NCLEX: Pharm Qbank

The nurse plans teaching for a client receiving quinapril. The nurse determines that further teaching is needed when the client makes which statements? (Select all that apply.) 1. "I should increase my intake of broccoli and bananas. " 2. "I should check my blood pressure weekly. " 3. "I should take the medication at the same time each day. " 4. "I should use a salt substitute to season meals. " 5. "I should change positions slowly when standing. " 6. "I should ask before taking over-the-counter medications. "

1) CORRECT - This client statement indicates the need for additional teaching. Quinapril is an ACE inhibitor that blocks the release of aldosterone, which promotes potassium retention. The client should avoid or limit foods high in potassium, such as broccoli and bananas. 2) INCORRECT - This client statement indicates appropriate understanding of the information regarding quinapril. Measuring blood pressure often is a positive client action when taking an antihypertensive. 3) INCORRECT - This client statement indicates appropriate understanding of the information regarding quinapril. Taking the medication on a schedule is a necessary requirement to keep the medication at a steady level and avoid hypotensive episodes. 4) CORRECT - This client statement indicates the need for additional teaching. Salt substitutes contain potassium, and this client will want to limit potassium while taking the ACE inhibitor. 5) INCORRECT - This client statement indicates appropriate understanding of the information regarding quinapril. Changing positions slowly is an appropriate action to prevent postural hypotension. 6) INCORRECT - This client statement indicates appropriate understanding of the information regarding quinapril. The client should seek medical advice before taking over-the-counter medications. This is especially important if taking over-the-counter cold medication.

The nurse teaches parents of children prescribed atomoxetine. Which information does the nurse include in the teaching? (Select all that apply.) 1. "There is a low risk of dependence with this medication." 2. "Your child may take atomoxetine with or without food." 3. "Record your child's weight weekly." 4. "Offer your child fresh fruits and vegetables daily to prevent constipation." 5. "Atomoxetine should not be taken by children under 95 pounds." 6. "Risk of suicidal thoughts may occur in children taking atomoxetine."

1) CORRECT -Atomoxetin is prescribed for attention deficit hyperactivity disorder (ADHD). When compared with other medications available to treat ADHD, atomoxetine has a low risk for dependence. 2) CORRECT - This is correct information. 3) CORRECT - Even though atomoxetine is not a stimulant, anorexia may occur, so parents should monitor their child's weight. 4) CORRECT - Atomoxetine may cause constipation. Increasing the intake of fresh fruits and vegetables (high in fiber) will help to alleviate this side effect. 5) INCORRECT - Children who weigh less than 95 lbs (43.1 kg) may safely take atomoxetine. 6) CORRECT - Suicidal ideation is an adverse effect of atomoxetine that may occur. Parents should monitor their child's mood.

The nurse provides care for a client receiving aluminum hydroxide gel. The nurse determines that teaching is effective when the client makes which statement? 1. "I will only take this medication before bedtime." 2. "I will take this medication before meals." 3. "I will take this medication 1 hour after meals." 4. "I will take this medication when I feel epigastric pain."

1) INCORRECT - Antacids must be taken several times per day to be effective. 2) INCORRECT - Aluminum hydroxide gel is most effective when taken after digestion has begun, but before the stomach has emptied. 3) CORRECT - Antacids neutralize gastric acids, increase gastric pH, and inactivate pepsin. The medications should be taken 1 hour after meals. 4) INCORRECT - The medication can be taken can be taken after pain has begun, but the medication prevents epigastric pain when taken just after the meal and before pain begins.

The nurse prepares to administer amikacin to a client diagnosed with an enterococcal infection. Which client findings cause the nurse to question administration of the medication? (Select all that apply.) 1. Reports nausea and diarrhea. 2. Has an activated partial thromboplastin time (aPTT) value of 28 seconds. 3. Receives warfarin for atrial fibrillation. 4. Smokes one pack of cigarettes a day. 5. Receives hemodialysis three times weekly.

1) CORRECT — Anti-infective medications can eradicate normal intestinal flora and lead to superinfection of the gastrointestinal and genitourinary tracts. Nausea and diarrhea are signs of superinfection. Therefore, the nurse questions the administration of this medication. 2) INCORRECT - An activated partial thromboplastin time (aPTT) of 28 seconds is within normal limits. There is no reason for the nurse to question the administration based on this data. 3) CORRECT — Anti-infective medications can eradicate normal flora, reducing the amount of vitamin K produced by these bacteria. Amikacin is an aminoglycoside and can potentiate the action of warfarin. The nurse questions the administration of this medication based on this data. 4) INCORRECT - Smoking is not a contraindication to antimicrobial therapy. There is no reason for the nurse to question the administration based on this data. 5) CORRECT — Aminoglycosides are nephrotoxic and are contraindicated in clients diagnosed with kidney impairment because toxic levels are reached rapidly. The nurse questions the administration of this medication based on this data.

The nurse reviews a prescription for glimepiride for a client with type 2 diabetes mellitus. Which entry in the client's medication record causes the nurse to question the glimepiride prescription? (Select all that apply.) 1. Propranolol.2. Gemfibrozil.3. Ginkgo biloba.4. Ginseng.5. Ibuprofen.6. Valerian.

1) CORRECT — Beta-adrenergic blocking agents may mask symptoms of hypoglycemia, which is a primary adverse effect of oral anti-diabetic agents. 2) CORRECT — Gemfibrozil increases the hypoglycemic effect of sulfonylureas. 3) INCORRECT— Ginkgo biloba does not interact with oral antidiabetic agents. This supplement interacts with anticoagulants. 4) CORRECT — Ginseng increases the hypoglycemic effect of sulfonylureas. 5) CORRECT — Ibuprofen increases the hypoglycemic effect of oral antidiabetic medications. 6) INCORRECT— Valerian does not interact with oral antidiabetic agents, but it does interact with sedative-type medications.

The nurse provides care for a client with a history of type 2 diabetes mellitus (DM). The client had an acute MI and is prescribed IV metoprolol. Which nursing interventions are required with IV metoprolol administration? (Select all that apply.) 1. Connect client to ECG. 2. Monitor for tachycardia. 3. Assess blood glucose level. 4. Administration with morphine is to be avoided. 5. Monitor for heart block. 6. Administer undiluted by direct intravenous infusion.

1) CORRECT — Clients receiving IV metoprolol should be monitored with an ECG to observe for dysrhythmias. 2) INCORRECT - Tachycardia is not associated with IV metoprolol, but bradycardia is a possible dysrhythmia. 3) CORRECT — Metoprolol is a beta-blocker and masks the symptoms of hypoglycemia and shock. The blood glucose is closely monitored. Watch for other symptoms of hypoglycemia, such as sweating, fatigue, hunger, or the inability to concentrate. 4) INCORRECT - Metoprolol is compatible with morphine. 5) CORRECT — Heart block is a possible adverse effect resulting from metoprolol, and ECG monitoring is required. 6) CORRECT— Metoprolol is administered undiluted by direct IV infusion at a rate of 5 mg over 60 seconds every 2 minutes for three doses after a myocardial infarction.

A pediatric client presents with flushed skin, generalized itching, nausea, wheezes, and inspiratory stridor after being stung by a bee. Which medication prescriptions will the nurse expect to implement for this client? (Select all that apply.) 1. IM epinephrine. 2. IV diphenhydramine. 3. IV bolus of lactated Ringer solution. 4. IV methylprednisolone. 5. Nebulized albuterol treatment.

1) CORRECT — The nurse expects to implement this medication prescription. Intramuscular (IM) epinephrine is appropriate for anaphylactic shock because it causes peripheral vasoconstriction and bronchodilation. 2) CORRECT — The nurse expects to implement this medication prescription. Intravenous (IV) diphenhydramine is appropriate for anaphylactic shock because it blocks histamine release. 3) INCORRECT - An IV bolus of lactated Ringer solution is appropriate for hypovolemic shock. However, this is not evident as this time. 4) CORRECT — The nurse expects to implement this medication prescription. Intravenous (IV) methylprednisolone is appropriate for anaphylactic shock because it treats inflammation and elevates blood pressure if needed. 5) CORRECT — The nurse expects to implement this medication prescription. A nebulized albuterol treatment is appropriate for anaphylactic shock because it opens the airways and promotes oxygenation.

The nurse provides education about influenza treatment and prevention at a local health fair. Which statement from a participant demonstrates correct understanding of oseltamivir? (Select all that apply.) 1. "I will begin taking the medication as soon as I experience flu symptoms." 2. "The capsules must be swallowed whole and never opened." 3. "If the medication upsets my stomach, I can take it with food." 4. "Children younger than 12 years should not take this medication." 5. "After I complete the medication, I will not need a yearly flu shot." 6. "I should not take this medication if I am allergic to eggs.

1) CORRECT — To lessen the severity of influenza symptoms, influenza sufferers should take oseltamivir as soon as symptoms appear. 2) INCORRECT — Capsules may be opened and mixed with flavoring if needed. 3) CORRECT — Oseltamivir may cause stomach upset, and taking it with food should decrease this adverse effect. 4) INCORRECT — Children as young as 1 year of age may take oseltamivir. 5) INCORRECT — Annual influenza immunizations are still recommended as the virus changes from year to year. Prevention is preferable to treatment, which only decreases the duration, and sometimes the intensity, of the infection. 6) INCORRECT — There is no contraindication for taking oseltamivir in persons allergic to eggs.

A client receives aminophylline 0.7 mg/kg/hr by continuous IV infusion into the left arm. Which adverse effects are important for the nurse to assess during the infusion? 1. Decreased pulse and elevated blood pressure. 2. Constipation and decreased bowel sounds. 3. Hypotension and cardiac arrhythmias. 4. Difficulty voiding and oliguria

1) INCORRECT - Aminophylline is a xanthine bronchodilator and can cause rapid pulse and dysrhythmias. 2) INCORRECT - Aminophylline causes nausea and vomiting. 3) CORRECT— Observe client receiving IV administration of medication closely for hypotension, arrhythmias, and convulsions until serum levels stabilize within therapeutic ranges. 4) INCORRECT - An increased urination may occur with toxicity.

The nurse supervises a team of LPN/LVNs. Which actions by an LPN/LVN will cause the nurse to take action? (Select all that apply.) 1. An LPN/LVN prepares to administer carvedilol to a client with a documented allergy to nadolol. 2. An LPN/LVN prepares to administer hydralazine to a client with a documented allergy to hydroxyzine. 3. An LPN/LVN prepares to administer thioridazine to a client with a documented allergy to promethazine. 4. An LPN/LVN prepares to administer ciprofloxacin to a client with a documented allergy to azithromycin. 5. An LPN/LVN prepares to administer ceftriaxone to a client with a documented allergy to cefazolin.

1) CORRECT— Carvedilol and nadolol are beta-blocker medications. An allergy to one type of beta-blocker likely means the client will be allergic to all beta-blockers. 2) INCORRECT— This medication is safe to administer as there no risk of an allergic reaction. 3) CORRECT— Thioridazine and promethazine are phenothiazine medications and should not be administered to a client who has a documented allergic reaction to promethazine. 4) INCORRECT— This medication is safe to administer as there is no risk of allergic reaction. 5) CORRECT — Ceftriaxone and cefazolin are cephalosporin medications. A documented allergic reaction to any cephalosporin dictates that no medications in this classification should be prescribed or administered to the client.

A client receives a prescription for clopidogrel. Which laboratory results are important for the nurse to monitor based on this new prescription? (Select all that apply.) 1. Hemoglobin. 2. Hematocrit. 3. Platelet count. 4. International normalized ratio (INR). 5. Activated partial thromboplastin time (aPTT).

1) CORRECT— Clopidogrel is an oral antiplatelet medication that interferes with platelet aggregation. Adverse effects include hemorrhage, bleeding, hematuria, and hemoptysis. A decreased hemoglobin may indicate bleeding. 2) CORRECT— A decreased hematocrit may indicate bleeding. 3) INCORRECT - Clopidogrel suppresses platelet aggregation, but it does not decrease platelet count. 4) INCORRECT - A prothrombin time (PT) along with an INR is useful for monitoring warfarin effectiveness. 5) INCORRECT - aPTT used to monitor effectiveness of heparin. Hemostasis refers to the cessation of bleeding from a damaged blood vessel. Coagulation, which is one step in the complex process of hemostasis, refers to blood clot formation. The coagulation cascade, which involves a complex series of chemical reactions between clotting factors, results in formation of the fibrin protein. Treatment of the client who experiences hypercoagulation may include administration of medications that (a) affect platelet function or (b) selectively target one or more mechanisms involved in the clotting cascade. Antiplatelet medications, such as clopidogrel, decrease the platelets' tendency to stick to one another and require monitoring of the client's bleeding time. Anticoagulant medications, such as warfarin, heparin, and fondaparinux sodium, alter the function of clotting factors and require monitoring of international normalized ratio (INR), prothrombin time (PT), or activated partial thromboplastin time (aPTT).

The nurse teaches a client who is prescribed prednisone for systemic lupus erythematosus (SLE). Which information related to prednisone does the nurse include in the teaching plan? (Select all that apply.) 1. Report any symptoms of infection. 2. Do not discontinue medication abruptly. 3. Take medication at bedtime. 4. Report unusual weight gain. 5. Get vaccinated for influenza. 6. Avoid salt substitutes.

1) CORRECT— Prednisone causes immunosuppression, and symptoms of infection should be reported. 2) CORRECT — Discontinuing prednisone abruptly can cause adrenal crisis. 3) INCORRECT - Prednisone should be taken before 0900 to mimic normal peak of corticosteroid blood levels. It seems to help avoid sleep disturbance that can occur with the drug. 4) CORRECT — Prednisone is associated with fluid retention and weight gain in most clients. 5) INCORRECT - Vaccinations are to be avoided when taking prednisone because of the decreased ability to mount an inflammatory response. 6) INCORRECT - Salt substitutes contain potassium that may help prevent the potential for hypokalemia that may be caused by prednisone

A client diagnosed with Addison disease comes to the emergency department experiencing nausea, vomiting, diarrhea, and abdominal pain. Which prescription does the nurse expect from the health care provider? 1. Dextrose 5% in normal saline IV solution and high-dose steroids. 2. Adrenocorticotropic hormone (ACTH) IM injection, 0.9% saline infusion, and potassium. 3. Sliding scale insulin asparte subcutaneous injection. 4. Oral administration of sodium chloride, potassium chloride, and steroids.

1) CORRECT— The client is exhibiting symptoms of Addisonian crisis, in which the client is hypotensive and experiences a severe deficiency of glucocorticosteroids. The nurse expects to administer isotonic fluid to increase fluid volume and to provide high-dose steroids to replenish the client. 2) INCORRECT - ACTH stimulates the adrenal cortex, but it does not help with Addisonian crisis. Clients with Addison disease have hyperkalemia rather than hypokalemia. 3) INCORRECT - Clients with Addison disease do not require insulin treatment. 4) INCORRECT - Sodium chloride should be administered intravenously, as clients with Addison disease experience sodium wasting. Potassium should not be administered. In this disease, the body does not have sufficient amounts of cortisol and aldosterone. Routine replacement of these hormones is required; however, when the body is stressed with another illness, the usual dosage is not sufficient. The deficit causes symptoms of acute Addisonian crisis to occur. The nurse should recognize that the client needs immediate care to balance electrolyte levels, replace fluids, and replenish hormones. The nurse will anticipate prescriptions to meet client needs.

The nurse provides discharge teaching for a client being treated with permethrin. Which client statements indicate to the nurse a correct understanding of the medication teaching session? (Select all that apply.) 1. "I leave the cream on my hair for 10 minutes before rinsing it out. "2. "I will use the cream daily until the nits are gone. " 3. "I plan to wash all my bed linens with bleach and hot water. " 4. "The cream may cause redness on my scalp and skin. " 5. "I will check my family members because this condition is easily spread. " 6. "This medication should make my itching stop. "

1) CORRECT— This is an appropriate use of permethrin. 2) INCORRECT - Permethrin is used once a week until nits and lice are gone. Using the medication more frequently can have serious adverse consequences. 3) INCORRECT - Linens should be washed in hot water and dried in the dryer; however, it is not necessary to use bleach. 4) CORRECT— Erythema and skin irritation are potential adverse effects of permethrin. 5) CORRECT— Lice and scabies spread easily and all contacts should be checked. 6) CORRECT— Once lice and nits are killed, clients should no longer experience pruritus.

A client comes to the clinic reporting muscle weakness, breathlessness, and bone pain. The nurse notes that the client takes phenytoin 100 mg three times a day. When providing nutritional counseling, which food grouping best meets this client's needs? 1. Bananas, mushrooms, yams. 2. Oranges, broccoli, papayas. 3. Milk, cantaloupe, kale. 4. Soybeans, spinach, pumpkin seeds.

1) INCORRECT - Bananas, mushrooms, and yams include some folate, but no vitamin D. 2) INCORRECT - These foods are high in vitamin C and potassium. Broccoli is a minor source of calcium. Oranges are a good source of folic acid. The papaya does supply some folic acid. None of these are sources of vitamin D. 3) CORRECT - Anticonvulsants can cause folate and vitamin D deficiencies. The client has symptoms reflective of anemia and bone resorption. Folate deficiency can cause anemia. Good sources of folate are green leafy vegetables, legumes, tomatoes, and various fruits such as oranges and cantaloupe. Good sources of vitamin D include fortified milk. Because vitamin D promotes calcium absorption, foods rich in this vitamin (e.g., kale) are also recommended. 4) INCORRECT - The spinach, soybeans, and pumpkin seeds are a good source of folate, but they do not address the client's vitamin D level.

The nurse prepares teaching material for a client prescribed levothyroxine. Which information does the nurse include when instructing the client? (Select all that apply.) 1. "Take the medication for a full 10 days, even if you feel better." 2. "Call your health care provider if you feel your heart is racing." 3. "You should have more energy once the medication has reached a therapeutic level." 4. "Ensure you have an adequate supply of medication when going on vacation." 5. "Take the medication with food, just before going to bed." 6. "Ask your health care provider before taking over-the-counter cold remedies."

1) INCORRECT - Levothyroxine must be taken for life and not just for 10 days. This statement would be included if the client is prescribed an antibiotic. 2) CORRECT — Feeling like the heart is racing may indicate that the dose is too high. Heart racing is an adverse effect of the medication. 3) CORRECT — This medication is used to treat hypothyroidism, which causes a loss of energy and feelings of lethargy. Taking the medication as prescribed should decrease these feelings. 4) CORRECT — The medication needs to be taken every day, so an adequate supply needs to be available. 5) INCORRECT - The medication should be taken in the morning on an empty stomach. 6) CORRECT — Some over-the-counter medications may interfere with levothyroxine. All over-the-counter medications should be approved by the health care provider before the client takes them.

The nurse provides care for a client receiving lithium carbonate 300 mg orally three times per day. Which clinical manifestations will the nurse identify as early indications of toxicity? (Select all that apply.) 1. Mild thirst. 2. Nausea and vomiting. 3. Coarse hand tremor. 4. Ataxia .5. Slurred speech. 6. Muscle weakness.

1) INCORRECT - Lithium is a mood stabilizer used to treat bipolar disorder. Mild thirst is an expected side effect. Other common side effects include fine hand tremor and polyuria. 2) CORRECT— Nausea and vomiting are early signs of toxicity. The nurse should withhold the medication and obtain a blood lithium level before the dose is re-evaluated. 3) INCORRECT - A coarse hand tremor is an advanced sign of toxicity. Other indications include persistent GI upset, mental confusion, and poor coordination. 4) INCORRECT - Defective, uncoordinated muscle movements indicate a severe toxicity. 5) CORRECT— Slurred speech is an early sign of lithium toxicity, along with possible diarrhea, thirst, and polyuria. 6) CORRECT— Muscle weakness is an early sign of toxicity, and the nurse should withhold the medication and obtain a blood lithium level.

A client diagnosed with a known history of substance abuse with opioids is recovering after a hysterectomy. Which actions will the nurse implement when providing care? (Select all that apply.) 1. Notifies the health care provider that the opioid prescription is twice the normal dose. 2. Determines what type and amount of opioids the client uses. 3. Administers opioids around-the-clock. 4. Uses physiological indicators of pain to confirm client's self-reported pain rating. 5. Provides nonopioid methods of pain relief.

1) INCORRECT - Opioids prescribed as pain management for a client with a history of using opioids will be at a much higher dosage than for clients without the same history of use. 2) CORRECT — The nurse should evaluate the medication prescription to avoid the opioid that was abused. 3) CORRECT — The medication should be provided around-the-clock to maintain a steady opioid level and prevent symptoms of withdrawal. 4) INCORRECT - The nurse does not need to use physiological indicators of pain to confirm the client's pain rating. The nurse needs to trust the client's report of pain. 5) INCORRECT - Withholding opioids will lead to symptoms of withdrawal and should not be done. Many postoperative clients will experience acute pain, which should be treated with an opioid medication. The nurse needs to be aware of difficulty with pain management because of the client's history of opioid abuse. The prescribed medication should be provided around the clock to reduce the risk of withdrawal symptoms. The type of opioid medication that the client abused should be evaluated so that the same medication is not used to treat postoperative pain; using the same medication can result in poor pain management with safe doses of the medication.

A child is prescribed pancrelipase. The nurse observes that the child has trouble swallowing the capsule. Which action by the nurse is best? 1. Instruct the child to chew the capsule thoroughly, take a deep breath, close the eyes, then swallow the capsule. 2. Open the capsule, sprinkle the contents onto applesauce, and instruct the child to swallow the applesauce without chewing. 3. Open the capsule, pour the contents into a glass of milk, and instruct the child to drink the milk slowly. 4. Crush the capsule and give the remains to the child using a spoon and small sips of water.

1) INCORRECT - The capsules should not be chewed. The capsule contents are enteric-coated microspheres. Damaging them by chewing or crushing would not allow the drug to survive the acidic environment of the stomach, and would also release digestive enzymes into the mouth. 2) CORRECT — The capsule can be opened since it contains enteric-coated microspheres. The contents should be mixed into a small amount of cool, soft food such as applesauce. The applesauce should then be swallowed immediately without chewing. Swallowing whole ensures that the microspheres will survive until reaching the intestines. 3) INCORRECT - The capsules can be opened since their contents are enteric-coated microspheres. However, pancreatic enzymes should not be mixed with milk, ice cream, or similar products because pancreatic enzymes curdle milk and formula. 4) INCORRECT - The capsules should not be crushed.

The nurse instructs a client on the use of antibiotic eye drops as treatment after cataract surgery. Which client statement indicates that further teaching is necessary? 1. "The drops should go into the center of the lower eyelid." 2. "I should not let the drops flow from one eye into the other." 3. "I should close my eye tightly after I put in each drop." 4. "I should tilt my head back to put in the drops."

1) INCORRECT - The drop should be placed in the lower conjunctival sac. The client should wash hands before instilling the drops. The client should look up while pulling the lower lid down when instilling the drops. 2) INCORRECT - The drops should not be permitted to flow across the nose into the opposite eye. The dropper should not touch the eye. 3) CORRECT— The client should blink between drops but should not close the eye tightly because it would cause the drop to be expelled. The client should be instructed to press the inner angle of the eye after instillation to prevent systemic absorption of the medication. 4) INCORRECT - Tilting the head back helps position the client for proper placement of the eye drops.

An infant who is prescribed digoxin 0.02 mg/kg by mouth in divided doses is sleeping and has a regular heart rate of 80 beats/min. Which action does the nurse take? 1. Stimulate the sole of the infant's foot to recheck heart rate. 2. Give the medication as prescribed and document the heart rate in the medical record. 3. Withhold the medication and immediately notify the health care provider. 4. Ask another nurse to recheck the infant's heart rate.

1) INCORRECT - The medication is given according to the client's resting heart rate. The client should not be stimulated. 2) INCORRECT - A normal heart rate for an infant is 120 to 140 (resting). Bradycardia is a rate below 80 to 100 beats per minute. The nurse should withhold the medication if rate is below 90 to 110 beats per minute. Excessive slowing of the heart beat may indicate digitalis toxicity. 3) CORRECT— The nurse should withhold the medication if the heart rate is below 90 to 110 beats per minute. Excessive slowing of the heart beat may indicate digitalis toxicity. 4) INCORRECT - It is not necessary to ask another nurse to recheck the infant's heart rate. The medication should not be given.

The nurse performs teaching for a client receiving clonidine via transdermal patch. Which statement made by the client indicates that teaching is successful? 1. "I like the new heart-healthy meals that can be microwaved." 2. "I will change the patch every 7 days." 3. "I will cut the used patch into four pieces before disposing of it." 4. "I use an electric blanket to keep warm at night."

1) INCORRECT - The nurse should instruct the client to be cautious around the microwave because leaking radiation can heat the patch's metallic backing and result in burns. 2) CORRECT— Clonidine is a centrally acting alpha-adrenergic used to treat hypertension. The client should apply to a non-hairy site every 7 days. Side effects include drowsiness, sedation, and orthostatic hypotension. 3) INCORRECT - The client should fold the used patch and either flush it down the toilet or place in a sharps container for return to the health care provider. The patch should not be cut, as medication may be retained on the scissor blades and transferred to hands or other objects. 4) INCORRECT - The use of a heating pad or blanket is contraindicated. An outside heat source will increase skin vasodilation and result in increased absorption of medication via the skin.

he nurse on the medical unit reviews laboratory results on four clients. Which result causes the nurse to notify the health care provider? 1. Theophylline level 15 mcg/mL (83.25 µmol/L ) for a client diagnosed with emphysema. 2. Digoxin level 2.5 ng/mL (3.2 nmol/L) for a client diagnosed with heart failure. 3. International normalized ratio (INR) 2.5 for a client who takes warfarin. 4. Lithium level of 1.2 mEq/L (1.2 mmol/L) for a client diagnosed with bipolar disorder.

1) INCORRECT - The therapeutic range for theophylline is 10 to 20 mcg/mL (56-111 µmol/L). Toxicity occurs with levels over 20 mcg/mL (111 µmol/L). Theophylline is a xanthine-derivative bronchodilator. 2) CORRECT - The normal therapeutic level of digoxin in the blood is between 0.5 and 2 ng/mL (0.6-2.6 nmol/L). The client with a digoxin level of 2.5 ng/mL (3.2 nmol/L) has digoxin toxicity, and this should be reported to the health care provider. Digoxin is a cardiac glycoside and a positive inotrope. 3) INCORRECT - The therapeutic range for the INR for a client prescribed warfarin varies by diagnosis, but it is generally 2 to 3. The optimal dose of warfarin prolongs the prothrombin time, which reduces the risk for clotting. 4) INCORRECT - The therapeutic range of lithium for the initial management is 1 to 1.5 mEq/L (1-1.5 mmol/L). The therapeutic range for maintenance is 0.8 to 1.2 mEq/L (0.8-1.2 mmol/L). This client's lithium level is within the therapeutic range.

The nurse provides care for a client with a history of heart failure. The health care provider writes prescriptions for the client. Which prescription does the nurse question? 1. Digoxin 0.25 mg PO in a.m. 2. Oxygen at 4 L/min per nasal cannula. 3. Verapamil 120 mg orally three times daily. 4. Furosemide 40 mg IV push now.

1) INCORRECT - This dose of digoxin is an appropriate prescription. It is a cardiac glycoside used to treat heart failure. 2) INCORRECT - Oxygen at 4 L/min is an appropriate prescription. 3) CORRECT - Verapamil is contraindicated in clients diagnosed with heart failure and in clients taking digoxin, because it can cause severe bradycardia. 4) INCORRECT - Furosemide is an appropriate prescription. It is a loop diuretic that eases symptoms of heart failure.

he nurse instructs a client about trimethoprim/sulfamethoxazole. The nurse needs to intervene if the client makes which statements? (Select all that apply.) 1. "I am being prescribed this medication because I have a bacterial infection." 2. "I should take the medication with food." 3. "This medication is safe during pregnancy." 4. "I should notify my health care provider if I develop nausea or abdominal pain." 5. "I should wear sunscreen while taking this medication."

1) INCORRECT - This statement does not require the nurse to intervene. The prescribed medication is sulfa-based and often used to treat bacterial infections such as UTIs. 2) CORRECT— This statement requires intervention by the nurse. Trimethoprim/sulfamethoxazole should be taken on an empty stomach 1 hour before, or 2 hours after, meals. 3) CORRECT— This statement requires intervention by the nurse. Trimethoprim/sulfamethoxazole is a pregnancy category C medication and may pose a risk to a fetus. 4) INCORRECT - This statement does not require the nurse to intervene. The development of hepatitis is a risk with trimethoprim/sulfamethoxazole. Clinical manifestations indicating hepatitis include nausea and abdominal pain. This data should be reported to the health care provider. 5) INCORRECT - This statement does not require the nurse to intervene. Skin photosensitivity may develop for the client who is prescribed this medication. The client should wear sunscreen and limit sun exposure during treatment.

The nurse provides care for clients in the outpatient clinic. Which client statements require intervention by the nurse? (Select all that apply.) 1. "While I 'm on gentamicin, I will call my health care provider if I have ringing in my ears. " 2. "I will limit fluids while on gentamicin to reduce damage to my kidneys. " 3. "Since I 'm taking ciprofloxacin, I will remember to go to the outpatient lab in a few days for blood work. " 4. "While I am taking ciprofloxacin, I will ask my spouse to take care of the yard work if it is sunny. " 5. "I know my child will be weighed by the health care provider before the dose of cefazolin is prescribed. " 6. "After receiving cefazolin in the hospital, I need to let my health care provider know if I have diarrhea. "

1) INCORRECT - Tinnitus is a potential adverse effect of gentamicin, so this is a correct statement and does not require intervention by the nurse. 2) CORRECT— The nurse should educate the client to increase fluids to minimize kidney damage while on gentamicin. 3) CORRECT— The nurse should instruct the client that medication levels are not needed while on ciprofloxacin. 4) INCORRECT - It is correct to avoid direct sunlight while taking a fluoroquinolone such as ciprofloxacin. 5) INCORRECT - It is correct that cefazolin doses are weight-based in children. 6) INCORRECT - It is correct that a common side effect of cefazolin and other cephalosporin medications is diarrhea. The health care provider may advise the client to take an anti-diarrheal medication, depending on the severity of gastrointestinal distress.

The nurse in a community clinic evaluates a client diagnosed with type 1 diabetes mellitus. Which observation indicates to the nurse that the client is not rotating insulin injection sites? 1. Wheal present at an injection site. 2. Discomfort at an injection site. 3. Glucose levels rise temporarily. 4. Increased muscle mass at an injection site.

1) INCORRECT — A wheal at an injection site indicates an allergic reaction to the insulin. 2) INCORRECT — Repeated injections into the same site become less painful rather than more uncomfortable. 3) CORRECT — Failure to rotate sites results in poor absorption of the insulin, which increases the blood glucose level. 4) INCORRECT — Increased muscle mass is not a complication of repeated insulin injections in the same site. Lipodystrophy, or an increase or decrease in fatty tissue, may occur.

A client comes to the clinic and reports general sadness, exhaustion, and a loss of interest in activities. The client is interested in taking St. John's wort. Which medications, currently prescribed to the client, cause the nurse to be concerned? (Select all that apply.) 1. Hydrochlorothiazide.2. Digoxin.3. Nifedipine.4. Simvastatin.5. Escitalopram.6. Metformin.

1) INCORRECT — There is no known interaction between hydrochlorothiazide and St. John's wort. 2) CORRECT — St. John's wort decreases the effectiveness of digoxin, so this prescription concerns the nurse. 3) CORRECT — St. John's wort decreases the effectiveness of nifedipine, so this prescription concerns the nurse. 4) CORRECT — St. John's wort decreases the effectiveness of simvastatin, so this prescription concerns the nurse. 5) CORRECT — St. John's wort can cause serotonin syndrome when taken with escitalopram. Therefore, this prescription concerns the nurse. 6) INCORRECT — There is no known interaction between St. John's wort and metformin.

The nurse provides care for a client receiving chemotherapy. The medication is an alkylating agent. Which actions will the nurse implement to minimize adverse effects? (Select all that apply.) 1. Prevent ileus formation by encouraging frequent ambulation. 2. Administer anti-emetics prophylactically and as needed. 3. Offer frequent high fat meals to prevent weight loss. 4. Teach client to use saline mouth rinse before and after meals. 5. Encourage client to increase fluid intake for the next 3 days .6. Educate client about the benefits of exercise to manage fatigue.

1) INCORRECT- Ileus formation is not a common side effect of chemotherapeutic medications. 2) CORRECT - Nausea and vomiting are common and should be prevented if possible. 3) INCORRECT- A high protein, nutrient-dense, high calorie diet is recommended to prevent weight loss. Clients should not choose high fat items solely for their fat content, unless the items also contain necessary nutrients, such as the calcium found in ice cream. 4) CORRECT - Stomatitis is a common adverse effect of chemotherapy, and it may be prevented or minimized with meticulous oral care. Salt water, usually mixed with baking soda, is used to rinse the mouth after every meal as a way to reduce particles and reduce oral acidity. 5) CORRECT - Cystitis occurs with many chemotherapeutic agents and may be prevented with increased fluid intake. 6) CORRECT - Mild to moderate exercise, along with frequent rest periods, will help to manage the fatigue often experienced during chemotherapy.

The client takes beclomethasone by metered dose inhaler (MDI). Which statement made by the client indicates that teaching is successful? 1. "I know it is time to have the prescription refilled when the canister floats in water." 2. "I will rinse my mouth and throat with water after each dose." 3. "I will be sure not to shake the canister before I use it." 4. "If the dose does not help, I will take extra and let the health care provider know the results

1) INCORRECT- Most MDIs have dose counters; however, if an MDI does not come with this option, a more accurate method of calculating doses is to count them. The MDI prescription should be refilled when the canister is nearly empty. 2) CORRECT- Beclomethasone is a corticosteroid. Inhaled corticosteroids can predispose the client to fungal oropharynx infection (candidiasis). Rinsing the mouth and gargling with warm water when each treatment is completed is imperative to remove residual medication and prevent the onset of infection. 3) INCORRECT- The canister should be shaken thoroughly before use to disperse and mix the medication with the propellant. 4) INCORRECT- The medication should be used exactly as it was prescribed. If the dose is not effective, the health care provider (HCP) is consulted. An overdose could result in hypertension, palpitations, angina, and dysrhythmias.

The nurse prepares an injection of glargine insulin at a client's bedside. Which client statements indicate a need for further teaching by the nurse? (Select all that apply.) 1. "I usually give myself this insulin in my stomach." 2. "I'd like you to mix this with my regular insulin, so I only have to have one shot." 3. "I always take this insulin just before I take my sleeping pill when I am at home." 4. "I will need a snack in about a half hour to prevent my blood glucose from going too low." 5. "My sister told me that I can get an insulin pump that will automatically inject this insulin throughout the day and night." 6. "My health care provider said when my infection heals, we may be able to decrease the amount of insulin I take."

1) INCORRECT- The abdomen is an appropriate place to administer insulin. The statement indicates that teaching was effective. 2) CORRECT - Glargine should not be mixed in a syringe with any other insulin. 3) INCORRECT- Taking the insulin before a sleeping pill at home is appropriate. Glargine should be given at the same time each day, usually at night. There are no known interactions between insulin and sedatives. 4) CORRECT - Glargine has no peak action. The onset of glargine is 3 to 4 hours, and it lasts 24 hours. 5) CORRECT - Glargine is given once daily, not continuously, as it is a long-action insulin. Insulin pumps use short- acting or rapid-acting insulins. 6) INCORRECT- Infection may temporarily increase the need for insulin. After an infection heals, the dose may need to be adjusted downward.

The nurse provides care to a client who sustained severe crush injuries of both legs during a motor vehicle crash. The client is diagnosed with rhabdomyolysis. The nurse anticipates the health care provider will prescribe which intervention for the client? 1. Potassium chloride. 2. Fluid restriction.3. Epoetin alfa.4. Mannitol.

1) INCORRECT— For the client with rhabdomyolysis, cellular destruction allows the release of intracellular potassium (K +) into the bloodstream. Administration of potassium chloride is contraindicated for the client with rhabdomyolysis, as the client is already at high risk for hyperkalemia (increased serum potassium). 2) INCORRECT— Fluid restriction is not an appropriate intervention for the client with rhabdomyolysis. For the client with rhabdomyolysis, administration of crystalloid IV fluid is the primary treatment. Rhabdomyolysis is characterized by the release of massive quantities of myoglobin from damaged muscle cells, as well as the release of intracellular potassium due to cell lysis. Administration of IV fluid is essential to preserving kidney function and promoting excretion of myoglobin and potassium. 3) INCORRECT— Epoetin alfa is administered to stimulate erythropoiesis (red blood cell production) in the client diagnosed with chronic renal disease. Epoetin alfa also may be administered for treatment of clients diagnosed with anemia due to pharmacologic agents (e.g., chemotherapy medications and zidovudine). 4) CORRECT— Administration of mannitol, an osmotic diuretic, is an appropriate intervention for the client diagnosed with rhabdomyolysis. Rhabdomyolysis is characterized by the release of massive quantities of myoglobin from damaged muscle cells, as well as the release of intracellular potassium (K +) due to cell lysis. Mannitol is administered to promote excretion of substances, including myoglobin and potassium. The nurse gives the client with rhabdomyolysis mannitol to reduce edema and compartment syndrome as a result of crush injuries. To monitor effectiveness, the nurse anticipates an increased urine output (in crush injury, a urine output of 300 mL or more is recommended, and volumes of up to 12 liters/24 hours may be required). In rhabdomyolysis, intravenous hydration coupled with diuresis is thought to decrease the risk of myoglobin-associated acute tubular damage and acute kidney injury. Alkalinizing the urine with bicarbonate-containing fluids to a urine pH greater than 6.5 may reduce the aggregation of myoglobin in the kidney.

The nurse teaches a client diagnosed with chronic gout about the prescribed allopurinol. Which client statements indicate that teaching has been effective? (Select all that apply.) 1. "I should never crush my allopurinol." 2. "I need to decrease my fluid intake to 1 liter a day." 3. "I need to switch to decaffeinated coffee." 4. "If I miss a dose, I should take an extra dose the next day." 5. "I should increase my intake of milk and yogurt." 6. "I can use ibuprofen for discomfort."

1) INCORRECT— It is safe to crush allopurinol as the medication is not extended release. 2) INCORRECT— The client needs to increase fluid intake to 2 liters a day when taking allopurinol. 3) CORRECT — Caffeine should be avoided because it increases uric acid production, which could exacerbate the symptoms of gout. 4) INCORRECT— The client should not double dose with allopurinol if one is missed. 5) INCORRECT— Dairy products, refined sugar, and meat should be limited in the diet of the client with chronic gout. 6) CORRECT — Non-steroidal anti-inflammatory medications are safe to take during an acute attack of gout.

The nurse provides care for an African-American client diagnosed with hypertension in a cardiac unit. Which medication prescription does the nurse question for this client? 1. Hydralazine hydrochloride. 2. Atenolol. 3. Chlorothiazide. 4. Nifedipine.

1) INCORRECT— There is no need to question this prescription. Hydralazine is a direct vasodilator. It lowers blood pressure by relaxing the smooth muscles, especially of arteries and arterioles, and decreasing the peripheral resistance. 2) CORRECT — Atenolol is a beta-adrenergic inhibitor (beta blocker) that slows heart rate and decreases cardiac contractility and cardiac output, thereby lowering blood pressure. Beta blockers are less effective in African Americans than they are in Caucasians and should be questioned in an African-American client with hypertension. 3) INCORRECT— There is no need to question this prescription. Chlorothiazide is a thiazide diuretic. It promotes water and sodium excretion, thereby lowering blood pressure. Diuretics are especially effective with African-American clients. 4) INCORRECT— There is no need to question this prescription. Nifedipine is a calcium channel blocker. It stops calcium movement into the cells, thereby relaxing smooth muscle and causing vasodilation. Calcium channel blockers are particularly effective in older clients and in African-American clients.

The client is placed on cephalexin prophylactically after surgery. Which foods will the nurse encourage the client to eat? 1. Bran cereals and fruits. 2. Egg whites and lean meats. 3. Yogurt and acidophilus milk. 4. Fish and poultry meats.

3) CORRECT — Yogurt and acidophilus milk will help maintain normal intestinal flora, which may be altered by cephalexin. The nurse should encourage the client to eat these foods. Foods high in fiber or protein will not help return the balance of normal intestinal flora.

The nurse obtains a history from a client who is prescribed rosuvastatin. Which client report is most important for the nurse to report to the health care provider? 1. Rash. 2. Headache.3. Abdominal pain.4. Muscle tenderness.

4) CORRECT- Even though it is rare, one of the greatest risks to a client who is taking rosuvastatin (Crestor) is myositis, or muscle inflammation, that can progress to rhabdomyolysis. Therefore, a client report of muscle tenderness is the priority for the nurse to report to the health care provider. The nurse should recall the purpose, mechanism of action, and side or adverse effects of the prescribed medication. Rosuvastatin is a medication used to lower cholesterol. The nurse is aware medications in this classification (lipid lowering) has rhabdomyolysis as an adverse effect, which begins with muscle aching and soreness. Since the client is experiencing muscle tenderness, the medication will most likely need to be discontinued. The nurse should report the client's symptom to the health care provider for evaluation and adjustments in medication prescriptions.