ATI PHARMACOLOGY 2 CURRENT

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1. A nurse is caring for four clients. After administering morning medications, she realizes that the nifedipine prescribed for one client was inadvertently administered to another client. Which of th... e following actions should the nurse take first? A. Notify the client's provider. Rationale: The nurse should notify the client's provider to inform her of the event; however, there is another action the nurse should take first. B. Check the client's vital signs. Rationale: The first action the nurse should take using the nursing process is to assess the client. The nurse should know that the action of nifedipine is to lower blood pressure. Immediately upon realizing the error, the nurse should check the client's vital signs (especially the client's blood pressure) to ensure that the client is not hypotensive as a result. Only after ensuring that the client is safe and has stable vital signs should the nurse take other actions. C. Fill out an occurrence form. Rationale: The nurse should fill out an occurrence form to report the event to hospital personnel; however, there is another action the nurse should take first. D. Administer the medication to the correct client. Rationale: The nurse should administer the medication to the correct client to fulfill the provider's prescription; however, there is another action the nurse should take first. 2. A nurse is reviewing a client's admission record. The nurse notes that there are prescriptions for several medications. Which of the following factors should the nurse recognize is of primary consideration when determining the schedule of administration? A. Institutional policies regarding routine medication administration times Rationale: The nurse should consider institutional policies regarding routine medication administration times; however, evidence-based practice indicates that the nurse should base medication administration times on another consideration. B. Specific characteristics of the medications Rationale: Evidence-based practice indicates that the specific characteristics of the medications be the primary consideration of scheduling administration times. The characteristics of each medication, including the indication, onset, durations of action, and potential adverse effects and interactions, primarily determine the schedule of administration. Although an institutional policy may require that all once daily medications be administered at 0800, the nurse should be aware that some classifications of medications should only be given at bedtime, or should only be given with food. Likewise, the client's preferences, as well as the availability of each medication from the pharmacy, play important but smaller roles in determining the schedule of administration. C. Schedule of administration that the client follows at home Rationale: The nurse should consider the schedule of administration that the client follows at home; however, evidence-based practice indicates that the nurse should base medication administration times on another consideration. D. Time at which the medication can be available from the pharmacy Rationale: The nurse should consider the time at which the medication can be available from the pharmacy; however, evidence-based practice indicates that the nurse should base medication administration times on another consideration. 3. A clinic nurse is giving instructions to a mother on the proper technique of applying ophthalmic ointment to her preschool-age child who has conjunctivitis. Which of the following should the nurse include in the instructions? A. "Warm the ointment by placing the tube in glass of hot tap water." Rationale: Eye drops that are stored in the refrigerator should come to room temperature before instillation. The parent should not warm the ointment by placing it in glass of hot water. B. "Cleanse the eye with a wet cotton ball in a direction towards the inner canthus before applying the ointment." Rationale: The parent should clean the eye in a direction from the inside canthus outward in order to prevent contamination of the lacrimal duct or the other eye. C. "Discard the first bead of ointment before each application." Rationale: The parent should discard the first bead of ointment from the tube because it is considered contaminated. D. "Instruct your child to squeeze his eyes shut following application." Rationale: Closing the eyes spreads the medication over the eyeball, but squeezing the eyelid shut can force out some of the medication. 4. A home health nurse is assessing an older adult client who reports falling a couple of times over the past week. Which of the following findings should the nurse suspect is contributing to the client's falls? A. The client takes alprazolam. Rationale: Alprazolam is a CNS depressant that can cause dizziness and orthostatic hypotension, which can cause the client to lose his balance and fall. B. The client has a nonslip bath mat in his shower. Rationale: A nonslip bath mat should reduce the risk for the client to fall. C. The client uses a raised toilet seat. Rationale: A raised toilet seat should reduce the risk for the client to fall. D. The client wears fitted slippers. Rationale: Fitted and nonslip slippers should reduce the risk for the client to fall. 5. A nurse is teaching a client who takes warfarin daily. Which of the following statements by the client indicates a need for further teaching? A. "I have started taking ginger root to treat my joint stiffness." Rationale: Ginger root can interfere with the blood clotting effect of warfarin and place the client at risk for bleeding. This statement indicates the client needs further teaching. B. "I take this medication at the same time each day." Rationale: The client should take warfarin at the same time each day to maintain a stable blood level. C. "I eat a green salad every night with dinner." Rationale: Green leafy vegetables are a good source of vitamin K, which can interfere with the clotting effects of warfarin. Clients who are taking warfarin do not need to restrict dietary vitamin K intake but rather should maintain a consistent intake of vitamin K in order to control the therapeutic effect of the medication. D. "I had my INR checked three weeks ago." Rationale: Clients who have been taking warfarin for more than 3 months should have their INR level checked every 2 to 4 weeks. 6. A nurse is assessing a client prior to administering a seasonal influenza vaccine. The client says he read about an influenza vaccine that is given as a nasal spray and wants to receive it. The nurse should recognize that which of the following findings is a contraindication for the client receiving the live attenuated influenza vaccine (LAIV)? A. The client's age is 62. Rationale: Clients must be between the ages of 2 and 49 to receive the LIAV; therefore, it is contraindicated for this client. Pregnancy and immunocompromised status are also contraindications. B. The client smokes one pack of cigarettes a day Rationale: Cigarette smoking is not a contraindication for receiving the LIAV. C. The client has a history of myocardial infarction. Rationale: A history of myocardial infarction is not a contraindication for receiving the LIAV. D. The client has recently traveled to Europe. Rationale: Recent travel to Europe is not a contraindication for receiving the LIAV. 7. A nurse is teaching a client about the adverse effects of cisplatin. Which of the following adverse effects should the nurse include in the teaching? A. Tinnitus Rationale: Tinnitus and hearing loss are adverse effects of cisplatin. B. Constipation Rationale: Diarrhea is an adverse effect of cisplatin. C. Hyperkalemia Rationale: Hypokalemia is an adverse effect of cisplatin. D. Weight gain Rationale: Weight gain is an adverse effect of docetaxel due to fluid retention. 8. A nurse is caring for a client who is experiencing severe nausea and vomiting after a course of chemotherapy. The nurse should monitor the client for which of the following clinical manifestations? A. Metabolic acidosis Rationale: Hypermetabolism, such as with fever or exercise, can cause metabolic acidosis. B. Metabolic alkalosis Rationale: Metabolic alkalosis can occur in clients who have excessive vomiting because of the loss of hydrochloric acid. C. Respiratory acidosis Rationale: Respiratory depression can cause respiratory acidosis. D. Respiratory alkalosis Rationale: Hyperventilation can cause respiratory alkalosis. 9. A nurse is assessing a client prior to the administration of morphine. The nurse should recognize that which of the following assessments is the priority? A. Pupil reaction Rationale: The nurse should assess the client's pupils because morphine can cause miosis; however, another assessment is the priority. B. Urine output Rationale: The nurse should assess the client's urine output because morphine can cause urinary retention; however, another assessment is the priority. C. Bowel sounds Rationale: The nurse should assess the client's bowel sounds because morphine can cause constipation; however, another assessment is the priority. D. Respiratory rate Rationale: When using the airway, breathing, circulation approach to client care, the nurse should determine the priority assessment is respiratory rate. Morphine can cause respiratory depression. The nurse should withhold the medication and notify the prescriber if the client has a respiratory rate less than 12/min. 10. A nurse is completing a medical interview with a client who has elevated cholesterol levels and takes warfarin. The nurse should recognize that which of the following actions by the client can potentiate the effects of warfarin? A. The client follows a low-fat diet to reduce cholesterol. Rationale: A low-fat diet should not potentiate the action of warfarin. B. The client drinks a glass of grapefruit juice every day. Rationale: Grapefruit juice can interfere with the metabolism of statins. C. The client sprinkles flax seeds on food 1 hr before taking the anticoagulant. Rationale: Flax seed can affect the absorption of medications and should be taken 1 hr before or 2 hr after medications. D. The client uses garlic to lower cholesterol levels. Rationale: The nurse should recognize that garlic can potentiate the action of the warfarin. 11. A nurse is providing dietary teaching for a client who takes furosemide. The nurse should recommend which of the following foods as the best source of potassium? A. Bananas Rationale: The nurse should determine that bananas are the best food source to recommend because 1 cup of bananas contains 806 mg of potassium. In addition to the potassium supplements the provider might prescribe, the client should increase his daily intake of foods that have high potassium content, such as bananas, orange juice, and spinach. B. Cooked carrots Rationale: The nurse should recommend a different food because there is another choice that contains more potassium C. Cheddar cheese Rationale: The nurse should recommend a different food because there is another choice that contains more potassium D. 2% milk Rationale: The nurse should recommend a different food because there is another choice that contains more potassium. 12. A nurse is teaching a client who has a new prescription for regular insulin and NPH insulin. Which of the following instructions should the nurse include in the teaching? A. Keep the open vial of insulin at room temperature. Rationale: The client should keep the vial in use at room temperature to minimize tissue injury and to reduce the risk for lipodystrophy. B. Inject the insulin into a large muscle. Rationale: The client should inject the medication into subcutaneous tissue. C. Aspirate the medication prior to administration. Rationale: It is not necessary for the nurse to aspirate the medication. D. Administer the insulin in two separate injections. Rationale: The client should mix compatible solutions, such as regular insulin and NPH insulin, to reduce the need for an additional injection and reduce the risk for lipodystrophy. 13.A A nurse is teaching a client who has iron deficiency anemia about ferrous sulfate. Which of the following instructions should the nurse include in the teaching? A. Take the ferrous sulfate at bedtime. Rationale: The client should take the medication at least 1 hr before bedtime to reduce the risk of stomach irritation. B. Take the ferrous sulfate with an antacid. Rationale: Antacids interfere with the absorption of ferrous sulfate. C. Take the ferrous sulfate between meals. Rationale: The client should take the medication between meals for optimal absorption. D. Take the ferrous sulfate with yogurt. Rationale: Dairy products interfere with the absorption of carbonyl iron; therefore, the client should not take the medication with yogurt. 14. A nurse is caring for a child who is experiencing status asthmaticus. Which of the following interventions is the priority for the nurse to take? A. Administer a short-acting ß2 –agonist (SABA). Rationale: When using the urgent versus non-urgent approach to client care, the nurse should determine that the priority action is to administer a nebulized high-dose SABA to relieve bronchoconstriction and improve ventilation. B. Obtain a peak flow reading. Rationale: Obtaining a peak flow reading is non-urgent while the client is in distress. Although a peak flow reading will assist with determining the severity of the bronchospasms and assist with management of medications to prevent further exacerbations, there is another action that is the priority. C. Administer an inhaled glucocorticoid. Rationale: Administering an inhaled glucocorticoid is non-urgent while the client is in distress. Although an inhaled glucocorticoid should be used for long-term therapy to prevent future exacerbations, there is another action that is the priority. The nurse should administer a systemic glucocorticoid for immediate relief of airway inflammation. D. Determine the cause of the acute exacerbation. Rationale: Determining the cause of the acute exacerbation is non-urgent while the client is in distress. Although the nurse should determine the trigger for the asthma exacerbation to prevent future attacks, there is another action that is the priority. 15.A A nurse is preparing to administer a unit of packed red blood cells to a client. Which of the following actions should the nurse plan to take? A. Check the unit of blood with an assistant personal (AP). Rationale: Two RNs or an RN and a practical nurse (PN) (in certain institutions) can check a unit of blood before it is transfused. This action is outside the scope of practice for an AP. B. Premedicate the client with an antiemetic. Rationale: The client might require premedication with an antipyretic, but not an antiemetic. C. Plan to infuse the unit of blood over 6 hr. Rationale: The unit of blood should infuse within 4 hr to reduce the risk for bacteria growth. D. Remain with the client for the first 15 minutes of the transfusion. Rationale: The nurse should remain with the client for the first 15 to 30 minutes of the transfusion to monitor for a transfusion reaction, which occurs often during the first 50 mL of the transfusion. 16.A A nurse is providing discharge teaching for a client who has a new prescription for warfarin. Which of the following instructions should the nurse include in the teaching? A. Mild nosebleeds are common during initial treatment. Rationale: Warfarin, an anticoagulant, increases the client's risk for bleeding. The nurse should instruct the client to stop the medication and notify the provider for manifestations of bleeding. B. Use an electric razor while on this medication. Rationale: Warfarin, an anticoagulant, increases the client’s risk for bleeding. The nurse should teach the client safety measures, such as using an electric razor, to decrease the risk for injury and bleeding. C. If a dose of the medication is missed, double the dose at the next scheduled time. Rationale: Warfarin, an anticoagulant, should be taken at the same time each day and the client should not adjust the dose. Doubling a dose increases the client's risk for bleeding. D. Increase fiber intake to reduce the adverse effect of constipation. Rationale: Warfarin can cause diarrhea. 17.A A charge nurse is supervising a newly licensed nurse care for a client who is receiving a transfusion of packed RBC. The nurse suspects a possible hemolytic reaction. After stopping the blood transfusion, which of the following actions by the new nurse requires intervention by the charge nurse? A. The nurse initiates an infusion of 0.9% sodium chloride. Rationale: When suspecting a hemolytic reaction, the nurse should maintain IV access and blood volume with an infusion of 0.9% sodium chloride. B. The nurse collects a urine specimen. Rationale: When suspecting a hemolytic reaction, the nurse should obtain a urine specimen to assess for the presence of hemoglobin in the urine. C. The nurse sends a blood specimen to the laboratory. Rationale: When suspecting a hemolytic reaction, the nurse should obtain a blood specimen from the client for laboratory analysis. D. The nurse starts the transfusion of another unit of blood product. Rationale: When suspecting a hemolytic reaction, the nurse should immediately stop the transfusion of all blood products. The transfusion of additional products can increase the client's risk for further complication. 18.A A nurse is preparing to initiate a transfusion of packed RBC for a client who has anemia. Which of the following actions should the plan to nurse take? A. Leave the client 5 min after beginning the transfusion. Rationale: The nurse should remain with the client for 15 to 30 min after the start of the transfusion to monitor for a reaction, which usually occurs during the first 50 mL of the transfusion. B. Infuse the transfusion at a rate of 200 mL/hr. Rationale: The transfusion should infuse in 2 to 4 hr to prevent fluid overload. C. Check the client's vital signs every hour during the transfusion. Rationale: The nurse should check the client's vital signs every 15 min at the start of the transfusion, then every 1 hr to monitor for a transfusion reaction. D. Flush the blood tubing with dextrose 5% in water. Rationale: The nurse should flush the blood tubing with 0.9% sodium chloride to prevent hemolysis of the blood. 19. A nurse is assessing a client who is receiving a unit of packed red blood cells. Which of the following findings is a manifestation of acute hemolytic reaction? A. Client report of low back pain Rationale: Manifestations of an acute hemolytic reaction include apprehension, tachypnea, hypotension, chest pain, and lower back pain. B. Client report of tinnitus Rationale: Tinnitus is a manifestation of ototoxicity and is an adverse effect of aminoglycoside antibiotics. C. A productive cough Rationale: A cough is a manifestation of circulatory overload. D. Distended neck veins Rationale: Distended neck veins are a manifestation of circulatory overload. 20.A A nurse is educating a group of clients about the contraindications of warfarin therapy. Which of the following statements should the nurse include in the teaching? A. "Clients who have glaucoma should not take warfarin." Rationale: Liver disease is a contraindication for warfarin therapy. B. "Clients who have rheumatoid arthritis should not take warfarin." Rationale: Thrombocytopenia is a contraindication for warfarin therapy. C. "Clients who are pregnant should not take warfarin." Rationale: Warfarin therapy is contraindicated in the pregnant client because it crosses the placenta and places the fetus at risk for bleeding. D. "Clients who have hyperthyroidism should not take warfarin." Rationale: Peptic ulcer disease is a contraindication for warfarin therapy 21.A A nurse is caring for a client who is receiving a transfusion of packed red blood cells and suspects that the client is experiencing a hemolytic reaction. Which of the following interventions is the priority? A. Collect a urine specimen. Rationale: The client is at risk for hemoglobinuria and acute kidney injury due to hemolysis; however, another action is the priority. B. Administer 0.9% sodium chloride through the IV line. Rationale: The client is at risk for hypotension and shock due to hemolysis, so it is important to keep an IV open to administer fluids and medications; however, another action is the priority. C. Stop the transfusion. Rationale: The greatest risk to the client is injury due to further hemolysis; therefore, the priority action is to stop the transfusion. When suspecting a hemolytic reaction, the priority action by the nurse is to immediately stop the transfusion to prevent further hemolysis. D. Notify the blood bank. Rationale: The client is at risk for hypotension and shock due to hemolysis, and the nurse must notify the blood bank to determine the cause of the hemolytic reaction; however, another action is the priority. 22.A A nurse is preparing to administer phenytoin IV to a client who has a seizure disorder. Which of the following actions should the nurse plan to take? A. Administer the medication at 100 mg/min. Rationale: The nurse should administer phenytoin IV slowly, not faster than 50 mg/min, to reduce the risk of hypotension. B. Administer a saline solution after injection. Rationale: The nurse should flush the injection site with a saline solution after the injection of phenytoin to reduce and prevent venous irritation. C. Hold the injection if seizure activity is present. Rationale: The nurse should administer phenytoin to prevent and to abort seizure activity. D. Dilute the medication with dextrose 5% in water. Rationale: The nurse should dilute phenytoin in 0.9% sodium chloride solution to prevent precipitation of the medication. 23. A nurse is planning care for a client who has a detached retina and is preoperative for a surgical repair. The nurse should prepare to administer which of the following medications? A. Phenylephrine Rationale: Mydriatic medications, such as phenylephrine, are used preoperatively to dilate pupils to facilitate intraocular surgery. B. Latanoprost Rationale: Latanoprost is a prostaglandin used for the treatment of glaucoma. C. Pilocarpine Rationale: Pilocarpine is a miotic medication used for the treatment of glaucoma. D. Timolol Rationale: Timolol is a beta-blocker used for the treatment of glaucoma. 24. A nurse is assessing a client who is receiving a parental lipid infusion. Which of the following findings is a manifestation of fat overload syndrome? A. Elevated temperature Rationale: An elevated temperature is an early manifestation of fat overload syndrome. The client is at risk for coagulopathy and multi-organ system failure due to fat overload syndrome. B. Hypertension Rationale: Hypertension is a manifestation of fluid overload. C. Peripheral edema Rationale: Peripheral edema is a manifestation of fluid overload. D. Erythema at the insertion site Rationale: Erythema at the insertion site is a manifestation of infection and can indicate the need to change infusion site. 25. A nurse is assessing an older adult client who is receiving digoxin. The nurse should recognize that which of the following findings is a manifestation of digoxin toxicity? A. Anorexia Rationale: Anorexia, vomiting, confusion, headache, and vision changes are manifestations of digoxin toxicity. B. Ataxia Rationale: Ataxia (lack of muscle coordination) is a manifestation of benzodiazepine toxicity. C. Photosensitivity Rationale: Digoxin toxicity causes halos around lights. Photosensitivity is a manifestation of NSAID toxicity. D. Jaundice Rationale: Jaundice is a manifestation of sulfonylurea toxicity. 26. A nurse is teaching a client who has a new prescription for colesevelam to lower his low-density lipoprotein level. Which of the following instructions should the nurse include? A. "Take this medication 4 hr after other medications." Rationale: The client should take this medication 4 hours after other medications to increase absorption of the medication. B. "Reduce fluid intake." Rationale: The client should increase fiber and fluid intake to reduce the risk for constipation. C. "Take this medication on an empty stomach." Rationale: The client should take the medication with meals. D. "Chew tablets before swallowing." Rationale: The client should swallow tablets whole to increase absorption. 27.A A nurse is teaching a client who has a new prescription for sucralfate to treat a gastric ulcer. Which of the following statements by the client indicates an understanding of the teaching? A. "I will take this medication as needed to reduce pain." Rationale: The client should take sucralfate on 4 times a day for 4 to 8 weeks to promote ulcer healing. B. "I will reduce my fluid intake with this medication." Rationale: The client should increase his fluid and fiber intake to prevent constipation. C. "I will take this medication with an antacid." Rationale: The client should wait 30 min between sucralfate and an antacid to increase absorption. D. "I will take this medication 1 hour before meals and at bedtime." Rationale: The client should take sucralfate on an empty stomach, 1 hr before each meal and at bedtime to create a protective coating over the ulcer. 28. A nurse is assessing a client who is receiving dopamine IV to treat left ventricular failure. Which of the following findings should indicate to the nurse that the medication is having a therapeutic effect? A. Systolic blood pressure is increased Rationale: When dopamine has a therapeutic effect, it causes vasoconstriction peripherally and increases systolic blood pressure. B. Cardiac output is reduced Rationale: A therapeutic effect of low-dose dopamine is increased cardiac output. C. Apical heart rate is increased Rationale: Tachycardia is an adverse effect, not a therapeutic effect, of dopamine. D. Urine output is reduced Rationale: A therapeutic effect of low-dose dopamine is increased urine output. Decreased urine output at high doses is an adverse effect of dopamine. 29.A A nurse is teaching a client who has diabetes mellitus and receives 25 units of NPH insulin every morning if her blood glucose level is above 200 mg/dL. Which of the following information should the nurse include? A. Discard the NPH solution if it appears cloudy. Rationale: The client should discard regular insulin if it appears cloudy. B. Shake the insulin vigorously before loading the syringe. Rationale: The client should gently roll the NPH insulin before loading the syringe to disperse the mixture without creating bubbles. C. Expect the NPH insulin to peak in 6 to 14 hr. Rationale: NPH insulin is an intermediate-acting insulin. Its onset of action is 1 to 2 hr, peaking at 6 to 14 hr. Its duration of action is 16 to 24 hr. The client is at risk for hypoglycemia during the peak time. D. Freeze unopened insulin vials. Rationale: The unopened insulin vials should be stored in the refrigerator. 30.A A nurse is planning to administer butorphanol to a client who is in labor. Which of the following medications should the nurse plan to have available to reverse the action of this medication? A. Protamine Rationale: Protamine reverses the effects of heparin, not butorphanol. B. Diphenhydramine Rationale: Diphenhydramine, an antihistamine, treats an allergic reaction. It does not reverse the effects of butorphanol. C. Atropine Rationale: Atropine, an anticholinergic medication, treats bradycardia. It does not reverse the effects of butorphanol. D. Naloxone Rationale: Butorphanol is an opioid analgesic. The nurse should have the opioid reversal agent naloxone and resuscitation equipment available in the event that the client develops respiratory depression. 31. A nurse is assessing a client who is receiving a unit of packed RBCs. The client appears flushed and reports low-back pain. Which of the following actions is the nurse's priority? A. Stop the transfusion. Rationale: The greatest risk to the client is injury due to further hemolysis; therefore, the priority action is to stop the transfusion. When a hemolytic reaction is suspected, the priority action by the nurse is to immediately stop the transfusion to prevent further hemolysis. B. Collect a urine specimen. Rationale: The client is at risk for hemoglobinuria and acute kidney injury due to hemolysis, so a urine specimen is required; however, another action is the priority. C. Notify the blood bank. Rationale: The client is at risk for hypotension and shock due to hemolysis, and the nurse must notify the blood bank to determine the cause of the hemolytic reaction; however, another action is the priority. D. Begin an infusion of 0.9% sodium chloride through new tubing. Rationale: The client is at risk for hypotension and shock due to hemolysis, so it is important to keep an IV open to administer fluids and medications; however, another action is the priority. 32.A A nurse is teaching a client who has a new prescription for fluoxetine to treat depression. Which of the following statements by the client indicates an understanding of the teaching? A. "I should expect to feel better after 24 hours of starting this medication." Rationale: The therapeutic effects of this medication can take 1 to 4 weeks to occur. B. "I should not take this medicine with grapefruit juice." Rationale: Grapefruit juice can interfere with the metabolism of lovastatin, but it does not affect fluoxetine. C. "I'll take this medicine with food." Rationale: The client can take fluoxetine with or without food. D. "I'll take this medicine first thing in the morning." Rationale: The client should take fluoxetine in the morning to reduce the risk for insomnia. 33.A A nurse is teaching a client who has a new prescription for docusate. Which of the following information should the nurse include in the teaching? A. "Do not take this medication before bedtime." Rationale: The client can take this medication in the morning or in the evening before bedtime. B. "Take the medication with a full glass of water." Rationale: The nurse should instruct the client to take this medication with a full glass of water, unless contraindicated, to reduce the risk for constipation. C. "Expect abdominal pain with this medication." Rationale: The client should notify the provider if abdominal pain occurs. D. "Take this medication on an empty stomach." Rationale: The client can take this medication with or without food. 34. A nurse is instructing the parents of a client who has a new prescription for methylphenidate. Which of the following instructions should the nurse include? A. Avoid activities that require alertness such as driving. Rationale: The client should avoid driving and other activities that require alertness until the effects of this medication are known. B. Increase caffeine intake. Rationale: The client should decrease caffeine intake to reduce the risk for excessive stimulation and irritability. C. Take this medication before bedtime. Rationale: The client should take this medication 6 hr before sleep to reduce the risk for insomnia. D. Reduce calorie intake. Rationale: This medication can cause anorexia and weight loss. 35. A nurse is teaching a client who has a new prescription for aluminum hydroxide to treat heartburn. The nurse should instruct the client to monitor for and report which of the following adverse reactions? A. Constipation Rationale: Aluminum hydroxide can cause constipation. The nurse should tell the client to increase fluid and fiber intake to reduce the risk for constipation. B. Flatulence Rationale: Calcium-containing antacids can cause flatulence. C. Palpitations Rationale: Cimetidine can cause dysrhythmias. D. Headache Rationale: Proton pump inhibitors can cause headaches. 36.A A nurse is preparing to administer heparin to a client. Which of the following actions should the nurse plan to take? A. Use a 22-gauge needle to inject the medication. Rationale: The nurse should use a small needle, 25- or 26-gauge, to administer the heparin. B. Use a 1-inch needle to inject the medication. Rationale: The nurse should use a short needle, 3/8 inch or smaller, to administer the heparin. C. Inject the medication into the abdomen above the level of the iliac crest. Rationale: The nurse should inject the medication into the abdomen above the level of the iliac crest, at least 2 inches from the umbilicus. D. Massage the injection site after administration of the medication. Rationale: The nurse should apply firm pressure without massage to the site for 1 to 2 min after administration. Massaging the area after injecting heparin can cause bleeding. 37.A A nurse is teaching a client who has a new prescription for pancrelipase to aid in digestion. The nurse should inform the client to expect which of the following gastrointestinal changes? A. Decreased mucus in stools Rationale: Pancrelipase can cause nausea and vomiting, but does not decrease mucous in stools. B. Decreased black tarry stools Rationale: Pancrelipase can cause hyperglycemia, but does not treat gastrointestinal bleeding. C. Decreased watery stools Rationale: Pancrelipase can cause diarrhea. D. Decreased fat in stools Rationale: Pancrelipase is a combination of pancreatic enzymes used to increase digestion of fats, carbohydrates and proteins. The client should expect a reduction of fat in stools. 38.A A nurse is teaching a client how to draw up regular insulin and NPH insulin into the same syringe. Which of the following instructions should the nurse include? A. Draw up the NPH insulin into the syringe first. Rationale: The nurse should teach the client to draw up the regular insulin into the syringe first. B. Inject air into the regular insulin first. Rationale: The nurse should teach the client to inject air into the NPH vial first. C. Shake the NPH insulin until it is well mixed. Rationale: The nurse should teach the client to roll the vial of NPH insulin between the palms of his hands, not to shake it, to prevent forming bubbles, which can cause inaccurate dosage. D. Discard regular insulin that appears cloudy. Rationale: The nurse should teach the client to discard any regular insulin that appears cloudy, as regular insulin should be clear. NPH insulin has a cloudy appearance. 39.A A nurse is assessing a client who is on long term omeprazole therapy. Which of the following findings should indicate to the nurse the medication is effective? A. Increased appetite Rationale: Omeprazole does not increase appetite. Nausea is an adverse effect of this medication. B. Regular bowel movements Rationale: Omeprazole does not produce regular bowel movements. Diarrhea is an adverse effect of this medication. C. Absence of headache Rationale: Omeprazole does not treat headaches. Headaches are an adverse effect of this medication. D. Reduced dyspepsia Rationale: Omeprazole, a proton pump inhibitor, reduces gastric acid secretion and treats duodenal and gastric ulcers, prolonged dyspepsia, gastrointestinal reflux disease, and erosive esophagitis. 40. A nurse is teaching a client who has a new prescription for dimenhydrinate. Which of the following instructions should the nurse include in the teaching? A. Monitor for dizziness. Rationale: The client should monitor for dizziness and avoid activities that require alertness because dimenhydrinate can cause dizziness and drowsiness. B. Observe for diarrhea. Rationale: Dimenhydrinate can cause constipation. C. Administer 24 hr before effects are desired. Rationale: The onset for dimenhydrinate is 15 to 30 min and duration is 4 to 6 hr. D. Expect an increase in salivation. Rationale: Dimenhydrinate can cause anticholinergic effects such as dry mouth and blurred vision. 41.A A nurse is teaching a client who has a new prescription for disulfiram. Which of the following information should the nurse include in the teaching? A. "Avoid grapefruit juice while taking this medication." Rationale: Grapefruit juice can reduce the metabolism of carbamazepine. B. "Do not crush this medication before swallowing." Rationale: The client can crush disulfiram before swallowing. C. "Do not drink alcohol while taking this medication." Rationale: Disulfiram is a type of aversion therapy that helps maintain abstinence from alcohol. Drinking alcohol while taking disulfiram can produce a life-threatening response that can include palpitations, headache, and hypotension. Therapy must not begin until the client has abstained from alcohol for at least 12 hr. The client should avoid all forms of alcohol including cough syrups and after-shave lotions. D. "Take this medication with food." Rationale: Disulfiram is taken with or without food. 42.A A nurse is reviewing the medication list for a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize which of the following medications can cause glucose intolerance? A. Ranitidine Rationale: Ranitidine can alter serum creatinine levels, but it does not affect blood glucose levels. B. Guaifenesin Rationale: Guaifenesin can cause drowsiness and dizziness, but does not alter blood glucose. C. Prednisone Rationale: Corticosteroids such as prednisone can cause glucose intolerance and hyperglycemia. The client might require increased dosage of a hypoglycemic medication. D. Atorvastatin Rationale: Atorvastatin can interfere with thyroid function tests. 43.A A nurse is teaching a client who has a new prescription for alprazolam to treat insomnia. Which of the following instructions should the nurse included? A. "Take this medication every night before sleep." Rationale: The client should take this medication intermittently (3 or 4 nights per week) to prevent physical dependence. B. "Take this mediation with a high fat meal." Rationale: Fatty foods reduce the absorption of this medication. C. "Avoid activities that require alertness such as driving." Rationale: The client should avoid activities that require alertness. Diazepam is a benzodiazepine that causes sedation and dizziness. D. "Monitor for urinary retention." Rationale: Morphine can cause urinary retention. 44.A A nurse in the emergency department is caring for a client who took 3 nitroglycerin tablets sublingually for chest pain. The client reports relief from the chest pain but now he is experiencing a headache. Which of the following statements should the nurse make? A. "A headache is an indication of an allergy to the medication." Rationale: Allergic reactions typically manifest as itching and a rash, and if worsening, laryngeal edema and bronchospasm. B. "A headache is an expected adverse effect of the medication." Rationale: The vasodilation nitroglycerin induces increases blood flow to the head and typically results in a headache. C. "A headache indicates tolerance to the medication." Rationale: With tolerance, the client needs more of the medication to achieve a therapeutic response. A headache is not a sign of this phenomenon. D. "A headache is likely due to the anxiety about the chest pain." Rationale: This is a nontherapeutic communication technique and offers the nurse's opinion about the cause of the headache rather than a factual statement. 45.A A nurse is teaching a client who has a new prescription for transdermal nitroglycerin to treat angina pectoris. Which of the following instructions should the nurse include in the teaching? A. Apply a new transdermal patch once a week. Rationale: The client should apply a new patch each day, not once a week. B. Apply the transdermal patch in the morning. Rationale: The client should apply the patch every morning and leave it in place for a 12 to 14 hr, then remove it in the evening. C. Apply the transdermal patch in the same location as the previous patch. Rationale: The client should rotate the sites used for patch placement to avoid areas of local skin irritation. D. Apply a new transdermal patch when chest pain is experienced. Rationale: The transdermal route of nitroglycerin has a delayed onset of action, making it suitable for prophylaxis use but not for immediate relief of chest pain. 46. A nurse is preparing to transfuse one unit of packed RBC to a client who experienced a mild allergic reaction during a previous transfusion. The nurse should administer diphenhydramine prior to the transfusion for which of the following allergic responses? A. Urticaria Rationale: For clients who have previously had allergic reactions to blood transfusions, administering an antihistamine such as diphenhydramine prior to the transfusion might prevent future reactions. Allergic reactions typically include urticaria (hives). B. Fever Rationale: An antihistamine will not prevent a febrile, non-hemolytic reaction to a blood transfusion. A possible preventive measure is transfusing leucocyte-poor blood products to avoid sensitization to the donor's WBC. C. Fluid overload Rationale: An antihistamine will not prevent fluid overload. Transfusing the blood product slowly and not exceeding the volume that is necessary can reduce this risk. D. Hemolysis Rationale: An antihistamine will not prevent hemolysis, which results from incompatibility between the donor and the recipient. 47. A nurse is preparing to administer nalbuphine to a postoperative client who is experiencing pain. The nurse should monitor the client for which of the following potential adverse effects of this medication? A. Miosis Rationale: Adverse effects of nalbuphine include visual disturbances such as miosis, blurred vision, and diplopia. B. Joint pain Rationale: Nalbuphine is unlikely to cause joint pain; however, it can cause headache and abdominal cramps. C. Diarrhea Rationale: Nalbuphine can cause constipation, cramps, and abdominal pain, but it does not have diarrhea as an adverse effect. D. Oliguria Rationale: Nalbuphine is unlikely to cause oliguria; however, it can cause urinary urgency. 48.A A nurse is caring for a client who is postoperative following a transurethral resection of the prostate (TURP). The nurse should plan to administer the client's PRN bethanechol when the client reports which of the following manifestations? A. Bladder spasms Rationale: Antispasmodic medications, not bethanechol, help control bladder spasms after a TURP. B. Severe pain. Rationale: Analgesic medications, not bethanechol, help relieve severe pain after a TURP. C. An inability to void Rationale: Bethanechol is a cholinergic medication that stimulates the parasympathetic nervous system, thus improving the tone and motility of the smooth muscles of the urinary tract enough to initiate urination. D. Frequent episodes of painful urination Rationale: Analgesic medications, or antibiotics if infection is the cause, help relieve frequent episodes of painful urination after a TURP. 49.A A nurse is caring for a client who is receiving mydriatic eye drops. Which of the following manifestations indicates to the nurse that the client has developed a systemic anticholinergic effect? A. Seizures Rationale: Mydriatic eye drops are unlikely to cause seizures, but they can cause central nervous system effects such as delirium and coma. B. Bradycardia Rationale: Mydriatic eye drops are more likely to cause tachycardia, not bradycardia. C. Constipation Rationale: Mydriatic eye drops can cause systemic anticholinergic effects, such as constipation and dry mouth. D. Hypothermia Rationale: Mydriatic eye drops are more likely to cause fever than hypothermia. 50.A A nurse is teaching a client who has a duodenal ulcer about his new prescription for cimetidine. The nurse should include which of the following instructions in the teaching? A. "Take the medication with an antacid to minimize stomach upset." Rationale: Clients should not take this medication within 1 hr of taking an antacid because the antacid will interfere with the absorption of cimetidine. B. "Your doctor might need to reduce your theophylline dose while taking this medication." Rationale: The nurse should instruct the client that the provider might need to reduce his theophylline dose due to the possibility of increased medication levels. C. "Take the medication on an empty stomach for better absorption." Rationale: Clients should take cimetidine with food to minimize gastric irritation. D. "You should plan to take this medication for at least 6 months." Rationale: The nurse should instruct the client that he should plan to take cimetidine for short-term treatment of a duodenal ulcer, which will be approximately 4 to 6 weeks. 51.A A nurse is reviewing discharge instructions with a client who has bipolar disorder and is taking lithium. Which of the following manifestations should the nurse include as an indication of mild toxicity? A. Constipation Rationale: The nurse should instruct the client that diarrhea is a manifestation of mild toxicity, not constipation. B. Urinary retention Rationale: The nurse should instruct the client that polyuria is a manifestation of mild toxicity, not urinary retention. C. Muscle weakness Rationale: The nurse should instruct the client that muscle weakness is a manifestation of mild toxicity. D. Hyperactivity Rationale: The nurse should instruct the client that lassitude is a manifestation of mild toxicity, not hyperactivity. 52. A nurse is reviewing the laboratory results of a client who has liver failure with ascites and is receiving spironolactone. Which of the following findings should the nurse expect? A. Decreased sodium level Rationale: The nurse should expect a decreased sodium level. Spironolactone is a potassium-sparing diuretic that inhibits the action of aldosterone, resulting in an increased excretion of sodium. B. Decreased phosphate level Rationale: The nurse should not expect a decreased phosphate level. Spironolactone inhibits the action of aldosterone, resulting in the retention of phosphate. C. Decreased potassium level Rationale: The nurse should not expect a decreased potassium level. Spironolactone is a potassium-sparing diuretic that inhibits the action of aldosterone, resulting in the retention of potassium. D. Decreased chloride level Rationale: The nurse should not expect a decreased chloride level. Spironolactone is a potassium-sparing diuretic that inhibits the action of aldosterone, resulting in the retention of chloride. 53.A A nurse is caring for a client who is postoperative following hip arthroplasty. The nurse should anticipate which of the following prescriptions for this client? A. Aspirin Rationale: Although aspirin has anticoagulant effects, clients generally take it for ongoing primary prevention of cardiovascular and cerebrovascular events, not for the immediate anticoagulant effects a client who is postoperative hip arthroplasty requires. B. Clopidogrel Rationale: Clopidogrel is an oral antiplatelet drug clients take to prevent stenosis of coronary stents and for some secondary prevention indications, not for the immediate anticoagulant effects a client who is postoperative hip arthroplasty requires. C. Enoxaparin Rationale: The nurse should anticipate a prescription for enoxaparin as prophylaxis therapy for venous thromboembolism. Clients following hip arthroplasty are usually on anticoagulants for 3 to 6 weeks after surgery. D. Alteplase Rationale: Alteplase is a thrombolytic agent used in clients experiencing an acute MI, acute ischemic stroke, or acute massive PE. 54.A A nurse is assessing a client who has systemic lupus erythematosus and is taking hydroxychloroquine. The nurse should report which of the following adverse effects to the provider immediately? A. Diarrhea Rationale: Diarrhea is a potential adverse effect of hydroxychloroquine that the nurse should report to the provider; however, it is not the priority finding. B. Blurred vision Rationale: When using the urgent vs non-urgent approach to client care, the nurse should determine that the priority finding to report to the provider is blurred vision, as this is a manifestation of hydroxychloroquine toxicity and can be an indication of retinal damage. C. Pruritus Rationale: Pruritus is a potential adverse effect of hydroxychloroquine that the nurse should report to the provider; however, it is not the priority finding. D. Fatigue Rationale: Fatigue is a potential adverse effect of hydroxychloroquine that the nurse should report to the provider; however, it is not the priority finding. 55.A A nurse is caring for a client who has thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin's effects? A. Vitamin K Rationale: Vitamin K reverses the effects of warfarin, not heparin, by promoting the synthesis of coagulation factors VI, IX, X, and prothrombin. B. Protamine sulfate Rationale: Protamine sulfate reverses the effects of heparin by binding with heparin to form a heparin-protamine complex that has no anticoagulant properties. C. Acetylcysteine Rationale: D. Deferasirox Acetylcysteine, a mucolytic, reduces the risk of hepatotoxicity after acetaminophen overdose. It does not reverse the effects of heparin toxicity. Rationale: A chelating agent such as deferasirox binds to iron to reduce iron toxicity from supplemental iron therapy. It does not reverse the effects of heparin toxicity. 56.A A nurse is caring for a client who has heart failure and is receiving IV furosemide. The nurse should monitor the client for which of the following electrolyte imbalances? A. Hypernatremia Rationale: The nurse should monitor the client who is receiving IV furosemide for hyponatremia. B. Hyperuricemia Rationale: The nurse should monitor the client who is receiving IV furosemide for hyperuricemia. The nurse should instruct the client to notify the provider for any tenderness or swelling of the joints. C. Hypercalcemia Rationale: The nurse should monitor the client who is receiving IV furosemide for hypocalcemia. D. Hyperchloremia Rationale: The nurse should monitor the client who is receiving IV furosemide for hypochloremia. 57. A nurse is teaching a client who has multiple sclerosis about a new prescription for baclofen. Which of the following instructions should the nurse include in the teaching? A. "Do not take antihistamines with this medication." Rationale: The nurse should instruct the client not to take antihistamines while taking baclofen. Antihistamines will intensity the depressant effects of baclofen. B. "Take the medication on an empty stomach." Rationale: The medication causes nausea and gastrointestinal distress, so the client should take it with milk or meals. C. "Stop taking the medication immediately for a headache." Rationale: Abrupt withdrawal of baclofen, a centrally acting muscle relaxant, might cause seizures, fever, and hypotension. A better alternative is to treat the headache, which can have many other causes, and see if it resolves as medication therapy with baclofen continues. D. "Expect to develop diarrhea initially." Rationale: Baclofen is more likely to cause constipation than diarrhea. 58. A nurse is caring for a client who has just begun therapy with alprazolam to treat anxiety. The nurse should monitor the client for which of the following adverse effects of this medication? A. Insomnia Rationale: The nurse should monitor the client for paradoxical effects such as insomnia and excitation. If these occur, the medication should be withdrawn. B. Bradycardia Rationale: Alprazolam is more likely to cause tachycardia than bradycardia. C. Hearing loss Rationale: Alprazolam can cause the adverse effect of tinnitus but does not cause hearing loss. D. Hypertension Rationale: The nurse should monitor the client for the adverse effects of hypotension and orthostatic hypotension rather than hypertension. 59. A nurse is teaching a client who has a new prescription for diazepam. Which of the following information should the nurse include in the teaching? A. Diazepam can cause drowsiness. Rationale: Diazepam has sedative properties, so the client should not engage in potentially hazardous activities after receiving diazepam. B. This medication must be swallowed whole. Rationale: Diazepam can be crushed and taken with food if the client is unable to swallow the medication whole. C. It is important to avoid foods that contain tyramine. Rationale: Clients who take monoamine oxidase inhibitors must avoid foods that contain tyramine. D. Grapefruit juice inactivates this medication. Rationale: Although grapefruit juice can affect the metabolism of many medications, generally raising their blood levels, diazepam is not among them. 60. A nurse is caring for a client who has prostate cancer. The nurse should expect the provider to prescribe which of the following medications for this client? A. Leuprolide Rationale: Leuprolide treats cancer of the prostate hormonally. It antagonizes the androgens that androgen-dependent neoplasms require. B. Cyclophosphamide Rationale: Cyclophosphamide treats leukemia, multiple myeloma, lymphomas, and head, ovary, breast, and lung cancer. C. Finasteride Rationale: Finasteride treats benign prostatic hypertrophy and also helps reduce the risk of prostate cancer. D. Tamoxifen Rationale: Tamoxifen treats breast cancer. 61.A A nurse is caring for a client who has developed agranulocytosis as a result of taking propylthiouracil to treat hyperthyroidism. The nurse should understand that this client is at increased risk for which of the following conditions? A. Excessive bleeding Rationale: Excessive bleeding is a risk with many disorders and various medication therapies, such as anticoagulation therapy, but not with agranulocytosis. B. Ecchymosis Rationale: Ecchymosis is a risk with many disorders and various medication therapies, such as anticoagulation therapy, but not with agranulocytosis. C. Infection Rationale: Agranulocytosis is a failure of the bone marrow to make enough white blood cells, causing neutropenia and lowering the body defenses against infection. D. Hyperglycemia Rationale: Hyperglycemia is a risk with many disorders and various medication therapies, such as glucocorticoid therapy, but not with agranulocytosis. 62.A A nurse is teaching a client who has angina pectoris about starting therapy with SL nitroglycerin tablets. The nurse should include which of the following instructions regarding how to take the medication? A. "Take this medication after each meal and at bedtime." Rationale: The client should take nitroglycerin tablets on a PRN basis, not routinely at specific times. B. "Take one tablet every 15 min during an acute attack." Rationale: If one tablet does not relieve the client's pain, he should access emergency services and then take two more at 5-min intervals if he still has pain. C. "Take one tablet at the first indication of chest pain." Rationale: The client should take nitroglycerin as soon as he feels pain, pressure, or tightness in his chest and not wait until his chest pain is severe. D. "Take this medication with 8 ounces of water." Rationale: Nitroglycerin tablets are sublingual. The client should place them under the tongue, not swallow them with water. 63.A A nurse is reviewing discharge instructions with a client who has rheumatoid arthritis and a new prescription for prednisone. Which of the following statements by the client indicates an understanding of the teaching? A. "I should take my flu vaccine within one week of starting this medication." Rationale: The nurse should instruct the client to avoid taking vaccines while taking prednisone. This medication can decrease antibody response to the vaccine and can increase the risk of infection from live virus vaccines. B. "I can expect a sore throat for the first week after starting this medication." Rationale: The nurse should instruct the client to report manifestations such as a sore throat or fever to the provider if they occur, as these may indicate infection. C. "I should eat more bananas while taking this medication." Rationale: The nurse should instruct the client to eat more potassium-rich foods such as bananas and citrus fruits while taking this medication. Prednisone can cause a loss of potassium, and the nurse should instruct the about the manifestations of hypokalemia such as muscle weakness and cramping and to notify the provider should these occur. D. "I should take aspirin for minor aches and pains while taking this medication." Rationale: The nurse should instruct the client not to take salicylates or NSAIDs for pain because these medications can increase the risk of gastric ulceration. 64.A A nurse is admitting a client who states he takes ginkgo biloba every day to improve his memory. The nurse should identify a potential interaction with which of the following medications the client is taking? A. Ranitidine Rationale: There is no documented interaction between ginkgo biloba and ranitidine. B. Levothyroxine Rationale: There is no documented interaction between ginkgo biloba and levothyroxine. C. Warfarin Rationale: The nurse should identify a potential interaction between gingko biloba and warfarin. Ginkgo might suppress coagulation and should be used with caution with antiplatelet drugs such as aspirin or anticoagulants such as warfarin or heparin. D. Loratadine Rationale: There is no documented interaction between ginkgo biloba and loratadine. 65.A A nurse is caring for a client who is at 6 weeks of gestation and has pneumonia. While the nurse is obtaining the client's history, the client tells the nurse that she takes the herb feverfew for migraine headaches. Which of the following actions should the nurse take? A. Tell the client that she should take an over-the-counter analgesic instead. Rationale: The nurse should not recommend any medications to a client who is pregnant. B. Explain to the client that she should not take this herb while she is pregnant. Rationale: The nurse should explain that feverfew interferes with platelet action and can therefore cause bleeding. It is unsafe for the client to take during pregnancy. C. Ask the client why she would take an herb during pregnancy. Rationale: Asking "why" questions is nontherapeutic because it challenges the client's judgment and can make her respond defensively. D. Suggest that the client ask her herbalist within the next few weeks about taking it while pregnant. Rationale: Imposing a delay in advising the client about this herb could result in her taking it again, which could be harmful to the fetus. 66. A nurse is teaching a client who has a new prescription for lithium to treat bipolar disorder. The nurse should instruct the client to ensure an adequate intake of which of the following dietary elements? A. Sodium Rationale: Lithium is a salt. If sodium level falls, the client will retain lithium and have an increased risk for lithium toxicity. B. Potassium Rationale: Potassium intake is an issue for clients who take diuretics, but it does not affect lithium levels. C. Vitamin K Rationale: Clients who take warfarin, not lithium, must keep their intake of vitamin K consistent. D. Vitamin C Rationale: Vitamin C promotes the absorption of iron, but it does not affect lithium levels. 67.A A nurse is teaching a group of young women about the use of oral contraceptives. The nurse should teach that taking which of the following herbal preparations reduces the effectiveness of this birth control method? A. Ginseng Rationale: Ginger root should not be taken by clients who are taking antiplatelet medications or those taking insulin and other medications for diabetes. B. Gingko biloba Rationale: Gingko biloba should not be used by clients taking antiplatelet drugs and those at risk for seizures. C. St. John's wort Rationale: St. John's wort decreases the effectiveness of oral contraceptives and can be responsible for breakthrough bleeding and unintended pregnancies. D. Saw palmetto Rationale: Saw palmetto should not be taken by clients taking antiplatelet mediations or anticoagulants. It can cause danger to a developing fetus and should not be taken during pregnancy. 68. A nurse is caring for a client who receives furosemide to treat heart failure. Which of the following laboratory values should the nurse monitor for this client due to this medication? A. Potassium Rationale: Furosemide is a loop diuretic that promotes the excretion of potassium. The nurse should monitor the client's potassium level to watch for hypokalemia. B. Albumin Rationale: Furosemide does not affect albumin levels. C. Cortisol Rationale: Furosemide does not affect cortisol levels, although it can lower serum sodium levels. D. Bicarbonate Rationale: Furosemide does not affect bicarbonate levels. 69. A nurse is caring for a client who has a prescription for 3,000 mL of dextrose 5% in 0.45% sodium chloride to infuse IV over 24 hr. The nurse initiates an IV infusion of 1,000 mL of this fluid at 0800. At what time should the nurse prepare to initiate the second 1,000 mL bag? A. 1600 Rationale: 3000 mL is going to be infused over 24 hr. Each 1000 mL will hang for 8 hr. The first 1000 mL bag was initiated at 0800, so the second 1000 mL bag will be initiated in 8 hr, or at 1600. B. 2400 Rationale: 2400 is the time that the third 1000 mL will be initiated. C. 1200 Rationale: 1200 would initiate the second 1000 mL too early. D. 1800 Rationale: 1800 would initiate the second 1000 mL bag too late. 70.A A nurse is caring for a client who is exhibiting signs of alcohol withdrawal. Which of the following medications should the nurse plan to administer? A. Methadone Rationale: Methadone is prescribed for detoxification of opiates rather than for the treatment of alcohol withdrawal. B. Disulfiram Rationale: Disulfiram is prescribed to deter alcohol consumption rather than for the treatment of alcohol withdrawal. C. Diazepam Rationale: Diazepam is prescribed to treat the symptoms and prevent complications of alcohol withdrawal. D. Buprenorphine Rationale: Buprenorphine is prescribed to block heroin cravings for detoxification of opiates rather than for the treatment of alcohol withdrawal. 71.A A nurse is providing dietary teaching for a client who has a new prescription for a monoamine oxidase inhibitor (MAOI). When the client develops a sample lunch menu, which of the following items requires intervention by the nurse? A. Glass of whole milk Rationale: Clients who are receiving an MAOI should avoid foods containing a high tyramine content. Milk is safe for a client taking an MAOI. B. Celery sticks Rationale: Clients who are receiving an MAOI should avoid foods containing a high tyramine content. Celery is safe for a client taking an MAOI. C. Bologna sandwich Rationale: Clients who are receiving an MAOI should avoid foods containing a high tyramine content. Bologna has a high tyramine content and should be avoided. D. Sliced apples Rationale: Clients who are receiving an MAOI should avoid foods containing a high tyramine content. Apples are safe for a client taking an MAOI. 72.A A nurse is caring for a client who has Wernicke–Korsakoff psychosis as a result of chronic alcohol use disorder. Which of the following interventions should the nurse anticipate? A. Laboratory analysis of cardiac enzymes Rationale: Analysis of cardiac enzymes is appropriate when the client has alcoholic myopathy rather than Wernicke-Korsakoff psychosis. B. Monitoring for the presence of esophageal varices Rationale: Monitoring for the presence of esophageal varices is appropriate for the client who has cirrhosis of the liver rather than Wernicke-Korsakoff psychosis. C. Administration of thiamine Rationale: Thiamine is administered to the client who has Wernicke-Korsakoff psychosis due to hepatic dysfunction and inadequate intake of sufficient vitamins. D. Placing the client in protective isolation Rationale: Placing a client in protective isolation is appropriate for the client who has leukopenia rather than Wernicke-Korsakoff psychosis. 73.A A nurse is providing discharge teaching to a client who has a new prescription for lithium. Which of the following information should the nurse include in the teaching? A. Follow a low-sodium diet. Rationale: Clients who are taking lithium should avoid a low-sodium diet due to the risk of hyponatremia. B. Limit daily fluid intake. Rationale: Clients who are taking lithium should drink plenty of fluids. C. Obtain a daily weight. Rationale: Clients who are taking lithium should monitor their daily weight due to the risk of fluid imbalance. D. Avoid foods that have a high tyramine content. Rationale: Clients who are taking a monoamine oxidase inhibitor (MAOI), rather than lithium, should avoid foods that have a high tyramine content. 74. A nurse is assessing a client who has schizophrenia and has been on long-term treatment with chlorpromazine. He notes the client is experiencing some involuntary movements of the tongue and face. The nurse should suspect the client has developed which of the following adverse effects? A. Tardive dyskinesia Rationale: These findings indicate tardive dyskinesia, which can develop in clients during long-term therapy with chlorpromazine. For many clients, the manifestations are irreversible. B. Parkinsonism Rationale: Parkinsonism can occur in clients taking chlorpromazine; however, it is characterized by drooling, shuffling gait and bradykinesia. C. Dystonia Rationale: Dystonia is an acute adverse effect involving severe spasm of the muscles of the tongue, face, neck or back that generally develops within the first few days of therapy. D. Akathisia Rationale: Akathisia can occur in clients taking chlorpromazine; however, it is characterized by pacing and squirming, which is brought on by an uncontrollable need to stay in motion. 75.A A nurse is caring for a client who has a prescription for olanzapine. The nurse should monitor the client for which of the following manifestations as an expected response to this medication? A. A decrease in resting blood pressure Rationale: Hypotension is an adverse effect of olanzapine. B. Control of seizure activity Rationale: Seizures are an adverse effect of olanzapine. C. Decreased auditory hallucinations Rationale: Olanzapine is prescribed for the treatment of the manifestations of schizophrenia, one of which is auditory hallucinations. D. Increased energy level and involvement in activities Rationale: Fatigue is an adverse effect of olanzapine. 76.A A nurse is providing discharge teaching to a client who has a new prescription for verapamil for angina. Which of the following instructions should the nurse include? A. "Limit your fluid intake to meal times." Rationale: The nurse should instruct the client to increase fluid intake rather than limit intake to meal times due to the potential adverse effect of constipation. B. "Do not take this medication on an empty stomach." Rationale: The nurse should instruct the client that verapamil can be taken without food. C. "Increase your daily intake of dietary fiber." Rationale: The nurse should instruct the client to increase his daily intake of dietary fiber to reduce the risk of constipation associated with verapamil. D. "You can expect swelling of the ankles while taking this medication." Rationale: The nurse should instruct the client to report any swelling of the ankles or feet to the provider immediately, as these are manifestations of an adverse effect. 77. A nurse is preparing to instill ear drops to a 3-year-old child. Which of the following techniques should the nurse use? A. Pull the auricle down and back. Rationale: The nurse should pull the auricle down and back. This is the correct technique used for infants and young children under the age of 4. B. Pull the auricle down and out. Rationale: The nurse should not pull the auricle down and out to instill eardrops to a 3-year-old child. C. Pull the auricle up and back. Rationale: The nurse should not pull the auricle up and back to instill eardrops to a 3-year-old child. D. Pull the auricle up and out. Rationale: The nurse should not pull the auricle up and out to instill eardrops to a 3-year-old child. The nurse should use this technique for children 4 years of age and older and adults. 78.A A nurse is caring for a client who requires a medication that is packaged in a single dose glass ampule. Which of the following techniques should the nurse use when opening the glass ampule? A. Wear sterile gloves and break off the neck of the glass ampule with a single snap to the right side. Rationale: The nurse does not need to wear sterile gloves and the ampule is not snapped off to the right side. B. Wear sterile gloves and break off the neck of the glass ampule with a single snap in a downward motion. Rationale: The nurse does not need to ear sterile gloves and the ampule is not snapped off in a downward motion. C. Tap the bottom of the ampule, place a gauze pad around the ampule neck, and break off the bottom with a forward motion away from the body. Rationale: The nurse should not tap the bottom of the ampule, place the gauze pad or alcohol swab around the neck and break at the bottom with a forward motion away from the hands. D. Tap the top of the ampule, place a sterile gauze pad around the ampule neck, and break off the top by bending it toward the body. Rationale: The nurse should tap the top of the ampule, place a sterile gauze pad around the ampule neck, and break off the top by bending it toward the body. The sterile gauze prevents broken glass coming in contact with the fingers, and bending the ampule top toward the body allows glass fragments to spray away from the nurse. 79. A nurse is preparing to administer a rectal suppository to a client. In which of the following positions should the nurse place the client for insertion of the suppository? A. Sim's position Rationale: The nurse should assist the client to the Sim's position by lying on the left side, left hip and lower extremity straight, and right hip and knee bent. This position exposes the anus and helps the client relax the external sphincter, allowing for easier insertion of the suppository. B. Prone position Rationale: This is the incorrect position for the client to be in to receive a suppository. C. Lying on the right side Rationale: This is the incorrect position for the client to be in to receive a suppository. D. Supine Rationale: This is the incorrect position for the client to be in to receive a suppository. 80.A A nurse is caring for a client who has a prescription for potassium chloride (KCL) 20 mEq PO daily. The nurse reviews the client's most recent laboratory results and finds the client's potassium level is 5.2 mEq/L. Which of the following actions should the nurse take? A. Give the ordered KCL as prescribed. Rationale: As a potassium level of 5.2 mEq/L is above the expected reference range, this is not the action the nurse should take. B. Omit the KCL dose and document it was not given. Rationale: It is not an appropriate action for the nurse to omit the administration of an ordered medication. C. Call the prescribing physician and inform her of the client's serum potassium level results. Rationale: As a potassium level of 5.2 mEq/L is above the expected reference range, the nurse should hold the medication and notify the provider of the client's serum potassium level. D. Call the lab to verify the client's results. Rationale: The nurse has already received the lab values from the lab, so notifying the laboratory is not indicated. 81. The nurse is preparing a medication for a client and observes the date of expiration on the vial occurred 2 months ago. Which of the following actions should the nurse take? A. Give the medication. Rationale: The nurse should not give the medication. B. Discard the medication. Rationale: The nurse should not discard the medication. C. Notify the provider. Rationale: The nurse should not notify the provider. D. Return the medication to the pharmacy. Rationale: The nurse should return the medication to pharmacy. Laws require that all medication include an expiration date. 82.A A nurse is preparing to administer medications to a client who states, "I don't want to take those drugs." Which of the following actions should the nurse take? A. Tell the client the physician wants him to take the medications. Rationale: This is not the appropriate action for the nurse to take. B. Ask the client why he is refusing to take the medications. Rationale: This is not the appropriate action for the nurse to take. C. Explain the purpose for the medications. Rationale: This is not the appropriate action for the nurse to take. D. Document that the client refuses the medications. Rationale: The client has the right to refuse the medication. It is appropriate for the nurse to document the client's refusal of the medications. The nurse should then inform the provider of the client's refusal. 83.A A nurse is caring for a client who has heart failure and a new prescription for furosemide. For which of the following adverse effects should the nurse monitor? A. Hypervolemia Rationale: Hypovolemia, not hypervolemia, is an adverse effect of furosemide. B. Hypertension Rationale: Hypotension, not hypertension, is an adverse effect of furosemide. C. Hypokalemia Rationale: Hypokalemia is an adverse effect of furosemide. D. Hypoglycemia Rationale: Hyperglycemia, not hypoglycemia, is an adverse effect of furosemide. 84.A A nurse is caring for a client who is experiencing Cushing's Triad following a subdural hematoma. Which of the following medications should the nurse plan to administer? A. Albumin 25% Rationale: Albumin 25% is not administered to relieve increased intracranial pressure. B. Dextran 70 Rationale: Dextran 70 is not administered to relieve increased intracranial pressure. C. Hydroxyethyl glucose Rationale: Hydroxyethyl glucose is not administered to relieve increased intracranial pressure. D. Mannitol 25% Rationale: Cushing's Triad is an indication that the client is experiencing increased intracranial pressure. The nurse should administer mannitol 25%, an osmotic diuretic that promotes diuresis to treat cerebral edema. 85. A nurse is preparing to administer blood to a client. The unit of blood on hand is type B, and the client has type AB blood. Which of the following actions should the nurse take? A. Administer the blood as ordered. Rationale: The nurse should administer the blood as ordered. Type B blood is compatible with type AB. Type AB blood is considered a universal recipient, as it contains no antibodies to react to transfused blood. B. Contact the provider for further orders. Rationale: It is not necessary for the nurse notify the provider for further orders. C. Notify the blood bank of the discrepancy. Rationale: It is not necessary for the nurse notify the blood bank of the discrepancy. D. Complete an incident report. Rationale: It is not necessary for the nurse to complete an incident report. 86.A A nurse is providing teaching to a client who has hypertension and a new prescription for hydrochlorothiazide. Which of the following instructions should the nurse provide? A. Weigh weekly to monitor therapeutic effect. Rationale: The nurse should instruct the client to weigh daily to determine fluid loss. B. Take the medication on an empty stomach. Rationale: Hydrochlorothiazide can be taken with food or milk. C. Take the medication early in the day. Rationale: The nurse should instruct the client to take hydrochlorothiazide early in the day to avoid nocturia. D. Muscle pain is an expected adverse effect. Rationale: The nurse should instruct the client that muscle pain may be an indication of hypokalemia and should be reported to the provider. 87.A A nurse is teaching a client who has diabetes mellitus and a new prescription for glimepiride. The nurse should teach the client to avoid which of the following drinks while taking this medication? A. Grapefruit juice Rationale: Grapefruit juice can cause atorvastatin toxicity if used while taking atorvastatin. B. Milk Rationale: Milk does not interact with chlorpropamide. C. Alcohol Rationale: The nurse should teach the client to avoid alcohol while taking this medication to prevent a disulfiram reaction, such as nausea, headache, and hypoglycemia. D. Coffee Rationale: Caffeine or coffee does not interact with chlorpropamide. 88.A A nurse is providing teaching to a client who has a new prescription for levothyroxine for hypothyroidism. The nurse should instruct the client to avoid which of the following herbal supplements? A. Saw palmetto Rationale: Saw palmetto can increase the risk for bleeding in clients who take anticoagulants or antiplatelet medications. B. Cranberry Rationale: Cranberry juice can increase the risk for uric acid kidney stones and can also increase the risk of bleeding in clients who take warfarin. C. Soy Rationale: The nurse should instruct the client to avoid soy because soy can reduce the effectiveness of the levothyroxine. D. Garlic Rationale: Garlic can increase the risk for bleeding in clients who take anticoagulants or antiplatelet medications. 89.A A nurse is providing discharge teaching for a client who has pulmonary edema and is about to start taking furosemide. Which of the following instructions should the nurse include? A. Take aspirin if headaches develop. Rationale: Furosemide can increase the effects of aspirin and anticoagulants. B. Eat foods that contain plenty of potassium. Rationale: Furosemide, a high-ceiling (loop) diuretic, can cause potassium loss. The client should add potassium-rich foods to his diet, such as nuts, dried fruits, bananas, and citrus fruits. C. Expect some swelling in the hands and feet. Rationale: Furosemide should reduce swelling in the hands and feet. D. Take the medication at bedtime. Rationale: The client should take furosemide early in the day so that the diuretic action will not disturb his sleep. 90.A A nurse is evaluating teaching on a client who has a new prescription for montelukast to treat asthma. Which of the following statements by the client indicates an understanding of the teaching? A. "I'll rinse my mouth after taking this medication." Rationale: Oral candidiasis is an adverse effect of inhaled glucocorticoids. B. "I'll take this medication when I get an asthma attack." Rationale: Montelukast is not a rescue medication for an acute asthma attack. C. "I'll take this medication once a day in the evening." Rationale: Montelukast, a leukotriene modifier, is used to prevent asthma exacerbations. The client should take it on a daily basis once a day in the evening. D. "I'll use a spacer device when I inhale this medication." Rationale: Montelukast is available as a tablet, chewable tablet, or granules for oral administration. It is not available for inhalation. 91. A nurse is teaching a client about taking diphenhydramine. The nurse should explain to the client that which of the following is an adverse effect of this medication? A. Sedation Rationale: Diphenhydramine can cause sedation. It is used to treat rhinitis, allergies, and insomnia. B. Constipation Rationale: Diphenhydramine can cause diarrhea. C. Hypertension Rationale: Diphenhydramine can cause hypotension. D. Bradycardia. Rationale: Diphenhydramine can cause palpitations. 92.A A nurse is teaching a client about taking an expectorant to treat a cough. The nurse should explain that this type of medication has which of the following actions? A. Reduces inflammation Rationale: Glucocorticoids reduce inflammation. B. Suppresses the urge to cough Rationale: Antitussives suppress the cough stimulus. C. Dries mucous membranes Rationale: Anticholinergic medications dry mucous membranes and reduce secretions. D. Stimulates secretions Rationale: Expectorants act by increasing secretions to improve a cough’s productivity. 93.A A nurse is providing discharge teaching to a client who has pulmonary tuberculosis and a new prescription for rifampin. Which of the following information should the nurse provide? A. "Treatment with this medication will last for 1 month." Rationale: Treatment with rifampin for tuberculosis lasts from 6 to 9 months. B. "This medication can cause insomnia." Rationale: Rifampin is more likely to cause fatigue and drowsiness than insomnia. C. "It is best to take the medication with meals." Rationale: The client should take rifampin on an empty stomach, 1 hr before or 2 hr after meals. D. "Urine and other secretions might turn orange." Rationale: Rifampin might turn the urine and other secretions reddish-orange. This includes sputum, tears, and sweat. 94.A A nurse is providing discharge instructions to a client who has asthma and is about to start taking theophylline (Theo-24). The nurse should tell the client that this medication might cause which of the following adverse effects? A. Drowsiness Rationale: Theophylline is more likely to cause insomnia than drowsiness. B. Constipation Rationale: Theophylline is more likely to cause diarrhea than constipation. C. Oliguria Rationale: Theophylline is more likely to cause urinary frequency than oliguria. D. Tachycardia Rationale: Theophylline can increase cardiac stimulation and cause tachycardia. 95.A A nurse is providing discharge instructions to a client who has asthma and a new prescription for montelukast. The nurse should instruct the client to report which of the following adverse effects to the provider? A. Blurred vision Rationale: Blurred vision is not an adverse effect of montelukast. B. Palpitations Rationale: Palpitations are not an adverse effect of montelukast. C. Constipation Rationale: Diarrhea, not constipation, is an adverse effect of montelukast. D. Depression Rationale: Montelukast can cause neuropsychiatric effects such as depression, behavior changes, hallucinations, and suicide ideation. The nurse should instruct the client to report such adverse effects. A change in medication might be prescribed. 96.A A nurse is providing discharge teaching to a client who has asthma and a new prescription for fluticasone/salmeterol. For which of the following adverse effects should the nurse instruct the client to report to the provider? A. Sedation Rationale: Fluticasone/salmeterol is more likely to cause insomnia rather than sedation. B. Increased appetite Rationale: Fluticasone/salmeterol does not cause increased appetite. C. White coating in the mouth Rationale: Fluticasone/salmeterol is an inhaled glucocorticoid and long acting beta2 adrenergic agonist combination inhalation medication that is used for daily management of asthma. It is not a rescue medication. An adverse effect of the medication is oropharyngeal candidiasis. The nurse should instruct the client to gargle after each use, use a spacer to reduce the amount of drug in the mouth and throat, and report any white patches inside the mouth or on the tongue to the provider. D. Dry oral mucous membranes Rationale: Dry mouth is more likely with anticholinergic drugs than with fluticasone/salmeterol. 97.A A nurse is caring for a client who has atrial fibrillation and receives digoxin daily. Before administering this medication, which of the following actions should the nurse take? A. Offer the client a light snack. Rationale: The client can take the medication with or without food, although giving it immediately after food can delay absorption slightly. B. Measure the client's blood pressure. Rationale: It is not necessary to measure blood pressure immediately before dosing, but the nurse should monitor the client's blood pressure routinely. C. Measure the client's apical pulse. Rationale: Digoxin decreases the heart rate, so the nurse should count the apical pulse for at least 1 min before administering. The nurse should hold the medication and notify the provider if the client's heart rate is below 60/min or if a change in heart rhythm is detected. D. Weigh the client. Rationale: It is not necessary to weigh the client immediately before dosing, but the nurse should monitor the client's weight routinely. 98.A A nurse in a provider's clinic is assessing a client who takes sublingual nitroglycerin for stable angina. The client reports getting a headache each time he takes the medication. Which of the following statements should the nurse make? A. "Take only one dose of nitroglycerin to reduce the risk of getting a headache." Rationale: Sublingual nitroglycerin may be taken up to three times, five minutes apart. Reducing the number of doses may not relieve the angina pain. B. "There's nothing that can be done to relieve the headaches that nitroglycerin causes." Rationale: The headaches associated with nitroglycerin use diminish over time. Until then, headaches can be relieved by mild analgesics. C. "Try taking a mild analgesic to relieve the headache." Rationale: Headache is a common side effect of nitroglycerin. The nurse should suggest conservative measures, such as taking aspirin, acetaminophen, or some other mild analgesic, to manage the headache. Generally, headaches that are a side effect of nitroglycerin are transient. D. "We will ask the provider to prescribe a different medication for you." Rationale: Nitroglycerine is the drug of choice for acute angina attacks. The headaches associated with its use diminish over time. Until then, headaches can be relieved by mild analgesics. 99.A A nurse is providing teaching to a client who has stable angina and a new prescription for nitroglycerin oral, sustained-release capsules. Which of the following instructions should the nurse include? A. Take 1 capsule at the onset of anginal pain. Rationale: Sustained-release capsules are not used for acute attacks of angina. B. Stop taking the medication if side effects are troublesome. Rationale: Abruptly discontinuing the use of long-acting nitroglycerin capsules can cause vasospasm. C. Take the medication with meals. Rationale: The client should take the medication on an empty stomach 1 hr before or 2 hr after a meal with 8 oz of water. D. Swallow the capsules whole. Rationale: The client should swallow the capsules whole and not chew or crush them or place them under the tongue. 100.A nurse is caring for a client who is receiving heparin by continuous IV infusion. Which of the following medications should the nurse plan to administer in the event of an overdose? A. Iron Rationale: Iron treats anemia, not a heparin overdose. B. Glucagon Rationale: Glucagon treats severe hypoglycemia from an insulin overdose. C. Protamine Rationale: Protamine reverses the effects of heparin and is used in the event of an overdose. D. Vitamin K Rationale: Vitamin K reverses the effects of warfarin, not heparin. 101.A nurse is providing teaching to a client who has hypertension and a new prescription for captopril. Which of the following instructions should the nurse provide? A. Do not use salt substitutes while taking this medication. Rationale: Captopril, an ACE inhibitor, can cause hyperkalemia due to potassium retention by the kidney. The client should avoid salt substitutes, as most of them are high in potassium. B. Take the medication with food. Rationale: The client should take captopril on an empty stomach, 1 hr before or 2 hr after a meal, in order to not reduce the medication’s absorption. C. Count your pulse rate before taking the medication. Rationale: It is not necessary to count a pulse before taking captopril. D. Expect to gain weight while taking this medication. Rationale: Weight gain is not an adverse effect of captopril. 102.A nurse is providing teaching to a client who has hypertension and a new prescription for verapamil. Which of the following beverages should the nurse tell the client to avoid while taking this medication? A. Milk Rationale: Milk has no known effect on the metabolism of verapamil; therefore, this is a safe beverage for the client to drink while on this medication. B. Orange juice Rationale: Orange juice has no known effect on the metabolism of verapamil; therefore, this is a safe beverage for the client to drink while on this medication. C. Coffee Rationale: Although coffee consumption should be limited while taking verapamil, it does not have to be avoided. D. Grapefruit juice Rationale: Grapefruit juice increases blood levels of verapamil, a calcium channel blocker, by inhibiting its metabolism. The excess amount of medication can intensify the medication's hypotensive effects, putting the client at risk for syncope and dizziness. 103.A nurse on a telemetry unit is caring for a client who has unstable angina and is reporting chest pain with a severity of 6 on a 0 to 10 scale. The nurse administers 1 sublingual nitroglycerin tablet. After 5 min, the client states that his chest pain is now a severity of 2. Which of the following actions should the nurse take? A. Administer another nitroglycerin tablet. Rationale: Administration guidelines for sublingual nitroglycerin indicate that it is appropriate to administer another tablet 5 min after the first one if the client is still reporting pain. B. Initiate a peripheral IV. Rationale: As the first dose of nitroglycerin decreased the client's pain, there is no indication that an IV is necessary. C. Call the Rapid Response Team. Rationale: As the first dose of nitroglycerin decreased the client's pain, there is no indication that calling the Rapid Response Team is necessary. D. Obtain an ECG. Rationale: There is no indication at this point for an ECG. The client's pain did decrease with nitroglycerin administration, which would not happen if the client were having a myocardial infarction. 104.A nurse is caring for a client who is on warfarin therapy for atrial fibrillation. The client's INR is 5.2. Which of the following medications should the nurse prepare to administer? A. Epinephrine Rationale: Epinephrine treats anaphylaxis or cardiac arrest. It does not reverse the effects of warfarin. B. Atropine Rationale: Atropine treats bradycardia. It does not reverse the effects of warfarin. C. Protamine Rationale: Protamine reverses the effects of heparin, not warfarin. D. Vitamin K Rationale: Vitamin K reverses the effects of warfarin. 105.A nurse is providing instruction to a new nurse about caring for clients who are receiving diuretic therapy to treat heart failure. The nurse should explain that which of the following medications puts clients at risk for both hyperkalemia and hyponatremia? A. Furosemide Rationale: Furosemide is a high-ceiling (loop) diuretic that increases the risk of hyponatremia and hypokalemia, not hyperkalemia. B. Hydrochlorothiazide Rationale: Hydrochlorothiazide is a thiazide diuretic that increases the risk of hypokalemia, not hyperkalemia. C. Metolazone Rationale: Metolazone is a thiazide diuretic that increases the risk of hyponatremia and hypokalemia, not hyperkalemia. D. Spironolactone Rationale: Spironolactone is a potassium-sparing diuretic. It blocks the effects of aldosterone in the renal tubules, causing a loss of sodium and water and the retention of potassium. The possible adverse reactions include hyperkalemia and hyponatremia. 106.A nurse is receiving a client who is immediately postoperative following hip arthroplasty. Which of the following medications should the nurse plan to administer for DVT prophylaxis? A. Aspirin PO Rationale: Aspirin therapy is used for existing thromboembolic disorders, not for DVT prophylaxis. B. Enoxaparin subcutaneous Rationale: Enoxaparin is a low molecular heparin that inhibits thrombus and clot formation. Preventive doses of enoxaparin are low and the client does not require monitoring of prothrombin time or activated partial thromboplastin time, making it the preferred treatment for DVT prophylaxis following orthopedic surgery. C. Heparin infusion Rationale: Heparin therapy by infusion is used to treat existing DVT, not prophylaxis. D. Warfarin PO Rationale: Warfarin therapy is started after dosing with enoxaparin. Both medications are given to allow the warfarin time to reach therapeutic levels. 107.A nurse is preparing to administer digoxin to a client who has heart failure. Which of the following actions is appropriate? A. Withholding the medication if the heart rate is above 100/min Rationale: The nurse should withhold the medication if the client's heart rate is below 60/min. B. Instructing the client to eat foods that are low in potassium Rationale: The client should eat foods high in potassium to prevent hypokalemia, which increases the risk of digoxin toxicity. C. Measuring apical pulse rate for 30 seconds before administration Rationale: The nurse should measure the apical pulse rate for 1 min. D. Evaluating the client for nausea, vomiting, and anorexia Rationale: Loss of appetite, nausea, vomiting, and blurred or yellow vision may be signs of digoxin toxicity. 108.A nurse is caring for a client who is taking digoxin for heart failure and develops indications of severe digoxin toxicity. Which of the following medications should the nurse prepare to administer? A. Fab antibody fragments Rationale: Fab antibody fragments, also called digoxin immune Fab, bind to digoxin and block its action. The nurse should prepare to administer this antidote IV to clients who have severe digoxin toxicity. B. Flumazenil Rationale: Flumazenil, a benzodiazepine antagonist, reverses the effects of benzodiazepines. C. Acetylcysteine Rationale: Acetylcysteine, a mucolytic, reduces the risk of hepatotoxicity after acetaminophen overdose. D. Naloxone Rationale: Naloxone reverses the effects of opioid analgesics. 109.A nurse is providing teaching to a client who has stable angina and a new prescription for transdermal nitroglycerin. Which of the following instructions should the nurse include? (Select all that apply.) A. Apply the patch to a hairless area and rotate sites. B. Apply a new patch each morning. C. Remove the patch for 10 to 12 hr daily. D. Apply the patch to dry skin and cover the area with plastic wrap. E. Apply a new patch at the onset of anginal pain. Rationale: <b>Apply the patch to a hairless area and rotate sites is correct.</b> Hair can interfere with the adhesion of the patch. Rotating sites helps prevent skin irritation.</br></br><b>Apply a new patch each morning is correct.</b> Therapeutic preventive effects of transdermal nitroglycerin patches begin 30 to 60 min after application and last up to 14 hr.</br></br><b>Remove the patch for 10 to 12 hr daily is correct.</b> Removing the patches for 10 to 12 hr each day helps prevent tolerance to the medication.</br></br><b>Apply the patch to dry skin and cover the area with plastic wrap is incorrect.</b> These instructions apply to topical nitroglycerin ointment, not to nitroglycerin patches.</br></br><b>Apply a new patch at the onset of anginal pain is incorrect.</b> Nitroglycerin patches prevent angina attacks. They do not treat acute angina attacks.</br></br> 110.A nurse is providing discharge teaching to a client who has a new prescription for warfarin. Which of the following statements by the client indicates an understanding of the teaching? A. "It's okay to have a couple of glasses of wine with dinner each evening." Rationale: Alcohol can alter the medication's effects. Excessive intake can increase its effects, while chronic intake can decrease its effects. B. "I'll be sure to eat more foods with vitamin K." Rationale: Clients taking warfarin should keep their intake of vitamin K consistent. C. "I'll take aspirin for my headaches." Rationale: Aspirin could compound the effects of warfarin and put the client at a higher risk for bleeding. D. "I'll use my electric razor for shaving." Rationale: Because this medication prolongs clotting times, the client should avoid situations that put him at high risk for bleeding, such as shaving with a straight razor or a razor blade. 111.A nurse is caring for a client who is postoperative following abdominal surgery and reports incisional pain. The surgeon has prescribed morphine 4 mg IV bolus every 6 hr as needed. Before administering this medication, the nurse should complete which priority assessment? A. Blood pressure Rationale: The nurse should check the client's blood pressure, but this is not the highest priority at this time. B. Apical heart rate Rationale: The nurse should check the client's apical heart rate, but this is not the highest priority at this time. C. Respiratory rate Rationale: The priority action the nurse should take when using the airway, breathing, and circulation (ABC) approach to client care is to evaluate the client's respirations. The respiratory rate is especially important because opioid analgesics like morphine can cause respiratory depression. D. Temperature Rationale: The nurse should check the client's temperature, but this is not the highest priority at this time. 112.A nurse is providing teaching to a client who has breast cancer about the adverse effects of chemotherapy. Which of the following client statements indicates an understanding of the teaching? A. "I will take the antiemetic as soon as the chemotherapy infusion is complete." Rationale: Antiemetics to treat nausea and vomiting associated with chemotherapy should be taken before, not after, the treatment. B. "I will run my toothbrush in the dishwasher every month." Rationale: Clients should be taught to run their toothbrush through the dishwasher every week to help prevent infection. C. "I'll call my doctor if I notice any unusual menstrual bleeding." Rationale: Clients should be taught bleeding precautions and to report bruising or excessive bleeding. D. "I will avoid crowds to keep from infecting others." Rationale: Clients who are neutropenic from chemotherapy are not infectious to others. Infected people are, however, hazardous to the client. 113.A nurse is providing teaching to a client who has a skin infection and a new prescription for gentamicin topical cream. Which of the following instructions should the nurse provide? A. Wash the affected area with soap and water before applying cream. Rationale: The client should wash the affected area with soap and water and dry it thoroughly before applying the cream. B. Increase intake of fluids while using this medication. Rationale: The client should increase fluid intake while taking the IV or IM form of gentamicin, not the topical cream. C. The medication might cause temporary blurred vision. Rationale: The ophthalmic form of gentamicin can cause temporary blurring of vision, not the topical cream. D. Apply the cream to large areas around the infection. Rationale: The client should only apply the cream to the affected skin area. 114.A nurse is monitoring a client who is receiving a unit of packed RBCs following surgery. Which of the following assessments is an indication that the client might be experiencing circulatory overload? A. Flushing Rationale: Flushing is a sign of an allergic reaction to a blood transfusion, not of circulatory overload. B. Dyspnea Rationale: Circulatory overload causes dyspnea, cough, rales, tachycardia, and jugular vein distention. C. Bradycardia Rationale: Circulatory overload causes tachycardia, not bradycardia. D. Vomiting Rationale: Vomiting is a sign of a septic reaction to a blood transfusion, not of circulatory overload. 115.A nurse is providing teaching to a client who has angina pectoris and a new prescription for nitroglycerin sublingual tablets. Which of the following statements by the client indicates an understanding of the teaching? A. "I'll dial 911 if I still have pain after taking 3 nitroglycerin tablets 5 minutes apart." Rationale: The client should access emergency services sooner than this. B. "I'll dial 911 if I still have pain after taking 4 nitroglycerin tablets over a 20-minute period." Rationale: The client should access emergency services sooner than this. C. "I'll dial 911 when I have pain and then take the nitroglycerin tablets." Rationale: The client should take the first nitroglycerin tablet at the onset of pain and see if it relieves symptoms. D. "I'll dial 911 if 1 nitroglycerin tablet does not relieve my pain, and then take up to 2 more tablets 5 minutes apart while waiting." Rationale: If 1 nitroglycerin tablet does not relieve the client's pain, he should access emergency services and then take 2 more tablets at 5-min intervals if he still has pain. 116.A nurse is providing teaching to a client who has peptic ulcer disease and a new prescription for sucralfate tablets. Which of the following information should the nurse provide? A. "An antacid may be taken with the medication if indigestion occurs." Rationale: The client should not take antacids within 30 min of taking sucralfate. B. "Take sucralfate 1 hr before meals." Rationale: Sucralfate is a mucosal protectant. The client should take it on an empty stomach, 1 hr before meals, for maximum effectiveness. C. "Take the tablets whole." Rationale: Sucralfate tablets may be broken or dissolved in water for easier ingestion. D. "Store sucralfate in the refrigerator." Rationale: Sucralfate should be stored at room temperature. 117.A nurse is caring for a client who is to receive a unit of packed RBCs. The nurse should prime the blood administration tubing using which of the following IV solutions? A. Lactated Ringer’s solution Rationale: The nurse should not prime the tubing with lactated Ringer’s solution, because it hemolyzes RBCs. B. 0.9% sodium chloride Rationale: The nurse should prime the tubing with 0.9% sodium chloride, as this is the only IV solution that does not hemolyze RBCs. C. Dextrose 5% in water Rationale: The nurse should not prime the tubing with dextrose 5% in water, because it hemolyzes RBCs. D. Dextrose 5% in 0.45% sodium chloride Rationale: The nurse should not prime the tubing with dextrose 5% in water, because it hemolyzes RBCs. 118.A nurse at a family practice clinic receives a call from a client who is prescribed oral contraceptives but forgot to take one dose. The client reports she is in the first week of a 28-day cycle pack. Which of the following instructions should the nurse provide? A. "Do not have vaginal intercourse until after your next period." Rationale: Missing one oral contraceptive pill is unlikely to increase the risk of pregnancy. However, if the client is concerned, she can avoid intercourse or use a barrier method of contraception. B. "Stop taking the pills and switch to a different contraceptive method." Rationale: Missing one oral contraceptive pill is unlikely to increase the risk of pregnancy. It is not necessary to stop the oral contraceptive and use a different birth control method. C. "Take the missed dose now, then continue the medication as ordered." Rationale: The nurse should tell the client to take the missed dose immediately, then continue with the pack as ordered. The nurse should also tell the client to use an additional form of contraception for 7 days. D. "Take a home pregnancy test." Rationale: Missing one oral contraceptive pill is unlikely to increase the risk of pregnancy. It is not necessary for the client to take a pregnancy test. 119.A nurse is caring for a client who has heart failure and a new prescription for furosemide. Which of the following laboratory values should the nurse review before administering furosemide? A. Bicarbonate Rationale: The nurse should check the client's electrolytes and other laboratory results before initiating diuretic therapy; however, furosemide does not generally affect bicarbonate levels. B. Carbon dioxide Rationale: The nurse should check the client's electrolytes and other laboratory results before initiating diuretic therapy; however, furosemide does not generally affect carbon dioxide levels. C. Potassium Rationale: Furosemide is a loop diuretic and therefore promotes excretion of potassium. The nurse should monitor the client's serum potassium level before administering it to prevent hypokalemia. D. Phosphate Rationale: The nurse should check the client's electrolytes and other laboratory results before initiating diuretic therapy; however, furosemide does not generally affect phosphate levels. 120.A nurse is providing teaching to a client who takes opioid pain medication and has a new prescription for docusate sodium. Which of the following statements by the client indicates an understanding of the teaching? A. "It might take up to 3 days for the medication to work." Rationale: The client understands docusate sodium is a stool softener and the therapeutic effect might take up to 3 days to achieve. B. "I will take the medication for diarrhea." Rationale: The client's statement indicates the need for further teaching. Docusate sodium is a stool softener and is not used to treat diarrhea. C. "I should drink 4 ounces of water when I take the medication." Rationale: The client's statement indicates the need for further teaching. Docusate sodium is a stool softener and the client should drink 8 ounces of water when taking the medication. The nurse should also instruct the client to increase fluid intake to prevent constipation. D. "I can take this medication along with mineral oil." Rationale: The client's statement indicates the need for further teaching. Docusate sodium may lead to toxicity if taken with mineral oil. 121.A nurse is caring for a client who has a traumatic head injury and is exhibiting signs of increasing intracranial pressure. Which of the following medications should the nurse plan to administer? A. Albumin 25% Rationale: Albumin 25% is not administered to relieve increased intracranial pressure. B. Dextran 70 Rationale: Dextran 70 is not administered to relieve increased intracranial pressure. C. Hydroxyethyl glucose Rationale: Hydroxyethyl glucose is not administered to relieve increased intracranial pressure. D. Mannitol 25% Rationale: The nurse should plan to administer mannitol 25%, an osmotic diuretic that lowers intracranial pressure by promoting diuresis. 122.A nurse is preparing to administer blood to a client. The unit of blood on hand is type O negative, and the client has type A positive blood. Which of the following actions should the nurse take? A. Administer the blood as ordered. Rationale: The nurse should administer the blood as ordered. Type O blood is compatible with type A. Type O blood is considered a universal donor, as it contains no antigens to react to transfused blood. B. Contact the provider for further orders. Rationale: It is not necessary for the nurse to contact the provider for further orders. C. Notify the blood bank. Rationale: It is not necessary for the nurse to notify the blood bank. D. Complete an incident report. Rationale: It is not necessary for the nurse to complete an incident report. 123.A nurse is preparing to instill eardrops to a 5-year-old child. Which of the following techniques should the nurse use? A. Pull the auricle down and back. Rationale: The nurse should not pull the auricle down and back. This is the correct technique used for infants and young children under the age of 4. B. Pull the auricle down and out. Rationale: The nurse should not pull the auricle down and out to instill eardrops to a 5-year-old child. C. Pull the auricle up and back. Rationale: The nurse should not pull the auricle up and back to instill eardrops to a 5-year-old child. D. Pull the auricle up and out. Rationale: The nurse should pull the auricle up and out to instill eardrops to a 5-year-old child. This technique is used for children 4 years of age and older, and adults. 124.A nurse is caring for a client who is taking sucralfate. Which of the following outcomes indicates a therapeutic effect of the medication? A. Alleviate Helicobacter pylori Rationale: This is not an intended effect of sucralfate. B. Relief of gastrointestinal pain Rationale: Sucralfate, an antiulcer medication, is prescribed for acute or maintenance therapy of duodenal ulcers. A therapeutic effect of the medication is relief of gastrointestinal pain associated with gastric ulcers. Sucralfate also promotes ulcer healing. C. Prevention of opportunistic infections Rationale: This is not an intended effect of sucralfate. D. Improvement of impaired vision Rationale: This is not an intended effect of sucralfate. 125.A nurse is caring for a client who has diabetes and plans to administer his regular insulin subcutaneously before he eats breakfast at 0800. After checking the client's morning glucose level, which of the following actions should the nurse take? A. Give the insulin at 0700. Rationale: This time is too early for the nurse to administer regular insulin. B. Give the insulin when the breakfast tray arrives. Rationale: Administering regular insulin when the client's breakfast tray arrives is too late. C. Give the insulin 30 min after breakfast with the client's other routine medicines. Rationale: Administering regular insulin 30 minutes after the client has eaten breakfast is too late. The client's blood glucose is likely to be high and the client might be experiencing symptoms of hyperglycemia. D. Give the insulin at 0730. Rationale: Regular insulin has an onset of 30 to 60 minutes and should be given at a specific time before meals, usually within 30 min. The nurse should always check the blood glucose levels prior to administering short-acting insulin. 126.A nurse at an ophthalmology clinic is providing teaching to a client who has open-angle glaucoma and a new treatment regimen of timolol and pilocarpine eye drops. Which of the following instructions should the nurse provide? A. Administer the medications by touching the tip of the dropper to the sclera of the eye. Rationale: The nurse should teach the client that, to prevent contamination, the dropper should not touch the eye. B. Hold pressure on the conjunctiva sac for 2 min following application of drops. Rationale: The nurse should instruct the client to hold pressure for 1 to 2 min on the lacrimal sac following administration of the drops. This action prevents excessive systemic absorption of the medications. C. Administer the medications 5 min apart. Rationale: The nurse should instruct the client that, if more than one ophthalmic medication is to be administered, they should be given 5 min apart. D. It is not necessary to remove contact lenses before administering medications. Rationale: The nurse should teach the client that contact lenses should be removed prior to administering eye drops. The contacts may be reinserted 15 min following medication administration. 127.A nurse is preparing to administer heparin subcutaneously to a client who has a deep vein thrombosis. Which of the following techniques should the nurse use? A. Cleanse the skin with an alcohol swab, insert the needle, aspirate, and inject the heparin. Rationale: This is the incorrect technique for the nurse to use to inject heparin. B. Cleanse the skin with an alcohol swab, insert the needle, aspirate, inject the heparin, and massage the site. Rationale: This is the incorrect technique for the nurse to use to inject heparin. C. Cleanse the skin with an alcohol swab, insert the needle, inject the heparin, and observe for bleeding. Rationale: This is the correct technique for the nurse to use to inject heparin. D. Cleanse the skin with an alcohol swab, insert the needle, inject the heparin, aspirate, and observe for bleeding. Rationale: This is the incorrect technique for the nurse to use to inject heparin. 128.A nurse is preparing to administer potassium chloride (KCL) to a client who is receiving diuretic therapy. The nurse reviews the client's serum potassium level results and discovers the client's potassium level is 3.2 mEq/L. Which of the following actions should the nurse take? A. Give the ordered KCL as prescribed. Rationale: The client's serum potassium level is below the recommended reference range. The nurse should administer the KCL as prescribed. B. Omit the KCL dose and document that it was not given. Rationale: The nurse should not omit the ordered medication. C. Hold the prescribed dose and notify the provider of the serum potassium level. Rationale: The client's serum potassium level is below the recommended reference range. The nurse should not hold the medication. There is no indication that the provider should be notified, as a prescription for the low level of potassium has been given. D. Call the lab to verify the client's results. Rationale: The nurse has already received the lab values from the lab, so notifying the laboratory is not indicated. 129.A nurse is caring for a client who is taking montelukast. Which of the following outcomes indicates a therapeutic effect of the medication? A. The client experiences less muscle pain. Rationale: This is not an intended effect of montelukast. B. The client's seizure threshold is reduced. Rationale: This is not an intended effect of montelukast. Montelukast may in fact induce seizures as an adverse effect. C. The client experiences an increased ease of breathing. Rationale: Montelukast is a bronchodilator that is prescribed for clients who have chronic asthma or seasonal rhinitis. Therapeutic effects of the medication are an increased ease of breathing. D. The client's platelet count is increased. Rationale: This is not an intended effect of montelukast. 130.A nurse is monitoring a client who is receiving a unit of packed RBCs following surgery. Which of the following assessments is an indication the client might be experiencing a hemolytic reaction? A. Flushing Rationale: Flushing is a sign of an allergic reaction to a blood transfusion, not of a hemolytic reaction. B. Dyspnea Rationale: Dyspnea is a sign of circulatory overload from a blood transfusion, not of a hemolytic reaction. C. Hypotension Rationale: A hemolytic reaction causes hypotension, headache, apprehension, chest pain, and low-back pain. D. Vomiting Rationale: Vomiting is a sign of a septic reaction to a blood transfusion, not of a hemolytic reaction. 131.A nurse is teaching an adolescent about medication therapy with oral acetylcysteine. Which of the following information should the nurse include in the teaching? A. "You should avoid eating eggs." Rationale: There are no dietary restrictions when taking acetylcysteine. B. "Your mouth will become dry." Rationale: Increased oral secretions occur when taking this medication. C. "It is necessary to monitor your serum electrolyte levels." Rationale: ABG levels and pulmonary function might be monitored when taking this medication. D. "This medication has a very unusual odor." Rationale: This medication has an odor similar to rotten eggs due to the presence of disulfide linkages. 132.A nurse is providing teaching to a client who is taking warfarin about monitoring its therapeutic effects. Which of the following explanations should the nurse provide about the international normalized ratio (INR) test? A. "The INR also monitors heparin therapy if the provider switches the medication prescription." Rationale: The INR monitors warfarin therapy, not heparin therapy. The activated partial thromboplastin time (aPTT) monitors heparin therapy. B. "The INR is the only test available for anticoagulant therapy monitoring." Rationale: Several tests are available for monitoring anticoagulant therapy, including the INR, prothrombin time (PT), and activated partial thromboplastin time (aPTT). C. "You will only need the test twice per month." Rationale: At the start of warfarin therapy, the prescriber should monitor the client's INR daily. D. "The INR is a standardized test that eliminates the variations between laboratories reports in prothrombin times." Rationale: The INR is a standardized test, which means that the result will be the same, no matter which laboratory performs it. 133.A nurse is caring for a client who has tuberculosis and new prescriptions for rifampin and pyrazinamide. Which of the following laboratory tests should the nurse instruct the client will be required while on this medication regimen? A. Liver function tests Rationale: Pyrazinamide and rifampin can both cause hepatotoxicity, thus the provider will monitor liver function regularly. B. Gallbladder studies Rationale: Pyrazinamide and rifampin do not interfere with gall bladder function. C. Thyroid function studies Rationale: Pyrazinamide and rifampin do not interfere with thyroid function. D. Blood glucose levels Rationale: Pyrazinamide and rifampin do not interfere with glucose metabolism. 134.A nurse in an emergency department is preparing to administer theophylline by continuous intravenous (IV) infusion to a client who is experiencing an asthma attack. Which of the following actions should the nurse take? A. Infuse the medication with an IV pump. Rationale: Theophylline should be administered slowly on an infusion pump. Rapid administration may cause hypotension and death. B. Cover the IV container with dark paper. Rationale: It is not necessary to cover the IV container with dark paper when administering theophylline. C. Administer a test dose first. Rationale: It is not necessary to administer a test dose when administering theophylline. D. Infuse the medication at 35 mg/min. Rationale: The nurse should regulate the theophylline infusion at no faster than 25 mg/min. A more rapid infusion rate may cause hypotension and death. 135.A nurse is caring for a client who has a central venous catheter and develops acute shortness of breath. Which of the following actions should the nurse take first? A. Clamp the catheter. Rationale: The greatest risk to this client is injury from further air entering the central venous catheter; therefore, the first action the nurse should take is to clamp the catheter. B. Position the client in left lateral Trendelenburg. Rationale: The nurse should position the client in the left lateral Trendelenburg to prevent the air from entering the coronary arteries; however, the nurse should take another action first. C. Initiate oxygen therapy. Rationale: The nurse should initiate oxygen therapy to treat any hypoxia the client may be experiencing; however, the nurse should take another action first. D. Auscultate breath sounds. Rationale: The nurse should auscultate breath sounds to determine if there is air movement within the lungs; however, the nurse should take another action first. 136.A nurse is caring for a client who has a central venous catheter and reports hearing a gurgling sound on the side of the catheter insertion. Which of the following complications should the nurse suspect? A. Catheter occlusion Rationale: Difficulty administering fluids or drawing blood through the line are manifestations of a catheter occlusion. B. Catheter rupture Rationale: Fluid leaking from the site or pain and swelling during infusion are manifestations of a catheter rupture. C. Catheter dislodgment Rationale: A change in the length of the external catheter is a manifestation of catheter dislodgment. D. Catheter migration Rationale: A client report of hearing a gurgling sound on the side of the catheter insertion is a manifestation of catheter migration. 137.A nurse is caring for a client who has E. coli infection and a prescription for gentamicin 5mg/kg/day by intermittent IV bolus every 8 hr. Which of the following manifestations indicate the client is experiencing gentamicin toxicity? (Select all that apply.) A. Insomnia B. Tinnitus C. Dizziness D. Restlessness E. Xerostomia Rationale: <b>Insomnia is incorrect.</b> A client with gentamicin toxicity is at risk for neurotoxicity. Clinical manifestations can include ringing of the ears and complaints of dizziness.</br></br><b>Tinnitus is correct.</b> A client with gentamicin toxicity is at risk for neurotoxicity. Clinical manifestations can include ringing of the ears and complaints of dizziness.</br></br><b>Dizziness is correct.</b> A client with gentamicin toxicity is at risk for neurotoxicity. Clinical manifestations can include ringing of the ears and complaints of dizziness.</br></br><b>Restlessness is incorrect.</b> A client with gentamicin toxicity is at risk for neurotoxicity. Clinical manifestations can include ringing of the ears and complaints of dizziness.</br></br><b>Xerostomia is incorrect.</b> A client with gentamicin toxicity is at risk for neurotoxicity. Clinical manifestations can include ringing of the ears and complaints of dizziness.</br></br> 138.A nurse is caring for a client who has hemophilia A and hemarthrosis of the left knee. Which of the following actions should the nurse take? A. Administer low dose aspirin. Rationale: It is not appropriate for the nurse to administer aspirin to a client who has hemophilia. Aspirin, NSAIDS, and some herbal products should be avoided, as they increase the risk of bleeding. B. Apply heat to the knee. Rationale: It is not appropriate for the nurse to apply heat to the affected extremity, as this this may increase the bleeding in the joint. C. Prepare for autologous blood transfusion. Rationale: An autologous transfusion would involve transfusing the client's own blood. As the client is deficient in clotting factors, this would not be of benefit. Products that are given to clients who have hemophilia include clotting factors, fresh-frozen plasma, and possibly whole blood. D. Obtain a stool specimen. Rationale: The nurse should obtain a stool specimen, as the client is at risk for bleeding in the gastrointestinal track. The stool specimen would show presence of blood. 139.A nurse is providing teaching to a client who has seizures and a new prescription for phenytoin. Which of the following information should the nurse provide? A. Phenytoin turns urine blue. Rationale: The nurse should include in the home instructions that phenytoin turns the urine pink, red, or red-brown, not blue. B. Alcohol increases the chance of phenytoin toxicity. Rationale: The nurse should include in the home instructions that alcohol alters the blood level of phenytoin. C. Avoid flossing the teeth to prevent gum irritation. Rationale: The nurse should instruct the client to floss the teeth to prevent gingival hyperplasia, which is associated with the use of phenytoin. D. Take an antacid with the medication if indigestion occurs. Rationale: The nurse should instruct the client to avoid taking an antacid within 2 hr of administering phenytoin. 140.A nurse is preparing to administer phenytoin 50 mg by intermittent IV bolus to a client who has a seizure disorder. Which of the following actions should the nurse take? A. Slow the injection if the medication crystallizes. Rationale: The nurse should discontinue the medications if it crystalizes. Mixing phenytoin with other solutions can cause a precipitate to form. It should not be added to an existing IV infusion and the tubing should be flushed before and after administration. B. Dilute the medication before injecting. Rationale: The nurse should not dilute the IV injection before administration, as phenytoin is given undiluted. C. Follow the IV injection with sterile water. Rationale: The nurse should follow the IV injection with sterile 0.9% sodium chloride, not water, to prevent a precipitate developing. D. Administer the medication over 1 min. Rationale: The nurse should administer phenytoin slowly, no faster than 50 mg/min. 141.A nurse is providing teaching to a client who has a new diagnosis of Parkinson's disease. On which of the following medications should the nurse prepare to instruct the client? A. Piperacillin/tazobactam Rationale: Piperacillin/tazobactam is a broad spectrum anti-infective used in the treatment of moderate to severe infections. It is not used in the treatment of Parkinson's disease. B. Levothyroxine Rationale: Levothyroxine is a thyroid hormone used in the treatment of hypothyroidism. It is not used in the treatment of Parkinson's disease C. Levodopa/carbidopa Rationale: Levodopa/carbidopa is the cornerstone of Parkinson's treatment. The nurse should prepare to instruct the client on the use of this medication. D. Carbamazepine Rationale: Carbamazepine is an anticonvulsant used in the treatment of seizures, trigeminal neuralgia, bipolar disorder, and diabetic neuropathy. It is not used in the treatment of Parkinson's disease. 142.A nurse is providing teaching to a client who has a new diagnosis of hypothyroidism. On which of the following medications should the nurse prepare to instruct the client? A. Radioactive iodine Rationale: Radioactive iodine is an anti-thyroid medication that is used to treat thyroid cancer, hyperthyroidism and as a diagnostic aid for thyroid function studies. It is not used in the treatment of hypothyroidism. B. Levothyroxine Rationale: Levothyroxine is a synthetic thyroid hormone that is chemically identical to thyroxine (T4). It is used in the treatment of hypothyroidism. The nurse should prepare to instruct the client on the use of this medication. C. Sumatriptan Rationale: Sumatriptan is an anti-migraine agent used for acute treatment migraine and cluster headaches. It is not used in the treatment of hypothyroidism. D. Levofloxacin Rationale: Levofloxacin is a broad spectrum anti-infective of the quinolone class that is used to treat infections of the sinuses, skin, lungs, ears, airways, bones, joints, and urinary tract. It is not used in the treatment of hypothyroidism. 143.A nurse is preparing to administer a transfusion of RBCs to a client who has heart failure. For which of the following manifestations should the nurse monitor to prevent fluid volume overload? (Select all that apply.) A. Dyspnea B. Gastrointestinal bloating C. Jugular vein distention D. Confusion E. Hypotension Rationale: <b>Dyspnea is correct.</b> Dyspnea is a clinical manifestation of fluid volume overload.</br></br><b>Gastrointestinal bloating is incorrect.</b> Gastrointestinal bloating is not a clinical manifestation of heart failure.</br></br><b>Jugular vein distention is correct.</b> Jugular vein distention is a clinical manifestation of fluid volume overload.</br></br><b>Confusion is correct.</b> Confusion is a clinical manifestation of fluid volume overload.</br></br><b>Hypotension is incorrect.</b> Hypertension, not hypotension, is a clinical manifestation of fluid volume overload. Hypotension is a manifestation of a hemolytic transfusion reaction.</br></br> 144.A nurse is caring for a client who has cirrhosis and a new prescription for lactulose. Which of the following manifestations indicates an adverse effect of the medication? A. Dry mouth Rationale: Dry mouth is not an adverse effect associated with lactulose. B. Vomiting Rationale: The nurse will monitor for vomiting as an adverse effect of lactulose. C. Headache Rationale: Headaches are not an adverse effect associated with lactulose. D. Peripheral edema Rationale: Peripheral edema is not an adverse effect associated with lactulose. 145.A nurse is caring for a client who has cirrhosis and a prothrombin time of 30 seconds. Which of the following medications should the nurse plan to administer? A. Vitamin K Rationale: A prothrombin time of 30 seconds indicates the clotting time is prolonged and bleeding could occur. Vitamin K injection increases the synthesis of prothrombin by the liver; therefore, the nurse should plan to administer vitamin k. B. Heparin Rationale: The nurse should not anticipate that the provider will prescribe heparin, as the client's clotting time is prolonged. C. Warfarin Rationale: The nurse should not anticipate that the provider will prescribe warfarin, as the client's clotting time is prolonged. D. Ferrous sulfate Rationale: While clients who have cirrhosis often have anemia, the nurse should not plan to administer ferrous sulfate in response to the prolonged prothrombin time. 146.A nurse is teaching a client who has a new prescription for aspirin to prevent cardiovascular disease. Which of the following instructions should the nurse include in the teaching? A. Take the tablets on an empty stomach. Rationale: The client should take aspirin with a full glass of water or with food to reduce gastric distress. B. Expect stools to turn black. Rationale: The client should monitor for black, tarry stools and other manifestations of bleeding, such as bruising. C. Anticipate the tablets to smell like vinegar. Rationale: Discard aspirin tablets that smell like vinegar because these tablets are decomposing and are ineffective. D. Monitor for tinnitus. Rationale: Tinnitus is a manifestation of salicylism, or aspirin toxicity. Other manifestations include sweating, headache, and dizziness. 147.A nurse is teaching a client who has a new diagnosis of asthma. Which of the following medications should the nurse instruct the client to use to abort an acute asthma attack? A. Beclomethasone Rationale: Beclomethasone is used on a fixed schedule to reduce inflammation and prevent an acute asthma attack. B. Salmeterol Rationale: Salmeterol is an inhaled long acting beta2 agonist (beta2-adrenergic agonist) used on a fixed schedule to reduce inflammation and prevent an acute asthma attack. C. Formoterol Rationale: Formoterol is an inhaled long acting beta2 agonist (beta2-adrenergic agonist) used on a fixed schedule to reduce inflammation and prevent an acute asthma attack. D. Albuterol Rationale: Albuterol is an inhaled short-acting beta2 agonist (beta2-adrenergic agonist) used as a rescue medication to relieve an acute asthma attack. Albuterol dilates the airways, decreases wheezing, and improves oxygenation. 148.A nurse is collecting data on a client who has a new prescription for ampicillin. The nurse should recognize which of the following findings is a priority? A. Nausea Rationale: The nurse should encourage increase in fluid intake if the client is experiencing nausea to prevent dehydration and electrolyte imbalance; however, another finding is the priority. B. Vomiting Rationale: The nurse should encourage increase in fluid intake if the client is experiencing vomiting to prevent dehydration and electrolyte imbalance; however, another finding is the priority. C. Wheezing Rationale: When using the airway, breathing, circulation approach to client care, the nurse should determine the priority finding is wheezing. Wheezing is a manifestation of an anaphylactic allergic reaction due to bronchospasm and edema in the airway. Wheezing indicates a constriction of the airway and requires immediate intervention to support respiratory function. The nurse should advise the client to wear identification to indicate an allergy to this medication. D. Moniliasis Rationale: The nurse should provide the client with a topical antifungal agent if the client experiences moniliasis to prevent itching and burning of the skin; however, another finding is the priority. 149.A nurse is reviewing the medication list for a client who has a new diagnosis of a small bowel obstruction. The nurse should withhold which of the following medications? A. Senna Rationale: Laxatives are contraindicated in clients who have fecal impaction, bowel obstruction, and acute abdominal surgery to prevent perforation. Because the bowel does not allow for any passage of stool with a complete small bowel obstruction, laxatives will cause increased abdominal cramping and discomfort. B. Ibuprofen Rationale: Ibuprofen is contraindicated for clients who have asthma or severe hepatic or renal disease. It should be used with caution in clients who have a bleeding disorder. C. Omeprazole Rationale: Omeprazole is contraindicated in clients who are allergic to omeprazole. It should be used with caution in clients who are pregnant or breast feeding. D. Zolpidem Rationale: Zolpidem is contraindicated in clients who are allergic to benzodiazepines. It should be used with caution in older adults and clients who have respiratory disease. 150.A nurse is caring for a client who is to start taking cyclosporine following a kidney transplant. The nurse should instruct the client that which of the following foods can have an adverse interaction with this medication? A. Pepperoni Rationale: Clients who are taking an MAOI should avoid foods high in tyramine, such as peperoni. If a client eats food containing tyramine while taking an MAOI, there is a risk of hypertensive crisis and the client can experience severe headache, tachycardia, hypertension, and confusion with possible stroke and death. B. Orange juice Rationale: Clients who take cyclosporine can drink orange juice without developing any interactions. C. Grapefruit juice Rationale: Clients taking cyclosporine should avoid drinking grapefruit juice because it can increase the therapeutic effect leading to renal and hepatic toxicity. D. Smoked salmon Rationale: Clients who are taking an MAOI should avoid foods high in tyramine such as smoked salmon. If a client eats food containing tyramine while taking an MAOI, there is a risk of hypertensive crisis and the client can experience severe headache, tachycardia, hypertension, and confusion with possible stroke and death. 151.A nurse is reviewing the medication administration records from the previous shift. Which of the following findings should indicate to the nurse a need for an incident report? A. A client received gentamicin intermittent IV bolus over 1 hr. Rationale: The nurse should administer the dose of gentamicin via intermittent IV bolus diluted in 50 to 200 mL of 0.9% sodium chloride over 30 to 60 min to prevent injury. B. A nurse used a 25-gauge 3/8 inch needle to administer a heparin injection. Rationale: The nurse should use a 25- or 26-gauge, ½ to 5/ inch needle when administering a subcutaneous heparin injection. The nurse should neither aspirate nor massage the site after injecting the medication into the fatty layer of the abdomen, 5.1 cm (2 in) away from the umbilicus. The nurse should hold gentle pressure over the site for 1 to 2 min after administering the heparin. C. A nurse injected Demerol IM into the vastus lateralis site of adult. Rationale: The nurse should use a large, well developed muscle for IM injections. The vastus lateralis is the best site because it has the largest muscle mass and does not have major blood vessels or nerves in the area. D. A client received a crushed bupropion XL tablet mixed with applesauce. Rationale: Extended or sustained release medications are intended to release medication levels over a long period of time to sustain therapeutic relief. Crushing, breaking, or chewing an extended release medication releases the medication at once into the bloodstream and could be life-threatening. Mixing this medication in applesauce deviates from standard of care and requires the nurse to complete an incident report. 152.A nurse is reviewing the medical record of a client who is to receive the first dose of cefoxitin via intermittent IV bolus. Which of the following findings should the nurse identify as a contraindication for the client to receive cefoxitin and report to the provider? A. A history of phlebitis following an IV infusion of 0.9% sodium chloride with 10 mEq of potassium chloride Rationale: A history of phlebitis is not a contraindication to receiving cefoxitin via intermittent IV bolus because the nurse can insert a new IV catheter at a new site to infuse the cefoxitin. B. A recent history of diarrhea for 3 days Rationale: Cephalosporin antibiotics can cause clostridium difficile infection. However, recent diarrhea does not predict the occurrence of this complication of therapy and is not a contraindication to receiving cefoxitin. C. Serum creatinine 0.8 mg/dL Rationale: Cefoxitin can lead to renal impairment with elevated BUN and serum creatinine. Serum creatinine 0.8 mg/dL is within the expected reference range and, therefore, is not a contraindication to receiving cefoxitin. D. A severe allergy to amoxicillin Rationale: A client who has a suspected or documented history of severe allergy to penicillins may also have an allergy to cephalosporins that could result in anaphylaxis. The nurse should withhold the dose and notify the provider. 153.A nurse is obtaining a medical history from a client who is to start warfarin therapy and currently uses herbal supplements at home. The nurse should inform the client that which of the following herbal supplements can interact adversely with warfarin? A. Feverfew Rationale: The nurse should instruct the client to avoid taking feverfew while taking warfarin because it will increase the anticoagulant effect. B. Black cohosh Rationale: Although evidence is inconclusive, clients can use black cohosh to decrease menopausal symptoms, such as hot flashes, vaginal dryness, and irritability. There are no interactions between black cohosh and warfarin. C. Echinacea Rationale: Although evidence is inconclusive, clients can use echinacea to boost the immune system, decrease inflammation and treat common viral infections. This action may result from the body's ability to mobilize phagocytes and stimulate T-lymphocytes and interferon. There are no interactions between echinacea and warfarin. D. Flaxseed Rationale: Flaxseed provides soluble plant fiber and will mimic the action of a bulk-forming laxative to treat constipation. In addition, flaxseed reduces total cholesterol and LDL cholesterol levels but has no effect on HDL cholesterol or triglycerides. There are no interactions between flaxseed and warfarin. 154.A nurse is assessing an older adult client who is receiving IV therapy. The nurse should recognize that which of the following findings indicates fluid volume excess? (Select all that apply.) A. Bounding pulse B. Pitting edema C. Swelling at the IV site D. Urine-specific gravity greater than 1.030 E. Crackles upon auscultation Rationale: <b>Bounding pulse is correct.</b> Fluid volume excess is due to excessive fluid intake or inadequate fluid excretion. Manifestations include increased blood pressure, pulse, and respirations. With fluid volume excess, the pulse is full and bounding.</br></br><b>Pitting edema is correct.</b> Excess extracellular fluid can lead to pitting edema in dependent areas of the body.</br></br><b>Swelling at the IV site is incorrect.</b> Edema at the IV site indicates a localized accumulation of fluid due to infiltration. Although this is a concern, this finding does not suggest fluid volume excess. This finding would suggest infiltration. The nurse should discontinue the IV and restarted at another site.</br></br><b>Urine specific gravity greater than 1.030 is incorrect.</b> Urine-specific gravity measures the concentration of all chemical particles in the urine. A therapeutic range is 1.005 to 1.030. A urine-specific gravity greater than 1.030 indicates dehydration, and a gravity of less than 1.010 indicates fluid volume excess.</br></br><b>Crackles upon auscultation is correct.</b> Pulmonary edema can occur with fluid volume excess.</br></br> 155.A nurse is teaching a client who has a new prescription for prednisone to treat rheumatoid arthritis. The nurse should inform the client that which of the following is a therapeutic effect of this medication? A. Reduces risk of infection Rationale: Prednisone causes immunosuppression, which can increase the risk for infection. The nurse should instruct the client to monitor for fever or sore throat. B. Decreases inflammation Rationale: Prednisone is used to treat rheumatoid arthritis because it produces anti-inflammatory and immunosuppressive effects, which reduces inflammation, decreases pain, and increases mobility. C. Improves peripheral blood flow Rationale: Prednisone can cause reduced wound healing and does not increase peripheral blood flow. D. Increases bone density Rationale: Prednisone can cause reduced bone density and osteoporosis. 156.A nurse is evaluating teaching with a client who is receiving continuous subcutaneous insulin via an external insulin pump. Which of the following statements by the client indicates a need for further teaching? A. "I will change the needle every 3 days." Rationale: The infusion set should be changed every 1 to 3 days to prevent infection. Clients should know how to operate the pump, adjust the settings, and respond to alarms. B. "I should store all unused insulin in the refrigerator." Rationale: Clients should refrigerate insulin that is not in use to maintain potency, prevent exposure to sunlight, and inhibit bacterial growth. Insulin in use should be kept at room temperature for up to 1 month to reduce irritation at the injection site. C. "If I skip lunch, I will skip my mealtime dose of insulin." Rationale: If a meal is skipped, the mealtime dose should not be given. The client also should know how to adjust the amount of insulin based on blood glucose results. D. "I will use insulin glargine in my insulin pump." Rationale: The client should use a short-acting insulin in the insulin pump. The insulin pump is designed to administer rapid-acting or short-acting insulin 24 hr a day. Insulin glargine is classified as a long-acting insulin and is administered at the same time each day to maintain stable blood glucose concentration for a 24-hr period. 157.A nurse is teaching a client who has a new prescription for bumetanide. Which of the following instructions should the nurse include in the teaching? A. "Report changes in hearing." Rationale: Bumetanide is a high-ceiling loop diuretic. It promotes diuresis by inhibiting sodium and chloride reabsorption in the thick ascending limb of the loop of Henle. High-ceiling loop diuretics can cause ototoxicity. Concurrent use of aminoglycosides, such as gentamycin, increases the risk of ototoxicity. Inform clients about possible hearing loss, and instruct clients to notify the prescriber if a hearing deficit or tinnitus develops. B. "Avoid foods high in potassium." Rationale: Hypokalemia is an adverse effect of bumetanide due to potassium loss through the distal nephron. The client should consume foods high in potassium content (such as dried fruits, nuts, bananas, and potatoes) to minimize the risk for hypokalemia. The client should be taught to monitor for manifestations of hypokalemia, such as irregular heartbeat, muscle weakness, and leg cramps. C. "Take the prescribed second dose at nighttime." Rationale: Inform the client to expect increased urine volume and frequency of voiding. The client should take diuretics early in the morning when prescribed daily. When prescribed twice per day, the client should take the medication at 0800 and 1400 to avoid frequent diuresis during the night. D. "Limit your fluid intake to no more than 1.5 L a day." Rationale: The client should consume 2-3 L of fluid per day to prevent dehydration due to loss of sodium, chloride, and water. 158.A nurse is assessing a client who is receiving liothyronine for treatment of hypothyroidism. The nurse should recognize which of the following findings is a therapeutic response to this medication? A. Decrease in appetite Rationale: Improved appetite is a therapeutic effect of liothyronine. A decrease in appetite is a manifestation of hypothyroidism. B. Increase in weight Rationale: An increase in weight is a manifestation of hypothyroidism. One therapeutic effect of liothyronine is a reduction of this manifestation. C. Increase in energy Rationale: An increase in energy is a therapeutic response to liothyronine. Depression, lethargy, and fatigue are manifestations of hypothyroidism and effective treatment will improve these manifestations. D. Decrease in body temperature Rationale: An increase in temperature is a manifestation of hypothyroidism. Body temperature should return to the expected reference range with effective therapy. 159.A nurse is teaching a client who has a new prescription for phenytoin. The nurse should instruct the client to monitor for and report which of the following adverse effects of this medication? A. Metallic taste Rationale: Adverse effects of clarithromycin include an altered taste. Phenytoin can cause gingival hyperplasia. B. Diarrhea Rationale: Adverse effects of phenytoin include constipation. C. Skin rash Rationale: Phenytoin is an antiepileptic medication used to treat partial seizures and generalized tonic-clonic seizures. Phenytoin can cause a rash that can progress to Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). If a rash develops, the client should notify the provider immediately and stop the use of phenytoin. D. Anxiety Rationale: Adverse effects of phenytoin include suicidal tendencies and aggression. 160.A nurse is teaching a client who has a new prescription for erythromycin. Which of the following information should the nurse include? A. "Take this medication with a glass of grapefruit juice." Rationale: Grapefruit juice can reduce the metabolism of this medication and increase the risk for toxicity. B. "Expect your skin to turn yellow." Rationale: Erythromycin can cause hepatotoxicity. The client should monitor and report manifestations of hepatotoxicity, such as abdominal pain, jaundice, and nausea. C. "Monitor for ringing in your ears." Rationale: Ototoxicity is an adverse effect of erythromycin. The client should monitor and report manifestations of ototoxicity, such as tinnitus, dizziness, and vertigo. D. "Increase fiber intake to prevent constipation." Rationale: Erythromycin can cause gastrointestinal disturbances such as nausea, vomiting, and diarrhea. 161.A nurse is preparing to administer a medication to a client who states, "That looks different from the pill I usually take." Which of the following responses should the nurse make? A. "Describe what the pill looks like." Rationale: The nurse must collect more data prior to administering the medication. There is a chance that this is not the correct dose or medication. The nurse should clarify the prescription with the provider in order to ensure safe and effective administration of therapy. B. "This is the medication prescribed by your provider." Rationale: The nurse needs to verify that this is the correct medication and dose. Additional data is needed before safely administering the medication. C. "This pill is probably from a different lot number than yours at home." Rationale: The nurse should not ignore the client’s concern with a guess. The nurse should determine why the pill has a different appearance to verify that it is the correct medication. Consultation with the pharmacy and provider might be required. D. "This hospital might use a different manufacturer, but the medication is the same." Rationale: Before administering the pill, the nurse should collect more data to confirm the medication is correct. 162.A nurse is assessing a client who has a peripheral IV with a continuous infusion. Which of the following findings is a manifestation of phlebitis? (Select all that apply.) A. Erythema B. Damp dressing C. Throbbing D. Warmth at insertion site E. Streak formation Rationale: <b>Erythema is correct.</b> Erythema is a reddened area at the insertion site and is a manifestation of phlebitis. Other manifestations can include throbbing, burning, and increased skin temperature.</br></br><b>Damp dressing is incorrect.</b> A damp dressing is a manifestation of infiltration. Other manifestations include pallor, local swelling, and decreased skin temperature. </br></br><b>Throbbing is correct.</b> Throbbing and pain at the insertion site are manifestations of vein inflammation and phlebitis. </br></br><b>Warmth at insertion site is correct.</b> Responses to inflammation include warmth and redness of the affected tissue. </br></br><b>Streak formation is correct.</b> Streak formation is a classic indicator of advanced phlebitis. </br></br> 163.A nurse is caring for a client who asks how albuterol helps his breathing. Which of the following responses should the nurse make? (Select all that apply.) A. The medication will stimulate flow of mucus. B. The medication will prevent wheezing. C. The medication will open the airways. D. The medication will reduce inflammation. E. The medication will decrease coughing episodes. Rationale: <b>The medication will stimulate flow of mucus is incorrect.</b> Expectorants, such as guaifenesin, stimulate the flow of mucous to produce a productive cough. Asthma is characterized by bronchoconstriction, airway edema, and increased mucus production. Albuterol relaxes the airways, allowing for expectoration of mucus.</br></br><b>The medication will prevent wheezing is correct.</b> Albuterol is used to prevent or treat wheezing.</br></br><b>The medication will open the airways is correct.</b> Albuterol promotes bronchodilation. The primary purpose is to provide rapid relief of bronchoconstriction, thus opening the airway and improving oxygenation.</br></br><b>The medication will reduce inflammation is incorrect.</b> Albuterol does not reduce inflammation. Glucocorticoid medications reduce inflammation.</br></br><b>The medication will decrease coughing episodes is correct.</b> Coughing is often an early indicator of bronchospasm. Albuterol provides a rapid response to relax smooth muscle and reduce bronchoconstriction, which will decrease coughing. </br></br> 164.A nurse is caring for a client who has a new prescription for propranolol. The nurse should monitor the client for which of the following adverse reactions to this medication? A. Ototoxicity Rationale: Propranolol can cause bronchoconstrictions in clients who have asthma. B. Tachycardia Rationale: Bradycardia is an adverse reaction of beta-blockers. The nurse should withhold the medication if the client's heart rate is less than 50/min. C. Postural hypotension Rationale: Propranolol can cause postural hypotension. The client should change positions slowly and the nurse should monitor the client's blood pressure from a lying to sitting to standing position. D. Hypokalemia Rationale: Propranolol can mask tachycardia, an early manifestation of hypoglycemia in clients who have diabetes mellitus. 165.A nurse is teaching a client who takes acetaminophen daily to manage mild knee pain. The nurse should instruct the client to monitor for which of the following adverse reactions to this medication? A. Tinnitus Rationale: Aspirin can cause ototoxicity. B. Muscle pain Rationale: Atorvastatin can cause muscle pain and rhabdomyolysis. Acetaminophen can reduce muscle pain. C. Hyperglycemia Rationale: Acetaminophen can cause leukopenia and thrombocytopenia. D. Jaundice Rationale: Acetaminophen can cause hepatotoxicity. The client should monitor and report jaundice, abdominal pain, clay colored stools, and fever. 166.A nurse is reviewing the laboratory data on a client who has a new prescription for heparin for treatment of a pulmonary embolism. Which of the following data should the nurse report to the provider? A. Hematocrit 45% Rationale: This hematocrit is within the expected reference range of 37-47% in females and 42-52% in males. B. Partial thromboplastin time (PTT) 65 seconds Rationale: The desired therapeutic range for anticoagulation is between 1.5-2 times the expected reference range, or 60-80 seconds. A PTT of 65 seconds is within the expected reference range for anticoagulation. C. White blood cell count 8,000/mm3 Rationale: This data is within the expected reference range of 5,000-10,000/mm3. D. Platelets 74,000/mm3 Rationale: Heparin-induced thrombocytopenia is a disorder characterized by low platelet counts. It is an adverse effect of heparin that causes the activation of platelets, resulting in widespread clot formation and depletion of platelets. The expected reference range for platelets is 150,000-400,000/mm3. 167.A nurse is assessing a client prior to administering atenolol. Which of the following findings should prompt the nurse to withhold the medication? A. Heart rate 46/min Rationale: The nurse should check the client's heart rate prior to administering a beta-blocker. If the client's heart rate is less than 50/min, the nurse should hold the medication and contact the provider. Atenolol is a beta-blocker and is used in the treatment of hypertension and angina, and following a myocardial infarction. This medication works by slowing the heart rate, decreasing the speed of electrical impulses through the atrioventricular node, and decreasing the force of contraction. B. Oxygen saturation 95% Rationale: Atenolol can cause bronchoconstriction in clients who have asthma. This pulse oximetry is within the expected reference range. C. Respiratory rate 18/min Rationale: This respiratory rate is within the expected reference range. Atenolol can cause dyspnea. D. Blood pressure 160/94 mm Hg Rationale: Atenolol is a beta-blocker and is used in the treatment of hypertension. This blood pressure is greater than the expected reference range, indicating hypertension. 168.A nurse is teaching a client who is taking atorvastatin daily. Which of the following statements by the client indicates an understanding of the teaching? A. "I will avoid drinking grapefruit juice." Rationale: Grapefruits and grapefruit juice can reduce metabolism of atorvastatin, which increases the risk for toxicity. B. "I should take this medication without food." Rationale: The client can take atorvastatin with or without food. C. "I should expect my stools to turn clay-colored." Rationale: Clay-colored stools are a manifestation of hepatotoxicity, an adverse effect to atorvastatin. D. "It is not necessary to have routine lab tests done." Rationale: Clients who are taking atorvastatin should have their liver enzymes assessed before treatment and 1 to 2 months initially, then in 6 to 12 weeks, and periodically during therapy. They should also have their cholesterol levels monitored to evaluate the effects of treatment. 169.A nurse is preparing to administer 10 units of regular insulin and 20 units of NPH insulin to a client. What is the sequence of events the nurse should follow? (Move the steps of mixing insulin on the left into the box on the right, placing them in the selected order of performance. All steps must be used.) D. Inspect vials for contaminants. C. Roll NPH vial between palms of hands. A. Inject air into NPH insulin vial. E. Inject air into regular insulin vial. B. Withdraw short-acting insulin into syringe. F. Add intermediate insulin to syringe. 170.A nurse is teaching a class about safe medication administration. The nurse should include in the teaching that which of the following references are acceptable for safe medication administration? (Select all that apply.) A. A website that ends in .com B. Published journals C. Pharmacists D. Physicians' Desk Reference E. Pharmaceutical sales representatives Rationale: <b>A website that ends in .com is not correct.</b> A website that ends in .com indicates it is a commercial enterprise and not a reliable source of information. The Internet can be a valuable source of drug information. However, because anyone can post information on the Internet regardless of qualifications, not everything that is found on the Internet is accurate.</br></br><b>Published journals is correct.</b> Published journals and reputable newsletters, such as The Medical Letter on Drugs and Therapeutics, and the Prescriber's Letter, are bimonthly and monthly publications that present current information on medications.</br></br><b>Pharmacists is correct.</b> Pharmacists provide expert information about medications, expected versus unexpected side effects, contraindications, compatibilities, and indications for use. </br></br><b>Physicians' Desk Reference is correct.</b> The Physicians' Desk Reference (PDR) is a reference work financed by the pharmaceutical industry. The information on each drug is identical to the information on the package insert. The PDR is updated annually to reflect current recommendations. </br></br><b>Pharmaceutical sales representatives is not correct.</b> Pharmaceutical sales representatives can be useful sources of medication information. However, the role of the pharmaceutical representative is sales, not education. 171.A nurse is teaching a class about medication reconciliation. Which of the following information should the nurse include in the teaching? A. Do not include over-the-counter medications in the medication reconciliation report. Rationale: The nurse should include all medications, including over-the-counter medications, in the reconciliation process. B. Provide a list of the client’s current medications during the change of shift report. Rationale: Change of shift report should include changes in client condition and priorities of care, not the list of the client's current medications. C. Do not perform reconciliation for a client at discharge from a health care facility. Rationale: Reconciliation is conducted whenever a client undergoes a transition in care in which new medications or treatments might be prescribed. Transitions in care include hospital admission, hospital discharge, and stepping to a different level of care within a facility. D. Provide a list of the client's current medications during admission to a health care facility. Rationale: The nurse should create a list of current medications including the name, indication, route, dosage, and dosing interval upon admission to a health care facility. The list consists of all medications, including vitamins, herbal products, and prescription and nonprescription medications. 172.A nurse is administering timolol eye drops to a client who has glaucoma. Which of the following actions should the nurse take? A. Apply pressure to the bridge of the nose after administration. Rationale: The nurse should apply pressure to the lacrimal sac for 1 to 2 min after insertion. B. Wipe the eye from the outer canthus to the inner canthus before instillation. Rationale: The nurse should clean the eye by wiping with a sterile cotton ball from the inner canthus to the outer canthus. C. Drop prescribed amount of medication into the conjunctival sac. Rationale: With the dominant hand resting on client's forehead, hold filled medication eyedropper or ophthalmic solution approximately 1 - 2 cm above conjunctival sac. Instill prescribed number of medication drops into the conjunctival sac. After instilling the drops, ask the client to close his eye gently. If the client is to receive more than one eye medication to the same eye, wait at least 5 min before administering the next medication. D. Protect the distal portion of the eyedropper using clean technique. Rationale: The nurse should use sterile technique when handling the distal portion of the eyedropper. Avoid touching any part of the application apparatus, and keep the lid in place when not in use. 173.A nurse is teaching a client who has a new prescription for captopril. Which of the following instructions should the nurse include in the teaching? A. Monitor for a cough. Rationale: Captopril is an ACE inhibitor used to treat hypertension. The client should monitor and report a cough and dyspnea. B. Hold medication for heart rate less than 60/min. Rationale: Captopril can cause tachycardia. C. Take this medication with food. Rationale: The client should take captopril on an empty stomach to increase absorption. D. Avoid grapefruit juice. Rationale: Grapefruit juice can reduce the metabolism of atorvastatin. 174.A nurse observes a parent administer a prescribed oral medication to an infant. Which of the following actions by the parent indicates a need for further instruction? A. Allows the infant to swallow some of the medication before administering more Rationale: The parent should give the infant a small amount of medication and wait for the infant to swallow before administering more to reduce the risk for aspiration. B. Administers medication with an oral syringe Rationale: When administering oral medications to an infant, an oral syringe is used to administer the correct dosage of medication. C. Positions the infant in a supine position Rationale: The parent should place the infant in a semi-upright position when administering medication to reduce the risk for aspiration. D. Inserts the medication in the infant's buccal cavity Rationale: The parent should slowly administer the liquid into the infant's buccal cavity to reduce the risk for aspiration. 175.A nurse is teaching about medications to a group of clients. Which of the following statements by a client indicates a need for further teaching? A. "I will take ibuprofen for arthritis." Rationale: Ibuprofen is classified as a nonsteroidal anti-inflammatory (NSAID) and is used for chronic, rheumatoid arthritis and osteoarthritis, as well as mild to moderate pain, and reduction of fever. Ibuprofen decreases inflammation caused by arthritis. B. "I will take morphine during sickle cell crisis." Rationale: Morphine is an opiate narcotic used for the symptomatic relief of severe, acute, and chronic pain. A client in sickle cell crisis experiences severe pain and hypoxia due to sickling of red blood cells and should benefit from morphine. C. "I will take propranolol to manage high blood pressure." Rationale: Propranolol is classified as a beta-blocker and is used in the management of cardiac dysrhythmias, myocardial infarction, angina pectoris, and hypertension. D. "I will take aspirin to reduce pain from my peptic ulcer. Rationale: Aspirin is contraindicated in clients who have bleeding disorders and peptic ulcer disease. 176.A nurse is reviewing the medication list for a client who has a new prescription for warfarin. The nurse should recognize that which of the following medications is incompatible with warfarin? A. Furosemide Rationale: Furosemide can cause potassium loss and increase the risk for digoxin toxicity when used concurrently with digoxin. B. Alprazolam Rationale: Alprazolam, used with sedative hypnotic medications, can increase the risk for CNS depression. C. Vitamin K Rationale: These two medications are not compatible. Vitamin K antagonizes the action of warfarin and is the antidote for warfarin toxicity. D. Vitamin A Rationale: Oral contraceptives can increase vitamin A levels. 177.A nurse is assessing a client who is taking oxacillin to treat an infection. The nurse should recognize which of the following findings is a manifestation of an allergic reaction? A. Pruritus Rationale: An allergic reaction is an immune response that can manifest as pruritus and urticaria and can progress to anaphylaxis. B. Diarrhea Rationale: Gastrointestinal side effects of oxacillin can include nausea, vomiting, flatulence, and diarrhea. Diarrhea is a manifestation of pseudomembranous colitis. C. Dark urine Rationale: Dark urine is a manifestation of dehydration or hepatic dysfunction. D. Fever Rationale: A fever is a manifestation of the infection or it can indicate bone marrow depression. 178.A nurse is assessing a client who is taking lisinopril to treat hypertension. Which of the following findings is a priority to report? A. Dry cough Rationale: Dry cough is non-urgent because it is a mild adverse effect of lisinopril; therefore, there is another finding that is the priority. B. Swelling of the tongue Rationale: When using the urgent vs non-urgent approach to client care, the nurse determines that the priority finding is swelling of the tongue, which is a manifestation of angioedema. The nurse should withhold the medication and notify the provider immediately if the client reports swelling of the tongue or throat. Other manifestations include giant wheals and edema of the tongue, glottis, and pharynx. Severe reactions are treated with subcutaneous epinephrine. If angioedema develops, ACE inhibitors are discontinued. C. Nausea Rationale: Nausea is non-urgent because it is a mild adverse effect of lisinopril; therefore, there is another finding that is the priority. D. Nasal congestion Rationale: Nasal congestion is non-urgent because it is a mild adverse effect of lisinopril; therefore, there is another finding that is the priority. 179.A nurse is preparing to administer bisacodyl suppository to a client. Which of the following actions should the nurse take? (Select all that apply.) A. Don sterile gloves. B. Lubricate index finger. C. Use a rectal applicator for insertion. D. Position client supine with knees bent. E. Insert suppository just beyond internal sphincter. Rationale: <b>Don sterile gloves is incorrect.</b> The nurse should wear clean gloves for the procedure. Gloves prevent the transmission of pathogens by direct and indirect contact. The nurse should wear clean gloves when touching blood, body fluid, secretions, excretions, most mucous membranes, nonintact skin, and contaminated items or surfaces.</br></br><b>Lubricate index finger is correct.</b> The rounded end of the suppository is lubricated with a sterile water-soluble lubricating jelly.</br></br><b>Use a rectal applicator for insertion is incorrect.</b> The nurse should administer the suppository with the dominant index finger, which is lubricated. The nurse should not use an applicator to insert a suppository.</br></br><b>Position client supine with knees bent is incorrect.</b> To avoid the rupturing the rectum, the client is positioned on the left lateral side.</br></br><b>Insert suppository just beyond internal sphincter is correct.</b> The nurse should gently retract the buttocks with the nondominant hand. Insert the suppository gently through the anus, past the internal sphincter, and against the rectal wall. Following the administration of the medication, the nurse should apply gentle pressure to hold the buttocks together momentarily if needed to keep medication in place. 180.A nurse is planning to administer ceftriaxone IM to an adult client. Which of the following actions should the nurse plan to take? A. Administer the medication using a 5/8-inch needle. Rationale: Ceftriaxone is classified as a cephalosporin and is painful when injected. Administer with a 1or 1.5-inch needle into a large muscle. B. Administer the medication at a 45&deg angle. Rationale: When administering an IM injection, the syringe should be held at a 90&deg angle. A 45&deg or 90&deg angle is used when administering a subcutaneous injection. C. Administer the medication in the deltoid muscle. Rationale: Ceftriaxone is painful when injected IM. It is administered deep into a large muscle. The deltoid muscle is too small. The ventrogluteal or vastus lateralis are the safest injection sites for this medication. D. Administer the medication using a Z-track technique. Rationale: The Z-tract technique is used to reduce pain and prevent medication to leak into subcutaneous tissue. 181.A nurse is assessing a client who reports acute pain. The nurse should anticipate which of the following findings? A. Increased heart rate Rationale: Acute pain stimulates the sympathetic nervous system and can cause an increase in heart rate. B. Decreased respiratory rate. Rationale: Acute pain can cause tachypnea. C. Hyperactive bowel sounds Rationale: Acute pain can cause pallor and diaphoresis. D. Decreased blood pressure Rationale: Acute pain can cause increased blood pressure. 182.A nurse is preparing to administer morphine IV to a client. Which of the following medications should the nurse plan to have available? A. Flumazenil Rationale: Flumazenil is used to reverse the effects of benzodiazepines. B. Naloxone Rationale: Naloxone is given to reverse the effects of morphine. Then nurse should monitor the client for respiratory depression, bradycardia, and hypotension. C. Protamine Rationale: Protamine is used to reverse the effects of heparin. D. Neostigmine Rationale: Neostigmine is used to reverse the effects of nondepolarizing neuromuscular blockers. 183.A nurse is teaching a client who has a new prescription for codeine. Which of the following instructions should the nurse include in the teaching? A. 'You should take the medication on an empty stomach to prevent nausea." Rationale: Nausea and vomiting are common adverse effects that can be minimized by taking the medication with food or milk. B. "You should limit alcohol intake to 12 ounces daily." Rationale: Codeine causes CNS depression; therefore, other CNS depressants, such as alcohol, should be avoided. C. "You should expect to experience diarrhea while taking this medication." Rationale: Constipation is an adverse effect of codeine. Codeine suppresses the propulsive contractions of the intestinal tract and inhibits secretion of fluids into the intestinal tract causing constipation. D. "You should change positions slowly." Rationale: The client should change positions slowly to avoid the risk of falls. Codeine is an opioid analgesic that causes CNS depression and orthostatic hypotension. 184.A nurse is preparing to administer ampicillin and gentamicin sulfate via IV infusion. Which of the following resources should the nurse consult first regarding medication compatibility? A. Nurse manager Rationale: The nurse may consult the nurse case manager who has significant clinical experience and is a good resource when providing client care; however, there is a better resource for information about medication compatibility. B. Hospital pharmacist Rationale: The greatest risk to the client is injury form medication error; therefore, the nurse should consult the hospital pharmacist first. The pharmacist will have information about medications, including adverse effects, recommended dosages, and drug incompatibilities. C. Health care provider Rationale: The nurse may consult the health care provider to determine if the medication is incompatible and to seek further information about the medication; however, there is a better resource for information about medication. D. Medication sales representative Rationale: The nurse may consult the pharmaceutical sales representative to provide detailed, accurate information about products, but their primary role is to sell a product, not provide education; therefore, there is a better resource for information about medication. 185.A nurse is preparing to administer the monthly injection of haloperidol decanoate to a client who has schizophrenia. Which of the following actions should the nurse plan to take? A. Have the client lie down for 30 min after the medication is injected. Rationale: The nurse should have the client lie down for 30 min after the medication is injected to prevent orthostatic hypotension. B. Monitor the client for bradycardia following the injection. Rationale: The nurse should monitor the client for tachycardia, especially upon rising. C. Assess the client for a sudden relapse of manifestations. Rationale: These long-acting (depot) antipsychotics are used for long-term therapy because the relapse rate may be lower. D. Administer the medication using a tuberculin syringe. Rationale: The nurse should administer the medication with a 2-inch needle IM into a large muscle mass. 186.A nurse is caring for a client who is receiving a continuous IV infusion of heparin. Which of the following actions should the nurse take? A. Administer 50,000 units of heparin by IV bolus every 12 hr. Rationale: Prior to beginning the continuous IV Heparin infusion, the client may receive an IV bolus of Heparin based on the client’s weight; however, administering a bolus every 12 hr would result in an increased risk of hemorrhage. B. Check the activated partial thromboplastin time (aPTT) every 4 hr. Rationale: Heparin is an anticoagulant. The activated partial thromboplastin time (aPTT) should be monitored every 4 hr and the infusion rate should be adjusted accordingly until the effective dose has been determined. C. Have vitamin K available on the nursing unit. Rationale: Vitamin K is the antidote for a warfarin overdose and is not indicated for the client receiving heparin. The antidote for heparin overdose is protamine sulfate. D. Use IV tubing specific for heparin sodium when administering the infusion. Rationale: IV heparin administration does not require any special tubing. A few medications, such as nitroglycerine, adhere to the IV tubing commonly used and require the use of IV tubing specific to that medication. 187.A nurse is reviewing the medical record of a client who has hypertension and a new prescription for metoprolol. Which of the following findings should the nurse investigate further? A. Diet-controlled Type 2 diabetes mellitus Rationale: Metoprolol does not suppress beta2 mediated glycogenolysis, so it can be used more safely than other beta blockers in clients who have diabetes mellitus, especially for a client who is diet-controlled and not taking diabetic medications. The nurse should instruct the client that manifestations of hypoglycemia can be masked with this medication. B. A history of left-sided heart failure Rationale: The nurse should further investigate the client’s history of heart failure. Although metoprolol can be used to treat heart failure, it can also cause heart failure, so this medication should be used with great caution with a client who has a history of heart failure. The nurse should teach the client to watch for signs of increasing left-sided heart failure, such as shortness of breath and weight gain indicating fluid retention, and report these findings to the provider. C. A concurrent prescription for tadalafil Rationale: Beta blockers are not contraindicated for concurrent use of an erectile dysfunction medication; however, erectile dysfunction medication used concurrently with nitrates can cause a catastrophic drop in blood pressure that does not respond to treatment. D. Recently treated bilateral pneumonia Rationale: Pneumonia, and its course of treatment, is not a contraindication for the use of beta blockers. Beta blockers are generally not used with clients who have bronchospastic diseases. 188.A client who is receiving magnesium sulfate has a urine output of 20 mL/hr. Which of the following medications should the nurse expect to administer? A. Calcium gluconate Rationale: Magnesium sulfate is used to manage clients who have preeclampsia and require close monitoring for signs of excessive administration. Central nervous system and respiratory depression, depression of deep tendon reflexes, hypotension, diaphoresis, and decreased or loss of urinary output are signs of excessive magnesium administration. Calcium gluconate is administered intravenously over several minutes as the antidote for magnesium sulfate toxicity. B. Flumazenil Rationale: Flumazenil is administered as a reversal agent for the sedative effects of benzodiazepines. C. Naloxone Rationale: Naloxone is administered to reverse the effects of opioid medications, including respiratory depression, sedation and hypotension. D. Protamine Rationale: Protamine is administered for a heparin overdose. 189.A nurse is preparing to administer oral medication to a 3-month-old infant. Which of the following actions should the nurse plan to take? A. Measure elixir using a medicine cup. Rationale: To accurately measure an infant dose, it is best to use a plastic, needleless syringe for small doses. This provides a reliable measurement, and is a convenient way to transport the medication to the infant. B. Mix medication with formula. Rationale: The nurse should not mix a medication with formula, because the infant may not take all of the formula, resulting in the infant not receiving the full dose of medication. This may also alter the taste of the formula, which may cause the infant to refuse future feedings. C. Place infant supine in the crib. Rationale: The infant should be held in a semi-reclining position to prevent aspiration. A child can aspirate a medication, especially when lying supine. D. Position the syringe to the side of the infant’s tongue. Rationale: The syringe should be placed along the side of the infant’s tongue, and the liquid should be administered slowly in small amounts, allowing the child time to swallow. 190.A nurse is teaching a client who reports taking gingko biloba to improve his memory. Which of the following adverse effects should the nurse include? A. Bad breath Rationale: Bad breath is not an expected adverse effect of gingko biloba. B. Decreased alertness Rationale: Decreased alertness is not an expected adverse effect of ginkgo biloba; however, ginkgo biloba can cause headache, dizziness, and vertigo. C. Breast enlargement Rationale: Breast enlargement is not an expected adverse effect of ginkgo biloba. D. Bleeding gums Rationale: Gingko biloba is an herbal medication used by clients to improve age-related memory loss as well as to decrease leg pain in clients with peripheral arterial disease (PAD). Although gingko biloba is generally well-tolerated, it may suppress coagulation. There have been reports of spontaneous bleeding in clients taking this herbal medication. Clients should be instructed to discontinue use and report increased bleeding, such as nosebleeds, bleeding gums, any cuts that do not stop bleeding, to their provider. 191.A nurse is providing teaching to a client who has schizophrenia and is receiving chlorpromazine. Which of the following client statements indicates an understanding of the teaching? A. "I will contact my provider if I have difficulty urinating." Rationale: Chlorpromazine is a first-generation, or typical, antipsychotic medication. The client should be instructed to monitor for increased anticholinergic adverse effects, such as dry mouth and urinary retention. Difficulty urinating could be a sign of urinary retention and should be reported to the provider for further evaluation. B. "I am less likely to get an infection while taking this medication." Rationale: Agranulocytosis, which causes an increased vulnerability to infection, is a rare, but potential adverse effect of this medication. C. "Weight loss is a sign that my medication dose is too high." Rationale: Chlorpromazine has the potential to cause weight gain, but weight loss is not an adverse effect, nor does it indicate an improper dosage. D. "I may need to take this medication with an antacid due to stomach upset." Rationale: The nurse should instruct the client to take antacids 2 hr before or after this medication, but not concurrently. 192.A nurse is assessing a client who has hypercholesterolemia and is receiving simvastatin. Which of the following findings should the nurse recognize as a potential adverse effect? A. Urinary retention Rationale: Urinary retention is not an adverse effect of simvastatin. B. Muscle weakness Rationale: Myopathy is an adverse effect of this medication. Signs of myopathy include muscle aches, tenderness, and muscle weakness. C. Orthostatic hypotension Rationale: Orthostatic hypotension is not an adverse effect of simvastatin. D. Blurred vision Rationale: Blurred vision is not an adverse effect of simvastatin. 193.A nurse is preparing to administer enoxaparin to a client. Which of the following actions should the nurse plan to take? A. Insert the needle at a 45º angle. Rationale: Enoxaparin should only be injected deep into the fatty layer of the abdominal wall at a 90º angle. B. Aspirate for a blood return before depressing the plunger. Rationale: The nurse should not aspirate for a blood return when administering enoxaparin. C. The nurse should not expel the air bubble in the prefilled syringe. Rationale: The nurse should not expel the air bubble that is in the pre-filled syringe prior to administering the medication. D. Administer the medication 2.54 cm (1 in) from the umbilicus. Rationale: Enoxaparin is a low-molecular weight anticoagulant medication that should be administered in the fatty tissue of the abdomen, avoiding a 2-inch diameter around the umbilicus for best absorption. 194.A nurse is observing a licensed practical nurse (LPN) preparing to administer a 2 mL penicillin G injection to a client. Which of the following actions by the LPN require intervention by the nurse? A. The LPN determines if the client has a history of allergies to cephalosporin. Rationale: Penicillins are contraindicated for clients who have a history of allergies to penicillin and cephalosporin. Clients who are allergic to one penicillin should be considered cross-allergic to other penicillins and at risk for a cross-allergy to cephalosporin. B. The LPN selects a 21 gauge, 1 ½-inch needle. Rationale: IM injections are used for irritating medications, solutions in oils, and aqueous medications. An injection of penicillin G is irritating to the tissue and causes pain at the injection site. The nurse should select a needle size of 21 or 22 gauge, and 1½ inches in length for an injection of 2 mL. C. The LPN plans to inject the needle 5.08 cm (2 in) below the acromion process. Rationale: This is the correct insertion site for an IM injection into the deltoid muscle; however, 2 mL of penicillin G should be injected deep into a large muscle. The deltoid is a small muscle and would not be an appropriate site of administration. Instead, this medication should be administered in the ventrogluteal muscle. D. The LPN states that she will aspirate for blood prior to injecting the medication. Rationale: The nurse should aspirate for blood to avoid inadvertent injection into an artery or peripheral nerve. 195.A nurse is teaching a client who has a new prescription for ferrous sulfate. Which of the following statements by the client indicates an understanding of the teaching? A. "I will expect the color of my urine to be amber." Rationale: The color of the urine is an indication of how concentrated or diluted the urine is and may be affected by food and medications; however, ferrous sulfate does not affect the color of the urine. B. "I should expect dark, tarry stools." Rationale: Ferrous sulfate is an iron supplement used to treat clients who have iron deficiency anemia. An expected adverse effect of this medication is black, tarry stools. C. "I should expect increased bruising." Rationale: Ferrous sulfate does not impact clotting factors or platelets, so the client should not expect increased bruising. D. "I will not get as many infections." Rationale: Ferrous sulfate will not impact white blood cells, so the client does not have any added protection from infection while taking this medication. 196.A nurse is assessing a client who is receiving a continuous IV infusion of dopamine. Which of the following findings should the nurse recognize as a therapeutic effect? A. Increased pulse Rationale: Tachycardia is an adverse effect of this medication and would not be an indication of its effectiveness. B. Increased urine output Rationale: Dopamine is used for the treatment of shock and heart failure. It increases cardiac output by increasing myocardial contractility. This medication also dilates renal blood vessels, which increases renal perfusion and leads to an increase in the client’s urinary output. This finding should indicate to the nurse a therapeutic effect has been achieved. C. Decreased blood pressure Rationale: Dopamine is used to treat hypotension. It increases cardiac output by increasing myocardial contractility leading to a decrease in blood pressure, but if not an indication of its effectiveness. D. Decreased dysrhythmias Rationale: The goal of treatment for shock is to improve the ability of the heart to pump blood. Dopamine is used to help increase cardiac output, blood pressure, and urinary output in the treatment of shock. Cardiovascular adverse effects include hypotension and cardiac dysrhythmias. 197.A nurse is caring for a client who is receiving magnesium sulfate to treat severe preeclampsia and asks the nurse "Is the medication working?" Which of the following responses should the nurse make? A. "The medication is working because there are no contractions." Rationale: Magnesium sulfate can be used in the treatment of preterm labor and may help relax the uterus; however the client is receiving this medication for the treatment of preeclampsia not preterm labor. B. "The medication is working, because there is no seizure activity." Rationale: Magnesium sulfate can be used for various reasons, including antacid, antiarrhythmic, anticonvulsant, electrolyte replacement and laxative. The primary indication for the client who is being treated for preeclampsia is the anticonvulsant properties. It is the preferred drug to prevent seizures in preeclampsia and treat seizures associated with eclampsia. C. "The medication is working, because all your lung fields are clear." Rationale: Magnesium sulfate is administered to clients who have preeclampsia for its anticonvulsant properties. The nurse would not measure its effectiveness by assessing the client’s lung fields. D. "The medication is working, because your blood pressure is normal." Rationale: Magnesium sulfate is administered to clients who have preeclampsia for its anticonvulsant properties. The nurse would not measure its effectiveness by measuring the client’s blood pressure. 198.A nurse is teaching a client who has a new prescription for esomeprazole to manage his GERD. Which of the following statements by the client indicates an understanding of the teaching? A. "I won’t pass gas as often now that I am taking this medication." Rationale: Flatulence is an adverse effect of this medication, so the client may experience an increase in passing gas. B. "I will take this medication each morning with my breakfast." Rationale: The nurse should instruct the client to take esomeprazole at the same time each day and at least 1 hr before a meal. C. "I have an increased risk of getting pneumonia while taking this medication." Rationale: The client taking esomeprazole is at a greater risk for developing pneumonia due to an elevation of gastric pH, especially during the first few days of treatment. The nurse should instruct the client about manifestations of a respiratory infection and to report these findings to the provider if they occur. D. "I will need to take a daily stool softener while taking this medication." Rationale: Diarrhea and headache are the most common adverse effects of esomeprazole. The client should not routinely take a stool softener while taking this medication. 199.A nurse is caring for a child who is allergic to penicillin. The nurse should verify which of the following prescriptions with the provider? A. Amoxicillin-clavulanate Rationale: Penicillin is the most common medication allergy. Clients who are allergic to one penicillin medication should be considered allergic to all penicillins, which would include amoxicillin-clavulanate. Reactions may mild or life-threatening. B. Gentamicin Rationale: Gentamicin is an aminoglycoside, which is often used to treat gram-negative bacilli. Aminoglycosides can be administered to clients who have a penicillin allergy. C. Erythromycin Rationale: Erythromycin is a macrolide, which is a broad-spectrum antibiotic used for gram-positive and gram-negative organisms causing skin and respiratory infections. This medication can be administered to a client who has a penicillin allergy as a safe alternative. D. Amphotericin B Rationale: Amphotericin B is an antifungal agent useful in treating vaginal and oral candidiasis, ringworm, and histoplasmosis. This medication can be administered to a client who has a penicillin allergy. 200.A nurse is providing education to a client who is in labor and has a prescription for a continuous IV infusion of oxytocin. Which of the information should the nurse include? A. "This medication will help prevent nausea and vomiting." Rationale: Nausea and vomiting can be adverse effects of oxytocin. Antiemetic medications are used to manage and prevent nausea and vomiting. B. "Your contractions will become stronger and more frequent." Rationale: Oxytocin is diluted with sodium chloride and administered IV via an infusion pump device to induce or strengthen uterine contractions during labor. The client who is receiving an oxytocin drip is closely monitored to promote a safe delivery and prevent maternal and/or fetal complications. The desired concentration of oxytocin medication is determined by the desired labor contraction pattern that should increase in frequency, duration, and intensity. The nurse closely monitors risks of continuous IV infusion of oxytocin to determine when to discontinue the medication. Risks include fetal distress (fetal bradycardia) caused by hyper-stimulation of the uterus compromising blood flow to the fetus. Uterine contractions lasting longer than 90 seconds should prompt the nurse to discontinue the medication. C. "I will remove the electronic fetal monitor once contractions are regular." Rationale: Electronic fetal monitoring is the most accurate means to detect fetal distress in response to oxytocin administration and should not be removed. Intrauterine pressure during a contraction is measured, and a fetal scalp electrode provides a more reliable recording of the fetal heart rather than an external monitor system. Oxytocin medication can cause hyper-stimulation of the uterus and requires close monitoring for both maternal and fetal distress. D. "You can push the button on the control device to administer more medication." Rationale: Oxytocin medication is used to induce or augment uterine activity during labor. It is administered via IV route with close monitoring of an infusion device pump and medical supervision. A client who is receiving oxytocin IV is assessed frequently to identify and prevent maternal and fetal complications. The dose of the medication is administered by the nurse in accordance with dosage protocol and maternal and fetal assessment findings. 201.A nurse is reviewing the medical record of a client who reports taking pseudoephedrine for sinus congestion as needed. The nurse should identify that pseudoephedrine is contraindicated for which of the following client conditions? A. Eczema Rationale: Pseudoephedrine is a decongestant and is not contraindicated for clients who have eczema. B. Migraines Rationale: The use of decongestants is not contraindicated for clients who have a history of migraines. Migraines are typically caused by cerebral vasodilation. Decongestants stimulate alpha1 adrenergic receptors, causing vasoconstriction; the target for therapy is the nasal membranes. C. Hypertension Rationale: Clients who have hypertension or acute coronary syndrome should speak with their provider prior to taking decongestants, because of the potential for vasoconstriction, which would aggravate the chronic condition. D. Diverticulitis Rationale: Pseudoephedrine is a decongestant and is not contraindicated for clients who have diverticulitis. 202.A nurse is teaching a client who has a new prescription for simvastatin. Which of the following instructions should the nurse include? A. "You should expect brown-colored urine." Rationale: Brown-colored urine is a manifestation of liver dysfunction, an adverse effect of simvastatin. The client should report this to the provider. B. "You should avoid grapefruit juice." Rationale: Grapefruit inhibits the drug-metabolizing enzyme CYP3A4 which slows the metabolism of simvastatin. This can cause an increase in serum simvastatin. Potential adverse effects include elevated liver enzymes, and rhabdomyolysis. C. "You should monitor for ringing in the ears." Rationale: Simvastatin can cause rhabdomyolysis and myopathy. D. "You should take the medication in the morning." Rationale: The nurse should instruct the client to take the medication in the evening to increase efficacy. 203.A charge nurse is supervising a newly licensed nurse provide care for a client who has a PCA pump. Which of the following statements made by the nurse requires further action by the charge nurse? A. "I discarded the remaining 2 milligrams of morphine from the PCA pump. Please document that you witnessed it." Rationale: Two nurses are required to witness the wasting of a narcotic and then sign the narcotic record. The nurse should not ask another nurse to sign the narcotic record if the nurse did not witness wasting the narcotic. B. "I noted that my client pushed the PCA button six times in the last hour, and the PCA lockout is set for 10 minutes." Rationale: The client is using the PCA effectively and no further action is required by the charge nurse. C. "I gave my client a bolus dose of morphine when I initiated the PCA pump." Rationale: PCA prescriptions can begin with a bolus dose in order to establish a blood level of the opioid. D. "I told the client’s family that they must not push the PCA button for the client." Rationale: The client should press the PCA button to reduce the risk for over sedation. 204.A nurse is caring for a client who is in her third trimester of pregnancy. The client asks the nurse about over-the-counter medications. The nurse should recognize which of the following medications is a pregnancy risk category B? A. Naproxen Rationale: Naproxen is a pregnancy risk category C and is not used in clients who are pregnant. B. Acetaminophen Rationale: Acetaminophen is pregnancy risk category B. However, clients who are pregnant should not take over-the-counter medications without consulting the provider. C. Aspirin Rationale: Aspirin is a pregnancy risk category D for clients who are in the third trimester of pregnancy. Aspirin can cause premature closure of the ductus arteriosus with fatal consequences to the fetus. Aspirin can increase the risk of maternal and fetal hemorrhage due to antiplatelet action. D. Ibuprofen Rationale: Ibuprofen is a pregnancy risk category D for clients who are in the third trimester of pregnancy. Ibuprofen can cause premature closure of the ductus arteriosus. 205.A nurse is teaching a client who has a new prescription for amoxicillin-clavulanate to treat pharyngitis. Which of the following statements by the client indicates an understanding of the teaching? A. "I will take this medication until my sore throat goes away." Rationale: The client should take the entire prescribed course of antibiotics to reduce the risk for drug resistance and dormant infections. The sore throat might disappear prior to the completion of the antibiotics. B. "I should take this medication on an empty stomach between meals." Rationale: The client should take amoxicillin-clavulanate with a light meal to increase absorption and reduce the risk for gastro-intestinal effects. C. "I will stop taking this medication if I develop itching." Rationale: Penicillin-derived medications are a common cause of medication allergic reactions. Manifestations of allergic reactions include rashes, hives, itchy and watery eyes, and swollen lips, tongue, or face. Anaphylactic reactions can develop within 1 hr of taking the dose, and include difficulty breathing, shortness of breath, stridor, and angioedema. The client should discontinue the medication and notify the provider if these manifestations occur. D. "I will double my dose, if I miss one." Rationale: The client should not double a dose and take this medication as prescribed to reduce the risk for adverse effects. 206.A nurse is teaching a client who has a new prescription for NPH insulin. Which of the following instructions should the nurse include? A. "Discard the medication if it is cloudy." Rationale: NPH insulin is cloudy. Regular insulin is clear and the client should discard cloudy regular insulin. B. "Briskly shake the medication before filling the syringe." Rationale: The client should roll the insulin vial between his hands to mix to prevent creating bubbles that can alter dosage. C. "Take this medication15 minutes before meals." Rationale: Short-acting insulins, such as insulin lispro, are taken within 15 min of meals. D. "Eat a snack 8 hours after taking this medication." Rationale: NPH insulin peaks in 6 to 14 hr after dosing. The client is at risk for hypoglycemia and might require a snack at this time. Clients should check blood glucose 8 to 10 hr after administration of NPH insulin, and if hypoglycemic, consume a small snack of 15 g of carbohydrates, followed by rechecking of the blood glucose in 15 min. 207.A nurse is providing teaching to a client who has a new prescription for transdermal nitroglycerin paste. Which of the following statements by the client indicates the need for further teaching? A. "I should measure the dosage on the supplied paper." Rationale: Transdermal nitroglycerin is measured by placing the nitroglycerin paste onto an applicator patch. B. "I should leave the patch in place until it is time for the next dose." Rationale: Clients should have a period of 10 to 12 hr without the patch on to reduce the risk for nitrate tolerance. C. "I should get up slowly when I stand." Rationale: Nitroglycerin patches can cause orthostatic hypotension. Instruct clients to rise slowly, and rest their feet on the floor for a few minutes before standing. D. "I might have a headache when I first start taking this medication." Rationale: Headaches caused by the vasodilation of cranial blood vessels can occur when using a topical nitroglycerin. The headaches should diminish as the client adjusts to the vasodilation effects of nitroglycerin. 208.A nurse is assessing a client after administering a dose of losartan. The client has a hoarse voice, and swollen lips and tongue. In which order should the nurse take the following actions? Move the nursing actions into the box on the right, placing them in the selected order of performance. All steps must be used.) F. Assess the client’s airway. C. Call the emergency response team. E. Apply high-flow oxygen. B. Initiate IV access. A. Administer IV epinephrine. D. Administer IV antihistamines. 209.A nurse is providing teaching to a client who has a new prescription for lisinopril. Which of following statements by the nurse indicates an understanding of the teaching? A. "I should increase my intake of potassium-rich foods." Rationale: ACE inhibitors can cause an increase in serum potassium. Clients should avoid foods high in potassium. B. "I should expect to have facial swelling when taking this medication." Rationale: Clients can develop angioedema when on ACE inhibitors. The client should immediately call 911 if shortness of breath, swelling of the tongue or lips, or facial edema develops. C. "I should take this medication with food." Rationale: Food does not alter absorption of lisinopril. Lisinopril can be administered with or without food. D. "I should report a cough to my provider." Rationale: The client should report a cough to the provider. The provider should discontinue the medication for a persistent, irritating cough. 210.A nurse is teaching a client who has a new prescription for ciprofloxacin to treat an uncomplicated UTI. Which of the following instructions should the nurse include? A. "Take this medication with an antacid." Rationale: The client should not take an antacid within 2 hr of this medication to increase absorption. B. "Monitor for tendon pain." Rationale: Ciprofloxacin can cause tendinitis and tendon rupture. The client should monitor and report tendon pain or inflammation. C. "Drink 1,000 milliliters of fluid daily." Rationale: The client should drink 3,000 mL of fluid daily to reduce the risk for crystallization of ciprofloxacin and to dilute urine. D. "Expect urine to turn dark orange." Rationale: Phenazopyridine turns urine red-orange. 211.A nurse is caring for an adolescent client who is receiving carbamazepine for partial seizure disorder. Which of the following statements by the client's parent is the nurse’s priority? A. "He takes a 2-hour nap every day after school." Rationale: Although the nurse should advise the parent to avoid activities that require the client to be alert and to administer the largest portion of the daily dose at bedtime, it is not the nurse’s priority. B. "He says he feels sick to his stomach after taking this medication." Rationale: Although the nurse should instruct the parent to administer the medication with food to reduce nausea, it is not the nurse’s priority. C. "He has so many new bruises on his body." Rationale: When using the urgent vs non-urgent approach to client care, the nurse determines that the priority concern is frequent bruising because this is a manifestation of carbamazepine toxicity. Carbamazepine toxicity can cause bone marrow depression, including leukopenia, anemia, and thrombocytopenia. The parent should monitor the client for bruising, bleeding, and sore throat and have periodic blood work drawn to monitor for myelosuppression. D. "He says his mouth is always dry." Rationale: Although the nurse should advise the parent to have the client rinse his mouth frequently and use hard candy to reduce this effect, it is not the nurse’s priority. 212.A nurse is assessing a client who has been taking sertraline for 2 weeks. The nurse should identify which of the following findings as an indication that the medication is effective? A. The client’s blood pressure is within the expected reference range. Rationale: A diuretic, such as hydrochlorothiazide, will promote fluid excretion and reduce blood pressure. B. The client reports a recent weight loss. Rationale: A diuretic, such as hydrochlorothiazide, will promote fluid excretion and cause weight loss. C. The client reports increase in mood. Rationale: Sertraline is a selective serotonin reuptake inhibitor used to treat major depressive disorders. Therapeutic effects include increase in mood, and an increased interest in activities. D. The client’s legs are not swollen. Rationale: A diuretic, such as hydrochlorothiazide, will reduce edema. 213.A client is teaching a client who has a new prescription for hydrochlorothiazide for management of hypertension. Which of the following instructions should the nurse include? A. "Take this medication before bedtime." Rationale: The client should take this medication in the morning to reduce the risk for nocturia. B. "Monitor for leg cramps." Rationale: Hydrochlorothiazide can cause hypokalemia. The client should monitor for manifestations of hypokalemia, such as fatigue, tachycardia, leg cramps, and muscle weakness. C. "Avoid grapefruit juice.' Rationale: Clients who take statins, such as atorvastatin, should avoid grapefruit juice because it can reduce the metabolism of the medication and cause toxicity. D. "Reduce intake of potassium-rich foods." Rationale: Hydrochlorothiazide can cause hypokalemia. The client should increase intake of potassium-rich foods, such as spinach and bananas. 214.A nurse is caring for a newborn who has respiratory depression. Which of the following medications should the nurse anticipate administering? A. Flumazenil Rationale: Flumazenil is a benzodiazepine antagonist and is given to reverse benzodiazepine toxicity. B. Physostigmine Rationale: Physostigmine is a cholinesterase inhibitor used to reverse the effects of nondepolarizing neuromuscular blockers. C. Terbutaline Rationale: Terbutaline is a bronchodilator and is used to relax uterine smooth muscle to stop premature labor. D. Naloxone Rationale: Naloxone is an opioid antagonist and is administered to reverse opioid toxicity or reverse neonatal respiratory depression. Dosage for a newborn is 0.01 mg/kg, and is repeated every 2 to 3 min until adequate respiratory function returns. 215.A nurse is teaching a client who has a new prescription for ranitidine to treat peptic ulcer disease. Which of the following statements by the client indicate an understanding of the teaching? (Select all that apply.) A. "I can take this medication with or without food." B. "I will take this medication in the morning." C. "I should expect my stools to turn black." D. "I will take this medication with an antacid." E. "I will take this medication when I need it for pain." F. "I will eat five small meals each day." Rationale: <b>"I can take this medication with or without food." is correct.</b> Food does not affect the absorption of ranitidine.</br></br><b>"I will take this medication in the morning." is incorrect.</b> The client should take ranitidine in the evening to reduce nocturnal acid production.</br></br><b>"I should expect my stools to turn black" is incorrect.</b> The client should report black stools because this is a manifestation of gastro-intestinal bleeding.</br></br><b>"I will take this medication with an antacid" is incorrect.</b> The client should take an antacid 1 hr before or after the ranitidine to increase absorption.</br></br><b>"I will take this medication when I need it for pain" is incorrect.</b> Ranitidine is taken on a regular basis to relieve pain, promote healing, and prevent recurrence.</br></br><b>"I will eat five small meals each day" is correct.</b> The client should eat 5 to 6 small meals each day to enhance the therapeutic effects of ranitidine. 216.A nurse is teaching a client who has diabetes mellitus and a new prescription for prednisone for a rash. Which of the following statements by the client indicates the need for further teaching? A. "I might need to increase my regular insulin during this time." Rationale: Glucocorticoids can cause hyperglycemia. Clients who have diabetes mellitus and take glucocorticoids might require reduced calories and increased hypoglycemic medication. B. "I will gradually stop the prednisone when my rash goes away." Rationale: The client should discontinue glucocorticoids gradually to reduce the risk for adrenal insufficiency. Manifestations of adrenal insufficiency include nausea, vomiting, confusion, and hypotension. C. "I might feel a little emotional when I am on this medicine." Rationale: Mood changes and irritability are adverse reactions to glucocorticoids. The client should report severe psychological disturbances, such as hallucination or depression. D. "I might have a hard time falling asleep while taking prednisone." Rationale: Insomnia is an adverse reaction to glucocorticoids. 217.A charge nurse is observing a newly licensed nurse administer medications to a client. Which of the following actions by the newly licensed nurse should prompt the charge nurse to intervene? A. Verifies the medication against the prescription and medication label. Rationale: The nurse should check the medication 3 times prior to administrating. The nurse should verify the medication against the provider’s prescription, the medication administration record, and the medication label. B. Scans the bar code on the medication administration record and the client’s arm band. Rationale: Most institutions now have client identifying bar codes that are located on charts, computer charting systems, electronic medical records, medication dispensing systems, and medication administration records. This bar code is scanned prior to administering the medication to ensure that the correct client is receiving the medication. C. Checks the provider's orders and confirmed dosage in a medication reference guide. Rationale: It is the nurse's responsibility to verify that the dose prescribed is correct for the client’s body size, weight, and renal and liver function. This is verified by checking the initial prescription and then double checking in a medication reference book as necessary. D. Documents medication administration prior to administering it. Rationale: The nurse should document administering medications after they are given to reduce the risk of error. 218.A nurse is teaching a client who has a new prescription for clopidogrel. Which of the following instructions should the nurse include? A. "Take this medication with food." Rationale: The client may take clopidogrel with or without food. B. "You might have to stop taking this medication 5 days before any planned surgeries." Rationale: Clopidogrel inhibits platelet aggregation and can cause bleeding. The client should report taking this medication to providers to determine whether to discontinue the medication prior to elective procedures to reduce the risk for bleeding. C. "Take this medication three times daily." Rationale: The client should take clopidogrel once daily. D. "Expect to have black-colored stools while taking this medication." Rationale: Clopidogrel can cause gastrointestinal bleeding. The client should monitor and report any manifestations of bleeding, such as black stools, hematuria, or coffee ground emesis. 219.A nurse is teaching a female client who has a new prescription for transdermal sumatriptan to treat migraine headaches. Which of the following instructions should the nurse include? A. "Take this medication daily to prevent headaches." Rationale: The client should take this medication as needed to abort an ongoing migraine headache. B. "Activate the patch 30 minutes after application." Rationale: The client should activate the patch within 15 min of application by pushing an activation button. C. "Use contraception while taking this medication." Rationale: Sumatriptan can cause teratogenesis and should not be used during pregnancy. D. "You can bathe with the patch in place." Rationale: The client should keep the transdermal sumatriptan dry to prevent malfunction of the device. The client should not bathe, shower, or swim with the patch. 220.A nurse is assessing a client after administering IV vancomycin. Which of the following findings is the nurse's priority to report to the provider? A. Localized redness at the catheter insertion site Rationale: The nurse should report redness at the catheter insertion site to reduce the risk for thrombophlebitis or infection which can lead to tissue damage; however, another finding is the nurse's priority. B. Client report of a headache Rationale: The nurse should report a headache to obtain a prescription for pain relief for the client; however, another finding is the nurse's priority. C. Client report of tinnitus Rationale: The nurse should report tinnitus because the client is at risk for ototoxicity from the vancomycin; however, another finding is the nurse's priority. D. Audible inspiratory stridor Rationale: When using the airway, breathing, circulation approach to client care the nurse determines the priority finding is inspiratory strider. The client is at risk for bronchospasms, hypotension and circulatory collapse due to anaphylaxis. The nurse should contact the rapid response team, discontinue the vancomycin, and administer epinephrine. 221.A nurse is caring for a client who reports taking bisacodyl to promote a daily bowel movement. Which of the following assessment questions should be the nurse's priority? A. "What do your bowel movements look like?" Rationale: The nurse should ask the client what his bowel movements look like to assess for adverse effects of the bisacodyl; however, another question is the priority. B. "How long have you been taking the bisacodyl?" Rationale: The greatest risk to this client is injury from dependency on laxatives, as bowel tone can be lost; therefore, the priority question the nurse should ask the client is how long he has been using bisacodyl. C. "Do you take the bisacodyl with a glass of milk?" Rationale: The nurse should ask the client how he takes the bisacodyl, as taking it with dairy products or antacids decreases the absorption of the medication; however, another question is the priority. D. "How often do you have a bowel movement?" Rationale: The nurse should ask the client how often he has a bowel movement to assess for regularity and the need for a laxative; however, another question is the priority. 222.A nurse is caring for a client who received an injection of penicillin G procaine. The client begins to experience dyspnea and tongue swelling. Which of the following actions should the nurse perform first? A. Obtain intravenous fluids for administration. Rationale: The nurse should begin administration of IV fluids to correct hypotension that may occur during an anaphylactic response; however, another action is the priority. B. Record the observed data in medical record. Rationale: The nurse should record the observed data to document the event; however, another action is the priority. C. Deliver a dose of aminophylline by inhalation. Rationale: The nurse should administer a bronchodilator to facilitate breathing; however, another action is the priority. D. Administer epinephrine subcutaneously. Rationale: The priority action the nurse should take when using the airway, breathing, circulation approach to client care is to administer epinephrine. The effect of the epinephrine is to act on adrenergic receptors, causing bronchodilation of the lungs and an elevation of blood pressure. By stimulating both alpha and beta adrenergic receptors to cause these effects, it accomplishes more of the goals of treatment of anaphylaxis than any other single therapy. 223.A nurse is administering sucralfate to a client who has a gastric ulcer. Which of the following actions should the nurse take? A. Instruct the client to chew the sucralfate for fasting absorption. Rationale: The nurse should instruct the client to not crush or chew sucralfate. B. Administer the medication without food or fluids. Rationale: The nurse should administer the medication to the client on an empty stomach for best absorption. C. Limit the client's fluids while on sucralfate therapy. Rationale: The nurse should instruct the client to increase fluids while on sucralfate therapy to decrease the risk of constipation related to the medication. D. Administer sucralfate with an antacid. Rationale: The nurse should instruct the client to avoid taking antacids 30 min before or after the administration of sucralfate. 224.A nurse is monitoring a client who received epinephrine for angioedema after a first dose of losartan. Which of the following data indicates a therapeutic response to the epinephrine? A. Respirations are unlabored. Rationale: Losartan is an angiotensin receptor blocker (ARB). Both ARBs and angiotensin converting enzyme (ACE) inhibitors have the adverse effect of angioedema. The primary symptom of angioedema is swelling of the tongue, glottis, and pharynx. This results in limitation or blockage of the airway. Angioedema causes the capillaries to become more permeable, resulting in fluid shifting into the subcutaneous tissues. Although the mouth and throat are most often affected, any area may be involved in the process. Untreated, angioedema can result in death. Improvement of respiratory effort following the administration of epinephrine is the most important therapeutic indicator. B. Client reports decreased groin pain of 3 on a 1 to 10 scale. Rationale: Although edema can occur in any area, the groin is not affected specifically by the disorder. Angioplasty and angiograms most often utilize the femoral vessels, but the prefix "angio" is a general term for blood vessel rather than a reference to the femoral area. C. The client's blood pressure when arising from resting position is at premedication levels. Rationale: Hypotension is a common side effect of angiotensin II receptor blockers (ARBs) such as losartan. For this side effect, the nurse should monitor blood pressure when the client changes position. However, angioedema is an adverse reaction that can result in swelling of the lips, tongue, and glottis. The client experiences extreme respiratory distress. D. The client tolerates a second dose of medication with no greater than 1+ peripheral edema. Rationale: Peripheral edema is not usually associated with angioedema. The edema that is significant in this client occurs in the lips, mouth, and throat, causing airway obstruction. Once the client has this response, the client must know to never take any medication in the angiotensin II receptor blocker classification. 225.A nurse is providing teaching for a client who has hypertension and a prescription change from metoprolol to metoprolol/hydrochlorothiazide. Which of the following statements by the client indicates an understanding of the teaching? A. "Now I will not have to diet to lose weight." Rationale: Hydrochlorothiazide (HCTZ) is a diuretic, and the loss of fluid will result in weight loss. The client should be instructed to weigh daily and watch for weight loss, but it is a change in fluid rather than loss of fat that is the cause of the weight loss. Continuing the recommended diet for control of blood pressure can be an additional part of the client’s care plan. This client needs further reinforcement of teaching to understand the action of the thiazide diuretic. B. "With the new medication, I should experience fewer side effects." Rationale: The client has stated an understanding of the purpose of the addition of the hydrochlorothiazide (HCTZ) to the metoprolol dosage. When used in combination with thiazide diuretics, a lower dose of the beta-blocker can be used. The benefit is there are fewer side effects when beta-blockers (and other antihypertensives) are used in lower dosages. C. "I will not have to do anything different because it is the same medication." Rationale: The client does not indicate an understanding that this medication includes a diuretic that requires an increase in potassium in the diet. This statement indicates a need for further teaching on the addition of the diuretic in the combination drug. D. "The extra letters after the name of medication means it is a stronger dose." Rationale: This statement by the client indicates a need for further reinforcement of teaching. The nurse should clarify that the additional letters indicate a new medication has been combined with the old medication rather than a stronger dose being given. 226.A nurse is caring for a client whose serum potassium level is 5.3 mEq/L. Which of the following scheduled medications should the nurse plan to administer? A. Lisinopril Rationale: Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. This class of antihypertensive interferes with the action of ACE and results in a decreased production of aldosterone. The medication causes the kidneys to possibly retain potassium, which would elevate the value B. Digoxin further. The provider needs to be notified of the elevated potassium level prior to administration of the scheduled dose. Rationale: Potassium competes with digoxin in binding with other electrolytes and cells. When the potassium level is elevated, digoxin is not therapeutic in normal doses. The nurse should notify the provider of the laboratory value and expect to administer the medication when the value has returned to within the expected reference range. C. Furosemide Rationale: Furosemide results in loss of potassium from the nephron as part of its diuretic effect. This medication can be given when a client has an elevated potassium level and can lower the potassium level. For this client, the depletion of potassium is a beneficial effect. For a client who has a therapeutic potassium level, there would be a risk for hypokalemia due to the excretion of potassium. D. Potassium iodide Rationale: Potassium iodide is prescribed for the treatment of Grave's disease. The iodine results in a decrease of thyroxine production. The potassium in the medication contributes to the overall potassium level and should not be given at this time. 227.A nurse is preparing to administer morphine 4 mg IV bolus to a client who reports pain. Available is morphine 10 mg/mL. Which of the following actions should the nurse take? A. Discard the extra medication in a sharps container. Rationale: Narcotic waste should not be placed in a sharps container. B. Save the extra medication for a later dosing. Rationale: All narcotics must be kept in a locked, secure place. Any unused portion of a narcotic must be wasted, not saved for dosing at a later time. C. Send the waste amount to the pharmacy. Rationale: Any unused portion of a narcotic must be wasted, not returned to the pharmacy. D. Have another nurse witness the disposal of the extra medication. Rationale: Any excess narcotic must be disposed. The disposal must be witnessed and documented by a second nurse. 228.A nurse is teaching a client who has angina about nitroglycerin sublingual tablets. Which of the following statements should the nurse include in the teaching? A. "Place one tablet under your tongue every 5 minutes for 30 minutes to relieve chest pain." Rationale: The client should place one tablet under the tongue every 5 min for 15 min, for 3 total doses, to relieve chest pain. B. "Nitroglycerin decreases chest pain by dissolving blood clots that are occluding the arteries." Rationale: Nitroglycerin relaxes the blood vessels, which increases blood and oxygen supply to the heart. Nitroglycerin does not dissolve blood clots. C. "You can store the bottle of tablets in your bathroom medicine cabinet." Rationale: Nitroglycerin loses its effectiveness after 6 months or after exposure to light or moisture. The client should not store the tablets in the bathroom. D. "Nitroglycerin dilates cardiac blood vessels to deliver more oxygen to the heart." Rationale: Nitroglycerin is a nitrate medication that increases collateral blood flow, redistributes blood flow toward the subendocardium, and dilates the coronary arteries. 229.A nurse is reviewing laboratory results of a client who has atrial fibrillation and is taking warfarin. For which of the following results should the nurse notify the provider? A. PT 45 seconds Rationale: The expected reference range for PT is 11 to 12.5 seconds. During therapy, the nurse should expect to see the values increase 1.5 to 2.5 times the baseline. Therefore, the nurse should withhold the warfarin and notify the provider. B. Hgb 16 g/dL Rationale: The expected reference range for Hgb in males is 14 to 18 g/dL and in females is 12 to 16 g/dL. C. Hct 44% Rationale: The expected reference range for Hct in males is 42% to 52% and in females is 37% to 47%. D. Platelets 190,000/mm3 Rationale: The expected reference range for platelets is 150,000 to 400,000/mm3. 230.A nurse is reviewing the medical record of a client who reports drinking three to four glasses of wine each night and taking 3,000 mg of acetaminophen daily. Which of the following laboratory values is the priority for the nurse to assess? A. Amylase Rationale: The nurse should evaluate the client's amylase level to assess for pancreatitis. However, there is another laboratory value that is the nurse's priority. B. Creatinine Rationale: The nurse should evaluate the client's creatinine level to monitor renal function. However, there is another laboratory value that is the nurse's priority. C. Aspartate aminotransferase (AST) Rationale: The greatest risk to this client is liver injury from the combined adverse effects of alcohol and acetaminophen. Therefore, the priority laboratory value for the nurse to evaluate is AST because an elevated level is an indication of liver damage. D. Antidiuretic hormone (ADH) Rationale: The nurse should evaluate the ADH level of the client to assess for syndrome of inappropriate ADH, CNS infections, hypovolemia, and dehydration. However, there is another laboratory value that is the nurse's priority. 231.A nurse is reinforcing teaching with a client who has a new prescription for colchicine orally to treat gout. The nurse should inform the client that which of the following findings is an adverse effect of colchicine? A. Increased appetite Rationale: The nurse should include in the teaching that anorexia is an adverse effect of colchicine. B. Urinary retention Rationale: Urinary retention is not an adverse effect of colchicine. C. Diarrhea Rationale: The nurse should inform the client that gastrointestinal effects, including diarrhea, are an adverse effect of colchicine and are an indication of toxicity due to the medication. The nurse should instruct the client to discontinue the medication if these gastrointestinal effects occur. D. Sore throat Rationale: Sore throat is not an adverse effect of colchicine. 232.A nurse is providing teaching to a client who has gastroesophageal reflux disease and a new prescription for omeprazole. Which of the following instructions should the nurse provide? A. Take NSAIDs if headaches occur. Rationale: The nurse should instruct the client to avoid the use of NSAIDs while taking omeprazole, as they increase the risk of GI irritation. B. Decrease intake of vitamin D. Rationale: The nurse should instruct the client to maintain an adequate intake of calcium and vitamin D, as omeprazole can increase the risk of osteoporosis and fractures. C. Expect muscle cramps for several weeks. Rationale: The nurse should instruct the client to report muscle cramps to the provider, as it may be an indication of decreased magnesium levels. D. Report diarrhea to the provider. Rationale: Omeprazole is associated with an increased risk of C. difficile infection. The nurse should instruct the client to contact the provider if diarrhea occurs. 233.A nurse is providing teaching to a female client who has type 2 diabetes and a new prescription for pioglitazone. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A. Expect urine to be darkened. B. Monitor weight daily. C. Increase calcium intake. D. Use oral contraceptives to avoid pregnancy. E. Take tablets whole. Rationale: <b>Expect urine to be darkened is incorrect.</b> Darkened urine may be an indication of hepatotoxicity and should be reported to the provider.</br></br><b>Monitor weight daily is correct.</b> Pioglitazone may lead to fluid retention and worsen heart failure. Clients should monitor weight and report any rapid gains to the provider.</br></br><b>Increase calcium intake is correct.</b> Pioglitazone increases the risk of fractures in women. Clients should be advised to exercise and ensure adequate intake of vitamin D and calcium to protect bone health.</br></br><b>Use oral contraceptives to avoid pregnancy is incorrect.</b> Pioglitazone decreases the effect of oral contraceptives and can cause ovulation in premenopausal women. Clients should be advised to use another form of contraception to avoid pregnancy.</br></br><b>Take tablets whole is incorrect.</b> Pioglitazone may be crushed and mixed with food for ease of swallowing. 234.A nurse is preparing to administer cephalexin oral suspension to an older adult client who has difficulty swallowing pills. Which of the following actions should the nurse take? A. Check the client for a penicillin allergy. Rationale: The nurse should check the client for a penicillin allergy because cephalexin is a beta-lactam antibiotic that is similar in actions and structure to penicillin. B. Monitor the client for constipation. Rationale: The nurse should monitor the client for diarrhea, not constipation, because cephalexin can cause pseudomembranous colitis. C. Store the medication at room temperature. Rationale: The nurse should plan to store the cephalexin oral suspension in the refrigerator and administer it cold to the client to maintain the potency of the medication. D. Avoid shaking the medication before administering. Rationale: The nurse should shake cephalexin oral suspension before administration to mix any ingredients that may have separated. 235.A nurse is monitoring a client who took an overdose of acetaminophen 72 hr ago. The nurse should identify which of the following findings as a manifestation of acetaminophen poisoning? A. Constipation Rationale: Diarrhea, not constipation, is an early manifestation of acetaminophen poisoning. B. Xerostomia Rationale: Xerostomia, or dry mouth, is not an expected manifestation for a client who has acetaminophen poisoning. C. Tinnitus Rationale: Tinnitus is an expected manifestation for a client who is taking NSAIDs, not for a client who has acetaminophen poisoning. D. Vomiting Rationale: The nurse should expect a client who has acetaminophen poisoning to have early manifestations of nausea, vomiting, abdominal distress, diarrhea, and sweating. 236.A nurse is providing teaching to a client who has a new prescription for hydroxychloroquine to treat mild manifestations of rheumatoid arthritis. Which of the following information should the nurse include in the teaching? A. This medication should be taken between meals. Rationale: The nurse should instruct the client to take the hydroxychloroquine with food or milk. B. This medication can turn skin an orange color. Rationale: The nurse should instruct the client that hydroxychloroquine can cause a blue-black discoloration of the skin and may turn urine a rust or brown color. C. Wear sunglasses when out in bright sunshine. Rationale: The nurse should instruct the client to wear sunglasses to decrease photophobia when taking hydroxychloroquine. Clients should have an ophthalmologic examination before treatment because the medication can cause retinopathy. D. Avoid crushing the medication. Rationale: The nurse should instruct the client that hydroxychloroquine can be crushed and mixed with food or fluids. 237.A nurse is teaching about necessary baseline examinations with a female client who is to start taking atorvastatin. Which of the following baseline examinations should the nurse include in the teaching? A. Liver function tests Rationale: The nurse should inform the client that statins such as atorvastatin can cause liver damage and should not be taken by clients who have a history of liver disease. The client should undergo baseline liver function testing before beginning therapy, and every 6 to 12 months thereafter. B. Hearing test Rationale: Atorvastatin does not affect the hearing. Therefore, the nurse should not recommend a baseline examination of the client’s hearing before starting this medication. C. Papanicolaou test Rationale: Papanicolaou test is not a necessary baseline examination for this medication. Atorvastatin is not known to affect the female reproductive system. However, it can cause impotence in male clients. D. Dental examination Rationale: A dental examination is not a necessary baseline examination for this medication. Atorvastatin is not known to affect the teeth and gums. 238.A nurse is caring for a client who has a prescription for digoxin 0.25 mg PO daily. The amount available is digoxin 0.125 mg tab. The client's current vital signs are: blood pressure 144/96, heart rate 54/min, respirations 18/min, and temperature 98.6&deg F. Which of the following actions should the nurse take? A. Administer digoxin 0.125 mg. Rationale: The nurse should not administer a reduced dose of digoxin, as the client's heart rate is less than 60/min, or administer a different dose without a written prescription from the provider. B. Administer digoxin 0.25 mg. Rationale: The nurse should not administer the prescribed dose of digoxin as the client's heart rate is less than 60/min. C. Withold the digoxin dose for elevated blood pressure. Rationale: The nurse should withhold the prescribed dose of digoxin as the client's heart rate is less than 60/min. D. Withhold the digoxin dose for decreased pulse rate. Rationale: The nurse should withhold the prescribed dose of digoxin as the heart rate is less than 60/min, and notify the provider. 239.A nurse is preparing to administer midazolam 0.2 mg/kg via IV bolus now. The client weighs 220 lb. How many mg should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) 20 mg Correct Rationale: Step 1: What is the unit of measurement the nurse should calculate? kg <br/>Step 2: Set up an equation and solve for X. <br/>2.2 lb/1 kg = Client's weight in lb/ X kg <br/>2.2 lb/1 kg - 220 lb/X kg <br/>X = 100 <br/>Step 3: Round if necessary. <br/>Step 4: Reassess to determine whether the conversion to kg makes sense. . If 1 kg = 2.2 lb, it makes sense that 220 lb = 100 kg. </br>Step 5: What is the unit of measurement the nurse should calculate? mg <br/>Step 6: Set up an equation and solve for X. <br/>mg x kg /day = X <br/>0.2 mg X 100 kg = 20 mg <br/>Step 7: Round if necessary. <br/>Step 8: Reassess to determine whether the amount makes sense. If the prescription reads 0.2mg/kg/now and the client weighs 100 kg, it makes sense to give midazolam 20 mg IV bolus now. InCorrect Rationale: Step 1: What is the unit of measurement the nurse should calculate? kg <br/>Step 2: Set up an equation and solve for X. <br/>2.2 lb/1 kg = Client's weight in lb/ X kg <br/>2.2 lb/1 kg - 220 lb/X kg <br/>X = 100 <br/>Step 3: Round if necessary. <br/>Step 4: Reassess to determine whether the conversion to kg makes sense. . If 1 kg = 2.2 lb, it makes sense that 220 lb = 100 kg. </br>Step 5: What is the unit of measurement the nurse should calculate? mg <br/>Step 6: Set up an equation and solve for X. <br/>mg x kg /day = X <br/>0.2 mg X 100 kg = 20 mg <br/>Step 7: Round if necessary. <br/>Step 8: Reassess to determine whether the amount makes sense. If the prescription reads 0.2mg/kg/now and the client weighs 100 kg, it makes sense to give midazolam 20 mg IV bolus now. 240.A nurse is providing teaching to a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following information should the nurse provide? A. Expect to have a fever for the first days of therapy. Rationale: Methotrexate causes bone marrow suppression and increases the risk for infection. A fever is not an expected effect and should be reported to the provider. B. Drink 2 to 3 L of water per day while on the medication. Rationale: Methotrexate can cause renal toxicity. Adequate hydration promotes its excretion and helps prevent this adverse effect. C. Administer the medication with an NSAID to enhance effectiveness. Rationale: NSAIDs may increase methotrexate toxicity. The client should be instructed to avoid NSAIDs while on the medication. D. Take the medication in the morning to prevent insomnia. Rationale: Insomnia is not an adverse effect of methotrexate. Malaise and fatigue are adverse effects. 241.A nurse is preparing to administer vancomycin 500 mL in 100 mL of dextrose 5% in water (D5W) to infuse over 1 hr. The drop factor of the manual IV tubing is 15 gtt/ml. The nurse should adjust the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) 25 gtt/min Correct Rationale: <b>Ratio and Proportion and Desired Over Have</b><br>STEP 1: What is the unit of measurement the nurse should calculate? gtt/min <br/>STEP 2: What is the volume the nurse should infuse? 100 mL<br/>STEP 3: What is the total infusion time? 1 hr <br/>STEP 4: Should the nurse convert the units of measurement? Yes (hr are not equal to min) <br/>1 hr/ 60 min = 1 hr/X min</br>X = 60 min <br/>STEP 5: What is the quantity of the drop factor available? 15 gtt/mL <br/> STEP 6: Set up an equation and solve for X. <br/>Volume (mL)/Time (min) x drop factor (gtt/mL) = X<br/>100 mL/60 min x 15 gtt/mL = X <br/>X = 25 <br/>STEP 7: Round if necessary. <br/> STEP 8: Reassess to determine whether the amount to administer makes sense. If the prescription reads D₅W 100 mL IV to infuse over 1 hr, it makes sense to administer 15 gtt/min. The nurse should set the manual IV infusion to deliver D₅W IV at 25 gtt/min. <br><br><b>Dimensional Analysis</b><br>STEP 1: What is the unit of measurement the nurse should calculate? gtt/min <br/>STEP 2: What is the quantity of the drop factor that is available? 15 gtt/min <br/>STEP 3: What is the total infusion time? 1 hr <br/>STEP 4: What is the volume the nurse should infuse? 100 mL<br/>STEP 5: Should the nurse convert the units of measurement? Yes (hr are not equal to min) <br/>1 hr/60 min = 1 hr/X min <br/> X = 60 min <br/>STEP 6: Set up an equation and solve for X. <br/>X = Quantity/1 mL x Volume (mL)/Time (min) <br/>X mL = 15 gtt/1 mL x 100 mL/1 hr <br/>X = 25 <br/>STEP 7: Round if necessary. <br/>STEP 8: Reassess to determine whether the amount to administer makes sense. If the prescription reads D₅W 100 mL IV to infuse over 1 hr, it makes sense to administer 25 gtt/min. The nurse should set the manual IV infusion to deliver D₅W IV at 25 gtt/min. InCorrect Rationale: <b>Ratio and Proportion and Desired Over Have</b><br>STEP 1: What is the unit of measurement the nurse should calculate? gtt/min <br/>STEP 2: What is the volume the nurse should infuse? 100 mL<br/>STEP 3: What is the total infusion time? 1 hr <br/>STEP 4: Should the nurse convert the units of measurement? Yes (hr are not equal to min) <br/>1 hr/ 60 min = 1 hr/X min</br>X = 60 min <br/>STEP 5: What is the quantity of the drop factor available? 15 gtt/mL <br/> STEP 6: Set up an equation and solve for X. <br/>Volume (mL)/Time (min) x drop factor (gtt/mL) = X<br/>100 mL/60 min x 15 gtt/mL = X <br/>X = 25 <br/>STEP 7: Round if necessary. <br/> STEP 8: Reassess to determine whether the amount to administer makes sense. If the prescription reads D₅W 100 mL IV to infuse over 1 hr, it makes sense to administer 15 gtt/min. The nurse should set the manual IV infusion to deliver D₅W IV at 25 gtt/min. <br><br><b>Dimensional Analysis</b><br>STEP 1: What is the unit of measurement the nurse should calculate? gtt/min <br/>STEP 2: What is the quantity of the drop factor that is available? 15 gtt/min <br/>STEP 3: What is the total infusion time? 1 hr <br/>STEP 4: What is the volume the nurse should infuse? 100 mL<br/>STEP 5: Should the nurse convert the units of measurement? Yes (hr are not equal to min) <br/>1 hr/60 min = 1 hr/X min <br/> X = 60 min <br/>STEP 6: Set up an equation and solve for X. <br/>X = Quantity/1 mL x Volume (mL)/Time (min) <br/>X mL = 15 gtt/1 mL x 100 mL/1 hr <br/>X = 25 <br/>STEP 7: Round if necessary. <br/>STEP 8: Reassess to determine whether the amount to administer makes sense. If the prescription reads D₅W 100 mL IV to infuse over 1 hr, it makes sense to administer 25 gtt/min. The nurse should set the manual IV infusion to deliver D₅W IV at 25 gtt/min. 242.A nurse is preparing to administer dexamethasone 8 mg IM divided into 4 equal doses QID. The amount available is dexamethasone 4 mg/mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.) 0.5 mL Correct Rationale: <b>Ratio and Proportion</b><br>STEP 1: What is the unit of measurement the nurse should calculate? mL <br/>STEP 2: What is the dose the nurse should administer? Dose to administer = Desired 8 mg <br/>STEP 3: What is the dose available? Dose available = Have 4 mg <br/>STEP 4: Should the nurse convert the units of measurement? No <br/>STEP 5: What is the quantity of the dose available? 1 mL <br/>STEP 6: Set up an equation and solve for X. <br/>Have/Quantity = Desired/X <br/>4 mg/1 mL = 8 mg/X mL <br/>X = 0.5 (2, divided into 4 equal doses) <br/>STEP 7: Round if necessary. <br/> STEP 8:Reassess to determine whether the amount to administer makes sense. If there are 4mg/mL and the prescription reads 8 mg daily divided into 4 equal doses QID, it makes sense to administer 0.5 mL. The nurse should administer dexamethasone 0.5 mL IM.<br/><br><b>Desired Over Have</b><br>STEP 1: What is the unit of measurement the nurse should calculate? mL <br/>STEP 2: What is the dose the nurse should administer? Dose to administer = Desired 8 mg <br/>STEP 3: What is the dose available? Dose available = Have 4 mg <br/>STEP 4: Should the nurse convert the units of measurement? No <br/>STEP 5: What is the quantity of the dose available? 1 mL <br/>STEP 6: Set up an equation and solve for X. <br/>Desired x Quantity/Have = X <br/>8 mg x 1 mL/4 mg <br/>0.5 (2, divided into 4 equal doses) = X <br/>STEP 7: Round if necessary. <br/>STEP 8: Reassess to determine whether the amount to administer makes sense. If there are 4mg/mL and the prescription reads 8 mg daily divided into 4 equal doses QID, it makes sense to administer 0.5 mL. The nurse should administer dexamethasone 0.5 mL IM.</br> <br><b>Dimensional Analysis</b><br>STEP 1: What is the unit of measurement the nurse should calculate? mL <br/>STEP 2: What is the quantity of the dose available? 1 mL <br/>STEP 3: What is the dose available? Dose available = Have 4 mg <br/>STEP 4: What is the dose the nurse should administer? Dose to administer = Desired 8 mg<br/>STEP 5: Should the nurse convert the units of measurement? No <br/>STEP 6: Set up an equation and solve for X. <br/>X = Quantity/Have x Conversion (Have)/Conversion(Desired) x Desired <br/>X mL = 1 mL/4 mg x 8 mg <br/>X = 0.5 (2, divided into 4 equal doses) <br/>STEP 7: Round if necessary. <br/>STEP 8: Reassess to determine whether the amount to administer makes sense. If there are 4mg/mL and the prescription reads 8 mg daily divided into 4 equal doses QID, it makes sense to administer 0.5 mL. The nurse should administer dexamethasone 0.5 mL IM. InCorrect Rationale: <b>Ratio and Proportion</b><br>STEP 1: What is the unit of measurement the nurse should calculate? mL <br/>STEP 2: What is the dose the nurse should administer? Dose to administer = Desired 8 mg <br/>STEP 3: What is the dose available? Dose available = Have 4 mg <br/>STEP 4: Should the nurse convert the units of measurement? No <br/>STEP 5: What is the quantity of the dose available? 1 mL <br/>STEP 6: Set up an equation and solve for X. <br/>Have/Quantity = Desired/X <br/>4 mg/1 mL = 8 mg/X mL <br/>X = 0.5 (2, divided into 4 equal doses) <br/>STEP 7: Round if necessary. <br/> STEP 8:Reassess to determine whether the amount to administer makes sense. If there are 4mg/mL and the prescription reads 8 mg daily divided into 4 equal doses QID, it makes sense to administer 0.5 mL. The nurse should administer dexamethasone 0.5 mL IM.<br/><br><b>Desired Over Have</b><br>STEP 1: What is the unit of measurement the nurse should calculate? mL <br/>STEP 2: What is the dose the nurse should administer? Dose to administer = Desired 8 mg <br/>STEP 3: What is the dose available? Dose available = Have 4 mg <br/>STEP 4: Should the nurse convert the units of measurement? No <br/>STEP 5: What is the quantity of the dose available? 1 mL <br/>STEP 6: Set up an equation and solve for X. <br/>Desired x Quantity/Have = X <br/>8 mg x 1 mL/4 mg <br/>0.5 (2, divided into 4 equal doses) = X <br/>STEP 7: Round if necessary. <br/>STEP 8: Reassess to determine whether the amount to administer makes sense. ense. If there are 4mg/mL and the prescription reads 8 mg daily divided into 4 equal doses QID, it makes sense to administer 0.5 mL. The nurse should administer dexamethasone 0.5 mL IM.</br> <br><b>Dimensional Analysis</b><br>STEP 1: What is the unit of measurement the nurse should calculate? mL <br/>STEP 2: What is the quantity of the dose available? 1 mL <br/>STEP 3: What is the dose available? Dose available = Have 4 mg <br/>STEP 4: What is the dose the nurse should administer? Dose to administer = Desired 8 mg<br/>STEP 5: Should the nurse convert the units of measurement? No <br/>STEP 6: Set up an equation and solve for X. <br/>X = Quantity/Have x Conversion (Have)/Conversion(Desired) x Desired <br/>X mL = 1 mL/4 mg x 8 mg <br/>X = 0.5 (2, divided into 4 equal doses) <br/>STEP 7: Round if necessary. <br/>STEP 8: Reassess to determine whether the amount to administer makes sense. If there are 4mg/mL and the prescription reads 8 mg daily divided into 4 equal doses QID, it makes sense to administer 0.5 mL. The nurse should administer dexamethasone 0.5 mL IM. 243.A nurse is preparing a presentation about echinacea to a group of clients. Which of the following information should the nurse include in the teaching? A. “Echinacea blocks testosterone receptors.” Rationale: Saw palmetto may help blocks testosterone receptors. B. “Echinacea boosts the immune system.” Rationale: The nurse should include in the teaching that echinacea may help boost the immune system. C. “Echinacea is used to treat vertigo.” Rationale: Ginger root is used to treat vertigo associated with motion sickness, morning sickness, seasickness and general anesthesia. D. “Echinacea increases the ability to walk further distances for clients who have PAD.” Rationale: Ginkgo biloba can increase the client’s ability to walk further distances by decreasing pain in the lower extremities. 244.A nurse is preparing a presentation about glucosamine to a group of clients. Which of the following information should the nurse include in the teaching? A. "Glucosamine can help relieve urinary frequency." Rationale: Saw palmetto may help relieve urinary frequency by anti-inflammatory effects. B. "Glucosamine is used to treat viral infections.” Rationale: Echinacea is used orally to treat viral infections, such as influenza. C. "Glucosamine can help relieve hot flashes." Rationale: Black cohosh may relieve menopausal symptoms, such as hot flashes, by suppressing the release of luteinizing hormone. D. "Glucosamine can suppress joint inflammation." Rationale: The nurse should include in the teaching that glucosamine suppresses joint inflammation and cartilage degradation by stimulating the activity of chondrocytes. 245.A nurse is preparing a presentation about black cohosh to a group of clients. Which of the following information should the nurse include in the teaching? A. "Black cohosh helps relieve nocturia." Rationale: Saw palmetto may help relieve urinary and prostate symptoms, such as nocturia, by suppressing inflammation. B. "Black cohosh is used to treat the common cold." Rationale: Echinacea may help boost the immune system and thus prevent or treat the common cold. C. "Black cohosh is used to alleviate menopausal symptoms." Rationale: Black cohosh may relieve menopausal symptoms, such as hot flashes, by suppressing the release of luteinizing hormone. D. "Black cohosh can help to reduce arthritis pain." Rationale: Capsicum is derived from red peppers and is an ingredient in topical preparations that treat arthritis pain. Capsicum may reduce the pain of inflammation by interfering with substance P, which transmits pain impulses. 246.A nurse is preparing a presentation about glucosamine to a group of clients. Which of the following information should the nurse include in the teaching? A. “Glucosamine may help to increase joint functionality.” Rationale: The nurse should include in the teaching that glucosamine may increase joint functionality by decreasing destruction of cartilage. B. “Glucosamine can be used in the treatment of herpes simplex infections.” Rationale: Echinacea may help treat herpes simplex infection by acting as an antiviral supplement. C. “Glucosamine can improve age-related memory impairment.” Rationale: Although evidence is inconclusive, ginkgo biloba may improve age-related memory impairment and senile dementia. D. “Glucosamine is derived from red peppers.” Rationale: Capsicum is derived from red peppers and the ingredient is found in topical preparations that treat arthritis pain. Capsicum may reduce the pain of inflammation by interfering with substance P, which transmits pain impulses. 247.A nurse manager is providing an educational program on antibiotic sensitivity to bacterial infections. The nurse should include in the teaching that vancomycin is indicated for which of the following infections? A. Pseudomonas aeruginosa Rationale: The nurse should teach that vancomycin is not sensitive to the infection pseudomonas aeruginosa. B. Klebsiella Rationale: The nurse should teach that vancomycin is not sensitive to the infection klebsiella. C. Candida Rationale: The nurse should teach that vancomycin is not sensitive to the infection candida. D. Methicillin-resistant Staphylococcus aureus Rationale: The nurse should teach that vancomycin is sensitive to the infection methicillin-resistant Staphylococcus aureus and Clostridium difficile infections, and should be the antibiotic of choice to treat this organism. 248.A charge nurse is teaching a group of nurses about the antagonist action of medications. The nurse should include in the teaching that which of the following antagonist medications is used for benzodiazepines? A. Flumazenil Rationale: The nurse should teach that flumazenil is an antagonist that reverses the effects of benzodiazepines by recognition site on the GABA/benzodiazepine receptor complex. B. Diphenhydramine Rationale: The nurse should teach that diphenhydramine hydrochloride is a H1-receptor antagonist, which blocks histamine that decreases allergic responses. C. Protamine Rationale: The nurse should teach that protamine is a heparin antagonist that binds with heparin and makes it ineffective. D. Naloxone Rationale: The nurse should teach that naloxone is an opiate antagonist that competes with opioids at opiate receptor sites making the opioid ineffective. 249.A nurse is reviewing the medication record for a client who has chronic kidney disease. Which of the following medications should the nurse identify as having the potential to cause nephrotoxicity? A. Omeprazole Rationale: Omeprazole, a proton pump inhibitor, does not cause nephrotoxicity. B. Vancomycin Rationale: The nurse should identify that vancomycin, an antibiotic, to be associated with nephrotoxic adverse effects. C. Ondansetron Rationale: Ondansetron, an antiemetic, does not cause nephrotoxicity. D. Diphenhydramine Rationale: Diphenhydramine, an antihistamine, does not cause nephrotoxicity. 250.A nurse is assessing a client who has heart failure and is prescribed furosemide. Which of the following findings is an adverse effect of this medication? A. Weight gain Rationale: Weight gain is not an adverse effect of furosemide. Weight loss can occur with fluid loss; a therapeutic effect of furosemide. B. Increased blood pressure Rationale: Hypotension is an adverse effect of furosemide. C. Hypoglycemia Rationale: Hyperglycemia is an adverse effect of furosemide. D. Leg cramps Rationale: Leg cramps is a manifestation of hypokalemia, an adverse effect of furosemide. The nurse should assess the client for hypokalemia and monitor the client’s potassium level. [Show More]

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