RN Pharmacology Latest 2026\2027 Actual Exam 242 Questions And Answers

RN Pharmacology LATEST 2026\2027 ACTUAL EXAM 242 QUESTIONS AND ANSWERS WITH RATIONALES (VERIFIED ANSWERS) ALREADY GRADED A+ A provider prescribes phenobarbital for a client who has a seizure disorder. The medication has a long half-life of 4 days. How many times per day should the nurse expect to administer this medication? A. One B. Two C. Three D. Four - CORRECT ANSWER A. Medications with long half-lives remain at their therapeutic levels between doses for long periods of time. The nurse should expect to administer this medication once a day. A staff educator is reviewing medication dosages and factors that influence medication metabolism with a group of nurses at an in-service presentation. Which of the following factors should the educator include as a reason to administer lower medication dosages? (Select all that apply.) A. Increased renal secretion B. Increased medication-metabolizing enzymes C. Liver failure D. Peripheral vascular disease E. Concurrent use of medication the same pathway metabolizes - CORRECT ANSWER C. Liver failure decreases metabolism and thus increases the concentration of a medication. This requires decreasing the dosage. E. When the same pathway metabolizes two medications, they compete for metabolism, thereby increasing the concentration of one or both medications. This requires decreasing the dosage of one or both medications. A nurse is preparing to administer eye drops to a client. Which of the following actions should the nurse take? (Select all that apply.) A.have the client lie on her side. B.Ask the client to look up at the ceiling. C.Tell the client to blink when the drops enter her eye. D.Drop the medication into the center of the client's conjunctival sac. E.Instruct the client to close her eye gently after instillation - CORRECT ANSWER B. The client should look upward to keep the drops from falling onto her cornea. D. The nurse should drop the medication into the center of the conjunctival sac to promote distribution. E. The client should close her eye gently to promote distribution of the medication A nurse is completing discharge teaching for a client who has a new prescription for transdermal patches. Which of the following statements should the nurse identify as an indication that the client understands the instructions? A."I will clean the site with an alcohol swab before I apply the patch." B."I will rotate the application sites weekly." C."I will apply the patch to an area of skin with no hair." D."I will place the new patch on the site of the old patch. - CORRECT ANSWER C. The client should apply the patch to a hairless area of skin to promote absorption of the medication. A nurse reviewing a client's medical record notes a new prescription for verifying the trough level of the client's medication. Which of the following actions should the nurse take? A.Obtain a blood specimen immediately prior to administering the next dose of medication. B.Verify that the client has been taking the medication for 24 hr before obtaining a blood specimen. C.Ask the client to pr ovide a urine specimen after the next dose of medication. D.Administer the medication,and obtain a blood specimen 30 min late - CORRECT ANSWER A. To verify trough levels of a medication, the nurse should obtain a blood specimen immediately before administering the next dose of medication. A nurse is preparing a client's medications. Which of the following actions should the nurse take in following legal practice guidelines? (Select all that apply.) A.maintain skill competency. B.Determine the dosage. C. monitor for adverse effects. D.Safeguard medications. E.Identify the client's diagnosis - CORRECT ANSWER A.maintaining skill competency and using appropriate administration techniques are legal responsibilities of the nurse C. A nurse is legally responsible for monitoring for side and adverse effects of medication D. Safeguarding of medications, such as controlled substances, is a legal responsibility of the nurse A nurse reviewing a client's health record notes a new prescription for lisinopril 10 mg PO once every day. The nurse should identify this as which of the following types of prescription? A.Single B.Stat C.Routine D.Standing - CORRECT ANSWER C. A routine or standard prescription identifies medications to give on a regular schedule with or without a termination date or a specific number of doses. The nurse will administer this medication every day until the provider discontinues it. A nurse is reviewing a new prescription for ondansetron 4 mg PO PRN for nausea and vomiting for a client who has hyperemesis gravidarum. The nurse should clarify which of the following parts of the prescription with the provider? A.Name B.Dosage C.Route D.Frequency - CORRECT ANSWER D. This prescription does not include the time or frequency of medication administration. The nurse must clarify this with the prescribing provide A nurse is admitting a client and completing a preassessment before administering medications. Which of the following data should the nurse include in the preassessment? (Select all that apply.) A.Use of herbal teas B.Daily fluid intake C.Current health status D.Previous surgical history E.Food allergies - CORRECT ANSWER A. The nurse should inquire about the client's use of herbal products, which often contain caffeine, prior to medication administration because caffeine can affect medication biotransformation C. The nurse should review the client's current health status because new prescriptions can cause alterations in current health status E. The nurse should inquire about food allergies during the preassessment to identify any potential reactions or interactions A nurse orienting a newly licensed nurse is reviewing the procedure for taking a telephone prescription. Which of the following statements should the nurse identify as an indication that the newly licensed nurse understands the process? A."A second nurse enters the prescription into the client's medical record." B."Another nurse should listen to the phone call." C."The provider can clarify the prescription when he signs the health record." D."I should omit the 'r ead back' if this is a one-time prescription - CORRECT ANSWER B.A second nurse should listen to a telephone prescription to prevent errors in communication. A nurse is preparing to administer vancomycin 1 g by intermittent IV bolus. Available is vancomycin 1 g in 100 mL of dextrose 5% in water (D5W) to infuse over 45 min. The drop factor of the manual IV tubing is 10 gtt/mL. The nurse should adjust the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Do not use a trailing zero. - CORRECT ANSWER 22 gtt/min A nurse is preparing to administer clindamycin 200 mg by intermittent IV bolus. The amount available is clindamycin injection 200 mg in 100 mL 0.9% sodium chloride (0.9% NaCl) to infuse over 30 min. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Do not use a trailing zero. - CORRECT ANSWER 200 mL/hr A nurse is preparing to administer furosemide 80 mg PO daily. The amount available is furosemide oral solution 10 mg/1 mL. how many mL should the nurse administer? (Round the answer to the nearest whole number. Do not use a trailing zero.) - CORRECT ANSWER 8 mL A nurse is preparing to administer haloperidol 2 mg PO every 12 hr. The amount available is haloperidol 1 mg/tablet. how many tablets should the nurse administer? (Round the answer to the nearest whole number. Do not use a trailing zero. CORRECT ANSWER 2 tablets A nurse is preparing to administer amoxicillin 20 mg/kg/day PO to divide equally every 12 hr to a preschooler who weighs 44 lb. The amount available is amoxicillin suspension 250 mg/5 mL. how many mL should the nurse administer per dose? (Round the answer to the nearest whole number. Do not use a trailing zero.) CORRECT ANSWER 4 mL A nurse is preparing to administer heparin 15,000 units subcutaneously every 12 hr. The amount available is heparin injection 20,000 units/mL. how many mL should the nurse administer per dose? (Round the answer to the nearest tenth. Do not use a trailing zero. - CORRECT ANSWER 0.8 mL A nurse is preparing to administer acetaminophen 650 mg PO every 6 hr PRN for pain. The amount available is acetaminophen liquid 500 mg/5 mL. how many mL should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero. - CORRECT ANSWER 6.5 mL A nurse is preparing to administer dextrose 5% in water (D5W) 750 mL IV to infuse over 6 hr. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Do not use a trailing zero. - CORRECT ANSWER 125 mL/hr A nurse is assessing a client's IV infusion site. Which of the following findings should the nurse identify as an indication of phlebitis? (Select all that apply.) A.Pallor B.Dampness C.Erythema D.Coolness E.Pain - CORRECT ANSWER C. Erythema at the insertion site is a manifestation of phlebitis. E.Pain at the insertion site is a manifestation of phlebitis. A nurse manager is reviewing the facility's policies for IV therapy with the members of his team. The nurse manager should remind the team that which of the following techniques helps minimize the risk of catheter embolism? A.Performing hand hygiene before and after IV insertion B.Rotating IV sites at least every 72 hr C.minimizing tourniquet time D.Avoiding reinserting the needle into an IV catheter - CORRECT ANSWER D. The nurse manager should remind the members of the team to avoid reinserting the stylet needle into an IV catheter. This action can result in severing the end of the catheter and consequently cause a catheter embolism A nurse is preparing to initiate IV therapy for an older adult client. Which of the following actions should the nurse plan to take? A.Use a disposable razor to remove excess hair on the extremity. B.Select the back of the client's hand to insert the IV catheter. C.Distend the veins by using a blood pressure cuff. D.Direct the client to raise his arm above his heart - CORRECT ANSWER C.The nurse should distend the veins using a blood pressure cuff to reduce overfilling of the vein, which can result in a hematoma. A nurse assessing a client's IV catheter insertion site notes a hematoma. Which of the following actions should the nurse take? (Select all that apply.) A.Stop the infusion. B.Apply alcohol to the insertion site. C.Apply warm compresses to the insertion site D.Elevate the client's arm. E.Obtain a specimen for culture at the insertion site - CORRECT ANSWER C. Warm compresses can help promote healing of a hematoma. D. Elevation of the arm helps reduce edema, which can cause pressure and pain and additional bleeding in the area of the hematoma. A nurse in a clinic is caring for a group of clients. The nurse should contact the provider about a potential contraindication to a medication for which of the following clients? (Select all that apply.) A.A client at 8 weeks of gestation who asks for an influenza immunization B.A client who takes prednisone and has a possible fungal infection C.A client who has chronic liver disease and is taking hydrocodone D.A client who has peptic ulcer disease, takes sucralfate, and tells the nurse she has started taking OTC aluminum hydroxide E.A client who has a pr osthetic heart valve, takes warfarin, and reports a suspected pregnancy - CORRECT ANSWER B. Glucocorticoids should not be taken by a client who has a possible systemic fungal infection. The nurse should recognize a contraindication and notify the provider. C. Acetaminophen is contraindicated due to toxicity for a client who has a liver disorder. The nurse should notify the provider, who can prescribe a medication that does not contain acetaminophen. E. Warfarin is a Pregnancy Category X medication, which can cause severe birth defects to the fetus. The nurse should notify the provider about the suspected pregnancy A nurse is preparing to administer an Im dose of penicillin to a client who has a new prescription. The client states she took penicillin 3 years ago and developed a rash. Which of the following actions should the nurse take? A.Administer the prescribed dose. B.Withhold the medication. C.Ask the provider to change the prescription to an oral form. D.Administer an oral antihistamine at the same time - CORRECT ANSWER B. The nurse should withhold the medication and notify the provider of the client's previous reaction to penicillin so that an alternative antibiotic can be prescribed. Allergic reactions to penicillin can range from mild to severe anaphylaxis, and prior sensitization should be reported to the provider. A nurse is providing discharge instructions for a client who has a new prescription for an antihypertensive medication. Which of the following statements should the nurse give? A."Be sure to limit your potassium intake while taking the medication." B."You should check your blood pressure every 8 hours while taking this medication." C."Your medication dosage will be increased if you develop tachycardia." D."Change positions slowly when you move from sitting to standing." CORRECT ANSWER D. Orthostatic hypotension is a common adverse effect of antihypertensive medications. The client should move slowly to a sitting or standing position and should be taught to sit or lie down if lightheadedness or dizziness occurs A nurse is reviewing a client's health record and notes that the client experiences permanent extrapyramidal effects caused by a previous medication. The nurse should recognize that the medication affected which of the following systems in the client? A.Cardiovascular B.Immune C.Central nervous D.Gastrointestina - CORRECT ANSWER C. The nurse should realize that extrapyramidal effects are movement disorders that can be caused by a number of central nervous system medications, such as typical antipsychotic medications A nurse is caring for a client who is taking oral oxycodone The client states he is also taking ibuprofen in three recommended doses daily. The nurse should identify that an interaction between these two medications will cause which of the following findings? A. A decrease in serum levels of ibuprofen, possibly leading to a need for increased doses of this medication B.A decrease in serum levels of oxycodone, possibly leading to a need for increased doses of this medication C.An increase in the expected therapeutic effect of both medications D.An increase in expected adverse effects for both medications - CORRECT ANSWER C. These medications work together to increase the pain-relieving effects of both medications. Oxycodone is a narcotic analgesic, and ibuprofen is an NSAID. They work by different mechanisms, but pain is better relieved when they are taken together A nurse is preparing to administer medications to a 4-month-old infant. Which of the following pharmacokinetic principles should the nurse consider when administering medications to this client? (Select all that apply.) A. Infants have a more rapid gastric emptying time. B.Infants have immature liver function. C.Infants' blood-brain barrier is poorly developed. D.Infants have an increased ability to absorb topical medications. E.Infants have an increased number of protein-binding sites. - CORRECT ANSWER B. Infants have immature liver function until 1 year of age. The nurse should administer medications the liver metabolizes in smaller dosages. C. Infants have a poorly developed blood-brain barrier, which places them at risk for adverse effects from medications that pass through the blood-brain barrier. The nurse should administer these medications in smaller dosages. D. Because infants have more blood flowing to the skin and their skin is thin, their medication absorption is increased, making them prone to toxicity from topical medications A nurse in a provider's office is reviewing the medical record of a client who is pregnant and is at her first prenatal visit. Which of the following immunizations may the nurse administer safely to this client? A.Varicella vaccine B.Rubella vaccine C.Inactivated influenza vaccine D.measles vaccine - CORRECT ANSWER C. During influenza season, providers recommend the inactivated influenza vaccine for women who are pregnant A nurse on a medical-surgical unit administers a hypnotic medication to an older adult client at 2100. The next morning, the client is drowsy and wants to sleep instead of eating breakfast. Which of the following factors should the nurse identify as a possible reason for the client's drowsiness? A.Reduced cardiac function B.First-pass effect C.Reduced hepatic function D.Increased gastric motility - CORRECT ANSWER C. Older adults have reduced hepatic function, which can prolong the effects of medications the liver metabolizes. The client probably needs a lower dosage of the hypnotic medication A nurse working in an emergency department is caring for a client who has benzodiazepine toxicity due to an overdose. Which of the following actions is the nurse's priority? A.Administer flumazenil. B.Identify the client's level of orientation. C.Infuse IV fluids. D.Prepare the client for gastric lavage - CORRECT ANSWER B. The first action the nurse should take when using the nursing process is to assess the client. Identifying the client's level of orientation is the priority action. A nurse is teaching a client who has a new prescription for escitalopram for treatment of generalized anxiety disorder. Which of the following statements by the client indicates understanding of the teaching? A."I should take the medication on an empty stomach." B."I will follow a low-sodium diet while taking this medication." C."I need to discontinue this medication slowly." D."I should not crush this medication before swallowing." - CORRECT ANSWER C. When discontinuing escitalopram, the client should taper the medication slowly according to a prescribed tapered dosing schedule to reduce the risk of withdrawal syndrome. A nurse is providing teaching to a client who has a new prescription for buspirone to treat anxiety. Which of the following information should the nurse include? A."Take this medication on an empty stomach" B."Expect optimal therapeutic effects within 24 hr." C."Take this medication when needed for anxiety" D."This medication has a low risk for dependency." - CORRECT ANSWER D. Buspirone has a low risk for physical or psychological dependence or tolerance. A nurse is teaching a client who has obsessive-compulsive disorder and has a new prescription for paroxetine. Which of the following instructions should the nurse include? A."It can take several weeks before you feel like the medication is helping." B."Take the medication just before bedtime to promote sleep." C."You should take the medication when needed for obsessive urges." D."monitor for weight gain while taking this medication." - CORRECT ANSWER A. Paroxetine can take 1 to 4 weeks before the client reaches full therapeutic benefit. A nurse is caring for a client who takes paroxetine to treat posttraumatic stress disorder and reports that he grinds his teeth during the night. The nurse should identify which of the following interventions to manage bruxism? (Select all that apply.) A.Concurrent administration of buspirone B.Administration of a different SSRI C.Use of a mouth guard D.Changing to a different class of antidepressant medication E.Increasing the dose of paroxetine - CORRECT ANSWER A. Concurrent administration of a low dose of buspirone is an effective measure to manage the adverse effects of paroxetine C.Using a mouth guard during sleep can decrease the risk for oral damage resulting from bruxism. D. Changing to different class of antidepressant medication that does not have the adverse effect of bruxism is an effective measure A nurse is caring for a client who has a new prescription for phenelzine for the treatment of depression. Which of the following indicates that the client has developed an adverse effect of this medication? A.Orthostatic hypotension B. hearing loss C.Gastrointestinal bleeding D.Weight loss - CORRECT ANSWER A.Orthostatic hypotension is an adverse of effect of mAOIs, including phenelzine. A nurse is providing teaching to a client who has a new prescription for amitriptyline for treatment of depression. Which of the following should the nurse include in the teaching? (Select all that apply.) A.Expect therapeutic effects in 24 to 48 hr. B.Discontinue the medication after a week of improved mood. C.Change positions slowly to minimize dizziness. D.Decrease dietary fiber intake to control diarrhea. E.Chew sugarless gum to prevent dry mouth - CORRECT ANSWER C. Changing positions slowly helps prevent orthostatic hypotension, which is an adverse effect of amitriptyline E. Chewing sugarless gum can minimize dry mouth, which is an adverse effect of amitriptyline A nurse is providing discharge teaching to a client who has a new prescription for fluoxetine for posttraumatic stress disorder. Which of the following statements should the nurse include in the teaching? A."You may have a decreased desire for intimacy while taking this medication." B."You should take this medication at bedtime to help promote sleep." C."You will have fewer urinary adverse effects if you urinate just before taking this medication." D."You'll need to wear sunglasses when outdoors due to the light sensitivity caused by this medication. - CORRECT ANSWER A.Decreased libido is a potential adverse effect of fluoxetine and other SSRIs A nurse is caring for a client who has depression and a new prescription for venlafaxine. For which of the following adverse effects should the nurse monitor this client? (Select all that apply) A.Cough B.Dizziness C.Decreased libido D.Alopecia E.hypotension - CORRECT ANSWER A.Cough and dyspnea can indicate that the client has developed bronchitis, which is an adverse effect of venlafaxine. B.Dizziness is a common adverse effect of venlafaxine. C.Sexual dysfunction, such as decreased A nurse is caring for a client who has been taking sertraline for the past 2 days. Which of the following assessment findings should alert the nurse to the possibility that the client is developing serotonin syndrome? A.Bruising B.Fever C.Abdominal pain D.Rash - CORRECT ANSWER B.Fever is a manifestation of serotonin syndrome, which can result from taking an SSRI such as sertraline A nurse is reviewing laboratory findings and notes that a client's plasma lithium level is 2.1 mEq/L. Which of the following is an appropriate action by the nurse? A.Perform immediate gastric lavage. B.Prepare the client for hemodialysis. C.Administer an additional oral dose of lithium. D.Request a stat repeat of the laboratory test - CORRECT ANSWER A.Gastric lavage is appropriate for a client who has severe toxicity, as evidenced by a plasma lithium level of 2.1 mEq/L. This action will lower the client's lithium level. A nurse is caring for a client who has a new prescription for lithium carbonate. When teaching the client about ways to prevent lithium toxicity, the nurse should advise the client to do which of the following? A. Avoid the use of acetaminophen for headaches. B.Restrict intake of foods rich in sodium. C.Decrease fluid intake to less than 1,500 mL daily D.Limit aerobic activity in hot weather - CORRECT ANSWER D.The client should avoid activities that have the potential to cause sodium/water depletion, which can increase the risk for toxicity A nurse is assessing a client who takes lithium carbonate for the treatment of bipolar disorder. The nurse should recognize which of the following findings as a possible indication of toxicity to this medication? A. Severe hypertension B.Coarse tremors C.Constipation D.muscle spasm - CORRECT ANSWER B.Coarse tremors are an indication of toxicity A nurse is caring for a client who has a new prescription for valproic acid. The nurse should instruct the client that while taking this medication he will need to have which of the following laboratory tests completed periodically? (Select all that apply.) A.Thrombocyte count B.hematocrit C.Amylase D.Liver function tests E.Potassium - CORRECT ANSWER A.Treatment with valproic acid can result in thrombocytopenia. The client's thrombocyte count should be monitored periodically. C.Treatment with valproic acid can result in pancreatitis. The client's amylase should be monitored periodically. D.Treatment with valproic acid can result in hepatotoxicity. The client's liver function should be monitored periodically. A nurse is preparing a teaching plan for a female client who has bipolar disorder and a new prescription for carbamazepine. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A."This medication can safely be taken during pregnancy." B."Eliminate grapefruit juice from your diet." C."You will need to have a complete blood count and carbamazepine levels drawn periodically." D."Notify your pr ovider if you develop a rash." E."Avoid driving for the first few days after starting this medication. - CORRECT ANSWER B. Grapefruit juice affects carbamazepine metabolism and should be avoided. C. Carbamazepine blood levels and the CBC should be monitored during therapy. The client is at risk for bone marrow depression while taking carbamazepine and should notify the provider for a sore throat or other manifestations of an infection. D. Carbamazepine can cause Stevens-Johnson syndrome, which can be fatal. The client should notify the provider promptly if a rash occurs. E. CNS effects such as drowsiness or dizziness can occur early in treatment with carbamazepine and the client should avoid activities requiring alertness until these effects subside A nurse is teaching a client who has schizophrenia strategies to cope with anticholinergic effects of fluphenazine. Which of the following should the nurse suggest to the client to minimize anticholinergic effects? A.Take the medication in the morning to prevent insomnia. B.Chew sugarless gum to moisten the mouth. C.Use cooling measures to decrease fever. D.Take an antacid to relieve nausea - CORRECT ANSWER B.Chewing sugarless gum can help the client cope with dry mouth, a potential anticholinergic effect of fluphenazine A nurse is assessing a male client who recently began taking haloperidol. Which of the following findings is the highest priority to report to the provider? A.Shuffling gait B.Neck spasms C.Drowsiness D.Impotence - CORRECT ANSWER B. Neck spasms are an indication of acute dystonia which is a crisis situation requiring rapid treatment. This is the greatest risk to the client and is therefore the priority finding. A nurse is providing discharge teaching to a client who has a new prescription for clozapine. Which of the following statements should the nurse include in the teaching? A."You should have a high-carbohydrate snack between meals and at bedtime." B."You are likely to develop hand tremors if you take this medication for a long period of time." C."You may experience temporary numbness of your mouth after each dose." D."You should have your white blood cell count monitored every week. - CORRECT ANSWER D. Due to the risk for fatal agranulocytosis weekly monitoring of the client's WBC count is recommended while taking clozapine A nurse is providing teaching for a male client who has schizophrenia and is taking risperidone. Which of the following instructions should the nurse include in the teaching? A."Add extra snacks to your diet to prevent weight loss." B."Notify the provider if you develop breast enlargement." C."You may begin to have mild seizures while taking this medication." D."This medication is likely to increase your libido." - CORRECT ANSWER B. Gynecomastia (breast enlargement) and galactorrhea can occur due to an increase in prolactin levels while taking risperidone. The client should inform the provider if these manifestations occur. A nurse is preparing to perform a follow-up assessment on a client who takes chlorpromazine for the treatment of schizophrenia. The nurse should expect to find the greatest improvement in which of the following manifestations? (Select all that apply.) A.Disorganized speech B.Bizarre behavior C.Impaired social interactions D. hallucinations E.Decreased motivation - CORRECT ANSWER A. A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as disorganized speech. B. A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as bizarre behavior D. A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as hallucinations. A nurse is teaching the parents of a child who has a new prescription for desipramine. The nurse should instruct the parents that which of the following adverse effects is the priority to report to the provider? A.Constipation B.Suicidal thoughts C.Photophobia D.Dry mouth - CORRECT ANSWER B. The greatest risk to this client is injury from a suicide attempt; therefore, this is the priority. Desipramine can cause suicidal thoughts and behaviors which puts the client at risk. The parents should monitor and report any indication of increased depression or thoughts of suicidal behavior. A nurse is teaching an adolescent client who has a new prescription for clomipramine for OCD. Which of the following instructions should the nurse include to minimize an adverse effect of his medication? A.Wear sunglasses when outdoors. B.Check your temperature daily. C.Take this medication in the morning. D.Add extra calories to your die - CORRECT ANSWER A. Wearing sunglasses when outdoors will decrease photophobia, an anticholinergic effect associated with TCA use A nurse is caring for a school-age child who has a new prescription for atomoxetine. The nurse should monitor the client for which of the following adverse effects of this medication? A.kidney toxicity B.Liver damage C.Seizure activity D.Adrenal insufficiency - CORRECT ANSWER B. Liver damage is an adverse effect of atomoxetine. The nurse should monitor for manifestations such as jaundice, upper abdominal tenderness, darkening of urine, and elevated liver enzymes A nurse is teaching the parents of a school-age child about transdermal methylphenidate. Which of the following instructions should the nurse include? A.Apply one patch twice per day. B.Leave the patch on for 9 hr. C.Apply the patch to the child's waist. D.Use opened tray within 6 months. - CORRECT ANSWER B. Transdermal methylphenidate is administered for 9 hr/day. A nurse is teaching a school-age child and his parents about a new prescription for lisdexamfetamine. Which of the following information should the nurse include in the teaching? (Select all that apply.) A.An adverse effect of this medication is CNS stimulation. B.Administer the medication before bedtime. C.monitor blood pressure while taking this medication. D.Therapeutic effects of this medication will take 1 to 3 weeks to fully develop. E.This medication raises the levels of dopamine in the brain - CORRECT ANSWER A. An adverse effect of lisdexamfetamine is CNS stimulation such as insomnia and restlessness. C. The nurse should instruct the client to monitor his blood pressure due to potential cardiovascular effects of lisdexamfetamine. E.Lisdexamfetamine, a CNS stimulant, works by raising the levels of norepinephrine and dopamine in the CNS A nurse is providing teaching for a client who is withdrawing from alcohol and has a new prescription for propranolol. Which of the following information should the nurse to include in the teaching? A.Increases the risk for seizure activity B.Provides a form of aversion therapy C.Decreases cravings D.Results in mild hypertension - CORRECT ANSWER C. Propranolol is an adjunct medication used during withdrawal to decrease the client's craving for alcoho A charge nurse is planning a staff education session to discuss medications used during the care of a client experiencing alcohol withdrawal. Which of the following medications should the charge nurse include in the discussion? (Select all that apply.) A.Lorazepam B.Diazepam C.Disulfiram D.Naltrexone E.Acamprosate - CORRECT ANSWER A. Lorazepam is a benzodiazepine used during alcohol withdrawal to decrease anxiety and reduce the risk for seizures. B. Diazepam is a benzodiazepine used during alcohol withdrawal to decrease anxiety and reduce the risk for seizure A nurse is providing teaching to a client who has a new prescription for clonidine to assist with maintenance of abstinence from opioids. The nurse should instruct the client to monitor for which of the following adverse effects? A.Diarrhea B.Dry mouth C.Insomnia D. hypertension - CORRECT ANSWER B. Dry mouth is a common adverse effect associated with clonidine use A nurse is teaching a female client who has tobacco use disorder about nicotine eplacement therapy. Which of the following statements by the client indicates understanding of the teaching? A."I should avoid eating right before I chew a piece of nicotine gum." B."I will need to stop using the nicotine gum after 1 year." C."I know that nicotine gum is a safe alternative to smoking if I become pregnant." D."I must chew the nicotine gum quickly for about 15 minutes. - CORRECT ANSWER A. The client should avoid eating or drinking 15 min prior to and while chewing the nicotine gum. A nurse in an acute mental health facility is caring for a client who is experiencing withdrawal from opioid use and has a new prescription for clonidine. Which of the following actions should the nurse identify as the priority? A.Administer the clonidine on the prescribed schedule. B.Provide ice chips at the client's bedside. C.Educate the client on the effects of clonidine. D.Obtain baseline vital signs - CORRECT ANSWER D. Assessment is the initial step of the nursing process. Obtaining the client's baseline vital signs is the priority nursing action A nurse in the post-anesthesia recovery unit is caring for a client who received a nondepolarizing neuromuscular blocking agent and has muscle weakness. The nurse should anticipate a prescription for which of the following medications? A.Neostigmine B.Naloxone C.Dantrolene D.Vecuronium - CORRECT ANSWER A. Neostigmine is a cholinesterase inhibitor used to reverse the effects of nondepolarizing neuromuscular blockers A nurse is providing information to a client who has early Parkinson's disease and a new prescription for pramipexole. The nurse should instruct the client to monitor for which of the following adverse effects of this medication? A. hallucinations B.Increased salivation C.Diarrhea D.Discoloration of urine - CORRECT ANSWER A. Pramipexole can cause hallucinations within 9 months of the initial dose and might require discontinuation. A nurse is teaching a client who has a new prescription for levodopa/carbidopa for Parkinson's disease. Which of the following instructions should the nurse include? A.Increase intake of protein-rich foods. B.Expect muscle twitching to occur. C.Take this medication with food. D.Anticipate relief of manifestations in 24 h - CORRECT ANSWER C.The client should take this medication with food to reduce GI effects. A nurse is preparing to administer a medication to a client who has absence seizures. The nurse should anticipate administering which of the following medications to the client? (Select all that apply.) A.Phenytoin B.Ethosuximide C.Gabapentin D.Carbamazepine E.Valproic acid F.Lamotrigine - CORRECT ANSWER B. Ethosuximide's only mechanism of action is to treat a client who has absence seizures E. Valproic acid has a therapeutic effect when treating a client who has absence seizures and all other forms of seizures. F. Lamotrigine has a therapeutic effect when treating a client who has absence seizures and all other forms of seizure A nurse is reviewing a new prescription for oxcarbazepine with a female client who has partial seizures. Which of the following instructions should the nurse include? (Select all that apply.) A."Use caution if given a prescription for a diuretic medication." B."Consider using an alternate form of contraception if you are using oral contraceptives." C."Chew gum to increase saliva production." D."Avoid driving until you see how the medication affects you." E."Notify your provider if you develop a skin rash - CORRECT ANSWER A. Diuretic medications are administered with caution because of the high risk for hyponatremia when taking oxcarbazepine. B. An alternate form of contraception is recommended for clients taking oral contraceptives because oxcarbazepine decreases oral contraceptive levels D. The client should avoid driving if CNS effects of dizziness, drowsiness, and double vision develop. E. The client should notify the provider if a skin rash occurs because life-threatening skin disorders can develop. A nurse is instructing a client who has a new prescription for timolol how to insert eye drops. The nurse should instruct the client to press on which of the following areas to prevent systemic absorption of the medication? A.Bony orbit B.Nasolacrimal duct C.Conjunctival sac D.Outer canthus - CORRECT ANSWER B. Pressing on the nasolacrimal duct blocks the lacrimal punctum and prevents systemic absorption of the medication A nurse is teaching a client who has a new prescription for brimonidine ophthalmic drops and wears soft contact lenses. Which of the following instructions should the nurse include in the teaching? A."This medication can stain your contacts." B."This medication can cause your pupils to constrict." C."This medication can absorb into your contacts." D."This medication can slow your heart rate." - CORRECT ANSWER C. Brimonidine can absorb into soft contact lenses. The client should remove his contacts then instill the medication and wait at least 15 min before putting in his contacts back in. A nurse in an emergency unit is reviewing the medical record of a client who is being evaluated for angle-closure glaucoma. Which of the following findings are indicative of this condition? A.Insidious onset of painless loss of vision B.Gradual reduction in peripheral vision C.Severe pain around eyes D.Intraocular pressure 12mm Hg - CORRECT ANSWER C. Severe pain around eyes that radiates over the face is a manifestation of acute angle-closure glaucoma A nurse is teaching a client about preventing otitis externa. Which of the following instructions should the nurse include? A.Clean the ear with a cotton-tipped swab daily B.Place earplugs in the ears when sleeping at night. C.Use a cool water irrigation solution to remove earwax. D.Tip the head to the side to remove water from the ears after showering - CORRECT ANSWER D. The client should remove water from the ear after showering or swimming to reduce the risk for otitis externa A nurse in a provider's office is instructing a parent of a toddler how to administer ear drops. Which of the following instructions should the nurse include? (Select all that apply.) A."Place the child on his unaffected side when you are ready to administer the medication." B."Warm the medication by gently rolling it between your hands for a few minutes." C."Gently shake medication that is in suspension form." D."keep the child on his side for 5 minutes after instillation of the ear drops." E."Tightly pack the ear with cotton after instillation of the ear drops. - CORRECT ANSWER A. The parent should have the child on his unaffected side to allow access to the affected ear and to promote drainage of the medication by gravity into the ear. B. The parent should warm the medication by rolling it between his hands. Administering the medication cold can cause dizziness. C. The parent should gently shake medication that is in suspension form to evenly- disperse the medication. D.The parent should keep the child on his side to promote drainage of the medication by gravity into the ear A nurse in the operating room is caring for a client who received a dose of succinylcholine. During the operation, the client suddenly develops rigidity, and his body temperature begins to rise. The nurse should anticipate a prescription for which of the following medications? A.Neostigmine B.Naloxone C.Dantrolene D.Vecuronium - CORRECT ANSWER C.muscle rigidity and a sudden rise in temperature is a manifestation of malignant hyperthermia. Dantrolene acts on skeletal muscles to reduce metabolic activity and treat malignant hyperthermia. A nurse in the post-anesthesia care unit is caring for a client who is experiencing malignant hyperthermia. Which of the following actions should the nurse take? (Select all that apply.) A.Place a cooling blanket on the client. B.Administer oxygen at 100%. C.Administer iced 0.9% sodium chloride. D.Administer potassium chloride IV. E. monitor core body temperature - CORRECT ANSWER A. The nurse should apply a cooling blanket and apply ice to the axilla and groin. B. The nurse should administer oxygen at 100% to treat decreased oxygen saturation. C. The nurse should take action to decrease the client's body temperature by administering iced IV fluids. E. The nurse should monitor core body temperature to prevent hypothermia and to determine progress with treatment measures A nurse is teaching a client who has a new prescription for baclofen to treat muscle spasms. Which of the following statements by the client indicates an understanding of the teaching? (Select all that apply.) A."I will stop taking this medication right away if I develop dizziness." B."I know the doctor will gradually increase my dose of this medication for a while." C."I should increase fiber to prevent constipation from this medication." D."I won't be able to drink alcohol while I'm taking this medication." E."I should take this medication on an empty stomach each morning." - CORRECT ANSWER B. The provider starts the client on a low dose, and the dose is increased gradually to prevent CNS depression. C. The client should increase fluids and fiber to reduce the risk for constipation. D. The intake of alcohol and other CNS depressants can exacerbate the CNS depressant effects of baclofen. Therefore, the client is instructed to avoid CNS depressants while taking baclofen A nurse is reviewing the health care record of a client who reports urinary incontinence and asks about a prescription for oxybutynin. The nurse should recognize that oxybutynin is contraindicated in the presence of which of the following conditions? A.Bursitis B.Sinusitis C.Depression D.Glaucoma - CORRECT ANSWER D. Oxybutynin is an anticholinergic and can increase intraocular pressure. It is contraindicated for clients who have glaucoma A nurse is caring for a client who has a prescription for bethanechol to treat urinary retention. The nurse should recognize that which of the following findings is a manifestation of muscarinic stimulation? A.Dry mouth B. hypertension C.Excessive perspiration D.Fecal impaction - CORRECT ANSWER C. Bethanechol is a muscarinic agonist. muscarinic stimulation can result in sweating A nurse is providing instructions to a client who has been experiencing insomnia and has a new prescription for temazepam. The nurse should inform the client that which of the following manifestations are adverse effects of temazepam? (Select all that apply.) A.Incoordination B.hypertension C.Pruritus D.Sleep driving E.Amnesia - CORRECT ANSWER A. Due to CNS depression, incoordination is an adverse effect of temazepam D. Sleep driving (driving after taking the medication without memory of doing so) is an adverse effect of temazepam. E. Retrograde amnesia, the inability to remember the events that occurred after taking the medication, can occur as an adverse effect of temazepam A nurse is caring for a client who is receiving moderate sedation with diazepam IV. The client is oversedated. Which of the following medications should the nurse anticipate administering to this client? A. ketamine B.Naltrexone C.Flumazenil D.Fluvoxamine - CORRECT ANSWER C. Flumazenil is a competitive benzodiazepine antagonist used to reverse the sedation and other effects of benzodiazepines A nurse is teaching a client who has a new prescription for ramelteon. The nurse should instruct the client to avoid which of the following foods while taking this medication? A.Baked potato B.Fried chicken C.Whole-grain bread D.Citrus fruits - CORRECT ANSWER B.high-fat foods, such as fried chicken prolong the absorption of ramelteon and should be avoided A nurse is caring for a client who is admitted to undergo a surgical procedure. Which of the following preexisting conditions can be a contraindication for the use of ketamine as an intravenous anesthetic? A.Peptic ulcer disease B.Breast cancer C.Diabetes mellitus D.Schizophrenia - CORRECT ANSWER D.ketamine can produce psychological effects, such as hallucinations. Therefore, schizophrenia can be a contraindication for the use of ketamine A nurse is providing instructions to a female client who has a new prescription for zolpidem. Which of the following instructions should the nurse include? A."Notify the provider if you plan to become pregnant." B."Take the medication 1 hr before you plan to go to sleep." C."Allow at least 6 hr for sleep when taking zolpidem." D."To increase the effectiveness of zolpidem, take it with a bedtime snack. - CORRECT ANSWER A. Zolpidem is Pregnancy Risk Category C. The client should notify the provider if she plans to become pregnant. A nurse is teaching a client who has a new prescription for beclomethasone. Which of the following instructions should the nurse include? A."Rinse your mouth after each use of this medication." B."Limit fluid intake while taking this medication." C."Increase your intake of vitamin B12 while taking this medication." D."You can take the medication as needed. - CORRECT ANSWER A. The client should rinse her mouth after each use to reduce the risk of oral fungal infection A nurse is providing instructions to a client who has a new prescription for albuterol and beclomethasone inhalers for the control of asthma. Which of the following instructions should the nurse include in the teaching? A.Take the albuterol at the same time each day. B.Administer the albuterol inhaler prior to using the beclomethasone inhaler. C.Use beclomethasone if experiencing an acute episode. D.Avoid shaking the beclomethasone before us - CORRECT ANSWER B. When a client is prescribed an inhaled beta2 -agonist (such as albuterol) and an inhaled glucocorticoid (such as beclomethasone), the client should take the beta2 -agonist first. The beta2-agonist promotes bronchodilation and enhances absorption of the glucocorticoid. A nurse is providing instructions to the parent of an adolescent client who has a new prescription for albuterol, PO. Which of the following instructions should the nurse include? A."You can take this medication to abort an acute asthma attack." B."Tremors are an adverse effect of this medication." C."Prolonged use of this medication can cause hyperglycemia." D."This medication can slow skeletal growth rate." - CORRECT ANSWER B. Tremors can occur due to excessive stimulation of beta2 receptors of skeletal muscles A nurse is teaching a client who has a prescription for long-term use of oral prednisone for treatment of chronic asthma. The nurse should instruct the client to monitor for which of the following adverse effects of this medication? A.Weight gain B.Nervousness C.Bradycardia D.Constipation - CORRECT ANSWER A. Weight gain and fluid retention are adverse effects of oral prednisone due to the effect of sodium and water retention A nurse is caring for a client who states she has been taking phenylephrine nasal drops for the past 10 days for sinusitis. The nurse should assess the client for which of the following adverse effects of this medication? A.Sedation B.Nasal congestion C.Productive cough D.Constipation - CORRECT ANSWER B. When used for over 5 days, rebound nasal congestion can occur when taking nasal sympathomimetic medications, such as phenylephrine A nurse is teaching a client who has a new prescription for dextromethorphan to suppress a cough. The nurse should instruct the client to monitor for which of the following adverse effects of this medication? A.Diarrhea B.Anxiety C.Sedation D.Palpitations - CORRECT ANSWER C.Dextromethorphan can cause sedation. Advise the client to avoid activities that require alertness A nurse is teaching the family of a child who has cystic fibrosis and a new prescription for acetylcysteine. Which of the following information should the nurse include in the instructions? A."Expect this medication to suppress your cough." B."Expect this medication to smell like rotten eggs." C."Expect this medication to cause euphoria." D."Expect this medication to turn your urine orange." - CORRECT ANSWER B. Acetylcysteine has a sulfur content that causes a rotten-egg odor A nurse is teaching a client who has a new prescription for diphenhydramine for allergic rhinitis. The nurse should instruct the client to monitor for which of the following adverse reactions of this medication? (Select all that apply.) A.Dry mouth B.Nonproductive cough C.skin rash D.Drowsiness E.Urinary hesitation - CORRECT ANSWER A. Dry mouth is an anticholinergic manifestation that can occur when a client takes diphenhydramine D. Drowsiness is an adverse reaction of this medication. Diphenhydramine is administered to treat insomnia. E. Urinary retention is an anticholinergic manifestation that can occur when a client takes diphenhydramine. A nurse is teaching a client about the use of fluticasone to treat perennial rhinitis. Which of the following statements by the client indicates an understanding of the teaching? A."I should use the spray every 4 hours while I am awake." B."It can take as long as 3 weeks before the medication takes a maximum effect." C."This medication can also be used to treat motion sickness." D."I can use this medication when my nasal passages are blocked. CORRECT ANSWER B. The client can see some benefits of the medication within a few hours, but the maximum benefits can take up to 3 weeks. A nursing is planning care for a client who is receiving furosemide IV for peripheral edema. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A.Assess for tinnitus. B.Report urine output 50 mL/hr. C. monitor serum potassium levels. D.Elevate the head of bed slowly before ambulation. E.Recommend eating a banana daily - CORRECT ANSWER A. An adverse effect of furosemide is ototoxicity. manifestations of tinnitus should be reported to the provider C. A decrease in serum potassium levels is an adverse effect of furosemide, and the nurse should notify the provider. D. Slowly elevating the head of the bed will prevent the client from developing orthostatic hypotension, which is a manifestation of hypovolemia. E. A banana is high in potassium. The nurse should encourage the client to eat foods high in potassium to prevent hypokalemia. A nurse is providing information to a client who has a new prescription for hydrochlorothiazide. Which of the following information should the nurse include? A.Take the medication with food. B.Plan to take the medication at bedtime. C.Expect increased swelling of the ankles. D.Fluid intake should be limited in the morning. - CORRECT ANSWER A. The client should take hydrochlorothiazide with or after meals to prevent gastrointestinal upset A nurse is providing information to a client who has a new prescription for hydrochlorothiazide. Which of the following information should the nurse include? A.Take the medication with food. B.Plan to take the medication at bedtime. C.Expect increased swelling of the ankles. D.Fluid intake should be limited in the morning. - CORRECT ANSWER C. Serum potassium of 5.2 mEq/L indicates hyperkalemia. Because spironolactone causes potassium retention, the nurse should withhold the medication and notify the provider A nurse is caring for a client who has increased intracranial pressure and is receiving mannitol. Which of the following findings should the nurse report to the provider? A.Blood glucose 150 mg/dL B.Urine output 40 mL/hr C.Dyspnea D.Bilateral equal pupil size - CORRECT ANSWER C. Dyspnea is a manifestation of heart failure, an adverse effect of mannitol. The nurse should stop the medication and notify the provider. A nurse is planning caring for a client who is has a new prescription for torsemide. The nurse should plan to monitor for which of the following adverse reactions of this medications? (Select all that apply.) A.Respiratory acidosis B. hypokalemia C. hypotension D.Ototoxicity E.Ventricular dysrhythmias - CORRECT ANSWER B. The nurse should plan to monitor for hypokalemia, which is an adverse effect of a loop diuretic. C. The nurse should plan to monitor for hypotension. D. The nurse should plan to monitor the client for ototoxicity. E. The nurse should plan to monitor for ventricular dysrhythmias, which is a manifestation of hypokalemia, an adverse effect of torsemide A nurse is reviewing the health record of a client who asks about using propranolol to treat hypertension. The nurse should recognize which of the following conditions is a contraindication for taking propranolol? A.Asthma B.Glaucoma C. hypertension D.Tachycardia - CORRECT ANSWER A. Propranolol is a nonselective beta-adrenergic blocker that blocks both beta1 and beta2 receptors. Blockade of beta2 receptors in the lungs causes bronchoconstriction, so it is contraindicated in clients who have asthma A nurse is teaching a client who has a new prescription for verapamil to control hypertension. Which of the following instructions should the nurse include? A.Increase the amount of dietary fiber in the diet. B.Drink grapefruit juice daily to increase vitamin C intake. C.Decrease the amount of calcium in the diet. D.Withhold food for 1 hr after the medication is taken - CORRECT ANSWER A. Increasing dietary fiber intake can help prevent constipation, an adverse effect of verapamil A nurse is caring for a client who has a new prescription for captopril for hypertension. The nurse should monitor the client for which of the following adverse effects of this medication? A. hypokalemia B. hypernatremia C.Neutropenia D.Bradycardia - CORRECT ANSWER C. Neutropenia is a serious adverse effect that can occur in clients taking an ACE inhibitor. The nurse should monitor the client's CBC and teach the client to report indications of infection to the provider. A nurse in an acute care facility is caring for a client who is receiving IV nitroprusside for hypertensive crisis. The nurse should monitor the client for which of the following adverse reactions to this medication? A.Intestinal ileus B.Neutropenia C.Delirium D. hyperthermia - CORRECT ANSWER C. Delirium and other mental status changes can occur in thiocyanate toxicity when IV nitroprusside is infused at a high dosage. monitor thiocyanate level during therapy to remain below 10 mg/dL. A nurse is planning to administer a first dose of captopril to a client who has hypertension. Which of the following medications can intensify first dose hypotension? (Select all that apply.) A.Simvastatin B. hydrochlorothiazide C.Phenytoin D.Clonidine E.Aliskiren - CORRECT ANSWER B.hydrochlorothiazide, a thiazide diuretic, is often used to treat hypertension. Diuretics can intensify first-dose orthostatic hypotension caused by captopril and can continue to interact with antihypertensive medications to cause hypotension. The nurse should monitor clients carefully for hypotension, especially after the first dose of captopril and keep the client safe from injury D. Clonidine, a centrally acting alpha2 agonist, is an antihypertensive medication that can interact with captopril to intensify first-dose orthostatic hypotension. The nurse should monitor clients carefully for hypotension, especially after the first dose of captopril, and keep the client safe from injury. E. Aliskiren, a direct renin inhibitor, is an antihypertensive medication that can interact with captopril to intensify its first-dose orthostatic hypotension. The nurse should monitor clients carefully for hypotension, especially after the first dose of captopril, and keep the client safe from injury A nurse in a provider's office is monitoring serum electrolytes for four older adult clients who take digoxin. Which of the following electrolyte values increases a client's risk for digoxin toxicity? A.Calcium 9.2 mg/dL B.Calcium 10.3 mg/dL C.Potassium 3.4 mEq/L D.Potassium 4.8 mEq/ - CORRECT ANSWER C. Potassium 3.4 mEq/L is below the expected reference range and puts a client at risk for digoxin toxicity. Low potassium can cause fatal dysrhythmias, especially in older clients who take digoxin. The nurse should notify the provider, who might prescribe a potassium supplement or a potassium-sparing diuretic for the client A nurse is caring for an older adult client who has a new prescription for digoxin and takes multiple other medications. The nurse should recognize that concurrent use of which of the following medications places the client at risk for digoxin toxicity? A.Phenytoin B.Verapamil C.Warfarin D.Aluminum hydroxide - CORRECT ANSWER B. Verapamil, a calcium-channel blocker, can increase digoxin levels. If these medications are given concurrently, the digoxin dosage might be decreased and the nurse should monitor digoxin levels carefully A nurse is administering a dopamine infusion at a low dose to a client who has severe heart failure. Which of the following findings is an expected effect of this medication? A.Lowered heart rate B.Increased myocardial contractility C.Decreased conduction through the AV node D.Vasoconstriction of renal blood vessel - CORRECT ANSWER B. The nurse should expect dopamine to cause increased myocardial contractility, which also increases cardiac output. This occurs with the stimulation of beta1 receptors and is a positive inotropic effect of dopamine when it is administered at a low dose A nurse is providing teaching to a client who has a new prescription for digoxin. The nurse should instruct the client to monitor and report which of the following adverse effects that is a manifestation digoxin toxicity? (Select all that apply.) A.Fatigue B.Constipation C.Anorexia D.Rash E.Diplopia - CORRECT ANSWER A. Fatigue and weakness are early CNS findings that can indicate digoxin toxicity. C. GI disturbances, such as anorexia, are manifestations of digoxin toxicity. E. Visual changes, such as diplopia and yellow-tinged vision, are manifestations of digoxin toxicity A nurse is teaching a client who has a new prescription for digoxin to treat heart failure. Which of the following instructions should the nurse include in the teaching? A.Contact provider if heart rate is less than 60/min. B.Check pulse rate for 30 seconds and multiply result by 2. C.Increase intake of sodium. D.Take with food if nausea occur - CORRECT ANSWER A. The client should contact the provider for a heart rate less than 60/min A nurse is teaching a client who has angina pectoris and is learning how to treat acute anginal attacks. The clients asks, "What is my next step if I take one tablet, wait 5 minutes, but still have anginal pain?" Which of the following responses should the nurse make? A."Take two more sublingual tablets at the same time." B."Call the emergency response team." C."Take a sustained-release nitroglycerin capsule." D."Wait another 5 minutes then take a second sublingual tablet." CORRECT ANSWER B. The next step is to call 911 and then take a second sublingual tablet. If the first tablet does not work, the client might be having a myocardial infarction. The client can take a third tablet if the second one has not relieved the pain after waiting an additional 5 minutes. A nurse is teaching a client who has a new prescription for nitroglycerin transdermal patch for angina pectoris. Which of the following instructions should the nurse include? A.Remove the patch each evening. B.Cut each patch in half if angina attacks are under control. C.Take off the nitroglycerin patch for 30 min if a headache occurs. D.Apply a new patch every 48 hr - CORRECT ANSWER A. In order to prevent tolerance to nitroglycerin, the client should remove the patch for 10 to 12 hr during each 24-hr period A nurse is taking a medication history from a client who has angina and is to begin taking ranolazine. The nurse should report which of the following medications in the client's history that can interact with ranolazine? (Select all that apply.) A.Digoxin B.Simvastatin C.Verapamil D.Amlodipine E.Nitroglycerin transdermal patch - CORRECT ANSWER A. Concurrent use with ranolazine increases serum levels of digoxin, so digoxin toxicity can result. B. Concurrent use with ranolazine increases serum levels of simvastatin, so liver toxicity can result. C. Verapamil is an inhibitor of CYP3A4, which can increase levels of ranolazine and lead to the dysrhythmia torsades de pointes. A nurse is caring for a client who is prescribed isosorbide mononitrate for chronic stable angina and develops reflex tachycardia. Which of the following medications should the nurse expect to administer? A.Furosemide B.Captopril C.Ranolazine D. metoprolol - CORRECT ANSWER D.metoprolol, a beta adrenergic blocker, is used to treat hypertension and stable angina pectoris, and is often prescribed to decrease heart rate in clients who have tachycardia A nurse is teaching a client who has angina how to use nitroglycerin transdermal ointment. The nurse should include which of the following instructions? A."Remove the prior dose before applying a new dose." B."Rub the ointment directly into your skin until it is no longer visible." C."Cover the applied ointment with a clean gauze pad." D."Apply the ointment to the same skin area each time. - CORRECT ANSWER A. The client should remove the prior dose before applying a new dose to prevent toxicity A nurse is assessing a client who is taking amiodarone to treat atrial fibrillation. Which of the following findings is a manifestation of amiodarone toxicity? A.Light yellow urine B.Report of tinnitus C.Productive cough D.Blue-gray skin discoloration - CORRECT ANSWER C. Productive cough can indicate pulmonary toxicity or heart failure. The nurse should assess for cough, chest pain, and shortness of breath A nurse is caring for a client who received IV verapamil to treat supraventricular tachycardia (SVT). The client's pulse rate is now 98/min and his blood pressure is 74/44 mg hg. The nurse should anticipate a prescription for which of the following IV medications? A.Calcium gluconate B.Sodium bicarbonate C.Potassium chloride D. magnesium sulfate - CORRECT ANSWER A. Reverse severe hypotension caused by verapamil with calcium gluconate, given slowly IV. The calcium counteracts vasodilation caused by verapamil. Other measures to increase blood pressure can include IV fluid therapy and placing the client in a modified Trendelenburg position. A nurse is assessing a client who is taking digoxin to treat heart failure. Which of the following findings is a manifestation of digoxin toxicity? A.Bruising B.Report of metallic taste C.muscle pain D.Report of anorexia - CORRECT ANSWER D. Anorexia, blurred vision, stomach pain, and diarrhea are manifestations of digoxin toxicity A nurse is assessing a client who has taken procainamide to treat dysrhythmias for the last 12 months. The nurse should assess the client for which of the following adverse effects of this medication? (Select all that apply.) A. hypertension B.Widened QRS complex C.Narrowed QT interval D.Easy bruising E.Swollen joints - CORRECT ANSWER B. On the ECG, procainamide can cause a widened QRS complex, which is a manifestation of cardiotoxicity if the QRS complex becomes widened by more than 50% of the expected reference range D. Procainamide can cause bone marrow depression, with neutropenia (infection) and thrombocytopenia (easy bruising, bleeding) E. Systemic lupus erythematosus-like syndrome can occur as an adverse effect of procainamide. manifestations include swollen, painful joints. Clients who take procainamide in large doses or for more than 1 year are at risk A nurse is preparing to administer propranolol to a client who has a dysrhythmia. Which of the following actions should the nurse plan to take? A. hold propranolol for an apical pulse greater than 100/min. B.Administer propranolol to increase the client's blood pressure. C.Assist the client when she sits up or stands after taking this medication. D.Check for hypokalemia frequently due to the risk for propranolol toxicity. - CORRECT ANSWER C. Propranolol can cause orthostatic hypotension, so it is important assess for dizziness during ambulation or when moving to a sitting position. A nurse is providing teaching to a client who is starting simvastatin. Which of the following information should the nurse include in the teaching? A.Take this medication in the evening. B.Change position slowly when rising from a chair. C. maintain a steady intake of green leafy vegetables. D.Consume no more than 1 L/day of fluid - CORRECT ANSWER A. The client should take simvastatin in the evening because nighttime is when the most cholesterol is synthesized in the body. Taking statin medications in the evening increases medication effectiveness A nurse is collecting data from a client who is taking gemfibrozil. Which of the following assessment findings should the nurse identify as an adverse reaction to the medication? A. mental status changes B.Tremor C.Jaundice D.Pneumonia - CORRECT ANSWER C. Jaundice, anorexia, and upper abdominal discomfort can be findings in liver impairment, which can occur in clients taking gemfibrozil. A nurse is teaching a client who is taking digoxin and has a new prescription for colesevelam. Which of the following instructions should the nurse include in the teaching? A."Take digoxin with your morning dose of colesevelam." B."Your sodium and potassium levels will be monitored periodically while taking colesevelam." C."Watch for bleeding or bruising while taking colesevelam." D."Take colesevelam with food and at least one glass of water. - CORRECT ANSWER D. Colesevelam should be taken with food and at least 8 oz of water A nurse is completing a nursing history for a client who takes simvastatin. The nurse should identify which of the following disorders as a contraindication to adding ezetimibe to the client's medications? A. history of severe constipation B.history of hypertension C.Active hepatitis C D.Type 2 diabetes mellitus - CORRECT ANSWER C. Ezetimibe is contraindicated in clients who have an active moderate-to-severe liver disorder, especially if the client is already taking a statin, such as simvastatin A nurse is caring for a client who has a new prescription for niacin to reduce cholesterol. The nurse should monitor for which of the following findings as an adverse effect of niacin? (Select all that apply.) A. muscle aches B. hyperglycemia C. hearing loss D.Flushing of the skin E.Jaundice - CORRECT ANSWER B.hyperglycemia can occur as an adverse effect of niacin. The nurse should plan to monitor blood glucose periodically. D. Flushing of the skin, along with tingling of the extremities, occurs soon after taking niacin. The effect should decrease in a few weeks, and can be minimized by taking an aspirin tablet 30 min before the niacin. E. Niacin can cause liver disorders, so the nurse should monitor for jaundice, abdominal pain, and anorexia. A nurse is planning to administer subcutaneous enoxaparin 40 mg using a prefilled syringe of enoxaparin 40 mg/0.4 mL to an adult client following hip arthroplasty. Which of the following actions should the nurse plan to take? A.Expel the air bubble from the prefilled syringe before injecting. B.Insert the needle completely into the client's tissue. C.Administer the injection in the client's thigh. D.Aspirate carefully after inserting the needle into the client's skin - CORRECT ANSWER B. The nurse should inject the needle on the prefilled syringe completely when administering enoxaparin in order to administer the medication by deep subcutaneous injection. A nurse is caring for a hospitalized client who is receiving IV heparin for a deep-vein thrombosis. The client begins vomiting blood. After the heparin has been stopped, which of the following medications should the nurse prepare to administer? A.Vitamin k1 B.Atropine C.Protamine D.Calcium gluconate - CORRECT ANSWER C. Protamine reverses the anticoagulant effect of heparin A nurse is planning to administer IV alteplase to a client who is demonstrating manifestations of a massive pulmonary embolism. Which of the following interventions should the nurse plan to take? A.Administer Im enoxaparin along with the alteplase dose. B. hold direct pressure on puncture sites for up to 30 min. C.Administer aminocaproic acid IV prior to alteplase infusion. D.Prepare to administer alteplase within 8 hr of manifestation onset. - CORRECT ANSWER B. The nurse should plan to hold direct pressure on puncture sites for 10 to 30 min or until oozing of blood stops. A nurse is monitoring a client who takes aspirin 81 mg PO daily. The nurse should identify which of the following manifestations as adverse effects of daily aspirin therapy? (Select all that apply.) A. hypertension B.Coffee-ground emesis C.Tinnitus D.Paresthesias of the extremities E.Nausea - CORRECT ANSWER B. GI bleeding with dark stools or coffeeground emesis can be an adverse effect of aspirin therapy. C. Tinnitus and hearing loss can occur as an adverse effect of aspirin therapy E. Nausea, vomiting, and abdominal pain can occur as a result of aspirin therapy A nurse is caring for a client who has atrial fibrillation and a new prescription for dabigatran to prevent development of thrombosis. Which of the following medications is prescribed concurrently to treat an adverse effect of dabigatran? A.Vitamin k1 B.Protamine C.Omeprazole D.Probenecid - CORRECT ANSWER C. Omeprazole or another proton pump inhibitor is prescribed for a client who is taking dabigatran and has abdominal pain and other GI findings that can occur as adverse effects of dabigatran. The nurse should advise the client who has GI effects to take dabigatran with food A nurse is caring for a client who is receiving daily doses of oprelvekin. Which of the following laboratory values should the nurse monitor to determine effectiveness of this medication? A. hemoglobin B.Absolute neutrophil count C.Platelet count D.Total white blood count - CORRECT ANSWER C. The expected outcome for oprelvekin is a platelet count greater than 50,000/mm^3. A nurse is preparing to administer filgrastim for the first time to a client who has just undergone a bone marrow transplant. Which of the following interventions is appropriate? A.Administer Im in a large muscle mass to prevent injury. B.Ensure that the medication is refrigerated until just prior to administration. C.Shake vial gently to mix well before withdrawing dose. D.Discard vial after removing one dose of the medication - CORRECT ANSWER D. Only one dose of filgrastim should be withdrawn from the vial and the vial should then be discarded. A nurse is monitoring a client who is receiving epoetin alfa for adverse effects. The nurse should identify which of the following findings as an adverse effect of this medication? (Select all that apply) A.Leukocytosis B. hypertension C.Edema D.Blurred vision E. headache - CORRECT ANSWER B.hypertension is an adverse effect of epoetin alfa that the nurse should monitor for throughout treatment. E.headache is an adverse effect of epoetin alfa A nurse is assessing a client who has chronic neutropenia and who has been receiving filgrastim. Which of the following actions should the nurse take to assess for an adverse effect of filgrastim? A.Assess for bone pain. B.Assess for right lower quadrant pain. C.Auscultate for crackles in the bases of the lungs. D.Auscultate the chest to listen for a heart murmur - CORRECT ANSWER A. Bone pain is a dose-related adverse effect of filgrastim. It can be treated with acetaminophen and, if necessary, an opioid analgesic A nurse is preparing to administer a transfusion of 300 mL of pooled platelets for a client who has severe thrombocytopenia. The nurse should plan to administer the transfusion over which of the following time frames? A.Within 30 min/unit B.Within 60 min/unit C.Within 2 hr/unit D.Within 4 hr/unit - CORRECT ANSWER A. Platelets are fragile and should be administered quickly to reduce the risk of clumping. The nurse should administer the platelets within 15 to 30 min/unit A nurse is transfusing a unit of packed red blood cells (PRBCs) for a client who has anemia due to chemotherapy. The client reports a sudden headache and chills. The client's temperature is 2° F higher than her baseline. In addition to notifying the provider, which of the following actions should the nurse take? (Select all that apply.) A.Stop the transfusion. B.Place the client in an upright position with feet down. C.Remove the blood bag and tubing from the IV catheter. D.Obtain a urine specimen. E.Infuse dextrose 5% in water through the IV - CORRECT ANSWER A. The nurse should stop the transfusion for a rise in temperature of 2° F and reports of chills and fever. The client can be having a hemolytic reaction to the blood or a febrile reaction C. The nurse should avoid infusing more PRBCs into the client's vein, and should remove the blood bag and tubing from the client's IV catheter. D. Obtaining a urine specimen to check for hemolysis is standard procedure when the client has a reaction to a blood transfusio A nurse is preparing to transfuse a unit of packed red blood cells (PRBCs) for a client who has severe anemia. Which of the following interventions will prevent an acute hemolytic reaction? A.Ensure that the client has a patent IV line before obtaining blood product from the refrigerator. B.Obtain help fr om another nurse to confirm the correct client and blood product. C.Take a complete set of vital signs before beginning transfusion and periodically during the transfusion. D.Stay with the client for the first 15 to 30 min of the transfusion - CORRECT ANSWER B. Identifying and matching the correct blood product with the correct client will prevent an acute hemolytic reaction from occurring because this reaction is caused by ABO or Rh incompatibility A nurse is caring for a hospitalized client who has an activated partial thromboplastin time (aPTT) greater than 1.5 times the expected reference range. Which of the following blood products should the nurse prepare to transfuse? A.Whole blood B.Platelets C.Fresh frozen plasma D.Packed red blood cells - CORRECT ANSWER C. Fresh frozen plasma is indicated for a client who has an elevated aPTT because it replaces coagulation factors and can help prevent bleeding. A nurse is assessing a client during transfusion of a unit of whole blood. The client develops a cough, shortness of breath, elevated blood pressure, and distended neck veins. The nurse should anticipate a prescription for which of the following medications? A.Epinephrine B.Lorazepam C.Furosemide D.Diphenhydramine - CORRECT ANSWER C. Furosemide, a loop diuretic, may be prescribed to relieve manifestations of circulatory overload A nurse is providing instructions to a client who has a prescription for amoxicillin and clarithromycin to treat a peptic ulcer. Which of the following information should the nurse include in the teaching? A."Take these medications with food." B."These medications can turn your stool black" C."These medications can cause photosensitivity." D."The purpose of these medications is to decrease the ph of gastric juices in the stomach." - CORRECT ANSWER A.The nurse should instruct the client to take these medications with food to reduce GI disturbances A nurse is teaching a client who has a new prescription for omeprazole for management of heartburn. Which of the following information should the nurse include in the teaching? A.Take this medication at bedtime. B.This medication decreases the production of gastric acid. C.Take this medication 2 hr after eating. D.This medication can cause hyperkalemia - CORRECT ANSWER B. Omeprazole reduces gastric acid secretion by inhibiting the enzyme that produces gastric acid. A nurse is teaching a client who is taking sucralfate PO for peptic ulcer disease has a new prescription for phenytoin to control seizures. Which of the following instructions should the nurse include? A.Take an antacid with the sucralfate. B.Take sucralfate with a glass of milk. C.Allow a 2-hr interval between these medications. D.Chew the sucralfate thoroughly before swallowing - CORRECT ANSWER C. Sucralfate can interfere with the absorption of phenytoin, so the client should allow a 2-hr interval between the sucralfate and phenytoin. A nurse is caring for four clients who have peptic ulcer disease. The nurse should recognize misoprostol is contraindicated for which of the following clients? A.A client who is pregnant B.A client who has osteoarthritis C.A client who has a kidney stone D.A client who has a urinary tract infection - CORRECT ANSWER A.misoprostol can induce labor and is contraindicated in pregnancy. A nurse is providing a client who has peptic ulcer disease with instructions about managing his condition. Which of the following instructions should the nurse include? (Select all that apply.) A."Eat a bedtime snack." B."Drink decaffeinated coffee" C."Low-dose aspirin therapy should be avoided." D."Seek measures to reduce stress." E."Avoid smoking." - CORRECT ANSWER D. Reducing stress is beneficial for healing of the ulcer and prevention of complications. E. Smoking inhibits healing of the ulcer. A nurse is caring for a client who received prochlorperazine 4 hr ago. The client reports spasms of his face. The nurse should anticipate a prescription for which of the following medications? A.Fomepizole B.Naloxone C.Phytonadione D.Diphenhydramine - CORRECT ANSWER D. An adverse effect of prochlorperazine is acute dystonia, which is evidenced by spasms of the muscles in the face, neck, and tongue. Diphenhydramine is used to suppress extrapyramidal effects of prochlorperazin A nurse is planning to administer ondansetron IV for an older adult client who has a history of diabetes mellitus and cardiac myopathy and is receiving chemotherapy for cancer. For which of the following adverse effects of ondansetron should the nurse monitor? (Select all that apply.) A. headache B.Diarrhea C.Shortened PR interval D. hyperglycemia E.Prolonged QT interval - CORRECT ANSWER A.headache is a common adverse effect of ondansetron. B. Diarrhea or constipation are both adverse effects of ondansetron E. A prolonged QT interval is a possible adverse effect of ondansetron that can lead to torsades de pointes, a serious dysrhythmia. A nurse is providing instructions about the use of laxatives to a client who has heart failure. The nurse should tell the client he should avoid which of the following laxatives? A.Sodium phosphate B.Psyllium C.Bisacodyl D.Polyethylene glycol - CORRECT ANSWER A. Typically, clients who have heart failure are on a sodium-restricted diet. Absorption of sodium from sodium phosphate causes fluid retention and is contraindicated for clients who have heart failure. A nurse is caring for a client who has diabetes and is experiencing nausea due to gastroparesis. The nurse should anticipate a prescription for which of the following medications? A.Lubiprostone B. metoclopramide C.Bisacodyl D.Loperamide - CORRECT ANSWER B.metoclopramide is a dopamine antagonist that is used to treat nausea and also increases gastric motility. It can relieve the bloating and nausea of diabetic gastroparesis. A nurse is providing information about probiotic supplements to a male client. Which of the following information should the nurse include? (Select all that apply.) A."Probiotics are micro-organisms that are normally found in the GI tract." B."Probiotics are used to treat Clostridium difficile." C."Probiotics are used to treat benign prostatic hyperplasia." D."You can experience bloating while taking probiotic supplements." E."If you are prescribed an antibiotic, you should take it at the same time you take your probiotic supplement." - CORRECT ANSWER A. Probiotics consist of lactobacilli, bifidobacteria, and Saccharomyces boulardii, which normally are found in the digestive tract. B. Probiotics are used to treat a number of GI conditions, including irritable bowel syndrome, diarrhea associated with Clostridium difficile, and ulcerative colitis D. Flatulence and bloating are adverse effects of probiotic supplements. A nurse is teaching a client who has anemia and a new prescription for a liquid iron supplement. Which of the following information should the nurse include in the teaching? (Select all that apply.) A."Add foods that are high in fiber to your diet." B."Rinse your mouth after taking the medication." C."Expect stools to be green or black in color." D."Take the medication with a glass of milk." E."Add red meat to your diet." - CORRECT ANSWER A. Foods high in fiber can prevent constipation, which can occur when taking iron supplements. B. Iron supplements can stain teeth when taken in a liquid form. The client should rinse orally after taking the medication. C. Dark green or black stools can occur when taking iron supplements. The client should anticipate this effect. E. Red meats are high in iron and recommended for a client to improve anemia when taken concurrently with iron supplements. A nurse is caring for a client who has increased liver enzymes and is taking herbal supplements. Which of the following herbal supplements should the nurse report to the provider? A.Glucosamine B.Saw palmetto C. kava D.St. John's wort - CORRECT ANSWER C. Chronic use or high doses of kava can cause liver damage, including severe liver failure A nurse is evaluating a group of clients at a health fair to identify the need for folic acid therapy. Which of the following clients require folic acid therapy? (Select all that apply.) A. 12-year-old child who has iron deficiency anemia B. 24-year-old female who has no health problems C. 44-year-old male who has hypertension D. 55-year-old female who has alcohol use disorder E. 35-year-old male who has type 2 diabetes mellitus CORRECT ANSWER B. The female client of childbearing age should take folic acid to prevent neural tube defects in the fetus D. The client who has alcohol use disorder can require folic acid therapy. Excess alcohol consumption leads to poor dietary intake of folic acid and injury to the liver A nurse is preparing to administer potassium chloride IV to a client who has hypokalemia. Which of the following actions should the nurse take? (Select all that apply.) A.Infuse medication through a large-bore needle. B. monitor urine output to ensure at least 20 mL/hr. C.Administer medication via direct IV bolus. D.Implement cardiac monitoring. E.Administer the infusion using an IV pump - CORRECT ANSWER A. Infuse potassium through a large-bore needle to prevent vein irritation, phlebitis, and infiltration. D. Implement cardiac monitoring to detect cardiac dysrhythmias in a client receiving IV potassium. E. Administer IV potassium using an infusion pump to prevent fatal hyperkalemia due to a rapid infusion rate A nurse is caring for a client who requests information on the use of feverfew. Which of the following responses should the nurse make? A."It is used to treat skin infections." B."It can decrease the frequency of migraine headaches." C."It can lessen the nasal congestion in the common cold." D."It can relieve nausea of morning sickness during pregnancy." - CORRECT ANSWER B. Feverfew is used to decrease the frequency of migraine headaches, but it has not been proven to relieve an existing migraine headache. A nurse is completing an assessment of a client's current medications. The client states she also takes gingko biloba. Which of the following medications is contraindicated for a client taking gingko biloba? A.Acetaminophen B.Warfarin C.Digoxin D.Lisinopri - CORRECT ANSWER B. Warfarin is contraindicated for a client taking gingko biloba because ginkgo biloba can suppress coagulation and increase the risk of bleeding or hemorrhage A nurse is reviewing the health care record of a client who is asking about conjugated equine estrogens. The nurse should inform the client this medication is contraindicated in which of the following conditions? A.Atrophic vaginitis B.Dysfunctional uterine bleeding C.Osteoporosis D.Thrombophlebitis - CORRECT ANSWER D. Estrogen increases the risk of thrombolytic events. Estrogen use is contraindicated for a client who has a history of thrombophlebitis A nurse is providing teaching to a female client who is taking testosterone to treat advanced breast cancer. The nurse should tell the client that which of the following are adverse effects of this medication? (Select all that apply.) A.Deepening voice B.Weight gain C.Low blood pressure D.Dry mouth E.Facial hair - CORRECT ANSWER A. Virilization, the development of adult male characteristics in a female, is an adverse effect of testosterone. The nurse should tell the client that a deepening voice is an adverse effect of testosterone. B. Edema and weight gain are adverse effects of testosterone E. Virilization is an adverse effect of testosterone. The nurse should tell the client that the development of facial hair is an adverse effect of testosterone A nurse is explaining the mechanism of action of combination oral contraceptives to a group of clients. The nurse should tell the clients that which of the following actions occur with the use of combination oral contraceptives? (Select all that apply.) A.Thickening the cervical mucus B.Inducing maturation of ovarian follicle C.Increasing development of the corpus luteum D.Altering the endometrial lining E.Inhibiting ovulation - CORRECT ANSWER A. Oral contraceptives cause thickening of the cervical mucus, which slows sperm passage D. Oral contraceptives alter the lining of the endometrium, which inhibits implantation of the fertilized egg. E. Oral contraceptives prevent pregnancy by inhibiting ovulation. A nurse is providing teaching to a client who will start alfuzosin for treatment of benign prostatic hyperplasia. The nurse should instruct the client that which of the following is an adverse effect of this medication? A.Bradycardia B.Edema C. hypotension D.Tremor - CORRECT ANSWER C. Alfuzosin relaxes muscle tone in veins and cardiac output decreases, which leads to hypotension. Clients taking this medication are advised to rise slowly from a sitting or lying position. A nurse is caring for a client who has angina and asks about obtaining a prescription for sildenafil to treat erectile dysfunction. Which of the following medications is contraindicated with sildenafil? A.Aspirin B.Isosorbide C.Clopidogrel D.Atorvastatin - CORRECT ANSWER B. Isosorbide is an organic nitrate that manages pain from angina. Concurrent use of it is contraindicated because fatal hypotension can occur. The client should avoid taking a nitrate medication for 24 hr after taking isosorbide. A nurse is teaching a client about terbutaline. Which of the following statements by the client indicates understanding of the teaching? A."This medication will stop my contractions." B."This medication will pr event vaginal bleeding." C."This medication will promote blood flow to my baby." D."This medication will increase my prostaglandin production - CORRECT ANSWER A. Terbutaline blocks beta2 -adrenergic receptors, which causes uterine smooth muscle relaxation A nurse is caring for a client who has reeclampsia and is receiving Magnesium sulfate IV Continuous infusion. Which of the following findings should the nurse report to the provider? A.2+ deep tendon reflexes B.2+ pedal edema C.24 mL/hr urinary output D.Respirations 12/mi - CORRECT ANSWER C. Urine output less than 25 to 30 mL/hr is associated with magnesium sulfate toxicity and should be reported to the provider A nurse is caring for a client who has a new prescription for oxytocin to stimulate uterine contractions. Which of the following interventions should the nurse make? (Select all that apply.) A.Use an infusion pump for medication administration. B.Obtain vital signs frequently and with every dosage change. C.Stop infusion if uterine contractions occur every 4 min and last 45 seconds. D.Increase medication infusion rate rapidly. E. monitor fetal heart rate continuously - CORRECT ANSWER A. Oxytocin must be administered by an infusion pump to ensure precise dosage. B. Vital signs are monitored to assess for hypertension, an adverse effect of oxytocin. E. Continuous FHR monitoring is required to assess for fetal distress A nurse is caring for a client who is in labor and receiving IV opioid analgesics. Which of the following actions should the nurse take? A.Instruct the client to self-ambulate every 2 hr. B.Offer oral hygiene every 2 hr. C.Anticipate medication administration 2 hr prior to delivery. D. monitor fetal heart rate every 2 hr - CORRECT ANSWER B. Oral hygiene should be offered on a regular basis to a client receiving opioid analgesics due to the adverse effects of dry mouth, nausea, and vomiting A nurse is reviewing a new prescription for terbutaline with a client who has a history of preterm labor. Which of the following client statements indicates understanding of the teaching? A."I can increase my activity now that I've started on this medication." B."I will increase my daily fluid intake to 3 quarts." C."I will report increasing intensity of contractions to my doctor." D."I am glad this will pr event preterm labor." - CORRECT ANSWER C. The client should report increasing intensity, frequency, or duration of contractions to the provider because these are manifestations of preterm labor A nurse is providing teaching for a client who has gout and a new prescription for allopurinol. For which of the following adverse effects should the client be taught to monitor? (Select all that apply.) A.Stomatitis B.Insomnia C.Nausea D.Rash E.Increased gout pain - CORRECT ANSWER C. Nausea and vomiting are adverse effects that can be caused by allopurinol. D. Rash and other hypersensitivity reactions can be caused by allopurinol. The client should be taught to contact the provider for any manifestation of hypersensitivity so that the medication can be discontinued. E. An increase in gout attacks can occur during the first few months in a client who is taking allopurinol. A nurse is caring for a client who has a new prescription for adalimumab for rheumatoid arthritis. Based on the route of administration of adalimumab, which of the following should the nurse plan to monitor? A.The vein for thrombophlebitis during IV administration B.The subcutaneous site for redness following injection C.The oral mucosa for ulceration after oral administration D.The skin for irritation following removal of transdermal patch - CORRECT ANSWER B. Adalimumab is administered subcutaneously, and injection-site redness and swelling are common. It is appropriate for the nurse to assess the site for redness following injection. A nurse is preparing to administer belimumab for a client who has systemic lupus erythematosus. Which of the following actions should the nurse plan to take? A.Warm the medication to room temperature over 1 hr before administering. B.Administer the medication by IV bolus over 5 min. C.Dilute the medication in 5% dextrose and water solution. D. monitor the client for hypersensitivity reactions - CORRECT ANSWER D. Belimumab can cause severe infusion reactions and can cause anaphylaxis. The nurse should carefully monitor the client during infusion of this medication and be prepared to slow or stop the medication if a reaction occurs. A nurse is caring for a client who has a new diagnosis of fibromyalgia. Which of the following medications should the nurse anticipate being prescribed for this client? A.Colchicine B. hydroxychloroquine C.Auranofin D.Duloxetine - CORRECT ANSWER D. Duloxetine is a serotonin-norepinephrine reuptake inhibitor used to treat fibromyalgia. Other uses for this medication include treating depression and diabetic peripheral neuropathy A nurse is evaluating teaching for a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following statements by the client indicates understanding of the teaching? A."I will be sure to return to the clinic at least once a year to have my blood drawn while I'm taking methotrexate." B."I will take this medication on an empty stomach." C."I'll let the doctor know if I develop sores in my mouth while taking this medication. D."I should stop taking oral contraceptives while I'm taking methotrexate." CORRECT ANSWER C. Ulcerations in the mouth, tongue, or throat are often the first signs of methotrexate toxicity and should be reported to the provider immediately A nurse is providing teaching to a client who is taking raloxifene to prevent postmenopausal osteoporosis. The nurse should advise the client that which of the following are adverse effects of this medication? (Select all that apply.) A. hot flashes B.Lump in breast C.Swelling or redness in calf D.Shortness of breath E.Difficulty swallowing - CORRECT ANSWER A. Raloxifene can cause hot flashes or increase existing hot flashes. C. Raloxifene increases the risk for thrombophlebitis, which can cause swelling or redness in the calf. D. Raloxifene increases the risk for pulmonary embolism, which can cause shortness of breath. A nurse is teaching a client who has osteoporosis and a new prescription for alendronate. Which of the following instructions should the nurse provide? (Select all that apply.) A.Take medication in the morning before eating. B.Chew tablets to increase bioavailability. C.Drink an 8 oz glass of water with each tablet. D.Take medication with an antacid if heartburn occurs. E.Avoid lying down after taking this medication - CORRECT ANSWER A. Take alendronate first thing in the morning before eating to increase absorption C. Clients should drink at least 240 mL (8 oz) water with alendronate tablets. E. Clients should sit upright or stand for at least 30 min after taking alendronate. A nurse is caring for a client who has a new prescription for calcitoninsalmon for osteoporosis. Which of the following tests should the nurse tell the client to expect before beginning this medication? A.Skin test for allergy to the medication B.ECG to rule out cardiac dysrhythmias C. mantoux test to rule out exposure to tuberculosis D.Liver function tests to assess risk for medication toxicity - CORRECT ANSWER A. Anaphylaxis can occur if the client is allergic to calcitonin-salmon. A skin test to determine allergy might be done before starting this medication. The nurse also should ask the client about previous allergies to fish A nurse is caring for a young adult client whose serum calcium is 8.8 mg/dL. Which of the following medications should the nurse anticipate administering to this client? A.Calcitonin-salmon B.Calcium carbonate C.Zoledronic acid D.Ibandronate - CORRECT ANSWER B. The client's serum calcium level is below the expected reference range. Calcium carbonate is an oral form of calcium used to increase serum calcium to the expected reference range. A nurse is providing instruction to a client who has a new prescription for calcitonin-salmon for postmenopausal osteoporosis. Which of the following instructions should the nurse include in the teaching? A.Swallow tablets on an empty stomach with plenty of water. B.Watch for skin rash and redness when applying calcitonin-salmon topically. C. mix the liquid medication with juice and take it after meals. D.Alternate nostrils each time calcitonin-salmon is inhale - CORRECT ANSWER D.Calcitonin-salmon can be administered Im or subcutaneously, but is commonly administered intranasally for postmenopausal osteoporosis. The client should alternate nostrils daily. A nurse is assessing a client who has salicylism. Which of the following findings should the nurse expect? (Select all that apply.) A.Dizziness B.Diarrhea C.Jaundice D.Tinnitus E. headache - CORRECT ANSWER A. The client who has salicylism can have dizziness, which is an expected finding. D. The client who has salicylism can have tinnitus, which is an expected finding. E. The client who has salicylism can have a headache, which is an expected finding A nurse is admitting a toddler to the hospital after an acetaminophen overdose. Which of the following medications should the nurse anticipate administering to this client? A.Acetylcysteine B.Pegfilgrastim C. misoprostol D.Naltrexone - CORRECT ANSWER A. The nurse should administer acetylcysteine, which is the antidote for acetaminophen overdose. A nurse is teaching a client about the a new prescription for celecoxib. Which of the following information should the nurse include in the teaching? A.Increases the risk for a myocardial infarction B.Decreases the risk of stroke C.Inhibits COX-1 D.Increases platelet aggregation - CORRECT ANSWER A. The client who takes celecoxib has an increased risk for a myocardial infarction secondary to suppressing vasodilation A nurse is taking a history for a client who reports that he is taking aspirin about four times daily for a sprained wrist. Which of the following prescribed medications taken by the client is contraindicated with aspirin? A.Digoxin B. metformin C.Warfarin D.Nitroglycerin - CORRECT ANSWER C. The effect of warfarin and other anticoagulants is increased by aspirin, which inhibits platelet aggregation. This client would have an increased risk for bleeding. Use of aspirin generally is contraindicated for clients who take warfarin. A nurse in an emergency department is performing an admission assessment for a client who has severe aspirin toxicity. Which of the following findings should the nurse expect? A.Body temperature 35° C (95° F) B.Lung crackles C.Cool, dry skin D.Respiratory depression - CORRECT ANSWER D. Respiratory depression due to increasing respiratory acidosis is an expected manifestation of severe aspirin toxicity. A nurse is preparing to administer an opioid agonist to a client who has acute pain. Which of the following complications should the nurse monitor? A.Urinary retention B.Tachypnea C. hypertension D.Irritating cough - CORRECT ANSWER A. The nurse should monitor for urinary retention because morphine can suppress awareness that the bladder is full. A nurse is caring for a client who has end-stage cancer and is receiving morphine. The client's daughter asks why the provider prescribed methylnaltrexone. Which of the following responses should the nurse make? A."The medication will increase your mother's respirations." B."The medication will prevent dependence on the morphine." C."The medication will relieve your mother's constipation." D."The medication works with the morphine to increase pain relief. - CORRECT ANSWER C.methylnaltrexone is an opioid antagonist used for treating severe constipation that is unrelieved by laxatives in clients who are opioid-dependent. The medication blocks the mu opioid receptors in the GI tract. A nurse is preparing to administer butorphanol to a client who has a history of substance use disorder. The nurse should identify which of the following information as true regarding butorphanol? A.Butorphanol has a gr eater risk for abuse than morphine. B.Butorphanol causes a higher incidence of respiratory depression than morphine. C.Butorphanol cannot be reversed with an opioid antagonist. D.Butorphanol can cause abstinence syndrome in opioid-dependent clients - CORRECT ANSWER D. Opioid agonist/antagonist medications, such as butorphanol, can cause abstinence syndrome in opioid-dependent clients. manifestations include abdominal pain, fever, and anxiety A nurse is planning to administer morphine IV to a client who is postoperative. Which of the following actions should the nurse take? A. monitor for seizures and confusion with repeated doses. B.Protect the client's skin from the severe diarrhea that occurs with morphine. C.Withhold this medication if respiratory rate is less than 12/min. D.Give morphine intermittent via IV bolus over 30 seconds or less - CORRECT ANSWER C. The nurse should withhold all opioids if the respiratory rate is 12/min or less, and notify the provider. A nurse is reviewing the medication administration record for a client who is receiving transdermal fentanyl for severe pain. Which of the following medications should the nurse expect to cause an adverse effect when administered concurrently with fentanyl? A.Ampicillin B.Diazepam C.Furosemide D.Prednisone - CORRECT ANSWER B. Diazepam, a benzodiazepine, is a CNS depressant, which can interact by causing the client to become severely sedated when administered concurrently with an opioid agonist or agonist/antagonist. A nurse is caring for a client who has cancer and is taking morphine and carbamazepine or pain. Which of the following effects should the nurse monitor for when giving the medications together? (Select all that apply.) A.Need for reduced dosage of the opioid B.Reduced adverse effects of the opioid C.Increased analgesic effects D.Enhanced CNS stimulation E.Increased opioid tolerance - CORRECT ANSWER A. Dosage of the opioid can be reduced when adjuvant medications are added for pain. B. Adverse effects of the opioid can be reduced when adjuvant medications are added for pain. C. Analgesic effects are increased when adjuvant medications are added for pain A nurse is planning care for a client who has brain cancer and is experiencing headaches. Which of the following adjuvant medications are indicated for this client? A.Dexamethasone B. methylphenidate C. hydroxyzine D.Amitriptyline - CORRECT ANSWER A.Dexamethasone, a glucocorticoid, decreases inflammation and swelling. It is used to reduce cerebral edema and relieve pressure from the tumor. A nurse is preparing to administer pamidronate to a client who has bone pain related to cancer. Which of the following precautions should the nurse take when administering pamidronate? A.Inspect the skin for redness and irritation when changing the intradermal patch. B.Assess the IV site for thrombophlebitis frequently during administration. C.Instruct the client to sit upright or stand for 30 min following oral administration. D.Watch for manifestations of anaphylaxis for 20 min after Im administration - CORRECT ANSWER B. Pamidronate is administered by IV infusion. This medication is irritating to veins, and the nurse should assess for thrombophlebitis during administration A nurse is planning care for a client who has cancer and is taking a glucocorticoid as an adjuvant medication for pain control. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A. monitor for urinary retention. B. monitor serum glucose. C. monitor serum potassium level. D. monitor for gastric bleeding. E. monitor for respiratory depression - CORRECT ANSWER B.monitoring serum glucose is important because glucocorticoids raise the glucose level, especially in clients who have diabetes mellitus. C.monitoring serum potassium level is important because glucocorticoids can cause hypokalemia. D.monitoring for gastric bleeding is important because glucocorticoids irritate the gastric mucosa and put the client at risk for a peptic ulcer. A nurse is administering amitriptyline to a client who is experiencing cancer pain. For which of the following adverse effects should the nurse monitor? A.Decreased appetite B.Explosive diarrhea C.Decreased pulse rate D.Orthostatic hypotension - CORRECT ANSWER D. Amitriptyline can cause orthostatic hypotension. The nurse should assess for this effect and instruct the client to move slowly from lying down or sitting after taking this medication. A nurse is providing teaching to a client who is experiencing migraine headaches. Which of the following instructions should the nurse provide? (Select all that apply.) A.Take ergotamine as a prophylaxis to prevent a migraine headache. B.Identify and avoid trigger factors. C.Lie down in a dark quiet room at the onset of a migraine. D.Avoid foods that contain tyramine. E.Avoid exercise that can increase heart rate - CORRECT ANSWER B. Identifying and avoiding trigger factors is an important action that can help to prevent some migraines. C. Lying down in a dark, quiet room at the onset of a migraine can prevent the onset of more severe manifestations. D. Foods that contain tyramine can be a trigger for some migraines and should be avoided. A nurse is planning care for a client who is to receive tetracaine prior to a bronchoscopy. Which of the following actions should the nurse include in the plan of care? A. keep the client NPO until pharyngeal response returns. B. monitor the insertion site for a hematoma. C.Palpate the bladder to detect urinary retention. D. maintain the client on bed rest for 12 hr following the procedure - CORRECT ANSWER A. The nurse should keep the client NPO following the procedure until normal pharyngeal sensation returns (approximately 1 hr) and should then monitor the client's first oral intake to ensure aspiration does not occur A nurse is caring for a client who receives a local anesthetic of lidocaine during the repair of a skin laceration. For which of the following adverse reactions should the nurse monitor the client? A.Seizures B.Tachycardia C. hypertension D.Fever - CORRECT ANSWER A. Seizure activity is an adverse effect that can occur as a result of local anesthetic injection. A nurse is reviewing the health history of a client who has migraine headaches and is to begin prophylaxis therapy with propranolol. Which of the following findings in the client history should the nurse report to the provider? A.The client had a prior myocardial infarction. B.The client takes warfarin for atrial fibrillation. C.The client takes an SSRI for depression. D.An ECG indicates a first-degree heart block - CORRECT ANSWER D. Propranolol is contraindicated in clients who have a first-degree heart block. The nurse should report this finding to the provider. A nurse is providing teaching to a client who has migraine headaches and a new prescription for ergotamine. For which of the following adverse effects should the nurse instruct the client to stop taking the medication and notify the provider? (Select all that apply.) A.Nausea B.Visual disturbances C.Positive home pregnancy test D.Numbness and tingling in fingers E. muscle pain - CORRECT ANSWER C. A client who has a positive home pregnancy test should stop taking ergotamine and notify the provider. Ergotamine is classified as Pregnancy Risk Category X and can cause fetal abortion. D. Numbness and tingling in fingers or toes can be a finding in ergotamine overdose. The medication should be stopped and the provider notified. E. Unexplained muscle pain can be a finding in ergotamine overdose. The medication should be stopped and the provider notified A nurse is teaching clients in an outpatient facility about the use of insulin to treat type 1 diabetes mellitus. For which of the following types of insulin should the nurse tell the clients to expect a peak effect 1 to 5 hr after administration? A.Insulin glargine B.NPH insulin C.Regular insulin D.Insulin lispro - CORRECT ANSWER C. Regular insulin has a peak effect around 1 to 5 hr following administration A nurse is caring for a client in an outpatient facility who has been taking acarbose for type 2 diabetes mellitus. Which of the following laboratory tests should the nurse plan to monitor? A.WBC B.Serum potassium C.Platelet count D.Liver function test - CORRECT ANSWER D. Acarbose can cause liver toxicity when taken long-term. Liver function tests should be monitored periodically while the client takes this medication A nurse is providing teaching to a client who has type 2 diabetes mellitus and is starting repaglinide. Which of the following statements by the client indicates understanding of the administration of this medication? A."I'll take this medicine with my meals." B."I'll take this medicine 30 minutes before I eat." C."I'll take this medicine just before I go to bed." D."I'll take this medicine as soon as I wake up in the morning." - CORRECT ANSWER B. Repaglinide causes a rapid, short-lived release of insulin. The client should take this medication within 30 min before each meal so that insulin is available when food is digested. A nurse is providing teaching for a client who has a new prescription for metformin. Which of the following adverse effects of metformin should the nurse instruct the client to report to the provider? A.Somnolence B.Constipation C.Fluid retention D.Weight gain - CORRECT ANSWER A. Somnolence can indicate lactic acidosis, which is manifested by extreme drowsiness, hyperventilation, and muscle pain. It is a rare but very serious adverse effect caused by metformin and should be reported to the provider. A nurse is providing teaching to a client who has a prescription for pramlintide for type 1 diabetes mellitus. Which of the following should the nurse include in the teaching? (Select all that apply.) A."Take oral medications 1 hr before injection." B."Use upper arms as preferred injection sites." C."mix pramlintide with breakfast dose of insulin." D."Inject pramlintide just before a meal." E."Discard open vials after 28 days. - CORRECT ANSWER D. Pramlintide can cause hypoglycemia, especially when the client also takes insulin, so it is important to eat a meal after injecting this medication. E.Unused medication in the open pramlintide vial should be discarded after 28 days A nurse is caring for a client who is taking propylthiouracil. For which of the following adverse effects of this medication should the nurse monitor? A.Bradycardia B.Insomnia C. heat intolerance D.Weight loss - CORRECT ANSWER A. Bradycardia is an adverse effect of propylthiouracil. The nurse should monitor for bradycardia. A nurse is teaching a client who has Graves' disease about her prescribed medications. Which of the following statements by the client indicates an understanding of the use of propranolol in the treatment of Graves' disease? A."Propranolol helps increase blood flow to my thyroid gland." B."Propranolol is used to prevent excess glucose in my blood." C."Propranolol will decrease my tremors and fast heart beat." D."Propranolol promotes a decrease of thyroid hormone in my body CORRECT ANSWER C. Propranolol is a betaadrenergic antagonist that decreases heart rate and controls tremors. A nurse is caring for an older adult client in a long-term care facility who has hypothyroidism and a new prescription for levothyroxine. Which of the following dosage schedules should the nurse expect for this client? A.The client will start at a high dose, and the dose will be tapered as needed. B.The client will remain on the initial dosage during the course of treatment. C.The client's dosage will be adjusted daily based on blood levels. D.The client will start on a low dose, which will be gradually increased - CORRECT ANSWER D. The nurse should expect that levothyroxine will be started at a low dose and gradually increased over several weeks. This is especially important in older adult clients to prevent toxicity A nurse is caring for a client who is taking for somatropin to stimulate growth. The nurse should plan to monitor the client's urine for which of the following? A.Bilirubin B.Protein C.Potassium D.Calcium - CORRECT ANSWER D. A large amount of calcium can be present in the urine of a client who takes somatropin. This puts the client at risk for renal calculi A nurse is assessing a client who takes desmopressin for diabetes insipidus. For which of the following adverse effects should the nurse monitor? A. hypovolemia B. hypercalcemia C.Agitation D. headache - CORRECT ANSWER D.headache during desmopressin therapy is an indication of water intoxication A nurse is admitting a client to an acute care facility for a total hip arthroplasty. The client takes hydrocortisone for Addison's disease. Which of the following actions is the nurse's priority? A.Administering a supplemental dose of hydrocortisone B.Instructing the client about coughing and deep breathing C.Collecting additional information from the client about his history of Addison's disease D.Inserting an indwelling urinary catheter - CORRECT ANSWER A. Acute adrenal insufficiency (adrenal crisis) is the greatest risk to a client who has Addison's disease, is taking a glucocorticoid, and is undergoing surgery. To prevent acute adrenal insufficiency, supplemental doses are administered during times of increased stress A nurse is caring for several clients who came to the clinic for a seasonal influenza immunization. The nurse should identify that which of the following clients is a candidate to receive the vaccine via nasal spray rather than an injection? A. 1-year-old who has no health problems B. 17-year-old who has a hypersensitivity to penicillin C. 25-year-old who is pregnant D. 52-year-old who takes a multivitamin supplement - CORRECT ANSWER B. A 17-year-old can be immunized for influenza with the LAIV via nasal spray. A hypersensitivity to penicillin is not a contraindication for an influenza immunizatio A nurse is teaching a group of new parents about immunizations. The nurse should instruct the parents that the series for which of the following vaccines is completed prior to the first birthday? A.Pneumococcal conjugate vaccine B. meningococcal conjugate vaccine C.Varicella vaccine D.Rotavirus vaccine - CORRECT ANSWER D. Rotavirus vaccine is administered only to infants less than 8 months, 0 days of age A nurse at a provider's office is preparing to administer RV, DTaP, hib, PCV13, and IPV immunizations to a 4-month-old infant. Which of the following actions should the nurse plan to take? (Select all that apply.) A.Administer IPV orally B.Administer subcutaneous injections in the anterolateral thigh. C.Administer Im injections in the deltoid muscle. D.Give the infant his pacifier during vaccine injections. E.Teach parents to give aspirin on a schedule for 24 hr after immunization - CORRECT ANSWER B. Subcutaneous immunizations may be administered in either the anterolateral thigh or the outer aspect of the upper arm to infants and children. D.Giving the infant a pacifier during injections is a comfort measure that should be encouraged by the nurse. A 12-month-old child just received the first measles, mumps, and rubella (mmR) vaccine. For which of the following possible reactions to this vaccine should the nurse teach the parents to monitor? (Select all that apply.) A.Rash B.Swollen glands C.Bruising D. headache E.Inconsolable crying - CORRECT ANSWER A. A rash and fever can develop in children 1 to 2 weeks following mmR immunization. B. Swollen glands can develop in children 1 to 2 weeks following mmR immunization. C. A temporary low platelet count, causing bruising or bleeding, can occur occasionally following mmR immunization A nurse is caring for a group of clients who are not protected against varicella. The nurse should prepare to administer the varicella vaccine at this time to which of the following clients? A.24-year-old woman in the third trimester of pregnancy B. 12-year-old child who has a severe allergy to neomycin C. 2-month-old infant who has no health problems D. 32-year-old man who has essential hypertension - CORRECT ANSWER D. A 32-year-old man who has essential hypertension and did not receive two doses of varicella vaccine earlier in life should be immunized. Essential hypertension is not a contraindication for this vaccine A nurse is caring for a client who has breast cancer and asks why she is receiving a combination therapy of cyclophosphamide, methotrexate, and fluorouracil. The response by the nurse should include that combination chemotherapy is used to do which of the following? (Select all that apply.) A.Decrease medication resistance B.Attack cancer cells at different stages of cell growth C.Block chemotherapy agent from entering healthy cells D.Stimulate immune system E.Decrease injury to normal body cells - CORRECT ANSWER A.medication resistance is decreased with combination therapy because the chance of developing resistance to several medication is less than to only one medication. B. Each medication kills cancer cells at a different stage of growth. A combination of medications can kill more cancer cells than only one medication. E. Injury to normal body cells can be decreased by combination therapy because the medications used have different toxicities A nurse is preparing to administer cyclophosphamide IV to a client who has hodgkin's disease. Which of the following medications should the nurse expect to administer concurrently with the chemotherapy to prevent an adverse effect of cyclophosphamide? A.Uroprotectant agent, such as mesna B.Opioid, such as morphine C.Loop diuretic, such as furosemide D. h1 receptor antagonist, such as diphenhydramine - CORRECT ANSWER A.mesna is a uroprotectant agent that can help prevent hemorrhagic cystitis when administered IV with a nitrogen mustard chemotherapy medication A nurse is preparing to administer leucovorin to a client who has cancer and is receiving chemotherapy with methotrexate. Which of the following responses should the nurse use when the client asks why leucovorin is being given? A."Leucovorin reduces the risk of a transfusion reaction from methotrexate." B."Leucovorin increases platelet production and prevents bleeding." C."Leucovorin potentiates the cytotoxic effects of methotrexate." D."Leucovorin protects healthy cells from methotrexate's toxic effect." CORRECT ANSWER D. Leucovorin, a folic acid derivative and an antagonist to methotrexate, is given within 12 hr of high doses of methotrexate to protect healthy cells from the toxic effects of methotrexate A nurse is teaching a client who has breast cancer about tamoxifen. Which of the following adverse effects of tamoxifen should the nurse discuss with the client? A.Irregular heart beat B.Abnormal uterine bleeding C.Yellow sclera or dark-colored urine. D.Difficulty swallowing - CORRECT ANSWER B. Vaginal discharge and bleeding are adverse effects of tamoxifen. The client who takes tamoxifen is also at increased risk for endometrial cancer, so any abnormal uterine bleeding should be carefully monitored and evaluated A nurse is caring for a client who is being treated with interferon alfa-2b for malignant melanoma. For which of the following adverse effects should the nurse monitor? (Select all that apply.) A.Tinnitus B. muscle aches C.Peripheral neuropathy D.Bone loss E.Depression - CORRECT ANSWER B.muscle aches and other flu-like manifestations are common adverse effects of interferon alfa-2b. Acetaminophen may be prescribed to relieve these manifestations. C. Peripheral neuropathy, dizziness, and fatigue are CNS effects that can occur when taking interferon alfa-2b. These should be reported to the provider, and the nurse should teach the client to prevent injury from falls. E. Depression and mental status changes can occur with interferon alfa-2b treatment. The nurse should assess the client for suicidal thoughts. A nurse is caring for a client who receives rituximab to treat nonhodgkin's leukemia and who asks the nurse how rituximab works. Which of the following should the nurse include? A.Blocks hormone receptors B.Increases immune response C.Binds with specific antigens on tumor cells D.Stops DNA replication during cell division - CORRECT ANSWER C. Rituximab is a monoclonal antibody that binds to specific antigens on B-lymphocytes and then destroying cancer cells. A nurse is implementing a plan of care for a client who has a wound infection. Which of the following actions should the nurse perform first? A.Administer antibiotic medication. B.Obtain a wound specimen for culture. C.Review WBC laboratory findings. D.Apply a dressing to the wound - CORRECT ANSWER B. When using the urgent vs. nonurgent approach to care, the nurse's priority action is to obtain a culture of the wound before initiating antibiotic therapy A nurse is caring for a client who has a urinary tract infection and a history of recurrence of this type of infection. The client asks why the provider has not yet prescribed an antibiotic. The nurse should explain that the provider has to wait for the results of which of the following laboratory tests to identify which antibiotic to prescribe? A.Gram stain B.Culture C.Sensitivity D.Specific gravity - CORRECT ANSWER C. A sensitivity test identifies the most effective antibiotic to prescribe to treat a specific micro-organism. A nurse is preparing information for the unit's nurses about the effectiveness of antimicrobial therapy for clients who have bacterial infections. Which of the following host factors should the nurse include as conditions that affect antimicrobial effectiveness? (Select all that apply.) A. meningitis B.Pacemaker C.Endocarditis D.Pneumonia E.Pyelonephriti - CORRECT ANSWER A. Some clients who have meningitis have difficulty responding to antimicrobial therapy because it is difficult for the medication to cross the blood-brain barrier to reaching the infecting micro-organisms. B. Some clients who have a pacemaker have difficulty responding to antimicrobial therapy due to colonization of micro-organisms around the pacemaker and the inability of phagocytic cells to destroy those micro-organisms. C. Some clients who have endocarditis have difficulty responding to antimicrobial therapy because the medication cannot penetrate the vegetative thrombus that develops on the injured endocardium A nurse is caring for a group of clients who are receiving antimicrobial therapy. Which of the following clients should the nurse plan to monitor for manifestations of antibiotic toxicity? A.An adolescent client who has a sinus infection B.An older adult client who has prostatitis C.A client who is postpartum and has mastitis D.A middle adult client who has a urinary tract infection - CORRECT ANSWER B. An older adult client who has prostatitis and is receiving antibiotics is at risk for toxicity due to the age-related reduction in medication metabolism and excretion A charge nurse is teaching a group of nurses about the importance of prophylactic antimicrobial therapy. Which of the following information should the charge nurse include in the teaching? (Select all that apply.) A.Administer prophylactic antimicrobial therapy to clients who report exposure to a sexually transmitted infection. B.Administer prophylactic antimicrobial therapy to clients who are having orthopedic surgery. C.Instruct clients who have a prosthetic heart valve about the need for prophylactic antimicrobial therapy before dental work. D.Consult the provider for prophylactic antimicrobial therapy for clients who have recurrent urinary tract infections. E.Instruct clients to request prophylactic antimicrobial therapy immediately when they have an upper respiratory infection - CORRECT ANSWER A. Clients who suspect exposure to a sexually transmitted infection require prophylactic antimicrobial therapy to prevent an infection. B. Clients who are having orthopedic surgery require prophylactic antimicrobial therapy to prevent an infection. C. Clients who are having dental work and have a prosthetic heart valve should receive prophylactic antimicrobial therapy to prevent an infection. D. Clients who have recurrent urinary tract infections should receive prophylactic antimicrobial therapy to prevent an infection A nurse in an outpatient facility is preparing to administer nafcillin Im to an adult client who has an infection. Which of the following actions should the nurse plan to take? (Select all that apply.) A.Select a 25-gauge, ½-inch needle for the injection. B.Administer the medication deeply into the ventrogluteal muscle. C.Ask the client about an allergy to penicillin before administering the medication. D. monitor the client for 30 min following the injection. E.Tell the client to expect a temporary rash to develop following the injection - CORRECT ANSWER B. It is important to administer nafcillin Im into a deep muscle mass, such as the ventrogluteal site. C. It is important to ask the client about an allergy to penicillin or other antibiotics before administering nafcillin. An allergy to another penicillin or to a cephalosporin is a contraindication for administering nafcillin. D. When administering a penicillin or other antibiotic parenterally, it is important to monitor the client for 30 min for an allergic reaction A nurse is preparing to administer cefotaxine IV to a client who has a severe infection and has been receiving cefotaxime for the past week. Which of the following findings indicates a potentially serious adverse reaction to this medication that the nurse should report to the provider? A.Diaphoresis B.Epistaxis C.Diarrhea D.Alopecia - CORRECT ANSWER C. Diarrhea is an adverse effect of cefotaxime and other cephalosporins that requires reporting to the provider. Severe diarrhea might indicate that the client has developed antibiotic-associated pseudomembranous colitis, which could be life-threatening. A nurse is obtaining a medication history from a client who is to receive imipenemcilastatin IV to treat an infection. Which of the following medications the client also receives puts him at risk for a medication interaction? A.Regular insulin B.Furosemide C.Valproic acid D.Ferrous sulfate - CORRECT ANSWER C.Imipenem-cilastatin decreases the blood levels of valproic acid, an antiseizure medication, putting the client at risk for increased seizure activity. If the client must take these two medications concurrently, the nurse should monitor for seizures A nurse is caring for a client who has a cerebrospinal fluid infection with gram-negative bacteria. Which of the following cephalosporin antibiotics should the nurse expect to administer IV to treat this infection? A.Cefaclor B.Cefazolin C.Cefepime D.Cephalexin - CORRECT ANSWER C. Cefepime, a fourth-generation cephalosporin, is more likely to be effective against this infection than the other medications, which are from the first or second generation. medications from each progressive generation of cephalosporins are more effective against gram-negative bacteria, more resistant to destruction by beta-lactamase, and more able to reach cerebrospinal fluid A nurse is preparing to administer penicillin V to a client who has a streptococcal infection. The client tells the nurse that she has difficulty swallowing tablets and doesn't "do well" with liquid or chewable medications because the taste gags her, even when the a nurse mixes the medication with food. The nurse should request a prescription for which of the following medications? A.Fosfomycin B.Amoxicillin C.Nafcillin D.Cefaclor - CORRECT ANSWER C. Nafcillin is an acceptable alternative within the penicillin classification because it is available for Im or IV use. A nurse is teaching a client about taking tetracycline to treat a GI infection due to Helicobacter pylori . Which of the following statements should the nurse identify as an indication that the client understands the instructions? A."I will take this medication with 8 ounces of milk." B."I will let my doctor know if I start having diarrhea." C."I can stop taking this medication when I feel completely well." D."I can take this medication just before bedtime. - CORRECT ANSWER B. Diarrhea can indicate that the client is developing a suprainfection, which can be very serious. The client should notify the provider if diarrhea occurs. A nurse is administering gentamicin by IV infusion at 0900. The medication will take 1 hr to infuse. When should the nurse plan to obtain a blood sample for a peak serum level of gentamicin? A.1000 B.1030 C.1100 D.1130 - CORRECT ANSWER B. The nurse should obtain the blood specimen for the peak serum level at 1030, 30 min after the end of the IV infusion. For the trough level, the nurse should collect the blood sample just before starting the infusion A nurse is caring for a client who is starting a course of gentamicin IV for a serious respiratory infection. For which of the following manifestations should the nurse monitor as an adverse effect of this medication? (Select all that apply.) A.Pruritus B. hematuria C. muscle weakness D.Difficulty swallowing E.Vertigo - CORRECT ANSWER A. Paresthesias of the hands and feet, urticaria, rash, and pruritus are indications of a hypersensitivity reaction that can occur in clients taking gentamicin. B.hematuria is an indication of acute kidney toxicity due to gentamicin. C.muscle weakness and respiratory depression can occur in clients taking gentamicin as a result of neuromuscular blockade E. Vertigo, ataxia, and hearing loss are indications of ototoxicity that can occur in clients taking gentamicin A nurse is caring for a client who has subacute bacterial endocarditis and is receiving several antibiotics, including streptomycin Im. For which of the following manifestations should the nurse monitor as an adverse effect of this medication? A.Extremity paresthesias B.Urinary retention C.Severe constipation D.Complex partial seizures - CORRECT ANSWER A. Paresthesias of the hands and feet are a common adverse effect of streptomycin. This medication treats infections in combination with other antibiotics or to treat severe infections when other antibiotics failed. A nurse is caring for a client who is undergoing preparation for extensive colorectal surgery. Which of the following oral antibiotics should the nurse expect to administer specifically to suppress normal flora in the GI tract? A. kanamycin B.Gentamicin C.Neomycin D.Tobramycin - CORRECT ANSWER C. The nurse should expect to administer neomycin, an aminoglycoside antibiotic, orally prior to GI surgery to rid the large intestine of normal flora A nurse reviewing a client's medication history notes an allergy to sulfonamides. This allergy is a contraindication for taking which of the following medications? (Select all that apply.) A. hydrochlorothiazide B. metoprolol C.Acetaminophen D.Glipizide E.Furosemide - CORRECT ANSWER A. A sulfonamide allergy is a contraindication for taking hydrochlorothiazide. hypersensitivity, including Stevens-Johnson syndrome, can result from taking hydrochlorothiazide and a sulfonamide concurrently. D. A sulfonamide allergy is a contraindication for taking some oral antidiabetes medications, including glipizide and glyburide. hypersensitivity, including Stevens-Johnson syndrome, can result from taking glipizide and a sulfonamide concurrently. E. A sulfonamide allergy is a contraindication for taking loop diuretics, such as furosemide. hypersensitivity, including Stevens-Johnson syndrome, can result from taking furosemide and a sulfonamide concurrently A nurse is teaching a client who has a new prescription for nitrofurantoin. Which of the following information should the nurse include? (Select all that apply.) A.Observe for bruising on the skin. B.Take the medication with milk or meals. C.Expect brown discoloration of urine. D.Crush the medication if it is difficult to swallow. E.Expect insomnia when taking it - CORRECT ANSWER A. Bruising can indicate a blood dyscrasia, and the client should notify the provider if this occurs. B. Taking the medication with milk or meals minimizes GI discomfort from nausea, vomiting, anorexia, and diarrhea. C. A brown discoloration of urine is a common adverse effect of nitrofurantoin. A nurse is teaching a female client who has a severe UTI about ciprofloxacin. Which of the following information about adverse reactions should the nurse include? (Select all that apply.) A.Observe for pain and swelling of the Achilles tendon. B.Watch for a vaginal yeast infection. C.Expect excessive nighttime perspiration. D.Inspect the mouth for cottage cheese-like lesions. E.Take the medication with a dairy product - CORRECT ANSWER A. Pain and swelling of the Achilles tendon indicate an adverse effect of ciprofloxacin to report to the provider. B. A vaginal yeast infection is an overgrowth of Candida albicans, which commonly occurs when taking ciprofloxacin. D. Cottage cheese-like lesions in the mouth indicate an overgrowth of Candida albicans, a common adverse effect when taking ciprofloxacin A nurse is planning discharge teaching for a female client who has a new prescription for trimethoprim-sulfamethoxazole. Which of the following information should the nurse include? A.Take the medication even if pregnant. B. maintain a fluid restriction while taking it. C.Take it on an empty stomach. D.Stop taking it when manifestations subside - CORRECT ANSWER C. The nurse should inform the client that she may take the medication with or without food. A nurse is planning to administer ciprofloxacin IV to a client who has cystitis. Which of the following actions should the nurse take? A.Administer a concentrated solution. B.Infuse the medication over 60 min. C.Infuse the solution through the primary IV fluid's tubing. D.Choose a small peripheral vein for administration. - CORRECT ANSWER B. The nurse should administer ciprofloxacin IV over 60 min to minimize irritation of the vein A nurse is caring for a client who has diabetes mellitus, pulmonary tuberculosis, and a new prescription for isoniazid. Which of the following supplements should the nurse expect to administer to prevent an adverse effect of INh? A.Ascorbic acid B.Pyridoxine C.Folic acid D.Cyanocobalami - CORRECT ANSWER B. Pyridoxine is frequently prescribed along with INh to prevent peripheral neuropathy for clients who have increased risk factors, such as diabetes mellitus or alcohol use disorder A nurse is infusing IV amphotericin B to a client who has a systemic fungal infection. The nurse should monitor the client for which of the following adverse effects of this medication? A. hypoglycemia B.Constipation C.Fever D. hyperkalemia - CORRECT ANSWER C. Amphotericin B can cause fever, chills, and nausea during the infusion. Pretreatment with diphenhydramine and acetaminophen can reduce these effects. A nurse is administering IV amphotericin B to a client who has a systemic fungal infection. The nurse should monitor which of the following laboratory values? (Select all that apply.) A.Serum calcium B.Serum amylase C. Serum potassium D. hematocrit E.Serum creatinine - CORRECT ANSWER C.hypokalemia is a serious adverse effect of amphotericin B. The nurse should monitor serum potassium values for hypokalemia. D. Amphotericin B can cause bone marrow suppression. The nurse should monitor CBC and platelet count periodically. E. Amphotericin B can cause nephrotoxicity. The nurse should monitor kidney function (with serum creatinine, BUN, and creatinine clearance) A nurse is teaching a client who is beginning a course of metronidazole to treat an infection. For which of the following adverse effects should the nurse instruct the client to stop taking metronidazole and notify the provider? A. metallic taste B.Nausea C.Ataxia D.Dark-colored urine - CORRECT ANSWER C. Ataxia, tremors, paresthesias of the extremities, and seizures are manifestations of CNS toxicity. The client should stop taking the medication and notify the provider if any of these effects occur. A nurse is teaching a client who has active tuberculosis about his treatment regimen. The client asks why he must take four different medications. Which of the following responses should the nurse make? A."Four medications decrease the risk for a severe allergic reaction" B."Four medications r educe the chance that the bacteria will become resistant." C."Four medications r educe the risk for adverse reactions" D."Four medications decrease the chance of having a positive tuberculin skin test. CORRECT ANSWER B. If the client took only one medication to treat active tuberculosis, resistance to the medication would occur quickly. Taking three or four medications decreases the possibility of resistance. A nurse is teaching a client who has a new prescription for combination oral NRTIs (abacavir, lamivudine, and zidovudine) for treatment of hIV. Which of the following statements should the nurse include? A."These medications work by blocking hIV entry into cells." B."These medications work by weakening the cell wall of the hIV virus." C."These medications work by inhibiting enzymes to prevent hIV replication." D."These medications work by preventing protein synthesis within the hIV cell." CORRECT ANSWER C. The NRTI antiretroviral medications this client takes work by inhibiting the enzyme reverse transcriptase and preventing hIV replication A nurse is caring for a client who takes several antiretroviral medications, including the NRTI zidovudine, to treat hIV infection. The nurse should monitor for which of the following adverse effects of zidovudine? (Select all that apply.) A.Fatigue B.Blurred vision C.Ataxia D. hyperventilation E.Vomiting - CORRECT ANSWER A. Fatigue is a manifestation of anemia, an adverse effect of zidovudine. Neutropenia can also occur, causing a high risk for infection D.hyperventilation is a finding that can occur if the client develops lactic acidosis, a serious adverse effect of zidovudine. E. Vomiting and other GI effects are adverse effects of zidovudine A nurse is caring for a client who is taking ritonavir, a protease inhibitor, to treat hIV infection. The nurse should monitor for which of the following adverse effects of this medication? A.Increased TSh level B.Decreased ALT level C. hypoglycemia D. hyperlipidemia - CORRECT ANSWER D.hyperlipidemia with increased cholesterol and triglyceride levels can occur as an adverse effect of ritonavir A nurse is caring for a client who has a new prescription for enfuvirtide to treat hIV infection. The nurse should monitor the client for which of the adverse reactions of this medication? (Select all that apply.) A.Bleeding B.Pneumonia C.Cerebral edema D.Localized erythema E. hypotension - CORRECT ANSWER B. Bacterial pneumonia with fever, cough, and difficulty breathing are manifestations of an adverse reaction to enfuvirtide. The nurse should assess breath sounds regularly D. Enfuvirtide is administered subcutaneously. Injection- site reactions, such as pain, redness, itching, and bruising, are common. E. A systemic allergic reaction can occur when taking enfuvirtide. manifestations of hypersensitivity include rash, hypotension, fever, and chills A nurse is administering IV acyclovir to a client who has varicella. Which of the following actions should the nurse take? A.Administer a stool softener B.Decrease fluid intake following infusion. C.Infuse acyclovir over 1 hr D. monitor for a for hypotension - CORRECT ANSWER C. The nurse should administer IV acyclovir slowly, over at least 1 hr, to prevent nephrotoxicity. A nurse is teaching a client who is beginning highly active antiretroviral therapy (HAART) for HIV infection about ways to prevent medication resistance. Which of the following information should the nurse teach the client about resistance? A.Taking low dosages of antiretroviral medication minimizes resistance. B.Taking one antiretroviral medication at a time minimizes resistance. C.Taking medication at the same times daily without missing doses minimizes resistance. D.Changing the medication regimen when adverse effects occur minimizes resistance - CORRECT ANSWER C. The nurse should emphasize the importance of taking each dose of medication exactly as prescribed. missing even a few doses of antiretroviral medication can promote medication resistance, which can cause treatment failure