Genitourinary System

1. 1. Epogen is a glycoprotein produced by the kidney that stimulates red blood cell production in response to hypoxia. A biological response modifier, Epogen, is prescribed to treat the anemia that occurs in clients with chronic kidney disease. 2. Filgrastim (Neupogen) is the biological response modifier that stimulates white blood cells and is not used in the treatment of chronic kidney disease. 3. Oprelvekin (Neumega) is the biological response modifier that stimulates megakaryocyte and thrombocyte production, which stimulates platelet production to prevent thrombocytopenia in clients receiving chemotherapy. 4. There is no medication that increases the production of urine. Diuretics increase the excretion of urine but do not affect the production of urine.

1. The client diagnosed with chronic kidney disease is prescribed erythropoietin (Epogen), a biologic response modifier. Which statement best describes the scientific rationale for administering this medication? 1. This medication stimulates red blood cell production. 2. This medication stimulates white blood cell production. 3. This medication is used to treat thrombocytopenia. 4. This medication increases the production of urine.

10. 1. Whole tablets of Fosrenol should not be swallowed. The medication must be chewed for absorption in the intestines. 2. Fosrenol may cause graft occlusion, not bleeding. 3. Fosrenol does not increase gastric acid secretion; therefore, the client would not need to take a proton-pump inhibitor. 4. Fosrenol may cause hypotension and the blood pressure must be checked, but it does not affect the pulse rate.

10. The client diagnosed with chronic kidney disease on hemodialysis is prescribed lanthanum (Fosrenol), an electrolyte- and water-balancing agent. Which intervention should the nurse discuss with the client? 1. Chew the tablets completely before swallowing. 2. Monitor the dialysis graft for bleeding. 3. Take an over-the-counter proton-pump inhibitor. 4. Check the radial pulse prior to taking the medication.

100. 1. Safety of the client is priority. 2. This is an appropriate intervention, but it is not priority over safety. 3. The nurse must document the medication in the MAR and the chart because it is a PRN medication, but it is not the first intervention after administering the medication. 4. The nurse must evaluate the client's pain to determine the effectiveness of the medication, but this is not the first intervention.

100. The male client with a renal stone is admitted to the medical department. The nurse administers intravenous morphine over 5 minutes. Which intervention should the nurse implement first? 1. Instruct the client to call for help before getting out of bed. 2. Tell the client to urinate into the urinal at all times. 3. Document the time in the MAR and the client's chart. 4. Reevaluate the client's pain within 30 minutes.

11. 1. Cranberry juice is acidic and will change the pH of the urine, making it harder for bacteria to survive in the environment. It can be used prophylactically to prevent urinary tract infections. It does not treat an infection. The nurse can arrange with the dietitian to include this in the client's dietary plan. 2. This is a prescription medication that is used to treat chronic urinary tract infections, but the nurse could not order this medication. 3. In a long-term care facility, this overthe- counter vitamin would require an HCP order. 4. This is an herb used for urinary tract infections, but in a long-term care facility it would require an HCP order. MEDICATION MEMORY JOGGER: Nurses do not order medications. Nurses do have latitude in deciding on components and consistency of the meals provided. The dietitian can include cranberry juice in any diet.

11. The nurse in the long-term care facility is caring for a client with an indwelling catheter. Which preparation should the nurse order for the client? 1. Cranberry juice with breakfast daily. 2. Nitrofurantoin (Macrodantin), a sulfa drug. 3. Vitamin C, a vitamin supplement. 4. Goldenseal, an herbal preparation.

12. 1. The IV is important to initiate therapy, but the nurse should obtain a clean voided midstream urine for culture and sensitivity before initiating the treatment. If the culture is not obtained prior to initiating the antibiotic, the results of the laboratory test will be skewed. 2. This should definitely be done, but obtaining the culture is the first intervention. 3. The nurse should obtain a clean voided midstream specimen for culture and sensitivity before initiating the antibiotics. This is the first intervention to implement. 4. A diet order is not priority over getting the treatment started. Urinary tract infections in males are difficult to treat and can be life threatening. MEDICATION MEMORY JOGGER: The first step in initiating antibiotic therapy is to obtain any ordered culture. Then the nurse must place a priority on initiating IV antibiotic therapy in a timely manner,within 1-2 hours after the order is written, depending on the facility's standard protocol.

12. The male client is admitted to the medical floor at 1200 with a diagnosis of pyelonephritis. Which intervention should the nurse implement first? 1. Initiate an intravenous access with a 20-gauge catheter. 2. Administer the IV antibiotic within 2 hours of admission. 3. Obtain a urine specimen for culture and sensitivity. 4. Notify the dietary department to order the client a regular diet.

13. 1. A urine specific gravity can indicate dehydration or water intoxication, but it will not provide information about a urinary tract infection. 2. A WBC of 35/hpf indicates a urinary tract infection—not that the antibiotic is effective. Normal is <5/hpf. 3. Normal urine pH is 5.0-9.0, but the pH does not evaluate a urinary tract infection. 4. A negative urine leukocyte esterase indicates the antibiotic is effective in treating the infection. Leukocytes and nitrates are used to determine bacteriuria and other sources of urinary tract infections.

13. The client diagnosed with glomerulonephritis is receiving trimethoprim sulfa (Bactrim DS). Which data indicates the medication is effective? 1. A urine specific gravity of 1.010. 2. WBC of 35/hpf on the urinalysis. 3. Urine pH of 6.9. 4. Negative urine leukocyte esterase.

14. 1. Rocephin is in the pregnancy risk category B. No research has shown harm to the fetus in humans or in animals. The nurse would not question this medication. 2. A cross-sensitivity exists in some clients between penicillin and the cephalosporins. The nurse should assess the type of reaction that the client experienced when taking penicillin. If the client indicates any symptom of an anaphylactic reaction, the nurse would hold the medication and discuss the situation with the HCP. 3. There is no reason for the nurse to question Bactrim for a client who has had prostate surgery. 4. There is no reason for the nurse to question Macrodantin for a client who has urinary stasis. Macrodantin is used to prevent or treat chronic urinary tract infections. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable of accepted standards of practice for disease processes and conditions. If the nurse administers a medication that the health-care provider has prescribed and it harms the client, the nurse could be held accountable. Remember that the nurse is a client advocate.

14. The nurse is administering medications to clients on a urology floor. Which medication should the nurse question? 1. Ceftriaxone (Rocephin), a third-generation cephalosporin, to a client who is pregnant. 2. Cephalexin (Keflex), a cephalosporin, to a client who is allergic to penicillin. 3. Trimethoprim sulfa (Bactrim), a sulfa antibiotic, to a client post-prostate surgery. 4. Nitrofurantoin (Macrodantin), a sulfa antibiotic, to a client with urinary stasis.

15. 1. The urinary output should be measured frequently in a client who has had a transurethral resection of the prostate. The client will have bladder irrigation and the indwelling catheter bag will need to be emptied frequently. The nurse would not intervene to stop this action. 2. A green-blue color indicates the client is taking bethanechol (Urecholine), a urinary stimulant used for clients with a neurogenic bladder. This is an expected color, and the UAP should not indicate that something is wrong with the client. 3. The client should be encouraged to drink fluids. The nurse would not intervene to stop this action. 4. This action encourages bowel and urine continence and is part of a falls prevention protocol. The nurse would not intervene to stop this action.

15. The nurse observes the unlicensed assistive personnel (UAP) performing delegated tasks. Which action by the UAP requires immediate intervention? 1. The UAP measures the output of a client who had a transurethral resection of the prostate. 2. The UAP tells the client whose urine is green that something must be wrong for the urine to be such an odd color. 3. The UAP encourages the client to drink a glass of water after the nurse administered the oral antibiotic. 4. The UAP assists the client diagnosed with a urinary tract infection to the bedside commode every 2 hours.

16. 1. The therapeutic range of vancomycin is 10-20 mg/dL. The nurse would not hold the medication because the client has not reached a therapeutic range. 2. The nurse should always ask the client if he/she is allergic to any medication prior to administering any medication, especially an antibiotic. 3. Vancomycin is administered over a minimum of 1 hour. The nurse should obtain an infusion pump to regulate the speed of administration. 4. Vancomycin is nephrotoxic. The nurse would monitor the BUN and creatinine levels, especially in children and the elderly. 5. The nurse should assess the intravenous insertion site to determine if there are any signs of infiltration or inflammation. The nurse should not administer vancomycin in an inflamed site.

16. The male client is diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) of the urine and is receiving vancomycin (IVPB). Which interventions should the nurse implement when administering this medication? Select all that apply. 1. Hold the medication if the trough level is 5 mg/dL. 2. Ask the client if he is allergic to any medication. 3. Administer the medication via an infusion pump. 4. Check the client's BUN and creatinine levels. 5. Assess the client's intravenous insertion site.

17. 1. This is a side effect of nitrofurantoin. The client should be warned that the urine might turn brown. This color will disappear when the client is no longer taking the medication. If the client is taking an oral suspension, the nurse should instruct to rinse the mouth after taking the medication to prevent staining of the teeth. 2. This does not indicate cystitis. 3. The client should be instructed to take the medication with food to avoid GI upset. 4. This is a side effect of the medication and does not indicate another problem.

17. The client taking nitrofurantoin (Macrodantin) for a urinary tract infection calls the clinic and tells the nurse the urine has turned dark. Which statement is the nurse's best response? 1. "This is a side effect of the medication and is not harmful." 2. "This means that you have cystitis and should come in to see the HCP." 3. "If you take the medication with food, it causes this reaction." 4. "There must be some other problem going on that is causing this."

18. 1. Pyridium is not an antibiotic; it will not treat an infection. 2. Pyridium is a urinary analgesic, not a urinary stimulant. It will not increase bladder tone. 3. Pyridium is a urinary analgesic. It is useful in treating the pain and burning associated with a urinary tract infection. 4. Antimuscarinic/anticholinergic medications control an overactive bladder; urinary analgesic medications do not. Pyridium does help control urinary frequency associated with a urinary tract infection.

18. The client diagnosed with a bladder infection is prescribed phenazopyridine (Pyridium). Which statement is the scientific rationale for prescribing this medication? 1. Pyridium is used to treat gram-negative urinary tract infections. 2. Pyridium stimulates a hypotonic bladder to increase urine output. 3. Pyridium alleviates pain and burning during urination. 4. Pyridium decreases urinary frequency to control an overactive bladder

19. 1. The client voiding 300-400 mL with each voiding indicates the client is able not to void until the bladder is full. This indicates the client is responding to the antibiotic and the medication is effective. 2. Urinary frequency indicates a urinary tract infection, which means the medication is not effective. 3. The client is afebrile. This indicates the client is responding to the antibiotic and the medication is effective. 4. Burning upon urination indicates a urinary tract infection, which means the medication is not effective. 5. Pinkish urine can result from the consumption of beets and does not indicate the client has a urinary tract infection

19. The client diagnosed with a urinary tract infection is prescribed aztreonam (Azactam) IVPB every 8 hours. Which data indicates the medication is not effective? Select all that apply. 1. The client is able to void 300-400 mL of urine each time. 2. The client complains of urinary frequency. 3. The client's temperature is 99.0°F. 4. The client has burning upon urination. 5. The client's urine is pinkish in color.

2. 1. Do not shake the vial because shaking may denature the glycoprotein, rendering it biologically inactive. 2. The nurse should apply ice to numb the injection site, not a warm washcloth after administration. 3. The nurse should only use the vial for one dose. The nurse should not reenter the vial and should discard any unused portion because the vial contains no preservatives. 4. The medication should be stored in the refrigerator and should be warmed to room temperature prior to its being administered. 5. This injection is administered subcutaneously not intramuscularly.

2. Which intervention should the nurse implement when administering the biological response modifier erythropoietin (Epogen) subcutaneously? Select all that apply. 1. Do not shake the vial prior to preparing the injection. 2. Apply a warm washcloth after administering the medication. 3. Discard any unused portion of the vial after pulling up the correct dose. 4. Keep the medication vials in the refrigerator until preparing to administer. 5. Administer the medication intramuscularly in the deltoid muscle.

20. 1. This is not a priority; the tubing should be taped to the leg on the side of the bed the bag will be suspended from. 2. This could be asked, but it is not priority. 3. This could be asked, but it is not priority. 4. Indwelling catheter kits come prepackaged with povidone iodine (Betadine) to use for cleansing the perineal skin before inserting the catheter. The nurse should assess for allergies to the medication before preparing to cleanse the perineum. Another type of skin cleanser may need to be used.

20. The nurse is preparing the client for the placement of an indwelling urinary catheter. Which statement has priority for the nurse to ask the client? 1. "Do you have a preference of which leg the tube is taped to?" 2. "When did you last attempt to void?" 3. "Do you feel the need to void?" 4. "Are you allergic to iodine or Betadine?"

61. 1. This herb is taken to treat depression, but it can cause more infertility problems; therefore, the nurse should discuss this with the client. 2. The client should discuss taking herbs with all health-care providers, but this is not the nurse's best response. 3. St. John's wort may cause effects on sperm cells, decreased sperm motility, and decreased viability; therefore, this client should not take this herb. 4. The significant other taking herbs should not affect the client's fertility; therefore, this is not an appropriate response

61. The male client experiencing infertility problems tells the clinic nurse that he is taking St. John's wort for his depression. Which statement is the nurse's best response? 1. "This herb is useful for depression. I hope it will help." 2. "Did you discuss taking this herb with your psychologist?" 3. "This herb may cause more infertility problems." 4. "Is your significant other taking any herbal medication?"

21. 1. The client's intake of water will not affect the medication. Drinking this much water each day until the medication has had an opportunity to shrink the enlarged prostate tissue could cause the client to have a difficult time emptying an uncomfortably full bladder. 2. The medication takes 6-12 months to have a full effect. There is no reason for the client to be seen in 1 week. 3. Proscar decreases serum prostatespecific antigen (PSA) levels. The client should have a PSA level drawn before beginning Proscar and a level drawn after 6 months. If the PSA level does not drop, the client should be assessed for cancer of the prostate. 4. Clients do not need to measure their urine outputs daily.

21. The client diagnosed with mild benign prostatic hypertrophy (BPH) is prescribed the 5-alpha-reductase inhibitor finasteride (Proscar) to relieve symptoms of urinary frequency. Which intervention should the clinic nurse implement? 1. Tell the client to drink at least 8-10 glasses of water a day. 2. Schedule an appointment with the HCP for a 1-week follow-up examination. 3. Have the laboratory draw a prostate-specific antigen level. 4. Give the client a urinal to measure his daily output of urine.

22. 1. There is documented evidence that this herb effectively treats BPH. Its use is not a folk remedy without a sound basis. 2. Research has proved the efficacy of saw palmetto in treating BPH. The exact mechanism of action is unknown, but the herb does shrink prostate tissue, resulting in relief of urinary obstructive symptoms. 3. The client reported that he has been taking the herb. The time to discuss allergies is before or shortly after initiation of a medication. 4. Research indicates that saw palmetto is as effective as finasteride (Proscar) but has fewer side effects. It is considered a safe and effective treatment for BPH. There is no evidence that the herb causes cancer.

22. The male client diagnosed with complaints of urinary frequency and nocturia tells the nurse he is taking the herbal supplement saw palmetto. Which statement is the nurse's best response? 1. "Use of saw palmetto is an old wives' tale." 2. "This herb does help shrink the prostate tissue." 3. "Have you noticed any itching or rashes?" 4. "Saw palmetto has been known to cause cancer."

23. 1. The medications used to treat hyperplasia of the prostate were originally developed to treat high blood pressure. The client may develop hypotension when taking these medications. This side effect makes them useful for clients who are also hypertensive. 2. The medication is not given for urinary tract infections; there is no need for a urinalysis to be done when administering this medication. 3. The client has symptoms of BPH, which could include nocturia, but this is not pertinent when administering the medication. 4. This is an intervention that assists clients who have incontinence, not BPH.

23. The client diagnosed with moderate benign prostatic hypertrophy (BPH) is being treated with the alpha-adrenergic agonist tamsulosin (Flomax). Which intervention should the nurse implement? 1. Check the client's blood pressure. 2. Send a urinalysis to the laboratory. 3. Determine if the client has nocturia. 4. Plan a scheduled voiding pattern.

24. 1450 mL of corrected urinary output. The drainage in the catheter bag equals 5550 mL of drainage. 1500 mL + 2100 mL + 1950 mL = 5550 mL of drainage emptied for the shift. Subtract the 4100 mL of normal saline irrigation fluid from the 5550 mL total drainage = 1450 mL of corrected urinary output.

24. The client diagnosed with benign prostatic hypertrophy (BPH) has had a transurethral resection of the prostate. The client returns to the unit with a continuous bladder irrigation (Murphy drip) in place. The unlicensed assistive personnel records emptying the catheter bag of red drainage three times during the shift of 1500 mL, 2100 mL, and 1950 mL. The nurse records infusing 4100 mL of normal saline irrigation fluid. Which is the client's corrected urinary output for the shift?

25. 1. Testosterone is converted to dihydrotestosterone (DHT) in the prostate; the 5-alphareductase inhibitors reduce DHT but not testosterone. With a reduction in DHT, the prostate tissue shrinks. The 5-alpha-reductase inhibitors do not elevate testosterone, nor do they improve impotence problems. 2. The 5-alpha-reductase inhibitors require 6-12 months for therapeutic relief of symptoms of BPH to occur. 3. The 5-alpha-reductase inhibitors work by reducing the size of the prostate gland, resulting in a relief of the obstructive symptoms of urgency, frequency, difficulty initiating a urine stream, and nocturia. 4. Surgery provides faster relief of symptoms after recovery has taken place. AVODART requires a lengthy time period for therapeutic effects of the medications and may not provide adequate relief of symptoms if the client has severe BPH.

25. Which is the scientific rationale for administering the 5-alpha-reductase inhibitor dutasteride (AVODART) to a client diagnosed with benign prostatic hypertrophy (BPH)? 1. The medication elevates male testosterone levels and decreases impotence. 2. AVODART causes a rapid reduction in the size of the prostate and relief of symptoms. 3. The medication decreases the mechanical obstruction of the urethra by the prostate. 4. AVODART is as fast as surgery in reducing the obstructive symptoms of BPH.

26. 1. B&O suppositories come in 15A (1/2 grain) and 16A (1 grain) formulations. When obtaining the medication from the narcotic cabinet the nurse should obtain the correct dose for the client. B&O suppositories are used to reduce bladder spasms for clients who have had bladder surgery. 2. Lubricating the suppository decreases the pain for the client when inserting the suppository. 3. Adhering to Standard Precautions is always an appropriate nursing intervention when caring for the client. 4. The nurse should check the armband before opening the medication and preparing to administer it. 5. The large intestine/rectum lies on the left side of the body, so placing the client on the left side makes insertion easier and reduces the chance of a ruptured bowel.

26. The client who has had a transurethral resection of the prostate is complaining of bladder spasms. The HCP prescribed an opiate suppository, belladonna and opiate (B&O). Which interventions should the nurse implement when administering this medication? Select all that apply. 1. Obtain the correct dose of the medication. 2. Lubricate the suppository with K-Y jelly. 3. Wash hands and don nonsterile gloves. 4. Check the client's armband for allergies. 5. Ask the client to lie on the left side.

27. 1. The major adverse effect of Hytrin is hypotension. Most blood pressure- lowering medications can also cause hypotension. The nurse would question administering two medications that can cause the client to become dizzy upon standing, possibly resulting in a fall. The medications that shrink the prostate gland were originally developed to treat high blood pressure. This is a safety issue. 2. Proscar does not cause hypotension and does not interact with digoxin. The nurse would not question administering these medications. 3. Flomax is an alpha1-adrenergic agonist but does not cause hypotension. Glucophage does not interact with Flomax. The nurse would not question administering these medications. 4. Saw palmetto has fewer side effects than most prescription medications that treat BPH and it does not cause hypotension or interact with Toprol XL. The nurse would not question administering these medications. MEDICATION MEMORY JOGGER: If the test taker did not know these medications, an alpha blocker usually will have some effect on the cardiovascular system and an ACE inhibitor is used to treat high blood pressure. Most blood pressure medications can cause orthostatic hypotension. Two medications that can cause similar side effects would be questioned.

27. The nurse is administering morning medications. Which combination of medications should the nurse question administering? 1. Terazosin (Hytrin), an alpha1-adrenergic agonist, and captopril (Capoten), an ACE inhibitor. 2. Finasteride (Proscar), a 5-alpha-reductase inhibitor, and digoxin (Lanoxin), a cardiac glycoside. 3. Tamsulosin (Flomax), an alpha1-adrenergic agonist, and metformin (Glucophage), a biguanide. 4. Serenoa repens (saw palmetto), an herbal preparation, and metoprolol (Toprol XL), a beta blocker.

28. 1. The medication is manufactured in a pill form; the nurse does not need eye protection to prevent exposure. 2. The nurse's mucosa should not be exposed to the medication because it comes only in pill form. 3. The nurse can administer dutasteride safely using the appropriate personal protective equipment. The nurse should not ask for another nurse to administer the medication. 4. Dutasteride is considered a category X medication and will cause harm to a developing fetus. The medication can be absorbed through the skin. The nurse should wear gloves when administering the medication. Men should not donate blood for at least 6 months after discontinuing the medication to avoid administration of the medication to a pregnant client through the transfusion. MEDICATION MEMORY JOGGER: The nurse must remember that some medications can cause harm when administering the medication. A nurse who is pregnant must be cautious.

28. Which intervention is priority for a pregnant nurse when administering dutasteride (AVODART) to a client diagnosed with benign prostatic hypertrophy (BPH)? 1. Use goggles for personal eye protection. 2. Protect the nurse's mucosa from contact with liquid. 3. Ask a male nurse to administer the medication. 4. Wear gloves while administering the medication.

29. 2, 4, 3, 5, 1 2. The most obvious reason for a client post-TURP to be having lower abdominal pain is that the bladder has blood clots that need to be flushed out. Clots that are not flushed from the bladder result in bladder spasms. Assessing the urinary drainage would be the first step. 4. The next step is to adjust the rate of the irrigation to ensure adequate drainage of blood and clots from the bladder. 3. Before administering a narcotic analgesic the nurse should rule out complication. Assessing for peritonitis (hard, rigid abdomen) is the next step in this situation. 5. Morphine and most other narcotic medications require a very slow intravenous rate, around 5 minutes, according to the manufacturer's recommendations. The morphine is dispensed in 1-mL tubex syringes or vials. It is difficult to maintain a steady, slow administration of the medication with only 1 mL over 5 minutes. If the medication is diluted to a total volume of 10 mL, then the nurse can administer the medication at a rate of 1 mL every 30 seconds. Dilution causes less pain for the client and helps decrease irritation to the vein. 1. The final step in this sequence is to actually administer the analgesic.

29. The client diagnosed with benign prostatic hypertrophy has had a transurethral resection of the prostate (TURP). The client is complaining of lower abdominal pain. Which interventions should the nurse implement? Rank in order of performance. 1. Administer the prescribed morphine by slow IVP. 2. Check the urinary catheter for drainage and clots. 3. Determine if the client has a hard, rigid abdomen. 4. Adjust the saline irrigation to flush the bladder. 5. Dilute the morphine with several milliliters of normal saline.

3. 1. This is the scientific rationale for administering antacids to clients with peptic ulcer disease or gastritis, not clients with chronic kidney disease. 2. Clients in CKD experience an increase in serum phosphorus levels (hyperphosphatemia), and aluminum hydroxide binds with phosphorus to be excreted in the feces. 3. Amphojel does not affect the calcium level. 4. Aluminum hydroxide can cause constipation; it is not used to treat constipation.

3. Which statement best describes the scientific rationale for administering aluminum hydroxide (Amphojel), an antacid, to a client in chronic kidney disease (CKD)? 1. This medication neutralizes gastric acid production. 2. It binds to phosphorus to help decrease hyperphosphatemia. 3. The medication is administered to decrease the calcium level. 4. It will help decrease episodes of constipation in the client with CKD.

30. 1. The client's intake and output measurements are important, but even accurate intake and output recordings cannot mea - sure for insensible losses. An output of 100 mL over the intake may or may not be considered adequate to determine effectiveness of a diuretic. 2. Ambulating to the bathroom without dyspnea is an indicator that the client is not experiencing pulmonary complications related to excess fluid volume, but it is not the best indicator of the effectiveness of a diuretic. 3. Terminology such as small, moderate, and large are not objective words. To quantify the results the nurse should use objective data—in this situation, numbers. This would provide an accurate comparison of data to determine the effectiveness of the medication. 4. The most reliable method of determining changes in fluid-volume status is to weigh a client in the same type of clothing at the same time each day. One liter (1000 mL) is approximately 0.9 kg, or 2 pounds. This client has lost approximately 500 mL more fluid than was taken in.

30. The client diagnosed with benign prostatic hypertrophy (BPH) and congestive heart failure (CHF) is receiving furosemide (Lasix), a loop diuretic, daily. Which information provided by the unlicensed assistive personnel (UAP) best indicates to the nurse the medication is effective? 1. The UAP recorded the intake as 350 mL and the output as 450 mL. 2. The UAP stated that the client ambulated to the bathroom without dyspnea. 3. The UAP emptied a moderate amount of urine from the bedside commode. 4. The UAP reports that the client lost 1 pound of weight from the day before.

31. 1. The client should notify the HCP if a skin rash or influenza symptoms (chills, fever, muscle aches and pain, nausea or vomiting) develop because these signs and symptoms may indicate hypersensitivity. 2. Allopurinol does not cause drowsiness, so the nurse does not need to tell the client to avoid activities that require alertness. 3. Allopurinol may be administered with milk or meals to minimize gastric irritation. 4. The client with uric acid should be eating a low-purine diet. A low-purine diet includes breads, cereals, cream-style soups made with low-fat milk, fruits, juices, low-fat cheeses, nuts, peanut butter, coffee, and tea. MEDICATION MEMORY JOGGER: If the client verbalizes a complaint, if the nurse assesses data, or if laboratory data indicates an adverse effect secondary to a medication, the nurse must intervene. The nurse must implement an independent intervention or notify the health-care provider because medications can result in serious or even life-threatening complications.

31. The client with renal calculi was prescribed allopurinol (Zyloprim) for uric acid stone calculi. Which medication teaching should the nurse discuss with the client? 1. Inform the client to report chills, fever, and muscle aches to the HCP. 2. Instruct the client to avoid driving or other activities that require alertness. 3. Tell the client that the medication must be taken on an empty stomach. 4. Explain the importance of not eating breads, cereals, and fruits.

32. 1. The client should take acetaminophen (Tylenol), instead of aspirin (salicylic acid), to reduce acidity of the urine. This statement does not warrant intervention by the nurse. 2. The client should increase fluid intake when taking allopurinol to prevent drug accumulation and toxic effects and to minimize the risk of kidney stone formation. Therefore, this statement does not warrant intervention by the nurse. 3. Salicylic acid (aspirin) increases the acidity of the urine, and the urine should be alkaline; therefore, this statement warrants intervention by the nurse. 4. The client should avoid high-purine foods (wine, alcohol, organ meats, sardines, salmon, gravy) to help keep the urine alkaline; therefore, this statement does not warrant intervention by the nurse.

32. The client with renal calculi was prescribed allopurinol (Zyloprim) for uric acid stone calculi. Which statement warrants intervention by the nurse? 1. "I had to take two Tylenol because of my headache." 2. "I drink at least eight glasses of water a day." 3. "My joints ache so I take a couple of aspirins." 4. "I do not drink wine or any type of alcoholic drinks."

33. 1. The client should drink adequate fluids or increase fluids when taking a thiazide diuretic and to help prevent formation of renal calculi. 2. Thiazide diuretics will help prevent renal stones, not increase the chance of developing renal calculi. 3. Thiazide diuretics cause an increase in potassium loss in the urine but not as significant as loop diuretics. In any case, the client would not check the potassium level daily at home. 4. The thiazide diuretic is not being administered the blood pressure would not have to be checked daily to ensure the effectiveness of the medication. 5. Diuretics should be taken in the morning so that the client is not up all night urinating. Thiazide diuretics are prescribed because they decrease the amount of calcium released by the kidneys into the urine by favoring calcium retention in the bone. Most kidney stones (75% to 80%) are calcium stones, composed of calcium.

33. Which interventions should the nurse discuss with the client who has calcium/oxalate renal calculi and has been prescribed a thiazide diuretic? Select all that apply. 1. Tell the client to increase the intake of fluids. 2. Discuss possible kidney stones caused by this diuretic. 3. Explain the need to check the potassium level daily. 4. Inform the client to check the blood pressure daily. 5. Instruct the client to take the diuretic in the morning.

34. 1. The PCA pump automatically administers a specific amount and has a lockout interval time in which the PCA pump cannot administer any morphine. The client can push the control button as often as needed and will not receive an overdose of pain medication. 2. The nurse should inform the client that the pain should be tolerable, not necessarily absent. 3. Adult clients use the 1-10 pain scale, with 0 being no pain and 10 being the worst pain. 4. The client receiving PCA morphine should be instructed not to ambulate without assistance due to the chance of falls. 5. All the client's urine should be strained by all staff members.

34. The client is admitted to the surgical department diagnosed with renal calculi. The HCP prescribes a morphine patient-controlled analgesia (PCA). Which interventions should the nurse implement? Select all that apply. 1. Instruct the client to push the control button as often as needed. 2. Explain the medication will ensure the client has no pain. 3. Discuss that medication effectiveness is evaluated on a pain scale of 1-10. 4. Inform the client to obtain assistance when getting out of the bed. 5. Instruct the unlicensed assistive personnel to strain all the client's urine

35. 1. This prescription would not need to be clarified with the HCP. 2. The client should not administer the suppository to himself or herself. 3. The client does not need to have a clean bowel to receive a suppository. 4. This medication is prescribed because it may reduce the amount of narcotic analgesia required for acute renal colic.

35. The male client diagnosed with renal calculi is receiving pain medication via a morphine patient-controlled analgesia (PCA) pump. The health-care provider prescribed the nonsteroidal anti-inflammatory drug (NSAID) indomethacin (Indocin) in a rectal suppository. Which intervention should the nurse implement? 1. Question and clarify the prescription with the health-care provider. 2. Give the suppository to the client and allow the client to insert it into the rectum. 3. Administer a Fleet's enema to clear the bowel prior to administering the suppository. 4. Have the client lie on the side and insert the rectal suppository with nonsterile gloves.

36. 1. Administering the rescue of morphine is an appropriate intervention, but it is not the nurse's first action. 2. Assessing the client and ruling out any complications is the nurse's first intervention. 3. The nurse should determine the last time the client received morphine and the amount of morphine the client has received, but it is not the first intervention. 4. Nonpharmacological interventions are appropriate to address the client's pain, but they should not be implemented first for a client with renal calculi.

36. The client diagnosed with renal calculi is receiving pain medication via morphine patient-controlled analgesia (PCA). The client is still voicing excruciating pain and is requesting something else. Which intervention should the nurse implement first? 1. Administer the rescue dose of morphine intravenous push. 2. Check the client's urine for color, sediment, and output. 3. Determine the last time the client received PCA morphine. 4. Demonstrate how to perform guided imagery with the client.

37. 1. This is the scientific rationale for administering allopurinol (Zyloprim) to help reduce the formation of uric stones. 2. This is the scientific rationale for administering a thiazide diuretic to help reduce the formation of calcium renal calculi. This medication will decrease calcium levels in the bloodstream by increasing calcium excretion in the urine. 3. This is the scientific rationale for administering Calcibind to reduce the formation of calcium renal calculi. 4. This is the scientific rationale for administering penicillamine to help prevent the formation of uric stones.

37. The client with calcium renal calculi is prescribed cellulose sodium phosphate (Calcibind). The client asks the nurse, "How will this medication help prevent my stones from coming back?" Which statement is the nurse's best response? 1. "Calcibind reduces the uric acid level in your bloodstream and the uric acid excreted in your urine." 2. "This medication will decrease calcium levels in the bloodstream by increasing calcium excretion in the urine." 3. "It binds calcium from food in the intestines, reducing the amount absorbed in the circulation." 4. "The medication will help alkalinize the urine, which reduces the amount of cystine in the urine."

38. 1. The client does not need to be NPO for this procedure because it is used to diagnose renal abnormalities, not gastrointestinal abnormalities. 2. The client should not have this diagnostic test if the kidneys are not working properly. The intravenous dye could damage the kidneys if normal functioning is not present. 3. The nurse would assess for iodine allergy. The nurse should ask if the client is allergic to Betadine or shellfish. 4. This is an invasive procedure; therefore, the client must give informed consent. 5. This diagnostic test does not require blood administration; therefore, the nurse should start a smaller gauge intravenous catheter such as a 22- or 20-gauge angiocatheter.

38. The client diagnosed with rule-out renal calculi is scheduled for an intravenous dye pyelogram (IVP). Which interventions should the nurse implement? Select all that apply. 1. Keep the client NPO. 2. Check the serum creatinine level. 3. Assess for an iodine allergy. 4. Obtain informed consent. 5. Insert an 18-gauge angiocatheter.

39. 1. This is the correct position for the client when an epidural anesthesia is being inserted. 2. The nurse would determine if the client's operative permit is signed. The admission nurse is responsible for determining if the client has an advance directive. 3. A client's gag and swallowing reflexes are assessed postoperatively for the client who has had general anesthesia. 4. The client's stretcher should be flat so that the client can lie on the side in the fetal position.

39. The client diagnosed with renal calculi is being scheduled for surgery. The client is having epidural anesthesia. Which intervention should the circulating nurse implement? 1. Have the client lie on the side in the fetal position. 2. Determine if the client has an advance directive. 3. Assess the client's gag and swallowing reflex. 4. Ensure that the head of the client's stretcher is elevated 30 degrees.

4. 1. Calcitriol does not affect the availability of vitamin D. 2. Calcitriol is used to treat hypoparathyroidism, but it does not stimulate excretion of calcium from the parathyroid gland. 3. The client in end-stage kidney disease has hypocalcemia, not hypercalcemia. 4. This is the scientific rationale for administering this medication to a client in chronic kidney disease. Calcitriol increases serum calcium levels by promoting calcium absorption and thereby helps to manage hypocalcemia, which is a symptom of CKD.

4. Which statement best describes the scientific rationale for administering calcitriol (Rocaltrol), a vitamin D analog, to a client in end-stage kidney disease? 1. This medication increases the availability of vitamin D in the intestines. 2. This medication stimulates excretion of calcium from the parathyroid gland. 3. The medication helps the body excrete calcium through the feces. 4. This medication increases serum calcium levels by promoting calcium absorption.

40. 1. Intravenous fluids are medications and the nurse cannot delegate medication administration to the UAP. 2. The UAP may be able to discontinue an IV, but the question asks which is the most appropriate task and the nurse should always delegate the least invasive and the simplest task. 3. The UAP should not be assigned to take a client outside to smoke. This is not in the job description of a hospital employee. After the nurse discourages the client from going downstairs to smoke, a family member or friend should escort the client outside. 4. The UAP can document the client's oral intake and urinary output, but the UAP cannot evaluate if the urine output is adequate and appropriate for the IVP procedure.

40. The client diagnosed with renal calculi has just had an intravenous pyelogram (IVP). Which task is most appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP)? 1. Hang a new bag of intravenous fluid. 2. Discontinue the client's intravenous catheter. 3. Assist the client outside to smoke a cigarette. 4. Maintain the client's intake and output.

41. 1. Sexually transmitted infections are considered a public health hazard and the client can be treated without parental permission. 2. Pregnancy may be a concern, but the client is discussing sexually transmitted infection and the nurse should address the client's concerns. 3. This is a judgmental statement and the nurse should not impair communication with the client. 4. There are many different STIs. The client needs to have tests run based on her presenting symptoms so that appropriate treatment can be initiated.

41. The 16-year-old female client tells the public health nurse that she thinks her boyfriend gave her a sexually transmitted infection (STI). Which statement is the nurse's best response? 1. "You will need parental permission to be seen in the clinic." 2. "Be sure and get the proper medications so that you don't become pregnant." 3. "How would you know that you have a sexually transmitted infection?" 4. "You need to have tests so you can be started on medications now."

42. 1. NRTI medications are prescribed for clients who are HIV positive during pregnancy to prevent maternal transmission of the virus to the fetus. 2. Valtrex is prescribed to treat herpes simplex 2 viral infections, but it is not administered routinely to neonates at birth. 3. Erythromycin ophthalmic ointment is the medication of choice to prevent ophthalmia neonatorum (blindness caused by a gonorrhea infection acquired when passing through the birth canal or coming into contact with the mother's tissues). Because the client has had no prenatal care, this would be recommended procedure in case the infant has been exposed to gonorrhea. 4. Metronidazole is administered for some STIs, but it is not routinely administered to neonates.

42. The teenage client has just delivered a 7-pound baby. The girl has not received any prenatal care. Which medication is administered to the neonate to prevent complications related to sexually transmitted infections? 1. Zidovudine (Retrovir), a nucleoside reverse transcriptase inhibitor (NRTI). 2. Valacyclovir (Valtrex), an antiretroviral. 3. Erythromycin ophthalmic ointment, an antibiotic. 4. Metronidazole (Flagyl), a gastrointestinal anti-infective.

43. 1. Consuming alcohol concurrently with Flagyl can cause a severe reaction. This statement indicates the need for more teaching. 2. The sexual partners must be treated simultaneously to prevent a reinfection from occurring. This statement indicates the client understands the teaching. 3. Untreated STIs can lead to pelvic inflammatory disease, scarred fallopian tubes, and infertility. This statement indicates the client understands the teaching. 4. Antibiotics may interfere with the effectiveness of some birth control pills. The client should use a supplemental form of birth control when taking birth control pills. This statement indicates the client understands the teaching. 5. This is a sexually transmitted infection that can be transmitted by any male partner; therefore, she understands the teaching. MEDICATION MEMORY JOGGER: The test taker should realize that consuming alcohol is contraindicated with most medications.

43. The 17-year-old client is prescribed metronidazole (Flagyl) and erythromycin (E Mycin) for a persistent Chlamydia infection. Which statements by the client indicate the need for further teaching? Select all that apply. 1. "I can have a beer or two while taking these medications." 2. "My boyfriend will have to take the medications too." 3. "I can develop more problems if I don't treat this disease." 4. "My birth control pills may not work because of the medications." 5. "Chlamydia is a sexually transmitted infection I got from my boyfriend."

44. 1. There are no medications, whether the client is allergic or not, available to cure the herpes simplex 2 virus and the human immunodeficiency virus (HIV). This is a false statement but one that teenagers would like to believe because of their feelings of invincibility. 2. There are no medications available to cure the herpes simplex 2 virus and the human immunodeficiency virus (HIV). There are many medications available to treat the problems associated with these STIs, and they provide hope for the client, but the students must be aware of the long-term ramifications of STIs. 3. Birth control medications provide no protection against an STI. They may increase the chance of acquiring an STI because the fear of pregnancy is removed, making sexual activity more likely. 4. Antibiotics have side effects and the medications for HIV infections have especially strong associated side effects and adverse reactions. The side effects and adverse reactions are more likely to decrease libido than to enhance it.

44. The school nurse is teaching a class on sexually transmitted infections to a group of high school students. Which statement provides accurate information regarding treatment of sexually transmitted infections? 1. Medications are available to cure STIs if the client is not allergic. 2. Medications will not cure all sexually transmitted infections. 3. Medications that prevent pregnancy will prevent most STIs. 4. Medications that treat STIs enhance sexual libido.

45. 1. Rocephin is administered IM or IV. There is no pill form of the medication. The medication burns when administered and should be administered in the large gluteus muscle. 2. There is no pill form of Rocephin, so drinking water will not affect the medication. 3. Rocephin is administered IM or IV. A tuberculin syringe is used to administer medications by the subcutaneous or intradermal route. 4. There is no pill form of the medication, so eating will not affect the medication. 5. The client should stay in the clinic to be observed in case of an allergic reaction to the medication. Note the stem states "clinic nurse." This tells the test taker that the client is in the clinic if a clinic nurse is caring for the client.

45. The 18-year-old male client is diagnosed with gonorrhea of the pharynx. The HCP has prescribed ceftriaxone (Rocephin), a cephalosporin. Which interventions should the clinic nurse implement? Select all that apply. 1. Administer the medication intramuscularly in the ventral gluteal muscle. 2. Have the client drink a full glass of water with the pill. 3. Use a tuberculin syringe to draw up the medication. 4. Make sure the client has eaten before administering the drug. 5. Instruct the client to stay in the clinic for 30 minutes after medication.

46. 1. Syphilis is treated with a penicillin antibiotic unless the client is allergic to penicillin. The dosing schedule of every 4 hours for 10 days would make it difficult to achieve compliance from an adult, much less an adolescent. 2. A one-time injection of benzathine penicillin G is the usual treatment for primary syphilis infections. 3. Syphilis is a bacterial infection, and an antifungal medication would not treat a bacterial infection. The antibiotic must be taken internally to treat syphilis. 4. Macrodantin is an antibiotic used primarily for chronic urinary tract infections, not syphilis.

46. Which is the preferred treatment for the diagnosis of primary syphilis in a teenage client? 1. Doxycycline (Vibramycin), a tetracycline, po every 4 hours for 10 days. 2. Benzathine penicillin G, an antibiotic, IM one time only. 3. Miconazole (Monistat), an antifungal, topical daily for 1 week. 4. Nitrofurantoin (Macrodantin), a macrolide, b.i.d. for 1 month.

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

47. The teenaged male client is diagnosed with herpes simplex 2 viral infection and is prescribed valacyclovir (Valtrex). Which information should the nurse teach? 1. The medication will dry the lesions within a day or two. 2. Valtrex may be taken once a week to control outbreaks. 3. The use of condoms will increase the spread of the herpes. 4. Even after the lesions have gone, it is still possible to transmit the virus.

48. 1. No scratch marks on the penis indicate the client has not scratched himself but does not indicate a lack of infestation in the pubic hair. 2. Pediculosis pubis is pubic lice, not head lice; a clear scalp would not indicate a lack of a pubic infestation. 3. Pediculosis causes intense itching. A lack of itching indicates the treatment is effective. A 16-year-old client is unlikely to submit to a visual inspection of his pubic area by the nurse. 4. Pediculosis pubis is pubic lice, not head lice, so no visible lice or nits on the head would not indicate a lack of a pubic infestation. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

48. The 16-year-old male client is diagnosed with pediculosis pubis and is prescribed permethrin (Nix), an ectoparasiticide cream rinse. Which data indicate the treatment has been effective? 1. There are no scratches on the client's penis. 2. The client shaved his head and his scalp is clear. 3. The client reports that the intense itching has abated. 4. The client has no visible lice or nits on his head.

49. 1. Wiping the perineum from front to back is encouraged to prevent a urinary tract infection from fecal contamination of the urethral meatus. 2. The procedure should be planned immediately after the menstrual cycle has ended so that protection will not be needed until the client has had time to heal. 3. The liquid nitrogen causes a chemical burn to form, destroying the genital wart. The client should be taught to cleanse the area carefully to decrease pain and risk of infection. 4. Daily Betadine douches would increase pain and discomfort. Betadine is an iodine preparation and could cause the area to sting. The client should be encouraged to limit use of any soap or chemical preparation until released to do so by the HCP.

49. The 18-year-old female client has been diagnosed with genital warts and has been treated with cryotherapy with liquid nitrogen, a freezing agent, on the external genitalia. Which discharge information should the nurse teach? 1. Wipe the perineum from front to back to prevent cross-contamination of the area. 2. Encourage the use of peripads during the client's menstrual cycle. 3. Gently cleanse the perineum with a squirt bottle and tepid water after urinating. 4. Administer daily Betadine douches until the area has healed completely

5. 1. Nausea is a side effect of calcitriol and can also result from ESRD itself. 2. Diarrhea is an expected side effect of the medication; therefore, it would not warrant intervention from the nurse. 3. The client in ESRD would have an increased serum creatinine level; therefore, this would not warrant immediate intervention by the nurse. 4. Hematuria is an adverse effect of calcitriol and the nurse should notify the health-care provider. This would warrant taking the client off the medication. MEDICATION MEMORY JOGGER: Any time there is blood in the urine it is a cause for concern, and the nurse should intervene and investigate what is causing the hematuria.

5. The client in end-stage renal disease (ERSD) is taking calcitriol, a vitamin D analog. Which assessment data warrants intervention by the nurse? 1. The client complains of nausea. 2. The client has had two episodes of diarrhea. 3. The client has an increase in the serum creatinine level. 4. The client has blood in the urine.

50. 1000 mg of medication will be administered with each dose. The client weighs 220 pounds. Convert weight to kilograms by dividing by 2.2 (220 ÷ 2.2 = 100 kg). To find the amount for each dose, multiply 100 kg times 10 mg, which equals 1000 mg per dose.

50. The 19-year-old client diagnosed with a severe herpes simplex 2 viral infection is admitted to the medical floor. The HCP prescribes acyclovir (Zovirax), an antiretroviral medication, 10 mg/kg IVPB every 8 hours. The client weighs 220 pounds. How many milligrams will the nurse administer with each dose?

51. 1. Category A medications have a remote risk of causing fetal harm and are prescribed for clients who are pregnant. 2. Category B medications have a slightly higher risk of causing fetal abnormalities than do Category A medications, but they are often prescribed for clients who are pregnant. 3. Category C medications pose a greater risk than category B medications and are cautiously prescribed for clients who are pregnant. Medications in this category have either not yet been the subject of research or may show a risk in animal studies. 4. Category D medications have a proven risk of fetal harm and are not prescribed for clients who are pregnant unless the mother's life is in danger. Category X medications have a definite risk of fetal abnormality or abortion.

51. Which medication category is contraindicated in clients who are pregnant? 1. Pregnancy category A 2. Pregnancy category B 3. Pregnancy category C 4. Pregnancy category D

52. 1. Iron causes constipation; therefore, the client should increase fluid and fiber to help decrease the possibility of becoming constipated. 2. Iron causes constipation; therefore, the client is instructed to take a daily stool softener to prevent constipation. 3. The iron preparation causes the stool to become black and tarry; therefore, the client would not need to notify the obstetrician. 4. Iron should be taken between meals, 2 hours after a meal, because food decreases absorption of the medication by 50%-70%.

52. The client who is pregnant is prescribed ferrous sulfate (Feosol), an iron product. Which statement indicates to the nurse the client needs more teaching? 1. "I should increase my fluid intake and fiber when taking this medication." 2. "I will take a daily stool softener to prevent becoming constipated." 3. "If I notice that my stool becomes black or dark, I will call my obstetrician." 4. "I should take my iron tablet 2 hours after I eat."

53. 1. Brethine causes bronchodilatation, and if the client's respiratory rate is greater than 30 or if there is a change in quality of lung sounds (wheezing, rales, or coughing), the HCP should be notified. 2. The normal FHR is 110-160; therefore, an FHR of 150 is within normal limits and would not warrant intervention by the nurse. 3. The client's apical heart rate is just above normal (60-100) and would not warrant intervention by the nurse. 4. Brethine is administered to prevent contractions; therefore, the medication is effective.

53. The client who is 32 weeks pregnant and in preterm labor is prescribed terbutaline (Brethine), a beta-adrenergic agonist. Which data warrants intervention by the nurse? 1. The client's respiratory rate is 34. 2. The fetus's heart rate is 150 bpm. 3. The client's apical heart rate is 104. 4. The client reports no contractions.

54. 1. The client with preeclampsia would be receiving magnesium sulfate to help prevent seizures; therefore, the nurse would not question administering this medication. 2. Cervidil is contraindicated in clients who have asthma because it can initiate an asthmatic attack; therefore, the nurse should question administering this medication. 3. Celestone is a medication used to increase surfactant in fetal lungs and would be administered to a client who is less than 36 weeks pregnant; therefore, the nurse would not question administering this medication. 4. Pitocin, a uterine stimulant, would be administered after a client has experienced an incomplete abortion to help the client expel the fetal fragments; therefore, the nurse would not question administering this medication.

54. The nurse is preparing to administer medication in a labor and delivery unit. Which medication should the nurse question administering? 1. The anticonvulsant magnesium sulfate to a client with preeclampsia. 2. The synthetic prostaglandin dinoprostone (Cervidil) to a client with asthma. 3. The corticosteroid betamethasone (Celestone) to a client who is 27 weeks pregnant. 4. The tocolytic oxytocin (Pitocin) to a client with an incomplete abortion

55. 3, 4, 2, 1, 5 3. The nurse must first determine if this is the right client receiving the right medication. 4. The nurse should always check about allergies. With this medication, "-caine" drugs are anesthetics and, if the client is allergic to lidocaine (suturing lacerations) or Novacaine (dental procedures), the client should not receive this medication. 2. Once the nurse determines that this is the right client receiving the right medication and that the client has no allergies, then the nurse must wash his or her hands and use gloves to administer a medication to the perineal area. 1. This position allows maximum exposure to the area that should be medicated. 5. After completing all of the previous steps, the nurse can apply the medication.

55. The nurse is preparing to administer a combination hydrocortisone and pramoxine (Proctofoam), a local anesthetic, to a client with a fourth-degree episiotomy. Which interventions should the nurse implement? Rank in order of performance. 1. Position the client on the side with top leg up and forward. 2. Wash hands and don nonsterile examination gloves. 3. Check the client's MAR with the identification band. 4. Ask the client if she is allergic to any "-caine" drugs. 5. Apply the Proctofoam to the perineal area.

56. 1. Breathing exercises are important, but the protection of the client's lower extremities while under anesthesia should be priority for the nurse. 2. Because the legs are numb as a result of the epidural, the nurse must ensure the legs are in the stirrups correctly so that the client will not experience neurovascular compromise or any type of injury to the legs when they are in the stirrups. 3. Preparing the significant other for the delivery is important, but it is not priority over the safety of the mother's lower extremities. 4. The anesthesiologist or nurse anesthetist would be responsible for administering the anesthesia during the delivery.

56. The client in labor has an epidural catheter in place for anesthesia. Which intervention is most important for the labor and delivery nurse? 1. Assist the client with breathing exercise during contractions. 2. Ensure the client's legs are correctly positioned in the stirrups. 3. Have the significant other scrub for the delivery of the baby. 4. Titrate the epidural medication to ensure analgesic effect.

57. 1. The uterus becoming hard and firm periodically indicates a contraction, which is expected when administering a uterine stimulant. 2. The client wanting to urinate would be expected because the baby's head is pushing against the bladder. 3. Denying the urge to push indicates the client is not in the last stages of labor. 4. During a contraction the fetal heart rate will decrease but should return to the baseline FHR after the contraction. If this does not occur, it indicates the infant is in distress and this warrants immediate intervention. This could also be a sign of uterine rupture resulting from overstimulation of the uterus.

57. Which assessment data warrants immediate intervention for the client in labor who is receiving an oxytocin (Pitocin) drip, a tocolytic agent? 1. The uterus periodically becomes hard and firm. 2. The client complains of an urgency to void. 3. The client denies the urge to push. 4. The fetal heart rate (FHR) does not return to baseline.

58. 1. The medication is administered to prevent seizure activity so if no activity is occurring the medication is effective. 2. The client's urine output does not indicate the medication is effective. 3. Magnesium sulfate is not administered to treat the client's blood pressure; therefore, this data cannot be used to evaluate the effectiveness of the medication. 4. Magnesium sulfate is administered to prevent seizure activity and is determined to be effective and in the therapeutic range when the client's deep tendon reflexes are normal, which is 2 to 3+ on a 0-4+ scale. 5. The client's apical pulse does not determine effectiveness of magnesium sulphate.

58. The client who is 38 weeks pregnant and diagnosed with preeclampsia is admitted to the labor and delivery area. The HCP has prescribed intravenous magnesium sulfate, an anticonvulsant. Which data indicates the medication is effective? Select all that apply. 1. The client has no seizure activity. 2. The client's urine output is 45 mL/hour. 3. The client's blood pressure is 148/90. 4. The client's deep tendon reflexes are 2 to 3+. 5. The client's apical pulse is 70.

59. 1. This is the scientific rationale for administering corticosteroids. A beta-adrenergic agonist, not a corticosteroid, is given to decrease uterine contractions in preterm labor. 2. This is not the reason why steroids are administered; it is not the rationale for any medication administered to the client who is pregnant. 3. This is the scientific rationale for administering corticosteroids. They are administered to a client who is in preterm labor because they accelerate lung maturation, resulting in surfactant development in the fetus. 4. Rho (D) immune globulin (RhoGAM) is administered to a mother who has Rh-negative blood and is pregnant with a Rh-positive fetus to prevent the development of maternal antibodies to the fetus's blood. Corticosteroids are not given for this reason.

59. Which statement best indicates the scientific rationale for administering corticosteroid therapy to a client who is 30 weeks pregnant? 1. Steroids are administered to decrease uterine contractions in preterm labor. 2. Steroids will increase the analgesic effects of opioid narcotics. 3. Steroids accelerate lung maturation, resulting in fetal surfactant development. 4. Steroids will prevent the development of maternal antibodies to the fetus's blood.

6. 1. The client should not drink more than 4 ounces of water because water quickens the gastric emptying time. 2. The client should drink some water to ensure the medication gets to the stomach. 3. Liquid antacids should be taken with 2-4 ounces of water to ensure that the medication reaches the stomach. 4. Antacids should be taken on an empty stomach and are effective for 30-60 minutes before passing into the duodenum.

6. The client in chronic kidney disease is taking aluminum hydroxide (Amphojel), a liquid antacid. Which information should the nurse discuss with the client? 1. Drink at least 500 mL of water after taking the medication. 2. Do not drink any water for 1 hour after taking the medication. 3. Drink 2-4 ounces of water after taking the medication. 4. Eat 30 minutes prior to taking the aluminum hydroxide.

60. 1. The client's H&H should be monitored, but an ongoing assessment of how much the client is bleeding is priority. 2. Monitoring the client's peripad count will allow the nurse to directly assess how much the client is bleeding, which will help determine if the medication is effective. 3. Vital signs should be monitored, but an ongoing assessment of how much the client is bleeding is priority. 4. The client's fundal height should be assessed, but it will not help determine how much blood the client has lost.

60. The client is experiencing postpartum hemorrhage and has received an ergot alkaloid, methylergonovine (Methergine). Which intervention is priority when administering this medication? 1. Check the client's hemoglobin and hematocrit levels. 2. Monitor the client's peripad count frequently. 3. Assess the client's vital signs every 2 hours. 4. Determine the client's fundal height.

62. 1. There is no increased risk of having a child with Down syndrome when taking this medication. 2. There are many risks associated with taking this fertility medication, including multiple fetuses, pain, visual disturbances, abnormal bleeding, and ovarian failure. 3. This medication should be taken at the same time every day to maintain a therapeutic drug level. 4. Clomid is an ovarian stimulant that promotes follicle maturation and ovulation. Many follicles can mature simultaneously, resulting in the increased possibility of multiple births.

62. The female client is taking clomiphene (Clomid), an estrogen antagonist. Which statement indicates the client understands the risk of taking this medication? 1. "The medication may cause my child to have Down syndrome." 2. "There are very few risks associated with taking this medication." 3. "I should stagger the times that I take this medication." 4. "This medication may increase my chance of having twins."

63. 1. The client should be aware that it may take 3-6 months for leuprolide therapy to achieve maximum benefits; therefore, the nurse should discuss the long-term possibility with the client. 2. Continuous use of this medication may cause amenorrhea or menstrual irregularities. 3. This medication is either given intramuscularly once a month or it is an implant that is given once every 12 months, but it is not administered daily. 4. This medication does not affect when the client can have intercourse. 5. This medication is administered intramuscularly and drinking grapefruit juice does not affect the medication.

63. The client who is infertile and diagnosed with endometriosis is prescribed leuprolide (Lupron), a GnRH medication. Which information should the nurse discuss with the client? Select all that apply. 1. Explain that this medication may take 3-6 months to work. 2. Discuss that this medication will help regulate the client's menstrual cycle. 3. Instruct to take the Lupron every night to help decrease menstrual pain. 4. Teach that this medication will not affect when the client has intercourse. 5. Tell the client not to drink grapefruit juice when taking this medication.

64. 1. A pelvic sonogram is used to determine ovarian response to Parlodel, but because the client thinks she is pregnant, performing a sonogram is not the first intervention. 2. The client must quit taking the medication immediately because it can cause a miscarriage of the fetus. Once the client becomes pregnant, the medication is not needed anymore. 3. The client needs to see the HCP, but it is not the first intervention the nurse should discuss with the client. 4. The client can perform a home pregnancy test, but it is not the first intervention the nurse should discuss with the client. MEDICATION MEMORY JOGGER: The test taker should question administering any medication to a client who is pregnant. Many medications cross the placental barrier and could affect the fetus.

64. The client experiencing infertility is prescribed bromocriptine (Parlodel). The client calls the clinic nurse and reports that she thinks she may be pregnant. Which intervention should the clinic nurse implement first? 1. Schedule the client for a pelvic sonogram. 2. Instruct the client to quit taking the medication. 3. Tell the client to make an appointment with the HCP. 4. Encourage the client to confirm with a home pregnancy test.

65. 1. This test determines how much medication has been administered, but it does not indicate that the medication is effective. 2. The serum estrogen level should increase three to four times the pretreatment baseline if the medications are effective and the client may be able to get pregnant. 3. A negative pregnancy test indicates the medications are not effective. 4. This is the test that determines the 3-month average blood glucose level.

65. The client experiencing infertility is receiving menotropin (Pergonal), an ovarian stimulant, and human chorionic gonadotropin. Which diagnostic test indicates the medications are effective? 1. A serum human chorionic gonadotropin level. 2. A serum estrogen level. 3. A negative urine pregnancy test. 4. A hemoglobin A1c.

66. 1. Abdominal bloating and vague gastrointestinal discomfort are signs of ovarian cancer. 2. This could indicate a miscarriage but does not support the diagnosis of ovarian hyperstimulation syndrome. 3. Ovarian hyperstimulation syndrome involves marked ovarian enlargement with exudation of fluid into the woman's peritoneal and pleural cavities. This syndrome can result in ovarian cysts that may rupture, causing pain. 4. These are signs and symptoms of urinary tract infection.

66. The female client has been taking infertility medications. Which signs or symptoms indicate ovarian overstimulation syndrome? 1. Abdominal bloating and vague gastrointestinal discomfort. 2. Bright-red vaginal bleeding with golf ball-size clots. 3. A positive fluid wave and lower abdominal wave. 4. Burning and an increased frequency of urinating.

67. 1. HCG acts immediately to promote ovulation; therefore, the couple should not wait to have sexual intercourse. 2. Wearing tight-fitting underwear causes the scrotum to be close to the body and the heat reduces the sperm count, which is why boxer shorts are recommended, but this has nothing to do with the HCG medication. 3. Taking the basal metabolic temperature is a first-line intervention for clients experiencing infertility to determine when a woman is ovulating. HCG stimulates ovulation, which should occur within hours to a day or two of administration of the medication. 4. The couple should have sexual intercourse during this time because this is the probable period of ovulation.

67. The nurse administers human chorionic gonadotropin (HCG) intramuscularly to the female client who is infertile. Which instruction should the nurse discuss with the couple regarding coitus? 1. Explain the need to abstain from sexual intercourse for 14 days after receiving the medication. 2. Instruct the male partner to wear boxer shorts while his female partner is taking human chorionic gonadotropin. 3. Discuss taking the basal metabolic temperature and having sexual intercourse when it becomes elevated 2 degrees. 4. Advise the couple to have intercourse on the eve of receiving medication and 3 days after receiving medication.

68. 1. Progesterone enhances the receptivity of the endometrium to implantation—the function of progesterone in the body— and is the scientific rationale for administering supplemental progesterone to a client preparing for in vitro fertilization. 2. Providing more hormones to the ovary for egg production is not the scientific rationale for administering supplemental progesterone to a client preparing to undergo in vitro fertilization. 3. Regulation of the menstrual cycle is not the scientific rationale for administering this medication. 4. This is not the scientific rationale for administering this medication.

68. The nurse is preparing a client for in vitro fertilization (IVF). Which statement best describes the scientific rationale for administering supplemental progesterone to this client? 1. To enhance the receptivity of the endometrium to implantation. 2. To provide more hormone to the ovary for egg production. 3. To help regulate the client's monthly menstrual cycle. 4. To decrease galactorrhea in the client if fertilization occurs.

69. 1. Infertility therapy is extremely expensive and most insurance plans do not cover it at all or cover only a small portion. 2. Pregnancy with more than twins carries a substantially higher risk to the mother and the fetuses because of preterm labor and birth, placental insufficiency, and high demand on maternal body systems. 3. There is no guarantee of pregnancy on the first attempt. 4. Most of the implanted zygotes do not result in live births.

69. The nurse is discussing fertility issues. Which statement indicates the couple is knowledgeable of fertility issues? 1. "My insurance should cover the cost of the medications completely." 2. "A multifetal pregnancy can result in preterm labor and birth." 3. "There is an excellent probability we will get pregnant the first time." 4. "Most of the implanted zygotes will result in a live birth."

7. 1. Kayexalate is a medication that is administered to decrease an elevated serum potassium level. Therefore, an elevated serum potassium (>5.5 mEq/L) would indicate the medication is not effective. 2. Kayexalate is not used to alter the serum sodium level. 3. Kayexalate is a medication that is administered to decrease an elevated serum potassium level. A potassium level within the normal range of 3.5-5.5 mEq/L indicates the medication is effective. 4. Kayexalate is not used to alter the serum sodium level. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

7. The client in chronic renal disease is receiving oral Kayexalate, a cation exchange resin. Which assessment data indicates the medication is effective? 1. The client's serum potassium level is 5.8 mEq/L. 2. The client's serum sodium level is 135 mEq/L. 3. The client's serum potassium level is 4.2 mEq/L. 4. The client's serum sodium level is 147 mEq/L.

70. 1. There is no documented drug regimen that helps men achieve sperm levels, except possibly testosterone medications or supplements. 2. This is a therapeutic response and the client is asking for information; therefore, the nurse should provide the facts. 3. Administration of testosterone will improve hormonal levels, resulting in a potential for increased spermatogenesis. 4. Clomid is an ovarian stimulant and will not help a male client.

70. The male client who is infertile asks the clinic nurse, "Is there anything I can take to increase my chances of fathering a child?" Which statement is the nurse's best response? 1. "I am sorry, but there are no medications to help men with infertility." 2. "Are you concerned about not being able to father a child?" 3. "Testosterone therapy may help increase your sperm count." 4. "You can take Clomid and it will help your partner get pregnant."

71. 1. Correct use of spermicide is required for contraceptive efficacy. The spermicide must be in place prior to intercourse, and the foam is immediately active. If a suppository or tablet is used, it must be inserted 10-15 minutes before intercourse to allow time for it to dissolve. 2. Douching is not allowed for at least 6 hours after intercourse; douching will remove the spermicide. 3. The spermicide must be inserted into the female's vagina. 4. The spermicide must be inserted prior to each sexual intercourse; it is only effective for one time. 5. Condoms or abstinence are the only two ways to prevent sexually transmitted infections.

71. The couple has decided to use a spermicide for birth control. Which information should the nurse discuss with the female partner? Select all that apply. 1. Insert the spermacide prior to having sexual intercourse. 2. Douche with vinegar and water immediately after intercourse. 3. Apply spermicide in the woman's vagina. 4. Tell the couple spermicide is effective up to 3 times. 5. Explain this form of birth control will not prevent STIs.

72. 1. The client who smokes more than 15 cigarettes a day is at a greater risk for cardiovascular complications when taking oral contraceptives. 2. A client taking an ACE inhibitor would have cardiovascular problems. Oral contraceptives elevate blood pressure by increasing both angiotensin and aldosterone; therefore, this client should not take oral contraceptives. 3. A client who is obese is at risk for hypertension, hypercholesterolemia, and deep vein thrombosis and should not take oral contraceptives. 4. Oral contraceptives decrease the risk for several disorders, including ovarian cancer, endometrial cancer, pelvic inflammatory disease, premenstrual syndrome, toxic shock, fibrocystic breast disease, ovarian cysts, and anemia. In addition to providing birth control for the client, the client gets a secondary benefit of decreasing her risk for ovarian cancer.

72. Which client should the nurse recommend taking oral contraceptive pills for birth control? 1. The client who smokes two packs of cigarettes a day. 2. The client who is taking an angiotensin-converting enzyme medication. 3. The client who is 65" tall and weighs 100 kg. 4. The client who has a family history of ovarian cancer.

73. 1. The client should be instructed to take any missed pill as soon as the omission is recognized; therefore, the client could and should take more than one pill in a day. 2. Breakthrough bleeding may mean the dosage of the oral contraceptive is not appropriate, but this is not a reason to discontinue taking the medication. The client should see the HCP. 3. The client should be instructed to take any missed pill as soon as the omission is recognized. Therefore, the client could and should take more than one pill in a day. To maintain ovulation suppression the client must take the medication routinely. 4. Antibiotics decrease the effectiveness of some oral contraceptives, and a secondary form of birth control should be used during antibiotic therapy.

73. Which instruction should the nurse discuss with the client who is prescribed oral contraceptives for birth control? 1. Never take more than one birth control pill a day. 2. If breakthrough bleeding occurs, discontinue the pill. 3. Take a missed pill as soon as you realize you have missed it. 4. Antibiotics will increase the ovulation suppression effect of the pill

91. 1. Synthetic surfactant does not affect the infant's blood glucose level. 2. Synthetic lung surfactant coats the alveoli and prevents collapse of the lung by reducing the surface tension of pulmonary fluids. Normal ABGs indicate the lungs are adequately oxygenating the body, which means the medication is effective. 3. PEEP cannot be used on a newborn because it increases intrathoracic pressure and increases the risk for pneumothorax. 4. Pulse oximeter readings measure peripheral oxygenation and should be greater than 93%, which indicates the client's arterial oxygen level would be above 80. A 90% to 92% pulse oximeter reading indicates hypoxia and that the medication is not effective.

91. The preterm infant is receiving synthetic surfactant. Which data indicates the medication is effective? 1. The infant's heel stick capillary blood glucose level is 90 mg/dL. 2. The infant's arterial blood gases are within normal limits. 3. The positive end-expiratory pressure (PEEP) on the ventilator is turned off. 4. The infant's pulse oximeter reading fluctuates between 90% and 92%.

74. 1. This is an appropriate question, but the timing of the sexual activity is not the important consideration for a new mother taking her baby home when discussing birth control. 2. This is the most important question because if the mother has decided on breastfeeding, the nurse should discourage the use of birth control pills. Birth control pills enter breast milk and reduce milk production. Breastfeeding may delay ovulation but should not be used as a form of birth control. 3. This is a question that the nurse could ask, but it is not the most important when concerned about birth control. 4. This question could be asked, but the most important issue is protecting the baby if the mother chooses to breastfeed because anything the mother ingests may affect the baby. This includes the effects of the type of birth control if the mother chooses to breastfeed. MEDICATION MEMORY JOGGER: The test taker should question administering any medication to a client who is breastfeeding. Many medications are transmitted to the baby via breast milk.

74. The nurse is providing discharge instructions for the postpartum client concerning birth control methods. Which question is most important for the nurse to ask the client? 1. "Has your doctor discussed when to resume sexual activity?" 2. "Have you decided if you will be breastfeeding your baby?" 3. "Are you concerned about how this baby will change your life?" 4. "Does your partner agree with the type of birth control you will use?"

75. 1. This statement is judgmental, and because he is already sexually active, it is not going to protect him from fathering a child or getting an STI. The nurse should encourage the sexually active adolescent to use protection. 2. The adolescent's comments should make the school nurse consider an allergic reaction to the condom, most of which are made of latex. Suggesting a type of condom made from lamb's intestines would prevent an allergic reaction. 3. STIs require an incubation period, and the red rash area would not occur the next morning. 4. A diaphragm is a form of birth control, but most are made of latex, which may cause a reaction for the male adolescent.

75. The male adolescent who is sexually active tells the school nurse, "I am embarrassed, but I don't know who else to tell. Last night when I used a condom with my girlfriend I got a red itchy rash down there. I don't know what it is or what to do." Which statement is the nurse's best response? 1. "You should abstain from sex until you are older." 2. "Use a condom made out of a lamb's intestines." 3. "Do you think your girlfriend gave you an STI?" 4. "Encourage your girlfriend to use a diaphragm."

76. 1. If the ring is expelled before 3 weeks have passed, it can be washed off in warm water and reinserted. A new one is reinserted only if the expelled ring cannot be used. 2. This statement is appropriate for using a diaphragm, not the ring. 3. The vaginal contraceptive ring works on the same principle that oral contraceptives work. It provides 21 days of hormone suppression, followed by 7 days to allow for menses. The ring slowly releases hormones that penetrate the vaginal mucosa and are absorbed by the blood and distributed throughout the body. The contraception occurs from systemic effects, not local effects in the vagina. 4. The client will have a period when using this form of birth control. MEDICATION MEMORY JOGGER: Medications are not usually administered to stop normal body functions, especially with birth control medication because the uterus must be able to expel the lining that was prepared for an ovum that did not appear.

76. Which statement indicates to the nurse the client using a vaginal contraceptive ring understands the birth control teaching? 1. "If the ring falls out during intercourse, I should get a new ring." 2. "I should insert the ring 30 minutes before having intercourse." 3. "I will remove the ring 3 weeks after I have inserted it." 4. "I am so glad that I will not have a period when using the ring."

77. 1. If signs of estrogen excess are apparent (nausea, edema, or breast discomfort), a preparation with lower estrogen content is needed. This statement therefore warrants the nurse to intervene. 2. Oral contraceptives may decrease or eliminate menstrual flow during the initial months of use; therefore, the nurse would not intervene based on this statement. 3. This statement would warrant praise from the clinic nurse because birth control pills do not protect the client from STIs. Only condoms or abstinence can do that. 4. The birth control pill suppresses ovulation for 3 weeks; then, when the pill is not taken, the client has her period. This statement indicates the client understands the teaching and does not warrant intervention.

77. The client has been taking birth control pills for 5 weeks. Which statement from the client warrants intervention by the clinic nurse? 1. "I stay nauseated and my breasts are very tender." 2. "I have not had a period since I started the pill." 3. "I make my boyfriend use a condom even though I am on the pill." 4. "I took the pills for 3 weeks then stopped for 1 week."

78. 1. This is not a true statement. The client will have a normal 28-day cycle. 2. Birth control pills will decrease cramping, but 7 days out of the month the pill the client takes does not contain hormones; it is a placebo. 3. This product is not any more expensive or cheaper than a 21-day product. 4. This 28-day pack contains 21 days of the hormone and 7 days of placebos. The client takes a pill every day. This eliminates the need for the woman to remember which day to restart taking the pill, as she would have to with a 21-day pack, with which the woman takes a pill for 21 days and then no pill for 7 days and then restarts a new pack.

78. The client is prescribed a 28-day oral contraceptive pack. Which statement best describes the scientific rationale for this birth control product? 1. This causes longer intervals between menses. 2. A hormone pill daily decreases cramping during menses. 3. It is not as expensive as other birth control products. 4. This ensures that the client will take a pill every day

79. 1. Depo-Provera is a safe, effective contraceptive that is effective for 3 months or longer and is administered via intramuscular injection every 3 months to provide for continuous protection. 2. When injections are discontinued, an average of 12 months is required for fertility to return. Some women remain infertile for as long as 2 1/2 years. 3. This medication is administered intramuscularly every 3 months. 4. An intrauterine device is not necessary when using this medication. An IUD is inserted by the HCP, not by the client. 5. The advantage to this medication is that it is only taken every 3 months, which is why it is recommended for adolescents or women who may not use other methods of birth control reliably.

79. The adolescent client is prescribed the birth control medication depot medroxypro - gesterone (Depo-Provera). Which interventions should the clinic nurse implement? Select all that apply. 1. Instruct the client to schedule an appointment every 3 months. 2. Explain that infertility may occur up to 2 years after discontinuing. 3. Demonstrate how to administer the medication subcutaneously in the abdomen. 4. Discuss how to care for the intrauterine device inserted in her vagina. 5. Tell the client that she will not have to take a pill every day.

8. 1. Tented skin turgor indicates the client is dehydrated and the nurse should question administering a loop diuretic. 2. The client in chronic renal disease would have a less than normal urine output, so the nurse would not question giving the client a diuretic. 3. A moist and pink mucosa indicates the client is hydrated; therefore, the nurse would not question administering this medication. 4. The medication is being administered to help decrease the sacral edema; therefore, the nurse would not question administering this diuretic. 5. Diuretics reduce circulating blood volume, which may cause orthostatic hypotension. Because the client's blood pressure is low, the nurse should question administering this medication. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable of accepted standards of practice for medication administration, including which client assessment data and laboratory data should be monitored prior to administering the medication.

8. The nurse is administering the thiazide diuretic hydrochlorothiazide (HydroDIURIL) to a client diagnosed with chronic renal disease. Which assessment data should cause the nurse to question the administration of this medication? Select all that apply. 1. The client's skin turgor on the upper chest is tented. 2. The urine output was 90 mL for the last 8 hours. 3. The client's oral mucosa is moist and pink. 4. The client has 3+ sacral and peripheral edema. 5. The client's blood pressure is 90/60 in the left arm.

80. 1. Because the client is receiving the medication for menstrual irregularity it is effective when the menstrual cycle is regular, which is every 28 days. 2. A decrease in abdominal bloating may occur, but it does not indicate the medication is effective. 3. This should occur but this is not why the client is taking the medication; therefore, it cannot be used to indicate the medication is effective. 4. Birth control pills have a positive effect on acne, but this is not why the client is taking the medication; therefore, it cannot be used to indicate the medication's effectiveness. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

80. The 14-year-old client is prescribed oral contraceptive medication for menstrual irregularity. Which assessment data indicates the medication is effective? 1. The client has a period every 28 days. 2. The client has a decrease in abdominal bloating. 3. The client has a negative pregnancy test. 4. The client reports a decrease in facial acne

81. 1. This is the antidote for morphine overdose, but the nurse would not administer the medication without first assessing the client because these data were provided by the UAP. 2. The client's respiration is less than normal; therefore, the priority should be assessing the respiratory status, not the client's pain level. 3. Because the UAP provided the initial abnormal data, the nurse should first assess the client to determine and validate the client's respiratory status. 4. The client's neurovascular status should be assessed because of the epidural analgesia, but the client's respiratory status is priority

81. The client postbirth via C-section is receiving epidural morphine. The unlicensed assistive personnel (UAP) tells the primary nurse the client has a pulse of 84, respirations of 10, and a blood pressure of 102/78. Which intervention should the nurse implement first? 1. Administer naloxone (Narcan), a central nervous system antagonist. 2. Assess the client's pain using the numerical (1-10) pain scale. 3. Check the client's respiratory rate and pulse oximeter reading. 4. Complete a neurovascular assessment of the client's lower extremities.

82. 1. Viagra should be used cautiously in clients with coronary heart disease because during sexual activity the client could have a myocardial infarction from the extra demands on the heart. Specifically, clients taking nitroglycerin or any nitrate medication should not take Viagra because the vasodilatation effect of Viagra may cause hypotension. A client with unstable angina would be taking a nitrate medication. 2. Viagra is not contraindicated for clients diagnosed with glaucoma. 3. Viagra is not contraindicated for clients diagnosed with Type 2 diabetes and may help erectile dysfunction. 4. Viagra is not contraindicated for clients with an SCI and may help erectile dysfunction.

82. Which male client should the nurse consider at risk for complications when taking sildenafil (Viagra), a sexual stimulant? 1. A 56-year-old client with unstable angina. 2. An 87-year-old client with glaucoma. 3. A 44-year-old client with type 2 diabetes. 4. A 32-year-old client with an L1 spinal cord injury (SCI).

83. 1. The number of UTIs is information the nurse would need to determine if the client is at risk for developing chronic urinary tract infections, but this is not the most important question when discussing antibiotic therapy. 2. Wearing cotton underwear or underwear with a cotton crotch should be encouraged because cotton is a natural material that breathes and allows air to circulate to the area, decreasing the risk for UTIs. It is an appropriate question, but it is not the most important question when discussing antibiotic therapy. 3. Cleaning from back to front after a bowel movement increases the risk of fecal contamination of the urinary meatus, but this is not the most important question when discussing antibiotic therapy. 4. Birth control pills and certain antibiotics may interact, making the birth control pills ineffective in preventing pregnancy. This is the most important question for the nurse to ask. MEDICATION MEMORY JOGGER: Any time the client is of childbearing age the nurse should determine if there is a potential pregnancy or drug interaction with birth control methods.

83. The 33-year-old female client is being prescribed an antibiotic for a urinary tract infection (UTI). Which question is most important for the nurse to ask the client when discussing the medication? 1. "How many UTIs have you had in the past year?" 2. "What type of underwear do you wear usually?" 3. "Which way do you clean after a bowel movement?" 4. "Are you currently using any type of birth control?"

84. 1. Insulin may better help control the blood glucose level, but that is not the reason why it is used during pregnancy. 2. Oral hypoglycemics are not used during pregnancy because they cross the placental barrier; they stimulate fetal insulin production and may be teratogenic. 3. Insulin has no effect on preterm labor. 4. Oral hypoglycemics do not affect fetal lung development.

84. The client with gestational diabetes asks the nurse, "Why do I have to take shots? Why can't I take a pill?" Which statement is the nurse's best response? 1. "The shots will help keep your blood glucose level down better." 2. "Pills may hurt the development of the baby in your womb." 3. "Insulin will help prevent you from having the baby too early." 4. "Pills for diabetes may delay the baby's lung development."

85. 1. Anticholinergic medications block the muscarinic receptors on the salivary glands and inhibit salivation, resulting in a dry mouth. This comment would not warrant notifying the HCP. 2. Inability to void all day long indicates an overdose of the medication and would require notifying the health-care provider to decrease the dosage. 3. The "LA" in the medication indicates this medication is long acting and should not be crushed. Because the client is swallowing the pill, the HCP would not need to be notified. 4. Grapefruit juice increases the effect of Detrol; therefore, the client not drinking it would not warrant notifying the HCP. MEDICATION MEMORY JOGGER: Grapefruit juice can inhibit the metabolism of certain medications. Specifically, grapefruit juice inhibits cytochrome P450-3A4 found in the liver and the intestinal wall. The nurse should investigate any medications the client is taking if the client drinks grapefruit juice.

85. The elderly male client is prescribed tolterodine (Detrol-LA), an anticholinergic, for urge incontinence. Which statement warrants notifying the health-care provider? 1. "I have to suck on sugarless candy because my mouth is so dry." 2. "I am so glad I can go all day without having to go to the bathroom." 3. "I really have problems swallowing the pills whole with water." 4. "I hate I had to give up my grapefruit juice, but I know it is best."

86. 1. There is no data in the stem that indicates that the baby is postmature; therefore, the nursery nurse would not assess for meconium aspiration. 2. The antidote for magnesium sulfate overdosage is calcium gluconate; therefore, the nurse should be prepared to administer it. 3. Glucose water is given to infants who are experiencing hypoglycemia. There is no indication that this infant is experiencing hypoglycemia, the mother does not have diabetes, and hypoglycemia in the infant does not occur as a result of preeclampsia. 4. The infant's respiratory status should be assessed, not the infant's temperature. 5. The baby is at risk for respiratory or neurological depression; therefore, the nurse should stimulate the baby until the effects of the magnesium sulfate have dissipated.

86. The mother with preeclampsia has received magnesium sulfate, an anticonvulsant, during labor and delivery. Which interventions should the nursery nurse implement for the newborn? Select all that apply. 1. Assess the lungs for meconium aspiration. 2. Prepare to administer IV calcium gluconate. 3. Administer 2 ounces of glucose water. 4. Assess the infant's axillary temperature. 5. Stimulate the baby by tapping the feet.

87. 1. The nurse would expect that a 56-year-old client should not be having normal menstrual cycles. 2. Abdominal bloating is associated with premenstrual syndrome and the nurse would not expect that a 56-year-old client would be having normal menstrual cycles. 3. Dong quai is used for menopausal symptoms and premenstrual syndrome, but because the client is 56 years old the nurse should consider the medication effective when there is a lack of menopausal symptoms. 4. This herb does not affect bone density.

87. The 56-year-old Asian female client tells the nurse that she is taking the herb Angelica sinensis (dong quai). Which data indicates to the nurse this medication is effective? 1. The client has normal menstrual cycles. 2. The client does not have abdominal bloating. 3. The client reports fewer hot flashes. 4. The client has a normal bone density test.

88. 1. The newborn's gut is sterile and the liver cannot synthesize vitamin K from the food ingested until there are bacteria present in the gut. 2. Ophthalmic ointment is administered to prevent eye infections. 3. Routine medications administered to the newborn do not include medications to stimulate the small intestines. 4. Routine medications administered to the newborn do not include medications to stimulate the digestive process.

88. Which statement best indicates the scientific rationale for administering vitamin K (AquaMEPHYTON) to the newborn infant? 1. It promotes blood clotting in the infant. 2. It prevents conjunctivitis in the infant's eyes. 3. It stimulates peristalsis in the small intestines. 4. It helps the digestive process in the newborn.

89. 1. The nurse should use latex-free gloves when touching the client, but this is not the most important intervention because this is a very short-term exposure to the latex for the client. 2. A smaller catheter does not address the material the catheter is made out of. 3. The most important intervention is for the client to have a latex-free Foley catheter because this will stay in the client for an extended period. 4. The solution used to clean the client would not have a bearing on the latex allergy.

89. The nurse is preparing to insert an 18-gauge indwelling urinary catheter in a client who has a latex allergy. Which intervention is most important for the nurse to implement? 1. Use latex-free gloves when performing this procedure. 2. Insert a 16-gauge indwelling urinary catheter into the client. 3. Obtain an appropriate indwelling urinary catheter for the client. 4. Use povidone iodine solution to cleanse the perineal area.

9. 1. A decreased potassium level indicates the dialysis is effective but not that the medication is effective. 2. Fosrenol does not affect sodium level. 3. A decreased BUN level indicates the dialysis is effective but not the medication. 4. Fosrenol decreases phosphate absorption in the intestines, and the phosphorus is excreted in the feces.

9. The client diagnosed with chronic kidney disease on hemodialysis is prescribed lanthanum (Fosrenol), an electrolyte- and water-balancing agent. Which laboratory data indicates the medication is effective? 1. A decreased serum potassium level. 2. A normal serum sodium level. 3. A decreased serum blood urea nitrogen (BUN) level. 4. A normal serum phosphorus level.

90. 1. Chlamydia is frequently asymptomatic and is diagnosed with an annual Pap smear. 2. Chlamydia does not cause canker sores; these sores are caused by syphilis. 3. Chlamydia is bacteria and must be treated with an antibiotic; condoms are used to prevent transmission to a partner. 4. Untreated Chlamydia can lead to pelvic inflammatory disease and long-term effects, including chronic pain, increased risk for ectopic pregnancy, postpartum endometritis, and infertility.

90. The client is diagnosed with Chlamydia trachomatis, a sexually transmitted infection, and asks the nurse, "Why must I take an antibiotic when I don't have any itching or pain?" Which statement is the nurse's best response? 1. "The itching and pain will start within 2 or 3 days." 2. "The antibiotics will prevent canker sores on your genitalia." 3. "If you use a condom, then you don't have to take the antibiotic." 4. "If it is not treated, you may never be able to have a baby."

92. 1. The nurse must first initiate steps to prevent the client from developing hypovolemic shock; therefore, the nurse should start a large-bore IV to infuse isotonic normal saline to maintain blood pressure. The nurse should anticipate the client receiving a blood transfusion, which supports the need for an 18-gauge catheter. 2. A urine specimen should be sent to the laboratory, but the client's safety and prevention of shock are the nurse's first priority. 3. Ordering blood is a priority but not a priority over caring for the client who may be going into hypovolemic shock. 4. Determining the source of bleeding is important, but caring for the client is priority. MEDICATION MEMORY JOGGER: The nurse's first priority is always caring for the client, not a laboratory or diagnostic test.

92. The 19-year-old client presents to the emergency department with trauma to the flank area resulting from a motor vehicle accident. The client's first urine specimen shows bright-red urine. Which intervention should the nurse implement first? 1. Initiate an 18-gauge angiocath with normal saline. 2. Send a sterile urine specimen to the laboratory. 3. Type and crossmatch for 2 units of blood. 4. Prepare the client for a CT scan of the abdomen.

93. 1. Spinal anesthesia has been shown to be well tolerated by a healthy fetus when a maternal intravenous fluid preload in excess of 500-1000 mL precedes the administration of the spinal. 2. The client will be in the side-lying or fetal position when the spinal anesthesia is being administered. 3. This neurovascular assessment should be performed prior to and after the spinal anesthesia to determine the effectiveness of the anesthesia. 4. Baseline vital signs can be obtained 30 minutes to 1 hour prior to spinal anesthesia; postprocedure vital signs are monitored every 1-2 minutes for the first 10 minutes and then every 5-10 minutes throughout the delivery. 5. Spinal anesthesia will cause the pregnant client not to feel the contractions, so the nurse needs to assist the client with pushing.

93. Which interventions should the nurse implement when the nurse anaesthetist is administering spinal anesthesia to a pregnant client in labor? Select all that apply. 1. Administer 500-1000 mL of intravenous fluid before inserting the spinal catheter. 2. Instruct the client to lie on the side in the fetal position when inserting the spinal catheter. 3. Perform a neurovascular assessment on the client's lower extremities. 4. Monitor the client's blood pressure, pulse, and respirations during spinal anesthesia. 5. Assist the client with pushing when instructed by obstetrician.

94. 1. The client is understandably distressed and is in a crisis situation. The suicide threat is not imminent in the emergency department and she would not know if she were pregnant for several weeks. 2. There are three emergency contraception options available: (1) Yuzpe regimen, which is a combination of estrogen and progesterone pills administered within 72 hours and a second dose 12 hours later that will initiate the onset of menstrual bleeding within 21 days; (2) the administration of mifepristone (RU 486) plus misoprostol (Cytotec), which will prevent pregnancy; and (3) the insertion of a copper IUD within 5 days of unprotected intercourse, which can prevent pregnancy (99% effective). 3. Spermicide after intercourse is not effective to prevent pregnancy. 4. If the client is adamant about not carrying a baby to term, then the nurse should discuss other available options to prevent the pregnancy.

94. The client who was raped is admitted to the emergency department and tells the nurse, "I will kill myself if I get pregnant from this monster." Which statement is the nurse's best response? 1. "Have you ever thought about killing yourself and do you have a plan?" 2. "There are medications that must be taken within 72 hours to prevent pregnancy." 3. "A vaginal spermicide can be prescribed that will prevent pregnancy." 4. "You may have to have an elective abortion if you do become pregnant."

95. 1. Category A medications have a remote risk of causing fetal harm and are prescribed for clients who are pregnant. 2. Category B medications are associated with a slightly higher risk than are category A medications and are often prescribed for clients who are pregnant. These medications should not be taken during the first 3 months of pregnancy. 3. Category C medications pose a greater risk than category B medications and are cautiously prescribed for clients who are pregnant. Research on medications in this category has not been done or may show risk in animal studies. 4. Category D medications have a proven risk of fetal harm and are not prescribed for clients who are pregnant unless the mother's life is in danger. Category X medications have a definite risk of fetal abnormality or abortion.

95. The client who is pregnant asks the nurse, "What does category A mean if the doctor orders that medication for me?" Which statement best describes the scientific rationale for the nurse's response? 1. Category A is the safest medication a client can take when pregnant. 2. Category A medications are safe as long as the client does not take them during the first trimester. 3. Research has not determined if these medications are harmful to the fetus or not. 4. This category is dangerous to the fetus but could be prescribed in emergencies.

96. 1. This action would break the nurse-client relationship. The nurse should encourage the client to tell his parents. 2. The nurse should not be concerned with where the medications are being obtained. The nurse should strongly discourage use of anabolic steroids because of the long-term effects, including psychological changes. 3. These are side effects of glucocortic - osteroids, not of anabolic steroids. 4. Anabolic steroids have serious side effects including low sperm counts and impotence in men, along with permanent liver damage and aggressive behavior. The use of anabolic steroids to improve athletic performance is illegal and strongly discouraged by HCPs and athletic associations.

96. The 17-year-old male athlete admits to the nurse he has been taking anabolic steroids to increase his muscle strength. Which action should the nurse implement? 1. Inform the client's parents about the illegal use of anabolic steroids. 2. Ask the client where he has been obtaining these anabolic steroids. 3. Assess the client for moon face, buffalo hump, and weight gain. 4. Explain that long-term effects of steroids may cause him to never father a baby.

97. 1. Questions about allergies to iodine or shellfish would be appropriate for a client undergoing a test with contrast dye. 2. The nurse should realize that a client taking cyclosporine has had some type of organ transplant because it is a major immune suppressant drug. 3. Cyclosporine would not be an expected medication for a client diagnosed with pneumonia or chronic kidney disease unless the client has had a kidney transplant; therefore, asking this question is appropriate. 4. Because the client has functioning kidneys there is no need to take the Amphojel, which is a phosphate binder.

97. The client with chronic kidney disease is admitted to the medical floor for pneumonia. The admission orders include Zithromax, cyclosporine, and Mylanta. Which question should the nurse ask the client? 1. "Are you allergic to iodine or any type of shellfish?" 2. "When is the last time you had your dialysis treatment?" 3. "Have you had any type of organ transplant?" 4. "Why don't you take Amphojel instead of Mylanta?"

98. 1. The RhoGAM prevents the formation of antibodies to the fetus's Rh-positive blood in the mother, but this cannot be done first because the client is a Jehovah's Witness. 2. The mother must sign a permit when taking this medication, but this is not the nurse's first intervention because the client is a Jehovah's Witness. 3. The nurse can confirm the newborn's blood type, but this is not the first intervention because the client is a Jehovah's Witness. 4. The RhoGAM is derived from blood products; therefore, the nurse must explain this to the client whose faith prohibits the administration of blood or blood products.

98. The woman who is Rh-negative and a Jehovah's Witness delivers a baby who is Rh positive. The HCP prescribed RhoGAM for the mother. Which intervention should the nurse implement first? 1. Administer the RhoGAM to the client within 72 hours. 2. Obtain a signed permit for administering this medication. 3. Confirm the infant's blood type with the laboratory. 4. Explain to the client that RhoGAM is a blood product.

99. 1. ACE inhibitors would not be questioned in clients with kidney transplants or taking cyclosporine. 2. Bactrim reduces cyclosporine levels, which can lead to organ rejection; therefore, the nurse should question administering this medication. 3. Tylenol is not contraindicated in clients with kidney transplants; it is contraindicated in clients with liver disorders. 4. Compazine is not contraindicated in clients with kidney transplants; it is contraindicated in clients with a liver disorder. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable of accepted standards of practice for disease processes and conditions. If the nurse administers a medication the health-care provider has prescribed and it harms the client, the nurse could be held accountable. Remember that the nurse is a client advocate.

99. The nurse is administering medication to a client who has had a kidney transplant and is taking cyclosporine, an antirejection medication. Which medication should the nurse question administering? 1. The ACE inhibitor captopril (Capoten). 2. The antibiotic trimethoprim-sulfamethoxazole (Bactrim DS). 3. The analgesic acetaminophen (Tylenol). 4. The antiemetic prochlorperazine (Compazine).