Saunders NCLEX

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The nurse receives a call from a client concerned about eliminating brown-colored urine after taking nitrofurantoin for a urinary tract infection. The nurse should make which appropriate response? A) "Continue taking the medication; the brown urine occurs and is not harmful." B) "Take magnesium hydroxide with your medication to lighten the urine color." C) "Discontinue taking the medication and make an appointment for a urine culture." D) "Decrease your medication to half the dose because your urine is too concentrated."

The nurse is monitoring a client with heart failure who is taking digoxin. Which findings are characteristic of digoxin toxicity? Select all that apply. A) Tremors B) Diarrhea C) Irritability D) Blurred vision E) Nausea and vomiting

B) Diarrhea D) Blurred vision E) Nausea and vomiting - Digoxin is a cardiac glycoside. The risk of toxicity can occur with the use of this medication. - Toxicity can lead to life-threatening events and the nurse needs to monitor the client closely for signs of toxicity. - Early signs of toxicity include gastrointestinal manifestations such as anorexia, nausea, vomiting, and diarrhea.

The nurse is evaluating the serum acetylsalicylic acid results for a client receiving acetylsalicylic acid for rheumatoid arthritis. Which noted result is indicative that the client is within the range for the medication's antiarthritic effect? A) 10 mg/dL (0.72 mmol/L) B) 18 mg/dL (1.31 mmol/L) C) 26 mg/dL (1.88 mmol/L) D) 38 mg/dL (2.75 mmol/L)

C) 26 mg/dL (1.88 mmol/L) - Acetylsalicylic acid is a nonsteroidal agent that is prescribed for its anti-inflammatory, antipyretic, and anticoagulant properties. - Serum blood levels may be determined periodically to assess for an effective antiarthritic effect in the client with rheumatoid arthritis. - The therapeutic serum level for an antiarthritic effect is between 20 and 30 mg/dL (1.45 and 2.17 mmol/L). - Toxicity occurs if levels are greater than 30 mg/dL (2.17 mmol/L).

Acetylsalicylic acid (ASA), or aspirin, has been prescribed for a client with angina, and the client asks the nurse how the medication will help. The nurse responds that this medication has been prescribed for which purpose? A) To reduce pain B) To reduce inflammation C) To inhibit platelet aggregation D) To maintain a normal body temperature

C) To inhibit platelet aggregation - ASA is a nonsteroidal agent that is prescribed for its anti-inflammatory, antipyretic, and anticoagulant properties. - All of the options identify actions of this medication; however, for the client with angina, this medication is prescribed to inhibit platelet aggregation.

A client with trigeminal neuralgia is being treated with carbamazepine, 400 mg orally daily. Which value indicates that the client is experiencing an adverse effect to the medication? A) Sodium level, 140 mEq/L (140 mmol/L) B) Uric acid level, 4.0 mg/dL (240 mcmol/L) C) White blood cell count, 3000 mm3 (3.0 × 109/L) D) Blood urea nitrogen level, 10 mg/dL (3.6 mmol/L)

C) White blood cell count, 3000 mm3 (3.0 × 109/L) - Carbamazepine, classified as an antiseizure medication, is used to treat nerve pain. - Adverse effects of carbamazepine appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, and leukopenia; cardiovascular disturbances, including thrombophlebitis and dysrhythmias; and dermatological effects. - The low white blood cell count reflects agranulocytosis. Agranulocytosis = rare condition in which your bone marrow doesn't make enough of a certain type of white cell

A client who is receiving digoxin daily has a serum potassium level of 3 mEq/L (3 mmol/L) and reports anorexia. The health care provider prescribes a serum digoxin level to be done. The nurse checks the results and should recognize which level that is outside of the therapeutic range? A) 0.5 ng/mL (0.63 nmol/L) B) 0.8 ng/mL (1.02 nmol/L) C) 0.9 ng/mL (1.14 nmol/L) D) 2.2 ng/mL (2.8 nmol/L)

D) 2.2 ng/mL (2.8 nmol/L) - The optimal therapeutic range for digoxin is 0.5 to 2.0 ng/mL (0.63 to 2.56 nmol/L).

The nurse is taking care of a client receiving oxybutynin. Which finding should the nurse expect to note if the client develops side or adverse effects of this medication? A) Itching B) Diarrhea C) Swelling D) Dry mouth

D) Dry mouth - Oxybutynin is an anticholinergic. Anticholinergic side effects include dry mouth, constipation, tachycardia, urinary hesitancy, urinary retention, mydriasis, blurred vision, and dry eyes. - Itching, diarrhea, and swelling are not associated with this medication.

Meperidine hydrochloride (demerol) is prescribed for a client with pain. What should the nurse monitor for as a side or adverse effect of this medication? A) Diarrhea B) Bradycardia C) Hypertension D) Urinary retention

D) Urinary retention - Side and adverse effects of meperidine include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention; therefore, the remaining options are incorrect.

Diclofenac is prescribed for a client with osteoarthritis. Which medication, if noted on the client's record, would alert the nurse to consult with the primary health care provider? A) Phenytoin B) Primidone C) Acetaminophen D) Warfarin sodium

D) Warfarin sodium - Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID). - Interactions may occur with the use of anticoagulants, and the nurse should consult with the primary health care provider about a potential medication interaction if an anticoagulant is prescribed. - Phenytoin and primidone are anticonvulsant medications, and acetaminophen is a nonopioid analgesic. - These medications are not contraindicated with diclofenac.

The nurse has given medication instructions to a client receiving phenytoin. Which statement indicates that the client has an adequate understanding of the instructions? - "Alcohol is not contraindicated while taking this medication." - "Good oral hygiene is needed, including brushing and flossing." - "The medication dose may be self-adjusted, depending on side effects." - "The morning dose of the medication should be taken before a serum medication level is drawn."

- "Good oral hygiene is needed, including brushing and flossing." - Phenytoin is an anticonvulsant used to treat seizure disorders. - The client should see a dentist at regularly scheduled times because gingival hyperplasia is a side effect of this medication. - The client should perform good oral hygiene, including flossing and brushing the teeth.

The nurse is giving medication instructions to a client who has been prescribed acetylsalicylic acid. Which client statement indicates that education was effective? A) "I may develop heartburn." B) "I should monitor for muscle aches." C) "I may experience burning on urination." D) "I should take measures to prevent constipation."

A) "I may develop heartburn." - Acetylsalicylic acid is a nonsteroidal agent that is prescribed for its anti-inflammatory, antipyretic, and anticoagulant properties. - Occasional side/adverse effects include gastrointestinal distress such as cramping, mild nausea, heartburn, and abdominal distention.

The nurse is providing instructions to a client who will be taking phenytoin. Which statement, if made by the client, would indicate an understanding of the information about this medication? A) "I need to perform good oral hygiene, including flossing and brushing my teeth." B) "I should try to avoid alcohol, but if I'm not able to, I can drink alcohol in moderation." C) "I should take my medication before coming to the laboratory to have a blood level drawn." D) "I should monitor for side effects and adjust my medication dose depending on how severe the side effects are."

A) "I need to perform good oral hygiene, including flossing and brushing my teeth." - Phenytoin is an anticonvulsant used to treat seizure disorders. - The client should see a dentist at regularly scheduled times because gingival hyperplasia is a side effect of this medication. - The client should perform good oral hygiene, including flossing and brushing the teeth. - The client should avoid alcohol while taking this medication. - The client should also be instructed that follow-up serum blood levels are important and that, on the day of the scheduled laboratory test, the client should avoid taking the medication before the specimen is drawn. - The client should not adjust medication dosages.

Phenytoin 100 mg to be given orally 3 times daily has been prescribed to a client. The home health nurse visits the client and provides instructions regarding the medication. Which statement, if made by the client, would indicate an understanding of the instructions? A) "I will use a soft toothbrush to brush my teeth." B) "It's okay to break the capsules to make it easier for me to swallow them." C) "If I forget to take my medication, I can wait until the next dose and eliminate that dose." D) "If my throat becomes sore, it's a normal effect of the medication, and it's nothing to be concerned about."

A) "I will use a soft toothbrush to brush my teeth." - Phenytoin is an anticonvulsant used to treat seizure disorders. - Gingival hyperplasia, bleeding, swelling, and tenderness of the gums can occur with the use of this medication. - The client needs to be taught good oral hygiene, gum massage, and the need for regular dentist visits.

A client with muscle aches and a diagnosis of rheumatism has been given a prescription for capsaicin topical cream. The nurse determines that the client understands the use of the medication if the client makes which statement? A) "The medication will act as a local analgesic." B) "The medication acts by decreasing muscle spasms." C) "The medication will cause redness, flaking, and the skin to peel." D) "A heating pad should be put on the area after applying the medication."

A) "The medication will act as a local analgesic." - Capsaicin is used for the temporary relief of muscular aches, rheumatism, arthritis, sprains, and neuralgia. - It is one of a group of products known as rubs or liniments, which contain combinations of antiseptics, local anesthetics, analgesics, and counterirritants.

A client with status epilepticus has been prescribed phenytoin to be given by the intravenous (IV) route. The nurse administering the medication is careful not to exceed which recommended infusion rate? A) 50 mg/min B) 60 mg/min C) 100 mg/min D) 750 mg/min

A) 50 mg/min - IV administration of phenytoin is performed slowly (no faster than 50 mg/min) because rapid administration can cause cardiovascular collapse. - It should not be added to any existing IV infusion because this is likely to produce a precipitate in the solution. - Solutions are highly alkaline and can cause local venous irritation.

A client has a medication prescription for phenytoin to be administered by the intravenous route. After drawing up the medication, the nurse notes the presence of precipitate in the syringe. Which action should the nurse take? A) Discard the syringe and begin again. B) Add sterile water to dissolve the precipitate. C) Draw up an additional 1 mL of normal saline into the syringe. D) Chart the medication as "not given," and write a note in the medical record.

A) Discard the syringe and begin again. - If the injectable solution is not clear or if precipitate is present, the medication should not be used and should be discarded.

A client is receiving phenobarbital sodium. Which finding on the nursing assessment would indicate that the client is experiencing a common side or adverse effect of this medication? A) Drowsiness B) Hypocalcemia C) Blurred vision D) Seizure activity

A) Drowsiness - Drowsiness is a common side or adverse effect of phenobarbital, which is a barbiturate and antiseizure medication. - Hypocalcemia is a rare effect. - Blurred vision is not an associated side effect of this medication. - Seizure activity could occur from abrupt withdrawal of this medication therapy or as a toxic reaction.

A clinic nurse is performing an assessment on a client with rheumatoid arthritis who has been taking acetylsalicylic acid for the disorder. The nurse assesses the client for signs of aspirin toxicity. Which finding should alert the nurse to the possibility of toxicity? A) Fever and signs of hyperventilation B) Constipation and abdominal bloating C) Client complaint of visual disturbances D) Abdominal discomfort and client complaint of diarrhea

A) Fever and signs of hyperventilation - Mild intoxication with acetylsalicylic acid is called salicylism and can be experienced by the client when the daily dosage of acetylsalicylic acid is more than 4 g. - Tinnitus (ringing in the ears) is the most frequent effect noted with intoxication. - Hyperventilation may occur because salicylates stimulate the respiratory center. - Fever may result because salicylates interfere with the metabolic pathways coupling oxygen consumption and heat reduction.

A client is scheduled to begin medication therapy with valproic acid. The nurse looks for the results of which laboratory test(s) before administering the first dose? A) Liver function tests B) Renal function tests C) Pulmonary function test D) Pancreatic enzyme studies

A) Liver function tests - Gastrointestinal effects from valproic acid are common and typically mild, but hepatotoxicity, although rare, is serious. - To minimize the risk of fatal liver injury, liver function is evaluated before initiation of treatment and periodically thereafter. - The other options are unrelated to the use of this medication.

A client with acute pyelonephritis who was started on antibiotic therapy 24 hours earlier is still complaining of burning with urination. The nurse should anticipate that the primary health care provider will prescribe which medication? A) Phenazopyridine B) Oxybutynin chloride C) Bethanechol chloride D) Propantheline bromide

A) Phenazopyridine - The pain experienced with pyelonephritis usually resolves as antibiotic therapy becomes effective. - However, clients may be treated for urinary tract pain with phenazopyridine, which is a urinary analgesic. - Oxybutynin chloride and propantheline bromide are antispasmodics that are used to treat bladder spasm. - Bethanechol chloride is a cholinergic agent used to treat neurogenic bladder or urinary retention.

The primary health care provider has prescribed a lidocaine 5% patch for a client with a diagnosis of neck pain due to osteoarthritis. Which should the nurse tell the client regarding this medication? A) The medication patch will act as a local anesthetic. B) The medication patch acts by decreasing muscle spasms. C) The medication is prescribed to cause the skin to peel below the patch. D) Apply a heating pad to the area after applying the medication patch to increase the effectiveness.

A) The medication patch will act as a local anesthetic. - A lidocaine patch provides a local anesthetic effect to the site of application. - The medication does not act in a systemic manner. - It is not prescribed to cause the skin to peel, so if this reaction occurs, the primary health care provider should be notified. - A heating pad should not be applied because irritation or burning of the skin may occur.

The client arrives at the emergency department complaining of back spasms. The client states, "I have been taking 2 to 3 aspirin every 4 hours for the last week, and it hasn't helped my back." Since acetylsalicylic acid intoxication is suspected, the nurse should assess the client for which manifestation? A) Tinnitus B) Diarrhea C) Constipation D) Photosensitivity

A) Tinnitus - Mild intoxication with acetylsalicylic acid is called salicylism and is experienced commonly when the daily dosage is higher than 4 g. - Tinnitus (ringing in the ears) is the most frequent effect noted with intoxication. - Hyperventilation may occur, because salicylate stimulates the respiratory center. - Fever may result, because salicylate interferes with the metabolic pathways coupling oxygen consumption and heat production.

The nurse has given medication instructions to a client receiving phenytoin. Which statement indicates that the client has an adequate understanding of the instructions? A) "Alcohol is not contraindicated while taking this medication." B) "Good oral hygiene is needed, including brushing and flossing." C) "The medication dose may be self-adjusted, depending on side effects." D) "The morning dose of the medication should be taken before a serum medication level is drawn."

B) "Good oral hygiene is needed, including brushing and flossing." - Typical antiseizure medication instructions include taking the prescribed daily dosage to keep the blood level of the medication constant and having a sample drawn for serum medication level determination before taking the morning dose. - The client is taught not to stop the medication abruptly, to avoid alcohol, to check with a primary health care provider before taking over-the-counter medications, to avoid activities in which alertness and coordination are required until medication effects are known, to provide good oral hygiene, and to obtain regular dental care. - The client should also wear a MedicAlert bracelet.

The nurse is observing a new nursing graduate who is preparing an intermittent intravenous (IV) infusion of phenytoin for a client with a diagnosis of seizures. Which solution used by the nursing graduate should indicate to the nurse an understanding of proper preparation of this medication? A) 5% dextrose in water B) 0.9% sodium chloride C) Lactated Ringer's solution D) 5% dextrose and 0.45% sodium chloride

B) 0.9% sodium chloride - Intermittent IV infusion of phenytoin is administered by injection into a large vein, using normal saline solution. - Dextrose solutions are avoided because the medication will precipitate in these solutions. - Therefore, the options containing dextrose identify incorrect solutions for IV administration with this medication. - In addition, lactated Ringer's solution contains electrolytes that can interfere with phenytoin administration.

The nurse is administering medications to a client with trigeminal neuralgia. The nurse expects that which medication will be prescribed for pain relief? A) Oxycodone plus aspirin B) Carbamazepine and gabapentin C) Acetaminophen and codeine sulfate D) Meperidine hydrochloride and hydroxyzine

B) Carbamazepine and gabapentin - The anticonvulsant medications carbamazepine and gabapentin help relieve the pain in many clients with trigeminal neuralgia. - They act by inhibiting the reactivity of neurons in the trigeminal nerve. - Opioid analgesics (oxycodone, codeine sulfate, and meperidine hydrochloride) are not very effective in controlling pain caused by trigeminal neuralgia.

A client who has been taking phenytoin for seizure control has a serum phenytoin level of 8 mcg/mL (35.71 mmol/L). On the basis of this finding, which note should the nurse enter in the client's health record? A) Client is experiencing a toxic level. B) Client has an inadequate medication level. C) Client's result is at the low end of therapeutic range. D) Client's result is at the high end of therapeutic range.

B) Client has an inadequate medication level. - The therapeutic serum level range for phenytoin is 10 to 20 mcg/mL (40 to 79 mmol/L). - A laboratory value of 8 mcg/mL is below the therapeutic range, indicating an inadequate medication level, so this should be noted in the health record and the primary health care provider should be notified.

A client is having the dosage of clonazepam adjusted. The nurse should plan to perform which action? A) Weigh the client daily. B) Institute seizure precautions. C) Monitor blood glucose levels. D) Observe for areas of ecchymosis.

B) Institute seizure precautions. - Clonazepam is a benzodiazepine that is used as an anticonvulsant. - During initial therapy and during periods of dosage adjustment, the nurse should initiate seizure precautions for the client.

The nurse is caring for a client with chronic back pain. Codeine has been prescribed for the client. Specific to this medication, which intervention should the nurse include in the plan of care while the client is taking this medication? A) Monitor radial pulse. B) Monitor bowel activity. C) Monitor apical heart rate. D) Monitor peripheral pulses.

B) Monitor bowel activity. - While the client is taking codeine, the nurse would monitor vital signs and assess for hypotension. - The nurse also should increase fluid intake, palpate the bladder for urinary retention, auscultate bowel sounds, and monitor the pattern of daily bowel activity and stool consistency because the medication causes constipation. - The nurse should monitor respiratory status and initiate deep-breathing and coughing exercises. - In addition, the nurse monitors the effectiveness of the pain medication.

A client with osteoarthritis is receiving diclofenac sodium. The nurse would be concerned about the administration of this medication if the client's history and physical included a diagnosis of which condition? A) Graves' disease B) Peptic ulcer disease C) Coronary artery disease D) Benign prostatic hypertrophy

B) Peptic ulcer disease - Diclofenac sodium is a nonsteroidal anti-inflammatory drug (NSAID). - It is a prostaglandin inhibitor and decreases mucus production in the stomach. - Use of NSAIDs in the client with ulcer disease could place the client at risk for perforation and hemorrhage. - The diagnoses of Graves' disease, coronary artery disease, and benign prostatic hypertrophy are not concerns with the use of this medication.

A client with pulmonary edema has a prescription to receive morphine sulfate intravenously. The nurse should determine that the client is experiencing an intended effect of the medication as indicated by which assessment finding? A) Increased pulse rate B) Relief of apprehension C) Decreased urine output D) Increased blood pressure

B) Relief of apprehension - Morphine sulfate reduces anxiety and dyspnea in the client with pulmonary edema. - It also promotes peripheral vasodilation and causes blood to pool in the periphery. - It decreases pulmonary capillary pressure, which reduces fluid migration into the alveoli. - The client receiving morphine sulfate is monitored for signs and symptoms of respiratory depression and extreme drops in blood pressure, especially when it is administered intravenously.

Meperidine has been prescribed for a client to treat pain. Which side and adverse effects should the nurse monitor for? Select all that apply. A) Diarrhea B) Tremors C) Drowsiness D) Hypotension E) Urinary frequency F) Increased respiratory rate

B) Tremors C) Drowsiness D) Hypotension - Meperidine is an opioid analgesic. - Side and adverse effects include respiratory depression, drowsiness, hypotension, constipation, urinary retention, nausea, vomiting, and tremors.

A home health nurse visits a client who suffered a back injury. On reviewing the primary health care provider's prescriptions, the nurse notes that codeine sulfate has been prescribed for the client, and the nurse provides instructions to the client regarding the medication. Which statement, if made by the client, indicates an understanding of health measures related to the medication? A) "The medication is not addicting." B) "I should watch out for diarrhea as a side effect." C) "I should increase my fluid intake while taking this medication." D) "I need to be sure to eat foods that are low in fiber to prevent diarrhea."

C) "I should increase my fluid intake while taking this medication." - Codeine sulfate is an opioid analgesic used to treat pain and can cause constipation. - Because it is an opioid analgesic, codeine sulfate can be addicting. - The client is instructed to increase fluid intake to prevent constipation. - The client also should consume foods high in fiber and should take a stool softener.

The nurse has a prescription to administer diazepam 5 mg by the intravenous (IV) route to a client. The nurse should administer the medication over a period of at least how long? A) 15 seconds B) 30 seconds C) 1 minute D) 5 minutes

C) 1 minute - The recommended rate of infusion of diazepam is to give each 5 mg of the medication over at least 1 minute. - This will prevent adverse effects, including apnea, bradycardia, hypotension, and possibly cardiac arrest.

The nurse in the primary health care provider's office is reviewing the results of a client's phenytoin level determination performed that morning. The nurse identifies that a therapeutic medication level has been achieved if which result is noted? A) 3 mcg/mL (11.9 mmol/L) B) 8 mcg/mL (31.74 mmol/L) C) 15 mcg/mL (59.52 mmol/L) D) 24 mcg/mL (95.23 mmol/L)

C) 15 mcg/mL (59.52 mmol/L) - The therapeutic range for serum phenytoin levels is 10 to 20 mcg/mL (40 to 79 mmol/L) in clients with normal serum albumin levels and renal function.

A client was just admitted to the hospital to rule out a gastrointestinal (GI) bleed. The client has brought several bottles of medications prescribed by different specialists. During the admission assessment, the client states, "Lately, I have been hearing some roaring sounds in my ears, especially when I am alone." Which medication would the nurse identify as the cause of the client's complaint? A) Doxycycline B) Atropine sulfate C) Acetylsalicylic acid D) Diltiazem hydrochloride

C) Acetylsalicylic acid - Aspirin (acetylsalicylic acid) is contraindicated for GI bleeding and is potentially ototoxic. - The client should be advised to notify the prescribing primary health care provider so the medication can be discontinued and/or a substitute that is less toxic to the ear can be taken instead.

A client has been prescribed codeine sulfate. The nurse has given the client instructions for its use. The nurse concludes that the client understands the instructions if the client verbalizes to self-assess for which side effect? A) Excitability B) Rapid pulse C) Constipation D) Excessive urination

C) Constipation - The client is taught about side and adverse effects that could occur with the use of codeine sulfate. - The most common side effects include drowsiness, confusion, hypotension, nausea and vomiting, and constipation. - Adverse effects include bradycardia, respiratory depression, and urinary retention.

The nurse has a prescription to administer phenytoin 100 mg mixed in 5% dextrose in water by the intravenous (IV) route to a client. After reading this prescription, which action should the nurse take? A) Prepare the solution for administration. B) Contact the agency pharmacy to obtain the medication. C) Contact the primary health care provider (PHCP) to question the prescription. D) Mix the medication in the prescribed solution and attach an in-line filter.

C) Contact the primary health care provider (PHCP) to question the prescription. - Precipitation will occur if phenytoin is mixed with any solution other than 0.9% (normal) saline. - This is especially true with solutions containing dextrose. - Therefore, the nurse would contact the PHCP who prescribed the medication to change the prescription.

The nurse is preparing to give a postcraniotomy client medication for incisional pain. The family asks the nurse why the client is receiving codeine sulfate and not "something stronger." In formulating a response, the nurse incorporates which information about codeine sulfate? A) It is one of the strongest opioid analgesics available. B) It cannot lead to physical or psychological dependence. C) It does not alter respirations or mask neurological signs as do other opioids. D) It does not cause gastrointestinal (GI) upset or constipation as do other opioids.

C) It does not alter respirations or mask neurological signs as do other opioids. - Codeine sulfate is an opioid analgesic used for clients after craniotomy. - It often is combined with a nonopioid analgesic such as acetaminophen for added effect. - It does not alter the respiratory rate or mask neurological signs as do other opioids. - Side effects of codeine sulfate include GI upset and constipation. - Chronic use of the medication can lead to physical and psychological dependence.

A client is taking clorazepate. The client asks the nurse if there is a risk of addiction with this medication. Which information should the nurse provide? A) It is not habit forming either physically or psychologically. B) It leads to physical tolerance, but only after 10 or more years of therapy. C) It leads to physical and psychological dependence with prolonged high-dose therapy. D) It can result in psychological dependence only because of the nature of the medication.

C) It leads to physical and psychological dependence with prolonged high-dose therapy. - Clorazepate is classified as an anticonvulsant, an anxiolytic (antianxiety agent), and a sedative-hypnotic (benzodiazepine). - One of the nursing implications of clorazepate therapy is that the medication can lead to physical or psychological dependence with prolonged therapy at high doses. - For this reason, the amount of medication that is readily available to the client at any one time is restricted.

A client reports frequent use of acetaminophen for relief of headaches and other discomforts. The nurse should evaluate which diagnostic data to determine if the client is at risk for toxicity? A) Chest x-ray B) Electrocardiogram C) Liver function studies D) Upper gastrointestinal x-ray results

C) Liver function studies - In adults, overdose of acetaminophen causes liver damage. - In addition, clients with liver disorders are at a higher risk of experiencing hepatotoxicity with chronic acetaminophen use. - Options 1, 2, and 4 are not associated with acetaminophen overdose.

The nurse is caring for a client who has been taking hydrocodone for the last 3 months. For which side and adverse effects of this medication should the nurse assess the client? A) Tachycardia and hypertension B) Diarrhea and abdominal cramping C) Psychological and physical dependence D) Increased respiratory rate and bronchospasm

C) Psychological and physical dependence - Hydrocodone is an opioid analgesic that also has antitussive properties. - Side and adverse effects of this medication include physical and psychological dependence, bradycardia and hypotension, respiratory depression, nausea, vomiting, constipation, sedation, and confusion.

A client with cancer is receiving a continuous intravenous infusion of morphine sulfate. The nurse monitoring the client for adverse effects would become most concerned about which vital sign? A) Temperature of 99.1º F (37.3º C) B) Blood pressure of 110/70 mm Hg C) Respirations of 10 breaths/minute D) Apical heart rate of 90 beats/minute

C) Respirations of 10 breaths/minute - Before an opioid is administered, respiratory rate, blood pressure, and pulse rate should be assessed. - Morphine sulfate should be withheld and the primary health care provider notified if the respiratory rate is at or below 12 breaths per minute, if the blood pressure is significantly below the pretreatment value, or if the pulse rate is significantly above or below pretreatment value.

A client is admitted to the hospital, and the nurse notes that the client is taking acetylsalicylic acid to treat a chronic rheumatoid disorder. The nurse should monitor the client for which sign or symptom that indicates a toxic effect of the medication? A) Jaundice B) Peripheral edema C) Ringing in the ears D) Bilateral lung crackles

C) Ringing in the ears - Acetylsalicylic acid is a nonsteroidal agent that is prescribed for its anti-inflammatory, antipyretic, and anticoagulant properties. - Low-grade toxicity is characterized by ringing in the ears, generalized pruritus (which may be severe), headache, dizziness, flushing, tachycardia, hyperventilation, sweating, and thirst. - Marked toxicity is manifested by hyperthermia, restlessness, abnormal breathing pattern, seizures, respiratory failure, and coma.

A client is taking the prescribed dose of phenytoin to control seizures. Results of a phenytoin blood level study reveal a level of 35 mcg/mL (140 mcmol/L). Which finding would be expected as a result of this laboratory result? A) Hypotension B) Tachycardia C) Slurred speech D) No abnormal finding

C) Slurred speech - The therapeutic phenytoin level is 10 to 20 mcg/mL (40 to 79 mcmol/L). - At a level higher than 20 mcg/mL, involuntary movements of the eyeballs (nystagmus) occur. - At a level higher than 30 mcg/mL (120 mcmol/L), ataxia and slurred speech occur.

A film-coated form of diflunisal, a nonsteroidal anti-inflammatory medication, has been prescribed for a client to treat chronic rheumatoid arthritis. The client calls the clinic nurse because of difficulty swallowing the tablets. Which instruction should the nurse provide to the client? A) Crush the tablets and mix with food. B) Open the tablet and mix the contents with food. C) Swallow the tablets with large amounts of water or milk. D) Notify the primary health care provider for a medication change.

C) Swallow the tablets with large amounts of water or milk. - Diflunisal may be given with water, milk, or meals. - The tablets should not be crushed or broken open. - This situation does not warrant primary health care provider (PHCP) notification at this time.

After review of the client's laboratory values, the nurse notes that a phenytoin level for a client receiving phenytoin is 7 mcg/mL (27.78 mmol/L). The nurse makes which interpretation regarding this laboratory result? A) The level is within the expected therapeutic range. B) The level indicates the medication should be stopped. C) The level is lower than the expected therapeutic range. D) The level is higher than the expected therapeutic range.

C) The level is lower than the expected therapeutic range. - The target range for a therapeutic serum level of phenytoin is between 10 and 20 mcg/mL (40 to 79 mmol/L). - Levels below 10 mcg/mL are too low to control seizures. - At levels above 20 mcg/mL (79 mmol/L), signs of toxicity begin to appear. - This client has a low serum level, and the dosage is likely to be increased.

The home health nurse visits a client who is taking phenytoin for control of seizures. During the assessment, the nurse notes that the client is taking birth control pills. Which information should the nurse include in the teaching plan? A) Pregnancy must be avoided while taking phenytoin B) The client may stop the medication if it is causing severe gastrointestinal effects. C) There is the potential of decreased effectiveness of birth control pills while taking phenytoin. D) There is the increased risk of thrombophlebitis while taking phenytoin and birth control pills together.

C) There is the potential of decreased effectiveness of birth control pills while taking phenytoin. - Phenytoin enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. - Pregnancy does not need to be "avoided" while taking phenytoin; however, because phenytoin may cause some risk to the fetus (Pregnancy Category D medication), consultation with the primary health care provider should be done if pregnancy is considered.

The home health nurse visits a client who is taking phenytoin for control of seizures. During the assessment, the nurse notes that the client is taking birth control pills. Which information should the nurse include in the teaching plan? A) Pregnancy must be avoided while taking phenytoin. B) The client may stop the medication if it is causing severe gastrointestinal effects. C) There is the potential of decreased effectiveness of birth control pills while taking phenytoin. D) There is the increased risk of thrombophlebitis while taking phenytoin and birth control pills together.

A client is taking large doses of acetylsalicylic acid (ASA/ aspirin) for rheumatoid arthritis. Which assessment findings indicate that the client is experiencing ototoxicity as a result of the medication? A) Dizziness, sore throat, and purpura B) Gastrointestinal upset and dizziness C) Tinnitus, hearing loss, dizziness, and ataxia D) Gastrointestinal bleeding, ecchymosis, and dizziness

C) Tinnitus, hearing loss, dizziness, and ataxia (ototoxicity: when a person develops hearing or balance problems due to a medicine) - Ototoxicity can occur as a result of the administration of acetylsalicylic acid. - Signs and symptoms of tinnitus, hearing loss, dizziness, and ataxia reflect damage to the eighth cranial nerve, the organ of hearing and balance.

The nurse has administered a dose of meperidine hydrochloride to a client with renal colic as treatment for pain. The nurse carefully monitors this client for which side and adverse effect of this medication? A) Bradycardia B) Hypertension C) Urinary retention D) Increased respirations

C) Urinary retention - Meperidine hydrochloride is an opioid analgesic. - Side effects of meperidine hydrochloride include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention.

A client with trigeminal neuralgia is being treated with carbamazepine, 400 mg orally daily. Which value indicates that the client is experiencing an adverse effect to the medication? A) Sodium level, 140 mEq/L (140 mmol/L) B) Uric acid level, 4.0 mg/dL (0.24 mmol/L) C) White blood cell count, 3000 mm3 (3.0 × 109/L) D) Blood urea nitrogen level, 10 mg/dL (3.6 mmol/L)

C) White blood cell count, 3000 mm3 (3.0 × 109/L) - Adverse effects of carbamazepine appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, and leukopenia; cardiovascular disturbances, including thrombophlebitis and dysrhythmias; and dermatological effects. - The low white blood cell count reflects agranulocytosis.

The nurse provides discharge instructions to a client with atrial fibrillation who is taking warfarin sodium. Which statement, by the client, reflects the need for further teaching? A) "I will avoid alcohol consumption." B) "I will take my pills every day at the same time." C) "I have already called my family to pick up a MedicAlert bracelet." D) "I will take coated aspirin for my headaches because it will coat my stomach."

D) "I will take coated aspirin for my headaches because it will coat my stomach." - Aspirin-containing products need to be avoided when a client is taking this medication. - Alcohol consumption should be avoided by a client taking warfarin sodium. - Taking the prescribed medication at the same time each day increases client compliance. - The MedicAlert bracelet provides health care personnel with emergency information.

A home care nurse visits a client at home. Clonazepam has been prescribed for the client, and the nurse teaches the client about the medication. Which client statement indicates that further teaching is necessary? A) "My drowsiness will decrease over time with continued treatment." B) "I should take my medicine with food to avoid any stomach problems." C) "I can take my medicine at bedtime if it tends to make me feel drowsy." D) "If I experience slurred speech, this problem will disappear in about 8 weeks."

D) "If I experience slurred speech, this problem will disappear in about 8 weeks." - Clients who are experiencing signs and symptoms of toxicity with the administration of clonazepam exhibit slurred speech, sedation, confusion, respiratory depression, hypotension, and eventually coma.

The home care nurse visits a client with a diagnosis of unstable angina. The client is taking acetylsalicylic acid (aspirin) on a daily basis to reduce the risk of myocardial infarction (MI). Which medication dose would the nurse expect the client to be taking? A) 3 g daily B) 1.3 g daily C) 650 to 700 mg daily D) 300 to 325 mg daily

D) 300 to 325 mg daily - Acetylsalicylic acid (aspirin) may be used to reduce the risk of recurrent transient ischemic attacks (TIAs) or stroke or reduce the risk of MI in clients with unstable angina or a history of previous MI. - The normal dose for clients being treated with acetylsalicylic acid to decrease thrombosis and MI is 300 to 325 mg daily, and some primary health care providers may prescribe an even lower dose.

The nurse is caring for a client in the emergency department who has been diagnosed with Bell's palsy. The client has been taking acetaminophen, and acetaminophen overdose is suspected. Which antidote should the nurse prepare for administration if prescribed? A) Pentostatin B) Auranofin C) Fludarabine D) Acetylcysteine

D) Acetylcysteine - The antidote for acetaminophen is acetylcysteine. - The normal therapeutic serum level of acetaminophen is 10 to 20 mcg/mL. - A toxic level is higher than 50 mcg/mL, and levels higher than 200 mcg/mL 4 hours after ingestion indicates that there is risk for liver damage.

The nurse is caring for a client receiving morphine sulfate for pain. Because this medication has been prescribed for this client, which nursing action should be included in the plan of care? A) Encourage fluids B) Monitor the client's temperature C) Maintain the client in a supine position D) Encourage the client to cough and deep breathe

D) Encourage the client to cough and deep breathe - Morphine sulfate suppresses the cough reflex. - Clients need to be encouraged to cough and deep breathe to prevent pneumonia. - The remaining options are not associated specifically with the use of this medication.

A client is scheduled to begin therapy with carbamazepine. The nurse should assess the results of which test(s) before administering the first dose of this medication to the client? A) Liver function tests B) Renal function tests C) Pancreatic enzyme studies D) Complete blood cell count

D) Complete blood cell count - Carbamazepine may be used to treat a seizure disorder. - It can cause leukopenia, anemia, thrombocytopenia, and, very rarely, fatal aplastic anemia. - To reduce the risk of serious hematological effects, a complete blood cell count should be done before treatment and periodically thereafter. - The client also is told to report the occurrence of fever, sore throat, pallor, weakness, infection, easy bruising, and petechiae.

A client is receiving phenytoin. To monitor for side and adverse effects of this medication, the nurse assesses the results of which laboratory test? A) Serum sodium B) Serum potassium C) Blood urea nitrogen D) Complete blood count (CBC)

D) Complete blood count (CBC) - Phenytoin is an anticonvulsant used to treat seizure disorders. - The nurse monitors the CBC because hematological effects of this therapy include aplastic anemia, agranulocytosis, leukopenia, and thrombocytopenia.

The nurse is reviewing the results of a test on a sample drawn from a child who is receiving carbamazepine for the control of seizures. The results indicate a serum carbamazepine level of 10 mcg/mL (42.33 mmol/L). The nurse analyzes the results and anticipates that the primary health care provider (PHCP) will note which prescription? A) Discontinuation of the medication B) A decreased dose of the medication C) An increased dose of the medication D) Continuation of the presently prescribed dosage

D) Continuation of the presently prescribed dosage - When carbamazepine is administered, blood levels need to be tested periodically to check for the child's absorption of the medication. - The amount of the medication prescribed is based on the blood level achieved. - Carbamazepine's therapeutic serum range is 6 to 12 mcg/mL (34 to 51 mmol/L). - Therefore, the nurse anticipates that the PHCP will continue the presently prescribed dosage.

A client with vascular headaches is taking ergotamine. The home health nurse should periodically assess him or her for which finding? A) Hypotension B) Constipation C) Dependent edema D) Cool, numb fingers and toes

D) Cool, numb fingers and toes - Ergotamine can produce vasoconstriction. - The nurse periodically assesses for hypertension; cool, numb fingers and toes; muscle pain; and nausea and vomiting. - This medication does not cause hypotension, constipation, or dependent edema.

A client with trigeminal neuralgia tells the nurse that acetaminophen is taken daily for the relief of generalized discomfort. Which laboratory value would indicate toxicity associated with the medication? A) Sodium level of 140 mEq/L (140 mmol/L) B) Platelet count of 400,000 mm3 (400 × 109/L) C) Prothrombin time of 12 seconds (12 seconds) D) Direct bilirubin level of 2 mg/dL (34 mcmol/L)

D) Direct bilirubin level of 2 mg/dL (34 mcmol/L) - In adults, overdose of acetaminophen causes liver damage. - The correct option is an indicator of liver function and is the only option that indicates an abnormal laboratory value. - The normal direct bilirubin level is 0.1 to 0.3 mm3 (150 to 400 × 109/L).

The nurse notes that a client taking ergotamine tartrate is having the intended effects of therapy if the client states relief from which symptom? A) Cough B) Diarrhea C) Backache D) Headaches

D) Headaches - Ergotamine tartrate is used to stop an ongoing migraine attack; it also is used to treat cluster headaches.

The nurse should question a prescription for which medication in the client concurrently receiving tramadol? A) Beta blockers B) Histamine H2 antagonists C) Calcium channel blockers D) Monoamine oxidase inhibitors (MAOIs)

D) Monoamine oxidase inhibitors (MAOIs) - Tramadol can precipitate a hypertensive crisis if combined with an MAOI. - The combination is contraindicated. Its use is not contraindicated with beta blockers, histamine H2 antagonists, or calcium channel blockers.

The nurse is collecting data from a client and notes that the client is taking acetylsalicylic acid 5 g daily in divided doses. The nurse determines that this medication has been prescribed to treat which condition? A) Backache B) Muscle aches C) Frequent headaches D) Rheumatoid arthritis

D) Rheumatoid arthritis - Acetylsalicylic acid is a nonsteroidal agent that is prescribed for its anti-inflammatory, antipyretic, and anticoagulant properties. - The client may self-administer acetylsalicylic acid to treat a headache, backache, or muscle aches, but a 5-g daily dose would not be used to treat these discomforts. - A dosage of 3.2 to 6 g daily in divided doses may be prescribed for the client with rheumatoid arthritis.

A client is seen in the hospital emergency department after injury to the right ankle. The client tells the nurse that she twisted her ankle while playing volleyball. The primary health care provider (PHCP) has prescribed a topical analgesic cream for the injury. The nurse providing instruction about the medication should provide the client with which information? A) To avoid hazardous activities while using the cream because it causes drowsiness B) To apply the medication three times a day and place a heating pad on top of the area C) That the onset of headache indicates a systemic reaction and the PHCP must be notified D) That the medication contains a combination of medications, one of which is an analgesic

D) That the medication contains a combination of medications, one of which is an analgesic - Topical analgesics are used for the temporary relief of muscular aches, rheumatism, arthritis, sprains, and neuralgia. - These types of products contain combinations of analgesics, menthol, local antiseptics, and counterirritants.

A client who was started on clonazepam tells the nurse of increasing clumsiness and unsteadiness since starting the medication. The client is visibly upset by these manifestations and asks the nurse what to do. The nurse's response is based on which understanding? A) These symptoms probably result from interaction with another medication. B) These symptoms usually occur when the client takes the medication with food. C) These symptoms indicate that the client is experiencing a severe adverse reaction to the medication. D) These symptoms are most severe during initial therapy and decrease or disappear with long-term use.

D) These symptoms are most severe during initial therapy and decrease or disappear with long-term use. - Clonazepam is classified as a benzodiazepine and is used as an anticonvulsant and antianxiety agent. - Drowsiness, unsteadiness, and clumsiness are expected effects of the medication during early therapy. - They are dose related and usually diminish or disappear altogether with continued use of the medication.

A client with a diagnosis of rheumatoid arthritis is taking sulindac. The primary health care provider prescribes misoprostol for the client. The nurse explains that this medication has been prescribed for which purpose? A) To enhance the effects of the sulindac B) To prepare the client for weaning off the sulindac C) To prevent further development of arthritic nodules D) To prevent gastric complications such as ulcer disease

D) To prevent gastric complications such as ulcer disease - Sulindac is a nonsteroidal anti-inflammatory drug (NSAID). - Misoprostol, a synthetic prostaglandin E1 analogue, may be prescribed to be taken concurrently with sulindac to prevent gastric complications such as ulcer disease.

Laboratory analysis of a urine sample for culture and sensitivity reveals a bacterial infection, and the client is diagnosed with cystitis. Nitrofurantoin is prescribed for the client. Which is the priority nursing assessment before administering this medication? A) Checking lung sounds B) Checking the blood pressure C) Checking the apical heart rate D) Checking the bowel sounds in all 4 quadrants

A) Checking lung sounds - Nitrofurantoin is an antibacterial used to treat urinary tract infections. - Although rare, the medication can cause an asthmatic exacerbation in those with a history of asthma. - Therefore, the priority baseline assessment should include questioning the client about a history of asthma and checking lung sounds.

A client has begun using a methylxanthine bronchodilator. What beverage should the nurse plan to teach the client to avoid while taking this medication? A) Coffee B) Orange juice C) Mineral water D) Cranberry juice

A) Coffee - Cola, coffee, and chocolate contain methylxanthine and should be avoided by the client taking a methylxanthine bronchodilator. - The additional methylxanthine could lead to increased incidence of cardiovascular and central nervous system side effects.

Propantheline bromide is prescribed for a client with bladder spasms. Which disorder, if noted in the client's record, should alert the nurse to question the prescription for this medication? A) Glaucoma B) Myxedema C) Hypothyroidism D) Coronary artery disease

A) Glaucoma - Propantheline bromide is contraindicated in clients with narrow-angle glaucoma, obstructive uropathy, gastrointestinal disease, or ulcerative colitis. - The medication decreases bladder muscle spasms.

The nurse is monitoring a client for adverse effects of medications. Which findings are characteristic of adverse effects of hydrochlorothiazide? Select all that apply. A) Sulfa allergy B) Osteoporosis C) Hypokalemia D) Hypouricemia E) Hyperglycemia F) Hypercalcemia

A) Sulfa allergy C) Hypokalemia E) Hyperglycemia F) Hypercalcemia - Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. - Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.

Bethanechol chloride is prescribed for an adult client with postoperative bladder spasms. Based on the normal adult dose, how should the nurse plan to administer this medication? A) 100 mg at bedtime B) 100 mg every 4 hours C) 10 to 50 mg 3 to 4 times a day D) 50 to 100 mg 3 to 4 times a day

C) 10 to 50 mg 3 to 4 times a day - The normal adult dosage of bethanechol chloride ranges from 10 to 50 mg given 3 to 4 times daily. - Therefore, the remaining options are incorrect.

A client is diagnosed with an ST segment elevation myocardial infarction (STEMI) and is receiving a tissue plasminogen activator, alteplase. Which action is a priority nursing intervention? A) Monitor for kidney failure. B) Monitor psychosocial status. C) Monitor for signs of bleeding. D) Have heparin sodium available.

C) Monitor for signs of bleeding. - Tissue plasminogen activator is a thrombolytic. - Hemorrhage is a complication of any type of thrombolytic medication. - The client is monitored for bleeding.

Tamsulosin hydrochloride is prescribed for a client. The nurse should suspect that this medication is prescribed to relieve which condition? A) Constipation B) Muscle spasms C) Urinary obstruction D) Respiratory congestion

C) Urinary obstruction - Tamsulosin hydrochloride is used to relieve mild to moderate manifestations that occur in benign prostatic hypertrophy. - The medication also improves urinary flow rates

Trimethoprim-sulfamethoxazole is prescribed for a client. The nurse should instruct the client to report which symptom if it develops during the course of this medication therapy? A) Nausea B) Diarrhea C) Headache D) Sore throat

D) Sore throat - Clients taking trimethoprim-sulfamethoxazole should be informed about early signs and symptoms of blood disorders that can occur from this medication. - These include sore throat, fever, and pallor, and the client should be instructed to notify the primary health care provider (PHCP) if these occur.

The client questions the nurse as to why the primary health care provider switched the usual prescription from a metered-dose inhaler (MDI) to a dry powder inhaler (DPI). The nurse should respond correctly by providing which facts? Select all that apply. A) Dry powder inhalers pose no environmental risks. B) Dry powder inhalers can be administered more frequently. C) Dry powder inhalers deliver more medication to the lungs. D) Dry powder inhalers require less hand-to-lung coordination. E) Dry powder inhalers pose no environmental risks.

E) Dry powder inhalers pose no environmental risks. C) Dry powder inhalers deliver more medication to the lungs. D) Dry powder inhalers require less hand-to-lung coordination. - DPIs are used to deliver medications in the form of a dry, micronized powder directly to the lungs. - DPIs do not require the hand-to-lung coordination needed with MDIs; thus, DPIs are much easier to use. - Compared with MDIs, DPIs deliver more medication to the lungs (20% of the total released versus 10%) and less to the oropharynx. - Because DPIs do not require propellant, they are not a risk to the environment.

A) "Continue taking the medication; the brown urine occurs and is not harmful." - Nitrofurantoin imparts a harmless brown color to the urine, and the medication should not be discontinued until the prescribed dose is completed. - Magnesium hydroxide will not affect urine color. - In addition, antacids should be avoided because they interfere with medication effectiveness.

The nurse is caring for a client receiving an albuterol/ipratropium nebulized breathing treatment. Which report from the client should the nurse note as an expected side effect of this combination medication? A) "I feel like my heart is racing." B) "I feel more bloated than usual." C) "My eyes have been watering lately." D) "I haven't had a bowel movement in 4 days."

A) "I feel like my heart is racing." - Albuterol/ipratropium is a combination agent—one is a β2-adrenergic agonist and the other is an anticholinergic medication, and in combination they produce an overall bronchodilation effect. - Common side and adverse effects include headache, dizziness, dry mouth, tremors, nervousness, and tachycardia.

When evaluating an asthmatic client's knowledge of self-care, the nurse recognizes that additional instruction is needed when the client makes which statement? A) "I use my corticosteroid inhaler each time I feel short of breath." B) "I see my doctor if I have an upper respiratory infection and always get a flu shot." C) "I use my bronchodilator inhaler before walking so I don't become short of breath." D) "I use my bronchodilator inhaler before I visit places like the zoo because of my allergies."

A) "I use my corticosteroid inhaler each time I feel short of breath." - Most asthma medications are administered via inhalation because of their fast action via this route. Inhaled corticosteroids are preferred for long-term control of persistent asthma. - They decrease inflammation and reduce bronchial hyperresponsiveness. - Bronchodilator medications are considered "rescue" types because their onset is faster.

A client with a prescription to take theophylline daily has been given medication instructions by the nurse. What statement by the client indicates the need for further education regarding the prescription? A) "I will take the daily dose at bedtime." B) "I need to drink at least 2 liters of fluid per day." C) "I know to avoid changing brands of the medication without my primary health care provider's approval." D) "I'll avoid over-the-counter cough and cold medications unless approved by my health care provider."

A) "I will take the daily dose at bedtime." - The client taking a single daily dose of theophylline, a xanthine bronchodilator, should take the medication early in the morning. - This enables the client to have maximal benefit from the medication during daytime activities. - In addition, this medication causes insomnia.

The nurse has given medication instructions to a client beginning carbamazepine. The nurse determines that the client understands the use of the medication if he makes which statement? A) "I will use sunscreen when outdoors." B) "I can drive a car as long as it is not at night." C) "I will keep tissues handy because of excess salivation." D) "I will discontinue the medication if fever or sore throat occurs."

A) "I will use sunscreen when outdoors." - Carbamazepine is an anticonvulsant. The client should use protective clothing and sunscreen to avoid photosensitivity reactions. - Carbamazepine acts by depressing synaptic transmission in the central nervous system (CNS). - Because of this, the client should avoid driving at any time or doing other activities that require mental alertness until the effect of the medication on the client is known. - The medication may cause dry mouth, and the client should be instructed to provide good oral hygiene and use sugarless candy or gum as needed.

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving theophylline. The nurse monitors the serum theophylline level and concludes that the medication dosage may need to be increased if which value is noted? A) 5 mg/mL (20 mcmol/L) B) 10 mg/mL (40 mcmol/L) C) 15 mg/mL (60 mcmol/L) D) 20 mg/mL (79 mcmol/L)

A) 5 mg/mL (20 mcmol/L) - Theophylline is a bronchodilator. - The nurse monitors the theophylline blood serum level daily when a client is on this medication to ensure that a therapeutic range is present and monitors for the potential for toxicity. - The therapeutic serum level range is 10 to 20 mg/mL (40 to 79 mcmol/L). - If the laboratory result indicated a level of 5 mg/mL (20 mcmol/L), the dosage of the medication would need to be increased.

Nitrofurantoin is prescribed for an adult client to treat acute urinary tract infection (UTI). Based on the normal adult dose, how should the nurse instruct the client to take this medication? A) 50 mg every 6 hours B) 150 mg 3 times daily C) 300 mg administered at bedtime D) 1 g distributed evenly throughout the day

A) 50 mg every 6 hours - For treatment of acute UTI, the adult dosage is 50 mg every 6 hours. - For prophylaxis of recurrent UTI, low doses are used, such as 50 to 100 mg at bedtime for adults.

The client has a prescription to receive pirbuterol 2 puffs and beclomethasone dipropionate 2 puffs by metered-dose inhaler. The nurse plans to give these medications in which way to ensure effectiveness? A) Administering the pirbuterol before the beclomethasone B) Alternating a single puff of each hourly, beginning with the beclomethasone C) Alternating a single puff of beclomethasone with pirbuterol, repeating the steps D) Administering the pirbuterol, waiting 30 minutes, and administering the beclomethasone

A) Administering the pirbuterol before the beclomethasone - Pirbuterol is a bronchodilator. Beclomethasone is a glucocorticoid. - Bronchodilators are administered before glucocorticoids when both are to be given on the same time schedule. - This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

The nurse has a prescription to administer bethanechol chloride subcutaneously. Before giving this medication, the nurse checks to ensure that which condition is not noted in the client's history? A) Asthma B) Lung infection C) Hypothyroidism D) Urinary retention

A) Asthma - Bethanechol chloride is a cholinergic medication that is used for urinary retention. - This medication should not be used for clients with asthma because it can precipitate bronchoconstriction by activating muscarinic receptors.

A client receiving oral theophylline is due to have a theophylline level drawn. The nurse should question the client to ensure that the client has not ingested which substance before the blood sample is drawn? A) Coffee B) Oatmeal C) Ginger ale D) Bagel with cream cheese

A) Coffee - Theophylline is a xanthine bronchodilator. - Before a serum level of the medication is drawn, the client should avoid taking foods or beverages that contain xanthine, such as colas, coffee, or chocolate; therefore, the client is told to avoid coffee before the test.

A client begins therapy with theophylline. The nurse plans to teach the client to limit the intake of which items while taking this medication? A) Coffee, cola, and chocolate B) Oysters, lobster, and shrimp C) Melons, oranges, and pineapple D) Cottage cheese, cream cheese, and dairy creamers

A) Coffee, cola, and chocolate - Theophylline is a methylxanthine bronchodilator. - The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These foods include coffee, cola, and chocolate.

A client with a urinary tract infection is receiving ciprofloxacin by the intravenous (IV) route. The nurse appropriately administers the medication by performing which action? A) Infusing slowly over 60 minutes B) Infusing in a light-protective bag C) Infusing only through a central line D) Infusing rapidly as a direct IV push medication

A) Infusing slowly over 60 minutes - Ciprofloxacin is prescribed for treatment of mild, moderate, severe, and complicated infections of the urinary tract, lower respiratory tract, and skin and skin structure. - A single dose is administered slowly over 60 minutes to minimize discomfort and vein irritation.

A client who has had a prostatectomy is complaining of pain from bladder spasms. The nurse checks the primary health care provider's prescription sheet and expects to see which medication prescribed to treat the problem? A) Oxybutynin B) Hydromorphone C) Morphine sulfate D) Meperidine hydrochloride

A) Oxybutynin - Bladder spasms after prostatectomy are treated with antispasmodic medications, such as oxybutynin. - Opioid analgesics such as morphine sulfate, hydromorphone, and meperidine hydrochloride usually are not effective in treating pain caused by spasms.

A client has a prescription for valproic acid. To maximize the client's safety, the nurse should plan to monitor for which potential complications of this medication? Select all that apply. A) Pancreatitis B) Hypotension C) Renal failure D) Hepatotoxicity E) Cardiotoxicity

A) Pancreatitis D) Hepatotoxicity - Valproic acid is an anticonvulsant that causes central nervous system depression. - Although rare, this medication has caused pancreatitis and hepatoxicity. - The nurse should monitor for these complications. - The other complications noted in the options are not specifically associated with this medication.

The nurse is told that the result of a serum carbamazepine level for a client who is receiving the medication for the control of seizures is 13 mcg/mL (55.03 mmol/L). Based on this laboratory result, the nurse anticipates that the primary health care provider (PHCP) will document which prescription? A) Discontinuation of the medication B) A decrease of the dosage of the medication C) An increase of the dosage of the medication D) Continuation of the presently prescribed dosage

B) A decrease of the dosage of the medication - When carbamazepine is administered, blood levels need to be monitored periodically to check for the child's absorption of the medication. - The amount of the medication prescribed is based on the blood level achieved. - The therapeutic serum range of carbamazepine is 8 to 12 mcg/mL (34 to 51). - The nurse would anticipate that the PHCP will decrease the dosage of the medication.

A client being admitted to the nursing unit has been taking bethanechol chloride at home. During the admission assessment, the nurse gives special attention to assessing the client for which side and adverse effect of this medication? A) Dry mouth B) Bradycardia C) Constipation D) Hypertension

B) Bradycardia - Bethanechol chloride is a direct-acting muscarinic agonist (cholinergic medication). - It can cause hypotension secondary to vasodilation and bradycardia. - It also can cause excessive salivation, increased secretion of gastric acid, abdominal cramps, and diarrhea. - Higher doses can cause involuntary defecation.

A client has begun therapy with a xanthine bronchodilator. The nurse determines that the client understands dietary alterations if the client states to limit which items while taking this medication? Select all that apply. A) Milk B) Coffee C) Oysters D) Oranges E) Pineapple F) Chocolate

B) Coffee F) Chocolate - The nurse teaches the client to limit the intake of xanthine-containing foods while taking a xanthine bronchodilator. - These include coffee and chocolate.

A client with valvular heart disease who has a clot in the right atrium is receiving a heparin sodium infusion at 1000 units/hr and warfarin sodium 7.5 mg at 5:00 p.m. daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT), 32 seconds; international normalized ratio (INR), 1.3. The nurse should take which action based on the client's laboratory results? A) Collaborate with the primary health care provider (PHCP) to discontinue the heparin infusion and administer the warfarin sodium as prescribed. B) Collaborate with the PHCP to obtain a prescription to increase the heparin infusion and continue the warfarin sodium as prescribed. C) Collaborate with the PHCP to withhold the warfarin sodium since the client is receiving a heparin infusion and the aPTT is within the therapeutic range. D) Collaborate with the PHCP to continue the heparin infusion at the same rate and to discuss use of dabigatran etexilate in place of warfarin sodium.

B) Collaborate with the PHCP to obtain a prescription to increase the heparin infusion and continue the warfarin sodium as prescribed. - When a client is receiving warfarin for clot prevention due to atrial fibrillation, an INR of 2 to 3 is appropriate for most clients. - Until the INR has achieved a therapeutic range, the client should be maintained on a continuous heparin infusion with the aPTT ranging between 60 and 80 seconds. - Therefore, the nurse should collaborate with the HCP to obtain a prescription to increase the heparin infusion and to administer the warfarin as prescribed

The nurse is monitoring a client with hypertension who is taking propranolol. Which assessment finding indicates a potential adverse complication associated with this medication? A) Report of infrequent insomnia' B) Development of expiratory wheezes C) A baseline blood pressure of 150/80 mm Hg after 2 doses of the medication D) A baseline resting heart rate of 88 beats per minute followed by a resting heart rate of 72 beats per minute after 2 doses of the medication

B) Development of expiratory wheezes - Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. - Beta blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. - Normal decreases in blood pressure and heart rate are expected. - Insomnia is a frequent mild side effect and should be monitored.

The nurse is providing discharge instructions to a client receiving trimethoprim-sulfamethoxazole. Which instruction should be included in the list? A) Advise that sunscreen is not needed. B) Drink 8 to 10 glasses of water per day. C) Decrease the dosage when symptoms are improving to prevent an allergic response. D) If the urine turns dark brown, call the primary health care provider (PHCP) immediately.

B) Drink 8 to 10 glasses of water per day. - Each dose of trimethoprim-sulfamethoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake to avoid crystalluria. - The medication is more soluble in alkaline urine. Crystalluria: is the presence of crystals in urine

The nurse is preparing an intravenous (IV) infusion of phenytoin as prescribed by the primary health care provider for the client with seizures. Which solution should the nurse plan to use to dilute this medication? A) Dextrose 5% B) Normal saline solution C) Lactated Ringer's solution D) Dextrose 5% and half-normal saline (0.45%)

B) Normal saline solution - IV infusion of phenytoin should be administered by injection into a large vein. - The medication may be diluted in normal saline solution; however, dextrose solution should be avoided because of medication precipitation

Trimethoprim-sulfamethoxazole is prescribed to be administered by intravenous infusion to a client with a recurrent urinary tract infection. How should the nurse administer this medication? A) Over 30 minutes B) Over 60 to 90 minutes C) Piggybacked into the peripheral line containing parenteral nutrition D) Piggybacked into the existing infusion of normal saline and potassium chloride

B) Over 60 to 90 minutes - Trimethoprim-sulfamethoxazole may be administered by intravenous infusion but should not be mixed with any other medications or solutions. - Trimethoprim-sulfamethoxazole is infused over 60 to 90 minutes, and bolus infusions or rapid infusions must be avoided.

A client is prescribed sulfamethoxazole for treatment of urinary tract infection. Identification of which other medication noted on the client's medical record requires further collaboration with the primary health care provider (PHCP)? A) Insulin B) Phenytoin C) Metoprolol D) Propranolol

B) Phenytoin - Sulfonamides can intensify the effects of warfarin, phenytoin, and sulfonylurea-type oral hypoglycemics (e.g., glipizide, glyburide). - The principal mechanism is inhibition of hepatic metabolism. - When combined with sulfonamides, these medications may require a reduction in dosage to prevent toxicity. - Therefore, the nurse should collaborate with the PHCP regarding dose adjustment of phenytoin.

A client is receiving levofloxacin for treatment of urinary tract infection. Which finding warrants an immediate call to the primary health care provider (PHCP)? A) Client complaint of constipation B) Prolonged QT interval on electrocardiogram C) Client will not take the levofloxacin without food D) The client's culture shows Staphylococcus aureus

B) Prolonged QT interval on electrocardiogram - Levofloxacin can prolong the client's QT interval, which would be noted on electrocardiogram. - This warrants a call to the PHCP because a prolongation in the QT interval can lead to torsades de pointes, a lethal dysrhythmia.

Intravenous heparin therapy is prescribed for a client with atrial fibrillation. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit? A) Vitamin K B) Protamine sulfate C) Potassium chloride D) Aminocaproic acid

B) Protamine sulfate - The antidote to heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrhage should occur.

Nitrofurantoin is prescribed for the client. The nurse checks the client's record, knowing that this medication is contraindicated in which disorder? A) Heart failure B) Renal disease C) Hepatic disease D) Diabetes insipidus

B) Renal disease - Nitrofurantoin is contraindicated in clients with renal impairment.

The nurse has a prescription to give a client salmeterol, 2 puffs, and beclomethasone dipropionate, 2 puffs, by metered-dose inhaler. The nurse should administer the medication using which procedure? A) Beclomethasone first and then the salmeterol B) Salmeterol first and then the beclomethasone C) Alternating a single puff of each, beginning with the salmeterol D) Alternating a single puff of each, beginning with the beclomethasone

B) Salmeterol first and then the beclomethasone - Salmeterol is an adrenergic type of bronchodilator, and beclomethasone dipropionate is a glucocorticoid. - Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule. - This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

The nurse should monitor the client receiving the first dose of albuterol for which side or adverse effect of this medication? A) Drowsiness B) Tachycardia C) Hyperkalemia D) Hyperglycemia

B) Tachycardia - Albuterol is a bronchodilator. Side and adverse effects include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache. - The nurse monitors for these effects during therapy.

Oral bethanechol chloride is prescribed for the client. The nurse should instruct the client to take this medication at which time? A) With meals B) Two hours after meals C) With a snack in the afternoon D) At bedtime with crackers and cheese

B) Two hours after meals - Administration of bethanechol chloride with food can cause nausea and vomiting. - To avoid this problem, oral doses should be administered 1 hour before meals or 2 hours after meals.

Bethanechol chloride is prescribed for a client with urinary retention. Which disorder would be a contraindication to the administration of this medication? A) Gastric atony B) Urinary strictures C) Neurogenic atony D) Gastroesophageal reflux

B) Urinary strictures - Bethanechol chloride can be hazardous to clients with urinary tract obstruction or weakness of the bladder wall. - The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. - Elevation of pressure within the urinary tract could damage or rupture the bladder in clients with these conditions.

Phenazopyridine is prescribed for a client with a urinary tract infection. The nurse evaluates that the medication is effective based on which observation? A) Urine is clear amber. B) Urination is not painful C) Urge incontinence is not present D) A reddish-orange discoloration of the urine is present.

B) Urination is not painful - Phenazopyridine is a urinary analgesic. It is effective when it eliminates pain and burning with urination. - It does not eliminate the bacteria causing the infection, so it would not make the urine clear amber.

Phenazopyridine is prescribed for a client with a urinary tract infection. The nurse evaluates that the medication is effective based on which observation? A) Urine is clear amber. B) Urination is not painful. C) Urge incontinence is not present. D) A reddish-orange discoloration of the urine is present.

B) Urination is not painful. - Phenazopyridine is a urinary analgesic. It is effective when it eliminates pain and burning with urination. - It does not eliminate the bacteria causing the infection, so it would not make the urine clear amber. - It does not treat urge incontinence. - It will cause the client to have reddish-orange discoloration of urine, but this is a side effect of the medication, not the desired effect.

The nurse administered intravenous bumetanide to a client being treated for heart failure. Which outcome indicates that the medication has achieved the expected effect? A) Cough becomes productive of frothy pink sputum. B) Urine output increases from 10 mL hourly. C) The serum potassium level changes from 3.8 to 3.1 mEq/L (3.8 to 3.1 mmol/L). D) B-type natriuretic peptide (BNP) factor increases from 200 to 262 ng/mL (200 to 262 mcg/L).

B) Urine output increases from 10 mL hourly. - Bumetanide is a diuretic and expected outcomes include increased urine output, decreased crackles, and decreased weight.

Nitrofurantoin is prescribed for a client with urinary tract infection. The nurse is instructing the client regarding the administration of the medication. Which information about the best time to take this medication should be included in the client's education? A) At bedtime B) With meals C) One hour before the dinner meal D) In the morning, 2 hours after breakfast

B) With meals - Nitrofurantoin is an antibacterial used to treat urinary tract infections. - The nurse would instruct the client to take the medication with food to reduce any gastrointestinal upset that the medication can cause. - Therefore, the best time to take the medication is with meals.

The nurse provides instructions regarding the administration of liquid oral cyclosporine solution to a client. Which statement, if made by the client, would indicate the need for further teaching? A) "I need to mix the concentrate well and drink it immediately." B) "I will mix the concentrate with orange juice to improve the taste." C) "I will purchase a dropper from the pharmacy to calibrate the amount of medication that I need." D) "After taking the medication, I need to rinse the container with diluent and drink it to ensure that I have taken the complete dose."

C) "I will purchase a dropper from the pharmacy to calibrate the amount of medication that I need." - The client needs to be instructed to dispense the oral liquid into a glass container using a specially calibrated pipette. - The client should not use any other type of dropper to calibrate the amount of prescribed medication. - The remaining options identify correct procedure for administering this medication.

The nurse is providing instructions to an adolescent prescribed phenytoin for the control of seizures. Which statement by the adolescent indicates a need for further teaching regarding the medication? A) "The medication may cause acne or oily skin." B) "Drinking alcohol may affect the medication." C) "If my gums become sore and swollen, I need to stop the medication." D) "Birth control pills may not be effective when I take this medication."

C) "If my gums become sore and swollen, I need to stop the medication." - The adolescent should not stop taking antiseizure medications suddenly or without discussing it with a primary health care provider (PHCP) or nurse. - Acne or oily skin may be a problem for the adolescent, and the adolescent is advised to call a PHCP for skin problems. - Alcohol will lower the seizure threshold, and it is best to avoid its use. Birth control pills may be less effective when the client is taking antiseizure medication.

A client with a urinary tract infection (UTI) is given a prescription for levofloxacin. The nurse should provide the client with which information about this medication? A) "You may experience altered taste." B) "You may get dizzy, so move around slowly." C) "Pain in the back of the leg should be reported." D) "Your urine may become dark and if it does, you should call your primary health care provider."

C) "Pain in the back of the leg should be reported." - Levofloxacin is a fluoroquinolone antibiotic and is used for a variety of infections, including UTI. - Adverse effects include peripheral neuropathy, rhabdomyolysis, tendonitis, tendon rupture, Clostridium difficile infection, muscle weakness in clients with myasthenia gravis, and photosensitivity. - Levofloxacin can also prolong the client's QT interval, leading to dysrhythmias. - Pain in the back of the leg could be indicative of tendonitis and therefore risk for tendon rupture.

A client who has been receiving theophylline by the intravenous (IV) route has the medication prescription changed to an immediate-release oral form of the medication. After discontinuing the IV medication, when should the nurse schedule the first dose of the oral medication? A) Just after the next meal B) Just before the next meal C) 4 hours after discontinuing the IV form D) Immediately on discontinuing the IV form

C) 4 hours after discontinuing the IV form - With immediate-release preparations, oral theophylline should be administered 4 to 6 hours after discontinuing the IV form of the medication. - If the sustained-release form is used, the first oral dose should be administered immediately on discontinuation of the IV infusion.

A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hr. The nurse determines that the client is receiving the therapeutic effect based on which results? A) Prothrombin time of 12.5 seconds B) Activated partial thromboplastin time of 28 seconds C) Activated partial thromboplastin time of 60 seconds D) Activated partial thromboplastin time longer than 120 seconds

C) Activated partial thromboplastin time of 60 seconds - Common laboratory ranges for activated partial thromboplastin time (aPTT) are 30 to 40 seconds. - Because the aPTT should be 1.5 to 2.5 times the normal value, the client's aPTT would be considered therapeutic if it was 60 seconds. - Prothrombin time assesses response to warfarin therapy.

The nurse is preparing a subcutaneous dose of bethanechol prescribed for a client with urinary retention. Before giving the dose, the nurse checks to see that which medication is available on the emergency cart for use if needed? A) Vitamin K B) Mucomyst C) Atropine sulfate D) Protamine sulfate

C) Atropine sulfate - Bethanechol is a cholinergic medication. Administration of bethanechol could result in cholinergic overdose. - The antidote is atropine (an anticholinergic), which should be readily available for use if overdose occurs. - Mucomyst is the antidote for acetaminophen overdose. - Protamine sulfate is the antidote for heparin. - Vitamin K is the antidote for warfarin.

A client is being treated with procainamide for a cardiac dysrhythmia. Following intravenous administration of the medication, the client complains of dizziness. What intervention should the nurse take first? A) Obtain a 12-lead electrocardiogram B) Check the client's fingerstick blood glucose level C) Auscultate the client's apical pulse and blood pressure D) Measure the QRS interval duration on the rhythm strip

C) Auscultate the client's apical pulse and blood pressure - Signs of toxicity from procainamide include confusion, dizziness, drowsiness, decreased urination, nausea, vomiting, and tachydysrhythmias. - If the client complains of dizziness, the nurse should assess the vital signs first. - Although measuring the QRS duration on the rhythm strip and obtaining a 12-lead electrocardiogram may be interventions, these would be done after the vital signs are taken

Following kidney transplantation, cyclosporine is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication? A) Creatinine level of 0.6 mg/dL (53 mcmol/L) B) Hemoglobin level of 14.0 g/dL (140 mmol/L) C) Blood urea nitrogen level of 25 mg/dL (8.8 mmol/L) D) Fasting blood glucose level of 99 mg/dL (5.5 mmol/L)

C) Blood urea nitrogen level of 25 mg/dL (8.8 mmol/L) - Cyclosporine is an immunosuppressant. - Nephrotoxicity can occur from the use of cyclosporine. - Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen and serum creatinine levels. - The normal blood urea nitrogen level is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). - The normal creatinine level for a male is 0.6 to 1.2 mg/dL (53 to 106 mcmol/L) and for a female is 0.5 to 1.1 mg/dL (44 to 97 mcmol/L).

The nurse, who is administering bethanechol chloride, is monitoring for cholinergic overdose associated with the medication. The nurse should check the client for which sign of overdose? A) Dry skin B) Dry mouth C) Bradycardia D) Signs of dehydration

C) Bradycardia - Cholinergic overdose of bethanechol chloride produces manifestations of excessive muscarinic stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension. - Remember that the sympathetic nervous system speeds the heart rate and the cholinergic (parasympathetic) nervous system slows the heart rate.

A client is prescribed dutasteride. Which outcome indicates that the medication is effective? A) Improved erectile function B) A reduction in blood pressure C) Decreased obstruction to outflow of urine through the urethra D) Decreased low-density lipoproteins and increased high-density lipoproteins

C) Decreased obstruction to outflow of urine through the urethra - Dutasteride promotes regression of prostate epithelial tissue and thereby decreases mechanical obstruction of the urethra. - Because the percentage of epithelial tissue is highest in very large prostates, it is most effective in men whose prostates are very enlarged.

Terbutaline is prescribed for a client with bronchitis. The nurse checks the client's medical history for which disorder in which the medication should be used with caution? A) Osteoarthritis B) Hypothyroidism C) Diabetes mellitus D) Polycystic disease

C) Diabetes mellitus - Terbutaline is a bronchodilator and is contraindicated in clients with hypersensitivity to sympathomimetics. - It should be used with caution in clients with impaired cardiac function, diabetes mellitus, hypertension, hyperthyroidism, or a history of seizures. - The medication may increase blood glucose levels.

Terbutaline is prescribed for a client with bronchitis. Which disorder in the client's medical history requires caution by the nurse? A) Osteoarthritis B) Hypothyroidism C) Diabetes mellitus D) Polycystic disease

A client taking albuterol by inhalation cannot cough up secretions. What should the nurse suggest that the client do to assist in expectoration of secretions? A) Get more exercise each day. B) Use a dehumidifier in the home. C) Drink increased amounts of fluids every day. D) Take an extra dose of albuterol before bedtime.

C) Drink increased amounts of fluids every day. - A client should drink increased fluids (2000 to 3000 mL/day) to decrease viscosity and increase expectoration of secretions. - This is standard advice for clients receiving any of the adrenergic bronchodilators, unless the client has another health problem that contraindicates an increased fluid intake.

The nurse is reviewing the laboratory results for a client receiving tacrolimus. Which laboratory result would indicate to the nurse that the client is experiencing an adverse effect of the medication? A) Potassium level of 3.8 mEq/L (3.8 mmol/L) B) Platelet count of 300,000 mm3 (300 × 109/L) C) Fasting blood glucose of 200 mg/dL (11.1 mmol/L) D) White blood cell count of 6000 mm3 (6.0 × 109/L)

C) Fasting blood glucose of 200 mg/dL (11.1 mmol/L) - A fasting blood glucose level of 200 mg/dL (11.1 mmol/L) is significantly elevated above the normal range of 70 to 99 mg/dL (3.9-5.5 mmol/L) and suggests an adverse effect. - Recall that fasting blood glucose levels are sometimes based on primary health care provider preference.

The nurse is providing dietary instructions to a client who has been prescribed cyclosporine. Which food item should the nurse instruct the client to exclude from the diet? A) Red meats B) Orange juice C) Grapefruit juice D) Green, leafy vegetables

C) Grapefruit juice - A compound present in grapefruit juice inhibits metabolism of cyclosporine through the cytochrome P450 system. - As a result, consumption of grapefruit juice can raise cyclosporine levels by 50% to 100%, thereby greatly increasing the risk of toxicity.

Zafirlukast is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication? A) Platelet count B) Neutrophil count C) Liver function tests D) Complete blood count

C) Liver function tests - Zafirlukast is a leukotriene receptor antagonist used in the prophylaxis and long-term treatment of bronchial asthma. - Zafirlukast is used with caution in clients with impaired hepatic function. - Liver function laboratory tests should be performed to obtain a baseline, and the levels should be monitored during administration of the medication.

The nurse is preparing to administer albuterol to a client. Which parameters should the nurse assess before and during therapy? A) Nausea and vomiting B) Headache and level of consciousness C) Lung sounds and presence of dyspnea D) Urine output and blood urea nitrogen level

C) Lung sounds and presence of dyspnea - Albuterol is an adrenergic bronchodilator. - The nurse assesses respiratory pattern, lung sounds, pulse, and blood pressure before and during therapy. - The nurse also notes the color, character, and amount of sputum.

Ciprofloxacin is prescribed for a client with a Pseudomonas aeruginosa infection of the urinary tract. The primary health care provider (PHCP) should be questioned by the nurse about the prescription if which underlying condition is noted in the client's record? A) Osteoarthritis B) Diabetes mellitus C) Myasthenia gravis D) Chronic obstructive pulmonary disease (COPD)

C) Myasthenia gravis - Ciprofloxacin and other fluoroquinolones can exacerbate muscle weakness in clients with myasthenia gravis. - Accordingly, clients with a history of myasthenia gravis should not receive these medications.

The primary health care provider prescribes cromolyn for the client with asthma. The nurse identifies that the client correctly understands the purpose of this medication when the client states that the medication will produce which effect? A) Promote bronchodilation B) Decrease the risk of infection C) Suppress an allergic response D) Eliminate the need for a rescue inhaler

C) Suppress an allergic response - Cromolyn is a first-line therapy for prophylactic treatment of asthma; it is a mast cell stabilizer, antiasthmatic, and antiallergic. - The medication acts in part by stabilizing the cytoplasmic membrane of mast cells, thereby preventing release of histamine and other mediators.

A client taking carbamazepine asks the nurse what to do if a dose is inadvertently missed. The nurse responds that which action should be taken? A) Withhold until the next scheduled dose. B) Withhold and call the primary health care provider (PHCP). C) Take the dose as long as it is not close to the time for the next dose. D) Withhold until the next scheduled dose, which should then be doubled.

C) Take the dose as long as it is not close to the time for the next dose. - IV administration of phenytoin is performed slowly (no faster than 50 mg/min) because rapid administration can cause cardiovascular collapse. - It should not be added to any existing IV infusion because this is likely to produce a precipitate in the solution. - Solutions are highly alkaline and can cause local venous irritation.

A client taking metronidazole calls the home health nurse to report dark discoloration to the urine. The nurse interprets that the client's complaint warrants which nursing action at this time? A) Instruct the client to increase fluid intake. B) Tell the client to discontinue the medication C) Tell the client that this is a harmless medication side effect. D) Instruct the client to call the primary health care provider (PHCP).

C) Tell the client that this is a harmless medication side effect. - Harmless darkening of the urine may occur, and the client should be told of this effect. - Metronidazole can produce a variety of side effects, but they rarely require termination of treatment.

Which statement made by a client taking montelukast indicates the need for further teaching? A) "I will need to have my liver function checked." B) "I can take the medication with food or without." C) "I may be able to decrease the use of my metered-dose inhaler." D) "I will take the medication when I first notice I am having trouble breathing."

D) "I will take the medication when I first notice I am having trouble breathing." - Montelukast cannot be used for quick relief of an asthma attack because effects of the medication develop too slowly. - For prophylaxis and maintenance therapy of asthma, maximal effects develop within 24 hours of the first dose and are maintained with once-daily dosing in the evening.

The home health care nurse is visiting a client with coronary artery disease with elevated triglyceride levels and a serum cholesterol level of 398 mmol/L). The client is taking cholestyramine, and the nurse teaches the client about the medication. Which statement by the client indicates the need for further teaching? A) "Constipation and bloating might be a problem." B) "I'll continue to watch my diet and reduce my fats." C) "Walking a mile each day will help the whole process." D) "I'll continue my nicotinic acid from the health food store."

D) "I'll continue my nicotinic acid from the health food store." - Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. - All lipid-lowering medications also can cause liver abnormalities, so a combination of nicotinic acid and cholestyramine resin needs to be avoided.

The nurse is providing teaching for a client prescribed ciprofloxacin for a urinary tract infection. Which statement made by the client indicates that there is a need for further teaching? A) "I can take the ciprofloxacin with or without food." B) "I'll need to wear sunscreen and protective clothing while taking ciprofloxacin." C) "I'll need to contact my primary health care provider if I develop any white patches in my mouth." D) "If I develop any tendon pain while taking ciprofloxacin, exercise should help to decrease the pain."

D) "If I develop any tendon pain while taking ciprofloxacin, exercise should help to decrease the pain." - The primary health care provider should be contacted immediately if the client develops any tendon pain, swelling, or inflammation because of the risk of tendon rupture. - Exercise is contraindicated until tendon rupture is ruled out. Fluorquinolones such as ciprofloxacin need to be discontinued at the first sign of any tendon pain, swelling, or inflammation.

A client with chronic obstructive pulmonary disease (COPD) is being changed from an oral glucocorticoid to triamcinolone by inhalation. The client asks why this change is necessary. Which statement by the nurse to the client is accurate? A) "Inhaled glucocorticoids cure the condition." B) "Inhaled glucocorticoids treat this condition more effectively." C) "Inhaled glucocorticoids decrease the symptoms more quickly." D) "Inhaled glucocorticoids are preferred because of decreased adverse effects."

D) "Inhaled glucocorticoids are preferred because of decreased adverse effects." - Triamcinolone is an adrenocorticosteroid. - Inhaled glucocorticoids are preferable for long-term management because there is a decreased incidence of adverse effects since the medication is not absorbed systemically. - COPD is a progressive condition and cannot be cured.

The nurse has just administered the first dose of omalizumab to a client. Which statement by the client alerts the nurse of a life-threatening effect? A) "I have a severe headache." B) "My feet are quite swollen." C) "I am nauseated and may vomit." D) "My lips and tongue are swollen."

D) "My lips and tongue are swollen." - Omalizumab is an antiinflammatory and monoclonal antibody used for long-term control of asthma. - Anaphylactic reactions can occur with the administration of omalizumab. - The nurse administering the medication should monitor for adverse reactions of the medication. - Swelling of the lips and tongue are an indication of an anaphylaxis.

A client who experiences allergic rhinitis asks the nurse about a nasal corticosteroid. How should the nurse reply? A) "Clear the nasal passages after use." B) "Take the medication only as needed." C) "The medication should start to work immediately." D) "The medication works locally and decreases inflammation."

D) "The medication works locally and decreases inflammation." Allergic rhinitis: inflammation of the inside of the nose caused by an allergen - Intranasal corticosteroids may be used to treat allergic rhinitis. The medication works locally and decreases inflammation. - The client should be instructed to clear the nasal passages before use for best medication effectiveness. - The client should take the medication regularly as prescribed in order for the effect to be achieved. - The medication may take several days to achieve maximal effect because it works by decreasing inflammation.

A client with an exacerbation of chronic obstructive pulmonary disease (COPD) has been on oral glucocorticoids and is currently being weaned to triamcinolone by inhalation. The nurse determines that the client understands the potential adverse effects to watch for during this medication change when the client states the need to report which signs and symptoms? A) Chills, fever, and generalized rash B) Vomiting, diarrhea, and increased thirst C) Blurred vision, headache, and insomnia D) Anorexia, nausea, weakness, and fatigue

D) Anorexia, nausea, weakness, and fatigue - The client being changed from oral to inhalation glucocorticoids could experience signs of adrenal insufficiency. - The nurse teaches the client to report anorexia, nausea, weakness, and fatigue. - Other signs that can be detected and are objective include hypotension and hypoglycemia

The primary health care provider (PHCP) writes a prescription for carbamazepine for a client who was admitted to the hospital. The nurse contacts the PHCP to verify the prescription if which condition is noted in the assessment data? A) Hypertension B) Tonic-clonic seizures C) Trigeminal neuralgia D) Bone marrow depression

D) Bone marrow depression - Carbamazepine is classified as an iminostilbene derivative and is used as an anticonvulsant, antineuralgic, antimanic, and antipsychotic. - It is used to treat seizure disorders, trigeminal neuralgia, and diabetic neuropathy. - The medication can cause blood dyscrasias as an adverse effect and is contraindicated if the client has a history of bone marrow depression, hypersensitivity to tricyclic antidepressants, or concurrent use of monoamine oxidase inhibitors.

A cromolyn sodium inhaler is prescribed for a client with allergic asthma. The nurse provides instructions regarding the adverse effects of this medication and should tell the client that which undesirable effect is associated with this medication? A) Insomnia B) Constipation C) Hypotension D) Bronchospasm

D) Bronchospasm Bronchospasm: when the airways (bronchial tubes) go into spasm and contract - Cromolyn sodium is an inhaled nonsteroidal antiallergy agent and a mast cell stabilizer. - Undesirable effects associated with inhalation therapy of cromolyn sodium are bronchospasm, cough, nasal congestion, throat irritation, and wheezing. - Clients receiving this medication orally may experience pruritus, nausea, diarrhea, and myalgia.

Carbamazepine has been prescribed for a client. The nurse should tell the client that which blood test will be done periodically while the client is taking this medication? A) Lipase level B) Amylase level C) Ammonia level D) Complete blood cell (CBC) count

D) Complete blood cell (CBC) count - Carbamazepine is classified as an iminostilbene derivative and is used as an anticonvulsant, antineuralgic, antimanic, and antipsychotic. - The medication can cause blood dyscrasias as an adverse effect, and the client should have a CBC count done before therapy and periodically during therapy.

A client who is receiving nitrofurantoin calls the clinic complaining of troublesome effects related to the medication. Which side or adverse effect(s) indicates the need to stop treatment with this medication? A) Nausea B) Anorexia C) Diarrhea D) Cough and chest pain

D) Cough and chest pain - Nitrofurantoin is an antimicrobial medication. Gastrointestinal (GI) effects are the most frequent side effects to this medication and can be minimized by administering the medication with milk or meals. - However, they are not an indication for discontinuing the medication. - Pulmonary reactions, manifested as dyspnea, chest pain, chills, fever, cough, and the presence of alveolar infiltrates on radiography, indicate the need to stop the treatment.

A client who is taking phenytoin for a seizure disorder is being admitted to the hospital because of an increase in seizure activity. The client reports severe vomiting for the last 24 hours and an inability to take phenytoin during that time. The nurse anticipates that the primary health care provider will most likely prescribe which medication? A) Clonazepam B) Phenobarbital C) Carbamazepine D) Fosphenytoin sodium

D) Fosphenytoin sodium - Fosphenytoin sodium is used for short-term parenteral (intravenous) infusion. - A client who is not tolerating medications orally and has a seizure disorder would need an anticonvulsant administered by the parenteral route.

The ambulatory care nurse is providing instructions to a client with a urinary tract infection (UTI) being started on nitrofurantoin. The nurse should provide the client with which information? A) It can cause urinary retention. B) It will cause the urine to become clear C) The sun should be avoided because it is a sulfa-based medication. D) If taken with meals, it will help decrease the risk for gastrointestinal (GI) upset.

D) If taken with meals, it will help decrease the risk for gastrointestinal (GI) upset. - Nitrofurantoin is a urinary antiseptic (not a sulfa-based medication) and should be taken with meals to decrease the incidence of GI side effects. - Food or milk decreases the GI upset. - The medication could cause the urine to turn rust yellow or brown.

A client taking theophylline has a serum theophylline level of 15 mcg/mL (60 mcmol/L). How does the nurse interpret this laboratory value? A) Below therapeutic range B) In excess of the therapeutic range C) Near the top of the therapeutic range D) In the middle of the therapeutic range

D) In the middle of the therapeutic range - The normal therapeutic range for the theophylline level is 10 to 20 mcg/mL (40 to 79 mcmol/L).

The nurse is administering a dose of pirbuterol to a client. The nurse should monitor for which side or adverse effect of this medication? A) Drowsiness B) Hypokalemia C) Hyperglycemia D) Increased pulse

D) Increased pulse - Pirbuterol is an adrenergic bronchodilator. Side and adverse effects include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache. - The nurse monitors for these effects during therapy.

Cromolyn sodium is prescribed for the client with allergic asthma. What goal does the nurse expect to achieve by administration of this medication? A) Dilation of the bronchi B) Increase in the number of eosinophils C) Promotion of the migration of eosinophils into the inflammatory site D) Inhibition of the release of mediators from mast cells after exposure to an antigen

D) Inhibition of the release of mediators from mast cells after exposure to an antigen - Cromolyn sodium is an antiasthmatic, antiallergic, and mast cell stabilizer that inhibits the release of mediators from mast cells after exposure to an antigen. - It can also interrupt the migration of eosinophils into the inflammatory site and decrease the number of eosinophils. - These actions decrease airway hyperresponsiveness in some clients with asthma.

A client is receiving oxybutynin. The nurse should suspect that this medication is prescribed to relieve which condition? A) Gastritis B) Renal calculi C) Ulcerative colitis D) Overactive bladder

D) Overactive bladder - When medication therapy for overactive bladder is indicated, anticholinergic agents are the medications generally prescribed. - These medications block muscarinic receptors on the bladder detrusor and thereby inhibit bladder contractions and decrease the urge to void.

A home care nurse has observed a client self-administer a dose of an adrenergic bronchodilator via metered-dose inhaler. Within a short time, the client begins to wheeze loudly. The nurse understands that this is the result of which occurrence? A) Insufficient dosage of the medication, which needs to be increased B) Probable interaction of this medication with an over-the-counter cold remedy C) Tolerance to the medication, indicating a need for a stronger type of bronchodilator D) Paradoxical bronchospasm, which must be reported to the primary health care provider (PHCP)

D) Paradoxical bronchospasm, which must be reported to the primary health care provider (PHCP) - The client taking adrenergic bronchodilators may experience paradoxical bronchospasm, which is evidenced by the client's wheezing. - This can occur with excessive use of inhalers. - Further medication should be withheld, and the PHCP should be notified.

The nurse is speaking with a client taking phenytoin for seizure control. The client states that she has started using birth control pills to prevent pregnancy. Which would be an important point for the nurse to emphasize to the client? A) Oral contraceptives decrease the effectiveness of phenytoin. B) Severe gastrointestinal side effects can occur when phenytoin and oral contraceptives are taken together. C) There is an increased risk of thrombophlebitis when phenytoin and oral contraceptives are taken at the same time. D) Phenytoin may decrease the effectiveness of birth control pills, and additional measures should be taken to avoid pregnancy.

D) Phenytoin may decrease the effectiveness of birth control pills, and additional measures should be taken to avoid pregnancy. - Phenytoin enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. - The nurse should tell the client to alert the health care provider about the use of birth control pills so that counseling may be provided about alternative birth control methods.

Oxybutynin chloride is prescribed for a client with urge incontinence. Which sign would indicate a possible toxic effect related to this medication? A) Pallor B) Drowsiness C) Bradycardia D) Restlessness

D) Restlessness - Toxicity (overdosage) of oxybutynin produces central nervous system excitation, such as nervousness, restlessness, hallucinations, and irritability. - Other signs of toxicity include hypotension or hypertension, confusion, tachycardia, flushed or red face, and signs of respiratory depression. - Drowsiness is a frequent side effect of the medication but does not indicate overdosage.

A client who has been taking high doses of acetylsalicylic acid to relieve pain from osteoarthritis now has more generalized joint pain and an elevated temperature. The nurse should assess for which complication to determine whether the client has other signs of aspirin toxicity? A) Diarrhea B) Constipation C) Double vision D) Ringing in the ears

D) Ringing in the ears - Mild intoxication with acetylsalicylic acid, called salicylism, commonly occurs when the daily dosage is more than 4 g. - Tinnitus (ringing in the ears) is the most frequent effect noted with intoxication. - Hyperventilation also may occur because a salicylate stimulates the respiratory center. - Fever may result because a salicylate interferes with the metabolic pathways coupling oxygen consumption and heat production. - The remaining options are not signs of aspirin toxicity.

Prior to administering a client's daily dose of digoxin to treat heart failure, the nurse reviews the client's laboratory data and notes the following results: serum calcium, 9.8 mg/dL (2.45 mmol/L); serum magnesium, 1.0 mEq/L (0.4 mmol/L); serum potassium, 4.1 mEq/L (4.1 mmol/L); serum creatinine, 0.9 mg/dL (79.5 mcmol/L). Which result should alert the nurse that the client is at risk for digoxin toxicity? A) Serum calcium level B) Serum potassium level C) Serum creatinine level D) Serum magnesium level

D) Serum magnesium level - An increased risk of toxicity exists in clients with hypercalcemia, hypokalemia, hypomagnesemia, hypothyroidism, and impaired renal function. - The calcium, creatinine, and potassium levels are all within normal limits. - The normal range for magnesium is 1.8-2.6 mEq/L (0.74-1.07 mmol/L), and the results in the correct option are reflective of hypomagnesemia.

Parenteral bethanechol chloride is prescribed for a client with urinary retention. The nurse should plan to administer this medication by which route? A) Intravenously B) Intradermally C) Intramuscularly D) Subcutaneously

D) Subcutaneously - The injectable form of bethanechol chloride is intended for subcutaneous administration only. - Bethanechol must never be injected intramuscularly or intravenously because the resulting high medication level can cause severe toxicity, resulting in bloody diarrhea, bradycardia, profound hypotension, and cardiovascular collapse.

A client is prescribed trimethoprim-sulfamethoxazole for a recurrent urinary tract infection (UTI). The nurse should give the client which instruction regarding this medication? A) Expect rashes or skin changes as a result of therapy. B) Discontinue the medication when symptoms subside C) Take most doses early in the day when fluid intake is greatest D) Take each dose with 8 oz of water, and drink extra water each day.

D) Take each dose with 8 oz of water, and drink extra water each day. - Trimethoprim-sulfamethoxazole is a combination medication. - The client takes each dose with 8 oz of water and drinks several extra glasses of water each day. - The client should space doses evenly around the clock for stable blood levels and should take the medication for the full course of therapy. - The client should report rashes or other skin changes, which could indicate an allergy to sulfa.

Tacrolimus is prescribed for a client who underwent a kidney transplant. Which instruction should the nurse include when teaching the client about this medication? A) Eat at frequent intervals to avoid hypoglycemia. B) Take the medication with a full glass of grapefruit juice. C) Change positions carefully due to risk of orthostatic hypotension. D) Take the oral medication every 12 hours at the same times every day.

D) Take the oral medication every 12 hours at the same times every day. - Tacrolimus is a potent immunosuppressant used to prevent organ rejection in transplant clients. - It is important that the medication be taken at 12-hour intervals to maintain a stable blood level to prevent organ rejection.

Nitrofurantoin is prescribed for a client with a urinary tract infection. The client contacts the nurse and reports a cough, chills, fever, and difficulty breathing. The nurse should make which interpretation about the client's complaints? A) The client may have contracted the flu. B) The client is experiencing anaphylaxis. C) The client is experiencing expected effects of the medication. D) The client is experiencing a pulmonary reaction requiring cessation of the medication.

D) The client is experiencing a pulmonary reaction requiring cessation of the medication. - Nitrofurantoin can induce 2 kinds of pulmonary reactions: acute and subacute. - Acute reactions, which are most common, manifest with dyspnea, chest pain, chills, fever, cough, and alveolar infiltrates. - These symptoms resolve 2 to 4 days after discontinuing the medication. - Acute pulmonary responses are thought to be hypersensitivity reactions.

Tamsulosin hydrochloride has been prescribed for a client with benign prostatic hypertrophy (BPH). How should the nurse instruct the client to take the medication? A) With breakfast B) With a glass of milk C) With the lunchtime meal D) Thirty minutes after a meal

D) Thirty minutes after a meal - Tamsulosin hydrochloride is a medication that will relieve mild to moderate manifestations of BPH and improve urinary flow rates. - The medication should be administered 30 minutes after meals because food decreases the peak plasma concentration and lengthens the time to achieve peak plasma medication concentrations.

Saunders NCLEX

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