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A client is prescribed digoxin (Lanoxin) 0.125mg PO daily and furosemide (Lasix) 20mg PO daily. Which of the following statements by the client should demonstrate to the nurse that the client has an accurate understanding regarding these medications?
a) "I will take my Lasix with my supper meal"
b) "I will measure my urine output and document it in my diary"
c) "I will skip a dose of my Lanoxin if my resting HR is below 72bpm"
d) "I will eat fruits and vegetables every day that have high-potassium content in them"
- d) "I will eat fruits and vegetables every day that have high-potassium content in them"
- -Hypokalemia is an adverse effect of Lasix therapy. Since the client is on Lanoxin, it is important to maintain the K+ level between 3.5 to 5.0 mg/dl to avoid Lanoxin toxicity.
Prior to administering Total Parenteral Nutrition (TPN) the nurse notices a marked separation of oil droplets from the rest of the solution. Which of the following actions should the nurse take?
a) Gently shake the solution until the oil is evenly dispersed.
b) Do nothing since this is the normal appearance of TPN.
c) Add a filter to the intravenous tubing line.
d) Return the solution to the pharmacy.
- d) Return the solution to the pharmacy.
- -The nurse should return the solution to the pharmacy is a noticeable layer of oil separation is observed. This is referred to as cracking of lipid emulsion, and the solution cannot be used.
The primary care provider prescribes heparin sodium (Heparin) IV 25,000 units in 500ml D5W to infuse at 900 units/hr. The nurse should set the IV pump at what ml/hr rate?
- -25,000 units/500 = X units/1ml -> x=50 units/ml
- -50 units/1ml = 900 units/X -> 50X=900 -> x=18
A nurse is caring for an infant who is fed expressed breast milk. The infant drank 2 oz of breast milk at 0800, 3 oz at 1100, and 2.5 oz at 1300. Which of the following should the nurse record on this client's intake record for the shift?
- c) 225ml
- -Multiply the total ounces by 30ml/oz. 7.5 X 30 = 225ml
The health care provider has changed a client's antyhypertensice medication from hydralazine (Apresoline) to metoprolol (Lopressor). The nurse should recognize that this change would mean the client is less likely to experience which of the following?
c) Sodium retention
- a) Tachycardia
- -Hydralazine can trigger reflex stimulation of the heart, thereby causing cardiac work and myocardial oxygen demand to increase. Whereas, metoprolol is used to treat reflex tachycardia but blocking beta adrenergic stimulation to the heart.
A client with a history of anxiety disorder presents at the mental health clinic experiencing a panic attack. The client is not currently on any medications, and the primary care provider prescribes a diazepam (Valium). The client asks the nurse, "Why can't I just take BuSpar like I used to?" The nurse should know that a disadvantage of buspirone (BuSpar) for this client is which of the following?
a) Sedative properties
b) Abuse potential
c) Delayed onset of action
d) Relatively long half-life
- c) Delayed onset of action
- -Buspirone is an effective nonbenzodiazepine antianxiety drug used for clients with anxiety disorders. However, it would not be a drug of choice for a client with acute anxiety, such as a person having a panic attack, because its effects are not usually evident for 7-10 days and may take up to 3-4 weeks for therapeutic levels to be achieved.
A client is prescribed nitroglycerine (Nitrostat) tablets to be taken sublingual for angina pain. Identify the sequence of instructions that the nurse should give to the client is he experiences chest pain.
1. Place tablet under tongue
2. Stop all activity
3. Call 911 if pain is not relieved
4. Wait 5 minutes
- 2, 1, 4, 3
- -The client should first stop all activity, place a tablet under the tongue, wait 5 minutes, and if pain is not relieved, call 911.
When a nurse is performing an admission history, a client reports using several herbal and vitamin supplements daily, including saw palmetto. The nurse should recognize that saw palmetto is a popular herb used by clients primarily to do which of the following?
a) Promote urinary health
b) Stimulate the immune system
c) Enhance memory and cognition
d) Boost vitality and libido
- a) Promote urinary health
- -Saw palmetto is used primarily for symptoms related to prostatic conditions such as benign prostatic hypertrophy (BPH).
A client tells a nurse, "I don't get the same relief as I used to with this pain medication." The nurse should recognize that the client is experiencing which of the following?
a) Drug addiction
b) Physical dependence
c) Drug tolerance
d) Psychological dependence
- c) Drug tolerance
- -Tolerance is indicated when a larger dose of the medication is needed to achieve the original pain relief. It may occur even over a short period of time.
A nurse is preparing a discharge teaching plan for a client who is prescribed albuterol (Preventil) MDI for asthma. Which of the following should the nurse recognize as the priority assessment?
a) Fine motor control
b) Use of OTC medications
c) Dietary preferences
d) Daily exercise routine
- a) Fine motor control
- -Fine motor control is necessary to use a MDI correctly. The greatest risk to the client would be inability to administer the medication. Therefore, assessment of fine motor control is the highest priority assessment.
The primary care provider prescribes chlorothiazide (Diuril) 25mg/kg/day PO BID for an infant weighing 6.5kg. Available is chlorothiazide 100mg per 5ml. How many ml should the nurse give to the child for each dose?
- -Total daily dose: 25mg X 6.5kg - 162.5 mg
- -Amount per dose: 162.5mg/2doses = 81.25 or 81.3mg
- -Dose needed: 81.3mg. Dose available: 100mg per 5ml
- -Set up equation: 100mg/5ml = 81.3ml/X -> 100X = 406.5 -> x=4.065ml or 4.1ml
A client has been taking theophylline (Theo-Dur) for relief of chronic bronchitis. Which of the following findings may indicate toxicity?
- b) Tremors
- -Theophylline is a xanthine derivative bronchodilator. The earliest manifestation of toxicity is central nervous system stimulation, often seen as tremors. Other manifestations include insomnia, confusion, and irritability.
A client is to receive Regular insulin (Humalin R) 20 units and NPH insulin (Humulin N) 30 units subcutaneously at 0730. The nurse anticipates the onset of insulin action to occur at which of the following?
- a) 0800
- -The onset of action for Regular insulin is 30-60 mins with a peak effect in 2-4 hrs.
A nurse is caring for a client who has dehydration secondary to diuretic therapy. Which of the following assessments should the nurse expect to find?
a) Dry mucous membranes
b) Distended neck veins
c) Increased blood pressure
d) Full, bounding radial pulses
- a) Dry mucous membranes
- -Dry mucous membranes is an expected finding with a fluid volume deficit.
To administer a Mantoux skin test for tuberculosis (TB), the appropriate nursing action is to:
a) Massage the area after administration of the medication
b) Administer the medication on the outer surface of the arm
c) Use a 21-gauge needle
d) Insert the needle with the bevel up
- d) Insert the needle with the bevel up
- -The tuberculin syringe should be held close to the skin so that the hub of the needle touches it as the needle is introduced bevel up. This reduces the needle angle at the skin surface and facilitates the injection of tuberculin just beneath the surface of the skin in order to form a wheal.
A client is admitted who has deep vein thrombosis. To produce the fastest anticoagulation effect, the nurse should anticipate the administration of which medication?
a) Aspirin (Ecotrin) PO
b) Heparin sodium IV
c) Ticlopidine (Ticlid) PO
d) Warfarin (Coumadin) PO
- b) Heparin sodium IV
- -Heparin sodium given IV will have immediate effects.
A nurse is providing teaching to a client being discharged with a prescription for warfarin (Coumadin). Which of the following should the nurse include in the teaching?
a) Take aspirin (ASA) as needed for headache
b) Carry a medic alert card at all times
c) Avoid regular exercise
d) Increase intake of dark green vegetables
- b) Carry a medic alert card at all times
- -A client taking warfarin is at increased risk for bleeding. In the case of an emergency, it is important that any medical personnel are aware of the client's medication history.
A nurse is planning care for a school-age child with asthma. Which of the following should the nurse anticipate will be prescribed as a rescue medication?
a) Montelukast (Singulair)
b) Cromolyn sodium (Intal)
c) Fluticasone propionate (Flovent)
d) Albuterol (Proventil)
- d) Albuterol (Proventil)
- -Albuterol is a beta 2-adrenergic agonist that is used to provide immediate relief for an acute asthma attack
A child is to receive 400ml of IV fluid in an 8-hr shift. The nurse should set the IVpump to deliver how many ml/hr?
- -The client is to receive 400ml in 8 hr. Therefore, 400ml/8hr - 50ml/hr
A nurse is to administer ampicillin/subactam (Unasyn) 250mg in 50ml of D5W IVPB to be infused over 20 mins. The drop factor on the infusion set will deliver 60gtt/ml. The nurse should set the IV to deliver how many gtt/min?
- 150 gtt/min
- -Volume to be infused X gtt factor = gtt/min
- 50ml/20min X 60 gtt = 150 gtt/min
A nurse is providing teaching to a client who is prescribed hydrochlorothiazide (Oretic) for hypertension. The nurse instructs the client to eat foods rich in potassium. Which of the following comments by the client should indicate to the nurse that he understands the rationale for the potassium-rich diet?
- a) "This medication will not work unless I have enough potassium."
- b) "Potassium will increase the therapeutic effect of my blood pressure medication."
- c) Potassium will lower my blood pressure."
- d) This medication may cause a loss of potassium."
- d) This medication may cause a loss of potassium."
- -Hydrochlorothiazide may result in hypokalemia. The client should supplement his diet with K+ enriched foods to avoid the occurrence of hypokalemia, Foods that are high in potassium include bananas, raisins, baked potatoes, pumpkin, and milk.
A nurse should know that a client taking isoniazid (INH) will need frequent monitoring of which of the following?
a) Thyroid hormones
b) Aspartate aminotransferase (AST)
c) Blood Glucose
- b) Aspartate aminotransferase (AST)
- -AST is part of liver function studies. These liver enzymes are monitored to detect the effects of INH that might be toxic to the liver. They should be monitored before drug therapy is started and at least monthly during the course of therapy.
A nurse is caring for a client with peptic ulcer disease who is prescribed bismuth subsalicylate (Pepto-Bismol). Bismuth subsalicylate is used in the treatment of peptic ulcer disease because of its:
a) Antimicrobial action.
b) Anticoagulation action.
c) Ability to increase gastric secretions.
d) Ability to neutralize gastric secretions.
- a) Antimicrobial action.
- -Bismuth subsalicylate is effective in treating peptic ulcer disease when the ulcer is caused by the bacteria, H. Pylori. It also coats the stomach and ulcer providing protection from gastric juices.
A client is being treated for congestive heart failure (CHF). Included in the client's orders is a prescription for furosemind (Lasix) 20mg PO daily. The nurse should assess the client for which of the following?
- c) Hypokalemia
- -Furosemide is a potent loop diuretic. With Lasix, potassium excretion is increased and may lead to hypokalemia.
A 4 year old child is admitted to the hospital with periorbital cellulitis. The child weighs 15kg and the health care provider prescribes cefazolin (Kefzol) 600mg IVPB every 8 hr. The medication manual states that Kefzol can be given 50 to 100 mg/kg/day. Which of the following should the nurse do?
a) Modify the dose to be in the safe range
b) Question giving cefazolin to treat periorbital cellulitis
c) Give the cefazolin as ordered
d) Discuss the dose with the primary care provider
- d) Discuss the dose with the primary care provider
- -The nurse should question the order with the primary care provider because the dose is higher than the acceptable range.
A client has had emergency surgery for a ruptured appendix. Medications the client has been taking prior to surgery include dexamethasone (Decadron) 4mg BID. Because the client was on this medication before surgery, the nurse should recognize that the client will be which of the following?
a) Be less susceptible to hemmorrhage
b) Have improved wound healing
c) Be more prone to developing infections
d) Have a greater risk for hypoglycemia
- c) Be more prone to developing infections
- -Dexamethasone is a glucocorticosteroid and has an immunosuppressant effect that increases the risk of infection. With a ruptured appendix, this client is already at risk for severe infection.
An older adult client is admitted to the mental health unit for a diagnostic work-up because he is experiencing increased forgetfulness and disorientation at home. The client has been taking lorazepam (Ativan) 0.5mg PO PRN to control restlessness. For which of the following should the nurse monitor the client?
b) Profound sedation
c) Excessive diuresis
- b) Profound sedation
- -Lorazepam is a benzodiazepine with anti-anxiety and sedative effects. Older adult clients are at greater risk for central nervous system depression even with low doses of benzodiazepines. Clients over the age of 50 years may have a more profound and prolonged sedation than younger clients.
A client was prescribed ciproflaxacin hydrochloride (Cipro) and phenazopyridine (Pyrodium) to treat a urinary tract infection. The client asks the nurse why both medications are needed. Which of the following is an appropriate response by the nurse?
a) "Phenazopyridine decreases the side effects of ciproflaxacin hydrochloride."
b) "Combining phenazopyridine with ciproflaxacin hydrochloride shortens the course of therapy."
c) "The use of phenazopyridine allows for a lower dosage of ciproflaxacin hydrochloride."
d) "Ciproflaxacin hydrochloride treats the infection, and the phenazopyridine treats the pain and discomfort."
- d) "Ciproflaxacin hydrochloride treats the infection, and the phenazopyridine treats the pain and discomfort."
- -Ciproflaxacin hyrdochloride is an effective antibiotic for UTIs and phenazopyridine relieves urinary tract pain and discomfort.
A client is admitted to the labor unit who has premature rupture of membrane and is given betamethasone (Celestone). The nurse should recognize that this drug is used for which of the following?
a) Enhancement of fetal oxygenation
b) Promotion of uterine relaxation
c) Prevention of chorioamnionitis
d) Developmental of fetal lung maturity
- d) Developmental of fetal lung maturity
- -Betamethasone is a glococorticoid that acts to accelerate fetal lung maturity in the client with preterm labor.
Fifteen minutes after beginning a transfusion of packed red blood cells, a nurse obtains the first set of vital signs and notes the client is febrile, tachycardiac, flushed, and reporting chills. Which of the following actions should the nurse take first?
a) Notify the primary care provider
b) Check the client's vital signs
c) Stop the infusion
d) Obtain a urine specimen
- c) Stop the infusion
- -This client is exhibiting manifestations of either hemolytic or febrile nonhemolytic transfusion reaction. The first action the nurse should take is to stop the infusion.
The primary care provider prescribes digoxin (Lanoxin) 0.2mg IVP for a client. The amount available is digoxin 0.5mg/2ml. How many ml should the nurse administer?
- b) 0.8ml
- -0.5mg/0.2mg = 2ml/Xml -> 0.5X = 0.4 -> X=0.8ml
A nurse is providing teaching to a client who is prescribed clonidine (Catapres). Which of the following instructions should the nurse include?
a) Discontinue the medication if you develop a rash
b) Take the medication in the morning
c) Minimize fiber intake to prevent diarrhea
d) Change positions slowly
- d) Change positions slowly
- -Clonodine may cause orthostatic hypotension. The client should be instructed to change positions slowly, such as from a lying to a sitting position and from a sitting to a standing position, tp prevent dizziness.
Shortly after administering the 0900 medications, a nurse realizes that digoxin (Lanoxin) 0.125mg was administered to the client instead of the prescribed furosemide (Lasix) 2.5mg. Which of the following actions should the nurse take first?
a) Notify the primary care provider
b) Assess the client's apical pulse
c) Contact the nursing supervisor
d) Complete an incident report
- b) Assess the client's apical pulse
- -The first action the nurse should take is to assess the client. Using the nursing process, collecting more date is the first step. TEST-TAKING STRATEGY: Whenever you are confronted with a priority setting question where all four choices appear right, but it includes various stages of the nursing process (assessment, interventions, evaluations), use the nursing process to help set the priorities. Remember that assessment always comes first, followed by analysis, planning, intervening, and finally evaluating.
A nurse is caring for a dehydrated client. The primary care provider has prescribed an IV fluid bolus of 1 liter 0.9% sodium chloride over 2 hr. The nurse should set the IV to deliver at what ml/hr rate?
- -Remember that 1L - 1,000ml. The nurse must deliver 1000ml in 2 hrs, which is 500ml/hr
A nurse is preparing a discharge teaching plan for a client on long-term oral glucocorticoid therapy for asthma. Which of the following should the nurse include in the plan?
a) Stop taking the medication if a rash occurs
b) Take the medication on an empty stomach to enhance absorption
c) Schedule the medication on alternate days to decrease side effects
d) Treat shortness of breath with an extra dose of the medication
- c) Schedule the medication on alternate days to decrease side effects
- -Some of the side effects of long-term glucocorticoid therapy can be avoided by using alternate day therapy.
A health care provider prescribes verapamil (Calan) 100mg PO TID for a client with angina pectoris. The client states, "My brother takes verapamil for high blood pressure. So you think the doctor made a mistake?" Which of the following would be an appropriate response from the nurse?
a) "Verapamil has more than one action and is used to treat anginal pain."
b) "I'll check with your provider to verify the order."
c) "Are you concerned that you might have high blood pressure?"
d) "Your provider has prescribed verapamil so that you will not develop high blood pressure."
- a) "Verapamil has more than one action and is used to treat anginal pain."
- -Verapamil is a calcium channel blocker that is used for both hypertension and anginal pain.
The primary care provider prescribes Ampicillin (Omnipen) 100mg/kg/day PO to be given in 4 divided doses. The client weight 33lb. Available is amoxicillin 125mg/5ml. How many ml should the nurse administer for each dose?
- -Client's weight in KG: 33lb divided by 2.2 = 15kg
- -Total daily dose: 100mg X 15kg = 1500 mg
- -Amount per dose: 15000mg divided by 4 doses = 375mg
- -Dose needed = 375mg. Dose available = 125mg/5ml
- -Set up equation and solve: 125mg/5ml = 375mg/Xml -> 125X = 1875 -> X=15ml
A client who has congestive heart failure (CHF) is taking spironlactone (Aldactone). Which of the following statements by the client requires further teaching by the nurse?
a) "I try to limit my intake of foods high in potassium"
b) "I like to use a salt substitute since I am on sodium retention"
c) "I take this medication everyday with my breakfast"
d) "I will weigh myself every 2-3 days and will report a weight gain of 3lb per day"
- b) "I like to use a salt substitute since I am on sodium retention"
- -Spironlactone is a potassium-sparing diuretic. Clients who are taking potassium-sparing diuretics should not use salt suvstitutes as these contain potassium and place the client at risk for hyperkalemia.
A nurse is administering hydroxyzine (Vistaril) to a client. Which of the following should the nurse instruct the client to expect?
c) Nausea & Vomiting
d) Dry mouth
- d) Dry mouth
- -Hydroxizine has anticholinergic properties. Dry mouth is a possible side effect
A client is discharged from the hospital with a prescription for diazepam (Valium). The nurse should instruct the client to avoid ingesting which of the following?
a) Alcoholic beverages
b) Cheddar cheese
d) Dairy products
Valium is a benzodiazepine antianxiety agent. Drinking alcoholic beverages would potentiate the CNS depressant effects of Valium. This could produce extreme sedation and potentially lead to a lethal overdose.
A nurse is caring for a client who is prescribed 5-FU (Flurouracil), an antineoplastic drug. When the client asks the nurse the classification of the drug, the appropriate response by the nurse should be which of the following?
b) Plant alkaloid
c) Alkylating agent
- a) Antimetabolite
- -5 FU belongs to the classification of antineoplastic drugs called antimetabolites
A nurse is caring for a client with congestive heart failure who is being treated with digoxin (Lanoxin). When the nurse brings in the client's breakfast tray, the client reports nausea. Which of the following is the first action the nurse should take?
a) Suggest the client try eating the toast
b) Administer an antiemetic
c) Inform the client's primary care provider
d) Check the client's apical pulse
- d) Check the client's apical pulse
- -The nurse should recognize that nausea is a sign of digoxin (Lanoxin) toxicity and should further assess the client to determine is there are other indications of digoxin toxicity, such as a slow apical pulse. Therefore, the first action the nurse should take is to check the client's apical pulse.
A nurse is providing discharge teaching to a client taking lithium (Eskalith). Which of the following behaviors should the nurse caution the client against to prevent lithium toxicity?
a) Mild exercise
c) Increased sodium intake
d) Decreased sleeping
- b) Fasting
- -Crash dieting or fasting can lead to lithium toxicity because the sodium and electrolyte balance would be altered, causing the blood levels of lithium to rise.
A nurse is teaching a client who is recovering from a renal transplant about the discharge medication regimen. The nurse should evaluate that the client understands the purpose of cyclosporin (Sandimmune) when the client states, "I will need to take the Sandimmune:
a) to help my new kidney make adaquate urine."
b) for the rest of my life."
c) until my blood urea nitrogen (BUN) returns to normal."
d) in order to boost my immune system."
- b) for the rest of my life."
- -Cyclosporine is an immunosuppressive agent. IT is used to reduce the body's natural immunity in clients who receive organ transplants and prevent rejection. Clients will need to take immunosuppressive therapy for the remainder of their lives.
A nurse is preparing to administer IM iron dextran (Infed) to a client. Which of the following is the appropriate site for administration?
a) Vastus Lateralis
- b) Dorsogluteal
- -Iron dextran should be administered into a deep, large muscle using the Z-tract method
A female client has been hospitalized for major depression with anitriptyline (Elavil). While preparing for discharge, whoch of the following statements by the client should indicate to the nurse a need for further instruction?
a) "I will see my psychiatrist regularly. If I continue to do well, maybe I can stop taking medication in a year."
b) "If I should feel hopeless and suicidal again, I have the telephone number of my therapist to call for help."
c) "I'm glad this medicine helps me. My husband and I would like to start our family as soon as possible"
d) "I might still have days when I am feeling down, so I will write in my journal to help me feel better."
- c) "I'm glad this medicine helps me. My husband and I would like to start our family as soon as possible"
- -Amitriptyline (Elavil) is a tricyclic antidepressant. Tricyclic antidepressants should be avoided during pregnancy, especially during the first trimester because they are associated with fetal anomalies.
A nurse administers procainamide (Pronestyl) 100mg intravenous push to a client who has developed paroxysmal atrial tachycardia. For which of the following should the nurse monitor the client?
d) Throbbing headache
- c) Hypotension
- -Blood pressure should be monitored continuously throughout intravenous administration. If the blood pressure drops more than 15mm Hg, intravenous administration is usually discontinued. The client should remain supine to minimize hypotension.
A nurse is planning to administer an osmotic laxative to a client. The nurse should recognize that these types of laxatives work by doing which of the following?
a) Lubricating the fecal material
b) Irritating the colonic nerve endings
c) Pulling water into the colon and feces
d) Promoting fecal absorption of fat and water
- c) Pulling water into the colon and feces
- -The osmotic laxatives work by pulling water into the colon and feces, thereby increasing bulk and stimulating peristalsis
The primary care provider prescribes codeine elixir 5mg PO every 4 hr PRN for pain. Available is codein 7.5mg/15ml. The nurse should administer what does in ml?
- -7.5mg/5mg = 15ml/Xml -> 7.5X = 75 -> x = 10ml
The nurse should recognize that nifedipine (Adalat) suppresses uterine contractions by doing which of the following?
a) Decreasing the amount of prostaglandins, which interfere with uterine activity
b) Inhibiting uterine contractions by blocking calcium channels
c) Decreasing the activity within the central nervous system, which regulates all smooth muscle
d) Stimulating beta 2 receptors, which results in uterine relaxation
- b) Inhibiting uterine contractions by blocking calcium channels
- -Adalat does cause uterine relaxation by blocking the flow of calcium to the myometrial cells
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