HESI PHARM 315 - 2024

A client taking atorvastatin develops an increased serum creatine phosphokinase (CK) level. The nurse should assess the client for the onset of which problem?

A. Muscle tenderness.

B. Nausea and vomiting.

C. Excessive bruising.

D. Peripheral edema.

A. Muscle tenderness.

An increase in which serum laboratory value indicates to the nurse that a prescription for atorvastatin is having the desired effect for a client at risk for coronary artery disease?

A. LDL (Low-density lipoprotein)

B. Triglycerides (Type of fat)

C. HDL (High-density lipoprotein)

D. VLDL (Very low-density lipoprotein)

C. HDL (High-density lipoprotein)

NGN - Patient Data

History and Physical:

The client is a 36-year-old female with moderate persistent asthma. She takes fluticasone/salmeterol 250 mcg/50 mcg 1 inhalation twice daily and albuterol 90 mcg/inhalation 2 inhalations every 4-6 hours as needed.

Nurses notes:

The client states that she has had more severe asthma symptoms than usual in the past week. Her forced expiratory volume has been 60-65% even with multiple doses of albuterol for several days in a row. She came to the hospital feeling dizzy, lightheaded, and complaining of “heart palpitations”. Upon assessment, no wheezes were found. Her oxygen saturation is 99%.

Review H and P, and nurse’s note. Identify from the choices below which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client’s progress.

Potential Condition:

Methemoglobinemia

Actions to Take:

1. Draw blood for a complete blood count

2. Administer methylene blue

Parameters to Monitor:

1. Methemoglobin level

2. Heart rate and rhythm

The nurse provide discharge instructions to a client who has been prescribed gabapentin 300 mg by mouth three times a day for post herpetic neuralgia. Which symptoms should the nurse tell the client to report to the healthcare provider?

A. Sexual dysfunction

B. Gastric irritation

C. Rapid weight gain

D. Photosensitivity

C. Rapid weight gain

A client with chronic lower back pain has been taking non steroidal anti-inflammatory (NSAID) drug ibuprofen by mouth twice a day for several months. Which assessment is most important for the nurse to complete?

A. Assess back pain using numeric scale

B. Palpate volume of pedal pulses

C. Determine presence of abdominal pain

D. Evaluate ongoing sleep patterns

C. Determine presence of abdominal pain

The nurse administers risedrineate to a client with osteoporosis at 0700. The client asks for a glass of milk to drink with the medication. Which action should the nurse take?

A. Instruct the client that it is necessary to take nothing but water with the medication.

B. Assign an unlicensed assistive personnel (UAP) to bring the client a glass of low fat milk.

C. Withhold the medication until the client's breakfast tray is available on the unit.

D. Consult with a pharmacist about scheduling the dose one hour after the client eats.

A. Instruct the client that it is necessary to take nothing but water with the medication.

Which action should the nurse implement to assess the effectiveness of calcium channel blocker amlodipine?

A. Note the clients serum calcium levels

B. Monitor the clients serum electrolytes

C. Review the clients intake and output

D. Measure the clients blood pressure

D. Measure the clients blood pressure

A client is receiving tamsulosin an alpha adrenergic - blocking agent for the management of urinary retention due to benign prostatic hyperplasia (BPH). Which instruction is most important for the nurse to provide?

A. Use a twice a week dosing schedule

B. Stand and sit up slowly

C. Take the medication early in the day

D. Reduce daily fluid intake

B. Stand and sit up slowly

A client with chemotherapy induced nausea receives a prescription for metoclopramide. Which adverse effect is most important for the nurse to report?

A. Nausea

B. Involuntary movements

C. Diarrhea

D. Unusual irritability

B. Involuntary movements

A client is receiving orlistat as part of a weight management program. Which ongoing assessment should be included in the plan of care to determine the effectiveness of the medication?

A. Body mass index

B. Depression screening

C. Daily calorie count

D. Serum protein levels

A. Body mass index

Before administering the initial dose of sumatriptan succinate to a client with a migraine headache, it is most important to determine if the client's history includes which problem?

A. Type 2 diabetes mellitus

B. Seasonal allergic rhinitis

C. Irritable bowel syndrome

D. Coronary artery disease

D. Coronary artery disease

A client receives a prescription for ciprofloxacin 400 mg intravenously (IV) every 12 hours which is to be infused over an hour. The IV bag contains ciprofloxacin 400 mg in dextrose 5%in water (D5W) 200 mL. How many mL/hr should the nurse program the infusion pump to deliver?

200 mL/hr

Rationale:

xmL/hr =

200 mL x 400 mg = 80,000 = 200 mL/hr

400 mg 1 hr 400

Before administering a laxative to a bed fast client, it is most important for the nurse to perform which assessment?

A. Determine the frequency and consistency of bowel movements

B. Observe the skin integrity of the clients rectal and sacral areas

C. Assess the clients strength in moving and turning the bed

D. Evaluate the clients ability to recognize the urge to defecate

A. Determine the frequency and consistency of bowel movements

The nurse is caring for a client who takes methotrexate for rheumatoid arthritis and is now prescribed adalimumab. Which instructions should the nurse provide the client?

A. Have a chest x-ray prior to your first dose

B. Avoid crowds and people who are sick

C. Obtain routine vaccinations as scheduled

D. Undergo annual eye examinations

B. Avoid crowds and people who are sick

The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse consults with the registered nurse regarding the administration of the medication if which of the following is documented in the client's history?

A. Pancreatitis

B. Diabetes mellitus

C. Myocardial infarction

D. Chronic obstructive pulmonary disease

A. Pancreatitis

Hormone replacement therapy with levothyroxine sodium is prescribed for a client with hypothyroidism. The nurse should instruct the client to report which symptom because it indicates that the client is taking too much of the hormonal agent, levothyroxine?

A. Intolerance to cold

B. Constipation

C. Restlessness

D. Decreased appetite

C. Restlessness

A client with peptic ulcer disease receives a new prescription for cimetidine. Which statement provided by the client requires additional instruction by the nurse?

A. Take the medication an hour after antacids.

B. Notify the healthcare provider of lethargy.

C. Decrease cigarette use to a pack per day.

D. Monitor for any signs of sexual dysfunction.

C. Decrease cigarette use to a pack per day.

The nurse initiates an infusion of piperacillin-tazobactam for a client with a urinary tract infection. Five minutes into the infusion, the client reports not feeling well. Which client manifestation should the nurse identify as a reason to stop the infusion?

A: Scratchy throat.

B: Pupillary constriction.

C: Bradycardia.

D: Hypertension.

A. Scratchy throat.

The nurse administers naloxone to a client with opioid-induced respiratory depression. One hour later, nursing assessment reveals that the client has a respiratory rate of 4 breaths/minute, oxygen saturation of 75%, and is unable to be aroused. Which action should the nurse implement?

A: Determine Glasgow Coma Scale score.

B: Initiate cardiopulmonary resuscitation (CPR).

C: Prepare to assist with chest tube insertion.

D: Administer a second dose of naloxone.

D: Administer a second dose of naloxone.

Before administering a newly prescribed dose of terbinafine HCL to a client with a fungal toenail infection, which assessment finding is most important for the nurse to address?

A: Employed as a construction worker.

B: Reported history of alcoholism.

C: White blood cell count of 8,500/mm3 (8.5 x 10^9/L).

D: Toenails appear thick and yellow.

B: Reported history of alcoholism.

A client is diagnosed with myasthenia gravis receives a prescription for the anticholinesterase medication pyridostigmine. Which intervention should the nurse implement when preparing to administer this medication?

• A Plan the doses close together for maximal therapeutic effect.

• B Always take with meals to avoid gastrointestinal distress.

• C Take the medication at least 30 minutes before eating meals.

• D Avoid dairy products two hours before and after taking medications.

Administer the medication thirty minutes prior to meals.

A client with benign prostatic hyperplasia receives a new prescription of tamsulosin. Which intervention should the nurse perform to monitor for an adverse reaction?

A: Perform a bladder scan.

B: Assess urine output.

C: Measure blood pressure.

D: Monitor daily weights.

C: Measure blood pressure.

After administering oral doses of calcitriol and calcium carbonate to a client with hypoparathyroidism, the nurse notes that the client's total calcium level is 14 mg/dL (3.5 mmol/L). Which action should the nurse implement?

A: Administer both prescribed medications as scheduled.

B: Hold the calcium carbonate, but administer the calcitriol as scheduled.

C: Hold both medications until contacting the healthcare provider.

D: Hold the calcitriol, but administer the calcium carbonate as scheduled.

C: Hold both medications until contacting the healthcare provider.

normal calcium is 2.2 t 2.6 and both of these drugs give a risk of hypercalcemia, requiring intervention.

Rivastigmine, a cholinesterase inhibitor, is prescribed for a female client with early stage Alzheimer's disease. The client's daughter tells the nurse that she plans to start administering the drug when her mother's symptoms are no longer manageable, in hopes that her mother will not have to go to a nursing home. How should the nurse respond?

A: Confirm that the daughter is aware of the progressive nature of the disease.

B: Affirm the decision to use the medication when the symptoms start to worsen.

C: Explain that the drug should be used early in the course of the disease process.

D: Assess the client's current mental status before deciding to support the decision.

C: Explain that the drug should be used early in the course of the disease process.

A client with psychosis who is receiving an antipsychotic medication is continually rubbing the back of the neck. Which nursing intervention is best for the nurse to implement?

A: Provide the client a heating pad to place on the neck.

B: Obtain a prescription for physical therapy services.

C: Give a PRN prescription for benztropine.

D: Obtain an extra pillow for the client to use at night.

C: Give a PRN prescription for benztropine.

A client receives a new prescription for levothyroxine. Which statement made by the client indicates to the nurse that the education was effective?

A: Take medication on an empty stomach.

B: Consume foods that are high in iodine.

C: Administer levothyroxine at bedtime.

D: Avoid the use of iron supplements.

A: Take medication on an empty stomach.

The nurse is administering muscle relaxant baclofen by mouth (PO) to a client diagnosed with multiple sclerosis. Which intervention is the most important for the nurse to implement?

A: Advise the client to move slowly and cautiously when rising and walking.

B: Evaluate muscle strength every 4 hours.

C: Monitor intake and output every 8 hours.

D: Ensure the client knows to stop baclofen before using other antispasmodics.

A: Advise the client to move slowly and cautiously when rising and walking.

A client with atrial fibrillation receives a new prescription for dabigatran. Which instruction should the nurse include in this client's teaching plan?

A: Eliminate spinach and other green vegetables in the diet.

B: Continue obtaining scheduled laboratory bleeding tests.

C: Keep an antidote available in the event of hemorrhage.

D: Avoid use of nonsteroidal anti-inflammatory drugs (NSAIDs).

D: Avoid use of nonsteroidal anti-inflammatory drugs (NSAIDs).

A client taking atorvastatin develops an increased serum creatine phosphokinase (CK) level. The nurse should assess the client for the onset of which problem?

A: Muscle tenderness.

B: Nausea and vomiting.

C: Excessive bruising.

D: Peripheral edema.

A: Muscle tenderness.

The nurse is planning care for a client with major depression who is receiving a new prescription for duloxetine. Which information is most important for the nurse to obtain?

A: Weight change in the last month.

B: Liver function laboratory results.

C: Recent use of other antidepressants.

D: Family history of mental illness.

C: Recent use of other antidepressants.

A client with Parkinson's disease who is taking carbidopa/levodopa reports the urine appears to be darker in color. Which action should the nurse take?

A: Measure the client's urinary output.

B: Explain the color change is normal.

C: Obtain a specimen for a urine culture.

D: Encourage an increase in oral intake.

B: Explain the color change is normal.

Before administering a newly prescribed dose of terbinafine HCL to a client with a fungal toenail infection, which assessment finding is most important for the nurse to address?

A: Employed as a construction worker.

B: Reported history of alcoholism.

C: White blood cell count of 8,500/mm3 (8.5 x 10^9/L).

D: Toenails appear thick and yellow

B: Reported history of alcoholism.

Prior to administering the evening dose of carbamazepine, the nurse notes that the client's morning carbamazepine level was 84 mcg/L (35.6 mmol/L). Which action should the nurse take?

A: Notify the healthcare provider of the carbamazepine level.

B: Administer the carbamazepine as prescribed.

C: Assess the client for side effects of carbamazepine.

D: Withhold this dose of the carbamazepine.

B: Administer the carbamazepine as prescribed.

The health care provider prescribes the antibiotic tetracycline HCl for an adult client who arrived at an outpatient clinic. Which instruction should the nurse include in the teaching plan for this client?

A: Protect the skin from sunlight while taking the drug.

B: Take with orange juice to enhance GI absorption.

C: Return to the clinic weekly to obtain serum drug levels.

D: Take with milk or antacids to prevent gastrointestinal (GI) irritation.

A: Protect the skin from sunlight while taking the drug.

The nurse prepares to administer a scheduled dose of labetalol by mouth to a client with hypertension. The client's vital signs are temperature 99° F (37.2° C), heart rate 48 beats/minute, respirations 16 breaths/minute, and blood pressure 150/90 mm Hg. Which action should the nurse take?

A: Assess for orthostatic hypotension before administering the dose.

B: Administer the dose and monitor the client's BP regularly.

C: Apply a telemetry monitor before administering the dose.

D: Withhold the scheduled dose and notify the health care provider.

D: Withhold the scheduled dose and notify the health care provider.

The client's heart rate of 48 beats/minute is considered bradycardia (a heart rate below 60 beats/minute) [1, 5]. Administering labetalol could further lower the heart rate

A client is receiving intravenous (IV) vancomycin and the nurse plans to draw blood for a peak and trough to determine the serum level of the medication. Which of the following collection times provide the best determination of these levels?

A: Thirty minutes into the administration of the IV dose and 30 minutes before the next administration of the medication.

B: One hour after completion of the IV dose and one hour before the next administration of the medication.

C: Two hours after completion of the IV dose and two hours before the next administration of the medication.

D: Immediately after completion of the IV dose and 30 minutes before the next administration of the medication.

B: One hour after completion of the IV dose and one hour before the next administration of the medication.

After taking orlistat for one week, a female client tells the home health nurse that she is experiencing increasingly frequent oily stools and flatus. Which action should the nurse take?

A: Instruct the client to increase her intake of saturated fats over the next week.

B: Advise the client to stop taking the drug and contact her healthcare provider.

C: Obtain a stool specimen to evaluate for occult blood and fat content.

D: Ask the client to describe her dietary intake history for the last several days.

D: Ask the client to describe her dietary intake history for the last several days.

A client with heart failure (HF) develops hyperaldosteronism and spironolactone is prescribed. Which instruction should the nurse include in this client's plan of care?

A: Replace salt with a salt substitute.

B: Monitor skin for excessive bruising.

C: Cover your skin before going outside.

D: Limit intake of high-potassium foods.

D: Limit intake of high-potassium foods.

The nurse administers risedronate to a client with osteoporosis at 0700. The client asks for a glass of milk to drink with the medication. Which action should the nurse take?

A: Instruct the client that it is necessary to take nothing but water with the medication.

B: Assign an unlicensed assistive personnel (UAP) to bring the client a glass of low fat milk.

C: Consult with a pharmacist about scheduling the dose one hour after the client eats.

D: Withhold the medication until the client's breakfast tray is available on the unit.

A: Instruct the client that it is necessary to take nothing but water with the medication.

A client with hepatic encephalopathy is receiving lactulose. Which assessment provides the nurse with the best information to evaluate the client's therapeutic response to the drug?

A: Stool color and character.

B: Serum electrolytes and ammonia.

C: Serum hepatic enzymes.

D: Fingerstick glucose.

B: Serum electrolytes and ammonia.

The nurse admits a client with a diagnosis of stage 4 cancer. The client has a prescription to wear a subcutaneous morphine sulfate patch for pain. The client is short of breath and difficult to arouse. While performing a head to toe assessment, the nurse discovers four patches on the client's body. Which action should the nurse take first?

A: Apply oxygen face mask.

B: Remove the morphine patches.

C: Administer a narcotic reversal drug.

D: Monitor blood pressure.

B: Remove the morphine patches.

An older adult with iron deficiency anemia is being discharged with a prescription for ferrous sulfate enteric-coated tablets. To promote best absorption of the medication, which information should the nurse include in the discharge instructions?

A: Take the tablet with a daily multivitamin.

B: Bedtime is the best time to take the tablet.

C: Wait 2 hours after meals to take the tablet.

D: Crush the tablets and mix with pudding.

C: Wait 2 hours after meals to take the tablet.

A client in the surgical recovery area asks the nurse to bring the largest possible dose of pain medication available. Which action should the nurse implement first?

A: Determine when the last dose was administered.

B: Encourage the client to use diversional thoughts to manage pain.

C: Review the history for a past use of recreational drugs.

D: Ask the client to rate the current level of pain using a pain scale.

D: Ask the client to rate the current level of pain using a pain scale.

The nurse is caring for a client who is taking diclofenac, a nonsteroidal anti-inflammatory (NSAID) drug for rheumatoid arthritis. During a clinic visit, the client appears pale and reports increasing fatigue. Which of the client's serum laboratory values is most important for the nurse to review?

A: Glucose.

B: Total protein.

C: Sodium.

D: Hemoglobin.

D: Hemoglobin.

Which nursing action has the highest priority when administering a dose of codeine with acetaminophen to a client?

A: Instruct the client to request assistance when ambulating to the bathroom.

B: Administer a stool softener/laxative at the same time as the analgesic.

C: Advise the client that the medication should start to work in about 30 minutes.

D: Tell the client to notify the nurse if the pain is not relieved.

A: Instruct the client to request assistance when ambulating to the bathroom.

Codeine is an opioid analgesic, which commonly causes central nervous system (CNS) depression symptoms such as sedation and dizziness

A client who is taking an oral contraceptive receives a new prescription for erythromycin. Which instruction should the nurse provide to the client?

A: Stop the oral contraceptive immediately.

B: Avoid prolonged exposure to direct sunlight.

C: Take the medications at least 12 hours apart.

D: Use an additional form of contraception.

D: Use an additional form of contraception.

experts still recommend a conservative approach due to individual variability and the serious consequences of unintended pregnancy. 

The nurse is planning to administer the antiulcer gastrointestinal (GI) agent sucralfate to a client with peptic ulcer disease. Which action should the nurse include in this client's plan of care?

A: Administer sucralfate once a day, preferably at bedtime.

B: Give sucralfate on an empty stomach.

C: Monitor for electrolyte imbalance.

D: Assess for secondary Candida infection.

B: Give sucralfate on an empty stomach.

A client with a seizure disorder is seen at the clinic for a follow-up visit and a prescription renewal for phenytoin. Which assessment finding warrants immediate intervention by the nurse?

A: Blood pressure 100/78 mm Hg.

B: Double vision.

C: Puffy, bleeding gums.

D: Chronic insomnia.

B: Double vision.

To control asthma, a client in a residential treatment facility uses a fluticasone propionate and salmeterol discus inhalation system, which provides an inhaled powdered form of these combined medications. Which instruction should the nurse provide to this client's caregivers?

A: When using the discus, have the client breathe out rapidly into the mouthpiece.

B: Offer the discus to the client for use during an acute asthma attack.

C: Clients using the discus may experience decreased blood pressure.

D: Explain that the client should not use the discus more than twice daily.

D: Explain that the client should not use the discus more than twice daily.

A client who received a renal transplant three months ago is readmitted to the acute care unit with signs of graft rejection. While taking the client's history, the nurse determines that the client has been self-administering St. John's Wort, an herbal preparation, on the advice of a friend. Which information is most significant about this finding?

A: St. John's Wort can decrease plasma concentrations of cyclosporine.

B: Adding the herb can decrease the need for corticosteroids.

C: The client probably used this herb to treat depression.

D: Ingestion of St. John's Wort can reduce the client's intake of sodium.

A: St. John's Wort can decrease plasma concentrations of cyclosporine.

A client with anemia secondary to chronic kidney disease (CKD) started a prescription for epoetin alfa two months ago. Which client finding best indicates that the medication is effective?

A: Reports of increased energy levels and decreased fatigue.

B: Food diary shows increased consumption of iron-rich foods.

C: Takes concurrent iron therapy without adverse effects.

D: Hemoglobin level increased to 12 g/dL (7.45 mmol/L).

D: Hemoglobin level increased to 12 g/dL (7.45 mmol/L).

The nurse is administering sodium polystyrene sulfonate to a client in acute kidney injury (AKI). Which laboratory finding indicates that the medication has been effective?

A: Serum ammonia level of 30 Mcg/dL (17.62 mmol/L).

B: Hemoglobin level of 13.5 g/dL (135 g/L).

C: Serum potassium level of 3.8 mEq/L (3.8 mmol/L).

D: Serum glucose level of 120 mg/dL (6.7 mmol/L).

C: Serum potassium level of 3.8 mEq/L (3.8 mmol/L).

A client with chemotherapy-induced nausea receives a prescription for metoclopramide. Which adverse effect is most important for the nurse to report?

A: Nausea.

B: Involuntary movements.

C: Unusual irritability.

D: Diarrhea.

B: Involuntary movements.

While assessing a client who takes acetaminophen for chronic pain, the nurse observes that the client's skin looks yellow in color. Which action should the nurse take in response to this finding?

A: Report the finding to the healthcare provider.

B: Check the client's capillary glucose level.

C: Use a pulse oximeter to assess oxygen saturation.

D: Advise the client to reduce the medication dose.

A: Report the finding to the healthcare provider.

A client with nasal congestion receives a prescription for phenylephrine 10 mg by mouth every 4 hours. Which client condition should the nurse report to the healthcare provider before administering the medication?

A: Diarrhea.

B: Bronchitis.

C: Hypertension.

D: Edema.

C: Hypertension.

When administering medications to a group of clients, which client should the nurse closely monitor for development of acute kidney injury (AKI)?

A: Lorazepam.

B: Digoxin.

C: Sucralfate.

D: Vancomycin.

D: Vancomycin.

watch for nephrotoxicity (kidney damage) and ototoxicity (ear damage). Specific signs to monitor for include decreased urine output, rising blood urea nitrogen (BUN) and creatinine levels, ringing in the ears (tinnitus), and hearing loss.

A glucagon emergency kit is prescribed for a client with type 1 diabetes mellitus to be used at home. When should the nurse instruct the client and family that glucagon needs to be administered?

A: At the onset of signs of diabetic ketoacidosis.

B: Before meals to prevent hyperglycemia.

C: When unable to eat during sick days.

D: When signs of severe hypoglycemia occur.

D: When signs of severe hypoglycemia occur.

Rivastigmine, a cholinesterase inhibitor, is prescribed for a female client with early stage Alzheimer's disease. The client's daughter tells the nurse that she plans to start administering the drug when her mother's symptoms are no longer manageable, in hopes that her mother will not have to go to a nursing home. How should the nurse respond?

A: Confirm that the daughter is aware of the progressive nature of the disease.

B: Affirm the decision to use the medication when the symptoms start to worsen.

C: Explain that the drug should be used early in the course of the disease process.

D: Assess the client's current mental status before deciding to support the decision.

C: Explain that the drug should be used early in the course of the disease process.

A client who receives multiple antihypertensive medications experiences syncope due to a drop in blood pressure to 70/40 mm Hg. Which is the rationale for the nurse's decision to hold the client's scheduled antihypertensive medications?

A: Increased urinary clearance of the multiple medications has produced diuresis and lowered the blood pressure.

B: The synergistic effect of the multiple medications has resulted in drug toxicity and hypotension.

C: The antagonistic interaction among the various blood pressure medications has reduced their effectiveness.

D: The additive effect of multiple medications has caused the blood pressure to drop too low.

D: The additive effect of multiple medications has caused the blood pressure to drop too low.

A client reports confusion and blurred vision after receiving a dose of glipizide. Which action should the nurse implement?

A: Perform a neurological exam.

B: Obtain a fingerstick blood glucose.

C: Administer glucagon intramuscularly.

D: Measure the client's vital signs.

B: Obtain a fingerstick blood glucose.

The nurse is providing instructions about a client's new medications. How should the nurse explain the purpose of probenecid, a uricosuric drug?

A: Decreases pain and burning during urination.

B: Increases the strength of the urine stream.

C: Prevents the formation of kidney stones.

D: Promotes excretion of uric acid in the urine.

D: Promotes excretion of uric acid in the urine.

Which intervention is most important for the nurse to implement for a client who is receiving insulin lispro?

A: Keep an oral liquid or glucose source available.

B: Provide meals at the same time this insulin is given.

C: Assess for hypoglycemia between meals.

D: Check blood glucose levels every six hours.

B: Provide meals at the same time this insulin is given.

A client with open-angle glaucoma asks the nurse how long the prescribed eye drops will need to be used. Which response made by the nurse is accurate?

A: Until the excess pressure is reduced.

B: For long-term control of pain and swelling.

C: Until a smaller angle can be restored.

D: For long-term control of normal eye pressure.

D: For long-term control of normal eye pressure.

A client with peptic ulcer disease receives a new prescription for cimetidine. Which statement provided by the client requires additional instruction by the nurse?

A: Take the medication an hour after antacids.

B: Notify the healthcare provider of lethargy.

C: Decrease cigarette use to a pack per day.

D: Monitor for any signs of sexual dysfunction.

C: Decrease cigarette use to a pack per day.

A female client with multiple sclerosis reports having less fatigue and improved memory since she began using the herbal supplement, ginkgo biloba. Which information is most important for the nurse to include in the teaching plan for this client?

A: Ginkgo biloba use should be limited and not taken during pregnancy.

B: Aspirin and non-steroidal anti-inflammatory drugs interact with ginkgo.

C: Nausea and diarrhea can occur when using this supplement.

D: Anxiety and headaches increase with the use of ginkgo biloba.

B: Aspirin and non-steroidal anti-inflammatory drugs interact with ginkgo.

A client with a history of chronic obstructive pulmonary disease (COPD) receives a new prescription for an ipratropium inhaler. Which action indicates to the nurse that additional teaching is needed?

A: Primes the inhaler with 7 pumps.

B: Rinses the mouth after each use.

C: Stores the medication at room temperature.

D: Attaches spacer device to the inhaler.

A: Primes the inhaler with 7 pumps.

A client who is taking albendazole reports experiencing fatigue, nausea, and dark urine. The nurse observes a yellowing of the client's skin and sclera. Which laboratory result should the nurse review?

A: Basic metabolic panel.

B: Thyroid function test.

C: Renal function panel.

D: Liver function test.

D: Liver function test.

NGN - Patient Data

History and Physical

The client is a 75-year-old female who was admitted to the preop area to prepare for pacemaker insertion. She states that she needs this procedure because her heart rate has been very low, she feels tired all the time, and she has fainted once due to low heart rate. She has a history of worsening symptomatic bradycardia and atrial fibrillation controlled by medication. She has been off anticoagulants for four days to prepare for the procedure.

Orders:

Diphenhydramine 25 mg IV now

Methylprednisolone 100 mg IV now

For each body system, select to specify the potential nursing intervention that would be appropriate for the care of the client. Each body system may support more than one potential nursing intervention. Each category must have at least one response option selected.

Body System: Respiratory (A)

A. Assess lung sounds

B. Provide a calm environment

C. Pain medication

D. Chest x-ray

Body System: Cardiovascular (A,B,C)

A. Monitor vital signs continuously

B. Provide warmth

C. Defibrillator at bedside

D. EHO

Body System: Immunological (A,D)

A. Administer antihistamine

B. IV fluids

C. Assess rash

D. Administer steroid

NGN - Patient Data

History and Physical

The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on post-op day 1.

Nurses Notes

1400: Started continuous morphine in the left antecubital vein peripheral intravenous line. No redness, edema, or bleeding noted at the site. Vital signs are heart rate 77 bpm, blood pressure 118/74 mmHg, respiratory rate 16 breaths/min.

Orders:

- Admit to the surgical floor

- Clear liquid diet, advance as tolerated

- Continuous cardiorespiratory monitoring

- Morphine 1 mg/hr intravenously

- Alert surgeon to signs of bleeding or infection in the surgical site

What other medications would the nurse expect the surgeon to prescribe along with morphine? Select all that apply.

A. Ibuprofen

B. Propofol

C. Methadone

D. Senna

E. Docusate sodium

F. Naloxone

A. Ibuprofen

D. Senna

E. Docusate sodium

NGN - Patient Data

History and Physical

The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on post-op day 1.

Nurses Notes

1400: Started continuous morphine in the left antecubital vein peripheral intravenous line. No redness, edema, or bleeding noted at the site. Vital signs are heart rate 77 bpm, blood pressure 118/74 mmHg, respiratory rate 16 breaths/min.

The charge nurse places a fall precautions sign on the client's door. What side effects of morphine could contribute to this client's fall risk? Select all that apply.

A. Seizures

B. Nausea

C. Orthostatic hypotension

D. Sedation

E. Euphoria

F. Itching

G. Urinary retention

B. Nausea

C. Orthostatic hypotension

D. Sedation

NGN - Patient Data

History and Physical

The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on post-op day 1.

Nurses Notes

1400: Started continuous morphine in the left antecubital vein peripheral intravenous line. No redness, edema, or bleeding noted at the site.

For each statement, click to indicate whether the statements by the student nurse indicate understanding or no understanding of naloxone.

A. "You can give naloxone intravenously, intramuscularly, or subcutaneously."

B. "Naloxone works best on pure agonist opioids."

C. "If the first dose does not work, you can give as many doses as needed to reverse respiratory depression."

D. "Naloxone will not affect the client's level of pain."

E. "When given IV, naloxone starts working immediately and can last several hours."

A. "You can give naloxone intravenously, intramuscularly, or subcutaneously." = Understanding

B. "Naloxone works best on pure agonist opioids." = Understanding

C. "If the first dose does not work, you can give as many doses as needed to reverse respiratory depression." = No understanding

D. "Naloxone will not affect the client's level of pain." = No understanding

E. "When given IV, naloxone starts working immediately and can last several hours." = No understanding

NGN - Patient Data

History and Physical

The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on post-op day 1.

Orders:

- Admit to the surgical floor

- Clear liquid diet, advance as tolerated

- Continuous cardiorespiratory monitoring

- Morphine 1 mg/hr intravenously

- Alert surgeon to signs of bleeding or infection in the surgical site

The nurse is discussing the client's pain management with a student nurse. Choose the most likely options for the information missing from the statement(s) by selecting from the lists of options provided.

Morphine is a(n) ____(A)___and it activates ___(B)__receptors and is used to relieve __(C)___.

A) Pure opioid antagonist

B) Mu

C) Severe pain

NGN - Patient Data

History and Physical

The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on post-op day 1.

What should the nurse do immediately? Select all that apply.

A. Print an electrocardiogram strip

B. Provide rescue breaths with a manual ventilation bag

C. Give naloxone 2 mg intravenously

D. Apply oxygen via nasal cannula

E. Perform chest compressions

F. Call for rapid response

B. Provide rescue breaths with a manual ventilation bag

C. Give naloxone 2 mg intravenously

F. Call for rapid response

NGN - Patient Data

History and Physical

The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on post-op day 1.

What actions should the nurse take to ensure safety during morphine administration? Select all that apply.

A. Take an initial respiratory rate

B. Perform a 12-lead electrocardiogram

C. Suction the client to clear the airway

D. Have a manual resuscitation bag at the bedside

E. Ask the client about other medications she takes

F. Restrain the client with soft restraints

A. Take an initial respiratory rate

D. Have a manual resuscitation bag at the bedside

E. Ask the client about other medications she takes

The nurse is planning discharge teaching for a client with diabetes mellitus who has a new prescription for insulin glargine. What action should the nurse plan to include in the discharge teaching?

A. Teach the client self injection skills for daily subcutaneous administration

B. Provide information on increasing medication dosage if ketoacidosis occurs

C. Demonstrate how to select dose based on before meal blood sugar readings

D. Explain to the family how to inject this medication for severe hypoglycemia

A. Teach the client self injection skills for daily subcutaneous administration

A client is scheduled for a spiral computed tomography (CT) scan with contrast to evaluate for pulmonary embolism. Which information in the clients history requires follow up by the nurse?

A. Metal hip prosthesis was placed twenty years ago

B. Takes metformin hydrochloride for type 2 diabetes millitus

C. CT scan that was performed six months earlier

D. Report of clients sobriety for the last five years

B. Takes metformin hydrochloride for type 2 diabetes millitus

A male client reports to the nurse that he is experiencing gastrointestinal distress from a high dose of corticosteroid and is planning to stop taking the medication. In response to the clients statement, which nursing action is most important for the nurse to implement?

A. Advise the client that the medication should be stopped gradually rather than abruptly

B. encourage the client to take the medication with food to decrease GI distress

C. Assess the client for other indications of adverse effects of corticosteroid use

D. review the clients dosing schedule to ensure he is taking the prescribed amount

A. Advise the client that the medication should be stopped gradually rather than abruptly

A client is receiving pilocarpine hydrochloride opthalmic drops for glaucoma. The client calls the clinic nurse and reports difficulty seeing at night. Which explanation should the nurse provide?

A. The drug can cause the lens to become more opaque

B. The drops increase the fluid in the eyes and cloud the visual field

C. The eye drops slow pupil response to accommodate for darkness

D. The medication causes pupils to dilate, which reduces night vision

C. The eye drops slow pupil response to accommodate for darkness

A client is receiving rifampin, an antitubercular medication. Which statement by this client should prompt the nurse to notify the healthcare provider of a potential problem?

A. Reports that the sclera are yellow

B. Voids urine that is orange colored

C. uses condoms for contraception

D. complains of persistent tinnitus

A. Reports that the sclera are yellow

A male client has been receiving the antibiotic gentamicin sulfate, IV piggyback every 12 hours for several days. Which observation by the nurse indicates that the client may be experiencing an adverse effect of gentamicin?

A. Decreased blood urea nitrogen

B. Reports of photophobia

C. Hearing has decreased

D. White blood cell count of 6,000/mm3

C. Hearing has decreased

An older adult client with restlessness syndrome begins taking melatonin at bedtime. When evaluating the effectiveness of the herb, which client assessment should the nurse complete?

A.) determine sleep patterns

B.) palpate pedal pulse volume

C.) assess anxiety level

D.) observe for peripheral edema

A.) determine sleep patterns

To evaluate the effectiveness of a clients prescription for rosuvastatin, which action should the nurse implement?

A.) evaluate the clients serum cholesterol level results

B.) measure skin folds for body mass index calculations

C.) obtain the clients heart rate and blood pressure

D.) review the clients daily food and weight log

A.) evaluate the clients serum cholesterol level results

A client receives a prescription to itraconazole. Which information provide by the client requires additional instruction by the nurse?

A.) monitor for changes in stool color

B.) report any difficulty with breathing

C.) take the medication with antacids

D.) avoid the consumption of grapefruit juice

C.) take the medication with antacids

When caring for a client with diabetes insipidus who is receiving an antidiuretic hormone intranasally, which serum lab test is most important for the nurse to monitor?

A.) calcium

B.) osmolality

C.) glucose

D.) platelets

B.) osmolality

When preparing to apply a scheduled fentanyl transdermal patch, the nurse notes that the previously applied patch is intact on the clients upper back and the client denies pain. Which action should the nurse take?

A.) remove the patch and consult with the healthcare provider about the clients pain resolution

B.) administer an oral analgesic and evaluate its effectiveness before applying the new patch

C.) apply the new patch in a different location after removing the original patch

D.) place the patch on the clients shoulder and leave both patches in place for 12 hrs

C.) apply the new patch in a different location after removing the original patch

The nurse is caring for an older client with multiple comorbidities. Which medication should the nurse recognize as increasing the clients risk for fractures?

A.) metformin

B.) Lansoprazole

C.) amlodipine

D.) simvastain

B.) Lansoprazole

The nurse is preparing a discharge teaching plan for a client who is taking ciprofloxacin hydrochloride tablets, which were prescribed because of a suspected anthrax exposure. Which instructions should be included in the teaching plan? (Select all that apply.)

A.) use NSAIDs to relieve mild joint aches and pains caused by the medication

B.) crush and mix the tablets with pudding if you have trouble swallowing the tablets

C.) increase fluid intake while taking this medication

D.) limit exposure to sunlight and avoid tanning beds

E.) report any tendon pain or swelling to the healthcare provider immediately

C.) increase fluid intake while taking this medication

D.) limit exposure to sunlight and avoid tanning beds

E.) report any tendon pain or swelling to the healthcare provider immediately

The client is in the provider’s office for a physical. He states that he has been monitoring his blood pressure, but it is continuing to go up.

The physician has given the client a prescription for captopril.

Choose the most likely options for the information missing from the statement(s) by selecting from the lists of options provided.

Captopril is a ____________ that works by _________________.

A. non-steroidal anti-inflammatory drug

B. angiotensin II receptor blocker

C. angiotensin-converting enzyme inhibitor

D. aldosterone antagonist

C. angiotensin - converting enzyme inhibitor

Captopril (Capoten)

Adverse Effects:

- Persistent nonproductive cough

- Rash

- Hypotension

- Hyperkalemia (higher than normal amounts of potassium in the blood associated with kidney failure or use of diuretic drugs)

- Hyponatremia (excessive amounts of sodium in the blood, possibly DM)

Contraindications -DO NOT GIVE:

- 2nd and 3rd trimester of pregnancy (causes injury to the fetus BLACK BOX)

- Hypersensitivity - other ACE inhibitors (cross sensitivity)

Lisinopril (Prinivil, Zestril)

Adverse Effects:

- Cough

- Headache

- Dizziness

- Orthostatic hypotension

- Rash

- Hyperkalemia

- Effects include taste disturbances

- Chest pain

- Nausea

- Vomiting

- Diarrhea

- Angioedema

Contraindications:

- Patients with hyperkalemia and in those who have previously experienced angioedema caused by ACE inhibitor therapy.

- Should not be used during pregnancy.

The healthcare provider prescribes Ceftazidime 1,500 mg IV every 12 hours. The available vial is labeled, "Ceftazidime 1 gram", and the instruction for reconstitution state, "For IV use add 10mL sterile water for injection. Concentration after reconstitution = 100 mg/mL. How many mL should the nurse administer?

15 mL

xmL = mL x 1,500 mg = 1,500 = 15 mL

100 mg 1 1

The nurse retrieves hydromorphone (Dilaudid) 4 mg/mL from the Pyxis Medstation, an automated dispensing system, for a client who is receiving Dilaudid 3 mg IM q6 hours PRN severe pain. How many mL should the nurse administer to the client. (Enter the numerical value only. If rounding is required round to the nearest tenth)

0.8 mL

xmL = mL x 3 mg = 3 = 0.75 = 0.8

4 mg 1 4

What action should the nurse take prior to administering digoxin (Lanoxin) PO?

a. Obtain a left radial pulse for 30 seconds

b. listen to the heart at the left 5th intercostal space

c. check the client for signs of orthostatic hypotension

d. verify that the urine output exceeds 30 ml/ hour

b. listen to the heart at the left 5th intercostal space

The nurse is instructing a client with allergic rhinitis about the correct technique for using an intranasal inhaler. What instruction is most important for the nurse to provide to this client?

A. use the inhaler when first awakening in the morning

B. avoid shaking the inhaler immediately before using

C. hold one nostril closed while spraying the other nostril

D. angle the tip of the inhaler upward while spraying

C. hold one nostril closed while spraying the other nostril

A client with muscle spasticity receives a prescription for baclofen. Which information provided by the client requires additional instruction by the nurse?

A. Use a stool softener as needed

B. Take medication with meals

C. Discontinue when spasms cease

D. Avoid the ingestion of alcohol

C. Discontinue when spasms cease

A male client who has erectile dysfunction (ED) recently received a new prescription for sildenafil citrate. During a clinic visit, the client reports the onset of nasal congestion, dizziness, nausea, and dyspepsia. Which nursing assessment takes priority?

A. Palpate abdomen for distention or tenderness

B. Measure blood pressure while lying and standing

C. Assess for the presence of muscle or back pain

D. Auscultate and compare breath sounds bilaterally.

B. Measure blood pressure while lying and standing

A client who is experiencing vasomotor symptoms related to menopause receives a new prescription for estrogen replacement. Which client condition should the nurse report the healthcare provider prior to administering the first dose of the medication?

A. Dyspareunia.

B. Osteoporosis

C. Colorectal cancer

D. Pulmonary embolism

A. Dyspareunia.

A female client with history of peptic ulcer disease received a prescription for misopprostol. Which information provided by the client indicates to the nurse a need for further teaching?

Ensure a negative pregnancy test results 2 weeks before therapy.

A client who developed syndrome of inappropriate antidiuretic hormone (SIADH) associated with small carcinoma of the lung is preparing for discharge. When teaching the client about self-management with demeclocycline (Declomycin), the nurse should instruct the client to report which condition to the health care provider?

Enamel hypoplasia

The nurse assess a client with intermittent claudification who is receiving pentoxifylline. Which assessment should the nurse perform to determine the effectiveness of the medication?

Monitor numeric pain scale