Pharmacology

Minoxidil is prescribed for a client to treat hair loss. The nurse provides instructions to the client regarding the application of the medication. Which statement by the client indicates that teaching is effective? 1."I will apply the prescribed amount of solution at bedtime." 2."I will apply the prescribed amount of solution twice a day." 3."I will apply the prescribed amount of solution 4 times a day." 4."I will apply the prescribed amount of solution 3 times a day."

2. i will apply the prescribed amount of solution twice a day A 2% minoxidil solution is used for topical treatment of baldness. The usual dosage is 1 mL applied twice a day. Options 1, 3, and 4 are incorrect.

A client has been given a prescription for benzonatate. Which observation should the nurse look for to evaluate the effectiveness of the medication? 1.Increasing the client's comfort level 2.Decreasing the client's anxiety level 3.Calming the client's persistent cough 4.Eliminating the client's nausea and vomiting

3. calming the client's persistent cough Benzonatate is a locally acting antitussive that decreases the intensity and frequency of cough without eliminating the cough reflex. The other options are not intended effects of this medication.

Terbutaline is prescribed for a client with bronchitis. The nurse checks the client's medical history for which disorder in which the medication should be used with caution? 1.Osteoarthritis 2.Hypothyroidism 3.Diabetes mellitus 4.Polycystic disease

3. diabetes mellitus Terbutaline is a bronchodilator and is contraindicated in clients with hypersensitivity to sympathomimetics. It should be used with caution in clients with impaired cardiac function, diabetes mellitus, hypertension, hyperthyroidism, or a history of seizures. The medication may increase blood glucose levels.

The nurse provides instructions to a client who is taking levothyroxine. The nurse should tell the client to take the medication in which way? 1.With food 2.At lunchtime 3.On an empty stomach 4.At bedtime with a snack

3. on an empty stomach Oral doses of levothyroxine should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast.

The nurse is caring for a client who is receiving asparaginase. The nurse should monitor the client for improvement of which condition? 1.Lung cancer 2.Breast cancer 3.Metastatic prostate cancer 4.Acute lymphocytic leukemia

4. acute lymphocytic leukemia Asparaginase is indicated for the treatment of acute lymphocytic leukemia. Lung cancer, breast cancer, and metastatic prostate cancer are treated with other antineoplastic agents.

The nurse should monitor the client receiving the first dose of albuterol for which side or adverse effect of this medication? 1.Drowsiness 2.Tachycardia 3.Hyperkalemia 4.Hyperglycemia

2. tachycardia Albuterol is a bronchodilator. Side and adverse effects include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache. The nurse monitors for these effects during therapy. The items in the other options are not side and adverse effects of this medication.

A burn-injured client is receiving treatments of topical mafenide acetate to the site of injury. The nurse should monitor the client for which systemic effect that can occur from the use of this medication? 1.Acidosis 2.Alkalosis 3.Hypotension 4.Hypertension

1. acidosis Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal excretion of acid, thereby causing acidosis. Clients receiving this treatment should be monitored for acidosis, and if the acidosis becomes severe, the medication should be discontinued for 1 to 2 days. An elevated blood pressure may be expected in the client with pain. Alkalosis and hypotension are not associated with the use of this medication.

The client has a prescription to receive pirbuterol 2 puffs and beclomethasone dipropionate 2 puffs by metered-dose inhaler. The nurse plans to give these medications in which way to ensure effectiveness? 1.Administering the pirbuterol before the beclomethasone 2.Alternating a single puff of each hourly, beginning with the beclomethasone 3.Alternating a single puff of beclomethasone with pirbuterol, repeating the steps 4.Administering the pirbuterol, waiting 30 minutes, and administering the beclomethasone

1. administering the pirbuterol before the beclomethasone Pirbuterol is a bronchodilator. Beclomethasone is a glucocorticoid. Bronchodilators are administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

The nurse is applying a topical corticosteroid to a client with eczema. The nurse should apply the medication to which body area? Select all that apply. 1.Back 2.Axilla 3.Eyelids 4.Soles of the feet 5.Palms of the hands

1. back 4. soles of the feet 5. palms of the hands Topical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions where permeability is poor (back, palms, soles). The nurse should avoid areas of higher absorption to prevent systemic absorption.

A client having a myocardial infarction is receiving alteplase therapy. Which action should be carried out by the nurse to monitor for the most frequent side/adverse effect? 1.Check for signs of bleeding. 2.Assess for allergic reaction. 3.Evaluate the client for muscle weakness. 4.Monitor for signs and symptoms of infection.

1. check for signs of bleeding Alteplase is a thrombolytic medication, which means that it breaks down or dissolves clots; therefore, bleeding is a concern. Allergic reaction is not a frequent response. Muscle weakness is not a side/adverse effect of this medication. Local or systemic infection could occur with poor aseptic technique during medication administration, but it is rare and not specifically associated with this medication.

The primary health care provider (PHCP) has prescribed codeine sulfate for a client with a nonproductive cough to suppress the cough reflex. The nurse should teach the client to monitor for which side effect of the medication? 1.Constipation 2.Painful coughing 3.Increased urination 4.Difficulty swallowing

1. constipation Codeine sulfate is an opioid analgesic, and a frequent side effect is constipation. Additional side effects include drowsiness, nausea, and vomiting. Urinary retention is also a concern, and urine output should be monitored. Painful coughing and difficulty swallowing are unrelated to the administration of this medication.

The nurse has just given a client a dose of an "as needed" (PRN) medication called loperamide. The nurse documents in the client's record that the client received this medication for complaints of what symptom? 1.Diarrhea 2.Tarry stools 3.Constipation 4.Abdominal pain

1. diarrhea Loperamide is an antidiarrheal agent commonly administered after the client experiences loose stools. It is used to treat both acute diarrhea and chronic diarrhea from disorders such as inflammatory bowel disease. It also can be used to reduce the volume of drainage from an ileostomy.

A client with a history of duodenal ulcer is taking calcium carbonate chewable tablets. Which finding indicates that the client is experiencing optimal effects of the medication? 1.Heartburn is relieved. 2.Muscle twitching stops. 3.The serum calcium level increases. 4.The serum phosphorus level decreases.

1. heartburn is relieved Calcium carbonate can be used as an antacid for the relief of heartburn and indigestion. Calcium carbonate also can be used as a calcium supplement (serum calcium level increases) or to bind phosphorus in the gastrointestinal tract with chronic kidney disease (serum phosphorus level decreases). Although adequate calcium levels are needed for proper neurological function, a reduction in muscle twitching is not an expected outcome when taking the medication for duodenal ulcer.

Rifabutin is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. For which side and adverse effects of the medication should the nurse monitor? Select all that apply. 1.Signs of hepatitis 2.Flu-like syndrome 3.Low neutrophil count 4.Vitamin B6 deficiency 5.Ocular pain or blurred vision 6.Tingling and numbness of the fingers

1. signs of hepatitis 2. flu-like syndrome 3. low neutrophil count 5. ocular pain or blurred vision Rifabutin may be prescribed for a client with active MAC disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis. Side and adverse effects include rash, gastrointestinal disturbances, neutropenia (low neutrophil count), red-orange-colored body secretions, uveitis (blurred vision and eye pain), myositis, arthralgia, hepatitis, chest pain with dyspnea, and flu-like syndrome. Vitamin B6 deficiency and numbness and tingling in the extremities are associated with the use of isoniazid.

The nurse has completed client teaching on use of thrombolytic medications in acute ischemic stroke. The nurse determines that the educational session was effective if the client states that thrombolytics are used for what purpose? 1.To dissolve clots 2.To prevent ischemia 3.To prevent bleeding 4.To decrease anxiety

1. to dissolve clots Thrombolytic medications are used to treat acute thrombolytic disorders. These medications dissolve clots. Because these medications alter the hemostatic capability of the client, any bleeding that does occur can be difficult to control. Options 2, 3, and 4 are not actions of this medication.

The nurse evaluates that the family of a client newly diagnosed with diabetes mellitus correctly understands the reason for having glucagon on hand for emergency home use if the family indicates that the purpose of the medication is to treat which complication? 1.Diabetic ketoacidosis 2.Hypoglycemia from insulin overdose 3.Hyperglycemia from overeating at meals 4.Hyperglycemia occurring on "sick days"

2. hypoglycemia from insulin overdose Glucagon is used to treat hypoglycemia resulting from insulin overdose. The family of the client is instructed in how to administer the medication. In an unconscious client, consciousness usually returns within 20 minutes of glucagon injection. After the client has regained consciousness, oral carbohydrates should be given. The other options are incorrect.

The nurse administers ondansetron to a client. Which statement by the client indicates that this medication has been effective? 1."My headache is gone." 2."I no longer feel nauseous." 3."The dizziness has stopped." 4."The pain at my incision has decreased."

2. i no longer feel nauseous Ondansetron is an antiemetic used in the treatment of nausea and vomiting. All of the other options are incorrect. Headache and dizziness are side effects of ondansetron. It is not used to treat pain.

A client with acute myelocytic leukemia is being treated with busulfan. Which laboratory value would the nurse specifically monitor during treatment with this medication? 1.Clotting time 2.Uric acid level 3.Potassium level 4.Blood glucose level

2. uric acid level Busulfan can cause an increase in the uric acid level. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute kidney injury. Options 1, 3, and 4 are not specifically related to this medication.

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving theophylline. The nurse monitors the serum theophylline level and concludes that the medication dosage may need to be increased if which value is noted? 1.5 mg/mL (20 mcmol/L) 2.10 mg/mL (40 mcmol/L) 3.15 mg/mL (60 mcmol/L) 4.20 mg/mL (79 mcmol/L)

1. 5 mg/mL Theophylline is a bronchodilator. The nurse monitors the theophylline blood serum level daily when a client is on this medication to ensure that a therapeutic range is present and monitors for the potential for toxicity. The therapeutic serum level range is 10 to 20 mg/mL (40 to 79 mcmol/L). If the laboratory result indicated a level of 5 mg/mL (20 mcmol/L), the dosage of the medication would need to be increased.

Lindane is prescribed. The nurse reviews the client's record, knowing that this medication therapy would be contraindicated in which client? 1.A child 2.A young adult 3.An older client 4.A middle-age client

1. a child Lindane can penetrate the intact skin and cause seizures if absorbed in sufficient quantities. Clients at highest risk for convulsions are premature infants, children, and clients with preexisting seizure disorders. Lindane should not be used in pediatric clients unless safer medications have failed to control the infection.

A hospitalized client with diabetes mellitus receives NPH insulin in the morning. The nurse monitors the client for hypoglycemia, knowing that the peak action is expected to occur how soon after the medication administration? 1.2 to 4 hours after administration 2.4 to 12 hours after administration 3.12 to 16 hours after administration 4.18 to 24 hours after administration

2. 4-12 hours after administration NPH insulin is an intermediate-acting insulin. Its onset of action is 3 to 4 hours, it peaks in 4 to 12 hours, and its duration of action is 16 to 20 hours.

A client has been given lansoprazole for the chronic management of Zollinger-Ellison syndrome. The nurse instructs the client to take which product for pain while taking this medication? 1.Ibuprofen 2.Acetaminophen 3.Naproxen sodium 4.Acetylsalicylic acid

2. acetaminophen Lansoprazole is a proton pump inhibitor. Zollinger-Ellison syndrome is a hypersecretory condition of the stomach, associated with increased risk of problems from irritation of the stomach lining. The client should take acetaminophen for pain relief. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen sodium, should be avoided, as should aspirin, because they are potential stomach irritants.

A client with a subarachnoid hemorrhage needs to have surgery delayed until a stable clinical condition is achieved. The nurse prepares to administer which medication as prescribed to prevent clot breakdown and dissolution? 1.Alteplase 2.Heparin sodium 3.Warfarin sodium 4.Aminocaproic acid

4. aminocaproic acid Aminocaproic acid is an antifibrinolytic agent that prevents clot breakdown or dissolution. It is commonly prescribed after subarachnoid hemorrhage if surgery is delayed or contraindicated, to prevent further hemorrhage. Alteplase is a fibrinolytic that actively breaks down clots. Warfarin sodium and heparin sodium are anticoagulants that interfere with propagation or growth of a clot.

A client has an as-needed prescription for ondansetron. For which condition(s) should the nurse administer this medication? 1.Paralytic ileus 2.Incisional pain 3.Urinary retention 4.Nausea and vomiting

4. nausea and vomiting Ondansetron is an antiemetic used to treat postoperative nausea and vomiting, as well as nausea and vomiting associated with chemotherapy. The other options are incorrect reasons for administering this medication.

A client has an "as needed" (PRN) prescription for trimethobenzamide. The nurse should assess the client for which sign or symptom to determine whether the client needs a dose of this medication? 1.Heartburn 2.Constipation 3.Abdominal pain 4.Nausea and vomiting

4. nausea and vomiting Trimethobenzamide is an antiemetic agent used for relief of nausea and vomiting. The medication is not used to treat heartburn, constipation, or abdominal pain.

A client has begun using a methylxanthine bronchodilator. What beverage should the nurse plan to teach the client to avoid while taking this medication? 1.Coffee 2.Orange juice 3.Mineral water 4.Cranberry juice

1. coffee Cola, coffee, and chocolate contain methylxanthine and should be avoided by the client taking a methylxanthine bronchodilator. The additional methylxanthine could lead to increased incidence of cardiovascular and central nervous system side effects. Orange juice, mineral water, and cranberry juice are fluids that are allowed.

A client diagnosed with peptic ulcer disease is prescribed an over-the-counter antacid suspension containing aluminum hydroxide, magnesium hydroxide, and simethicone. What should the nurse include in the client instructions for time of administration of this medication? 1.Just before each meal 2.An hour before breakfast 3.1 and 3 hours after meals 4.Immediately after each meal

3. 1 and 3 hours after meals Antacids are alkaline compounds that neutralize stomach acid. The objective of peptic ulcer therapy is to promote healing in addition to relieving pain. Consequently, antacids should be taken on a regular schedule, not just in response to discomfort. In the usual dosing schedule, antacids are administered 7 times a day: 1 and 3 hours after each meal and at bedtime. Thus, option 4 is the correct option. Options 1, 2, and 4 are incorrect because they are either not the correct timing or not often enough as recommended.

The nurse is preparing to administer furosemide 40 mg by intravenous (IV) injection (IV push) to a client. The nurse should administer the medication over which time period? 1.10 seconds 2.30 seconds 3.2 minutes 4.5 minutes

3. 2 minutes When furosemide is administered by IV injection, each 40 mg or fraction thereof should be given over a 1- to 2-minute period. Options of 10 seconds and 30 seconds identify administration times that are too rapid and could cause adverse effects. Five minutes is too slow of a time period for administration and may affect the effectiveness of the IV medication.

A client is seen in the clinic for a complaint of scalp itching that has been persistent over the past several weeks. After an assessment, it is determined that the client has head lice. Permethrin shampoo is prescribed, and the nurse provides instructions to the client regarding the use of the medication. The nurse should tell the client to take which measure? 1.Put the medication in 1 time only. 2.Leave the medication in for at least 4 hours. 3.Wash, rinse, and towel-dry the hair before applying. 4.Leave the shampoo on for 8 to 12 hours and then remove by washing.

3. wash, rinse, and towel-dry the hair before applying Permethrin is toxic to adult mites and lice but less toxic to the ova. For this reason, retreatment may be required. It is required to wash, rinse, and towel-dry the hair before applying the medication. It is left in for 10 minutes and removed by a warm water rinse. Therefore, options 1, 2, and 4 are incorrect.

A client who is receiving digoxin daily has a serum potassium level of 3 mEq/L (3 mmol/L) and reports anorexia. The health care provider prescribes a serum digoxin level to be done. The nurse checks the results and should recognize which level that is outside of the therapeutic range? 1.0.5 ng/mL (0.63 nmol/L) 2.0.8 ng/mL (1.02 nmol/L) 3.0.9 ng/mL (1.14 nmol/L) 4.2.2 ng/mL (2.8 nmol/L)

4. 2.2 ng/mL The optimal therapeutic range for digoxin is 0.5 to 2.0 ng/mL (0.63 to 2.56 nmol/L). If the client is experiencing symptoms such as anorexia and is experiencing hypokalemia as evidenced by a low potassium level, digoxin toxicity is a concern. Therefore, option 4 is correct because it is outside of the therapeutic level and elevated.

A client with testicular cancer is receiving cisplatin. The nurse assesses for which finding as a toxic effect of this medication? 1.Tinnitus 2.Diarrhea 3.Nausea and vomiting 4.Elevated white blood cell (WBC) count

1. tinnitus Cisplatin is a medication that kills cells primarily by forming cross-links between and within strands of deoxyribonucleic acid (DNA). Its principal use is in the treatment of testicular cancer, although it also can be used to treat carcinomas of the ovary, bladder, head, and neck. It can cause neurotoxicity, nephrotoxicity, bone marrow depression, and ototoxicity, which manifests as tinnitus and high-frequency hearing loss. Nausea and vomiting are expected side effects, which can be severe and begin 1 hour after administration, persisting for 1 to 2 days. Diarrhea is not an associated side effect or toxic effect.

A client with suspected opioid overdose has received a dose of naloxone hydrochloride. The client subsequently becomes restless, starts to vomit, and complains of abdominal cramping. The blood pressure increases from 110/72 mm Hg to 160/86 mm Hg. The nurse provides emotional support and reassurance while administering care to the client, knowing which piece of information? 1.The client may next become suicidal. 2.These are signs of opioid withdrawal. 3.These effects will last only a few moments. 4.The client may otherwise sign out against medical advice.

2. these are signs of opioid withdrawal Signs of opioid withdrawal include increased temperature and blood pressure, abdominal cramping, vomiting, and restlessness. Time of onset may be anywhere from a few minutes to a few hours after administration of naloxone hydrochloride, depending on the opioid involved, the degree of dependence, and the dose of naloxone. The remaining options are incorrect interpretations.

Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed? 1.Potassium level 2.Triglyceride level 3.Hemoglobin A1C 4.Total cholesterol level

2. triglyceride level Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before treatment and periodically thereafter until the effect on the triglycerides has been evaluated. There is no indication that isotretinoin affects potassium, hemoglobin A1C, or total cholesterol levels.

The nurse has completed medication administration that included a nitroglycerin. Within minutes, the client is complaining of a headache. Which is the priority nursing action at this time? 1.Evaluate pupil response. 2.Place the client on the left side. 3.Administer the prescribed analgesic. 4.Notify the primary health care provider (PHCP) immediately.

3. administer the prescribed analgesic Nitroglycerin causes vasodilation. The major side effect of nitroglycerin is a headache that can be alleviated by an analgesic. It is an expected response to the medication, and the PHCP does not need to be notified. Placing the client on the left side will not alleviate the headache. There is no indication for the need to evaluate pupil response.

The primary health care provider has prescribed coal tar treatments for a client with psoriasis, and the nurse provides information to the client about the treatments. Which statement made by the client indicates a need for further education about the treatments? 1."The medication has an unpleasant odor." 2."The medication can cause phototoxicity." 3."The medication can stain the skin and hair." 4."The medication always causes systemic toxicity."

4. the medication always causes systemic toxicity Coal tar is used to treat psoriasis and other chronic disorders of the skin. Coal tar suppresses DNA synthesis, mitotic activity, and cell proliferation. Coal tar has an unpleasant odor, frequently stains the skin and hair, and can cause phototoxicity. Systemic toxicity does not occur.

The nurse administers 20 units of insulin isophane recombinant to a hospitalized client with diabetes mellitus at 7:00 a.m. The nurse should monitor the client most closely for a hypoglycemic reaction at which time? 1.4:00 p.m. 2.9:00 a.m. 3.10:00 a.m. 4.12:00 midnight

1. 4:00pm Insulin isophane recombinant is an intermediate-acting insulin with an onset of action in 3 to 4 hours, a peak action in 6 to 12 hours, and a duration of action of 18 to 28 hours. A hypoglycemic reaction is most likely to occur at peak time. The correct option is the only one that represents a time within the peak hours after administration of the insulin.

The nurse has the following prescription for a postcraniotomy client: "dexamethasone 4 mg by the intravenous (IV) route now." How does the nurse administer the medication? 1.IV push over 1 minute 2.IV push over 4 minutes 3.IV piggyback in 100 mL of normal saline over 10 minutes 4.IV piggyback in 100 mL of normal saline over 30 minutes

1. IV push over 1 minute Dexamethasone is an adrenocorticosteroid administered after craniotomy to control cerebral edema. It is given by IV push, and single doses are administered over 1 minute. Dexamethasone IV doses are changed to the oral route after 24 to 72 hours and are tapered until discontinued. In addition, IV fluids are administered cautiously after craniotomy to prevent increased cerebral edema.

A client admitted to the hospital is taking capecitabine for breast cancer. The nurse should monitor the client for which symptom that is a side or adverse effect of the medication? 1.Dyspnea 2.Dizziness 3.Headache 4.Constipation

1. dyspnea Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. Adverse effects include bone marrow depression, cardiovascular toxicity, and respiratory toxicity. Headache, constipation, and dizziness are not adverse effects of this medication.

A client with peptic ulcer disease asks the nurse what medications they might be prescribed for this problem. The nurse tells the client that which medications will be prescribed? Select all that apply. 1.Antacids 2.Antibiotics 3.Proton pump inhibitors 4.Cytoprotective therapy 5.Histamine H2-receptor blockers 6.Nonsteroidal anti-inflammatory drugs (NSAIDs)

1. antacids 2. antibiotics 3. proton pump inhibitors 4. cytoprotective therapy 5. histamine H2-receptor blockers Medications to treat peptic ulcer disease include antacids, antibiotics, proton pump inhibitors, cytoprotective therapy, and histamine H2-receptor blockers. NSAIDs are contraindicated in peptic ulcer disease because of the risk of bleeding.

Propylthiouracil is prescribed for a client with hyperthyroidism. The nurse provides instructions to the client regarding the medication and informs the client to notify the primary health care provider (PHCP) if which sign or symptom occurs? 1.Fever 2.Dry mouth 3.Drowsiness 4.Increased urination

1. fever An adverse effect of propylthiouracil is agranulocytosis. The client needs to be informed of the early signs of this side and adverse effect, which include fever and sore throat. Drowsiness is an occasional side effect of the medication. Dry mouth and increased urination are unrelated to this medication.

The nurse is teaching a client with hyperthyroidism about the prescribed medication, propylthiouracil. The nurse determines that teaching has been successful if the client states to report which symptom to the primary health care provider (PHCP)? 1.Fever 2.Fatigue 3.Excitability 4.Nervousness

1. fever An adverse effect of propylthiouracil is agranulocytosis. The client should be alert for this adverse effect by noting the presence of fever or sore throat, which should be reported to the PHCP immediately. Excitability is not a side or adverse effect of this medication. Fatigue may be an occasional side effect of the medication but does not warrant PHCP notification.

The nurse is teaching the client about his prescribed prednisone. Which statement, if made by the client, indicates that further teaching is necessary? 1."I can take aspirin or my antihistamine if I need it." 2."I need to take the medication every day at the same time." 3."I need to avoid coffee, tea, cola, and chocolate in my diet." 4."If I gain more than 5 lb (2.25 kg) a week, I will call my primary health care provider (PHCP)."

1. i can take aspirin or my antihistamine if i need it Aspirin and other over-the-counter medications should not be taken unless the client consults with the PHCP. The client needs to take the medication at the same time every day and should be instructed not to stop the medication. A slight weight gain as a result of an improved appetite is expected; however, after the dosage is stabilized, a weight gain of 5 lb (2.25 kg) or more weekly should be reported to the PHCP. Caffeine-containing foods and fluids need to be avoided because they may contribute to steroid-ulcer development.

A client with a history of type 2 diabetes is admitted to the hospital with chest pain. The client is scheduled for a cardiac catheterization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure? 1.Glipizide 2.Metformin 3.Repaglinide 4.Regular insulin

2. metformin Metformin needs to be withheld 24 hours before and for 48 hours after cardiac catheterization because of the injection of contrast medium during the procedure. If the contrast medium affects kidney function, with metformin in the system the client would be at increased risk for lactic acidosis. The medications in the remaining options do not need to be withheld before and after cardiac catheterization.

The nurse is caring for a client who is receiving heparin sodium intravenously as a continuous infusion. Which laboratory finding requires immediate nursing intervention? 1.Platelet count of 100,000 mm3 (100 × 109/L) 2.Red blood cell count of 4.2 cells (4.2 × 1012/L) 3.International normalized ratio (INR) of 1.2 (1.2) 4.Activated partial thromboplastin time (aPTT) of 60 seconds (60 seconds)

1. platelet count of 100,000 mm3 The platelet count indicates that the client receiving heparin sodium is at risk for heparin-induced thrombocytopenia (HIT). HIT should be suspected whenever platelet counts fall below normal. If severe thrombocytopenia develops (platelet count less than 100,000 mm3 [100 × 109/L]), heparin sodium should be discontinued. The aPTT in option 4 represents an expected finding for intravenous heparin sodium therapy. Option 3 is not a value measured for heparin sodium therapy but is used to measure a response to warfarin sodium therapy, and the red blood cell count in option 2 is normal.

A client with previously well-controlled diabetes mellitus has had fasting blood glucose levels ranging from 180 to 200 mg/dL. The client takes glyburide 5 mg orally daily. In reviewing the client's medication list, the home health care nurse suspects that which newly added medications could be contributing to the elevated blood glucose levels? 1.Prednisone 2.Ranitidine 3.Cimetidine 4.Ciprofloxacin

1. prednisone Corticosteroids, thiazide diuretics, and lithium may decrease the effect of glyburide, thus causing hyperglycemia. The medications listed in the incorrect options increase the effect of glyburide, leading to hypoglycemia.

Atenolol has been prescribed for a client, and the client asks the nurse about the action of the medication. How should the nurse respond regarding the action of this medication? 1.Slows the heart rate 2.Increases cardiac output 3.Increases myocardial oxygen demand 4.Maintains the blood pressure at a level within the 140/90 mm Hg range

1. slows the heart rate Atenolol is a beta-adrenergic blocker that is used as an antihypertensive, antianginal, and antidysrhythmic. It blocks beta-adrenergic receptors in cardiac tissue and produces the therapeutic effects of slowing the heart rate, decreasing cardiac output, decreasing myocardial oxygen demand, and decreasing blood pressure.

A man has developed atrial fibrillation and has been placed on warfarin. The nurse is doing discharge dietary teaching with the client and determines that the client needs additional education if he states that he would choose which food while taking this medication? 1.Cherries 2.Potatoes 3.Broccoli 4.Spaghetti

3. broccoli Anticoagulant medications work by antagonizing the action of vitamin K, which is needed for clotting. When a client is taking an anticoagulant, foods high in vitamin K are often omitted from the diet. Vitamin K is found in large amounts in green leafy vegetables, such as broccoli, cabbage, turnip greens, and lettuce. The other options listed are foods that are lower in vitamin K.

A client has begun a course of therapy with rifampin. The home care nurse instructs the client on which measure due to an anticipated side effect? 1.Wear dark clothing to avoid staining. 2.Always take the medication with food or antacids. 3.Double the next medication dose if one is forgotten. 4.Stop the medication if symptoms disappear in 2 months.

1. wear dark clothing to avoid staining Rifampin causes orange-red discoloration of body secretions and will permanently stain light clothing as well as soft contact lenses. The medication should be taken on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin should be taken exactly as directed, and doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a primary health care provider.

The primary health care provider (PHCP) prescribes exenatide for a client with type 1 diabetes mellitus who takes insulin. The nurse should plan to take which most appropriate intervention? 1.Withhold the medication and call the PHCP, questioning the prescription for the client. 2.Teach the client about the signs and symptoms of hypoglycemia and hyperglycemia. 3.Monitor the client for gastrointestinal side effects after administering the medication. 4.Withdraw the insulin from the prefilled pen into an insulin syringe to prepare for administration.

1. withhold the medication and call the PHCP, questioning the prescription for the client Exenatide is an incretin mimetic used for type 2 diabetes mellitus only. It is not recommended for clients taking insulin. Hence the nurse should withhold the medication and question the PHCP regarding this prescription. Although options 2 and 3 are correct statements about the medication, in this situation the medication should not be administered. The medication is packaged in prefilled pens ready for injection without the need for drawing it up into another syringe.

Gemfibrozil is prescribed for a client. Which laboratory finding should alert the nurse to the need to withhold the medication and contact the primary health care provider? 1.Elevated glucose 2.Elevated triglycerides 3.Elevated liver function tests 4.Elevated blood urea nitrogen (BUN)

3. elevated liver function tests Gemfibrozil is used to treat hypercholesterolemia. One adverse effect is hepatotoxicity. The medication does not affect glucose. An elevated triglyceride level is not an indication to hold the medication. An elevated BUN is unrelated to this medication and would not be an indication that the medication should be held.

The nurse is teaching a client about the effects of diphenhydramine, an ingredient in the cough suppressant prescribed for the client. The nurse should plan to tell the client to take which measure while taking this medication? 1.Take it on an empty stomach. 2.Avoid activities requiring mental alertness. 3.Use alcohol for additional effect in reducing cough. 4.Avoid chewing sugarless gum or using oral rinses mouth.

2. avoid activities requiring mental alertness Diphenhydramine has several uses, including antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. Because the medication causes drowsiness, the client should avoid use of alcohol or central nervous system depressants, operating a car, or engaging in other activities that require mental acuity. It should be taken with food or milk to decrease gastrointestinal upset, and oral rinses, sugarless gum, or hard candy may be used to minimize dry mouth.

A client taking rifampin reports, "My urine has blood in it." When the nurse assesses the urine, it is brown. Which is the nurse's best action? 1.Notify the primary health care provider (PHCP). 2.Chart the finding as a normal response to the rifampin. 3.Immediately start prescribed intravenous (IV) fluids to prevent shock. 4.Get the client into bed, and put the bed in modified Trendelenburg's position.

2. chart the finding as a normal response to the rifampin Brown-tinged urine is a normal finding associated with rifampin; thus, there is no need to notify the PHCP. There is no indication that the client is in shock, so eliminate the options that indicate to start prescribed IV fluids and to place the client in modified Trendelenburg's position. The nurse should also inform the client that his is a harmless side effect.

The nurse is administering a dose of morphine sulfate to a client via an epidural catheter after nephrectomy. Before administering the medication, what should the nurse plan to do? 1.Place the head of the bed flat. 2.Ensure that naloxone is readily available. 3.Flush the catheter with 6 mL of sterile water. 4.Aspirate with a syringe to ensure a cerebrospinal fluid (CSF) return.

2. ensure that naloxone is readily available Epidural analgesia is used for clients with expected high levels of postoperative pain. The nurse carefully checks the medication, notes the client's level of sedation, and makes sure that the head of the bed is elevated 30 degrees unless contraindicated. The nurse aspirates with a syringe to make sure that no CSF return occurs. If CSF returns with aspiration, the catheter has migrated from the epidural space into the subarachnoid space. The catheter is not flushed with 6 mL of sterile water. Naloxone should be readily available for use if respiratory depression should occur.

The nurse notes in the medication record that a client is taking calcium carbonate chewable tablets. Based on the data, the nurse should ask the client about a history of which symptom? 1.Flatus 2.Heartburn 3.Rectal pain 4.Muscle twitching

2. heartburn Calcium carbonate can be used as an antacid for the relief of heartburn and indigestion. It also can be used as a calcium supplement or to bind phosphorus in the gastrointestinal tract in clients with chronic kidney disease. The other options are incorrect and are not indications for the use of calcium carbonate.

The nurse has given a client information about the use of nitroglycerin sublingual tablets. The client has a prescription for PRN (as needed) use if chest pain occurs. Which client statement indicates an understanding of this medication? 1."It's best to keep this medication in a shirt pocket close to the body." 2."I need to discard unused tablets 6 months after the bottle is opened." 3."I will avoid using the medication until the chest pain actually begins and gets worse." 4."I can take aspirin for any headache that occurs when I first start taking the nitroglycerin."

2. i need to discard unused tablets 6 months after the bottle is opened Nitroglycerin may be self-administered sublingually 5 to 10 minutes before an activity that could trigger chest pain. Tablets should be discarded 6 months after opening the bottle (expiration date on the bottle should always be checked), and a new bottle of pills should be obtained from the pharmacy. Note, however, that some resources will advise that tablets should be replaced every 3 to 5 months. If the tablet produces a tingling sensation under the tongue, then it is potent. Nitroglycerin is very unstable and is affected by heat and cold, so it should not be kept close to the body (warmth) in a shirt pocket; rather, it should be kept in a jacket pocket or purse. Headache often occurs with early use and diminishes in time. Acetaminophen, rather than acetylsalicylic acid (aspirin), may be used to treat headache.

The nurse teaches the client who is newly diagnosed with diabetes insipidus about the prescribed intranasal desmopressin. Which statements by the client indicate understanding? Select all that apply. 1."This medication will turn my urine orange." 2."I should decrease my oral fluids when I start this medication." 3."The amount of urine I make should increase if this medicine is working." 4."I need to follow a low-fat diet to avoid pancreatitis when taking this medicine." 5."I should report headache and drowsiness to my doctor since these symptoms could be related to my desmopressin."

2. i should decrease my oral fluids when i start this medication 5. i should report headache and drowsiness to my doctor since these symptoms could be related to my desmopressin In diabetes insipidus, there is a deficiency in antidiuretic hormone (ADH), resulting in large urinary losses. Desmopressin is an antidiuretic hormone that enhances reabsorption of water in the kidney. Clients with diabetes insipidus drink high volumes of fluid (polydipsia) as a compensatory mechanism to counteract urinary losses and maintain fluid balance. Once desmopressin is started, oral fluids should be decreased to prevent water intoxication. Therefore, clients with diabetes insipidus should decrease their oral fluid intake when they start desmopressin. Headache and drowsiness are signs of water intoxication in the client taking desmopressin and should be reported to the primary health care provider. Desmopressin does not turn urine orange. The amount of urine should decrease, not increase, when desmopressin is started. Desmopressin does not cause pancreatitis.

A client is seen in the clinic for complaints of thirst, frequent urination, and headaches. After diagnostic studies, diabetes insipidus is diagnosed. Desmopressin is prescribed. The client asks why this medication was prescribed. Which is a correct statement by the nurse? 1."It relieves the headaches." 2."It increases water reabsorption." 3."It stimulates the production of aldosterone." 4."It decreases the production of the antidiuretic hormone."

2. it increases water reabsorption Desmopressin is an antidiuretic hormone (ADH) used in the treatment of diabetes insipidus. It promotes renal conservation of water by acting on the collecting ducts of the kidney to increase the permeability to water, which results in increased water reabsorption. Desmopressin does not relieve headaches, stimulate aldosterone, or decrease production of ADH.

Minoxidil is prescribed for a client to treat hair loss. The client asks the nurse if the hair will continue to grow when the medication is stopped. What is the appropriate nursing response? 1."The hair will continue to grow." 2."Newly gained hair is lost in 3 to 4 months." 3."It depends on how long you have been taking the medication." 4."I'm not sure-you need to ask your primary health care provider."

2. newly gained hair is lost in 3-4 months Hair regrowth with the use of minoxidil is most likely to occur when baldness has developed recently and has been limited to a small area. Benefits of the medication take several months. On discontinuation of the medication, newly gained hair is lost in 3 to 4 months, and the natural progression of hair loss resumes. Options 1 and 3 are incorrect. Option 3 places the client's question on hold and is inappropriate.

The nurse is monitoring a client who is taking propranolol. Which assessment finding indicates a potential adverse complication associated with this medication? 1.The development of complaints of insomnia 2.The development of audible expiratory wheezes 3.A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after 2 doses of the medication 4.A baseline resting heart rate of 88 beats/minute followed by a resting heart rate of 72 beats/minute after 2 doses of the medication

2. the development of audible expiratory wheezes Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. Beta blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored.

Which is the nurse's priority assessment for monitoring for adverse effects for the client taking isoniazid? 1.Skin color 2.Urine color 3.Hydration status 4.Respiratory effort

2. urine color Isoniazid is an antituberculosis medication. The most serious adverse effect associated with isoniazid is hepatic injury, which on rare occasions has been fatal; therefore, monitoring of liver function tests and for signs and symptoms of liver injury is the priority. Dark urine is a sign of liver injury and the client should be taught to report this, and the nurse should assess for this. Skin color, hydration status, and respiratory effort are not directly related to adverse effects of this medication.

The nurse administered intravenous bumetanide to a client being treated for heart failure. Which outcome indicates that the medication has achieved the expected effect? 1.Cough becomes productive of frothy pink sputum. 2.Urine output increases from 10 mL hourly. 3.The serum potassium level changes from 3.8 to 3.1 mEq/L (3.8 to 3.1 mmol/L). 4.B-type natriuretic peptide (BNP) factor increases from 200 to 262 ng/mL (200 to 262 mcg/L).

2. urine output increases from 10 mL hourly Bumetanide is a diuretic and expected outcomes include increased urine output, decreased crackles, and decreased weight. Potassium loss is a side effect rather than an expected effect of the diuretic. Frothy pink sputum indicates progression to pulmonary edema. A BNP greater than 100 pg/mL (100 ng/L) is indicative of heart failure; thus, a rise from a previous level indicates worsening of the condition.

A client is taking a prescribed course of therapy with ethambutol. The home health nurse assesses the client at each home visit for which adverse effect of this medication? 1.Orange urine 2.Visual disturbances 3.Hearing disturbances 4.Gastrointestinal (GI) upset

2. visual disturbances Ethambutol causes optic neuritis, which decreases visual acuity and impairs the ability to discriminate between red and green. This form of color blindness poses a potential safety hazard in driving a motor vehicle. The client is taught to report this symptom immediately. The client also is taught to take the medication with food if GI upset occurs. Impaired hearing results from antituberculosis therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin.

A client who has been receiving theophylline by the intravenous (IV) route has the medication prescription changed to an immediate-release oral form of the medication. After discontinuing the IV medication, when should the nurse schedule the first dose of the oral medication? 1.Just after the next meal 2.Just before the next meal 3.4 hours after discontinuing the IV form 4.Immediately on discontinuing the IV form

3. 4 hours after discontinuing the IV form With immediate-release preparations, oral theophylline should be administered 4 to 6 hours after discontinuing the IV form of the medication. If the sustained-release form is used, the first oral dose should be administered immediately on discontinuation of the IV infusion. Therefore, the remaining options are incorrect.

Levothyroxine is prescribed for a client diagnosed with hypothyroidism. Upon review of the client's record, the nurse notes that the client is taking warfarin. Which modification to the plan of care should the nurse review with the client's primary health care provider? 1.A decreased dosage of levothyroxine 2.An increased dosage of levothyroxine 3.A decreased dosage of warfarin sodium 4.An increased dosage of warfarin sodium

3. a decreased dosage of warfarin sodium Levothyroxine accelerates the degradation of vitamin K-dependent clotting factors. As a result, the effects of warfarin are enhanced. If thyroid hormone replacement therapy is instituted in a client who has been taking warfarin, the dosage of warfarin should be reduced.

A client has been started on long-term therapy with rifampin. The nurse should provide which information to the client about the medication? 1.Should always be taken with food or antacids 2.Should be double-dosed if 1 dose is forgotten 3.Causes orange discoloration of sweat, tears, urine, and feces 4.May be discontinued independently if symptoms are gone in 3 months

3. causes orange discoloration of sweat, tears, urine, and feces Rifampin causes orange-red discoloration of body secretions and will stain soft contact lenses permanently. Rifampin should be taken exactly as directed. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a primary health care provider. It is best to administer the medication on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication.

An older client recently has been taking cimetidine. The nurse monitors the client for which most frequent central nervous system side effect of this medication? 1.Tremors 2.Dizziness 3.Confusion 4.Hallucinations

3. confusion Cimetidine is a histamine (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations.

The nurse is assigned to care for several male and female clients who take estrogen or progestins. For which complication should the nurse monitor these clients? 1.Sepsis 2.Dehydration 3.Deep vein thrombosis (DVT) 4.Electrocardiographic changes

3. deep vein thrombosis (DVT) Male and female clients who take estrogen or progestins are at increased risk for DVT. Women who receive estrogens or progestins may also experience fluid retention and breast tenderness. The remaining options are not specifically associated with these types of medications.

A postpartum client with deep vein thrombosis is being treated with anticoagulant therapy. The nurse teaches the client that the primary health care provider (PHCP) should be contacted for which noted side and adverse effects? Select all that apply. 1.Vertigo 2.Dysuria 3.Epistaxis 4.Hematuria 5.Ecchymosis

3. epistaxis 4. hematuria 5. ecchymosis The treatment for deep vein thrombosis is anticoagulant therapy. The nurse assesses for bleeding, which is an adverse effect of anticoagulants. This includes hematuria, ecchymosis, and epistaxis. Vertigo and dysuria are not associated specifically with bleeding.

A client diagnosed with hypothyroidism is taking levothyroxine. The client returns to the clinic 1 week after beginning the medication and tells the nurse that the medication has not helped. What is the appropriate nursing response to the client? 1.A higher dosage is required. 2.The medication may need to be changed. 3.Full therapeutic effect may take 1 to 3 weeks. 4.Full therapeutic effect may take up to 4 months.

3. full therapeutic effect may take 1-3 weeks Levothyroxine is used in the treatment of hypothyroidism. Although therapy with levothyroxine may begin with small doses that are gradually increased, the most appropriate response is to inform the client that the full therapeutic effect may take 1 to 3 weeks. Therefore, the remaining options are incorrect.

Atorvastatin has been prescribed for a client, and the client asks the nurse about the side and adverse effects of the medication. What should the nurse tell the client is a frequent side effect of this medication? 1.Tremors 2.Lethargy 3.Headache 4.Tiredness

3. headache Atorvastatin is a reductase inhibitor (HMG-CoA reductase inhibitor) that is used to treat hypercholesterolemia and hypertriglyceridemia. A frequent side effect is headache. Occasional side effects include myalgia, rash or pruritus (signs of an allergic reaction), flatulence, and dyspepsia. The symptoms in the remaining options are not side and adverse effects of this medication.

A postpartum nurse is caring for a client with an epidural catheter in place for opioid analgesic administration following cesarean birth. The client develops respiratory depression and requires naloxone administration. Which finding should the nurse anticipate as a result of the naloxone administration? 1.Bradycardia 2.Decrease in sensation 3.Increase in pain level 4.Sudden onset of itching

3. increase in pain level Opioids are used for epidural analgesia. Naloxone is an opioid antagonist, which reverses the effects of opioids. If it is given, the client may complain of an increase in her pain level. One of the side effects of naloxone is rapid pulse or tachycardia, not bradycardia. Sudden onset of itching would not be a typical reaction. Naloxone would not affect sensation.

Atorvastatin has been prescribed for a client, and the client asks the nurse about the action of the medication. How should the nurse respond? 1."It increases plasma cholesterol." 2."It increases plasma triglycerides." 3."It decreases low-density lipoproteins (LDLs)." 4."It decreases high-density lipoproteins (HDLs)."

3. it decreases low density lipoproteins (LDLs) Atorvastatin is a reductase inhibitor (HMG-CoA reductase inhibitor) that is used to treat hypercholesterolemia and hypertriglyceridemia. It decreases LDL cholesterol and plasma triglycerides and increases HDL cholesterol (the good cholesterol). The remaining options are not actions of this medication.

The nurse provides family teaching to the mother of a 13-year-old client with pituitary dwarfism who is on growth hormone therapy. Which statement by the mother indicates that teaching has been successful? 1."My child's growth will be slow and steady." 2."My child will have growth spurts every 2 years." 3."My child will have an immediate increase in growth." 4."My child will have an increase in height in young adulthood."

3. my child will have an immediate increase in growth Growth hormone may be used in the treatment of dwarfism. When treatment is started, height may be increased by as much as 6 inches. The increase is immediate and continual. To monitor treatment, height and weight should be measured monthly. All other options indicate delayed or sporadic increases in growth, which are incorrect.

A client is taking docusate sodium. Which finding by the nurse indicates that treatment has been effective? 1.Reduction in steatorrhea 2.Hematest-negative stools 3.Regular bowel movements 4.Absence of abdominal pain

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

A client who has been taking iodine solution is admitted to the emergency department, and an iodine overdose is suspected. Gastric lavage is initiated to remove the iodine from the stomach. In addition to treatment with gastric lavage, the nurse anticipates that which medication will be administered? 1.Vitamin K 2.Acetylcysteine 3.Sodium thiosulfate 4.Calcium gluconate

3. sodium thiosulfate Iodine solution can cause iodine toxicity. Iodine is corrosive, and an overdose will injure the gastrointestinal tract. Symptoms include abdominal pain, vomiting, and diarrhea. Swelling of the glottis may result in asphyxiation. Treatment consists of gastric lavage to remove iodine from the stomach and administration of sodium thiosulfate to reduce iodine to iodide. Vitamin K is the antidote for warfarin. Acetylcysteine is the antidote for acetaminophen overdose. Calcium gluconate is used for acute hypocalcemia.

The primary health care provider prescribes cromolyn for the client with asthma. The nurse identifies that the client correctly understands the purpose of this medication when the client states that the medication will produce which effect? 1.Promote bronchodilation 2.Decrease the risk of infection 3.Suppress an allergic response 4.Eliminate the need for a rescue inhaler

3. suppress an allergic response Cromolyn is a first-line therapy for prophylactic treatment of asthma; it is a mast cell stabilizer, antiasthmatic, and antiallergic. The medication acts in part by stabilizing the cytoplasmic membrane of mast cells, thereby preventing release of histamine and other mediators. It is not a bronchodilator. It does not decrease the risk of infection. It does not eliminate the need for the rescue inhaler.

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

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

Potassium iodide is prescribed for a client with thyrotoxic crisis. The client calls a clinic nurse and complains of a brassy taste in the mouth. Which instruction should the nurse provide the client? 1.Continue with the medication. 2.Take half of the prescribed dose for the next 24 hours. 3.Withhold the medication and notify the primary health care provider (PHCP). 4.Withhold the medication for the next 24 hours and then continue as prescribed.

3. withhold the medication and notify the PHCP Chronic ingestion of iodine can produce iodism. The client needs to be instructed about the symptoms of iodism, which include a brassy taste, soreness of gums and teeth, vomiting, and abdominal pain. The client needs to be instructed to notify the PHCP if these symptoms occur.

A client with a history of heart failure who is receiving digoxin daily has a serum potassium level of 3 mEq/L (3 mmol/L) and is complaining of anorexia. The primary health care provider prescribes a serum digoxin level to be done. The nurse checks the results and should expect to note which level that is outside of the therapeutic range? 1.0.3 ng/mL 2.0.5 ng/mL 3.0.8 ng/mL 4.1.0 ng/mL

4. 1.0 ng/mL The optimal therapeutic range for digoxin is 0.5 to 0.8 ng/mL, and the therapeutic serum level is 0.5 to 2 ng/mL. If the client is experiencing symptoms such as anorexia and is experiencing hypokalemia as evidenced by a low potassium level, digoxin toxicity is a concern. Therefore, option 4 is correct because it is outside of the therapeutic level and an elevated level.

Isoniazid is prescribed for a child with human immunodeficiency virus (HIV) infection who has a positive tuberculin skin test result. The mother of the child asks the nurse how long the child will need to take the medication. For how long should the nurse tell the mother the medication will need to be taken? 1.4 months 2.6 months 3.9 months 4.12 months

4. 12 months For children with HIV infection who demonstrate a positive tuberculin skin test result, a minimum of 12 months of treatment with isoniazid is recommended.

The nurse is reviewing the laboratory results for a client who arrives at the health care clinic for follow-up assessment after being diagnosed with atrial fibrillation. The international normalized ratio (INR) is analyzed because the client has been taking warfarin sodium since discharge from the hospital. The nurse determines that the INR range is at an appropriate level if what value is noted on the laboratory report? 1.0.6 2.0.75 3.1.0 4.2.3

4. 2.3 The recommended INR range for warfarin sodium therapy for atrial fibrillation is 2.0 to 3.0 (2.0 to 3.0). Subtherapeutic INRs increase the client's risk for thrombus formation. The normal range for INR is 0.81 to 1.2 (0.81 to 1.2), so option 4 is therapeutic for this client.

The adult client with hepatic encephalopathy has a serum ammonia level of 200 mcg/dL (120 mcmol/L) and receives treatment with lactulose. The nurse determines that the client had the best and most realistic response if the serum ammonia level changed to which value after medication administration? 1.5 mcg/dL (3 mcmol/L) 2.10 mcg/dL (6 mcmol/L) 3.15 mcg/dL (9 mcmol/L) 4.90 mcg/dL (54 mcmol/L)

4. 90 mcg/dL The normal serum ammonia level is 10 to 80 mcg/dL (6 to 47 mcmol/L). In the client with hepatic encephalopathy, the ammonia level is not likely to drop below normal, nor is it likely to drop into the low-normal range. A level of 90 mcg/dL (54 mcmol/L) is slightly above normal and represents the most realistic response of the medication. The nurse should also monitor the client for signs and symptoms that indicate improvement in the condition.

The nurse is caring for a client at home with a diagnosis of actinic keratosis. The client tells the nurse that her skin is very dry and irritated. The treatment includes diclofenac sodium. The nurse teaches the client that this medication is from which class of medications? 1. anti-infectives 2. vitamin A lotions 3. coal tar preparations 4. nonsteroidal anti-inflammatory drugs (NSAIDs)

4. NSAIDs Diclofenac sodium is an NSAID for topical use. It is indicated for use to treat actinic keratosis. The mechanism underlying its benefits is unknown. The most common side effects are dry skin, itching, redness, and rash at the site of application. Diclofenac sodium may sensitize the skin to ultraviolet radiation, and clients should therefore avoid sunlamps and minimize exposure to sunlight. Anti-infectives are used for infections. Vitamin A would be contraindicated in the treatment of actinic keratosis. Coal tar is for psoriasis.

A client with a documented exposure to tuberculosis is on medication therapy with isoniazid. The nurse is monitoring laboratory results and determines that which laboratory value indicates the need for follow-up? 1.Platelet count 325,000 mm3 (325 × 109/L) 2.Serum creatinine 1.0 mg/dL (88.3 mcmol/L) 3.Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L) 4.Aspartate aminotransferase (AST) 55 U/L (55 U/L)

4. aspartate aminotransferase (AST) 55 U/L Because isoniazid therapy can cause elevated hepatic enzymes and hepatitis, liver enzymes are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 years of age or who abuses alcohol. The normal AST level is 0 to 35 U/L (0 to 30 U/L). The other options are not monitored routinely and are also normal.

A client is scheduled to have heparin sodium 5000 units subcutaneously. What is the most appropriate nursing intervention? 1.Inject via an infusion device. 2.Inject ½ inch (1.25 cm) from the umbilicus. 3.Massage the injection site after administration. 4.Avoid aspirating prior to injecting the medication.

4. avoid aspirating prior to injecting the medication Aspiration should be avoided before injecting the heparin because it can cause hematoma at the administration site. Heparin sodium administered subcutaneously does not require an infusion device and is injected at least 2 inches (5 cm) from the umbilicus or any scar tissue. The needle is withdrawn rapidly, and the site is not massaged (although pressure is applied).

A client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client should be questioned about the use of which medication? 1.Diuretics 2.Antibiotics 3.Antilipemics 4.Decongestants

4. decongestants In the client with benign prostatic hyperplasia, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. These medications lessen the voluntary ability to contract the bladder. The client should be questioned about the use of these medications if he has urinary retention. Diuretics increase urine output. Antibiotics and antilipemics do not affect ability to urinate.

A client with a severe allergic reaction is prescribed intravenous corticosteroids. The nurse should expect that which desired effect will be achieved? 1.Pain relief 2.Enhanced immunity 3.Increased serum glucose 4.Decreased inflammation

4. decreased inflammation A corticosteroid acts as an anti-inflammatory. Although reduction of inflammation may relieve pain, this is not the indication of the use of corticosteroids in the allergic response. Corticosteroids increase serum glucose, but this is not a therapeutic response. These medications decrease immunity.

A clinic nurse is assessing a client who has been on isoniazid for 6 months. Which client complaint should most concern the nurse? 1.Dry mouth 2.Cramping diarrhea 3.Frequent headaches 4.Difficulty tying shoes

4. difficulty tying shoes The client complaint that should most concern the nurse is difficulty tying shoes because this may indicate neuropathy. Dose-related peripheral neuropathy is one of the more common adverse effects of isoniazid. Dry mouth, cramping diarrhea, and frequent headaches are not concerns with administration of this medication.

A medication has been prescribed for a client with hypoparathyroidism for management of hypocalcemia. The client arrives at the clinic for follow-up evaluation and complains of chronic constipation since beginning the medication. The nurse provides information to the client regarding measures to alleviate the constipation and determines that the client needs additional information when the client makes which statement? 1."I will increase my daily fluid intake." 2."I will increase my activity level as tolerated." 3."I will increase my daily intake of high-fiber foods." 4."I will add ½ ounce of mineral oil to my daily diet."

4. i will add 1/2 ounce of mineral oil to my daily diet Clients taking medications to treat hypocalcemia should be instructed to avoid the use of mineral oil as a laxative because mineral oil decreases vitamin D absorption, and vitamin D is needed to assist in the absorption of calcium. The remaining options are basic measures to alleviate constipation.

A client with chronic atrial fibrillation is being started on quinidine sulfate as maintenance therapy for dysrhythmia suppression, and the nurse provides instructions to the client about the medication. Which statement by the client indicates a need for further instruction? 1."I will avoid chewing the tablets." 2."I will take the dose at the same time each day." 3."I will take the medication with food if my stomach becomes upset." 4."I will stop taking the prescribed anticoagulant after starting this new medication."

4. i will stop taking the prescribed anticoagulant after starting this new medication Medication-specific teaching points for quinidine sulfate include to take the medication exactly as prescribed, not to chew the tablets, to take with food if stomach upset occurs, to wear a medical identification (e.g., MedicAlert) bracelet or tag, and to have periodic checks of heart rhythm and blood counts. The client should not stop taking a prescribed medication unless specifically told to do so by the primary health care provider.

The home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL (10 mmol/L). The client is taking cholestyramine, and the nurse teaches the client about the medication. Which statement, by the client, indicates the need for further teaching? 1."Constipation and bloating might be a problem." 2."I'll continue to watch my diet and reduce my fats." 3."Walking a mile each day will help the whole process." 4."I'll continue my nicotinic acid from the health food store."

4. ill continue my nicotinic acid from the health food store Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid-lowering medications also can cause liver abnormalities, so a combination of nicotinic acid and cholestyramine resin needs to be avoided. Constipation and bloating are the 2 most common adverse effects. Walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels.

Insulin lispro is prescribed for the client with diabetes mellitus, and the client is instructed to administer the insulin before meals. When should the nurse instruct the client to administer the insulin? 1.45 minutes before eating 2.60 minutes before eating 3.90 minutes before eating 4.Immediately before eating

4. immediately before eating Insulin lispro acts more rapidly than regular insulin and has a shorter duration of action. The effect of insulin lispro begins within 25 minutes after subcutaneous injection, peaks in 0.5 to 1.5 hours, and has a duration of action of approximately 5 hours. Because of its rapid onset, it can be administered from 15 minutes to immediately before eating. In contrast, regular insulin is generally administered 30 minutes before meals.

A client taking theophylline has a serum theophylline level of 15 mcg/mL (60 mcmol/L). How does the nurse interpret this laboratory value? 1.Below therapeutic range 2.In excess of the therapeutic range 3.Near the top of the therapeutic range 4.In the middle of the therapeutic range

4. in the middle of the therapeutic range The normal therapeutic range for the theophylline level is 10 to 20 mcg/mL (40 to 79 mcmol/L). A level above 20 mcg/mL (79 mcmol/L) is considered toxic. The value of 15 mcg/mL places the client in the middle of the therapeutic range.

The nurse provides education to the client with hyperthyroidism about potassium iodide before medication administration. The client is scheduled for a subtotal thyroidectomy. Which response by the client indicates understanding? 1."It replaces thyroid hormone." 2."It prevents iodine absorption." 3."It increases thyroid hormone." 4."It suppresses thyroid hormone."

4. it suppresses thyroid hormone Potassium iodide is administered to hyperthyroid individuals in preparation for thyroidectomy to suppress thyroid function. Initial effects develop within 24 hours. Peak effects develop in 10 to 15 days. In most cases, plasma levels of thyroid hormone are reduced with propylthiouracil before potassium iodide therapy is initiated. Then potassium iodide, along with propylthiouracil, is administered for the last 10 days before surgery. Therefore, the remaining options are incorrect.

The nurse is caring for a client with an exacerbation of multiple sclerosis. Which medication(s) will the nurse expect to be prescribed to hasten recovery from the exacerbation? 1.Carbamazepine and phenytoin by mouth 2.Lioresal by mouth and diazepam intravenously 3.Phenytoin intravenously, then tapered to oral route 4.Methylprednisolone and cyclophosphamide intravenously

4. methylprednisolone and cyclophosphamide intravenously Intravenous methylprednisolone or adrenocorticotropic hormone in combination with cyclophosphamide may be prescribed to accelerate recovery from an exacerbation of multiple sclerosis. Carbamazepine may be prescribed for trigeminal neuralgia, and phenytoin may be prescribed to control seizures. Lioresal and diazepam are used to treat muscle spasticity

The nurse has just administered the first dose of omalizumab to a client. Which statement by the client alerts the nurse of a life-threatening effect? 1."I have a severe headache." 2."My feet are quite swollen." 3."I am nauseated and may vomit." 4."My lips and tongue are swollen."

4. my lips and tongue are swollen Omalizumab is an antiinflammatory and monoclonal antibody used for long-term control of asthma. Anaphylactic reactions can occur with the administration of omalizumab. The nurse administering the medication should monitor for adverse reactions of the medication. Swelling of the lips and tongue are an indication of an anaphylaxis. The client statements in options 1, 2, and 3 are not indicative of an adverse reaction

A client with gastrointestinal hypermotility has a prescription to receive atropine sulfate. The nurse should withhold the medication and question the prescription if the client has a history of which disease process? 1.Biliary colic 2.Sinus bradycardia 3.Peptic ulcer disease 4.Narrow-angle glaucoma

4. narrow angle glaucoma Atropine sulfate can cause a blockade of muscarinic receptors on the iris sphincter, producing mydriasis (dilation of the pupils). It also produces cycloplegia (relaxation of the ciliary muscles). It is contraindicated in clients with narrow-angle glaucoma. The other options are therapeutic reasons for using the medication.

A home care nurse has observed a client self-administer a dose of an adrenergic bronchodilator via metered-dose inhaler. Within a short time, the client begins to wheeze loudly. The nurse understands that this is the result of which occurrence? 1.Insufficient dosage of the medication, which needs to be increased 2.Probable interaction of this medication with an over-the-counter cold remedy 3.Tolerance to the medication, indicating a need for a stronger type of bronchodilator 4.Paradoxical bronchospasm, which must be reported to the primary health care provider (PHCP)

4. paradoxical bronchospasm, which must be reported to the PHCP The client taking adrenergic bronchodilators may experience paradoxical bronchospasm, which is evidenced by the client's wheezing. This can occur with excessive use of inhalers. Further medication should be withheld, and the PHCP should be notified. The remaining options are incorrect interpretations.

The nurse is reviewing heparin infusion therapy and pertinent laboratory values to monitor with the nursing student. Which statement by the student indicates that teaching has been effective? 1."Bleeding time assesses for therapeutic effect of heparin." 2."Thrombin time assesses for therapeutic effect of heparin." 3."Prothrombin time assesses for therapeutic effect of heparin." 4."Partial thromboplastin time assesses for therapeutic effect of heparin."

4. partial thromboplastin time assesses for therapeutic effect of heparin The partial thromboplastin time will assess the therapeutic effect of heparin. The prothrombin time is one test that will assess for the therapeutic effect of warfarin. Bleeding time and thrombin time are hematological studies that may be prescribed for clients with coagulopathy or other disorders.

A client has been taking pyrazinamide for 6 months. The nurse determines that the medication is effective if which cultures yield a negative result? 1.Urine 2.Blood 3.Wound 4.Sputum

4. sputum Pyrazinamide is an antituberculosis medication that is given in conjunction with other antituberculosis medications. Its use may be discontinued by the prescriber if sputum cultures become negative. The remaining options are incorrect.

A nurse provides instructions to a client taking fludrocortisone acetate. The nurse instructs the client to notify the primary health care provider (PHCP) if which manifestation occurs? 1.Nausea 2.Fatigue 3.Weight loss 4.Swelling of the feet

4. swelling of the feet Excessive levels of fludrocortisone acetate cause retention of sodium and water and excessive excretion of potassium, resulting in expansion of blood volume, hypertension, cardiac enlargement, edema, and hypokalemia. The client needs to be informed about the signs of sodium and water retention, such as unusual weight gain or swelling of the feet or lower legs. If these signs occur, the PHCP needs to be notified.

A client who experiences allergic rhinitis asks the nurse about a nasal corticosteroid. How should the nurse reply? 1."Clear the nasal passages after use." 2."Take the medication only as needed." 3."The medication should start to work immediately." 4."The medication works locally and decreases inflammation."

4. the medication works locally and decreases inflammation Intranasal corticosteroids may be used to treat allergic rhinitis. The medication works locally and decreases inflammation. The client should be instructed to clear the nasal passages before use for best medication effectiveness. The client should take the medication regularly as prescribed in order for the effect to be achieved. The medication may take several days to achieve maximal effect because it works by decreasing inflammation.

A client is scheduled to receive acetylcysteine 20% solution diluted in 0.9% normal saline by nebulizer. Which outcome would the nurse expect as a result of the administration of this medication? 1.Bronchodilation 2.Decreased coughing 3.Absence of wheezing 4.Thinning of respiratory secretions

4. thinning of respiratory secretions Acetylcysteine is administered to thin bronchial secretions and is considered a mucolytic. The remaining options are the outcomes of respiratory medication therapy but not of acetylcysteine.

Megestrol acetate, an antineoplastic medication, is prescribed for a client with metastatic endometrial carcinoma. The nurse reviews the client's history and should contact the primary health care provider if which diagnosis is documented in the client's history? 1.Gout 2.Asthma 3.Myocardial infarction 4.Venous thromboembolism

4. venous thromboembolism Megestrol acetate suppresses the release of luteinizing hormone from the anterior pituitary by inhibiting pituitary function and regressing tumor size. Megestrol is used with caution if the client has a history of venous thromboembolism. Options 1, 2, and 3 are not contraindications for this medication.

A client has been taking omeprazole for 4 weeks. The ambulatory care nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom? 1.Diarrhea 2.Heartburn 3.Flatulence 4.Constipation

2. heartburn Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called heartburn by clients. Omeprazole is not used to treat the conditions identified in options 1, 3, and 4.

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

3. vitamin A Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements should be discontinued before isotretinoin therapy. There are no contraindications associated with digoxin, phenytoin, or furosemide.

Silver sulfadiazine is prescribed for a client with a burn injury. Which laboratory finding requires the need for follow-up by the nurse? 1.Glucose level of 99 mg/dL (5.5 mmol/L) 2.Platelet level of 300,000 mm3 (300 × 109/L) 3.Magnesium level of 1.5 mEq/L (0.75 mmol/L) 4.White blood cell count of 3000 mm3 (3.0 × 109/L)

white blood cell count of 3000 Silver sulfadiazine is used for the treatment of burn injuries. Adverse effects of this medication include rash and itching, blue-green or gray skin discoloration, leukopenia, and interstitial nephritis. The nurse should monitor a complete blood count, particularly the white blood cells, frequently for the client taking this medication. If leukopenia develops, the primary health care provider is notified and the medication is usually discontinued. The white blood cell count noted in option 4 is indicative of leukopenia. The other laboratory values are not specific to this medication and are also within normal limits.

The nurse is reviewing the prescriptions for a newly admitted client. The nurse sees a prescription for intravenous pantoprazole but does not see any gastrointestinal conditions in the medical record. How should the nurse interpret this prescription? 1.It is used as a prophylactic measure. 2.It is inaccurate and should be questioned. 3.It is likely that the client has a new gastrointestinal disorder. 4.It is used before surgery, so the client will probably require surgery.

1. it is used as a prophylactic measure Pantoprazole is a proton pump inhibitor and is commonly used as a gastrointestinal prophylactic measure to prevent stress ulcers. The other options are incorrect.

A child with severe seborrheic dermatitis is receiving treatments of topical corticosteroid applied over an extensive area of the body, followed by the application of an occlusive dressing. The nurse should monitor the child closely, knowing that which systemic effect can occur as a result of this treatment? 1.Local infection 2.Growth retardation 3.Thinning of the skin 4.Adrenal hyperactivity

2. growth retardation Topical corticosteroid can be absorbed in sufficient amounts to produce systemic toxicity. Principal concerns are growth retardation (in children) and adrenal suppression (in all age groups). Systemic toxicity is more likely under extreme conditions of use, such as with prolonged therapy in which extensive surfaces are treated with high doses of high-potency agents in conjunction with occlusive dressings.

A client has been taking omeprazole for 4 weeks. The ambulatory care nurse evaluates medication effectiveness by asking the client if relief was obtained from which symptom? 1.Diarrhea 2.Heartburn 3.Flatulence 4.Constipation

2. heartburn Omeprazole is a proton pump inhibitor and is classified as an antiulcer agent. The medication relieves pain from gastric irritation, which often is experienced as "heartburn" by clients. The medication does not relieve the symptoms identified in the remaining options.

A client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication? 1.Glucose level 2.Calcium level 3.Potassium level 4.Prothrombin time

2. calcium level Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium level should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain.

A home health nurse is visiting a client who has been started on therapy with clotrimazole. The nurse determines the effectiveness of the medication by noting a decrease in which problem? 1.Pain 2.Rash 3.Fever 4.Sneezing

2. rash

Capecitabine has been prescribed for a client with breast cancer. The nurse should tell the client that which blood test will be done periodically while the client is taking this medication? 1.Liver function tests 2.Bilirubin level assay 3.Complete blood count (CBC) 4.Triglyceride level determination

3. complete blood count (CBC) Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. Bone marrow depression can occur from the use of this medication, and a CBC and blood chemistry studies should be done periodically. Liver function tests, bilirubin level assay, and triglyceride levels are unnecessary.

A client has received a dose of dimenhydrinate. The nurse should observe relief of what sign or symptom to evaluate that the medication has been effective? 1.Chills 2.Headache 3.Nausea and vomiting 4.Buzzing sound in the ears

3. nausea and vomiting Dimenhydrinate is used to prevent and treat the symptoms of dizziness, vertigo, nausea, and vomiting that accompany motion sickness. The other options are incorrect reasons for administering the medication.

The nurse is reviewing the record of a client who arrives at the primary health care clinic. The nurse notes that the client is taking letrozole. The nurse should suspect that the client has which disorder? 1.Hypothyroidism 2.Diabetes mellitus 3.Chronic kidney disease 4.Advanced breast cancer

4. advanced breast cancer Letrozole is used in the palliative treatment for advanced breast cancer in the postmenopausal woman with disease progression after treatment with antiestrogen therapy. The conditions in options 1, 2, and 3 are not treated with this medication.

The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied at which times? 1.Immediately before swimming 2.5 minutes before exposure to the sun 3.Immediately before exposure to the sun 4.At least 30 minutes before exposure to the sun

4. at least 30 minutes before exposure to the sun

The nurse is monitoring a client receiving glipizide. The nurse knows that which finding would indicate a therapeutic outcome for this client? 1.A decrease in polyuria 2.An increase in appetite 3.A glycosylated hemoglobin of 10% 4.A fasting blood glucose of 220 mg/dL (12.6 mmol/L)

1. a decrease in polyuria Glipizide is an oral hypoglycemic agent given to reduce the serum glucose level and the signs and symptoms of hyperglycemia. Therefore, a decrease in polyuria (a symptom of hyperglycemia) would denote a beneficial response to glipizide. Excessive appetite (polyphagia) also is a symptom of hyperglycemia. Thus, an increase in appetite would not signify a therapeutic effect. A therapeutic fasting blood glucose should be less than 100 mg/dL, and the glycosylated hemoglobin should be less than 7%

A client with hyperthyroidism has been given methimazole. Which nursing considerations are associated with this medication? Select all that apply. 1.Administer methimazole with food. 2.Place the client on a low-calorie, low-protein diet. 3.Assess the client for unexplained bruising or bleeding. 4.Instruct the client to report side and adverse effects such as sore throat, fever, or headaches. 5.Use special radioactive precautions when handling the client's urine for the first 24 hours following initial administration.

1. administer methimazole with food 3. assess the client for unexplained bruising or bleeding 4. instruct the client to report side and adverse effects such as sore throat, fever, or headaches Common side effects of methimazole include nausea, vomiting, and diarrhea. To address these side effects, this medication should be taken with food. Because of the increase in metabolism that occurs in hyperthyroidism, the client should consume a high-calorie diet. Antithyroid medications can cause agranulocytosis with leukopenia and thrombocytopenia. Sore throat, fever, headache, or bleeding may indicate agranulocytosis, and the primary health care provider should be notified immediately. Methimazole is not radioactive and should not be stopped abruptly due to the risk of thyroid storm

Which clients can safely receive lindane? Select all that apply. 1.An 89-year-old client with dementia 2.A 32-year-old client with renal stones 3.A 6-year-old child with a fractured arm 4.A 42-year-old woman with osteoporosis 5.A 52-year-old man with hypertension and high cholesterol

1. an 89 year old client with dementia 2. a 32 year old client with renal stones 4. a 42 year old woman with osteoporosis 5. a 52 year old with hypertension and high cholesterol Lindane can penetrate intact skin and cause seizures if absorbed in sufficient quantities. Clients at highest risk for seizures are premature infants, children, and those with preexisting seizure disorders. Lindane should not be used on pediatric clients unless safer medications have failed to control the infestation.

A primary health care provider has written a prescription for ranitidine 300 mg once daily. The client indicates understanding of use of this medication by stating that the prescribed dose is best taken at what time? 1.At bedtime 2.After lunch 3.With supper 4.Before breakfast

1. at bedtime Ranitidine is a histamine H2-receptor antagonist and should be taken at bedtime, when it is given as a single daily dose. This allows for prolonged effect and provides the greatest protection of the gastric mucosa both during sleep and around the clock.

The nurse is administering a dose of a prescribed diuretic to an assigned client. The nurse should monitor the client for hypokalemia as a side effect of therapy if the client has been receiving which medication? 1.Bumetanide 2.Triamterene 3.Amiloride HCl 4.Spironolactone

1. bumetanide Bumetanide is a loop diuretic that places the client at risk for hypokalemia. The nurse would monitor this client carefully for signs of hypokalemia, monitor serum potassium levels, and encourage intake of high-potassium foods. The other medications listed are potassium-retaining diuretics.

A nurse is caring for a client with a diagnosis of hyperthyroidism. Laboratory studies are performed, and the serum calcium level is 12.0 mg/dL (3 mmol/L). Which medication should the nurse anticipate to be prescribed for the client? 1.Calcitonin 2.Calcium chloride 3.Calcium gluconate 4.Large doses of vitamin D

1. calcitonin The normal serum calcium level is 9 to 10.5 mg/dL (2.25 to 2.75 mmol/L). This client is experiencing hypercalcemia. Calcitonin, a thyroid hormone, decreases the plasma calcium level by increasing the incorporation of calcium into the bones, thus keeping it out of the serum. Calcium chloride and calcium gluconate are medications used for the treatment of tetany that occurs from acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided.

A client receiving oral theophylline is due to have a theophylline level drawn. The nurse should question the client to ensure that the client has not ingested which substance before the blood sample is drawn? 1.Coffee 2.Oatmeal 3.Ginger ale 4.Bagel with cream cheese

1. coffee Theophylline is a xanthine bronchodilator. Before a serum level of the medication is drawn, the client should avoid taking foods or beverages that contain xanthine, such as colas, coffee, or chocolate; therefore, the client is told to avoid coffee before the test. The items in the other options do not need to be avoided before this test.

A client begins therapy with theophylline. The nurse plans to teach the client to limit the intake of which items while taking this medication? 1.Coffee, cola, and chocolate 2.Oysters, lobster, and shrimp 3.Melons, oranges, and pineapple 4.Cottage cheese, cream cheese, and dairy creamers

1. coffee, cola, and chocolate Theophylline is a methylxanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These foods include coffee, cola, and chocolate.

Which finding suggests to the nurse that a client with bleeding esophageal varices is experiencing a side or adverse effect of vasopressin therapy? 1.Complaints of chest pain 2.Bounding peripheral pulses 3.Temperature of 102º F (39.8º C) 4.Blood urea nitrogen (BUN) of 20 mg/dL (7.1 mmol/L)

1. complaints of chest pain Vasopressin therapy causes vasoconstriction, and side and adverse effects include myocardial ischemia, which may be evident by the client's complaints of chest pain. Elevated temperature, bounding peripheral pulses, and a BUN of 20 mg/dL (7.1 mmol/L) are not adverse effects. Vasopressin therapy can cause hypothermia. Because vasopressin has potent vasoconstrictive effects on the peripheral arterioles, weak versus bounding pulses may be found. The normal BUN is 10 to 20 mg/dL (3.6 to 7.1 mmol/L).

The nurse monitors the client taking octreotide acetate for acromegaly for which most common side or adverse effect of this medication? 1.Diarrhea 2.Dyspnea 3.Constipation 4.Bradycardia

1. diarrhea Octreotide acetate is used to reduce growth hormone levels in clients with acromegaly. The most common side effects of this medication are diarrhea, nausea, gallstone formation, and abdominal discomfort. Hypertension, although rare, may occur. Constipation, bradycardia, and dyspnea are not associated with use of this medication.

The nurse is preparing to administer an intravenous (IV) insulin injection. The vial of regular insulin has been refrigerated. On inspection of the vial, the nurse finds that the medication is frozen. Which should the nurse do? 1.Discard the insulin and obtain another vial. 2.Wait for the insulin to thaw at room temperature. 3.Check the temperature settings of the refrigerator. 4.Rotate the vial between the hands until the medication becomes liquid.

1. discard the insulin and obtain another vial Insulin should not be frozen. If the nurse notes that the vial of insulin is frozen, the insulin is discarded and a new vial is obtained. The remaining options are incorrect actions.

The nurse is preparing the client's morning insulin isophane dose. The nurse notices a clumpy precipitate inside the insulin vial. What is the most appropriate nursing action related to this finding? 1.Draw the dose from a new vial. 2.Draw up and administer the dose. 3.Shake the vial in an attempt to disperse the clump. 4.Warm the bottle under running water to dissolve the clump.

1. draw the dose from a new vial The nurse should always inspect the vial of insulin before use for changes that may signify loss of potency. Insulin isophane normally is uniformly cloudy. Clumping, frosting, and precipitates are signs of insulin damage. In this situation, because potency is questionable, it is safer to discard the vial and draw up the dose from a new vial. Therefore, the remaining options are incorrect.

A client receives a dose of scopolamine. The nurse determines that which sign or symptom later displayed by the client is a result of medication side and adverse effects? 1.Dry mouth 2.Diaphoresis 3.Excessive urination 4.Pupillary constriction

1. dry mouth Side and adverse effects of scopolamine, an anticholinergic medication, are dry mouth, urinary retention, decreased sweating, and dilation of the pupils. Each of the incorrect options states the opposite of a side effect of this medication.

The primary health care provider (PHCP) writes a prescription for lisinopril for a hospitalized client with hypertension. The nurse caring for the client determines that the medication has been prescribed to treat which disorder? 1.Hypertension 2.Immune disorder 3.Venous insufficiency 4.Gastroesophageal reflux disorder

1. hypertension Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that is used to treat hypertension or heart failure. It is not used to treat immune disorder, venous insufficiency, or gastroesophageal reflux disorder.

A client who is taking chlorothiazide comes to the clinic for periodic evaluation. In monitoring the client's laboratory test results for medication side effects, what is the clinic nurse most likely to note if a side or adverse effect is present? 1.Hypokalemia 2.Hypocalcemia 3.Hypernatremia 4.Hyperphosphatemia

1. hypokalemia The client taking a potassium-losing diuretic such as chlorothiazide should be monitored for decreased potassium levels. Other possible fluid and electrolyte imbalances that occur with use of this medication include hypercalcemia, hyponatremia, hypophosphatemia, and hypomagnesemia.

The nurse is caring for a client receiving an albuterol/ipratropium nebulized breathing treatment. Which report from the client should the nurse note as an expected side effect of this combination medication? 1."I feel like my heart is racing." 2."I feel more bloated than usual." 3."My eyes have been watering lately." 4."I haven't had a bowel movement in 4 days."

1. i feel like my heart is racing Albuterol/ipratropium is a combination agent—one is a β2-adrenergic agonist and the other is an anticholinergic medication, and in combination they produce an overall bronchodilation effect. Common side and adverse effects include headache, dizziness, dry mouth, tremors, nervousness, and tachycardia. Therefore, option 1 is correct. Options 2, 3, and 4 are not specifically associated with this medication.

A hypertensive client has been prescribed clonidine hydrochloride, a transdermal patch. The nurse provides written instructions to the client on the use of the patch. Which statement by the client indicates the need for further instruction? 1."I need to change the patch every 24 hours." 2."I need to apply the patch to a hairless body site." 3."I need to apply the patch to skin areas that are not broken." 4."I need to apply the patch to the skin on the upper arm or body."

1. i need to change the patch every 24 hours Clonidine is an antihypertensive medication that is applied every 7 days to a hairless intact skin area of the upper arm or torso. The remaining options are correct statements.

When evaluating an asthmatic client's knowledge of self-care, the nurse recognizes that additional instruction is needed when the client makes which statement? 1."I use my corticosteroid inhaler each time I feel short of breath." 2."I see my doctor if I have an upper respiratory infection and always get a flu shot." 3."I use my bronchodilator inhaler before walking so I don't become short of breath." 4."I use my bronchodilator inhaler before I visit places like the zoo because of my allergies."

1. i use my corticosteroid inhaler each time i feel short of breath Most asthma medications are administered via inhalation because of their fast action via this route. Inhaled corticosteroids are preferred for long-term control of persistent asthma. They decrease inflammation and reduce bronchial hyperresponsiveness. Bronchodilator medications are considered "rescue" types because their onset is faster. Clients would use this type of medication to provide rapid relief of symptoms such as bronchospasm, which can be caused by a variety of triggers. Clients need to be evaluated for understanding of their disease, identifying triggers, and the proper use of equipment and medications.

A nurse has provided discharge instructions to a client being placed on long-term anticoagulant therapy with warfarin sodium. Adequate learning would be evident if the client makes which statements? Select all that apply. 1."I may take over-the-counter medications as needed." 2."I will inform my dentist that I am taking this medication." 3."I should alternate the timing of my daily dose of this medication." 4."I should use a firm-bristled toothbrush to prevent the side effects of this medication." 5."I will have my blood levels checked as prescribed by my primary health care provider (PHCP)." 6."I will report any signs of blood in my urine or stool to my primary health care provider (PHCP)."

1. i will inform my dentist that i am taking this medication 5. i will have my blood levels checked as prescribed by my PHCP 6. i will report any signs of blood in my urine or stool to my PHCP Clients need to notify all primary health care providers (PHCPs) that they are on warfarin sodium therapy. Dental procedures may put the client at risk for increased bleeding, so this should direct you to option 2. Knowing that the effectiveness of warfarin sodium is based on maintaining a therapeutic blood level will direct you to select option 5. Awareness of bleeding as a primary complication will direct you to option 6.

The nurse is caring for a child with heart failure (HF). The nurse provides instructions to the mother regarding the procedure for administration of the prescribed digoxin. Which statement by the mother indicates a need for further teaching? 1."I will make sure to mix the medication with food." 2."I need to take my child's pulse before administering the medication." 3."If more than 1 dose is missed, I need to call the primary health care provider." 4."If my child vomits after being given the medication, I should not repeat the dose."

1. i will make sure to mix the medication with food Medication should not be mixed with food because this method of administration would not ensure that the child received the prescribed dose. The parents need to be instructed that if the child vomits after the digoxin is administered, they are not to repeat the dose. In addition, the parents should be instructed that if a dose is missed and is not identified until 4 or more hours later, the dose should not be administered. If more than 1 dose is missed, the primary health care provider needs to be notified.

The nurse determines the client needs further instruction on cimetidine if which statements were made? Select all that apply. 1."I will take the cimetidine with my meals." 2."I'll know the medication is working if my diarrhea stops." 3."My episodes of heartburn will decrease if the medication is effective." 4."Taking the cimetidine with an antacid will increase its effectiveness." 5."I will notify my primary health care provider if I become depressed or anxious." 6."Some of my blood levels will need to be monitored closely since I also take warfarin for atrial fibrillation."

1. i will take the cimetidine with my meals 2. i'll know the medication is working if my diarrhea stops 4. taking the cimetidine with an antacid will increase its effectiveness Cimetidine, a histamine (H2)-receptor antagonist, helps alleviate the symptom of heartburn, not diarrhea. Because cimetidine crosses the blood-brain barrier, central nervous system side and adverse effects, such as mental confusion, agitation, depression, and anxiety, can occur. Food reduces the rate of absorption, so if cimetidine is taken with meals, absorption will be slowed. Antacids decrease the absorption of cimetidine and should be taken at least 1 hour apart. If cimetidine is concomitantly administered with warfarin therapy, warfarin doses may need to be reduced, so prothrombin and international normalized ratio results must be followed.

A client with a prescription to take theophylline daily has been given medication instructions by the nurse. What statement by the client indicates the need for further education regarding the prescription? 1."I will take the daily dose at bedtime." 2."I need to drink at least 2 liters of fluid per day." 3."I know to avoid changing brands of the medication without my primary health care provider's approval." 4."I'll avoid over-the-counter cough and cold medications unless approved by my health care provider."

1. i will take the daily dose at bedtime The client taking a single daily dose of theophylline, a xanthine bronchodilator, should take the medication early in the morning. This enables the client to have maximal benefit from the medication during daytime activities. In addition, this medication causes insomnia. The client should take in at least 2 L of fluid per day to decrease viscosity of secretions. The client should check with the primary health care provider (PHCP) before changing brands of the medication because levels of bioavailability may vary for different preparations. The client also should check with the PHCP before taking over-the-counter cough, cold, or other respiratory preparations because they could have interactive effects, increasing the side and adverse effects of theophylline and causing dysrhythmias.

The nurse teaches a client about the effects of diphenhydramine, which has been prescribed as a cough suppressant. The nurse determines that the client needs further instruction if the client makes which statement? 1."I will take the medication on an empty stomach." 2."I won't drink alcohol while taking this medication." 3."I won't do activities that require mental alertness while taking this medication." 4."I will use sugarless gum, candy, or oral rinses to decrease dryness in my mouth."

1. i will take the medication on an empty stomach Diphenhydramine has several uses, including as an antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. Instructions for use include taking with food or milk to decrease gastrointestinal upset and using oral rinses, sugarless gum, or hard candy to minimize dry mouth. Because the medication causes drowsiness, the client should avoid use of alcohol or central nervous system depressants, operating a car, or engaging in other activities requiring mental awareness during use.

A neurologist prescribed ticlopidine to the client with thrombotic stroke. The nurse provides instructions to the client and spouse regarding the medication. Which statement made by the client indicates that education was effective? 1."I'll take the medicine with meals." 2."If I do not feel well, I should skip the medication." 3."I won't have another stroke if I take this medicine faithfully." 4."If I have any gastrointestinal side effects, I should call the neurologist."

1. ill take the medicine with meals Ticlopidine is an antiplatelet agent that is used to assist in preventing a thrombotic stroke. Ticlopidine is best tolerated when taken with meals. The most common side effects are gastrointestinal (GI) disturbances. Taking ticlopidine with meals tends to lessen those effects. It is not necessary to contact the neurologist or prescribing provider if GI upset occurs. The client should not skip medications. The medication is used to prevent strokes but does not guarantee that a stroke will not occur.

The nurse is monitoring a client receiving levothyroxine sodium for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply. 1.Insomnia 2.Weight loss 3.Bradycardia 4.Constipation 5.Mild heat intolerance

1. insomnia 2. weight loss 5. mild heat intolerance Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication, and rather, are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat.

Coal tar has been prescribed for the client with psoriasis, and the nurse provides instructions to the client regarding this treatment. Which statement by the client indicates a need for further instruction? 1."The medication can cause diarrhea." 2."The medication can cause phototoxicity." 3."The medication has an unpleasant odor." 4."The medication can stain the skin and hair."

1. the medication can cause diarrhea Coal tar is used to treat psoriasis and other chronic disorders of the skin. It suppresses DNA synthesis, mitotic activity, and cell proliferation. It has an unpleasant odor, frequently can stain the skin and hair, and can cause phototoxicity. It does not cause diarrhea.

A primary health care provider (PHCP) prescribes warfarin sodium for a client. The home care nurse visits the client at home and teaches the client about the medication and its administration. Which statement by the client indicates a need for further teaching? 1."The urine normally changes to orange." 2."This medicine will still be working 4 to 5 days after it is discontinued." 3."This medication will require frequent blood work to monitor its effects." 4."I cannot take aspirin or any aspirin-containing medications while I'm on this medication."

1. the urine normally changes to orange Warfarin is an anticoagulant. Bleeding is a concern while the client is taking this medication. Orange urine indicates blood in the urine from an overdose of the medication. Bleeding also may be identified by urine that turns red, smoky, or black. The half-life of the medication is 2 days, the peak effect is between 1 and 3 days, and the anticoagulation effect extends 4 to 5 days after discontinuation. The prothrombin time or international normalized ratio is determined to monitor the clotting mechanism. Aspirin is an antiplatelet agent and would increase the risk of bleeding.

Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which finding indicates the presence of systemic toxicity from this medication? 1.Tinnitus 2.Diarrhea 3.Constipation 4.Decreased respirations

1. tinnitus Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can result. Symptoms include tinnitus, dizziness, hyperpnea, and psychological disturbances. Constipation and diarrhea are not associated with salicylism.

Atenolol has been prescribed for a hospitalized client. The nurse should check which item before administering this medication? 1.Pedal pulses 2.Apical heart rate 3.Most recent potassium level 4.Most recent electrolyte levels

2. apical heart rate Atenolol is a beta-adrenergic blocker that is used as an antihypertensive, antianginal, and antidysrhythmic. It blocks beta-adrenergic receptors in cardiac tissue and produces the therapeutic effects of slowing the heart rate, decreasing cardiac output, decreasing blood pressure, and decreasing myocardial oxygen demand. The nurse should check the client's apical heart rate and blood pressure immediately before administering the medication. If the heart rate is 60 beats/min or lower or if the systolic blood pressure is less than 90 mm Hg, the medication is withheld and the primary health care provider is contacted. The remaining options are unrelated to the administration of this medication.

A client who had surgery 3 days earlier is receiving heparin sulfate by subcutaneous injection every 12 hours. In planning for the client's morning care, the priority nursing intervention is which action? 1.Allow the client to sit only at the bedside. 2.Assist the client to shave using an electric razor. 3.Monitor the prothrombin time (PT) every 4 hours. 4.Tell the client that brushing the teeth is not allowed.

2. assist the client to shave using an electric razor Clients receiving heparin are at risk for bleeding. An electric razor rather than a straight blade razor is used for shaving. Allowing the client to only sit on the side of the bed and prohibiting brushing of the teeth are inappropriate and unnecessary nursing actions. It is not necessary to monitor laboratory values every 4 hours when the client is taking subcutaneous heparin. The PT is monitored when the client is taking warfarin.

A client has begun therapy with a xanthine bronchodilator. The nurse determines that the client understands dietary alterations if the client states to limit which items while taking this medication? Select all that apply. 1.Milk 2.Coffee 3.Oysters 4.Oranges 5.Pineapple 6.Chocolate

2. coffee 6. chocolate The nurse teaches the client to limit the intake of xanthine-containing foods while taking a xanthine bronchodilator. These include coffee and chocolate. The other food items are acceptable to consume.

A client with a burn injury is applying mafenide acetate cream to the wound. The client calls the primary health care provider's (PHCP's) office and tells the nurse that the medication is uncomfortable and is causing a burning sensation. The nurse should instruct the client to take which action? 1.Discontinue the medication. 2.Continue with the treatment, as this is expected. 3.Apply a thinner film than prescribed to the burn site. 4.Come to the office to see the PHCP immediately.

2. continue with the treatment, as this is expected Topical mafenide acetate is used to treat partial- and full-thickness burns. It is bacteriostatic for both gram-negative and gram-positive organisms present in avascular tissues. The client should be warned that the medication will cause local discomfort and burning. The nurse does not instruct a client to alter a medication prescription (options 1 and 3). It is not necessary that the client see the PHCP at this time.

The client with a traumatic brain injury (TBI) has begun excreting copious amounts of dilute urine through the Foley catheter. The client's urine output for the previous shift was 3000 mL. The nurse expects that the primary health care provider will prescribe which medication? 1.Mannitol 2.Desmopressin 3.Ethacrynic acid 4.Dexamethasone

2. desmopressin A complication of TBI is diabetes insipidus, which can occur with insult to the hypothalamus, the antidiuretic hormone storage vesicles, or the posterior pituitary gland. Urine output that exceeds 9 L per day generally requires treatment with desmopressin. Dexamethasone is usually given to control cerebral edema secondary to brain tumors. Ethacrynic acid and mannitol are diuretics, which would be contraindicated.

The nurse is monitoring a client who is taking digoxin for adverse effects. Which findings are characteristic of digoxin toxicity? Select all that apply. 1.Tremors 2.Diarrhea 3.Irritability 4.Blurred vision 5.Nausea and vomiting

2. diarrhea 4. blurred vision 5. nausea and vomiting Digoxin is a cardiac glycoside. The risk of toxicity can occur with the use of this medication. Toxicity can lead to life-threatening events, and the nurse needs to monitor the client closely for signs of toxicity. Early signs of toxicity include gastrointestinal manifestations such as anorexia, nausea, vomiting, and diarrhea. Subsequent manifestations include headache; visual disturbances such as diplopia, blurred vision, yellow-green halos, and photophobia; drowsiness; fatigue; and weakness. Cardiac rhythm abnormalities can also occur. The nurse also monitors the digoxin level. The optimal therapeutic range for digoxin is 0.5 to 0.8 ng/mL.

The client questions the nurse as to why the primary health care provider switched the usual prescription from a metered-dose inhaler (MDI) to a dry powder inhaler (DPI). The nurse should respond correctly by providing which facts? Select all that apply. 1.Dry powder inhalers have fewer side effects. 2.Dry powder inhalers pose no environmental risks. 3.Dry powder inhalers can be administered more frequently. 4.Dry powder inhalers deliver more medication to the lungs. 5.Dry powder inhalers require less hand-to-lung coordination.

2. dry powder inhalers pose no environmental risks 4. dry powder inhalers deliver more medication to the lungs 5. dry powder inhalers require less hand-to-lung coordination DPIs are used to deliver medications in the form of a dry, micronized powder directly to the lungs. DPIs do not require the hand-to-lung coordination needed with MDIs; thus, DPIs are much easier to use. Compared with MDIs, DPIs deliver more medication to the lungs (20% of the total released versus 10%) and less to the oropharynx. Because DPIs do not require propellant, they are not a risk to the environment. Both types of inhalers have side effects. Frequency of use is prescribed by the primary health care provider.

The nurse has provided instructions to a client receiving enalapril maleate for hypertension. Which statement by the client indicates a need for further instruction? 1."I need to rise slowly from a lying to a sitting position." 2."I need to notify the primary health care provider if fatigue occurs." 3."I need to notify the primary health care provider if a sore throat occurs." 4."I know that several weeks of therapy may be required for the full therapeutic effect."

2. i need to notify the PHCP if fatigue occurs To reduce the hypotensive effect of this medication, the client is instructed to rise slowly from a lying to a sitting position and to permit the legs to dangle from the bed momentarily before standing. If fatigue occurs, it is not necessary to notify the primary health care provider (PHCP); the client is encouraged to pace activities. The client should report signs of a sore throat or fever to the PHCP because these may indicate infection. The client should be notified that several weeks may be needed for the full therapeutic effect of blood pressure reduction. The client also should be instructed not to skip doses or discontinue the medication because severe rebound hypertension could occur.

A client has been taking isoniazid for 2 months. The client complains to the nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing which problem? 1.Hypercalcemia 2.Peripheral neuritis 3.Small blood vessel spasm 4.Impaired peripheral circulation

2. peripheral neuritis Isoniazid is an antitubercular medication. A common side effect of isoniazid is peripheral neuritis, manifested by numbness, tingling, and paresthesias in the extremities. This can be minimized with pyridoxine (vitamin B6) intake. Options 1, 3, and 4 are not associated with the information in the question.

The nurse is providing medication information to a client who is beginning medication therapy with enalapril. The nurse should tell the client that which is an anticipated, although unpleasant, side effect of this medication? 1.Rapid pulse 2.Persistent dry cough 3.Increased blood pressure 4.Metallic taste in the mouth

2. persistent dry cough The principal side and adverse effects of enalapril, an angiotensin-converting enzyme (ACE) inhibitor, are persistent cough, first-dose hypotension, and hyperkalemia. The medication is used to treat hypertension. A persistent dry cough is a harmless side effect, although it can be disturbing. If this side effect occurs and is troublesome, the primary health care provider should be notified so that the medication can be changed to a different one. A rapid pulse and metallic taste in the mouth are not side or adverse effects of this medication.

The nurse has a prescription to give dexamethasone by the intravenous (IV) route to a client with cerebral edema. How should the nurse prepare this medication? 1.Diluting the medication in 500 mL of 5% dextrose 2.Preparing an undiluted direct injection of the medication 3.Diluting the medication in 1 mL of lactated Ringer's solution for direct injection 4.Diluting the medication in 10% dextrose in water and administering it as a direct injection

2. preparing an undiluted direct injection of the medication Dexamethasone may be given by direct IV injection or IV infusion. For IV infusion, it may be mixed with 50 to 100 mL of 0.9% sodium chloride or 5% dextrose in water. It is not mixed with lactated Ringer's solution or 10% dextrose in water.

The nurse would anticipate that the primary health care provider (PHCP) would add which medication to the regimen of the client receiving isoniazid? 1.Niacin 2.Pyridoxine 3.Gabapentin 4.Cyanocobalamin

2. pyridoxine Isoniazid is an antituberculosis medication. Clients receiving isoniazid can develop neuropathy, and the agent of choice to help prevent this adverse effect is pyridoxine, vitamin B6. Niacin is used to lower the cholesterol level. Gabapentin is used to prevent seizures and for peripheral neuropathy, and cyanocobalamin is used to treat anemia.

Glimepiride is prescribed for a client with diabetes mellitus. The nurse instructs the client that which food items are most acceptable to consume while taking this medication? Select all that apply. 1.Alcohol 2.Red meats 3.Whole-grain cereals 4.Low-calorie desserts 5.Carbonated beverages

2. red meats 3. whole grain cereals 5. carbonated beverages When alcohol is combined with glimepiride, a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol consumption while taking this medication. Low-calorie desserts should also be avoided. Even though the calorie content may be low, carbohydrate content is most likely high and can affect the blood glucose. The items in options 2, 3, and 5 are acceptable to consume.

The home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should tell the client to take which action? 1.Freeze the insulin. 2.Refrigerate the insulin. 3.Store the insulin in a dark, dry place. 4.Keep the insulin at room temperature.

2. refrigerate the insulin Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be frozen. When stored unopened under refrigeration, insulin can be used up to the expiration date on the vial. Options 1, 3, and 4 are incorrect.

The emergency department nurse is caring for a client admitted with diabetic ketoacidosis. The primary health care provider prescribes intravenous (IV) insulin. The nurse plans to prepare which type of insulin for the client? 1.Insulin glargine 2.Regular insulin 3.Insulin isophane 4.50% human insulin isophane/50% human insulin

2. regular insulin Regular insulin can be administered by the IV route. Insulin glargine is a long-acting insulin. Insulin isophane and 50% human insulin isophane/50% human insulin are intermediate-acting insulins.

A client who uses nonsteroidal anti-inflammatory drugs (NSAIDs) has been taking misoprostol. The nurse determines that the misoprostol is having the intended therapeutic effect if which finding is noted? 1.Resolved diarrhea 2.Relief of epigastric pain 3.Decreased platelet count 4.Decreased white blood cell count

2. relief of epigastric pain The client who uses NSAIDs is prone to gastric mucosal injury. Misoprostol is a gastric protectant and is given specifically to prevent this occurrence in clients taking NSAIDs frequently. Diarrhea can be a side effect of the medication but is not an intended effect. Options 3 and 4 are unrelated to the purpose of misoprostol.

A client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to teach the client to take which action? 1.Use alcohol in small amounts only. 2.Report yellow eyes or skin immediately. 3.Increase intake of Swiss or aged cheeses. 4.Avoid vitamin supplements during therapy.

2. report yellow eyes or skin immediately Isoniazid is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately, which include yellow skin and sclera. For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of isoniazid therapy.

The nurse has a prescription to give a client salmeterol, 2 puffs, and beclomethasone dipropionate, 2 puffs, by metered-dose inhaler. The nurse should administer the medication using which procedure? 1.Beclomethasone first and then the salmeterol 2.Salmeterol first and then the beclomethasone 3.Alternating a single puff of each, beginning with the salmeterol 4.Alternating a single puff of each, beginning with the beclomethasone

2. salmeterol first and then the beclomethasone Salmeterol is an adrenergic type of bronchodilator, and beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

The nurse is educating a client about medroxyprogesterone. The nurse should provide the client with which information about the medication? 1.Should be taken once daily by mouth 2.Should be administered intramuscularly every 3 months 3.Should be taken immediately following sexual intercourse 4.Provides some protection against sexually transmitted infections

2. should be administered intramuscularly every 3 months Medroxyprogesterone is given intramuscularly in the deltoid or gluteus maximus muscle. Injections should be administered every 12 weeks. Advantages of medroxyprogesterone include contraceptive effectiveness comparable to combined oral contraceptives and long-lasting effects. Additionally, injections are required only 4 times a year. Disadvantages are prolonged amenorrhea or uterine bleeding, increased risk of venous thrombosis and thromboembolism, and no protection against sexually transmitted infections

A client rings the call bell and asks for medication to relieve postoperative gas pains. The nurse selects which medication to be given as prescribed on the medication sheet? 1.Droperidol 2.Simethicone 3.Acetaminophen 4.Magnesium hydroxide

2. simethicone Simethicone is an antiflatulent used in the relief of pain caused by excessive gas in the gastrointestinal tract. Droperidol relieves postoperative nausea and vomiting. Acetaminophen is a nonopioid analgesic. Magnesium hydroxide is an antacid and laxative.

Acarbose is prescribed to treat a client with type 2 diabetes mellitus. Which instruction should the nurse provide when teaching the client about this medication? 1.Take the medication at bedtime. 2.Take the medication with the first bite of each regular meal. 3.The medication will be used to treat symptoms of hypoglycemia. 4.Headache and dizziness are the most common side effects of this medication.

2. take the medication with the first bite of each regular meal Acarbose is an α-glucosidase inhibitor. Taken with the first bite of each major meal, acarbose delays absorption of ingested carbohydrates, decreasing postprandial hyperglycemia. It is not taken at bedtime. Abdominal pain and flatulence (not headache and dizziness) are the most common side effects of this medication.

A client with tuberculosis receiving cycloserine orally twice daily must have blood drawn in 1 week to measure the serum concentration of the medication. The nurse prepares the client for this test by providing which information to the client? 1.Withhold the morning dose on the day of the scheduled blood test. 2.Take the morning dose, and have the blood drawn 2 hours after taking the dose. 3.Withhold the evening dose before the test and the dose scheduled for the morning of the test. 4.Double the dose the evening before the test, and withhold the morning dose on the day of the test.

2. take the morning dose, and have the blood drawn 2 hours after taking the dose Cycloserine is an antituberculosis medication that requires weekly serum medication level determinations to monitor for neurotoxicity and other adverse effects. Peak concentrations are measured 2 hours after dosing and should be between 25 and 35 mcg/mL.

A client has a prescription to take guaifenesin. The nurse should conclude that the client understands the most effective use of this medication if the client states that they need to take which action? 1.Watch for irritability as a side effect. 2.Take the tablet with a full glass of water. 3.Take an extra dose if the cough is accompanied by fever. 4.Crush the sustained-release tablet if immediate relief is needed.

2. take the tablet with a full glass of water Guaifenesin is an expectorant and should be taken with a full glass of water to decrease the viscosity of secretions. The medication occasionally may cause dizziness, headache, or drowsiness as side effects. The client should contact the primary health care provider if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache. Sustained-release preparations should not be broken open, crushed, or chewed.

The nurse is providing instructions to the client newly diagnosed with diabetes mellitus who has been prescribed pramlintide. Which instruction should the nurse include in the discharge teaching? 1."Inject the pramlintide at the same time you take your other medications." 2."Take your prescribed pills 1 hour before or 2 hours after the injection." 3."Be sure to take the pramlintide with food so you don't upset your stomach." 4."Make sure you take your pramlintide immediately after you eat so you don't experience a low blood sugar."

2. take your prescribed pills 1 hour before or 2 hours after the injection Pramlintide is used for clients with types 1 and 2 diabetes mellitus who use insulin. It is administered subcutaneously before meals to lower blood glucose level after meals, leading to less fluctuation during the day and better long-term glucose control. Because pramlintide delays gastric emptying, any prescribed oral medications should be taken 1 hour before or 2 hours after an injection of pramlintide; therefore, instructing the client to take his or her pills 1 hour before or 2 hours after the injection is correct. Pramlintide should not be taken at the same time as other medications. Pramlintide is given immediately before the meal in order to control postprandial rise in blood glucose, not necessarily to prevent stomach upset. It is incorrect to instruct the client to take the medication after eating, as it will not achieve its full therapeutic effect.

A client with diabetes mellitus received 20 units of Humulin N insulin subcutaneously at 0800. At what time should the nurse plan to assess the client for a hypoglycemic reaction? 1.1000 2.1100 3.1700 4.2400

3. 1700 Humulin N is an intermediate-acting insulin. The onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and the duration of action is 16 to 24 hours. Hypoglycemic reactions most likely occur during peak time.

The nurse is applying a topical glucocorticoid as prescribed for a client with psoriasis. The nurse would be concerned about the potential for systemic absorption of the medication if it were being applied in which situation? 1.Applied for 2 days until the irritation has resolved 2.Applied to a small area on the arm underneath a gauze dressing 3.Applied to a reddened, itchy area underneath an occlusive dressing 4.Applied to a small area on the neck and another small area on the back

3. applied to a reddened, itchy area underneath an occlusive dressing Topical glucocorticoids can be absorbed into the systemic circulation. Toxicity is a concern if a glucocorticoid is used for an extended period of time, if it is applied underneath an occlusive dressing, or if it is applied to a large area of the body. Therefore, options 1, 2, and 4 are incorrect.

A client is taking lansoprazole. The nurse anticipates that the primary health care provider will advise the client to take which product if needed for a headache? 1.Naproxen 2.Ibuprofen 3.Acetaminophen 4.Acetylsalicylic acid

3. acetaminophen Lansoprazole is a proton pump inhibitor and is commonly used to treat a gastrointestinal disorder. The client with gastrointestinal disease should avoid taking medications that are irritating to the stomach lining. Irritants would include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), which include naproxen and ibuprofen. The client should be advised to take acetaminophen for a headache.

A client with diabetes mellitus calls the clinic and tells the nurse that he has been nauseated during the night. The client asks the nurse if the morning insulin should be administered. Which is the most appropriate nursing response? 1.Omit the insulin. 2.Administer half of the prescribed dose. 3.Administer the full dose as prescribed. 4.Wait until noon before making a decision.

3. administer the full dose as prescribed When the client with diabetes mellitus becomes ill, control is more difficult. Insulin is not omitted, and the client is encouraged to consume liquid carbohydrates if unable to eat regular meals. The client is instructed to notify the primary health care provider if vomiting or diarrhea occurs or if the illness progresses past 2 days. Prescribed medication is not altered by the nurse.

A client has an as needed prescription for loperamide hydrochloride. For which condition should the nurse administer this medication? 1.Constipation 2.Abdominal pain 3.An episode of diarrhea 4.Hematest-positive nasogastric tube drainage

3. an episode of diarrhea Loperamide is an antidiarrheal agent. It is used to manage acute and chronic diarrhea in conditions such as inflammatory bowel disease. Loperamide also can be used to reduce the volume of drainage from an ileostomy. It is not used for the conditions in options 1, 2, and 4.

A hospitalized client with coronary artery disease complains of substernal chest pain. After assessing the client's heart rate and blood pressure, the nurse administers nitroglycerin, 0.4 mg sublingually. After 5 minutes the client states, "My chest still hurts." Which actions should the nurse take? Select all that apply. 1.Call a Code Blue. 2.Contact the client's family. 3.Assess the client's pain level. 4.Check the client's blood pressure. 5.Contact the primary health care provider (PHCP). 6.Administer a second nitroglycerin, 0.4 mg sublingually.

3. assess the client's pain level 4. check the client's blood pressure 6. administer a second nitroglycerin, 0.4 mg sublingually The usual guidelines for administering nitroglycerin tablets for chest pain to a hospitalized client include administering 1 tablet every 5 minutes PRN (as needed) for chest pain, for a total dose of 3 tablets. If the client does not obtain relief after taking a third dose of nitroglycerin, the PHCP is notified. Because the client is still complaining of chest pain, the nurse would administer a second nitroglycerin tablet. The nurse would assess the client's pain level and check the client's blood pressure before administering each nitroglycerin dose. There are no data in the question that indicate the need to call a Code Blue. In addition, it is not necessary to contact the client's family unless he or she has requested this.

A client with portosystemic encephalopathy is receiving oral lactulose daily. The nurse should check which item to determine that this medication has been effective? 1.Lung sounds 2.Blood pressure 3.Blood ammonia level 4.Serum potassium level

3. blood ammonia level Lactulose is a hyperosmotic laxative and ammonia detoxicant. It is used to prevent or treat portosystemic encephalopathy, including hepatic precoma and coma. It also is used to treat constipation. The medication retains ammonia in the colon (decreases the blood ammonia concentration), producing an osmotic effect. It promotes increased peristalsis and bowel evacuation, expelling ammonia from the colon. This medication has no effect on lung sounds, blood pressure, or serum potassium level.

The nurse has given a client the prescribed dose of intravenous hydralazine. The nurse evaluates the effectiveness of the medication by monitoring which client parameter? 1.Pulse rate 2.Urine output 3.Blood pressure 4.Potassium level

3. blood pressure Hydralazine is an antihypertensive medication used in the management of moderate to severe hypertension. It is a vasodilator medication that decreases afterload. The blood pressure needs to be monitored. The remaining options are unrelated to the use of this medication.

Atenolol has been prescribed for a client with hypertension, and the client asks the nurse about the side effects of the medication. What should the nurse tell the client is an occasional side effect of this medication? 1.Dry skin 2.Flushing 3.Decreased libido 4.Increased blood pressure

3. decreased libido Atenolol is a beta-adrenergic blocker that is used as an antihypertensive, antianginal, and antidysrhythmic. It blocks beta-adrenergic receptors in cardiac tissue and produces the therapeutic effects of slowing the heart rate, decreasing cardiac output, decreasing blood pressure, and decreasing myocardial oxygen demand. Frequent side effects include hypotension manifested as dizziness, nausea, diaphoresis, headache, cold extremities, fatigue, and constipation or diarrhea. Occasional side effects include insomnia, flatulence, urinary frequency, and impotence or decreased libido. The remaining options are not side effects of this medication.

Terbutaline is prescribed for a client with bronchitis. Which disorder in the client's medical history requires caution by the nurse? 1.Osteoarthritis 2.Hypothyroidism 3.Diabetes mellitus 4.Polycystic disease

3. diabetes mellitus Terbutaline is a bronchodilator and is contraindicated in clients with hypersensitivity to sympathomimetics. It should be used with caution in clients with impaired cardiac function, diabetes mellitus, hypertension, hyperthyroidism, or a history of seizures. The medication may increase blood glucose levels.

A client is admitted to the hospital with a diagnosis of myocardial infarction (MI). The client is started on alteplase therapy. The nurse determines that teaching has been effective when the client's significant other states that the purpose of the medication is to perform which action? 1.Thin the blood. 2.Slow the clotting of the blood. 3.Dissolve any clots in the coronary arteries. 4.Prevent further clots from forming in the coronary arteries.

3. dissolve any clots in the coronary arteries Alteplase converts plasminogen in the blood to plasmin. Plasmin is an enzyme that digests or dissolves fibrin clots wherever they exist. Heparin sodium and warfarin sodium thin the blood, slow clotting, and prevent further clots from forming.

A client is taking cetirizine. The nurse should inform the client of which side effect of this medication? 1.Diarrhea 2.Excitability 3.Drowsiness 4.Excess salivation

3. drowsiness Cetirizine is an antihistamine; frequent side effects are drowsiness or sedation. Others include blurred vision, hypertension (and sometimes hypotension), dry mouth, constipation, urinary retention, and sweating. Therefore, the other options are incorrect.

The nurse is planning to administer hydrochlorothiazide to a client diagnosed with hypertension. The nurse should monitor for which adverse effects related to the administration of this medication? 1.Hypouricemia, hyperkalemia 2.Increased risk of osteoporosis 3.Hypokalemia, hyperglycemia, sulfa allergy 4.Hyperkalemia, hypoglycemia, penicillin allergy

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

The nurse teaches a client newly diagnosed with type 1 diabetes about storing Humulin N insulin. Which statement indicates to the nurse that the client understood the discharge teaching? 1."I should keep the insulin in the cabinet during the day only." 2."I know I have to keep my insulin in the refrigerator at all times." 3."I can store the open insulin bottle in the kitchen cabinet for 1 month." 4."The best place for my insulin is on the windowsill, but in the cupboard is just as good."

3. i can store the open insulin bottle in the kitchen cabinet for 1 month An insulin vial in current use can be kept at room temperature for 1 month without significant loss of activity. Direct sunlight and heat must be avoided. Therefore, options 1, 2, and 4 are incorrect.

The client with hyperparathyroidism is taking alendronate. Which statements by the client indicate understanding of the proper way to take this medication? Select all that apply. 1."I should take this medication with food." 2."I should take this medication at bedtime." 3."I should sit up for at least 30 minutes after taking this medication." 4."I should take this medication first thing in the morning on an empty stomach." 5."I can pick a time to take this medication that best fits my lifestyle as long as I take it at the same time each day."

3. i should sit up for at least 30 minutes after taking this medication 4. i should take this medication first thing in the morning on an empty stomach Alendronate is a bisphosphonate used in hyperparathyroidism to inhibit bone loss and normalize serum calcium levels. Esophagitis is an adverse effect of primary concern in clients taking alendronate. For this reason the client is instructed to take alendronate first thing in the morning with a full glass of water on an empty stomach, not to eat or drink anything else for at least 30 minutes after taking the medication, and to remain sitting upright for at least 30 minutes after taking it.

The nurse is providing education to a client with type 2 diabetes about starting insulin glargine to help with improved glycemic control. Which statement made by the client indicates understanding? 1."It has a distinct peak." 2."It can be given intravenously." 3."It has a decreased risk for hypoglycemia." 4."I don't have to perform fingerstick glucose monitoring."

3. it has a decreased risk for hypoglycemia In contrast to other long-acting insulins, insulin glargine achieves blood levels that are relatively steady over 24 hours. As a result, there is less risk of hypoglycemia or hyperglycemia. The only insulins that can be administered intravenously are the short-acting insulins. All medications used to treat diabetes mellitus require fingerstick monitoring.

A client is being treated for moderate hypertension and has been taking diltiazem for several months. The client schedules an appointment with the primary health care provider because of episodes of chest pain, and Prinzmetal's angina is diagnosed. The client asks the nurse which therapeutic effects the medication will provide, and the nurse provides education. Which statement by the client indicates that the teaching has been effective? 1."It increases the force of contraction of heart tissues." 2."It increases oxygen demands within the myocardium." 3."It prevents an influx of calcium ions in the smooth muscle." 4."It leads to an increase in calcium absorption in the smooth muscle."

3. it prevents an influx of calcium ions in smooth muscle Diltiazem is a calcium channel blocker that inhibits calcium influx through the slow channels of the membrane of smooth muscle cells. These medications decrease myocardial oxygen demands and block calcium channels, thereby decreasing the force of contraction of the ventricular tissue.

Zafirlukast is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication? 1.Platelet count 2.Neutrophil count 3.Liver function tests 4.Complete blood count

3. liver function tests Zafirlukast is a leukotriene receptor antagonist used in the prophylaxis and long-term treatment of bronchial asthma. Zafirlukast is used with caution in clients with impaired hepatic function. Liver function laboratory tests should be performed to obtain a baseline, and the levels should be monitored during administration of the medication. It is not necessary to perform the other laboratory tests before administration of the medication.

The nurse is preparing to administer albuterol to a client. Which parameters should the nurse assess before and during therapy? 1.Nausea and vomiting 2.Headache and level of consciousness 3.Lung sounds and presence of dyspnea 4.Urine output and blood urea nitrogen level

3. lung sounds and presence of dyspnea Albuterol is an adrenergic bronchodilator. The nurse assesses respiratory pattern, lung sounds, pulse, and blood pressure before and during therapy. The nurse also notes the color, character, and amount of sputum.

A client is diagnosed with an ST segment elevation myocardial infarction (STEMI) and is receiving a tissue plasminogen activator, alteplase. Which action is a priority nursing intervention? 1.Monitor for kidney failure. 2.Monitor psychosocial status. 3.Monitor for signs of bleeding. 4.Have heparin sodium available.

3. monitor for signs of bleeding Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychosocial status are important but are not the most critical interventions. Heparin may be administered after thrombolytic therapy, but the question is not asking about follow-up medications.

The nurse has been given a medication prescription to administer intravenous (IV) hydralazine. The nurse obtains which priority piece of equipment needed for use during administration of this medication? 1.Pulse oximetry 2.Cardiac monitor 3.Noninvasive blood pressure cuff 4.Non-rebreather oxygen face mask

3. noninvasive blood pressure cuff Hydralazine is an antihypertensive medication used for moderate to severe hypertension. Because the blood pressure and pulse should be monitored frequently after administration, a noninvasive blood pressure cuff should be obtained. The other options are not priority items specific to the use of this medication.

The nurse is caring for a client who is taking warfarin. The nurse notes the presence of gross hematuria and large areas of bruising on the client's body. The nurse notifies the primary health care provider (PHCP) and ensures that which prescribed medication is available? 1.Heparin sulfate 2.Protamine sulfate 3.Phytonadione (vitamin K) 4.Oral potassium supplements

3. phytonadione (vitamin K) Warfarin is an oral anticoagulant. The effects of warfarin overdose can be reversed with phytonadione (vitamin K). Vitamin K is an antagonist to the action of warfarin that can reverse warfarin-induced inhibition of clotting factor synthesis. For mild bleeding, vitamin K should be administered orally; a dose of 10 to 20 mg will cause prothrombin levels to normalize within 24 hours. If bleeding is severe, parenteral vitamin K is indicated. Protamine sulfate is the antidote for heparin sulfate, an anticoagulant that would cause increased bleeding. The question presents no data suggesting that potassium supplements are indicated.

A client is admitted to a hospital with acute myocardial infarction and is started on tissue plasminogen activator (tPA) by infusion. Which parameter should the nurse determine requires the least frequent assessment to detect complications of therapy with tPA? 1.Neurological signs 2.Blood pressure and pulse 3.Presence of bowel sounds 4.Complaints of abdominal and back pain

3. presence of bowel sounds Thrombolytic agents dissolve existing clots, and bleeding can occur anywhere in the body. The nurse monitors for any obvious signs of bleeding and also for occult signs of bleeding, which would include hemoglobin and hematocrit values, blood pressure and pulse, neurological signs, assessment of abdominal and back pain, and the presence of blood in the urine or stool.

A client receiving heparin sodium by continuous intravenous (IV) infusion removes the tubing from the pump to change his hospital gown. The nurse is concerned that the client received a bolus of medication. After requesting a prescription for a stat partial thromboplastin time (PTT), the nurse should check for the availability of which medication in the medication cart? 1.Enoxaparin 2.Phytonadione 3.Protamine sulfate 4.Aminocaproic acid

3. protamine sulfate If the tubing is removed from an IV pump and the tubing is not clamped, the client will receive a bolus of the solution and the medication contained in the solution. The client who receives a bolus dose of heparin sodium is at risk for bleeding. If the results of the next PTT are extremely high, a dose of protamine sulfate, the antidote for heparin sodium, may be prescribed. Enoxaparin is an anticoagulant. Phytonadione is the antidote for warfarin sodium. Aminocaproic acid is an antifibrinolytic agent (inhibits clot breakdown).

The nurse is preparing to administer a dose of naloxone intravenously to a client with an opioid overdose. Which supportive medical equipment should the nurse plan to have at the client's bedside if needed? 1.Nasogastric tube 2.Paracentesis tray 3.Resuscitation equipment 4.Central line insertion tray

3. resuscitation equipment The nurse administering naloxone for suspected opioid overdose should have resuscitation equipment readily available to support naloxone therapy if it is needed. Other adjuncts that may be needed include oxygen, a mechanical ventilator, and vasopressors.

A client diagnosed with active tuberculosis has been prescribed a combination of isoniazid and rifampin for treatment. The nurse teaches the client to perform which action? 1.Report any change in urine color. 2.Take both medications with food. 3.Take both medications together once a day. 4.Expect to take the medications for 2 to 3 weeks.

3. take both medications together once a day Rifampin in combination with isoniazid prevents the emergence of medication-resistant organisms. This combination, taken together daily, eliminates the tubercle bacilli from the sputum and improves clinical status. Rifampin produces a harmless red-orange color in all body fluids and should be taken along with the isoniazid 1 hour before or 2 hours after eating to maximize absorption. The treatment regimen is maintained for at least 6 months for effectiveness, and the therapeutic effect may be evident in 2 to 3 weeks.

A client is taking amiloride 10 mg orally daily for hypertension. What medication instruction should the nurse provide to the client? 1.Take the dose without food. 2.Eat foods with extra sodium. 3.Take the dose in the morning. 4.Withhold the dose if the blood pressure is high

3. take the dose in the morning Amiloride is a potassium-retaining diuretic used to treat edema or hypertension. The daily dose should be taken in the morning to avoid nocturia, and the medication should be taken with food to increase bioavailability. Sodium should be restricted or limited as prescribed. Increased blood pressure is not a reason to withhold the medication; rather, it may be an indication for its use.

A client with a history of gastroesophageal reflux disease (GERD) is diagnosed with peptic ulcer disease (PUD). The primary health care provider prescribes sucralfate in addition to the client's other medications. What teaching should the nurse include in this client's instructions? 1.Take the sucralfate once a day at bedtime with food. 2.Take the sucralfate daily with the proton pump inhibitor. 3.Take the sucralfate before meals and at bedtime on an empty stomach. 4.Take the sucralfate immediately after eating and within 30 minutes of an antacid.

3. take the sucralfate before meals and at bedtime on an empty stomach Sucralfate is an antiulcer medication that promotes ulcer healing by creating a protective barrier against acid and pepsin. It should be taken on an empty stomach. The usual recommended adult dosage is 1 gram 4 times a day, taken 1 hour before meals and at bedtime. Options 1, 2, and 4 are incorrect, as sucralfate should be taken on an empty stomach, at least twice a day, and at least 30 minutes apart from an antacid.

A client has a prescription to take guaifenesin. The nurse determines that the client understands the proper administration of this medication if the client states that he or she will perform which action? 1.Take an extra dose if fever develops. 2.Take the medication with meals only. 3.Take the tablet with a full glass of water. 4.Decrease the amount of daily fluid intake.

3. take the tablet with a full glass of water Guaifenesin is an expectorant and should be taken with a full glass of water to decrease the viscosity of secretions. Extra doses should not be taken. The client should contact the primary health care provider if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache. Fluids are needed to decrease the viscosity of secretions. The medication does not have to be taken with meals.

Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. The client asks the nurse if her family member with bladder cancer can also take this medication. The nurse most appropriately responds by making which statement? 1."This medication can be used only to treat breast cancer." 2."Yes, your family member can take this medication for bladder cancer as well." 3."This medication can be taken to prevent and treat clients with breast cancer." 4."This medication can be taken by anyone with cancer as long as their primary health care provider approves it."

3. this medication can be taken to prevent and treat clients with breast cancer Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy and for preventing breast cancer in those that are at high risk.

A primary health care provider prescribes cisplatin and vincristine to a client with bladder cancer. The nurse should explain to the client that 2 medications are administered together for which reason? 1.To prevent alopecia 2.To decrease the destruction of cells 3.To increase the therapeutic response 4.To prevent gastrointestinal side effects

3. to increase the therapeutic response Cisplatin is an alkylating type of medication, and vincristine is a vinca (plant) alkaloid. Alkylating medications are cell-cycle nonspecific. Vinca alkaloids are cell-cycle specific and act on the M phase. Combinations of medications are used to enhance tumoricidal effects and increase the therapeutic response. Alopecia and gastrointestinal disturbances are side and adverse effects of chemotherapy.

The nurse is preparing to administer heparin sodium subcutaneously. Which nursing action is the most appropriate? 1.Apply heat after the injection. 2.Aspirate before injection of the medication. 3.Use a 25- to 26-gauge, ⅝-inch (1.5 cm) needle. 4.Use a 21- to 23-gauge, 1-inch (2.5 cm) needle.

3. use a 25 to 26 gauge, 5/8 inch needle For subcutaneous heparin sodium injection, a 25- to 26-gauge, ⅝-inch (1.5 cm) needle is used to prevent tissue trauma and inadvertent intramuscular injection. The application of heat may affect the absorption of the heparin sodium and cause bleeding. A 1-inch (2.5 cm) needle would inject the heparin sodium into the muscle. Aspiration before injection is an incorrect technique with heparin sodium administration because it could cause bleeding in the tissues.

A client with tuberculosis (TB) has a prescription for rifampin. What instruction should the nurse include in the client's teaching plan? 1.Yellow-colored skin is common with this medication. 2.The medication must always be taken on an empty stomach. 3.Wearing glasses instead of soft contact lenses will be necessary. 4.As soon as the cultures come back negative, the medication may be stopped.

3. wearing glasses instead of soft contact lenses will be necessary Soft contact lenses may be permanently damaged by the orange discoloration in body fluids caused by rifampin. Any sign of possible jaundice (yellow-colored skin) should always be reported. If rifampin is not tolerated on an empty stomach, it may be taken with food. The client may be on the medication for 12 months even if cultures give negative results.

A client with an exacerbation of chronic obstructive pulmonary disease (COPD) has been on oral glucocorticoids and is currently being weaned to triamcinolone by inhalation. The nurse determines that the client understands the potential adverse effects to watch for during this medication change when the client states the need to report which signs and symptoms? 1.Chills, fever, and generalized rash 2.Vomiting, diarrhea, and increased thirst 3.Blurred vision, headache, and insomnia 4.Anorexia, nausea, weakness, and fatigue

4. anorexia, nausea, weakness, and fatigue The client being changed from oral to inhalation glucocorticoids could experience signs of adrenal insufficiency. The nurse teaches the client to report anorexia, nausea, weakness, and fatigue. Other signs that can be detected and are objective include hypotension and hypoglycemia.

A nurse is providing teaching regarding nateglinide. A portion of the teaching involves time of administration, and the nurse should tell the client to take the medication at which time? 1.Bedtime 2.During lunch 3.During breakfast 4.Before each meal

4. before each meal Nateglinide has a rapid onset of action (within 20 minutes) and a short duration of action (4 hours). It is administered 3 times daily immediately before meals. The other time frames would not provide the best outcome.

A cromolyn sodium inhaler is prescribed for a client with allergic asthma. The nurse provides instructions regarding the adverse effects of this medication and should tell the client that which undesirable effect is associated with this medication? 1.Insomnia 2.Constipation 3.Hypotension 4.Bronchospasm

4. bronchospasm Cromolyn sodium is an inhaled nonsteroidal antiallergy agent and a mast cell stabilizer. Undesirable effects associated with inhalation therapy of cromolyn sodium are bronchospasm, cough, nasal congestion, throat irritation, and wheezing. Clients receiving this medication orally may experience pruritus, nausea, diarrhea, and myalgia.

A client who is scheduled to have warfarin sodium therapy has a prothrombin time (PT) of 28 seconds (28 seconds). What is the most appropriate nursing intervention at this time? 1.Give double the dose. 2.Administer the next dose. 3.Give half of the next dose. 4.Call the primary health care provider (PHCP).

4. call the primary health care provider (PHCP) The PT is one test that may be used to monitor warfarin sodium therapy. The international normalized ratio is another laboratory test used to monitor warfarin therapy. The normal PT is 11 to 12.5 seconds (11 to 12.5 seconds). A PT of 28 seconds represents an elevated value. The nurse should withhold the next dose and notify the PHCP. A medication dose should not be changed without a specific prescription (options 1 and 3).

The nurse is preparing to give a client directions for proper use of aluminum hydroxide tablets. Which instruction should the nurse provide to the client? 1."Take the tablet at the same time as an antacid." 2."Swallow the tablet whole with a full glass of water." 3."Take each dose with a laxative to prevent constipation." 4."Chew the tablet thoroughly and then drink 8 ounces of water."

4. chew the tablet thoroughly and then drink 8 ounces of water Aluminum hydroxide tablets are an antacid and should be chewed thoroughly before swallowing to prevent them from entering the small intestine undissolved. An antacid should not be taken with the medication to prevent additive and interactive effects. Constipation is a side or adverse effect of the use of aluminum products, but the client should not take a laxative with each dose. This would promote laxative abuse and should be avoided if less habit-forming means can be used

The nurse is administering a dose of pirbuterol to a client. The nurse should monitor for which side or adverse effect of this medication? 1.Drowsiness 2.Hypokalemia 3.Hyperglycemia 4.Increased pulse

4. increased pulse Pirbuterol is an adrenergic bronchodilator. Side and adverse effects include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache. The nurse monitors for these effects during therapy. The other options are not side and adverse effects of this medication.

Vasopressin is prescribed for a client with diabetes insipidus. The nurse should be particularly cautious in monitoring a client receiving this medication if the client has which preexisting condition? 1.Depression 2.Endometriosis 3.Pheochromocytoma 4.Coronary artery disease

4. coronary artery disease Because of its powerful vasoconstrictor actions, vasopressin can cause adverse cardiovascular effects. By constricting arteries of the heart, vasopressin can cause angina pectoris and even myocardial infarction, especially if administered to clients with coronary artery disease. In addition, vasopressin may cause vascular problems by decreasing blood flow in the periphery. The remaining options are not conditions of concern with the use of this medication.

The nurse has given a client taking ethambutol information about the medication. The nurse determines that the client understands the instructions if the client states that he or she will immediately report which finding? 1.Impaired sense of hearing 2.Gastrointestinal side effects 3.Orange-red discoloration of body secretions 4.Difficulty in discriminating the color red from green

4. difficulty in discriminating the color red from green Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client also is taught to take the medication with food if gastrointestinal upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin.

The nurse has given a client taking ethambutol information about the medication. The nurse determines that the client understands the instructions if the client states that they will immediately report which finding? 1.Impaired sense of hearing 2.Gastrointestinal side effects 3.Orange-red discoloration of body secretions 4.Difficulty in discriminating the color red from green

4. difficulty in discriminating the color red from green Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client also is taught to take the medication with food if gastrointestinal upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin.

The nurse has completed giving medication instructions to a client receiving benazepril. Which client statement indicates to the nurse that the client needs further instruction? 1."I need to change positions slowly." 2."I will monitor my blood pressure every week." 3."I will report signs and symptoms of infection immediately." 4."I can use salt substitutes freely and eat foods high in potassium."

4. i can use salt substitutes freely and eat foods high in potassium The client taking an angiotensin-converting enzyme (ACE) inhibitor is instructed to take the medication exactly as prescribed, to monitor blood pressure weekly, and to continue with other lifestyle changes to control hypertension. The client should change positions slowly to avoid orthostatic hypotension and report fever, mouth sores, or sore throat (neutropenia) to the health care provider. In addition, salt substitutes and high-potassium foods should be avoided because they contain potassium and increase the risk for hyperkalemia.

Cortisone acetate is prescribed for a client with adrenal insufficiency. The nurse provides instructions to the client regarding the medication. Which statement, if made by the client, indicates a need for further instruction? 1."I will limit my sodium intake." 2."I will avoid people with colds." 3."I will eat a good breakfast every day." 4."I will stop the medication when I feel better."

4. i will stop the medication when i feel better To prevent acute adrenal insufficiency, glucocorticoids should not be abruptly discontinued. These medications can cause sodium and water retention and the loss of potassium, so clients should be instructed to limit sodium intake and consume potassium-rich foods. These medications can increase the risk of infection, and the client should avoid contact with clients who are ill. Additionally, adequate dietary intake is important.

The nurse provides discharge instructions to a client who is taking warfarin sodium. Which statement, by the client, reflects the need for further teaching? 1."I will avoid alcohol consumption." 2."I will take my pills every day at the same time." 3."I have already called my family to pick up a MedicAlert bracelet." 4."I will take coated aspirin for my headaches because it will coat my stomach."

4. i will take coated aspirin for my headaches because it will coat my stomach Aspirin-containing products need to be avoided when a client is taking this medication. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking the prescribed medication at the same time each day increases client compliance. The MedicAlert bracelet provides health care personnel with emergency information.

Which statement made by a client taking montelukast indicates the need for further teaching? 1."I will need to have my liver function checked." 2."I can take the medication with food or without." 3."I may be able to decrease the use of my metered-dose inhaler." 4."I will take the medication when I first notice I am having trouble breathing."

4. i will take the medication when i first notice i am having trouble breathing Montelukast cannot be used for quick relief of an asthma attack because effects of the medication develop too slowly. For prophylaxis and maintenance therapy of asthma, maximal effects develop within 24 hours of the first dose and are maintained with once-daily dosing in the evening. The remaining options are correct statements.

A client with chronic obstructive pulmonary disease (COPD) is being changed from an oral glucocorticoid to triamcinolone by inhalation. The client asks why this change is necessary. Which statement by the nurse to the client is accurate? 1."Inhaled glucocorticoids cure the condition." 2."Inhaled glucocorticoids treat this condition more effectively." 3."Inhaled glucocorticoids decrease the symptoms more quickly." 4."Inhaled glucocorticoids are preferred because of decreased adverse effects."

4. inhaled glucocorticoids are preferred because of decreased adverse effects Triamcinolone is an adrenocorticosteroid. Inhaled glucocorticoids are preferable for long-term management because there is a decreased incidence of adverse effects since the medication is not absorbed systemically. COPD is a progressive condition and cannot be cured. Options 2 and 3 are incorrect.

Cromolyn sodium is prescribed for the client with allergic asthma. What goal does the nurse expect to achieve by administration of this medication? 1.Dilation of the bronchi 2.Increase in the number of eosinophils 3.Promotion of the migration of eosinophils into the inflammatory site 4.Inhibition of the release of mediators from mast cells after exposure to an antigen

4. inhibition of the release of mediators from mast cells after exposure to an antigen Cromolyn sodium is an antiasthmatic, antiallergic, and mast cell stabilizer that inhibits the release of mediators from mast cells after exposure to an antigen. It can also interrupt the migration of eosinophils into the inflammatory site and decrease the number of eosinophils. These actions decrease airway hyperresponsiveness in some clients with asthma. It has no bronchodilating action.

A client with a gastric ulcer has a prescription for sucralfate 1 gram by mouth 4 times daily. The nurse should schedule the medication for which times? 1.With meals and at bedtime 2.Every 6 hours around the clock 3.One hour after meals and at bedtime 4.One hour before meals and at bedtime

4. one hour before meals and at bedtime Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation. The other options are incorrect.

A client is being discharged to home with enoxaparin for short-term therapy. What should the nurse explain to the family about the medication action? 1.Relieves joint pain 2.Dissolves urinary calculi 3.Stops progression of multiple sclerosis 4.Reduces the risk of deep vein thrombosis

4. reduces the risk of deep vein thrombosis Enoxaparin is an anticoagulant that is administered to prevent deep vein thrombosis and thromboembolism in clients at risk. It is not used to treat the conditions listed in options 1, 2, or 3.

A client has been taking pyrazinamide for 1 month. The client asks the nurse whether the therapy is due to be terminated soon. The nurse determines that the medication probably will be continued based on a positive finding in which report? 1.Blood culture 2.Urine culture 3.Wound culture 4.Sputum culture

4. sputum culture Pyrazinamide is an antituberculosis medication given with other antituberculosis medications. Pyrazinamide might not be discontinued if sputum cultures continue to be positive. The remaining options are not related directly to the use of this medication.

A client has a prescription to receive enoxaparin. The nurse should plan to administer this medication by which route? 1.Oral 2.Intravenous 3.Intramuscular 4.Subcutaneous

4. subcutaneous Enoxaparin is an anticoagulant that is administered by the subcutaneous route. It is used in preventing thromboembolism in selected clients at risk. It also may be administered by the client at home after hospital discharge with follow-up assessments by a home health nurse. It is not administered orally or by the intravenous or intramuscular routes.

The diabetes nurse specialist conducts a teaching session to a group of nursing students regarding sulfonylureas, oral hypoglycemic medications used for type 2 diabetes mellitus. Which statement, describing the primary action of these medications, should the nurse include in the teaching session? 1."Sulfonylureas decrease insulin resistance." 2."Sulfonylureas inhibit carbohydrate digestion." 3."Sulfonylureas decrease glucose production by the liver." 4."Sulfonylureas promote insulin secretion by the pancreas."

4. sulfonylureas promote insulin secretion by the pancreas Sulfonylureas promote insulin secretion by the pancreas and may also increase tissue response to insulin. Thiazolidinediones decrease insulin resistance. α-Glucosidase inhibitors inhibit carbohydrate digestion. Biguanides decrease glucose production by the liver.

Silver sulfadiazine is prescribed for a client with a partial-thickness burn, and the nurse provides teaching about the medication. Which statement made by the client indicates a need for further teaching about the treatments? 1."The medication is an antibacterial." 2."The medication will help heal the burn." 3."The medication should be applied directly to the wound." 4."The medication is likely to cause stinging every time it is applied."

4. the medication is likely to cause stinging every time it is applied Silver sulfadiazine is an antibacterial that has a broad spectrum of activity against gram-negative bacteria, gram-positive bacteria, and yeast. It is applied directly to the wound to assist in healing. It does not cause stinging when applied.

A client is receiving somatropin. The nurse should monitor which most significant laboratory study during therapy with this medication? 1.Lipase level 2.Amylase level 3.Blood urea nitrogen (BUN) level 4.Thyroid-stimulating hormone level

4. thyroid-stimulating hormone level Somatropin is used to stimulate linear growth in pediatric clients who lack adequate normal human growth hormone. An adverse effect of somatropin is hypothyroidism. Therefore, thyroid function is monitored throughout therapy. Lipase and amylase levels would evaluate pancreatic function, and BUN level evaluates renal function.

A client has a new prescription for metoclopramide. On review of the chart, the nurse identifies that this medication can be safely administered with which condition? 1.Intestinal obstruction 2.Peptic ulcer with melena 3.Diverticulitis with perforation 4.Vomiting following cancer chemotherapy

4. vomiting following cancer chemotherapy Metoclopramide is a gastrointestinal stimulant and antiemetic. Because it is a gastrointestinal stimulant, it is contraindicated with gastrointestinal obstruction, hemorrhage, or perforation. It is used in the treatment of vomiting after surgery, chemotherapy, or radiation.

The nurse caring for a client receiving vincristine is monitoring the client for toxicity. The nurse interprets that the client is experiencing a toxic effect of this medication on the basis of which assessment finding? 1.Nausea and vomiting 2.Decreased platelet count 3.Decreased white blood cell count 4.Weakness and sensory loss in the legs

4. weakness and sensory loss in the legs Peripheral neuropathy is the major dose-limiting toxicity associated with vincristine. Nearly all clients exhibit signs and symptoms of sensory or motor nerve injury such as decreased reflexes, weakness, paresthesia, and sensory loss. Nausea and vomiting are rare with the use of this medication. In contrast with most anticancer medications, vincristine causes little toxicity to bone marrow.

A primary health care provider (PHCP) writes a prescription for digoxin, 0.25 mg daily. The nurse teaches the client about the medication and tells the client that it is most important to be sure to implement which measure? 1.Count the radial and carotid pulses every morning. 2.Check the blood pressure every morning and evening. 3.Stop taking the medication if the pulse is faster than 100 beats/min. 4.Withhold the medication and call the PHCP if the pulse is slower than 60 beats/min.

4. withhold the medication and call the PHCP if the pulse is slower than 60 beats/min An important component of taking digoxin is monitoring the pulse rate; however, it is not necessary for the client to take both radial and carotid pulses. It is also unnecessary for the client to check the blood pressure every morning and evening because the medication does not directly affect blood pressure. It is most important for the client to know the guidelines related to withholding the medication and calling the PHCP. The client should not stop taking the medication.

apecitabine has been prescribed for a client with breast cancer, and the client asks the nurse about the side effects of the medication. The nurse responds that a frequent side effect of this medication is which finding? 1.Diarrhea 2.Weakness 3.Irritability 4.Increased appetite

1. diarrhea Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. Frequent side effects include diarrhea, nausea, vomiting, stomatitis, hand and foot syndrome (painful palmar-plantar erythema and swelling with paresthesias, tingling, and blistering), fatigue, anorexia, and dermatitis. Weakness, irritability, and increased appetite are not side effects of this medication.

A burn client is receiving treatments of topical mafenide acetate to the site of injury. The nurse monitors the client, knowing that which finding indicates that a systemic effect has occurred? 1.Hyperventilation 2.Elevated blood pressure 3.Local rash at the burn site 4.Local pain at the burn site

1. hyperventilation Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal excretion of acid, thereby causing acidosis. Clients receiving this treatment should be monitored for signs of an acid-base imbalance (hyperventilation). If this occurs, the medication will probably be discontinued for 1 to 2 days. Options 3 and 4 describe local rather than systemic effects. An elevated blood pressure may be expected from the pain that occurs with a burn injury.

An older client takes a stimulant laxative for ongoing management of chronic constipation. Which findings should the nurse expect to note when reviewing the client's laboratory results? 1.Hypokalemia 2.Hyperkalemia 3.Hyponatremia 4.Hypernatremia

1. hypokalemia Hypokalemia can result from long-term use of a stimulant laxative. The medication stimulates peristalsis and alters fluid and electrolyte transport, thus helping fluid to accumulate in the colon. The remaining options are not specifically associated with the use of this medication.

The nurse has provided instructions to a client regarding the use of tretinoin. Which statement made by the client indicates the need for further instruction? 1."I must apply it to wet to damp skin." 2."Optimal results will be seen after 6 weeks." 3."I will wash my hands thoroughly after applying the medication." 4."I will cleanse the skin thoroughly before applying the medication."

1. i must apply it to wet to damp skin Therapeutic results with the use of tretinoin should be seen after 2 to 3 weeks but may not be optimal until after 6 weeks. The hands are washed thoroughly before and immediately after applying tretinoin. The skin needs to be cleansed thoroughly and dried fully before the medication is applied.

Isotretinoin is prescribed for a client with severe cystic acne. The nurse provides instructions to the client regarding administration of the medication. Which phrase stated by the client indicates a need for further teaching regarding this medication? 1."I need to continue to take my vitamin A supplements." 2."The medication may cause dryness and burning in my eyes." 3."I need to use emollients and lip balms for my dry skin and lips." 4."I will need to return for a blood test to check my triglyceride level."

1. i need to continue to take my vitamin A supplements In severe cystic acne, isotretinoin is used to inhibit inflammation. Adverse effects include elevated triglyceride levels, skin dryness, eye discomfort such as dryness and burning, and cheilitis (lip inflammation). Close medical follow-up is required, and dry skin and cheilitis can be decreased by the use of emollients and lip balms. Vitamin A supplements are stopped during this treatment.

A client who has been diagnosed with breast cancer is to receive chemotherapy with both cisplatin and vincristine. The client asks the nurse why both medications must be given together. The nurse should explain to the client that the combination of 2 chemotherapeutic medications is used for which reason? 1.Increase the destruction of tumor cells. 2.Prevent the destruction of normal cells. 3.Decrease the risk of the alopecia and stomatitis. 4.Increase the likelihood of erythrocyte and leukocyte recovery.

1. increase the destruction of tumor cells Cisplatin is an alkylatinglike medication, and vincristine is a vinca alkaloid. Alkylating medications are cell-cycle nonspecific. Vinca alkaloids are cell-cycle specific and act on the M phase. Single-agent medication therapy seldom is used. Combinations of medications are used to increase the destruction of tumor cells.

Sodium hypochlorite solution is prescribed for a client with a wound on the left foot that is draining purulent material. Which action should the nurse plan to take? 1.Irrigate the wound with the solution. 2.Soak the foot in the solution for 20 minutes daily. 3.Place the solution in the wound, and cover with an occlusive dressing. 4.Soak a sterile dressing with the solution, and pack the dressing into the wound.

1. irrigate the wound with the solution Sodium hypochlorite is a solution that is used for irrigating and cleaning necrotic or purulent wounds. It can be used for packing necrotic wounds but cannot be used to pack purulent wounds because the solution is inactivated by copious pus. It should not come into contact with healing or normal tissue, and it should be rinsed off immediately if used for irrigation.

he school nurse has provided instructions regarding the use of permethrin rinse to the parents of children diagnosed with pediculosis capitis (head lice). Which statement by one of the parents indicates a need for further instruction? 1."It is applied to the hair and then shampooed out." 2."The hair should not be shampooed for 24 hours after treatment." 3."The permethrin rinse can be obtained over the counter in a local pharmacy." 4."It is applied to the hair after shampooing, left on for 10 minutes, and then rinsed out."

1. it is applied to the hair and then shampooed out Permethrin rinse is an over-the-counter scabicide that kills lice and eggs with 1 application and has residual activity for 10 days. It is applied to the hair after shampooing (using a conditioner-free shampoo) and left for 10 minutes before rinsing out. The hair should not be shampooed for 24 hours after the treatment.

The clinic nurse is performing an admission assessment on a client and notes that the client is taking azelaic acid to treat acne. The nurse determines that which client complaint may be associated with use of this medication? 1.Itching 2.Euphoria 3.Drowsiness 4.Frequent urination

1. itching Azelaic acid is a topical medication used to treat mild to moderate acne. Adverse effects include burning, itching, stinging, redness of the skin, and hypopigmentation of the skin in clients with a dark complexion. The effects noted in the other options are not specifically associated with this medication.

The clinic nurse is performing an admission assessment on a client and notes that the client is taking azelaic acid. The nurse determines that which client complaint may be associated with use of this medication? 1.Itching 2.Euphoria 3.Drowsiness 4.Frequent urination

1. itching Azelaic acid is a topical medication used to treat mild to moderate acne. Adverse effects include burning, itching, stinging, redness of the skin, and hypopigmentation of the skin in clients with a dark complexion. The effects noted in the other options are not specifically associated with this medication.

A client with squamous cell carcinoma is receiving bleomycin. What is the priority assessment of the nurse when monitoring for side and adverse effects of bleomycin? 1.Lung sounds 2.Platelet count 3.Blood pressure 4.White blood cell count

1. lung sounds The major form of dose-limiting toxicity with bleomycin is injury to the lungs. It manifests initially as pneumonitis but can progress to severe pulmonary fibrosis and death. In addition to auscultation of lung sounds, pulmonary function studies should be monitored. Bleomycin is discontinued at the first sign of these adverse changes. Nausea and vomiting usually are mild with the use of this medication, and unlike most other anticancer agents, bleomycin exerts minimal toxicity to bone marrow. It does not directly affect the blood pressure.

The nurse transcribes a medication prescription for ifosfamide for a client with a diagnosis of germ cell cancer of the testes. The nurse reviews the client's history and looks for another prescription for which medication, which usually is administered with the antineoplastic medication? 1.Mesna 2.Melphalan 3.Prednisone 4.Bleomycin sulfate

1. mesna Ifosfamide is used to treat refractory germ cell cancer of the testes. Concurrent therapy with mesna and at least 2 L of oral or intravenous fluid daily will limit the toxicity of this medication, evidenced by bone marrow depression and hemorrhagic cystitis. Mesna is a detoxifying agent used to inhibit the hemorrhagic cystitis induced by ifosfamide. The medications in options 2, 3, and 4 are not routinely administered with ifosfamide.

The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase, an antineoplastic agent. The nurse contacts the primary health care provider before administering the medication if which disorder is documented in the client's history? 1.Pancreatitis 2.Diabetes mellitus 3.Myocardial infarction 4.Chronic obstructive pulmonary disease

1. pancreatitis Asparaginase is contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function, and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between dose administrations. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. The conditions noted in options 2, 3, and 4 are not contraindicated with this medication.

A female client with a diagnosis of breast cancer is taking cyclophosphamide. The client calls the health care clinic and tells the nurse that the medication is upsetting her stomach. Which instruction should the nurse provide to the client? 1.Take the medication with food. 2.Avoid drinking fluids while taking the medication. 3.Try to take the medication with a small amount of orange juice. 4.Continue to take the medication on an empty stomach, and lie down after taking the medication.

1. take the medication with food Hemorrhagic cystitis is a toxic effect that can occur with the use of this medication. The medication should be taken on an empty stomach, but if the client complains of gastrointestinal (GI) upset, it can be taken with food. The client who is taking cyclophosphamide needs to be instructed to drink copious amounts of fluids during the administration of this medication. Orange juice probably would cause and increase the GI upset. Option 4 will not assist in relieving the discomfort experienced by the client.

A client with bladder cancer is about to be started on mitomycin. The nurse should contact the primary health care provider after noting that the client is also taking which medication? 1.Warfarin 2.Furosemide 3.Allopurinol 4.Ondansetron

1. warfarin Mitomycin is an antitumor antibiotic. The use of aspirin, anticoagulants, and thrombolytic agents should be avoided concurrently with this medication because mitomycin causes thrombocytopenia. Warfarin is an anticoagulant, and the risk of bleeding is increased if administered during mitomycin therapy. Furosemide is a diuretic and is not related to the question. Allopurinol is an antigout medication, which prevents or treats hyperuricemia resulting from blood dyscrasias caused by cancer chemotherapy. Ondansetron is an antiemetic used to prevent or treat nausea and vomiting during chemotherapy.

Capecitabine has been prescribed for a client with breast cancer, and the nurse provides instructions to the client about the medication. Which statement by the client indicates the need for further instruction? 1."I need to monitor my temperature." 2."I need to be sure to go to the clinic to receive my yearly flu vaccine." 3."I may have some diarrhea, but if it becomes severe, I will call my health care provider." 4."It's important for me to contact my primary health care provider if I have any fever or other signs of infection."

2. i need to be sure to go to the clinic to receive my yearly flu vaccine Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. Adverse effects include bone marrow depression, cardiovascular toxicity, and respiratory toxicity. The client is instructed to obtain primary health care provider (PHCP) approval before receiving immunizations because the medication lowers the body's resistance to infection. Diarrhea is a frequent side effect of this medication, but the client should contact the PHCP if it becomes severe. The client should monitor his or her temperature and call the PHCP for severe diarrhea or for a fever or other sign of infection.

The nurse teaches the client, who is newly diagnosed with diabetes insipidus, about the prescribed intranasal desmopressin. Which statements by the client indicate understanding? Select all that apply. 1."This medication will turn my urine orange." 2."I should decrease my oral fluids when I start this medication." 3."The amount of urine I make should increase if this medicine is working." 4."I need to follow a low-fat diet to avoid pancreatitis when taking this medicine." 5."I should report headache and drowsiness to my primary health care provider since these symptoms could be related to my desmopressin."

2. i should decrease my oral fluids when i start this medication 5. i should report headache and drowsiness to my primary health care provider since these symptoms could be related to my desmopressin In diabetes insipidus, there is a deficiency in antidiuretic hormone (ADH), resulting in large urinary losses. Desmopressin is an analog of ADH. Clients with diabetes insipidus drink high volumes of fluid (polydipsia) as a compensatory mechanism to counteract urinary losses and maintain fluid balance. Once desmopressin is started, oral fluids should be decreased to prevent water intoxication. Therefore, clients with diabetes insipidus should decrease their oral fluid intake when they start desmopressin. Headache and drowsiness are signs of water intoxication in the client taking desmopressin and should be reported to the primary health care provider. Desmopressin does not turn urine orange. The amount of urine should decrease, not increase, when desmopressin is started. Desmopressin does not cause pancreatitis.

The client with breast cancer has been given a prescription for cyclophosphamide. The nurse determines that the client understands the proper use of the medication if the client states to take which measure? 1.Increase dietary intake of potassium. 2.Increase fluid intake to 2 to 3 L/day. 3.Take the medication with large meals. 4.Decrease dietary intake of magnesium.

2. increase fluid intake to 2-3 L/day An adverse effect of cyclophosphamide is hemorrhagic cystitis. The client should drink large amounts of fluid during the administration of this medication. Clients also should observe for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be encouraged to increase potassium intake. The client would not be instructed to alter magnesium intake.

The nurse is providing medication instructions to a client with breast cancer who is receiving cyclophosphamide. The nurse should tell the client to take which action? 1.Take the medication with food. 2.Increase fluid intake to 2000 to 3000 mL daily. 3.Decrease sodium intake while taking the medication. 4.Increase potassium intake while taking the medication.

2. increase fluid intake to 2000-3000 mL/day Hemorrhagic cystitis is an adverse effect that can occur with the use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be told to increase potassium intake. The client would not be instructed to alter sodium intake.

Capecitabine has been prescribed for a client with breast cancer, and the client asks the nurse about the action of the medication. The nurse formulates a response based on which mechanism of action of this medication? 1.Promotes DNA synthesis 2.Interferes with protein synthesis 3.Assists with the processing of RNA 4.Processes enzymes needed for cellular growth

2. interferes with protein synthesis Capecitabine is an antimetabolite that inhibits enzymes necessary for the synthesis of essential cellular components. It interferes with DNA synthesis, RNA processing, and protein synthesis. Capecitabine does not promote DNA synthesis, assist with the processing of RNA, or process enzymes needed for cellular growth.

A client with lung cancer is receiving a high dose of methotrexate. A primary health care provider also prescribes leucovorin to the client. The nurse should explain to the client that leucovorin is prescribed for which reason? 1."It promotes DNA synthesis." 2."It helps to preserve normal cells." 3."It promotes excretion of the medication." 4."It facilitates the synthesis of nucleic acids."

2. it helps to preserve normal cells High concentrations of methotrexate harm and damage normal cells. To save normal cells, leucovorin is given; this is known as leucovorin rescue. Leucovorin bypasses the metabolic block caused by methotrexate, thereby permitting normal cells to synthesize. Note that leucovorin rescue is potentially hazardous. Failure to administer leucovorin in the right dose at the right time can be fatal.

A client who has had a myocardial infarction has a prescription to take a powdered form of psyllium after discharge. The nurse should plan to include which information when teaching the client about this medication? 1.Mix the medication with applesauce. 2.Mix the medication with a full glass of water or juice. 3.Decrease fluid intake following administration of the medication. 4.Decrease the amount of fiber in the diet when taking this medication.

2. mix the medication with a full glass of water or juice Psyllium is a bulk-forming laxative that should be taken with a full glass of water or juice (not applesauce), followed by another glass of liquid. This will help prevent impaction of the medication in the stomach or small intestine. Fiber in the diet and fluid intake should not be decreased unless specifically prescribed by the primary health care provider.

Tetracycline is prescribed for a client with severe acne. The nurse instructs the client regarding the importance of reporting which finding if it occurs? 1.Sunburn 2.Persistent diarrhea 3.Epigastric burning 4.Abdominal cramping

2. persistent diarrhea Tetracycline can be used to treat severe acne. Adverse effects include gastrointestinal irritation manifested as epigastric burning, cramps, nausea, vomiting, and diarrhea. These effects do not need to be reported unless the diarrhea becomes persistent and severe. If this does occur, this could indicate another adverse effect, superinfection. Clostridium difficile infection is another potential adverse effect associated with tetracycline use. In addition, photosensitivity is another potential effect, which can more easily result in sunburn. Clients should be instructed to wear sunscreen. A sunburn does not need to be reported necessarily, as this is an expected and self-limiting effect. Other adverse effects include yellowing of the teeth (which can occur in the unborn fetus), hepatotoxicity, and renal toxicity

Topical azelaic acid is prescribed for a client, and the clinic nurse provides instructions regarding the use of this medication. Which statement by the client indicates a need for further instruction? 1."I need to apply the medication twice daily." 2."The medication is used to treat my eczema." 3."I need to massage a thin film gently into the affected area." 4."I need to wash and dry my skin before I apply the medication."

2. the medication is used to treat my eczema Azelaic acid is a topical medication used to treat mild to moderate acne. It appears to work by suppressing growth of Propionibacterium acnes and decreasing proliferation of keratinocytes. Options 1, 3, and 4 are accurate statements regarding the use of this medication.

A topical corticosteroid is prescribed for an infant with dermatitis in the gluteal area. The nurse provides instructions to the mother regarding the use of the medication. Which statement by the mother indicates an understanding of the use of the medication? 1."I should not rub the medication into the skin." 2."The medication will help relieve the inflammation." 3."I need to apply the medication in a thick layer to protect the skin." 4."I should protect the area by covering it with a diaper and plastic pants."

2. the medication will help relieve the inflammation A topical corticosteroid will relieve inflammation. The mother should be advised not to apply a tight-fitting diaper or plastic pants after applying the medication because these items will act as an occlusive dressing. The use of occlusive dressings (bandages or plastic wraps) over the affected site is avoided after application of the topical corticosteroid unless the health care provider specifically prescribes this wound coverage. The medication is gently rubbed into the skin after a thin layer is applied.

The health education nurse provides instructions to a group of clients regarding measures that will assist in preventing skin cancer. Which instructions should the nurse provide? Select all that apply. 1.Sunscreen should be applied every 8 hours. 2.Use sunscreen when participating in outdoor activities. 3.Wear a hat, opaque clothing, and sunglasses when in the sun. 4.Avoid sun exposure in the late afternoon and early evening hours. 5.Examine your body monthly for any lesions that may be suspicious.

2. use sunscreen when participating in outdoor activities 3. wear a hat, opaque clothing, and sunglasses when in the sun 5. examine your body monthly for any lesions that may be suspicious The client should be instructed to avoid sun exposure between the hours of brightest sunlight: 10 a.m. and 4 p.m. Sunscreen, a hat, opaque clothing, and sunglasses should be worn for outdoor activities. The client should be instructed to examine the body monthly for the appearance of any cancerous or precancerous lesions. Sunscreen should be applied 30 minutes to 1 hour before sun exposure, and reapplied every 2 to 3 hours, and after swimming or sweating; otherwise, the duration of protection is reduced.

A hospitalized client is diagnosed with scabies. The primary health care provider (PHCP) recommended that the client and the client's roommate be treated with lindane. Which finding, if noted on this client's chart, would alert the nurse to notify the PHCP before the treatment with lindane? 1.Client history of diabetes 2.Client history of hypertension 3.Client history of seizure disorders 4.Client history of coronary artery disease

3. client history of seizure disorders Lindane can penetrate intact skin and cause seizures if absorbed in sufficient quantities. A client with a preexisting seizure disorder is at high risk. Other clients at high risk for seizures include premature infants and children. Lindane should not be used on pediatric clients unless safer medications have failed to control the infection. Options 1, 2, and 4 do not identify contraindications related to the use of this medication.

The nurse is monitoring a client with leukemia who is receiving doxorubicin by intravenous infusion. The nurse should monitor for which finding that would indicate doxorubicin toxicity? 1.Elevated creatinine 2.Red coloration in the urine 3.Electrocardiogram (ECG) changes 4.Elevated blood urea nitrogen (BUN)

3. electrocardiogram (ECG) changes Cardiotoxicity can occur with the use of doxorubicin. The medication can produce irreversible toxicity to the heart, including ECG changes and heart failure. Elevated values on renal function tests are not associated with the use of this medication. A red coloration of the urine may occur with the use of this medication, but this effect is harmless.

A client with psoriasis is being treated with calcipotriene cream. Administration of high doses of this medication can cause which side or adverse effect? 1.Alopecia 2.Hyperkalemia 3.Hypercalcemia 4.Thinning of the skin

3. hypercalcemia Calcipotriene, an analogue of vitamin D3, is indicated for mild to moderate psoriasis. Responses are equal to those achieved with medium-potency topical glucocorticoids. The most common adverse effect is local irritation. Unlike glucocorticoids, calcipotriene does not cause thinning of the skin. At high doses, calcipotriene has caused hypercalcemia. Alopecia and hyperkalemia are not associated with this medication.

The nurse provides instructions to a client regarding the use of topical tretinoin. Which statement by the client indicates a need for further instruction? 1."I should begin to see results in about 3 weeks." 2."I will apply the medication liberally to the skin." 3."I cannot use any cosmetics while I am using this medication." 4."I will wash my hands thoroughly after applying this medication."

3. i cannot use any cosmetics while i am using this medication Tretinoin is applied liberally to the skin. The skin needs to be cleansed thoroughly before applying the medication. The hands are washed thoroughly immediately after applying the medication. Therapeutic results should be seen after 2 to 3 weeks but may not be optimal until after 6 weeks. The client may use cosmetics.

The nurse is providing instructions to a mother of a child with atopic dermatitis (eczema) regarding the application of topical cortisone cream to the affected skin sites. Which statement made by the mother indicates an understanding of the use of this medication? 1."I shouldn't rub the medication into the skin." 2."The medication is applied everywhere except the face." 3."I need to wash the sites gently before I apply the medication." 4."I need to apply the medication generously and allow it to absorb."

3. i need to wash the sites gently before i apply the medication Topical corticosteroids should be applied sparingly and rubbed into the area thoroughly. The affected area should be cleansed gently before application. It should not be applied everywhere or over extensive areas. Systemic absorption is more likely to occur with extensive application. It is applied to the affected sites.

The nurse is assigned to care for a client with metastatic breast cancer who is taking tamoxifen citrate. The nurse plans to monitor for which changes in laboratory values for this client? Select all that apply. 1.Increase in lipase level 2.Increase in blood glucose level 3.Increase in serum calcium level 4.Increase in serum potassium level 5.Decrease in low-density lipoprotein levels

3. increase in serum calcium level 5. decrease in low-density lipoprotein levels Tamoxifen citrate is an antiestrogen and antineoplastic medication. It may increase the calcium level and lower the low-density lipoprotein levels. Before the initiation of therapy, the complete blood count (CBC), platelet count, and serum calcium levels should be determined. These blood levels should continue to be monitored periodically during therapy. The nurse should monitor for signs of hypercalcemia while the client is taking this medication. These signs include increased urine volume, excessive thirst, nausea, vomiting, constipation, decreased muscle tone, and deep bone or flank pain. Options 1, 2, and 4 are not associated with this medication.

A child is diagnosed with impetigo. The primary health care provider prescribes a topical medication for treatment. The nurse anticipates that which medication will be prescribed? 1.Cortisone 2.Acyclovir 3.Mupirocin 4.Benzoyl peroxide

3. mupirocin Mupirocin is a topical antibacterial agent active against impetigo caused by staphylococci or streptococci. Cortisone would not be effective in treating impetigo. Benzoyl peroxide is a keratolytic. Acyclovir is a topical antiviral agent that inhibits DNA replication in the virus. It inhibits the activity of herpes simplex types 1 and 2, varicella zoster, Epstein-Barr virus, and cytomegalovirus.

The nurse is monitoring a client with acute lymphocytic leukemia for toxic effects of asparaginase. The nurse should notify the primary health care provider if monitoring reveals which finding? 1.Alopecia 2.Oral ulcerations 3.Prolonged blood clotting times 4.Decreased white blood cell count

3. prolonged blood clotting times Asparaginase can cause severe adverse effects; however, they often are different from those of other antineoplastic medications. By inhibiting protein synthesis, the medication can cause coagulation deficiencies and injury to the liver, pancreas, and kidneys. Signs and symptoms of central nervous system depression ranging from confusion to coma can occur. Nausea and vomiting can be intense and may limit the dose that can be tolerated. In contrast with most antineoplastic medications, asparaginase does not depress the bone marrow, nor does it cause alopecia, oral ulceration, or intestinal ulceration

A client with colon cancer has received a course of chemotherapy with fluorouracil. The nurse should tell the client to report which finding immediately? 1.Alopecia 2.Headache 3.Stomatitis and diarrhea 4.Changes in color vision

3. stomatitis and diarrhea Fluorouracil should be discontinued as soon as reactions (stomatitis, diarrhea) occur. Dosage can also be limited by palmar-plantar erythrodysesthesia syndrome (also called hand-foot syndrome), characterized by tingling, burning, redness, flaking, swelling, and blistering of the palms and soles. Alopecia is common and would not require immediate reporting. Headache and vision changes are not associated with fluorouracil.

Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. The client asks the nurse if her family member with bladder cancer can also take this medication. The nurse most appropriately responds by making which statement? 1."This medication can be used only to treat breast cancer." 2."Yes, your family member can take this medication for bladder cancer as well." 3."This medication can be taken to prevent and treat clients with breast cancer." 4."This medication can be taken by anyone with cancer as long as their health care provider approves it."

3. this medication can be taken to prevent and treat clients with breast cancer Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy and for preventing breast cancer in those that are at high risk.

The nurse is preparing a plan of care for a client who will be receiving intravenous mitomycin for the treatment of liver cancer. In developing the plan of care, the nurse includes monitoring which as the priority? 1.Heart rate 2.Lung sounds 3.White blood cell count 4.Level of consciousness

3. white blood cell count Mitomycin is an antineoplastic medication that can cause bone marrow suppression, which can progress to infection. The priority is to monitor nadirs for neutropenia and thrombocytopenia. Although options 1, 2, and 4 may be a component of the nurse's assessment, assessing the white blood cell count is the priority when administering this medication.

A burn client has been having 1% silver sulfadiazine applied to burns twice a day for the past 3 days. Which laboratory abnormality indicates that the client is experiencing a side or adverse effect of this medication? 1.Serum sodium of 120 mEq/L (120 mmol/L) 2.Serum potassium of 3.0 mEq/L (3.0 mmol/L) 3.White blood cell count of 3000 mm3 (3 × 109/L) 4.pH of 7.30, PaCO2 of 32 mm Hg (32 mmHg), HCO3- of 19 mEq/L (19 mmol/L)

3. white blood cell count of 3000 Transient leukopenia typically occurs after 2 to 3 days of treatment. Knowing this and knowing normal white blood cell values will direct you to option 3. Although options 1, 2, and 4 are abnormal findings, they are not associated with this medication.

A client arrives at the clinic complaining of fatigue, lack of energy, constipation, and depression. Following diagnostic studies, hypothyroidism is diagnosed and levothyroxine is prescribed. The nurse informs the client that which is the expected outcome of the medication? 1.Alleviate depression. 2.Increase energy levels. 3.Increase blood glucose levels. 4.Achieve normal thyroid hormone levels.

4. achieve normal thyroid hormone levels Laboratory determinations of the serum thyroid-stimulating hormone (TSH) level are an important means of evaluation. Successful therapy will cause elevated TSH levels to fall. These levels will begin their decline within hours of the onset of therapy and will continue to drop as plasma levels of thyroid hormone build up. If an adequate dosage is administered, TSH levels will remain suppressed for the duration of therapy. Although energy levels may increase, this occurs as a result of achievement of the normal thyroid hormone levels. Alleviation of depression and increased blood glucose levels are not expected outcomes.

The primary health care provider (PHCP) writes a prescription for capecitabine for a client with breast cancer who was admitted to the hospital. The nurse should contact the PHCP to verify the prescription if which condition is noted in the assessment data? 1.Myalgia 2.Psoriasis 3.Rheumatoid arthritis 4.Chronic kidney disease

4. chronic kidney disease Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. A contraindication to the use of this medication is severe renal impairment such as that which occurs in chronic kidney disease. Myalgia, psoriasis, and rheumatoid arthritis are not contraindications to this medication.

A client is told by the primary health care provider to take aluminum hydroxide as needed for heartburn. The nurse advises the client to watch for which common side effect of this medication? 1.Dizziness 2.Excitability 3.Restlessness 4.Constipation

4. constipation Because of the antacid's aluminum base, aluminum hydroxide causes constipation as a side effect. The other side effect is hypophosphatemia, which is noted by monitoring serum laboratory studies. The other options are not side effects of this medication.

A client with non-Hodgkin's lymphoma is receiving daunorubicin. Which finding would indicate to the nurse that the client is experiencing an adverse effect related to the medication? 1.Fever 2.Sores in the mouth and throat 3.Complaints of nausea and vomiting 4.Crackles on auscultation of the lungs

4. crackles on auscultation of the lungs Cardiotoxicity noted by abnormal electrocardiographic findings or cardiomyopathy manifested as heart failure (lung crackles) is an adverse effect of daunorubicin. Bone marrow depression is also an adverse effect. Fever is a frequent side effect, and sores in the mouth and throat can occur occasionally. Nausea and vomiting is a frequent side effect associated with the medication that begins a few hours after administration and lasts 24 to 48 hours. Options 1, 2, and 3 are not adverse effects.

A primary health care provider (PHCP) prescribes isotretinoin for a client with severe acne. The nurse reviews the client's record and notifies the PHCP if which prescribed medication is noted on the medication record? 1.Digoxin 2.Phenytoin 3.Furosemide 4.Doxycycline

4. doxycycline Doxycycline is a tetracycline. Adverse effects of isotretinoin can be increased by the use of tetracyclines. Tetracyclines increase the risk of pseudotumor cerebri and papilledema. Because of the potential for increased toxicity, tetracyclines should be discontinued before isotretinoin therapy. Phenytoin, digoxin, and furosemide are not contraindicated.

Metformin is prescribed for a client with type 2 diabetes mellitus. What is the most common side effect that the nurse should include in the client's teaching plan? 1.Weight gain 2.Hypoglycemia 3.Flushing and palpitations 4.Gastrointestinal disturbances

4. gastrointestinal disturbances The most common side effect of metformin is gastrointestinal disturbances, including decreased appetite, nausea, and diarrhea. These generally subside over time. This medication does not cause weight gain; clients lose an average of 7 to 8 lb (3.2 to 3.6 kg) because the medication causes nausea and decreased appetite. Although hypoglycemia can occur, it is not the most common side effect. Flushing and palpitations are not specifically associated with this medication.

A female client with carcinoma of the breast is admitted to the hospital for treatment with intravenously administered doxorubicin. The client tells the nurse that she has been told by her friends that she is going to lose all her hair. What is the most appropriate nursing response? 1."Your friends are correct." 2."You will not lose your hair." 3."Hair loss may occur, but it will grow back just as it is now." 4."Hair loss may occur, and it will grow back, but it may have a different color or texture."

4. hair loss may occur, and it will grow back, but it may have a different color or texture Alopecia (hair loss) can occur after the administration of many antineoplastic medications. Alopecia is reversible, but the new hair growth may have a different color and texture. Therefore, options 1, 2, and 3 are incorrect.

Isotretinoin is prescribed for a client to treat severe cystic acne, and the nurse provides instructions to the client regarding the medication. Which statement by the client indicates a need for further instruction? 1."I need to take the medication with food." 2."I will be taking the medication twice a day." 3."I will need to take the medication for 15 to 20 weeks." 4."I cannot crush or chew the tablets if I have difficulty swallowing them whole."

4. i cannot crush or chew the tablets if i have difficulty swallowing them whole Isotretinoin is administered 2 times daily for 15 to 20 weeks. The usual adult dosage is 0.5 to 1 mg/kg/day. If needed, a second course may be given but not until 2 months have elapsed after completing the first course. The medication needs to be taken with food to facilitate absorption. Capsules can be chewed or opened and added to a soft food like applesauce or pudding.

A topical corticosteroid is prescribed for a client with dermatitis. The nurse provides instructions to the client regarding the use of the medication. Which statement by the client would indicate a need for further instruction? 1."I need to apply the medication in a thin film." 2."I should gently rub the medication into the skin." 3."The medication will help relieve the inflammation and itching." 4."I should place a bandage over the site after applying the medication."

4. i should place a bandage over the site after applying the medication Clients should be advised not to use occlusive dressings (bandages or plastic wraps) to cover the affected site after application of the topical corticosteroid unless the primary health care provider specifically prescribes wound coverage. The remaining options are accurate statements related to the use of this medication.

Collagenase is prescribed for a client with a severe burn to the hand. The home care nurse provides instructions to the client regarding the use of the medication. Which client statement indicates an accurate understanding of the use of this medication? 1."I will apply the ointment at bedtime and in the morning." 2."I will apply the ointment once a day and leave it open to the air." 3."I will apply the ointment twice a day and leave it open to the air." 4."I will apply the ointment once a day and cover it with a sterile dressing."

4. i will apply the ointment once a day and cover it with a sterile dressing Collagenase is used to promote debridement of dermal lesions and severe burns. It is applied once daily and covered with a sterile dressing. The remaining options are incorrect.

Tretinoin is prescribed for a client with acne, and the nurse provides instructions to the client regarding the medication. Which statement by the client indicates a need for further instruction? 1."I need to avoid exposure to the sun." 2."I should start to see results in 2 to 3 weeks." 3."I will cleanse the skin thoroughly before applying the medication." 4."If my skin begins to peel, I will notify the primary health care provider (PHCP)."

4. if my skin begins to peel, i will notify the PHCP Tretinoin decreases cohesiveness of the epithelial cells, increasing cell mitosis and turnover. It is potentially irritating, particularly when used correctly. Within 48 hours of use, the skin generally becomes red and begins to peel. It is not necessary to notify the PHCP if this occurs. The client needs to avoid sun exposure, will see therapeutic results within 2 to 3 weeks, and needs to cleanse the skin thoroughly before applying the medication.

A client with acute seborrheic dermatitis of the back, chest, and legs is receiving treatments with salicylic acid. The nurse should monitor the client for which symptom that indicates the presence of systemic toxicity from this medication? 1.Diarrhea 2.Constipation 3.Lower leg pain 4.Increased respirations

4. increased respirations Salicylic acid is readily absorbed through the skin, and systemic toxicity (salicylism) can result. Symptoms include tinnitus, hyperpnea, dizziness, and psychological disturbances. Lower leg pains, constipation, and diarrhea are not associated with salicylism.

Mafenide acetate is prescribed for a client with a burn injury to the hand. Which should the nurse include in the instructions to the client regarding the use of this medication? 1.If stinging occurs, discontinue the medication. 2.Apply a thinner film than prescribed to the burn site if the medication stings. 3.If local stinging and burning occur after the medication is applied, notify the health care provider. 4.It is normal to experience local discomfort and stinging and burning after the medication is applied.

4. it is normal to experience local discomfort and stinging and burning after the medication is applied Mafenide acetate is bacteriostatic for both gram-negative and gram-positive organisms and is used to treat second- and third-degree burns to reduce the number of bacteria present in avascular tissues. The client should be informed that the medication will cause local discomfort, stinging, and burning and that this is normal. Therefore, options 1, 2, and 3 are incorrect.

A client is seen in the clinic for complaints of skin itchiness that has persisted for several weeks. After an assessment, the client is determined to have scabies. Lindane is prescribed, and the nurse provides instructions to the client regarding the use of the medication. Which action should the nurse tell the client to take? 1.Apply the cream for 2 days in a row. 2.Apply a thick layer of cream to the entire body. 3.Apply the cream to the entire body and scalp, excluding the face. 4.Leave the cream on for 8 to 12 hours, and then remove it by washing.

4. leave the cream on for 8 to 12 hours, and then remove it by washing Lindane is applied in a thin layer to the body below the head. No more than 30 g (1 oz) should be used. The medication is removed by washing 8 to 12 hours later. In most cases, only 1 application is required.

An outbreak of head lice infestation has occurred at a local school. The school nurse is providing instructions to the mothers of the children attending the school regarding the application of malathion. The nurse should tell the mothers to take which action? 1.Apply the lotion immediately after washing the hair. 2.Pour the lotion onto the hair and then rinse immediately. 3.Allow the lotion to remain on the hair for 10 minutes and then rinse with water. 4.Leave the lotion on for 8 to 12 hours, and then wash the hair with nonmedicated shampoo.

4. leave the lotion on for 8 to 12 hours, and then wash the hair with nonmedicated shampoo The instructions for the use of malathion are as follows: Sprinkle lotion on dry hair and rub gently until the scalp is moistened; allow to dry naturally; after 8 to 12 hours, wash the hair with a nonmedicated shampoo; rinse and use a fine-toothed comb to remove lice; and repeat in 7 to 9 days if needed.

The clinic nurse is caring for a client with a diagnosis of scabies who has just been prescribed crotamiton. The nurse instructs the client to perform which action when applying this medication? 1.Apply the medication to the entire body, washing it off after 2 hours. 2.Apply the application to the entire body, leave it on for 24 hours, and then take a cleansing bath. 3.Apply the medication to the entire body, avoiding the skin folds and creases, and wash it off in 12 hours. 4.Massage the medication into the skin from the chin downward. Apply a second application in 24 hours, followed by a cleansing bath 48 hours after the second application.

4. massage the medication into the skin from the chin downward. apply a second application in 24 hours, followed by a cleansing bath 48 hours after the second application

A client with recurrent constipation has been prescribed psyllium. Teaching provided by the nurse should include which instruction? 1.Take the powder with food. 2.Sprinkle the powder on top of a hot beverage. 3.Mix the powder with warm applesauce. 4.Mix the powder with a full glass of water or juice followed by drinking an additional glass of liquid.

4. mix the powder with a full glass of water or juice followed by drinking an additional glass of liquid Metamucil is a bulk-forming laxative. It should be mixed with 8 oz of water or juice, followed by drinking another 8 oz of liquid. This will help prevent impaction of the medication in the stomach or small intestine. The other options are incorrect methods of administration.

A client has an as needed prescription for ondansetron. For which condition(s) should the nurse administer this medication? 1.Paralytic ileus 2.Incisional pain 3.Urinary retention 4.Nausea and vomiting

4. nausea and vomiting Ondansetron is an antiemetic used to treat postoperative nausea and vomiting, as well as nausea and vomiting associated with chemotherapy. The other options are incorrect reasons for administering this medication.

A client with small cell lung cancer is being treated with etoposide. The nurse monitors the client during administration, knowing that which adverse effect is specifically associated with this medication? 1.Alopecia 2.Chest pain 3.Pulmonary fibrosis 4.Orthostatic hypotension

4. orthostatic hypotension An adverse effect specific to etoposide is orthostatic hypotension. Etoposide should be administered slowly over 30 to 60 minutes to avoid hypotension. The client's blood pressure is monitored during the infusion. Hair loss occurs with nearly all antineoplastic medications. Chest pain and pulmonary fibrosis are unrelated to this medication.

A client with ovarian cancer is being treated with vincristine. The nurse monitors the client, knowing that which manifestation indicates an adverse effect specific to this medication? 1.Diarrhea 2.Hair loss 3.Chest pain 4.Peripheral neuropathy

4. peripheral neuropathy An adverse effect specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation rather than diarrhea is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all antineoplastic medications. Chest pain is unrelated to this medication.

A client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed? 1.Echocardiography 2.Electrocardiography 3.Cervical radiography 4.Pulmonary function studies

4. pulmonary function studies Bleomycin is an antineoplastic medication that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to the specific use of this medication.

The nurse is providing instructions to a client with a diagnosis of Addison's disease regarding the administration of prescribed glucocorticoids. The nurse should provide which instruction to the client? 1.To stop the medication if side effects occur 2.To avoid taking the medication if nausea occurs 3.That minimal side effects will occur with use of this medication 4.That an increased dose of medication may be needed during times of stress

4. that an increased dose of medication may be needed during times of stress The client with Addison's disease will require lifelong replacement of adrenal hormones. The medications must be taken daily, and an alternate route of administration must be used if the client cannot take oral medications for any reason, such as nausea and vomiting. Additional doses of glucocorticoids will be needed during times of stress. The nurse must emphasize that the client must call the primary health care provider (PHCP) to obtain a prescription for a dosage increase when experiencing stressful situations. Abrupt withdrawal of this medication can result in Addisonian crisis. Although side effects are mild at lower doses, more severe side effects occur with long-term glucocorticoid administration. It is very unsafe to stop taking the medication without first consulting the PHCP