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86. 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.

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.

The client diagnosed with AIDS has a pruritic rash with pinkish-red macules. Which medication would the nurse suspect is causing the rash? 1. The antibiotic trimethoprim-sulfamethoxazole (Bactrim). 2. The antiretroviral medication nelfinavir (Viracept). 3. The non-nucleoside reverse transcriptase inhibitor efavirenz (Sustiva). 4. The nucleoside analog reverse transcriptase inhibitor zidovudine (AZT).

1 A sulfa allergy with this type of rash develops in up to 60% of clients diag- nosed with AIDS. Common side effects of Viracept are hyper- glycemia and diarrhea but not allergic rashes. Common side effects of Sustiva are central nervous system symptoms but not allergic rashes. Gastrointestinal intolerance and bone marrow suppression are common side

20. The male client with a renal stone is admitted to the medical department. The nurse administers intravenous morphine over 5 minutes. Which intervention should the nurse implement first? 1. Instruct the client to call for help before getting out of bed. 2. Tell the client to urinate into the urinal at all times. 3. Document the time in the MAR and the client's chart. 4. Reevaluate the client's pain within 30 minutes.

1 1. Safety of the client is priority. 2. This is an appropriate intervention, but it is not priority over safety. 3. The nurse must document the medication in the MAR and the chart because it is a PRN medication, but it is not the first intervention after administering the medication. 4. The nurse must evaluate the client's pain to determine the effectiveness of the medica- tion, but this is not the first intervention.

A code has been called for the client experiencing ventricular fibrillation. Which medication should the nurse prepare to administer to the client? 1. Epinephrine, an adrenergic agonist, intravenous push. 2. Lidocaine, an antidysrhythmic, intravenous push. 3. Atropine, an antidysrhythmic, intravenous push. 4. Digoxin, a cardiac glycoside, intravenous push.

1 Epinephrine is the first medication administered in a code because it constricts the periphery and shunts the blood to the trunk of the body.

3. The client with glaucoma is prescribed epinephrine (Epitrate), mydriatic ophthalmic drops. Which statement indicates the client understands the client teaching? 1. "I will call my health-care provider if I start experiencing any eye pain." 2. "This medication does not interfere with any over-the-counter medication." 3. "I will probably experience anxiety, nervousness, and muscle tremors." 4. "After putting the medication in my eyes I must lie down for 1 hour."

1 Eye pain may indicate an attack of angle- closure glaucoma and must be reported to the HCP immediately. The client should avoid using any over-the- counter sinus and cold medications contain- ing pseudoephedrine and phenylephrine, which may accentuate the side effects of epinephrine. If the client experiences any central nervous system side effects, such as anxiety, nervous- ness, or muscle tremors, the client should notify the HCP. Depending on the severity of the side effects, the HCP may or may not discontinue the medication. There is no reason why the client must lie down for 1 hour after administering this medication.

The client with arterial occlusive disease is taking clopidogrel (Plavix), an antiplatelet medication. Which statement by the client would warrant 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."

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.

The client in end-stage renal disease is receiving oral Kayexalate, a cation exchange resin. Which assessment data indicates the medication is not effective? 1. The client's serum potassium level is 5.8 mEq/L. 2. The client's serum sodium level is 135 mEq/L. 3. The client's serum potassium level is 4.2 mEq/L. 4. The client's serum sodium level is 147 mEq/L.

1 Kayexalate is a medication that is administered to decrease an elevated serum potassium level; therefore, an elevated serum potassium (5.5 mEq/L) would indicate the medication is not effective.

38. The conscious client was admitted to the emergency department with an overdose of the anxiolytic alprazolam (Xanax). Which intervention should the nurse implement first? 1. Prepare to administer an emetic with activated charcoal. 2. Request a mental health consultation for the client. 3. Prepare to administer the antidote flumazenil (Romazicon) IV. 4. Determine why the client chose to overdose on the medication.

1 The first intervention in a case of Xanax overdose is to encourage vomiting—to remove the medication from the stomach before the medica- tion is metabolized and absorbed into the system. Administering an emetic with activated charcoal would induce vomiting.

The nurse is caring for the client in septic shock. The nurse administered the twice-a- day, intravenous, broad-spectrum antibiotic ceftriaxone (Rocephin) at 0900. At 1100 the health-care provider prescribed daily intravenous vancomycin, an aminoglycoside antibiotic. Which action should the nurse implement? 1. Administer the vancomycin within 2 hours. 2. Notify the HCP and question the antibiotic order. 3. Schedule the vancomycin to be administered at 2100. 4. Assess the client's white blood cell count.

1 Septic shock is secondary to an infection of the blood and a broad-spectrum anti- biotic (such as Rocephin) is prescribed until cultures and sensitivity results are obtained. The antibiotic that is specific to the bacteria causing the septic shock— in this case, vancomycin—should be administered as soon as possible. 2. There is no reason for the nurse to call the HCP and question this order. 3. The nurse should not wait 10 hours to administer an antibiotic that will help save the client's life. Septic shock is life threatening and must be treated with the appropriate antibiotic as soon as possible. 4. The client's white blood cell count does not affect the nurse's responsibility to adminis- ter the vancomycin antibiotic as soon as possible.

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. None. 4. The cardiac glycoside digoxin (Lanoxin).

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 to 1.2 ng/mL and toxic range is 2.0 ng/mL or higher. This digoxin level is extremely high and requires stopping the medication and prescribing the antidote. Lasix is not an antidote for digoxin. The nurse should anticipate the HCP prescribing a medication to lower the digoxin level. The level is above the toxic range, and the nurse should not administer any more digoxin—it could be fatal.

The client diagnosed with Meniere's disease is admitted with an acute attack and prescribed intravenous diazepam (Valium), a sedative-hypnotic. Which intervention should the nurse implement when administering this medication? 1. Dilute the Valium to a 10-mL bolus with normal saline. 2. Administer the diazepam undiluted via a saline lock 3. Infuse the diazepam via an IV piggyback over 1 hour. 4. Question the order because diazepam cannot be given IVP.

2 Diazepam cannot be diluted because it is oil based and will not dissolve with normal saline. Diazepam cannot be diluted because it is oil based and will not dissolve with normal saline. Diazepam should be administered via a saline lock or at the port closest to the client if administered through an existing intravenous line. Diazepam is administered via intravenous push over 2-5 minutes, but it is not admin- istered via an intravenous piggyback over 30 minutes. Diazepam can be administered via intra- venous push.

15. The client with epilepsy is seen in the clinic and has a serum Dilantin level of 5.4 mg/dL. Which action should the nurse implement first? 1. Request that the laboratory verify the results of the test. 2. Ask the client when the dose was taken last. 3. Instruct the client to not take the Dilantin for 2 days. 4. Discuss the need to increase the dose of the medication.

2 There is no indication of a reason for veri- fying the serum Dilantin level. This level is below the therapeutic range of 10-20 mg/dL; therefore, the nurse should determine if the client is taking the medication as directed. This is below the therapeutic range; therefore, the medication should not be omitted. Because this level is below therapeutic range, the nurse must determine how the medication is being taken before discussing the need to increase the dose.

71. The nurse is preparing to administer warfarin (Coumadin), an anticoagulant. The client's current laboratory values are as follows: PT38 PTT 39 Control 12.9 Control 36 INR 5.9 Which action 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.

2 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.

The nurse on an oncology floor is administering morning medications. Which medication would the nurse question? 1. Cyanocobalamin (vitamin B12) to a client with pernicious anemia. 2. Erythropoietin (Epogen) to a client with chronic lymphocytic leukemia. 3. Filgrastim (Neupogen) to a client with a solid tissue tumor. 4. Heparin intravenously to a client with disseminated intravascular coagulation.

2 Cyanocobalamin is the treatment for pernicious anemia. The nurse would not question administering this medication. 2. Erythropoietin stimulates the bone marrow to produce more cells. Stimulation of the bone marrow is questioned when the cancer is in the bone marrow. 3. Stimulation of the bone marrow is not questioned in clients with solid tissue tumors. The nurse would not question administering this medication. 4. Heparin is part of the standard treatment regimen for disseminated intravascular coagulation (DIC).

The nurse is administering digoxin (Lanoxin) 0.25 mg intravenous push medication to the client. Which intervention should the nurse implement? 1. Administer the medication undiluted in a 1-mL syringe. 2. Insert the needle in the port closest to the client's IV site. 3. Pinch off the intravenous tubing below the port. 4. Inject the medication quickly and at a steady rate.

2 Using the closest port ensures the least resistance to the flow of medication into the client and helps to control the rate at which the medication reaches the client's bloodstream.

The client is having a CT scan and starts having a severe anxiety attack. The HCP prescribed the anxiolytic diazepam (Valium), intravenous push. Which action should the nurse implement? 1. Dilute the Valium with normal saline and administer IVP. 2. Do not dilute the Valium and inject in a port closest to the client. 3. Inject the Valium into a 50-mL normal saline bag and infuse. 4. Question the order because Valium should not be administered IV.

2 Valium is oil-based and should not be diluted with normal saline. The nurse should administer the Valium undiluted over 2-3 minutes in the IV port closest to the client's hand so the medication can get to the client's blood stream faster. The Valium should be administered as an IVP, not as an IV piggyback. Valium can be administered safely via the intravenous route and is recommended for acute, severe anxiety attacks because it will be effective within 1-5 minutes.

28. The nurse is administering digoxin (Lanoxin), a cardiac glycoside, to a client diag- nosed with congestive heart failure (CHF). Which interventions should the nurse implement? Select all that apply. 1. Assess the client's carotid pulse for 1 full minute. 2. Check the client's current potassium level. 3. Ask the client if he or she is seeing a yellow haze around objects. 4. Have the client squeeze the nurse's fingers. 5. Teach the client to get up slowly from a sitting position.

2, 3 The client's potassium level, as well as the digoxin level, is monitored because high levels of potassium impair thera- peutic response to digoxin and low levels can cause toxicity. The most common cause of dysrhythmias in clients receiving digoxin is hypokalemia from diuretics that are usually given simultaneously. Yellow haze indicates the client may have high serum digoxin levels. The therapeutic range for digoxin is rela- tively small (0.5 to 1.2), and levels of 2.0 or greater are considered toxic.

The 13-year-old child admitted to the intensive care department diagnosed with an overdose of Ambien CR, a sedative hypnotic, is ordered whole bowel irrigation. Which intervention should the nurse implement? 1. Administer 0.5 L of GoLYTELY every hour. 2. Administer 1.0 L of GoLYTELY every hour. 3. Administer 1.5-2.0 L of GoLYTELY every hour. 4. Administer 2.5-3.0 L of GoLYTELY every hour.

3 0.5 L of GoLYTELY every hour is the dose for children younger than 6 years old. 1.0 L GoLYTELY every hour is the dose for children 6-12 years old. 1.5-2.0 L of GoLYTELY is the dose for clients 12 years old or older. Whole bowel irrigation is effective following ingestion of lead, lithium, iron, and sustained-release medications. This dosage is not recommended for any client.

Which intervention should the nurse implement when administering the biologic response modifier erythropoietin (Epogen) subcutaneously? 1. Shake the dose well prior to preparing the injection. 2. Apply a warm washcloth after administering the medication. 3. Discard any unused portion of the vial after pulling up the correct dose. 4. Keep the medication vials in the freezer until preparing to administer.

3 Do not shake the vial because shaking may denature the glycoprotein, rendering it biologically inactive. The nurse should apply ice to numb the injection site, not a warm washcloth after administration. The nurse should only use the vial for one dose. The nurse should not reenter the vial and should discard any unused portion because the vial contains no preservatives. The medication should be stored in the refrigerator, not the freezer, and should be warmed to room temperature prior to its being administered.

75. The nurse is administering therapeutic heparin, an anticoagulant, for a client diag- nosed with deep vein thrombosis. Which laboratory value should the nurse monitor? 1. International Normalized Ratio (INR). 2. Prothrombin time (PT). 3. Partial thromboplastin time (PTT). 4. Platelet count.

3 INR is monitored for oral anticoagulant therapy, warfarin (Coumadin). PT is not directly monitored for oral anti- coagulant therapy but will be elevated in clients receiving oral anticoagulants. The PTT should be 1.5 to 2.0 times the normal PTT or a control to deter- mine if intravenous heparin is thera- peutic. The platelet count is not monitored during heparin therapy.

The client in end-stage renal disease is receiving oral Kayexalate, a cation exchange resin. Which assessment data indicates the medication is effective? 1. The client's serum potassium level is 5.8 mEq/L. 2. The client's serum sodium level is 135 mEq/L. 3. The client's serum potassium level is 4.2 mEq/L. 4. The client's serum sodium level is 147 mEq/L.

3 Kayexalate is a medication that is admin- istered to decrease an elevated serum potassium level. A potassium level within the normal range of 3.5-5.5 mEq/L indi- cates the medication is effective.

The nurse is providing discharge instructions for a client prescribed the thiazide diuretic hydrochlorothiazide (Diuril). Which instruction should the nurse include? 1. Drink at least 8 to 10 glasses of water a day. 2. Weigh monthly and report the weight to the HCP. 3. Eat bananas or oranges regularly. 4. Try to sleep in an upright position.

3 Loop and thiazide diuretics cause the body to excrete potassium in the urine. The client should attempt to replace the potassium by eating potassium-rich foods such as bananas and orange juice.

The charge nurse on an orthopedic unit is transcribing orders for a client diagnosed with back pain. Which HCP order should the charge nurse question? 1. Physical therapy for hot packs and massage. 2. CBC and CMP (complete metabolic panel). 3. Hydrocodone (Vicodin), an opioid analgesic, PRN. 4. Carisoprodol (Soma), a muscle relaxant, po, b.i.d.

3 Physical therapy for heat and massage is standard therapy for back pain. There is no reason to question this order. Many medications can affect the kidneys or the liver and the blood counts. Baseline data should be obtained. There is no reason to question this order. This medication order is incomplete. The nurse should contact the HCP for a time limitation. Soma comes in one strength so this order is complete. There is no reason to question this order.

15. 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.

3 Protamine sulfate is the antidote for heparin toxicity. Heparin is a parenteral anticoagulant and would not be administered for Coumadin toxicity. 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. The antidote is vitamin K, not vitamin C.

The client diagnosed with hypothyroidism is prescribed levothyroxine (Synthroid). Which assessment data would support that the client is taking too much medication? 1. The client has a 2-kg weight gain. 2. The client complains of being too cold. 3. The client's radial pulse rate is 110 bpm. 4. The client complains of being constipated.

3 Weight gain indicates the client is not taking enough medication. Intolerance to cold indicates the client is not taking enough medication. Tachycardia, heart rate greater than 100, is a sign of hyperthyroidism and indicates the client is taking too much medication. Decreased metabolism, constipation, indi- cates the client is not taking enough thyroid hormone.

According to the American Heart Association, 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.

3 The AHA recommends that a client having chest pain chew two baby aspirins or one 325-mg tablet immedi- ately to help prevent platelet aggrega- tion and further extension of a coronary thrombosis.

3. The client is 2 days postoperative right total hip replacement and is receiving the low molecular weight heparin (Lovenox) subcutaneously. Which laboratory data should the nurse monitor? 1. The prothrombin time (PT). 2. The International Normalized Ratio (INR). 3. There is no laboratory data to monitor. 4. The partial thromboplastin time (PTT).

3. This anticoagulant is administered prophylactically to prevent deep vein thrombosis, but it will not achieve a therapeutic value because of its short half-life; therefore, no bleeding studies are monitored.

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 would be 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."

3. This medication works in the arteries to prevent platelet aggregation and is prescribed for a client diagnosed with arteriosclerosis.

The elderly client diagnosed with coronary artery disease has been taking aspirin daily for more than a year. Which data would 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.

4 must understand the correct rationale for administering medications even if the client may say it "thins the blood." Angina is a complication of atherosclero- sis, and aspirin may help decrease angina, but that is not the scientific rationale as to why it is prescribed. 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. Baby aspirin can cause gastric distress, but the question is asking for the scientific rationale for taking this medication. This medication should be adminis- tered with water, fruit juice, soup, or pulpy fruit (applesauce, pineapple) to reduce the risk of esophageal irritation and impaction. The client should increase, not decrease, fiber consumption while taking this medication to help decrease constipation. The cholesterol level is initially monitored monthly and then at longer intervals. 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. 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. Elderly clients often have a loss of hear- ing, but it is not a complication of long- term aspirin use. Tinnitus is, however, a possible complication of aspirin use. Elderly clients often lose taste buds, which may cause a funny taste in the mouth, but it is not a complication of taking daily aspirin. A complication of long-term aspirin use is gastric bleeding, which could result in dark, tarry stools. This data would warrant further intervention.

82. The nurse is preparing to administer a nitroglycerin patch to a client diagnosed with coronary artery disease. Which interventions should the nurse implement first? 1. Date and time the nitroglycerin patch. 2. Remove the old patch. 3. Apply the nitroglycerin patch. 4. Check the patch against the MAR.

4 After opening the medication the nurse should date and time the patch prior to putting it on the client so that the nurse is not pressing on the client when writing on the patch. The old patch should be removed but not before checking the MAR. The nurse should administer the patch in a clean, dry, nonhairy place while wearing gloves. The nurse should implement the five rights of medication administration, and the first ones are to make sure it is the right medication and the right client.

The client diagnosed with ulcerative colitis is prescribed mesalamine (Asacol), an aspirin product. Which information should the nurse discuss with the client? 1. Explain to the client that undissolved tablets may be expelled in stool. 2. Discuss the importance of taking the medication on an empty stomach only. 3. Tell the client to avoid drinking any type of carbonated beverages. 4. Instruct the client not to crush, break, or chew the tablets or capsules.

4 The tablets must be swallowed whole because they are specially formulated to release the medication after it has passed through the stomach.

9. 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.

4 Because the client has had one myocar- dial infarction, the client may have sublingual NTG 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.

68. The client admitted to the medical floor for pneumonia informs the nurse of taking an aspirin every day. Which intervention should the nurse implement? 1. Assess the client's blood pressure and pulse. 2. Check the client's urine for ketones. 3. Monitor for an elevated temperature. 4. Document the information in the chart.

4 This information should be docu- mented in the chart, and no further action should be taken.

The nurse is administering morning medications. Which medication would the nurse question administering? 1. Bupropion (Zyban), an antidepressant, to a client who has chronic obstructive pulmonary disease (COPD). 2. Meperidine (Demerol), a narcotic analgesic, to a client who has had gastric bypass surgery for obesity. 3. Loperamide (Imodium), an antidiarrheal, to a client who has irritable bowel syndrome (IBS). 4. Sibutramine (Meridia), an appetite suppressant, to a client receiving fluoxetine (Prozac) for depression.

4 Combining Meridia with any other serotonergic medication, such as Prozac, can cause serotonin syndrome, a potentially life-threatening reaction characterized by incoordination, hyper- reflexia, myoclonus, fever, tremors, sweating, and mental changes. The nurse should hold the medication and discuss this with the HCP.

The 43-year-old female client diagnosed with schizophrenia has been taking the conventional antipsychotic medication chlorpromazine (Thorazine) for 20 years. Which assessment data would warrant discontinuing the medication? 1. The client has had menstrual irregularities for the last year. 2. The client has to get up very slowly from a sitting position. 3. The client complains of having a dry mouth and blurred vision. 4. The client has fine, wormlike movements of the tongue.

4 Exhibiting fine, wormlike movements of the tongue is a symptom of tardive dyskinesia, which is an adverse effect that may develop after months or years of continuous therapy with a conven- tional antipsychotic medication. The medication should be discontinued, and a benzodiazepine should be admin- istered.

The client with hepatitis is being treated with interferon alfa (Roferon), a biologic response modifier. Which information should the clinic nurse discuss with the client? 1. Explain that if flulike symptoms occur, the client must stop taking the medication. 2. Discuss that the client may experience some abnormal bruising and bleeding. 3. Tell the client that the skin will become yellow while taking this medication. 4. Recommend taking acetaminophen (Tylenol), two tablets, before the injection.

4 Interferon is naturally produced by the body in response to a viral infection. The administration of synthetic interferon produces the same flulike symptoms and should be treated with Tylenol, which will help decrease the severity of the symptoms from the injection. After multiple interferon injections, the client will no longer have the flulike symptoms.

The client diagnosed with end-stage liver failure is taking lactulose (Chronulac), a laxative. Which assessment data indicate the medication is effective? 1. The client reports a decrease in pruritus. 2. The client's abdominal girth has decreased. 3. The client is experiencing diarrhea. 4. The client's ammonia level is decreased.

4 Lactulose is not administered to help with the client's complaints of itching. 2. Lactulose will not help decrease the client's ascites. 3. Diarrhea is a sign of medication toxicity and would warrant decreasing the medi- cation dose. 4. Lactulose is administered to decrease the client's serum ammonia level; the normal adult level is 19-60 mcg/dL.

The client in cardiogenic shock is receiving norepinephrine (Levophed), a sympath- omimetic. Which priority intervention should the nurse implement? 1. Do not abruptly discontinue the medication. 2. Administer medication on an infusion pump. 3. Check the client's creatinine level and BUN. 4. Monitor the client's blood pressure continuously.

4 Levophed must be tapered, but this is not the priority nursing intervention when administering this medication. Caring for the client is always priority. 2. Administering medication on an infusion pump is important, but the priority inter- vention is caring for the client, not a machine. 3. The nurse should check the client's renal status, but the priority nursing intervention is assessing the data for which the client is receiving the medication. 4. Norepinephrine is a powerful vasocon- strictor; therefore, continuous monitor- ing of the blood pressure is required to avoid hypertension.

The client receiving telemetry is showing ventricular fibrillation and has no pulse. Which medication should the nurse administer first? 1. Lidocaine. 2. Atropine. 3. Adenosine. 4. Epinephrine.

4 Lidocaine suppresses ventricular ectopy and is a first-line drug for the treatment of ventricular dysrhythmias, but it is not the first medication to be administered in a code. Atropine decreases vagal stimulation, which increases the heart rate and is the drug of choice for asystole, complete heart block, and symptomatic bradycardia. Adenosine is the drug of choice for termi- nating paroxysmal supraventricular tachy- cardia by decreasing the automaticity of the SA node and slows conduction through the AV node. Epinephrine constricts the periphery, shunts the blood to the central trunk, and is the first medication adminis- tered in a client who is coding. The client does not have a pulse; therefore, the nurse must call a code.

The male client who has had bilateral knee replacement surgery calls the nurse's desk and reports that he noticed bruises on both sides of his abdomen while taking his bath. The client's MAR notes Ancef, an antibiotic; morphine, a narcotic analgesic; and Lovenox, a low molecular weight heparin. Which is the nurse's best response to the client? 1. "This is a reaction to the antibiotic you are receiving and it will need to be changed." 2. "This is caused by straining when trying to have a bowel movement." 3. "This occurs because of the positioning during the surgical procedure." 4. "This happened because of the medication used to prevent complications."

4 Lovenox is a low molecular weight heparin and is administered in the "love handles" or upper anterior lateral abdominal walls. Small "bruises" or hematomas in this area suggest a non-life-threatening side effect

The client is having status epilepticus and is prescribed intravenous diazepam (Valium). The client has an IV of D5W 75 mL/hr in the right arm and a saline lock in the left arm. Which intervention should the nurse implement? 1. Dilute the Valium and administer over 5 minutes via the existing IV. 2. Do not dilute the medication and administer at the port closest to the client. 3. Question the order because Valium cannot be administered with D5W. 4. Inject 3 mL of normal saline in the saline lock and administer Valium undiluted.

4 Valium is oil based and should not be diluted. Valium is oil based and should not be administered in an existing intravenous line if another option is available. Valium should not be administered in an existing intravenous line, but the nurse does not need to question the order because there is an existing saline lock. The nurse should administer the Valium undiluted through the saline lock.

The nurse is administering the thiazide diuretic hydrochlorothiazide (HydroDIURIL) to a client diagnosed with end-stage renal disease (ESRD). Which assessment data would cause the nurse to question the administration of this medication? 1. The urine output was 90 mL for the last 8 hours. 2. The skin turgor is elastic and oral mucosa is moist. 3. The client's has 3 sacral and peripheral edema. 4. The client's blood pressure is 90/60 in the left arm.

4. Diuretics reduce circulating blood volume, which may cause orthostatic hypotension. Because the client's blood pressure is low, the nurse should ques- tion administering this medication.

The long-term-care facility nurse is caring for a client diagnosed with a cerebro- vascular accident (CVA) 6 months ago who has residual cognitive deficits. The HCP has ordered alprazolam (Xanax), an antianxiety medication, to be administered at bedtime. Which intervention should the nurse initiate for this client? 1. Offer toileting every 2 hours. 2. Move the client to the end of the hall for less noise. 3. Administer the medication at 1800. 4. Give the medication with a full glass of water.

1 This medication has a side effect of drowsiness, which is why the HCP chose this medication for the client—to help the client rest at night. The client has cognitive deficits and should be on fall precautions, so it is hoped that assisting the client to the bathroom every 2 hours will prevent the client from falling while trying to get to the bathroom. The client at risk for falling should be as near the nursing station as possible. This allows the staff to keep a closer watch on the client. The medication is ordered for bedtime, usually 2100, in most health-care facilities. Giving the medication with a full glass of water would increase the client's need to get up during the night to use the bath- room, increasing the risk of falling.

7. The client in pelvic traction on strict bed rest has a red, edematous, tender left calf. Which medication would the nurse prepare to administer? 1. The intravenous anticoagulant heparin. 2. The oral anticoagulant warfarin (Coumadin). 3. The subcutaneous antiplatelet clopidogrel (Plavix). 4. The oral antiplatelet acetylsalicylic acid (aspirin).

1 1. The drug of choice for acute deep vein thrombosis is intravenous heparin, an anticoagulant. These signs and symptoms should indicate DVT to the nurse. 2. Oral anticoagulants are prescribed for a resolving DVT to a client prior to discharge from the hospital. 3. Antiplatelets are for arterial blood disorders, and they are not administered subcuta- neously. 4. Aspirin is prescribed as an antiplatelet for arterial disorders, not venous disorders.

The home health nurse is caring for a client diagnosed with congestive heart failure (CHF) who has been prescribed the cardiac glycoside digoxin (Lanoxin) and the loop diuretic furosemide (Lasix). Which statement by the client indicates the medications are effective? 1. "I am able to walk next door now without being short of breath." 2. "I keep my feet propped up as much as I can during the day." 3. "I have gained 3 pounds since my last visit here." 4. "I am staying on my diet, and I don't salt my foods anymore."

1 A symptom of CHF is shortness of breath. The fact that the client can ambulate without being short of breath is an improvement of symptoms, which shows that the medications are effec- tive. This statement indicates compliance with treatment guidelines, not effectiveness of a medication. Weight gain would indicate that the client is retaining fluid and the medications are not effective. This statement indicates compliance with treatment guidelines, not effectiveness of a medication.

14. 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 action 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 MedicAlert bracelet at all times.

1 Abnormal bleeding is a sign of Coumadin overdose; the client needs to be assessed immediately and have a STAT International Normalized Ratio laboratory test. Ice causes vasoconstriction, but this bleed- ing is abnormal and will not stop without medical treatment. Abnormal bleeding to this extent is not expected while receiving Coumadin therapy. This is an appropriate teaching interven- tion for clients receiving Coumadin, but this is not an appropriate action at this time.

24. The client diagnosed with schizophrenia is prescribed clozapine (Clozaril), an atypi- cal antipsychotic. Which information should the nurse discuss with the client concerning this medication? 1. Discuss the need for regular exercise. 2. Instruct the client to monitor for weight loss. 3. Tell the client to take the medication with food. 4. Explain to the client the need to decrease alcohol intake.

1 Clozaril can promote significant weight gain; therefore, the client should exer- cise regularly, monitor weight, and reduce caloric intake. Clozaril promotes weight gain, not weight loss. Clozaril does not cause gastrointestinal distress and can be taken with food or on an empty stomach. The client should not decrease alcohol intake; the client should avoid alcohol intake completely.

53. The client diagnosed with Alzheimer's disease (AD) is prescribed rivastigmine (Exelon), a cholinesterase inhibitor. Which medication should the nurse question administering to the client? 1. Amitriptyline (Elavil), a tricyclic antidepressant. 2. Warfarin (Coumadin), an anticoagulant. 3. Phenytoin (Dilantin), an anticonvulsant. 4. Prochlorperazine (Compazine), an antiemetic.

1 Tricyclic antidepressants, first-genera- tion antihistamines, and antipsychotics can reduce the client's response to cholinesterase inhibitors. Antipsy- chotics are useful for clients whose behavior is erratic and uncontrollable in the end stage of the disease. The cholinesterase inhibitor Exelon would not be useful in end-stage disease.

43. The 17-year-old client is prescribed metronidazole (Flagyl) and erythromycin (E Mycin) for a persistent Chlamydia infection. Which statement by the client indicates the need for further teaching? 1. "I can have a beer or two while taking these medications." 2. "My boyfriend will have to take the medications too." 3. "I can develop more problems if I don't treat this disease." 4. "My birth control pills may not work because of the medications."

1 Consuming alcohol concurrently with Flagyl can cause a severe reaction. This statement indicates the need for more teaching. The sexual partners must be treated simultaneously to prevent a reinfection from occurring. This statement indicates the client understands the teaching. Untreated STDs can lead to pelvic inflam- matory disease, scarred fallopian tubes, and infertility. This statement indicates the client understands the teaching. Antibiotics may interfere with the effec- tiveness of some birth control pills. The client should use a supplemental form of birth control when taking birth control pills. This statement indicates the client understands the teaching.

The client diagnosed with chronic renal failure is prescribed erythropoietin (Epogen), a biologic response modifier. Which statement best describes the scientific rationale for administering this medication? 1. This medication stimulates red blood cell production. 2. This medication stimulates white blood cell production. 3. This medication is used to treat thrombocytopenia. 4. This medication increases the production of urine.

1 Epogen is a glycoprotein produced by the kidney that stimulates red blood cell production in response to hypoxia. A biologic response modifier, Epogen, is prescribed to treat the anemia that occurs in clients with chronic renal failure. Filgrastim (Neupogen) is the biologic response modifier that stimulates white blood cells and is not used in the treatment of chronic renal failure. Oprelvekin (Neumega) is the biologic response modifier that stimulates megakary- ocyte and thrombocyte production, which stimulates platelet production to prevent thrombocytopenia in clients receiving chemotherapy. There is no medication that increases the production of urine. Diuretics increase the excretion of urine but do not affect the production of urine.

The client diagnosed with the flu is prescribed the cough medication hydrocodone. Which information should the nurse teach the client regarding this medication? 1. Teach the client to monitor the bowel movements for constipation. 2. Driving or operating machinery is all right while taking this medication. 3. This medication usually causes insomnia, so plan for rest periods. 4. This medication is more effective when taken with a mucolytic.

1 Hydrocodone is an opioid and can slow the peristalsis of the bowel, resulting in constipation. The client should be aware of this and increase the fluid intake and use bulk laxatives and stool softeners, if needed. Opioids can cause drowsiness, so driving or operating machinery should be discour- aged. Opioids usually cause the client to be drowsy, not have insomnia. Hydrocodone is a cough suppressant and a mucolytic is an expectorant. These are opposite-acting medications.

The client is diagnosed with primary hyperaldosteronism and prescribed the aldos- terone agonist spironolactone (Aldactone). Which data would support that the medica- tion is effective? 1. The client's potassium level is 4.2 mEq/L. 2. The client's urinary output is 30 mL/hr. 3. The client's blood pressure is 140/96. 4. The client's serum sodium is 137 mEq/L.

1 Hyperaldosteronism causes hypokalemia, metabolic alkalosis, and hypertension. Spironolactone, a potassium-sparing diuretic, normalizes potassium levels in clients with hyperaldosteronism within 2 weeks; therefore, a normal potassium level, which is 4.2 mEq/L, indicates the medication is effective. The urinary output is not used to determine the effectiveness of this medication in a client with hyperaldosteronism. The client does have hypertension, but this blood pressure is above normal limits and does not indicate the medication is effective. The serum sodium level is not used to determine the effectiveness of this medica- tion in a client with hyperaldosteronism.

The client diagnosed with chronic hypertension is prescribed furosemide (Lasix), a loop diuretic, and enalapril (Vasotec), an ACE inhibitor. The client's blood pressures for the last 3 weeks have averaged 178/95, and the HCP has added atenolol (Tenormin), a beta blocker, to the client's current medication regimen. Which state- ment is the scientific rationale for including this medication in the client's regimen? 1. Achieving a lower average blood pressure will help to prevent a stroke. 2. The other medications are not effective without the addition of atenolol. 3. The atenolol will potentiate the effects of loop diuretics. 4. The HCP will taper off the ACE inhibitor and eventually discontinue it.

1 Hypertension is a risk factor for devel- oping a stroke. Some clients require multiple medications to control their hypertension. If this were true, then atenolol would be the only medication the client needs. Beta blockers are frequently used in combina- tion with other antihypertensive medica- tions to control a client's blood pressure. Atenolol does not potentiate the effective- ness of loop diuretics. Beta blockers, not ACE inhibitors, must be tapered off when discontinuing them to prevent rebound cardiac dysrhythmias. The HCP is adding the beta blocker to the current medications.

46. The client who is 38 weeks pregnant and diagnosed with preeclampsia is admitted to the labor and delivery area. The HCP has prescribed intravenous magnesium sulfate, an anticonvulsant. Which data indicates the medication is not effective? 1. The client's deep tendon reflexes are 4. 2. The client's blood pressure is 148/90. 3. The client's deep tendon reflexes are 2 to 3. 4. The client's deep tendon reflexes are 0.

1 If the client's deep tendon reflexes are 4, this indicates the client may have a seizure at any time, which indicates the medication is not effective.

The client is diagnosed with hypothyroidism and is taking the thyroid hormone levothyroxine (Synthroid). Which data indicates the medication is effective? 1. The client's apical pulse is 84 and the blood pressure is 134/78. 2. The client's temperature is 96.7F and respiratory rate is 14. 3. The client reports having a soft, formed stool every 4 days. 4. The client tells the nurse that the client only needs 3 hours of sleep.

1 If the thyroid medication is effective, the client's metabolism should be within normal limits, and this pulse and blood pressure support this. These vital signs are subnormal, indicating hypothyroidism. A stool every 4 days indicates constipation and constipation is a sign of hypothy- roidism. This indicates the medication is not effective. Six to 8 hours of sleep would be normal. Three hours would indicate hyperactivity, which is a sign of hyperthyroidism; perhaps a dosage adjustment in the medication is needed.

46. The HCP ordered furosemide (Lasix) for a client diagnosed with syndrome of inap- propriate antidiuretic hormone (SIADH). Which laboratory test would be monitored to determine the effectiveness of the medication? 1. Serum sodium levels. 2. Serum potassium levels. 3. Creatinine levels. 4. Serum ACTH levels.

1 In SIADH, the body retains too much water. Elevated fluid levels in the body result in dilutional hyponatremia. Hyponatremia can cause seizures and other central nervous system dysfunc- tion. The sodium level is monitored to determine the effectiveness of the intervention. The serum potassium level is important to monitor, but it will not measure the effec- tiveness of Lasix in treating this condition. The problem in SIADH is in the pituitary gland; it is not a kidney problem. The pituitary gland produces ACTH, but ACTH production is not the problem in SIADH. SIADH is an overproduction of vasopressin, the antidiuretic hormone.

5. 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 NTG, you can take your Viagra." 4. "You should get clarification with your HCP about your taking Viagra."

1 Life-threatening hypotension can result with concurrent use of nitroglycerin and sildenafil (Viagra). 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. 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. The nurse should provide the client with correct information about medication and should not rely on the HCP for medication teaching.

The client with chronic pain is prescribed both MS Contin and liquid morphine (Roxanol), narcotic analgesics. How should the nurse administer the medications? 1. Administer the MS Contin at prescribed intervals and the Roxanol PRN. 2. Administer both medications PRN for the client's chronic pain. 3. Administer the Roxanol every 4 hours and the MS Contin PRN pain. 4. Administer the MS Contin for breakthrough pain and hold the Roxanol.

1 MS Contin is a sustained-release formulation and is administered routinely every 6-8 hours to control chronic pain. Roxanol is administered sublingually to treat breakthrough pain. This is the correct administration procedure.

The male client tells the clinic nurse that he purchased over-the-counter Tylenol in Mexico for back pain that worked very well and now he has purchased Tylenol at the local drug store, but now the medication does not work. Which statement would be the nurse's best response? 1. "Do you still have the container of the Tylenol you purchased in Mexico?" 2. "The Food and Drug Administration makes the company halve the dose in the United States." 3. "What makes you think there is a difference in the two bottles of medication?" 4. "You are still having back pain. Would you like to talk about the pain?"

1 Many medications that are prescription in the United States are available over the counter in other countries. Antibi- otics, narcotics, and steroids are some of the medications that can be pur- chased over the counter in Mexico. The nurse should investigate to deter- mine if the Tylenol purchased in Mexico was Tylenol #2, #3, or #4. All of these medications have codeine in them.

The nurse is administering medications. Which medication would the nurse question administering? 1. Morphine sulfate, an opioid, to a client diagnosed with pancreatitis. 2. Diphenhydramine (Benadryl), an H1 blocker, to a client with an allergic reaction. 3. Methylprednisolone (Solu-Medrol), a glucocorticoid, to a client with Type 2 diabetes. 4. Vasopressin (DDAVP), a hormone, to a client diagnosed with diabetes insipidus.

1 Morphine can cause spasm of the pancreatic ducts and the sphincter of Oddi. Therefore, the nurse would question administering this medication. Diphenhydramine is a histamine1 blocker that blocks the release of histamine1 that occurs during allergic reactions. The nurse would not question this medication. Clients with diabetes mellitus may at times have a need for a steroid medication. The medication may elevate the client's glucose levels, and these levels should be monitored. The nurse would not question this medication. Vasopressin is the hormone that is lacking in clients diagnosed with diabetes insipidus (DI) and is the treatment for DI. The nurse would not question administering this medication.

19. The charge nurse on an orthopedic unit is transcribing orders for a client diagnosed with back pain. Which HCP order should the charge nurse question? 1. Morphine sulfate, a narcotic analgesic, Q 4 hours ATC. 2. CBC and CMP (complete metabolic panel). 3. Hydrocodone (Vicodin), an opioid analgesic, Q 4 hours PRN. 4. Carisoprodol (Soma), a muscle relaxant, po, B.I.D.

1 Morphine is a potent analgesic with addictive properties, and the nurse should question a routine administra- tion of this medication. The HCP may have failed to write PRN after the order.

The nurse administered the narcotic agonist naloxone (Narcan) to a 7-year-old child who drank a large bottle of narcotic cough syrup. Which intervention should the nurse be prepared to implement? 1. Administer Narcan again in 30 minutes. 2. Place the child on a negative pressure ventilator. 3. Prepare the child for a tracheostomy. 4. Have the parents discuss the situation with the police.

1 Narcan has a short half-life and could wear off before the effects of the narcotic cough syrup. The nurse should observe for signs of returning respiratory depression and be ready to intervene.

The client has been taking alprazolam (Xanax), a benzodiazepine, daily for the last 2 years. Which signs or symptoms would warrant intervention by the nurse? 1. Nausea, vomiting, and agitation. 2. Yawning, rhinorrhea, and cramps. 3. Disorientation, lethargy, and craving. 4. Ataxia, hyperpyrexia, and respiratory distress.

1 Nausea, vomiting, and agitation, along with tachycardia, diaphoresis, tremors, and marked insomnia, are adverse effects of central nervous system depressants, such as benzodiazepines. Yawning, rhinorrhea, and cramps are signs of withdrawal from opiates, such as heroin, meperidine, morphine, and methadone. Disorientation, lethargy, and craving are signs of withdrawal from a stimulant, such as crack cocaine and amphetamines. Ataxia, hyperpyrexia, and respiratory distress are signs of an overdose of a stimulant, such as crack cocaine and amphetamines.

The nurse is completing an admission assessment on a client being admitted to a medical unit diagnosed with pneumonia. The client's list of home medications includes Lasix, a loop diuretic; Metamucil, a bulk laxative; and Reminyl, a cholinesterase inhibitor. Which intervention should the nurse implement first? 1. Make sure the client has a room near the nursing station. 2. Check the client's white blood cell count and potassium level. 3. Have the unlicensed assistant get ice chips for the client to suck on. 4. Determine the client's usual bowel elimination pattern.

1 Reminyl is prescribed for mild to moderate AD, and the safety of the client should be the nurse's first concern. Moving the client to a room that can be observed more closely is one of the first steps in a falls pre- vention protocol. This should be done, but it is not a prior- ity over client safety. The medications do not cause dry mouth. The unlicensed assistive personnel (UAP) can provide water for the client, providing that there is no reason not to. Clients taking bulk laxatives should increase the fluid intake, but this is not the first inter- vention. The nurse should assess for effectiveness of all medications, including laxatives, but this is not the first concern.

The 18-year-old male client is diagnosed with gonorrhea of the pharynx. The HCP has prescribed ceftriaxone (Rocephin), a cephalosporin. Which intervention should the nurse implement? 1. Administer the medication intramuscularly in the gluteus muscle. 2. Have the client drink a full glass of water with the pill. 3. Use a tuberculin syringe to draw up the medication. 4. Make sure the client has eaten before administering the drug.

1 Rocephin is administered IM or IV. There is no pill form of the medica- tion. The medication burns when administered and should be adminis- tered in the large gluteus muscle. There is no pill form of Rocephin, so drinking water will not affect the medication. Rocephin is administered IM or IV. A tuberculin syringe is used to administer medications by the subcutaneous or intra- dermal route. There is no pill form of the medication, so eating will not affect the medication.

17. The client newly diagnosed with a seizure disorder also has Type 2 diabetes. The health-care provider prescribes phenytoin (Dilantin) for the client. Which interven- tion should the nurse implement? 1. Instruct the client to monitor his or her blood glucose more closely. 2. Explain that the Dilantin will not affect the client's antidiabetic medication. 3. Discuss the need to discontinue oral hypoglycemic medication and take insulin. 4. Call the health-care provider to discuss prescribing the Dilantin.

1 Serum glucose must be monitored more closely because phenytoin may inhibit insulin release, thus causing an increase in glucose level. This is not a true statement. Dilantin may affect the client's antidiabetic medication. This is not a true statement. The client can still take oral hypoglycemic medi- cations. The nurse should call and discuss any questionable medication with the HCP, but there is no reason to discuss Dilantin being prescribed for a client with Type 2 diabetes.

52. Which complication should the nurse assess for in the elderly client newly diagnosed with hypothyroidism who has been prescribed levothyroxine (Synthroid)? 1. Cardiac dysrhythmias. 2. Respiratory depression. 3. Paralytic ileus. 4. Thyroid storm.

1 Synthroid increases the basal metabolic rate, which can precipitate cardiac dysrhythmias in clients with undiag- nosed heart disease, especially in elderly clients. Synthroid can also cause cardiovascular collapse. Therefore the client's cardiovascular function should be assessed by the nurse. Respiratory depression is not a complica- tion of thyroid hormone therapy. The client with hypothyroidism may expe- rience a paralytic ileus due to decreased metabolism. This would not be an expected complication in a client taking Synthroid. A thyroid storm may occur when the thyroid gland is manipulated during a thyroidectomy, not when the client starts taking Synthroid.

3. The Asian male client is prescribed fluoxetine (Prozac), a selective serotonin reuptake inhibitor (SSRI), for clinical depression after the death of his wife. Which question should the nurse ask the client when discussing this medication? 1. "How do you feel about taking this medication?" 2. "Do you have insurance to pay for the medications?" 3. "Does your diet include a lot of aged cheese and wine?" 4. "Are you currently taking any ACE inhibitors?"

1 The Asian culture does not acknowledge mental illness as a problem, and the client may not believe in taking anti- depressant medications. The Asian male may see taking medications as a weak- ness; therefore, the nurse must deter- mine if the client will take the medications.

89. The nurse is preparing to administer warfarin (Coumadin), an anticoagulant. The client's current laboratory values are as follows: PT 48 PTT 40 Control 12.9 Control 36 INR 4.2 Which action should the nurse implement? 1. Question administering the medication. 2. Prepare to administer protamine sulfate. 3. Notify the health-care provider to increase the dose. 4. Administer the medication as ordered.

1 The INR is outside of therapeutic range; therefore, the nurse should question administering this medication. Vitamin K is the antidote for Coumadin toxicity. Protamine sulfate is the antidote for heparin toxicity. There is no reason to notify the HCP to request an increase in the dose; the dose should be discontinued. The HCP should be notified of this abnormal lab data. When the nurse is administering Coumadin the International Normalized Ratio (INR) must be monitored to deter- mine therapeutic level, which is 2-3. Because the INR is 4.2, the nurse should not administer this medication.

34. The client is admitted to the surgical department diagnosed with renal calculi. The HCP prescribes a morphine patient-controlled analgesia (PCA). Which intervention should the nurse implement? 1. Instruct the client to push the control button as often as needed. 2. Explain that the medication will ensure the client has no pain. 3. Discuss that medication effectiveness is evaluated with the Wong-Baker FACES Pain Scale. 4. Inform the client to ambulate very carefully to the bathroom and to strain urine.

1 The PCA pump automatically adminis- ters a specific amount and has a lock- out interval time in which the PCA pump cannot administer any morphine. The client can push the control button as often as needed and will not receive an overdose of pain medication.

The nurse is caring for a client diagnosed with a hemorrhagic stroke. Which medica- tion should the nurse question administering? 1. Clopidogrel (Plavix), an antiplatelet. 2. Osmitrol (Mannitol), an osmotic diuretic. 3. Nifedipine (Procardia), a calcium channel blocker. 4. Dexamethasone (Decadron), a glucocorticoid.

1 The client has experienced a bleed into the cranium. Plavix interferes with the client's clotting ability. This medication should be held and discussed with the HCP.

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's has had a weight loss of 1.3 kg in 7 days. 4. The client reports occasional lightheadedness and dizziness.

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. This blood pressure has increased; there- fore, the medication is not effective. 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). These are signs of orthostatic hypotension and do not indicate the medication is effective.

The elderly client being prepared for major abdominal surgery has been taking alpra- zolam (Xanax), a benzodiazepine, PRN for many years for nerves. Which informa- tion should the nurse discuss with the HCP? 1. Discuss prescribing another benzodiazepine medication postoperatively. 2. Make sure that the alprazolam (Xanax) is ordered after surgery. 3. Taper the medication to prevent complications. 4. Change the alprazolam (Xanax) to a medication for sleep.

1 The client is having abdominal surgery so the client will be NPO for a while. Xanax is only manufactured as an oral medication. Therefore, the client will need a similar medication postopera- tively. The nurse should discuss this with the HCP. The client will be NPO after a major abdominal surgery; Xanax only comes in an oral preparation. If the client is going to stop taking Xanax, it should be tapered, but the stem does not indicate a need to discontinue the medication. The Xanax is being taken PRN, not just for sleep but also for anxiety.

The client with osteoarthritis is prescribed the COX-2 inhibitor celecoxib (Celebrex), a nonsteroidal anti-inflammatory drug (NSAID). Which statement by the client would warrant intervention by the nurse? 1. "I take aspirin daily to help prevent heart disease." 2. "I am allergic to penicillin and aminoglycosides." 3. "I know I am overweight and need to lose 50 pounds." 4. "I walk 30 minutes at least three times a week."

1 The client should not take aspirin with an NSAID because it can increase the risk of gastrointestinal upset and possi- ble gastrointestinal bleeding. Allergies to antibiotics are not a contraindication to the use of NSAIDs. Obesity is not contraindicated in clients taking NSAIDs. Exercising is recommended for clients with osteoarthritis unless it causes pain; therefore, this activity would not warrant the client not taking Celebrex.

31. The client with renal calculi was prescribed allopurinol (Zyloprim) for uric acid stone calculi. Which medication teaching should the nurse discuss with the client? 1. Inform the client to report chills, fever, and muscle aches to the HCP. 2. Instruct the client to avoid driving or other activities that require alertness. 3. Tell the client that the medication must be taken on an empty stomach. 4. Explain the importance of not eating breads, cereals, and fruits.

1 The client should notify the HCP if a skin rash or influenza symptoms (chills, fever, muscle aches and pain, nausea or vomiting) develop because these signs and symptoms may indicate hypersen- sitivity. Allopurinol does not cause drowsiness, so the nurse does not need to tell the client to avoid activities that require alertness. Allopurinol may be administered with milk or meals to minimize gastric irritation. The client with uric acid should be eating a low-purine diet. A low-purine diet includes breads, cereals, cream-style soups made with low-fat milk, fruits, juices, low- fat cheeses, nuts, peanut butter, coffee, and tea.

5. The client is having an acute exacerbation of asthma. The health-care provider has prescribed epinephrine (adrenaline) subcutaneously. Which intervention should the nurse implement when administering this medication? 1. Administer the medication using a tuberculin syringe. 2. Dilute the medication to a 5-mL bolus prior to administering. 3. Perform a complete respiratory assessment. 4. Monitor the client's serum epinephrine level.

1 The medication is prescribed in very low doses of 0.2 to 1.0 mg for an adult. The dosage of a sympathomimetic must be carefully monitored to prevent tachycar- dia, decreased or increased blood pres- sure, nausea, headache, and other central nervous system symptoms. A tuberculin syringe should be used to help ensure accuracy of dosage adminis- tered. The medication is being administered subcutaneously; therefore, the nurse will not dilute the medication. The client is in distress with an acute exac- erbation of asthma. Therefore, the nurse should not assess but should treat the client because delaying the medication may result in a respiratory arrest. There is no such laboratory test as a serum epinephrine level.

The client diagnosed with moderate benign prostatic hypertrophy (BPH) is being treated with the alpha-adrenergic agonist tamsulosin (Flomax). Which intervention should the nurse implement? 1. Check the client's blood pressure. 2. Send a urinalysis to the laboratory. 3. Determine if the client has nocturia. 4. Plan a scheduled voiding pattern.

1 The medications used to treat hyper- plasia of the prostate were originally developed to treat high blood pressure. The client may develop hypotension when taking these medications. This side effect makes them useful for clients who are also hypertensive. The medication is not given for urinary tract infections; there is no need for a urinalysis to be done when administering this medication. The client has symptoms of BPH, which could include nocturia, but this is not pertinent when administering the medication. This is an intervention that assists clients who have incontinence, not BPH.

Which statement best indicates the scientific rationale for administering vitamin K (AquaMEPHYTON) to the newborn infant? 1. It promotes blood clotting in the infant. 2. It prevents conjunctivitis in the infant's eyes. 3. It stimulates peristalsis in the small intestines. 4. It helps the digestive process in the newborn.

1 The newborn's gut is sterile and the liver cannot synthesize vitamin K from the food ingested until there are bacte- ria present in the gut. Ophthalmic ointment is administered to prevent eye infections. Routine medications administered to the newborn do not include medications to stimulate the small intestines. Routine medications administered to the newborn do not include medications to stimulate the digestive process.

The nurse is preparing to administer medications to the following clients. To which client would the nurse question administering the medication? 1. Lactulose (Cephulac), a laxative, to a client who has an ammonia level of 10 g/dL. 2. Furosemide (Lasix), a loop diuretic, to a client who has a potassium level of 3.7 mEq/L. 3. Spironolactone (Aldactone), a potassium-sparing diuretic, to a client with a potas- sium level of 3.5 mEq/L. 4. Vasopressin (Pitressin) to a client with a serum sodium level of 137 mEq/L.

1 The normal plasma ammonia level is 15-45 g/dL (varies with method); this is below the normal level. The client with end-stage liver failure would be receiving this medication, and the client does not need to receive a laxative that will cause diarrhea The normal serum potassium level is 3.5-5.5 mEq/L; therefore, the nurse should administer this medication because the potassium level is within normal limits. The normal serum potassium level is 3.5-5.5 mEq/L; therefore, the nurse should not question administering this medication because the potassium level is within normal limits. Hyponatremia (normal sodium 135-145 mEq/L) may occur when the client is taking vasopressin therapy. This sodium level is within normal limits; therefore, the nurse would not question administering this medication.

74. The nurse is administering heparin via the subcutaneous route. Which intervention should the nurse implement? 1. Prepare the medication using a 25-gauge, 1/2-inch needle. 2. After injecting the needle, aspirate and observe for blood. 3. After removing the needle, massage the area gently. 4. Administer the medication in the client's "love handles."

1 The nurse should prepare the medica- tion using a 25-gauge, 1/2- to 5/8-inch needle. The nurse should not aspirate for blood when administering heparin because this can damage surrounding tissue and cause bruising. The nurse should not massage after inject- ing heparin because this may cause bruis- ing or bleeding. Heparin is administered in the lower abdominal area at least 2 inches from the umbilicus. Lovenox is administered in the "love handles," located anterolateral to the upper abdomen.

The parent of a 1-year-old child calls the clinic to ask about medications that can be administered to reduce fever. Which medication should the nurse discuss with the parent? 1. Acetylsalicylic acid (aspirin), an antipyretic. 2. Diphenhydramine (Benadryl), an antihistamine. 3. Docosanol (Abreva), an anti-infective. 4. Docusate sodium (Colace), a gastrointestinal agent.

1 The parent should be taught to never administer aspirin to a child because of the association of aspirin with Reye's syndrome. Tylenol or ibuprofen may be administered to a child for a fever.

92. The client diagnosed with inflammatory bowel disease is prescribed mesalamine (Asacol) suppository, an aspirin product. Which statement indicates the client does not understand the medication teaching? 1. "I should retain the suppository for at least 15 minutes." 2. "The suppository may stain my underwear or clothing." 3. "I should store my medication in my medication cabinet." 4. "I should have an empty rectum when applying the suppository."

1 The suppository should be retained for 1-3 hours if possible to get the maximum benefit of the medication. This statement indicates the client does not understand the medication teaching.

73. 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 PTT 62 Control 12.9 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.

1 The therapeutic range for heparin is 1.5 to 2.0 times the control, or 54 to 72. The client's PTT of 62 indicates the client is within therapeutic range and the next bag should be adminis- tered at the same rate. The client's PTT is within therapeutic range; therefore, there is no need to order any further laboratory studies. The HCP need not be notified of the client's situation because the client's PTT is within therapeutic range. The client's PTT is within therapeutic range. This level does not indicate a potential for abnormal bleeding.

Which task would be most appropriate for the nurse to assign to the licensed practical nurse (LPN) working in the psychiatric department? 1. Administer alprazolam (Xanax), a benzodiazepine, to a client diagnosed with a panic disorder. 2. Administer haloperidol (Haldol), an antipsychotic, to a client experiencing tardive dyskinesia. 3. Administer lithium (Lithobid) to a client diagnosed with bipolar disease who has a lithium level of 2.0 mEq/L. 4. Administer oral thiamine (B1), a vitamin, to a client diagnosed with chronic alco- holism who is experiencing delirium tremens.

1 This client is stable and has a diagnosis of panic attack; administering Xanax would be an appropriate task to assign to an LCP. Tardive dyskinesia is a life-threatening complication of antipsychotic medication, and the nurse should not delegate care of an client who is unstable. This lithium level is toxic, and the client should not receive any lithium. The client should receive intravenous, not oral, thiamine medication. The client is not stable and the nurse should not delegate this medication administration.

5. The client prescribed phenytoin (Dilantin) for epilepsy calls the clinic and reports a measles-like rash. Which action should the nurse implement? 1. Instruct the client to come to the clinic immediately. 2. Determine if the client is drinking grapefruit juice. 3. Encourage the client to apply a hydrocortisone cream to the rash. 4. Explain that this is a common side effect of this medication.

1 This morbilliform (measles-like) rash may progress to a more serious reaction; therefore, the client should come to the clinic immediately and the medication should be stopped immediately.

48. The nurse is preparing to hang the next bag of heparin. The client's current labora- tory values are as follows: PT 13.4 PTT 92 Control 12.9 Control 36 INR 1 Which intervention should the nurse implement first? 1. Discontinue the heparin infusion. 2. Prepare to administer protamine sulfate. 3. Notify the health-care provider. 4. Assess the client for bleeding.

1 This would be the first intervention because the client is above the thera- peutic range. The therapeutic range for heparin is 1.5 to 2.0 times the control, or 54 to 72. The client's PTT of 92 places the client at risk for bleeding. Therefore, the nurse must prevent further infusion of medication. This is the antidote for heparin, but the nurse would not administer this first. Discontinuing the infusion of heparin for a few hours may be sufficient to correct the overdose. The HCP should be notified of the client's situation, but it is not the first interven- tion. Assessment is the first step in the nursing process, but if the client is in "distress" or experiencing a complication, the nurse should first treat the client.

10. The adult client recently has been diagnosed with asthma. Which medication would be recommended to treat this problem? 1. Omeprazole (Prilosec), a proton-pump inhibitor, daily. 2. Amoxicillin (Amoxil), an antibiotic, twice daily. 3. Loratadine (Claritin), an antihistamine, twice daily. 4. Prednisone, a glucocorticoid, daily.

1 Up to 90% of adult-onset asthma is the result of gastroesophageal reflux disease (GERD). Treating the gastric reflux will treat the asthma. The client is diagnosed with asthma, not an infection. There is no reason to admin- ister an antibiotic. Antihistamines such as Claritin are used to treat allergic reactions to pollens, dust, or other irritating substances. They are not effective against asthma. Glucocorticoids are prescribed daily for clients with chronic lung diseases, such as emphysema or chronic bronchitis. A client with asthma would not be prescribed a daily steroid.

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.

1 When preparing to administer a potas- sium-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. 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. The client should not eat potassium-rich foods because this medication retains potas- sium. This medication can be administered with or without food; therefore, this is not a priority intervention.

The client diagnosed with chronic obstructive pulmonary disease is prescribed methylprednisolone (Solu-Medrol), a glucocorticoid, IVP. Which laboratory data would warrant immediate intervention by the nurse? 1. The white blood cell (WBC) count is 15,000. 2. The hemoglobin and hematocrit levels are 13 g/dL and 39%. 3. The blood glucose level is 138 mg/dL. 4. The creatinine level is 1.2 mg/dL.

1 White blood cells are monitored to detect the presence of an infection, and an elevated WBC is a sign of infection that would warrant intervention. Steroids mask infection.

31. The client diagnosed with a general anxiety disorder is prescribed alprazolam (Xanax), a benzodiazepine. Which information should the clinic nurse discuss with the client? 1. Explain to the client that this medication is for short-term use. 2. Inform the client that rage and excitement are expected side effects. 3. Tell the client to avoid foods that are high in vitamin K. 4. Instruct the client to take the medication with at least 8 ounces of water.

1 Xanax has the potential for depend- ency, but that potential can be mini- mized by using the lowest effective dosage for the shortest time necessary. Rage, excitement, and heightened anxiety are signs of paradoxical reactions and should be reported to the HCP. The medication will be discontinued. There is no contraindication to eating foods high in vitamin K and taking Xanax. There is no reason for the client to take the medication with 8 ounces of water.

4. The client diagnosed with low back pain is prescribed morphine sulfate, an opioid analgesic. Which interventions should the nurse implement? Select all that apply. 1. Discuss with the HCP starting the client on a stool softener. 2. Teach the client about rating the pain on a numeric pain scale. 3. Inform the client to rise quickly from a supine position. 4. Administer anticonvulsant medications around the clock. 5. Tell the client to call for assistance when getting out of bed.

1,2,5 Narcotic pain medications slow peristal- sis in the small and large intestines, increasing the risk for constipation and fecal impaction. The nurse should discuss a bowel regimen with the HCP. The nurse should attempt to have the client quantify the pain so that the effec- tiveness of interventions can be evalu- ated. The numeric pain scale is one method of objectifying the pain. Rising quickly from a flat-on-the-back (supine) position could increase the client's pain. Some of the medications administered for back pain can cause orthostatic hypoten- sion. The nurse should teach the client to turn on the side and push up on the elbow slowly when getting out of bed. The client may be taking antispasmodic and pain medications, but there is no reason for anticonvulsant medications. This is a safety issue. The client should call for assistance to prevent falls.

71. The nurse is preparing to administer warfarin (Coumadin), an anticoagulant. The client's current laboratory values are as follows: PT38 PTT 39 Control 12.9 Control 36 INR 5.9 Which action 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.

2 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.

The nurse is administering medication to a client who has had a kidney transplant and is taking cyclosporine, an antirejection medication. Which medication would the nurse question administering? 1. The ACE inhibitor captopril (Capoten). 2. The antibiotic trimethoprim-sulfamethoxazole (Bactrim DS). 3. The analgesic acetaminophen (Tylenol). 4. The antiemetic prochlorperazine (Compazine).

2 ACE inhibitors would not be questioned in clients with kidney transplants or taking cyclosporine. Bactrim reduces cyclosporine levels, which can lead to organ rejection; therefore, the nurse should question administering this medication. Tylenol is not contraindicated in clients with kidney transplants; it is contraindi- cated in clients with liver disorders. Compazine is not contraindicated in clients with kidney transplants; it is contraindicated in clients with a liver disorder.

36. The client diagnosed with renal calculi is receiving pain medication via morphine patient-controlled analgesia (PCA). The client is still voicing excruciating pain and is requesting something else. Which intervention should the nurse imple- ment first? 1. Administer the rescue dose of morphine intravenous push. 2. Check the client's urine for color, sediment, and output. 3. Determine the last time the client received PCA morphine. 4. Demonstrate how to perform guided imagery with the client.

2 Administering the rescue of morphine is an appropriate intervention, but it is not the nurse's first action. Assessing the client and ruling out any complications is the nurse's first inter- vention. The nurse should determine the last time the client received morphine and the amount of morphine the client has received, but it is not the first intervention. Nonpharmacologic interventions are appropriate to address the client's pain, but they should not be implemented first for a client with renal calculi.

The client in end-stage liver failure has an elevated ammonia level. The health-care provider prescribes lactulose (Cephulac), a laxative. Which intervention should the nurse implement to determine the effectiveness of the medication? 1. Monitor the client's intake and output. 2. Assess the client's neurological status. 3. Measure the client's abdominal girth. 4. Document the number of bowel movements.

2 An elevated ammonia level affects the client's neurological status. Lactu- lose is prescribed to remove ammonia through the intestinal tract. Assessing the client's neurological status will determine the effectiveness of the medication.

8. The client with a head injury is admitted into the intensive care unit (ICU). Which health-care provider medication order would the ICU nurse question? 1. Osmitrol (Mannitol), an osmotic diuretic. 2. Methylprednisolone (Solu-Medrol), a corticosteroid. 3. Phenytoin (Dilantin), an anticonvulsant. 4. Oxygen, 6 L via nasal cannula.

2 An osmotic diuretic is the treatment of choice to help decrease intracranial pres- sure that occurs with a head injury. Research supports the finding that clients with head injuries who are treated with anti-inflammatory corti- costeroids are 20% more likely to die within 2 weeks after the head injury than those who aren't so treated. The nurse should question this medication. Seizures are a common complication of head injuries; therefore, an order for an anticonvulsant medication would be appropriate. There is no reason for the nurse to ques- tion an order for oxygen—which is considered a medication—for a client with a head injury.

The HCP prescribed amoxicillin/clavulanate (Augmentin), an antibiotic, for a client diagnosed with chronic obstructive pulmonary disease (COPD) who has a cold. Which intervention should the nurse implement? 1. Discuss the prescription with the HCP because antibiotics do not help viral infec- tions. 2. Teach the client to take all the antibiotics as ordered. 3. Encourage the client to seek a second opinion before taking the medication. 4. Ask the client if he or she is allergic to sulfa drugs or shellfish.

2 Antibiotics do not treat viral infections, but HCPs will frequently prescribe prophylactic antibiotics for clients with comorbid condi- tions (such as COPD) to prevent a second- ary bacterial infection. Clients prescribed antibiotics should always be taught to take all the medica- tion as ordered to prevent resistant strains of bacteria from developing. There is no reason for a second opinion; this is standard medical practice. This is a penicillin preparation, not a sulfa medication or iodine.

The client diagnosed with obsessive-compulsive disorder is prescribed the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft). Which statement indicates the client understands the medication teaching? 1. "If I get a headache or become nauseated, I will notify my HCP." 2. "It will take a couple of months before I see a change in my behavior." 3. "I need to be careful because SSRIs may cause physical addiction." 4. "I am glad I do not need to go to my psychologist's appointments."

2 Common side effects of SSRIs include nausea, headache, insomnia, and sexual dysfunction; if these side effects develop, the client would not need to notify the HCP. The client does not understand the medication teaching. The beneficial effects of SSRIs develop slowly, taking several months to become maximal when used to treat obsessive-compulsive disorder. The client understands this. SSRIs are antidepressants used to treat obsessive-compulsive disorder. They do not have addictive properties. The client does not understand the medica- tion teaching. The client should continue to go to a counselor or psychologist to determine the cause of the anxiety so that the client can eventually discontinue the SSRI. The client does not understand the medication teaching.

22. The nurse is caring for clients on the telemetry unit. Which medication should the nurse administer first? 1. The cardiotonic digoxin to the client diagnosed with CHF whose digoxin level is 1.9 mg/dL. 2. The narcotic morphine IVP to the client who has pleuritic chest pain that is a "7" on a 1-10 pain scale. 3. The sodium channel blocker lidocaine to the client exhibiting two unifocal PVCs per minute. 4. The ACE inhibitor lisinopril (Vasotec) to the client diagnosed with HTN who has a B/P of 130/68.

2 Pleuritic pain is pain involving the thoracic pleura, and pain of a "7" should be addressed before routine medications.

The client with a major depressive disorder taking the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac) calls the psychiatric clinic and reports feeling confused and restless and having an elevated temperature. Which action should the psychiatric nurse take? 1. Determine if the client has flulike symptoms. 2. Instruct the client to stop taking the SSRI. 3. Recommend the client take the medication at night. 4. Explain that these are expected side effects.

2 Confusion and restlessness would not indi- cate the flu. The elevated temperature should make the nurse suspect a possible serious complication of SSRIs. Serotonin syndrome is a serious compli- cation of SSRIs that produces mental changes (confusion, anxiety, and restless- ness), hypertension, tremors, sweating, hyperpyrexia (elevated temperature), and ataxia. Conservative treatment includes stopping the SSRI and supportive treat- ment. If untreated, ESE can lead to death. Taking the medication at night will not treat serotonin syndrome. These are not expected side effects. They require nursing intervention.

49. The client in end-stage liver failure is taking the laxative lactulose (Cephulac). Which statement indicates the client needs more teaching concerning this medication? 1. "I will notify my doctor if I have any watery diarrhea." 2. "If I get nauseated, I will quit taking the lactulose." 3. "I will take my lactulose with fruit juice." 4. "I should have two or three soft stools a day."

2 Diarrhea indicates an overdose of the medication and the client should call the HCP for a decrease in the dosage; there- fore, this comment indicates the client understands the teaching. Although the drug may cause nausea, the client should keep taking it because it decreases the ammonia level. The nurse should instruct the client to take the medication with crackers or a soft drink, which may decrease the nausea. This statement indicates the client does not understand the medication teaching and needs more teaching. To mask the sweet taste, lactulose can be diluted with fruit juice. This statement indicates the client understands the medication teaching. Having two to three soft stools a day indi- cates the medication is working to help decrease the ammonia level.

Which client would the nurse question receiving the hematopoietic growth factor erythropoietin (Epogen)? 1. The client diagnosed with end-stage renal disease. 2. The client diagnosed with essential hypertension. 3. The client diagnosed with lung cancer and metastasis. 4. The client diagnosed with anemia and leukopenia.

2 Epogen is frequently administered to clients in end-stage kidney disease to stim- ulate their bodies to produce red blood cells. The kidneys naturally produce erythropoietin to stimulate red blood cell production, but clients with renal disease may not be able to produce the cytokine erythropoietin. A rapid increase in hematocrit, which may occur with Epogen, can result in uncontrolled hypertension. The client must have the hypertension well- controlled for Epogen to be adminis- tered safely. The nurse would question this medication for this client. The client diagnosed with lung cancer and metastasis would be a candidate for Epogen. The nurse would not question this medication. Epogen is given to clients with anemia. Leukopenia will not be increased or decreased by the medication.

The client diagnosed with chronic hepatitis C who is taking interferon alfacon (Infergen), an antiviral medication, reports having fever, muscle pain, and headaches to the nurse. Which action should the nurse take? 1. Instruct the client to taper off the medications immediately. 2. Encourage the client to take acetaminophen (Tylenol). 3. Explain that the client will just have to live with these side effects. 4. Recommend that the client see the health-care provider.

2 Flulike symptoms, including fever, fatigue, myalgia, headache, and chills, are the most common side effects of Infergen and do not require discontinuing the medication. Some of the flulike symptoms (fever, headache, myalgia) can be reduced with acetaminophen. These flulike symptoms tend to diminish with continued therapy; therefore, the client will not have to live with these side effects. The nurse must be knowledgeable about the expected side effects of medications and is responsible for teaching the client. These side effects are common and the client does not need to see the health-care provider.

43. The HCP has ordered streptokinase (Streptase), a thrombolytic, intravenously for the client diagnosed with a pulmonary embolus. The client has intravenous heparin infusing at 1600 units per hour via a 20-gauge angiocath. Which intervention should the nurse implement? 1. Administer the streptokinase via a Y-tubing. 2. Start a second intravenous site to infuse the streptokinase. 3. Discontinue the heparin and infuse streptokinase via the 20-gauge angiocath. 4. Piggyback the streptokinase through the heparin line at the port closest to the client.

2 Heparin and streptokinase cannot be administered in the same intravenous line because they are incompatible. The nurse must start a second line to administer the streptokinase simulta- neously with the heparin. The nurse does not need an order to do this.

46. The client diagnosed with a pulmonary embolus (PE) is receiving intravenous heparin, and the HCP prescribes 5 mg warfarin (Coumadin) orally once a day. Which statement best explains the scientific rationale for prescribing these two anticoagulants? 1. Coumadin interferes with production of prothrombin. 2. It takes 3-5 days to achieve a therapeutic level of Coumadin. 3. Heparin is more effective when administered with warfarin. 4. Coumadin potentiates the therapeutic action of heparin.

2 Heparin has a short half-life and is prescribed as soon as a PE is suspected. The client must go home having taken an oral anticoagulant such as Coumadin, which has a long half-life and needs at least 3-5 days to reach a therapeutic level. Discontinuing the heparin prior to achieving a therapeu- tic level of Coumadin places the client at risk for another PE.

42. The client diagnosed with chronic pancreatitis is complaining of steatorrhea. Which medication should the nurse prepare to administer? 1. Humalog, a fast-acting insulin, intravenously, then monitor glucose levels. 2. Pancrelipase (Cotazym) sprinkled on the client's food with meals. 3. Humulin R subcutaneously after assessing the blood glucose level. 4. Ranitidine (Zantac), a histamine2 receptor blocker, orally.

2 Humalog is not administered intra- venously, and glucose levels should be monitored prior to insulin administration. Steatorrhea is fatty, frothy stools that indicate the pancreatic enzymes are not sufficient for digestive purposes. The nurse should be prepared to administer pancreatic enzymes. Humulin R insulin is administered by slid- ing scale to decrease blood glucose levels. Clients with pancreatitis should be moni- tored for the development of diabetes mellitus. Zantac would not treat the client's symp- toms.

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."

2 If the client experiences any abnormal bleeding, the HCP should be notified. 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. 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. 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 immunohemolytic 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.

2 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 immunohe- molytic 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 megaloblas- tic anemia or as rescue factors for methotrexate toxicity, not for immunohe- molytic anemias.

The nurse is taking the male client's medication history. The client informs the nurse he takes megadoses of vitamin C daily, a daily aspirin, and an iron tablet. Which statement is the nurse's best response? 1. "I am glad you take megadoses of vitamin C because it prevents the common cold." 2. "Taking aspirin and megadoses of vitamin C may cause crystals in your urine." 3. "Megadoses of vitamins and a balanced diet will help prevent you from getting sick." 4. "You should take megavitamins—not just megadoses of vitamin C alone."

2 Megadoses of vitamin C taken with aspirin or sulfonamides may cause crystalluria, crystal formation in the urine.

3. 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 infarc- tion (MI) and has ordered morphine sulfate (MS), a narcotic analgesic, for the pain. Which intervention should the nurse implement? 1. Administer the morphine intramuscularly in the ventral gluteal muscle. 2. Dilute the MS to a 10-mL bolus with normal saline and administer intravenous push. 3. Question the order because MS should not be administered to a client with an MI. 4. Assess the client's pain prior to administering the medication orally.

2 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. An intravenous push also allows the nurse to inject the medication more accurately over the 5-minute administration time.

The male client tells the clinic nurse that he has been taking the over-the-counter medication Prilosec for heartburn. Which statement would be the nurse's best response? 1. "You should not take medications without notifying the HCP." 2. "Have you also had breathing difficulties, especially at night?" 3. "Be sure to limit taking the medication to less than 1 week." 4. "OTC Tagamet is cheaper and works better than Prilosec."

2 Most adult clients self-medicate for minor problems, such as a headache or indiges- tion, and only seek medical attention if the symptoms are unrelieved. This is not the best response for the nurse to make. Up to 90% of adult-onset asthma is caused by gastroesophageal reflux disease (GERD). The nurse should assess what other symptoms are occur- ring. The medication is taken for up to 2 weeks per package instructions. Many clients have been prescribed Prilosec for many months to years. The histamine2 blockers (Tagamet, Zantac, Pepcid) may or may not be more effective than Prilosec. It depends on the individual's response to the medication. Most clients report better symptom control with the proton-pump inhibitors.

20. The nurse is administering medications to clients on an orthopedic unit. Which medication should the nurse question? 1. Ibuprofen (Motrin), an NSAID, to a client diagnosed with back pain. 2. Morphine, an opioid analgesic, to a client with a "2" back pain on the pain scale. 3. Methocarbamol (Robaxin), a muscle relaxant, to a client with chronic back pain. 4. Propoxyphene (Darvon N), a narcotic, to a client with mild back pain.

2 NSAIDs are appropriate interventions for clients diagnosed with back pain. They decrease pain and inflammation. Opioid analgesics are administered for pain. The client is in the mild pain range. The nurse would question administering this medication because of its addictive properties. A less potent analgesic should be administered. Muscle relaxant medications are adminis- tered to clients with back pain to relax the muscles and decrease the pain. The nurse would administer this medication. Darvon N is a pain medication. The nurse would administer this medication.

The nurse is preparing to administer a nitroglycerin (Tridil) drip to a client in cardio- genic shock. Which intervention should the nurse implement? 1. Mix the nitroglycerin in 500 mL of lactated Ringer's. 2. Wrap the intravenous bag and tubing in a foil package. 3. Use regular intravenous tubing when administering Tridil. 4. Ensure that the client's nitroglycerin patch is in a nonhairy area.

2 Nitroglycerin should be mixed with D5W or normal saline (NS) only. These drugs must be protected from light. They must be protected in the package that is provided or wrapped in tin foil. Regular intravenous tubing can absorb 40%-80%of the nitroglycerin. This medica- tion should be administered in the special tubing that comes with the medication. Nitroglycerin patches should be removed when administering Tridil to prevent over- dosage.

The emergency department nurse received a client on warfarin (Coumadin) who has an International Normalized Ratio (INR) of 1.5. Which intervention should the nurse implement? 1. Prepare to administer protamine sulfate, an antidote. 2. Document the laboratory result and take no action. 3. Prepare to administer AquaMEPHYTON (vitamin K). 4. Notify the client's health-care provider.

2 Protamine sulfate is the antidote for heparin toxicity. The therapeutic range for INR is 2-3; therefore, the nurse should document the results and take no action. AquaMEPHYTON, vitamin K, is the antidote for Coumadin toxicity, which is supported by an elevated INR greater than 3. The nurse does not need to notify the HCP for a normal laboratory value.

The client diagnosed with Cushing's disease is prescribed pantoprazole (Protonix), a proton-pump inhibitor. Which statement is the scientific rationale for prescribing this medication? 1. Protonix increases the client's ability to digest food. 2. Protonix decreases the excess amounts of gastric acid. 3. Protonix absorbs gastric acid and eliminates it in the bowel. 4. Protonix coats the stomach and prevents ulcer formation.

2 Protonix does not increase the ability to digest food. Protonix decreases the production of stomach acid by inhibiting the proton-pump step in gastric acid production. Protonix does not absorb gastric acid; it prevents its production. Sucralfate (Carafate) is a mucosal barrier agent that coats the stomach lining. Protonix does not coat the stomach.

11. The client diagnosed with coronary artery disease is prescribed atorvastatin (Lipitor), an HMG-CoA reductase inhibitor. Which statement by the client would warrant the nurse notifying the health-care 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."

2 Statins can cause muscle injury, which can lead to myosititis, fatal rhabdomy- olysis, or myopathy. Muscle pain or tenderness should be reported to the HCP immediately; usually the medica- tion is discontinued.

24. The client diagnosed with a stroke has been prescribed phenytoin (Dilantin), an anti- convulsant. Which statement explains the scientific rationale for prescribing this medication? 1. The client's stroke was caused by some damage to cerebral tissue. 2. The stroke caused damage to the brain tissue that could result in seizures. 3. Hemorrhagic strokes leave residual blood in the brain that causes seizures. 4. This medication can help the client with cognitive deficits think more clearly.

2 Strokes cause damage to the cerebral tissue; the brain does not cause the damage to itself. Stroke-caused loss of function in areas of the brain leads to a problem with nerve impulse transmission; this blocked transmission can initiate a seizure. If the client survives a hemorrhagic stroke, the body will reabsorb the blood. There should not be any residual blood. Anticonvulsants do not increase cognitive ability.

The client diagnosed with a stroke has been prescribed phenytoin (Dilantin), an anti- convulsant. Which statement explains the scientific rationale for prescribing this medication? 1. The client's stroke was caused by some damage to cerebral tissue. 2. The stroke caused damage to the brain tissue that could result in seizures. 3. Hemorrhagic strokes leave residual blood in the brain that causes seizures. 4. This medication can help the client with cognitive deficits think more clearly.

2 Strokes cause damage to the cerebral tissue; the brain does not cause the damage to itself. Stroke-caused loss of function in areas of the brain leads to a problem with nerve impulse transmission; this blocked transmission can initiate a seizure. If the client survives a hemorrhagic stroke, the body will reabsorb the blood. There should not be any residual blood. Anticonvulsants do not increase cognitive ability.

77. The client on strict bed rest is prescribed subcutaneous heparin. Which data indi- cates 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 nontender. 3. The client performs active range-of-motion exercises every 4 hours. 4. The client's varicose veins have reduced in size and appearance.

2 Subcutaneous heparin is used prophy- lactically to prevent deep vein throm- bosis. 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 medica- tion is effective.

22. The adolescent client has been admitted to the intensive care department for an overdose of acetaminophen (Tylenol). Which laboratory data should the nurse monitor for long-term complications from the attempt? 1. The arterial blood gases. 2. The liver function tests. 3. The BUN and creatinine. 4. The complete blood count.

2 The arterial blood gases would give infor- mation about the immediate situation, not long-term problems. Tylenol is toxic to the liver, and the liver function tests should be moni- tored in the hospital and in the HCP's office afterward to determine if there is permanent liver damage. BUN and creatinine tests determine kidney functioning. Tylenol does not affect the kidneys. Tylenol does not damage the bone marrow. It is not necessary to monitor the CBC.

2. The female client diagnosed with anorexia nervosa is in the inpatient psychiatric unit receiving amitriptyline (Elavil), an antidepressant, and cyproheptadine (Periactin), an antihistamine. Which data suggests the medications are effective? 1. The client eats at least 90% of the meal. 2. The client has a weight gain of 1 kg. 3. The client has no symptoms of hay fever. 4. The client states she will eat all her meals.

2 The client eating 90% of the meal does not indicate the client has gained weight. The medication is effective if the client gains weight, and 2.2 pounds is an excel- lent weight gain for a client with anorexia. The antihistamine would be effective if the client had no signs of hay fever, but this is not why this medication is being adminis- tered. The client can say anything, but weight gain indicates the medication is effective.

The nurse prepared 2 mg of morphine with 9 mL normal saline for a client who is complaining of pain. When the nurse enters the room the client tells the nurse, "I don't want to take a shot. I would like to have a pain pill." Which action should the nurse take? 1. Explain that the medication must be administered because it has been drawn up. 2. Ask another nurse to watch the medication being wasted into the sink. 3. Place the syringe in the sharps container in the client's room. 4. Notify the pharmacy that a narcotic was not administered to the client.

2 The client has the right to refuse medica- tion; therefore; the nurse cannot force the client to take the medication. This nurse must have a witness when wasting a narcotic. Legally the nurse must have someone witness the narcotic being wasted. The pharmacy does not need to be noti- fied that a narcotic was wasted; it must be witnessed and documented on the narcotics log.

The client diagnosed with coronary artery disease is prescribed atorvastatin (Lipitor), an HMG-CoA reductase inhibitor. Which statement by the client indicates the medication is effective? 1. "I really haven't changed my diet, but I am taking my medication every day." 2. "I am feeling good since my doctor told me my cholesterol level came down." 3. "I am swimming at the local pool about three times a week for 30 minutes." 4. "Since I have been taking this medication the swelling in my legs is better."

2 The client should adhere to a low-fat, low-cholesterol diet, but this does not indicate the medication is effective. This medication is prescribed to help decrease the client's cholesterol level; therefore, this statement indicates it is effective. A sedentary lifestyle is a risk factor for developing atherosclerosis; therefore, exercising should be praised but it does not indicate the medication is effective. The medication is not administered to decrease edema; therefore, this statement does not indicate the medication is effec- tive.

The client with multiple mouth ulcers is prescribed Nystatin swish and swallow. Which intervention should the nurse implement when administering this medica- tion? 1. Instruct the client to swish the medication in the mouth and spit it out. 2. Encourage the client to swish the medication in the mouth for at least 2 minutes. 3. Tell the client to swish the mouth with normal saline after swallowing the medica- tion. 4. Apply the Nystatin medication to the mouth ulcers with a sterile cotton swab.

2 The client should swish the medication in the mouth for at least 2 minutes and then swallow the medication. The client should swish the medication in the mouth for at least 2 minutes and then swallow the medication. The client should not swish the mouth with normal saline because the medication should remain in the mouth even after the medication is swallowed. This is not the correct procedure for administering this medication.

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.

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.

The client diagnosed with tuberculosis is administered rifampin (Rifadin), an antitu- bercular medication. Which information should the nurse discuss with the client? 1. Instruct the client to consume fewer dark-green, leafy vegetables. 2. Explain that the client's urine and other body fluids will turn orange. 3. Encourage the client to stop smoking cigarettes while taking this medication. 4. Tell the client to increase fluid intake to 3000 mL a day.

2 The consumption of dark-green, leafy vegetables will not affect this medication. The client should be informed that this medication turns the urine and body secretions orange and can discolor contact lenses. This is not harmful to the client. The client should be encouraged to stop smoking for general health reasons, but smoking will not affect this medication. Increasing fluid intake has no bearing on taking this medication.

40. The nurse is administering Humalog, a fast-acting insulin, at 0730 to a client diag- nosed with Type 1 diabetes. Which intervention should the nurse implement? 1. Ensure the client eats at least 90% of the lunch tray. 2. Do not administer unless the breakfast tray is in the client's room. 3. Check the client's blood glucose level 1 hour after receiving insulin. 4. Have 50% dextrose in water at the bedside for emergency use.

2 The insulin will not be working 4-5 hours after being administered. This insulin peaks in 15-20 minutes after being administered; therefore, the meal should be at the bedside prior to administering this medication. The glucose level should be checked prior to meals, not after meals. This medication is administered when a client is unconscious secondary to hypo- glycemia and should not be kept at the bedside. Orange juice or some type of simple glucose should be kept at the bedside.

The client diagnosed with chronic obstructive pulmonary disease (COPD) is prescribed morphine sulfate (MS Contin). Which statement is the scientific rationale for prescribing this medication? 1. MS Contin will depress the respiratory drive. 2. Morphine dilates the bronchi and improves breathing. 3. MS Contin is not addicting, so it can be given routinely. 4. Morphine causes bronchoconstriction and decreased sputum.

2 The nurse does not administer medica- tions to decrease the respiratory drive for any client—especially not one diagnosed with pulmonary disease. Morphine is a mild bronchodilator, and the continuous-release formulation provides a sustained effect for the client. All forms of morphine can be addicting. Bronchoconstriction would increase the client's difficulty in breathing and trap sputum below the constricted bronchus.

The nurse on a medical unit is providing discharge instructions to a client who is prescribed fluticasone (AeroBid), a glucocorticoid, and a metered-dose inhaler. Which statement by the client would warrant intervention? 1. "I will use a spacer when using my inhaler." 2. "I will hold the medication in my mouth for 10 seconds." 3. "I will wait a few minutes between puffs." 4. "I will notify my HCP if I get mouth sores."

2 The site of action for inhalers is the lungs. The client should not hold the medication in the mouth because this will increase the likelihood of the client developing a fungal infection of the mouth. The client should inhale deeply and hold the breath after the medication is in the lung. The nurse should correct this misinformation.

19. The client diagnosed with inflammatory bowel disease is prescribed mesalamine (Asacol), an aspirin product, suppositories. Which statement indicates the client understands the medication teaching? 1. "I should retain the suppository for at least 15 minutes." 2. "The suppository may stain my underwear or clothing." 3. "I should store my medication in the refrigerator." 4. "I should have a full rectum when applying the suppository."

2 The suppository should be retained for 1-3 hours if possible to get the maximum benefit of the medication. The client should use caution when using the suppository because it may stain clothing, flooring, painted surfaces, vinyl, enamel, marble, granite, and other surfaces. This statement indicates the client understands the teaching. The medication should be stored at room temperature away from moisture and heat. The client should empty the bowel just before inserting the rectal suppository.

The client 4 hours postoperative bunionectomy (removal of hallux valgus) is prescribed hydromorphone (Dilaudid), a narcotic analgesic. The client is complain- ing of pain "9" on the 1-10 pain scale. Which action should the nurse implement? 1. Request the HCP to prescribe a less potent analgesic. 2. Administer the pain medication as prescribed. 3. Encourage the client to use distraction techniques. 4. Give the client an NSAID with one full glass of water.

2 The surgery causes extreme pain, and potent narcotics are frequently prescribed for this client. A hallux valgus is a deformity in which the great toe deviates laterally. The surgery to correct this deformity may cause an intense throbbing pain at the operative site that requires liberal amounts of potent analgesics. This surgery causes intense throbbing pain, and distraction techniques could be used in conjunction with narcotics, but they could not be used alone. An NSAID medication is not the drug of choice for a client with intense throbbing pain secondary to a surgical procedure.

21. The client admitted to the psychiatric unit diagnosed with schizophrenia is prescribed clozapine (Clozaril), an atypical antipsychotic. Which laboratory data should the nurse evaluate? 1. The client's clozapine therapeutic level. 2. The client's white blood cell count. 3. The client's red blood cell count. 4. The client's arterial blood gases.

2 There is no such test as a therapeutic serum level for clozapine. Weekly WBCs are taken because the client is at risk for fatal agranulocyto- sis. Initially the medication will not be administered if the WBC is not available. The client's RBC count is not affected by clozapine. The respiratory system is not affected by clozapine; therefore, ABGs do not have to be evaluated when taking this medication.

The client with chronic reactive airway disease is taking the leukotriene receptor inhibitor montelukast (Singulair). Which statement by the client would warrant intervention by the nurse? 1. "I have been having a lot of headaches lately." 2. "I have started taking an aspirin every day." 3. "I keep this medication up on a very high shelf." 4. "I must protect this medication from extreme temperatures."

2 These drugs are generally safe and well- tolerated, with a headache being the most common side effect; therefore, this state- ment would not warrant intervention by the nurse. This medication interacts with aspirin, warfarin, erythromycin, and theophyl- line; therefore, this statement warrants further intervention by the nurse. All medications should be kept out of the reach of children, and keeping the medica- tion on a high shelf would not warrant intervention by the nurse. This medication does not need to be kept from extreme temperatures; it is the anti- asthmatic zafirlukast (Accolate) that must be protected from extremes of tempera- ture, light, and humidity.

The nurse is preparing to administer medications on a pulmonary unit. Which medication should the nurse administer first? 1. Prednisone, a glucocorticoid, for a client diagnosed with chronic bronchitis. 2. Ceftriaxone (Rocephin), an intravenous antibiotic, an initial dose (ID). 3. Lactic acidophilus (Lactinex) to a client receiving IVPB antibiotics. 4. Cephalexin (Keflex) po, an antibiotic, to a client being discharged.

2 This is an oral preparation and one that can be given daily; this is not the first medication to be administered. An initial dose of intravenous antibiotic is priority because the client must be started on the medication as soon as possible to prevent the client from becoming septic. Lactinex is administered to replace the good bacteria in the body destroyed by the antibiotic, but it does not need to be administered first. Keflex is an oral antibiotic, but this client is being discharged, indicating the client's condition has improved. This client could wait until the initial dose of an IV antibi- otic is administered.

The client with major depressive disorder is prescribed the selective serotonin reup- take inhibitor (SSRI) fluoxetine (Prozac). Which intervention should the nurse teach the client concerning this medication? 1. Instruct the client not to eat any type of tyramine-containing foods such as wines or cheeses. 2. Notify the health-care provider if the client becomes anxious or has an elevated temperature. 3. Encourage the client to take the medication with grapefruit juice. 4. Explain that tremors and sweating are initial expected side effects.

2 This would be appropriate for monoamine oxidase inhibitors (MAOIs). Serotonin syndrome (SES) is a serious complication of SSRIs that produces mental changes (confusion, anxiety, and restlessness), hypertension, tremors, sweating, hyperpyrexia (elevated temper- ature), and ataxia. Conservative treat- ment includes stopping the SSRI and using supportive treatment. If untreated it can lead to death. Grapefruit juice does not specifically affect SSRIs, but the nurse should be aware that many medications interact negatively with grapefruit juice and its consumption should not be encouraged. These are additional signs of serotonin syndrome and should be reported to the health-care provider.

The client with a brain tumor is complaining of headache that is a "5" on a scale of 1-10. The client's Medication Administration Record (MAR) has acetaminophen (Tylenol) 2 po PRN pain, hydrocodone (Vicodin) 2 po PRN pain, morphine 4 mg IVP PRN pain, and lorazepam (Ativan) 1 mg IVP PRN. Which medication should the nurse prepare to administer? 1. Tylenol 2 tablets. 2. Vicodin 2 tablets. 3. Morphine 4 mg IVP. 4. Ativan 1 mg IVP.

2 Vicodin, a narcotic analgesic, is equiva- lent to codeine. It is useful for the relief of moderate to severe pain, 4-6 on the pain scale. This client has a brain tumor, which would include increasing intracranial pressure and pain. Therefore, this would be the most appropriate medication at this time.

The client is 4 hours postamputation. The nurse notes a large amount of bright red blood on the dressing and notifies the surgeon. The client's prothrombin time (PT) result is 22.5. Which action would the nurse implement based on the PT results? 1. Prepare to administer warfarin (Coumadin). 2. Prepare to administer vitamin K (AquaMEPHYTON). 3. Apply direct pressure to the residual limb. 4. Prepare to administer protamine sulfate.

2 Warfarin is an anticoagulant that would cause increased bleeding; therefore, the nurse would not prepare to administer this medication. Vitamin K increases clotting; therefore, the surgeon would order this medication to decrease the prolonged PT. (A normal PT is 12.9 seconds.) Applying direct pressure will help decrease bleeding but will not correct a prolonged PT. Protamine sulfate is the antidote for heparin and the postoperative client would not be taking heparin, an anticoagulant.

The client diagnosed with chronic kidney disease is prescribed erythropoietin (Procrit). Which intervention should the nurse implement? Select all that apply. 1. Administer it intramuscularly in the deltoid. 2. Have the client take Tylenol, an analgesic, for pain. 3. Monitor the client's complete blood count. 4. Teach the client to pace activities. 5. Inform the client not to drive for 90 days.

2, 3, 4, 5

Which medications and supplies can be purchased over the counter to treat diabetes mellitus? Select all that apply. 1. Glargine (Lantus), a steady-state insulin. 2. Humulin R (regular), a fast-acting insulin. 3. Glucose tablets. 4. Glucose monitoring strips. 5. Humulin N, an intermediate-acting insulin.

2, 3, 4, 5 Lantus is not available over the counter. A prescription is required. 2. Humulin R, N, L, and U are all avail- able over the counter, but they are usually kept behind the counter with the pharmacist. These insulins can be purchased without a prescription. In some states syringes may be purchased without a prescription. A prescription is only required if the client has insur- ance that is paying for part of the cost. 3. Glucose tablets are recommended for clients to carry with them in case of a hypoglycemic reaction and may be purchased without a prescription. 4. Glucose monitoring devices and strips may be purchased without a prescrip- tion. However, if the client has insur- ance that will pay for the equipment, a prescription is required. 5. Humulin R, N, L, and U are all avail- able over the counter. They are kept behind the counter with the pharma- cist but can be purchased without a prescription. In some states syringes may be purchased without a prescrip- tion. A prescription is only required if the client has insurance that is paying for part of the cost.

The nurse is administering methylprednisolone sodium succinate (Solu-Medrol), a glucocorticoid, intravenous push to a client diagnosed with pericarditis. The client has a saline lock in the left forearm. After the nurse reconstitutes the powdered medication in the Act-O-Vial, which intervention should the nurse implement? 1. Dilute the medication and flush the saline lock with 10 mL of normal saline before and after administration. 2. Administer the medication undiluted and flush the saline lock with 3 mL of normal saline. 3. Flush the saline lock, administer the diluted medication, and flush the saline lock. 4. Initiate an intravenous line of D5W and administer the medication through the intravenous tubing.

3 1The saline lock does not need to be flushed with 10 mL of normal saline; it should be flushed with 2-3 mL, depending on hospital policy. 2. Intravenous push medication should be diluted to ensure correct rate of adminis- tration, to protect the vein, and to decrease the client's pain during administration. 3. The medication should be diluted (see # 2 rationale), then the saline lock should be flushed before administra- tion of the medication to ensure vein patency, and then it should be flushed after administration to ensure all medication was delivered. 4. There is no reason the medication cannot be administered safely through the saline lock.

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 action 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 action. 4. Put cool compresses on the abdominal wall.

3 A baby aspirin would not cause the client to have petechiae. Petechiae have nothing to do with the client's pain level. 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. Cool compresses cause vasoconstriction, but this would not help prevent or treat petechiae.

The parents of a 2-year-old child with measles call the pediatric clinic and tell the nurse the child is very uncomfortable, irritable, and fretful. Which recommendation should the nurse discuss with the parents? 1. Alternate Motrin with children's aspirin every 4 hours. 2. Apply diphenhydramine (Benadryl) cream to the rash. 3. Administer acetaminophen (Tylenol) elixir to the child. 4. Tell the parents that there is no medication for the child.

3 A child should not take aspirin because it may cause Reye's syndrome. Benadryl ointment should not be applied to the rash area. Tylenol elixir is the drug of choice for children to decrease irritability and any discomfort. There is no treatment for the measles; it must run its course, but a mild nonnar- cotic analgesic such as Tylenol can decrease irritability and discomfort.

Which statement best describes the scientific rationale for prescribing the biguanide metformin (Glucophage)? 1. This medication decreases insulin resistance, improving blood glucose control. 2. This medication allows the carbohydrates to pass slowly through the large intestine. 3. This medication will decrease the hepatic production of glucose from stored glycogen. 4. This medication stimulates the beta cells to release more insulin into the blood- stream.

3 A thiazolidinedione, pioglitazone (Actos) or rosiglitazone (Avandia), not a biguanide like metformin, is prescribed to decrease insulin resistance. An alpha-glucosidase inhibitor, acarbose (Precose) or miglitol (Glyset), is adminis- tered to allow carbohydrates to pass slowly through the intestine. Glucophage does not do this. The scientific rationale for administer- ing metformin (Glucophage) is that it diminishes the increase in serum glucose following a meal and blunts the degree of postprandial hyperglycemia by preventing gluconeogenesis. A meglitinide, repaglinide (Prandin), sulfonylurea, or nateglinide (Starlix) is prescribed to stimulate the beta cells to release more insulin into the bloodstream.

23. The client diagnosed with stage D congestive heart failure (CHF) has a brain natri- uretic peptide (BNP) level greater than 1500. Which medication would the nurse anticipate the HCP prescribing? 1. Captopril (Capoten), an angiotensin-converting enzyme inhibitor, orally. 2. Digoxin (Lanoxin), a cardiac glycoside, IVP. 3. Dobutamine (Dobutrex), a synthetic catecholamine, IV. 4. Metoprolol (Lopressor), a beta blocker, orally.

3 ACE inhibitors should be prescribed for clients with diabetes, hyperlipidemia, and hypertension when in stage A heart failure. 2. Digoxin is prescribed in stage C heart failure. 3. Dobutamine is given for short-term IV therapy for clients in stage D CHF and is preferred to dopamine because it does not increase vascular resistance. Dobutamine increases myocardial contractility and cardiac output. 4. Beta blockers are prescribed in stage C heart failure. The client may not see an improvement of symptoms, but research has demonstrated that beta blockers can prolong life even in the absence of clinical improvement.

41. The client diagnosed with rule-out deep vein thrombosis (DVT) is experiencing dyspnea and chest pain on inspiration. On assessment, the nurse finds a respiratory rate of 40. Which medication should the nurse anticipate the health-care provider ordering? 1. Warfarin (Coumadin), an oral anticoagulant. 2. Enoxaparin (Lovenox), a low molecular weight heparin. 3. Heparin, an intravenous anticoagulant. 4. Ticlopidine (Ticlid), an antiplatelet medication.

3 An oral anticoagulant would not be prescribed in an acute situation. Lovenox is prescribed prophylactically to prevent deep vein thrombosis. The client is currently experiencing a complication of DVT; therefore, the nurse should not anticipate an order for this medication. Heparin is the medication of choice for treating a pulmonary embolus, which the nurse should suspect with these signs and symptoms. Intravenous heparin will prevent further clotting. Ticlid is a medication used to treat arte- rial, not venous, conditions.

The 72-year-old client is admitted to the medical unit diagnosed with an acute exac- erbation of diverticulosis. The health-care provider has prescribed the intravenous antibiotic ceftriaxone (Rocephin). Which intervention should the nurse implement first? 1. Monitor the client's white blood cell count. 2. Assess the client's most recent vital signs. 3. Determine if the client has any known allergies. 4. Send a stool specimen to the laboratory.

3 Antibiotics are notorious for causing allergic reactions, and the nurse should make sure the client is not allergic to any antibiotics prior to administering this medication. Therefore, this is the first intervention.

1. The client postbirth via C-section is receiving epidural morphine. The unlicensed assis- tive personnel (UAP) tells the primary nurse the client has a pulse of 84, respirations of 10, and a blood pressure of 102/78. Which action should the nurse implement first? 1. Administer naloxone (Narcan), a central nervous system antagonist. 2. Assess the client's pain using the numerical (1-10) pain scale. 3. Check the client's respiratory rate and pulse oximeter reading. 4. Complete a neurovascular assessment of the client's lower extremities.

3 Because the UAP provided the initial abnormal data, the nurse should first assess the client to determine and vali- date the client's respiratory status.

The client diagnosed with history of a gastric ulcer is having transient ischemic attacks (TIA) and is prescribed a daily 325-mg aspirin. Which information is most important for the nurse to discuss with the client? 1. Encourage the client to take the aspirin with food. 2. Notify the health-care provider if ringing in the ears occurs. 3. Instruct the client to take an enteric-coated brand of aspirin. 4. Explain that the client may experience black, tarry stools.

3 Because the client has a history of a gastric ulcer, the client should take an enteric-coated aspirin to ensure that the medication will not dissolve in the stomach and potentially cause gastric irritation leading to bleeding.

13. The nurse is preparing to administer the following medications. Which medication would the nurse question administering? 1. Ibuprofen (Motrin), an NSAID, to a client receiving furosemide (Lasix). 2. Nabumetone (Relafen), a COX-2 inhibitor, to a client receiving digoxin (Lanoxin). 3. Acetylsalicylic acid (ASA), a salicylate, to a client receiving warfarin (Coumadin). 4. Ketorolac (Toradol), an NSAID, intramuscularly to a client on a morphine PCA.

3 NSAIDs do not interfere with the effec- tiveness of loop diuretics; therefore, the nurse would not question administering the Motrin. COX-2 inhibitors do not interfere with the effectiveness of cardiac glycosides; therefore, the nurse would not question administering the Relafen. Aspirin displaces warfarin from protein-binding sites and will increase the client's bleeding; therefore, the nurse should question administering the aspirin. Toradol is often administered around the clock to a client in pain, along with a narcotic analgesic. Toradol decreases the inflammation to help decrease the pain.

The client with Type 1 diabetes is scheduled for a CT scan of the abdomen with contrast. The client is taking metformin (Glucophage), a biguanide, and 70/30 insulin 24 units at 0700 and 1600. Which instruction should the nurse give the client? 1. Administer the 70/30 insulin the morning of the test. 2. Take half the dose of the morning insulin on the day of the test. 3. Do not take the Glucophage after the procedure until the HCP approves. 4. Take the medications as prescribed because they will not affect the test.

3 Because the client is NPO for the test, the 11. 1. 2. 3. 4. Constipation does not determine the effectiveness of the Pancrease. Steatorrhea (fatty, frothy, foul-smelling stools) or diarrhea indicates a lack of pancreatic enzymes in the small intes- tines. This would indicate the dosage is too small and needs to be increased. Urine output does not determine effec- tiveness of Pancrease. An increase in midepigastric pain is a symptom of peptic ulcer disease or gastrointestinal reflux disease and does not indicate the effectiveness of the pancreatic enzyme. The client with chronic pancre- insulin should be held. 2. Because the client is NPO for the test, the insulin should be held. In addition, the nurse cannot prescribe medication or change the dosage. 3. Glucophage has a potential side effect of producing lactic acid. When it is administered simultaneously or within a close time span of the contrast dye used for the CT scan, lactic acidosis could result. It is recommended to hold the medication prior to and up to 48 hours after the scan. The HCP should obtain a BUN and creatinine to determine kidney function prior to restarting Glucophage. 4. Insulin should be held when the client is NPO, and Glucophage will be held because of the contrast dye.

The client diagnosed with cancer is being prepared for surgery. Which information should the outpatient surgery nurse convey to the surgeon immediately? 1. The client takes digoxin (Lanoxin) for heart problems. 2. The client stopped taking acetylsalicylic acid (aspirin) last week. 3. The client has been taking clopidogrel (Plavix) every day. 4. The client becomes nauseated after receiving anesthesia.

3 Clopidogrel is an antiplatelet medica- tion the client has been taking. It should be discontinued at least 7 days before surgery. The nurse should notify the surgeon because the surgery will need to be rescheduled.

18. The nurse is preparing to administer the morning medications to the client who is 1-day postoperative total knee replacement. Which medication would the nurse question administering? 1. Ceftriaxone (Rocephin), a broad-spectrum antibiotic. 2. Enoxaparin (Lovenox), a low molecular weight heparin. 3. Cyclosporine (Neoral), an immunosuppressant. 4. Morphine PCA, a narcotic analgesic.

3 Cyclosporine is not an expected medication to be prescribed for a client with total knee replacement. The nurse should determine why the client is receiving this medica- tion. The client taking cyclosporine has had some type of organ trans- plant.

11. The client with a seizure disorder is prescribed the anticonvulsant phenytoin (Dilantin). Which statement indicates the client understands the medication teaching? 1. "If my urine turns a reddish-brown color, I should call my doctor." 2. "I should take my medication on an empty stomach." 3. "I will use a soft-bristled toothbrush to brush my teeth." 4. "I may get a sore throat when taking this medication."

3 Dilantin may cause the client's urine to turn a harmless pinkish-red or reddish- brown; therefore, the client does not need to call the health-care provider. The client should take Dilantin at the same time every day with food or milk to prevent gastric upset. The client should use a soft-bristled toothbrush to prevent gum irritation and bleeding. Gingival hyperplasia (overgrowth of gums) is a side effect of this medication. A sore throat, bruising, or nosebleeds should be reported to the health-care provider because this may indicate a blood dyscrasia.

20. The nurse is preparing to administer phenytoin (Dilantin) intravenous push. The client has an IV of D5W 0.45 NS at 50 mL/hr. Which action should the nurse implement? 1. Administer the Dilantin undiluted over 5 minutes via the port closest to the client. 2. Dilute the medication with normal saline and administer over 2 minutes. 3. Flush tubing with normal saline (NS), administer diluted Dilantin, and then flush with NS. 4. Insert a saline lock in the other arm and administer the medication undiluted.

3 Dilantin should be diluted in a saline solution and the IV tubing should be flushed before and after administration because a dextrose solution will cause drug precipitation.

The client diagnosed with pancreatitis is complaining of polydipsia and polyuria. Which medication should the nurse prepare to administer? 1. Humalog, a fast-acting insulin intravenously, and then monitor glucose levels. 2. Pancrelipase (Cotazym) sprinkled on the client's food with meals. 3. Humulin R subcutaneously after assessing the blood glucose level. 4. Ranitidine (Zantac), a histamine2 receptor blocker, orally.

3 Humalog is not administered intra- venously, and glucose levels should be monitored prior to insulin administration. The client's symptoms should indicate hyperglycemia to the nurse, not pancreatic enzyme deficiency. Humulin R insulin is administered by sliding scale to decrease blood glucose levels. Clients with pancreatitis should be monitored for the development of diabetes mellitus. Polydipsia and polyuria are classic signs of diabetes mellitus. Zantac would not treat the client's symp- toms.

58. The client who is 38 weeks pregnant and diagnosed with preeclampsia is admitted to the labor and delivery area. The HCP has prescribed intravenous magnesium sulfate, an anticonvulsant. Which data indicates the medication is effective? 1. The client's deep tendon reflexes are 4. 2. The client's blood pressure is 148/90. 3. The client's deep tendon reflexes are 2 to 3. 4. The client's deep tendon reflexes are 0.

3 Magnesium sulfate is administered to prevent seizure activity and is deter- mined to be effective and in the therapeutic range when the client's deep tendon reflexes are normal, which is 2 to 3 on a 0-4 scale.

66. Which statement best describes the scientific rationale for administering acetylcys- teine (Mucomyst), an antidote, to a child who was brought to the emergency room? 1. Mucomyst neutralizes toxic substances by changing the pH of the poison. 2. Mucomyst binds with bleach, and it is excreted through the bowel. 3. Mucomyst is the antidote for acute acetaminophen (Tylenol) poisoning. 4. Mucomyst induces vomiting, and the client eliminates much of the narcotics.

3 Mucomyst does not neutralize substances by changing their pH. Mucomyst is not used to treat bleach poisonings. Charcoal binds with poisons to form an inert substance that can be eliminated through the bowel because the body is incapable of absorbing charcoal molecules. This is the scientific rationale for administering Mucomyst. Mucomyst does not cause emesis. An emetic such as ipecac would induce vomiting.

13. The nurse is preparing to administer the following medications. Which medication would the nurse question administering? 1. Ibuprofen (Motrin), an NSAID, to a client receiving furosemide (Lasix). 2. Nabumetone (Relafen), a COX-2 inhibitor, to a client receiving digoxin (Lanoxin). 3. Acetylsalicylic acid (ASA), a salicylate, to a client receiving warfarin (Coumadin). 4. Ketorolac (Toradol), an NSAID, intramuscularly to a client on a morphine PCA.

3 NSAIDs do not interfere with the effec- tiveness of loop diuretics; therefore, the nurse would not question administering the Motrin. COX-2 inhibitors do not interfere with the effectiveness of cardiac glycosides; therefore, the nurse would not question administering the Relafen. Aspirin displaces warfarin from protein-binding sites and will increase the client's bleeding; therefore, the nurse should question administering the aspirin. Toradol is often administered around the clock to a client in pain, along with a narcotic analgesic. Toradol decreases the inflammation to help decrease the pain.

2. 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 B/P is less than 110/70. 2. Use nonsterile gloves when applying the transdermal patch. 3. Date and time transdermal patch prior to applying to client's skin. 4. Place the transdermal patch on the site where the old patch was removed.

3 Nitroglycerin causes hypotension and the nurse should question administering a transdermal patch if the client's blood pres- sure is less than 90/60 but not if it is less than 110/70. 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 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. The transdermal patch must be rotated so that skin irritation will not occur.

26. The nurse in the HCP's office is completing an assessment on a client who has been prescribed the cardiac glycoside digoxin (Lanoxin) for congestive heart failure (CHF). Which data indicates the medication has been effective? 1. The client's sputum is pink and frothy. 2. The client has 2 pitting edema of the sacrum. 3. The client has clear breath sounds bilaterally. 4. The client's heart rate is 78 beats per minute.

3 Pink, frothy sputum indicates that the client's lungs are filling with fluid. This indicates the client's condition is becom- ing worse. Pitting edema of the sacrum would be seen in clients on bed rest. This is a symp- tom of CHF and would only indicate the client is getting better if the client had 3 or 4 edema initially. Clear lung sounds bilaterally indicate the treatment is effective. The nurse assesses for the signs and symptoms of the disease for which the medication is being administered. If the symptoms are resolving, then the medication is effective. The client's heart rate must be 60 or above to administer digoxin safely, but the heart rate does not indicate the client with CHF is getting better.

The client with renal calculi was prescribed allopurinol (Zyloprim) for uric acid stone calculi. Which statement would warrant intervention by the nurse? 1. "I had to take two Tylenol because of my headache." 2. "I drink at least eight glasses of water a day." 3. "My joints ache so I take a couple of aspirins." 4. "I do not drink wine or any type of alcoholic drinks."

3 Salicylic acid (aspirin) increases the acidity of the urine, and the urine should be alkaline; therefore this statement warrants intervention by the nurse.

The client diagnosed with chronic obstructive pulmonary disease is prescribed methylprednisolone (Solu-Medrol), a glucocorticoid, IVP. Which laboratory test should the nurse monitor? 1. The white blood cell (WBC) count. 2. The hemoglobin and hematocrit. 3. The blood glucose level. 4. The BUN and creatinine.

3 Steroid therapy interferes with glucose metabolism and increases insulin resistance. The blood glucose levels should be monitored to determine if an intervention is needed.

88. The nurse is preparing to administer the following medications. To which client would the nurse question administering the medication? 1. The client receiving prednisone, a glucocorticoid, who has a glucose level of 140 mg/dL. 2. The client receiving ceftriaxone (Rocephin), an antibiotic, who has a white blood cell count of 15,000. 3. The client receiving heparin, an anticoagulant, who has a PTT of 108 seconds with a control of 39. 4. The client receiving theophylline (Theo-Dur) who has a theophylline level of 12 mg/dL.

3 Steroids increase insulin resistance; this would be an expected effect of the pred- nisone. The nurse would not question administering this medication. This WBC is elevated and indicates an infection. Antibiotics are administered for bacterial infections. The nurse would not question administering this medication. The therapeutic range for this control would be 59-78 seconds. This is an extremely high PTT level, and the client is at risk for bleeding. The heparin should be discontinued imme- diately. The nurse would question this medication. This theophylline level is in therapeutic range (10-20 mg/dL); the nurse would not question administering this medication.

The client diagnosed with Type 2 diabetes is prescribed the sulfonylurea glipizide (Glucotrol). Which statement by the client would warrant intervention by the nurse? 1. "I have to eat my diabetic diet even if I am taking this medication." 2. "I will need to check my blood glucose level at least once a day." 3. "I usually have one glass of wine with my evening meal." 4. "I do not like to walk every day, but I will if it will help my diabetes."

3 Sulfonylureas and biguanides may cause an Antabuse-like reaction when taken with alcohol, causing the client to become nauseated and vomit. Advise the client to abstain from alcohol and to avoid liquid over-the-counter (OTC) medications that may contain alcohol. Alcohol also increases the half-life of the medication and can cause a hypo- glycemic reaction.

The client recently diagnosed with rheumatoid arthritis is prescribed 4 grams of aspirin daily. Which statement indicates the client needs more teaching concerning the medication? 1. "I will decrease my dose for a few days if my ears start ringing." 2. "I should take my aspirin with meals, food, milk, or antacids." 3. "I need to take the entire aspirin dose at night before going to bed." 4. "If I have any stomach upset, I will take enteric-coated aspirin."

3 The aspirin should be taken in divided doses (three to four 325-mg tablets four times a day). This statement indi- cates the client needs more teaching.

15. At 0900 the charge nurse observes the primary nurse crushing an enteric-coated aspirin in the medication room. Which action should the charge nurse implement? 1. Take no action because this is an acceptable standard of practice. 2. Correct the primary nurse's behavior in the medication room. 3. Explain that enteric-coated medication should not be crushed. 4. Complete an adverse occurrence report on the primary nurse.

3 The charge nurse should explain to the primary nurse that enteric-coated ASA should not be crushed because the coating that ensures the ASA will dissolve in the small intestine is destroyed. The aspirin will be absorbed in the stomach if the coating is crushed.

15. The 3-year-old child is admitted to the emergency department with an acute episode of laryngotracheobronchitis (LTB). The health-care provider has prescribed racemic epinephrine nebulized with oxygen. Which intervention should the nurse implement? 1. Administer the epinephrine with a tuberculin syringe. 2. Ensure that antibiotics are given simultaneously. 3. Notify the pediatric floor of the child's admission. 4. Obtain a culture and sensitivity of the throat.

3 The child taking this medication must be hospitalized to monitor for changes in respiratory status and should not be treated with epinephrine on an outpa- tient basis because the effects of epinephrine are temporary and respira- tory distress may return.

The client in end-stage liver failure is being admitted to the medical floor. Which health-care provider's order would the nurse question? 1. Prepare the client for a paracentesis. 2. Administer vitamin C 100 mg po daily. 3. Administer morphine 2 mg IVP for pain. 4. Give D5W 0.9 NS at 25 mL/hour.

3 The client in end-stage liver failure would have hepatic encephalopathy, which affects the client's neurological status. Therefore, sedatives, tranquiliz- ers, and analgesic medications are not administered to the client. The nurse would question this order.

72. 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 MedicAlert 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."

3 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. 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 pres- sure and seek medical attention. This statement indicates the client understands the medication teaching. 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 inter- fere with the therapeutic effects of Coumadin. This statement indicates the client does not understand the medication teaching. 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 main- tained. The client should regularly see the HCP. This statement indicates the client understands the medication teaching.

31. The client who had surgery for a hip fracture is complaining of severe pain 45 minutes after the nurse administered morphine IVP. Which intervention should the nurse implement first? 1. Administer another dose of morphine. 2. Turn on the television to distract the client. 3. Assess the client's affected leg for alignment. 4. Notify the health-care provider of the problem.

3 The client is not receiving pain relief from the morphine. The client should have better relief than "severe" 45 minutes after an IVP. One cause of unrelieved pain would be dislocation of the affected joint. The nurse should assess the situation to determine further action.

15. The client diagnosed with inflammatory bowel disease taking mesalamine (Asacol), an aspirin product, has complaints of nausea, vomiting, and diarrhea. Which action should the clinic nurse take? 1. Instruct the client to quit taking the medication immediately. 2. Tell the client to take Prevacid, a proton-pump inhibitor, with the medication. 3. Advise the client to keep taking the medication, but notify the HCP. 4. Explain that these symptoms are expected and will resolve with time.

3 The client should not quit taking the medication abruptly because that would result in an acute exacerbation of the inflammatory bowel disease. A PPI will not help treat these symptoms. These are side effects of the medica- tion, and the HCP should be notified, but the client should not stop taking the medication. These symptoms will not resolve with time and should be reported to the HCP.

1. The nurse is teaching the client diagnosed with angina about sublingual nitroglycerin (NTG), a coronary vasodilator. Which statement indicates the client needs more medication teaching? 1. "I will always carry my nitroglycerin in a dark-colored bottle." 2. "If I have chest pain, I will put a tablet underneath my tongue." 3. "If my pain is not relieved with one tablet, I will get medical help." 4. "I should expect to get a headache after taking my nitroglycerin."

3 The client should put one tablet under the tongue every 5 minutes and, if the chest pain is not relieved after taking three tablets, the client should seek medical attention. This statement indi- cates the client needs more teaching about the medication.

The HCP prescribed morphine 2-5 mg IM every 2 hours for the client with full- thickness burns to the chest and abdominal area. The client reports pain of "10" on the 1 to 10 scale. Which intervention should the nurse implement? 1. Administer 5 mg of morphine IM to the client immediately. 2. Contact the HCP to request an increase in the medication. 3. Request a patient-controlled analgesia (PCA) pump for the client. 4. Assess the client for complications and then administer the medication.

3 The client should receive intravenous (IV) medication, not intramuscular (IM) medication. The client should receive IV medication, not IM medication; therefore, the nurse should be a client advocate and notify the health-care provider for a change in the route of the morphine. The client should have intravenous pain medication until hemodynamic stability and unimpaired tissue perfu- sion return. The PCA pump provides an intravenous route, and the client can control the amount of medication administered with the PCA, ensuring safe limits of pain medication. The client should receive IV medication, not IM medication; therefore, the nurse should not administer this medication after assessing the client.

32. The client with renal calculi was prescribed allopurinol (Zyloprim) for uric acid stone calculi. Which statement would warrant intervention by the nurse? 1. "I had to take two Tylenol because of my headache." 2. "I drink at least eight glasses of water a day." 3. "My joints ache so I take a couple of aspirins." 4. "I do not drink wine or any type of alcoholic drinks."

3 The client should take acetaminophen (Tylenol), instead of aspirin (salicylic acid), to reduce acidity of the urine. This state- ment does not warrant intervention by the nurse. The client should increase fluid intake when taking allopurinol to prevent drug accumulation and toxic effects and to minimize the risk of kidney stone forma- tion. Therefore, this statement does not warrant intervention by the nurse. Salicylic acid (aspirin) increases the acidity of the urine, and the urine should be alkaline; therefore this statement warrants intervention by the nurse. The client should avoid high-purine foods (wine, alcohol, organ meats, sardines, salmon, gravy) to help keep the urine alka- line; therefore, this statement does not warrant intervention by the nurse.

33. The nurse is preparing to administer the benzodiazepine alprazolam (Xanax) to a client who has a generalized anxiety disorder. Which intervention should the nurse implement prior to administering the medication? 1. Assess the client's apical pulse. 2. Assess the client's respiratory rate. 3. Assess the client's anxiety level. 4. Assess the client's blood pressure.

3 The client's apical pulse would not be monitored prior to the nurse administer- ing the Xanax. The client's respiratory rate would not be monitored prior to the nurse administer- ing the Xanax. The nurse must assess the client's anxiety level on a scale of 1 to 10, with 10 being the most anxious, before administering the Xanax. If the nurse does not do this, there is no way to evaluate the effectiveness of the medication later. The client's blood pressure would not be monitored prior to the nurse administer- ing the Xanax.

52. The client who is pregnant is prescribed ferrous sulfate (Feosol), an iron product. Which statement indicates to the nurse the client needs more teaching? 1. "I should increase my fluid intake and fiber when taking this medication." 2. "I will take a daily stool softener to prevent becoming constipated." 3. "If I notice that my stool becomes black or dark, I will call my obstetrician." 4. "I should take my iron tablet 2 hours after I eat."

3 The iron preparation causes the stool to become black and tarry; therefore, the client would not need to notify the obstetrician.

The nurse is administering epinephrine 0.5 mg intravenous push to a client in a code. The client has a primary intravenous line of D5W at to keep open (TKO) rate. Which intervention should the nurse implement? 1. Administer the medication over 5 minutes. 2. Flush the tubing before and after administering epinephrine. 3. Elevate the arm after administering the medication. 4. Dilute the medication with 10 mL normal saline.

3 The medication should be pushed as fast as possible in a code situation. Epinephrine is compatible with the primary intravenous line; therefore, there is no reason to flush the tubing before and after administering the medication. A client in a code does not have blood circulating in the vascular system. Elevating the client's arm will help the medication get into the central circula- tion. The epinephrine in the crash cart is diluted in 10 mL of normal saline in a bristojet and ready for administration; therefore, the nurse should not dilute the medication.

7. The nurse is preparing to administer medications to the following clients. Which medication would the nurse question administering? 1. The loop diuretic furosemide (Lasix) to a client with a serum potassium level of 4.2 mEq/L. 2. The osmotic diuretic mannitol (Osmitrol) to a client with a serum osmolality of 280 mOsm/kg. 3. The cardiac glycoside digoxin (Lanoxin) to a client with a digoxin level of 2.4 mg/dL. 4. The anticonvulsant phenytoin (Dilantin) to a client with a Dilantin level of 14 g/mL.

3 The normal digoxin level is 0.8-2.0 mg/dL. A digoxin level of 2.4 mg/dL would warrant the nurse questioning the administration of this medication.

The nurse is preparing to administer medications to the following clients. To which client would the nurse question administering the medication? 1. Lactulose (Cephulac), a laxative, to a client who has an ammonia level of 50 g/dL. 2. Furosemide (Lasix), a loop diuretic, to a client who has a potassium level of 3.7 mEq/L. 3. Spironolactone (Aldactone), a potassium-sparing diuretic, to a client with a potas- sium level of 5.9 mEq/L. 4. Vasopressin (Pitressin) to a client with a serum sodium level of 137 mEq/L.

3 The normal plasma ammonia level is 15-45 g/dL (varies with method), and this client's level is above normal so the nurse would not question administering this medication, which is prescribed to remove ammonia from the intestinal tract. This client's potassium level is within normal limits (3.5-5.5 mEq/L); therefore, the nurse should not question the admin- istration of the diuretic. This client's potassium level is above normal level (3.5-5.5 mEq/L); there- fore, the nurse should question admin- istering this potassium-sparing diuretic. This client's sodium level is within normal limits (135-145 mEq/L); therefore, the nurse would not question administering the medication. Clients taking vasopressin may, however, develop hyponatremia, or below-normal sodium levels.

The nurse is preparing to administer medications to the following clients. Which medication would the nurse question administering? 1. The loop diuretic furosemide (Lasix) to a client with a serum potassium level of 4.2 mEq/L. 2. The osmotic diuretic mannitol (Osmitrol) to a client with a serum osmolality of 280 mOsm/kg. 3. The cardiac glycoside digoxin (Lanoxin) to a client with a digoxin level of 2.4 mg/dL. 4. The anticonvulsant phenytoin (Dilantin) to a client with a Dilantin level of 14 g/mL.

3 The normal serum potassium level is 3.5-4.5 mEq/L. Because the client's potas- sium level is within normal range, the nurse has no reason to question this medication order. The normal serum osmolality is 275-300 mOsm/kg. Because the client's level is within this range, the nurse would have no reason to question administering this medication. The normal digoxin level is 0.8-2.0 mg/dL. A digoxin level of 2.4 mg/dL would warrant the nurse questioning the administration of this medication. The therapeutic serum level of Dilantin is 10-20 g/mL. Because the client's level is within this range, the nurse should not question administering this medication.

The client with an implanted port has completed the chemotherapy medications and is ready for discharge. Which action should the nurse take to prepare the client for discharge? 1. Teach the client how to manage the port at home. 2. Insert a sterile, noncoring needle into the port. 3. Flush the port with saline followed by heparin. 4. Scrub the port access with povidone-iodine (Betadine).

3 The nurse should make sure that all the chemotherapy is infused into the client by flushing the port with normal saline. Instilling heparin into the port, reservoir, and catheter will help to prevent clot formation in the catheter.

10. The nurse is administering 0800 medications. Which medication would the nurse question? 1. Misoprostol (Cytotec), a prostaglandin analog, to a 29-year-old male with an NSAID-produced ulcer. 2. Omeprazole (Prilosec), a proton-pump inhibitor, to a 68-year-old male with a duodenal ulcer. 3. Furosemide (Lasix), a loop diuretic, to a 56-year-old male with a potassium level of 3.0 mEq/L. 4. Acetaminophen (Tylenol), a nonnarcotic analgesic, to an 84 year old with a frontal headache.

3 The potassium level is low (3.5- 5.5 mEq/L); therefore, the nurse should question this medication and request a potassium supplement or possibly telemetry.

14. The client diagnosed with Type 2 diabetes is receiving the combination oral antidia- betic medication glyburide/metformin (Glucovance). Which data indicate the medication is effective? 1. The client's skin turgor is elastic. 2. The client's urine ketones are negative. 3. The serum blood glucose level is 118 mg/dL. 4. The client's glucometer level is 170 mg/dL.

3 The serum blood glucose level should be within normal limits, which is 70-110 mg/dL. A level of 118 mg/dL is close to normal; therefore, the medica- tion can be considered effective.

The male client is diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) of the urine and is receiving vancomycin (IVPB). Which intervention should the nurse implement when administering this medication? 1. Hold the medication if the trough level is 5 mg/dL. 2. Ask the client if he is allergic to penicillin. 3. Administer the medication via an infusion pump. 4. Check the client's CPK-MB isoenzyme level.

3 The therapeutic range of vancomycin is 10-20 mg/dL. The nurse would not hold the medication because the client has not reached a therapeutic range. Vancomycin is not in the penicillin family of medications. An allergy to penicillin would not prevent administering the vancomycin. Vancomycin is administered over a minimum of 1 hour. The nurse should obtain an infusion pump to regulate the speed of administration. Vancomycin is nephrotoxic. The nurse would monitor the BUN and creatinine levels, especially in children and the elderly, but there is no need to monitor cardiac enzymes.

14. The nurse is preparing to administer the following anticonvulsant medications. Which medication would the nurse question administering? 1. Carbamazepine (Tegretol) to the client who has a Tegretol serum level of 8 g/mL. 2. Clonazepam (Klonopin) to the client who has a Klonopin serum level of 60 ng/mL. 3. Phenytoin (Dilantin) to the client who has a Dilantin serum level of 26 g/mL. 4. Ethosuximide (Zarontin) to the client who has a Zarontin serum level of 45 g/mL.

3 The therapeutic serum level of Tegretol is 5-12 g/mL. Because the client's level is within that range, the nurse has no reason to question administering the drug. The therapeutic serum level of Klonopin is 20-80 ng/m. Because the client's level is within that range, the nurse has no reason to question administering the drug. The therapeutic serum level of Dilantin is 10-20 g/mL. Because the client's level is above that range, the nurse should question administering this medication. The therapeutic serum level of Zarontin is 40-100 g/mL. Because the client's level is within that range, the nurse has no reason to question administering the drug.

The male client diagnosed with a brain tumor tells the clinic nurse that he has been having seizures more frequently. The client is taking the anticonvulsant phenytoin (Dilantin), the narcotic morphine sulfate (Roxanol), the analgesic acetaminophen (Tylenol), and the antianxiety medication alprazolam (Xanax). Which question about the client's medications should the nurse ask next? 1. "How often do you need to take the Xanax?" 2. "Do you take any vitamins that might cause the seizures?" 3. "What was your last Dilantin level?" 4. "Have you had any x-rays to determine the cause of the seizures?"

3 Therapeutic levels of Dilantin are needed to control aberrant brain activ- ity. The therapeutic level is 10-20 mg/dL.

The client diagnosed with an acute gout attack is prescribed allopurinol (Zyloprim). Which data indicates the medication is effective? 1. The client has been symptom-free for several days. 2. The client has developed an aversion reaction to alcohol. 3. The serum uric acid levels are within normal limits. 4. The client develops tophi in the joints of the feet.

3 There are four phases of gout. Phase 1 is asymptomatic hyperuricemia; phase 2 is acute gouty arthritis; phase 3 is intercritical gout; and phase 4 is chronic tophaceous gout. Being asymptomatic after an acute attack indicates the client is in phase 3, intercritical gout; it does not indicate that the medication is effective. Zyloprim does not cause an aversion reaction to alcohol. The client should be instructed not to consume alcoholic beverages because alcohol can induce an attack. The main problem in gout is hyper- uricemia. A normal value indicates a suppression of the production of uric acid by the body and that the medica- tion is effective. Tophiareaccumulationsofsodiumurate crystals, which are deposited in periph- eral areas of the body. The presence of tophi indicates the medication is not effective.

17. The elderly client in the hospital is complaining of arthritic pain. Which action should the nurse implement? 1. Administer meloxicam (Mobic), an NSAID COX-2 inhibitor. 2. Administer acetylsalicylic acid (ASA), a salicylate. 3. Administer acetaminophen (Tylenol), a nonnarcotic analgesic. 4. Administer morphine intravenous push, a narcotic analgesic.

3 These medications are administered around the clock and are not specifically for acute pain. Aspirin has side effects, such as gastroin- testinal discomfort, and is not the drug of choice for elderly clients. Acetaminophen is generally preferred for use in older clients because it has fewer toxic side effects. Morphine is a narcotic, is not used to treat chronic arthritis pain, and should be used cautiously in elderly clients.

The male client diagnosed with paranoid schizophrenia has been taking the antipsy- chotic medication chlorpromazine (Thorazine). The client tells the psychiatric clinic nurse that he has frequent joint pain and stiffness and gets a rash when in the sun. Which statement is the nurse's best response? 1. "This is part of your illness and will go away if you don't pay attention." 2. "What have your voices said about the aches and pains and rash?" 3. "Don't take your medication today, and come in to see the HCP." 4. "This is a reaction to medications and you can no longer take medications."

3 These symptoms are not part of schizo- phrenia and should be investigated. The hallucinations the client has are not part of actual physical symptoms. Further investigation is needed to determine if the client is having a reaction to the medication. This is the best response by the nurse. These are symptoms of drug-induced systemic lupus erythematosus. The nurse should make sure the client is seen by the HCP. The nurse should not tell the client that he or she would no longer be able to take medications to control the symptoms of schizophrenia. The Thorazine may need to be changed to a different medication. Medication compliance in clients with psychiatric illnesses can be poor. This statement would give the client a reason not to take any medication.

36. The elderly client diagnosed with a panic attack disorder is in the busy day room of a long-term care facility and appears anxious, is starting to hyperventilate, is trembling, and is sweating. Which action should the nurse implement first? 1. Administer the benzodiazepine alprazolam (Xanax). 2. Assess the client's vital signs. 3. Remove the client from the day room. 4. Administer the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft).

3 This is an appropriate medication for an anxiety attack, but it will take at least 15-30 minutes for the medication to treat the physiological signs or symptoms. The client is in distress. The nurse should not assess the client; the nurse needs to help the client. This is the most appropriate interven- tion; the nurse should remove the client from the busy day room to help decrease the anxiety attack. SSRIs can be used to treat panic attacks, but the medication takes weeks to work; therefore, it would not be helpful in an acute panic attack.

The client is prescribed albuterol (Ventolin), a sympathomimetic bronchodilator, metered-dose inhaler. Which behavior indicates the teaching concerning the inhaler is effective? 1. The client holds his or her breath for 5 seconds and then exhales forcefully. 2. The client states the canister is full when it is lying on top of the water. 3. The client exhales and then squeezes the canister as the next inspiration occurs. 4. The client connects the oxygen tubing to the inhaler before administering the dose.

3 This is the correct way to use an inhaler because it will carry the medication down into the lung.

7. Which statement is the scientific rationale for prescribing atomoxetine (Strattera), a norepinephrine reuptake inhibitor, for a child diagnosed with attention deficit-hyper- activity disorder (ADHD)? 1. It increases acetylcholine levels and the brain's cholinergic function. 2. This medication normalizes the reuptake of certain neurotransmitters. 3. This medication is a nonstimulant, nonnarcotic that regulates impulse control. 4. It results in mild central nervous stimulation to control the child's behavior.

3 This is the scientific rationale for adminis- tering donepezil (Aricept) to a client with Alzheimer's disease. This is the scientific rationale for adminis- tering lithium to a client with bipolar disorder. Strattera is prescribed for ADHD because it is not a CNS stimulant or controlled substance. It acts to increase norepinephrine and regulate impulse control, organizes thoughts, and focuses attention. It does not decrease appetite, and the child does not need to take drug holidays. This is the scientific rationale for adminis- tering methylphenidate (Ritalin) to chil- dren with ADHD.

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.

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.

58. The nurse is discussing the thyroid hormone levothyroxine (Synthroid) with a client diagnosed with hypothyroidism. Which intervention should be included in the client teaching? 1. Discuss the importance of not using iodized salt. 2. Explain the importance of not taking medication with grapefruit juice. 3. Instruct the client to take the medication in the morning. 4. Teach the client to monitor daily glucose levels.

3 This would be appropriate if the client is taking antithyroid medication, not thyroid hormones. Iodine increases the production of thyroid hormones, which is not desir- able in clients taking antithyroid medica- tions. Grapefruit juice is contraindicated when taking some medications, but not thyroid hormone therapy. The medication should be taken in the morning to decrease the incidence of drug-related insomnia. Thyroid medications do not affect the client's blood glucose level; therefore, there is no need for the client to monitor the glucose level.

26. The client calls the clinic nurse to discuss problems concerning not being able to sleep at night. Which over-the-counter medications are taken to assist with sleep? 1. Acetaminophen (Tylenol), an analgesic. 2. Ibuprofen (Motrin), an NSAID. 3. Diphenhydramine (Benadryl), an antihistamine. 4. Zolpidem (Ambien), a sedative-hypnotic.

3 Tylenol is an analgesic. It is not formu- lated with ingredients that induce sleep. Tylenol PM contains diphenhydramine. This medication can be taken to aid in sleep. Ibuprofen is an analgesic and antipyretic, not a sleeping medication. Diphenhydramine is an antihistamine that has the side effect of causing drowsiness. This is the main ingredient in over-the-counter sleep aids. Ambien is not an over-the-counter medication.

The client diagnosed with coronary artery disease is instructed to take 81 mg of 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.

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.

The nurse is administering 0800 medications. Which medication would the nurse question? 1. Misoprostol (Cytotec), a prostaglandin analog, to a 29-year-old male with an NSAID-produced ulcer. 2. Omeprazole (Prilosec), a proton-pump inhibitor, to a 68-year-old male with a duodenal ulcer. 3. Furosemide (Lasix), a loop diuretic, to a 56-year-old male with a potassium level of 3.0 mEq/L. 4. Acetaminophen (Tylenol), a nonnarcotic analgesic, to an 84 year old with a frontal headache.

3 the potassium level is low (3.5- 5.5 mEq/L); therefore, the nurse should question this medication and request a potassium supplement or possibly telemetry.

34. The male client who has had bilateral knee replacement surgery calls the nurse's desk and reports that he noticed bruises on both sides of his abdomen while taking his bath. The client's MAR notes Ancef, an antibiotic; morphine, a narcotic analgesic; and Lovenox, a low molecular weight heparin. Which is the nurse's best response to the client? 1. "This is a reaction to the antibiotic you are receiving and it will need to be changed." 2. "This is caused by straining when trying to have a bowel movement." 3. "This occurs because of the positioning during the surgical procedure." 4. "This happened because of the medication used to prevent complications."

4

The clinic nurse is assessing a client 3 weeks after a suicide attempt. The client was prescribed sertraline (Zoloft), an SSRI. Which behavior indicates the medication is effective? 1. The client sleeps 14-16 hours a day. 2. The client has lost 3 pounds. 3. The client regrets the suicide attempt. 4. The client has started a new job.

4 Sleeping most of the day does not indicate the medication is effective; this may indicate the client is very depressed or is taking too much medication. 2. Weight loss or gain may indicate the client is depressed. 3. Verbalizing remorse does not indicate the medication is effective. 4. Setting new goals and priorities such as getting a job indicate the client may no longer be depressed and the medication is effective.

The client with coronary artery disease is prescribed nicotinic acid (Niacin). The client complains of flushing of the face, neck, and ears. Which priority action 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.

4 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 complaints first. 4. Taking an aspirin prior to the medica- tion will help reduce the flushing of the face, neck, and ears.

31. The nurse is caring for a client with a malignant brain tumor. Which medication would the nurse anticipate the health-care provider ordering? 1. Cyclophosphamide (Cytoxan), an alkylating agent, IVPB. 2. Octreotide (Sandostatin), a pituitary suppressant. 3. Erythropoietin (Epogen), a biologic response modifier. 4. Phenytoin (Dilantin), an anticonvulsant.

4 A brain tumor has the potential to cause erratic stimulation of the neurons in the brain, resulting in seizures. The nurse should expect the HCP to order an anticonvulsant to prevent or control seizures.

The nurse is administering 0900 medications to clients on a medical unit. Which medication should be administered first? 1. MS Contin, a narcotic analgesic, to a client with low back pain. 2. Chlorzoxazone (Parafon Forte), a muscle relaxant, to a client on bed rest. 3. Acetaminophen (Tylenol), an analgesic, to a client with a headache. 4. Diazepam (Valium), a benzodiazepine, to a client with muscle spasms.

4 A client having muscle spasms is a priority for the nurse. Muscle spasms can be extremely painful. This medica- tion should be administered first.

The elderly client diagnosed with coronary artery disease has been taking aspirin daily for more than a year. Which data would 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 is complaining of bleeding gums.

4 A complication of long-term aspirin use is gastric bleeding, which could also result in bleeding gums; this data would warrant further intervention.

14. The elderly client diagnosed with coronary artery disease has been taking aspirin daily for more than a year. Which data would 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.

4 A complication of long-term aspirin use is gastric bleeding, which could result in dark, tarry stools. This data would warrant further intervention.

13. The client diagnosed with glomerulonephritis is receiving trimethoprim sulfa (Bactrim DS). Which indicates the medication is effective? 1. A urine specific gravity of 1.010. 2. WBC of 35/hpf on the urinalysis. 3. Urine pH of 6.9. 4. Negative urine leukocyte esterase.

4 A negative urine leukocyte esterase indicates the antibiotic is effective in treating the infection. Leukocytes and nitrates are used to determine bacteri- uria and other sources of urinary tract infections.

Which assessment data indicates the atypical antipsychotic quetiapine (Seroquel) is effective for the client diagnosed with paranoid schizophrenia? 1. The client does not exhibit any tremors or rigidity. 2. The client reports a "2" on an anxiety scale of 1-10. 3. The family reports the client is sleeping all night. 4. The client denies having auditory hallucinations.

4 Antipsychotic medications are prescribed to decrease the signs or symptoms of schizophrenia. If the client denies auditory hallucinations, the medication is effective.

76. Which discharge instruction should the emergency department (ED) nurse discuss with the client who sustained a concussion and is being discharged home? 1. Instruct the client to not take any acetaminophen (Tylenol) for at least 48 hours. 2. Tell the client to stay on a clear liquid diet for the next 24 hours. 3. Instruct the client to take one hydrocodone (Vicodin) if experiencing a headache. 4. Tell the client to return to the ED if experiencing nausea and vomiting.

4 Any nausea, vomiting (especially projectile), or blurred vision could be increasing ICP; therefore, the client should return to the ED for further evaluation.

7. The nurse in the medical department is preparing to administer Humalog, a rapid- acting insulin, to a client diagnosed with Type 1 diabetes. Which intervention should the nurse implement? 1. Ensure the client is wearing a MedicAlert bracelet. 2. Administer the dose according to the regular insulin sliding scale. 3. Assess the client for hyperosmolar, hyperglycemic, nonketotic coma. 4. Make sure the client eats the food on the meal tray that is at the bedside.

4 Because the client is in the hospital the client must have a hospital identification band; a MedicAlert bracelet would be needed when the client is not in the hospital. Humalog is not regular insulin; it is fast- acting insulin. It is not administered accord- ing to the regular insulin sliding scale. The peak time for Humalog is 30 minutes to 1 hour; regular insulin peaks in 2-4 hours. A client with Type 1 diabetes will experi- ence diabetic ketoacidosis; a client with Type 2 diabetes will experience hyperosmo- lar, hyperglycemic, nonketotic coma. Humalog peaks in 30 minutes to 1 hour; therefore, the client needs to eat when or shortly after the medication is admin- istered to prevent hypoglycemia.

The male client diagnosed with chronic obstructive pulmonary disease (COPD) tells the nurse that he has been expectorating "rusty-colored" sputum. Which medication would the nurse anticipate the HCP prescribing? 1. Prednisone, a glucocorticoid. 2. Habitrol, a transdermal nicotine system. 3. Dextromethorphan (Robitussin), an antitussive. 4. Ceftriaxone (Rocephin), a cephalosporin.

4 Clients diagnosed with COPD are commonly prescribed a steroid (glucocor- ticoid) medication to decrease inflamma- tion in the lungs. This client should already be taking this or a similar medica- tion. The client's "rusty-colored" sputum indicates an infection and an antibiotic should be ordered. 2. The client should quit smoking if still smoking, but the client's "rusty-colored" sputum indicates an infection and an antibiotic should be ordered. 3. The client may require an antitussive but more likely would require a mucolytic to help to expectorate the thick tenacious sputum associated with COPD. 4. The client's "rusty-colored" sputum indicates an infection and an antibiotic should be ordered. Rocephin is a broad-spectrum antibiotic.

37. The client with an anxiety disorder is prescribed the anxiolytic alprazolam (Xanax). The client calls the clinic and reports a dizzy, weak feeling when getting out of the chair. Which action should the nurse take? 1. Instruct the client to quit taking the medication. 2. Make an appointment for the client to come to the clinic. 3. Determine if the client is drinking enough fluids. 4. Discuss ways to prevent orthostatic hypotension.

4 Feeling dizzy and weak when getting out of a chair is indicative of orthostatic hypotension, which is a common side effect of antianxiety medications and is not a reason to quit taking the medication. Feeling dizzy and weak when getting out of a chair is indicative of orthostatic hypo- tension, which is a common side effect of antianxiety medications and is not a reason for the client to come to the clinic. Feeling dizzy and weak when getting out of a chair is indicative of orthostatic hypo- tension, which is a common side effect of antianxiety medications, and fluid intake would not affect the client's behavior. Feeling dizzy and weak when getting out of a chair is indicative of orthosta- tic hypotension, which is a common side effect of antianxiety medications. The nurse should instruct the client to rise slowly from the sitting to standing position to avoid dizziness.

The nurse is preparing to administer medication to the following clients. Which medication should the nurse question? 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 hyper- tension. 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.

4 Glucophage acts on the liver to prevent gluconeogenesis and is often prescribed along with insulin for Type 1 or Type 2 diabetes.

The client who is obese is participating in an investigational study using metformin (Glucophage), a biguanide antidiabetic medication, for weight loss. Which data should the nurse monitor? 1. The hemoglobin A1C every 2 months. 2. Daily fasting glucose levels. 3. The urine ketones every 2 weeks. 4. The client's weight every month.

4 Glucophage is being investigated for weight loss in clients who do not have diabetes. There is no need to monitor the hemoglobin A1C. Glucophage acts on the liver to prevent gluconeogenesis; it does not increase insulin levels. Glucophage is being investigated for weight loss in clients who do not have diabetes. There is no need to monitor daily fasting blood glucose levels. Glucophage acts on the liver to prevent gluconeogenesis; it does not increase insulin levels. Urine ketones are monitored when a client diagnosed with diabetes has a high glucose level and sometimes by clients on the Atkins diet to monitor if they are having success. Normal diets do not monitor urine ketones. The medication is being administered for weight loss; the client's weight should be monitored.

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 action 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.

4 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 nurs- ing process, and determining if the client is taking any antiulcer medica- tion is the first question the nurse should ask the client.

83. The client with congestive heart failure is taking digoxin (Lanoxin), a cardiac glyco- side. Which data indicates the medication is ineffective? 1. The client's blood pressure is 110/68. 2. The client's apical pulse rate is 68. 3. The client's potassium level is 4.2 mEq/L. 4. The client's lungs have crackles bilaterally.

4 Signs or symptoms of CHF are crack- les in the lungs, jugular vein distention, and pitting edema; therefore, the medication is not effective.

The client with partial- and full-thickness burns to 35% of the body is admitted to the burn department. The HCP has prescribed famotidine (Pepcid), a histamine2 antagonist. Which statement best describes the scientific rationale for administering this medication? 1. Pepcid acts on the cell wall to prevent bacterial growth. 2. Pepcid will help control the client's pain. 3. Pepcid will help decrease the client's nausea and vomiting. 4. Pepcid will help decrease gastric acid production.

4 Silver sulfadiazine (Silvadene), not Pepcid, acts on the cell membrane and cell wall of susceptible bacteria and binds to cellular DNA. Intravenous opioid medications, not Silvadene, will help decrease the client's pain. Antiemetics, not Silvadene, will help prevent the client's nausea and vomiting. Curling's ulcer (stress ulcer) is an acute ulceration of the stomach or duode- num that forms following a burn injury. Histamine2 antagonists like Pepcid are administered to decrease gastric acid secretion in the acute phase of burn care.

9. The client diagnosed with insomnia asks the nurse, "Why did my HCP prescribe Ambien CR and tell me to quit taking Tylenol PM?" Which response by the nurse would be most appropriate? 1. "Over-the-counter medications are not as good as prescriptions." 2. "Tylenol PM is addicting and you should not take it nightly." 3. "You are concerned your HCP gave you a prescription drug." 4. "Ambien CR will help you get to sleep and stay asleep through the night."

4 Some OTC medications are as effective as prescription medications; therefore, this is a false statement. Tylenol PM is a combination of acetamin- ophen and Benadryl, and it is not addic- tive. The client did not verbalize this concern. The client needs factual information, not a therapeutic response. This medication allows the client to fall asleep and stay asleep, which is why it is prescribed for clients with insomnia. Short-term use does not result in an addiction to this medi- cation.

The client diagnosed with insomnia asks the nurse, "Why did my HCP prescribe Ambien CR and tell me to quit taking Tylenol PM?" Which response by the nurse would be most appropriate? 1. "Over-the-counter medications are not as good as prescriptions." 2. "Tylenol PM is addicting and you should not take it nightly." 3. "You are concerned your HCP gave you a prescription drug." 4. "Ambien CR will help you get to sleep and stay asleep through the night."

4 Some OTC medications are as effective as prescription medications; therefore, this is a false statement. Tylenol PM is a combination of acetamin- ophen and Benadryl, and it is not addic- tive. The client did not verbalize this concern. The client needs factual information, not a therapeutic response. This medication allows the client to fall asleep and stay asleep, which is why it is prescribed for clients with insomnia. Short-term use does not result in an addiction to this medi- cation.

6. The mother with preeclampsia is received magnesium sulfate, an anticonvulsant, during labor and delivery. Which intervention will the nursery nurse implement for the newborn? 1. Assess the lungs for meconium aspiration. 2. Prepare to administer naloxone (Narcan). 3. Administer 2 ounces of glucose water. 4. Stimulate the baby by tapping the feet.

4 The baby is at risk for respiratory or neurological depression; therefore, the nurse should stimulate the baby until the effects of the magnesium sulfate have dissipated.

The nurse is preparing to administer the following medications. Which medication would 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.

4 The blood pressure (168/94) is elevated; therefore, the nurse should administer this medication without questioning it. The normal serum sodium level is 135-145 mEq/L. Therefore, the nurse should administer this medication without questioning. 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. 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.

Which medication would the nurse question administering? 1. Lisinopril (Zestril), an ACE inhibitor, to a client with a BP of 118/84. 2. Carvedilol (Coreg), a beta blocker, to a client with an apical pulse of 62. 3. Verapamil (Calan), a calcium channel blocker, to a client with angina. 4. Furosemide (Lasix), a loop diuretic, to a client complaining of leg cramps.

4 The blood pressure is above 90/60; there is no reason for the nurse to question administering an ACE inhibitor in this situation. The apical pulse is above 60, so the nurse would not question administering a beta blocker in this situation. Calcium channel blockers are prescribed to treat angina, so there is no reason for the nurse to question the medication. Leg cramps may indicate a low blood potassium level; the nurse should hold the medication until the potas- sium level can be checked. Loop diuretics cause the kidneys to excrete potassium. Hypokalemia can cause life- threatening dysrhythmias.

45. The nurse is discharging the female client diagnosed with a pulmonary embolus (PE) who is prescribed the anticoagulant warfarin (Coumadin). Which statement indicates the client understands the medication teaching? 1. "I should use a straight razor when I shave my legs." 2. "I will use a hard-bristled toothbrush to clean my teeth." 3. "An occasional nosebleed is common with this drug." 4. "It will be important for me to have regular bloodwork done."

4 The client is at risk for bleeding and should be encouraged to use an electric razor. The client is at risk for bleeding, and a soft-bristled toothbrush should be used. Any abnormal bleeding, such as a nose- bleed, is not expected and should be reported to the HCP. Unexplained bleed- ing is a sign of toxicity. The client's International Normalized Ratio (INR) is monitored at routine intervals to determine if the medica- tion is within the therapeutic range, INR 2-3.

The client with seasonal allergic rhinitis is prescribed fluticasone (Flonase), an intranasal glucocorticosteroid. Which intervention should the nurse implement first? 1. Instruct the client not to eat licorice. 2. Explain that this is for short-term use. 3. Instruct not to use other nasal decongestants. 4. Assess the nares for excoriation or bleeding.

4 The nurse must first assess the client's nares because broken mucous membranes allow direct access to the bloodstream, increasing the likelihood of systemic effects of the drug. Therefore, this is the first intervention the nurse should implement. The HCP may not prescribe the medication if nasal excoriation or bleeding is present.

7. 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 via saline lock. 4. Administer oxygen via nasal cannula.

4 The client is having chest pain with activ- ity; 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.

The client with rheumatoid arthritis is taking etodolac (Lodine), a nonsteroidal anti- inflammatory drug (NSAID). The client is complaining of a headache. Which action should the nurse implement? 1. Administer two aspirins to the client. 2. Administer an additional dose of Lodine. 3. Administer one oral narcotic analgesic. 4. Administer two acetaminophen (Tylenol).

4 The client should not take aspirin, an NSAID, while taking another NSAID. 2. The client should not receive an addi- tional dose of a routine medication that is being administered for treatment of rheumatoid arthritis. 3. Thenurseshouldadministeranonnarcotic analgesic for a headache, not a narcotic. 4. Acetaminophen, a nonnarcotic anal- gesic, would be the most appropriate medication to give the client who is experiencing a headache and is taking an NSAID.

The home health nurse is caring for a client diagnosed with HIV infection. Which data suggest the need for prophylaxis with trimethoprim sulfa (Bactrim)? 1. The client has a positive HIV viral load. 2. The client's white blood cell count is 5000/mm3. 3. The client has a hacking cough and dyspnea. 4. The client's CD4 count is less than 300/mm3.

4 The client who is HIV positive could be expected to have a positive viral load. This is a reason to institute HAART (highly active antiretroviral therapy) but not Bactrim. This is a normal WBC count and is not a reason to start a prophylactic antibiotic. This client is showing symptoms of Pneumocystis carinii pneumonia (PCP); any treatment now would not be prophylactic. The client with a CD4 count of less than 300/mm3 is at risk for developing Pneumocystis carinii pneumonia (PCP). Bactrim is prophylaxis for PCP. Normal levels for CD4 are 450-1400/mm3.

The client tells the triage nurse in the emergency department (ED) that she has food poisoning like the rest of the people who ate at a local restaurant. The client has been vomiting and has had diarrhea for the last 6 hours and needs help. Which medication should the nurse administer first? 1. Diphenoxylate (Lomotil), an antidiarrheal. 2. Ceftriaxone (Rocephin), an antibiotic, intravenous piggyback. 3. Pantoprazole (Protonix), a proton-pump inhibitor. 4. Diluted promethazine (Phenergan), an antiemetic, intravenous push.

4 The client will not be able to tolerate oral medications until the nausea is controlled; therefore, Lomotil will be administered. The client needs to rid the body of the offending substance; therefore, diarrhea is not stopped. Antibiotics are not administered to clients with food poisoning. Medications administered to decrease gastric acid may or may not be given to the client, but it is not the first medication administered. Measures to control nausea and vomit- ing will prevent further fluid and elec- trolyte loss; therefore, an antiemetic is the first medication that should be administered.

51. The client diagnosed with hypothyroidism is prescribed levothyroxine (Synthroid). Which assessment data would support that the client is not taking enough medica- tion? 1. The client has a 2-kg weight loss. 2. The client complains of being too hot. 3. The client's radial pulse rate is 110 bpm. 4. The client complains of being constipated.

4 The client would have signs or symptoms of hypothyroidism if the client is not taking enough medication. Weight loss is a sign of hyperthyroidism, which indicates the client is taking too much Synthroid. The client would have signs or symptoms of hypothyroidism if the client is not taking enough medication. Intolerance to heat is a sign of hyperthyroidism and indicates the client is taking too much medication. Tachycardia, a heart rate greater than 100, is a sign of hyperthyroidism and indicates the client is taking too much medication. Decreased metabolism and constipa- tion indicate that the client is not taking enough of the thyroid hormone.

The client diagnosed with benign prostatic hypertrophy (BPH) and congestive heart failure (CHF) is receiving furosemide (Lasix), a loop diuretic, daily. Which informa- tion provided by the unlicensed assistive personnel (UAP) best indicates to the nurse that the medication is effective? 1. The UAP recorded the intake as 350 mL and the output as 450 mL. 2. The UAP stated that the client ambulated to the bathroom without dyspnea. 3. The UAP emptied a moderate amount of urine from the bedside commode. 4. The UAP reports that the client lost 1 pound of weight from the day before.

4 The client's intake and output measure- ments are important, but even accurate intake and output recordings cannot meas- ure for insensible losses. An output of 100 mL over the intake may or may not be considered adequate to determine effec- tiveness of a diuretic. Ambulating to the bathroom without dyspnea is an indicator that the client is not experiencing pulmonary complications related to excess fluid volume, but it is not the best indicator of the effectiveness of a diuretic. Terminology such as small, moderate, and large are not objective words. To quantify the results the nurse should use objective data—in this situation, numbers. This would provide an accurate comparison of data to determine the effectiveness of the medication. The most reliable method of determin- ing changes in fluid-volume status is to weigh a client in the same type of clothing at the same time each day. One liter (1000 mL) is approximately 0.9 kg, or 2 pounds. This client has lost approximately 500 mL more fluid than was taken in.

56. The nurse is discussing the thyroid hormone levothyroxine (Synthroid) with the client diagnosed with hypothyroidism. Which intervention should the nurse discuss with the client? 1. Encourage the client to decrease the fiber in the diet. 2. Discuss the need to monitor the T3, T4 levels daily. 3. Tell the client to take the medication with food only. 4. Instruct the client to report any significant weight changes.

4 The client's weight should be moni- tored weekly. Weight loss is expected as a result of the increased metabolic rate, and weight changes help to deter- mine the effectiveness of the drug therapy.

The client with major depressive disorder has been taking amitriptyline (Elavil), a tricyclic antidepressant, for more than 1 year. The client tells the psychiatric clinic nurse that the client wants to quit taking the antidepressant. Which intervention is most important for the nurse to discuss with the client? 1. Ask questions to determine if the client is still depressed. 2. Ask the client why he or she wants to stop taking the medication. 3. Tell the client to notify the HCP before stopping medication. 4. Explain the importance of tapering off the medication.

4 The nurse should discuss what behavior led to the client being prescribed antidepres- sants and determine if the client is still depressed, but the most important thing to discuss with the client is that the antidepres- sant medication should not be discontinued abruptly. The nurse should discuss why the client wants to stop taking the medication, but the most important intervention is to teach the client that the medication must be tapered. The client could quit taking medication without telling an HCP; therefore, teaching safety is priority. The client should notify the HCP before stopping the medication, but the most important intervention is to keep the client safe and inform the client to taper off the medication. The client must first know the impor- tance of needing to taper off the medica- tion because rebound dysphoria, irritability, or sleepiness may occur if the medication is discontinued abruptly. Then the client should see the HCP to determine what action should be taken because the client doesn't want to take the medication.

7. The nurse is administering heparin via the subcutaneous route. Which intervention should the nurse implement? 1. Prepare the medication using a 20-gauge, 1.5-inch needle. 2. After injecting the needle, aspirate and observe for blood. 3. After removing the needle, massage the area gently. 4. Check previous injection sites and administer in another area.

4 The nurse should not administer the heparin in the same site because this may cause tissue necrosis or other damage to the tissue.

Which discharge instructions should the nurse provide for the client diagnosed with cancer who is taking hydrocodone with acetaminophen (Vicodin) PRN for pain? 1. Take the medication only when the pain is severe. 2. Use Tylenol for any pain unrelieved by the Vicodin. 3. Notify the HCP if the medication relieves the pain. 4. Increase the intake of fluids and roughage in the diet.

4 The nurse should teach the client to take the pain medications as soon as the client begins to feel uncomfortable. Waiting to take the medication can make it difficult to get the pain under control. The nurse should instruct the client to avoid using other forms of acetaminophen (Tylenol). The maximum daily adult dose is 4 grams. Each Vicodin tablet contains 500 mg of Tylenol, and Vicodin HP contains 660 mg. The client only needs to notify the HCP if the pain is unrelieved. Hydrocodone slows peristalsis; the client should increase fluids and roughage in the diet to prevent consti- pation.

75. 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).

4 The nurse would not anticipate the HCP prescribing a medication that would cause bleeding for a client who has had surgery. 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. Thrombolytic medications would destroy thrombus formations and would not be prescribed for a surgical client. 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 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).

4 The nurse would not anticipate the HCP prescribing a medication that would cause bleeding for a client who has had surgery. 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. Thrombolytic medications would destroy thrombus formations and would not be prescribed for a surgical client. 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 medication to the following clients. Which medication should the nurse question? 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 hyper- tension. 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.

4 The nurse would question administer- ing 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 vasodilatation and reduced cardiac output, both of which lower blood pressure.

The nurse is preparing to administer medications to the following clients. Which client would the nurse question administering the medication? 1. The client receiving the angiotensin-receptor blocker losartan (Cozaar) who has a B/P 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.

4 The nurse would want to give this antihy- pertensive medication to a client with an elevated blood pressure; the nurse would question the medication if the B/P were low, which it is not. The client with 1 nonpitting edema would not be affected by a calcium channel blocker. Hytrin is not contraindicated in a client who has a headache; the apical pulse should be greater than 60. 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.

74. 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 would be 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."

4 This is a false statement; this medication does not work better during the night. This medication can be taken on an empty stomach or with food. There are not any side effects of Coumadin that would be decreased by taking the medication in the evening. Routine laboratory tests are drawn in the morning. If Coumadin is adminis- tered 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 clinic nurse is assessing a client diagnosed with pericarditis. The client reports to the nurse, "I take an aspirin every morning to help prevent a heart attack." Which statement would be the nurse's best response based on the client's medical diagnosis? 1. "Aspirin is known to prevent heart attacks. It is excellent that you take it." 2. "Have you noticed that you are bruising more easily since you started taking it?" 3. "I would recommend taking the enteric-coated aspirin to prevent gastric upset." 4. "You should quit taking the aspirin immediately, and I will talk to your HCP."

4 This is a true statement, but it is not appropriate for a client diagnosed with pericarditis. 2. Clients taking one aspirin a day should not notice an increase in bleeding. 3. This is a true statement, but it is not appropriate for clients diagnosed with pericarditis. 4. The client with pericarditis should avoid taking aspirin and anticoagulants because they may increase the possibil- ity of cardiac tamponade.

39. The client is receiving the anxiolytic alprazolam (Xanax) for a generalized anxiety disorder. Which assessment data best indicates the medication is effective? 1. The client reports not feeling anxious. 2. The client's pulse is not greater than 100. 3. The client's respiratory rate is not greater than 22. 4. The client reports a "1" on a 1-10 anxiety scale.

4 This is subjective and does not best indi- cate the medication's effectiveness. The pulse rate is elevated in an acute anxi- ety attack, but pulse rate is not the best assessment data to indicate if the medica- tion is effective. The client hyperventilates in an acute anxiety attack; respiratory rate is not the best assessment data to indicate the medication is effective. The best indicator of the medication's effectiveness is the client's objective report of his or her anxiety level.

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 occlu- sive 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.

4 This medication can be administered after the nurse treats the client with a life- threatening dysrhythmia. 2. Digoxin is not a priority medication over treating a client with a life-threatening dysrhythmia. 3. An iron dextran infusion must be adminis- tered 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 medica- tion. 4. Ventricular bigeminy is a life-threaten- ing dysrhythmia that must be treated immediately to prevent cardiac arrest.

35. The male client diagnosed with renal calculi is receiving pain medication via a morphine patient-controlled analgesia (PCA) pump. The HCP prescribed the non- steroidal anti-inflammatory drug (NSAID) indomethacin (Indocin) in a rectal suppository. Which action should the nurse take? 1. Question and clarify the prescription with the health-care provider. 2. Give the suppository to the client and allow the client to insert it into the rectum. 3. Administer a Fleets enema to clear the bowel prior to administering the suppository. 4. Have the client lie on the side and insert the rectal suppository with nonsterile gloves.

4 This prescription would not need to be clarified with the HCP. The client should not administer the suppository to himself or herself. The client does not need to have a clean bowel to receive a suppository. This medication is prescribed because it may reduce the amount of narcotic analgesia required for acute renal colic.

The nurse in the intensive care unit is caring for a client diagnosed with a left cere- bral artery thrombotic stroke who received a thrombolytic medication in the emer- gency department. Which intervention should be implemented? 1. Administer the antiplatelet medication ticlopidine (Ticlid) po. 2. Place the client in the Trendelenburg position. 3. Keep the client turned to the right side and high Fowler's position. 4. Monitor the anticoagulant heparin infusion.

4 Ticlid may be ordered in the future once the cause of the thrombus is determined, but this would not be ordered in the intensive care unit. The Trendelenburg position is head down and would increase intracranial pressure. There is no reason to restrict the client to lying on the right side, and high Fowler's is sitting upright. This would be a difficult position for the client to maintain. The client should have the head of the bed elevated approximately 30 degrees to decrease intracranial pressure by gravity drainage. The anticoagulant heparin is adminis- tered to prevent clot reformation after lysis of the clot by the thrombolytic, and its infusion should be monitored.

25. The female client diagnosed with essential hypertension tells the nurse that she has a cold and a runny nose. Which over-the-counter medication should the nurse tell the client to take? 1. Tylenol Cold and Sinus. 2. Advil Cold and Sinus. 3. Nyquil. 4. Coricidin HBP.

4 Tylenol Cold and Sinus contains ingredi- ents that cause vasoconstriction. The client with hypertension should not take any medication that increases vasocon- striction. Advil Cold and Sinus contains ingredients that cause vasoconstriction. The client with hypertension should not take any medication that increases vasoconstriction. Nyquil contains ingredients that cause vasoconstriction. The client with hyper- tension should not take any medication that increases vasoconstriction. Coricidin HBP has been formulated to control symptoms of the cold or flu without causing vasoconstriction. This is the only medication in this list that will not increase the client's blood pressure.

The male client diagnosed with chronic obstructive pulmonary disease (COPD) is admitted to the medical unit. During the admission process the client tells the nurse that he cannot sleep without Valium, a benzodiazepine, every night. Which action should the nurse take? 1. Inform the client that clients with COPD should not take Valium. 2. Ask the client when was the last time he had any seizure activity. 3. Determine what effect the Valium has on the client when he takes it. 4. Ask the health-care provider for an order for Valium.

4 Valium can depress respirations, but this client has already been taking the medica- tion. Valium is administered to clients during a seizure to treat a seizure, but this client has informed the nurse that it is being taken for sleep. The client has already told the nurse that the Valium is used to induce sleep. Benzodiazepines should be tapered off when the client is trying to stop taking them. The nurse should request an order for the Valium.

8. 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.

4. Signs and symptoms of CHF are crack- les 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.

The client taking the combination medication hydrocodone and acetaminophen (Vicodin), a narcotic analgesic, calls the clinic and tells the nurse, "I have not had a bowel movement in more than 3 days." Which statement is the nurse's best response? 1. "This medication causes constipation. You need to increase your fluid intake." 2. "Have you been taking the stool softeners that I told you to take along with Vicodin?" 3. "You should go to the emergency department so that you can see a doctor." 4. "You should take a laxative, and if you do not have a BM within 24 hours, call me."

4. The nurse can recommend an over- the-counter stimulant laxative to help evacuate the bowel because the nurse is aware that constipation is a side effect of Vicodin. Giving the client a 24-hour deadline for having a bowel movement is a safeguard.

42. The nurse is preparing to administer warfarin (Coumadin), an anticoagulant. The client's current laboratory values are as follows: PT 22 PT 39 Control 12.9 Control 36 INR 2.6 Which action should the nurse implement? 1. Question administering the medication. 2. Prepare to administer AquaMEPHYTON (vitamin K). 3. Notify the health-care provider to increase the dose. 4. Administer the medication as ordered.

4. When the nurse is administering Coumadin, the International Normalized Ratio (INR) must be monitored to determine therapeutic level, which is 2-3. Because the INR is 2.6, the nurse should administer this medication.