Reviewing the medical record of a client

• A nurse is assessing a client who is taking levothyroxine. The nurse should recognize that which of the following findings is a manifestation of levothyroxine overdose?
  1. Insomnia
     1. Rationale: Levothyroxine overdose will result in manifestations of hyperthyroidism, which include Insomnia, tachycardia, and hyperthermia.
  2. Constipation
     1. Rationale: Constipation is a manifestation of hypothyroidism and indicates an inadequate dose of levothyroxine.
  3. Drowsiness
     1. Rationale: Drowsiness is a manifestation of hypothyroidism and indicates an inadequate dose of levothyroxine.
  4. Hypoactive deep-tendon reflexes
     1. Rationale: Hypoactive deep-tendon reflexes are manifestations of hypothyroidism and indicate an inadequate dose of levothyroxine.

• A nurse is reviewing the medical record of a client who has been on levothyroxine for several months. Which of the following findings indicates a therapeutic response to the medication?
  1. Decrease in level of thyroxine (T4)
     4. Rationale: If the dose of this medication has been adequate, the nurse should see an increase in the T4.
  2. Increase in weight
     1. Rationale: If the dose of this medication has been adequate, the nurse should see a decrease in weight, as hypothyroidism causes a decrease in metabolism with weight gain.
  3. Increase in hr of sleep per night
     1. Rationale: If the dose of this medication has been adequate, the nurse should see a decrease in the hr of sleep per night, as hypothyroidism causes sluggishness with increased hr of sleep.
  4. Decrease in level of thyroid stimulating hormone (TSH).
     1. Rationale: In hypothyroidism, the nonfunctioning thyroid gland is unable to respond to the TSH, and no endogenous thyroid hormones are released. This results in an elevation of the TSH level as the anterior pituitary continues to release the TSH to stimulate the thyroid gland. Administration of exogenous thyroid hormones, such as levothyroxine, turns off this feedback loop, which results in a decreased level of TSH.

• A nurse is reviewing the medication list for a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize which of the following medications can cause glucose intolerance?
  1. Ranitidine
     1. Serum creatinine levels
  2. Guafenesin
     1. Drowsiness and dizziness
  3. Prednisone
     1. Glucose intolerance and hyperglycemia, patient might require increased dosage of hypoglycemic med.
  4. Atorvastatin
     1. Thyroid function tests.

• A nurse is caring for a client receiving mydriatic eye drops. Which of the following clinical manifestations indicates to the nurse that the client has developed a systemic anticholinergic effect?
  1. Seizures
  2. Tachypnea
  3. Constipation
     1. Mydriatic eye drops can cause systemic anticholinergic effects such as constipation, dry mouth, photophobia, and tachycardia.
  4. Hypothermia

• A nurse is caring for a client who has heart failure and is receiving IV furosemide. The nurse should monitor the client for which of the following electrolyte imbalances?
  1. Hypernatremia
     1. Rationale: The nurse should monitor the client who is receiving IV furosemide for hyponatremia.
  2. Hyperuricemia
     1. Rationale: The nurse should monitor the client who is receiving IV furosemide for hyperuricemia. The nurse should instruct the client to notify the provider for any tenderness or swelling of the joints.
  3. Hypercalcemia
     1. Rationale: The nurse should monitor the client who is receiving IV furosemide for hypocalcemia.
  4. Hyperchloremia
     1. Rationale: The nurse should monitor the client who is receiving IV furosemide for hypochloremia.

• A nurse is talking to a client who is taking a calcium supplement for osteoporosis. The client tells the nurse she is experiencing flank pain. Which of the following adverse effects should the nurse suspect?
  1. Renal stones

• A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin?
  1. Hemoglobin
  2. Prothrombin time (PT)
     1. Rationale: This test is used to monitor warfarin therapy. For a client receiving full anticoagulant therapy,should typically be approximately two to three times the normal value, depending on the indication for therapeutic anticoagulation.
  3. Bleeding time
  4. Activated partial thromboplastin time (aPTT)

• A nurse is preparing to administer a dose of lactulose to a client who has cirrhosis. The client states, "I don't need this medication. I am not constipated." The nurse should explain that in clients who have cirrhosis, lactulose is used to decrease levels of which of the following components in the bloodstream?
  1. Glucose
  2. Ammonia
     1. Rationale: Lactulose, a disaccharide, is a sugar that works as an osmotic diuretic. It prevents absorption of ammonia in the colon. Accumulation of ammonia in the bloodstream, which occurs in pathologic conditions of the liver, such as cirrhosis, may affect the central nervous system, causing hepatic encephalopathy or coma.
  3. Potassium
  4. Bicarbonate
• A nurse is educating a group of clients about the contraindications of warfarin therapy. Which of the following statements should the nurse include in the teaching?
  1. "Clients who have glaucoma should not take warfarin."
  2. "Clients who have rheumatoid arthritis should not take warfarin."
  3. "Clients who are pregnant should not take warfarin."
     1. Rationale: Warfarin therapy is contraindicated in the pregnant client because it crosses the placenta and places the fetus at risk for bleeding.
  4. "Clients who have hyperthyroidism should not take warfarin."
• A nurse is teaching a client who takes warfarin daily. Which of the following statements by the client indicates a need for further teaching?
  1. "I have started taking ginger root to treat my joint stiffness."
     1. Rationale: Ginger root can interfere with the blood clotting effect of warfarin and place the client at risk for bleeding. This statement indicates the client needs further teaching.
  2. "I take this medication at the same time each day."
     1. Rationale: The client should take warfarin at the same time each day to maintain a stable blood level.
  3. "I eat a green salad every night with dinner."
     1. Rationale: Green leafy vegetables are a good source of vitamin K, which can interfere with the clotting effects of warfarin. Clients who are taking warfarin do not need to restrict dietary vitamin K intake but rather should maintain a consistent intake of vitamin K in order to control the therapeutic effect of the medication.
  4. "I had my INR checked three weeks ago.
     1. " Rationale: Clients who have been taking warfarin for more than 3 months should have their INR level checked every 2 to 4 weeks.

• A patient is starting warfarin (Coumadin) therapy as part of treatment for atrial fibrillation. The nurse will follow which principles of warfarin therapy? (Select all that apply.)
  1. Teach proper subcutaneous administration
  2. Administer the oral dose at the same time every day
  3. Assess carefully for excessive bruising or unusual bleeding
  4. Monitor laboratory results for a target INR of 2 to 3
  5. Monitor laboratory results for a therapeutic aPTT value of 1.5 to 2.5 times the control value

• Atorvastatin can elevate LFT
  1. Baseline total cholesterol, LDL and HDL level, triglycerides, and liver and renal function test obtained and then monitored periodically throughout treatment
• The nurse teaches a client who is recovering from acute kidney disease to avoid which type of medication?
  1. NSAIDS
     1. NSAIDs may be nephrotoxic to a client with acute kidney disease, and should be avoided. ACE inhibitors are used for treatment of hypertension and to protect the kidneys, especially in the diabetic client, from progression of kidney disease. Opiates may be used by clients with kidney disease if severe pain is present; however, excretion may be delayed. Calcium channel blockers can improve the glomerular filtration rate and blood flow within the kidney.
  2. ACE inhibitors
  3. Opiates
  4. Calcium channel blockers
• Which of the following are adverse reactions related to the use of CELECOXIB? Select all that apply
  1. Rhinitis
  2. Neutropenia
  3. Oliguria
  4. Stomatitis

• A nurse is caring for a client who has active pulmonary tuberculosis (TB) and is to be started on intravenous rifampin therapy. The nurse should instruct the client that this medication can cause which of the following adverse effects?
  1. Constipation
  2. Black colored stools
  3. Staining of teeth
  4. Body secretions turning a red-orange color
     1. Rationale: Rifampin is used in combination with other medicines to treat TB. Rifampin will cause the urine, stool, saliva

• A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first?
  1. Check the client's vital signs.
     1. Rationale: It is possible that the client's nausea is secondary to digoxin toxicity. Assess for bradycardia, a symptom of digoxin toxicity. The nurse should withhold the medication and call the provider if the client's heart rate is less than 60 bpm.
  2. Request a dietitian consult.
  3. Suggest that the client rests before eating the meal.
  4. Request an order for an antiemetic.

• A nurse is caring for a client who has difficulty swallowing medications and is prescribed enteric-coated aspirin PO once daily. The client asks if the medication can be crushed to make it easier to swallow. Which of the following responses should the nurse provide?
  1. "Crushing the medication might cause you to have a stomachache or indigestion.
     1. Rationale: The pill is enteric-coated to prevent breakdown in the stomach and decrease the possibility of GI distress. Crushing destroys protection.
  2. "Crushing the medication is a good idea, and I can mix it in some ice cream for you.”
  3. "Crushing the medication would release all the medication at once, rather than over time."
  4. "Crushing is unsafe, as it destroys the ingredients in the medication."

• A nurse is caring for a client who has thrombophlebitis and is receiving heparin by continuous IV infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give?
  1. "It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level."
  2. "A pharmacist is the person to answer that question."
  3. "Heparin does not dissolve clots. It stops new clots from forming."
     1. Rationale: This statement accurately answers the client's question.
  4. "The oral medication you will take after this IV will dissolve the clot.

• A nurse is caring for a client who has bipolar disorder and has been taking lithium for 1 year. Before administering the medication, the nurse should check to see that which of the following tests have been completed?
  1. Thyroid hormone assay
     1. Rationale: Thyroid testing is important because long-term use of lithium may lead to thyroid dysfunction.
  2. Liver function tests:
     1. Rationale: LFTs must be monitored before and during valproic acid therapy
  3. Erythrocyte sedimentation rate
     1. Rationale: This is not a necessary test related to lithium therapy.
  4. Brain natriuretic peptide
• A nurse caring for a client who has hypertension and asks the nurse about a prescription for propranolol. The nurse should inform the client that this medication is contraindicated in clients who have a history of which of the following conditions?
  1. Asthma
     1. Rationale: Propranolol, a beta-blocker, is contraindicated in clients who have asthma because it can cause bronchospasms. Propranolol blocks the sympathetic stimulation, which prevents smooth muscle relaxation.
  2. Glaucoma
  3. Depression
  4. Migraines

• A nurse is teaching a client who has a new prescription for colchicine to treat gout. Which of the following instructions should the nurse include?
  1. "Take this medication with food if nausea develops."
  2. "Monitor for muscle pain."
     1. Rationale: This medication can cause rhabdomyolysis. The client should monitor and report muscle pain.
  3. "Expect to have increased bruising."
  4. "Increase your intake of grapefruit juice”

• A nurse is teaching a client who has a urinary tract infection (UTI) and is taking ciprofloxacin. Which of the following instructions should the nurse give to the client?
  1. "If the medicine causes an upset stomach, take an antacid at the same time."
  2. "Limit your daily fluid intake while taking this medication."
  3. "This medication can cause photophobia, so be sure to wear sunglasses outdoors."
  4. "You should report any tendon discomfort you experience while taking this medication."
     1. Rationale: The nurse should instruct the client to report any tendon discomfort as well as swelling or inflammation of the tendons due to the risk of tendon rupture.

• A nurse is caring for a client who has cancer and a new prescription for ondansetron to treat chemotherapy-induced nausea. For which of the following adverse effects should the nurse monitor?
  1. Headache
     Rationale: Headache is a common adverse effect of ondansetron. Analgesic relief is often required.
  2. Dependent edema
  3. Photosensitivity

• A nurse is preparing to administer verapamil by IV bolus to a client who is having cardiac dysrhythmias. For which of the following adverse effects should the nurse monitor when giving this medication?
  1. Hyperthermia
  2. Hypotension
     1. Rationale: Verapamil, a calcium channel blocker, can be used to control supraventricular tachyarrhythmias. It also decreases blood pressure and acts as a coronary vasodilator and antianginal agent. A major adverse effect of verapamil is hypotension; therefore, blood pressure and pulse must be monitored before and during parenteral administration.
  3. Ototoxicity
  4. Muscle pain

• A nurse is providing teaching to a client who has renal failure and an elevated phosphorous level. The provider instructed the client to take aluminum hydroxide 300 mg PO three times daily. For which of the following adverse effects should the nurse inform the client?
  1. Constipation
     1. Rationale: Constipation is a common side effect of aluminum-based antacids. The nurse should instruct the client to increase fiber intake and that stool softeners or laxatives may be needed
  2. Metallic taste
  3. Headache
  4. Muscle spasms

• A nurse is teaching a client who has been taking prednisone to treat asthma and has a new prescription to discontinue the medication. The nurse should explain to the client to reduce the dose gradually to prevent which of the following adverse effects?
  1. Hyperglycemia
  2. Adrenocortical insufficiency
     1. Rationale: Prednisone, a corticosteroid, is similar to cortisol, the glucocorticoid hormone produced by the adrenal glands. It relieves inflammation and is used to treat certain forms of arthritis, severe allergies, autoimmune disorders, and asthma. Administration of glucocorticoids can suppress production of glucocorticoids, and an abrupt withdrawal of the drug can lead to a syndrome of adrenal insufficiency.
  3. Severe dehydration
  4. Rebound pulmonary congestion

• A nurse is preparing a client for surgery. Prior to administering the prescribed hydroxyzine, the nurse should explain to the client that the medication is for which of the following indications? (Select all that apply.)
  1. Controlling emesis
  2. Diminishing anxiety
  3. Reducing the amount of narcotics needed for pain relief
  4. Preventing thrombus formation
  5. Drying secretions

• A nurse is caring for a client who has acute respiratory distress syndrome (ARDS), and requires mechanical ventilation. The client receives a prescription for pancuronium. The nurse recognizes that this medication is for which of the following purposes?
  1. Decrease chest wall compliance
  2. Suppress respiratory effort
     1. Rationale: Neuromuscular blocking agents, such as pancuronium, induce paralysis and suppress the client's respiratory efforts to the point of apnea, allowing the mechanical ventilator to take over the work of breathing for the client. This therapy is especially helpful for a client who has ARDS and poor lung compliance.
  3. Induce sedation
  4. Decrease respiratory secretions

• A nurse is caring for a client who is taking lisinopril. Which of the following outcomes indicates a therapeutic effect of the medication?
  1. Decreased blood pressure
     1. Rationale: Lisinopril, an ACE inhibitor, may be used alone or in combination with other antihypertensives in the management of hypertension and congestive heart failure. A therapeutic effect of the medication is a decrease in blood pressure.
  2. Increase of HDL cholesterol
     1. Rationale: This is not an intended effect of lisinopril.
  3. Prevention of bipolar manic episodes
     1. Rationale: This is not an intended effect of lisinopril.
  4. Improved sexual function
     1. Rationale: This is not an intended effect of lisinopril. Lisinopril may in fact cause sexual dysfunction and impotence.

• A nurse is caring for a client who has poison ivy and is prescribed diphenhydramine. Which of the following instructions should the nurse give regarding the adverse effect of dry mouth associated with diphenhydramine?
  1. Administer the medication with food
  2. Chew on sugarless gum or suck on hard, sour candies
     1. Rationale: Clients who report dry mouth can get the most effective relief by sucking on hard candies (especially the sour varieties that stimulate salivation), chewing gum, or rinsing the mouth frequently. It is the local effect of these actions that provides comfort to the client.
  3. Place a humidifier at your bedside every evening
  4. Discontinue the medication and notify your provider

• A nurse on an oncology unit is preparing to administer doxorubicin to a client who has breast cancer. Prior to beginning the infusion, the nurse verifies the client's current cumulative lifetime dose of the medication. For which of the following reasons is this verification necessary?
  1. An excess amount of doxorubicin can lead to myelosuppression.
  2. Exceeding the lifetime cumulative dose limit of doxorubicin might cause extravasation.
  3. An excess amount of doxorubicin can lead to cardiomyopathy.
     1. Rationale: Doxorubicin is an antineoplastic antibiotic used in the treatment of various cancers. Irreversible cardiomyopathy with congestive heart failure can result from repeated doses of doxorubicin, and prolonged use can also cause severe heart damage, even years after the client has stopped taking it. The maximum cumulative dose a client should receive is 550 mg/m or 450
        mg/m with a history of radiation to the mediastinum.
  4. Exceeding the lifetime cumulative dose limit of doxorubicin might produce red tinged urine and sweat.

• A nurse on an oncology unit is preparing to administer doxorubicin to a client who has breast cancer. Prior to beginning the infusion, the nurse verifies the client's current cumulative lifetime dose of the medication. For which of the following reasons is this verification necessary?
  1. An excess amount of doxorubicin can lead to myelosuppression.
  2. Exceeding the lifetime cumulative dose limit of doxorubicin might cause extravasation.
  3. An excess amount of doxorubicin can lead to cardiomyopathy.
     1. Rationale: Doxorubicin is an antineoplastic antibiotic used in the treatment of various cancers. Irreversible cardiomyopathy with congestive heart failure can result from repeated doses of doxorubicin, and prolonged use can also cause severe heart damage, even years after the client has stopped taking it. The maximum cumulative dose a client should receive is 550 mg/m or 450
        mg/m with a history of radiation to the mediastinum.
  4. Exceeding the lifetime cumulative dose limit of doxorubicin might produce red tinged urine and sweat.

• A nurse at an ophthalmology clinic is providing teaching to a client who has open angle glaucoma and a new prescription for timolol eye drops. Which of the following instructions should the nurse provide?
  1. The medication is to be applied when the client is experiencing eye pain.
  2. The medication will be used until the client's intraocular pressure returns to normal.
  3. The medication should be applied on a regular schedule for the rest of the client's life.
     1. Rationale: Medications prescribed for open angle glaucoma are intended to enhance aqueous outflow, or decrease its production, or both. The client must continue the eye drops on an uninterrupted basis for life to maintain intraocular pressure at an acceptable level.
  4. The medication is to be used for approximately 10 days, followed by a gradual tapering off.
• A nurse is providing teaching to a client who has emphysema and a new prescription for theophylline. Which of the following instructions should the nurse provide?
  1. Consume a high-protein diet.
     1. Rationale: The nurse should instruct the client that a high-protein diet should be avoided, as it decreases theophylline's duration of action.
  2. Administer the medication with food.
     1. Rationale: The nurse should instruct the client that theophylline should be administered with 8 oz of water if GI upset occurs. It should not be administered with food.
  3. Avoid caffeine while taking this medication.
     1. Rationale: The nurse should instruct the client that caffeine should be avoided while taking theophylline, as it can increase central nervous system stimulation.
  4. Increase fluids to 1L/per day.
     1. Rationale: The nurse should instruct the client to increase fluid intake to 2L/day while taking theophylline to decrease the thickness of mucous secretions related to emphysema.

• A nurse is caring for a client who is taking naproxen following an exacerbation of rheumatoid arthritis. Which of the following statements by the client requires further discussion by the nurse?
  1. "I signed up for a swimming class."
  2. "I've been taking an antacid to help with indigestion."
     1. NSAIDs, like naproxen, can cause serious adverse gastrointestinal reactions such as ulceration, bleeding, and perforation. Warning manifestations such as nausea or vomiting, gastrointestinal burning, and blood in the stool reported by the client require further investigation by the nurse. The client might be taking an antacid because he is experiencing one or more of these manifestations.
  3. "I've lost 2 pounds since my appointment 2 weeks ago."
  4. "The naproxen is easier to take when I crush it and put it in applesauce."
• A nurse is performing discharge teaching for a client who has seizures and a new prescription for phenytoin. Which of the following statements by the client indicates a need for further teaching?
  1. "I will notify my doctor before taking any other medications."
  2. "I have made an appointment to see my dentist next week."
  3. "I know that I cannot switch brands of this medication."
  4. "I'll be glad when I can stop taking this medicine."
     1. Rationale: Phenytoin is an anticonvulsant used to treat various types of seizures. Clients on anticonvulsant medications commonly require them for lifetime administration, and phenytoin should not be stopped without the advice of the client's provider.

• A nurse is teaching a client who has asthma about how to use an albuterol inhaler. Which of the following actions by the client indicates an understanding of the teaching?
  1. The client holds his breath for 10 seconds after inhaling the medication.
     1. Rationale: The medication should be retained in the lungs for a minimum of 10 seconds so the maximum amount of the dosage can be delivered properly to the airways. To use the inhaler, the client exhales normally just prior to releasing the medication, inhales deeply as the medication is released, then holds the medication in the lungs for approximately 10 seconds prior to exhaling.
  2. The client takes a quick inhalation while releasing the medication from the inhaler.
  3. The client exhales as the medication is released from the inhaler.
     1. Rationale: Exhaling as the medication is released from the inhaler means that no medication will reach the client's bronchioles. The client should inhale slowly as the medication is released from the inhaler.
  4. The client waits 10 min between inhalations.
     1. Rationale: The client should wait approximately 20 to 30 seconds between inhalations of the same medication, and 2 to 5 minutes between inhalations of different medications for maximum benefit.

• A nurse is providing discharge teaching to a client who has asthma and new prescriptions for cromolyn and albuterol, both by nebulizer. Which of the following statements by the client indicates an understanding of the teaching?
  1. “If my breathing begins to feel tight, I will use the cromolyn immediately.”
  2. “I will be sure to take the albuterol before taking the cromolyn.”
     1. Rationale: The client should always use the bronchodilator (albuterol) prior to using the leukotriene modifier (cromolyn). Using the bronchodilator first allows the airways to be opened, ensuring that the maximum dose of medication will get to the client's lungs.
  3. “I will use both medications immediately after exercising.”
  4. “I will administer the medications 10 minutes apart.”

• A nurse is caring for a client who has heart failure and a prescription for digoxin. Which of the following statements by the client indicates an adverse effect of the medication?
  1. "I can walk a mile a day."
  2. "I've had a backache for several days."
  3. "I am urinating more frequently."
  4. "I feel nauseated and have no appetite."
     Rationale: Anorexia, nausea, vomiting, and abdominal discomfort are early signs of digoxin toxicity.

• A nurse is caring for a client who has HIV-1 infection and is prescribed zidovudine as part of antiretroviral therapy. The nurse should monitor the client for which of the following adverse effects of this medication?
  1. Cardiac dysrhythmia
  2. Metabolic alkalosis
  3. Renal failure
  4. Aplastic anemia

• A nurse is caring for a client who has chronic renal disease and is receiving therapy with epoetin alfa. Which of the following laboratory results should the nurse review for an indication of a therapeutic effect of the medication?
  1. The leukocyte count
  2. The platelet count
  3. The hematocrit (Hct)
     1. Rationale: Epoetin alfa is an antianemic medication that is indicated in the treatment of clients who have anemia due to reduced production of endogenous erythropoietin, which may occur in clients who have end-stage renal disease or myelosuppression from chemotherapy. The therapeutic effect of epoetin alfa is enhanced red blood cell production, which is reflected in an increased RBC, Hgb, and Hct.
  4. The erythrocyte sedimentation rate (ESR)

• A nurse is providing teaching for a client who is newly diagnosed with type 2 diabetes mellitus and has a prescription for glipizide. Which of the following statements by the nurse best describes the action of glipizide?
  1. "Glipizide absorbs the excess carbohydrates in your system."
  2. "Glipizide stimulates your pancreas to release insulin."
     1. Rationale: Glipizide is an oral antidiabetic medication in the pharmacological classification of sulfonylurea agents. These medications help to lower blood glucose levels in clients who have type 2 diabetes mellitus using several methods, including reducing glucose output by the liver, increasing peripheral sensitivity to insulin, and stimulating the release of insulin from the functioning beta cells of the pancreas.
  3. "Glipizide replaces insulin that is not being produced by your pancreas."
  4. "Glipizide prevents your liver from destroying your insulin.”

• A nurse is caring for a client who has deep vein thrombosis and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make?
  1. "Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level."

Rationale: Heparin and warfarin are both anticoagulants that decrease the clotting ability of the blood and help prevent thrombosis formation in the blood vessels. However, these medications work in different ways to achieve therapeutic coagulation and must be given together until therapeutic levels of anticoagulation can be achieved by warfarin alone, which is usually within 1 to 5 days. When the client's PT and INR are within therapeutic range, the heparin can be discontinued.

1. "I will call the provider to get a prescription for discontinuing the IV heparin today." Rationale: Discontinuing the IV heparin is not indicated at this time.
2. "Both heparin and warfarin work together to dissolve the clots."

• A nurse in a critical care unit is caring for a client who is postoperative following a right pneumonectomy. After extubation from the ventilator, in which of the following positions should the client be placed?
  1. Prone
  2. On the nonoperative side
  3. Sims'
  4. Semi-Fowler's

• A nurse in a coronary care unit is admitting a client who has had CPR following a cardiac arrest. The client is receiving lidocaine IV at 2 mg/min. When the client asks the nurse why he is receiving that medication, the nurse should explain that it has which of the following actions?
  1. Prevents dysrhythmias
     1. Rationale: Lidocaine is an antidysrhythmic medication that delays the conduction in the heart and reduces the automaticity of heart tissue.
  2. Slows intestinal motility
  3. Dissolves blood clots
  4. Relieves pain

• A nurse is providing teaching for a client who has anemia and a new prescription for ferrous sulfate liquid. Which of the following instructions should the nurse provide?
  1. Take the medication on an empty stomach to decrease gastrointestinal irritation.
  2. Take the medication with orange juice to enhance absorption.
     1. Take between meals for optimal absorption
     2. Rationale: Ascorbic acid (vitamin C), which is found in orange juice, will enhance the absorption of iron and increase its bioavailability. This will also help to decrease the gastrointestinal side effects of iron.
  3. Take the medication with milk.
  4. Rinse the mouth before taking the iron.

• nurse is caring for a child who has asthma and a prescription for montelukast granules. Which of the following instructions should the nurse provide the client's parent on administering the medication?
  1. Give the medication in the morning daily.
     1. Rationale: Montelukast is a leukotriene receptor antagonist that is used to prevent asthma symptoms. It works by blocking the action of leukotrienes (substances that cause inflammation, fluid retention, mucous secretion, and constriction) in the client's lungs. Due to the side effect of drowsiness, it is usually taken once a day in the evening.
  2. Administer the medication 2 hr before exercise.
     1. Rationale: Montelukast should be given daily during the evening, except when being used for exercise-induced bronchospasm. It should then be given 2 hr before exercise, and not given again for 24 hr.
  3. Give the medication at the onset of wheezing.
     1. Rationale: Montelukast is ineffective as a rescue medication.
  4. Administer the granules mixed with 20 oz of water.
     1. Rationale: Montelukast granules should be taken directly or mixed with certain soft foods (applesauce, carrots, rice or ice cream).

• A nurse in a provider's clinic is assessing a client who has cancer and a prescription for methotrexate PO. Which of the following actions should the nurse take when the client reports bleeding gums?
  1. Explain to the client that this is an expected adverse effect.
  2. Check the value of the client's current platelet count.
  3. Instruct the client to use an electric toothbrush.
  4. Have the client make an appointment to see the dentist.

• A nurse is teaching a client who has bipolar disorder and a prescription for lithium to recognize the manifestations of toxicity. Which of the following statements by the client indicates an understanding of the teaching?
  1. "I will report any loss of appetite."
  2. "Increased flatulence is an indication of toxicity."
  3. "Vomiting is an indication of toxicity."
  4. "I will call my provider if I experience any headaches."

• Bacterial conjunctivitis, know to apply
  1. Thin line into the conjunctival sac

• A nurse in a public clinic is planning a health fair for older adult clients in the community. In teaching medication safety, which of the following foods should the nurse advise the clients to avoid when taking their prescriptions?
  1. Carbonated beverage
  2. Milk
  3. OJ
  4. Grapefruit juice

• A nurse is caring for a client who has nausea and a prescription for metoclopramide intermittent IV bolus every 4 hr as needed. The client asks the nurse how metoclopramide will relieve her nausea. Which of the following explanations should the nurse provide?
  1. "The medication relieves nausea by promoting gastric emptying."
     1. Rationale: Reglan is a gastrointestinal stimulant used to relieve nausea, vomiting, heartburn, stomach pain, bloating, and a persistent feeling of fullness after meals. Reglan works by promoting gastric emptying.
  2. "The medication works by decreasing gastric acid secretions."
     1. Rationale: Reglan does not decrease gastric acid secretions.
  3. "The medication relieves nausea by slowing peristalsis."
     1. Rationale: Reglan does not slow peristalsis.
  4. "The medication works by relaxing gastric muscles.
     1. Rationale: Metoclopramide increases gastric muscle contraction.

• A nurse is caring for a client who has developed gout. Which of the following medications should the nurse prepare to administer?
  1. Zolpidem
  2. Alprazolam
  3. Spironolactone
  4. Allopurinol

.

• A nurse is caring for a client who has diabetes insipidus and is receiving vasopressin. The nurse should identify which of the following findings as an indication that the medication is effective?
  1. A decrease in blood sugar
  2. A decrease in blood pressure
  3. A decrease in urine output
     1. Rationale: The major manifestations of diabetes insipidus are excessive urination and extreme thirst. Vasopressin is used to control frequent urination, increased thirst, and loss of water associated with diabetes insipidus. A decreased urine output is the desired response.
  4. A decrease in specific gravity

• A nurse on a medical unit is planning care for an older adult client who takes several medications. Which of the following prescribed medications places the client at risk for orthostatic hypotension? (Select all that apply.)
  1. Furosemide
  2. Telmisartan
  3. Duloxetine
  4. Clopidogrel
  5. Atorvastatin

• A nurse is reviewing the health history for a client who has angina pectoris and a prescription for propranolol hydrochloride PO 40 mg twice daily. Which of the following findings in the history should the nurse report to the provider?
  1. The client has a history of hypothyroidism.
  2. The client has a history of bronchial asthma.
     1. Rationale: Beta-adrenergic blockers can cause bronchospasm in clients who have bronchial asthma; therefore, this is a contraindication to its use and should be reported to the provider.
  3. The client has a history of hypertension.
  4. The client has a history of migraine headaches.

• Ophthalmic ointment for pre-k age child w pink eye, what should nurse include in instructions
  1. Discard first few drops

• A nurse is teaching a client who takes warfarin daily. Which of the following statements by the client indicates a need for further teaching?
  1. "I have started taking ginger root to treat my joint stiffness."
     1. Rationale: Ginger root can interfere with the blood clotting effect of warfarin and place the client at risk for bleeding. This statement indicates the client needs further teaching.
  2. "I take this medication at the same time each day."
     1. Rationale: The client should take warfarin at the same time each day to maintain a stable blood level.
  3. "I eat a green salad every night with dinner."
     1. Rationale: Green leafy vegetables are a good source of vitamin K, which can interfere with the clotting effects of warfarin. Clients who are taking warfarin do not need to restrict dietary vitamin K intake but rather should maintain a consistent intake of vitamin K in order to control the therapeutic effect of the medication.
  4. "I had my INR checked three weeks ago."
     1. Rationale: Clients who have been taking warfarin for more than 3 months should have their INR level checked every 2 to 4 weeks.

• A nurse is teaching a client about the adverse effects of cisplatin. Which of the following adverse effects should the nurse include in the teaching?
  1. Tinnitus
  2. Constipation
  3. Hyperkalemia
  4. Weight gain

• nurse is caring for a client who is experiencing severe nausea and vomiting after a course of chemotherapy. The nurse should monitor the client for which of the following clinical manifestations?
  1. Metabolic acidosis
  2. Metabolic alkalosis
     1. Rationale: Metabolic alkalosis can occur in clients who have excessive vomiting because of the loss of hydrochloric acid.
  3. Respiratory acidosis
  4. Respiratory alkalosis

• A nurse is completing a medical interview with a client who has elevated cholesterol levels and takes warfarin. The nurse should recognize that which of the following actions by the client can potentiate the effects of warfarin?
  1. The client follows a low-fat diet to reduce cholesterol.
  2. The client drinks a glass of grapefruit juice every day.
  3. The client sprinkles flax seeds on food 1 hr before taking the anticoagulant.
  4. The client uses garlic to lower cholesterol levels.
     1. Rationale: The nurse should recognize that garlic can potentiate the action of the warfarin.

• A nurse is caring for a client who has a new prescription for ferrous sulfate tablets twice daily for iron-deficiency anemia. The client asks the nurse why the provider instructed that she take the ferrous sulfate between meals. Which of the following responses should the nurse make?
  1. "Taking the medication between meals will help you avoid becoming constipated."
  2. "Taking the medication with food increases the risk of esophagitis."
  3. "Taking the medication between meals will help you absorb the medication more efficiently."
     1. Ferrous sulfate provides the iron needed by the body to produce red blood cells. Taking iron supplements between meals helps to increase the bioavailability of the iron.
  4. "The medication can cause nausea if taken with food."
• Status asmaticus
  1. Severe acute asthma attack --give SABA

• A nurse is providing discharge teaching for a client who has a new prescription for warfarin. Which of the following instructions should the nurse include in the teaching?
  1. Mild nosebleeds are common during initial treatment.
  2. Use an electric razor while on this medication.
     1. Rationale: Warfarin, an anticoagulant, increases the client’s risk for bleeding. The nurse should teach the client safety measures, such as using an electric razor, to decrease the risk for injury and bleeding.
  3. If a dose of the medication is missed, double the dose at the next scheduled time.
  4. Increase fiber intake to reduce the adverse effect of constipation.

• A nurse is preparing to initiate a transfusion of packed RBC for a client who has anemia. Which of the following actions should the plan to nurse take?
  1. Leave the client 5 min after beginning the transfusion.
  2. Infuse the transfusion at a rate of 200 mL/hr
  3. Check the client's vital signs every hour during the transfusion.
  4. Flush the blood tubing with dextrose 5% in water.

• A charge nurse is supervising a newly licensed nurse care for a client who is receiving a transfusion of packed RBC. The nurse suspects a possible hemolytic reaction. After stopping the blood transfusion, which of the following actions by the new nurse requires intervention by the charge nurse?
  1. The nurse initiates an infusion of 0.9% sodium chloride.
  2. The nurse collects a urine specimen.
  3. The nurse sends a blood specimen to the laboratory.
  4. The nurse starts the transfusion of another unit of blood product.
     1. When suspecting a hemolytic reaction, the nurse should immediately stop the transfusion of all blood products. The transfusion of additional products can increase the client's risk for further complication

• A nurse is assessing a client who is receiving a unit of packed red blood cells. Which of the following findings is a manifestation of acute hemolytic reaction?
  1. Client report of low back pain
     1. Rationale: Manifestations of an acute hemolytic reaction include apprehension, tachypnea, hypotension, chest pain, and lower back pain.
  2. Client report of tinnitus
     1. Rationale: Tinnitus is a manifestation of ototoxicity and is an adverse effect of aminoglycoside antibiotics.
  3. A productive cough
     1. Rationale: A cough is a manifestation of circulatory overload.
  4. Distended neck veins
     1. Rationale: Distended neck veins are a manifestation of circulatory overload.

• A nurse is caring for a client who is receiving a transfusion of packed red blood cells and suspects that the client is experiencing a hemolytic reaction. Which of the following interventions is the priority?
  1. Collect a urine specimen.
  2. Administer 0.9% sodium chloride through the IV line.
  3. Stop the transfusion.
     1. Rationale: The greatest risk to the client is injury due to further hemolysis; therefore, the priority action is to stop the transfusion. When suspecting a hemolytic reaction, the priority action by the nurse is to immediately stop the transfusion to prevent further hemolysis.
  4. Notify the blood bank.

• A nurse is preparing to administer phenytoin IV to a client who has a seizure disorder. Which of the following actions should the nurse plan to take?
  1. Administer the medication at 100 mg/min.
     1. Rationale: The nurse should administer phenytoin IV slowly, not faster than 50 mg/min, to reduce the risk of hypotension.
  2. Administer a saline solution after injection.
     1. Rationale: The nurse should flush the injection site with a saline solution after the injection of phenytoin to reduce and prevent venous irritation.
  3. Hold the injection if seizure activity is present.
     1. Rationale: The nurse should administer phenytoin to prevent and to abort seizure activity.
  4. Dilute the medication with dextrose 5% in water.
     1. Rationale: The nurse should dilute phenytoin in 0.9% sodium chloride solution to prevent precipitation of the medication.

• A nurse is planning care for a client who has a detached retina and is preoperative for a surgical repair. The nurse should prepare to administer which of the following medications?
  1. Phenylephrine
     1. Mydriatic medications, such as phenylephrine, are used preoperatively to dilate pupils to facilitate intraocular surgery.
  2. Latanoprost
  3. Pilocarpine
  4. Timolol

• A nurse is assessing a client who is receiving a parental lipid infusion. Which of the following findings is a manifestation of fat overload syndrome?
  1. Elevated temperature
     1. Rationale: An elevated temperature is an early manifestation of fat overload syndrome. The client is at risk for coagulopathy and multi-organ system failure due to fat overload syndrome.
  2. Hypertension
  3. Peripheral edema
  4. Erythema at the insertion site

• A nurse is caring for a female client who has rheumatoid arthritis and asks the nurse if it is safe for her to take aspirin. The nurse should recognize which of the following findings in the client's history is a contraindication to this medication?
  1. Report of recent migraine headaches
  2. History of gastric ulcers
     1. Rationale: Aspirin is contraindicated for clients who have a history of gastrointestinal bleeding and peptic ulcer disease because it impedes platelet aggregation. An adverse effect of aspirin is gastric bleeding.
  3. Current diagnosis of glaucoma
  4. Prior reports of amenorrhea

• A nurse is teaching a client who has a new prescription for colesevelam to lower his low-density lipoprotein level. Which of the following instructions should the nurse include?
  1. "Take this medication 4 hr after other medications."
     1. Rationale: The client should take this medication 4 hours after other medications to increase absorption of the medication.
  2. "Reduce fluid intake."
  3. "Take this medication on an empty stomach.”
  4. "Chew tablets before swallowing."

• A nurse is assessing a client who is receiving dopamine IV to treat left ventricular failure. Which of the following findings should indicate to the nurse that the medication is having a therapeutic effect?
  1. Systolic blood pressure is increased
     1. Rationale: When dopamine has a therapeutic effect, it causes vasoconstriction peripherally and increases systolic blood pressure.
  2. Cardiac output is reduced
  3. Apical heart rate is increased
  4. Urine output is reduced

• A nurse is teaching a client who has diabetes mellitus and receives 25 units of NPH insulin every morning if her blood glucose level is above 200 mg/dL. Which of the following information should the nurse include?
  1. Discard the NPH solution if it appears cloudy.
  2. Shake the insulin vigorously before loading the syringe.
  3. Expect the NPH insulin to peak in 6 to 14 hr.
  4. Freeze unopened insulin vials.

• A nurse is teaching a client who has a new prescription for fluoxetine to treat depression. Which of the following statements by the client indicates an understanding of the teaching?
  1. "I should expect to feel better after 24 hours of starting this medication."
  2. "I should not take this medicine with grapefruit juice."
  3. "I'll take this medicine with food."
  4. "I'll take this medicine first thing in the morning."

• A nurse is instructing the parents of a client who has a new prescription for methylphenidate. Which of the following instructions should the nurse include?
  1. Avoid activities that require alertness such as driving.
     1. Rationale: The client should avoid driving and other activities that require alertness until the effects of this medication are known.
  2. Increase caffeine intake.
  3. Take this medication before bedtime.
  4. Reduce calorie intake.

• A client has begun medication therapy with pancrelipase (Pancrease). The nurse determines that the medication is having the optimal intended benefit if which effect is observed?
  1. Weight loss
  2. Relief of heartburn
  3. Reduction of steatorrhea
  4. Absence of abdominal pain

• A nurse is teaching a client who has a new prescription for pancrelipase to aid in digestion. The nurse should inform the client to expect which of the following GI changes?
  1. Decreased fat in stools, as this medication is used to increase digestions of fats, carbs, and proteins.

• A nurse is teaching a client how to draw up regular insulin and NPH insulin into the same syringe. Which of the following instructions should the nurse include?
  1. Discard regular insulin that appears cloudy. Regular insulin is clear. NPH is cloudy.

• A HCP should question the use of dimenhydrinate for a patient who has which of the following disorders?
  1. Angle-closure glaucoma. An antihistamine is inappropriate for patients who have this condition because it has anticholinergic properties, which increase intraocular pressure.

• A HCP is caring for a patient who is about to begin using dimenhydrinate to prevent motion sickness. Which of the following instructions should the HCP include when talking with the patient? (select all that apply)
  1. Take the drug 30-60 minutes before activities that trigger nausea; avoid activities that require alertness, as this medication can cause sedation; and increase fluid and fiber intake, as this medication can cause dry mouth and constipation.

• A nurse is teaching a client who has a new prescription for dimenhydrinate. Which of the following instructions should the nurse include in the teaching?
  1. Monitor for dizziness. Dimenhydrinate can cause dizziness and drowsiness.

• A nurse in a substance abuse clinic is assessing a client who recently started taking disulfiram. The client reports having discontinued the medication after experiencing severe nausea and vomiting. Which of the following reasons should the nurse suspect to be a likely cause of the client's distress?
  1. The client demonstrated an allergic response to the medication.
  2. The client experienced a common side effect to the medication.
  3. The client consumed alcohol while taking the medication.
     1. Rationale: Disulfiram is given to clients who have a history of alcohol abuse. It produces a sensitivity to alcohol that results in a highly unpleasant reaction when the client ingests even small amounts of alcohol. When combined with alcohol, disulfiram produces nausea and vomiting.
  4. The client took an overdose of the medication

• A HCP should monitor an older adult patient who is taking alprazolam for which of the following adverse effects?
  1. Tolerance, anxiety (a paradoxical reaction), sedation, and respiratory depression.

• A HCP should question the use of alprazolam (Xanax) for a patient who:
  1. Drinks two 8-oz. glasses of wine each evening. To prevent severe sedation and respiratory depression, alcohol and other CNS depressants should be avoided.

• A HCP is caring for a patient who has been taking alprazolam for an extended period of time to treat anxiety. The HCP should recognize that stopping alprazolam suddenly can result in which of the following?
  1. Withdrawal symptoms. This medication needs to be tapered slowly over several weeks

• A home health nurse is assessing an older adult client who reports falling a couple of times over the past week. Which of the following findings should the nurse suspect is contributing to the client's falls?
  1. The client takes alprazolam.
     1. Rationale: Alprazolam is a CNS depressant that can cause dizziness and orthostatic hypotension, which can cause the client to lose his balance and fall.
  2. The client has a nonslip bath mat in his shower.
     1. Rationale: A nonslip bath mat should reduce the risk for the client to fall.
  3. The client uses a raised toilet seat.
     1. Rationale: A raised toilet seat should reduce the risk for the client to fall.
  4. The client wears fitted slippers.
     1. Rationale: Fitted and nonslip slippers should reduce the risk for the client to fall.

• A nurse in the emergency department is caring for a client who took 3 nitroglycerin tablets sublingually for chest pain. The client reports relief from the chest pain but now he is experiencing a headache. Which of the following statements should the nurse make?
  1. “A headache is is an indication of an allergy to the medication."
  2. “A headache is an expected adverse effect of this medication”
  3. “A headache indicates tolerance to this medication”
  4. “A headache is likely due to the anxiety about the chest pain”

• A nurse is preparing to transfuse one unit of packed RBC to a client who experienced a mild allergic reaction during a previous transfusion. The nurse should administer diphenhydramine prior to the transfusion for which of the following allergic responses?
  1. Urticaria
     1. Rationale: For clients who have previously had allergic reactions to blood transfusions, administering an antihistamine such as diphenhydramine prior to the transfusion might prevent future reactions. Allergic reactions typically include urticaria (hives).
  2. Fever
     1. Rationale: An antihistamine will not prevent a febrile, non-hemolytic reaction to a blood transfusion. A possible preventive measure is transfusing leucocyte-poor blood products to avoid sensitization to the donor's WBC.
  3. Fluid overload
     1. Rationale: An antihistamine will not prevent fluid overload. Transfusing the blood product slowly and not exceeding the volume that is necessary can reduce this risk.
  4. Hemolysis
     1. Rationale: An antihistamine will not prevent hemolysis, which results from incompatibility between the donor and the recipient.

• A nurse is preparing to administer nalbuphine to a postoperative client who is experiencing pain. The nurse should monitor the client for which of the following potential adverse effects of this medication?
  1. Miosis
     1. Rationale: Adverse effects of nalbuphine include visual disturbances such as miosis, blurred vision, and diplopia.
  2. Joint pain
  3. Diarrhea
  4. Oliguria

• A HCP is caring for a patient who is about to begin taking dantrolene for skeletal muscle spasms. The HCP should tell the patient to report which of the following adverse effects?
  1. Other adverse effects include nausea and vomiting.

• A HCP is caring for a patient who is about to begin taking dantrolene (Dantrium) for skeletal muscle spasms. The HCP should recognize that which of the following laboratory tests requires monitoring?
  1. Liver function, as liver toxicity is a serious side effect of dantrolene.

• A nurse is teaching a client who has a duodenal ulcer about his new prescription for cimetidine. The nurse should include which of the following instructions in the teaching?
  1. Your doctor might need to reduce your theophylline dose while taking this medication.

• A nurse is reviewing the laboratory results of a client who has liver failure with ascites and is receiving spironolactone. Which of the following findings should the nurse expect?
  1. Decreased sodium level
     1. Rationale: The nurse should expect a decreased sodium level. Spironolactone is a potassium-sparing diuretic that inhibits the action of aldosterone, resulting in an increased excretion of sodium.
  2. Decreased phosphate level
  3. Decreased potassium level
  4. Decreased chloride level

• A patient recovering from a total knee arthroplasty has been prescribed acetaminophen for mild discomfort that does not require an opioid. The health care professional should tell the patient to report which of the following early indications of acetaminophen overdose?
  1. Diaphoresis, nausea, and diarrhea.

• Someone had a arthroplasty for hip, the nurse should anticipate which of the following px:
  1. aspirin, lovenox/enoxaparin

• A health care professional is caring for a patient who is about to begin taking celecoxib (Celebrex) to treat RA. The health care professional should tell the patient to report which of the following adverse reactions?
  1. Chest pain. COX-2 inhibitors can cause cardiovascular or cerebrovascular events.

• A nurse is assessing a client who has heart failure and is prescribed furosemide. Which of the following findings is an adverse effect of this medication?
  1. Leg cramps, which is a manifestation of hypokalemia.

• A nurse is caring for a client who has heart failure and a new prescription for furosemide. Which of the following laboratory values should the nurse review before administering furosemide?

• A nurse is planning to apply a transdermal analgesic cream prior to inserting an IV for a preschool-age child. Which of the following actions should the nurse plan to take?
  1. Apply to intact skin, apply the medication 1 hour before the procedure begins, cleanse the skin prior to procedure, and use a visual pain rating scale to evaluate the effectiveness of the treatment

• A nurse is caring for a 2-year-old child who has seizures and is receiving phenytoin in suspension form. Which of the following actions should the nurse take before administering each dose?
  1. Shake the container vigorously. This ensures the particles of the medication are evenly distributed.

• A nurse is providing teaching to a client who has a new prescription for Lisinopril. Which of the following statements by the client indicates an understanding of the teaching?
  1. I should report a cough to the provider.