K- LPN 2108 20198 -- PN 2018-1

The LPN/LVN performs discharge teaching for a client receiving an antihypertensive medication. The LPN/LVN determines further teaching is needed if the client states which of the following? 1. "I should take the medication at the same time every day." 2. "I can stop taking the medication when my blood pressure goes down." 3. "The physician will check my blood pressure and may need to change the medication." 4. "When I first start taking the medication, I may feel some drowsiness."

"I can stop taking the medication when my blood pressure goes down." Strategy: "Further teaching is necessary" indicates incorrect information. (1) true statement; each medication has onset, peak, and duration time periods; ingesting the same time every day assures a more stable outcome (2) CORRECT—usually required to take medication for the rest of their lives; reinforce that clients are not to stop medication even though they have no symptoms and to report any side effects to the physician (3) true statement; teach client how to monitor blood pressure and perform health teaching about diet and exercise (4) some of the antihypertensive medication causes drowsiness

The nurse cares for a client receiving 40 drops per minute of D 5 W. The IV set delivers 10 drops per ml. If the nurse begins infusing 1,000 ml of D 5 W at 12 noon, how many milliliters of D 5 W will be remaining at 3:30 PM? Type the correct answer into the blank.

40 drops per min /10 drops per ml = 4ml/min 3.5hr x 60 min/hr =210 min 210 min x4 ml/min=840 ml 1000ml -840 ml=160 ml left ay 3:30 pm

The nurse cares for a child receiving 40 drops of IV fluid per minute. The IV set has a drip factor of 60 drops per mL. At this rate, record how many hours it will take the nurse to infuse 400 mL? Type the correct answer into the blank.

40 drops/min= 40 ml/hr 400 ml/40 mll/hr= 10 hr

The nurse cares for a client receiving IV fluids. The physician orders 600 mL of IV fluids to infuse in 4 hours. The nurse should set the infusion device to infuse how many mL per hour? Type the correct answer into the blank.

Correct Response: 150

The nurse dilutes a 2-g vial of cefazolin (Ancef) with 3 mL of diluent to yield a volume of 3.2 mL. How many mL should the nurse administer if the physician orders 550 mg IM? Type the correct answer in the blank. Record the answer to the hundredths place. Do not round ___________ Your Response: Correct Response: 0.88

Correct answer: 0.88

A patient is ordered to receive an intravenous infusion of 3,000 cc of 0.9% NaCl over 24 hours. The nurse observes the rate is 150 mL/h. If the solution runs continuously at this rate, how many hours will it take to complete the infusion? Type the correct answer into the blank. ___________ Your Response: Correct Response: 20

Correct answer: 20

The LPN/LVN administers meperidine (Demerol) 50 mg IM for preoperative sedation. Which of the following positions may help decrease the pain of the IM injection? 1. Leaning over the side of the bed while standing. 2. Prone with toes pointed in 3. Prone with toes pointed out. 4. Recumbent with toes pointed down.

Prone with toes pointed in Strategy: Determine the outcome of each answer. Is it desired? (1)client not supported (2) CORRECT—this position will reduce pain (3)point toes in (4)will not decrease pain

The LPN/LVN administers medication in the long-term care facility. Which of the following situations would cause the LPN/LVN to withhold the medication and contact the health care provider? Select all that apply: 1. A client diagnosed with a peptic ulcer is ordered to receive ibuprofen (Advil). 2. A client receiving warfarin (Coumadin) has a prothrombin time of 16 seconds. 3. A client receiving glipizide (Glucotrol) has a known allergy to sulfasalazine (Azulfidine). 4. A client receiving insulin complains of nausea and vomiting. 5. A client receiving hydrochlorothiazide (HydroDIURIL) suddenly has difficulty speaking. 6. A client receiving verapamil (Calan) has a blood pressure of 130/78.

Look for a contraindication to administering the medication. (1.) CORRECT— ibuprofen is contraindicated in active bleeding or ulcer disease (2.) normal prothrombin time is 9 to 12 seconds; therapeutic range is 1.25 to 2.5 times the control; within normal limits (3.) CORRECT — glipizide is a sulfonylurea used to treat type 2 diabetes; contraindicated if client has allergy to sulfonamides (4.) administer insulin; check blood glucose or urine ketones every 3 to 4 hours (5.) CORRECT— may have difficulty swallowing; assess and notify the physician (6.) Calan is a calcium channel blocker used to treat angina and hypertension; blood pressure within normal limits

The LPN/LVN cares for a client diagnosed with schizophrenia receiving chlorpromazine (Thorazine) 100 mg QID. The LPN/LVN should observe the client for which of the following? 1. Photophobia and hypotension. 2. Vomiting and diarrhea. 3. Diuresis and sodium loss. 4. Hypertension and insomnia.

Photophobia and hypotension. Strategy: Think about each answer. (1) CORRECT—most common side effects of chlorpromazine (Thorazine) are photosensitivity and hypotension; chlorpromazine (Thorazine) is an antipsychotic (2) side effect of erythromycin (3) occurs with diuretics (4) hypertension may occur with MAO inhibitors; insomnia may occur with selective serotonin reuptake inhibitors (SSRIs)

The nurse cares for a child receiving amoxicillin 10 mg/kg every 8 hours. If the child weighs 55 pounds, how many milligrams of amoxicillin will the nurse administer in 24 hours? Type the correct answer into the blank. ___________ Your Response: Correct Response: 750

Strategy: 2.2 pounds = 1 kg Correct answer: 750

The LPN/LVN assists in the nursing management of a client diagnosed with degenerative joint disease (osteoarthritis). The health-care provider orders indomethacin (Indocin) 50 mg PO BID. The LPN/LVN is MOST concerned if the client states which of the following? 1. "I am allergic to aspirin." 2. "I should take this medication with food." 3. "This medication will reduce joint discomfort." 4. "I will contact the physician if I have any weight gain."

1. "I am allergic to aspirin." Strategy: "MOST concerned" indicates a complication. (1.) CORRECT—clients allergic to aspirin tend to be allergic to other NSAIDs, such as ibuprofen and indomethacin (2.) causes GI upset and peptic ulceration; take with food, milk, or antacid (3.) nonsteroidal antiinflammatory used to relieve inflammation and pain (4.) causes sodium retention; monitor for increased weight gain and increased blood pressure, especially true in clients with hypertension

The LPN/LVN cares for a client receiving a new prescription for naproxen (Anaprox) 1.5 g/day in two doses. The LPN/LVN should instruct the client to take which of the following doses? 1. 175 mg twice daily. 2. 250 mg twice daily. 3. 500 mg twice daily. 4. 750 mg twice daily.

4. 750 mg twice daily. Strategy: Perform the math. (1) incorrect dose; 175 mg 2 = 350 mg (2) incorrect dose; 250 mg 2 = 500 mg (3) incorrect dose; 500 mg 2 = 1,000 mg (1 g) (4) CORRECT—1.5 g = 1,500 mg: 1,500 mg 2 doses = 750 mg per dose; naproxen is a nonsteroidal anti-inflammatory; side effects include headache, dizziness, epigastric distress

The LPN/LVN assists in the discharge teaching for a client receiving sodium warfarin (Coumadin). The LPN/LVN determines that further teaching is required if the client makes which of the following statements? 1. "I should look for yellow-tinged complexion." 2. "I will wear a Medic-Alert bracelet." 3. "I should tell the physician if I have black stools." 4. "I should consult the physician before taking any medication."

"I should tell the physician if I have black stools." Strategy: "Further teaching is necessary" indicates incorrect information. (1) CORRECT—yellow-tinged complexion or eyes are symptoms of hepatitis, which is not a side effect of Coumadin (2)appropriate action; instruct to watch for signs and symptoms of bleeding (3)indicates bleeding; report to physician (4)over-the-counter medication may contain aspirin

The LPN/LVN assists in the admission of a client diagnosed with an acute episode of schizophrenia. Which of the following actions by the LPN/LVN is MOST appropriate for this client? 1. Give the client a brief orientation and remain with the client for a while. 2. Give the client a description of ward activities and introduce the client to other clients. 3. Introduce the client to another client and have the other client show the new client around. 4. Sit the client in a quiet room and wait until the hallucinations stop.

1 Give the client a brief orientation and remain with the client for a while. Strategy: "MOST" appropriate indicates discrimination is required to answer the question. (1) CORRECT—because this client has a reduced attention span and an inability to concentrate, a brief orientation is best; by staying with the client, the LPN/LVN conveys an attitude of caring and protection (2) due to lack of trust and feeling for safety and security, keep interactions brief and limit the number of individual contacts (3) do not force client to interact with other clients; important for client to interact with the same staff members (4) no indication client is hallucinating; care during a hallucination includes maintaining an accepting attitude, commenting on feeling tone of hallucination, encouraging diversional activities; do not leave client alone

The LPN/LVN assists with the instruction of a client about how to administer insulin. It is MOST important for the LPN/LVN to make which of the following statements? 1. "You should rotate the injection sites." 2. "Wipe the needle with alcohol prior to the injection." 3. "Hold the hub of the needle when drawing up the medication." 4. "Cool the insulin prior to injecting it."

1. "You should rotate the injection sites." Strategy: "MOST important" indicates discrimination is required to answer the question. (1) CORRECT—the site of the injection must be rotated in order to get absorption; lipodystrophy can occur with repeated injections, causing poor absorption of the insulin (2) needle should not be touched, especially not with alcohol; one of the primary goals of nursing care is to teach the client how to maintain tissues used for injection of insulin (3) holding syringe is commonly recommended; touching the hub of the needle increases risk of touching needle (4) should not draw up refrigerated insulin; warm in hands

A health care provider prescribed NPH insulin (Humulin N) 25 U IV stat for a client with type 1 diabetes. Which of the following actions should the LPN/LVN take FIRST? 1. Contact health care provider. 2. Administer the NPH insulin 0.10 mL/10 seconds. 3. Assess for signs/symptoms of hypoglycemia. 4. Check serum glucose level.

1. Contact health care provider. Strategy: "FIRST" indicates priority. (1) CORRECT— intermediate-acting insulin should not be administered IV; not usually administered stat; normal guideline for IV administration is do not administer a cloudy substance, use rapid- or short-acting insulin (2) order is incorrect (3) onset of NPH insulin is 1 to 4 hours and it peaks in 6 to 12 hours; hypoglycemia occurs during peak action; do not follow incorrect order (4) appropriate to determine glucose before administering insulin of any kind; priority is to clarify incorrect order

The physician prescribes lithium carbonate (Eskalith) for a client. The LPN/LVN understands that which of the following medications is contraindicated for this client? 1. Diuretics. 2. Monoamine oxidase inhibitors. 3. Benzodiazepines. 4. Penicillins.

1. Diuretics. Strategy: Think about each answer. (1) CORRECT—lithium causes sodium depletion, polydipsia, hypotension, and polyuria; diuretics are contraindicated for clients on lithium (2) although MAOIs and lithium have similar CNS side effects, they are not as impairing as hypotension and dehydration (3) postural hypotension is side effect of both drugs, but the loss of fluid could compound the problem (4) no significant overlapping characteristics

The LPN/LVN cares for a client diagnosed with type 1 diabetes receiving insulin glargine (Lantus) at HS. It is MOST appropriate for the LPN/LVN to reinforce which of the following about the administration of insulin glargine (Lantus)? 1. Do not mix other insulin with insulin glargine (Lantus). 2. Determine if the client has purchased a medic alert identification (ID) bracelet. 3. Confirm that the client carries candy at all times. 4. Ensure that the client knows this drug does not cure diabetes

1. Do not mix other insulin with insulin glargine (Lantus). Strategy: "MOST appropriate" indicates discrimination is required to answer the question. (1) CORRECT—insulin glargine (Lantus) has an acid pH of 4.0, which precipitates when mixed with other insulin; Lantus is a long-acting insulin analog and is given once daily to provide basal insulin coverage (2) alerts health care providers; any diabetic client should wear a medic alert bracelet, not specific to client receiving insulin glargine (Lantus) (3) candy used to treat or prevent hypoglycemia resulting in increased safety risks; not unique to clients receiving insulin glargine (Lantus) (4) promotes adherence to health care regime; does not override threats to resulting risks associated with mixing the drug with other insulin; is not unique to this drug

The home care nurse visits a client diagnosed with Cushing's syndrome. It is MOST important for the LPN/LVN to teach the client about the side effects of which of the following drugs? 1. Insulin. 2. Levothyroxine (Synthroid). 3. Estrogen. 4. Cortisone.

1. Insulin Strategy: "MOST important" indicates discrimination is required to answer the question. (1) CORRECT—Cushing's syndrome is hypersecretion of adrenal hormones; common manifestation of Cushing's syndrome: increased sodium, increased blood pressure, decreased potassium, and hyperglycemia; to counteract the hyperglycemia, it may be necessary to give insulin (2) used to treat hypothyroidism (3) Cushing's syndrome causes decreased libido; ingestion of a female hormone will not improve the problem

The LPN/LVN administers filgrastim (Neupogen) 100 mcg IV. It is MOST important for the LPN/LVN to assess for which of the following? 1. Nausea/vomiting, bone pain. 2. Bruising, bleeding gums. 3. Gastrointestinal bleeding. 4. Frequent upper respiratory infections.

1. Nausea/vomiting, bone pain. Strategy: Topic of question is unstated. (1) CORRECT— filgrastim given to increase neutrophils following chemotherapy; 57% of clients receiving drug experience nausea/vomiting; 22% experience bone pain that requires analgesia (2) associated with decreased platelets often associated with chemotherapy; drug is given to increase neutrophils following chemotherapy; signs/symptoms are not associated with the drug (3) commonly associated with ingestion of aspirin and nonsteroidal anti-inflammatories (4) reduced response to infection is associated more with chemotherapy; drug increases response to infection

A client is started on heparin therapy. The LPN/LVN knows that which of the following laboratory tests is used to monitor the effectiveness of heparin? 1. Partial thromboplastin time. 2. Prothrombin time. 3. Bleeding time. 4. Protein electrophoresis.

1. Partial thromboplastin time. Strategy: Think about each answer. (1) CORRECT—heparin inactivates prothrombin and prevents the formation of thromboplastin, prolonging the clotting time; anticoagulation is effective when the PTT is 1.5 to 2 times the control (2)used to measure therapeutic level of Coumadin; antidote is vitamin K (3)measures duration of bleeding after standardized skin incision; prolonged in thrombocytopenic purpura, platelet abnormality, leukemia, and severe liver disease (4)differentiates between protein fractions

The home care LPN/LVN cares for a client receiving prophylactic isoniazid 5 mg/kg/day. The LPN/LVN determines that teaching is successful if the client makes which statement? 1. "I take vitamin B 6 every day." 2. "I will eat a snack when I take isoniazid." 3. "I will get a repeat tuberculin skin test after 90 days of treatment" 4. "I have to take warfarin while taking isoniazid."

1."I take vitamin B 6 every day. "Strategy: "Teaching is successful" indicates correct information. (1) CORRECT— reduces or prevents peripheral neuritis associated with medication; isoniazid is an antitubercular medication (2) isoniazid should be taken on empty stomach (3) medication therapy will not reverse positive tuberculin skin test (4) anticoagulant; not used in this situation

The LPN/LVN cares for a client in the psychiatric unit who is experiencing alcohol withdrawal delirium. The LPN/LVN expects to administer which of the following medications? 1. Phenytoin sodium (Dilantin) and chlordiazepoxide (Librium). 2. Disulfiram (Antabuse) and chlorpromazine (Thorazine). 3. Disulfiram (Antabuse) and phenobarbital (Luminal). 4. Amitriptyline hydrochloride (Elavil) and alprazolam (Xanax).

1. Phenytoin sodium (Dilantin) and chlordiazepoxide (Librium) Strategy: Think about each answer. (1) CORRECT—anticonvulsants such as phenytoin sodium (Dilantin) and sedatives such as chlordiazepoxide (Librium) are used for delirium tremens; sedation used to control anxiety and agitation; anticonvulsants are used to prevent withdrawal seizures (2) disulfiram (Antabuse) is utilized to help client associate unpleasant experiences with the ingestion of alcohol; chlorpromazine (Thorazine) is an antipsychotic; side effect is postural hypotension (3) phenobarbital (Luminal) is an anticonvulsant; side effects include drowsiness, rash, and GI upset (4) amitriptyline hydrochloride (Elavil) is a tricyclic antidepressant; alprazolam (Xanax) is an antianxiety

The LPN/LVN assists in the care of a client after the surgical repair of a cystocele. The client receives morphine for pain and several hours later the LPN/LVN cannot rouse the client. The health care provider orders naloxone 0.4 mg IV every 2-3 minutes until awake. The LPN/LVN anticipates performing which intervention first? 1. Place client on cardiac monitor. 2. Set up seizure precautions. 3. Measure blood pressure. 4. Monitor for delirium tremors.

1. Place client on cardiac monitor Strategy: "FIRST" indicates priority. (1) CORRECT— naloxone is an antidote for opioids; reverses CNS depression and respiratory depression due to overdose of opioids; when administered postoperatively, client is at risk for ventricular tachycardia and ventricular fibrillation (2) occurs infrequently; is less life-threatening than ventricular dysrhythmia; cystocele is bladder hernia that protrudes into the vagina (3) hypertension or hypotension is a side effect; not as life-threatening as ventricular dysrhythmia, which results in a significantly decreased cardiac output and non-life sustaining coronary circulation (4) is an opiate antagonist; withdrawal signs/symptoms are more likely to occur in clients with an opiate addiction

The LPN/LVN cares for a client receiving IV fluids. The order reads, "1,000 mL D 51/2 NS @ 150 mL/hr." After the IV has infused for 3 hours and 20 minutes, the LPN/LVN notes that 500 ml are remaining in the IV. Which of the following actions by the LPN/LVN is MOST appropriate? 1. Recalculate IV flow rate. 2. Notify the health care provider. 3. Determine if new IV rate is appropriate for the particular client. 4. Place IV on infusion pump

1. Recalculate IV flow rate Strategy: "MOST appropriate" indicates discrimination is required to answer the question. (1) CORRECTneed to determine the rate needed to meet the requirements of the original order (2) need to report to health care provider if recalculation exceeds 25% of the original rate or if is contraindicated because of the client's status (3) need to calculate new rate prior to correlating with the client; would need to determine if is >25% or original rate (4) probably needs to be implemented to prevent the rate from falling behind again, but is not the next step

The LPN/LVN makes a home visit for a client scheduled for a subtotal thyroidectomy. The LPN/LVN should intervene if which of the following is observed? 1. The client drinks strong iodine solution from a cup. 2. The client mixes strong iodine solution in fruit juice. 3. The client takes strong iodine solution after meals. 4. The client does not use iodized salt. View Explanation

1. The client drinks strong iodine solution from a cup. Strategy: "Should intervene" indicates an incorrect action. (1) CORRECT—iodine solutions cause staining of the teeth and should be administered through a straw (2) mix in water, milk, or fruit juices to hydrate client and to mask salty taste (3) minimizes gastric irritation; side effects include nausea, vomiting, metallic taste, and rash (4) client should not consume iodized salt or shellfish because they contain iodine and may lessen effectiveness of medication

The home care LPN/LVN instructs an elderly client receiving digoxin (Lanoxin) 0.125 mg daily. The LPN/LVN determines further teaching is necessary if which of the following behaviors is observed? 1. The client takes an over-the-counter (OTC) antacid. 2. The client checks labels on all medications. 3. The client measures the radial pulse before taking the medication. 4. The client washes his hands before taking the medication.

1. The client takes an over-the-counter (OTC) antacid. Strategy: "Further teaching is necessary" indicates incorrect information. (1) CORRECT—decreases absorption of medication; digoxin (Lanoxin) is a cardiac glycoside; side effects include anorexia, nausea, bradycardia, visual disturbances (2) appropriate action; many older adults are ingesting multiple prescription drugs (3) appropriate action; hold medication if pulse is below 60 beats per minute (4) appropriate action; decreases transmission of microorganisms

The LPN/LVN observes a client diagnosed with type 1 diabetes prepare a dose of regular insulin (Humulin R) 7 units and NPH insulin (Humulin N) 23 units. The LPN/LVN determines the client is using correct technique if which of the following is observed? 1. The client withdraws the regular insulin first. 2. The client prepares each insulin dose as a separate injection. 3. The client reviews self-monitoring serum glucose results for the previous 24 hours. 4. The client confirms the NPH insulin is transparent.

1. The client withdraws the regular insulin first Strategy: Think about each answer. (1) CORRECT—prevents risk of mixing long-acting insulin with short-acting insulin; onset of regular insulin is one-half hour to 1 hour; onset of NPH insulin is 1 to 2 hours (2) standard of practice requires using least number of injections as possible; volume is appropriate for subcutaneous injection (3) insulin dose may be based on current blood sugar reading (4) NPH is normally cloudy; regular insulin is clear

A client has a diagnosis of onychomycosis and the health care provider has prescribed terbinafine HCl 250 mg PO daily. It is most important for the LPN/LVN to instruct the client to report which sign/symptom? 1. Unexplained fatigue and jaundice. 2. Vaginal itching with drainage. 3. Decreased urinary output. 4. Generalized rash.

1. Unexplained fatigue and jaundice. Strategy: "Most important" indicates discrimination is required to answer the question. 1) CORRECT — terbinafine HCl is an antifungal used to treat onychomycosis (fungal nail infections); hepatotoxicity is a life-threatening adverse reaction to terbinafine HCl; instruct client to immediately report signs and symptoms of liver dysfunction 2) antibiotics can cause destruction or reduction of normal flora, resulting in vaginal infection 3) kidney damage associated more with amphotericin B 4) terbinafine HCL can cause rash; hepatotoxicity is more serious

The LPN/LVN cares for a client diagnosed with type 1 diabetes. The LPN/LVN reinforces the signs/symptoms of hypoglycemia. The LPN/LVN determines teaching is effective if the client states which of the following? 1. "Low blood sugar will cause cool skin, sweating, and headache." 2. "Low blood sugar will cause constipation, increased weight, and hunger." 3. "Low blood sugar will cause hot skin, rapid pulse, and thirst." 4. "Low blood sugar will cause nausea, fruity breath odor, and diarrhea."

1."Low blood sugar will cause cool skin, sweating, and headache." Strategy: "Teaching is effective" indicates correct information. (1) CORRECT—other symptoms of hypoglycemia are weakness and tremors, and in some cases nausea and vomiting (2) hunger can occur with hypoglycemia (3) occurs with diabetic ketoacidosis (4) nausea and fruity breath odor indicate diabetic ketoacidosis

The nurse cares for the client receiving 1,200 mL of TPN solution daily. The IV set delivers 10 drops per mL. The nurse should adjust the flow rate so that the client receives how many drops of fluid per minute? Type the correct answer into the blank. Round to a whole number. ___________ drops/minute

1200x10/1440=12000/1440=8 drops/min

The nurse cares for a client receiving 1,800 ml of IV fluid over a 12-hour period. The physician orders that the amount of fluid lost in gastric drainage every 2 hours be replaced during the next 2 hours. Between 8 AM and 10 AM, the nurse measures 250 cc of gastric fluid. How many milliliters of fluid should the nurse administer the client between 10 AM and 12 noon? Type the correct answer into the blank.

1800ml/12 hr=150ml/hr =250=400 ml . 150 ccx2=300ml+250= 550

The LPN/LVN cares for a client diagnosed with methicillin-resistantStaphylococcus aureus (MRSA) infection of an abdominal wound. The health care provider orders vancomycin 15 mg/kg every 12 hours. It is most important for the LPN/LVN to report which finding? 1. Decreased white blood cells (WBCs) and increased eosinophils. 2. Decreased urinary output and ototoxicity. 3. Large amount of mucoid wound drainage. 4. Delayed healing with healing by second intention.

2 Decreased urinary output and ototoxicity Strategy: "MOST important" indicates discrimination is required to answer the question. (1) vancomycin (Vancocin) is an antibiotic; side effects include ototoxicity, nephrotoxicity, nausea, and vomiting; decreased WBCs could indicate drug effectiveness; eosinophils are related to allergic reactions (2) CORRECT—nephrotoxicity and ototoxicity are common side effects; monitor intake and output, daily weights, and evaluate functioning of the eighth cranial nerve (3) drainage from wound expected; kidney damage would be more significant to client recovery (4) infected wounds are commonly left open to heal by second intention; primary focus is on client response to drug therapy

The nurse cares for a client receiving 2,500 mL intravenous fluid in 24 hours. The nurse determines that the client should receive how many milliliters of fluid in 3 hours? Enter the mL answer as a whole number. ___________ Your Response: Correct Response: 313

2,500ml/24 hr = xml/3 hr . 7,500/24x x=312.5 ml/hr

The LPN/LVN cares for a client receiving enteral feeding through a nasogastric tube. The physician orders isosorbide (Isordil) 2.5 mg sublingual as needed for chest pain. The LPN/LVN instructs the client's wife about the correct administration of the medication. The teaching is effective if the client's wife makes which of the following statements? 1. "I should irrigate the tube with 50 cc of water before giving this medication." 2. "I should place the tablet under my husband's tongue." 3. "I should dissolve this medication in warm water prior to instilling it." 4. "I should ask the physician to change the medication to a liquid form."

2. "I should place the tablet under my husband's tongue." Strategy: "Teaching is effective" indicates correct information. (1) irrigating with 30-50 cc of water before and after administering medication through the tube prevents tube occlusion (2) CORRECT—isosorbide (Isordil) is an antianginal; sublingual administration is for treatment of angina; PO administration given to prevent angina; buccal or sublingual medication given as ordered to clients with NG tube (3) appropriate action for compressed tablets; not related to isosorbide (Isordil) administration (4) appropriate action if medication is enteric-coated tablets; not related to isosorbide (Isordil) administration

The LPN/LVN cares for clients in an assisted care facility. The LPN/LVN observes a client instill eyedrops. The LPN/LVN notes that the client closed the right eye before instilling the eyedrops. Which of the following responses by the LPN/LVN is MOST appropriate? 1. "You will have to put more eyedrops in your right eye because you missed." 2. "Let me help you hold your eye open so you can instill the drops in your eye." 3. "When you instill your eyedrops tonight, put in twice as many drops." 4. "You should be able to keep your eye open when you instill the eyedrops."

2. "Let me help you hold your eye open so you can instill the drops in your eye.

The LPN/LVN cares for a client after a cataract extraction. The physician orders prochlorperazine (Compazine) postoperatively. The LPN/LVN's explanation to the family should include which of the following statements? 1. "Prochlorperazine (Compazine) is ordered to prevent retinal detachment." 2. "Prochlorperazine (Compazine) is ordered to prevent pressure on the suture line." 3. "Prochlorperazine (Compazine) is ordered to help the client sleep better." 4. "Prochlorperazine (Compazine) increases the client's nutritional intake."

2. "Prochlorperazine (Compazine) is ordered to prevent pressure on the suture line." Strategy: Think about each answer. (1.) retinal detachment is a common complication of cataract surgery; cause of tear in the retina is not known; is not believed to be related to increased ocular pressure that would occur during vomiting (2.) CORRECT— Prochlorperazine (Compazine) is an antiemetic given to prevent nausea; avoid any activity that increases intraocular pressure after eye surgery; can predispose to hemorrhage and put stress on delicate suture lines (3.) Prochlorperazine (Compazine) does cause moderate amount of sedation but that is not the rationale for ordering; is ordered for its antiemetic affects (4.) because prochlorperazine (Compazine) is an antiemetic, client likely to eat and drink more because nausea will be resolved

During labor induction with oxytocin, the LPN/LVN should stop the infusion if which of the following patterns of contraction is observed? 1. 3-minute intervals and last more than 60 seconds. 2. 2-minute intervals and last more than 90 seconds. 3. 2.5-minute intervals and last more than 90 seconds. 4. 2-minute intervals and last more than 60 seconds.

2. 2-minute intervals and last more than 90 seconds. Strategy: Determine the outcome of each answer. Is it desired? (1) is an acceptable pattern; if contractions are at 3-minute intervals lasting 60 seconds, there is 2 minutes of rest between contractions (2) CORRECT it's extremely important for nurse to continually assess contractions for patient receiving an oxytocin drip; if contractions occur too frequently (at intervals of less than 2 minutes) or last too long (more than 90 seconds), they may endanger mother and fetus; nurse should stop infusion and notify physician (3) acceptable (4) stop infusion if contraction lasts more than 90 seconds

To deliver 3,000 mL of D 5W in 24 hours using an administration set that delivers 15 gtt/mL, the LPN/LVN determines that the flow rate should be which? 1. 15 gtt/min. 2. 31 gtt/min. 3. 69 gtt/min. 4. 80 gtt/min.

2. 31 gtt/min. Strategy: 15 drops per minute = 1 mL (1) incorrect (2) CORRECT— to calculate drops per minute, first calculate the number of mL per hour by dividing 3,000 by 24 = 125 mL per hour; multiply mL per hour by the drops factor, 125 X 15 = 1,875; divide 1,875 by 60 minute = flow rate is 31.25, or 31 drops per minute (3) incorrect (4) incorrect

A client reports experiencing a fever for several days prior to admission to the hospital. The client's temperature is 101.0 F (38.4 C), and the physician orders penicillin therapy. It is essential for the LPN/LVN to monitor the client for which of the following conditions? 1. Increased BUN. 2. Allergic reaction. 3. Anemia. 4. Decreased appetite.

2. Allergic reaction. Strategy: "Essential" indicates priority. (1) penicillin is not a nephrotoxic antibiotic, so BUN does not have to monitored; elevated blood urea nitrogen (BUN) due to renal impairment or a diet high in meat (2) CORRECT—penicillin is a high allergen; allergic reaction or anaphylaxis occurs within an hour, but usually within minutes, after administration of penicillin to a client who is hypersensitive (3) cephalosporins can cause bone marrow depression (4) penicillin causes stomatitis, gastritis, diarrhea, and oral superinfections

After 2 weeks of chemotherapy treatments, a client's white blood cell count is 2,000/mm 3. The LPN/LVN knows that this finding is most likely due to which of the following? 1. Infection. 2. Bone marrow depression. 3. Weight loss. 4. Polycythemia

2. Bone marrow depression. Strategy: Think about each answer. (1) normal white blood cell count is 4,500 to 11,000/mm 3; decreased white blood cell counts will cause infection; place client in private room; meticulous hand washing; monitor for signs of infection (2) CORRECT—chemotherapy causes bone marrow depression (3) chemotherapy causes nausea and vomiting, which can lead to weight loss; cancer also contributes to weight loss (4) hematocrit that is persistently >55%; treatment is repeated phlebotomy

The LPN/LVN knows that which of the following is the MOST life-threatening side effect of chemotherapy? 1. Alopecia. 2. Bone marrow suppression. 3. Vomiting. 4. Mucositis.

2. Bone marrow suppression. Strategy: "MOST life-threatening" indicates discrimination is required to answer the question. (1) loss of hair; common side effect that affects body image (2) CORRECT—results in decreased leukocytes, erythrocytes, and platelets (3) nausea and vomiting are common side effects (4) sores in mucous membranes of gastrointestinal tract; mouth sores interfere with client's ability to eat

The LPN/LVN identifies that which of the following medications is used for the treatment of Parkinson's disease? 1. Phenobarbital (Luminal). 2. Carbidopa/Levodopa (Sinemet). 3. Cimetidine (Tagamet). 4. Doxapram hydrochloride (Dopram).

2. Carbidopa/Levodopa (Sinemet).

The LPN/LVN cares for a client diagnosed with heart failure. The health care provider prescribes digoxin (Lanoxin) 0.125 PO and furosemide (Lasix) 10 mg PO daily for the client. Which of the following actions should the LPN/LVN take FIRST? 1. Instruct the client to measure urinary output. 2. Contact the supervising nurse. 3. Measure the client's apical pulse rate. 4. Administer the medications with food.

2. Contact the supervising nurse. Strategy: "FIRST" indicates priority. (1) instruct client to take medication in the morning due to diuretic effect; priority is to address the potential for hypokalemia (2) CORRECT—both drugs are potassium-depleting; supplement is needed; hypokalemia potentiates the action of digoxin (Lanoxin) (3) take pulse for one full minute prior to administering the medication; more important to address the loss of potassium (4) digoxin (Lanoxin) can be irritating to gastric mucosa, resulting in nausea/vomiting; needs to be administered with food

After inserting a needle into the deltoid muscle to inject phytonadione 10 mg IM, which action should the LPN/LVN perform next? 1. Instruct the client to contract the muscle. 2. Grasps the base of the syringe for stability. 3. Administer the phytonadione as quickly as possible. 4. Pulls back the needle while injecting slowly.

2. Grasps the base of the syringe for stability. Strategy: "NEXT" indicates priority. (1) contracting the muscle will cause more pain than relaxing (2) CORRECT— most important action is to stabilize the syringe to prevent the needle from moving in the tissue (3) no reason to give quickly; watch for signs of flushing, weakness, tachycardia, and hypotension (4) phytonadione is an antihemorrhagic factor that promotes hepatic formation of active prothrombin

The LPN/LVN carries out the teaching plan for a post-myocardial infarction client. The LPN/LVN explains the client is receiving digoxin (Lanoxin) because of which of the following? 1. Lanoxin dilates the coronary arteries. 2. Lanoxin regulates cardiac rhythm. 3. Lanoxin prevents premature ventricular contractions. 4. Lanoxin increases the rate of myocardial contractions.

2. Lanoxin regulates cardiac rhythm Strategy: Think about the action of Lanoxin (1) action of nitroglycerin (2) CORRECT—cardiac glycoside, decreases conduction through the SA node and AV node (3) action of lidocaine and procainamide (Pronestyl); decreases the response to ectopic pacemakers (4) atropine increases heart rate; digoxin is prescribed for above normal cardiac rate

The LPN/LVN understands that the antagonist of coumadin is which of the following? 1. Protamine sulfate. 2. Calcium. 3. DigiFab. 4. Vitamin K.

4. Vitamin K. Strategy: Think about each answer. (1) antagonist for heparin (2) electrolyte; calcium gluconate is the antidote for magnesium sulfate excess (3) used to treat digoxin overdose (4) CORRECT—vitamin K is a coumadin antagonist because it promotes blood clotting

Which does the LPN/LVN identify as the chief advantage of using methadone for treatment of drug addiction? 1. Methadone is less addictive than heroin. 2. Methadone relieves the withdrawal effects of heroin. 3. Methadone has no street value and cannot be abused. 4. Methadone makes the client sick if taken with heroin.

2. Methadone relieves the withdrawal effects of heroin. Strategy: Think about each answer. 1) methadone is a legally controlled narcotic; dosages are prescribed according to need, with limited prescription periods to prevent addiction; other narcotic medications have the same characteristic but do not assist in the treatment of narcotic drug addiction 2) CORRECT — methadone relieves the euphoric and withdrawal symptoms of heroin, thereby allowing the client to be able to function socially 3) because physical dependence has a psychological element, almost any medication can be abused; does have street value because produces similar high feeling like many other narcotics 4) unlike disulfiram, which causes excessive sympathetic and gastrointestinal sign/symptoms if ingested with alcohol, this medication compounds the CNS signs/symptoms, such as drowsiness

The LPN/LVN cares for a 71-year-old diagnosed with Parkinson's disease. Yesterday, the client received an initial dose of furosemide (Lasix) 40 mg. The LPN/LVN notes that the client's weight the day before taking Lasix was 183 lb, and the client now weighs 177 lb. Which of the following actions should the nurse take FIRST? 1. Assess the client's skin turgor. 2. Notify health care provider. 3. Obtain the client's blood pressure while lying, sitting, and standing. 4. Request change of medication.

2. Notify health care provider Strategy: "FIRST" indicates priority. (1) not an effective measure of hydration in a client in this age group (2) CORRECT—client has lost 6 lb in 24 hours; weight loss >5 lb/24 hours is considered marked dehydration and requires intervention; would not be able to restore by drinking (3) no further assessment is required before contacting the health care provider (4) priority is to contact health care provider

The LPN/LVN understands that which of the following is the principal reason for the use of ranitidine hydrochloride (Zantac) in a client with pancreatitis? 1. Pancreatic enzymes are irritating to the liver. 2. Pancreatic enzymes are activated by an acidic pH. 3. Pancreatic enzymes are missing and must be replaced. 4. Pancreatic enzymes are inactivated and must be enhanced.

2. Pancreatic enzymes are activated by an acidic pH trategy: Think about each answer. (1) pancreatitis results in autodigestion of the pancreas; enzymes cause pancreatic necrosis (2) CORRECT—interstitial pancreatitis is characterized by a swelling of the gland and the escape of its digestive enzymes, lipase and amylase, into the surrounding tissues and into the peritoneal cavity, causing necrosis; Zantac decreases the production of hydrochloric acid; pancreatic enzymes are activated by an acidic pH (3) enzymes are present and must be decreased (4) in order for pancreas to heal, must decrease the pancreatic enzymes

The nurse cares for an older client receiving digoxin (Lanoxin) 0.25 mg PO daily. It is MOST important for the LPN/LVN to monitor which of the following? 1. Blood pressure. 2. Potassium level. 3. Cardiac dysrhythmias. 4. Peripheral edema.

2. Potassium level. Strategy: "MOST important" indicates discrimination is required to answer the question. (1) digoxin (Lanoxin) is a cardiac glycoside; side effects include anorexia, nausea, bradycardia, visual disturbances; primarily affects cardiac function, has little or no effect on blood pressure (2) CORRECT—digoxin (Lanoxin) potentiated by hypokalemia (3) digoxin (Lanoxin) is prescribed to reduce cardiac dysrhythmias; would not expect them to occur (4) commonly given for heart disease; if peripheral edema exists, would be related to the disease and not to the drug

The home care LPN/LVN cares for a client who has just been discharged home after surgery. The physician orders cimetidine (Tagamet) 300 mg PO ac and hs. It is MOST important for the LPN/LVN to perform which of the following activities? 1. Determine if the client has a history of peptic ulcer disease (PUD). 2. Review all of the medication the client is currently taking. 3. Obtain the current laboratory results. 4. Delay the initial dose until a stool guaiac is obtained.

2. Review all of the medication the client is currently taking. Strategy: "MOST important" indicates discrimination is required to answer the question. (1) cimetidine (Tagamet) is an H 2-receptor blocker; postoperative clients are more prone to PUD; medication given prophylactically; interaction with other drugs places client more at risk (2) CORRECT—this category of drugs interferes with a long list of drugs; anytime drugs are prescribed, LPN/LVN should conduct a review of other categories to determine the degree of interactions and the risks to the client (3) common side effect is aplastic anemia; LPN/LVN needs to be aware of current blood cell levels; primary concern with drug ingestion is to determine if significant drug interactions may occur

he LPN/LVN completes an assessment form for a client in the outpatient psychiatric unit. The client states he has been taking imipramine (Tofranil) for 2 weeks. It is MOST important for the LPN/LVN to be alert for which of the following? 1. Anger and sarcasm. 2. Suicidal behaviors. 3. Withdrawal from reality. 4. Early-morning waking.

2. Suicidal behaviors. Strategy: "MOST important" indicates discrimination is required to answer the question. (1) more likely to see drowsiness and anxiety (2) CORRECT—tricyclic antidepressants begin to take effect about 10 to 14 days after treatment is started; at that time, clients may have enough physical and emotional energy to act upon their suicidal thoughts (3) psychotic behavior; does not occur with antidepressants (4) causes sedation; other side effects include dry mouth, blurred vision, photosensitivity, orthostatic hypotension

The LPN/LVN assesses a client receiving levothyroxine sodium. The LPN/LVN identifies that which indicates a favorable outcome to medication therapy? 1. The client's blood pressure decreases. 2. The client has increased urine output. 3. The client's pulse rate decreases. 4. The client's respiratory rate increases.

2. The client has increased urine output. Strategy: Think about each answer. (1) levothyroxine sodium stimulates metabolism of body tissues; hypotension is a symptom of hypothyroidism (2) CORRECT—levothyroxine sodium increases metabolic processes in the body, including glomerular filtration, thereby increasing urine output; edema will decrease as the water is excreted via the renal system; side effects include nervousness, tremors, insomnia, tachycardia, and palpitations; LPN/LVN should instruct client to report chest pain, palpitations, sweating, nervousness, and shortness of breath to health care provider; take medication at the same time every day in the A.M. (3) bradycardia is a symptom of hypothyroidism; should monitor client's pulse and blood pressure when on levothyroxine sodium (4) dyspnea is a symptom of hypothyroidism

Prednisone 2 mg PO q d is prescribed for a client with rheumatoid arthritis. What important points should the LPN/LVN include when teaching the client about this drug? 1. The dosage will be adjusted until maximum effect is achieved. 2. The dosage should be increased and decreased gradually. 3. Some clients experience incontinence as a side effect of this drug. 4. Prednisone is a dangerous drug and must be carefully monitored.

2. The dosage should be increased and decreased gradually. Strategy: Think about the action of Prednisone. (1.) true statement; however, will experience a reduction in joint pain but not necessarily achieve complete relief of symptoms (2.) CORRECT—it is important to withdraw this drug gradually to minimize the reaction of the body to the sudden loss of exogenous steroids; with prolonged steroid administration, the adrenal glands are suppressed (3.) major side effects include risk of peptic ulcers, depression, fluid retention, and hypertension (4.) has very serious long-term side effects which warrant monitoring; however, client needs to recognize the importance of adhering to drug schedule

The LPN/LVN assists the charge nurse to initiate an IV for a client with chronic alcoholism. The LPN/LVN anticipates that in addition to receiving glucose, the client should also receive which of the following? 1. Phenobarbital (Solfoton). 2. Thiamine (Thiamilate). 3. Naloxone (Narcan). 4. Methadone (Dolophine).

2. Thiamine (Thiamilate). Strategy: Think about the action of each medication. (1) anticonvulsant; side effects include drowsiness, rash, GI upset, respiratory depression (2) CORRECT—thiamine is essential for the metabolism of carbohydrates; in order for the glucose to be utilized, thiamine is necessary; giving glucose without thiamine will not help the alcoholic client (3) naloxone (Narcan) is a narcotic antagonist; will cause tachycardia; if client is abusing narcotics, will result in delirium tremens (4) similar to morphine and used in drug abuse programs to alleviate the craving for opioids

The physician prescribes hydrochlorothiazide (HydroDIURIL) 50 mg once a day for an older adult client. The LPN/LVN should administer this medication at which of the following times? 1. 6 A.M. 2. With breakfast. 3. With dinner. 4. At bedtime.

2. With breakfast Strategy: Think about the action of HydroDIURIL. (1) if given early, trips to the bathroom would be resolved early; because can irritate gastric mucosa, hydrochlorothiazide should be given with food; is a potassium wasting diuretic; side effects include hypokalemia, hyperglycemia, blurred vision, dry mouth, and hypotension (2) CORRECT—hydrochlorothiazide is a thiazide diuretic and should be taken with early morning meal because can cause nausea and vomiting, 50% remains in the bloodstream for 6 to 14 h if given with dinner, diuresis would occur while the client was sleeping, causing interruptions in sleep (3) administer as early as possible to prevent nocturia (4) diuretics should not be administered at bedtime; reduces quality sleep and places client at risk for falling while getting up in the dark or while disoriented

The home health LPN/LVN visits a client diagnosed with multiple sclerosis. The client is receiving interferon beta-1a. The client reports to the LPN/LVN of having fever, chills, and myalgia periodically. Which response by the LPN/LVN is most appropriate? 1. "You should contact your health care provider." 2. "Interferon beta-1a causes flu-like symptoms." 3. "Have you felt more fatigued lately?" 4. "Have you taken the prescribed acetaminophen?"

3. "Have you felt more fatigued lately?" Strategy: "MOST appropriate" indicates discrimination is required to answer the question. (1) interferon beta-1a is an immune modifier used to treat multiple sclerosis; inform client that flu-like symptoms may occur during therapy (2) is factual statement; priority is to find out if client suffering from fatigue (3) CORRECT—fatigue is a cumulative side effect and may cause the health care provider to decrease or discontinue the therapy; other side effects include nausea, diarrhea, vomiting, and anorexia; anorexia is also a dose-limiting side effect (4) appropriate to treat fever and myalgia; first complete assessment

The LPN/LVN instructs a client about the potential side effects of pilocarpine hydrochloride (Isopto-Carpine). The LPN/LVN determines that teaching is effective if the client makes which of the following statements? 1. "This medication reduces my ability to see distances." 2. "This medication is going to cause me to be color-blind." 3. "This medication may cause me to have blurred vision." 4. "This medication may cause me to develop blindness."

3. "This medication may cause me to have blurred vision." Strategy: "Teaching is effective" indicates correct information. (1.) does not affect the client's ability to see distances (2.) color-blindness is genetically determined; defective or absent color perception is not a side effect of the drug (3.) CORRECT—this is true especially when the drops are first instilled; because there can be some ciliary spasm, the focus of the eye is affected and the ability to see in dim lighting is decreased; a client who is to be sent home on pilocarpine drops should therefore be cautioned to avoid driving and operating machinery, especially immediately after instillation (4.) untreated glaucoma can result in blindness

The LPN/LVN assists in the preparation of a client scheduled for a subtotal thyroidectomy. The client asks the LPN/LVN why the health care provider has prescribed strong iodine solution. Which response by the LPN/LVN is best? 1. "The medication will increase the release of thyroid hormone." 2. "This medication will increase your basal metabolic rate." 3. "This medication will prevent postoperative hemorrhage." 4. "This medication will prevent nervousness and anxiety."

3. "This medication will prevent postoperative hemorrhage." Strategy: "BEST" indicates discrimination is required to answer the question. (1) strong iodine solution will decrease the release of thyroid hormones; administered 10 to 14 days prior to surgery (2) will decrease BMR (3) CORRECT—reduces vascularity and size of the thyroid; will reduce postop hemorrhage (4) beta-adrenergic blocking agents used to control effects of the sympathetic nervous system, such as nervousness, tachycardia, tremor, anxiety, and heat intolerance

The home care LPN/LVN participates in the evaluation of the medications prescribed for a client diagnosed with chronic closed-angle glaucoma. It is MOST important for the LPN/LVN to report to the supervising nurse that the client is taking which of the following medications? 1. Pilocarpine sulfate (Isopto-Carpine). 2. Acetazolamide (Diamox). 3. Atropine sulfate. 4. Dipivefrin (Propine).

3. Atropine sulfate. Strategy: "MOST important" indicates that discrimination is required to answer the question. (1.) miotic used to treat glaucoma by pulling pupil away from cornea (2.) goal of treatment of glaucoma is to lower intraocular pressure by decreasing production of or to increase outflow of aqueous humor; drug decreases production (3.) CORRECT—atropine is a mydriatic that results in pupillary dilation forcing the pupil against the cornea, resulting in a decreased angle; use of this type of medication in a client with narrow-angle glaucoma may result in blindness (4.) because decreases production of aqueous humor, is used to treat open-angle glaucoma (chronic glaucoma)

The health care provider orders Heparin 5,000 U IM for a postoperative client. Which of the following actions should the LPN/LVN take FIRST? 1. Check the client's aPTT level. 2. Determine which prescribed and over-the-counter medications the client is taking. 3. Contact the health care provider. 4. Determine the purpose for the order.

3. Contact the health care provider. Strategy: "FIRST" indicates priority. (1) because heparin prolongs clotting time, is appropriate activity; dose may be adjusted based on the results of aPTT (2) heparin interacts with a large number of drugs; assessment of the effect of other drugs on the clotting process prior to administration is appropriate (3) CORRECT—drug is not administered IM because it can cause localized pain, hematomas, ulcerations, and erythema; administer SQ or IV (4) important information, but LPN/LVN must first obtain a valid order

The child is diagnosed with attention deficit hyperactivity disorder (ADHD). The health care provider prescribes atomoxetine 45 mg PO daily. The LPN/LVN notes the medication is available in 10, 25, and 40 mg capsules. Which action by the LPN/LVN is best? 1. Administer half 10 mg capsule and one 40 mg capsule. 2. Administer two 10 mg capsules and one 25 mg capsule. 3. Contact the prescribing health care provider. 4. Administer half 40 mg capsule and one 25 mg capsule.

3. Contact the prescribing health care provider. Strategy: Think about each answer. (1) medication placed in capsule because of potential irritation to gastric lining; no guarantee that medication is equally distributed; great risk for error or damage to client (2) the greater the number of components, the greater the risk for error (3) CORRECT—need to investigate alternatives that would not place client at risk; the greater the number of components, the greater the chances of a medication error (4) medication is placed in capsule because of potential irritation to gastric lining

The LPN/LVN cares for the client receiving high doses of aspirin for a prolonged period of time. It is most important for the LPN/LVN to assess for which sign or symptom? 1. Urinary frequency. 2. Hypoventilation. 3. Gastritis. 4. Hemoconcentration.

3. Gastritis. Strategy: "MOST important" indicates that discrimination is required to answer the question. (1)more commonly associated with diuretics (2)respiratory depression caused by narcotics (3) CORRECT— salicylism results in gastritis; gastrointestinal bleeding, blood dyscrasia, and acid-base disturbances, with fluid and electrolyte imbalances; directly associated with prolonged high doses of aspirin (4)dehydration is commonly associated with diuretics resulting in hemoconcentration

A client is placed on phenytoin sodium (Dilantin) twice a day. The LPN/LVN should assess the client for which of the following? 1. Extensive drowsiness, hypotension. 2. Hypotension, cardiac dysrhythmias. 3. Gum hypertrophy, red-colored urine. 4. Decreased red blood cells (RBCs), reduced platelets.

3. Gum hypertrophy, red-colored urine. Strategy: Topic of question is unstated. (1.) exhibited with toxicity (2.) hypotension can occur if administered too rapidly IV; is often prescribed for dysrhythmias (3.) CORRECT—gum hypertrophy and red-colored urine are side effects; other side effects include vomiting, nystagmus, drowsiness, rash, and fever (4.) toxic effects include blood dyscrasias

The LPN/LVN cares for a client diagnosed with duodenal ulcers. The physician prescribed sucralfate 1 g PO, ac, and hs, and cimetidine 300 mg PO, ac, and hs. Which of the following actions by the LPN/LVN is MOST appropriate? 1. Administer vitamin B 12 injections monthly. 2. Instruct the client to remain in upright position for 30 minutes pc. 3. Instruct the client to continue to ingest medications after signs/symptoms cease. 4. Teach the client about the pathophysiological process associated with the disease.

3. Instruct the client to continue to ingest medications after signs/symptoms cease. Strategy: "MOST appropriate" indicates that discrimination may be required to answer the question. (1) more commonly associated with pernicious anemia; duodenal ulcers cause pain 2 to 3 hours after meals and during the early sleeping hours of the night; food intake relieves pain (2) more commonly associated with gastroesophageal reflux disease (GERD) (3) CORRECT— signs/symptoms are absent or reduced within 7 days; client often discontinues medications even though the ulcer has not healed; LPN/LVN needs to emphasize the importance of continuing to ingest the medications; Carafate is a cytoprotective agent; side effects include constipation, vertigo, and flatulence; give 2 hours after Tagamet; Tagamet is an H 2-receptor blocker, side effects include diarrhea, dizziness; large doses produce confusion in the elderly (4) needs to know about disease; emphasis on drug therapy is more important because clients are apt to discontinue treatment when signs/symptoms are relieved

The LPN/LVN cares for a postoperative client being monitored via telemetry. The client experiences frequent premature ventricular contractions (PVCs). The LPN/LVN anticipates that which of the following medications is MOST likely to be administered IV to the client? 1. Digoxin (Lanoxin). 2. Enalapril maleate (Vasotec). 3. Lidocaine (Xylocaine). 4. Ibutilide fumarate (Convert).

3. Lidocaine (Xylocaine). Strategy: "MOST likely" indicates discrimination is required to answer the question. (1) cardiac glycoside used to treat heart failure, atrial fibrillation, and atrial flutter (2) antihypertensive, not used to treat dysrhythmias (3) CORRECT—because PVCs can lead to ventricular tachycardia, is life-threatening; side effects include hypotension, tremors, confusion, blurred vision (4) used to treat atrial flutter and fibrillation

The LPN/LVN cares for a client who is severely immunosuppressed. The LPN/LVN observes another licensed staff member reconstitute a powdered drug with sterile water rather than the recommended bacteriostatic water. Which of the following actions should the LPN/LVN take FIRST? 1. Do not interfere with the administration of the medication. 2. Instruct the licensed staff member to discard the reconstituted drug solution after the dose is administered. 3. Notify the supervising nurse. 4. Instruct the licensed staff member to store reconstituted drug in refrigerator.

3. Notify the supervising nurse. Strategy: "FIRST" indicates priority. (1) introduction of sterile water likely to result in clumping; is believed that the benzyl alcohol in bacteriostatic water causes the powder to dissolve; failing to follow manufacturer's instruction likely to place client at greater risk (2) priority is to contact supervising nurse (3) CORRECT—introduction of sterile water likely to result in clumping; is believed that the benzyl alcohol in bacteriostatic water causes the powder to dissolve; failing to follow manufacturer's instruction likely to place client at greater risk (4) priority is to notify supervising nurse

The health care provider orders potassium hydrochloride 40 mEq PO daily for the client. Which action should the LPN/LVN take first? 1. Instruct the client to dissolve contents of packet in fruit juice. 2. Check client identification bracelet. 3. Review the client's serum blood urea nitrogen (BUN) and creatinine levels. 4. Review the client's serum glucose levels.

3. Review the client's serum blood urea nitrogen (BUN) and creatinine levels. Strategy: "First" indicates priority. 1) appropriate action; take with or after meals to decrease GI irritation 2) appropriate activity immediately before administration 3) CORRECT — potassium hydrochloride is excreted via kidneys; reduced function can result in hyperkalemia; assess for toxicity (slow, irregular heartbeat, fatigue, muscle weakness) 4) insulin promotes movement of potassium (K +) into cells, resulting in decreased K + serum levels; no relationship between glucose levels and potassium

The LPN/LVN cares for a client receiving sulfasalazine (Azulfidine) 500 mg PO qid. It is MOST important for the LPN/LVN to notify the health care provider about which of the following? 1. The client has a history of peptic ulcer disease. 2. The client complains of orange-colored urine. 3. The client takes an oral hypoglycemic. 4. The client drinks 2 to 3 liters of water per day.

3. The client takes an oral hypoglycemic. Strategy: "MOST important" indicates discrimination is required to answer the question. (1) sulfasalazine (Azulfidine) is a GI anti-inflammatory used to treat ulcerative colitis; can cause GI distress and should be administered with food; history of PUD not relevant (2) expected outcome; contraindicated in client with hypersensitivity to sulfonamides, salicylates, or sulfasalazine (3) CORRECT—sulfasalazine (Azulfidine) enhances action of oral hypoglycemics, may increase risk of toxicity (4) necessary to prevent dehydration

Following a male client's treatment for Addison's disease, the LPN/LVN assists in planning the client's discharge. The client asks how long he has to take the prescribed medication. Which of the following responses by the LPN/LVN is BEST? 1. "You will need to check with your physician." 2. "As long as you have panic attacks in response to mental stress." 3. "Until the lab values are within normal limits." 4. "For the rest of your life."

4. "For the rest of your life." Strategy: "BEST" indicates discrimination is required to answer the question. (1) physician will need to renew when it expires; LPN/LVN can provide appropriate information (2) psychological stress can cause an Addisonian crisis; the medication is prescribed to maintain the hormone at a normal level and not solely to prevent a crisis (3) the goal of the therapy is to maintain serum levels of cortisone at a normal level; will need to continue medication to maintain the appropriate level (4) CORRECT—glucocorticoids, hormones that are essential to life, are decreased in Addison's disease; client will need exogenous glucocorticoid therapy for the rest of his life

The LPN/LVN cares for a client receiving filgrastim (Neupogen) 5 mcg/kg. The client weighs 170 lb. How many mcg should the LPN/LVN administer to the client? 1. 170 mcg. 2. 253 mcg. 3. 300 mcg. 4. 386.4 mcg.

4. 386.4 mcg. Strategy: 2.2 pounds equals one kilogram. (1) dose inadequate; filgrastim (Neupogen) given to increase neutrophils following chemotherapy; 57% of clients receiving drug experience nausea/vomiting; 22% experience bone pain that requires analgesia (2) dose inadequate (3) dose incorrect (4) CORRECT—170 lb 2.2 kg = 77.3 kg; 77.3 kg 5 mcg = 386.36 = 386.4 mcg

The LPN/LVN cares for clients in the pediatric unit. The health care provider prescribes oxycodone (Roxicodone) 5 mg q 4 to 6 h for a child weighing 73 lb. The drug comes in an oral solution 5 mg/mL. The recommended dosage range is 0.15 mg/kg. After noting the order, which of the following actions should the LPN/LVN take FIRST? 1. Teach the parents about the medication. 2. Assess client's level of consciousness. 3. Contact the health care provider. 4. Administer the medication.

4. Administer the medication. Strategy: "FIRST" indicates priority. (1) appropriate action but should first determine if the dose is within the safe range (2) although assessment of LOC is appropriate before administering narcotics, must first determine if dose is safe (3) no reason to contact the health care provider (4) CORRECT—73 lb = 33.2 kg; 0.15 mg 33.2 kg = 4.97 mg; 4.97 mg = 5 mg; dose falls within safe range; oxycodone is a narcotic analgesic; side effects include light-headedness, dizziness, sedation, and nausea

The LPN/LVN cares for a client receiving tetracycline HCl 500 mg PO BID. It is most important for the LPN/LVN to take which action? 1. Administer the medication via an infusion pump. 2. Re-assess history of client's drug allergies. 3. Have laboratory assess the drug level before administering the medication. 4. Avoid administering the drug with dairy products.

4. Avoid administering the drug with dairy products. Strategy: Determine the outcome of each answer. Is it desired? (1) drug is produced for the oral and topical routes; more common to administer Amphotericin B via infusion pump because of risk of nephrotoxicity (2) more appropriate for high allergens such as penicillins and sulfonamides; ask about allergies immediately before initial dose (3) measurement of peak and valley levels of aminoglycosides is conducted to prevent acute kidney injury ; not associated with this drug (4) CORRECT—decreases absorption

Fluphenazine (Prolixin) is ordered for a client. If the client develops tardive dyskinesia, the LPN/LVN expects the client to exhibit which of the following? 1. Tremors and an unsteady gait. 2. Tingling sensations in the extremities and stiffness. 3. Shuffling and pacing. 4. Bizarre facial movements and difficulty in swallowing.

4. Bizarre facial movements and difficulty in swallowing. Strategy: Think about each answer. (1) antipsychotics can cause extrapyramidal side effects, which include dystonia, tardive dyskinesia, akathisia, and pseudoparkinsonism; tremors and unsteady gait indicative of pseudoparkinsonsim (2) more representative of neuroleptic malignant syndrome (extrapyramidal effects, hyperthermia, and autonomic disturbance) (3) akathisia is the inability to sit or stand still, foot tape or pace (4) CORRECT—bizarre facial movements, such as protrusion of the tongue and lip smacking, and difficulty swallowing are characteristics of tardive dyskinesia; observe for symptoms; prevent by maintaining client on lowest possible dose of medication

The LPN/LVN cares for a postoperative patient who has just received naloxone (Narcan). It is MOST important for the LPN/LVN to take which of the following actions? 1. Elevate the head of the client's bed. 2. Observe the condition of the client's wound. 3. Assess the client's level of pain. 4. Count the client's respirations.

4. Count the client's respirations. Strategy: "MOST important" indicates priority. (1) naloxone (Narcan) is an opioid antagonist given to reverse respiratory depression due to opioid overdose; monitor respiratory rate, rhythm, and depth of respirations (2) appropriate for postoperative management; assessing client's respiratory status takes priority (3) reverses analgesia as well as respiratory depression; pain management is major part of postop nursing care, would be secondary to risks associated with excessive sedation (4) CORRECT—primary focus is to reduce respiratory depression

The LPN/LVN understands that the action of pilocarpine (Isopto-Carpine) eyedrops administered to a client with closed-angle glaucoma includes which of the following? 1. Enhances vitreous humor production. 2. Produces ciliary muscle contraction. 3. Increases clarity of the lens. 4. Induces pupil constriction.

4. Induces pupil constriction. Strategy: Think about each answer. (1.) disease occurs because of entrapment of aqueous humor; would not administer a drug that increases the volume of aqueous humor (2.) has no effect on the lens; density of lens changes with age or some disease processes (3.) pupillary dilation narrows the angle and increases intraocular pressure (IOP) (4.) CORRECT—pilocarpine (Isopto-Carpine) eyedrops constrict the pupil, that is, induce miosis, pulling the iris away from the cornea and increasing the size of the angle; allows the aqueous humor to flow out more easily, decreasing the intraocular pressure

The LPN/LVN administers phytonadione (AquaMEPHYTON) 10 mg IV to a client. The LPN/LVN recognizes that which of the following is the BEST indicator of the drug's effectiveness? 1. Increased blood pressure. 2. Decreased abdominal cramping. 3. Clot formation near the wound's edges. 4. Post-injection prothrombin time.

4. Post-injection prothrombin time. Strategy: "BEST" indicates discrimination is required to answer the question. (1) phytonadione (AquaMEPHYTON) used to treat hypoprothrombinemia; has no direct effect on blood pressure; hypotension can occur with hemorrhage (2) does not provide direct evidence of drug effectiveness (3) oozing blood from a fresh wound is likely to decrease as drug becomes effective; offers little information regarding general effect of the drug (4) CORRECT—drug is required for hepatic synthesis of prothrombin and coagulating factors VII, IX, and X; measurement of PT would reveal drug effectiveness; normal is 10-13 seconds

The LPN/LVN cares for a client with diabetes insipidus. The physician prescribes vasopressin (Pitressin). The LPN/LVN determines that the medication is effective if which of the following is observed? 1. The client's 24-hour urinary output is 5,000 cc. 2. The client's weight decreases by 4 pounds in a week. 3. The client complains of thirst. 4. The client's specific gravity is 1.015.

4. The client's specific gravity is 1.015. Strategy: Think about each answer. (1) diabetes insipidus is deficiency of antidiuretic hormone (ADH); symptoms include excessive urine output, excessive thirst, chronic, severe dehydration; 5,000 cc is excessive urine output (2) indicates dehydration (3) excessive thirst is indication of diabetes insipidus (4) CORRECT—normal specific gravity is 1.010 to 1.030; low specific gravity indicative of diabetes insipidus

The LPN/LVN understands that which of the following occurrences are COMMON signs of aspirin toxicity? 1. Nausea and vertigo. 2. Epistaxis and paralysis. 3. Arrhythmia and hypoventilation. 4. Tinnitus and gastric distress.

4. Tinnitus and gastric distress. Strategy: Think about each answer. (1.) causes nausea and gastric irritation (2.) causes prolonged bleeding related to low platelets (3.) may cause rash; is common allergen (4.) CORRECT—tinnitus and gastric distress are common signs of salicylism, or aspirin toxicity

The LPN/LVN cares for a client receiving warfarin (Coumadin) 5 mg PO daily. Because the client's latest prothrombin time (PT) is 59 seconds, the LPN/LVN anticipates administering which of the following drugs? 1. Ibuprofen (Advil). 2. Phenytoin (Dilantin). 3. Lisinopril (Zestril). 4. Vitamin K.

4. Vitamin K. Strategy: Think about each answer. (1) nonsteroidal anti-inflammatory; can increase the bleeding time (2) anticonvulsant; can cause aplastic anemia resulting in decreased platelet count, which results in increased bleeding time (3) ACE inhibitor, treatment for hypertension; has no impact on bleeding time (4) CORRECT—vitamin K is warfarin (Coumadin) antagonist; warfarin (Coumadin) is an anticoagulant; PT measures the clotting ability of factors I, II, V, VII, and X; normal is 10 to 13 seconds; therapeutic level is 1.5 to 2.5 times the control; 59 seconds is far above the therapeutic level

The nurse cares for a client receiving amitriptyline (Elavil) 25 mg QID. It is MOST important for the LPN/LVN to instruct the client to observe for which of the following side effects? 1. Photophobia. 2. Postural hypotension. 3. Epistaxis. 4. Hypertensive crisis.

Postural hypotension. Strategy: "MOST important" indicates discrimination is required to answer the question. (1) sensitivity to light is a side effect, but postural hypotension is a safety issue; instruct client to avoid exposure to sunlight and to wear sunscreen (2) CORRECT—postural hypotension is common side effect; clients should be cautioned to move slowly from a sitting to a standing position; Elavil is a tricyclic antidepressant; other side effects include sedation, dry mouth, and blurred vision (3) nosebleed; may be caused by anticoagulants (4) side effect of MAO inhibitors

The nurse cares for a client ordered to receive 3,000 ml of intravenous fluid in 24 hours. The IV unit delivers 15 drops per ml. The nurse should adjust the flow rate to deliver how many drops per minute? Type the correct answer into the blank. Type the correct answer in the blank. Round to the nearest whole number. ___________ Your Response: Correct Response: 31

rategy: Correct answer: 31