NCLEX PHARMACOLOGY 350 ACTUAL EXAM QUESTIONS AND ANSWERS GRADED A+ 2023/2024, Exams of Nursing

Download NCLEX PHARMACOLOGY 350 ACTUAL EXAM QUESTIONS AND ANSWERS GRADED A+ 2023/2024 and more Exams Nursing in PDF only on Docsity! NCLEX PHARMACOLOGY 350 ACTUAL EXAM QUESTIONS AND ANSWERS GRADED A+ 2023/2024 One of the most common side effects of Enalapril (Vasotec) is: 1. Dry hacking cough. 2. Hypertension. 3. Constipation. 4. Irritability. - ANSWER- 1. Dry hacking cough. A cough is commonly associated with angiotensin-converting enzyme inhibitors, resulting from increased sensitivity of cough reflex. A student nurse questions the nurse about why the patient has 20mEq of Potassium Chloride (KCl) in his IV. The nurse explains the purpose and then refers the student to which laboratory tests? 1. Electrolytes. 2. Glucose. 3. Hemoglobin. 4. Arterial blood gases. - ANSWER- 1. Electrolytes. It measures potassium, among other things. A patient asks the nurse why he is receiving patches of Nitroglycerin instead of just taking it under the tongue when he needs it. The nurse explains that: 1. "Given in this manner, the medication is absorbed at a slow, steady rate." 2. "This manner is effective in acute situations." 3. "This manner allows for more accurate dosage." 4. "Patches administer a day's to a week's worth of medications." - ANSWER- 1. "Given in this manner, the medication is absorbed at a slow, steady rate." After application to the skin, the medication is absorbed at a slow, constant rate, allowing for the maintenance of a therapeutic level. A patient with cancer has been receiving high doses of Morphine for several days. During an assessment, the side effect that the nurse would be likely to see is: 1. Constipation. NCLEX PHARMACOLOGY 350 ACTUAL EXAM QUESTIONS AND ANSWERS GRADED A+ 2023/2024 One of the most common side effects of Enalapril (Vasotec) is: 1. Dry hacking cough. 2. Hypertension. 3. Constipation. 4. Irritability. - ANSWER- 1. Dry hacking cough. A cough is commonly associated with angiotensin-converting enzyme inhibitors, resulting from increased sensitivity of cough reflex. A student nurse questions the nurse about why the patient has 20mEq of Potassium Chloride (KCl) in his IV. The nurse explains the purpose and then refers the student to which laboratory tests? 1. Electrolytes. 2. Glucose. 3. Hemoglobin. 4. Arterial blood gases. - ANSWER- 1. Electrolytes. It measures potassium, among other things. A patient asks the nurse why he is receiving patches of Nitroglycerin instead of just taking it under the tongue when he needs it. The nurse explains that: 1. "Given in this manner, the medication is absorbed at a slow, steady rate." 2. "This manner is effective in acute situations." 3. "This manner allows for more accurate dosage." 4. "Patches administer a day's to a week's worth of medications." - ANSWER- 1. "Given in this manner, the medication is absorbed at a slow, steady rate." After application to the skin, the medication is absorbed at a slow, constant rate, allowing for the maintenance of a therapeutic level. A patient with cancer has been receiving high doses of Morphine for several days. During an assessment, the side effect that the nurse would be likely to see is: 1. Constipation. A nurse is assessing signs of alcohol withdrawal in one of her patients. These assessments would include: - ANSWER- - Tremors. - Anxiety. - Increased blood pressure. All of these are signs of alcohol withdraw. Along with tachycardia, diaphoresis, anorexia, nausea, vomiting, insomnia. hallucinations and seizures. Items that would be appropriate to teach a patient being treated with Warfarin (Coumadin): - ANSWER- - "It is important to avoid eating excessive amounts of broccoli." - "It is important to monitor for any signs of bleeding in urine and stool." - "The physician will regulate your medication according to your blood work." Broccoli contains large amounts of Vitamin K. Bleeding may occur if the dosage is not regulated properly. Dosage is managed by monitoring therapeutic levels. An 89 year old man is complaining of urinary retention during the medication history. Which assessment would be a priority to report to the physician? 1. Baclofen (Lioresal). 2. Diazepam (Valium). 3. Benstropine (Cogentin). 4. Cyclobenzaprine hydrochloride (Flexeril). - ANSWER- 3. Benstropine (Cogentin). This is a cholinergic-blocking agent. Urinary retention is an adverse effect. A patient is receiving Aminophylline. The nurse knows the medication acts to: 1. Dilate blood vessels, increasing capillary permeability. 2. Increase contraction of the bronchi and alveolar. 3. Decrease contraction of the smooth muscles of the bronchioles. 4. Decrease the amount of mucus secretion from the bronchi. - ANSWER- 2. Increase contraction of the bronchi and alveolar. When a nurse is giving dietary instructions appropriate to a person taking Ibandronate Sodium (Boniva), it would be especially important to include which of the following: 1. "Maintain adequate intake of Calcium and Vitamin D." 2. "Increase fiber, whole grains, and rhubarb." 3. "Increase intake of Vitamin C" 4. "Maintain appropriate calories to avoid gaining weight." - ANSWER- 1. "Maintain adequate intake of Calcium and Vitamin D." Patients being treated with Boniva require calcium supplements to maintain blood levels. The nurse in a physicians office interviews a patient being treated for asthma. The patient is jittery and complains of nausea. A statement that might indicate a cause for the jitteriness would be: 1. "I have been taking Diazepam (Valium) for my nerves." 2. "I am overdue to have a Theophylline level drawn." 3. "I am taking Cimetidine (Tagamet) for my epigastric pain." 4. "I take a laxative when I am constipated." - ANSWER- 2. "I am overdue to have a Theophylline level drawn." Theophylline can cause these effects; a level is necessary to determine if the medication is in the therapeutic range. Indicate in which order of priority the nurse should administer the medications to these patients: 1. A cardiac patient receiving a daily dose of Digoxin (Lanolin). 2. An asthmatic patient receiving a daily dose of Montelukast (Singulair). 3. A patient receiving an antibiotic four times per day for a wound infection. 4. A patient with diabetes receiving a daily dose of insulin. - ANSWER- 4. A patient with diabetes receiving a daily dose of insulin. 3. A patient receiving an antibiotic four times per day for a wound infection. 2. An asthmatic patient receiving a daily dose of Montelukast (Singulair). 1. A cardiac patient receiving a daily dose of Digoxin (Lanolin). During an admission interview, the nurse learns that a patient has been taking Dipyridamole (Persantine) for several months. This assessment is an indication for: 1. Assessing respirations after activity. 2. Monitoring blood pressure sitting, standing, and lying. 3. Assessing temperature every 4 hours. A clinic nurse is concerned when a patient diagnosed with active Tuberculosis (TB) returns to the clinic after two weeks of treatment and reports a worsening cough and recurring night sweats. These findings most likely indicate: 1. Noncompliance with medication regimen. 2. Additional exposure to infected individuals. 3. The need for additional medication. 4. The need for follow-up care for family members. - ANSWER- 1. Noncompliance with medication regimen. TB medications must be taken over an extended period (6 months to 2 years) to ensure effective treatment. (50) A patient is taking Gantrisin. Which statement would indicate that the patient understands the purpose of this medication? 1. "I have had urinary frequency and burning for the last two days." 2. "I am allergic to penicillin." 3. "I have had a runny nose for 3 days." 4. "I have loose, four-smelling diarrhea." - ANSWER- 1. "I have had urinary frequency and burning for the last two days." Most common antibiotic to treat UTI's. The nurse knows that an 80-year-old patient taking medication would be prone to: 1. Developing a tolerance to medication. 2. Metabolizing medications more rapidly. 3. Developing more frequent adverse reactions. 4. Experiencing more cumulative effects - ANSWER- 4. Experiencing more cumulative effects. Elderly persons metabolize drugs more slowly because of declining body function, thus prolonging the half life of the drug, resulting in drug accumulation. A patient is being treated with Pyridostigmine (Mestinon) for Myasthenia Gravis. How would the nurse evaluate the therapeutic effectiveness of this medication? 1. Decreased arrhythmias. 2. Decrease nausea and vomiting. 3. Increased perspiration. 4. Increased muscle strength. - ANSWER- 4. Increased muscle strength. Increased muscle strength would indicate an improvement in the symptoms. A nurse is administering Amoxycillin PO to a three year old child diagnosed with an ear infection. The most appropriate approach with the child would be to: 1. Give a detail explanation to the child about why he needs this medicine. 2. Explain that it is time to take your "pink medicine." 3. Have the parent hold the client in his or her arms, and inject it quickly into the child's mouth. 4. Administer the medication in 240 mL of apple juice. - ANSWER- 2. Explain that it is time to take your "pink medicine." Explanations should be geared to the child's ability to understand. Atropine, 1/150 grain, is ordered as a preoperative medication. On hand 0.4 mg/ML. The appropriate amount of fluid to be administered is: - ANSWER- 1 mL 0.4mg = 1/150 grain A nurse is assigned to administer morning medications to four patients. Place the patient in order of priority from highest to lowest for those medications. 1. Ascirbic Acid (Vitamin C), Os-Cal, Furosemide (Lasix). 2. Metformin, Digoxin (Lanoxin). 3. Escitalopram (Lexapro), Multivitamin, Ascorbic Acid. 4. Metoprolol, Multivitamins, Aspirin. - ANSWER- 2. Metformin, Digoxin (Lanoxin). 1. Ascirbic Acid (Vitamin C), Os-Cal, Furosemide (Lasix). 4. Metoprolol, Multivitamins, Aspirin. 3. Escitalopram (Lexapro), Multivitamin, Ascorbic Acid. Metformin is an oral hypoglycemic agent that should be given before breakfast. Lasix should be given before breakfast. The remaining medications are not time sensitive. The nurse will administer thyroid drugs: 1. In a single dose, usually before breakfast. 2. Blood urea nitrogen and creatinine. 3. Hemoglobin and hematocrit. 4. White blood cell count. - ANSWER- 3. Hemoglobin and hematocrit. Epogan is indicated for treating low hemoglobin and hematocrit in anemia. While taking a medication history on a pre-operative patient, the nurse is concerned when she discovers that the patient is being treated with Acetazolamide (Diamox) for narrow angle glaucoma. She knows that this is important to communicate to the physician because the patient should not receive which medication? 1. Meperidine (Demerol). 2. Atropine Sulfate (Isopto Atropine). 3. Pentazocine (Talwin). 4. Naloxone hydrochloride (Narcan). - ANSWER- 2. Atropine Sulfate (Isopto Atropine). This is a cholinergic-blocking agent that increases pupil dilation. A patient is admitted for the treatment of gastroesophageal reflux disease. His treatment has not responded to first-line medications, so the physician is planning to place him on regimen of Metoclopramide (Regalan) for a short period. The nurse should instruct the patient on all items except: 1. Advise the patient to avoid alcohol and other central nervous system (CNS) depressants. 2. Monitor carefully for signs of hyperglycemia because the food is more efficiently absorbed into the bloodstream. 3. Avoid tasks that require concentration. 4. Administer the oral dose 30 minutes before meals and at bedtime. - ANSWER- 2. Monitor carefully for signs of hyperglycemia because the food is more efficiently absorbed into the bloodstream. Reglan is more likely to cause hypoglycemia because the food moves more rapidly through the GI tract. Protease inhibitors should be taken: 1. With meals to improve absorption. 2. 1 hour before or 2 hours after meals. 3. With only a small sip of water. 4. With the scheduled vitamins. - ANSWER- 2. 1 hour before or 2 hours after meals. These medications are better absorbed on an empty stomach. Zidovudine (Retrovir) is commonly prescribed for patients with HIV. The nurse knows that the ideal time for beginning treatment is: 1. When symptoms of immune deficiency first begin to appear. 2. After other antiviral medicines have been tried. 3. Before symptoms of immunodeficiency appear. 4. At the end stage of the disease. - ANSWER- 3. Before symptoms of immunodeficiency appear. The aim of this therapy is to reduce the viral load as much as possible. A student nurse is worried that a patient with a terminal illness is receiving too high a dose of Morphine in her continuous morphine drip. The oncology nurse explains that: - ANSWER- 3. "Patients with cancer pain can be administered gradually increasing doses without side effects of respiratory depression and sedation." Patient's develop a tolerance to all side effects except constipation. A postoperative patient is reluctant to take pain medication, even though he is rating his pain as an 8 on a scale of 1 to 10. The nurse assessed the patients feelings and concludes that he has a fear of addiction. She explains to him that: - ANSWER- 3. Addiction is minimal in hospitalized patients. The nurse in an outpatient clinic is concerned because a patient comes to the clinic complaining of heartburn that she has been experiencing for the last 2 weeks. She has been experiencing for the last 2 weeks. She has been self-medicating with Sodium Bicarbonate. The nurse anticipates that the physician will order which blood test? - ANSWER- 3. Electrolytes. Older patients on long term use of alkalizing agents are especially susceptible to electrolyte disorders. A patient asks the nurse why his Aluminum Hydroxide (Amphojel) is always given 1 hour before meals. the nurse replies: - ANSWER- 2. "An empty stomach allows the medication to decrease hydrochloric acid secretions more effectively." Is has a protective effect and is better able to work if it can come into contact with the lining of the stomach. 1. At bedtime. 2. Before dinnertime. 3. After meals. 4. In the early morning. - ANSWER- 3. After meals. This time would minimize impact on nutrition and growth and development. A postpartum patient complains of dysuria. the physician prescribes which of these medications to ease symptoms? 1. Phenazopyridine (Pyridium). 2. Furosemide (Lasix). 3. Loperamide (Imodium). 4. Sulfisoxazole (Gantrisin). - ANSWER- 1. Phenazopyridine (Pyridium). It is urinary tract analgesic that is prescribed for these symptoms. An adverse side effect of Oxybutynin (Ditropan) that needs to be reported immediately is: 1. Jaundice. 2. Restlessness. 3. Bradycardia. 4. Fatigue. - ANSWER- 1. Jaundice. This may indicate liver damage. A patient is being discharged taking Biphosphonates Alendronate (Fosamax). Which instructions are not appropriate? 1. "Drinking 3000 to 4000 ml of fluid will help your kidneys excrete the medication." 2. "Increasing your intake of dairy products will help this medication to work better." 3. "Remember to take your other vitamins at least 30 minutes after this pill." 4. "Laboratory work needs to be scheduled to make sure this medication is working." - ANSWER- 2. "Increasing your intake of dairy products will help this medication to work better." Patients should limit intake of dairy products because of their high calcium content. (111) which is a sign of salicylate toxicity? - ANSWER- (1) tinnitus (2) Headache (3) Dizziness (4) Irritability A patient is receiving Bisphosphonates-Alendronate (Fosomax). The proper time to schedule this medication is: 1. With meals. 2. With other medications early in the day. 3. 30 minutes before other medications. 4. 30 minutes before uncomfortable procedures. - ANSWER- 3. 30 minutes before other medications. This medication is more effective if taken by itself. Which dietary pattern would be contraindicated for the administration of Enoxaparin (Lovenox)? 1. Hyperalimentation. 2. A kosher diet. 3. A vegitarian diet. 4. A low sodium diet. - ANSWER- 2. A kosher diet. This product is partially made from pork. Identify all of the instruction that are necessary for a patient starting antibiotic therapy: - ANSWER- - The doctor will prescribe medicine based on the results of the culture and sensitivity. - Always monitor renal and liver functions for any long term use. - Monitor for signs of superinfection. A patient with Type 2 Diabetes is hospitalized for surgery. He has been maintaining glycemic control using an oral hypoglycemic agent. He is concerned that his blood sugar has been elevated and that he has been needing to receive insulin. The best response for the nurse at this time would be: The effects of these medications is enhanced because it interferes with the body's metabolism of the medication. A patient is experiencing seizures. the physician has prescribed the anticonvulsant Carbamazepine (Tegretol). the nurse understands that this drug can be used to treat all except: 1. The treatment of trigeminal nerve pain. 2. Grand mal seizures. 3. Petit mal seizures. 4. Pain caused by neuritis. - ANSWER- 3. Petit mal seizures. A postoperative patient is refusing any medication for pain. Which intervention would be a priority for the nurse? 1. Assess the severity of the patients pain on a scale of 1 to 10. 2. Praise the patient for his tolerance of pain. 3. Try nuring measures (e.g. repositioning, back rub). 4. Determine what information the patient understands concerning his medications. - ANSWER- 4. Determine what information the patient understands concerning his medications. A patient enters a clinic. The student nurse is assigned to assist the nurse with a physical assessment and history taking. The patient complains of decreased energy levels, inability to concentrate, and increased sensitivity to cold. The student nurse might expect to see which physical signs? - ANSWER- - Puffy hands and feet. - Dry or leathery skin. These symptoms are commonly associated with hypothyroidism. Thyroid hormones promote metabolism, growth, and development are complete. After the physician has made a diagnosis of hypothyroidism in the previous scenario, the student nurse asks the physician about the patients prognosis. the physicians response would be: 1. After surgery, she has 50% chance of recovery. 2. With surgery and radiation treatment, the prognosis is good. 3. With the administration of thyroid hormones, the prognosis is good. 4. Methimazole (Tapazole) inhibits synthesis of the thyroid hormones. - ANSWER- 3. With the administration of thyroid hormones, the prognosis is good. It is generally successful because unlike with children, growth and development are complete. A patient is halfway through a 10 day course of Bactrim (Co-trimoxazole). She is complaining of itching on her extremities. Which questions should be included in the assessment interview? - ANSWER- - What other medications have you taken in the week? - Are there any other symptoms that you have noticed recently? - Have you obtained relief from this medication? There are many medications that interfere with sulfa drugs. Ask if there is additional symptoms or any relief. A patient is 7 days postoperative after abdominal surgery. he arrives in the ER with a temperature of 104. Place the following physicians orders in priority of action from highest to lowest priority. 1. Administer antipyretic. 2. Obtain blood work for culture and sensitivity. 3. Administer intravenous antibiotic. 4. Perform irrigation and dressing change. 5. Perform cool sponge baths. - ANSWER- 1. Administer antipyretic. 2. Obtain blood work for culture and sensitivity. 3. Administer intravenous antibiotic. 4. Perform irrigation and dressing change. 5. Perform cool sponge baths. A 76 year old woman is being started on the medication Zoledronic Acid (Reclast, Zometa) for the treatment of osteoperosis. A teaching plan for this patient should include: - ANSWER- - The medication should be taken with a full glass of water. - Dental work should be postponed for at least four months after discontinuation of the medication. An empty stomach promotes quicker absorption and decreases GI upsets. Osteomyelitis is a common adverse effect. A patient is diagnosed with a tumor of the parathyroid glands. The nurse asks the reason why the physician has prescribed teriparatide (Forteo). the physician responds: B6) depletion causes neurotoxic effects. Vitamin B6 supplementation of 10-50 mg usually accompanies isoniazid use. Aged cheeses and smoked fish are high in tyramine which may cause palpitations, flushing, and blood pressure elevation while taking isoniazid. Avoid these foods during treatment. Isoniazid should be taken on an empty stomach, one hour before or two hours after food. Some clients experience orthostatic hypotension while taking isoniazid, so caution against rapid positional changes. 4. Incorrect: Histamine containing foods such as tuna and yeast extracts may cause exaggerated drug response (H/A, hypotension, palpitations sweating, itching, flushing, diarrhea).) A client diagnosed with new onset atrial fibrillation has been prescribed dabigatran. What should the nurse teach this client? Select all that apply 1. Place medication in a weekly pill organizer so that medication is not forgotten. 2. Do not take with clopidogrel. 3. Dabigatran decreases the risk of stroke associated with atrial fibrillation. 4. Take this medication with food. 5. aPTT and INR levels will be drawn monthly. - ANSWER- 2. Do not take with clopidogrel. 3. Dabigatran decreases the risk of stroke associated with atrial fibrillation. 4. Take this medication with food. (2., 3., & 4. Correct: Do not take dabigatran with any other anticoagulants, including clopidogrel due to increased bleeding risk. Dabigatran decreases the risk of stroke and systemic embolism in clients with atrial fibrillation that is not associated with a cardiac valve problem. Take this medication with food to decrease gastric side effects such as dyspepsia and gastritis. Proton pump inhibitors and histamine 2 recepter blockers may also decrease gastric side effects. 1. Incorrect: After container is opened, medication should be used within 30 days. It is sensitive to moisture and should not be stored in weekly pill organizers. To maintain efficacy, keep medication in manufacturer- supplied bottle. 5. Incorrect: This medication does not require monitoring of INR levels. However, the client should be informed about the risk of bleeding and to monitor for signs of bleeding.) A client has a prescription for nitroglycerin gr 1/400 SL prn for angina pain. How many tablets should the nurse give the client? Use numbers and decimals only. Nitroglycerin tablets, USP Rx Only 0.3 mg (1/200 gr) 100 Sublingual Tablets Ans:______ - ANSWER- 0.5 (Rationale: (0.0025 gr ÷ 1) × (0.3 mg ÷ 0.005 gr) × (1 tab ÷ 0.3 mg) = (0.00075 ÷ 0.0015) = 0.5 tab Ans: 0.5 tab) A client has been started on intravenous gentamicin for osteomyelitis. The nurse informs the client frequent blood work will be done to monitor the amount of medication in the body. The nurse knows what labs are a priority to check every three days for the client? 1. BUN and creatinine. 2. Liver function studies. 3. Hemoglobin and hematocrit. 4. Peak and trough levels. - ANSWER- 4. Peak and trough levels. (4. Correct: Peak and trough levels help to determine the amount of medication in the body system at specific times. Gentamicin is a very potent antibiotic; therefore, it is crucial to keep track of blood levels of this medication. Too low a level of this drug would be ineffective against the bacteria while too high a level increases the potential for severe side effects or toxicity from this antibiotic. 1. Incorrect: Because aminoglycosides such as gentamicin can lead to nephrotoxicity, checking BUN and creatinine levels periodically is important. However, it would not be necessary to check those values every three days. The nurse is reinforcing the dietary discharge instruction for a client prescribed warfarin. Which food choices should be avoided on the warfarin dietary instruction plan? Select all that apply 1. Corn 2. Carrot 3. Spinach 4. Broccoli 5. Watermelon - ANSWER- 3. Spinach 4. Broccoli (3. & 4. Correct: Clients prescribed warfarin will need to reduce the intake of food sources with high levels of vitamin K. High levels of vitamin K interfere with warfarin by decreasing the effectiveness of warfarin to prevent blood clots. The vitamin K level of 1 cup of raw spinach is 144.87 mcg. The vitamin K level of 1 cup of raw broccoli is 92.46 mcg. Because spinach and broccoli are high in vitamin K, the client should eat sparingly or refrain from eating spinach, and broccoli. 1. Incorrect: There is 0.31 mcg of Vitamin K in 1.0 ear, medium (6-3/4" to 7-1/2" long) of corn. This level of vitamin K in the corn can be consumed with warfarin. The vitamin K level of corn will not interfere with the action of warfarin. 2. Incorrect: The level of vitamin K in a cup of raw carrots is 16.9 mcg. Carrots will not reduce the action of warfarin, due to the low level of vitamin K in corn. 5. Incorrect: The content of vitamin K in a cup of watermelon is 0.15 mcg. Due to the low level of vitamin K in watermelon. Watermelon will not lower the effectiveness of warfarin. The nurse is preparing to give a client's prescribed ceftazidime dose. How many mL will the nurse give to the client? Answer to the first decimal place. Answer with numbers and decimal only. Perscription: Ceftazidime 1 gm IM every 6 hours Tazicef Ceftazidime For Injection, USP For IM injection, IV direct (bolus) injection, or IV infusion, reconstitute with Sterile Water for injection according to the following information. The vacuum may assist entry of the diluent. SHAKE WELL. Vial Size → Diluent to Be Added → Approx. Avail. Volume Intramuscular or Intravenous Direct (bolus) Injection: 1 gram → 3.0 mL → 3.6 mL Intravenous Infusion: 1 gram → 10 mL → 10.6 mL 2 gram → 10 mL → 11.2 mL Ans:______ - ANSWER- 3.6 (Rationale: Prescription: Ceftazidime 1 gm IM every 6 hours Available: Ceftazidime 1 gm in 3.6 mL Step 1: The instructions say to add 3.0 mL sterile water for injection to the vial. Volume yields 3.6 mL.) The unlicensed assistive personnel (UAP) reports to the nurse that a client who received morphine sulfate 4 mg IVP 30 minutes ago has a respiratory rate of 10 breaths/ minute. What is the nurse's priority intervention? 1. Administer naloxone 0.4 mg IVP. 2. Notify the primary healthcare provider of respiratory status. 3. Deliver breaths at 20 breaths/ minute via a bag-valve mask. 4. Instruct the UAP to ambulate the client. - ANSWER- 1. Administer naloxone 0.4 mg IVP. (1. Correct: The problem is respiratory depression due to morphine sulfate IV. Giving naloxone will reverse the respiratory depression. 2. Incorrect: The primary healthcare provider needs to know what happened, however, fix the problem first if you can. And we can, by giving the naloxone. Select all that apply 1. Levothyroxine 2. Methimazole 3. Propranolol 4. Iodine compounds 5. Calcitonin - ANSWER- 2. Methimazole 3. Propranolol 4. Iodine compounds (2., 3., & 4. Correct: Methimazole is correct because it decreases the production of thyroid hormones. It is an antithyroid drug and it is used to "stun" the thyroid pre- operatively. It makes the thyroid "freak out" and stop producing hormones temporarily. Propanolol is correct because it is a beta blocker and beta blockers decrease the heart rate and decrease anxiety. Why is this important? Because the heart rate and anxiety are going to be increased in the hyperthyroid client. Iodine compounds like Lugol's solution® are correct because these decrease the size and vascularity of the thyroid gland. Do you think this might be important pre- operatively? Yes, to decrease the likelihood of bleeding/hemorrhage. And we also, just learned that pharmacologic doses of iodine will also do what? That's right, large doses will decrease thyroid hormone production for a few weeks. So that's two reasons we might use an Iodine compound for Hyperthyroidism. 1. Incorrect: We are not going to give levothyroxine, that's just going to make the problem worse. Levothyroxine is the synthetic form of T4. 5. Incorrect: What about calcitonin? It is a thyroid hormone too, they don't need more. They are hyperthyroid.) The nurse is assisting with a client who will receive electroconvulsive therapy (ECT). The anesthesiologist administers succinylcholine chloride intravenously. What adverse effects should the nurse monitor for post procedure? Select all that apply 1. Malignant hyperthermia 2. Hypokalemia 3. Apnea 4. Tetany 5. Arrhythmias - ANSWER- 1. Malignant hyperthermia 3. Apnea 4. Tetany 5. Arrhythmias (1., 3., 4. & 5. Correct: Succinylcholine is a paralytic used to relax the muscles to prevent severe muscle contractions during the seizure, thereby reducing the possibility of fracture or dislocated bones. Adverse effects include malignant hyperthermia, apnea, and arrhythmias. It causes paralysis of the muscles of the face and those used to breath, so monitoring for apnea is very important. Tetany, spasms or stiffness in the jaw would be adverse effects and can indicate malignant hyperthermia. 2. Incorrect: Hyperkalemia can occur. Succinylcholine is a depolarizing muscle relaxant which means during prolonged muscle depolarization, the muscle may release large amounts of potassium into the blood.) The nurse is assigned a group of clients. For which client would the use of acetaminophen pose a higher risk? 1. 42 year old female who abuses cocaine. 2. 54 year old male who abuses alcohol. 3. 23 year old female who has asthma. 4. 34 year old male with sickle cell anemia. - ANSWER- 2. 54 year old male who abuses alcohol. (2. Correct: The use of acetaminophen poses a higher risk for the client who abuses alcohol due to its interaction with the liver. Clients should be educated to be cautious if using acetaminophen due to the hepatotoxicity that can occur with liver dysfunction and failure. (1. Correct: Maintaining a client's airway is always a priority. The nurse should observe the client for excessive sedation. After a benzodiazepine is administered, the client may fall asleep, transition into respiratory depression and apnea. 2. Incorrect: A side effect of benzodiazepine is drowsiness. Though the actions of the client may be slower, and the client may feel drowsy, the nurse's priority is to assess the client's sedation level. 3. Incorrect: Benzodiazepine therapy can result in substance abuse which can result in physical dependence. Maintaining a client's airway or apnea is a life-threatening situation. The priority intervention is to monitor the client's sedation. 4. Incorrect: The client may experience impaired coordination when prescribed benzodiazepine. Benzodiazepine depresses the central nervous system (CNS). The nurse's priority is to monitor the sedation level of the client.) The nurse is discharging a client who had a kidney transplant and the primary healthcare provider has prescribed mycophenolate. Which nursing instruction is priority regarding this medication? 1. Take the medication with food 2. Notify primary healthcare provider at first signs of an infection 3. Nausea, vomiting, and diarrhea are common side effects 4. Use sunscreen when planning to be outdoors - ANSWER- 2. Notify primary healthcare provider at first signs of an infection (2. Correct: Calling the primary healthcare provider at the first signs of an infection is priority because mycophenolate is an immunosuppressant. It diminishes the body's ability to identify and eliminate pathogens. 1. Incorrect: It is recommended the client take the medication on an empty stomach but the drug may be taken with food if the client experiences stomach upset. This is not the priority teaching point. 3. Incorrect: These side effects may be experienced but this is not the priority teaching point. 4. Incorrect: Sun exposure should be avoided and clients should be advised to use sunscreen because it can make the client more prone to sunburn but this is not the priority teaching point.) A client with the diagnosis of mild anxiety asks the nurse why the primary healthcare provider switched medications from lorazepam to buspirone. What should the nurse tell the client? 1. "Lorazepam takes longer to start working than buspirone so the primary healthcare provider decided to switch medications." 2. "Buspirone can be stopped quickly if neccessary." 3. "Buspirone does not depress the central nervous system like lorazepam does, so you should not have as much sedation." 4. "You need to ask your primary healthcare provider why the medication was changed from lorazepam to buspirone." - ANSWER- 3. "Buspirone does not depress the central nervous system like lorazepam does, so you should not have as much sedation." (3. Correct: Buspirone does not depress the CNS system and is believed to produce the desired effects through interaction with serotonin, dopamine, and other neurotransmitter receptors. 1. Incorrect: Buspirone takes 1-2 weeks to take effect and can take up to 4-6 weeks to achieve full clinical benefits. Lorazepam is a benzodiazepine and begins to work within a few hours to 1-2 days. 2. Incorrect: The client should not stop taking any antianxiety medications abruptly. Serious withdrawal symptoms can occur: depression, insomnia, anxiety, abdominal and muscle cramps, tremors, vomiting, sweating, convulsions, delirium. 4. Incorrect: The nurse should be able to discuss medication administration with the primary healthcare provider.) The nurse is caring for a client taking lithium. Which comment by the client indicates lack of understanding of the therapeutic regimen? 1. "I must keep my sodium intake steady over time. " 2. "If I miss a dose of lithium, I should make it up with the next dose." 3. "I must check with my primary healthcare provider before changing my diet for weight loss." A client who has been admitted to the intensive care unit with malignant hypertension has been prescribed nitroprusside IV. BP on admit is 210/112. Weight - 56 kg. Based on the prescription, what should the flow rate for a volumetric pump be set at initially? Round to the whole number. Titrate nitroprusside 50 mg in 250 mL D5W at 3 to 6 mcg/kg/min to maintain client's systolic blood pressure below 140 mm Hg. Ans:______ - ANSWER- 50 (Rationale: Always start with the lowest dosage when beginning nitropusside. 3 mcg/kg × 56 kg = 168 mcg/min (168 mcg ÷ 1 min) × (1 mg ÷ 1,000 mcg) × (250 mL ÷ 50 mg) × (60 min ÷ 1 hr) = (2,520,000 ÷ 50,000) = 50 mL/hr Ans: 50 mL/hr) A client with a history of congestive heart failure (CHF) has been admitted with digoxin toxicity. After reviewing the initial laboratory results, the nurse knows what abnormal findings most likely contributed to the digoxin toxicity? Sodium: 146 mEq/L, Potassium 3.1 mEq/L, Calcium 9.9 mg/dL, Magnesium 1.2 mEq/L, Albumin 4.8 gm/dL Select all that apply 1. Sodium 2. Calcium 3. Albumin 4. Potassium 5. Magnesium - ANSWER- 4. Potassium 5. Magnesium (4., & 5. Correct: Hypokalemia and hypomagnesemia both can increase the client's potential to develop digoxin toxicity. Digoxin and potassium both bind at the same location on the ATPase pump. When potassium levels are low, more digoxin will attach to the sites, leading to toxicity. Low magnesium levels sensitize the cardiovascular system to the toxic effects of digoxin. 1. Incorrect: The presence of digoxin in the body does slightly inhibit the activity of the Na/K⁺ pump. However, even though the sodium level is slightly elevated, there is no direct correlation between that increased sodium level and digoxin toxicity. 2. Incorrect: A calcium level of 9.9 is within the normal limits of 9.0 to 10.5 mg/dL (2.25-2.62 mmol/L). Calcium is controlled by the parathyroid glands, generally shifting between the bones and serum. A normal calcium level would not contribute to digoxin toxicity. 3. Incorrect: Albumin is a protein synthesized by the liver which helps to maintain fluid within the vascular spaces and transport soluble products throughout the body. This specific laboratory result is within normal limits. Nonetheless, albumin has no effect on digoxin levels in the body.) A client is given an intramuscular injection of morphine following a laparoscopic cholecystectomy four hours ago. What client data would best indicate to the nurse that the medication has been effective? 1. Rates pain as 6 on 1-10 scale. 2. Heart rate is within normal limits. 3. Ambulates with assistance of one. 4. Voided 250 mL in 4 hours. - ANSWER- 3. Ambulates with assistance of one. (3. Correct: The client's ability to ambulate with one assistant indicates that pain is controlled enough to get out of bed. Even a laparoscopic procedure can cause extreme discomfort in the immediate post-op period. This action is the best indicator the client has experienced some pain relief. 1. Incorrect: Although a baseline pain measurement is not noted, a level of 6 on the 1-10 scale is still very elevated. This client response indicates the morphine was not effective. (Rationale: (63.64 kg ÷ 1) × (15 mcg ÷ 1 kg) = (954.6 ÷ 1) = 954.6 mcg 954.6 × ½ = 477.3 ≈ 477 mcg Ans: 477 mcg) A nurse is providing education to a client regarding the use of an inhaler for acute asthma symptoms. Which statement made by the client would indicate the need for further teaching? 1. "I should shake the inhaler well before use." 2. "I should breathe out slowly and completely through my mouth before placing the mouthpiece of the inhaler in my mouth." 3. "I should hold my breath for approximately 8-10 seconds before exhaling slowly." 4. "I should administer the two puffs that are ordered in rapid sequence." - ANSWER- 4. "I should administer the two puffs that are ordered in rapid sequence." (4. Correct: Rapid sequencing of the puffs is not a correct measure for using an inhaler. The client should wait 1 minute between puffs. This statement indicates the need for further teaching. 1. Incorrect: This is a correct measure that should be followed when using an inhaler. Clients are instructed to shake the inhaler well before use. 2. Incorrect: This is a correct measure that should be followed when using an inhaler. Clients are instructed to exhale slowly before bringing the inhaler to the mouth. 3. Incorrect: This is a correct measure that should be followed when using an inhaler. After removing the inhaler from the mouth, clients are instructed to hold their breath for 10 seconds, then breath out slowly.) The primary healthcare provider has prescribed hydromorphone 2 mg intravenously (IV) every 4 hours as needed for pain. When should the nurse plan to administer the medication to the client? 1. Only when requested. 2. Prior to onset of intense pain. 3. With reports of acute pain lasting for at least one hour. 4. Continuously every 4 hours to keep the client pain free. - ANSWER- 2. Prior to onset of intense pain. (2. Correct: Pain is best managed before acute pain has developed. If the client waits until the pain is intense, the pain medication may not work as effectively or not at all. 1. Incorrect: Clients sometimes need pharmacologic treatment for pain even if not requested. Nurses should monitor the client for physical signs of pain. Vital sign changes and facial grimacing may be signs of pain. The word "only" is too limiting. 3. Incorrect: Clients should be treated for pain before acute pain develops when possible. The client should be educated to report pain prior to experiencing it for at least one hour. 4. Incorrect: The order is as needed, not continuously. Also, the goal of being pain free may be unrealistic. The nurse wants to keep the client's pain at a tolerable level. Always measure pain on a pain scale such as 0-10.) The nurse is preparing to hang an IV bottle of fat emulsions 20% on a client. At what rate should the nurse set the IV infusion pump? Answer in numbers only. Perscription: 200 mL fat emulsion 20% IV at 17 mL/hour. *CHANGE TUBING/BOTTLE EVERY 12 HOURS. Liposyn II 20% 500 mL Intravenous Fat Emulsion Ans:______ - ANSWER- 17 (Perscription: 200 mL fat emulsion 20% IV at 17 mL/hr.) The nurse is teaching a client diagnosed with asthma about using a peak expiratory flow meter. The nurse asks the client what action should be taken if the reading is 3. Incorrect: Administering the antibiotic into different parts of the IV tubing is the same as mixing the IVs together. Only one antibiotic should be administered at a time.) The nurse is developing a teaching plan for a female client who is taking one of the thiazolidinediones for the treatment of type 2 diabetes. What instruction should be included in the teaching plan? 1. Make sure that you use effective contraception while taking this drug. 2. The drug may lead to weight loss. 3. Therapeutic effect is reached within one to two weeks. 4. Therapeutic effect is reached within one month. - ANSWER- 1. Make sure that you use effective contraception while taking this drug. (1. Correct: Thiazolidinediones may reduce the plasma concentration of the contraceptives. Additionally, post-menopausal women may resume ovulation. 2. Incorrect: Thiazolidinediones may lead to weight gain and exacerbate congestive heart failure. 3. Incorrect: With thiazolidinediones therapy, therapeutic effect may not be reached until 8 to 12 weeks of treatment. 4. Incorrect: With thiazolidinediones therapy, therapeutic effect may not be reached until 2 to 3 months of treatment.) A nurse is caring for a client who has been prescribed sucralfate. Which client education intervention would the nurse include for the client prescribed sucralfate? 1. Take medication 1 hour after meals. 2. Crush tablets prior to taking medication. 3. Consume 1000 mL of fluid every 24 hours. 4. Avoid antacids 1 hour before and after this medication. - ANSWER- 4. Avoid antacids 1 hour before and after this medication. (4. Correct: Sucralfate is absorbed more effectively in an acidic state. Since an antacid medication will increase the alkaline state, the client should avoid taking antacids within 1 hour before or after taking sucralfate to increase the absorption rate of sucralfate. 1. Incorrect: Sucralfate should not be taken 1 hour after a meal. To increase the absorption of sucralfate the medication should be taken on an empty stomach when the stomach is more acidic. 2. Incorrect: Clients should not crush, or chew sucralfate tablets. The outer layer of the tablet has specific formulated pharmacokinetic properties that should not be crushed or chewed. 3. Incorrect: A potential side effect of sucralfate is constipation. An increase of fluids during the medication therapy is recommended to decrease the side effect of constipation. An intake of 1000 mL of fluid per 24 hours intervention is not enough fluid to reduce the possibility of constipation.) The nurse is caring for a diabetic client. The client's glucose level at 0700 is 265. What is the nurse's best action? Perscription: 40 units NPH insulin every AM Regular Insulin per Sliding Scale both AC and HS Sliding Scale: Blood glucose < 200: 0 units Blood glucose 200-249: 2 units Blood glucose 250-299: 4 units Blood glucose 300-349: 6 units Blood glucose 350-399: 8 units Blood glucose 400 or >: Call primary healthcare provider 1. Hold the NPH and regular insulin 2. Give 8 units of regular insulin and hold the NPH 3. Give the NPH and 4 units of regular insulin 4. Give 40 units of NPH and hold the regular insulin - ANSWER- 3. Give the NPH and 4 units of regular insulin (3. Correct: According to the prescription and sliding scale, the client will need 40 units of NPH and 4 units of regular insulin for a glucose level of 250-299. 3. Incorrect: Avoid foods high in tyramine. Foods high in tyramine such as smoked salmon can result in severe reactions when client is taking isoniazid.) The nurse is preparing to initiate a dopamine infusion per protocol. The primary healthcare provider prescription: Dopamine 5 mcg/kg/min IV per infusion pump. At what rate should the nurse set the pump? Use numbers only. Height - 187 cm Weight - 80 kg A mixture of 400 mg Dopamine in 250 mL = 1,600 mcg/mL Rate for 20kg client → 40kg → 60 → 80 → 100 2 mcg dose: 2 → 3 → 5 → 6 → 8 5 mcg dose: 4 → 8 → 11 → 15 → 19 10 mcg dose: 8 → 15 → 23 → 30 → 38 15 mcg dose: 11 → 23 → 34 → 45 → 56 20 mcg dose: 15 → 30 → 45 → 60 → 75 Ans:______ - ANSWER- 15 (Rationale: 5 mcg/kg × 80 kg = 400 mcg/min (400 mcg ÷ 1 min) × (1 mL × 1600 mcg) × (60 min × 1 hr) = (24,000 ÷ 1,600) = 15 mL/hr Ans: 15 mL/hr Always double check with the chart) Which statement made by a client prescribed naproxen for rheumatoid arthritis would require further investigation by the nurse? 1. "I signed up for swimming classes at the local recreation center." 2. "I take acetaminophen when I have a headache." 3. "I have lost 2 pounds in the past 2 weeks." 4. "I am taking an antacid to help with indigestion." - ANSWER- 4. "I am taking an antacid to help with indigestion." (4. Correct: Naproxen is a nonsteroidal anti-inflammatory drug (NSAID). It works by reducing hormones that cause inflammation and pain in the body. So what do we know is a concern about NSAIDs? They may cause GI bleeding and dyspepsia. This client might be experiencing these symptoms if they are taking an antacid for indigestion. Follow-up is required. 1. Incorrect: There is nothing wrong with the client taking swimming classes. This form of aerobic exercise can help decrease pain and improve strength. 2. Incorrect: Acetaminophen is not considered an NSAID. It can be taken for a headache while taking an NSAID. It is best to stagger the acetamenophen between naproxen doses if needed for headache. 3. Incorrect: There is nothing unusual or worrisome about a 1 to 2 pound (0.45 - 0.9 kg) weight loss a week. This weight loss would not be related to the medication.) A client newly diagnosed with insulin dependent diabetes mellitus is started on insulin aspart protamine suspension/insulin aspart solution mixture. The nurse would teach the client that the insulin should start to lower the blood sugar within how many minutes? 1. 15 2. 30 3. 45 4. 90 - ANSWER- 1. 15 (1. Correct: Insulin aspart mixture is a rapid-acting insulin and starts to work within 15 minutes after given subcutaneously. (2. Correct: The onset of action for nitroglycerin sublingual is 1 to 3 minutes. So the effectiveness can be assessed 3 minutes after the drug is administered. 1. Incorrect: This time frame is too short for the onset of action of nitroglycerin given sublingual. 3. Incorrect: Sublingual doses of nitroglycerin can be repeated every 5 minutes. The drug would start to be effective before 5 minutes. 4. Incorrect: Fifteen minutes would be to long to wait to assess the effectiveness of nitroglycerin sublingual, in a client suspected of a myocardial infarction.) The nurse is caring for a client with tuberculosis receiving isoniazid therapy. Because of the possible peripheral neuropathy that can occur, which supplementary nutritional agents would the nurse expect to administer? 1. Cyanocobalamin 2. Vitamin D 3. Ascorbic acid 4. Pyridoxine - ANSWER- 4. Pyridoxine (4. Correct: Isoniazid interferes with vitamin B6 (pyridoxine) metabolism by inhibiting the formation of the active form of vitamin B6. This interference often results in peripheral neuropathy. 1. Incorrect: Vitamin B12 (Cyanocobalamin) is not given to prevent peripheral neuropathy caused from isoniazid therapy. It is used to treat vitamin B12 deficiency often caused by pernicious anemia. It may be given in client's with peripheral neuropathy, but is not beneficial in clients whose neuropathy is due to isoniazid therapy. 2. Incorrect: Vitamin D is not given to prevent peripheral neuropathy. It is used in the treatment of weak bones, bone pain and/or bone loss. 3. Incorrect: Vitamin C is not given to prevent peripheral neuropathy cause from isoniazid therapy. It's use can be beneficial in clients with diabetic peripheral neuropathy.) A client with asthma uses a corticoid inhaler. What teaching should the nurse provide to decrease the risk of an oral fungal infection? 1. Lessen the exposure of the oral mucosa to the ICS by exhaling rapidly. 2. Rinse the mouth completely and brush teeth following the use of the ICS. 3. Use alcohol based mouth rinses with ICS. 4. Drink water prior to using the ICS. - ANSWER- 2. Rinse the mouth completely and brush teeth following the use of the ICS. (2. Correct: Thrush, is an oral fungal infection, which is one of the most common side effects of ICS. Up to 1/3 of all clients on ICS develop this infection. Rinsing and brushing helps to remove the medication residual from the oral mucosa and upper pharyngeal area. 1. Incorrect: This is not appropriate because exhaling rapidly would result in a loss of the medication and reduce the effectiveness. 3. Incorrect: This is not accurate because alcohol based mouth rinses have not been shown to reduce the risk of thrush. Alcohol based mouth wash can be drying to the oral mucosa. 4. Incorrect: Drinking water, prior to using the ICS is not an effective means of preventing thrush.) A pregnant client who had been on a magnesium drip for severe pregnancy induced hypertension (PIH) has had an emergency cesarean section at 35 weeks. The nursery nurse should anticipate what findings in the newborn related to the magnesium therapy? Select all that apply 1. Hypotension 2. Hypoglycemia 3. Hyperreflexia 4. Flaccid muscle tone 5. Respiratory depression - ANSWER- 1. Hypotension 4. Flaccid muscle tone 1. Incorrect: No, you should monitor liver function regularly, not kidney function. 2. Incorrect: Again, no. Sertraline is an SSRI (selective serotonin reuptake Inhibitor) and should not be given with MAO inhibitors. Do you know why? Because both SSRIs and MAO inhibitors increase the levels of serotonin in the brain, we don't want to give both and double dose them. 4. Incorrect: Antidepressants usually cause weight gain.) The nurse is reviewing medications for a client who is being treated for major depression. The client is prescribed a selective serotonin reuptake inhibitor (SSRI). Which over the counter medication/supplement taken by the client should be reported to the primary healthcare provider immediately? 1. Daily intake of St. John's Wort. 2. Daily intake of a multi-vitamin. 3. Occasional use of ibuprofen. 4. Twice daily intake of an antacid. - ANSWER- 1. Daily intake of St. John's Wort. (1. Correct: St. John's Wort is an herbal supplement often used in the treatment of mild depression. It should not be taken in combination with a selective serotonin reuptake inhibitor due to the risk of serotonin syndrome, which can be fatal. 2. Incorrect: A multi-vitamin taken with an SSRI poses no risk. 3. Incorrect: This medication taken with the SSRI would not warrant immediate reporting to the primary healthcare provider. 4. Incorrect: Antacids would not require immediate reporting.) A school nurse is planning a session on the effects of cannabis use for a high school health class. Which information does the nurse need to include? Select all that apply 1. Cannabis ingestion can cause tachycardia. 2. Inhaled cannabis produces a greater amount of tar than tobacco. 3. Cannabis smoke contains more carcinogens than tobacco smoke. 4. Cannabis ingestion reduces the risk for heart disease 5. Orthostatic hypotension can be caused by cannabis ingestion. - ANSWER- 1. Cannabis ingestion can cause tachycardia. 2. Inhaled cannabis produces a greater amount of tar than tobacco. 3. Cannabis smoke contains more carcinogens than tobacco smoke. 5. Orthostatic hypotension can be caused by cannabis ingestion. (1., 2., 3. & 5. Correct: Tetrahydrocannabinol (THC) is the chemical compound in cannabis. THC enters the blood stream quickly and is transported to the brain and other organs. Within minutes, the heart rate may increase by 20-50 bpm and last for up to 3 hours. Cannabis ingestion may cause tachycardia and orthostatic hypotension. Cannabis smoke contains more carcinogens and tar than tobacco. Lowering of blood pressure during use is common and can lead to orthostatic hypotension. 4. Incorrect: Research has indicated that the ingestion of cannabis increases the risk for heart disease.) A child diagnosed with acute lymphocytic leukemia (ALL) is receiving vincristine sulfate during the induction phase of chemotherapy. What client side effect should the nurse report immediately to the primary healthcare provider? 1. Anemia 2. Paresthesia 3. Nosebleeds 4. Alopecia - ANSWER- 2. Paresthesia (2. Correct: Paresthesia is an uncommon but serious reaction to chemotherapy, particularly vinca alkaloids like vincristine sulfate. The abnormal tingling or pins and needles sensation is caused by pressure or damage to peripheral nerves which may include both motor and sensory sensations. The nurse should immediately notify the primary healthcare provider of this critical side effect of vincristine therapy. (4. Correct: The client's output is below normal. This could indicate a problem with renal perfusion. Potassium is excreted through the kidneys, so if the kidneys are not being perfused, the client would retain potassium. The healthcare provider would need to be aware of the client's low urine output. 1. Incorrect: A client in fluid volume deficit would have a low blood pressure. This is an expected assessment prior to fluid resuscitation. 2. Incorrect: A client in fluid volume deficit would have a fast pulse rate. This is an expected assessment prior to fluid resuscitation. 3. Incorrect: A client in fluid volume deficit would have tenting of skin. This is an expected assessment prior to fluid resuscitation.) What nursing intervention takes priority for the client one day postoperative bowel resection reporting pain of a 6 on a 0 to 10 pain scale? 1. Assist the client in changing positions. 2. Use a distraction technique. 3. Administer the prescribed analgesic. 4. Encourage the client to walk. - ANSWER- 3. Administer the prescribed analgesic. (3. Correct: Rating pain a 1-3 is a mild pain. This pain is nagging, annoying, interfering little with the client's activities of daily living. This is when repositioning, alternative therapies, and distraction techniques are beneficial. Pain rated between 4-6 is considered to be moderate in severity and interferes significantly with activities of daily living. This is the time to give pain medication in an attempt to lessen the severity of the pain. A score of 7-10 is severe pain that is disabling. The client is unable to perform activities of daily living. Pain medication is often delayed in helping at this point. We want to give pain medication before it reaches this intense level. 1. Incorrect: There is no information to indicate repositioning may be effective. 2. Incorrect: Distraction is not an effective strategy for severe pain. 4. Incorrect: There is no information to indicate walking would be effective.) The nurse is caring for a client on the surgical unit. Which prescriptions could the nurse safely administer to the client? Select all that apply 1. Chlordiazepoxide 10 mg p.o. q 4h p.r.n. for agitation 2. Regular insulin 10 U stat 3. MS 2 mg IVP every 2 hours as needed for pain 4. Cefepime 1 gram IVPB every 8 hours 5. Diphenhydramine 25 mg p.o. hour of sleep for three nights - ANSWER- 1. Chlordiazepoxide 10 mg p.o. q 4h p.r.n. for agitation 4. Cefepime 1 gram IVPB every 8 hours 5. Diphenhydramine 25 mg p.o. hour of sleep for three nights (1., 4. & 5. Correct: These medication prescriptions are correctly written following approved Joint Commission abbreviations. 2. Incorrect: The "U" can be mistaken for "0" (zero), the number "4" (four) or "cc". Units should be written out completely. 3. Incorrect: MS can mean morphine sulfate or magnesium sulfate. Write "morphine sulfate". Write "magnesium sulfate".) What would the nurse include when teaching a client newly prescribed timolol maleate eyedrops for glaucoma? 1. The medication works by causing the pupils to constrict 2. The medication will dilate the canals of Schlemm 3. This medication decreases the production of aqueous humor 4. The medication improves ciliary muscle contraction - ANSWER- 3. This medication decreases the production of aqueous humor Having a MAOI prescribed and eating a diet high in tyramine can cause a severe increase in blood pressure. Smoked ham and avocados are high in tyramine. 2. Incorrect. Clients taking these medications cannot eat the following foods: sausage, salami, liver, or bologna which have high levels of tyramine. 3. Incorrect. Clients taking these medications cannot consume beer, sherry, chianti wines, or ales due to their high tyramine levels. 4. Incorrect. Consuming blue cheese on a salad may result in a hypertensive crisis due to the presence of tyramine.) The nurse is caring for a client diagnosed with deep vein thrombosis, who has been treated with intravenous heparin for one week. The primary healthcare provider plans to change the medication from heparin IV to warfarin sodium by mouth. The nurse understands which approach would be appropriate? 1. Begin the warfarin sodium and stop the heparin simultaneously. 2. Stop the heparin 24 hours, then begin the warfarin sodium. 3. Begin the warfarin sodium before stopping the heparin. 4. Stop the heparin, wait for the coagulation studies to reach the control value, and begin the warfarin sodium. - ANSWER- 3. Begin the warfarin sodium before stopping the heparin. (3. Correct: Warfarin sodium is initiated while the client remains on heparin. This is done so that the client remains adequately anticoagulated during the transition from IV heparin to warfarin sodium. The onset of action of warfarin sodium is 36 hours to 3 days. 1. Incorrect: Warfarin sodium's onset of action is 36 hours to 3 days. If heparin were stopped and warfarin sodium initiated there would be a lag time when the client would be inadequately anticoagulated and at an increased risk for clotting. 2. Incorrect: Warfarin sodium's onset of action is 36 hours to 3 days. Stopping heparin 24 hours before administering warfarin sodium would cause a lag time and increased risk of clotting. 4. Incorrect: Waiting for coagulation studies before administering warfarin sodium would cause a lag time and put the client at increased risk for clotting. Additionally, heparin and warfarin are measured by different clotting lab tests. The aPTT can measure the effectiveness of heparin. The PT and INR can be used to measure the effectiveness of warfarin sodium.) Which assessment finding by the nurse is likely to be the result of long-term corticosteroid use in a client? Select all that apply 1. Occasional nausea that occurs after eating the evening meal. 2. A wound that is slow to heal. 3. Weight loss of 15 pounds (6.8 kg) over a 6 week period. 4. The appearance of acne on the forehead and cheeks. 5. Vertebral compression fracture. - ANSWER- 2. A wound that is slow to heal. 4. The appearance of acne on the forehead and cheeks. 5. Vertebral compression fracture. (2., 4., & 5. Correct: Suppression of the immune system occurs with long-term steroid use. This leads to slow wound healing. Acne is sometimes seen with steroid use due to oily skin and overproduction of the acne bacterium. Osteoporosis risk is increased with long-term use of steroids. Remember steroids pull calcium from the bone and place it in the blood. 1. Incorrect: Nausea is not commonly seen with steroid use. 3. Incorrect: Changes in metabolism usually lead to weight gain, not weight loss.) The nurse is caring for a client with Addison's disease that is taking fludrocortisone 0.1mg/day. What assessment data by the nurse would suggest that the client's dose is too high? Select all that apply 1. Weight loss of 2 lbs (0.907 kg)/24 hours 2. Elevated serum sodium level 3. Bilateral pedal edema When reconsitituted with 6.6 mL diluent, (SEE INSERT - INTRAMUSCULAR ROUTE), each vial contains 8 mL solution. Ans:______ - ANSWER- 2 (Rationale: (500 mg ÷ 1) × (1 g ÷ 1,000 mg) × (8 mL ÷ 2 g) = (4,000 ÷ 2,000) = 2 mL Ans: 2 mL) A client diagnosed with bipolar mania was prescribed lithium carbonate 2000 mg daily two months ago. What is the nurse's best action? Sodium - 143 mEq/L (143 mmol/L) Potassium - 4.5 mEq/L (4.5 mmol/L) Magnesium - 1.9 mEq/L (0.8 mmol/L) Serum Lithium - 1.8 mEq/L 1. Record the lab results in the chart and recheck in one month. 2. Inform the primary healthcare provider that the lithium level is too high. 3. Notify the primary healthcare provider because the sodium level is too high. 4. Let the primary healthcare provider know that the magnesium level is too low. - ANSWER- 2. Inform the primary healthcare provider that the lithium level is too high. (2. Correct: The appropriate serum lithium level for acute mania is 1.0 to 1.5 mEq/L. For maintenance it is 0.6 to 1.2 mEq/L. Levels exceeding 1.5 to 2.5 mEq/L begin to produce toxicity. 1. Incorrect: All lab results should be documented; however, the lithium needs to be reported so that the dose can be adjusted. 3. Incorrect: The sodium level is normal: 135-145 mEq/L (135-145 mmol/l). 4. Incorrect: The magnesium level is normal: 1.3 - 2.1 mEq/L (0.65-1.05 mmol/l).) Donepezil has been prescribed to a client with cognitive impairment. Which statement by the family member indicates understanding of the nurse's instructions on this medication? 1. This medicine will control agitation and aggression. 2. This medication should be given at bedtime since it is for insomnia. 3. Notify the primary healthcare provider if the client is vomiting coffee ground material. 4. This drug is given as needed for confusion. - ANSWER- 3. Notify the primary healthcare provider if the client is vomiting coffee ground material. (3. Correct: A rare but very serious side effect that can occur: black stools, vomit that looks like coffee grounds, severe stomach/abdominal pain. Notify the primary healthcare provider immediately. 1. Incorrect: An antipsychotic medication such as risperidone is used for agitation, aggression, hallucinations, thought disturbances, and wandering. Donepezil helps to decrease the symptoms of dementia (impairment of memory, judgment, abstract thinking and personality changes) in client's with Alzheimer disease. 2. Incorrect: Donepezil should be given in the evening just before bedtime, however, it is not for insomnia. Sedative/hypnotics such as zolpidem and temzaepam are given for insomnia. 4. Incorrect: Donepezil should be given regularly in order to get the most benefit from it. Do not stop taking it or increase the dosage unless the primary healthcare provider changes the dose. It may take a few weeks before the full benefit of this drug takes effect.) The nurse is caring for a client post heart transplant who is being discharged on cyclosporine and azathioprine. Which precautions would be important for the nurse to teach the client? Select all that apply 1. Avoid crowds. 2. Do not obtain live vaccinations. 3. Drink at least 3 liters of fluids per day and watch the urine for sediment. A client comes into the clinic reporting muscle pain and tenderness but denies previous injury. Based on data gathered by the nurse, what client medication does the nurse suspect is causing this problem? CPK: 300 U/L ALT: 38 U/L AST: 42 U/L Alert, oriented client with general weakness and muscle tenderness noted. Reports myalgia, muscle weakness, fatigue, and joint pain. Urine sample obtained; urine cola-colored. 1. Captopril 2. Furosemide 3. Nadolol 4. Rosuvastatin - ANSWER- 4. Rosuvastatin (4. Correct: Rosuvastatin is a lipid-lowering agent. All lab work is abnormal and indicates muscle and liver damage. Lipid-lowering drugs can cause liver damage. The assessment of the lab values reveals muscle damage and could indicate rhabdomyolysis development. Creatine phosphokinase: males 55-170 u/L and females 30-135 u/L; Alanine aminotransferase (ALT): 4-36 u/L; Aspartate aminotransferase (AST): 0-35 u/L. 1. Incorrect: Captopril does not affect the liver or muscle. Captopril is an angiotensin-converting enzyme (ACE) prescribed for treatment of hypertension. 2. Incorrect: Furosemide does not affect the liver or muscle. Furosemide is a loop diuretic which promotes diuresis. 3. Incorrect: Nadolol does not affect the liver or muscle. Nadolol is a non-selective beta blocker. The action of nadolol is to treat arterial fibrillation, hypertension, migraines and chest pain.) The nurse is caring for a client on the cardiac unit. Which assessments are most important for the nurse to perform prior to the administration of diltiazem? Select all that apply 1. Note the rate and character of the apical pulse. 2. Ausculate the anterior and posterior breath sounds. 3. Check the morning results of serum calcium. 4. Review the last 24 hour urine output. 5. Monitor blood pressure. 6. Assess for chest pain. - ANSWER- 1. Note the rate and character of the apical pulse. 5. Monitor blood pressure. 6. Assess for chest pain. (1., 5., & 6. Correct: Diltiazem is a calcium channel blocker. It works by relaxing the muscles of the heart and blood vessels. Monitor blood pressure and pulse before and frequently during administration of diltiazem, as it causes systemic vasodilation and suppresses arrhythmias. Diltiazem is used to treat angina, so the nurse should assess for anginal pain. 2. Incorrect: Breath sounds need to be assessed to monitor for signs of heart failure, this would be a complication after diltiazem administration. Breath sounds are not necessarily assessed just prior to administration. 3. Incorrect: Diltiazem is a calcium channel blocker, but the total serum calcium concentration is not affected by it. Calcium channel blockers affect the flow of calcium into muscle cells. 4. Incorrect: A decrease in output would be an indicator of heart failure, which is a complication of diltiazem administration. This would be assessed after giving the medication.) A client diagnosed with hypertension has been prescribed metoprolol. Which statement by the client indicates that the client's medication instruction for metoprolol has been effective? 1. "I should not stop taking this drug immediately." 2. "I will need to rinse my mouth with water 3 times a day." 3. "I can decrease my aerobic exercises from 3 to 2 times per week."