RNSG 1128 DA and Pharmacology Level 2 Spring 2018

The health care provider orders 2 g of ampicillin in 50 ml of D5W, to infuse IV piggyback (IVPB) over 30 minutes, for a client who had a right total knee replacement secondary to osteoarthritis. At what rate would the nurse set the IV infusion pump in milliliters per hour? Record your answer using a whole number.

mL/hr = 50mL/30min x 60min/1hr = 3000/30 = 100mL/hr

The nurse is administering penicillian V potasium to a child with cellulitis. The child weighs 27.5 lb (12.5 kg). The order reads penicillian V potasium 40 mg/kg/day po divided every six hours. How many milligrams of antibiotics should this child receive with each dose? Record your answer using a whole number.

mg/dose = 40mg/kg x 12.5kg/4doses = 500/4 = 125mg/dose 40 mg/kg/day equals a total of 500 mg given every six hours or four times in 24 hours. 500 mg divided by four equals 125 mg.

Teaching children and parents about the potential adverse effects of treatment for leukemia is important. What is an adverse effect of taking prednisone? A. Decreased risk of infection B. Increased blood glucose C. Decreased hair growth D. Decreased appetite

B. Increased blood glucose Prednisone may cause an increase in blood glucose requiring doses of insulin, especially when other factors are involved. Increased appetite, increased risk of infection, and increased hair growth are also adverse effects of prednisone.

A client is receiving spironolactone to treat hypertension. Which instruction should the nurse provide? A. Avoid salt substitutes B. Take daily potassium supplements C. Discontinue sodium restrictions D. Eat foods high in potassium

A. Avoid salt substitutes Because spironolactone is a potassium-sparing diuretic, the client should avoid salt substitutes because of their high potassium content. The client should also avoid potassium-rich foods and potassium supplements. To reduce fluid-volume overload, sodium restrictions should continue.

Which oral medication would the nurse anticipate being prescribed to prevent further thrombus formation? A. Heparin B. Warfarin C. Furosemide D. Metoprolol

B. Warfarin Warfarin prevents vitamin K from synthesizing certain clotting factors. This oral anticoagulant can be given long term. Heparin is a parenteral anticoagulant that interferes with coagulation by readily combining with antithrombin. It cannot be administered orally. Neither furosemide nor metoprolol affects anticoagulation.

While administering medication, the client tells the nurse, "I've never seen this pill before." The nurse should: A. inform the client that pills often look different because of different brands. B. reassure the client that the health care provider has ordered this medication. C. check the medication orders. D. teach the client about the effects of the medication.

C. check the medication orders. When a client indicates that something looks different, the nurse should verify the medication before assuming it is a correct.

The nurse receives an order to administer 350 mg of amoxicillin to a toddler po/q6h. The pharmacy supplies the amoxicillin with a concentration of 250 mg/5 ml. How many milliliters would the nurse give for each dose? Record the answer using a whole number:

mL = 5mL/250mg x 350mg/1 = 1750/250 = 7mL

A client with Hodgkin's disease who weighs 143 lb (65 kg) is to receive vincristine 25 mcg/kg IV. The nurse computes the correct dose in micrograms. How many micrograms should the client receive? Record your answer using a whole number.

mcg = 25mcg/kg x 65kg = 1625 mcg

A client with symptoms of acute asthma is ordered IV aminophylline 350 mg in 100 ml to be administered over 30 minutes. The nurse has vials of IV aminophylline labeled 250 mg/5 ml. How many milliliters of fluid contain the dose ordered? Record your answer using a whole number.

350mL/x = 250mg/5mL 1/X = 1/7 X=7

The nurse will administer a dosage of captopril at 1.5 mg/kg/day, in divided doses, q12h, to an infant who weighs 10 kg. How much would the nurse give per dose? Record your answer using one decimal place.

mg/doses = 1.5mg/kg x 10kg/2doses = 15/2 = 7.5mg/doses

The child's provider orders 720 ml of total parenteral nutrition (TPN) to be infused over the next 24 hours. The nurse will record TPN intake of how many milliliters at the end of the eight hour shift? Record your answer using a whole number.

ml/hr = 720mL/24hr = 30mL/hr x 8 hrs = 240 mL The nurse may calculate the rate two ways. First method: 720 ml TPN ÷ 24 hours = 30 ml/hour; 30 ml/hour x 8 hours = 240 ml Second method: 720 ml TPN ÷ 3 (ie, three 8 hour segments in 24 hours0 = 240 ml

A client is admitted with a diagnosis of diabetic ketoacidosis. An insulin drip is initiated with 50 units of insulin in 100 ml of normal saline solution. The IV is being infused via an infusion pump, and the pump is currently set at 10 ml/hr. How many units of insulin each hour is this client receiving? Record your answer using whole number.

u/hr = 50u/100mL x 10mL/hr = 500/100 = 5 u/hr

A client with deep vein thrombosis (DVT) has an IV infusion of heparin sodium infusing at 1,500 units/hr. The concentration in the bag is 25,000 units/500 ml. How many milliliters should the nurse document as intake from this infusion following an 8-hr shift? Record your answer using a whole number.

240 mL

A client with type 2 diabetes mellitus is prescribed capsaicin cream 0.075% What should the nurse include in a teaching plan for this medication? A. "Apply capsaicin cream four times daily to decrease neuropathic pain sensations." B. "This cream should be applied to open sores to prevent infection." C. "This cream should be applied to necrotic areas of ulcers to aid in debridement." D. "This cream should be applied daily to prevent dry skin."

A. "Apply capsaicin cream four times daily to decrease neuropathic pain sensations." This drug reduces amounts of substance P, which is involved in pain transmission. The nurse should teach the client to apply the cream four times daily for several weeks. The cream does not prevent dry skin, debride or treat infections.

One hour after receiving pyridostigmine bromide for myasthenia gravis, a client reports difficulty swallowing and excessive respiratory secretions. What medication would the nurse anticipate to reverse the effects of pyridostigmine bromide? A. Atropine B. Additional pyridostigmine bromide C. Edrophonium D. Acyclovir

A. Atropine These symptoms suggest cholinergic crisis or excessive acetylcholinesterase medication, typically appearing 45 to 60 minutes after the last dose of acetylcholinesterase inhibitor. Atropine, an anticholinergic drug, is used to antagonize acetylcholinesterase inhibitors. The other drugs are acetylcholinesterase inhibitors. Edrophonium is used for diagnosis, and pyridostigmine bromide is used to treat myasthenia gravis and would worsen these symptoms. Acyclovir is an antiviral and would not be used to treat these symptoms.

A nurse is about to give a client with type 2 diabetes mellitus her insulin before breakfast on her first day postpartum. Which client statement indicates an understanding of insulin requirements immediately postpartum? A. "I will need more insulin now than before I was pregnant." B. "I will need less insulin now than during my pregnancy." C. "I will probably be able to control my diabetes with diet and exercise now." D. "I will need more insulin now than during my pregnancy."

B. "I will need less insulin now than during my pregnancy." Postpartum insulin requirements are usually significantly lower than requirements during pregnancy. Occasionally, clients may require little or no insulin during the first 24 to 48 hours postpartum. Management of type 2 diabetes includes: healthy eating, regular exercise, possibly diabetes medication or insulin therapy, and blood sugar monitoring. However, there is not way of knowing if the client will now be able to control her diabetes without insulin.

Liquid oral iron supplements have been prescribed for a child. What is the most important information for the nurse to provide to this child's parents? A. Stop the medication if vomiting occurs B. Give the medicine via a dropper or through a straw C. Give the supplements with food D. Decrease the dose if constipation occurs

B. Give the medicine via a dropper or through a straw Liquid iron preparations may temporarily stain the teeth. The drug should be given by dropper or through a straw. Iron supplements should be given between meals, when the presence of free hydrochloric acid is greatest. If vomiting occurs, supplementation should not be stopped, but it should be administered with food. Constipation can be decreased by increasing intake of fruits and vegetables.

The family of a client in rehabilitation following heroin withdrawal asks a nurse why the client is receiving naltrexone. What is the nurse's best response? A. To keep the client sedated during withdrawal B. To help reverse withdrawal symptoms C. To take the place of detoxification with methadone D. To decrease the client's memory of the withdrawal experience

B. To help reverse withdrawal symptoms Naltrexone is an opioid antagonist and helps the client stay drug free. Keeping the client sedated during withdrawal isn't the reason for giving this drug. The drug doesn't decrease the client's memory of the withdrawal experience, and isn't used in place of detoxification with methadone.

What is the most important assessment for the nurse to make when administering tamsulosin to a client with benign prostatic hyperplasia (BPH)? A. Serum testosterone level B. Voiding pattern C. Creatinine clearance D. Size of the prostate

B. Voiding pattern The alpha-adrenergic blocker tamsulosin relaxes the smooth muscle of the bladder neck and prostate, so the urinary voiding symptoms of BPH are reduced in many clients. These drugs do not affect the size of the prostate, renal function, or the production or metabolism of testosterone.

The nurse should tell parents to stop administering aspirin and notify a provider if their child is exposed to: A. stress. B. influenza. C. scabies. D. environmental allergies.

B. influenza. A strong association exists between influenza and aspirin administration and the development of Reye syndrome. There are no contraindication with the other conditions.

The nurse reviews information about how to take the prescribed tetracycline. Which statement, by the client, allows the nurse to determine that the client understands the information? A. "I can take tetracycline with or without meals." B. "I can take tetracycline on an empty stomach with small amounts of water." C. "I can take tetracycline one hour before or two hours after meals with plenty of water." D. "I can take tetracycline with milk and milk products."

C. "I can take tetracycline one hour before or two hours after meals with plenty of water." Tetracycline must be taken on an empty stomach to increase absorption, and with ample water to avoid esophageal irritation. Milk products impede absorption.

A five-year-old child, diagnosed with cerebral palsy, has just been prescribed oral baclofen. Which assessment finding, by the nurse, would indicate effective drug therapy? A. The child has less frequent seizures. B. The child is better able to concentrate on mental activities. C. The child is exhibiting less spasticity. D. The child no longer sleeps during the daytime.

C. The child is exhibiting less spasticity Baclofen is a skeletal muscle relaxant that is effective in reducing overall spasticity. It is not an anti-seizure drug. Significant side effects of this drug are drowsiness and confusion, so this child would not be sleeping less, nor demonstrating a better ability to concentrate on mental activities.

A client with chronic alcohol use is admitted to the hospital for detoxification. Later that day, the client's blood pressure increases and the client is given lorazepam to prevent: A. anxiety reaction. B stroke. C. seizure. D. fainting.

C. seizure. During detoxification from alcohol, changes in the client's physiological status, especially an increase in blood pressure, may indicate a possible seizure. Clients are treated with benzodiazepines to prevent this. Stroke, fainting, and anxiety aren't the primary concerns when withdrawing from alcohol.

The nurse is teaching a client with iron-deficiency anemia about ferrous gluconate therapy. Which statement, if made by the client, would indicate a correct understanding of the teaching? A. "I will take the medication with a glass of milk." B. "I will take the medication with whole-grain cereal." C. "I will take the medication with an antacid." D. "I will take the medication on an empty stomach with orange juice."

D. "I will take the medication on an empty stomach with orange juice." Preferably, ferrous gluconate should be taken on an empty stomach with orange juice. Ferrous gluconate shouldn't be taken with antacids, milk, or whole-grain cereals because these foods reduce iron absorption.

A client is receiving furosemide for therapeutic diuresis. When administering furosemide, which level will require monitoring, and possible replacement, due to this diuresis? A. Magnesium B. Sodium C. Chloride D. Potassium

D. Potassium Supplemental potassium may be administered with furosemide due to potassium loss that often occurs as a result of this diuretic. Neither chloride, magnesium nor sodium are lost during diuresis.

The nurse is instructing a client who will be discharged on anticoagulant therapy. What is the most important instruction for this nurse to include? A. Do not shave with an electric razor B. Eat green, leafy vegetables and salad daily C. Take ibuprofen or aspirin for pain D. Take the anticoagulant at the same time each day

D. Take the anticoagulant at the same time each day It is important to take the anticoagulant at the same time each day to maintain an adequate blood level. An electric razor reduces the risk of cutting the skin. Avoid the use of standard razors. Avoid taking aspirin or ibuprofen because these drugs decrease clotting time. Eating a large amount of green, leafy vegetables that contain vitamin K will increase clotting time, thus requiring more anticoagulants.

A nurse is evaluating the effectiveness of drug therapy for a client undergoing alcohol detoxification. Which finding would indicate that this client's drug therapy needs to be adjusted? A. The medication has allowed the client to have appropriate interactions with staff B. The client has tolerated dosage increase during treatment C. There are signs that the drug has prevented the occurrence of further problems D. There are signs of toxicity from the drug

D. There are signs of toxicity from the drug If signs of toxicity exist during the detoxification period, drug therapy needs to be adjusted. Drug therapy is effective if it prevents further problems. Medication dosage may require adjustment to obtain the maximum benefit. If the drug enables the client to have therapeutic interactions with the staff, the client is benefiting from the therapy.

What should the nurse teach a client receiving vitamin D therapy for hypoparathyroidism? A. Vitamin D therapy will stabilize potassium levels. B. Vitamin D will cure hypoparathyroidism. C. Vitamin A and C will increase absorption of calcium. D. Vitamin D is taken to increase absorption of calcium.

D. Vitamin D is taken to increase absorption of calcium. A client with hypoparathyroidism has a decreased serum calcium level. Variable doses of vitamin D preparations enhance the absorption of calcium from the gastrointestinal tract. This does not cure the client's hypoparathyroidism. Vitamins A, C, and E are not involved with this process. Vitamin D therapy will not assist in stabilizing potassium.

A client, diagnosed with asthma, is experiencing an anaphylactic reaction to a medication. After administering initial emergency care, the nurse would: A. have the client lie flat in the bed. B. obtain serum electrolyte levels. C. administer bronchodilators. D. administer beta-adrenergic blockers.

D. administer bronchodilators. Bronchodilators will open the client's airway and improve oxygenation status. Beta-adrenergic blockers aren't indicated in the management of asthma because they may cause bronchospasm. Obtaining laboratory values wouldn't be done during an emergency, and having the client lie flat in bed could impede his ability to breathe..

A 75-year-old client is admitted to the hospital with lower gastrointestinal bleeding. The client's hemoglobin on admission to the emergency department is 7.3 g/dl. The health care provider prescribes two units of packed red blood cells (RBCs) to infuse over one hour each. Each unit of packed RBCs contains 250 ml. The blood administration set has a drip factor of 10 gtt/ml. What is the flow rate in drops per minute? Record your answer using a whole number.

gtt/min = 10gtt/mL x 250mL/1 hr x 1 hr/60min = 2500/60 = 41.6 = 42gtt/min

A client with pneumonia is ordered azithromycin 500 mg IV daily via a peripheral IV catheter. The medication is pre-mixed from the pharmacy in a 50 ml bag of solution to be infused over 30 minutes. The IV tubing delivers 15 gtts/ml. At what drip rate should the nurse set the infusion pump? Record your answer using a whole number.

gtt/min = 15gtt/mL x 50mL/30min = 750/30 = 25gtt/min

A client is ordered to receive 1,000 ml of 0.45% normal saline with 20 mEq of potassium chloride (KCl) over six hours. The infusion set administers 15 gtt/ml. How many drops per minute should this client receive? Record your answer using a whole number.

gtt/min = 15gtt/ml x 1000mL/6hr x 1hr/60min = 15000/360 = 41.66....= 42 gtt/min The flow rate is determined by the rate of infusion and the number of drops per milliliters of the fluid being administered. gtt/ml x amount to be infused/number of minutes = the IV flow rate 15 gtt/ml x 1,000 ml/360 min = 42 gtt/min

A client with pneumonia is ordered ampicillin 200 mg/q4h. The vial is labeled 500 mg/10 ml. How many milliliters of the fluid contains the dose ordered? Record your answer using a whole number.

mL = 10mL/500mg x 200mg/1 = 2000/500 = 4mL

A child with sickle cell anemia is being treated for a crisis. The provider orders morphine sulfate 2 mg IV. The concentration of the vial is 10 mg/1 ml of solution. How many milliliters of solution should the nurse administer? Record your answer using one decimal point.

mL = 1mL/10mg x 2 mg/1 = 2/10 = 0.2mL

Erythromycin is given to a six-year-old child before dental work to prevent endocarditis. The child weighs 44 lb (20 kg). The order is for 20 mg/kg by mouth two hours before the dental appointment. The bottle comes concentrated as 400 mg/5 ml. How many milliliters should the child receive? Record your answer using a whole number.

mL = 5mL/400mg x 20mg/1 kg x 20kg/1 = 2000/400 = 5mL

A client with a history of hypertension has just had a total hip replacement. The provider orders hydrochlorothiazide 35 mg oral solution po/day. The label on the solution reads hydrochlorothiazide 50 mg/5 ml. How many milliliters should the nurse pour to administer the correct dose? Record your answer using one decimal place.

mL = 5mL/50mg x 35mg/1 = 175/50 = 3.5 mL The correct formula to calculate a drug dosage is: Dose on hand ÷ Quantity on hand = Dose desired ÷ X.

A client is prescribed heparin subQ 6,000 units/q12h for deep vein thrombosis prophylaxis. The pharmacy dispenses a vial containing 10,000 units/ml. How many milliliters of heparin should a nurse administer? Record your answer using one decimal place.

mL = mL/10000u x 6000u/1 = 6000/10000 = 0.6mL

A 10-year-old child is admitted with asthma. The health care provider orders a methylprednisolone loading dose of 3 mg/kg. The child weighs 30 kg. It comes as a solution of 40 mg/ml. How many milliliters should the child receive? Record your answer using two decimal places.

mL = mL/40mg x 3mg/kg x 30kg/1 = 90/40 = 2.25mL

A client, with heart failure, is receiving furosemide, 40 mg IV. The provider orders 40 mEq of potassium chloride in 100 ml of dextrose 5% in water, to infuse over four hours. The client's most recent serum potassium level is 3.0 mEq/L. At which infusion rate should the nurse set the IV pump? Record your answer using a whole number.

mL/hr = 100mL/4hr = 25ml/hr

The pediatric nurse is caring for a 10-month-old infant. The health care provider orders an IV infusion of dextrose 5% in 0.45% NaCl solution to be infused at 7 ml/kg/hr. The infant weighs 22 lb (10 kg). How many ml/hr of the ordered solution should the nurse infuse? Record your answer using a whole number.

mL/hr = 7mL/kg x 10kg/hr = 70mL/hr

The nurse is preparing to administer IV methylprednisolone sodium succinate to a child who weighs 44 lb (20 kg). The order is for 0.03 mg/kg IV daily. How many milligrams should the nurse prepare? Record your answer using one decimal point.

mg = 0.03mg/kg x 20kg/1 = 0.6mg

A client, weighing 132 lb (60 kg), is to receive phenobarbital 2mg/kg/day to be given in a divided into three equal doses. How many milligrams of phenobarbital will the client receive in each dose? Record your answer using a whole number.

mg = 2mg/kg/day x 60/1 x 1 day/3 doses = 120/3 = 40 mg/dose

A child is prescribed high-dose aspirin as part of the therapy for Kawasaki disease. The order is for 80 mg/kg/day PO in four divided doses until the child is afebrile. The child weighs 33.1 lb (15 kg). How many milligrams is given in one dose? Record your answer using a whole number.

mg/dose = 80mg/kg x 15kg/4doses = 1200/4 = 300mg/dose

A client has primary insomnia and requires pharmacological assistance to sleep. The health care provider prescribes secobarbital sodium 75 mg/po/hs. The nurse has secobarbital sodium 25 mg tablets on hand. How many tablets should the nurse administer to the client? Record your answer using a whole number.

tab = 75mg/25mg = 3 tabs

Hydrocodone with acetaminophen has been prescribed for a client with metastatic prostate cancer. What information is essential for the nurse to include in the teaching plan? A. "Constipation may develop with constant use." B. "Nausea may occur." C. "You may feel more relaxed and calm." D. "You may develop blurred vision."

A. "Constipation may develop with constant use." Constipation commonly develops with constant use of hydrocodone. The nurse should teach the client about constipation, and tell the client ways to decrease this risk, such as increasing fiber and liquids in the diet. Nausea may occur on occasion, however, it is not a severe problem, and could be related to constipation. Blurred vision and diarrhea are not associated with the use of hydrocodone with acetaminophen. Feeling relaxed and calm is a common side effect does not need medical attention. As the body adjusts to the medicine during treatment these side effects may go away.

A client is receiving aspirin. Which statement made by the client needs follow-up? A. "I'll take the medication after a meal." B. "I can take Ginkgo biloba with aspirin." C. "I need to report loss of hearing in my ears." D. "I need to report if I have black stool."

B. "I can take Ginkgo biloba with aspirin." Aspirin, also known as acetylsalicylic acid, is used for mild to moderate pain, fever, inflammation, and atrial fibrillation stroke prevention. Aspirin may increase the bleeding when taken with herbal supplement Ginkgo biloba. The medication can cause gastrointestinal bleeding and ototoxicity. Nausea, vomiting, diaphoresis, and tinnitus are the earliest signs and symptoms of salicylate toxicity. Other early symptoms and signs are vertigo, hyperventilation, tachycardia, and hyperactivity. It should be taken with food especially if it causes stomach upset.

The nurse is caring for a client admitted for a herniated nucleus pulposus. The client reports a pain level of 7 out of 10 and is currently using the ordered morphine sulfate patient-controlled analgesia pump for pain management. What is the priority nursing assessment for this client? A. Gastrointestinal system B. Respiratory system C. Cardiovascular system D. Neurological system

B. Respiratory system The respiratory system is the highest priority nursing assessment because morphine sulfate can lead to respiratory depression, which can cause death for the client. The other systems should be monitored, but are not the priority.

The client tells the nurse that she frequently experiences nausea and vomiting after receiving radiation and chemotherapy. The nurse adapts the plan of care to include antiemetics. What is the most appropriate time for the administration of the medication? A At the same time as therapy B. Thirty minutes before therapy begins C. Immediately after nausea begins D. When therapy is completed

B. Thirty minutes before therapy begins Antiemetics are most beneficial if given before the onset of nausea and vomiting. To calculate the optimum time for administration, the first dose is given 30 minutes to one hour before nausea is expected, and then every two, four, or six hours for approximately 24 hours after chemotherapy. If the antiemetic was given with the medication, or after the medication, it could lose its maximum effectiveness when needed.

A newly admitted client, diagnosed with delirium, has a history of hypertension and anxiety. The client had been taking digoxin, furosemide, and diazepam. The nurse suspects that this client's impairment may be the result of: A. metabolic acidosis. B. drug intoxication. C. hepatic encephalopathy. D. opportunistic infection.

B. drug intoxication. Digoxin, furosemide, and diazepam have a propensity for producing delirium.

A client is receiving chlordiazepoxide as needed for signs and symptoms of alcohol withdrawal. The nurse assesses the client and determines the need for medication when the client displays: A. hypotension, decreased reflexes, drowsiness. B. mild tremors, hypertension, tachycardia. C. bradycardia, hyperthermia, sedation. D. hypothermia, mild tremors, slurred speech.

B. mild tremors, hypertension, tachycardia. Chlordiazepoxide is given during alcohol withdrawal. Symptoms that indicate a need for this drug include tremors, hypertension, tachycardia, and elevated body temperature. Bradycardia, sedation, hypotension, decreased reflexes, hypothermia, and slurred speech aren't symptoms of alcohol withdrawal.

The health care provider orders heparin, 7,500 units subcutaneous, for a client who had a left total hip replacement secondary to osteoarthritis. The pharmacy sent heparin 5,000 units/0.5 ml to the unit. How many milliliters should the nurse administer to this client? Record your answer using two decimal places.

mL = 0.5mL/5000u x 7500u/1 = 3750/5000 = 0.75mL

A client has just received a renal transplant, and has started cyclosporine therapy. What is the most important information for the nurse to share with this client? A. "You may have a decreased appetite." B. "Report any fever, a flushed feeling, or lethargy." C. "Dizziness is common." D. "Report any stomach discomfort or dyspepsia."

B. "Report any fever, a flushed feeling, or lethargy." Fever, a flushed feeling, or lethargy suggest an infection. The nurse should closely monitor these symptoms in clients taking cyclosporine because it is an immunosuppressive drug. This medication should not cause decreased appetite, dizziness or stomach discomfort.

A client, hospitalized for pulmonary embolism, is being discharged on warfarin therapy. The client asks the nurse to explain how warfarin works. What is the nurse's best response? A. It will dissolve an existing clot. B. It inhibits the formation of blood clots. C. It will reduce the size of the pulmonary embolism. D. It will reduce blood pressure and prevent venous stasis.

B. It inhibits the formation of blood clots. Warfarin inhibits clot formation by interfering with clotting factors that are dependent on vitamin K. Warfarin doesn't dissolve clots and won't reduce the size of the pulmonary embolus. It doesn't reduce blood pressure and won't prevent venous stasis. Coagulation studies will be performed every 2 to 4 weeks while the client is receiving warfarin.

Which antiparkinsonian drug can cause drug tolerance or toxicity if taken for too long? A. Selegiline B. Levodopa-carbidopa C. Amantadine D. Pergolide

B. Levodopa-carbidopa Long-term therapy with levodopa-carbidopa can result in drug tolerance or toxicity manifested by confusion, hallucinations, or decreased drug effectiveness. The other drugs listed don't require the client to take a drug holiday.

A client with type 1 diabetes mellitus often skips his ordered dose of insulin. What priority information should the nurse give to this client regarding the omission of insulin doses? A. May cause diabetes insipidus B. May lead to ketoacidosis C. May cause hypoglycemic coma D. May lead to pancreatitis

B. May lead to ketoacidosis A client who fails to regularly take insulin is at risk for hyperglycemia, which could lead to diabetic ketoacidosis. Hypoglycemia would not occur because the lack of insulin would lead to increased levels of sugar in the blood. A client with chronic pancreatitis may develop diabetes, but insulin-dependent diabetes mellitus does not lead to pancreatitis. Diabetes insipidus isn't caused by alteration in insulin levels.

What adverse reaction might the nurse observe after administering enteric-coated erythromycin to a client? A. Constipation B. Nausea and vomiting C. Increased appetite D. Weight gain

B. Nausea and vomiting Erythromycin is an antibiotic. Common adverse effects include nausea, vomiting, diarrhea, abdominal pain, and anorexia. It should be given with a full glass of water and after meals, or with food, to lessen gastrointestinal symptoms.

A client has been prescribed corticosteroids. The nurse would also anticipate an order for: A. lactulose 40 g in 4 oz (118 ml) of water daily. B. serum platelet counts every 12 hours. C. blood glucose checks every 6 hours. D. fluid restriction to 1,000 ml in 24 hours.

C. blood glucose checks every 6 hours. Corticosteroids cause elevated blood glucose levels; insulin may be necessary to maintain normal blood glucose levels. Corticosteroids can cause edema, but fluid restrictions are generally unnecessary unless the client also has renal or cardiac disease. Lactulose is given for constipation and to treat hepatic encephalopathy. Platelet count every 12 hours is not necessary when monitoring clients undergoing corticosteroid therapy.

After undergoing small-bowel resection, a client is prescribed metronidazole 500 mg IV The mixed IV solution contains 100 milliliters. A nurse is to run the drug over 30 minutes. The drip factor of the available IV tubing is 15 gtt/ml. What is the drip rate? Record your answer using a whole number.

gtt/min = 15gtt/ml x 100mL/30min = 1500/30 = 50gtt/min

A client with renal insufficiency is being treated with intravenous antibiotics. Which laboratory value should be monitored closely? A. Blood urea nitrogen (BUN) and creatinine levels B. Arterial blood gas (ABG) levels C. Potassium level D. Platelet count

A. Blood urea nitrogen (BUN) and creatinine levels BUN and creatinine levels should be monitored closely to detect elevations due to nephrotoxicity. ABG determinations are inappropriate in this situation. Platelets and potassium levels should be monitored according to routine.

A client, recovering from a spinal cord injury, has a great deal of spasticity. Which medication would the nurse anticipate to relieve spasticity? A. Baclofen B. Lidocaine C. Methylprednisolone D. Hydralazine

A. Baclofen Baclofen is a skeletal muscle relaxant used to decrease spasms. It may be given orally or intrathecally. Hydralazine is an antihypertensive and afterload-reducing agent. Lidocaine is an antiarrhythmic and a local anesthetic agent. Methylprednisolone is an anti-inflammatory drug used to decrease spinal cord edema in the acute phase.

A nurse is teaching a client with glaucoma the proper technique for instilling eye drops. The nurse determines that teaching is effective when the client states: A. "I should instill the drop in the lower conjunctival sac." B. "I should instill the drop directly onto the cornea." C. "I should instill the drop near the opening of the lacrimal duct." D. "I should instill the drop in the outer canthus."

A. "I should instill the drop in the lower conjunctival sac." Eye drops should be placed in the lower conjunctival sac starting at the inner, not outer, canthus. Placing eye drops on the cornea causes discomfort and should be avoided. Eye drops shouldn't be placed by the opening of the lacrimal ducts to avoid systemic absorption.

A nurse is providing instruction to a 38-year-old male client undergoing treatment for anxiety and insomnia. The practitioner has prescribed lorazepam 1 mg/po/tid. The nurse determines that teaching has been effective when the client states: A. "I'll avoid coffee." B. "I must eat enough salt." C. "I can drink red wine." D. "I'll avoid sunlight."

A. "I'll avoid coffee." Lorazepam is a benzodiazepine used to treat various forms of anxiety and insomnia. Caffeine is contraindicated because it is a stimulant and increases anxiety. A client taking lorazepam should avoid alcoholic beverages. Clients taking certain antipsychotic medications should avoid sunlight. Salt intake has no effect on lorazepam.

The nurse is checking the blood sugar level of a client who is at 33-weeks' gestation. This client has had type 1 diabetes since she was 12 years old. Which value would indicate to the nurse that this client's disease is controlled? A. 85 mg/dl (4.7 mmol/L) B. 136 mg/dl (7.6 mmol/L) C. 45 mg/dl (2.5 mmol/L) D. 120 mg/dl (6.7 mmol/L)

A. 85 mg/dl (4.7 mmol/L)

An adolescent client ingests a large number of acetaminophen tablets in an attempt to commit suicide. Which laboratory result is most consistent with acetaminophen overdose? A. Elevated liver enzyme levels B. Increased serum creatinine level C. Increased white blood cell (WBC) count D. Elevated bilirubin levels

A. Elevated liver enzyme levels Elevated liver enzyme levels, which could indicate liver damage, are associated with acetaminophen overdose. Metabolic acidosis isn't associated with acetaminophen overdose. An increased serum creatinine level may indicate renal damage. An increased WBC count indicates infection.

A client, who was recently hospitalized, has constipation related to her medical regimen. Which medication may contribute to this problem? A. Iron B. Potassium C. Vitamin E D. Folic acid

A. Iron Iron may cause constipation when supplements are taken at 100% of the recommended daily allowance (RDA). Folic acid, potassium, and vitamin E don't increase the likelihood of constipation.

A nurse is preparing to instill ear drops in a 28-year-old client with otitis externa. What is the correct procedure for instillation? A. Pull the pinna up and back B. Pull the pinna down and back C. Separate the palpebral fissures with a clean gauze pad D. Pull the tragus up and back

A. Pull the pinna up and back To straighten the ear canal of an adult, the pinna is pulled up and back. Options 1 and 3 aren't appropriate methods for preparing the ear to receive eardrops. The palpebral fissures are in the eye.

A client, who is withdrawing from alcohol, is being given lorazepam. The client's family asks the nurse about the medication. What is the nurse's best response? A. The lorazepam will reduce the symptoms of withdrawal. B. The lorazepam will make a client forget about symptoms of withdrawal. C. The lorazepam will also help with heart disease. D. Short-term use of lorazepam can lead to dependence.

A. The lorazepam will reduce the symptoms of withdrawal. Lorazepam is a short-acting benzodiazepine usually given for one week to ease the effects of alcohol withdrawal. Long-term use of lorazepam can lead to dependence. The medication isn't given to help forget the experience. Lorazepam isn't used to treat coexisting cardiovascular problems.

The nurse has provided teaching for a client who will be taking lorazepam upon discharge. The nurse determines that teaching was effective when the client states the need to avoid: A. alcohol. B shellfish. C. cheese. D. coffee.

A. alcohol. Alcohol should be avoided because of the added depressive effects. Ingestion of shellfish, coffee, and cheese is not problematic.

The nurse instills atropine drops into both eyes for a client undergoing an ophthalmic examination. Which instruction should this client follow until the medication wears off? A. "Avoid wearing your regular glasses when driving." B. "Wear dark glasses in bright light because the pupils are dilated." C. "Use caution because your blink reflex is paralyzed." D. "Be aware that the pupils may be unusually small."

B. "Wear dark glasses in bright light because the pupils are dilated." Atropine, an anticholinergic drug, has mydriatic effects causing pupil dilation. This allows more light onto the retina and may cause photophobia and blurred vision. Atropine doesn't paralyze the blink reflex or cause miosis (pupil constriction). Driving may be contraindicated to blurred vision.

A hospitalized child is to receive 75 mg/po/q4h of acetaminophen for fever control. How many milliliters per dose should the nurse administer if the available acetaminophen is 40 mg/0.4 ml? A. 1.5 ml B. 0.75 ml C. 0.37 ml D. 1.12 ml

B. 0.75 ml

A child requires IV fluids to infuse at 27 ml/hr. The tubing delivers 60 gtts/ml. How many gtts/min should the nurse count to ensure that the fluid is safely infusing? A. 60 gtts/min B. 27 gtts/min C. 54 gtts/min D. 14 gtts/min

B. 27 gtts/min gtt/min = 60 gtt/mL x 27mL/hr x hr/60min = 1620/60 = 27gtt/min

Which client would be most at risk for secondary Parkinson's disease caused by pharmacotherapy? A. A 50-year-old client taking nitroglycerin tablets for angina B. A 30-year-old client with schizophrenia who is taking chlorpromazine C. A 75-year-old client using naproxen for rheumatoid arthritis D. A 60-year-old client who is taking prednisone for chronic obstructive pulmonary disease

B. A 30-year-old client with schizophrenia who is taking chlorpromazine Phenothiazines such as chlorpromazine deplete dopamine, which may lead to extrapyramidal effects. The other drugs don't place the client at a greater risk for developing Parkinson's disease.

The nurse is preparing to administer the initial dose of digoxin PO to a client. What is the nurse's priority assessment before administering this medication? A. Respiratory rate B. Apical heart rate C. Blood pressure D. Radial heart rate

B. Apical heart rate Assessing the client's apical heart rate is essential before administering digoxin. The apex of the heart is the most accurate pulse point in the body. Blood pressure is only affected if the heart rate is too low, in which case the nurse would withhold digoxin. The radial heart rate can be affected by cardiac and vascular disease and; therefore, will not accurately depict the heart rate. Digoxin has no effect on respiratory function.

Which drug should a nurse choose as an antagonist for magnesium sulfate? A. Terbutaline B. Calcium gluconate C. Oxytocin D. Naloxone

B. Calcium gluconate Calcium gluconate should be kept at the bedside while a client is receiving a magnesium infusion. If magnesium toxicity occurs, calcium gluconate is administered as an antidote. Oxytocin is the synthetic form of the naturally occurring pituitary hormone used to initiate or augment uterine contractions. Terbutaline is a B2-adrenergic agonist that may be used to relax the smooth muscle of the uterus, especially for preterm labor and uterine hyperstimulation. Naloxone is an opiate antagonist administered to reverse the respiratory depression that may follow administration of opiates.

A client with a dependent personality disorder is taking fluoxetine for depression. Which instruction should be included in client teaching? A. Be aware that you will sleep more when taking the medication B. Expect three to four weeks to go by before the medication is effective C. Drink only wine and beer when taking this drug D. Add as-needed doses if depression becomes worse

B. Expect three to four weeks to go by before the medication is effective The client must take the drug for three to four weeks before therapeutic effects are seen. The nurse must caution the client against the use of alcohol, including wine and beer, when taking fluoxetine. The client is to take the drug as prescribed. Additional doses must not be self-administered. Insomnia is a major side effect of fluoxetine.

A client is receiving epoetin alfa. Which findings indicate the effectiveness of the drug? A. Decrease in blood coagulation B. Increase in red blood cells C. Decrease in blood glucose D. Increase in white blood cells

B. Increase in red blood cells Epoetin alfa is a man-made form of the protein human erythropoietin used to lessen the need for red blood cell transfusions. It stimulates the bone marrow to produce more red blood cells. The drug is used to treat anemia caused by chronic kidney disease, chemotherapy, and zidovudine, which is a drug used to treat HIV infection. The drug does not affect white blood cells or coagulation, nor does it cause blood glucose to decrease.

Atropine is being administered to a child with sinus bradycardia. Which information is most accurate about the administration of this medication? A. Raises blood pressure B. Increases heart rate C. Dilates bronchial tubes D. Decreases heart rate

B. Increases heart rate Atropine blocks vagal impulses to the myocardium and stimulates the cardioinhibitory center in the medulla, which increases heart rate and cardiac output. Atropine is not given to directly increase blood pressure or dilate the bronchial tubes.

What is the most appropriate action for a nurse to take when administering a new blood pressure medication to a client? A. Inform the client of the new drug only if he asks about it B. Inform the client of the new medication, its name and use, and the reason for the medication C. Administer the medication, and inform the client that the provider will later explain the medication D. Administer the medication to the client without explanation

B. Inform the client of the new medication, its name and use, and the reason for the medication Informing the client of the medication, its use, and the reason for the medication change is important information for the client. Teaching the client about his treatment regimen promotes compliance. The other responses are inappropriate.

The nurse is admitting a client diagnosed with diabetic ketoacidosis (DKA). What is the nurse's priority intervention? A. Transfusion of whole blood B. Intravenous insulin C. Subcutaneous glucagon administration D. Glucocorticoid administration

B. Intravenous insulin A client with DKA should receive IV insulin to lower glucose and IV fluids to correct hypotension. Glucagon is given to treat hypoglycemia and is not appropriate for DKA. Blood products aren't needed to correct DKA. Glucocorticoids are not used to treat DKA, and may aggravate the hyperglycemia.

A client who is receiving acetaminophen for osteoarthritis reports continuing pain. The health care provider prescribes celecoxib. What important information regarding this medication, should the nurse share with this client? A. If you miss a dose, take a double dose the next day B. Report black and tarry stools to the health care provider C. Use a stool softener or fiber laxative daily to prevent constipation D. Don't take the medication with dairy products

B. Report black and tarry stools to the health care provider Black and tarry stools are a sign of gastrointestinal (GI) bleeding, and may necessitate a medication change. Dairy products can help reduce GI irritation. The celecoxib dose should never be doubled. Constipation isn't an adverse effect of this medication.

A client is receiving nutritional counseling following the application of a plaster cast for a fracture. The client asks the nurse why vitamin D intake is important. What is the nurse's best response? A. It increases the absorption and use of potassium and phosphorus. B. It aids in the excretion of calcium and phosphorus. C. It increases the absorption and use of calcium and phosphorus. D. It aids in the excretion of potassium and calcium.

C. It increases the absorption and use of calcium and phosphorus. Vitamin D increases the absorption and use of calcium and phosphorus. Vitamin D does not affect potassium, nor does it reduce the absorption or affect the excretion of calcium and phosphorus.

A new medication has been prescribed for a client with a sleep disorder. The nurse is teaching the precautions associated with this type of medication. The nurse determines that teaching has been successful when the client states: A. "I can double the dose if I feel I need more." B. "It is acceptable to smoke while I take this medication." C. "I must avoid drinking alcohol while taking this medication." D. "I will need to take this medication for a long time."

C. "I must avoid drinking alcohol while taking this medication." Alcohol is contraindicated when most prescribed medications, but especially with sedating medications. Sedation may be magnified by the use of alcohol. These medications include those prescribed for hypnotic sleep or antidepressants and antipsychotics that may also cause sedation. It is especially risky to increase the dosage of sedating medications without first consulting your provider. Sedative-hypnotic medications should only be used for a limited time because of the risk of dependence. Smoking reduces drug effectiveness.

The nurse has instructed a client with an eating disorder about fluoxetine, and determines that teaching has been effective when the client states: A. "I cannot wait to get home so I can go for a drive in my car." B. "I can eat anything and anytime I want. This medication will control my eating." C. "It may take 1 to 3 weeks for this medication to be effective for me." D. "I should call my provider if I have cravings for large amounts of food."

C. "It may take 1 to 3 weeks for this medication to be effective for me." It is important for the client to understand that fluoxetine can take 1 to 3 weeks to be effective. Fluoxetine does not control eating. Operating hazardous equipment, or driving may be hazardous, and should only be done only after the effects of this medication are determined. Cravings should be monitored in a food diary or discussed in treatment sessions. Providers should be notified if sexual dysfunction occurs, or is intolerable.

A nurse is talking to a client with bulimia nervosa about the complications of laxative abuse. Which client statement indicates an understanding of the risks? A. "Laxatives help me get rid of extra calories before they are added to my body. I know I just shouldn't eat the extra calories to begin with." B. "I don't really have much taste for food, so there's no loss in getting it out of my system more quickly." C. "Using laxatives prevents my body from absorbing essential nutrients, such as protein, fat, and calcium." D. "Laxatives are over-the-counter medications that have no harmful effect."

C. "Using laxatives prevents my body from absorbing essential nutrients, such as protein, fat, and calcium." A serious complication of laxative abuse is the malabsorption of nutrients, such as proteins, fats, and calcium. Laxative abuse doesn't tend to affect the client's sense of taste. Clients with bulimia nervosa need to change their negative thinking about calories and the use of laxatives.

The home health nurse is speaking to the wife of a client with neurocognitive disorder due to Alzheimer's disease. The client has been taking donepezil. The nurse is most concerned when the caregiver states: A. "In the last few days, the main thing that my husband wants to eat is bread." B. "My husband no longer has any interest in listening to the radio with me." C. "Yesterday, I managed to weigh my husband, and he has lost 8 lbs this month." D. "Somehow, this medication has been making my husband sleep longer in the morning."

C. "Yesterday, I managed to weigh my husband, and he has lost 8 lbs this month." "A side effect of donepezil is weight loss, and it would be important to discuss the weight loss with the primary care provider. The desire to eat bread, the ability to sleep longer, and the lack of interest in listening to the radio are not changes related to the use of donepezil.

The supervisor is performing a chart review. The nurse can be held legally liable for which documentation? A. 0800 administered 2 mg hydromorphone IVP per PRN orders of 1 to 2 mg every 4 hours -BSmith, RN B. 0900 Withheld mononitrate dose. Client's blood pressure is 80/40 mmHg -BSmith, RN C. 1200 Administered cephalosporin. The client has an allergy to penicillin -BSmith, RN D. 0900 Withheld digoxin dose. Client's apical pulse is 56 beats/min -BSmith, RN

C. 1200 Administered cephalosporin. The client has an allergy to penicillin -BSmith, RN There is a cross-sensitivity between cephalosporin and penicillin, and the drug should not have been given. When a dosage range is ordered, any dose in that range is acceptable. Digoxin is a cardiac glycoside that acts to improve the efficiency of the heart and may slow the heart rateand the drug should not ordinarily be given if the apical pulse is less the 60. Mononitrate is a Nitrate that can cause vasodilation and should not be given when hypotension is present.

Where is the best site for the nurse to assess a client's pulse prior to administering digoxin? A. The anterior aspect of the right arm at the antecubital fossa B. Inner aspect of right wrist at the base of the thumb C. At the left fifth intercostal space, midclavicular line D. The left second intercostal space in the midclavicular line

C. At the left fifth intercostal space, midclavicular line The administration of digoxin requires the assessment of the client's apical pulse. The correct landmark for obtaining an apical pulse is the left fifth intercostal space at the midclavicular line. This is the point of maximum impulse, and the location of the left ventricular apex. The left second intercostal space in the midclavicular line is where pulmonic sounds are auscultated.

During a home health visit, a nurse assesses a client's medication and notes that the client has two prescriptions for fluid retention. One prescription reads, "Lasix, 40 milligrams one tablet daily." The next prescription reads, "Furosemide, 40 milligrams one tablet daily." Which instruction should be given to the client? A. Take both medications as ordered B. Use Lasix one day and furosemide the next day C. Call the health care provider for verification D. Throw away one of the drugs to avoid confusing the client

C. Call the health care provider for verification The nurse understands that Lasix and furosemide are the same drug. Calling the health care provider to determine the correct dosage and frequency the nurse's role as a client advocate. Setting up medications in a medication tray, using only one pharmacy to dispense medications, and using all medications until the bottle is emptied will reduce medication errors. However, it is a priority to verify the medication orders first.

An 18-month-old is diagnosed with otitis media, and his mother asks what she can do to help ease his pain. Which medication would the nurse anticipate for pain relief? A. Amoxicillin trihydrate 20 mg/kg p0 q8h B. Children's chewable acetylsalicylic acid one 80/mg q4h C. Children's liquid acetaminophen 5/ml q4h D. Cetirizine 1.3 ml q4h

C. Children's liquid acetaminophen 5/ml q4h Children's acetaminophen is an anti-inflammatory and will decrease inflammation and pain. Children's acetylsalicylic acid is contradicted in all children due to the risk of Reye's Syndrome. Amoxicillin is an antibiotic used to treat bacterial infections of the middle ear and cetirizine is an antihistamine used to dry up secretions. Neither of these relieve pain.

One hour after IV furosemide has been administered to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which electrolyte imbalance should the nurse suspect? A. Hypocalcemia B. Hypermagnesemia C. Hypokalemia D. Hypernatremia

C. Hypokalemia Furosemide is a potassium-depleting diuretic that can cause hypokalemia. In turn, hypokalemia increases myocardial excitability, leading to ventricular tachycardia. Hypocalcemia, which slows conduction through the atrioventricular junction, can cause such bradyarrhythmias as atrioventricular block. Hypermagnesemia may lead to bradycardia, not tachycardia. Hypernatremia may cause sinus tachycardia as a result of water loss.

The parents of an eight-month-old child with iron deficiency anemia have not been compliant with the administration of oral iron supplements. The child must now receive an iron dextran injection. How should the nurse administer this injection? A. Intravenous B. Intradermally C. Intramuscularly using the z-track method D. Subcutaneously

C. Intramuscularly using the z-track method If iron dextran is ordered, it must be injected deep into a large muscle mass, using the z-track method to minimize skin staining and irritation. Neither a subcutaneous nor an intradermal injection would inject the dextran into muscle. The z-track method is preferred over a normal intramuscular injection. Intravenous is not appropriate for this scenario.

A client reports a dry mouth two days after starting therapy with trihexyphenidyl for Parkinson's disease. What is the best action by the nurse? A. Withhold the medication and notify the provider B. Encourage the use of supplemental puddings and shakes to maintain weight C. Offer the client ice chips and frequent sips of water D. Change the client's diet to clear liquid until the symptoms subside

C. Offer the client ice chips and frequent sips of water Trihexyphenidyl is an anticholinergic agent that causes blurred vision, dry mouth, constipation, and urinary retention. There is no need to withhold the drug unless hypotension or tachyarrhythmia occurs. A clear liquid diet isn't indicated at this time. I doesn't provide adequate nutrition, and may be more difficult to swallow than thickened liquids if dysphagia is present. Although weight loss may occur with Parkinson's disease, it is not a side effect of trihexyphenidyl.

A community health nurse is administering pneumococcal polysaccharide vaccinations and flu vaccinations to clients with asthma, chronic bronchitis, and emphysema. A client asks the nurse why these vaccines are recommended. What is the nurse's best response? A. These vaccines produce bronchodilation and improve oxygenation. B. These vaccines help reduce the tachypnea these clients experience. C. Respiratory infections can cause severe hypoxia and possibly death in these clients. D. These vaccines are recommended for all clients.

C. Respiratory infections can cause severe hypoxia and possibly death in these clients. It's highly recommended that clients with respiratory disorders receive vaccines to protect against respiratory infections. These clients may require intubation and mechanical ventilation if they become infected. The vaccines have no effect on bronchodilation or respiratory rate.

A client who has just received morphine IV for postoperative pain. Which assessment finding should alert a nurse to a potential problem? A. Sleeping but easily aroused B. Blood pressure 90/62 mmHg C. Respiratory rate 8 breaths/min D. Heart rate 124/bpm

C. Respiratory rate 8 breaths/min Since morphine depresses the respiratory center of the brain, the nurse should alert the health care provider of a respiratory rate less than 10 breaths/min. While a heart rate of 124/bpm is considered tachycardia, the nurse should further assess the client before calling the health care provider. Morphine shouldn't be given to a client who is sedated and not easily aroused. Morphine can cause hypotension, but the nurse should further assess the client before calling the health care provider because this may be the client's usual blood pressure.

A client taking alprazolam reports light-headedness and nausea every day while getting out of bed. What is the most important action by the nurse? A. Obtain a blood chemistry profile B. Teach the Valsalva maneuver C. Take the client's blood pressure D. Monitor body temperature

C. Take the client's blood pressure The nurse should take a blood pressure reading to validate orthostatic hypotension. A body temperature reading or chemistry profile won't yield useful information about hypotension. The Valsalva maneuver is performed to lower the heart rate and isn't an appropriate intervention.

How should the nurse proceed when instilling neomycin and polymyxin B sulfates and hydrocortisone optic suspension, two drops in the right ear? A. Hold an emesis basin under the client's ear B. Warm the solution to prevent dizziness C. Verify the proper client and route D. Position the client in the semi-Fowler's position

C. Verify the proper client and route When giving medications, a nurse should follow the five "Rs" of medication administration: right client, right drug, right dose, right route, and right time. The drops may be warmed to prevent pain or dizziness, but this action isn't essential. An emesis basin would be used for irrigation of the ear. The client should be placed in the lateral position for five minutes, not semi-Fowler's position, to prevent the drops from draining.

The provider has ordered an IV of 5% dextrose in lactated Ringer's solution at 125 ml/hr. The IV tubing delivers 10 gtts/ml. How many gtts/min should fall into the drip chamber? A. 10 to 11 B. 22 to 24 C. 12 to 13 D. 20 to 21

D. 20 to 21

The nurse is educating the parents of a two-year-old child with neonatal bronchopulmonary dysplasia (chronic lung disease) who is placed on furosemide. Which statement by the parents best indicates an understanding of this medication? A. "I need to make sure my child wears short sleeves when outside." B. "I need to make sure my child gets his blood pressure checked twice a year." C. "I need to make sure my child uses the bathroom at least every six hours." D. "I need to make sure my child eats foods rich in potassium."

D. "I need to make sure my child eats foods rich in potassium." Children should eat foods rich in potassium to replace what is lost through diuresis while taking furosemide. Parents should take their child to the bathroom often if he is toilet trained to prevent accidents. Blood pressure should be checked regularly and sun protection utilized.

The effectiveness of selective serotonin reuptake inhibitor (SSRIs) therapy, in a client with post traumatic stress disorder (PTSD), can be verified when the client states: A. "I've lost my phobia for water." B. "I've lost my craving for alcohol." C. "I'm not losing my temper." D. "I'm sleeping better now."

D. "I'm sleeping better now." Selective serotonin reuptake inhibitors are used to treat sleep problems, nightmares, and intrusive thoughts in individuals with PTSD. Selective serotonin reuptake inhibitors are not used to control flashbacks, to treat a specific phobia, or to decrease the craving for alcohol.

A client was diagnosed with type 2 diabetes mellitus five years ago, and has now started insulin therapy. What is the most important information to teach the client? A. "All clients with type 2 diabetes mellitus need insulin therapy." B. "This therapy is not usually warranted." C. "This therapy is only temporary." D. "Your diabetes was not controlled with several drugs, so insulin therapy is the next step."

D. "Your diabetes was not controlled with several drugs, so insulin therapy is the next step." For treatment of type 2 diabetes mellitus, oral agents are started at the lowest effective dose and increased every one to two weeks until the client reaches the desired blood glucose control or the maximum dosage. If the maximum dosage of one agent does not control blood glucose levels, a second agent with a different mechanism of action may be added. Insulin therapy is indicated for the patient with type 2 diabetes mellitus when blood glucose cannot be controlled with the use of two or three different antidiabetic agents. This is the standard therapy, and the therapy would be lifelong.

A client, with new onset of atrial fibrillation, is receiving warfarin to help prevent thromboemboli. The client will be discharged when the warfarin reaches therapeutic levels, and when the international normalized ratio (INR) ranges from: A. 3.5 to 4 INR B. 0.5 to 1 INR C. 1.25 to1.75 INR D. 2 to 3 INR

D. 2 to 3 INR In a client with atrial fibrillation, the warfarin is at a therapeutic level when the INR ranges from 2 to 3. A range of 3.5 to 4 is too high, and increases the risk of hemorrhage. Discharge would be considered when the INR is within the therapeutic range.

A child is given 0.5 mg/kg/day of prednisone divided into two doses. The child weighs 22 lb (10 kg). How much is given in each dose? A. 1.5 mg B. 5 mg C. 10 mg D. 2.5 mg

D. 2.5 mg

Which mediation can the nurse administer through a nasogastric (NG) tube? A. Regular insulin B. Enteric-coated aspirin C. Sublingual nitroglycerin D. Acetaminophen

D. Acetaminophen Most oral medications can be given through an NG tube because they're intended for passage into the stomach. Some oral drugs have special coatings intended to keep the pill intact until it passes into the small intestine. These enteric-coated pills shouldn't be crushed and put through an NG tube. Some parenteral medications, such as insulin, may be destroyed by gastric juices. Sublingual medications must be given under the tongue.

After a thyroidectomy, the client develops a positive Trousseau's sign. What is the nurse's priority action? A. Administer liothyronine therapy B. Administer potassium chloride C. Administer levothyroxine therapy D. Administer calcium gluconate

D. Administer calcium gluconate Damage to the parathyroid glands can inadvertently occur during a thyroidectomy. This may cause a decrease in serum calcium, which causes muscle hyperexcitability and tetany. The treatment for a client who develops hypocalcemia and tetany following a thyroidectomy is calcium gluconate. Hypokalemia does not cause a positive Trousseau's sign. Decreased thyroid hormones will not cause tetany, however, the client will have to take thyroid replacement therapy following a thyroidectomy.

A depressed client, who is taking fluoxetine, tells the nurse that he has difficulty sleeping at night, is often sleepy during the day, and does not feel like doing anything. What is the nurse's best response? A. Tell the client to stop taking the drug until he sees his health care provider B. Advise the client to continue taking the drug to see whether these effects wear off C. Advise the client to see another provider to obtain another opinion D. Ask the prescriber whether the medication can be given early in the day

D. Ask the prescriber whether the medication can be given early in the day A common side effect of fluoxetine is insomnia, which is best addressed by administering this medication early in the day. It is inappropriate for the nurse to tell the client to stop taking the drug, to continue taking it until the undesired effects wear off, or to seek a second opinion.

Which assessment should a nurse do prior to administering disulfiram to a client with a history of alcohol abuse? A. Assess the client's nutritional status B. Assess the client's commitment to attend Alcoholics Anonymous (AA) meetings C. Assess whether the client admits to a problem with alcohol D. Assess when the client's last alcoholic beverage was consumed

D. Assess when the client's last alcoholic beverage was consumed The client must be alcohol free for 12 hours before starting therapy with disulfiram. Assessing the client's commitment to attend AA meetings, the client's perception of his problem, and nutritional status are all important interventions, but they aren't necessary prior to starting disulfiram.

The nurse is planning discharge teaching for a client who will continue taking the prescribed warfarin sodium at home. What is the priority teaching? A. Take the medication at 9 am daily B. Dietary restrictions include tomatoes and cucumbers C. Injections may be given in the abdomen D. Avoid injury and watch for signs of bleeding

D. Avoid injury and watch for signs of bleeding Coumadin is an anticoagulant, so the priority teaching would include watching for signs of hemorrhage and to prevent bleeding. Warfarin is administered orally. The client should have scheduled blood tests for prothrombin time. Consumption of leafy green vegetables should be limited.

The nurse is planning care for a client receiving IV magnesium sulfate for hypertension. Which medication should the nurse have available for an emergency? A. Hydralazine B. Rho(D) immune globulin C. Naloxone D. Calcium gluconate

D. Calcium gluconate Calcium gluconate is the antidote for magnesium toxicity. Ten milliliters of 10% calcium gluconate is given IV push over three to five minutes to correct the effects of toxicity. Hydralazine is given for sustained elevated blood pressures in preeclamptic clients. Naloxone is used to correct narcotic toxicity. Rho(D) immune globulin is given to women with Rh-negative blood to prevent antibody formation from Rh-positive conceptions.

Monoamine oxidase inhibitors (MAOIs) have been prescribed for a client with bulimia nervosa. What is the most important information for the nurse to give this client? A. Drink several glasses of water with each dose. Do not drink water with meals. B. Call your provider if you have tremors or feel anxious or agitated. C. Watch for bleeding and bruising. D. Do not eat foods that contain tyramines, such as cheese, cottage cheese, pickled herring, and salami.

D. Do not eat foods that contain tyramines, such as cheese, cottage cheese, pickled herring, and salami. The ingestion of foods containing tyramines can result in a hypertensive crisis. Water and other fluids may be taken with meals, but can limit the amount of food that can be eaten. Bleeding and bruising is not related to taking MAOIs. Symptoms such as tremors, anxiety, or agitation are also unrelated to taking MAOIs.

The health care provider's order reads 2 g of cephalexin daily in equally divided doses of 500 mg each. At which frequency should the nurse administer this medication? A. Six times per day B. Three times per day C. Eight times per day D. Four times per day

D. Four times per day Two grams is equivalent to 2,000 mg. To give equally divided doses of 500 mg, divide the desired dose of 500 mg into the total daily dose of 2,000 mg. This medication should be given every six hours, four times each day.

The nurse is preparing to administer IV insulin to a client diagnosed with diabetic ketoacidosis (DKA). What will the nurse monitor while the client is receiving this intervention? A. Hyperkalemia and hyperglycemia B. Hypernatremia and hypercalcemia C. Hypocalcemia and hyperkalemia D. Hypokalemia and hypoglycemia

D. Hypokalemia and hypoglycemia The nurse should monitor for decreased potassium and decreased glucose. Hypoglycemia might occur if too much insulin is administered, or insulin is administered too quickly. Intravenous insulin forces potassium into cells, thereby lowering plasma levels of potassium. The client may have hyperkalemia prior to starting the insulin therapy, but hypokalemia will occur with insulin administration. Calcium and sodium levels should not be affected.

Which statement best describes the action of furosemide for the treatment of hypertension? A. It dilates peripheral blood vessels. B. It decreases sympathetic cardioacceleration. C. It inhibits the angiotensin-converting enzyme. D. It inhibits reabsorption of sodium and water in the loop of Henle.

D. It inhibits reabsorption of sodium and water in the loop of Henle. Furosemide is a loop diuretic that inhibits sodium and water reabsorption in the loop of Henle, thereby causing a decrease in blood pressure. Vasodilators cause dilation of peripheral blood vessels, directly relaxing vascular smooth muscle and decreasing blood pressure. Adrenergic blockers decrease sympathetic cardioacceleration and decrease blood pressure. Angiotensin-converting enzyme inhibitors decrease blood pressure due to their action on angiotensin.

A client reports pain one day after a colostomy. The nurse administers four milligrams morphine IV, and reassesses the client 30 minutes later. The following is noted: Respiratory rate at 8 breaths/min. Nasal cannula on floor. Arterial blood gas (ABG) results are: pH, 7.23; PaO2, 58 mmHg; PaCO2, 61 mmHg; HCO3 24 mEq/l. Which factors most likely contribute to this client's ABG results? A. Pain, respiratory rate of 8 breaths/min, and the nasal cannula on the floor B. Morphine, the nasal cannula on the floor, and the colostomy C. Colostomy, pain, and morphine D. Morphine, respiratory rate of 8 breaths/min, and the nasal cannula on the floor

D. Morphine, respiratory rate of 8 breaths/min, and the nasal cannula on the floor This client has respiratory acidosis. Opioids can suppress respirations, causing retention of carbon dioxide. A PaO2 of 58 mmHg indicates hypoxemia caused by the removal of the client's supplementary oxygen and decreased respiratory rate. Pain increases the rate of respirations, which causes a decrease in PaCO2. Colostomy drainage doesn't start until 2 to 3 days postoperatively, and this drainage would contribute to metabolic alkalosis.

A client with heart failure is given furosemide 40 mg IV daily. The morning serum potassium level is 2.8 mEq/L. Which nursing action is the most appropriate? A. Give the furosemide and get an order for sodium polystyrene sulfonate B. Give 20 mg of the ordered dose and recheck the laboratory test results C. Question the health care provider about the dosage D. Notify the health care provider and obtain additional orders

D. Notify the health care provider and obtain additional orders Furosemide is a diuretic. Serum potassium is flushed from the body along with excess fluid. Notifying the health care provider of the low potassium level and getting an order for potassium chloride are appropriate actions before giving the furosemide. The nurse should not give half the dose without an order from the provider. Giving furosemide and sodium polystyrene sulfonate together would further lower the potassium level.

The nurse is performing discharge teaching for a school-aged child who experienced an asthma attack. What is the most important information the nurse can provide this client about the prescription for budesonide? A. There is no need to use a spacer when taking this medication. B. This medication is used for acute asthma attacks. C. Use the medication before using a bronchodilator. D. Rinse the mouth after using this medication.

D. Rinse the mouth after using this medication. Oral candidiasis or thrush (a fungal infection of the throat) may occur in 1 in 25 persons who use budesonide without a spacer device on the inhaler. The risk is even higher with large doses, but is less in children than in adults. The child should be instructed to rinse the mouth after use and parents should be instructed to monitor the child's mouth for this. The medication should be given after using a bronchodilator to ensure maximum effectiveness. Corticosteroids should not be used for acute asthma attacks.

A parent asks the nurse if medications can cause Reye syndrome. The nurse's most appropriate response is that Reye syndrome has been connected to: A. acetaminophen. B. ibuprofen. C. guaifenesin. D. aspirin.

D. aspirin. Aspirin administration is associated with the development of Reye syndrome. Acetaminophen, ibuprofen, and guaifenesin have not been associated with the development of Reye syndrome. There has been a decreased incidence of Reye syndrome with the increased use of acetaminophen and ibuprofen for management of fevers in children.