PHARM final (NCLEX Q's)

methylprednisone (Solu-Medrol), a glucocorticoid

A client newly diagnosed with hemolytic anemia the nurse should anticipate what medication?

The client has gained 2lbs and has pink buccal mucosa

A client with folic acid deficiency is taking oral folic acid. Effectiveness of this treatment is:

3. Cor pulmonale is right-sided heart failure, often secondary to chronic obstructive pulmonary disease (COPD). Because mannitol pulls fluid off the brain, it may lead to a circulatory overload, which the heart with right-sided failure could not handle. This client would need an order for a loop diuretic to prevent serious cardiac complications.

All the following clients have a head injury. Which client would the nurse question administering the osmotic diuretic mannitol (Osmitrol)? 1. The 34-year-old client who is HIV positive. 2. The 84-year-old client who has glaucoma. 3. The 68-year-old client who has cor pulmonale. 4. The 16-year-old client who has cystic fibrosis.

Low weight molecular heparin

Patient has thrombocytopenia-- what do you give?

LDL <100

Someone is taking Lipitor to reduce cholesterol, what is the golden number?

4. Many medications for HTN have the adverse effect of causing erectile dysfunction, which many men are hesitant to discuss with their HCP, and the man may simply stop taking the medication to avoid this side effect. The nurse should assess how the client has been controlling his HTN and ask specifically about erectile dysfunction related to hypertensive medication. HTN is a risk factor for developing other cardiovascular diseases, including stroke. This client has two risk factors for developing a stroke: HTN and his racial background.

The 55-year-old African American male client presents to the emergency department with blurred vision, slurred speech, and left-sided weakness. The client has a history of hypertension (HTN) and benign prostatic hypertrophy (BPH). Which statement regarding the client's medications should the nurse ask at this time? 1. "Have you been taking over-the-counter herbs to treat the BPH?" 2. "Do you take an aspirin every day to prevent heart attacks and strokes?" 3. "Do you eat green, leafy vegetables frequently?" 4. "Have you been taking medications routinely to control the HTN?"

1. Meperidine metabolizes into normeperidine in the body, and accumulation of this substance in the body can cause seizures. It is not recommended to give Demerol to children, and the schedule may be excessive. The nurse should not automatically administer narcotics to a client who is neurologically impaired. The nurse should determine the neurological status of the client before administering a medication that can mask symptoms.

The 6-year-old client diagnosed with a brain tumor has returned from the postanesthesia care unit to intensive care. Which medication should the nurse question? 1. Meperidine (Demerol), a narcotic analgesic, IVP every 2 hours. 2. Methylprednisolone (Solu-Medrol), a steroid, IVPB every 8 hours. 3. Acetaminophen (Tylenol), an antipyretic, po or rectal PRN. 4. Promethazine (Phenergan), an antiemetic, IVP PRN.

4. Human growth hormone is diabetogenic and can cause hyperglycemia.

The 8-year-old male client has been determined to have a benign tumor in the anterior pituitary gland. Surgery has resulted in an inadequate production of growth hormone (GH). The nurse is teaching the parents about growth hormone therapy. Which statement indicates the parent understands the medication? 1. "If I give too much, then my child will grow to be a giant." 2. "After a few months I can taper my child off the growth hormone." 3. "If I don't give the hormone, my child will become retarded." 4. "I should monitor my child's blood glucose levels."

2,1,4,5,3

The HCP ordered a transfusion to be administered to a client with aplastic anemia. Place in order the steps: 1. obtain informed consent for procedure 2. make sure client understands procedure 3. check blood out from lab 4. perform a pre-bood assessment 5. Start an IV with an 18-gauge catheter

2. Notify the HCP if you develop localized edematous areas that itch. *a condition in which there are localized edematous areas (wheals), accompanied by intense itching of the skin and mucous membranes, is called angioedema. This adverse reintervention of ACE inhibitors and should be reported to HCP.

The HCP prescribed an angiotensin-converting enzyme (ACE) inhibitor for a client diagnosed with congestive heart failure (CHF). Which instruction should the nurse provide? 1. Eat a banana or drink orange juice at least twice a day. 2. Notify the HCP if you develop localized edematous areas that itch. 3. A dry cough is expected early in the morning on arising. 4. The symptoms of CHF should improve rapidly.

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.

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.

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.

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.

1. Amitriptyline (Elavil), a tricyclic antidepressant. Tricyclic antidepressants, antihistamines, and antipsychotics can reduce the client's response to cholinesterase inhibitors.

The client diagnosed with AD is prescribed rivastigmine (Exelon), a cholinesterase inhibitor. Which med should the nurse question administering to the client? 1. Amitriptyline (Elavil), a TCA 2. Warfarin (coumadin), an anticoagulant 3. Phenytoin (Dilantin). an anticonvulsant 4. Prochlorperazine (Compazine), an antiemetic

IM folic acid * Crohn's is the 2nd most common cause of folic acid deficiency due to malabsorption

The client diagnosed with Crohn's disease and is also folic acid deficient. Which med should the nurse anticipate being prescribed? 1. oral folic acid 2. cyanocobalamin, IM 3. B complex, orally 4. IM folic acid

2. If symptoms return, the client should notify the HCP. This is b/c the effectiveness of amantadine may diminish in 3-6 mos.

The client diagnosed with PD is prescribed the antiviral drug amantadine (Symmetrel). Which info should the nurse teach the client? 1. do not get the flu vaccine because there could be interactions 2. If symptoms return, the client should notify the HCP. 3. the dose should be decreased if taking other PD meds 4. if dry mouth develops. d/c med immediately

4. "This allows for a more accurate INR level when we draw your morning labs"

The client diagnosed with a DVT asks the nurse, "Why do I have to take my coumadin in the evening?" You respond how: 1. "the medication works more effectively while you are sleeping" 2. "the medication should be given with the largest meal of the day" 3. "the side effects of 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"

1. Mannitol can crystallize in the containers in which it is packaged, and the crystals must not be infused into the client. The nurse should inspect the bottle for crystals before beginning the administration. 2. Any client receiving a diuretic should be monitored for intake and output to determine if the client is excreting more than the intake. 3. Mannitol is an osmotic diuretic and works by pulling fluid from the tissues into the blood vessels. Clients diagnosed with heart failure or who may be at risk for heart failure may develop fluid volume overload. Therefore, the nurse should assess lung sounds before administering this medication.

The client diagnosed with a brain tumor is ordered the osmotic diuretic mannitol (Osmitrol) to be given intravenously. Which interventions for this medication should the nurse implement? Select all that apply. 1. Inspect the bottle for crystals. 2. Record intake and output every 8 hours. 3. Auscultate the client's lung fields. 4. Perform a neurological examination. 5. Have calcium gluconate at the bedside.

2. Any bleeding from the intravenous site, gums, rectum, or vagina should be reported to the HCP. The HCP may not be able to take action to prevent the bleeding during therapy, but it warrants notifying the HCP.

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

2. 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.

The client diagnosed with a stroke has been prescribed phenytoin (Dilantin), an anticonvulsant. 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.

1. Life-threatening hypotension can result with concurrent use of nitroglycerin and sildenafil (Viagra).

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. The client's 8-hour intake is 1800 mL and the output is 2300 mL.

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

1. Hypertension is a risk factor for developing a stroke. Some clients require multiple medications to control their hypertension.

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 statement 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.

2. By reducing the levels of angiotensin II, ACE inhibitors dilate blood vessels, reduce blood volume, and prevent or reverse angiotensin II pathologic changes in the heart and kidneys.

The client diagnosed with congestive heart failure (CHF) is prescribed the angiotensin-converting enzyme (ACE) inhibitor enalapril (Vasotec). Which statement explains the scientific rationale for administering this medication? 1. ACE inhibitors increase the levels of angiotensin II in the blood vessels. 2. ACE inhibitors dilate arteries, which reduces the workload of the heart. 3. ACE inhibitors decrease the effects of bradykinin in the body. 4. ACE inhibitors block the action of antidiuretic hormone in the kidney.

4. Signs and symptoms of CHF are crackles in the lungs, jugular vein distention, and pitting edema. Therefore, if the client has clear lung sounds, the nurse can assume the medication is effective.

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.

1. "I should get up slowly when I am getting out of my bed." 2. "I should check and record my blood pressure once a day."

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

take anticoagulant warfarin as ordered

The client diagnosed with polycythemia vera is being discharged. What discharge instruction should the nurse teach the client?

A, E

The client dx with early stage PD has been prescribed pramipexole (Mirapex). Which side effects of this medication should the nurse discuss w/ the client? Select all that apply A. daytime somnolence B. on-off effect C. excessive salivation D. Pill rolling motion E. Stiff muscles

The low molecular weight heparin enoxaparin (Lovenox)

The client has had a total right hip replacement. Which med should the nurse anticipate the HCP prescribing?

Answer: 37.5 g To determine this, first find the client's weight in kilograms (165 pounds / 2.2 = 75 kg). Then, multiply 0.5 g by weight in kilograms (0.5 x 75 kg= 37.5 kg).

The client has increased intracranial pressure and the health-care provider orders a bolus of 0.5 g/kg IV of 25% osmotic diuretic solution. The client weighs 165 pounds. How much medication will the nurse administer to the client? Answer ____________________

Document the finding and take no intervention --it just happens, not an adverse reaction; it is 2/2 the SUBQ injections of the heparin

The client has petechiae on the anterior lateral upper-abdominal wall. The medication admin record indicates the clinet is receiving a daily baby aspirin, an iV narcotic, and a low-molecular, weight heparin. What intervention should the nurse implement?

4. The nurse should administer the Valium undiluted through the saline lock.

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.

1. Serum glucose must be monitored more closely because phenytoin may inhibit insulin release, thus causing an increase in glucose level.

The client newly diagnosed with a seizure disorder also has Type 2 diabetes. The health-care provider prescribes phenytoin (Dilantin) for the client. Which intervention 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. Anticonvulsant dosages usually start low and gradually increase over a period of weeks until the serum drug level is within therapeutic range or the seizures stop.

The client newly diagnosed with epilepsy is prescribed an anticonvulsant medication. Which information should the nurse tell the client? 1. The medication dosage will start low and gradually increase over a few weeks. 2. The dosage prescribed initially will be the dosage prescribed for the rest of your life. 3. The health-care provider will prescribe a loading dose and decrease dosage gradually. 4. The dose of medication will be adjusted monthly until a serum drug level is obtained.

The client's calves are normal size, nontender, normal color

The client on strict bed rest is prescribed subcutaneous heparin. What data indicates the medication is effective?

2. Research supports the finding that clients with head injuries who are treated with anti-inflammatory corticosteroids 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.

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.

Use a filter needle when administering the medication rationale: crystals may form in the solution and syringe and be inadvertently injected into the client if a filter needle is not used.

The client with a head injury is experiencing increased intracranial pressure. The neurosurgeon prescribes the osmotic diuretic mannitol (Osmitrol). Which intervention should the nurse implement when administering this medication? 1. Monitor the client's arterial blood gases during administration. 2. Do not administer if the client's blood pressure is less than 90/60. 3. Ensure that the client's cardiac status is monitored by telemetry. 4. Use a filter needle when administering the medication.

B - Serotonin Syndrome is a serious complication of SSRIs that produces mental changes (confusion, anxiety, and restlessness), HTN, tremors, sweating, hyperpyrexia (elevated temp), and ataxia Conservative treatment includes stopping the SSRI and supportive treatment. If untreated, ESE can lead to death.

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? a) determine if the client has flulike symptoms b) instruct the client to stop taking the SSRI c) recommend the client take the medication at night d) explain that these are expected side effects

1. The client should wear a MedicAlert bracelet and carry identification so that a health-care provider and others possibly providing care know that the client has a seizure disorder. 2. The client should not take any overthe- counter medications without first consulting with the HCP or pharmacist because many medications interact with Cerebyx. 5. Dilantin may cause anorexia, nausea, and vomiting; therefore, the client should maintain an adequate nutritional intake.

The client with a seizure disorder is prescribed the anticonvulsant fosphenytoin (Cerebyx). Which interventions should the nurse discuss with the client? Select all that apply. 1. Instruct the client to wear a MedicAlert bracelet and carry identification. 2. Tell the client to not self-medicate with over-the-counter medications. 3. Encourage the client to decrease drinking of any type of alcohol. 4. Discuss the importance of maintaining good oral hygiene. 5. Explain the importance of maintaining adequate nutritional intake.

3. 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.

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."

1. Evening primrose oil may lower the seizure threshold, and the Tegretol dose may need to be modified. Therefore, the client should notify the health-care provider.

The client with a seizure disorder who is taking carbamazepine (Tegretol) tells the clinic nurse, "I am taking evening primrose oil for my premenstrual cramps and it is really working." Which statement would be the nurse's best response? 1. "You should inform your health-care provider about taking this herb." 2. "It is very dangerous to take both the herb and Tegretol." 3. "Herbs are natural substances and I am glad it is helping your PMS." 4. "Are you sure you should be taking herbs along with Tegretol?"

3. Mannitol is administered to decrease intracranial pressure. Changes in intracranial pressure affect neurological status; therefore, the client's neurological status should be evaluated to determine the effectiveness of the medication.

The client with increased intracranial pressure is receiving the osmotic diuretic mannitol (Osmitrol). Which intervention should the nurse implement to evaluate the effectiveness of the medication? 1. Monitor the client's vital signs. 2. Maintain strict intake and output. 3. Assess the client's neurological status. 4. Check the client's serum osmolality level.

1.The serum osmolality is 330mOsm/kg rationale: Normal serum osmolality is 275-300. Mannitol is head if the serum osmolality exceeds 310-320.

The client with increased intracranial pressure is receiving the osmotic diuretic mannitol (Osmitrol). Which data would cause the nurse to hold the administration of this medication? 1. The serum osmolality is 330 mOsm/kg. 2. The urine osmolality is 550 mOsm/kg. 3. The BUN is 8mg/dL. 4. The creatinine level is 1.8 mg/dL.

Tell the client that his/her stools will be greenish black

The client with iron deficiency anemia is being discharged. What intstruction should the nurse include regarding the oral iron preparation prescribed?

4. "Hormone replacement therapy may prevent the development of AD"

The daughter of a client with AD asks the nurse, "Is there anything I can do to prevent getting this disease?" What statement is the nurse's best response?

1. A symptom of CHF is SOB. The fact that the client can ambulate without being SOB is an improvement of symptoms, which shows that the medications are effective. 3. Weight gain would indicate that the client is retaining fluid and the medications are not effective. No weight gain indicates the medication is effective.

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? (select all that apply) 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 not gained any weight since my last doctor visit" 4. "My BP has been within normal limits" 5. "I am staying on my diet, and I don't salt my foods anymore"

2. the client is discussing an upcoming event with the family

The home-health care nurse is caring for a client taking donepezil (Aricept), a cholinesterase inhibitor. Which finding indicates the medication is effective? 1. the client is unable to relate his/her name or DOB 2. the client is discussing an upcoming event with the family 3. the client is wearing underwear on the outside of the clothes 4. the client is talking on a phone that is signaling a dial tone

3. "You need to discuss this with your health-care provider." *this may be a side effect of the medication and is a reason for noncompliance is males. The HCP should be notified to discuss the situation and possible options.

The male client diagnosed with essential hypertension tells the nurse, "I am not able to make love to my wife since I started my blood pressure medications." Which statement by the nurse is most appropriate? 1. "You are concerned that you cannot make love to your wife." 2. "I will refer you to a psychologist so that you can talk about it." 3. "You need to discuss this with your health-care provider." 4. "Ask your wife to come in and we can discuss it together."

4. The anticoagulant heparin is administered to prevent clot reformation after lysis of the clot by the thrombolytic, and its infusion should be monitored.

The nurse in the intensive care unit is caring for a client diagnosed with a left cerebral artery thrombotic stroke who received a thrombolytic medication in the emergency 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.

1.The client receiving a calcium channel blocker (CCB) should avoid grapefruit juice because it can cause the CCB to rise to toxic levels.

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

2. Check the client's current potassium level. 3. Ask the client if he or she is seeing a yellow haze around objects.

The nurse is administering digoxin (Lanoxin), a cardiac glycoside, to a client diagnosed 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

Administer the medication by the Z-track method

The nurse is administering iron dextran (Imferon), an iron preparatio, to a client diagnosed with iron deficincy anemia. What intervention should the nurse implement?

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 nurse is caring for a client diagnosed with a hemorrhagic stroke. Which medication 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. Instruct the client to rise slowly from a seated or lying position (can cause postural hypotension), 2. teach about on-off effects, 4. tell the client that the sweat and urine my become darker.

The nurse is caring for a client newly diagnosed with PD who is receiving the anti-PD med levodopa. Which interventions should the nurse implement? 1. instruct client to rise slowly from seated or lying position 2. teach about on-off effects of the med 3. discuss taking the med w/ meals or snacks 4. teach client that sweat and urine may become darker 5. inform client about having routine blood levels drawn.

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 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.

1. Make sure the client has a room near the nursing station. 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 prevention protocol.

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 meds includes Ladix, 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 nurses station 2. check the clients WBC count and K+ level 3. have the UAP get the client ice chips to suck on 4. determine the clients usual bowel elimination pattern

3. "I will increase the amount of green, leafy vegetables I eat"

The nurse is discharging the female client diagnosed w/DVT who is prescribed warfarin. Which statement indicates the client needs more teaching? 1. "I should wear a medical alert bracelet in case of an emergency" 2. "If I get cut I will apply pressure for at least 5mins" 3. "I will increase the amount of green, leafy vegetables I eat" 4. "I will have to see my HCP regularly while taking this med

2. Instruct the client to drink adequate fluids. 8The client should drink adequate amounts of fluids to replace insensible loss of fluids and to help prevent dehydration.

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

2. The client will maintain functional ability.

The nurse is preparing a care plan for a client diagnosed with PD. Which statement is the goal of medication therapy for the client diagnosed with PD? 1. the medication will cure the client of PD 2. The client will maintain functional ability. 3. the client will take all medications as ordered 4. the med will control all symptoms of PD

2. Check the clients BP

The nurse is preparing to administer a CCB, a loop diuretic, and a beta blocker to a client diagnosed with arterial HTN. Which intervention should the nurse implement? 1. Hold the medication and notify the HCP on rounds 2. Check the clients BP 3. contact the pharmacist to discuss the medication 4. double-check the health-care providers orders

3. The client's ability to swallow must be assessed before attempting to administer any oral medication. Water is the best fluid to use because it will not damage the lungs if aspirated.

The nurse is preparing to administer an oral medication to a client diagnosed with a stroke. Which intervention should the nurse implement first? 1. Crush all oral medications and place them in pudding. 2. Elevate the head 60 degrees. 3. Ask the client to swallow a drink of water. 4. Have suction equipment at the bedside.

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. 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. 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 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. 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 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.

4. The loop diuretic furosemide (Lasix) to the client with a serum potassium level of 3.1 mEq/L.

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

2. Prepare to administer Aqua MEPHYTON (Vitamin K). *this is the antidote for coumadin toxicity. Normal INR range is 2-3. Client w/ INR of 5.9 is at great r/f hemorrhage and should be given the Vit K.

The nurse is preparing to administer warfarin. The clients lab values are as follows: PT 38, PTT 39, INR 5.9. What intervention should the nurse implicate? 1. d/c the IV bag immediately 2. Prepare to administer Aqua MEPHYTON (Vitamin K). 3. notify HCP to increase dose 4. Administer the medication as ordered

1. Hang the intravenous bag at the same rate *the therapeutic range for heparin is 1.5-2.0 times the control, or 54 to 72. The client's PTT of 62 indicates the client is within range and the next bag should be administered at the same rate

The nurse is preparing to hang the next bag of heparin to a client diagnosed with DVT. The client's current lab values are as follows. PT: 12.7 PTT: 62 INR: 1; Which intervention should the nurse implement? 1. Hang the IV bag at the same rate 2. order a STAT PT/PTT/INR 3. Notify HCP 4. Assess the client for abnormal bleeding

3. eat bananas or oranges regularly

The nurse is providing discharge instructions for a client prescribed a thiazide diuretic hydrochlorothiazide (Diuril). Which instruction should the nurse include? 1. drink 8-10 glasses of water daily 2. weigh monthly and report weight to HCP 3. eat bananas or oranges regularly 4. try to sleep in an upright position

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 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."

C

The older adult patient diagnosed with Parkinson's disease (PD) has been prescribed carbidopa/levodopa (Sinemet). Which data indicates the medication is effective? a. The patient has cogwheel motion when swinging the arms. b. The patient does not display emotions when discussing the illness. c. The patient is able to walk upright without stumbling. d. The patient eats 30%-40% of meals within 1 hour.

B

The patient diagnosed with Parkinson's disease has been on a long-term levodopa, an anti Parkinson's disease drug. Which data supports the rationale for placing the patient on a "drug holiday." a. The medication is expensive and difficult to afford for patients on a fixed income. b. The therapeutic effects of the drug have diminished and the adverse effects have increased. c. The patient has developed hypertension that is uncontrolled by medication. d. An overdose is being taken and the medication needs to clear the system.

dosing schedule for Aricept is only once a day

What is the advantage of prescribing donepezil (Aricpet) over the prescription drugs for AD?

2. Aricept increases the availability of acetylcholine at cholinergic synapses.

What is the scientific rationale for prescribing and administering donepezil (Aricept), a cholinesterase inhibitor?

Leg cramps, muscle aches

When should you call physician when you are on Lipitor?

4.The nurse should not administer this medication if the client's blood pres- sure is less than 90/60 because it will further decrease the blood pressure, resulting in the brain not being perfused with oxygen.

Which assessment data should the nurse obtain prior to administering a calcium channel blocker? 1. The serum calcium level. 2. The client's radial pulse. 3. The current telemetry reading. 4. The client's blood pressure.

3. The client diagnosed with glaucoma. Anticholinergics block cholinergic receptors in the eye and may precipitate or aggravate glaucoma.

Which client diagnosed with PD should the nurse question administering the anticholinergic med benztropine (Cogentin)? 1. the client with CHF 2. The client with MI 3. The client with glaucoma 4. The client undergoing hip replacement surgery

3. Hepatotoxicity is one of the possible adverse reactions to Depakote; therefore, the liver enzymes should be monitored.

Which data should the nurse assess for the client with a seizure disorder who is taking valproate (Depakote)? 1. Creatinine and BUN. 2. White blood cell count. 3. Liver enzymes. 4. Red blood cell count.

1. Ibuprofen (Motrin), a nonsteroidal anti-inflammatory drug (NSAID).

Which medication should the nurse question administering to a client diagnosed with stage C congestive heart failure (CHF)? 1. Ibuprofen (Motrin), a nonsteroidal anti-inflammatory drug (NSAID). 2. Amlodipine (Norvasc), a calcium channel blocker. 3. Spironolactone (Aldactone), a potassium-sparing diuretic. 4. Atenolol (Tenormin), a beta blocker.

4. Comtan causes blood levels of levodopa to be smoother and more sustained.

Which statement is an advantage of administering the catechol-O-methyltransferase (COMT) inhibitor entacapone (Comtan) to a client diagnosed with PD? 1. comtan increases vasodilation effect of levodopa 2. levodopa can be d/c while the client is taking comtan 3. There are no side effects of the drug to interfere w/ tx 4. Comtan causes blood levels of levodopa to be smoother and more sustained.

A

Which statement is the scientific rationale for the combination drug cabidopa/levodopa (Sinemet) prescribed to a patient diagnosed with Parkinson's disease? a. The carbidopa delays the breakdown of levodopa in the periphery so more dopamine gets to the brain. b. The medication is less expensive when combined, so it is more affordable to patients on a fixed income. c. The carbidopa breaks down in the periphery and causes vasoconstriction of the blood vessels. d. Carbidopa increases the action of levodopa on the renal arteries, increasing renal perfusion.

2. PD is treated with medications and surgery. The medications have side effects and adverse effects, and the effectiveness of the medications may be reduced over time.

Which statement made by the wife of a client diagnosed with Parkinson's disease (PD) indicates that teaching about the medication regimen has been effective? 1. "The medications will control all the symptoms of the PD if they are taken correctly." 2. "The medications provide symptom management, but the effects may not last." 3. "The medications will have to be taken for about 6 months and then stopped." 4. "The medications must be tapered off when he is better or he will have a relapse."

initiate IV fluids

the 28-year old client diagnosed with sickle cell anemia has been admitted to the medical unit for a vaso occlusive crisis. What intervention should the nurse implement first?

3. Epoetin *Procrit stimulates the bone marrow to produce RBCs.

the nurse is caring for a client diagnosed with sickle cell disease. Which medication would the nurse question? 1. Morphine sulfate, IVP 2. Fentanyl patch 3. Epoetin, SQ 4. Piperacillin and tazobactam (Zosyn), IVPB