Success Pharmacology - Comprehensive Examination

1. 1. These are adverse effects that would cause the HCP to discontinue this medication. This medication can cause pulmonary toxicity, which is progressive dyspnea, cough, fatigue, and pleuritic pain. 2. The medication can be taken at the client's convenience; the medication should be taken at the same time each day. 3. The client checks the radial pulse at home, not the apical pulse, which requires a stethoscope. 4. This medication does not cause the stool to turn black. Iron supplements make the client's stool turn black.

1. The client with cardiac disease is prescribed amiodarone (Cordarone), an antidysrhythmic, orally. Which teaching intervention should the nurse implement? 1. Notify the health-care provider of dyspnea, fatigue, and cough. 2. Instruct the client to take the medication prior to going to bed. 3. Tell the client not to take the medication if the apical pulse is less than 60. 4. Explain that this medication may cause the stool to turn black.

10. 1. The client with an ulcer would be prescribed a medication that decreases gastric acid secretion; therefore, the nurse would not question administering this medication. Females of childbearing age should not receive this medication because it can cause an abortion. 2. Prilosec is prescribed to treat duodenal and gastric ulcers; the nurse would not question this medication. 3. The potassium level is low (3.5- 5.5 mEq/L); therefore, the nurse should question this medication and request a potassium supplement or possibly telemetry. 4. Tylenol is frequently administered for headaches; the nurse would not question this medication.

10. The nurse is administering 0800 medications. Which medication should the nurse question? 1. Misoprostol (Cytotec), a prostaglandin analog, to a 29-year-old male with an NSAID-produced ulcer. 2. Omeprazole (Prilosec), a proton-pump inhibitor, to a 68-year-old male with a duodenal ulcer. 3. Furosemide (Lasix), a loop diuretic, to a 56-year-old male with a potassium level of 3.0 mEq/L. 4. Acetaminophen (Tylenol), a nonnarcotic analgesic, to an 84-year-old with a frontal headache.

100. 1. The dose of corticosteroids may have to be increased during the stress of an infection or surgery; therefore, this statement indicates the client does not understand the discharge teaching. 2. This statement indicates the client understands the discharge teaching. The client may be prescribed both mineral and glucocorticoid medications. 3. If the client gets weak or dizzy, it may indicate an underdosage of medication; therefore, this indicates the client does not understand the discharge teaching. 4. The client does not have to take prophylactic antibiotics prior to invasive procedures.

100. The client diagnosed with Addison's disease is being discharged. Which statement indicates the client understands the medication discharge teaching? 1. "I will be sure to keep my dose of steroid constant and not vary." 2. "I may have to take two forms of steroids to remain healthy." 3. "It is normal to become weak and dizzy when taking this medication." 4. "I must take prophylactic antibiotics prior to getting my teeth cleaned."

11. 1. The nurse can recommend the client take over-the-counter (OTC) medication to help relieve the constipation. 2. The client should be encouraged to eat high-fiber foods and increase fluid intake, preferably water. 3. The nurse should determine when the last bowel movement was so that appropriate action can be taken to resolve the constipation. 4. The client does not need to go to the emergency department because the constipation should resolve with medication, but the client may need to be seen in the clinic if there is still no bowel movement within several days. 5. The nurse should determine what other medications the client is taking because constipation can be a side effect of many prescribed and OTC medications.

11. The elderly client calls the clinic and is complaining of being constipated and having abdominal discomfort. Which interventions should the nurse implement? Select all that apply. 1. Instruct the client to take an OTC laxative as recommended on the label. 2. Recommend the client drink clear liquids only, such as tea or broth. 3. Determine when the client last had a bowel movement. 4. Tell the client to go to the emergency department as soon as possible. 5. Ask the client what other medications are currently being taken.

12. 1. Regular insulin sliding scale is administered prior to meals; therefore, this medication should be administered first. 2. This medication can be administered within the 30-minute acceptable time frame. 3. A pain medication is a priority, but it can be administered after the sliding scale. 4. Etanercept (Enbrel) can be administered within the 30-minute acceptable time frame.

12. The nurse is administering morning medications on a medical floor. Which medication should the nurse administer first? 1. Regular insulin sliding scale to an elderly client diagnosed with Type 1 diabetes mellitus. 2. Methylprednisolone, a glucocorticoid, to a client diagnosed with lupus erythematosus. 3. Morphine, a narcotic analgesic, to a client diagnosed with Guillain-Barré syndrome. 4. Etanercept, a biologic response modifier, to a client diagnosed with rheumatoid arthritis.

13. 1. This is standard precaution and does not require intervention by the nurse. 2. Herbs are considered medications, and the UAP cannot administer medications to the client even if they are from home. Many herbs will interact with prescribed medications, and the nurse must be aware of what the client is taking. 3. The client can apply his or her own moisture barrier protection cream. This does not warrant immediate intervention by the nurse. 4. This is a comfort measure and does not warrant intervention by the nurse.

13. The nurse is caring for clients diagnosed with acquired immunodeficiency syndrome (AIDS). Which action by the unlicensed assistive personnel (UAP) warrants immediate action by the nurse? 1. The UAP uses nonsterile gloves to empty a client's urinal. 2. The UAP is helping a client take OTC herbs brought from home. 3. The UAP provides a tube of moisture barrier cream to a client. 4. The UAP fills a client's water pitcher with ice and water.

14. 1. Do not shake the vial because shaking may denature the glycoprotein, rendering it biologically inactive. 2. The nurse should apply ice to numb the injection site, not a warm washcloth. 3. The nurse should only use the vial for one dose. The nurse should not reenter the vial and should discard any unused portion because the vial contains no preservatives. 4. The medication should be stored in the refrigerator and should be warmed to room temperature prior to administering the medication. 5. The medication can cause bone pain; therefore, the nurse should encourage the client to take Tylenol before and after the injection to decrease pain.

14. Which interventions should the nurse implement when administering the biologic response modifier filgrastim (Neupogen) subcutaneously? Select all that apply. 1. Do not shake the vial prior to preparing the injection. 2. Apply a warm washcloth after administering the medication. 3. Discard any unused portion of the vial after withdrawing the correct dose. 4. Keep the medication vials in the refrigerator until preparing to administer. 5. Instruct the client to take acetaminophen prior to and 24 hours after injection.

15. 1. A 5-pound weight loss in 1 month would not make the nurse suspect the client is experiencing any long-term complications from taking daily aspirin. 2. Elderly clients often have a loss of hearing, but it is not a complication of longterm aspirin use. 3. Elderly clients often lose taste buds, which may cause a funny taste in their mouth, but it is not a complication of taking daily aspirin. 4. A complication of long-term aspirin use is gastric bleeding, which could also result in bleeding gums; this data would warrant further intervention.

15. The elderly client diagnosed with coronary artery disease has been taking aspirin daily for more than a year. Which data warrants notifying the health-care provider? 1. The client has lost 5 pounds in the past month. 2. The client has trouble hearing low tones. 3. The client reports having a funny taste in the mouth. 4. The client is complaining of bleeding gums.

16. 1. The WBC count is within normal range; therefore, the nurse would not need to assess for infection. 2. The client's platelet count is less than the normal of 150,000 but still greater than 100,000. Less than 100,000 is thrombocytopenia. Critical values begin at 50,000, which would cause the client to have petechiae. 3. The client's hemoglobin is critically low; therefore, the client might fatigue easily because of oxygen demands on the body and have shortness of breath. 4. The client would not have rubor (redness); the client would be pale.

16. The nurse is reviewing the laboratory data of a male client receiving chemotherapy. Which intervention should the nurse implement? 1. Assess for an infection. 2. Assess for petechiae. 3. Assess for shortness of breath. 4. Assess for rubor.

17. 1. This would not indicate the fluid resuscitation is effective. 2. This would indicate the respiratory system is functioning but does not indicate fluid resuscitation is effective. 3. The client's blood pressure indicates that the fluid resuscitation is effective and able to maintain an adequate blood pressure to perfuse the vital organs. 4. This would indicate that the fluid resuscitation is not effective because this is a sign of decreased urine output.

17. The client experienced a full-thickness burn to 45% of the body including the chest area. The HCP ordered fluid resuscitation. Which data indicates the fluid resuscitation has been effective? 1. The client's urine output is less than 30 mL/hour. 2. The client has a productive cough and clear lungs. 3. The client's blood pressure is 110/70. 4. The client's urine contains sediment.

18. 1. This is the scientific rationale for miotic medications, which constrict the pupil and block sympathetic nervous system input, causing the pupil to dilate in low light and contract the ciliary muscle. 2. This is the scientific rationale for mydriatic medications, which dilate the pupil, reduce the production of aqueous humor, and increase the absorption effectiveness, reducing intraocular pressure in open-angle glaucoma. 3. This is the scientific rationale for betaadrenergic blockers, which reduce intraocular pressure but do not affect pupil size and lens accommodation. 4. This is the scientific rationale for carbonic anhydrase inhibitors, which reduce intraocular pressure.

18. Which statement best describes the scientific rationale for administering a miotic ophthalmic medication to a client diagnosed with glaucoma? 1. It constricts the pupil, which causes the pupil to dilate in low light. 2. It dilates the pupil to reduce the production of aqueous humor. 3. It decreases production of aqueous humor but does not affect the eye. 4. It is used as adjunctive therapy primarily to reduce intraocular pressure.

19. 1. Morphine is a potent analgesic with addictive properties, and the nurse should question a routine administration of this medication. The HCP may have failed to write PRN after the order. 2. Many medications can affect the kidneys or the liver and the blood counts. Baseline data should be obtained. There is no reason to question this order. 3. This medication order is an appropriate order. The nurse would not question this order. 4. Soma comes in one strength, so this order is complete. There is no reason to question this order.

19. The charge nurse on an orthopedic unit is transcribing orders for a client diagnosed with back pain. Which HCP order should the charge nurse question? 1. Morphine sulfate, a narcotic analgesic, Q q 4 hours ATC. 2. CBC and CMP (complete metabolic panel). 3. Hydrocodone (Vicodin), an opioid analgesic, q 4 hours PRN. 4. Carisoprodol (Soma), a muscle relaxant, PO, b.i.d.

2. 1. The client receiving a calcium channel blocker (CCB) can take the medication with water; therefore, the nurse would not question administering this medication. 2. This blood pressure is above 90/60; therefore, the nurse would not question administering this medication. 3. Headache is a side effect of nitroglycerin; therefore, the nurse would not question administering this medication but could administer Tylenol or a nonnarcotic analgesic. 4. The client's platelet count is not monitored when administering antiplatelet medication, but if the nurse is aware that the client has a low platelet count the nurse would question administering any medication that would inactivate the platelets.

2. The nurse is administering 0900 medications to the following clients. Which client should the nurse question administering the medication? 1. The client receiving a calcium channel blocker who drank a full glass of water. 2. The client receiving a beta blocker who has a blood pressure of 96/70. 3. The client receiving a nitroglycerin patch who is complaining of a headache. 4. The client receiving an antiplatelet medication who has a platelet count of 33,000.

20. 1. NSAIDs are appropriate interventions for clients diagnosed with back pain. They decrease pain and inflammation. 2. Opioid analgesics are administered for pain. The client is in the mild pain range. The nurse would question administering this medication because of its addictive properties. A less potent analgesic should be administered. 3. Muscle relaxant medications are administered to clients with back pain to relax the muscles and decrease the pain. The nurse would administer this medication. 4. Darvon N is a pain medication. The nurse would administer this medication.

20. The nurse is administering medications to clients on an orthopedic unit. Which medication should the nurse question? 1. Ibuprofen (Motrin), an NSAID, to a client diagnosed with back pain. 2. Morphine, an opioid analgesic, to a client with back pain rated a 2 on a pain scale of 1-10. 3. Methocarbamol (Robaxin), a muscle relaxant, to a client with chronic back pain. 4. Propoxyphene (Darvon N), a narcotic, to a client with mild back pain.

21. 1. Decongestants vasoconstrict the blood vessels, resulting in decreased inflammation in the nasal passages. This vasoconstriction is the reason that OTC cold medications are labeled not to be used by clients diagnosed with hypertension and diabetes. 2. Decongestants do not decrease the immune system's response to the virus. 3. Activating viral receptors would increase the symptoms of a cold. 4. This is the rationale for zinc. Theoretically, zinc blocks the virus from binding to nasal epithelium. Research has shown that increased amounts of zinc can prevent the binding and development of rhinovirus.

21. Which is the scientific rationale for prescribing decongestants for a client with a cold? 1. Decongestants vasoconstrict the blood vessels, reducing nasal inflammation. 2. Decongestants decrease the immune system's response to a virus. 3. Decongestants activate viral receptors in the body's immune system. 4. Decongestants block the virus from binding to the epithelial cells of the nose.

22. 1. The digoxin level is within therapeutic range; therefore, the nurse could administer this medication, but it is a routine medication and can be administered at any time. 2. Pleuritic pain is pain involving the thoracic pleura, and pain rated a 7 should be addressed before routine medications are dispensed. 3. A client with two unifocal PVCs in a minute would be considered normal, and no intervention would be needed at this time. 4. This blood pressure is within normal limits, and this medication could be given within the 30-minute time frame.

22. The nurse is caring for clients on the telemetry unit. Which medication should the nurse administer first? 1. The cardiotonic digoxin to the client diagnosed with CHF whose digoxin level is 1.9 mg/dL. 2. The narcotic morphine IVP to the client who has pleuritic chest pain that is rated a 7 on a pain scale of 1-10. 3. The sodium channel blocker lidocaine to the client exhibiting two unifocal PVCs per minute. 4. The ACE inhibitor lisinopril (Vasotec) to the client diagnosed with HTN who has a B/P of 130/68.

23. 1. The normal serum potassium level is 3.5-4.5 mEq/L; therefore, the nurse would administer this medication. 2. The normal serum osmolality is 275- 300 mOsm/kg; therefore, the nurse would administer this medication. 3. The normal digoxin level is 0.8-2.0 mg/dL; a digoxin level of 1.2 mg/dL is within therapeutic range. The nurse would administer this medication. 4. The therapeutic serum level of Dilantin is 10-20 μg/mL; therefore, the nurse should question administering this medication.

23. The nurse is preparing to administer medications to the following clients. Which medication should the nurse question administering? 1. The loop diuretic furosemide (Lasix) to the client with a serum potassium level of 4.2 mEq/L. 2. The osmotic diuretic mannitol (Osmitrol) to the client with a serum osmolality of 280 mOsm/kg. 3. The cardiac glycoside digoxin (Lanoxin) to the client with a digoxin level of 1.2 mg/dL. 4. The anticonvulsant phenytoin (Dilantin) to the client with a phenytoin (Dilantin) level of 24 μg/mL.

24. 1. The medication should be diluted with normal saline to increase the longevity of the vein for intravenous medication and fluids. Diluting decreases the client's pain secondary to the IV push. A 5-mL or 10-mL amount allows the nurse to inject the medication over a 5-minute time frame with better control than a 0.5-mL amount. 2. Hypokalemia may potentiate digoxin toxicity; therefore, the nurse should check the client's potassium level. 3. The nurse should pinch off the tubing above the port to ensure that the medication flows into the client's vein and not upward into the IV tubing. 4. The medication should be injected slowly over 5 minutes (2 minutes for most IV medications, except for medications that act directly on the cardiovascular system and narcotics) and at a steady rate because a rapid injection could cause speed shock. Speed shock is a sudden adverse physiological reaction secondary to an IVP medication wherein the client develops a flushed face, a headache, a tight feeling in the chest, an irregular pulse, loss of consciousness, and possible cardiac arrest. 5. A yellow haze along with nausea, vomiting, and anorexia are signs of digoxin toxicity and should be reported to the HCP.

24. The nurse is administering digoxin (Lanoxin) 0.25 mg intravenous push medication to the client. Which interventions should the nurse implement? Select all that apply. 1. Administer the medication undiluted in a 1-mL syringe. 2. Check the client's serum potassium level. 3. Pinch off the intravenous tubing above the port. 4. Inject the medication over 5 minutes at a steady rate. 5. Explain that experiencing a yellow haze is an expected side effect.

25. 1. Librium would not help a client addicted to cocaine. 2. Methadone, not Librium, blocks the craving for heroin. 3. Librium would not help a client addicted to amphetamines. 4. Librium is the drug of choice for preventing neurological complications and delirium tremens, which is a lifethreatening complication of alcohol withdrawal.

25. Which client should the nurse expect the health-care provider to prescribe chlordiazepoxide (Librium), a benzodiazepine? 1. A client addicted to cocaine. 2. A client addicted to heroin. 3. A client addicted to amphetamines. 4. A client addicted to alcohol.

26. 1. A smoking cessation support group may be helpful, but nicotine involves a physical withdrawal and medication should be used to help with the withdrawal symptoms. 2. Tapering the number of cigarettes daily is not the most successful method to quit smoking cigarettes. 3. Research has shown that 44% of smokers were able to quit smoking at the end of 12 weeks with Chantix as compared to other smoking cessation medications, which have a 30% chance of success. It reduces the urge to smoke. 4. Clonidine is used to help prevent delirium tremens in clients with an alcohol dependence.

26. The client is discussing wanting to quit smoking cigarettes with the clinic nurse. Which intervention is most successful in helping the client to quit smoking cigarettes? 1. Encourage the client to attend a smoking cessation support group. 2. Discuss tapering the number of cigarettes smoked daily. 3. Instruct the client to use varenicline (Chantix), a smoking cessation medication. 4. Explain that clonidine can be taken daily to help decrease withdrawal symptoms.

27. 1. Mannitol would not be contraindicated in a client who is HIV positive. 2. Mannitol, an osmotic diuretic, would not be contraindicated in a client who has glaucoma. The osmotic diuretic medication Diamox is administered to clients with glaucoma. 3. Because mannitol will pull fluid off the brain by osmosis into the circulatory system it can lead to a circulatory overload, which the heart could not handle because the client already has CHF. This client would need an order for a loop diuretic to prevent serious cardiac complications. 4. The client is 16 years old, and even with CF the client's heart should be able to handle the fluid-volume overload.

27. Each of the following clients has a head injury. Which client would the nurse question administering the osmotic diuretic mannitol (Osmitrol)? 1. The 34-year-old client who is HIV positive. 2. The 84-year-old client who has glaucoma. 3. The 68-year-old client who has congestive heart failure. 4. The 16-year-old client who has cystic fibrosis.

28. 1. This would be half the dose prescribed. 2. The line is in increments of 0.5 (1/2 inch) and the order is 1 inch. 3. This would be 11/2 inches, which is not the correct dose. 4. This would be 2 inches, which is not the correct dose.

28. The nurse is administering 1.0 inch of Nitropaste, a coronary vasodilator. How much paste should the nurse apply to the application paper? 1. 1/2" 2. 1" 3. 11/2" 4. 2"

29. 1. Lidocaine suppresses ventricular ectopy and is a first-line drug for the treatment of ventricular dysrhythmias. 2. Atropine decreases vagal stimulation, which increases the heart rate, and is the drug of choice for asystole, complete heart block, and symptomatic bradycardia. 3. Adenosine is the drug of choice for terminating paroxysmal supraventricular tachycardia by decreasing the automaticity of the SA node and slowing conduction through the AV node. 4. Epinephrine constricts the periphery and shunts the blood to the central trunk and is the first medication administered in a client who is coding.

29. The client receiving telemetry is exhibiting supraventricular tachycardia. Which antidysrhythmic medication should the nurse administer? 1. Lidocaine. 2. Atropine. 3. Adenosine. 4. Epinephrine.

3. 1. Antihypertensive medications do not interfere with the contrast dye that is used when performing a CT scan. Glucophage may be held prior to or following the procedure until a normal creatinine level can be established. 2. The client will have an intravenous line to administer the contrast dye. 3. The contrast dye is iodine based so an allergy to shellfish would be important, but there is no contraindication to taking an NSAID. 4. Sedatives are not administered for this procedure; however, if the client is anxious about the machine, sometimes an antianxiety medication is administered.

3. The client with a head injury is ordered a CT scan of the head with contrast dye. Which intervention should the nurse include when discussing this procedure? 1. Instruct the client to not take any of the routine medications. 2. Inform the client an intravenous line will be started prior to the procedure. 3. Ask about any allergies to nonsteroidal anti-inflammatory medication. 4. Explain that the client will be given sedatives prior to the procedure.

30. 1. The client should adhere to a low-fat, low-cholesterol diet, but this does not indicate the medication is effective. 2. This medication is prescribed to help decrease the client's cholesterol level; therefore, this statement indicates it is effective. 3. A sedentary lifestyle is a risk factor for developing atherosclerosis; therefore, exercising should be praised but it does not indicate the medication is effective. 4. The medication is not administered to decrease edema; therefore, this statement does not indicate the medication is effective.

30. The client diagnosed with coronary artery disease is prescribed atorvastatin (Lipitor), an HMG-CoA reductase inhibitor. Which statement by the client indicates the medication is effective? 1. "I really haven't changed my diet, but I am taking my medication every day." 2. "I am feeling good since my doctor told me my cholesterol level came down." 3. "I am swimming at the local pool about three times a week for 30 minutes." 4. "Since I have been taking this medication the swelling in my legs is better."

31. 1. This is an oral preparation and one that can be given daily; this is not the first medication to be administered. 2. An initial dose of intravenous antibiotic is priority because the client must be started on the medication as soon as possible to prevent the client from becoming septic. 3. Lactinex is administered to replace the good bacteria in the body destroyed by the antibiotic, but it does not need to be administered first. 4. Keflex is an oral antibiotic, but this client is being discharged, indicating the client's condition has improved. This client could wait until the initial dose of an IV antibiotic is administered

31. The nurse is preparing to administer medications on a pulmonary unit. Which medication should the nurse administer first? 1. Prednisone, a glucocorticoid, for a client diagnosed with chronic bronchitis. 2. Ceftriaxone (Rocephin), an intravenous antibiotic, an initial dose (ID). 3. Lactic acidophilus (Lactinex) to a client receiving IVPB antibiotics. 4. Cephalexin (Keflex) PO, an antibiotic, to a client being discharged.

32. 1. White blood cells are monitored to detect the presence of an infection, and an elevated WBC is a sign of infection that would warrant intervention. Steroids mask infection. 2. The hemoglobin and hematocrit are monitored to detect blood loss, not for steroid therapy. 3. Steroid therapy interferes with glucose metabolism and increases insulin resistance. The blood glucose levels should be monitored to determine if an intervention is needed and a glucose level of 238 would warrant intervention. 4. The creatinine is monitored to determine renal status. The adrenal glands produce cortisol. 5. The client's potassium level is within normal limits; therefore, this does not warrant intervention.

32. The client diagnosed with chronic obstructive pulmonary disease is prescribed methylprednisolone (Solu-Medrol), a glucocorticoid, IVP. Which laboratory data warrants intervention by the nurse? Select all that apply. 1. The white blood cell (WBC) count is 15,000. 2. The hemoglobin and hematocrit levels are 13 g/dL and 39%. 3. The blood glucose level is 238 mg/dL. 4. The creatinine level is 1.2 mg/dL. 5. The potassium level is 3.9 mEq/L.

33. 1. This client has normal ABGs, but the oxygen level is below normal (80-100); therefore, the nurse should administer oxygen. 2. The client has normal ABGs; therefore, an antianxiety medication does not need to be administered. The client needs oxygen. 3. Sodium bicarbonate is the drug of choice for metabolic acidosis and this client has normal ABGs except for hypoxia. 4. The client has normal ABGs with hypoxia.

33. The client's arterial blood gas results are pH 7.35, PaO2 75, PCO2 35, and HCO3 24. Which intervention is most appropriate for this client? 1. Administer oxygen 10 L/min via nasal cannula. 2. Administer an antianxiety medication. 3. Administer 1 amp of sodium bicarbonate IVP. 4. Administer 30 mL of an antacid.

34. 1. This hematocrit is normal but does not indicate that the client is responding to the antibiotics. 2. Thick green sputum is a symptom of pneumonia, which indicates the antibiotic therapy is not effective. If the sputum were changing from a thick green sputum to a thinner, lighter-colored sputum, it would indicate an improvement in the condition. 3. The symptoms of pneumonia include crackles and wheezing in the lung fields. Clear lung sounds indicate an improvement in the pneumonia and that the medication is effective. 4. Pleuritic chest is a symptom of pneumonia and does not indicate the medication is effective. Lack of symptoms indicates the medication is effective.

34. Which data indicates the antibiotic therapy has been successful for a client diagnosed with a bacterial pneumonia? 1. The client's hematocrit is 45%. 2. The client is expectorating thick green sputum. 3. The client's lung sounds are clear to auscultation. 4. The client has complaints of pleuritic chest pain.

35. 1. This is the mechanism of action for antacids. 2. This is the mechanism of action for histamine2 blockers. 3. This is the mechanism of action for protonpump inhibitors. 4. This is the mechanism of action for mucosal barrier agents.

35. Which statement is the scientific rationale for administering an antacid to a client diagnosed with gastrointestinal reflux disease (GERD)? 1. Antacids neutralize the gastric secretions. 2. Antacids block H2 receptors on the parietal cells. 3. Antacids inhibit the enzyme that generates gastric acid. 4. Antacids form a protective barrier against acid and pepsin.

36. 1. The TPN is 50% dextrose; therefore, the client's blood glucose level should be checked every 6 hours and sliding-scale insulin coverage should be ordered. 2. TPN should always be administered using an intravenous pump and not left to run by gravity; fluid volume and increased glucose resulting from an overload of TPN could cause a lifethreatening fluid-volume or hyperglycemic crisis. 3. TPN must be administered via a subclavian line, and any infection may lead to endocarditis; therefore, the nurse should assess the site. 4. TPN is considered a medication and should be administered as any other medication. 5. The client with severe acute exacerbation of Crohn's is NPO to rest the bowel. When a client is on TPN he or she is usually NPO because the TPN provides all necessary nutrients; therefore, the nurse would not encourage the client to eat food.

36. The client with a severe acute exacerbation of Crohn's disease is prescribed total parenteral nutrition (TPN). Which interventions should the nurse implement when administering TPN? Select all that apply. 1. Monitor the client's glucose level daily. 2. Administer the TPN via an intravenous pump. 3. Assess the subclavian line insertion site. 4. Check the TPN according to the five rights prior to administering. 5. Encourage the client to eat all of the food offered at meals.

37. 1. This is the rationale for administering mineral oil. 2. This is the rationale for administering stimulants. 3. Stool softeners or surfactants have a detergent action to reduce surface tension, permitting water and fats to penetrate and soften the stool. 4. This is the rationale for bulk-forming agents.

37. The client is prescribed a stool softener. Which statement best describes the scientific rationale for administering this medication? 1. The medication acts by lubricating the stool and the colon mucosa. 2. Stool softeners irritate the bowel to increase peristalsis. 3. The medication causes more water and fat to be absorbed into the stool. 4. Stool softeners absorb water, which adds size to the fecal mass.

38. 1. The normal plasma ammonia level is 15-45 μg/dL (varies with method); this is below the normal level. The client with end-stage liver failure would be receiving this medication, and the client does not need to receive a laxative that will cause diarrhea. 2. The normal serum potassium level is 3.5-5.5 mEq/L; therefore, the nurse should administer this medication because the potassium level is within normal limits. 3. The normal serum potassium level is 3.5-5.5 mEq/L; therefore, the nurse should not question administering this medication because the potassium level is within normal limits. 4. Hyponatremia (normal sodium 135- 145 mEq/L) may occur when the client is taking vasopressin therapy. This sodium level is within normal limits; therefore, the nurse would not question administering this medication.

38. The nurse is preparing to administer medications to the following clients. Which client should the nurse question administering the medication? 1. Lactulose (Cephulac), a laxative, to a client who has an ammonia level of 10 μg/dL. 2. Furosemide (Lasix), a loop diuretic, to a client who has a potassium level of 3.7 mEq/L. 3. Spironolactone (Aldactone), a potassium-sparing diuretic, to a client with a potassium level of 3.5 mEq/L. 4. Vasopressin (Pitressin) to a client with a serum sodium level of 137 mEq/L.

39. 1. Humulin N is an intermediate-acting insulin that will peak 6-8 hours after administration; therefore, the client would experience signs of hypoglycemia around 1300-1500. 2. The nurse needs to ensure the client eats the night-time (HS) snack to help prevent night-time hypoglycemia if the Humulin N is administered at 1600. This insulin has been administered at 0700, so the nurse should ensure that the client eats lunch and/or a mid-afternoon snack for this administration time. 3. The client should have the blood glucose checked; it should be done with a glucometer at the bedside. 4. Eating the food from the lunch tray will help prevent a hypoglycemic reaction because the Humulin N is an intermediate- acting insulin that peaks in 6-8 hours. 5. The Humulin N peaks in 6-8 hours; therefore, the nurse should assess the client for hypoglycaemia around 1500.

39. The nurse administered 25 units of Humulin N to a client with Type 1 diabetes at 0700. Which interventions should the nurse implement? Select all that apply. 1. Assess the client for hypoglycemia around 1800. 2. Ensure the client eats the night-time snack. 3. Check the client's blood glucose level via glucometer. 4. Determine how much food the client ate at lunch. 5. Monitor the client for low blood glucose around 1500.

4. 1. Mineral oil will not affect folic acid, but it will inhibit the absorption of vitamin A. 2. The client should avoid drinking alcohol products because they increase folic acid requirements. 3. Research has proved that decreased stores of folic acid in the maternal body directly affect the development of spina bifida in the fetus. 4. This would be significant if a client is at risk for developing pregnancy-induced hypertension but not when taking folic acid.

4. The obstetric clinic nurse is discussing folic acid, a vitamin, with a client who is trying to conceive. Which information should the nurse discuss with the client when taking this medication? 1. Do not use any laxatives containing mineral oil when taking folic acid. 2. Drink one glass of red wine daily to potentiate the medication. 3. This medication will help prevent spina bifida in the unborn child. 4. Notify the health-care provider if the client's vision becomes blurry.

40. 1. The insulin will not be working 4-5 hours after being administered. 2. This insulin peaks in 15-20 minutes after being administered; therefore, the meal should be at the bedside prior to administering this medication. 3. The glucose level should be checked prior to meals, not after meals. 4. This medication is administered when a client is unconscious secondary to hypoglycemia and should not be kept at the bedside. Orange juice or some type of simple glucose should be kept at the bedside.

40. The nurse is administering Humalog, a fast-acting insulin, at 0730 to a client diagnosed with Type 1 diabetes. Which intervention should the nurse implement? 1. Ensure the client eats at least 90% of the food on the lunch tray. 2. Do not administer unless the breakfast tray is in the client's room. 3. Check the client's blood glucose level 1 hour after receiving insulin. 4. Have 50% dextrose in water at the bedside for emergency use.

41. 1. Weight gain indicates the client is not taking enough medication. 2. Intolerance to hot indicates the client is not taking too much medication. 3. Tachycardia, a heart rate greater than 100, is a sign of hyperthyroidism and indicates the client is taking too much medication. 4. Increased metabolism, diarrhea, indicates the client is taking too much thyroid hormone. 5. Fine hand tremors indicate the client is taking too much medication; this is a sign of hyperthyroidism.

41. The client diagnosed with hypothyroidism is prescribed levothyroxine (Synthroid). Which assessment data supports the client is taking too much medication? Select all that apply. 1. The client has a 2-kg weight gain. 2. The client complains of being too hot. 3. The client's radial pulse rate is 110 bpm. 4. The client complains of having diarrhea. 5. The client has fine tremors of the hands.

42. 1. Humalog is not administered intravenously, and glucose levels should be monitored prior to insulin administration. 2. Steatorrhea is fatty, frothy stools that indicate the pancreatic enzymes are not sufficient for digestive purposes. The nurse should be prepared to administer pancreatic enzymes. 3. Humulin R insulin is administered by sliding scale to decrease blood glucose levels. Clients with pancreatitis should be monitored for the development of diabetes mellitus. 4. Zantac would not treat the client's symptoms.

42. The client diagnosed with chronic pancreatitis is complaining of steatorrhea. Which medication should the nurse prepare to administer? 1. Humalog, a fast-acting insulin, intravenously, then monitor glucose levels. 2. Pancrelipase (Cotazym) sprinkled on the client's food with meals. 3. Humulin R subcutaneously after assessing the blood glucose level. 4. Ranitidine (Zantac), a histamine2 receptor blocker, orally.

43. 1. Kayexalate is a medication that is administered to decrease an elevated serum potassium level; therefore, an elevated serum potassium (5.5 mEq/L) would indicate the medication is not effective. 2. Kayexalate is not used to alter the serum sodium level. 3. Kayexalate is a medication that is administered to decrease an elevated serum potassium level; therefore, a potassium level within the normal range of 3.5-5.5 mEq/L indicates the medication is effective. 4. Kayexalate is not used to alter the serum sodium level.

43. The client in end-stage renal disease is receiving oral Kayexalate, a cation exchange resin. Which assessment data indicates the medication is not effective? 1. The client's serum potassium level is 5.8 mEq/L. 2. The client's serum sodium level is 135 mEq/L. 3. The client's serum potassium level is 4.2 mEq/L. 4. The client's serum sodium level is 147 mEq/L.

44. 1. The saline irrigation is being instilled into the bladder and requires nursing judgment; therefore, this nursing task requires immediate intervention. 2. The UAP reporting abnormal data is appropriate. A green-blue color indicates the client is taking bethanechol (Urecholine), a urinary stimulant used for clients with a neurogenic bladder. This is an expected color. 3. The client should be encouraged to drink fluids. The nurse would not intervene to stop this action. 4. This action encourages bowel and urine continence and is part of a falls prevention protocol. The nurse would not intervene to stop this action.

44. The nurse observes the unlicensed assistive personnel (UAP) performing nursing tasks. Which action by the UAP requires immediate intervention? 1. The UAP increases the rate of the saline irrigation for a client who had a transurethral resection of the prostate. 2. The UAP tells the nurse that a client who is on strict bed rest has green, funnylooking urine in the bedpan. 3. The UAP encourages the client to drink a glass of water after the nurse administered the oral antibiotic. 4. The UAP assists the client diagnosed with a urinary tract infection to the bedside commode every 2 hours.

45. 1. The time period for the lesions to heal depends on several factors, including the immune status of the individual who is infected and the amount of stress the individual is experiencing at the time. It usually requires several days to more than a week for an outbreak to be healed. 2. Suppressive therapy with Valtrex is once daily, every day. This is an advantage of Valtrex over other antiretroviral medications, which require twice-a-day dosing. 3. The use of condoms may prevent the spread of herpes infections; it does not increase the spread of the virus. 4. It is possible to transmit the virus to a sexual partner with no visible signs of a lesion being present. Valtrex will not absolutely prevent the spread of the virus. It will treat an outbreak and decrease the risk of transmission.

45. The male client is diagnosed with herpes simplex 2 viral infection and is prescribed valacyclovir (Valtrex). Which information should the nurse teach? 1. The medication will dry the lesions within a day or two. 2. Valtrex is taken once a day to control outbreaks. 3. The use of condoms will increase the spread of the herpes. 4. After the lesions are gone, the client will not transmit the virus

46. 1. If the client's deep tendon reflexes are 4+, indicating the client may have a seizure at any time, which indicates the medication is not effective. 2. Magnesium sulfate is not administered to treat the client's blood pressure; therefore, this data cannot be used to evaluate the effectiveness of the medication. 3. Magnesium sulfate is administered to prevent seizure activity and is determined to be effective and in the therapeutic range when the client's deep tendon reflexes are normal, which is 2+ to 3+ on a 0-4+ scale. 4. A 0 deep tendon reflex indicates the client has received too much magnesium sulfate but the client would not have seizure activity; therefore, it is effective. The client is at risk for respiratory depression.

46. The client who is 38 weeks pregnant and diagnosed with preeclampsia is admitted to the labor and delivery area. The HCP has prescribed intravenous magnesium sulfate, an anticonvulsant. Which data indicates the medication is not effective? 1. The client's deep tendon reflexes are 4+. 2. The client's blood pressure is 148/90. 3. The client's deep tendon reflexes are 2 to 3+. 4. The client's deep tendon reflexes are 0.

47. 1. The client should swallow the medication. The client should not crush, chew, or suck the medication. 2. The medication should be taken on an empty stomach at least 30 minutes before eating or drinking any liquid. Foods and beverages greatly decrease the effect of Fosamax. 3. The medication will irritate the stomach and esophagus if the client lies down; therefore, the medication should be taken when the client can remain upright at least 30 minutes. 4. Fosamax can be taken daily or weekly, but because of the high risk of esophageal complications if the client does not take Fosamax exactly as prescribed, most HCPs prescribe the medication to be taken once a week. The client must take the medication on an empty stomach and remain in an upright position for a minimum of 30 minutes.

47. The client who is postmenopausal is prescribed alendronate (Fosamax), a bisphosphonate, to help prevent osteoporosis. Which information should the nurse discuss with the client? 1. Chew the tablet thoroughly before swallowing. 2. Eat a meal prior to taking the medication. 3. Take the medication at night before going to sleep. 4. Remain upright for 30 minutes after taking medication.

48. 1. Parafon Forte would not have an effect on whether or not the client has had the flu. 2. This medication can make the client drowsy; this is why the nurse teaches the client not to drive or operate heavy machinery when taking a muscle relaxant. 3. The client should not be driving at all when the medication makes them less than alert. The nurse should address this with the client. 4. This would keep the client from overdosing on the medication.

48. The client with low back pain syndrome is prescribed chlorzoxazone (Parafon Forte), a skeletal muscle relaxant. Which statement by the client warrants intervention by the nurse? 1. "I have not had the flu since I started the medication." 2. "I am always drowsy after taking this medication." 3. "I find driving my car difficult when I take my back pain medicine." 4. "If I miss a dose I wait until the next dose time to take a pill."

49. 1. The urine does not change color when the client takes methotrexate. 2. The client should be encouraged to eat a balanced diet; drinking a supplement is not necessary. 3. Methotrexate suppresses the bone marrow, resulting in decreased numbers of white blood cells; the client should notify the HCP if a fever develops because this could indicate an infection. 4. There is no reason to increase the amount of green, leafy vegetables consumed when taking this medication.

49. The client is prescribed methotrexate (Rheumatrex), an antineoplastic agent, for psoriasis. Which intervention should the nurse teach the client? 1. Teach the client that the urine may turn a red-orange color. 2. Have the client drink Ensure to increase nutritional status. 3. Tell the client to notify the HCP if a fever develops. 4. Encourage the client to increase green, leafy vegetables in the diet.

5. 1. This is scientific rationale for administering thiazolidinediones, pioglitazone (Actos), or rosiglitazone (Avandia). 2. This is the scientific rationale for administering an alpha-glucosidase inhibitor, acarbose (Precose), or miglitol (Glyset). 3. This is the scientific rationale for administering metformin (Glucophage). It diminishes the increase in serum glucose following a meal and blunts the degree of postprandial hyperglycemia. 4. This is the scientific rationale for administering meglitinides, repaglinide (Prandin), sulfonylureas, or nateglinide (Starlix).

5. Which statement best describes the scientific rationale for prescribing the thiazolidinedione (pioglitazone) (Actos)? 1. This medication increases glucose uptake in the skeletal muscles and adipose tissue. 2. This medication allows the carbohydrates to pass slowly through the large intestine. 3. This medication will decrease the hepatic production of glucose from stored glycogen. 4. This medication stimulates the beta cells to release more insulin into the bloodstream.

50. 1. This medication affects the acid-base balance in the body and should not be administered to clients with renal disease. A 2.8 mg/dL serum creatinine level indicates renal insufficiency; therefore, the nurse would use caution with this client. 2. Clients with congestive heart failure would not be affected by this medication. 3. This client has adequate respiratory status; therefore, the nurse would not need to use caution with this client. 4. There is no reason a client with diabetes could not be prescribed mafenide acetate.

50. With which client should the nurse use caution when applying mafenide acetate (Sulfamylon), a topical antimicrobial agent, to a burned area? 1. A client with a creatinine level of 2.8 mg/dL. 2. A client with congestive heart failure. 3. A client with a pulse oximeter reading of 95%. 4. A client with diabetes Type 2 taking insulin.

51. 1. Botox will reduce wrinkles, but that is not why it is administered to a client with a cerebrovascular accident, a brain attack. The paralysis of the facial muscles lasts from 3-6 months. 2. Botox produces partial chemical denervation of the muscle, resulting in localized reduction in muscle activity and spasticity. 3. This medication will not improve limb weakness. 4. This medication does not help with pain secondary to neuropathy.

51. The long-term care nurse is administering botulinum toxin type A (Botox), an antispasmodic, to a client diagnosed with a brain attack. Which statement best describes the scientific rationale for administering this medication? 1. This medication is administered for the cosmetic effect to reduce wrinkles. 2. This medication reduces muscle spasticity associated with strokes. 3. This medication will improve the client's residual limb strength. 4. This medication will decrease the pain associated with neuropathy.

52. 500 mL/hour. The nurse should divide 8000 mL by 2, which equals 4000 mL. The 4000 must be divided by 8, which equals 500 mL/hour. There are formulas that are used to determine the client's fluid-volume resuscitation. The formulas specify that the total amount of fluid must be infused in 24 hours, 50% in the first 8 hours followed by the other 50% over the other 16 hours. This is a large amount of fluid, but it is not uncommon in clients with full-thickness burns over greater than 20% total body surface area burned.

52. The client has second- and third-degree burns to 40% of the body. The HCP writes an order for 8000 mL of fluid to be infused over the next 24 hours. The order reads that half of the total amount should be administered in the first 8 hours with the other half being infused over the remaining 16 hours. At what rate would the nurse set the intravenous pump for the first 8 hours?

53. 1. Wearing insect repellent is an appropriate intervention, but if the client has an insect bite, the repellent will not help prevent anaphylaxis; therefore, this is not the priority intervention. 2. Antihistamines are used in clients with anaphylaxis, but it takes at least 30 minutes for the medication to work, and if the client has an insect bite, it is not the priority medication. 3. Clients with documented severe anaphylaxis should carry an EpiPen, which is a prescribed epinephrine injectable device that clients can administer to themselves in case of an insect bite. Keeping the medication in the refrigerator does not allow it to be available to the client at all times. 4. The client should wear an identification bracelet because even if the client uses insect repellent, a sting could occur. The bracelet indicates the client is at risk for an anaphylactic reaction; therefore, this is the priority intervention.

53. The client has a severe anaphylactic reaction to insect bites. Which priority discharge intervention should the nurse discuss with the client? 1. Wear an insect repellent on exposed skin. 2. Keep prescribed antihistamines on their person. 3. Keep an EpiPen in the refrigerator at all times. 4. Wear a MedicAlert identification bracelet.

54. 1. There is not a cure for the HIV infection; HIV is a retrovirus that never dies as long as the host is alive. 2. HAART is complex and expensive and poses a risk of toxicity and serious drug interactions. 3. Because of HAART plasma levels of HIV can be reduced to undetectable levels with current technology. 4. HAART medications are very expensive.

54. Which statement is the scientific rationale for prescribing the regimen known as highly active antiretroviral therapy (HAART) to clients diagnosed with HIV infection? 1. HAART will cure clients diagnosed with HIV infection. 2. HAART poses less risk of toxicity than other regimens. 3. HAART can decrease HIV to undetectable levels. 4. HAART is less costly than other medication regimens.

55. 1. Plaquenil can cause pigmentary retinitis and vision loss, so the client should have a thorough vision examination every 6 months; therefore, the client does not understand the medication teaching. 2. Plaquenil may increase the risk of liver toxicity when administered with hepatotoxic drugs, so alcohol use should be eliminated during therapy; therefore, the client does not understand the medication teaching. 3. The medication should be taken with milk to decrease gastrointestinal upset. This statement indicates the client understands the medication teaching. 4. The medication takes 3-6 months to achieve the desired response; therefore, the client needs more medication teaching.

55. The client with rheumatoid arthritis is prescribed hydroxychloroquine sulfate (Plaquenil), a disease-modifying antirheumatic drug (DMARD). Which statement indicates the client understands the medication teaching? 1. "I will get my eyes checked yearly." 2. "I can only have two beers a week." 3. "It is important to take this medication with milk." 4. "I will call my HCP if the pain is not relieved in 2 weeks."

56. 1. A 3 is considered mild pain and could wait until the client whose needs are more emergent is medicated. 2. An antianxiety medication is not priority over a client who must take the medication on an empty stomach. This is a potential anxiety attack over a physiological problem. 3. The medication must be administered prior to a meal. Administering a mucosal barrier agent after a meal places medication in the stomach that will coat the food, not the stomach lining. This medication should be administered first. 4. This medication stimulates the bone marrow to produce red blood cells; the full effect of the medication will not be seen for 30-90 days. It could be administered after the antianxiety medication and the analgesic.

56. The nurse is preparing to administer morning medications on an oncology floor. Which medication should the nurse administer first? 1. An analgesic to a female client with a headache rated a 3 on a pain scale of 1-10. 2. An anxiolytic to a female client who thinks she might become anxious. 3. A mucosal barrier agent to a male client who has peptic ulcer disease. 4. A biologic response modifier to a male client with low red blood cell counts.

57. 1. The nurse should not administer pain medication until after assessing the client's pain. 2. The first action is always to assess the client in pain to determine if the client is having a complication that requires medical intervention rather than PRN pain medication. 3. The nurse should assess the client, then administer the pain medication whether the client has visitors or not. 4. The nurse should first assess the client's pain.

57. The client calls the nursing station and requests pain medication. When the nurse enters the room with the narcotic medication, the nurse finds the client laughing and talking with visitors. Which action should the nurse implement first? 1. Administer the client's prescribed pain medication. 2. Assess the client's perception of pain on a 1-10 scale. 3. Wait until the visitors leave to administer any medication. 4. Check the MAR to see if there is a nonnarcotic medication ordered.

58. 1. Keeping the eyes closed and drapes drawn would not indicate the pain medication is effective. These actions may be the client's way of dealing with the pain. 2. Using guided imagery is an excellent method to assist with the control of pain, but its use does not indicate effectiveness of the medication. 3. Light snoring indicates the client is asleep, which would indicate the medication is effective. 4. This action may be the client's way of dealing with the pain, but it does not indicate the medication is effective.

58. The nurse administered a narcotic pain medication 30 minutes ago to a client diagnosed with cancer. Which data indicates the medication was effective? 1. The client keeps his or her eyes closed and the drapes drawn. 2. The client uses guided imagery to help with pain control. 3. The client is snoring lightly when the nurse enters the room. 4. The client is lying as still as possible in the bed.

59. 1. The client's WBC is low and the absolute neutrophil count is 1100, which indicates the client is immunosuppressed; therefore, the client should not be exposed to people with active infections. 2. This is good information to teach, but it is not based on the laboratory values. The client may develop mouth ulcers as a result of chemotherapy administration and the nurse should discuss methods of maintaining nutrition for this reason, not the laboratory values. 3. The client's WBC is low and the absolute neutrophil count is 1100, which indicates the client is immunosuppressed; therefore, the client should avoid contact with live plants or flowers (soil and standing water may have germs). 4. This is good information to teach, but it is not based on the laboratory values. Cancer and treatment-related fatigue are real and should be addressed; an Hgb and Hct of around 8 and 24 could cause fatigue, but at the current level this is not indicated. 5. A platelet count of less than 100,000 is the definition of thrombocytopenia; therefore, this client is not at risk for bleeding.

59. The client has received chemotherapy 2 days a week every 3 weeks for the past 8 months. The client's current lab values are Hgb 10.3 and Hct 31, WBC 2000, neutrophils 50, and platelets 189,000. Which information should the nurse teach the client? Select all that apply. 1. Avoid individuals with colds or other infections. 2. Maintain nutritional status with supplements. 3. Do not allow the patient to eat raw fruit or have plants/flowers in the room. 4. Plan for periods of rest to prevent fatigue. 5. Use a soft-bristled toothbrush and electric razor.

6. 1. Epinephrine is the first medication administered in a code because it constricts the periphery and shunts the blood to the trunk of the body. 2. Lidocaine, an antidysrhythmic, is a drug of choice for treating ventricular dysrhythmias. 3. Atropine is administered for asystole. 4. Digoxin is administered for cardiac failure.

6. The client is experiencing ventricular tachycardia and has a weak, thready apical pulse. Which medication should the nurse prepare to administer to the client? 1. Epinephrine, an adrenergic agonist, intravenous push. 2. Lidocaine, an antidysrhythmic, intravenous push. 3. Atropine, an antidysrhythmic, intravenous push. 4. Digoxin, a cardiac glycoside, intravenous push.

60. 1. This level is above therapeutic range; therefore, the nurse should not administer the medication. 2. The therapeutic serum level is 0.6 to 1.5 mEq/L; therefore, the first intervention is to hold the medication. 3. After holding the medication, the nurse should notify the health-care provider. 4. The nurse should first hold the medication and then verify the level at a later time.

60. The nurse is preparing to administer lithium (Eskalith), an antimania medication, to a client diagnosed with bipolar disorder. The lithium level is 3.5 mEq/L. Which intervention should the nurse implement first? 1. Administer the medication. 2. Hold the medication. 3. Notify the health-care provider. 4. Verify the lithium level.

61. 1. All medication must be kept in a safe place to prevent accidental poisoning of children. 2. The last medication should be administered no later than 1400 in the afternoon or the child will not be able to sleep at night. Ritalin is a stimulant. This statement indicates the mother does not understand the medication teaching. 3. Growth rate may be stalled in response to nutritional deficiency caused by anorexia; it does not cause growth spurts. This statement indicates the mother does not understand the medication teaching. 4. Insomnia is an adverse reaction to the medication; central nervous stimulants may disrupt normal sleep patterns. This statement indicates the medication teaching has not been effective.

61. The 8-year-old child newly diagnosed with attention deficit-hyperactivity disorder (ADHD) is prescribed methylphenidate (Ritalin), a central nervous stimulant. Which statement by the mother indicates the medication teaching is effective? 1. "I will keep the medication in a safe place." 2. "I will give my child this medication every 12 hours." 3. "It may cause my child to have growth spurts." 4. "My child will probably experience insomnia."

62. 1. The client should instill eye ointment into the lower conjunctival sac, which is the inner edge of the lower lid margin. 2. This pressure will prevent systemic absorption of the medication. 3. The client does not have to wear gloves when applying the ointment to his or her own eyes; the client should be instructed to wash hands prior to and after applying the ointment. 4. The antibiotic ointment should be applied from the inner canthus to the outer canthus, from the nose side of the eye to the outer area. 5. The client should be in this position when applying ophthalmic ointment or drops to better access the lower conjunctival sac.

62. The client diagnosed with bilateral conjunctivitis is prescribed antibiotic ophthalmic ointment. Which medication teaching should the nurse discuss with the client? Select all that apply. 1. Apply a thin line of ointment evenly along the inner edge of the lower lid margin. 2. Press the nasolacrimal duct after applying the antibiotic ointment. 3. Don nonsterile gloves prior to administering the medication. 4. Apply antibiotic ointment from the outer canthus to the inner canthus. 5. Instruct the client to sit with the head slightly tilted back or lie supine.

63. 1. The outer canthus does not have access to the systemic system; therefore, the nurse would not hold pressure in this area. 2. The nurse should not hold pressure under the eyelid because the medication will not be retained in the eye. 3. The nurse cannot hold pressure in the lower conjunctival sac because this would be painful for the client and would not prevent systemic absorption of the medication. 4. The lacrimal duct is located in the inner canthus area, and systemic absorption of the medication can occur if the nurse does not apply light pressure to the area.

63. The nurse has administered an ophthalmic medication to the client. Which area should the nurse hold pressure to prevent systemic absorption? 1. A 2. B 3. C 4. D

64. 1. This is a low blood pressure reading for a client in hypovolemic shock. A B/P less than 90/60 warrants intervention by the nurse and indicates the fluid resuscitation is not effective. 2. A pulse oximeter reading of greater than 93% indicates the arterial oxygen level is between 80 and 100, which is normal. 3. The client's lungs are clear, which indicates the client is not in fluid-volume overload; therefore, this does not warrant immediate intervention. 4. If the client has at least 30 mL of urine output an hour, then the kidneys are being perfused adequately. This indicates the client is urinating 40 mL an hour.

64. The client in hypovolemic shock is receiving normal saline by rapid intravenous infusion. Which assessment data warrants immediate intervention by the nurse? 1. The client's blood pressure is 89/48. 2. The client's pulse oximeter reading is 95%. 3. The client's lung sounds are clear bilaterally. 4. The client's urine output is 120 mL in 3 hours.

65. 1. The client in asystole would not benefit from defibrillation because there is no heart activity; the client must have some heart activity (ventricular activity) for defibrillation to be successful. 2. Synchronized cardioversion is used for new-onset atrial fibrillation or unstable ventricular tachycardia. 3. Atropine is the drug of choice for asystole because it decreases vagal stimulation and increases heart rate. 4. Amiodarone is administered in lifethreatening ventricular dysrhythmias, not asystole.

65. The client who is coding is in asystole. Which intervention should the nurse implement first? 1. Prepare to defibrillate the client at 360 joules. 2. Prepare for synchronized cardioversion. 3. Prepare to administer atropine, intravenous push. 4. Prepare to administer amiodarone, an antidysrhythmic.

66. 1. Mucomyst does not neutralize substances by changing their pH. 2. Mucomyst is not used to treat bleach poisonings. Charcoal binds with poisons to form an inert substance that can be eliminated through the bowel because the body is incapable of absorbing charcoal molecules. 3. This is the scientific rationale for administering Mucomyst. 4. Mucomyst does not cause emesis. An emetic such as ipecac would induce vomiting.

66. Which statement best describes the scientific rationale for administering acetylcysteine (Mucomyst), an antidote, to a child who was brought to the emergency room? 1. Mucomyst neutralizes toxic substances by changing the pH of the poison. 2. Mucomyst binds with bleach, and it is excreted through the bowel. 3. Mucomyst is the antidote for acute acetaminophen (Tylenol) poisoning. 4. Mucomyst induces vomiting, and the client eliminates much of the narcotics.

67. 1. The weight of the child is pertinent information, but it is not the most important question. 2. Most dishwashing liquids are vegetable- based products and will produce osmotic diarrhea when ingested; therefore, the nurse should ask about abdominal cramping. The soap is not poisonous, but the child may become dehydrated and be uncomfortable. 3. Because the mother has called the emergency department it is not priority to know if she called the Poison Control Center. 4. Determining where the soap was is not going to help the child.

67. The mother of a 2-year-old child calls the emergency department and reports that the child drank some dishwashing detergent. Which question is most important for the nurse to ask the mother? 1. "How much does your child weigh?" 2. "Is your child complaining of a stomach ache?" 3. "Have you called the Poison Control Center?" 4. "Where did you keep the dishwashing soap?"

68. 1. Aspirin does not affect the blood pressure and pulse; therefore, the nurse would not need to implement this intervention. 2. Aspirin will not cause a breakdown of fat, which results in increased ketone production. 3. Daily aspirin is taken as an antiplatelet medication, not as an antipyretic. 4. This information should be documented in the chart, and no further action should be taken.

68. The client admitted to the medical floor for pneumonia informs the nurse of taking an aspirin every day. Which intervention should the nurse implement? 1. Assess the client's blood pressure and pulse. 2. Check the client's urine for ketones. 3. Monitor for an elevated temperature. 4. Document the information in the chart.

69. 1. Iron turns the stool a harmless black or dark green. This statement indicates the client does understand the medication teaching. 2. The iron tablet should be taken between meals and with 8 ounces of water to promote absorption. The iron tablet should not be taken within 1 hour of ingesting antacid, milk, ice cream, or other milk products such as pudding. This statement indicates the client does not understand the medication teaching. 3. Sitting upright will prevent esophageal corrosion from reflux. This statement indicates the client understands the medication teaching. 4. The drug treatment for anemia generally lasts less than 6 months. This statement indicates the client understands the medication teaching.

69. The client diagnosed with anemia is taking an iron tablet, a mineral, daily. Which statement indicates the client needs more medication teaching? 1. "I will not call my HCP if my stools become black or dark green." 2. "I must take my iron tablet with meals and one glass of milk." 3. "I will sit upright for 30 minutes after taking my iron tablet." 4. "I will have to take an iron tablet for about 6 months."

7. 1. An antidepressant often takes 2-4 weeks to build up its effect and work fully. 2. This would be appropriate for monoamine oxidase inhibitors (MAOIs). 3. Serotonin syndrome (SES) is a serious complication of SSRIs that produces mental changes (confusion, anxiety, and restlessness), hypertension, tremors, sweating, hyperpyrexia (elevated temperature), and ataxia. Conservative treatment includes stopping the SSRI and using supportive treatment. If untreated, it can lead to death. 4. The medication has to be weaned because the client may develop some withdrawal symptoms. The dose is usually gradually reduced before stopping completely at the end of a course of treatment. 5. These are additional signs of serotonin syndrome and should be reported to the health-care provider.

7. The client with major depressive disorder is prescribed the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac). Which information should the nurse discuss with the client? Select all that apply. 1. Tell the client it will take 2 to 3 weeks for the medication to be effective. 2. Instruct the client not to eat any type of tyramine-containing foods such as wines or cheeses. 3. Notify the health-care provider if the client becomes anxious or has an elevated temperature. 4. Tell the client not to stop taking the Prozac abruptly; the medication should be weaned. 5. Explain that tremors and sweating are initial expected side effects.

70. 1. This is the scientific rationale of a coronary vasodilator. 2. This is the scientific rationale for antiplatelet medications. 3. Antioxidants are being prescribed to help prevent cardiovascular diseases. 4. Rest is the only action that will help decrease the oxygen demands of the peripheral tissues.

70. Which statement best explains the scientific rationale for a client taking antioxidants? 1. Antioxidants will increase the availability of oxygen to the heart muscle. 2. Antioxidants will help prevent platelet aggregation in the arteries. 3. Antioxidants decrease the buildup of atherosclerotic plaque in the arteries. 4. Antioxidants decrease the oxygen demands of the peripheral tissues

71. 1. According to guidelines for prudent use of herbs, babies and young children should not be given any types of herbs. 2. Herbs exposed to sunlight and heat may lose their potency. 3. When presenting information as a nurse, the nurse must encourage a discussion with a health-care provider when substituting herbs for prescribed medications. 4. This is a guideline that both consumers and health-care providers must be aware of when using herbal therapy.

71. The nurse is presenting a lecture on herbs to a group in the community. Which guideline should the nurse discuss with the group? 1. Administer smaller amounts of herbs to babies and young children. 2. Store the herbal remedy in a sunny, warm, moist area. 3. Encourage clients to use herbs as an alternative to other medications. 4. Consumers should think of herbs as medicines; more is not necessarily better.

72. 1. The nurse should offer water so that the client can swallow the medication, but it is not the first intervention. 2. The nurse should determine if the client can swallow the medication; this is the first intervention. 3. The nurse should check the medication against the Medication Administration Record, open the medication package, and place it in the medication cup at the bedside, but this is not the first intervention. If the client cannot swallow or refuses the medication, the medication can be sent back to the pharmacy if it has not been taken out of the package. 4. The nurse should remain with the client until the medication is swallowed.

72. Which intervention should the nurse implement first when administering a tablet to the client? 1. Offer a glass of water to facilitate swallowing the medication. 2. Assess that the client is alert and has the ability to swallow. 3. Open the medication and place it in the medication cup. 4. Remain with the client until all medication is swallowed.

73. 1. The UAP cannot administer medications, and the medications should not be left at the bedside. Medication aides are permitted in some states to practice in long-term care facilities. This was not stated in the stem. Regardless, no one should administer a medication dispensed by another person. 2. The UAP should take the medication cup back to the medication room and tell the primary nurse. Medications should never be left at the bedside. 3. The UAP nurse should not correct the primary nurse in front of the client; therefore, this would not be an appropriate intervention. This is not in the realm of a UAP's duties. The person over the nurse is the one to confront the nurse. 4. The UAP is a vital part of the health-care team and is expected to maintain safety for the client.

73. The unlicensed assistive personnel (UAP) is making rounds and notices that the primary nurse left a medication cup with three tablets at the client's bedside. Which action should the UAP implement? 1. Administer the client's medications. 2. Remove the medication cup from the room. 3. Request the primary nurse come to the room. 4. Leave the cup at the bedside and do nothing.

74. 1. The nurse should prepare the medication using a 25-gauge, 1/2- to 5/8-inch needle. 2. The nurse should not aspirate for blood when administering heparin because this can damage surrounding tissue and cause bruising. 3. The client's PTT is not monitored for subcutaneous administration of heparin because the heparin must be administered intravenously to increase the PTT level. 4. The nurse should not massage after injecting heparin because this may cause bruising or bleeding. 5. Heparin is administered in the lower abdominal area at least 2 inches from the umbilicus. Lovenox is administered in the "love handles," located anterolateral to the upper abdomen.

74. The nurse is administering heparin via the subcutaneous route. Which interventions should the nurse implement? Select all that apply. 1. Prepare the medication using a 25-gauge, 1/2-inch needle. 2. After injecting the medication do not aspirate. 3. Check the client's PTT prior to administering the medication. 4. After removing the needle, massage the area gently. 5. Administer the medication in the client's "love handles."

75. 1. INR is monitored for oral anticoagulant therapy, warfarin (Coumadin). 2. PT is not directly monitored for oral anticoagulant therapy but will be elevated in clients receiving oral anticoagulants. 3. The PTT should be 1.5 to 2.0 times the normal PTT or a control to determine if intravenous heparin is therapeutic. 4. The platelet count is not monitored during heparin therapy.

75. The nurse is administering therapeutic heparin, an anticoagulant, for a client diagnosed with deep vein thrombosis. Which laboratory value should the nurse monitor? 1. International Normalized Ratio (INR). 2. Prothrombin time (PT). 3. Partial thromboplastin time (PTT). 4. Platelet count.

76. 1. The client can take nonnarcotic analgesics if experiencing a headache, and Tylenol would be appropriate to take for a headache. 2. The client can eat anything after experiencing a concussion. 3. Narcotic analgesics should not be taken after a head injury because of further depression of the neurological status. 4. The client should not take aspirin because it may cause bleeding which could increase intracranial pressure. 5. Any nausea, vomiting (especially projectile), or blurred vision could be increasing ICP; therefore, the client should return to the ED for further evaluation.

76. Which discharge instructions should the emergency department (ED) nurse discuss with the client who sustained a concussion and is being discharged home? Select all that apply. 1. Instruct the client to take acetaminophen (Tylenol) for a headache. 2. Tell the client to stay on a clear liquid diet for the next 24 hours. 3. Instruct the client to take one hydrocodone (Vicodin) for pain. 4. Tell the client to return to the ED if experiencing nausea and vomiting. 5. Recommend the client take aspirin for any physical discomfort.

77. 1. The therapeutic serum level of Tegretol is 5-12 μg/mL; therefore, the nurse should question administering this medication. 2. The therapeutic serum level of Klonopin is 20-80 ng/mL; therefore, the nurse should administer this medication. 3. The therapeutic serum level of Dilantin is 10-20 μg/mL; therefore, the nurse should administer this medication. 4. The therapeutic serum level of Zarontin is 40-100 μg/mL; therefore, the nurse should administer this medication.

77. The nurse is preparing to administer the following anticonvulsant medications. Which medication should the nurse question administering? 1. Carbamazepine (Tegretol) to the client who has a Tegretol serum level of 22 μg/mL. 2. Clonazepam (Klonopin) to the client who has a Klonopin serum level of 60 ng/mL. 3. Phenytoin (Dilantin) to the client who has a Dilantin serum level of 19 μg/mL. 4. Ethosuximide (Zarontin) to the client who has a Zarontin serum level of 45 μg/mL.

78. 1. Aricept and other cholinesterase inhibitors have shown the potential to delay the progression of Alzheimer's disease. The client and family should be told that, although it offers them hope, it only lasts for 6 months to a year. 2. Aricept does not repair the brain tissue; there is no medication that repairs lost brain tissue. 3. Aricept is not an experimental medication. Aricept works by preventing the breakdown of acetylcholine (Ach) by acetylcholinesterase and thereby increases the availability of Ach at the cholinergic synapses. 4. Aricept is the best tolerated of the cholinesterase inhibitors because it has fewer side effects.

78. Which information should the nurse teach the client and family of a client prescribed donepezil (Aricept), a cholinesterase inhibitor? 1. Aricept may delay the progression of Alzheimer's for 6 months to a year. 2. Aricept will repair the brain damage in clients with Alzheimer's. 3. Aricept is still experimental as far as how it works to treat Alzheimer's. 4. Aricept is difficult for clients to tolerate because of the many side effects.

79. 1. Primary brain tumors rarely metastasize outside of the cranium because they kill by occupying space and increasing intracranial pressure. 2. Decadron is not an anticonvulsant; it may decrease the chance of seizures by decreasing intracranial pressure, but the client may still have a seizure while taking Decadron. 3. Decadron does not affect the uptake of serotonin. 4. Decadron decreases the inflammatory response of tissues. It is particularly used for edema (swelling) of the brain tissues.

79. Which statement is the scientific rationale for prescribing dexamethasone (Decadron), a glucocorticoid, to a client diagnosed with a primary brain tumor? 1. Decadron will prevent metastasis to other parts of the body. 2. Decadron is a potent anticonvulsant and will prevent seizures. 3. Decadron increases the uptake of serotonin in the brain tissues. 4. Decadron decreases intracranial pressure by decreasing inflammation.

8. 100 mL. The pump is set at the rate to be administered per hour; therefore, the nurse should set the rate at 100.

8. The client who has had abdominal surgery has an IV of Ringer's lactate infusing at 100 mL/hour. The nurse is hanging a new bag of fluid. Which rate should the nurse set the pump to infuse the Ringer's lactate?

80. 1. Administration of Activase is not contraindicated in clients who are diagnosed with congestive heart failure. 2. Surgery and bleeding ulcers are both reasons for not administering thrombolytic therapy to the client. 3. A CT scan must be done before administering Activase to make sure that the cerebrovascular accident (CVA) is not being caused by an intracranial hemorrhage. There are three types of stroke: thrombotic, embolic, and hemorrhagic. If the client is experiencing a hemorrhagic stroke, then administering a medication that dissolves clots could initiate more bleeding and cause death. 4. The client receiving anticoagulants cannot receive thrombolytic therapy due to increased bleeding time secondary to the anticoagulant therapy. 5. This history would indicate the client has experienced a deep vein thrombosis and may have been on anticoagulants but is not on them at this time; therefore, the client can receive thrombolytic therapy.

80. The HCP in the emergency department has prescribed alteplase (Activase) for a client with complaints of new onset of slurred speech, difficulty swallowing, and paralysis of the left arm. Which situations should the nurse question administering the medication? Select all that apply. 1. The client has the comorbid condition of congestive heart failure. 2. The client had abdominal surgery 6 weeks ago for a bleeding ulcer. 3. The client has not had a computerized axial tomography scan done. 4. The client is taking the anticoagulant, warfarin (Coumadin). 5. The client has a history of deep vein thrombosis with pulmonary embolism

81. 1. Protamine sulfate is the antidote for heparin toxicity. 2. The therapeutic range for INR is 2-3; therefore, the nurse should document the results and take no action. 3. AquaMEPHYTON, vitamin K, is the antidote for Coumadin toxicity, which is supported by an elevated INR greater than 3. 4. The nurse does not need to notify the HCP for a normal laboratory value.

81. The emergency department nurse received a client on warfarin (Coumadin) who has an International Normalized Ratio (INR) of 1.5. Which intervention should the nurse implement? 1. Prepare to administer protamine sulfate, an antidote. 2. Document the laboratory result and take no action. 3. Prepare to administer AquaMEPHYTON (vitamin K). 4. Notify the client's health-care provider.

82. 1. After opening the medication the nurse should date and time the patch prior to putting it on the client so that the nurse is not pressing on the client when writing on the patch. 2. The old patch should be removed but not before checking the MAR. 3. The nurse should administer the patch in a clean, dry, nonhairy place while wearing gloves. 4. The nurse should implement the five Rights of Medication Administration, and the first ones are to make sure it is the right medication and the right client.

82. The nurse is preparing to administer a nitroglycerin patch to a client diagnosed with coronary artery disease. Which interventions should the nurse implement first? 1. Date and time the nitroglycerin patch. 2. Remove the old patch. 3. Apply the nitroglycerin patch. 4. Check the patch against the MAR.

83 . 1. Digoxin does not affect the client's blood pressure; therefore, it cannot be used to determine the effectiveness of the medication. 2. The client's apical pulse must be assessed prior to administering the medication, but it is not used to determine the effectiveness of the medication. 3. The client's potassium level must be assessed prior to administering the medication, but it is not used to determine the effectiveness of the medication. 4. Signs or symptoms of CHF are crackles in the lungs, jugular vein distention, and pitting edema; therefore, the medication is not effective.

83. The client with congestive heart failure is taking digoxin (Lanoxin), a cardiac glycoside. Which data indicates the medication is ineffective? 1. The client's blood pressure is 110/68. 2. The client's apical pulse rate is 68. 3. The client's potassium level is 4.2 mEq/L. 4. The client's lungs have crackles bilaterally.

84. 1. Lidocaine suppresses ventricular ectopy and is a first-line drug for the treatment of ventricular dysrhythmias, but it is not the first medication to be administered in a code. 2. Atropine decreases vagal stimulation, which increases the heart rate and is the drug of choice for asystole, complete heart block, and symptomatic bradycardia. 3. Adenosine is the drug of choice for terminating paroxysmal supraventricular tachycardia by decreasing the automaticity of the SA node and slows conduction through the AV node. 4. Epinephrine constricts the periphery, shunts the blood to the central trunk, and is the first medication administered in a client who is coding. The client does not have a pulse; therefore, the nurse must call a code.

84. The client receiving telemetry is showing ventricular fibrillation and has no pulse. Which medication should the nurse administer first? 1. Lidocaine. 2. Atropine. 3. Adenosine. 4. Epinephrine.

85. 1. The nurse would want to give this antihypertensive medication to a client with an elevated blood pressure; the nurse would question the medication if the B/P was low. 2. The client with 2+ pitting edema would not be affected by a calcium channel blocker. 3. The nurse should question this medication if the apical rate is less than 60. 4. A headache is not an adverse effect of HCTZ; therefore, the nurse would not question administering this medication.

85. The nurse is preparing to administer medications to the following clients. Which client should the nurse question administering the medication? 1. The client receiving the angiotensin receptor blocker losartan (Cozaar) who has a B/P of 168/94. 2. The client receiving the calcium channel blocker diltiazem (Cardizem) who has 2+ pitting edema. 3. The client receiving the alpha blocker terazosin (Hytrin) who has a regular apical pulse of 56. 4. The client receiving the thiazide diuretic hydrochlorothiazide (HCTZ), who is complaining of a headache.

86. 1. Steroids (glucocorticoids) cannot be abruptly discontinued because the adrenal glands stop producing cortisol (a steroid) when the client is taking them exogenously and the client could experience a hypotensive crisis. 2. Prednisone can produce gastric distress; it is given with food to minimize the gastric discomfort. 3. Weight gain is a side effect of steroid therapy; the client should not stop taking the medication. This medication must be tapered off if the client is able to discontinue the medication at all. 4. Prednisone is not affected by light so it does not have to be kept in a dark-colored bottle. Sublingual nitroglycerin needs to be kept in a dark-colored bottle. 5. Prednisone, a steroid, suppresses the immune system response of the body, increasing the risk of developing an infection.

86. The nurse is discharging a client diagnosed with chronic obstructive pulmonary disease (COPD). Which discharge instructions should the nurse provide regarding the client's prednisone, a glucocorticoid? Select all that apply. 1. Explain the prednisone must be tapered when discontinuing. 2. Take the prednisone with food to prevent gastrointestinal upset. 3. Stop taking the prednisone if a noticeable weight gain occurs. 4. Keep the prednisone in a dark-colored bottle at all times. 5. The medication will increase the risk of developing an infection.

87. 1. The PEFR is defined as the maximal rate of air flow during expiration; it can be measured with a relatively inexpensive, handheld device. If the peak flow is less than 80% of the client's personal best, more frequent monitoring should be done. The PEFR should be measured every morning. 2. A normal respiratory assessment does not indicate that the medication regimen is effective and has "good" or "bad" control. 3. Three asthma attacks in the past month would not indicate the client has "good" control of the reactive airway disease. 4. A serum theophylline level between 10 and 20 μg/mL indicates the medication is within the therapeutic range, but it is not the best indicator of the client's control of the signs or symptoms.

87. Which assessment data best indicates the client with reactive airway disease has not achieved "good" control with the medication regimen? 1. The client's peak expiratory flow rate (PEFR) is greater than 80% of his or her personal best. 2. The client's lung sounds are clear bilaterally both anteriorly and posteriorly. 3. The client has only had three acute exacerbations of asthma in the past month. 4. The client's monthly serum theophylline level is 18 μg/mL

88. 1. Steroids increase insulin resistance; this would be an expected effect of the prednisone. The nurse would not question administering this medication. 2. This WBC is elevated and indicates an infection. Antibiotics are administered for bacterial infections. The nurse would not question administering this medication. 3. The therapeutic range for this control would be 59-78 seconds. This is an extremely high PTT level, and the client is at risk for bleeding. The heparin should be discontinued immediately. The nurse would question this medication. 4. This theophylline level is in the therapeutic range (10-20 mg/dL); the nurse would not question administering this medication.

88. The nurse is preparing to administer the following medications. Which client should the nurse question administering the medication? 1. The client receiving prednisone, a glucocorticoid, who has a glucose level of 140 mg/dL. 2. The client receiving ceftriaxone (Rocephin), an antibiotic, who has a white blood cell count of 15,000. 3. The client receiving heparin, an anticoagulant, who has a PTT of 108 seconds with a control of 39. 4. The client receiving theophylline (Theo-Dur) who has a theophylline level of 12 mg/dL.

89. 1. The INR is outside of therapeutic range; therefore, the nurse should question administering this medication. 2. Vitamin K is the antidote for Coumadin toxicity. Protamine sulfate is the antidote for heparin toxicity. 3. There is no reason to notify the HCP to request an increase in the dose; the dose should be discontinued. The HCP should be notified of this abnormal lab data. 4. When the nurse is administering Coumadin, the International Normalized Ratio (INR) must be monitored to determine therapeutic level, which is 2-3. Because the INR is 4.2, the nurse should not administer this medication.

89. The nurse is preparing to administer warfarin (Coumadin), an anticoagulant. The client's current laboratory values are as follows: PT 48 PTT 40 Control 12.9 Control 36 INR 4.2 Which intervention should the nurse implement? 1. Question administering the medication. 2. Prepare to administer protamine sulfate. 3. Notify the health-care provider to increase the dose. 4. Administer the medication as ordered.

9. 1. The therapeutic level for theophylline is 10-20 μg/mL; therefore, the nurse should continue to monitor the medication because this is within therapeutic range. 2. If the serum theophylline level rises above 20 μg/mL, the client will experience nausea, vomiting, diarrhea, insomnia, and restlessness. This theophylline level may result in serious effects such as convulsion and ventricular fibrillation; therefore, the client should not be assessed first. 3. The nurse should not discontinue the medication because the client's blood level is within therapeutic range. 4. There is no reason to notify the HCP because the theophylline level is within the therapeutic range.

9. The client admitted for an acute exacerbation of reactive airway disease is receiving intravenous aminophylline. The client's serum theophylline level is 18 μg/mL. Which intervention should the nurse implement first? 1. Continue to monitor the aminophylline drip. 2. Assess the client for nausea and restlessness. 3. Discontinue the aminophylline drip. 4. Notify the health-care provider immediately.

90. 1. The client's WBC count indicates a normal value, which would indicate the medication is effective. 2. This culture indicates there is still infection; therefore, the medication is not effective. 3. This indicates medication compliance, not effectiveness of the medications. 4. Pleurisy is noncardiac chest pain, which indicates that the medication is not effective.

90. The nurse is caring for a client diagnosed with pneumonia. Which data indicates the antibiotic therapy has been effective? 1. The white blood cell count is 7.2 (103) mg/dL. 2. The C&S shows gram-negative rods. 3. The client completed taking all the prescribed antibiotics. 4. The client complains of pleurisy.

91. 1. NSAIDs decrease prostaglandin and increase the client's risk for ulcer disease. They are contraindicated for use in clients diagnosed with ulcer disease. The nurse should question this medication. 2. Prilosec is prescribed to treat duodenal and gastric ulcers; the nurse would not question this medication. 3. Hypokalemia can increase digoxin toxicity. This potassium level is within normal range (3.5-5.5 mEq/L); the nurse would not question this medication. 4. Riopan is a low-sodium antacid and is the antacid of choice for clients diagnosed with CHF. The nurse would not question this medication.

91. The nurse is administering 0800 medications. Which medication should the nurse question? 1. Ibuprofen (Motrin), a nonsteroidal anti-inflammatory drug, to a 49-year-old female with a peptic ulcer. 2. Omeprazole (Prilosec), a proton-pump inhibitor, to an 18-year-old male with a duodenal ulcer. 3. Digoxin (Lanoxin), a cardiotonic, to a 76-year-old male with a potassium level of 4.2 mEq/L. 4. Riopan, an antacid, to a 67-year-old client diagnosed with congestive heart failure who is complaining of indigestion.

92. 1. The suppository should be retained for 1-3 hours if possible to get the maximum benefit of the medication. This statement indicates the client does not understand the medication teaching. 2. The client should use caution when using the suppository because it may stain clothing, flooring, painted surfaces, vinyl, enamel, marble, granite, and other surfaces. This statement indicates the client understands the teaching. 3. The medication should be stored at room temperature away from moisture and heat. This indicates the client understands the teaching. 4. The client should empty the bowel just before inserting the rectal suppository. This statement indicates the client understands the teaching.

92. The client diagnosed with inflammatory bowel disease is prescribed mesalamine (Asacol) suppository, an aspirin product. Which statement indicates the client needs more medication teaching? 1. "I should retain the suppository for at least 15 minutes." 2. "The suppository may stain my underwear or clothing." 3. "I should store my medication in my medication cabinet." 4. "I should have an empty rectum when applying the suppository."

93. 1. No one but the client should push the PCA button. If the client has pain, the client should push the button. Family members administering doses "whenever" could overdose the client. This statement indicates the client and family do not understand the correct use of the PCA. 2. The client should premedicate himself or herself with the PCA so that effective coughing, deep breathing, and turning can be performed with some degree of comfort. This indicates the client understands the teaching. 3. The family should let the client decide when he or she is in pain and the client should use the PCA at that time. This statement indicates the family does not understand the correct use of the PCA. 4. The client should use the PCA before the pain level reaches this level. This statement indicates the client does not understand the correct use of the PCA.

93. The client post-gastrectomy has a patient-controlled analgesia (PCA) pump. Which data indicates the client and family understand the instructions regarding the PCA pump? 1. The family pushes the PCA button whenever the time limit has expired. 2. The client uses the PCA before turning, coughing, and deep breathing. 3. The family discourages the client from using the PCA pump. 4. The client pushes the PCA button when the pain is an 8 or 9 on the pain scale of 1-10

94. 1. Medications alone will not guarantee weight loss. The client should exercise regularly and limit calories to lose an appreciable amount of weight. 2. Some of the medications have drug interactions with selective serotonin reuptake inhibitors, MAO inhibitors, triptans, and some opioids but not with antihypertensive medications. 3. These symptoms indicate serotonin syndrome and can be life threatening. The nurse should teach the client to monitor the pulse and blood pressure and report significant changes. 4. The medications are prescribed for up to a year at a time.

94. The client who is obese is prescribed sibutramine (Meridia), a selective serotonin reuptake inhibitor, therapy to aid in weight reduction. Which information should the nurse teach the client? 1. While taking the medications the client does not need to limit the caloric intake. 2. The medications cannot be taken with antihypertensive medications. 3. Report a sustained increase of heart rate and blood pressure immediately. 4. The client will be taking the medications for 2 or 3 weeks at a time.

95. 1. This is true, but the client is using stimulant laxatives on a daily basis. This is not the most important teaching. 2. Fluids are increased when taking bulk laxatives so that fluid is available to increase the volume of stool. 3. If the client insists on taking a laxative daily, it should be a bulk-forming laxative such as Metamucil. This type of laxative encourages the bowel to perform its normal job and will not harm the integrity of the bowel. Stimulant laxative use over time causes a narrowing of the lumen of the bowel and will increase the likelihood of obstipation and bowel obstruction. 4. Increasing the amount of stimulant laxative will increase the potential for serious complications related to laxative abuse.

95. The elderly male client diagnosed with diverticulosis tells the nurse he takes bisacodyl (Dulcolax), a stimulant laxative, daily. Which teaching is most important for the nurse to provide the client? 1. "It is not necessary for you to have a bowel movement every day." 2. "You need to increase fluids to prevent dehydration when taking this medication." 3. "You should use a bulk laxative when taking laxatives daily." 4. "You will need to increase the dose of laxative if you do not get good results."

96. 1. The nurse cannot delegate care of a client who is unstable, and hypoglycemia is a complication of treatment for diabetes mellitus. 2. The treatment of choice for a client who is conscious and experiencing a hypoglycemic reaction is to administer food or a source of glucose, but it is not the first intervention. Orange juice is a source of glucose and the UAP can get it. 3. The nurse should check the MAR to determine when the last dose of insulin or oral hypoglycemic medication was administered, but it is not the first intervention. 4. These are symptoms of a hypoglycemic reaction and the nurse should assess the client immediately; therefore, this is the first intervention.

96. The unlicensed assistive personnel (UAP) notified the primary nurse that the client is complaining of being jittery and nervous and is diaphoretic. The client is diagnosed with diabetes mellitus. Which interventions should the primary nurse implement first? 1. Have the UAP check the client's glucose level. 2. Tell the UAP to get the client some orange juice. 3. Check the client's Medication Administration Record. 4. Immediately go to the room and assess the client.

97. 1 According to the sliding scale, blood glucose results should be verified when less than 60 or greater than 400. 2. The HCP does not need to be notified unless the blood glucose is greater than 400. 3. The client's reading is 299; therefore, the nurse should administer six units of regular insulin as per the HCP's order. 4. There is no reason for the nurse to recheck the results.

97. The nurse is administering medications to a client diagnosed with Type 1 diabetes. The client's 1100 glucometer reading is 299. Which intervention should the nurse implement? 1. Have the laboratory verify the glucose results. 2. Notify the health-care provider of the results. 3. Administer six units of regular insulin subcutaneously. 4. Recheck the client's glucometer reading at 1130.

98. 1. Constipation does not determine the effectiveness of the medication. 2. Steatorrhea (fatty, frothy, foul-smelling stools) or diarrhea indicates a lack of pancreatic enzymes in the small intestines. This would indicate the dosage is too small and needs to be increased. 3. Normal bowel movements indicate the medication is effective in preventing steatorrhea. 4. Normal bowel sounds would not indicate the medication is effective.

98. The client diagnosed with chronic pancreatitis is prescribed the pancreatic enzyme Pancrease. Which data indicates the medication is effective? 1. No bowel movement for 3 days. 2. Fatty, frothy, foul-smelling stools. 3. Brown, soft, formed stools. 4. Normal bowel sounds in four quadrants.

99. 1. The major symptom with DI is polyuria resulting in polydipsia (extreme thirst); therefore, the client being thirsty indicates the medication is not effective and would warrant notifying the health-care provider. 2. If the client is able to sleep throughout the night, this indicates the client is not up urinating as a result of polyuria; therefore, the medication is effective. 3. A weight loss of 1 pound would not warrant notifying the health-care provider. 4. The client only urinating five times a day indicates the medication is effective; therefore, the client would not have to notify the HCP.

99. The client diagnosed with diabetes insipidus (DI) is receiving desmopressin (DDAVP), a pituitary hormone, intranasally. Which assessment data warrants the client notifying the health-care provider? 1. The client complains of being thirsty all the time. 2. The client is able to sleep through the night. 3. The client has lost 1 pound in the past 24 hours. 4. The client has to urinate at least five times daily.