NCLEX LPN Pharmacological Parenteral Therapies

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The LPN/LVN prepares to draw up medication from an ampule. The LPN/LVN should take which of the following actions? Select all that apply: 1. Perform hand hygiene. 2. Snap the neck of the ampule toward the hands. 3. Draw the medication slowly out of the ampule. 4. Expel aspirated air bubbles into the ampule. 5. Set ampule on flat surface and aspirate medication. 6. Cover needle with safety sheath.

Determine the outcome of each answer. Is it appropriate? (1.) CORRECT— decreases transmission of microorganisms (2.) exposes the LPN/LVN to shattering glass; snap neck away from hands (3.) exposes medication to airborne contaminants; draw up medication quickly (4.) air pressure will force medication out of ampule; remove needle from ampule and expel air bubbles (5.) CORRECT— ampule can also be held upside down (6.) CORRECT— appropriate action

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

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

The nurse cares for a client receiving cimetidine (Tagamet) by continuous IV infusion. The physician has ordered 900 mg infused over 24 hours. The medication is mixed in 500 cc of D 5 W and the IV unit delivers 60 drops per ml. The nurse should adjust the flow rate to deliver how many drops per minute? Type the correct answer into the blank.

Strategy: Correct answer: 21

Strategy: Correct answer: 21 500 x 60/ 1440 = 30000/1440= 21 drops/minute

The nurse cares for a client receiving gentamycin (Garamycin) IV. The physician orders the medication to be administered IV piggyback in 100 mL D 5 W over 30 minutes. The IV set delivers 15 drops per mL. Record the number of drops per minute the client should receive. Type a whole number in the blank.

Strategy: Correct answer: 50

Strategy: Correct answer: 50 100 x 15/30 = 1500/30 = 50 drops/minute

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

Strategy: total volume x drop factor/ total time in minutes Correct answer: 8

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

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

The LPN/LVN knows that the medication is absorbed BEST by a client with a major burn by way of which of the following routes? 1. Intramuscularly. 2. Orally. 3. Intravenously. 4. Topically.

Strategy: "BEST" indicates discrimination may be required to answer the question. (1) fluid shift during emergent post-burn phase causes limited absorption from subcutaneous and intramuscular spaces (2) oral route not an option because client likely to be in shock or physical resources need to be routed to the burn rather than to GI tract for absorption and metabolism of drugs (3) CORRECT—fluid shift during emergent post-burn phase causes limited absorption from subcutaneous and intramuscular spaces; administer medication before painful procedures; keep environment warm to prevent shivering (4) because peripheral blood vessels have been destroyed, absorption is poor; inappropriate if goal is for drug to have systemic effect; most drugs used to promote healing of burn wounds are topical; localized effect is desired

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

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

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

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

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

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

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

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

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

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

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

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

The LPN/LVN cares for a client with an IV ordered to infuse at 100 mL/hr into the left arm. Five hours after the IV is started, the LPN/LVN notes that 250 cc of IV fluids have infused. Which of the following actions by the LPN/LVN is MOST appropriate? 1. Notify the health care provider. 2. Assess the client's lung sounds and skin turgor. 3. Note the client's intake and output during the previous 24 hours. 4. Tell the next shift the client's volume of IV solution is behind.

Strategy: "MOST appropriate" indicates discrimination is required to answer the question. (1) CORRECTcommon practice to adjust IV rate up to 25% without consulting with health care provider; to infuse the IV in the remaining 5 hours, the rate would have to be increased to 150 ml/hr, which is an increase of 33% (2) infusing the IV fluid too rapidly can result in hypervolemia, exhibited by lung congestion; volume received is less than prescribed (3) compromised renal function should be considered when administering IV solutions; the IV solution deficit is not related to renal function (4) nurse should immediately intervene

The LPN/LVN cares for a client receiving IV fluids. The order reads, "1,000 mL D51/2 NS @ 150 mL/hr." After the IV has infused for 3 hours and 20 minutes, the LPN/LVN notes that 500 ml are remaining in the IV. Which of the following actions by the LPN/LVN is MOST appropriate? 1. Recalculate IV flow rate. 2. Notify the health care provider. 3. Determine if new IV rate is appropriate for the particular client. 4. Place IV on infusion pump.

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

Strategy: Think about each answer. (1) nitroglycerin does not treat anxiety (2) angina occurs because of inadequate perfusion tissue perfusion to heart, not because of inflamed cardiac tissue (3) CORRECT—nitroglycerin is used to produce coronary artery dilation; anginal pain is caused by ischemia or lack of oxygen to the heart muscle; by dilating coronary arteries, more blood and therefore more oxygen reaches the heart (4) nitro is a vasodilator, not an antidysrhythmic

Strategy: "MOST appropriate" indicates that discrimination may be required to answer the question. (1) more commonly associated with pernicious anemia; duodenal ulcers cause pain 2 to 3 hours after meals and during the early sleeping hours of the night; food intake relieves pain (2) more commonly associated with gastroesophageal reflux disease (GERD) (3) CORRECT— signs/symptoms are absent or reduced within 7 days; client often discontinues medications even though the ulcer has not healed; LPN/LVN needs to emphasize the importance of continuing to ingest the medications; Carafate is a cytoprotective agent; side effects include constipation, vertigo, and flatulence; give 2 hours after Tagamet; Tagamet is an H2-receptor blocker, side effects include diarrhea, dizziness; large doses produce confusion in the elderly (4) needs to know about disease; emphasis on drug therapy is more important because clients are apt to discontinue treatment when signs/symptoms are relieved

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

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

The LPN/LVN prepares to administer the initial doses of furosemide (Lasix) to a client. It is MOST important for the LPN/LVN to review the client's chart for which of the following client data? 1. Allergy to sulfa drugs. 2. Intake and output for the previous 24 hours. 3. Admission weight and current weight. 4. Signs/symptoms of infection.

Strategy: "MOST important" indicates discrimination is required to answer the question. (1) CORRECT— furosemide (Lasix) is a sulfa-based drug; sulfa is a common allergen; Lasix is a loop diuretic; side effects include hypotension, hypokalemia (2) may monitor to determine client's response to diuretic; more concerned about intake and output after client takes medication (3) since is diuretic, can significantly alter weight; not necessary before administering drug (4) no impact on infectious processes

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

Strategy: "MOST important" indicates discrimination is required to answer the question. (1) CORRECT—Cushing's syndrome is hypersecretion of adrenal hormones; common manifestation of Cushing's syndrome: increased sodium, increased blood pressure, decreased potassium, and hyperglycemia; to counteract the hyperglycemia, it may be necessary to give insulin (2) used to treat hypothyroidism (3) Cushing's syndrome causes decreased libido; ingestion of a female hormone will not improve the problem (4) clients with Cushing's syndrome have excessive amounts of cortisone; goal of therapy is to reduce the levels

The LPN/LVN cares for clients in the outpatient clinic. A client develops onychomycosis while serving a tour of duty in the military, and the health care provider prescribed terbinafine HCl (Lamisil) 250 mg PO daily. It is MOST important for the LPN/LVN to instruct the client to report the following? 1. Unexplained fatigue and jaundice. 2. Vaginal itching with drainage. 3. Decreased urinary output. 4. Generalized rash.

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

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

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

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

Strategy: "MOST important" indicates discrimination is required to answer the question. (1) cimetidine (Tagamet) is an H2-receptor blocker; postoperative clients are more prone to PUD; medication given prophylactically; interaction with other drugs places client more at risk (2) CORRECT—this category of drugs interferes with a long list of drugs; anytime drugs are prescribed, LPN/LVN should conduct a review of other categories to determine the degree of interactions and the risks to the client (3) common side effect is aplastic anemia; LPN/LVN needs to be aware of current blood cell levels; primary concern with drug ingestion is to determine if significant drug interactions may occur (4) appropriate assessment, since medication is prescribed for PUD; priority is to determine if there are any potential drug interactions

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

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

The nurse in the long-term care facility cares for a client receiving chlordiazepoxide (Librium) 10 mg PO bid due to the unexpected death of her son. After administering the medication, it is MOST important for the LPN/LVN to instruct the nursing assistants to monitor the client for the following? 1. Skeletal muscle spasms and insomnia. 2. Anorexia and dry mouth. 3. Diarrhea and euphoria. 4. Drowsiness and confusion.

Strategy: "MOST important" indicates discrimination is required to answer the question. (1) dystonia (muscle spasms) is side effect of thioridazine (Mellaril), and insomnia is caused by selective serotonin reuptake inhibitors (SSRIs) (2) side effect of Ritalin is anorexia; dry mouth caused by the tricyclic antidepressants (3) more likely to experience constipation and depression (4) CORRECT—chlordiazepoxide (Librium) causes CNS depressant effects of drowsiness and sedation; caution should be used when driving or operating equipment; confusion may indicate an immediate need for reduction of dosage

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

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

The physician prescribes phenazopyridine hydrochloride (Pyridium) and trimethoprim/sulfamethoxazole (Bactrim) for a client. It is MOST important for the LPN/LVN to include which of the following statements to the client? 1. "You may experience dizziness and lethargy." 2. "Your urine will become bright orange in color." 3. "You will notice that your urine will be more dilute." 4. "You may experience some pain when urinating."

Strategy: "MOST important" indicates discrimination is required to answer the question. (1) phenazopyridine hydrochloride (Pyridium) has an anesthetic action on urinary mucosa and should be taken with food; trimethoprim/sulfamethoxazole (Bactrim) used to treat urinary tract infections, and side effects include nausea, vomiting, rashes, and hypersensitivity reactions; neither medication causes dizziness or lethargy (2) CORRECT—phenazopyridine hydrochloride (Pyridium) discolors urine red or orange and may stain fabrics; red or orange urine could be upsetting to client not prepared to see it (3) with a urinary tract infection, should force fluids to 3,000 cc per day, which will make the urine more dilute (4) burning on urination, urgency, and frequency are indications of a UTI; phenazopyridine hydrochloride (Pyridium) soothes the urethra

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

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

The LPN/LVN cares for a client diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) infection of an abdominal wound. The physician orders vancomycin (Vancocin) 15 mg/kg q 12 h. It is MOST important for the LPN/LVN to report which of the following? 1. Decreased white blood cells (WBCs) and increased eosinophils. 2. Decreased urinary output and ototoxicity. 3. Large amount of mucoid wound drainage. 4. Delayed healing with healing by second intention.

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

Because the LPN/LVN administers lithium (Lithobid) to the clients on an inpatient unit, it is MOST important for the LVN/LPN to instruct the nursing assistants to take which of the following actions? 1. Report the development of skin eruptions. 2. Monitor intake and output. 3. Report frequent urination. 4. Report vomiting and diarrhea.

Strategy: "MOST important" indicates discrimination may be required to answer the question. (1) may develop acne, but is not the most relevant side effect listed (2) important to monitor I and O and report significant changes; encourage client to drink 2,000-3,000 cc fluid daily (3) side effect of the drug and needs to be monitored; drug can result in dehydration and electrolyte imbalance; sodium loss can result in decreased lithium retention (4) CORRECT—vomiting, diarrhea, slurred speech, decreased coordination are indications of lithium toxicity; withhold dose and report to health care provider

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

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

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

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

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

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

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

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

The LPN/LVN assists in instructing a client diagnosed with type 1 diabetes about the correct method for administering insulin. Which of the following statements, if made by the client to the LPN/LVN, requires a follow-up? 1. "I will use my abdomen for the morning injection." 2. "I will inject insulin into my left arm prior to weight training." 3. "I will carry hard candy with me at all times." 4. "I will eat a piece of fruit prior to exercising."

Strategy: "Requires a follow-up" indicates incorrect information. (1) it is preferable that the client consistently use the same anatomic area at the same time of the day to reduce variations in the absorption rate of insulin (2) CORRECT—should not inject insulin into limb that will be exercised because absorption will be faster and could cause hypoglycemia (3) appropriate action to treat insulin reaction (4) appropriate action; will prevent hypoglycemia

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

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

The LPN/LVN notes orders for a client admitted with acute cholecystitis. The client has severe nausea and vomiting and reports severe abdominal pain radiating to the right shoulder. The LPN/LVN should question which order? 1. Insert nasogastric tube and attach to intermittent low suction. 2. Trimethobenzamide hydrochloride (Tigan) 200 mg per rectum (PR) tid. 3. Morphine 15 mg IM q 4 h prn. 4. Nothing by mouth.

Strategy: "Should question which of the following orders" indicates an incorrect order. (1) appropriate action for severe nausea and vomiting; achieves decompression of stomach (2) antiemetic; may cause drowsiness or dizziness (3) CORRECT— even though morphine might cause spasms of the sphincter of Oddi and further pain, it still is ordered and effective for pain relief (4) NPO decreases stimulation of gallbladder and will help prevent nausea and vomiting

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

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

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

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

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

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

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

Strategy: 1 g = 1,000 mg. Correct answer: 0.88

The physician orders streptomycin sulfate 0.4 g IM BID. After reconstituting a 1-g vial of streptomycin sulfate with 3.5 mL of water for injection, the vial contains 250 mg/mL. How many mL per dose should the nurse administer? Type the correct answer in the blank.

Strategy: 1 g = 1,000 mg. Correct answer: 1.6

Strategy: 1 g = 1,000 mg. Correct answer: 1.6 250 mg/1 mL = 400 mg/ X mL X = 1.6 mL

The nurse cares for clients on the pediatric unit. The physician orders ampicillin (Omnipen) 90 mg/kg PO QID for a 22-lb child. The label on the multidose bottle reads 300 mg/5 mL. How many mL should the nurse administer for each dose? Type the correct answer in the blank.

Strategy: 1 kg = 2.2 lb. Correct answer: 15 2.2 lb /1 kg = 22 lb/ X kg =10 kg 1 kg/ 90 mg = 10 kg/ X mg = 900 mg 300 mg/5 mL = 900 mg/ X kg = 15 ml

To deliver 3,000 cc of D5W in 24 h using an administration set that delivers 15 gtt/mL, the LPN/LVN determines that the flow rate should be which of the following? 1. 15 gtt/min. 2. 31 gtt/min. 3. 69 gtt/min. 4. 80 gtt/min.

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

The nurse cares for children on the pediatric unit. A physician orders doxycycline (Vibramycin) 4.4 mg/kg IV once per day for a child weighing 88 lb. Record the correct amount of medication, in mg, that the child should receive for each dose. Type the correct answer into the blank.

Strategy: 2.2 lb = 1 kg Correct answer: 176

Strategy: 2.2 lb = 1 kg Correct answer: 176 X mg/40 kg = 4.4 mg/ 1 kg X = 176 mg

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

Strategy: 2.2 pounds = 1 kg Correct answer: 750

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

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

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

Strategy: Do the math. Correct answer: 160 3.5 hr × 60 min/hr = 210 min 210 min × 4 ml/min = 840 ml 1,000 ml - 840 ml = 160 ml left at 3:30 PM

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

Strategy: Do the math. Correct answer: 550 1800 ml/12 hr = 150 ml/hr +250 = 400 ml 150 cc x 2 = 300 ml +250 = 550

The LPN/LVN informs a client diagnosed with angina about common side effects of nitroglycerin, including which of the following? 1. Palpitations, hypertension, and tachycardia. 2. Flushing, bradycardia, and muscle weakness. 3. Dizziness, headache, and hypotension. 4. Flushing, vertigo, and seizures.

Strategy: If answer has multiple parts, all parts of the answer have to be correct. (1) increases collateral blood flow and causes dilation of coronary arteries; will cause hypotension, not hypertension (2) causes tachycardia and dizziness from vasodilation (3) CORRECT—because of the vasodilation, common side effects of nitroglycerin include dizziness, headache, and hypotension (4) does not cause seizures

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

Strategy: If the IV set delivers 60 drops per minute, drops per minute equals mL per hour. Correct answer: 10

Strategy: If the IV set delivers 60 drops per minute, drops per minute equals mL per hour. Correct answer: 10 40 drops/min = 40 ml/hr 400 mL/40 mL/hr = 10 hr

The physician orders a patient to receive D 5 W 100 cc/h and to discontinue the IV after the fluids have infused. The nurse hangs D 5 W 1,000 cc at 0545. What time (in military time) does the nurse anticipate discontinuing the IV fluids? Type the correct answer in the blank.

Strategy: Miliary time uses a 24 hour time scale. To calculate times after 12 noon, add the time to 1200. Correct answer: 1545 Ten hours from 0545 would be 0545 + 1000 = 1545.

Strategy: Miliary time uses a 24 hour time scale. To calculate times after 12 noon, add the time to 1200. Correct answer: 1545 100 cc/ 1 h = 1000 cc/ X h X = 10 h Ten hours from 0545 would be 0545 + 1000 = 1545.

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

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

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

Strategy: Perform the math. Correct answer: 150

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

Strategy: Perform the math. Correct answer: 20

The health care provider orders a heparin drip for a client with cardiac disease. The order reads "2,000 units of heparin per hour." The IV solution contains 20,000 units of heparin in 500 mL of 5% dextrose in water. The nurse should regulate the client's IV to deliver how many mL per hour?

Strategy: Perform the math. Correct answer: 50

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

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

The LPN/LVN understands that the chief advantage of methadone use for drug addiction is because of which of the following? 1. Methadone is less addictive than heroin. 2. Methadone relieves the withdrawal effects of heroin. 3. Methadone has no street value and cannot be abused. 4. Methadone makes the client sick if he takes heroin with it.

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

A client with heart failure (HF) comes to the cardiac clinic complaining of anorexia, nausea, and blurred vision. The LPN/LVN understands these symptoms indicate that the client may be experiencing which of the following? 1. Cardiac tamponade. 2. Hyperkalemia. 3. Myocardial infarction. 4. Digitalis toxicity.

Strategy: Think about each answer. (1) because of compression of heart caused by fluid within the pericardial sac, is life-threatening alteration; signs/symptoms are more pronounced, such as falling blood pressure, narrowing pulse pressure, rising venous pressure, and muffled heart sounds; can occur with blunt chest trauma, cardiac catheterization, metastasis, and heart failure; signs/symptoms do not match this alteration (2) blood potassium >5.0 mEq/L; more likely to be below normal; digoxin is most commonly prescribed drug and is K+ depleting (3) symptoms include dyspnea, chest pain, nausea, vomiting, apprehension (4) CORRECT—landmark treatment of HF is digoxin;, vomiting, anorexia, and visual disturbances are all signs of digitalis toxicity, as well as bradycardia; normal range for digoxin is 0.5 to 2.0 ng/mL

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

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

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

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

The LPN/LVN cares for clients in the pediatric clinic. A child is diagnosed with attention deficit hyperactivity disorder (ADHD), and the health care provider prescribes atomoxetine HCL (Straterra) 45 mg PO daily. The LPN/LVN notes the medication is available in 10, 25, and 40 mg capsules. Which of the following actions by the LPN/LVN is BEST? 1. Administer half 10 mg capsule and one 40 mg capsule. 2. Administer two 10 mg capsules and one 25 mg capsule. 3. Contact the prescribing health care provider. 4. Administer half 40 mg capsule and one 25 mg capsule.

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

The LPN/LVN cares for a client diagnosed with angina. The LPN/LVN explains to the client that nitroglycerin is used in the treatment of angina pectoris for which of the following reasons? 1. Prevents attacks precipitated by anxiety. 2. Decreases inflammation. 3. Produces coronary artery dilation. 4. corrects drug-induced dysrhythmias.

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

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

After 2 weeks of chemotherapy treatments, a client's white blood cell count is 2,000/mm3. The LPN/LVN knows that this finding is most likely due to which of the following? 1. Infection. 2. Bone marrow depression. 3. Weight loss. 4. Polycythemia.

Strategy: Think about each answer. (1) normal white blood cell count is 4,500 to 11,000/mm3; decreased white blood cell counts will cause infection; place client in private room; meticulous hand washing; monitor for signs of infection (2) CORRECT—chemotherapy causes bone marrow depression (3) chemotherapy causes nausea and vomiting, which can lead to weight loss; cancer also contributes to weight loss (4) hematocrit that is persistently >55%; treatment is repeated phlebotomy

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

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

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

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

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

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

The nurse cares for a client receiving 2,500 ml intravenous fluid in 24 hours. The nurse determines that the client should receive how many milliliters of fluid in 3 hours? Type the correct answer into the blank

2500 ml/24 hr = x ml/ 3 hr 500/24x = x = 312.5 ml/hr

The LPN/LVN instructs a client with hypertension that a common side effect of methyldopa (Aldomet) is which of the following? 1. Dysrhythmias. 2. Loss of potassium. 3. Loss of libido. 4. Tachycardia.

Strategy: Think about each answer. (1) change in the heart rhythm is a common side effect of nicardipine (Cardene), a calcium channel blocker (2) thiazide diuretics cause hypokalemia (3) CORRECT—methyldopa (Aldomet) is a centrally acting sympatholytic antihypertensive that reduces peripheral vascular resistance; has a side effect of reduce of or loss of libido (4) causes bradycardia

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The home health LPN/LVN visits a client diagnosed with multiple sclerosis. The client is receiving interferon beta-1a (Avonex). The client reports to the LPN/LVN that she periodically has fever, chills, and myalgia. Which of the following responses by the LPN/LVN is MOST appropriate? 1. "You should contact your physician." 2. "Avonex causes flu-like symptoms." 3. "Have you felt more fatigued lately?" 4. "Have you taken the prescribed acetaminophen?"

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

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

Strategy: "MOST appropriate" indicates that discrimination may be required to answer the question. (1.) the dose will have to be repeated, but LPN/LVN should assist the client (2.) CORRECT— dose will have to be repeated, medication works only if instilled in the conjunctival sac; LPN/LVN assists client while maintaining client's independence (3.) should immediately repeat procedure (4.) is not helpful to client

The home care LPN/LVN cares for a client complaining of chronic low back pain. The physician orders naproxen (Naprosyn) 500 mg bid. Prior to client taking the initial dose, it is MOST important for the LPN/LVN to take which of the following actions? 1. Instruct the client to take the initial dose 30 minutes before eating. 2. Inform the client to take medication exactly as prescribed. 3. Determine if the client has experienced photosensitivity in the past. 4. Ask client to report changes in skin color.

Strategy: "MOST important" indicates discrimination is required to answer the question. (1) CORRECT— initial dose should be taken on empty stomach to cause a rapid initial response; after the initial dose, can be given with food (2) appropriate instruction; more important to take initial dose on empty stomach to alleviate pain more quickly (3) does cause photosensitivity; instruct client to wear sunscreen and protective clothing (4) drug-induced hepatitis is common side effect; is appropriate teaching parameter; priority is to instruct client about initial dose

The LPN/LVN instructs a client in the outpatient clinic about probenecid (Benemid). It is MOST important for the LPN/LVN to make which of the following statements? 1. "Drink at least 6 to 8 glasses of water each day." 2. "Take the medication on an empty stomach." 3. "You may take aspirin for minor pain." 4. "You are permitted to drink wine with dinner."

Strategy: "MOST important" indicates that discrimination is required to answer the question. (1.) CORRECT—probenecid (Benemid) is an antigout medication that increases the excretion of uric acid; increased fluids will increase the excretion of uric acid (2.) take with milk, food, or antacids to decrease GI distress (3.) because of compounded side effects, clients with gout should avoid all products containing aspirin (4.) avoid alcohol because it increases urate levels

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

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

The home care LPN/LVN cares for a client receiving prophylactic isonicotinic acid hydrazide (INH) 5 mg/kg/day. The LPN/LVN determines that teaching is successful if the client states which of the following? 1. "I take vitamin B6 every day." 2. "I will eat a snack when I take INH." 3. "I will get a repeat tuberculin skin test after 90 days of treatment" 4. "I have to take warfarin (Coumadin) while taking INH."

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

Salicylic acid (aspirin) is prescribed for a client. The LPN/LVN should administer this medication with which of the following? 1. A glass of milk. 2. A glass of orange juice. 3. A glass of diet soda. 4. A small amount of water.

Strategy: Determine the outcome of each answer. Is it desired? (1.) CORRECT—take with food, milk, or a large glass of water to reduce GI upset (2.) vitamin C will increase the absorption of iron (3.) caffeine may increase the absorption of aspirin (4.) take with a large glass of water

The nurse administers phenobarbital 120 mg orally to a 3-year-old child. The label on the multidose vial reads 160 mg/5mL. How many mL of phenobarbital should the nurse administer? Type the answer in the blank. Record the answer to the tenths place. Do not round.

Strategy: Follow the rounding rules given in the stem of the question. 160 mg/5 mL = 120 mg/X X = 3.75 mL or 3.7 mL

A type 1 diabetic client asks the LPN/LVN why she can't "take a pill" for her diabetes. Which of the following responses by the LPN/LVN is BEST? 1. "Oral hypoglycemics stimulate beta cells in the pancreas to release the insulin your pancreas has produced." 2. "Oral hypoglycemics supply exogenous insulin, which enhances the transfer of glucose into cells." 3. "Oral hypoglycemics supply exogenous insulin, which restores efficient sugar and fat utilization." 4. "Oral hypoglycemics stimulate adipose tissue to release endogenous insulin."

Strategy: Think about each answer. (1) CORRECT—hypoglycemics act by stimulating beta cells in the pancreas to release endogenous insulin; some oral hypoglycemics also facilitate insulin's action on peripheral receptor sites; other oral hypoglycemics delay the absorption of glucose in the intestinal tract (2) action of insulin (3) insulin transports and metabolizes glucose for energy, stimulates storage of glucose in the liver and muscle in the form of glycogen, enhances the storage of dietary fat in adipose tissue (4) not the action of oral hypoglycemics

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

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

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

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

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

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

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

The LPN/LVN cares for a client diagnosed with type 1 diabetes. The LPN/LVN understands that which of the following types of insulin has the longest duration of action? 1. Regular. 2. Ultralente. 3. NPH. 4. Humulin R.

Strategy: Think about each answer. (1) onset half hour; peak 2.5 to 5 hours; duration 8 hours (2) CORRECT—onset 4 hours; peak 10 to 30 hours; duration 36 hours (3) onset 1.5 hours; peak 4 to 12 hours; duration 24 hours (4) onset one-half to 1 hour; peak 2 to 4 hours; duration 6 to 8 hours

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

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

The LPN/LVN knows that the major difference between preop medication given before general surgery and that given before cesarean section includes which of the following? 1. The overall dosage of medication is lower. 2. The dosages of sedatives and hypnotics are lower. 3. The amount of narcotic given is lower. 4. All medications are routinely withheld.

Strategy: Think about each answer. (1) the dosage of sedatives or hypnotics usually remains the same; potentiate the analgesic action of lower-dose narcotic (2) remains the same (3) CORRECT lower level of narcotic given to prevent respiratory depression in the infant and drowsiness at birth; reversal of narcotics can be achieved by administering Narcan to the mother 15 min before delivery (4) preoperative medication is administered before cesarean section

The LPN/LVN cares for pediatric clients. The LPN/LVN determines that the correct dose of acetaminophen (Tylenol) for a pediatric client is 1.7 mL. Which of the following actions by the LPN/LVN is MOST appropriate? 1. Pour the dose into a calibrated medicine cup. 2. Round the dose of medication to the next whole number. 3. Assess the client's temperature. 4. Draw up medication in a syringe.

Strategy: Topic of question is unstated. (1) not the most accurate method for measuring a small amount of medication (2) exceeds prescribed dosage (3) no reason to measure temperature (4) CORRECT—most accurate method to measure small volume; pediatric population more easily effected by overdose

The home care LPN/LVN participates in the evaluation of the medications prescribed for a client diagnosed with chronic closed-angle glaucoma. It is MOST important for the LPN/LVN to report to the supervising nurse that the client is taking which of the following medications? 1. Pilocarpine sulfate (Isopto-Carpine). 2. Acetazolamide (Diamox). 3. Atropine sulfate. 4. Dipivefrin (Propine). Show/hide explanation Strategy: "MOST important" indicates that discrimination is required to answer the question. (1.) miotic used to treat glaucoma by pulling pupil away from cornea (2.) goal of treatment of glaucoma is to lower intraocular pressure by decreasing production of or to increase outflow of aqueous humor; drug decreases production (3.) CORRECT—atropine is a mydriatic that results in pupillary dilation forcing the pupil against the cornea, resulting in a decreased angle; use of this type of medication in a client with narrow-angle glaucoma may result in blindness (4.) because decreases production of aqueous humor, is used to treat open-angle glaucoma (chronic glaucoma)

Correct answer: 550

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

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

A 5-year-old is scheduled for a tonsillectomy and adenoidectomy. The child is given midazolam (Versed) preoperatively. The LPN/LVN understands that the purpose for administering this medication includes which of the following? 1. Decrease the child's gag reflex. 2. Decrease the child's psychological responses. 3. Enhance the child's wound healing. 4. Decrease secretions from the child's mucous membranes.

Strategy: Think about each answer. (1)more common with topical Xylocaine (2)CORRECT—reduces anxiety and causes amnesia and sedation; is excellent for use in children because of short duration and rarely causes respiratory depression (3)diet high in protein and vitamin C will enhance wound healing (4)more commonly associated with atropine sulfate

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

Strategy: Think about each answer. (1.) anticonvulsant: decreases dysrhythmic brain activity (2.) CORRECT—Sinemet is a dopamine agonist or a decarboxylase inhibitor; it prevents peripheral destruction of levodopa; levodopa has an inhibiting affect on motor activity; in Parkinson's the inhibitory effect is lost (3.) anti-ulcer medication; has no effect on signs and symptoms of Parkinson's (4.) stimulates respirations

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

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

NCLEX LPN Pharmacological Parenteral Therapies

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