pharmacology and parental

Which statement made by a client who is taking misoprostol indicates a therapeutic outcome of therapy? "My blood pressure is normal." "My stomach feels better." "My heart doesn't beat as fast now." "I can breathe easier.

"My stomach feels better." Explanation: Misoprostol is used to protect the stomach's lining when a client has a peptic ulcer. Misoprostol does not affect the cardiac or respiratory systems

A client with severe pain is prescribed hydromorphone 10 mg by mouth every 4 hours as needed for pain. The client rates the pain as eight on a one-to-ten scale, so the nurse prepares to administer a dose. The oral liquid contained in the unit's opioid stock contains 5 mg/5 ml. How many milliliters of solution should the nurse give to the client? Record your answer using a whole number.

10

A nurse needs to give a pediatric client furosemide orally before one unit of packed red blood cells. How many mL should the nurse give? Record the answer using a whole number. Order: Furosemide 3 mg/kg/dose orally Dose on hand: Furosemide 40 mg/5 mL Client's weight: 40 kg

15ML

Before surgery, a neonate is to receive an IM injection of an antibiotic. Which gauge and size of needle should the nurse select? 23G, 2" (5 cm) needle 19G, 1 1/2" (3.8 cm) needle 25G, 5/8" (1.6 cm) needle 20G, 1" (2.5 cm) needle

25G, 5/8" (1.6 cm) needle Explanation: When administering an IM injection to most term neonates, a 25G to 27G, 5/8? (1.6 cm) long needle is appropriate. A 19G, 1 1/2? (3.8 cm) needle is too large for an infant. A 20G 1? (2.5 cm) needle is too large for an infant. A 23G, 2? (5 cm) needle is too large for an infant.

The nurse is instructing the client on insulin administration. The client is performing a return demonstration for preparing the insulin. The client's morning dose of insulin is 10 units of regular and 22 units of NPH. The nurse checks the dose accuracy with the client. The nurse determines that the client has prepared the correct dose when the syringe reads how many units? Record your answer using a whole number.

32 Explanation: Clients commonly need to mix insulin, requiring careful mixing and calculation. The total dosage is 10 units plus 22 units, for a total of 32 units

A nurse has an order to start magnesium sulfate on a preterm labor client. The order reads: Give a 4-g bolus over 15 minutes, then decrease the rate to 2g/hour. The nurse has 50 g of magnesium sulfate mixed in 1000 mL of lactated Ringer's on hand. What is the rate the nurse will set the pump to deliver the 2g maintenance dose? Record your answer using a whole number.

40 Explanation: (2 g)/(1 hour) × 1000 mL/50 g = 2000/50 = 40 mL/hour

Betamethasone syrup 0.9 mg has been prescribed. It is available in a 0.6 mg/5 mL solution. How many milliliters should the nurse administer? Record your answer using one decimal place.

7.5 ML

A client with chest pain is prescribed intravenous nitroglycerin. Which finding is of greatest concern for the nurse initiating the nitroglycerin drip? Blood pressure is 88/46 mm Hg. Serum potassium is 3.5 mEq/L (3.5 mmol/L). ST elevation is present on the electrocardiogram. Heart rate is 61 bpm.

Blood pressure is 88/46 mm Hg. EXPLANATION Nitroglycerin is a vasodilator that will lower blood pressure. The client is having chest pain, and the ST elevation indicates injury to the myocardium, which may benefit from nitroglycerin. The potassium and heart rate are within normal range.

A client complains of difficulty swallowing when the nurse tries to administer a medication in capsule form. What action should the nurse take next? Dissolve the capsule in a full glass of water. Withhold the medication. Break the capsule and mix the contents with applesauce

Check for availability of a liquid preparation. Explanation: The nurse should find out whether the medication is available in liquid form. Dissolving or breaking the capsule may interfere with drug action or absorption. The nurse shouldn't withhold any medication without first notifying the physician

At an outpatient visit 3 months after discharge from the hospital, a client says he has stopped his olanzapine even though it controls his symptoms of schizophrenia better than other medications. "I've gained 20 lb (9.1 kg) already. I can't stand it anymore." Which response by the nurse is most appropriate? "You can be switched to another medicine." "I can help you with a diet and exercise plan to keep your weight down." "Your weight gain will level off if you stay on the medication 3 more months." "I don't think you look fat; why do you think so?"

I can help you with a diet and exercise plan to keep your weight down. EXPLANATION Helping the client control his weight is the most appropriate approach. The nurse's contradiction of the client's statement is inappropriate. Most atypical antipsychotics cause weight gain and are not a solution to the weight gain. There is little evidence that weight gain from taking olanzapine decreases with time.

A client with type 1 diabetes mellitus asks the nurse about taking ginseng at home. What should the nurse tell the client? "There are no therapeutic benefits of ginseng." "You can take the ginseng to help improve your memory." "It's ok to take ginseng if you take it with a carbohydrate." "Taking ginseng will increase the risk of hypoglycemia."

Taking ginseng will increase the risk of hypoglycemia. EXPLANATION Taking ginseng when on insulin is not encouraged because ginseng increases the risk of hypoglycemia. Ginseng can be therapeutic in certain situations but is potentially harmful to clients taking insulin. Taking ginseng with a carbohydrate will not offset the long acting effect of the ginseng.

A client with an intravenous (I.V.) site is experiencing pain. The nurse understands that pain with infusion is a sign of: fibrin sheath occlusion. catheter position at the insertion site due to movement. pinch-off syndrome. external compression from the tape holding the tubing in place.

catheter position at the insertion site due to movement. Explanation: The catheter pressing against the vein causes the pain. This would be a common result due to normal movement of the client throughout the day. The other choices should not cause pain at insertion

A client wants to avoid methods of birth control that contain estrogen. Which method would be the nurse recommend? etonogestrel/ethinyl estradiol vaginal ring depot medroxyprogesterone acetate injection birth control patch combined hormonal oral contraceptive

depot medroxyprogesterone acetate injection EXPLANATION Birth control methods that contain estrogen increase risk for clotting disorders especially in women over the age of 35 years who smoke or who have had a previous clotting problem. Depot medroxyprogesterone acetate (DMPA) injections contain progesterone, but no estrogen. Combined hormonal contraceptives, vaginal rings, and the birth control patch all contain estrogen.

A client is taking spironolactone to control hypertension. The client's serum potassium level is [6 mEq/L (56mmol/L)]. For this client, the nurse's priority should be to assess their electrocardiogram (ECG) results. respiratory rate. bowel sounds. neuromuscular function.

electrocardiogram (ECG) results. EXPLANATION Although changes in all these findings are seen in hyperkalemia, ECG results should take priority because changes can indicate potentially lethal arrhythmias such as ventricular fibrillation. It wouldn't be appropriate to assess the client's neuromuscular function, bowel sounds, or respiratory rate for effects of hyperkalemia.

Clients who are receiving parenteral nutrition (PN) are at risk for development of which complication? hypostatic pneumonia pulmonary hypertension fluid imbalances orthostatic hypotension

fluid imbalance EXPLANATION Clients receiving TPN are at risk for a number of complications, including fluid imbalances such as fluid overload and hyperosmolar diuresis. Other common complications include hyperglycemia, sepsis, pneumothorax, and air embolism. Hypostatic pneumonia, pulmonary hypertension, and orthostatic hypotension are not complications of TPN.

A client with quadriplegia is experiencing severe muscle spasms. To relieve them, a physician orders baclofen, 5 mg P.O. three times daily. What is the principal indication for baclofen? spasticity related to stroke acute, painful musculoskeletal conditions skeletal muscle hyperactivity secondary to cerebral palsy muscle spasms with paraplegia or quadriplegia from spinal cord lesions

muscle spasms with paraplegia or quadriplegia from spinal cord lesions EXPLANATION Baclofen's principal clinical indication is for the paraplegic or quadriplegic client with spinal cord lesions, most commonly caused by multiple sclerosis or trauma. For these clients, baclofen significantly reduces the number and severity of painful flexor spasms. Baclofen isn't indicated for acute, painful musculoskeletal conditions; skeletal muscle hyperactivity secondary to cerebral palsy; or spasticity related to stroke

Which finding is the best indication that fluid replacement for the client in hypovolemic shock is adequate? systolic blood pressure greater than 110 mm Hg urine output greater than 30 ml/hour diastolic blood pressure greater than 90 mm Hg respiratory rate of 20 breaths/minute

urine output greater than 30 ml/hour EXPLANATION Urine output provides the most sensitive indication of the client's response to therapy for hypovolemic shock. Urine output should be consistently greater than 35 mL/h. Blood pressure is a more accurate reflection of the adequacy of vasoconstriction than of tissue perfusion. Respiratory rate is not a sensitive indicator of fluid balance in the client recovering from hypovolemic shock.

A client has been prescribed digoxin. Which symptom should the nurse tell the client to report as a potential indication of digoxin toxicity? urticaria shortness of breath hypertension visual disturbances

visual disturbances EXPLANATION Visual disturbances are a symptom of digoxin toxicity. These disturbances can include double, blurred, or yellow vision. Cardiovascular manifestations of digoxin toxicity include bradycardia, other dysrhythmias, and pulse deficit. Gastrointestinal symptoms include anorexia, nausea, and vomiting.

A physician prescribes penicillin potassium oral suspension 56 mg/kg/day in four divided doses for a client with anorexia nervosa who weighs 25 kg. The medication dispensed by the pharmacy contains a dosage strength of 125 mg/5 mL. How many milliliters of solution should the nurse administer with each dose? Record your answer using a whole number.

14 Explanation: To determine the total daily dosage, set up this proportion: 25 kg/X = 1 kg/56 mg X = 1,400 mg. Next, divide the daily dosage by four doses to determine the dose to administer every 6 hours: X = 1,400 mg/4 doses X = 350 mg/dose. The adolescent should receive 350 mg every 6 hours. Lastly, calculate the volume to give for each dose by setting up this proportion: X/350 mg = 5 mL/125 mg X = 14 mL.

A client is to receive total parental nutrition (TPN) solution. The nurse is aware it will be given via a central line and contains which main nutrient? 10% fat emulsions electrolytes and 10 units of heparin 50% dextrose amino acids, including vitamin K

50% dextrose EXPLANATION TPN is a hypertonic solution that consists of dextrose, proteins, and electrolytes. High-glucose solutions are better tolerated in a central line based on viscosity. Other answers can be given peripherally and do not require a central line.

A 10-year-old client with asthma is prescribed 2 mg of albuterol syrup four times per day. The syrup is available as a formulation of 2 mg/5 mL. How many milliliters of syrup should the nurse administer with each dose? Record the answer as a whole number.

5ML

A client receiving intravenous heparin has developed hematuria and petechiae. What is the nurse's best action? Administer potassium chloride. Administer protamine sulfate. Administer vitamin K. Administer albumin.

Administer protamine sulfate. EXPLANATION Heparin is a pharmacotherapeutic agent for those with disorders such as coronary artery disease and other ischemic coronary events, atrial fibrillation, heart valve diseases, stroke, pulmonary embolism, and deep venous thrombosis. But there is a potential for many side effects with the use of this drug. Thrombocytopenia and bleeding events are the most common drug-related problems associated with heparin. Protamine sulfate is the heparin antidote. The administration of any of the other drugs will not aid in coagulation and resolve the bleeding.

The nurse is reviewing the physician's order written for a postmenopausal client: "calcitonin salmon nasal spray 200 IU, one spray every day." What is the appropriate action to be taken by the nurse regarding this order? Clarify with the physician that the spray should be given in only one nostril per day. Inform the physician that the medication is not a nasally applied medication. Remind the physician that this medication can be purchased over-the-counter. Ask the physician why this medication was ordered for a postmenopausal client.

Clarify with the physician that the spray should be given in only one nostril per day. EXPLANATION Calcitonin salmon nasal spray should be administered in only one nostril per day. Many preprinted order sheets automatically print "administer in both nostrils" when a nasal spray is ordered. Nurses must be familiar with the directions for each medication they give before administering medications. The other options are incorrect because calcitonin salmon nasal spray is prescribed to postmenopausal clients for the treatment of osteoporosis and requires a physician's order.

A client has a nasogastric (NG) tube. How should the nurse administer oral medication to this client?

Crush the tablets and prepare a liquid form; then insert the liquid into the NG tube. EXPLANATION To administer oral medication through an NG tube, the nurse must reproduce the disintegration and dissolution processes by crushing the tablets and preparing a liquid form. Making sure not to crush sustained-release tablets or empty capsules, the nurse then inserts the liquid into the NG tube. Heating the tablets may destroy or alter the drug's action. Washing cut tablets or crushed powder down the tube may cause the medication to stick to the sides of the tube, possibly providing inaccurate dosing and clogging the tube.

The nurse enters the medication room and observes another nurse placing a partially used vial of morphine sulfate into a uniform pocket. What is the best response by the nurse? Offer to act as a witness to the placement of the vial into the client's medication drawer. Promptly report the nurse to a supervisor. Offer to act as a witness while the nurse disposes of the medication into the sink. Offer to act as a witness while disposing of the vial in the sharps container.

Offer to act as a witness while the nurse disposes of the medication into the sink EXPLANATION Morphine sulfate is a controlled substance with a high risk for abuse. Federal law requires strict monitoring of all controlled substances. Partial doses of a controlled substance require two nurses to witness and document the waste of the partial dose. The nurse should offer to act as a witness to wasting the partial dose in the sink or the pharmaceutical waste container to avoid diversion and misuse. Controlled substances should not be carried in a nurse's pocket. Controlled substances should not be placed in a sharps container or in a client's medication drawer as these are not secure and may promote diversion or misuse. Reporting the nurse to a supervisor would be a premature action.

The nurse cares for a child receiving a blood transfusion. The child becomes flushed and is wheezing. What should the nurse do first? Take the child's vital signs. Switch the transfusion to normal saline solution. Administer oxygen. Notify the health care provider (HCP).

Switch the transfusion to normal saline solution. EXPLANATION The child is having a reaction to the blood transfusion. The priority is to stop the blood transfusion but maintain an open venous access for medication or high fluid volume delivery. Thus, switching the transfusion to normal saline solution would be done first. Since the child is having difficulty breathing, applying oxygen would be the next action. Additionally, vital signs are taken to determine the extent of circulatory involvement. Then the HCP would be notified and, if necessary, the crash cart would be obtained.

The nurse administers an intramuscular injection to an infant. Indicate the appropriate site for this injection.

The vastus lateralis in the thickest part of the anterolateral thigh is a safe injection site for infants. The needle should be inserted at a 90-degree angle to the long axis of the femur.

A school-age client with rheumatic fever is on long-term aspirin therapy. Which client statement most indicates that the client is experiencing a serious adverse reaction to aspirin? "These pills make me cough." "My stomach hurts after I take that medicine." "I put lotion on my itchy skin." "I hear ringing in my ears."

"I hear ringing in my ears." EXPLANATION Tinnitus is an adverse effect of prolonged aspirin therapy, and the child should be examined by a health care provider (HCP) for hearing loss. Itchy skin commonly accompanies the rash associated with rheumatic fever and the nurse can encourage lotion use. The nurse teaches clients to take aspirin with food or milk to avoid abdominal discomfort. The nurse can also address the fact that coughing after ingesting aspirin can be caused by inadequate fluid intake during administration

A client with bipolar disorder is taking lithium carbonate 300 mg t.i.d. The client's lithium level is 2.7 mEq/L. In assessing the client, the nurse finds no evidence of lithium toxicity. The first assessment question the nurse should ask before ordering another blood test is: "Are you experiencing depression and suicidal ideation?" "When did you take your last dose of lithium?" "Are you embarrassed or afraid to report medication problems?" "Do you understand why you are taking this medication?"

"When did you take your last dose of lithium EXPLANATION Normal lithium levels range from 0.6 to 1.2 mEq/L. This client's lithium level is extremely high. The nurse needs to determine when the client took a dose of lithium in relation to having blood drawn because the test results may have been affected if the client had blood drawn too soon after the last dose. Blood work should be done at least 12 hours after a client's last dose of lithium. Questioning the client about reporting medication problems or experiencing depression or suicidal ideation wouldn't elicit information that would help the nurse understand why the client's lithium level is elevated. Although it's appropriate for the nurse to review the medication with the client, the main concern at this time is ensuring that the blood work is done at the proper time in relation to the last dose of lithium.

The nurse is preparing to administer pain medication to a client reporting right lower quadrant pain. Place the nursing intervention steps in the correct order. All options must be used. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1Administer the medication to the client. 2Remove the medication from the narcotic drawer. 3Document the administration on the client's MAR. 4Ask the client about allergies. 5Evaluate the client's pain level for medication effectiveness. SUBMIT ANSWER

Ask the client about allergies. Remove the medication from the narcotic drawer. Administer the medication to the client. Document the administration on the client's MAR. Evaluate the client's pain level for medication effectiveness. Explanation: The nurse should 1) assess for allergies, 2) obtain the medication, 3) administer after assessing pain rating and identifying the client, 4) document the medication was given in the MAR, and 5) evaluate the client for medication effectiveness.

Which is the correct technique when the nurse is instilling eye drops for an adult who is alert? Select all that apply. Blot excess drops from the client's face. Have the client look down, and instill the medication onto the client's cornea. Hold the dropper over the eye, and instill the drops into the lower lid. Instruct the client to apply pressure to the eyes after instillation of the eyedrops. Have the client tilt the head back and look up.

Blot excess drops from the client's face. Hold the dropper over the eye, and instill the drops into the lower lid. Have the client tilt the head back and look up. EXPLANATION Correct technique for instilling eyedrops includes having the client tilt the head back and look up to protect the cornea; holding the dropper over the eye and pulling the lower eyelid down to release the drops in the conjunctival sac. The client should not apply pressure on the eyes and can gently apply pressure over the inner canthus to prevent systemic absorption of the drug, but is not told to apply pressure to the eyes. The drops should not be instilled on the cornea. After instilling the medication the nurse can blot any excess medication from the clients face.

Which instruction should a nurse give a client with prostatitis who is receiving co-trimoxazole double strength? "If your mouth or throat becomes sore, take the medication with milk or an antacid." "Don't expect improvement of symptoms for 7 to 10 days." "To protect against drug-induced photosensitivity, use a sunscreen of at least SPF-15 with PABA." "Drink 6 to 8 glasses of fluid daily while taking this medication."

Drink 6 to 8 glasses of fluid daily while taking this medication." EXPLANATION The client must drink 6 to 8 glasses of fluid daily to prevent renal problems, such as crystalluria and stone formation. If the drug is effective, symptoms should improve within a few days. Sore throat and sore mouth are adverse effects; the client should report them to a physician right away. The drug causes photosensitivity, but the client should use a PABA-free sunscreen; PABA can interfere with the drug's action.

A healthcare provider (HCP) has prescribed valproic acid for a client with bipolar disorder who has achieved limited success with lithium carbonate. Which information should the nurse teach the client about taking valproic acid? Consumption of a moderate amount of alcohol is safe if the medication is taken in the morning. The extended-release tablet can be crushed if necessary for ease of swallowing. Tachycardia and upset stomach are common side effects. Follow-up blood tests are necessary while on this medication. SUBMIT ANSWER

Follow-up blood tests are necessary while on this medication. EXPLANATION Valproic acid can cause hepatotoxicity, so regular liver function tests are needed. Other side effects include nausea and drowsiness. Extended-release tablets should not be split or crushed; doing so changes their absorption. Alcohol should never be mixed with this medication. There will be medication in the client's body at all times. Nausea and tachycardia are not common side effects of valproic acid

A client is to be discharged with a prescription for lactulose. The nurse teaches the client how to administer this medication. Which statement would indicate that the client has understood the information? "I will take it with a laxative." "I will mix it with apple juice." "I will mix the crushed tablets in some gelatin." "I will take it with an antacid."

I will mix it with apple juice. EXPLANATION The taste of lactulose is a problem for some clients. Mixing it with fruit juice, water, or milk can make it more palatable. Lactulose should not be given with antacids, which may inhibit its action. Lactulose should not be taken with a laxative because increased stooling is an adverse effect of the drug and would be potentiated by using a laxative. Lactulose comes in the form of syrup for oral or rectal administration.

The client is taking 50 mg of lamotrigine daily for bipolar depression. The client shows the nurse a rash on his arm. What should the nurse do? Report the rash to the health care provider (HCP). Give the client an ice pack for his arm. Explain that the rash is a temporary adverse effect. Question the client about recent sun exposure.

Report the rash to the health care provider (HCP). Explanation: The nurse should immediately report the rash to the HCP because lamotrigine can cause Stevens-Johnson syndrome, a toxic epidermal necrolysis. The rash is not a temporary adverse effect. Giving the client an ice pack and questioning the client about recent sun exposure are irresponsible nursing actions because of the possible seriousness of the rash.

The nurse is teaching the client how to use a metered-dose inhaler (MDI) to administer a corticosteroid. Which observations indicates that the client is using the MDI correctly? Select all that apply. The client waits 5 minutes between puffs. The client lies supine for 15 minutes following administration. The client rinses the mouth with water following administration. The inhaler is held upright. The head is tilted down while inhaling the medicine.

The client rinses the mouth with water following administration. EXPLANATION The client should shake the inhaler and hold it upright when administering the drug. The head should be tilted back slightly. The client should wait about 30 seconds between puffs. The mouth should be rinsed following the use of a corticosteroid MDI to decrease the likelihood of developing an oral infection. The client does not need to lie supine; instead, the client will likely to be able to breathe more freely if sitting upright

A physician orders lactulose, 30 ml three times daily, for a client with cirrhosis to treat elevated serum ammonia level. The nurse will know that this medication is effective by which finding? The client will have an increase in urine output. Abdominal swelling would decrease. The client's level of consciousness (LOC) would improve. The client would develop diarrhea.

The client's level of consciousness (LOC) would improve. EXPLANATION In cirrhosis, the liver fails to convert ammonia to urea. Ammonia then builds up in the blood and is carried to the brain, causing cerebral dysfunction. When this occurs, the client will often have a decreased level of consciousness and appear confused. Lactulose is administered to promote ammonia excretion in the stool and thus improve cerebral function. Because LOC is an accurate indicator of cerebral function, the nurse can evaluate the effectiveness of lactulose by monitoring the client's LOC. Monitoring urine output, abdominal girth, and stool frequency helps evaluate the progress of cirrhosis, not the effectiveness of lactulose.

A nurse is preparing to give an I.M. injection in the left leg of a 2-year-old child. Identify the area where the nurse should give the injection.

The vastus lateralis muscle, located in the thigh, is the muscle into which the nurse should administer an I.M. injection in the leg of a toddler. To give an injection into the vastus lateralis muscle, the nurse should divide the distance between the greater trochanter and the knee joints into quadrants. The injection should be given in the center of the upper quadrant.

A client with early acute renal failure has anemia, tachycardia, hypotension, and shortness of breath. The health care provider (HCP) has prescribed 2 units of packed red blood cells (RBCs). What should the nurse determine prior to initiating the blood transfusion? Select all that apply. The client has an identification bracelet. There is a signed informed consent for transfusion therapy. There is an IV access with the appropriate tubing and normal saline as the priming solution. The vital signs have been taken and documented in accordance with facility policy and procedure. There is the second unit of blood in the medication room. Blood typing and cross-matching are documented in the medical record.

There is an IV access with the appropriate tubing and normal saline as the priming solution. There is a signed informed consent for transfusion therapy. Blood typing and cross-matching are documented in the medical record. The vital signs have been taken and documented in accordance with facility policy and procedure. There is the second unit of blood in the medication room. The client has an identification bracelet. Explanation: Before prescribing and administering packed RBCs, the nurse should assess the IV site to make sure it has an 18G to 20G infusion set. The nurse should also ensure that normal saline solution is used to prime the tubing to prevent RBCs from adhering to the tubing. The client must indicate informed consent for the procedure by signing the consent form. The client's blood must be typed to determine ABO blood typing and Rh factor and ensure that the client receives compatible blood. Cross-matching is done to detect the presence of recipient antibodies to the donor's minor antigens. Vital signs provide a baseline reference for continuous monitoring throughout the transfusion. An identification bracelet and red blood band are essential for client identification per facility policy. Two nurses must double check the client's identification with the client listed on the unit of RBCs. The transfusion should be started within 30 minutes of the time that the RBC unit is checked out of the blood bank. Thus, no blood should be kept in the medication room before transfusion.

Case Study Item 1 of 1 A nurse on the medical-surgical unit is caring for a 32-year-old female client following a procedure (dilation and curettage) who is receiving intravenous fluids and is requesting pain medication. Nurse's Notes Orders 0915 Vital signs: temperature, 98.2°F (36.8°C); heart rate, 82 beats/min; respiratory rate, 20 breaths/min; blood pressure, 140/78 mm Hg. Client reports abdominal cramping and rates discomfort as an 8/10 on the pain scale. Abdomen is soft and nontender on palpation. Bowel sounds hypoactive in all 4 quadrants. Skin warm, dry, and intact. Capillary refill brisk. Lungs clear to auscultation bilaterally in all lobes. No edema noted. Scant, dark red vaginal bleeding noted on peri pad. Intravenous fluid (IVF) Ringer's lactate 1000 mL infusing at 75 mL/hr. IV site dry and intact on right forearm. Client medicated for severe pain with meperidine 25 mg intravenous push (IVP) as prescribed. Call light in place. Client alert and oriented to person, place, and time. Will continue to monitor. 0930 Client now reports pain as 0/10 on the pain scale. Resting comfortably in bed. IV site dry and intact. Continue to monitor. Call light in place. 1000 Client rings call bell light, reports that arm with IV site is uncomfortable. Inspection of site reveals slight swelling, erythema, and a red streak going up the arm.

Two nursing actions, Discontinue IV site. Contact the health care provider. Potential condition, phlebitis Parameters to Monitor, IV site right upper extremity Explanation: Clinical data supports a clinical diagnosis of phlebitis: discomfort at the IV site, slight swelling, erythema, and a red streak going up the arm. Irritation/inflammation of the vein can be caused by IV push administration of medication and/or dislodgement of the IV catheter within the vein. Intravenous administration of meperidine can cause pain at the IV site and even phlebitis at the site. The first correct action to take is to discontinue the IV site. Phlebitis can lead to additional complications such as clot dislodgement. The second correct action it to notify the health care provider that phlebitis is present, so additional treatment can be ordered as needed for pain relief and subsequent continued monitoring of the site and right upper extremity. The first correct parameter to monitor is the IV site to make sure that following discontinuation of site and the application of warm compresses, that the vein's irritation will resolve. The second correct parameter is to monitor the entire right arm because the streaking goes up the vein. Observation of the arm's overall function is necessary to identify potential complications (numbness, tingling, weakness) and ensure prompt action. Extravasation is not occurring because there is no vesicant fluid being administered. Clinical signs of extravasation are due to leakage of caustic fluids into the surrounding tissue that can cause necrotic tissue damage. Infiltration is not occurring because this is due to leaking of fluid into the surrounding tissue leading to swelling, coolness at the site, and pain. Hematoma is not occurring because there is no clinical data to support the presence of a raised, reddened area on the skin. A hematoma is a collection of blood within the surrounding tissues. Applying a topical antibiotic is not a treatment for the complication of phlebitis during IV therapy. There are no open areas or source of bacterial infection noted. Decreasing the IV flow rate is not indicated because the IV site should be discontinued and if needed restarted in the other extremity at the specified rate. There is no clinical data to support the presence of infection. Vital signs are stable. Therefore, there is no need to request an order to obtain blood cultures. Monitoring intake and output is part of nursing assessment but it is unrelated to the complication of phlebitis during IV therapy. There is no clinical data to support the monitoring the client's level of consciousness because the client is alert and oriented to surroundings. Monitoring the client's temperature is part of nursing assessment but it is unrelated to the complication of phlebitis during IV therapy.

The nurse gives a client an oral narcotic analgesic medication to treat postoperative pain. Which follow-up assessment most clearly indicates that the treatment was effective? Within 30 minutes the client says that the pain is reduced. Within 20 minutes the client is reading with a relaxed posture. Within 10 minutes the client is moving down the hall. Within 40 minutes the client breathes slowly with eyes closed.

Within 30 minutes the client says that the pain is reduced EXPLANATION To evaluate the effectiveness of medications, the nurse assesses for indications of pain at the time of the onset of action. Oral narcotic agents have a typical onset of action within 30 minutes of administration. The strongest indication of pain control is a client statement that the pain has decreased. The other situations could occur while the client continues to experience pain.

What should be the nurse's priority assessment after an epidural anesthetic has been given to a nulligravid client in active labor? blood pressure cognitive function level of consciousness contraction pattern

blood pressure Explanation: Administration of an epidural anesthetic can result in a hypotensive effect on maternal blood pressure. Therefore, the priority assessment is the mother's blood pressure. Ephedrine or wedging the client to a position to keep pressure off the vena cava, such as on the left side, can be used to elevate maternal blood pressure should it drop too low. Epidural anesthesia has no effect on the level of consciousness or the client's cognitive function. Although the client's contraction pattern may decrease in frequency after administration of the anesthesia, the priority assessment is the client's blood pressure. After blood pressure is maintained, contractions can be assessedx

A client on mechanical ventilation is receiving pancuronium I.V. as needed. Which assessment finding indicates that the client needs another pancuronium dose? lip movement leg movement finger movement fighting the ventilator

fighting the ventilator EXXPLANATION Pancuronium, a nondepolarizing blocking agent, is used for muscle relaxation and paralysis. It assists mechanical ventilation by promoting endotracheal intubation and paralyzing the client so the client breathes in synchrony with the ventilator. Fighting the ventilator is a sign that the client needs another pancuronium dose. The nurse should administer a dose I.V. every 20 to 60 minutes. Movement of the legs, fingers, or lips has no effect on the ventilator and therefore isn't used to determine the need for another dose.

Which combination of adverse effects should a nurse monitor for when administering I.V. insulin to a client with diabetic ketoacidosis?

hypokalemia and hypoglycemia EXPLANATION Blood glucose needs to be monitored in clients receiving I.V. insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels aren't affected by I.V. insulin administration.

The nurse should assess older adults for which serious adverse effects of ibuprofen? neuropathy hypoglycemia impaired renal function rebound headaches

impaired renal function EXPLANATION Renal function may already be compromised in the elderly, and ibuprofen can further impair renal or liver function. Nonsteroidal anti-inflammatory drugs can also cause nephrosis, cirrhosis, and heart failure in elderly persons.Rebound headaches are not a serious adverse effect of ibuprofen.Neuropathy and hypoglycemia are not adverse effects of ibuprofen

After an eye examination, a client is diagnosed with open-angle glaucoma. The physician orders pilocarpine ophthalmic solution, 0.25% gtt i, OU q.i.d. Based on this prescription, the nurse should teach the client or a family member to administer the drug by instilling one drop of pilocarpine 0.25% into both eyes four times daily. instilling one drop of pilocarpine 0.25% into both eyes daily. instilling one drop of pilocarpine 0.25% into the right eye daily. instilling one drop of pilocarpine 0.25% into the left eye four times daily.

instilling one drop of pilocarpine 0.25% into both eyes four times daily. EXPLANATION The abbreviation "gtt" stands for drop, "i" is the apothecary symbol for the number 1, "OU" signifies both eyes, and "q.i.d." means four times per day. Therefore, one drop of pilocarpine 0.25% should be instilled into both eyes four times daily.

A physician orders digoxin for a client with heart failure. During digoxin therapy, which laboratory value may predispose the client to digoxin toxicity? magnesium level of 2.5 mg/dl (0.1 mmol/L) potassium level of 3.1 mEq/L (3.1 mmol/L) sodium level of 152 mEq/L (152 mmol/L) calcium level of 7.5 mg/dl (0.4 mmol/L)

potassium level of 3.1 mEq/L (3.1 mmol/L) EXPLANATION Conditions that may predispose a client to digoxin toxicity include hypokalemia (evidenced by a potassium level less than 3.5 mEq/L), hypomagnesemia (evidenced by a magnesium level less than 1.5 mEq/L), hypothyroidism, hypoxemia, advanced myocardial disease, active myocardial ischemia, and altered autonomic tone. Hypermagnesemia (evidenced by a magnesium level greater than 2.5 mEq/L), hypercalcemia (evidenced by an ionized calcium level greater than 5.3 mg/dl), and hypernatremia (evidenced by a sodium level greater than 145 mEq/L) aren't associated with a risk of digoxin toxicity.

The client with preeclampsia asks the nurse why she is receiving magnesium sulfate. The nurse's most appropriate response to is to tell the client that the priority reason for giving her magnesium sulfate is to reduce blood pressure. increase diuresis. prevent seizures. slow the process of labor

prevent seizures. Explanation: The chemical makeup of magnesium is similar to that of calcium and, therefore, magnesium will act like calcium in the body. As a result, magnesium will block seizure activity in a hyperstimulated neurologic system caused by preeclampsia by interfering with signal transmission at the neural musculature junction. Reducing blood pressure, slowing labor, and increasing diuresis are secondary effects of magnesium.

A health care provider prescribes gentamicin for a client with peritonitis. The client has preexisting impaired vision and hearing. The nurse should: question the prescription because gentamicin could cause further hearing impairment. question the prescription because gentamicin could cause further visual impairment. question whether the drug is appropriate for treatment of peritonitis. give the drug as prescribed.

question the prescription because gentamicin could cause further hearing impairment EXPLANATION Aminoglycoside antibiotics can cause damage to the eighth cranial nerve and result in ototoxicity. If the client is already hearing impaired, the nurse should question the prescription with the health care provider, who may determine that prescribing another antibiotic would be safer. Gentamicin is an appropriate antibiotic for gram-negative infections such as peritonitis. Gentamicin does not cause visual impairment.

The nurse has administered aminophylline to a client with emphysema. Which indicates the medication has been effective? stimulation of the medullary respiratory center efficient pulmonary circulation relaxation of smooth muscles in the bronchioles relief from spasms of the diaphragm

relaxation of smooth muscles in the bronchioles EXPLANATION Aminophylline, a bronchodilator that relaxes smooth muscles in the bronchioles, is used in the treatment of emphysema to improve ventilation by dilating the bronchioles. Aminophylline does not have an effect on the diaphragm or the medullary respiratory center and does not promote pulmonary circulation.

Which food should the nurse tell the client to avoid while taking phenelzine? roasted chicken hamburger fresh fish salami

salami Explanation: Phenelzine is a monoamine oxidase inhibitor (MAOI). MAOIs block the enzyme monoamine oxidase, which is involved in the decomposition and inactivation of norepinephrine, serotonin, dopamine, and tyramine (a precursor to the previously stated neurotransmitters). Foods high in tyramine—those that are fermented, pickled, aged, or smoked—must be avoided because when they are ingested in combination with MAOIs a hypertensive crisis occurs. Some examples include salami, bologna, dried fish, sour cream, yogurt, aged cheese, bananas, pickled herring, caffeinated beverages, chocolate, licorice, beer, red wine, and alcohol-free beer

Propylthiouracil (PTU) is prescribed for a client with Graves' disease. Which symptom should the nurse teach the client to report? excessive menstruation sore throat increased urine output constipation

sore throat Explanation: The most serious adverse effects of PTU are leukopenia and agranulocytosis, which usually occur within the first 3 months of treatment. The client should be taught to promptly report to the health care provider (HCP) signs and symptoms of infection, such as a sore throat and fever. Clients having a sore throat and fever should have an immediate white blood cell count and differential performed, and the drug must be withheld until the results are obtained. Painful menstruation, constipation, and increased urine output are not associated with PTU therapy.

A client with migraine headaches and a history of angina asks the nurse why the health care provider does not prescribe one of the newer medications for migraine, such as sumatriptan. The nurse responds that: sumatriptan is contraindicated in clients with angina. these drugs are very expensive. sumatriptan is used only for migraines with an aura. sumatriptan is used only for prophylactic treatment of migraines.

sumatriptan is contraindicated in clients with angina. EXPLANATION Sumatriptan is contraindicated in clients with ischemic heart disease, such as angina, myocardial infarction, or coronary artery disease, because it is a vasoconstrictor.The cost of the medication is not the concern at this time; the drugs are contraindicated because of the client's history of angina. Sumatriptan is used for the abortive treatment of migraines, not prophylactic treatment, and it is effective in treating acute migraines with or without aura.

A healthcare provider prescribes an antibiotic for a 6-year-old client with an upper respiratory tract infection. For what prescribed antibiotic will the nurse seek clarification from the healthcare provider? amoxicillin penicillin tetracycline erythromycin

tetracycline EXPLANATION Tetracycline should be avoided in children younger than age 8 because it may cause enamel hypoplasia and permanent yellowish gray to brownish tooth discoloration. Penicillin, erythromycin, and amoxicillin are not contraindicated.

Lorazepam is commonly given along with a neuroleptic agent. What is the purpose of administering the drugs together? to counteract the neuroleptic's extrapyramidal effects to increase a client's level of awareness and concentration to manage depressed clients to reduce anxiety and potentiate the neuroleptic's sedative action

to reduce anxiety and potentiate the neuroleptic's sedative action Explanation: Lorazepam, when taken with a neuroleptic such as haloperidol, potentiates the neuroleptic's sedating effect and is used to treat severely agitated clients. Lorazepam wouldn't be given to counteract extrapyramidal effects. Both drugs can cause depression, so they aren't used to treat depression. The drugs' depressant effect would decrease concentration, not increase it.

The nurse has a prescription to administer an IM injection to a neonate. Which injection site should the nurse select? deltoid dorsogluteal vastus lateralis ventroglutea

vastus lateralis EXPLANATION The vastus lateralis muscle of the thigh is preferred for administering IM injections to infants because there is less danger of injuring nerves, blood vessels, or bony structures at this site. The deltoid muscle is used for IM injections only when other areas are unavailable. The dorsogluteal site has long been contraindicated for use in children who have not been walking for at least 1 year and is seldom used in other clients because of the risk of sciatic nerve. The ventrogluteal site is relatively free of major nerves and blood vessels, but the vastus lateralis remains the preferred IM injection site in infants.