RN Pharmacology Online Practice 2023 A

A nurse is caring for a client who is to receive treatment for opiod use disorder. Which of the following medications should the nurse expect to administer?

A. Bupropion

B. Disulfiram

C. Modafinil

D. Methadone

D. Methadone

Rationale:

The nurse should expect to administer methadone for treatment of opioid use disorder. Methadone can be administered for withdrawal and to assist with maintenance and suppressive therapy.

The nurse should administer modafinil to assist with the fatigue and prolonged sleep from methamphetamine withdrawal.

The nurse should administer disulfiram as an aversion therapy to assist with maintaining abstinence from alcohol.

The nurse should administer bupropion to assist the client with smoking cessation.

A nurse is caring for a client on a medical-surgical unit.

Nurses' Notes​:

Yesterday:Client was admitted 1 week ago with a Crohn's disease exacerbation. A central venous access device (CVAD) was placed in the client's right subclavian vein. Total parental nutrition (TPN) and lipids initiated 3 days ago. The client is NPO. The client reports abdominal pain as 5 on a scale of 0 to 10. Bowel sounds are hyperactive and lower right quadrant is tender to palpation.

Today:The 24-hr bag of TPN infusion was complete 1 hr ago, pharmacy notified and waiting for a new bag. CVAD dressing is clean, dry, and intact. CVAD is difficult to flush. The client reports abdominal pain as 4 on a scale of 0 to 10 and chills.

Vital Signs:

​Yesterday:

Oral temperature 36.6° C (97.9° F)

Pulse 80/min

Respiratory rate 16/min

Blood pressure 105/78 mm Hg

Oxygen saturation 99% on room air

Today:

Oral temperature 37.4° C (99.4° F)

Pu

The nurse should first address the client's Glucose level, followed by the client's CVAD.

Rationale:

When analyzing cues, the nurse should identify that the client is developing hypoglycemia and experiencing a complication with the central venous line (CVL). Hypoglycemia can occur if the TPN is stopped abruptly. A CVAD can become occluded or infected. Findings of a CVL complication can include difficulty flushing, pain while flushing, fever, or chills.

A nurse is preparing to administer hydrochlorothiazide (HCTZ) to a client. Which of the following actions should the nurse take prior to administering the medication?

A. Ask the client to drink 8 oz of water.

B. Review the client's most recent Hgb level.

C. Obtain the client's blood pressure.

D. Determine if the client is allergic to NSAIDs.

C. Obtain the client's blood pressure.

Rationale:

HCTZ is a thiazide diuretic administered to promote urine output and reduce blood pressure and edema. The nurse should obtain the client's blood pressure prior to administration of the medication.

HCTZ is a thiazide diuretic administered to promote urine output and reduce blood pressure and edema. The client does not need to drink 8 oz of water prior to taking the medication.

HCTZ does not affect Hgb levels. The nurse should monitor the client's electrolytes, especially potassium, before and periodically while the client is taking this medication.

The nurse should assess the client for an allergy to sulfonamides due to the potential of cross-sensitivity with HCTZ. NSAIDs can decrease the effectiveness of HCTZ.

A nurse is planning care for a client who is receiving mannitol via continuous IV infusion. Which of the following adverse effects should the nurse monitor the client for?

A. Weight loss

B. Increased intraocular pressure

C. Auditory hallucinations

D. Bibasilar crackles

D. Bibasilar crackles

Rationale:

Mannitol, an osmotic diuretic, can precipitate heart failure and pulmonary edema. Therefore, the nurse should recognize lung crackles as an indicator of a potential complication and stop the infusion.

Mannitol is an osmotic diuretic used to promote diuresis, decrease intracranial pressure, and improve renal function. An expected therapeutic effect of mannitol is weight loss resulting from diuresis.

An indication for the use of mannitol is increased intraocular pressure. Mannitol decreases the intraocular pressure by creating an osmotic gradient between the intraocular fluid and the plasma.

Mannitol has several neurologic adverse effects, including increased intracranial pressure, seizures, confusion, and headaches. However, it does not cause auditory hallucinations.

A nurse is caring for a client who is taking nitroglycerin for angina and reports feeling faint when standing up. Which of the following actions should the nurse take?

A. Inform the client that feeling faint is caused by rapid constriction of the blood vessels in the legs.

B. Assist the client into bed, elevate the lower extremities, and check their blood pressure.

C. Request a prescription for dobutamine from the client's provider.

D. Check the client's blood pressure while they're still standing.

B. Assist the client into bed, elevate the lower extremities, and check their blood pressure.

Rationale:

The nurse should first assist the client into bed to prevent injuries from a fall. The nurse should elevate the client's legs on pillows to enhance venous return from the lower extremities. The nurse should then check the client's blood pressure.

Orthostatic, or postural, hypotension is caused by vasodilation of the blood vessels of the lower extremities, which allows pooling of blood. This pooling leads to manifestations such as dizziness, light headedness, or feeling faint. Nitroglycerin causes vasodilation.

Dobutamine is an adrenergic agonist medication used in the treatment of heart failure or cardiogenic shock. It is not used in the treatment of orthostatic hypotension.

To assess for orthostatic hypotension, the nurse should have the client lie supine for at least 5 minutes, then check their blood pressure. The nurse should then have the client sit up and recheck the blood pressure. Last, the client should stand up and the nurse should measure the blood pressure.

A nurse is preparing medication instructions for a client who is receiving end-of-life care and their family. The client has a prescription for fentanyl patches. Which of the following information regarding the manifestations and use of fentanyl should the nurse include in the instructions?

A. Respiratory depression as a result of fentanyl use will cause a need for an at-home nefazodone prescription.

B. Removing the patch will immediately reverse any adverse effects of fentanyl.

C. An increase in urinary output should be expected.

D. Taking a stool softener daily will be needed.

D. Taking a stool softener daily will be needed.

Rationale:

Constipation is an adverse effect of opioid use. Stool softeners can decrease the severity of this adverse effect.

Urinary retention is an adverse effect of opioids, including fentanyl.

After removing the patch, the effects will persist for several hours due to the absorption of the residual medication on the skin.

Naloxone may be prescribed for the reversal of severe respiratory depression, not nefazodone, an atypical antidepressant.

A nurse is providing teaching to a client who has a gastric ulcer and a new prescription for famotidine.

Which of the following instructions should the nurse include?

A. "Take the medication on an empty stomach for full effectiveness."

B. "You may discontinue this medication when stomach discomfort subsides."

C. "Report yellowing of the skin."

D. "You will be taking this medication for 2 weeks."

C. "Report yellowing of the skin."

Rationale:

Famotidine can be hepatotoxic and cause jaundice. The nurse should instruct the client to monitor for and report yellowing of the skin or eyes to the provider.

The client can take famotidine with or without food because food does not affect the medication's effectiveness.

For clients who have a gastric ulcer, famotidine is prescribed to inhibit gastric secretion and must be taken for the full course of therapy to be effective.

The client who has a gastric ulcer will be prescribed famotidine for a minimum of 6 weeks and typically no longer than a year for treatment.

A nurse is providing discharge teaching about handling medication to a client who is to continue taking oral transmucosal fentanyl raspberry-flavored lozenges on a stick. Which of the following information should the nurse include in the teaching?

A. Chew on the medication stick to release the medication.

B. Leave the medication stick in one location of the mouth until melted.

C. Allow the medication 1 hr for analgesia effects to begin.

D. Store unused medication sticks in a storage container.

D. Store unused medication sticks in a storage container.

Rationale:

The nurse should instruct the client to store unused, used, or partially used medication sticks in the safe storage container that comes in the kit when the medication is initially prescribed.

The nurse should instruct the client to expect the medication's analgesia effects to begin within 10 to 15 min.

The nurse should instruct the client to periodically move the medication stick to a different location in the mouth for best absorption.

The nurse should instruct the client to place the fentanyl stick between their cheek and lower gum and actively suck it for increased absorption of the medication.

A nurse is preparing to administer a scheduled antibiotic at 0800 to a client and discovers the antibiotic is not present in the client's medication drawer. The nurse should identify that administration of the medication can occur at which of the following time periods without requiring an incident report?

A. 1000

B. 0900

C. 0830

D. 1200

C. 0830

Rationale:

The nurse should identify that an antibiotic can be administered 30 min before or after the scheduled time to maintain therapeutic blood levels without requiring an incident report.

The nurse should identify that administering an antibiotic 4 hr after the scheduled time is too late and requires filing an incident report.

The nurse should identify that administering an antibiotic 1 hr after the scheduled time is too late and requires filing an incident report.

The nurse should identify that administering an antibiotic 2 hr after the scheduled time is too late and requires filing an incident report.

A nurse is caring for a client who is receiving filgrastim. Which of the following findings should the nurse document to indicate the effectiveness of the therapy?

A. Increased RBC count

B. Increased neutrophil count

C. Decreased prothrombin time

D. Decreased triglycerides

B. Increased neutrophil count

Rationale:

Filgrastim stimulates the bone marrow to produce neutrophils. For clients receiving chemotherapy, the risk of infection is minimized.

Filgrastim stimulates the bone marrow to produce neutrophils and has no effect on a client's RBC count.

Prothrombin time measures the effectiveness of warfarin therapy. Filgrastim therapy does not cause a decrease in prothrombin time.

Triglycerides are a form of lipids found in the blood stream. Increased levels are associated with an increased risk for heart disease. Decreased levels can occur in clients who have malnutrition or malabsorption disorders. Filgrastim is used to treat chemotherapy-induced neutropenia and has no effect on a client's triglyceride levels.

A nurse is teaching a client who has a new prescription for docusate sodium about the medication's mechanism of action. Which of the following information should the nurse include in the teaching?

A. Docusate sodium reduces the surface tension of the stools to change their consistency.

B. Docusate sodium causes rectal contractions.

C. Docusate sodium acts as a fiber agent, increasing bulk in the intestines.

D. Docusate sodium stimulates the motility of the intestines.

A. Docusate sodium reduces the surface tension of the stools to change their consistency.

Rationale:

Docusate sodium is a surfactant that softens stool by reducing surface tension, allowing water to penetrate the stool more easily.

Osmotic laxatives, such as glycerin suppositories, act by lubricating the lower colon and initiating reflex contractions of the rectum.

Bulk-forming laxatives, such as methylcellulose, mimic the action of dietary fiber, forming a viscous compound that softens the fecal mass and increases its bulk, which stimulates peristalsis.

Stimulant laxatives, such as bisacodyl, stimulate the intestinal wall to cause peristalsis by pulling water into the intestines.

A nurse is providing teaching to a client who has peptic ulcer disease and is to start a new prescription for sucralfate. Which of the following information should the nurse include in the teaching?

A. Decreases stomach acid secretion

B. Neutralizes acids in the stomach

C. Forms a protective barrier over ulcers

D. Treats ulcers by eradicating H. pylori

C. Forms a protective barrier over ulcers

Rationale:

Secretions by the parietal and chief cells, hydrochloric acid and pepsin, can further irritate the ulcerated areas. Sucralfate, a mucosal protectant, forms a gel-like substance that coats the ulcer, creating a barrier to hydrochloric acid and pepsin.

A common cause of peptic ulcers is a bacterial infection with Helicobacter pylori. Treatment of the ulcer includes a combination of antibiotics, such as metronidazole, tetracycline, clarithromycin, or amoxicillin, to eradicate the H. pylori infection.

Peptic ulcer disease manifests as an erosion of the gastric or duodenal mucosa. The acid production in the stomach causes further irritation and pain. H2 receptor antagonists, such as famotidine, decrease stomach acid secretion.

Acid production in the stomach causes further irritation and pain to a client who has a peptic ulcer. Antacids, such as aluminum hydroxide, neutralize acids in the stomach and prevent pepsin formation, a digestive enzyme that can further damage the eroded epithelium.

A nurse is preparing to administer amoxicillin 250 mg PO to a school-age child. The amount available is amoxicillin oral suspension 200mg/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.)

Answer: 6.3mL

Rationale:

Step 1: What is the unit of measurement the nurse should calculate? mL

Step 2: What is the dose the nurse should administer? Dose to administer = Desired 250 mg

Step 3: What is the dose available? Dose available = Have 200 mg

Step 4: Should the nurse convert the units of measurement? No

Step 5: What is the quantity of the dose available? 5 mL

Step 6: Set up an equation and solve for X.

HaveDesired = QuantityX

200 mg250 mg = 5 mLX mL

X mL = 6.25

Step 7: Round if necessary. 6.25 mL = 6.3 mL

Step 8: Determine whether the amount to administer makes sense. If there are 200 mg/5 mL and the prescription reads 250 mg, it makes sense to administer 6.3 mL. The nurse should administer amoxicillin 6.3 mL PO

Follow these steps for the Desired Over Have method of calculation:

Step 1: What is the unit of measurement the nurse should calculate? mL

Step 2: What is the dose the nurse should administer? Dose to administer = Desired 250 mg

Step 3: What is the dose available? Dose available = Have 200 mg

Step 4: Should the nurse convert the units of measurement? No

Step 5: What is the quantity of the dose available? 5 mL

Step 6: Set up an equation and solve for X.

HaveDesired = QuantityX

200 mg250 mg = 5 mLX mL

X mL = 6.25

Step 7: Round if necessary. 6.25 mL = 6.3 mL

Step 8: Determine whether the amount to administer makes sense. If there are 200 mg/5 mL and the prescription reads 250 mg, it makes sense to administer 6.3 mL. The nurse should administer amoxicillin 6.3 mL PO

Follow these steps for the Dimensional Analysis method of calculation:

Step 1: What is the unit of measurement the nurse should calculate? (Place the unit of measure being calculated on the left side of the equation.)

X mL =

Step 2: Determine the ratio that contains the same unit as the unit being calculated. (Place the ratio on the right side

A nurse in an emergency department is caring for a client who has myasthenia gravis and is in a cholinergic crisis. Which of the following medications should the nurse plan to administer?

A. Potassium iodide

B. Glucagon

C. Atropine

D. Protamine

C. Atropine

Rationale:

A cholinergic crisis is caused by an excess amount of cholinesterase inhibitor, such as neostigmine. The nurse should plan to administer atropine, an anticholinergic agent, to reverse cholinergic toxicity.

Potassium iodide is a thyroid hormone antagonist used in the treatment of radioactive iodine exposure.

Glucagon is an antihypoglycemic medication used in the treatment of low blood glucose levels.

Protamine is a heparin antagonist that is administered to reverse heparin toxicity evidenced by an aPTT greater than 70 seconds.

A nurse is teaching a client who is starting to take diltiazem. Which of the following statements should the nurse identify as an indication that the client understands the teaching?

A."I will stop taking the medication if I get dizzy."

B."I should not drink orange juice while taking this medication."

C."I should expect to gain weight while taking this medication."

D."I will check my heart rate before I take the medication."

D."I will check my heart rate before I take the medication."

Rationale:

Diltiazem, a calcium channel blocker, has cardio-suppressant effects at the SA and AV nodes, which can lead to bradycardia. The client should check their heart rate before taking the medication and notify the provider if it falls below the expected reference range.

Diltiazem, a calcium channel blocker, can decrease myocardial contraction, which can lead to heart failure. If the client gains weight or develops shortness of breath, they should notify the provider.

The client should not drink grapefruit juice while taking diltiazem because it can interfere with metabolism of the medication, increasing the blood levels of diltiazem and leading to toxicity.

Diltiazem is a calcium channel blocker that causes vascular dilation, which can result in orthostatic hypotension. The client should rise slowly when standing and avoid hazardous activities until there is a stabilization of the medication and dizziness no longer occurs.

A nurse is caring for a client who has a new prescription for spironolactone. Which of the following laboratory results should the nurse monitor while the client is taking this medication?

A. Potassium level

B. WBC count

C. Protein level

D. Adrenocorticotropic hormone level

A. Potassium level

Rationale:

The nurse should monitor the client's potassium level as spironolactone is a potassium sparing diuretic that can cause hyperkalemia. The client's potassium level should be obtained and monitored within 1 week of beginning spironolactone, with any increase in dosage, and periodically throughout therapy. Additional laboratory results to monitor include sodium, uric acid, glucose, and renal function tests.

he nurse does not need to monitor the client's white blood cell count as spironolactone does not affect white blood cells. Spironolactone is a potassium sparing diuretic that can cause hyperkalemia. Potassium level should be obtained and monitored within 1 week of initiation of therapy, with any increase in dosage, and periodically throughout therapy. Additional laboratory results to monitor include sodium, uric acid, glucose, and renal function tests.

The nurse does not need to monitor the client's protein level as spironolactone does not affect protein. Spironolactone is a potassium sparing diuretic that can cause hyperkalemia. Potassium level should be obtained and monitored within 1 week of initiation of therapy, with any increase in dosage, and periodically throughout therapy. Additional laboratory results to monitor include sodium, uric acid, glucose, and renal function tests.

The nurse does not need to monitor the client's adrenocorticotropic hormone level as spironolactone does not affect this hormone. Spironolactone is a potassium sparing diuretic that can cause hyperkalemia. Potassium level should be obtained and monitored within 1 week of initiation of therapy, with any increase in dosage, and periodically throughout therapy. Additional laboratory results to monitor include sodium, uric acid, glucose, and renal function tests.

A nurse at an urgent care clinic is collecting a history from a client who has a urinary tract infection. The nurse anticipates a prescription for ciprofloxacin. The nurse should identify that which of the following client statements indicates a contraindication for administering this medication?

A. "I have tendonitis, so I haven't been able to exercise."

B. "I take a stool softener for chronic constipation."

C. "I take medicine for my thyroid."

D. "I am allergic to sulfa."

A. "I have tendonitis, so I haven't been able to exercise."

Rationale:

The nurse should identify tendonitis as a contraindication for taking ciprofloxacin due to the risk of tendon rupture.

Ciprofloxacin is not contraindicated for the client who takes a stool softener for chronic constipation. Diarrhea is an adverse effect of the medication.

Ciprofloxacin does not affect thyroid function and is not contraindicated for the client who takes thyroid medication.

Ciprofloxacin does not affect thyroid function and is not contraindicated for the client who takes thyroid medication.

A nurse is reviewing the medication list of a client who wants to begin taking oral contraceptives. Which of the following client medications should the nurse identify will interfere with the effectiveness of an oral contraceptive?

A. Sumatriptan

B. Carbamazepine

C. Atenolol

D. Glipizide

B. Carbamazepine

Rationale:

Carbamazepine causes an accelerated inactivation of oral contraceptives because of its action on hepatic medication-metabolizing enzymes.

There is no medication interaction between oral contraceptives and sumatriptan, which is a medication to treat migraines.

There is no medication interaction between oral contraceptives and atenolol, a beta blocker.

There is no medication interaction between oral contraceptives and glipizide, an antidiabetic medication.

A nurse is providing teaching to a client who is to begin taking oxybutynin for urinary incontinence. Which of the following adverse effects should the nurse include in the teaching? (Select all that apply.)

A. Dry mouth

B. Tinnitus

C. Blurred Vision

D. Bradycardia

E. Dry eyes

A. Dry mouth

C. Blurred Vision

E. Dry eyes

Rationale:

-Dry mouth is correct. Oxybutynin is an anticholinergic agent that can cause dry mouth.

-Tinnitus is incorrect. Oxybutynin can cause several sensory adverse effects including increased intraocular pressure. The nurse should instruct the client to report eye pain, seeing colored halos around lights, and a decreased ability to perceive light changes. However, tinnitus is not an adverse effect associated with oxybutynin administration.

-Blurred vision is correct. Oxybutynin is an anticholinergic agent that can cause blurred vision due to an increase in intraocular pressure.

-Bradycardia is incorrect. Oxybutynin can cause several cardiovascular adverse effects such as a prolongation of the QT interval, palpitations, hypertension, and tachycardia.

-Dry eyes is correct. Oxybutynin is an anticholinergic agent that can cause dry eyes and mydriasis, or pupil dilation.

A nurse is caring for a client who has a magnesium level of 3.1 mEq/L (1.3 to 2.1 mEq/L). The nurse should expect to administer which of the following medications?

A. Magnesium gluconate

B. Cinacalcet

C. Calcium gluconate

D. Regular insulin

C. Calcium gluconate

Rationale:

The nurse should expect to administer IV calcium gluconate to the client and prepare to provide ventilatory support. This client is at risk for respiratory depression and cardiac dysrhythmias because a magnesium level of 3.1 mEq/L is above the expected reference range of 1.3 to 2.1 mEq/L.

Regular insulin is administered to treat hyperkalemia.

A magnesium level of 3.1 mEq/L is above the expected reference range of 1.3 to 2.1 mEq/L. Magnesium gluconate is administered to treat hypomagnesemia.

Cinacalcet is administered to treat hypercalcemia.

A nurse contacts a clinet's provider on the telephone to obtain a prescription for pain medication. Which of the following actions should the nurse take?

A. Write the order on a prescription pad designated for the client's provider.

B. Have the provider spell out the unfamiliar medication names.

C. Read the prescription back to the provider using abbreviations.

D. Consult with a second nurse for any questions regarding dosage.

B. Have the provider spell out the unfamiliar medication names.

Rationale:

The nurse should ask the provider to spell out the name of the medication if the stated name is one the nurse is not familiar with.

The nurse should write the order on the provider's order form in the client's medical record or place the order into the computer on the provider's order form according to facility policy.

The nurse should read the prescription back to the provider using words in place of abbreviations to reduce the risk of error. The nurse should ask the provider to acknowledge that the prescription is correct after having it read back.

The nurse should consult the provider about any questions concerning the prescription.

A nurse is assessing a client 1 hr after administering morphine for pain. Which of the following findings should the nurse identify as the best indication that the morphine has been effective?

A. The client's vital signs are within normal limits.

B. The client has not requested additional medication.

C. The client is resting comfortably with eyes closed.

D. The client rates pain as 3 on a scale of 0 to 10.

D. The client rates pain as 3 on a scale of 0 to 10.

Rationale:

The client's description of the pain is the most accurate assessment of pain.

The client might rest with their eyes closed as a method to try to manage pain. However, this does not indicate that the pain is controlled.

Clients often do not request medicine even when they are experiencing pain.

Vital signs can be within normal limits for clients who have pain.

A nurse in a provider's office is assessing a client who has been taking aspirin daily for the past year. For which of the following findings should the nurse immediately notify the provider?

A. Hyperventilation

B. Heartburn

C. Anorexia

D. Swollen ankles

A. Hyperventilation

Rationale:

When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is hyperventilation. This finding indicates the client might have acute salicylate poisoning, which causes respiratory alkalosis in the early stages.

Heartburn is nonurgent because the client who is taking aspirin can experience gastrointestinal distress. Therefore, there is another finding that is the nurse's priority.

Anorexia is nonurgent because the client who is taking aspirin can experience a decrease in appetite. Therefore, there is another finding that is the nurse's priority.

Swollen ankles are nonurgent because the client who is taking aspirin can experience sodium and fluid retention. Therefore, there is another finding that is the nurse's priority.

A nurse is teaching a client who has insomnia about zolpidem. The nurse should identify that which if the following client statements indicates an understanding of the teaching?

A. "I will need to get laboratory testing prior to a refill of this medication."

B. "I will use this medication for a short period of time."

C. "I will need to take this medication for 1 week before results are seen."

D. "I will need to change the medications to prevent building up a tolerance."

B. "I will use this medication for a short period of time."

Rationale:

Zolpidem is used for short-term treatment of insomnia. Therefore, the provider should reassess the client before refilling the prescription.

Laboratory testing is not needed when taking this medication for sleep.

The client who takes zolpidem should experience improved sleep within 2 days of starting this medication.

The client who takes zolpidem should not build up a tolerance to the medication with short-term use.

A nurse is assessing a client who is receiving epoetin alfa to treat anemia.

Which of the following findings should the nurse monitor?

A. Paresthesia

B. Increased blood pressure

C. Fever

D. Respiratory depression

B. Increased blood pressure

Rationale: The therapeutic effect of epoetin alfa is an increase in hematocrit levels, which can result in an increase in a client's blood pressure. If the client's hematocrit level rises too rapidly, hypertension and seizures can result. The nurse should monitor the client's blood pressure and ensure hypertension is controlled prior to administering the medication.

Epoetin alfa stimulates the bone marrow to increase production of red blood cells. Adverse effects include neurological manifestations such as seizures, headache, and dizziness. However, epoetin alfa does not cause paresthesia.

Adverse effects of epoetin alfa include neurological manifestations, such as coldness and sweating. However, it does not cause fever.

Heart failure is an adverse effect of epoetin alfa. The nurse should monitor the client's respiratory status and notify the provider if the client develops crackles or rhonchi. However, epoetin alfa does not cause respiratory depression.

A nurse is assessing a client who has schizophrenia and is taking haloperidol. The nurse should report which of the following findings to the provider as a manifestation of neuroleptic malignant syndrome (NMS)?

A. Temperature of 39.7° C (103.5° F)

B. Urinary retention

C. Heart rate 56/min

D. Muscle flaccidity

A. Temperature of

39.7° C (103.5° F)

Rationale:

The nurse should report fever to the provider as an indication of NMS, an acute life-threatening emergency. Other manifestations can include respiratory distress, diaphoresis, and either hypertension or hypotension.

The nurse should report incontinence as a manifestation of NMS.

The nurse should report tachycardia as a manifestation of NMS.

The nurse should report severe muscle rigidity as a manifestation of NMS.

A nurse is planning to teach about inhalant medications to a client who has recent diagnosis of exercise-induced asthma. Which of the following medications should the nurse plan to include in the teaching for the client to use prior to physical activity?

A. Cromolyn

B. Beclomethasone

C. Budesonide

D. Tiotropium

A. Cromolyn

Rationale:

Cromolyn sodium stabilizes mast cells, which inhibit the release of histamine and other inflammatory mediators. The client should use cromolyn 10 to 15 min before planning to exercise to prevent bronchospasms.

Beclomethasone is a prophylactic glucocorticoid inhalant medication that suppresses the inflammatory and humoral immune responses. Beclomethasone should be administered with a fixed schedule, not for PRN use before physical exercise.

Budesonide is a glucocorticoid medication used to treat asthma as a long-term inhaled agent. This medication is administered by inhalation twice daily, not prior to physical activity.

Tiotropium is an anticholinergic medication that decreases mucus production and produces bronchodilation. Tiotropium is used for maintenance therapy of bronchospasms and has a duration of 24 hr.

A nurse is preparing to administer dextrose 5% in water (D5W) 400 mL IV to infuse over 1 hr. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero).

100 gtt/min

Rationale:

Follow these steps to calculate the infusion rate using the Ratio and Proportion or Desired Over Have method of calculation:

Step 1: What is the unit of measurement the nurse should calculate? gtt/min

Step 2: What is the volume the nurse should infuse? 400 mL

Step 3: What is the total infusion time? 1 hr

Step 4: Should the nurse convert the units of measurement? Yes (hr ? min) 1 hr = 60 min

Step 5: Set up an equation and solve for X.

Volume (mL)X gtt/min = × Drop factor (gtt/mL)Time (min)

400 mL15 gttX gtt/min = × 60 min1 mL

X gtt/min = 100 gtt/min

Step 6: Round if necessary.

Step 7: Determine whether the amount ot administer makes sense. If the prescription reads D5W 400 mL IV to infuse over 60 min with a drop factor of 15 gtt/mL, it makes sense to administer 100 gtt/min. The nurse should set the manual IV infusion to deliver D5W IV at 100 gtt/min.

Follow these steps to calculate the infusion rate using the Dimensional Analysis method of calculation:

Step 1: What is the unit of measurement the nurse should calculate? (Place the unit of measure being calculated on the left side of the equation.)

X gtt/min =

Step 2: Determine the ratio that contains the same unit as the unit being calculated. (Place the ratio on the right side of the equation, ensuring that the unit in the numerator matches the unit being calculated.)

15 gttX gtt/min = 1 mL

Step 3: Place any remaining ratios that are relevant to the item on the right side of the equation, along with any needed conversion factors, to cancel out unwanted units of measurement.

15 gtt400 mLX gtt/min = × 1 mL60 min

Step 4: Solve for X.

X gtt/min = 100 gtt/min

Step 5: Round if necessary.

Step 6: Determine whether the amount ot administer makes sense. If the prescription reads D5W 400 mL IV to infuse over 60 min with a drop factor of 15 gtt/mL, it ma

A nurse is instructing a client on the application of nitroglycerin transdermal patches. Which of the following statements by the client indicates an understanding of the teaching?

A. "I should apply a patch every 5 minutes if I develop chest pain."

B. "I will take the patch off right after my evening meal."

C. "I will leave the patch off at least 1 day each week."

D. "I should discard the used patch by flushing it down the toilet."

B. "I will take the patch off right after my evening meal."

Rationale:

Clients should remove the patch each evening for a medication free time of 12 to 14 hr before applying a new patch to avoid developing a tolerance to the medication's effects.

Nitroglycerin sublingual tablets are used to treat new onset of angina pain. A client who uses sublingual tablets should place one tablet under their tongue at the onset of angina pain and continue taking a tablet every 5 min for a total of three doses of nitroglycerin. The effects of a nitroglycerin patch will take 30 to 60 min to occur and are not useful to prevent an ongoing angina attack.

Nitroglycerin is an antianginal medication that results in dilation of the coronary vessels. Clients should apply the patch daily to sustain prophylaxis.

Medication remains in the transdermal patch after removing it from the body and must be discarded safely. The nurse should instruct the client to fold the patch ends together with the medication on the inside and place the discarded patch in a closed container so that children and pets cannot gain access to the medication.

A nurse is providing teaching to a client who has depression and a new prescription for fluoxetine. Which of the following statements by the client indicates an understanding of the teaching?

A. "I should start to feel better within 24 hours of starting this medication."

B. "I will be sure to follow a strict diet to avoid foods with tyramine."

C. "I will continue to take St. John's Wort to increase the effects of the medication."

D."I should take acetaminophen instead of ibuprofen for my headaches while taking this medication."

D."I should take acetaminophen instead of ibuprofen for my headaches while taking this medication."

Rationale:

Fluoxetine suppresses platelet aggregation, which increases the risk of bleeding when used concurrently with NSAIDs and anticoagulants. Therefore, clients who are taking fluoxetine should take acetaminophen for headaches or pain, since acetaminophen does not suppress platelet aggregation.

Concurrent use of St. John's Wort and fluoxetine can increase the client's risk for serotonin syndrome, a potentially life-threatening complication. Manifestations of serotonin syndrome include confusion, hallucinations, hyperreflexia, excessive sweating, and fever.

Clients taking fluoxetine, a selective serotonin reuptake inhibitor, are not required to restrict their dietary intake of tyramine. A client who is taking an MAOI, such as selegiline, should avoid products containing tyramine.

The nurse should inform the client that the therapeutic levels of fluoxetine can take between 1 and 4 weeks to achieve desired effects. The client should take the medication as prescribed and use other strategies to manage depression in the interim.

A nurse is reviewing the medication administration record of a client who has hypocalcemia and a new prescription for IV calcium gluconate. The nurse should identify that which of the following medications can interact with calcium gluconate?

A. Felodipine

B. Guaifenesin

C. Digoxin

D. Regular insulin

C. Digoxin

Rationale:

The nurse should identify that calcium gluconate can cause hypercalcemia, which increases the risk of digoxin toxicity.

Calcium gluconate does not interact with felodipine.

Calcium gluconate does not interact with guaifenesin.

Calcium gluconate does not interact with insulin.

A nurse is teaching a client who is taking allopurinol for the treatment of gout. Which of the following information should the nurse include in the teaching?

A. Plan to increase the dosage each week by 200 mg increments.

B. Prolonged use of the medication can cause glaucoma.

C. Drink 2 L of water daily.

D. A fine red rash is transient and can be treated with antihistamines.

C. Drink 2 L of water daily.

Rationale:

The nurse should instruct the client to drink at least 2 L of water each day to prevent renal stone formation and kidney injury, because allopurinol is eliminated through the kidneys.

The nurse should instruct the client to report a rash to the provider immediately as this can be an indication of hypersensitivity syndrome, a life-threatening toxicity. Treatment for allopurinol toxicity can require hemodialysis or the administration of glucocorticoid medications.

The nurse should instruct the client to increase the dosage each week by 50 to 100 mg until they experience relief or reach a maximum of 800 mg daily.

The nurse should instruct the client that the prolonged use of allopurinol can cause cataracts. Therefore, the client should have periodic ophthalmic checkups.

A nurse is caring for a client who has heart failure and is receiving an IV infusion of dopamine. Which of the following findings indicates that the medication is effective?

A. Decreased blood pressure

B. Increased heart rate

C. Increased cardiac output

D. Decreased serum potassium

C. Increased cardiac output

Rationale:

Dopamine is an adrenergic that causes a receptor specificity effect, which increases cardiac output and improves perfusion.

Dopamine is an adrenergic that causes a receptor specificity effect, which increases blood pressure.

Tachycardia is an adverse effect of dopamine and does not indicate the medication's effectiveness.

Dopamine does not affect serum potassium levels.

A nurse is preparing to administer medications to a client who tells the nurse, "I don't want to take my fluid pill until I get home today." Which of the following actions should the nurse take?

A. File an incident report with the risk manager.

B. Document the refusal and inform the client's provider.

C. Contact the pharmacist to pick up the medication.

D. Give the client the medication to take at home and document that it was administered.

B. Document the refusal and inform the client's provider.

Rationale:

The nurse has the responsibility to verify that the client understands the risks of refusing the medication so that an informed decision can be made. The nurse should then document the refusal in the client's medical record and notify the health care provider.

The nurse does not need to complete an incident report if a client refuses to take a medication. An incident report is necessary for a medication error.

The nurse should follow facility protocols for discarding the medication. It is not the role of the pharmacist to retrieve medications that a client refuses to take.

The nurse should not give the client a scheduled medication to take at home and then document that it was administered, because this violates the ethical principle of accountability.

A nurse is caring for a client who is experiencing acute alcohol withdrawal. For which of the following client outcomes should the nurse administer chlordiazepoxide?

A. Minimize diaphoresis

B. Maintain abstinence

C. Lessen craving

D. Prevent delirium tremens

D. Prevent delirium tremens

Rationale:

The client should take chlordiazepoxide to prevent delirium tremens during acute alcohol withdrawal.

The client should take clonidine or a beta-adrenergic blocker, such as atenolol, to minimize autonomic components, such as diaphoresis, during alcohol withdrawal.

The client should take acamprosate to help maintain abstinence from alcohol by decreasing anxiety and other uncomfortable manifestations.

The client should take propranolol to decrease cravings during alcohol withdrawal.

A nurse administers a dose of metformin to a client instead of the prescribed dose of metoclopramide.

Which of the following actions should the nurse take first?

A. Report the incident to the charge nurse.

B. Notify the provider.

C. Fill out an incident report.

D. Check the client's blood glucose.

D. Check the client's blood glucose.

Rationale:

The first action the nurse should take using the nursing process is to assess the client. The client is at risk for hypoglycemia. The nurse should monitor the client's blood glucose and provide the client with a snack to reduce the risk for hypoglycemia.

The nurse should fill out an incident report to document the incident. However, there is another action the nurse should take first. The incident report alerts the risk manager to the incident, who then determines the cause and a plan of action to reduce the risk of reoccurrence.

The nurse should notify the provider to protect the client from injury. However, there is another action the nurse should take first.

The nurse should report the incident to the charge nurse to protect the client from injury. However, there is another action the nurse should take first.

A nurse is preparing to administer heparin subcutaneously to a client. Which of the following actions should the nurse plan to take?

A. Administer the medication outside the 5-cm (2-in) radius of the umbilicus.

B. Aspirate for blood return before injecting.

C. Rub vigorously after the injection to promote absorption.

D. Place a pressure dressing on the injection site to prevent bleeding.

A. Administer the medication outside the 5-cm (2-in) radius of the umbilicus.

Rationale:

The nurse should administer the heparin by subcutaneous injection to the abdomen in an area that is above the iliac crest and at least 5 cm (2 in) away from the umbilicus.

The nurse should not aspirate by pulling back on the plunger of the heparin syringe to check for a blood return, because this will cause the injection site to bruise.

The nurse should apply firm pressure to the injection site for 1 to 2 min after the administration of the heparin to prevent bruising.

The nurse does not need to apply a dressing over the injection site if pressure is held for at least 1 min to prevent bleeding.

A client is prescribed a second dose of IV ceftriaxone postoperatively. The nurse notes urticaria and dyspnea. Which of the following actions should the nurse prioritize?

A. Administer oxygen.

B. Administer diphenhydramine.

C. Notify the charge nurse.

D. Discontinue the infusion.

D. Discontinue the infusion.

Rationale:

The greatest risk to the client is anaphylaxis. Therefore, the priority intervention is to stop the medication.

Administering oxygen is an appropriate intervention for dyspnea. However, this is not the priority action currently relative to the client's situation.

Administering diphenhydramine is an appropriate intervention for urticaria. However, this is not the priority action currently relative to the client's situation.

Notifying the charge nurse is an appropriate intervention. However, this is not the priority action currently relative to the client's situation.

A nurse is monitoring an older adult client who has heart failure for adverse effects of hydrochlorothiazide after administering the medication. Which of the following findings should the nurse identify as an adverse effect of the medication?

A. Hypoglycemia

B. Orthostatic hypotension

C. Bradycardia

D. Conjunctivitis

B. Orthostatic hypotension

Rationale:

The nurse should identify that hydrochlorothiazide is an antihypertensive thiazide diuretic medication, which can cause orthostatic hypotension and light headedness. Therefore, the nurse should instruct the client to rise slowly when moving from a recumbent to a standing position.

Hydrochlorothiazide is an antihypertensive thiazide diuretic medication, which can cause hyperglycemia.

The nurse should identify palpitations as an adverse effect of hydrochlorothiazide, which is an antihypertensive thiazide diuretic medication.

The nurse should identify that hydrochlorothiazide is an antihypertensive thiazide diuretic medication and may have the adverse effects of blurred vision and xanthopsia, which causes objects to appear yellow. Conjunctivitis is not an adverse effect of this medication.

A nurse is reviewing the medical record of a client who has schizophrenia and a prescription for clozapine. Which of the following laboratory tests should the nurse review before administering the medication?

A. Troponin

B. Total cholesterol

C. Creatinine

D. Thyroid stimulating hormone

B. Total cholesterol

Rationale:

The nurse should review the client's total cholesterol before administering clozapine, because this medication can cause hyperlipidemia.

The nurse should review the troponin level of a client who has chest pain and possible myocardial infarction.

Clozapine is not metabolized by the kidneys. Therefore, the nurse does not need to review the creatinine level before administering the medication.

The nurse should review the thyroid stimulating hormone level of a client who has hypothyroidism or hyperthyroidism.

A nurse is providing teaching to a client who is to start treatment for asthma with beclomethasone and albuterol inhalers. Which of the following instructions should the nurse include in the teaching?

A. "Take beclomethasone to avoid an acute attack."

B. "Use beclomethasone 5 minutes before using albuterol."

C. "Limit your calcium and vitamin D intake when taking beclomethasone."

D. "Rinse your mouth after inhaling the beclomethasone."

D. "Rinse your mouth after inhaling the beclomethasone."

Rationale:

The client should rinse their mouth after using beclomethasone, a glucocorticoid inhaler, to prevent oropharyngeal candidiasis and hoarseness.

The client should take albuterol, a short-acting beta2-adrenergic agonist, to avoid an acute asthma attack.

The client should use the bronchodilator, albuterol, prior to taking beclomethasone, a glucocorticoid inhaler, to enhance its absorption.

The client should increase the intake of calcium and vitamin D to minimize bone loss while taking beclomethasone, a glucocorticoid inhaler.

A nurse is assessing a client who has received atropine eye drops during an eye examination. Which of the following findings should the nurse expect as an effect of the medication?

A. Difficulty seeing in the dark

B. Pinpoint pupils

C. Blurred vision

D. Excessive tearing

C. Blurred vision

Rationale:

Blurred vision is an expected finding following the administration of atropine eye drops. This is due to the cycloplegic effects of the medication, which cause near objects to appear blurry to the client.

Blurred vision is an expected finding following the administration of atropine eye drops. This is due to the cycloplegic effects of the medication, which cause near objects to appear blurry to the client.

Dilation of pupils, or mydriasis, is an expected finding following the administration of atropine eye drops.

Excessive tearing is not an expected finding following the administration of atropine eye drops.

A nurse is teaching a client about the use of risedronate for the treatment of osteoporosis. Which of the following statements by the client should indicate to the nurse an understanding of the teaching?

A. "I will drink a glass of milk when I take the risedronate."

B. "I will take the risedronate 15 minutes after my evening meal."

C. "I should take an antacid with the risedronate to avoid nausea."

D. "I should sit up for 30 minutes after taking the risedronate."

D. "I should sit up for 30 minutes after taking the risedronate."

Rationale:

Sitting upright for at least 30 min after taking risedronate will reduce the adverse gastrointestinal effects of esophagitis and dyspepsia. Risedronate is contraindicated for a client who cannot sit or stand upright for this length of time.

The nurse should reinforce that risedronate should be taken with a full glass of water, rather than any other liquid.

Although the delayed release form of the medication can be taken after eating, the immediate release form of the medication should be taken at least 30 min prior to consuming food or other liquids. Both forms of medication should be taken in the morning.

The absorption of risedronate, a bisphosphonate, will be reduced if it is taken with antacids containing calcium, aluminum, or magnesium. The nurse should instruct the client to take the antacid 2 hr after taking risedronate.

A nurse is reviewing the laboratory results of a client who is taking digoxin for heart failure. Which of the following results should the nurse report to the provider due to it increasing the risk for digoxin toxicity?

A. Decreased platelet count

B. Decreased albumin level

C. Decreased hematocrit

D. Decreased potassium level

D. Decreased potassium level

Rationale:

The nurse should notify the provider if a client has hypokalemia prior to administration of digoxin due to the increased risk of developing digoxin toxicity and cardiac dysrhythmias.

A decreased platelet count can increase the client's risk for bleeding. However, it does not increase the risk for digoxin toxicity.

A decreased albumin level can indicate malnutrition, liver disorders, or severe inflammation, such as with burns. However, it does not increase the risk for digoxin toxicity.

A decreased hematocrit can indicate anemia, hemorrhage, or certain types of cancers. However, it does not increase the risk for digoxin toxicity.

A nurse is administering diazepam to a client who is having a colonoscopy. Which of the following actions should the nurse take?

A. Ensure flumazenil is available to administer for toxicity management.

B. Monitor the client for an increase in blood pressure.

C. Expect the client to become unconscious within 30 seconds.

D. Measure the capnography level every hour until the client is awake and oriented.

A. Ensure flumazenil is available to administer for toxicity management.

Rationale:

The nurse should monitor the client for manifestations of diazepam toxicity, such as respiratory depression and hypotension. The nurse should be prepared to administer flumazenil to reverse the effects of diazepam.

The nurse should monitor the client for the adverse effect of hypotension.

When diazepam is administered IV for induction of anesthesia, the nurse should expect the client to develop the full effect of the medication in 2 min.

The nurse should measure the capnography level every 15 to 30 min until the client is awake and oriented and vital signs have returned to baseline.

A nurse is providing teaching to a client who is to start therapy with digoxin. For which of the following adverse effects should the nurse instruct the client to monitor and report to the provider?

A. Dry cough

B. Pedal edema

C. Bruising

D. Yellow-tinged vision

D. Yellow-tinged vision

Rationale:

The nurse should instruct the client to monitor for and report yellow-tinged vision, which is a sign of digoxin toxicity. Other manifestations of digoxin toxicity include nausea, vomiting, loss of appetite, and fatigue. As the digoxin levels increase, the client can experience cardiac dysrhythmias.

Clients taking an anticoagulant, such as enoxaparin, might develop bruising and should report this adverse effect to the provider. However, hematologic adverse effects are not associated with digoxin.

Clients taking a calcium channel blocker, such as verapamil, might develop pedal edema and should report this adverse effect to the provider. However, peripheral edema is not associated with digoxin.

Clients taking an ACE inhibitor, such as captopril, might develop a dry cough due to a buildup of bradykinin and should report this adverse effect to the provider. However, respiratory adverse effects are not associated with digoxin.

A nurse is reviewing the ECG of a client who is receiving IV furosemide for heart failure. The nurse should identify which of the following findings as an indication of hypokalemia?

A. Tall, tented T-waves

B. Presence of U-waves

C. Widened QRS complex

D. ST elevation

B. Presence of U-waves

Rationale:

The nurse should identify the presence of U-waves as a manifestation of hypokalemia, an adverse effect of furosemide.

The nurse should identify tall, tented T-waves as a manifestation of hyperkalemia. Flattened or inverted T-waves are a manifestation of hypokalemia.

The nurse should identify a widened QRS complex as a manifestation of hyperkalemia.

The nurse should identify ST elevation is an indication of ischemia. ST depression is a manifestation of hypokalemia.

A nurse is teaching a client about cyclobenzaprine. Which of the following client statements should the indicate to the nurse that the teaching if effective?

A. "I will have increased saliva production."

B. "I will continue taking the medication until the rash disappears."

C. "I will taper off the medication before discontinuing it."

D. "I will report any urinary incontinence."

C. "I will taper off the medication before discontinuing it."

Rationale:

The client should taper off cyclobenzaprine before discontinuing it to prevent abstinence syndrome or rebound insomnia.

The client should use gum or sip on water to prevent dry mouth, which is an adverse effect of cyclobenzaprine.

The client should take cyclobenzaprine for treatment of muscle spasms. This medication does not affect skin rashes.

The client should report any urinary retention because of the anticholinergic effects caused when taking cyclobenzaprine.

A nurse is teaching a client who has been prescribed tamoxifen for breast cancer treatment. Which of the following adverse effects of this medication should the nurse include in the teaching?

A. Hot flashes

B. Urinary retention

C. Constipation

D. Bradycardia

A. Hot flashes

Rationale:

The estrogen receptor blocking action of tamoxifen commonly results in the adverse effect of hot flashes.

Tamoxifen can cause genitourinary adverse effects such as vaginal discharge and uterine cancer. However, urinary retention is not an expected adverse effect of tamoxifen.

Gastrointestinal adverse effects of tamoxifen include nausea and vomiting. However, constipation is not an expected adverse effect of tamoxifen.

Tamoxifen is an antiestrogen medication that works by blocking estrogen receptors. Cardiovascular adverse effects of the medication include chest pain, flushing, and the development of thrombus. However, bradycardia is not an expected adverse effect of tamoxifen.

A nurse is teaching about self-administration of transdermal medication with a client who has a new prescription for nitroglycerin. Which of the following client statements indicates an understanding of the teaching?

A. "I can apply the patch to a chest area that has hair."

B. "I can take this medication while using an erectile dysfunction product."

C. "I will remove the patch after 14 hours."

D. "I need to apply a new patch to the same area every day."

C. "I will remove the patch after 14 hours."

Rationale:

The client should remove the patch after 12 to 14 hr to prevent tolerance of the medication.

The client should apply the patch to an area of the skin that is hairless to enhance absorption of the medication.

The client should not use erectile dysfunction products while taking nitroglycerin because this combination can cause severe hypotension and death.

The client should rotate the location of the patch daily to avoid irritation of the skin.

A nurse is completing an incident report for a medication error. Which of the following information should the nurse include in the report?

A. This could have been avoided if I had double checked the medication administration record with the client's identification band.

B. It was easy to get confused because another client is receiving a similar sounding medication.

C. While I rarely make medication errors, the client was given 80 mg of propranolol by mistake at 1800.

D. Administered propranolol 80 mg PO at 1800 to the client who did not have a prescription for the medication.

D. Administered propranolol 80 mg PO at 1800 to the client who did not have a prescription for the medication.

Rationale:

The incident report should clearly and thoroughly report the facts of the error.

The incident report should clearly and thoroughly report the facts of the error. It should not include the nurse's opinion as to how the error might have been prevented.

The incident report should clearly and thoroughly report the facts of the error. It should not include the nurse's opinion as to why the error might have occurred.

The incident report should clearly and thoroughly report the facts of the error. It should not include statements by the nurse regarding personal characteristics.

A nurse is caring for a 20-year-old client who has a prescription for isotretinoin for severe nodulocystic

acne vulgaris. Before the client can obtain a refill, the nurse should advise the client that which of the following tests is required?

A. Serum calcium

B. Pregnancy test

C. 24-hr urine collection for protein

D. Aspartate aminotransferase level

B. Pregnancy test

Rationale:

The nurse should instruct the client that isotretinoin has teratogenic effects. Therefore, pregnancy must be ruled out before the client can obtain a refill. The client must provide two negative pregnancy tests for the initial prescription and one negative test before monthly refills.

The client does not need to have a laboratory test for serum calcium levels while taking isotretinoin.

The client does not need to have a 24-hr urine test for protein levels when taking isotretinoin.

The client should have a laboratory test for aspartate aminotransferase levels prior to starting isotretinoin, 1 month after starting the medication, and periodically thereafter. However, a laboratory test for aspartate aminotransferase is not required to renew a prescription for isotretinoin.

A nurse is caring for a client who is receiving haloperidol. Which of the following findings should the nurse identify as an adverse effect of the medication?

A. Paresthesia

B. Akathisia

C. Excess tear production

D. Anxiety

B. Akathisia

Rationale:

An adverse effect associated with haloperidol is the development of extrapyramidal manifestations such as dystonia, pseudoparkinsonism, and akathisia.

Haloperidol, an antipsychotic neuroleptic medication, can cause CNS adverse effects, such as seizures, confusion, and neuroleptic syndrome. However, paresthesia is not an adverse effect of haloperidol.

Haloperidol has anticholinergic properties that can cause sensory adverse effects, such as increased intraocular pressure, blurred vision, and dry eyes.

Haloperidol can be prescribed to treat severe agitation as well as psychotic manifestations.

A nurse is providing discharge instructions to a client who is to self-administer insulin at home. Which of the following client statements should indicate to the nurse that the teaching is effective?

A. "I should avoid getting rid of the air bubble in the syringe."

B. "I should inject the insulin into my thigh for the fastest absorption."

C. "I will store my unopened bottles of insulin in the refrigerator."

D. "I need to shake the insulin before using it to make sure it is well mixed."

C. "I will store my unopened bottles of insulin in the refrigerator."

Rationale:

The client should store unopened vials of insulin in the refrigerator to maintain medication viability. Once opened, the insulin can remain at room temperature for up to 1 month.

The nurse should instruct the client to expel all air bubbles in the syringe to ensure an accurate dosage is delivered.

The nurse should instruct the client that the fastest absorption of insulin occurs with abdominal injections. Absorption is slowest when the injection is into the thigh.

The nurse should instruct the client to mix insulin by rolling the insulin in the palm of their hand to prevent frothing, which can cause the drawing up of an inaccurate dose of insulin.

A nurse is teaching a group of unit nurse about medication reconciliation. Which of the following information should the nurse include in the teaching?

A. The client's provider is required to complete medication reconciliation.

B. Medication reconciliation at discharge is limited to the medication ordered at the time of discharge.

C. A transition in care requires the nurse to conduct medication reconciliation.

D. Medical reconciliation is limited to the name of the medications that the client is currently taking.

C. A transition in care requires the nurse to conduct medication reconciliation.

Rationale:

The nurse should conduct medication reconciliation anytime the client is undergoing a change in care, such as admission, transfer from one unit to another, or discharge. A complete listing of all prescribed and over-the-counter medications should be reviewed.

The nurse or a member of the health care team, such as the pharmacist, is required to complete medication reconciliation.

Medication reconciliation at discharge includes medications ordered at the time of discharge, over-the-counter medications, vitamins, herbal supplements, nutritional supplements, and other medications the client is taking.

The name of the current medication and new medication, over-the-counter medications, vitamins, herbal supplements, and nutritional supplements are included at the medication reconciliation. The indication, route, dosage size, and dosing interval are also required.

A nurse on a mental health unit is caring for a client.

Provider Prescriptions

Day 1, 0900:

Fluphenazine 2.5 mg PO four times dailyRegular diet

Nurses' Notes

Day 1, 0900:

Client admitted from emergency department for psychosis. Client diagnosed with schizophrenia approximately 5 years ago, has had one prior hospitalization for psychosis. Client exhibiting disorganized, pressured speech and agitation. Also reports hearing voices and appears fearful.

Day 3, 0800:

LPN entered client's room to administer medication and noted that client did not respond to verbal or tactile stimulation, was diaphoretic, and hot to palpation. Notified RN. Vital signs obtained. Client noted to be incontinent of urine. Client mumbles in response to painful stimuli, muscle rigidity noted. Provider notified.

Vital Signs

Day 1, 0900:

Temperature 36.9° C (98.4° F)

Heart rate 88/min

Blood pressure 124/82 mm Hg

Respiratory rate 18/min

SpO2 9

A. Apply a cooling blanket

B. Administer bromocriptine

C. Administer dantrolene

F. Discontinue fluphenazine

Rationale:

When taking actions, the nurse should administer dantrolene and bromocriptine, apply a cooling blanket, and discontinue the fluphenazine. The client is exhibiting manifestations of neuroleptic malignant syndrome (NMS), a potentially fatal adverse effect of antipsychotic medications, such as fluphenazine. Other manifestations can include electrolyte imbalance, delirium, and dysrhythmias. Dantrolene and bromocriptine can relieve muscle rigidity and decrease body temperature. Cooling blankets can also assist in decreasing body temperature. The fluphenazine should be discontinued and the client should be transferred to a critical care unit for ongoing treatment.

A nurse at a clinic is evaluating a client.

Drag 1 condition and 1 client finding to fill in each blank in the following sentence.

Vital Signs:

Temperature 37.7°C (99.9°F)

Heart rate 110/min

Respiratory rate 20/min

Blood pressure 126/74 mmHg

SaO2 95% on room air

Notes​: Today: Adult female client is here for 3 month follow up visit after receiving a new prescription 3 months ago. Client reports feeling nervous and being irritable. Client is alert and oriented to person place and time. Skin moist and intact some sweating noted on forehead. Heart rate regular and fast. Respirations even and non-labored. Bowel sounds hyperactive in all 4 quadrants. Reports occasional loose stools that have increased lately.

Lab Results: TSH 0.1 mU/L (0.3 to 5 mU/L);

Triiodothyronine 220 ng/dL (70 to 205 ng/dL);

Thyroxine 4 ng/dL (0.8 to 2.8 ng/dL)

Provider Prescriptions: 3 months ago: Levothyroxine 50 mcg PO daily

The client is likely experiencing hyperthyroidism as evidenced by the client's blood thyroxine level.

Rationale:

When evaluating outcomes for a client who has taken levothyroxine for 3 months, the nurse should determine that the client is likely experiencing hyperthyroidism as evidenced by the client's blood thyroxine level. Levothyroxine is thyroid hormone that is used to treat clients who have hyperthyroidism. An adverse effect of levothyroxine is hyperthyroidism which is manifested by findings of increased metabolism such a nervousness, irritability, diaphoresis, tachycardia, and laboratory findings of decreased thyroid stimulating hormone (TSH) and elevated thyroid hormone levels (triiodothyronine and thyroxine).

A nurse is caring for a female older adult on a medical-surgical unit.

History and Physical5 Days Ago:

Past Medical HistoryHypertension

Congestive heart failure

Physical:Client alert and oriented x3. Lung sounds clear to auscultation. S1, S2 present, no extra heart sounds. Peripheral pulses 2+ in all extremities. Client reported flank pain and dysuria. Client had an outpatient urine culture done which was positive for Escherichia coli. Client was admitted for intravenous antibiotic therapy. Height 160 cm (63 in), weight 65 kg (144 lb).

Medication Administration Record

Gentamicin 5mg/kg once daily IVCefazolin 1 g every 8 hr IVFurosemide 20 mg once daily by mouth​

Laboratory Results

2 Days Ago:

Gentamicin trough 2.5 mcg/mL (less than 2 mcg/mL)

1 Day Ago:

Gentamicin trough 3 mcg/mL (less than 2 mcg/mL)

Today:Blood urea nitrogen (BUN) 22 mg/dL (10 to 20 mg/dL)

Creatinine 1.3 mg/dL (0.5 to 1.2 mg/dL)

Gentamicin peak

The client is at greatest risk for nephrotoxicity

due to kidney function.

Rationale:

When prioritizing hypothesis, the nurse should recognize that the client is most at risk for developing nephrotoxicity. The client has elevated BUN and creatinine levels indicating altered kidney function. The risk of nephrotoxicity is increased when concurrent use of other ototoxic drugs like furosemide are used. When trough levels are consistently elevated, ototoxicity can occur, but this is not the immediate concern.

Nurses' Notes​

3 days ago,

1200:

Client is admitted due to postoperative infection. The proximal end of the abdominal incision is open and draining a large amount of thick yellow drainage. Peripheral IV initiated in the right antecubital space. Cultures obtained. Height 175 cm (69 inches), weight 89 kg (197 lb).

Provider Prescriptions​

3 days ago, 1100:

Initiate IV for antibiotic therapy

Obtain and send to laboratory, blood cultures, abdominal incision drainage cultures, electrolytes, BUN, creatinine, CBC

Administer gentamicin IV 5 mg/kg once dailyAdminister acetaminophen PO 650 mg every 6 hr for temperature above 38.5° C (101.3° F)

Yesterday, 1100:

Obtain blood specimen and send for gentamycin trough level once daily prior to gentamycin dose.

Medication Administration Record​Today, 1300:

Gentamycin 445 mg IV Acetaminophen 650 mg PO

Laboratory Results​

Yesterday:

Abdominal incision drainage culture: Po

-BUN 48 mg/dL (10 to 20 mg/dL)

-Creatinine 2.7 mg/dL (0.5 to 1.1 mg/dL)

-Output 60mL

-Urine is dark amber.

Rationale:

When recognizing cues, the nurse should review the client's EMR, the nurse should recognize the client's elevated BUN, elevated creatinine level, urine output of less than 30mL/hr, and dark amber colored urine are manifestations of nephrotoxicity which is an adverse effect gentamycin and other aminoglycosides. Therefore, the nurse should hold the dose until further directions from the provider.

A nurse is preparing to administer a client's prescribed medications.

Vital Signs

0815:

Temperature 37.7° C (97.8° F)

Heart rate 90/min

Respiratory rate 16/min

Blood pressure 126/74 mmHg

SaO2 97% on room air

Nurses' Notes

0815:

Client has history of fibromyalgia and is being admitted for pain management. Client rates pain as 7 on a scale of 0 to 10. Client is alert and oriented to person place and time. Skin dry and intact. Heart rate regular with S1 and S2 present. Respirations even and non-labored. Bowel sounds hyperactive in all 4 quadrants. 20 G IV saline lock present in the right basilic.

Provider Prescriptions

0900:

Fentanyl 25 mcg/hr apply transdermal every 72 hr

Morphine sulfate 4 mg IV bolus every 2 hr as needed for pain

-clean the iv injection port with an antiseptic swab

-flush the IV,

-check for blood return

-clean area on skin with soap and water

-Sterile gloves?

Rationale:

When generating solutions, the nurse should prepare to administer morphine sulfate via IV bolus route. Therefore, prior to administering the medication, the nurse should clean the injection port with an antiseptic swab to prevent infection, flush the IV catheter with 0.9% sodium chloride before and after to ensure and maintain patency of the IV, and check for blood return to ensure the IV is in the vein. When administering a fentanyl transdermal patch, the nurse should apply clean gloves and cleanse the skin area with soap and water.