for chest pain, for a total dose of three tablets. The registered nurse should be notified of the client's condition, who will then notify the health care provider as appropriate. Because the client is still complaining of chest pain, the nurse would administer a second nitroglycerin tablet. The nurse would assess the client's pain level and check the client's blood pressure before administering each nitroglycerin dose. There are no data in the question that indicate the need to call a code blue. In addition, it is not necessary to contact the client's family unless the client has requested this.

The patient receives hydrochlorothiazide (HydroDIURIL). He tells the nurse he is urinating a lot and questions how this drug affects his blood pressure. What is the best response by the nurse? 1. Hydrochlorothiazide (HydroDIURIL) enhances kidney function causing you to urinate more and that decreases your blood pressure. 2. Hydrochlorothiazide (HydroDIURIL) decreases the fluid in your bloodstream and this lowers your blood pressure. 3. Hydrochlorothiazide (HydroDIURIL) dilates your blood vessels so you urinate more and your blood pressure decreases. 4. Hydrochlorothiazide (HydroDIURIL) increases your heart rate; this pumps blood faster to your kidneys so you urinate more and your blood pressure decreases.

2. Hydrochlorothiazide (HydroDIURIL) decreases the fluid in your bloodstream and this lowers your blood pressure. Rationale 1: Hydrochlorothiazide (HydroDIURIL) does not enhance kidney function. Rationale 2: Blood volume is one of the three factors influencing blood pressure. Diuretics like hydrochlorothiazide (HydroDIURIL) decrease blood pressure by decreasing total blood volume. Rationale 3: Hydrochlorothiazide (HydroDIURIL) does not dilate blood vessels. Rationale 4: Hydrochlorothiazide (HydroDIURIL) does not increase heart rate.

A nurse is caring for a client who has been prescribed furosemide (Lasix) and is monitoring for adverse effects associated with this medication. Which of the following should the nurse recognize as a potential adverse effect Select all that apply. 1. Nausea 2. Tinnitus 3. Hypotension 4. Hypokalemia 5. Photosensitivity 6. Increased urinary frequency

2. Tinnitus 3. Hypotension 4. Hypokalemia Rationale: Furosemide is a loop diuretic; therefore, an expected effect is increased urinary frequency. Nausea is a frequent side effect, not an adverse effect. Photosensitivity is an occasional side effect. Adverse effects include tinnitus (ototoxicity), hypotension, and hypokalemia and occur as a result of sudden volume depletion.

A client is receiving meperidine hydrochloride (Demerol) for pain. Which of the following are side effects of this medication. Select all that apply. 1. Diarrhea 2. Tremors 3. Drowsiness 4. Hypotension 5. Urinary frequency 6. Increased respiratory rate

2. Tremors 3. Drowsiness 4. Hypotension Rationale: Meperidine hydrochloride is an opioid analgesic. Side effects include respiratory depression, drowsiness, hypotension, constipation, urinary retention, nausea, vomiting, and tremors.

A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3.0 mEq/L and is complaining of anorexia. A health care provider prescribes a digoxin level to rule out digoxin toxicity. A nurse checks the results, knowing that which of the following is the therapeutic serum level (range) for digoxin? 1. 3 to 5 ng/mL 2. 0.5 to 2 ng/mL 3. 1.2 to 2.8 ng/mL 4. 3.5 to 5.5 ng/mL

2.) 0.5 to 2 ng/mL Rationale: Therapeutic levels for digoxin range from 0.5 to 2 ng/mL. Therefore, options 1, 3, and 4 are incorrect.

A nurse reinforces discharge instructions to a postoperative client who is taking warfarin sodium (Coumadin). Which statement, if made by the client, reflects the need for further teaching? 1. "I will take my pills every day at the same time." 2. "I will be certain to avoid alcohol consumption." 3. "I have already called my family to pick up a Medic-Alert bracelet." 4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated."

4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated." Rationale: Ecotrin is an aspirin-containing product and should be avoided. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking prescribed medication at the same time each day increases client compliance. The Medic-Alert bracelet provides health care personnel emergency information.

The nursing care plan for a client receiving epoetin alfa (Epogen, Procrit) should include careful monitoring for symptoms of: a) Angina, or a change in level of consciousness. b) Impaired liver function. c) Severe hypotension. d) Severe diarrhea.

A. angina Rationale: This drug increases the risk of thromboembolic disease. The client should be monitored for early signs of stroke or heart attack.

The nurse who is administering epoetin alfa (Epogen, Procrit) knows that the most patients who take epoetin alfa or darbepoetin alfa (Aranesp) also need to take A. iron B. potassium C. antacids D. analgesics

A. iron

For a patient prescribed hydrochlorothiazide (HydroDIURIL), the nurse should closely monitor which laboratory test value? A. Sodium B. Glucose C. Calcium D. Chloride

B. Glucose

Nurse is monitoring a client who is receiving epoetin alfa for adverse effects. Which of the following is an adverse effect to this medication? a. Leukocytosis b. Hypertension c. Edema d. Blurred vision

Answer is B Hypertension (Hypertension is an adverse effect of epoetin alfa that the nurse should monitor for throughout treatment)

A nurse is reinforcing discharge instructions to a client receiving baclofen (Lioresal). Which of the following would the nurse include in the instructions? 1. Restrict fluid intake. 2. Avoid the use of alcohol. 3. Stop the medication if diarrhea occurs. 4. Notify the health care provider if fatigue occurs.

Avoid the use of alcohol. Rationale: Baclofen is a central nervous system (CNS) depressant. The client should be cautioned against the use of alcohol and other CNS depressants, because baclofen potentiates the depressant activity of these agents. Constipation rather than diarrhea is an adverse effect of baclofen. It is not necessary to restrict fluids, but the client should be warned that urinary retention can occur. Fatigue is related to a CNS effect that is most intense during the early phase of therapy and diminishes with continued medication use. It is not necessary that the client notify the health care provider if fatigue occurs.

The nurse is teaching a patient about self-administration of enoxaparin (Lovenox). Which statement will be included in this teaching session? A. "We will need to teach a family member how ti give this drug in your arm." B. "This drug is given in the folds of your abdomen, but at least 2 inches away from your navel." C. "This drug needs to be taken at the same time every day with a full glass of water." D. "Be sure to massage the injection site thoroughly after giving the drug."

B. "This drug is given in the folds of your abdomen, but at least 2 inches away from your navel."

A patient is starting warfarin (Coumadin) therapy as part of treatment for atrial fibrillation. The nurse will follow which principles of warfarin therapy? (SELECT ALL THAT APPLY) A. Teach proper subcutaneous administration. B. Administer the oral dose at the same time ever day. C. Assess carefully for excessive bruising or unusual bleeding. D. Monitor laboratory results for a target INR or 2 to 3. E. Monitor laboratory results for a therapeutic aPTT value of 1.5 to 2.5 times the control value.

B. Administer the oral dose at the same time ever day. C. Assess carefully for excessive bruising or unusual bleeding. D. Monitor laboratory results for a target INR or 2 to 3.

A nurse is monitoring a client who takes aspirin 81 mg PO daily. The nurse should identify which of the following manifestations as adverse effects of daily aspirin therapy? Select all that apply. A) Hypertension B) Coffee ground emesis C) Tinnitus D) Paresthesias of the extremities E) Nausea

B. Coffee ground emesis C. Tinnitus E. Nausea

The patient's chart notes the administration of dantrolene (Dantrium) immediately postoperatively. What does the nurse expect the patient has experienced? A. Delirium tremens B. Malignant hyperthermia C. Tonic-clonic seizure D. Respiratory arrest

B. Malignant hyperthermia It is a direct-acting musculoskeletal muscle relaxant and is the drug of choice to treat malignant hyperthermia, a complication of generalized anesthesia.

A physician tells a patient to take aspirin for back pain. It is most important to instruct the patient to A. Take the medication on an empty stomach to enhance absorption. B. Take the medication after a meal to prevent gastric irritation. C. Crush the enteric-coated tablet for increased effectiveness. D. Take the medication 2 hours after a meal to enhance the absorption.

B. The patient should take aspirin with food to prevent gastric irritation.

A nurse should recognize that a patient who takes an angiotensin-converting enzyme (ACE) inhibitor while also taking high-dose aspirin is at risk of developing which complication? a) hemorrhage b) renal failure c) liver toxicity d) congestive heart failure

B.renal failure High-dose aspirin therapy should be avoided in patients taking ACE inhibitors. In susceptible patients, these medications can impair renal function when they are combined with aspirin. Liver toxicity, congestive heart failure, and hemorrhage are not effects of ACE inhibitor and aspirin interactions.

The nurse is evaluating drug effects in a patient who has been given interferon alfa-2b (Intron-A) for hepatitis B and C. Which of the following is a common adverse effect? a. Depression and thoughts of suicide b. Flulike symptoms of fever, chills, or fatigue c. Edema, hypotension, and tachycardia d. Hypertension, renal or hepatic insufficiency

b. Flulike symptoms of fever, chills, or fatigue Interferon alfa-2b (Intron-A) com- monly causes flulike symptoms in up to 50% of patients receiving the drug.

A nurse is caring for a client who has been on a prolonged interferon alfa-2b (Intron A) therapy. For what should the nurse monitor in this client? a. Nephrotoxicity b. Hepatotoxicity c. Hypertension d. Diabetes

b. Hepatotoxicity Prolonged therapy with interferon alfa-2b can result in serious toxicities such as immunosuppression, hepatotoxicity, and neurotoxicity.

A client is admitted to the hospital with complaints of back spasms. The client states, "I have been taking two or three aspirin every 4 hours for the past week and it hasn't helped my back." Aspirin intoxication is suspected. Which of the following complaints would indicate aspirin intoxication? 1. Tinnitus 2. Constipation 3. Photosensitivity 4. Abdominal cramps

Tinnitus Rationale: Mild intoxication with acetylsalicylic acid (aspirin) is called salicylism and is commonly experienced when the daily dosage is higher than 4 g. Tinnitus (ringing in the ears) is the most frequently occurring effect noted with intoxication. Hyperventilation may occur because salicylate stimulates the respiratory center. Fever may result because salicylate interferes with the metabolic pathways involved with oxygen consumption and heat production.

Which statement(s) about the care of a patient with aspirin poisoning does the nurse identify as correct? Select all that apply. a) Hemodialysis or peritoneal dialysis can accelerate salicylate removal. b) Warming blankets are routinely used to raise the patient's temperature. c) Activated charcoal is contraindicated in the treatment of aspirin poisoning. d) Bicarbonate infusions are used to reverse acidosis and promote renal excretion of salicylate. e) Diuretics and fluid restrictions are needed to correct the fluid overload commonly seen with aspirin poisoning.

a) Hemodialysis or peritoneal dialysis can accelerate salicylate removal. d) Bicarbonate infusions are used to reverse acidosis and promote renal excretion of salicylate. rationale: Aspirin poisoning is an acute medical emergency that requires hospitalization. Treatment is largely supportive and consists of external cooling (eg, sponging with tepid water), infusion of fluids (to correct dehydration and electrolyte loss), infusion of bicarbonate (to reverse acidosis and promote renal excretion of salicylates), and mechanical ventilation (if respiration is severely depressed). Absorption of aspirin can be reduced by gastric lavage and by giving activated charcoal. If necessary, hemodialysis or peritoneal dialysis can accelerate salicylate removal.

A nurse is assessing a client who has chronic neutropenia and who has been receiving filgastim. Which of the following actions should the nurse take to assess for an adverse effect of filgastim? a. Assess for bone pain. b. Assess for right lower quadrant pain. c. Auscultate for crackles in the bases of the lungs. d. Auscultate the chest to listen for a heart murmur.

a. Assess for bone pain. (Bone pain is a dose-related adverse effect of filgastim. It can be treated with acetaminophen and, if necessary, an opioid analgesic)

The nursing care plan for a client receiving epoetin alfa (Epogen, Procrit) should include careful monitoring for which symptom? a. Chest pain b. Severe hypotension c. Impaired liver function d. Severe diarrhea

a. Chest pain Rationale: Epoetin alfa increases the risk of thromboembolic disease. The client should be monitored for early signs of stroke or heart attack.

A patient is prescribed lorazepam (Ativan). What does the nurse know to be true regarding lorazepam? a. It may cause anterograde amnesia and sleep-related behaviors. b. It has a maximum adult dose of 25 mg/day. c. When combined with cimetidine, it causes plasma levels to be decreased. d. It interferes with the binding of dopamine receptors.

a. It may cause anterograde amnesia and sleep-related behaviors.

A 28-year-old female client with breast cancer is receiving methotrexate. Which information should the nurse include during client teaching? a. Use reliable birth control measures during and after therapy. b. Use aspirin or NSAIDs such as ibuprofen for minor discomfort. c. Take oral methotrexate with food to avoid gastric upset. d. Limit oral fluid intake during therapy with methotrexate.

a. Use reliable birth control measures during and after therapy. Rationale: Many antineoplastics are contraindicated in pregnancy. Methotrexate is pregnancy category X. Pregnancy should be avoided during therapy and for at least 6 months after therapy.

The patient has been taking aspirin long term for a chronic inflammatory illness. Which adverse effects should the nurse teach the patient to report? Select all that apply. a) diaphoresis b) black, tarry stools c) ringing in the ears d) bleeding of the gums e) increase in urine output

b) black, tarry stools c) ringing in the ears d) bleeding of the gums Increase in bleeding is an adverse effect of aspirin. Black, tarry stools and bleeding of the gums are both indications this could be occurring. Ringing in the ears is a symptom of salicylism, a syndrome that occurs when therapeutic levels are slightly elevated. Diaphoresis could indicate reduction of fever, which is a desired effect of aspirin. Aspirin can cause renal impairment, which is characterized by decreased urine output.

A client taking methotrexate for cancer asks the nurse why leucovorin (folinic acid) has been prescribed. Which response by the nurse is most appropriate? a. "This drug is a vitamin to help with building up your resistance." b. "The drug protects normal cells from damage by methotrexate." c. "This is a second antineoplastic drug used to attack the cancer cells." d. "The drug will prevent arthritis that often accompanies methotrexate use."

b. "The drug protects normal cells from damage by methotrexate." Rationale: Leucovorin is administered with methotrexate to rescue normal cells and protect the client from severe bone marrow damage.

Which laboratory value will the nurse report to the health care provider as a potential adverse response to hydrochlorothiazide (HydroDIURIL)? a. Sodium level of 140 mEq/L b. Fasting blood glucose level of 140 mg/dL c. Calcium level of 9 mg/dL d. Chloride level of 100 mEq/L

b. Fasting blood glucose level of 140 mg/dL

A female patient is prescribed dantrolene (Dantrium) for painful muscle spasms associate with multiple sclerosis. The nurse is writing the discharge plan for the patient and will include which of the following teaching points? (Select all that apply) a. If muscle spasms are severe, supplement the medication with hot baths or showers three times per day b. Inform the health care provider if she is taking estrogen products c. Sip water, ice, or hard candy to relieve dry mouth d. Return periodically for required lab work e. Obtain at least 20 minutes of sun exposure per day to boost vitamin D levels

b. Inform the health care provider if she is taking estrogen products c. Sip water, ice, or hard candy to relieve dry mouth d. Return periodically for required lab work Dantrolene (Dantrium) may cause hepatotoxicity with the greatest risk occurring for women over age 35, and periodic laboratory tests will be required for monitoring. Estrogen taken concurrently with dantrolene may increase this risk. The drug may cause dry mouth and sucking on hard candy, sucking ice chips, or sipping water may help relieve the dryness.

A client with a diagnosis of cancer is receiving epoetin alfa (Epogen, Procrit) as part of the treatment regimen. Which nursing action is most appropriate for determining the effectiveness of this drug? a. Assessing the client's energy level b. Monitoring the hematocrit and hemoglobin levels c. Monitoring the client's blood pressure d. Assessing the client's level of consciousness

b. Monitoring the hematocrit and hemoglobin levels Rationale: This medication does not cure the primary disease condition; however, it helps reduce the anemia that dramatically affects the client's ability to function. The hematocrit and hemoglobin levels will provide a reference for evaluating the drug's effectiveness.

The nurse should monitor a transplant patient for the major adverse effect of cyclosporine therapy by evaluating which laboratory test? a. Complete blood count (CBC) b. Serum creatinine c. Liver enzymes d. Electrolyte levels

b. Serum creatinine Rationale: The primary adverse effect of cyclosporine occurs in the kidneys, with up to 75 percent of patients experiencing reduction in urine output. Serum creatinine level is a good indicator of renal function.

A client undergoing antineoplastic therapy is also prescribed filgrastim (Neupogen). The client asks the nurse why he is receiving this new medication. Which would be the best response by the nurse? a. This drug works with chemotherapy to attack cancer cells. b. This drug helps reduce nausea during chemotherapy. c. This drug helps decrease the risk of opportunistic infections. d. This drug will help prevent hair loss during chemotherapy.

c. This drug helps decrease the risk of opportunistic infections. Rationale: The administration of filgrastim often prevents or shortens the time period of neutropenia, thus lowering the risk of opportunistic infections and allowing the patient to maintain an optimum dosing schedule.

The nurse determines that which statement made by a client who is prescribed dantrolene sodium (Dantrium) indicates understanding of the side effects of the drug? a. "I will be able to do my regular work as soon as I get home." b. "I will not be concerned if I cannot empty my bladder." c. "I will be able to drive myself home from the hospital." d. "I will report frequent changes in my blood pressure to my doctor."

d. "I will report frequent changes in my blood pressure to my doctor." Adverse effects of dantrolene sodium (Dantrium) include erratic blood pressure and urinary retention. The client should not drive until the full effect of the drug has been established. Activity should be restricted.

Which statement by a client taking cyclosporine would indicate a need for further teaching by the nurse? a. "I will report any reduction in urine output to my healthcare provider." b. "I will wash my hands frequently and thoroughly." c. "I will take my blood pressure at home every day." d. "I will take cyclosporine at breakfast with a glass of grapefruit juice."

d. "I will take cyclosporine at breakfast with a glass of grapefruit juice." Rationale: Grapefruit juice will increase cyclosporine levels 50 percent to 200 percent, resulting in drug toxicity. Thus, the nurse should instruct the client to avoid taking cyclosporine with grapefruit juice. Handwashing is important to prevent infection while taking cyclosporine. Renal toxicity and hypertension are adverse effects of cyclosporine therapy for which the client should monitor and which the client should report to the healthcare provider.

A client is prescribed Lorazepam (Ativan) and a glucocorticoid during chemotherapy treatments. What is the nurse's best action? a. Call the health care provider and question the order. b. Only administer the Ativan if the client seems anxious. c. Administer the two medications at least 12 hours apart. d. Administer the medications and assess the client for relief.

d. Administer the medications and assess the client for relief.

The nurse should monitor the client receiving filgrastim (Neupogen) for which common adverse effect? a. Hypoglycemia b. Elevated liver enzymes c. Elevated serum creatinine d. Bone pain

d. Bone pain Rationale: Bone pain may occur in up to 33 percent of patients receiving filgrastim. Bone pain tends to occur 2-3 days prior to rise in circulating WBC due to the production of WBCs in bone marrow. Other common adverse effects of the drug include fatigue, rash, epistaxis, decreased platelet counts, neutropenic fever, nausea, and vomiting.