HESI Pharmacology Practice Exam

The nurse receives a call from a client concerned about eliminating brown-colored urine after taking nitrofurantoin for a urinary tract infection. The nurse should make which appropriate response?

"Continue taking the medication; the brown urine occurs and is not harmful." Rationale: Nitrofurantoin imparts a harmless brown color to the urine, and the medication should not be discontinued until the prescribed dose is completed. Magnesium hydroxide will not affect urine color. In addition, antacids should be avoided because they interfere with medication effectiveness.

Which statement by a client warrants further instruction by the nurse about the changing insulin needs of a diabetic client during pregnancy? "Episodes of hypoglycemia are more likely to occur during the first 3 months." "I will increase my insulin dosage by 5 units each month during the first trimester." "Insulin dosage will likely need to be increased during the second and third trimesters." "Breastfeeding will decrease my insulin needs to lower than my prepregnancy levels."

"I will increase my insulin dosage by 5 units each month during the first trimester."

The nurse provides instructions regarding the administration of liquid oral cyclosporine solution to a client. Which statement, if made by the client, would indicate the need for further teaching?

"I will purchase a dropper from the pharmacy to calibrate the amount of medication that I need."

The nurse is providing teaching for a client prescribed ciprofloxacin for a urinary tract infection. Which statement made by the client indicates that there is a need for further teaching?

"If I develop any tendon pain while taking ciprofloxacin, exercise should help to decrease the pain."

Epoetin alfa is prescribed for a client diagnosed with chronic kidney disease. The client asks the nurse about the purpose of the medication. Which response by the nurse is most appropriate?

"It is used to treat anemia."

A client with a urinary tract infection (UTI) is given a prescription for levofloxacin. The nurse should provide the client with which information about this medication?

"Pain in the back of the leg should be reported."

Dosage calculations

(DO/DH) x V DO = dose ordered DH = dose on hand V = vehicle of delivery

Lamisil contraindications:

(Terbinafine) Renal & Hepatic impairment Immunosuppression tx for fungal infection

Vasopressin

(antidiuretic hormone) hormone released by posterior pituitary; raises blood pressure and enables kidneys to conserve water

Vasopressin report/outcomes

-Antidiuretic -Treats neurogenic diabetes insipidus -Will cause water retention -Monitor electrolytes and signs of fluid overdose --Weight gain, confusion, drowsiness, headache

Antibiotic adverse reactions

-Hypersensitivity - Organ Toxicity - Superinfection - antibiotic causes another infection - Antibiotic overuse

Ferrous sulfate liquid procedure

-Liquid ferrous sulfate may cause staining of the mouth/teeth -Works better if taken on empty stomach -If using antacids, take at a different time -Mix liquid with water or juice and drink from a straw for less stains on teeth

Myasthenia gravis anticholinesterase

-Myasthenia Gravis (MG) is an autoimmune disease that affects the neuromuscular system affecting mostly muscles of eyes, face, chewing and swallowing. -Mestinon: An anticholinesterase that is commonly used to treat MG. --Should instruct patients to take this drug 30 mins BEFORE meals on an empty stomach to help improve chewing and swallowing.

Inhaler instructions

-Rinse mouth after using -Metered dose inhaler Exhale completely -- begin inspiration -- activate MDI -- slow, deep breath -Exhaling completely through pursed lips allows room for maximum inspiratory volume. A slow, deep inspiration (through the mouth) is most efficient in drawing aerosol deep into the lungs. The metered-dose inhaler (MDI) should be activated just after inspiration begins, so that aerosol is drawn into the lungs with the inspiratory airflow over a 3-5 second period. The breath should be held for at least 10 seconds. -A second puff of inhalant medication should be taken a few minutes after the first puff, unless otherwise prescribed.

Oral hypoglycemic classes

-Sulfonyureas -Biguinides -Thiazoldineiones -Januvia

Vancomycin peak and trough when to draw

-Trough levels drawn right before a person's next dose (should be 5-15) --Trough: minimal effective concentration -Peak levels drawn at least an hour after dose (should be 20-40) --Peak = highest therapeutic range

Anticoagulant interactions

-Warfarin/heparin/antiplatelets - many drugs interact with these drugs -many of these drugs cause INCREASED bleeding (increased anticoagulant effect) -Herbal supplements (be cautious) -> can cause a LOT of interactions -Ginkgo, Garlic, Ginseng -> greatly INCREASE risk of bleeding -ST. Johns wort -> INCREASED bleeding NSAIDS and aspirin

Biguinides MOA

-decrease production of glucose by the liver -improves insulin sensitivity -decreases glucose absorbed by the intestine **use cautiously in renal insufficiency

Glucagon Emergency Kit

-elevates blood sugar; used when a diabetic patient becomes hypoglycemic and becomes unconscious -it is a powder that is mixed with the liquid given and then administered as an injection by someone else

Rapid acting insulin

-rapid onset short duration Onset: 15 mins Peak: 30-90 min

Biguinides SE

-weight loss -GI side effects: diarrhea, gas, abdominal distention

Digoxin serum levels

0.5-2.0 ng/mL Asses apical rate 1 minute: hold in adults if HR <60, children <70

What should the nurse include in the instructions to a client who has been prescribed sublingual nitroglycerin for anginal pain? 1. Take one tablet every 15 minutes for 3 doses for pain relief. 2. Dissolve the tablet under the tongue when pain begins. 3. If tablet stings mouth when used, discontinue medication. 4. Do not chew or crush medication and swallow tablet whole.

1

The healthcare provider prescribed a peak level for the second dose and a trough level for the third dose of amikacin. What actions should the nurse do? Draw a trough level prior to the scheduled third dose of medication. Administer the third dose of medication when trough level is verified as therapeutic. Obtain a peak level 30 minutes after the infusion of the second dose of medication. Obtain the peak level immediately after the injection of the second dose of medication. Notify the healthcare provider if the peak level of second dose is higher than the trough level.

1, 2, 3

What actions should the nurse take when administering fluticasone (Flonase) to a client for non-allergic rhinitis? 1. Gently shake the medication container. 2. Clean the tip of the delivery device after use. 3. Prime the medication delivery device if using it for the first time. 4. Instruct the client to blow the nose before administration. 5. Have the client pinch the nostrils and hold breath for one minute after administration.

1, 2, 3, 4

The nurse reviews in the client's medical history the following: congestive heart failure, weight gain of 15 pounds (6.8kg) in the last 72 hours, crackles in lungs bilaterally, shortness of breath at rest, respiration at 24 breaths per minute, O2 saturations 96% on 2 lpm of oxygen (O2), and pedal edema +3. The admitting lab values are Na: 139mEq/L, K: 2.9mEq/L, Cl : 98mEq/L, and Mg: 1.7mEq/L. Which client outcomes indicate that spironolactone is effective? Repiration at 18 breaths per minute. Pedal edema +1. Potassium level of 5.2mEq/L. Weight loss 5 pounds (2.3kg). O2 saturations 96% on 3 lpm O2.

1, 2, 4

The nurse is preparing the discharge instructions for a client prescribed calcium carbonate for heartburn. What should the nurse teach the client to help lessen the risk of constipation while taking this antacid? 1. Increase fluids to at least 2 liters per day, unless contraindicated. 2. Avoid long periods of being sedentary and be mobile throughout the day. 3. Include the consumption of caffeinated and carbonated beverages with meals. 4. Take the prescribed medication with a glass of milk immediately prior to eating. 5. Consume more foods with roughage and bulk such as fresh fruits and vegetables.

1, 2, 5

The nurse is preparing client instructions about the administration of baclofen (Gablofen). Which information should the nurse include about this medication? (select all that apply) 1. Do not discontinue medication abruptly. 2. Avoid drinking grape fruit juice with product. 3. Rise slowly from a sitting or lying down position. 4. Do not drink alcohol or other CNS depressants while taking this medication. 5. Expect full therapeutic response within 48 hours of prescribed therapy.

1, 3, 4

Which nursing actions demonstrate a nurse's competence in administering anticoagulant injections? 1.Administering the medication at the same time each day. 2. Massaging the injection after administration of medication. 3. Aspirating the plunger of the syringe prior to administering 4. Applying gentle pressure to the injection site after administration. 5 Rotating the injection sites in the abdomen between the pelvic bones.

1, 3, 4, 5

The nurse is preparing a teaching session for a client who has been prescribed disulfiram. What topics should be included in the teaching? 1. Carry a medical identification card. 2. Avoid foods containing tyramine. 3. Some mouthwashes may contain alcohol and should not be used. 4. Limit the amount of caffeine and caffeinated products consumed. 5. Double-check labels such as cold medicine for any alcohol content.

1, 3, 5

What actions should the nurse take when applying a fentanyl transdermal patch to a client? 1. Apply the patch to a flat surface on the upper torso. 2. Reapply the new patch to the same site as the previous patch. 3. Remove any fentanyl patches that are still attached to the skin. 4. Apply to clean, moist skin and cover with a bandage. 5. If it is the first patch, obtain a short-acting analgesic prescription.

1, 3, 5

A client is prescribed telavancin (Vibativ) for a methicillin-resistant Staphylococcus aureus (MRSA) skin abscess. Which client outcomes would indicate to the nurse that the prescribed medication is effective? (select all that apply) 1. Client is afebrile for 24 hours. 2. The presence of leukopenia and thrombocytopenia. 3. Decrease of erythema surrounding edges of abscess. 4. Amount of drainage in the wound vacuum container decreasing. 5. A culture and sensitivity wound culture that is resistant to telavancin.

1, 3, and 4.

What should the nurse do when administering cinacalcet to a client diagnosed with hyperparathyroidism? 1. Check the client for signs of hypocalcemia. 2. Do not give if calcium level is greater than 8.3mg/dL. 3. Hold medication if client is experiencing excessive thirst. 4. Ensure a calcium level has been drawn prior to administration. 5. Do not administer if GI upset present to include constipation or diarrhea.

1, 4

Mega vitamin C

1,000 mg or more daily. Can be used for ascorbic acid deficiency. Excess doses can lead to diarrhea and urinary stone formation. Foods high in ascorbic acid include citrus fruits, tomatoes, strawberries, cantaloupe, and raw peppers. Abrupt withdrawal of megadoses of ascorbic acid may cause rebound deficiency. (F.A. Davis Company, 2015)

A client is taking beclomethasone (Beconase AQ) for seasonal allergies. Which factor has an impact on the effectiveness of the medication? 1. The regular use of the medication as prescribed. 2. The concurrent use of an antihistamine with the medication. 3. The seasonal amount of allergens present in the environment. 4. The administration of medication when symptoms are present.

1. The regular use of the medication as prescribed.

A client experiencing an acute ischemic stroke has been prescribed 60mg of alteplase (Activase) intravenously (IV), to be infused over one hour. The medication is available in an IV bag of 60mg/100ml normal saline. How many milliliters of solution will the client have received after the first minute of dosing? 1. 10ml. 2. 0.6ml. 3. 1.66ml. 4. 2.77ml.

1. 10ml. Rationale: The client is to receive 60mg of the prescribed medication in one hour. The medication is available in 60mg/100ml normal saline. Thus there is 0.6mg/ml.60mg/100ml :: X/ml = 0.6mg/ml. A client prescribed this medication for an acute ischemic stroke is to receive 10% of the prescribed dose over the first minute and then the remaining dose over the next 59 minutes. The client should receive 10ml of the medication over the first minute, with the remaining 90ml over the next 59 minutes. 60mg x 10% = 6mg 6mg/x :: 0.6mg/ml = 10ml

The nurse reviews a client's prescribed medication list and notes that the client is taking oral antidiabetic medication to manage type 2 diabetes mellitus. Which client outcome indicates the medication is effective in helping the client therapeutically manage glucose levels for the past two months? 1. A1c is less than 7%. 2. Fasting glucose is less than 110 mg/dl. 3. Client demonstrates weight loss. 4. Urine dipstick is negative for glucose and ketones.

1. A1c is less than 7%. Rationale: The measurement of the A1c reflects the average blood glucose over the past 120 days. An A1c level less than 7% is usually the target indicating good glycemic control.

A client is prescribed Ibandronate (Boniva) for the treatment of osteoporosis. Which is the appropriate administration route for this medication? 1. By mouth once a month. 2. Intramuscular every other month. 3. Intradermal patch changed once a week. 4. Tropically applied to upper inner arm daily.

1. By mouth once a month. Rationale: The acceptable prescribed route for the administration of Boniva is once a month by mouth. Another acceptable route is intravenously every three months.

The nurse is preparing a teaching session for a client who has been prescribed disulfiram. What topics should be included in the teaching? SATA 1. Carry a medical identification card. 2. Avoid foods containing tyramine. 3. Some mouthwashes may contain alcohol and should not be used. 4. Limit the amount of caffeine and caffeinated products consumed. 5. Double-check labels such as cold medicine for any alcohol content.

1. Carry a medical identification card. 3. Some mouthwashes may contain alcohol and should not be used 5. Double-check labels such as cold medicine for any alcohol content.

The nurse is preparing a teaching session for a client who has been prescribed disulfiram. What topics should be included in the teaching? (SATA) 1. Carry a medical identification card. 2. Avoid foods containing tyramine. 3. Some mouthwashes may contain alcohol and should not be used. 4. Limit the amount of caffeine and caffeinated products consumed. 5. Double-check labels such as cold medicine for any alcohol content.

1. Carry a medical identification card. 3. Some mouthwashes may contain alcohol and should not be used. 5. Double-check labels such as cold medicine for any alcohol content. Rationale: Disulfiram is an alcohol deterrent medication. Disulfiram interacts with alcohol. While taking this medication, if the person consumes as little as one-fourth of an ounce (7.5mL) of alcohol side effects include pounding in the chest, hypotension, nausea and vomiting. Products such as mouthwash and cough syrups that contain alcohol would cause the above mentioned symptoms.

What should the nurse do when administering cinacalcet to a client diagnosed with hyperparathyroidism? (SATA) 1. Check the client for signs of hypocalcemia. 2. Do not give if calcium level is greater than 8.3mg/dL. 3. Hold medication if client is experiencing excessive thirst. 4. Ensure a calcium level has been drawn prior to administration. 5. Do not administer if GI upset present to include constipation or diarrhea.

1. Check the client for signs of hypocalcemia. 4. Ensure a calcium level has been drawn prior to administration. Rationale: Cinacalcet is given for the treatment of elevated calcium levels. Signs and symptoms of hypercalcemia include excessive thirst and frequent urination, GI upset to include nausea, vomiting, diarrhea and constipation. The nurse should assess for signs of hypocalcemia such as cramping, seizures, tetany, myalgia and paresthesia. A serum calcium level should be drawn prior to administration and then monthly once a therapeutic dosing level has been established. Ensure the calcium level is at least greater than 8.3mg/dl before initiating therapy.

A client who has just begun treatment with tretinoin (Retin-A; Rejuva-A) asks the nurse how long it would take to see therapeutic results. Which is the correct response reflective of expected outcome of this medication? 1. Clearing of the acne is usually first noticed in 2 to 3 weeks. 2. Psoriasis plaques will begin to diminish within one month. 3. Pruritus from eczema will begin to decrease as soon as applied. 4. Darkened pigmentation will begin to fade in about 48 hours after applying.

1. Clearing of the acne is usually first noticed in 2 to 3 weeks. Rationale: The Retin-A/Rejuva-A is used to treat acne vulgaris. Therapeutic results are usually noted within 2 to 3 weeks from the initiation of therapy, with best results seen within 6 weeks.

A client is prescribed telavancin (Vibativ) for a methicillin-resistant Staphylococcus aureus(MRSA) skin abscess. Which client outcomes would indicate to the nurse that the prescribed medication is effective? (SATA) 1. Client remains afebrile for 24 hours. 2. The presence of leukopenia and thrombocytopenia. 3. Decrease of erythema surrounding edges of abscess. 4. Amount of drainage in the wound vacuum container decreasing. 5. A culture and sensitivity wound culture that is resistant to telavancin.

1. Client remains afebrile for 24 hours. 3. Decrease of erythema surrounding edges of abscess. 4. Amount of drainage in the wound vacuum container decreasing. Rationale: Absence of fever, fatigue, and malaise, as well as a decrease in wound drainage and a decrease of erythema indicate that the antibiotic is effective against the MRSA-infected abscess.

When providing client teaching about the use of antibiotics, which is the most important instruction to decrease drug-resistant bacteria? 1. Complete the entire 10 to 14 days of the medication as prescribed. 2. Take antacids and antidiarrheal medications if GI distress occurs. 3. Once the signs and symptoms subside, discontinue the medication. 4. Avoid the consumption of cultured dairy products such as yogurt.

1. Complete the entire 10 to 14 days of the medication as prescribed. Rationale: It is important to complete the entire prescription of an antibiotic, even if feeling better, to completely kill the bacteria and prevent the development of drug-resistant strains of bacteria.

The nurse is preparing client instructions about the administration of baclofen (Gablofen). Which information should the nurse include about this medication? SATA 1. Do not discontinue medication abruptly. 2. Avoid drinking grape fruit juice with product. 3. Rise slowly from a sitting or lying down position. 4. Do not drink alcohol or other CNS depressants while taking this medication. 5. Expect full therapeutic response within 48 hours of prescribed therapy.

1. Do not discontinue medication abruptly. 3. Rise slowly from a sitting or lying down position. 5. Expect full therapeutic response within 48 hours of prescribed therapy.

A client who is experiencing muscle spasms following a spinal cord injury at the T-5 level has been prescribed baclofen (Gablofen). Which medical condition of the client would the nurse need to monitor closely with the administration of this medication? 1. Epilepsy. 2. Ulcerative colitis. 3. Diabetes mellitus. 4. Addison's disease.

1. Epilepsy. Rationale: Baclofen decreases the seizure threshold for clients with known seizure disorders such as epilepsy. Clients with known seizure disorders need to be monitored closely while taking this medication. The nurse should initiate seizure precautions.

A client began receiving haloperidol (Haldol) medication three weeks ago. The nurse observes that the client is exhibiting dystonia and tardive dyskinesia. Which term would the nurse use to document these symptoms? 1. Extrapyramidal symptoms. 2. Serotonin syndrome. 3. Hypertensive crisis. 4. Allergic reaction.

1. Extrapyramidal symptoms Rationale: Haloperidol, along with other anti-psychotic medications may cause extrapyramidal symptoms characterized by dystonia (involuntary muscle contractions) and tardive dyskinesia (involuntary repetitive body movements). The reduction or discontinuation of neuroleptic medications once these symptoms appear may help reduce these symptoms

Which medication would the nurse anticipate to be prescribed for a client who suffers rhinitis as a result of seasonal allergies? 1. Fluticasone (Flonase). 2. Cyclosporine (Restasis). 3. Ranibizumab (Lucentis). 4. Brimonidine/timolol (Combigan).

1. Fluticasone (Flonase).

The nurse is preparing client instruction for a woman taking clomiphene (Clomid). For how long will the woman be taking clomiphene? SATA 1. For a total of 12 months. 2. Indefinitely every three months. 3. Until a pregnancy occurs. 4. Once a week for one month. 5. Maximum of six menstrual cycles.

1. For a total of 12 months. 3. Until a pregnancy occurs. 5. Maximum of six menstrual cycles. Rationale: Clomid is indicated for the treatment of ovulatory dysfunction in women desiring pregnancy. The medication regime of clomiphene (Clomid) therapy may be repeated until a pregnancy occurs or a maximum of six menstrual cycles due to an increased risk of developing ovarian tumors with prolonged use.

A nurse is preparing to administer buspirone for a client with anxiety. Which food on the client's breakfast tray should the nurse remove because of potential food-drug interactions? 1. Grapefruit juice. 2. Scrambled eggs. 3. Coffee. 4. Fried bacon.

1. Grapefruit juice. Rationale: Clients taking buspirone should not consume grapefruit juice. The grapefruit juice increases the peak levels of buspirone which could lead to drug toxicity.

Bethanechol chloride is prescribed for an adult client with postoperative bladder spasms. Based on the normal adult dose, how should the nurse plan to administer this medication?

10 to 50 mg 3 to 4 times a day

How should the nurse respond when the client asks how tamsulosin (Flomax) will treat his benign prostatic hyperplasia (BPH)? 1. It will help relax the muscles in the prostate and bladder. 2. It will help reduce the inflammation and the size of the prostrate. 3. It will stimulate the adrenal glands to increase testosterone levels. 4. It will decrease volume of urine produce by the glomerular filtration rate.

1. It will help relax the muscles in the prostate and bladder. Rationale: Tamsulosin (Flomax) treats the symptoms of BPH by helping the muscles in the prostrate and bladder to relax, alleviating the symptoms of BPH.

Which assessment finding should the nurse monitor closely during the administration of mannitol? 1. Neurological checks. 2. Daily weights. 3. Temperature. 4. Apical pulse.

1. Neurological checks. Rationale: Mannitol treats increased intracranial pressure. Neurological checks should be closely monitored to help give an indication of the status of the client's intracranial pressure.

The nurse reviews in the client's medical history the following: congestive heart failure, weight gain of 15 pounds (6.8kg) in the last 72 hours, crackles in lungs bilaterally, shortness of breath at rest, respiration at 24 breaths per minute, O2 saturations 96% on 2 lpm of oxygen (O2), and pedal edema +3. The admitting lab values are Na: 139mEq/L, K: 2.9mEq/L, Cl : 98mEq/L, and Mg: 1.7mEq/L. Which client outcomes indicate that spironolactone is effective? SATA 1. Respiration at 18 breaths per minute. 2. Pedal edema +1. 3. Potassium level of 5.2mEq/L. 4. Weight loss 5 pounds (2.3kg). 5. O2 saturations 96% on 3 lpm O2.

1. Respiration at 18 breaths per minute. 2. Pedal edema +1. 4. Weight loss 5 pounds (2.3kg).

Rifabutin (Mycobutin) is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. For which side/adverse effects of the medication should the nurse monitor? Select all that apply. 1. Signs of hepatitis 2. Flulike syndrome 3. Low neutrophil count 4. Vitamin B6 deficiency 5. Ocular pain or blurred vision 6. Tingling and numbness of the fingers

1. Signs of hepatitis 2. Flulike syndrome 3. Low neutrophil count 5. Ocular pain or blurred vision Rationale: Rifabutin (Mycobutin) may be prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis. Side/adverse effects include rash, gastrointestinal disturbances, neutropenia (low neutrophil count), red-orange-colored body secretions, uveitis (blurred vision and eye pain), myositis, arthralgia, hepatitis, chest pain with dyspnea, and flulike syndrome. Vitamin B6 deficiency and numbness and tingling in the extremities are associated with the use of isoniazid. Ethambutol (Myambutol) causes peripheral neuritis.

What information should the nurse include in the client's instructions for the administration of levothyroxine? 1. Take the medication in the morning upon arising. 2. Take with a glass of milk, dairy product or antacids. 3. Take at nighttime, just prior to lying down for the night. 4. Take with breakfast or within 30 minutes of finishing eating.

1. Take the medication in the morning upon arising. Rationale: Levothyroxine is used to treat hypothyroidism. It is best to take levothyroxine first thing in the morning, at the same time each day to avoid interference with sleep and to take on an empty stomach to avoid decreased absorption of the medication.

A 9-year old child with asthma has been receiving beclomethasone. Which assessment findings should the nurse report immediately to the healthcare provider? 1. The presence of oral candidiasis. 2. The loss of the senses of taste and smell. 3. Reports of nausea, fatigue and weakness. 4. Developing psychiatric and behavioral changes.

1. The presence of oral candidiasis.

Which heparin concentration should the nurse use to convert an intravenous site to a heparin lock? 10 units/ml. 100 units/ml. 1000 units/ml. 10,000 units/ml.

100 units/ml.

A client experiencing an acute ischemic stroke has been prescribed 60mg of alteplase (Activase) intravenously (IV), to be infused over one hour. The medication is available in an IV bag of 60mg/100ml normal saline. How many milliliters of solution will the client have received after the first minute of dosing? 10ml. 0.6ml. 1.66ml. 2.77ml.

10ml.

A client is being discharged on multiple cardiac medications including anti-hypertensives, diuretics, anti-arrhythmics, and anti-anginals. Which types of products should the nurse instruct the client to avoid using prior to consulting with their healthcare provider 1. Apple juice. 2. Natural herbs. 3. Caffeinated products. 4. Vitamin B- enriched foods. 5. Over the counter medications.

2, 3, 5

What should the nurse include in the client education for a client who has been prescribed tamsulosin (Flomax)? Discontinue usin tamsulosin once symptoms subside. Take medication half hour after the same meal each day. Change positions slowly when moving from sitting to standing. Ensure the capsule is completely crushed prior to mixing with food. Do not drive or operate machinery for 4 hours if dose is increased.

2, 3, 5

The nurse is preparing the procedure room for a client who is to receive aflibercept (Eylea) administered to both eyes. What should the nurse ensure has been done prior the beginning of the procedure? (select all that apply) 1. A sterile procedure set is available. 2. Two sterile vials of aflibercept are available. 3. Two separate sterile procedure sets are available. 4. An ophthalmic broad-spectrum antinfective has been administered in both eyes. 5. The client has received one prophylactic dose of an antibiotic intravenously.

2, 3, and 4

A client being discharged home is prescribed 5 mg of oral concentration of oxyCodone (OxyFast) 20mg/ml for pain relief every 4 to 6 hours as needed. Which statements by the client indicate to the nurse the client understands the proper administration of this medication? 1. Shake previously prepared solution prior to administration. 2. Add 0.25ml of medication to 15ml of liquid and drink solution immediately. 3. The medication can only be added to a clear liguid when being mixed for administration. 4. A medication mixture of oxyCodone/clear liquid (20mg/90ml) is good for use up to 24 hours.

2. Add 0.25ml of medication to 15ml of liquid and drink solution immediately.

The nurse is caring for a client with paroxysmal supraventricular tachycardia (PSVT) who has a heart rate of 180 to 220 beats per minute. Which medication has most likely been prescribed to assist with a cardioversion for this client? 1. Verapamil. 2. Adenosine. 3. Furosemide. 4. Epinephrine.

2. Adenosine. Rationale: Adenosine is the drug of choice to cardiovert the paroxysmal supraventricular tachycardia (PSVT). Adenosine slows the conduction through the AV node and attempts to restore normal sinus rhythm from the PSVT.

A laboring client received meperidine hydrochloride (Demerol) IV push for severe labor pains. Three hours later the woman delivers her newborn. The neonate is exhibiting signs and symptoms of respiratory depression. Which is the priority nursing action? 1. Administer naloxone (Narcan) based on the infant's weight. 2. Assist the infant's ventilation with 60% oxygen via ambu bag. 3. Place the infant in the "sniff position" and suction the nasopharynx. 4. Stimulate the infant by rubbing the sternum and flicking the sole of the foot.

2. Assist the infant's ventilation with 60% oxygen via ambu bag.

A client has begun therapy with oxtriphylline (Choledyl). The nurse determines that the client understands dietary alterations if the client states to limit which items while taking this medication? Select all that apply. 1. Milk 2. Coffee 3. Oysters 4. Oranges 5. Pineapple 6. Chocolate

2. Coffee 6. Chocolate Rationale: Oxtriphylline is a xanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These include coffee and chocolate. The other food items are acceptable to consume.

Which laboratory value is most useful in regulating the dosing of warfarin (Coumadin)? 1. Partial thromboplastin time (PTT). 2. International normalized ratio (INR). 3. Coagulation factor IX. 4. Tissue thromboplastin.

2. International normalized ratio (INR). Rationale: The nurse should anticipate the healthcare provider to order serum INR labs to help regulate the dosing of warfarin (Coumadin)

The client questions the nurse as to why the health care provider switched the usual prescription from a metered-dose inhaler (MDI) to a dry powder inhaler (DPI). The nurse should respond correctly by providing which fact? Select all that apply. 1. Dry powder inhalers have fewer side effects. 2. Dry power inhalers pose no environmental risks. 3. Dry powder inhalers deliver more medication to the lungs. 4. Dry power inhalers can be administered more frequently. 5. Dry powder inhalers require less hand-to-lung coordination.

2. Dry power inhalers pose no environmental risks. 3. Dry powder inhalers deliver more medication to the lungs. 5. Dry powder inhalers require less hand-to-lung coordination. Rationale: DPIs are used to deliver medications in the form of a dry, micronized powder directly to the lungs. DPIs do not require the hand-to-lung coordination needed with MDIs, thus DPIs are much easier to use. Compared with MDIs, DPIs deliver more medication to the lungs (20% of the total released versus 10%) and less to the oropharynx. Because DPIs do not require propellant, they are not a risk to the environment. Both types of inhalers have side effects. Frequency of use is prescribed by the health care provider.

When is the best time for a nurse to administer radioactive iodine (I131) to a client? 1. Immediately before the client lies down for the night. 2. In the morning after the client has been NPO since midnight. 3. In the morning within one hour after the client has eaten breakfast. 4. Any time of the day as consuming food has no effect on this medication.

2. In the morning after the client has been NPO since midnight. Rationale: The best time to administer radioactive iodine is in the morning after the client has been NPO since midnight. Food in the client's stomach and intestine will delay the action of the medication.

A client had a total knee arthroplasty one day ago. The client is receiving oxycodone with ibuprofen 5mg/400mg every 4 to 6 hours for pain. Which assessment finding requires immediate intervention by the nurse? 1. No bowel movement for 36 hours. 2. Input of 1400ml and output of 400ml. 3. Signs of drowsiness and euphoria. 4. Complaint of a sharp throbbing knee pain.

2. Input of 1400ml and output of 400ml.

The healthcare provider (HCP) prescribes ketoconazole topical (Nizoral) for a client diagnosed with tinea pedis (athlete's foot). Which of the client's allergies prompts the nurse to withhold administering the medication and to contact the HCP? 1. Egg. 2. Latex. 3. Peanut. 4. Sulfite.

4. Sulfite.

The nurse is assessing a client who has developed diarrhea after taking a prescribed antacid for the past two days for heartburn as needed. Which type of antacid may have caused this non-therapeutic outcome? 1. Aluminum based. 2. Magnesium based. 3. Sodium bicarbonate. 4. Calcium bicarbonate.

2. Magnesium based. Rationale: One of the side effects of a magnesium based antacids is diarrhea.

The nurse is assessing the medication history for a six-year-old client diagnosed with rheumatoid arthritis. Which medication would most likely be prescribed for this client? 1. Aspirin. 2. Naproxen. 3. Oxycodone. 4. Acetaminophen.

2. Naproxen. Rationale: Naproxen would be the drug of choice who primary use is relief of mild to moderate pain seen in osteoarthritis, and rheumatoid arthritis. Naproxen decreases prostaglandin synthesis by inhibiting an enzyme needed for biosynthesis. Naproxen does not carry the risk of Reyes syndrome associated with aspirin use in children

What is the proper method for the nurse to warm up refrigerated insulin prior to administration? 1. Place the insulin vial in a cup of warm water for 15 minutes. 2. Roll the insulin vial between both palms to warm it. 3. No need to warm the vial; administer insulin after drawing up. 4. Draw the prescribed dose into insulin syringe; let it sit on counter for 30 minutes.

2. Roll the insulin vial between both palms to warm it.

A client with type 1 diabetes mellitus has been prescribed regular insulin. Based on its pharmacological action, to which group does regular insulin belong? 1. Rapid acting. 2. Short acting. 3. Intermediate acting. 4. Long acting.

2. Short acting. Rationale: Insulin regular is a short-acting insulin with an onset of 30 minutes, peak of 2.5 to 5 hours, and duration of 7 hours. It is often used as a prandial (meal-time) insulin because of its quick action.

During the fourth infusion of vancomycin (Vancocin), a client experiences red flushing of the neck and face and decreased blood pressure. Which action should the nurse take first? 1. Activate the emergency response team. 2. Slow the infusion rate of the medication. 3. Administer epinephrine as per anaphylactic protocol. 4. Stop the infusion and contact the healthcare provider immediately.

2. Slow the infusion rate of the medication. Rationale: Red flushing of the neck and face, accompanied by a decrease in blood pressure can occur with rapid infusion of an antibiotic. The nurse should slow down the infusion rate and request a prescription for an antihistamine.

The nurse administered cyclobenzaprine (Flexeril) to a client approximately one hour ago. Which situation is an expected therapeutic outcome? 1. The client's temperature has decreased and is now afebrile. 2. The client states the pain level has gone from 8 to 3. 3. The client states that heartburn pain and gas have diminished. 4. The client's erythema has subsided and skin is pale pink in color.

2. The client states the pain level has gone from 8 to 3. Rationale: Cyclobenzaprine (Flexeril) is a skeletal muscle relaxant and is adjunct for relief of muscle spasm and pain in musculoskeletal conditions. Its effectiveness is measured by subjective reports of decreasing pain.

The nurse is preparing the procedure room for a client who is to receive aflibercept (Eylea) administered to both eyes. What should the nurse ensure has been done prior the beginning of the procedure? (SATA) 1. A sterile procedure set is available. 2. Two sterile vials of aflibercept are available. 3. Two separate sterile procedure sets are available. 4. An ophthalmic broad-spectrum antinfective has been administered in both eyes. 5. The client has received one prophylactic dose of an antibiotic intravenously.

2. Two sterile vials of aflibercept are available. 3. Two separate sterile procedure sets are available. 4. An ophthalmic broad-spectrum antinfective has been administered in both eyes. Rationale: Aflibercept (Eylea) is an intravitreal-administered medication for the treatment of age-related macular degeneration. A topical broad-spectrum antiinfective should be applied to each eye prior to the procedure. Two separate sterile procedure sets should be used, one for each eye. Each eye should have its own sterile single-use vial of medication to be administered separately.

A nurse is to administer levonorgestrel/ ethinyl estradiol (Preven) to a client who was a victim of sexual assault. What is the latest time period this medication can be administered after sexual intercourse? 1. 24 hours (1 day). 2. 48 hours (2 days). 3. 72 hours (3 days). 4. One week (7 days).

3. 72 hours (3 days). Rationale: Levonorgestrel/ ethinyl estradiol prevents ovulation, interferes with fertilization, and inhibits implantation. This emergency contraceptive should be administered within 72 hours of unprotected sexual intercourse.

While assessing a client's health history, the nurse notes that the client has been prescribed an anti-diarrheal. The nurse should notify the healthcare provider of which health outcome found during the assessment ? 1. Abdominal cramping. 2. Flatulence and bloating. 3. Absence of bowel sounds. 4. Passage of hard, solid stools.

3. Absence of bowel sounds. Rationale: The absence of bowel sounds could be indicative of paralytic ileus, a rare condition associated with anti-diarrheal use. Treatment of a paralytic ileus typically includes placement of a nasogastric tube, close medical management, and possible surgical intervention.

The healthcare provider has prescribed lisinopril 5mg to be added to a client's current medication plan of furosemide 60 mg PO BID to treat the client's heart failure and edema. Which action is most important for the nurse do first related to the client's new prescription for lisinopril? 1. Reconcile the new prescription in the client's electronic medical administration record. 2. Review the client's most recent serum potassium, magnesium, sodium and chloride levels. 3. Check with the healthcare provider about reducing or discontinuing the dose of the diuretic before starting lisinopril. 4. Assess the client's blood pressure every four hours at the beginning of treatment and periodically when administered.

3. Check with the healthcare provider about reducing or discontinuing the dose of the diuretic before starting lisinopril.

Prior to administering an antibiotic to a client, the nurse should ensure which lab procedure is complete? 1. A complete urinalysis. 2. Blood typing and cross match. 3. Culture and sensitivity of specimen. 4. Complete blood count with a differential.

3. Culture and sensitivity of specimen. Rationale: A culture and sensitivity of a specimen should be completed prior to the administration of an antibiotic so the test would be accurate.

The nurse administered sumatriptan (Imitrex) nasally 1 spray in one nostril for a client experiencing a migraine headache. When should the nurse administer another dose of the nasal spray? 1. If the pain persists after the first dose, administer dose again. 2. Medication may only be administered once every 24 hours. 3. If headache returns, repeat dose every two hours, not to exceed 40mg/24 hours. 4. Double the medication dose and administer up to 6 times in 24 hours.

3. If headache returns, repeat dose every two hours, not to exceed 40mg/24 hours. Rationale: The nasal dose of sumatriptan is a single dose in one nostril and may be repeated in two hours if headache returns. The daily dose may not exceed 40mg/24 hour period. Do not repeat in less than 2 hours if pain not relieved after first dose.

The nurse notes that the client is being treated for a heart block with atropine. Which clinical outcome would indicate that this medication is effective? 1. Bilateral pupil constriction. 2. Decreased ectopic heart beats. 3. Increase in heart rate. 4. Presence of the vagal reflex.

3. Increase in heart rate. Rationale: Atropine, an anticholinergic chronotropic agent, is given to treat bradycardia (<40 to 50 beats per minute), bradydysrhythmia, and AV block. An increase in heart rate would be indicative that the medication is effective.

A client diagnosed with active pulmonary tuberculosis has been taking prescribed rifampin and isoniazid for the past two weeks. The client reports feeling tired all the time, loss of appetite and urine having a dark appearance. The nurse notices icterus in the client's sclera and gums. Which lab test should the nurse request the healthcare provider to prescribe? 1. Purified protein derivative skin test. 2. Complete blood cell count with differential. 3. Liver function test to include ALT, AST and bilirubin. 4. Serum folate and vitamin B12.

3. Liver function test to include ALT, AST and bilirubin.

A client is prescribed 250mg of tetracycline every other day for acne. What instruction should the nurse give to the client regarding the best way to take the medication? 1. Take medication before taking an iron product. 2. Take medication with a meal. 3. Take medication on an empty stomach. 4. Take medication with a dairy product.

3. Take medication on an empty stomach. Rationale: Tetracycline should be taken either one hour before a meal or two hours after a meal. It should not be taken within two hours before or after an iron product and one hour after an antacid.

A male client has been prescribed an antibiotic to treat a respiratory infection. The client asks the clinic nurse how long he will be required to take the medication. Which is the best response? 1. For an additional one to two days after your symptoms have subsided. 2. Until you have been afebrile for twenty-four hours. 3. The time period is usually for ten to fourteen days in a row. 4. As soon as you feel better, you can stop taking the medication.

3. The time period is usually for ten to fourteen days in a row. Rationale: Anti-infective are usually prescribed for 10 to 14 days to ensure the infectious organism is completely treated. This is done to prevent a superinfection or a drug-resistant organism

A nurse should encourage a client who is prescribed cyancobalamin (hydroxocobalamin) to increase foods that are enriched with which type of vitamin? 1. Calcium. 2. Potassium. 3. Vitamin B12. 4. Magnesium.

3. Vitamin B12. Rationale: Cyancobalamin (hydroxocobalamin) is vitamin B12 and given to clients with a vitamin B12 deficiency.

A client diagnose with scabies has been prescribed lindane lotion. What is the recommended method of administration of this medicated lotion? (Select of that apply.) 1. Apply to affected areas twice a day for one week. 2. Avoid placing lotion on skin areas when crusts are present. 3. After the application of lotion, cover the affected areas. 4. Leave the lotion on the skin for 8 to 12 hours and then wash off. 5. Apply a thin layer of lotion on the skin from the neck to soles of the feet.

4 & 5

A client diagnose with scabies has been prescribed lindane lotion. What is the recommended method of administration of this medicated lotion? (Select of that apply.) Apply to affected areas twice a day for one week. Avoid placing lotion on skin areas when crusts are present. After the application of lotion, cover the affected areas. Leave the lotion on the skin for 8 to 12 hours and then wash off. Apply a thin layer of lotion on the skin from the neck to soles of the feet.

4, 5

Which intervention should the nurse implement when a client is to receive the first dose of an intramuscular injection of chlorpromazine? 1. Use the Z-track method to administer the medication. 2. Slowly inject the medication over a two minute period. 3. Inject into an area with adequate adipose for maximize absorption. 4. Ensure that the client remains lying down for 30 minutes after the injection.

4. Ensure that the client remains lying down for 30 minutes after the injection. Rationale: Hypotension may occur with the first dose of IM chlorpromazine. The drop in BP typically resolves in about 30 minutes. The nurse should ensure that the client remains lying down in the recumbent position for a minimum of 30 minutes after the first injection.

A client who is diagnosed with epilepsy and dementia has been treated effectively with antiepileptic medication for the past three years. Within the past 72 hours, the client experiences a new onset of seizures. The client's spouse states they have started a new herbal regimen. Which herbal supplement has been known to decrease the effectiveness of antiepileptic medications? 1. Garlic. 2. Ginger. 3. Ginseng. 4. Ginkgo biloba.

4. Ginkgo biloba. Rationale: Ginkgo biloba has been shown to decrease the effects of anticonvulsant medications. This herb is used to improve cerebral functioning and peripheral vascular insufficiency with Alzheimer's disease and other age-related dementia.

The nurse on the oncology unit is reviewing the laboratory results of a client receiving chemotherapy. Based on these findings, what is the nurse's priority action? RBC: 3.8 x 1,000,000/mm3 Platelets: 160 x 1000/mm3 1. Obtain a pulse oximetry reading. 2. Place the client on bleeding precautions. 3. Encourage the client to eat a protein-enriched diet. 4. Move the client into a private room with positive pressure airflow.

4. Move the client into a private room with positive pressure airflow Rationale: An absolute neutrophil count (ANC) lab value of less than 500 g/dL is the most concerning. Low ANC indicates too few neutrophils to fight infection. This client should be placed on protective isolation due to depleted neutrophils and a compromised immune system

The nurse is reviewing the medication calcium acetate (Phoslo) with a client who receives dialysis three times per week. Which statement by the client indicates a need for additional client teaching? 1. My dose of medication is based on my calcium levels. 2. I should try to avoid dark green leafy vegetable such as spinach. 3. My phosphate levels indicate the effectiveness of the medication. 4. I should take this medication one hour before eating my meals or snacks.

4. I should take this medication one hour before eating my meals or snacks. Rationale: For phosphate binding purposes, calcium acetate (Phoslo) should be taken one hour after each meal and snack and again at bedtime.

The nurse is reviewing the prescribed medications for a client admitted for a kidney transplant. Which medication would the nurse anticipate to have been prescribed to the client in preparation for this procedure? 1. Antiplatelet. 2. Thrombolytic. 3. Antineoplastic. 4. Immunosuppressant.

4. Immunosuppressant. Rationale: In order to try to prevent the client's body from building up antibodies to fight against and reject the donated organ, the client is usually placed on immunosuppressant medication before surgery and then for the remainder of their life. The medication inhibits the lymphocytes from forming and attacking the donated organ.

A male client has been taking a histamine H2 antagonist for the treatment of an active duodenal ulcer. The client reports to the nurse that his breasts appear to be getting bigger and he has experienced episodes of being impotent. Which action should the nurse implement? 1. Instruct the client to discontinue the medication immediately. 2. Recommend to the client to place cool compresses to his breasts. 3. Notify the healthcare provider and obtain a prescription for a serum estradiol level. 4. Inform the client that these symptoms are reversible once the medication is discontinued.

4. Inform the client that these symptoms are reversible once the medication is discontinued.

A client was prescribed loperamide 48 hours ago and is still experiencing loose, watery and explosive stools. Which intervention should the nurse perform next? 1. Continue to administer loperamide as prescribed. 2. Ensure the client is drinking fluids and eating solids. 3. Implement measures to help maintain the perineal skin integrity. 4. Notify the healthcare provider of the client's current health status.

4. Notify the healthcare provider of the client's current health status. Rationale: The nurse should notify the healthcare provider that the client continues to have diarrhea after 48 hours of antidiarrheal medication. An anti-diarrheal medication should not be administered for more than 48 hours. If there is a lack of therapeutic response, further investigation is needed.

Nitrofurantoin is prescribed for an adult client to treat acute urinary tract infection (UTI). Based on the normal adult dose, how should the nurse instruct the client to take this medication?

50 mg every 6 hours

A nurse is to administer levonorgestrel/ ethinyl estradiol (Preven) to a client who was a victim of sexual assault. What is the latest time period this medication can be administered after sexual intercourse? 24 hours (1 day). 48 hours (2 days). 72 hours (3 days). One week (7 days).

72 hours (3 days).

While assessing a client's health history, the nurse notes that the client has been prescribed potassium iodine in preparation for a thyroidectomy. Which health outcome would indicate this medication has been effective? The client is more tolerant of the cold. A decrease in the size of the thyroid gland. Consistent weight loss over a two week period. The client has Increased levels of energy and stamina.

A decrease in the size of the thyroid gland

A client asks the nurse to explain the meaning of a narrow therapeutic index of a medication. What information should the nurse use to answer the question? The onset of action for the medication occurs very quickly. A small margin exists between safe and toxic plasma levels. Bioavailability is significantly reduced by the first-pass effect. Minimum dosage is needed for the medication to be effective.

A small margin exists between safe and toxic plasma levels.

Dietary trays usually arrive on the hospital unit at 7:30 AM. When should the practical nurse (PN) plan to administer NPH insulin 40 units subcutaneously to a client with diabetes mellitus? A) 6:30 and 7:00 AM. B) 7:00 and 7:30 AM. C) 7:30 and 8:00 AM. D) 8:00 and 8:30 AM.

A) 6:30 and 7:00 AM. Feedback: NPH, an intermediate-acting insulin, should be given 30 to 60 minutes (A) before the arrival of breakfast trays at 7:30 AM. (B, C, and D) delay the action of NPH.

The nurse is assessing the medication history for a client who is starting treatment for newly diagnosed Hodgkin's disease. Which medication has most likely been prescribed to treat this client's condition? Antiplatelet. Thrombolytic. Antineoplastic. Immunosuppressant.

Antineoplastic.

Which serum laboratory result should the practical nurse (PN) monitor for the effectiveness of lactulose (Cephulac)? A) Ammonia. B) Potassium. C) Uric acid. D) Triglycerides.

A) Ammonia. Feedback: Lactulose reduces blood ammonia (A) levels to improve mental status of a client with hepatic encephalopathy resulting from cirrhosis or other liver problems. Changes in (B, C, and D) do not evaluate the therapeutic response of lactulose.

A client receives a prescription for an oral opioid analgesic for post-operative pain. Which adverse effect should the practical nurse (PN) monitor for with the client? A) Constipation. B) Photosensitivity. C) Decreased heart rate. D) Frequent urination.

A) Constipation. Feedback: Opioid analgesics slow peristalsis, which leads to constipation (A), a common side effect of opiates. (B, C, and D) are not associated with opioid analgesics.

The healthcare provider prescribes an antibiotic for a male adolescent with an upper respiratory tract infection who asks the practical nurse (PN) how long the prescribed antibiotics should be taken. What information should the PN provide? A) Continue the medication until all of the prescription is taken. B) Use the medication for 24 hours after the cough subsides. C) Stop the medication when the temperature returns to normal. D) Take any remaining capsules if the infection occurs again.

A) Continue the medication until all of the prescription is taken. Feedback: Although the client may feel better after 24 hours of antibiotics, the prescription (A) should be taken until all of it is used. If the antibiotic is discontinued because symptoms have disappeared (B and C), pathogens have an opportunity to increase in virulence or become resistant to the drug. Antibiotics should not be saved (D) for other infections, but new symptoms should be evaluated by the healthcare provider.

A client with Attention Deficit Disorder (ADD) is prescribed amphetamine (Adderall). Which side effect should the practical nurse (PN) explain is commonly experienced? A) Difficulty sleeping. B) Increased fatigue. C) Improved appetite. D) Decreased heart rate.

A) Difficulty sleeping. Feedback: Adderall is a central nervous system stimulant, which often causes the client to experience difficulty sleeping (A). Due to central nervous stimulation, Adderall causes an increase in energy, a decrease in appetite, and an increase in heart rate, not (B, C, and D).

A male client diagnosed with tuberculosis asks the practical nurse (PN) about his course of drug therapy. Which information should the PN provide? A) Drug therapy requires compliance for 6 to 12 months. B) Medication is stopped when clinical symptoms subside. C) To prevent reactivation, drug therapy is maintained for life. D) To prevent resistance and side effects, drugs are changed.

A) Drug therapy requires compliance for 6 to 12 months. Feedback: Antitubercular drug therapy is prescribed for 6 to 12 months, which requires continuous compliance to prevent resistance of the tubercle bacillus, to ensure encapsulation, and prevent reactivation. Drug therapy continues until sputum tests are negative for the tubercle bacillus, and the client is no longer infectious to others, not (B). (C) is inaccurate. Although antibiotics used in antitubercular drug protocols may be changed throughout the course of therapy (D), strict compliance for the duration of therapy is vital in preventing reinfection and spread to others.

A client who received succinylcholine (Anectine), a neuromuscular blocking agent, during a surgical procedure returns to the postoperative unit and is complaining of thirst and wants to drink something. What assessment is most important for the practical nurse (PN) to check before giving oral liquids? A) Gag and swallow reflexes. B) Appetite and interest in food. C) Sensation and movement of all limbs. D) Ability to breathe deeply on command.

A) Gag and swallow reflexes. Feedback: Anectine, a neuromuscular blocking agent, paralyzes musculoskeletal muscles and the gag reflex. To reduce the possibility of aspiration, the PN should confirm the return of the client's gag and swallow reflexes (A) before allowing intake of food or liquids. (B, C, and D) should be assessed but do not have the priority of initiating oral intake post-anesthesia.

An older client who takes risperidone (Risperdal), an antipsychotic, is complaining of constipation. Which dietary changes should the practical nurse (PN) recommend? A) Increase daily green vegetables and bran. B) Take a laxative and stool softener daily. C) Eat liver and turnips once a week. D) Use a retention enema every four days.

A) Increase daily green vegetables and bran. Feedback: Constipation, a side effect of antipsychotics, is managed by encouraging the client to drink additional water and increase dietary roughage, such as bran and green vegetables daily (A). (B, C, and D) are not routine recommendations for constipation.

The practical nurse (PN) is unable to arouse a client who is receiving meperidine (Demerol) for postoperative pain. The client is stuporous, has constricted pupils, and a respiratory rate of 8 breaths/minute. Which PRN prescription should the PN give the client? A) Naloxone (Narcan). B) Promethazine (Phenergan). C) Metoclopramide (Reglan). D) Bethanechol (Urecholine).

A) Naloxone (Narcan). Feedback: Narcan (A) is an opioid antagonist and should be administered to reverse the effects of a Demerol, an opioid, overdose. (B, C, and D) are common postoperative PRN prescriptions but are not indicated for narcotic overdose.

A client with gastroesophageal reflux disease (GERD) is having symptoms of reflux despite taking omeprazole (Prilosec) 20 mg daily. What action should the practical nurse (PN) implement? A) Notify the healthcare provider about the symptoms. B) Obtain vital signs every 30 minutes until symptoms are alleviated. C) Instruct the client to stop taking the medication. D) Tell the client to take an antacid in addition to the omeprazole.

A) Notify the healthcare provider about the symptoms. Feedback: Omeprazole, a proton pump inhibitor, acts to reduce gastric acid secretion. If once daily dosing fails to control the client's symptoms, the healthcare provider should be notified (A) for dose adjustment. (B) will not help to reduce the client's symptoms. Unless the client shows symptoms of a hypersensitivity to the medication, the client should not stop the medication (C). (D) should not suggested without a prescription from the healthcare provider.

While assessing a client's health history, the nurse notes that the client has been prescribed vitamin A. Which health outcome would indicate this vitamin administration therapy is effective? Decreased symptoms of bone disease. Absence of hemolytic anemia. Absence of night blindness. Decreased bleeding of gums.

Absence of night blindness.

The practical nurse asks a male client who came to the clinic with an upper respiratory infection if he has any drug allergies. The client cannot remember if he does or if he ever received penicillin. After administering the injection of penicillin, the PN tells the client to stay for 30 minutes of observation. Which finding should the PN identify that is indicative of a reaction to the medication? A) Rash, itching, and hives. B) Fever and abdominal pain. C) Drop in temperature and blood pressure. D) A vasovagal response with bradycardia.

A) Rash, itching, and hives. Feedback: A client who is unsure about the response to a new antibiotic, especially penicillin, should be assessed for allergy to the drug after receiving a parenteral dose. The symptoms that indicate an allergic reaction include rash, itching, hives (A) and anaphylactic reactions causing laryngeal edema with difficulty breathing. (B, C, and D) are not typical of allergic responses to penicillin.

A client who returns from surgery for bowel resection complains of severe pain around the incision. Which assessment is most important for the practical nurse (PN) to obtain prior to the administration of morphine sulfate? A) Rate of respirations. B) Core temperature. C) Appearance of the incision. D) Presence of bowel sounds.

A) Rate of respirations. Feedback: Opioids cause respiratory depression, so the respiratory rate (A) should be assessed prior to administration of morphine sulfate. (B, C, and D) do not address the concept of medication safety.

A male client who is hypertensive is starting a new prescription for clonidine (Catapress) 0.4 mg PO daily. In reviewing common side effects, what information should the practical nurse (PN) provide the client? A) Report problems with sexual function. B) Monitor respirations on a daily basis. C) Increased libido may be experienced. D) Weight gain may indicate fluid retention.

A) Report problems with sexual function. Feedback: Sexual dysfunction (A), such as impotence and decreased libido, is a common complication of antihypertensive medications in male clients. Respiratory changes (B), increased libido (C), and increased weight (D) do not commonly occur with this antihypertensive.

The practical nurse (PN) should recommend that oral contraceptives be avoided in which group of women? A) Women who smoke. B) Multigravidous women. C) Monogamous women. D) Women with an intrauterine device.

A) Women who smoke. Feedback: Oral contraceptives pose an increased risk of thromboembolism for women who smoke (A), and this risk is not increased in (B, C, and D).

The nurse reviews a client's prescribed medication list and notes that the client is taking oral antidiabetic medication to manage type 2 diabetes mellitus. Which client outcome indicates the medication is effective in helping the client therapeutically manage glucose levels for the past two months? Correct A1c is less than 7%. Incorrect Fasting glucose is less than 110 mg/dl. Client demonstrates weight loss. Urine dipstick is negative for glucose and ketones.

A1c is less than 7%.

Ramipril

ACE inhibitor, antihypertensive Adverse: hyperkalemia, can cause cardiac dysrhythmia Avoid potassium

A school-aged child is taking methylphenidate hydrochloride (Ritalin, Biphentin) for the treatment of attention-deficit hyperactivity disorder (ADHD). The mother tells the nurse that she gives the medication at bedtime so it is "working" during school the next morning. What modification to the administration plan should the nurse recommend to this mother? Continue administering the medication dose at bedtime. Give the medication when the child arrives at school. Take the medication with meals. Administer at least six hours before bedtime.

Administer at least six hours before bedtime.

Based on the blood culture and sensitivity results, the healthcare provider prescribes an IV aminoglycoside antibiotic and discontinues the current prescription for another broad spectrum antibiotic. The medication administration record indicates that the client received the broad spectrum antibiotic two hours ago. Which action should the nurse implement? Obtain peak and trough serum levels so the aminoglycoside antibiotic can be initiated. Administer the initial dose of the aminoglycoside antibiotic as soon as possible. Withhold antibiotic administration until the healthcare provider clarifies the prescriptions. Schedule the initial dose of the aminoglycoside antibiotic for the following day.

Administer the initial dose of the aminoglycoside antibiotic as soon as possible.

The nurse is preparing a class about the use of over-the-counter (OTC) medications. Which population of clients does not required special dosing of OTC antitussives and expectorants? Infants. Children. Adult. Geriatric.

Adult.

Dopaminergic side effect

Adverse effects usually result from stimulation of dopamine receptors -Anxiety, nervousness, headache, malaise, fatigue, confusion, mental changes, blurred vision, muscle twitching, ataxia, anorexia, n/v, cardiac arrhythmias, hypotension, palpitations, urinary retention, hot flashes

Antipsychotic foot tap

Akathisia is a side effect of older, first-generation antipsychotic drugs used to treat mental health conditions like bipolar disorder and schizophrenia, but it can also occur with newer antipsychotics as well. Between 20 and 75 percent of people who take these medicines have this side effect, especially in the first few weeks after they start treatment.

Lithium toxicity

Akathisia is a side effect of older, first-generation antipsychotic drugs used to treat mental health conditions like bipolar disorder and schizophrenia, but it can also occur with newer antipsychotics as well. Between 20 and 75 percent of people who take these medicines have this side effect, especially in the first few weeks after they start treatment.

The nurse should instruct a client to avoid which product while taking carisoprodol (Soma) for muscle spasms? Aspirin products. Antacids. Alcoholic beverages. Dairy products.

Alcoholic beverages.

Which drug of choice is indicated for acute ventricular dysrhythmias associated with myocardial infarction? Diltiazem.VT dys Bretylium. Amiodarone. Adenosine.

Amiodarone.

The nurse is assessing the medication history for a client with rheumatoid arthritis who has been prescribed tocilizumab (Actemra). What is the intended action of this medication? An interleukin-6 (IL-6) receptor inhibiting formation of monoclonal antibodies. Inhibition of synaptic responses in the CNS by stimulating GABA receptor subtype. Inhibition of bone reabsorption without inhibiting bone formation and mineralization. Potassium channel blocker inhibitors, increasing the action potential conduction in demyelinated axons.

An interleukin-6 (IL-6) receptor inhibiting formation of monoclonal antibodies.

heparin

Anticoagulant Bleeding precautions

Heparin/bleeding

Anticoagulant Antidote: protamine sulfate Monitor: PTT Bleeding is major adverse reaction Work to prevent new clots

The nurse is assessing the medication history for a client who has been on prolonged bedrest following abdominal surgery. Which medication has most likely been prophylactically prescribed for this client? Thrombolytic. Anticoagulant. Antineoplastic. Immunosuppressant.

Anticoagulant.

Metformin (Glucophage)

Antidiabetic stop 24-48 hours before administration of any IV contrast dye

Octreotide (Sandostatin)

Antigrowth hormone

Doxazosin side effects {845}

Antihypertensive drug and Urinary retention medication It can treat urinary problems caused by an enlarged prostate (benign prostatic hyperplasia). It can also treat high blood pressure when used alone or in combination with other medications. Sudden syncope with first dose, orthostatic hypotension, dizziness, palpitations, fluid retention

Doxazosin side effects

Antihypertensive medication Also treats urinary retention in BPH Side effects: dizzy/vertigo, headache, swelling of feet/ankles/fingers, urinary urgency

The nurse is assessing the medication history of a client. The client has been prescribed a medication which acts in the central nervous system to potentiate the action of inhibitory transmitters such as GABA. Which condition is most likely being treated with such a medication? Anxiety. Psychosis. Cluster headaches. Vertigo.

Anxiety.

A laboring client received meperidine hydrochloride (Demerol) IV push for severe labor pains. Three hours later the woman delivers her newborn. The neonate is exhibiting signs and symptoms of respiratory depression. Which is the priority nursing action? Administer naloxone (Narcan) based on the infant's weight. Assist the infant's ventilation with 60% oxygen via ambu bag. Place the infant in the "sniff position" and suction the nasopharynx. Stimulate the infant by rubbing the sternum and flicking the sole of the foot.

Assist the infant's ventilation with 60% oxygen via ambu bag.

The nurse has a prescription to administer bethanechol chloride subcutaneously. Before giving this medication, the nurse checks to ensure that which condition is not noted in the client's history?

Asthma

The nurse is preparing a subcutaneous dose of bethanechol prescribed for a client with urinary retention. Before giving the dose, the nurse checks to see that which medication is available on the emergency cart for use if needed?

Atropine sulfate

A client with pneumonia receives a prescription for tetracycline (Sumycin). What precaution should the nurse include in this client's teaching? Take the medication with a glass of orange juice. Avoid over-the-counter medications containing alcohol. Avoid diary products for 2 hours after taking the medication. Do not use teeth whitening agents during the treatment regimen.

Avoid diary products for 2 hours after taking the medication.

A client who has Trichomonas vaginalis receives a prescription for metronidazole (Flagyl). Which instruction should the nurse provide during client education? Do not ingest with diary products. Notify the clinic if the urine changes color. Obtain liver function tests every 3 months. Avoid over-the-counter antitussives.

Avoid over-the-counter antitussives.

A client with depression receives a prescription for amitriptyline (Elavil). Which instruction should the nurse include in the client's teaching? Do not ingest foods with tyramine. Avoid the consumption of alcohol. Obtain daily blood pressure readings. Take with a glass of orange juice.

Avoid the consumption of alcohol.

Which International Normalized Ratio (INR) value indicates that warfarin (Coumadin) therapy is at a therapeutic range? A) 1.0 to 2.0 B) 2.1 to 3.0 C) 3.1 to 4.0 D) 4.1 to 5.0

B) 2.1 to 3.0 Feedback: Warfarin dosage for therapeutic anticoagulation is adjusted to target a client's INR range between 2 to 3 (B). (A, C, and D) are outside the narrow therapeutic range.

Which prescription should the practical nurse administer for a client who is experiencing an acute episode of bronchial asthma? A) Nedocromil (Tilade). B) Albuterol (Proventil). C) Zafirlukast (Accolate). D) Triamcinolone (Azmacort).

B) Albuterol (Proventil). Feedback: Albuterol (Proventil) (B), an adrenergic agonist, is the first line of treatment for acute episodes of bronchial asthma. (A, C, and D) are maintenance medications used in the prevention of asthmatic episodes and are routinely taken every day, not during an acute episode.

Which instruction should the practical nurse (PN) reinforce with a client who is taking disulfiram (Antabuse)? A) Cigarette smoking cessation program should be started. B) Avoid using any over-the-counter substances containing alcohol. C) This drug is similar to alcohol but without euphoric effects. D) Small amounts of mouthwash or cough medicine can be used.

B) Avoid using any over-the-counter substances containing alcohol. Feedback: The use of disulfiram (Antabuse) with over-the-counter (OTC) products that contain alcohol causes severe adverse reactions, such as severe nausea, vomiting, chest pain, hyperventilation, tachycardia, seizures, and cardiovascular collapse, and should be avoided (B). Although a smoking cessation program is always a good health recommendation (A), it is not a priority with Antabuse. (C) is inaccurate. Small amounts, as little as 7 ml, of mouthwash or cough syrup that contains alcohol can precipitate a disulfiram reaction and should not be used (D).

The practical nurse (PN) discusses antihypertensive drug therapy with several clients diagnosed with high blood pressure. To improve client understanding, the PN should emphasize that which medication preserves renal function in a client with diabetes? A) Verapamil (Calan). B) Captopril (Capoten). C) Clonidine (Catapres). D) Nifedipine (Procardia).

B) Captopril (Capoten). Feedback: Hypertension contributes to diabetic nephropathy, and angiotensin converting enzyme (ACE) inhibitors, such as captopril (B), slow progression of renal damage for clients with diabetes by reducing blood pressure, contributing to blood sugar control by increasing the body's sensitivity to insulin, and moving glucose from the bloodstream into cells. Verapamil (A), nifedipine (D), and clonidine (C) are used the treatment of hypertension, but do not provide the same effects on blood glucose as captopril does for clients with diabetes.

The practical nurse (PN) is reinforcing teaching for a client who is receiving diltiazem (Cardizem), a calcium channel blocker. Which drug action should the practical nurse explain? A) Increased force of contraction. B) Decreased rate of contraction. C) Decreased peripheral resistance. D) Increased speed of conduction.

B) Decreased rate of contraction. Feedback: Calcium-channel blockers decrease cardiac contractility (inotropy), atrioventricular-node conduction (dromotropy), and heart rate (chronotropy) (B). (A, C, and D) are not pharmacotherapeutic actions for Cardizem.

Which prescription should the practical nurse (PN) administer for a client who is experiencing an anaphylactic reaction to an antibiotic? A) Ephedra (ma-huang). B) Epinephrine (Adrenalin). C) Phenylephrin (Neo-Synephrine). D) Fexofenadine with pseudoephedrine (Allegra D).

B) Epinephrine (Adrenalin). Feedback: Epinephrine (Adrenalin), a potent sympathomimetic, is the drug of choice for the treatment of anaphylaxis (B). (A, C, and D) are not used for an acute immunololgical dysfunction that causes cardiovascular effects.

An older adult client receives a prescription for hydrochlorothiazide (HydroDIURIL), a thiazide diuretic for the treatment of heart failure. Which side effect(s) should the practical nurse reinforce with the client? (Select all that apply.) A) Constipation. B) Fatigue. C) Edema. D) Nausea. E) Dehydration. F) Blurred vision.

B) Fatigue. E) Dehydration. Feedback: Hydrochlorothiazide (HydroDIURIL), a thiazide diuretic, reduces blood pressure by reducing blood volume and reducing arterial resistance. Adverse effects of thiazides include hypokalemia, fatigue (B), dehydration (E), hyperglycemia, and hyperuricemia. Although (A, C, D and F) may be associated with aging or other pathology, they are not side effects commonly associated with HydroDIURIL.

A female client with recurring headaches tells the practical nurse (PN) that she has been taking at least 4 grams of acetaminophen a day. Which laboratory studies should the PN review for this client? A) Creatinine clearance. B) Hepatic enzymes. C) Coagulation values. D) Arterial blood gases.

B) Hepatic enzymes. Feedback: Liver toxicity can occur when doses of acetaminophen exceed 4 grams a day, resulting in an elevation in hepatic enzyme values (B). (A, C, and D) do not reveal findings related to acetaminophen toxicity.

A client who is receiving an antibiotic suddenly develops hives. The practical nurse should report that the client is most likely experiencing which type of drug response? A) Adverse response. B) Hypersensitivity reaction. C) Idiosyncratic reaction. D) Multiple drug interaction.

B) Hypersensitivity reaction. Feedback: Hives, a symptom of a hypersensitivity reaction (B), involve an abnormal immune response and are not uncommon with the use of antibiotics. Although (A, C, and D) are unexpected pharmacologic reactions, hives represent a life-threatening allergic response and should be reported to ensure prompt intervention.

Which client statement indicates to the practical nurse (PN) that a client understands discharge instructions about a new prescription for digoxin (Lanoxin)? A) I should double the dose if one is missed. B) I will take my pulse for one minute every day. C) I should take an antacid to minimize stomach upset. D) I will alternate my dose between morning and afternoon.

B) I will take my pulse for one minute every day. Feedback: The client is conveying understanding of the use of Lanoxin by the statement that daily pulse rates should be taken for a full one minute (B), which provides information about possible drug toxicity. (A, C, and D) are inaccurate.

The practical nurse (PN) is caring for a client who is receiving dexamethasone (Decadron) after abdominal surgery. Which finding should the PN report to the charge nurse? A) Weight loss. B) Impaired healing. C) Bradycardia. D) Hyperkalemia.

B) Impaired healing. Feedback: Glucocorticoids, such as Decadron, are used in the treatment of allergic, inflammatory, and debilitating conditions. A common side of exogenous corticosteroid therapy is hyperglycemia and delayed wound healing (B). (A, C, and D) are side effects not associated with the administration of Decadron.

A client receives a prescription for clotrimazole 1% (Gyne-Lotrimin) vaginal cream for Candidiasis. Which information should the practical nurse provide the client? A) Discontinue medication if menstruation begins. B) Instill cream using the intravaginal applicator each night for 7 days. C) Use daily douching as part of the treatment for vaginal yeast infections. D) Abstain from sexual intercourse until treatment is completed.

B) Instill cream using the intravaginal applicator each night for 7 days. Feedback: The intravaginal cream should be instilled each night for 7 days to complete the medication (B) even if symptoms are relieved. Medication should be continued until it is completed, even during menstruation (A). Douching (C) is contraindicated. Abstinence (D) is not required.

The practical nurse (PN) should emphasize the importance of monitoring for which side effect(s) in a client who takes a daily antilipemic agent? A) Photosensitivity. B) Liver dysfunction. C) Upper respiratory infections (URI). D) Water soluble vitamin deficiencies.

B) Liver dysfunction. Feedback: Antilipemic agents (lipid-regulating agents) are metabolized by the liver and require regular monitoring of liver function studies for hepatic dysfunction (B). Photosensitivity (A), URI (C), and vitamin deficiencies (D) are not side-effects of antilipemics.

A client who is comatose is admitted after an overdose of baclofen (Lioresal). What nursing action should the practical nurse (PN) implement? A) Provide continuous telemetry monitoring. B) Monitor for signs of respiratory arrest. C) Administer prescribed naloxone (Narcan). D) Keep a dose of diazepam at the bedside.

B) Monitor for signs of respiratory arrest. Feedback: An overdose of baclofen (Lioresal), a centrally acting muscle relaxant, can cause coma and respiratory depression that requires respiratory support. Monitoring for early signs of respiratory arrest (B) is most important so immediate respiratory resuscitation can be provided. Although telemetry (A) provides close cardiac monitoring, early recognition of respiratory arrest is indicated due to the actions of Lioresal. Narcan (C) is ineffective for baclofen overdose. (D) is not indicated.

The practical nurse (PN) is caring for a client who has been taking prednisone (Deltasone) daily for a year. Which adverse effect should the PN document in the client's record? A) Photosensitvity. B) Weight gain. C) Loss of hair. D) Pale skin color.

B) Weight gain. Feedback: Long term use of prednisone causes fluid retention and redistribution of fat deposition. Weight gain (B) and moon face reflect adverse effects of long-term prednisone use and should be documented. (A, C, and D) do not occur with treatment using prednisone.

The mother of a newborn asks the nurse why her infant needs the vitamin K (AquaMEPHYTON) injection. What information should the nurse provide? Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract. Oral vitamin K impedes the synthesis of clotting factors in the liver. The maternal diet is often deficient in vitamin K, so the infant is deficient in the vitamin.aquamephyton The synthesis of vitamin K is inadequate for 3 to 4 months in the newborn.

Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract.

Labetalol side effects

Beta blockers can cause weight gain

A culture and sensitivity wound culture that is resistant to telavancin.The nurse is assessing the medication history for a client with migraines. Which pharmacological action is most likely desired in the treatment of migraines? Binding selectively to the vascular 5-HT receptor sites causing cranial vasoconstriction. Similar to inhibiting neurotransmitters, binding to high-voltage gated calcium channels in CNS tissues. Decreasing osmolarity of glomerular filtrate, inhibiting reabsorption of water and electrolytes. Inhibiting synaptic responses in CNS by stimulating receptors and decreasing neurotransmissions.

Binding selectively to the vascular 5-HT receptor sites causing cranial vasoconstriction.

The nurse is assessing the medication history for a client with migraines. Which pharmacological action is most likely desired in the treatment of migraines? Binding selectively to the vascular 5-HT receptor sites causing cranial vasoconstriction. Similar to inhibiting neurotransmitters, binding to high-voltage gated calcium channels in CNS tissues. Decreasing osmolarity of glomerular filtrate, inhibiting reabsorption of water and electrolytes. Inhibiting synaptic responses in CNS by stimulating receptors and decreasing neurotransmissions.

Binding selectively to the vascular 5-HT receptor sites causing cranial vasoconstriction.

Actonel Administration

Bisphosphonate for osteoporosis and pagets Increases bone mass Take with plain water at least 30 min before firs food or drink of day. Do not lie down for 30 minutes

Which herbal supplement is often recommended for women experiencing perimenopausal or menopausal symptoms? Valerian. Black cohosh. Coenzyme Q10. Evening Primrose Oil.

Black cohosh.

Adverse drug reaction report heparin

Bleeding Report signs of bleeding - black/tarry stools Antidote: Protamine Sulfate

Following kidney transplantation, cyclosporine is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication?

Blood urea nitrogen level of 25 mg/dL (8.8 mmol/L) rationale: Cyclosporine is an immunosuppressant. Nephrotoxicity can occur from the use of cyclosporine. Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen and serum creatinine levels. The normal blood urea nitrogen level is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). The normal creatinine level for a male is 0.6 to 1.2 mg/dL (53 to 106 mcmol/L) and for a female is 0.5 to 1.1 mg/dL (44 to 97 mcmol/L). Cyclosporine can lower complete blood cell count levels. A normal hemoglobin is 14 to 18 g/dL (140 to 180 mmol/L) for a male and 12 to 16 g/dL (120 to 160 mmol/L) for a female. A normal hemoglobin is not an adverse effect. Cyclosporine does affect the glucose level. The normal fasting glucose is 70 to 99 mg/dL (3.9-5.5 mmol/L).

A client being admitted to the nursing unit has been taking bethanechol chloride at home. During the admission assessment, the nurse gives special attention to assessing the client for which side and adverse effect of this medication?

Bradycardia

The nurse, who is administering bethanechol chloride, is monitoring for cholinergic overdose associated with the medication. The nurse should check the client for which sign of overdose?

Bradycardia rationale: Cholinergic overdose of bethanechol chloride produces manifestations of excessive muscarinic stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension. Remember that the sympathetic nervous system speeds the heart rate and the cholinergic (parasympathetic) nervous system slows the heart rate. Treatment includes supportive measures and the administration of atropine sulfate (anticholinergic) subcutaneously or intravenously.

Albuterol

Bronchodilator Affects sympathetic nervous system

Maxair

Bronchodilator the prevention and reversal of bronchospasm in patients 12 years of age and older with reversible bronchospasm including asthma.

The nurse is administering a dose of a prescribed diuretic to an assigned client. The nurse should monitor the client for hypokalemia as a side effect of therapy if the client has been receiving which medication?

Bumetanide

A client is prescribed Ibandronate (Boniva) for the treatment of osteoporosis. Which is the appropriate administration route for this medication? By mouth once a month. Intramuscular every other month. Intradermal patch changed once a week. Tropically applied to upper inner arm daily.

By mouth once a month.

Byetta

Byetta works by increasing the secretion of insulin from the pancreas, reducing the action of glucagon (the hormone which raises blood sugar levels) and slowing the absorption of glucose from the gut. Together, these actions lower blood sugar levels and serve to reduce appetite. Watch for hypoglycemia

A client receives a new prescription for beclomethasone (Beclovent Oral Inhaler). What information should the practical nurse (PN) reinforce with the client about the use of this medication? A) Use for rapid results in acute asthmatic attacks. B) Most effective in preventing upper respiratory infections. C) Daily use provides prophylaxis in asthma management. D) Inhale when exposed to allergens in the environment.

C) Daily use provides prophylaxis in asthma management. Feedback: Beclovent Oral Inhaler, an inhaled glucocorticoid, is used for prophylaxis in the management of chronic asthma (C) and should be administered on a fixed schedule, not (D). Inhaled beta 2 agonists, not a glucocorticoid, work rapidly in acute asthma attacks (A) precipitated by environmental allergen exposure (D).

On which therapeutic action should the practical nurse (PN) base an explanation to a client who is receiving a cardiac glycoside? A) Decreased cardiac output. B) Increased renal perfusion. C) Decreased rate of contraction. D) Increased blood volume.

C) Decreased rate of contraction. Feedback: Cardiac glycosides increase the force of cardiac contraction (inotropy) and decrease the heart rate (chronotropy) (C) by decreasing the speed of conduction through the heart (dromotropy). (A, B, and D) are incorrect.

The practical nurse (PN) is administering an enteric-coated form of erythromycin (EES) to a male client with an upper respiratory infection. The client tells the PN that the medication should be taken with his meals. What information should the PN offer the client? A) Taking EES with food anytime is recommended. B) EES should be taken on an empty stomach. C) ESS may be taken without regard to meals. D) The best time to take EES is once daily at night.

C) ESS may be taken without regard to meals. Feedback: The enteric-coated formulation of erythromycin may be taken without regard to meals (C). Because an enteric coating makes the drug less irritating to the gastrointestinal tract, this is likely to enhance compliance with drug therapy without regard to meals. (A, B, and D) are not indicated.

A client who has been taking phenazopyridine (Pyridium) for symptoms of urethritis and cystitis comes to the clinic because her urine is reddish-orange. Which question should the practical nurse ask to determine if the medication has been effective? A) How much water have you been drinking each day? B) Does the urine color stain your toilet bowl or undergarments? C) Have you had any relief from urinary pain, burning, or urgency? D) Did your urine appear cloudy or have a foul odor on voiding?

C) Have you had any relief from urinary pain, burning, or urgency? Feedback: Phenazopyridine, an over-the-counter urinary analgesic, acts on the mucosa of the urinary tract to relieve urinary pain, burning, itching, or urgency (C) associated with urethritis and cystitis. Although determining if the client is forcing fluids (A), experiencing staining from Pyridium's side effect (B), or having signs of a urinary infection (D) are worthwhile assessments, the therapeutic response of Pyridium is related to urinary discomforts only.

Which adverse effect should the practical nurse monitor for in a client who is taking amikacin (Amikin)? A) Irritability. B) Constipation. C) Hearing loss. D) Insomnia.

C) Hearing loss. Feedback: Adverse effects associated with aminoglycoside antibiotics, such as amikacin, are nephrotoxicity and ototoxicity, so the client should be monitored for hearing loss (C). (A, B, and D) are not associated with amikacin.

A client's tissue culture results indicate the wound is infected with methicillin-resistant Staphylococcus aureus (MRSA). What action should the practical nurse (PN) implement first? A) Provide sterile wound care as prescribed. B) Give the first dose of Vancomycin (Vancocin). C) Implement contact isolation precautions. D) Document wound site appearance and drainage.

C) Implement contact isolation precautions. Feedback: The risk of transmitting a hospital acquired infectious disease among clients is high with an organism such as MRSA. Infection prevention and control practices, including contact isolation precautions, should be implemented first (C). (A, B, and D) may be implemented after isolation precautions are in place.

The practical nurse (PN) administers isoproterenol (Isuprel) to a client with heart block. The PN should evaluate the client for which physiological response? A) Thirst and dry mucous membranes. B) Decrease in gastric motility. C) Increased heart rate. D) Bronchoconstriction.

C) Increased heart rate. Feedback: Isoproterenol (Isuprel) acts on beta 1 receptors in the heart, causing an increased cardiac reactivity in AV heart block and an increase in the client's heart rate (C). (A and B) are anticholinergic responses and are not typical with adrenergic agents, such as isoproterenol. By activating beta 2 receptors found in the smooth muscle of bronchioles, isoproterenol causes bronchodilation, not (D).

A client with type 1 diabetes mellitus received an early AM dose of regular insulin per sliding scale. At 10:00 AM, the practical nurse (PN) should report which signs indicative of hypoglycemia? A) Urticaria and rash. B) Nausea and diarrhea. C) Irritability and confusion. D) Fruity, acetone odor to the breath.

C) Irritability and confusion. Feedback: Irritability and confusion (C) are early signs of hypoglycemia. (A, B, and D) are not signs of hypoglycemia.

A client receives a prescription for nystatin (Mycostatin) oral suspension for the treatment of oral thrush. Which information should the practical nurse (PN) provide? A) Take on an empty stomach. B) Mix the suspension with water. C) Swish then swallow the medication. D) Keep in the refrigerator.

C) Swish then swallow the medication. Feedback: The client should swish the suspension in the mouth for as long as possible before swallowing it (C). The method of swish and swallow distributes the medication within the oral cavity to ensure topical coverage of the affected mucosal surfaces. Although (A, B, and D) are medication administration instructions, swish and swallow is the most specific administration information for nystatin.

The practical nurse (PN) should reinforce what time frame with a client about self-administration of lispro insulin (Humalog)? A) Take after a meal is completed. B) Take once daily at the midday meal. C) Take within 15 minutes of beginning a meal. D) Take only before bedtime with an evening snack.

C) Take within 15 minutes of beginning a meal. Feedback: Lispro, a very rapid acting insulin, has on onset of 5 to15 minutes after administration with a duration of 4 to 6 hours, so the client should self-administer this insulin within 15 minutes before a meal (C). (A, B, and D) are inaccurate.

Which information should the practical nurse (PN) provide a client who receives a new prescription for a benzodiazepine medication? A) A list of foods to avoid while taking this prescription. B) Symptoms that indicate increasing the dose of medication. C) The interactions of alcohol consumption and CNS depressant drugs. D) Explanations that support taking a work absence during drug therapy.

C) The interactions of alcohol consumption and CNS depressant drugs. Feedback: The concomitant use of alcohol and benzodiazepines (C), both CNS depressants, causes an increase in sedation, which places the client at risk for injury and should be avoided. (A, B, and D) are not indicated.

An adult male arrives in the clinic requesting a prescription for sildenafil (Viagra). Which client history should the practical nurse (PN) report to the healthcare provider? A) Hypogonadism. B) Fluid retention. C) The use of nitrates. D) Benign prostatic hypertrophy.

C) The use of nitrates. Feedback: Sildenafil can lower blood pressure by causing vasodilation. A client who takes a nitrate (C), a vasodilator, for a pre-existing cardiovascular disease can experience significant hypotension if Viagra is taken concomittently with nitrates, such as nitroglycerin, which should be reported to the healthcare provider. (A, B, and D) are not contraindications for the use of Viagra.

What assessment is most important for the practical nurse (PN) to obtain prior to initiating medication therapy with phenelzine (Nardil) for a client with depression? A) Activity level. B) Mood and affect. C) Understanding of diet modification. D) The client's support system.

C) Understanding of diet modification. Feedback: To prevent a potentially lethal hypertensive crisis, a tyramine-free diet should be maintained during antidepressant therapy with Nardil, a monoamine oxidase inhibitor (MAOI). It is most important to determine if the client understands diet modification (C) before Nardil is initiated to prevent consumption of foods that interact with Nardil. Although a client's activity level (A) and mood and affect (B) should be monitored during antidepressant therapy, it is most important that the client understand diet modifications. The client's support system (D) and network of family and friends is important, but the client should understand the responsibility of dietary compliance with the medication regimen.

PhosLo

Calcium Acetate Lower Phosphate Levels in Blood Tablet is a calcium supplement used to control the level of phosphate in the blood for patients on dialysis due to severe kidney disease.

A male client with meningitis is prescribed cefotaxime (Claforan) IV and asks the nurse why he cannot receive an oral drug, such as cefaclor (Ceclor) or cefadroxil (Duricef),that he has taken before for infections. How should the nurse respond when considering the actions of cephalosporins? Cefazolin (Ancef) is another IV antibiotic that can be prescribed. Cefaclor (Ceclor) is a good alternative to suggest to the healthcare provider. Cefadroxil (Duricef) is usually prescribed when the IV is discontinued. Cefotaxime (Claforan) provides therapeutic CNS concentrations.

Cefotaxime (Claforan) provides therapeutic CNS concentrations.

Cephalosporins/penicillin allergy

Cephalosporins are antibiotics Cross sensitivity to penicillin

Laboratory analysis of a urine sample for culture and sensitivity reveals a bacterial infection, and the client is diagnosed with cystitis. Nitrofurantoin is prescribed for the client. Which is the priority nursing assessment before administering this medication?

Checking lung sounds

The nurse should expect the healthcare provider to prescribed what treatment regimen for a client with peptic ulcer caused by Helicobacter pylori ? (Select all that apply.) Select all that apply Clarithromycin (Biaxin). Sulfisoxazole (Gantrisin). Misoprostol (Cytotec). Omeprazole (Prilosec). Metronidazole (Flagyl). Sucralfate (Carafate).

Clarithromycin (Biaxin). Omeprazole (Prilosec). Metronidazole (Flagyl).

A client who has just begun treatment with tretinoin (Retin-A; Rejuva-A) asks the nurse how long it would take to see therapeutic results. Which is the correct response reflective of expected outcome of this medication? Clearing of the acne is usually first noticed in 2 to 3 weeks. Psoriasis plaques will begin to diminish within one month. Pruritus from eczema will begin to decrease as soon as applied. Darkened pigmentation will begin to fade in about 48 hours after applying.

Clearing of the acne is usually first noticed in 2 to 3 weeks.

A client is prescribed atenolol for chronic stable angina pectoris. Which health outcome would indicate to the nurse that atenolol is effective? Client demonstrates an improvement in activity tolerance. Client's heart rate is between 80 to 100 beats per minute. Client is able to void without any hesitancy or urgency. Client's 12-lead ECG demonstrates a normal sinus rhythm.

Client demonstrates an improvement in activity tolerance.

Which factor is a contraindication to the administration of mecasermin or somatropin? Closed epiphyses. Children less than 4 years old. A documented allergy to pork. Treatment that exceeds 5 years.

Closed epiphyses.

The nurse should withhold which medication if a client reports nausea, vomiting, and diarrhea? Colchicine (Colchicine). Erythromycin (E-Mycin). Naproxen (Aleve, Naprosyn). Labetolol (Normodyne).

Colchicine (Colchicine).

multitaq with digoxin interaction

Combining these medications may significantly increase the blood levels and effects of digoxin. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications.

When providing client teaching about the use of antibiotics, which is the most important instruction to decrease drug-resistant bacteria? Complete the entire 10 to 14 days of the medication as prescribed. Take antacids and antidiarrheal medications if GI distress occurs. Once the signs and symptoms subside, discontinue the medication. Avoid the consumption of cultured dairy products such as yogurt.

Complete the entire 10 to 14 days of the medication as prescribed.

A client taking cefaclor (Ceclor) for otitis media reports loose, semi-liquid stool that does not smell foul or appear to have pus or blood present. What should the nurse recommend to the client? Eat a diet consisting of bananas, rice, apple sauce, and toast. Immediately discontinue the medication and return to the clinic. Consume some yogurt or buttermilk at least three times a day. Take an over the counter antidiarrheal medication such loperamide (Imodium).

Consume some yogurt or buttermilk at least three times a day.

he nurse is reviewing medication education with a client who was prescribed triamcinolone (Dermasorb) for the treatment of eczema. Which statement by the client indicates the client misunderstands safe administration? Apply to affected areas, avoiding contact with the eyes. Continue to apply medication for a few days after area has cleared. Cover weeping or denuded areas with an occlusive dressing after medication application. Affected areas treated with the medication can burn easily with sunlight exposure.

Cover weeping or denuded areas with an occlusive dressing after medication application.

A client is taking cyclosporine for renal allograft rejection prevention. After 9 months of drug therapy, the nurse reviews laboratory data and notes that the blood urea nitrogen level is 36 mg/dl. What additional finding should the nurse identify? Hypotension. White blood cell count 10,000. Creatinine 28 mg/dl. Anaphylactic reaction.

Creatinine 28 mg/dl.

A client who is transferred to the cardiac rehabilitation unit after a myocardial infarction is ready for discharge with a new prescription for metoprolol (Lopressor). The client asks, I don't have high blood pressure, so why did my healthcare provider give me this medicine? What information should the practical nurse (PN) provide? A) Anticoagulation is the most important action of metoprolol. B) Beta-blockers are routinely prescribed after heart damage. C) Heart failure is prevented as a complication while healing. D) A slower heart rate reduces the heart's oxygen demand.

D) A slower heart rate reduces the heart's oxygen demand. Feedback: Lopressor, a beta-blocker, slows the heart rate and is prescribed after a myocardial infarction to reduce the heart's work load and oxygen demand (D). (A, B, and D) are incorrect.

What laboratory results should the practical nurse monitor to evaluate the therapeutic effects of heparin? A) Platelet count. B) Hematocrit. C) Prothrombin time (PT). D) Activated partial thromboplastin time (APTT).

D) Activated partial thromboplastin time (APTT). Feedback: Ongoing APTT (D) values measure the prolongation times of thromboplastin in the clotting cascade, which is monitored during heparin therapy. (A, B, and C) do not indicate the therapeutic action of heparin.

Which information should the practical nurse (PN) reinforce with a client who is self-administering insulin injections? A) Shake the vial of insulin to mix the contents before administration. B) Store opened vials of insulin in a refrigerator no more than 30 days. C) Use a different syringe to prepare and inject each type of insulin. D) Aspirate regular insulin in the syringe first when mixing insulins.

D) Aspirate regular insulin in the syringe first when mixing insulins. Feedback: When administering two types of insulin, the regular insulin should be prepared first (D) to prevent the contamination of the regular insulin vial with long-acting insulins. Gently rolling the vial of insulin between the palms of the hands is recommended, not (A). Opened vials of insulin can be stored at room temperature for 30 days after being opened, and refrigeration (B) is not necessary. Different syringes (C) are not needed when administering two types of insulin.

A client with schizophrenia has been taking clozapine (Clozaril) for several months. The practical nurse (PN) monitors the client for extrapyramidal symptoms (EPS). Which reason supports the PN's assessment? A) Prolonged use of antidepressant medications reduce skeletal muscle tone. B) The excess amount of norepinephrine causes an increase in blood pressure. C) The increased availability of serotonin affects mood and behavior. D) Atypical antipsychotics can deplete the brain's supply of dopamine.

D) Atypical antipsychotics can deplete the brain's supply of dopamine. Feedback: The use of an atypical antipsychotic, such as clozapine, should include an assessment of musculoskeletal functioning for signs and symptoms of any EPS reaction that can occur from a lack of the brain neurotransmitter dopamine (D). (A, B, and C) do not explain the cause of EPS.

The practical nurse (PN) observes a thick white coating on the tongue of a client who takes fluphenazine (Prolixin). What instructions should the PN reinforce with the client about this medication? A) No treatment is needed as the coating should subside in a couple of weeks. B) Attempt to stop smoking if the white coating on your tongue persists. C) If you are taking any inhalants, wash the mouthpiece after each use. D) Brush your teeth and tongue, floss, gargle, and notify the healthcare provider.

D) Brush your teeth and tongue, floss, gargle, and notify the healthcare provider. Feedback: Fluphenazine (Prolixin), an antipsychotic with anticholinergic effects, causes dry mouth, which contributes to a thick white coating on the tongue that alters the normal flora in the mouth. Regular brushing of the tongue and teeth is a good preventive measure, and the healthcare provider should be notified (D) because treatment may be indicated if an oral infection develops. (A) is inaccurate. (B and C) do not convey the importance of calling the healthcare provider.

A client with chest pain is diagnosed with angina pectoris. On discharge the client receives a prescription for sublingual nitroglycerin tablets PRN. Which instruction should the practical nurse (PN) reinforce with this client? A) Take up to five doses at 15 minute intervals for an anginal attack. B) Chew the tablet for maximal effect because does not dissolve quickly. C) Seek immediate hospitalization after the first dose is taken for chest pain. D) Change positions slowly after taking a dose to reduce the chance of falling.

D) Change positions slowly after taking a dose to reduce the chance of falling. Feedback: Sublingual nitroglycerin may cause hypotension, so the client should be instructed to change positions slowly to avoid injury falling or fainting after taking a dose (D). (A, B, and C) are inaccurate.

The healthcare provider prescribes cycloplegic and mydriatic ophthalmic drops for a client who is having a cataract removal. What explanation about the drug actions should the practical nurse (PN) provide the client? A) Reduces intraocular pressure. B) Relieves eye pain. C) Treats conjunctivitis. D) Dilates the pupil.

D) Dilates the pupil. Feedback: Cycloplegic drugs cause ciliary paralysis, and mydriatics dilate the pupil (D), which facilitates access into the anterior chamber for removal of the lens in cataract surgery. (A, B, and C) are incorrect actions.

A client is receiving the third course of 5-fluorouracil (5FU) therapy for a tumor of the liver. Which action should the practical nurse implement to reduce the client's risk for stomatitis? A) Use commercial oral products to reduce the risk of oral infections. B) Observe for black, tarry stools or bleeding ulcerations. C) Increase intake of foods containing fiber and citric acid. D) Examine mouth daily for bleeding, white spots, and ulcerations.

D) Examine mouth daily for bleeding, white spots, and ulcerations. Feedback: 5-fluorouracil (5FU) is an antimetabolite, antineoplastic agent that causes sloughing of the rapid proliferating epithelial cells of the oral mucosa causing ulceration, bleeding, and oral candidiasis (thrush). Daily examination of the oral mucosa (D) should be implemented to identify signs of stomatitis, such as white spots, ulcerations, and bleeding of the mouth, so early intervention can be implemented. Oral commercial products usually contain alcohol, which contributes to inflammation of the oral mucosa, and should be avoided (A). Although monitoring the stool for bleeding (B) should be implemented, stomatitis occurs in 75% of clients who receive 5FU. Foods high in fiber and citric acid should also be avoided (C) to reduce pain and trauma to the mouth.

What side effect should the practical nurse (PN) report to the healthcare provider for a client who is taking prednisone (Deltasone)? A) Dehydration. B) Hypoglycemia. C) Thickened skin. D) Gastric bleeding.

D) Gastric bleeding. Feedback: Prednisone, a glucocorticoid, decreases the viscosity of gastric mucus, which normally protects the lining of the stomach from irritants, which increases the risk of gastric erosion by hydrochloric acid, resulting in gastric bleeding (D). Other adverse effects include sodium and fluid retention, hyperglycemia, and skin fragility, not (A, B, and C).

What side effect should the practical nurse (PN) report to the healthcare provider for a client who is taking prednisone (Deltasone)? A) Dehydration. Feedback: INCORRECT B) Hypoglycemia. Feedback: INCORRECT C) Thickened skin. Feedback: INCORRECT D) Gastric bleeding. Feedback: CORRECT

D) Gastric bleeding. Feedback: Prednisone, a glucocorticoid, decreases the viscosity of gastric mucus, which normally protects the lining of the stomach from irritants, which increases the risk of gastric erosion by hydrochloric acid, resulting in gastric bleeding (D). Other adverse effects include sodium and fluid retention, hyperglycemia, and skin fragility, not (A, B, and C).

A male client tells the practical nurse (PN) that he takes acetylsalicylic acid (aspirin) 325 mg daily. Which finding should alert the PN that the client may be experiencing a side effect of salicylate therapy? A) Skin tears. B) Hypothermia. C) Hepatotoxicity. D) Gastrointestinal distress.

D) Gastrointestinal distress. Feedback: Salicylates, such as aspirin, commonly irritate the gastric mucosa, causing gastrointestinal distress (D). (A, B, and C) are inaccurate.

The practical nurse (PN) is reviewing the discharge plan for a client with mania who is receiving lithium carbonate (Eskalith). To achieve a stable serum level, which information should the PN reinforce with the client? A) How to inject this drug. B) When to increase the dosage. C) When to stop using this drug. D) How to recognize symptoms of toxicity.

D) How to recognize symptoms of toxicity. Feedback: Lithium carbonate has a very narrow therapeutic serum range, so the client should understand the signs and symptoms of toxicity (D). (A) is not available. (B) increases the client's risk for toxicity. (C) will precipitate recurrence of mania.

A client with Parkinson's disease has been taking antiparkinsonian medications for three months. Which client finding should the practical nurse (PN) identify as a therapeutic response? A) Decreased appetite. B) Gradual development of cogwheel rigidity. C) Occurrence of confusion. D) Improved ability to perform activities.

D) Improved ability to perform activities. Feedback: Therapeutic responses to antiparkinsonian agents include an improved sense of well-being and improved ability to think clearly and perform activities (D). An increase in appetite, not (A), and less-intense parkinsonism manifestations are expected, not (B or C).

The healthcare provider prescribes celecoxib (Celebrex), a nonsteroidal antiinflammatory drug (NSAID), for a client with osteoarthritis. Which finding in the client's history should the practical nurse (PN) report? A) Gout. B) Hypertension. C) Diabetes mellitus. D) Peptic-ulcer disease.

D) Peptic-ulcer disease. Feedback: Celecoxib (Celebrex), an NSAID, causes gastrointestinal irritation and bleeding. Peptic-ulcer disease is a contraindication to therapy with NSAIDs (D). (A, B, and C) are inaccurate.

Which action should the practical nurse implement when administering a buccal medication? A) Encourage the client to swallow. B) Administer water with medication. C) Ensure the medication is positioned under the tongue. D) Place the medication between the upper molar teeth and cheek.

D) Place the medication between the upper molar teeth and cheek. Feedback: Buccal medications are placed between the upper molar teeth and the cheek (D) for absorption by the capillaries of the oral mucosa. The client should be cautioned against swallowing, not (A). Buccal medications are not administered with water (B). (C) describes sublingual administration.

A client with tuberculosis (TB) asks the practical nurse (PN) the value of prescribed multidrug therapy. What explanation should the PN provide? A) Required to eradicate TB. B) Enhances the effect of each drug. C) Provides a faster effect than single drug therapy. D) Reduces development of TB resistant drugs.

D) Reduces development of TB resistant drugs. Feedback: The use of multiple medications reduces the possibility of the tubercle bacilli becoming drug resistant (D). (A, B, and C) are incorrect.

A male client who has been receiving an antineoplastic drug has developed thrombocytopenia. What instructions should the practical nurse (PN) reinforce? A) Use suppository form of drugs. B) Avoid large public gatherings. C) Rise slowly when standing up. D) Shave with an electric razor.

D) Shave with an electric razor. Feedback: Thrombocytopenia is a common side effect of bone marrow depression caused by several antineoplastic agents. The client is experiencing a low platelet count and should use an electric razor (D) to reduce his risk of bleeding. (A, B, and C) are not indicated for a client who needs to implement thrombocytopenia precautions.

The practical nurse (PN) is reinforcing information to a client about the use of an antiemetic to help manage nausea and vomiting during a course of chemotherapy. Which information is most important for the PN to provide? A) Eat small amounts of food, such as crackers, to soothe the stomach lining. B) Drink any palatable liquid as tolerated when nauseated. C) Ensure safety by taking at bedtime if drowsiness occurs. D) Take at least 30 minutes before a chemotherapeutic agent is received.

D) Take at least 30 minutes before a chemotherapeutic agent is received. Feedback: Antiemetics should be given before any chemotherapeutic agent is administered, often 30 minutes to 3 hours before treatment (D). Although (A, B, and C) are useful tips, if tolerated, they do not ensure the maximum therapeutic response.

A client with a long history of alcoholism was admitted for detoxification and rehabilitation. The client reports drinking alcohol 2 hours ago. Which medication should the nurse anticipate will be prescribed for this client? Diazepam (Valium). Donepezil (Aricept). Haloperidol (Haldol). Amitriptyline (Elavil).

Diazepam (Valium).

Diclofenac and anemia

Diclofenac: NSAID Diclofenac has potential to cause anemia as a side effect

A 35-week gestation primigravida who takes lithium (Eskalith) tells the practical nurse (PN) that she would like to breastfeed her infant. What information should the PN provide to the client? A) The medication does not cross the placental barrier. B) Mood swings will occur if lithium is discontinued. C) Breast milk should be discarded after each oral dose of lithium. D) The drug is excreted in breast milk so use formula to feed the infant.

D) The drug is excreted in breast milk so use formula to feed the infant. Feedback: Lithium crosses the placental barrier and is excreted in the breast milk, so the client should formula feed her newborn. (A and C) are inaccurate information. Although (B) may occur, the option of the mother discontinuing the prescribed lithium should not be suggested.

The practical nurse (PN) is assessing a client who takes olanzapine (Zyprexa), an antipsychotic. Which side effect should the PN most likely note in this client? A) Insomnia and irritability. B) Hand tremors and tearing. C) Nausea and frontal headache. D) Weight gain and constipation.

D) Weight gain and constipation. Feedback: Olanzapine (Zyprexa), an atypical antipsychotic, causes orthostatic hypotension, weight gain, and anticholinergic effects, such as constipation (D). Common anticholinergic side effects include dry mouth, blurred vision, nasal stuffiness, weight gain, difficulty urinating, decreased sweating, increased sensitivity to sunlight, and constipation (D). (A, B, and C) are not expected side effects of this medication.

A client is prescribed donepezil for Alzheimer's disease. When is the best time for the nurse to administer the medication to the client? Daily in the evening, prior to bedtime. First thing in the morning, upon arising. Anytime of the day, on an empty stomach. To be given with the morning breakfast meal.

Daily in the evening, prior to bedtime.

A client is admitted for atrial fibrillation, and the healthcare provider prescribes disopyramide (Norpace). After explaining the action of this antidysrhythmic agent, which complaint should the nurse instruct the client to report? Joint pain. Dizziness or muscle weakness. Daily weight gain of 2 pounds. Dry mouth.

Daily weight gain of 2 pounds.

A client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client should be questioned about the use of which medication?

Decongestants

While assessing a client's health history, the nurse notes that the client has been prescribed mannitol. Which health outcome would indicate this medication is effective? Decrease in the severity and frequency of seizures. Decrease in the increased intracranial pressure. Increase in the blood pressure and tissue perfusion. Increase in the client's oxygen saturation and capillary refill.

Decrease in the increased intracranial pressure.

The nurse is reviewing a client's prescribed medication list and notes that the client is taking vitamin K. Which client outcome would indicate the medication is effective? Increased prothrombin time. Decreased clotting time. Increased night vision. Decreased dry skin.

Decreased clotting time.

A client is prescribed dutasteride. Which outcome indicates that the medication is effective?

Decreased obstruction to outflow of urine through the urethra

While assessing a client's health history, the nurse notes that the client has been prescribed ketoconazole topical (Nizoral) shampoo. Which health outcome would indicate this medication is effective? Decreased pruritus and dandruff. Decreased bacterial reproduction. Decreased number of lentigines. Decreased sebaceous gland production.

Decreased pruritus and dandruff.

What pathophysiological action supports the expected outcome for a client with chronic cancer pain who is treated with imipramine (Tofranil), a tricyclic antidepressant? Increases pain threshold by stimulating opiate receptors in the CNS to release of endogenous enkephalins. Decreases perception of pain by blocking opiate receptors in the brain and descending inhibitory nerves. Decreases transmission of pain impulses by altering serotonin and norepinephrine activity at nerve synapses. Increases pain tolerance through relief of depression by increasing the amounts of norepinephrine in the brain.

Decreases transmission of pain impulses by altering serotonin and norepinephrine activity at nerve synapses.

The nurse is assessing the medication history for a client and notes that a medication has been prescribed which improves cognitive functioning by increasing acetylcholine and inhibiting cholinesterase. Which condition is most likely being treated? Anxiety. Neurosis. Dementia. Depression.

Dementia.

What action should the nurse implement to provide analgesic titration for a client in pain ? Teach the client to increase the time range between doses of pain medication. Monitor the effects of continuous intravenous infusion of narcotic analgesics. Plan with the client how to use a specific total dose of analgesic over a 24-hour period. Determine the optimal analgesic dosage required that causes the least side effects.

Determine the optimal analgesic dosage required that causes the least side effects.

LASIK complications

Diuretics increase the body's excretion of some electrolytes — including sodium, chloride and potassium — through the urine. Low levels of these can cause extreme fatigue and muscle weakness, as well as achy joints, bones and muscles.

A pediatric client who has been diagnosed with partial seizures receives a prescription for topiramate (Topamax). What information should the nurse provide to the child's parents? Do not crush the tablet prior to administration. Give the medication with 8 oz of orange juice. Avoid prolonged exposure to direct sunlight. Administer the tablet an hour before meals.

Do not crush the tablet prior to administration.

Steroids discontinue protocol

Do not stop taking abruptly, must wean down Patient at risk for hypoadrenal crisis (shock and circulatory collapse) if stopped abruptly

The nurse is providing discharge instructions to a client receiving trimethoprim-sulfamethoxazole. Which instruction should be included in the list?

Drink 8 to 10 glasses of water per day. rationale: Each dose of trimethoprim-sulfamethoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake to avoid crystalluria. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Clients should be advised to use sunscreen since the skin becomes sensitive to the sun. Some forms of trimethoprim-sulfamethoxazole cause urine to turn dark brown or red. This does not indicate the need to notify the PHCP.

A client receives a prescription for sulfamethoxazole-trimethoprim (Septra) for a urinary tract infection (UTI). What instruction should the nurse provide the client? Ingest food prior to taking the antibiotic. Drink at least 8 glasses of water a day. Take the medication with grapefruit juice. Avoid prolonged exposure to sunlight.

Drink at least 8 glasses of water a day.

The nurse is taking care of a client receiving oxybutynin. Which finding should the nurse expect to note if the client develops side or adverse effects of this medication?

Dry mouth

Long Acting insulin

Duration: 24 hours onset: 1 hour no peak do not mix with other insulins

A blind client has been prescribed tasimelteon (Hetlioz) 20 mg once a day. When is the best time for the nurse to instruct the client to take the medication? Upon rising from sleep. Before eating breakfast. After eating the evening meal. Each night before sleep.

Each night before sleep.

Miotic drug therapy for the treatment of glaucoma is based chiefly upon which physiologic action? Enhancing aqueous humor outflow. Inhibiting aqueous humor production. Maintaining intraocular pressure. Preventing extraocular infection.

Enhancing aqueous humor outflow.

low molecular weight heparins

Enoxaparin (lovenox), dalteparin -Given sub-Q -Less risk for bleeding than regular heparin -Monitor platelets, H&H (don't need to monitor PTT and INR) --If low H&H or BP drop of 20 points - hold and notify HCP -Normal to have mild pain, bruising, irritation, redness at site

Which intervention should the nurse implement when a client is to receive the first dose of an intramuscular injection of chlorpromazine? Use the Z-track method to administer the medication. Slowly inject the medication over a two minute period. Inject into an area with adequate adipose for maximize absorption. Ensure that the client remains lying down for 30 minutes after the injection.

Ensure that the client remains lying down for 30 minutes after the injection.

A newly admitted client has been prescribed cardiac, pulmonary and antacid medications. What is important for the nurse to plan in regards to the medication administration times for this client? Group the cardiac medications into morning and evening administration times. Ensure the antacids administration times are 1 to 2 hours separated from other medications. Discuss with the client what their scheduled medication times at home were prior to be being admitted. Set up the pulmonary medication administration times to be centered on the client's prescribed vital signs.

Ensure the antacids administration times are 1 to 2 hours separated from other medications.

A client who is experiencing muscle spasms following a spinal cord injury at the T-5 level has been prescribed baclofen (Gablofen). Which medical condition of the client would the nurse need to monitor closely with the administration of this medication? Epilepsy. Ulcerative colitis. Diabetes mellitus. Addison's disease.

Epilepsy.

A 48-year-old client is experiencing a severe anaphylactic reaction to an injection of contrast media. What pharmacologic agent is of greatest use in this situation? Dopamine (Intropin). Loratadine (Claritin). Nitroprusside (Nipride). Epinephrine (Adrenalin).

Epinephrine (Adrenalin).

The healthcare provider prescribes a medication for an older adult client who is complaining of insomnia, and instructs the client to return in two weeks. The nurse should question which prescription? Zolpidem (Ambien) 10 milligrams orally at bedtime. Eszopiclone (Lunesta) 10 milligrams orally at bedtime. Temazepam (Restoril) 7.5 milligrams orally at bedtime. Ramelteon (Rozerem) 8 milligrams orally at bedtime.

Eszopiclone (Lunesta) 10 milligrams orally at bedtime.

A client began receiving haloperidol (Haldol) medication three weeks ago. The nurse observes that the client is exhibiting dystonia and tardive dyskinesia. Which term would the nurse use to document these symptoms? Extrapyramidal symptoms. Serotonin syndrome. Hypertensive crisis. Allergic reaction.

Extrapyramidal symptoms.

The therapeutic effect of insulin in treating Type 1 diabetes mellitus is based on which physiologic action? Facilitates transport of glucose into the cells. Stimulates function of beta cells in the pancreas. Increases intracellular receptor site sensitivity. Delays carbohydrate digestion and absorption.

Facilitates transport of glucose into the cells.

The nurse is reviewing the laboratory results for a client receiving tacrolimus. Which laboratory result would indicate to the nurse that the client is experiencing an adverse effect of the medication?

Fasting blood glucose of 200 mg/dL (11.1 mmol/L) rationale: A fasting blood glucose level of 200 mg/dL (11.1 mmol/L) is significantly elevated above the normal range of 70 to 99 mg/dL (3.9-5.5 mmol/L) and suggests an adverse effect. Recall that fasting blood glucose levels are sometimes based on primary health care provider preference. Other adverse effects include neurotoxicity evidenced by headache, tremor, and insomnia; gastrointestinal effects such as diarrhea, nausea, and vomiting; hypertension; and hyperkalemia. The remaining options identify normal reference levels. The normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). The normal platelet count is 150,000 to 400,000 mm3 (5 to 10 × 109/L).

Fentanyl transdermal action

Fentanyl patch used for chronic, persistent pain Does not provide immediate relief Always remove old patch and clean that area Apply new patch on dry skin (may have to shave hair)

The nurse is assessing the medication history for a hospice client with metastatic liver cancer. Which medication has most likely been prescribed for this client? Fentanyl. Propofol. Lidocaine. Oxycodone.

Fentanyl.

Ciprofloxacin (Cipro)

Fluoroquinolone tendon rupture especially with corticosteroids

Which medication would the nurse anticipate to be prescribed for a client who suffers rhinitis as a result of seasonal allergies? Fluticasone (Flonase). Cyclosporine (Restasis). Ranibizumab (Lucentis). Brimonidine/timolol (Combigan).

Fluticasone (Flonase).

Rivastigmine side effect

GI bleeding, changes in mood/personality

Digoxin toxicity s/s

GI effects - anorexia, nausea, vomiting, abdominal pain; CNS effects - fatigue, weakness, diplopia, blurred vision, yellow-green or white halos around objects

Ibuprofen/antacids/GI distress

Gastric motility changes/PPIs/Antacids can affect medication absorption of other meds (meds are meant to be absorbed in acid) -Ibuprofen is often administered with an antacid because of its gastric-irritant effects -given cytotec

A client who is diagnosed with epilepsy and dementia has been treated effectively with antiepileptic medication for the past three years. Within the past 72 hours, the client experiences a new onset of seizures. The client's spouse states they have started a new herbal regimen. Which herbal supplement has been known to decrease the effectiveness of antiepileptic medications? Garlic. Ginger. Ginseng. Ginkgo biloba.

Ginkgo biloba.

A client has been prescribed Vincristine for the treatment of acute lymphoblastic leukemia. The prescribed dose is 1.25mg intravenously (IV) once a week. The medication is available in 1mg/10mL normal saline. How should the nurse prepare to administer this medication? Give 12.5 mL directly through IV over one minute. Infuse medication over 30 minutes via a syringe pump. Dilute into a 50mL bag of normal saline and infuse 120mL/hour. Add to 1000mL bag of D5W and infuse at 100mL/hour.

Give 12.5 mL directly through IV over one minute.

Rifampin

Give on empty stomach (anti-tuberculosis) remember Rifampin causes red urine uses barrier contraceptive hepatoxicity

Propantheline bromide is prescribed for a client with bladder spasms. Which disorder, if noted in the client's record, should alert the nurse to question the prescription for this medication?

Glaucoma

The nurse is providing dietary instructions to a client who has been prescribed cyclosporine. Which food item should the nurse instruct the client to exclude from the diet?

Grapefruit juice rationale: A compound present in grapefruit juice inhibits metabolism of cyclosporine through the cytochrome P450 system. As a result, consumption of grapefruit juice can raise cyclosporine levels by 50% to 100%, thereby greatly increasing the risk of toxicity. Red meats, orange juice, and green, leafy vegetables do not interact with the cytochrome P450 system. *Recall that grapefruit juice is contraindicated with many medications.

A nurse is preparing to administer buspirone for a client with anxiety. Which food on the client's breakfast tray should the nurse remove because of potential food-drug interactions? Grapefruit juice. Scrambled eggs. Coffee. Fried bacon.

Grapefruit juice.

Heparin-induced thrombocytopenia (HIT)

Happens if platelets decrease by half in 24 hours after heparin (any type) Very deadly Alert HCP

side effects of orlistat

Headache, dizziness, otitis, flatus w/ discharge, fecal urgency, fatty or oily stool, tooth and gingival disorders, menstrual irregularity, cholelithiasis

A client who is receiving chemotherapy is prescribed ondansetron (Zofran). What side effect should the nurse include in the teaching plan? Headache. Dry mouth. Impaired taste. Blurred vision.

Headache.

A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication?

Hematocrit of 33% (0.33)

A client receives a prescription for esomeprazole (Nexium) for heartburn. Which finding in the client's history should the nurse report to the healthcare provider before administering the prescription? Eats spicy food three times a week. History of deep vein thrombosis. Drinks 2 alcoholic beverages on weekends. Family history of diabetes mellitus.

History of deep vein thrombosis.

An adolescent female client is prescribed isotretinoin (Accutane) for a severe case of recalcitrant cystic acne. Which lab should the nurse ensure is performed prior to beginning treatment? Liver function tests (LFT). Two hour glucose tolerance test (GTT). Human chorionic gonadotropin (HCG). Whole blood count with differential (WBC).

Human chorionic gonadotropin (HCG).

Insulin Regular

Humulin R, Novolin R Onset: 30 Peak: 2-3 hours

Hypercalcemia signs and symptoms

Hypercalcemia: signs and symptoms - muscular weakness - ataxia: lack of muscle coordination - constipation, abdominal pain/distension - confusion, depression - absent tendon reflexes - arrhythmias

The nurse is reviewing the medication calcium acetate (Phoslo) with a client who receives dialysis three times per week. Which statement by the client indicates a need for additional client teaching? My dose of medication is based on my calcium levels. I should try to avoid dark green leafy vegetable such as spinach. My phosphate levels indicate the effectiveness of the medication. I should take this medication one hour before eating my meals or snacks.

I should take this medication one hour before eating my meals or snacks.

An older client is taking warfarin sodium (Coumadin) PO 2.5 mg twice a day. Which laboratory value should the nurse identify as a therapeutic response of the medication? INR of 2 to 3. PT of 4 seconds. PTT of 20 seconds. aPTT of 3 times normal.

INR of 2 to 3.

Naloxone repeat dose

IV dose peaks in 15 minutes, and onset is only 2-3 minutes, so repeat doses will be given if needed

The nurse is assessing the medication history for a client with osteoporosis. Which medication has most likely been prescribed for this client? Sumatriptan (Imitrex). Ibandronate (Boniva). Baclofen (Gablofen). Diazepam (Diastat).

Ibandronate (Boniva).

The nurse administered sumatriptan (Imitrex) nasally 1 spray in one nostril for a client experiencing a migraine headache. When should the nurse administer another dose of the nasal spray? If the pain persists after the first dose, administer dose again. Medication may only be administered once every 24 hours. If headache returns, repeat dose every two hours, not to exceed 40mg/24 hours. Double the medication dose and administer up to 6 times in 24 hours.

If headache returns, repeat dose every two hours, not to exceed 40mg/24 hours.

Adderall dosage timing

If taken for long periods of time risk for dependence occurs; tolerance develops (need higher doses of drug to get same effects) Made up of amphetamine and dextroamphetamine Take more than 4 hours before bedtime

If taken with meals, it will help decrease the risk for gastrointestinal (GI) upset.

If taken with meals, it will help decrease the risk for gastrointestinal (GI) upset.

The ambulatory care nurse is providing instructions to a client with a urinary tract infection (UTI) being started on nitrofurantoin. The nurse should provide the client with which information?

If taken with meals, it will help decrease the risk for gastrointestinal (GI) upset.

The nurse is reviewing the prescriptions of a newly admitted client. One of the client's prescriptions is a daily multivitamin. When is the best time of day to administer the client's multivitamin? One hour before eating breakfast. Prior to going to sleep for the night. Two hours after the consumption of food. Immediately after eating breakfast.

Immediately after eating breakfast.

The nurse is reviewing the prescribed medications for a client admitted for a kidney transplant. Which medication would the nurse anticipate to have been prescribed to the client in preparation for this procedure? Antiplatelet. Thrombolytic. Antineoplastic. Immunosuppressant.

Immunosuppressant.

The nurse is reviewing a client's prescribed medication list and notes that the client is using rivastigmine transdermal patches to treat Alzheimer's disease. Which client outcome would indicate the medication is effective? Increase in hours of sleep. Improved mood and cognition. Cessation in brain plaque formation. Decrease craving for nicotine products.

Improved mood and cognition.

When is the best time for a nurse to administer radioactive iodine (I131) to a client? Immediately before the client lies down for the night. In the morning after the client has been NPO since midnight. In the morning within one hour after the client has eaten breakfast. Any time of the day as consuming food has no effect on this medication

In the morning after the client has been NPO since midnight.

The nurse is reviewing a client's prescribed medication list and notes that the client is taking Ibandronate (Boniva). Which of the following is an anticipated therapeutic outcome? Increase in bone mass and absence of fractures. Ability to move more easily with less pain and resistance. Decrease in spasticity of muscles and increased range of motion. Correction of calcium, magnesium and phosphate imbalances.

Increase in bone mass and absence of fractures.

The nurse notes that the client is being treated for a heart block with atropine. Which clinical outcome would indicate that this medication is effective? Bilateral pupil constriction. Decreased ectopic heart beats. Increase in heart rate. Presence of the vagal reflex.

Increase in heart rate.

A client receiving dialysis therapy is prescribed cinacalcet (Sensipar) for secondary hyperparathyroidism. The healthcare provider has prescribed that the medication be titrated starting with 30mg/day and advancing to 180mg/day. The nurse is preparing client education. Which titration schedule should the nurse anticipate for cinacalcet? Triple the dosing every two weeks in sequential increments of 30mg/day, 90mg/day and 270mg/day. Increase the dose every two weeks in sequential increments of 30mg/day, 60mg/day, 90mg/day, 120mg/day, and 180mg/day. Double the dosing every other month in sequential increments of 30mg/day, 60mg/day, 120mg/day, until maximum dose is reached. Add 30mg to the dose every week in sequential increments of 30mg/day, 60mg/day, 90mg/day, 120mg/day, 150mg/day, 180mg/day.

Increase the dose every two weeks in sequential increments of 30mg/day, 60mg/day, 90mg/day, 120mg/day, and 180mg/day.

RenaGel CKD

Indicated for the control of serum phosphorus in patients with chronic kidney disease (CKD) who are on dialysis

A male client has been taking a histamine H2 antagonist for the treatment of an active duodenal ulcer. The client reports to the nurse that his breasts appear to be getting bigger and he has experienced episodes of being impotent. Which action should the nurse implement? Instruct the client to discontinue the medication immediately. Recommend to the client to place cool compresses to his breasts. Notify the healthcare provider and obtain a prescription for a serum estradiol level. Inform the client that these symptoms are reversible once the medication is discontinued.

Inform the client that these symptoms are reversible once the medication is discontinued.

A client with a urinary tract infection is receiving ciprofloxacin by the intravenous (IV) route. The nurse appropriately administers the medication by performing which action?

Infusing slowly over 60 minutes rationale: Ciprofloxacin is prescribed for treatment of mild, moderate, severe, and complicated infections of the urinary tract, lower respiratory tract, and skin and skin structure. A single dose is administered slowly over 60 minutes to minimize discomfort and vein irritation. Ciprofloxacin is not light-sensitive, may be infused through a peripheral IV access, and is not given by IV push method.

What is the effect of beta-blocking agents when used for treatment of glaucoma? Inhibiting aqueous humor production. Enhancing aqueous humor outflow. Increasing intraocular pressure. Preventing extraocular infection.

Inhibiting aqueous humor production.

The nurse is assessing the medication history for a client with active pulmonary tuberculosis. Which pharmacological action is expected from an antitubercular medication? Liquefaction and reduction of thick, tenacious pulmonary secretions. Suppression of the cough reflex by direct action on the cough center. Inhibition of the RNA or DNA synthesis decreasing replication of the bacilli. Blockage of phosphodiesterase and increase of cAMP, easing respiratory effort.

Inhibition of the RNA or DNA synthesis decreasing replication of the bacilli.

A client had a total knee arthroplasty one day ago. The client is receiving oxycodone with ibuprofen 5mg/400mg every 4 to 6 hours for pain. Which assessment finding requires immediate intervention by the nurse? No bowel movement for 36 hours. Input of 1400ml and output of 400ml. Signs of drowsiness and euphoria. Complaint of a sharp throbbing knee pain.

Input of 1400ml and output of 400ml.

Trental (pentoxifylline)

Intermittent claudication (burning pain in leg that comes and goes)

Which laboratory value is most useful in regulating the dosing of warfarin (Coumadin)? Partial thromboplastin time (PTT). International normalized ratio (INR). Coagulation factor IX. Tissue thromboplastin.

International normalized ratio (INR).

A client wants a contraceptive that has the longest coverage to prevent a pregnancy and does not require her to do anything, once it has been administered. Which type of contraceptive will best meet this client's needs? Implant. Vaginal ring. Transdermal. Intrauterine device.

Intrauterine device.

Restless leg syndrome vitamins and herbs

Iron, B12, Vitamin C, Vitamin E

When assessing a client prior to the administration of digoxin (Lanoxin, APO-Digoxin), which data is most important for the nurse to consider? Presence of a grade 2 murmur. Nailbed capillary refill of 5 seconds. Irregular apical pulse with a rate of 87. Bilateral lower extremity dependent rubor.

Irregular apical pulse with a rate of 87.

Spironolactone teaching

Keep fluid intake up (diuretic) Warn patient to avoid excess ingestion of potassium-rich foods and ACE inhibitors to avoid hyperkalemia

Long acting insulin drugs

Lantus: glargine Levemir: detemir

Pneumonia acetylcysteine

Liquefy secretions - help thin and loosen mucus in the airways and clear from the lungs in patients with pneumonia

Furosemide action

Loop diuretic Potassium wasting (can cause hypokalemia) Ototoxic Can cause up to 20 lbs of weight loss per day

A client with rheumatoid arthritis is receiving a prescription for minocycline (Minocin). Which side effect is most important for the nurse to instruct the client to report? Loss of balance and dizziness. Nausea and vomiting. Headache and mouth sores. Abdominal pain and diarrhea.

Loss of balance and dizziness.

When prescribed for a client with hepatic encephalopathy, what is the therapeutic action of lactulose (Portalac)? Lowers the pH of the colon. Softens the stool. Increases glucose absorption. Stimulates peristalsis.

Lowers the pH of the colon.

The nurse is assessing a client who has developed diarrhea after taking a prescribed antacid for the past two days for heartburn as needed. Which type of antacid may have caused this non-therapeutic outcome? Aluminum based. Magnesium based. Sodium bicarbonate. Calcium bicarbonate.

Magnesium based.

RA meds action

Medications used for rheumatoid arthritis: NSAIDs, corticosteroids, and disease modifying anti-rheumatic drugs (DMARDs). No cure for RA so meds are utilized to decrease symptoms and slow progression DMARDs: methotrexate, leflunomide, hydroxychloroquine, and sulfasalazine These suppress the body's immune and inflammatory reactions to slow progression of RA

Metformin interaction

Metformin: anti-diabetic drug Will interact with contrast dye Hold medication 48 hours prior to receiving contrast dye to reduce chance of lactic acidosis

A 38-year-old gravida 2 para 2 is diagnosed with bacterial vaginosis 9-months postpartum. A prescription is written for metronidazole (Flagyl). Which information is most important for the nurse to obtain from the client before initiating treatment? Sexual history. Use of oral contraceptives. Method of infant feeding. Possibility of pregnancy.

Method of infant feeding.

A client with chronic kidney disease (CKD) who is receiving an antihypertensive medication is experiencing frequent hypotensive episodes. The nurse reviews the client's medication record, knowing that which medication would have the greatest tendency to cause hypotension?

Methyldopa

Nursing Action: Lantus and Novolog

Monitor for hypokalemia (<3.5mg/dL)

Which side effects should the nurse monitor for a client who is receiving dexamethasone (Decadron) following neurosurgery? (Select all that apply.) Select all that apply Mood swings. Decreased appetite. Increased weight gain. Serum glucose level of 65 mg/dl. Delayed incisional wound healing. Serum hemoglobin level of 9 mg/dl.

Mood swings. Increased weight gain. Delayed incisional wound healing. Serum hemoglobin level of 9 mg/dl.

Acetylcysteine (Mucomyst)

Mucolytic Treats pneumonia Don't use in asthma clients

Acetylcysteine

Mucolytic Liquefy secretions - help thin and loosen mucus in the airways ANTIDOTE FOR ACETAMINOPHEN TOXICITY

Muscarinic drug action

Muscarinic receptors are activated by acetylcholine and increase the activity of the parasympathetic nervous system (rest and digest)

ACTH (adrenocorticotropic hormone) tapering

Must taper drug so adrenal glands can kick in. They are suppressed by exogenous drugs.

Ciprofloxacin is prescribed for a client with a Pseudomonas aeruginosa infection of the urinary tract. The health care provider (HCP) should be questioned by the nurse about the prescription if which underlying condition is noted in the client's record?

Myasthenia gravis

Intermediate acting insulin drug

NPH: Humulin N

Naloxone

Narcan (naloxone) is an opioid antagonist used for the complete or partial reversal of opioid overdose, including respiratory depression - Used for treatment of OD

Which assessment finding should the nurse monitor closely during the administration of mannitol? Neurological checks. Daily weights. Temperature. Apical pulse.

Neurological checks.

NTG patch

Nitroglycerine Rotate sites wear gloves clean/hairless area do not rub into skin can be worn in shower Don't take with viagra (sildenafil)

The nurse administers the initial dose of a fentanyl (Duragesic) transdermal patch to a client with chronic pain. When monitoring the client an hour later, which assessment is most important for the nurse to obtain? Level of consciousness. Moistness of mucosa. Bowel sound activity. Numeric pain scale.

Numeric pain scale.

A client with Paget's disease is started on calcitonin (Calcimar) 500 mcg subcutaneously daily. During the initial treatment, what is the priority nursing action? Assess the injection site for inflammation. Evaluate the client's level of pain. Monitor the client's alkaline phosphatase levels. Observe the client for signs of hypersensitivity.

Observe the client for signs of hypersensitivity.

Peak Lantus (long acting insulin)

Onset: 1-1.5 hours Peak: no peak Duration: 20-24 hours

Which route should the nurse clarify with the healthcare provider prior to administering a drug with a high first-pass effect? Oral. Buccal. Sublingual. Intravenous.

Oral.

Trimethoprim-sulfamethoxazole is prescribed to be administered by intravenous infusion to a client with a recurrent urinary tract infection. How should the nurse administer this medication?

Over 60 to 90 minutes

A client is receiving oxybutynin. The nurse should suspect that this medication is prescribed to relieve which condition?

Overactive bladder

A client who has had a prostatectomy is complaining of pain from bladder spasms. The nurse checks the health care provider's prescription sheet and expects to see which medication prescribed to treat the problem?

Oxybutynin

Premarin adverse effects

PREMARIN is a type of treatment called hormone replacement therapy (HRT) and contains the hormone estrogen in the form known as conjugated estrogens. GI upset vaginal spotting/bleeding gallbladder disease thromboembolism breast/uterine cancer

An older client admitted for bronchitis has been prescribed diphenhydramine for a non-productive cough. While reviewing the client's electronic medical record, the nurse notes that the client has demonstrated a decrease in urine output. Which intervention should the nurse do first? Palpate the client's bladder. Auscultate the client's lungs. Assist the client with ambulation. Encourage the client to drink more fluids.

Palpate the client's bladder.

Pilocarpine ophthalmic evaluate

Pilocarpine: medication used to reduce pressure inside the eye (glaucoma) and treat dry mouth Works by causing the pupil of the eye to shrink and decreasing the amount of fluid within the eye

Atorvastatin diet

Patient should follow cholesterol-lowering diet before/during therapy Avoid grapefruit juice while taking this drug

Trental: ischemic pain

Pentoxifylline (trental) treats ischemic pain and intermittent claudication

Peptic ulcer disease medication timing

Peptic ulcers treated by PPI, H2 blockers, antibiotics Be conscious of antacids changing the pH of the stomach Take at least two hours before or after other meds

A client with acute pyelonephritis who was started on antibiotic therapy 24 hours earlier is still complaining of burning with urination. The nurse should anticipate that the health care provider will prescribe which medication?

Phenazopyridine

A client is prescribed sulfamethoxazole for treatment of urinary tract infection. Identification of which other medication noted on the client's medical record requires further collaboration with the health care provider (HCP)?

Phenytoin

Isotretinoin (Accutane)

Photosensitivity Treats acne. Reduces oil production from sebaceous glands. Also reduces gland size. Dries out the rest of the skin, thus SEs: blepharoconjunctivitis, dry eye, pseudotumor cerebri, nyctalopia. This drug is teratogenic!!

The nurse is planning to administer furosemide 40 mg by intravenous push (IVP) through an existing intravenous (IV) line. To deliver this medication safely, the nurse should perform which action?

Pinch the IV tubing above the injection port, and inject slowly over 1 to 2 minutes.

A client receives a new prescription for nitroglycerin (Nitrostat) tablets. Which instruction should the nurse include in this client's teaching? Take the medication at least an hour before every meal. Monitor your pulse for 60 seconds before administration. Place under the tongue as needed every 5 minutes up to 3 times. Resume normal activities after chest pain relief is obtained.

Place under the tongue as needed every 5 minutes up to 3 times.

The healthcare provider has prescribed digoxin for a client who has been taking furosemide (Lasix) for six months. What laboratory serum levels should the nurse review before administering the digoxin? Calcium. Magnesium. Potassium. Furosemide.

Potassium.

Pregabalin side effect

Pregabalin (Lyrica) Treats neuropathic pain and fibromyalgia Side effects: dizziness, sleepiness, blurry vision, weight gain

A client is taking danazol (Danocrine) for endometriosis and calls the clinic nurse to complain of a dark, swollen, and painful leg. What instructions should the nurse provide the client? Wear support stockings. Elevate both legs and apply heat. Proceed to the closest emergency room. Walk for 20 to 30 minutes to reduce muscle cramps.

Proceed to the closest emergency room.

A pregnant client had dinoprostone (Prostaglandin E2) administered to her cervix. Which outcome would indicate to the nurse that the medication was effective? Increased secretion from cervical glands. Thickening and shortening of the cervical os. Intact cervix and suppression of contractions. Progressive effacement and dilation of cervix.

Progressive effacement and dilation of cervix.

A client is receiving levofloxacin for treatment of urinary tract infection. Which finding warrants an immediate call to the health care provider (HCP)?

Prolonged QT interval on electrocardiogram

What is the expected outcome of esomeprazole (Nexium) when prescribed for a client with gastroesophageal reflux disease (GERD)? Promotion of rapid tissue healing. Increased gastric emptying. Improved esophageal peristalsis. Neutralization of gastric secretions.

Promotion of rapid tissue healing.

A client is taking sulfisoxazole (Gantrisin) for a urinary tract infection (UTI) and complains of nausea and gastric upset since starting the medication. Which additional adverse reaction should the nurse instruct the client to report? Rash. Diarrhea. Hematuria. Muscle cramping.

Rash.

A client with chronic gouty arthritis takes allopurinol (Zyloprim) and experiences an acute attack of gouty arthritis. The healthcare provider prescribes concurrent low-dose colchicine. What information should the nurse provide the client that best explains the action of the colchicine? Acts like aspirin to relieve pain. Facilitates the excretion of uric acid. Reduces inflammation at the affected site. Prevents formation of uric acid crystals.

Reduces inflammation at the affected site.

While assessing a client's health history, the nurse notes that the client has been prescribed methotrexate (Rheumatrex, Trexall). Which health outcome would indicate this medication is effective? Suppression of the human immunodeficiency virus. Reduction of joint swelling and increased ROM. Increased eye lash growth and darkened irises. Decreased abnormal rise of creatinine and BUN levels.

Reduction of joint swelling and increased ROM.

While assessing a client's health history, the nurse notes that the client has been prescribed levonorgestrel and ethinyl estradiol (Lutera). Which health outcome would indicate this medication is effective? Pregnancy. Regularity of menstrual cycles. Enlargement of mammary tissues. Increase maturation of ovarian follicle.

Regularity of menstrual cycles.

A client receives a new prescription for an angiotensin-converting enzyme (ACE) inhibitor. What client history contraindicates its use? Asthma. Heart failure. Renal artery stenosis. Coronary artery disease.

Renal artery stenosis.

Nitrofurantoin is prescribed for the client. The nurse checks the client's record, knowing that this medication is contraindicated in which disorder?

Renal disease

A resident of a long-term care facility is taking lithium carbonate (Eskalith) to treat bipolar disorder. Which instruction should the nurse provide to this client's caregivers? Offer the morning dose of the medicine before breakfast. Have the client chew the pill if it is difficult to swallow. Encourage high energy fluid intake by providing sports drinks or sodas. Report symptoms of hypothyroidism such as fatigue and constipation.

Report symptoms of hypothyroidism such as fatigue and constipation.

A client receives a new prescription for pentazocine (Talwin), a mixed opioid agonist-antagonist, after an opioid agonist is discontinued. What is the advantage for the client when the new prescription is implemented? Tolerance does not occur. Less agitation is experienced. The analgesic ceiling is higher. Respiratory depression is less.

Respiratory depression is less.

Atenolol action/ teaching

Slows HR and lowers BP Do not stop abruptly!! Caution in patients with DM (masks blood sugar variations) Caution in patients with COPD or chronic respiratory issues (masks bronchospasms)

Oxybutynin chloride is prescribed for a client with urge incontinence. Which sign would indicate a possible toxic effect related to this medication?

Restlessness rationale: Toxicity (overdosage) of oxybutynin produces central nervous system excitation, such as nervousness, restlessness, hallucinations, and irritability. Other signs of toxicity include hypotension or hypertension, confusion, tachycardia, flushed or red face, and signs of respiratory depression. Drowsiness is a frequent side effect of the medication but does not indicate overdosage.

The nurse receives a unit of blood from the blood bank for a postoperative client who is currently in the X-ray department. What action should the nurse implement? Return the blood to the blood bank for refrigeration within 30 minutes. Hang the blood transfusion as soon as the client returns to the unit. Store the blood bag in the nursing unit's refrigerator until the client returns. Take the unit of blood to the X-ray department to initiate the transfusion.

Return the blood to the blood bank for refrigeration within 30 minutes.

The nurse is providing medication teaching for a client who has recently received a prescription for clozapine (Clozaril). Which instruction should be included in this client's teaching plan? Avoid prolonged sun exposure. Rise slowly from a lying position. Do not eat any aged cheese. Take as needed for anxiety.

Rise slowly from a lying position.

What is the proper method for the nurse to warm up refrigerated insulin prior to administration? Place the insulin vial in a cup of warm water for 15 minutes. Roll the insulin vial between both palms to warm it. No need to warm the vial; administer insulin after drawing up. Draw the prescribed dose into insulin syringe; let it sit on counter for 30 minutes.

Roll the insulin vial between both palms to warm it.

A client who takes a statin and gemfibrozil (Lopid) for hyperlipidemia reports onset of muscle pain and weakness. What additional assessment is most important for the nurse to obtain? Serum liver enzymes. T3 and T4 blood levels. Bowel function. Peripheral sensation.

Serum liver enzymes.

An emergency department triage nurse is interviewing a female client who has a history of epilepsy with tonic-clonic seizures controlled by phenytoin (Dilantin). Which information is most significant in planning this client's care? She has missed 2 menstrual periods. She has had no dental care for several years. She ran out of her medication 4 days ago. She has smoked 3 packs of cigarettes a day for 10 years.

She ran out of her medication 4 days ago.

Laxatives

Short term relief of constipation Not recommended for use in peds Kinds of laxatives include: Chemical stimulants Bulk stimulants Osmotic laxatives Lubricants

Maxair (pirbuterol) bronchodilator

Short-acting Used for acute asthmatic episodes in patients 12 or older

Leukotrienes teaching

Singulair (montelukast) Long term, not a rescue drug Not for acute attacks

During the fourth infusion of vancomycin (Vancocin), a client experiences red flushing of the neck and face and decreased blood pressure. Which action should the nurse take first? Activate the emergency response team. Slow the infusion rate of the medication. Administer epinephrine as per anaphylactic protocol. Stop the infusion and contact the healthcare provider immediately.

Slow the infusion rate of the medication.

What should a nurse include in the client instructions to help prevent orthostatic hypotension if the client is prescribed an antihypertensive medication? Increase the amount of fluids and fiber in the diet. Slowly change position when rising from sitting or lying down. Consume a minimum of two to three liters of fluid a day. Check blood pressure prior to taking any cardiac medication.

Slowly change position when rising from sitting or lying down.

The nurse is conducting client education. Which statement lets the nurse know that the client understands the education regarding vitamin C? Foods high in vitamin C should be avoided. Smoking decreases vitamin C levels in the body. Large doses of vitamin C can cause a decrease urine output. Omit a missed dose of vitamin C and take the next dose the following day.

Smoking decreases vitamin C levels in the body.

Trimethoprim-sulfamethoxazole is prescribed for a client. The nurse should instruct the client to report which symptom if it develops during the course of this medication therapy?

Sore throat rationale: Clients taking trimethoprim-sulfamethoxazole should be informed about early signs and symptoms of blood disorders that can occur from this medication. These include sore throat, fever, and pallor, and the client should be instructed to notify the primary health care provider (PHCP) if these occur. The other options do not require PHCP notification.

A client at 30-weeks gestation is in preterm labor. The healthcare provider prescribes two 12-mg doses of betamethasone (Celestone) intramuscularly every 12 hours. The client asks the nurse why she is receiving the Celestone. What information should the nurse use to explain the action of the medication? Suppresses uterine contractions. Stimulates fetal surfactant production. Reduces maternal and fetal tachycardia associated with terbutaline (Brethine) administration. Maintains adequate maternal respiratory effort and ventilation with magnesium administration.

Stimulates fetal surfactant production.

Vasopressin (ADH)

Stimulates water reabsorption in the kidneys

A client with chronic kidney disease has a medication prescription for epoetin alfa. The nurse should plan to administer this medication by which method?

Subcutaneously

Parenteral bethanechol chloride is prescribed for a client with urinary retention. The nurse should plan to administer this medication by which route?

Subcutaneously

Carafate teaching

Sucralfate coats the injured area in the stomach to prevent further damage and promotes healing. This should be given 2hrs from other medications to prevent affecting absorption of other medications

Metronidazole

Swallow metronidazole tablets with plenty of water. Take them with a meal or a snack. Do not drink alcohol while you are taking metronidazole, and for 48 hours after finishing your course of treatment.

Hypoglycemia signs and symptoms

Sweaty, cool, and clammy give me candy.

A client calls the clinic and states that she forgot to take her oral contraceptives for the past two days. Which instruction is best for the nurse to provide to this client? Take 2 pills a day for 2 days and use an alternate method of contraception for 7 days. Quit the pills for this cycle, use an alternate method of contraception, and resume pills on the fifth day of menstruation. Take one extra pill per day for the rest of this cycle, then resume taking pills as usual next cycle. Take 4 pills now and use an alternate method of contraception for the rest of this cycle.

Take 2 pills a day for 2 days and use an alternate method of contraception for 7 days.

A client is diagnosed with peptic ulcer disease and receives a prescription for esomeprazole (Nexium) 20 mg capsule daily. When providing this client with discharge teaching, the nurse should include which instruction? Drink fluids between meals to relieve gastric distress. Monitor for an increase in blood pressure during therapy. Dissolve capsule contents in fruit juice for easier ingestion. Take at same time each day one hour before eating a meal.

Take at same time each day one hour before eating a meal.

A client is prescribed 250mg of tetracycline every other day for acne. What instruction should the nurse give to the client regarding the best way to take the medication? Take medication before taking an iron product. Take medication with a meal. Take medication on an empty stomach. Take medication with a dairy product.

Take medication on an empty stomach.

The healthcare provider prescribes pyridostigmine bromide (Mestinon) tablets for a client with myasthenia gravis (MG). What instruction should the nurse provide this client? Increase activity in the afternoon when the medication is most effective. Take the medication 30 to 45 minutes before eating. Use a PRN dose for increasing muscular weakness or fasciculations. Give the client a dietary guide that describes low-protein foods.

Take the medication 30 to 45 minutes before eating.

A client who is recently diagnosised with myasthenia gravis receives a prescription for pyridostigmine (Mestinon), a cholinergic agent. Which information should the nurse instruct the client to implement when taking this medication? Always take with meals to avoid gastrointestinal distress. Plan the doses close together for maximal therapeutic effect. Take the medication at least 30 minutes before eating meals. Avoid dairy products two hours before and after taking medications.

Take the medication at least 30 minutes before eating meals.

A client with chronic pancreatitis receives a new prescription for pancrelipase (Pancrease). Which instruction is most important for the nurse to include in this client's teaching? Avoid prolonged exposure to direct sunlight. Stay away from products containing alcohol. Ingest 8 oz of grapefruit juice with the medication. Take the medication when consuming food.

Take the medication when consuming food.

Tacrolimus is prescribed for a client who underwent a kidney transplant. Which instruction should the nurse include when teaching the client about this medication?

Take the oral medication every 12 hours at the same times every day. rationale: Tacrolimus is a potent immunosuppressant used to prevent organ rejection in transplant clients. It is important that the medication be taken at 12-hour intervals to maintain a stable blood level to prevent organ rejection. Adverse effects include hyperglycemia and hypertension, so the client does not eat frequently to avoid hypoglycemia or use precautions to avoid orthostatic hypotension. Tacrolimus is metabolized through the cytochrome P450 system, so grapefruit juice is not allowed. *Focus on the subject, teaching a transplant client regarding tacrolimus. Focus on the goal of avoiding organ rejection by maintaining a stable level of tacrolimus in the blood by taking the medication at regular intervals every day.

What is an important fact the nurse should include in client education about the administration of norgestimate/ ethinyl estradiol (Ortho Tri Cyclen)? Take the pill at the same time each day. Take a pill 24 hours prior to intercourse. Take the pill twice a day, 12 hours apart. Take the pill on the days during menstruation.

Take the pill at the same time each day.

What teaching should the nurse provide a client who has received a new prescription for sildenafil (Viagra)? (Select all that apply.) Select all that apply Frequent use can lead to the development of hypertension. Most effective if taken after at least 6 hours of REM sleep. Take within 30 to 60 minutes of sexual stimulation. Report rebound priapism that occurs for 4 hours or more. Can cause facial flushing and headache.

Take within 30 to 60 minutes of sexual stimulation. Report rebound priapism that occurs for 4 hours or more. Can cause facial flushing and headache.

Tetracycline avoid dairy

Taking dairy products with tetracycline interferes with absorption into bloodstream

ACTH taper dose

Tapering must be done with steroids Done to give adrenal glands time to resume normal function

Atorvastatin (Lipitor)

Teaching: Report sore muscles Take med at bedtime Avoid grapefruit juice

A client taking metronidazole telephones the home health nurse to report dark discoloration to the urine. The nurse interprets that the client's complaint warrants which nursing action at this time?

Tell the client that this is a harmless medication side effect.

The nurse is assessing the medication history of a client who has been diagnosed with a bladder infection and also is currently using tretinoin (Retin-A; Rejuva-A) for the treatment of acne. Which antibiotic if prescribed for treatment of the infection should the nurse withhold and consult with the healthcare provider? Tetracycline (Sumycin). Levofloxacin (Levaquin). Minocycline HCL (Minocycline ). Azithromycin (Zithromax Z-Pak).

Tetracycline (Sumycin).

A client was prescribed acetylcysteine (expectorant) inhalation therapy for treatment of cystic fibrosis. Which data would indicate the medication has been an effective therapeutic? The client has decreased amount of secretions suctioned from client's lungs. The client coughed up a moderate amount of liquefied secretions. Client's breath sounds and wheezing are diminished on auscultation. Client's appetite is increased with decreased amount of steatorrhea present.

The client coughed up a moderate amount of liquefied secretions.

Nitrofurantoin is prescribed for a client with a urinary tract infection. The client contacts the nurse and reports a cough, chills, fever, and difficulty breathing. The nurse should make which interpretation about the client's complaints?

The client is experiencing a pulmonary reaction requiring cessation of the medication. rationale: Nitrofurantoin can induce 2 kinds of pulmonary reactions: acute and subacute. Acute reactions, which are most common, manifest with dyspnea, chest pain, chills, fever, cough, and alveolar infiltrates. These symptoms resolve 2 to 4 days after discontinuing the medication. Acute pulmonary responses are thought to be hypersensitivity reactions. Subacute reactions are rare and occur during prolonged treatment. Symptoms (e.g., dyspnea, cough, malaise) usually regress over weeks to months following nitrofurantoin withdrawal. However, in some clients, permanent lung damage may occur. The remaining options are incorrect interpretations.

The nurse is assessing a client who has been prescribed ibandronate (Boniva) 150mg by mouth. In which situation should the nurse withhold the dose and consult with the healthcare provider (HCP) regarding the prescription? The client is post op laminectomy and is to remain flat in bed with log-rolling side to side every two hours. The client's hemoglobin is 13 g/dl and hemacrit is 36% forty-eight post-operative. The client has a history of asthma and is allergic to seafood and sulfur. The client states it has been one month since she took her last Boniva dose.

The client is post op laminectomy and is to remain flat in bed with log-rolling side to side every two hours.

The nurse administered cyclobenzaprine (Flexeril) to a client approximately one hour ago. Which situation is an expected therapeutic outcome? The client's temperature has decreased and is now afebrile. The client states the pain level has gone from 8 to 3. The client states that heartburn pain and gas have diminished. The client's erythema has subsided and skin is pale pink in color.

The client's erythema has subsided and skin is pale pink in color.

The healthcare provider discontinues prednisone, a glucocorticoid, for a client with chronic obstructive pulmonary disease. What instructions should the nurse give the client about the regimen to follow? Life-long treatment is common for chronic disease. The drug should be stopped immediately if no longer needed. The dose must be tapered over the course of 7 to 10 days. Another glucocorticoid should be used to prevent cross-tolerance.

The dose must be tapered over the course of 7 to 10 days.

The healthcare provider prescribes oral antifungal therapy for a client with onychomycosis. What information should the nurse tell the client? A single dose of the oral antifungal agent is usually sufficient to treat the infection. The infection is difficult to eradicate and requires prolonged therapy for 3 to 6 months. Complete eradicate is important because of the risk of a systemic infection. Prolonged therapy provides no benefit and increases the risk of adverse effects.

The infection is difficult to eradicate and requires prolonged therapy for 3 to 6 months.

The nurse is preparing to administer alprazolam to a geriatric client diagnosed with chronic hepatitis C. Which precaution is indicated for this client? The medication should be withheld because of the client's hepatic function. The medication dose should be decreased because of the client's age. The tablet should be swallowed whole, not crushed or chewed. The medication should be taken 1 hour before meals or 2 hours after meals.

The medication dose should be decreased because of the client's age.

A 9-year old child with asthma has been receiving beclomethasone. Which assessment findings should the nurse report immediately to the healthcare provider? The presence of oral candidiasis. The loss of the senses of taste and smell. Incorrect Reports of nausea, fatigue and weakness. Developing psychiatric and behavioral changes.

The presence of oral candidiasis.

Tamsulosin hydrochloride has been prescribed for a client with benign prostatic hypertrophy (BPH). How should the nurse instruct the client to take the medication?

Thirty minutes after a meal

A client diagnosed with gastroesophageal reflux disease has been prescribed cimetidine. Which explanation should the nurse give the client about the mechanism of action for this medication? This medication neutralizes the gastric secretions. This medication blocks the secretions of gastric acids. This medication decreases the rate of gastric emptying. This medication slows down the prostaglandin synthesis.

This medication blocks the secretions of gastric acids.

Ferrous Sulfate

This medicine works better if you take it on an empty stomach. ... If antacids are used, they may need to be taken at some other time than ferrous sulfate liquid. ... Measure liquid doses carefully. ... Mix liquid with water or juice and drink it from a straw for less stains on your teeth.

Which findings should the nurse identify in an adult client with possible chronic salicylate intoxication? Tinnitus and hearing loss. Photosensitivity and nervousness. Acute gastrointestinal bleeding and anorexia. Hyperventilation and central nervous system effects.

Tinnitus and hearing loss.

A male client who is in the terminal stage of cancer is cared for at home by his family and receives a prescription for morphine at a rate to control intractable pain. When the hospice nurse visits, the client awakens, moans in severe pain, and asks for an increase in the morphine dosage. After determining the client's respirations are 10 per minute, what is the best action for the nurse to implement? Titrate the morphine dose upward until the client has adequate pain relief. Suggest to the family that they can also give the client ibuprofen, a non-narcotic analgesic. Hold additional morphine until the client's respirations are at least 16 per minute. Inform the client that an increased dose of morphine increases side effects without additional pain control.

Titrate the morphine dose upward until the client has adequate pain relief.

Azithromycin: STD

Treatment for chlamydia

Somatropin

Treats growth hormone deficiencies in Peds and Adult Acts by mimicing naturally occurring growth hormones. Helps stimulate growth and protein synthesis Side effects: hyperglycemia Want to administer via IM or SQ and rotate sites *Stop treatment prior to epiphyseal closure* Closely monitor patient's growth rate in order to know when to stop medication Used for AIDs related wasting syndrome (cachexia)

Kayexalate

Treats hyperkalemia (>5.0) Monitor bowel movements and potassium levels. Can cause life-threatening cardiac arrhythmias

A client with chronic schizophrenia illness is admitted after taking risperidone (Risperdal) 10 mg/day for three months. The nurse implements a daily assessment using the Abnormal Involuntary Movement Scale (AIMS). What findings should the nurse report to the healthcare provider? Cogwheel rigidity. Drowsiness and dizziness. Tremors and muscle twitching. Dry mouth, constipation, and blurred vision.

Tremors and muscle twitching.

Tigan sedation

Trimethobenzamide Used to treat nausea and vomiting (antiemetic) after surgery Side effects: diarrhea, headache, dizziness, drowsiness, or blurred vision

Oral bethanechol chloride is prescribed for the client. The nurse should instruct the client to take this medication at which time?

Two hours after meals

Desmopressin

Typically, this form is treated with a synthetic hormone called desmopressin (DDAVP, Nocdurna). This medication replaces the missing anti-diuretic hormone (ADH) and decreases urination. You can take desmopressin in a tablet, as a nasal spray or by injection

Tamsulosin hydrochloride is prescribed for a client. The nurse should suspect that this medication is prescribed to relieve which condition?

Urinary obstruction

A c lient is receiving fentanyl via an epidural infusion. Which side effect should the nurse anticipate in the first 24 hours of epidural analgesia ? Headache. Agitation. Urinary retention. Abdominal cramping and diarrhea.

Urinary retention.

Bethanechol chloride is prescribed for a client with urinary retention. Which disorder would be a contraindication to the administration of this medication?

Urinary strictures rationale: Bethanechol chloride can be hazardous to clients with urinary tract obstruction or weakness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract could damage or rupture the bladder in clients with these conditions.

Phenazopyridine is prescribed for a client with a urinary tract infection. The nurse evaluates that the medication is effective based on which observation?

Urination is not painful. Phenazopyridine is a urinary analgesic. It is effective when it eliminates pain and burning with urination. It does not eliminate the bacteria causing the infection, so it would not make the urine clear amber. It does not treat urge incontinence. It will cause the client to have reddish-orange discoloration of urine, but this is a side effect of the medication, not the desired effect.

A female client receives a prescription for cefadroxil (Duricef) for a urinary tract infection. The client informs the nurse that she is currently taking oral contraceptives (OCP). What information is important for the nurse to share with the client? The antibiotic may be less effective while taking OCP. The medication combination potentiates the risk of adverse reactions. Avoid prolonged sun exposure while taking the antibiotic. Use an additional form of contraception until your menstrual cycle.

Use an additional form of contraception until your menstrual cycle.

Gingko reactions

Used for memory loss, anxiety, anticoagulant properties -Side effects --GI upset --Headache Risk for bleeding --Stop use prior to surgery

The nurse is assessing a client with history of plaque psoriasis. Which medication has most likely been prescribed for this client? Ustekinumab (Stelara). Miconazole nitrate (Lotrimin AF). Benzoyl perioxide (Clean and Clear).

Ustekinumab (Stelara).

Which common side effect should the nurse alert a female client about when medroxyprogesterone (Depo-Provera) is prescribed? Leg or calf pain. Headaches or visual changes. Vaginal bleeding after discontinuing the medication. Jaundice during the first 3 weeks of administration.

Vaginal bleeding after discontinuing the medication.

s/s digoxin toxicity

Vision changes (green/yellow halos), nausea/vomiting, dizzy Check serum levels if you suspect patient is toxic

vitamin E interacts with

Warfarin

A client with left congestive heart failure and pulmonary hypertension is admitted for weight gain of 15 pounds (6.8kg) within the last 72 hours, crackles bilaterally in lungs, and increased shortness of breath with exertion. Which nursing action provides a definitive evaluation of the effectiveness of the prescribed diuretic? Weighing the client daily. Auscultating the client's lungs. Palpating the client's distal pulses. Measuring the client's blood pressure.

Weighing the client daily.

A client being treated with monoamine oxidase inhibitor (MAOIs) for post- traumatic stress disorder (PTSD) appears at the clinic reporting a severe headache, nausea and vomiting, and palpitations. The client's heart rate is 122 beats/minute and BP 190/110 mmHg. What question should the nurse ask first? Are there any changes or ongoing stressors happening in your life? What foods had you consumed prior to the onset of these symptoms? Where were you when you noticed the onset of symptoms? Were you doing any strenuous activity when the symptoms appeared?

What foods had you consumed prior to the onset of these symptoms?

A client who is diagnosed with methillicin-resistant Staphylococcus aureus receives a prescription for vancomycin (Vancocin). Which assessment should the nurse perform to identify a potential adverse effect? Whisper test. Romberg test. Tactile discrimination. Skin turgor.

Whisper test.

Aluminum hydroxide is prescribed for a client with chronic kidney disease (CKD). The nurse should instruct the client to take this medication at what time?

With meals

Nitrofurantoin is prescribed for a client with urinary tract infection. The nurse is instructing the client regarding the administration of the medication. Which information about the best time to take this medication should be included in the client's education?

With meals

A client is prescribed the pump nasal spray beclomethasone (Beconase) 42 mcg/spray, two sprays in each nostril twice daily. The pharmacy delivers metered-dose aerosol beclomethasone 80 mcg/actuation to be administered to the client. What is the priority action for the nurse? Give two sprays in each nostril one time daily. Withhold the medication and contact the pharmacy. Notify the healthcare provider and request a new prescription. Administer one spray to each nostril twice daily.

Withhold the medication and contact the pharmacy.

A client is beginning therapy with montelukast (Singulair) PO 10 mg once a day in the evening. The client asks the nurse, "When should I begin to feel better?" How should the nurse respond? Immediately. Within 24 hours. In about 12 hours. 30 minutes to 1 hour.

Within 24 hours.

A client receives a new prescription for ciprofloxacin (Cipro), a synthetic quinolone. When teaching about this drug, which information in the client's history requires special emphasis by the nurse? Snacks on dairy products such as yogurt or ice cream. Previously had a mild allergic reaction to a cephalosporin. Consumes alcoholic drinks occasionally on the weekends. Works twenty hours a week as a lifeguard at the local pool.

Works twenty hours a week as a lifeguard at the local pool.

Tetracycline adverse effects

Yellow/brown discoloration of teeth, hepatotoxicity, photosensitivity, photosensitivity, suprainfection/superinfection no dairy

Azithromycin

Zithromax, Z-Pak for STD Finish all hepatoxicity

The nurse is caring for a client with a diagnosis of influenza who first began to experience symptoms yesterday. Antiviral therapy is prescribed and the nurse provides instructions to the client about the therapy. Which statement by the client indicates an understanding of the instructions? a) "I must take the medication exactly as prescribed." b) "Once I start the medication, I will no longer be contagious." c) "I will not get any colds or infections while taking this medication." d) "This medication has minimal side effects and I can return to normal activities."

a) "I must take the medication exactly as prescribed." Rationale: Antiviral medications for influenza must be taken exactly as prescribed. These medications do not prevent the spread of influenza and clients are usually contagious for up to 2 days after the initiation of antiviral medications. Secondary bacterial infections may occur despite antiviral treatment. Side effects occur with these medications and may necessitate change in activities, especially when driving or operating machinery if dizziness occurs.

A client receiving oral theophylline is due to have a theophylline level drawn. The nurse should question the client to ensure that the client has not ingested which substance before the blood sample is drawn? a) Coffee b) Oatmeal c) Ginger ale d) Bagel with cream cheese

a) Coffee

When evaluating an asthmatic client's knowledge of self-care, the nurse recognizes that additional instruction is needed when the client makes which statement? a) "I use my corticosteroid inhaler each time I feel short of breath." b) "I see my doctor if I have an upper respiratory infection and always get a flu shot." c) "I use my bronchodilator inhaler before walking so I don't become short of breath." d) "I use my bronchodilator inhaler before I visit places like the zoo because of my allergies."

a) "I use my corticosteroid inhaler each time I feel short of breath." Rationale: Most asthma medications are administered via inhalation because of their fast action via this route. Inhaled corticosteroids are preferred for long-term control of persistent asthma. They decrease inflammation and reduce bronchial hyperresponsiveness. Bronchodilator medications are considered "rescue" types because their onset is faster. Clients would use this type of medication to provide rapid relief of symptoms such as bronchospasm, which can be caused by a variety of triggers. Clients need to be evaluated for understanding of their disease, identifying triggers, and the proper use of equipment and medications.

A client with a prescription to take theophylline (Theo-24) daily has been given medication instructions by the nurse. What statement by the client indicates the need for further education regarding his prescription? a) "I will take the daily dose at bedtime." b) "I need to drink at least 2 liters of fluid per day." c) "I know to avoid changing brands of the medication without my health care provider's approval." d) "I'll avoid over-the-counter cough and cold medications unless approved by my health care provider (HCP)."

a) "I will take the daily dose at bedtime." Rationale: The client taking a single daily dose of theophylline, a xanthine bronchodilator, should take the medication early in the morning. This enables the client to have maximal benefit from the medication during daytime activities. Additionally, this medication causes insomnia. The client should take in at least 2 L of fluid per day to decrease viscosity of secretions. The client should check with the HCP before changing brands of the medication because levels of bioavailability may vary for different preparations. The client also should check with the HCP before taking over-the-counter cough, cold, or other respiratory preparations because they could have interactive effects, increasing the side and adverse effects of theophylline and causing dysrhythmias.

The nurse teaches a client about the effects of diphenhydramine (Benadryl), which has been prescribed as a cough suppressant. The nurse determines that the client needs further instruction if the client makes which statement? a) "I will take the medication on an empty stomach." b) "I won't drink alcohol while taking this medication." c) "I will use sugarless gum, candy, or oral rinses to decrease dryness in my mouth." d) "I won't do activities that require mental alertness while taking this medication."

a) "I will take the medication on an empty stomach." Rationale: Diphenhydramine (Benadryl) has several uses, including as an antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. Instructions for use include taking with food or milk to decrease gastrointestinal upset and using oral rinses or sugarless gum or hard candy to minimize dry mouth. Because the medication causes drowsiness, the client should avoid use of alcohol or central nervous system depressants, operating a car, or engaging in other activities requiring mental awareness during use.

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving theophylline (Theo-24). The nurse monitors the serum theophylline level and concludes that the medication dosage may need to be increased if which value is noted? a) 5 mg/mL b) 10 mg/mL c) 15 mg/mL d) 20 mg/mL

a) 5 mg/mL Rationale: Theophylline is a bronchodilator. The nurse monitors the theophylline blood serum level daily when a client is on this medication to ensure that a therapeutic range is present and monitor for the potential for toxicity. The therapeutic serum level range is 10 to 20 mg/mL. If the laboratory result indicated a level of 5 mg/mL, the dosage of the medication would need to be increased.

Which supplies should the nurse obtain for the administration of ribavirin (Virazole) to a hospitalized child with respiratory syncytial virus (RSV)? a) A mask and pair of goggles b) Isolation gown and sterile gloves c) An intravenous (IV) pole and hood d) Intramuscular (IM) syringe and needle

a) A mask and pair of goggles Rationale: Ribavirin (Virazole) is administered via hood, face mask, or oxygen tent and is not administered by the IV or IM route. Some caregivers experience headaches, burning nasal passages and eyes, and crystallization of soft contact lenses as a result of administration of ribavirin (Virazole). Specific to this medication is the use of goggles. A mask may be worn. A gown is not necessary. The medication used for the prevention of RSV is palivizumab (Synagis), a monoclonal antibody, which is given monthly in an IM injection to prevent hospitalization associated with RSV.

The client has a prescription to receive pirbuterol (Maxair Autoinhaler) two puffs and beclomethasone dipropionate (Beclovent) two puffs by metered-dose inhaler. The nurse plans to give these medications in which way to ensure effectiveness? a) Administering the pirbuterol before the beclomethasone b) Alternating a single puff of each hourly, beginning with the beclomethasone c) Alternating a single puff of beclomethasone with pirbuterol; repeat the steps d) Administering the pirbuterol; wait 30 minutes and administer the beclomethasone

a) Administering the pirbuterol before the beclomethasone Rationale: Pirbuterol is a bronchodilator. Beclomethasone is a glucocorticoid. Bronchodilators are administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

A client has begun a course of therapy with rifampin (Rifadin). The home care nurse instructs the client to perform which action while taking this medication? a) Avoid wearing contact lenses. b) Always take the medication with food or antacids. c) Double the next medication dose if one is forgotten. d) Stop the medication if symptoms disappear in 2 months.

a) Avoid wearing contact lenses. Rationale: Rifampin (Rifadin) causes orange-red discoloration of body secretions and will permanently stain soft contact lenses. The medication should be taken on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin should be taken exactly as directed, and doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a health care provider.

A client has begun using a methylxanthine bronchodilator. What beverage should the nurse plan to teach the client to avoid while taking this medication? a) Coffee b) Orange juice c) Mineral water d) Cranberry juice

a) Coffee

A client has begun therapy with theophylline (Theo-24). The nurse should plan to teach the client to limit the intake of which items while taking this medication? a) Coffee, cola, and chocolate b) Oysters, lobster, and shrimp c) Melons, oranges, and pineapple d) Cottage cheese, cream cheese, and dairy creamers

a) Coffee, cola, and chocolate Rationale: Theophylline (Theo-24) is a methylxanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These foods include coffee, cola, and chocolate.

The health care provider (HCP) has prescribed codeine sulfate for a client with a nonproductive cough to suppress the cough reflex. The nurse should teach the client to monitor for which side effect of the medication? a) Constipation b) Painful coughing c) Increased urination d) Difficulty swallowing

a) Constipation Rationale: Codeine sulfate is an opioid analgesic and a frequent side effect is constipation. Additional side effects include drowsiness, nausea, and vomiting. Urinary retention is also a concern, and urine output should be monitored. Painful coughing and difficulty swallowing are unrelated to the administration of this medication.

An adult client has prescriptions for morphine sulfate 2.5 mg IV q6h and ketorolac (Toradol) 30 mg IV q6h. Which action should the nurse implement? a. Administer both medications according to the prescription. b. Hold the ketorolac to prevent an antagonistic effect. c. Hold the morphine to prevent an additive drug interaction. d. Contact the healthcare provider to clarify the prescription.

a. Administer both medications according to the prescription. Morphine and ketorolac (Toradol) can be administered concurrently (A), and may produce an additive analgesic effect, resulting in the ability to reduce the dose of morphine, as seen in this prescription. Toradol is an antiinflammatory analgesic, and does not have an antagonistic effect with morphine (B), like an agonist-antagonist medication would have. An additive analgesic effect is desirable (C), because it allows a reduced dose of morphine. This prescription does not require any clarification, and can be administered safely as written (D).

An adult client is given a prescription for a scopolamine patch (Transderm Scop) to prevent motion sickness while on a cruise. Which information should the nurse provide to the client? a. Apply the patch at least 4 hours prior to departure b. Change the patch every other day while on the cruise. c. Place the patch on a hairless area at the base of the skull. d. Drink no more than 2 alcoholic drinks during the cruise.

a. Apply the patch at least 4 hours prior to departure Scopolamine, an anticholinergic agent, is used to prevent motion sickness and has a peak onset in 6 hours, so the client should be instructed to apply the patch at least 4 hours before departure (A) on the cruise ship. The duration of the transdermal patch is 72 hours, so (B) is not needed. Scolopamine blocks muscarinic receptors in the inner ear and to the vomiting center, so the best application site of the patch is behind the ear, not at the base of the skull (C). Anticholinergic medications are CNS depressants, so the client should be instructed to avoid alcohol (D) while using the patch.

Following the administration of sublingual nitroglycerin to a client experiencing an acute anginal attack, which assessment finding indicates to the nurse that the desired effect has been achieved? a. Client states chest pain is relieved. b. Client's pulse decreases from 120 to 90. c. Client's systolic blood pressure decreases from 180 to 90. d. Client's SaO2 level increases from 92% to 96%.

a. Client states chest pain is relieved. Nitroglycerin reduces myocardial oxygen consumption which decreases ischemia and reduces chest pain (A). (B and D) would also occur if the angina was relieved, but are not as significant as the client's subjective report of decreased pain. (C) may indicate a reduction in pain, or a potentially serious side effect of the medication.

A client with hyperlipidemia receives a prescription for niacin (Niaspan). Which client teaching is most important for the nurse to provide? a. Expected duration of flushing. b. Symptoms of hyperglycemia. c. Diets that minimize GI irritation. d. Comfort measures for pruritis.

a. Expected duration of flushing. Flushing of the face and neck, lasting up to an hour, is a frequent reason for discontinuing niacin. Inclusion of this effect in client teaching (A) may promote compliance in taking the medication. While (B, C, and D) are all worthwhile instructions to help clients minimize or cope with normal side effects associated with niacin (Niaspan), flushing is intense and causes the most concern for the client.

A client is receiving digoxin for the onset of supraventricular tachycardia (SVT). Which laboratory findings should the nurse identify that places this client at risk? a. Hypokalemia. b. Hyponatremia. c. Hypercalcemia. d. Low uric acid levels.

a. Hypokalemia. Hypokalemia affects myocardial contractility, so (A) places this client at greatest risk for dysrhythmias that may be unresponsive to drug therapy. Although an imbalance of serum electrolytes, (B and C), can effect cardiac rhythm, the greatest risk for the client receiving digoxin is (A). (D) does not cause any interactions related to digoxin therapy for supraventricular tachycardia (SVT).

Which instruction(s) should the nurse give to a female client who just received a prescription for oral metronidazole (Flagyl) for treatment of trichomonas vaginalis? (Select all that apply.) a. Increase fluid intake, especially cranberry juice. b. Do not abruptly discontinue the medication; taper use. c. Check blood pressure daily to detect hypertension. d. Avoid drinking alcohol while taking this medication. e. Use condoms until treatment is completed. f. Ensure that all sexual partners are treated at the same time.

a. Increase fluid intake, especially cranberry juice. d. Avoid drinking alcohol while taking this medication. e. Use condoms until treatment is completed. f. Ensure that all sexual partners are treated at the same time. Correct selections are (A, D, E, and F). Increased fluid intake and cranberry juice (A) are recommended for prevention and treatment of urinary tract infections, which frequently accompany vaginal infections. It is not necessary to taper use of this drug (B) or to check the blood pressure daily (C), as this condition is not related to hypertension. Flagyl can cause a disulfiram-like reaction if taken in conjunction with ingestion of alcohol, so the client should be instructed to avoid alcohol (D). All sexual partners should be treated at the same time (E) and condoms should be used until after treatment is completed to avoid reinfection (F).

A client is admitted to the coronary care unit with a medical diagnosis of acute myocardial infarction. Which medication prescription decreases both preload and afterload? a. Nitroglycerin. b. Propranolol (Inderal). c. Morphine. d. Captopril (Capoten).

a. Nitroglycerin. Nitroglycerin (A) is a nitrate that causes peripheral vasodilation and decreases contractility, thereby decreasing both preload and afterload. (B) is a beta adrenergic blocker that decreases both heart rate and contractility, but only decreases afterload. Morphine (C) decreases myocardial oxygen consumption and preload. Capoten (D) is an angiotensin converting enzyme (ACE) inhibitor that acts to prevents vasoconstriction, thereby decreasing blood pressure and afterload.

Which method of medication administration provides the client with the greatest first-pass effect? a. Oral. b. Sublingual. c. Intravenous. d. Subcutaneous.

a. Oral. The first-pass effect is a pharmacokinetic phenomenon that is related to the drug's metabolism in the liver. After oral (A) medications are absorbed from the gastrointestinal tract, the drug is carried directly to the liver via the hepatic portal circulation where hepatic inactivation occurs and reduces the bioavailability of the drug. Alternative method of administration, such as sublingual (B), IV (C), and subcutaneous (D) routes, avoid this first-pass effect.

A client is receiving ampicillin sodium (Omnipen) for a sinus infection. The nurse should instruct the client to notify the healthcare provider immediately if which symptom occurs? a. Rash. b. Nausea. c. Headache. d. Dizziness.

a. Rash. Rash (A) is the most common adverse effect of all penicillins, indicating an allergy to the medication which could result in anaphylactic shock, a medical emergency. (B, C, and D) are common side effects of penicillins that should subside after the body adjusts to the medication. These would not require immediate medical care unless the symptoms persist beyond the first few days or become extremely severe.

A client is receiving methylprednisolone (Solu-Medrol) 40 mg IV daily. The nurse anticipates an increase in which laboratory value as the result of this medication? a. Serum glucose. b. Serum calcium. c. Red blood cells. d. Serum potassium.

a. Serum glucose. Solu-Medrol is a corticosteroid with glucocorticoid and mineralocorticoid actions. These effects can lead to hyperglycemia (A), which is reflected as an increase in the serum glucose value. The client taking Solu-Medrol is at risk for hypocalcemia (B) and hypokalemia (D), which result in a decrease, not an increase, in the serum calcium and serum potassium levels. This medication does not adversely affect the RBC count (C).

A client is being treated for osteoporosis with alendronate (Fosamax), and the nurse has completed discharge teaching regarding medication administration. Which morning schedule would indicate to the nurse that the client teaching has been effective? a. Take medication, go for a 30 minute morning walk, then eat breakfast. b. Take medication, rest in bed for 30 minutes, eat breakfast, go for morning walk. c. Take medication with breakfast, then take a 30 minute morning walk. d. Go for a 30 minute morning walk, eat breakfast, then take medication.

a. Take medication, go for a 30 minute morning walk, then eat breakfast. Alendronate (Fosamax) is best absorbed when taken thirty minutes before eating in the morning. The client should also be advised to remain in an upright position for at least thirty minutes after taking the medication to reduce the risk of esophageal reflux and irritation. (A) is the best schedule to meet these needs. (B, C, and D) do not meet these criteria.

After abdominal surgery, a male client is prescribed low molecular weight heparin (LMWH). During administration of the medication, the client asks the nurse why he is receiving this medication. Which is the best response for the nurse to provide? a. This medication is a blood thinner given to prevent blood clot formation. b. This medication enhances antibiotics to prevent infection. c. This medication dissolves any clots that develop in the legs. d. This abdominal injection assists in the healing of the abdominal wound.

a. This medication is a blood thinner given to prevent blood clot formation. Unfractionated heparin or low molecular weight heparin (LMWH) is an anticoagulant that inhibits thrombin-mediated conversion of fibrinogen to fibrin and is given prophylactically to prevent postoperative venous thrombosis (A) or to treat pulmonary embolism or deep vein thrombosis following knee and abdominal surgeries. Heparin does not dissolve clots but prevents clot extension or further clot formation (C). The anticoagulant heparin does not prevent infection (B) or influence operative wound healing (D).

A category X drug is prescribed for a young adult female client. Which instruction is most important for the nurse to teach this client? a. Use a reliable form of birth control. b. Avoid exposure to ultra violet light. c. Refuse this medication if planning pregnancy. d. Abstain from intercourse while on this drug.

a. Use a reliable form of birth control. Drugs classified in the category X place a client who is in the first trimester of pregnancy at risk for teratogenesis, so women in the childbearing years should be counseled to use a reliable form of birth control (A) during drug therapy. (B) is not a specific precaution with Category X drugs. The client should be encouraged to discuss plans for pregnancy with the healthcare provider, so a safer alternative prescription (C) can be provided if pregnancy occurs. Although the risk of birth defects during pregnancy explains the restriction of these drugs during pregnancy, (D) is not indicated.

A female client with rheumatoid arthritis take ibuprofen (Motrin) 600 mg PO 4 times a day. To prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is prescribed. Which information is most important for the nurse to include in client teaching? a. Use contraception during intercourse. b. Ensure the Cytotec is taken on an empty stomach. c. Encourage oral fluid intake to prevent constipation. d. Take Cytotec 30 minutes prior to Motrin.

a. Use contraception during intercourse. Cytotec, a synthetic form of a prostaglandin, is classified as pregnancy Category X and can act as an abortifacient, so the client should be instructed to use contraception during intercourse (A) to prevent loss of an early pregnancy. (B) is not necessary. A common side effect of Cytotec is diarrhea, so constipation prevention strategies are usually not needed (C). Cytotec and Motrin should be taken together (D) to provide protective properties against gastrointestinal bleeding.

The nurse is transcribing a new prescription for spironolactone (Adactone) for a client who receives an angiotensin-converting enzyme (ACE) inhibitor. Which action should the nurse implement? a. Verify both prescriptions with the healthcare provider. b. Report the medication interactions to the nurse manager. c. Hold the ACE inhibitor and give the new prescription. d. Transcribe and send the prescription to the pharmacy.

a. Verify both prescriptions with the healthcare provider. The concomitant use of an angiotensin-converting enzyme (ACE) inhibitor and a potassium-sparing diuretic such as spironolactone, should be given with caution because the two drugs may interact to cause an elevation in serum potassium levels. Although the client is currently receiving an ACE inhibitor, verifying both prescriptions (A) alerts the healthcare provider about the client's medication regimen and provides the safest action before administering the medication. (B) is not necessary at this time. Holding the prescribed antihypertensive medication (C) places the client at risk. The nurse should inform the healthcare provider of the client's medication history before proceeding with the fulfillment of the prescription (D).

The nurse is preparing the 0900 dose of losartan (Cozaar), an angiotensin II receptor blocker (ARB), for a client with hypertension and heart failure. The nurse reviews the client's laboratory results and notes that the client's serum potassium level is 5.9 mEq/L. What action should the nurse take first? a. Withhold the scheduled dose. b. Check the client's apical pulse. c. Notify the healthcare provider. d. Repeat the serum potassium level.

a. Withhold the scheduled dose. The nurse should first withhold the scheduled dose of Cozaar (A) because the client is hyperkalemic (normal range 3.5 to 5 mEq/l). Although hypokalemia is usually associated with diuretic therapy in heart failure, hyperkalemia is associated with several heart failure medications, including ARBs. Because hyperkalemia may lead to cardiac dysrhythmias, the nurse should check the apical pulse for rate and rhythm (B), and the blood pressure. Before repeating the serum study (D), the nurse should notify the healthcare provider (C) of the findings.

A client with a dysrhythmia is to receive procainamide (Pronestyl) in 4 divided doses over the next 24 hours. What dosing schedule is best for the nurse to implement? a. q6h. b. QID. c. AC and bedtime. d. PC and bedtime.

a. q6h. Pronestyl is a class 1A antidysrhythmic. It should be taken around-the-clock (A) so that a stable blood level of the drug can be maintained, thereby decreasing the possibility of hypotension (an adverse effect) occurring because of too much of the drug circulating systemically at any particular time of day. (B, C, and D) do not provide an around-the-clock dosing schedule. Pronestyl may be given with food if GI distress is a problem, but an around-the-clock schedule should still be maintained.

Cytotec

antacid that is given to patients who need NSAIDs but are at high risk for ulcer.

Tetracycline

antibiotic (acne, chlamydia, E. Coli)

diabetes insipidus (DI)

antidiuretic hormone (ADH) is not secreted, or there is a resistance of the kidney to ADH Dry inside Treats DI

lamisil

antifungal

spironolactone

antihypertensive (potassium sparing diuretic)

Cephalosphorins

ask about penicillin allergy

Cyclosporine contraindications

avoid grapefruit juice avoid sun exposure renal impairment pregnancy/lactation liver impairment

A nurse is teaching a client about the effects of diphenhydramine (Benadryl), an ingredient in the cough suppressant prescribed for the client. The nurse should plan to tell the client to take which measure while taking this medication? a) Take it on an empty stomach. b) Avoid activities requiring mental alertness. c) Use alcohol for additional effect in reducing cough. d) Avoid chewing sugarless gum or using oral rinses mouth.

b) Avoid activities requiring mental alertness. Rationale: Diphenhydramine (Benadryl) has several uses, including antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. Because the medication causes drowsiness, the client should avoid use of alcohol or central nervous system (CNS) depressants, operating a car, or engaging in other activities requiring mental acuity during use. It should be taken with food or milk to decrease gastrointestinal upset, and oral rinses, sugarless gum, or hard candy may be used to minimize dry mouth.

A client taking rifampin (Rifadin) reports, "My urine has blood in it." When the nurse assesses the urine, it is brown. Which is the nurse's best action? a) Notify the health care provider. b) Chart the finding as a normal response to the rifampin. c) Get the client into bed, and put the bed in Trendelenburg's position. d) Immediately start prescribed intravenous (IV) fluids to prevent shock.

b) Chart the finding as a normal response to the rifampin. Rationale: Brown-tinged urine is a normal finding associated with rifampin; thus, there is no need to notify the health care provider.

antiobiotic

compound that blocks the growth and reproduction of bacteria

antitussives/expectorants

control cough, promote elimination of mucus

The nurse is administering a dose of morphine sulfate to a client via an epidural catheter after nephrectomy. Before administering the medication, what should the nurse plan to do? a) Place the head of the bed flat. b) Ensure that naloxone is readily available. c) Flush the catheter with 6 mL of sterile water. d) Aspirate with a syringe to ensure presence of a cerebrospinal fluid (CSF) return.

b) Ensure that naloxone is readily available. Rationale: Epidural analgesia is used for clients with expected high levels of postoperative pain. The nurse carefully checks the medication, notes the client's level of sedation, and makes sure that the head of bed is elevated 30 degrees unless contraindicated. The nurse aspirates with a syringe to make sure that no CSF return occurs. If CSF returns with aspiration, the catheter has migrated from the epidural space into the subarachnoid space. The catheter is not flushed with 6 mL of sterile water. Naloxone should be readily available for use if respiratory depression should occur.

A client with a documented exposure to tuberculosis is being started on medication therapy with isoniazid. The nurse plans to set up appointments for the client to have which laboratory study done periodically during the course of therapy? a) Platelet count b) Liver function testing c) Serum creatinine determination d) Blood urea nitrogen determination

b) Liver function testing

Which is the nurse's priority assessment for monitoring the client taking isoniazid? a) Electrolytes b) Liver function tests c) Arterial blood gases (ABGs) d) White blood cell (WBC) counts

b) Liver function tests

Ribavirin (Virazole) is prescribed for a hospitalized child with respiratory syncytial virus (RSV). The nurse prepares to administer this medication via which route? a) Oral b) Oxygen tent c) Intramuscular d) Subcutaneous

b) Oxygen tent Rationale: Ribavirin is an antiviral respiratory medication used mainly for hospitalized children with severe RSV. Administration is via hood, face mask, or oxygen tent. Ribavirin is not administered orally, intramuscularly, or subcutaneously.

A client has been taking isoniazid for 1½ months. The client complains to the nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing which problem? a) Hypercalcemia b) Peripheral neuritis c) Small blood vessel spasm d) Impaired peripheral circulation

b) Peripheral neuritis Rationale: Isoniazid is an antitubercular medication. A common side effect of isoniazid is peripheral neuritis, manifested by numbness, tingling, and paresthesias in the extremities. This can be minimized with pyridoxine (vitamin B6) intake.

A client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to teach the client to take which action? a) Use alcohol in small amounts only. b) Report yellow eyes or skin immediately. c) Increase intake of Swiss or aged cheeses. d) Avoid vitamin supplements during therapy.

b) Report yellow eyes or skin immediately. Rationale: Isoniazid is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately, which include yellow skin and sclera. For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of isoniazid therapy.

The nurse has a prescription to give a client salmeterol (Serevent Diskus), two puffs, and beclomethasone dipropionate (Qvar), two puffs, by metered-dose inhaler. The nurse should administer the medication using which procedure? a) Beclomethasone first and then the salmeterol b) Salmeterol first and then the beclomethasone c) Alternating a single puff of each, beginning with the salmeterol d) Alternating a single puff of each, beginning with the beclomethasone

b) Salmeterol first and then the beclomethasone Rationale: Salmeterol (Serevent Diskus) is an adrenergic type of bronchodilator and beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

The nurse should monitor the client receiving the first dose of albuterol (Proventil HFA) for which side effect of this medication? a) Drowsiness b) Tachycardia c) Hyperkalemia d) Hyperglycemia

b) Tachycardia Rationale: Albuterol is a bronchodilator. Side effects can include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache, among others. The nurse monitors for these effects during therapy. The items in the other options are not side effects of this medication.

A client with tuberculosis receiving cycloserine (Seromycin Pulvules) orally twice daily must have blood drawn in 1 week to measure the serum concentration of the medication. The nurse prepares the client for this test by providing which information to the client? a) Withhold the morning dose on the day of the scheduled blood test. b) Take the morning dose and have the blood drawn 2 hours after taking the dose. c) Withhold the evening dose before the test and the dose scheduled for the morning of the test. d) Double the dose the evening before the test and withhold the morning dose on the day of the test.

b) Take the morning dose and have the blood drawn 2 hours after taking the dose. Rationale: Cycloserine is an antituberculosis medication that requires weekly serum drug level determinations to monitor for neurotoxicity and other adverse effects. Peak concentrations are measured 2 hours after dosing and should be between 25 and 35 mcg/mL.

A client has a prescription to take guaifenesin (Mucinex). The nurse should conclude that the client understands the most effective use of this medication if the client states that they need to take which action? a) Watch for irritability as a side effect. b) Take the tablet with a full glass of water. c) Take an extra dose if the cough is accompanied by fever. d) Crush the sustained-release tablet if immediate relief is needed.

b) Take the tablet with a full glass of water.

A client with Parkinson's disease is taking carbidopa-levodopa (Sinemet). Which observation by the nurse would indicate that the desired outcome of the medication is being achieved? a. Decreased blood pressure. b. Lessening of tremors. c. Increased salivation. d. Increased attention span.

b. Lessening of tremors. Sinemet increases the amount of levodopa to the CNS (dopamine to the brain). Increased amounts of dopamine improve the symptoms of Parkinson's, such as involuntary movements, resting tremors (B), shuffling gait, etc. (A) is a side effect of Sinemet. Decreased drooling would be a desired effect, not (C). Sinemet does not affect (D).

A client is taking a prescribed course of therapy with ethambutol (Myambutol). The home health nurse assesses the client at each home visit for which adverse effect of this medication? a) Orange urine b) Visual disturbances c) Hearing disturbances d) Gastrointestinal (GI) upset

b) Visual disturbances Rationale: Ethambutol causes optic neuritis, which decreases visual acuity and impairs the ability to discriminate between red and green. This form of color blindness poses a potential safety hazard in driving a motor vehicle. The client is taught to report this symptom immediately. The client also is taught to take the medication with food if GI upset occurs. Impaired hearing results from antituberculosis therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin.

When assessing an adolescent who recently overdosed on acetaminophen (Tylenol), it is most important for the nurse to assess for pain in which area of the body? a. Flank. b. Abdomen. c. Chest. d. Head.

b. Abdomen. Acetaminophen toxicity can result in liver damage; therefore, it is especially important for the nurse to assess for pain in the right upper quadrant of the abdomen (B), which might indicate liver damage. (A, C, and D) are not areas where pain would be anticipated.

The healthcare provider prescribes digitalis (Digoxin) for a client diagnosed with congestive heart failure. Which intervention should the nurse implement prior to administering the digoxin? a. Observe respiratory rate and depth. b. Assess the serum potassium level. c. Obtain the client's blood pressure. d. Monitor the serum glucose level.

b. Assess the serum potassium level. Hypokalemia (decreased serum potassium) will precipitate digitalis toxicity in persons receiving digoxin (B). (A and C) will not affect the administration of digoxin. (D) should be monitored if he/she is a diabetic and is perhaps receiving insulin.

Which medications should the nurse caution the client about taking while receiving an opioid analgesic? a. Antacids. b. Benzodiazepines. c. Antihypertensives. d. Oral antidiabetics.

b. Benzodiazepines. Respiratory depression increases with the concurrent use of opioid analgesics and other central nervous system depressant agents, such as alcohol, barbiturates, and benzodiazepines (B). (A and D) do not interact with opiates to produce adverse effects. Antihypertensives (C) may cause morphine-induced hypotension, but should not be withheld without notifying the healthcare provider.

While taking a nursing history, the client states, "I am allergic to penicillin." What related allergy to another type of antiinfective agent should the nurse ask the client about when taking the nursing history? a. Aminoglycosides. b. Cephalosporins. c. Sulfonamides. d. Tetracyclines.

b. Cephalosporins. Cross allergies exist between penicillins and cephalosporins (B). Penicillin allergies are unrelated to allergies associated with (A, C, or D).

The nurse is teaching a client with cancer about opioid management for intractable pain and tolerance related side effects. The nurse should prepare the client for which side effect that is most likely to persist during long-term use of opioids? a. Sedation. b. Constipation. c. Urinary retention. d. Respiratory depression.

b. Constipation. The client should be prepared to implement measures for constipation (B) which is the most likely persistent side effect related to opioid use. Tolerance to opiate narcotics is common, and the client may experience less sedation (A) and respiratory depression (D) as analgesic use continues. Opioids increase the tone in the urinary bladder sphincter, which causes retention (C) but may subside.

A client with congestive heart failure (CHF) is being discharged with a new prescription for the angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten). The nurse's discharge instruction should include reporting which problem to the healthcare provider? a. Weight loss. b. Dizziness. c. Muscle cramps. d. Dry mucous membranes.

b. Dizziness. Angiotensin-converting enzyme (ACE) inhibitors are used in CHF to reduce afterload by reversing vasoconstriction common in heart failure. This vasodilation can cause hypotension and resultant dizziness (B). (A) is desired if fluid overload is present, and may occur as the result of effective combination drug therapy such as diuretics with ACE inhibitors. (C) often indicates hypokalemia in the client receiving diuretics. Excessive diuretic administration may result in fluid volume deficit, manifested by symptoms such as (D).

The nitrate isosorbide dinitrate (Isordil) is prescribed for a client with angina. Which instruction should the nurse include in this client's discharge teaching plan? a. Quit taking the medication if dizziness occurs. b. Do not get up quickly. Always rise slowly. c. Take the medication with food only. d. Increase your intake of potassium-rich foods.

b. Do not get up quickly. Always rise slowly. An expected side effect of nitrates is orthostatic hypotension and the nurse should address how to prevent it--by rising slowly (B). Dizziness is expected, and the client should not quit taking the medication without notifying the healthcare provider (A). (C and D) are not indicated when taking this medication.

Which dosing schedule should the nurse teach the client to observe for a controlled-release oxycodone prescription? a. As needed. b. Every 12 hours. c. Every 24 hours. d. Every 4 to 6 hours.

b. Every 12 hours. A controlled-release oxycodone provides long-acting analgesia to relieve moderate to severe pain, so a dosing schedule of every 12 hours (B) provides the best around-the-clock pain management. Controlled-release oxycodone is not prescribed for breakthrough pain on a PRN or as needed schedule (A). (C) is inadequate for continuous pain management. Using a schedule of every 4 to 6 hours (D) may jeopardize patient safety due to cumulative effects.

A peak and trough level must be drawn for a client receiving antibiotic therapy. What is the optimum time for the nurse to obtain the trough level? a. Sixty minutes after the antibiotic dose is administered. b. Immediately before the next antibiotic dose is given. c. When the next blood glucose level is to be checked. d. Thirty minutes before the next antibiotic dose is given.

b. Immediately before the next antibiotic dose is given. Trough levels are drawn when the blood level is at its lowest, which is typically just before the next dose is given (B). (A, C, and D) do not describe the optimum time for obtaining a trough level of an antibiotic.

A client with osteoarthritis receives a new prescription for celecoxib (Celebrex) orally for symptom management. The nurse notes the client is allergic to sulfa. Which action is most important for the nurse to implement prior to administering the first dose? a. Review the client's hemoglobin results. b. Notify the healthcare provider. c. Inquire about the reaction to sulfa. d. Record the client's vital signs.

b. Notify the healthcare provider. Celebrex contains a sulfur molecule, which can lead to an allergic reaction in individuals who are sensitive to sulfonamides, so the healthcare provider should be notified of the client's allergies (B). Although (A, C, and D) are important assessments, it is most important to notify the healthcare provider for an alternate prescription.

In teaching a client who had a liver transplant about cyclosporine (Sandimmune), the nurse should encourage the client to report which adverse response to the healthcare provider? a. Changes in urine color. b. Presence of hand tremors. c. Increasing body hirsutism. d. Nausea and vomiting.

b. Presence of hand tremors. Neurological complications, such as hand tremors (B), occur in about 50% of clients taking cyclosporine and should be reported. Although this drug can be nephrotoxic, (A) typically does not occur. (C and D) are common side effects, but are not usually severe.

Following heparin treatment for a pulmonary embolism, a client is being discharged with a prescription for warfarin (Coumadin). In conducting discharge teaching, the nurse advises the client to have which diagnostic test monitored regularly after discharge? a. Perfusion scan. b. Prothrombin Time (PT/INR). c. Activated partial thromboplastin (APTT). d. Serum Coumadin level (SCL).

b. Prothrombin Time (PT/INR). When used for a client with pulmonary embolus, the therapeutic goal for warfarin therapy is a PT 1 to 2 times greater than the control, or an INR of 2 to 3 (B). A perfusion might be performed to monitor lung function, but not monthly (A). APTT is monitored for the client receiving heparin therapy (C). A blood level for Coumadin cannot be measured (D).

A client with heart failure is prescribed spironolactone (Aldactone). Which information is most important for the nurse to provide to the client about diet modifications? a. Do not add salt to foods during preparation. b. Refrain for eating foods high in potassium. c. Restrict fluid intake to 1000 ml per day. d. Increase intake of milk and milk products.

b. Refrain for eating foods high in potassium. Spironolactone (Aldactone), an aldosterone antagonist, is a potassium-sparing diuretic, so a diet high in potassium should be avoided (B), including potassium salt substitutes, which can lead to hyperkalemia. Although (A) is a common diet modification in heart failure, the risk of hyperkalemia is more important with Aldactone. Restriction of fluids (C) or increasing milk and milk products (D) are not indicated with this prescription.

A 43-year-old female client is receiving thyroid replacement hormone following a thyroidectomy. What adverse effects associated with thyroid hormone toxicity should the nurse instruct the client to report promptly to the healthcare provider? a. Tinnitus and dizziness. b. Tachycardia and chest pain. c. Dry skin and intolerance to cold. d. Weight gain and increased appetite.

b. Tachycardia and chest pain. Thyroid replacement hormone increases the metabolic rate of all tissues, so common signs and symptoms of toxicity include tachycardia and chest pain (B). (A, C, and D) do not indicate a thyroid hormone toxicity.

The nurse is reviewing the use of the patient-controlled analgesia (PCA) pump with a client in the immediate postoperative period. The client will receive morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes per PCA to total 5 mg IV maximally per hour. What assessment has the highest priority before initiating the PCA pump? a. The expiration date on the morphine syringe in the pump. b. The rate and depth of the client's respirations. c. The type of anesthesia used during the surgical procedure. d. The client's subjective and objective signs of pain.

b. The rate and depth of the client's respirations. A life-threatening side effect of intravenous administration of morphine sulfate, an opiate narcotic, is respiratory depression (B). The PCA pump should be stopped and the healthcare provider notified if the client's respiratory rate falls below 12 breaths per minute, and the nurse should anticipate adjustments in the client's dosage before the PCA pump is restarted. (A, C, and D) provide helpful information, but are not as high a priority as the assessment described in (B).

In evaluating the effects of lactulose (Cephulac), which outcome would indicate that the drug is performing as intended? a. An increase in urine output. b. Two or three soft stools per day. c. Watery, diarrhea stools. d. Increased serum bilirubin.

b. Two or three soft stools per day. Lactulose is administered to reduce blood ammonia by excretion of ammonia through the stool. Two to three stools a day indicate that lactulose is performing as intended (B). (A) would be expected if the patient received a diuretic. (C) would indicate an overdose of lactulose and is not expected. Lactulose does not affect (D).

Which symptoms are serious adverse effects of beta-adrenergic blockers such as propranolol (Inderal)? a. Headache, hypertension, and blurred vision. b. Wheezing, hypotension, and AV block. c. Vomiting, dilated pupils, and papilledema. d. Tinnitus, muscle weakness, and tachypnea.

b. Wheezing, hypotension, and AV block. (B) represents the most serious adverse effects of beta-blocking agents. AV block is generally associated with bradycardia and results in potentially life-threatening decreases in cardiac output. Additionally, wheezing secondary to bronchospasm and hypotension represent life-threatening respiratory and cardiac disorders. (A, C, and D) are not associated with beta-blockers.

The healthcare provider prescribes naloxone (Narcan) for a client in the emergency room. Which assessment data would indicate that the naloxone has been effective? The client's a. statement that the chest pain is better. b. respiratory rate is 16 breaths/minute. c. seizure activity has stopped temporarily. d. pupils are constricted bilaterally.

b. respiratory rate is 16 breaths/minute. Naloxone (Narcan) is a narcotic antagonist that reverses the respiratory depression effects of opiate overdose, so assessment of a normal respiratory rate (B) would indicate that the respiratory depression has been halted. (A, C, and D) are not related to naloxone (Narcan) administration.

Atenolol

beta blocker, treats hypertension and angina Teaching: Orthostatic hypotension Taper or rebound hypertension

Coumadin (warfarin)

blood thinner Bleeding precautions

A client who has been receiving theophylline by the intravenous (IV) route has the medication prescription changed to an immediate-release oral form of the medication. After discontinuing the IV medication, when should the nurse schedule the first dose of the oral medication? a) Just after the next meal b) Just before the next meal c) 4 hours after discontinuing the IV form d) Immediately on discontinuing the IV form

c) 4 hours after discontinuing the IV form Rationale: With immediate-release preparations, oral theophylline should be administered 4 to 6 hours after discontinuing the IV form of the medication. If the sustained-release form is used, the first oral dose should be administered immediately on discontinuation of the IV infusion.

A client has been given a prescription for benzonatate (Tessalon). Which observation should the nurse look for to evaluate the effectiveness of the medication? a) Increasing the client's comfort level b) Decreasing the client's anxiety level c) Calming the client's persistent cough d) Eliminating the client's nausea and vomiting

c) Calming the client's persistent cough

A client has been started on long-term therapy with rifampin (Rifadin). The nurse should provide which information to the client about the medication? a) Should always be taken with food or antacids b) Should be double-dosed if one dose is forgotten c) Causes orange discoloration of sweat, tears, urine, and feces d) May be discontinued independently if symptoms are gone in 3 months

c) Causes orange discoloration of sweat, tears, urine, and feces Rationale: Rifampin should be taken exactly as directed. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a health care provider. The medication should be administered on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin causes orange-red discoloration of body secretions and will stain soft contact lenses permanently.

Terbutaline is prescribed for a client with bronchitis. The nurse understands that this medication should be used with caution if which medical condition is present in the client? a) Osteoarthritis b) Hypothyroidism c) Diabetes mellitus d) Polycystic disease

c) Diabetes mellitus Rationale: Terbutaline is a bronchodilator and is contraindicated in clients with hypersensitivity to sympathomimetics. It should be used with caution in clients with impaired cardiac function, diabetes mellitus, hypertension, hyperthyroidism, or a history of seizures. The medication may increase blood glucose levels.

A client taking albuterol (ProAir HFA) by inhalation cannot cough up secretions. What should the nurse suggest that the client do to assist in expectoration of secretions? a) Get more exercise each day. b) Use a dehumidifier in the home. c) Drink increased amounts of fluids every day. d) Take an extra dose of albuterol before bedtime.

c) Drink increased amounts of fluids every day.

A client is taking cetirizine (Zyrtec). The nurse should inform the client of which side effect of this medication? a) Diarrhea b) Excitability c) Drowsiness d) Excess salivation

c) Drowsiness Rationale: Cetirizine (Zyrtec) is an antihistamine; frequent side effects are drowsiness or sedation. Others include blurred vision, hypertension (and sometimes hypotension), dry mouth, constipation, urinary retention, and sweating.

A client with tuberculosis is being started on antituberculosis therapy with isoniazid. Before giving the client the first dose, the nurse should ensure that which baseline study has been completed? a) Electrolyte levels b) Coagulation times c) Liver enzyme levels d) Serum creatinine level

c) Liver enzyme levels Rationale: Isoniazid therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 or abuses alcohol.

Zafirlukast (Accolate) is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication? a) Platelet count b) Neutrophil count c) Liver function tests d) Complete blood count

c) Liver function tests Rationale: Zafirlukast (Accolate) is a leukotriene receptor antagonist used in the prophylaxis and long-term treatment of bronchial asthma. Zafirlukast is used with caution in clients with impaired hepatic function. Liver function laboratory tests should be performed to obtain a baseline, and the levels should be monitored during administration of the medication.

A nurse is preparing to administer albuterol (Proventil HFA) to a client. Which parameters should the nurse assess before and during therapy? a) Nausea and vomiting b) Headache and level of consciousness c) Lung sounds and presence of dyspnea d) Urine output and blood urea nitrogen level

c) Lung sounds and presence of dyspnea

The nurse would expect the health care provider (HCP) to add which medication to the regimen of the client receiving isoniazid? a) Niacin b) Neurontin c) Pyridoxine (vitamin B6) d) Cyanocobalamin (vitamin B12)

c) Pyridoxine (vitamin B6) Rationale: isoniazid is an anti-tuberculosis medication. Clients receiving isoniazid can develop neuropathy, and the agent of choice to help prevent this adverse effect is pyridoxine, vitamin B6. Niacin is used to lower the cholesterol level. Neurontin is used to prevent seizures, and cyanocobalamin is used to treat anemia.

The nurse is preparing to administer a dose of naloxone hydrochloride intravenously to a client with an intravenous opioid overdose. Which supportive medical equipment should the nurse plan to have at the client's bedside if needed? a) Nasogastric tube b) Paracentesis tray c) Resuscitation equipment d) Central line insertion tray

c) Resuscitation equipment Rationale: The nurse administering naloxone for suspected opioid overdose should have resuscitation equipment readily available to support naloxone therapy if it is needed. Other adjuncts that may be needed include oxygen, mechanical ventilator, and vasopressors.

The health care provider (HCP) prescribes cromolyn (Intal) for the client with asthma. The nurse identifies that the client correctly understands the purpose of this medication when the client states that the medication will produce which effect? a) Promote bronchodilation. b) Decrease the risk of infection. c) Suppress an allergic response. d) Eliminate the need for a rescue inhaler.

c) Suppress an allergic response. Rationale: Cromolyn is a first-line therapy for prophylactic treatment of asthma; it is a mast-cell stabilizer, antiasthmatic, and antiallergic. The medication acts in part by stabilizing the cytoplasmic membrane of mast cells, thereby preventing release of histamine and other mediators. It is not a bronchodilator. It does not decrease the risk of infection. It does not eliminate the need for the rescue inhaler.

A client diagnosed with active tuberculosis has been prescribed a combination of isoniazid and rifampin (Rifadin) for treatment. The nurse teaches the client to perform which action? a) Report any change in urine color. b) Take both medications with food. c) Take both medications together once a day. d) Expect to take the medication for 2 to 3 weeks.

c) Take both medications together once a day. Rationale: Rifampin in combination with isoniazid prevents the emergence of drug-resistant organisms. This combination, taken together daily, eliminates the tubercle bacilli from the sputum and improves clinical status. Rifampin produces a harmless red-orange color in all body fluids and should be taken along with the isoniazid 1 hour before or 2 hours after eating to maximize absorption. The treatment regimen is maintained for at least 6 months for effectiveness, and the therapeutic effect may be evident in 2 to 3 weeks.

A client has a prescription to take guaifenesin (Mucinex). The nurse determines that the client understands the proper administration of this medication if the client states that he or she will perform which action? a) Take an extra dose if fever develops. b) Take the medication with meals only. c) Take the tablet with a full glass of water. d) Decrease the amount of daily fluid intake.

c) Take the tablet with a full glass of water. Rationale: Guaifenesin (Mucinex) is an expectorant and should be taken with a full glass of water to decrease the viscosity of secretions. Extra doses should not be taken. The client should contact the health care provider if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache. Fluids are needed to decrease the viscosity of secretions. The medication does not have to be taken with meals.

A client with tuberculosis (TB) has a prescription for rifampin (Rifadin). What instruction should the nurse include in the client's teaching plan? a) Yellow-colored skin is common with this medication. b) The medication must always be taken on an empty stomach. c) Wearing glasses instead of soft contact lenses will be necessary. d) As soon as the cultures come back negative, the medication may be stopped.

c) Wearing glasses instead of soft contact lenses will be necessary.

A client asks the nurse if glipizide (Glucotrol) is an oral insulin. Which response should the nurse provide? a. "Yes, it is an oral insulin and has the same actions and properties as intermediate insulin." b. "Yes, it is an oral insulin and is distributed, metabolized, and excreted in the same manner as insulin." c. "No, it is not an oral insulin and can be used only when some beta cell function is present." d. "No, it is not an oral insulin, but it is effective for those who are resistant to injectable insulins."

c. "No, it is not an oral insulin and can be used only when some beta cell function is present." An effective oral form of insulin has not yet been developed (C) because when insulin is taken orally, it is destroyed by digestive enzymes. Glipizide (Glucotrol) is an oral hypoglycemic agent that enhances pancreatic production of insulin. (A, B, and D) do not provide accurate information.

A client is taking hydromorphone (Dilaudid) PO q4h at home. Following surgery, Dilaudid IV q4h PRN and butorphanol tartrate (Stadol) IV q4h PRN are prescribed for pain. The client received a dose of the Dilaudid IV four hours ago, and is again requesting pain medication. What intervention should the nurse implement? a. Alternate the two medications q4h PRN for pain. b. Alternate the two medications q2h PRN for pain. c. Administer only the Dilaudid q4h PRN for pain. d. Administer only the Stadol q4h PRN for pain.

c. Administer only the Dilaudid q4h PRN for pain. Dilaudid is an opioid agonist. Stadol is an opioid agonist-antagonist. Use of an agonist-antagonist for the client who has been receiving opioid agonists may result in abrupt withdrawal symptoms, and should be avoided (C). (A, B, and D) do not reflect good nursing practice.

A client's dose of isosorbide dinitrate (Imdur) is increased from 40 mg to 60 mg PO daily. When the client reports the onset of a headache prior to the next scheduled dose, which action should the nurse implement? a. Hold the next scheduled dose of Imdur 60 mg and administer a PRN dose of acetaminophen (Tylenol). b. Administer the 40 mg of Imdur and then contact the healthcare provider. c. Administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol). d. Do not administer the next dose of Imdur or any acetaminophen until notifying the healthcare provider.

c. Administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol). Imdur is a nitrate which causes vasodilation. This vasodilation can result in headaches, which can generally be controlled with acetaminophen (C) until the client develops a tolerance to this adverse effect. (A and B) may result in the onset of angina if a therapeutic level of Imdur is not maintained. Lying down (D) is less likely to reduce the headache than is a mild analgesic.

A client receiving albuterol (Proventil) tablets complains of nausea every evening with her 9:00 p.m. dose. What action can the nurse take to alleviate this side effect? a. Change the time of the dose. b. Hold the 9 p.m. dose. c. Administer the dose with a snack. d. Administer an antiemetic with the dose.

c. Administer the dose with a snack. Administering oral doses with food (C) helps minimize GI discomfort. (A) would be appropriate only if changing the time of the dose corresponds to meal times while at the same time maintaining an appropriate time interval between doses. (B) would disrupt the dosing schedule, and could result in a nontherapeutic serum level of the medication. (D) should not be attempted before other interventions, such as (C), have been proven ineffective in relieving the nausea.

Adrenocorticotropic hormone (ACTH)

controls production of cortisol

Upon admission to the emergency center, an adult client with acute status asthmaticus is prescribed this series of medications. In which order should the nurse administer the prescribed medications? (Arrange from first to last.) a. Prednisone (Deltasone) orally. b. Gentamicin (Garamycin) IM. c. Albuterol (Proventil) puffs. d. Salmeterol (Serevent Diskus).

c. Albuterol (Proventil) puffs. d. Salmeterol (Serevent Diskus). a. Prednisone (Deltasone) orally. b. Gentamicin (Garamycin) IM. Status asthmaticus is potentially a life-threatening respiratory event, so albuterol, a beta2 adrenergic agonist and short acting bronchodilator, should be administered by inhalation first to provide rapid and deep topical penetration to relieve bronchospasms, dilate the bronchioles, and increase oxygenation. In stepwise management of persistent asthma, a long-action bronchodilator, such as salmeterol (Serevent Diskus), with a 12-hour duration of action should be given next. Prednisone, an oral corticosteroid, provides prolonged anti-inflammatory effects and should be given after the client's respiratory distress begins to resolves. Gentamicin, an antibiotic, is given deep IM, which can be painful, and may require repositioning the client, so should be last in the sequence.

The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with osteoarthritis of the hands. The client tells the nurse that the drug does not seem to be effective after three weeks. Which is the best response for the nurse to provide? a. The frequency of the dosing is necessary to increase the effectiveness. b. Therapeutic blood levels of this drug are reached in 4 to 6 weeks. c. Another type of nonsteroidal antiinflammatory drug may be indicated. d. Systemic corticosteroids are the next drugs of choice for pain relief.

c. Another type of nonsteroidal antiinflammatory drug may be indicated. Individual responses to nonsteroidal antiinflammatory drugs are variable, so (C) is the best response. Naproxen is usually prescribed every 8 hours, so (A) is not indicated. The peak for naproxen is one to two hours, not (B). Corticosteroids are not indicated for osteoarthritis (D).

Which action is most important for the nurse to implement prior to the administration of the antiarrhythmic drug adenosine (Adenocard)? a. Assess pupillary response to light. b. Instruct the client that facial flushing may occur. c. Apply continuous cardiac monitoring. d. Request that family members leave the room.

c. Apply continuous cardiac monitoring. Adenosine (Adenocard) is an antiarrhythmic drug used to restore a normal sinus rhythm in clients with rapid supraventricular tachycardia. The client's heart rate should be monitored continuously (C) for the onset of additional arrhythmias while receiving adenosine. (A and B) are valuable nursing interventions, but are of less importance than monitoring for potentially fatal arrhythmias. Family members may be asked to leave the room because of the potential for an emergency situation (D), however, this is also of less priority than (C).

Which antidiarrheal agent should be used with caution in clients taking high dosages of aspirin for arthritis? a. Loperamide (Imodium). b. Probanthine (Propantheline). c. Bismuth subsalicylate (Pepto Bismol). d. Diphenoxylate hydrochloride with atropine (Lomotil).

c. Bismuth subsalicylate (Pepto Bismol). Bismuth subsalicylate (Pepto Bismol) contains a subsalicylate that increases the potential for salicylate toxicity when used concurrently with aspirin (acetylsalicylic acid, another salicylate preparation). (A, B, and D) do not pose the degree of risk of drug interaction with aspirin as Pepto Bismol would.

A client is receiving metoprolol (Lopressor SR). What assessment is most important for the nurse to obtain? a. Temperature. b. Lung sounds. c. Blood pressure. d. Urinary output.

c. Blood pressure. It is most important to monitor the blood pressure (C) of clients taking this medication because Lopressor is an antianginal, antiarrhythmic, antihypertensive agent. While (A and B) are important data to obtain on any client, they are not as important for a client receiving Lopressor as (C). Intake and output ratios and daily weights should be monitored while taking Lopressor to assess for signs and symptoms of congestive heart failure, but (D) alone does not have the importance of (C).

A postoperative client has been receiving a continuous IV infusion of meperidine (Demerol) 35 mg/hr for four days. The client has a PRN prescription for Demerol 100 mg PO q3h. The nurse notes that the client has become increasingly restless, irritable and confused, stating that there are bugs all over the walls. What action should the nurse take first? a. Administer a PRN dose of the PO meperidine (Demerol). b. Administer naloxone (Narcan) IV per PRN protocol. c. Decrease the IV infusion rate of the meperidine (Demerol) per protocol. d. Notify the healthcare provider of the client's confusion and hallucinations.

c. Decrease the IV infusion rate of the meperidine (Demerol) per protocol. The client is exhibiting symptoms of Demerol toxicity, which is consistent with the large dose of Demerol received over four days. (C) is the most effective action to immediately decrease the amount of serum Demerol. (A) will increase the toxic level of medication in the bloodstream. Naloxone (B) is an opioid antagonist that is used during an opioid overdose, but it is not beneficial during Demerol toxicity and can precipitate seizures. The healthcare provider should be notified (D), but that is not the initial action the nurse should take; first the amount of drug infusing should be decreased.

The nurse is assessing a client who is experiencing anaphylaxis from an insect sting. Which prescription should the nurse prepare to administer this client? a. Dopamine. b. Ephedrine. c. Epinephrine. d. Diphenhydramine.

c. Epinephrine. Epinephrine (C) is an adrenergic agent that stimulate beta receptors to increase cardiac automaticity in cardiac arrest and relax bronchospasms in anaphylaxis. Dopamine (A) is a vasopressor used to treat clients with shock. Ephedrine (B) causes peripheral vasoconstriction and is used in the treatment of nasal congestion. Diphenhydramine (D) is an antihistamine decongestant used in the treatment of mild allergic reactions and motion sickness.

A medication that is classified as a beta-1 agonist is most commonly prescribed for a client with which condition? a. Glaucoma. b. Hypertension. c. Heart failure. d. Asthma.

c. Heart failure. Beta-1 agonists improve cardiac output by increasing the heart rate and blood pressure and are indicated in heart failure (C), shock, atrioventricular block dysrhythmias, and cardiac arrest. Glaucoma (A) is managed using adrenergic agents and beta-adrenergic blocking agents. Beta-1 blocking agents are used in the management of hypertension (B). Medications that stimulate beta-2 receptors in the bronchi are effective for bronchoconstriction in respiratory disorders, such as asthma (D).

Which nursing intervention is most important when caring for a client receiving the antimetabolite cytosine arabinoside (Arc-C) for chemotherapy? a. Hydrate the client with IV fluids before and after infusion. b. Assess the client for numbness and tingling of extremities. c. Inspect the client's oral mucosa for ulcerations. d. Monitor the client's urine pH for increased acidity.

c. Inspect the client's oral mucosa for ulcerations. Cytosine arabinoside (Arc-C) affects the rapidly growing cells of the body, therefore stomatitis and mucosal ulcerations are key signs of antimetabolite toxicity (C). (A, B, and D) are not typical interventions associated with the administration of antimetabolites.

A client who was prescribed atorvastatin (Lipitor) one month ago calls the triage nurse at the clinic complaining of muscle pain and weakness in his legs. Which statement reflects the correct drug-specific teaching the nurse should provide to this client? a. Increase consumption of potassium-rich foods since low potassium levels can cause muscle spasms. b. Have serum electrolytes checked at the next scheduled appointment to assess hyponatremia, a cause of cramping. c. Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect. d. Be sure to consume a low-cholesterol diet while taking the drug to enhance the effectiveness of the drug.

c. Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect. Myopathy, suggested by the leg pain and weakness, is a serious, and potentially life-threatening, complication of Lipitor, and should be evaluated immediately by the healthcare provider (C). Although electrolyte imbalances such as (A or B) can cause muscle spasms in some cases, this is not the likely cause of leg pain in the client receiving Lipitor, and evaluation by the healthcare provider should not be delayed for any reason. A low-cholesterol diet is recommended for those taking Lipitor since the drug is used to lower total cholesterol (D), but diet is not related to the leg pain symptom.

The nurse is assessing the effectiveness of high dose aspirin therapy for an 88-year-old client with arthritis. The client reports that she can't hear the nurse's questions because her ears are ringing. What action should the nurse implement? a. Refer the client to an audiologist for evaluation of her hearing. b. Advise the client that this is a common side effect of aspirin therapy. c. Notify the healthcare provider of this finding immediately. d. Ask the client to turn off her hearing aid during the exam.

c. Notify the healthcare provider of this finding immediately. Tinnitus is an early sign of salicylate toxicity. The healthcare provider should be notified immediately (C), and the medication discontinued. (A and D) are not needed, and (B) is inaccurate.

A client has myxedema, which results from a deficiency of thyroid hormone synthesis in adults. The nurse knows that which medication would be contraindicated for this client? a. Liothyronine (Cytomel) to replace iodine. b. Furosemide (Lasix) for relief of fluid retention. c. Pentobarbital sodium (Nembutal Sodium) for sleep. d. Nitroglycerin (Nitrostat) for angina pain.

c. Pentobarbital sodium (Nembutal Sodium) for sleep. Persons with myxedema are dangerously hypersensitive to narcotics, barbiturates (C), and anesthetics. They do tolerate liothyronine (Cytomel) (A) and usually receive iodine replacement therapy. These clients are also susceptible to heart problems such as angina for which nitroglycerin (Nitrostat) (D) would be indicated, and congestive heart failure for which furosemide (Lasix) (B) would be indicated.

Which nursing diagnosis is important to include in the plan of care for a client receiving the angiotensin-2 receptor antagonist irbesartan (Avapro)? a. Fluid volume deficit. b. Risk for infection. c. Risk for injury. d. Impaired sleep patterns.

c. Risk for injury. Avapro is an antihypertensive agent, which acts by blocking vasoconstrictor effects at various receptor sites. This can cause hypotension and dizziness, placing the client at high risk for injury (C). Avapro does not act as a diuretic (A), impact the immune system (B), or alter sleep patterns (D).

An antacid (Maalox) is prescribed for a client with peptic ulcer disease. The nurse knows that the purpose of this medication is to a. decrease production of gastric secretions. b. produce an adherent barrier over the ulcer. c. maintain a gastric pH of 3.5 or above. d. decrease gastric motor activity.

c. maintain a gastric pH of 3.5 or above. The objective of antacids is to neutralize gastric acids and keep pH of 3.5 or above (C) which is necessary for pepsinogen inactivity. (A) is the purpose of H2 receptor antagonists (cimetidine, ranitidine). (B) is the purpose of sucralfate (Carafate). (D) is the purpose of anticholinergic drugs which are often used in conjunction with antacids to allow the antacid to remain in the stomach longer.

Verapamil

calcium channel blocker; lowers HR and BP

feverfew interactions

can cause increased risk of bleeding in clients taking NSAIDS, heparin and warfarin. Discontinue 2 weeks before elective surgery.

Solumedrol (Glucosteroid)

can lead to osteoporosis

narcotic agonists

cause analgesia, sedation, or euphoria

Vancomycin

class of medications called glycopeptide antibiotics; works by killing bacteria in the intestines

Which of the following statements by a client taking montelukast (Singulair) should indicate the need for further teaching? a) "I will need to have my liver function checked." b) "I can take the medication with food or without." c) "I may be able to decrease the use of my metered-dose inhaler." d) "I will take the medication when I first notice I am having trouble breathing."

d) "I will take the medication when I first notice I am having trouble breathing." Rationale: Montelukast cannot be used for quick relief of an asthma attack because effects of the medication develop too slowly. For prophylaxis and maintenance therapy of asthma, maximal effects develop within 24 hours of the first dose and are maintained with once-daily dosing in the evening.

The nurse has just administered the first dose of omalizumab (Xolair) to a client. Which statement by the client would alert the nurse that the client may be experiencing a life-threatening effect? a) "I have a severe headache." b) "My feet are quite swollen." c) "I am nauseated and may vomit." d) "My lips and tongue are swollen."

d) "My lips and tongue are swollen." Rationale: Omalizumab is an antiinflammatory used for long-term control of asthma. Anaphylactic reactions can occur with the administration of omalizumab. The nurse administering the medication should monitor for adverse reactions of the medication. Swelling of the lips and tongue are an indication of an adverse reaction.

Isoniazid is prescribed for a child with human immunodeficiency virus infection who has a positive Mantoux tuberculin skin test result. The mother of the child asks the nurse how long the child will need to take the medication. For how long should the nurse tell the mother the medication will need to be taken? a) 4 months b) 6 months c) 9 months d) 12 months

d) 12 months Rationale: For children with human immunodeficiency virus infection who demonstrate a positive Mantoux tuberculin skin test result, a minimum of 12 months of treatment with isoniazid is recommended.

Which is the expected duration for the pharmacological management of latent tuberculosis (TB)? a) 10 days b) 14 days c) 1 month d) 9 months

d) 9 months Rationale: The duration of therapy for latent TB must be at least 6 months. The other time frames for administration are too short to effect resolution of the infection.

A client with an exacerbation of chronic obstructive pulmonary disease has been on oral glucocorticoids and is currently being weaned to triamcinolone (Azmacort) by inhalation. The nurse determines that the client understands the potential adverse effects to watch for during this medication change when the client states the need to report which signs and symptoms? a) Chills, fever, and generalized rash b) Vomiting, diarrhea, and increased thirst c) Blurred vision, headache, and insomnia d) Anorexia, nausea, weakness, and fatigue

d) Anorexia, nausea, weakness, and fatigue Rationale: The client being changed from oral to inhalation glucocorticoids could experience signs of adrenal insufficiency. The nurse teaches the client to report anorexia, nausea, weakness, and fatigue. Other signs that can be detected and are objective include hypotension and hypoglycemia.

A client with chronic obstructive pulmonary disease (COPD) is being changed from an oral glucocorticoid to triamcinolone (Azmacort) by inhalation. The nurse plans to monitor the client for which signs/symptoms during the change? a) Chills, fever, generalized rash b) Vomiting and diarrhea, increased thirst c) Blurred vision, headache, and insomnia d) Anorexia, nausea, weakness, and fatigue

d) Anorexia, nausea, weakness, and fatigue Rationale: Triamcinolone (Azmacort) is an adrenocorticosteroid. The client who is being changed from an oral to an inhalation glucocorticoid could experience signs of adrenal insufficiency. The nurse should monitor the client for anorexia, nausea, weakness, and fatigue. The nurse should also monitor for hypotension and hypoglycemia.

A cromolyn sodium inhaler is prescribed for a client with allergic asthma. The nurse provides instructions regarding the side and adverse effects of this medication and should tell the client that which undesirable effect is associated with this medication? a) Insomnia b) Constipation c) Hypotension d) Bronchospasm

d) Bronchospasm Rationale: Cromolyn sodium is an inhaled nonsteroidal antiallergy agent and a mast cell stabilizer. Undesirable effects associated with inhalation therapy of cromolyn sodium are bronchospasm, cough, nasal congestion, throat irritation, and wheezing. Clients receiving this medication orally may experience pruritus, nausea, diarrhea, and myalgia.

A nurse has administered a dose of salmeterol (Serevent Diskus) to a client. The client develops a generalized rash and urticaria, and the eyelids begin to swell. Which action should the nurse take? a) Apply a lanolin-based cream to the rash. b) Encourage the client to drink fluids quickly. c) Assess the client's vision with a Snellen chart. d) Call the health care provider (HCP) immediately.

d) Call the health care provider (HCP) immediately. Rationale: Hypersensitivity reaction can occur in clients taking salmeterol. Signs include rash, urticaria, and swelling of the face, lips, or eyelids. The nurse should call the HCP immediately if any of these occur.

The nurse has given a client taking ethambutol (Myambutol) information about the medication. The nurse determines that the client understands the instructions if the client states he or she will immediately report which finding? a) Impaired sense of hearing b) Gastrointestinal side effects c) Orange-red discoloration of body secretions d) Difficulty in discriminating the color red from green

d) Difficulty in discriminating the color red from green Rationale: Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client also is taught to take the medication with food if gastrointestinal upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin (Rifadin).

A clinic nurse is assessing a client who has been on isoniazid for 6 months. Which client complaint should most concern the nurse? a) Dry mouth b) Cramping diarrhea c) Frequent headaches d) Difficulty tying shoes

d) Difficulty tying shoes Rationale: The client complaint that should most concern the nurse is difficulty tying shoes because this may indicate neuropathy. Dose-related peripheral neuropathy is one of the more common adverse effects of isoniazid.

A client taking theophylline has a serum theophylline level of 15 mcg/mL. How does the nurse interpret this laboratory value? a) Below therapeutic range b) In excess of the therapeutic range c) Near the top of the therapeutic range d) In the middle of the therapeutic range

d) In the middle of the therapeutic range Rationale: The normal therapeutic range for the theophylline level is 10 to 20 mcg/mL. A level above 20 mcg/mL is considered toxic. The value of 15 mcg/mL places the client in the middle of the therapeutic range.

A postpartum nurse is caring for a client with an epidural catheter in place for opioid analgesic administration following cesarean birth. If the client develops respiratory depression and requires naloxone (Narcan) as an antidote, she may develop which complaint? a) Bradycardia b) Decrease in sensation c) Sudden onset of itching d) Increase in her pain level

d) Increase in her pain level Rationale: Opioids are used for epidural analgesia. Naloxone is an opioid antagonist, which reverses the effects of opioids. If it is given, the client may complain of an increase in her pain level. One of the side effects of naloxone is rapid pulse or tachycardia, not bradycardia. Sudden onset of itching would not be a typical reaction. Naloxone would not affect sensation.

The nurse is administering a dose of pirbuterol (Maxair Autohaler) to a client. The nurse should monitor for which side/adverse effect of this medication? a) Drowsiness b) Hypokalemia c) Hyperglycemia d) Increased pulse and blood pressure

d) Increased pulse and blood pressure Rationale: Pirbuterol is an adrenergic bronchodilator. Side/adverse effects can include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache. The nurse monitors for these effects during therapy.

Cromolyn sodium is prescribed for the client with allergic asthma. The nurse should plan care understanding that which is an action of this medication? a) Dilate the bronchi. b) Increase the number of eosinophils. c) Promote the migration of eosinophils into the inflammatory site. d) Inhibit the release of mediators from mast cells after exposure to an antigen.

d) Inhibit the release of mediators from mast cells after exposure to an antigen. Rationale: Cromolyn sodium is an antiasthmatic, antiallergic, and mast cell stabilizer that inhibits the release of mediators from mast cells after exposure to an antigen. It can also interrupt the migration of eosinophils into the inflammatory site and decrease the number of eosinophils. These actions decrease airway hyperresponsiveness in some clients with asthma. It has no bronchodilating action.

A home care nurse has observed a client self-administer a dose of an adrenergic bronchodilator via metered-dose inhaler. Within a short time, the client begins to wheeze loudly. The nurse understands that this is the result of which occurrence? a) Insufficient dosage of the medication, which needs to be increased b) Probable interaction of this medication with an over-the-counter cold remedy c) Tolerance to the medication, indicating a need for a stronger type of bronchodilator d) Paradoxical bronchospasm, which must be reported to the health care provider (HCP)

d) Paradoxical bronchospasm, which must be reported to the health care provider (HCP) Rationale: The client taking adrenergic bronchodilators may experience paradoxical bronchospasm, which is evidenced by the client's wheezing. This can occur with excessive use of inhalers. Further medication should be withheld and the HCP should be notified.

A client has been taking pyrazinamide (Pyrazinamide) for 6 months. The nurse determines that the medication is effective if which cultures yield a negative result? a) Urine b) Blood c) Wound d) Sputum

d) Sputum Rationale: Pyrazinamide is an antituberculosis medication that is given in conjunction with other antituberculosis medications. Its use may be discontinued by the prescriber if sputum cultures become negative.

A client has been taking pyrazinamide for 1 month. The client asks the nurse whether the therapy is due to be terminated soon. The nurse determines that the medication probably will be continued based on a positive finding in which report? a) Blood culture b) Urine culture c) Wound culture d) Sputum culture

d) Sputum culture

A client is scheduled to receive acetylcysteine (Mucomyst) 20% solution diluted in 0.9% normal saline by nebulizer. Which outcome would the nurse expect to see as a result of the administration of this medication? a) Bronchodilation b) Decreased coughing c) Absence of wheezing d) Thinning of respiratory secretions

d) Thinning of respiratory secretions Rationale: Acetylcysteine is administered to thin bronchial secretions and is considered a mucolytic. The other three options are the outcomes of respiratory medication therapy, but not of acetylcysteine.

A client who has been taking levodopa PO TID to control the symptoms of Parkinson's disease has a new prescription for sustained release levodopa/carbidopa (Sinemet 25/100) PO BID. The client took his levodopa at 0800. Which instruction should the nurse include in the teaching plan for this client? a. "Take the first dose of Sinemet today, as soon as your prescription is filled." b. "Since you already took your levodopa, wait until tomorrow to take the Sinemet." c. "Take both drugs for the first week, then switch to taking only the Sinemet." d. "You can begin taking the Sinemet this evening, but do not take any more levodopa."

d. "You can begin taking the Sinemet this evening, but do not take any more levodopa." Carbidopa significantly reduces the need for levodopa in clients with Parkinson's disease, so the new prescription should not be started until eight hours after the previous dose of levodopa (D), but can be started the same day (B). (A and C) may result in toxicity.

Which client should the nurse identify as being at highest risk for complications during the use of an opioid analgesic? a. An older client with Type 2 diabetes mellitus. b. A client with chronic rheumatoid arthritis. c. A client with a open compound fracture. d. A young adult with inflammatory bowel disease.

d. A young adult with inflammatory bowel disease. The principal indication for opioid use is acute pain, and a client with inflammatory bowel disease (D) is at risk for toxic megacolon or paralytic ileus related to slowed peristalsis, a side effect of morphine. Adverse effects of morphine do not pose as great a risk for (A, B, and C) as the client with bowel disease.

client is receiving clonidine (Catapres) 0.1 mg/24hr via transdermal patch. Which assessment finding indicates that the desired effect of the medication has been achieved? a. Client denies recent episodes of angina. b. Change in peripheral edema from +3 to +1. c. Client denies recent nausea or vomiting. d. Blood pressure has changed from 180/120 to 140/70.

d. Blood pressure has changed from 180/120 to 140/70. Catapres acts as a centrally-acting analgesic and antihypertensive agent. (D) indicates a reduction in hypertension. Catapres does not affect (A, B, or C), so these findings do not indicate desired outcomes of Catapres.

Which change in data indicates to the nurse that the desired effect of the angiotensin II receptor antagonist valsartan (Diovan) has been achieved? a. Dependent edema reduced from +3 to +1. b. Serum HDL increased from 35 to 55 mg/dl. c. Pulse rate reduced from 150 to 90 beats/minute. d. Blood pressure reduced from 160/90 to 130/80.

d. Blood pressure reduced from 160/90 to 130/80. Diovan is an angiotensin receptor blocker, prescribed for the treatment of hypertension. The desired effect is a decrease in blood pressure (D). (A, B, and C) do not describe effects of Diovan.

A client is admitted to the hospital for diagnostic testing for possible myasthenia gravis. The nurse prepares for intravenous administration of edrophonium chloride (Tensilon). What is the expected outcome for this client following administration of this pharmacologic agent? a. Progressive difficulty with swallowing. b. Decreased respiratory effort. c. Improvement in generalized fatigue. d. Decreased muscle weakness.

d. Decreased muscle weakness. Administration of edrophonium chloride (Tensilon), a cholinergic agent, will temporarily reduce muscle weakness (D), the most common complaint of newly-diagnosed clients with myasthenia gravis. This medication is used to diagnose myasthenia gravis due to its short duration of action. This drug would temporarily reverse (A and B), not increase these symptoms. (C) is not a typical complaint of clients with myasthenia gravis, but weakness of specific muscles, especially after prolonged use, is a common symptom.

Which drug is used as a palliative treatment for a client with tumor-induced spinal cord compression? a. Morphine Sulfate (Duromorph). b. Ibuprofen (Advil). c. Amitriptyline (Amitril). d. Dexamethasone (Decadron).

d. Dexamethasone (Decadron). Dexamethasone (D) is a palliative treatment modality to manage symptoms related to compression due to tumor growth. Morphine sulphate (A) is an opioid analgesic used in oncology to manage severe or intractable pain. Ibuprofen (B), a nonsteroidal antiinflammatory drug (NSAID), provides relief for mild to moderate pain, suppression of inflammation, and reduction of fever. Amitriptyline (C), a tricyclic antidepressant, is often prescribed for pain related to neuropathic origin and provides a reduction in opioid dosage.

A client receiving Doxorubicin (Adriamycin) intravenously (IV) complains of pain at the insertion site, and the nurse notes edema at the site. Which intervention is most important for the nurse to implement? a. Assess for erythema. b. Administer the antidote. c. Apply warm compresses. d. Discontinue the IV fluids.

d. Discontinue the IV fluids. Doxorubicin is an antineoplastic agent that causes inflammation, blistering, and necrosis of tissue upon extravasation. First, all IV fluids should be discontinued at the site (D) to prevent further tissue damage by the vesicant. Erythema is one sign of infiltration and should be noted, but edema and pain at the infusion site require stopping the IV fluids (A). Although an antidote may be available (B), additional fluids contribute to the trauma of the subcutaneous tissues. Depending on the type of vesicant, warm or cold compresses (C) may be prescribed after the infusion is discontinued.

An older client with a decreased percentage of lean body mass is likely to receive a prescription that is adjusted based on which pharmacokinetic process? a. Absorption. b. Metabolism. c. Elimination. d. Distribution.

d. Distribution. A decreased lean body mass in an older adult affects the distribution of drugs (D), which affects the pharmacokinetics of drugs. Decreased gastric pH, delayed gastric emptying, decreased splanchnic blood flow, decreased gastrointestinal absorption surface areas and motility affect (A) in the older adult population. Decreased hepatic blood flow, decreased hepatic mass, and decreased activity of hepatic enzymes affect (B) in older adults. Decreased renal blood flow, decreased glomerular filtration rate, decreased tubular secretion, and decreased number of nephrons affects (C) in an older adult.

Dobutamine (Dobutrex) is an emergency drug most commonly prescribed for a client with which condition? a. Shock. b. Asthma. c. Hypotension. d. Heart failure.

d. Heart failure. Dobutamine is a beta-1 adrenergic agonist that is indicated for short term use in cardiac decompensation or heart failure (D) related to reduced cardiac contractility due to organic heart disease or cardiac surgical procedures. Alpha and beta adrenergic agonists, such as epinephrine and dopamine, are sympathomimetics used in the treatment of shock (A). Other selective beta-2 adrenergic agonists, such as terbutaline and isoproterenol, are indicated in the treatment of asthma (B). Although dobutamine improves cardiac output, it is not used to treat hypotension (C).

A client has a continuous IV infusion of dopamine (Intropin) and an IV of normal saline at 50 ml/hour. The nurse notes that the client's urinary output has been 20 ml/hour for the last two hours. Which intervention should the nurse initiate? a. Stop the infusion of dopamine. b. Change the normal saline to a keep open rate. c. Replace the urinary catheter. d. Notify the healthcare provider of the urinary output.

d. Notify the healthcare provider of the urinary output. The main effect of dopamine is adrenergic stimulation used to increase cardiac output, which should also result in increased urinary output. A urinary output of less than 20 ml/hour is oliguria and should be reported to the healthcare provider (D) so that the dose of dopamine can be adjusted. Depending on the current rate of administration, the dose may need to be increased or decreased. If the dose is decreased, it should be titrated down, rather than abruptly discontinued (A). Fluid intake may need to be increased, rather than (B). The urinary catheter is draining and does not need to be replaced (C).

A client with giardiasis is taking metronidazole (Flagyl) 2 grams PO. Which information should the nurse include in the client's instruction? a. Notify the clinic of any changes in the color of urine. b. Avoid overexposure to the sun. c. Stop the medication after the diarrhea resolves. d. Take the medication with food.

d. Take the medication with food. Flagyl, an amoebicide and antibacterial agent, may cause gastric distress, so the client should be instructed to take the medication on a full stomach (D). Urine may be red-brown or dark from Flagyl, but this side effect is not necessary to report (A). Photosensitivity (B) is not a side effect associated with Flagyl. Despite the resolution of clinical symptoms, antiinfective medications should be taken for their entire course because stopping the medication (C) can increase the risk of resistant organisms.

A client with coronary artery disease who is taking digoxin (Lanoxin) receives a new prescription for atorvastatin (Lipitor). Two weeks after initiation of the Lipitor prescription, the nurse assesses the client. Which finding requires the most immediate intervention? a. Heartburn. b. Headache. c. Constipation. d. Vomiting.

d. Vomiting. Vomiting, anorexia and abdominal pain are early indications of digitalis toxicity. Since Lipitor increases the risk for digitalis toxicity, this finding requires the most immediate intervention by the nurse (D). (A, B and C) are expected side effects of Lipitor.

A client is being treated for hyperthyroidism with propylthiouracil (PTU). The nurse knows that the action of this drug is to a. decrease the amount of thyroid-stimulating hormone circulating in the blood. b. increase the amount of thyroid-stimulating hormone circulating in the blood. c. increase the amount of T4 and decrease the amount of T3 produced by the thyroid. d. inhibit synthesis of T3 and T4 by the thyroid gland.

d. inhibit synthesis of T3 and T4 by the thyroid gland. PTU is an adjunct therapy used to control hyperthyroidism by inhibiting production of thyroid hormones (D). It is often prescribed in preparation for thyroidectomy or radioactive iodine therapy. Thyroid-stimulating hormone (TSH) is produced by the pituitary gland, and PTU does not affect the pituitary (A and B). PTU inhibits the synthesis of all thyroid hormones--both T3 and T4(C).

A superinfection results from

decrease in most normal flora with overgrowth of an unaffected species. Caused by broad spectrum antibiotics.

Sulfonylureas MOA

enhance release of insulin from beta cells of the pancrease

short-acting insulin

fast onset, short duration onset: 30 mins-1 hr peak: 2-4 hours

Sulfonylureas drugs

glipizide (Glucotrol) glimeperide 9Amaryl)

earliest symptoms of hypoglycemia

headache

Amphotericin B

herpes anti-fungal. HIGHLY TOXIC - infusin rxns (fever and chills) - nephrotoxicity - hypokalemia - hepatoxicity - gynecomasita - C/I with aminoglycosides (just like PCN)

lamisil contraindications

history of allergic reaction to terbinafine; risk of anaphylaxis

Verapamil evaluation

hold if patient's systolic BP is less than 100 or HR is less than 60

Vitamin D overdose

hypercalcemia

Thiazoldineiones (glitazones) MOA

improve sensitivity of insulin receptors

Calcitriol action

increases blood levels of calcium by increasing the absorption of calcium in the kidneys

Calcitriol (Vitamin D)

increases calcium absorption in GI tract therefore increases calcium in blood; steroid hormone; over-the-counter calcium supplements are often sold with Vit D

Januvia (sitagliptin) MOA

inhibit breakdown of incretin allowing insuling release

Insulin Administration

injection areas: abdomen, thigh, and hips Rotate injection sites and 1.5 inches apart Don't rub site 45-90 degree angle and leave for 5 sec

Rapid acting insulin drugs

lispro: Humalog aspart: Novolog

Furosemide (Lasix)

loop diuretic Potassium wasting Monitor potassium, hypokalemia can lead to lethal cardiac dysrhythmias

IV pump rate

mL/hr

drips per minute

mL/minutes x drip (gtt) factor *always a whole number*

Januvia potential SE

may increase dig levels (narrow therapeutic range)

Biguinides drugs

metformin (Glucophage)

KCL IV Administration

must be diluted and ECG monitored if given faster than 10 mEq/hr

Intermediate acting insulin

onset: 1-2 hours peak: 6-12 hours duration: 18-20 hours

Thiazoldineiones drugs

pioglitazone (Actos) rosiglitazone (Avandia)

Spirolactone

potassium sparing diuretic teach: orthostatic hypotension constipation: fiber, fruit, and fluid take diuretics in morning

short-acting insulin drugs

regular: Humulin R

narcotic antagonist

reverse the effects of opioids, resulting in pain for the patient

Sildenafil (Viagra)

s/s: headache, heartburn, diarrhea, flushing, nosebleeds, parathesias, changes in color vision Contradicted in clients taking nitrates, anticoags, anti HTN

The home health nurse is caring for a client who is taking probenecid. The client has been instructed to restrict the diet to low-purine foods. Which food item should the nurse instruct the client to avoid?

scallops

mist dangerous problem with insulin

severe hypoglycemia elders most at risk

SIADH

syndrome of inappropriate antidiuretic hormone Soaked inside

Thyroid overdose symptoms

tachycardia, palpitations, angina, dysrhythmias, hypertension

Rivastigmine

treats dementia

Atorvastatin

treats high cholesterol

Phenazopyridine (Pyridium)

turns urine orange finish entire course of antibiotics

orlistat

used to help patients lose weight and/or maintain weight loss

Digoxin

used to treat heart failure (negative chronotropic & positive inotrope) therapeutic level = 0.5-2