Pharmacology HESI Part 2 of 10

The nurse is caring for a client who suddenly starts to complain of palpitations, restlessness, and anxiety. The nurse obtains a stat electrocardiogram (ECG), which shows this rhythm. Refer to figure. The nurse would perform which actions in anticipation of appropriate medication therapy with amiodarone? a. Obtain an infusion pump and prepare to administer 150 mg over 1 hour followed by a maintenance dose. B. Obtain an infusion pump and prepare to administer 150 mg over 10 minutes followed by a maintenance dose. c. Obtain a syringe and administer 150 mg over 1 minute via intravenous push followed by a maintenance dose. d. Obtain a syringe and administer 360 mg over 2 minutes via intravenous push followed by a maintenance dose.

Correct Answer B. Obtain an infusion pump and prepare to administer 150 mg over 10 minutes followed by a maintenance dose. Rationale:The dysrhythmia shown in the figure is atrial fibrillation with a rapid and irregular ventricular rate. This dysrhythmia is life-threatening due to the risk for clot formation and inadequate cardiac output. Amiodarone is a class III antidysrhythmic medication that is highly effective against both atrial and ventricular dysrhythmias. When used in emergent situations for life-threatening dysrhythmias, this medication needs to be given using an infusion pump so that an accurate dose can be administered. An initial loading dose of 150 mg over 10 minutes would be infused as a bolus using the pump. Next, maintenance doses of 360 mg over 6 hours, then 540 mg over 18 hours, followed by 720 mg over 24 hours are infused. The infusion is titrated based on blood pressure.

TThe nurse is caring for a child with heart failure (HF). The nurse provides instructions to the parent regarding the procedure for administration of the prescribed digoxin. Which statement by the parent indicates a need for further teaching? a. "I will make sure to mix the medication with food." b. "I need to take my child's pulse before administering the medication." c. "If more than one dose is missed, I need to call the primary health care provider." d. "If my child vomits after being given the medication, I would not repeat the dose."

Correct Answer a. "I will make sure to mix the medication with food." Rationale:Medication would not be mixed with food because this method of administration would not ensure that the child received the prescribed dose. The parents need to be instructed that if the child vomits after the digoxin is administered, they are not to repeat the dose. In addition, the parents need to be instructed that if a dose is missed and is not identified until 4 or more hours later, the dose would not be administered. If more than one dose is missed, the primary health care provider needs to be notified.

A client with diabetes mellitus taking daily NPH insulin has been started on therapy with dexamethasone. The nurse anticipates that which adjustments in medication dosage will be made? a. An increased dose of NPH insulin b. A change to oral diabetic medications c. A lower dose of dexamethasone than usual d. An increase in the amount of daily dietary calories

Correct Answer a. An increased dose of NPH insulin Rationale:Dexamethasone is a glucocorticoid (corticosteroid) and therefore can elevate the blood glucose level. Diabetic clients may need their dosage of insulin or oral hypoglycemic medications increased during glucocorticoid therapy. This is most often a temporary change, needed to compensate for the actions of the medication. The client would not change to an oral diabetic medication if taking daily insulin. Additional calories would not be required. The client would not take a lower dose of dexamethasone than usual to compensate.

Insulin glargine is prescribed for a client with diabetes mellitus. The nurse would tell the client that it is best to take the insulin at which time? a. At bedtime every day b. 1 hour after each meal c. 15 minutes before the morning and evening meals d. Before each meal, on the basis of the blood glucose level

Correct Answer a. At bedtime every day Rationale:Insulin glargine is a long-acting recombinant DNA human insulin that is used to treat type 1 and type 2 diabetes mellitus. It has a 24-hour duration of action and is administered once a day at the same time, usually at bedtime. Therefore, the remaining options are incorrect times.

A client is started on tolbutamide once daily. When would the nurse tell the client to take the medication? a. At breakfast b. At suppertime c. Before going to bed at night d. Between breakfast and lunch

Correct Answer a. At breakfast Rationale:Tolbutamide is an oral hypoglycemic agent that is taken in the morning with breakfast to minimize gastric irritation and enhance diabetic control. It stimulates the pancreas to produce the insulin that is needed during the day.

A nurse is caring for a client with a diagnosis of hyperthyroidism. Laboratory studies are performed, and the serum calcium level is 12.0 mg/dL (3 mmol/L). Which medication would the nurse anticipate to be prescribed for the client? a. Calcitonin b. Calcium chloride c. Calcium gluconate d. Large doses of vitamin D

Correct Answer a. Calcitonin Rationale:The normal serum calcium level is 9 to 10.5 mg/dL (2.25 to 2.75 mmol/L). This client is experiencing hypercalcemia. Calcitonin, a thyroid hormone, decreases the plasma calcium level by increasing the incorporation of calcium into the bones, thus keeping it out of the serum. Calcium chloride and calcium gluconate are medications used for the treatment of tetany, which occurs from acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided.

What would the nurse teach a client about an expected outcome of nesiritide administration? a. The client will have an increase in urine output. b. The client will have an absence of dysrhythmias. c. The client will have an increase in blood pressure. d. The client will have an increase in pulmonary capillary wedge pressure.

Correct Answer a. The client will have an increase in urine output. Rationale:Nesiritide is a recombinant version of human B-type natriuretic peptide, which vasodilates arteries and veins. It is used for the treatment of decompensated heart failure, increases renal glomerular filtration, and increases urine output. The remaining options are incorrect about the intended effect of this medication.

A nurse caring for a 23-year-old client newly diagnosed with type 1 diabetes mellitus teaches the client insulin administration. Which statement by the client indicates a need for further teaching? a. "It is not necessary for me to aspirate before injecting my insulin." b. "I will rotate my insulin injection between my arms, thighs, and abdomen on a daily basis." c. "I will perform a capillary blood glucose measurement before I administer my insulin regimen." d. "My glargine insulin is long acting and should be administered once a day, but insulin lispro is given just before I eat."

Correct Answer b. "I will rotate my insulin injection between my arms, thighs, and abdomen on a daily basis." Rationale:Rotation of insulin injections should be done within one anatomical site to maintain consistent absorption of insulin. The remaining options are correct statements regarding insulin administration and thus do not indicate a need for additional client teaching.

A client is seen in the clinic for complaints of thirst, frequent urination, and headaches. After diagnostic studies, diabetes insipidus is diagnosed. Desmopressin is prescribed. The client asks why this medication was prescribed. Which is a correct statement by the nurse? a. "It relieves the headaches." b. "It increases water reabsorption." c. "It stimulates the production of aldosterone." d. "It decreases the production of the antidiuretic hormone."

Correct Answer b. "It increases water reabsorption." Rationale:Desmopressin is an antidiuretic hormone (ADH) used in the treatment of diabetes insipidus. It promotes renal conservation of water by acting on the collecting ducts of the kidney to increase the permeability to water, which results in increased water reabsorption. Desmopressin does not relieve headaches, stimulate aldosterone, or decrease production of ADH.

A client with diabetes mellitus is self-administering NPH insulin from a vial that is kept at room temperature. The client asks the nurse about the length of time an unrefrigerated vial of insulin will maintain its potency. What is the most appropriate response to the client? a. 12 weeks b. 1 month c. 2 months d. 6 months

Correct Answer b. 1 month Rationale:An insulin vial in current use can be kept at room temperature for up to 1 month without significant loss of activity. Direct sunlight and heat must be avoided.

The nurse is instructing a client who is taking levothyroxine and tells the client that full therapeutic benefits will be seen when? a. Immediately b. In 1 to 3 weeks c. Within 24 hours d. Within 3 to 5 days

Correct Answer b. In 1 to 3 weeks Rationale:It takes up to 1 month for plateau levels of levothyroxine to be achieved, so clients must be told that full benefits will not be seen for 1 to 3 weeks. Therefore, the remaining options are incorrect.

A client with diabetes mellitus received 20 units of Humulin N insulin subcutaneously at 0800. At what time would the nurse plan to assess the client for a hypoglycemic reaction? a. 1000 b. 1100 c. 1700 d. 2400

Correct Answer c. 1700 Rationale:Humulin N is an intermediate-acting insulin. The onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and the duration of action is 16 to 24 hours. Hypoglycemic reactions most likely occur during peak time.

A man has developed atrial fibrillation and has been placed on warfarin. The nurse is doing discharge dietary teaching with the client and determines that the client needs additional education if he states that he would choose which food while taking this medication? a. Cherries b. Potatoes c. Broccoli d. Spaghetti

Correct Answer c. Broccoli Rationale:Anticoagulant medications work by antagonizing the action of vitamin K, which is needed for clotting. When a client is taking an anticoagulant, foods high in vitamin K are often omitted from the diet. Vitamin K is found in large amounts in green leafy vegetables, such as broccoli, cabbage, turnip greens, and lettuce. The other options listed are foods that are lower in vitamin K.

A client is started on tolbutamide once daily. The nurse would instruct the client to monitor for which intended effect of this medication? a. Weight loss b. Resolution of infection c. Decreased blood glucose d. Decreased blood pressure

Correct Answer c. Decreased blood glucose Rationale:Tolbutamide is an oral hypoglycemic agent. It is not used to enhance weight loss, treat infection, or decrease blood pressure.

The nurse is assigned to care for clients who take estrogen or progestins. For which complication would the nurse monitor these clients? a. Sepsis b. Dehydration c. Deep vein thrombosis (DVT) d. Electrocardiographic changes

Correct Answer c. Deep vein thrombosis (DVT) Rationale:Clients who take estrogen or progestins are at increased risk for DVT. Clients who receive estrogens or progestins may also experience fluid retention and breast tenderness. The remaining options are not specifically associated with these types of medications.

The nurse has a prescription to give a client a scheduled dose of digoxin. Prior to administering the medication, the nurse would assess for which manifestations that could indicate digoxin toxicity? a. Dyspnea, edema, and palpitations b. Chest pain, hypotension, and paresthesias c. Double vision, loss of appetite, and nausea d. Constipation, dry mouth, and sleep disorder

Correct Answer c. Double vision, loss of appetite, and nausea Rationale:Double vision, loss of appetite, and nausea are signs of digoxin toxicity. Other signs of digoxin toxicity include bradycardia, visual alterations (such as green and yellow vision, or seeing spots or halos), confusion, vomiting, diarrhea, decreased libido, and impotence. The other options are incorrect because they do not identify manifestations of digoxin toxicity.

The primary health care provider has prescribed regular insulin 6 units and NPH insulin 20 units subcutaneously to be administered every morning for a client diagnosed with diabetes mellitus. How would the nurse prepare to administer insulin? a. Shake the NPH insulin vial to distribute the suspension. b. Administer regular insulin and NPH insulin in separate syringes. c. Draw up the regular insulin first and then the NPH insulin in the same syringe. d. Draw up the NPH insulin first and then the regular insulin in the same syringe.

Correct Answer c. Draw up the regular insulin first and then the NPH insulin in the same syringe. Rationale:Regular insulin is always drawn up before NPH insulin, and NPH insulin can be drawn into the same syringe as the regular insulin. Insulins usually are administered 15 to 30 minutes before a meal. To mix the NPH insulin suspension, the vial would be rotated gently. Shaking introduces air bubbles into the solution.

The nurse is caring for a client who is receiving growth hormone replacement therapy. The nurse monitors the client for which adverse effect of this therapy? a. Hypocalciuria b. Hypoglycemia c. Hyperglycemia d. Hyperthyroidism

Correct Answer c. Hyperglycemia Rationale:Hyperglycemia can occur as a result of the administration of growth hormone, particularly in a client with diabetes mellitus. Hypercalciuria can occur, particularly during the first 2 to 3 months of therapy. Growth hormone therapy is associated with a decline in thyroid function.

The nurse is completing a health history for an insulin-dependent client who has been self-administering insulin for 40 years. The client reports experiencing periods of hypoglycemia followed by periods of hyperglycemia. What is the most likely cause for this pattern of blood glucose fluctuation? a. Eating snacks between meals b. Initiating the use of the insulin pump c. Injecting insulin at a site of lipodystrophy d. Adjusting insulin according to blood glucose levels

Correct Answer c. Injecting insulin at a site of lipodystrophy Rationale:Tissue hypertrophy (lipodystrophy) involves thickening of the subcutaneous tissue at the injection sites. This dense tissue can interfere with the absorption of insulin, resulting in erratic blood glucose levels. Because the client has been on insulin for many years, this is the most likely cause of poor control. The remaining options are appropriate for use in regulating blood glucose levels.

A client is admitted to a hospital with acute myocardial infarction and is started on tissue plasminogen activator (tPA) by infusion. Which parameter would the nurse determine requires the least frequent assessment to detect complications of therapy with tPA? a. Neurological signs b. Blood pressure and pulse c. Presence of bowel sounds d. Complaints of abdominal and back pain

Correct Answer c. Presence of bowel sounds Rationale:Thrombolytic agents dissolve existing clots, and bleeding can occur anywhere in the body. The nurse monitors for any obvious signs of bleeding and also for occult signs of bleeding, which would include hemoglobin and hematocrit values, blood pressure and pulse, neurological signs, assessment of abdominal and back pain, and the presence of blood in the urine or stool.

The diabetes nurse specialist conducts a teaching session to a group of nursing students regarding sulfonylureas, oral hypoglycemic medications used for type 2 diabetes mellitus. Which statement, describing the primary action of these medications, would the nurse include in the teaching session? a. "Sulfonylureas decrease insulin resistance." b. "Sulfonylureas inhibit carbohydrate digestion." c. "Sulfonylureas decrease glucose production by the liver." d. "Sulfonylureas promote insulin secretion by the pancreas."

Correct Answer d. "Sulfonylureas promote Rationale:Sulfonylureas promote insulin secretion by the pancreas and may also increase tissue response to insulin. Thiazolidinediones decrease insulin resistance. α-Glucosidase inhibitors inhibit carbohydrate digestion. Biguanides decrease glucose production by the liver.

A nurse is providing teaching regarding acarbose. The nurse would tell the client that which expected side or adverse effect(s) may occur with this medication? a. Tachycardia and dizziness b. Tachycardia and dizziness c. Tinnitus and decreased hearing d. Abdominal distention and diarrhea

Correct Answer d. Abdominal distention and diarrhea Rationale:Acarbose delays absorption of dietary carbohydrates and thereby reduces the rise in blood glucose after a meal. Its activity in the bowel promotes flatulence, cramping, and diarrhea. Acarbose does not have an effect on the heart. It may cause hypoglycemia and possibly associated diaphoresis, but this is not an expected side effect. Tinnitus and decreased hearing are side effects of aminoglycosides.

A nurse is providing teaching regarding nateglinide. A portion of the teaching involves time of administration, and the nurse would tell the client to take the medication at which time? a. Bedtime b. During lunch c. During breakfast d. Before each meal

Correct Answer d. Before each meal Rationale:Nateglinide has a rapid onset of action (within 20 minutes) and a short duration of action (4 hours). It is administered 3 times daily immediately before meals. The other time frames would not provide the best outcome.

Vasopressin is prescribed for a client with diabetes insipidus. The nurse would be particularly cautious in monitoring a client receiving this medication if the client has which preexisting condition? a. Depression b. Endometriosis c. Pheochromocytoma d. Coronary artery disease

Correct Answer d. Coronary artery disease Rationale:Because of its powerful vasoconstrictor actions, vasopressin can cause adverse cardiovascular effects. By constricting arteries of the heart, vasopressin can cause angina pectoris and even myocardial infarction, especially if administered to clients with coronary artery disease. In addition, vasopressin may cause vascular problems by decreasing blood flow in the periphery. The remaining options are not conditions of concern with the use of this medication.

A client is receiving scheduled doses of lovastatin. The nurse determines that the medication is having the intended effect if which is noted? a. Weight loss b. Increased pulse rate c. Lowered blood pressure d. Decreased cholesterol level

Correct Answer d. Decreased cholesterol level Rationale:Lovastatin is an HMG-CoA reductase inhibitor used to lower blood cholesterol levels. It does not induce weight loss, does not stimulate heart rate, and is not an antihypertensive.

The nurse would educate the client receiving pravastatin to immediately report which finding? a. Fatigue b. Diarrhea c. Sore throat d. Muscle pain

Correct Answer d. Muscle pain Rationale:Pravastatin is used to treat hyperlipidemia. Muscle pain could indicate rhabdomyolysis, a serious complication of this medication. It must be reported immediately. The remaining options are not associated concerns with the medication.

A client is admitted to the emergency department with a diagnosis of myocardial infarction (MI). The primary health care provider (PHCP) prescribes the administration of alteplase. The registered nurse (RN) preceptor is orienting a new RN in the use of this medication. Which statement by the new RN indicates that teaching has been effective? a. "Administer the medication within 4 to 6 hours after onset of chest pain." b. "Administer the medication concurrently with the administration of heparin." c. "Administer the medication with the administration solution set protected from light." d. "Administer the medication after the results of all laboratory tests have been received."

Correct Answer a. "Administer the medication within 4 to 6 hours after onset of chest pain." Rationale:Alteplase is a fibrinolytic medication. In a client with an acute coronary artery thrombosis that evolves into a transmural MI, fibrinolytic therapy is most effective when started within 4 to 6 hours after onset of symptoms. The solution does not need to be protected from light. Heparin may be administered after the administration of alteplase but not concurrently, and it is not appropriate to wait for all laboratory tests to administer the medication.

The nurse determines that the client needs further instruction about prescribed thyroid replacement medication if which statement is made? a. "I would expect full therapeutic effect from the medication within 3 to 5 days." b. "I need to take my medication in the morning about 1 hour before eating breakfast." c. "I need to make sure that I store the medication in the dark container I received it in." d. "I need to check with my primary health care provider before taking any over-the-counter medications."

Correct Answer a. "I would expect full therapeutic effect from the medication within 3 to 5 days." Rationale:The client would be taught that it may take up to 3 to 4 weeks to see the full therapeutic effects of thyroid medications, so expecting a full therapeutic effect in 3 to 5 days indicates a need for additional teaching. The medication needs to be taken in the morning to prevent insomnia at night and on an empty stomach. All thyroid tablets must be protected from light. The client taking thyroid medications needs to consult with the primary health care provider before taking any over-the-counter medications, and labels need to be read thoroughly.

The nurse administers 20 units of insulin isophane recombinant to a hospitalized client with diabetes mellitus at 7:00 a.m. The nurse would monitor the client most closely for a hypoglycemic reaction at which time? a. 4:00 p.m. b. 9:00 a.m. c. 10:00 a.m. d. 12:00 midnight

Correct Answer a. 4:00 p.m. Rationale:Insulin isophane recombinant is an intermediate-acting insulin with an onset of action in 3 to 4 hours, a peak action in 6 to 12 hours, and a duration of action of 18 to 28 hours. A hypoglycemic reaction is most likely to occur at peak time. The correct option is the only one that represents a time within the peak hours after administration of the insulin.

The nurse is monitoring a client receiving glipizide. The nurse knows that which finding would indicate a therapeutic outcome for this client? a. A decrease in polyuria b. An increase in appetite c. A glycosylated hemoglobin of 10% d. A fasting blood glucose of 220 mg/dL (12.6 mmol/L)

Correct Answer a. A decrease in polyuria Rationale:Glipizide is an oral hypoglycemic agent given to reduce the serum glucose level and the signs and symptoms of hyperglycemia. Therefore, a decrease in polyuria (a symptom of hyperglycemia) would denote a beneficial response to glipizide. Excessive appetite (polyphagia) also is a symptom of hyperglycemia. Thus, an increase in appetite would not signify a therapeutic effect. A therapeutic fasting blood glucose would be less than 100 mg/dL, and the glycosylated hemoglobin needs to be less than 7%.

Levothyroxine is prescribed for a client diagnosed with hypothyroidism. The nurse reviews the client's record and notes that the client is presently taking warfarin. The nurse contacts the primary health care provider (PHCP), anticipating that the PHCP will prescribe which medication? a. A decreased dosage of warfarin b. An increased dosage of warfarin c. A decreased dosage of levothyroxine d. An increased dosage of levothyroxine

Correct Answer a. A decreased dosage of warfarin Rationale:Levothyroxine accelerates the degradation of vitamin K-dependent clotting factors. As a result, the effects of warfarin are enhanced. Therefore, if thyroid hormone replacement therapy is instituted in a client who has been taking warfarin, the dosage of warfarin should be reduced.

A hospitalized client with a history of angina pectoris complains of substernal chest pain. The nurse checks the client's blood pressure and administers nitroglycerin, gr 1/4 sublingually. Five minutes later, the client is still experiencing chest pain. If the blood pressure remains stable, the nurse would take which action next? a. Administer another nitroglycerin tablet. b. Administer 10 L of oxygen via nasal cannula. c. Call for a 12-lead electrocardiogram (ECG) to be performed. d. Wait an additional 5 minutes, and then give a second nitroglycerin tablet.

Correct Answer a. Administer another nitroglycerin tablet. Rationale:Nitroglycerin tablets are usually prescribed 1 every 5 minutes PRN (as needed) for chest pain for the hospitalized client, up to a total dose of 3 tablets. The nurse would administer the second tablet. The client with known angina pectoris would have low-flow oxygen at a rate of 1 to 3 L/min via nasal cannula. A 12-lead ECG would be done if prescribed by standing protocol or by individual primary health care provider prescription.

The nurse is preparing to administer an intravenous (IV) insulin injection. The vial of regular insulin has been refrigerated. On inspection of the vial, the nurse finds that the medication is frozen. Which would the nurse do? a. Discard the insulin and obtain another vial. b. Wait for the insulin to thaw at room temperature. c. Check the temperature settings of the refrigerator. d. Rotate the vial between the hands until the medication becomes liquid.

Correct Answer a. Discard the insulin and obtain another vial. Rationale:Insulin would not be frozen. If the nurse notes that the vial of insulin is frozen, the insulin is discarded and a new vial is obtained. The remaining options are incorrect actions.

The nurse is preparing the client's morning insulin isophane dose. The nurse notices a clumpy precipitate inside the insulin vial. What is the most appropriate nursing action related to this finding? a. Draw the dose from a new vial. b. Draw up and administer the dose. c. Shake the vial in an attempt to disperse the clump. d. Warm the vial under running water to dissolve the clump.

Correct Answer a. Draw the dose from a new vial. Rationale:The nurse would always inspect the vial of insulin before use for changes that may signify loss of potency. Insulin isophane normally is uniformly cloudy. Clumping, frosting, and precipitates are signs of insulin damage. In this situation, because potency is questionable, it is safer to discard the vial and draw up the dose from a new vial. Therefore, the remaining options are incorrect.

The nurse is preparing a dose of 10 units of regular insulin and 35 units of NPH insulin for a client with type 1 diabetes mellitus. The nurse obtains an insulin syringe, gently rotates the insulin solutions, cleans the tops of the vials of insulin, and injects an amount of air equal to the dose prescribed into each vial. What is the next nursing action? a. Draws up 10 units of regular insulin and checks the syringe contents with another nurse before drawing up the NPH insulin b. Draws up 10 units of regular insulin, draws up 35 units of NPH insulin, and checks the syringe contents with another nurse c. Draws up 35 units of NPH insulin and checks the syringe contents with another nurse before drawing up the regular insulin d. Draws up 35 units of NPH insulin, draws up 10 units of regular insulin, and checks the syringe contents with another nurse

Correct Answer a. Draws up 10 units of regular insulin and checks the syringe contents with another nurse before drawing up the NPH insulin Rationale:Insulin dosages are verified by another nurse before administration. When two types of insulins are mixed, the doses must be verified after each is drawn up so as to verify the dosage for each one. The regular insulin is drawn into the syringe first.

The nurse is teaching a client with hyperthyroidism about the prescribed medication, propylthiouracil. The nurse determines that teaching has been successful if the client states to report which symptom to the primary health care provider (PHCP)? a. Fever b. Fatigue c. Excitability d. Nervousness

Correct Answer a. Fever Rationale:An adverse effect of propylthiouracil is agranulocytosis. The client needs to be alert for this adverse effect by noting the presence of fever or sore throat, which would be reported to the PHCP immediately. Excitability is not a side or adverse effect of this medication. Fatigue may be an occasional side effect of the medication but does not warrant PHCP notification.

Propylthiouracil is prescribed for a client with hyperthyroidism. The nurse provides instructions to the client regarding the medication and informs the client to notify the primary health care provider (PHCP) if which sign or symptom occurs? a. Fever b. Dry mouth c. Drowsiness d. Increased urination

Correct Answer a. Fever Rationale:An adverse effect of propylthiouracil is agranulocytosis. The client needs to be informed of the early signs of this side and adverse effect, which include fever and sore throat. Drowsiness is an occasional side effect of the medication. Dry mouth and increased urination are unrelated to this medication.

The nurse is preparing to care for a client admitted to the emergency department with a diagnosis of diabetic ketoacidosis (DKA). The nurse gathers supplies and obtains which type of insulin, anticipating that it will be initially prescribed for the client? Click on the image to indicate your answer. a. Humulin R b. Humalog c. Humulin N d. Lantus

Correct Answer a. Humulin R Rationale:A component of initial therapy for the treatment of DKA is the administration of regular insulin by the intravenous (IV) route. The remaining insulin types are not used to treat DKA and are not administered by the IV route.

A client is taking Humulin NPH insulin and regular insulin every morning. The nurse would provide which instructions to the client? Select all that apply. a. Hypoglycemia may be experienced before dinnertime. b. The insulin dose needs to be decreased if illness occurs. c. The insulin needs to be administered at room temperature. d. The insulin vial needs to be shaken vigorously to break up the precipitates. e. The NPH insulin needs to be drawn into the syringe first, then the regular insulin.

Correct Answer a. Hypoglycemia may be experienced before dinnertime. c. The insulin needs to be administered at room temperature. Rationale:Humulin NPH is an intermediate-acting insulin. The onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and its duration of action is 16 to 24 hours. Regular insulin is a short-acting insulin. Depending on the type, the onset of action is 30 to 60 minutes, it peaks in 1 to 5 hours, and its duration is 6 to 10 hours. Hypoglycemic reactions most likely occur during peak time. Insulin would be at room temperature when administered. Clients may need their insulin dosages increased during times of illness. Insulin vials would never be shaken vigorously. Regular insulin is always drawn up before NPH.

A client has been taking glucocorticoids to control rheumatoid arthritis. Which laboratory abnormality is the client at risk for as a result of taking this medication? a. Increased serum glucose b. Decreased serum sodium c. Elevated serum potassium d. Increased white blood cells

Correct Answer a. Increased serum glucose Rationale:Glucocorticoids have three primary uses: replacement therapy for adrenal insufficiency, immunosuppressive therapy, and anti-inflammatory therapy. Exogenous glucocorticoids cause the same effects on cellular activity as those of the naturally produced glucocorticoids; however, exogenous glucocorticoids also may have undesired effects. The glucocorticoids stimulate appetite and increase caloric intake. They also increase the availability of glucose for energy. These combined effects cause the blood glucose levels to rise, making the client prone to hyperglycemia. Glucocorticoids can also lead to hypokalemia. The remaining options are not expected effects of the use of glucocorticoids.

A client with previously well-controlled diabetes mellitus has had fasting blood glucose levels ranging from 180 to 200 mg/dL. The client takes glyburide 5 mg orally daily. In reviewing the client's medication list, the home health care nurse suspects that which newly added medications could be contributing to the elevated blood glucose levels? a. Prednisone b. Ranitidine c. Cimetidine d. Ciprofloxacin

Correct Answer a. Prednisone Rationale:Corticosteroids, thiazide diuretics, and lithium may decrease the effect of glyburide, thus causing hyperglycemia. The medications listed in the incorrect options increase the effect of glyburide, leading to hypoglycemia.

The nurse is preparing to discharge a client who has had a parathyroidectomy. The discharge instructions include medication administration of oral calcium supplements that the client will need daily. Which statement by the nurse would be most appropriate regarding the oral calcium supplement therapy? a. Take the tablets following a meal. b. Store the tablets in the refrigerator to maintain potency. c. Avoid sunlight because the medication can cause skin color changes. d. Check the pulse daily; if it is less than 60 beats/minute, do not take the tablets.

Correct Answer a. Take the tablets following a meal. Rationale:Oral calcium supplements can be administered with food to enhance their absorption as well as to decrease gastrointestinal irritation. The remaining options are unrelated to oral calcium therapy.

An 8-year-old child is being treated with desmopressin. Understanding the purpose of this medication, the nurse would set which goal for this child? a. The child will have 5 nights in sequence without enuresis. b. The child will have increased urine output to 2400 mL per day. c. The child will have an increase in white blood cell count to 4000 mm3 (4 × 109/L). d. The child will have decreased use of the metered-dose inhaler to 3 times per week.

Correct Answer a. The child will have 5 nights in sequence without enuresis. Rationale:Desmopressin may be used to treat nocturnal enuresis; therefore, the goal for the child will be several nights in sequence without enuresis. The medication does not increase urine output and does not have an effect on white blood cells. The medication is not indicated as an intervention in the child with asthma.

The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching? a. Withdraws the NPH insulin first b. Withdraws the regular insulin first c. Injects air into NPH insulin vial first d. Injects an amount of air equal to the desired dose of insulin into each vial

Correct Answer a. Withdraws the NPH insulin first Rationale:When preparing a mixture of short-acting insulin, such as regular insulin, with another insulin preparation, the short-acting insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of short-acting insulin with insulin of another type. Options 2, 3, and 4 identify correct actions for preparing NPH and short-acting insulin.

The nurse teaches the client, who is newly diagnosed with diabetes insipidus, about the prescribed intranasal desmopressin. Which statements by the client indicate understanding? Select all that apply. a. "This medication will turn my urine orange." b. "I need to decrease my oral fluids when I start this medication." c. "The amount of urine I make would increase if this medicine is working." d. "I need to follow a low-fat diet to avoid pancreatitis when taking this medicine." e. "I need to report headache and drowsiness to my primary health care provider since these symptoms could be related to my desmopressin."

Correct Answer b. "I need to decrease my oral fluids when I start this medication." e. "I need to report headache and drowsiness to my primary health care provider since these symptoms could be related to my desmopressin." Rationale:In diabetes insipidus, there is a deficiency in antidiuretic hormone (ADH), resulting in large urinary losses. Desmopressin is an analog of ADH. Clients with diabetes insipidus drink high volumes of fluid (polydipsia) as a compensatory mechanism to counteract urinary losses and maintain fluid balance. Once desmopressin is started, oral fluids would be decreased to prevent water intoxication. Therefore, clients with diabetes insipidus would decrease their oral fluid intake when they start desmopressin. Headache and drowsiness are signs of water intoxication in the client taking desmopressin and need to be reported to the primary health care provider. Desmopressin does not turn urine orange. The amount of urine would decrease, not increase, when desmopressin is started. Desmopressin does not cause pancreatitis.

The nurse is caring for a client after insertion of an implanted insulin pump. Which statement by the client indicates a need for further instruction? a. "I would expect to gain less weight with this pump." b. "I need to make sure I still give my insulin before I eat." c. "This will help me to have better control of my blood sugar." d. "This pump delivers a continuous infusion of insulin throughout the day."

Correct Answer b. "I need to make sure I still give my insulin before I eat." Rationale:Insulin devices are implanted in the abdomen either intraperitoneally or intravenously. They deliver a basal insulin infusion plus a bolus dose with meals. The client would not self-administer mealtime insulin when he or she has an insulin pump. These pumps allow for better glycemic control and cause less hypoglycemia and less weight gain. They can potentially improve the overall quality of life.

A client with nausea and bradycardia is admitted to a medical unit. The family hands the nurse a small white envelope labeled "heart pill." The envelope is sent to the pharmacy, and it is found to be digoxin. A family member states, "That doctor doesn't know how to take care of my family." Which statement would convey a therapeutic response by the nurse? a. "Don't worry about this. I'll take care of everything." b. "You are concerned your loved one receives the best care." c. "You're right! I've never seen them put pills in an envelope." d. "I think you're wrong. That physician has been in practice for more than 30 years."

Correct Answer b. "You are concerned your loved one receives the best care." Rationale:Option 2 is a therapeutic, nonjudgmental response. The statement reflects the family's concern but remains nonjudgmental. Option 1 dismisses the family's concerns and disempowers the family. Option 3 creates doubt about the physician's practice without actually knowing the circumstances. Option 4 is argumentative and nontherapeutic.

The nurse monitors the blood glucose level of the client who received NPH insulin at 7:00 a.m. with an understanding that the client may experience a hypoglycemic reaction during which time frame? a. 9:00 a.m. to 11:00 a.m. b. 11:00 a.m. to 7:00 p.m. c. 7:00 p.m. to 11:00 p.m. d. Midnight to 6:00 a.m.

Correct Answer b. 11:00 a.m. to 7:00 p.m. Rationale:NPH insulin is an intermediate-acting insulin. It peaks in 4 to 12 hours after administration. (Its onset is in 1.5 hours, and its duration is 16 to 24+ hours.) If the medication was given at 7:00 a.m., the nurse would monitor for hypoglycemia during the time of peak action, which would be between 11:00 a.m. and 7:00 p.m.

A hospitalized client with diabetes mellitus receives NPH insulin in the morning. The nurse monitors the client for hypoglycemia, knowing that the peak action is expected to occur how soon after the medication administration? a. 2 to 4 hours after administration b. 4 to 12 hours after administration c. 12 to 16 hours after administration d. 18 to 24 hours after administration

Correct Answer b. 4 to 12 hours after administration Rationale:NPH insulin is an intermediate-acting insulin. Its onset of action is 3 to 4 hours, it peaks in 4 to 12 hours, and its duration of action is 16 to 20 hours.

A client has recently begun medication therapy with propranolol. The long-term care nurse would plan to notify the primary health care provider (PHCP) if which assessment finding is noted? a. Complaints of insomnia b. Audible expiratory wheezes c. Decrease in heart rate from 86 to 78 beats/min d. Decrease in blood pressure from 162/90 to 136/84 mm Hg

Correct Answer b. Audible expiratory wheezes Rationale:Propranolol is a beta blocker. Audible expiratory wheezes could indicate bronchospasm, a serious adverse reaction. Beta blockers that are not cardioselective, such as propranolol, may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Insomnia is a frequent mild side effect and would continue to be monitored. A normal decrease in heart rate and blood pressure is expected.

The nurse is caring for a client with hyperlipidemia who is taking cholestyramine. Which nursing assessment is most significant for this client relative to the medication therapy? a. Observe for joint pain. b. Auscultate bowel sounds. c. Assess deep tendon reflexes. d. Monitor cardiac rate and rhythm.

Correct Answer b. Auscultate bowel sounds. Rationale:Cholestyramine is used to treat hyperlipidemia. The site of action of the medication is the bowel; therefore, option 2 is correct. The remaining options are unrelated assessments.

A client in the postpartum care unit who is recovering from disseminated intravascular coagulopathy is to be discharged on low dosages of an anticoagulant medication. In developing home care instructions for this client, the nurse would include which priority safety instruction regarding this medication? a. Avoid brushing the teeth. b. Avoid taking acetylsalicylic acid (aspirin). c. Avoid walking long distances and climbing stairs. d. Avoid all activities because bruising injuries can occur.

Correct Answer b. Avoid taking acetylsalicylic acid (aspirin). Rationale:Aspirin can interact with the anticoagulant medication to increase clotting time beyond therapeutic ranges. Avoiding aspirin is a priority. The client does not need to avoid brushing the teeth; however, the client needs to be instructed to use a soft toothbrush. Walking and climbing stairs are acceptable activities. Not all activities need to be avoided.

Atenolol hydrochloride is prescribed for a hospitalized client. The nurse would perform which action as a priority before administering this medication? a. Listen to the client's lung sounds. b. Check the client's blood pressure. c. Assess the client for muscle weakness. d. Check the client's most recent electrolyte levels.

Correct Answer b. Check the client's blood pressure. Rationale:Atenolol hydrochloride is a beta blocker that is used to treat hypertension. Therefore, the priority nursing action before administration of the medication is to check the client's blood pressure. The nurse also checks the client's apical heart rate. If the systolic blood pressure is lower than 90 mm Hg or the apical pulse is 60 beats/min or slower, the medication is withheld and the primary health care provider is notified. The nurse checks baseline renal and liver function tests. The medication can cause weakness, and the nurse would assist the client if weakness with activities occurs.

The primary health care provider has prescribed clonidine for a client with hypertension. The nurse would inform the client that which is a side effect of this medication? a. Restlessness b. Constipation c. Hypertension d. Increased salivation

Correct Answer b. Constipation Rationale:Clonidine is an antihypertensive medication. Side effects of clonidine include dry mouth, drowsiness, constipation, and hypotension. Therefore, symptoms in the remaining options are incorrect.

A client taking verapamil has been given information about side effects of this medication. The nurse determines that the client understands the information if the client states to watch for which most common side effect of this medication? a. Weight loss b. Constipation c. Nasal stuffiness d. Abdominal cramping

Correct Answer b. Constipation Rationale:Verapamil is a calcium channel blocker. The most common complaint with the use of verapamil is constipation. Other frequent side effects are dizziness, facial flushing, headache, and edema of the hands and feet. Weight loss, nasal stuffiness, and abdominal cramping are not associated with the use of this medication.

A sulfonamide is prescribed for a client with a urinary tract infection. The client has diabetes mellitus and is receiving tolbutamide. Because the client will be taking these two medications, which prescription would the nurse anticipate for this client? a. Increased dosage of tolbutamide b. Decreased dosage of tolbutamide c. Increased dosage of sulfonamide d. Decreased dosage of sulfonamide

Correct Answer b. Decreased dosage of tolbutamide Rationale:Sulfonamides can intensify the effects of warfarin sodium phenytoin and orally administered hypoglycemics such as tolbutamide. When combined with sulfonamides, these medications may require a reduction in dosage.

The client with a traumatic brain injury (TBI) has begun to excrete copious amounts of dilute urine through the Foley catheter. The client's urine output for the previous shift was 3000 mL. The nurse expects that the primary health care provider will prescribe which medication? a. Mannitol b. Desmopressin c. Ethacrynic acid d. Dexamethasone

Correct Answer b. Desmopressin Rationale:A complication of TBI is diabetes insipidus, which can occur with insult to the hypothalamus, the antidiuretic hormone storage vesicles, or the posterior pituitary gland. Urine output that exceeds 9 L per day generally requires treatment with desmopressin. Dexamethasone is usually given to control cerebral edema secondary to brain tumors. Ethacrynic acid and mannitol are diuretics, which would be contraindicated.

The nurse in the health care clinic is reviewing the record of a client with diabetes mellitus who was just seen by the primary health care provider (PHCP). The nurse notes that the PHCP has prescribed metformin. What preexisting disorder, if noted in the client's record, would indicate a need to collaborate with the PHCP before instructing the client to take the medication? a. Foot ulcer b. Emphysema c. Hypertension d. Hypothyroidism

Correct Answer b. Emphysema Rationale:Metformin is an antidiabetic agent and acts by decreasing hepatic production of glucose. Metformin needs to be used with caution in clients with kidney or liver disease, heart failure, chronic lung disease, or a history of heavy alcohol consumption. The presence of a foot ulcer, hypertension, and hypothyroidism are not contraindications associated with use of this medication.

A client newly diagnosed with diabetes mellitus is instructed by the primary health care provider to obtain glucagon for emergency home use. The client asks the home care nurse about the purpose of the medication. The nurse would instruct the client that the purpose of the medication is to treat which problem? a. Lipoatrophy from insulin injections b. Hypoglycemia from insulin overdose c. Hyperglycemia from insufficient insulin d. Lipohypertrophy from inadequate insulin absorption

Correct Answer b. Hypoglycemia from insulin overdose Rationale:Glucagon is used to treat hypoglycemia resulting from insulin overdose. The family of the client is instructed in how to administer the medication. In an unconscious client, arousal usually occurs within 20 minutes of glucagon injection. Once consciousness has been regained, oral carbohydrates would be given. Lipoatrophy and lipohypertrophy result from insulin injections.

The nurse evaluates that the family of a client newly diagnosed with diabetes mellitus correctly understands the reason for having glucagon on hand for emergency home use if the family indicates that the purpose of the medication is to treat which complication? a. Diabetic ketoacidosis b. Hypoglycemia from insulin overdose c. Hyperglycemia from overeating at meals d. Hyperglycemia occurring on "sick days"

Correct Answer b. Hypoglycemia from insulin overdose Rationale:Glucagon is used to treat hypoglycemia resulting from insulin overdose. The family of the client is instructed in how to administer the medication. In an unconscious client, consciousness usually returns within 20 minutes of glucagon injection. After the client has regained consciousness, oral carbohydrates would be given. The other options are incorrect.

The nurse teaches the client being discharged to home with a prescription for a daily dose of prednisone to take the medication at which best time? a. Any time of the day b. In the early morning c. In the middle of the day d. An hour before bedtime

Correct Answer b. In the early morning Rationale:The client would be instructed to take glucocorticoids (corticosteroids) before 9:00 a.m. This helps minimize adrenal insufficiency and also mimics the burst of glucocorticoids released naturally by the adrenal glands each morning. Therefore, in the middle of the day, an hour before bedtime, and any time of the day are incorrect.

The nurse is educating a client about medroxyprogesterone. The nurse would provide the client with which information about the medication? a. Would be taken once daily by mouth b. Needs to be administered intramuscularly every 3 months c. Needs to be taken immediately following sexual intercourse d. Provides some protection against sexually transmitted infections

Correct Answer b. Needs to be administered intramuscularly every 3 months Rationale:Medroxyprogesterone is given intramuscularly in the deltoid or gluteus maximus muscle. Injections needs to be administered every 12 weeks. Advantages of medroxyprogesterone include contraceptive effectiveness comparable to combined oral contraceptives and long-lasting effects. Additionally, injections are required only 4 times a year. Disadvantages are prolonged amenorrhea or uterine bleeding, increased risk of venous thrombosis and thromboembolism, and no protection against sexually transmitted infections.

The nurse is caring for a client who is receiving dopamine. Which potential problem is a priority concern for this client? a. Fluid overload b. Peripheral vasoconstriction c. Inability to perform self-care d. Inability to discriminate hot or cold sensations

Correct Answer b. Peripheral vasoconstriction Rationale:The client who is receiving dopamine therapy should be assessed for peripheral vasoconstriction related to the action of the medication. The remaining options are not related directly to this medication therapy.

The nurse is providing medication information to a client who is beginning medication therapy with enalapril. The nurse would tell the client that which is an anticipated, although unpleasant, side effect of this medication? a. Rapid pulse b. Persistent dry cough c. Increased blood pressure d. Metallic taste in the mouth

Correct Answer b. Persistent dry cough Rationale:The principal side and adverse effects of enalapril, an angiotensin-converting enzyme (ACE) inhibitor, are persistent cough, first-dose hypotension, and hyperkalemia. The medication is used to treat hypertension. A persistent dry cough is a harmless side effect, although it can be disturbing. If this side effect occurs and is troublesome, the primary health care provider needs to be notified so that the medication can be changed to a different one. A rapid pulse and metallic taste in the mouth are not side or adverse effects of this medication.

A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL (10.2 to 11.4 mmol/L). Which medication, if added to the client's regimen, may have contributed to the hyperglycemia? a. Atenolol b. Prednisone c. Phenelzine d. Allopurinol

Correct Answer b. Prednisone Rationale:Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 1, a beta blocker, and option 3, a monoamine oxidase inhibitor, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

The emergency department nurse is caring for a client admitted with diabetic ketoacidosis. The physician prescribes intravenous (IV) insulin. The nurse plans to prepare which type of insulin for the client? a. Insulin glargine b. Regular insulin c. Insulin isophane d. 50% human insulin isophane/50% human insulin

Correct Answer b. Regular insulin Rationale:Regular insulin can be administered by the IV route. Insulin glargine is a long-acting insulin. Insulin isophane and 50% human insulin isophane/50% human insulin are intermediate-acting insulins.

A client scheduled to undergo subtotal thyroidectomy is taking a potassium iodide solution. The client complains to the nurse about a brassy taste in the mouth when taking the medication. Which instruction would the nurse provide to the client? a. Dilute the medication in 8 oz of water. b. Report the symptom to the primary health care provider (PHCP). c. Continue to take the medication because the symptom is normal. d. Take one-half dose of the prescribed medication for the next 2 days.

Correct Answer b. Report the symptom to the primary health care provider (PHCP). Rationale:The client needs to be instructed about symptoms of iodism that can occur with the administration of potassium iodide solution. These symptoms include a brassy taste, burning sensation in the mouth, and soreness of the gums and teeth. The client needs to be instructed to withhold the medication and notify the PHCP if these symptoms are noted.

Glyburide daily is prescribed for a client. What instruction would the nurse include in the client's teaching plan? a. The medication is used to prevent foot infections. b. Take the medication in the morning before breakfast. c. Expect skin color change from pink to yellow and pale-colored stools. d. Contact the primary health care provider (PHCP) immediately if an altered taste sensation is noted.

Correct Answer b. Take the medication in the morning before breakfast. Rationale:Glyburide is a second-generation sulfonylurea used to treat diabetes mellitus. The client is instructed to take a single daily dose 15 to 30 minutes before breakfast. The medication is not used to prevent foot infections. Cholestatic jaundice is a potential adverse effect, and if the client exhibits signs of jaundice (skin color changes or pale stools), the PHCP needs to be notified. Altered taste sensation is a frequent side or adverse effect and does not warrant PHCP notification.

Acarbose is prescribed to treat a client with type 2 diabetes mellitus. Which instruction would the nurse provide when teaching the client about this medication? a. Take the medication at bedtime. b. Take the medication with the first bite of each regular meal. c. The medication will be used to treat symptoms of hypoglycemia. d. Headache and dizziness are the most common side effects of this medication.

Correct Answer b. Take the medication with the first bite of each regular meal. Rationale:Acarbose is an α-glucosidase inhibitor. Taken with the first bite of each major meal, acarbose delays absorption of ingested carbohydrates, decreasing postprandial hyperglycemia. It is not taken at bedtime. Abdominal pain and flatulence (not headache and dizziness) are the most common side effects of this medication.

The nurse would tell the client, who is taking levothyroxine, to notify the primary health care provider (PHCP) if which problem occurs? a. Fatigue b. Tremors c. Cold intolerance d. Excessively dry skin

Correct Answer b. Tremors Rationale:Levothyroxine is prescribed to treat hypothyroidism. Excessive doses of levothyroxine can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, extreme heat intolerance, and sweating. The client needs to be instructed to notify the PHCP if these occur. Options 1, 3, and 4 are signs of hypothyroidism.

The client with hyperparathyroidism is taking alendronate. Which statements by the client indicate understanding of the proper way to take this medication? Select all that apply. a. "I need to take this medication with food." b. "I need to take this medication at bedtime." c. "I would sit up for at least 30 minutes after taking this medication." d. "I need to take this medication first thing in the morning on an empty stomach." e. "I can pick a time to take this medication that best fits my lifestyle as long as I take it at the same time each day."

Correct Answer c. "I would sit up for at least 30 minutes after taking this medication." d. "I need to take this medication first thing in the morning on an empty stomach." Rationale:Alendronate is a bisphosphonate used in hyperparathyroidism to inhibit bone loss and normalize serum calcium levels. Esophagitis is an adverse effect of primary concern in clients taking alendronate. For this reason, the client is instructed to take alendronate first thing in the morning with a full glass of water on an empty stomach, not to eat or drink anything else for at least 30 minutes after taking the medication, and to remain sitting upright for at least 30 minutes after taking it. A daily dosing schedule and a once-weekly dosing schedule are available for clients taking alendronate.

The nurse is providing education to a client with type 2 diabetes about starting insulin glargine to help with improved glycemic control. Which statement made by the client indicates understanding? a. "It has a distinct peak." b. "It can be given intravenously." c. "It has a decreased risk for hypoglycemia." d. "I don't have to perform fingerstick glucose monitoring."

Correct Answer c. "It has a decreased risk for hypoglycemia." Rationale:In contrast to other long-acting insulins, insulin glargine achieves blood levels that are relatively steady over 24 hours. As a result, there is less risk of hypoglycemia or hyperglycemia. The only insulins that can be administered intravenously are the short-acting insulins. All medications used to treat diabetes mellitus require blood glucose monitoring.

A client with diabetes insipidus asks the nurse about the purpose of a new medication, vasopressin. The nurse provides teaching about the medication. Which statement by the client indicates successful teaching? a. "It decreases muscle contractions." b. "It opens up my blood vessels." c. "It prevents me from 'peeing' so much." d. "It decreases stomach cramping and colon motility."

Correct Answer c. "It prevents me from 'peeing' so much." Rationale:Vasopressin is a vasopressor and an antidiuretic. It increases reabsorption of water by the renal tubules, resulting in a decreased urinary flow rate. It also directly stimulates contraction of smooth muscle, causing vasoconstriction and stimulating peristalsis.

The nurse provides family teaching to the parent of a 13-year-old client with pituitary dwarfism who is on growth hormone therapy. Which statement by the parent indicates that teaching has been successful? a. "My child's growth will be slow and steady." b. "My child will have growth spurts every 2 years." c. "My child will have an immediate increase in growth." d. "My child will have an increase in height in young adulthood."

Correct Answer c. "My child will have an immediate increase in growth." Rationale:Growth hormone may be used in the treatment of dwarfism. When treatment is started, height may be increased by as much as 6 inches. The increase is immediate and continual. To monitor treatment, height and weight would be measured monthly. All other options indicate delayed or sporadic increases in growth, which are incorrect.

A new registered nurse (RN) prepares to administer sodium polystyrene sulfonate to a client. Before administering the medication, the nurse reviews the action of the medication with another RN. Which statement by the new RN indicates that the teaching has been effective? a. "Bicarbonate is exchanged for primarily sodium ions." b. "Potassium ions are exchanged for primarily sodium ions." c. "Sodium ions are exchanged for primarily potassium ions." d. "Sodium ions are exchanged for primarily bicarbonate ions."

Correct Answer c. "Sodium ions are exchanged for primarily potassium ions." Rationale:Sodium polystyrene sulfonate is a cation exchange resin used for the treatment of hyperkalemia. The resin passes through the intestine or is retained in the colon. It releases sodium ions primarily in exchange for potassium ions. The therapeutic effect occurs 2 to 12 hours after oral administration and longer after rectal administration. Therefore, the remaining options are incorrect.

Thyroid replacement therapy is prescribed for the client diagnosed with hypothyroidism. The client asks the nurse when the medication will no longer be needed. Which is the appropriate nursing response? a. "It depends on the results of the laboratory tests." b. "Most clients require medication for about 1 year." c. "The medication will need to be continued for life." d. "You will need to ask your primary health care provider."

Correct Answer c. "The medication will need to be continued for life." Rationale:For most clients with hypothyroidism, replacement therapy must be continued for life. Treatment provides symptomatic relief but does not produce a cure. The client needs to be told that although therapy will cause symptoms to improve, these improvements do not constitute a reason to interrupt or discontinue the medication. The outcome of the laboratory results does not bear influence on the length of time the client will need the medication. The statement that indicates that most clients need the medication for about a year implies that the disease is curable, so this option needs to be eliminated. Referring the client to the primary health care provider places the client's question on hold.

Somatropin, a growth hormone, is prescribed for a client. The nurse reviews the assessment data in the client's health record, knowing that the medication would be contraindicated for which client? a. A child with growth failure b. A child with pituitary dwarfism c. A 20-year-old with growth failure d. A child with growth hormone deficiency

Correct Answer c. A 20-year-old with growth failure Rationale:Somatotropin would not be administered during or after epiphyseal closure. Efficacy of therapy declines as the client ages and is usually lost entirely by age 20 to 24 years. The conditions in the remaining options are indications for use of the medication.

A client with diabetes mellitus calls the clinic and reports being nauseated during the night. The client asks the nurse if the morning insulin would be administered. Which is the most appropriate nursing response? a. Omit the insulin b. Administer half of the prescribed dose. c. Administer the full dose as prescribed d. Wait until noon before making a decision

Correct Answer c. Administer the full dose as prescribed Rationale: When the client with diabetes mellitus becomes ill, control is more difficult. Insulin is not omitted, and the client is encouraged to consume liquid carbohydrates if unable to eat regular meals. The client is instructed to notify the primary health care provider if vomiting or diarrhea occurs or if the illness progresses past 2 days. Prescribed medication is not altered by the nurse

The nurse has completed medication administration that included a nitroglycerin. Within minutes, the client is complaining of a headache. Which is the priority nursing action at this time? a. Evaluate pupil response. b. Place the client on the left side. c. Administer the prescribed analgesic. d. Notify the primary health care provider (PHCP) immediately.

Correct Answer c. Administer the prescribed analgesic. Rationale:Nitroglycerin causes vasodilation. The major side effect of nitroglycerin is a headache that can be alleviated by an analgesic. It is an expected response to the medication, and the PHCP does not need to be notified. Placing the client on the left side will not alleviate the headache. There is no indication for the need to evaluate pupil response.

A client with atrial fibrillation is taking digoxin and complains of having no appetite and experiencing diarrhea and blurry vision. The nurse notes that the client's serum potassium level is 3.0 mEq/L (3.0 mmol/L). Based on analysis of the data, what might the nurse expect to note when reviewing the digoxin level results? a. Digoxin level of 0.6 ng/mL b. Digoxin level lower than 1.0 ng/mL c. Digoxin level higher than 2.0 ng/mL d. Digoxin level of 0 ng/mL because of diarrhea

Correct Answer c. Digoxin level higher than 2.0 ng/mL Rationale:When a client is taking digoxin, digoxin toxicity is a concern. The therapeutic digoxin level is 0.5 to 2.0 ng/mL. Anorexia, diarrhea, and visual disturbances are symptoms of digoxin toxicity. In addition, a low serum potassium level potentiates the risk for digoxin toxicity. This client's potassium level is low at 3.0 mEq/L (3.0 mmol/L). The client's complaints are indicative of digoxin toxicity. Therefore, the only correct choice is the digoxin level higher than 2.0 ng/mL.

Gemfibrozil is prescribed for a client. Which laboratory finding would alert the nurse to the need to withhold the medication and contact the primary health care provider? a. Elevated glucose b. Elevated triglycerides c. Elevated liver function tests d. Elevated blood urea nitrogen (BUN)

Correct Answer c. Elevated liver function tests Rationale:Gemfibrozil is used to treat hypercholesterolemia. One adverse effect is hepatotoxicity. The medication does not affect glucose. An elevated triglyceride level is not an indication to hold the medication. An elevated BUN is unrelated to this medication and would not be an indication that the medication should be held.

A client diagnosed with hypothyroidism is taking levothyroxine. The client returns to the clinic 1 week after beginning the medication and tells the nurse that the medication has not helped. What is the appropriate nursing response to the client? a. A higher dosage is required. b. The medication may need to be changed. c. Full therapeutic effect may take 1 to 3 weeks. d. Full therapeutic effect may take up to 4 months.

Correct Answer c. Full therapeutic effect may take 1 to 3 weeks. Rationale:Levothyroxine is used in the treatment of hypothyroidism. Although therapy with levothyroxine may begin with small doses that are gradually increased, the most appropriate response is to inform the client that the full therapeutic effect may take 1 to 3 weeks. Therefore, the remaining options are incorrect.

A client who has been taking iodine solution is admitted to the emergency department, and an iodine overdose is suspected. Gastric lavage is initiated to remove the iodine from the stomach. In addition to treatment with gastric lavage, the nurse anticipates that which medication will be administered? a. Vitamin K b. Acetylcysteine c. Sodium thiosulfate d. Calcium gluconate

Correct Answer c. Sodium thiosulfate Rationale:Iodine solution can cause iodine toxicity. Iodine is corrosive, and an overdose will injure the gastrointestinal tract. Symptoms include abdominal pain, vomiting, and diarrhea. Swelling of the glottis may result in asphyxiation. Treatment consists of gastric lavage to remove iodine from the stomach and administration of sodium thiosulfate to reduce iodine to iodide. Vitamin K is the antidote for warfarin. Acetylcysteine is the antidote for acetaminophen overdose. Calcium gluconate is used for acute hypocalcemia.

Somatropin is administered to a client with growth failure. A nurse monitors the client, knowing that which is the expected therapeutic effect of this medication? a. Promote weight gain. b. Increase bone density. c. Stimulate linear growth. d. Decrease the mobilization of fats.

Correct Answer c. Stimulate linear growth. Rationale:Somatropin is a growth stimulator used in the long-term treatment of growth failure resulting from endogenous growth hormone deficiency. Somatropin stimulates linear growth, increases the number and size of muscle cells, and increases red cell mass. Somatropin affects carbohydrate metabolism by antagonizing the action of insulin, increases mobilization of fats, and increases cellular protein synthesis. The remaining options are not actions of this medication.

Potassium iodide is prescribed for a client with thyrotoxic crisis. The client calls a clinic nurse and complains of a brassy taste in the mouth. Which instruction would the nurse provide the client? a. Continue with the medication. b. Take half of the prescribed dose for the next 24 hours. c. Withhold the medication and notify the primary health care provider (PHCP). d. Withhold the medication for the next 24 hours and then continue as prescribed.

Correct Answer c. Withhold the medication and notify the primary health care provider (PHCP). Rationale:Chronic ingestion of iodine can produce iodism. The client needs to be instructed about the symptoms of iodism, which include a brassy taste, soreness of gums and teeth, vomiting, and abdominal pain. The client needs to be instructed to notify the PHCP if these symptoms occur.

A medication has been prescribed for a client with hypoparathyroidism for management of hypocalcemia. The client arrives at the clinic for follow-up evaluation and complains of chronic constipation since beginning the medication. The nurse provides information to the client regarding measures to alleviate the constipation and determines that the client needs additional information when the client makes which statement? a. "I will increase my daily fluid intake." b. "I will increase my activity level as tolerated." c. "I will increase my daily intake of high-fiber foods." d. "I will add ½ ounce of mineral oil to my daily diet."

Correct Answer d. "I will add ½ ounce of mineral oil to my daily diet." Rationale:Clients taking medications to treat hypocalcemia would be instructed to avoid the use of mineral oil as a laxative because mineral oil decreases vitamin D absorption, and vitamin D is needed to assist in the absorption of calcium. The remaining options are basic measures to alleviate constipation.

Cortisone acetate is prescribed for a client with adrenal insufficiency. The nurse provides instructions to the client regarding the medication. Which statement, if made by the client, indicates a need for further instruction? a. "I will limit my sodium intake." b. "I will avoid people with colds." c. "I will eat a good breakfast every day." d. "I will stop the medication when I feel better."

Correct Answer d. "I will stop the medication when I feel better." Rationale:To prevent acute adrenal insufficiency, glucocorticoids would not be abruptly discontinued. These medications can cause sodium and water retention and the loss of potassium, so clients need to be instructed to limit sodium intake and consume potassium-rich foods. These medications can increase the risk of infection, and the client would avoid contact with clients who are ill. Additionally, adequate dietary intake is important.

The nurse provides education to the client with hyperthyroidism about potassium iodide before medication administration. The client is scheduled for a subtotal thyroidectomy. Which response by the client indicates understanding? a. "It replaces thyroid hormone." b. "It prevents iodine absorption." c. "It increases thyroid hormone." d. "It suppresses thyroid hormone."

Correct Answer d. "It suppresses thyroid hormone." Rationale:Potassium iodide is administered to hyperthyroid individuals in preparation for thyroidectomy to suppress thyroid function. Initial effects develop within 24 hours. Peak effects develop in 10 to 15 days. In most cases, plasma levels of thyroid hormone are reduced with propylthiouracil before potassium iodide therapy is initiated. Then potassium iodide, along with propylthiouracil, is administered for the last 10 days before surgery. Therefore, the remaining options are incorrect.

The nurse is reviewing heparin infusion therapy and pertinent laboratory values to monitor with the nursing student. Which statement by the student indicates that teaching has been effective? a. "Bleeding time assesses for therapeutic effect of heparin." b. "Thrombin time assesses for therapeutic effect of heparin." c. "Prothrombin time assesses for therapeutic effect of heparin." d. "Partial thromboplastin time assesses for therapeutic effect of heparin."

Correct Answer d. "Partial thromboplastin time assesses for therapeutic effect of heparin." Rationale:The partial thromboplastin time will assess the therapeutic effect of heparin. The prothrombin time is one test that will assess for the therapeutic effect of warfarin. Bleeding time and thrombin time are hematological studies that may be prescribed for clients with coagulopathy or other disorders.

Octreotide acetate is prescribed for a client with acromegaly. The nurse monitors the client, knowing that which side or adverse effect is associated with the administration of this medication? a. Polyuria b. Hypotension c. Constipation d. Abdominal pain

Correct Answer d. Abdominal pain Rationale:Octreotide is used to reduce growth hormone levels in clients with acromegaly. The most common side and adverse effects of octreotide are diarrhea, nausea, gallstone formation, and abdominal discomfort. Polyuria is not associated with this medication. Hypertension, although rare, may occur.

A client arrives at the clinic complaining of fatigue, lack of energy, constipation, and depression. Following diagnostic studies, hypothyroidism is diagnosed and levothyroxine is prescribed. The nurse informs the client that which is the expected outcome of the medication? a. Alleviate depression. b. Increase energy levels. c. Increase blood glucose levels. d. Achieve normal thyroid hormone levels.

Correct Answer d. Achieve normal thyroid hormone levels. Rationale:Laboratory determinations of the serum thyroid-stimulating hormone (TSH) level are an important means of evaluation. Successful therapy will cause elevated TSH levels to fall. These levels will begin their decline within hours of the onset of therapy and will continue to drop as plasma levels of thyroid hormone build up. If an adequate dosage is administered, TSH levels will remain suppressed for the duration of therapy. Although energy levels may increase, this occurs as a result of the achievement of normal thyroid hormone levels. Alleviation of depression and increased blood glucose levels are not expected outcomes.

Metformin is prescribed for a client with type 2 diabetes mellitus. The nurse would tell the client that which is the most common side or adverse effect of the medication? a. Weight gain b. Hypoglycemia c. Flushing and palpitations d. Gastrointestinal (GI) disturbances

Correct Answer d. Gastrointestinal (GI) disturbances Rationale:The most common side effect of metformin is GI disturbances, including decreased appetite, nausea, and diarrhea. These generally subside over time. causes nausea and decreased appetite. Although flushing, palpitations, and hypoglycemia canThis medication does not cause weight gain; in fact, clients lose an average of 7 to 8 lb because the medication occur, they are not the most common side effects.

Insulin lispro is prescribed for the client with diabetes mellitus, and the client is instructed to administer the insulin before meals. When would the nurse instruct the client to administer the insulin? a. 45 minutes before eating b. 60 minutes before eating c. 90 minutes before eating d. Immediately before eating

Correct Answer d. Immediately before eating Rationale:Insulin lispro acts more rapidly than regular insulin and has a shorter duration of action. The effect of insulin lispro begins within 25 minutes after subcutaneous injection, peaks in 0.5 to 1.5 hours, and has a duration of action of approximately 5 hours. Because of its rapid onset, it can be administered from 15 minutes to immediately before eating. In contrast, regular insulin is generally administered 30 minutes before meals.

The clinic nurse develops a plan of care for a client with emphysema who will be started on long-term corticosteroid therapy. Which specific instruction would the nurse include in the plan of care? a. Instruct the client to maintain a low-potassium diet. b. Encourage the client to consume a fluid intake of 3000 mL/day. c. Encourage the client to increase the amount of sodium intake in the diet. d. Instruct the client to return to the clinic for monitoring of blood glucose levels.

Correct Answer d. Instruct the client to return to the clinic for monitoring of blood glucose levels. Rationale:Corticosteroid therapy can cause calcium and potassium depletion, sodium retention, and glucose intolerance. The client needs to be monitored for hyperglycemia. Also, an increase in potassium and a decrease in sodium intake are recommended to prevent potassium depletion and sodium retention while taking the corticosteroid. Although increased fluids are important for the client with emphysema to maintain thin respiratory secretions, this action is not specific to the use of corticosteroids.

A nurse is caring for a client recently diagnosed with type 2 diabetes mellitus who has been prescribed sustained-release glipizide. What is the most important point for the nurse to include in teaching this client about this medication? a. Take the medication at least 1 hour after eating. b. Make sure to take the medication every 12 hours. c. Take measures to prevent and treat hyperglycemia. d. Swallow the medication whole and never crush or chew it.

Correct Answer d. Swallow the medication whole and never crush or chew it. Rationale:Sustained-release glipizide is designed to be slowly absorbed in the gastrointestinal tract. Crushing or chewing the tablet alters absorption of the medication. It must be taken 30 minutes before eating because absorption is delayed by food. Hypoglycemia may occur when taking this medication, especially with insufficient caloric intake. Sustained-release glipizide has a duration of action of 24 hours and is taken once a day.

A nurse provides instructions to a client taking fludrocortisone acetate. The nurse instructs the client to notify the primary health care provider (PHCP) if which manifestation occurs? a. Nausea b. Fatigue c. Weight loss d. Swelling of the feet

Correct Answer d. Swelling of the feet Rationale:Excessive levels of fludrocortisone acetate cause retention of sodium and water and excessive excretion of potassium, resulting in expansion of blood volume, hypertension, cardiac enlargement, edema, and hypokalemia. The client needs to be informed about the signs of sodium and water retention, such as unusual weight gain or swelling of the feet or lower legs. If these signs occur, the PHCP needs to be notified.

A client is on enalapril for the treatment of hypertension. The nurse teaches the client to seek emergent care if which is experienced? a. Nausea b. Insomnia c. Dry cough d. Swelling of the tongue

Correct Answer d. Swelling of the tongue Rationale:Enalapril is an angiotensin-converting enzyme inhibitor. Angioedema is an adverse effect. Swelling of the tongue and lips can result in airway occlusion. Nausea, insomnia, and a cough can occur as side effects, not adverse effects of the medication.

The nurse is providing instructions to a client with a diagnosis of Addison's disease regarding the administration of prescribed glucocorticoids. The nurse would provide which instruction to the client? a. To stop the medication if side effects occur b. To avoid taking the medication if nausea occurs c. That minimal side effects will occur with use of this medication d. That an increased dose of medication may be needed during times of stress

Correct Answer d. That an increased dose of medication may be needed during times of stress Rationale:The client with Addison's disease will require lifelong replacement of adrenal hormones. The medications must be taken daily, and an alternate route of administration must be used if the client cannot take oral medications for any reason, such as nausea and vomiting. Additional doses of glucocorticoids will be needed during times of stress. The nurse must emphasize that the client must call the primary health care provider (PHCP) to obtain a prescription for a dosage increase when experiencing stressful situations. Abrupt withdrawal of this medication can result in addisonian crisis. Although side effects are mild at lower doses, more severe side effects occur with long-term glucocorticoid administration. It is very unsafe to stop taking the medication without first consulting the PHCP.

A client is receiving somatropin. The nurse would monitor which most significant laboratory study during therapy with this medication? a. Lipase level b. Amylase level c. Blood urea nitrogen (BUN) level d. Thyroid-stimulating hormone level

Correct Answer d. Thyroid-stimulating hormone level Rationale:Somatropin is used to stimulate linear growth in pediatric clients who lack adequate normal human growth hormone. An adverse effect of somatropin is hypothyroidism. Therefore, thyroid function is monitored throughout therapy. Lipase and amylase levels would evaluate pancreatic function, and BUN level evaluates renal function.

A primary health care provider (PHCP) writes a prescription for digoxin, 0.25 mg daily. The nurse teaches the client about the medication and tells the client that it is most important to be sure to implement which measure? a. Count the radial and carotid pulses every morning. b. Check the blood pressure every morning and evening. c. Stop taking the medication if the pulse is faster than 100 beats/min. d. Withhold the medication and call the PHCP if the pulse is slower than 60 beats/min.

Correct Answer d. Withhold the medication and call the PHCP if the pulse is slower than 60 beats/min. Rationale:An important component of taking digoxin is to monitor the pulse rate; however, it is not necessary for the client to take both radial and carotid pulses. It is also unnecessary for the client to check the blood pressure every morning and evening because the medication does not directly affect blood pressure. It is most important for the client to know the guidelines related to withholding the medication and calling the PHCP. The client would not stop taking the medication.