Which action is most important for the nurse to implement prior to the administration of the antiarrhythmic drug adenosine (Adenocard)?
Assess pupillary response to light.
Instruct the client that facial flushing may occur.
Apply continuous cardiac monitoring.
Request that family members leave the room.
Rationale
Adenosine (Adenocard) is an antiarrhythmic drug used to restore a normal sinus rhythm in clients with rapid supraventricular tachycardia. The client’s heart rate should be monitored continuously for the onset of additional arrhythmias while receiving adenosine.
Which instruction(s) should the nurse give to a female client who just received a prescription for oral metronidazole (Flagyl) for treatment of trichomonas vaginalis? (Select all that apply.)
Select all that apply
Increase fluid intake, especially cranberry juice.
Do not abruptly discontinue the medication; taper use.
Check blood pressure daily to detect hypertension.
Avoid drinking alcohol while taking this medication.
Use condoms until treatment is completed.
Ensure that all sexual partners are treated at the same time.
Rationale
Increased fluid intake and cranberry juice are recommended for prevention and treatment of urinary tract infections, which frequently accompany vaginal infections. It is not necessary to taper use of this drug or to check the blood pressure daily, as this condition is not related to hypertension. Flagyl can cause a disulfiram-like reaction if taken in conjunction with ingestion of alcohol, so the client should be instructed to avoid alcohol. All sexual partners should be treated at the same time and condoms should be used until after treatment is completed to avoid reinfection.
Following heparin treatment for a pulmonary embolism, a client is being discharged with a prescription for warfarin (Coumadin). In conducting discharge teaching, the nurse advises the client to have which diagnostic test monitored regularly after discharge?
Perfusion scan.
Prothrombin Time (PT/INR).
Activated partial thromboplastin (APTT).
Serum Coumadin level (SCL).
Rationale
When used for a client with pulmonary embolus, the therapeutic goal for warfarin therapy is a PT 1 to 2 times greater than the control, or an INR of 2 to 3.
A client is admitted to the coronary care unit with a medical diagnosis of acute myocardial infarction. Which medication prescription decreases both preload and afterload?
Nitroglycerin.
Propranolol (Inderal).
Morphine.
Captopril (Capoten).
Rationale
Nitroglycerin is a nitrate that causes peripheral vasodilation and decreases contractility, thereby decreasing both preload and afterload.
A medication that is classified as a beta-1 agonist is most commonly prescribed for a client with which condition?
Glaucoma.
Hypertension.
Heart failure.
Asthma.
Rationale
Beta-1 agonists improve cardiac output by increasing the heart rate and blood pressure and are indicated in heart failure, shock, atrioventricular block dysrhythmias, and cardiac arrest. In contrast, glaucoma is managed using adrenergic agents and beta-adrenergic blocking agents. Beta-1 blocking agents are used in the management of hypertension. Medications that stimulate beta-2 receptors in the bronchi are effective for bronchoconstriction in respiratory disorders, such as asthma.
An adult client has prescriptions for morphine sulfate 2.5 mg IV q6h and ketorolac (Toradol) 30 mg IV q6h. Which action should the nurse implement?
Administer both medications according to the prescription.
Hold the ketorolac to prevent an antagonistic effect.
Hold the morphine to prevent an additive drug interaction.
Contact the healthcare provider to clarify the prescription.
Rationale
Morphine and ketorolac (Toradol) can be administered concurrently, and may produce an additive analgesic effect, resulting in the ability to reduce the dose of morphine, as seen in this prescription. Toradol is an antiinflammatory analgesic, and does not have an antagonistic effect with morphine.
In teaching a client who had a liver transplant about cyclosporine (Sandimmune), the nurse should encourage the client to report which adverse response to the healthcare provider?
Changes in urine color.
Presence of hand tremors.
Increasing body hirsutism.
Nausea and vomiting.
Rationale
Neurological complications, such as hand tremors, occur in about 50% of clients taking cyclosporine and should be reported. Although this drug can be nephrotoxic, changes in urine color typically does not occur. Nausea is a common side effects, but is not usually severe.
A client with heart failure is prescribed spironolactone (Aldactone). Which information is most important for the nurse to provide to the client about diet modifications?
Do not add salt to foods during preparation.
Refrain for eating foods high in potassium.
Restrict fluid intake to 1000 ml per day.
Increase intake of milk and milk products.
Rationale
Spironolactone (Aldactone), an aldosterone antagonist, is a potassium-sparing diuretic, so a diet high in potassium should be avoided, along with table salt substitutes which are generally contain potassium chloride which can lead to hyperkalemia.
A client is taking hydromorphone (Dilaudid) PO q4h at home. Following surgery, Dilaudid IV q4h PRN and butorphanol tartrate (Stadol) IV q4h PRN are prescribed for pain. The client received a dose of the Dilaudid IV four hours ago, and is again requesting pain medication. What intervention should the nurse implement?
Alternate the two medications q4h PRN for pain.
Alternate the two medications q2h PRN for pain.
Administer only the Dilaudid q4h PRN for pain.
Administer only the Stadol q4h PRN for pain.
Rationale
Dilaudid is an opioid agonist. Stadol is an opioid agonist-antagonist. Use of an agonist-antagonist for the client who has been receiving opioid agonists may result in abrupt withdrawal symptoms, and should be avoided.
The nurse is reviewing the use of the patient-controlled analgesia (PCA) pump with a client in the immediate postoperative period. The client will receive morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes per PCA to total 5 mg IV maximally per hour. What assessment has the highest priority before initiating the PCA pump?
The expiration date on the morphine syringe in the pump.
The rate and depth of the client’s respirations.
The type of anesthesia used during the surgical procedure.
The client’s subjective and objective signs of pain.
Rationale
A life-threatening side effect of intravenous administration of morphine sulfate, an opiate narcotic, is respiratory depression. Prior to the initiation of the PCA pump, the nurse should assess the client’s respirations to obtain a baseline of their respiratory rate and depth. Once the PCA pump is initiated and if the client’s respiratory rate falls below 12 breaths per minute, the PCA pump should be stopped and the healthcare provider notified immediately.
A client has myxedema, which results from a deficiency of thyroid hormone synthesis in adults. The nurse knows that which medication would be contraindicated for this client?
Liothyronine (Cytomel) to replace iodine.
Furosemide (Lasix) for relief of fluid retention.
Pentobarbital sodium (Nembutal Sodium) for sleep.
Nitroglycerin (Nitrostat) for angina pain.
Rationale
Persons with myxedema are dangerously hypersensitive to narcotics, barbiturates and anesthetics.
A client is receiving clonidine (Catapres) 0.1 mg/24hr via transdermal patch. Which assessment finding indicates that the desired effect of the medication has been achieved?
Client denies recent episodes of angina.
Change in peripheral edema from +3 to +1.
Client denies recent nausea or vomiting.
Blood pressure has changed from 180/120 to 140/70 mmHg.
Rationale
Catapres acts as a centrally-acting analgesic and antihypertensive agent. A reduction of the blood pressure to 140/70 mmHg indicates a reduction in hypertension.
A female client with rheumatoid arthritis take ibuprofen (Motrin) 600 mg PO 4 times a day. To prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is prescribed. Which information is most important for the nurse to include in client teaching?
Use contraception during intercourse.
Ensure the Cytotec is taken on an empty stomach.
Encourage oral fluid intake to prevent constipation.
Take Cytotec 30 minutes prior to Motrin.
Rationale
Cytotec, a synthetic form of a prostaglandin, is classified as pregnancy Category X and can act as an abortifacient, so the client should be instructed to use contraception during intercourse to prevent loss of an early pregnancy. A common side effect of Cytotec is diarrhea, so constipation prevention strategies are usually not needed. Cytotec and Motrin should be taken together to provide protective properties against gastrointestinal bleeding.
A client with Parkinson’s disease is taking carbidopa-levodopa (Sinemet). Which observation by the nurse would indicate that the desired outcome of the medication is being achieved?
Decreased blood pressure.
Lessening of tremors.
Increased salivation.
Increased attention span.
Rationale
Sinemet increases the amount of levodopa to the CNS (dopamine to the brain). Increased amounts of dopamine improve the symptoms of Parkinson’s, such as involuntary movements, resting tremors, shuffling gait, etc. Decreased drooling would be a desired effect, not increased salivation.
A client has a continuous IV infusion of dopamine (Intropin) and an IV of normal saline at 50 ml/hour. The nurse notes that the client’s urinary output has been 20 ml/hour for the last two hours. Which intervention should the nurse initiate?
Stop the infusion of dopamine.
Change the normal saline to a keep open rate.
Replace the urinary catheter.
Notify the healthcare provider of the urinary output.
Rationale
The main effect of dopamine is adrenergic stimulation used to increase cardiac output, which should also result in increased urinary output. A urinary output of less than 20 ml/hour is oliguria and should be reported to the healthcare provider, so the dose of dopamine can be adjusted. Depending on the current rate of administration, the dose may need to be increased or decreased.
Which dosing schedule should the nurse teach the client to observe for a controlled-release oxycodone prescription?
As needed.
Every 12 hours.
Every 24 hours.
Every 4 to 6 hours.
Rationale
A controlled-release oxycodone provides long-acting analgesia to relieve moderate to severe pain, so a dosing schedule of every 12 hours provides the best around-the-clock pain management. Controlled-release oxycodone is not prescribed for breakthrough pain on a PRN or as needed schedule. Using a schedule of every 4 to 6 hours may jeopardize patient safety due to cumulative effects.
A client with osteoarthritis receives a new prescription for celecoxib (Celebrex) orally for symptom management. The nurse notes the client is allergic to sulfa. Which action is most important for the nurse to implement prior to administering the first dose?
Review the client’s hemoglobin results.
Notify the healthcare provider.
Inquire about the reaction to sulfa.
Record the client’s vital signs.
Rationale
Celebrex contains a sulfur molecule, which can lead to an allergic reaction in individuals who are sensitive to sulfonamides, so the healthcare provider should be notified of the client’s allergies.
The nurse is teaching a client with cancer about opioid management for intractable pain and tolerance related side effects. The nurse should prepare the client for which side effect that is most likely to persist during long-term use of opioids?
Sedation.
Constipation.
Urinary retention.
Respiratory depression.
Rationale
The client should be prepared to implement measures for constipation which is the most likely persistent side effect related to opioid use. Tolerance to opiate narcotics is common, and the client may experience less sedation and respiratory depression as analgesic use continues. Opioids increase the tone in the urinary bladder sphincter, which causes retention but may subside. The most likely persistent side effect is constipation.
The healthcare provider prescribes digitalis (Digoxin) for a client diagnosed with heart failure. Which intervention should the nurse implement prior to administering the digoxin?
Observe respiratory rate and depth.
Assess the serum potassium level.
Obtain the client’s blood pressure.
Monitor the serum glucose level.
Rationale
Hypokalemia (decreased serum potassium) will precipitate digitalis toxicity in persons receiving digoxin. The nurse should monitor the client’s serum potassium levels. Blood pressure and respiratory rate will not inform the nurse about potential safety issues with digitalis.
A postoperative client has been receiving a continuous IV infusion of meperidine (Demerol) 35 mg/hr for four days. The client has a PRN prescription for Demerol 100 mg PO q3h. The nurse notes that the client has become increasingly restless, irritable and confused, stating that there are bugs all over the walls. What action should the nurse take first?
Administer a PRN dose of the PO meperidine (Demerol).
Administer naloxone (Narcan) IV per PRN protocol.
Decrease the IV infusion rate of the meperidine (Demerol) per protocol.
Notify the healthcare provider of the client’s confusion and hallucinations.
Rationale
The client is exhibiting symptoms of Demerol toxicity which is consistent with the large doses of Demerol received over four days. Decreasing the infusion rate of the Demerol as per protocol is the most effective action to immediately decrease the amount of serum Demerol. The next nursing action is for the nurse to notify the healthcare provider.
Which change in data indicates to the nurse that the desired effect of the angiotensin II receptor antagonist valsartan (Diovan) has been achieved?
Dependent edema reduced from +3 to +1.
Serum HDL increased from 35 to 55 mg/dl.
Pulse rate reduced from 150 to 90 beats/minute.
Blood pressure reduced from 160/90 to 130/80.
Rationale
Diovan is an angiotensin receptor blocker, prescribed for the treatment of hypertension. The desired effect is a decrease in blood pressure.
A client is admitted to the hospital for diagnostic testing for possible myasthenia gravis. The nurse prepares for intravenous administration of edrophonium chloride (Tensilon). What is the expected outcome for this client following administration of this pharmacologic agent?
Progressive difficulty with swallowing.
Decreased respiratory effort.
Improvement in generalized fatigue.
Decreased muscle weakness.
Rationale
Administration of edrophonium chloride (Tensilon), a cholinergic agent, will temporarily reduce muscle weakness, the most common complaint of newly-diagnosed clients with myasthenia gravis. This medication is used to diagnose myasthenia gravis due to its short duration of action. This drug would temporarily reverse difficulty in swallowing and respiratory effort.
A client who was prescribed atorvastatin (Lipitor) one month ago calls the triage nurse at the clinic complaining of muscle pain and weakness in his legs. Which statement reflects the correct drug-specific teaching the nurse should provide to this client?
Increase consumption of potassium-rich foods since low potassium levels can cause muscle spasms.
Have serum electrolytes checked at the next scheduled appointment to assess hyponatremia, a cause of cramping.
Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect.
Be sure to consume a low-cholesterol diet while taking the drug to enhance the effectiveness of the drug.
Rationale
Myopathy, suggested by the leg pain and weakness, is a serious, and potentially life-threatening, complication of Lipitor, and should be evaluated immediately by the healthcare provider.
Which nursing intervention is most important when caring for a client receiving the antimetabolite cytosine arabinoside (Arc-C) for chemotherapy?
Hydrate the client with IV fluids before and after infusion.
Assess the client for numbness and tingling of extremities.
Inspect the client’s oral mucosa for ulcerations.
Monitor the client’s urine pH for increased acidity.
Rationale
Cytosine arabinoside (Arc-C) affects the rapidly growing cells of the body, therefore stomatitis and mucosal ulcerations are key signs of antimetabolite toxicity.
Which nursing diagnosis is important to include in the plan of care for a client receiving the angiotensin-2 receptor antagonist irbesartan (Avapro)?
Fluid volume deficit.
Risk for infection.
Risk for injury.
Impaired sleep patterns.
Rationale
Avapro is an antihypertensive agent, which acts by blocking vasoconstrictor effects at various receptor sites. This can cause hypotension and dizziness, placing the client at high risk for injury.
The nurse is transcribing a new prescription for spironolactone (Aldactone) for a client who receives an angiotensin-converting enzyme (ACE) inhibitor. Which action should the nurse implement?
Verify both prescriptions with the healthcare provider.
Report the medication interactions to the nurse manager.
Hold the ACE inhibitor and give the new prescription.
Transcribe and send the prescription to the pharmacy.
Rationale
The concomitant use of an angiotensin-converting enzyme (ACE) inhibitor and a potassium-sparing diuretic such as spironolactone, should be given with caution because the two drugs may interact to cause an elevation in serum potassium levels. Although the client is currently receiving an ACE inhibitor, verifying both prescriptions alerts the healthcare provider about the client’s medication regimen and provides the safest action before administering the medication.
The nitrate isosorbide dinitrate (Isordil) is prescribed for a client with angina. Which instruction should the nurse include in this client’s discharge teaching plan?
Quit taking the medication if dizziness occurs.
Do not get up quickly. Always rise slowly.
Take the medication with food only.
Increase your intake of potassium-rich foods.
Rationale
An expected side effect of nitrates is orthostatic hypotension and the nurse should address how to prevent it–by rising slowly.
Which antidiarrheal agent should be used with caution in clients taking high dosages of aspirin for arthritis?
Loperamide (Imodium).
Probanthine (Propantheline).
Bismuth subsalicylate (Pepto Bismol).
Diphenoxylate hydrochloride with atropine (Lomotil).
Rationale
Bismuth subsalicylate (Pepto Bismol) contains a subsalicylate that increases the potential for salicylate toxicity when used concurrently with aspirin (acetylsalicylic acid, another salicylate preparation).
A client is receiving metoprolol (Lopressor SR, Nu-Metop). What assessment is most important for the nurse to obtain?
Temperature.
Lung sounds.
Blood pressure.
Urinary output.
Rationale
It is most important to monitor the blood pressure of clients taking this medication because metoprolol is an antianginal, antiarrhythmic, antihypertensive agent.
A client receiving albuterol (Proventil) tablets complains of nausea every evening with her 9:00 p.m. dose. What action can the nurse take to alleviate this side effect?
Change the time of the dose.
Hold the 9 p.m. dose.
Administer the dose with a snack.
Administer an antiemetic with the dose.
Rationale
Administering oral doses of albuterol with food helps minimize GI discomfort.
The nurse is assessing the effectiveness of high dose aspirin therapy for an 88-year-old client with arthritis. The client reports that she can’t hear the nurse’s questions because her ears are ringing. What action should the nurse implement?
Refer the client to an audiologist for evaluation of her hearing.
Advise the client that this is a common side effect of aspirin therapy.
Notify the healthcare provider of this finding immediately.
Ask the client to turn off her hearing aid during the exam.
Rationale
Tinnitus is an early sign of salicylate toxicity. The healthcare provider should be notified immediately, and the medication discontinued.
Which method of medication administration provides the client with the greatest first-pass effect?
Oral.
Sublingual.
Intravenous.
Subcutaneous.
Rationale
The first-pass effect is a pharmacokinetic phenomenon that is related to the drug’s metabolism in the liver. After oral medications are absorbed from the gastrointestinal tract, the drug is carried directly to the liver via the hepatic portal circulation where hepatic inactivation occurs and reduces the bioavailability of the drug. Alternative method of administration, such as sublingual, IV, and subcutaneous routes, avoid this first-pass effect.
Which client should the nurse identify as being at highest risk for complications during the use of an opioid analgesic?
An older client with Type 2 diabetes mellitus.
A client with chronic rheumatoid arthritis.
A client with a open compound fracture.
A young adult with inflammatory bowel disease.
Rationale
The principal indication for opioid use is acute pain, and a client with inflammatory bowel disease is at risk for toxic megacolon or paralytic ileus related to slowed peristalsis, a side effect of morphine. Adverse effects of morphine do not pose as great a risk for clients with diabetes or a fracture as for the client with bowel disease.
Which symptoms are serious adverse effects of beta-adrenergic blockers such as propranolol (Inderal)?
Headache, hypertension, and blurred vision.
Wheezing, hypotension, and AV block.
Vomiting, dilated pupils, and papilledema.
Tinnitus, muscle weakness, and tachypnea.
Rationale
Wheezing, hypotension, and AV block represents the most serious adverse effects of beta-blocking agents. AV block is generally associated with bradycardia and results in potentially life-threatening decreases in cardiac output. Additionally, wheezing secondary to bronchospasm and hypotension represent life-threatening respiratory and cardiac disorders.
When assessing an adolescent who recently overdosed on acetaminophen (Tylenol), it is most important for the nurse to assess for pain in which area of the body?
Flank.
Abdomen.
Chest.
Head.
Rationale
Acetaminophen toxicity can result in liver damage; therefore, it is especially important for the nurse to assess for pain in the right upper quadrant of the abdomen, which might indicate liver damage, along with nausea and vomiting.
Upon admission to the emergency center, an adult client with acute status asthmaticus is prescribed this series of medications. In which order should the nurse administer the prescribed medications? (Arrange from first to last.)
1.
Albuterol (Proventil) puffs.
2.
Salmeterol (Serevent Diskus).
3.
Prednisone (Deltasone) orally.
4.
Gentamicin (Garamycin) IM.
Rationale
Status asthmaticus is potentially a life-threatening respiratory event, so albuterol, a beta2 adrenergic agonist and short acting bronchodilator, should be administered by inhalation first to provide rapid and deep topical penetration to relieve bronchospasms, dilate the bronchioles, and increase oxygenation. In stepwise management of persistent asthma, a long-action bronchodilator, such as salmeterol (Serevent Diskus), with a 12-hour duration of action should be given next. Prednisone, an oral corticosteroid, provides prolonged anti-inflammatory effects and should be given after the client’s respiratory distress begins to resolves. Gentamicin, an antibiotic, is given deep IM, which can be painful, and may require repositioning the client, so should be last in the sequence.
An older client with a decreased percentage of lean body mass is likely to receive a prescription that is adjusted based on which pharmacokinetic process?
Absorption.
Metabolism.
Elimination.
Distribution.
Rationale
A decreased lean body mass in an older adult affects the distribution of drugs which affects the pharmacokinetics of drugs. In contrast, decreased gastric pH, delayed gastric emptying, decreased splanchnic blood flow, decreased gastrointestinal absorption surface areas and motility affect absorption in the older adult population. Decreased hepatic blood flow, decreased hepatic mass, and decreased activity of hepatic enzymes affect metabolism in older adults. Decreased renal blood flow, decreased glomerular filtration rate, decreased tubular secretion, and decreased number of nephrons affects elimination in an older adult.
A client is receiving ampicillin sodium (Omnipen) for a sinus infection. The nurse should instruct the client to notify the healthcare provider immediately if which symptom occurs?
Rash.
Nausea.
Headache.
Dizziness.
Rationale
Rash is the most common adverse effect of all penicillins, indicating an allergy to the medication which could result in anaphylactic shock, a medical emergency.
A client with heart failure (HF) is being discharged with a new prescription for the angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten). The nurse’s discharge instruction should include reporting which problem to the healthcare provider?
Weight loss.
Dizziness.
Muscle cramps.
Dry mucous membranes.
Rationale
Angiotensin-converting enzyme (ACE) inhibitors are used in HF to reduce afterload by reversing vasoconstriction common in heart failure. This vasodilation can cause hypotension and resultant dizziness. Weight loss is desired if fluid overload is present, and may occur as the result of effective combination drug therapy such as diuretics with ACE inhibitors. It does not reuiqre reporting to the healthcare provider. Unlike ACE inhibitors, diuretics may result in hypokalemia and excessive diuretic administration may result in fluid volume deficit manifested by symptoms of dehydration.
A client is receiving digoxin for the onset of supraventricular tachycardia (SVT). Which laboratory finding should the nurse identify that places this client at risk?
Hypokalemia.
Hyponatremia.
Hypercalcemia.
Low uric acid levels.
Rationale
Hypokalemia affects myocardial contractility and places this client at greatest risk for dysrhythmias that may be unresponsive to drug therapy. Although an imbalance of serum sodium and calcium can effect cardiac rhythm, the greatest risk for the client receiving digoxin is low potassium.
A client is being treated for hyperthyroidism with propylthiouracil (PTU). The nurse knows that the action of this drug is to
decrease the amount of thyroid-stimulating hormone circulating in the blood.
increase the amount of thyroid-stimulating hormone circulating in the blood.
increase the amount of T4 and decrease the amount of T3 produced by the thyroid.
inhibit synthesis of T3 and T4 by the thyroid gland.
Rationale
PTU is an adjunct therapy used to control hyperthyroidism by inhibiting production of thyroid hormones. It is often prescribed in preparation for thyroidectomy or radioactive iodine therapy.
Dobutamine (Dobutrex) is an emergency drug most commonly prescribed for a client with which condition?
Shock.
Asthma.
Hypotension.
Heart failure.
Rationale
Dobutamine is a beta-1 adrenergic agonist that is indicated for short term use in cardiac decompensation or heart failure related to reduced cardiac contractility due to organic heart disease or cardiac surgical procedures. On the other hand, alpha and beta adrenergic agonists, such as epinephrine and dopamine, are sympathomimetics used in the treatment of shock. Other selective beta-2 adrenergic agonists, such as terbutaline and isoproterenol, are indicated in the treatment of asthma. Although dobutamine improves cardiac output, it is not used to treat hypotension.
After abdominal surgery, a male client is prescribed low molecular weight heparin (LMWH). During administration of the medication, the client asks the nurse why he is receiving this medication. Which is the best response for the nurse to provide?
This medication is a blood thinner given to prevent blood clot formation.
This medication enhances antibiotics to prevent infection.
This medication dissolves any clots that develop in the legs.
This abdominal injection assists in the healing of the abdominal wound.
Rationale
Unfractionated heparin or low molecular weight heparin (LMWH) is an anticoagulant that inhibits thrombin-mediated conversion of fibrinogen to fibrin and is given prophylactically to prevent postoperative venous thrombosis in order to prevent pulmonary embolism or deep vein thrombosis following knee and abdominal surgeries.
The nurse is preparing the 0900 dose of losartan (Cozaar), an angiotensin II receptor blocker (ARB), for a client with hypertension and heart failure. The nurse reviews the client’s laboratory results and notes that the client’s serum potassium level is 5.9 mEq/L. What action should the nurse take first?
Withhold the scheduled dose.
Check the client’s apical pulse.
Notify the healthcare provider.
Repeat the serum potassium level.
Rationale
The nurse should first withhold the scheduled dose of Cozaar because the client is hyperkalemic (normal range 3.5 to 5 mEq/l). Although hypokalemia is usually associated with diuretic therapy in heart failure, hyperkalemia is associated with several heart failure medications, including ARBs. Because hyperkalemia may lead to cardiac dysrhythmias, the nurse should check the apical pulse for rate and rhythm, and the blood pressure.
The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with osteoarthritis of the hands. The client tells the nurse that the drug does not seem to be effective after three weeks. Which is the best response for the nurse to provide?
The frequency of the dosing is necessary to increase the effectiveness.
Therapeutic blood levels of this drug are reached in 4 to 6 weeks.
Another type of nonsteroidal antiinflammatory drug may be indicated.
Systemic corticosteroids are the next drugs of choice for pain relief.
Rationale
Individual responses to nonsteroidal antiinflammatory drugs are vary from person to person, so another nonsteroidal antiinflammatory drug (NSAID) may be indicated for this particular client.
A client with a dysrhythmia is to receive procainamide (Pronestyl) in 4 divided doses over the next 24 hours. What dosing schedule is best for the nurse to implement?
q6h.
QID.
AC and bedtime.
PC and bedtime.
Rationale
Pronestyl is a class 1A antidysrhythmic. It should be taken around-the-clock, so that a stable blood level of the drug can be maintained, thereby decreasing the possibility of hypotension (an adverse effect) occurring because of too much of the drug circulating systemically at any particular time of day. Pronestyl may be given with food if GI distress is a problem.
The nurse is assessing a client who is experiencing anaphylaxis from an insect sting. Which prescription should the nurse prepare to administer this client?
Dopamine.
Ephedrine.
Epinephrine.
Diphenhydramine.
Rationale
Epinephrine is an adrenergic agent that stimulates beta receptors to increase cardiac automaticity in cardiac arrest and relax bronchospasms in anaphylaxis. On the ither hand, dopamine is a vasopressor used to treat clients with shock. Ephedrine causes peripheral vasoconstriction and is used in the treatment of nasal congestion. Diphenhydramine is an antihistamine decongestant used in the treatment of mild allergic reactions and motion sickness. Epinephrine is the medication of choice in treating anaphylaxis.
While taking a nursing history, the client states, “I am allergic to penicillin.” What related allergy to another type of antiinfective agent should the nurse ask the client about when taking the nursing history?
Aminoglycosides.
Cephalosporins.
Sulfonamides.
Tetracyclines.
Rationale
If a client has a history of being allergic to penicillin (PCN); there is appears to be a cross sensitivity between penicillins and 1st generation cephalosporins. According to research, there appears to be no cross sensitivity between PCN and 3rd or 4th generation cephalosporins.
In evaluating the effects of lactulose (Cephulac), which outcome would indicate that the drug is performing as intended?
An increase in urine output.
Two or three soft stools per day.
Watery, diarrhea stools.
Increased serum bilirubin.
Rationale
The medication lactulose can be administered for either chronic constipation or for portal-systemic encephalopathy in clients with hepatic disease. Two to three stools a day indicate that lactulose is performing as intended for chronic constipation. This would also indicate it should be effective for the clients with encephalopathy because the lactulose’s action prevents absorption of ammonia in the colon as it increases water absorption and softens the stool. The efficacy of the use for ammonia absorption would have to be verified by a serum ammonia level and observation of clearing of the client’s mental status.
Following the administration of sublingual nitroglycerin to a client experiencing an acute anginal attack, which assessment finding indicates to the nurse that the desired effect has been achieved?
Client states chest pain is relieved.
Client’s pulse decreases from 120 to 90.
Client’s systolic blood pressure decreases from 180 to 90.
Client’s SaO2 level increases from 92% to 96%.
Rationale
Nitroglycerin reduces myocardial oxygen consumption which decreases ischemia and reduces chest pain.
A 43-year-old female client is receiving thyroid replacement hormone following a thyroidectomy. What adverse effects associated with thyroid hormone toxicity should the nurse instruct the client to report promptly to the healthcare provider?
Tinnitus and dizziness.
Tachycardia and chest pain.
Dry skin and intolerance to cold.
Weight gain and increased appetite.
Rationale
Thyroid replacement hormone increases the metabolic rate of all tissues, so common signs and symptoms of toxicity include tachycardia and chest pain.
A client with hyperlipidemia receives a prescription for niacin (Niaspan). Which client teaching is most important for the nurse to provide?
Expected duration of flushing.
Symptoms of hyperglycemia.
Diets that minimize GI irritation.
Comfort measures for pruritis.
Rationale
Flushing of the face and neck, lasting up to an hour, is a frequent reason for discontinuing niacin. Inclusion of this effect in client teaching may promote compliance in taking the medication. While nutrition tips and managing pruritis are worthwhile instructions to help clients minimize or cope with normal side effects associated with niacin (Niaspan), flushing is intense and causes the most concern for the client.
The healthcare provider prescribes naloxone (Narcan) for a client in the emergency room. Which assessment data would indicate that the naloxone has been effective? The client’s
statement that the chest pain is better.
respiratory rate is 16 breaths/minute.
seizure activity has stopped temporarily.
pupils are constricted bilaterally.
Rationale
Naloxone (Narcan) is a narcotic antagonist that reverses the respiratory depression effects of opiate overdose, so assessment of a normal respiratory rate would indicate that the respiratory depression has been reversed.
Which medications should the nurse caution the client about taking while receiving an opioid analgesic?
Antacids.
Benzodiazepines.
Antihypertensives.
Oral antidiabetics.
Rationale
Respiratory depression increases with the concurrent use of opioid analgesics and other central nervous system depressant agents, such as alcohol, barbiturates, and benzodiazepines. Antacids and antidiabetic agents do not interact with opiates to produce adverse effects. Antihypertensives may cause morphine-induced hypotension, but should not be withheld without notifying the healthcare provider.
A client is being treated for osteoporosis with alendronate (Fosamax), and the nurse has completed discharge teaching regarding medication administration. Which morning schedule would indicate to the nurse that the client teaching has been effective?
Take medication, go for a 30 minute morning walk, then eat breakfast.
Take medication, rest in bed for 30 minutes, eat breakfast, go for morning walk.
Take medication with breakfast, then take a 30 minute morning walk.
Go for a 30 minute morning walk, eat breakfast, then take medication.
Rationale
Alendronate (Fosamax) is best absorbed when taken thirty minutes before eating in the morning. The client should also be advised to remain in an upright position for at least thirty minutes after taking the medication to reduce the risk of esophageal reflux and irritation.
A client’s dose of isosorbide dinitrate (Imdur) is increased from 40 mg to 60 mg PO daily. When the client reports the onset of a headache prior to the next scheduled dose, which action should the nurse implement?
Hold the next scheduled dose of Imdur 60 mg and administer a PRN dose of acetaminophen (Tylenol).
Administer the 40 mg of Imdur and then contact the healthcare provider.
Administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol).
Do not administer the next dose of Imdur or any acetaminophen until notifying the healthcare provider.
Rationale
Imdur is a nitrate which causes vasodilation. This vasodilation can result in headaches, which can generally be controlled with acetaminophen until the client develops a tolerance to this adverse effect.
A peak and trough level must be drawn for a client receiving antibiotic therapy. What is the optimum time for the nurse to obtain the trough level?
Sixty minutes after the antibiotic dose is administered.
Immediately before the next antibiotic dose is given.
When the next blood glucose level is to be checked.
Thirty minutes before the next antibiotic dose is given.
Rationale
Trough levels are drawn when the blood level is at its lowest, which is typically just before the next dose is given.
An antacid (Maalox) is prescribed for a client with peptic ulcer disease. The nurse knows that the purpose of this medication is to
decrease production of gastric secretions.
produce an adherent barrier over the ulcer.
maintain a gastric pH of 3.5 or above.
decrease gastric motor activity.
Rationale
The objective of antacids is to neutralize gastric acids and keep pH of 3.5 or above which is necessary for pepsinogen inactivity.
A client with coronary artery disease who is taking digoxin (Lanoxin) receives a new prescription for atorvastatin (Lipitor). Two weeks after initiation of the Lipitor prescription, the nurse assesses the client. Which finding requires the most immediate intervention?
Heartburn.
Headache.
Constipation.
Vomiting.
Rationale
Vomiting, anorexia and abdominal pain are early indications of digitalis toxicity. Since Lipitor increases the risk for digitalis toxicity, this finding requires the most immediate intervention by the nurse.
A client who has been taking levodopa PO TID to control the symptoms of Parkinson’s disease has a new prescription for sustained release levodopa/carbidopa (Sinemet 25/100) PO BID. The client took his levodopa at 0800. Which instruction should the nurse include in the teaching plan for this client?
“Take the first dose of Sinemet today, as soon as your prescription is filled.”
“Since you already took your levodopa, wait until tomorrow to take the Sinemet.”
“Take both drugs for the first week, then switch to taking only the Sinemet.”
“You can begin taking the Sinemet this evening, but do not take any more levodopa.”
Rationale
Carbidopa significantly reduces the need for levodopa in clients with Parkinson’s disease, so the new prescription should not be started until eight hours after the previous dose of levodopa, but can be started the same day.
A category X drug is prescribed for a young adult female client. Which instruction is most important for the nurse to teach this client?
Use a reliable form of birth control.
Avoid exposure to ultra violet light.
Refuse this medication if planning pregnancy.
Abstain from intercourse while on this drug.
Rationale
Drugs classified in the category X place a client who is in the first trimester of pregnancy at risk for teratogenesis, so women in the childbearing years should be counseled to use a reliable form of birth control during drug therapy. If the client is planning to become pregnant, she should be encouraged to discuss plans for pregnancy with the healthcare provider, so a safer alternative prescription can be provided if pregnancy occurs.
A client with giardiasis is taking metronidazole (Flagyl) 2 grams PO. Which information should the nurse include in the client’s instruction?
Notify the clinic of any changes in the color of urine.
Avoid overexposure to the sun.
Stop the medication after the diarrhea resolves.
Take the medication with food.
Rationale
Flagyl, an amoebicide and antibacterial agent, may cause gastric distress, so the client should be instructed to take the medication on a full stomach. Urine may be red-brown or dark from Flagyl, but this side effect is an expectant finding and not necessary to report tot he healthcare provider.
A client asks the nurse if glipizide (Glucotrol) is an oral insulin. Which response should the nurse provide?
“Yes, it is an oral insulin and has the same actions and properties as intermediate insulin.”
“Yes, it is an oral insulin and is distributed, metabolized, and excreted in the same manner as insulin.”
“No, it is not an oral insulin and can be used only when some beta cell function is present.”
“No, it is not an oral insulin, but it is effective for those who are resistant to injectable insulins.”
Rationale
An effective oral form of insulin has not yet been developed because when insulin is taken orally, it is destroyed by digestive enzymes. Glipizide (Glucotrol) is an oral hypoglycemic agent that enhances pancreatic production of insulin.
A client receiving Doxorubicin (Adriamycin) intravenously (IV) complains of pain at the insertion site, and the nurse notes edema at the site. Which intervention is most important for the nurse to implement?
Assess for erythema.
Administer the antidote.
Apply warm compresses.
Discontinue the IV fluids.
Rationale
Doxorubicin is an antineoplastic agent that causes inflammation, blistering, and necrosis of tissue upon extravasation. First, all IV fluids should be discontinued at the site to prevent further tissue damage by the vesicant.
Which drug is used as a palliative treatment for a client with tumor-induced spinal cord compression?
Morphine Sulfate (Duromorph).
Ibuprofen (Advil).
Amitriptyline (Amitril).
Dexamethasone (Decadron).
Rationale
Dexamethasone is a palliative treatment modality to manage symptoms related to compression due to tumor growth ( the focus of this question). Morphine sulphate is an opioid analgesic used in oncology to manage severe or intractable pain. Ibuprofen, a nonsteroidal antiinflammatory drug (NSAID), provides relief for mild to moderate pain, suppression of inflammation, and reduction of fever. Amitriptyline, a tricyclic antidepressant, is often prescribed for pain related to neuropathic origin and provides a reduction in opioid dosage.
An adult client is given a prescription for a scopolamine patch (Transderm Scop) to prevent motion sickness while on a cruise. Which information should the nurse provide to the client?
Apply the patch at least 4 hours prior to departure.
Change the patch every other day while on the cruise.
Place the patch on a hairless area at the base of the skull.
Drink no more than 2 alcoholic drinks during the cruise.
Rationale
Scopolamine, an anticholinergic agent, is used to prevent motion sickness and has a peak onset in 6 hours, so the client should be instructed to apply the patch at least 4 hours before departure on the cruise ship. The duration of the transdermal patch is 72 hours. Scolopamine blocks muscarinic receptors in the inner ear and to the vomiting center, so the best application site of the patch is behind the ear. Anticholinergic medications are CNS depressants, so the client should be instructed to avoid alcohol while using the patch.
A client is receiving methylprednisolone (Solu-Medrol) 40 mg IV daily. The nurse anticipates an increase in which laboratory value as the result of this medication?
Serum glucose.
Serum calcium.
Red blood cells.
Serum potassium.
Rationale
Solu-Medrol is a corticosteroid with glucocorticoid and mineralocorticoid actions. These effects can lead to hyperglycemia which is reflected as an increase in the serum glucose value. The client taking Solu-Medrol is also at risk for hypocalcemia and hypokalemia which result in a decrease in the serum calcium and serum potassium levels. These medications also alter the some of the body’s immune responses by suppressing the migration of white blood cells decreasing inflammation response.