Pharm Practice for Exit HESI

A thin 24-year-old woman who runs 10 miles each week asks the nurse for advice about preventing osteoporosis. Which vitamin would the nurse recommend? a. vitamin e b. vitamin b c. vitamin d d. vitamin c

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

The nurse recognizes that hormonal therapy (HT) increases the risk of which condition in postmenopausal women? a. Breast cancer b. Rapid weight loss c. Accelerated bone loss d. Vaginal tissue atrophy

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

A client who is 25 weeks' pregnant and who is being treated with atenolol reports labor pain. Which medication would the nurse anticipate incorporating into the plan of care? a. Sucralfate b. Nifedipine c. Indomethacin d. Dexamethasone

b. Nifedipine Nifedipine inhibits myometrial activity by blocking calcium reflux. This action helps reduce preterm labor. Indomethacin is commonly used to treat preterm labor. However, concomitant use of atenolol and indomethacin may increase maternal and fetal risk. Dexamethasone is administered if neither indomethacin nor nifedipine is effective. Sucralfate is used to protect the stomach from gastrointestinal issues associated with indomethacin.

The clinic nurse receives a call from the mother of an infant prescribed digoxin. The mother reports she forgot whether she gave the morning dose of digoxin. Which response by the nurse is most appropriate? a. "Give the next dose immediately." b. "Wait 2 hours before giving the medication." c. "Skip this dose and give it at the next prescribed time." d. "Take the baby's pulse and give the medication if it's more than 90 beats/min."

c. "Skip this dose and give it at the next prescribed time." An additional dose may cause overdosage, leading to toxicity; it is better to skip the dose. Giving the dose without waiting may cause an overdose, which could result in toxicity. Even waiting 2 hours may cause an overdose, leading to toxicity. Taking the pulse is not a reliable method for determining a missed dose; 90 to 110 beats/min is within the expected range for this age.

Which mechanism of action explains how aluminum hydroxide decreases serum phosphorus? a. Binding with phosphorus in the intestine b. Promoting excretion of phosphorus c. Promoting excretion of excessive urinary phosphates d. Dissolving stones as they pass through the urinary tract

a. Binding with phosphorus in the intestine Aluminum hydroxide binds phosphorus in the intestine, preventing its absorption; this decreases serum phosphorus. Promoting excretion of phosphorus, promoting excretion of excessive urinary phosphates, and dissolving stones as they pass through the urinary tract are not actions of this medication.

Which instructions would the nurse provide a client prescribed rifampin for tuberculosis (TB)? Select all that apply. One, some, or all responses may be correct. a. "You should report any yellow tinge to your skin." b. "Your soft contact lenses will be stained permanently." c. "You should report any reddish orange tinge to your secretions." d. "You need to drink at least 8 ounces of water with the medication." e. "You should report any increased tendency to bruising or bleeding."

a. "You should report any yellow tinge to your skin." b. "Your soft contact lenses will be stained permanently." e. "You should report any increased tendency to bruising or bleeding." Rifampin is a first-line medication in the treatment of TB, and clients should report any yellow tinge to the skin because this may be a sign of liver toxicity or failure. Staining of bodily fluids such as tears, urine, and sweat, is commonly associated with rifampin, so warning the clients who use contact lenses of staining side effects will be beneficial. The nurse should instruct the client to report any increased tendency to bruise or bleed immediately, because this may indicate liver toxicity or damage. The need to drink at least 8 ounces of water with the medication is beneficial information for a client prescribed pyrazinamide. A reddish orange tinge to secretions is common with rifampin and not harmful, so the client does not need to report the color change.

Which statement about benzodiazepines requires correction? a. They are indicated for ethanol withdrawal. b. These medications increase the activity of gamma-aminobutyric acid. c. Benzodiazepines are the first-line medications used in chronic anxiety disorders. d. These medications depress activity in the brainstem.

b. These medications increase the activity of gamma-aminobutyric acid. Benzodiazepines act by decreasing the activity of gamma-aminobutyric acid, which is an inhibitory neurotransmitter. Apart from their indication in the treatment of depression, benzodiazepines are also prescribed for ethanol withdrawal, insomnia, and muscle spasms. Benzodiazepines are the first-line medications of choice in acute and chronic anxiety disorders. Benzodiazepines act by depressing activity in the brainstem and the limbic system.

A client has been receiving lithium for the past 2 weeks for the treatment of bipolar disorder, manic phase. Which information will the nurse include in the teaching plan for this client? a. A diuretic is necessary for anyone taking lithium. b. Lithium must be taken for the rest of the client's life. c. The blood level of lithium must be checked every month. d. A low-sodium diet must be followed while lithium is being taken.

c. The blood level of lithium must be checked every month. Lithium's therapeutic window is very narrow, and a toxic level may accumulate in the body unless routine checks of the medication's concentration in the blood are performed. During the acute phase of mania, the therapeutic blood level of lithium should be between 1.0 and 1.5 mEq/L (1.0-1.5 mmol/L); the maintenance therapeutic blood level of lithium ranges from 0.5 and 1.2 mEq/L (0.5-1.2 mmol/L). Diuretics reduce sodium and should be avoided; lithium is not excreted when the sodium level is decreased, resulting in toxicity. Lithium may or may not need to be taken for the rest of a client's life. A low-sodium diet can lead to hyponatremia, which must be avoided because it limits the excretion of lithium, resulting in toxicity.

Which condition may be the result of an adverse medication effect associated with administration of chloramphenicol in infants? a. Gray syndrome b. Tendon rupture c. Reye syndrome d. Sudden infant death syndrome

a. Gray syndrome Administration of chloramphenicol in infants may cause Gray syndrome, also called Gray baby syndrome. This condition occurs because of limited medication-metabolizing capacity in infants. Fluoroquinolones may cause tendon rupture in pediatric clients. Administration of aspirin and other salicylates in infants and children may cause Reye syndrome. Phenothiazines may increase the risk of sudden infant death syndrome.

A depressed client is receiving paroxetine. The nurse would monitor this client for which side effects? Select all that apply. One, some, or all responses may be correct. a. Sexual dysfunction b. Depressed respiration c. Insomnia and restlessness d. Hypertension or hypotension e. Irregular menses or secondary amenorrhea

a. Sexual dysfunction c. Insomnia and restlessness Genitourinary side effects of paroxetine include ejaculatory disorders, male genital disorders, and urinary frequency. Central nervous system (CNS) side effects of paroxetine include insomnia, restlessness, dizziness, tremors, nervousness, and headache. Depressed respiration is associated with opioids that affect the CNS. Irregular menses and secondary amenorrhea are not associated with paroxetine.

Which medication for depression would be safe to use with a breast-feeding mother who wishes to continue breast-feeding the newborn? a. Fluoxetine b. Paroxetine c. Valproic acid d. Methotrexate

b. Paroxetine Paroxetine can be safely given during breast-feeding. Fluoxetine can easily enter breast milk; therefore this medication would be used only when other selective serotonin reuptake inhibitors are ineffective. Valproic acid is an antiepileptic medication that can be given safely to breast-feeding women. Methotrexate is an anticancer medication that cannot be given during breast-feeding because it enters the breast milk and can cause adverse effects in the baby.

Which advice will the nurse give the client to avoid lipodystrophy when self-administering insulin therapy? a. Exercise regularly. b. Rotate injection sites. c. Use the Z-track technique. d. Vigorously massage the injection site.

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

Which vaccine would the nurse administer orally in children? a. MMR vaccine b. Rotavirus vaccine c. Live influenza vaccine d. Meningococcal conjugate vaccine (MCV4)

b. Rotavirus vaccine Rotavirus vaccines are generally administered orally because these live viruses should replicate in the gut of the infant. MMR vaccines are generally administered subcutaneously in the upper region of the arm. Live influenza vaccines are administered nasally. Meningococcal conjugate vaccines (MCV4) are administered intramuscularly in the deltoid region.

An infant undergoes surgery for the repair of a myelomeningocele and develops metabolic acidosis, accompanied by decreased urine output. Which medication would the nurse anticipate providing teaching for? a. Isotonic saline b. Sodium lactate c. Serum albumin d. Potassium chloride

b. Sodium lactate Sodium lactate is converted to sodium bicarbonate; it helps correct the sodium deficiency and the metabolic acidosis. Normal saline solution results in the combination of the chloride with the hydrogen ion, intensifying the acidosis. Albumin is a colloid found in blood plasma; it is not used in the treatment of metabolic acidosis. Potassium is not administered until urine function has been restored.

The nurse assesses a client who has an intravenous (IV) infusion of normal saline. Which assessment finding is the nurse's priority concern? a. There is bleeding at the infusion site. b. The client feels short of breath and is orthopneic. c. The IV limits client mobility. d. Infiltration has occurred at the catheter insertion site.

b. The client feels short of breath and is orthopneic. Hypervolemia may precipitate pulmonary edema, which produces shortness of breath and orthopnea; because it presents the greatest risk to the client, it is the priority concern. The other concerns are not as serious and can be easily remedied. Although bleeding at the infusion site may occur, it is not the most serious complication. Limited mobility is a concern that can be addressed with client teaching. Although infiltration at the catheter insertion site may occur, it is not the most serious complication because normal saline does not cause serious tissue damage.

Which assessment would the nurse perform specific to the safe administration of intravenous mannitol? a. Body weight daily b. Urine output hourly c. Vital signs every 2 hours d. Level of consciousness every 8 hours

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

A client presents to the clinic for a follow-up appointment after starting pyridostigmine for management of myasthenia gravis. Which new client problems are adverse effects of pyridostigmine? Select all that apply. One, some, or all responses may be correct. a. respiratory depression b. increased urinary frequency c. diplopia d. muscle twitching e. diarrhea

b. increased urinary frequency d. muscle twitching e. diarrhea Pyridostigmine is an acetylcholinesterase inhibitor. By inhibiting the enzyme that breaks down acetylcholine, it increases cholinergic activity. The increased cholinergic activity is responsible for the most common adverse effects of pyridostigmine such as diarrhea and increased urinary frequency. Another adverse effect is muscle twitching that occurs as pyridostigmine affects the muscle weakness that is characteristic of myasthenia gravis. Respiratory depression is a clinical manifestation of myasthenia gravis that can occur due to respiratory muscle weakness. Weakness of eye muscles results in ptosis or diplopia in about half of clients with myasthenia gravis.

In addition to hydration, parenteral lorazepam is prescribed for a client during alcohol withdrawal delirium. The nurse knows that this medication is given during detoxification primarily for which purpose? a. To prevent injury when seizures occur b. To enable the client to sleep better during periods of agitation c. To reduce the anxiety tremor state and prevent more serious withdrawal symptoms d. To calm the client and promote acceptance of the treatment plan

c. To reduce the anxiety tremor state and prevent more serious withdrawal symptoms Lorazepam potentiates the actions of gamma-aminobutyric acid, which reduces anxiety and irritability that are common during withdrawal. This medication helps reduce the risk of seizures but does not prevent physical injury if a seizure occurs. Although the medication may enable the client to sleep better during periods of agitation, this is not its primary objective. The ability of the client to accept treatment depends on readiness to accept the reality of the problem.

The nurse is caring for a client who is receiving total parenteral nutrition (TPN). The nurse will assess for which complications? Select all that apply. One, some, or all responses may be correct. a. Infection b. Hyperglycemia c. ABO incompatibility d. Electrolyte imbalance e. Cardiac dysrhythmias

a. Infection b. Hyperglycemia d. Electrolyte imbalance The concentration of glucose in the solution is an excellent culture medium that promotes the growth of microorganisms. Hyperglycemia is a common complication with TPN because of the high-glucose formulas used; blood glucose levels need to be monitored carefully during therapy. TPN formulas may need to be adjusted daily based on the client's daily electrolyte levels. ABO incompatibility is not associated with TPN. Cardiac dysrhythmias are not related to TPN.

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

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

Which therapeutic effect would the nurse expect to identify when mannitol is administered to a client? a. Improved renal blood flow b. Decreased intracranial pressure c. Maintenance of circulatory volume d. Prevention of the development of thrombi

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

Antipsychotic medications can cause extrapyramidal side effects. Which responses would the nurse document as indicating pseudoparkinsonism? Select all that apply. One, some, or all responses may be correct. a. Rigidity b. Tremors c. Mydriasis d. Photophobia e. Bradykinesia

a. rigidity b. tremors e. bradykinesia Rigidity, tremors, and bradykinesia may occur because of the effect of the antipsychotic on the postsynaptic dopamine receptors in the brain. Mydriasis and photophobia are not side effects of antipsychotic medications.

A child with Wilms tumor is prescribed doxorubicin hydrochloride. Which common side effect unique to doxorubicin would the nurse expect to observe in the child? a. hair loss b. vomiting c. red urine d. stomatitis

c. red urine Red urine is a common side effect of doxorubicin administration. The medication is not metabolized and is excreted in the urine. The genitourinary responses to vincristine are nocturia, oliguria, urine retention, and gonadal suppression. Hair loss, vomiting, and stomatitis occur with both medications.

The details of four clients with psychiatric disorders are given below. Which client can be indicated for the administration of mood stabilizers? a. client a b. client b c. client c d. client d

d. client d Mood stabilizers such as lithium salts are indicated for clients with bipolar disease. Tricyclic antidepressant medications are indicated for conditions such as anorexia nervosa, childhood enuresis, and obsessive-compulsive disorders.

A client with insomnia takes a new medication to promote sleep. Two hours later, the client is wide awake and feeling more energized than before the medication was taken. Which type of response is the client demonstrating? a. Allergic b. Synergistic c. Paradoxical d. Idiosyncratic

c. paradoxical A paradoxical response to a medication is directly opposite to the desired therapeutic response. An allergic response is an antigen-antibody reaction. A synergistic response involves medication combinations that enhance each other. Idiosyncratic responses to a medication are unpredictable and unrelated to the medication purpose. They are commonly attributed to immune responses or genetic factors.

Captopril is prescribed for a client. Which effect would the nurse anticipate? a. increased urine output b. decreased anxiety c. improved sleep d. decreased blood pressure

d. decreased blood pressure Captopril is an angiotensin-converting enzyme (ACE) inhibitor antihypertensive. It does not have diuretic, sedative, or hypnotic properties. Diuretics promote fluid excretion. Sedatives reduce muscle tension and anxiety. Hypnotics promote sleep.

Which medication would be listed as the antidote to a nerve agent in the disaster plan for a terrorist attack? a. Atropine b. Dopamine c. Epinephrine d. Norepinephrine

a. Atropine Atropine should be listed as the antidote for nerve agent poisoning in the disaster plan for a terrorist attack. Nerve gases cause the client's system to be flooded with acetylcholine, which results in an overstimulation of the nerve cell. Atropine works by blocking the acetylcholine receptors. The receptors will not pick up the acetylcholine. Dopamine, epinephrine, and norepinephrine are not medications used to treat nerve agent poisoning.

When taking the blood pressure of a client who had a thyroidectomy, the nurse identifies that the client is pale and has spasms of the hand. The nurse notifies the health care provider. Which medication will the nurse expect the health care provider to prescribe? a. Calcium b. Magnesium c. Bicarbonate d. Potassium chloride

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

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

a. Confusion b. Drowsiness c. Diaphoresis d. Nervousness e. Heart rate 110 beats/min Signs of hypoglycemia include confusion, drowsiness, diaphoresis, nervousness, tachycardia, and headache. The nurse would recheck the blood glucose level of a diabetic client with these symptoms to avoid worsening hypoglycemia caused by administration of additional insulin.

A pregnant client with iron-deficiency anemia is prescribed iron supplements daily. To help the client increase iron absorption, the nurse would suggest the client eat foods high in which substance? a. Vitamin C b. Fat content c. Water content d. Vitamin B complex

a. Vitamin C Vitamin C aids the absorption of iron. Fat content, water content, and vitamin B complex are all unrelated to the absorption of iron.

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

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

An obese client must self-administer insulin at home. The nurse will teach the client to inject insulin at which angle? a. 30-degree angle b. 60-degree angle c. 45-degree angle d. 90-degree angle

d. 90-degree angle Injection should be made at a 90-degree angle for most clients, including those of normal weight. According to step 6, Table 48-5, Teaching client and caregiver how to give insulin, the directions state: Push the needle straight into the skin (90-degree angle). If you are very thin, muscular, or using an 8- or 12-mm needle, you may need to pinch the skin and/or use a 45-degree angle. Injecting at a 30-degree angle or a 60-degree angle is not appropriate for the obese, normal weight, child, or the thin client. If injecting into a child or a thin client, the injection should be made at a 45-degree angle.

The nurse is assessing a child receiving chemotherapy for treatment of leukemia. Which side effect would the nurse anticipate? a. Epistaxis b. Tachycardia c. Flushed skin d. Increased temperature

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

Which medication would the nurse anticipate including in the plan of care to alleviate hot flashes in a woman with low estrogen levels? a. Estradiol b. Raloxifene c. Clomiphene d. Dinoprostone

a. Estradiol Estradiol is a form of estrogen that helps alleviate hot flashes by increasing estrogen levels. Raloxifene may cause or increase hot flashes. Clomiphene may cause conception in infertile women and is not advised. Dinoprostone may cause a termination of pregnancy.

While assessing a 5-year-old child, which clinical finding would the nurse recognize as indicative of a verbal response score of 3 on the Glasgow Coma Scale? a. Oriented b. Confused c. Inappropriate words d. Incomprehensible sounds

c. Inappropriate words A verbal response score of 3 on the Glasgow Coma Scale signifies that the child speaks inappropriate words. A score of 5 shows that the child's speech is well oriented. A confused state is equal to a score of 4. Incomprehensible sounds are recorded as a score of 2.

Which antipyretic medication may cause Reye syndrome in children? a. Aspirin b. Naproxen c. Ibuprofen d. Dantrolene

a. aspirin Aspirin increases the risk of swelling in the brain and liver, which are the main symptoms of Reye syndrome in children. Aspirin is not recommended in children. Medications such as naproxen and ibuprofen do not induce swelling in the brain and liver; therefore, these medications may not cause Reye syndrome. Dantrolene does not induce swelling in the brain and liver; instead, it decreases calcium levels during malignant hyperthermia conditions.

The nurse is planning to administer a modified bacteria immunization to a preschool child. Which agent will be administered? a. A toxoid b. A vaccine c. An allergen d. An antitoxin

b. A vaccine The microbes in the vaccine have been modified so they will not cause active infection but will still elicit an immune response. A toxoid is a modified toxin in which the poisonous properties have been destroyed but the toxin is still capable of producing antibodies. An allergen is a substance that causes an allergic reaction. An antitoxin is an antibody that is capable of neutralizing a specific toxin.

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

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

The nurse administers magnesium sulfate to a client with severe preeclampsia. Which adverse effect would the nurse address when evaluating the client's response to the medication? a. Blurred vision b. Epigastric pain c. Fetal tachycardia d. Respiratory depression

d. Respiratory depression Respiratory depression is a late indicator of toxicity; if the respiratory rate decreases below 12 breaths/min, the infusion should be discontinued. Blurred vision and epigastric pain are both associated with worsening of preeclampsia, which could lead to a seizure; neither is a toxic effect of the magnesium sulfate. The fetal heart rate is not affected by the infusion of magnesium sulfate.

A client at 31 weeks' gestation is admitted in preterm labor. Which class of medications would the nurse anticipate providing education for? a. An oxytocic b. An analgesic c. A corticosteroid d. A beta-adrenergic

d. a beta-adrenergic Beta-adrenergic medications are tocolytic agents that may halt labor, although only temporarily. Other tocolytics that may be used are magnesium sulfate, prostaglandin inhibitors, and calcium channel blockers. Oxytocin is a hormone that is secreted by the posterior pituitary gland; it stimulates contractions and is released after birth to initiate the let-down reflex. Analgesics do not halt preterm labor. Corticosteroids do not halt labor; they are used during preterm labor to accelerate fetal lung maturity when birth is likely to occur within 24 to 48 hours.

Which medications would the hospital emergency department staff keep on hand in anticipation of the arrival of victims exposed to sarin gas in a terrorist attack? a. furosemide and nitroglycerin b. fentalnyl and acetaminophen c. azithromycin and ceftriaxone d. atropine and pralidoxime chloride

d. atropine and pralidoxime chrloride Sarin is a highly toxic nerve gas that enters the body through the eyes and skin and acts by paralyzing the respiratory muscles. Atropine and pralidoxime chloride are an antidote for the nerve gas poisoning. Furosemide and nitroglycerin do not reverse the effects of sarin gas. Fentanyl and acetaminophen are analgesics but do not act as antidotes for sarin gas poisoning. Azithromycin and ceftriaxone are antibiotics that treat infections but do not reverse the sarin gas poisoning.

The nurse teaches the parents of a child with classic hemophilia how to administer plasma component factor VIII prescribed three times a week. Which instruction would the nurse give the parents about administration time? a. Whenever a bleed is suspected b. Give in the morning on scheduled days c. At bedtime while the child is lying quietly in bed d. On a regular schedule at the parents' convenience

b. give in the morning on scheduled days Factor VIII has a short half-life; therefore prophylactic treatment involves administering the factor on the scheduled days in the morning, so the child will get the most benefit during the day, while he is most active. Prophylactic treatment is administered on a scheduled basis to prevent bleeds from occurring. Administering the medication at bedtime will limit its effectiveness because bleeds are more common when the child is active. Administering the medicine on a regular schedule at the parents' convenience does not take into consideration the properties of the medication.

A primary health care provider diagnoses chronic, low-grade depression in a client. Which medication is indicated for this condition? a. Alprazolam b. Lithium salts c. Amitriptyline d. Clomipramine

c. Amitriptyline Dysthymia (chronic low-grade depression) can be treated by the administration of antidepressant medications such as amitriptyline. Alprazolam is the medication of choice for treating anxiety disorders. Lithium salt is prescribed to treat bipolar disorders. Clomipramine is a tricyclic antidepressant medication prescribed for treating obsessive-compulsive disorder.

The nurse prepares an intravenous (IV) solution of lactated Ringer solution to replace the T-tube output of a client who had a cholecystectomy and common bile duct exploration. Which condition will improve if the administration of lactated Ringer solution is effective? a. Urinary stasis b. Paralytic ileus c. Metabolic acidosis d. Increased potassium level

c. metabolic acidosis Lactated Ringer solution is an alkaline solution that replaces bicarbonate ions lost from T-tube bile drainage, thus preventing or treating acidosis. Urinary stasis is unrelated to the effectiveness of the administration of IV lactated Ringer solution. Paralytic ileus is unrelated to the effectiveness of the administration of IV lactated Ringer solution. An increased potassium level is unrelated to the effectiveness of the administration of IV lactated Ringer solution.

Which question would the nurse ask a 39-year-old primigravida client to elicit information about exposure to diethylstilbestrol (DES)? a. "Have you ever taken oral contraceptives?" b. "Did you ever have an unusual vaginal discharge?" c. "Have you noticed any lesions in your perineal area?" d. "Do you know if your mother took hormones during her pregnancy?"

d. "Do you know if your mother took hormones during her pregnancy?" Problems of the reproductive system may occur in the daughters of women who took the synthetic hormone diethylstilbestrol during pregnancy. Use of oral contraceptives is not associated with DES exposure. Although clients exposed to DES may exhibit abnormal bleeding or a heavy mucoid vaginal discharge, there are other causes for these problems, such as chlamydial infection. Lesions on the perineum are not related to exposure to DES.

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

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

A client currently taking medication for bacterial vaginosis complains of an unpleasant metallic taste, nausea, and vomiting. Which medication would be responsible for this condition? a. Tinidazole b. Miconazole c. Clotrimazole d. Metronidazole

d. Metronidazole Metronidazole is used to treat bacterial vaginosis. Common side effects include an unpleasant metallic taste in the mouth, furry tongue, central nervous system reactions, and urinary tract disturbances. Tinidazole is used to treat trichomoniasis. Miconazole and clotrimazole are used to treat candidiasis.

A client who has paroxysmal supraventricular tachycardia reports a mild "fluttering feeling" in the chest and has a blood pressure of 110/55 mm Hg. Which potential treatment by the health care provider would the nurse question? a. Intravenous adenosine b. Intravenous metoprolol c. Carotid sinus massage d. Synchronized cardioversion

d. synchronized cardioversion Because the client is hemodynamically stable and experiencing only mild symptoms associated with the tachycardia, synchronized cardioversion is not indicated at this time. Rapid injection of adenosine would slow the rate or possibly convert the rhythm to sinus rhythm. Intravenous injection of beta blockers such as metoprolol may slow the rate. Carotid sinus massage or having the client perform a Valsalva maneuver may be used to slow the rate or convert the rhythm.

A female client receiving cortisone therapy for adrenal insufficiency expresses concern that she is developing facial hair. How would the nurse respond? a. "It is just another sign of adrenal insufficiency." b. "This side effect will disappear after therapy." c. "This is not important as long as you are feeling better." d. "The medication contains a hormone that causes male characteristics."

d. "The medication contains a hormone that causes male characteristics." Some cortisol derivatives possess 17-keto-steroid (androgenic) properties, which result in hirsutism. Facial hair is not a sign of the illness; it results from androgens that are present in cortisol. Hirsutism will be a long-term problem because therapy is provided on a long-term, usually lifelong, basis. The response "This is not important as long as you are feeling better" doesn't address the client's concerns.

Which statement regarding treatment with interferon indicates that the client understands the nurse's teaching? a. "I will drink 2 to 3 liters [2-3 quarts] of fluid a day." b. "Any reconstituted solution must be discarded in 1 week." c. "I can continue driving my car as long as I have the stamina." d. "While taking this medicine I should be able to continue my usual active lifestyle."

a. "I will drink 2 to 3 liters [2-3 quarts] of fluid a day." Adequate fluid intake helps prevent nephrotoxicity, especially during the early phase of treatment. Reconstituted solution may be stored in the refrigerator for 1 month. Confusion, dizziness, and hallucinations are side effects of this medication; the client should avoid hazardous tasks, such as driving or using machinery. Activity may have to be altered because fatigue and other flu-like symptoms are common with this medication.

Metformin 2 g by mouth is prescribed for a client with type 2 diabetes. Each tablet contains 500 mg. How many tablets will the nurse administer? Record your answer using a whole number.

4 First, convert the prescribed dose (2 g) to the available dose (mg).Then, use the dimensional analysis and/or ratio and proportion methods to determine the appropriate number of tablets to be administered.

A client takes morphine sulfate for severe metastatic bone pain. The nurse will assess the client for which adverse effect? a. diarrhea b. addiction c. respiratory depression d. diuresis

C. respiratory depression Morphine sulfate is a central nervous system depressant that commonly decreases the respiratory rate, which can lead to respiratory arrest. Morphine, an opioid, will cause constipation, not diarrhea. Addiction is not a concern for a terminally ill client. Urinary retention, not diuresis, is a common side effect of morphine.

Which concern will the nurse keep in mind when a client has been taking a benzodiazepine? a. Rebound insomnia may occur if the medication is discontinued abruptly. b. Lifelong treatment is often required. c. Higher doses are needed to accommodate physiological changes during pregnancy. d. These medications have both analgesic and antidepressant properties.

a, Rebound insomnia may occur if the medication is discontinued abruptly. Benzodiazepine often leads to tolerance and withdrawal; therefore it can cause rebound insomnia when discontinued abruptly. Benzodiazepine is not indicated for lifelong treatment; addiction is a concern. Benzodiazepine should be discontinued if the client becomes pregnant. Benzodiazepines not have analgesic, antidepressant, or antipsychotic properties.

The nurse is reviewing a newly admitted client's medication administration record (MAR). Which element, if missing, makes the record incomplete?a. Height b. Allergies c. Vital signs d. Body weight

b. allergies Allergies should be listed on all MARs to prevent the administration of medications to which the client is allergic. Height, weight, and vital signs are part of the initial health history/physical assessment data.

A prescription is written for famotidine 20 mg intravenous piggyback (IVPB) every 12 hours. The vial is labeled 10 mg/1 mL. How many milliliters will the nurse administer? Record your answer using a whole number

2 mL The prescribed dose is 20 mg. The available concentration is 10 mg/mL. Use the dimensional analysis and/or ratio and proportion methods to determine how many milliliters the nurse would administer.

A client needs a continuous intravenous infusion of heparin at a rate of 1000 units per hour. There are 25,000 units of heparin in 500 mL of 5% dextrose solution. The nurse will set the infusion control device to deliver how many milliliters per hour? Record your answer using a whole number.

20 The prescribed rate is 1000 u/h. The available concentration is 25,000 u in 500 mL D 5W. Make the necessary conversions and use dimensional analysis to determine the appropriate rate in mL/h. The ratio and proportion method is not appropriate for this situation.

The nurse changing the dressing on the client's perineum would fall into which zone? A. Public zoneI B. Intimate zone C. Personal zone d. Vulnerable zone

B. Intimate zone Changing a client's dressing on the perineum falls under the intimate zone. For this action, the appropriate interpersonal distance between the nurse and the client would be between 0 and 18 inches. The nurse lecturing a class of students or speaking at a community forum lies within a public zone. A personal zone refers to the nurse sitting on the client's bedside, taking a client's history, or teaching a client individually. The vulnerable zone is where special care is needed.

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

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

Which assessment would the nurse perform for a 10-year-old client prescribed methylphenidate to treat attention-deficit/hyperactivity disorder (ADHD)? Select all that apply. One, some, or all responses may be correct. a. Grades b. Weight c. Appetite d. Behavior e. Heart rate

a. Grades b. Weight c. Appetite d. Behavior e. Heart rate ADHD can affect the client's ability to focus. The nurse would assess the client's grades and behavior at school to determine the effectiveness of the medication. Methylphenidate can adversely affect the client's weight and appetite. The client's heart rate can increase when taking this medication.

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

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

When treating a client with psoriasis, which medications would the nurse anticipate teaching the mode of action and side effects? Select all that apply. One, some, or all responses may be correct. a. Methoxsalen b. Anthralin c. Isotretinoin d. Clindamycin e. Calcipotriene

a. Methoxsalen b. Anthralin e. Calcipotriene Psoriasis is a chronic autoimmune dermatitis treated with a systemic photosensitizer, such as methoxsalen (a light-sensitive medication that absorbs ultraviolet light) and topical agents such as calcipotriene and anthralin. Acne vulgaris treatment includes the use of isotretinoin and clindamycin.

A client with a myocardial infarction is admitted to the cardiac intensive care unit. Which pain relief medication would the nurse expect to find on the plan of care for this client? a. Morphine b. Diazepam c. Midazolam d. Oxycodone

a. Morphine Morphine is the medication of choice for a myocardial infarction because it relieves pain quickly and reduces anxiety. It also decreases cardiac workload. Diazepam is a muscle relaxant that may be used for its sedative effect; it is not effective for the severe pain associated with a myocardial infarction. Midazolam is a hypnotic that may be used to reduce fear and restlessness; it is not effective for the severe pain associated with a myocardial infarction. Oxycodone is an orally administered analgesic; an analgesic that is administered via the intravenous, not the oral, route provides more immediate pain relief.

A health care provider prescribes aspirin therapy for a client with arthritis. The nurse will advise the client to report which adverse effects? Select all that apply. One, some, or all responses may be correct. a. Ongoing nausea b. Constipation c. Easy bruising d. Decreased pulse e. Ringing in the ears

a. Ongoing nausea c. Easy bruising e. Ringing in the ears Aspirin is a gastrointestinal irritant that can cause nausea, vomiting, and gastrointestinal bleeding. Salicylates decrease platelet aggregation, resulting in easy bruising and gastrointestinal bleeding. Tinnitus and hearing loss can occur as a result of the effects of the medication on the eighth cranial nerve. Salicylates may cause diarrhea, not constipation, because of gastrointestinal irritation. Salicylates may increase, not decrease, the heart rate.

The provider prescribes one unit of packed red blood cells to be administered to a client. To ensure the client's safety, which action will the nurse take during administration of blood products? a. Stay with client during first 15 minutes of infusion. b. Flush packed red blood cells with 5% dextrose and 0.45% normal saline. c. Remove the intravenous catheter if a blood transfusion reaction occurs. d. Administer the red blood cells through a percutaneously inserted central catheter line with a 20-gauge needle.

a. Stay with client during first 15 minutes of infusion. The nurse would remain with the client for the first 15 to 30 minutes. Any severe reaction usually occurs with the infusion of the first 50 mL of blood. Blood components are viscous, requiring a large needle to be used for venous access. A 20-gauge needle is not used to access a central catheter line. Normal saline is the solution to administer with blood productions. Lactated Ringer and dextrose in water are not used for infusion because of hemolysis.

Which issues would the nurse identify as being associated with the difficulty in identification of teratogens? Select all that apply. One, some, or all responses may be correct. a. Teratogenic effects may be delayed. b. Prolonged medication exposure may be required. c. Animal test results may not be applicable to humans. d. Behavioral effects can be easily documented and evaluated. e. Controlled experiments on humans can reveal the effect of teratogens.

a. Teratogenic effects may be delayed. b. Prolonged medication exposure may be required. c. Animal test results may not be applicable to humans. Teratogenic effects may be delayed; some medications may take years to show their effects. To identify a teratogenic effect, the subject may need to be exposed to medications for a prolonged time. Some medications may not be toxic to animals but may have adverse effects in humans. Studies aiming to observe the behavioral effects are difficult to document because the behavior varies from person to person. Controlled experiments cannot be done in humans; this makes the identification of teratogens difficult.

A client is admitted to the hospital, and benazepril is prescribed for hypertension. Which is an appropriate nursing action for clients taking this medication? a. assess for dizziness b. assess for dark, tarry stools c. administer the medication after meals d. monitor the electroencephalogram (EEG)

a. assess for dizziness

Which assessment finding supports the diagnosis of neuroleptic malignant syndrome (NMS) in a client with schizophrenia being treated with haloperidol? Select all that apply. One, some, or all responses may be correct. a. rigidity b. sweating c. tongue rolling d. temperature of 105.8 e. arching of the trunk

a. rigidity b. sweating d. temperature of 105.8 NMS can be fatal and requires immediate treatment. Seizures and dysrhythmias are clinical manifestations of NMS; however, these symptoms may be due to other conditions. Therefore, the nurse will assess a client for other signs of NMS, which include rigidity, sweating, and high fevers that may exceed 105.8°F (41°C). Tongue rolling and arching of the trunk are signs of acute dystonia, not NMS.

A client's phenytoin level is 16 mcg/L. Which action will the nurse take? a. Hold the medication and notify the health care provider. b. Administer the next dose of the medication as prescribed. c. Hold the next dose and then resume administration as prescribed. d. Call the health care provider to obtain a prescription with an increased dose.

b. Administer the next dose of the medication as prescribed. Administering the next dose of the medication as prescribed is within the therapeutic range of 10 to 20 mcg/L (40-80 mcmol/L); the nurse would administer the medication as prescribed. Holding the next dose and then resuming administration as prescribed is unsafe and will reduce the therapeutic blood level of the medication. Calling the health care provider to obtain a prescription with an increased dose is inappropriate because the blood level is within the therapeutic range.

Which medications would the nurse anticipate teaching the parents about for a preschooler newly diagnosed with cystic fibrosis? Select all that apply. One, some, or all responses may be correct. a. Steroids b. Antibiotics c. Antihistamines d. Pancreatic enzymes c. Fat-soluble vitamins

b. Antibiotics d. Pancreatic enzymes c. Fat-soluble vitamins Antibiotics are prescribed to treat recurrent respiratory tract infections. Thick secretions obstruct the pancreatic ducts, and essential pancreatic enzymes are blocked from reaching the duodenum; therefore pancreatic enzymes are administered with meals to aid digestion. Fat-soluble vitamins are necessary because of the decreased absorption of fat. Steroids are not indicated in the treatment of cystic fibrosis. Antihistamines are not used because of their drying effect on the already tenacious mucus.

A client with a history of depression presents with multiple physical complaints and reports taking very high doses of vitamin D to "naturally" treat depression. Which symptoms might be explained by this vitamin toxicity? Select all that apply. One, some, or all responses may be correct. a. Hunger b. Confusion c. Bone pain d. Frequent urination e. Malaise and fatigue

b. Confusion c. Bone pain d. Frequent urination e. Malaise and fatigue Vitamin D toxicity can result in confusion, bone pain, frequent urination, malaise, and fatigue. Vitamin D toxicity does not result in hunger but can cause loss of appetite.

Which medication mechanism describes the action of delavirdine in a client with human immunodeficiency virus (HIV)? a. Binds with the integrase enzyme b. Inhibits the action of reverse transcriptase c. Blocks binding of HIV to reproducing cells d. Prevents the protease enzyme from cutting HIV proteins

b. Inhibits the action of reverse transcriptase Delavirdine is a nonnucleoside reverse transcriptase inhibitor that acts by inhibiting the action of reverse transcriptase. Integrase inhibitors such as raltegravir act by binding with integrase enzyme and prevent HIV from incorporating its genetic material into the host cell. Entry inhibitors and fusion inhibitors prevent the binding of HIV to human cells, thereby preventing entry of HIV into cells where replication would occur. Protease inhibitors such as saquinavir prevent the protease enzyme from cutting HIV proteins and, therefore, prevent viable virions from assembling into the cell membrane.

Which medication would be prescribed for the client to treat severe nodulocystic acne? a. Imiquimod b. Isotretinoin c. Clindamycin d. Corticosteroids

b. Isotretinoin Isotretinoin is used for nodulocystic acne and may provide lasting remission. Imiquimod is a topical immunomodulator used to treat plantar warts. Clindamycin is a topical antibiotic used to treat acne vulgaris to suppress new lesions and minimize scarring. Corticosteroids may cause flare-ups in clients with acne.

A client on antidepressant therapy develops hyponatremia. Which medication may be responsible for the client's electrolyte imbalance? a. Phenelzine b. Paroxetine c. Imipramine d. Amitriptyline

b. Paroxetine Paroxetine is a selective serotonin reuptake inhibitor; side effects include hyponatremia. Phenelzine is a monoamine oxidase inhibitor; side effects include orthostatic hypotension. Imipramine and amitriptyline are tricyclic antidepressants; side effects associated with these medications include dry mouth and blurred vision.

A client who is on long-term corticosteroid therapy after an adrenalectomy is admitted to the surgical intensive care unit after being involved in a motor vehicle crash. Which statement is an important concern for client safety? a. The dosage of steroids will have to be tapered down slowly to prevent acute adrenal crisis. b. Steroid therapy will need to be increased to avert a life-threatening crisis. c. Osteoporosis secondary to long-term corticosteroids increases fracture risk. d. The client is at risk for Cushing syndrome if taking long-term corticosteroid therapy.

b. Steroid therapy will need to be increased to avert a life-threatening crisis. Clients with adrenocorticoid insufficiency who are receiving steroid therapy require increased amounts of medication during periods of stress because they are unable to produce the excess needed by the body. With severe stress, a failure to ensure adequate corticosteroid levels can be life-threatening. Increased stress requires an increase, not a decrease, in glucocorticoids. Although osteoporosis may have contributed to fractures secondary to trauma, this does not present a current risk. Cushing syndrome is a problem with excess corticosteroid therapy, but after an adrenalectomy, the corticosteroid is given in amounts sufficient to replace what the body cannot produce.

A newborn receiving medication therapy for an infection has developed jaundice. The newborn has poor sucking and extreme sleepiness. Which medication would the nurse suspect as responsible for the newborn's condition? a. Tetracycline b. Sulfonamide c. Phenothiazine d. Chloramphenicol

b. Sulfonamide Jaundice, poor sucking, and extreme sleepiness are the clinical manifestations of kernicterus. Kernicterus is a condition seen in newborns due to deposition of bilirubin in the brain and is caused by sulfonamides. Tetracycline can cause staining of developing teeth in pediatric clients. Phenothiazine may cause sudden infant death syndrome. Chloramphenicol may cause Gray syndrome in pediatric clients.

When talking with a client who has been receiving paroxetine, the nurse determines that more clarification is needed when the client makes which statement? a. "I'll be a little drowsy in the mornings." b. "I'm expecting to feel somewhat better, but I may need other therapy." c. "I've been on the medication for 8 days now, and I don't feel any better." d. "I know that I'll probably have to take this medication for several months."

c. "I've been on the medication for 8 days now, and I don't feel any better." The response "I've been on the medication for 8 days now, and I don't feel any better" indicates that the client has not been taking the medication long enough to expect a therapeutic response; clients who begin taking antidepressants usually begin to feel a lightening of depression in approximately 14 to 20 days, with the full antidepressant effect felt between 3 and 4 weeks. Drowsiness, fatigue, and insomnia are common side effects. Medication alone may not be effective; some form of psychotherapy often is needed. Clients usually remain on these medications for several months.

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

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

Tetanus immune globulin is prescribed for the client with a puncture wound. Which information will the nurse include when teaching the client about this medication? a. "It will take about a week to become effective." b. "Immune globulin provides lifelong passive immunity." c. "It provides immediate, passive, short-term immunity." d. "Immune globulins stimulate the production of antibodies."

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

The nurse is preparing to administer vaccinations to four different infants. Which infant's vaccination plan requires correction? a. 13-month-old with a MMR vaccine (live) SubQ; outer aspect of upper arm b. 2-month-old with a DTap vaccine (toxoid) IM; deltoid, mediolateral aspect of thigh c. 12-month-old with a Hep A vaccine (Inactive viral antigen) SubQ; outer aspect of upper arm d. 1-month-old with a Hep B vaccine (inactive viral antigen) SubQ; deltoid anterolateral aspect of thigh

c. 12-month-old with a Hep A vaccine (Inactive viral antigen) SubQ; outer aspect of upper arm The hepatitis A vaccine is a form of inactive viral antigen and is administered intramuscularly into the deltoid in two doses. The measles, mumps, and rubella (MMR) vaccine is a combination of three live virus vaccines administered subcutaneously on the outer aspect of the upper arm in two doses. The first dose is given between the ages of 12 to 15 months. The diphtheria, tetanus toxoid, and acellular pertussis (DTaP) vaccine is injected intramuscularly into the deltoid or the mediolateral aspect of the thigh. It is administered in five doses at the ages of 2 months, 4 months, 6 months, between 15 and 18 months, and at 4 to 6 years of age. The hepatitis B vaccine is injected intramuscularly into the deltoid or anterolateral aspect of the thigh in three different doses. The first dose is given at birth followed by a second dose at 1 month of age and a final dose 5 months after administering the second dose.

A client with stage 4 ovarian cancer is admitted for dehydration. The client is to receive an intravenous (IV) bolus of 500 mL D 5W (5% dextrose in water) for 1 hour, after which the rate is to be changed to 150 mL/h. The drop factor is 15 gtt/mL. At which rate, in drops per minute, would the nurse regulate the IV after delivery of the 500-mL bolus? a. 15 b. 25 c. 38 d. 42

c. 38

A client who had a myocardial infarction has runs of ventricular tachycardia. Which medication will the nurse prepare to administer? a. Digoxin b. Furosemide c. Amiodarone d. Norepinephrine

c. Amiodarone Amiodarone decreases the irritability of the ventricles by prolonging the duration of the action potential and refractory period. It is used in the treatment of ventricular dysrhythmias such as ventricular tachycardia. Digoxin slows and strengthens ventricular contractions; it will not rapidly correct ectopic beats. Furosemide, a diuretic, does not affect ectopic foci. Norepinephrine is a sympathomimetic and is not the medication of choice for ventricular irritability.

A client is admitted to the emergency department with multiple fractures and potential internal injuries. The client's history reveals abuse of multiple medications for the past 8 months. When caring for this client, the nurse determines that the most serious life-threatening responses usually result from withdrawal from which medication? a. Heroin b. Methadone c. Barbiturates d. Amphetamines

c. Barbiturates Withdrawal from central nervous system depressants, such as barbiturates, is associated with more severe morbidity and mortality. Symptoms begin with anxiety, shakiness, and insomnia; within 24 hours convulsions, delirium, tachycardia, and death may occur. Withdrawal from heroin or methadone is rarely life threatening, but it does cause severe discomfort, including abdominal cramping and diarrhea. Withdrawal from amphetamines is rarely life threatening, but it causes severe exhaustion and depression.

The nurse needs to administer fluid in a severely burned 2-year-old child, but the peripheral vein is obscured. Which other route would the nurse use? a. Intrathecal b. Intraarterial c. Intraosseous d. Intraperitoneal

c. Intraosseous The nurse would use the intraosseous route for administering fluid if the peripheral vein is not accessible. Intrathecal administration often is associated with long-term medication administration through surgically implanted catheters. Intraarterial infusions are common in clients who have arterial clots. Chemotherapeutic agents, insulin, and antibiotics are administered by the intraperitoneal route. Hence, the nurse would not use these routes.

The nurse is caring for an 8-year-old child with acute poststreptococcal glomerulonephritis (APSGN). Which medications would the nurse anticipate incorporating into the plan of care? Select all that apply. One, some, or all responses may be correct. a. Penicillin b. Morphine c. Labetalol d. Furosemide e. Phenobarbital

c. Labetalol d. Furosemide The child with APSGN is oliguric; diuretics are used to increase urine output. The child with APSGN is hypertensive; antihypertensives are used to reduce the blood pressure. Penicillin is administered if there is evidence of streptococcal infection; however, the strep infection is usually not active when APSGN develops. Children with APSGN do not experience pain; therefore morphine is not needed. If the hypertension is controlled, seizures are not expected, and phenobarbital is not necessary.

The primary health care provider prescribed benzoyl peroxide to a client with severe acne. During a follow-up visit, the nurse finds that the client did not respond to the therapy. Which other medications would the nurse suspect to be beneficial for the client? Select all that apply. One, some, or all responses may be correct. a. Trazodone b. Isotretinoin c. Minocycline d. Streptomycin e. Erythromycin

c. Minocycline d. Streptomycin e. Erythromycin If moderate to severe acne does not respond to topical treatments, then systemic antibiotic therapy is indicated. Systemic antibiotic therapy includes minocycline, streptomycin, and erythromycin. Trazodone may cause priapism; it may not be beneficial for the client. Isotretinoin is an effective oral medication that is reserved for the treatment of severe cystic acne in clients who do not respond to other treatments.

Status epilepticus develops in an adolescent with a seizure disorder who is taking antiseizure medication. Which reason would the nurse identify as the most common reason for the development of status epilepticus? a. The provider failed to account for a growth spurt. b. The amount prescribed is insufficient to cover activities. c. The prescribed antiseizure medication probably is not taken consistently. d. The client is prescribed a medication that is ineffective in preventing seizures.

c. The prescribed antiseizure medication probably is not taken consistently. Skipping doses of the medication is a form of denial that an adolescent client may engage in once the seizures are controlled; also, adolescents tend to feel invincible. The dosage is based not on activity but on the type of seizure. Medications are prescribed according to the type of seizure and are effective if taken consistently. The dosage of antiepileptic medications is based on many factors, including age, type of medication, and presence of infection, as well as on changes in height and weight.

A client who has schizophrenia takes a phenothiazine antipsychotic medication. Which serious client responses to the medication will the nurse immediately report to the primary health care provider? Select all that apply. One, some, or all responses may be correct. a. Akathisia b. Shuffling gait c. Yellow sclerae d. Photosensitivity e. Involuntary tongue movements

c. Yellow sclerae e. Involuntary tongue movements Yellow sclerae are a sign of toxicity that has damaged the liver and necessitates withholding the medication. Abnormal movements of involuntary muscle groups, particularly of the face, mouth, tongue, fingers, and toes, can occur after a prolonged period of dopamine blockade. Conversion to an atypical antipsychotic is warranted. Akathisia and a shuffling gait are common side effects that usually are alleviated by antiparkinsonian agents. Photosensitivity is an expected side effect of the medication; the medication does not have to be withheld.

A client with diabetes is being taught to self-administer a subcutaneous injection of insulin. Identify the preferred site for the self-administration of this medication. a. a b. b c. c d. d

c. c The abdomen is the preferred site for an insulin injection because it is easily accessible and absorption is more even and rapid than when it is injected in the extremities. The other available options are not the preferred site for the self-administration of insulin.

A client with cirrhosis of the liver develops ascites, and the health care provider prescribes spironolactone. The nurse will monitor the client for which adverse medication effect? a. Bruising b. Tachycardia c. Hyperkalemia d. Hypoglycemia

c. hyperkalemia Spironolactone is a potassium-sparing diuretic that is used to treat clients with ascites; therefore the nurse would monitor the client for signs and symptoms of hyperkalemia. Bruising and purpura are associated with cirrhosis, not with the administration of spironolactone. Spironolactone does not cause tachycardia. Spironolactone does not cause hypoglycemia.

A client with type 1 diabetes tells the nurse, "I take guaifenesin cough syrup when I have a cold." Which instruction would the nurse include in client teaching about this medication? a. "Substitute an elixir for the cough syrup." b. "Increase fluid intake and use a humidifier to control the cough." c. "The small amounts of sugar in medications are not a concern with diabetes." d. "Include the glucose in the cough syrup when calculating daily carbohydrate allowance."

d. "Include the glucose in the cough syrup when calculating daily carbohydrate allowance." Cough syrup contains a glucose base; the client should use a glucose-free product or account for the glucose. Elixirs contain natural sweeteners. Although increasing fluid intake and using a room humidifier will also loosen secretions, this does not include important information about the medication. Additional sweeteners, even the amounts in medications, may increase serum glucose levels beyond the desired range; once control is achieved, it is unwise to alter dietary intake or medications without supervision.

Nortriptyline is prescribed for a depressed client. When would the nurse expect a therapeutic response? a. 30 minutes to 2 hours b. 12 to 24 hours c. 1 to 3 days d. 2 to 3 weeks

d. 2 to 3 weeks As with other tricyclics, optimal therapeutic effects take 2 to 3 weeks to occur. One to 3 days, 12 to 24 hours, and 30 minutes to 2 hours are all too soon to expect a response to nortriptyline.

How would the nurse determine if a client is experiencing the therapeutic effect of valsartan? a. Check a lipid profile. b. Assess an apical pulse. c. Measure urinary output. d. Check the blood pressure.

d. Check the blood pressure. Angiotensin II receptor blockers (ARBs) are antihypertensive medications that lower the blood pressure. ARBs do not directly affect lipid profile, apical pulse, or urinary output.

For which medication would the nurse monitor the serum creatinine and blood urea nitrogen (BUN) levels, when administered to a client receiving therapy for extensive burn wounds? a. Nitrofurantoin b. Mafenide acetate c. Silver sulfadiazine d. Gentamicin sulfate

d. Gentamicin sulfate Gentamicin sulfate may cause nephrotoxicity in the client; therefore the nurse would monitor the client prescribed this medication for serum creatinine and BUN changes. The nurse monitors the client on nitrofurantoin for signs of allergic reactions. Mafenide acetate requires monitoring of blood gases and serum electrolyte levels. In clients who are on silver sulfadiazine, the nurse monitors the wounds for infections.

Which effect explains the purpose for gradual dosage reduction of glucocorticoids such as dexamethasone? a. Builds glycogen stores in the muscles b. Produces antibodies by the immune system c. Allows the increased intracranial pressure to return to normal d. Promotes return of cortisone production by the adrenal glands

d. Promotes return of cortisone production by the adrenal glands Hormone therapy must be withdrawn slowly to allow the adrenal glands to adjust and resume production of their hormone. Building glycogen stores in the muscles, producing antibodies by the immune system, and allowing the increased intracranial pressure to return to normal are not reasons for the gradual withdrawal of dexamethasone.

A client receiving a betamimetic for preterm labor experiences muscle tremors, exhibits signs of nervousness, and has palpitations. The nurse assesses the client's pulse rate and notes that it is 110 beats/min and regular. Which action would the nurse take next? a. Discontinue the medication as per protocol. b. Obtain the client's laboratory results for electrolyte levels. c. Inform the client that these are signs of preterm labor. d. Reassure the client that these are expected side effects of the medication.

d. Reassure the client that these are expected side effects of the medication. Betamimetics have the unpleasant side effects of nervousness, tremors, and palpitations; clients should be informed that these side effects are expected. If contractions are lessened and the maternal heart rate is less than 120 beats/min and regular, the medication is performing as expected and does not need to be discontinued. Electrolyte levels are unrelated to these side effects of the tocolytic agent. Muscle tremors and palpitations are not signs and symptoms of preterm labor.

For clients in a behavioral health unit, which advantage does olanzapine have over other antipsychotic medications? a. Extrapyramidal symptoms do not occur. b. Medication effects last for weeks after administration. c. Dopamine is increased at receptor sites, decreasing psychotic behavior. d. Tablets disintegrate immediately in the mouth, preventing tablet "cheeking."

d. Tablets disintegrate immediately in the mouth, preventing tablet "cheeking." Olanzapine is a disintegrating oral tablet that dissolves on contact with moisture. Extrapyramidal effects are possible side effects of this medication. It must be administered daily. Olanzapine's action is unknown; it is believed to be a dopamine and serotonin type 2 antagonist. Increased dopamine at receptor sites increases psychotic behavior.

A client with acquired immunodeficiency syndrome (AIDS) is prescribed epoetin. Which step would the nurse include during the administration of this medication? a. Administer the medication via the Z-track technique. b. Shake the vial before withdrawing the solution. c. Obtain the client's pulse rate before administration. d. Use a syringe that has a 1-inch (2.5-cm), 25-gauge needle

d. Use a syringe that has a 1-inch (2.5-cm), 25-gauge needle Epoetin is administered via the subcutaneous or intravenous route; a 1-inch (2.5-cm), 25-gauge needle is appropriate for either method of administration. The client's vital signs, particularly the blood pressure, need to be monitored only routinely to determine the effectiveness of the medication. Epoetin is not administered via the intramuscular route, so the Z-track technique is not used. Shaking the vial denatures the glycoprotein, making the medication biologically inactive and therefore ineffective.

A client requires intravenous fluids postoperatively. The health care provider has prescribed 5% dextrose in water (D 5W) to infuse at 125 mL/h. To deliver the solution at the correct drip rate, which information would the nurse require to calculate the rate? a. total fluid volume in bag b. diameter of the tubing being used c. size of the needle or catheter in the vein d. drops per mililiter delivered by the infusion set

d. drops for mililiter delivered by the infusion set Knowing the number of drops per milliliter delivered by the infusion set is necessary to calculate the drip rate of an intravenous infusion. The total fluid volume in the bag does not determine the drip rate. The diameter of the tubing being used does not determine the drip rate, only the size of the drop. The size of the needle or catheter in the vein does not determine the drip rate. Different infusion sets deliver different, preset numbers of drops per milliliter.

The nurse would assess a client receiving haloperidol for which adverse effect? a. Ataxia b. Asthenia c. Insomnia d. Gynecomastia

d. gynecomastia Haloperidol is an antipsychotic medication used in the long-term treatment of psychosis. Gynecomastia is one of the adverse effects of this medication. Ataxia, asthenia, and insomnia are the adverse effects of clozapine.

A complete blood count is prescribed before each round of a client's cancer chemotherapy. Which component of the complete blood count is of greatest concern to the nurse? a. Platelets b. Hematocrit c. Red blood cells (RBCs) d. White blood cells (WBCs)

d. white blood cells Antineoplastic medications depress bone marrow, which causes leukopenia; the client must be protected from infection, which can be life-threatening. RBCs diminish slowly and can be replaced with a transfusion of packed RBCs. Platelets decrease as rapidly as WBCs, but complications can be limited with infusions of platelets.