Pharmacology Unit 6 Review

After administering diphenoxylate to a client, the nurse would assess the client closely for increased CNS depression if the client was also receiving which medication? Select all that apply. A)Fexofenadine (Allegra) B)Glyburide (DiaBeta) C)Sucralfate (Carafate) D)Zolpidem (Ambien) E).Temazepam (Restoril)

A Fexofenadine (Allegra) D Zolpidem (AmbienE .Temazepam (Restoril) The nurse should monitor a client closely for increased CNS depression when diphenoxylate (Lomotil) is given to a client taking antihistamines (fexofenadine), opioids, sedatives (zolpidem), and hypnotics (temazepam)

When reviewing a client's history, a nurse determines that the use of laxatives would be contraindicated if the client has a history of which of the following? Select all that apply. A) Chronic hepatitis B) Type 1 diabetes C) Acute appendicitis D) Intestinal obstruction E) Fecal impaction

C Acute appendicitis ,D,Intestinal E Fecal impaction Laxatives are contraindicated in clients with known hypersensitivity and those with persistent abdominal pain, nausea, vomiting, or pain of unknown cause or signs of acute appendicitis, fecal impaction, intestinal obstruction, or acute hepatitis.

After teaching a group of nursing students about upper gastrointestinal system drugs, the instructor determines that the teaching was successful when the students identify which of the following as a gastrointestinal stimulant? A) Ranitidine (Zantac) B) Misoprostol (Cytotec) C) Omeprazole (Prilosec) D) Metoclopramide (Reglan)

D) Metoclopradmide (Reglan) Metoclopramide (Reglan) is classified as a gastrointestinal stimulant. Ranitidine is a histamine-2 receptor antagonist. Omeprazole is a proton pump inhibitor. Misoprostol is a miscellaneous acid reducer.

A client is prescribed an antidiarrheal drug. The nurse reviews the client's medical record for possible contraindications for use. Which of the following would alert the nurse to a possible contraindication? Select all that apply. A) Pseudomembranous colitis B) Type 1 diabetes C) Abdominal pain of unknown origin D) Liver disease E) Obstructive jaundice

A Pseudomembranous colitis ,C Abdominal pain of unknown origin E Obstructive Jaundice Clients with pseudomembranous colitis, abdominal pain of unknown origin, and obstructive jaundice should not take antidiarrheals.

A nurse is caring for a client who has been prescribed aluminum carbonate gel (Basaljel) for the relief of an acute peptic ulcer. Which of the following interventions should the nurse perform to promote an optimal response to therapy? A) Administer the drug hourly for the first 2 weeks. B) Administer the drug early in the morning before breakfast. C) Administer the drug with 40 mL of apple juice. D) Administer the first dose by IV route and then orally.

A) Administer the drug hourly for the first 2 weeks The nurse should administer the drug hourly for the first 2 weeks when treating an acute peptic ulcer. The nurse instructs the client to administer the drug 1 to 2 hours after meals and at bedtime after the first 2 weeks. The nurse need not suggest to the client to administer the drug early in the morning before breakfast nor to administer it with apple juice. The drug is not given intravenously.

A nurse is caring for a client with intestinal stenosis who has been prescribed psyllium. During the course of the treatment, the client shows the signs of colon obstruction. What intervention should the nurse perform to avoid the occurrence of colon obstruction? A) Administer the drug with adequate fluid intake. B) Give mineral oil to the client after meals. C) Administer the drug after chilling it. D) Provide foods high in bulk or roughage.

A) Administer the drug with adequate fluid intake The nurse should administer the drug with adequate fluid intake to avoid obstruction of the esophagus, stomach, small intestine, and colon in a client with intestinal stenosis. Mineral oil is given to the client as a laxative on an empty stomach in the evening. The nurse should provide foods high in bulk or roughage to avoid constipation in a client receiving laxatives. The nurse administers a laxative with an unpleasant or salty taste after chilling it to disguise its taste.

Which of the following antacids may produce constipation and should be used cautiously in clients who have chronic constipation? Select all that apply. A) Calcium carbonate (Mylanta) B) Magnesium hydroxide (Milk of Magnesia) C) Magnesium oxide (Mag-Ox) D) Aluminum hydroxide (ALternaGEL) E) Sodium bicarbonate (Bell/ans)

A) Calcium carbonate (Mylanta), D) Aluminum hydroxide (ALternaGEL). The aluminum- and calcium-containing antacids may produce constipation. Magnesium- and sodium-containing antacids tend to have a laxative effect

A nurse is caring for a client brought to the health care facility for a drug overdose. In which of the following cases can the client be administered an emetic? A) Client's mental status is intact. B) Client has an existing condition of severe hypertension. C) Client has a medical history of convulsions. D) Client has an existing condition of hemorrhagic diathesis.

A) Client's mental status is intact. The client can be administered an emetic only if the client does not have an altered mental status or is not comatose. A client who is comatose has an increased risk of aspiration of stomach contents. Clients with an existing condition of severe hypertension, a medical history of convulsions, or an existing condition of hemorrhagic diathesis should not be given an emetic as these conditions may be exacerbated by vomiting.

A nurse is teaching a client who is prescribed metoclopramide about signs and symptoms to report to the primary health care provider. The nurse determines that the teaching was successful when the client states which of the following? Select all that apply. A) Difficulty swallowing B) Uncontrolled tongue movements C) Muscle laxity D) Shuffling gait E) Diarrhea

A) Difficulty swallowing B) Uncontrolled tongue movements D) Shuffling gait When taking metoclopramide, the client should immediately report any of the following signs: difficulty speaking or swallowing; mask-like face; shuffling gait; rigidity; tremors; uncontrolled movements of the mouth, face, or extremities; and uncontrolled chewing or unusual movements of the tongue. Diarrhea does not require the client to notify the health care provider.

After teaching a group of nursing students about laxatives, the instructor determines that the teaching was successful when the students identify which drug as producing the laxative effect by promoting water retention in the fecal mass and softening the stool? Select all that apply. A) Docusate sodium (Colace) B) Methylcellulose (Citrucel) C) Bisacodyl (Dulcolax) D) Lactulose (Chronulac)

A) Docusate sodium Stool softeners, like docusate sodium (Colace) and docusate calcium (Surfak), produce their laxative effect by promoting water retention in the fecal mass and softening the stool. Methylcellulose is a bulk-producing laxative. Bisacodyl is a stimulant laxative. Lactulose is a hyperosmolar laxative.

A client is prescribed diphenoxylate. The nurse informs the client that he may experience which of the following effects? Select all that apply. A) Euphoric effects B) Analgesic effects C) Anti-inflammatory effects D) Sedative effects E) Slowed GI effects

A) Euphoric effects D) Sedative Effects E) Slowed GI effects Because diphenoxylate (Lomotil) is opioid related, it may have sedative, slowed GI, and euphoric effects but no analgesic or anti-inflammatory activity.

A client is taking ginger medicinally for motion sickness. The nurse would urge the client to use caution if the client has which medical condition? A) Gallstones B) Blood dyscrasia C) Parkinson's disease D) Severe liver disease

A) Gallstones Ginger should be used with caution in clients with hypertension or gallstones and during pregnancy or lactation. Antiemetic prochlorperazine is contraindicated in clients with blood dyscrasia, Parkinson's disease, and severe liver disease.

A physician has prescribed simethicone to a client with postoperative abdominal distention. After administering the drug, the nurse would assess the client for the possibility of which of the following? A) Heartburn B) Vomiting C) Fainting D) Nausea

A) Heartburn The nurse should monitor for heartburn, bloating, constipation, and diarrhea in the client after administering simethicone. Vomiting, fainting, and nausea are adverse reactions to methylcellulose, which is administered for the relief of constipation.

When describing the drugs used as treatment for clients with ulcerative colitis to a group of nursing students, the instructor discusses aspirin-like compounds with anti- inflammatory properties. Which of the following would the instructor most likely include? Select all that apply. A) Mesalamine (Asacol) B) Bisacodyl (Dulcolax) C) Magnesium oxide (Mag-Ox) D) Polyethylene glycol (MiraLAX) E) Olsalazine (Dipentum)

A) Mesalamine (Asacol) E) Olsalazine (Dipentum) Aminosalicylates, like mesalamine (Asacol) and olsalazine (Dipentum), are aspirin-like compounds with anti-inflammatory properties used in the treatment of clients with ulcerative colitis.

Which of the following drugs used to manage lower gastrointestinal disorders increase the risk of bleeding when administered to clients taking warfarin (Coumadin)? Select all that apply. A) Mesalamine (Asacol) B) Bisacodyl (Dulcolax) C) Psyllium (Metamucil) D) Polyethylene glycol (MiraLAX) E) Olsalazine (Dipentum)

A) Mesalamine (Asacol) E) Olsalazine (Dipentum) Aminosalicylates, like mesalamine (Asacol) and olsalazine (Dipentum), can increase the risk of bleeding in clients taking warfarin (Coumadin).

A client is prescribed a laxative. Which of the following would the nurse include in the teaching plan for the client about possible adverse reactions? Select all that apply. A) Nausea B) Perianal irritation C) Bloating D) Constipation E) Cramps

A) Nausea B) Perianal irritation C) Bloating E) Cramps Laxatives may cause diarrhea, loss of water and electrolytes, abdominal pain or discomfort, nausea, vomiting, perianal irritation, fainting, bloating, flatulence, cramps, and weakness.

A client is using chamomile tea as a remedy to treat gastrointestinal upset. When discussing the use of this herb, the nurse would alert the client that contact dermatitis is a possibility if the client has a hypersensitivity to which of the following plants? Select all that apply. A)rageweed B)Foxglove C)asters D)lavender E)Chrysanthemums

A) Rageweed, C) Asters E) Chrysanthemums Although chamomile is generally safe and nontoxic, the tea is prepared from the pollen- filled flower heads and has resulted in symptoms ranging from contact dermatitis to severe anaphylactic reactions in individuals hypersensitive to ragweed, asters, and chrysanthemums.

A nurse educating a client on the antacid calcium carbonate (Mylanta) should warn the client of which of the following adverse reactions? Select all that apply. A) Rebound hyperacidity B) Anorexia C) Headache D) Dehydration E) Confusion

A) Rebound C) Headache E)Confusion Adverse reactions of calcium carbonate (Mylanta) include rebound hyperacidity, metabolic alkalosis, hypercalcemia, vomiting, confusion, headache, renal calculi, and neurologic impairment.

A client is receiving an antiemetic. The nurse identifies a nursing diagnosis of Imbalanced Nutrition: Less Than Body Requirements. Which of the following would the nurse include in the client's plan of care? Select all that apply. A) Remove items with strong smells and odors. B) Use mouthwash or frequent oral rinses. C) Make the environment as pleasant as possible. D) Explain that the drug may change the color of the stool. E) Follow the medication with a small amount of water.

A) Remove items with strong smells and odors. B) Use mouthwash or frequent oral rinses. C) Make the environment as pleasant as possible. When caring for a client receiving an antiemetic with a nursing diagnosis of Imbalanced Nutrition: Less Than Body Requirements, the nurse makes the environment as pleasant as possible to enhance the client's appetite and removes items with strong smells and odors. The nurse gives the client mouthwash or frequent oral rinses to remove the disagreeable taste that accompanies vomiting. Stool color is unaffected. Liquid antacids could be followed with a small amount of water.

A nurse in a health care facility is caring for a client who is receiving an antiemetic to control vomiting related to chemotherapy. Which of the following nursing diagnoses should the care plan for this client include? A) Risk for Imbalanced Fluid Volume B) Disturbed Sensory Perception C) Impaired Physical Mobility D) Ineffective Tissue Perfusio

A) Risk for Imbalanced Fluid Volume The care plan should include Risk for Imbalanced Fluid Volume for the client receiving an antiemetic due to the possible fluid losses associated with vomiting as well as the possible decrease in fluid intake. Disturbed sensory perception, impaired physical mobility, and ineffective tissue perfusion are not applicable.

Which of the following produce their laxative effect by direct action on the intestine to increase peristalsis? Select all that apply. A) Sennosides (Senokot) B) Methylcellulose (Citrucel) C) Glycerin (Fleet Babylax) D) Bisacodyl (Dulcolax) E) Lactulose (Chronulac)

A) Sennosides ( senokot) D) bisacodyl ( dulclcolax

A nurse is conducting a class for a community group. As part of the class, the nurse is explaining the use of syrup of ipecac. The nurse would emphasize that this drug is contraindicated in which of the following cases? Select all that apply. A) The client is comatose or has altered mental status. B) The client has erosive esophagitis. C) The client is having seizures. D) The substance is a caustic or corrosive agent. E) The substance is a low-viscosity petroleum distillate.

A) The client is comatose or has altered mental status. C) The client is having seizures. D) The substance is a caustic or corrosive agent. E) The substance is a low-viscosity petroleum distillate. The use of syrup of ipecac is contraindicated in the following cases: the client is comatose or has altered mental status, the client is having seizures, the substance is a caustic or corrosive agent, the substance is a low-viscosity petroleum distillate, or the substance is capable of also altered mental status or convulsions.

Before administering a prescribed emetic, which of the following would the nurse need to assess? Select all that apply. A) What chemicals or substances were ingested? B) What are the client's current medications? C) What time was the substance ingested? D) What is the client's blood pressure? E) What symptoms were noted before seeking treatment?

A) What chemicals or substances were ingested?C) What time was the substance ingested? E) What symptoms were noted before seeking treatment? Before an emetic is given, it is extremely important to know the chemicals or substances that have been ingested, the time they were ingested, and what symptoms were noted before seeking medical treatment.

At a yearly physical examination, a client asks the nurse if it would be okay to take ginger to aid with digestion. Before telling the client it is okay to take ginger, which medical conditions should the nurse make sure the client does not have? Select all that apply. A) Hypertension B) Kidney stones C) Vitamin B12 deficiency D) Gallstones E) Liver disease

A) hypertension D) Gallstones Ginger should be used cautiously in clients with hypertension or gallstones and during pregnancy and lactation.

A nurse would most likely expect a primary health care provider to prescribe psyllium (Metamucil) to a client who is experiencing constipation related to which drug? Select all that apply. A)Spironolactone (Aldactone) B) Clonidine (Catapres) C) Enalapril (Vasotec) D)Fexofenadine (Allergra) E) amitriptyline (elavil)

A)Spironolactone (Aldactone) B) Clonidine (Catapres) D)Fexofenadine (Allergra) E) amitriptyline (elavil) The following drugs may cause constipation in clients and require the use of a laxative to relieve constipation: anticholinergics, antihistamines (fexofenadine), phenothiazines, tricyclic antidepressants (amitriptyline), opioids, non-potassium-sparing diuretics (spironolactone), iron preparations, barium, clonidine, and calcium- or aluminum- containing antacids.

A client's history reveals that the client is experiencing intestinal gas. Which of the following would the nurse expect the primary health care provider to prescribe? Select all that apply. A) Charcoal (Flatulex) B) Omeprazole (Prilosec) C)Ranitidine (Zantac) D)Odansetron (Zofran) E)Simethicone (Mylicon)

A, charcoal (flatulex) E Simethoiconen Charcoal (Flatulex) and simethicone (Mylicon) are antiflatulents used to help relieve gas in the intestinal tract of a client. Omeprazole and ranitidine are used to treat hyperacidity disorders. Odansetron is used to treat nausea and vomiting.

When describing the adverse reactions associated with anti-infectives for UTIs, which of the following would the nurse explain as being most common? A) Gastrointestinal B) Dermatologic C) Neurologic D) Urologic

Ans: A Feedback: Although dermatologic reactions such as rash, pruritus, and photosensitivity reactions can occur and neurologic reactions such as dizziness, drowsiness, headache, blurred vision, and weakness can occur, adverse reactions associated with anti-infectives are primarily gastrointestinal in nature.

A client is admitted for tocolytic therapy for preterm labor. The client states, I'm so afraid that I'm so early. Is my baby okay? What if the drug doesn't help? Based on the client's statement, the nurse would identify which nursing diagnosis as the priority? A) Anxiety B) Risk for Injury C) Impaired Gas Exchange D) Excess Fluid Volume

Ans: A Feedback: Based on the client's statements, the nurse would identify Anxiety as the priority nursing diagnosis because of the client's stated concern for her fetus and cessation of labor. Risk for Injury and Excess Fluid Volume would be more appropriate for a client receiving oxytocin. Impaired Gas Exchange would be appropriate if the client was experiencing adverse reactions related to the tocolytic.

1. A nurse is caring for a client receiving goserelin acetate for prostate cancer. The nurse would monitor the client for which of the following adverse reactions? A) Breast atrophy, sexual dysfunction B) Pharyngitis, asthenia C) Breast tenderness, edema D) Hyperglycemia, leukocytosis

Ans: A Feedback: Breast atrophy and sexual dysfunction may be seen as adverse reactions of goserelin acetate therapy. Pharyngitis and asthenia are seen with the use of anastrozole. Breast tenderness and edema are seen with drugs such as estramustine. Hyperglycemia and leukocytosis are seen as adverse reactions of mitotane.

The nurse is developing a plan of care for a client who is receiving an anti-infective drug for treatment of a UTI. The nurse has identified a nursing diagnosis of Impaired Urinary Elimination. Which of the following would the nurse include? A) Encouraging a fluid intake of at least 2000 mL/day B) Offering the client orange juice when administering the medication C) Monitoring urine output every 1 to 2 hours D) Checking the urine pH every 4 hours

Ans: A Feedback: Encouraging a fluid intake of at least 2000 mL/day would be appropriate. The nurse should offer fluids such as water, cranberry juice, or prune juice rather than orange juice or other citrus or vegetable juices. Intake and output are usually measured every 8 hours, not every 1 to 2 hours. Urine pH measurements would be appropriate if the client was receiving methenamine or nitrofurantoin.

A client is diagnosed with euthyroid goiter. The nurse would expect to administer which of the following? A) Levothyroxine B) Methimazole C) Propylthiouracil D) Sodium iodide

Ans: A Feedback: Euthyroid goiter is treated with thyroid hormones, such as levothyroxine. Methimazole, propylthiouracil, and sodium iodide are used to treat hyperthyroidism.

A nurse is caring for a client with type 2 diabetes receiving a meglitinide. The nurse reviews the client's medical record based on the understanding that which condition would contraindicate the use of this drug? A) Diabetic ketoacidosis B) Kidney disease C) Severe heart failure D) Liver disease

Ans: A Feedback: Meglitinides are contraindicated in clients with diabetic ketoacidosis and severe endocrine disease. Thiazolidinediones are contraindicated in clients with severe heart failure and used with caution in clients with kidney disease, severe heart failure, and liver disease.

A client is diagnosed with thyroid cancer. Which drug would the nurse anticipate being prescribed for the client? A) Iodine-131 B) Methimazole C) Propylthiouracil D) Liothyronine

Ans: A Feedback: Radioactive iodine (131I) is used for the treatment of hyperthyroidism and cancer of the thyroid. Methimazole and propylthiouracil are used to manage hyperthyroidism. Liothyronine is used to treat hypothyroidism.

A client diagnosed with hyperthyroidism has been prescribed propylthiouracil. After administering the drug, the nurse would assess the client for which of the following? A) Skin rash B) Tachycardia C) Nervousness D) Constipation

Ans: A Feedback: The adverse reactions to propylthiouracil include paresthesias, numbness, headache, skin rash, nausea, vomiting, and agranulocytosis. The nurse need not observe for tachycardia, nervousness, and constipation as adverse reactions associated with propylthiouracil. Tachycardia, nervousness, and vomiting are the adverse reactions associated with the thyroid hormone levothyroxine sodium (T4).

A client receiving prescribed magnesium sulfate shows signs of dyspnea, tachycardia, and increased respiratory rate and rales. The nurse notices frothy sputum. Which of the following conditions should the nurse suspect? A) Pulmonary edema B) Water intoxication C) Renal failure D) Cardiac arrest

Ans: A Feedback: The client is most likely experiencing pulmonary edema. If there is an increase in respiratory rate of more than 20 respirations/min with the administration of magnesium sulfate, the nurse should assess the respiratory status for symptoms of pulmonary edema such as dyspnea, tachycardia, rales, and frothy sputum. In such cases, the primary health care provider is notified immediately because use of the drug may be discontinued or the dosage may be decreased. The danger of water intoxication is associated with oxytocin as it has an antidiuretic effect, and not with magnesium sulfate. Renal failure and cardiac arrest are not associated with magnesium sulfate.

A client is being discharged after being diagnosed with diabetes. The client is being taught how to monitor his blood glucose. After teaching the client, which statement indicates to the nurse that additional teaching is needed? A) I should prick the tip of my finger to get the blood. B) I should clean my finger with warm, soapy water. C) I should massage my finger to get a hanging drop of blood. D) I should avoid smearing the blood on the test strip.

Ans: A Feedback: The client should insert the lancet to prick the side of the finger, not the tip, because the side has more capillaries and fewer nerve endings. The finger should be washed with warm, soapy water and then dried before testing. The client should massage the finger to get a hanging drop of blood to be placed on the test strip. The client needs to avoid smearing the blood on the strip to prevent inaccurate readings.

A nurse at a health care facility is assigned to administer insulin to the client. Which of the following interventions should the nurse perform before administering each insulin dose? A) Inspect the previous injection site for inflammation. B) Keep prefilled syringes horizontally. C) Check for symptoms of myalgia or malaise. D) Mix the insulin with sterile water in the syringe.

Ans: A Feedback: The nurse should check the previous injection site before administering each insulin dose. The injection sites should be rotated to prevent lipodystrophy. Prefilled syringes should not be kept horizontally; they should be kept in a vertical or oblique position to avoid plugging the needle. The nurse checks for symptoms of myalgia or malaise when administration of metformin leads to lactic acidosis. Insulin should not be mixed with other drugs in the syringe. Some types of insulin may be combined in one syringe, but sterile water is never used.

A nurse is caring for a client with thyrotoxicosis. The physician prescribes liotrix for the client. The nurse would be alert for the development of which of the following? A) Tachycardia B) Agranulocytosis C) Loss of hair D) Skin rash

Ans: A Feedback: The nurse should monitor for tachycardia, palpitations, headache, nervousness, insomnia, diarrhea, vomiting, weight loss, fatigue, sweating, and flushing as adverse reactions after administering liotrix to a client with thyrotoxicosis. Agranulocytosis, loss of hair, and skin rash are not the adverse reactions to liotrix; they are adverse reactions found in a client receiving a methimazole drug.

A client is receiving oxybutynin for treatment of overactive bladder. The client also takes haloperidol (Haldol) as an antipsychotic agent. What effect of the interaction of these two drugs should the nurse observe for in the client? A) Decreased effect of the antipsychotic drug B) Increased risk for bleeding C) Lowered plasma concentrations D) Increased effect of the antispasmodic drug

Ans: A Feedback: The nurse should observe for decreased effectiveness of the antipsychotic drug in the client as the effect of the interaction of the antispasmodic drug and haloperidol. Increased risk for bleeding results from the interaction of oral anticoagulants with anti-infective drugs. Increased effect of the antispasmodic drug occurs with the interaction of an antispasmodic drug with a tricyclic antidepressant. Plasma concentrations are lowered due to the interaction of fosfomycin, which is an anti-infective, with metoclopramide, which is used to relieve gastric upset.

A nurse is caring for a client who is prescribed thyroid hormone replacement. From which of the following signs during ongoing assessment should the nurse conclude that the client is responding to the therapy? A) Increased appetite B) Swollen neck C) Excessive sweating D) Flushing

Ans: A Feedback: The nurse should observe for signs of therapeutic responses, which include increased appetite, weight loss, mild diuresis, an increased pulse rate, and decreased puffiness of the face, hands, and feet. The nurse need not observe for swollen neck, excessive sweating, or heat intolerance as signs of responding to therapy. Swollen neck, sore throat, and cough may occur after 2 to 3 days of administering radioactive iodine. Sweating and flushing are the adverse reactions to thyroid hormones.

1. When describing the use of anti-infectives to treat urinary tract infections, which of the following would the nurse identify as the most common structure affected? A) Bladder B) Kidney C) Prostate gland D) Urethra E) Ureters

Ans: A Feedback: The urinary tract consists of the following anatomic structures: kidneys, ureters, bladder, prostate gland, and urethra. UTIs most commonly affect the bladder.

A client who is receiving metformin develops lactic acidosis. When planning the care for this client, which nursing diagnosis would the nurse most likely identify? A) Ineffective Breathing Pattern B) Risk for Fluid Volume Deficit C) Acute Confusion D) Anxiety

Ans: A Feedback: When taking metformin, the patient is at risk for lactic acidosis manifested by unexplained hyperventilation, myalgia, malaise, GI symptoms, or unusual somnolence. Thus, a nursing diagnosis of Ineffective Breathing Pattern would be most likely. There are no problems with fluid balance. Acute Confusion would be appropriate if the client was experiencing hypoglycemia. Anxiety would be appropriate for a client who is newly diagnosed with diabetes and having difficulty accepting the diagnosis.

19. A female client receiving fluoxymesterone for metastatic breast cancer is disturbed by the physical changes seen in her body. The nurse provides support to the client based on assessment of which of the following features the client is experiencing related to this therapy? A) Deepening of the voice B) Hypopigmentation of the skin C) Decrease in clitoris size D) Increase in body weight

Ans: A Feedback: Deepening of the voice may be seen as a feature of virilization following male hormone therapy in a female client. Virilization is the acquisition of male characteristics in the female. Other features of virilization include pigmentation, and not hypopigmentation, of the skin and an increase, not a decrease, in the size of the clitoris. An increase in body weight is not a sign of virilization. It may occur due to impaired nutrition of the body.

21. A client taking oral contraceptive drugs complains of occasional bloating of the abdomen. Which of the following instructions should the nurse offer the client to help alleviate the condition? A) Limit fluid intake with meals. B) Take the drug along with food. C) Decrease the intake of salt. D) Elevate the legs when sitting.

Ans: A Feedback: The nurse should instruct the client to limit fluid intake with meals if she experiences bloating of the abdomen after oral contraceptive use. Light to moderate exercise also may be helpful. Taking the drug with food alleviates nausea and GI irritation, and not the bloating of the abdomen. A decrease in salt intake causes a decrease in the intake of sodium, which may be beneficial when there is an excess fluid volume, and not when there is bloating of the abdomen. Elevating the legs when sitting prevents thromboembolism seen with oral contraceptive use. It does not prevent bloating of the abdomen.

24. The client develops acne. What should the nurse instruct the client with acne? A) Use water-based cosmetics or creams. B) Do not receive live virus vaccines. C) Avoid the use of alcohol while taking the drug. D) Avoid exposure to infections. drug.

Ans: A Feedback: The nurse should instruct the client with acne to keep the affected areas clean and use over-the-counter acne drugs and water-based cosmetics or creams. The nurse need not instruct the client to stop receiving live virus vaccines, avoid using alcohol, or avoid exposure to infections. When the client is undergoing long-term or high-dose glucocorticoid therapy, the nurse should inform the client to avoid receiving live virus vaccines and avoid exposure to infections if possible in the teaching plan for the client and family. If the client is undergoing vasopressin therapy, the nurse needs to instruct the client to avoid the use of alcohol while taking the

18. A nurse is caring for a client with nocturnal enuresis. A physician has prescribed desmopressin acetate to the client. The nurse would assess the client for which of the following as a possible adverse reaction? A) Nasal congestion B) Breast tenderness C) Fluid retention D) Gynecomastia

Ans: A Feedback: The nurse should monitor for nasal congestion, abdominal cramps, headache, and nausea in the client as the adverse reactions to desmopressin acetate. When the client is administered gonadotropin, the nurse needs to monitor for fluid retention and gynecomastia as the adverse reactions to the drug. When choriogonadotropin alfa is administered to the client, the nurse should monitor for breast tenderness, ovarian overstimulation, and vasomotor flushes as the adverse reactions to the drug.

23. A client is receiving corticosteroids at a health care facility. The client is also receiving digoxin as treatment for heart failure. The nurse understands that which of the following is a possibility due to the interaction of these two drugs? A) Increased risk for toxicity B) Decreased muscle function C) Increased risk of hyperkalemia D) Decreased serum corticosteroid levels

Ans: A Feedback: The nurse should observe for an increased risk for digoxin toxicity when corticosteroids are given with digoxin. Decreased muscle function, hyperkalemia, and decreased serum corticosteroid levels are not associated with the interaction.

17. When caring for a client receiving estrogen replacement therapy for postmenopausal symptoms, the nurse documents a diagnosis of Ineffective Tissue Perfusion. Which of the following conditions is the nurse referring to in the diagnosis? A) Thromboembolism B) Edema of the feet C) Gastrointestinal upset D) Chloasma

Ans: A Feedback: The nursing diagnosis of Ineffective Tissue Perfusion is related to thromboembolism, which is a complication of estrogen replacement therapy. A nurse may note other female hormone-related adverse reactions such as edema of the feet due to excess fluid volume or gastrointestinal upset, which manifests as nausea, vomiting, abdominal cramps, and bloating. Chloasma is a dermatologic reaction due to female hormones, which results in excessive pigmentation of the skin.

26. A client has been prescribed glucocorticoids for the treatment of congenital adrenal hyperplasia. Which of the following assessments should the nurse perform for the client? A) Take and record vital signs every 4 to 8 hours. B) Test the serum electrolyte levels. C) Auscultate the abdomen and record the findings. D) Observe for signs of blanching of the skin.

Ans: A Feedback: When glucocorticoids are administered to the client, the nurse should take and record vital signs every 4 to 8 hours. The nurse need not perform assessments related to serum electrolyte levels, abdominal auscultation, or skin blanching. These are appropriate for a client receiving vasopressin therapy.

After teaching a client who is prescribed methimazole, the nurse determines that the teaching was effective when the client states which of the following? Select all that apply. A) I need to take the drug around the clock. B) I should call my primary health care provider if I have a fever. C) I can use any over-the-counter medications if I need to. D) I might have some tenderness and swelling of my neck. E) I don't need to monitor my weight like I did before.

Ans: A, B Feedback: The client taking methimazole should take the drug as prescribed around the clock and call the primary health care provider if he develops fever, sore throat, cough, easy bleeding or bruising, headache, or a general feeling of malaise. The client also needs to check with the prescriber before using any nonprescription drugs and monitor his weight twice a week, notifying the primary health care provider if there is any sudden weight gain or loss. Tenderness and swelling would be noted if the client received radioactive iodine for a procedure.

20. A nurse is caring for a client receiving norethindrone for endometriosis. After administering the drug, the nurse would assess the client for which of the following? Select all that apply. A) Breast tenderness B) Edema C) Somnolence D) Hyperglycemia E) Thinning hair

Ans: A, B Feedback: Adverse reactions associated with norethindrone, a progestin, include breast tenderness, edema, insomnia, breakthrough bleeding, weight changes, and acne. Hyperglycemia and thinning hair are not associated with norethindrone.

A nurse should monitor a client for which of the following adverse reactions during the administration of tocolytic therapy to prevent uterine contractions? Select all that apply. A) Fatigue B) Diaphoresis C) Diplopia D) Hypertension E) Prolonged vaginal bleeding

Ans: A, B, C Feedback: A nurse should monitor a client for the following adverse reactions during tocolytic therapy to prevent uterine contractions: fatigue, flushing, headache, diplopia, diaphoresis, hypotension, depressed reflexes, and flaccid paralysis.

A nurse is caring for a client receiving insulin detemir 10 units at bedtime. Which of the following drugs, if started, would most likely require a decrease in the dosage of insulin? Select all that apply. A) Sulfamethoxazole/trimethoprim (Septra) B) Metoprolol (Lopressor) C) Fenofibrate (Tricor) D) Diltiazem (Verapamil) E) Albuterol (Ventolin)

Ans: A, B, C Feedback: Sulfonamides (sulfamethoxazole/trimethoprim), beta-blocking drugs (metoprolol), and fibrates (fenofibrate), among others, can increase the effect of insulin and require a decrease in insulin dosage to control the client's diabetes. Diltiazem and albuterol decrease the effect of insulin, requiring an increase in the dosage.

A nurse suspects that a client receiving an oxytocic drug is developing water intoxication based on assessment of which of the following? Select all that apply. A) Tachypnea B) Wheezing C) Confusion D) Hypoglycemia E) Hypotension

Ans: A, B, C Feedback: The nurse immediately reports any signs of water intoxication or fluid overload, which include drowsiness, confusion, headache, listlessness, wheezing, coughing, and tachypnea, to the physician.

The nurse should monitor a client receiving radioactive iodine (131I) for which of the following severe reactions? Select all that apply. A) Agranulocytosis B) Exfoliative dermatitis C) Hypoprothrombinemia D) Seizures E) Stroke

Ans: A, B, C Feedback: The nurse should monitor a client receiving radioactive iodine (131I) for severe reactions including agranulocytosis, exfoliative dermatitis, hypoprothrombinemia, and granulocytopenia.

A client is to receive indomethacin as tocolytic therapy. Which of the following laboratory tests would the nurse expect to be performed as a baseline? Select all that apply. A) Complete blood count B) Serum creatinine level C) Liver function tests D) Amniotic fluid index E) Blood glucose level

Ans: A, B, C, D Feedback: Baseline laboratory testing includes a complete blood count, creatinine level, liver function tests, and amniotic fluid index. Blood glucose level may be done if diabetes is suspected or confirmed.

During ongoing assessment the nurse should observe a client taking levothyroxine for which of the following indicating a therapeutic response? Select all that apply. A) Weight loss B) Mild diuresis C) Increased appetite D) Increased mental activity E) Decreased pulse rate

Ans: A, B, C, D Feedback: Signs of therapeutic response to levothyroxine include weight loss; mild diuresis; increased appetite; increased pulse rate; decreased puffiness of face, hands, and feet; and client report of increased mental activity and increased sense of well-being.

A nurse is preparing to administer oxytocin (Pitocin) intravenously to a client based on the understanding that this drug is used for which of the following reasons? Select all that apply. A) Gestational diabetes and a large fetus B) Rh problems C) Premature rupture of membranes D) Uterine inertia E) Pregnancy-induced hypertension

Ans: A, B, C, D, E Feedback: A nurse may be asked to administer oxytocin (Pitocin) intravenously to a client with the following: gestational diabetes and a large fetus, Rh problems, premature rupture of membranes, uterine inertia, or pregnancy-induced hypertension.

A nurse monitoring a hospitalized client with a UTI notifies the physician if which of the following occur with drug therapy? Select all that apply. A) Fever B) Poor fluid intake C) Decreased urinary output D) Appearance of concentrated urine E) Worsening of UTI symptoms

Ans: A, B, C, D, E Feedback: A nurse monitoring a hospitalized client with a UTI notifies the physician if any of the following occur: fever, poor fluid intake, decreased urinary output, appearance of concentrated urine, or worsening of UTI symptoms.

A client is receiving estrogen therapy. When teaching the client about this therapy, the nurse would inform the client about which of the following as a possible adverse reaction? Select all that apply. A) Migraines B) Breakthrough bleeding C) Changes in libido D) Weight gain E) Breast tenderness

Ans: A, B, C, D, E Feedback: Adverse reactions associated with estrogens include headache, including migraines; breakthrough bleeding, spotting, or changes in menstrual flow; changes in libido; weight gain or loss; and breast pain, enlargement, and tenderness.

A nurse caring for a client who is receiving warfarin (Coumadin) will monitor for signs of bleeding if which of the following thyroid hormone-regulating drugs is initiated? Select all that apply. A) Propylthiouracil (PTU) B) Desiccated thyroid (Armour Thyroid) C) Liotrix (Thyrolar) D) Methimazole (Tapazole) E) Liothyronine (Triostat)

Ans: A, B, C, D, E Feedback: All of the thyroid hormone replacement drugs and methimazole (Tapazole) and propylthiouracil (PTU) can increase the risk for bleeding, especially in clients taking warfarin (Coumadin).

Before beginning an IV infusion of oxytocin (Pitocin) to induce labor, the nurse obtains an obstetric history that includes which of the following? Select all that apply. A) Parity B) Stillbirths C) Abortions D) Previous obstetric problems E) Type of labor

Ans: A, B, C, D, E Feedback: Before beginning an IV infusion of oxytocin (Pitocin) to induce labor, the nurse obtains an obstetric history that includes parity, gravidity, previous obstetric problems, type of labor, stillbirths, abortions, and live-birth infant abnormalities.

A nurse caring for a client being treated with nitrofurantoin (Macrodantin) for a UTI should ask the client specifically about resolution of which of the following symptoms during ongoing assessment? Select all that apply. A) Urgency B) Frequency C) Pressure D) Burning during urination E) Pain during urination

Ans: A, B, C, D, E Feedback: Clinical manifestations of a UTI include urgency, frequency, pressure, burning and pain on urination, and pain caused by spasm in the region of the bladder and the suprapubic area and should be assessed by the nurse during ongoing assessment to determine effectiveness of drug therapy.

A nurse informs a client prescribed nitrofurantoin (Macrodantin) and her family that pulmonary reactions have been reported with the drug's use hours to 3 weeks after the drug therapy is initiated. The nurse determines that the teaching was successful when the client states that she will notify the primary health care provider if which of the following occur? Select all that apply. A) Dyspnea B) Chest pain C) Cough D) Fever E) Chills

Ans: A, B, C, D, E Feedback: Signs and symptoms of an acute pulmonary reaction to nitrofurantoin (Macrodantin) include dyspnea, chest pain, cough, fever, and chills, and any of these should be reported to the physician immediately.

When monitoring uterine contractions of a client receiving an oxytocin infusion, the nurse should notify the primary health care provider immediately if which of the following occur? Select all that apply. A) No palpable relaxation of the uterus B) Significant change in client's blood pressure C) Significant change in fetal heart rhythm D) Significant change in rhythm of uterine contractions E) Significant change in frequency of uterine contractions

Ans: A, B, C, D, E Feedback: When monitoring uterine contractions, the nurse should notify the physician immediately if any of the following occur: a significant change in fetal heart rate or rhythm; a marked change in the frequency, rate, or rhythm of uterine contractions; uterine contractions lasting longer than 60 seconds; contractions occurring more frequently than every 2 or 3 minutes; no palpable relaxation of the uterus; a marked increase or decrease in the client's blood pressure or pulse; or any significant change in the client's general condition.

A client is receiving glyburide. The nurse assesses the client for a decrease in the drug's effect if which of the following drugs are initiated? Select all that apply. A) Atenolol (Tenormin) B) Amlodipine (Norvasc) C) Phenytoin (Dilantin) D) Lithium (Eskalith) E) Levothyroxine (Synthroid)

Ans: A, B, C, E Feedback: Beta blockers (atenolol), calcium channel blockers (amlodipine), hydantoins (phenytoin), and thyroid agents (levothyroxine), among others, can result in decreased hypoglycemic effects of sulfonylureas (glyburide).

While conducting a health promotion presentation for a local group of women who are in their 30s and 40s, one of the women asks the nurse, I've heard horror stories about menopause. Are there any herbal products that can help? Which of the following would the nurse include in the response? Select all that apply. A) Black cohosh B) Sage C) Calendula D) Saw palmetto E) Dandelion

Ans: A, B, C, E Feedback: Black cohosh, sage, dandelion, and calendula are herbs that may be used to address menopausal symptoms. Saw palmetto is used to relieve the symptoms of benign prostatic hypertrophy.

During initial therapy with levothyroxine, the most common reactions a nurse might observe in a client include which of the following? Select all that apply. A) Elevated body temperature B) Weight loss C) Tachycardia D) Hypotension E) Insomnia

Ans: A, B, C, E Feedback: During initial therapy with levothyroxine, the most common reactions a nurse would observe are signs of overdose and hyperthyroidism, which include increased metabolism; heat intolerance; elevated body temperature; weight loss; tachycardia; hypertension; nervousness; anxiety; insomnia; exophthalmos; flushed, warm, moist skin; thinning hair; goiter; and irregular or scant menses.

Hormones may be used in cancer therapy, especially for advanced disease. Which of the following are hormones used as antineoplastic drugs? Select all that apply. A) Testolactone (Teslac) B) Leuprolide (Lupron) C) Megestrol (Megace) D) Bicalutamide (Casodex) E) Goserelin (Zoladex)

Ans: A, B, C, E Feedback: Testolactone (Teslac), leuprolide (Lupron), megestrol (Megace), bicalutamide (Casodex), and goserelin (Zoladex) are hormones used as antineoplastic drugs.

A physician has ordered an iodine procedure for a client with thyroid dysfunction. What should be included in the nurse's preadministration assessment for the client? Select all that apply. A) Allergy history B) Weight C) Pulse D) Blood glucose E) Temperature

Ans: A, B, C, E Feedback: The nurse's preadministration assessment for the client should include vital signs (blood pressure, respiratory rate, pulse, and temperature), allergy history, weight, and notation regarding the outward symptoms of the hyperthyroidism.

A client is prescribed flavoxate. When reviewing the client's history, the nurse would expect to find which of the following complaints? Select all that apply. A) Dysuria B) Nocturia C) Leakage D) Suprapubic pain E) Inability to void

Ans: A, B, D Feedback: Flavoxate, an antispasmodic, is used to relieve symptoms of dysuria, urinary urgency, nocturia, suprapubic pain, and frequency and urge incontinence. Other antispasmodics are used to treat bladder instability, such as leakage caused by a neurogenic bladder. The drug is not used to treat an inability to void.

The nurse monitoring a client receiving insulin glulisine (Apidra) notices the client has become confused, diaphoretic, and nauseated. The nurse checks the client's blood glucose and it is 60 mg/dL. Which of the following would the nurse most likely give? Select all that apply. A) Orange or other fruit juice B) Glucose tablets C) Insulin glargine (Lantus) D) Hard candy E) Insulin detemir (Levemir)

Ans: A, B, D Feedback: Methods of terminating a hypoglycemic reaction include the administration of one or more of the following: orange or other fruit juice, hard candy or honey, glucose tablets, glucagon, or glucose 10% or 50% IV.

Prior to administering oxybutynin (Ditropan) to a client, the nurse should get a full medical history because the use of oxybutynin (Ditropan) is contraindicated in clients with which of the following? Select all that apply. A) Myasthenia gravis B) Urinary tract blockage C) Diabetes D) Intestinal blockage E) Hypertriglyceridemia

Ans: A, B, D Feedback: The use of oxybutynin (Ditropan) is contraindicated in clients with the following: known hypersensitivity, glaucoma, myasthenia gravis, abdominal bleeding, and intestinal, gastric, or urinary tract blockages.

A nurse should monitor a client taking glyburide (DiaBeta) for increased hypoglycemic effect if which of the following drugs are initiated? Select all that apply. A) Ranitidine (Zantac) B) Warfarin (Coumadin) C) Digoxin (Lanoxin) D) Lithium (Eskalith) E) Amitriptyline (Elavil)

Ans: A, B, E Feedback: H2 antagonists (ranitidine), anticoagulants (warfarin), and tricyclic antidepressants (amitriptyline), among others, can result in increased hypoglycemic effects of sulfonylureas (glyburide).

As part of the ongoing assessment of a client receiving insulin detemir, the nurse would suspect that the insulin is not effective based on assessment of which of the following? Select all that apply. A) Increased thirst B) Increased urination C) Increased appetite D) Confusion E) Abdominal pain

Ans: A, B, E Feedback: If the insulin was not effective, the client would exhibit signs and symptoms of hyperglycemia including drowsiness, dim vision, thirst, nausea, vomiting, abdominal pain, loss of appetite, acetone breath, and excessive urination.

Immediately before starting an IV infusion of oxytocin (Pitocin), the nurse assesses which of the following? Select all that apply. A) Client's blood pressure B) Fetal heart rate C) Client's blood glucose D) Client's temperature E) Client's respiratory rate

Ans: A, B, E Feedback: Immediately before starting an IV infusion of oxytocin (Pitocin), the nurse assesses the fetal heart rate and the client's blood pressure, pulse, and respiratory rate.

1. After teaching a group of students about uterine drugs, the instructor determines that the teaching was successful when the students identify which of the following as oxytocic drugs? Select all that apply. A) Oxytocin (Pitocin) B) Methylergonovine (Methergine) C) Estradiol (Estrace) D) Indomethacin (Indocin) E) Misoprostol (Cytotec)

Ans: A, B, E Feedback: Oxytocin (Pitocin), methylergonovine (Methergine), and misoprostol (Cytotec) are classified as oxytocic drugs. Indomethacin is a tocolytic. Estradiol is an estrogen.

Which of the following produce their glucose-lowering effect by decreasing insulin resistance and increasing insulin sensitivity? Select all that apply. A) Rosiglitazone (Avandia) B) Metformin (Glucophage) C) Pioglitazone (Actos) D) Miglitol (Glyset) E) Acarbose (Precose)

Ans: A, C Feedback: The thiazolidinediones, rosiglitazone (Avandia) and pioglitazone (Actos), produce their glucose-lowering effect by decreasing insulin resistance and increasing insulin sensitivity. The alpha-glucosidase inhibitors, acarbose (Precose) and miglitol (Glyset), produce their glucose-lowering effects by delaying the digestion and absorption of carbohydrates in the intestine. Metformin sensitizes the liver to circulating insulin levels and reduces hepatic glucose production.

A client is receiving methylergonovine (Methergine). After administering the drug, the nurse would be alert for which of the following? Select all that apply. A) Chest pain B) Hypoglycemia C) Increase in blood pressure D) Diarrhea E) Water intoxication

Ans: A, C, D Feedback: Adverse reactions associated with methylergonovine include temporary chest pain, hypertension, diarrhea, nausea, vomiting, dizziness, and headache.

After reviewing information about estrogens and their use, the instructor determines that the teaching was successful when the students identify which of the following as true? Select all that apply. A) Changes in lipids levels occur with the use of estrogens. B) Progestin use is recommended when estrogen is used after a hysterectomy. C) Estrogen replacement therapy (ERT) helps to lessen the changes to the aging tissues. D) Estrogens increase a woman's risk for gallbladder disease. E) The use of estrogens is associated with relatively few adverse reactions.

Ans: A, C, D Feedback: Estrogens can relieve symptoms of menopause but can lead to blood pressure and lipid changes. ERT can help lessen the changes to aging tissues, but the estrogen does increase a woman's risk for gallbladder disease. The addition of progestin is recommended when estrogen is used to treat menopausal symptoms in a woman with an intact uterus. Estrogen alone may be used for estrogen replacement therapy after a hysterectomy. The administration of estrogen by any route may result in many adverse reactions, although these reactions vary in incidence and intensity.

When preparing to administer insulin glargine to a client, which of the following would be appropriate for the nurse to do? Select all that apply. A) Check the expiration date on the vial. B) Shake the vial vigorously. C) Check the physician's orders for the type and dosage of insulin. D) Remove all air bubbles from the syringe barrel. E) Mix with short-acting insulin prior to administration.

Ans: A, C, D Feedback: Prior to administering insulin glargine (Lantus) to a client, the nurse must complete the following preadministration steps: carefully check the physician's order for the type and dosage of insulin, check the expiration date on the vial, gently rotate the vial between the palms of the hands, gently tilt end to end before withdrawing the insulin, and remove all air bubbles from the syringe barrel. The nurse should never mix or dilute insulin glargine (Lantus) with any other insulin or solution because the insulin will not be effective.

A nurse is administering magnesium to a client as part of therapy to halt preterm labor. The nurse is alert to the possibility of increased central nervous system depression if the client is also receiving which of the following? Select all that apply. A) Fentanyl (Duragesic) B) Glyburide (DiaBeta) C) Lorazepam (Ativan) D) Meperidine (Demerol) E) Enalapril (Vasotec)

Ans: A, C, D Feedback: The administration of magnesium with the following drugs results in increased central nervous system depression: opioids (fentanyl and meperidine), sedatives (lorazepam), and analgesics.

A nurse is describing the action of thyroid hormones to a client. The nurse would include information that thyroid hormones are principally concerned with the increase in the metabolic rate of tissues that can result in which of the following? Select all that apply. A) Increased heart rate B) Decreased respiratory rate C) Increased body temperature D) Increased cardiac output E) Decreased oxygen consumption

Ans: A, C, D Feedback: Thyroid hormones are principally concerned with the increase in the metabolic rate of tissues, which results in increases in the heart and respiratory rate, body temperature, cardiac output, oxygen consumption, and metabolism of fats, proteins, and carbohydrates.

7. Which of the following should be included in the nurse's preadministration assessment of a client receiving desmopressin (DDAVP) for relief of abdominal distention? Select all that apply. A)Abdominal girth B)Weight C)Pulse D)Respiratory rate E)Blood glucose

Ans: A, C, D Feedback: Blood pressure, pulse, respiratory rate, and abdominal girth should be included in the nurse's preadministration assessment of a client receiving desmopressin (DDAVP) for relief of abdominal distention.

A client is receiving metformin (Glucophage). The nurse suspects that the client is developing lactic acidosis based on assessment of which of the following? Select all that apply. A) Malaise B) Hypertension C) Tachypnea D) Abdominal pain E) Muscular pain

Ans: A, C, D, E Feedback: Symptoms of lactic acidosis include malaise, abdominal pain, tachypnea, shortness of breath, and muscular pain.

A nurse administering oxytocin (Pitocin) to a client should monitor the client for which of the following? Select all that apply. A) Water intoxication B) Diarrhea C) Uterine rupture D) Headache E) Cardiac arrhythmias

Ans: A, C, E Feedback: A nurse should monitor a client receiving oxytocin (Pitocin) for the following adverse reactions: fetal bradycardia, uterine rupture, uterine hypertonicity, nausea, vomiting, cardiac arrhythmias, and anaphylactic reactions. Serious water intoxication (fluid overload, fluid volume excess) may occur, particularly when the drug is administered by continuous infusion and the patient is receiving fluids by mouth.

After administering an injection of oxytocin (Pitocin), the nurse continues to assess which of the following? Select all that apply. A) Blood pressure B) Blood glucose C) Pulse D) Temperature E) Respiratory rate

Ans: A, C, E Feedback: After an injection of oxytocin (Pitocin), during ongoing assessment the nurse monitors the following: the client's blood pressure, pulse, and respiratory rate.

A nurse caring for a client taking which of the following drugs may notice increased adverse reactions if the client was prescribed nitrofurantoin (Macrodantin) resulting from an increased absorption of nitrofurantoin (Macrodantin)? Select all that apply. A) Benztropine (Cogentin) B) Simvastatin (Zocor) C) Tiotropium (Spiriva) D) Albuterol (Proventil) E) Dicyclomine (Bentyl)

Ans: A, C, E Feedback: Anticholinergic drugs, like benztropine (Cogentin), tiotropium (Spiriva), and dicyclomine (Bentyl), can cause delayed gastric emptying, leading to increased absorption of nitrofurantoin (Macrodantin), which may result in increased adverse reactions.

The nurse is preparing to administer a prescribed drug to help prevent hemorrhage caused by uterine atony. Which drug would the nurse most likely administer? Select all that apply. A) Carboprost (Hemabate) B) Indomethacin (Indocin) C) Methylergonovine (Methergine) D) Terbutaline (Brethine) E) Misoprostol (Cytotec)

Ans: A, C, E Feedback: Carboprost (Hemabate), methylergonovine (Methergine), misoprostol (Cytotec), and ergonovine (Ergotrate) are used postpartum to prevent hemorrhage caused by uterine atony. Indomethacin and terbutaline are used as tocolytics.

A nurse is educating a client receiving sulfamethoxazole/trimethoprim (Septra) about common dermatologic adverse reactions. Which of the following would the nurse include in the teaching? Select all that apply. A) Rash B) Stevens-Johnson syndrome C) Photosensitivity D) Exfoliative dermatitis E) Pruritus

Ans: A, C, E Feedback: Common dermatologic adverse reactions seen with the use of sulfamethoxazole/trimethoprim (Septra) include rash, photosensitivity, pruritus, and urticaria.

A nurse prepares to administer oxytocin (Pitocin) intramuscularly during the third stage of labor for which of the following reasons? Select all that apply. A) Production of uterine contractions B) Stimulation of milk ejection C) Control of postpartum bleeding D) Initiation of labor E) Control of postpartum hemorrhage

Ans: A, C, E Feedback: Oxytocin (Pitocin) may be given intramuscularly during the third stage of labor to produce uterine contractions and control postpartum bleeding and hemorrhage.

A nurse is to obtain a daily urine pH as ordered. The client would most likely be receiving which of the following anti-infectives for a UTI because they work better in acidic urine? Select all that apply. A) Methenamine (Hiprex) B) Amoxicillin (Amoxil) C) Fosfomycin (Monurol) D) Nitrofurantoin (Macrodantin) E) Nalidixic (NegGram)

Ans: A, D Feedback: A daily urine pH level may be ordered by the physician for clients taking methenamine (Hiprex) or nitrofurantoin (Macrodantin) for a UTI because they work better in acidic urine.

A nurse educating a client and his family about levothyroxine for the treatment of hypothyroidism should include which of the following information? Select all that apply. A) Therapy is lifelong. B) Drug is taken in the evening. C) Therapy needs to be evaluated every week initially. D) Weekly weights are needed with significant changes reported. E) Changing brands of the drug is okay.

Ans: A, D Feedback: A nurse educating a client and his family about levothyroxine includes the following: therapy is lifelong, dose is taken in the morning before breakfast, therapy needs to be evaluated every 2 weeks initially, weekly weights are needed and significant changes are reported to the physician, and the client should not change brands of the drug without consulting the physician.

A client is prescribed finasteride to treat his symptoms of BPH. When teaching the client about this drug, the nurse would most likely include a discussion about the possibility of which of the following? A) Erectile dysfunction B) Dry mouth C) Constipation D) Decreased libido E) Weight gain

Ans: A, D Feedback: Androgen hormone inhibitors such as finasteride have been associated with the adverse reaction of erectile dysfunction and decreased libido. Dry mouth and constipation are associated with antispasmodics. Weight gain is associated with alpha-adrenergic blockers.

A nurse is preparing to administer a drug that helps lower blood glucose by increasing the production of insulin by beta cells in the pancreas. Which of the following might this be? Select all that apply. A) Glyburide (DiaBeta) B) Metformin (Glucophage) C) Pioglitazone (Actos) D) Glipizide (Glucotrol) E) Acarbose (Precose)

Ans: A, D Feedback: Sulfonylureas, like glyburide (DiaBeta) and glipizide (Glucotrol), help lower blood glucose by increasing the production of insulin by beta cells in the pancreas.

A nurse is developing a teaching plan for a client diagnosed with a UTI and prescribed nitrofurantoin (Macrodantin). The nurse would warn the client about which of the following common gastrointestinal adverse reactions? Select all that apply. A) Anorexia B) Ileus C) Toxic megacolon D) Nausea E) Diarrhea

Ans: A, D, E Feedback: Common gastrointestinal adverse reactions seen with the use of nitrofurantoin (Macrodantin) include anorexia, nausea, vomiting, diarrhea, and abdominal pain.

A nurse is caring for a client receiving insulin glargine (Lantus) 20 units at bedtime. Initiation of which of the following drugs may increase the client's insulin requirement? Select all that apply. A) Methylprednisolone (Medrol) B) Metoprolol (Lopressor) C) Fenofibrate (Tricor) D) Estradiol (Estrace) E) Niacin (Niaspan)

Ans: A, D, E Feedback: Corticosteroids (methylprednisolone), estrogens (estradiol), and niacin (Niaspan) are among the drugs can decrease the effect of insulin and require an increase in insulin dosage to control the client's diabetes. Beta blockers and fibrates increase the effect of insulin and thus may require a decrease in the dosage of insulin.

After teaching an in-service presentation to a group of nurses about diabetes and insulin, the presenter determines that the presentation was successful when the group identifies which of the following as a rapid-acting insulin? Select all that apply. A) Insulin aspart (NovoLog) B) Isophane insulin suspension (Novolin N) C) Insulin glargine (Lantus) D) Insulin detemir (Levemir) E) Insulin glulisine (Apidra)

Ans: A, E Feedback: Insulin aspart (NovoLog) and insulin glulisine (Apidra) are rapid-acting insulins. Isophane insulin suspension is an intermediate-acting insulin. Insulin glargine and detemir are long-acting insulins.

After teaching a group of nursing students about thyroid drugs, the instructor determines that the teaching was successful when the students identify which of the following as an antithyroid drug? Select all that apply. A) Propylthiouracil B) Levothyroxine C) Liotrix D) Desiccated thyroid E) Methimazole

Ans: A, E Feedback: Propylthiouracil and methimazole are antithyroid drugs. Levothyroxine, liotrix, and desiccated thyroid are thyroid hormone supplements.

A nurse understands that methylergonovine (Methergine) should not be administered to which client because excessive vasoconstriction may result? Select all that apply. A) Client who is a heavy smoker B) Client taking a diuretic C) Client receiving insulin D) Client taking an antihypertensive E) Client taking a vasopressor

Ans: A, E Feedback: When methylergonovine (Methergine) is administered concurrently with vasopressors or to clients who are heavy smokers, excessive vasoconstriction may result.

9. A nurse completing discharge counseling should advise a client taking vasopressin (Pressyn) to notify the physician if which of the following occur? Select all that apply. A) Changes in urine output B) Abdominal cramps C) Skin blanching D) Diarrhea E) Cough

Ans: A,B,C Feedback: A nurse completing discharge counseling should advise a client taking vasopressin (Pressyn) to notify the physician if any of the following occur: a significant increase or decrease in urine output, abdominal cramps, skin blanching, nausea, confusion, headache, drowsiness, or signs of inflammation or infection at the injection sites.

3. A nurse should advise a client beginning therapy with testosterone (Androderm) about which of the following adverse effects? Select all that apply. A) Impotence B) Fluid retention C) Male-pattern baldness D) Somnolence E) Mania

Ans: A,B,C Feedback: A nurse should advise a client beginning therapy with testosterone (Androderm) of the following adverse effects: gynecomastia, testicular atrophy, inhibition of testicular function, impotence, enlargement of the penis, nausea, vomiting, jaundice, headache, anxiety, male-pattern baldness, acne, depression, and fluid and electrolyte imbalances (which include sodium, water, chloride, potassium, calcium, and phosphate retention).

4. A female client with inoperable advanced breast cancer is prescribed methyltestosterone. The nurse would be alert for the development of which of the following? Select all that apply. A) Amenorrhea B) Acne C) Facial hair growth D) Somnolence E) Mania

Ans: A,B,C Feedback: A nurse should advise a female client beginning therapy with methyltestosterone (Testred) for the treatment of inoperable advanced breast carcinoma of the following adverse reactions: amenorrhea, other menstrual irregularities, acne, male-pattern baldness, and virilization (facial hair growth, voice deepening, and clitoromegaly).

27. A nurse is assessing a client who is receiving desmopressin therapy and suspects that the client is experiencing water intoxication. Which of the following would support the nurse's suspicions? Select all that apply. A) Drowsiness B) Headache C) Confusion D) Abdominal pain E) Diarrhea

Ans: A,B,C Feedback: Symptoms of water intoxication include drowsiness, listlessness, confusion, and headache (which may precede convulsions and coma). Abdominal pain and diarrhea are not associated with water intoxication.

25. A nurse is developing a teaching plan for a client who is prescribed testosterone gel. The nurse instructs the client to apply the gel to which location? Select all that apply. A) Shoulders B) Upper arms C) Abdomen D) Thighs E) Groin

Ans: A,B,C Feedback: Testosterone gel (AndroGel) is applied once daily (preferably in the morning) to clean, dry, intact skin of the shoulders, upper arms, or abdomen.

28. A client receiving gonadotropin therapy comes to the clinic for follow-up. Which of the following would the nurse immediately report to the primary health care provider? Select all that apply. A) Ascites B) Abdominal distention C) Abdominal pain D) Weight gain E) Irritability

Ans: A,B,C Feedback: The client is at risk for ovarian enlargement manifested by abdominal distention, pain, and ascites (with serious cases). The nurse would immediately notify the primary health care provider and the drug would be discontinued at the first sign of ovarian stimulation or enlargement. Weight gain and irritability would not need to be reported immediately.

26. A group of nursing students are reviewing information about male and female hormones. The students demonstrate understanding of the information when they identify which of the following as an anabolic steroid? Select all that apply. A) Nandrolone B) Oxymetholone C) Oxandrolone D) Testosterone E) Fluoxymesterone

Ans: A,B,C Feedback: Anabolic steroids include nandrolone, oxymetholone, and oxandrolone. Testosterone and fluoxymesterone are testosterones.

14. A nurse is teaching a client about transdermal estrogen therapy. The nurse understands that this method of delivery has been found to be safer especially for women with which of the following conditions? Select all that apply. A) Hypertriglyceridemia B) Type 2 diabetes C) Migraine headaches D) Hypertension E) Rheumatoid arthritis

Ans: A,B,C,D Feedback: Transdermal delivery of estrogens has been found to be safer especially for women with hypertriglyceridemia, type 2 diabetes, hypertension, and migraine headaches and those who smoke.

5. A nurse suspects a client might be abusing anabolic steroids. Which of the following signs might a client exhibit that would indicate abuse of anabolic steroids? Select all that apply. A) Uncontrolled rage B) Jaundice C) Inability to concentrate D) Acne E) Severe depression

Ans: A,B,C,D,E Feedback: A client abusing anabolic steroids might exhibit the following signs: uncontrolled rage, severe depression, suicidal tendencies, malignant or benign liver tumors, aggressive behavior, inability to concentrate, personality changes, acne, jaundice, anorexia, male- pattern baldness, fluid and electrolyte imbalances, and muscle cramps.

12. A nurse educating a client on Ortho Tri-Cyclen Lo should strongly caution the client not to smoke because smoking increases the risk of which of the following adverse events? Select all that apply. A) Venous thromboembolism B) Arterial thromboembolism C) Hemorrhagic stroke D) Myocardial infarction E) Thrombotic stroke

Ans: A,B,C,D,E Feedback: Smoking while taking oral contraceptives, like Ortho Tri-Cyclen Lo, increases a client's risk for venous and arterial thromboembolism, myocardial infarction, and thrombotic and hemorrhagic stroke.

12. Which of the following should be included in the nurse's preadministration assessment of a client about to receive somatropin (Nutropin)? Select all that apply. A) Height B) Weight C) Blood pressure D) Pulse E) Respiratory rate

Ans: A,B,C,D,E Feedback: Blood pressure, pulse, respiratory rate, temperature, height, and weight should be included in the nurse's preadministration assessment of a client about to receive somatropin (Nutropin).

13. When completing the ongoing assessment of clients receiving estrogen, progestin, or combination products, which of the following would the nurse include? Select all that apply. A) Blood pressure B) Pulse C) Respiratory rate D) Temperature E) Therapeutic effects

Ans: A,B,C,E Feedback: The nurse's ongoing assessment of clients receiving estrogen, progestin, or combination products should include blood pressure, pulse, respiratory rate, weight, and questioning about adverse effects and therapeutic effects.

1. A nursing instructor is preparing for a class discussion on pituitary gland hormones. Which of the following hormones would the instructor include as being secreted by the anterior pituitary gland? Select all that apply. A) Growth hormone B) Adrenocorticotropic hormone C) Vasopressin D) Prolactin E) Oxytocin

Ans: A,B,D Feedback: Prolactin, adrenocorticotropic hormone, growth hormone, luteinizing hormone, follicle- stimulating hormone, and thyroid-stimulating hormone are secreted by the anterior pituitary gland. Vasopressin and oxytocin are secreted by the posterior pituitary gland.

15. The nurse should educate a client receiving adrenocorticotropic hormone (ACTH) to report which of the following to the health care provider? Select all that apply. A) Malaise B) Sores that don't heal C) Otic irritation D) Fever E) Diarrhea

Ans: A,B,D Feedback: The nurse instructs a client receiving adrenocorticotropic hormone (ACTH) to report any of the following adverse reactions to the physician: sore throat, cough, fever, malaise, sores that don't heal, or redness or irritation of the eyes.

14. Which of the following should be included in the nurse's preadministration assessment of a client about to receive adrenocorticotropic hormone (ACTH)? Select all that apply. A) Lung auscultation B) Mental status assessment C) Height D) Pulse E) Skin integrity assessment

Ans: A,B,D,E Feedback: Blood pressure, pulse, respiratory rate, temperature, weight, skin integrity assessment, mental status assessment, and lung auscultation should be included in the nurse's preadministration assessment of a client about to receive ACTH.

8. A nurse is educating a client and his family about vasopressin (DDAVP) for the treatment of diabetes insipidus. In addition to administration instructions, which of the following should the nurse discuss with the client and family? Select all that apply. A) Wearing a medical alert bracelet B) Monitoring the daily intake of fluids C) Avoiding sun exposure while using the drug D) Carrying extra doses with the client at all times E) Carrying liquids with the client at all times

Ans: A,B,D,E Feedback: In addition to administration instructions, the nurse should include the following: wear a medical alert bracelet, monitor the daily intake and output of fluids, avoid the use of alcohol, and carry extra doses and liquids with the client at all times.

13. A client is receiving treatment with adrenocorticotropic hormone. The nurse would instruct the client to avoid receiving which vaccine? Select all that apply. A) Zostavax (shingles) B) Meruvax (rubella) C) Td (tetanus and diphtheria) D) Fluzone (influenza) E) Attenuvax (measles)

Ans: A,B,E Feedback: Clients taking ACTH should avoid any vaccination with live virus including Zostavax, Meruvax, and Attenuvax.

1. A nursing instructor is describing the role of androgens to a nursing class. The instructor determines that the class was successful when the students identify that from puberty onward, androgens continue to aid in the development and maintenance of secondary sex characteristics that include which of the following? Select all that apply. A) Body fat distribution B) Muscle development C) Epiphyseal growth D) Glucose metabolism E) Body hair

Ans: A,B,E Feedback: From puberty onward, androgens continue to aid in the development and maintenance of secondary sex characteristics, which include facial hair, deep voice, body hair, body fat distribution, and muscle development.

6. A nurse's preadministration assessment for a client about the receive oxymetholone (Anadrol-50) should include which of the following? Select all that apply. A) Weight B) Blood glucose C) Serum lipid levels D) Hepatic function tests E) Pain assessment

Ans: A,C,D Feedback: A nurse's preadministration assessment for a client about the receive oxymetholone (Anadrol-50) should include weight, blood pressure, pulse, respiratory rate, complete blood count, hepatic function tests, serum electrolytes, and serum lipid levels.

8. A female client is prescribed norethindrone (Aygestin). The nurse understands that this drug is indicated for which of the following? Select all that apply. A) Treatment of amenorrhea B) Treatment of edema C) Treatment of endometriosis D) Pregnancy prevention E) Prevention of estrogen-dependent breast carcinoma

Ans: A,C,D Feedback: Progestins, like norethindrone (Aygestin), are used to treat amenorrhea, endometriosis, and functional uterine bleeding and to prevent pregnancy.

10. A client with estrogen excess may report which of the following symptoms to the nurse during ongoing assessment during treatment with Ortho-Novum 7/7/7? Select all that apply. A) Nausea B) Early breakthrough bleeding C) Cervical mucorrhea D) Edema E) Increased spotting

Ans: A,C,D Feedback: Signs of excess estrogen include nausea, bloating, cervical mucorrhea, polyposis, hypertension, migraine headache, breast fullness or tenderness, and edema.

A client is receiving terbutaline for preterm labor. After administering the drug, the nurse would be alert for which of the following as an adverse reaction? Select all that apply. A) Diplopia B) Nervousness C) Tremor D) Palpitations E) Heartburn

Ans: B, C, D Feedback: Adverse reactions associated with terbutaline include nervousness, restlessness, tremor, headache, anxiety, hypertension, palpitations, arrhythmias, hypokalemia, and pulmonary edema. Diplopia and heartburn are associated with indomethacin.

17. Which of the following adrenocortical hormone drugs influence or regulate functions such as the immune response; glucose, fat, and protein metabolism; and the anti- inflammatory response? Select all that apply. A) Betamethasone (Celestone) B) Fludrocortisone (Florinef) C) Budesonide (Entocort EC) D) Hydrocortisone (Cortef) E) Dexamethasone (Decadron)

Ans: A,C,D,E Feedback: Glucocorticoids, like betamethasone (Celestone), budesonide (Entocort EC), hydrocortisone (Cortef), and dexamethasone (Decadron), influence or regulate functions such as the immune response; glucose, fat, and protein metabolism; and the anti- inflammatory response.

5. A nurse is caring for a client receiving desmopressin (DDAVP). The nurse would assess the client for which of the following adverse reactions? Select all that apply. A) Tremor B) Hypotension C) Diaphoresis D) Dehydration E) Nausea

Ans: A,C,E Feedback: A nurse should monitor a client taking desmopressin (DDAVP) for the following adverse reactions: tremor, diaphoresis, vertigo, nasal congestion, nausea, vomiting, abdominal cramps, and water intoxication.

A nurse is administering methenamine to a client with a UTI. Which of the following would the nurse instruct the client to avoid? A) Ascorbic acid B) Sodium bicarbonate C) Acetaminophen D) Ibuprofen

Ans: B Feedback: An increased urinary pH (alkaline urine) decreases the effectiveness of methenamine. Therefore, to avoid raising the urine pH when taking methenamine, the client should not use antacids containing sodium bicarbonate or sodium carbonate.

A nurse is caring for a client with diabetes mellitus who is receiving an oral antidiabetic drug. Which of following ongoing assessments should the nurse perform when caring for this client? A) Assess the skin for ulcers, cuts, and sores. B) Observe the client for hypoglycemic episodes. C) Monitor the client for lipodystrophy. D) Document family medical history.

Ans: B Feedback: As the ongoing assessment activity, the nurse should observe the client for hypoglycemic episodes. Documenting family medical history and assessing the client's skin for ulcers, cuts, and sores should be completed before administering the drug. Lipodystrophy occurs if the sites of insulin injection are not rotated.

A 32-year-old pregnant woman has been prescribed an IV infusion of oxytocin to induce labor. Which of the following interventions would be most appropriate for the nurse to implement before starting the IV infusion of oxytocin for the client? A) Ask the client to drink plenty of water. B) Obtain an obstetric and general health history. C) Examine for signs of water intoxication. D) Place the client in an upright position.

Ans: B Feedback: Before starting an IV infusion of oxytocin to induce labor, the nurse should obtain a complete obstetric history (e.g., parity, gravidity, previous obstetric problems, type of labor, stillbirths, abortions, live-birth infant abnormalities) and a general health history. Clients should not have water before labor, as the oxytocin may lead to water intoxication. The nurse should examine for any signs of water intoxication or fluid overload as a sign of an adverse reaction to the drug and need not assess this before administration of the medication. Placing the client in an upright position is advised when oxytocin is administered intranasally to facilitate the letdown of milk for breastfeeding.

A nurse needs to start methenamine for a client. The nurse checks the client's medical record for an allergy to which of the following? A) Sulfa B) Tartrazine C) Shellfish D) Penicillin

Ans: B Feedback: Clients who are allergic to tartrazine, a food dye, should not receive methenamine.

A 30-year-old pregnant woman has been prescribed oxytocin. When assessing the client's drug regimen, the nurse understands that the client is taking vasopressors. Which of the following risks is the client most susceptible to if oxytocin is administered along with vasopressors? A) Anaphylactic shock B) Hypertension C) Respiratory failure D) Heart attack

Ans: B Feedback: Combining oxytocin with vasopressor drugs increases the risk of severe hypertension. Combining oxytocin and vasopressors does not increase the risk of heart attack or respiratory failure. Anaphylactic shock is associated with a hypersensitivity reaction and does not occur with the interaction of vasopressors and oxytocin.

A client asks the nurse about drinking cranberry juice to prevent UTIs. The nurse informs the client that it is safe to use, suggesting an intake of which amount daily? A) 1 to 2 ounces B) 4 to 8 ounces C) 8 to 12 ounces D) 12 to 16 ounces

Ans: B Feedback: Cranberry juice is safe for use as a food and for urinary tract health. The recommended dosage is 4 to 8 ounces of juice per day.

A 31-year-old pregnant woman has been prescribed a tocolytic drug. The nurse understands that this drug is primarily indicated for which of the following? A) Antepartal hypertension B) Preterm labor C) Postpartum hemorrhage D) Protracted labor

Ans: B Feedback: Drugs used to prevent uterine contractions are called tocolytics. They are useful in the management of preterm labor. These drugs will decrease uterine activity and prolong the pregnancy to allow the fetus to develop more fully, thereby increasing the chance of neonatal survival. Oxytocic drugs are used antepartum (before birth of the neonate) to induce uterine contractions and initiate or augment labor. Tocolytics are not used for postpartum hemorrhage or protracted labor.

A nurse identifies a nursing diagnosis of Impaired Mucous Membranes based on the client's complaints of dry mouth for a client with urge incontinence who is receiving drug therapy. The nurse would most likely identify this nursing diagnosis as related to the use of which of the following? A) Sildenafil B) Fesoterodine C) Dutasteride D) Silodosin

Ans: B Feedback: Fesoterodine is an antispasmodic that can cause dry mouth. Sildenafil, dutasteride, and silodosin are not associated with this adverse reaction.

A client receives insulin lispro at 8 a.m. The nurse would be alert for signs and symptoms of hypoglycemia at about which time? A) 8:15 a.m. B) 9 a.m. C) 10 a.m. D) 11 a.m.

Ans: B Feedback: Insulin lispro reaches its peak action in 30 minutes to 1.5 hours. Therefore, the client's greatest risk for hypoglycemia would be during this time or about 9 a.m. Onset of action occurs in 5 to 10 minutes, so the drug would begin being effective at this time.

A client is prescribed miglitol. The nurse would instruct the client to administer this drug at which time? A) At bedtime B) Three times a day with the first bite of a meal C) 30 minutes before eating breakfast D) Before or after a meal during the day

Ans: B Feedback: Miglitol is given three times a day with the first bite of the meal because food increases absorption.

A nurse is caring for a pregnant client receiving oxytocin. The client is in the third stage of labor. The nurse would expect to administer oxytocin by which route? A) Intravenous B) Intramuscular C) Subcutaneous D) Intranasal

Ans: B Feedback: Oxytocin is given intramuscularly (IM) during the third stage of labor. It is the time period from when the neonate is expelled until the placenta is expelled. Oxytocin is given intramuscularly to produce uterine contractions and control postpartum bleeding and hemorrhage. Oxytocin is not given intravenously, subcutaneously, or intranasally during the third stage of labor.

A client is beginning therapy with prescribed terazosin for treatment of BPH. Based on the nurse's understanding of the action of this drug, the nurse would identify which nursing diagnosis as most likely? A) Acute Pain B) Risk for Injury C) Impaired Mucous Membranes D) Deficient Knowledge

Ans: B Feedback: Terazosin, an antiadrenergic drug, can cause a hypotensive reaction. Thus, the client may experience an immediate lowering of blood pressure when first starting this drug and be at risk for injury. Acute Pain would be more appropriate for a client experiencing priapism from erectile dysfunction drugs. Impaired Mucous Membranes would be appropriate for the client receiving antispasmodics. Deficient Knowledge could apply to any client receiving medication.

A physician has prescribed a thyroid supplement for a client with euthyroid goiter. Which of the following should the nurse include in the nursing diagnosis checklist? A) Disturbed Thought Processes related to adverse drug reactions B) Anxiety related to symptoms, adverse reactions, and treatment regimen C) Risk for Infection related to adverse drug reactions D) Risk for Impaired Skin Integrity related to adverse reactions

Ans: B Feedback: The nurse should include Anxiety related to symptoms, adverse reactions, and treatment regimen as a nursing diagnosis. Disturbed Thought Processes related to adverse drug reactions, Risk for Infection, and Risk for Impaired Skin Integrity related to adverse drug reactions are inappropriate. Risk for Infection related to adverse drug reactions and Risk for Impaired Skin Integrity related to adverse reactions would be appropriate for a client receiving antithyroid drugs. Disturbed Thought Processes may apply for a client receiving ACTH.

A physician has prescribed desiccated thyroid USP for thyroid-stimulating hormone suppression. The client is also taking serotonin reuptake inhibitors to overcome depression. The nurse would be alert to the development of which of the following due to the interaction of the two drugs? A) Prolonged bleeding B) Decreased effectiveness of the thyroid drug C) Increased risk of paresthesias D) Increased risk of hypoglycemia

Ans: B Feedback: The nurse should monitor for a decreased effectiveness of the thyroid drug as the result of the interaction between desiccated thyroid USP and serotonin reuptake inhibitors. When the client is receiving desiccated thyroid USP with serotonin reuptake inhibitors, there is no increase in the risk of paresthesias, hypoglycemia, or prolonged bleeding. When the client is receiving oral anticoagulants with thyroid hormones, the client is at risk of prolonged bleeding. Increased risk of hypoglycemia occurs when oral hypoglycemics and insulin are administered with thyroid hormones to the client. The nurse should observe for paresthesias as one of the adverse reactions in a client receiving antithyroid drugs.

A client at a health care facility has been prescribed diazoxide for hypoglycemia due to hyperinsulinism. After administration, the nurse would assess the client for which adverse reaction? A) Myalgia B) Tachycardia C) Flatulence D) Epigastric discomfort

Ans: B Feedback: The nurse should monitor for tachycardia, congestive heart failure, sodium and fluid retention, hyperglycemia, and glycosuria as the adverse reactions in the client receiving diazoxide drug therapy. Myalgia, fatigue, and headache are the adverse reactions observed in clients undergoing pioglitazone HCl drug therapy. Flatulence is one of the adverse reactions found in clients receiving metformin drug therapy. Epigastric discomfort is one of the adverse reactions observed in clients receiving acetohexamide drugs.

A nurse is assigned to administer insulin glargine to a client at a health care facility. What precaution should the nurse take when administering this drug? A) Administer glargine via IV route. B) Avoid mixing glargine with other insulin. C) Shake the vial vigorously before withdrawing insulin. D) Be sure the insulin has been refrigerated.

Ans: B Feedback: When administering insulin glargine to the client, the nurse should avoid mixing it with other insulins or solutions. It will precipitate in the syringe when mixed. If glargine is mixed with another solution, it will lose glucose control, resulting in decreased effectiveness of the insulin. Glargine is administered via the subcutaneous route once daily at bedtime. The nurse should not shake the vial vigorously before withdrawing insulin. The vial should be gently rotated between the palms of the hands and tilted gently end to end immediately before withdrawing the insulin. The nurse administers insulin from vials at room temperature. Vials are stored in the refrigerator if they are to be stored for about 3 months for later use.

A nurse is caring for an older adult client who is hospitalized. The client develops a UTI and is receiving prescribed anti-infective therapy. Which of the following should the nurse perform while caring for this client? A) Document symptoms of the client's condition. B) Monitor the client's vital signs every 4 hours. C) Document the client's urine output every hour. D) Assess the client for bladder distension.

Ans: B Feedback: When caring for a client with a UTI undergoing urinary tract anti-infective drug therapy, the nurse should monitor the vital signs of the client every 4 hours after administration of the drug or as ordered by the primary health care provider. Any significant rise in body temperature is reported to the primary health care provider because the methods of reducing the fever or culture and sensitivity tests may need to be repeated. The nurse should document the symptoms experienced by the client and assess the client for bladder distension as part of the preadministration assessment before administering the drug to the client. The nurse need not document the client's urine output every hour or monitor the client's respiratory rate in this case.

A nurse is assessing a client who is prescribed levothyroxine. The nurse understands that this drug is prescribed to treat the thyroid condition associated with which of the following symptoms? Select all that apply. A) Nervousness B) Anorexia C) Coarse hair D) Cold intolerance E) Tachycardia

Ans: B, C, D Feedback: Levothyroxine is used to treat hypothyroidism manifested by anorexia, coarse hair, cold intolerance, lethargy, and bradycardia.

22. A client with diabetes insipidus has been prescribed vasopressin. The client's ambulatory status is limited. Which of the following would be most important for this client? A) Measuring the amount of fluid loss every 24 hours B) Refilling the water container at frequent intervals C) Giving four glasses of water immediately after the client takes the drug D) Examining the client's abdomen every 15 to 30 minutes

Ans: B Feedback: Clients with diabetes insipidus are continually thirsty, and in this case, the client also has limited ambulatory activities. Therefore, the nurse should be careful to refill the water container at frequent intervals to ensure the availability of enough drinking water at hand for the client. The nurse need not be careful to measure the amount of fluid loss every 24 hours, give four glasses of water immediately after the client takes the drug, or examine the client's abdomen every 15 to 30 minutes. The nurse instructs the client to measure the amount of urine excreted at each voiding and then total the amount for each 24-hour period. The nurse should instruct the client to drink one or two glasses of water immediately before taking the drug. The nurse need not auscultate the abdomen every 15 to 30 minutes in a client with diabetes insipidus. The nurse auscultates the abdomen every 15 to 30 minutes in a client with abdominal distention.

24. After reviewing the various contraceptive options with a client, the client opts for the etonogestrel/ethinyl estradiol vaginal ring. After teaching the client about this choice, the nurse determines that the teaching was effective when the client states which of the following? A) "Once I insert the ring, it won't come out." B) "The ring should stay in place for 3 weeks." C) "When bleeding starts, that's the signal to change the ring." D) "I can reuse the ring several times before discarding it."

Ans: B Feedback: When using the vaginal ring, the client should insert the ring and keep it in place for 3 weeks and then remove it on the same day of the week it was inserted. The ring can be expelled accidentally, such as with straining on defecation or removing a tampon. Typically, bleeding occurs once the ring is removed. The ring should be discarded after each use.

11. The nurse should discontinue therapy and notify the physician if which of the following adverse reactions occurs in a client taking gonadotropin (Menopur)? A) Abdominal pain B) Visual disturbances C) Auditory disturbances D) Ascites

Ans: B Feedback: If the patient complains of visual disturbances, the drug therapy is discontinued and the primary health care provider notified. An examination by an ophthalmologist is usually indicated. Abdominal pain and ascites are adverse reactions that may or may not require discontinuation of the drug. Auditory disturbances are not associated with this drug.

A group of nursing students are reviewing information about thyroid disorders. The students demonstrate understanding of the information when they identify which of the following as indicative of hyperthyroidism? Select all that apply. A) Low body temperature B) Weight loss C) Tachycardia D) Hypotension E) Sleepiness

Ans: B, C Feedback: The signs and symptoms of hyperthyroidism include increased metabolism; heat intolerance; elevated body temperature; weight loss; tachycardia; hypertension; nervousness; anxiety; insomnia; exophthalmos; flushed, warm, moist skin; thinning hair; goiter; and irregular or scant menses.

A nurse is preparing to administer a drug that is used to prevent uterine contractions. Which drug might the nurse be preparing to administer? Select all that apply. A) Misoprostol (Cytotec) B) Indomethacin (Indocin) C) Terbutaline (Brethine) D) Oxytocin (Pitocin) E) Dinoprostone (Cervidil)

Ans: B, C Feedback: Tocolytics, like indomethacin (Indocin) and terbutaline (Brethine), are used to prevent uterine contractions. Misoprostol and oxytocin are uterine stimulants. Dinoprostone is used to ripen the cervix.

1. A nurse is preparing a presentation for a local community group about diabetes. Which of the following would the nurse include when describing type 1 diabetes? Select all that apply. A) Insidious onset B) Occurs before age 20 C) Insulin supplementation required for survival D) Formally known as non-insulin-dependent diabetes mellitus E) Obesity a risk factor

Ans: B, C Feedback: Type 1 diabetes is formerly known as insulin-dependent diabetes mellitus. It usually has a rapid onset and occurs before age 20. Those with type 1 diabetes produce insulin in insufficient amounts and therefore must have insulin supplementation to survive. Type 1 diabetes is an autoimmune disorder; therefore, obesity is not a risk factor.

2. A nurse may be asked to administer androgen drugs to clients with which of the following medical conditions? Select all that apply. A) Anemia of renal insufficiency B) Hypogonadism C) Postmenopausal metastatic breast carcinoma D) Male-pattern baldness E) Benign prostatic hypertrophy

Ans: B, C Feedback: A nurse may be asked to administer androgen drugs to clients with the following medical conditions: testosterone deficiency, hypogonadism, delayed puberty, testosterone deficiency after puberty, postmenopausal metastatic breast carcinoma, and premenopausal, hormone-dependent metastatic breast carcinoma.

16. A nurse suspects that a client taking short-term high-dose methylprednisolone (Medrol) is developing Cushing's syndrome based on assessment of which of the following? Select all that apply. A) Weight loss B) Moon face C) Buffalo hump D) Dry skin E) Hypotension

Ans: B, C Feedback: A nurse should monitor a client taking short-term high-dose methylprednisolone (Medrol) for signs and symptoms of Cushing's syndrome, which include buffalo hump, moon face, oily skin, acne, osteoporosis, purple striae on the abdomen and hips, altered skin pigmentation, and weight gain.

3. Which of the following hormones are secreted by the adrenal gland? Select all that apply. A) Growth hormone B) Mineralocorticoids C) Glucocorticoids D) Prolactin E) Oxytocin

Ans: B, C Feedback: Glucocorticoids and mineralocorticoids are secreted by the adrenal gland. Growth hormone, prolactin, and oxytocin are secreted by the pituitary gland.

Based on the nurse's understanding about anti-infectives, the nurse would administer nitrofurantoin cautiously to a client with which condition? Select all that apply. A) Hypertension B) Diabetes C) Glucose-6-phosphate dehydrogenase (G6PD) deficiency D) Cerebral arteriosclerosis E) Myasthenia gravis

Ans: B, C, D Feedback: A nurse should administer nitrofurantoin cautiously to a client with the following conditions: diabetes, G6PD deficiency, and cerebral arteriosclerosis.

A nurse is providing care to a client with hyperthyroidism. Which treatment modalities would the nurse anticipate being used? Select all that apply. A) Levothyroxine (Synthroid) B) Methimazole (Tapazole) C) Radioactive iodine (131I) D) Propylthiouracil (PTU) E) Subtotal thyroidectomy

Ans: B, C, D, E Feedback: Methimazole (Tapazole), propylthiouracil (PTU), radioactive iodine (131I), and subtotal thyroidectomy are treatment modalities used in the treatment of clients with hyperthyroidism.

When teaching a client about his prescribed levothyroxine therapy, the nurse determines that the teaching was successful when the client states that he will contact his primary health care provider if which of the following occur? Select all that apply. A) Constipation B) Palpitations C) Excessive diaphoresis D) Significant weight changes E) Chest pain

Ans: B, C, D, E Feedback: The client taking levothyroxine should contact his primary health care provider if any of the following occur: headache, nervousness, palpitations, diarrhea, excessive diaphoresis, heat intolerance, chest pain, increased pulse rate, significant weight changes, or any unusual physical change or event.

A nurse educating a client receiving tolterodine (Detrol) should warn the client about which of the following common adverse reactions? Select all that apply. A) Anorexia B) Xerostomia C) Decreased lacrimation D) Blurred vision E) Diarrhea

Ans: B, C, E Feedback: Common adverse reactions seen with the use of tolterodine (Detrol) include xerostomia, drowsiness, constipation, headache, decreased lacrimation, decreased sweating, GI disturbances, blurred vision, and urinary hesitancy.

A client is diagnosed with hypothyroidism. Which of the following would the nurse expect to assess? Select all that apply. A) Elevated body temperature B) Weight gain C) Bradycardia D) Hypertension E) Sleepiness

Ans: B, C, E Feedback: The signs and symptoms of hypothyroidism include decreased metabolism; cold intolerance; low body temperature; weight gain; bradycardia; hypotension; lethargy; sleepiness; pale, cool, dry skin; face appearing puffy; coarse hair; thick, hard nails; heavy menses; fertility problems; and low sperm count.

A nurse completing a preadministration assessment on a 70-year-old client prior to the administration of levothyroxine may confuse which of the following symptoms of hypothyroidism with which symptoms associated with the aging process? Select all that apply. A) Constipation B) Confusion C) Unsteady gait D) Decreased visual acuity E) Cold intolerance

Ans: B, C, E Feedback: The symptoms of hypothyroidism may be confused with symptoms associated with aging, such as depression, cold intolerance, weight gain, confusion, or unsteady gait.

A client with a heart condition controlled on which of the following drugs must be monitored closely by the nurse for worsening atrial fibrillation if levothyroxine is initiated to treat hypothyroidism? Select all that apply. A) Lisinopril (Prinivil) B) Digoxin (Lanoxin) C) Diltiazem (Cardizem) D) Metoprolol (Toprol) E) Warfarin (Coumadin)

Ans: B, D Feedback: A client with a heart condition controlled on digoxin (Lanoxin) and metoprolol (Toprol) must be monitored closely by the nurse for worsening atrial fibrillation if levothyroxine is initiated to treat hypothyroidism because levothyroxine can decrease the effectiveness of digoxin and beta blockers (metoprolol).

A nurse is providing care to a client diagnosed with benign prostatic hypertrophy. The nurse understands that which of the following drugs inhibit the conversion of testosterone into 5-alpha-dihydrotestosterone (DHT), resulting in a decrease in prostate gland size? Select all that apply. A) Terazosin (Hytrin) B) Finasteride (Proscar) C) Methyltestosterone (Testred) D) Dutasteride (Avodart) E) Doxazosin (Cardura)

Ans: B, D Feedback: Finasteride (Proscar) and dutasteride (Avodart) inhibit the conversion of testosterone into 5-alpha-dihydrotestosterone (DHT), which results in a decrease in prostate gland size, making them useful in the treatment of benign prostatic hypertrophy.

A nurse is preparing to administer the thyroid hormone replacement drug levothyroxine to a client. The nurse understands which of the following about this drug? Select all that apply. A) Equivalent to all other thyroid hormone replacement drugs B) More uniform potency than other thyroid hormone replacement drugs C) Twice-daily dosing necessary D) Relatively inexpensive E) Less frequent lab monitoring required

Ans: B, D Feedback: The following is true of the thyroid hormone replacement drug levothyroxine: it is relatively inexpensive, requires once-daily dosing, and has a more uniform potency than do other thyroid hormone replacement drugs.

After teaching a client how to use an estradiol transdermal system, the nurse determines that the teaching was successful when the client states which of the following? Select all that apply. A) I can put the patch on my breasts. B) I should rotate the sites, staying away from the same site for about a week. C) When I apply it, I should rub the patch vigorously for about 10 seconds. D) I apply the patch immediately after I open the pouch. E) If the area is oily or irritated, I need to avoid that area.

Ans: B, D Feedback: When using a transdermal system, the client should apply the system immediately after opening the pouch with the adhesive side down, applying it to the clean, dry skin of the buttocks, trunk, abdomen, upper inner thigh, or upper arm. The system should not be applied to the breasts, waistline, or a site exposed to sunlight. The area should not be oily or irritated. Once the patch is applied, the client should press on it firmly with the palm of the hand for about 10 seconds. The application site is rotated with at least 1-week intervals between applications to a particular site.

Nurses who are pregnant or may become pregnant should not handle which drugs if they are crushed or broken due to the drugs' substantial risk of abnormal growth to a male fetus? Select all that apply. A) Methyltestosterone (Testred) B) Finasteride (Proscar) C) Testosterone (Striant) D) Dutasteride (Avodart) E) Oxandrolone (Oxandrin)

Ans: B, D Feedback: Women of childbearing age should not handle androgen hormone inhibitors, such as finasteride (Proscar) or dutasteride (Avodart) tablets, if they are crushed or broken due to the drugs' substantial risk of abnormal growth to a male fetus.

A client comes to the emergency department and reports that he is in extreme pain. Physical assessment reveals priapism. When obtaining the client's medication history, which of the following would the nurse expect the client to report using? A) Tamsulosin B) Terazosin C) Tadalafil D) Tolterodine

Ans: C Feedback: Priapism occurs with the use of phosphodiesterase type 5 inhibitors, such as tadalafil. It is not associated with use of antiadrenergic drugs or antispasmodics.

4. A nurse is preparing to teach a client about vasopressin. Which of the following would the nurse integrate into the teaching? Select all that apply. A) Vasopressin is secreted by the adrenal gland. B) Vasopressin is secreted when body fluids must be conserved. C) Vasopressin exhibits its greatest activity in the bladder. D) Vasopressin regulates the reabsorption of water from the kidney. E) Vasopressin is used to treat diabetes mellitus.

Ans: B, D Feedback: The following is true of the hormone vasopressin: it is secreted by the posterior pituitary gland, is secreted when body fluids must be conserved, exhibits its greatest activity on the renal tubular epithelium, regulates the reabsorption of water from the kidney, and is used to treat diabetes insipidus.

The nurse is assessing a client for risk factors associated with type 2 diabetes. Which of the following would the nurse identify? Select all that apply. A) Younger age B) Impaired glucose tolerance C) Caucasian race D) Obesity E) History of gestational diabetes

Ans: B, D, E Feedback: A nurse should be able to identify all the risk factors for type 2 diabetes in a client. These include obesity, older age, family history of diabetes, history of gestational diabetes, impaired glucose tolerance, minimal or no physical activity, and race/ethnicity (African Americans, Hispanic/Latino Americans, Native Americans, and some Asian Americans).

A nurse is conducting a presentation for a group of middle-aged women about menopause and the changes that occur to the female genitourinary system. Which of the following would the nurse include in the discussion? Select all that apply. A) Lengthening of the vaginal wall B) Slowed rate of lubrication during sexual arousal C) Decreased risk of yeast infection from pH changes D) Weakening of the pelvic floor muscles E) Thinning of the vaginal walls

Ans: B, D, E Feedback: Genitourinary changes associated with aging include thinning of the vaginal walls with shortening and loss of elasticity; decreased lubrication with a slowing of the rate during sexual arousal; increased risk of yeast infections due to changes in the pH of the environment; and weakening of the pelvic floor muscles, which can lead to stress incontinence.

When explaining the action of oxytocin to a client, the nurse integrates knowledge of which of the following about the drug? Select all that apply. A) Secretion by the anterior pituitary gland B) Uterine-stimulating properties C) Diuretic effects D) Vasopressor effects E) Stimulation of milk ejection

Ans: B, D, E Feedback: Oxytocin is a hormone secreted by the posterior pituitary gland that has uterine-stimulating properties, exerts antidiuretic and vasopressor effects, and stimulates milk ejection.

After teaching a client about her prescribed anti-infective therapy for her UTI, the nurse determines that the teaching was successful when the client states which of the following? Select all that apply. A) I can stop the drug once my symptoms disappear. B) I can take the medication with food or meals. C) I can drink pineapple juice to keep things acidic. D) I'll call my primary health care provider if I don't feel better in about 3 days. E) I should avoid drinking any beverages that contain alcohol.

Ans: B, D, E Feedback: The client should complete the full course of therapy even with symptom relief to ensure that all bacteria have been eliminated from the urinary tract. The client should take the drug with food or meals. Cranberry juice, prune juice, and water are recommended. Alcohol and citrus juices such as orange or pineapple juice are to be avoided. The client should notify her primary health care provider if the symptoms do not subside within 3 to 4 days.

6. A nurse would administer vasopressin (Pressyn) cautiously to a client with which of the following? Select all that apply. A) Sleep apnea B) Migraine headaches C) Asthma D) Seizure disorders E) Angina

Ans: B,C,D,E Feedback: Vasopressin (Pressyn) is used cautiously in clients with a history of seizure disorder, migraine headaches, asthma, congestive heart failure, or vascular disease (angina and myocardial infarction).

7. A nurse is describing the action of estrogen in the female body to a client. Which of the following would the nurse include? Select all that apply. A) Diuresis B) Calcium and phosphorus conservation C) Thinning of the cervical mucus D) Protein catabolism E) Stimulation of fallopian tube contraction

Ans: B,C,E Feedback: The actions of estrogen on the female body include fluid retention, calcium and phosphorus conservation, protein anabolism, thinning of the cervical mucus, stimulation of fallopian tube contraction, growth of axillary and pubic hair, restoration of the endometrium after menstruation, and at puberty promotion of growth and development of the vagina, uterus, fallopian tubes, and breasts.

10. Which of the following drugs might a nurse administer to a female client with fertility problems to help increase her chances of becoming pregnant? Select all that apply. A) Vasopressin (Pressyn) B) Clomiphene (Clomid) C) Octreotide (Sandostatin) D) Cetrorelix (Cetrotide) E) Gonadotropin (Menopur)

Ans: B,D,E Feedback: A nurse might administer clomiphene (Clomid), cetrorelix (Cetrotide), or gonadotropin (Menopur) to a female client with fertility problems to help increase her chances of becoming pregnant.

After teaching a group of nursing students about drugs that affect the uterus, the instructor determines that the teaching was successful when the students identify which drug as being used for cervical ripening? A) Terbutaline B) Nifedipine C) Dinoprostone D) Misoprostol

Ans: C Feedback: Dinoprostone is a cervical ripening agent. Terbutaline and nifedipine are used for tocolysis. Misoprostol is used as a uterine stimulant.

A client who is receiving a tocolytic develops hypotension. The nurse would notify the primary health care provider and place the client in which position? A) Supine B) Lithotomy C) Left lateral D) Knee-chest

Ans: C Feedback: If a client develops hypotension while receiving a tocolytic drug, the nurse would notify the primary health care provider and place the client in the left lateral position to promote adequate fetal perfusion until the provider orders otherwise.

A client has received a special formulation of oxytocin for intranasal use. The nurse understands that the rationale for using this formulation of the drug involves which effect? A) Antistimulating properties on the uterus B) Diuretic effect C) Stimulation of the milk ejection reflex D) Control of antepartum bleeding

Ans: C Feedback: Oxytocin, when administered intranasally, stimulates the milk ejection (milk letdown) reflex. Oxytocin has uterine-stimulating properties, not antistimulating properties, on the uterus. Tocolytics have an antistimulating effect on the uterus. Oxytocin has an antidiuretic effect, which might lead to a danger of excessive fluid volume (water intoxication), and not a diuretic effect. Oxytocin is given IM during the third stage of labor to produce uterine contractions and control postpartum, and not antepartum, bleeding and hemorrhage.

A nurse caring for a client taking warfarin (Coumadin) develops a UTI. The nurse should monitor the client for increased risk of bleeding if which of the following anti-infectives is prescribed? A) Amoxicillin B) Methenamine C) Sulfamethoxazole D) Nitrofurantoin

Ans: C Feedback: Sulfamethoxazole, when administered concomitantly with warfarin (Coumadin), can increase a client's risk for bleeding. This interaction is not associated with amoxicillin, methenamine, or nitrofurantoin.

A nurse is caring for a client diagnosed with type 2 diabetes. When teaching the client about this condition, the nurse would identify which of the following as a risk factor? A) Young age B) Regular exercise C) Obesity D) Polyuria

Ans: C Feedback: The nurse informs the client that obesity is a risk factor associated with type 2 diabetes. Young age and regular exercise are not risk factors for type 2 diabetes. Polyuria is a symptom of diabetes and not a risk factor leading to type 2 diabetes.

A client has been prescribed acarbose. Which of the following interventions should the nurse perform to promote an optimal response to the medication? A) Administer the drug with breakfast. B) Expect to add an oral sulfonylurea with the drug. C) Administer the drug with the first bite of the meal. D) Report unusual somnolence to the primary health care provider.

Ans: C Feedback: The nurse should administer acarbose to the client with the first bite of the meal. The nurse needs to administer glyburide (Micronase) with breakfast. An oral sulfonylurea will likely be added to metformin if the client does not experience a response in 4 weeks using the maximum dose of metformin. Clients taking metformin may experience unusual somnolence, of which the nurse should inform the primary health care provider.

A client with benign hypertrophy of the prostate has heard claims that the herb saw palmetto can help relieve his symptoms. The client is eager to know more about this herb. Which of the following pieces of information should the nurse provide the client regarding the use of the herb? A) Take the herb as tea, prepared in hot water. B) Improvement can be seen within 2 to 3 weeks. C) It may delay the need for prostatic surgery. D) Stop the herb after 3 months of intake.

Ans: C Feedback: The nurse should inform the client that saw palmetto might help delay the need for prostatic surgery. The active components are not water soluble and should not be taken as a tea. Improvement can be seen after 1 to 3 months of taking the herb, and not within 2 to 3 weeks. The herb intake should not be stopped after 3 months but should be continued for 6 months, followed by evaluation by the health care provider.

A nurse is caring for a client receiving methenamine as outpatient treatment for chronic bacterial UTIs. Which instruction should the nurse include in the teaching plan for the client about the administration of the drug? A) Avoid prolonged exposure to sunlight. B) Increase the intake of milk products. C) Avoid an excessive intake of citrus fruits. D) Take the drug preferably with food.

Ans: C Feedback: The nurse should instruct the client taking the anti-infective methenamine to avoid an excessive intake of citrus fruits. The nurse need not instruct the client taking methenamine to avoid prolonged exposure to sunlight, to increase the intake of milk products, or to take the drug preferably with food. Instead, the nurse should instruct the client to avoid milk and milk products when the client is taking methenamine.

A nurse is caring for a client receiving fosfomycin for the treatment of an acute bacterial UTI. Which of the following interventions should the nurse include in the teaching plan for the client about this drug? A) Ensure that the drug is administered every 3 hours. B) Administer the drug after dissolving it in 90 to 120 mL of hot water. C) Ensure that the drug is administered immediately after mixing with water. D) Administer the drug on an empty stomach.

Ans: C Feedback: The nurse should instruct the client to take the drug immediately after mixing it with water. The nurse need not instruct the client to take the drug at an interval of 3 hours, to take the drug after dissolving it in 90 to 120 mL of hot water, or to take the drug on an empty stomach. Fosfomycin, which comes in dry form, should be dissolved in 90 to 120 mL water, but not hot water. The nurse should instruct the client to take the drug with food to prevent gastric upset, which occurs with the administration of fosfomycin.

A nurse is caring for a client with hyperthyroidism. The physician prescribes methimazole to the client. The nurse observes that the client has developed skin rashes after the drug is administered. Which of the following interventions should the nurse perform while caring for the client? A) Offer suggestions to alter the drug schedule. B) Instruct the client to avoid applying lubricants. C) Instruct the client to use soap sparingly. D) Check if discoloration of the hair occurs.

Ans: C Feedback: The nurse should instruct the client to use soap sparingly and apply soothing creams or lubricants until the rash subsides. The nurse need not offer suggestions to alter the drug schedule, instruct the client to avoid applying lubricants, or check if discoloration of hair occurs.

A nurse is conducting an in-service presentation for a group of nurses about UTIs and hospitalized clients. When discussing preventive measures, the nurse would identify which of the following as the primary nursing intervention for prevention? A) Proper perineal hygiene B) Use of urinary acidifiers C) Hand hygiene D) Routine urinalysis

Ans: C Feedback: UTIs may affect the hospitalized client or nursing home resident with an indwelling catheter or a disorder such as a stone in the urinary tract. The primary nursing intervention to prevent UTIs in the hospitalized client is good hand hygiene or handwashing. Proper perineal hygiene may be helpful but not as effective as hand hygiene. The use of urinary acidifiers is appropriate to maintain pH of the urine but not prevent UTIs. Routine urinalysis would help identify potential infections but not prevent them.

A client is receiving estrogen therapy but also takes phenytoin for seizure control. The nurse would alert the client to the possibility of which of the following? A) Potential for blood clots B) Increased risk for infection C) Possibility of breakthrough bleeding D) Increased risk for seizures

Ans: C Feedback: When estrogen is given with phenytoin, a hydantoin, the client is at increased risk for breakthrough bleeding. Blood clots can be an adverse reaction with estrogen therapy alone. There is no increased risk for infection. When given together, these drugs do not increase the risk for seizures.

19. A physician has prescribed vasopressin to the client for regulating the reabsorption of water by the kidneys. Which of the following assessments should the nurse perform after the administration of vasopressin? A) Observe for and report any evidence of edema, such as dyspnea. B) Measure and record the client's abdominal girth every hour. C) Observe the client for blanching of the skin, abdominal cramps, and nausea. D) Weigh the client every day to obtain a baseline weight.

Ans: C Feedback: After vasopressin is administered to the client, the nurse should observe the client every 10 to 15 minutes for signs of an excessive dosage, which include blanching of the skin, abdominal cramps, and nausea. After corticotropin is administered to the client, the nurse needs to observe for and report any evidence of edema, such as weight gain, rales, increased pulse or dyspnea, or swollen extremities. If the client is receiving vasopressin for abdominal distention, the nurse needs to auscultate the abdomen every 15 to 30 minutes and measure abdominal girth hourly. The nurse needs to weigh the client to obtain a baseline weight for future comparison before administering vasopressin to the client.

23. A client has a levonorgestrel implant contraceptive system inserted. The nurse understands that this type of contraceptive provides protection for how long? A) 1 year B) 2 years C) 5 years D) 8 years

Ans: C Feedback: Levonorgestrel, a progestin, is available as an implant contraceptive system (Norplant System). Six capsules, each containing levonorgestrel, are implanted using local anesthesia in the subdermal (below the skin) tissues of the midportion of the upper arm. The capsules provide contraceptive protection for 5 years but may be removed at any time at the request of the patient.

16. A nurse is caring for a client with advanced breast cancer who is receiving androgen therapy. Which of the following signs might alert the nurse to the possibility of liver toxicity? A) Edema of the feet B) Increase in appetite C) Clinical jaundice D) Increase in weight

Ans: C Feedback: Liver toxicity is indicated by the presence of jaundice. Edema of the feet and an increase in weight may be seen because of fluid and electrolyte imbalance but does not indicate liver toxicity. An increase in appetite shows that the client is responding well to the drug and is not a sign of liver toxicity.

25. A physician has ordered a client to receive growth hormone subcutaneously. Which of the following tests would the nurse anticipate as required at different intervals during the treatment? A) Carbohydrate tolerance B) Serum electrolyte levels C) Glucose tolerance D) pH level of the blood

Ans: C Feedback: Periodic testing of growth hormone levels, glucose tolerance, and thyroid functioning are required during growth hormone treatment for the client. The pH level of blood and carbohydrate tolerance testing are not required. Testing serum electrolyte levels is needed when a client is undergoing vasopressin therapy.

20. A nurse is reviewing the medical history report of a client who is to receive gonadotropins. In which of the following conditions would the use of gonadotropins be contraindicated? A) Sensitivity to benzyl alcohol B) Epiphyseal closure C) Adrenal dysfunction D) Epilepsy

Ans: C Feedback: While reviewing the medical history of the client, the nurse should identify that gonadotropins are contraindicated in clients with adrenal dysfunction, high gonadotropin levels, thyroid dysfunction, liver disease, abnormal bleeding, ovarian cysts, sex-hormone-dependent tumors, or organic intracranial lesions (pituitary tumors). Gonadotropins should be used cautiously in clients with epilepsy. Somatropin growth hormones are contraindicated in clients with sensitivity to benzyl alcohol, epiphyseal closure, and underlying cranial lesions.

After teaching a group of nursing students about drugs used to treat genitourinary problems in the older adult, the instructor determines that the teaching was successful when the students identify which of the following as an alpha-adrenergic blocker used to treat BPH? Select all that apply. A) Darifenacin B) Oxybutynin C) Alfuzosin D) Tamsulosin E) Raloxifene

Ans: C, D Feedback: Alpha-adrenergic drugs used to treat BPH include alfuzosin and tamsulosin. Darifenacin and oxybutynin are antispasmodics. Raloxifene is a miscellaneous agent used to prevent and treat osteoporosis.

A nurse is preparing to administer a long-acting insulin to a client. Which of the following might the nurse administer? Select all that apply. A) Insulin aspart (NovoLog) B) Insulin lispro (Humalog) C) Insulin glargine (Lantus) D) Insulin detemir (Levemir) E) Insulin glulisine (Apidra)

Ans: C, D Feedback: Insulin glargine (Lantus) and insulin detemir (Levemir) are long-acting insulins with a duration of 24 hours. Insulin aspart, lispro, and glulisine are rapid-acting insulins.

A client presents to the physician's office with complaints of worsening hypothyroidism symptoms. When questioned about medication changes, the client tells the nurse that she has recently started taking an antidepressant prescribed by another physician. Which of the following antidepressants can decrease the effectiveness of levothyroxine? A) Amitriptyline (Elavil) B) Quetiapine (Seroquel) C) Sertraline (Zoloft) D) Fluoxetine (Prozac) E) Topiramate (Topamax)

Ans: C, D Feedback: Selective serotonin reuptake inhibitors (SSRIs), like sertraline (Zoloft) and fluoxetine (Prozac), can decrease the effectiveness of levothyroxine, leading to the reappearance of hypothyroidism symptoms in clients previously controlled on a dose of levothyroxine.

After administering glimepiride, the nurse would assess the client for which of the following? Select all that apply. A) Lactic acidosis B) Edema C) Hypoglycemia D) Heartburn E) Nausea

Ans: C, D, E Feedback: Adverse reactions associated with sulfonylureas, like glimepiride (Amaryl), include hypoglycemia, anorexia, nausea, vomiting, epigastric discomfort, weight gain, heartburn, and various vague neurologic symptoms, such as numbness and weakness of the extremities.

After administering insulin detemir to a client with diabetes, the nurse suspects that the client is developing hypoglycemia based on assessment of which of the following? Select all that apply. A) Increased thirst B) Increased urination C) Headache D) Confusion E) Diaphoresis

Ans: C, D, E Feedback: The symptoms of hypoglycemia include fatigue, weakness, nervousness, agitation, confusion, headache, diplopia, convulsions, dizziness, unconsciousness, hunger, nausea, diaphoresis, and numbness or tingling of the lips or tongue. Increased thirst and urination suggest hyperglycemia.

1. When describing the thyroid gland, the nursing instructor would include which hormones as being secreted by the thyroid gland? Select all that apply. A) Thyroid-stimulating hormone B) Adrenocorticotropic hormone C) Thyroxine D) Prolactin E) Tri-iodothyronine

Ans: C, E Feedback: Thyroxine and tri-iodothyronine are hormones secreted by the thyroid gland. The anterior pituitary secretes thyroid-stimulating hormone. Prolactin and adrenocorticotropic hormone are secreted by the pituitary gland.

2. A group of nursing students demonstrate understanding of a class discussion on pituitary hormones when they identify which of the following hormones as secreted by the posterior pituitary gland? Select all that apply. A) Growth hormone B) Adrenocorticotropic hormone C) Vasopressin D) Prolactin E) Oxytocin

Ans: C, E Feedback: Vasopressin and oxytocin are secreted by the posterior pituitary gland. Growth hormone, adrenocorticotropic hormone, and prolactin are secreted by the posterior pituitary gland.

11. A client with progestin excess may report which of the following symptoms to the nurse during ongoing assessment during treatment with Estrostep Fe? Select all that apply. A) Amenorrhea B) Late breakthrough bleeding C) Hair loss D) Weight gain E) Hirsutism

Ans: C,D,E Feedback: Signs of excess progestin include increased appetite, weight gain, tiredness, fatigue, hypomenorrhea, acne, oily scalp, hair loss, hirsutism, depression, monilial vaginitis, and breast regression.

A nurse is caring for a client with thyroid storm. Which of the following would the nurse expect to assess? A) Memory impairment B) Cold intolerance C) Constipation D) Altered mental status

Ans: D Feedback: A severe form of hyperthyroidism called thyroid storm is characterized by high fever, extreme tachycardia, and altered mental status. The nurse need not observe for memory impairment, cold intolerance, or constipation as characteristics of thyroid storm. Memory impairment, cold intolerance, and constipation are the manifestations of myxedema, which is a severe form of hypothyroidism.

A client with a UTI is experiencing dysuria. The nurse would expect which of the following to be prescribed? A) Nitrofurantoin (Macrodantin) B) Oxybutynin (Ditropan) C) Sulfamethoxazole/trimethoprim (Bactrim) D) Phenazopyridine (Pyridium)

Ans: D Feedback: Phenazopyridine (Pyridium) is a urinary tract analgesic that is useful in treating dysuria caused by a UTI.

A nurse is preparing to administer phenazopyridine to a client. To help promote maximum effectiveness, the nurse would expect to administer this drug at which time? A) Before meals B) At bedtime C) Around the clock D) After meals

Ans: D Feedback: Phenazopyridine is administered after meals to prevent GI upset.

A client is receiving tamsulosin for treatment of BPH. The client also has hypertension, for which he takes atenolol. Which assessment would be most important for the nurse to obtain? A) Temperature B) Pulse rate C) Respiratory rate D) Blood pressure

Ans: D Feedback: Tamsulosin, an alpha-adrenergic blocker, when given with a beta blocker such as atenolol can cause an increase in hypotension. Therefore, assessment of the client's blood pressure would be most important.

A nurse is caring for a client who has developed a hypoglycemic reaction. Which of the following interventions should the nurse perform if swallowing and gag reflexes are present in the client? A) Administer glucagon by the parenteral route. B) Administer the insulin via insulin pump. C) Administer oral antidiabetics to the client. D) Give oral fluids or candy.

Ans: D Feedback: The nurse should administer oral fluids or candy to the hypoglycemic client with swallowing and gag reflexes. If the client is unconscious, the nurse should administer glucose or glucagon parenterally. The nurse should administer insulin through an insulin pump for diabetic clients who are pregnant or have had a renal transplant. Oral antidiabetic drugs are administered to clients with type 2 diabetes.

A nurse is caring for a client with chronic lymphocytic thyroiditis. The physician has prescribed liothyronine to the client. The nurse understands that the drug is administered cautiously to clients with which of the following? A) Upper respiratory tract infection B) Diabetes C) Elevated body temperature D) Cardiac disease

Ans: D Feedback: The nurse should be cautious about existing conditions such as cardiac disease and also cautious about lactating clients before administering liothyronine to clients with chronic lymphocytic thyroiditis. The nurse need not be cautious about administering liothyronine to clients with an upper respiratory tract infection, diabetes, or elevated body temperature. The nurse should be cautious about clients contracting an upper respiratory tract infection on administrating antithyroid drugs. A client with diabetes may experience an increase in diabetes while undergoing thyroid hormone replacement therapy. The nurse should observe for elevated body temperature while managing the needs of a client administered thyroid hormones.

After nitrofurantoin is administered to a client with an acute bacterial UTI, assessment reveals dyspnea, chest pain, cough, fever, and chills. Which of the following actions would be most appropriate? A) Monitor client for tightness of the chest. B) Offer fluids to the client at regular intervals. C) Provide oxygen support to the client. D) Withhold the drug and contact the primary health care provider.

Ans: D Feedback: The nurse should immediately notify the primary health care provider and withhold the next dose of the drug until the client is seen by the primary health care provider if acute pulmonary reactions are observed in the client. The nurse should monitor the client for signs of a nonproductive cough or malaise, which may indicate a chronic pulmonary reaction, which may occur during prolonged therapy. Tightness of the chest is not known to occur in the case of a chronic pulmonary reaction, so the nurse need not monitor the client for this. The nurse offers fluids at regular intervals to elderly clients who develop decreased thirst sensation as an adverse reaction to the urinary tract anti-infectives.

A nurse is caring for a client who is being prescribed phenazopyridine. The client is distressed on seeing that the urine is exhibiting a reddish-orange discoloration. Which response by the nurse would be most appropriate? A) We will have to get a specimen for a urinalysis. B) I will have to notify the primary health care provider immediately. C) You will need to increase your fluid intake. D) This discoloration is a normal result of the medication. Nothing is wrong.

Ans: D Feedback: The nurse should inform the client that phenazopyridine may cause a reddish-orange discoloration of the urine, which is normal, so there is no cause to worry. Periodic urinalyses are conducted as part of the ongoing assessment when caring for a client with a UTI. Since the reddish-orange discoloration of the urine is normal, the nurse need not notify the primary health care provider immediately. The nurse also need not ask the client to increase intake of fluids.

A nurse is caring for a client undergoing thyroid hormone replacement therapy. The nurse instructs the client to take the drug at which time? A) Before bedtime B) Just before dinner C) After lunch D) Before breakfast

Ans: D Feedback: The nurse should inform the client undergoing thyroid hormone replacement therapy to take the drug in the morning, preferably before breakfast. The nurse should not ask the client to take the drug before bedtime, just before dinner, or after lunch as that is not generally recommended by the health care provider.

A nurse is educating a client undergoing treatment for genitourinary tract bacterial infections on an outpatient basis. What instructions should the nurse offer the client as part of the client teaching plan? A) Notify the primary health care provider if abdominal pain occurs. B) Discontinue the therapy if symptoms vanish. C) Decrease fluid intake if symptoms subside. D) Increase fluid intake to at least 2000 mL/day.

Ans: D Feedback: The nurse should instruct the client to increase the fluid intake to at least 2000 mL/day to help remove bacteria from the genitourinary tract when caring for a client with a genitourinary tract bacterial infection. The nurse should stress the importance of continued therapy even if symptoms vanish or the client feels better after a few doses. The nurse should encourage continued increased fluid intake even if the symptoms subside. Abdominal pain is not commonly associated with genitourinary tract bacterial infections, so this instruction would not be necessary.

A nurse is caring for a client receiving amoxicillin for the treatment of an acute bacterial urinary tract infection. After administering the drug, the nurse would be alert for which of the following as an adverse reaction to the drug? A) Abdominal cramps B) Vaginitis C) Bladder irritation D) Stomatitis

Ans: D Feedback: The nurse should monitor for stomatitis in the client, which is an adverse reaction to amoxicillin, an anti-infective drug. Vaginitis is an adverse reaction to an anti-infective drug called fosfomycin. Abdominal cramps and bladder irritation are adverse reactions to the anti-infective drug methenamine.

A client is receiving glipizide at a health care facility. The client is also prescribed an anticoagulant. The nurse would be alert for which of the following related to the interaction of these two drugs? A) Increased risk of lactic acidosis B) Risk of acute renal failure C) Increased risk for bleeding D) Increased hypoglycemic effect

Ans: D Feedback: The nurse should observe for increased hypoglycemic effect in the client as the effect of the interaction of sulfonylureas with the anticoagulants, chloramphenicol, clofibrate, fluconazole, histamine-2 antagonists, methyldopa, monoamine oxidase inhibitors (MAOIs), salicylates, sulfonamides, and tricyclic antidepressants. Increased risk of lactic acidosis is an effect of the interaction of metformin with glucocorticoids. Increased risk for bleeding is an effect of the interaction of oral anticoagulants with anti-infective drugs. There is a risk of acute renal failure when iodinated contrast material used for radiologic studies is administered with metformin.

29. A client is receiving corticosteroid therapy. Which nursing diagnosis would the nurse be least likely to identify for this client? A) Risk for Infection B) Disturbed Body Image C) Risk for Injury D) Deficient Fluid Volume

Ans: D Feedback: A client who is receiving corticosteroid therapy would be least likely to have a nursing diagnosis of Deficient Fluid Volume. Rather, Excess Fluid Volume would be more appropriate. Risk for Infection related to immunosuppression, Disturbed Body Image related to cushingoid effects, and Risk for Injury related to muscle atrophy and osteoporosis would be appropriate.

18. A client with delayed puberty has been advised to undertake transdermal androgen therapy, Androderm. Which of the following instructions should the nurse provide the client to help promote an optimal response to this therapy? A) Apply the Androderm to the underside of the scrotum. B) Repeat the application to the scrotum after 3 days. C) Moisten the skin before the application. D) Apply immediately after removing the cover.

Ans: D Feedback: Applying the system immediately after opening the pouch and removing the protective cover may help obtain an optimal response to the transdermal androgen delivery system. The drug should not be applied to the underside of the scrotum. It is applied to clean, dry skin on the abdomen, thigh, back, or upper arm. Thus, the skin should not be moistened before the application; rather, it should be dry. Seven days should be allowed between applications to a specific site, and application to the same site should not be repeated after 3 days.

15. An 80-year-old client with chronic renal insufficiency is prescribed anabolic steroid therapy for the management of anemia associated with renal insufficiency. The nurse understands that this client is at increased risk for which of the following? A) Hypoglycemic attacks B) Serious cardiac disease C) Hypotensive shock D) Cancer of the prostate

Ans: D Feedback: Elderly clients undergoing anabolic steroid therapy are at an increased risk of developing cancer of the prostate gland. Therefore, anabolic steroid therapy needs to be administered cautiously in these clients. Hypoglycemic attacks, serious cardiac disease, and hypotensive shock are not seen in elderly clients on anabolic steroid therapy.

30. After teaching a group of nursing students about corticosteroids, the instructor determines that the teaching was successful when the students identify which of the following as a mineralocorticoid? A) Hydrocortisone B) Betamethasone C) Triamcinolone D) Fludrocortisone

Ans: D Feedback: Fludrocortisone is a mineralocorticoid. Hydrocortisone, betamethasone, and triamcinolone are glucocorticoids.

21. A nurse is caring for a client who has been undergoing glucocorticoid therapy at a health care facility and is getting discharged. Which of the following instructions should the nurse include in the teaching plan for the client and family? A) Report any symptoms of sore throat or fever immediately. B) Notify the PHCP if glucose appears in the urine. C) Measure the amount of fluids taken each day. D) Take the oral drug with meals or snacks.

Ans: D Feedback: The nurse should instruct the client to take the oral drug with meals or snacks to decrease the gastrointestinal effects and upsets in the teaching plan for the client and family. Reporting any symptoms of sore throat or fever immediately and notifying the primary health care provider if glucose appears in the urine should be included in the teaching plan for a client undergoing adrenocorticotropic hormone (ACTH) therapy. The nurse should instruct the client to measure the amount of fluids taken each day in the teaching plan for the client receiving vasopressin.

22. A nurse is conducting a presentation for a young adult women's group about oral contraceptives and the risks. Which of the following would the nurse include as an increased risk? A) Fibrocystic breast disease B) Ovarian cysts C) Endometrial cancer D) Hepatic adenoma

Ans: D Feedback: The risks of hepatic adenoma may be increased with the use of oral contraceptives. Oral contraceptives also increase the risk of cardiovascular diseases, thromboembolic disorders, strokes, visual disturbances, gallbladder disease, hypertension, and fetal abnormalities. The risks of fibrocystic breast disease, ovarian cysts, and endometrial cancer are decreased, not increased, with the use of oral contraceptives.

After teaching a group of nursing students about antidiabetic drugs, the instructor determines that the teaching was successful when the students identify which of the following as producing the glucose-lowering effects by delaying the digestion and absorption of carbohydrates in the intestine? Select all that apply. A) Glimepiride (Amaryl) B) Metformin (Glucophage) C) Pioglitazone (Actos) D) Miglitol (Glyset) E) Acarbose (Precose)

Ans: D, E Feedback: The alpha-glucosidase inhibitors, acarbose (Precose) and miglitol (Glyset), produce their glucose-lowering effects by delaying the digestion and absorption of carbohydrates in the intestine. Glimepiride is a sulfonylurea. Metformin sensitizes the liver to circulating insulin levels and reduces hepatic glucose production. Pioglitazone decreases insulin resistance and increases insulin sensitivity by modifying several processes, resulting in decreased hepatic glucogenesis (formation of glucose from glycogen) and increased insulin-dependent muscle glucose uptake.

9. A nurse is teaching a client about the use of estradiol (Estrace). The nurse warns the client of which of the following dermatologic reactions that may continue after drug discontinuation? Select all that apply. A) Dermatitis B) Stevens-Johnson syndrome C) Pruritus D) Chloasma E) Melasma

Ans: D, E Feedback: Chloasma and melasma are dermatologic reactions that can result from the use of estrogens, like estradiol (Estrace), and may continue when use of the drug is discontinued.

Which of the following antacids may have a laxative effect and should be used cautiously in clients who have chronic diarrhea? Select all that apply. A) Calcium carbonate (Mylanta) B) Magnesium hydroxide (Milk of Magnesia) C) Magnesium oxide (Mag-Ox) D) Aluminum hydroxide (ALternaGEL) E) Sodium bicarbonate (Bell/ans)

B Magnesium Hydroxide, C Magnesium Oxide , E Sodium Bicarbonate The magnesium- and sodium-containing antacids may have a laxative effect and may produce diarrhea. Aluminum- and calcium-containing antacids tend to produce constipation.

The nurse is preparing to administer a laxative that adds bulk and water to the contents of the intestines, thereby stimulating intestinal peristalsis. Which of the following would the nurse be likely to administer? Select all that apply. A) Docusate (Colace) B) Methylcellulose (Citrucel) C) Polycarbophil (FiberCon) D) Bisacodyl (Docusate) E) Lactulose (Chronulac)

B Methylcellulose (Citrucel) C, Polycarbophil (FiberCon) Bulk-producing laxatives, like methylcellulose (Citrucel) and polycarbophil (FiberCon), produce their laxative effect by adding bulk and water to the contents of the intestines, thereby stimulating intestinal peristalsis. Docusate is a stool softener. Bisacodyl is a stimulant laxative. Lactulose is a hyperosmotic agent.

Antidiarrheals are contraindicated in clients whose diarrhea is associated with which of the following organisms that can harm the intestinal mucosa? Select all that apply. A) Staphylococcus B) Shigella C) Salmonella D) Streptococcus E) Escherichia coli

B Shigella ,C Salmonella ,E Escherichia coli Antidiarrheals are contraindicated in clients whose diarrhea is associated with Shigella, Salmonella, and Escherichia coli, which can harm the intestinal mucosa.

During a routine clinic visit, a client tells the nurse that he is taking an over-the-counter antidiarrheal agent for treatment of diarrhea. The nurse reviews the drug information with the client. Afterward, the nurse determines that the teaching was successful when the client states that he will contact his primary health care provider if the diarrhea is not resolved within which time frame? A) 24 hours B) 48 hours C) 72 hours D) 96 hours

B) 48 Hours If diarrhea persists for more than 2 days when over-the-counter (OTC) antidiarrheal drugs are being used, the client should discontinue use and seek treatment from the primary health care provider.

A nurse educating a client on the antacid aluminum hydroxide (ALternaGEL) should warn the client about which of the following adverse reactions? Select all that apply. A) Alopecia B) Anorexia C) Diarrhea D) Tremors E) Bone pain

B) Anorexia, D) Tremors, E) Bone pain Adverse reactions of aluminum hydroxide (ALternaGEL) include constipation, intestinal impaction, anorexia, weakness, tremors, and bone pain.

A nurse is caring for a client with constipation. The physician prescribes cascara sagrada to the client. Which of the following effects should the nurse monitor for in the client after administration of the drug? A) Sudden increase in weight B) Brownish discoloration of urine C) Reduced sperm count D) Abdominal pain and cramping

B) Brownish discoloration of urine The nurse should monitor for pink-red, red-violet, red-brown, yellow-brown, or black discoloration of urine after administration of cascara sagrada to the client. Reduced sperm count is the adverse effect of sulfasalazine. Abdominal pain and cramping are the adverse effects of olsalazine. Cascara sagrada does not cause a sudden increase in the weight of the client.

A nurse should monitor a client taking which of the following drugs for increased adverse effects and toxicity if omeprazole (Prilosec) therapy is initiated? Select all that apply. A) Phenobarbital (Luminal) B) Digoxin (Lanoxin) C) Diazepam (Valium) D) Warfarin (Coumadin) E) Ketoconazole (Nizoral)

B) Digoxin (Lanoxin) C) Diazepam (Valium),D Warfarin (Coumadin) The initiation of proton pump inhibitors, like omeprazole (Prilosec), can result in increased adverse reactions and toxicities of warfarin (Coumadin), benzodiazepines (diazepam), digoxin (Lanoxin), phenytoin (Dilantin), and clarithromycin (Biaxin).

A nurse educating a client on balsalazide (Colazal) should advise the client about possible adverse reactions not involving the gastrointestinal tract. Which of the following would the nurse include in the teaching plan? Select all that apply. A) Alopecia B) Headache C) Fever D) Tremors E) Bone pain

B) Headache C) Fever Balsalazide (Colazal) is an aminosalicylate. Nongastrointestinal adverse effects of aminosalicylates include headache, dizziness, fever, and weakness.

A physician has prescribed difenoxin with atropine to a client with acute diarrhea. The client informs the nurse that he is also taking MAOI antidepressants. The nurse would assess the client for which of the following that might result from the interaction of the two drugs? A) Decreased effect of difenoxin B) Increased risk of hypertensive crisis C) Increased cholinergic blocking adverse reactions D) Increased risk of CNS depression

B) Increased risk of Hypertesive crisis The nurse should monitor the client for an increased risk of hypertensive crisis as an effect of the interaction between difenoxin with atropine and MAOI antidepressants. When the client is administered antihistamines, opioids, sedatives, or hypnotics with antidiarrheal drugs, there will be increased risk of CNS depression. When the client is administered antihistamines and general antidepressants with antidiarrheal drugs, there will be increased cholinergic blocking adverse reactions. There will not be a decreased effect of difenoxin when there is an interaction between difenoxin and MAOI antidepressants.

A client with a nasogastric tube is prescribed therapy to prevent ulcer development. Which of the following would be the best option for the drug? A) Tablet that can be crushed B) Liquid formulation C) Intravenous administration D) Intramuscular injection

B) Liquid formulation The nurse should request the liquid form when administration is in a tube to decrease the chance of a clogged NG tube. Although it is appropriate to crush the tablet and mix it with apple juice, there is still a risk for clogging. Intravenous or intramuscular administration would be inappropriate. The IV route is typically preferred if the patient has an existing IV line, because these drugs are irritating, and IM injections need to be given deep into the muscular tissue to minimize harm.

A client is diagnosed with an infection with H. pylori. Which of the following drugs are commonly used in combination with certain antibiotics in the treatment of this infection? Select all that apply. A) Metoclopramide (Reglan) B) Omeprazole (Prilosec) C) Ondansetron (Zofran) D) Lansoprazole (Prevacid) E) Promethazine (Phenergan)

B) Omeprazole (Prilosec) D) Lansoprazole (Prevacid) The proton pump inhibitors, like omeprazole (Prilosec) and lansoprazole (Prevacid), are commonly used in combination with certain antibiotics in the treatment of H. pylori.

A group of nursing students are reviewing information about upper gastrointestinal system drugs. The students demonstrate understanding of the material when they identify which of the following as a proton pump inhibitor? A) Nizatidine B) Omeprazole C) Esomeprazole D) Sucralfate E) Misoprostol

B) Omeprazole C) Esomeprazole Omeprazole and esomeprazole are examples of proton pump inhibitors. Nizatidine is a histamine-2 receptor antagonist. Sucralfate and misoprostol are examples of miscellaneous acid reducers.

The nurse should administer which of the following medications cautiously to clients with vitamin B12 deficiency as the prolonged use of these drugs decreases the body's ability to absorb vitamin B12? Select all that apply. A) Metoclopramide (Reglan) B) Rabeprazole (AcipHex) C) Sucralfate (Carafate) D) Pantoprazole (Protonix) E) Promethazine (Phenergan)

B) Rabeprazole (AcipHex) D) Pantoprazole The nurse should administer proton pump inhibitors, like rabeprazole (AcipHex) and pantoprazole (Protonix), cautiously to clients with vitamin B12 deficiency as the prolonged use of these drugs decreases the body's ability to absorb vitamin B12.

A nurse is caring for a client who is prescribed omeprazole for a duodenal ulcer. The client is also taking benzodiazepines for the management of a seizure disorder. The nurse would assess the client for which of the following? A) Decreased absorption of the proton pump inhibitor B) Risk for toxic level of benzodiazepines C) Increased risk of respiratory depression D) Increased risk of bleeding

B) Risk for toxic level of benzodiazepines When the proton pump inhibitor is administered with benzodiazepines, there will be a risk for a toxic level of benzodiazepines. When the client is administered sucralfate with the proton pump inhibitor, there will be a decrease in absorption of the proton pump inhibitor. When the client is administered an antacid with opioid analgesics, there will be an increased risk of respiratory depression. There will be an increased risk of bleeding when the client is taking oral anticoagulants with the proton pump inhibitor.

A nurse is caring for a client receiving bismuth subsalicylate for the relief of diarrhea. Which of the following interventions should the nurse perform to promote an optimal response to the prescribed drug therapy? A) Thoroughly mix and stir the drug before administering. B) Administer the drug after each loose bowel movement. C) Ensure the client receives adequate sunlight. D) Encourage the client to lightly exercise on a daily basis.

B) administer the drug after each loose bowel movement The nurse should administer the drug after each loose bowel movement to promote an optimal response to the prescribed drug therapy in the client with diarrhea. The nurse should inspect each bowel movement before making a decision to administer the drug. Laxatives that are in powder, flake, or granule form are mixed and stirred before being administered to the client with constipation. The nurse need not ensure that the client receives adequate sunlight or encourage the client to lightly exercise on a daily basis as these interventions will not help in promoting an optimal response to the prescribed drug therapy.

A nurse should recognize that administering antacids to clients taking which of the following medications can result in decreased drug absorption and decreased drug effects? Select all that apply. A) Simvastatin (Zocor) B) Isoniazid (Nydrazid) C) Digoxin (Lanoxin) D) Phenytoin (Dilantin) E) Enalapril (Vasotec)

B) isoniazid (Nydrazid) C) Digoxin (Lanoxin) D) Phenytoin (Dilantin) Antacids decrease the absorption of digoxin, isoniazid, phenytoin, and chlorpromazine, leading to decreased effect of those drugs.

A nursing student is preparing a presentation on antidiarrheal drugs. Which of the following drugs would the student include as being chemically related to opioid drugs and used to treat diarrhea by decreasing intestinal peristalsis? Select all that apply. A) Bisacodyl (Dulcolax) B) Difenoxin (Motofen) C) Alosetron (Lotronex) D) Diphenoxylate (Lomotil) E) Bismuth (Pepto-Bismol)

B)Difeboxin (Motofen) D) Diphenoxylate (Lomotil) Difenoxin (Motofen) and diphenoxylate (Lomotil) are chemically related to opioid drugs and treat diarrhea by decreasing intestinal peristalsis.

A nurse follows a specific protocol when administering which of the following medications to prevent nausea induced by doxorubicin (Adriamycin) administration? Select all that apply. A) Lansoprazole (Prevacid) B) Ondansetron (Zofran) C) Metoclopramide (Reglan) D) Promethazine (Phenergan) E) Granisetron (Kytril)

B)Ondansetron (Zofran) E) Granisetron (Kytril) 5-HT3 receptor antagonists, like ondansetron (Zofran) and granisetron (Kytril), are used in the prevention of chemotherapy-induced nausea and vomiting.

A client is administered trimethobenzamide hydrochloride (Tigan) to control nausea and vomiting. The nurse would assess the client for which of the following? A) Acid rebound B) Neurotoxicity C) Blurred vision D) Bone softening

C) Blurred Vision The nurse should monitor the client for blurred vision as an adverse reaction to the trimethobenzamide hydrochloride (Tigan). The nurse need not monitor the client for acid rebound, neurotoxicity, and bone softening as they are not adverse reactions to trimethobenzamide hydrochloride (Tigan). Acid rebound is an adverse reaction to calcium carbonate. Neurotoxicity and bone softening are adverse reactions to aluminum carbonate gel.

A nurse is caring for an elderly client who has received cimetidine. Which of the following interventions should the nurse perform? A) Monitor the client for complaints of pain or sour taste. B) Monitor the client for concentrated urine and restlessness. C) Closely monitor the client for confusion and dizziness. D) Report symptoms of tardive dyskinesia to the primary health care provider.

C) Closely monitor the client for confusion and dizziness. The nurse should closely monitor the elderly client who has been administered cimetidine for confusion and dizziness. When the client is receiving an antiemetic, the nurse monitors the client frequently for continued complaints of pain, sour taste, spitting blood, or coffee-ground-colored emesis. When antacids are given to the client, the nurse should observe the client for concentrated urine and restlessness. When the client is administered prolonged doses of metoclopramide, the nurse reports any sign of tardive dyskinesia or extrapyramidal symptoms to the primary health care provider.

A nurse educating a client on the antacid magnesium oxide (Mag-Ox) should warn the client of which of the following adverse reactions? Select all that apply. A) Tremors B) Anorexia C) Diarrhea D) Dehydration E) Hypotension

C) Diarrhea D) Dehydration E) Hypotension Adverse reactions of magnesium oxide (Mag-Ox) include severe diarrhea, dehydration, and hypermagnesemia (nausea, vomiting, hypotension, and decreased respirations).

A nurse is caring for a client with pseudomembranous colitis. The physician has prescribed loperamide. Which of the following would the nurse identify as indicative of effectiveness? A) Elevation in temperature is noted. B) Rectal bleeding is noted. C) Diarrhea is resolved. D) Nausea and vomiting are resolved.

C) Diarrhea is resolved Loperamide is an antidiarrheal medication. The nurse will know that the medication is effective if the diarrhea is resolved in the client. The nurse should monitor the client for an elevation in body temperature, severe abdominal pain, abdominal rigidity, or distention because these are the indicators of intestinal perforation. The nurse should monitor for rectal bleeding when laxatives are administered.

The nurse is reviewing a client's history and finds that the client uses a laxative that produces its effects by dehydrating local tissues, which causes irritation and increased peristalsis, with consequent evacuation of the fecal mass. Which of the following would this be? Select all that apply. A) Docusate sodium (Colace) B) Methylcellulose (Citrucel) C) Glycerin (Fleet Babylax) D) Bisacodyl (Dulcolax) E) Lactulose (Chronulac)

C) Glycerin (Fleet Babylax E) Lactulose (Chronulac) Hyperosmotic agents, like glycerin (Fleet Babylax) and lactulose (Chronulac), produce their laxative effect by dehydrating local tissues, which causes irritation and increased peristalsis, with consequent evacuation of the fecal mass. Docusate is a stool softener. Methylcellulose is a bulk-forming laxative. Bisacodyl is an irritant laxative.

A client is prescribed ranitidine. A review of the client's medication history reveals that she also takes warfarin for treatment of deep vein thrombosis. The nurse would monitor the client for which of the following? A) Decreased white blood cell count B) Increased risk of respiratory depression C) Increased risk for bleeding D) Decreased seizure threshold

C) Increased risk for bleeding Histamine-2 receptor antagonists when given with warfarin place the client at an increased risk for bleeding. A decreased white blood cell count occurs when histamine-2 receptor antagonists are given with carmustine. An increased risk of respiratory depression occurs when histamine-2 receptor antagonists are given with opioid analgesics. This class of drugs does not interact with any antiseizure medications.

The nurse is caring for a client who is prescribed mesalamine. The client is also taking warfarin. Which of the following interactions should the nurse monitor the client for when he is administered mesalamine with warfarin? A) Increased risk of immunosuppression B) Increased blood glucose level C) Increased risk of bleeding D) Increased risk of CNS depression

C) Increased risk of bleeding The client administered mesalamine and warfarin is at an increased risk of bleeding. Warfarin is an anticoagulant used as a blood thinner; mesalamine is an aminosalicylate, which is an aspirin-like compound with anti-inflammatory action. The combination of mesalamine and warfarin does not increase the risk of immunosuppression, increase the blood glucose level, or increase the risk of CNS depression. There is an increased risk of immunosuppression if an aminosalicylate interacts with methotrexate used in cancer and autoimmune conditions. There is an increased blood glucose level when oral hypoglycemic drugs interact with aminosalicylates. There is an increased risk of CNS depression when opioids are administered with aminosalicylates.

When describing the action of which drug would the nurse explain that it works to reduce gastric motility and decrease the amount of acid secreted by the stomach via blockade of cholinergic receptors? Select all that apply. A) Omeprazole (Prilosec) B) Ranitidine (Zantac) C) Propantheline (Pro-Banthine) D) Sucralfate (Carafate) E) Glycopyrrolate (Robinul)

C) Propantheline (Pro-Banthine) E) Glycopyrrolate (Robinul) Propantheline (Pro-Banthine) and glycopyrrolate (Robinul) are anticholinergic drugs used to reduce gastric motility and decrease the amount of acid secreted by the stomach via blockade of cholinergic receptors.

A nurse is caring for a client with irritable bowel syndrome. The physician has prescribed polycarbophil to the client. The nurse would administer this drug cautiously if the client's history revealed which of the following? A) Abdominal pain B) Pseudomembranous colitis C) Rectal bleeding D) Intestinal obstruction

C) Rectal bleeding The nurse should administer polycarbophil with caution in clients with rectal bleeding, in pregnant women, and during lactation. Antidiarrheals are contraindicated in clients with abdominal pain and pseudomembranous colitis. Aminosalicylates are contraindicated in clients with intestinal obstruction.

A client is receiving a bowel evacuant in preparation for a colonoscopy. The client tells the nurse that he has been "going to the bathroom about every 30 to 45 minutes" since he started taking the drug and his stools are "like water." He reports that he is thirsty and his mouth feels dry. Which nursing diagnosis would the nurse most likely identify? A) Risk for Infection B) Risk for Injury C) Risk for Imbalanced Fluid Volume D) Deficient Knowledge

C) Risk for imbalanced Fluid Volume The client's report of frequent stools, which is a result of the drug therapy, along with complaints of feeling thirsty and dry mouth suggest the nursing diagnosis of Risk for Imbalanced Fluid Volume due to the large losses of fluid from the body from the drug. There is no evidence to support a risk for infection or deficient knowledge. Risk for Injury would be appropriate if the client was experiencing drowsiness or dizziness in conjunction with the fluid losses.

A client has been diagnosed with ulcerative colitis. The physician has prescribed sulfasalazine to the client. Based on the nurse's understanding of this condition, the nurse would monitor the client for which of the following? A) Mild symptoms of contact dermatitis B) Abdominal pain and distention C) Severe blood- and mucus-filled diarrhea D) Frequent loose or watery stools

C) severe blood- and mucus- filled diarrhea The nurse should monitor for severe blood- and mucus-filled diarrhea in the client with ulcerative colitis. Pain and fatigue also accompany this disorder. Abdominal pain and distention are clinical manifestations of Crohn's disease. When clients are hypersensitive to ragweed, asters, and chrysanthemums are administered the chamomile herb, mild symptoms of contact dermatitis are observed. Frequent loose or watery stools are not associated with ulcerative colitis.

A physician has prescribed bisacodyl to a client with constipation. The client complains of epigastric pain and a burning sensation after taking the drug. Which of the following instructions should the nurse provide to the client? A) Immediately stop taking the drug. B) Take antacids between meals. C) Take the drug in powdered form. D) Avoid milk before taking the drug.

D) Avoid milk before taking the drug The nurse should instruct the client to avoid milk, antacids, H2 antagonists, and proton pump inhibitors 1 to 2 hours before taking the bisacodyl tablets because the enteric coating may dissolve early before reaching the intestinal tract, resulting in gastric lining irritation or dyspepsia and decreasing the laxative effect of the drug. The nurse need not instruct the client to immediately stop taking the drug, take the drug in powdered form, or take antacids between meals as these interventions will not help in preventing gastric lining irritation.

A nurse is preparing to administer sulfasalazine (Azulfidine) to a client with inflammatory bowel disease. The nurse checks the client's medical record for a history of hypersensitivities, understanding that the drug should not be administered to a client with hypersensitivity to which of the following drugs? Select all that apply. A) Enalapril (Vasotec) B) Doxycycline (Vibramycin) C) Azithromycin (Zithromax) D) Sulfamethoxazole/trimethoprim (Bactrim)

D) Sulfamethoxazole/trimethoprim (Bactrim) Sulfasalazine (Azulfidine) is an aminosalicylate. The use of aminosalicylates is contraindicated in clients with hypersensitivity to sulfonamides and sulfites, which includes sulfamethoxazole/trimethoprim (Bactrim).

A 30-year-old nonpregnant client is prescribed misoprostol. Which of the following should the nurse instruct the client as part of the teaching plan? A) Swallow the tablet 1 hour before eating. B) Administer the drug 1 hour before travel. C) Do not chew, open, or crush the tablet. D) Use a reliable contraceptive method.

D) Use a reliable contraceptive method. The nurse should instruct the client to use a reliable contraceptive method to avoid pregnancy during the course of treatment as it can cause spontaneous abortion. The nurse should instruct the client taking proton pump inhibitors not to chew, open, or crush the tablet and to swallow the tablet whole at least 1 hour before eating. The nurse needs to inform the client taking a drug for motion sickness to administer it about 1 hour before travel.