EXAM 2

A nurse in a provider's office receives a call from a client who has been taking penicillin V three times daily and reports abdominal cramping with bloody diarrhea for several days. Which of the following instructions should the nurse give the client? "Bring in a stool sample for testing." "Take the drug only twice daily." "Use an over-the-counter anti-diarrheal medication." "Return to the clinic for blood work."

"Bring in a stool sample for testing."MY ANSWERAbdominal cramping and bloody diarrhea can be caused by an overgrowth of the organism Clostridium difficile. The client should bring a stool sample in to be tested for the presence of this organism. "Take the drug only twice daily."The nurse should not make changes to the client's prescription. The provider will likely have the client stop the drug and prescribe a different antibiotic. "Use an over-the-counter anti-diarrheal medication."Clients should not self-treat diarrhea with over-the-counter drugs until the cause of the abdominal distress and diarrhea has been determined. "Return to the clinic for blood work."Blood work is not indicated for the client's reported symptoms.

A nurse is teaching a client about naproxen enteric-coated tablets. Which of the following statements should the nurse include in the teaching? "Drug absorption occurs in the stomach." "You should expect immediate absorption of the drug." "You should allow the tablet to dissolve in your mouth." "Do not crush or chew the tablet."

"Drug absorption occurs in the stomach."Enteric-coated tablets are absorbed in the small intestine. "You should expect immediate absorption of the drug."Enteric coating slows the absorption of the drug. "You should allow the tablet to dissolve in your mouth."Dissolving an enteric-coated tablet in the mouth destroys its protective coating. "Do not crush or chew the tablet."MY ANSWERDrugs that irritate the stomach are often covered with an enteric coating that does not dissolve until the drug enters the alkaline environment of the small intestine. Clients should not crush or chew enteric-coated drugs because this will damage the enteric coating.

A nurse is obtaining a client's health history. The client reports no allergies but has experienced mild itching while taking amoxicillin in the past. Which of the following responses should the nurse make? "Itching is an expected adverse effect of amoxicillin." "Itching can indicate amoxicillin toxicity." "Itching can indicate a hypersensitivity to amoxicillin." "Itching can result from dry skin, which is often caused by amoxicillin."

"Itching is an expected adverse effect of amoxicillin."Itching is not an expected adverse effect of amoxicillin. "Itching can indicate amoxicillin toxicity."Itching does not indicate amoxicillin toxicity. "Itching can indicate a hypersensitivity to amoxicillin."MY ANSWERItching can be an indication of drug hypersensitivity, and a more severe allergic reaction can develop with future exposures. The client might be allergic to amoxicillin and other penicillins. "Itching can result from dry skin, which is often caused by amoxicillin."Dry skin is not an adverse effect of amoxicillin.

A nurse is teaching a client who has a prescription for a drug that has a receptor agonist effect. Which of the following information should the nurse include in the teaching? "This will increase the effects of normal cellular functions." "This prevents cells in your body from performing certain actions." "This prevents hormones in your body from attaching to cell receptor sites." "This minimizes the risk that the medications you take will become toxic."

"This will increase the effects of normal cellular functions." MY ANSWERAgonist drugs bind to cell receptors in the body and are targeted to a specific type of receptor. When they attach to the receptors, they perform the same action as a hormone or chemical would, increasing the effects of that hormone or chemical. For example, pharmacological insulin is administered to clients who have little to no insulin to mimic insulin's effects in the body. "This prevents cells in your body from performing certain actions."Antagonists are drugs that bind with a receptor and either block a response or precipitate a less than typical response. "This prevents hormones in your body from attaching to cell receptor sites."Competitive antagonists are drugs that bind with a receptor and prevent other drugs or chemicals in the body from attaching to cell receptors, which means they prevent or minimize certain effects. "This minimizes the risk that the medications you take will become toxic."Agonist drugs do not affect the risk for toxicity of other drugs. They might produce undesirable effects if they are too effective, such as when a drug given to treat bradycardia increases the client's heart rate to the point of tachycardia.

Ancef (cefazolin)

1st generation cephalosporin antibiotic bacterial infection

Ceftriaxone

3rd generation cephalosporin (IV)

Pneumonia vaccine

65 and above need 2 vaccines

A health care facility recently opened a research department to collect and analyze data related to improved client outcomes. Which of the following examples represents integration of technology to support creation of scholarly knowledge? ​Administration of an online survey for new nurses post-orientation regarding satisfaction with teaching methods ​Electronic collection of healing times of sacral wounds post-hyperbaric treatment, with and without antibiotic administration ​Piloting an instant messaging system between hand-held computers for nursing and pharmacy

Administration of an online survey for new nurses post-orientation regarding satisfaction with teaching methods ​This is important for nursing retention and construction of an effective employee orientation program but does not support the creation of scholarly knowledge. ​Electronic collection of healing times of sacral wounds post-hyperbaric treatment, with and without antibiotic administration MY ANSWER ​This supports research through data collection examining and intervention and comparison intervention. Technology supports the timely and accurate collection and analysis of data related directly to client outcomes. This helps support the creation of scholarly knowledge. ​Piloting an instant messaging system between hand-held computers for nursing and pharmacy ​This improves communication between health care team members but does not support the creation of scholarly knowledge.

A nurse is caring for a client who has a new prescription for a drug. After receiving the first dose of the drug, the client experiences anaphylaxis. The nurse should identify that anaphylaxis represents which of the following results of the drug? Adverse effect Paradoxical effect Therapeutic effect Toxicity

Adverse effectMY ANSWERAdverse effects are the unintended and unexpected effects of a drug, which can range from mildly annoying to life-threatening, such as an anaphylactic reaction. Paradoxical effectParadoxical effects are the opposite of the intended or desired effect of a drug, such as a drug intended to aid with sedation causing increased excitability in certain clients. Therapeutic effectA therapeutic effect is the intended benefit of the drug for the client. ToxicityToxicity occurs when the client receives a drug in excessive dosages. Manifestations of toxicity differ between drugs.

A nurse is teaching a client about the adverse effects of digoxin. Which of the following statements should the nurse include in the teaching? "Adverse effects are the intended effects of the medication." "Adverse effects indicate a severe allergy to the medication." "Decrease your medication dose if adverse effects occur." "Contact your provider if adverse effects occur."

Adverse effects are the intended effects of the medication."An adverse effect is an unexpected or unintended effect of a drug, which can range from annoying to life-threatening. "Adverse effects indicate a severe allergy to the medication."Adverse effects are a result of the drug's unintended or undesired effect on the body, but they do not always indicate an allergy to the drug. Clients might experience minor and annoying adverse effects, such as nausea or headache, without being allergic to the drug. "Decrease your medication dose if adverse effects occur."Adverse effects can occur at therapeutic dose levels. The client should not decrease dosage without consulting their provider. "Contact your provider if adverse effects occur."MY ANSWERAdverse effects can be severe and life-threatening. The client should contact their provider if adverse effects occur.

A nurse is preparing to administer a drug to a client. In which of the following sections of a drug handbook should the nurse look to determine if the client can receive the drug? Adverse effects Contraindications Implementation Black box warning

Adverse effectsThe nurse should review the adverse effects and side effects section in the drug handbook to review possible reactions the client might experience while taking the drug. ContraindicationsMY ANSWERThe nurse should review the contraindications section in the drug handbook to determine if a client can receive the drug. This section lists pre-existing diseases or clinical situations that could make it unsafe to administer a drug. ImplementationThe nurse should review the implementation section of the drug handbook to review specific nursing considerations when administering the drug. Black box warningThe nurse should review the black box warning section of the drug handbook to find alerts and information about severe adverse effects associated with a drug and ways to reduce harm to the client.

A nurse is preparing to administer a drug to a client. In which of the following sections of a drug handbook should the nurse look to determine if the drug has more than one use? Adverse effects Indications Pharmacokinetics Nursing implications

Adverse effectsThis section categorizes the adverse effects of a drug. IndicationsMY ANSWERThe indications section provides information on conditions and diseases for which the drug is used. PharmacokineticsThe pharmacokinetics section outlines how the drug is processed in the body through absorption, distribution, metabolism, and excretion, but it does not address the disease or conditions that the drug is used to treat. Nursing implicationsThe nursing implications section explains how the nurse will apply the nursing process to the use of the drug.

A nurse is caring for a client who is newly admitted to the facility for chest pain. At which of the following times should the nurse begin teaching about drugs and discharge planning? After the client has a definitive diagnosis On the day of discharge When the client's family members are present As soon as possible

After the client has a definitive diagnosisInstruction should begin before confirmation of the diagnosis. On the day of dischargeInstruction should begin before discharge to maximize the chance for the client to learn. When the client's family members are presentFamily members can participate, but the nurse should not delay instruction until family members arrive. As soon as possibleMY ANSWERInstruction should start at the beginning of care and when the client is receptive to learning.

Flu vaccine

Annually for pts >6 mo

Oseltamivir (Tamiflu)

Antiviral (Flu)

A nurse is preparing to administer amphotericin B IV to a client who has a systemic fungal infection. Which of the following drugs should the nurse prepare to administer prior to the infusion to prevent or minimize adverse reactions? (Select all that apply.) Aspirin Hydrocortisone Acetaminophen Diphenhydramine Ibuprofen

Aspirin is incorrect. Infusion reactions to IV amphotericin B include fever, chills, nausea, and headache. Although aspirin, an NSAID, can help for these symptoms, it also increases the client's risk for renal injury because aspirin is nephrotoxic and is therefore not an appropriate drug to prevent or minimize adverse reactions. Hydrocortisone is incorrect. Although a hydrocortisone, a glucocorticoid, can reduce fever and chills, it can also decrease the client's resistance to infection and is therefore not an appropriate drug to prevent or minimize adverse reactions.Acetaminophen is correct. Infusion reactions to amphotericin B IV, such as fever, chills, nausea, and headache, start 1 to 2 hr after the infusion begins and subside within 4 hr. The nurse can help prevent these effects by administering acetaminophen prior to the infusion.Diphenhydramine is correct. The nurse can help prevent adverse reactions by administering diphenhydramine prior to the infusion.Ibuprofen is incorrect. Although ibuprofen, an NSAID, can help prevent adverse reactions, it also increases the client's risk for renal injury because ibuprofen is nephrotoxic and is therefore not an appropriate drug to prevent or minimize adverse reactions.

A newly licensed nurse is expected to do which of the following? Assess the use of technology by peers and clients in the clinical setting Use technology to obtain information about unfamiliar procedures Integrate nursing knowledge and information technology to advance the science of nursing

Assess the use of technology by peers and clients in the clinical setting ​Assessing the use of technology by peers and clients in the clinical setting is not an expectation of a newly licensed nurse. C; Use technology to obtain information about unfamiliar procedures ​A newly licensed nurse should be able to use technology to obtain information about unfamiliar procedures. Integrate nursing knowledge and information technology to advance the science of nursing ​The informatics nurse specialist and the informatics innovator are expected to integrate nursing knowledge and information technology to improve client care in the clinical setting.

Ativan (lorazepam)

Benzodiazepine Antianxiety; C-IV

A nurse is caring for a client who is taking warfarin and has a new prescription for trimethoprim/sulfamethoxazole to treat a urinary tract infection. The nurse should clarify the prescriptions with the provider because taking these two drugs concurrently can increase the client's risk for which of the following? Bleeding Thrombosis ECG changes Ototoxicity

BleedingMY ANSWERTrimethoprim/sulfamethoxazole, a sulfonamide combination, can increase the effects of warfarin and increase the client's risk for bleeding. The nurse should request another prescription to treat the infection, or, if the client decides to take the drug, ask the provider to prescribe a lower warfarin dose and monitor prothrombin time carefully. The client should report any sign of bleeding, such as easy or unexplained bruising. ThrombosisA drug interaction between warfarin and trimethoprim/sulfamethoxazole, a sulfonamide combination, is unlikely to increase the client's risk of thrombosis. Rifampin is an antimicrobial drug that decreases warfarin levels and increases the risk for thrombosis. ECG changesA drug interaction between warfarin and trimethoprim/sulfamethoxazole, a sulfonamide combination, is unlikely to cause ECG changes. Erythromycin is an antimicrobial drug that can cause ECG changes, such as a prolonged QT interval. OtotoxicityA drug interaction between warfarin and trimethoprim/sulfamethoxazole, a sulfonamide combination, is unlikely to cause ototoxicity. Several antimicrobial drugs can cause ototoxicity, including erythromycin and gentamicin.

A nurse is caring for a client who is about to begin gentamicin therapy to treat an infection. The nurse should monitor the client for an alteration in which of the following? Bowel function Peripheral pulses Urine output Level of consciousness

Bowel functionIntravenous gentamicin, a sulfonamide combination, is unlikely to alter bowel function, but it can cause nausea and vomiting. Peripheral pulsesAlthough monitoring peripheral pulses is a standard assessment for every client, gentamicin, a sulfonamide combination, is unlikely to affect the peripheral pulses. The drug can, however, cause either hypotension or hypertension. Urine outputMY ANSWERGentamicin, an aminoglycoside, can cause nephrotoxicity. The nurse should monitor the client's BUN and creatinine levels and for an increased output of diluted urine. It is also essential to monitor serum gentamicin levels and maintain a therapeutic range. Level of consciousnessAlthough monitoring level of consciousness is a standard assessment for every client, gentamicin, a sulfonamide combination, is unlikely to affect the level of consciousness. The drug can, however, cause vertigo and skeletal muscle weakness.

A nurse is providing palliative care for a client who has end-stage lung cancer and is dyspneic. Which of the following actions should the nurse take? Apply supplemental oxygen. Ask the client how they are feeling. Place the client in the supine position. Administer haloperidol 0.5 mg sublingual.

C; Apply supplemental oxygen The nurse should administer haloperidol orally or sublingually if the client is experiencing agitation or restlessness, not dyspnea. Ask the client how they are feeling.The nurse can ask how the client is feeling. However, the nurse is already able to determine that the client is dyspneic and should provide an intervention. Place the client in the supine position.The nurse should place the client in a sitting position to promote the client's breathing and enhance chest expansion. Administer haloperidol 0.5 mg sublingual.The nurse should apply supplemental oxygen as a palliative measure for a client who has end-stage lung cancer and is dyspneic. The oxygen will ease the client's breathing and provide comfort to the client.

The primary goal of nursing informatics is to do which of the following? Improve health by optimizing information management and communication Provide a scientific basis for nursing practice and access to evidence-based practice guidelines Identify and quantify nursing interventions

C; Improve health by optimizing information management and communication ​The primary goal of nursing informatics is to improve health care outcomes by allowing nurses and health care providers to access, evaluate, and use best practice guidelines, scientific theories, and research information. Provide a scientific basis for nursing practice and access to evidence-based practice guidelines ​Nursing informatics technology provide a scientific basis for nursing practice and access to evidence-based practice guidelines, but this is not the primary goal. Identify and quantify nursing interventions ​Nursing informatics technology provides a way to identify and quantify the effects of nursing interventions, but this is not the primary goal.

​A new staff member asks a nurse what the abbreviation CDSS means. The correct response is clinical decision support system. clinical documentation specific systems. communication documentation support system.

C; clinical decision support system. ​Clinical decision support systems use evidence-based practice and clinical guidelines to assist physicians, nurses, and others to make the best practice decisions based on client data. clinical documentation specific systems. ​CDSS does not stand for clinical documentation specific systems. communication documentation support system. ​CDSS does not stand for a communication documentation support system.

​The purpose of using critical pathways to help manage the care of clients who have specific clinical problems is to improve client outcomes by providing timely interventions. increase variation of care to each individual client. control the degree of standardization across populations.

C; improve client outcomes by providing timely interventions. Critical pathways are used by the interdisciplinary team to track a client's progress. The clinical pathway outlines assessments, interventions, treatments, and outcomes for health-related conditions for a specified period of time. increase variation of care to each individual client. The purpose of critical pathways does not increase the variation of care for each individual client. control the degree of standardization across populations. The purpose of critical pathways does not control the degree of standardization across populations. It increases the degree of standardization.

​Which of the following electronic resources should a nurse use to obtain clinical practice guidelines and interventions to reduce the risk of negative client outcomes while in a hospital? Centers for Disease Control (CDC) Agency for Healthcare Research and Quality (AHRQ) Quality & Safety Education for Nursing (QSEN)

Centers for Disease Control (CDC) ​The CDC website has information on health promotion; prevention of disease, injury, and disability; and preparedness for new health threats. C; Agency for Healthcare Research and Quality (AHRQ) ​AHRQ supports research designed to improve the quality of health care, including providing evidence-based guidelines. Quality & Safety Education for Nursing (QSEN) ​QSEN's website is a resource for quality and safety education for nurses.

A nurse is caring for a client who is taking acetaminophen and codeine for pain relief. These analgesic drugs interact with one another to cause an additive effect. The nurse should identify that which of the following are characteristics of additive drug interactions? (Select all that apply.) Clients can achieve desired effects with the use of lower dosages. Taking the two drugs together can reduce the effects of one or both drugs. Taking the two drugs together can potentiate the effects of one or both drugs. The two drugs can produce an action neither would have produced alone. Both drugs have similar actions.

Clients can achieve desired effects with the use of lower dosages is correct. When two or more drugs are given at the same time and have similar actions, an additive effect will occur. Clients can take some drugs together for their additive effects, so they can take lower doses of each drug.Taking the two drugs together can reduce the effects of one or both drugs is incorrect. Drugs that interact together to cause reduced effects are antagonistic.Taking the two drugs together can potentiate the effects of one or both drugs is incorrect. Drugs that interact together to cause greatly increased effects are synergistic.The two drugs can produce an action neither would have produced alone is incorrect. Two drugs given together can produce a unique effect neither would have produced when taken alone. However, this is not an additive effect.Both drugs have similar actions is correct. Additive effects occur when two or more drugs with similar actions are taken at the same time.

​Risks associated with the use of information technologies include which of the following? Compromising client and caregiver safety related to nursing care and health outcomes Loss of electronic information due to glitches and external threats to security Decreased dependence on tradition and trial and error when problem solving

Compromising client and caregiver safety related to nursing care and health outcomes Information management systems provide links to evidence-based practice resources that nurses can use to guide care in the clinical setting. C; Loss of electronic information due to glitches and external threats to security The primary risk associated with the use of electronic health records and other information science technologies is the potential loss of information due to system errors, mechanical glitches, and external security threats. Decreased dependence on tradition and trial and error when problem solving Information management systems decrease the nurse's dependence on tradition and trial and error, promotes client safety, and improves health care outcomes.

A nurse is caring for a client who is about to begin taking nitrofurantoin to treat a urinary tract infection. The nurse should tell the client to report which of the following adverse effects of the drug? Constipation Dark brown urine Cough Tremors

ConstipationNitrofurantoin, a urinary tract antiseptic, is more likely to cause diarrhea than constipation. Dark brown urineNitrofurantoin, a urinary tract antiseptic, can turn urine a dark brown color, but it is a harmless effect. The drug can also stain teeth, so clients should rinse their mouth after drinking the oral suspension. CoughMY ANSWERNitrofurantoin, a urinary tract antiseptic, can cause cough, shortness of breath, chest pain, and fever. These adverse effects can indicate an acute allergic reaction and require immediate discontinuation of drug therapy. TremorsNitrofurantoin, a urinary tract antiseptic, is unlikely to cause tremors, but it can cause peripheral neuropathy.

A nurse is administering cefotetan IV to a client to treat an intra-abdominal infection. The nurse notes that the IV insertion site is warm, edematous, and painful to the touch. Which of the following actions should the nurse take? Decrease the rate of the cefotetan infusion. Administer diphenhydramine to the client. Request a prescription for another antibiotic. Stop the cefotetan infusion.

Decrease the rate of the cefotetan infusion.Because the client could have thrombophlebitis, slowing the infusion will not alleviate the potential tissue damage or risk of embolus, and the IV site should be changed. To prevent thrombophlebitis, the nurse should dilute cefotetan, a second-generation cephalosporin, and infuse it slowly over 20 to 30 min. Administer diphenhydramine to the client.The edematous, painful, and warm IV insertion site does not indicate an allergic reaction. The nurse should administer an antihistamine, such as diphenhydramine, if the client has hives, a rash, or other indications of an allergy to cephalosporins. Request a prescription for another antibiotic.Switching the client to another antibiotic is essential when the current drug is ineffective or the client has an intolerable reaction to it. Stop the cefotetan infusion.MY ANSWERThe nurse should stop the infusion, remove the IV catheter, assess for tissue damage, and treat the client accordingly. The nurse should then initiate IV access via another site, continuing cefotetan therapy according to prescribed parameters.

​A nurse should recognize that to be a meaningful user of electronic health records, he should do which of the following? Develop all nursing care plans from the choices listed in the electronic health record. Respond appropriately to all clinical decision-making support systems and alerts. Search all possible electronic data locations to retrieve client health information.

Develop all nursing care plans from the choices listed in the electronic health record. The nurse will use a nursing standard care plan but must individualize the plan of care to reflect each client's unique needs. C; Respond appropriately to all clinical decision-making support systems and alerts. Clinical decision-making support systems use automated guidelines and alerts to help nurses prevent errors and assist with improved decision-making. Search all possible electronic data locations to retrieve client health information. Many current EHR systems have a number of pertinent tab headings so that a nurse can view or retrieve client health information.

​Which of the following support the integration of informatics into nursing practice to support safety in client care? (Select all that apply.) ​Embedded medication alerts for side effects in an electronic health care record ​Immediate access to digital X-rays ​Use of phones that connect directly to an assigned nurse for clients ​Integration of telehealth to follow up with clients in rural locations ​​Wireless Internet access for clients from the health care facility

Embedded medication alerts for side effects in an electronic health care record is correct. This promotes safe, effective nursing care through notifications to prevent medical errors and enhanced communication within and outside the health care facility. ​Immediate access to digital X-rays is correct. This promotes safe, effective nursing care through notifications to prevent medical errors and enhanced communication within and outside the health care facility. ​Use of phones that connect directly to an assigned nurse for clients is correct. This promotes safe, effective nursing care through notifications to prevent medical errors and enhanced communication within and outside the health care facility. ​Integration of telehealth to follow up with clients in rural locations is correct. This promotes safe, effective nursing care through notifications to prevent medical errors and enhanced communication within and outside the health care facility. ​Wireless Internet access for clients from the health care facility is incorrect. This provides client convenience but is not directly connected to improved safety in client care.

A nurse is reviewing a client's prescriptions prior to administering gentamicin to the client to treat a systemic infection. The nurse should clarify the use of gentamicin with the provider if the client is taking which of the following drugs? Ethacrynic acid Diphenhydramine Acetaminophen Levothyroxine

Ethacrynic acidMY ANSWERGentamicin, an aminoglycoside, and ethacrynic acid, a loop diuretic, are ototoxic drugs. The nurse should identify that concurrent use increases the client's risk for hearing loss. DiphenhydramineDiphenhydramine does not specifically interact with gentamicin, an aminoglycoside. Amphotericin B is an antifungal drug that interacts adversely with gentamicin to increase the risk for nephrotoxicity. AcetaminophenAcetaminophen does not interact with gentamicin, an aminoglycoside. NSAIDs, such as ibuprofen, interact adversely with gentamicin to increase the risk for nephrotoxicity. LevothyroxineLevothyroxine does not interact with gentamicin, an aminoglycoside. Vancomycin is an antimicrobial drug that interacts adversely with gentamicin to increase the risk for ototoxicity.

A nurse is caring for a client who has a new diagnosis of bacterial meningitis. The nurse should expect the provider to prescribe a drug from which of the following classifications of antibiotics? First generation cephalosporins Third generation cephalosporins Monobactams Macrolides

First generation cephalosporinsFirst generation cephalosporins are primarily used to treat infections of the skin, bone, and joints. They are not effective in the treatment of meningitis. Third generation cephalosporinsMY ANSWERLater generation cephalosporins are used to treat infections that cross the blood-brain barrier, and third-generation are specifically prescribed to treat bacterial meningitis. MonobactamsMonobactams are typically prescribed to treat infections of the abdomen, respiratory system, and female reproductive tract. MacrolidesMacrolides, such as erythromycin, are typically used to treat severe infections, such as whooping cough, diphtheria, and chlamydia.

Ciprofloxacin (Cipro)

Fluoroquinolone Antibiotic

A nurse is caring for a client who has a prescription for rifampin to treat tuberculosis. The nurse should expect the provider to prescribe which of the following drugs to the client to prevent possible resistance to rifampin? Gentamicin Vancomycin Isoniazid Metronidazole

GentamicinGentamicin is not used to treat tuberculosis. It is prescribed to treat infective endocarditis and is used for management of enterococcal infections. VancomycinVancomycin is not used to treat tuberculosis. It is effective for treating osteomyelitis, pneumonia, and Clostridium difficile-associated diarrhea. IsoniazidMY ANSWERIsoniazid is used to treat tuberculosis and reduces the possibility of resistance to rifampin when combined with the drug. Drug resistance can develop quickly if the client only takes rifampin. MetronidazoleMetronidazole is not used to treat tuberculosis. It is effective for treating septicemia or protozoal infections, such as giardiasis.

A nurse is caring for a client who has a new prescription for aztreonam to treat a respiratory tract infection. Which of the following findings in the client's medical record should the nurse recognize as requiring cautious use for this prescription and report to the provider? Glaucoma Closed-head injury Heart failure Renal impairment

GlaucomaClients who have glaucoma can take aztreonam, a monobactam. Viral infection is a contraindication for the use of the drug. Closed-head injuryClients who have a closed-head injury can take aztreonam, a monobactam. The drug requires cautious use with older adults. Heart failureClients who have heart failure can take aztreonam, a monobactam. Metronidazole is an antimicrobial drug that requires cautious use with clients who have heart failure. Renal impairmentMY ANSWERAztreonam, a monobactam, requires cautious use with clients who have renal dysfunction because it is excreted in the urine. Renal impairment could affect the excretion of aztreonam, allowing the level of the drug to accumulate. The nurse should report this finding to the provider, so the provider can prescribe a lower dose for the client or prescribe a different antimicrobial drug.

Ranitidine

H2 receptor antagonist (Zantac) treats ERD

A nurse is assessing a client who is in the end stages of life. The client is unconscious and has a "death rattle." Which of the following medications should the nurse plan to administer to the client? Haloperidol Morphine Scopolamine Prochlorperazine

HaloperidolThe nurse should administer haloperidol to clients who are restless and have agitation. MorphinE The nurse should administer morphine to clients who have unrelieved pain. C;ScopolamineThe nurse should administer scopolamine to clients who have excessive oral secretions along with wet respirations, also known as the "death rattle." Scopolamine is an anticholinergic that assists with drying the client's secretions, making it easier for the client to breathe. ProchlorperazineThe nurse should administer prochlorperazine to clients who have nausea or vomiting.

Which of the following legislative acts stipulate that clients be allowed to see and make corrections to their health care records? Health Information Technology for Economic and Clinical Health (HITECH) Act Health Information Portability and Accountability Act (HIPAA) American Recovery and Reinvestment Act (ARRA)

Health Information Technology for Economic and Clinical Health (HITECH) Act ​HITECH is part of ARRA, which was intended to increase the use of electronic health records by physicians and hospitals. CORRECT: Health Information Portability and Accountability Act (HIPAA) ​One privacy rule of HIPAA is to establish client ownership of the health care record and allow for client-initiated corrections and amendments. American Recovery and Reinvestment Act (ARRA) ​ARRA was intended to increase the use of electronic health records by physicians and hospitals.

A nurse is caring for a client who is about to begin receiving acyclovir IV to treat a viral infection. The nurse should recognize that cautious use of the drug is essential if the client also has which of the following conditions? Heart failure Dehydration Asthma

Heart failureClients who have heart failure can take acyclovir, an antiviral drug. Metronidazole, an antiparasitic drug, is an antimicrobial drug that requires cautious use with clients who have heart failure. DehydrationMY ANSWERAcyclovir, an antiviral drug, can cause renal toxicity, especially in clients who are dehydrated. Hydration during and after IV infusion of the drug can help prevent crystalluria. AsthmaClients who have asthma can take acyclovir, an antiviral drug. Amoxicillin, a penicillin, is an antimicrobial drug that requires cautious use with clients who have asthma. TinnitusClients who have tinnitus can take acyclovir, an antiviral drug. Vancomycin is an antimicrobial drug that requires cautious use with clients who have tinnitus.

A nurse in a provider's office receives a call from a client who is taking tetracycline orally to treat a chlamydia infection and reports severe blood-tinged diarrhea. The nurse should suspect the client is experiencing which of the following? Hemorrhoids Clostridium difficile-associated diarrhea Diverticular disease Small bowel obstruction

HemorrhoidsTetracycline, an antibiotic, is unlikely to cause hemorrhoids, although adverse effects include diarrhea, which can cause existing hemorrhoids to bleed. The nurse should assess the client for more serious causes of blood-tinged diarrhea if the client does have hemorrhoids. Clostridium difficile-associated diarrheaMY ANSWERSevere diarrhea, often containing mucus and blood, can indicate Clostridium difficile-associated diarrhea. Treatment includes stopping drug therapy and replacing fluids and electrolytes. Clients should immediately report severe diarrhea and blood in the stools. Diverticular diseaseTetracycline, an antibiotic, is unlikely to cause diverticular disease, a disorder that manifests as small pouches, or diverticula, that develop in the wall of the colon. Adverse effects of the drug include diarrhea, which can make existing diverticula bleed. Small bowel obstructionTetracycline, an antibiotic, is unlikely to cause small bowel obstruction, which manifests as nausea, vomiting, abdominal pain, and constipation. The drug causes diarrhea, not constipation.

When administering oral erythromycin to a client who has acute diphtheria, a nurse should monitor for which of the following adverse effects? Hypothermia Blurred vision Constipation Cardiac dysrhythmias

HypothermiaErythromycin, a macrolide, is more likely to cause fever than hypothermia. Blurred visionErythromycin, a macrolide, is more likely to cause hearing loss than vision changes. ConstipationErythromycin, a macrolide, is more likely to cause diarrhea than constipation. Cardiac dysrhythmiasMY ANSWERErythromycin, a macrolide, can cause ECG changes, including a prolonged QT interval, and put the client at risk for a potentially fatal ventricular dysrhythmia. The nurse should monitor the client's ECG and tell the client to report palpitations, fainting, or dizziness. The drug is contraindicated for clients who have a history of QT prolongation.

A nurse is preparing to teach a client how to take care of a newly created colostomy. The nurse should identify that which of the following factors can decrease the client's ability to learn? (Select all that apply.) Impaired cognitive level Language barrier Discomfort Repetition of teaching Unreadiness to learn

Impaired cognitive level is correct. A lack of understanding due to impaired cognitive and developmental levels can decrease the client's ability to learn. The nurse should adjust instructional methods to accommodate the client's developmental or cognitive level.Language barrier is correct. If the nurse and the client speak different languages, this can affect the client's ability to learn. The nurse should provide written information in the language the client speaks and make arrangements for finding an interpreter if necessary.Discomfort is correct. A client who is uncomfortable is not able to learn optimally. The nurse should ensure that the client is comfortable prior to giving instructions.Repetition of teaching is incorrect. Repeating important facts frequently and allowing clients to practice new skills often enhances learning. Unreadiness to learn is correct. A client's readiness to learn is an essential part of the client's ability to learn. For example, a client who is experiencing denial or distress is not ready to learn.

A nurse is providing teaching for a client who takes an oral contraceptive and is about to begin rifampin therapy to treat tuberculosis. Which of the following instructions should the nurse include? Increase the rifampin dose. Increase the oral contraceptive dose. Allow 2 hr between taking the two drugs. Use a non-hormonal form of contraception.

Increase the rifampin dose.Oral contraceptives do not reduce the effects of rifampin, an antimycobacterial drug. They can, however, reduce the effects of warfarin and hypoglycemic drugs. Increase the oral contraceptive dose.Taking additional oral contraceptives would increase the risk of serious adverse effects from the oral contraceptives and is not recommended. Allow 2 hr between taking the two drugs.Allowing 2 hr between taking the oral contraceptive and taking rifampin, an antimycobacterial drug, will not reduce the drug interaction. Use a non-hormonal form of contraception.MY ANSWERRifampin, an antimycobacterial drug, can increase the metabolism of oral contraceptives, reducing their effectiveness. Clients who are taking oral contraceptives and rifampin should use additional, non-hormonal contraceptive methods to prevent an unwanted pregnancy.

When reviewing a list of drugs in a drug handbook, a nurse can identify the generic name for a drug in which of the following ways? It begins with a lower-case letter. It is listed in parentheses along with the trade name. There are both letters and numbers in the name. The chemical name is listed in parentheses before the generic name.

It begins with a lower-case letter.MY ANSWERGeneric names are not capitalized. The brand, or trade name, is a drug's commercial name and is capitalized. It is listed in parentheses along with the trade name.Trade names, not generic names, are placed in parentheses. There are both letters and numbers in the name.Letters and numbers are part of the chemical identifier of a drug, which relates to its chemical make-up, and are not found in the generic name. The chemical name is listed in parentheses before the generic name.Drugs are rarely listed by their chemical name. Trade names, not chemical names, are placed in parentheses.

A nurse is caring for a client who is about to begin taking isoniazid to treat tuberculosis. The nurse should instruct the client to report which of the following adverse effects of the drug? (Select all that apply.) Jaundice Numbness of the hands Dizziness Hearing loss Oral ulcers

Jaundice is correct. Isoniazid, an antimycobacterial drug, can cause liver toxicity, especially in clients who abuse alcohol. The nurse should monitor liver enzymes during therapy and instruct the client to report indications of liver damage, such as jaundice, abdominal pain, and fatigue.Numbness of the hands is correct. Isoniazid can cause peripheral neuropathy. The nurse should instruct the client to report numbness, pain, or tingling in the hands or feet. Administering pyridoxine (vitamin B6) can help minimize these effects.Dizziness is correct. Isoniazid can cause dizziness, ataxia, and seizures. The nurse should instruct the client to report these CNS effects.Hearing loss is incorrect. Isoniazid is more likely to cause visual disturbances than hearing loss.Oral ulcers is incorrect. Isoniazid is unlikely to cause a superinfection and oral ulcers, but it can cause dry mouth.

A nurse is caring for a client who is having difficulty remembering to take their prescribed drug three times each day. The nurse should identify that which of the following alternate forms of the drug can help to promote adherence to the prescribed dosage? Liquid suspension Immediate-release capsule Extended-release tablet Powder form

Liquid suspensionAbsorption is rapid for drugs in a liquid form. Clients must take them at relatively frequent intervals. Immediate-release capsuleAbsorption is rapid for drugs in an immediate-release form. Clients must take them at relatively frequent intervals. Extended-release tabletMY ANSWERExtended-release tablets release the drug over an extended period of time. Clients can take them less frequently. Powder formAbsorption is rapid for drugs in a powder form. Clients must take them at relatively frequent intervals.

A nurse is caring for a client who arrived at an emergency department following a bee sting. Which of the following findings indicates an anaphylactic reaction? (Select all that apply.) Low blood pressure Wheezing Bradycardia Peripheral edema Difficulty swallowing

Low blood pressure is correct. Anaphylaxis is an immediate and life-threatening allergic response, manifesting as bronchospasm, laryngeal edema, and a rapid drop in blood pressure. Immediate treatment with epinephrine and IV fluids is imperative.Wheezing is correct. Anaphylaxis is an immediate and life-threatening allergic response, manifesting as bronchospasm, laryngeal edema, and a rapid drop in blood pressure. Wheezing is an indication of bronchospasm and is treated using bronchodilators. Bradycardia is incorrect. Tachycardia, rather than bradycardia, is an indication of anaphylaxis.Peripheral edema is incorrect. Angioedema, or facial swelling, rather than peripheral edema, is an indication of anaphylaxis.Difficulty swallowing is correct. Anaphylaxis is an immediate and life-threatening allergic response, manifesting as bronchospasm, laryngeal edema, and a rapid drop in blood pressure. Difficulty swallowing is an indication of laryngeal edema and, therefore, anaphylaxis.

A nurse in a provider's office receives a call from a client who was recently hospitalized and treated with imipenem IV for a bacterial infection and reports an inability to eat due to mouth pain. The nurse should identify that the client might be experiencing which of the following as an adverse effect of this drug? Malabsorption Superinfection Anorexia Dental caries

MalabsorptionImipenem, a carbapenem, is unlikely to cause malabsorption, but it can cause gastroenteritis, abdominal pain, and vomiting. SuperinfectionMY ANSWERImipenem, a carbapenem, can cause the superinfection Candida albicans in the mouth, throat, or vagina. It can also cause glossitis, an inflammation or infection of the tongue. Clients taking the drug should report any mouth pain or vaginal discharge and itching because they might require treatment with an antifungal drug. AnorexiaImipenem, a carbapenem, is unlikely to cause anorexia, but it can cause gastroenteritis, abdominal pain, and vomiting. Dental cariesImipenem, a carbapenem, is unlikely to cause dental caries, but dental caries are a possible cause of mouth pain. The drug can, however, cause glossitis, an inflammation or infection of the tongue, nausea, heartburn, and diarrhea.

A nurse is providing teaching to a pregnant client who is taking captopril, an ACE inhibitor, to treat hypertension. The nurse informs the client that captopril is a teratogenic drug. The nurse should explain that teratogenic drugs can cause which of the following? Maternal bleeding Maternal blood clots Gestational diabetes mellitus Fetal malformation

Maternal bleedingTeratogenic drugs do not cause maternal bleeding. Anticoagulants can cause this effect. Maternal blood clotsTeratogenic drugs do not cause maternal blood clots. Various hormonal preparations can increase the risk of this adverse effect. Gestational diabetes mellitusTeratogenic drugs do not cause gestational diabetes mellitus. Hormones produced during pregnancy can block the action of insulin, causing gestational diabetes mellitus. Fetal malformationMY ANSWERTeratogenic drugs can cause birth defects. Clients who are pregnant should not take these drugs.

Antacids in general

Mechanism of Action: -Neutralize acid in stomach Indications: Acute relief of symptoms associated with peptic ulcer, gastritis, gastric hyperacidity, and heartburn Adverse Effects: -Bleeding ulcers -Malignancy -Blood pH to elevate Nursing Responsibilities: -Separate antacids from other meds for 1-2 hours

A nurse is caring for a client who has streptococcal pharyngitis and an allergy to penicillin. The nurse should recognize that which of the following drugs can be safely administered to this client? Nafcillin Azithromycin Cephalexin Amoxicillin/clavulanic acid

NafcillinNafcillin is a penicillin and is therefore contraindicated for clients who are allergic to penicillin. Vancomycin and clindamycin are safer alternatives. AzithromycinMY ANSWERAzithromycin, a macrolide, is an acceptable alternative to penicillin for patients who have bacterial infections and are allergic to penicillin. The medication is effective against many gram-positive and gram-negative bacteria and is used for streptococcal pharyngitis. CephalexinA small percentage of clients who are allergic to penicillin have a cross sensitivity to cephalosporins. Cephalexin is a cephalosporin and is an inappropriate choice for the client. Amoxicillin/clavulanic acidAmoxicillin is a penicillin and is therefore contraindicated for clients who are allergic to penicillin. Vancomycin and clindamycin are safer alternatives.

A nurse is caring for a client who has a gynecologic infection and a history of alcohol use disorder. The nurse should identify that which of the following drugs can cause a reaction similar to disulfiram if the client drinks alcohol while taking it? (Select all that apply.) Nitrofurantoin Amoxicillin Aztreonam Cefotetan Metronidazole

Nitrofurantoin is incorrect. Nitrofurantoin, a urinary tract antiseptic, does not cause a reaction similar to disulfiram when clients consume alcohol. However, the drug can cause diarrhea, nausea, and vomiting.Amoxicillin is incorrect. Amoxicillin, a penicillin, does not cause a reaction similar to disulfiram when clients consume alcohol. However, the drug can cause diarrhea, nausea, and vomiting.Aztreonam is incorrect. Aztreonam, a monobactam, does not cause a reaction similar to disulfiram when clients consume alcohol. However, the drug can cause a superinfection with Candida albicans.Cefotetan is correct. Cefotetan, a second-generation cephalosporin, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension.Metronidazole is correct. Metronidazole, an antiparasitic drug, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension.

Which of the following illustrates the integration of informatics into a health care system to support cost containment? ​Offering free wireless Internet access to clients and visitors ​Installing bar codes on medications with alerts for low supplies ​Integrating an electronic health care record on a platform compatible with computers and tablets

Offering free wireless Internet access to clients and visitors ​This is a convenience geared toward customer satisfaction, not cost containment. ​CORRECT: Installing bar codes on medications with alerts for low supplies ​This illustrates cost containment by allowing inventory management related to supply and demand, directly affecting management of medication and supply costs. ​Integrating an electronic health care record on a platform compatible with computers and tablets ​This is an excellent method to improve communication among health care team members but is not related to cost containment.

Morphine Sulfate

Opioid Analgesic

Oxycodone

Opioid Analgesic

A nurse is caring for a client who is receiving hospice care. Which of the following findings should the nurse identify as a manifestation of impending death? Pale yellow urine Increased blood pressure Decreased strength of peripheral pulses Tightening of the facial muscles

Pale yellow urineThe nurse should recognize that a client who is approaching death will have dark, concentrated urine and a decreased urine output. Increased blood pressureThe nurse should recognize that a client who is approaching death will have a decreased blood pressure, not an increased blood pressure. C; Decreased strength of peripheral pulses The nurse should recognize that a client who is approaching death will develop a decreased heart rate and a decrease in peripheral pulse strength. Tightening of the facial musclesThe nurse should recognize that a client who is approaching death will have a decrease in muscle tone causing the jaw to relax.

A nurse is providing teaching for a client who has a new prescription for a drug with a high potential for toxicity. Which of the following information should the nurse include? (Select all that apply.) Periodic laboratory tests are essential to measure serum drug levels. Monitoring for indications of toxicity is important. Taking the drug with an inducing agent will increase the possibility of toxicity. Taking the smallest effective dose is crucial. Increasing fluid intake is recommended to avoid toxicity.

Periodic laboratory tests are essential to measure serum drug levels is correct. Clients who are taking drugs that have a high potential for toxicity should undergo regular monitoring of serum drug levels to be certain the drug level stays within the therapeutic range.Monitoring for indications of toxicity is important is correct. Drugs that have a high potential for toxicity can quickly build up to toxic levels in the blood, resulting in effects that can be irreversible or life-threatening. Therefore, the nurse should monitor for manifestations of toxicity particular to the drug the client is taking.Taking the drug with an inducing agent will increase the possibility of toxicity is incorrect. Inducing agents are drugs that have the effect of increasing the metabolism of drugs they are combined with, thereby reducing their efficacy and blood levels. Inducing agents can be prescribed to allow clients to take a lower dose of a drug, so the chances of drug toxicity are lessened. Taking the smallest effective dose is crucial is correct. It is optimal to use the lowest effective dose of a drug to achieve therapeutic effects because doing so helps minimize the risk for toxicity. Increasing fluid intake is recommended to avoid toxicity is incorrect. Increasing fluids will not reduce the risk for drug toxicity. Increasing fluids can change the urine's specific gravity, but it will not alter glomerular filtration, passive tubular reabsorption, or active tubular secretion, which are the three mechanisms by which drugs are excreted renally.

A nurse is caring for a client who was prescribed an antidepressant based on its ability to prevent the reuptake of neurotransmitters. The nurse should identify that which of the following terms describes why this drug was prescribed for the client? Pharmacologic action Chemical stability Route Adverse effects

Pharmacologic action MY ANSWER The nurse should identify that the mechanism of action of a drug on the body to achieve the desired effect is referred to as pharmacologic action. Chemical stabilityThe nurse should identify that knowledge of how a drug should be stored and handled to maintain maximum effectiveness is referred to as chemical stability. RouteThe nurse should identify that route refers to the method of administering the drug, such as oral, topical, or parenterally. Adverse effectsThe nurse should identify that adverse effects refer to the unintended and undesired effects that drugs have on the body, which can range from annoying to life-threatening.

An informatics nurse specialist may engage in numerous roles. Which of the following roles is specific to her qualifications? Project manager to design and implement updates to the electronic health record in a facility Liaison between health care professionals, information technology department, and administration Data processing and reviewing statistics related to research programs

Project manager to design and implement updates to the electronic health record in a facility The role of project manager is reserved for the informatics innovator. C; Liaison between health care professionals, information technology department, and administration The informatics nurse specialist is expected to be able to "talk the talk" of nursing informatics and communicate the importance of informatics technology to an interdisciplinary team. The INS is expected to promote the effectiveness of information systems and revise existing systems to meet the needs of clinical staff. Data processing and reviewing statistics related to research programs The experienced nurse is expected to use data processing programs and review statistics related to quality control concerns and research problems.

A nurse is caring for a client who has a new prescription for acyclovir to treat a herpes simplex infection. Which of the following laboratory values should the nurse monitor for this client? Prothrombin time Hct BUN Aspartate aminotransferase

Prothrombin timeAcyclovir, an antiviral drug, is unlikely to alter prothrombin times. Cefotetan, a second-generation cephalosporin, is an antimicrobial drug that can cause thrombocytopenia and prolonged bleeding times. HctAcyclovir, an antiviral drug, is unlikely to alter the client's hematocrit level. Amphotericin B is an antimicrobial drug that can cause anemia due to RBC suppression. BUNMY ANSWERAcyclovir, an antiviral drug, can cause renal toxicity due to drug accumulation in renal tubules. The nurse should monitor the client's urine output, BUN, and creatinine levels, and increase fluid intake to hydrate and flush the kidneys. Aspartate aminotransferaseAcyclovir, an antiviral drug, is excreted by the kidneys and is unlikely to alter liver function tests. Ketoconazole is an antimicrobial drug that can cause liver toxicity and requires monitoring of liver function.

Pantoprazole

Protonix GERD

A nurse is speaking to a client who is taking sertraline and reports drinking grapefruit juice. The nurse explains that grapefruit juice inhibits an enzyme in the liver that is used to metabolize sertraline. The nurse should recognize the client's risk for which of the following? Reduced drug absorption Drug dependence Altered drug distribution Drug toxicity

Reduced drug absorptionGrapefruit juice can increase the amount of the drug available for absorption. Drug dependenceDrug dependence occurs when a client takes a drug over a period of time and develops a physiological and psychological dependence on it. Grapefruit juice should not affect a client's dependence on a drug. Altered drug distributionDistribution refers to the movement of a drug to the site of action. Grapefruit juice should not affect the distribution of a drug. Drug toxicityMY ANSWERGrapefruit juice can cause increased levels of certain drugs, such as sertraline, which can lead to drug toxicity. Clients should avoid drinking grapefruit juice while taking these drugs.

When administering a client's medication, a nurse uses which of the following actions as the best way to reduce preventable medication errors? Scan the client's medication, and ask the client to state her name and date of birth. Scan the client's medication, and then scan the client's hospital identification armband. Visually verify the medication, and ask the client to state her name and date of birth.

Scan the client's medication, and ask the client to state her name and date of birth. ​Although scanning the client's medication and asking the client to state her name and date of birth is part of the right to administering medication, this is not the best way to prevent a medication error. Scan the client's medication, and then scan the client's hospital identification armband. ​Although scanning the client's medication and then scanning the client's hospital identification armband is part of the right to administering medication, this is not the best way to prevent a medication error. C; Visually verify the medication, and ask the client to state her name and date of birth. ​The nurse should visually verify the correct medication and dosage, as well as use two client identifiers before administering the medication. This is the best way to reduce preventable medication errors.

A nurse is caring for a client who has stage IV heart failure. The client has audible crackles in the lungs and is experiencing fluid overload. Which of the following medications should the nurse expect the provider to prescribe? Scopolamine Amoxicillin/clavulanate Furosemide Lorazepam

ScopolamineThe nurse should administer scopolamine to clients who have oral secretions along with wet respirations and are experiencing difficulty breathing. Amoxicillin/clavulanateThe nurse should administer amoxicillin/clavulanate to clients who have an upper respiratory infection, such as aspiration pneumonia. C; Furosemide The nurse should administer furosemide to the client who has stage IV heart failure with crackles in their lungs and is experiencing fluid overload. Furosemide is a diuretic which reduces the workload of the heart along with the congestion and excess fluid. This will allow the client to breathe easier. LorazepamThe nurse should administer lorazepam to clients who are experiencing fear and anxiety, which can result from the inability to breathe from respiratory distress.

A nurse is caring for a client who is about to begin taking metronidazole to treat an anaerobic intra-abdominal bacterial infection. The nurse should recognize that cautious use of the drug is indicated if the client also has which of the following conditions? Seizure disorder Hearing loss Asthma Anemia

Seizure disorderMY ANSWERMetronidazole, an antiparasitic drug, can cause ataxia, vertigo, and seizures. It requires cautious use with clients who have a history of seizure activity, liver or renal failure, or heart failure. Hearing lossClients who have hearing loss may take metronidazole, an antiparasitic drug. Vancomycin is an antimicrobial drug that requires cautious use with clients who have hearing loss. AsthmaClients who have asthma may take metronidazole, an antiparasitic drug. Amoxicillin, a penicillin, is an antimicrobial drug that requires cautious use with clients who have asthma. AnemiaClients who have anemia may take metronidazole, an antiparasitic drug. Amphotericin B, a polyene antibiotic, is an antimicrobial drug that requires cautious use with clients who have anemia.

​Which of the following uses of technology would constitute a violation of HIPAA? ​Sharing a client's lab results with a consulting provider via email on the health care facility intranet ​Charting client data on an electronic health care record while at the bedside with family members present ​Texting a picture of a client's wound from one nurse to another nurse related to wound care protocol

Sharing a client's lab results with a consulting provider via email on the health care facility intranet ​This is an accepted form of electronic communication and does not violate client confidentiality. ​Charting client data on an electronic health care record while at the bedside with family members present ​This is an accepted form of electronic communication and does not violate client confidentiality. ​Texting a picture of a client's wound from one nurse to another nurse related to wound care protocol MY ANSWER ​This is a violation of client confidentiality due to identifiable client assessment data shared outside the health care facility. Even though the nurse sent the photo to another nurse related to wound care protocol, this is not acceptable use of technology and violates HIPAA.

A nurse is caring for a client who is taking ciprofloxacin to treat a urinary tract infection. The client also takes prednisolone to treat rheumatoid arthritis. Recognizing the adverse effects of ciprofloxacin, the nurse should instruct the client to report which of the following adverse effects? Tachycardia Hair loss Insomnia Tendon pain

TachycardiaCiprofloxacin, a fluoroquinolone, is unlikely to cause tachycardia. Amphotericin B is an antimicrobial drug that can cause this adverse effect. Hair lossCiprofloxacin, a fluoroquinolone, is unlikely to cause hair loss, but it can cause photosensitivity. Clients should wear sunscreen and protective clothing while outdoors to prevent severe sunburn. InsomniaCiprofloxacin, a fluoroquinolone, is unlikely to cause insomnia, but it can cause vertigo and malaise. Tendon painMY ANSWERCiprofloxacin, a fluoroquinolone, can cause tendon rupture, most often of the Achilles tendon. This adverse effect is especially common for older adults or clients who take glucocorticoids, such as prednisolone. The nurse should tell the client to report tendon pain and stop taking the drug.

A nurse in a provider's office receives a call from a client who is taking ciprofloxacin to treat a respiratory tract infection and reports dyspepsia. Which of the following instructions should the nurse give the client? Take an antacid at least 2 hr after taking the drug. Take the drug with a cup of coffee. Take an iron supplement with the drug. Take the drug with 240 mL (8 oz) of milk.

Take an antacid at least 2 hr after taking the drug.MY ANSWERThe nurse should recommend that the client take an antacid to relieve the dyspepsia at least 2 hr after taking ciprofloxacin, a fluoroquinolone. This is because antacids decrease the absorption of the drug. Take the drug with a cup of coffee.Clients who are taking ciprofloxacin, a fluoroquinolone, should avoid caffeine because it can increase the drug's CNS effects, including insomnia, restlessness, and anxiety. Take an iron supplement with the drug.Clients who are taking ciprofloxacin, a fluoroquinolone, should avoid taking the drug with supplemental iron because iron decreases the absorption of the drug. Take the drug with 240 mL (8 oz) of milk.Clients who are taking ciprofloxacin, a fluoroquinolone, should avoid taking the drug with milk or other dairy products because the calcium in these products decreases the absorption of the drug.

A nurse is caring for a client who is receiving nitroglycerin IV and is switching to the oral form of the drug. The nurse should identify that the oral dose will be higher than the IV dose for which of the following reasons? The IV form crosses the blood-brain barrier. The oral form has a decreased half-life. The oral form has decreased bioavailability because of the first-pass effect. The oral form has an increased rate of excretion.

The IV form crosses the blood-brain barrier.This is not the reason why the oral dose is higher than the IV dose for nitroglycerin. Both the IV and oral forms of nitroglycerin, a lipid-soluble drug, can cross the blood-brain barrier. The oral form has a decreased half-life.This is not the reason why the oral dose is higher than the IV dose for nitroglycerin. The method of administration does not affect the half-life of a drug, which is the amount of time it takes for the body to eliminate half of the drug. The oral form has decreased bioavailability because of the first-pass effect.MY ANSWEROral doses are often larger than IV doses of the same drug because of the first-pass effect by the liver, which reduces the bioavailability of the drug. Enzymes in the liver metabolize drugs, making less of the drug available for use by the body. The oral form has an increased rate of excretion.This is not the reason why the oral dose is higher than the IV dose for nitroglycerin. The rate of excretion of IV and oral drugs are generally the same.

A nurse is caring for a client who is postpartum and breastfeeding. The client asks the nurse about the effects that taking over-the-counter drugs will have on her newborn. Which of the following should the nurse consider when recommending a drug for the client? (Select all that apply.) The newborn's weight How much breast milk the newborn consumes each day Whether or not the benefits to the client outweigh the risks to the newborn The properties of the drug The route of administration of the drug

The newborn's weight is correct. The nurse should consider the weight of the newborn when recommending a drug for a client who is breastfeeding. The lower the newborn's weight, the greater the effects of the drug absorbed via breastmilk will be to the newborn.How much breast milk the newborn consumes each day is correct. The nurse should consider the amount of breast milk the newborn consumes per day when recommending a drug for a client who is breastfeeding. The more breast milk the newborn consumes, the more of the drug is likely to be absorbed into the newborn's circulation.Whether or not the benefits to the client outweigh the risks to the newborn is correct. The nurse should weigh the benefits against the risks when recommending a drug for a client who is breastfeeding. If the benefits will be minimal, it is generally not worth the risk to the newborn.The properties of the drug is correct. The nurse should consider the properties of the drug when recommending a drug for a client who is breastfeeding. Certain drugs can transfer more easily into breast milk, depending on properties like fat solubility.The route of administration of the drug is incorrect. Over-the-counter drugs are available in various enteral and topical forms. Any drug, regardless of route, that has the potential for systemic absorption poses a potential risk to a newborn who is being breastfed.

A nurse is obtaining a client's health history and discovers that the client takes loratadine, an over-the-counter drug. The nurse should identify that which of the following is correct regarding over-the-counter drugs? (Select all that apply.) They do not require the supervision of a nurse. They can interact with other drugs. They should be included in the client's drug history assessment. They are less effective than prescription drugs. They do not cause toxicity.

They do not require the supervision of a nurse is correct. Over-the-counter drugs do not require a prescription or the supervision of a nurse.They can interact with other drugs is correct. Many over-the-counter drugs interact with other drugs.They should be included in the client's drug history assessment is correct. Over-the-counter drugs are often omitted from the drug history assessment, but they should be included. Nurses should ask specific questions about over-the-counter drugs and herbal remedies.They are less effective than prescription drugs is incorrect. Over-the-counter drugs can be as effective as prescription drugs. This varies with the individual client and drug.They do not cause toxicity is incorrect. Over-the-counter drugs can cause toxicity in clients who have certain conditions or if clients take them in excess.

A nurse is reviewing drugs in a drug reference. The nurse should identify that drugs in the same class share which of the following similarities? They have similar mechanisms of actions. They have the same half-life. They are administered by the same route. They have similar availability.

They have similar mechanisms of actions.MY ANSWERDrugs in the same class often share similar mechanisms of action, as well as assessment guidelines, interactions, and precautions. They have the same half-life.Drugs in the same class do not necessarily have the same half-life. They are administered by the same route.Drugs in the same class are not necessarily administered by the same route. They have similar availability.Drugs in the same class do not necessarily have the same availability.

A nurse is caring for a client who has been diagnosed with cervical cancer. The client asks the nurse about palliative care. Which of the following responses should the nurse give? "This treatment is for clients who have 6 months or less to live." "This treatment is provided to clients when curative measures have been discontinued." "Care is provided in 60-day increments and continued if the criteria is met." "Care is delivered for serious illnesses and focuses on quality of life."

This treatment is for clients who have 6 months or less to live." The nurse should identify that hospice care treatment is for clients who have 6 months or less to live, not palliative care. "This treatment is provided to clients when curative measures have been discontinued."The nurse should identify that hospice care treatment is for clients when curative measures have been discontinued, not palliative care. "Care is provided in 60-day increments and continued if the criteria is met."The nurse should identify that hospice care is provided in 60-day increments and continued if the criteria is met, not palliative care. C; "Care is delivered for serious illnesses and focuses on quality of life."The nurse should identify that palliative care is care that is delivered for serious illnesses and focuses on quality of life.

A nurse is caring for a client who is about to begin taking itraconazole to treat a fungal infection. The nurse should instruct the client to report which of the following adverse effects of the drug? Tingling in the hands and feet Joint pain Swelling of hands or feet Excessive sweating

Tingling in the hands and feetItraconazole, an azole antifungal drug, is unlikely to cause paresthesia. Isoniazid is an antimicrobial drug that can cause tingling and numbness in the hands and feet. Joint painItraconazole, an azole antifungal drug, is more likely to cause headaches than joint pain. Swelling of hands or feetMY ANSWERItraconazole, an azole antifungal drug, can cause edema, which can also indicate heart dysfunction, and should be monitored closely. Excessive sweatingItraconazole, an azole antifungal drug, is unlikely to cause diaphoresis, but it can cause skin rashes, photosensitivity, and dry mouth.

A nurse is preparing to teach a client about a newly prescribed drug. Prior to providing teaching, the nurse should review the precautions section of a drug handbook for which of the following reasons? To determine drug-food interactions To determine if dosage modification is indicated To determine how the drug is absorbed To determine availability

To determine drug-food interactionsThe interactions section lists interactions the drug might have with other drugs, foods, or herbal remedies. To determine if dosage modification is indicatedMY ANSWERThe precautions section includes diseases or clinical situations in which drug use involves particular risks or dosage modification might be necessary, such as the presence of a client condition or restrictions due to the client's age. To determine how the drug is absorbedDrug absorption is included in the pharmacokinetics section of the handbook. To determine availabilityFormulations available are listed in a separate section and can be found on the Food and Drug Administration's website. Availability, including the strength and concentrations of dosage forms, is not relevant to client education.

A nurse is caring for a client who has a history of renal insufficiency and is taking lithium. The nurse should monitor the client for which of the following? Tolerance to the drug Drug interaction Drug toxicity Dependence on the drug

Tolerance to the drugTolerance to a drug develops when it is taken over an extended period of time and the body's response to the same dose of the drug decreases. Drug interactionA drug interaction occurs when a client is taking two or more drugs together, and it results in an increase or decrease in therapeutic effects or causes adverse drug interactions that could result in harm to the client. Drug toxicityMY ANSWERDrug toxicity develops when the amount of a drug that is taken is greater than its rate of excretion, and it results in the drug accumulating in the body. A client who has renal insufficiency might have delayed or impaired excretion of the drug. The drug dosage should be reduced if toxicity occurs. Dependence on the drugDependence on a drug can develop when a client takes a drug over an extended period of time. If the client is dependent on the drug, withdrawal symptoms can occur when it is abruptly discontinued. Withdrawal is also called abstinence syndrome, and it can cause sweating, tremors, and nausea.

A nurse is caring for a client whose sputum culture results indicate methicillin-resistant Staphylococcus aureus (MRSA). The nurse should recognize that which of the following medications will likely be administered to this client? Trimethoprim/sulfamethoxazole Tetracycline Cephalexin Vancomycin

Trimethoprim/sulfamethoxazoleMRSA is resistant to trimethoprim/sulfamethoxazole, a sulfonamide combination. TetracyclineMRSA is resistant to tetracycline, an antimicrobial drug. CephalexinMRSA is resistant to cephalexin, a first-generation cephalosporin. VancomycinMY ANSWERVancomycin, a potentially toxic antibiotic, is used primarily to treat serious infections in clients who are allergic to penicillin or whose infecting bacteria are resistant to penicillin, such as MRSA. The term methicillin-resistant refers generally to a lack of susceptibility to methicillin (no longer prescribed), all penicillins, cephalosporins, tetracyclines, beta-lactams, and many other antimicrobial drugs.

​A nurse needs to determine the use of technology as an assistive device to facilitate discharge teaching for a client. Which of the following represents an appropriate application of technology in this situation? (Select all that apply.) ​Using translation software for a Spanish-speaking client who has a new diagnosis of acute renal failure ​Providing instruction for access to the facility's free wireless Internet ​Supplying the link to a website with a video demonstrating home care for a client after a knee arthroplasty ​Explaining the use of automatic email reminders to increase medication compliance ​Accessing an iPad to review side effects of medications with a client

Using translation software for a Spanish-speaking client who has a new diagnosis of acute renal failure is correct. This facilitates nurse and client communication regarding discharge teaching through integration of technology. ​Providing instruction for access to the facility's free wireless Internet is incorrect. This is a client convenience, but it is not directly related to discharge teaching. ​Supplying the link to a website with a video demonstrating home care for a client after a knee arthroplasty is correct. This facilitates nurse and client communication regarding discharge teaching through integration of technology. ​Explaining the use of automatic email reminders to increase medication compliance is correct. This facilitates nurse and client communication regarding discharge teaching through integration of technology. ​Accessing an iPad to review side effects of medications with a client is correct. This facilitates nurse and client communication regarding discharge teaching through integration of technology.

A nurse in a provider's office receives a call from a client who is taking amoxicillin to treat a respiratory infection and reports a rash and wheezing. Which of the following instructions should the nurse give the client? Wait 1 hr and contact the provider if there is no improvement. Skip today's dose of amoxicillin and resume taking the drug tomorrow. Call emergency services immediately. Take an NSAID to reduce skin and airway inflammation.

Wait 1 hr and contact the provider if there is no improvement.The client might be experiencing respiratory difficulties due to an allergic reaction. It is unsafe to delay treatment. Skip today's dose of amoxicillin and resume taking the drug tomorrow.A drug allergy can cause rash, hives, and wheezing, and can get progressively worse. The client should not take the drug again. Call emergency services immediately.MY ANSWERAmoxicillin can cause a severe anaphylactic reaction. A client who has difficulty breathing should call emergency services and seek immediate care. The client will need to be treated with epinephrine and an antihistamine, such as diphenhydramine, to treat an anaphylactic reaction. Take an NSAID to reduce skin and airway inflammation.A drug allergy can cause rash, hives, and wheezing and can get progressively worse. An NSAID is unlikely to reverse that progression, although an antihistamine, such as diphenhydramine, can help.

Solu-Medrol (Methylprednisolone)

corticosteroid; anti-inflammatory

​Confidential information in a secure network is most often breached by hackers and others who enter the secure network from external systems. use of laptops, tablets, thumb drives, or other portable devices. unauthorized access to and disclosure of information by authorized users.

hackers and others who enter the secure network from external systems. Hackers can threaten information security and garner public attention, but this type of breach is uncommon. use of laptops, tablets, thumb drives, or other portable devices. Confidential information can be compromised through the use of unprotected information systems and portable devices, but this type of breach is prevented by organizational security devices and is not the most common breach. C;unauthorized access to and disclosure of information by authorized users. The most common breach in information security is caused by people who are authorized to use secure networks.

The Centers for Medicare and Medicaid Services electronically reports specific quality outcome measures based on data collected from hospitals. These data allow the public to compare hospitals that have the best health care providers. ​have the most up-to-date surgical services. have a higher percentage of hospital-acquired infections.

have the best health care providers. ​Having the best health care providers is not part of the CMS quality outcome measures. ​have the most up-to-date surgical services. ​Having the most up-to-date surgical services is not part of the CMS quality outcome measures. C; have a higher percentage of hospital-acquired infections. ​Hospital-acquired infection is one of the quality outcome measures publicly reported by the Centers for Medicare and Medicaid Services (CMS). These measures hold hospitals accountable for client care and provide useful information to health care consumers when choosing hospital care.

A nurse is reviewing a drug handbook prior to administering a drug to a client who has kidney disease. The handbook states that the drug can be administered but identifies certain risks. Which of the following terms describes these risks? Contraindications Precautions Paradoxical effects Adverse effects

ontraindicationsContraindications are pre-existing disease states or clinical situations that make a drug unsafe for a client to take. PrecautionsMY ANSWERA precaution includes disease states, such as kidney disease, or clinical situations in which use of a drug involves particular risks or dosage modification might be necessary. Paradoxical effectsParadoxical effects are the opposite of the intended or desired effect of a drug, such as a drug intended to aid with sedation causing increased excitability in certain clients. Adverse effectsAn adverse effect is an unexpected or unintended effect of a drug, which can range from annoying to life-threatening.

A nurse is caring for a client who is taking diphenhydramine for insomnia and reports drowsiness. The nurse should identify that drowsiness indicates which of the following? Therapeutic effect Adverse reaction Contraindication Precaution

therapeutic effectMY ANSWERDrowsiness is a therapeutic effect of diphenhydramine for a client who is taking the drug to treat insomnia. Adverse reactionAn adverse reaction is an unexpected or dangerous result of using a drug. ContraindicationA contraindication is a reason that a drug is withheld for a client due to the risk for causing harm. Contraindications are usually related to pre-existing client conditions, such as allergies, diseases, or organ failure. PrecautionPrecautions are noted prior to administering a drug and indicate a need to implement closer monitoring after drug administration or the need to give a reduced dose.

Which of the following is a standardized tool used to outline daily nursing care to clients who have common needs or medical conditions? ​Concept map ​Critical pathway ​Protocol

​Concept map A concept map is a visual diagram of client problems, supporting data, interventions, and evaluations. ​C;Critical pathway A critical pathway defines the sequence of care that must be given on each day during the projected length of stay for the specific type of condition. ​Protocol A protocol indicates the actions commonly required for a particular group of clients.

​A nurse off duty receives a photo on her cell phone from a fellow nurse who is at work. The photo shows a celebrity receiving physical therapy. Which of the following actions should the nurse take first? ​Make factual notes of the event that has occurred. ​Notify nursing administration, explaining who sent the photo. ​Delete the photo.

​Make factual notes of the event that has occurred. ​It is important to take factual notes of an event that has occurred, but it is not the first action the nurse should take. ​Notify nursing administration, explaining who sent the photo. ​Nursing administration should be notified about the incident, but it is not the first action the nurse should take. ​C; Delete the photo. ​Deleting the photo is the correct action to prevent further violation of HIPAA and is the first action for the nurse to take.

​Which of the following illustrates the use of technology to improve communication with a client who is cognitively impaired? ​Provide the client with an online video as a teaching aid that allows multiple viewings. Use an electronic drawing screen allowing the client to create pictures during an assessment. ​Offer translation software for the client.

​Provide the client with an online video as a teaching aid that allows multiple viewings. ​Use of a video to provide teaching to a client who is cognitively impaired is not a method of two-way communication. CORRECT: Use an electronic drawing screen allowing the client to create pictures during an assessment. ​When a client has a cognitive impairment, understanding and reactions are often diminished. Allowing the client to communicate through use of pictures is effective. ​Offer translation software for the client. ​Translation software does improve communication with non-English speaking clients, but does not offer an advantage for the client who is cognitively impaired.