Patho/Pharm: Cardiac Saunder's Questions

The nurse is administering 0.5 inch of nitro-paste, a coronary vasodilator. How much paste should the nurse apply to the application paper? 1. 0.5 in aka 1 line 2. 1 in 3. 1 ½ in 4. 2 in

Answer: 1 Rationale: 1. A. The line is in increments of 0.5 (1/2inch) and the order is 0.5 inch, or 1/2inch; therefore, the nurse should apply this much paste. 2. B. This would be 1 inch, which is twice the prescribed dose of medication. 3. C. This would be 11/2inches, which is not the correct dose. 4. D. This would be 2 inches, which is not the correct dose.

The home health-care nurse is visiting a client diagnosed with deep vein thrombosis who is taking warfarin (Coumadin), an oral anticoagulant. The nurse assesses a large hematoma on the abdomen and multiple small ecchymotic areas scattered over the body. Which intervention should the nurse implement? 1. Send the client to the emergency department immediately. 2. Encourage the client to apply ice to the abdominal area. 3. Inform the client that this is expected when taking this medication. 4. Instruct the client to wear a Medic Alert bracelet at all times.

Answer: 1 Rationale: 1. Abnormal bleeding is a sign of Coumadin overdose; the client needs to be assessed immediately and have a Stat International Normalized Ratio (INR) laboratory test. 2. Ice causes vasoconstriction, but this bleeding is abnormal and will not stop without medical treatment. 3. Abnormal bleeding to this extent is not expected while receiving Coumadin therapy. 4. This is an appropriate teaching intervention for clients receiving Coumadin, but this is not an appropriate intervention at this time.

The client with arterial occlusive disease is taking clopidogrel (Plavix), an antiplatelet medication. Which statement by the client warrants intervention by the nurse? 1. "I am taking the herb ginkgo to help improve my memory." 2. "I am a vegetarian and eat a lot of green, leafy vegetables." 3. "I have not had any blood drawn in more than a year." 4. "I always use a soft-bristled toothbrush to brush my teeth."

Answer: 1 Rationale: 1. Ginkgo, an herb, can increase bleeding when taken with an antiplatelet medication such as aspirin or Plavix. Therefore, this statement warrants intervention and the nurse should encourage the client to quit taking ginkgo. Ginkgo has been shown to have a beneficial effect of increasing blood flow to the brain, but in this case, the risk of bleeding warrants the nurse's intervention. 2. Green, leafy vegetables would interfere with warfarin (Coumadin) anticoagulant therapy, not with antiplatelet medications; therefore, this would not warrant intervention by the nurse. 3. Antiplatelet medication does not require routine bloodwork to determine effective-ness; therefore, this would not warrant intervention by the nurse. 4. Soft-bristled toothbrushes should be used to help prevent abnormal bleeding. MEDICATION MEMORY JOGGER: Some herbal preparations are effective, some are not, and a few can be harmful or even deadly. If a client is taking an herbal supplement and a conventional medicine, the nurse should investigate to determine if there is a possible intervention that could cause harm to the client. The nurse should always be the client's advocate.

The client on telemetry is showing multifocal premature ventricular contractions. Which antidysrhythmic medication should the nurse administer? 1. Lidocaine. 2. Atropine. 3. Adenosine. 4. Epinephrine.

Answer: 1 Rationale: 1. Lidocaine suppresses ventricular ectopy and is a first-line drug for the treatment of ventricular dysrhythmias. 2. Atropine decreases vagal stimulation, which increases the heart rate and is the drug of choice for asystole, complete heart block, and symptomatic bradycardia. 3. Adenosine is the drug of choice for terminating paroxysmal supraventricular tachycardia by decreasing the automaticity of the sinoatrial node and slowing conduction through the AV node. 4. Epinephrine constricts the periphery and shunts the blood to the central trunk and is the first medication administered to a client in a code.

The client diagnosed with angina is prescribed nitroglycerin (Nitrobid) and tells the nurse, "I don't understand why I can't take my Viagra. I need to take it so that I can make love to my wife." Which statement is the nurse's best response? 1. "If you take the medications together, you may get very low blood pressure." 2. "You are worried your wife will be concerned if you cannot make love." 3. "If you wait at least 8 hours after taking your nitroglycerin (NTG), you can take your Viagra." 4. "You should get clarification with your HCP about your taking Viagra."

Answer: 1 Rationale: 1. Life-threatening hypotension can result with concurrent use of nitroglycerin and sildenafil (Viagra). 2. This is a therapeutic response, which is not appropriate because the nurse must make sure the client understands the importance of not taking the medications together. 3. The client should not take Viagra within 24 hours of taking nitrates, but the client should be instructed not to take Viagra at all while taking Nitrobid, which is an oral medication taken daily. 4. The nurse should provide the client with correct information about medication and should not rely on the HCP for medication teaching.

The client diagnosed with polycythemia vera is being discharged. Which discharge instruction should the nurse teach the client? 1. Take the anticoagulant warfarin (Coumadin) as ordered. 2. Do not abruptly stop taking prednisone, a steroid. 3. Rise slowly from a seated position to prevent hypotension. 4. Restrict fluids to 1000-1500 mL per day.

Answer: 1 Rationale: 1. Polycythemia vera is a malignant over-production of red blood cells. The blood becomes viscous and has a tendency to clot. Anticoagulants are ordered to prevent clot formation. 2. Steroids are not ordered for polycythemia vera. 3. Clients diagnosed with polycythemia vera develop hypertension as a result of the in-creased red blood cell volume. The viscosity of the blood causes increased resistance in the blood vessels. 4. The blood is "thick" (viscous) so fluids are increased, not limited.

The male client at the outpatient clinic was diagnosed with folic acid deficiency anemia and was given a sample of oral folic acid. At the follow-up visit the nurse assesses the client to determine effectiveness of the treatment. Which data indicates the treatment is effective? 1. The client has gained 2 pounds and has pink buccal mucosa. 2. The client does not have any paresthesias of the hands and feet. 3. The client stopped drinking any alcoholic beverage. 4. The client can tolerate eating green, leafy vegetables.

Answer: 1 Rationale: 1. Symptoms of folic acid deficiency include pallor, pale mucous membranes, fatigue, and weight loss. A weight gain and pink buccal mucosa indicate an improvement in the client's condition and that the medication is effective. 2. Paresthesias of the hands and feet are symptoms of vitamin B12deficiency, not of folic acid deficiency. The lack of neuro-logical symptoms is the differentiating fac-tor used to diagnosis folic acid deficiency because the anemias share most other symptoms. 3. One of the main causes of folic acid deficiency anemia is chronic alcoholism, but abstaining from alcohol would not indicate the anemia is better. 4. The client should be encouraged to eat green, leafy vegetables, but tolerance of foods does not indicate effectiveness of the medication. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

The client diagnosed with arterial hypertension is receiving furosemide (Lasix), a loop diuretic. Which data indicates the medication is effective? 1. The client's 8-hour intake is 1800 mL and the output is 2300 mL. 2. The client's blood pressure went from 144/88 to 154/96. 3. The client has had a weight loss of 1.3 kg in 7 days. 4. The client reports occasional light-headedness and dizziness.

Answer: 1 Rationale: 1. The client has had 500 mL (2300 -1800 = 500) excess urinary output. This indicates the medication is effective—the diuretic is causing an increase in urinary output. 2. This blood pressure has increased; there-fore, the medication is not effective. 3. A weight loss of 1.3 kg (2.6 pounds) in 7 days would not indicate a loss of fluid; it could be a loss of fat. Remember 1000 mL equals about 1 kg (2.2 pounds). 4. These are signs of orthostatic hypotension and do not indicate the medication is effective. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

The nurse is administering 0900 medications to the following clients. Which client should the nurse question administering the medication? 1. The client receiving a calcium channel blocker who drank a glass of grapefruit juice. 2. The client receiving a beta blocker who has an apical pulse of 62 beats per minute. 3. The client receiving a nitroglycerin patch who has a blood pressure of 148/92. 4. The client receiving an antiplatelet medication who has a platelet count of 150,000.

Answer: 1 Rationale: 1. The client receiving a calcium channel blocker (CCB) should avoid grapefruit juice because it can cause the CCB to rise to toxic levels. 2. The apical heart rate should be greater than60 beats per minute before a beta blocker is administered; because the apical pulse is 62, the nurse should administer this medication. 3. The nitroglycerin patch should be held if the client's blood pressure is less than90/60; because it is above that, the nurse should not question administering this medication. 4. The client's platelet count is not monitored when administering medication. MEDICATION MEMORY JOGGER: Grapefruit juice can inhibit the metabolism of certain medications. Specifically, grapefruit juice inhibits cytochrome P450-3A4 found in the liver and the intestinal wall. The nurse should investigate any medications the client is taking if the client drinks grape-fruit juice.

The nurse is preparing to hang the next bag of heparin to a client diagnosed with deep vein thrombosis. The client's current laboratory values are as follows: PT 12.7 (Control 12.9); PTT 62 (Control 36); INR 1. Which intervention should the nurse implement? 1. Hang the intravenous bag at the same rate. 2. Order a STAT PT/INR/PTT. 3. Notify the health-care provider. 4. Assess the client for abnormal bleeding.

Answer: 1 Rationale: 1. The therapeutic range for heparin is 1.5 to 2.0 times the control, or 54 to72. The client's PTT of 62 indicates the client is within therapeutic range and the next bag should be administered at the same rate. 2. The client's PTT is within therapeutic range; therefore, there is no need to order any further laboratory studies. 3. The HCP need not be notified of the client's situation because the client's PTT is within therapeutic range. 4. The client's PTT is within therapeutic range. This level does not indicate a potential for abnormal bleeding.

The health-care provider prescribed a beta blocker for the client diagnosed with arterial hypertension. Which statement is the scientific rationale for administering this medication? 1. This medication decreases the sympathetic stimulation to the heart, thereby decreasing the client's heart rate and blood pressure. 2. This medication prevents the calcium from entering the cell, which helps decrease the client's blood pressure. 3. This medication prevents the release of aldosterone, which decreases absorption of sodium and water, which, in turn, decreases blood pressure. 4. This medication will cause an increased excretion of water from the vascular system, which will decrease the blood pressure.

Answer: 1 Rationale: 1. This is the correct scientific rationale for administering this medication. 2. This is the scientific rationale for a calcium channel blocker. 3. This is the scientific rationale for an angiotensin-converting enzyme inhibitor. 4. This is the scientific rationale for a diuretic.

The client with coronary artery disease is prescribed cholestyramine, a bile-acid sequestrant. Which intervention should the nurse implement when administering the medication? 1. Administer the medication with fruit juice. 2. Instruct the client to decrease fiber when taking the medication. 3. Monitor the cholesterol level before giving medication. 4. Assess the client for upper-abdominal discomfort.

Answer: 1 Rationale: 1. This medication should be administered with water, fruit juice, soup, or pulpy fruit (applesauce, pineapple) to reduce the risk of esophageal irritation and imp intervention. 2. The client should increase, not decrease, fiber consumption while taking this medication to help decrease constipation. 3. The cholesterol level is initially monitored monthly and then at longer intervals. 4. There is no reason for the nurse to assess the client for upper-abdominal discomfort because this is not a potential complication of this medication.

The client taking digoxin (Lanoxin), a cardiac glycoside, has a serum digoxin level of 4.2 ng/mL. Which medication should the nurse anticipate the HCP prescribing? 1. The digitalis binder Fab antibody fragments (Digibind). 2. The loop diuretic furosemide (Lasix). 3. The HCP will not prescribe any medications. 4. The cardiac glycoside digoxin (Lanoxin).

Answer: 1 Rationale: 1. When digoxin overdose is suspected, as it would be with a digoxin level of 4.2 ng/mL. Fab antibody fragments bind digoxin and prevent it from acting. The therapeutic range of digoxin is 0.5-1.2 ng/mL and toxic range is 2.0 ng/mL or higher. 2. This digoxin level is extremely high and requires stopping the medication and prescribing the antidote. Lasix is not an antidote for digoxin. 3. The nurse should anticipate the HCP prescribing a medication to lower the digoxin level. 4. The level is above the toxic range, and the nurse should not administer any more digoxin—it could be fatal.

The nurse is preparing to administer spironolactone (Aldactone), a potassium-sparing diuretic. Which priority intervention should the nurse implement? 1. Check the client's potassium level. 2. Monitor the client's urinary output. 3. Encourage consumption of potassium-rich foods. 4. Give the medication with food.

Answer: 1 Rationale: 1. When preparing to administer a potassium-sparing diuretic, the nurse should check the potassium level because both hyperkalemia and hypokalemia can result in cardiac dysrhythmias that are life threatening. Therefore, checking potassium level is a priority nursing intervention. 2.Monitoring the client's output is more appropriate for determining the effective-ness of the medication. It is not data that would prevent the nurse from administering the medication. 3. The client should not eat potassium-rich foods because this medication retains potassium. 4. This medication can be administered with or without food; therefore, this is not a priority intervention.

The client is complaining of severe chest pain radiating down the left arm and is nauseated and diaphoretic. The HCP suspects the client is having a myocardial infarction (MI) and has ordered morphine sulfate (MS), a narcotic analgesic, for the pain. Which interventions should the nurse implement? Select all that apply. 1. Instruct the client not to get up out of the bed without notifying the nurse. 2. Administer the morphine sulfate (MS) intramuscularly in the ventral gluteal muscle. 3. Dilute the morphine sulfate (MS) to a 10-mL bolus with normal saline. 4. Administer the morphine sulfate (MS) slowly over 5 minutes. 5. Question the order because morphine sulfate (MS) should not be administered to a client with a myocardial infarction (MI).

Answer: 1, 3, 4 Rationale: 1. The client should not get out of the bed without assistance due to the drowsiness the client will experience after receiving MS. Also, the client is having chest pain and should not get out of the bed without assistance. 2. Morphine sulfate should not be administered intramuscularly to a client with a suspected MI because it will take longer for the medication to take effect and it can skew the cardiac enzyme results. 3. Morphine sulfate is the drug of choice for chest pain, and it is administered intravenously so that it acts as soon as possible, within 10-15 minutes. Intravenous push medications should be diluted to help decrease the pain when it is administered and to prevent irritation to the vein. 4. An intravenous push also allows the nurse to inject the medication more accurately over the 5-minute administration time. 5. Morphine sulfate should not be questioned; it is the medication of choice and the nurse should know it is always administered intravenously for a client with an MI.

The client is receiving an intravenous infusion of heparin. The bag hanging has 10,000 units of heparin in 100 mL of D5W. The HCP has ordered the medication to be delivered at 1000 units per hour. At what rate would the nurse set the intravenous pump?

Answer: 10 mL per hour Rationale: 10 mL per hour. When setting the intravenous pump the nurse must first determine the number of units per mL. 10,000 units/100 mL = 100 units per mL. Then divide the desired number of units per hour by the units per mL. 1000 ÷ 100 = 10

The client with arterial occlusive disease has been taking 325 mg of aspirin daily for 1 month. The client tells the nurse, "I have been having a lot of stomach pain." Which priority intervention should the nurse implement? 1. Instruct the client to take a non-enteric-coated aspirin. 2. Encourage the client to take the medication with food. 3. Discuss the need to take only one 81-mg aspirin a day. 4. Tell the client to notify the health-care provider.

Answer: 2 Rationale: 1. Aspirin causes gastric irritation and the best way to prevent this is to take enteric-coated aspirin, not a non-enteric-coated aspirin. Enteric-coated aspirin will be absorbed in the intestines and not in the stomach. 2. The client should take the aspirin with food to help prevent gastric irritation, and the nurse should instruct the client to take an enteric-coated aspirin. 3. A baby aspirin or a regular aspirin can cause gastric irritation, so the nurse should instruct the client to take an enteric-coated aspirin. 4. The nurse can provide correct information about the client's complaint. The nurse is not prescribing it because the client is already taking the medication.

The nurse is preparing to administer warfarin (Coumadin), an anticoagulant. The client's current laboratory values are as follows: PT 38 (Control 12.9); PTT 39 (Control 36); INR 5.9 Which intervention should the nurse implement? 1. Discontinue the intravenous bag immediately. 2. Prepare to administer AquaMEPHYTON (vitamin K). 3. Notify the health-care provider to increase the dose. 4. Administer the medication as ordered.

Answer: 2 Rationale: 1. Coumadin is administered orally. There is no reason to discontinue an IV. 2. AquaMEPHYTON is the antidote for Coumadin toxicity. The therapeutic range for the INR is 2-3. With an INR of 5.9, this client is at great risk for hemorrhage and should be given the vitamin K. 3. The dose should not be administered because it is above the therapeutic range. The dose should be held until the therapeutic range is obtained. 4. Administering this medication is a medication error that could possibly result in the death of the client. MEDICATION MEMORY JOGGER: When trying to remember which laboratory value correlates with which anticoagulant, follow this helpful hint: "PT boats go to war (warfarin) and if you cross the small "t's" in "Ptt" with one line it makes an "h" (heparin).

The client on strict bed rest is prescribed subcutaneous heparin. Which data indicates the medication is effective? 1. The client's current PT is 22, the INR is 2.4, and the PTT is 70. 2. The client's calves are normal size, are normal skin color, and are non-tender. 3. The client performs active range-of-motion exercises every 4 hours. 4. The client's varicose veins have reduced in size and appearance.

Answer: 2 Rationale: 1. Heparin has a very short half-life, and to achieve a therapeutic level it must be administered intravenously. Subcutaneous heparin is used prophylactically to prevent deep vein thrombosis (DVT). Laboratory tests are not monitored for this route. 2. Subcutaneous heparin is used prophylactically to prevent deep vein thrombosis. Symptoms of a DVT include calf edema, redness, warmth, and pain on dorsiflexion. Lack of these symptoms indicates the client does not have a DVT and that, therefore, the medication is effective. 3. ROM exercise is an intervention and does not indicate the medication is effective. 4. In most people, the appearance of varicose veins will improve when the legs are elevated. Remember, however, that varicose veins are superficial veins and that subcutaneous heparin is not used to treat this condition. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

Which statement indicates to the nurse that the client with coronary artery disease (CAD) understands the medication teaching for taking aspirin, an antiplatelet, daily? 1. "I will probably have occasional bleeding when taking this medication." 2. "I will call 911 if I have chest pain unrelieved and I will chew an aspirin." 3. "If I have any ringing in my ears, I will call my health-care provider." 4. "I should take my daily aspirin on an empty stomach for better absorption."

Answer: 2 Rationale: 1. If the client experiences any abnormal bleeding, the HCP should be notified. 2. Aspirin is administered as an antiplatelet to prevent coronary artery occlusion. It is not administered for chest pain. If the client has chest pain that is not relieved with NTG, the client should call the Emergency Medical Services (EMS)and get medical treatment immediately. Taking an extra aspirin may prevent further cardiac damage. 3. Tinnitus, ringing in the ears, is a symptom of aspirin toxicity, but the client taking one aspirin a day would not be at risk for this symptom. 4. Aspirin is very irritating to the gastric mucosa and should be taken with food to help prevent gastric irritation resulting in ulcers. Enteric-coated aspirin is used to help prevent this complication.

The nurse is caring for a client newly diagnosed with immune-hemolytic anemia. Which medication should the nurse anticipate the HCP ordering? 1. Filgrastim (Neupogen), a hematopoietic growth factor. 2. Methylprednisolone (Solu-Medrol), a glucocorticoid. 3. A transfusion of red blood cells. 4. Leucovorin (folinic acid), a blood former.

Answer: 2 Rationale: 1. In immunohemolytic anemias, the client's own immune system attacks and destroys red blood cells. The client does not have leukopenia (low white blood cells) for which Neupogen is administered. 2. The first-line therapy for immunohemolytic anemia is steroids, which are temporarily effective in most clients. Splenectomy followed by immune suppressive therapy usually follows. Plasma exchange therapy may be done if immune suppressive therapy is not successful. 3. Red blood cells are seen by the body as nonself and are attacked. A transfusion is not indicated for this client. 4. Leucovorin is administered in megaloblastic anemia or as rescue factors for methotrexate toxicity, not for immunohemolytic anemias.

The nurse is preparing to administer a calcium channel blocker, a loop diuretic, and a beta blocker to a client diagnosed with arterial hypertension. Which intervention should the nurse implement? 1. Hold the medication and notify the HCP on rounds. 2. Check the client's blood pressure. 3. Contact the pharmacist to discuss the medication. 4. Double-check the health-care provider's orders.

Answer: 2 Rationale: 1. Many clients with hypertension are prescribed multiple medications to help decrease the blood pressure. There is no need to hold the medication or notify the HCP. 2. These medications all work in different parts of the body to help decrease the client's blood pressure. The nurse should realize the HCP is having difficulty controlling the client's blood pressure and should monitor the client's blood pressure prior to administering. 3. Multiple antihypertensive medications are prescribed to help control a client's blood pressure; therefore, there would be no need for the nurse to contact the pharmacist. 4. The nurse should not question administering multiple antihypertensive medications that work on different parts of the body; this is an accepted standard of care.

The client who has had a gastric bypass surgery asks the nurse, "Why do I need to take vitamin B12 injections?" Which statement is the nurse's best response? 1. "You have pernicious anemia, and the injections will cure the problem." 2. "Your body cannot absorb the vitamin from the food you eat." 3. "Since the surgery you cannot eat enough food to get the amount you need." 4. "You will need to take the injections daily until your body begins to make B12."

Answer: 2 Rationale: 1. Pernicious anemia is a disease caused by the body's lack of intrinsic factor needed to absorb vitamin B12from the food ingested. There is no cure for the disease; there is only treatment with cyanocobalamin, vitamin B12. This client has not been identified as having pernicious anemia. 2. The rugae in the stomach produce intrinsic factor, which is necessary for the absorption of vitamin B12 from the food eaten. A gastric bypass surgery eliminates much of the surface area of the stomach and the rugae so the client cannot absorb vitamin B12. The client will need to replace vitamin B12, which is needed for the production of red blood cells. 3. The problem is not in the amount of food eaten; it is the lack of rugae in the stomach lining. 4. The injections are given on a weekly or monthly schedule depending on the severity of the deficit of the vitamin. The body does not make vitamin B12 on its own; the body absorbs the vitamin from the foods ingested.

The client diagnosed with a myocardial infarction is receiving thrombolytic therapy. Which data warrants immediate intervention by the nurse? 1. The client's telemetry has reperfusion dysrhythmias. 2. The client is oozing blood from the intravenous site. 3. The client is alert and oriented to date, time, and place. 4. The client has no signs of infiltration at the insertion site.

Answer: 2 Rationale: 1. Reperfusion dysrhythmias indicate the thrombolytic therapy is effective; it indicates that the cardiac tissue is being perfused. 2. Any bleeding from the intravenous site, gums, rectum, or vagina should be reported to the HCP. The HCP may not be able to take intervention to prevent the bleeding during therapy, but it warrants notifying the HCP. 3. Being alert and oriented would not warrant intervention by the nurse. However, the nurse should monitor the patient's level of consciousness because cerebral hemorrhage is a major concern when a client is being given thrombolytic therapy. 4. The nurse should monitor the intravenous site for signs of infiltration, which could lead to tissue damage. If there are no signs of infiltration, intervention by the nurse is not warranted.

The client diagnosed with coronary artery disease is prescribed atorvastatin (Lipitor), an HMG-CoA reductase inhibitor. Which statement by the client warrants the nurse notifying the healthcare provider? 1. "I really haven't changed my diet, but I am taking my medication every day." 2. "I am feeling pretty good except I am having muscle pain all over my body." 3. "I am swimming at the local pool about three times a week for 30 minutes." 4. "I am taking this medication first thing in the morning with a bowl of oatmeal."

Answer: 2 Rationale: 1. The client should adhere to a low-fat, low-cholesterol diet, and the nurse is able to teach the client about diet; therefore, the HCP does not need to be notified. 2. Statins can cause muscle injury, which can lead to myosititis, fatal rhabdomyolysis, or myopathy. Muscle pain or tenderness should be reported to the HCP immediately; usually the medication is discontinued. 3. Sedentary lifestyle is a risk factor for developing atherosclerosis; therefore, exercising should be praised and does not need to be reported to the HCP. 4. The medication should not be taken in the morning, but the nurse can teach this and there is no need to notify the HCP. MEDICATION MEMORY JOGGER: If the client verbalizes a complaint, if the nurse assesses data, or if laboratory data indicates an adverse effect secondary to a medication, the nurse must intervene. The nurse must implement an independent intervention during intervention or notify the health-care provider because medications can result in serious or even life-threatening complications.

The nurse is discussing the thiazide diuretic chlorothiazide (Diuril) with the client diagnosed with essential hypertension. Which discharge instruction should the nurse discuss with the client? 1. Encourage the intake of sodium-rich foods. 2. Instruct the client to drink adequate fluids. 3. Teach the client to keep strict intake and output. 4. Explain taking the medication at night only.

Answer: 2 Rationale: 1. The client should be discouraged from eating sodium-rich foods and encouraged to increase intake of potassium-rich food. 2. The client should drink adequate amounts of fluids to replace insensible loss of fluids and to help prevent dehydration. 3. To ask the client to keep strict intake and output is unrealistic; this would be done in the hospital, but not in the client's home. 4. The medication should be taken in the morning to prevent nocturia.

The client is being prepared for a cardiac catheterization. Which statement by the client warrants immediate intervention by the nurse? 1. "I took my blood pressure medications yesterday." 2. "I broke out in an awful rash after eating oysters." 3. "I have not had my daily aspirin in more than a week." 4. "I am highly allergic to poison ivy or oak."

Answer: 2 Rationale: 1. The client should take his or her blood pressure medication prior to the cardiac catheterization; therefore, this statement does not warrant intervention. 2. This may indicate the client is allergic to iodine, a component of the cardiac catheterization dye, and warrants further assessment by the nurse. 3. The client should stop any medication that interferes with clot formation, so this statement does not require intervention by the nurse. 4. An allergy to poison ivy or oak would not interfere with this procedure. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about diagnostic tests and surgical procedures. If the client provides information that would indicate a potential harm to the client, then the nurse must intervene. Iodine is found in many types of seafood and is used in many diagnostic tests.

The nurse is discharging a client who has undergone surgery for a mechanical valve replacement. Which statement indicates the client needs more discharge teaching? 1. "I will have to take an anticoagulant the rest of my life." 2. "I don't have to take any medications after this surgery." 3. "I must take antibiotics prior to all dental procedures." 4. "I must go to my HCP for routine bloodwork."

Answer: 2 Rationale: 1. The client will be taking warfarin (Coumadin), an anticoagulant, the rest of his or her life. This statement indicates the client understands the teaching. 2. The client with a mechanical valve replacement will be taking anticoagulants and periodic antibiotics. The client needs more discharge teaching. 3. If antibiotics are not taken prior to dental procedures, the client may develop strep infections leading to vegetative growth on cardiac structures. The client under-stands this. 4. The client must have regular INR labs drawn to determine if anticoagulant levels are within therapeutic range. Therapeutic INR for a client with a mechanical valve replacement is 2.0-3.5.

Which data indicates to the nurse that simvastatin (Zocor), an HMG-CoA reductase inhibitor, is effective? 1. The client's blood pressure is 132/80. 2. The client's cholesterol level is 180 mg/dL. 3. The client's LDL is 180 mg/dL. 4. The client's HDL is 35 mg/dL.

Answer: 2 Rationale: 1. The client's blood pressure is within nor-mal limits, but that does not indicate that the medication is effective. 2. A cholesterol level less than 200 mg/dL is desirable and indicates the medication is effective. 3. The client's optimal LDL is less than 100 mg/dL, and greater than 200 mg/dL is considered very high. A level of 180 mg/dL is high. 4. HDL promotes cholesterol removal, and the level should be greater than 60 mg/dL. The client's HDL is low, less than 40 mg/dL, which indicates the medication is not effective.

The client with a venous stasis ulcer has exudate. A calcium alginate dressing is applied to the draining ulcer. The client asks the nurse, "How often will the dressing be changed?" Which statement is the nurse's best response? 1. "The dressing will have to be changed daily." 2. "It will be changed when the exudate seeps through." 3. "The doctor will determine when the dressing is changed." 4. "It will not be changed until the wound is healed."

Answer: 2 Rationale: 1. The dressing is changed at least every 7 days or when the exudate seeps through the dressing. 2. The dressing is changed when the exudate seeps through the dressing or at least every 7 days. 3. The doctor does not determine when the dressing will be changed. 4. The dressing will be changed many times before the wound is healed.

The client with arterial occlusive disease is prescribed pentoxifylline (Trental), a hemorrheologic agent. Which information should the nurse discuss with the client? 1. Explain that the medication should be taken on an empty stomach. 2. Instruct the client to avoid smoking when taking this medication. 3. Discuss that common side effects are flushing of the skin and sedation. 4. Encourage the client to wear long sleeves and a hat when in the sunlight.

Answer: 2 Rationale: 1. The medication should be taken with food to prevent gastric upset. 2. The client should avoid smoking because nicotine increases vasoconstriction. 3.Flushing of the skin, faintness, sedation, and gastrointestinal disturbances are signs of an overdose of this medication, not common side effects, and should be reported to the health-care provider. 4. This medication does not cause photosensitivity, so there is no need for the client to wear long sleeves and a hat.

The client with essential hypertension is prescribed the beta blocker metoprolol (Lopressor). Which assessment data should make the nurse question administering this medication? 1. The client's blood pressure is 112/90. 2. The client's apical pulse is 56. 3. The client has an occipital headache. 4. The client is complaining of a yellow haze.

Answer: 2 Rationale: 1. The nurse would question administering a beta blocker if the client's blood pressure was less than 90/60 because this medication would further lower the blood pressure. 2. The nurse would question administering a beta blocker if the client's apical pulse was less than 60 because this medication decreases the heart rate. 3. An occipital headache could be a sign of high blood pressure; therefore, the nurse would administer the medication. 4. A yellow haze is a common symptom of a client who is exhibiting digoxin (a cardiacglycoside) toxicity.

The mother of a child diagnosed with strep throat asks the nurse, "Why do you have to give my child that antibiotic shot?" Which statement is the nurse's best response? 1. "You sound concerned. Are you worried about your child getting a shot?" 2. "This injection may keep your child from getting rheumatic fever." 3. "Strep throat always results in children developing heart problems." 4. "I am giving this medication because the throat culture showed a viral infection."

Answer: 2 Rationale: 1. This is a therapeutic response and does not answer the mother's question. This type of response is used to encourage the client to ventilate feelings. 2. Antibiotics will treat the strep throat, which will decrease the child's fever and pain. If untreated, strep throat can lead to the development of rheumatic fever, which can result in rheumatic endocarditis in future years. 3. This is a false statement. 4. Strep throat is a bacterial infection, not a viral infection.

The client with a serum cholesterol level of 320 mg/dL is taking the antihyperlipidemic medication ezetimibe (Zetia). Which statement by the client indicates the client needs more teaching concerning this medication? 1. "This medication helps decrease the absorption of cholesterol in my intestines." 2. "I cannot take this medication with any other cholesterol-lowering medication." 3. "I need to eat a low-fat, low-cholesterol diet even when taking the medication." 4. "It will take a few months for my cholesterol level to get down to normal levels."

Answer: 2 Rationale: 1. This is a true statement; therefore, the client does not need more teaching. 2. This is not a true statement; therefore, the client needs more teaching. Zetia acts by decreasing cholesterol absorption in the intestine and is used together with statins to help lower cholesterol in clients whose cholesterol levels cannot be controlled by taking statins alone. 3. This is a true statement; therefore, the client does not need more teaching. 4. This is a true statement; therefore, the client does not need more teaching.

The health-care provider ordered a transfusion to be administered to a client diagnosed with aplastic anemia. Which intervention should the nurse implement? Rank in order of performance. 1. Obtain informed consent to administer blood. 2. Make sure the client understands the procedure. 3. Check the blood out from the laboratory. 4. Perform a pre-blood assessment. 5. Start an IV with an 18-gauge catheter.

Answer: 2, 1, 4, 5, 3 Rationale: 2. The nurse should determine that the client understands the procedure prior to having the client sign the permission form for receiving blood or blood products. The HCP is responsible for informing the client about the procedure, but the nurse should make sure the client understands before witnessing the signature. 1. The administration of blood or blood products requires that the client sign a consent form. If the client does not consent, the procedure is stopped at this point, and resumed if or when the client decides to agree. 4. A preblood assessment should be per-formed to determine preexisting conditions or problems. The nurse uses this information to guide the safe administration of the blood. 5. An 18-gauge catheter is preferred to administer blood so that the cells are not broken (lysed) during the transfusion. 3. The blood is not retrieved from the laboratory until the nurse is ready to transfuse it. The nurse has 30 minutes from the time the blood is checked out from the laboratory until the initiation of the infusion.

The nurse is preparing to administer the initial intravenous antibiotic to a client with an arterial ulcer on the right ankle. The client has a saline lock in the right forearm. Which order should the nurse prepare to administer the medication? Rank in order of performance. 1. Inject 3 mL of normal saline into the saline lock. 2. Check to see if a culture and sensitivity test has been done. 3. Flush the intravenous tubing with the antibiotic. 4. Determine if the client has any known allergies. 5. Connect the antibiotic medication to the saline lock.

Answer: 2, 4, 3, 1, 5 Rationale: 2. If a culture and sensitivity (C&S) has been ordered and the nurse administers the antibiotic, the C&S will be skewed and an accurate result will not be available. 4. The nurse should always check to see if a client has any known allergies before administering the initial medication, especially an antibiotic. 3. The nurse should prepare the intravenous antibiotic in the medication room—not at the bedside—and should always flush the tubing so that air will not be injected into the client's vein. 1. The nurse must determine if the saline lock is patent; this is done by injecting normal saline into the lock. 5. After all the previously listed interventions are completed, then the nurse can infuse the medication.

The client has petechiae on the anterior lateral upper-abdominal wall. The medication administration record (MAR) indicates the client is receiving a daily baby aspirin, an intravenous narcotic, and a low-molecular-weight heparin. Which intervention should the nurse implement? 1. Request an order to discontinue the 81-mg aspirin. 2. Assess the client's pain level on a 1-10 scale. 3. Document the finding and take no intervention. 4. Put cool compresses on the abdominal wall.

Answer: 3 Rationale: 1. A baby aspirin would not cause the client to have petechiae. 2. Petechiae have nothing to do with the client's pain level. 3. The petechiae, tiny purple or red spots that appear on the skin as a result of minute hemorrhages within the dermal or submucosal areas, are secondary to subcutaneous injections of Lovenox, a low-molecular-weight heparin. 4. Cool compresses cause vasoconstriction, but this would not help prevent or treat petechiae.

The nurse is preparing to administer clopidogrel bisulfate (Plavix), an antiplatelet medication, to the client with coronary artery disease. The client asks the nurse, "Why am I getting this medication?" Which statement by the nurse is most appropriate? 1. "It will help decrease your chance of developing deep vein thrombosis." 2. "Plavix will help decrease your LDL cholesterol levels in about 1 month." 3. "This medication will help prevent your blood from clotting in the arteries." 4. "The medication will help decrease your blood pressure if you take it daily."

Answer: 3 Rationale: 1. Anticoagulants, not antiplatelets, help prevent deep vein thrombosis 2. Plavix decreases platelet aggregation, not LDL cholesterol levels. 3. This medication works in the arteries to prevent platelet aggregation and is prescribed for a client diagnosed with arteriosclerosis. 4. Plavix is not an antihypertensive medication; it an antiplatelet medication.

The client diagnosed with coronary artery disease is instructed to take 81 mg of aspirin ("baby aspirin," "children's aspirin" or "adult low-dose aspirin") daily. Which statement best describes the scientific rationale for prescribing this medication? 1. This medication will help thin the client's blood. 2. Daily aspirin will decrease the incidence of angina. 3. This medication will prevent platelet aggregation. 4. Baby aspirin will not cause gastric distress.

Answer: 3 Rationale: 1. Aspirin does not thin the blood. It prevents platelet aggregation. The nurse must understand the correct rationale for administering medications even if the client may say it "thins the blood." 2. Angina is a complication of atherosclerosis, and aspirin may help decrease angina, but that is not the scientific rationale as to why it is prescribed. 3. When a baby aspirin is taken daily, it helps prevent platelet aggregation, which, in turn, helps the blood pass through the narrowed arteries more easily. 4. Baby aspirin can cause gastric distress, but the question is asking for the scientific rationale for taking this medication.

The nurse is preparing to administer the alpha-beta blocker labetalol (Normodyne) intravenous push (IVP) to a client diagnosed with hypertensive crisis. Which intervention should the nurse implement? 1. Monitor the client's labetalol serum drug level. 2. Keep the medication covered with tin foil. 3. Administer the medication slow IVP over 5 minutes. 4. Teach the client signs/symptoms of hypertension.

Answer: 3 Rationale: 1. Labetalol does not have a serum drug level. 2. Only medications that are inactivated or weakened by exposure to light would have to be covered; this medication is not affected by light. 3. Medications that directly affect the cardiac muscle or vasculature are administered slowly over a minimum of 5 minutes for safety reasons. Many medications require dilution with normal saline to have sufficient volume for a smooth equal delivery to prevent cardiac dysrhythmias. 4. The nurse should teach the client about possible signs or symptoms of hypertension, but remember, clients with hypertension are often asymptomatic. Hypertension is the "silent killer."

According to the American Heart Association (AHA), which medication should the client suspected of having a myocardial infarction take immediately when having chest pain? 1. Morphine, a narcotic analgesic. 2. Acetaminophen (Tylenol), a nonnarcotic analgesic. 3. Acetylsalicylic acid (aspirin), an antiplatelet. 4. Nitroglycerin paste, a coronary vasodilator.

Answer: 3 Rationale: 1. Morphine must be administered intravenous push to achieve rapid relief of chest pain; therefore, the client could not administer this medication to himself or herself. 2. A nonnarcotic analgesic will not help the client having a "heart attack." 3. The AHA recommends that a client having chest pain chew two baby aspirins or one 325-mg tablet immediately to help prevent platelet aggregation and further extension of a coronary thrombosis. 4. Nitroglycerin must be taken sublingually, not as a paste, during acute chest pain to achieve rapid effect of the medication.

The nurse is preparing to administer nitroglycerin, a coronary vasodilator transdermal patch, to the client diagnosed with a myocardial infarction. Which intervention should the nurse implement? 1. Question applying the patch if the client's BP is less than 110/70. 2. Use nonsterile gloves when applying the transdermal patch. 3. Date and time the transdermal patch prior to applying to client's skin. 4. Place the transdermal patch on the site where the old patch was removed.

Answer: 3 Rationale: 1. Nitroglycerin causes hypotension and the nurse should question administering a transdermal patch if the client's blood pressure is less than 90/60 but not if it is less than 110/70. 2. The nurse should use gloves when applying nitroglycerin paste, not a transdermal patch. The patch will not cause any medication to be absorbed through the nurse's skin 3. The nurse should remove the old patch, wash the client's skin, note the date and time the new patch is applied, and apply it in a new area that is not hairy. 4. The transdermal patch must be rotated so that skin irritation will not occur.

The emergency department nurse received a client with multiple hematomas and has an International Normalized Ratio (INR) of 7.2. Which medication should the nurse prepare to administer? 1. Protamine sulfate. 2. Heparin. 3. AquaMEPHYTON. 4. Vitamin C.

Answer: 3 Rationale: 1. Protamine sulfate is the antidote for heparin toxicity. 2. Heparin is a parenteral anticoagulant and would not be administered for Coumadin toxicity. 3. AquaMEPHYTON, vitamin K, is the antidote for Coumadin toxicity, which is supported by an INR of 7.2 and the bruising. The therapeutic range is 2-3. 4. The antidote is vitamin K, not vitamin C.

The nurse is discharging the female client diagnosed with deep vein thrombosis (DVT) who is prescribed the anticoagulant warfarin (Coumadin). Which statement indicates the client needs more teaching concerning this medication? 1. "I should wear a Medic Alert bracelet in case of an emergency." 2. "If I get cut, I will apply pressure for at least 5 minutes." 3. "I will increase the amount of green, leafy vegetables I eat." 4. "I will have to see my HCP regularly while taking this medication."

Answer: 3 Rationale: 1. The client is at risk for bleeding and should wear a medical alert bracelet to notify HCPs about the anticoagulant; therefore, the client understands the medication teaching. 2. If the client cuts himself or herself, the client should apply direct pressure for 5 minutes without peeking at the cut. If the cut is still bleeding after this time, the client should continue to apply pressure and seek medical attention. This statement indicates the client understands the medication teaching. 3. Green, leafy vegetables are high in vitamin K, which is the antidote for Coumadin toxicity. AquaMEPHYTON is the chemical name for vitamin K. Green, leafy vegetables would interfere with the therapeutic effects of Coumadin. This statement indicates the client does not understand the medication teaching. 4. The client's PT/INR is monitored at routine intervals to determine if the medication is within the therapeutic range: an INR of 2-3 should be maintained. The client should regularly see the HCP. This statement indicates the client understands the medication teaching.

The client being discharged after sustaining an acute myocardial infarction is prescribed the ACE inhibitor lisinopril (Zestril). Which instruction should the nurse include when teaching about this medication? 1. Instruct the client to monitor the blood pressure weekly. 2. Encourage the client to take medication on an empty stomach. 3. Discuss the need to rise slowly from lying to a standing position. 4. Teach the client to take the medication at night only.

Answer: 3 Rationale: 1. The client is taking the ACE inhibitor to improve survival following an acute MI, and the blood pressure should be monitored daily, not weekly. 2. The client can take the medication with food to help decrease gastric distress. 3. This medication causes orthostatic hypotension, and the client should be instructed to rise slowly from lying to sitting to standing position to prevent falls and injury. 4. There is no reason for the medication to be taken at night; it is usually taken in the morning.

The client diagnosed with chronic venous insufficiency has a venous stasis ulcer that is being treated with autolytic medication for debridement and an occlusive dressing. The nurse notices a foul-smelling odor. Which intervention should the nurse implement? 1. Assess the client's vital signs, especially the temperature. 2. Obtain a culture and sensitivity of the venous stasis ulcer. 3. Document the finding and take no further intervention. 4. Ask the health-care provider to discontinue the medication.

Answer: 3 Rationale: 1. The foul odor does not indicate an infection; therefore, the client's vital signs do not need to be assessed. 2. A culture and sensitivity would only be taken if the nurse suspected an infection, and this foul odor does not indicate a wound infection. 3. This is an expected reintervention. The foul odor is produced by the breakdown of cellular debris and does not indicate that the wound is infected. 4. There is no need to discontinue the medication; the foul odor indicates the medication is working effectively.

The nurse is caring for a client diagnosed with sickle cell disease (SCD). Which medication would the nurse question? 1. Morphine sulfate (MS), a narcotic analgesic, IVP. 2. Fentanyl (Duragesic), a narcotic agonist, patch. 3. Epoetin (Procrit), a biological response modifier, SQ. 4. Piperacillin and tazobactam (Zosyn), an antibiotic combination, IVPB.

Answer: 3 Rationale: 1. The nurse would not question administering morphine to a client subject to painful infarcts of organs and infiltrations of the joints. 2. The nurse would not question administering a sustained-release medication for pain to a client subject to painful infarcts of organs and infiltrations of the joints. 3. Procrit stimulates the bone marrow to produce red blood cells (erythropoiesis). The client with sickle cell disease produces red blood cells that "sickle," increasing the levels of hemoglobin S (HbS). The client does not need more RBCs; therefore, the nurse would question administering this medication. 4. Clients diagnosed with sickle cell disease may go into a crisis situation for several reasons, including dehydration and infection. The nurse would not question an antibiotic. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for disease processes and conditions. If the nurse administers a medication the health-care provider has prescribed and it harms the client, the nurse could be held accountable. Remember that the nurse is a client advocate.

The wound care nurse is applying an enzyme debridement ointment to a client with a venous stasis ulcer on the left ankle. Which priority intervention should the nurse implement? 1. Cover the wound with wrung-out, saline-soaked gauze. 2. Place dry gauze and a loose bandage over the wound. 3. Do not allow any ointment on the normal surrounding skin. 4. Apply the ointment with a sterile tongue blade.

Answer: 3 Rationale: 1. The wound should be covered with a thoroughly wrung-out, saline-soaked gauze, but this is not the priority intervention. 2. After applying the ointment and then the saline-soaked gauze, a dry gauze should be applied to the wound, but this is not the priority intervention. 3. The most important intervention is not to allow any of the enzymatic ointment to be placed on the normal surrounding skin because it will cause necrosis of the normal skin. 4. The ointment should be applied with a sterile tongue blade to prevent any type of bacteria from entering the stasis ulcer, but this is not the priority intervention.

The client with arterial occlusive disease is postoperative right femoral-popliteal bypass surgery. Which health-care provider's order should the nurse question? 1. D5W 1000 mL to infuse at 75 mL/hr. 2. Ceftriaxone (Rocephin) 500 mg every 12 hours. 3. Dipyridamole (Persantine) 50 mg three times a day. 4. Meperidine (Demerol) 25 mg IVP every 4 hours.

Answer: 3 Rationale: 1. This intravenous order would be an expected order for a client who has under-gone surgery; therefore, the nurse would not question this order. 2. This is an antibiotic that would be expected for a client who has just had surgery; therefore, the nurse would not question this order. 3. This is an antiplatelet medication that should have been discontinued 5-7 days prior to surgery because it may cause bleeding in the postoperative client; therefore, the nurse would question why the client is receiving this medication. 4. This is a pain medication that would be ordered for a client who has undergone surgery; therefore, the nurse would not question this medication. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for disease processes and conditions. If the nurse administers a medication the healthcare provider has prescribed and it harms the client, the nurse could be held account-able. Remember that the nurse is a client advocate.

The client is immobile. In which area should the nurse administer the subcutaneous heparin injection? (Show Figure of different sites) 1. love handles 2. Deltoid 3. lower abdomen 4. thigh

Answer: 3 Rationale: 1. This is the area called the "love handles," and low-molecular-weight heparin, Lovenox, is administered here to prevent abdominal wall trauma. 2. This is the area where intramuscular injections are primarily administered. 3. Subcutaneous heparin is administered in the lower abdomen for better absorption and should be at least 2 inches away from the umbilicus. 4. If subcutaneous heparin is administered in the thigh area, it could possibly result in large hematoma formation secondary to leg movement.

The elderly client diagnosed with coronary artery disease has been taking aspirin daily for more than a year. Which data warrant notifying the health-care provider? 1. The client has lost 5 pounds in the last month. 2. The client has trouble hearing low tones. 3. The client reports having a funny taste in the mouth. 4. The client has hard, dark, tarry stools.

Answer: 4 Rationale: 1. A 5-pound weight loss in 1 month would not make the nurse suspect the client is experiencing any long-term complications from taking daily aspirin. 2. Elderly clients often have a loss of hearing, but it is not a complication of long-term aspirin use. Tinnitus is, however, a possible complication of aspirin use. 3. Elderly clients often lose taste buds, which may cause a funny taste in the mouth, but itis not a complication of taking daily aspirin. 4. A complication of long-term aspirin use is gastric bleeding, which could result in dark, tarry stools. This data would warrant further intervention.

The client diagnosed with congestive heart failure is taking digoxin (Lanoxin), a cardiac glycoside. Which data indicates the medication is effective? 1. The client's blood pressure is 110/68. 2. The client's apical pulse rate is regular. 3. The client's potassium level is 4.2 mEq/L. 4. The client's lungs are clear bilaterally.

Answer: 4 Rationale: 1. Digoxin does not affect the client's blood pressure; therefore, it cannot be used to determine the effectiveness of the medication. 2. The client's apical pulse must be assessed prior to administering the medication, but this data is not used to determine the effectiveness of the medication. 3. The client's potassium level must be assessed prior to administering the medication, but itis not used to determine the effectiveness of the medication. 4. Signs and symptoms of CHF are crackles in the lungs, jugular vein distention, and pitting edema. Therefore, if the client has clear lung sounds, the nurse can assume the medication is effective. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

The 28-year-old client diagnosed with sickle cell anemia has been admitted to the medical unit for a vaso-occlusive crisis. Which intervention should the nurse implement first? 1. Elevate the head of the client's bed. 2. Administer the narcotic analgesic. 3. Apply oxygen via nasal cannula. 4. Initiate intravenous fluids.

Answer: 4 Rationale: 1. Elevating the head of the client's bed would assist with dyspnea but would not help the client's pain, which is priority, along with reversing the sickling process. 2. Pain medication is administered intravenously; therefore, the first intervention would be to initiate intravenous fluids and then administer pain medication. 3. Oxygen is usually administered, but the best method of promoting oxygenation is the reversal of sickling, which is accomplished by administering IV fluids. 4. Intravenous fluids help reverse the sickling process, which is priority; this reversal will relieve the pain and increase the oxygenation to the cells.

The nurse is preparing to administer medication to the following clients. Which medication should the nurse question administering? 1. The biguanide metformin (Glucophage) to a client with type 1 diabetes who is receiving insulin. 2. The loop diuretic bumetanide (Bumex) to a client diagnosed with essential hypertension. 3. The biologic response modifier erythropoietin (Procrit) to a client diagnosed with end-stage renal failure. 4. The central-acting alpha agonist clonidine (Catapres) to a client diagnosed with heart failure.

Answer: 4 Rationale: 1. Glucophage acts on the liver to prevent gluconeogenesis and is often prescribed along with insulin for type 1 or type 2 diabetes. 2.A client with hypertension would be prescribed a diuretic; therefore, the nurse would not question administering this medication. 3.Procrit is administered to stimulate the bone marrow to produce red blood cells and is often prescribed for clients with chronic kidney disease. 4. The nurse would question administering Catapres to a client with decreased cardiac output (heart failure), because this medication acts within the brain stem to suppress sympathetic outflow to the heart and blood vessels. The result is vasodilation and reduced cardiac output, both of which lower blood pressure.

The client diagnosed with iron-deficiency anemia is being discharged. Which discharge instruction should the nurse include regarding the oral iron preparation prescribed? 1. Teach the client to perform a fecal occult blood test daily. 2. Demonstrate how to crush the tablets and mix with pudding. 3. Inform the client to take the medication at night. 4. Tell the client that his or her stools will be greenish black.

Answer: 4 Rationale: 1. HCPs sometimes ask clients to obtain fecal occult blood test specimens, usually once a year. The client brings the card to the HCP's office for the test to be completed. This is not a daily test the client performs at home. 2. The tablets should not be crushed; they are enteric-coated. If the client cannot swallow tablets, liquid iron preparations are available. 3. The medication should not be taken with food if the client can tolerate it, but it does not need to be taken at night. 4. Iron causes the stool to turn a greenish-black and can mask the appearance of blood in the stool. The client should know that this will occur.

The client newly diagnosed with coronary artery disease is being prescribed a daily aspirin. The client tells the nurse, "I had a bad case of gastritis last year." Which intervention should the nurse implement first? 1. Ask the client if he or she informed the HCP of the gastritis. 2. Explain that regular aspirin could cause gastric upset. 3. Instruct the client to take an enteric-coated aspirin. 4. Determine if the client is taking any antiulcer medication.

Answer: 4 Rationale: 1. If the HCP is not aware of this significant history, then the HCP should be informed, but it is not the first nursing intervention. 2. Teaching is important, but it is not the first intervention. 3. Enteric-coated aspirin is appropriate for this client to take, but it is not the first intervention. 4. Assessment is the first part of the nursing process, and determining if the client is taking any antiulcer medication is the first question the nurse should ask the client.

The client is diagnosed with folic acid deficiency anemia and Crohn's disease. Which medication should the nurse anticipate being prescribed? 1. Oral folic acid. 2. Cyanocobalamin, vitamin B12IM. 3. B complex vitamin therapy orally. 4. Intramuscular folic acid.

Answer: 4 Rationale: 1. Oral preparations of folic acid are administered to clients diagnosed with a folic acid deficiency who do not have a malabsorption problem, such as Crohn's disease. 2. A vitamin B12deficiency is not the problem for this client. 3. B complex vitamins are not folic acid. 4. Crohn's disease is the second most common cause of folic acid deficiency anemia. Crohn's disease is a malabsorption syndrome of the small intestines. The client must receive the medication via the parenteral route.

The nurse is preparing to administer the following medications. Which medication should the nurse question administering? 1. The vasodilator hydralazine (Apresoline) to the client with a blood pressure of 168/94. 2. The alpha blocker prazosin (Minipress) to the client with a serum sodium level of 137 mEq/L. 3. The calcium channel blocker diltiazem (Cardizem) to the client with a glucose level of 280 mg/dL. 4. The loop diuretic furosemide (Lasix) to the client with a serum potassium level of 3.1 mEq/L.

Answer: 4 Rationale: 1. The blood pressure (168/94) is elevated; therefore, the nurse should administer this medication without questioning it. 2. The normal serum sodium level is 135-145 mEq/L. Therefore, the nurse should administer this medication without questioning. 3. The glucose level is not pertinent when administering this medication. Although the glucose level is elevated (70-110 mg/dL is normal), it would not cause the nurse to question administering this medication. 4. The serum potassium level is low (normal is 3.5-5.0 mEq/L). Therefore, because a loop diuretic will cause further potassium loss, the nurse should question administering this medication and obtain a potassium supplement for the client. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for medication administration, including which client assessment data and laboratory data should be monitored prior to administering the medication.

The nurse is completing A.M. care with a client diagnosed with angina when the client complains of chest pain. The client has a saline lock in the right forearm. Which intervention should the nurse at the bedside implement first? 1. Assess the client's vital signs. 2. Administer sublingual nitroglycerin (NTG). 3. Administer intravenous morphine sulfate (MS) via saline lock. 4. Administer oxygen via nasal cannula.

Answer: 4 Rationale: 1. The client is having chest pain with activity; therefore, the nurse should treat the client. 2. Administering sublingual NTG would be appropriate, but unless the nurse has the NTG in the room, the nurse should not leave the client alone. 3. Administering morphine sulfate would be appropriate, but the nurse at the bedside would not have MS at the bedside and it would take time to prepare. 4. The nurse would have oxygen at the bedside, and applying it would be the first intervention the nurse could implement at the bedside. MEDICATION MEMORY JOGGER: When answering test questions or when caring for clients at the bedside, the nurse should remember assessing the client may not be the correct intervention to take when the client is in distress. The nurse may need to intervene directly to help the client.

The nurse is administering iron dextran (Imferon), an iron preparation, to a client diagnosed with iron-deficiency anemia. Which intervention should the nurse implement? 1. Make sure the client is well hydrated. 2. Give the medication subcutaneously in the deltoid. 3. Check for allergies to fish or other seafood. 4. Administer the medication by the Z-track method.

Answer: 4 Rationale: 1. The client's hydration status will not affect the medication. 2. The medication is black and will stain the skin, sometimes permanently. It is never given in the upper extremities or subcutaneously. 3. Knowledge of allergies to seafood is important when administering any preparation of iodine, not iron. 4. Iron is black and stains the skin. The medication is administered deep IM in the dorsogluteal muscle in adults and the lateral thigh in small children. It is given by the Z-track method to trap the medication in the deep tissues and prevent leakage back into the shallow tissues.

Which client should the nurse most likely suspect will require polypharmacy to control essential hypertension? 1. The 84-year-old white male client. 2. The 22-year-old Hispanic female client. 3. The 60-year-old Asian female client. 4. The 46-year-old African American male client.

Answer: 4 Rationale: 1. The elderly client is often prescribed multiple medications, but people who are white usually respond well to one antihypertensive medication. 2. A young Hispanic female would not be considered high risk for hypertension and would probably not require multiple antihypertensive medications. 3. The Asian diet is high in omega-3 fatty acid, which decreases atherosclerosis, a risk factor for hypertension; this population usually does not require multiple antihypertensive medications. 4. Ethnically and racially, African Americans have poorer responses to ACE inhibitors, beta blockers, and other antihypertensive medications than do people of other backgrounds. There is no specific reason known for this, but it is empirically and scientifically documented. Polypharmacy is using multiple medications to medically treat a client, and African Americans often require this to treat hypertension.

The older adult client diagnosed with iron-deficiency anemia has been prescribed an oral iron preparation. Which information should the nurse teach the client? 1. Instruct the client to take the medication with food. 2. Teach the client to take the iron with milk products. 3. Explain that this medication may discolor the teeth. 4. Discuss taking the medication 2 hours after a meal.

Answer: 4 Rationale: 1. The medication should be taken on an empty stomach because food interferes with the absorption of iron. 2. Milk products would interfere with the absorption of the medication. 3.Oral medication (pill) will not stain the teeth, but liquid iron preparations would stain the teeth. Just because the client is elderly does not mean the client cannot take pills. 4. The medication should be taken on an empty stomach or 2 hours after a meal because food interferes with the absorption of iron.

The client diagnosed with essential hypertension is taking the loop diuretic bumetanide (Bumex). Which statement by the client warrants notifying the client's health-care provider? 1. "I really wish my mouth would not be so dry." 2. "I get a little dizzy when I get up too fast." 3. "I usually have one or two glasses of wine a day." 4. "I have been experiencing really bad leg cramps."

Answer: 4 Rationale: 1. The nurse should instruct the client to increase fluids or suck on hard candy, but the HCP does not need to be notified because dry mouth is an expected side effect of this medication. 2. The nurse should discuss how to prevent orthostatic hypotension, but the HCP does not need to be notified because this is an expected side effect. 3. The client should not be drinking alcohol because it may potentiate orthostatic hypotension, but the nurse should discuss this with the client and not necessarily notify the HCP. 4. Leg cramps could indicate hypokalemia, which is potentially life threatening secondary to cardiac dysrhythmias. This needs to be reported to the HCP so that the dosage can be reduced or potassium supplements can be ordered for the client. MEDICATION MEMORY JOGGER: If the client verbalizes a complaint, if the nurse assesses data, or if laboratory data indicates an adverse effect secondary to a medication, the nurse must intervene. The nurse must implement an independent intervention or notify the healthcare provider because medications can result in serious or even life-threatening complications.

The client has had a total right hip replacement. Which medication should the nurse anticipate the HCP prescribing? 1. The oral anticoagulant warfarin (Coumadin). 2. The intravenous anticoagulant heparin. 3. The thrombolytic alteplase (Activase). 4. The low-molecular-weight heparin enoxaparin (Lovenox).

Answer: 4 Rationale: 1. The nurse would not anticipate the HCP prescribing a medication that would cause bleeding for a client who has had surgery. 2. The nurse would not anticipate the HCP prescribing a medication that would cause bleeding for a client who has had surgery. Intravenous heparin is only used to treat clients with actual clotting problems. 3. Thrombolytic medications would destroy thrombus formations and would not be prescribed for a surgical client. 4. Lovenox is prescribed for clients who are immobile, such as this surgical client, to help prevent deep vein thrombosis; therefore, the nurse should anticipate this medication being prescribed.

The nurse is preparing to administer medications to the following clients. Which client should the nurse question administering the medication? 1. The client receiving the angiotensin-receptor blocker losartan (Cozaar) who has a BP of 168/94. 2. The client receiving the calcium channel blocker diltiazem (Cardizem) who has 1+ nonpitting edema. 3. The client receiving the alpha blocker terazosin (Hytrin) who is complaining of a headache. 4. The client receiving the thiazide diuretic hydrochlorothiazide (HCTZ) who is complaining of leg cramps.

Answer: 4 Rationale: 1. The nurse would want to give this antihypertensive medication to a client with an elevated blood pressure; the nurse would question the medication if the BP were low, which it is not. 2. The client with 1+ nonpitting edema would not be affected by a calcium channel blocker. 3. Hytrin is not contraindicated in a client who has a headache; the apical pulse should be greater than 60. 4. Leg cramps could indicate hypokalemia, which may lead to life-threatening cardiac dysrhythmias. Therefore, the nurse should question administering this medication until a serum potassium level is obtained. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for medication administration, including which client assessment data and laboratory data should be monitored prior to administering the medication.

The client diagnosed with a deep vein thrombosis (DVT) asks the nurse, "Why do I have to take my Coumadin in the evening?" Which statement is the nurse's best response? 1. "The medication works more effectively while you are sleeping." 2. "The medicine should be given with the largest meal of the day." 3. "The side effects of the Coumadin are less if you take it in the evening." 4. "This allows for a more accurate INR level when we draw your morning labs."

Answer: 4 Rationale: 1. This is a false statement; this medication does not work better during the night. 2. This medication can be taken on an empty stomach or with food. 3. There are not any side effects of Coumadin that would be decreased by taking the medication in the evening. 4. Routine laboratory tests are drawn in the morning. If Coumadin is administered in the morning, the International Normalized Ratio (INR) will be lower as a result of the medication's effects wearing off. If the Coumadin is taken in the evening, then the INR level will reflect more accurately the peak blood level.

The client with coronary artery disease is prescribed nicotinic acid (niacin). The client complains of flushing of the face, neck, and ears. Which priority intervention should the nurse implement? 1. Instruct the client to stop taking the medication immediately. 2. Encourage the client to take the medication with meals only. 3. Discuss that this is a normal side effect and will decrease with time. 4. Tell the client to take 325 mg of aspirin 30 minutes before taking medication.

Answer: 4 Rationale: 1. This is an expected side effect of the medication, and there is no need to quit taking the medication. 2. Taking the medication with meals will not stop the flushing of the face, neck, and ears. 3. The flushing of the face, neck, and ears may or may not decrease with time, but the nurse should address the client's com-plaints first. 4. Taking an aspirin prior to the medication will help reduce the flushing of the face, neck, and ears.

The nurse is preparing to administer digoxin (Lanoxin), a cardiac glycoside, to a client diagnosed with congestive heart failure. Which area should the nurse assess prior to administering the medication? (Show figure to locate where to auscultate apical heart rate) 1. 2nd ICS right sternal notch 2. 2nd ICS left sternal notch 3. 4th and 5th ICS 4. 5th ICS mid clavicular

Answer: 4 Rationale: 1. This is the second intercostal space right sternal notch, which is one of the two areas used to auscultate the aortic valve, but it is not where the apical pulse is assessed. 2. This is the second intercostal space left sternal notch, which is used to auscultate the pulmonic valve, but it is not where the apical pulse is assessed. This is the fourth and fifth intercostal space to the left of the sternum and is where the tricuspid valve is best heard. 3. This is the fourth and fifth intercostal space to the left of the sternum and is where the tricuspid valve is best heard. 4. The apical pulse located at the fifth intercostal midclavicular space must be assessed for 1 minute prior to administering digoxin. If the apical pulse is less than 60 beats per minute, the nurse should hold the medication.

The nurse is caring for the clients on the telemetry unit. Which medication should the nurse administer first? 1. The antiplatelet medication clopidogrel (Plavix) to the client with arterial occlusive disease. 2. The cardiac glycoside digoxin (Lanoxin) to the client diagnosed with congestive heart failure. 3. The iron dextran infusion to the client diagnosed with iron-deficiency anemia who has pale skin. 4. The antidysrhythmic amiodarone (Cordarone) to the client in ventricular bigeminy on the telemetry monitor.

Answer: 4 Rationale: 1. This medication can be administered after the nurse treats the client with a life-threatening dysrhythmia. 2. Digoxin is not a priority medication overtreating a client with a life-threatening dysrhythmia. 3. An iron dextran infusion must be administered and closely monitored. The nurse must treat the client with a life-threatening dysrhythmia before being able to devote time to the administration of the medication. 4. Ventricular bigeminy is a life-threatening dysrhythmia that must be treated immediately to prevent cardiac arrest.

The client calls the clinic and says, "I am having chest pain. I think I am having another heart attack." Which intervention should the nurse implement first? 1. Call 911 emergency medical services. 2. Instruct the client to take an aspirin. 3. Determine if the client is at home alone. 4. Ask if the client has any sublingual nitroglycerin.

Answer: 4 Rationale: 1. This should be done, but the nurse should not hang up the phone until taking other interventions. 2. The client should take an aspirin because aspirin has been shown to be effective in decreasing the mortality rate of death from myocardial infarction, but the client should not walk to get the aspirin. 3. This should be the second intervention; the nurse needs to assess the situation to determine if the client has anyone who can get the aspirin and let the EMS personnel in when they arrive at the home. 4. Because the client has had one myocardial infarction, the client may have sublingual nitroglycerin in a pocket and can take it immediately. If the client does not have any on the body, then the nurse should determine if there is anyone in the home that can help the client.

The nurse is preparing to administer a nitroglycerin patch to a client diagnosed with coronary artery disease. Which interventions should the nurse implement? Rank in order of performance. 1. Date and time the nitroglycerin patch. 2. Remove the old patch. 3. Clean the site of the old patch. 4. Apply the nitroglycerin patch. 5. Check the patch against the MAR.

Answer: 5, 1, 2, 4, 3 Rationale: 5. The nurse should implement the five rights of medication administration, and the first is to make sure it is the right medication and the right client. 1. Before applying the nitroglycerin paste, the nurse should date and time the application paper prior to putting it on the client so that the nurse is not pressing on the client when writing on the patch. 2. The nurse should have the gloves on when removing the old application paper for the above reason. 4. Last, the nurse should administer the nitro patch application paper in a clean, dry, nonhairy place. 3. The nurse should make sure no medication remains on the client's skin.

The client is receiving an intravenous infusion of heparin. The bag hanging has 20,000 units of heparin in 500 mL of D5W at 22 mL per hour via an intravenous pump. How many units of heparin is the client receiving every hour?

Answer: 880 units of heparin are being infused every hour 880 units of heparin are being infused every hour. When determining the units, the nurse must first determine how many units are in each mL. 20,000 units/500 mL = 40 units per 40 units per mL ×22 mL per hour = 880 mL per hour

The client diagnosed with high blood pressure is ordered the angiotensin-converting enzyme inhibitor captopril (Capoten). Which statements by the client indicate to the nurse the discharge teaching has been effective? Select all that apply. 1. "I should get up slowly when I am getting out of my bed." 2. "I should check and record my blood pressure once a day." 3. "If I get leg cramps, I should increase my potassium supplements." 4. "If I forget to take my medication, I will take two doses the next day." 5. "I can eat anything I want as long as I take my medication every day."

Answers: 1, 2 Rationale: 1. Antihypertensive medications in general cause orthostatic hypotension. Therefore, the client should be taught to get up slowly from lying to sitting and sitting to a standing position to help prevent dizziness and light-headedness. 2. The blood pressure must be checked daily. 3. ACE inhibitors do not require potassium supplements. 4. The client should never make up doses of medication missed; that may cause hypotension. 5. The client should be on a low-salt, low-fat, low-carbohydrate diet for hypertension along with taking medication.

The nurse is administering the combination medication Tenoretic (chlorthalidone and atenolol), a thiazide diuretic and beta blocker, to a client diagnosed with chronic hypertension. Which interventions should the nurse implement? Select all that apply. 1. Do not administer if the client's BP is less than 90/60. 2. Do not administer if the client's apical pulse is less than 60. 3. Teach the client how to prevent orthostatic hypotension. 4. Encourage the client to eat potassium-rich foods. 5. Monitor the client's oral intake and urinary output.

Answers: 1, 2, 3, 4, 5 Rationale: 1. If the client's BP is less than 90/60, the medication should be held so that the client will not experience profound hypotension. 2. If the client's apical pulse is less than 60, the medication should be held so that the client's pulse will not plummet to less than 60, which is sinus bradycardia. 3. A side effect of antihypertensive medications is orthostatic hypotension, and the nurse should discuss how to prevent episodes. 4. Thiazide diuretics do not cause excess loss of potassium, but the client should be encouraged to eat potassium-rich foods to prevent hypokalemia, which may occur as a result of increased urination. 5. The nurse should monitor the client's intake and output to determine if the medication is effective.