Pharmacology HESI Comprehensive Review for the NCLEX-PN Exam, 6th Edition Study Mode

The practical nurse prepares to administer ophthalmic drops to a client before cataract surgery. List the steps in the order they should be implemented from first step to final step. Arrange the sequence options in the correct order by assigning each option a number. Drop prescribed number of drops into the conjunctival sac. Ask the client to close the eye gently. Wash hands and apply clean gloves. Place the dominant hand on the client's forehead.

1. Wash hands and apply clean gloves. 2. Place the dominant hand on the client's forehead. 3. Drop prescribed number of drops into the conjunctival sac. 4. Ask the client to close the eye gently. Rationale: Washing hands and applying gloves before procedure initiation prevent the spread of infection. Placing the dominant hand on the client's forehead stabilizes the hand, so the nurse can hold the dropper 1 to 2 cm above the conjunctival sac and drop the prescribed number of drops, and asking the client to close the eye gently helps distribute the medication.

The health care provider orders 1000 mL of 0.45% lactated ringers to run over 8 hours. The drop factor is 15 gtt/mL. The nurse plans to adjust the flow rate to how many gtt/min? (Round to the nearest whole number.) gtt/min

31 Rationale: First convert the 8 hours to minutes (8 hours × 60 minutes/hour = 480 minutes).Then use the formula below to determine the gtt/min. Finally, round to the nearest whole number.Total volume in mL × gtt factor = flow rate in gtt/minTime in minutes:(1000 mL × 15 gtt/mL)/480 minutes = 15,000/480 = 31.2 or 31 gtt/min

An older client is prescribed gentamicin sulfate. Which question should the practical nurse (PN) ask an older client before beginning treatment? a. "Are you hard of hearing?" b. "Have you ever had cancer?" c. "Do you have diabetes?" d. "Did you ever have anemia?"

a. "Are you hard of hearing?" Rationale: Complications of gentamicin sulfate therapy include ototoxicity, nephrotoxicity, and neurotoxicity. Determining and monitoring the client's hearing before initiation of this medication and as the treatment progresses is important. Peak and trough levels are usually prescribed around the second and third dose.

A client prescribed chemotherapy asked the practical nurse (PN), "Why is so much of my hair falling out each day?" Which response by the PN best explains the reason for alopecia? a. "Chemotherapy affects the cells of the body that grow rapidly, both normal and malignant." b. "Alopecia is a common side effect you will experience during long-term steroid therapy." c. "Your hair will grow back completely after your course of chemotherapy is completed." d. "The chemotherapy causes permanent alterations in your hair follicles that lead to hair loss."

a. "Chemotherapy affects the cells of the body that grow rapidly, both normal and malignant." Rationale: The common adverse effects of chemotherapy (nausea, vomiting, alopecia, bone marrow depression) are results of chemotherapy's effect on the rapidly reproducing cells, both normal and malignant.

A client has sublingual nitroglycerine tablets prescribed to treat angina. The nurse realizes the client requires further education if the client makes which statements? (Select all that apply.) a. "I will need to replace the nitroglycerine tablets in a year." b. "I should stop taking nitroglycerine tablets if I develop a headache." c. "I am worried I might become addicted to these tablets if I take them often." d. "If I feel dizzy when I take these, I should sit down or lie down until I feel better." e. "If I know I am going to do an activity that normally causes angina, I take a tablet before that activity."

a. "I will need to replace the nitroglycerine tablets in a year." b. "I should stop taking nitroglycerine tablets if I develop a headache." c. "I am worried I might become addicted to these tablets if I take them often." Rationale: Nitroglycerine sublingual tablets need to be replaced every 3 to 5 months, not every year. Nitroglycerine can cause a headache, but the prescribed nitroglycerine should still be taken if the client has angina. Nitroglycerine tablets do not cause addiction. Dizziness and weakness are associated with the hypotensive effect of nitroglycerine, and the client should sit down or lie down if this occurs. Nitroglycerine tablets can be taken prior to an activity known to cause angina.

Escitalopram is prescribed for a 16-year-old adolescent client who is clinically depressed. Five days later, the parent tells the practical nurse (PN) that the drug is not working because their child is not feeling any better. Which explanation should the PN provide? a. "It takes 1 to 4 weeks for antidepressant medications to become effective." b. "The dosage may need to be increased; I will contact your health care provider." c. "Depression is difficult to treat with drugs alone. Therapy sessions would enhance their effectiveness." d. "Based on your child's response to this drug, the health care provider is reviewing your medication regimen."

a. "It takes 1 to 4 weeks for antidepressant medications to become effective." Rationale: Antidepressant medications take 1 to 4 weeks to reach its full therapeutic effect. The family needs to be educated that their child may experience increased anxiety in the first week of administration.

The health care provider prescribes morphine sulfate 8 IM stat. Morphine is available in 10 mg/mL. How many milliliters should the practical nurse (PN) administer? a. 0.8 mL b. 1 mL c. 1.5 mL d. 2 mL

a. 0.8 mL Rationale: 0.8 mL, Formula: D/H × Q = (8 mg/10 mg) × 1 mL = 0.8 mL.

A client has been prescribed pregabalin. Which outcome(s) should the practical nurse (PN) anticipate a client to experience? (Select all that apply.) a. A decrease in joint pain resulting from osteoarthritis b. Elevated mood with improved responsiveness to family c. Decrease of inflammation in all major joints d. Improved range of motion during physical therapy exercises e. Decrease in the preprandial blood sugar level

a. A decrease in joint pain resulting from osteoarthritis d. Improved range of motion during physical therapy exercises Rationale: The precise mechanism of pregabalin is unknown, but it is a gamma-aminobutyric acid (GABA) analogue that binds with calcium channels in the central nervous system (CNS), which reduces neuropathic pain to the spinal cord. When pain relief is achieved, then client's range of motion should improve during physical therapy exercises.

A client prescribed ephedrine nasal drops 0.5% prn complains of having difficulty falling asleep to the nurse. What action should the nurse take to minimize the client's insomnia? a. Administer the dose a few hours before bedtime. b. Offer the client a sedative with the bedtime dose. c. Provide warm milk when administering the bedtime dose. d. Reduce environmental stimuli by closing the client's door.

a. Administer the dose a few hours before bedtime. Rationale: Administering the dose a few hours before bedtime is effective in minimizing insomnia.

A 6-month-old infant is prescribed digoxin for the treatment of congestive heart failure. Which observation by the practical nurse (PN) warrants immediate intervention for signs of digoxin toxicity? a. Apical heart rate of 60 beats/min b. Sweating across the forehead c. Poor sucking effort d. Respiratory rate of 30 breaths/min

a. Apical heart rate of 60 beats/min Rationale: A heart rate of 60 beats/min for a 6 month old warrants immediate intervention. The normal heart rate for a 6 month old is 80 to 150 beats/min when awake, and a rate of 70 beats/min while sleeping is considered to be within normal limits.

At 1900, the nurse has received change of shift report regarding a 3-year-old child who is hospitalized for observation after swallowing his older sister's dose of phenytoin. During the "recommendation" section of the report, the off-going nurse states "You'll need to continue monitoring his gait. So far it has been normal." The nurse is monitoring for which adverse drug effect? a. Ataxia b. Nystagmus c. Gingival hyperplasia d. Paradoxical excitement

a. Ataxia Rationale: The nurse is monitoring for ataxia, or unsteady gait, which is a sign of an adverse reaction. Nystagmus is uncoordinated eye movements which would not be detected by only observing the gait. Gingival hyperplasia is gum overgrowth. Paradoxical excitement would not be detected by only observing the gait.

A health care provider (HCP) prescribed an antibiotic for a client. Which of the medications listed should be used with caution when given to a client with a penicillin (PCN) allergy? a. Cephalosporin b. Aminoglycosides c. Erythromycins d. Sulfonamides

a. Cephalosporin Rationale: Penicillins (PCN) have a 1% cross allergy with first-generation cephalosporins and lesser rate with second-generation. If a client has a known PCN allergy, then cephalosporin should be given with caution to these clients.

The nurse is caring for a client who was newly prescribed insulin aspart 7 units subcutaneously prior to each meal. Which nursing intervention has the highest priority when planning this client's care? a. Ensure that the client's meal will be available within the next 15 minutes before administration of insulin. b. Rotate sites at least once weekly and label the sites used on a diagram. c. Use a 23- to 25-gauge syringe with a 1-inch needle for maximum absorption. d. Help the client express his/her feelings about the injection.

a. Ensure that the client's meal will be available within the next 15 minutes before administration of insulin. Rationale: Rapid-acting synthetic insulin analogs like insulin aspart have an onset of action of approximately 15 minutes and should be injected 0 to 15 minutes before the meal to prevent or decrease the risk of hypoglycemia.

A 59-year-old client is prescribed furosemide 40 mg twice a day for the management of heart failure. The practical nurse (PN) should monitor the client for the development of which complication? a. Hypokalemia b. Hyperchloremia c. Hypercalcemia d. Hypophosphatemia

a. Hypokalemia Rationale: Furosemide is a loop diuretic. The action of this medication inhibits the reabsorption of sodium and chloride at the proximal and distal tubule and in the loop of Henle. This medication potentiates the excretion of potassium, causing hypokalemia. Hypokalemia can cause cardiac irregularities.

A 78-year-old client prescribed furosemide 40 mg PO twice daily is demonstrating EKG changes. Which condition should the practical nurse suspect is causing these changes? a. Hypokalemia b. Hyperchloremia c. Hypernatremia d. Hypophosphatemia

a. Hypokalemia Rationale: Furosemide potentiates the excretion of potassium causing hypokalemia. Hyperchloremia, hypernatremia, and hypophosphatemia are not related to furosemide administration.

A client is prescribed phenobarbital 100 mg daily for the treatment of seizures. Which statement made by the client indicates an accurate understanding of the medication phenobarbital? a. I will take my medicine at 10 PM before retiring to bed. b. The medication will turn the color of my urine to a pink color. c. I should not eat or drink anything for at least 2 hours before taking my medicine. d. In the event a seizure occurs in the middle of the day, I need to take an extra dose of my medicine.

a. I will take my medicine at 10 PM before retiring to bed. Rationale: Phenobarbital should be taken at the same time every day to maintain blood levels and enhance compliance. Common side effects of the phenobarbital are drowsiness, lethargy, dizziness, and nausea; it is best to take it before bedtime.

The practical nurse interprets the client's PPD as a positive skin test. Which drug is considered the primary prophylaxis for a client exposed to active tuberculosis? a. Isoniazid b. Rifampin c. Acyclovir d. Griseofulvin

a. Isoniazid Rationale: Isoniazid is highly specific for Mycobacterium tuberculosis and is the primary drug of choice for clients with positive PPD skin tests.

A client has been taking simvastatin for 3 days, and phones the nurse at the clinic to report extreme muscle tenderness and pain. Which is the most appropriate action? a. Notify the health care provider. b. Review powder mixing instructions with the client. c. Advise the client to take the medication with grapefruit juice. d. Remind the client to limit physical activity until the muscle pain goes away.

a. Notify the health care provider. Rationale: Muscle pain or extreme muscle tenderness is associated with rhabdomyolysis, which is a medical emergency. The health care provider should be contacted immediately. There is no need to review powder mixing instructions with simvastatin. Some bile sequestrants must be mixed carefully with applesauce. Grapefruit juice should be avoided because it is associated with adverse effects. The muscle pain should be evaluated by the health care provider, so the nurse should not advise the client regarding physical activity until after the client has been evaluated.

A client diagnosed with a urinary tract infection is prescribed an ampicillin. Which nursing intervention is most important for the practical nurse to do first before administering the client's medication? a. Obtain a clean-catch urine specimen. b. Assess the urine pH for acidity. c. Insert an indwelling catheter. d. Assess for complaints of dysuria.

a. Obtain a clean-catch urine specimen. Rationale: A clean-catch urine specimen is used to determine the causative organism and to evaluate the effectiveness of pharmacological therapy in treating the source of the infection. The initial specimen should be obtained before beginning treatment with an antiinfective agent.

A client is experiencing an adverse effect of the gastrointestinal stimulant metoclopramide HCL. Which assessment finding would require immediate intervention by the nurse? a. Parkinson-like symptoms b. Inability to see well at night c. Dizziness when first getting up d. An unpleasant metallic taste in the mouth

a. Parkinson-like symptoms Rationale: Metoclopramide HCL blocks dopamine receptors in the brain, which can cause the extrapyramidal symptoms associated with Parkinson disease. It is not associated with an inability to see well, dizziness, or an unpleasant metallic taste.

A client taking long-term steroids also has ranitidine prescribed. The nurse provides which explanation as to why these drugs are given together? a. Ranitidine reduces the risk of ulcers associated with steroids. b. Ranitidine decreases the risk of infection associated with steroids. c. Ranitidine decreases blood sugar elevations associated with steroids. d. Ranitidine reduces sodium retention associated with steroid usage.

a. Ranitidine reduces the risk of ulcers associated with steroids. Rationale: Ranitidine reduces the risk of ulcers associated with steroids. It does not decrease the risk of infection or reduce sodium retention. Ranitidine does not affect blood sugar changes associated with steroids.

A client diagnosed with a sinus infection is prescribed ampicillin sodium. The practical nurse (PN) should instruct the client to notify the health care provider immediately if which symptom occurs? a. Rash b. Nausea c. Headache d. Dizziness

a. Rash Rationale: Rash is the most common adverse side effect of all generations of penicillin, indicating an allergy to the medication, which could result in anaphylactic shock, a medical emergency.

A client diagnosed with asthma is prescribed methylprednisolone 40 mg IV daily. Which laboratory test results should the practical nurse closely monitor for increased values? a. Serum glucose b. Serum calcium c. Red blood cells d. Serum potassium

a. Serum glucose Rationale: Methylprednisolone is a corticosteroid with glucocorticoid and mineralocorticoid actions. These effects can increase a client's glucose levels, which can lead to hyperglycemia.

A client with a productive cough and fever has been diagnosed with bacterial pneumonia and is being admitted to the unit from the emergency room. Which intervention should the practical nurse ensure that it has been done prior to the administration of antibiotics? a. Sputum specimen b. Set of vital signs c. Electrocardiogram d. Glucometer check

a. Sputum specimen Rationale: A culture and sensitivity of a sputum specimen should be done prior to the initiation of the administration of antibiotics.

Daily dose of alendronate is prescribed for a 54-year-old postmenopausal client. Which instruction should the practical nurse provide to this client regarding taking the prescribed medications? a. Take medication 30 minutes before breakfast and remain in an upright position for 30 minutes after taking the medication. b. The medications should be taken together 2 hours after a meal with a full glass of water. c. Divide the medication over the course of the day and take it in small doses 1 hour after meals and at bedtime. d. The medication may be taken with or without food but should be taken at the same time every day.

a. Take medication 30 minutes before breakfast and remain in an upright position for 30 minutes after taking the medication. Rationale: Studies have shown a significant reduction in fractures when clients take the alendronate. It is important to instruct the client to remain in an upright position for at least 30 minutes after administration to prevent esophageal irritation.

A client who is prescribed sildenafil for pulmonary hypertension calls the clinic for advice. Which condition should the practical nurse notify the health care provider immediately and instruct the client to stop taking the medication? a. The client is experiencing vision and hearing loss. b. The client has an erection lasting longer than 2 hours. c. The client is complaining about nasal congestion. d. The client is complaining about feeling flushed.

a. The client is experiencing vision and hearing loss. Rationale: The client should be instructed to discontinue the use of the medication and notify the health care provider immediately if the client is experiencing vision and/or hearing loss or an erection lasting more than 4 hours.

The nurse will be administering an intramuscular injection of iron to a client who experienced a postpartum blood loss and is refusing a blood transfusion, citing religious objections. Which action should the nurse take when administering this medication? a. Use the Z-track method of administration. b. Use the deltoid muscle to avoid exposure of the gluteal area. c. After the injection, massage the injection site to enhance absorption. d. Inject some of the medication subcutaneously to avoid skin stains.

a. Use the Z-track method of administration. Rationale: The nurse should use the Z-track method to administer the medication into the deep gluteal muscles. The deltoid site is not of adequate size, and dark iron stains would be more visible. The nurse should not massage the injection site because this can cause the dark iron liquid to become closer to the skin. The nurse should avoid injecting the dark iron liquid into the subcutaneous tissue to avoid iron stains under the skin.

While taking a client's history, the practical nurse (PN) discovers that the client, who takes warfarin daily for atrial fibrillation, has added a St. John's wort to their daily regime. What recommendation should the PN provide to this client? a. You need to discontinue the use of the herb and consult with your health care provider. b. Cut your warfarin dose in half if you notice an increase of bruising or bleeding from the gums. c. You should increase your consumption of dark green leafy vegetables and tomatoes. d. Check your apical pulse daily and withhold the warfarin if your heart rate is below 60 beats/min.

a. You need to discontinue the use of the herb and consult with your health care provider. Rationale: Use of natural products should be shared with the health care provider, so possible interactions can be addressed. The St. John's wort may interfere with the effectiveness of the warfarin.

A client diagnosed with angina has been prescribed nitrate isosorbide dinitrate. Which instruction should the practical nurse (PN) reinforce in this client's teaching? a. "Quit taking the medication if dizziness occurs." b. "Do not get up quickly. Always rise slowly." c. "Take the medication with food only." d. "Increase your intake of potassium-rich foods."

b. "Do not get up quickly. Always rise slowly." Rationale: An anticipated side effect of nitrates is orthostatic hypotension. The PN should instruct the client to rise slowly when rising from a sitting or lying down position in order to prevent orthostatic hypotension.

The practical nurse (PN) administered 15 units of NPH insulin subcutaneously to a client before they consumed their breakfast at 7:30 AM. At what time is the client at an increased risk for a hypoglycemic reaction? a. 8:30 to 11:30 AM b. 3:30 to 7:30 PM c. 9:30 PM to midnight d. 1:00 to 5:00 AM

b. 3:30 to 7:30 PM Rationale: NPH, an intermediate acting insulin, peaks approximately 8 to 12 hours after subcutaneous injection. The most likely time for this client to experience a hypoglycemic reaction is between 3:30 and 7:30 PM.

A first-day postoperative client vomits 30 minutes after receiving a dose of hydromorphone. What initial intervention is best for the practical nurse (PN) to implement? a. Obtain a prescription for nasogastric intubation. b. Administer a prn dose of ondansetron. c. Reduce the next scheduled dose of hydromorphone. d. Assess the client's abdomen and bowel sounds.

b. Administer a prn dose of ondansetron. Rationale: Because the emesis appears to be directly related to the administration of the opiate analgesic, the first action should be to reduce the client's nausea with the administration of the ondansetron, which is an antiemetic.

A practical nurse is getting ready to administer digoxin to a client. Which assessment finding would require the nurse to hold the medication? a. Irregular apical pulse rhythm b. Apical pulse rate of 50 beats/min c. Apical pulse heard best at the pulmonic site d. Presence of a systolic heart murmur

b. Apical pulse rate of 50 beats/min Rationale: Digoxin slows the contractions of the heart. Bradycardia is a late sign of toxicity. Therefore, the practical nurse (PN) must always assess the apical pulse for 1 minute to determine that the rate is 60 beats/min or greater. If the apical pulse is less than 60 beats /min, the PN should not administer the medication and notify the health care provider.

A client who is in the rehabilitation facility with newly diagnosed Parkinson's disease (PD) has levodopa-carbidopa prescribed. During the care planning session for this client, the nurse discusses which aspects with the other members of the health care team? (Select all that apply.) a. Ask the dietician to increase the amounts of foods high in Vitamin B6. b. Ask the physical therapy assistant to help the client avoid sudden position changes. c. Remind others on the team that this medication should relieve all symptoms of PD. d. Ask the evening shift nurses to give the last dose earlier in the day if the client has insomnia. e. Ask the nursing assistants to report drowsiness if it interferes with activities or becomes unsafe.

b. Ask the physical therapy assistant to help the client avoid sudden position changes. d. Ask the evening shift nurses to give the last dose earlier in the day if the client has insomnia. e. Ask the nursing assistants to report drowsiness if it interferes with activities or becomes unsafe. Rationale: Levodopa-carbidopa can cause hypotension with sudden position changes. The physical therapy assistant can help the client avoid sudden position changes. If insomnia occurs, the last dose of the day can be given earlier in the day. Drowsiness can interfere with activities and should be reported to the nurse. Foods high in Vitamin B6 can interfere with the absorption of the drug, and the client should not be given a high-protein diet. This drug will not relieve all symptoms of PD.

A client has vancomycin intravenous piggybacks (IVPB) prescribed. Which is the crucial aspect of care for this client? a. Monitoring the client's laboratory results for increased liver enzymes on a daily basis b. Besides noting the urine output is less than the intake, report increased creatinine levels c. The licensed practical/vocational nurse cannot care for a client receiving IVPB medication d. It is expected that the client experiences tinnitus, headache, dizziness, and hearing loss.

b. Besides noting the urine output is less than the intake, report increased creatinine levels Rationale: Vancomycin is in the aminoglycoside category and can cause nephrotoxicity, or renal damage. The nurse should monitor for fluid retention and increasing creatinine levels. This medication is not associated with liver disorders. The LP/VN can care for a client receiving IVPB medications and should report any abnormal findings. A client taking an aminoglycoside is at risk of ototoxicity. The nurse should report characteristics of this: tinnitus, hearing loss, and dizziness.

A 78-year-old client with congestive heart failure (CHF) receives digoxin 0.25 mg PO daily. Which observation by the nurse indicates that the medication has been effective? a. Systolic blood pressure readings range from 120 to 130 mm Hg b. Clear breath sounds bilaterally c. Jugular venous distention present with supine positioning d. Radial pulse volume of +4 bilaterally

b. Clear breath sounds bilaterally Rationale: Digoxin is a cardiac glycoside, which increases force of the heart contractions and decreases heart rate, which in turn increases cardiac output. Clear breath sounds bilaterally indicates that the medication was effective in increasing the cardiac output thus preventing pulmonary edema.

A client has been taking lithium carbonate to treat symptoms of the manic phase of bipolar disorder. The nurse is monitoring for which early manifestation of lithium toxicity? a. Fever b. Diarrhea c. Weight loss d. Hypernatremia

b. Diarrhea Rationale: The nurse is monitoring for diarrhea, an early manifestation of lithium toxicity. Fever is not associated with lithium toxicity. The client may gain weight when taking lithium. Hyponatremia can increase lithium levels; lithium does not cause hypernatremia.

A client whose seizure disorder has been managed with phenytoin is admitted to the emergency department with status epilepticus. Which drug should the practical nurse (PN) anticipate to be prescribed for administration to treat these seizures? a. Phenytoin b. Diazepam c. Phenobarbital d. Carbamazepine

b. Diazepam Rationale: Diazepam is the drug of choice for the treatment of status epilepticus and is given during a seizure.

A 67-year-old client is discharged from the hospital with a prescription for digoxin 0.25 mg daily. Which instruction by the practical nurse (PN) is correct? a. Take the medication in the morning before rising. b. Do not take the medication if the heartbeat is irregular or slow. c. Expect some vision changes due to the medication. d. Increase intake of foods rich in vitamin K.

b. Do not take the medication if the heartbeat is irregular or slow. Rationale: Monitoring the pulse rate for 1 minute is very important when taking digoxin. The client should be further instructed to report pulse rates lower than 60, greater than 110 beats/min, or irregular, and to withhold the dosage until consulting with the health care provider in such cases.

An immobile client is prescribed dalteparin subcutaneously and has been receiving the medication for 5 days. Which finding indicates that the PN should hold the prescribed dose? a. Tachypnea b. Guaiac-positive stool c. Dependent pitting edema d. Multiple small abdominal bruises

b. Guaiac-positive stool Rationale: Dalteparin is a low-molecular-weight heparin (LMWH) anticoagulant used to prevent DVT in the at-risk client. If the client develops overt signs of bleeding such as guaiac-positive stool while receiving an anticoagulant, the medication should be held and coagulation studies completed.

The health care provider (HCP) has prescribed a 74-year-old client to be vaccinated with the influenza vaccine prior to discharge. Which client condition will make the practical nurse not to vaccinate the client and consult with the charge nurse? a. History of congested heart failure b. History of an allergy to eggs c. History of pneumococcal vaccination d. History of end-stage renal disease

b. History of an allergy to eggs Rationale: According to the CDC website, the flu vaccination is contraindicated if a client has a severe allergy to any part of the vaccine. "Most, but not all, types of flu vaccine contain a small amount of egg protein." The practical nurse needs not to administer the flu vaccination and consult with the charge nurse for further guidance.

A client receiving the antibiotic vancomycin is prescribed to have a peak and trough level done with the next dose. What time should the practical nurse obtain the blood specimen for the trough level? a. 60 minutes after the antibiotic dose is administered. b. Immediately before the next antibiotic dose is given. c. When the next blood glucose level is to be checked. d. 30 minutes before the next antibiotic dose is given.

b. Immediately before the next antibiotic dose is given. Rationale: Trough levels are drawn when the blood level is at its lowest, which is typically just before the next dose is given. The PN needs to wait for the lab results of the trough level from the lab before administering the scheduled antibiotic. If the trough level is above the recommended levels, the medication needs to be held and the health care provider needs to be notified.

A client with pulmonary tuberculosis has been taking rifampin for 3 weeks. The client reports orange urine. What should be the nurse's next action? a. Notify the health care provider. b. Inform the client this is not harmful. c. Assess the client for other signs of nephrotoxicity. d. Monitor the results of the most recent creatinine level.

b. Inform the client this is not harmful. Rationale: Rifampin can cause the color of the urine to turn to orange. This change is harmless. There is no need to notify the health care provider or to monitor the creatinine level. This drug does not cause nephrotoxicity.

The practical nurse (PN) administers two newly prescribed medications, isosorbide dinitrate (a nitrate) and hydrochlorothiazide (a diuretic), to a client. What instructions should the PN reinforce with the client in regard to these medications? a. Instruct the client to use soft bristle toothbrush. b. Instruct the client to slowly rise from a sitting or lying down position. c. Instruct the client to elevate their legs above the level of their heart. d. Instruct the client to limit the amount of fiber in their diet.

b. Instruct the client to slowly rise from a sitting or lying down position. Rationale: The additive effects of the concomitant use of nitrates, such as isosorbide dinitrate, which produce vasodilation, and diuretics, such as hydrochlorothiazide, which reduce blood volume, can cause hypotension, so it is important to instruct the client to slowly change positions when rising from a sitting or lying position. Both of these medications can cause orthostatic hypotension.

The practical nurse administered carbidopa-levodopa to a client diagnosed with Parkinson disease. Which outcome by the client would indicate a therapeutic response? a. Decreased blood pressure b. Lessening of tremors c. Increased salivation d. Increased attention span

b. Lessening of tremors Rationale: Carbidopa-levodopa increases the amount of levodopa to the CNS (dopamine to the brain). Increased amounts of dopamine improve the symptoms of Parkinson, such as involuntary movements, resting tremors, and shuffling gait.

A practical nurse (PN) is reviewing the plan of care for client who is prescribed glucocorticoid methylprednisolone to treat an exacerbation of chronic obstructive pulmonary disease (COPD). The nurse expects to see which intervention is emphasized in the plan of care? a. Monitor the client's red blood cell (RBC) counts. b. Remind staff to wash hands before patient care. c. Encourage liquids to liquefy bronchial secretions. d. Administer nasal cannula oxygen at 4 L/m.

b. Remind staff to wash hands before patient care. Rationale: Corticosteroids depress the immune system, placing the client at risk for infection. The Hand hygiene is emphasized due to the fact that glucocorticoids may affect the body's ability to fight infections and is directly related to the administration of glucocorticoid methylprednisolone.

A 43-year-old female client who has had a thyroidectomy due to Grave's disease is prescribed a thyroid replacement hormone. Which signs and symptoms are associated with thyroid hormone toxicity and should be reported promptly to the health care provider? a. Tinnitus and dizziness b. Tachycardia and chest pain c. Dry skin and intolerance to cold d. Weight gain and increased appetite

b. Tachycardia and chest pain Rationale: The signs and symptoms of thyroid replacement hormone toxicity include tachycardia and chest pain.

A client is receiving the medication haloperidol. Which client data would indicate to the practical nurse that the medication is therapeutic? a. The client has maintained a consistent weight loss of 2 pounds/week. b. The client has demonstrated a decrease in paranoia behaviors. c. The client's blood pressure has remained within the normal limits. d. The client's fasting blood glucose has remained below 120 mg/dL.

b. The client has demonstrated a decrease in paranoia behaviors. Rationale: Haloperidol is an antipsychotic, neuroleptic medication. A therapeutic response would be decrease in emotional excitement, hallucinations, delusions, paranoia, and clear process of thought and speech.

A healthy 68-year-old client asks the practical nurse (PN) should they take the pneumococcal vaccine. Which statement should the PN offer to the client that provides the most accurate information about this vaccine? a. The vaccine is given annually before the flu season to those older than 50 years. b. The immunization is recommended for children younger than 2 years old and all adults 65 years or older. c. The vaccine is for all ages and is given primarily to those persons traveling overseas to areas of infection. d. The vaccine will prevent the occurrence of pneumococcal pneumonia for up to 5 years.

b. The immunization is recommended for children younger than 2 years old and all adults 65 years or older. Rationale: It is usually recommended that persons younger than 2 years old and 65 years and older get vaccinated. Those with a history of certain medical conditions may also be recommended to receive the immunization.

A client in the immediate postoperative period is prescribed morphine via a patient-controlled analgesia (PCA) pump. Which finding should the PN consider the highest priority in this client? a. The expiration date of the PCA morphine b. The rate and depth of the client's respirations c. The type of anesthesia used during the surgery d. The client's signs of disorientation

b. The rate and depth of the client's respirations Rationale: A life-threatening side effect of intravenous administration of morphine sulfate, an opiate narcotic, is respiratory depression. If the client is going in to respiratory depression, the PCA pump should be stopped and the registered nurse (RN) or health care provider should be notified if the client's respiratory rate falls below 10 breaths/min.

The practical nurse administers lactulose to a client. Which client outcome would indicate a therapeutic response? a. An increase in urine output b. Two or three soft stools per day c. Absence of nausea d. Decreased serum potassium

b. Two or three soft stools per day Rationale: Lactulose is an ammonia detoxicant (hyperosmotic) laxative which prevents absorption of ammonia in the colon by acidifying the stool. This causes the stool to absorb more water, therefore softening the stool. Two to three stools per day indicate that lactulose is performing as intended.

On the medical unit, multiple clients are taking warfarin. The nurse should have which medication readily available in the event it is need to treat a client who has taken an excessive dose? a. Naloxone b. Vitamin K c. Enoxaparin d. Protamine sulfate

b. Vitamin K Rationale: The antagonist to warfarin is Vitamin K. This drug should be readily available to treat clients who have had an excessive dosage. Naloxone is the antagonist to the respiratory depressant effects of opioids. Enoxaparin is an anticoagulant used to treat or prevent deep vein thrombosis. Protamine sulfate is the antagonist to heparin.

A client prescribed glipizide asked why they had to take their insulin orally. How should the practical nurse respond? a. "Glipizide is an oral form of insulin and has the same actions and properties as intermediate insulin." b. "Glipizide is an oral form of insulin and is distributed, metabolized, and excreted in the same manner as insulin." c. "Glipizide is not an oral form of insulin and can be used only when some beta cell function is present." d. "Glipizide is not an oral form of insulin, but it is effective for those who are resistant to injectable insulins."

c. "Glipizide is not an oral form of insulin and can be used only when some beta cell function is present." Rationale: Glipizide is an oral hypoglycemic agent that enhances pancreatic production of insulin when some beta cell function is present.

A child is admitted to the emergency department for accidental ingestion of a poison. The practical nurse (PN) should know that inducing vomiting is recommended for which child? a. An 8 month old who ate four to six ibuprofen tablets b. A 3 year old who drank an unknown amount of charcoal lighter fluid c. A 16 month old who drank 2 ounces of acetaminophen elixir d. A 2 year old who ate a handful of automatic dishwasher detergent

c. A 16 month old who drank 2 ounces of acetaminophen elixir Rationale: Emesis should be induced for the child who drank the large dose of acetaminophen elixir because this medication is hepatotoxic. Vomiting is contraindicated for children younger than 1 year of age. Inducing vomiting of corrosives such as dishwasher detergents and lighter fluid is contraindicated.

A client diagnosed with a herniated disc is prescribed hydrocodone/acetaminophen 10 mg/300 mg prn every 4 to 6 hours. As the practical nurse (PN) enters the client's room to administer their requested medication, the client is seen talking and laughing with his visiting family. Which action should the PN implement? a. Hold the pain medication until after the visitors leave. b. Notify the health care provider of the client's drug-seeking behavior. c. Administer analgesia as requested by the client. d. Inform the client based on their display behavior, the medication is not needed.

c. Administer analgesia as requested by the client. Rationale: The medication should be administered as per client's request. The client's self-report of pain is the single most reliable indication of the existence, character, and intensity of pain. Analgesics should be administered as soon as pain occurs and before it increases in intensity. The PN should consult with the charge nurse after administering the medication about the situation.

A client who received a prescription for cyclosporine ophthalmic emulsion for dry eyes asks the practical nurse (PN) if it is safe to continue using artificial tears. What information should the PN provide? a. Avoid the use of artificial tears because they decrease the efficacy of cyclosporine. b. Discontinue the use of both products if transient blurring occurs after administration. c. Allow a 15-minute interval between the administration of cyclosporine and artificial tears. d. Discontinue the use of cyclosporine and artificial tears when tear production reaches a normal level.

c. Allow a 15-minute interval between the administration of cyclosporine and artificial tears. Rationale: Cyclosporine, an ophthalmic emulsion which increases tear production, may be used in conjunction with artificial tears as long as the products are administered 15 minutes apart. Transient blurring after administration is a side effect of cyclosporine and does not necessitate discontinuation of the medication. After tear production is increased, artificial tears may be stopped, but discontinuing cyclosporine will result in a decrease in tear production.

A child has swallowed medication he found in his grandmother's purse. The grandmother had several tablets of pyridostigmine bromide she had been taking to treat myasthenia gravis. The nurse should observe for which indication of toxicity from this medication? a. Dry eyes b. Constipation c. Bradycardia d. Hypertension

c. Bradycardia Rationale: The child should be observed for bradycardia, diarrhea, hypotension, and lacrimation as signs of medication excess (cholinergic crisis).

A client diagnosed with a urinary tract infection has been prescribed phenazopyridine. Which data would indicate to the practical nurse that the therapeutic outcome has been achieved? a. White blood cell count is 5000/mm3. b. Urine is a bright yellow and without sediment. c. Client denies pain when voiding. d. Urine culture is negative for bacterial growth.

c. Client denies pain when voiding. Rationale: Phenazopyridine is a urinary analgesic that relieves the symptoms of UTI but does not treat the underlying cause. One of the side effects of phenazopyridine is that it changes the color of the urine to a bright yellow, but that is not a therapeutic effect.

A female client who started taking an oral sulfonamide for a urinary tract infection the previous day reports to the nurse that the medication is causing slight anorexia. She also states that she continues to experience urinary frequency, so she takes the medication with a glass of cranberry juice and with a snack. What information should the practical nurse provide? a. Take the medication with an antacid instead of cranberry juice to reduce the anorexia. b. Continue to take the medication with a sip of cranberry juice, restricting fluids until the frequency is controlled. c. Continue to drink the cranberry juice, but take medicine on an empty stomach with a full glass of water. d. Take the medication with a spoonful of ice cream or applesauce and avoid drinking cranberry juice.

c. Continue to drink the cranberry juice, but take medicine on an empty stomach with a full glass of water. Rationale: The PN should emphasize the need to take sulfonamides with a full glass of water to help prevent crystalluria and to take the medicine on an empty stomach, ideally 1 hour before anything is eaten or 2 hours after eating something.

Which assessment finding indicates that the expected outcome of administering donepezil to a client with Alzheimer disease has been accomplished? a. Increased muscle strength and tone b. Fewer episodes of urinary incontinence c. Decreased confusion and improved mood d. Reversal of disease process as evidenced by increased functioning

c. Decreased confusion and improved mood Rationale: Donepezil is used for those suffering from Alzheimer disease. Its action elevates acetylcholine concentrations by slowing down degradation of acetylcholine released in cholinergic neurons. It does not reverse or cure Alzheimer disease but slows down the deterioration.

An adolescent client with a seizure disorder is prescribed the anticonvulsant medication carbamazepine. The nurse should notify the health care provider if the client develops which condition? a. Experiences dry mouth. b. Experiences dizziness. c. Develops a sore throat. d. Develops gingival hyperplasia.

c. Develops a sore throat. Rationale: Blood dyscrasias (aplastic anemia, leukopenia, anemia, and thrombocytopenia) can be an adverse effect of carbamazepine. Flu-like symptoms, such as pallor, fatigue, sore throat, and fever, are indications of such dyscrasias.

The practical nurse is assigned a client on digoxin therapy. Which finding is likely to predispose this client to developing digoxin toxicity? a. Hyponatremia b. Hypernatremia c. Hypokalemia d. Hyperkalemia

c. Hypokalemia Rationale: Hypokalemia predisposes the client on digoxin to digoxin toxicity and is usually presented as abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and atrioventricular (AV) dissociation. Assessment of serum potassium levels and prompt correction of hypokalemia are important interventions for the client taking digoxin.

The practical nurse administered cyclobenzaprine to a client. Which outcome would indicate a therapeutic response? a. Elevated mood with improved responsiveness to family b. A decreased amount of inflammation present in the joint c. Improved range of motion during physical therapy exercises d. Fewer absence seizures with lengthened attention span

c. Improved range of motion during physical therapy exercises Rationale: Cyclobenzaprine is a central skeletal muscle relaxant used to relieve muscle spasms, so an improved range of motion would indicate a therapeutic response and expected outcome of therapy.

A client is prescribed an antacid for the treatment of peptic ulcer disease. What is the action of this medication that is effective in treating the client's ulcer? a. Decrease in the production of gastric secretions b. Production of an adherent barrier over the ulcer c. Maintenance of a gastric pH of 3.5 or above d. Decrease in the gastric motor activity

c. Maintenance of a gastric pH of 3.5 or above Rationale: The objective of antacids is to neutralize gastric acids and keep a pH of 3.5 or above which is necessary for pepsinogen inactivity.

The health care provider (HCP) recommends the over-the-counter (OTC) expectorant guaifenesin for a client who has a dry, nonproductive cough and congested nasal passages. The client reports that they usually have a glass of wine with dinner nightly. Which information should the practical nurse provide to this client? a. Return to the clinic if they start to cough up thin, watery secretions. b. Frequent use can cause rebound nasal congestion. c. Notify the HCP if the cough persists longer than 7 days. d. Consumption of alcohol will interact with this medication and cause vomiting.

c. Notify the HCP if the cough persists longer than 7 days. Rationale: A cough that lasts more than 1 week or is accompanied by a fever, rash, or headache may be an indication of more serious medical condition such as a bacterial infection and should be followed up by the health care provider. Alcohol and CNS depressants, such as guaifenesin, have a cumulative effect when consumed concurrently which can be lethal such as respiratory depression. The combination would not likely cause vomiting. The client needs to be aware of this and advise that alcohol consumption should not be consumed while taking this medication.

A client with metastatic breast cancer who has been using morphine patches for several weeks reports to the nurse that the medication is not effectively controlling the pain. Which action should the nurse initiate? a. Instruct the client about the indications of opioid dependence. b. Monitor the client for symptoms of acute opioid withdrawal. c. Notify the health care provider of the need to increase the dose. d. Administer naloxone doses per protocol as needed for reversal.

c. Notify the health care provider of the need to increase the dose. Rationale: Clients can develop a tolerance to the analgesic effect of opioids and may require an increased dose for effective long-term pain relief. The client is not exhibiting indications of dependence, withdrawal or toxicity.

A client is admitted to a long-term care facility and the nurse and a new employee are conducting medication reconciliation. The nurses note that oxybutynin has been prescribed. The nurse realizes the new employee understands the drug effect if the new employee explains that this medication is prescribed to treat which condition? a. Pain b. Depression c. Overactive bladder d. Chronic anxiety

c. Overactive bladder Rationale: Oxybutynin is prescribed to treat an overactive bladder. There are several other drugs which could be confused with this drug due to the look alike/sound alike issue. Oxycodone is a drug used to treat clients with chronic pain. Bupropion is a drug used to treat clients with depression. Buspirone is a drug used to treat anxiety.

A client is receiving heparin to treat a deep vein thrombosis. The nurse should monitor which laboratory result to assist in evaluating the efficacy of the drug? a. Platelet count b. Prothrombin time c. Partial thromboplastin time d. Serum levels of protamine sulfate

c. Partial thromboplastin time Rationale: The nurse should monitor the partial thromboplastin time to evaluate the efficacy of heparin. The platelet count does not monitor heparin efficacy. A client who is taking warfarin should have the prothrombin time monitored. Protamine sulfate levels do not monitor efficacy of heparin.

A client arrives to the emergency department experiencing diabetic ketoacidosis (DKA). The health care provider prescribes an insulin intravenous drip. The nurse locates which type of insulin for the registered nurse to mix into the intravenous fluids? a. Isophane b. Glargine c. Regular d. Detemir

c. Regular Rationale: The nurse should locate regular insulin for the registered nurse to mix into the intravenous fluids. Glargine and detemir are long-acting insulin. Isophane is intermediate-acting insulin. The client experiencing DKA requires lowering of the blood sugar, so administration of the regular insulin is required.

A client has metoprolol prescribed. The nurse should reinforce instructions that this medication has which potential adverse effect? a. Anxiety b. Tachycardia c. Sexual dysfunction d. Acute renal failure

c. Sexual dysfunction Rationale: The nurse should reinforce education that metoprolol (a beta-blocker) can cause sexual dysfunction as an adverse effect. It can cause depression, rather than anxiety. Bradycardia is another potential adverse reaction. Acute renal failure is not associated with a beta blocking agent.

A practical nurse (PN) is reviewing teaching with the client and/or significant others about the concurrent use of benztropine and olanzapine to manage psychotic behavior. What information should the PN reinforce? a. Benztropine will reduce the olanzapine's side effect of urinary retention. b. Benztropine potentiates the effect of olanzapine. c. The benztropine is used to control the side effects of olanzapine. d. The combined effect of these drugs will modify psychotic behavior.

c. The benztropine is used to control the side effects of olanzapine. Rationale: Benztropine, an anticholinergic drug, is used to control extrapyramidal symptoms associated with olanzapine use. Caution is required in the dosage of benztropine used in conjunction with olanzapine.

A client diagnosed with vaginal trichomoniasis is prescribed oral metronidazole. What instructions should the practical nurse (PN) review with the client while taking this medication? a. Vinegar or commercial product douches should be done daily. b. Avoid direct sunlight exposure and use sunscreen product with SPF100. c. The client's sexual partner(s) should also be treated. d. Dairy products should be eliminated from the diet during treatment.

c. The client's sexual partner(s) should also be treated. Rationale: Sexual intercourse is the route of spread for vaginal trichomoniasis and the sexual partner(s) should be treated simultaneously to prevent reinfection.

A client undergoing hemodialysis for chronic kidney disease is taking the medication erythropoietin. The nurse should reinforce instructions to explain which is the reason for this medication to be prescribed? a. This drug prevents infections associated with dialysis. b. This drug prevents deep vein thrombosis in older clients. c. This drug helps to stimulate production of red blood cells. d. This drug helps balance the level of phosphorus in the body.

c. This drug helps to stimulate production of red blood cells. Rationale: Erythropoietin is prescribed to stimulate production of red blood cells. Clients undergoing hemodialysis develop anemia from end-stage renal disease. This drug does not prevent infections or deep vein thrombosis. Erythropoietin does not balance the body's phosphorus level.

The practical nurse (PN) is obtaining the medical history of a client starting a new prescription for conjugated estrogens PO daily. Which medical condition is not treated by this medication? a. Menopausal symptoms b. Prostatic cancer c. Thromboembolic diseases d. Abnormal uterine bleeding

c. Thromboembolic diseases Rationale: Premarin is not indicated in the treatment of thromboembolic diseases. The serious side effects of it are thromboembolism, stroke, pulmonary embolism, and MI.

Phenazopyridine is commonly prescribed for clients with urinary tract infections (UTI). Which statement by the practical nurse describes the purpose for the administration of phenazopyridine? a. To change the pH level of the urine b. To decrease the frequency of bladder spasms c. To relieve the painful symptoms caused by the UTI d. To inhibit bacterial replication and avoid growth of resistant organisms

c. To relieve the painful symptoms caused by the UTI Rationale: Phenazopyridine, a urinary analgesic, is used to relieve pain associated with urinary tract infections such as burning, pain, urgency, and frequent voiding. The administration of phenazopyridine will turn the urine to a bright red orange color. This medication should be taken with food to decrease gastric irritation. Phenazopyridine should only be used for 2 days when taken together with an antibacterial agent, which is typically prescribed for approximately 2 weeks.

The nurse is assisting with evaluating the effectiveness of the drug amiodarone. Which client statement best indicates the drug has been effective? a. "I have not had as many spells of angina." b. "I have not had as much swelling in my ankles lately." c. "My doctor told me my cholesterol levels were getting better every visit." d. "I do not notice as many irregular heartbeats as before I started taking this medication."

d. "I do not notice as many irregular heartbeats as before I started taking this medication." Rationale: Amiodarone is the first choice drugs to treat ventricular dysrhythmias. It will not reduce angina spells, reduce ankle swelling, or improve cholesterol levels.

Phenytoin is prescribed for a client who has a seizure disorder. Which statement by the client needs to be clarified by the practical nurse? a. "I should notify the health care provider if the color of my urine turns pink." b. "I should never stop taking this medication abruptly." c. "I should monitor my glucose levels closely since I am diabetic." d. "I should take the medicine with antacids if gastric upset occurs."

d. "I should take the medicine with antacids if gastric upset occurs." Rationale: Antacids should not be taken within 2 hours of taking medication. Antacids will decrease the effects of phenytoin. Phenytoin can increase glucose levels. Do not discontinue medication abruptly as seizures could occur. Medicine may cause pink discoloration of urine.

Famotidine 20 mg bid is prescribed for a client for gastroesophageal reflux disease (GERD). Which client statement indicates to the practical nurse (PN) that teaching was effective regarding use of this medication? a. "I will take the famotidine first thing in the morning." b. "I will take the famotidine as needed for GI discomfort." c. "I will take the famotidine at bedtime." d. "I will take the famotidine twice a day."

d. "I will take the famotidine twice a day." Rationale: Famotidine inhibits histamine at the histamine H2-receptor site, thus decreasing gastric secretions. In the treatment of GERD, it should be taken twice a day.

A client who is being discharged to home asks the practical nurse (PN) for a dose of hydrocodone before leaving the hospital. How should the PN respond to this client's request? a. Determine if a take-home prescription for hydrocodone was provided and, if so, tell him to take one of them. b. Encourage him to wait until he is at home to take a medication that might impair reasoning. c. Give him a tablet from the hospital stock and tell him to wait until he is almost home to take it. d. Ask him to describe the location and severity of the pain and to rate it on a scale from 1 to 10.

d. Ask him to describe the location and severity of the pain and to rate it on a scale from 1 to 10. Rationale: Hydrocodone is a narcotic analgesic, and the practical nurse should gather more data from the client about the pain he is experiencing before giving the medication. The client's need for pain medication should be addressed, and pain medication should not be withheld because he is going home.

Benztropine is prescribed for a client with Parkinson disease. After a few days of therapy, the client complains of a constipation and abdominal distention. What response by the practical nurse would be most appropriate? a. Contact the health care provider and report symptoms, so that a prescription can be obtained to relieve the symptoms. b. Inform the client that the constipation and abdominal distention are unrelated to your use of these drugs. c. Ask the client if they are concerned that these conditions may be symptoms of progression of the Parkinson disease. d. Auscultate for bowel sounds and ask the client when they last had a bowel movement.

d. Auscultate for bowel sounds and ask the client when they last had a bowel movement. Rationale: One of the side effects of benztropine is a paralytic ileus. It is important to first assess the client's abdomen, listen for bowel sounds, and determine when they last had a bowel movement. The practical nurse should then consult with the charge nurse and report findings.

A client is prescribed clonidine 0.1 mg/24 hour via transdermal patch. Which client outcome would indicate the medication is effective? a. No complaints of recent episodes of angina b. Change in peripheral edema from +3 to +1 c. No complaints of new onset of nausea or vomiting d. Blood pressure changes from 180/120 to 140/70 mm Hg

d. Blood pressure changes from 180/120 to 140/70 mm Hg Rationale: Clonidine acts as a centrally acting analgesic and antihypertensive agent. The decrease in the blood pressure indicates a reduction in hypertension.

A client has been prescribed losartan. Which change in data indicates to the practical nurse (PN) that the desired effect of this medication has been achieved? a. Dependent edema reduced from +3 to +1. b. Serum HDL increased from 35 to 55 mg/dL. c. Pulse rate reduced from 150 to 90 beats/min. d. Blood pressure reduced from 160/90 to 130/80 mm Hg.

d. Blood pressure reduced from 160/90 to 130/80 mm Hg. Rationale: Losartan is prescribed for the treatment of hypertension. The desired effect is a decrease in blood pressure.

A client diagnosed with seizures is prescribed phenytoin. Which medication instruction should the practical nurse (PN) reinforce to this client? a. Maintain consistent sodium intake. b. Use sunscreen when outdoors. c. Return for monthly urinalysis. d. Brush and floss teeth daily.

d. Brush and floss teeth daily. Rationale: Brushing and flossing the teeth daily prevents gingival hyperplasia (gum disease) that is common with long-term phenytoin therapy.

A client status post hip replacement 24 hours ago has been prescribed enoxaparin 30 mg IVP bid × 4 doses. Which intervention is most important for the practical nurse (PN) to implement? a. Assess the client's IV site for signs of inflammation. b. Evaluate the client's degree of mobility. c. Instruct the client regarding medication side effects. d. Clarify the prescription with the RN and health care provider.

d. Clarify the prescription with the RN and health care provider. Rationale: Enoxaparin is a low-molecular-weight heparin that can only be administered subcutaneously, so the PN should contact and ask the registered nurse (RN) to call the health care provider to clarify the route of administration.

A client diagnosed with essential hypertension is prescribed phenylephrine for nasal congestion as needed every 4 hours. The client is complaining about nasal congestion. Which nursing action should the practical nurse (PN) do next? a. Administer the medication as prescribed. b. Instruct the client to gently blow nose prior to administration of medication. c. Perform nasal irrigation prior to administration. d. Hold the medication and consult with the charge nurse.

d. Hold the medication and consult with the charge nurse. Rationale: Phenylephrine can cause transient hypertension and should not be taken by a client with hypertension. The PN should hold the medication and consult with the charge nurse about the client's diagnosed hypertension and prescribed medication.

A client who is taking hydrochlorothiazide is admitted to the hospital and is experiencing muscle weakness and cramps. Which condition should the practical nurse suspect is causing these changes? a. Hypolipidemia b. Hypermagnesemia c. Hyperchloremia d. Hyponatremia

d. Hyponatremia Rationale: Hydrochlorothiazide acts on the distal tubule and ascending limb of loop of Henle by increasing excretion of water, sodium, chloride, and potassium. The signs and symptoms of hyponatremia include muscle weakness and cramps.

A client with angina pectoris has been prescribed nitroglycerin tablets prn for chest pain. Which statement by the client causes the practical nurse (PN) to clarify instructions for this client? a. I will take one tablet every 5 minutes, up to three tablets. b. I should take one tablet at the onset of angina and stop activity. c. I need to replace nitroglycerin tablets every 3 to 6 months to maintain freshness. d. I should ensure that I chew the pill completely before swallowing it.

d. I should ensure that I chew the pill completely before swallowing it. Rationale: Nitroglycerin tablets should be taken at the onset of angina, and the client should stop activity and rest. One tablet should be placed under the tongue (sublingually), not chewed or swallowed. One tablet can be taken every 5 minutes, up to three doses. If pain relief not achieved after taking three pills, seek medical attention immediately. Nitroglycerin should be replaced every 3 to 6 months. Nitroglycerin pain relief should occur in 5 minutes and duration should last 30 minutes.

A client who was diagnosed with oral thrush calls the clinic saying the medication bottle broke and all of the medication was spilled. The client is requesting a refill order. The nurse should contact the health care provider about a refill for which medication? a. Ampicillin b. Ciprofloxacin c. Neomycin sulfate d. Nystatin

d. Nystatin Rationale: Nystatin is an antifungal drug that is effective in treating thrush, an oral fungal infection.

The dosing of heparin intravenous infusion is guided by which laboratory value? a. Prothrombin time b. Fibrin split products c. Platelet count d. Partial thromboplastin time

d. Partial thromboplastin time Rationale: Heparin therapy is guided by changes in the partial thromboplastin time (PTT).

An 18-month-old toddler with a 3-day history of diarrhea was administered loperamide by their parent. What intervention is most important for the PN to implement initially? a. Tell the parent never to give this drug to her toddler. b. Ask if any other siblings have experienced diarrhea. c. Obtain the child's oral and tympanic temperatures. d. Question the parent how many wet diapers has the child had in 24 hours.

d. Question the parent how many wet diapers has the child had in 24 hours. Rationale: Determining the amount and when the child last voided is most important because urine output is decreased with dehydration. An 18 month old with a 3-day history of diarrhea could be severely dehydrated. Additionally, loperamide causes an anticholinergic effect of urinary retention. Although the manufacturer states that loperamide should not be given to a child younger than the age of 2 years except under the direction of a health care provider, this information is not the best answer for the question being asked.

A client who takes metformin for diabetes mellitus type 2 is taking nothing by mouth (NPO) for surgery. The practical nurse (PN) anticipates which pre-op prescription for this client's glucose management. a. NPO except for metformin and regular snacks b. NPO except for oral antidiabetic agent c. Novolin-N insulin subcutaneously twice daily d. Regular insulin subcutaneously per sliding scale

d. Regular insulin subcutaneously per sliding scale Rationale: Regular insulin dosing based on the client's blood glucose levels (sliding scale) is the best method to achieve control of the client's blood glucose while the client is NPO.

The nurse has administered albuterol as an inhaled medication. The nurse should monitor the client for which possible adverse reaction? a. Enuresis b. Lethargy c. Depression d. Tachycardia

d. Tachycardia Rationale: Albuterol is a bronchodilator in the adrenergic category. Its actions and adverse effects are similar to adrenaline or epinephrine. The nurse should monitor the client for tachycardia. Enuresis or night bed-wetting is not an adverse effect. The client should be monitored for anxiety, not lethargy or depression.

A client has been diagnosed with open-angle glaucoma. The health care provider prescribes pilocarpine 1% eye drops. The nurse explains that which action of this drug makes it a useful treatment for the client's condition? a. The production of aqueous humor in the eyes is decreased. b. Ciliary muscles are paralyzed to decrease accommodation. c. Bilateral mydriasis with cycloplegia is accomplished. d. The ciliary muscle contracts increasing the outflow of aqueous humor in the eye.

d. The ciliary muscle contracts increasing the outflow of aqueous humor in the eye. Rationale: Pilocarpine, a cholinergic agent, causes pupillary constriction (miosis), which facilitates outflow of aqueous humor, causing a decrease in intraocular pressure.

A client has been using bimatoprost eye drops for several months. Which change is the nurse most likely to note with this client? a. The pupils are dilated. b. The eyelash hairs are missing. c. The pupils do not accommodate. d. The iris has become browner in color.

d. The iris has become browner in color. Rationale: Long-term use of bimatoprost to treat glaucoma can cause the iris to form increased brown pigmentation. The pupils do not dilate and their ability to accommodate does not change. Eyelash hairs actually have increased growth.

A client with diagnoses of diabetes mellitus and gastroesophageal reflux disease is newly prescribed atenolol for hypertension. Which information should the nurse provide to this client? a. To remain in an upright position for 30 minutes after taking the atenolol b. To take atenolol either 1 hour before breakfast or 2 hours later c. To hold the dose of atenolol if blood glucose is below 50 mg/dL d. To use glucometer frequently throughout the day

d. To use glucometer frequently throughout the day Rationale: The client needs to be instructed to monitor blood glucose because atenolol may mask symptoms of hypoglycemia. The propranolol should be taken with 8 ounces (240 mL) of water and food because food enhances bioavailability.

The nurse is caring for a client who is taking prednisone to treat rheumatoid arthritis. The nurse expects which aspect of care to be emphasized with this client? a. Reducing the dose of insulin b. Monitoring for hyperkalemia c. Monitoring for substance abuse d. Treating infections as soon as they occur

d. Treating infections as soon as they occur Rationale: A client with rheumatoid arthritis will be taking prednisone chronically. Prednisone masks early signs of an infection, so any infection needs to be treated as soon as possible. Prednisone increases the blood sugar, often requiring an increased dose of insulin. Hypokalemia, rather than hyperkalemia, is common with prednisone. Prednisone is not associated with substance abuse.