N331 Pharm 1 HESI

A client asks a nurse why captopril was prescribed. What specific drug classification should the nurse include in the explanation to the client? diuretic sedative hypnotic antihypertensive

antihypertensive Captopril is an antihypertensive; it inhibits conversion of angiotensin I to angiotensin II. Diuretics promote fluid excretion. Sedatives reduce muscle tension and anxiety. Hypnotics promote sleep.

The healthcare provider prescribes 1 liter of intravenous (IV) fluid to infuse over 4 hours for a client admitted for a urinary tract infection and hyponatremia. The tubing drop factor is 10 drops/mL. At what rate will the nurse infuse the medications? 20 drops/min 34 drops/min 42 drops/min 60 drops/min

42 drops/min (250/60)*10 = 41.66 = 42

A client who is dehydrated is to receive an intravenous (IV) solution of normal saline to be infused at 175 mL/hr. The drop factor of the IV set is 15 gtts/mL. At what drop rate will the nurse adjust the flow to provide the prescribed solution? Record your answer using a whole number.

44 ggts/min

Aspirin is prescribed on a regular schedule for a client with rheumatoid arthritis. The nurse understands that the drug is being used primarily for which of its properties? Analgesic Antipyretic Antiinflammatory Antiplatelet

Antiinflammatory The antiinflammatory action of aspirin reduces joint inflammation. Aspirin reduces fever, but this is not the rationale for prescribing it for clients with rheumatoid arthritis. Aspirin does not preserve bone integrity. Flexion contractures are prevented by exercise, not aspirin.

A client with hypertensive heart disease, who had an acute episode of heart failure, is to be discharged on a regimen of metoprolol and digoxin. What outcome does the nurse anticipate when metoprolol is administered with digoxin?

Bradycardia Metoprolol and digoxin both exert a negative chronotropic effect, resulting in a decreased heart rate. Metoprolol reduces, not produces, headaches. These drugs may cause hypotension, not hypertension. These drugs may depress nodal conduction; therefore, junctional tachycardia would be less likely to occur.

A nurse has provided teaching to a client with a newly prescribed proton pump inhibitor (PPI). The nurse determines that the teaching is effective when the client states that the medication is used for the treatment of which condition?

GERD PPIs are effective in decreasing the secretion of gastric acid, helping to alleviate symptoms of GERD. PPIs are not used for the treatment of diarrhea, vomiting, or cardiac dysrhythmias.

A client is admitted to the cardiac care unit with an anterior lateral myocardial infarction. The healthcare provider prescribes 500 mL of D 5W with 50 mg of nitroglycerin to be administered intravenously to relieve pain. The nurse should assess for which most common side effect of this medication? Nausea Syncope Bradycardia Hypotension

Hypotension The major action of intravenous nitroglycerin is venous and then arterial dilation, leading to a decrease in blood pressure. Nausea is not a common side effect of intravenous nitroglycerin. Syncope is an infrequent effect when nitroglycerin is given intravenously. Reflex tachycardia may occur with the decrease in blood pressure.

The nurse is caring for a client with deep partial-thickness burns who is receiving an opioid for pain management. What is the preferred mode of medication administration for this client? oral rectal IV IM

IV The intravenous route provides for the quickest onset of action of the opioid; pain relief occurs almost immediately. Nausea, vomiting, and paralytic ileus may occur postburn, making oral medications impractical. The rectal route does not provide uniform absorption; also, relief of pain will be delayed. With the intramuscular route, medication may be sequestered in the tissues, and with fluid shifts it takes time for the medication to take effect.

Which insulin should the nurse prepare for the emergency treatment of ketoacidosis? Glargine NPH insulin Insulin aspart Insulin detemir

Insulin aspart Insulin aspart is a rapid-acting insulin (within 10 to 20 minutes) and is used to meet a client's immediate insulin needs. Glargine is a long-acting insulin, which has an onset of 1.5 hours; for diabetic acidosis, the individual needs rapid-acting insulin. NPH insulin is an intermediate-acting insulin, which has an onset of 1 to 2 hours; for diabetic acidosis, the individual needs rapid-acting insulin. Insulin detemir is a long-acting insulin; for diabetic acidosis, the individual needs rapid-acting insulin.

A nurse considers that the safe administration of high-dose methotrexate therapy should include which intervention? Maintaining an acidic urine Restricting intravenous fluids Providing a diet high in folic acid Monitoring plasma levels of the medication

Monitoring plasma levels of the medication Plasma levels indicate whether therapeutic or toxic levels are present. Methotrexate (Rheumatrex) crystallizes in the kidneys if urine becomes acidic. The regimen should include hydration with a minimum of intravenous fluids of 125 mL/hr 6 to 12 hours before and during therapy. The effectiveness of methotrexate, a folic acid antagonist, is minimized by a diet high in folic acid.

A nurse provides discharge teaching about ampicillin that is prescribed for a client. The nurse evaluates that the teaching is effective when the client makes which statement?

The client should increase fluid intake when taking ampicillin to prevent nephrotoxicity; side effects include oliguria, hematuria, proteinuria, and glomerulonephritis. An antibiotic should be continued until the entire prescription is completed; discontinuing before completion lowers its serum level, thereby decreasing its effectiveness. Ampicillin should be taken when the stomach is empty, either one to two hours before eating or three to four hours after eating. There are no restrictions on eating grapefruit when taking an antibiotic; this is contraindicated when taking some calcium channel blockers because grapefruit juice increases their serum level.

A client has been receiving digoxin. The client calls the clinic and complains of "yellow vision." What is the nurse's best response? This is related to your illness rather than to your medication Take the medication because this is not a serious side effect This side effect is only temporary. You should continue medication The side effect is only temporary . You should continue the medication The medication may need to be discontinued. Come to the clinic this afternoon.

The medication may need to be discontinued. Come to the clinic this afternoon. Yellow vision indicates digoxin toxicity; the medication should be withheld until the healthcare provider can assess the client and check the digoxin blood level. Yellow vision is related to digoxin therapy, not the client's underlying medical condition. Yellow vision is a sign of digoxin toxicity; taking more digoxin will escalate the digoxin toxicity.

An older client develops hypokalemia, and an intravenous infusion containing 40 mEq of potassium is instituted. The client tells the nurse that the IV stings a little. What is the nurse's best reply?

The response "You are receiving a large dose of potassium, and unfortunately it often causes a stinging sensation" validates the client's concerns and provides information. The potassium solution will be irritating to other peripheral veins as well. Although imagery may help to distract the client from discomfort, this response provides no information as to why the stinging sensation is occurring. The response "Some people are more sensitive to pain than others. I'll get a prescription for pain medication for you" belittles the client and implies that the client is intolerant of pain. Also, pain medication is not needed in this situation.

A client who is receiving chemotherapy for lung cancer has nausea and vomiting because of the therapy. The client wants to know if it is true that smoking marijuana will help. What is the nurse's best response? Smoking marijuana is not legal in any state Marijuana is effective for nausea and vomiting if it is injected Marijuana is not proven to be effective in preventing chemotherapy-induced nausea and vomiting There are some tetrahydrocannabinol (THC)-based medications that contain marijuana that control chemotherapy-induced nausea and vomiting in some people

There are some tetrahydrocannabinol (THC)-based medications that contain marijuana that control chemotherapy-induced nausea and vomiting in some people THC, an ingredient in marijuana, acts as an antiemetic in some people and can be absorbed through the gastrointestinal tract or inhaled. THC-based medications, dronabinol (Marinol) and nabilone (Cesamet), are available by prescription to control nausea and vomiting resulting from cancer chemotherapy. The statement, "Smoking marijuana is not legal in any state," does not answer the client's question and is inaccurate. Marijuana is not injected. THC is an effective antiemetic for some clients.

A nurse is administering 40 mg of furosemide (Lasix) intravenously. Which sensation reported by the client does the nurse consider when determining that it is being administered too quickly? "Bladder feels full." "Ears are buzzing." "Heart is beating fast." "Left arm feels numb."

"Ears are buzzing." Rapid administration of furosemide can cause tinnitus (a perceived ringing or buzzing in the ears), loss of hearing, and ear pain. Lasix has a diuretic effect; urinary retention does not occur. Lasix does not affect the heart rate. Lasix does not cause peripheral neuropathy.

A client with metastatic melanoma is being treated with interferon gamma 1b. The nurse concludes that the teaching about this drug is understood when the client makes which statement? "I will increase my fluid intake to several quarts (liters) every day." "I need to discard any reconstituted solution at the end of the week." "I can continue driving my car as before as long as I have the stamina." "I should be able to continue my usual activity while taking this medication."

"I will increase my fluid intake to several quarts (liters) every day." Increasing fluid intake to several quarts (liters) every day helps flush the kidneys and prevent nephrotoxicity, especially during the early phase of treatment. Reconstituted solution can be stored in the refrigerator for one month. Confusion, dizziness, and hallucinations are side effects of this drug; the client should avoid hazardous tasks, such as driving or using machinery. Activity may have to be altered because fatigue and other flulike symptoms are common with this drug.

The healthcare provider prescribes neostigmine for a client with myasthenia gravis. The nurse evaluates that the client understands the teaching about this drug when the client makes what statement regarding drug management plans? "Keep the drug in a container in the refrigerator." "Take the drug at the exact time that is listed on the prescription." "Plan to take the drug between meals to promote absorption." "Expect that the onset of the action of the drug will occur several hours after I take it."

"Take the drug at the exact time that is listed on the prescription." Neostigmine should be taken as prescribed, usually before meals, to limit dysphagia and possible aspiration. Keeping neostigmine refrigerated is not necessary; it may be kept at room temperature. Neostigmine should be taken with milk to prevent gastrointestinal irritation; usually it is taken about 30 minutes before meals. The onset of the action of neostigmine occurs 45 to 75 minutes after administration; the duration of its action is 2.5 to 4 hours.

A client with type 1 diabetes is placed on an insulin pump. What is the priority short-term goal when teaching this client to control the diabetes? "The client will adhere to the medical regimen." "The client will remain normoglycemic for 3 weeks." "The client will demonstrate correct use of the insulin pump." "The client will list three self-care activities that are necessary to control the diabetes."

"The client will demonstrate correct use of the insulin pump." Demonstrating the correct use of the administration equipment is a short-term goal, client oriented, necessary for the client to control the diabetes and measurable when the client performs a return demonstration for the nurse. Adhering to the medical regimen is not a short-term goal. Remaining normoglycemic for 3 weeks is measurable, but it is a long-term goal. Although listing three self-care activities that are necessary to control the diabetes is measurable and a short-term goal, it is not the one with the greatest priority when a client has an insulin pump that must be mastered before discharge.

A client with tuberculosis is to begin combination therapy with isoniazid, rifampin, pyrazinamide, and streptomycin. The client says, "I've never had to take so much medication for an infection before." How will the nurse respond? "This type of organism is difficult to destroy." "Streptomycin prevents side effects of the other drugs." "You'll only need to take the medications for a couple of weeks." "Aggressive therapy is needed because the infection is well advanced."

"This type of organism is difficult to destroy." Multiple drugs are administered because of the concern regarding drug resistance. Streptomycin sulfate is an antibiotic; it does not prevent the side effects of other drugs used in therapy. Multiple antitubercular drugs are necessary for an extended period, approximately 6 to 8 months depending on the individual. Aggressive therapy may increase anxiety and may not be needed even when the infection is well advanced.

A client is scheduled to receive conscious sedation during a colonoscopy. The client asks the nurse, "How will they 'knock me out' for this procedure?" Which answer by the nurse correctly describes the route of administration for conscious sedation? "You will receive the anesthesia through a face mask." "You will receive medication through an intravenous (IV) catheter." "We will give you an oral medication about 1 hour before the procedure." "The medicine will be injected into your spine."

"You will receive medication through an intravenous (IV) catheter." Conscious sedation is administered by direct IV injection (IV push) to dull or reduce the intensity of pain or awareness of pain during a procedure without loss of defensive reflexes. General anesthesia usually is administered via inhalation of the vapor of a volatile liquid or an anesthetic gas via a mask or endotracheal tube; as a result, the client is unconscious, unaware, and anesthetized. The oral route of drug administration is commonly used for pediatric clients, not adults. An epidural block, a type of regional anesthesia, involves the injection of a local anesthetic into the epidural (extradural) space; it works by binding to nerve roots as they enter and exit the spinal cord. Epidural blocks are not used for moderate sedation.

A client develops a seizure disorder as a result of a traumatic fall. When the client returns to the clinic for a routine visit, the client states, "I have not had a seizure in 2 years. When can I stop taking my antiseizure medications?" What is the nurse's best response? "a gradual reduction in seizure medication may be considered" "You will require medication ..."

"a gradual reduction in seizure medication may be considered" Specific protocols are designed to gradually reduce the dosage of antiseizure medications after a client is seizure free, provided the electroencephalogram is within acceptable limits. The client is monitored for seizure activity because recurrence is greatest within the first year after drug withdrawal. Depending on the status of the client, antiseizure medications may not be necessary for life. Medications must be withdrawn slowly to prevent an abrupt reduction in serum drug levels, which may precipitate a seizure. The response "A minimum of 10 years without seizures is necessary before discontinuation of medications is considered" indicates too long a time.

A client with terminal cancer is to receive 2 mg of hydromorphone intravenously (IV) every four hours as needed for severe breakthrough pain. It is supplied at 10 mg/mL. When the client complains of severe pain, how much solution of hydromorphone should the nurse administer? Record your answer using one decimal place. Include a leading zero if applicable.

0.2 mL

An older client who is living in a nursing home is admitted to the hospital to be treated with intravenous antibiotics for sepsis. After the client becomes agitated and attempts to pull out the IV, the healthcare provider prescribes a stat dose of haloperidol 0.5 mg intramuscularly (IM). The haloperidol is available in a vial that contains 2 mg/mL. How much solution will the nurse administer? Record your answer using two decimal places. Include a leading zero if applicable.

0.25 mL =0.5/2 The prescribed dose is 0.5 mg. The available concentration is 2 mg/mL. Use the dimensional analysis and/or ratio and proportion methods to determine how many milliliters the nurse should administer.

A client with terminal cancer is to receive 4 mg of hydromorphone intravenously (IV) every 4 hours as needed for severe breakthrough pain. It is supplied at 10 mg/mL. When the client complains of severe pain, how much solution of hydromorphone should the nurse administer? Record your answer using one decimal place and leading zero if applicable.

0.4 mL =4/10 The prescribed dose is 4 mg. The available concentration is 10 mg/mL. Use the dimensional analysis and/or ratio and proportion methods to determine how many milliliters the nurse should administer.

A healthcare provider prescribes 250 mg of a medication. The vial reads 500 mg/mL. How much medication should the nurse administer? Include a leading zero if applicable. Record your answer using one decimal place.

0.5 mL = 250/500 The prescribed dose is 250 mg. The available concentration is 500 mg/mL. Use the dimensional analysis and/or ratio and proportion methods to determine the number of milliliters the nurse should administer.

A healthcare provider orders heparin 6000 units subcutaneously daily. The pharmacy dispenses a vial containing 10,000 units per milliliter. How many milliliters of heparin should the nurse administer? Include a leading zero if applicable. Record your answer using one decimal place.

0.6 mL The prescribed dose is 6,000 units. The available concentration is 10,000 units/mL. Use the dimensional analysis and/or ratio and proportion methods to determine the appropriate amount of medicine to be administered.

The healthcare provider prescribes 7500 units erythropoietin to be administered subcutaneously weekly. The vial reads 10,000 units per milliliter. How much erythropoietin will the nurse give for each weekly dose? Include a leading zero if applicable. Record your answer using two decimal places.

0.75 mL The prescribed dose is 7,500 units. The available concentration is 10,000 units/mL. Use the dimensional analysis and/or ratio and proportion methods to determine the appropriate amount of medication to be administered.

After surgery, a client received a prescription for 8 mg of morphine sulfate to be given by injection. The vial on hand is labeled 1 mL = 10 mg. How much solution should the nurse administer? Record your answer using one decimal place and include a leading zero if applicable.

0.8 mL The prescribed dose is 8 mg. The available concentration is 10 mg/mL. Use the dimensional analysis and/or ratio and proportion methods to determine how many milliliters the nurse shoul administer.

A healthcare provider prescribes 250 mg of an antibiotic intravenous piggyback (IVPB). A vial containing 1 gram of the powdered form of the medication must be reconstituted with 2.8 mL of diluent to form a volume of 3 mL. How many mL of the solution should the nurse administer? Record your answer using one decimal place and leading zero if applicable. Do not include units in your answer. mL

0.8 mL The nurse is adding a prescribed dosage of reconstituted medication to an intravenous piggyback solution for infusion. The prescribed medication is 250 mg. The question gives the total volume in the vial as 3.0 mL. The available concentration is therefore 1 g/3 mL. Now the volume of reconstituted medication can be calculated in three different ways to get the correct answer. Given: 250 mg = 0.25 g, Total volume in the reconstituted vial is 3.0 mL Using ratio and proportion: 0.25 g : X mL :: 1 g : 3 mL; X = 0.25 x 3 = 0.75 mL = 0.8 Using dimensional analysis: 250 mg x 0.001 g/1 mg x 3 mL/1 g = 0.25 x 3 = 0.75 mL = 0.8 Using Desired/Have x Q (mL): 0.25 g/1 g x 3 mL = 0.75 mL = 0.8

The healthcare provider has prescribed enoxaparin 1 mg/kg for a client who had a total knee replacement. The client weighs 187 pounds (85 kg). This medication is available in a concentration of 30 mg/0.3 mL. What dose will the nurse administer in milliliters? 0.8 mL 0.85 mL 0.9 mL 0.95 mL

0.85 mL The answer is calculated as follows: 1 kg = 2.2 lb (187 divided by 2.2 = 85 kg) 85 mg × 0.3 mL = 25.5 mg/mL25.5 mg divided by 30 = 0.85 mL

A client with a history of severe diarrhea for the past 3 days is admitted for dehydration. The nurse anticipates that which intravenous (IV) solution will be prescribed initially?

0.9% sodium chloride An IV solution of 0.9% sodium chloride is the most appropriate initial IV fluid for this client because it is an isotonic solution that will act as a volume expander to quickly replace volume losses and promote physiological stabilization. Three percent sodium chloride is a high-concentration (hypertonic) electrolyte solution; it would only be used in a client with hyponatremia and must be closely monitored during infusion. Five percent dextrose and 0.9% sodium chloride and 5% dextrose and lactated Ringer solution may be appropriate fluids to infuse after 0.9% sodium chloride.

At 10 AM the nurse hangs a 1000-mL bag of D 5W with 20 mEq of potassium chloride to be administered at 80 mL/hr. At noon the healthcare provider prescribes a stat infusion of an intravenous (IV) antibiotic of 100 mL to be administered via piggyback over 1 hour. How much longer than expected will it take the primary bag to empty if the nurse interrupts the primary infusion to use the circulatory access for the secondary infusion of the antibiotic?

1 hour An infusion of 1000 mL at 80 mL should take 12.5 hours. Because the primary infusion is interrupted for an hour while the antibiotic is infused, the primary bag will run an hour longer than if it were running uninterrupted. One quarter, half, and three quarters of an hour are incorrect calculations.

A client is to receive 0.25 mg of digoxin intramuscularly. The ampule is labeled 0.5 mg = 2 mL. How many mL should the nurse administer? Record your answer using a whole number.

1 mL

Nitroglycerin sublingual tablets are prescribed for a client with the diagnosis of angina. The client asks the nurse how long it should take for the chest pain to subside after nitroglycerin is taken. What should the nurse tell the client? 1-3 min 4-5 sec 30-45 sec 20-45 min

1-3 min The onset of action of sublingual nitroglycerin tablets is rapid (1 to 3 minutes); duration of action is 30 to 60 minutes. If nitroglycerin is administered intravenously, the onset of action is immediate, and the duration is 3 to 5 minutes. It takes longer than 30 to 45 seconds for sublingual nitroglycerin tablets to have a therapeutic effect. Sustained-release nitroglycerin tablets start to act in 20 to 45 minutes, and the duration of action is 3 to 8 hours.

A client with gastroesophageal reflux is to receive metoclopramide 15 mg orally before meals. The concentrated solution contains 10 mg/mL. How much solution should the nurse administer? Record your answer using one decimal place.

1.5 mL =15/10 The prescribed dose is 15 mg. The available concentration is 10 mg/mL. Use the dimensional analysis and/or ratio and proportion methods to determine the appropriate amount of medication to be administered.

A healthcare provider prescribes cefazolin sodium 375 mg intravenous piggyback (IVPB) every 8 hours. The vial of powder contains 500 mg of the medication. This must be reconstituted with 2 mL of 0.9% sodium chloride. In the resulting solution 1 mL contains 225 mg of cefazolin. How many mL of cefazolin solution should the nurse administer? Record your answer using one decimal place.

1.7 mL

A client has a prescription for an antibiotic in an intravenous piggyback (IVPB) of 50 mL of D5W to run for 30 minutes. The microdrip tubing has a drop factor of 60 gtt/mL. At what rate should the nurse set the IV infusion? Record your answer using a whole number.

100 gtts/min

A nurse administers two units of packed red blood cells ([RBCs] 250 mL each), followed by 500 mL of 0.9% sodium chloride. How much total solution (blood and sodium chloride) has infused? Record your answer as a whole number.

1000 mL Each bag of packed RBCs contains 250 mL, for a total of 500 mL of packed RBCs. The total amount of sodium chloride received is 500 mL. 500 + 500 = 1000 mL of solution.

A healthcare provider prescribes lidocaine HCl, 1.5 mg per minute, for a client whose ECG tracing reveals multiple premature ventricular complexes (PVCs). The nurse adds 500 mg of lidocaine HCl to 100 mL of D5W. To administer the correct amount of medication, at what rate should the nurse set the intravenous (IV) infusion pump? Record your answer using a whole number.

18 mL/hr = 1.5 mg/min * (100 mL/500 mg) * (60 min/1 hr) The ordered rate is 1.5 mg/min. The available concentration is 500 mg in 100 mL. Use dimensional analysis and/or ratio and proportion to determine the appropriate rate for the infusion pump.

Colchicine 1200 mcg orally is prescribed for client with gout. Each tablet contains 0.6 mg. How many tablets should the nurse administer? Record your answer using a whole number.

2 =1.2/0.6 The prescribed dose is 1200 mcg. The available medication is a tablet with 0.6 mg. First, convert the prescribed medication to units of the available medication. Then, use the dimensional analysis and/or ratio and proportion methods to determine the appropriate number of tablets to be administered.

Nitrofurantoin 0.1 g is prescribed for a client with a urinary tract infection. Each tablet contains 50 mg. How many tablets will the nurse administer? Record your answer using a whole number.

2 The prescribed dose is 0.1 g. The available medication are 50 mg tablets. Use the dimensional analysis and/or ratio and proportion methods to determine how many tablets the nurse should administer. For the ratio and proportion method, convert the prescribed dose units to the available dose units.

A healthcare provider prescribes 0.2 mg of cyanocobalamin (vitamin B12) intramuscularly for a client with pernicious anemia. A vial of the drug labeled 100 mcg = 1 mL is available. How much solution should the nurse administer? Record your answer using a whole number.

2 mL The prescribed dose is 0.2mg. The available concentration is 100 mcg/mL. Use dimensional analysis and/or ratio and proportion to determine the appropriate dose in mL.

A nurse must administer streptomycin 1 g intramuscularly (IM) to a client with tuberculosis. The vial contains 500 mg/mL. How much solution must the nurse administer? Record your answer using a whole number.

2 mL The prescribed dose is 1 g. The available concentration is 500 mg/mL. Use the dimensional analysis and/or ratio and proportion methods to determine how many milliliters the nurse should administer. When using the ratio and proportion method, first convert the prescribed dose unit to the available concentration unit.

Cyanocobalamin (vitamin B12) 0.2 mg intramuscularly (IM) is prescribed for a client with pernicious anemia. A vial of the drug labeled "1 mL = 100 mcg" is available. How many milliliters should the nurse administer? Record your answer using a whole number.

2 mL = 0.2/0.1 First, convert the units of the ordered dose to match the units of the available dose. Then, use dimensional analysis and/or ratio and proportion to determine amount in mL to be administered

A client with a stage IV pressure ulcer is to receive 0.22 g of zinc sulfate by mouth. Each tablet contains 110 mg. How many tablets should the nurse administer? Record your answer using a whole number.

2 tablets =0.22/0.11 The prescribed dose is 0.22 g. The available medication is 110 mg/tablet. First, convert the prescribed dose in grams to the available medication in milligrams. Then, use the dimensional analysis and ratio and proportion methods to determine the appropriate number of tablets to be administered.

Levothyroxine 12.5 mcg orally each day is prescribed for a client with hypothyroidism. The pharmacy dispensed 90 tablets with each tablet containing 12.5 mcg. Six weeks later, the healthcare provider increases the client's dose to 25 mcg daily and gives the client a prescription to be filled at the pharmacy. The client asks the nurse whether the tablets in the original prescription can be used before filling the new prescription. How many of the original tablets should the nurse instruct the client to take daily? Record your answer using a whole number.

2 tablets The client has 12.5 mcg tablets. The prescribed dose is 25 mcg. Use the dimensional analysis and/or ratio and proportion methods to determine the appropriate number of tablets for the client to take daily.

A child is to receive 60 mg of phenytoin. The medication is available as an oral suspension that contains 125 mg/5 mL. How many milliliters should the nurse administer? Record your answer using one decimal place.

2.4 mL The prescribed dose is 60 mg. The available concentration is 125 mg/5 mL. Use the dimensional analysis and/or ratio and proportion methods to determine how many milliliters the nurse should administer.

A client presents with a severe stiff neck, shuffling gate, and other extrapyramidal symptoms. Benztropine 2.5 mg by mouth is prescribed. The medication is available in 1-mg scored tablets. How many tablets should the nurse administer? Record your answer using one decimal place.

2.5 tablet(s) The prescribed dose is 2.5 mg. The available medication is 1 mg tablets. Use the dimensional analysis and/or ratio and proportion methods to determine how many tablets the nurse should administer.

Acyclovir 0.8 g by mouth is prescribed for a client with herpes zoster. The oral suspension contains 200 mg/5 mL. How much solution should the nurse administer? Record your answer by using a whole number.

20 mL = 800/200 = 4*5 The prescribed dose is 0.8 g. The available concentration of medication is 200 mg in 5 mL. First, convert the prescribed dose to the available concentration. Then use the dimensional analysis and/or ratio and proportion methods to determine the appropriate amount of medication to be administered.

A client with a thromboembolic disorder is receiving a continuous intravenous infusion of heparin at a rate of 1000 units per hour. There are 25,000 units of heparin in 500 mL of 5% dextrose solution. At how many milliliters per hour should the nurse set the rate on the electronic infusion control device? Record your answer using a whole number.

20 mL/hr The ordered rate is 1000 u/hr. The available concentration is 25,000 u in 500 mL D5W. Make the necessary conversions and use dimensional analysis to determine the appropriate rate in mL/h. The ratio and proportion method is not appropriate for this situation.

A healthcare provider prescribes 20 mEq potassium chloride to be given to a client over an 8-hour period by IV drip in 1000 mL of D5W. The IV equipment is calibrated at 10 drops per milliliter. At how many drops per minute should the nurse regulate the IV? Record your answer using a whole number.

21 drops/minute The provider has prescribed 1000 mL to run over 8 hours (125 mL/h). The IV equipment has a drop factor of 10 drops/mL. There is a set equation used to determine drop rates

A client is to receive 125 mL of intravenous (IV) fluid every hour. The drop factor of the IV tubing is 10 gtt/mL. How many drops per minute should the nurse administer? Record your answer using a whole number.

21 gtts/min The ordered rate is 125 ml/hr. The drop factor of the tubing is 10 gtt/mL. Use the flow rate equation to determine the appropriate flow rate in drops/minute.

What is the maximum length of time a nurse should allow an intravenous bag of solution to infuse? 6 hours 12 hours 18 hours 24 hours

24 hours After 24 hours there is increased risk for contamination of the solution and the bag should be changed. It is unnecessary to change the bag any less often, such as 6 hours, 12 hours, or 18 hours.

The nurse is caring for a client admitted for a severe kidney infection and hyponatremia. The healthcare provider prescribes ceftriaxone 1 gram to be administered intravenously over 30 minutes. The intravenous (IV) piggyback contains 50 mL. The IV tubing drop factor is 15 drops/mL. At what rate will the nurse infuse the medication? 15 drops/min 20 drops/min 25 drops/min 30 drops/min

25 drops/min

Levofloxacin 750 mg intravenous piggyback (IVPB) is prescribed for a client with pneumonia. The dose is available in 150 mL of 5% dextrose and is to infuse over 90 minutes. The administration set has a drop factor of 15 drops per mL. At how many drops per minute should the nurse regulate the IVPB to infuse? Record your answer using a whole number.

25 gtt/min

A nurse is reviewing the history and physicals of several clients from the clinic who are taking rifampin for the treatment of tuberculosis. Which client presents a specific concern for the nurse? 45-year old taking loop diuretic 26-y.o. taking oral contraceptives 32-y.o. taking a proton pump inhibitor 72-y.o. taking intermediate-acting insulin

26-y.o. taking oral contraceptives Rifampin increases metabolism of oral contraceptives, which may result in an unplanned pregnancy. Rifampin does not interact with a loop diuretic, a proton pump inhibitor, or intermediate-acting insulin.

Atenolol 150 mg by mouth is prescribed for a client with hypertension. Each tablet contains 50 mg. How many tablets should the nurse administer? Record your answer using a whole number.

3 tablets

The healthcare provider's prescription for intravenous fluid states that the client is to receive 1 L of fluid every 8 hours. If the equipment delivers 15 drops/mL, at what rate should the nurse regulate the flow? Record your answer using a whole number.

31 drops/minute The prescribed dose is 1 L to be infused with a total infusion time of 8 hours. The drop factor is 15 gtt/mL. Use the formula below to calculate the rate of the infusion in drops per minute.

An intravenous (IV) solution of 1000 mL 5% dextrose in water is to be infused at 125 mL/hr to correct a client's fluid imbalance. The infusion set delivers 15 drops/mL. To ensure that the solution will infuse over an 8-hour period, at how many drops per minute should the nurse set the rate of flow? Record your answer using a whole number.

31 gtts/min The total volume to be infused is 1000 mL. The drop factor is 15 gtts/mL. The total infusion time is 8 hours. The fluid rate of 125 ml/hr is simply 1000 mL infused in 8 hours and is not necessary for this formula.

The healthcare provider orders 1000 mL normal saline to be infused over 8 hours for a client with a diagnosis of dehydration. The intravenous (IV) tubing delivers 15 drops per milliliter (drop factor). The nurse should administer the IV infusion at what rate? Record your answer using a whole number.

31 gtts/minute.

A client has an IV of D 5W 250 mL to which 100 mg of morphine is added. The healthcare provider prescribes 14 mg of morphine per hour for end of life palliative treatment of a client . At how many mL per hour should the nurse set the intravenous pump? Record your answer using a whole number.

35 =(14/100) 250 The prescribed rate is 14 mg/hr. The available concentration is 100 mg/250 mL. Use dimensional analysis to determine the appropriate rate.

A client is scheduled to receive an intravenous (IV) solution of lactated Ringer to run at 150 mL/hr. To deliver the solution, the nurse plans to use an administration set that delivers 15 gtt/mL. At how many drops per minute should the nurse set the IV to administer the prescribed amount of fluid? Record your answer using a whole number.

38 gtt/min

Metformin 2 g by mouth is prescribed for a client with type 2 diabetes. Each tablet contains 500 mg. How many tablets should the nurse administer? Record your answer using a whole number.

4 =2/0.5 First, convert the prescribed dose (2 g) to the available dose (mg).Then, use the dimensional analysis and/or ratio and proportion methods to determine the appropriate number of tablets to be administered.

A client is rescued from a house fire and arrives at the emergency department 1 hour after the rescue. The client weighs 132 pounds (60 kilograms) and is burned over 35% of the body. The nurse expects that the amount of lactated Ringer solution that will be prescribed to be infused in the next 8 hours is what? 2100 mL 4200 mL 6300 mL 8400 mL

4200 mL In the first 8 hours 4200 mL should be infused. According to the Parkland (Baxter) formula, one half of the total daily amount of fluid should be administered in the first 8 hours. Because the client weighs 60 kg (132 pounds ÷ 2.2 kg = 60 kg), the calculation is 60 kg × 4 mL/kg × 35% burns = 8400 mL per day; half of this amount should be infused within the first 8 hours. 2100 mL, 6300 mL, and 8400 mL are incorrect calculations.

The health care provider prescribes 1000 mL of total parenteral nutrition to be administered in 12 hours. Based on this prescription, how many milliliters of solution should be administered per hour? 83 mL/hr 100 mL/hr 108 mL/hr 125 mL/hr

83 mL/hr 83 mL/hr is the correct calculation. 1000 mL of solution divided by 12 hours equals 83.3 mL/hr. Always round to the nearest whole number. 100 mL/hr is an incorrect calculation; it is too much solution per hour. 108 mL/hr is an incorrect calculation; it is too much solution per hour. 125 mL/hr is an incorrect calculation; it is too much solution per hour.

Ceftriaxone 2.5 grams intravenous piggyback (IVPB) every 8 hours is prescribed for a client with a severe infection. The pharmacy sends a vial labeled 5 grams per 10 mL. What volume of ceftriaxone should the nurse add to the IVPB solution? Record your answer using a whole number.

5 mL The prescribed dose is 2.5 mg. The available dose is 5g/10mL. Use ratio and proportion and/or dimensional analysis to calculate how many milliliters should be administered.

A client with urge incontinence is receiving oxybutynin 30 mg orally. Each tablet contains 5 mg. How many tablets will the nurse administer? Record your answer using a whole number.

6 The prescribed dose is 30 mg. The available medication is 5 mg/tablet. Use the dimensional analysis method to determine how many tablets the nurse should administer.

A client with tuberculosis asks the nurse how long drug therapy will be continued. What is the nurse's most accurate reply? 1 to 2 weeks 4 to 5 months 6 to 12 months 3 years or longer

6 to 12 months The tubercle bacillus is a drug-resistant organism and takes a long time to be eradicated; usually a combination of three medications is used for a minimum of 6 months, and at least 6 months beyond culture conversion. One to 2 weeks or 4 to 5 months are too short a time for eradication of this organism. Usually, the organism can be eradicated in a shorter period of time than 3 years, unless a resistant strain of the bacillus has developed.

A client who weighs 176 pounds (80 kg) is being immunosuppressed by daily maintenance doses of cyclosporine to prevent organ transplant rejection. The dose prescribed is 8 mg/kg each day. How many milligrams should the nurse plan to administer each day? Record your answer using a whole number.

640 mg The ordered dose is 8 mg/kg. The client's weight is 80 kg. Use dimensional analysis and/or ratio and proportion to determine the daily dose.

A healthcare provider orders guaifenesin 300 mg four times a day. The dosage strength is 200 milligrams/5 milliliters. How many milliliters should the nurse administer for each dose? Record your answer using one decimal place.

7.5 mL The prescribed dose is 300 mg. The available concentration is 200 mg/5 mL. Use the dimensional analysis and/or ratio and proportion methods to determine how many milliliters the nurse should administer.

Phenytoin suspension 200 mg is prescribed for a client with epilepsy. The suspension contains 125 mg/5 mL. How much solution will the nurse administer? Record your answer using a whole number.___ mL

8 mL = (200/125)*5 The prescribed dose is 200 mg. The available concentration is 125 mg in 5 mL. Use the dimensional analysis and ratio and proportion methods to determine how many milliliters the nurse should administer.

A client taking levodopa is taught about the signs of levodopa toxicity. The nurse instructs the client to contact the primary healthcare provider if the client develops what symptom?

Abnormal involuntary movements (dyskinesias), such as muscle twitching, rapid eye blinking, facial grimacing, head bobbing, and an exaggerated protrusion of the tongue, are signs of toxicity; these probably result from the body's failure to readjust properly to the reduction of dopamine. Nausea is a side effect of therapy, not toxicity. Dizziness is a side effect of therapy, not toxicity. Constipation is unrelated to levodopa toxicity.

A client is admitted to the hospital for medical management of acute pancreatitis. Which nursing action is most likely to reduce the pancreatic and gastric secretions of a client with pancreatitis? Encouraging clear liquids Obtaining a prescription for morphine Assisting the client into a semi-Fowler position Administering prescribed anticholinergic medication

Administering prescribed anticholinergic medication Anticholinergic drugs block the neural impulses that stimulate pancreatic and gastric secretions; they inhibit the action of acetylcholine at postganglionic cholinergic nerve fibers. Oral fluids stimulate pancreatic secretion and are contraindicated. Morphine sulfate is an analgesic and therefore does not decrease gastric secretions; in the past morphine sulfate was contraindicated for pain control with pancreatitis because it can precipitate spasms of the smooth musculature of the pancreatic ducts and the sphincter of Oddi. However, recent research indicates that it is the drug of choice over meperidine hydrochloride because the metabolites of meperidine hydrochloride can cause central nervous system irritation and seizures. The semi-Fowler position decreases pressure against the diaphragm; it will not decrease pancreatic secretions.

Prednisone is prescribed for a client with an exacerbation of colitis. What does the nurse teach the client before administering the first dose? Client will be protected from getting an infection Symptoms associated with the colitis will decrease over time Although medication causes anorexia, weight loss may not occur Although medication decreases intestinal inflammation, it will not cure the colitis

Although medication decreases intestinal inflammation, it will not cure the colitis Prednisone inhibits phagocytosis and suppresses other clinical phenomena of inflammation; this is a symptomatic treatment that is not curative. The response usually is rapid. The drug suppresses the immune response and increases the potential for infection. Appetite is increased; weight gain may result from this or from fluid retention.

A client is admitted to the cardiac care unit with a myocardial infarction. The cardiac monitor reveals several runs of ventricular tachycardia. The nurse anticipates that the client will be receiving a prescription for which drug? Atropine Epinephrine Amiodarone Sodium bicarbonate

Amiodarone Amiodarone suppresses ventricular activity; therefore, it is used for treatment of premature ventricular complexes (PVCs). It works directly on the heart tissue and slows the nerve impulses in the heart. Atropine blocks vagal stimulation; it increases the heart rate and is used for bradycardia, not PVCs. Epinephrine increases myocardial contractility and heart rate; therefore, it is contraindicated in the treatment of PVCs. Sodium bicarbonate increases the serum pH level; therefore, it combats metabolic acidosis.

A client who had a myocardial infarction is in the coronary care unit on a cardiac monitor. The nurse observes runs of ventricular tachycardia on the screen. What medication should the nurse prepare to administer?

Amiodarone Amiodarone decreases the irritability of the ventricles by prolonging the duration of the action potential and refractory period. It is used in the treatment of ventricular dysrhythmias such as ventricular tachycardia. Digoxin slows and strengthens ventricular contractions; it will not rapidly correct ectopic beats. Furosemide, a diuretic, does not affect ectopic foci. Norepinephrine is a sympathomimetic and is not the drug of choice for ventricular irritability.

A client's cardiac monitor indicates multiple multifocal premature ventricular complexes (PVCs). The nurse expects that the treatment plan will include a prescription for which medication?

Amiodarone Amiodarone has an antiarrhythmic action that stabilizes cell membranes of the heart, reducing cardiac excitability; it is used for acute ventricular dysrhythmias. Methyldopa is not used to treat multiple PVCs. Epinephrine increases the contractibility of the heart; the effect is opposite to what is needed. Hydrochlorothiazide is used for hypertension, not for correcting multiple PVCs.

While receiving a blood transfusion, a client develops acute dyspnea, generalized urticaria, a heart rate of 128, and a blood pressure of 70/38. What type of reaction does the nurse conclude that the client probably is experiencing?

Anaphylactic Anaphylactic reactions result from hypersensitivity to a product in the blood. Signs and symptoms are due to bronchospasm, systemic vasodilation, and compensatory tachycardia. The client may go into life-threatening shock without prompt treatment. Panic reactions (also known as panic attacks) involve high levels of anxiety and may be coupled with autonomic symptoms such as tachycardia. Bacterial pyrogens are present in contaminated blood and can cause a febrile transfusion reaction; signs include fever and chills. Hemolytic reaction results from the incompatibility of a recipient's antibodies with transfused red blood cells (RBCs); the reactions result from RBC hemolysis, agglutination, and capillary plugging.

A client who is receiving phenytoin to control a seizure disorder questions the nurse regarding this medication after discharge. How will the nurse respond? Antiseizure drugs will probably be continued for life Phenytoin prevents further occurrence of seizures This drug needs to be taken during periods of emotional stress Your antiseizure drug usually can be stopped after a year's absence of seizures

Antiseizure drugs will probably be continued for life Seizure disorders usually are associated with marked changes in the electrical activity of the cerebral cortex, requiring prolonged or lifelong therapy. Seizures may occur despite drug therapy; the dosage may need to be adjusted. A therapeutic blood level must be maintained through consistent administration of the drug irrespective of emotional stress. Absence of seizures will probably result from medication effectiveness rather than from correction of the pathophysiologic condition.

A nurse prepares to administer intravenous (IV) albumin to a client with ascites. What effect does the nurse anticipate? Ascites and blood ammonia levels will decrease. Decreased capillary perfusion and blood pressure. Venous stasis and blood urea nitrogen level will increase. As extravascular fluid decreases, the hematocrit will decrease.

As extravascular fluid decreases, the hematocrit will decrease. Serum albumin is administered to maintain blood volume and normal oncotic (osmotic) pressure; it does this by pulling fluid from the interstitial spaces into the intravascular compartment. Serum albumin does affect blood ammonia levels; fluid accumulated in the abdominal cavity is removed via a paracentesis. The administration of albumin results in a shift of fluid from the interstitial to the intravascular compartment, which probably will increase the blood pressure. Albumin administration does not affect venous stasis or the blood urea nitrogen level.

A client had surgery for a ruptured appendix. Postoperatively, the health care provider prescribes an antibiotic to be administered intravenously twice a day. The nurse administers the prescribed antibiotic via a secondary line into the primary infusion of 0.9% sodium chloride. During the administration of the antibiotic, the client becomes restless and flushed, and begins to wheeze. What should the nurse do after stopping the antibiotic infusion? Check client's temperature Take client's blood pressure Obtain client's pulse oximetry Assess client's respiratory status

Assess client's respiratory status The client is experiencing an allergic reaction that may progress to anaphylaxis. Anaphylactic shock can lead to respiratory distress as a result of laryngeal edema or severe bronchospasm. Assessing and maintaining the client's airway is the priority. Checking the client's temperature and taking the client's blood pressure are not the priority; vital signs should be obtained after airway patency is ensured and maintained. Pulse oximetry is only one portion of the needed respiratory status assessment.

To prevent excessive bruising when administering subcutaneous heparin, what technique will the nurse employ? Administer the injection via the Z-track technique Avoid massaging the injection site after the injection Use 2 mL of sterile normal saline to dilute the heparin Inject the drug into the vastus lateralis muscle in the thigh

Avoid massaging the injection site after the injection The site of the injection should not be massaged to avoid dispersion of the heparin around the site and subsequent bleeding into the area. The Z-track technique and the intramuscular route are not used with heparin; subcutaneous injection and intravenous administration are the routes appropriate for heparin administration. The drug should be injected into the subcutaneous tissue slowly, not quickly. Diluting heparin with normal saline is unnecessary. Generally heparin is provided by the pharmacy department in single-dose syringes.

A nurse is caring for a client who is scheduled to have an abdominal perineal resection for colorectal cancer. The client has type B negative blood. If a blood infusion is needed, which type is preferred for administration? A positive B negative O negative AB positive

B negative B negative is the same as the client's blood type and is preferred; only in an emergency will type O negative blood be given. Irrespective of blood type, Rh-positive blood is incompatible with the client's blood and will cause hemolysis if it is transfused. Although O negative blood can be used in an emergency, it is not the preferred blood type in an elective situation.

A client with cancer is receiving a multiple chemotherapy protocol. Included in the protocol is leucovorin. The nurse concludes that this drug is administered for what purpose? To potentiate the effect of alkylating agents Because it diminishes toxicity of folic acid antagonists To limit the occurrence of vomiting associated with chemotherapy Interference with cell division at a different stage of cell division than the other drugs

Because it diminishes toxicity of folic acid antagonists Leucovorin limits toxicity of folic acid antagonists, such as methotrexate sodium, by competing for transport into cells. Leucovorin does not potentiate the effect of alkylating agents; however, leucovorin promotes binding of fluorouracil (5-FU) to target tumor cells. Antiemetics such as prochlorperazine maleate and ondansetron minimize nausea and vomiting associated with chemotherapeutic agents. Leucovorin does not interfere with cell division; this is the purpose of a multiple-drug protocol.

The nurse is evaluating a client who received intravenous morphine. Which life-threatening response indicates the need to notify the healthcare provider?

Because morphine is a central nervous system depressant, it may cause bradycardia, shock, and cardiac arrest. Although headache, drowsiness, and nausea may be a response to morphine, they are not life threatening.

A client with systemic lupus erythematosus is taking prednisone. The nurse anticipates that the steroid may cause hypokalemia. What food will the nurse encourage the client to eat? Broccoli Oatmeal Fried Rice Cooked carrots

Broccoli Potassium is plentiful in green leafy vegetables; broccoli provides 207 mg of potassium per half cup. Oatmeal provides 73 mg of potassium per half cup. Rice provides 29 mg of potassium per half cup. Cooked fresh carrots provide 172 mg of potassium per half cup; canned carrots provide only 93 mg of potassium per half cup.

When taking the blood pressure of a client who had a thyroidectomy, the nurse identifies that the client is pale and has spasms of the hand. The nurse notifies the health care provider. Which should the nurse expect the health care provider to prescribe? Calcium Magnesium Bicarbonate Potassium chloride

Calcium These signs may indicate calcium depletion as a result of accidental removal of parathyroid glands during thyroidectomy. Symptoms associated with hypomagnesemia include tremor, neuromuscular irritability, and confusion. Symptoms associated with metabolic acidosis include deep, rapid breathing, weakness, and disorientation. Symptoms associated with hypokalemia include muscle weakness and dysrhythmias.

After a surgical thyroidectomy a client exhibits carpopedal spasm and some tremors. The client complains of tingling in the fingers and around the mouth. What medication should the nurse expect the primary health care provider to prescribe after being notified of the client's adaptations? Potassium iodide Calcium gluconate Magnesium sulfate Potassium chloride

Calcium gluconate The client is exhibiting signs and symptoms of hypocalcemia, which occurs with accidental removal of the parathyroid glands; calcium gluconate is administered to treat hypocalcemia. Potassium iodide is prescribed for hyperthyroidism because it inhibits the release of thyroid hormones. Magnesium sulfate is prescribed for hypomagnesemia or to treat pregnant women who have preeclampsia. Potassium chloride is prescribed for hypokalemia, not hypocalcemia.

A client who has been taking digoxin for 20 years is hospitalized. The client exhibits signs of dehydration, and laboratory results identify the presence of hypokalemia. The nurse should monitor the client for which clinical finding indicating digoxin toxicity? Constipation Decreased urination Cardiac dysrhythmias Metallic taste in the mouth

Cardiac dysrhythmias The development of cardiac dysrhythmias is often a sign of digoxin toxicity. Constipation is not a sign of toxicity; gastrointestinal signs and symptoms of toxicity include anorexia, nausea, vomiting, and diarrhea. Decreased urination is not a sign of toxicity. The client will have a decrease in urination because of dehydration. Digoxin does not cause a metallic taste in the mouth.

A client receiving combination chemotherapy for treatment of metastatic carcinoma asks the nurse in the clinic why more than one type of drug is necessary. Which concept is most important to teach the client in relation to why drug cocktails are more effective than a single drug in cancer therapy? Drug resistance Tumor doubling time Cellular growth cycle Retained radioactive particles

Cellular growth cycle Different drugs destroy cells at different stages of their replication; rapidly dividing cells not destroyed by one drug may be destroyed by another drug during a different stage of cell replication stage. Although certain tumors are drug resistant, it is not the reason for multiple chemotherapeutic drugs; drug-resistant tumors may be treated with surgery, radiation therapy, or other methods. Doubling time of the tumor is a factor that influences the length of time chemotherapy will be given, but it is not the reason multiple drugs are given. Retained radioactive particles can occur with internal radiation therapy, not chemotherapy.

What should the nurse include in a teaching plan to help reduce the side effects associated with diltiazem? Lie down after meals Avoid dairy products in diet Take drug with an antacid Change slowly from sitting to standing

Change slowly from sitting to standing Changing positions slowly will help prevent the side effect of orthostatic hypotension. Lying down after meals can relax the esophagus and lead to acid reflux. Avoiding dairy products and taking the drug with an antacid are not necessary.

A client residing in an assisted living facility is diagnosed with Parkinson disease, and the healthcare provider prescribes selegiline. What precaution will the nurse teach the client? Change to a standing position slowly Take medication between meals Perform self-blood between meals Perform self-blood glucose monitoring Withhold next dose if nausea occurs

Change to a standing position slowly A common side effect of selegiline is dizziness. Safety precautions are necessary to prevent falls caused by orthostatic hypotension. Taking the medication with food or milk limits gastrointestinal irritation. Monitoring blood glucose levels is not necessary. Nausea is a common side effect of selegiline; the medication should not be withheld without the healthcare provider's supervision. Abrupt withdrawal may precipitate a parkinsonian crisis.

A client is scheduled to begin chemotherapy 2 weeks after surgery for colon cancer. What explanation does the nurse give to explain the delay following surgery?

Chemotherapeutic agents can attack healthy as well as malignant cells; they generally interfere with protein synthesis and cell division in all rapidly dividing cells, including those regenerating traumatized tissue (as in wound healing), bone marrow, and cutaneous and alimentary tract epithelial tissue. Vomiting should not disturb the integrity of the area. Decreased red blood cell levels caused by bone marrow depression can be corrected with transfusions. Chemotherapy should not cause a blockage of lymph channels, with destroyed lymphocytes increasing edema.

A client newly diagnosed with myasthenia gravis is to begin taking pyridostigmine, a cholinesterase inhibitor. Two days later the client develops loose stools and increased salivation. What conclusion does the nurse make about these new developments? Indicative of a myasthenic crisis Cholinergic effects A temporary response Toxic effects of the medication

Cholinergic effects Because this drug inhibits the destruction of acetylcholine, parasympathetic activity may be increased. The signs do not indicate a myasthenic crisis. Myasthenic crisis is characterized by difficulty breathing or speaking, morning headaches, feeling tired during the daytime, waking up frequently at night, not sleeping well, weak cough with increased secretions (mucus or saliva), an inability to clear secretions, a weak tongue, trouble swallowing or chewing, and weight loss. Side effects are not temporary; they continue as long as the drug is continued. The dosage may be adjusted or an anticholinergic given to limit side effects. Toxicity or cholinergic crisis is manifested by increased muscle weakness, including muscles of respiration.

A client is receiving patient-controlled analgesia (PCA) after surgery. What does the nurse identify as the primary benefit with this type of therapy? Client is able to self-administer pain-relieving drugs as necessary Amount of medication received is determined entirely by the client Amount of drug used for analgesia matches sleep-wake cycles Self-administration relieves nurse of monitoring client for pain relief

Client is able to self-administer pain-relieving drugs as necessary The ability of the client to self-administer pain-relieving medications as necessary is the purpose of patient-controlled analgesia; usually smaller amounts of analgesics are used with self-administration. The amount and dosage of the medication are programmed to prevent accidents or abuse. Drug levels are kept in a maintenance range, and pain relief is achieved without extreme fluctuations. Requests for pain relief by any route would be anticipated to match sleep-wake cycles. The nurse is not absolved of responsibility when PCA is used; monitoring the client for effectiveness, refilling the apparatus with the prescribed narcotic, and charting the amount administered and the client's response are required.

Several hours after administering insulin, the nurse is assessing a client for an adverse response to the insulin. Which client responses are indicative of a hypoglycemic reaction? Select all that apply. Tremors Anorexia Confusion Glycosuria Diaphoresis

Confusion Tremors Diaphoresis Confusion is typically the first sign of a hypoglycemic reaction. Tremors are a sympathetic nervous system response that occurs because circulating glucose in the brain decreases. Diaphoresis is a cholinergic response to hypoglycemia. Hypoglycemia causes hunger, not anorexia. Because blood glucose is low in hypoglycemia, the renal threshold is not exceeded and glycosuria does not occur.

A nurse assesses a client's intravenous site. What clinical finding, unique to infiltration, leads the nurse to conclude that the intravenous (IV) site has infiltrated, rather than become inflamed? Pain Coolness Localized swelling Cessation in flow of solution

Coolness When an IV infiltrates, the IV solution entering the interstitial space is at room temperature (approximately 75° F [23.9° C]), whereas body temperature is approximately 98.6° F (37° C); therefore, the client's skin will feel cool to the touch at the site of an IV infiltration. The site of an inflammation will feel warm to the touch because of vasodilation and hyperemia. Pain may occur with both an inflammation and an infiltration. The pain of an inflammation is related to the pressure of edema on nerve endings. The pain of an infiltration is related to the IV solution in the interstitial compartment pressing on nerve endings. An increase in interstitial fluid occurs with both an inflammation and an infiltration. With an inflammation there is increased vascular permeability at the site; fluid, proteins, and leukocytes then move from the intravascular compartment into the interstitial compartment. With an infiltration the IV solution enters the interstitial compartment rather than the intravascular compartment. A cessation in flow of solution occurs with both an inflammation and an infiltration. An inflammation in the vein at the insertion site may close the lumen of the vessel, interfering with the flow of solution. An infiltration will cause excess fluid in the interstitial compartment to the extent that it will not accommodate more solution, interfering with the flow of the solution.

A client diagnosed with asthma has received a prescription for an inhaler. The nurse teaches the client how to determine when the inhaler is empty, instructing the client to do what? Count the number of doses taken. Taste the medication when sprayed into the air. Shake the canister. Place the canister in water to see if it floats.

Count the number of doses taken. The only way to determine if the canister is empty is to count the number of doses taken. The client is tracking the number of daily doses. It is wasteful to spray medication into the air; tasting it from the air is not an effective method of determining if the canister is empty. Shaking the canister is not effective; even if there is no more medication, some propellant may be left. It is futile to place the canister in water; the flotation test is ineffective.

A nurse is teaching a client about drug therapy for gonorrhea. Which fact about drug therapy should the nurse emphasize? cures infection prevents complications controls its transmission reverses pathologic changes

Cures the infection Ceftriaxone (Rocephin), followed by doxycycline (Vibramycin), is specific for Neisseria gonorrhoeae and eradicates the microorganism; other treatment regimens are available for resistant strains. If the disease progresses before the diagnosis is made, complications such as sterility, heart valve damage, or joint degeneration may occur. Transmission is not controlled; the organism is eliminated. If tubal structures, heart valves, or joints degenerate, the pathologic changes will not be reversed by antibiotic therapy.

A nurse is evaluating the results of treatment with erythropoietin. Which assessment finding indicates an improvement in the underlying condition being treated? 2+ pedal pulses Decreased pallor Decreased jaundice 2+ deep tendon reflexes

Decreased pallor Erythropoietin stimulates red blood cell production, thereby decreasing the pallor that accompanies anemia. It would not have a role in alleviating jaundice. It would not have an appreciable effect on pulses or deep tendon reflexes.

A client develops kidney damage as a result of a transfusion reaction. What is the most significant clinical response that the nurse will assess when determining kidney damage? Glycosuria Blood in the urine Decreased urinary output Acute pain over the kidney

Decreased urinary output Diminished renal function usually is evidenced by a decrease in urine output to less than 100 to 400 mL/24 hours. Glycosuria is unrelated to a transfusion reaction. Although blood in the urine and acute pain over the kidney are related to the renal system and are signs of an acute hemolytic reaction, their presence does not necessarily indicate kidney damage.

A client with myasthenia gravis is to receive immunosuppressive therapy. What assures the nurse that this therapy will be effective? A.Inhibits the breakdown of acetylcholine at the neuromuscular junction. B.Decreases the production of autoantibodies that attack the acetylcholine receptors. C.Promotes the removal of antibodies that impair the transmission of impulses D.Stimulates the production of acetylcholine at the neuromuscular junction.

Decreases the production of autoantibodies that attack the acetylcholine receptors. Steroids decrease the body's immune response, limiting the production of antibodies that attack acetylcholine receptors at the neuromuscular junction. Inhibiting the breakdown of acetylcholine at the neuromuscular junction is the action of anticholinergic medications. Stimulating the production of acetylcholine at the neuromuscular junction is not the action of immunosuppressives. Promoting the removal of autoantibodies that impair the transmission of impulses is the rationale for plasmapheresis.

What is the priority goal for a client with asthma who is being discharged from the hospital with prescriptions for inhaled bronchodilators? Able to obtain pulse oximeter readings Demonstrates use of metered-dose inhaler Knows healthcare provider's office hours Can identify foods that may cause wheezing

Demonstrates use of a metered-dose inhaler Clients with asthma use metered-dose inhalers to administer medications prophylactically or during times of an asthma attack; this is an important skill to have before discharge. Pulse oximetry is rarely conducted in the home; home management usually includes self-monitoring of the peak expiratory flow rate. Although knowing the healthcare provider's office hours is important, it is not the priority; during a persistent asthma attack that does not respond to planned interventions, the client should go to the emergency department of the local hospital or call 911 for assistance. Not all asthma is associated with food allergies.

A client who had abdominal surgery is receiving patient-controlled analgesia intravenously to manage pain. The pump is programmed to deliver a basal dose and bolus doses that can be accessed by the client, with a lock-out time frame of 10 minutes. The nurse assesses use of the pump during the last hour and identifies that the client attempted to self-administer the analgesic 10 times. Further assessment reveals that the client is experiencing pain still. What should the nurse do first? Monitor the client's pain level for another hour. Determine the integrity of the intravenous delivery system. Reprogram the pump to deliver a bolus dose every 8 minutes. Arrange for the client to be evaluated by the healthcare provider.

Determine the integrity of the intravenous delivery system. Initially, integrity of the intravenous system should be verified to ensure that the client is receiving medication. The intravenous tubing may be kinked or compressed or the catheter may be dislodged. Continued monitoring will result in the client experiencing unnecessary pain. The nurse may not reprogram the pump to deliver larger or more frequent doses of medication without a healthcare provider's prescription. The healthcare provider should be notified if the system is intact and the client is not obtaining relief from pain. The prescription may have to be revised; the basal dose may be increased, the length of the delay may be reduced, or another medication or mode of delivery may be prescribed.

Some clients self-prescribe over-the-counter glucosamine to help relieve joint pain and stiffness. Which condition should the nurse identify as a reason for a client not to take this supplement?

Diabetes mellitus Glucosamine, a precursor in the synthesis of glycosylated proteins and lipids, helps prevent cartilage degeneration. The glucosamine molecule is glucose-based and may be unsafe for a client who has impaired glucose tolerance; also it may increase resistance to insulin and interfere with antidiabetic medications. Studies suggest that glucosamine helps to slow the progression of osteoarthritis and even regenerate damaged cartilage; this results in improved joint function and reduction of joint pain and stiffness. Glucosamine does not appear to be harmful to clients with heart disease or hyperthyroidism.

A client has a tonic-clonic seizure that involves all extremities. The nurse anticipates that the healthcare provider will prescribe the intravenous administration of which drug? Naloxone Diazepam Epinephrine Atropine

Diazepam Parenterally administered diazepam is a benzodiazepine that has muscle relaxant and anticonvulsant effects that help limit massive muscular spasms. Naloxone does not limit seizures; it is an opioid antagonist and is used for morphine, meperidine, and methadone overdose. Epinephrine HCl does not limit seizures; it increases contractility of the heart. Atropine sulfate is not used for seizures. It is used for bradycardia resulting from vagal overstimulation, but it does not reverse bradycardia caused by metabolic changes, such as acid-base or electrolyte imbalances.

A client with stage III Hodgkin disease is started on ABVD therapy, a multiple-drug regimen. The client asks why so many drugs need to be given all at once. Which is the best response by the nurse? Using groups of drugs reduces likelihood of serious side effects Each drug destroys cancer cell at a different time in cell cycle Several drugs are used to destroy cells that are not susceptible to radiation therapy Because there are stages of Hodgkin disease, if one drug is ineffective, another will work

Each drug destroys cancer cell at a different time in cell cycle Cells are vulnerable to specific drugs through the stages of mitosis, and a combination bombards the malignant cells at various stages. The side effects of a drug are not ameliorated by a combination with others. Although the statement that several drugs are used to destroy cells that are not susceptible to radiation therapy is true, it is not the reason for using a combination of drugs. Although there is more than one stage of Hodgkin disease, this is not the reason for using a combination of drugs.

A client is admitted for dehydration and an intravenous (IV) infusion of normal saline at 125 mL/hr has been started. One hour after the IV initiation the client begins screaming, "I can't breathe!" What is the nurse's priority action? Elevate the head of the bed and obtain vital signs. Discontinue the IV site and contact the primary healthcare provider. Change the IV to an intermittent infusion device. Contact the primary healthcare provider to obtain a prescription for a sedative.

Elevate the head of the bed and obtain vital signs. The client's ability to speak indicates that the client is breathing. Elevating the head of the bed facilitates breathing by decreasing pressure against the diaphragm. Checking the vital signs after this is the first step in assessing the cause of the distress. Discontinuing the IV access line may cause unnecessary discomfort if it must be restarted; there are too few data to call the healthcare provider at this time. There is not enough information to support calling the healthcare provider and obtaining a prescription for a sedative; further assessment is required. There is no information to support changing the IV to an intermittent infusion device.

What instructions should a nurse give a client for whom nitroglycerin tablets are prescribed? Limit the number of tablets to four per day. Discontinue the medication if a headache develops. Increase the number of tablets if dizziness is experienced. Ensure that the medication is stored in its original dark container.

Ensure that the medication is stored in its original dark container. Nitroglycerin is sensitive to light and moisture, so it must be stored in a dark, airtight container. Limit the number of tablets to four per day, taken as needed. If more than three tablets are necessary in a 15-minute period, emergency medical attention should be received. A headache may be an expected side effect, and the medication should not be discontinued. Dizziness indicates the dosage may need to be decreased by the healthcare provider.

What should the nurse monitor when a client is receiving a platelet aggregation inhibitor such as clopidogrel? Nausea Epistaxis Chest pain Elevated temperature

Epistaxis The high vascularity of the nose, combined with its susceptibility to trauma (e.g., sneezing, nose blowing), makes it a frequent site of hemorrhage. Nausea, chest pain, and elevated temperature usually are not associated with anticoagulant therapy.

A healthcare provider prescribes bed rest, loperamide, and esomeprazole for a client who just had major surgery. After several days of this regimen, the client complains of diarrhea. Which treatment strategy does the nurse conclude is the most likely cause of the diarrhea? Loperamide Esomeprazole Bed rest Diet alteration

Esomeprazole Esomeprazole, a proton pump inhibitor, may cause diarrhea related to a higher risk for Clostridium difficile intestinal infection. Loperamide, an antidiarrheal, may cause constipation, not diarrhea. Immobility causes constipation, not diarrhea. Although diet can affect elimination, no data are presented to support this conclusion.

A client is admitted to the hospital for a subtotal thyroidectomy. When discussing postoperative drug therapy with the client, what will the nurse include in the teaching? take iodine daily to increase formation of thyroid hormone understand medication will be temporary until body adjusts to postsurgical activities take propylthiouracil that is prescribed to stimulate secretion of thyroid-stimulating hormone report palpitations, nervousness, tremors, or loss of weight that may indicate an overdose of thyroid hormone

Excessive thyroid hormone replacement may lead to signs and symptoms of hyperthyroidism. Iodine may be administered before, not after, surgery. Thyroid hormone replacement is required for life. Propylthiouracil blocks thyroid hormone synthesis; this often is administered before, not after, surgery.

A nurse attempts to give a client with chronic arterial insufficiency of the legs the prescribed dose of aspirin (ASA). The client refuses it, stating, "My legs are not painful." Which action by the nurse is appropriate? Explain the reason for the medication and encourage the client to take it Withhold the medication at this time and return to check with the client again in 30 minutes Withhold the medication and tell the client to ask for it if the legs become uncomfortable Request that the client take the medication and explain that it prevents the client from being uncomfortable in the next few hours

Explain the reason for the medication and encourage the client to take it Aspirin is given to the client to prevent platelet aggregation and possible deep vein thrombosis. The client needs information to make an educated decision. Aspirin is not prescribed to relieve pain. The client should receive information and support before making the decision to refuse the medication. Clients should never be pressured to take medication, especially when they do not have an understanding of the risks and benefits of the medication.

After the nurse provides education about hydrochlorothiazide, the client will agree to notify the healthcare provider regarding the development of which symptom? Insomnia Nasal congestion Increased thirst Generalized weakness

Generalized weakness Generalized weakness is a symptom of significant hypokalemia, which may be a sequela of diuretic therapy. Insomnia is not known to be related to hypokalemia or hydrochlorothiazide therapy. Although a stuffy nose is unrelated to hydrochlorothiazide therapy, it can occur with other antihypertensive drugs. Increased thirst is associated with hypernatremia. Because this drug increases excretion of water and sodium in addition to potassium and chloride, hyponatremia, not hypernatremia, may occur.

A client is admitted to the hospital with a diagnosis of an exacerbation of asthma. What should the nurse plan to do to best help this client? Determine the client's emotional state. Give prescribed drugs to promote bronchiolar dilation. Provide education about the impact of a family history. Encourage the client to use an incentive spirometer routinely.

Give prescribed drugs to promote bronchiolar dilation. Asthma involves spasms of the bronchi and bronchioles as well as increased production of mucus; this decreases the size of the lumina, interfering with inhalation and exhalation. Bronchiolar dilation will reduce airway resistance and improve the client's breathing. Although identifying and addressing a client's emotional state is important, maintaining airway and breathing are the priority. In addition, emotional stress is only one of many precipitating factors, such as allergens, temperature changes, odors, and chemicals. Although recent studies indicate a genetic correlation along with other factors that may predispose a person to develop asthma, exploring this issue is not the priority. Use of an incentive spirometer is not helpful because of mucosal edema, bronchoconstriction, and secretions, all of which cause airway obstruction.

While receiving a blood transfusion, a client develops flank pain, chills, and fever. What type of transfusion reaction does the nurse conclude that the client probably is experiencing? Allergic Pyrogenic Hemolytic Anaphylactic

Hemolytic A hemolytic transfusion reaction results from a recipient's antibodies that are incompatible with transfused red blood cells; it is called a type II hypersensitivity. The clinical findings are a result of red blood cell hemolysis, agglutination, and capillary plugging. An allergic transfusion reaction is the result of an immune sensitivity to foreign serum protein; it is called a type I hypersensitivity, and associated clinical findings include urticaria, wheezing, dyspnea, and shock. Bacterial pyrogens are present in contaminated blood and can cause a febrile transfusion reaction; associated clinical findings include fever and chills, but not flank pain. An anaphylactic reaction may occur with an allergic transfusion reaction.

A client is taking furosemide. At each clinic visit, the nurse should assess for what adverse effect? Rapid weight loss Xanthopsia Hyporeflexia Bronchospasm

Hyporeflexia Furosemide enhances the excretion of potassium, producing signs and symptoms of hypokalemia, such as hyporeflexia. Rapid weight loss, xanthopsia, and bronchospasm are not side effects of furosemide.

The healthcare provider prescribes atenolol for a client with angina. What potential side effect will the nurse mention when instructing the client about this medication? Headache Tachycardia Constipation Hypotension

Hypotension Atenolol competitively blocks stimulation of beta-adrenergic receptors within vascular smooth muscles, which lowers the blood pressure. This drug does not cause headaches; this drug may be used to relieve vascular headaches. This drug may cause bradycardia, not tachycardia. This drug may cause diarrhea, not constipation.

A nurse administers an intravenous solution of 0.45% sodium chloride. In what category of fluids does this solution belong? Isotonic Isomeric Hypotonic Hypertonic

Hypotonic Hypotonic solutions are less concentrated (contain less than 0.85 g of sodium chloride in each 100 mL) than body fluids. Isotonic solutions are those that cause no change in the cellular volume or pressure because their concentration is equivalent to that of body fluid. This relates to two compounds that possess the same molecular formula but that differ in their properties or in the position of atoms in the molecules (isomers). Hypertonic solutions contain more than 0.85 g of solute in each 100 mL.

Immediately after a bilateral adrenalectomy a client is receiving corticosteroids that are to be continued after discharge from the hospital. Which statement by the client indicates to the nurse that additional education is needed? I need to have periodic tests of my blood for glucose I am glad that I only have to take medication once a day I must take medicine with meals while I have food in my stomach I should tell the doctor if I am overly restless or have trouble sleeping

I am glad that I only have to take medication once a day Usually a larger dose is given at 8 am and the second dose is given before 4 pm to mimic expected hormonal secretion and prevent insomnia. Having periodic blood tests for glucose is necessary because long-term administration of steroids leads to elevated blood glucose levels and possible steroid-induced diabetes. Oral corticosteroids should be taken with food or antacids to prevent gastric irritation and gastric hemorrhage. Neurological and emotional side effects, such as euphoria, mood swings, and sleeplessness, are expected.

The healthcare provider prescribes nitroglycerin ointment for a client who was admitted for chest pain and a myocardial infarction (MI). Which statement, if made by the client, would indicate understanding of the side effects of nitroglycerin ointment? I may experience a headache Confusion is a common adverse effect A slow pulse rate in an expected side effect Increased blood pressure reading readings may occur initially

I may experience a headache The most common side effect of nitroglycerin is a headache. Additional cardiovascular side effects are hypotension, not hypertension; tachycardia, not bradycardia; and dizziness, not confusion.

A nurse is preparing a client for discharge from the emergency department. Which client statement provides evidence that the client understands the instructions for the prescribed high-dose ampicillin? i should take this med with meals i can stop taking this med when I feel better I will miss eating my yogurt while taking this med I must increase my intake of fluids while taking this med

I must increase my intake of fluids while taking this med Because penicillin in high doses is nephrotoxic, keeping hydrated helps flush the kidneys as the drug is excreted. It should be taken on an empty stomach for best absorption. Stopping this medication when the client feels better is contraindicated; completing the medication treatment as prescribed prevents the development of resistant strains of bacteria. Dietary restrictions are not imposed while this medication is taken.

A nurse provides teaching regarding vitamin B 12 injections to a client with pernicious anemia. What statement by the client indicates that teaching was understood?

I must take this monthly for the rest of my life Because the intrinsic factor does not return to gastric secretions even with therapy, B 12 injections will be required for the remainder of the client's life. Vitamin B 12 must be taken on a regular basis for the rest of the client's life.

The client who takes furosemide and digoxin reports that everything looks yellow. How will the nurse respond? this is related to your heart problems, not to the medication it is a medication that is necessary, and that side effect is only temporary take this dose, and when I see your healthcare provider I will ask about it I will hold medication until I consult with your healthcare provider

I will hold medication until I consult with your healthcare provider The response "I will hold the medication until I consult with your healthcare provider" is a safe practice because yellow vision indicates digitalis toxicity. The response "This is related to your heart problems, not to the medication" is incorrect; yellow vision is not a symptom of heart disease. The response "It is a medication that is necessary, and that side effect is only temporary" is incorrect; yellow vision is not a temporary side effect. The response "Take this dose, and when I see your healthcare provider I will ask about it" is unsafe.

The nurse is caring for an older client who is scheduled for a bronchoscopy. Midazolam has been prescribed for the procedure. What administration guidelines will the nurse follow?

In an older client, peak effect may be delayed; increments should be smaller and rate of injection slower. When used for sedation/anxiolysis/amnesia for a procedure, the dosage must be individualized and titrated. Midazolam should always be titrated slowly; administer over at least 2 minutes and allow an additional 2 or more minutes to fully evaluate the sedative effect. Titration to effect with multiple small doses is essential for safe administration. Central nervous system depression is the most serious side effect. A sudden rise in blood pressure shortly after administration has not been evidenced. Midazolam is given for sedation/anxiolysis/amnesia for a procedure.

The healthcare provider prescribes cisplatin for a client with metastatic cancer. What will the nurse do to prevent toxic effects? Ask the client's healthcare provider about prescribing leucovorin. Encourage regular vigorous oral care. Increase hydration to promote diuresis. Assist the client in selecting foods appropriate for a high-protein, low-residue diet

Increase hydration to promote diuresis Cisplatin is nephrotoxic and can cause kidney damage unless the client is adequately hydrated to flush the kidneys. Leucovorin, a form of folic acid, is used to combat toxic effects of methotrexate; cisplatin does not interfere with folic acid metabolism. Gentle, not vigorous, oral care is needed to cleanse the mouth without further aggravating the expected stomatitis. A low-residue diet is unnecessary. Prolonged gastrointestinal irritation is not the major concern; nausea and vomiting last about 24 hours, and although diarrhea may occur and last longer, it is not the primary concern.

A client who is obtunded has a blood pressure of 80/35 mm Hg after a blood transfusion. In an effort to support renal perfusion, the nurse administers dopamine at 2 mcg/kg/min as prescribed. What is the most relevant outcome indicating effectiveness of the medication for this client? Decrease in BP Increase in urinary output Decrease in core Temperature Increase in level of consciousness

Increase in urinary output As renal perfusion increases, urinary output also should increase; doses greater than 10 mcg/kg/min can cause renal vasoconstriction and decreased urinary output. A change in blood pressure is not a direct predictor of the effectiveness of dopamine given at a level of 2 mcg/kg/min; at 10 mcg/kg/min a client will experience an increased cardiac output and an increased blood pressure. Body temperature does not indicate improved renal perfusion. In this situation, improvement of renal perfusion is not directly related to the client's level of consciousness.

Ranitidine has been prescribed to help treat a client's gastric ulcer. The nurse expects this drug to act specifically by which mechanism? Lowering gastric pH Promoting release of gastrin Regenerating gastric mucosa Inhibiting histamine at H2 receptors

Inhibiting histamine at H2 receptors Ranitidine inhibits histamine at H 2 receptor sites in parietal cells, which limits gastric secretion. Lowering the gastric pH is not the direct action of this drug. Promoting the release of gastrin is undesirable; gastric hormones increase gastric acid secretion. Ranitidine does not regenerate the gastric mucosa; the drug prevents its erosion by gastric secretions.

A nurse administers the drug desmopressin acetate (DDAVP) to a client with diabetes insipidus. What should the nurse monitor to evaluate the effectiveness of the drug? Arterial blood pH Intake and output Fasting serum glucose Pulse and respiratory rates

Intake and output DDAVP replaces antidiuretic hormone, facilitating reabsorption of water and consequent return of a balanced fluid intake and urinary output. The mechanisms that regulate pH are not affected. DDAVP does not alter serum glucose levels; diabetes mellitus, not diabetes insipidus, results in hyperglycemia. Although correction of tachycardia is consistent with correction of dehydration, the client is not dehydrated if the fluid intake is adequate; respirations are unaffected.

The spouse of a client with an intracranial hemorrhage asks the nurse, "Why aren't they administering an anticoagulant?" How will the nurse respond? It is not advisable because bleeding will increase if necessary it will be started to enhance circulation if necessary it will be started to prevent pulmonary thrombosis It is inadvisable because it masks the effects of the hemorrhage

It is not advisable because bleeding will increase An anticoagulant should not be administered to a client who is bleeding because it will interfere with clotting and will increase hemorrhage. Anticoagulants are unsafe and will not be used to enhance the circulation or prevent pulmonary thrombosis. The response "It is inadvisable because it masks the effects of the hemorrhage" is not the reason why it is contraindicated; if given, it will increase, not mask, the effects of the hemorrhage.

A nurse is teaching a client about ampicillin that has been prescribed for a severe infection. Which statement indicates to the nurse that the client needs further teaching? I should report any problems with my hearing I may be required to get additional blood tests It is okay for me to stop taking this medication after I improve If I develop a fever, I will notify my primary healthcare provider

It is okay for me to stop taking this medication after I improve It is most important for the client to complete the antibiotic prescription to prevent the development of antibiotic-resistant bacteria. Ototoxicity is an adverse effect of aminoglycoside antibiotics such as gentamicin. Blood tests for toxicity may be required. Because the client has an infection, it is important to report temperature elevation.

A client with follicular non-Hodgkin lymphoma is to be treated with rituximab, a targeted monoclonal antibody. The nurse should monitor the client for what common side effect of rituximab? Polyphagia Leukopenia Constipation Hypertension

Leukopenia Rituximab targets the CD 20 antigen, which regulates cell cycle differentiation and is found on malignant B lymphocytes; as a result, rituximab therapy can cause leukopenia and neutropenia. Anorexia, not polyphagia, may occur with rituximab therapy. Frequent stools and diarrhea, not constipation, may occur with rituximab therapy. Hypotension, not hypertension, may occur as a fatal infusion reaction to rituximab therapy.

A client is receiving combination chemotherapy for treatment of metastatic carcinoma. For which systemic side effect should the nurse monitor the client? Ascites Nystagmus Leukopenia Polycythemia

Leukopenia Leukopenia, a reduction in white blood cells, is a systemic effect of chemotherapy as a result of myelosuppression. Ascites is not a side effect of chemotherapy. Chemotherapy does not affect the eyes; nystagmus is an involuntary, rapid rhythmic movement of the eyeballs. Also, nystagmus is a local, not a systemic, response. The red blood cells will be decreased, not increased.

A client with multiple myeloma who is receiving the alkylating agent melphalan returns to the oncology clinic for a follow-up visit. For which side effect should the nurse monitor the client?

Leukopenia Melphalan depresses the bone marrow, causing a reduction in white blood cells (leukopenia), red blood cells (anemia), and thrombocytes (thrombocytopenia); leukopenia increases the risk of infection. Hirsutism occurs with the administration of androgens to women. Diarrhea, not constipation, occurs with melphalan. Photosensitivity occurs with 5-fluorouracil, floxuridine, and methotrexate, not with melphalan.

The nurse identifies a 5-cm indurated region on the upper arm of a client with type 1 diabetes. The client says to the nurse, "That is where I give myself insulin shots." The nurse concludes that the nodule, which is neither warm nor painful, is a result of what condition?

Lipodystrophy Lipodystrophy is a noninflammatory reaction causing localized atrophy or hypertrophy and a localized increase in collagen deposits. Injections of insulin will not cause a horny growth such as a wart or callus. An allergic response will precipitate a localized or systemic inflammatory response. Hyperthermia and localized heat, erythema, and pain are associated with an infection.

When a client is receiving dexamethasone for adrenocortical insufficiency, what action does the nurse take to monitor for an adverse effect of the medication? Auscultate for bowel sounds. Assess deep tendon reflexes. Culture respiratory secretions. Measure blood glucose levels.

Measure blood glucose levels. Corticosteroids, such as dexamethasone, have a hyperglycemic effect, and blood glucose levels should be monitored routinely. Assessing bowel sounds is unnecessary; corticosteroids are not known to precipitate cessation of gastrointestinal activity. Although corticosteroids may increase the risk of developing an infection, routine culturing of respiratory secretions is unnecessary. Culturing respiratory secretions becomes necessary when the client exhibits adaptations of a respiratory infection. Monitoring deep tendon reflexes is required when administering magnesium sulfate, not dexamethasone.

A client is diagnosed with acute lymphoid leukemia and is receiving chemotherapy. The nurse should monitor what thrombocytopenic side effects of chemotherapy? Select all that apply. Nausea Melena Purpura Diarrhea Hematuria

Melena Purpura Hematuria Black, tarry feces caused by the action of intestinal secretions on blood are associated with bleeding in the gastrointestinal tract; bleeding is related to a reduced number of thrombocytes, which are part of the coagulation process. Hemorrhages into the skin and mucous membranes (purpura) may occur with reduced numbers of thrombocytes, which are part of the coagulation process. Blood in the urine (hematuria) may occur with a reduced number of thrombocytes, which are part of the coagulation process. Nausea and vomiting are not related to thrombocytopenia; they occur because of the effect of chemotherapy on the rapidly dividing cells of the mucous membranes of the gastrointestinal system. Diarrhea may be a side effect of chemotherapy, but it is not a thrombocytopenic side effect.

Which medication should the nurse question when it is prescribed for a client with acute pancreatitis? Ranitidine Cimetidine Meperidine Promethazine

Meperidine Meperidine should be avoided because accumulation of its metabolites can cause central nervous system irritability and even tonic-clonic seizures (grand mal seizures). Ranitidine is useful in reducing gastric acid stimulation of pancreatic enzymes. Cimetidine is useful in reducing gastric acid stimulation of pancreatic enzymes. Promethazine is useful as an antiemetic for clients with pancreatitis.

A client who is postoperative hip replacement is receiving morphine by patient-controlled analgesia and has a respiratory rate of 6 breaths/min. What intervention should the nurse anticipate?

Naloxone is an opioid antagonist and will reverse respiratory depression caused by opioids. Nasotracheal suction, mechanical ventilation, and cardiopulmonary resuscitation are not needed; naloxone will correct the respiratory depression.

A client with cancer develops pancytopenia during the course of chemotherapy. The client asks the nurse why this has occurred. What explanation will the nurse provide? Steroid hormones have a depressant effect on the spleen and bone marrow. Lymph node activity is depressed by radiation therapy used before chemotherapy. Noncancerous cells also are susceptible to the effects of chemotherapeutic drugs. Dehydration caused by nausea, vomiting, and diarrhea results in hemoconcentration.

Noncancerous cells also are susceptible to the effects of chemotherapeutic drugs. Chemotherapy destroys erythrocytes, white blood cells, and platelets indiscriminately along with the neoplastic cells because these are all rapidly dividing cells that are vulnerable to the effects of chemotherapy. Stating that steroid hormones have a depressant effect on the spleen and bone marrow is not a true description of the side effects of steroids. Depressed lymph node activity as a result of radiation therapy used before chemotherapy is not the cause for fewer erythrocytes, white blood cells, and platelets. Although it is true that dehydration caused by nausea, vomiting, and diarrhea results in hemoconcentration, this does not explain pancytopenia.

A client hospitalized for uncontrolled hypertension and chest pain was started on a daily diuretic 2 days ago upon admission, with prescriptions for a daily basic metabolic panel. The client's potassium level this morning is 2.7 mEq/L (2.7 mmol/L). Which action should the nurse take next? Send another blood sample to the lab to retest the serum potassium level Notify the healthcare provider that the potassium level is above normal Notify the healthcare provider that the potassium level is below normal No action is required because the potassium level is within normal limits

Notify the healthcare provider that the potassium level is below normal The healthcare provider should be notified immediately because the client's potassium is below normal. The normal potassium level range is 3.5 mEq/L to 5.0 mEq/L (3.5 mmol/L to 5.0 mmol/L). Clients on diuretic therapy require close monitoring of their electrolytes because supplemental potassium may be needed. Retesting the serum potassium level is unnecessary and will delay the treatment required by the client.

After teaching a family member how to administer subcutaneous enoxaparin sodium, how should a nurse evaluate the effectiveness of the training? Return demonstration on a manikin Verbalization of side effects of the medication Observing family member administering enoxaparin sodium to the client Correctly verbalizing all necessary steps in enoxaparin sodium administration

Observing the family member administering enoxaparin sodium to the client The best way to evaluate the effectiveness of the teaching is to observe the family member administering the medication to the client. The family member may be able to perform a subcutaneous injection on a manikin but fear hurting the family member. Knowing the side effects of enoxaparin sodium is important, but it does not provide any information as to the family member's ability to administer the medication. The family member may be able to verbalize all the steps but fear puncturing the skin with the needle.

A client is admitted to the hospital with a diagnosis of dehydration and hypokalemia. Which statement/intervention is most accurate when administering potassium chloride intravenously to this client with hypokalemia? Oliguria is an indication for withholding intravenous (IV) potassium. Rapid infusion of potassium prevents burning at the IV site. Clients with severe deficits should be given IV push potassium. Average IV dosage of potassium should not exceed 60 mEq in one hour.

Oliguria is an indication for withholding intravenous (IV) potassium. Potassium chloride should not be given unless renal flow is adequate; otherwise, the potassium chloride will accumulate in the body, causing hyperkalemia. Rapid infusion may cause severe pain at the infusion site and precipitate cardiac arrest. Potassium chloride must be well diluted or it will precipitate cardiac arrest. A dose of 60 mL of KCl/hr is too high a dosage; the IV dosage should not exceed 10 to 20 mEq of potassium chloride per hour, depending on hospital policy and clinical unit of the client.

A client is admitted with head trauma after a fall. The client is being prepared for a supratentorial craniotomy with burr holes, and an intravenous infusion of mannitol is instituted. The nurse concludes that this medication primarily is given to do what?

Osmotic diuretics remove excessive cerebrospinal fluid (CSF), reducing intracranial pressure. Osmotic diuretics increase, not decrease, the blood pressure by increasing the fluid in the intravascular compartment. Osmotic diuretics do not directly influence blood glucose levels. Although there is an increase in cardiac output when the vascular bed expands as CSF is removed, it is not the primary purpose for administering the medication.

A client is scheduled for an adrenalectomy. What does the nurse expect that the plan of care will include? Low-protein diet Parenteral corticosteriods Preoperative 24-hour urine specimen Withholding all medications 48 hours before surgery

Parenteral corticosteriods Steroid therapy usually is given intravenously or intramuscularly preoperatively and continued intraoperatively to prepare for the acute adrenal insufficiency that follows surgery. The diet must supply ample protein and potassium. A 24-hour urine specimen is unnecessary. Corticosteroids must be administered preoperatively to prevent adrenal insufficiency during surgery, so withholding all medications for 48 hours before surgery is contraindicated.

A client is admitted to the hospital after general paresis develops as a complication of syphilis. Which therapy should the nurse anticipate will most likely be prescribed for this client? Penicillin therapy Major tranquilizers Behavior modification Electroconvulsive therapy

Penicillin therapy Massive doses of penicillin may limit central nervous system damage if treatment is started before neural deterioration from syphilis occurs. Tranquilizers are used to modify behavior, not to treat general paresis. Behavior, not paresis, is treated with behavior modification. Electroconvulsive therapy is used to treat certain psychiatric disorders.

A client with type 1 diabetes requests information about the differences between penlike insulin delivery devices and syringes. What information does the nurse provide about the penlike devices? The penlike devices have a shorter injection time. Penlike devices provide a more accurate dose delivery. The penlike delivery system uses a smaller-gauge needle. Penlike devices cost less by having reusable insulin cartridges.

Penlike devices provide a more accurate dose delivery. Penlike insulin delivery devices are more accurate because they are easy to use; also, they promote adherence to insulin regimens because the medication can be administered discreetly. One disadvantage of the penlike insulin delivery device is that the injection time will be longer; the device must remain in place for several seconds after the insulin is injected to ensure that no insulin leaks out. The penlike insulin delivery device has a larger-gauge needle that has a smaller diameter. The insulin cartridges of a penlike insulin delivery device are single use and disposable.

A client with leukemia who is receiving a chemotherapeutic regimen that includes vincristine reports numbness and loss of feeling in the legs below the knees. The client asks the nurse about what is causing these problems. What fact forms the basis for the nurse's response? Enlarged lymph nodes in the groin related to the cancer may cause these symptoms. Most chemotherapeutic regimens do not affect the nervous or peripheral vascular system. Vascular occlusion may be the cause, and immediate medical evaluation is indicated. Peripheral neuropathies can result from chemotherapy and usually are reversible if promptly treated.

Peripheral neuropathies can result from chemotherapy and usually are reversible if promptly treated. Muscle weakness, tingling, and numbness are related to drugs like vincristine; neuropathies usually are transient if the drug is stopped or reduced. Nodal enlargement produces vascular rather than neural side effects. Most chemotherapeutic regimens do affect the nervous or peripheral vascular system; neuropathies and peripheral vascular adaptations are potential side effects of chemotherapy. Tingling and numbness are characteristic of neuropathy, not vascular occlusion.

A client has an order for a sublingual nitroglycerin tablet. The nurse should teach the client to use what technique when self-administering this medication? Place pill inside cheek and let it dissolve Place pill under tongue and let it dissolve Chew pill thoroughly and then swallow Swallow pill will full glass of water

Place pill under tongue and let it dissolve Sublingual medication is placed under the tongue and is quickly absorbed through the mucous membranes into blood. The buccal route requires placing medication between the cheek and gums. Chewing the pill and then swallowing it may be done for oral administration of some large size pills, but not with the sublingual route of administration. Taking the pill with water is required with the PO route of administration of medication, but not with sublingual. In addition, a full glass of water may be an excessive amount of fluid to swallow one pill.

A client receives a prescription for nitroglycerin sublingual as needed for anginal pain. What should the nurse include in the teaching about this medication? Place the tablet under the tongue or between the cheek and gum. It takes 30 to 45 minutes for the nitroglycerin to achieve its effect. If dizziness occurs, take a few deep breaths and lean the head back. To facilitate absorption, drink a large glass of water after taking the medication.

Place the tablet under the tongue or between the cheek and gum. Nitroglycerin sublingual tablets should not be chewed, crushed, or swallowed. They work much faster when absorbed through the lining of the mouth. Clients are instructed to place the tablet under the tongue or between the cheek and gum and let it dissolve. The client should not eat, drink, smoke, or use chewing tobacco while a tablet is dissolving; this will decrease the effectiveness of the drug. If taken with water, the tablet is washed away from the site of absorption or may be swallowed. Nitroglycerin sublingual tablets usually give relief in 1 to 5 minutes. If a client experiences dizziness or lightheadedness, the client is instructed to take several deep breaths and bend forward with the head between the knees. This position promotes blood flow to the head.

A client is brought to the emergency department with chest pain. A myocardial infarction is suspected, and 500 mL of D 5W with 50 mg of nitroglycerin intravenously (IV) has been prescribed. The nurse should monitor the client for what most common side effect? Bradycardia Postural hypotension Nausea and vomiting Cherry red lips and cheeks

Postural hypotension The major action of intravenous nitroglycerin is venous and then arterial dilation, leading to a decrease in blood pressure; orthostatic hypotension can occur. Bradycardia is not an anticipated response. Nausea and vomiting may occur but are not the most common side effects of IV nitroglycerin. Cherry red lips and cheeks occur with carbon monoxide poisoning.

A nurse reviews a list of medications that have been prescribed for a client. The nurse is aware that it is unsafe to administer which medication as an intravenous (IV) bolus? saline flush potassium chloride naloxone adenosine

Potassium chloride Potassium chloride given as an IV bolus can cause cardiac arrest. It should never be administered intravenously without being diluted and infused slowly through an IV infusion pump. Saline flush, naloxone, and adenosine are appropriate to be given as an IV bolus undiluted.

Prednisone, an adrenal steroid, is prescribed for a client with an exacerbation of colitis. When administering the first dose of the medication, what information does the nurse provide to the client? Prednisone protects the client from getting an infection. The medication may cause weight loss by decreasing appetite. Prednisone is not curative, but does cause a suppression of the inflammatory process. The medication is relatively slow in precipitating a response, but is effective in reducing symptoms.

Prednisone is not curative, but does cause a suppression of the inflammatory process. Prednisone inhibits phagocytosis and suppresses other clinical phenomena of inflammation; this is a symptomatic treatment that is not curative. Prednisone suppresses the immune response, which increases the potential for infection. The appetite is increased with prednisone; weight gain may result from the increased appetite or from fluid retention. Generally the response to prednisone is rapid.

A client is admitted to the hospital with a diagnosis of deep vein thrombosis, and intravenous (IV) heparin sodium is prescribed. If the client experiences excessive bleeding, what should the nurse be prepared to administer? Vitamin K Oprelvekin Warfarin sodium Protamine sulfate

Protamine sulfate Protamine sulfate binds with heparin sodium to form a physiologically inert complex; it corrects clotting deficits. Vitamin K counteracts the effects of drugs like warfarin sodium (Coumadin). Oprelvekin is a thrombopoietic growth factor that stimulates the production of platelets. It would not be appropriate for emergency management. Warfarin sodium is an oral anticoagulant that interferes with the synthesis of prothrombin.

What nursing care should be included for a client who is receiving doxorubicin for acute myelogenous leukemia? Serving hot liquids with each meal Providing frequent oral hygiene and increasing oral fluids Emphasizing that the disease will be cured with this treatment Administering medications intramuscularly and encouraging activity

Providing frequent oral hygiene and increasing oral fluids Stomatitis and hyperuricemia are possible complications of therapy; therefore, oral care and hydration are important. Food and fluids with extremes in temperature should be avoided because of the common occurrence of stomatitis. Emphasizing that the disease will be cured with this treatment may provide false reassurance. Abnormal bleeding is a common problem, and thus injections are contraindicated; rest is important for increased fatigability.

A client diagnosed with tuberculosis is taking isoniazid. To prevent a food and drug interaction, the nurse should advise the client to avoid which food item? Hot dogs Red wine Sour cream Apple juice

Red wine Clients taking isoniazid should avoid foods containing tyramine such as red wine, tuna fish, and hard cheese. Hot dogs, sour cream, and apple juice do not contain tyramine and therefore are not contraindicated.

The nurse is caring for a client with diabetes mellitus who is scheduled to receive an intravenous (IV) administration of 25 units of insulin in 250 mL normal saline. What does the nurse recognize as the only type of insulin that is compatible with intravenous solutions? NPH insulin Insulin lispro Regular insulin Insulin glargine

Regular insulin Regular insulin acts rapidly, is approved for IV administration, and is compatible with intravenous solutions. Insulin lispro is not compatible with intravenous solutions; it is a rapid-acting insulin. Insulin glargine is not compatible with intravenous solutions; it is a long-acting insulin. NPH insulin is not compatible with intravenous solutions; it is an intermediate-acting insulin.

A nurse adds 20 mEq of potassium chloride to the intravenous solution of a client with diabetic ketoacidosis. What is the primary purpose for administering this drug? Treat hyperpnea Prevent flaccid paralysis Replace excessive losses Treat cardiac dysrhythmias

Replace excessive losses Once treatment with insulin for diabetic ketoacidosis is begun, potassium ions reenter the cell, causing hypokalemia; therefore potassium, along with replacement fluids, is needed. Potassium will not correct hyperpnea. Flaccid paralysis does not occur in diabetic ketoacidosis. Considering the relationship between insulin and potassium, treatment with potassium is prophylactic, preventing the development of dysrhythmias.

The nurse provides medication teaching to a client on diuretic therapy who receives a prescription for potassium supplements. The nurse concludes that the teaching was effective when the client agrees to which commitment? Report any abdominal distress Use salt substitutes to season food Take the drug on an empty stomach Increase the dosage if muscle cramps occur

Report any abdominal distress Potassium supplements can cause gastrointestinal ulceration and bleeding. Most salt substitutes contain potassium, and their use with potassium supplements can cause hyperkalemia. Because they can be irritating to the stomach, potassium supplements should not be taken on an empty stomach. Although muscle cramps may indicate hypokalemia, clients should not adjust their own dosage.

What should the nurse teach a client who is taking warfarin? Report episodes of spontaneous bleeding Increase dose with prolonged inactivity Take antibiotics, if injured, to prevent infection Eat a diet with an increased quantity of green vegetables

Report episodes of spontaneous bleeding Warfarin is an anticoagulant; therefore, excessive bleeding, especially that which occurs spontaneously and unrelated to injury, may require a dosage adjustment for safety reasons. Activity or inactivity is unrelated to the need to alter the dose of warfarin. The dose should not be altered without healthcare supervision. The problem of bleeding is more significant than infection when a client is taking warfarin. Green vegetables that contain vitamin K, which is necessary for the synthesis of clotting factors VII, IX, and X, should be kept consistent in the diet from week to week; increased consumption will decrease the action of warfarin, and a decreased consumption will increase the action of warfarin.

A client is receiving oxycodone postoperatively for pain. The healthcare provider's prescription indicates that the dose should be administered every 3 hours for eight doses. What should the nurse assess before administering each dose of oxycodone? Respiratory rate and level of consciousness Color, character, and amount of urine output Intravenous site and patency of intravenous catheter Amount and character of drainage in the portable drainage system

Respiratory rate and level of consciousness Oxycodone is an opioid that depresses the central nervous system, resulting in a decreased level of consciousness and depressed respirations. The medication should be administered, delayed, or held, depending on the client's status. Although urinary output of postoperative clients should be assessed, urinary output is not related directly to the administration of opioid medications. Oxycodone is administered via tablets, not intravenously. Wound drainage is unrelated to the administration of oxycodone.

A client is diagnosed with Parkinson disease and receives a prescription for levodopa therapy. What does the nurse identify as the drug's mechanism of action? Blocks effects of acetylcholine Increases production of dopamine Restores dopamine levels in the brain Promotes production of acetylcholine

Restores dopamine levels in the brain Levodopa is a precursor of dopamine, a catecholamine neurotransmitter; it increases dopamine levels in the brain that are depleted in Parkinson disease. Blocking the effects of acetylcholine is accomplished by anticholinergic drugs. Increasing the production of dopamine is ineffective because it is believed that the cells that produce dopamine have degenerated in Parkinson disease. Levodopa does not affect acetylcholine production.

A client who recently started receiving oral corticosteroids for a severe allergic reaction is instructed that the dosage will be reduced gradually until all medication is stopped at the end of two weeks. What reason does the nurse provide for this gradual reduction in dosage? Discontinuing the drug too fast will cause the allergic reaction to reappear. Slow reduction of the drug will prevent a physiologic crisis because the adrenal glands are suppressed. The healthcare provider is attempting to determine the minimal dose that will be effective for the allergy. Sudden cessation of the drug will cause development of serious side effects, such as moon face and fluid retention.

Slow reduction of the drug will prevent a physiologic crisis because the adrenal glands are suppressed. The body's natural corticosteroid production has been suppressed during treatment; avoiding abrupt cessation of the drug will give the body time to adjust to less and less of the exogenous source and to resume secretion of endogenous corticosteroid. Not completing the course of therapy, rather than stopping it quickly, may cause signs and symptoms of the allergy to recur. The healthcare provider has already determined the correct dosage, and it has been prescribed. Moon face and fluid retention are associated with long-term steroid use, not with the cessation of therapy.

A client is receiving chemotherapy with doxorubicin. What response to the medication should the nurse teach the client to report immediately? Nausea Sore throat Loss of hair Constipation

Sore throat A respiratory tract infection may be the first clinical sign of bone marrow suppression, which can be life threatening. Nausea is an expected side effect of doxorubicin, but it is not life threatening. Hair loss is not a side effect of doxorubicin. Constipation is an expected side effect of doxorubicin, but it is not life threatening.

A client with hypertension is to take an angiotensin II receptor blocker (ARB). What should the nurse teach about this medication? Select all that apply. Monitor the blood pressure daily. Stop treatment if a cough develops. Stop the medication if swelling of the mouth, lips, or face develops. Have blood drawn for potassium levels 2 weeks after starting the medication. Do not take nonsteroidal antiinflammatory drugs (NSAIDs) concurrently with this medication.

Stop the medication if swelling of the mouth, lips, or face develops. Have blood drawn for potassium levels 2 weeks after starting the medication. The medication should be stopped if angioedema occurs, and the healthcare provider should be notified. Electrolyte levels of potassium, sodium, and chloride should be obtained 2 weeks after the start of therapy and then periodically thereafter. Daily monitoring is not indicated. The blood pressure should be monitored at routine office visits. There is no need to avoid the use of NSAIDs while taking an ARB. A dry cough may occur during treatment with ARBs; however, it is not necessary to discontinue the medication because the cough usually resolves.

A healthcare provider prescribes oral aluminum-magnesium hydroxide and intravenous ranitidine for a client with traumatic burns and crush injuries. The client asks how these medications work. What is the nurse's best response?

Stress from burns and crush injuries increases gastric acid production and contributes to Curling ulcer formation. Ranitidine (an H2 receptor antagonist) reduces gastric acid formation, and aluminum-magnesium hydroxide (an antacid) neutralizes gastric acid once it is formed. These drugs reduce gastrointestinal acidity, but do not decrease bowel irritability. Stating that they "are effective in clients with multiple trauma" does not answer the client's question about how the medications work. These drugs do not work in the same way as antidiarrhea medications, which work to slow gastrointestinal motility.

Hydrocortisone is prescribed for a client with Addison disease. Before discharge, the nurse teaches the client about this medication. What did the nurse include as a therapeutic effect of the drug? Supports a better response to stress Promotes a decrease in blood pressure Decreases episodes of shortness of breath Controls an excessive loss of potassium from the body

Supports a better response to stress Hydrocortisone is a glucocorticoid that has antiinflammatory action and aids in metabolism of carbohydrates, fats, and proteins, causing elevation of the blood glucose level. Thus it enables the body to adapt to stress. It may promote fluid retention that results in hypertension and edema. Shortness of breath (dyspnea) is caused by hypovolemia and decreased oxygen supply; neither is affected by hydrocortisone. It may cause potassium depletion.

A nurse is caring for a client who is receiving total parenteral nutrition (TPN) after extensive colon surgery. The nurse concludes that the client understands teaching about the purpose of TPN when the client makes which statement? TPN provides supplemental nutrition TPN provides short-term nutrition after surgery TPN provides total nutrition when gastrointestinal function is questionable TPN assists people who are unable to eat but have active gastrointestinal function

TPN provides total nutrition when gastrointestinal function is questionable When GI absorption is inadequate, TPN is the nutritional therapy of choice because it provides needed nutrients. TPN usually is used with chronic or long-term therapy, not for short-term therapy. TPN is used for total, not supplemental, nutrition. The response "TPN assists people who are unable to eat but have active gastrointestinal function" is not the indication for TPN; a feeding tube would be used in this instance.

When preparing discharge teaching for a client who had a kidney transplant, in addition to a corticosteroid, the nurse expects what other medications to be prescribed to prevent kidney rejection? Furosemide and sirolimus Cefazolin and methotrexate Methylprednisolone and phenytoin Tacrolimus and mycophenolate mofetil

Tacrolimus and mycophenolate mofetil Standard triple therapy includes a corticosteroid prednisone (methylprednisolone), an antimetabolite (mycophenolate), and a calcineurin inhibitor (tacrolimus and cyclosporine). Although sirolimus is used for immunosuppression, furosemide is a diuretic. Neither of these medications are immunosupressives. Cefazolin is an antibiotic, and methotrexate is a folic acid antagonist used in cancer chemotherapy. Although methylprednisolone is used for immunosuppression, phenytoin is an antiseizure medication.

A client is newly diagnosed with hypertension. The primary healthcare provider prescribes an antihypertensive medication to be taken once in the morning and a 2 gram sodium diet. What is most important for the nurse to teach the client about lowering the blood pressure?

The most effective way to lower the blood pressure is to take the prescribed medication daily. It is not necessary to take daily blood pressure measurements unless specifically prescribed to do so by the primary healthcare provider. Restricting salt in the diet will help limit fluid retention and thus reduce the blood pressure, but it is not as effective as an antihypertensive. Salt should not be added during food preparation. The natural sodium content of foods should be calculated into a 2 gram sodium diet. Although salt should not be added, this alone will not help lower the blood pressure. The natural sodium content of foods should be calculated into a 2 gram sodium diet.

A client has been admitted with severe edema and hypertension. Intravenous furosemide has been prescribed. Which subjective clinical manifestations lead the nurse to suspect that the furosemide is infusing too rapidly? Select all that apply. Hunger Tinnitus Weakness Leg cramps Excess salivation

Tinnitus Weakness Leg cramps Tinnitus is a central nervous system side effect of furosemide. Weakness and leg cramps result from hypokalemia caused by an overload of furosemide. Nausea and anorexia, not hunger, are side effects of dehydration that may occur with an overload of furosemide. Dry mouth, not salivation, results from dehydration caused by an overload of furosemide.

A nurse is planning to administer a prescribed intravenous solution that contains potassium chloride. What assessment should be brought to the healthcare provider's attention before administration of the intravenous line? Uncharacteristic irritability Poor tissue turgor with tenting Urinary output of 200 mL during the previous 8 hours Oral fluid intake of 300 mL during the previous 12 hours

Urinary output of 200 mL during the previous 8 hours Decreased urinary output will result in the retention of potassium, causing hyperkalemia. Reporting uncharacteristic irritability is unnecessary; this is a sign of dehydration, which can be corrected with appropriate hydration. Reporting poor tissue turgor with tenting is unnecessary; this may indicate dehydration, which is probably the rationale for the fluid prescribed. Reporting an oral fluid intake of 300 mL during the previous 12 hours is unnecessary; this can precipitate dehydration or can compound an existing dehydration, which can be treated with appropriate hydration.

A client develops severe bone marrow suppression related to cancer treatment. What is important for the nurse to include in the client's teaching? Be prepared to experience alopecia. Increase fluids to at least 3 liters/day. Use a soft toothbrush for oral hygiene. Monitor your intake and output of fluids.

Use a soft toothbrush for oral hygiene. Thrombocytopenia occurs with several cancer treatment programs; using a soft toothbrush helps prevent bleeding gums. Although alopecia does occur, it is not related to bone marrow suppression. Increasing fluids will neither reverse bone marrow suppression nor stimulate hematopoiesis. Monitoring intake and output of fluids is not related to bone marrow suppression.

A client who is immunosuppressed is receiving filgrastim. When monitoring effectiveness, the nurse will check for an increase in which blood component? Platelets Erythrocytes Thrombocytes White blood cells

White blood cells Filgrastim, a granulocyte colony-stimulating factor, increases the production of neutrophils with little effect on the production of other blood components. The production of platelets is not stimulated by filgrastim. The production of erythrocytes is not stimulated by filgrastim. The production of thrombocytes is not stimulated by filgrastim.

A client is receiving clonidine for hypertension. What side effect of clonidine will the nurse include when providing drug education? Xerostomia Diarrhea Euphoria Photosensitivity

Xerostomia Xerostomia (dry mouth) is one of the common side effects of this drug. The reaction usually diminishes over the first 2 to 4 weeks of therapy. This drug causes constipation, not diarrhea. This drug may cause depression, anxiety, fatigue, and drowsiness, not euphoria. Photosensitivity is not a side effect of this medication.

A nurse is administering serum albumin intravenously to a client with ascites. In response to this therapy, what does the nurse expect to decrease? confusion urinary output abdominal girth serum ammonia level

abdominal girth An increased serum albumin level increases the osmotic effect and pulls fluid back into the intravascular compartment. This will increase renal flow and urine output, with a resulting decrease in abdominal girth. Urinary output therapy will increase blood volume and blood flow to the kidney, thereby increasing urinary output. Albumin therapy has no effect on blood ammonia levels. An increased, not decreased, blood ammonia level causes hepatic encephalopathy.

A nurse is reviewing a newly admitted client's medication administration record (MAR). Which element, if missing, makes the record incomplete? height allergies vital signs body weight

allergies Allergies should be listed on all MARs to prevent the administration of drugs to which the client is allergic. Height is part of the initial health history/physical assessment data. Weight is part of the initial health history/physical assessment data. The vital signs are part of the initial health history/physical assessment data.

For a client with difficulty swallowing, the nurse should crush which medication?

acetaminophen extra strength Acetaminophen extra strength (Tylenol ES [extra strength]) is not coated or intended to be released slowly; crushing this medication will not cause a bolus to be administered to the client. Crushing of extended- or sustained-release drugs such as potassium chloride extended release will cause a bolus of medication to be given at once rather than slowly; if crushing is necessary, another form of the medication or another medication should be requested from the health care provider. Crushing an SR (sustained-release) medication will cause a bolus to be administered at once rather than slowly as intended; if crushing is necessary, another form of the medication or another medication should be requested of the health care provider. Crushing of an XL (extended-release) medication will cause a bolus to be given; if crushing is necessary, another form of the medication or another medication should be requested of the health care provider.

A client is receiving warfarin for a pulmonary embolism. Which drug is often contraindicated when taking warfarin? atenolol ferrous sulfate chlorpromazine acetylsalicylic acid

acetylsalicylic acid Acetylsalicylic acid can cause decreased platelet aggregation, increasing the risk for undesired bleeding that may occur with administration of anticoagulants. It should not be administered unless specifically prescribed, usually by a cardiologist or other specialist, to manage serious risks of thrombosis. Ferrous sulfate does not affect warfarin; it is used for red blood cell synthesis. Atenolol is a beta-blocker that reduces blood pressure; it does not affect bleeding. Chlorpromazine is a neuroleptic; it does not affect bleeding.

The healthcare provider prescribes enoxaparin to be administered subcutaneously daily to a client who had a total knee replacement. To ensure client safety, which measure would the nurse take when administering this medication? remove air pocket from prepackaged syringe before administration rub injection site after administration for 30 seconds administer medication over 2 min administer in the abdomen area only

administer in the abdomen area only The preferred site for enoxaparin administration is the abdomen. According to package directions, the air pocket in the prepackaged syringe should not be removed. Rubbing the injection site also is contraindicated. Subcutaneous injections should not be given over 2 minutes.

A client with a history of malabsorption syndrome is admitted to the hospital for medical management. Total parenteral nutrition (TPN) has been prescribed. What action will the nurse take to prevent a major reaction to the TPN infusion?

administer infusion slowly Total parenteral nutrition should be infused at a slow, constant rate; this will prevent both hyperglycemia and cellular dehydration from too rapid infusion of a hypertonic solution. Recording intake and output is essential because of the danger of fluid overload; however, monitoring will not prevent the complication. Generally a major vein is selected for administration of total parenteral nutrition; the site is not changed every 24 hours. Monitoring vital signs may identify a complication such as infection; monitoring will not prevent a complication from occurring.

A client with type 1 diabetes mellitus has a finger stick glucose level of 258 mg/dL (14.3 mmol/L) at bedtime. A prescription for sliding-scale regular insulin exists. What should the nurse do? call health care provider encourage intake of fluids administer insulin as prescribed give the client a half cup of orange juice

administer insulin as prescribed A value of 258 mg/dL (14.3 mmol/L) is above the expected range of 70 to 100 mg/dL (3.6 to 5.6 mmol/L); the nurse should administer the regular insulin as prescribed. Calling the health care provider is unnecessary; a prescription for insulin exists and should be implemented. Encouraging the intake of fluids is insufficient to lower a glucose level this high. Giving the client a half cup of orange juice is contraindicated because it will increase the glucose level further; orange juice, a complex carbohydrate, and a protein should be given if the glucose level is too low.

A client is taking phenytoin to treat clonic-tonic seizures. The client's phenytoin level is 16 mcg/L. Which action should the nurse take?

administer next dose of med as prescribed Administering the next dose of the medication as prescribed is within the therapeutic range of 10 to 20 mcg/L (40 to 80 mcmol/L); the nurse should administer the drug as prescribed. The phenytoin level is within the therapeutic range of 10 to 20 mcg/L (40-80 mcmol/L); there is no need to hold the dose and notify the healthcare provider. Holding the next dose and then resuming administration as prescribed is unsafe and will reduce the therapeutic blood level of the drug. Calling the healthcare provider to obtain a prescription with an increased dose is unnecessary; the blood level is within the therapeutic range.

After cataract surgery, a client reports feeling nauseated. How can the nurse help relieve the nausea? administer prescribed antiemetic drug provide some dry crackers for the client to eat explain that this is expected following surgery teach how to breathe deeply until the nausea subsides

administer prescribed antiemetic drug An antiemetic will prevent vomiting; vomiting increases intraocular pressure and should be avoided. Providing some dry crackers for the client to eat, explaining that this is expected following surgery, and teaching how to breathe deeply until the nausea subsides. are unsafe; vomiting increases intraocular pressure, and aggressive intervention is required.

A client with a recent history of sinusitis develops meningitis and demonstrates a positive Brudzinski sign. What is the priority nursing care? monitoring intracranial pressure adding pads to side of bed administering prescribed antibiotics hydrating client with hypotonic saline

administering prescribed antibiotics The Brudzinski sign (when the neck is flexed while in the supine position, flexion of the hips occurs) indicates bacterial meningitis, a complication of sinusitis; the client's greatest need is a regimen of antibiotics to which the causative agent is sensitive. Bacterial meningitis causes increased intracranial pressure and it is important for the nurse to monitor for manifestations of increased intracranial pressure; however, in this circumstance, it is not the priority because monitoring alone does not affect outcomes . Because of the risk for seizures in bacterial meningitis, padded side rails are an important nursing intervention; however, this intervention does not have priority over instituting the appropriate antibiotic therapy to eradicate the cause of the meningitis. The data do not indicate a need for a hypotonic solution for hydrating the client.

A nurse is caring for an older adult who is taking acetaminophen for the relief of chronic pain. Which substance is most important for the nurse to determine if the client is taking because it intensifies the most serious adverse effect of acetaminophen? alcohol caffeine saw palmetto st. john's wort

alcohol Too much ingestion of alcohol can cause scarring and fibrosis of the liver. Eighty-five percent to 95% of acetaminophen is metabolized by the liver. Acetaminophen and alcohol are both hepatotoxic substances. Metabolites of acetaminophen, along with alcohol, can cause irreversible liver damage. Caffeine stimulates the cardiovascular system, not the liver. In addition, caffeine does not interact with acetaminophen. Saw palmetto is not associated with increased liver damage when taking acetaminophen. It often is taken for benign prostatic hypertrophy because of its antiinflammatory and antiproliferative properties in prostate tissue. St. John's wort is classified as an antidepressant and is not associated with increased liver damage when taking acetaminophen. However, it does decrease the effectiveness of acetaminophen

A client develops a fever after surgery. Ceftriaxone is prescribed. For which potential adverse effect should the nurse monitor the client?

allergic response Rash, urticaria, pruritus, angioedema, and other signs and symptoms of an allergic response may occur a few days after therapy is instituted. Ceftriaxone does not cause dehydration, does not affect the heart, and may cause diarrhea, not constipation.

A client with lymphosarcoma is receiving allopurinol and methotrexate. The nurse can help the client prevent complications related to uric acid nephropathy by administering which drug in relation to fluid intake? Allopurinol and restricting fluid intake ...

allopurinol and encouraging increased fluid intake Allopurinol decreases serum uric acid levels before and during chemotherapy; increased fluid intake aids in the increased excretion of uric acid. Allopurinol and increased fluids help prevent renal tubular impairment and kidney failure because of hyperuricemia. The client should be encouraged to follow a diet that promotes urine alkalinity. If the oral route is used, administering the methotrexate after providing an antacid will limit gastric irritation, not uric acid nephropathy. Fluid intake should be increased to 2 to 3 liters per day to prevent urate deposits and calculus formation.

A client with the diagnosis of primary hypertension is started on a regimen of hydrochlorothiazide. The nurse is providing instructions regarding this medication. What information should the nurse include?

an antihypertensive medication will likely be required for remainder of life If medication is necessary to control primary hypertension, usually it is a lifetime requirement. The client should not adjust the dosage without the healthcare provider's direction. Impotence may occur with some antihypertensive medications but not with hydrochlorothiazide. The drug should not be stopped; orthostatic hypotension can be controlled by a slow change of body position.

A primary health care provider prescribes 1000 mL total parenteral nutrition (TPN) to be infused over 12 hours via a central venous access device. What is most important for the nurse to obtain when preparing the equipment? an infusion pump a steady IV pole an infusion set delivering 60 gtts/mL a set of hemostats to be taped at the bedside

an infusion pump An infusion pump should be administered in a continuous and uniform infusion to prevent hyperosmolar diuresis. A steady IV pole is true for any intravenous infusion; this is not unique to total parenteral nutrition. Also, infusion pumps can be placed on the bedside table. The tubing set should be specific for the type of infusion pump. Hemostats (clamps) are not necessary when administering total parenteral nutrition; an infusion pump should be used.

A client develops a gallstone that becomes lodged in the common bile duct. An endoscopic sphincterotomy is scheduled. The client asks the nurse what will be done to prevent pain. What should the nurse reply? all you'll need is oral painkiller epidural anesthesia usually is given you will get a local injection at the site an intravenous sedative usually is administered

an intravenous sedative usually is administered An intravenous sedative usually is administered to produce effective sedation (conscious sedation) for the procedure. An oral analgesic is insufficient for this procedure. Epidural anesthesia is not necessary. A local anesthetic is insufficient for this procedure.

A client with rheumatoid arthritis has been given a prescription for acetylsalicylic acid. The client asks the nurse, "What kind of drug is acetylsalicylic acid?" The nurse recalls that this drug has which property? sedative hyponotic analgesic antibiotic

analgesic Acetylsalicylic acid (aspirin) acts as an analgesic by inhibiting production of inflammatory mediators. Acetylsalicylic acid does not act as a sedative to calm individuals. Acetylsalicylic acid does not act as a hypnotic to induce sleep. Acetylsalicylic acid does not destroy or control microorganisms.

A client diagnosed with gastroesophageal reflux disease (GERD) is being treated with antacid therapy. When teaching the client about the therapy, what does the nurse reinforce? antacids should be taken 1 hour before meals these should be schedule at 4-hour intervals antacid tablets are just as fast and effective as the liquid form antacids commonly interfere with the absorption of other drugs

antacids commonly interfere with the absorption of other drugs Antacids interfere with absorption of drugs such as anticholinergics, barbiturates, tetracycline, and digoxin. Liquid antacids are faster acting and more effective than antacid tablets. Antacids should be taken 1 or 2 hours after meals and at bedtime. Antacid tablets may be taken more frequently than every 4 hours.

Which assessment should the nurse obtain before administering digoxin to a client? apical heart rate radial pulse on left side radial pulse in both right and left arms difference between apical and radial pulses

apical heart rate Because digoxin slows the heart rate, the apical pulse should be counted for 1 minute before administration. If the apical rate is below a preset parameter (usually 60 beats/min), digoxin should be withheld because its administration may further decrease the heart rate. Some protocols permit waiting for one hour and retaking the apical rate; the result determines if it is administered or if the healthcare provider is notified. Obtaining the radial pulse on the left side is not as accurate as an apical pulse; the client also may have an atrial dysrhythmia, which cannot be detected through a radial rate alone. Obtaining the radial pulse in both right and left arms is not as accurate as an apical pulse; the client also may have an atrial dysrhythmia, which cannot be detected through a radial rate alone. Obtaining the difference between apical and radial pulses is a pulse deficit, not a pulse rate.

A client will be discharged with a peripherally inserted central venous catheter (PICC) for administration of peripheral parenteral nutrition (PPN). What would be appropriate for the nurse to include in the client's discharge teaching? learning how to change percutaneous catheter determine which days to self-administer PRN solution arranging for professional help to monitor alternative nutrition scheduling administration of PPN solution around mealtimes

arranging for professional help to monitor alternative nutrition Professional assistance will ensure correct administration, which may limit complications such as intravascular overload and sepsis; eventually, the client may self-administer the PPN with supervision. Learning how to change the percutaneous catheter usually is done by an appropriate health care provider. PPN usually is administered every day. The PPN solution usually is administered as an intermittent infusion while the client is sleeping at night, not at mealtimes; this allows for independent movement during the day.

Which medication should the nurse anticipate the healthcare provider will prescribe to relieve the pain experienced by a client with rheumatoid arthritis? aspirin hydromorphone meperidine alprazolam

aspirin Because of its antiinflammatory effect, acetylsalicylic acid is useful in treating arthritis symptoms. Opioids such as hydromorphone and meperidine should be avoided because they promote drug dependency and do not affect the inflammatory process. Alprazolam is an antianxiety, not an antiinflammatory, agent.

A client with rheumatoid arthritis takes aspirin routinely to reduce pain. The client asks whether it is the arthritis, the aspirin, or some other ear problem that causes the bilateral ear buzzing the client is now experiencing. What is an appropriate nursing response? the ringing in your ears is a sign of an ear infection aspirin may have caused some nerve damage in your ear accumulation of ear wax causes ringing in the ears your symptoms are an expected response to the aging process

aspirin may have caused some nerve damage in your ear Aspirin may damage the eighth cranial (acoustic) nerve, causing ringing in the ears and impaired hearing. Pain, not ringing in the ears, is a sign of otitis media. Diminished hearing, not ringing, occurs because of mechanical obstruction of the outer ear. Aging may cause decreasing acuity in the extremes of pitch, but it does not cause ringing in the ears.

A terminally ill client in a hospice unit for several weeks is receiving a morphine drip. The dose is now above the typical recommended dosage. The client's spouse tells the nurse that the client is again uncomfortable and needs the morphine increased. The prescription states to titrate the morphine to comfort level. What should the nurse do? add a placebo to the morphine to appease the spouse discuss with spouse the risk for morphine addiction assess client's pain before increasing dose of morphine check client's heart rate before increasing morphine to next level

assess client's pain before increasing dose of morphine Over time clients receiving morphine develop tolerance and require increasing doses to relieve pain, thus requiring continuing reassessments. Adding a placebo to the morphine to appease the spouse will not meet the client's need for relief from pain. The client is terminal, and the risk for addiction is of no concern. The respiratory, not heart, rate is the significant vital sign to be monitored; morphine depresses the central nervous system, specifically the respiratory center in the brain.

A client is receiving morphine sulfate for severe metastatic bone pain. What will the nurse do to assess for complications from a common serious side effect of morphine? monitor for diarrhea observe for an opioid addiction assess for altered breathing patterns check for a decreased urinary output

assess for altered breathing patterns Morphine sulfate is a central nervous system depressant that commonly decreases the respiratory rate, which can lead to respiratory arrest. Morphine, an opioid, will cause constipation, not diarrhea. Addiction is not a concern for a terminally ill client. Although morphine sulfate may cause urinary retention, it is not a common side effect and is not life threatening.

A client is admitted to the hospital and benazepril is prescribed for hypertension. Which is an appropriate nursing action for clients taking this medication? monitor electroencephalogram assess for dizziness administer drug after meals assess for dark, tarry stools

assess for dizziness Dizziness may occur during the first few weeks of therapy until the client adapts physiologically to the medication. An EEG is unnecessary. Cardiac monitoring may be instituted because of possible dysrhythmias. Administering the drug after meals is unnecessary; however, if nausea occurs, the medication may be taken with food or at bedtime. The blood pressure should be monitored before and after administration. Dark, tarry stools are not a side effect of benazepril.

The nurse is preparing to discharge a client who presented to the emergency room for an acute asthma attack. The nurse notes that upon discharge the healthcare provider has prescribed theophylline 300 mg orally to be taken daily at 9:00 AM. The nurse will teach the client to take the medication on which schedule? with a meal only at bedtime at a specific time prescribed until symptoms are gone

at a specific time prescribed For theophylline to be effective, therapeutic serum levels must be maintained by taking the medication at the prescribed time. If the medication is not taken at the prescribed time, the level may drop below the therapeutic range. The medication will not be effective if it drops below the therapeutic range. Theophylline should be given after a meal and with a full glass of water to decrease gastric irritability. It should not be taken at night, as it can cause central nervous system stimulation resulting in insomnia, restlessness, irritability, etc. Theophylline is used for long-term medication therapy.

A client who has been experiencing double vision, drooping of the eyelids, and fatigue visits the neurologic clinic. A diagnosis of myasthenia gravis is made, and the healthcare provider prescribes pyridostigmine. The nurse should teach the client that it is important to take this drug based on what schedule?

at exact time intervals prescribed Taking the medication as prescribed promotes an even therapeutic blood level, which maintains muscle strength. Because of drug-related nausea and gastric irritation, the drug should be taken with crackers or milk. Thirty, not 60, minutes before meals is recommended for maximum chewing and swallowing function. Taking the drug according to muscle strength is unsafe because it will not maintain constant therapeutic drug levels.

While a pacemaker catheter is being inserted, the client's heart rate drops to 38 beats/min. What medication should the nurse expect the healthcare provider to prescribe?

atropine sulfate Atropine blocks vagal stimulation of the sinoatrial (SA) node, resulting in an increased heart rate. Digoxin slows the heart rate; hence it would not be indicated in this situation. Lidocaine decreases myocardial sensitivity and will not increase the heart rate. Amiodarone is an antidysrhythmic drug used for ventricular tachycardia; it will not stimulate the heart rate.

A client is admitted to the hospital with a diagnosis of heart failure and acute pulmonary edema. The healthcare provider prescribes furosemide 40 mg intravenous (IV) stat to be repeated in 1 hour. What nursing action will best evaluate the effectiveness of the furosemide in managing the client's condition?

auscultate breath sounds Maintaining adequate gas exchange and minimizing hypoxia with pulmonary edema are critical; therefore, assessing the effectiveness of furosemide therapy as it relates to the respiratory system is most important. Furosemide inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule, causing diuresis; as diuresis occurs fluid moves out of the vascular compartment, thereby reducing pulmonary edema and the bilateral crackles. Although a liter of fluid weighs approximately 2.2 pounds (1 kilogram) and weight loss will reflect the amount of fluid lost, it will take time before a change in weight can be measured. Although identifying a greater output versus intake indicates the effectiveness of furosemide, it is the client's pulmonary status that is most important with acute pulmonary edema. Although the lessening of a client's dependent edema reflects effectiveness of furosemide therapy, it is the client's improving pulmonary status that is most important.

A primary healthcare provider prescribes atenolol 20 mg by mouth four times a day for a client who has had double coronary artery bypass surgery. What information is most important for the nurse to include in the discharge teaching plan for this client? drink alcoholic beverages in moderation avoid abruptly discontinuing medication increase medication if chest pain develops report pulse rate less than 70 bpm

avoid abruptly discontinuing medication An abrupt discontinuation of atenolol may cause an acute myocardial infarction. Alcohol is contraindicated for clients taking atenolol because it can cause additive hypotension. Clients should never increase medications without a healthcare provider's direction. The pulse rate can go much lower as long as the client feels well and is not dizzy.

A client is admitted to the hospital with pancytopenia as a result of chemotherapy. What should the nurse plan to teach this client in an effort to minimize the risk of complications as a result of pancytopenia? avoid traumatic injuries and exposure to infection perform frequent mouth care with firm toothbrush increase oral fluid intake to a minimum of 3 L daily report any unusual muscle cramps or tingling sensations in extremities

avoid traumatic injuries and exposure to infection Reduced platelets increase the likelihood of uncontrolled bleeding; reduced lymphocytes increase susceptibility to infection. Aggressive oral hygiene can precipitate bleeding from the gums. Although fluids may be increased to flush out the toxic by-products of chemotherapy, this has no effect on pancytopenia. Muscle cramps or tingling sensations in the extremities are adaptations to hypocalcemia; hypocalcemia is unrelated to pancytopenia.

A nurse is providing discharge instructions about digoxin. Which response should a nurse include as a reason for a client to withhold the digoxin? chest pain blurred vision persistent hiccups increased urinary output

blurred vision Visual disturbances, such as blurred or yellow vision, may be evidence of digoxin toxicity. Chest pain is not a toxic effect of digoxin. Persistent hiccups are not related to digoxin toxicity. An increased urinary output is not a sign of digoxin toxicity; it may be a sign of a therapeutic response to the drug and an improved cardiac output.

A client admitted for uncontrolled hypertension and chest pain was prescribed a low-sodium diet and started on furosemide. The nurse should instruct the client to include which foods in the diet? liver apples cabbage bananas

bananas Furosemide is a loop diuretic that eliminates potassium by preventing renal absorption. Bananas have a significant amount of potassium. Bananas: 450 mg; cabbage: 243 mg; liver: 73.6 mg; apples: 100-120 mg.

A health care provider prescribes vancomycin peak and trough levels for a client who is receiving vancomycin intravenous piggyback (IVPB). When should the nurse have the laboratory obtain a blood sample to determine a peak level of the antibiotic?

between 30-40 min after dose Because the drug was administered IV, the blood level of the drug will be at its highest shortly after administration. A drug blood level measured halfway between two doses will not obtain the peak level. Immediately before the medication is administered is done for a trough level, when the drug level is at its lowest. Anytime it is convenient for the client and the laboratory will produce inaccurate results; peak and trough levels are measured in relation to the time a drug is administered.

A client with myasthenia gravis has been receiving neostigmine and asks about its action. What information about its action should the nurse consider when formulating a response? stimulates cerebral cortex blocks action of cholinesterase replaces deficient neurotransmitters accelerates transmission along neural sheaths

blocks action of cholinesterase Neostigmine, an anticholinesterase, inhibits the breakdown of acetylcholine, thus prolonging neurotransmission. Neostigmine's action is at the myoneural junction, not the cerebral cortex. Neostigmine prevents neurotransmitter breakdown, but it is not a neurotransmitter. Neostigmine's action is at the myoneural junction, not the sheath.

What client response indicates to the nurse that a vasodilator medication is effective? absence of adventitious breath sounds increase in daily amount of urine produced pulse rate decreases from 110 to 75 beats/min blood pressure changes from 154/90 to 126/72 mm Hg

blood pressure changes from 154/90 to 126/72 mm Hg Vasodilation will lower the blood pressure. The pulse rate is not decreased and may increase. Breath sounds are not directly affected by vasodilation, although vasodilator medications can decrease preload and afterload, which could indirectly affect breath sounds in heart failure. The urine output is not affected immediately, although control of blood pressure can help preserve renal function over time.

A client receiving chemotherapy asks the nurse why an antibiotic was prescribed. Which tissue affected by chemotherapy should the nurse consider when formulating a response? liver blood bone marrow lymph nodes

bone marrow Prolonged chemotherapy may slow production of leukocytes in bone marrow, thus suppressing the immune system. Antibiotics may be required to help counter infections that the body can no longer handle easily. The liver does not produce leukocytes. Although leukocytes are in both blood and lymph nodes, these cells are more mature than those found in the bone marrow and thus are more resistant to the effects of chemotherapy.

Metoprolol is prescribed for a client with hypertension. For which side effect should the nurse monitor the client? hirsutism bradycardia restlessness hypertension

bradycardia Beta-blockers block stimulation of beta 1 (myocardial) adrenergic receptors, which decreases the heart rate and blood pressure. The client should be monitored for bradycardia, which can progress to heart failure or cardiac arrest. Excessive growth of hair or the presence of hair in unusual places does not occur with this medication; however, absence or loss of hair (alopecia) may occur. A side effect of this medication is fatigue, not restlessness. This medication may produce hypotension, not hypertension.

A client is experiencing both tingling of the extremities and tetany. What should the nurse anticipate will be prescribed by the healthcare provider? dialysis calcium supplement mechanical ventilation intravenous fluids with potassium

calcium supplement Paresthesias (tingling of the extremities) and tetany are signs of hypocalcemia, which is corrected by the administration of calcium. Dialysis is indicated for hyperkalemia and renal failure. Mechanical ventilation is indicated for respiratory insufficiency. Intravenous fluids with potassium are indicated for hypokalemia.

A client is diagnosed with trigeminal neuralgia. Which medication should the nurse anticipate will be prescribed for this client?

carbamazepine Carbamazepine is an anticonvulsant, antineuraligic drug used to control pain in trigeminal neuralgia and to prevent future attacks. It sometimes eliminates the need for surgery. Ascorbic acid (vitamin C) may be used as an adjunct to the specific treatment for trigeminal neuralgia. Vitamin C is prescribed when the body is subject to stress, as occurs with pain. Morphine sulfate is an opioid analgesic that will relieve severe pain but will not prevent its recurrence; prolonged frequent use is contraindicated because of possible addiction. Allopurinol is used in the treatment of gout.

A nurse administers a parenteral preparation of potassium slowly and cautiously to avoid which complication? acidosis cardiac arrest psychotic-like reactions edema of the extremities

cardiac arrest Too rapid administration can cause hyperkalemia, which contributes to a long refractory period in the cardiac cycle, resulting in cardiac dysrhythmias and arrest. Although acidosis can cause hyperkalemia, hyperkalemia will not lead to acidosis. Psychoticlike reactions do not occur with hyperkalemia. Hyperkalemia usually causes nausea, vomiting, and diarrhea, which may result in dehydration; in this instance, fluid will shift from interstitial spaces to the intravascular compartment. With edema, the fluid shift occurs in the opposite direction.

A client who is receiving a cardiac glycoside, a diuretic, and a vasodilator has been placed on bed rest. The client's apical pulse rate is 44 beats per minute. The nurse concludes that the decreased heart rate most likely is a result of which drug?

cardiac glycoside A cardiac glycoside such as digoxin decreases the conduction speed within the myocardium and slows the heart rate. The primary effect of a diuretic is on the kidneys, not the heart; it may reduce the blood pressure, not the heart rate. A vasodilator can cause tachycardia, not bradycardia, which is an adverse effect. A bed rest regimen does not drastically reduce the heart rate.

A client who has been diagnosed with acute lymphocytic leukemia will be receiving doxorubicin infusions as part of a chemotherapy regimen. The nurse monitors the client for signs and symptoms of doxorubicin toxicity. What clinical finding indicates that toxicity has occurred?

cardiac rhythm abnormalities Doxorubicin is cardiotoxic, which is manifested by transient ECG abnormalities. Alopecia is an expected side effect of doxorubicin, not a toxic effect. Dyspnea and a metallic taste to food are not effects of doxorubicin.

A client is to receive doxorubicin as part of a chemotherapy protocol. The nurse should assess for which major life-threatening adverse effect? <p>A client is to receive doxorubicin as part of a chemotherapy protocol. The nurse should assess for which major life-threatening adverse effect?</p>

cardiotoxicity Congestive heart failure and dysrhythmias are life-threatening toxic effects unique to doxorubicin. Infiltration can cause severe tissue damage; however, this is not typically life threatening. Pulmonary fibrosis is not a side effect of doxorubicin or of any of the other antineoplastic agents. Ulcerative stomatitis is a very uncomfortable side effect, but is not life threatening.

A client is receiving doxorubicin as part of a chemotherapy protocol. The nurse should assess the client for which major life-threatening side effect of doxorubicin? anemia cardiotoxicity pulmonary fibrosis ulcerative stomitis

cardiotoxicity Heart failure and dysrhythmias are the primary life-threatening toxic effects unique to doxorubicin. When bone marrow is depressed to precarious levels, the dose is altered or blood components administered. Pulmonary fibrosis is not an adverse effect of doxorubicin or of any of the other antineoplastic agents. Ulcerative stomatitis is an uncomfortable side effect of doxorubicin, but it is not life threatening as are the primary life-threatening toxic effects unique to doxorubicin.

Following surgery, total parenteral nutrition is instituted via a central venous infusion. During the fourth hour of the infusion the client complains of nausea, fatigue, and a headache. The hourly urine output is twice the amount of the previous hour. After contacting the primary health care provider, what is the next action the nurse should take? check serum glucose obtain oxygen saturation level administer prescribed analgesic prepare client for immediate surgery for possible bowel obstruction

check serum glucose Rapid administration can cause glucose overload, leading to osmotic diuresis and dehydration. There is no indication of hypoxia. Signs of bowel obstruction are not present. The client's headache should disappear with oral fluid replacement; analgesics are not indicated.

A client with myasthenia gravis, who is living in a nursing home, experiences inadequate symptomatic control with pyridostigmine bromide, and long-term steroid therapy has been initiated. What is especially important for the nurse to ensure? client increases sodium intake protective isolation is established total daily fluid intake is decreased client is monitored for an exacerbation of symptoms

client is monitored for an exacerbation of symptoms Exacerbation of myasthenia gravis may occur temporarily at the beginning of steroid therapy, causing respiratory embarrassment and dysphagia. Increasing sodium intake is contraindicated because steroids increase sodium retention. Although clients should avoid contact with persons who have upper respiratory infections, protective isolation (neutropenic precautions) is not required. Decreasing total daily fluid intake is unnecessary; adequate fluid intake should be maintained.

The health care provider prescribes an oral hypoglycemic for the client with type 2 diabetes. What will the nurse need to consider when developing the teaching plan? oral hypoglycemia work by decreasing absorption of carbohydrate oral hypoglycemia work by stimulating the pancreas to produce insulin clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control clients with type 2 diabetes do not need to be concerned about serious adverse effects from oral hypoglycemics

clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control Taking a tablet may give the client a false sense that the disease is under control, and this can lead to dietary indiscretions. Some oral hypoglycemics work by stimulating the pancreas to produce insulin, others work by decreasing carbohydrate absorption, and others work in a variety of other ways; therefore teaching should be specific to the drug prescribed. Oral hypoglycemic drugs can have serious adverse effects.

The nurse provides discharge teaching to a client with tuberculosis. Which treatment measure does the nurse reinforce as the highest priority?

consistently taking prescribed medication Tubercle bacilli are particularly resistant to treatment and can remain dormant for prolonged periods; medication must be taken consistently as prescribed. Although getting sufficient rest, getting plenty of fresh air, and changing the current lifestyle are important, the microorganisms must be eliminated with medication.

A client is diagnosed with pulmonary tuberculosis, and the healthcare provider prescribes a combination of rifampin and isoniazid. The nurse evaluates that the teaching regarding the drug is effective when the client reports which action as most important? report any changes in vision take medicine with my meals call my doctor if my urine or tears turn red=orange continue taking medicine even after I feel better

continue taking medicine even after I feel better The medication should be taken for the full course of therapy; most regimens last from 6 to 9 months, depending on the state of the disease. Visual changes are not side effects of this medication. The medication should be taken 1 hour before meals or 2 hours after meals for better absorption. Urine or tears turning red-orange is a side effect of rifampin; although this should be reported, it is not an adverse side effect.

A client is diagnosed with myasthenia gravis, and the anticholinesterase medication pyridostigmine is prescribed. When teaching the client about this medication, the nurse explains to expect an increase in what function? intestinal peristalsis salivary and gastric secretions contraction of skeletal muscles secretion and discharge of tears

contraction of skeletal muscles Anticholinesterase drugs inactivate cholinesterase, allowing sufficient acetylcholine to mediate stronger muscle responses. Increasing intestinal peristalsis is not a therapeutic response to pyridostigmine. Increasing salivary and gastric secretions are side effects of, not therapeutic responses to, pyridostigmine. Secretion and discharge of tears are side effects of, not therapeutic responses to, pyridostigmine.

What client response must the nurse monitor to determine the effectiveness of amiodarone?

decrease in cardiac dysrhythmias Amiodarone is a class III antidysrhythmic used for treating ventricular and supraventricular tachycardia and for conversion of atrial fibrillation. Results of fasting lipid profile are expected with antilipidemics. Degree of blood pressure control is expected with antihypertensives. Incidence of ischemic chest pain is expected with antianginal agents, such as nitrates.

A nurse gave a client the prescribed sodium polystyrene sulfonate. What assessment finding indicates that the drug has been effective? presence of diarrhea narrowing of QRS complex An increase in serum calcium level decrease in serum potassium level

decrease in serum potassium level Sodium polystyrene sulfonate is given to treat hyperkalemia. Therefore the effectiveness of the medication is determined by a decreasing serum potassium level. Sodium polystyrene sulfonate binds with the potassium in the gastrointestinal system and often causes diarrhea. Sodium polystyrene sulfonate has no effect on serum calcium levels. A wide QRS complex is a late finding in hyperkalemia. Sodium polystyrene sulfonate takes time to work and therefore would not be the drug of choice for hyperkalemia evidenced by a widening QRS complex.

The nurse is caring for a client who is scheduled for an electrophysiology study (EPS) because of persistent ventricular tachycardia. Before the procedure the client is to receive a beta-blocker. What client's response during the procedure best indicates that the beta-blocker is working effectively?

decreased HR A decreased heart rate or sinus bradycardia is the expected response to a beta-blocker. Beta-blockers inhibit the activity of the sympathetic nervous system and of adrenergic hormones, decreasing the heart rate, conduction velocity, and workload of the heart. A beta-blocker is not an anxiolytic and does not reduce anxiety. A beta-blocker is not an analgesic and does not reduce chest pain. Beta-blockers reduce blood pressure.

A client who had a myocardial infarction receives a prescription for a nitroglycerin patch. What does the nurse identify as the purpose of the nitroglycerin patch? decreased heart rate lowers cardiac output increased cardiac output increases oxygen demand decreased cardiac preload reduces cardiac workload peripheral venous and arterial constriction increases peripheral resistance

decreased cardiac preload reduces cardiac workload Nitroglycerin reduces cardiac workload by decreasing the preload of the heart by its vasodilating effect. It decreases blood pressure, not heart rate (which may increase to compensate for the decreased blood pressure). It decreases, not increases, oxygen demand. Nitroglycerin dilates, not constricts, peripheral veins and arteries.

What therapeutic effect does the nurse expect to identify when mannitol is administered parenterally to a client with cerebral edema? improved renal blood flow decreased intracranial pressure maintenance of circulatory volume prevention of development of thrombi

decreased intracranial pressure As an osmotic diuretic, mannitol helps reduce cerebral edema. Although there may be a transient increase in blood volume as a result of an increased osmotic pressure, which increases renal perfusion, this is not the therapeutic effect. Prevention of the development of thrombi is not the reason for giving this drug.

A healthcare provider prescribes morphine for a client being treated for myocardial infarction. What physiologic response will occur if the client experiences the intended therapeutic effect of morphine?

decreased workload of heart Morphine reduces pain and anxiety. This limits the response of the sympathetic nervous system, ultimately decreasing cardiac preload and the workload of the heart. Reduced respiratory rate is a side effect of morphine; it is not the intended therapeutic effect for a client being treated for myocardial infarction. Decreasing the size of the clot blocking the coronary artery is the action of antithrombolytic therapy. Decreasing metabolites within the ischemic heart muscle is not the action of morphine.

While awaiting surgery, a client with a long history of Crohn disease is receiving total parenteral nutrition (TPN) on an outpatient basis. The nurse teaches the client that TPN helps to prepare for surgery by which process? decreasing fecal bulk preventing bowel infection providing stimulation of secretions maintaining negative nitrogen balance

decreasing fecal bulk By decreasing fecal bulk and bowel stimulation, TPN provides rest for the bowel while the client awaits surgery. TPN does not prevent a bowel infection. TPN does not stimulate gastrointestinal secretions. TPN promotes positive nitrogen balance.

A nurse concludes that clients who receive intravenous (IV) fluids rather than total parenteral nutrition for gastrointestinal problems lose weight for what reason? lack of bulk in diet deficient carbohydrate intake insufficient intake of water-soluble vitamins increasing concentration of electrolytes in cells

deficient carbohydrate intake Intravenous fluids supply minimal calories; a client receiving only intravenous fluids will lose weight and become malnourished. Lack of bulk in the diet is not related to weight; lack of bulk in the diet results in constipation. Vitamins are not related to weight loss. Intracellular electrolytes are not related to weight loss.

A client with postradiation enteritis is to continue receiving total parenteral nutrition (TPN) at home after discharge. What information should the nurse include in the client's teaching plan?

demonstrating how to test capillary glucose levels Blood glucose should be monitored because total parenteral nutrition may cause hyperglycemia. Nutritional solutions for TPN are prepared by a pharmacist who adds electrolytes, vitamins, and trace elements to base solutions. Identifying the types of infusion pumps that can be used may be confusing. The client and family should be taught how to use one pump that they will use in the home. Checking for catheter placement by palpating the insertion site is not the correct method for assessing catheter placement. Solutions are administered through a central venous catheter via a subclavian or jugular vein, or through a peripherally inserted central catheter (PICC).

An older adult client who has type 1 diabetes and chronic bronchitis is prescribed atenolol for the management of angina pectoris. Which clinical manifestation should alert the nurse to the fact that the client may be developing a life-threatening response to the drug? difficulty breathing increased pulse rate orthostatic hypotension increased blood glucose

difficulty breathing Atenolol is associated with the adverse reactions of bradycardia, heart failure, and pulmonary edema; these are the most serious responses to atenolol. A decreased, not increased, pulse rate is associated with atenolol. It does not usually affect beta 2 (vascular) receptor sites, which will cause an increase in pulse rate. Orthostatic hypotension may be experienced; however, it can be minimized by teaching the client to move from lying to sitting and from sitting to standing positions slowly to allow the body time for the blood pressure to adjust to the change in position. Atenolol will not cause an increase in blood glucose. It may increase the hypoglycemic response to insulin, causing hypoglycemia. In addition, the drug may mask the clinical manifestations of hypoglycemia.

A client who is receiving multiple medications for a myocardial infarction complains of severe nausea, and the client's heartbeat is irregular and slow. The nurse determines that these signs and symptoms are toxic effects of what drug? digoxin captopril furosemide morphine sulfate

digoxin Signs of digoxin toxicity include cardiac dysrhythmias, anorexia, nausea, vomiting, and visual disturbances. Although nausea and heart block may occur with captopril, these symptoms rarely are seen; drowsiness and central nervous system disturbances are more common. Toxic effects of morphine are slow, deep respirations, stupor, and constricted pupils; nausea is a side effect, not a toxic effect. Toxic effects of furosemide are renal failure, blood dyscrasias, and loss of hearing.

A client has been given a prescription for furosemide 40 mg every day in conjunction with digoxin. What would prompt the nurse to ask the provider about potassium supplements? digoxin causes significant potassium depletion liver destroys potassium as digoxin is detoxified lasix requires adequate serum potasium to promtoe diuresis digoxin toxicity occurs rapidly in presence of hypokalemia

digoxin toxicity occurs rapidly in presence of hypokalemia Furosemide promotes potassium excretion, and low potassium (hypokalemia) increases cardiac excitability. Digoxin is more likely to cause dysrhythmias when potassium is low. Digoxin does not affect potassium excretion. Furosemide causes potassium excretion. Potassium is excreted by the kidneys, not destroyed by the liver. Furosemide causes diuresis and consequent potassium loss regardless of the serum potassium level.

A client with hypertension has received a prescription for metoprolol. Which information should the nurse include when teaching this client about metoprolol?

do not abruptly discontinue medication Abrupt discontinuation of metoprolol may cause rebound hypertension and an acute myocardial infarction. Alcohol is contraindicated for clients taking beta-adrenergic blockers such as metoprolol. Clients should never increase medications without medical direction. The pulse rate can go lower than 70 beats per minute as long as the client feels well and is not dizzy.

A nurse inspects a two-day-old intravenous (IV) site and identifies erythema, warmth, and mild edema. The client reports tenderness when the area is palpated. What should the nurse do first? irrigate IV tubing discontinue infusion slow rate of infusion obtain a prescription for an analgesic

discontinue infusion The clinical findings indicate the presence of inflammation. The IV catheter should be removed to prevent the development of thrombophlebitis. Irrigating the IV tubing and slowing the rate of the infusion do not address the underlying problem and may further irritate the vein and precipitate a thrombophlebitis. Although an analgesic may relieve the discomfort, it is not an intervention that will resolve the problem.

A nurse is caring for a client who is receiving an intravenous (IV) infusion. What should the nurse do first if the IV infusion infiltrates? elevate IV site discontinue infusion attempt to flush tubing apply a warm, moist compress

discontinue infusion When an IV infusion infiltrates, it should be removed to prevent edema and pain. Elevation does not change the position of the IV cannula; the infusion must be discontinued. Flushing the tubing will add to the infiltration of fluid. Soaks may be applied, if prescribed, after the IV cannula is removed.

A client with arthritis is taking large doses of aspirin. What symptom does the nurse include when teaching the client about the clinical manifestations of aspirin toxicity? feelings of drowsiness disturbances in hearing intermittent constipation metallic taste in mouth

disturbances in hearing Ringing in the ears occurs because of its effect on the eighth cranial nerve and is a classic symptom of aspirin toxicity. Feelings of drowsiness are not side effects of aspirin; aspirin promotes comfort, which may permit rest. Aspirin may cause diarrhea, nausea, and vomiting, not intermittent constipation. A metallic taste in the mouth is not a side effect of salicylates such as aspirin.

A nurse identifies signs of electrolyte depletion in a client with heart failure who is receiving bumetanide and digoxin. What does the nurse determine is the cause of the depletion? diuretic therapy sodium restriction continuous dyspnea inadequate oral intake

diuretic therapy Diuretic therapy that affects the loop of Henle generally involves the use of drugs (e.g., bumetanide) that directly or indirectly increase urinary sodium, chloride, and potassium excretion. Sodium restriction does not necessarily accompany administration of bumetanide. Dyspnea does not directly result in a depletion of electrolytes. Unless otherwise prescribed, oral intake is unaffected.

A client is receiving metoprolol. Which side effect should the nurse teach the client to expect?

dizziness with strenuous activity Because metoprolol competes with catecholamines at beta-adrenergic receptor sites, the expected increase in the heart's rate and contractility in response to exercise does not occur. This, combined with the drug's hypotensive effect, may lead to dizziness. Metoprolol decreases the heart rate. Flushing sensations and pounding of the heart do not represent side effects of metoprolol.

A client with type 2 diabetes is taking one glyburide tablet daily. The client asks whether an extra pill should be taken before exercise. What is the nurse's best reply? you will need to decrease how much you are exercising an extra pill will help your body use glucose when exercising the amount of medication you need to take is not related to exercising do not take an extra pill because you may become hypoglycemic when exercising

do not take an extra pill because you may become hypoglycemic when exercising Exercise improves glucose metabolism. Exercise is associated with a risk for hypoglycemia, not hyperglycemia; an additional antidiabetic agent is contraindicated. Exercise should not be decreased because it improves glucose metabolism. Also, this response does not answer the client's question. An extra tablet probably will result in hypoglycemia because exercise alone improves glucose metabolism. Control of glucose metabolism is achieved through balanced diet, exercise, and pharmacologic therapy.

A healthcare provider prescribes mannitol for a client with a head injury. The nurse concludes that the purpose of the medication is to relieve cerebral edema by which mechanism?

drawing fluid from brain cells into bloodstream Mannitol, an osmotic diuretic, pulls fluid from the white cells of the brain to relieve cerebral edema. Mannitol's diuretic action does not decrease the production of cerebrospinal fluid. Mannitol does not affect brain metabolism; rest and lowered body temperature reduce brain metabolism. Preventing uncontrolled electrical discharges in the brain is the action of phenytoin sodium, not mannitol.

A client is scheduled to receive intravenous (IV) fluids to be delivered at 80 mL/hr. To adjust the drip rate when administering the IV via gravity, what must the nurse determine? total volume of fluid in IV bag size of needle or catheter in vein drops per milliliter delivered by infusion set diameter of tubing being used to instill fluid

drops per milliliter delivered by infusion set Different infusion sets deliver different preset numbers of drops per milliliter. Knowing this is a necessity for calculating the drip rate. Total volume of fluid in the IV bag and size of the needle or catheter in the vein do not determine the drip rate. Diameter of the tubing being used to instill the fluid determines the size of the drop, not the drip rate.

A client with irritable bowel syndrome has instructions to take psyllium 2 rounded teaspoons full twice a day for constipation. What is most important for the nurse to include in the teaching plan? urine may be discolored stop taking the laxative once a bowel movements occurs each dose should be taken with a full glass of water or juice daily use may inhibit absorption of some fat-soluble vitamins

each dose should be taken with a full glass of water or juice This bulk-forming laxative works by absorbing water into the intestine, which increases bulk and distends the bowel to initiate reflex bowel activity, thus promoting a bowel movement. A full glass of fluid taken at the same time will help minimize the risk of esophageal obstruction or fecal impaction. Senna, a stimulant laxative, may cause urine discoloration. Bulk-forming laxatives, such as psyllium, are the only laxatives that are recommended for long-term use, and in cases of irritable bowel syndrome; they are used to prevent constipation and therefore should not be stopped once a bowel movement occurs. Prolonged use of lubricant laxatives, such as mineral oil, can inhibit the absorption of some fat-soluble vitamins.

A client is undergoing diagnostic testing to determine if the client has myasthenia gravis. The nurse understands that the test that is most specific for determining the presence of this disease is what? electromyography pyridostigmine test history of physical deterioration edrophonium chloride test

edrophonium chloride test Edrophonium chloride test uses a drug that is a cholinergic and an anticholinesterase; it blocks the action of cholinesterase at the myoneural junction and inhibits the destruction of acetylcholine. Its action of increasing muscle strength is immediate for a short time. The results of an electromyography will be added to the database, but they are nonspecific. Pyridostigmine is a slower-acting anticholinesterase drug that is prescribed commonly to treat myasthenia gravis; edrophonium chloride is used instead of pyridostigmine to diagnose myasthenia gravis because, when injected intravenously, it immediately increases muscle strength for a short time. The results of a history and physical are added to the database, but the data collected are not as definitive as another specific test for the diagnosis of myasthenia gravis.

A nurse is caring for a client who is receiving serum albumin. What indicates that the albumin is effective? improved clotting of blood formation of red blood cells activation of white blood cells (WBCs) effective cardiac output

effective cardiac output Serum albumin, a protein, establishes the plasma colloid osmotic (oncotic) pressure because of its high molecular weight and size. Indicators of adequate osmotic pressure include an effective cardiac output. Blood clotting involves blood protein fractions other than albumin; for example, prothrombin and fibrinogen are within the alpha- and beta-globulin fractions. Red blood cell formation (erythropoiesis) occurs in red marrow and can be related to albumin only indirectly; albumin is the blood transport protein for thyroxine, which stimulates metabolism in all cells, including those in red bone marrow. Albumin does not activate WBCs; WBCs are activated by antigens and substances released from damaged or diseased cells.

A nurse is caring for a postoperative client who has a nasogastric (NG) tube set to low intermittent suction. The nurse recalls that the primary reason that an intravenous infusion of 5% dextrose with 0.45% sodium chloride and 20 mEq of potassium has been prescribed is to prevent which complication? constipation dehydration electrolyte imbalance nausea and vomiting

electrolyte imbalance When clients do not receive nutrients or fluids by mouth and have loss of electrolytes through the removal of gastric secretions via an NG tube, then electrolyte imbalance is a primary concern. Constipation is usually not a concern in this type of situation. Although dehydration is a possible effect of an NG tube removing gastric secretions and fluid, electrolyte balance is still the priority. An NG tube set to low intermittent suction usually relieves nausea and vomiting.

A client is admitted for dehydration, and an intravenous (IV) infusion of normal saline is started at 125 mL/hour. One hour later, the client begins screaming, "I can't breathe!" How should the nurse respond? discontinue IV and notify healthcare provider elevate head of client's bed and obtain vital signs assess client for allergies and change IV to an intermittent lock contact healthcare provider to request a prescription for a sedative

elevate head of client's bed and obtain vital signs Verbalization indicates that the client is breathing; elevating the head of the bed facilitates breathing by decreasing pressure against the diaphragm. Vital signs reflect the current status of the client. Auscultation of breath sounds should be done also. Discontinuing the IV access line is unsafe and may cause unnecessary discomfort if it must be restarted; more information is needed before calling the healthcare provider. No information is available to support changing the IV to an intermittent lock; assessment for allergies should be done on admission. Not enough information is available to support requesting a prescription for a sedative; further assessment is required.

A nurse is administering erythropoietin three times a week to a client receiving chemotherapy for cancer. Which client response is considered most significant?

elevated hematocrit level Erythropoietin stimulates red blood cell production, thereby increasing the hematocrit and hemoglobin level. An elevated liver panel is not related to erythropoietin because erythropoietin is not hepatotoxic. Erythropoietin increases red blood cells (RBCs), not WBCs. Increased Kaposi sarcoma lesions are a sign of acquired immunodeficiency syndrome (AIDS) progression and are not affected by erythropoietin.

What effect of povidone-iodine does a nurse consider when using it on the client's skin before obtaining a specimen for a blood culture? avoids drying the skin makes skin more supple eliminate surface bacteria that may contaminate culture provides cooling agent to diminish feeling from puncture wound

eliminate surface bacteria that may contaminate culture Povidone-iodine exerts bactericidal action that helps eliminate surface bacteria that will contaminate culture results. Povidone-iodine does not make the skin more supple. It does dry the skin. Although povidone-iodine may provide a cool feeling, this is not a reason for its use.

A client is to receive metoclopramide intravenously 30 minutes before initiating chemotherapy for cancer of the colon. The nurse explains that metoclopramide is given for what purpose?

enhance relaxation of upper GI tract The relaxation effect increases the passage of food through the gastrointestinal tract, limiting reverse peristalsis, gastroesophageal reflux, and vomiting, all of which are precipitated by chemotherapeutic agents. Metoclopramide does not stimulate the production of gastrointestinal secretions. Metoclopramide has no effect on the excretion of chemotherapeutic medications. Metoclopramide has no effect on the absorption of chemotherapeutic medications.

A client is admitted and diagnosed with myasthenia gravis. Pyridostigmine bromide therapy via tablets has been prescribed. The nurse anticipates that the dosage will be changed frequently during the first week of therapy. While the dosage is being adjusted, what action does the nurse perform? administer medication after meals administer medication on an empty stomach evaluate client's psychological responses between medication doses evaluate client's muscle strength every hour after medication is given

evaluate client's muscle strength every hour after medication is given The onset of action of pyridostigmine is 30 to 45 minutes after administration, and the effects last up to 6 hours; the client's response will influence dosage levels. Pyridostigmine usually is administered before meals to promote mastication. Pyridostigmine should be administered with food to prevent gastric irritation. There are no psychological side effects associated with pyridostigmine.

Before a client with syphilis can be treated, what should be determined? portal of entry size of chancre existence of allergies names of sexual contacts

existence of allergies Although the treatment of choice is penicillin, clients who are allergic must be given other antimicrobial agents to avoid an anaphylactic reaction. The portal of entry does not influence treatment. The chancre is present only in the primary stage; it does not alter treatment. Although sexual contacts should be identified and notified, treatment should not be delayed.

A client with Hodgkin disease is placed on an ABVD combination chemotherapy regimen. Because doxorubicin is part of this therapy, what education will the nurse provide about this drug? cease taking any medication that contains vitamin D keep doxorubicin in a dark place protected from light expect urine to turn red for a few days after taking this drug take doxorubicin on an empty stomach with large amounts of fluids

expect urine to turn red for a few days after taking this drug Doxorubicin causes the urine to turn red for a few days; the client should be informed of this expectation so as not to become alarmed when it occurs. Discontinuing the intake of vitamin D is true for plicamycin, not the drugs in this protocol. It is unnecessary to keep doxorubicin in a dark area, protected from light. Doxorubicin is not given orally, only via the intravenous route.

A client who is taking rifampin tells the nurse, "My urine looks orange." What action will the nurse take? explain this is expected check liver enzymes strain urine for stones ask what foods were eaten

explain this is expected Rifampin causes a reddish-orange discoloration of secretions such as urine, sweat, and tears. Although liver enzymes should be monitored because of the risk of hepatitis, this action is not addressing the client's statement. Straining the urine for stones is indicated for renal calculi, which are not related to rifampin. The medication, not food, is responsible for the urine color.

A nurse prepares to administer extended-release metformin to an older adult who has asked that it be crushed because it is difficult to swallow. What will prompt the nurse to ask the provider for a different form of metformin? drug has wax matrix frame that is difficult to crush drug has an unpleasant taste, which most clients find intolerable if crushed if crushed, this drug irritates mucosal tissue and can cause oral and esophageal ulcer formation extend-release formulations are designed to be released slowly, and crushing the tablet will prevent this from occurring

extend-release formulations are designed to be released slowly, and crushing the tablet will prevent this from occurring The slow-release formulary will be compromised and the client will not receive the entire dose if it is chewed or crushed. The capsules are not difficult to crush. Irritation of the mucosal tissue is not the reason the medication should not be crushed; however, this drug should be given with meals to prevent gastrointestinal irritation. Although taste could be a factor, it is not the priority issue.

A nurse plans an evening snack of milk, crackers, and cheese for a client who is receiving NPH insulin. What is the purpose of this snack?

food to counteract late insulin activity The protein in milk and cheese is converted slowly to glucose (gluconeogenesis), providing the body with some glucose during sleep while the insulin still is acting. The purpose of an evening snack is to cover for insulin activity during sleep, not to encourage the client to stay on the diet. There are no data that indicate a need to gain weight. The foods chosen are rich in protein and are used slowly.

A nurse teaches a client who is scheduled for a kidney transplant about the need for immunosuppressive medications. The nurse determines that the client understands the teaching when the client states that medications must be taken for what period of time? for the rest of my life until surgery is over until surgery heals during intraoperative period

for the rest of my life These drugs must be taken continuously to prevent rejection of the transplanted organ. The danger of rejection always exists. The client must take the medications longer than after the surgery or until the anastomosis heals or during the intraoperative period.

A client is receiving total parenteral nutrition. Which nursing assessment finding would indicate that the client has hyperglycemia?

fruity odor to the breath Hyperglycemia is indicated by a fruity odor to the breath. Paralytic ileus is not associated with hyperglycemia. With hyperglycemia there is hyperventilation (respiration rate greater than 20). Serum glucose of 105 mg/dL is within the expected range.

A client is admitted to the intensive care unit with acute pulmonary edema. Which diuretic does the nurse anticipate will be prescribed? furosemide chlorothiazide spironolactone acetazolamide

furosemide Furosemide acts on the loop of Henle by increasing the excretion of chloride and sodium, is available for intravenous administration, and is more effective than chlorothiazide, spironolactone, and acetazolamide. Although used in the treatment of edema and hypertension, chlorothiazide is not as efficacious as furosemide. Spironolactone is a potassium-sparing diuretic; it is less efficacious than thiazide diuretics. Acetazolamide is used in the treatment of glaucoma to lower intraocular pressure.

A client who was admitted with a diagnosis of acute lymphoblastic leukemia is receiving chemotherapy. Which assessment findings would alert the nurse to the possible development of thrombocytopenia? Select all that apply.

headache hematuria ecchymosis Thrombocytopenia is a condition characterized by abnormally low levels of thrombocytes, also known as platelets, in the blood. This reduction in platelet activity impairs blood clotting, so any assessment finding associated with potentially abnormal bleeding would alert the nurse to the possibility of thrombocytopenia. This includes headache (bleeding into brain tissue), hematuria (bleeding within the renal system) and ecchymosis (bleeding into skeletal soft tissue). Fever and diarrhea are common side effects of chemotherapy, but are not findings specifically attributed to thrombocytopenia.

A client with a history of coronary artery disease is admitted with pneumonia. The healthcare provider prescribes atenolol. What should the nurse monitor to determine the therapeutic effect of atenolol? heart rate respirations temperature pulse oximetry

heart rate Atenolol, a beta-blocker, slows the rate of sinoatrial (SA) node discharge and AV node conduction, thus decreasing the heart rate; it prevents angina by decreasing the cardiac workload and myocardial oxygen consumption. Atenolol may promote bronchospasm and wheezing; however, the question specified therapeutic effects, not adverse effects. Atenolol is not an antipyretic. Atenolol does not directly affect gas exchange in the lungs.

After cataract surgery the nurse teaches a client how to self-administer eyedrops. The nurse reinforces the use of what technique? placing drops on the cornea of eye raising upper eyelid with gentle traction holding dropper tip above the conjuctival sac squeezing eye shut after instilling medication

holding dropper tip above the conjuctival sac Drops are placed within the lower lid (conjunctival sac). To protect against physical injury and infection, the dropper tip should not touch the eye. The lower lid is retracted for placement of eyedrops. Squeezing the eyes shut after administration of the medication should be avoided; this will squeeze medication out of the eye.

A nurse is caring for a client who is scheduled for a bilateral adrenalectomy. Which medication should the nurse expect to be prescribed for this client on the day of surgery and in the immediate postoperative period? methimazole regular insulin pituitary extract hydrocortisone succinate

hydrocortisone succinate Hydrocortisone succinate is a glucocorticoid. A client undergoing bilateral adrenalectomy must be given adrenocortical hormones so that adjustment to the sudden lack of these hormones that occurs with this surgery can take place Methimazole is used to treat a client with hyperthyroidism, not a client with a bilateral adrenalectomy. Because the surgery involves the adrenal glands, not the pituitary gland, secretion of pituitary hormones will not be affected. Regular insulin is not necessary. Insulin is produced by the pancreas, and its function is not altered by this surgery.

A client newly diagnosed with diabetes arrives at the emergency department complaining of dizziness and weakness. The client's spouse reports that the client has been confused since this morning. The spouse reports that the client administered the morning dose of 10 units of regular insulin and 25 units of NPH insulin with difficulty and did not eat much breakfast. What does the nurse identify as the most likely cause of the client's signs and symptoms? hyperglycemia hyperlipidemia hypoglycemia hypocalcemia

hypoglycemia Severe hypoglycemia is a finding in diabetic clients who take insulin and miss a meal. Signs and symptoms of hypoglycemia are dizziness, weakness, confusion, and disorientation. Hyperglycemia is rare in clients who are on insulin therapy and decrease their intake. Hyperlipidemia is excessive blood fat levels. Hypocalcemia is low calcium.

At 4:30 pm, a client who is receiving NPH insulin every morning states, "I feel very nervous." The nurse observes that the client's skin is moist and cool. What is the nurse's most accurate interpretation of what the client is likely experiencing?

hypoglycemia The time of the client's response corresponds to the expected peak action (4 to 12 hours after administration) of the intermediate-acting insulin that was administered in the morning; this can result in hypoglycemia. Hypoglycemia triggers the sympathetic nervous system; epinephrine causes diaphoresis and nervousness. Osmotic diuresis causes thirst; this is related to hyperglycemia, not to hypoglycemia. Warm, dry, flushed skin and lethargy are associated with ketoacidosis. Glycogenesis, the formation of glycogen in the liver, is unrelated to nervousness and cool, moist skin.

A client is receiving furosemide to relieve edema. The nurse should monitor the client for which response to the medication? hypernatremia low blood urea nitrogen hypokalemia increase in urine specific gravity

hypokalemia Furosemide is a potent diuretic used to provide rapid diuresis; it acts in the loop of Henle and causes depletion of electrolytes, such as potassium and sodium. Furosemide inhibits the reabsorption, not retention, of sodium. Furosemide does not affect protein metabolism. With edema, the specific gravity of the fluid more likely will be low.

A client with diabetic ketoacidosis who is receiving intravenous fluids and insulin complains of tingling and numbness of the fingers and toes and shortness of breath. The cardiac monitor shows the appearance of a U wave. What complication does the nurse suspect? hypokalemia hypoglycemia hypernatremia hypercalcemia

hypokalemia These are classic signs of hypokalemia that occur when potassium levels are reduced as potassium reenters cells with glucose. Symptoms of hypoglycemia are weakness, nervousness, tachycardia, diaphoresis, irritability, and pallor. Symptoms of hypernatremia are thirst, orthostatic hypotension, dry mouth and mucous membranes, concentrated urine, tachycardia, irregular heartbeat, irritability, fatigue, lethargy, labored breathing, and muscle twitching or seizures. Symptoms of hypercalcemia are lethargy, nausea, vomiting, paresthesias, and personality changes.

A client is admitted to the hospital for an adrenalectomy. The nurse is providing postoperative care before the client's replacement steroid therapy is regulated fully. The nurse should monitor the client for which complication? hypotension hypokalemia hypernatremia hyperglycemia

hypotension Because of instability of the vascular system and the lability of circulating adrenal hormones after an adrenalectomy, hypotension frequently occurs until the hormonal level is controlled by replacement therapy. Hyperglycemia is a sign of excessive adrenal hormones; after an adrenalectomy, adrenal hormones are not secreted. Sodium retention is a sign of hyperadrenalism; it does not occur after the adrenals are removed. Potassium excretion is a response to excessive adrenal hormones; after an adrenalectomy, adrenal hormones are decreased until replacement therapy is regulated.

A client with diabetes who is receiving long-term corticosteroid therapy is admitted to the hospital with leg ulcers. What increased risk does the nurse consider when assessing this client? weight loss hypoglycemia decreased blood pressure inadequate wound healing

inadequate wound healing Because the antiinflammatory response is depressed as a result of increased cortisol levels, the wounds of clients receiving long-term corticosteroid therapy tend to heal slowly. A common finding associated with long-term corticosteroid use is weight gain, caused not only by fluid retention but also by alterations in fat, carbohydrate, and protein metabolism. Persistent hyperglycemia (steroid diabetes) occurs because of altered glucose metabolism. Hypertension, not hypotension, occurs as a result of sodium and fluid retention.

A client will be taking nitrofurantoin 50 mg orally every evening at home to manage recurrent urinary tract infections. What instructions should the nurse give to the client? increase intake of fluids strain urine for crystals and stones stop drug if urinary output increase maintain exact time schedule for taking drug

increase intake of fluids To prevent crystal formation, the client should have sufficient intake to produce 1000 to 1500 mL of urine daily while taking this drug. Straining urine is not indicated when the client is taking a urinary antiinfective. Urinary decrease is of concern because it may indicate renal failure. If fluids are encouraged, the client's output should increase. The drug need not be taken at a strict time daily.

After being hospitalized for a transient ischemic attack (TIA) related to hypertension, a client is discharged with a prescription of hydrochlorothiazide. What should the nurse instruct the client to do when taking this medication? increase intake of potassium-rich foods drink a protein supplement daily avoid eating foods high in insoluble fiber resume regular eating habits

increase intake of potassium-rich foods The client must increase the dietary intake of potassium because of potassium loss associated with hydrochlorothiazide. Protein supplements are not necessary and may be obtained from meat, fish, and dairy products in the diet or complementary vegetable and grain proteins. Foods high in insoluble fiber are part of the food pyramid and should be included in the diet. The client should be taught about medication-induced deficiencies, which may necessitate a change in diet, and not just return to regular eating habits once home.

A client with hyperthyroidism is to receive methimazole. What instructions does the nurse provide? initial improvement will take several weeks There are few side effects associated with this drug This medication may be taken at any time during the day Large doses are used to quickly correct the functions of thyroid

initial improvement will take several weeks Methimazole blocks thyroid hormone synthesis; it takes several weeks of medication therapy before the hormones stored in the thyroid gland are released and the excessive level of thyroid hormone in the circulation is metabolized. There are many common side effects that include nausea, vomiting, diarrhea, rash, urticaria, pruritus, alopecia, hyperpigmentation, drowsiness, headache, vertigo, and fever. Methimazole should be spaced at regular intervals because blood levels are reduced in approximately 8 hours. Large doses cause toxic side effects that can be life threatening, including nephritis, hepatitis, agranulocytosis, leukopenia, thrombocytopenia, hypothrombinemia, and lymphadenopathy.

A client has had a total gastrectomy. What should the nurse include in the discharge teaching? daily use of stool softener injections of vitamin B12 for life monthly injections of iron dextran replacement of pancreatic enzymes

injections of vitamin B12 for life Intrinsic factor is lost with removal of the stomach, and vitamin B 12 is needed to maintain the hemoglobin level and prevent pernicious anemia. Adequate diet, fluid intake, and exercise should prevent constipation. Iron-deficiency anemia is not expected. Secretion of pancreatic enzymes should not be affected because this surgery does not alter this function.

During a teaching session about insulin injections, a client asks the nurse, "Why can't I take the insulin in pills instead of taking shots?" What is the nurse's best response? insulin cannot be manufactured in pill form insulin is destroyed by gastric juices, rendering it ineffective your health care provider decides the route of administration your health care provider will prescribe pills when you are ready

insulin is destroyed by gastric juices, rendering it ineffective Insulin in tablet form is inactivated by gastric juices; insulin given by injection avoids exposure to digestive enzymes. Insulin is not given orally at this time because it is inactivated by digestive enzymes. The response "Your health care provider will prescribe pills when you are ready" is incorrect information and provides false reassurance; the client currently is insulin dependent. The response "Your health care provider decides the route of administration" does not answer the client's question; insulin is administered intravenously or subcutaneously, and the route depends on the client's needs.

During the administration of total parenteral nutrition (TPN), an assessment of the client reveals a bounding pulse, distended jugular veins, dyspnea, and cough. What is the priority nursing intervention? restart client's infusion at another site slow rate of client's infusion and notify the healthcare provider interrupt client's infusion and notify healthcare providers obtain vital signs and continue monitoring the client's status

interrupt client's infusion and notify healthcare providers The client is experiencing pulmonary edema because of a fluid volume excess. The high concentration of TPN precipitates a fluid shift from the interstitial compartment into the intravascular compartment. Fluid will continue to be infused, which will continue to increase the intravascular volume.

A healthcare provider prescribes furosemide for a client with hypervolemia. The nurse recalls that furosemide exerts its effects in what part of the renal system? distal tubule collecting duct glomerulus of the nephron loop of henle

loop of henle Furosemide acts in the ascending limb of the loop of Henle in the kidney. Thiazides act in the distal tubule in the kidney. Potassium-sparing diuretics act in the collecting duct in the kidney. Plasma expanders, not diuretics, act in the glomerulus of the nephron in the kidney.

A client is admitted to the emergency department with burns to the anterior trunk, entire right arm, and anterior right leg. The practitioner prescribes morphine sulfate for pain. What route of administration should the nurse expect to administer this medication? orally intravenously subcutaneously intramuscularly

intravenously The intravenous route is the preferred route for medication for a client with impaired peripheral circulation. Oral medications usually are not given to burn clients because of the frequent occurrence of paralytic ileus; oral analgesics take too long to provide immediate relief from pain. Impaired peripheral circulation does not permit accurate prediction of the dose absorbed when it is administered subcutaneously. Impaired peripheral circulation does not permit accurate prediction of the dose absorbed when it is administered intramuscularly.

A nurse concludes that a client has a hypoglycemic reaction to insulin. Which clinical findings support this conclusion? Select all that apply.

irritability heart palpations Irritability, a neuroglycopenic symptom, occurs when the glucose in the brain declines to a low level. Heart palpitations, a neurogenic symptom, occur when the sympathetic nervous system responds to a rapid decline in blood glucose. Because the blood glucose level is decreased, the renal threshold is not exceeded, and there is no glycosuria. Dry, hot skin is consistent with dehydration, which often is associated with hyperglycemic states. Fruity odor of the breath is associated with hyperglycemia; it is caused by the breakdown of fats as a result of inadequate insulin supply.

Which information does the nurse include in the teaching plan for the client who is prescribed sumatriptan for migraine headache? should be administered when headache is at its peak should be administered by deep intramuscular injection is contraindicated in people with coronary artery disease injectable sumatriptan may be administered every 6 hours as needed

is contraindicated in people with coronary artery disease In addition to promoting therapeutic cerebral vasoconstriction, sumatriptan promotes undesirable coronary artery vasoconstriction. Coronary vasoconstriction may cause harm to the client with coronary artery disease. For maximum effectiveness, sumatriptan should be administered at the onset of migraine headache. Sumatriptan may be given orally, subcutaneously, or as a nasal spray. The maximum adult dose of sumatriptan is two 6-mg doses in a 24-hour period for a total of 12 milligrams. The two doses must be separated by at least an hour. The second dose should not be administered unless some response was observed with the first dose.

A blood donor whose blood type is O negative is known as a "universal donor." What does the nurse consider about O negative blood that accounts for this classification? it does not have any of the antigens that can cause a reaction donor can donate blood more frequently than other people more people have this blood type, so it is more universally available it is more frequently administered when compared with other blood types

it does not have any of the antigens that can cause a reaction Type O Rh negative red blood cells will not cause an antigen-antibody reaction in people with O, A, B, AB, Rh-positive, or Rh negative blood; therefore, this type of blood can be administered "universally" to others. However, an exact match of blood type is preferred because there may be other factors in the donor's blood that can cause a reaction. People, regardless of their blood types, can donate blood approximately every 2 months. The availability of blood type does not affect the compatibility of donated blood with a recipient's blood. While it is a common blood type, this is not why people with this type are considered universal donors.

The healthcare provider prescribes isosorbide dinitrate 10 mg for a client with chronic angina pectoris. The client asks the nurse why the isosorbide dinitrate is prescribed. How will the nurse respond?

it improves oxygen supply in ventricles Isosorbide dinitrate dilates the coronary vasculature, improving the supply of oxygen to the hypoxic myocardium. Preventing blood from clotting is the action of anticoagulants. Suppressing irritability in the ventricles is the action of antidysrhythmics. Increasing the force of contraction of the heart is the action of cardiac glycosides.

Neomycin 1 gram is prescribed preoperatively for a client with cancer of the colon. The client asks why this is necessary. How should the nurse respond? it is used to prevent you from getting a bladder infection before surgery it will decrease your kidney function and lessen urine production during surgery it will kill bacteria in your bowel and decrease risk for infection after surgery it is used to alter body flora, which reduces spread of tumor to adjacent organs

it will kill bacteria in your bowel and decrease risk for infection after surgery Neomycin provides preoperative intestinal antisepsis. It is not administered to prevent bladder infection. Nephrotoxicity is an adverse, not a therapeutic, effect. Neomycin will not prevent metastasis of the tumor to other areas.

A nurse is administering gold salts to a client with the diagnosis of rheumatoid arthritis. For which adverse effect of this drug should the client be monitored? kidney damage persistent nausea pulmonary emboli cardiac decompensation

kidney damage Gold salts, bound to plasma proteins, are distributed irregularly throughout the body, but the highest concentration occurs in the kidneys. When the slow excretion of gold salts cannot keep up with their intake, they can accumulate in the kidneys, causing damage. Persistent nausea, pulmonary emboli, and cardiac decompensation are not side effects associated with gold salts.

A client has severe diarrhea, and the health care provider prescribes intravenous fluids, sodium bicarbonate, and an antidiarrheal medication. Which drug does the nurse expect the health care provider to prescribe? psyllium bisacodyl loperamide docusate sodium

loperamide Loperamide inhibits peristalsis and prolongs transit time by its effect on the nerves in the muscle wall of the intestines. Bisacodyl is a laxative, not an antidiarrheal; it increases gastrointestinal motility. Psyllium is not an antidiarrheal; it is a bulk laxative that promotes easier expulsion of feces. Docusate sodium corrects constipation, not diarrhea; water and fat are increased in the intestine, permitting easier expulsion of feces.

A client is diagnosed with type 2 diabetes, and the health care provider prescribes an oral hypoglycemic. For what side effect should the nurse teach this client to monitor? ketonuria weight loss ketoacidosis low blood sugar

low blood sugar Oral hypoglycemic agents decrease serum glucose levels that may precipitate hypoglycemia. Ketonuria occurs with insulin-dependent diabetes. Weight gain usually is noted in adult-onset diabetes. Ketoacidosis occurs with insulin-dependent diabetes.

A client is taking furosemide and digoxin for heart failure. Why does the nurse advise the client to drink a glass of orange juice every day? maintaining potassium levels preventing increased sodium levels limiting drugs' synergistic effects correcting associated dehydration

maintaining potassium levels Orange juice is an excellent source of potassium. Furosemide promotes excretion of potassium, which can result in hypokalemia. Digoxin toxicity can occur in the presence of hypokalemia. Neither drug increases sodium levels. Digoxin does not potentiate the action of furosemide; therefore, the client should not experience dehydration. Orange juice will not prevent an interaction between digoxin and furosemide.

A client with type 1 diabetes consistently has high glucose levels on awakening in the morning. What should the nurse instruct the client to do to differentiate between the Somogyi effect and the dawn phenomenon? eat a snack before going to bed measure blood glucose level between 2 AM and 4 AM identify whether morning symptoms are typical for hyperglycemia administer prescribed bedtime insulin immediately before going to bed

measure blood glucose level between 2 AM and 4 AM During the hours of sleep, the Somogyi effect may be caused by a decline in the blood glucose level in response to too much insulin. The resulting hypoglycemia stimulates counterregulatory hormones, which precipitate lipolysis, gluconeogenesis, and glycogenolysis, which in turn produce rebound hyperglycemia and ketosis. Treatment involves decreasing the evening insulin. The client should check blood glucose between 2 AM and 4 AM and if the blood glucose is less than 70, the client is having a Somogyi effect. The dawn phenomenon is characterized by the release of counterregulatory hormones in the predawn hours, precipitating hyperglycemia on awakening. Treatment involves an increase in insulin. Eating a snack before going to bed should be done when insulin is taken before sleep, but it will not help to differentiate between the Somogyi effect and the dawn phenomenon. Administering the prescribed bedtime insulin immediately before going to bed depends on the insulin regimen prescribed by the health care provider and will not help to differentiate between the Somogyi effect and the dawn phenomenon. The manifestation (symptoms) of hyperglycemia has no role in differentiating the conditions.

What should the nurse include when teaching a client with severe Parkinson's Disease about carbidopa-levodopa?

med can be taken with meals Carbidopa-levodopa is often taken with meals to reduce the nausea and vomiting commonly associated with this drug. Although the best practice is to take carbidopa-levodopa on an empty stomach, this is often not feasible for many clients who suffer from gastrointestinal disturbances related to this medication. Multivitamins are contraindicated as they often contain pyridoxine (vitamin B 6), which diminishes the effects of levodopa. Moderate alcohol consumption can also antagonize the drug effect. A high-protein diet is contraindicated because levodopa is an amino acid that may increase blood urea nitrogen (BUN) levels. Additionally, some proteins contain pyridoxine, which diminishes the desired therapeutic effect by increasing peripheral levodopa metabolism and reducing the amount of bioavailable levodopa crossing the blood-brain barrier.

A client has an excision of a thrombosed external hemorrhoid. What should the nurse teach the client to use when cleaning the anus after a bowel movement? betadine pads soft facial tissue medicated pads (tucks) sterile 4*4 inch (10*10 cm) pads

medicated pads (tucks) Witch hazel-moistened pads (Tucks) are not irritating and are soothing to the anal mucosa. Betadine may cause excessive drying and irritation. The rectum always is contaminated; external cleansing with Betadine will not affect appreciably the bacteria present. Dry facial tissue is irritating and can cause trauma. Sterile gauze pads are unnecessary; the rectal area is considered contaminated.

A pain scale of 1 to 10 is used by a nurse to assess a client's degree of pain. The client rates the pain as an 8 before receiving an analgesic and a 7 after being medicated. What conclusion should the nurse make regarding the client's response to pain medication? client has low pain tolerance medication is not adequately effective medication has sufficiently decreased pain level client needs more education about use of the pain scale

medication is not adequately effective The expected effect should be more than a 1-point decrease in the pain level. Identifying whether a client has a low pain tolerance cannot be determined with the data available. The medication has not achieved an adequate response; pain generally is considered to be tolerable if it is 4 or below on a pain scale of 1 to 10. Determining that the client needs more education about the use of the pain scale cannot be determined with the data available.

A nurse teaches a client about the dangers of using sodium bicarbonate regularly. What effect of sodium bicarbonate is the nurse trying to prevent? gastric distention metabolic alkalosis chronic constipation cardiac dysrhythmias

metabolic alkalosis Prolonged use of sodium bicarbonate may cause systemic alkalosis, as well as retention of sodium and water. Gastric distention is not an effect of sodium bicarbonate. Chronic constipation is not an effect of sodium bicarbonate. Cardiac dysrhythmias are not an effect of sodium bicarbonate.

The postoperative prescriptions for a client who had repair of an inguinal hernia include docusate sodium daily. Before discharge, the nurse instructs the client about what potential side effect? rectal bleeding fecal impaction nausea and vomiting mild abdominal cramping

mild abdominal cramping Mild abdominal cramping is the only side effect of docusate sodium; this emollient laxative permits water and fatty substances to penetrate and mix with fecal material. Rectal bleeding is more likely to occur with a saline-osmotic laxative. Docusate sodium promotes defecation, not constipation. Nausea and vomiting are more likely to occur with a saline-osmotic laxative.

After several days of intravenous (IV) therapy for chloroquine-resistant malaria, the health care provider replaces the IV medication with oral quinine, 2 g per day in divided doses. The nurse advises the client to take this medication after meals for what purpose? delay its absorption minimize gastric irritation reduce its antidysrhythmic action decrease stimulation of the appetite

minimize gastric irritation Quinine administered orally can cause gastric irritation, resulting in nausea and vomiting. Administration of the medication immediately after meals minimizes its irritating effect. Absorption of the drug is not significantly affected by administration after meals. The appetite is not affected by this drug as long as gastric irritation is avoided. Quinidine, not quinine, is given for its antidysrhythmic effect.

A healthcare provider prescribes enalapril for a client. Which is the most important nursing action? assess client for hypokalemia ensure medication is ingested with food monitor client's blood pressure during therapy teach that a missed dose can be doubled at the next scheduled time

monitor client's blood pressure during therapy Enalapril is an antihypertensive. A lowering of the client's blood pressure reflects a therapeutic response and needs to be monitored frequently. The client may be at risk for hyperkalemia, not hypokalemia. Enalapril may be taken without regard to meals. Doubling a dose is unsafe as it may cause an extreme lowering of blood pressure. A missed dose can be taken as long as it is not close to the next scheduled dose.

A healthcare provider prescribes losartan for a client. Which is the most important nursing action?

monitor client's blood pressure during therapy Losartan is an antihypertensive. It blocks vasoconstrictor and aldosterone-producing effects of angiotensin II at receptor sites. A lowering of the client's blood pressure reflects a therapeutic response and should be monitored frequently. The client may be at risk for hyperkalemia, not hypokalemia. Losartan may be taken without regard to meals. Doubling a dose is unsafe. A missed dose can be taken as long as it is not close to the next scheduled dose.

Which nursing interventions are important when caring for clients receiving IV digoxin? Select all that apply. monitor heart rate closely check blood levels of digoxin administer dose over 1 minute monitor serum potassium level give drug with other infusion medications

monitor heart rate closely check blood levels of digoxin monitor serum potassium level Bradycardia or other dysrhythmias may occur; therefore, the heart rate and rhythm should be monitored. ECG monitoring should be continuous. The digoxin level is checked before administration to avoid toxicity. A low serum potassium level when digoxin is administered can contribute to toxicity. Digoxin should be given over a 5-minute period through a Y-tube or three-way stopcock. There are many syringe, Y-site, and additive incompatibilities; the manufacturer recommends that digoxin not be administered with other drugs.

A client has a tonic-clonic seizure caused by an overdose of aspirin. What is an appropriate nursing action?

monitor vital signs every 15 min Because of the lethal toxicity of an aspirin overdose, hypotensive crisis and cardiac irregularities can occur. The central nervous system is not involved at the reflex level at this time. CVP readings are not indicated in this situation. Inserting a urinary retention catheter is not the priority at this time.

Which is an independent nursing action that should be included in the plan of care for a client after an episode of ketoacidosis? monitoring for signs of hypoglycemia withholding glucose in any form until situation is corrected giving fruit juices, broth, and milk as soon as client is able to take fluids orally regulating insulin dosage according to the amount of ketones found in the client's urine

monitoring for signs of hypoglycemia During treatment for acidosis, hypoglycemia may develop; careful observation for this complication should be made by the nurse. Withholding all glucose may cause insulin coma. Whole milk and fruit juices are high in carbohydrates, which are contraindicated immediately following ketoacidosis. The regulation of insulin depends on the prescription for coverage; the prescription usually depends on the client's blood glucose level rather than ketones in the urine.

In the postanesthesia care unit a client received intrathecal morphine intraoperatively to control pain. Considering the administration of this medication, what should the nurse include as part of the client's initial 24-hour postoperative care? monitoring of respiratory rate hourly assessing client for tachycardia administering naloxone every 3 to 4 hours observing client for signs of central nervous system (CNS) excitement

monitoring of respiratory rate hourly Intrathecal morphine can depress respiratory function depending on the level it reaches within the spinal column; hourly assessments during the first 12 to 24 hours will allow for early intervention with an antidote if respiratory depression needs to be corrected. Bradycardia, not tachycardia, and hypotension occur. Administering naloxone every 3 to 4 hours is too infrequent if the client's respirations are depressed. The recommended adult dosage usually is 0.4 to 2 mg every 2 to 3 minutes, if indicated. CNS depression occurs secondary to hypoxia.

A client has increased intracranial pressure resulting from a traumatic brain injury. Assessment findings indicate that the client is unconscious with vital signs of pulse 60 beats/min, respirations 16 breaths/min, and blood pressure 142/64 mm Hg. The nurse reviews the treatment plan and questions which prescription?

morphine Morphine injection is contraindicated for an unconscious, neurologically impaired client because it depresses respirations. Mannitol, an osmotic diuretic, is used to reduce increased intracranial pressure. Dexamethasone, a corticosteroid antiinflammatory agent, is used to help reduce increased intracranial pressure. Chlorpromazine, an antipsychotic/neuroleptic/antiemetic, can be given safely to a neurologically impaired client for restlessness.

A client is admitted to the cardiac intensive care unit with intense chest pain. What pain relief medication does the nurse expect to find on the plan of care for this client? morphine diazepam midazolam oxycodone

morphine Morphine is the drug of choice for a myocardial infarction because it relieves pain quickly and reduces anxiety. Diazepam is a muscle relaxant that may be used for its sedative effect; it is not effective for the severe pain associated with a myocardial infarction. Midazolam is a hypnotic that may be used to reduce fear and restlessness; it is not effective for the severe pain associated with a myocardial infarction. Oxycodone is an orally administered analgesic; an analgesic that is administered via the intravenous, not the oral, route provides more immediate pain relief.

A client admitted with a myocardial infarction is prescribed docusate and morphine and takes digoxin and fluoxetine at home. Which drug should the nurse recognize as a risk factor for straining due to constipation? <p>A client admitted with a myocardial infarction is prescribed docusate and morphine and takes digoxin and fluoxetine at home. Which drug should the nurse recognize as a risk factor for straining due to constipation?</p>

morphine Morphine is an opioid. Opioids decrease intestinal peristalsis, which may precipitate constipation; straining at stool should be avoided to prevent the Valsalva maneuver, which increases demands on the heart. Digoxin is unrelated to intestinal peristalsis and the potential for constipation. Docusate sodium is a stool softener which would relieve, not cause, constipation. A side effect of fluoxetine is diarrhea, not constipation.

The nurse provides education about signs and symptoms of hypoglycemia to a client with newly diagnosed type 1 diabetes. The nurse concludes that the teaching was effective when the client acknowledges the need to drink orange juice when experiencing which symptoms? nervous and weak thirsty with a headache flushed and short of breath nausea and abdominal cramps

nervous and weak Nervousness and weakness are the most commonly reported symptoms of hypoglycemia and are related to increased sympathetic nervous system activity. Feeling flushed and short of breath are adaptations of hyperglycemia. Being thirsty, having a headache, being nauseated, or having abdominal cramps are symptoms of hyperglycemia.

A client with a parotid tumor that involves the lymph glands in the neck is prescribed vincristine, cyclophosphamide, and prednisone. The nurse should monitor the client for what adverse effect?

peripheral paresthesia Peripheral paresthesia is an indication of toxicity from a plant alkaloid such as vincristine. Anginal-type chest pain, ophthalmic papilledema, and bilateral crackles in the lung are not side effects of any of the drugs listed.

A client with gastroesophageal reflux disease (GERD) receives a prescription for an H 2 receptor antagonist. Which medications are within the classification of an H 2 receptor antagonist? Select all that apply. nizatidine ranitidine famotidine lansoprazole metoclopramide

nizatidine ranitidine famotidine Nizatidine is an H2 receptor antagonist that reduces gastric acid secretion and provides for symptomatic improvement in GERD. Ranitidine is an H 2 receptor antagonist that reduces gastric acid secretion and provides for symptomatic improvement in GERD. Famotidine is an H 2 receptor antagonist that reduces gastric acid secretion and provides for symptomatic improvement in GERD. Lansoprazole is a proton pump inhibitor that inhibits gastric secretion up to 90% with one dose daily and provides for symptomatic improvement in GERD. Metoclopramide is a prokinetic agent that increases the rate of gastric emptying; it has multiple side effects and is not appropriate for long-term treatment of GERD.

While the nurse is at the bedside of a client in acute renal failure, the client states, "My healthcare provider said that I will be getting some insulin. Do I also have diabetes?" What is the best nursing response? no, insulin will help your body handle the increased potassium level I suggest that you ask your healthcare provider that question You probably had an elevated blood glucose level, so your healthcare provider is being cautious No, but insulin will reduce toxins in your blood by lowering your metabolic rate

no, insulin will help your body handle the increased potassium level Insulin promotes the transfer of potassium into cells, which reduces the circulating blood level of potassium. The response "I suggest that you ask your healthcare provider that question" halts communication and is not supportive. Blood glucose levels usually are not elevated in acute renal failure. Insulin will not lower the metabolic rate.

Which statement made by a client recently diagnosed with type 1 diabetes indicates that further education is necessary regarding the teaching plan? i will need to have my eyes and vision examined once a year i will need to check my blood sugar at home to evaluate my response to my treatment plan i can improve metabolic and cardiac risk factors of this disease if i follow a low-calorie diet and lose weight once I reach my target weight there is a good chance that i will be able to switch from insulin to an oral medication

once I reach my target weight there is a good chance that i will be able to switch from insulin to an oral medication Type 1 diabetes mellitus (DM) is an autoimmune disorder in which beta cells are destroyed. No insulin or very little insulin is produced. Therefore a person with type 1 DM will need lifelong insulin injections to control blood sugar. Early detection of changes in the eye permits treatment plan adjustments that can slow or halt progression of retinopathy. Blood glucose monitoring should be done at home to evaluate the treatment plan. Disease risk factors can be improved with weight loss and a low-calorie diet.

A healthcare provider prescribes famotidine and magnesium hydroxide/aluminum hydroxide antacid for a client with a peptic ulcer. The nurse should teach the client to take the antacid at what time? only at bedtime, when famotidine is not taken only if famotidine is ineffective at the same time as famotidine, with a full glass of water one hour before or 2 hours after famotidine

one hour before or 2 hours after famotidine Antacids interfere with complete absorption of famotidine; therefore antacids should be administered at least 1 hour before or 2 hours after famotidine. Magnesium hydroxide/aluminum hydroxide usually is taken 1 hour after meals and at bedtime. Famotidine usually is prescribed once a day at bedtime. The client has received a prescription for both medications; the client should not be instructed to omit one of the medications without checking with the healthcare provider first.

A nurse is caring for a client who is admitted to the hospital with a diagnosis of unstable angina. Sublingual nitroglycerin has been prescribed. What client response indicates that nitroglycerin is effective? pain subsides as a result of arteriole and venous dilation pulse rate increases because the cardiac output has been stimulated sublingual area tingles because sensory nerves are being triggered capacity for activity improves as a response to increased collateral circulation

pain subsides as a result of arteriole and venous dilation Nitroglycerin causes vasodilation, increasing the flow of blood and oxygen to the myocardium and reducing anginal pain. An increased pulse rate does not indicate effectiveness; it is a side effect of nitroglycerin. The tingling indicates that the medication is fresh; relief of pain is the only indicator of effectiveness. Nitroglycerin does not promote the formation of new blood vessels.

A client is receiving an antihypertensive drug intravenously for control of severe hypertension. The client's blood pressure is 160/94 mm Hg before the infusion. Fifteen minutes after the infusion is started, the blood pressure increases to 180/100 mm Hg. Which type of response is the client demonstrating? allergic synergistic paradoxical hypersusceptibility

paradoxical A paradoxical response to a drug is directly opposite to the desired therapeutic response. An allergic response is an antigen-antibody reaction. A synergistic response involves drug combinations that enhance each other. Hypersusceptibility is a response to a drug that is more pronounced than the common response.

A male client who is receiving prolonged steroid therapy complains of always being thirsty and urinating frequently. What is the nurse's best initial action? have client assessed for an enlarged prostate obtain a urine specimen from the client to test for ketonuria perform a finger stick to test the client's blood glucose level assess client's lower extremities for presence of pitting edema

perform a finger stick to test the client's blood glucose level The client has signs of an increased serum glucose level, which may result from steroid therapy; testing the blood glucose level is a method of gathering more data. The symptoms are not those of benign prostatic hyperplasia. The blood glucose level, not the amount of ketones in the urine, should be assessed. The symptoms presented are not those of fluid retention, but of hyperglycemia.

A nurse teaches a client about warfarin. Which information is essential for the nurse to include in the education plan?

periodic testing is necessary Testing is essential to determine dosing; a therapeutic prothrombin time (PT) ranges from 1.3 to 1.5 times greater than the control and is equal to an international normalized ratio (INR) of 2 to 3 times control. Foods high in vitamin K may affect the medication if eaten in larger than usual amounts. Activities usually are not restricted. Doses may be withheld if the PT is prolonged excessively or if minor bleeding occurs; warfarin may be stopped for dental, medical, and surgical procedures.

A client who had a myocardial infarction receives 15 mg of morphine sulfate for chest pain. Fifteen minutes after receiving the drug, the client complains of feeling dizzy. What action should the nurse take? determine if this is an allergic reaction elevate client's head and keep extremities warm place client in supine position and take vital signs tell client that this is not a typical sensation after receiving morphine sulfate

place client in supine position and take vital signs Vertigo is a symptom of hypotension, a side effect of morphine sulfate. The supine position increases venous return, increases cardiac output, and increases blood flow to the brain. Dizziness is a symptom of hypotension that is a side effect, not an allergic response, to morphine sulfate. Raising the client's head may aggravate dizziness. Dizziness is a typical side effect of morphine sulfate.

A client is admitted to the hospital with deep partial-thickness burns to both hands and forearms after an accident. How should the nurse apply the prescribed antimicrobial medication?

place medication directly on burn wound in a thin layer using sterile gloves Sterile aseptic technique is necessary for an open wound, and a thin layer of ointment is applied directly to the affected area. Surgically aseptic, not medically aseptic, technique is used. Although some medications may be placed directly in the tank, antimicrobial medications are placed directly on the affected area using surgically aseptic technique.

A nurse is caring for a client who is receiving total parenteral nutrition. Which responses indicate that the client is experiencing hyperglycemia? Select all that apply. polyuria polydipsia paralytic ileus respiratory rate of 24 breaths/min serum glucose of 105 mg/dL (5.8 mmol/L)

polyuria polydipsia respiratory rate of 24 Glucose that is being filtered in the kidney acts as an osmotic diuretic; glycosuria promotes polyuria. Polydipsia (excessive thirst) and fluid intake are the responses to excess fluid loss related to osmotic diuresis. With hyperglycemia, there may be hyperventilation in an attempt to blow off carbon dioxide if ketones are produced; 24 breaths/min is characteristic of hyperventilation. Paralytic ileus is not associated with hyperglycemia. Serum glucose of 105 mg/dL (5.8 mmol/L), by most standards, is within the expected range of 60 to 110 mg/dL (3.3 to 6.1 mmol/L).

A client develops thrombophlebitis in the right calf. Bed rest is prescribed, and an IV of heparin is initiated. What drug action will the nurse include when describing the purpose of this drug to the client?

prevents extension of clot Heparin interferes with activation of prothrombin to thrombin and inhibits aggregation of platelets. Heparin does not reduce the size of a thrombus. Heparin does not dissolve blood clots in the veins. Heparin does not facilitate the absorption of red blood cells.

Selegiline is prescribed for a client with Parkinson disease who is having an inadequate response to levodopa therapy. What information does the nurse include when teaching the client about the addition of this drug to the regimen?

primary hcp should be contacted immediately if a severe h/a occurs A severe headache is a sign of a monoamine oxidase inhibitor-induced hypertensive crisis and should be reported to the healthcare provider immediately. Monthly blood tests are unnecessary, but routine medical evaluations of the client should be scheduled. Adjusting the dose of the drug daily is unsafe; the recommended daily dose of the drug should be taken as prescribed. The side effects of levodopa will increase, not decrease, when these two drugs are taken concurrently.

A client with a head injury has been receiving dexamethasone. The health care provider plans to reduce the dosage gradually and to continue a lower maintenance dosage. Which effect associated with the gradual dosage reduction of the drug should the nurse explain to the client? builds glycogen stores in muscles produces antibodies by immune system allows increased intracranial pressure to return to normal promotes return of cortisone production by the adrenal glands

production by the adrenal glands Hormone therapy must be withdrawn slowly to allow the adrenal glands to adjust and resume production of their hormone. Building glycogen stores in the muscles, producing antibodies by the immune system, and allowing the increased intracranial pressure to return to normal are not reasons for the gradual withdrawal of dexamethasone.

A nurse is caring for a client who is receiving aspirin therapy. Which clinical indicator would be related to this therapy? urinary calculi atrophy of liver prolonged bleeding time premature erythrocyte destruction

prolonged bleeding time Aspirin interferes with platelet aggregation, thereby lengthening bleeding time. Urate excretion is enhanced by high doses of aspirin. Aspirin does not cause atrophy of the liver; it is readily broken down in the gastrointestinal tract and liver. Aspirin does not destroy erythrocytes.

Which relationship does the nurse consider reflective of the relationship of naloxone to morphine sulfate? aspirin to warfarin amoxicillin to infection enoxaparin to dalteparin protamine sulfate to heparin

protamine sulfate to heparin Protamine sulfate is the antidote for heparin overdose, and naloxone will reverse the effects of opioids such as morphine. Aspirin and warfarin both interfere with coagulation. While amoxicillin is used to treat some infections, an infection is not a medication, so amoxicillin cannot be considered an antidote. Both enoxaparin and dalteparin are low-molecular-weight heparins.

Enoxaparin 40 mg subcutaneously daily is prescribed for a client who had abdominal surgery. The nurse explains that the medication is given for what purpose? control postoperative fever provide a constant source of mild analgesia limit postsurgical inflammatory response provide prophylaxis against postoperative thrombus formation

provide prophylaxis against postoperative thrombus formation Enoxaparin, a low-molecular-weight heparin, prevents the conversion of fibrinogen to fibrin and of prothrombin to thrombin by enhancing the inhibitory effects of antithrombin III. Enoxaparin is not an antipyretic. Enoxaparin is not an analgesic. Enoxaparin is not an antiinflammatory drug.

Which information from the client's history does the nurse identify as a risk factor for developing osteoporosis?

receives long term steroid therapy Increased levels of steroids will accelerate bone demineralization. Hyperparathyroidism, not hypoparathyroidism, accelerates bone demineralization. Weight bearing that occurs with strenuous activity promotes bone integrity by preventing bone demineralization. Estrogen promotes deposition of calcium into bone which may prevent, not cause, osteoporosis.

The nurse is caring for a client who is receiving azathioprine, cyclosporine, and prednisone before receiving a kidney transplant. What does the nurse identify as the purpose of these drugs? stimulates leukocytosis provide passive immunity prevent iatrogenic infection reduce antibody production

reduce antibody production These drugs suppress the immune system, decreasing the body's production of antibodies in response to the new organ, which acts as an antigen. These drugs decrease the risk of rejection. These drugs inhibit leukocytosis. These drugs do not provide immunity; they interfere with natural immune responses. Because these drugs suppress the immune system, they increase the risk of infection.

A client with rheumatoid arthritis asks the nurse why it is necessary to inject hydrocortisone into the knee joint. What reason should the nurse include in a response to this question? lubricate joint reduce inflammation provide physiotherapy prevent ankylosis of joint

reduce inflammation Steroids have an antiinflammatory effect that can reduce arthritic pannus formation. Lubricating the joint does not provide lubrication. Injection of a drug into a joint is not physiotherapy. Ankylosis refers to fusion of joints. It is only indirectly influenced by steroids, which exert their major effect on the inflammatory process.

After a basal cell carcinoma is removed by fulguration, a client is given a topical steroid to apply to the surgical site. The nurse evaluates that the teaching regarding steroids and skin lesions is effective when the client identifies which action as the primary purpose of the medication? prevent infection of wound increase fluid loss from skin reduce inflammation at the surgical site limit itching around the area of the lesion

reduce inflammation at the surgical site Steroids are used for their antiinflammatory, vasoconstrictive, and antipruritic effects. Steroids increase the incidence of infections because they are antiinflammatory agents and mask symptoms of infection. Steroids increase fluid retention because they promote the reabsorption of sodium from the tubular fluid into the plasma. Although steroid ointments have an antipruritic effect, their major purpose after surgery is their systemic antiinflammatory effect.

Dexamethasone has been prescribed for a client after a craniotomy for a brain tumor. When evaluating the effectiveness of the medication, the nurse expects what physiologic response?

reduced cerebral edema

A client is to receive intraarterial chemotherapy for cancer of the liver. What benefit of chemotherapy via this method does the nurse explain to the client?

reduces systemic toxicity Higher concentrations of the drug can be delivered to the specific site of the tumor, with reduced systemic toxicity. Providing for rapid dilution of chemotherapy is the purpose of central vascular access devices. The ability to pass the blood-brain barrier is the purpose of intrathecal or intraventricular access devices. Delivering chemotherapy to the peritoneal cavity is the purpose of intraperitoneal chemotherapy; temporary Silastic catheters are used.

A client with a history of hypertension comes to the emergency department with double vision and a blood pressure of 260/120 mm Hg. The healthcare provider prescribes a sodium nitroprusside infusion. The nurse recalls that sodium nitroprusside decreases blood pressure by what mechanism? decreasing heart rate increasing CO increasing peripheral resistance relaxing arterial smooth muscles

relaxing arterial smooth muscles This drug decreases blood pressure by relaxing venous and arteriolar smooth muscles and is used for immediate reduction of blood pressure. This drug may increase the heart rate as a response to vasodilation. It decreases cardiac workload by decreasing preload and afterload. It decreases peripheral resistance by dilating peripheral blood vessels.

A nurse has administered sublingual nitroglycerin. Which parameter should the nurse use to determine the effectiveness of sublingual nitroglycerin? relief of anginal pain improved cardiac output decreased blood pressure dilation of superficial blood vessels

relief of anginal pain Cardiac nitrates relax smooth muscles of the coronary arteries; they dilate and deliver more blood to heart muscle, relieving ischemic pain. Although cardiac output may improve because of improved oxygenation of the myocardium, improved cardiac output is not a basis for evaluating the effectiveness of sublingual nitroglycerin. Although dilation of blood vessels and a subsequent drop in blood pressure is a reason why IV nitroglycerin may be administered, decreased blood pressure is not the basis for evaluating the effectiveness of sublingual nitroglycerin, which is indicated for pain relief. Although superficial vessels dilate, lowering the blood pressure and creating a flushed appearance, dilation of superficial blood vessels is not the basis for evaluating the drug's effectiveness.

Morphine via an epidural catheter is prescribed for a client after abdominal surgery. The client asks the nurse why this medicine is necessary. What primary rationale does the nurse give for the administration of an opioid analgesic after abdominal surgery? facilitates oxygen use relieves abdominal pain decreases anxiety and restlessness dilates coronary and peripheral blood vessels

relieves abdominal pain Analgesics alleviate pain by binding with opioid receptors in the brain, thus altering the perception of and response to pain; patient-controlled analgesia (PCA) via an epidural catheter gives the client control over medication administration and usually results in the client using less medication. Opioids do not facilitate oxygen use; they decrease the respiratory rate, and less oxygen is used; the client should be monitored. Although decreasing anxiety and restlessness may be responses to an opioid, they are not the primary reason why opioids are used after abdominal surgery. Opioids are not given to dilate blood vessels; antianginal medications and vasodilators are used for this purpose.

A nurse is preparing to teach a client to apply a nitroglycerin patch as prophylaxis for angina. Which instruction should the nurse include in the teaching plan? apply patch on distal extremity remove a previous patch before applying next one massage area gently after applying patch to the skin apply warm compress to the site before attaching patch

remove a previous patch before applying next one Removing the previous patch before applying the next patch ensures that the client receives just the prescribed dose. Ideally, a patch should be removed after 12 to 14 hours to avoid the development of tolerance. The patch should be rotated among hair-free and scar-free sites; acceptable sites include chest, upper abdomen, proximal anterior thigh, or upper arm. The patch should be gently pressed against the skin to ensure adherence; it should not be massaged. Applying a warm compress to the site before attaching the patch is unnecessary and can result in an excessive absorption of the medication.

A client using fentanyl transdermal patches for pain management in late-stage cancer dies. What should the hospice nurse who is caring for this client do about the patch? tell family to remove and dispose of the patch leave patch in place for the mortician to remove have family return patch to the pharmacy for disposal remove and dispose of patch in an appropriate receptacle

remove and dispose of patch in an appropriate receptacle The nurse should remove and dispose of the patch in a manner that protects self and others from exposure to the fentanyl. This involves folding the patch so that adhesive edges are together. The nurse should flush the patch down toilet or place it in a proper disposal receptacle following the institutional policy. Having the family remove and dispose of the patch or having the mortician remove the patch is not safe. It is not the responsibility of nonprofessionals because they do not know how to protect themselves and others from exposure to the fentanyl. It is unnecessary to return a used fentanyl patch to the pharmacy.

A nurse is evaluating a client who received intravenous morphine. Which life-threatening response indicates the potential need for naloxone administration? blurred vision urinary retention mental confusion respiratory depression

respiratory depression Because morphine is a central nervous system depressant, it affects the medulla, the respiratory center in the brain. Respiratory depression may progress to respiratory arrest and death. Naloxone will reverse the effects of an opioid. Although blurred vision, urinary retention, and mental confusion may be responses to morphine, they are not life threatening.

What should a nurse teach the client to do to avoid lipodystrophy when self-administering insulin therapy? exercise regularly rotate injection sites use Z-track technique avoid massaging injection site

rotate injection sites Fibrous scar tissue can result from the trauma of repeated injections at the same site. Exercise is unrelated to lipodystrophy, but it reduces blood glucose, which decreases insulin requirements. Insulin is given subcutaneously; the Z-track technique is used with some intramuscular injections. Gentle pressure over the injection site after insulin administration promotes absorption.

A nurse is caring for a client who is a victim of trauma and is to receive a blood transfusion. How should the nurse respond when the client expresses fear that acquired immunodeficiency syndrome (AIDS) may be acquired as a result of the blood transfusion? blood is treated with radiation to kill virus ability to directly identify HIV has eliminated this concern consideration should be given to donating your own blood for transfusion screening for human immunodeficiency virus (HIV) antibodies has minimized this risk

screening for human immunodeficiency virus (HIV) antibodies has minimized this risk Although blood is screened for the antibodies, there is a period between the time a potential donor is infected and the time when antibodies are detectable; there is still a risk, but it is minimal. There is no current method of destroying the virus in a blood transfusion. The screening tests involve identification of the antibody, not the virus itself; the virus can be identified by the polymerase chain reaction test but is not part of routine screening. Although many people consider autotransfusion for elective procedures, a trauma victim does not have this option.

A client receiving morphine is being monitored by the nurse for adverse effects of the drug. Which clinical findings warrant immediate follow up by the nurse? Select all that apply.

sedation bradycardia slow respiration The central nervous system (CNS) depressant effect of morphine causes sedation. The CNS depressant effect of morphine causes bradycardia and bradypnea. Morphine does not increase urine output. Morphine causes constriction of pupils.

A client takes isosorbide dinitrate daily. The client states, "I would like to start taking sildenafil for erectile dysfunction." The nurse explains that taking both of these medications concurrently may result in which complication? constipation protracted vomiting respiratory distress severe hypotension

severe hypotension Concurrent use of sildenafil and a nitrate, which causes vasodilation, may result in severe, potentially fatal hypotension. Protracted vomiting and respiratory distress are not adverse effects associated with concurrent use of sildenafil and a nitrate. Sildenafil may cause diarrhea; adding a nitrate will not constipation.

Tissue plasminogen activator (t-PA) is to be administered to a client in the emergency department. Which is the priority nursing assessment? apical heart rate electrolyte levels signs of bleeding tissue compatibility

signs of bleeding Assessment for bleeding is a priority when administering a thrombolytic agent because it may lead to hemorrhage. While it is important to assess the heart rate and other vital signs, a failure to do so would not be potentially life-threatening. Electrolyte levels are not affected. Tissue compatibility assessment is not necessary.

A client is receiving imatinib for chronic myelogenous leukemia (CML). The nurse should assess for which complication of this protein-tyrosine kinase inhibitor? Select all that apply.

signs of infection bleeding tendencies Rationale Imatinib affects the bone marrow, causing neutropenia; an adequate number of neutrophils are necessary to fight bacterial infections. Imatinib affects the bone marrow, causing thrombocytopenia; an adequate number of thrombocytes are necessary to prevent bleeding. Hair loss is a complication associated with antimetabolites. Stomatitis is a complication associated with antimetabolites and antitumor antibiotics. Severe fluid retention is a side effect, not dehydration.

A client with heart failure is to receive digoxin and asks the nurse why the medication is necessary. What physiologic response will the nurse include when answering the client's question? reduces edema increases cardiac conduction increases rate of ventricular contractions slows and strengthens cardiac contractions

slows and strengthens cardiac contractions Digoxin increases the strength of myocardial contractions (positive inotropic effect) and, by altering the electrophysiological properties of the heart, slows the heart rate (negative chronotropic effect). Digoxin increases the strength of the contractions but decreases the heart rate. Although a reduction in edema may result from the increased blood supply to the kidneys, it is not the reason for administering digoxin. Digoxin decreases, not increases, cardiac impulses through the conduction system of the heart.

A nurse on the Code Blue/Arrest team responds to a code that is called for a client with hyperkalemia who is experiencing cardiac standstill. What would an appropriate immediate treatment plan include?

sodium bicarbonate Sodium bicarbonate decreases the potassium level. It works by increasing the movement of potassium from the blood into the cells. The body stores potassium inside the cells, with only a small amount in the bloodstream. Electrical defibrillation should not be applied indiscriminately to the client in asystole. This is not only fruitless but also detrimental, eliminating any possibility of recovering a rhythm. Furosemide is a diuretic commonly used for heart failure. There is no indication for anticoagulation therapy.

A client develops a maculopapular rash on the upper extremities and audible wheezing during the administration of intravenous vancomycin. To ensure the client's safety, which action would the nurse carry out first? notify healthcare provider stop infusion decrease flow rate reassess in 15 min

stop infusion The first action the nurse should take is to stop the infusion immediately. The client may be experiencing an allergic reaction. The nurse should stop the medication infusion and then notify the healthcare provider. Decreasing the flow rate is not an appropriate action. Infusions must be stopped if allergic reaction is suspected. This could be an emergent situation, so reassessing in 15 minutes is not the most appropriate action.

A client with type 1 diabetes comes to the clinic because of concerns regarding erratic control of blood glucose with the prescribed insulin therapy. The client has been experiencing a sudden fall in the blood glucose level, followed by a sudden episode of hyperglycemia. Which complication of insulin therapy should the nurse conclude that the client is experiencing? somogyi effect dawn phenomenon diabetic ketoacidosis hypersmolar nonketotic syndrome

somogyi effect The Somogyi effect is a response to hypoglycemia induced by too much insulin; the body responds to the hypoglycemia by counterregulatory hormones stimulating lipolysis, gluconeogenesis, and glycogenolysis, resulting in rebound hyperglycemia. The Dawn phenomenon is hyperglycemia that is present on awakening in the morning because of the release of counterregulatory hormones in the predawn hours; it is thought that growth hormone or cortisol is related to this phenomenon. Diabetic ketoacidosis (diabetic coma) is a profound deficiency of insulin and is characterized by hyperglycemia, ketosis, acidosis, and dehydration. Hyperosmolar nonketotic syndrome occurs in clients with type 2 diabetes. It is a condition in which the client produces enough insulin to prevent diabetic ketoacidosis but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.

A client with Hodgkin disease is started on chemotherapy. The nurse teaches the client to notify the healthcare provider to seek treatment for which adverse response to chemotherapy?

sores in mouth Stomatitis is a common response to chemotherapy and should be brought to the healthcare provider's attention because a swish-and-swallow anesthetic solution can be prescribed to make the client more comfortable. Hair loss is also anticipated with some chemotherapeutic drugs; the effects are temporary and reversible. Moderate diarrhea is expected and is not a cause for concern unless dehydration results. Nausea is expected but should be reported if it lasts more than 24 hours.

A client with midsternal pain presents to the emergency department. Vital signs are stable. Which form of nitroglycerin does the nurse anticipate giving initially? oral spray intravenous transdermal

spray Nitroglycerin spray provides prompt relief of symptoms. The nurse administers one to two sprays, up to a maximum of three sprays, onto or under the tongue every 5 minutes until pain is relieved. If unrelieved after three sprays, IV nitroglycerin may be considered. Both the transdermal and oral forms of nitroglycerin are used for prophylactic purposes, not management of acute pain.

The provider prescribes one unit of packed red blood cells to be administered to a client. To ensure the client's safety, which measure should the nurse take during administration of blood products? stay with client during first 15 min of infusion flush packed red blood cells with 5% dextrose and 0.45% normal saline discontinue intravenous catheter if a blood transfusion reaction occurs administer red blood cells though a percutaneously inserted central catheter line with a 20-guage needle

stay with client during first 15 min of infusion The nurse should remain with the client for the first 15 to 30 minutes. Any severe reaction usually occurs with the infusion of the first 50 mL of blood. Blood components are viscous, requiring a large needle to be used for venous access. A 20-gauge needle is not used to access a central catheter line. Normal saline is the solution to administer with blood productions. Lactated Ringer and dextrose in water are not used for infusion because of hemolysis.

A client who is on long-term corticosteroid therapy following an adrenalectomy is admitted to the surgical intensive care unit after being involved in a motor vehicle crash. What is the nurse's most important concern related to the client's history?

steroid therapy will need to be increased to avert a life-threatening crisis Clients with adrenocorticoid insufficiency who are receiving steroid therapy usually require increased amounts of medication during periods of stress because they are unable to produce the excess needed by the body. With severe stress, a failure to ensure adequate corticosteroid levels can be life threatening. Increased stress requires an increase, not decrease, in glucocorticoids. Although osteoporosis may have contributed to fractures secondary to trauma, this does not present a current risk in the critical care unit. Although immunosuppression is a risk concern, the issue of inadequate corticosteroid is an actual concern, and prompt treatment for adrenal insufficiency is urgent.

A client newly diagnosed with type 2 diabetes is receiving glyburide and asks the nurse how this drug works. What mechanism of action does the nurse provide? stimulates pancreas to produce insulin accelerates liver's release of stored glycogen increases glucose transport across cell membrane lowers blood glucose in absence of pancreatic function

stimulates pancreas to produce insulin Glyburide, an antidiabetic sulfonylurea, stimulates insulin production by the beta cells of the pancreas. Accelerating the liver's release of stored glycogen occurs when serum glucose drops below normal levels. Increasing glucose transport across the cell membrane occurs in the presence of insulin and potassium. Antidiabetic medications of the chemical class of biguanide improve sensitivity of peripheral tissue to insulin, which ultimately increases glucose transport into cells. Beta cells must have some function to enable this drug to be effective.

A client has had a recent brain attack (cerebrovascular accident/stroke). What does the nurse anticipate will be prescribed daily to prevent straining due to constipation? stimulant laxatives tap water enemas stool softener saline laxatives such as magnesium citrate

stool softener A stool softener can soften stool and promote defecation, thus avoiding the Valsalva maneuver. Enemas may precipitate a forcible exhalation against a closed glottis (Valsalva maneuver) during evacuation. Elevated intraabdominal and intrathoracic pressures associated with the Valsalva maneuver increase intracranial pressure and should be avoided. Also, daily enemas promote dependence. Stimulant laxatives are not recommended for daily use because laxative dependency has occurred in some clients. Saline laxatives can cause hypermagnesemia if given so frequently.

A client receiving intravenous vancomycin reports ringing in both ears. Which initial action should the nurse take? notify primary healthcare provider consult an audiologist stop infusion document finding and continue to monitor the client

stop infusion The first action the nurse should take is to stop the infusion immediately. Vancomycin can cause temporary or permanent hearing loss. The nurse should stop the medication infusion and then notify the healthcare provider at once if a client reports any hearing problems or ringing in the ears. An audiologist may need to be consulted at a later date, but this is not the best first action. The nurse should document the findings; however, it is not the initial action.

A client with a hemoglobin level of 6.2 g/dL (62 mmol/L) is receiving packed red blood cells. Twenty minutes after the infusion starts, the client complains of chest pain, difficulty breathing, and feeling cold. What is the first action the nurse should take? stop transfusion notify healthcare provider provide several warm blankets slow down rate of infusion

stop transfusion The client is experiencing an anaphylactic reaction, and the infusion should be stopped to prevent further problems. The healthcare provider should be notified after the transfusion is stopped. The blood transfusion should be stopped before implementing actions that address the client's anaphylactic reaction. Slowing the infusion will permit more of the incompatible blood to infuse, worsening the response.

A client with a seizure disorder is receiving phenytoin and phenobarbital. What client statement indicates that the instructions regarding the medications are understood? i will not have any seizures with these medications these medicines must be continued to prevent falls and injury stopping drugs can cause continuous seizures and I may die By my staying on the medicine I will prevent post-seizure confusion

stopping drugs can cause continuous seizures and I may die Combination therapy suggests that this client has seizures that are difficult to control. Sudden withdrawal of any antiepileptic medication can cause onset of frequent seizures or even status epilepticus. Death can occur if seizures are continuous due to lack of adequate oxygenation and cardiac irregularities. It is important to take medication as prescribed to lessen the frequency of seizures; there is no guarantee that seizures will stop. Medication may or may not eliminate the seizures; stress may precipitate a seizure. Antiepileptic medications are not prescribed to prevent falls and injury. Although seizures may occur while the client is taking the medications, the medications do not stop post seizure confusion.

Which information should be included in the teaching plan for the elderly client with peptic ulcer disease who is taking an antacid and sucralfate? antacids should be taken 30 minutes before a meal sucralfate should be taken on an empty stomach one hour before meals sucral fate is prescribed for long-term maintenance of peptic ulcer disease sodium bicarbonate is an inexpensive over-the-counter antacid with few adverse effects

sucralfate should be taken on an empty stomach one hour before meals Sucralfate works best in a low pH environment; therefore it should be given on an empty stomach either one hour before or two hours after meals. Sucralfate also should be administered no sooner than 30 minutes before or after an antacid. The acid-neutralizing effects of antacids last approximately 30 minutes when taken on an empty stomach and 3 to 4 hours when taken after meals. When sucralfate and an antacid are both prescribed, they are each most effective when the sucralfate is scheduled an hour before meals and the antacid is scheduled after meals. Sucralfate is prescribed for the short-term treatment of peptic ulcers. Its use is limited to 4 to 8 weeks. The client should follow the recommendations of the primary health care provider with regard to antacid selection. Sodium bicarbonate can produce acid-base imbalances which could be harmful, especially in elderly clients.

A nurse administers leucovorin calcium to a client before the prescribed methotrexate. The client asks the reason for this. What effect of leucovorin calcium should the nurse consider when formulating a response?

supplies llevels of folic acid required by blood forming organs Methotrexate is a folic acid antagonist that can depress the bone marrow; this serious toxic effect sometimes is prevented by administration of folic acid. Some healthcare providers advocate its administration after a course of methotrexate therapy to avoid interfering with methotrexate activity. Folic acid is a metabolite and does not destroy cancer cells. Leucovorin calcium does not increase the production of phagocytes.

A nurse is providing discharge instructions for a client with angina who has a prescription for sublingual nitroglycerin tablets. What will the nurse identify as an indicator that the nitroglycerin sublingual tablets have lost their potency?

tablets are more than 3 months old Nitroglycerin tablets are affected by light, heat, and moisture. Loss of potency can occur after 3 months, reducing the drug's effectiveness in relieving pain. A new supply should be obtained routinely. Experiencing sublingual tingling indicates the tablets have retained their potency. Unrelieved pain with an increase of facial flushing and delayed relief with the duration of relief remaining the same do not necessarily indicate loss of potency.

A client who is taking an oral hypoglycemic daily for type 2 diabetes develops the flu and is concerned about the need for special care. What should the nurse advise the client? Select all that apply. avoid solid food take oral medication drink fluids throughout day monitor capillary glucose levels do not take medication until tolerating food

take oral medication drink fluids throughout day monitor capillary glucose levels Physiologic stress increases gluconeogenesis, requiring continued pharmacologic therapy despite an inability to eat; fluids prevent dehydration; monitoring of glucose levels permits early intervention if necessary. Skipping the oral hypoglycemic agent may precipitate hyperglycemia. Food intake should be attempted to prevent acidosis. Delaying an oral hypoglycemic agent may precipitate hyperglycemia.

A client who has a gastric ulcer asks what to do if epigastric pain occurs. The nurse evaluates that teaching is effective when the client makes which statement? eliminating fluids with mels will prevent pain i will increase my food intake to avoid an empty stomach taking an aspirin with milk will relieve my pain and coat my ulcer taking an antacid preparation will decrease pain due to gastric acid

taking an antacid preparation will decrease pain due to gastric acid Over-the-counter antacid preparations neutralize gastric acid and relieve pain. Although eating food initially prevents gastric acid from irritating the gastric walls, it can precipitate acid production. Aspirin is contraindicated because it irritates gastric mucosa and promotes bleeding by preventing platelet aggregation. Reduction of fluids with meals does not affect pain.

A female client receiving cortisone therapy for adrenal insufficiency expresses concern that she is developing facial hair. How should the nurse respond? it is just another sign of adrenal insufficiency do not worry because it will disappear with therapy this is not important as long as you are feeling better the drug contains a hormone that causes male characteristics

the drug contains a hormone that causes male characteristics Some cortisol derivatives possess 17-keto-steroid (androgenic) properties, which result in hirsutism. Facial hair is not a sign of the illness; it results from androgens that are present in cortisol. The response "Do not worry because it will disappear with therapy" denies the client's concerns; hirsutism results from therapy, which is provided on a long-term basis. The response "This is not important as long as you are feeling better" denies the client's feelings.

A client with hepatitis B asks the nurse, "Are there any medications to help me get rid of this problem?" Which is the best response by the nurse? sedatives can be given to help you relax we can give you immune serum globulin vitamin supplements are frequently helpful and hasten recovery there are medications to help reduce viral load and liver inflammation

there are medications to help reduce viral load and liver inflammation Drugs are available to help reduce the viral load (antivirals), including lamivudine, ribavirin, and adefovir dipivoxil. Although sedatives can be given to help the client relax, sedatives are given only as needed and do not treat the hepatitis. The response "We can give you immune serum globulin" is used only during the incubation period. Vitamins are used as adjunctive therapy and will not eliminate the hepatitis.

A client who is scheduled for a bowel resection is to receive antibiotics preoperatively. What does the nurse include when teaching the client about the purpose of the antibiotics? prevent incisional infection antibiotics prevent postoperative pneumonia drugs limit risk of a UTI they are given to eliminate bacteria from GI tract

they are given to eliminate bacteria from GI tract The GI tract contains numerous bacteria; antibiotics are given to decrease the number of microorganisms in the bowel before surgery. Preventing incisional infection is a potential complication prevented by the use of sterile technique when changing the dressing. Avoiding postoperative pneumonia is a potential complication prevented by coughing, deep breathing, and early ambulation postoperatively. Limiting the risk of a urinary tract infection is a potential complication prevented by hygiene, meatal care, and increased hydration postoperatively.

The nurse is administering lactulose to a client with a history of cirrhosis of the liver. The client asks the nurse why this medication is needed because the client is not constipated. How will the nurse respond? this medication helps you to stop drinking so much alcohol this medication helps you relax and not feel anxious this medication helps you lower the high ammonia level caused by your liver disease this medication helps you keep your abdomen from being so distended

this medication helps you lower the high ammonia level caused by your liver disease Lactulose is a hyperosmotic laxative and ammonia detoxicant. It decreases serum ammonia concentration by preventing reabsorption of ammonia. Lactulose has been used to lower blood ammonia content in clients with portal hypertension and hepatic encephalopathy secondary to chronic liver disease. Lactulose has no effect on the craving for alcohol or anxiety and is not prescribed to reduce abdominal distension.

A client is to receive conscious sedation during a cardiac catheterization. Which route of administration should the nurse explain will be used to deliver the conscious sedation?

through IV catheter Conscious sedation is administered by direct intravenous (IV) injection or IV push to dull or reduce the intensity of pain or awareness of pain during a procedure without loss of defensive reflexes. General anesthesia usually is administered via inhalation of the vapor of a volatile liquid or an anesthetic gas via a mask or endotracheal tube; as a result, the client is unconscious, unaware, and anesthetized. An epidural block, a type of regional anesthesia, involves the injection of a local anesthetic into the epidural (extradural) space; it works by binding to nerve roots as they enter and exit the spinal cord. A nerve block, a type of regional anesthesia, is achieved by injection of the anesthetic agent into or around the nerves supplying the area; it interrupts sensory, motor, and sympathetic transmission.

A client with cirrhosis of the liver and ascites has been taking chlorothiazide, a thiazide diuretic. Why did the provider add spironolactone to the client's medication regimen? to stimulate sodium excretion to help prevent potassium loss to increase urine specific gravity to reduce arterial blood pressure

to help prevent potassium loss Spironolactone is a potassium-sparing diuretic often used in conjunction with thiazide diuretics. The provider was prompted to add spironolactone to the chlorothiazide to prevent potassium loss. Both medications stimulate sodium excretion. Both medications increase urine specific gravity and reduce arterial blood pressure.

A client with gastric ulcer disease asks the nurse why the health care provider has prescribed metronidazole. What purpose does the nurse provide? to augment immune response to potentiate effect of antacids to treat Helicobacter pylori infection To reduce hydrochloric acid secretion

to treat Helicobacter pylori infection Approximately two thirds of clients with peptic ulcer disease are found to have Helicobacter pylori infecting the mucosa and interfering with its protective function. Antibiotics do not augment the immune response, potentiate the effect of antacids, or reduce hydrochloric acid secretion.

A client with burns develops a wound infection. The nurse plans to teach the client that local wound infections primarily are treated with what type of antibiotics? oral topical intravenous intramuscular

topical Topical antibiotics are applied directly to the wound and are effective against many gram-positive and gram-negative organisms found on the skin. Although oral, intravenous, and intramuscular antibiotics may be administered, they are most effective for systemic rather than local infections; the vasculature in and around a burn is impaired, and the medication may not reach the organisms in the wound.

A nurse concludes that the simvastatin being administered to a client is effective. A decrease in what clinical finding supports this conclusion? heart rate triglycerides blood pressure international normalized ratio (INR)

triglycerides Therapeutic effects of simvastatin include decreased levels of serum triglycerides, low-density lipoprotein (LDL), and cholesterol. INR is not related to simvastatin; it is a measure used to evaluate blood coagulation. Heart rate and blood pressure are not related to simvastatin.

A nurse is assessing the adequacy of a client's intravenous fluid replacement therapy during the first 2 to 3 days after sustaining full-thickness burns to the trunk and right thigh. What assessment will provide the nurse with the most significant data?

urinary output every hour A client with extensive burns has an indwelling urinary catheter so that urine output can be measured hourly. Urinary output reflects circulating blood volume; it is the most reliable, immediately available information to assess fluid needs. Although daily weights reflect fluid retention or loss, they are not as immediately accurate as hourly urine measurements. A blood pressure reading may indicate hypervolemia or hypovolemia, but it is not as accurate an indicator of fluid replacement as hourly urine output. Peripheral edema may have many causes; it is not an effective indicator of fluid balance.

A client is receiving intravenous mannitol after sustaining a critical head injury. What assessment will the nurse perform that is specific to the safe administration of the medication?

urine output hourly Mannitol, an osmotic diuretic, increases the intravascular volume that must be excreted by the kidneys. The client's urine output should be monitored hourly to determine the client's response to therapy. Although with mannitol there is an increase in urinary excretion that is reflected in a decrease in body weight (1 L of fluid is equal to 2.2 pounds [1 kg]), a daily assessment of the client's weight is too infrequent to assess the client's response to therapy. Urine output can be monitored hourly and is a more frequent, accurate, and efficient assessment than is a daily weight. Vital signs should be monitored every hour considering the severity of the client's injury and the administration of mannitol. Although the level of consciousness should be monitored with a head injury, assessments every 8 hours are too infrequent to monitor the client's response to therapy.Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly because there usually is no pattern to the answers.

The healthcare provider prescribes epoetin for a client who has acquired immunodeficiency syndrome (AIDS). What step will the nurse include during administration of this drug?

use syringe and 25 gauge needle Epoetin is administered via the subcutaneous or intravenous route; a 1-inch (2.5-cm), 25-gauge needle is appropriate for either method of administration. The client's vital signs, particularly the blood pressure, need to be monitored only routinely to determine the effectiveness of the medication. Epoetin is not administered via the intramuscular route, so the Z-track technique is not used. Shaking the vial denatures the glycoprotein, making the medication biologically inactive and therefore ineffective.

A client with chronic liver disease reports, "My gums have been bleeding spontaneously." The nurse identifies small hemorrhagic lesions on the client's face. The nurse concludes that the client needs which additional supplement? bile salts folic acid vitamin A vitamin K

vitamin K Fat-soluble vitamin K is essential for synthesis of prothrombin by the liver; a lack results in hypoprothrombinemia, inadequate coagulation, and hemorrhage. Although cirrhosis may interfere with production of bile, which contains the bilirubin needed for optimum absorption of vitamin K, the best and quickest manner to counteract the bleeding is to provide vitamin K intramuscularly. Folic acid is a coenzyme with vitamins B 12 and C in the formation of nucleic acids and heme; thus, a deficiency may lead to anemia, not bleeding. Vitamin A deficiency contributes to the development of polyneuritis and beriberi, not hemorrhage.

A client is taking warfarin. If an antidote is needed, which agent will the nurse anticipate being prescribed?

vitamin k Warfarin sodium inhibits vitamin K; therefore, vitamin K is the antidote for warfarin sodium. Fibrinogen and prothrombin are blood-clotting factors, not the antidotes for warfarin sodium. Protamine sulfate is the antidote for heparin, not warfarin sodium.

The healthcare provider prescribes enalapril maleate. Which instruction should the nurse include when educating the client about the new medication?

when standing up, change position slowly Enalapril is an angiotensin-converting enzyme inhibitor and can cause postural hypotension. For safety purposes, the client should be instructed, when standing, to change positions slowly to avoid dizziness or fainting. Checking pulse rate is not indicated before administration; checking blood pressure is indicated. While electrolytes often are checked for clients with hypertension who are receiving medication therapy, weekly basic metabolic panels are not required while taking this medication. It is not necessary to take the medication with orange juice.

A client who has a long leg cast for a fractured bone is to be discharged from the emergency department. When discussing pain management, when does the nurse advise the client to take the prescribed as-needed oxycodone? just as a last resort before going to sleep as the pain becomes intense when the discomfort begins

when the discomfort begins Pain is most effectively relieved when an analgesic is administered at the onset of pain, before it becomes intense; this prevents a pain cycle from occurring. Analgesics are less effective if administered when pain is at its peak. Before going to sleep, it may or may not be necessary; the medication should be taken when the client begins to feel uncomfortable within the parameters specified by the healthcare provider's prescription. Analgesics are less effective if administered when pain is at its peak.

A client is admitted to the hospital with a diagnosis of acute pancreatitis. The health care provider's prescriptions include nothing by mouth and total parenteral nutrition (TPN). The nurse explains that the TPN therapy provides what benefit? Is the easiest method for administrating needed nutrition Is the safest method for meeting the client's nutritional requirements Will satisfy client's hunger without discomfort associated with eating Will meet client's nutritional needs without causing discomfort precipitated by eating

will meet client's nutritional needs without causing discomfort precipitated by eating Providing nutrients by the intravenous route eliminates pancreatic stimulation, therefore reducing the pain experienced with pancreatitis. TPN is used to meet the client's needs, not the nurse's needs. TPN creates many safety risks for the client. Hunger can be experienced with TPN therapy.

The nurse provides teaching to a client who has received a prescription for oral pancreatic enzymes, pancrelipase. The nurse evaluates that teaching is understood when the client identifies which time for medication scheduling?

with meals The pancreatic enzymes (amylase, trypsin, and lipase) must be present when food is ingested for digestion to take place. At bedtime the food eaten for dinner has passed beyond the duodenum; at bedtime the enzyme is given too late to aid digestion. Taking pancrelipase one hour before meals or on arising each morning will have no chyme in the duodenum on which the enzyme can act.

Carbidopa/levodopa is prescribed for a client with Parkinson disease. What will the nurse teach the client about this medication?

you may be experiencing dizziness when moving from sitting to standing Carbidopa/levodopa is a metabolic precursor of dopamine; it reduces sympathetic outflow by limiting vasoconstriction, which may result in orthostatic hypotension. Carbidopa/levodopa should be administered with food to minimize gastric irritation. Although periodic tests to evaluate hepatic, renal, and cardiovascular status are required for prolonged therapy, whether these tests should be done on a weekly basis has not been established. Carbidopa/levodopa may produce either happiness or depression, but no established pattern of such responses exists.

A client is to receive 2000 mL of intravenous (IV) fluid in 12 hours. At what rate should the nurse set the electronic infusion control device? Record your answer using a whole number.

~167 mL/hr The volume to be infused is 2000 mL. The total time of infusion is 12 hours.