Pharmy

A client has a diagnosis of major depression and began taking a selective serotonin reuptake inhibitor (SSRI) three days ago. The client says, "I am just not feeling well. My medicine is not working. Which reply by the nurse indicates adequate understanding of treatment?

You should reach desired effect in 1-3 weeks."

Normal TSH levels

0.4-4.2

A client with an ischemic stroke was prescribed warfarin 5 mg daily by mouth 48 hours ago. At 0830 the international normalized ratio (INR) reading was 2.0. What action should the nurse take? You answered this question Correctly 1. Administer warfarin. 2. Administer phytonadione. 3. Request the lab to run another INR. 4. Notify the primary healthcare provider about the INR level.

1. Correct: The nurse should continue to monitor the client, and administer the warfarin. The normal range for INR is 0.8 - 1.1 for a client not prescribed an anticoagulant. The optimal therapeutic INR range for a client on warfarin should be 2.0 - 3.0. 2. Incorrect: Phytonadione is administered to reverse the anticoagulant effects of warfarin. Since the INR is within the acceptable therapeutic INR range (2.0 - 3.0) for a client prescribed an anticoagulant, the phytonadione should not be prescribed. 3. Incorrect: The INR reading of 2.0 is not within the critical level for a client prescribed an anticoagulant. It is not necessary to notify the lab to run another INR. 4. Incorrect: There are client situations where the primary healthcare provider should be consulted. In this situation the primary healthcare provider does not need to be notified since the INR of 2.0 is within the acceptable range of a client prescribed warfarin.

Divalproex Sodium

a coordination compound of valproate and valproic acid that is used especially to treat manic episodes of bipolar disorder and absence seizures of epilepsy.

An elderly client was admitted with a diagnosis of Type II diabetes. The primary healthcare provider initiated the Insulin Sliding Scale Protocol for Type II Diabetic Clients. The prescription regimen was to begin at the low dose regimen with regular insulin every 6 hours. The 2400 hours glucose level is 252 mg/dL. How much regular insulin should the nurse give the client at this time? Answer using numbers only

Answer: 8 Rationale: Prescription: The prescription regimen was to begin at the low dose regimen with regular insulin every 6 hours using the Insulin Sliding Scale Protocol for Type II Diabetic Clients. The protocol states to advance to the next higher dose regimen if glucose level is greater than 250 two (2) times in 24 hours and all readings are greater than 100. All glucose readings were greater than 100 and greater than 250 at 1800 hours and 2400 hours, so the client should be moved to the medium dose regimen which indicates that 8 units of regular insulin should be given at 2400 hours.

The nurse is preparing to administer a dose of potassium iodide 300 mg by mouth to a client diagnosed with hyperthyroidism. The nurse has not administered this medication before and is using a drug reference to review information about the medication. Which client and drug reference information supports the nurse's decision to hold the potassium iodide dose and notify the primary healthcare provider? Exhibit You answered this question Incorrectly 1. Creatinine - 0.9 mg/dL (79.5 µmol/L) 2. Potassium- 5.5 mEq/L (5.5 mmol/L) 3. Glucose- 98 mg/dl (5.4 mmol/L) 4. Taking losartan 50 mg one by mouth daily. 5. Currently taking methimazole 10 mg by mouth daily. 6. Creatinine Clearance 110 mL/min

Potassium iodide is used along with antithyroid medicines to prepare the thyroid gland for surgical removal, to treat hyperthyroidism, and to protect the thyroid in a radiation exposure emergency. It works by shrinking the size of the thyroid gland and decreasing the amount of thyroid hormones produced. In this situation, it has been prescribed to decrease the number of thyroid hormones produced. There are lots of hints in the stem and in the exhibits. The client has hyperthyroidism, and is prescribed potassium iodide. You are asked to find evidence to support the nurse's decision to hold the potassium iodide dose and notify the primary healthcare provider. So, look at the options. Option 1: Creatinine - 0.9 mg/dL (79.5 µmol/L). The drug guide says this medication is contraindicated when there is impaired renal function. Is there impaired renal function? Not based on this creatinine level, which is normal. False. Option 2: Potassium- 5.5 mEq/L (5.5 mmol/L). According to the drug guide, hyperkalemia is a contraindication for giving potassium iodide, as it can also cause hyperkalemia. Does this value indicate hyperkalemia? Yes, it does. Now some labs say up to 5.0 is normal whereas other labs say 5.5 is normal. In either case, you need to worry about a value of 5.5, because giving potassium iodide can be a problem when the blood potassium level is this high. So, this one is true. Option 3: Is glucose discussed anywhere in the drug guide for this medication? No. Potassium iodide does not affect glucose and this is a normal glucose level. Option 4: The drug guide states, "hyperkalemia may result from combined use with potassium-sparing diuretics, Ace inhibitors, angiotensin II receptor antagonists (ARB) or potassium supplements." What is losartan? It is an ARB. True. Option 5: The drug guides states that potassium iodide increases the antithyroid effect of methimazole and propylthiouracil. This client is currently on methimazole. True 6. Incorrect: The normal creatinine clearance is 75-125 mL/min. This client has a creatinine clearance of 110 mL/min, which does not indicate poor renal function. False

Which medication should the nurse administer first after receiving the morning shift report? You answered this question Incorrectly 1. Levothyroxine to the client with hypothyroidism and a thyroid stimulating hormone (TSH) level of 2.8 mU/L 2. Amlodipine to the client with hypertension and a blood pressure of 150/86 3. Regular insulin sliding scale dose to the client with diabetes and a 210 blood glucose level. 4. Cefotaxime intravenous piggyback to the newly admitted client with a diagnosis of pneumonia and a white blood cell count (WBC) of 12,000mm3

This is a priority question, so you have to decide which client needs their medication first. If you look at these option you will see that three are really routine meds given at a set time. Only one is different. Only one is a new medication for a new admit. See it? Option 1 is false. The thyroid medication can be administered within the 30 minute time before and after the scheduled administration time. The TSH is a normal value. Option 2 is false. Although the blood pressure is elevated, the amlodipine is for high blood pressure and should be administered. It is not a priority over the first dose of the IV antibiotic. Option 3 is false. The regular insulin is important to administer but it is not priority over initiating the IV antibiotic therapy. The blood glucose level is elevated but it is not a critical value. Option 4 is true. The first dose of an intravenous antibiotic medication is the priority and should be administered within 1 to 2 hours from when the prescription was placed. This is the priority medication to administer first. The WBC count is elevated

Hemoglobin levels

males: 14-18 females: 12-16

The normal serum creatinine range in your blood and urine

is 0.6-1.1 mg/dL in women and 0.7-1.3 mg/dL in men. This test compares creatinine in your blood and urine.

Peramivir (Rapivab)

is an antiviral drug developed by BioCryst Pharmaceuticals for the treatment of influenza. Peramivir is a neuraminidase inhibitor, acting as a transition-state analogue inhibitor of influenza neuraminidase and thereby preventing new viruses from emerging from infected cells.

Which side effect of chemo should the nurse immediately report to the primary healthcare provider? You answered this question Correctly 1. Nausea 2. Fatigue 3. Paresthesia 4. Anorexia

3. Correct: Paresthesia is a side effect of some chemotherapeutic medications and if it occurs, the primary healthcare provider needs to modify the dosage or discontinue. 1. Incorrect: Nausea and vomiting are common side effects of many chemotherapeutic medications. 2. Incorrect: Fatigue is a common side effect of many chemotherapeutic medications. 4. Incorrect: Anorexia is a common side effect of many chemotherapeutic medications.

The nurse is preparing to give a client's prescribed nafcillin dose. How many mL will the nurse give to the client? Answer as a whole number.

Answer: 2 Rationale: Prescription: Nafcillin 500 mg IM every 6 hours Available: Nafcillin 2 grams in 8 mL Step 1: Convert grams to mg (1 gram = 1000 mg), so 2 grams = 2000 mg Step 2: Think, 500 mg is ¼ of 2000 mg. Look at the reconstitution instruction. Adding 6.6 mL diluent will provide 8 mL solution in the vial. So 2000 mg is in 8 mL. ¼ of 8 is 2. Step 3: D/H x Q = X 500mg/2000 mg x 8 mL = ¼ x 8/1 = 8/4 = 2 mL

The nurse has been teaching the client about warfarin for prevention of pulmonary emboli. Which comments by the client indicate understanding of the medication? You answered this question Incorrectly 1. "I must get my blood levels checked regularly." 2. "I shouldn't change my diet to include a lot of foods containing vitamin K without supervision." 3. "I should eat lots of foods containing vitamin K." 4. "I should report this medication to any primary healthcare provider that I see." 5. "I should not change the dosage without talking with my primary healthcare provider."

Do you know what warfarin is? Well you know from the stem that it is prescribed for the prevention of pulmonary emboli. How? Warfarin is an anticoagulant that reduces the formation of blood clots by inhibiting vitamin K dependent coagulation factors. So know you have an idea of what options could be correct. Let's look at them. Option 1. What do you think? True. Too much warfarin can lead to bleeding/hemorrhage. The client needs regular follow up visits to check the INR level. INR is the international normalization ratio and is used for clients taking anticoagulants. Option 2. This is true. What would happen if the client ate too much vitamin K? Vitamin K is the antidote for warfarin. So the client's INR level would not be therapeutic. Can you say pulmonary emboli?! So the client should eat a normal healthy diet, but should not increase foods containing high amounts of vitamin K. Option 3. Well if option 2 is true, can option 3 be true? No! Watch out for opposites. They cannot both be correct. Vitamin K reverses the anticoagulant effects of warfarin, so instruct the client to avoid foods high in vitamin K (examples are green leafy vegetables, brussels sprouts, prunes, cucumbers and cabbage). Option 4. This is a safety issue isn't it? Yes. This is correct. In fact, a list of all medications should be provided to any healthcare providers caring for a client. What about option 5? This is True. The client should not manipulate the dosage unless instructed by the primary healthcare provider. An identification card or bracelet may also be recommended in case of emergencies

The nurse should wear gloves when administering which medication? You answered this question Incorrectly 1. Lorazepam 1mg orally. 2. Nitroglycerin ointment 2% 0.5 inch to chest. 3. Ceftriaxone 250mg intramuscularly. 4. Metronidazole 500mg intravenous piggyback. 5. Humalog 8 units subcutaneously.

Look at each option as True or False. Option 1 is false. Gloves are not needed when the nurse is administering oral medications unless there is the chance that the nurse will come into contact with the client's mucous membranes or the medication is a biohazard medication such as an oral chemotherapeutic agent. Option 2 is true. The nurse should not allow the nitroglycerin ointment to come in contact with hands or skin to prevent accidental exposure. The medication would be absorbed into your skin. Then what will happen? Your blood pressure will drop! And you will get a headache!! Option 3 is true. Gloves should be worn with all IM injections because of the potential for contact with body fluids. Option 4 is false. Unless the nurse is preparing a biohazard medication, gloves are not needed for preparing IV piggyback medications. Option 5 is true. Gloves should be worn with all SQ injections because of the potential for contact with body fluids.

What instruction should a client know about a newly prescribed salmeterol inhaler? You answered this question Correctly 1. "Use the inhaler immediately if wheezing and shortness of breath occur during exercise." 2. "Use the inhaler when you experience a stuffy nose due to seasonal allergies." 3. "Carry the inhaler with you at all times and take 2 puffs anytime you experience an exacerbation." 4. "This inhaler should be used routinely as prescribed even when free of symptoms."

Option 1, 2, and 3 are false. Salmeterol is a beta2-agonist, a maintenance medication that clients with asthma use twice a day every 12 hours. Clients should know that if symptoms occur before next scheduled dose, use a rapid acting inhaled bronchodilator. Clients should be cautioned not to use salmeterol to treat acute symptoms. Clients using salmeterol for prevention of exercise induced bronchospasm should not use additional doses for 12 hours.

A nurse notes redness, warmth, and pain at a client's intravenous (IV) insertion site. What does the nurse suspect? You answered this question Correctly 1. Colonization 2. Phlebitis 3. Infectious disease 4. Bacteremia

So that leaves option 2. Phlebitis refers to inflammation of a vein and it can be caused by any insult to the blood vessel wall, impaired venous flow, or coagulation abnormality.Clinical evidence includes redness, heat and pain. These signs and symptoms show that the client is experiencing a localized inflammation such as phebitis. Look at option 1. Colonization is used to describe microorganisms present without host interference or interaction. There is an absence of tissue invasion or damage. Is there an absence of tissue damage in this stem? No, we see that there is redness, warmth, and pain at the IV insertion site. So option 1 is false. Option 3 is infectious disease. Infectious disease is the state in which the infected host displays a decline in wellness due to the infection. Clinical signs and symptoms may or may not be present. Is there any indication in the stem that the client is not well due to the signs and symptoms provided? No. Option 4 is bacteremia. Bacteremia is determined by presence of bacteria in the bloodstream. Bacteremia can lead to sepsis and signs and symptoms such as fever, hypothermia, tachycardia, tachypnea and inadequate blood flow to internal organs. There are no s/s identified in the stem that would indicate bacteremia

A client diagnosed with rheumatoid arthritis has been prescribed dexamethasone orally as part of treatment therapy. What side effects should the nurse inform the client are expected? You answered this question Incorrectly 1. Fatigue 2. Insomnia 3. Hypoglycemia 4. Truncal obesity 5. Increased appetite 6. Low blood pressure

These "select all that apply" questions can seem a bit intimidating at first, but the more you practice the basics, the better you will feel when faced with multiple options. Always start with the clues provided in the question. The client is being treated for RA, an auto-immune, inflammatory disease process which damages joints and organs in the body. Because there is no cure, the goal of treatment is to stop, or decrease, the inflammatory response in order to preserve joint and organ function while improving physical mobility. RA clients are treated with combinations of drug categories to achieve possible remission of the disease process. Some of these categories include NSAIDS, like ibuprophen or naproxen, disease modifying anti-rheumatic drugs (DMARDs) such as methotrexate, and short term corticosteroids like methylprednisolone (Medrol). The client in this question has been placed on dexamethasone (Decadron) which falls in the corticosteroid category. Recall what happens to the body when the adrenal glands are over producing glucocorticoids, as in Cushing's disease. The symptoms are the same when a client is taking corticosteroids, regardless of the reason. Steroids are prescribed when inflammation becomes very severe, and, because of the adverse side effects, the treatment is usually short term. But even over a period of a few weeks, the client can develop significant symptoms. Option 1: Good choice! There are many side effects from the use of steroids, and fatigue is one of the chief client complaints because interruption of sleep is common. Many things can contribute to a client's exhaustion, including not sleeping well, constant pain, and systemic response to an auto-immune process. Additionally, the use of steroids increases catabolism in the body, exacerbating all body responses and leaving the client very fatigued. Option 2: Absolutely. Steroids speed up normal body processes, including vital signs, appetite and gastric function. Additionally, corticosteroids wreak havoc on the adrenal glands, which you remember control the "fight and flight" response, making it very difficult for this client to relax and rest properly. The client may have great difficulty getting to sleep or staying asleep, creating an on going cycle of fatigue and even depression. This is why this medication is given early in the day or, in the case of multiple daily doses, the largest dose is given first thing in the morning. Option 3: Not this one. Did you notice it said "hypo", indicating low blood sugar? Recall that the action of excessive corticosteroids on the adrenal glands is the body's inability to regulate all that glucose, and therefore the client would become hyperglycemic. In addition to all the other problems caused by RA, think about what happens to the body when blood sugar is too high. Do you think the nurse might also reinforce client teaching on finger sticks for blood glucose monitoring? Consider all the ways the body could be adversely affected if blood sugar is not controlled. Option 4: Another good selection. Clients with RA will be prescribed systemic corticosteroids in some form intermittently for life, whenever the disease exacerbates. The drugs may be oral, injected, or even by infusion but the body's response is similar to Cushing's disease. Truncal obesity occurs because of redistribution of body fat while very thin extremities develop because of muscle wasting. This client might develop the buffalo hump as well if steroids are used long term. Option 5: Yes! When body processes are accelerated, whether by disease or medications, an increased appetite is the logical response. It is a complicated process, but the basic version is that the corticosteroids stimulate the release of amino acids and breakdown of fats. Remembering your nursing anatomy and physiology, and the gluconeogenesis process, the body's increase in blood sugar levels also increases the appetite for more sugar and starches. Option 6: Nope. We have been describing the acceleration of the body when given corticosteroids, so it is not logical to expect blood pressure to decrease. In fact, high blood pressure is often a problem for clients when taking these medications. Steroids influence the balance of water and sodium in the body, leading to fluid retention and even CHF. Don't forget this client will also be experiencing a weight gain, which will contribute to elevated blood pressure readings.

The nurse is reinforcing client education on zolpidem. Which statement by the client indicates to the nurse that the client understands important points about zolpidem? You answered this question Incorrectly 1. "There is a high potential for tolerance with this medication." 2. "I may do things in my sleep that I will not remember the next day." 3. "Daytime drowsiness is rare when taking this medication." 4. "The most common side effects of this medication are confusion and a bitter aftertaste."

Zolpidem is a sedative, also called a hypnotic. It affects chemicals in the brain that may be unbalanced in people with sleep problems (insomnia). Zolpidem may impair the client's thinking or reactions. The cleint may still feel sleepy the morning after taking this medicine, especially if taking the extended-release tablet. Wait at least 4 hours or until fully awake before doing anything that requires being awake and alert. Some people using this medicine have engaged in activity such as driving, eating, walking, making phone calls, or having sex and later having no memory of the activity.

paresthesia

abnormal tactile sensation often described as creeping, burning, tingling, or numbness

Akathisia

restlessness

The nurse is caring for a client on the medical unit. The primary healthcare provider prescribed Lactulose 30 gram orally once a day. Available is Lactulose labeled 10 g per 15 mL. How many mL will the nurse administer? Round answer to the nearest whole number.

10 g : 15 mL = 30 g : x mL 10 x = 450 x = 45

A postpartum client is receiving methylergonovine maleate 0.2 mg by mouth three times a day. What is most important for the nurse to monitor with this client? You answered this question Correctly 1. Dizziness 2. Hypertension 3. Nausea and vomiting 4. Headache

2. Correct: Methylergonovine affects smooth muscle of a woman's uterus. It improves muscle tone and strength. It is used after childbirth to help deliver the placenta. Cardiovascular side effects have included palpitations, hypertension, hypotension, acute myocardial infarction, transient chest pains, arterial spasm (coronary and peripheral), bradycardia, and tachycardia. These need to be reported to the primary healthcare provider. 1. Incorrect: Dizziness is a rare side effect and not as life threatening as hypertension. 3. Incorrect: Nausea and vomiting are minor signs and symptoms and not as life threatening as hypertension. 4. Incorrect: Headache is a minor symptom and not as life threatening as hypertension.

You have an order to administer a pediatric medication according to the client's weight in kilograms (kg). The client's weight this morning was 64 pounds (lb). You would calculate the medication dosage after determining that this client's weight in kg is? (Round to the nearest tenth) You answered this question Incorrectly Enter the answer for the question below.

2.2 lb : 1 kg = 64 lb : x kg 2.2 x = 64 x = 29.1

What is most important for the nurse to ensure prior to administering Peramivir?

Creatinine clearance is greater than 50 mL/min.

The nurse is preparing to give a client's prescribed azithromycin dose. How many tablets will the nurse give to the client? Answer with numbers only. Exhibit You answered this question Correctly Enter the answer for the question below.

Answer: 2 Rationale: Prescription: Azithromycin 1 gram by mouth times one dose now Available: Azithromycin 500 mg/tablet Step 1 is to convert grams to mg (1 gram = 1000 mg) Step 2: Think, 1 tablet is 500 mg and you need to give 1000 or twice the amount that is available. Step 3: D/H x Q = X 1000mg/500 mg x 1 tablet = 2/1 = 2 tablets

A client diagnosed Alzheimer's disease has been prescribed memantine. The nurse is reinforcing education about this medication. What points should the client know about this medication? You answered this question Incorrectly 1. When beginning this medication provide ambulatory assistance. 2. This medication is prescribed to help improve mild dementia. 3. This medication must be taken without food. 4. If a dose is missed, double the next dose. 5. If the client cannot swallow the capsule you sprinkle on applesauce.

1. & 5. Correct: This medication can cause dizziness, so safety precautions should be taught to the caregiver. Extended release caps should not be crushed, chewed, or divided. If the client cannot swallow it whole, it can be opened and sprinkled on a small amount of applesauce. 2. Incorrect: Memantine is used for moderate to severe dementia associated with Alzheimer's disease. 3. Incorrect: Memantine can be taken with or without food. 4. Incorrect: If the client misses a single dose of memantine, that client should not double up on the next dose. The next dose should be taken as scheduled.

The client has been taking divalproex for the management of bipolar disorder. The nurse should give priority to monitoring which laboratory test? You answered this question Correctly 1. Alanine aminotransferase (ALT) 2. Serum glucose 3. Serum creatinine 4. Serum electrolytes

1. Correct: ALT levels will increase primarily in liver damage/disorders. A side effect of administering divalproex is drug-induced hepatitis. 2. Incorrect: Divalproex is not expected to alter glucose metabolism. 3. Incorrect: Divalproex should not cause a change in renal function. 4. Incorrect: Divalproex should not interfere with electrolytes balance

On morning rounds, the nurse finds a somnolent client with a blood glucose of 89 mg/dL(4.9 mmol/l). A sulfonylurea and a proton pump inhibitor are scheduled to be administered. What is the nurse's best action? You answered this question Incorrectly 1. Give proton pump inhibitor and hold sulfonylurea until client eats 2. Hold medications and notify the primary healthcare provider 3. Arouse the client and give some orange juice with sugar packets added 4. Give the medications as ordered and re-check blood sugar in one hour

1. Correct: Hold sulfonylureas for BS <100 until the client eats. 2. Incorrect: No need to call the primary healthcare provider, you are just waiting until the client eats. 3. Incorrect: Not hypoglycemia, don't treat unless lower than 70-80 range. 4. Incorrect: No, if you give it, you are going to make them secrete insulin from their pancreas and the blood sugar will drop and they will get hypoglycemic.

The nurse is caring for a client taking digoxin. Which electrolyte imbalance should be of most concern? You answered this question Correctly 1. Hypokalemia 2. Hyponatremia 3. Hypomagnesemia 4. Hypocalcemia

1. Correct: The serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity could occur. 2. Incorrect: Hyponatremia, hypomagnesemia, and hypocalcemia do not interfere with digoxin. Any electrolyte imbalance can predispose the client to digoxin toxicity, but hypokalemia is the imbalance that can potentiate digoxin toxicity the most. 3. Incorrect:Hyponatremia, hypomagnesemia, and hypocalcemia do not interfere with digoxin. Any electrolyte imbalance can predispose the client to digoxin toxicity, but hypokalemia is the imbalance that can potentiate digoxin toxicity the most. 4. Incorrect: Hyponatremia, hypomagnesemia, and hypocalcemia do not interfere with digoxin. Any electrolyte imbalance can predispose the client to digoxin toxicity, but hypokalemia is the imbalance that can potentiate digoxin toxicity the most.

Two days after being prescribed enoxaparin the nurse notes hematemesis. Lab work has been obtained. Based on this data what action is most important for the nurse to take? Exhibit You answered this question Incorrectly 1. Administer protamine sulfate. 2. Administer the next dose of enoxaparin. 3. Obtain vital signs. 4. Insert a nasogastric tube.

1. Correct: This client has a low hgb, hct, and platelet count and is actively bleeding. Protamine sulfate is the antidote for enoxaparin. 2. Incorrect: Administering another dose of enoxaparin would make the problem worse. The client is actively bleeding and has a low platelet count. 3. Incorrect: The client is actively bleeding. Obtaining vital signs is delaying treatment. The client needs protamine sulfate. 4. Incorrect: The client needs protamine sulfate to correct the problem CBC Guaiac stool: + for occult blood Hemaglobin: 10.0 g/dL Hematocrit: 40% RBCs: 4.5 Platelets: 90,000

What problem in the client with chronic renal failure would be prevented by receiving epoetin alfa? You answered this question Correctly 1. Anemia 2. Halitosis 3. Edema 4. Pain

1. Correct: Yes, the diseased kidney does not produce the hormone necessary for bone marrow stimulation to promote RBCs. Epoetin alfa stimulates erythropoiesis (production of RBC). 2. Incorrect: No affect in breath odor. 3. Incorrect: No affect in edema. 4. Incorrect: Does not help with pain.

The nurse is reinforcing client education about timolol maleate. What should the client know about the newly prescribed timolol maleate eyedrops for glaucoma? You answered this question Correctly 1. The medication works by causing the pupils to constrict. 2. The medication will dilate the canals of Schlemm. 3. This medication decreases the production of aqueous humor. 4. The medication improves ciliary muscle contraction.

1. Look at each option as True or False. 2. Option 1 in false. Miotics are medications that cause pupillary constriction such as pilocarpine. The action of miotics are to increase aqueous fluid outflow by contracting ciliary muscle and causing miosis (constriction of the pupil) and opening of the trabecular network. 3. Option 2 is false. The canal of Schlemn may be widened by laser trabeculoplasty to promote outflow of aqueous humor and decrease IOP. 4. Option 3 is true. Timolol maleate is a beta-blocker. Beta-blockers decrease aqueous humor production. 5. Option 4 is false. Ciliary muscle contraction is affected by cholinerigcs causing an increase in the outflow of aqueous humor through a larger opening between the iris and the trabecular meshwork.

Which signs and symptoms would indicate to the nurse that the client is having an anaphylactic response after receiving penicillin? You answered this question Correctly 1. Reports a scratchy throat 2. Faint expiratory wheeze on auscultation. 3. Client statement, "I feel like something is wrong." 4. Bounding radial pulse rate of 100/min 5. BP 100/70

1., 2. & 3. Correct: Swelling of face, mouth, throat, and a scratchy throat are indicative of an inflammatory response that could obstruct the airway. Wheezes and stridor are indicators of breathing difficulties seen with anaphylactic reaction. A sense that something bad is happening should serve as a warning that something bad is really going on. Suspect anaphylactic response. 4. Incorrect: The pulse rate would be increased, but the client would have a thready, weak pulse, not bounding. The pulse may also be irregular. 5. Incorrect: This blood pressure is not below 90 systolic which could indicate shock. Although on the low side, simply getting this BP reading does not tell you if perfusion is adequate. Once blood pressure decreases, other symptoms may appear such as dizziness, blurred vision and loss of bladder/bowel control.

A client is taking methylphenidate to treat attention deficit disorder. Which changes are likely to be observed by the nurse when working with this client? You answered this question Incorrectly 1. Decreased intake of food 2. Calmer demeanor 3. Increased attention span 4. Increased activity level 5. Insomnia

1., 2., 3. & 5. Correct: The medication may cause anorexia and subsequent weight loss. The client should be calmer if taking the medication as prescribed. The client's ability to focus on the task at hand should be increased. Insomnia is common. 4. Incorrect: The client's activity level should be decreased compared to behavior seen before the medication was prescribed

The nurse is caring for a client receiving digoxin. What information should be reinforced by the nurse to the client about this medication? You answered this question Incorrectly 1. Check your pulse daily before taking the medication. 2. Report a marked decline in pulse rate. 3. Consume foods high in potassium to maintain adequate serum potassium levels. 4. Report pulse rate of 64 or more. 5. Report symptoms of nausea, loss of appetite, or visual disturbances.

1., 2., 3., & 5. Correct: The client should be told to take his pulse daily to assure pulse rate is above 60. Any marked decline in pulse rate should be reported as it could indicate heart block or toxicity. Digoxin works best when potassium levels are adequate. Symptoms of toxicity include anorexia, nausea, bradycardia, visual disturbances. 4. Incorrect: Only when the pulse rate is below 60 should the client be concerned about not taking the medication as prescribed.

What actions would be appropriate for a nurse who is administering ear drops to a six year old child? You answered this question Incorrectly 1. Position supine with affected ear up. 2. Administer ear drops immediately upon removing from the refrigerator. 3. Open ear canal by drawing back on the pinna and slightly downward. 4. Allow prescribed number of drops to fall along inside of ear and flow into ear by gravity. 5. Have client remain supine for several minutes.

1., 4., & 5. Correct: Supine with affected ear up allows for proper administration of medication. Never attempt to put drops directly on the eardrum. Administer along inside of ear so that drops flow by gravity into ear. Remaining supine for several minutes permits the fluid to be absorbed. 2. Incorrect: If medication is not instilled at room temperature, the client may experience vertigo, dizziness, pain, and nausea. Additionally, cold ear drops cause discomfort. 3. Incorrect: This is the method for a child less than 3 years of age. For older than 3 years, open canal of ear by drawing back on the pinna and slightly upward.

A client was started on haloperidol 5 days ago, the nurse notes restlessness, muscle weakness, drooling, and a shuffling gait. What should be the nurse's first action? You answered this question Incorrectly 1. Hold the next haloperidol dose. 2. Administer the prn benztropine mesylate. 3. Notify the primary healthcare provider to discontinue the haloperidol. 4. Draw a blood sample for drug level.

2. Correct: Benztropine mesylate is an anticholinergic that counteracts the extrapyramidal symptoms (EPS) seen with the use of haloperidol. 1. Incorrect: Holding a single dose of haloperidol does not correct the extrapyramidal symptoms. 3. Incorrect: The primary healthcare provider has prescribed benztropine mesylate to combat the side effects of the haloperidol. There is no need to notify the primary healthcare provider, which will delay treatment. 4. Incorrect: The client is showing extrapyramidal symptoms associated with haloperidol therapy. Benztropine mesylate is an anticholinergic agent that can be used to treat the extrapyramidal effects that may be seen as a side effect of haloperidol therapy.

The son of a client diagnosed with Alzheimer's Disease who is listed as a person who has access to the client's health information asks the nurse why his father has been prescribed donepezil. What response should the nurse make? Exhibit You answered this question Correctly 1. "Depression is often treated with this medication." 2. "This medication is used to treat confusion." 3. "Behavioral problems are diminished when the client receives this medication." 4. "This medication will address sleep disturbances."

2. Correct: Donepezil is a cholinesterase inhibitor. It improves the function of nerve cells in the brain. It works by preventing the breakdown of acetylcholine. People with dementia usually have lower levels of this chemical, which is important for the processes of memory, thinking, and reasoning. Donepezil is used to treat mild to moderate dementia caused by Alzheimer's disease. 1. Incorrect: Common antidepressant medications used for treating depression related to Alzheimer's are the selective serotonin reuptake inhibitors (SSRIs). 3. Incorrect: Antipsychotics and Benzodiazepines are used for behavioral problems such as agitation, physical aggression, and disinhibition. 4. Incorrect: Zolpidem is the most common prescription used to help with sleep disturbance found in the client diagnosed with Alzheimer's Disease.

A client has recently been diagnosed with rheumatoid arthritis. The nurse anticipates which class of pharmacologic agents will likely be a part of the client's treatment regimen? You answered this question Correctly 1. Mitotic inhibitors 2. Systemic glucocorticoids 3. Antifungals 4. Anticoagulants

2. Correct: Glucocorticoids (steroids) are an appropriate pharmacologic treatment for rheumatoid arthritis. Other treatment options include the use of NSAIDs, biologic and nonbiologic DMARDs (methotrexate and others). Remember, all the other problems associated with the use of steroids. 1. Incorrect: Mitotic inhibitors are a class of chemotherapeutic agents and are not indicated for the treatment of rheumatoid arthritis. Medications in this class include plant alkaloids (vincristine) and taxanes (paclitaxel). 3. Incorrect: Antifungals are not indicated for the treatment of rheumatoid arthritis. Rheumatoid arthritis is an autoimmune disease, not associated with a fungal disorders. 4. Incorrect: Anticoagulants are indicated for the treatment and prevention of thrombolytic disease and are not indicated for the treatment of rheumatoid arthritis. Salicylate (aspirin), an antiplatelets, may be used as an anti-inflammatory agent.

What is the most important goal of care for a client who is receiving warfarin? You answered this question Incorrectly 1. Be compliant with dietary restrictions. 2. Maintain a therapeutic prothrombin time. 3. Be compliant with medication dosage daily. 4. Avoid other anticoagulant medications.

2. Correct: Goal of therapy is to prevent thrombus formation. A therapeutic prothombin (PT) , international normalized ratio (INR) is the best indicator of the ability to avoid this. 1. Incorrect: Avoiding foods rich in Vitamin K will help maintain a therapeutic INR, but is not the most important goal of therapy. This answer is a broader indicator that other interventions are being carried out. 3. Incorrect: Compliance is another area that ensures the therapeutic level but, is not the best goal overall 4. Incorrect: Avoiding other anticoagulants will aid in a therapeutic level but, is not the best goal.

The nurse is caring for a client admitted to rule out myocardial infarction. The nurse has administered sublingual nitroglycerin. What time frame should the nurse expect the earliest onset of effectiveness? You answered this question Incorrectly 1. 15 seconds 2. 3 minutes 3. 5 minutes 4. 15 minutes

2. Correct: The onset of action for nitroglycerin sublingual is 1 to 3 minutes. So the effectiveness can be assessed 3 minutes after the drug is administered. 1. Incorrect: This time frame is too short for the onset of action of nitroglycerin given sublingual. 3. Incorrect: Sublingual doses of nitroglycerin can be repeated every 5 minutes. The drug would start to be effective before 5 minutes. 4. Incorrect: Fifteen minutes would be to long to wait to assess the effectiveness of nitroglycerin sublingual, in a client suspected of a myocardial infarction.

After discontinuing a peripheral IV line, it is most important for the nurse to record which information? You answered this question Incorrectly 1. How the client tolerated the procedure. 2. The length and intactness of the catheter tip. 3. The amount of fluid left in the IV solution container. 4. That a dressing was applied to the insertion site.

2. Correct: This is the most important information that needs to be documented. This information would be important in determining if a potential safety issue/complication could occur as a result of the IV line being removed or a portion of the catheter tip breaking off before removal. 1. Incorrect: This is not the most important information that needs to be documented. There are no client safety issues with charting the client's tolerance of the procedure. 3. Incorrect: This would be charted so the intake and output could be calculated. This is not the most important data that needs to be documented related to the removal of the IV line. 4. Incorrect: This would need to be documented because a dressing is applied to the insertion site after removal. However, this is not the most important data that would need to be documented after this procedure.

A client with a history of adrenal insufficiency is placed on fludrocortisone. Which value is most important for the nurse to monitor? You answered this question Incorrectly 1. Magnesium 2. Weight 3. Pain 4. Glucose

2. Correct: Weight is monitored daily to check for sudden increases which would indicate fluid retention. Fludrocortisone is a man made glococorticoid and is used to treat low gloucocorticoid levels caused by diseases of the adrenal gland. Glucocorticoids are important in maintaining salt and water balance in the body and normalizing blood pressure. 1. Incorrect: No, monitor for lowered serum potassium instead of magnesium because fludrocortisone causes the body to retain sodium, and excrete calcium and potassium. 3. Incorrect: Adrenal insufficiency and steroid therapy are not precursors of pain. 4. Incorrect: Glucose may increase as a result of steroid therapy as glucocorticoids inhibit insulin. But, weight is the critical value to monitor for dosing, as treatment may be discontinued with a sudden weight increase.

The nurse is caring for a client diagnosed with Addison's disease. Which finding would indicate to the nurse that a client has received excessive mineralocorticoid replacement? You answered this question Incorrectly 1. Oily skin 2. Weight gain of 4 pounds in one week 3. Loss of muscle mass in extremities 4. Blood glucose of 58 mg/dL 5. Serum potassium of 3.2 mEq

2., & 5. Correct: Remember that aldosterone is a mineralocorticoid, which causes the client to retain sodium and water. Retaining sodium and water will cause the client's weight to increase. Also remember, any sudden gain in weight is due to water retention. Too much aldosterone makes you retain too much sodium and water and lose potassium. Normal potassium is 3.5-5.0 mEq/L, so a lowering of potassium could indicate high levels of aldosterone. 1. Incorrect: Oily skin would be seen with an increase in sex hormones such as testosterone and estrogen. Oily skin is not common with mineralocorticoids like aldosterone. 3. Incorrect: Too many glucocorticoids will cause the breakdown of protein and fat but muscular weakness and increased fatigue is seen with too little mineralocorticoids. 4. Incorrect: Too many glucocorticoids will inhibit insulin, causing the serum blood glucose level to go up. Normal blood glucose is 70-110.

A client who has Parkinson's disease has a new prescription for benztropine. What does the nurse reinforce to the client about this medication? You answered this question Incorrectly 1. This medication blocks dopamine in the brain to decrease tremors and muscle stiffness. 2. The client should notify their primary healthcare provider if urinary retention develops. 3. Benztropine can reduce the ability to sweat, so do not become overheated. 4. No lab tests are needed while taking this medication. 5. Sit up or stand up slowly to prevent lightheadedness.

2., 3., & 5. Correct: Urinary retention is a side effect of benztropine. Benztropine can reduce the ability to sweat and cause the body to overheat. Do not become overheated in hot weather or while you are being active because heatstroke may occur. Benztropine may cause dizziness, lightheadedness, or fainting. Alcohol, hot weather, exercise, or fever may increase these effects. To prevent these negative effects, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects. 1. Incorrect: Benztropine is an anticholinergic. It works by decreasing the effects of acetylcholine, a chemical in the brain. This results in decreased tremors or muscle stiffness, and helps improve walking ability for clients with Parkinson's disease. 4. Incorrect: Lab tests, including liver function, kidney function, lung function, blood pressure, fasting blood glucose, and blood cholesterol, may be performed while using benztropine. These tests may be used to monitor the client's condition or check for side effects

After drawing up insulin for subcutaneous administration, the nurse receives a return phone call from a primary healthcare provider who wants to give prescription orders on a new admit. The nurse asks a new nurse to administer the insulin dose. What action should the new nurse take? You answered this question Correctly 1. Administer the insulin dose to the client. 2. Consult with the charge nurse about administering the insulin dose to the client. 3. Tell the nurse that whoever draws up the medication has to administer that medication. 4. Offer to take the call from the primary healthcare provider so the nurse can administer the insulin.

3. Correct: A nurse can only administer medication that has been drawn up by that nurse. It is not acceptable practice to administer a medication drawn up by another nurse. 1. Incorrect: The nurse who gives this medication does not really know what was drawn up. It could be the wrong medication, the wrong dose, the wrong time. A nurse can only administer medication that has been drawn up by that nurse. 2. Incorrect: There is no need to consult the charge nurse because the new nurse should not administer the medication that has been drawn up by another nurse. 4. Incorrect: The nurse should first take the return phone call from the primary healthcare provider and then administer the insulin yourself.

Which medication does the nurse expect will help decrease tremors in a client diagnosed with hyperthyroidism? You answered this question Correctly 1. Steroids 2. Anticonvulsants 3. Beta blockers 4. Iodine compounds

3. Correct: Beta blockers help anxiety and tremors. Beta blockers reduce the effects of adrenaline in the body and help decrease anxiety. In times of stress and emergency the adrenal gland produces adrenaline that acts on various organs in the body to enable us to deal with the situation. For example, the heart beats faster due to adrenaline. In order for adrenaline to be able to do this, various organs have beta receptors to accept the adrenaline and use it to behave differently in times of stress. Beta blockers block these receptors. They stop various organs in the body from accepting adrenaline. Taking them means the heart does less work generally and doesn't get over-worked in times of stress. One of the main symptoms of anxiety is a speeding heart which is part of the fight-or-flight response. In times of danger our body produces adrenaline to stop the heart from beating faster makes us feel calmer. Taking beta blockers for anxiety also makes us feel less shaky. The energy boost to our muscles (from the increased supply of blood and oxygen) which makes us feel 'jittery' and 'on-edge' doesn't happen without a fast heartbeat. 1. Incorrect: Steroids influence the body system in several ways, but they are used mostly for their strong anti-inflammatory effects and in conditions that are related to the immune system function such as arthritis, colitis (ulcerative colitis, and Crohn's disease), asthma, bronchitis. Steroids are used to treat systemic lupus, severe psoriasis, leukemia, lymphomas, idiopathic thrombocytopenic purpura, and autoimmune hemolytic anemia. These corticosteroids also are used to suppress the immune system and prevent rejection in people who have undergone organ transplant as well as many other conditions. 2. Incorrect: Anticonvulsants are used to normalize the electrical activity in the brain which in turn reduces the risk of seizures. But anticonvulsants have also been shown to work on mood disorders such as depression or mania. Anticonvulsants help increase the naturally occurring nerve calming chemical known as GABA while decreasing the nerve exciting chemical known as glutamate. Tremors can actually be a side effect of anticonvulsants. 4. Incorrect: Iodine compounds decrease the production of thyroid hormones in the treatment of hyperthyroidism. It does not have an effect on tremors.

A female client has used Depo-Provera injections for birth control for several years. For the past 6 months, attempts to become pregnant have been unsuccessful. What information should the nurse provide the client? You answered this question Correctly 1. A primary healthcare provider who specializes in this problem should be seen. 2. Have a sperm count performed on the client's partner. 3. Ovulation may not occur for many months after using Depo-Provera. 4. Ensure proper nutrition, rest, and establish an exercise program.

3. Correct: Ovulation ceases with Depo-Provera use. It may take 6 to 18 months to reestablish normal ovulation and menstruation. 1. Incorrect: A fertility workup for the client and her partner may be warranted after adequate time to reestablish ovulation has passed. 2. Incorrect: A sperm count on the client's partner may be warranted after adequate time to reestablish ovulation has passed. 4. Incorrect: Good nutrition, rest, and exercise are important for all individuals, but does not apply to this client's concerns.

The nurse is caring for a client who is taking an antipsychotic medication for the treatment of schizophrenia. The nurse is told in report that the client has akathisia, as a side effect of their antipsychotic medication. What symptom should the nurse expect this client to have? You answered this question Incorrectly 1. Upward gaze of the eyes. 2. Involuntary movement of the tongue. 3. Reports of restlessness. 4. Lack of movement or slowed movement.

3. Correct: Reports of restlessness, inability to sit still, and nervous energy indicate akathisia. These symptoms respond poorly to treatment. If possible, the dose of the medication may be reduced. 1. Incorrect: Upward gaze of the eyes indicates dystonia, a possible adverse reaction to the antipsychotic medications. 2. Incorrect: Tardive dyskinesia has the symptoms of involuntary movement of the tongue, chewing movements of the mouth, and lip smacking. These symptoms may be irreversible. 4. Incorrect: Slowed movement refers to the side effect of bradykinesi

One hour after administering pyridostigmine, the nurse notes increased salivation, lacrimation, and urination in the client. What initial action should the nurse take? You answered this question Correctly 1. Administer a second dose of pyridostigmine. 2. Place client in side lying position. 3. Notify the primary healthcare provider. 4. Prepare for intubation and mechanical ventilation.

3. Correct: These are signs and symptoms of cholinergic crisis. The client can get increasingly worse. The primary healthcare provider can prescribe atropine as treatment of overdose. 1. Incorrect: Giving an additional dose of pyridostigmine will make the client worse. 2. Incorrect: For better respiratory effort the client should be placed in a semi fowler's position. 4. Incorrect: This can be done after notifying the primary healthcare provider

What should the nurse know when caring for a client diagnosed with Grave's disease who is scheduled to receive radioactive iodine? You answered this question Incorrectly 1. Stay 6 feet from people for 2 weeks. 2. This medication is given intravenously as a one-time dose. 3. Radioactive iodine will leave the body in urine and saliva within a few days. 4. You cannot receive radioactive iodine if you are pregnant. 5. Radioactive iodine is absorbed by the parathyroid glands.

3., & 4. Correct: Within a few days after treatment, the radioactive iodine will leave the body in urine and saliva. If the client is pregnant, she should not receive radioactive iodine treatment. This kind of treatment can damage the fetus's thyroid gland or expose the fetus to radioactivity. Women should wait a year before conceiving if they have been treated with radioactive iodine. 1. Incorrect: Stay away from babies for 1 week and do not kiss anyone for 1 week. 2. Incorrect: Radioactive iodine is given in a capsule or liquid form. One dose is usually all that is needed. 5. Incorrect: Radioactive iodine is absorbed by the thyroid gland. It destroys the thyroid. So now the client becomes hypothyroid.

The nurse is caring for a client admitted with an episode of bleeding esophogeal varices. What should the nurse monitor for after administering propranolol to this client? You answered this question Incorrectly 1. Increased systolic BP 2. Hypokalemia 3. Bradycardia 4. Wheezing 5. Decreased hematemesis

3., 4., & 5. Correct: Propranolol is a beta blocker that affects the heart and circulation. It is used in the treatment of high blood pressure, irregular heartbeats and in the prevention of angina and headaches. This medication works by blocking epinephrine and reduces heart rate, blood pressure and strain on the heart. Decreasing the heart rate should decrease bleeding. Wheezing is an adverse reaction from propranolol and should be monitored for after administration. A decreased in heart rate and blood pressure will help to decrease bleeding. Hematemesis is vomiting blood. 1. Incorrect: Blood pressure is the force of blood flow against the walls of your arteries. Propranolol should decrease blood pressure, thus decreasing bleeding. 2. Incorrect: Beta blockers inhibit renin release which can decrease the release of aldosterone. We should monitor for hyperkalemia, rather than hypokalemia.

A client with heart failure and pulmonary edema is given furosemide IM. Which data indicates the furosemide has achieved the desired effect? You answered this question Incorrectly 1. Weight has decreased 2 pounds 2. Systolic blood pressure has decreased 3. Urinary output has increased 4. Lungs have fewer rales on auscultation.

4. Correct: The goal for diuretic therapy in this client is to prevent/relieve fluid accumulation in the lungs. This answer addresses the most life threatening sequelae with heart failure (HF). The number one thing to "worry" about in clients with HF is pulmonary edema because this is what can kill the client. 1. Incorrect: Weight loss is a good check of fluid loss or gain, especially acute weight changes. The stem of the question, however asks "which is the desired effect"? The desired effect is to decrease fluid in the lungs. 2. Incorrect: Lowered blood pressure is an expected finding, but prevention of pulmonary edema is the primary goal. 3. Incorrect: Increased urinary output is an expected finding, but prevention of pulmonary edema is the primary goal.

A client who has chronic renal failure has been prescribed synthetic erythropoietin for the prevention of anemia. Which data should be reported to the primary healthcare provider? You answered this question Incorrectly 1. Hemoglobin level of 10 g/dL (1.6 mmol/L) 2. Blood pressure of 120/84 3. Constipation 4. Swelling of feet and ankles

4. Correct: Erythropoietin is generally well tolerated. Swelling of feet and ankles may indicate the beginning of a cardiovascular problem. Clients taking this drug are at risk for myocardial infarctions and risk of blood clots. 1. Incorrect: The purpose of this drug is to increase hemoglobin levels. A level of 10g/dL (1.6 mmol/L) would be considered favorable even though still low. The client would still need the medication since anemia still exists. If hgb is above 12 g/dL (1.9 mmol/l), the level should be reported as the client does not need the med any longer. 2. Incorrect: An elevated blood pressure is one of the more common and major side effects. If elevated it should be reported, but this blood pressure is within normal limits. 3. Incorrect: Constipation may be caused by iron preparations. Increasing fiber in the diet may improve that symptom. A common side effect of synthetic erythropoietin is darrhea

The nurse enters the client's room to administer the morning dose of digoxin. Before administration, the nurse checks the client's apical pulse to find the rate to be 70. What should the nurse do? You answered this question Correctly 1. Hold the medication as the pulse rate is too low. 2. Wait 30 minutes and attempt to give the medication again. 3. Contact the primary healthcare provider. 4. Give the medication as prescribed.

4. Correct: The pulse rate is high enough to give the medication. A pulse rate of less than 60 would warrant holding the medication. 1. Incorrect: There is no need to hold the medication as the heart rate is above 60. 2. Incorrect: There is no need to wait to administer the medication with a heart rate of 70. 3. Incorrect: Calling the primary healthcare provider is not indicated. The heart rate is above 60.

The nurse is preparing to administer nadolol to a hospitalized client. Which client data would indicate to the nurse that the medication should be held and the primary healthcare provider notified? You answered this question Incorrectly 1. Blood pressure 102/68 2. Glucose 118 3. Urinary output (UOP) 440 mL over previous 8 hour shift. 4. Heart rate 56/min

4. Correct: This is a beta blocker. It slows the heart rate. If a client's heart rate is less than 60 beats per minute, notify the primary healthcare provider and ask if the client should receive this medication. Administering a beta blocker to a client who has a heart rate less than 60 could possibly cause the client to develop symptomatic bradycardia and hypotension. 1. Incorrect: If the client's BP drops below 90/60, this beta blocker should be held and the primary healthcare provider notified. The BP in this option is high enough to administer the medication, but the BP in clients on beta blockers should be monitored and the client should be taught about signs and symptoms of hypotension. 2. Incorrect: This is a normal glucose level. If the client is a diabetic, beta blockers can mask the signs of hypoglycemia. Diabetics on beta blockers should monitor their blood sugar carefully. 3. Incorrect: Urinary output is adequate. Beta blockers do not alter renal function. However, if pulse and BP are reduced too much, renal perfusion could ultimately be affected.

Normal creatinine clearance

88-128 mL/min for healthy women and 97-137 mL/min for healthy men

Gloucocorticoids

: A hormone that predominantly affects the metabolism of carbohydrates and, to a lesser extent, fats and proteins (and has other effects). beclomethasone. betamethasone. budesonide. cortisone. dexamethasone. hydrocortisone. methylprednisolone. prednisolone.

A client with an ischemic stroke was prescribed warfarin 5 mg daily by mouth 48 hours ago. At 0830 the international normalized ratio (INR) reading was 2.0. What action should the nurse take? You answered this question Correctly 1. Administer warfarin. 2. Administer phytonadione. 3. Request the lab to run another INR. 4. Notify the primary healthcare provider about the INR level.

A clue is the use of a word or phrase that leads you to the correct answer. First let's identify the key words in the stem. The key words are ischemic stroke, warfarin, and international normalized ratio (INR). Also, there is an INR value of 2.0. This question is asking if the INR value of 2.0 is within the acceptable limits to administer the warfarin. 1. Yes, the nurse can administer the warfarin. The optimal therapeutic INR range for a client on warfarin should be 2.0 - 3.0. The INR value is 2.0. 2. The nurse should not administer phytonadione since the action of phytonadione is to reverse the anticoagulant effects of warfarin. Also the INR is within the acceptable therapeutic INR range (2.0 - 3.0) for a client prescribed an anticoagulant. 3. Why instruct the lab to run another INR when the INR value of 2.0 is not a critical level for a client prescribed an anticoagulant. It is not necessary to notify the lab to run another INR. 4. Why would the nurse notify the primary healthcare provider of an INR value that is within the acceptable range of a client prescribed warfarin? In this situation the primary healthcare provider does not need to be notified since the INR of 2.0 is within the acceptable range.

pyridostigmine

Anticholinesterase drugs are aimed at enhancing function of the neuromuscular junction. Acetylcholinesterase is the enzyme that breaks down acetylcholine. Thus inhibition of this enzyme by an anticholinesterase inhibitor will prolong the action of acetylcholine and facilitate transmission of impulses at the neuromuscular junction. Pyridostigmine is the most successful drug of this group in long-term treatment of myasthenia gravis. Cholinergic crisis happens when too much cholinergic medications are taken and, if not treated accordingly, respiratory failure and hypotension might happen. When cholinergic crisis takes place, the muscles cannot react to the inflow of acetylcholine so symptoms usually follow. Symptoms may include salivation, lacrimation, urination, and defecation. Failure of the respiratory system occurs due to the insufficient gas exchange. Flaccid paralysis, too much sweating, bronchial secretions, and miosis develop. While myasthenic crisis requires the application of more anticholesterase drugs, cholinergic crisis must not use these. Atropine is given in order to enhance and maintain respiration.

In which situations should the nurse notify the primary healthcare provider of a medication incident? You answered this question Correctly 1. Every occurrence. 2. Client is harmed or dies. 3. Medication incident is a near miss. 4. Nurse administers an incorrect dosage. 5. Client questions the medication color.

Before we review the options, let's look at the question. The key words in a question should be identified. The key words in this question are medication incident, nurse, notify, and primary healthcare provider. Each option stands alone with the question. After reading each answer, you need to ask yourself is this answer true or false. Remember client safety is always a priority. This question is asking when should the nurse notify the primary healthcare provider about a medication incident. So let's look at the options. Option 1 Before notifying the healthcare provider about a medication incident,the nurse should first identify if any harm occurred to the client. Is a client harmed with every medication incident? False The client is not harmed every time there is a medication incident. The nurse should assess the client to identify if the client has been harmed. An incident report should be completed so the hospital can track incident patterns for quality improvement. Option 2 Do you think the primary healthcare provider (PHP) should be notified if harm is brought to the client or death occurs as a result of a medication incident? True The PHP should be notified if the client is harmed or died. The PHP may need to prescribe additional prescriptions as a result of the medication incident. Obviously the healthcare provider needs to be notified if their client has died. Option 3 If the nurse identifies that there is a possible medication error prior to administration (near miss), the primary healthcare provider (PHP) needs to be notified. False The nurse should initiate the rights of medication administration every time which will ensures medication error prevention. The PHP does not need to be notified if a medication error was prevented from utilizing the rights of medication administration. Option 4 If a nurse administers the wrong medication dosage, should the HCP be notified? True The primary healthcare provider should be notified if the nurse administers an incorrect dosage to the client., and an incident report needs to be completed in this situation. The nurse did not initiate the rights of medication administration correctly. The PHP may need to prescribe additional prescriptions as a results the medication incident. Option 5 Does the PCP need to be notified if the client questions the color of a pill? False It is within the scope of practice of the nurse to answer questions about the color of the pills. Depending on the manufacturer, the shape and color of the medication can vary.

A client is diagnosed with a duodenal ulcer due to Helicobacter pylori (H Pylori). In addition to antibiotic therapy, the nurse anticipates that the client will also receive what class of pharmacologic agent? You answered this question Correctly 1. Proton pump inhibitor 2. Mitotic inhibitor 3. Serotonin antagonist 4. Acetylsalicyclic acid

Correct: Antisecretory agents like proton pump inhibitors are indicated for the treatment of peptic ulcer disease. Antisecretory agents decrease the secretion of gastric acids. Protein pump inhibitors, a combination of antibiotics and bismuth salts are most commonly used for treatment of H Pylori. 2. Incorrect: Mitotic inhibitors are chemotherapeutic agents that are indicated for the treatment of malignancies and cancerous cells. They are most often used in combination chemotherapy regimens to enhance the overall cytotoxic effect. 3. Incorrect: Serotonin antagonists are antiemetic agents that are indicated for the treatment of nausea and vomiting. Serotonin antagonists block the serotonin receptor sites located throughout the body responsible for the mediation of nausea and vomiting. 4. Incorrect: Acetylsalicylic acid is a non narcotic analgesic that inhibits the cox-2 protective mechanisms to the gastric mucosa. This could make the ulcer worse. Clients are advised to avoid the use of NSAIDs and acetylsalicylic acid due to increased bleeding potential.

The nurse is caring for a client admitted with heart failure. Which prescriptions would necessitate that the nurse seek clarification from the primary healthcare provider? You answered this question Incorrectly 1. Furosemide 20.0 mg p.o. daily. 2. Rosuvastatin 5 mg p.o hs 3. Digoxin 0.125 mg PO every 8 hours for three doses 4. Folic acid 1 mg daily. 5. Heparin 1000 IU subcutaneously daily.

When you first read this question, you probably thought, "What medications should not be given to this client?" Right? Yes, that is what I initially thought. But look at the options. Some of these prescriptions are written incorrectly and could cause a medication error if not clarified with the primary healthcare provider. This is a safety issue. So select the options that you would need to clarify with the primary healthcare provider. Option 1: Yes. You better clarify this one! It is inappropriate to have a trailing zero after a decimal point for doses expressed in whole numbers. It can be mistaken as 200 if the decimal point is not seen. Option 2: No clarification needed here. This is a statin medication that is written correctly. Option 3: No need to clarify this digoxin prescription. It is written correctly. Option 4: Yes, clarification is needed with this prescription. The folic acid order lacks a route, thus needs clarification. Option 5: Yes, you better clarify this one. The Heparin order should be written as Heparin 1,000 units subcutaneously daily. Use commas for dosing units at or above 1,000 or use words such as one thousand to improve readability. Use units rather than IU (International units) as this can be mistaken as IV or 10.

The nurse is caring for a client on the surgical unit. Which prescriptions could the nurse safely administer to the client? You answered this question Incorrectly 1. Chlordiazepoxide 10 mg p.o. q 4h p.r.n. for agitation 2. Regular insulin 10 U stat 3. MS 2 mg IM every 2 hours as needed for pain 4. Cefepime 1 gram IVPB every 8 hours 5. Diphenhydramine 25 mg p.o. hour of sleep for three nights

You should have learned in your fundamentals course what abbreviations are approved by Joint Commission to use when medications are prescribed or documentation is done in the nurse's notes. Let's see what you remember. Option 1 is true. There is nothing wrong with how this prescription is written. It is a complete prescription with medication, dose, route, time, and reason since for as needed use. Abbreviations used are acceptable. Option 2 is false. The "U" can be mistaken for "0" (zero), the number "4" (four) or "cc". Units should be written out completely. Think safety here. What would happen if you gave 100 units or 10 cc's. Hypoglycemia!!! Killer! Option 3 is also false. MS can mean morphine sulfate or magnesium sulfate. Write "morphine sulfate". Write "magnesium sulfate". Option 4 is true. This antibiotic prescription is correctly written with appropriate abbreviations. Option 5? This one is true as well.

Methylphenidate (Ritalin)

a synthetic drug that stimulates the sympathetic and central nervous systems, used chiefly to improve mental activity in attention deficit disorder.