Q/exp *IMPORTANT* contains QfromQ-Pain
A nurse is providing discharge teaching to a client who has a new prescription for lithium. Which of the following information should the nurse include in the teaching?
Obtain a daily weight. Clients were taking lithium should monitor their daily weight due to the risk of fluid imbalance
A nurse is caring for a client who has bipolar disorder and has been taking lithium for one year. Before administering the medication, the nurse should check to see that which of the following tests have been completed?
Thyroid hormone assay. Thyroid testing is important because long-term use of lithium may lead to thyroid dysfunction
A nurse is assessing a client who reports acute pain. The nurse should anticipate which of the following findings?
Increased heart rate. Acute pain stimulates the sympathetic nervous system and can cause an increase in heart rate.
A nurse is caring for a client who is just begun therapy with Alprazolam to treat anxiety. The nurse should monitor the client for which of the following adverse effects of this medication?
Insomnia. The nurse should monitor the client for paradox so affect such as insomnia and excitation. If these occur, the medication should be withdrawn.
A nurse is planning care for a patient who has a detached retina and his preoperative for surgical repair. The nurse should prepare do a master which of the following medications?
Phenylephrine Mydriatic medications, such as phenylephrine, are used preoperatively dilate pupils to facilitate intraocular surgery
The hospice nurse is caring for a client who has terminal cancer and takes PO morphine for pain relief. The client reports that he had increased the dose of morphine this week to obtain pain relief. Which of the following scenario should the nurse document as the explanation for this situation?
The client develop a tolerance to the medication. The nurse should document that the client has developed a tolerance to this medication. Morphine is her narcotic analgesic used for the treatment of severe pain. Tolerance is an adverse effect of narcotic analgesics in which a larger dose is needed to produce the same response .
A nurse is assessing a client who has systemic lupus erythematosus and is taking hydroxychloroquine. The nurse report which of the following adverse effects to the provider immediately?
Blurred vision. When using the urgent first non-urgent approach to client care the nurse should determine that the priority finding to report to the provider is blurred vision, as this is a manifestation of toxicity and can be an indication of retinal damage.
A nurse is preparing to administer cephalexin oral suspension to an older adult client who has difficulty swallowing pills. Which of the following actions should the nurse take?
Check the client for a penicillin allergy. Inertia check the client for a penicillin allergy because cephalexin is a beta-lactam antibiotic that is similar and actions and structure to penicillin
Nurses caring for a client who is exhibiting signs of alcohol withdrawal. Which of the following medication should the nurse plan to administer?
Diazepam. Diazepam is prescribed to treat the symptoms and prevent complications of alcohol withdrawal.
A nurse is administering timolol eyedrops to a client who has glaucoma. Which of the following actions should the nurse take?
Drop prescribed amount of medication into the conjunctival sac
I nursed preparing a presentation about glucosamine to a group of clients. Which of the following information should the nurse include in the teaching?
Glucosamine can suppress joint inflammation. The nurse should include in the teaching that glucosamine suppresses joint inflammation and cartilage degradation by stimulating the activity of chondrocytes
A nurse is monitoring a patient who is receiving a unit of packed RBCs Following surgery. Which of the following assessments as an indication the client might be experiencing a Hemolytic reaction?
Hypotension I hemolytic reaction causes hypertension, headache, a prehension, chest pain and low back pain.
A nurse is teaching a client has a new prescription for fluoxetine treat depression. Which of the following statements by the client indicates an understanding of the teaching?
I'll take this medication first thing in the morning.
A nurse is teaching a client who has a prescription for colchicine to treat gout. To the following instructions should the nurse include?
Monitor for muscle pain. This medication can cause rhabdomyolysis. The client should monitor and report muscle pain
A nurse is caring for a client who is postoperative following abdominal surgery and reports incisional pain. The surgeon has prescribed morphine 4 mg IV bolus every six hours as needed. Before administering this medication, the nurse should complete which priority assessment?
Respiratory rate. The priority action the nurse should take when using the ABC approach to client care if evaluate the clients respirations. The respiratory rate is especially important because opioid analgesics like morphine can cause respiratory depression.
A nurse is preparing to administer nalbuphine to a postoperative client who is experiencing pain. The nurse should monitor the client for which of the following potential adverse effects of this medication?
miosis Adverse affects of Nalbuphine include visual disturbances such as miosis, blurred vision, and diplopia.
A nurse is assessing a client after administering a does of losartan. Client has a horse voice, and swollen lips and tongue. In which order should the nurse take the following actions? Move the nursing actions into the box.
1 Assess the client airways 2 call the rapid response team 3 apply high flow oxygen 4 initiate IV access 5 administer IV epinephrine 6 administer IV antihistamine's
I charge nurse to supervising a newly licensed nurse provide for a client who has a PCA pump. Which of the following statements made by the nurse requires further action by the charge nurse?
I discarded the remaining 2 mg of morphine from the PCA pump. Please document that you witnessed it. Two nurses are required to witness the wasting of narcotic and then sign the narcotic record. The nurse should not ask another nurse to sign the narcotix record if the nurse did not witness wasting narcotic.
I nurse is caring for a client who is receiving mydriatic eyedrops. Which of the following manifestations indicates to the nurse that the client has developed a systemic anticholinergic effect?
Constipation. Mydratic eyedrops can cause a systemic anticholinergic effects, such as constipation a dry mouth.
A nurse is providing teaching to a client who has rheumatoid off rightists in a new prescription for methotrexate. Which of the following information should the nurse provide?
Drink 2 to 3 L of water per day while on the medication. Methotrexate can cause renal toxicity. Adequate hydration promotes it's excretion and helps prevent this adverse affect.
I nurse is preparing to administer the monthly injection of haloperidol decanter to a client who has schizophrenia. Which of the following actions should the nurse plan to take?
Have a client lie down for 30 minutes after the medication is injected This is to prevent orthostatic hypotension
A nurse is caring for a female client who has rheumatoid arthritis and asks the nurse if it is safe for her to take aspirin. The nurse should recognize which of the following findings in the clients history is a contraindication to this medication.
History of gastric ulcers. Aspirin is contraindicated for clients who have a history of gastrointestinal bleeding and peptic also disease because it impedes platelet aggregation. An adverse effect of aspirin is gastric bleeding.
A nurse is providing teaching to a client who has schizophrenia and is receiving chlorpromazine. Which of the following client statements indicates an understanding of the teaching?
I will contact my provider if I have difficulty urinating. Chlorpromazine is a first generation or typical antipsychotic medication. The client should be instructed to monitor for increasing anticholinergic adverse effects, such as dry mouth and urinary retention. Difficulty urinating could be a sign of urinary retention and should be reported to the provider for further evaluation
A nurse is reviewing discharge instructions with a client who has bipolar disorder and is taking lithium. Which of the following manifestation should the nurse include as an indication of mile toxicity?
Muscle weakness. The nurse and instruct the client that muscle weakness is a manifestation of mild toxicity
A nurse is preparing to administer morphine IV to a client. Which of the following medication should the nurse plan to have available?
Naloxone Naloxone was given to reverse the effects of morphine. Then the nurse should monitor the client for respiratory depression, brachycardia, and hypotension
A nurse is going to administer butorphanol to a client who is in labor. Which of the following medication should the nurse plan to have available to reverse the action of this medication?
Naloxone. Butorphanol is an opioid analgesic. The nurse have the opioid reversal agent naloxone and resuscitation equipment available in the event that the client develops respiratory depression.
A nurse is assessing a client who is taking oxacillin to train on faction. The nurse should recognize which of the following findings is a manifestation of an allergic reaction?
Pruritus An allergic reaction is an immune response I can manifest as pruritus and urticaria and can progress to anaphylaxis
A nurse is caring for a client who has streptococcal pneumonia and a prescription for penicillin G by intermittent IV bolus. 10 minutes into the infusion of the third dose, the patient reports that the IV site inches and that he feels dizzy and short of breath. Which of the following actions should the nurse take first ?
Stop the infusion. When using the airway breathing circulation approach to client care, the nurse should place The priority on stopping the infusion. The client is exhibiting signs of penicillin anaphylaxis and the first action that should be taking us to withdraw the medication
A nurse is assessing a client who has schizophrenia and has been on long-term treatment with chlorpromazine. He knows the client is experiencing some involuntary movements of the tongue and face. The nurse should suspect the client has developed which of the following adverse effects?
Tardive Dyskinesia. These findings indicate tardive dyskinesia, which can develop in clients during long-term therapy with chlorpromazine. Or many clients, the manifestations are irreversible.
A nurse is assessing a client has been taking sertraline fir 2 weeks. The nurse should identify which of the following findings as an indication that the medication is effective?
The client reports increase in mood Seraline is and SSRI used to treat major depressive disorder's. Therapeutic effects include increasing mood and an increase interest in activities
A nurse is caring for a client who has a fractured Ulna and a new prescription for Cyclobenzaprine. For administering, which of the following exclamation should the nurse provide to explain the purpose of the medication?
The medication will relieve muscle spasms that might occur with a fracture. The nurse should explain that the provider prescribes cyclobenzaprine to relieve muscle spasms that can accompany the Acute pain of fractures
A nurse is preparing to administer Enocaparin to a client. Which of the following actions should the nurse plan to take?
The nurse should not expel the air bubble in the prefilled syringe. The nurse should not expel the air bubble that is in the prefilled syringe prior to administering the medication
A nurse is calling data on a client who has a new prescription for ampicillin. Nurse should recognize which of the following findings is a priority?
Wheezing. When using the ABC approach to client care, the nurse should determine the priority finding is wheezing. Wheezing is a manifestation of an anaphylactic allergic reaction due to bronchospasm and Edema in the airway. Wheezing indicates a construction of the airway and requires immediate intervention to support respiratory function. The nurse should advise the client to wear identification to indicate an allergy to this medication
