HESI & Final: Comprehensive Review – Flashcards
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A client receives a prescription for theophylline (Theo-Dur) PO to be initiated in the morning after the dose of theophylline IV is complete. The nurse determines that a theophylline level drawn yesterday was 22 mcg/mL. Based on this information, which action should the nurse implement? A. Hold the theophylline dose and notify the health care provider. B. Start the client on a half-dose of theophylline PO. C. The theophylline dose can be initiated as planned. D. The client is not ready to be weaned from the IV to the PO route.
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A. Hold the theophylline dose and notify the health care provider. ***The therapeutic range for theophylline is 10 to 20 mcg/mL, so the theophylline dose should be held for fear of causing toxicity (A). (B, C, and D) are not indicated actions based on the reported theophylline level.
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The nurse is reviewing a client's laboratory results before a procedure in which a neuromuscular blocking agent is a standing order. Which finding should the nurse report to the health care provider? A. Hypokalemia B. Hyponatremia C. Hypercalcemia D. Hypomagnesemia
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A. Hypokalemia ***Low potassium levels enhance the effects of neuromuscular blocking agents, so the health care provider should be informed of the client's hypokalemia (A). (B, C, and D) are of concern but do not enhance the effects of neuromuscular blocking agents.
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The nurse is preparing a child for transport to the operating room for an emergency appendectomy. The anesthesiologist prescribes atropine sulfate (Atropine), IM STAT. What is the primary purpose for administering this drug to the child at this time? A. Decrease the oral secretions. B. Reduce the child's anxiety C. Potentiate the opioid effects D. Prevent possible peritonitis
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A. Decrease the oral secretions. ***Atropine sulfate (Atropine), an anticholinergic agent, is given to decrease oral secretions during a surgical procedure (A). (B, C, and D) are not actions of anticholinergic agents.
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When caring for a client on digoxin (Lanoxin) therapy, the nurse knows to be alert for digoxin (Lanoxin) toxicity. Which finding would predispose this client to developing digoxin toxicity? A. Low serum sodium level B. High serum sodium level C. Low serum potassium level D. High serum potassium level
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C. Low serum potassium level ***Hypokalemia (C) predisposes the client on digoxin to digoxin toxicity, which usually presents as abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and atrioventricular (AV) dissociation. Assessment of serum potassium levels with prompt correction of hypokalemia are important interventions for the client taking digoxin. (A, B, and D) are not relevant.
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A client is receiving anti-infective drug therapy for a postoperative infection. Which complaint should alert the nurse to the possibility that the client has contracted a superinfection? A. " My mouth feels sore" B. "I have a headache." C. "My ears feel plugged up." D. "I feel constipated"
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A. " My mouth feels sore" ***Stomatitis caused by a thrush infection, which can cause mouth pain, is a sign of superinfection (A). (B, C, and D) are more typical side effects, rather than symptoms, of a superinfection.
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During the initial nursing assessment history, a client tells the nurse that he is taking tetracycline hydrochloride (Sumycin) for urethritis. Which medication taken concurrently with Sumycin could interfere with its absorption? A. Sucralfate (Carafate) B. Hydrochlorothiazide (Diuril) C. Acetaminophen (Tylenol) D. Phenytoin (Dilantin)
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A. Sucralfate (Carafate) ***Sucralfate (Carafate) (A) is used to treat duodenal ulcers and will bind with tetracycline hydrochloride (Sumycin), inhibiting this antibiotic's absorption. (B, C, and D) have no drug interaction properties that prohibit concurrent use with tetracycline hydrochloride (Sumycin).
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Following the administration of sublingual nitroglycerin, which assessment finding indicates that the medication was effective? A. Decrease in level of chest pain B. Clear bilateral breath sounds C. Increase in blood pressure D. Increase in urinary output
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A. Decrease in level of chest pain ***Nitroglycerin reduces myocardial oxygen consumption, which decreases ischemia and reduces chest pain (A). (B, C, and D) are not expected outcomes of sublingual nitroglycerin.
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Alteration of which laboratory finding represents the achievement of a therapeutic goal for heparin administration? A. Prothrombin time (PT) B. Fibrin split products C. Platelet count D. Partial thromboplastin time (PTT)
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D. Partial thromboplastin time (PTT) ***Heparin therapy is guided by changes in the partial thromboplastin time (PTT) (D). (A, B, and C) are not used to track the therapeutic effect of heparin administration.
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The nurse is assessing a stuporuous client in the emergency department who is suspected of overdosing with opioids. Which agent should the nurse prepare to administer if the client becomes comatose? A. Naloxone hydrochloride (naracan) B. Atropine Sulfate C. Vitamin K D. Romazicon
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A. Naloxone hydrochloride (naracan) ***Naloxone is an opioid antidote used in opioid overdose (A) to reverse CNS and respiratory depression. Atropine (B) is used for bradycardia, intestinal hypertonicity and hypermotility, muscarinic agonist poisoning, peptic ulcer disease, and biliary colic. Vitamin K (C) is used to manage warfarin overdose and vitamin K deficiency in newborns. Flumazenil (D) reduces the sedative effects of benzodiazepines following general anesthesia or overdose.
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A client with HIV who was recently diagnosed with tuberculosis (TB) asks the nurse, "Why do I need to take all of these medications for TB?" What information should the nurse provide? A. Antiretroviral medications decrease the efficacy of the TB drugs. B. Multiple drugs prevent the development of resistant organisms. C. Duration of the medication regimen is shortened. D. Potential adverse drug reactions are minimized.
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B. Multiple drugs prevent the development of resistant organisms. ***A multidrug regimen is prescribed for a client with HIV and TB to prevent the development of resistance of the tubercle bacilli (B). Although antitubercular medications can inhibit some antiretrovirals (A), a multidrug regimen is needed to inhibit the proliferation of the virulent tubercle bacilli. The duration of antitubercular therapy is typically 6 to 9 months and is not shortened (C) by the use of multiple medications. A client who is receiving HIV and TB therapy is at an increased risk of adverse reactions (D) because of the complex medication regimens and complications secondary to immunosuppression.
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Two hours after taking the first dose of penicillin, a client arrives at the emergency department complaining of feeling ill, exhibiting hives, having difficulty breathing, and experiencing hypotension. These findings are consistent with which client response that requires immediate action? A. Severe acute anaphylactic response B. Side reaction that should resolve C. Idiosyncratic reaction D. Cumulative drug response
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A. Severe acute anaphylactic response ***Anaphylaxis related to penicillin can cause a life-threatening allergic response characterized by bronchospasm, laryngeal edema, and a precipitous drop in blood pressure. This client's ingestion of penicillin and presenting clinical picture indicates the client is having an acute reaction (A) with respiratory difficulty. (B, C, and D) are other physiologic responses to medications, but immediate action is required for a potential loss of airway, breathing, and circulation (A).
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Which question should the nurse ask a client prior to the initiation of treatment with IV infusions of gentamicin sulfate (Garamycin)? A. "Are you having difficulty hearing?" B. "Have you ever been diagnosed with cancer?" C. "Do you have any type of diabetes mellitus?" D. "Have you ever had anemia?"
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A. "Are you having difficulty hearing?" ***Complications of gentamicin sulfate (Garamycin) therapy include ototoxicity, nephrotoxicity, and neurotoxicity. Determining if the client is hard of hearing (A) prior to initiation of this aminoglycoside will be helpful as the treatment progresses and ototoxicity is identified as a possible complication. Information obtained in (B, C, and D) are important elements of any medical history, but they do not have the priority of (A) when assessing for complications of aminoglycoside therapy.
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A male client who has chronic back pain is on long-term pain medication management and asks the nurse why his pain relief therapy is not as effective as it was 2 months ago. How should the nurse respond? A. The phenomenon occurs when opiates are used for more than 6 months to relieve pain. B. Withdrawal occurs if the drug is not tapered slowly while being discontinued. C. Pharmacodynamic tolerance requires increased drug levels to achieve the same effect. D. A consistent dosage with around-the-clock administration is the most effective.
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C. Pharmacodynamic tolerance requires increased drug levels to achieve the same effect. ***Pharmacodynamic tolerance explains the client's need for an increased drug level to produce effects that formerly occurred at lower drug levels (C). Tolerance can occur with opioids (A) during shorter periods of use. Although a withdrawal syndrome can occur if the client develops a dependency (B), this does not address the client's immediate concern of drug effectiveness. Although a stable serum drug level provides effective pain management (D), the client's complaint is consistent with a tolerance to his current pain management regimen.
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The nurse is providing discharge instructions to a client who has received a prescription for an antibiotic that is hepatotoxic. Which information should the nurse include in the instructions? A. Avoid ingesting any alcohol or acetaminophen (Tylenol). B. Schedule a follow-up visit for a liver biopsy in 1 month. C. Activities that are strenuous should be avoided. D. Notify the health care provider of any increase in appetite.
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A. Avoid ingesting any alcohol or acetaminophen (Tylenol). ***Combining hepatotoxic drugs, such as acetaminophen and alcohol, increases the risk of liver damage, so (A) is an important discharge instruction. Although clients who receive hepatotoxic drugs should be screened for any changes in serum liver function test (LFT) results, (B) is not indicated. Rest is advantageous during an infectious process, but activity restriction (C) is unnecessary. A client who is receiving a hepatotoxic drug should report any hepatotoxic symptoms, such as jaundice, dark urine, or light-colored stools, but an increased appetite (D) does not need medical attention.
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A client with mild Parkinsonism is started on oral amantadine (Symmetrel). Which statement accurately describes the action of this medication? A. Viral organisms that cause Parkinsonism are eliminated. B. Acetylcholine in the myoneural junction is enhanced. C. Dopamine in the central nervous system is increased. D. Norepinephrine release is reduced within the periphery.
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C. Dopamine in the central nervous system is increased. ***Amantadine (Symmetrel) is a dopamine-releasing agent (C); therefore, this medication increases the amount of dopamine present in the central nervous system. Although this medication is also an antiviral agent (A), the antiviral effect is not significant in the treatment of parkinsonism. (B and D) are not affected by amantadine (Symmetrel).
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A female client who has started long-term corticosteroid therapy tells the nurse that she is careful to take her daily dose at bedtime with a snack of crackers and milk. Which is the best response by the nurse? A. Advise the client to take the medication in the morning, rather than at bedtime. B. Teach the client that dairy products should not be taken with her medication. C. Tell the client that absorption is improved when taken on an empty stomach. D. Affirm that the client has a safe and effective routine for taking the medication.
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A. Advise the client to take the medication in the morning, rather than at bedtime. ***Daily doses of long-term corticosteroid therapy should be administered in the morning (A) to coincide with the body's normal secretion of cortisol. Clients receiving long-term corticosteroids need to increase their intake of calcium, which generally means an increase in dairy products (B). Corticosteroids can often cause gastrointestinal distress and should be administered with meals (C). The client has established a safe routine by taking the medication with a snack, but the routine will be more effective if done in the morning (D).
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A female client with myasthenia gravis is taking a cholinesterase inhibitor and asks the nurse what can be done to remedy her fatigue and difficulty swallowing. What action should the nurse implement? A. Explore a plan for development of coping strategies for the symptoms with the client. B. Explain to the client that the dosage is too high, so she should skip every other dose of medication. C. Advise the client to contact her health care provider because of the development of tolerance to the medication. D. Develop a teaching plan for the client to self- adjust the dose of medication in response to symptoms
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D. Develop a teaching plan for the client to self- adjust the dose of medication in response to symptoms ***Maintaining optimal dosage for cholinesterase inhibitors can be challenging for clients with myasthenia gravis. Clients should be taught to recognize signs of overmedication and undermedication so that they can modify the dosage themselves (D) based on a prescribed sliding scale. (A, B, and C) do not adequately address the client's concerns.
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A female client is receiving tetracycline (Vibramycin) for acne. Which client teaching should the nurse include? A. Oral contraceptives may not be effective. B. Drinking cranberry juice will promote healing. C. Breast tenderness may occur as a side effect. D. The urine will turn a red-orange color.
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A. Oral contraceptives may not be effective. ***Certain antibiotics, such as tetracycline (Vibramycin), decrease the effectiveness of oral contraceptives (A). (B, C, and D) do not convey accurate information related to client teaching about this medication.
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A female client with trichomoniasis (Trichomonas vaginalis) receives a prescription for metronidazole (Flagyl). Which instruction is most important for the nurse to include this client's teaching plan? A. Avoid alcohol consumption. B. Complete the medication regimen. C. Use a barrier contraceptive method. D. Treat partner(s) concurrently.
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A. Avoid alcohol consumption. ***Clients should be instructed to avoid alcohol and products containing alcohol (A) while taking metronidazole (Flagyl) because of the possibility of a disulfiram (Antabuse)-like reaction. (B) helps prevent the development of Flagyl-resistant T. vaginalis. To prevent reinfection, clients should abstain from sexual contact or use a barrier contraceptive (C) while taking Flagyl, and their partner(s) should be treated concurrently (D). The most important instruction for client well-being is (A).
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A 2-month-old infant is scheduled to receive the first DPT immunization. What is the preferred injection site to administer this immunization? A. Dorsal gluteal B. Vastus lateralis C. Ventral gluteal D. Deltoid
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B. Vastus lateralis ***The preferred intramuscular site for children younger than 2 years is the vastus lateralis (B). (A, C, and D) are not preferred injection sites for the infant at 2 months of age.
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The nurse is evaluating a client's understanding of the prescribed antilipemic drug lovastatin (Mevacor). Which client statement indicates that further teaching is needed? A. "My bowel habits should not be affected by this drug." B. "This medication should be taken once a day only." C. "I will still need to follow a low-cholesterol diet." D. "I will take the medication every day before breakfast."
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D. "I will take the medication every day before breakfast." ***The enzyme that helps metabolize cholesterol is activated at night, so this medication should be taken with the evening meal (D). (A, B, and C) reflect correct information about lovastatin.
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An older client who had a colon resection yesterday is receiving a constant dose of hydromorphone (Dilaudid) via a patient-controlled analgesia (PCA) pump. Which assessment finding is most significant and requires that the nurse intervene? A. The client is drowsy and complains of pruritus. B. Pupils are 3 mm; PERRLA. C. The area around the sutures is reddened and swollen. D. Respirations decrease to 14 breaths/min.
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D. Respirations decrease to 14 breaths/min. ***Hydromorphone (Dilaudid) is an opioid agonist-analgesic of opiate receptors that inhibits ascending pathways and can cause respiratory depression. Older adults are more sensitive to opioids so the "start low and go slow" approach should be taken (D). (A) lists common side effects of opioids, particularly the opiates, which are usually harmless and often transient . (B) is within the normal range (2 to 6 cm). The suture site may be red and swollen as an inflammatory response, but no action is required if the skin around the incision is a normal color and temperature (C).
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A client receives an antihypertensive agent daily. Which action is most important for the nurse to implement prior to administering the medication? A. Verify the expiration date. B. Obtain the client's blood pressure. C. Determine the client's history of adverse reactions. D. Review the client's medical record for a change in drug route.
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B. Obtain the client's blood pressure. ***To determine the most accurate response to antihypertensive therapy, baseline blood pressures should be obtained before an antihypertensive drug is administered and should be compared with orthostatic vital signs to determine whether any side effects are occurring (B). Although (A, C, and D) are required nursing actions prior to giving any drug, the therapeutic response should be determined before another dose is administered.
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The charge nurse is reviewing the admission history and physical data for four clients newly admitted to the unit. Which client is at greatest risk for adverse reactions to medications? A. 30-year-old man with a fracture B. 7-year-old child with an ear infection C. 75-year-old woman with liver disease D. 50-year-old man with an upper respiratory tract infection
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C. 75-year-old woman with liver disease ***Impaired hepatic metabolic pathways for drug and chemical degradation place (C) at greatest risk for adverse reactions to medications based on advancing age and liver disease. (A and D) have no predisposing factors, such as genetics, pathophysiologic dysfunction, or drug allergies, that would increase the risk for cumulative toxicity or adverse drug reactions. (B) is at risk for dose-related adverse reactions but is at less risk than (C).
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The health care provider has prescribed a low-molecular-weight heparin, enoxaparin (Lovenox) prefilled syringe, 30 mg/0.3 mL IV every 12 hours, for a client following hip replacement. Prior to administering the first dose, which intervention is most important for the nurse to implement? A. Assess the client's IV site for signs of inflammation. B. Evaluate the client's degree of mobility. C. Instruct the client regarding medication side effects. D. Contact the health care provider to clarify the prescription.
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D. Contact the health care provider to clarify the prescription. ***Lovenox is a low-molecular-weight heparin that can only be administered subcutaneously, so the nurse should contact the health care provider to clarify the route of administration (D). (A and B) are important nursing interventions but not necessary to the administration of this medication. The client should be instructed about medication side effects (C), but this is of lower priority than obtaining a correct prescription.
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The nurse is preparing a plan of care for a client receiving the glucocorticoid methylprednisolone (Solu-Medrol). Which nursing diagnosis reflects a problem related to this medication that should be included in the care plan? A. Ineffective airway clearance B. Risk for infection C. Deficient fluid volume D. Impaired gas exchange
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B. Risk for infection ***Corticosteroids depress the immune system, placing the client at risk for infection (B). Although (A, C, and D) reflect diagnostic statements that may be applicable to this client, only (B) is directly related to the administration of this medication.
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The nurse is reviewing prescribed medications with a female client who is preparing for discharge. The client asks the nurse why the oral dose of an opioid analgesic is higher than the IV dose that she received during hospitalization. Which response is best for the nurse to provide? A. A higher dose of analgesic medication may be needed after discharge. B. An error in the dose calculation may have occurred when the prescribed dose was converted. C. The doses should be the same unless the pain is not well controlled. D. Oral forms of drugs must pass through the liver first, where more of the dose is metabolized.
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D. Oral forms of drugs must pass through the liver first, where more of the dose is metabolized. ***Oral doses of medication are usually larger than parenteral doses to compensate for the first-pass effect in the liver after oral administration (D), which metabolizes more of the drug's dose before affecting its therapeutic response. Although recommended dose ranges for adults should be individualized, a client's pain should be controlled at discharge, not (A or C). (B) is inaccurate information to convey to the client.
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Amoxicillin, 500 mg PO every 8 hours, is prescribed for a client with an infection. The drug is available in a suspension of 125 mg/5 mL. How many milliliters should the nurse administer with each dose? A. 10 B. 15 C. 20 D. 25
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C. 20 ***500 mg/X mL = 125 mg/5 mL; 125X = 2500; X = 20 mL
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Minocycline (Minocin), 50 mg PO every 8 hours, is prescribed for an adolescent girl diagnosed with acne. The nurse discusses self-care with the client while she is taking the medication. Which teaching points should be included in the discussion? (Select all that apply.) A. Report vaginal itching or discharge. B. Take the medication at 0800, 1500, and 2200 hours. C. Protect skin from natural and artificial ultraviolet light. D. Avoid driving until response to medication is known. E. Take with an antacid tablet to prevent nausea. F. Use a nonhormonal method of contraception if sexually active.
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A. Report vaginal itching or discharge. C. Protect skin from natural and artificial ultraviolet light. D. Avoid driving until response to medication is known. F. Use a nonhormonal method of contraception if sexually active. ***Correct selections are (A, C, D, and F). Adverse effects of tetracyclines include superinfections, photosensitivity, and decreased efficacy of oral contraceptives. Therefore, the client should report vaginal itching or discharge (A), protect the skin from ultraviolet light (C), and use a nonhormonal method of contraception (F) while on the medication. Minocycline (Minocin) is known to cause dizziness and ataxia, so until the client's response to the medication is known, driving (D) should be avoided. Tetracyclines should be taken around the clock (B) but exhibit decreased absorption when taken with antacids, so (E) is contraindicated.
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The health care provider prescribes carbamazepine (Tegretol) for a child whose tonic-clonic seizures have been poorly controlled. The nurse informs the mother that the child must have blood tests every week. The mother asks why so many blood tests are necessary. Which complication is assessed through frequent laboratory testing that the nurse should explain to this mother? A. Nephrotoxicity B. Ototoxicity C. Myelosuppression D. Hepatotoxicity
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C. Myelosuppression ***Myelosuppression (C) is the highest priority complication that can potentially affect clients managed with carbamazepine (Tegretol) therapy. The client requires close monitoring for this condition by weekly laboratory testing. Hepatic function may be altered (D), but this complication does not have as great a potential for occurrence as (C). (A and B) are not typical complications of carbamazepine (Tegretol) therapy.
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A 67-year-old client is discharged from the hospital with a prescription for digoxin (Lanoxin), 0.25 mg daily. Which instruction should the nurse include in this client's discharge teaching plan? A. Take the medication in the morning before rising. B. Take and record radial pulse rate daily. C. Expect some vision changes caused by the medication. D. Increase intake of foods rich in vitamin K.
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B. Take and record radial pulse rate daily. ***Monitoring pulse rate is very important when taking digoxin (Lanoxin) (B). The client should be further instructed to report pulse rates below 60 or greater than 110 beats/min and to withhold the dosage until consulting with the health care provider in such a case. (A and D) are not necessary. (C) is an indication of drug toxicity, and the client should be instructed to report this immediately.
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A pediatric client is discharged home with multiple prescriptions for medications. Which information should the nurse provide that is most helpful to the parents when managing the medication regimens? A. Maintain a drug administration record. B. Fill all prescriptions at one pharmacy. C. Allow one person to give the medications. D. Give all medications in small volumes.
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A. Maintain a drug administration record. ***A written drug administration record (A) provides a consistent plan to ensure safe adherence to multiple medication dosages and times. Although (B) is an important safeguard to monitor for drug interactions, the parents should be given a tool to enhance their confidence and provide a mechanism to ensure accurate and timely medication administration without duplicating or omitting a dose. Using a written record to record medication administration allows more than one person (C) to share the responsibility of giving medications to the child. Although smaller volumes (D) ensure that all the medication is taken, it is more important to maintain an accurate administration schedule.
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A 6-year-old child is admitted to the emergency department with status epilepticus. His parents report that his seizure disorder has been managed with phenytoin (Dilantin), 50 mg PO bid, for the past year. Which drug should the nurse plan to administer in the emergency department? A. Phenytoin (Dilantin) B. Diazepam (Valium) C. Phenobarbital (Luminal) D. Carbamazepine (Tegretol)
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B. Diazepam (Valium) ***Diazepam (Valium) (B) is the drug of choice for treatment of status epilepticus. (A, C, and D) are used for the long-term management of seizure disorders but are not as useful in the emergency management of status epilepticus.
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A client who is hypertensive receives a prescription for hydrochlorothiazide (HCTZ). When teaching about the side effects of this drug, which symptoms are most important for the nurse to instruct the client to report? A. Fatigue and muscle weakness B. Anxiety and heart palpitations C. Abdominal cramping and diarrhea D. Confusion and personality changes
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A. Fatigue and muscle weakness ***Thiazide diuretics, such as HCTZ, cause potassium wasting in the urine, so the client should be instructed to report fatigue and muscle weakness (A), which are characteristic of hypokalemia. Although (B, C, and D) should be reported, they are not indicative of hypokalemia, which is a side effect of HCTZ that can cause cardiac dysrhythmias.
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When providing nursing care for a client receiving pyridostigmine bromide (Mestinon) for myasthenia gravis, which nursing intervention has the highest priority? A. Monitor the client frequently for urinary retention. B. Assess respiratory status and breath sounds often. C. Monitor blood pressure each shift to screen for hypertension. D. Administer most medications after meals to decrease gastrointestinal irritation.
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B. Assess respiratory status and breath sounds often. ***The client should be assessed often for signs of respiratory complications (B). The client with myasthenia gravis is at greatest risk for life-threatening respiratory complications because of the weakness of the diaphragm and ancillary respiratory muscles caused by the disease process. Cholinergic agents used to reduce muscle weakness can also cause hypersalivation, increased respiratory secretions, and possible bronchoconstriction. Although (A, C, and D) reflect helpful interventions, they do not have the priority of (B) in caring for the client with myasthenia gravis.
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A client is being discharged with a prescription for sulfasalazine (Azulfidine) to treat ulcerative colitis. Which instruction should the nurse provide to this client prior to discharge? A. Maintain good oral hygiene. B. Take the medication 30 minutes before a meal. C. Discontinue use of the drug gradually. D. Drink eight glasses of fluid a day.
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D. Drink eight glasses of fluid a day. ***Adequate hydration is important for all sulfa drugs because they can crystallize in the urine (D). If possible, the drug should be taken after eating to provide longer intestinal transit time (B). (A) is important for other medications, such as phenytoin (Dilantin), because of the incidence of gingival hyperplasia, and (C) is important for steroid administration, but (D) is most important to stress with this client.
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Which parameter is most important for the nurse to check prior to administering a subcutaneous injection of heparin? A. Heart rate B. Urinary output C. Activated partial thromboplastin time (aPTT) D. Prothrombin time (PT) and international normalized ratio (INR)
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C. Activated partial thromboplastin time (aPTT) ***The laboratory value that measures heparin's therapeutic anticoagulation time is the aPTT (C). (A) should be checked before the administration of digoxin. (B) is valuable information but not a parameter measured for heparin therapy. (D) is evaluated during anticoagulation therapy using sodium warfarin (Coumadin).
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The nurse plans to draw blood samples for the determination of peak and trough levels of gentamicin sulfate (Garamycin) in a client receiving IV doses of this medication. When should the nurse plan to obtain the peak level? A. Thirty minutes after the dose is administered B. Immediately before giving the next dose C. When the next electrolyte levels are drawn D. Sixty minutes after the dose is administered
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A. Thirty minutes after the dose is administered ***Peak drug serum levels are achieved 30 minutes after the IV administration of aminoglycosides, so (A) is the optimum time to get a peak level. (B, C, and D) are not appropriate times associated with peak levels for gentamicin.
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A client receiving a continuous infusion of heparin IV starts to hemorrhage from an arterial access site. Which medication should the nurse anticipate administering to prevent further heparin-induced hemorrhaging? A. Vitamin K1 (AquaMEPHYTON) B. Protamine sulfate C. Warfarin sodium (Coumadin) D. Prothrombin
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B. Protamine sulfate ***Protamine sulfate (B) is the antagonist for heparin and is given for episodes of acute hemorrhage. (A, C, and D) are not heparin antagonists.
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A client with acute lymphocytic leukemia is to begin chemotherapy today. The health care provider's prescription specifies that ondansetron (Zofran) is to be administered IV 30 minutes prior to the infusion of cisplatin (Platinol). What is the rationale for administering Zofran prior to the chemotherapy induction? A. Promotion of diuresis to prevent nephrotoxicity B. Reduction or elimination of nausea and vomiting C. Prevention of a secondary hyperuricemia D. Reduction in the risk of an allergic reaction
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B. Reduction or elimination of nausea and vomiting ***Ondansetron (Zofran) is a type 3 receptor (5-HT3) antagonist that is recognized for improved control of acute nausea and vomiting associated with chemotherapy (B). 5-HT3 antagonists are most effective when administered IV prior to the induction of the chemotherapeutic agent(s). (A, C, and D) are not therapeutic actions of ondansetron (Zofran).
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The health care provider prescribes cisplatin (Platinol) to be administered in 5% dextrose and 0.45% normal saline with mannitol (Osmitrol) added. Which assessment parameters would be most helpful to the nurse in evaluating the effectiveness of the Osmitrol therapy? A. Oral temperature B. Blood cultures C. Urine output D. Liver enzyme levels
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C. Urine output ***The effectiveness of the diuresis is best measured by urine output (C). Mannitol, an osmotic diuretic, is given during cisplatin (Platinol) therapy to promote diuresis and reduce the risk of nephrotoxicity and ototoxicity associated with this chemotherapeutic agent. (A, B, and D) do not provide information about the risk for nephrotoxicity and ototoxicity related to Platinol administration.
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Which factor is most important to ensure compliance when planning to teach a client about a drug regimen? A. Genetics B. Client age C. Client education D. Absorption rate
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C. Client education ***The client's educational level (C) is the most important factor when planning teaching to ensure a client's compliance with taking a prescribed drug. (A and D) are physiologic responses that do not relate to a client's compliance. Although maturity level and age (B) contribute to compliance, the client's basic understanding of instructions, which is best indicated by educational level, is more significant.
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A client being treated for an acute myocardial infarction is to receive the tissue plasminogen activator alteplase (Activase). The nurse would be correct in providing which explanation to the client regarding the purpose of this drug? A. This drug is a nitrate that promotes vasodilation of the coronary arteries. B. This drug is a clot buster that dissolves clots within a coronary artery. C. This drug is a blood thinner that will help prevent the formation of a new clot. D. This drug is a volume expander that improves myocardial perfusion by increasing output.
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B. This drug is a clot buster that dissolves clots within a coronary artery. ***t-PA, or tissue plasminogen activator, is a coronary-specific fibrinolytic agent that dissolves clots within the coronary arteries (B). This drug is not a calcium channel blocker or nitrate, which would promote vasodilation of the coronary arteries (A). This medication is not an anticoagulant, such as warfarin or heparin, which would prevent new clot formation (C). Volume expansion is not provided by an infusion of TPA and would not necessarily improve myocardial perfusion caused by an increased cardiac output in a client with coronary artery disease (D).
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In addition to nitrate therapy, a client is receiving nifedipine (Procardia), 10 mg PO every 6 hours. The nurse should plan to observe for which common side effect of this treatment regimen? A. Hypotension B. Hyperkalemia C. Hypokalemia D. Seizures
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A. Hypotension ***Nifedipine (Procardia) reduces peripheral vascular resistance and nitrates produce vasodilation, so concurrent use of nitrates with nifedipine can cause hypotension with the initial administration of these agents (A). (B, C, and D) are not side effects of this treatment regimen.
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Dopamine (Intropin) is administered to a client who is hypotensive. Which finding should the nurse identify as a therapeutic response? A. Gain in weight B. Increase in urine output C. Improved gastric motility D. Decrease in blood pressure
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B. Increase in urine output ***Intropin activates dopamine receptors in the kidney and dilates blood vessels to improve renal perfusion, so an increase in urine output (B) indicates an increase in glomerular filtration caused by increased arterial blood pressure. (A) is related to fluid retention but is not an indicator of a therapeutic response to dopamine therapy. (C) is not related to the vasopressor effect of dopamine therapy. Dopamine increases cardiac output, which increases a client's blood pressure, not (D).
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A client taking linezolid (Zyvox) at home for an infected foot ulcer calls the home care nurse to report the onset of watery diarrhea. Which intervention should the nurse implement? A. Schedule appointments to obtain blood samples for drug peak and trough levels. B. Reassure the client that this is an expected side effect that will resolve in a few days. C. Instruct the client to obtain a stool specimen to be taken to the laboratory for analysis. D. Advise the client to begin taking an over-the-counter antidiarrheal agent.
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C. Instruct the client to obtain a stool specimen to be taken to the laboratory for analysis. ***Antibiotics, such as Zyvox, can cause pseudomembranous colitis, resulting in severe watery diarrhea. The prescriber should be notified, and a stool specimen (C) should be obtained and analyzed for this complication. Severe diarrhea is not an indication of drug toxicity, so (A) is not warranted. Although gastrointestinal disturbance can be an adverse effect of Zyvox (B), a stool specimen should be obtained because the client reports the diarrhea is severe. Antidiarrheal medications (D) are contraindicated in the presence of this colitis and should not be started until this potential complication is ruled out.
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To evaluate whether the administration of an antihypertensive medication has caused a therapeutic effect, which action should the nurse implement? A. Ask the client about the onset of any dizziness since taking the medication. B. Measure the client's blood pressure while the client is lying, sitting, and then standing. C. Compare the client's blood pressure before and after the client takes the medication. D. Interview the client about any past or recent history of high blood pressure.
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C. Compare the client's blood pressure before and after the client takes the medication. ***Therapeutic effects are the expected or predictable physiologic responses to a medication. An antihypertensive medication is administered to lower blood pressure, so to determine if the therapeutic effect has been achieved, the nurse should compare the client's blood pressure before and after the client takes the medication (C). (A and B) provide data related to the side effect of hypotension, which may occur following the administration of an antihypertensive medication. (D) provides useful data but does not evaluate the medication's effectiveness.
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The nurse is scheduling a client's antibiotic peak and trough levels with the laboratory personnel. What is the best schedule for drawing the trough level? A. Give the dose of medication, and call the laboratory to draw the trough STAT. B. Arrange for the laboratory to draw the trough 1 hour after the dose is given. C. Instruct the laboratory to draw the trough immediately before the next scheduled dose. D. Give the first dose of medication after the laboratory reports that the trough has been drawn.
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C. Instruct the laboratory to draw the trough immediately before the next scheduled dose. ***The best time to draw a trough is the closest time to the next administration (C). (A) will provide a peak level. (B) will not provide the most accurate trough level. The medication is given before peak and trough levels are obtained (D).
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Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which finding indicates the presence of systemic toxicity from this medication? A. tinnitus B. diarrhea C. constipation D. decreased respirations
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A. tinnitus ***Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can result. Symptoms include tinnitu, dizziness, hyperpnea, and psychological disturbances. Constipation and diarrhea are not associated with salicylism.
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Isotretinoin is prescribed for a client with severe acne. Before administration of this medication, the nurse anticipates that which laboratory test will be prescribed? A. K levels B. triglyceride levels C. Hemoglobin A1C D. total cholesterol level
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D. total cholesterol level ***Isotretinoin can elevate triglyceride levels. They should be measure before treatment and peridoically thereafter until the effect on the triglycerides is know.
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A client with sever acne is seen in the clinic and the HCP prescribes isotretinoin. The nurse reviews the client's medication record and would contact the HCP if the client is also taking which medication? A. digoxin B. phenytoin C. vitamin A D. furosemide
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C. vitamin A ***This drug is a derivative of vitamin A.
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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 at which times? A. immediately before swimming B. 5 minutes before exposure to the sun C. immediately before exposure to the sun D. at least 30 minutes before exposure to the sun
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D. at least 30 minutes before exposure to the sun ***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.
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The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching? A. withdraws the NPH insulin first B. withdraws the regular insulin first C. injects air into NPH insulin vial first D. injects an amount of air equal to the desired dose of insulin into each vial
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A. withdraws the NPH insulin first
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The home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Hummulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should tell the client to take which action? A. freeze the insulin B. refrigerate the insulin C. store the insulin in a dark, dry place D. keep the insulin at room temperature
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B. refrigerate the insulin
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A nurse is preparing to administer a dose of warfarin to a patient. Based on the nurse's knowledge of this drug, the nurse knows to monitor for which of the following side effects? A. Black stools B. Constipation C. Abdominal bloating D. Back pain
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A. Black stools ***Warfarin is an anticoagulant medication that prevents blood clots. Alternatively, it may also increase the risk of bleeding. The nurse should assess for signs of bleeding in the gastrointestinal system, which could manifest as black stools.
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Which of the following is considered a contraindication for administration of Furosemide [Lasix®]? A. 4+ pitting edema in the lower extremities B. Hypertension C. Facial swelling D. Decreased urine output
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D. Decreased urine output ***Lasix is a diuretic medication that can be given to induce elimination of excess fluid from the body. Lasix is typically used when a patient has excess fluid because of such diseases as heart failure or when pulmonary edema is present. Lasix should not be used when a patient has decreased urine output as a method to get the patient to urinate.
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After starting an IV dose of sulfamethoxazole (Bactrim®), the nurse notes that the patient is having difficulty breathing, his face is flushed, and he complains of back pain. Which type of hypersensitivity reaction is this patient most likely experiencing? A. Cytotoxic B. Serum sickness C. Anaphylactic D. Infectious
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C. Anaphylactic ***A patient may have an adverse reaction to a medication, which can occur as a result of various types of interactions, including cytotoxic response or an infection. An anaphylactic reaction is manifested as difficulty breathing and wheezing, facial edema, and flushing of the skin, which represent a hypersensitivity of the patient's body to the medication.
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A nurse is caring for a pregnant patient who needs treatment for rosacea. The patient asks the nurse about using topical corticosteroids for treatment. Which of the following information should the nurse provide this patient? A. The patient can safely use this type of medication B. The patient can only use this medication in areas away from the abdomen C. This medication causes teratogenic effects and should be avoided D. There is no safety evidence of this medication during pregnancy, so it should be avoided
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D. There is no safety evidence of this medication during pregnancy, so it should be avoided ***When working with a pregnant client, the nurse must be familiar with those situations and medications that can be harmful to the pregnant mother and/or her unborn baby. An example is corticosteroid use, which has not been shown to be safe during pregnancy. The nurse should be aware of this and counsel the client against using this type of drug.
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Which of the following agents would increase sedation caused by morphine? A. ethanol B. diazepam C. chlorpromazine D. clomipramine E. All of the above
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E. All of the above
