EnweQuiz3

vancomycin 1 g in 250 mL d5W over 2 hr...

125 mL/hr

A nurse is preparing to administer furosemide (Lasix) 40 mg IV. Available is furosemide 10 mg/1 mL. How many mL should the nurse administer to the client? (Round to the nearest whole number.)

4 mL

Calculate the drops per minute of an IV bolus of 500 ml of LR to be infused over 3 hours using 20 drop/ml tubing. (Round the answer to the nearest whole number.)

56 gtts/min

A nurse is preparing to administer 250 mg of antibiotic IM. Available is 3 g/5mL. How many mL should the nurse administer to the client? (Round to the nearest tenth.)

0.4 mL ​3 g = 3,000 mg Desired x Quantity ————————— = Amount to give Have 250 mg x 5 mL ——————— = X mL 3,000 mg 1,250 ———— = 0.416 mL 3,000 X (after rounding) = 0.4 mL

A client is prescribed 2 mg morphine sulfate (Duramorph) IV. The medication is dispensed by the pharmacy in vials labeled morphine sulfate, 10 mg/mL. How many mL should the nurse administer per dose?

0.2 mL The amount available is 10 mg/mL. The amount prescribed is 2 mg.Set up an equation:10 mg = 2 mg 1 mL X mLCross multiply and solve for X. 1(2) = 10X X = 0.2 mL

A nurse is preparing to administer hydrocodone/acetaminophen (Lortab) 5 mg. It is available in 7.5 mg/500 mg/15 mL elixir. How many mL should the nurse administer? (Round the answer to the nearest whole number.)

10 mL

A newborn who weighs 1,260 g on admission is prescribed a dose of cephazolin (Kefzol). The safe dose of cephazolin for a newborn is 50 mg/kg. How many mg does the nurse determine is a safe dose to administer to the newborn?

63 mg

A nurse is giving discharge instructions to a client who has asthma and is about to start taking zileuton (Zyflo). The nurse should tell the client to report which of the following adverse effects to the provider? ​A. Blurred vision ​B. Headache ​C. Diarrhea ​D. Abdominal pain

​D. Abdominal pain ​Zileuton can cause liver damage and hepatitis. The client should report any signs of hepatic toxicity, such as abdominal pain or jaundice.

A nurse is monitoring the flow rate of an IV solution prescribed to infuse at 100 mL/hr using a drop factor 15 gtt/mL. The nurse should ensure the flow rate is set to infuse how many gtt/min?(Round to the nearest whole number)

25 gtt/min

A client is prescribed an IV drip medication to infuse at 4 mcg/min to maintain the diastolic blood pressure of less than 80 mmHg. The solution strength is 6 mg in 1000 mL 5% dextrose in water. Calculate the rate of infusion mL/hr.

40 mL/hr The nurse can use a variety of methods to solve this problem. Dimensional analysis was used in this situation. 1000 mL X 4 mcg = 4000 = 0.666 X 60 min = 39.96 or 40 mL/hr 6000 mcg 1 min 6000 1 hr

A nurse is caring for a child in status asthmaticus. Which of the following is the priority action for the nurse to take? A. Administer a short-acting β2 -agonist. B. Obtain a peak flow reading. C. Administer a corticosteroid. D. Start intervenous fluids.

A. Administer a short-acting β2 -agonist. Therapy for status asthmaticus is improving ventilation and decreasing airway resistance. Therefore, administering a short-acting β2 -agonist is the priority action for the nurse to take.

A nurse is praparing to administer blood to a client. As the nurse begins to check the 1st unit with another nurse, she notices that the unit of blood is type B and the client's blood type is AB. Which of the following actions should the nurse take? A. Administer the blood as ordered B. Contact the provider for IV orders C. Notify the blood bank D. Notify the blood bank supervisor

A. Administer the blood as ordered ​ Administering the blood as ordered is the action that the nurse should take. Type B blood is compatible with type AB. Type AB blood is considered a universal recipient.

A home health nurse is reviewing the medication list of an older adult client who reports falling a couple of times over the past week. Which of the following medications should the nurse suspect is contributing to the client's falls? A. Alprazolam (Xanax) B. Acetaminophen (Tylenol) C. Docusate sodium (Colace) D. Nystatin (Mycostatin)

A. Alprazolam (Xanax) Alprazolam is a CNS depressant that can cause dizziness and lightheadedness which may be a contributing factor to the client's loss of balance and falling.

A nurse is caring for a client who has poison ivy and dermatitis and is started on dipenhydramine (Benadryl). Which of the following nursing recommendations is appropriate for decreasing the dry mouth associated with the use of dephenhydramine? A. "Drink extra fluids while taking this medication." B. "Chew on sugarless gum or suck on hard, sour candies." C. "Place a humidifier at your bedside every evening." D. "I'll ask your doctor to prescribe Salagen."

B. "Chew on sugarless gum or suck on hard, sour candies." Clients who report dry mouth can get the most effective relief by sucking on hard candies (especially the sour varieties that stimulate salivation), chewing gum, or rinsing the mouth frequently. It is the local effect of these actions that provides comfort to the client.

A nurse is caring for a client who is newly diagnosed with diabetes mellitus and is prescribed glipizide (Glucotrol). When instructing the client about this medication, the nurse should describe its method of action with which of the following statements? A. "Glucotrol absorbs the excess carbohydrates in your system." B. "Glucotrol stimulates your pancreas to release adequate insulin." C. "Glucotrol replaces insulin that is not being produced by your pancreas." D. "Glucotrol prevents your liver from destroying your insulin."

B. "Glucotrol stimulates your pancreas to release adequate insulin." Glipizide is an oral antidiabetic medication in the pharmacological classification of sulfonylurea agents. These medications help to lower blood glucose levels in clients who have type 2 diabetes mellitus using several methods, including reducing glucose output by the liver, increasing peripheral sensitivity to insulin, and stimulating the release of insulin from the beta cells of the pancreas.

A nurse is teaching a patient who has rheumatoid arthritis about taking methotrexate (Rheumatrex). The nurse should tell the patient to A. Take it with food to reduce gastric irritation B. Drink 2 to 3 L of water per day to promotes its excretion. C. Take an NSAID to help reduce toxicity. D. Take it in the morning to prevent insomnia.

B. Drink 2 to 3 L of water per day to promotes its excretion. ​Methotrexate can cause renal toxicity. Adequate hydration promotes its excretion and helps prevent this adverse effect. ​The client should take methotrexate on an empty stomach. ​NSAIDs may increase methotrexate toxicity. The client should not take them with methotrexate. ​Methotrexate is more likely to cause drowsiness than insomnia.

A nurse is talking with a client who is about to start taking nitroglycerin oral, sustained- release capsules (Nitro-Time). Which of the following instructions should the nurse include? A. Take on capsule at the onset of anginal pain B. Stop taking the medication if side effects are troublesome C. Take the medications with meals D. Swallow the capsules whole

D. Swallow the capsules whole ​The client should swallow the capsules whole and not chew or crush them or place them under the tongue. Sustained-release capsules do not act fast enough to stop an anginal attack.Abruptly discontinuing the use of long-acting nitroglycerin capsules can cause vasospasm. The client should take the medication on an empty stomach with 8 oz of water.

A client who has left ventricular failure and a high pulmonary capillary wedge pressure (PCWP) is receiving dopamine IV to improve ventricular function. Which of the following changes indicates to the nurse that medication is having a therapeutic effect? ​A. Systolic blood pressure increases. ​B. QRS width increases. ​C. Apical heart rate increases. ​D. PCWP increases.

​A. Systolic blood pressure increases. ​When dopamine has a therapeutic effect, it causes vasoconstriction peripherally and increases systolic blood pressure.

A nurse is instructing a pediatric client and his family about how methylphenidate (Ritalin) will help manage attention-deficit hyperactivity disorder (ADHD). The nurse should explain that this medication therapy will help ​A. increase focus. B. ​promote rest. ​C. improve appetite. ​D. prevent panic.

​A. increase focus. ​Methylphenidate acts on the cerebral cortex to create a stimulating effect that helps increase focus on metal activities and tasks.

A nurse is talking with a client about taking diphenhydramine (Benadryl). The nurse should explain that the most common side effect of this medication is ​A. sedation. ​B. anxiety. C. ​insomnia. ​D. bradycardia.

​A. sedation. ​The most common adverse effect of diphenhydramine, a first-generation antihistamine, is sedation. In fact, this medication is sometimes used as a sleep aid.

A nurse observes the parent of an infant administer a prescribed oral medication. Which of the following actions by the parent indicates a need for further instruction ​A. Wraps infant in a blanket ​B. Administers medication with an oral syringe ​C. Positions infant in a supine position ​D. Inserts medication in the buccal cavity

​C. Positions infant in a supine position ​An infant should be held in a semi-upright position when administering medication. Placing an infant in a supine position will increase the risk of aspiration and should be avoided.

A nurse is monitoring a client's transfusion of packed red blood cells and suspects that a hemolytic reaction is occuring. Which of the following is the priority intervention? ​A. Assess the client's respiratory rate. ​B. Administer 0.9% sodium chloride through the IV line. ​C. Stop the transfusion. ​D. Notify the blood bank.

​C. Stop the transfusion. ​When suspecting a hemolytic reaction the priority action by the nurse is to immediately stop the transfusion to prevent further hemolysis.

A client who is postoperative following a transurethral resection of the prostate (TURP) has a new prescription for bethanechol (Urecholine) PRN. The nurse should administer this medication if the client reports? ​A. bladder spasms. ​B. severe pain. ​C. an inability to void. ​D. frequent episodes of painful urination.

​C. an inability to void. ​Bethanechol is a cholinergic medication that stimulates the parasympathetic nervous system, thus improving the tone and motility of the smooth muscles of the urinary tract enough to initiate urination.

A nurse is teaching a client who has angina pectoris about starting therapy with nitrroglycerin (Nitrostat) tablets. The nurse should instruct the client to take the medication A. ​after each meal and at bedtime. B. every 15 min during an acute attack. ​C. at the first indication of chest pain. ​D. with 8 oz of water.

​C. at the first indication of chest pain. ​The client should take nitroglycerin as soon as he feels pain, pressure, or tightness in his chest and, not wait until his chest pain is severe.

A nurse is caring for a client. The client states, "I don't want to take my medication". Which of the following actions should the nurse take? ​A. Tell the client the physician wants the client to take the medicine. ​B. Ask the client why he refuses to take the medication. ​C. Explain the purpose for the medication. ​D. Document that the client refuses the medication.

​D. Document that the client refuses the medication. ​The client has the right to refuse the medication. It is appropriate for the nurse to document the client's wishes.

A nurse is to administer a rectal suppository to a client. The nurse should instruct the client to lie in which of the following position's while in bed? ​A. Sim's position ​B. Prone position ​C. Lying on the right side ​D. Lying on the left side

​S. Sim's position ​The Sim's position exposes the anus and helps the client relax the external sphincter while lying in bed. This allows for easier insertion of the suppository.

A nurse is caring for a client who takes levothyroxine (Synthroid) 88 mcg/day PO, furosemide (Lasix) 100 mg/day PO, acyclovir (Zovirax) 200 mg PO BID, and cimetidine (Tagamet) 300 mg PO QID. Which one of the following medications poses the highest risk for life-threatening adverse effects? A. Levothyroxine B. Furosemide C. Acyclovir D. Cimetidine

B. Furosemide ​Furosemide has the potential for life-threatening cardiac dysrhythmias. The drug causes potassium loss, and with the relatively high dose of 100 mg/day, hypokalemia can develop easily, leading to ventricular dysrhythmias.

A nurse is preparing to administer cefazolin (Ancef) 1g in dextrose 5% in water 100 mL over 30 min. The IV tubing drop factor is 10 gtt/mL. The nurse should administer the medication at how many gtt/min? (Round the answer to the nearest whole number.)

33 gtt/min ​gtt = 10 gtt x 100 mL = 10 gtt x 100 = 1,000 gtt = 33.3 = 33 gtt/min

A client who has a gastric ulcer is about to start taking sucralfate (Carafate). The nurse determines that teaching... ​every 4 hr around the clock. ​after each meal. ​with meals and first thing in the morning. ​1 hr before meals and at bedtime.

​1 hr before meals and at bedtime. ​Sucralfate creates a protective coating over the ulcer. To achieve this, the client should take it on an empty stomach - 1 hr before each meal and at bedtime.

A nurse is interviewing a client during a yearly health assessment. The client reports occasionally taking several over the counter (OTC) medications, including H-2 blockers, as needed. When evaluating th effectiveness of H2 blocker therapy, the nurse should assess for A. relief of heartburn B. cessation of diarrhea C. passage of flatus D. absence of constipation

A. relief of heartburn Histamine H2-receptor antagonists, also known as H2-blockers, are used to treat duodenal ulcers and prevent their return. In OTC strengths, these medicines are used to relieve or prevent heartburn, acid indigestion, and sour stomach.

A nurse is caring for a client who has supraventricular tachycardia. In addition to an electrocardiogram, which of the following assesment parameters should the nurse monitor closely during IV administration of verapamil (Calan)? A. Respiratory rate B. Blood pressure C. Urine output D. Level of consciousness

B. Blood pressure Verapamil, a calcium channel blocker, can be used to control supraventricular tachyarrhythmias. It also decreases blood pressure and acts as a coronary vasodilator and antianginal agent. A major side effect of verapamil is hypotension; therefore, blood pressure and pulse must be monitored before and during parenteral administration.

A nurse is teaching a client who has asthma the appropriate use of inhaled beclomethasone (Beclovent). To avoid complications related to the use of beclomethasone, the nurse should encourage the client to A. check the pulse after medication administration. B. take the medication with meals. C. rinse the mouth after administration. D. limit caffeine intake.

C. rinse the mouth after administration. Use of glucocorticoids by metered dose inhaler can allow a fungal overgrowth in the mouth. Rinsing the mouth after administration can lessen the likelihood of this complication.

A client in the hospital is prescribed digoxin (Lanoxin) 125 mcg. The computerized medication delivery system on the unit dispenses tablets labeled digoxin 0.25mg. How many tablets should the nurse dispense to the client?

0.5 tablets

A client's provider prescribes 3,000 mL of dextrose 5% in 0.45% sodium chloride to infuse IV over 24 hr. The nurse initiates an IV infusion of 1,000 mL of this fluid at 0800. At what time should the nurse prepare to initiate the second 1,000 mL bag? (Document the response in 24-hr [military] time.)

1600 ​1,000-mL bag should infuse for 8 hr, for a total of 3,000 mL in 24 hr. The nurse should initiate the second 1,000 mL-bag at 1600 and the third at 0000 (midnight).

A nurse is preparing to administer digoxin (Lanoxin) 10 mcg/kg to a client who weighs 209 lb. The medication is available as 0.5 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest whole number.)

2 mL ​209 lb/2.2 = 95 kg (client's weight)95 kg x 10 mcg = 950 mcg (this is the total mcg to be given)950 mcg/1,000mg = 0.95 mg (this is the total mg to be given)0.95 mg/0.5 mg = 1.9 mL (this is the total mL to be given)Round 1.9 to the nearest whole number: 2 mL

A nurse is preparing to administer desmopressin (Vasopressin) 0.2 mg daily to a client. Available is 0.1 mg tablets. How many tablets should the nurse administer? (Round the answer to the nearest whole number.)

2 tablets ​Required dose/available dose = dose to administer to client. 0.2 mg/0.1 mg = 2 tablets

A client is prescribed a heparin IV infusion at 1,200 units/hr. Heparin comes premixed from the pharmacy in 25,000 units per 500 mL D5W. At how many mL /hr should the nurse set the IV pump?

24 mL/hr The client is prescribed 1,200 units/hr. Set up an equation to determine how many mL of fluid contains 1,200 units. 25,000 units = 1,200 units 500 mL X mL Cross multiply and solve for X. 500 (1,200) = 25,000 X 600,000 = 25,000X X = 24 mL IV pumps can only be set to deliver hourly rates. The nurse should set the pump to deliver 24 mL/hr.

A client prescribed an IV infusion of D 5 1/4 NS at 150 mL/hr. There are no IV pumps available, so the nurse must hang the solution on gravity flow tubing. The tubing has a drop factor of 10 gtt/mL. The nurse should adjust the IV to run at how many gtt/min?

25 gtt/min Set up the equation: gtt/min = total mL x gtt factor total min 1 hr = 60 min gtt/min = 150 mL x 10 gtt/mL 60 min gtt/min = 25 The nurse should sets the IV at 25 gtt/min.

A provider prescribes 2 g of a medication to give to a client in eight divided doses over the next 24 hr. How many mg should the nurse administer for each dose?

250 mg

A provider prescribes 1 L of dextrose 5% in 0.45% sodium chloride to infuse at 100 mL/hr. The nurse is using microtubing. The nurse should adjust the IV flow rate to deliver how many gtt/min? (Round to the nearest whole number.)

100 gtt/min ​Microtubing has a drop factor of 60. Volume to be infused x Drop factor (gtt/mL) = IV flow rate (gtt/min) Time (min) 100 mL x 60 gtt/mL = 6,000 = 100 gtt/min 60 60

A nurse is attempting to administer a dose of lactulose (Cephulac) to a client who has cirrhosis when the client states, "I don't need this medication. I am not constipated." The nurse should explain that lactulose is also used to decrease serum A. glucose. B. ammonia. C. potassium. D. bicarbonate.

B. ammonia. Lactulose, a disaccharide, is a sugar that works as an osmotic diuretic. It prevents absorption of ammonia in the colon. Accumulation of ammonia in the bloodstream, which occurs in pathologic conditions of the liver, such as cirrhosis, may affect the central nervous system, causing hepatic encephalopathy or coma.

A nurse is giving discharge instructions to a client who has asthma and is about to start using beclomethasone (QVAR). The nurse should tell the client to report which of the following adverse effects to the provider? ​A. Tremors ​B. Nausea C. ​White coating in the mouth ​D. Dry oral mucous membranes

C. ​White coating in the mouth ​Beclomethasone, an inhaled glucocorticoid, may cause oropharyngeal candidiasis. Patients should gargle after each use, use a spacer to reduce the amount of drug in the mouth and throat, and report any white patches inside the mouth or on the tongue.

A hospice nurse makes weekly visits to a client who has terminal cancer. For several weeks, the client has been taking morphine sulfate for pain relief. At today's visit the client reports to the nurse that the usual dose of morphine does not seem to be working. The nurse should understand that the most likely explanation is that the client has A. not been taking the medication properly. B. experienced episodes of confusion. C. become addicted to the medication. D. developed a tolerance to the medication.

D. developed a tolerance to the medication. Morphine sulfate is a narcotic analgesic used for the treatment of severe pain. Tolerance is an undesirable side effect of narcotic analgesics in which a larger dose is needed to produce the same response.

A nurse is caring for a client who is prescribed furosemide (Lasix). Which of the following adverse effects should the nurse monitor? ​A. Hypervolemia ​B. Hypertension C. ​Hypokalemia ​D. Hypoglycemia

​C. Hypokalemia ​Hypokalemia is an adverse effect of furosemide.

A nurse is preparing to administer amoxicillin (Amoxil) 350 mg PO. Available is amoxicillin 250 mg/5 mL. How many mL should the nurse administer? (Round to the nearest whole number.)

7 mL ​Desired x Quantity ——————————= Amount to give Have 350 mg x 5 mL ———————= X mL 250 mg 1,750 —— = X mL 250 X = 7 mL

A client is to receive 500 mg of an antibiotic via IV bolus every 6 hr. Available is 2 g/5 mL after reconstitution with sterile water....

1.25 mL Desired x Quantity ————————— = Amount to be given Have 500 mg x 5 mL ——————— = X mL 2 g 2 g = 2000 mg 500 mg x 5 mL ——————— = X mL 2000 mg 2500 ———— = 1.25 mL 2000 X = 1.25 mL

A provider prescribes lactated Ringer's solution IV to infuse at 120 mL/hr for a client who has respiratory disorder. The drop factor on the manual IV tubing is 60 gtt/mL. The nurse should set the IV flow rate to deliver how many gtt/min? (Round to the nearest whole number.)

120 gtt/min MY ANSWER ​Volume to infuse x Drop factor (gtt/mL) = IV flow rate (gtt/min) Time (min) 120 mL x 60 gtt/mL = 7200 = 120 gtt/min 60 min 60

A client with a severe infection is prescribed IV vancomycin (Vancocin) 1 g in 250 mL D5W over 2 hr. The nurse should set the IV pump to infuse at how many mL/hr?

125 mL/hr 250 mL ÷ 2 hr = 125 mL/hr IV pumps can only be set to deliver hourly rates.

A provider prescribes 40 mEq of potassium chloride to infuse in 500 mL of dextrose 5% in water at the rate of 10 mEq/hr. The nurse should set the IV pump to deliver how many mL/hr to the client? (Round to the nearest whole number.)

125 mL/hr ​40 mEq = 10 mEq 500 mL X 5,000 = 40X X = 125 mL/hr

A nurse is monitoring a client's IV site. Which of the following findings are associated with phlebitis and should be reported to the RN ? (Select all that apply). 1. Erythema ​2. Damp dressing ​3. Throbbing 4. ​Warmth at insertion site ​5. Streak formation

1. Erythema ​3. Throbbing 4. ​Warmth at insertion site ​5. Streak formation ​Erythema is correct. Erythema is a reddened area at the insertion site and may be accompanied by throbbing, burning, and increased skin temperature. Damp dressing is incorrect. A damp dressing is associated with infiltration. Other indicators of infiltration include pallor, local swelling, and decreased skin temperature. Throbbing is correct. Throbbing and pain at the insertion site are indicators of vein inflammation. Warmth at insertion site is correct. Responses to inflammation include warmth and redness of the affected tissue. Streak formation is correct. Streak formation is a classic indicator of advanced phlebitis.

A provider prescribes 400 mg of dopamine (Intropin) to infuse in 250 mL of dextrose 5% in water at the rate of 300 mcg/kg/hr for a client who weighs 80 kg and requires hemodynamic support. The nurse should set the IV pump to deliver how many mL/hr to the client? (Round to the nearest whole number.)

15 mL/hr ​300 mcg/kg/hr = 300 mcg x 80 kg = 24,000 mcg/hr 1 mg = 1,000 mcg 24,000 mcg = 24 mg 400 mg = 24 mg 250 mL X 6,000 = 400X X = 15 mL/hr

A client is prescribed 50 mg chlorpromazine (Thorazine) IM. The medication is dispensed by the pharmacy in vials labeled 25 mg/mL. How many mL should the nurse administer?

2 mL Set up an equation: 25 mg = 50 mg 1 mL X mL Cross multiply and solve for X. 1(50) = 25X 50 = 25X X = 2 mL The nurse administer will administer 2 mL chlorpromazine per dose.

A nurse is teaching a client who is about to start therapy with alendronate (Fosamax) to treat osteoporosis. Which of the following adverse effects should the nurse instruct the client to report? 1. Tinnitus 2. Jaw pain 3. Blurred vision 4. Drowsiness 5. Dysphagia

2. Jaw pain 3. Blurred vision 5. Dysphagia ​Tinnitus is incorrect. Alendronate is unlikely to cause tinnitus. Salicylate toxicity is a common cause of tinnitus. Jaw pain is correct. Alendronate can cause osteonecrosis of the jaw, so the client should report this effect to the provider. Blurred vision is correct. Alendronate can cause ocular inflammation, so the client should report vision problems to the provider. Drowsiness is incorrect. Alendronate is unlikely to cause drowsiness. It can, however, cause headache. Dysphagia is correct. Alendronate can cause esophagitis, so the client should report any difficulty or pain with swallowing.

A client with severe pancreatitis is receiving total parenteral nutrition (TPN). The physician prescribes 1,800 mL to be infused at a continuous rate over 24 hr. At how many mL/hr should the nurse set the IV pump?

75 mL /hr 1,800 mL ÷ 24 hr = 75 mL/hr IV pumps can only be set to deliver hourly rates.

A nurse is administering a unit of RBC (350 mL) to a client who has a low hemoglobin. The infusion rate of the unit of blood is started at 42 gtt/min and drop factor of the IV tubing is 10 gtt/mL . Calculate the number of minutes to infuse the blood . (Round the answer to the nearest whole number.)

83 minutes STEP 1: What is the unit of measurement to calculate? gtt/min STEP 2: What is the volume needed? 350 mL STEP 3: What is the total infusion time? x STEP 4: Should the nurse convert the units of measurement? No STEP 5: Set up an equation and solve for X. Volume (mL)/Time (min) x drop factor (gtt)/1 mL = x 350 mL/X x 10 gtt/1 mLr = 42 gtt x= STEP 6: Round if necessary. 83.3333 = 83 minutes STEP 7: Reassess to determine if the amount to administer makes sense. If the amount prescribed is 350 mL with a 10gtt/min that infuses at 42gtt/min, it makes sense that an infusion would take 83 min to administer. The nurse should run the manual IV infusion for 83 m in.

A nurse is assessing a client who has numerous bruises on his upper extremities. The client reports that he has taken warfarin (Coumadin) daily for the past 3 months. Which of the following statements by the client indicates the client needs further teaching? A. "I have started taking ginger root to treat my joint stiffness." B. "I take Tylenol whenever I have a headache." C. "I eat a green salad every night with dinner." D. "I had my INR checked three weeks ago."

A. "I have started taking ginger root to treat my joint stiffness." Ginger root can interfere with the blood clotting effect of warfarin and place the client at risk for bleeding. This statement indicates the client needs further teaching. Clients who are taking warfarin can use acetaminophen (Tylenol) for mild to moderate pain relief. However, they should avoid taking more than 1 g/day and using for more than 2 to 3 days at a time. Green leafy vegetables are a good source of vitamin K, which can interfere with the clotting effects of warfarin. Clients who are taking warfarin do not need to restrict vitamin K intake but instead maintain a consistent intake of vitamin K in order to control the therapeutic effect of the medication. Clients who have been taking warfarin for more than 3 months should have an INR level checked every 2 to 4 weeks.

A nurse is caring for a client who is hospitalized with deep vein thrombosis and has been on IV heparin for 5 days. The provider prescribes oral warfarin (Coumadin) without discontinuing the heparin. The client asks that nurse why both anticoagulants are necessary. Which of the following is an appropriate nursing response? A. "The Coumadin takes several days to work, so the IV heparin will be used until the Coumadin reaches a therapeutic level." B. "I will call the provider to get a prescription for discontinuing the IV heparin today." C. "Both heparin and Coumadin work together to dissolve the clots." D. "The IV heparin increases the effects of the Coumadin and decreases the length of your hospital stay."

A. "The Coumadin takes several days to work, so the IV heparin will be used until the Coumadin reaches a therapeutic level." Heparin and warfarin are both anticoagulants that decrease the clotting ability of the blood and help prevent thrombosis formation in the blood vessels. However, these medications work in different ways to achieve therapeutic coagulation and must be given together until therapeutic levels of anticoagulation can be achieved by warfarin alone, which is usually within 1 to 5 days. When the client's PT and INR are within therapeutic range, the heparin can be discontinued.

A nurse is caring for a client who was admitted to the hospital with congestive heart failure (CHF) and is taking digoxin (Lanoxin) 0.25mg daily. The client refused breakfast and is complaining of nausea and generalized weakness. Which of the following actions should the nurse perform first? A. Check the client's vital signs. B. Request a dietitian consult. C. Suggest that the client rests before eating the meal. D. Request an order for an antiemetic.

A. Check the client's vital signs It is possible that the client's nausea is secondary to digoxin toxicity. By obtaining vital signs, the nurse can assess for bradycardia, which is a symptom of digoxin toxicity. The nurse should withhold the drug and call the provider if the client has bradycardia.

A nurse is talking with a client who is about to start taking captopril (Capoten) to treat hypertension. Which of the following instructions should the nurse include to help the client manage this medication's adverse effects? A. Do not use salt substitutes while taking this medication. B. Eat a meal before taking this medication. C. Count your pulse rate before taking this medication. D. Expect to gain weight while taking this medication.

A. Do not use salt substitutes while taking this medication. ​Captopril, an ACE inhibitor, can cause hyperkalemia due to potassium retention by the kidney. The client should avoid salt substitutes, as most of them are high in potassium.

A nurse is monitoring a client who is receiving a parental lipid infusion. Which of the following findings is the highest priority for the nurse to report to the provider? A. Elevated temperature B. Hyperlipidemia C. Periorbital edema D. Erythema at the insertion site

A. Elevated temperature​ The nurse should immediately report an elevated temperature to the provider as this is a potential sign of an allergic reaction or fat overload syndrome. According to the safety and risk reduction priority setting framework, this finding is the highest priority.

A nurse is caring for a client who is taking levothyroxine (Synthroid). Which of the following manifestations should suggest to the nurse that the client may have taken an overdose of levothyroxine? A. Insomnia B. Constipation C. Drowsiness D. Hypoactive deep-tendon reflexes

A. Insomnia Too much levothyroxine will result in manifestations of hyperthyroidism. Insomnia is a manifestation of hyperthyroidism.

A nurse is caring for an adolescent client who has a sarcoma of the femur and is admitted for chemotherapy. The client is to receive ifosfamide (Ifex) and mesna (Mesnex). The nurse should assess for which of the following manifestations of a serious adverse reaction? A. Painful urination and hematuria B. Dependent edema and dyspnea C. Fatigue and muscle weakness D. Paresthesia and paralysis

A. Painful urination and hematuria Ifosfamide, an antineoplastic, is an alkylating agent that slows or stops the growth of cancer cells. Ifosfamide can cause hemorrhagic cystitis, a serious urinary system side effect. The client will be given mesna, a hemorrhagic cystitis prophylactic medication, and will receive intravenous hydration to prevent damage to the kidneys and bladder. The nurse should monitor the client for the development of hemorrhagic cystitis by assessing for the presence of painful urination or hematuria.

A nurse is caring for a client who has a detached retina and is scheduled for surgical repair. Preoperatively, the nurse should prepare to administer which of the following medications? A. Phenlephrine hydrochloride (AK-Dilate) B. Latanoprost (Xalatan) C. Pilocarpine (Pilocar) D. Timolol maleate (Timoptic)

A. Phenlephrine hydrochloride (AK-Dilate) ​Mydriatic drugs such as phenylephrine hydrochloride are used preoperatively so that the pupil is widely dilated.

A nurse is caring a for a 2-year old child who is receiving phenytoin (Dilantin) in suspension form. Which of the following actions should the nurse take before administering each dose? A. Shake the container vigorously. B. Be sure the child has not eaten within the hour. C. Perform mouth care. D. Check the child's blood pressure.

A. Shake the container vigorously. A suspension form of medication refers to one in which the particles of medication are mixed with, but not dissolved in, a fluid. It is important for the nurse to shake the container that contains the suspension, because the child can be under-medicated if the medication is not evenly distributed. Phenytoin is a gastric irritant. It should be given with meals to decrease gastric upset. Mouth care is not necessary prior to every dose. When giving the oral form of phenytoin, this action is not necessary.

A nurse in a clinic is performing a routine examination for a client. The client has a blood pressure of 170/104 mm Hg, and the provider prescribes propanolol (Inderal). The nurse should question the prescription after noting in the client's medical record a history of A. asthma. B. glaucoma. C. depression. D. migraines.

A. asthma. Propranolol, a beta-blocker, is used to treat high blood pressure. It causes bronchospasm because it blocks the sympathetic stimulation for smooth muscle relaxation. Because asthma is characterized by bronchospasm, the use of propranolol is contraindicated in clients who have asthma.

The nurse is caring for a client who takes prednisone (Deltasone) and has developed an infection. The nurse should expect that the provider will A. increase the dosage of prednisone. B. discontinue prednisone therapy. ​C. decrease the dosage of prednisone. ​D. make no changes in the prednisone dosage.

A. increase the dosage of prednisone. increase the dosage of prednisone. ​Infection increases the body's need for glucocorticoids. During times of stress such as infection, the provider should increase the dosage to help prevent adrenal insufficiency in clients who take these medications on a long-term basis.

A nurse is teaching a client with multiple sclerosis who has a new prescription for dantrolene (Dantrium). Which of the following client statements indicates that the client understand the teaching? A. ​"I need to apply a sunscreen when I go outside." ​B. "I can't take pain medications when I'm taking this drug." ​C. "I should take this medication when my spasms are bad." ​D. "My muscle strength should improve a lot in 2 to 3 days."

A. ​"I need to apply a sunscreen when I go outside." ​This medication can cause photosensitivity; therefore, the client should protect her skin by wearing a hat and using sunscreen while in sunlight.

A nurse on a medical unit is caring for a client who has angina pectoris and reports chest pain with a severity of 6 on a 0 to 10 scale. The nurse administer sublingual nitroglycerin (Nitrostat). After 5 min, the client stat the his chest pain is now a 2. Which of the following actions should the nurse take? A. ​Administer another nitroglycerin tablet. ​B. Measure the client's blood pressure. ​C. Check the client's apical heart rate. ​D. Obtain an ECG.

A. ​Administer another nitroglycerin tablet. ​Administration guidelines for sublingual nitroglycerin indicate that it is appropriate to administer another tablet 5 min after the first if the client is still reporting pain.

A nurse is caring for a client who has a detached retina and is scheduled for surgical repair. Preoperatively, the nurse should prepare to administer which of the following medications? A. ​Phenylephrine hydrochloride (AK-Dilate) ​B. Latanoprost (Xalatan) ​C. Pilocarpine (Pilocar) ​D. Timolol maleate (Timoptic)

A. ​Phenylephrine hydrochloride (AK-Dilate) ​Mydriatic drugs such as phenylephrine hydrochloride are used preoperatively so that the pupil is widely dilated.

A nurse is discontinuing a course of prednisone (Deltasone) for a client with an exacerbation of asthma. The nurse should taper the dose so that the client does not experience A. hyperglycemia. B. adrenocortical insufficiency. C. severe dehydration. D. rebound pulmonary congestion.

B. adrenocortical insufficiency. Prednisone, a corticosteroid, is similar to cortisol, the glucocorticoid hormone produced by the adrenal glands. It relieves inflammation and is used to treat certain forms of arthritis, severe allergies, autoimmune disorders, and asthma. Administration of glucocorticoids may depress the body's normal adrenocortical activity, and abrupt withdrawal of the drug can lead to a syndrome of adrenal insufficiency.

A nurse is caring for a client admitted for acute inflammation of the ankle. The provider diagnoses an acute attack of gout and orders colchicine (Colsalide) 2 mg IV now, then 0.5 mg IV every 6 hr. The nurse should know that the purpose of colchicine is to A. reduce serum uric acid levels. B. decrease joint inflammation. C. prevent joint destruction. D. increase phagocytosis in the involved joint.

B. decrease joint inflammation. Clients who have gout have too much uric acid in their blood and joints. An attack of gout occurs when uric acid causes inflammation in a joint. Colchicine is used to relieve an acute attack of gout by decreasing joint inflammation and pain. It inhibits the formation of lactic acid in leukocytes, decreasing phagocytosis and joint inflammation.

A nurse who is teaching a client who is about to start taking docusate (Colace) should make sure that the client understands that this medication should result in A. fewer bowel movements B. regular bowel movements C. relief from nausea D. less diarrhea

B. regular bowel movements ​The intended outcome of docusate therapy is to produce stool that is softer in consistency and easier for the client to pass. That should improve the regularity of the client's bowel movements.

A postoperative client is prescribed an IV infusion of D5 Ringer's Lactate at 120 mL/hr. The tubing has a drop factor of 20 gtt/mL. The nurse should set the IV flow rate to how many gtt/min?

The nurse should set the IV at 40 gtt/min to deliver 120 mL/hr

A nurse is preparing to administer haloperidol (Haldol) 5 mg IM to a client. Available is haloperidol 20 mg/ml. How many mL should the nurse administer? (Round the answer to the nearest hundredth.)

0.25 mL ​X mL = 1 mL x 5 mg = 5 ÷ 20 = 0.25 mL

A nurse is caring for a client who is to receive liquid medications via gastrostomy tube. The client is prescribe phenytoin (Dilantin) 250 mg. The nurse has available unit dose vials of phenytoin that are labeled 125 mg/5 mL. How many mL should the nurse administer per dose?

10 mL Set up an equation using the desired and available doses: 125 mg = 250 mg 5 mL X mL Cross multiply and solve for X: 5(250) = 125X 1,250 = 125X X = 10 mL The nurse should administer 10 mL per dose.

response to losartan (Cozaar) Respirations are unlabored. ​Client reports decreased groin pain of 3 on a 1-10 scale. ​Blood pressure when arising from resting position is at premedication levels. ​Client tolerates ordered dose of medication with no greater than 1+ peripheral edema.

Respirations are unlabored. ​Losartan (Cozaar) is an angiotensin receptor blocker (ARB). Both ARBs and angiotensin converting enzyme (ACE) inhibitors have the adverse effect of angioedema. The primary symptom of angioedema is edema of the tongue, glottis, and pharynx. This results in limitation or blockage of the airway. Angioedema causes the capillaries to become more permeable, resulting in fluid shifting into the subcutaneous tissues. Although the mouth and throat are most often affected, any area may be involved in the process. Untreated angioedema can result in death. Improvement of respiratory effort is the most important indicator of improvement.

A nurse is caring for a client who has a severe infection and is being treated with IV gentamycin sulfate (Garamycin)... at 1400 and 2200. 90 min prior to and 90 min after the next dose. immediately prior to and 30 min after the next dose. at 1100 and 1700.

immediately prior to and 30 min after the next dose. Timing of the peak and trough is based on the pharmacokinetics of absorption and the half-life of the medication. The trough level is the lowest serum level after pharmacokinetic effects have taken place. Correct timing for the trough is up to 15 min prior to administering the next dose. The peak is the highest serum level of the medication; if this level is too low, then the medication will not be effective. Correct timing for the peak is between 30 and 60 min after the dose has finished infusing.

A charge nurse is evaluating the care of a newly licensed nurse as he cares for a client who is receiving a transfusion of packed RBC. The nurse suspects a possible hemolytic reaction. After stopping the blood transfusion, which of the following actions by the newly licensed nurse requires intervention by the charge nurse? ​ A. The nurse initiates an infusion of 0.9% sodium chloride. ​B. The nurse collects a urine specimen. ​C. The nurse sends a blood specimen to the laboratory. ​D. The nurse starts the transfusion of another unit of blood product.

​D. The nurse starts the transfusion of another unit of blood product. ​When suspecting a hemolytic reaction, the nurse should immediately stop the transfusion of all blood products. The transfusion of additional products can increase the client's risk for further complication.

A client has a new prescription for transdermal nitroglycerin (Nitro-Dur) to treat angina pectoris. When talking with the patient about using this drug, the nurse should include which of the following instructions? (Select all that apply.) 1. Apply the patch to a hairless area and rotate sites. ​2. Apply a new patch each morning. ​3. Remove the patch for 10 to 12 hr daily. ​4. Apply the patch to dry skin and cover the area with plastic wrap. ​5. Apply a new patch at the onset of anginal pain.

1. Apply the patch to a hairless area and rotate sites. ​2. Apply a new patch each morning. ​3. Remove the patch for 10 to 12 hr daily. Apply the patch to a hairless area and rotate sites is correct. Hair can interfere with the adhesion of the patch. Rotating sites helps prevent skin irritation. Apply a new patch each morning is correct. Therapeutic preventive effects of transdermal nitroglycerin patches begin 30 to 60 min after application and last up to 14 hr. Remove the patch for 10 to 12 hr daily is correct. Removing the patches for 10 to 12 hr each day helps prevent tolerance to the drug. Apply the patch to dry skin and cover the area with plastic wrap is incorrect. These instructions apply to topical nitroglycerin ointment, not to nitroglycerin patches. Apply a new patch at the onset of anginal pain is incorrect. Nitroglycerin patches prevent angina attacks. They do not treat angina attacks.

A nurse is caring for a preoperative client who is prescribed hydroxyzine (Vistaril). The nurse should know that which of the following are beneficial actions of hydroxyzine for the preoperative client? (Select all that apply.) 1. Controlling emesis 2. Diminishing anxiety 3. Reducing the amount of narcotics needed for pain relief 4. Preventing thrombus formation 5. Drying secretions

1. Controlling emesis 2. Diminishing anxiety 3. Reducing the amount of narcotics needed for pain relief 5. Drying secretions Controlling emesis is correct. Hydroxyzine is an effective antiemetic that may be used to control nausea and vomiting in preoperative and postoperative clients. ​ Diminishing anxiety is correct. Hydroxyzine is an effective antianxiety agent that may be used to diminish anxiety in surgical clients as well as in clients who have moderate anxiety. ​ Reducing the amount of narcotics needed for pain relief is correct. Hydroxyzine potentiates the actions of narcotic pain medications; therefore, when hydroxyzine is used for surgical clients, narcotic requirements may be significantly reduced. ​ Preventing thrombus formation is incorrect. Hydroxyzine, an antihistamine, has no role in the prevention of thrombi. ​ Drying secretions is correct. Hydroxyzine, an antihistamine, commonly causes drying of the oral mucous membranes.

A nurse is preparing to administer 10 units of regular insulin and 20 units of NPH insulin to a client. What is the sequence of events the nurse should follow? 1. Inject air into NPH insulin vial 2. Withdraw short-acting insulin into syringe 3. Roll NPH vial between palms of hands 4. Inspect vial for contaminants 5. Inject air into regular insulin vial 6. Add intermediate insulin to syringe

1. Inspect vials for contaminants. 2. Roll NPH vial between palms of hands. 3. Inject air into NPH insulin vial. 4. Inject air into regular insulin vial. 5. Withdraw short-acting insulin into syringe. 6. Add intermediate insulin to syringe.

A nurse is reinforcing the controlled substance guidlines with a newly licensed nurse. Which of the following should the nurse include in the teaching? (Select all that apply.) 1. ​Count each dose of narcotics in inventory. ​2. Match number of available doses to record. ​3. Sign acceptance of narcotic count if correct. ​4. Check each client MAR to ensure matching records. ​5. Confirm that wasted narcotics are identified on the report form.

1. ​Count each dose of narcotics in inventory. ​2. Match number of available doses to record. ​3. Sign acceptance of narcotic count if correct. ​Count each dose of narcotics in inventory is correct. When counting narcotics, the nurse is expected to visually confirm that all doses of medication are present and count each individual dose that is available. The nurse that is beginning the shift also should confirm that all pills, tablets, and injectables of each type of narcotic match in appearance. Visual inspection for color and amount in each package, as well as the number of doses, is part of the process of counting narcotics. Match number of available doses to record is correct. The nurse should check for the number of remaining or available doses on the narcotics administration record. Most written systems have a number that clearly identifies the number of doses that should be available. This number should match the number seen by the nurse. Sign acceptance of narcotic count if correct is correct. Each of the two nurses who perform narcotic count must sign that the narcotic count is correct. The signature of the nurse coming on shift, as well as acceptance of the narcotic keys, communicates that the count was accurate and responsibility for the controlled substances has been accepted. Check each client MAR to ensure matching records is incorrect. The narcotic administration record that is used with controlled substances is not routinely checked with each client MAR. This step can be included if there is a discrepancy in the narcotic count. It is the responsibility of the nurse counting for the shift that is leaving to rectify any discrepancy in the narcotic count prior to the departure of any member of the staff who administers narcotics. Confirm that wasted narcotics are identified on the report form is incorrect. It is the responsibility of the nurse who will not use all or part of any narcotic dose to dispose of the dose according to facility policy and record the wastage. Most facilities require a second nurse's signature to verify that the wastage was according to policy. The nurse beginning the next shift is responsible for present inventory rather than the doses that were administered or used during the previous shift.

A provider prescribes dextrose 5% in water IV to infuse at 100 mL/hr. The drop factor on the manual IV tubing is 60 gtt/mL. The nurse should set the IV flow rate to deliver how many gtt/min? (Round to the nearest whole number)

100 gtt/min ​Volume to infuse x Drop factor (gtt/mL) = IV flow rate (gtt/min) Time (min) 100 mL x 60 gtt/mL = 6000 = 100 gtt/min 60 min 60

A client is prescribed 300 mg clindamycin (Cleocin) IV to infuse over 30 min. The medication comes premixed in a 50 mL bag. At how many mL/hr should the nurse set the IV pump?

100 mL/hr Set up an equation: 1 hr = 60 min 50 mL = X mL 30 min 60 min Cross multiply and solve for X: 50(60) = 30X 300 = 30X X = 100 The nurse should set the IV to deliver 100 mL/hr.

A nurse is caring for a client who has a prescription for digoxin 0.25 mg PO daily. The amount available is digoxin 0.125 mg tablets. How many tablets should the nurse administer to the client? (Round to the nearest whole number.)

2 tablets STEP 1: What is the unit of measurement to calculate? tab STEP 2: What is the dose needed? Dose needed = Desired. 0.25 mg STEP 3: What is the dose available? Dose available = Have. 0.125 mg STEP 4: Should the nurse convert the units of measurement? No STEP 5: What is the quantity of the dose available? 1 tab STEP 6: Set up an equation and solve for X. Have/Quantity = Desired/X 0.125 mg/1 tab = .025 mg/x tab X = 2 STEP 7: Round if necessary. STEP 8: Reassess to determine whether the amount to give makes sense. If there are 0.125/tab and the amount prescribed is 0.25 mg, it makes sense to administer 2 tabs. The nurse should administer digoxin 2 tab PO.

A nurse is providing discharge teaching to the parent of a child who is prescribed 10 mL of dipenhydramine (Benadryl) elixir every 4 hr as needed for an allergic response. How many tsp of diphenhydramine should the nurse instruct the parent to administer per dose?

2 tsp Convert mL to tsp. 5 mL = 1 tsp Set up an equation. 5 mL = 10 mL 1 tsp X tsp Cross multiply and solve for X. 10 = 5X X = 2 tsp

A nurse is caring for a client who asks how albuterol (Proventil) helps his breathing. Which of the following should the nurse include in the response? (Select all that apply.) 1. The medication will increase the amount of mucus 2. The medication will prevent wheezing 3. The medication will open the airways 4. The medication will reduce inflammation 5. The medication will decrease coughing episodes

2. The medication will prevent wheezing 3. The medication will open the airways 5. The medication will decrease coughing episodes The medication will increase the amount of mucus is incorrect. Asthma is characterized by bronchoconstriction, airway edema, and increased mucus production. Albuterol reduces inflammation and relaxes the airways, allowing for expectoration of mucus. The medication will prevent wheezing is correct. Albuterol may be used to prevent or treat wheezing. The medication will open the airways is correct. Albuterol promotes bronchodilation. The primary purpose is to provide rapid relief of bronchoconstriction, thus opening the airway and improving oxygenation. The medication will reduce inflammation is incorrect. Albuterol does not reduce inflammation. Steroid medications reduce inflammation. The medication will decrease coughing episodes is correct. Coughing is often an early indicator of bronchospasm. Albuterol provides a rapid response to reduce bronchoconstriction, which will decrease coughing. An absence of wheezing does not exclude a diagnosis of asthma. Some clients who have asthma will not wheeze.

A nurse is caring for a client who has an IV fluid prescription for 1,000 mL lactated Ringer's, followed by 1,000 mL dextrose 5% in 0.9% sodium chloride, then followed by 1000 mL dextrose 5% in water. The three solutions are to infuse over 24 hr. The drop factor of the manual IV tubing is 10 gtt/mL. The nurse should adjust the IV flow rate to deliver how many gtt/min? (Round to the nearest whole number.)

21 gtt/min STEP 1: What is the unit of measurement to calculate? gtt/min STEP 2: What is the volume to infuse? 3000 mL STEP 3: What is the total infusion time? 24 hr STEP 4: Should the nurse convert the units of measurement? Yes (min does not equal hr) 60 min = 1 hr STEP 5: Set up an equation and solve for X. X mL/hr = Volume (mL)/Time (hr) x Conversion (hr)/Conversion (min) x drop factor (gtt)/1 mL X mL/hr = 3000 mL/24 hr x 1 hr/60 min x 10 gtt/1mL STEP 6: Round if necessary. 20.83333 = 21 STEP 7: Reassess to determine if the amount to administer makes sense. If the amount prescribed is 3000 mL to infuse over 24 hr, it makes sense to administer 21 gtt/min. The nurse should set the manual IV infusion to deliver the IV fluids at 21gtt/min.

A nurse is preparing to administer lidocaine 2 g in dextrose 5% in water 500 mL IV to infuse at the rate of 2 mg/min. The nurse should set the IV pump to deliver how many mL/hr? (round to the nearest whole number)

30 mL/hr ​2 g = 2,000 mg 2,000 mg = 4 mg/mL = 2 mg.0.5 mL 500 mL Volume (mL) = X mLTime (min) 60 min 0.5 mL = X mL 1 min 60 min X = 30 The nurse should set the IV pump to deliver 30 mL/hr.

A client who has type 1 diabetes mellitus is to have IV fluid that contains 48 units of Regular insulin (Humulin R) in 1,000 mL to infuse at 2 units/hr. The nurse should set the IV pump to deliver how many ml/hr?

42 mL/hr ​The nurse must determine how many mL contain the 2 units of insulin to infuse every hr. 1,000 mL = X mL 48 units 2 units Cross-multiply: 48 X = 2,000 X = 2,000 48 X = 41.67 mL After rounding, X = 42

A provider prescribes an IV medication to infuse in 50 mL of 0.9% sodium chloride over 20 min. The drop factor on the manual IV tubing is 20 gtt/mL. The nurse should adjust the IV flow rate to deliver how many gtt/min to the client? (Round to the nearest whole number.)

50 gtt/min

A nurse is preparing to administer amoxicillin (Amoxil) 300 mg PO. Available is amoxicillin 250 mg/5 mL. How many mL should the nurse administer? (Round to the nearest whole number.)

6 mL ​Desired x Quantity ——————————= Amount to give Have 300 mg x 5 mL ———————= X mL 250 mg 1,500 —— = X mL 250 X = 6 mL

A provider prescribes an IV medication to infuse in 100 mL of dextrose 5% in water over 20 in. The drop factor on the manual IV tubing is 15gtt/mL. The nurse should set the IV flow rate to deliver how many gtt/min to the client? ​

75 gtt/min ​Volume to infuse x Drop factor (gtt/mL) = IV flow rate (gtt/min) Time (min) 100 mL x 15 gtt/mL = 1,500 = 75 gtt/min 20 20

A nurse is preparing to infuse 10,000 units of heparin to infuse in 100 mL of dextrose 5% in water at the rate of 800 units/hr for a client who has deep-vein thrombosis. The nurse should set the IV pump to deliver how many mL/hr to the client? (Round to the nearest tenth.)

8 mL/hr ​10,000 units = 800 units 100 mL X 80,000 = 10,000X X = 8 mL/hr

A nurse prepares to administer a medication to a client who states, "That looks different from the pill I usually take." How should the nurse respond? A. "Describe what the pill looks like." B. "This is the medication prescribed by your provider." C. "This pill is probably from a different lot number than yours at home." D. "This hospital uses a different manufacturer, but the medication is the same."

A. "Describe what the pill looks like." ​The nurse must collect more data prior to administering the medication. There is a chance that this is not the correct dose or medication. If the medication is different from the client's home medication, the nurse should clarify the prescription with the provider in order to ensure safe and effective administration of therapy.

A nurse is caring for a client who is taking lisinopril (Zestril). Which of the following outcomes should the nurse anticipate? A. Decreased blood pressure B. Diarrhea C. Chest pain D. Impotence

A. Decreased blood pressure Lisinopril, an ACE inhibitor, may be used alone or in combination with other antihypertensives in the management of hypertension and congestive heart failure.

A nurse is assessing a client who comes to the clinic for a seasonal influenza vaccine. The client says he read about an influenza vaccine that is given as a nasal spray and wants to receive it. Which of the following is a contraindication for the client to receiving the live attenuated influenze vaccine (LAIV)? A. Just turned 62 B. Smokes one pack of cigarettes a day C. Has a history of myocardial infarction D. Recent traveled to Europe

A. Just turned 62 Clients must be between the ages of 2 and 49 to receive the LIAV; therefore, it is contraindicated for this client. Pregnancy and immunocompromised status are also contraindications.

A nurse is reinforcing teaching to a client who is to start therapy with Regular insulin (Humuin R) and NPH insulin (Humulin N). Which of the following should the nurse include in the teaching? A. Keep the open vial of insulin at room temperature. B. Inject the insulin into a large muscle. C. Aspirate the medication prior to administration. D. Administer the insulin in two separate injections.

A. Keep the open vial of insulin at room temperature. The client should keep the vial in use at room temperature to minimize tissue injury and the minimize the development of lipodystrophies.

A client tells the nurse she took a dose of dimenhydrinate (Dramamine) before coming to the health care clinic. The nurse determines that the medication is effective when the client reports relief of A. Nausea B. Dry mouth C. Headache D. Diarrhea

A. Nausea ​Dimenhydrinate helps prevent and treat motion sickness. It also treats vertigo and reduces nausea and vomiting from radiation sickness. ​Dimenhydrinate does not treat dry mouth; in fact, dry mouth is an adverse effect of this medication. ​Dimenhydrinate does not treat headache; in fact, headache is an adverse effect of this medication. ​Dimenhydrinate does not treat diarrhea; in fact, diarrhea is an adverse effect of this medication.

A nurse administers oxacillin sodium (Bactocill) to a client. Which of the following indicates an allergic reaction? A. Pruritus and urticaria B. Flatulence and diarrhea C. Jaundice and dark urine D. Leukopenia and eosinophilia

A. Pruritus and urticaria ​ An allergic reaction is defined as an immune response that can manifest in milder forms such as pruritus and urticaria, or a more severe form such as anaphylaxis. Pruritus is generalized itching, and urticaria is hives; both of these symptoms indicate the client is experiencing an allergic reaction. Oxacillin sodium is classified as an antibiotic used to treat staphylococcal infections. The "cillin" in oxacillin sodium is a tip to help determine oxacillin sodium is an antibiotic.

A nurse is caring for a client who is in renal failure with an elevated serum phosphorous level and is to be started on alumninum hydroxide (Amphojel). The client asks the nurse about potential side effects. The nurse should explain to the client that a common side effect of aluminum-based antacids is A. constipation. B. metallic taste. C. headache. D. diarrhea.

A. constipation. Aluminum-based antacids have few side effects, and the most common one is constipation.

A nurse is instructing a hospitalized client who has asthma about how to use an albuterol (Proventil) inhaler. The nurse should recognize that the client understands how to use the inhaler when the client demonstrates by A. holding a breath for 10 seconds after inhaling the medication B. taking a deep breath just prior to releasing the medication from the inhaler. C. exhaling as the medication is released from the inhaler means that no medication will reach the client's bronchioles D. waiting 5 min between inhalations

A. holding a breath for 10 seconds after inhaling the medication The medication should be retained in the lungs for a minimum of 10 seconds so the maximum amount of the dosage can be delivered properly to the airways. To use the inhaler, the client exhales deeply just prior to releasing the medication, inhales deeply as the medication is released, then holds the medication in the lungs for approximately 10 seconds prior to exhaling.

A nurse is caring for a client who has chronic renal disease and is receiving epoetin alfa (Epogen) therapy. The nurse should instruct the client to increase dietary consumption of A. iron. B. calories. C. vitamin C. D. carbohydrates.

A. iron. Epoetin alfa is a synthetic form of erythropoietin, a substance produced by the kidneys that stimulates the bone marrow to produce red blood cells. If the body does not produce enough erythropoietin, as is the case in a client who has renal failure, severe anemia may occur. Increased iron is needed for the production of hemoglobin and red blood cells by the bone marrow.

A nurse is caring for a client who is hospitalized and on day 1 of a 10-day course of IV penicillin G potassium. Ten minutes into the infusion of the third dose, the client reports that the IV site itches. The client also states that he is "feeling dizzy and short of breath." The nurse's priority action is to A. stop the infusion. B. call the client's provider. C. elevate the head of the bed. D. auscultate the client's breath sounds.

A. stop the infusion. The client is exhibiting several manifestations of an anaphylactic response to a the penicillin G potassium, which is known to pose a high risk for hypersensitivity (allergic) reactions. The nurse's priority action is to stop the client's continued exposure to the potential allergen.

A provider prescribes a transfusion of one unit of packed RBC for a client who has a low hemoglobin level. The provider also prescribes diphenhydramine (Benadryl) for administration before the transfusion to prevent A. urticaria B. fever C. fluid overload D. hemolysis

A. urticaria ​For clients who have previously had allergic reactions to blood transfusions, administering an antihistamine such as diphenhydramine (Benadryl) before transfusion may prevent future reactions. Allergic reactions typically include urticaria (hives).

A client is about to start using gentamicin (Garamycin) cream to treat a serious skin infection. Which of the following instructions should the nurse include when talking with the client about using this preparation? A. ​"I'll wash the area with soap and water before I apply the cream." ​B. "After I apply the cream, I will leave the area open to the air." ​C. "I can expect a little blurry vision while I'm using this cream." ​D. "I should apply the cream to large areas around the infection."

A. ​"I'll wash the area with soap and water before I apply the cream." ​The client should wash the area with soap and water and dry it thoroughly before applying the cream. ​The client should cover the area with sterile gauze after applying the medication. ​The ophthalmic form of gentamicin can cause temporary blurring of vision. ​The client should not apply the cream to large areas due to the risk of systemic absorption and toxicity.

A nurse is caring for a client in liver failur with ascites who is receiving spironolactone (Aldactone). Which of the following outcomes should the nurse expect from the client's medication therapy? A. ​Increased sodium excretion ​B. Decreased urinary output ​C. Increased potassium excretion ​D. Decreased chloride excretion

A. ​Increased sodium excretion ​The primary action of spironolactone is to increase sodium excretion in the urines.

A nurse is caring for a client who is diagnosed with a urinary tract infection (UTI) and is taking ciprofloxacin (Cipro) 500 mg PO every 12 hr. Which of the following instructions should the nurse give to the client? A. "If the medicine causes an upset stomach, take an antacid at the same time." B. "Drink at least 1 to 2 quarts of fluid each day while taking Cipro." C. "Cipro may cause photophobia, so be sure to wear sunglasses outdoors." D. "Immediately report any ringing in your ears to your provider."

B. "Drink at least 1 to 2 quarts of fluid each day while taking Cipro." Ciprofloxacin is a fluoroquinolone antibiotic used in the treatment of mild to severe infections. It is excreted primarily via the kidneys, and drinking extra fluids will reduce the risk of crystalluria.

A nurse is caring for a client who has several environmental allergies and was admitted in status asthmaticus. The provider prescribes cromolyn sodium (Intal) via metered dose inhaler (MDI) to be added to the client's home management along with an albuterol (Proventil) MDI. When performing discharge teaching, the nurse should identify the need for additional teaching when the client states, A. If my breathing begins to feel tight, I will use the Proventil immediately." B. "I will be sure to take the Intal four times a day before using the Proventil." C. "It may take 2 to 3 weeks before the Intal will make a difference in my manifestations." D. "If I miss a dose of Intal and it is not yet time for the next dose, I will take it as soon as I remember."

B. "I will be sure to take the Intal four times a day before using the Proventil." The client should always use the bronchodilator MDI prior to any other MDI. This helps to ensure that the maximum dose of medication will get to the client's lungs. Albuterol is a beta-agonist bronchodilator, but cromolyn sodium is a mast cell inhibitor that prevents the release of histamine; therefore, the albuterol should be used prior to the cromolyn sodium.

A nurse is caring for a client who is taking naproxen (Naprosyn) following an exacerbation of rheumatoid arthritis. Which of the following comments by the client requires further discussion by the nurse? A. "I signed up for a swimming class." B. "I've been buying Tagamet to help with the indigestion I've had." C. "I've lost 2 pounds since my appointment 2 weeks ago." D. "The Naprosyn goes down easier when I crush it and put it in applesauce."

B. "I've been buying Tagamet to help with the indigestion I've had." NSAIDs, like Naprosyn, can cause serious adverse gastrointestinal reactions such as ulceration, bleeding, and perforation. Warning manifestations such as nausea or vomiting, gastrointestinal burning, and blood in the stool reported by the client require further investigation by the nurse. The client may be taking cimetidine (Tagamet) because he is experiencing one or more of these manifestations.

A nurse is talking with a client who has peptic ulcer disease and is starting therapy with sucralfate (Carafate). The nurse should instruct the client to take the medication A. with an antacid. B. 1 hr before meals. C. with food or milk D. immediately after meals.

B. 1 hr before meals. ​Sucralfate is a mucosal protectant. The client should take it on an empty stomach, 1 hr before meals, for maximum effectiveness. ​Taking sucralfate with food or milk reduces its effectiveness. ​Taking sucralfate on a full stomach reduces its effectiveness.

A nurse is preparing to administer an IV injection of phenytoin (Dilantin) to a client. Which of the following nursing actions is appropriate? A. Administer the drug rapidly B. Administer a saline solution after injection C. Hold the injection if seizure activity is present D. Dilute the medication with dextrose 5% in water

B. Administer a saline solution after injection ​The nurse should immediately flush the injection site with a saline solution after the injection of phenytoin (Dilantin). This intervention helps reduce and prevent venous irritation.

A nurse is caring for a client treated with intermittent IV vancomycin (Vancocin). The client reports pain at the IV site when the nurse starts the infusion. Which of the following nursing actions is appropriate at this time? A. Notify the provider and have the medication changed. B. Assess the patency of the IV site. C. Turn down the infusion rate on the IV. D. Apply cold compresses to the site after the medication has infused.

B. Assess the patency of the IV site. Vancomycin (Vancocin) is irritating to tissues and can cause damage if allowed to infiltrate. The medication should be infusing through a large vein, and any signs of infiltration must be investigated immediately.

A nurse is caring for a client who has thrombophlebitis and is recieving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin's effects? A. Vitamin K B. Protamine sulfate C. Acetylcysteine (Mucomyst) D. Deferoxamine (Desferal)

B. Protamine sulfate ​Protamine sulfate reverses the effects of heparin by binding with heparin to form a heparin-protamine complex that has no anticoagulant properties. ​Vitamin K reverses the effects of warfarin (Coumadin), not heparin, by promoting the synthesis of coagulation factors VI, IX, X and prothrombin. ​Acetylcysteine, a mucolytic, reduces the risk of hepatotoxicity after acetaminophen (Tylenol) overdose. It does not reverse the effects of heparin toxicity. ​A chelating agent such as deferoxamine binds to iron to reduce iron toxicity from supplemental iron therapy. It does not reverse the effects of heparin toxicity.

A nurse is caring for a client who is recovering from surgical placement of an artificial heart valve and is to be started on warfarin (Coumadin) prior to discharge. Which of the following diagnostic test should the nurse use to monitor the effect of this therapy? A. Platelet count B. Prothrombin time (PT) C. Bleeding time D. aPTT

B. Prothrombin time (PT) This test is used to monitor warfarin therapy. For a client receiving full anticoagulant therapy, the PT should typically be approximately two to three times the normal value, depending on the indication for therapeutic anticoagulation.

A nurse is caring for a client who has acute respiratory distress syndrome (ARDS), requires mechanical ventilation, and is receiving pancuronium (Pavulon). The nurse should recognize that the purpose of this medication is to A. decrease chest wall compliance. B. suppress respiratory effort. C. induce sedation. D. decrease respiratory secretions.

B. suppress respiratory effort. Neuromuscular blocking agents, such as pancuronium, induce paralysis and suppress the client's respiratory efforts to the point of apnea, allowing the mechanical ventilator to take over the work of breathing for the client. This therapy is especially helpful for a client who has ARDS and poor lung compliance.

A clinic nurse is giving instructions to a mother on the proper technique of applying opthalmic ointment for her preschool-age child who has conjunctivitis. Which of the following should the nurse include in the instructions? A. "Warm the ointment by placing the tube in glass of hot tap water." B. "Cleanse the eye with a wet cotton ball in a direction towards the inner canthus before applying the ointment." C. "Discard the first bead of ointment before each application." D. "Instruct your child to squeeze his eyes shut following application."

C. "Discard the first bead of ointment before each application." The parent should discard the first bead of ointment from the tube because it is considered contaminated.

A nurse is caring for a client diagnosed with thrombophlebitis who has a swollen and inflamed right calf. The client is started on a continuous heparin infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give? A. "It usually takes at least two to three days to reach a therapeutic blood level." B. "A pharmacist is the person to answer this question." C. "Heparin does not dissolve clots, it stops new clots from forming." D. "The pill that you will take after this IV will dissolve the clot."

C. "Heparin does not dissolve clots, it stops new clots from forming." This statement accurately answers the client's question.

A nurse is talking with a client about how to use montelukast (Singulair) to treat asthma. Which of the following client statements should indicate that the client understood the nurse's instructions? A. "Ill rinse my mouth after taking this medication." B. "I'll take this medication when I get an asthma attack." C. "I'll take this medication once a day in the evening." D. "I'll take this medication with meals."

C. "I'll take this medication once a day in the evening." ​The purpose of montelukast, a leukotriene modifier, is to prevent asthma exacerbations. The client should take it on a daily basis once a day in the evening, whether or not he has symptoms. ​Oral candidiasis may develop with inhaled glucocorticoids. It is not likely with montelukast. ​Montelukast is not a rescue medication for an acute asthma attack. ​It is inappropriate for the client to take this medication with meals.

A nurse is caring for a client who is taking ferrous sulfate (Feosol) tablets twice daily for iron-deficiency anemia. The client asks the nurse why the provider suggested that she take the ferrous sulfate with orange juice. Which of the following is an appropriate response by the nurse? A. "The orange juice will help you avoid becoming constipated." B. "The medication has an unpleasant taste, and the orange juice will help to disguise it." C. "The orange juice will help you absorb the medication more efficiently." D. "The medication can cause nausea, and the orange juice will prevent this."

C. "The orange juice will help you absorb the medication more efficiently." Ferrous sulfate provides the iron needed by the body to produce red blood cells. Taking iron supplements with a citrus fruit juice, such as orange juice, helps to increase the bioavailability of the iron.

A nurse is preparing to administer potassium chloride (KCL). The provider prescribes potassium chloride (KCL) 20 mEq suspension PO daily. The bottle is labeled KCL elixir, 10 mEq/mL. How many milliliters should the nurse administer? A. 1 mL B. 1.5 mL C. 2 mL D. 2.5 mL

C. 2 mL ​20 Meg/10 Meq = 1mL x 2 = 2mL

A nurse is preparing to administer potassium chloride (KCL) The provider prescribes Potassium chlorid (KCL) 20 mEq suspension PO daily. The bottle is labeled KCL elixir, 10 mEq/mL. Which of the following should the nurse administer? A. 1 mL B. 1.5 mL C. 2 mL D. 2.5 mL

C. 2 mL ​20Meg/10Meq=1mLx2=2mL

A nurse has received a new order. The order reads amoxicillin 250 mg PO every eight hours. The pharmacy has 125 mg chewable amoxicillin tablets in stock. How many tablets should the nurse administer? A. 1/2 tablet B. 1 tablet C. 2 tablets D. 4 tablets

C. 2 tablets ​250mg/125mg=1tabx2=2tabs

A nurse is teaching about ferrous iron to a parent of a child with iron deficiency anemia. Which of the following should be included in the teaching? A. Administer ferrous iron with milk B. Administer ferrous iron with meals C. Administer ferrous iron with fruit juice D. Administer ferrous iron with yogurt

C. Administer ferrous iron with fruit juice Ferrous iron is best absorbed with an acidic environment. Therefore, administering with fruit juice is recommended.

A nurse is preparing to administer potassium chloride (KCL). The nurse reviews the client's serum potassium level results and discovers the client's potassium level is 5.2 mEq/L. Which of the following actions should the nurse take? A. Give the ordered KCL as prescribed. B. Omit the KCL dose and document it was not given. C. Call the prescribing physician and inform her of the client's serum potassium level results. D. Call the lab to verify the client's results.

C. Call the prescribing physician and inform her of the client's serum potassium level results. ​The nurse should notify the provider and inform her of the client's serum potassium level.

A nurse is caring for a client who has a prescription for clozapine (Clozaril). Which of the following is an expected response to this medication? A. Development of orthostatic hypotension. B. Control of seizure activity. C. Decreased auditory hallucinations. D. Increased energy level and involvement in activities.

C. Decreased auditory hallucinations. ​Seizures are an adverse effect of clozapine. ​Orthostatic hypotension is an adverse effect of clozapine. ​Clozapine is prescribed for the treatment of psychotic findings which include auditory hallucinations. ​Fatigue is an adverse effect of clozapine.

A nurse is preaparing to administer heparin to a client via the deep subcutaneous (intrafat) route. Which of the following is an appropriate action for administering this medication? A. Use a 22-gauge needle to inject the medication B. Use a 1-inch needle to inject the medication C. Inject the medication into the abdomen above the level of the iliac crest D. Massage the injection site after administration

C. Inject the medication into the abdomen above the level of the iliac crest ​The nurse should inject the medication into the abdomen above the level of the iliac crest, at least 2 inches from the umbilicus.

A client is telling the nurse in the clinic that he gets a headache after he takes sublingual nitroglycerin (Nitrostat) for his angina pain. Which of the following should the nurse instruct the client to do? A. Reduce the nitroglycerin dose B. Ask the provider to prescribe a strong analgesic C. Lie down in a cool environment and rest D. Ask the provider to prescribe a different medication

C. Lie down in a cool environment and rest ​Headache is a common side effect of nitroglycerin. The nurse should suggest conservative measures to manage the headache. Generally, headaches that are a side effect of nitroglycerin are transient. They usually last about 5 min and rarely longer than 20 min.

A nurse is caring for a client who begins showing signs of alcohol withdrawal delirium. Which of the following medications should the nurse plan to administer? A. Methadone (Dolophine) B. Disulfiram (Antabuse) C. Lorazepam (Ativan) D. Topiramate (Topamax)

C. Lorazepam (Ativan) ​ Lorazepam is prescribed to treat the symptoms and prevent complications of alcohol withdrawal delirium. ​Methadone is prescribed to block heroin cravings rather than for the treatment of alcohol withdrawal delirium. ​Disulfiram is prescribed to deter alcohol consumption rather than for the treatment of alcohol withdrawal delirium. ​Topiramate is used to decrease the craving for alcohol rather than for the treatment of alcohol withdrawal delirium.

A nurse is caring for a client who receives digoxin (Lanoxin). Before administering this medication, which of the following actions should the nurse take? A. Offer the client a light snack B. Measure the client's blood pressure C. Measure the client's apical pulse D. Weight the client

C. Measure the client's apical pulse ​Digoxin decreases the heart rate, so the nurse should count the apical pulse for at least 1 min before administering it. The nurse should withhold the medication if the client's heart rate is below 60/min.

A nurse is caring for a client who has a diagnosis of diabetes mellitus and hypertension and recently began taking propanolol (Inderal). When the client reports dizziness upon standing, the nurse should perfrom which of the following actions? A. ​Auscultate lung sounds bilaterally. B. Check the heart rate and capillary refill. C. Monitor blood pressure lying, sitting, and standing. D. ​Obtain a capillary glucose level with a glucometer.

C. Monitor blood pressure lying, sitting, and standing. ​Blood pressure that decreases from a lying to sitting to standing position is orthostatic or postural hypotension. It can occur following a recent blood loss, prolonged bed rest, or hypovolemia. It is also the side effect of certain medications, such as beta-blockers. The symptoms of orthostatic hypotension include lightheadedness or weakness upon standing. Therefore, if a client reports dizziness upon standing, the nurse should check the blood pressure in lying, sitting, and standing positions to determine whether there is a drop in the blood pressure with each of these positions. This is particularly important if the symptoms are reported following the new onset of a medication that can cause orthostatic hypotension, or a recent increase in the dose of the medication.

A nurse at an ophthalmology clinic is caring for a client who has open-angle glaucoma. The client is started on a treatment regimen of timolol (Timoptic) and pilocarpine (Pilocar) eye drops. The nurse should understand that these medications will be administered A. When the client is experiencing eye pain. B. Until the client's intraocular pressure returns to normal. C. On a regular schedule for the rest of the client's life. D. For approximately 10 days, followed by a gradual tapering off.

C. On a regular schedule for the rest of the client's life. Medications prescribed for glaucoma are intended to enhance aqueous outflow, or decrease its production, or both. The client must continue the eye drops on an uninterrupted basis for life.

A nurse is caring for a client who has a prescription for phenytoin (Dilantin). For which of the following findings should the nurse instruct the client to notify the the provider? A. Headache B. Insomnia C. Skin rash D. Gastric discomfort

C. Skin rash ​Phenytoin is an antiepileptic medication used to treat partial seizures and generalized tonic-clonic seizures. It slows the entrance of sodium and calcium back into the neuron and extends the time it takes for the nerve to return to its active state. Phenytoin can cause a rash that may progress to more serious conditions, such as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). If a rash develops, the client should notify the provider immediately and stop the use of phenytoin.

A nurse in a substance abuse clinic is assessing a client who recently startes taking disulfiram (Antabuse). The client reports having discontinues the medication after experiencing severe nausea and vomiting. Which of the following should the nurse suspect to be a likely cause of the client's distress? A. The client demonstrated an allergic response to the medication. B. The client experienced a common side effect to the medication. C. The client consumed alcohol while taking the medication. D. The client took an overdose of the medication.

C. The client consumed alcohol while taking the medication. Disulfiram is given to clients who have a history of alcohol abuse. It produces a sensitivity to alcohol that results in a highly unpleasant reaction when the client ingests even small amounts of alcohol. When combined with alcohol, disulfiram produces nausea and vomiting.

A nurse is administering ipratropium bromide (Atrovent) via nebulizer to a client who emphysema. Which of the following client findings should cause the nurse to consult the provider before administering the next dose? A. Nervousness B. Tachycardia C. Visual changes D. Dizziness

C. Visual changes Anticholinergics, like ipratropium bromide, can increase intraocular pressure and should be used with caution in clients who have glaucoma. The visual changes that have been reported by this client may indicate the presence of glaucoma.

A nurse in a regional oncology is recording the dose of doxorubicin (Adriamycin) that a client receives with each visit. The nurse should know that this medication has a maximum lifetime cumulative dose range due to the risk for irreversible A. mylelosuppression B. alopecia C. cardiomyopathy D. paresthesia

C. cardiomyopathy Doxorubicin is an antineoplastic antibiotic used in the treatment of various cancers. Irreversible cardiomyopathy with congestive heart failure can result from repeated doses of doxorubicin, and prolonged use can also cause severe heart damage, even years after the client has stopped taking it. The maximum cumulative dose a client should receive is 550 mg/m2 or 450 mg/m2 with a history of radiation to the mediastinum.

A nurse is preparing to administer heparin subcutaneously to a client. Which of the following techniques should the nurse use? ​A. Cleanse the skin with an alcohol swab, insert the needle, and aspirate and inject the heparin. ​B. Cleanse the skin with an alcohol swab, insert the needle, aspirate and inject the heparin, and massage the site. ​C. Cleanse the skin with an alcohol swab, insert the needle, inject the heparin, and observe for bleeding. ​D. Cleanse the skin with an alcohol swab, insert the needle, inject the heparin, and aspirate and observe for bleeding.

C. ​Cleanse the skin with an alcohol swab, insert the needle, inject the heparin, and observe for bleeding. ​This is the correct technique for the nurse to use prior to injecting heparin.

A client provides a nurse with a list of home medications. Which of the following should the nurse recognize as incompatible? ​A. Furosemide (Lasix) and digoxin (Lanoxin) ​B. Alprazolam (Xanax) and zolpidem (Ambien) C. ​Warfarin sodium (Coumadin) and multivitamins ​D. Gentamicin sulfate (Garamycin) and fluconazole (Diflucan)

C. ​Warfarin sodium (Coumadin) and multivitamins ​These two medications must be considered for incompatibility. Warfarin sodium is classified as an anticoagulant used for prophylaxis and treatment of deep-vein thrombosis, pulmonary embolism, and atrial fibrillation. Multivitamins contain fat-soluble vitamins A, D, E, and K. Vitamin K is the antidote for overdosage of warfarin sodium because it assists in hepatic synthesis of blood coagulation. The amount of vitamin K in the multivitamins must be considered for incompatibility.

A client admitted to an inpatient mental health unit is about to start receiving disulfiram (Antabuse). Which of the following information is most important for the nurse to obtain before administering this medication? ​A. History of liver disease ​B. History of renal disease C. ​When the client last drank alcohol ​D. If the client has taken this medication before

C. ​When the client last drank alcohol ​Disulfiram is a type of aversion therapy that helps maintain abstinence from alcohol. Therapy must not begin until the client has abstained from alcohol for at least 12 hr and preferably for 48 hr. ​Disulfiram can cause hepatotoxicity, thus it is important for the nurse to determine any history of liver disease. However, this is not the highest priority among these options. ​Caution is essential when clients who have renal disease take disulfiram, so it is important for the nurse to determine any history of renal disease. However, this is not the highest priority among these options. . ​Previous history of the use of any medication is important to determine whether or not hypersensitivity is an issue. However, this is not the highest priority among these options.

A nurse is reinforcing teaching with a client who is receiving continuous subcutaneous insulin via an external insulin pump. Which of the following client statements indicates a need for further teaching? A. "I will change the needle every 3 days" B. "I should store all unused insulin in the refrigerator" C. "If I skip lunch, I will skip my mealtime dose of insulin" D. "I will adjust my dosages of Lantus insulin according to my blood glucose results"

D. "I will adjust my dosages of Lantus insulin according to my blood glucose results" ​A client receiving insulin via an insulin pump strictly monitors the appropriate dose based on glucose monitoring. The insulin pump is designed to administer rapid-acting or short-acting insulin 24 hr a day. Lantus is classified as a long-acting insulin and is administered at nighttime to maintain the same blood glucose concentration for a 24-hr period. Lantus is not used on a sliding scale.

A nurse is performing discharge teaching for a client who is taking phenytoin (Dilantin). Which of the following comments by the client should alert the nurse that further teaching is needed? A. "I will notify my doctor before taking any other medications." B. "I have made an appointment to see my dentist next week." C. "I know that I cannot substitute a generic brand of this medication." D. "I'll be glad when I am free of seizures so I can stop taking this medicine."

D. "I'll be glad when I am free of seizures so I can stop taking this medicine." Phenytoin is an anticonvulsant used to treat various types of seizures. Clients on anticonvulsant medications commonly require them for lifetime administration, and phenytoin should not be stopped without the advice of the client's provider.

A nurse receives a new prescription from the provider which reads "give 14 units of regular insulin and 28 units of long-acting insulin to be given subcutaneously at the breakfast hour." What is the total number of units of insulin that the nurse will prepare in the insulin syringe? A. 14 units B. 28 units C. 32 units D. 42 units

D. 42 units ​42 units. Each order of for units of insulin is combined in the same syringe and added together for a total amount in the syringe.

A nurse in the emergency department is assessing a client. The client's laboratory values are obtained, and she is now requesting an alcoholic beverage. After reviewing the client's admission laboratory results, which of the following medication prescriptions should the nurse question? Sodium 144 mEq/L Potassium 3.5 mEq/L Chloride 106 mEq/L Carbon dioxide 32 mEq/L BUN 55 mg/dL Glucose 468 mg/dL Creatinine 5 mg/dL A. Oxazepam (Serax) B. Glipizide (Glucotrol) C. Regular insulin (Humulin R) D. Amphotericin B (Fungizone)

D. Amphotericin B (Fungizone) Oxazepam is an appropriate medication for this client. It is a benzodiazepine, which is an antianxiety agent given to clients at risk for acute alcohol withdrawal. Glucotrol, a sulfonylurea medication, is an antidiabetic agent given to lower blood glucose levels in clients who have type 2 diabetes mellitus. This client's admission glucose is quite elevated, and is highly suspicious for diabetes mellitus. Regular insulin is an appropriate medication for this client. This client's admission glucose is quite elevated and is highly suspicious for type 2 diabetes mellitus. There are no known contraindications for insulin, except hypoglycemia.

A nurse is caring for a client who is HIV positive is started on zidovudine (AZT). The nurse should monitor the client for which of the following life-threatening side effects of this medication? A. Cardiac dysrhythmia B. Fever C. Renal failure D. Aplastic anemia

D. Aplastic anemia Severe myelosuppression (bone marrow depression) that results in anemia (decreased red blood cells), agranulocytosis (decreased white blood cells), and thrombocytopenia (decreased platelets) is a life-threatening adverse reaction to zidovudine therapy. Consequently, zidovudine must be used cautiously in clients already experiencing myelosuppression, and the client must be monitored with a CBC performed every few weeks for early detection of marrow failure.

A nurse is preparing to teach a client how to draw up regular insulin and neutral protamine hagedorn (NPH) insulin into the same syringe. Which of the following instructions is appropriate for the nurse to provide? A. Draw up the NPH insulin into the syringe first. B. Inject air into the regular insulin first. C. Shake the NPH insulin until it is well mixed. D. Discard any regular insulin that appears cloudy.

D. Discard any regular insulin that appears cloudy. ​The nurse should teach the client to discard any regular insulin that appears cloudy, as regular insulin should be clear. NPH insulin has a cloudy appearance.

A nurse is giving a presentation about caring for client who are receiving diuretic therapy to treat heart failure. The nurse should explain that which of the following medications put clients at risk for both hyperkalemia and hyponatremia? A. Furosemide (Lasix) B. Hydrochlorothiazide (HCTZ) C. Mannitol (Osmitrol) D. Spironolactone (Aldactone)

D. Spironolactone (Aldactone) ​Spironolactone is a potassium-sparing diuretic. It blocks the effects of aldosterone in the renal tubules, causing a loss of sodium and water and retention of potassium. Thus possible adverse reactions include hyperkalemia and hyponatremia. ​Furosemide is a high-ceiling (loop) diuretic that increases the risk of hyponatremia and hypokalemia, not hyperkalemia. ​Hydrochlorothiazide is a thiazide diuretic that increases the risk of hypokalemia, not hyperkalemia. ​Mannitol (Osmitrol) is an osmotic diuretic that increases the risk of hyponatremia and hypokalemia, not hyperkalemia.

A nurse is preparing to administer amoxicillin (Polymox) 100 mg PO every 8 hr to a toddler who weighs 20 kg. The recommended dosage range is 20-25 mg/kg/day. Which of the following demonstrates the nurse 's understanding? A. The nurse administers the calculated dosage. B. The calculated dosage is above the recommended dosage range. ​C. The nurse contacts the pharmacist to adjust the prescribed dosage. D. The prescription is insufficient to achieve the desired effect.

D. The prescription is insufficient to achieve the desired effect. The dose is below the recommended range: 20 kg x 20 mg = 400 mg/kg/day 20 kg x 25 mg = 500 mg/kg/day Based on the toddler's weight, it would be safe for the client to receive 400-500 mg/day of amoxicillin. The toddler is receiving a total of 300 mg/day. The nurse should notify the provider as the prescribed dose is below the recommended dosage range.

A nurse is caring for a client who is hospitalized with active pulmonary tuberculosis (TB) and is to be started on intavenous rifampin (Rifadin) therapy. The nurse should instruct the client that this medication might do which of the following? A. Cause constipation B. Cause stools to turn black C. Stain teeth D. Turn body secretions to a red-orange color

D. Turn body secretions to a red-orange color Rifampin is used in combination with other medicines to treat TB. Rifampin will cause the urine, stool, saliva, sputum, sweat, and tears to turn reddish-orange to reddish-brown.

A nurse is talking with a client who has hypertension and stable angina pectoris and is about to start taking verapamil (Calan). The nurse should instruct the client to avoid taking this medication with A. milk B. orange juice C. coffee D. grapefruit juice

D. grapefruit juice ​Large amounts of grapefruit juice increase blood levels of verapamil, a calcium channel blocker, by inhibiting its metabolism. The excess amount of drug can intensify the medication's hypotensive effects, putting the client at risk for syncope and dizziness.

A nurse is caring for a client who has been on levonthroxine (Synthroid) for several months. If the dose of this medication has been adequate, the nurse should expect to see a decrease in the A. thyroxine (T4) B. free thyroxine (TF4) C. tri-iodothronine (T3) D. thyroid stimulating hormone (TSH)

D. thyroid stimulating hormone (TSH) In hypothyroidism, the nonfunctioning thyroid gland is unable to respond to the TSH, and no endogenous thyroid hormones are released. This results in an elevation of the TSH level as the anterior pituitary continues to release the TSH to stimulate the thyroid gland. Administration of exogenous thyroid hormones, such as levothyroxine, turns off this feedback loop, which results in a decreased level of TSH.

A nurse is caring for a client who reports occasionally self-medicating with an over-the-counter calcium carbonate antacid. To avoid the adverse effects of calcium carbonate, the nurse should recommend that the client take this medication with A. orange juice. B. milk. C. a carbonated beverage. D. water.

D. water. Calcium carbonate is a dietary supplement used when the amount of calcium taken in the diet is not enough. Calcium carbonate may also be used as an antacid to relieve heartburn, acid indigestion, and stomach upset. The client should drink a full glass of water after taking an antacid to enhance effectiveness. Orange juice does not affect the action or absorption of calcium carbonate. Taking calcium carbonate with milk predisposes the client to milk alkali syndrome, which is characterized by headache, confusion, nausea, vomiting, alkalosis, and hypercalcemia. Taking calcium carbonate with carbonated beverages may cause gas.

A nurse is teaching a client who has angina pectoris about starting therapy with nitroglycerin (Nitrostat) sublingual tablets. The nurse verifies the client's understanding when the client states which of the following? ​A. "I'll dial 911 if I still have pain after taking three tablets 5 minutes apart." ​B. "I'll dial 911 if I still have pain after taking four nitroglycerin tablets over a 20-minute period." ​C. "I'll dial 911 when I have pain and then take the nitroglycerin tablets." D. ​"I'll dial 911 if one tablet does not relieve my pain and then take up to two more 5 minutes apart while waiting.

D. ​"I'll dial 911 if one tablet does not relieve my pain and then take up to two more 5 minutes apart while waiting. ​If one tablet does not relieve the client's pain, he should access emergency services and then take two more at 5-min intervals if he still has pain.

A nurse is caring for a client that is experiencing Cushing's Triad following a subdural hematoma. The client exhibits a widening pulse pressure (increased systolic and decreased diastolic blood pressure), a decrease in pulse rate, and altered respiratory pattern. Which of the following should the nurse administer? A. ​Albumin 25% ​B. Dextran 70 ​C. Hydroxyethyl glucose (Hetastarch or Hespan) D. ​Mannitol 25%

D. ​Mannitol 25% ​The nurse should administer mannitol 25% to this client. Administering this medication will promote diuresis.

A nurse is caring for a client who has just begun therapy with alprazolam (Xanax) to treat anxiety. The nurse should observe the client for which of the following adverse effects of this medication? ​A. Sedation ​B. Bradycardia ​C. Hearing loss ​D. Abdominal pain

​A. Sedation ​Sedation and drowsiness are common side effects of this medication.

A nurse is caring for a client is 6 feet tall, weighs 190 lb, and has a body surface are of 2.1 m2. The client is prescribed cisplatin (Platinol). The appropriate dose for this medication is 20 mg/m2. How many mg is an appropriate dose to administer to the client?

Multiply the dose per m² by the client's BSA. 20 mg/m² x 2.1 m² = 42 mg

A nurse is caring for a client who has prostate cancer. The nurse should expect the provider to prescribe which of the following medications for this client ​A. Leuprolide (Lupron) ​B. Cyclophosphamide (Cytoxan) ​C. Finasteride (Proscar) ​D. Tamoxifen (Nolvadex)

​A. Leuprolide (Lupron) ​Leuprolide treats cancer of the prostate hormonally. It antagonizes the androgens that androgen-dependent neoplasms require.

A nurse is caring for a client who receives furosemide (Lasix) to treat heart failure. Which of the following laboratory values should the nurse be sure to monitor specifically for this client? ​A. Potassium ​B. Albumin C. ​Chloride ​D. Bicarbonate

​A. Potassium ​Furosemide is a loop diuretic that promotes the excretion of potassium. The nurse should monitor the client's potassium level to watch for hypokalemia.

A nurse is preparing a medication and is converting 0.8 grams to milligrams. The nurse should do which of the following? ​A. Move the decimal point 3 places to the right. ​B. Move the decimal point 3 places to the left. ​C. Move the decimal point 2 places to the right. ​D. Move the decimal point 2 places to the left.

​A. Move the decimal point 3 places to the right. ​The conversion is grams to milligrams, so the nurse should move the decimal point 3 places to the right.

Reinforcing teaching taking atorvastation (Lipitor) daily ​"I will avoid drinking grapefruit juice." ​"I must take this medication without food." ​"It is best if I take this medication in the morning." ​"It is not necessary to have any routine lab tests done."

​"I will avoid drinking grapefruit juice." ​Atorvastatin (Lipitor) is an HMG-CoA reductase inhibitor. It is in a class of medications more commonly known as statins, which are the most effective medications in lowering LDL and total cholesterol. They also can lower triglycerides and raise HDLs in some clients. Two serious adverse effects of statins are hepatotoxicity and myopathy. Clients taking statins should have their liver enzymes assessed before treatment and every 3 to 6 months thereafter. These clients also should report any onset of muscle weakness or aches to the provider due to the possibility of myopathy. Grapefruits and grapefruit juice can increase the blood levels of statin medications and should be avoided by clients taking them.

A nurse is teaching a client who is about to start therapy with methotrexate (Rheumatrex) to treat rheumatoid arthritis. Which of the following instructions should the nurse include? (Select all that apply.) 1. ​Expect to feel the medication's effects immediately. ​2. Do not drink alcoholic beverages. ​3. Report unexplained bruising to the provider. ​4. Avoid people who have infections. ​5. Take ascorbic acid to help minimize side effects.

​2. Do not drink alcoholic beverages. ​3. Report unexplained bruising to the provider. ​4. Avoid people who have infections. ​Expect to feel the medication's effects immediately is incorrect. It may take 4 to 6 weeks to achieve the drug's therapeutic effects. Do not drink alcoholic beverages is correct. Alcohol ingestion can increase the risk of liver damage. Report unexplained bruising to the provider is correct. Methotrexate can cause thrombocytopenia. Clients should report bruising or petechiae as they may indicate a low platelet count. Avoid people who have infections is correct. Methotrexate causes bone marrow suppression and increases the risk for infection. Take ascorbic acid to help minimize side effects is incorrect. Providers sometimes prescribe folic acid to help minimize the side effects of methotrexate.

A nurse is preparing to administer a bisacodyl (Dulcolax) 10 mg suppository. Which of the following are correct administration guidelines for the nurse to implement? (Select all that apply.) 1. ​Don sterile gloves. ​2. Lubricate index finger. ​3. Use a rectal applicator for insertion. ​4. Position client supine with knees bent. ​5. Insert suppository just beyond internal sphincter.

​2. Lubricate index finger. ​5. Insert suppository just beyond internal sphincter. ​Don sterile gloves is incorrect. The nurse should wear gloves for the procedure, but sterile gloves are not necessary. Gloves help to prevent the transmission of pathogens by direct and indirect contact. The Centers for Disease Control notes that a nurse should wear clean gloves when touching blood, body fluid, secretions, excretions, most mucous membranes, nonintact skin, and contaminated items or surfaces. Gloves should be removed promptly following the administration of a suppository, and hand hygiene should be performed to avoid transfer of micro-organisms to other clients or environments. Lubricate index finger is correct. The rounded end of the suppository should be lubricated with a sterile water-soluble lubricating jelly. In addition to lubricating the suppository, the index finger of the nurse's dominant hand should be lubricated with a water-soluble lubricant to promote insertion. Use a rectal applicator for insertion is incorrect. The nurse should administer the suppository with the dominant index finger, which has been lubricated. The nurse should not use an applicator to insert a suppository. The nurse should be aware that vaginal applicators are used to deposit medication such as vaginal creams or foams into the vagina. Position client supine with knees bent is incorrect. To avoid the unlikely event of rupturing the rectum, the client should be assisted to a left lateral position. When lying on the right side, the descending and sigmoid colon and rectum transition to the right due to gravity. When lying on one's left, these end structures of the gastrointestinal tract are more or less aligned, resulting in an easier suppository insertion. The client who is receiving a vaginal suppository should be positioned supine with knees bent, feet flat on the bed and close to hips (modified lithotomy position). Insert suppository just beyond internal sphincter is correct. The nurse should gently retract the buttocks with the nondominant hand. The suppository should be inserted gently through the anus, past the internal sphincter, and against the rectal wall. Following the administration of the medication, the nurse should apply gentle pressure to hold the buttocks together momentarily if needed to keep medication in place. The internal sphincter is constantly contracted and prevents small amounts of stool from leaking from the rectum and will hold the suppository in place.

Which of the following are appropriate references for the nurse to use to ensure safe medication administration? (Select all that apply.) ​1. Internet ​2. Published journals ​3. Pharmacists ​4. Physicians' Desk Reference ​5. Pharmaceutical sales representatives

​2. Published journals ​3. Pharmacists ​4. Physicians' Desk Reference Internet is not correct. The Internet can be a valuable source of drug information. However, because anyone can post information on the Internet regardless of qualifications, not everything that is found on the Internet will be accurate. The nurse will need to exercise discretion when searching for information. The Internet is not an appropriate point of reference when checking on the purposes and actions of pharmacological agents. Many facilities have approved resources available on their intranet websites. Published journals is correct. Published journals and reputable newsletters, such as The Medical Letter on Drugs and Therapeutics, and the Prescriber's Letter, are bimonthly and monthly publications that present current information on medications, typically focusing on two to three medication agents. Discussions may consist of clinical trial summary data or new FDA warnings on new uses of older agents. Pharmacists is correct. Pharmacists provide expert information about medications, expected versus unexpected side effects, contraindications, compatibilities, and indications for use. Physicians' Desk Reference is correct. The Physicians' Desk Reference (PDR) is a reference work financed by the pharmaceutical industry. The information on each drug is identical to the information on the package insert. The PDR is updated annually to reflect current recommendations. Nurses should check the publication date on the PDR in order to ensure that they are reviewing the most current information. The PDR is an appropriate reference to review purposes and actions of pharmacological agents. Pharmaceutical sales representatives is not correct. Pharmaceutical sales representatives can be useful sources of medication information. These people know their own products very well and they can provide detailed, authoritative information about them. However, the role of the drug representative is sales, not education.

A nurse is caring for a client with diabetes mellitus who receives 25 units of NPH insuline every morning if her blood glucose is above 200 mg/dl..... ​30 min to 1 hr ​2 to 3 hr ​4 to 12 hr ​18 to 24 hr

​4 to 12 hr ​NPH insulin is an intermediate-acting insulin. Its onset of action is 1 to 2 hr, its peak is 4 to 12 hr, and its duration of action is 18 to 24 hr. The client is at particular risk for hypoglycemia during the peak time.

A nurse is teaching a client who takes pain medication and was recently prescribed docusate sodium (Colace). Which of the following statements indicates the client understands the information? ​A. "I am to have 1 to 2 soft stools each day." ​B. "I will take the medication for diarrhea." ​C. "I drink 4 ounces of water when I take the medication." ​D. "I may occasionally take with mineral oil."

​A. "I am to have 1 to 2 soft stools each day." ​The client's understands docusate sodium is a stool softener and the therapeutic effect is achieved when having 1 to 2 soft stools each day.

A nurse is reinforcing teaching with a client who has a prescription for bumetanide (Bumex). Which of the following instructions should the nurse include in the teaching? ​A. "Report changes in hearing." ​B. "Avoid foods high in potassium." C. ​"Take the prescribed second dose at nighttime." ​D. "Limit your fluid intake to no more than 1.5 L a day."

​A. "Report changes in hearing." ​Bumetanide is a high-ceiling loop diuretic. It promotes diuresis by inhibiting sodium and chloride reabsorption in the thick ascending limb of the loop of Henle. High-ceiling loop diuretics cause ototoxicity. Concurrent use of aminoglycosides, such as gentamycin, increases the risk of ototoxicity. Inform clients about possible hearing loss, and instruct clients to notify the prescriber if a hearing deficit develops.

A charge nurse is assessing a newly licensed nurse's understanding of the need to administer 0.9% sodium chloride with packed RBC for a client who has anemia. Which of the following statements by the newly licensed nurse indicates an understanding of this intervention? ​A. "These products should be administered together to decrease the risk of hemolysis." ​B. "0.9% sodium chloride decreases the risk of an allergic reaction during the transfusion." C. ​"When these products are administered together the risk for circulatory overload is decreased." D. ​"0.9% sodium chloride decreases the risk of bacterial contamination during a transfusion."

​A. "These products should be administered together to decrease the risk of hemolysis." ​The nurse should administer 0.9% sodium chloride with blood products to decrease the risk for clotting and hemolysis.

A nurse is assessing an older adult who is receiving a digoxin (Lanoxin). To evaluate the client for digoxin toxicity, the nurse should check for which of the following manifestations? ​A. Anorexia ​B. Ataxia ​C. Photosensitivity ​D. Jaundice

​A. Anorexia ​Anorexia, vomiting, confusion, headache, and vision changes are typical manifestations of digoxin toxicity in older adult clients.

A nurse is teaching a client who has multiple sclerosis about starting therapy with baclofen (Lioresal). Which of the following instructions should the nurse include? ​A. Avoid driving until the drug's effects are evident. ​B. Take the medication on an empty stomach. ​C. Stop taking the drug immediately for headache. ​D. Expect to develop diarrhea initially.

​A. Avoid driving until the drug's effects are evident. Several CNS-related effects are common, including drowsiness, dizziness, headache, and confusion. Therefore, until the client knows show the medication will affect him, he should not drive a vehicle.

Following surgery, a client has a prescription for nalbuphine (Nubain) for moderate to severe pain. The nurse caring for the client should check for possible adverse reactions by assessing for which of the following findings? ​A. Blurred vision ​B. Joint pain ​C. Anorexia ​D. Oliguria

​A. Blurred vision ​Nalbuphine can cause blurred vision as well as mitosis.

A nurse is speaking with a client who is about to receive a one-time dose of diazepam (Valium). Which of the following information should the nurse be sure to give to the client? ​A. Diazepam can cause drowsiness. ​B. A single dose of diazepam is unlikely to cause side effects. ​C. It is important to avoid foods that contain tyramine. ​D. Grapefruit juice inactivates this medication.

​A. Diazepam can cause drowsiness. ​Valium has sedative properties, so the client should not engage in potentially hazardous activities after receiving diazepam.

A nurse is instilling ear drops to a young child and must straighten the ear canal by pulling the auricle of the ear. The nurse will pull the auricle in which directions? ​A. Down and backward. B. ​Down and outward. ​C. Upward and backward. ​D. Upward and outward.

​A. Down and backward. ​The nurse should pull the auricle down and backward. This is the correct technique used for infants and young children.

A client who is taking digoxin (Lanoxin) develops ECG changes and other indications of severe digoxing toxicity. Which of the following medications should the nurse prepare to administer? ​A. Fab antibody fragments (Digibind) ​B. Flumazenil (Mazicon) ​C. Acetylcysteine (Mucomyst) ​D. Naloxone (Narcan)

​A. Fab antibody fragments (Digibind) ​ ​Fab antibody fragments, also called digoxin immune Fab, bind to digoxin and block its action. The nurse should prepare to administer this antidote IV to clients who have severe digoxin toxicity.

A nurse is preparing to administer atenolol (Tenormin) to a client. Which of the following should prompt the nurse to withhold the medication? ​A. Heart rate 56/min ​B. Oxygen saturation 90% ​C. Respiratory rate 18/min ​D. Blood pressure 160/94 mm Hg

​A. Heart rate 56/min ​Atenolol (Tenormin) is a beta-blocker and is used in the treatment of hypertension and angina, and following a myocardial infarction. Generic names of beta-blockers end in "olol." Atenolol is a selective beta-blocker for beta1 receptors in the heart. This medication works by slowing the heart rate, decreasing the speed of electrical impulses through the atrioventricular node, and decreasing the force of contraction. The nurse should check the client's heart rate prior to administering a beta-blocker. If the client's heart rate is less than 60/min, the nurse should hold the medication and contact the provider.

A nurse is reviewing the following vital signs: heart rate 86/min, blood pressure 80/40 mm Hg, respiration 28/min with stridor, and temperature 101.5 F (38.6 C). Which of the following actions should the nurse take next? ​A. Hold captopril (Capoten). ​B. Hold albuterol (Proventil). ​C. Administer furosemide (Lasix). ​D. Administer erythromycin (Erythrocin).

​A. Hold captopril (Capoten). ​Captopril is an ACE inhibitor used to treat hypertension. An adverse effect of captopril is hypotension. This dose must be held to prevent a further decrease in blood pressure, which could create a medical emergency. It is also important to note that a cough is an adverse effect of an ACE inhibitor and should be considered when collecting data on the respiratory system. ​Albuterol is a bronchodilator used to treat bronchospasm associated with acute or chronic asthma, bronchitis, or other reversible obstructive airway diseases. Bronchodilators are administered to promote respiratory function and prevent respiratory distress. Heart rate and blood pressure can increase or decrease with albuterol and must be carefully monitored. ​Furosemide is a loop diuretic indicated for the treatment of heart failure, hepatic impairment, renal disease, and hypertension. The client is hypotensive, and furosemide will deplete more fluid volume and further lower the blood pressure. ​Erythromycin is a broad-spectrum antibiotic and would be indicated for a client who has an infection. Although the temperature is elevated, holding captopril would take priority over administering an antibiotic.

A nurse is caring for a client who requests pain medication. The nurse should understand that acute pain can cause which of the following? ​A. Increased heart rate ​B. Decreased breath sounds ​C. Hyperactive bowel sounds ​D. Decreased oxygen saturation

​A. Increased heart rate ​Blood pressure, pulse, and respiratory rate are increased temporarily by acute pain. Pain stimulates the sympathetic nervous system, causing physiologic responses similar to the fight-or-flight reaction. Eventually, the vital signs may stabilize despite the persistence of pain. Therefore, physiologic indicators may not be an accurate measure of pain over time. Other physiologic responses include anxiety, diaphoresis, muscle tension, and decreased GI motility. Inadequate pain management can affect quality of life. Chronic pain is the most common cause of long-term disability. Older adults in nursing homes are especially at risk for poor pain management.

A client has started to take lithium carbonate (Eskalith) to treat bipolar disorder. The nurse should make sure the client understands that he must maintain consistency in his intake of which of the following dietary elements? ​A. Sodium ​B. Potassium ​C. Vitamin K ​D. Vitamin C

​A. Sodium ​Lithium is a salt. If sodium level falls, the client will retain lithium and have an increased risk for lithium toxicity.

A nurse is caring for a client who is receiving a unit of packed RBC. The nurse notices the client's face is flushing and he begins to report low back pain. Which of the following actions is the nurses's priority? ​A. Stop the transfusion. ​B. Administer an antihistamine. C. Monitor vital signs. D. Begin an infusion of 0.9% sodium chloride through new tubing.

​A. Stop the transfusion. ​When using the Saftey/Greatest Risk approach to client care, the nurse should place priority on stopping the blood transfusion as even a small additional amount of blood can worsen the client's adverse reaction and will post the greatest risk to the client's safety.

A nurse is reviewing the history and physical for a client who has schizophrenia. Reported findings include jerky choreiform movements, lip smacking, and neck and back tonic contractions. These findings are chronic despite the discontinuation of chlorpromazine (Thorazine). The nurse should suspect that the client has developed which of the following adverse effects? ​A. Tardive dyskinesia ​B. Pseudoparkinsonism ​C. Dystonia ​D. Akathisia

​A. Tardive dyskinesia ​These findings indicate tardive dyskinesia which is persistent even with the discontinuation of the conventional antipsychotic.

A nurse is preparing to use the z-track technique to administer a medication to a client Which of the following is an appropriate action during this procedure? ​Pull the skin 1.3 cm (1/2 inch) to the side. Insert the needle slowly and gently. ​Use a 45-degree angle of insertion. ​Aspirate for 5 to 10 seconds.

​Aspirate for 5 to 10 seconds. ​Aspirating for 5 to 10 seconds allows blood in a small blood vessel to appear, an indication that the nurse should withdraw the needle and prepare a fresh injection.

A nurse is caring for a client who reports taking bisacodyl (Ducolax) to promote a daily bowel movement. Which of the following should be the nurse's priority response? ​A. "What do your bowel movements look like?" ​B. "How long have you been taking the Ducolax?" ​C. "Have you taken the Ducolax with a glass of milk?" ​D. "How often do you have a bowel movement?"

​B. "How long have you been taking the Ducolax?" ​Bisocodyl is a stimulant laxative indicated for short-term use due to a risk of dependency. It is important for the nurse to determine the history, specifically the length of time the client has relied on this medication for bowel elimination.

A nurse is talking with a client who is about to start taking allopurinal (Zyloprim) to treat gout. Which of the following statements indicated that the client understands how to take this medication? ​A. "If I get a rash, I will take my usual antihistamine." ​B. "I need to drink at least 3 quarts of water a day." C. ​"I should take the medicine on an empty stomach." D. ​"If I get a fever, I will take some aspirin."

​B. "I need to drink at least 3 quarts of water a day." ​Clients taking allopurinol must drink enough fluid to produce 2,000 mL of urine per day. The recommended amount to drink is 3,000 mL, which is equivalent to 3 quarts. ​Clients can develop a toxicity syndrome a few weeks after they start therapy with this medication. They should report a rash to the provider immediately. ​The client should take allopurinol after meals. ​Clients can develop a toxicity syndrome a few weeks after they start therapy with this medication. They should report a fever to the provider immediately.

A nurse is caring for a client who has a prescription for oral erythromycin (E-mycin). Which of the following statements is appropriate for the nurse to document regarding expected side effects of this medication? ​A. "The client has swollen lips." ​B. "The client had a small amount of yellow emesis." ​C. "The client verbalizes a ringing in the ears." ​D. "The client reports constipation with abdominal cramping."

​B. "The client had a small amount of yellow emesis." ​Erythromycin can cause gastrointestinal disturbances, such as epigastric pain, nausea, vomiting, and diarrhea. These side effects can be reduced by administering the medication with food. The best absorption occurs when taken on an empty stomach. If the drug is not tolerated on an empty stomach, it can be taken with food. Severe vomiting should be reported. Weight, fluid, and electrolytes should be monitored.

A nurse is reinforcing teaching with a client whose medication was changed from metoprolol (Lopressor) to metoprolol/hydrochlorothiazide (Lopressor HCT). Which of the following statements by the client indicates understanding of the teaching? A. ​"Now I will not have to diet to lose weight." ​B. "With the new medication, I should experience fewer side effects." ​C. "I will not have to do anything different because it is the same medication." ​D. "The extra letters after the name of medication means it is a stronger dose."

​B. "With the new medication, I should experience fewer side effects." ​The client has stated an understanding of the purpose of the addition of the hydrochlorothiazide (HCTZ) to the metoprolol dosage. When used in combination with thiazide diuretics, a lower dose of the beta-blocker can be used. The benefit is there are fewer side effects when beta-blockers (and other antihypertensives) are used in lower dosages.

A nurse is caring for a client who received morphine sulfate 30 min ago. Which of the following best determines therapeutic client response to this medication? ​A. Stable vital signs ​B. 0 rating on pain scale ​C. No nausea with good appetite D. ​Improved output with decreased peripheral edema

​B. 0 rating on pain scale ​Morphine is an opioid analgesic used to treat moderate to severe pain. Most opioid analgesics reduce pain by centrally blocking the release of neurotransmitters in the spinal cord, altering perception and response to pain. Clients should not operate heavy machinery or drive until central nervous system effects are known, and they should not increase dosage without consulting the provider. Response to opioids varies widely from one person to another. Nurses should monitor the effectiveness of analgesic medications 30 to 60 min after administration. The best indicator that the analgesic medication is effective is the client's interpretation of pain relief and verbalization that pain is at an acceptable level. There are various types of pain scales used in determining pain relief, including numeric, descriptive, visual, and percent scales. The client's pain goal should be ascertained and pain managed accordingly.

A client is to receive a unit of packed red blood cells. The nurse should prime the blood administration tubing using which of the following IV solutions? ​A. Lactated Ringer's solution ​B. 0.9% sodium chloride ​C. Dextrose 5% in water ​D. Dextrose 5% in 0.45% sodium chloride

​B. 0.9% sodium chloride ​The nurse should prime the tubing with 0.9% sodium chloride, as this is the only IV solution that does not hemolyze RBCs.

A nurse is talking with a client who is about to start using transdermal nitroglycerin (Nitro-Dur) to treat angina pectoris. Which of the following is an appropriate instruction for this medication therapy? ​A. Apply a new transdermal patch once a week. ​B. Apply the transdermal patch in the morning. ​C. Apply the transdermal patch below the level of the waist. ​D. Wait 24 hr to apply a new patch if the applied patch falls off.

​B. Apply the transdermal patch in the morning. ​ ​The client should apply the patch every morning after showering and leave it in place for a minimum of 12 hr.

A nurse is caring for a client who has systemic lupus erythematosus and is about to start taking hydroxychloroquine (Plaquenil) to reduce skin inflammation. The nurse should instruct the client to report which of the following as an indication of a toxic reaction to this medication? A. ​Muscle cramps ​B. Decreased visual acuity ​C. Cardiac dysrhythmias ​D. Joint pain

​B. Decreased visual acuity ​Hydroxychloroquine can cause retinopathy, thus it is essential that the client report any changes in vision immediately.

When talking with a patient about taking cimetidine (Tagamet), the nurse should include which of the following instructions? A. ​Take the medication with an antacid to minimize stomach upset. ​B. Do not take this medication if you start taking blood-thinning medications. ​C. Take the medication on an empty stomach for better absorption. ​D. Do not stop taking this medication after a few days or weeks.

​B. Do not take this medication if you start taking blood-thinning medications. ​Cimetidine can interfere with the absorption of warfarin (Coumadin) and several other medications, including phenytoin (Dilantin) and propranolol (Inderal).

A client who is postoperative is receiving IV fluids and a unit of whole blood. The nurse should observe the client for which of the following as an early sign of circulatory overload? ​A. Flushing ​B. Dyspnea ​C. Bradycardia ​D. Vomiting

​B. Dyspnea ​Circulatory overload causes dyspnea, cough, rales, tachycardia, and jugular vein distention.

A nurse is providing discharge teaching for a client who has pulmonary edema and is about to start taking furosemide (Lasix). Which of the following instructions should the nurse include? ​A. Take aspirin if headaches develop. ​B. Eat foods that contain plenty of potassium. ​C. Expect some swelling in the hands and feet. ​D. Take the medication at bedtime.

​B. Eat foods that contain plenty of potassium. ​Furosemide, a high-ceiling (loop) diuretic, can cause potassium loss. To prevent this, the client should add potassium-rich foods to his diet.

A nurse is talking with a client who is about to undergo hip arthroplasty. The nurse explains that the surgeon will prescribe anticoagulant therapy to prevent deep-vein thrombosis postoperatively. The nurse should explain that the client will not require frequent clotting time determinations because the surgeon plans to prescribe which of the following medications? A. ​Aspirin ​B. Enoxaparin (Lovenox) ​C. Heparin ​D. Warfarin (Coumadin)

​B. Enoxaparin (Lovenox) ​Enoxaparin (Lovenox) is a low molecular heparin that inhibits thrombus and clot formation. Preventive doses are low and the client does not require monitoring of prothrombin time or activated partial thromboplastin time.

A nurse is caring for a client who is at 6 weeks of gestation and has pneumonia. While the nurse is obtaining the client's history, she tells the nurse that she takes the herb feverfew for migraine headaches. Which of the following actions should the nurse take? ​A. Tell her that she should take an over-the-counter analgesic instead. ​B. Explain that she should not take this herb while she is pregnant. ​C. Ask her why she would take an herb during pregnancy. ​D. Suggest that she ask her herbalist about taking it while pregnant.

​B. Explain that she should not take this herb while she is pregnant. ​The nurse should explain that feverfew interferes with platelet action and can therefore cause bleeding. It is unsafe for the client to take during pregnancy.

A nurse is providing discharge teaching for a client who has a new prescription for warfarin sodium (Coumadin). Which of the following should the nurse include in the teaching? A. ​Mild nosebleeds are common during initial treatment. ​B. He should use an electric razor while on this medication. ​C. If he misses a dose, he should double the dose at the next scheduled time. ​D. Coumadin increases the risk for deep vein thrombosis.

​B. He should use an electric razor while on this medication. ​Coumadin, an anticoagulant, increases the client's risk for bleeding. The nurse should teach the client safety measure, such as using an electric razor, to decrease the risk for injury and bleeding. ​Coumadin, an anticoagulant, increases the client's risk for bleeding. The nurse should instruct the client to stop the medication and notify the provider if signs of bleeding are present. ​Coumadin, an anticoagulant, should be taken at the same time each day and the client should not adjust the dose. Doubling a dose increases the client's risk for bleeding. ​Coumadin, an anticoagulant, is a medication for the prophylaxis and treatment of deep vein thrombosis.

A female client who has rheumatoid arthritis asks the nurse if it is safe for her to take aspirin. Which of the following is a contraindication to this medication? ​A. Report of recent migraine headaches. ​B. History of gastric ulcers. ​C. Current diagnosis of glaucoma. ​D. Prior reports of amenorrhea.

​B. History of gastric ulcers. ​Aspirin impedes clotting by blocking prosta-glandin synthesis, which can lead to bleeding. A side effect of prednisone is gastric irritation, also leading to bleeding. Therefore, a history of gastric ulcers is a contraindication to the use of aspirin.

A client is taking ibuprofen (Advil, Motrin) to treat hip pain. The nurse should teach the client that, to minimize gastric mucosal irritation, she should take this medication at which of the following times? ​A. At bedtime ​B. Immediately after a meal ​C. On arising ​D. On an empty stomach

​B. Immediately after a meal ​To minimize gastric irritation, the client should take ibuprofen with a meal or immediately after a meal.

A nurse is preparing to administer prednisone (Deltasone) to a client for treatment of rheumatoid arthritis. Which of the following indicates effective therapy? ​A. Elevated blood glucose ​B. Improved range of motion ​C. Increased blood pressure ​D. Improved long-term memory

​B. Improved range of motion ​This is an expected response of prednisone administration. Prednisone is a glucocorticoid that produces anti-inflammatory and immunosuppressive effects. When used for rheumatoid arthritis, the client should experience a reduction in pain and inflammation, and improved range of motion in joints. Local injections can be highly effective, and clients should be warned against overactivity in the affected joint to prevent overuse, which can lead to injury. Because of the risk for complications, long-term systemic use should be avoided.

A nurse is administering medication to a client. Which of the following medications is most effective when administered with little or no water? ​A. Famotidine (Pepcid) ​B. Sucralfate (Carafate) ​C. Syrup of ipecac (Ipecac) ​D. Calcium carbonate (Mylanta)

​B. Sucralfate (Carafate) ​Sucralfate (Carafate) is given as a protective barrier in the stomach to protect against excessive acid erosion. Sucralfate coats the stomach and is not absorbed systemically, making administration of additional fluid unnecessary. The purpose of a full glass of water for most oral medications is to promote absorption of medications systemically, thus this medication does not benefit from water or any other fluid. This medication does not need to be diluted.

A nurse is preparing to administer lisinopril (Prinvil). Which of the following findings should be reported to the provider immediately? ​A. Rash and impaired sense of taste ​B. Swelling of the tongue and oral pharynx ​C. Decreased blood pressure and pulse rate ​D. Low urine output and white blood cell count

​B. Swelling of the tongue and oral pharynx ​The nurse should withhold the medication and notify the provider immediately if the client reports swelling of the tongue or throat. Known as angioedema, ACE inhibitors can cause this potentially fatal reaction that develops in up to 1% of patients. Symptoms include giant wheals and edema of the tongue, glottis, and pharynx. Severe reactions should be treated with subcutaneous epinephrine. If angioedema develops, ACE inhibitors should be discontinued and never used again.

An older adult client's provider prescribes aspirin, 650 mg/q6h PO to treat rheumatoid arthritis. The nurse should teach the client that a possible adverse effect of aspirin therapy is ​A. constipation. ​B. bleeding. ​C. blurred vision. ​D. insomnia.

​B. bleeding. ​Aspirin can cause bleeding, tinnitus, gastric ulceration, nausea, and heartburn.

A nurse is teaching a patient who has rheumatoid arthritis about taking methotrexate (Rheumatrex). The nurse should tell the patient to ​A. take it with food to reduce gastric irritation. ​B. drink 2 to 3 L of water per day to promote its excretion. ​C. take an NSAID to help reduce toxicity. ​D. take it in the morning to prevent insomnia.

​B. drink 2 to 3 L of water per day to promote its excretion. ​Methotrexate can cause renal toxicity. Adequate hydration promotes its excretion and helps prevent this adverse effect.

A client who has angina pectoris is experiencing chest pain and has taken three nitroglycerin tablets sublingually. The client reports relief from the chest pain but now reports a headache. The nurse should explain to the client that this symptom ​A. could mean an allergy to the medication. ​B. is an expected side effect of the medication. ​C. indicates tolerance to the medication. ​D. is probably a result of anxiety about the chest pain.

​B. is an expected side effect of the medication ​The vasodilation nitroglycerin induces increases blood flow to the head and typically results in a headache.

A nurse is talking with a client who is about to start taking the bile acid sequestrant colestipol (Colestid) to lower his low-density lipoprotein (LDL) level. It comes in powder form or tablets. The nurse should inform the client that if he chooses tablet form, he ​A. will have to chew the tablets thoroughly. ​B. will have to take up to 30 tablets per day. ​C. should take the medication after each meal. ​D. should not take the medication with orange juice.

​B. will have to take up to 30 tablets per day. ​The therapeutic dose of colestipol is 15 to 30 g/day. The tablets contain 1 g of colestipol, so the client would have to take 15 to 30 tablets per day.

A nurse who has just admitted a client to an inpatient medical unit notices that the client brought a container of ginkgo biloba with him. When the nurse asks him about it, he says he takes it every day to "help his brain." Which of the following is an appropriate nursing response? ​A. "We don't allow anyone to bring their own medications to the hospital with them." ​B. "How do you know that this herb is actually helping your brain?" ​C. "For now, let's just make sure your doctor is okay with you taking it while you're in the hospital." ​D. "Are you aware of the dangers of taking herbal preparations?"

​C. "For now, let's just make sure your doctor is okay with you taking it while you're in the hospital." ​Herbal preparations like ginkgo biloba can interact with other medications and can cause various adverse effects. However, it can also have therapeutic effects. Offering to check with the provider is reasonable, as it will help ensure the client's safety while also recognizing his rights.

A nurse is teaching a client about the side effects of taking tamoxifen (Nolvadex) to treat breast cancer. Which client statement indicates understanding of the possible effects? A. ​"I won't worry about changes in my hearing because it's temporary." ​B. "I can expect to lose some weight while taking this medication." ​C. "I'll call my doctor if I notice any unusual menstrual bleeding." ​D. "If I have trouble sleeping, I'll let you know."

​C. "I'll call my doctor if I notice any unusual menstrual bleeding." ​ ​Tamoxifen, an estrogen receptor blocker, can cause uterine cancer. The client should watch for and report abnormal uterine bleeding, pelvic pain, or pressure and have regular gynecologic examinations.

A nurse is caring for a client who has a prescriptions for diphenhydramine (Benadryl) to relieve pruritus. The client asks the nurse how he can minimize the daytime sedation he is experiencing. Which of the following is an appropriate response by the nurse? A. ​"Gradually decrease the dose once tolerance to the effect is reached." ​B. "Distribute the doses evenly throughout the day." ​C. "Take most of the daily dose at bedtime." ​D. "Take the medication with meals."

​C. "Take most of the daily dose at bedtime." ​Taking most of the dose at bedtime will allow the client to obtain the benefit of maximum relief of symptoms and rest without itching.

A nurse at a family practice clinic receives a call from a client who is taking oral contraceptive but forgot to take one oral contraceptive pill. Which of the following instructions should the nurse give her? ​A. "Do not have vaginal intercourse until after your next period." ​B. "Stop taking the pills and switch to a different contraceptive method." ​C. "Take the missed dose along with the next dose." ​D. "Take a home pregnancy test."

​C. "Take the missed dose along with the next dose." ​ ​The nurse should tell the client to take the missed dose along with the next dose. If she misses two doses, she should take an additional dose each day for the next 2 days.

A nurse is preparing to initiate a transfusion of packed RBC for a client who has anemia. Which of the following rates is appropriate when the nurse starts the transfusion? ​A. 10 mL/min for 10 minutes. ​B. 20 mL/min for 10 minutes. ​C. 5 mL/min for 15 minutes. ​D. 15 mL/min for 15 minutes.

​C. 5 mL/min for 15 minutes. ​The nurse should begin the transfusion no faster than 5 mL/min during the first 15 minutes in order to decrease the risk for adverse reactions.

A nurse is caring for a client who develops Wernicke's encephalopathy as a result of chronic alcohol abuse. Which of the following interventions should the nurse anticipate? ​A. Laboratory analysis of cardiac enzymes. ​B. Monitoring for the presence of esophageal varices. ​C. Administration of thiamine (Vitamin B1) ​D. Placing the client in protective isolation.

​C. Administration of thiamine (Vitamin B1) ​ ​Administration of thiamine is a priority intervention for the client who has Wernicke's encephalopathy.

A nurse is providing teaching to a client who has diabetes mellitus and has a new prescription for chlorpropamide (Diabinese). The nurse should teach the client to avoid consumption of which of the following while taking this medication? ​A. Grapefruit ​B. Milk ​C. Alcohol ​D. Shellfish

​C. Alcohol ​The nurse should teach the client to avoid alcohol while taking this medication to prevent a disulfiram reaction.

A nurse is educating a group of clients about contrainindications of warfarin (Coumadin) therapy. Which of the following statements is appropriate to include in the teaching? ​A. Clients who have diabetes mellitus type 1 should not take Coumadin." ​B. Clients who have rheumatoid arthritis should not take Coumadin." ​C. Clients who are pregnant should not take Coumadin." ​D. Clients who have chronic alcoholism should not take Coumadin."

​C. Clients who are pregnant should not take Coumadin." ​Coumadin therapy is contraindicated in the pregnant client because it crosses the placenta and places the fetus at risk.

A nurse is caring for a client who is receiving mydriatic eye drops. Which of the following clinical manifestations indicates to the nurse that the client has developed systemic anticholinergic effect? ​A. Seizures ​B. Tachypnea ​C. Constipation ​D. Hypothermia

​C. Constipation ​ ​Mydriatic eye drops can cause systemic anticholinergic effects, such as constipation, dry mouth, photophobia, and tachycardia.

A nurse is caring for a client who has been prescribed timolol (Timoptic). Which of the following is the appropriate procedure for administration of this medication? ​A. Place the eyedropper gently against the sclera. ​B. Instill the medication directly onto the client's cornea. ​C. Drop prescribed amount of medication into the conjunctival sac. ​D. Protect the distal portion of the eye dropper using clean technique.

​C. Drop prescribed amount of medication into the conjunctival sac. ​With the dominant hand resting on client's forehead, hold filled medication eyedropper or ophthalmic solution approximately 1-2 cm above conjunctival sac. Instill prescribed number of medication drops into the conjunctival sac. After instilling drops, ask client to close eye gently. If the client is to receive more than one eye medication to the same eye, wait at least 5 min before administering the next medication.

A nurse is caring for a client whose serum potassium level is 5.3 mEq/L. Which of the following scheduled medications should the nurse plan to administer? ​A. Lisinopril (Zestril) ​B. Digoxin (Lanoxin) ​C. Furosemide (Lasix) ​D. Potassium iodide (SSKI)

​C. Furosemide (Lasix) ​Furosemide results in loss of potassium from the nephron as part of its diuretic effect. This medication can be given when a client has an elevated potassium level and can lower the potassium level. For this client, the depletion of potassium is a beneficial effect. For a client who has a therapeutic potassium level, there would be a risk for hypokalemia due to the excretion of potassium.

A nurse is caring for a client who has a hip fracture. The nurse should expect the provider to prescribe which of the following medications for prophylactic anticoagulant therapy? ​A. Aspirin ​B. Clopidogrel (Plavix) ​C. Heparin ​D. Warfarin (Coumadin)

​C. Heparin ​A client who has a hip fracture requires the immediate anticoagulant prophylaxis heparin therapy provides. ​Although aspirin has anticoagulant effects, clients generally take it for ongoing primary prevention of cardiovascular and cerebrovascular events, not for the immediate anticoagulant effects a client with a hip fracture requires. ​Clopidogrel is an oral antiplatelet drug clients take to prevent stenosis of coronary stents and for some secondary prevention indications, not for the immediate anticoagulant effects a client with a hip fracture requires. . ​Warfarin is an oral anticoagulant clients take for long-term anticoagulant prophylaxis, not for the immediate anticoagulant effects a client with a hip fracture requires.

A nurse is caring for a client who is receiving liothyronine (Cytomel) for treatment of hypothyroidism. Which of the following should the nurse recognize as a therapeutic response? ​A. Loss of appetite B. ​Increase in daily weight ​C. Improvement of overall mood ​D. Decrease in body temperature

​C. Improvement of overall mood ​Depression, lethargy, and fatigue are symptoms of hypothyroidism. Effective treatment will improve these symptoms, and the client will report an improvement in mood. Liothyronine is a synthetic preparation of triiodothyronine (T3), a naturally occurring thyroid hormone. Liothyronine is used to treat and improve the symptoms of hypothyroidism, which include anorexia, depression, lethargy, fatigue, cold and dry skin, a pale and puffy face, brittle hair, decreased heart rate, decreased temperature, weight gain, and intolerance to cold. ​Depression, lethargy, and fatigue are symptoms of hypothyroidism. Effective treatment will improve these symptoms, and the client will report an improvement in mood. Liothyronine is a synthetic preparation of triiodothyronine (T3), a naturally occurring thyroid hormone. Liothyronine is used to treat and improve the symptoms of hypothyroidism, which include anorexia, depression, lethargy, fatigue, cold and dry skin, a pale and puffy face, brittle hair, decreased heart rate, decreased temperature, weight gain, and intolerance to cold.

A client has developed agranulocytosis as a result of taking propylthiouracil (PTU) to treat hyperthyroidism. When preparing to counsel the client, the nurse should base her instructions on the fact that the client is at serious risk for which of the following? ​A. Excessive bleeding ​B. Ecchymosis ​C. Infection ​D. Hyperglycemia

​C. Infection ​Agranulocytosis is a failure of the bone marrow to make enough white blood cells causing neutropenia and lowering the body defenses against infection.

A nurse is caring for a client who is to begin therapy (furosemide) Lasix. The nurse notes that the client has not been receiving supplemental electrolytes. Which laboratory value is a priority for the nurse to check before administering furosemide? A. ​Bicarbonate ​B. Chloride ​C. Potassium ​D. Phosphate

​C. Potassium ​Furosemide is a loop diuretic and therefore promotes excretion of potassium. The nurse should monitor the client's serum potassium level before administering it to prevent hypokalemia.

A nurse is talking with a client who has type 2 diabetes mellitus that has responded well to oral hypoglycemic medication. The client reports morning fasting blood glucose levels above 180 mg/dL for the past week. In reviewing the client's medication history, the nurse should identify which of the following medications as possible contributing factor to the recent change in glycemic control? ​A. Ranitidine (Zantac) ​B. Cephalexin (Keflex) ​C. Prednisone. (Deltasone) ​D. Levothyroxine (Synthroid)

​C. Prednisone. (Deltasone) ​Corticosteroids such as prednisone can reduce the effectiveness of oral hypoglycemic medications and cause hyperglycemia.

Whenever a nurse is caring for clients who are receiving heparin, which of the following medications should the nurse have on hand in the event of an overdose? ​A. Iron ​B. Glucagon ​C. Protamine ​D. Vitamin K

​C. Protamine ​Protamine reverses the effects of heparin.

A nurse has just administered a dose of diazepam (Valium to a client. Which of the following actions should the nurse take before she leaves the client's room? A. ​Turn off the overhead lights. ​B. Reduce the ringer volume on the client's telephone. ​C. Put up the side rails on the client's bed. ​D. Turn off the client's television.

​C. Put up the side rails on the client's bed. ​Diazepam is a benzodiazepine that causes sedation and has antianxiety and muscle relaxation properties. For the client's safety, the nurse should raise the side rails, place the bed in the lowest position, and make sure the client's call light access device is within reach.

A nurse is caring for a client who has osteoporosis and is taking a calcium supplement. When the client tells the nurse she has been having some flank pain, which of the following adverse effects should the nurse suspect? A. Hepatitis ​B. Hip fracture ​C. Renal stones ​D. Pancreatitis

​C. Renal stones ​Calcium supplements may cause renal stones. Clients should increase their water intake while taking calcium supplements to hydrate the kidneys and should report any blood in the urine or flank pain.

A client who is postoperative reports incisional pain. The surgeon has prescribed subcutaneous morphine. Before administering this medication, the nurse should complete which priority assessment? ​A. Blood pressure ​B. Apical heart rate ​C. Respiratory rate ​D. Temperature

​C. Respiratory rate ​The priority action the nurse should take when using the airway, breathing, and circulation (ABC) approach to client care is to evaluate the client's respirations. The respiratory rate is especially important because opioid analgesics like morphine can cause respiratory depression.

A nurse is providing teaching to a client who has hypothyroidism and has a new prescription for levothyroxine (Synthroid). The nurse should instruct the client to avoid which of the following herbal supplements? ​A. Saw palmetto ​B. Cranberry ​C. Soy isoflavones ​D. Garlic

​C. Soy isoflavones ​The nurse should instruct the client to avoid taking soy isoflavones due to the possibility of reducing the absorption of the medication.

A nurse is talking with a group of young women about the use of oral contraceptive. The nurse should point out that taking which of the following herbal preparations reduces the effectiveness of this birth control method? ​A. Ginseng ​B. Gingko biloba ​C. St. John's wort ​D. Black cohosh

​C. St. John's wort ​St. John's wort, which some people take to help with depression, decreases the effectiveness of oral contraceptives.

A client is receiving lithium carbonate (Eskalith) to treat manic behavior. The nurse caring for this client should use which of the following strategies to guide the administration of the medication? A. Maintaining a therapeutic dose of 900 mg TID ​B. Encouraging regular (serum lithium level) determination until stabilization of the maintenance dose ​C. Telling the client to expect control of manic symptoms 7 to 10 days after starting lithium therapy ​D. Advising the client to report muscle weakness as it indicates severe toxicity

​C. Telling the client to expect control of manic symptoms 7 to 10 days after starting lithium therapy ​It will take 7 to 10 days before the client experiences a decrease in the manic symptoms.

A provider prescribes cyclobenzaprine (Flexeril) for a client who has a fractured ulna. When the client asks the nurse what this medication is supposed to do for him, the nurse should explain that cyclobenzaprine will ​A. kill microorganisms. ​B. reduce itching. ​C. relieve muscle spasms. ​D. relieve pain.

​C. relieve muscle spasms. ​The nurse should explain that the provider prescribed cyclobenzaprine to relieve muscle spasms that can accompany the acute pain of fractures.

A nurse plans to administer ceftriaxone (Rocephin) 1 mL to an older adult client. Which of the following indicates the correct technique? ​A. Uses a 5/8-inch needle ​B. njects at a 45° angle C. ​Administers medication in deltoid muscle ​D. Locates the vastus lateralis injection site

​D. Locates the vastus lateralis injection site ​The ventrogluteal or vastus lateralis are the safest injection sites for this medication. The nurse locates the vastus lateralis muscle by placing one hand below the greater trochanter of the femur and one hand's width above the knee. This creates an imaginary border where the nurse prepares to inject lateral to midline of the upper portion of the quadriceps muscle.

A nurse is caring for a client who reports daily use of acetaminophen (Tylenol) to manage mild knee pain. Which of the following statements by the client should be of most concern to the nurse? A. ​"I have a glass of wine before bedtime each evening." ​B. "I have my blood checked often due to the heparin I am taking." ​C. "I take two regular-strength tablets in the morning and two in the evening." ​D. "I take three or four Vicodin ES tablets a day for severe knee and joint pain."

​D. "I take three or four Vicodin ES tablets a day for severe knee and joint pain." ​Vicodin ES is a combination analgesic that contains 650 mg of acetaminophen in each tablet. If the client took three of these tablets, that would be 1,950 mg of acetaminophen and four tablets would be 2,600 mg. If the client takes four in one day, it would take only four regular-strength acetaminophen (Tylenol) tablets (325 mg each) to reach the maximum recommended dose of 4,000 mg. There are other prescription medications (e.g., Lortab, Percocet) and numerous over-the-counter medications that contain acetaminophen. The FDA is requesting combination medications limit the amount of acetaminophen to no more than 325 mg in each tablet. Clients should check the amount of acetaminophen in OTC products to be sure not to exceed the daily maximum dose if they are taking other acetaminophen products. This option creates the highest potential for acetaminophen overdose. In the event of an overdose, administer the antidote for acetaminophen, which is acetylcysteine (Mucomyst).

A nurse is reinforcing medication instruction to a group of clients. Which of the following statements indicates a need for further clarification? ​A. "I will take ibuprofen for arthritis." ​B. "I will take morphine sulfate during sickle cell crisis." ​C. "I will take propranolol hydrochloride to manage high blood pressure." ​D. "I will take aspirin for headaches like I did when I had a stroke."

​D. "I will take aspirin for headaches like I did when I had a stroke." ​This is an incorrect client response because aspirin may be contraindicated. Aspirin is classified as a nonnarcotic analgesic that powerfully inhibits platelet aggregation, which increases bleeding. A client who has experienced a hemorrhagic stroke should not take any medications that could cause further bleeding. The nurse should reinforce education regarding the effect of aspirin therapy.

A provider prescribes fluoxetine (Prozac) for a client who reports frequent periods of extreme sadness. The nurse teaching the client knows he understands how to take this medication when he makes which of the following statements? ​A. "I'll take this medicine at bedtime." B. ​"I should not take this medicine with grapefruit juice." ​C. "I'll take this medicine with food." ​D. "I'll take this medicine first thing in the morning."

​D. "I'll take this medicine first thing in the morning." ​The usual recommendation is to take fluoxetine as a single dose in the morning.

The nurse is providing discharge teaching for a client who will be taking warfarin (Coumadin) at home. Which of the following statements indicates that the client understands the effects of this medication? ​A. "It's okay to have a couple of glasses of wine with dinner." ​B. "I'll be sure to eat foods with lots of vitamin K." ​C. "I'll take aspirin for my headaches." ​D. "I'll use my electric razor for shaving."

​D. "I'll use my electric razor for shaving." ​Because this medication prolongs clotting times, the client should avoid situations that put him at risk for bleeding, such as shaving with a straight razor or a razor blade.

A nurse is caring for a client who received an injection of penicillin G procaine (Bicillin). The client experiences dyspnea and states, "My tongue feels swollen." Which of the following should be the nurse's priority action? A. ​Obtain intravenous fluids for administration. ​B. Record the observed data in medical record. C. ​Deliver a dose of albuterol (Proventil) by inhalation. ​D. Administer epinephrine (Adrenalin) subcutaneously.

​D. Administer epinephrine (Adrenalin) subcutaneously. ​Epinephrine (Adrenalin) is the drug of choice in response to anaphylaxis that occurs in a non-acute setting. Because this medication is given subcutaneously, the nurse can administer this medication. It can be given subcutaneously in the upper arm or in the thigh. The location should be above the location of the injection that resulted in the anaphylaxis. Epinephrine can be given through clothing to prevent delay of administration. The effect of the epinephrine is to act on adrenergic receptors, causing bronchodilation of the lungs and an elevation of blood pressure. By stimulating both alpha and beta adrenergic receptors to cause these effects, it accomplishes more of the goals of treatment of anaphylaxis than any other single therapy. This action is the priority action of the nurse to save the client.

A client is receiving pancreatic enzymes as a digestive aid. The nurse should tell the client expect which of the following gastrointestinal changes? A. ​Increased mucus in stools ​B. Decreased black tarry stools ​C. Increased watery stools ​D. Decreased fat in stools

​D. Decreased fat in stools ​Clients who have cystic fibrosis or pancreatitis, for example, need to supplement meals with oral pancreatic enzymes to reduce the fat content in their stools. Clients receiving pancreatic enzymes as a digestive aid should expect to have a reduction of fat in their stools.

A nurse is preparing to administer digoxin (Lanoxin) to a client who has heart failure. Which of the following actions is appropriate? A. Withholding the medication if the heart rate is above 100/min ​B. Instructing the client to eat foods that are low in potassium ​C. Measuring apical pulse rate for 30 seconds before administration ​D. Evaluating the client for nausea, vomiting, and anorexia

​D. Evaluating the client for nausea, vomiting, and anorexia ​Loss of appetite, nausea, vomiting, and blurred or yellow vision may be signs of digoxin toxicity.

A nurse is to adminisster subcutaneous short-acting insulin combined with long acting insulin to the client before he eats breakfast at 8:00 AM. Which of the following should the nurse do? A. ​Give the insulin at 7:00 B. ​Give the insulin when the breakfast tray arrives. ​C. Give the insulin one half hour after breakfast with other routine medicines. ​ ​D. Give the insulin at 7:30 AM after checking the blood glucose level results.

​D. Give the insulin at 7:30 AM after checking the blood glucose level results. ​Short-acting insulin has an onset of 30 minutes. Insulin should be given at a specific time before meals, usually one half hour. The nurse should always check the blood glucose levels prior to administering short-acting insulin. ​This time is too soon for the nurse to administer insulin to the client. A blood glucose should be taken first so the nurse knows how much insulin to administer. ​Administering insulin when the client's breakfast tray arrives is too late. ​Administering insulin 30 minutes after the client has ate breakfast it too late. The client's blood glucose is likely to be high and experiencing symptoms of hyperglycemia.

A client who is in labor receives butorphanol (Stadol) for pain management. Which of the following medications should the nurse have readily available? ​A. Protamine ​B. Diphenhydramine (Benadryl) ​C. Atropine ​D. Naloxone (Narcan)

​D. Naloxone (Narcan) ​Butorphanol is an opioid analgesic. The nurse should have the opioid reversal agent naloxone and resuscitation equipment available in the event that the client develops respiratory depression.

A nurse is caring for a client who has diagnosis of pulmonary embolism (PE). Which of the following should the nurse report to the provider? ​A. Hematocrit 45% B. Partial thromboplastin time (PTT) 55 seconds C. ​White blood cell count 8,000/mm³ ​D. Platelets 74,000/mm³​

​D. Platelets 74,000/mm³​ Heparin-induced thrombocytopenia is a disorder characterized by low platelet counts (thrombocytopenia). It is an adverse effect of heparin that causes the activation of platelets, resulting in widespread clot formation and depletion of platelets. It occurs in between 1-3% of clients receiving heparin for more than 4 days and places the client at risk for the formation of clots such as deep-vein thrombosis, ischemic cerebrovascular accident, myocardial infarction, and limb ischemia. Platelets should be monitored two to three times a week during the first 3 weeks of heparin use and monthly thereafter. The expected reference range for heparin is 150,000-400,000/mm³. The heparin should be stopped if the platelet count becomes less than 100,000/mm³. The platelet count in this option is 74,000/mm³.​

A nurse is talking with a client who is about to start therapy with cyclophosphamide (Cytoxan) to treat multiple myeloma. Which of the following instructions should the nurse reinforce? ​A. Expect constipation while taking this medication. ​B. Report dizziness or fatigue. ​C. Limit fluid intake while taking this medication. ​D. Report chills and fever.

​D. Report chills and fever. ​Cyclophosphamide, a nitrogen mustard, can cause bone marrow suppression. The nurse should instruct the client to report a sore throat, fever, or chills immediately so that the provider can initiate the appropriate therapy promptly.

The nurse is preparing a medication and observes the date of expiration on the vial occurred two months ago. Which action should the nurse perform? ​A. Give the medication. ​B. Discard the medication. ​C. Notify the provider. ​D. Return the medication to the pharmacy.

​D. Return the medication to the pharmacy. ​The nurse should return the medication to pharmacy. Laws require that all medication include an expiration date.

A nurse is talking with a client about taking an expectorant to treat a cough. The nurse should explain that this type of medication treats cough because of which of the following actions? A. Reduces inflammation ​B. Suppresses the urge to cough C. ​Dries mucous membranes ​D. Stimulates secretions

​D. Stimulates secretions ​Expectorants act by increasing secretions to improve a cough's productivity. ​An expectorant does not reduce inflammation. Glucocorticoids have this therapeutic effect. ​An expectorant does not suppress the cough stimulus. Antitussives have this therapeutic effect. ​An expectorant does not dry mucous membranes. Anticholinergic drugs have this effect.

A nurse is giving discharge instructions to a client who has asthma and is about to start taking theophylline (Theo-24). The nurse should tell the client that this medication might cause which of the following adverse effects? A. ​Drowsiness ​B. Constipation ​C. Oliguria ​D. Tachycardia

​D. Tachycardia ​Theophylline can increase cardiac stimulation and cause tachycardia.

A nurse is preparing an injection using a single dose glass ampule. Which of the following techniques should the nurse use when opening the glass ampule? ​A. Wear sterile gloves and break off the neck of the glass ampule with a single snap to the right side. ​B. Wear sterile gloves and break off the neck of the glass ampule with a single snap downward motion. ​C. Tap the bottom of the ampule, place a gauze pad or alcohol swab around the ampule neck, and break off the bottom with a forward motion away from the hands. ​D. Tap the top of the ampule, place a gauze pad or unwrapped alcohol swab around the ampule neck, and break off the top with a forward motion away from the hands.

​D. Tap the top of the ampule, place a gauze pad or unwrapped alcohol swab around the ampule neck, and break off the top with a forward motion away from the hands. ​The nurse should tap the top of the ampule, place a gauze pad or unwrapped alcohol swab around the ampule neck and break off the top with a forward motion away from the hands. This is the correct technique to use.

A provider is discharging a client who has pulmonary tuberculosis with a prescription for rifampin (Rifadin). The nurse should include which of the following information in the client's discharge teaching? ​A. Purified protein derivative skin test results will improve in 3 months. ​B. This medication can cause insomnia. ​C. It is best to take the medication with meals. ​D. Urine and other secretions will turn orange.

​D. Urine and other secretions will turn orange. ​ Rifampin will turn the urine and other secretions reddish-orange. This includes sputum, tears, and sweat.

Whenever a nurse is caring for clients who are receiving warfarin (Coumadin), which of the following medications should the nurse have on hand in the event of an overdose? ​A. Epinephrine ​B. Atropine ​C. Protamine ​D. Vitamin K

​D. Vitamin K ​Vitamin K reverses the effects of warfarin.

A client has been taking omeprazole (Prilosec) for the past 4 weeks. The nurse determines that the medication is effective when the client reports relief from ​A. nausea. ​B. diarrhea. ​C. headache. ​D. acid indigestion.

​D. acid indigestion. ​Omeprazole, a proton pump inhibitor, reduces gastric acid secretion and treats duodenal and gastric ulcers, prolonged dyspepsia, gastrointestinal reflux disease, and erosive esophagitis.

A nurse is discussing with a newly licensed nurse the information that should match on the requistion and the blood product prior to administration. Which of the following statements by the newly licensed nurse necessitates intervention? "Both the requistion and the blood products should identify the ​A. client's identification number." ​B. blood group and type." ​C. blood unit number." ​D. blood bank of origin."

​D. blood bank of origin." ​The purpose of checking the requisition and blood product prior to administration is to verify that the nurse is preparing to administer the right blood product to the right client. The blood bank that supplies the blood product is not necessary information to check prior to blood product administration.

dose of diazepam (Valium) to a client ​Turn off the overhead lights. ​Reduce the ringer volume on the client's telephone. ​Put up the side rails on the client's bed. ​Turn off the client's television.

​Put up the side rails on the client's bed. ​Diazepam is a benzodiazepine that causes sedation and has antianxiety and muscle relaxation properties. For the client's safety, the nurse should raise the side rails, place the bed in the lowest position, and make sure the client's call light access device is within reach.

Which of the following should be recognized by the nurse as part of the medication reconciliation process? A. The nurse writes a prescription to resume home medications not prescribed by the provider. ​B. A list of medications received during the hospitalization. ​C. Reconciliation occurs only during admission and discharge from a health care facility. ​​D. The documented list includes all medications taken by the client.

​​D. The documented list includes all medications taken by the client. The nurse should create a list of current medications including the name, indication, route, dosage, and dosing interval. The list consists of all medications, including vitamins, herbal products, and prescription and nonprescription medications. This allows the nurse to check for any duplication or incompatibilities. The nurse should compare the list of current medications with the list of newly prescribed medications. Once the data is collected, the provider will evaluate the needs of the client.​

A nurse is preparing to administer 10 units of regular insulin and 20 units of NPH insulin to a client. What is the sequence of events the nurse should follow?

​• Inspect vials for contaminants: With the exception of NPH insulin, all insulin available today is supplied as a clear, colorless solution. Insulin that has become colored, cloudy, or has formed a precipitate should not be used. The first step is to observe the characteristics of the regular and NPH insulin to determine whether they are safe to use. If they appear abnormal, the nurse should discard them. • Roll NPH vial between palms of hands: Because NPH insulin is a suspension, the particles must be evenly dispersed by rolling the vial gently between the palms of the hands. This should be done gently because vigorous mixing may cause the solution to become frothy and cause inaccurate dosing. If granules or clumps are present after mixing, the solution should be discarded. This should be done prior to withdrawing the solution into the syringe. • Inject air into NPH insulin vial: This creates a pressure in the vial for accuracy in measuring the amount prescribed. • Inject air into regular insulin vial: The amount of air injected into the vial of short-acting insulin is equal to the amount to be administered. • Withdraw short-acting insulin into syringe: When the prescription requires the administration of two types of insulin, it is generally preferable to mix the solutions into one syringe if they are compatible to prevent the client from receiving two injections. Of the longer-acting insulin available, only NPH insulin is appropriate for mixing with short-acting insulin. When two insulins are to be mixed, it is best to withdraw the short-acting insulin first to avoid contaminating the stock vial with NPH insulin. • Add intermediate insulin to syringe: The mixture is stable for 28 days.