Patient identifiers
-Medical record number
-home telephone number
What lab values should a nurse monitor for a patient with chronic renal failure?
? Urinalysis
? Hematuria, proteinuria, and alterations in specific gravity
? Serum creatinine
- Gradual increase of 1 to 2 mg/dL per every 24 to 48 hr for acute renal
failure (ARF)
- Gradual increase over months to years for chronic renal failure (CRF)
ex
What food should you increase when taking Lasix?
-increased amounts of potassium-rich foods (e.g., bananas, prunes, raisins, and orange juice)
Patient reports IV discomfort, what is your first action?
color and temperature
Sumatriptan (treats migraine headaches) adverse effect
pain, tightness, pressure, or heaviness in the chest, throat, neck, and/or jaw
slow or difficult speech
Know about Transdermal patch
-� Apply at the same time once each day,
preferably in the morning. Keep patch on
for 12 to 14 hr each day.
� Remove the patch at night to reduce
the risk of developing tolerance to
nitroglycerin. Be medication-free a
minimum of 10 to 12 hr each day (usua
RBC Blood transfusion
(prime with normal saline and infuse with sodium chloride).
What to understand about Parkinson's Meds?
-they don't cure disease, they slow the process.
NEUPOGEN (filgrastim)-what is the appropriate route of this med?
administered by subcutaneous injection or IV infusion
Lisinopril therapeutic effect
blood pressure answer (e.g. 120/80)
Medication for Schizophrenia
risperidone, Risperdal
Macrodantin medication
used to treat or prevent certain urinary tract infections
Haldol-inform if you are taking ____________ medication.
-benzodiazepine class of anti-anxiety drugs (all ending with "pam") and even, Xanax.
Fosomax
same as-Alendronate is used for treating osteoporosis in men and postmenopausal women.
Lipitor
-lowers cholesterol in blood, "statins". Reduce LDL and total cholesterol. Raise HDL.
Garamycin-
Antibiotic that is toxic to the kidney, injected for radiology studies.
Digoxin side effects
-Fatigue
-Bradycardia
-Anorexia
-Nausea/Vomiting
Singulair
used before exercise to prevent breathing problems during exercise (bronchospasm).
What medication to administer with Tylenol overdose?
acetylcysteine (Mucomyst) must be given IV
HPV vaccine
Human Papilloma Virus (HPV2, HPV4) - -Three doses should be given over a 6 month
-interval for females at 11 to 12 years of age (minimum age is 9 years).
-The second dose should be administered 2 months after the first dose, and the third dose should be a
Opioid toxicity-what to check first
oxygen saturation
Valporic Acid lab
liver
Lithium report immediately
slurred speech
Prednisone report
sore throat
Food to avoid when taking Lithium
-salty foods
-alcoholic beverages
Labs for patients taking hydrothiazide
Periodic determination of serum electrolytes to detect possible electrolyte imbalance should be done at appropriate intervals.
1) A nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13 mg/dL. Which medication should the nurse prepare to administer as prescribed to the client?
1. Calcium chloride
2. Calcium gluconate
3. Calcit
3. Calcitonin (Miacalcin)
Rationale:
The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing hypercalcemia. Calcium gluconate and calcium chloride are medications used for the treatment of tetany, which occurs as a result of acute
2.) Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia. The nurse instructs the mother to administer the iron with which best food item?
1. Milk
2. Water
3. Apple juice
4. Orange juice
4. Orange juice
Rationale:
Vitamin C increases the absorption of iron by the body. The mother should be instructed to administer the medication with a citrus fruit or a juice that is high in vitamin C. Milk may affect absorption of the iron. Water will no
3.) Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which of the following would indicate the presence of systemic toxicity from this medication?
1. Tinnitus
2. Diarrhea
3. Constipation
1. Tinnitus
Rationale:
Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can result. Symptoms include tinnitus, dizziness, hyperpnea, and psychological disturbances. Constipation and diarrhea are not associated with s
4.) The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied:
1. Immediately before swimming
2. 15 minutes before exposure to the
4. At least 30 minutes before exposure to the sun
Rationale:
Sunscreens are most effective when applied at least 30 minutes before exposure to the sun so that they can penetrate the skin. All sunscreens should be reapplied after swimming or sweating.
5.) Mafenide acetate (Sulfamylon) is prescribed for the client with a burn injury. When applying the medication, the client complains of local discomfort and burning. Which of the following is the most appropriate nursing action?
1. Notifying the register
3. Informing the client that this is normal
Rationale:
Mafenide acetate is bacteriostatic for gram-negative and gram-positive organisms and is used to treat burns to reduce bacteria present in avascular tissues. The client should be informed that the medi
6.) The burn client is receiving treatments of topical mafenide acetate (Sulfamylon) to the site of injury. The nurse monitors the client, knowing that which of the following indicates that a systemic effect has occurred?
1.Hyperventilation
2.Elevated blo
1.Hyperventilation
Rationale:
Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal excretion of acid, thereby causing acidosis. Clients receiving this treatment should be monitored for signs of an acid-base imbalance (hyperventilation
7.) Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed?
1. Platelet count
2. Triglyceride level
3. Complete blood count
4. White blood
2. Triglyceride level
Rationale:
Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before treatment and periodically thereafter until the effect on the triglycerides has been evaluated. Options 1, 3, and 4 do not n
8.) A client with severe acne is seen in the clinic and the health care provider (HCP) prescribes isotretinoin. The nurse reviews the client's medication record and would contact the (HCP) if the client is taking which medication?
1. Vitamin A
2. Digoxin
1. Vitamin A
Rationale:
Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements should be discontinued before isotretinoin thera
9.) The nurse is applying a topical corticosteroid to a client with eczema. The nurse would monitor for the potential for increased systemic absorption of the medication if the medication were being applied to which of the following body areas?
1. Back
2.
2. Axilla
Rationale:
Topical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions in which
10.) The clinic nurse is performing an admission assessment on a client. The nurse notes that the client is taking azelaic acid (Azelex). Because of the medication prescription, the nurse would suspect that the client is being treated for:
1. Acne
2. Ecze
1. Acne
Rationale:
Azelaic acid is a topical medication used to treat mild to moderate acne. The acid appears to work by suppressing the growth of Propionibacterium acnes and decreasing the proliferation of keratinocytes. Options 2, 3, and 4 are incorrect
11.) The health care provider has prescribed silver sulfadiazine (Silvadene) for the client with a partial-thickness burn, which has cultured positive for gram-negative bacteria. The nurse is reinforcing information to the client about the medication. Whi
3. "The medication will permanently stain my skin."
Rationale:
Silver sulfadiazine (Silvadene) is an antibacterial that has a broad spectrum of activity against gram-negative bacteria, gram-positive bacteria, and yeast. It is applied directly to the wound
12.) A nurse is caring for a client who is receiving an intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. During an inspection of the site, the nurse notes redness and swell
1. Notify the registered nurse.
Rationale:
When antineoplastic medications (Chemotheraputic Agents) are administered via IV, great care must be taken to prevent the medication from escaping into the tissues surrounding the injection site, because pain, ti
13.) The client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed?
1. Echocardiography
2. Electrocardiography
3. Cervical radiography
4. Pulmonary function studies
Rationale:
Bleomycin is an antineoplastic medication (Chemotheraputic Agents) that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, an
14.) The client with acute myelocytic leukemia is being treated with busulfan (Myleran). Which laboratory value would the nurse specifically monitor during treatment with this medication?
1. Clotting time
2. Uric acid level
3. Potassium level
4. Blood glu
2. Uric acid level
Rationale:
Busulfan (Myleran) can cause an increase in the uric acid level. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute renal failure. Options 1, 3, and 4 are not specifically related to this medication.
15.) The client with small cell lung cancer is being treated with etoposide (VePesid). The nurse who is assisting in caring for the client during its administration understands that which side effect is specifically associated with this medication?
1. Alo
4. Orthostatic hypotension
Rationale:
A side effect specific to etoposide is orthostatic hypotension. The client's blood pressure is monitored during the infusion. Hair loss occurs with nearly all the antineoplastic medications. Chest pain and pulmonary f
16.) The clinic nurse is reviewing a teaching plan for the client receiving an antineoplastic medication. When implementing the plan, the nurse tells the client:
1. To take aspirin (acetylsalicylic acid) as needed for headache
2. Drink beverages containin
3. Consult with health care providers (HCPs) before receiving immunizations
Rationale:
Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without a HCP's approval. Clients also need t
17.) The client with ovarian cancer is being treated with vincristine (Oncovin). The nurse monitors the client, knowing that which of the following indicates a side effect specific to this medication?
1. Diarrhea
2. Hair loss
3. Chest pain
4. Numbness and
4. Numbness and tingling in the fingers and toes
Rationale:
A side effect specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depr
18.) The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse consults with the registered nurse regarding the administration of the medication if which of the
1. Pancreatitis
Rationale:
Asparaginase (Elspar) is contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function and pancreatic function tests should be performed b
19.) Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse understands that the primary action of this medication is to:
1. Increase DNA and RNA synthesis.
2. Promote the biosynthesis of nucleic acids.
3. Increase estrogen con
4. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors.
Rationale:
Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations o
20.) The client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication?
1. Glucose level
2. Calcium level
3. Potassium level
4. Prothrombin time
2. Calcium level
Rationale:
Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium levels should be assessed. These blood levels, along with cholest
21.) A nurse is assisting with caring for a client with cancer who is receiving cisplatin. Select the adverse effects that the nurse monitors for that are associated with this medication. Select all that apply.
1. Tinnitus
2. Ototoxicity
3. Hyperkalemia
4
1. Tinnitus
2. Ototoxicity
5. Nephrotoxicity
6. Hypomagnesemia
Rationale:
Cisplatin is an alkylating medication. Alkylating medications are cell cycle phase-nonspecific medications that affect the synthesis of DNA by causing the cross-linking of DNA to in
22.) A nurse is caring for a client after thyroidectomy and notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed to:
1. Treat thyroid storm.
2. Prevent cardiac irritability.
3. Treat hypo
3. Treat hypocalcemic tetany.
Rationale:
Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed or injured during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingl
23.) A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which information should the nurse teach when carrying out plans for discharge?
1. Keep insulin vials refrigerated at all times.
2. Rotate
2. Rotate the insulin injection sites systematically.
Rationale:
Insulin dosages should not be adjusted or increased before unusual exercise. If acetone is found in the urine, it may possibly indicate the need for additional insulin. To minimize the disco
24.) A nurse is reinforcing teaching for a client regarding how to mix regular insulin and NPH insulin in the same syringe. Which of the following actions, if performed by the client, indicates the need for further teaching?
1. Withdraws the NPH insulin f
1. Withdraws the NPH insulin first
Rationale:
When preparing a mixture of regular insulin with another insulin preparation, the regular insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of regular insulin with insuli
25.) A home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse tells the client to:
1. Freeze the insulin.
2. Refrig
2. Refrigerate the insulin.
Rationale:
Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be frozen. When stored unopened under refrigeration, insulin can be used up to the expiration date on the vial. Options 1,
26.) Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. A nurse reinforces instructions for the client and tells the client to avoid which of the following while taking this medication?
1. Alcohol
2. Organ meats
3. Whole-grain cereals
1. Alcohol
Rationale:
When alcohol is combined with glimepiride (Amaryl), a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication. Clients need
27.) Sildenafil (Viagra) is prescribed to treat a client with erectile dysfunction. A nurse reviews the client's medical record and would question the prescription if which of the following is noted in the client's history?
1. Neuralgia
2. Insomnia
3. Use
3. Use of nitroglycerin
Rationale:
Sildenafil (Viagra) enhances the vasodilating effect of nitric oxide in the corpus cavernosum of the penis, thus sustaining an erection. Because of the effect of the medication, it is contraindicated with concurrent use
28.) The health care provider (HCP) prescribes exenatide (Byetta) for a client with type 1 diabetes mellitus who takes insulin. The nurse knows that which of the following is the appropriate intervention?
1. The medication is administered within 60 minute
2. The medication is withheld and the HCP is called to question the prescription for the client.
Rationale:
Exenatide (Byetta) is an incretin mimetic used for type 2 diabetes mellitus only. It is not recommended for clients taking insulin. Hence, the nurs
29.) A client is taking Humulin NPH insulin daily every morning. The nurse reinforces instructions for the client and tells the client that the most likely time for a hypoglycemic reaction to occur is:
1. 2 to 4 hours after administration
2. 4 to 12 hours
2. 4 to 12 hours after administration
Rationale:
Humulin NPH is an intermediate-acting insulin. The onset of action is 1.5 hours, it peaks in 4 to 12 hours, and its duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.
30.) A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. Which medication,
1. Prednisone
Rationale:
Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 2, a monoamine oxidase inhibitor, and option 3, a ?-blocker, have their own intrinsic hypoglycemic activity. Option 4
31.) A community health nurse visits a client at home. Prednisone 10 mg orally daily has been prescribed for the client and the nurse reinforces teaching for the client about the medication. Which statement, if made by the client, indicates that further t
1. "I can take aspirin or my antihistamine if I need it."
Rationale:
Aspirin and other over-the-counter medications should not be taken unless the client consults with the health care provider (HCP). The client needs to take the medication at the same tim
32.) Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response?
1. Decreased urinary output
2. Decreased blood pressure
3. Decreased per
1. Decreased urinary output
Rationale:
Desmopressin promotes renal conservation of water. The hormone carries out this action by acting on the collecting ducts of the kidney to increase their permeability to water, which results in increased water reabsor
33.) The home health care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client is prescribed repaglinide (Prandin) and metformin (Glucophage) and asks the nurse to explain these medications. The nurse should rein
1. Diarrhea can occur secondary to the metformin.
2. The repaglinide is not taken if a meal is skipped.
3. The repaglinide is taken 30 minutes before eating.
4. Candy or another simple sugar is carried and used to treat mild hypoglycemia episodes.
Rationa
34.) A client with Crohn's disease is scheduled to receive an infusion of infliximab (Remicade). The nurse assisting in caring for the client should take which action to monitor the effectiveness of treatment?
1. Monitoring the leukocyte count for 2 days
2. Checking the frequency and consistency of bowel movements
Rationale:
The principal manifestations of Crohn's disease are diarrhea and abdominal pain. Infliximab (Remicade) is an immunomodulator that reduces the degree of inflammation in the colon, ther
35.) The client has a PRN prescription for loperamide hydrochloride (Imodium). The nurse understands that this medication is used for which condition?
1. Constipation
2. Abdominal pain
3. An episode of diarrhea
4. Hematest-positive nasogastric tube draina
3. An episode of diarrhea
Rationale:
Loperamide is an antidiarrheal agent. It is used to manage acute and also chronic diarrhea in conditions such as inflammatory bowel disease. Loperamide also can be used to reduce the volume of drainage from an ileostom
36.) The client has a PRN prescription for ondansetron (Zofran). For which condition should this medication be administered to the postoperative client?
1. Paralytic ileus
2. Incisional pain
3. Urinary retention
4. Nausea and vomiting
4. Nausea and vomiting
Rationale:
Ondansetron is an antiemetic used to treat postoperative nausea and vomiting, as well as nausea and vomiting associated with chemotherapy. The other options are incorrect.
37.) The client has begun medication therapy with pancrelipase (Pancrease MT). The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed?
1. Weight loss
2. Relief of heartburn
3. Reduction of steatorrhea
4.
3. Reduction of steatorrhea
Rationale:
Pancrelipase (Pancrease MT) is a pancreatic enzyme used in clients with pancreatitis as a digestive aid. The medication should reduce the amount of fatty stools (steatorrhea). Another intended effect could be improve
38.) An older client recently has been taking cimetidine (Tagamet). The nurse monitors the client for which most frequent central nervous system side effect of this medication?
1. Tremors
2. Dizziness
3. Confusion
4. Hallucinations
3. Confusion
Rationale:
Cimetidine is a histamine 2 (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side e
39.) The client with a gastric ulcer has a prescription for sucralfate (Carafate), 1 g by mouth four times daily. The nurse schedules the medication for which times?
1. With meals and at bedtime
2. Every 6 hours around the clock
3. One hour after meals an
4. One hour before meals and at bedtime
Rationale:
Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulce
40.) The client who chronically uses nonsteroidal anti-inflammatory drugs has been taking misoprostol (Cytotec). The nurse determines that the medication is having the intended therapeutic effect if which of the following is noted?
1. Resolved diarrhea
2.
2. Relief of epigastric pain
Rationale:
The client who chronically uses nonsteroidal anti-inflammatory drugs (NSAIDs) is prone to gastric mucosal injury. Misoprostol is a gastric protectant and is given specifically to prevent this occurrence. Diarrhea ca
41.) The client has been taking omeprazole (Prilosec) for 4 weeks. The ambulatory care nurse evaluates that the client is receiving optimal intended effect of the medication if the client reports the absence of which symptom?
1. Diarrhea
2. Heartburn
3. F
2. Heartburn
Rationale:
Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called heartburn by clients. Omeprazole is not used to treat the conditi
42.) A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is reinforcing teaching for the client about the medications prescribed, including clarithromycin (Biaxin), esomeprazole (Nexium), and amoxicillin (Amoxil). Whi
3. "The medications will kill the bacteria and stop the acid production."
Rationale:
Triple therapy for Helicobacter pylori infection usually includes two antibacterial drugs and a proton pump inhibitor. Clarithromycin and amoxicillin are antibacterials.
43.) A histamine (H2)-receptor antagonist will be prescribed for a client. The nurse understands that which medications are H2-receptor antagonists? Select all that apply.
1. Nizatidine (Axid)
2. Ranitidine (Zantac)
3. Famotidine (Pepcid)
4. Cimetidine (T
1. Nizatidine (Axid)
2. Ranitidine (Zantac)
3. Famotidine (Pepcid)
4. Cimetidine (Tagamet)
Rationale:
H2-receptor antagonists suppress secretion of gastric acid, alleviate symptoms of heartburn, and assist in preventing complications of peptic ulcer disea
44.) A client is receiving acetylcysteine (Mucomyst), 20% solution diluted in 0.9% normal saline by nebulizer. The nurse should have which item available for possible use after giving this medication?
1. Ambu bag
2. Intubation tray
3. Nasogastric tube
4.
4. Suction equipment
Rationale:
Acetylcysteine can be given orally or by nasogastric tube to treat acetaminophen overdose, or it may be given by inhalation for use as a mucolytic. The nurse administering this medication as a mucolytic should have suction
45.) A client has a prescription to take guaifenesin (Humibid) every 4 hours, as needed. The nurse determines that the client understands the most effective use of this medication if the client states that he or she will:
1. Watch for irritability as a si
2. Take the tablet with a full glass of water.
Rationale:
Guaifenesin is an expectorant. It should be taken with a full glass of water to decrease viscosity of secretions. Sustained-release preparations should not be broken open, crushed, or chewed. The m
46.) A postoperative client has received a dose of naloxone hydrochloride for respiratory depression shortly after transfer to the nursing unit from the postanesthesia care unit. After administration of the medication, the nurse checks the client for:
1.
3. Sudden increase in pain
Rationale:
Naloxone hydrochloride is an antidote to opioids and may also be given to the postoperative client to treat respiratory depression. When given to the postoperative client for respiratory depression, it may also revers
47.) A client has been taking isoniazid (INH) for 2 months. The client complains to a nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing:
1. Hypercalcemia
2. Peripheral neuritis
3. Sma
2. Peripheral neuritis
Rationale:
A common side effect of the TB drug INH is peripheral neuritis. This is manifested by numbness, tingling, and paresthesias in the extremities. This side effect can be minimized by pyridoxine (vitamin B6) intake. Options 1
48.) A client is to begin a 6-month course of therapy with isoniazid (INH). A nurse plans to teach the client to:
1. Drink alcohol in small amounts only.
2. Report yellow eyes or skin immediately.
3. Increase intake of Swiss or aged cheeses.
4. Avoid vita
2. Report yellow eyes or skin immediately.
Rationale:
INH is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately (which include yellow skin and sclera). For the same reason, alcohol should be avoided durin
49.) A client has been started on long-term therapy with rifampin (Rifadin). A nurse teaches the client that the medication:
1. Should always be taken with food or antacids
2. Should be double-dosed if one dose is forgotten
3. Causes orange discoloration
3. Causes orange discoloration of sweat, tears, urine, and feces
Rationale:
Rifampin should be taken exactly as directed as part of TB therapy. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a health
50.) A nurse has given a client taking ethambutol (Myambutol) information about the medication. The nurse determines that the client understands the instructions if the client states that he or she will immediately report:
1. Impaired sense of hearing
2.
2. Problems with visual acuity
Rationale:
Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The
51.) Cycloserine (Seromycin) is added to the medication regimen for a client with tuberculosis. Which of the following would the nurse include in the client-teaching plan regarding this medication?
1. To take the medication before meals
2. To return to th
2. To return to the clinic weekly for serum drug-level testing
Rationale:
Cycloserine (Seromycin) is an antitubercular medication that requires weekly serum drug level determinations to monitor for the potential of neurotoxicity. Serum drug levels lower t
52.) A client with tuberculosis is being started on antituberculosis therapy with isoniazid (INH). Before giving the client the first dose, a nurse ensures that which of the following baseline studies has been completed?
1. Electrolyte levels
2. Coagulati
3. Liver enzyme levels
Rationale:
INH therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in t
53.) Rifabutin (Mycobutin) is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. The nurse monitors for which side effects of the medication? Select all that apply.
1. Signs of hepatitis
2. Flu-like syndrome
3.
1. Signs of hepatitis
2. Flu-like syndrome
3. Low neutrophil count
5. Ocular pain or blurred vision
Rationale:
Rifabutin (Mycobutin) may be prescribed for a client with active MAC disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polym
54.) A nurse reinforces discharge instructions to a postoperative client who is taking warfarin sodium (Coumadin). Which statement, if made by the client, reflects the need for further teaching?
1. "I will take my pills every day at the same time."
2. "I
4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated."
Rationale:
Ecotrin is an aspirin-containing product and should be avoided. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking prescribed
55.) A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3.0 mEq/L and is complaining of anorexia. A health care provider prescribes a digoxin level to rule out digoxin toxicity. A nurse checks the results, knowing that which
2.) 0.5 to 2 ng/mL
Rationale:
Therapeutic levels for digoxin range from 0.5 to 2 ng/mL. Therefore, options 1, 3, and 4 are incorrect.
56.) Heparin sodium is prescribed for the client. The nurse expects that the health care provider will prescribe which of the following to monitor for a therapeutic effect of the medication?
1. Hematocrit level
2. Hemoglobin level
3. Prothrombin time (PT)
4. Activated partial thromboplastin time (aPTT)
Rationale:
The PT will assess for the therapeutic effect of warfarin sodium (Coumadin) and the aPTT will assess the therapeutic effect of heparin sodium. Heparin sodium doses are determined based on these la
57.) A nurse is monitoring a client who is taking propranolol (Inderal LA). Which data collection finding would indicate a potential serious complication associated with propranolol?
1. The development of complaints of insomnia
2. The development of audib
2. The development of audible expiratory wheezes
Rationale:
Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. ?-Blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma
58.) Isosorbide mononitrate (Imdur) is prescribed for a client with angina pectoris. The client tells the nurse that the medication is causing a chronic headache. The nurse appropriately suggests that the client:
1. Cut the dose in half.
2. Discontinue th
3. Take the medication with food.
Rationale:
Isosorbide mononitrate is an antianginal medication. Headache is a frequent side effect of isosorbide mononitrate and usually disappears during continued therapy. If a headache occurs during therapy, the client
59.) A client is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase (Activase, tPA). Which action is a priority nursing intervention?
1. Monitor for renal failure.
2. Monitor psychosocial status.
3. Moni
3. Monitor for signs of bleeding.
Rationale:
Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client'
60.) A nurse is planning to administer hydrochlorothiazide (HydroDIURIL) to a client. The nurse understands that which of the following are concerns related to the administration of this medication?
1. Hypouricemia, hyperkalemia
2. Increased risk of osteo
3. Hypokalemia, hyperglycemia, sulfa allergy
Rationale:
Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglyc
61.) A home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine (Questran). Which of the following statements, if made by the client, indicates the need f
4. "I'll continue my nicotinic acid from the health food store."
Rationale:
Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid-lowering medications also can cause liver abnormalities, so
62.) A client is on nicotinic acid (niacin) for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client would indicate an understanding of the instructions?
1. "It is not necessary to avoid the
4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing."
Rationale:
Flushing is a side effect of this medication. Aspirin or a nonsteroidal anti-inflammatory drug can be taken 30 minutes before taking the medication
63.) A client with coronary artery disease complains of substernal chest pain. After checking the client's heart rate and blood pressure, a nurse administers nitroglycerin, 0.4 mg, sublingually. After 5 minutes, the client states, "My chest still hurts.
2. Contact the registered nurse.
4. Assess the client's pain level.
5. Check the client's blood pressure.
6. Administer a second nitroglycerin, 0.4 mg, sublingually.
Rationale:
The usual guideline for administering nitroglycerin tablets for a hospitalized
64.) Nalidixic acid (NegGram) is prescribed for a client with a urinary tract infection. On review of the client's record, the nurse notes that the client is taking warfarin sodium (Coumadin) daily. Which prescription should the nurse anticipate for this
2. A decrease in the warfarin sodium (Coumadin) dosage
Rationale:
Nalidixic acid can intensify the effects of oral anticoagulants by displacing these agents from binding sites on plasma protein. When an oral anticoagulant is combined with nalidixic acid,
65.) A nurse is reinforcing discharge instructions to a client receiving sulfisoxazole. Which of the following should be included in the list of instructions?
1. Restrict fluid intake.
2. Maintain a high fluid intake.
3. If the urine turns dark brown, cal
2. Maintain a high fluid intake.
Rationale:
Each dose of sulfisoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake. The medication is more soluble in alkaline urine. The client should not be instru
66.) Trimethoprim-sulfamethoxazole (TMP-SMZ) is prescribed for a client. A nurse should instruct the client to report which symptom if it developed during the course of this medication therapy?
1. Nausea
2. Diarrhea
3. Headache
4. Sore throat
4. Sore throat
Rationale:
Clients taking trimethoprim-sulfamethoxazole (TMP-SMZ) should be informed about early signs of blood disorders that can occur from this medication. These include sore throat, fever, and pallor, and the client should be instructed
67.) Phenazopyridine hydrochloride (Pyridium) is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. The nurse reinforces to the client:
1. To take the medication at bedtime
2. To take the medication befo
4. That a reddish orange discoloration of the urine may occur
Rationale:
The nurse should instruct the client that a reddish-orange discoloration of urine may occur. The nurse also should instruct the client that this discoloration can stain fabric. The m
68.) Bethanechol chloride (Urecholine) is prescribed for a client with urinary retention. Which disorder would be a contraindication to the administration of this medication?
1. Gastric atony
2. Urinary strictures
3. Neurogenic atony
4. Gastroesophageal r
2. Urinary strictures
Rationale:
Bethanechol chloride (Urecholine) can be harmful to clients with urinary tract obstruction or weakness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the ur
69.) A nurse who is administering bethanechol chloride (Urecholine) is monitoring for acute toxicity associated with the medication. The nurse checks the client for which sign of toxicity?
1. Dry skin
2. Dry mouth
3. Bradycardia
4. Signs of dehydration
3. Bradycardia
Rationale:
Toxicity (overdose) produces manifestations of excessive muscarinic stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension. Treatment includes supportive measures and t
70.) Oxybutynin chloride (Ditropan XL) is prescribed for a client with neurogenic bladder. Which sign would indicate a possible toxic effect related to this medication?
1. Pallor
2. Drowsiness
3. Bradycardia
4. Restlessness
4. Restlessness
Rationale:
Toxicity (overdosage) of this medication produces central nervous system excitation, such as nervousness, restlessness, hallucinations, and irritability. Other signs of toxicity include hypotension or hypertension, confusion, ta
71.) After kidney transplantation, cyclosporine (Sand immune) is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication?
1. Decreased creatinine level
2. Decreased hemoglobin level
3. Elevated blo
3. Elevated blood urea nitrogen level
Rationale:
Nephrotoxicity can occur from the use of cyclosporine (Sandimmune). Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen (BUN) and serum creatinine levels. Cyclosporine is an immunosup
72.) Cinoxacin (Cinobac), a urinary antiseptic, is prescribed for the client. The nurse reviews the client's medical record and should contact the health care provider (HCP) regarding which documented finding to verify the prescription? Refer to chart.
1.
1. Renal insufficiency
Rationale:
Cinoxacin should be administered with caution in clients with renal impairment. The dosage should be reduced, and failure to do so could result in accumulation of cinoxacin to toxic levels. Therefore the nurse would verif
73.) A client with myasthenia gravis is suspected of having cholinergic crisis. Which of the following indicate that this crisis exists?
1. Ataxia
2. Mouth sores
3. Hypotension
4. Hypertension
4. Hypertension
Rationale:
Cholinergic crisis occurs as a result of an overdose of medication. Indications of cholinergic crisis include gastrointestinal disturbances, nausea, vomiting, diarrhea, abdominal cramps, increased salivation and tearing, miosis,
74.) A client with myasthenia gravis is receiving pyridostigmine (Mestinon). The nurse monitors for signs and symptoms of cholinergic crisis caused by overdose of the medication. The nurse checks the medication supply to ensure that which medication is av
2. Atropine sulfate
Rationale:
The antidote for cholinergic crisis is atropine sulfate. Vitamin K is the antidote for warfarin (Coumadin). Protamine sulfate is the antidote for heparin, and acetylcysteine (Mucomyst) is the antidote for acetaminophen (Tyle
75.) A client with myasthenia gravis becomes increasingly weak. The health care provider prepares to identify whether the client is reacting to an overdose of the medication (cholinergic crisis) or increasing severity of the disease (myasthenic crisis). A
4. A temporary worsening of the condition
Rationale:
An edrophonium (Enlon) injection, a cholinergic drug, makes the client in cholinergic crisis temporarily worse. This is known as a negative test. An improvement of weakness would occur if the client wer
76.) Carbidopa-levodopa (Sinemet) is prescribed for a client with Parkinson's disease, and the nurse monitors the client for adverse reactions to the medication. Which of the following indicates that the client is experiencing an adverse reaction?
1. Prur
4. Impaired voluntary movements
Rationale:
Dyskinesia and impaired voluntary movement may occur with high levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia (the temporary muscle weakness that lasts 1 minute
77.) Phenytoin (Dilantin), 100 mg orally three times daily, has been prescribed for a client for seizure control. The nurse reinforces instructions regarding the medication to the client. Which statement by the client indicates an understanding of the ins
1. "I will use a soft toothbrush to brush my teeth."
Rationale:
Phenytoin (Dilantin) is an anticonvulsant. Gingival hyperplasia, bleeding, swelling, and tenderness of the gums can occur with the use of this medication. The client needs to be taught good o
78.) A client is taking phenytoin (Dilantin) for seizure control and a sample for a serum drug level is drawn. Which of the following indicates a therapeutic serum drug range?
1. 5 to 10 mcg/mL
2. 10 to 20 mcg/mL
3. 20 to 30 mcg/mL
4. 30 to 40 mcg/mL
2. 10 to 20 mcg/mL
Rationale:
The therapeutic serum drug level range for phenytoin (Dilantin) is 10 to 20 mcg/mL.
*
A helpful hint may be to remember that the theophylline therapeutic range and the acetaminophen (Tylenol) therapeutic range are the same as
79.) Ibuprofen (Advil) is prescribed for a client. The nurse tells the client to take the medication:
1. With 8 oz of milk
2. In the morning after arising
3. 60 minutes before breakfast
4. At bedtime on an empty stomach
1. With 8 oz of milk
Rationale:
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs should be given with milk or food to prevent gastrointestinal irritation. Options 2, 3, and 4 are incorrect.
80.) A nurse is caring for a client who is taking phenytoin (Dilantin) for control of seizures. During data collection, the nurse notes that the client is taking birth control pills. Which of the following information should the nurse provide to the clien
3. The potential for decreased effectiveness of the birth control pills exists while taking phenytoin (Dilantin).
Rationale:
Phenytoin (Dilantin) enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. O
81.) A client with trigeminal neuralgia is being treated with carbamazepine (Tegretol). Which laboratory result would indicate that the client is experiencing an adverse reaction to the medication?
1. Sodium level, 140 mEq/L
2. Uric acid level, 5.0 mg/dL
3. White blood cell count, 3000 cells/mm3
Rationale:
Adverse effects of carbamazepine (Tegretol) appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia, cardiovascular disturbances, thrombophlebitis, dysrhythm
82.) A client is receiving meperidine hydrochloride (Demerol) for pain. Which of the following are side effects of this medication. Select all that apply.
1. Diarrhea
2. Tremors
3. Drowsiness
4. Hypotension
5. Urinary frequency
6. Increased respiratory ra
2. Tremors
3. Drowsiness
4. Hypotension
Rationale:
Meperidine hydrochloride is an opioid analgesic. Side effects include respiratory depression, drowsiness, hypotension, constipation, urinary retention, nausea, vomiting, and tremors.
83.) The client has been on treatment for rheumatoid arthritis for 3 weeks. During the administration of etanercept (Enbrel), it is most important for the nurse to check:
1. The injection site for itching and edema
2. The white blood cell counts and plate
2. The white blood cell counts and platelet counts
Rationale:
Infection and pancytopenia are side effects of etanercept (Enbrel). Laboratory studies are performed before and during drug treatment. The appearance of abnormal white blood cell counts and abn
84.) Baclofen (Lioresal) is prescribed for the client with multiple sclerosis. The nurse assists in planning care, knowing that the primary therapeutic effect of this medication is which of the following?
1. Increased muscle tone
2. Decreased muscle spasm
2. Decreased muscle spasms
Rationale:
Baclofen is a skeletal muscle relaxant and central nervous system depressant and acts at the spinal cord level to decrease the frequency and amplitude of muscle spasms in clients with spinal cord injuries or diseases
85.) A nurse is monitoring a client receiving baclofen (Lioresal) for side effects related to the medication. Which of the following would indicate that the client is experiencing a side effect?
1. Polyuria
2. Diarrhea
3. Drowsiness
4. Muscular excitabili
3. Drowsiness
Rationale:
Baclofen is a central nervous system (CNS) depressant and frequently causes drowsiness, dizziness, weakness, and fatigue. It can also cause nausea, constipation, and urinary retention. Clients should be warned about the possible r
86.) A nurse is reinforcing discharge instructions to a client receiving baclofen (Lioresal). Which of the following would the nurse include in the instructions?
1. Restrict fluid intake.
2. Avoid the use of alcohol.
3. Stop the medication if diarrhea occ
2. Avoid the use of alcohol.
Rationale:
Baclofen is a central nervous system (CNS) depressant. The client should be cautioned against the use of alcohol and other CNS depressants, because baclofen potentiates the depressant activity of these agents. Const
87.) A client with acute muscle spasms has been taking baclofen (Lioresal). The client calls the clinic nurse because of continuous feelings of weakness and fatigue and asks the nurse about discontinuing the medication. The nurse should make which appropr
4. "Weakness and fatigue commonly occur and will diminish with continued medication use."
Rationale:
The client should be instructed that symptoms such as drowsiness, weakness, and fatigue are more intense in the early phase of therapy and diminish with c
88.) Dantrolene sodium (Dantrium) is prescribed for a client experiencing flexor spasms, and the client asks the nurse about the action of the medication. The nurse responds, knowing that the therapeutic action of this medication is which of the following
2. Acts directly on the skeletal muscle to relieve spasticity
Rationale:
Dantrium acts directly on skeletal muscle to relieve muscle spasticity. The primary action is the suppression of calcium release from the sarcoplasmic reticulum. This in turn decreas
89.) A nurse is reviewing the laboratory studies on a client receiving dantrolene sodium (Dantrium). Which laboratory test would identify an adverse effect associated with the administration of this medication?
1. Creatinine
2. Liver function tests
3. Blo
2. Liver function tests
Rationale:
Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, liver function tests should be performed before treatment and periodically throughout the treatment course.
90.) A nurse is reviewing the record of a client who has been prescribed baclofen (Lioresal). Which of the following disorders, if noted in the client's history, would alert the nurse to contact the health care provider?
1. Seizure disorders
2. Hyperthyro
1. Seizure disorders
Rationale:
Clients with seizure disorders may have a lowered seizure threshold when baclofen is administered. Concurrent therapy may require an increase in the anticonvulsive medication. The disorders in options 2, 3, and 4 are not a
91.) Cyclobenzaprine (Flexeril) is prescribed for a client to treat muscle spasms, and the nurse is reviewing the client's record. Which of the following disorders, if noted in the client's record, would indicate a need to contact the health care provider
1. Glaucoma
Rationale:
Because this medication has anticholinergic effects, it should be used with caution in clients with a history of urinary retention, angle-closure glaucoma, and increased intraocular pressure. Cyclobenzaprine hydrochloride should be
92.) In monitoring a client's response to disease-modifying antirheumatic drugs (DMARDs), which findings would the nurse interpret as acceptable responses? Select all that apply.
1. Symptom control during periods of emotional stress
2. Normal white blood
1. Symptom control during periods of emotional stress
2. Normal white blood cell counts, platelet, and neutrophil counts
3. Radiological findings that show nonprogression of joint degeneration
4. An increased range of motion in the affected joints 3 month
93.) The client who is human immunodeficiency virus seropositive has been taking stavudine (d4t, Zerit). The nurse monitors which of the following most closely while the client is taking this medication?
1. Gait
2. Appetite
3. Level of consciousness
4. He
1. Gait
Rationale:
Stavudine (d4t, Zerit) is an antiretroviral used to manage human immunodeficiency virus infection in clients who do not respond to or who cannot tolerate conventional therapy. The medication can cause peripheral neuropathy, and the nurs
94.) The client with acquired immunodeficiency syndrome has begun therapy with zidovudine (Retrovir, Azidothymidine, AZT, ZDV). The nurse carefully monitors which of the following laboratory results during treatment with this medication?
1. Blood culture
4. Complete blood count
Rationale:
A common side effect of therapy with zidovudine is leukopenia and anemia. The nurse monitors the complete blood count results for these changes. Options 1, 2, and 3 are unrelated to the use of this medication.
95.) The nurse is reviewing the results of serum laboratory studies drawn on a client with acquired immunodeficiency syndrome who is receiving didanosine (Videx). The nurse interprets that the client may have the medication discontinued by the health care
3. Serum amylase
Rationale:
Didanosine (Videx) can cause pancreatitis. A serum amylase level that is increased 1.5 to 2 times normal may signify pancreatitis in the client with acquired immunodeficiency syndrome and is potentially fatal. The medication ma
96.) The nurse is caring for a postrenal transplant client taking cyclosporine (Sandimmune, Gengraf, Neoral). The nurse notes an increase in one of the client's vital signs, and the client is complaining of a headache. What is the vital sign that is most
3. Blood pressure
Rationale:
Hypertension can occur in a client taking cyclosporine (Sandimmune, Gengraf, Neoral), and because this client is also complaining of a headache, the blood pressure is the vital sign to be monitoring most closely. Other adverse
97.) Amikacin (Amikin) is prescribed for a client with a bacterial infection. The client is instructed to contact the health care provider (HCP) immediately if which of the following occurs?
1. Nausea
2. Lethargy
3. Hearing loss
4. Muscle aches
3. Hearing loss
Rationale:
Amikacin (Amikin) is an aminoglycoside. Adverse effects of aminoglycosides include ototoxicity (hearing problems), confusion, disorientation, gastrointestinal irritation, palpitations, blood pressure changes, nephrotoxicity, and
98.) The nurse is assigned to care for a client with cytomegalovirus retinitis and acquired immunodeficiency syndrome who is receiving foscarnet. The nurse should check the latest results of which of the following laboratory studies while the client is ta
3. Serum creatinine
Rationale:
Foscarnet is toxic to the kidneys. Serum creatinine is monitored before therapy, two to three times per week during induction therapy, and at least weekly during maintenance therapy. Foscarnet may also cause decreased levels
99.) The client with acquired immunodeficiency syndrome and Pneumocystis jiroveci infection has been receiving pentamidine isethionate (Pentam 300). The client develops a temperature of 101� F. The nurse does further monitoring of the client, knowing that
4. The result of another infection caused by leukopenic effects of the medication.
Rationale:
Frequent side effects of this medication include leukopenia, thrombocytopenia, and anemia. The client should be monitored routinely for signs and symptoms of inf
100.) Saquinavir (Invirase) is prescribed for the client who is human immunodeficiency virus seropositive. The nurse reinforces medication instructions and tells the client to:
1. Avoid sun exposure.
2. Eat low-calorie foods.
3. Eat foods that are low in
1. Avoid sun exposure.
Rationale:
Saquinavir (Invirase) is an antiretroviral (protease inhibitor) used with other antiretroviral medications to manage human immunodeficiency virus infection. Saquinavir is administered with meals and is best absorbed if th
101.) Ketoconazole is prescribed for a client with a diagnosis of candidiasis. Select the interventions that the nurse includes when administering this medication. Select all that apply.
1. Restrict fluid intake.
2. Instruct the client to avoid alcohol.
3
2. Instruct the client to avoid alcohol.
3. Monitor hepatic and liver function studies.
5. Instruct the client to avoid exposure to the sun.
Rationale:
Ketoconazole is an antifungal medication. It is administered with food (not on an empty stomach) and an
102.) A client with human immunodeficiency virus is taking nevirapine (Viramune). The nurse should monitor for which adverse effects of the medication? Select all that apply.
1. Rash
2. Hepatotoxicity
3. Hyperglycemia
4. Peripheral neuropathy
5. Reduced b
1. Rash
2. Hepatotoxicity
Rationale:
Nevirapine (Viramune) is a non-nucleoside reverse transcriptase inhibitors (NRTI) that is used to treat HIV infection. It is used in combination with other antiretroviral medications to treat HIV. Adverse effects inclu
103.) A nurse is caring for a hospitalized client who has been taking clozapine (Clozaril) for the treatment of a schizophrenic disorder. Which laboratory study prescribed for the client will the nurse specifically review to monitor for an adverse effect
3. White blood cell count
Rationale:
Hematological reactions can occur in the client taking clozapine and include agranulocytosis and mild leukopenia. The white blood cell count should be checked before initiating treatment and should be monitored closely
104.) Disulfiram (Antabuse) is prescribed for a client who is seen in the psychiatric health care clinic. The nurse is collecting data on the client and is providing instructions regarding the use of this medication. Which is most important for the nurse
4. When the last alcoholic drink was consumed
Rationale:
Disulfiram is used as an adjunct treatment for selected clients with chronic alcoholism who want to remain in a state of enforced sobriety. Clients must abstain from alcohol intake for at least 12 h
105.) A nurse is collecting data from a client and the client's spouse reports that the client is taking donepezil hydrochloride (Aricept). Which disorder would the nurse suspect that this client may have based on the use of this medication?
1. Dementia
2
1. Dementia
Rationale:
Donepezil hydrochloride is a cholinergic agent used in the treatment of mild to moderate dementia of the Alzheimer type. It enhances cholinergic functions by increasing the concentration of acetylcholine. It slows the progression of
106.) Fluoxetine (Prozac) is prescribed for the client. The nurse reinforces instructions to the client regarding the administration of the medication. Which statement by the client indicates an understanding about administration of the medication?
1. "I
3. "I should take the medication in the morning when I first arise."
Rationale:
Fluoxetine hydrochloride is administered in the early morning without consideration to meals.
*
Eliminate options 1, 2, and 4 because they are comparable or alike and indicate
107.) A client receiving a tricyclic antidepressant arrives at the mental health clinic. Which observation indicates that the client is correctly following the medication plan?
1. Reports not going to work for this past week
2. Complains of not being able
3. Arrives at the clinic neat and appropriate in appearance
Rationale:
Depressed individuals will sleep for long periods, are not able to go to work, and feel as if they cannot "do anything." Once they have had some therapeutic effect from their medicatio
108.) A nurse is performing a follow-up teaching session with a client discharged 1 month ago who is taking fluoxetine (Prozac). What information would be important for the nurse to gather regarding the adverse effects related to the medication?
1. Cardio
2. Gastrointestinal dysfunctions
Rationale:
The most common adverse effects related to fluoxetine include central nervous system (CNS) and gastrointestinal (GI) system dysfunction. This medication affects the GI system by causing nausea and vomiting, cram
109.) A client taking buspirone (BuSpar) for 1 month returns to the clinic for a follow-up visit. Which of the following would indicate medication effectiveness?
1. No rapid heartbeats or anxiety
2. No paranoid thought processes
3. No thought broadcasting
1. No rapid heartbeats or anxiety
Rationale:
Buspirone hydrochloride is not recommended for the treatment of drug or alcohol withdrawal, paranoid thought disorders, or schizophrenia (thought broadcasting or delusions). Buspirone hydrochloride is most ofte
110.) A client taking lithium carbonate (Lithobid) reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is checked as a part of the routine follow-up and the level is 3.0 mEq/L. The nurse knows that this lev
1. Toxic
Rationale:
The therapeutic serum level of lithium is 0.6 to 1.2 mEq/L. A level of 3 mEq/L indicates toxicity.
111.) A client arrives at the health care clinic and tells the nurse that he has been doubling his daily dosage of bupropion hydrochloride (Wellbutrin) to help him get better faster. The nurse understands that the client is now at risk for which of the fo
3. Seizure activity
Rationale:
Bupropion does not cause significant orthostatic blood pressure changes. Seizure activity is common in dosages greater than 450 mg daily. Bupropion frequently causes a drop in body weight. Insomnia is a side effect, but seiz
112.) A hospitalized client is started on phenelzine sulfate (Nardil) for the treatment of depression. The nurse instructs the client to avoid consuming which foods while taking this medication? Select all that apply.
1. Figs
2. Yogurt
3. Crackers
4. Aged
1. Figs
2. Yogurt
4. Aged cheese
Rationale:
Phenelzine sulfate (Nardil) is a monoamine oxidase inhibitor(MAOI). The client should avoid taking in foods that are high in tyramine. Use of these foods could trigger a potentially fatal hypertensive crisis. So
113.) A nurse is reinforcing discharge instructions to a client receiving sulfisoxazole. Which of the following would be included in the plan of care for instructions?
1. Maintain a high fluid intake.
2. Discontinue the medication when feeling better.
3.
1. Maintain a high fluid intake.
Rationale:
Each dose of sulfisoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake. The medication is more soluble in alkaline urine. The client should not be instru
114.) A postoperative client requests medication for flatulence (gas pains). Which medication from the following PRN list should the nurse administer to this client?
1. Ondansetron (Zofran)
2. Simethicone (Mylicon)
3. Acetaminophen (Tylenol)
4. Magnesium
2. Simethicone (Mylicon)
Rationale:
Simethicone is an antiflatulent used in the relief of pain caused by excessive gas in the gastrointestinal tract. Ondansetron is used to treat postoperative nausea and vomiting. Acetaminophen is a nonopioid analgesic. M
115.) A client received 20 units of NPH insulin subcutaneously at 8:00 AM. The nurse should check the client for a potential hypoglycemic reaction at what time?
1. 5:00 PM
2. 10:00 AM
3. 11:00 AM
4. 11:00 PM
1. 5:00 PM
Rationale:
NPH is intermediate-acting insulin. Its onset of action is 1 to 2� hours, it peaks in 4 to 12 hours, and its duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.
116.) A nurse administers a dose of scopolamine (Transderm-Scop) to a postoperative client. The nurse tells the client to expect which of the following side effects of this medication?
1. Dry mouth
2. Diaphoresis
3. Excessive urination
4. Pupillary constr
1. Dry mouth
Rationale:
Scopolamine is an anticholinergic medication for the prevention of nausea and vomiting that causes the frequent side effects of dry mouth, urinary retention, decreased sweating, and dilation of the pupils. The other options describ
117.) A nurse has given the client taking ethambutol (Myambutol) information about the medication. The nurse determines that the client understands the instructions if the client immediately reports:
1. Impaired sense of hearing
2. Distressing gastrointes
4. Difficulty discriminating the color red from green
Rationale:
Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when driving a motor ve
118.) A nurse is caring for an older client with a diagnosis of myasthenia gravis and has reinforced self-care instructions. Which statement by the client indicates that further teaching is necessary?
1. "I rest each afternoon after my walk."
2. "I cough
4. "I can change the time of my medication on the mornings that I feel strong."
Rationale:
The client with myasthenia gravis should be taught that timing of anticholinesterase medication is critical. It is important to instruct the client to administer th
119.) A client with diabetes mellitus who has been controlled with daily insulin has been placed on atenolol (Tenormin) for the control of angina pectoris. Because of the effects of atenolol, the nurse determines that which of the following is the most re
4. Low blood glucose level
Rationale:
?-Adrenergic blocking agents, such as atenolol, inhibit the appearance of signs and symptoms of acute hypoglycemia, which would include nervousness, increased heart rate, and sweating. Therefore, the client receiving
120.) A client is taking lansoprazole (Prevacid) for the chronic management of Zollinger-Ellison syndrome. The nurse advises the client to take which of the following products if needed for a headache?
1. Naprosyn (Aleve)
2. Ibuprofen (Advil)
3. Acetamino
3. Acetaminophen (Tylenol)
Rationale:
Zollinger-Ellison syndrome is a hypersecretory condition of the stomach. The client should avoid taking medications that are irritating to the stomach lining. Irritants would include aspirin and nonsteroidal antiinfla
121.) A client who is taking hydrochlorothiazide (HydroDIURIL, HCTZ) has been started on triamterene (Dyrenium) as well. The client asks the nurse why both medications are required. The nurse formulates a response, based on the understanding that:
1. Both
4. Triamterene is a potassium-sparing diuretic, whereas hydrochlorothiazide is a potassium-losing diuretic.
Rationale:
Potassium-sparing diuretics include amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium). They are weak diuretics
122.) A client who has begun taking fosinopril (Monopril) is very distressed, telling the nurse that he cannot taste food normally since beginning the medication 2 weeks ago. The nurse provides the best support to the client by:
1. Telling the client not
3. Informing the client that impaired taste is expected and generally disappears in 2 to 3 months
Rationale:
ACE inhibitors, such as fosinopril, cause temporary impairment of taste (dysgeusia). The nurse can tell the client that this effect usually disapp
123.) A nurse is planning to administer amlodipine (Norvasc) to a client. The nurse plans to check which of the following before giving the medication?
1. Respiratory rate
2. Blood pressure and heart rate
3. Heart rate and respiratory rate
4. Level of con
2. Blood pressure and heart rate
Rationale:
Amlodipine is a calcium channel blocker. This medication decreases the rate and force of cardiac contraction. Before administering a calcium channel blocking agent, the nurse should check the blood pressure and
124.) A client with chronic renal failure is receiving ferrous sulfate (Feosol). The nurse monitors the client for which common side effect associated with this medication?
1. Diarrhea
2. Weakness
3. Headache
4. Constipation
4. Constipation
Rationale:
Feosol is an iron supplement used to treat anemia. Constipation is a frequent and uncomfortable side effect associated with the administration of oral iron supplements. Stool softeners are often prescribed to prevent constipatio
125.) A nurse is preparing to administer digoxin (Lanoxin), 0.125 mg orally, to a client with heart failure. Which vital sign is most important for the nurse to check before administering the medication?
1. Heart rate
2. Temperature
3. Respirations
4. Blo
1. Heart rate
Rationale:
Digoxin is a cardiac glycoside that is used to treat heart failure and acts by increasing the force of myocardial contraction. Because bradycardia may be a clinical sign of toxicity, the nurse counts the apical heart rate for 1 fu
126.) A nurse is caring for a client who has been prescribed furosemide (Lasix) and is monitoring for adverse effects associated with this medication. Which of the following should the nurse recognize as a potential adverse effect Select all that apply.
1
2. Tinnitus
3. Hypotension
4. Hypokalemia
Rationale:
Furosemide is a loop diuretic; therefore, an expected effect is increased urinary frequency. Nausea is a frequent side effect, not an adverse effect. Photosensitivity is an occasional side effect. Adver
127.) The nurse provides medication instructions to an older hypertensive client who is taking 20 mg of lisinopril (Prinivil, Zestril) orally daily. The nurse evaluates the need for further teaching when the client states which of the following?
1. "I can
1. "I can skip a dose once a week."
Rationale:
Lisinopril is an antihypertensive angiotensin-converting enzyme (ACE) inhibitor. The usual dosage range is 20 to 40 mg per day. Adverse effects include headache, dizziness, fatigue, orthostatic hypotension, t
128.) A nurse is providing instructions to an adolescent who has a history of seizures and is taking an anticonvulsant medication. Which of the following statements indicates that the client understands the instructions?
1. "I will never be able to drive
3. "I can't drink alcohol while I am taking my medication."
Rationale:
Alcohol will lower the seizure threshold and should be avoided. Adolescents can obtain a driver's license in most states when they have been seizure free for 1 year. Anticonvulsants ca
129.) Megestrol acetate (Megace), an antineoplastic medication, is prescribed for the client with metastatic endometrial carcinoma. The nurse reviews the client's history and contacts the registered nurse if which diagnosis is documented in the client's h
3. Thrombophlebitis
Rationale:
Megestrol acetate (Megace) suppresses the release of luteinizing hormone from the anterior pituitary by inhibiting pituitary function and regressing tumor size. Megestrol is used with caution if the client has a history of t
130.) The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the nurse specifically note as a result of the massive cell destruction that occurred from the chemother
3. Increased uric acid level
Rationale:
Hyperuricemia is especially common following treatment for leukemias and lymphomas because chemotherapy results in a massive cell kill. Although options 1, 2, and 4 also may be noted, an increased uric acid level is
131.) The nurse is reinforcing medication instructions to a client with breast cancer who is receiving cyclophosphamide (Neosar). The nurse tells the client to:
1. Take the medication with food.
2. Increase fluid intake to 2000 to 3000 mL daily.
3. Decrea
2. Increase fluid intake to 2000 to 3000 mL daily.
Rationale:
Hemorrhagic cystitis is a toxic effect that can occur with the use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this med
132.) The client with non-Hodgkin's lymphoma is receiving daunorubicin (DaunoXome). Which of the following would indicate to the nurse that the client is experiencing a toxic effect related to the medication?
1. Fever
2. Diarrhea
3. Complaints of nausea a
4. Crackles on auscultation of the lungs
Rationale:
Cardiotoxicity noted by abnormal electrocardiographic findings or cardiomyopathy manifested as congestive heart failure is a toxic effect of daunorubicin. Bone marrow depression is also a toxic effect. N
133.) A nurse is monitoring a client receiving desmopressin acetate (DDAVP) for adverse effects to the medication. Which of the following indicates the presence of an adverse effect?
1. Insomnia
2. Drowsiness
3. Weight loss
4. Increased urination
2. Drowsiness
Rationale:
Water intoxication (overhydration) or hyponatremia is an adverse effect to desmopressin. Early signs include drowsiness, listlessness, and headache. Decreased urination, rapid weight gain, confusion, seizures, and coma also may oc
134.) A nurse reinforces instructions to a client who is taking levothyroxine (Synthroid). The nurse tells the client to take the medication:
1. With food
2. At lunchtime
3. On an empty stomach
4. At bedtime with a snack
Rationale:
Oral doses of levothyroxine (Synthroid) should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast.
*
Note that options 1, 2, and 4 are comparable or alike in that these options address admi
135.) A nurse reinforces medication instructions to a client who is taking levothyroxine (Synthroid). The nurse instructs the client to notify the health care provider (HCP) if which of the following occurs?
1. Fatigue
2. Tremors
3. Cold intolerance
4. Ex
2. Tremors
Rationale:
Excessive doses of levothyroxine (Synthroid) can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, heat intolerance, and sweating. The client should be
136.) A nurse performs an admission assessment on a client who visits a health care clinic for the first time. The client tells the nurse that propylthiouracil (PTU) is taken daily. The nurse continues to collect data from the client, suspecting that the
2. Graves' disease
Rationale:
PTU inhibits thyroid hormone synthesis and is used to treat hyperthyroidism, or Graves' disease. Myxedema indicates hypothyroidism.
Cushing's syndrome and Addison's disease are disorders related to adrenal function.
137.) A nurse is reinforcing instructions for a client regarding intranasal desmopressin acetate (DDAVP). The nurse tells the client that which of the following is a side effect of the medication?
1. Headache
2. Vulval pain
3. Runny nose
4. Flushed skin
3. Runny nose
Rationale:
Desmopressin administered by the intranasal route can cause a runny or stuffy nose. Headache, vulval pain, and flushed skin are side effects if the medication is administered by the intravenous (IV) route.
138.) A daily dose of prednisone is prescribed for a client. A nurse reinforces instructions to the client regarding administration of the medication and instructs the client that the best time to take this medication is:
1. At noon
2. At bedtime
3. Early
3. Early morning
Rationale:
Corticosteroids (glucocorticoids) should be administered before 9:00 AM. Administration at this time helps minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenal glands each mor
139.) Prednisone is prescribed for a client with diabetes mellitus who is taking Humulin neutral protamine Hagedorn (NPH) insulin daily. Which of the following prescription changes does the nurse anticipate during therapy with the prednisone?
1. An additi
3. An increased amount of daily Humulin NPH insulin
Rationale:
Glucocorticoids can elevate blood glucose levels. Clients with diabetes mellitus may need their dosages of insulin or oral hypoglycemic medications increased during glucocorticoid therapy. The
140.) The client has a new prescription for metoclopramide (Reglan). On review of the chart, the nurse identifies that this medication can be safely administered with which condition?
1. Intestinal obstruction
2. Peptic ulcer with melena
3. Diverticulitis
4. Vomiting following cancer chemotherapy
Rationale:
Metoclopramide is a gastrointestinal (GI) stimulant and antiemetic. Because it is a GI stimulant, it is contraindicated with GI obstruction, hemorrhage, or perforation. It is used in the treatment of em
141.) The nurse has reinforced instructions to a client who has been prescribed cholestyramine (Questran). Which statement by the client indicates a need for further instructions?
1. "I will continue taking vitamin supplements."
2. "This medication will h
3. "This medication should only be taken with water."
Rationale:
Cholestyramine (Questran) is a bile acid sequestrant used to lower the cholesterol level, and client compliance is a problem because of its taste and palatability. The use of flavored produc
142.) A health care provider has written a prescription for ranitidine (Zantac), once daily. The nurse should schedule the medication for which of the following times?
1. At bedtime
2. After lunch
3. With supper
4. Before breakfast
1. At bedtime
Rationale:
A single daily dose of ranitidine is usually scheduled to be given at bedtime. This allows for a prolonged effect, and the greatest protection of the gastric mucosa.
*
recall that ranitidine suppresses secretions of gastric acids
143.) A client has just taken a dose of trimethobenzamide (Tigan). The nurse plans to monitor this client for relief of:
1. Heartburn
2. Constipation
3. Abdominal pain
4. Nausea and vomiting
4. Nausea and vomiting
Rationale:
Trimethobenzamide is an antiemetic agent used in the treatment of nausea and vomiting. The other options are incorrect.
144.) A client is taking docusate sodium (Colace). The nurse monitors which of the following to determine whether the client is having a therapeutic effect from this medication?
1. Abdominal pain
2. Reduction in steatorrhea
3. Hematest-negative stools
4.
4. Regular bowel movements
Rationale:
Docusate sodium is a stool softener that promotes the absorption of water into the stool, producing a softer consistency of stool. The intended effect is relief or prevention of constipation. The medication does not r
145.) A nurse has a prescription to give a client albuterol (Proventil HFA) (two puffs) and beclomethasone dipropionate (Qvar) (nasal inhalation, two puffs), by metered-dose inhaler. The nurse administers the medication by giving the:
1. Albuterol first a
1. Albuterol first and then the beclomethasone dipropionate
Rationale:
Albuterol is a bronchodilator. Beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are to be given on the same tim
146.) A client has begun therapy with theophylline (Theo-24). The nurse tells the client to limit the intake of which of the following while taking this medication?
1. Oranges and pineapple
2. Coffee, cola, and chocolate
3. Oysters, lobster, and shrimp
4.
2. Coffee, cola, and chocolate
Rationale:
Theophylline is a xanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These include coffee, cola, and chocolate.
147.) A client with a prescription to take theophylline (Theo-24) daily has been given medication instructions by the nurse. The nurse determines that the client needs further information about the medication if the client states that he or she will:
1. D
2. Take the daily dose at bedtime.
Rationale:
The client taking a single daily dose of theophylline, a xanthine bronchodilator, should take the medication early in the morning. This enables the client to have maximal benefit from the medication during day
148.) A client is taking cetirizine hydrochloride (Zyrtec). The nurse checks for which of the following side effects of this medication?
1. Diarrhea
2. Excitability
3. Drowsiness
4. Excess salivation
3. Drowsiness
Rationale:
A frequent side effect of cetirizine hydrochloride (Zyrtec), an antihistamine, is drowsiness or sedation. Others include blurred vision, hypertension (and sometimes hypotension), dry mouth, constipation, urinary retention, and swe
149.) A client taking fexofenadine (Allegra) is scheduled for allergy skin testing and tells the nurse in the health care provider's office that a dose was taken this morning. The nurse determines that:
1. The client should reschedule the appointment.
2.
1. The client should reschedule the appointment.
Rationale:
Fexofenadine is an antihistamine, which provides relief of symptoms caused by allergy. Antihistamines should be discontinued for at least 3 days (72 hours) before allergy skin testing to avoid fa
150.) A client complaining of not feeling well is seen in a clinic. The client is taking several medications for the control of heart disease and hypertension. These medications include a ?-blocker, digoxin (Lanoxin), and a diuretic. A tentative diagnosis
3. Double vision, loss of appetite, and nausea
Rationale:
Double vision, loss of appetite, and nausea are signs of digoxin toxicity. Additional signs of digoxin toxicity include bradycardia, difficulty reading, visual alterations such as green and yellow
151.) A client is being treated for acute congestive heart failure with intravenously administered bumetanide. The vital signs are as follows: blood pressure, 100/60 mm Hg; pulse, 96 beats/min; and respirations, 24 breaths/min. After the initial dose, whi
3. Monitoring blood pressure
Rationale:
Bumetanide is a loop diuretic. Hypotension is a common side effect associated with the use of this medication. The other options also require assessment but are not the priority.
*
priority ABCs�airway, breathing, a
152.) Intravenous heparin therapy is prescribed for a client. While implementing this prescription, a nurse ensures that which of the following medications is available on the nursing unit?
1. Protamine sulfate
2. Potassium chloride
3. Phytonadione (vitam
1. Protamine sulfate
Rationale:
The antidote to heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrhage occurs. Potassium chloride is administered for a potassium deficit. Vitamin K is an antidote for warfa
153.) A client is diagnosed with pulmonary embolism and is to be treated with streptokinase (Streptase). A nurse would report which priority data collection finding to the registered nurse before initiating this therapy?
1. Adventitious breath sounds
2. T
3. Blood pressure of 198/110 mm Hg
Rationale:
Thrombolytic therapy is contraindicated in a number of preexisting conditions in which there is a risk of uncontrolled bleeding, similar to the case in anticoagulant therapy. Thrombolytic therapy also is contr
154.) A nurse is reinforcing dietary instructions to a client who has been prescribed cyclosporine (Sandimmune). Which food item would the nurse instruct the client to avoid?
1. Red meats
2. Orange juice
3. Grapefruit juice
4. Green, leafy vegetables
3. Grapefruit juice
Rationale:
A compound present in grapefruit juice inhibits metabolism of cyclosporine. As a result, the consumption of grapefruit juice can raise cyclosporine levels by 50% to 100%, thereby greatly increasing the risk of toxicity. Grap
155.) Mycophenolate mofetil (CellCept) is prescribed for a client as prophylaxis for organ rejection following an allogeneic renal transplant. Which of the following instructions does the nurse reinforce regarding administration of this medication?
1. Adm
4. Contact the health care provider (HCP) if a sore throat occurs.
Rationale:
Mycophenolate mofetil should be administered on an empty stomach. The capsules should not be opened or crushed. The client should contact the HCP if unusual bleeding or bruising
156.) A nurse is reviewing the laboratory results for a client receiving tacrolimus (Prograf). Which laboratory result would indicate to the nurse that the client is experiencing an adverse effect of the medication?
1. Blood glucose of 200 mg/dL
2. Potass
1. Blood glucose of 200 mg/dL
Rationale:
A blood glucose level of 200 mg/dL is elevated above the normal range of 70 to 110 mg/dL and suggests an adverse effect. Other adverse effects include neurotoxicity evidenced by headache, tremor, insomnia; gastroin
157.) A client receiving nitrofurantoin (Macrodantin) calls the health care provider's office complaining of side effects related to the medication. Which side effect indicates the need to stop treatment with this medication?
1. Nausea
2. Diarrhea
3. Anor
4. Cough and chest pain
Rationale:
Gastrointestinal (GI) effects are the most frequent adverse reactions to this medication and can be minimized by administering the medication with milk or meals. Pulmonary reactions, manifested as dyspnea, chest pain, ch
158.) A client with chronic renal failure is receiving epoetin alfa (Epogen, Procrit). Which laboratory result would indicate a therapeutic effect of the medication?
1. Hematocrit of 32%
2. Platelet count of 400,000 cells/mm3
3. White blood cell count of
1. Hematocrit of 32%
Rationale:
Epoetin alfa is used to reverse anemia associated with chronic renal failure. A therapeutic effect is seen when the hematocrit is between 30% and 33%. The laboratory tests noted in the other options are unrelated to the use
159.) A nurse is caring for a client receiving morphine sulfate subcutaneously for pain. Because morphine sulfate has been prescribed for this client, which nursing action would be included in the plan of care?
1. Encourage fluid intake.
2. Monitor the cl
4. Encourage the client to cough and deep breathe.
Rationale:
Morphine sulfate suppresses the cough reflex. Clients need to be encouraged to cough and deep breathe to prevent pneumonia.
*
ABCs�airway, breathing, and circulation
n**
160.) Meperidine hydrochloride (Demerol) is prescribed for the client with pain. Which of the following would the nurse monitor for as a side effect of this medication?
1. Diarrhea
2. Bradycardia
3. Hypertension
4. Urinary retention
4. Urinary retention
Rationale:
Meperidine hydrochloride (Demerol) is an opioid analgesic. Side effects of this medication include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary rete
161.) A nurse is caring for a client with severe back pain, and codeine sulfate has been prescribed for the client. Which of the following would the nurse include in the plan of care while the client is taking this medication?
1. Restrict fluid intake.
2.
2. Monitor bowel activity.
Rationale:
While the client is taking codeine sulfate, an opioid analgesic, the nurse would monitor vital signs and monitor for hypotension. The nurse should also increase fluid intake, palpate the bladder for urinary retention,
162.) Carbamazepine (Tegretol) is prescribed for a client with a diagnosis of psychomotor seizures. The nurse reviews the client's health history, knowing that this medication is contraindicated if which of the following disorders is present?
1. Headaches
2. Liver disease
Rationale:
Carbamazepine (Tegretol) is contraindicated in liver disease, and liver function tests are routinely prescribed for baseline purposes and are monitored during therapy. It is also contraindicated if the client has a history of b
163.) A client with trigeminal neuralgia tells the nurse that acetaminophen (Tylenol) is taken on a frequent daily basis for relief of generalized discomfort. The nurse reviews the client's laboratory results and determines that which of the following ind
4. A direct bilirubin level of 2 mg/dL
Rationale:
In adults, overdose of acetaminophen (Tylenol) causes liver damage. Option 4 is an indicator of liver function and is the only option that indicates an abnormal laboratory value. The normal direct bilirubi
164.) A client receives a prescription for methocarbamol (Robaxin), and the nurse reinforces instructions to the client regarding the medication. Which client statement would indicate a need for further instructions?
1. "My urine may turn brown or green.
3. "If my vision becomes blurred, I don't need to be concerned about it."
Rationale:
The client needs to be told that the urine may turn brown, black, or green. Other adverse effects include blurred vision, nasal congestion, urticaria, and rash. The clien
165.) The client has been on treatment for rheumatoid arthritis for 3 weeks. During the administration of etanercept (Enbrel), it is most important for the nurse to assess:
1. The injection site for itching and edema
2. The white blood cell counts and pla
2. The white blood cell counts and platelet counts
Rationale:
Infection and pancytopenia are adverse effects of etanercept (Enbrel). Laboratory studies are performed before and during treatment. The appearance of abnormal white blood cell counts and abnor
166.) Alendronate (Fosamax) is prescribed for a client with osteoporosis. The client taking this medication is instructed to:
1. Take the medication at bedtime.
2. Take the medication in the morning with breakfast.
3. Lie down for 30 minutes after taking
4. Take the medication with a full glass of water after rising in the morning.
Rationale:
Precautions need to be taken with administration of alendronate to prevent gastrointestinal side effects (especially esophageal irritation) and to increase absorptio
167.) A nurse prepares to reinforce instructions to a client who is taking allopurinol (Zyloprim). The nurse plans to include which of the following in the instructions?
1. Instruct the client to drink 3000 mL of fluid per day.
2. Instruct the client to t
1. Instruct the client to drink 3000 mL of fluid per day.
Rationale:
Allopurinol (Zyloprim) is an antigout medication used to decrease uric acid levels. Clients taking allopurinol are encouraged to drink 3000 mL of fluid a day. A full therapeutic effect m
168.) Colcrys (colchicine) is prescribed for a client with a diagnosis of gout. The nurse reviews the client's medical history in the health record, knowing that the medication would be contraindicated in which disorder?
1. Myxedema
2. Renal failure
3. Hy
2. Renal failure
Rationale:
Colchicine is contraindicated in clients with severe gastrointestinal, renal, hepatic or cardiac disorders, or with blood dyscrasias. Clients with impaired renal function may exhibit myopathy and neuropathy manifested as genera
169.) Insulin glargine (Lantus) is prescribed for a client with diabetes mellitus. The nurse tells the client that it is best to take the insulin:
1. 1 hour after each meal
2. Once daily, at the same time each day
3. 15 minutes before breakfast, lunch, an
2. Once daily, at the same time each day
Rationale:
Insulin glargine is a long-acting recombinant DNA human insulin used to treat type 1 and type 2 diabetes mellitus. It has a 24-hour duration of action and is administered once a day, at the same time eac
170.) Atenolol hydrochloride (Tenormin) is prescribed for a hospitalized client. The nurse should perform which of the following as a priority action before administering the medication?
1. Listen to the client's lung sounds.
2. Check the client's blood p
2. Check the client's blood pressure.
Rationale:
Atenolol hydrochloride is a beta-blocker used to treat hypertension. Therefore the priority nursing action before administration of the medication is to check the client's blood pressure. The nurse also che
171.) A nurse is preparing to administer furosemide (Lasix) to a client with a diagnosis of heart failure. The most important laboratory test result for the nurse to check before administering this medication is:
1. Potassium level
2. Creatinine level
3.
1. Potassium level
Rationale:
Furosemide is a loop diuretic. The medication causes a decrease in the client's electrolytes, especially potassium, sodium, and chloride. Administering furosemide to a client with low electrolyte levels could precipitate vent
172.) A nurse provides dietary instructions to a client who will be taking warfarin sodium (Coumadin). The nurse tells the client to avoid which food item?
1. Grapes
2. Spinach
3. Watermelon
4. Cottage cheese
2. Spinach
Rationale:
Warfarin sodium is an anticoagulant. Anticoagulant medications act by antagonizing the action of vitamin K, which is needed for clotting. When a client is taking an anticoagulant, foods high in vitamin K often are omitted from the di
173.) A nurse reviews the medication history of a client admitted to the hospital and notes that the client is taking leflunomide (Arava). During data collection, the nurse asks which question to determine medication effectiveness?
1. "Do you have any joi
1. "Do you have any joint pain?"
Rationale:
Leflunomide is an immunosuppressive agent and has an anti-inflammatory action. The medication provides symptomatic relief of rheumatoid arthritis. Diarrhea can occur as a side effect of the medication. The other
174.) A client with portosystemic encephalopathy is receiving oral lactulose (Chronulac) daily. The nurse assesses which of the following to determine medication effectiveness?
1. Lung sounds
2. Blood pressure
3. Blood ammonia level
4. Serum potassium lev
3. Blood ammonia level
Rationale:
Lactulose is a hyperosmotic laxative and ammonia detoxicant. It is used to prevent or treat portosystemic encephalopathy, including hepatic precoma and coma. It also is used to treat constipation. The medication retains a
175.) A nurse notes that a client is receiving lamivudine (Epivir). The nurse determines that this medication has been prescribed to treat which of the following?
1. Pancreatitis
2. Pharyngitis
3. Tonic-clonic seizures
4. Human immunodeficiency virus (HIV
4. Human immunodeficiency virus (HIV) infection
Rationale:
Lamivudine is a nucleoside reverse transcriptase inhibitor and antiviral medication. It slows HIV replication and reduces the progression of HIV infection. It also is used to treat chronic hepatit
176.) A nurse notes that a client is taking lansoprazole (Prevacid). On data collection, the nurse asks which question to determine medication effectiveness?
1. "Has your appetite increased?"
2. "Are you experiencing any heartburn?"
3. "Do you have any pr
2. "Are you experiencing any heartburn?"
Rationale:
Lansoprazole is a gastric acid pump inhibitor used to treat gastric and duodenal ulcers, erosive esophagitis, and hypersecretory conditions. It also is used to treat gastroesophageal reflux disease (GERD
177.) A nurse is assisting in caring for a pregnant client who is receiving intravenous magnesium sulfate for the management of preeclampsia and notes that the client's deep tendon reflexes are absent. On the basis of this data, the nurse reports the find
4. The client is experiencing magnesium toxicity.
Rationale:
Magnesium toxicity can occur as a result of magnesium sulfate therapy. Signs of magnesium sulfate toxicity relate to the central nervous system depressant effects of the medication and include r
178.) Methylergonovine (Methergine) is prescribed for a client with postpartum hemorrhage caused by uterine atony. Before administering the medication, the nurse checks which of the following as the important client parameter?
1. Temperature
2. Lochial fl
4. Blood pressure
Rationale:
Methylergonovine is an ergot alkaloid used for postpartum hemorrhage. It stimulates contraction of the uterus and causes arterial vasoconstriction. Ergot alkaloids are avoided in clients with significant cardiovascular disease
179.) A nurse provides medication instructions to a client who had a kidney transplant about therapy with cyclosporine (Sandimmune). Which statement by the client indicates a need for further instruction?
1. "I need to obtain a yearly influenza vaccine.
1. "I need to obtain a yearly influenza vaccine."
Rationale:
Cyclosporine is an immunosuppressant medication. Because of the medication's effects, the client should not receive any vaccinations without first consulting the HCP. The client should report de
180.) A health care provider (HCP) writes a prescription for digoxin (Lanoxin), 0.25 mg daily. The nurse teaches the client about the medication and tells the client that it is important to:
1. Count the radial and carotid pulses every morning.
2. Check t
4. Withhold the medication and call the HCP if the pulse is less than 60 beats per minute.
Rationale:
An important component of taking this medication is monitoring the pulse rate; however, it is not necessary for the client to take both the radial and ca
181.) A client is taking ticlopidine hydrochloride (Ticlid). The nurse tells the client to avoid which of the following while taking this medication?
1. Vitamin C
2. Vitamin D
3. Acetaminophen (Tylenol)
4. Acetylsalicylic acid (aspirin)
4. Acetylsalicylic acid (aspirin)
Rationale:
Ticlopidine hydrochloride is a platelet aggregation inhibitor. It is used to decrease the risk of thrombotic strokes in clients with precursor symptoms. Because it is an antiplatelet agent, other medications th
182.) A client with angina pectoris is experiencing chest pain that radiates down the left arm. The nurse administers a sublingual nitroglycerin tablet to the client. The client's pain is unrelieved, and the nurse determines that the client needs another
Rationale:
Nitroglycerin acts directly on the smooth muscle of the blood vessels, causing relaxation and dilation. As a result, hypotension can occur. The nurse would check the client's blood pressure before administering the second nitroglycerin tablet.
183.) A client who received a kidney transplant is taking azathioprine (Imuran), and the nurse provides instructions about the medication. Which statement by the client indicates a need for further instructions?
1. "I need to watch for signs of infection.
2. "I need to discontinue the medication after 14 days of use."
Rationale:
Azathioprine is an immunosuppressant medication that is taken for life. Because of the effects of the medication, the client must watch for signs of infection, which are reported i
184.) A nurse preparing a client for surgery reviews the client's medication record. The client is to be nothing per mouth (NPO) after midnight. Which of the following medications, if noted on the client's record, should the nurse question?
1. Cyclobenzap
4. Prednisone
Rationale:
Prednisone is a corticosteroid that can cause adrenal atrophy, which reduces the body's ability to withstand stress. Before and during surgery, dosages may be temporarily increased. Cyclobenzaprine is a skeletal muscle relaxant. A
185.) Which of the following herbal therapies would be prescribed for its use as an antispasmodic? Select all that apply.
1.Aloe
2.Kava
3.Ginger
4.Chamomile
5.Peppermint oil
4.Chamomile
5.Peppermint oil
Rationale:
Chamomile has a mild sedative effect and acts as an antispasmodic and anti-inflammatory. Peppermint oil acts as an antispasmodic and is used for irritable bowel syndrome. Topical aloe promotes wound healing. Aloe ta
186.) A nurse prepares to administer sodium polystyrene sulfonate (Kayexalate) to a client. Before administering the medication, the nurse reviews the action of the medication and understands that it:
1. Releases bicarbonate in exchange for primarily sodi
2. Releases sodium ions in exchange for primarily potassium ions
Rationale:
Sodium polystyrene sulfonate is a cation exchange resin used in the treatment of hyperkalemia. The resin either passes through the intestine or is retained in the colon. It releas
187.) A clinic nurse prepares to administer an MMR (measles, mumps, rubella) vaccine to a child. How is this vaccine best administered?
1. Intramuscularly in the deltoid muscle
2. Subcutaneously in the gluteal muscle
3. Subcutaneously in the outer aspect
3. Subcutaneously in the outer aspect of the upper arm
Rationale:
The MMR vaccine is administered subcutaneously in the outer aspect of the upper arm. The gluteal muscle is most often used for intramuscular injections. The MMR vaccine is not administered
188.) The nurse should anticipate that the most likely medication to be prescribed prophylactically for a child with spina bifida (myelomeningocele) who has a neurogenic bladder would be:
1. Prednisone
2. Sulfisoxazole
3. Furosemide (Lasix)
4. Intravenous
2. Sulfisoxazole
Rationale:
A neurogenic bladder prevents the bladder from completely emptying because of the decrease in muscle tone. The most likely medication to be prescribed to prevent urinary tract infection would be an antibiotic. A common prescrib
189.) Prostaglandin E1 is prescribed for a child with transposition of the great arteries. The mother of the child asks the nurse why the child needs the medication. The nurse tells the mother that the medication:
1. Prevents hypercyanotic (blue or tet) s
4. Provides adequate oxygen saturation and maintains cardiac output
Rationale:
A child with transposition of the great arteries may receive prostaglandin E1 temporarily to increase blood mixing if systemic and pulmonary mixing are inadequate to maintain a
190.) A child is hospitalized with a diagnosis of lead poisoning. The nurse assisting in caring for the child would prepare to assist in administering which of the following medications?
1. Activated charcoal
2. Sodium bicarbonate
3. Syrup of ipecac syrup
4. Dimercaprol (BAL in Oil)
Rationale:
Dimercaprol is a chelating agent that is administered to remove lead from the circulating blood and from some tissues and organs for excretion in the urine. Sodium bicarbonate may be used in salicylate poisoning. Syr
191.) A child is brought to the emergency department for treatment of an acute asthma attack. The nurse prepares to administer which of the following medications first?
1. Oral corticosteroids
2. A leukotriene modifier
3. A ?2 agonist
4. A nonsteroidal an
3. A ?2 agonist
Rationale:
In treating an acute asthma attack, a short acting ?2 agonist such as albuterol (Proventil HFA) will be given to produce bronchodilation. Options 1, 2, and 4 are long-term control (preventive) medications.
192.) A nurse is collecting medication information from a client, and the client states that she is taking garlic as an herbal supplement. The nurse understands that the client is most likely treating which of the following conditions?
1. Eczema
2. Insomn
4. Hyperlipidemia
Rationale:
Garlic is an herbal supplement that is used to treat hyperlipidemia and hypertension. An herbal supplement that may be used to treat eczema is evening primrose. Insomnia has been treated with both valerian root and chamomile.
193.) Sodium hypochlorite (Dakin's solution) is prescribed for a client with a leg wound containing purulent drainage. The nurse is assisting in developing a plan of care for the client and includes which of the following in the plan?
1. Ensure that the s
1. Ensure that the solution is freshly prepared before use.
Rationale:
Dakin solution is a chloride solution that is used for irrigating and cleaning necrotic or purulent wounds. It can be used for packing necrotic wounds. It cannot be used to pack purule
194.) A nurse provides instructions to a client regarding the use of tretinoin (Retin-A). Which statement by the client indicates the need for further instructions?
1. "Optimal results will be seen after 6 weeks."
2. "I should apply a very thin layer to m
2. "I should apply a very thin layer to my skin."
Rationale:
Tretinoin is applied liberally to the skin. The hands are washed thoroughly immediately after applying. Therapeutic results should be seen after 2 to 3 weeks but may not be optimal until after 6
195.) A nurse is caring for a client who is taking metoprolol (Lopressor). The nurse measures the client's blood pressure (BP) and apical pulse (AP) immediately before administration. The client's BP is 122/78 mm/Hg and the AP is 58 beats/min. Based on th
1. Withhold the medication.
Rationale:
Metoprolol (Lopressor) is classified as a beta-adrenergic blocker and is used in the treatment of hypertension, angina, and myocardial infarction. Baseline nursing assessments include measurement of BP and AP immedia
196.) A client has been prescribed amikacin (Amikin). Which of the following priority baseline functions should be monitored?
1. Apical pulse
2. Liver function
3. Blood pressure
4. Hearing acuity
4. Hearing acuity
Rationale:
Amikacin (Amikin) is an antibiotic. This medication can cause ototoxicity and nephrotoxicity; therefore, hearing acuity tests and kidney function studies should be performed before the initiation of therapy. Apical pulse, live
197.) Collagenase (Santyl) is prescribed for a client with a severe burn to the hand. The nurse provides instructions to the client regarding the use of the medication. Which statement by the client indicates an accurate understanding of the use of this m
3. "I will apply the ointment once a day and cover it with a sterile dressing."
Rationale:
Collagenase is used to promote debridement of dermal lesions and severe burns. It is usually applied once daily and covered with a sterile dressing.
198.) Coal tar has been prescribed for a client with a diagnosis of psoriasis, and the nurse provides instructions to the client about the medication. Which statement by the client indicates a need for further instructions?
1. "The medication can cause ph
4. "The medication can cause systemic effects."
Rationale:
Coal tar is used to treat psoriasis and other chronic disorders of the skin. It suppresses DNA synthesis, mitotic activity, and cell proliferation. It has an unpleasant odor, can frequently stain
199.) A nurse is applying a topical glucocorticoid to a client with eczema. The nurse monitors for systemic absorption of the medication if the medication is being applied to which of the following body areas?
1. Back
2. Axilla
3. Soles of the feet
4. Pal
2. Axilla
Rationale:
Topical glucocorticoids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axillae, face, eyelids, neck, perineum, genitalia), and lower from regions where p
200.) A client is seen in the clinic for complaints of skin itchiness that has been persistent over the past several weeks. Following data collection, it has been determined that the client has scabies. Lindane is prescribed, and the nurse is asked to pro
4. Leave the cream on for 8 to 12 hours and then remove by washing.
Rationale:
Lindane is applied in a thin layer to the entire body below the head. No more than 30 g (1 oz) should be used. The medication is removed by washing 8 to 12 hours later. Usually
201.) A nurse is preparing to administer eardrops to an infant. The nurse plans to:
1. Pull up and back on the ear and direct the solution onto the eardrum.
2. Pull down and back on the ear and direct the solution onto the eardrum.
3. Pull down and back o
3. Pull down and back on the ear and direct the solution toward the wall of the canal.
Rationale:
When administering eardrops to an infant, the nurse pulls the ear down and straight back. In the adult or a child older than 3 years, the ear is pulled up an
202.) A nurse is collecting data from a client about medications being taken, and the client tells the nurse that he is taking herbal supplements for the treatment of varicose veins. The nurse understands that the client is most likely taking which of the
1. Bilberry
Rationale:
Bilberry is an herbal supplement that has been used to treat varicose veins. This supplement has also been used to treat cataracts, retinopathy, diabetes mellitus, and peripheral vascular disease. Ginseng has been used to improve me
203.) A nurse is preparing to give the postcraniotomy client medication for incisional pain. The family asks the nurse why the client is receiving codeine sulfate and not "something stronger." In formulating a response, the nurse incorporates the understa
4. Does not alter respirations or mask neurological signs as do other opioids
Rationale:
Codeine sulfate is the opioid analgesic often used for clients after craniotomy. It is frequently combined with a nonopioid analgesic such as acetaminophen for added
204.) A client receives a dose of edrophonium (Enlon). The client shows improvement in muscle strength for a period of time following the injection. The nurse interprets that this finding is compatible with:
1. Multiple sclerosis
2. Myasthenia gravis
3. M
2. Myasthenia gravis
Rationale:
Myasthenia gravis can often be diagnosed based on clinical signs and symptoms. The diagnosis can be confirmed by injecting the client with a dose of edrophonium . This medication inhibits the breakdown of an enzyme in the n
205.) A nurse is assisting in preparing to administer acetylcysteine (Mucomyst) to a client with an overdose of acetaminophen (Tylenol). The nurse prepares to administer the medication by:
1. Administering the medication subcutaneously in the deltoid musc
4. Mixing the medication in a flavored ice drink and allowing the client to drink the medication through a straw
Rationale:
Because acetylcysteine has a pervasive odor of rotten eggs, it must be disguised in a flavored ice drink. It is consumed preferably
206.) A client is receiving baclofen (Lioresal) for muscle spasms caused by a spinal cord injury. The nurse monitors the client, knowing that which of the following is a side effect of this medication?
1. Muscle pain
2. Hypertension
3. Slurred speech
4. P
Rationale:
Side effects of baclofen include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesia of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion. Paradox
207.) A client is suspected of having myasthenia gravis, and the health care provider administers edrophonium (Enlon) to determine the diagnosis. After administration of this medication, which of the following would indicate the presence of myasthenia gra
3. An increase in muscle strength
Rationale:
Edrophonium is a short-acting acetylcholinesterase inhibitor used as a diagnostic agent. When a client with suspected myasthenia gravis is given the medication intravenously, an increase in muscle strength woul
208.) A client with myasthenia gravis verbalizes complaints of feeling much weaker than normal. The health care provider plans to implement a diagnostic test to determine if the client is experiencing a myasthenic crisis and administers edrophonium (Enlon
auto-define "A client with myasthen..."
Rationale:
Edrophonium (Enlon) is administered to determine whether the client is reacting to an overdose of a medication (cholinergic crisis) or to an increasing severity of the disease (myasthenic crisis). When th
209.) A client with multiple sclerosis is receiving diazepam (Valium), a centrally acting skeletal muscle relaxant. Which of the following would indicate that the client is experiencing a side effect related to this medication?
1. Headache
2. Drowsiness
3
2. Drowsiness
Rationale:
Incoordination and drowsiness are common side effects resulting from this medication. Options 1, 3, and 4 are incorrect.
210.) Dantrolene (Dantrium) is prescribed for a client with a spinal cord injury for discomfort resulting from spasticity. The nurse tells the client about the importance of follow-up and the need for which blood study?
1. Creatinine level
2. Sedimentatio
3. Liver function studies
Rationale:
Dantrolene can cause liver damage, and the nurse should monitor liver function studies. Baseline liver function studies are done before therapy starts, and regular liver function studies are performed throughout therap
211.) A client with epilepsy is taking the prescribed dose of phenytoin (Dilantin) to control seizures. A phenytoin blood level is drawn, and the results reveal a level of 35 mcg/ml. Which of the following symptoms would be expected as a result of this la
3. Slurred speech
Rationale:
The therapeutic phenytoin level is 10 to 20 mcg/mL. At a level higher than 20 mcg/mL, involuntary movements of the eyeballs (nystagmus) appear. At a level higher than 30 mcg/mL, ataxia and slurred speech occur.
212.) Mannitol (Osmitrol) is being administered to a client with increased intracranial pressure following a head injury. The nurse assisting in caring for the client knows that which of the following indicates the therapeutic action of this medication?
1
4. Induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes
Rationale:
Mannitol is an osmotic diuretic that induces diuresis by raising the osmotic pressure of glomerular filtrat
213.) A client is admitted to the hospital with complaints of back spasms. The client states, "I have been taking two or three aspirin every 4 hours for the past week and it hasn't helped my back." Aspirin intoxication is suspected. Which of the following
1. Tinnitus
Rationale:
Mild intoxication with acetylsalicylic acid (aspirin) is called salicylism and is commonly experienced when the daily dosage is higher than 4 g. Tinnitus (ringing in the ears) is the most frequently occurring effect noted with intox
214.) A health care provider initiates carbidopa/levodopa (Sinemet) therapy for the client with Parkinson's disease. A few days after the client starts the medication, the client complains of nausea and vomiting. The nurse tells the client that:
1. Taking
2. Taking the medication with food will help to prevent the nausea.
Rationale:
If carbidopa/levodopa is causing nausea and vomiting, the nurse would tell the client that taking the medication with food will prevent the nausea. Additionally, the client sho
215.) A client with rheumatoid arthritis is taking acetylsalicylic acid (aspirin) on a daily basis. Which medication dose should the nurse expect the client to be taking?
1. 1 g daily
2. 4 g daily
3. 325 mg daily
4. 1000 mg daily
2. 4 g daily
Rationale:
Aspirin may be used to treat the client with rheumatoid arthritis. It may also be used to reduce the risk of recurrent transient ischemic attack (TIA) or brain attack (stroke) or reduce the risk of myocardial infarction (MI) in cli
216.) A nurse is caring for a client with gout who is taking Colcrys (colchicine). The client has been instructed to restrict the diet to low-purine foods. Which of the following foods should the nurse instruct the client to avoid while taking this medica
2. Scallops
Rationale:
Colchicine is a medication used for clients with gout to inhibit the reabsorption of uric acid by the kidney and promote excretion of uric acid in the urine. Uric acid is produced when purine is catabolized. Clients are instructed t
217.) A health care provider prescribes auranofin (Ridaura) for a client with rheumatoid arthritis. Which of the following would indicate to the nurse that the client is experiencing toxicity related to the medication?
1. Joint pain
2. Constipation
3. Rin
4. Complaints of a metallic taste in the mouth
Rationale:
Ridaura is the one gold preparation that is given orally rather than by injection. Gastrointestinal reactions including diarrhea, abdominal pain, nausea, and loss of appetite are common early in th
218.) A film-coated form of diflunisal has been prescribed for a client for the treatment of chronic rheumatoid arthritis. The client calls the clinic nurse because of difficulty swallowing the tablets. Which initial instruction should the nurse provide t
4. "Swallow the tablets with large amounts of water or milk."
Rationale:
Diflunisal may be given with water, milk, or meals. The tablets should not be crushed or broken open. Taking the medication with a large amount of water or milk should be tried befor
219.) A health care provider instructs a client with rheumatoid arthritis to take ibuprofen (Motrin). The nurse reinforces the instructions, knowing that the normal adult dose for this client is which of the following?
1. 100 mg orally twice a day
2. 200
3. 400 mg orally three times a day
Rationale:
For acute or chronic rheumatoid arthritis or osteoarthritis, the normal oral adult dose is 400 to 800 mg three or four times daily.
220.) A adult client with muscle spasms is taking an oral maintenance dose of baclofen (Lioresal). The nurse reviews the medication record, expecting that which dose should be prescribed?
1. 15 mg four times a day
2. 25 mg four times a day
3. 30 mg four t
1. 15 mg four times a day
Rationale:
Baclofen is dispensed in 10- and 20-mg tablets for oral use. Dosages are low initially and then gradually increased. Maintenance doses range from 15 to 20 mg administered three or four times a day.
221.) A nurse is reviewing the health care provider's prescriptions for an adult client who has been admitted to the hospital following a back injury. Carisoprodol (Soma) is prescribed for the client to relieve the muscle spasms; the health care provider
1. The normal adult dosage
Rationale:
The normal adult dosage for carisoprodol is 350 mg orally three or four times daily.
222.) A nurse has administered a dose of diazepam (Valium) to a client. The nurse would take which important action before leaving the client's room?
1. Giving the client a bedpan
2. Drawing the shades or blinds closed
3. Turning down the volume on the te
4. Per agency policy, putting up the side rails on the bed
Rationale:
Diazepam is a sedative-hypnotic with anticonvulsant and skeletal muscle relaxant properties. The nurse should institute safety measures before leaving the client's room to ensure that t
223.) A client with a psychotic disorder is being treated with haloperidol (Haldol). Which of the following would indicate the presence of a toxic effect of this medication?
1. Nausea
2. Hypotension
3. Blurred vision
4. Excessive salivation
4. Excessive salivation
Rationale:
Toxic effects include extrapyramidal symptoms (EPS) noted as marked drowsiness and lethargy, excessive salivation, and a fixed stare. Akathisia, acute dystonias, and tardive dyskinesia are also signs of toxicity. Hypoten
224.) Neuroleptic malignant syndrome is suspected in a client who is taking chlorpromazine. Which medication would the nurse prepare in anticipation of being prescribed to treat this adverse effect related to the use of chlorpromazine?
1. Protamine sulfat
2. Bromocriptine (Parlodel)
Rationale:
Bromocriptine is an antiparkinsonian prolactin inhibitor used in the treatment of neuroleptic malignant syndrome. Vitamin K is the antidote for warfarin (Coumadin) overdose. Protamine sulfate is the antidote for hepa
225.) A nursing student is assigned to care for a client with a diagnosis of schizophrenia. Haloperidol (Haldol) is prescribed for the client, and the nursing instructor asks the student to describe the action of the medication. Which statement by the nur
4. It blocks the binding of dopamine to the postsynaptic dopamine receptors in the brain.
Rationale:
Haloperidol acts by blocking the binding of dopamine to the postsynaptic dopamine receptors in the brain. Imipramine hydrochloride (Tofranil) blocks the r
226.) A client receiving lithium carbonate (Lithobid) complains of loose, watery stools and difficulty walking. The nurse would expect the serum lithium level to be which of the following?
1. 0.7 mEq/L
2. 1.0 mEq/L
3. 1.2 mEq/L
4. 1.7 mEq/L
4. 1.7 mEq/L
Rationale:
The therapeutic serum level of lithium ranges from 0.6 to 1.2 mEq/L. Serum lithium levels above the therapeutic level will produce signs of toxicity.
227.) When teaching a client who is being started on imipramine hydrochloride (Tofranil), the nurse would inform the client that the desired effects of the medication may:
1. Start during the first week of administration
2. Not occur for 2 to 3 weeks of a
2. Not occur for 2 to 3 weeks of administration
Rationale:
The therapeutic effects of administration of imipramine hydrochloride may not occur for 2 to 3 weeks after the antidepressant therapy has been initiated. Therefore options 1, 3, and 4 are incorrec
228.) A client receiving an anxiolytic medication complains that he feels very "faint" when he tries to get out of bed in the morning. The nurse recognizes this complaint as a symptom of:
1. Cardiac dysrhythmias
2. Postural hypotension
3. Psychosomatic sy
2. Postural hypotension
Rationale:
Anxiolytic medications can cause postural hypotension. The client needs to be taught to rise to a sitting position and get out of bed slowly because of this adverse effect related to the medication. Options 1, 3, and 4 a
229.) A client who is taking lithium carbonate (Lithobid) is scheduled for surgery. The nurse informs the client that:
1. The medication will be discontinued a week before the surgery and resumed 1 week postoperatively.
2. The medication is to be taken un
3. The medication will be discontinued 1 to 2 days before the surgery and resumed as soon as full oral intake is allowed.
Rationale:
The client who is on lithium carbonate must be off the medication for 1 to 2 days before a scheduled surgical procedure an
230.) A client is placed on chloral hydrate (Somnote) for short-term treatment. Which nursing action indicates an understanding of the major side effect of this medication?
1. Monitoring neurological signs every 2 hours
2. Monitoring the blood pressure ev
3. Instructing the client to call for ambulation assistance
Rationale:
Chloral hydrate (a sedative-hypnotic) causes sedation and impairment of motor coordination; therefore, safety measures need to be implemented. The client is instructed to call for assi
231.) A client admitted to the hospital gives the nurse a bottle of clomipramine (Anafranil). The nurse notes that the medication has not been taken by the client in 2 months. What behaviors observed in the client would validate noncompliance with this me
4. Frequent handwashing with hot, soapy water
Rationale:
Clomipramine is commonly used in the treatment of obsessive-compulsive disorder. Handwashing is a common obsessive-compulsive behavior. Weight gain is a common side effect of this medication. Tachyc
232.) A client in the mental health unit is administered haloperidol (Haldol). The nurse would check which of the following to determine medication effectiveness?
1. The client's vital signs
2. The client's nutritional intake
3. The physical safety of oth
4. The client's orientation and delusional status
Rationale:
Haloperidol is used to treat clients exhibiting psychotic features. Therefore, to determine medication effectiveness, the nurse would check the client's orientation and delusional status. Vital
233.) Diphenhydramine hydrochloride (Benadryl) is used in the treatment of allergic rhinitis for a hospitalized client with a chronic psychotic disorder. The client asks the nurse why the medication is being discontinued before hospital discharge. The nur
3. Addictive properties are enhanced in the presence of psychotropic medications.
Rationale:
The addictive properties of diphenhydramine hydrochloride are enhanced when used with psychotropic medications. Allergic symptoms may not be short term and will o
234.) A hospitalized client is started on phenelzine sulfate (Nardil) for the treatment of depression. At lunchtime, a tray is delivered to the client. Which food item on the tray will the nurse remove?
1. Yogurt
2. Crackers
3. Tossed salad
4. Oatmeal coo
1. Yogurt
Rationale:
Phenelzine sulfate is a monoamine oxidase inhibitor (MAOI). The client should avoid taking in foods that are high in tyramine. These foods could trigger a potentially fatal hypertensive crisis. Foods to avoid include yogurt, aged chee
235.) A tricyclic antidepressant is administered to a client daily. The nurse plans to monitor for the common side effects of the medication and includes which of the following in the plan of care?
1. Offer hard candy or gum periodically.
2. Offer a nutri
1. Offer hard candy or gum periodically.
Rationale:
Dry mouth is a common side effect of tricyclic antidepressants. Frequent mouth rinsing with water, sucking on hard candy, and chewing gum will alleviate this common side effect. It is not necessary to mo
236.) A client is being treated for depression with amitriptyline hydrochloride. During the initial phases of treatment, the most important nursing intervention is:
1. Prescribing the client a tyramine-free diet
2. Checking the client for anticholinergic
4. Getting baseline postural blood pressures before administering the medication and each time the medication is administered
Rationale:
Amitriptyline hydrochloride is a tricyclic antidepressant often used to treat depression. It causes orthostatic change
237.) A client who is on lithium carbonate (Lithobid) will be discharged at the end of the week. In formulating a discharge teaching plan, the nurse will instruct the client that it is most important to:
1. Avoid soy sauce, wine, and aged cheese.
2. Have
4. Check with the psychiatrist before using any over-the-counter (OTC) medications or prescription medications.
Rationale:
Lithium is the medication of choice to treat manic-depressive illness. Many OTC medications interact with lithium, and the client is
238.) Ribavirin (Virazole) is prescribed for the hospitalized child with respiratory syncytial virus (RSV). The nurse prepares to administer this medication via which of the following routes?
1. Orally
2. Via face mask
3. Intravenously
4. Intramuscularly
2. Via face mask
Rationale:
Ribavirin is an antiviral respiratory medication used mainly in hospitalized children with severe RSV and in high-risk children. Administration is via hood, face mask, or oxygen tent. The medication is most effective if adminis
239.) Which of the following precautions will the nurse specifically take during the administration of ribavirin (Virazole) to a child with respiratory syncytial virus (RSV)?
1. Wearing goggles
2. Wearing a gown
3. Wearing a gown and a mask
4. Handwashing
1. Wearing goggles
Rationale:
Some caregivers experience headaches, burning nasal passages and eyes, and crystallization of soft contact lenses as a result of administration of ribavirin. Specific to this medication is the use of goggles. A gown is not ne
240.) A client with Parkinson's disease has been prescribed benztropine (Cogentin). The nurse monitors for which gastrointestinal (GI) side effect of this medication?
1. Diarrhea
2. Dry mouth
3. Increased appetite
4. Hyperactive bowel sounds
2. Dry mouth
Rationale:
Common GI side effects of benztropine therapy include constipation and dry mouth. Other GI side effects include nausea and ileus. These effects are the result of the anticholinergic properties of the medication.
*
Eliminate options
241.) A client with a history of simple partial seizures is taking clorazepate (Tranxene), and asks the nurse if there is a risk of addiction. The nurse's response is based on the understanding that clorazepate:
1. Is not habit forming, either physically
3. Leads to physical and psychological dependence with prolonged high-dose therapy
Rationale:
Clorazepate is classified as an anticonvulsant, antianxiety agent, and sedative-hypnotic (benzodiazepine). One of the concerns with clorazepate therapy is that t
242.) A client who was started on anticonvulsant therapy with clonazepam (Klonopin) tells the nurse of increasing clumsiness and unsteadiness since starting the medication. The client is visibly upset by these manifestations and asks the nurse what to do.
4. Are worse during initial therapy and decrease or disappear with long-term use
Rationale:
Drowsiness, unsteadiness, and clumsiness are expected effects of the medication during early therapy. They are dose related and usually diminish or disappear altog
243.) A hospitalized client is having the dosage of clonazepam (Klonopin) adjusted. The nurse should plan to:
1. Weigh the client daily.
2. Observe for ecchymosis.
3. Institute seizure precautions.
4. Monitor blood glucose levels.
3. Institute seizure precautions.
Rationale:
Clonazepam is a benzodiazepine used as an anticonvulsant. During initial therapy and during periods of dosage adjustment, the nurse should initiate seizure precautions for the client. Options 1, 2, and 4 are no
244.) A client has a prescription for valproic acid (Depakene) orally once daily. The nurse plans to:
1. Administer the medication with an antacid.
2. Administer the medication with a carbonated beverage.
3. Ensure that the medication is administered at t
3. Ensure that the medication is administered at the same time each day.
Rationale:
Valproic acid is an anticonvulsant, antimanic, and antimigraine medication. It may be administered with or without food. It should not be taken with an antacid or carbonat
245.) A client taking carbamazepine (Tegretol) asks the nurse what to do if he misses one dose. The nurse responds that the carbamazepine should be:
1. Withheld until the next scheduled dose
2. Withheld and the health care provider is notified immediately
3. Taken as long as it is not immediately before the next dose
Rationale:
Carbamazepine is an anticonvulsant that should be taken around the clock, precisely as directed. If a dose is omitted, the client should take the dose as soon as it is remembered, a
-dipine
Ca+ channel blocker
Slows movement of calcium into smooth muscle= arterial dilation & decreased BP
Tx: angina, HTN (verapamil & diltiazem may be used for AFIB, A flutter, SVT
S/S: Constipation, reflex tachycardia, peripheral edema, toxicity
Common meds- n
nifedipine (procardia), verapamil, diltiazem
Slows movement of calcium into smooth muscle= arterial dilation & decreased BP
Tx: angina, HTN (verapamil & diltiazem may be used for AFIB, A flutter, SVT
S/S: Constipation, reflex tachycardia, peripheral edema, toxicity
-afil
Erectile dysfunction
s/s: headache, heartburn, diarrhea, flushing, nosebleeds, parathesias, changes in color vision
Contradicted in clients taking nitrates, anticoags, anti HTN
Common meds- sildenafil (viagra)
sildenafil (viagra)
s/s: headache, heartburn, diarrhea, flushing, nosebleeds, parathesias, changes in color vision
Contradicted in clients taking nitrates, anticoags, anti HTN
-pril
ACE inhibitor
Block the conversion of angiotensin I to angiotensin II
TX: HTN, HF, MI, diabetic nephropathy
S/S: Anigoedema, Cough, Electrolyte imbalance (^k+)
NI: Monitor K+ levels, BP
Common med- catopril, lisinopril, enalapril (vastotec)
catopril, lisinopril, enalapril (vastotec)
Block the conversion of angiotensin I to angiotensin II
TX: HTN, HF, MI, diabetic nephropathy
S/S: Anigoedema, Cough, Electrolyte imbalance (^k+)
NI: Monitor K+ levels, BP
-pam, -lam
Benzodiazipines
TX: Sedative-hypnotics for sleep, Adjuncts to anesthesia to induce relaxation and amnesia (procedural memory loss), To reduce anxiety (anxiolytic), Panic disorders, To treat or prevent seizures, For alcohol withdrawal, Muscle relaxant
lorazepam
TX: Sedative-hypnotics for sleep, Adjuncts to anesthesia to induce relaxation and amnesia (procedural memory loss), To reduce anxiety (anxiolytic), Panic disorders, To treat or prevent seizures, For alcohol withdrawal, Muscle relaxant
-statin
Antilipidemic
aid in lowering LDL & increasing HDL
S/S: muscle aches, hepatotoxicity, myopathy, rhabdomyolysis, peripheral neruopathy
NI: take in evening, monitor renal and liver function, low fat/high fiber diet, drug interactions: digoxin, warfarin, NSA
lovastatin (mevacor)
aid in lowering LDL & increasing HDL
S/S: muscle aches, hepatotoxicity, myopathy, rhabdomyolysis, peripheral neruopathy
NI: take in evening, monitor renal and liver function, low fat/high fiber diet, drug interactions: digoxin, warfarin, NSAIDs, etc.
-asone, -solone
- onide
Pred-
Cort-
Corticosteroid
prevent inflammatory response
S/S: Hyperglycemia, peptic ulcer, fluid retention (increased appetite), withdrawal symptoms, euphoria, insomnia, psychotic behavior
NI: admin w/ meals, DO NOT take with NSAIDS, teach DO NOT stop abruptly
Common
rednisone (deltasone), betamethasone (celestone), hydrocortisone sodium succinate (Solu-cortef), Methylprednisolone sodium succinate (solu-medrol), fluticasone propionate (advair, flovent)
prevent inflammatory response
S/S: Hyperglycemia, peptic ulcer, fluid retention (increased appetite), withdrawal symptoms, euphoria, insomnia, psychotic behavior
NI: admin w/ meals, DO NOT take with NSAIDS, teach DO NOT stop abruptly
-olol
Beta Blocker
inhibit stimulation of receptor sites= decreased cardiac excitability, CO, myocaridal O2 demand, lower BP by decreasing release of renin in the kidney
TX: HTN, angina, tachydysryhmias, HF, MI
S/S: Bradycardia, Bradypena, Bronchospasms, decrea
metropolol, labetalol, propanolol
inhibit stimulation of receptor sites= decreased cardiac excitability, CO, myocaridal O2 demand, lower BP by decreasing release of renin in the kidney
TX: HTN, angina, tachydysryhmias, HF, MI
S/S: Bradycardia, Bradypena, Bronchospasms, decreased BP
NI: Mo
-cillin
Penicillin
TX: pneumonia, upper respiratory infections, septicemia, endocarditis, rheumatic fever, GYN infections
NI: hypersensitivity w/ poss. anaphylaxis
Penicillin
TX: pneumonia, upper respiratory infections, septicemia, endocarditis, rheumatic fever, GYN infections
NI: hypersensitivity w/ poss. anaphylaxis
-ide
Oral hypoglycemic
Used in conjunction with diet & exercise; type II
NI: teach s/s of hypoglycemia, HbA1C
metformin (glucophage): withhold 48 hrs before/after test w/ contrast
(biguanide) Metformin
Oral hypoglycemic
Used in conjunction with diet & exercise; type II
NI: teach s/s of hypoglycemia, HbA1C
metformin (glucophage): withhold 48 hrs before/after test w/ contrast
-prazole
Proton pump inhibitor
S/S: D,V, N, can increase risk for fractures,, pneumonia, & acid rebound
NI: DO NOT crush, chew, break, notify PROVIDER if GI bleeding!
Common meds- omepazole (prilosec)
omepazole (prilosec)
S/S: D,V, N, can increase risk for fractures,, pneumonia, & acid rebound
NI: DO NOT crush, chew, break, notify PROVIDER if GI bleeding!
-vir
Antiviral
-ase
Thrombolytic
dissolves clots
TX: acute MI, DVT, massive PE, ischemic stroke
S/S: serious bleeding risks from recent wounds, puncture sites, weakened vessels, hypotension
NI: Must take 4-6 hrs of onset
Common meds- alteplase (activase, tPA)
-azine
- setron
Antiemtic
reduce N & V
S/S: drowsiness, anticholenergic effects, restlessness, tardive dyskinesia, EPS
NI: monitor VS
Common meds- promethazine (phenergan), metaoclopramide (reglan), ondansertron (zofran)
alteplase (activase, tPA)
dissolves clots
TX: acute MI, DVT, massive PE, ischemic stroke
S/S: serious bleeding risks from recent wounds, puncture sites, weakened vessels, hypotension
NI: Must take 4-6 hrs of onset
-phylline,
-terol
Bronchodilator
S/S: tachcardia, palpitations, tremors
Common meds- albeuterol
promethazine (phenergan), metaoclopramide (reglan), ondansertron (zofran)
reduce N & V
S/S: drowsiness, anticholenergic effects, restlessness, tardive dyskinesia, EPS
NI: monitor VS
-arin
Anticoagulant
inhibit clotting factors (warfarin = factors VII, IX, X)
TX: evolving stroke, pulmonary embolism, massive deep vein thrombosis, cardiac cath, MI, DIC
S/S: hemorrhage, heparin induced thrombocytopenia, toxicity/overdose
Common meds- warfarin
albuterol
Bronchodilator
S/S: tachcardia, palpitations, tremors
-tidine
Antiulcer
S/S: lethargy, depression, confusion, decreased libido
Common meds- ranitidine hydrochloride (zantac), cimetidine (tagamet), famotidine (pepcid)
warfarin (coumadin) {admin once daily, avoid NSAIDs & aspirin}, enoxaparin (lovenox)
inhibit clotting factors (warfarin = factors VII, IX, X)
TX: evolving stroke, pulmonary embolism, massive deep vein thrombosis, cardiac cath, MI, DIC
S/S: hemorrhage, heparin induced thrombocytopenia, toxicity/overdose
-zine
Antihistamine
S/S: anticholenergic effects (cant see, spit, pee, poop), drowsiness
NI: use cautiously pts w/ HTN, PUD, urinary retention, assess hypokalemia, BP, Advise to take @ night
Common meds- diphenhydramine (benadryl), loratadine (claratin), cetiri
-cycline,
-floxacin
Antibiotic
diphenhydramine (benadryl), loratadine (claratin), cetirizine (zyrtec), fexofenadrine (allegra)
S/S: anticholenergic effects (cant see, spit, pee, poop), drowsiness
NI: use cautiously pts w/ HTN, PUD, urinary retention, assess hypokalemia, BP, Advise to take @ night
-mycin
Aminoglycoside
(Antimicrobials)
TX: pneumonia, meningitis, septicemia
NI: high risk for ototoxicity, nephrotoxicity, monitor creatinine & BUN
Common meds- gentamicin sulfate (garamycin) therapeutic range: 4-12mcg/dL
-tyline
Tricyclic antidepressant
S/S: anticholenergic effects, sedation, toxicity
NI: DO NOT admin with MAOIs, avoid alcohol, contradicted in clients w/ seizures
Common meds- amitripytyline (elavil)
gentamicin sulfate
TX: pneumonia, meningitis, septicemia
NI: high risk for ototoxicity, nephrotoxicity, monitor creatinine & BUN
-pram, -ine
SSRIs
S/S: weight gain, fatigue, sexual dysfunction, drowsiness
NI: avoid alcohol, do not discontinue abrubptly, monitor for serotonin syndrome! (agitation, confusion, hallucinations) within first 72 hrs
amitripytyline (elavil)
TCA
S/S: anticholenergic effects, sedation, toxicity
NI: DO NOT admin with MAOIs, avoid alcohol, contradicted in clients w/ seizures
-iprazole
-apine
-idone
Second Generation Antipsychotic (SGA)
-gliptin
-glitazone
Diabetes Mellitus
Duloxetine (Cymbalta)
Fluoxetine (Provac)
Escitalopram (Lexapro)
Sertraline (Zoloft)
S/S: weight gain, fatigue, sexual dysfunction, drowsiness
NI: avoid alcohol, do not discontinue abrubptly, monitor for serotonin syndrome! (agitation, confusion, hallucinations) within first 72 hrs
-zosin
HTN/Prostate