1. 1) A nurse is caring for a client withhyperparathyroidism and notes that theclient's serum calcium level is 13 mg/dL.Which medication should the nurse prepareto administer as prescribed to the client?1. Calcium chloride2. Calcium gluconate3. Calcitonin (Miacalcin)4. Large doses of vitamin D

3. Calcitonin (Miacalcin)Rationale:The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencinghypercalcemia. Calcium gluconate and calcium chloride are medications used for thetreatment of tetany, which occurs as a result of acute hypocalcemia. Inhypercalcemia, large doses of vitamin D need to be avoided. Calcitonin, a thyroidhormone, decreases the plasma calcium level by inhibiting bone resorption andlowering the serum calcium concentration.

2. 2.) Oral iron supplements are prescribed fora 6-year-old child with iron deficiencyanemia. The nurse instructs the mother toadminister the iron with which best fooditem?1. Milk2. Water3. Apple juice4. Orange juice

4. Orange juiceRationale:Vitamin C increases the absorption of iron by the body. The mother should beinstructed to administer the medication with a citrus fruit or a juice that is high invitamin C. Milk may affect absorption of the iron. Water will not assist in absorption.Orange juice contains a greater amount of vitamin C than apple juice.

3. 3.) Salicylic acid is prescribed for a clientwith a diagnosis of psoriasis. The nursemonitors the client, knowing that which ofthe following would indicate the presence ofsystemic toxicity from this medication?1. Tinnitus2. Diarrhea3. Constipation4. Decreased respirations

1. TinnitusRationale:Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism)can result. Symptoms include tinnitus, dizziness, hyperpnea, and psychologicaldisturbances. Constipation and diarrhea are not associated with salicylism.

4. 4.) The camp nurse asks the childrenpreparing to swim in the lake if they haveapplied sunscreen. The nurse reminds thechildren that chemical sunscreens are mosteffective when applied:1. Immediately before swimming2. 15 minutes before exposure to the sun3. Immediately before exposure to the sun4. At least 30 minutes before exposure to thesun

4. At least 30 minutes before exposure to the sunRationale:Sunscreens are most effective when applied at least 30 minutes before exposure to thesun so that they can penetrate the skin. All sunscreens should be reapplied afterswimming or sweating.

5. 5.) Mafenide acetate (Sulfamylon) isprescribed for the client with a burn injury.When applying the medication, the clientcomplains of local discomfort and burning.Which of the following is the mostappropriate nursing action?1. Notifying the registered nurse2. Discontinuing the medication3. Informing the client that this is normal4. Applying a thinner film than prescribed tothe burn site

3. Informing the client that this is normalRationale:Mafenide acetate is bacteriostatic for gram-negative and gram-positive organismsand is used to treat burns to reduce bacteria present in avascular tissues. The clientshould be informed that the medication will cause local discomfort and burning andthat this is a normal reaction; therefore options 1, 2, and 4 are incorrect

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6. 6.) The burn client is receiving treatments oftopical mafenide acetate (Sulfamylon) to thesite of injury. The nurse monitors the client,knowing that which of the following indicatesthat a systemic effect has occurred?1.Hyperventilation2.Elevated blood pressure3.Local pain at the burn site4.Local rash at the burn site

1.HyperventilationRationale:Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renalexcretion of acid, thereby causing acidosis. Clients receiving this treatment shouldbe monitored for signs of an acid-base imbalance (hyperventilation). If this occurs,the medication should be discontinued for 1 to 2 days. Options 3 and 4 describelocal rather than systemic effects. An elevated blood pressure may be expected fromthe pain that occurs with a burn injury.

7. 7.) Isotretinoin is prescribed for a client withsevere acne. Before the administration of thismedication, the nurse anticipates that whichlaboratory test will be prescribed?1. Platelet count2. Triglyceride level3. Complete blood count4. White blood cell count

2. Triglyceride levelRationale:Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should bemeasured before treatment and periodically thereafter until the effect on thetriglycerides has been evaluated. Options 1, 3, and 4 do not need to be monitoredspecifically during this treatment.

8. 8.) A client with severe acne is seen in theclinic and the health care provider (HCP)prescribes isotretinoin. The nurse reviewsthe client's medication record and wouldcontact the (HCP) if the client is taking whichmedication?1. Vitamin A2. Digoxin (Lanoxin)3. Furosemide (Lasix)4. Phenytoin (Dilantin)

1. Vitamin ARationale:Isotretinoin is a metabolite of vitamin A and can produce generalizedintensification of isotretinoin toxicity. Because of the potential for increasedtoxicity, vitamin A supplements should be discontinued before isotretinoin therapy.Options 2, 3, and 4 are not contraindicated with the use of isotretinoin.

9. 9.) The nurse is applying a topicalcorticosteroid to a client with eczema. Thenurse would monitor for the potential forincreased systemic absorption of themedication if the medication were beingapplied to which of the following body areas?1. Back2. Axilla3. Soles of the feet4. Palms of the hands

2. AxillaRationale:Topical corticosteroids can be absorbed into the systemic circulation. Absorption ishigher from regions where the skin is especially permeable (scalp, axilla, face,eyelids, neck, perineum, genitalia), and lower from regions in which permeabilityis poor (back, palms, soles).

10. 10.) The clinic nurse is performing anadmission assessment on a client. The nursenotes that the client is taking azelaic acid(Azelex). Because of the medicationprescription, the nurse would suspect thatthe client is being treated for:1. Acne2. Eczema3. Hair loss4. Herpes simplex

1. AcneRationale:Azelaic acid is a topical medication used to treat mild to moderate acne. The acidappears to work by suppressing the growth of Propionibacterium acnes anddecreasing the proliferation of keratinocytes. Options 2, 3, and 4 are incorrect.

11. 11.) The health care provider has prescribed silversulfadiazine (Silvadene) for the client with a partial-thickness burn, which has cultured positive forgram-negative bacteria. The nurse is reinforcinginformation to the client about the medication.Which statement made by the client indicates a lackof understanding about the treatments?1. "The medication is an antibacterial."2. "The medication will help heal the burn."3. "The medication will permanently stain my skin."4. "The medication should be applied directly to thewound."

3. "The medication will permanently stain my skin."Rationale:Silver sulfadiazine (Silvadene) is an antibacterial that has a broadspectrum of activity against gram-negative bacteria, gram-positivebacteria, and yeast. It is applied directly to the wound to assist in healing.It does not stain the skin.

12. 12.) A nurse is caring for a client who is receiving anintravenous (IV) infusion of an antineoplasticmedication. During the infusion, the clientcomplains of pain at the insertion site. During aninspection of the site, the nurse notes redness andswelling and that the rate of infusion of themedication has slowed. The nurse should take whichappropriate action?1. Notify the registered nurse.2. Administer pain medication to reduce thediscomfort.3. Apply ice and maintain the infusion rate, asprescribed.4. Elevate the extremity of the IV site, and slow theinfusion.

1. Notify the registered nurse.Rationale:When antineoplastic medications (Chemotheraputic Agents) areadministered via IV, great care must be taken to prevent the medicationfrom escaping into the tissues surrounding the injection site, because pain,tissue damage, and necrosis can result. The nurse monitors for signs ofextravasation, such as redness or swelling at the insertion site and adecreased infusion rate. If extravasation occurs, the registered nurse needsto be notified; he or she will then contact the health care provider.

13. 13.) The client with squamous cell carcinoma of thelarynx is receiving bleomycin intravenously. Thenurse caring for the client anticipates that whichdiagnostic study will be prescribed?1. Echocardiography2. Electrocardiography3. Cervical radiography4. Pulmonary function studies

4. Pulmonary function studiesRationale:Bleomycin is an antineoplastic medication (Chemotheraputic Agents) thatcan cause interstitial pneumonitis, which can progress to pulmonaryfibrosis. Pulmonary function studies along with hematological, hepatic,and renal function tests need to be monitored. The nurse needs to monitorlung sounds for dyspnea and crackles, which indicate pulmonary toxicity.The medication needs to be discontinued immediately if pulmonary toxicityoccurs. Options 1, 2, and 3 are unrelated to the specific use of thismedication.

14. 14.) The client with acute myelocytic leukemia isbeing treated with busulfan (Myleran). Whichlaboratory value would the nurse specificallymonitor during treatment with this medication?1. Clotting time2. Uric acid level3. Potassium level4. Blood glucose level

2. Uric acid levelRationale:Busulfan (Myleran) can cause an increase in the uric acid level.Hyperuricemia can produce uric acid nephropathy, renal stones, and acuterenal failure. Options 1, 3, and 4 are not specifically related to thismedication.

15. 15.) The client with small cell lung cancer is beingtreated with etoposide (VePesid). The nurse who isassisting in caring for the client during itsadministration understands that which side effectis specifically associated with this medication?1. Alopecia2. Chest pain3. Pulmonary fibrosis4. Orthostatic hypotension

4. Orthostatic hypotensionRationale:A side effect specific to etoposide is orthostatic hypotension. The client'sblood pressure is monitored during the infusion. Hair loss occurs withnearly all the antineoplastic medications. Chest pain and pulmonaryfibrosis are unrelated to this medication.

16. 16.) The clinic nurse is reviewing a teachingplan for the client receiving an antineoplasticmedication. When implementing the plan, thenurse tells the client:1. To take aspirin (acetylsalicylic acid) asneeded for headache2. Drink beverages containing alcohol inmoderate amounts each evening3. Consult with health care providers (HCPs)before receiving immunizations4. That it is not necessary to consult HCPsbefore receiving a flu vaccine at the localhealth fair

3. Consult with health care providers (HCPs) before receiving immunizationsRationale:Because antineoplastic medications lower the resistance of the body, clients mustbe informed not to receive immunizations without a HCP's approval. Clients alsoneed to avoid contact with individuals who have recently received a live virusvaccine. Clients need to avoid aspirin and aspirin-containing products to minimizethe risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicityand side effects.

17. 17.) The client with ovarian cancer is beingtreated with vincristine (Oncovin). The nursemonitors the client, knowing that which of thefollowing indicates a side effect specific tothis medication?1. Diarrhea2. Hair loss3. Chest pain4. Numbness and tingling in the fingers andtoes

4. Numbness and tingling in the fingers and toesRationale:A side effect specific to vincristine is peripheral neuropathy, which occurs inalmost every client. Peripheral neuropathy can be manifested as numbness andtingling in the fingers and toes. Depression of the Achilles tendon reflex may bethe first clinical sign indicating peripheral neuropathy. Constipation rather thandiarrhea is most likely to occur with this medication, although diarrhea may occuroccasionally. Hair loss occurs with nearly all the antineoplastic medications.Chest pain is unrelated to this medication.

18. 18.) The nurse is reviewing the history andphysical examination of a client who will bereceiving asparaginase (Elspar), anantineoplastic agent. The nurse consults withthe registered nurse regarding theadministration of the medication if which ofthe following is documented in the client'shistory?1. Pancreatitis2. Diabetes mellitus3. Myocardial infarction4. Chronic obstructive pulmonary disease

1. PancreatitisRationale:Asparaginase (Elspar) is contraindicated if hypersensitivity exists, in pancreatitis,or if the client has a history of pancreatitis. The medication impairs pancreaticfunction and pancreatic function tests should be performed before therapy beginsand when a week or more has elapsed between administration of the doses. Theclient needs to be monitored for signs of pancreatitis, which include nausea,vomiting, and abdominal pain. The conditions noted in options 2, 3, and 4 are notcontraindicated with this medication.

19. 19.) Tamoxifen is prescribed for the clientwith metastatic breast carcinoma. The nurseunderstands that the primary action of thismedication is to:1. Increase DNA and RNA synthesis.2. Promote the biosynthesis of nucleic acids.3. Increase estrogen concentration andestrogen response.4. Compete with estradiol for binding toestrogen in tissues containing highconcentrations of receptors.

4. Compete with estradiol for binding to estrogen in tissues containing highconcentrations of receptors.Rationale:Tamoxifen is an antineoplastic medication that competes with estradiol forbinding to estrogen in tissues containing high concentrations of receptors.Tamoxifen is used to treat metastatic breast carcinoma in women and men.Tamoxifen is also effective in delaying the recurrence of cancer followingmastectomy. Tamoxifen reduces DNA synthesis and estrogen response.

20. 20.) The client with metastatic breast canceris receiving tamoxifen. The nurse specificallymonitors which laboratory value while theclient is taking this medication?1. Glucose level2. Calcium level3. Potassium level4. Prothrombin time

2. Calcium levelRationale:Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before theinitiation of therapy, a complete blood count, platelet count, and serum calciumlevels should be assessed. These blood levels, along with cholesterol andtriglyceride levels, should be monitored periodically during therapy. The nurseshould assess for hypercalcemia while the client is taking this medication. Signs ofhypercalcemia include increased urine volume, excessive thirst, nausea, vomiting,constipation, hypotonicity of muscles, and deep bone and flank pain.

21. 21.) A nurse is assisting with caringfor a client with cancer who isreceiving cisplatin. Select theadverse effects that the nursemonitors for that are associatedwith this medication. Select all thatapply.1. Tinnitus2. Ototoxicity3. Hyperkalemia4. Hypercalcemia5. Nephrotoxicity6. Hypomagnesemia

1. Tinnitus2. Ototoxicity5. Nephrotoxicity6. HypomagnesemiaRationale:Cisplatin is an alkylating medication. Alkylating medications are cell cycle phase-nonspecificmedications that affect the synthesis of DNA by causing the cross-linking of DNA to inhibitcell reproduction. Cisplatin may cause ototoxicity, tinnitus, hypokalemia, hypocalcemia,hypomagnesemia, and nephrotoxicity. Amifostine (Ethyol) may be administered beforecisplatin to reduce the potential for renal toxicity.

22. 22.) A nurse is caring for a clientafter thyroidectomy and notes thatcalcium gluconate is prescribed forthe client. The nurse determinesthat this medication has beenprescribed to:1. Treat thyroid storm.2. Prevent cardiac irritability.3. Treat hypocalcemic tetany.4. Stimulate the release ofparathyroid hormone.

3. Treat hypocalcemic tetany.Rationale:Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentallyremoved or injured during surgery. Manifestations develop 1 to 7 days after surgery. If theclient develops numbness and tingling around the mouth, fingertips, or toes or muscle spasmsor twitching, the health care provider is notified immediately. Calcium gluconate should bekept at the bedside.

23. 23.) A client who has been newlydiagnosed with diabetes mellitushas been stabilized with dailyinsulin injections. Whichinformation should the nurse teachwhen carrying out plans fordischarge?1. Keep insulin vials refrigerated atall times.2. Rotate the insulin injection sitessystematically.3. Increase the amount of insulinbefore unusual exercise.4. Monitor the urine acetone level todetermine the insulin dosage.

2. Rotate the insulin injection sites systematically.Rationale:Insulin dosages should not be adjusted or increased before unusual exercise. If acetone isfound in the urine, it may possibly indicate the need for additional insulin. To minimize thediscomfort associated with insulin injections, the insulin should be administered at roomtemperature. Injection sites should be systematically rotated from one area to another. Theclient should be instructed to give injections in one area, about 1 inch apart, until the wholearea has been used and then to change to another site. This prevents dramatic changes indaily insulin absorption.

24. 24.) A nurse is reinforcing teachingfor a client regarding how to mixregular insulin and NPH insulin inthe same syringe. Which of thefollowing actions, if performed bythe client, indicates the need forfurther teaching?1. Withdraws the NPH insulin first2. Withdraws the regular insulinfirst3. Injects air into NPH insulin vialfirst4. Injects an amount of air equal tothe desired dose of insulin into thevial

1. Withdraws the NPH insulin firstRationale:When preparing a mixture of regular insulin with another insulin preparation, the regularinsulin is drawn into the syringe first. This sequence will avoid contaminating the vial ofregular insulin with insulin of another type. Options 2, 3, and 4 identify the correct actions forpreparing NPH and regular insulin.

25. 25.) A home care nurse visits a clientrecently diagnosed with diabetesmellitus who is taking Humulin NPHinsulin daily. The client asks the nursehow to store the unopened vials ofinsulin. The nurse tells the client to:1. Freeze the insulin.2. Refrigerate the insulin.3. Store the insulin in a dark, dry place.4. Keep the insulin at room temperature.

2. Refrigerate the insulin.Rationale:Insulin in unopened vials should be stored under refrigeration until needed. Vials shouldnot be frozen. When stored unopened under refrigeration, insulin can be used up to theexpiration date on the vial. Options 1, 3, and 4 are incorrect.

26. 26.) Glimepiride (Amaryl) is prescribedfor a client with diabetes mellitus. Anurse reinforces instructions for theclient and tells the client to avoid whichof the following while taking thismedication?1. Alcohol2. Organ meats3. Whole-grain cereals4. Carbonated beverages

1. AlcoholRationale:When alcohol is combined with glimepiride (Amaryl), a disulfiram-like reaction mayoccur. This syndrome includes flushing, palpitations, and nausea. Alcohol can alsopotentiate the hypoglycemic effects of the medication. Clients need to be instructed toavoid alcohol consumption while taking this medication. The items in options 2, 3, and4 do not need to be avoided.

27. 27.) Sildenafil (Viagra) is prescribed totreat a client with erectile dysfunction. Anurse reviews the client's medical recordand would question the prescription ifwhich of the following is noted in theclient's history?1. Neuralgia2. Insomnia3. Use of nitroglycerin4. Use of multivitamins

3. Use of nitroglycerinRationale:Sildenafil (Viagra) enhances the vasodilating effect of nitric oxide in the corpuscavernosum of the penis, thus sustaining an erection. Because of the effect of themedication, it is contraindicated with concurrent use of organic nitrates andnitroglycerin. Sildenafil is not contraindicated with the use of vitamins. Neuralgia andinsomnia are side effects of the medication.

28. 28.) The health care provider (HCP)prescribes exenatide (Byetta) for a clientwith type 1 diabetes mellitus who takesinsulin. The nurse knows that which ofthe following is the appropriateintervention?1. The medication is administeredwithin 60 minutes before the morningand evening meal.2. The medication is withheld and theHCP is called to question theprescription for the client.3. The client is monitored forgastrointestinal side effects afteradministration of the medication.4. The insulin is withdrawn from thePenlet into an insulin syringe to preparefor administration.

2. The medication is withheld and the HCP is called to question the prescription for theclient.Rationale:Exenatide (Byetta) is an incretin mimetic used for type 2 diabetes mellitus only. It is notrecommended for clients taking insulin. Hence, the nurse should hold the medicationand question the HCP regarding this prescription. Although options 1 and 3 are correctstatements about the medication, in this situation the medication should not beadministered. The medication is packaged in prefilled pens ready for injection withoutthe need for drawing it up into another syringe.

29. 29.) A client is taking Humulin NPH insulindaily every morning. The nurse reinforcesinstructions for the client and tells the client thatthe most likely time for a hypoglycemic reactionto occur is:1. 2 to 4 hours after administration2. 4 to 12 hours after administration3. 16 to 18 hours after administration4. 18 to 24 hours after administration

2. 4 to 12 hours after administrationRationale:Humulin NPH is an intermediate-acting insulin. The onset of action is 1.5hours, it peaks in 4 to 12 hours, and its duration of action is 24 hours.Hypoglycemic reactions most likely occur during peak time.

30. 30.) A client with diabetes mellitus visits ahealth care clinic. The client's diabetes mellituspreviously had been well controlled withglyburide (DiaBeta) daily, but recently thefasting blood glucose level has been 180 to 200mg/dL. Which medication, if added to theclient's regimen, may have contributed to thehyperglycemia?1. Prednisone2. Phenelzine (Nardil)3. Atenolol (Tenormin)4. Allopurinol (Zyloprim)

1. PrednisoneRationale:Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics,and potassium supplements. Option 2, a monoamine oxidase inhibitor, andoption 3, a -blocker, have their own intrinsic hypoglycemic activity. Option 4decreases urinary excretion of sulfonylurea agents, causing increased levels ofthe oral agents, which can lead to hypoglycemia.

31. 31.) A community health nurse visits a client athome. Prednisone 10 mg orally daily has beenprescribed for the client and the nursereinforces teaching for the client about themedication. Which statement, if made by theclient, indicates that further teaching isnecessary?1. "I can take aspirin or my antihistamine if Ineed it."2. "I need to take the medication every day at thesame time."3. "I need to avoid coffee, tea, cola, and chocolatein my diet."4. "If I gain more than 5 pounds a week, I willcall my doctor."

1. "I can take aspirin or my antihistamine if I need it."Rationale:Aspirin and other over-the-counter medications should not be taken unless theclient consults with the health care provider (HCP). The client needs to take themedication at the same time every day and should be instructed not to stop themedication. A slight weight gain as a result of an improved appetite is expected,but after the dosage is stabilized, a weight gain of 5 lb or more weekly should bereported to the HCP. Caffeine-containing foods and fluids need to be avoidedbecause they may contribute to steroid-ulcer development.

32. 32.) Desmopressin acetate (DDAVP) isprescribed for the treatment of diabetesinsipidus. The nurse monitors the client aftermedication administration for whichtherapeutic response?1. Decreased urinary output2. Decreased blood pressure3. Decreased peripheral edema4. Decreased blood glucose level

1. Decreased urinary outputRationale:Desmopressin promotes renal conservation of water. The hormone carries outthis action by acting on the collecting ducts of the kidney to increase theirpermeability to water, which results in increased water reabsorption. Thetherapeutic effect of this medication would be manifested by a decreased urineoutput. Options 2, 3, and 4 are unrelated to the effects of this medication.

33. 33.) The home health care nurse isvisiting a client who was recentlydiagnosed with type 2 diabetes mellitus.The client is prescribed repaglinide(Prandin) and metformin (Glucophage)and asks the nurse to explain thesemedications. The nurse should reinforcewhich instructions to the client? Selectall that apply.1. Diarrhea can occur secondary to themetformin.2. The repaglinide is not taken if a mealis skipped.3. The repaglinide is taken 30 minutesbefore eating.4. Candy or another simple sugar iscarried and used to treat mildhypoglycemia episodes.5. Metformin increases hepatic glucoseproduction to prevent hypoglycemiaassociated with repaglinide.6. Muscle pain is an expected side effectof metformin and may be treated withacetaminophen (Tylenol).

1. Diarrhea can occur secondary to the metformin.2. The repaglinide is not taken if a meal is skipped.3. The repaglinide is taken 30 minutes before eating.4. Candy or another simple sugar is carried and used to treat mild hypoglycemiaepisodes.Rationale:Repaglinide is a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulinsecretion that should be taken before meals, and that should be withheld if the clientdoes not eat. Hypoglycemia is a side effect of repaglinide and the client should always beprepared by carrying a simple sugar with her or him at all times. Metformin is an oralhypoglycemic given in combination with repaglinide and works by decreasing hepaticglucose production. A common side effect of metformin is diarrhea. Muscle pain mayoccur as an adverse effect from metformin but it might signify a more serious conditionthat warrants health care provider notification, not the use of acetaminophen.

34. 34.) A client with Crohn's disease isscheduled to receive an infusion ofinfliximab (Remicade). The nurseassisting in caring for the client shouldtake which action to monitor theeffectiveness of treatment?1. Monitoring the leukocyte count for 2days after the infusion2. Checking the frequency andconsistency of bowel movements3. Checking serum liver enzyme levelsbefore and after the infusion4. Carrying out a Hematest on gastricfluids after the infusion is completed

2. Checking the frequency and consistency of bowel movementsRationale:The principal manifestations of Crohn's disease are diarrhea and abdominal pain.Infliximab (Remicade) is an immunomodulator that reduces the degree of inflammationin the colon, thereby reducing the diarrhea. Options 1, 3, and 4 are unrelated to thismedication.

35. 35.) The client has a PRN prescriptionfor loperamide hydrochloride(Imodium). The nurse understands thatthis medication is used for whichcondition?1. Constipation2. Abdominal pain3. An episode of diarrhea4. Hematest-positive nasogastric tubedrainage

3. An episode of diarrheaRationale:Loperamide is an antidiarrheal agent. It is used to manage acute and also chronicdiarrhea in conditions such as inflammatory bowel disease. Loperamide also can beused to reduce the volume of drainage from an ileostomy. It is not used for the conditionsin options 1, 2, and 4.

36. 36.) The client has a PRN prescription forondansetron (Zofran). For which conditionshould this medication be administered to thepostoperative client?1. Paralytic ileus2. Incisional pain3. Urinary retention4. Nausea and vomiting

4. Nausea and vomitingRationale:Ondansetron is an antiemetic used to treat postoperative nausea and vomiting,as well as nausea and vomiting associated with chemotherapy. The otheroptions are incorrect.

37. 37.) The client has begun medication therapywith pancrelipase (Pancrease MT). The nurseevaluates that the medication is having theoptimal intended benefit if which effect isobserved?1. Weight loss2. Relief of heartburn3. Reduction of steatorrhea4. Absence of abdominal pain

3. Reduction of steatorrheaRationale:Pancrelipase (Pancrease MT) is a pancreatic enzyme used in clients withpancreatitis as a digestive aid. The medication should reduce the amount of fattystools (steatorrhea). Another intended effect could be improved nutritionalstatus. It is not used to treat abdominal pain or heartburn. Its use could result inweight gain but should not result in weight loss if it is aiding in digestion.

38. 38.) An older client recently has been takingcimetidine (Tagamet). The nurse monitors theclient for which most frequent central nervoussystem side effect of this medication?1. Tremors2. Dizziness3. Confusion4. Hallucinations

3. ConfusionRationale:Cimetidine is a histamine 2 (H2)-receptor antagonist. Older clients areespecially susceptible to central nervous system side effects of cimetidine. Themost frequent of these is confusion. Less common central nervous system sideeffects include headache, dizziness, drowsiness, and hallucinations.

39. 39.) The client with a gastric ulcer has aprescription for sucralfate (Carafate), 1 g bymouth four times daily. The nurse schedules themedication for which times?1. With meals and at bedtime2. Every 6 hours around the clock3. One hour after meals and at bedtime4. One hour before meals and at bedtime

4. One hour before meals and at bedtimeRationale:Sucralfate is a gastric protectant. The medication should be scheduled foradministration 1 hour before meals and at bedtime. The medication is timed toallow it to form a protective coating over the ulcer before food intake stimulatesgastric acid production and mechanical irritation. The other options areincorrect.

40. 40.) The client who chronically usesnonsteroidal anti-inflammatory drugs has beentaking misoprostol (Cytotec). The nursedetermines that the medication is having theintended therapeutic effect if which of thefollowing is noted?1. Resolved diarrhea2. Relief of epigastric pain3. Decreased platelet count4. Decreased white blood cell count

2. Relief of epigastric painRationale:The client who chronically uses nonsteroidal anti-inflammatory drugs(NSAIDs) is prone to gastric mucosal injury. Misoprostol is a gastric protectantand is given specifically to prevent this occurrence. Diarrhea can be a side effectof the medication, but is not an intended effect. Options 3 and 4 are incorrect.

41. 41.) The client has been taking omeprazole(Prilosec) for 4 weeks. The ambulatory carenurse evaluates that the client is receivingoptimal intended effect of the medication if theclient reports the absence of which symptom?1. Diarrhea2. Heartburn3. Flatulence4. Constipation

2. HeartburnRationale:Omeprazole is a proton pump inhibitor classified as an antiulcer agent. Theintended effect of the medication is relief of pain from gastric irritation, oftencalled heartburn by clients. Omeprazole is not used to treat the conditionsidentified in options 1, 3, and 4.

42. 42.) A client with a peptic ulcer is diagnosed with aHelicobacter pylori infection. The nurse is reinforcingteaching for the client about the medicationsprescribed, including clarithromycin (Biaxin),esomeprazole (Nexium), and amoxicillin (Amoxil).Which statement by the client indicates the bestunderstanding of the medication regimen?1. "My ulcer will heal because these medications will killthe bacteria."2. "These medications are only taken when I have painfrom my ulcer."3. "The medications will kill the bacteria and stop theacid production."4. "These medications will coat the ulcer and decreasethe acid production in my stomach."

3. "The medications will kill the bacteria and stop the acid production."Rationale:Triple therapy for Helicobacter pylori infection usually includes twoantibacterial drugs and a proton pump inhibitor. Clarithromycin andamoxicillin are antibacterials. Esomeprazole is a proton pumpinhibitor. These medications will kill the bacteria and decrease acidproduction.

43. 43.) A histamine (H2)-receptor antagonist will beprescribed for a client. The nurse understands thatwhich medications are H2-receptor antagonists? Selectall that apply.1. Nizatidine (Axid)2. Ranitidine (Zantac)3. Famotidine (Pepcid)4. Cimetidine (Tagamet)5. Esomeprazole (Nexium)6. Lansoprazole (Prevacid)

1. Nizatidine (Axid)2. Ranitidine (Zantac)3. Famotidine (Pepcid)4. Cimetidine (Tagamet)Rationale:H2-receptor antagonists suppress secretion of gastric acid, alleviatesymptoms of heartburn, and assist in preventing complications ofpeptic ulcer disease. These medications also suppress gastric acidsecretions and are used in active ulcer disease, erosive esophagitis, andpathological hypersecretory conditions. The other medications listedare proton pump inhibitors.H2-receptor antagonists medication names end with -dine.Proton pump inhibitors medication names end with -zole.

44. 44.) A client is receiving acetylcysteine (Mucomyst), 20%solution diluted in 0.9% normal saline by nebulizer. Thenurse should have which item available for possible useafter giving this medication?1. Ambu bag2. Intubation tray3. Nasogastric tube4. Suction equipment

4. Suction equipmentRationale:Acetylcysteine can be given orally or by nasogastric tube to treatacetaminophen overdose, or it may be given by inhalation for use as amucolytic. The nurse administering this medication as a mucolyticshould have suction equipment available in case the client cannotmanage to clear the increased volume of liquefied secretions.

45. 45.) A client has a prescription to take guaifenesin(Humibid) every 4 hours, as needed. The nursedetermines that the client understands the mosteffective use of this medication if the client states that heor she will:1. Watch for irritability as a side effect.2. Take the tablet with a full glass of water.3. Take an extra dose if the cough is accompanied byfever.4. Crush the sustained-release tablet if immediate reliefis needed.

2. Take the tablet with a full glass of water.Rationale:Guaifenesin is an expectorant. It should be taken with a full glass ofwater to decrease viscosity of secretions. Sustained-releasepreparations should not be broken open, crushed, or chewed. Themedication may occasionally cause dizziness, headache, ordrowsiness as side effects. The client should contact the health careprovider if the cough lasts longer than 1 week or is accompanied byfever, rash, sore throat, or persistent headache.

46. 46.) A postoperative client hasreceived a dose of naloxonehydrochloride for respiratorydepression shortly after transfer tothe nursing unit from thepostanesthesia care unit. Afteradministration of the medication, thenurse checks the client for:1. Pupillary changes2. Scattered lung wheezes3. Sudden increase in pain4. Sudden episodes of diarrhea

3. Sudden increase in painRationale:Naloxone hydrochloride is an antidote to opioids and may also be given to the postoperativeclient to treat respiratory depression. When given to the postoperative client for respiratorydepression, it may also reverse the effects of analgesics. Therefore, the nurse must check theclient for a sudden increase in the level of pain experienced. Options 1, 2, and 4 are notassociated with this medication.

47. 47.) A client has been taking isoniazid(INH) for 2 months. The clientcomplains to a nurse aboutnumbness, paresthesias, and tinglingin the extremities. The nurseinterprets that the client isexperiencing:1. Hypercalcemia2. Peripheral neuritis3. Small blood vessel spasm4. Impaired peripheral circulation

2. Peripheral neuritisRationale:A common side effect of the TB drug INH is peripheral neuritis. This is manifested bynumbness, tingling, and paresthesias in the extremities. This side effect can be minimizedby pyridoxine (vitamin B6) intake. Options 1, 3, and 4 are incorrect.

48. 48.) A client is to begin a 6-monthcourse of therapy with isoniazid(INH). A nurse plans to teach theclient to:1. Drink alcohol in small amountsonly.2. Report yellow eyes or skinimmediately.3. Increase intake of Swiss or agedcheeses.4. Avoid vitamin supplements duringtherapy.

2. Report yellow eyes or skin immediately.Rationale:INH is hepatotoxic, and therefore the client is taught to report signs and symptoms ofhepatitis immediately (which include yellow skin and sclera). For the same reason, alcoholshould be avoided during therapy. The client should avoid intake of Swiss cheese, fish suchas tuna, and foods containing tyramine because they may cause a reaction characterized byredness and itching of the skin, flushing, sweating, tachycardia, headache, orlightheadedness. The client can avoid developing peripheral neuritis by increasing theintake of pyridoxine (vitamin B6) during the course of INH therapy for TB.

49. 49.) A client has been started on long-term therapy with rifampin(Rifadin). A nurse teaches the clientthat the medication:1. Should always be taken with food orantacids2. Should be double-dosed if one doseis forgotten3. Causes orange discoloration ofsweat, tears, urine, and feces4. May be discontinued independentlyif symptoms are gone in 3 months

3. Causes orange discoloration of sweat, tears, urine, and fecesRationale:Rifampin should be taken exactly as directed as part of TB therapy. Doses should not bedoubled or skipped. The client should not stop therapy until directed to do so by a health careprovider. The medication should be administered on an empty stomach unless it causesgastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should betaken at least 1 hour before the medication. Rifampin causes orange-red discoloration ofbody secretions and will permanently stain soft contact lenses.

50. 50.) A nurse has given a clienttaking ethambutol (Myambutol)information about the medication.The nurse determines that theclient understands theinstructions if the client states thathe or she will immediately report:1. Impaired sense of hearing2. Problems with visual acuity3. Gastrointestinal (GI) side effects4. Orange-red discoloration ofbody secretions

2. Problems with visual acuityRationale:Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminatebetween the colors red and green. This poses a potential safety hazard when a client is driving amotor vehicle. The client is taught to report this symptom immediately. The client is also taughtto take the medication with food if GI upset occurs. Impaired hearing results fromantitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs withrifampin (Rifadin).

51. 51.) Cycloserine (Seromycin) isadded to the medication regimenfor a client with tuberculosis.Which of the following would thenurse include in the client-teaching plan regarding thismedication?1. To take the medication beforemeals2. To return to the clinic weekly forserum drug-level testing3. It is not necessary to call thehealth care provider (HCP) if askin rash occurs.4. It is not necessary to restrictalcohol intake with thismedication.

2. To return to the clinic weekly for serum drug-level testingRationale:Cycloserine (Seromycin) is an antitubercular medication that requires weekly serum drug leveldeterminations to monitor for the potential of neurotoxicity. Serum drug levels lower than 30mcg/mL reduce the incidence of neurotoxicity. The medication must be taken after meals toprevent gastrointestinal irritation. The client must be instructed to notify the HCP if a skin rashor signs of central nervous system toxicity are noted. Alcohol must be avoided because itincreases the risk of seizure activity.

52. 52.) A client with tuberculosis isbeing started on antituberculosistherapy with isoniazid (INH).Before giving the client the firstdose, a nurse ensures that whichof the following baseline studieshas been completed?1. Electrolyte levels2. Coagulation times3. Liver enzyme levels4. Serum creatinine level

3. Liver enzyme levelsRationale:INH therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liverenzyme levels are monitored when therapy is initiated and during the first 3 months of therapy.They may be monitored longer in the client who is greater than age 50 or abuses alcohol.

53. 53.) Rifabutin (Mycobutin) isprescribed for a client with activeMycobacterium avium complex(MAC) disease and tuberculosis.The nurse monitors for which sideeffects of the medication? Select allthat apply.1. Signs of hepatitis2. Flu-like syndrome3. Low neutrophil count4. Vitamin B6 deficiency5. Ocular pain or blurred vision6. Tingling and numbness of thefingers

1. Signs of hepatitis2. Flu-like syndrome3. Low neutrophil count5. Ocular pain or blurred visionRationale:Rifabutin (Mycobutin) may be prescribed for a client with active MAC disease and tuberculosis.It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis.Side effects include rash, gastrointestinal disturbances, neutropenia (low neutrophil count),red-orange body secretions, uveitis (blurred vision and eye pain), myositis, arthralgia,hepatitis, chest pain with dyspnea, and flu-like syndrome. Vitamin B6 deficiency andnumbness and tingling in the extremities are associated with the use of isoniazid (INH).Ethambutol (Myambutol) also causes peripheral neuritis.

54. 54.) A nurse reinforces discharge instructions to apostoperative client who is taking warfarin sodium(Coumadin). Which statement, if made by the client,reflects the need for further teaching?1. "I will take my pills every day at the same time."2. "I will be certain to avoid alcohol consumption."3. "I have already called my family to pick up a Medic-Alert bracelet."4. "I will take Ecotrin (enteric-coated aspirin) for myheadaches because it is coated."

4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because itis coated."Rationale:Ecotrin is an aspirin-containing product and should be avoided. Alcoholconsumption should be avoided by a client taking warfarin sodium.Taking prescribed medication at the same time each day increases clientcompliance. The Medic-Alert bracelet provides health care personnelemergency information.

55. 55.) A client who is receiving digoxin (Lanoxin) dailyhas a serum potassium level of 3.0 mEq/L and iscomplaining of anorexia. A health care providerprescribes a digoxin level to rule out digoxin toxicity.A nurse checks the results, knowing that which of thefollowing is the therapeutic serum level (range) fordigoxin?1. 3 to 5 ng/mL2. 0.5 to 2 ng/mL3. 1.2 to 2.8 ng/mL4. 3.5 to 5.5 ng/mL

2.) 0.5 to 2 ng/mLRationale:Therapeutic levels for digoxin range from 0.5 to 2 ng/mL. Therefore,options 1, 3, and 4 are incorrect.

56. 56.) Heparin sodium is prescribed for the client. Thenurse expects that the health care provider willprescribe which of the following to monitor for atherapeutic effect of the medication?1. Hematocrit level2. Hemoglobin level3. Prothrombin time (PT)4. Activated partial thromboplastin time (aPTT)

4. Activated partial thromboplastin time (aPTT)Rationale:The PT will assess for the therapeutic effect of warfarin sodium(Coumadin) and the aPTT will assess the therapeutic effect of heparinsodium. Heparin sodium doses are determined based on these laboratoryresults. The hemoglobin and hematocrit values assess red blood cellconcentrations.

57. 57.) A nurse is monitoring a client who is takingpropranolol (Inderal LA). Which data collectionfinding would indicate a potential seriouscomplication associated with propranolol?1. The development of complaints of insomnia2. The development of audible expiratory wheezes3. A baseline blood pressure of 150/80 mm Hgfollowed by a blood pressure of 138/72 mm Hg aftertwo doses of the medication4. A baseline resting heart rate of 88 beats/minfollowed by a resting heart rate of 72 beats/min aftertwo doses of the medication

2. The development of audible expiratory wheezesRationale:Audible expiratory wheezes may indicate a serious adverse reaction,bronchospasm. -Blockers may induce this reaction, particularly inclients with chronic obstructive pulmonary disease or asthma. Normaldecreases in blood pressure and heart rate are expected. Insomnia is afrequent mild side effect and should be monitored.

58. 58.) Isosorbide mononitrate (Imdur) is prescribedfor a client with angina pectoris. The client tells thenurse that the medication is causing a chronicheadache. The nurse appropriately suggests that theclient:1. Cut the dose in half.2. Discontinue the medication.3. Take the medication with food.4. Contact the health care provider (HCP).

3. Take the medication with food.Rationale:Isosorbide mononitrate is an antianginal medication. Headache is afrequent side effect of isosorbide mononitrate and usually disappearsduring continued therapy. If a headache occurs during therapy, the clientshould be instructed to take the medication with food or meals. It is notnecessary to contact the HCP unless the headaches persist with therapy.It is not appropriate to instruct the client to discontinue therapy or adjustthe dosages.

59. 59.) A client is diagnosed with an acutemyocardial infarction and is receivingtissue plasminogen activator, alteplase(Activase, tPA). Which action is a prioritynursing intervention?1. Monitor for renal failure.2. Monitor psychosocial status.3. Monitor for signs of bleeding.4. Have heparin sodium available.

3. Monitor for signs of bleeding.Rationale:Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of anytype of thrombolytic medication. The client is monitored for bleeding. Monitoring forrenal failure and monitoring the client's psychosocial status are important but arenot the most critical interventions. Heparin is given after thrombolytic therapy, butthe question is not asking about follow-up medications.

60. 60.) A nurse is planning to administerhydrochlorothiazide (HydroDIURIL) to aclient. The nurse understands that which ofthe following are concerns related to theadministration of this medication?1. Hypouricemia, hyperkalemia2. Increased risk of osteoporosis3. Hypokalemia, hyperglycemia, sulfaallergy4. Hyperkalemia, hypoglycemia, penicillinallergy

3. Hypokalemia, hyperglycemia, sulfa allergyRationale:Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and aclient with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk forhypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.

61. 61.) A home health care nurse is visiting aclient with elevated triglyceride levels and aserum cholesterol level of 398 mg/dL. Theclient is taking cholestyramine (Questran).Which of the following statements, if madeby the client, indicates the need for furthereducation?1. "Constipation and bloating might be aproblem."2. "I'll continue to watch my diet and reducemy fats."3. "Walking a mile each day will help thewhole process."4. "I'll continue my nicotinic acid from thehealth food store."

4. "I'll continue my nicotinic acid from the health food store."Rationale:Nicotinic acid, even an over-the-counter form, should be avoided because it may leadto liver abnormalities. All lipid-lowering medications also can cause liverabnormalities, so a combination of nicotinic acid and cholestyramine resin is to beavoided. Constipation and bloating are the two most common side effects. Walkingand the reduction of fats in the diet are therapeutic measures to reduce cholesteroland triglyceride levels.

62. 62.) A client is on nicotinic acid (niacin) forhyperlipidemia and the nurse providesinstructions to the client about themedication. Which statement by the clientwould indicate an understanding of theinstructions?1. "It is not necessary to avoid the use ofalcohol."2. "The medication should be taken withmeals to decrease flushing."3. "Clay-colored stools are a common sideeffect and should not be of concern."4. "Ibuprofen (Motrin) taken 30 minutesbefore the nicotinic acid should decreasethe flushing."

4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease theflushing."Rationale:Flushing is a side effect of this medication. Aspirin or a nonsteroidal anti-inflammatory drug can be taken 30 minutes before taking the medication to decreaseflushing. Alcohol consumption needs to be avoided because it will enhance this sideeffect. The medication should be taken with meals, this will decrease gastrointestinalupset. Taking the medication with meals has no effect on the flushing. Clay-coloredstools are a sign of hepatic dysfunction and should be immediately reported to thehealth care provider (HCP).

63. 63.) A client with coronary arterydisease complains of substernal chestpain. After checking the client's heartrate and blood pressure, a nurseadministers nitroglycerin, 0.4 mg,sublingually. After 5 minutes, the clientstates, "My chest still hurts." Select theappropriate actions that the nurseshould take. Select all that apply.1. Call a code blue.2. Contact the registered nurse.3. Contact the client's family.4. Assess the client's pain level.5. Check the client's blood pressure.6. Administer a second nitroglycerin,0.4 mg, sublingually.

2. Contact the registered nurse.4. Assess the client's pain level.5. Check the client's blood pressure.6. Administer a second nitroglycerin, 0.4 mg, sublingually.Rationale:The usual guideline for administering nitroglycerin tablets for a hospitalized client withchest pain is to administer one tablet every 5 minutes PRN for chest pain, for a total doseof three tablets. The registered nurse should be notified of the client's condition, who willthen notify the health care provider as appropriate. Because the client is still complainingof chest pain, the nurse would administer a second nitroglycerin tablet. The nurse wouldassess the client's pain level and check the client's blood pressure before administeringeach nitroglycerin dose. There are no data in the question that indicate the need to call acode blue. In addition, it is not necessary to contact the client's family unless the clienthas requested this.

64. 64.) Nalidixic acid (NegGram) isprescribed for a client with a urinarytract infection. On review of the client'srecord, the nurse notes that the client istaking warfarin sodium (Coumadin)daily. Which prescription should thenurse anticipate for this client?1. Discontinuation of warfarin sodium(Coumadin)2. A decrease in the warfarin sodium(Coumadin) dosage3. An increase in the warfarin sodium(Coumadin) dosage4. A decrease in the usual dose ofnalidixic acid (NegGram)

2. A decrease in the warfarin sodium (Coumadin) dosageRationale:Nalidixic acid can intensify the effects of oral anticoagulants by displacing these agentsfrom binding sites on plasma protein. When an oral anticoagulant is combined withnalidixic acid, a decrease in the anticoagulant dosage may be needed.

65. 65.) A nurse is reinforcing dischargeinstructions to a client receivingsulfisoxazole. Which of the followingshould be included in the list ofinstructions?1. Restrict fluid intake.2. Maintain a high fluid intake.3. If the urine turns dark brown, call thehealth care provider (HCP)immediately.4. Decrease the dosage when symptomsare improving to prevent an allergicresponse.

2. Maintain a high fluid intake.Rationale:Each dose of sulfisoxazole should be administered with a full glass of water, and theclient should maintain a high fluid intake. The medication is more soluble in alkalineurine. The client should not be instructed to taper or discontinue the dose. Some forms ofsulfisoxazole cause urine to turn dark brown or red. This does not indicate the need tonotify the HCP.

66. 66.) Trimethoprim-sulfamethoxazole(TMP-SMZ) is prescribed for a client. Anurse should instruct the client toreport which symptom if it developedduring the course of this medicationtherapy?1. Nausea2. Diarrhea3. Headache4. Sore throat

4. Sore throatRationale:Clients taking trimethoprim-sulfamethoxazole (TMP-SMZ) should be informed aboutearly signs of blood disorders that can occur from this medication. These include sorethroat, fever, and pallor, and the client should be instructed to notify the health careprovider if these symptoms occur. The other options do not require health care providernotification.

67. 67.) Phenazopyridine hydrochloride(Pyridium) is prescribed for a client forsymptomatic relief of pain resulting froma lower urinary tract infection. The nursereinforces to the client:1. To take the medication at bedtime2. To take the medication before meals3. To discontinue the medication if aheadache occurs4. That a reddish orange discoloration ofthe urine may occur

4. That a reddish orange discoloration of the urine may occurRationale:The nurse should instruct the client that a reddish-orange discoloration of urine mayoccur. The nurse also should instruct the client that this discoloration can stain fabric.The medication should be taken after meals to reduce the possibility of gastrointestinalupset. A headache is an occasional side effect of the medication and does not warrantdiscontinuation of the medication.

68. 68.) Bethanechol chloride (Urecholine) isprescribed for a client with urinaryretention. Which disorder would be acontraindication to the administration ofthis medication?1. Gastric atony2. Urinary strictures3. Neurogenic atony4. Gastroesophageal reflux

2. Urinary stricturesRationale:Bethanechol chloride (Urecholine) can be harmful to clients with urinary tractobstruction or weakness of the bladder wall. The medication has the ability to contractthe bladder and thereby increase pressure within the urinary tract. Elevation ofpressure within the urinary tract could rupture the bladder in clients with theseconditions.

69. 69.) A nurse who is administeringbethanechol chloride (Urecholine) ismonitoring for acute toxicity associatedwith the medication. The nurse checks theclient for which sign of toxicity?1. Dry skin2. Dry mouth3. Bradycardia4. Signs of dehydration

3. BradycardiaRationale:Toxicity (overdose) produces manifestations of excessive muscarinic stimulation suchas salivation, sweating, involuntary urination and defecation, bradycardia, and severehypotension. Treatment includes supportive measures and the administration ofatropine sulfate subcutaneously or intravenously.

70. 70.) Oxybutynin chloride (Ditropan XL) isprescribed for a client with neurogenicbladder. Which sign would indicate apossible toxic effect related to thismedication?1. Pallor2. Drowsiness3. Bradycardia4. Restlessness

4. RestlessnessRationale:Toxicity (overdosage) of this medication produces central nervous system excitation,such as nervousness, restlessness, hallucinations, and irritability. Other signs oftoxicity include hypotension or hypertension, confusion, tachycardia, flushed or redface, and signs of respiratory depression. Drowsiness is a frequent side effect of themedication but does not indicate overdosage.

71. 71.) After kidney transplantation,cyclosporine (Sand immune) is prescribedfor a client. Which laboratory result wouldindicate an adverse effect from the use ofthis medication?1. Decreased creatinine level2. Decreased hemoglobin level3. Elevated blood urea nitrogen level4. Decreased white blood cell count

3. Elevated blood urea nitrogen levelRationale:Nephrotoxicity can occur from the use of cyclosporine (Sandimmune). Nephrotoxicityis evaluated by monitoring for elevated blood urea nitrogen (BUN) and serumcreatinine levels. Cyclosporine is an immunosuppressant but does not depress thebone marrow.

72. 72.) Cinoxacin (Cinobac), a urinary antiseptic, isprescribed for the client. The nurse reviews the client'smedical record and should contact the health careprovider (HCP) regarding which documented finding toverify the prescription? Refer to chart.1. Renal insufficiency2. Chest x-ray: normal3. Blood glucose, 102 mg/dL4. Folic acid (vitamin B6) 0.5 mg, orally daily

1. Renal insufficiencyRationale:Cinoxacin should be administered with caution in clients with renalimpairment. The dosage should be reduced, and failure to do so couldresult in accumulation of cinoxacin to toxic levels. Therefore thenurse would verify the prescription if the client had a documentedhistory of renal insufficiency. The laboratory and diagnostic testresults are normal findings. Folic acid (vitamin B6) may beprescribed for a client with renal insufficiency to prevent anemia.

73. 73.) A client with myasthenia gravis is suspected ofhaving cholinergic crisis. Which of the following indicatethat this crisis exists?1. Ataxia2. Mouth sores3. Hypotension4. Hypertension

4. HypertensionRationale:Cholinergic crisis occurs as a result of an overdose of medication.Indications of cholinergic crisis include gastrointestinaldisturbances, nausea, vomiting, diarrhea, abdominal cramps,increased salivation and tearing, miosis, hypertension, sweating,and increased bronchial secretions.

74. 74.) A client with myasthenia gravis is receivingpyridostigmine (Mestinon). The nurse monitors for signsand symptoms of cholinergic crisis caused by overdose ofthe medication. The nurse checks the medication supplyto ensure that which medication is available foradministration if a cholinergic crisis occurs?1. Vitamin K2. Atropine sulfate3. Protamine sulfate4. Acetylcysteine (Mucomyst)

2. Atropine sulfateRationale:The antidote for cholinergic crisis is atropine sulfate. Vitamin K isthe antidote for warfarin (Coumadin). Protamine sulfate is theantidote for heparin, and acetylcysteine (Mucomyst) is the antidotefor acetaminophen (Tylenol).

75. 75.) A client with myasthenia gravis becomes increasinglyweak. The health care provider prepares to identifywhether the client is reacting to an overdose of themedication (cholinergic crisis) or increasing severity ofthe disease (myasthenic crisis). An injection ofedrophonium (Enlon) is administered. Which of thefollowing indicates that the client is in cholinergic crisis?1. No change in the condition2. Complaints of muscle spasms3. An improvement of the weakness4. A temporary worsening of the condition

4. A temporary worsening of the conditionRationale:An edrophonium (Enlon) injection, a cholinergic drug, makes theclient in cholinergic crisis temporarily worse. This is known as anegative test. An improvement of weakness would occur if the clientwere experiencing myasthenia gravis. Options 1 and 2 would notoccur in either crisis.

76. 76.) Carbidopa-levodopa (Sinemet) is prescribed for aclient with Parkinson's disease, and the nurse monitorsthe client for adverse reactions to the medication. Whichof the following indicates that the client is experiencingan adverse reaction?1. Pruritus2. Tachycardia3. Hypertension4. Impaired voluntary movements

4. Impaired voluntary movementsRationale:Dyskinesia and impaired voluntary movement may occur with highlevodopa dosages. Nausea, anorexia, dizziness, orthostatichypotension, bradycardia, and akinesia (the temporary muscleweakness that lasts 1 minute to 1 hour, also known as the "on-offphenomenon") are frequent side effects of the medication.

77. 77.) Phenytoin (Dilantin), 100 mg orallythree times daily, has been prescribedfor a client for seizure control. The nursereinforces instructions regarding themedication to the client. Whichstatement by the client indicates anunderstanding of the instructions?1. "I will use a soft toothbrush to brushmy teeth."2. "It's all right to break the capsules tomake it easier for me to swallow them."3. "If I forget to take my medication, I canwait until the next dose and eliminatethat dose."4. "If my throat becomes sore, it's anormal effect of the medication and it'snothing to be concerned about."

1. "I will use a soft toothbrush to brush my teeth."Rationale:Phenytoin (Dilantin) is an anticonvulsant. Gingival hyperplasia, bleeding, swelling,and tenderness of the gums can occur with the use of this medication. The client needsto be taught good oral hygiene, gum massage, and the need for regular dentist visits. Theclient should not skip medication doses, because this could precipitate a seizure.Capsules should not be chewed or broken and they must be swallowed. The client needsto be instructed to report a sore throat, fever, glandular swelling, or any skin reaction,because this indicates hematological toxicity.

78. 78.) A client is taking phenytoin(Dilantin) for seizure control and asample for a serum drug level is drawn.Which of the following indicates atherapeutic serum drug range?1. 5 to 10 mcg/mL2. 10 to 20 mcg/mL3. 20 to 30 mcg/mL4. 30 to 40 mcg/mL

2. 10 to 20 mcg/mLRationale:The therapeutic serum drug level range for phenytoin (Dilantin) is 10 to 20 mcg/mL. * A helpful hint may be to remember that the theophylline therapeutic rangeand the acetaminophen (Tylenol) therapeutic range are the same as thephenytoin (Dilantin) therapeutic range.*

79. 79.) Ibuprofen (Advil) is prescribed for aclient. The nurse tells the client to takethe medication:1. With 8 oz of milk2. In the morning after arising3. 60 minutes before breakfast4. At bedtime on an empty stomach

1. With 8 oz of milkRationale:Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs should be givenwith milk or food to prevent gastrointestinal irritation. Options 2, 3, and 4 are incorrect.

80. 80.) A nurse is caring for a client who istaking phenytoin (Dilantin) for controlof seizures. During data collection, thenurse notes that the client is taking birthcontrol pills. Which of the followinginformation should the nurse provide tothe client?1. Pregnancy should be avoided whiletaking phenytoin (Dilantin).2. The client may stop taking thephenytoin (Dilantin) if it is causingsevere gastrointestinal effects.3. The potential for decreasedeffectiveness of the birth control pillsexists while taking phenytoin (Dilantin).4. The increased risk ofthrombophlebitis exists while takingphenytoin (Dilantin) and birth controlpills together.

3. The potential for decreased effectiveness of the birth control pills exists while takingphenytoin (Dilantin).Rationale:Phenytoin (Dilantin) enhances the rate of estrogen metabolism, which can decrease theeffectiveness of some birth control pills. Options 1, 2, are 4 are not accurate.

81. 81.) A client with trigeminal neuralgia isbeing treated with carbamazepine(Tegretol). Which laboratory resultwould indicate that the client isexperiencing an adverse reaction to themedication?1. Sodium level, 140 mEq/L2. Uric acid level, 5.0 mg/dL3. White blood cell count, 3000cells/mm34. Blood urea nitrogen (BUN) level, 15mg/dL

3. White blood cell count, 3000 cells/mm3Rationale:Adverse effects of carbamazepine (Tegretol) appear as blood dyscrasias, includingaplastic anemia, agranulocytosis, thrombocytopenia, leukopenia, cardiovasculardisturbances, thrombophlebitis, dysrhythmias, and dermatological effects. Options 1, 2,and 4 identify normal laboratory values.

82. 82.) A client is receiving meperidinehydrochloride (Demerol) for pain.Which of the following are side effects ofthis medication. Select all that apply.1. Diarrhea2. Tremors3. Drowsiness4. Hypotension5. Urinary frequency6. Increased respiratory rate

2. Tremors3. Drowsiness4. HypotensionRationale:Meperidine hydrochloride is an opioid analgesic. Side effects include respiratorydepression, drowsiness, hypotension, constipation, urinary retention, nausea, vomiting,and tremors.

83. 83.) The client has been on treatmentfor rheumatoid arthritis for 3 weeks.During the administration ofetanercept (Enbrel), it is mostimportant for the nurse to check:1. The injection site for itching andedema2. The white blood cell counts andplatelet counts3. Whether the client is experiencingfatigue and joint pain4. A metallic taste in the mouth, with aloss of appetite

2. The white blood cell counts and platelet countsRationale:Infection and pancytopenia are side effects of etanercept (Enbrel). Laboratory studies areperformed before and during drug treatment. The appearance of abnormal white bloodcell counts and abnormal platelet counts can alert the nurse to a potentially life-threatening infection. Injection site itching is a common occurrence followingadministration. A metallic taste with loss of appetite are not common signs of side effectsof this medication.

84. 84.) Baclofen (Lioresal) is prescribedfor the client with multiple sclerosis.The nurse assists in planning care,knowing that the primary therapeuticeffect of this medication is which of thefollowing?1. Increased muscle tone2. Decreased muscle spasms3. Increased range of motion4. Decreased local pain and tenderness

2. Decreased muscle spasmsRationale:Baclofen is a skeletal muscle relaxant and central nervous system depressant and acts atthe spinal cord level to decrease the frequency and amplitude of muscle spasms in clientswith spinal cord injuries or diseases and in clients with multiple sclerosis. Options 1, 3,and 4 are incorrect.

85. 85.) A nurse is monitoring a clientreceiving baclofen (Lioresal) for sideeffects related to the medication. Whichof the following would indicate that theclient is experiencing a side effect?1. Polyuria2. Diarrhea3. Drowsiness4. Muscular excitability

3. DrowsinessRationale:Baclofen is a central nervous system (CNS) depressant and frequently causes drowsiness,dizziness, weakness, and fatigue. It can also cause nausea, constipation, and urinaryretention. Clients should be warned about the possible reactions. Options 1, 2, and 4 arenot side effects.

86. 86.) A nurse is reinforcing dischargeinstructions to a client receiving baclofen(Lioresal). Which of the following wouldthe nurse include in the instructions?1. Restrict fluid intake.2. Avoid the use of alcohol.3. Stop the medication if diarrhea occurs.4. Notify the health care provider iffatigue occurs.

2. Avoid the use of alcohol.Rationale:Baclofen is a central nervous system (CNS) depressant. The client should be cautionedagainst the use of alcohol and other CNS depressants, because baclofen potentiates thedepressant activity of these agents. Constipation rather than diarrhea is an adverseeffect of baclofen. It is not necessary to restrict fluids, but the client should be warnedthat urinary retention can occur. Fatigue is related to a CNS effect that is most intenseduring the early phase of therapy and diminishes with continued medication use. It isnot necessary that the client notify the health care provider if fatigue occurs.

87. 87.) A client with acute muscle spasmshas been taking baclofen (Lioresal). Theclient calls the clinic nurse because ofcontinuous feelings of weakness andfatigue and asks the nurse aboutdiscontinuing the medication. The nurseshould make which appropriate responseto the client?1. "You should never stop themedication."2. "It is best that you taper the dose if youintend to stop the medication."3. "It is okay to stop the medication if youthink that you can tolerate the musclespasms."4. "Weakness and fatigue commonlyoccur and will diminish with continuedmedication use."

4. "Weakness and fatigue commonly occur and will diminish with continuedmedication use."Rationale:The client should be instructed that symptoms such as drowsiness, weakness, andfatigue are more intense in the early phase of therapy and diminish with continuedmedication use. The client should be instructed never to withdraw or stop themedication abruptly, because abrupt withdrawal can cause visual hallucinations,paranoid ideation, and seizures. It is best for the nurse to inform the client that thesesymptoms will subside and encourage the client to continue the use of the medication.

88. 88.) Dantrolene sodium (Dantrium) isprescribed for a client experiencing flexorspasms, and the client asks the nurseabout the action of the medication. Thenurse responds, knowing that thetherapeutic action of this medication iswhich of the following?1. Depresses spinal reflexes2. Acts directly on the skeletal muscle torelieve spasticity3. Acts within the spinal cord to suppresshyperactive reflexes4. Acts on the central nervous system(CNS) to suppress spasms

2. Acts directly on the skeletal muscle to relieve spasticityRationale:Dantrium acts directly on skeletal muscle to relieve muscle spasticity. The primaryaction is the suppression of calcium release from the sarcoplasmic reticulum. This inturn decreases the ability of the skeletal muscle to contract. *Options 1, 3, and 4 are all comparable or alike in that they address CNSsuppression and the depression of reflexes. Therefore, eliminate theseoptions.*

89. 89.) A nurse is reviewing the laboratorystudies on a client receiving dantrolenesodium (Dantrium). Which laboratorytest would identify an adverse effectassociated with the administration of thismedication?1. Creatinine2. Liver function tests3. Blood urea nitrogen4. Hematological function tests

2. Liver function testsRationale:Dose-related liver damage is the most serious adverse effect of dantrolene. To reducethe risk of liver damage, liver function tests should be performed before treatment andperiodically throughout the treatment course. It is administered in the lowest effectivedosage for the shortest time necessary.*Eliminate options 1 and 3 because these tests both assess kidneyfunction.*

90. 90.) A nurse is reviewing the record of a client whohas been prescribed baclofen (Lioresal). Which ofthe following disorders, if noted in the client'shistory, would alert the nurse to contact the healthcare provider?1. Seizure disorders2. Hyperthyroidism3. Diabetes mellitus4. Coronary artery disease

1. Seizure disordersRationale:Clients with seizure disorders may have a lowered seizure threshold whenbaclofen is administered. Concurrent therapy may require an increase in theanticonvulsive medication. The disorders in options 2, 3, and 4 are not aconcern when the client is taking baclofen.

91. 91.) Cyclobenzaprine (Flexeril) is prescribed for aclient to treat muscle spasms, and the nurse isreviewing the client's record. Which of the followingdisorders, if noted in the client's record, wouldindicate a need to contact the health care providerregarding the administration of this medication?1. Glaucoma2. Emphysema3. Hyperthyroidism4. Diabetes mellitus

1. GlaucomaRationale:Because this medication has anticholinergic effects, it should be used withcaution in clients with a history of urinary retention, angle-closureglaucoma, and increased intraocular pressure. Cyclobenzaprinehydrochloride should be used only for short-term 2- to 3-week therapy.

92. 92.) In monitoring a client's response to disease-modifying antirheumatic drugs (DMARDs), whichfindings would the nurse interpret as acceptableresponses? Select all that apply.1. Symptom control during periods of emotionalstress2. Normal white blood cell counts, platelet, andneutrophil counts3. Radiological findings that show nonprogressionof joint degeneration4. An increased range of motion in the affectedjoints 3 months into therapy5. Inflammation and irritation at the injection site3 days after injection is given6. A low-grade temperature upon rising in themorning that remains throughout the day

1. Symptom control during periods of emotional stress2. Normal white blood cell counts, platelet, and neutrophil counts3. Radiological findings that show nonprogression of joint degeneration4. An increased range of motion in the affected joints 3 months into therapyRationale:Because emotional stress frequently exacerbates the symptoms ofrheumatoid arthritis, the absence of symptoms is a positive finding.DMARDs are given to slow progression of joint degeneration. In addition,the improvement in the range of motion after 3 months of therapy withnormal blood work is a positive finding. Temperature elevation andinflammation and irritation at the medication injection site could indicatesigns of infection.

93. 93.) The client who is human immunodeficiencyvirus seropositive has been taking stavudine (d4t,Zerit). The nurse monitors which of the followingmost closely while the client is taking thismedication?1. Gait2. Appetite3. Level of consciousness4. Hemoglobin and hematocrit blood levels

1. GaitRationale:Stavudine (d4t, Zerit) is an antiretroviral used to manage humanimmunodeficiency virus infection in clients who do not respond to or whocannot tolerate conventional therapy. The medication can cause peripheralneuropathy, and the nurse should monitor the client's gait closely and askthe client about paresthesia. Options 2, 3, and 4 are unrelated to the use ofthe medication.

94. 94.) The client with acquired immunodeficiencysyndrome has begun therapy with zidovudine(Retrovir, Azidothymidine, AZT, ZDV). The nursecarefully monitors which of the following laboratoryresults during treatment with this medication?1. Blood culture2. Blood glucose level3. Blood urea nitrogen4. Complete blood count

4. Complete blood countRationale:A common side effect of therapy with zidovudine is leukopenia and anemia.The nurse monitors the complete blood count results for these changes.Options 1, 2, and 3 are unrelated to the use of this medication.

95. 95.) The nurse is reviewing the results of serumlaboratory studies drawn on a client withacquired immunodeficiency syndrome who isreceiving didanosine (Videx). The nurseinterprets that the client may have themedication discontinued by the health careprovider if which of the following significantlyelevated results is noted?1. Serum protein2. Blood glucose3. Serum amylase4. Serum creatinine

3. Serum amylaseRationale:Didanosine (Videx) can cause pancreatitis. A serum amylase level that isincreased 1.5 to 2 times normal may signify pancreatitis in the client withacquired immunodeficiency syndrome and is potentially fatal. The medicationmay have to be discontinued. The medication is also hepatotoxic and can resultin liver failure.

96. 96.) The nurse is caring for a postrenaltransplant client taking cyclosporine(Sandimmune, Gengraf, Neoral). The nursenotes an increase in one of the client's vital signs,and the client is complaining of a headache.What is the vital sign that is most likelyincreased?1. Pulse2. Respirations3. Blood pressure4. Pulse oximetry

3. Blood pressureRationale:Hypertension can occur in a client taking cyclosporine (Sandimmune, Gengraf,Neoral), and because this client is also complaining of a headache, the bloodpressure is the vital sign to be monitoring most closely. Other adverse effectsinclude infection, nephrotoxicity, and hirsutism. Options 1, 2, and 4 areunrelated to the use of this medication.

97. 97.) Amikacin (Amikin) is prescribed for a clientwith a bacterial infection. The client is instructedto contact the health care provider (HCP)immediately if which of the following occurs?1. Nausea2. Lethargy3. Hearing loss4. Muscle aches

3. Hearing lossRationale:Amikacin (Amikin) is an aminoglycoside. Adverse effects of aminoglycosidesinclude ototoxicity (hearing problems), confusion, disorientation,gastrointestinal irritation, palpitations, blood pressure changes,nephrotoxicity, and hypersensitivity. The nurse instructs the client to reporthearing loss to the HCP immediately. Lethargy and muscle aches are notassociated with the use of this medication. It is not necessary to contact theHCP immediately if nausea occurs. If nausea persists or results in vomiting, theHCP should be notified.*(most aminoglycoside medication names end in the letters -cin)*

98. 98.) The nurse is assigned to care for a clientwith cytomegalovirus retinitis and acquiredimmunodeficiency syndrome who is receivingfoscarnet. The nurse should check the latestresults of which of the following laboratorystudies while the client is taking thismedication?1. CD4 cell count2. Serum albumin3. Serum creatinine4. Lymphocyte count

3. Serum creatinineRationale:Foscarnet is toxic to the kidneys. Serum creatinine is monitored before therapy,two to three times per week during induction therapy, and at least weeklyduring maintenance therapy. Foscarnet may also cause decreased levels ofcalcium, magnesium, phosphorus, and potassium. Thus these levels are alsomeasured with the same frequency.

99. 99.) The client with acquiredimmunodeficiency syndrome andPneumocystis jiroveci infection has beenreceiving pentamidine isethionate (Pentam300). The client develops a temperature of 101F. The nurse does further monitoring of theclient, knowing that this sign would most likelyindicate:1. The dose of the medication is too low.2. The client is experiencing toxic effects of themedication.3. The client has developed inadequacy ofthermoregulation.4. The result of another infection caused byleukopenic effects of the medication.

4. The result of another infection caused by leukopenic effects of the medication.Rationale:Frequent side effects of this medication include leukopenia, thrombocytopenia,and anemia. The client should be monitored routinely for signs and symptoms ofinfection. Options 1, 2, and 3 are inaccurate interpretations.

100. 100.) Saquinavir (Invirase) is prescribed forthe client who is human immunodeficiencyvirus seropositive. The nurse reinforcesmedication instructions and tells the client to:1. Avoid sun exposure.2. Eat low-calorie foods.3. Eat foods that are low in fat.4. Take the medication on an empty stomach.

1. Avoid sun exposure.Rationale:Saquinavir (Invirase) is an antiretroviral (protease inhibitor) used with otherantiretroviral medications to manage human immunodeficiency virus infection.Saquinavir is administered with meals and is best absorbed if the clientconsumes high-calorie, high-fat meals. Saquinavir can cause photosensitivity,and the nurse should instruct the client to avoid sun exposure.

101. 101.) Ketoconazole is prescribed for a clientwith a diagnosis of candidiasis. Select theinterventions that the nurse includes whenadministering this medication. Select all thatapply.1. Restrict fluid intake.2. Instruct the client to avoid alcohol.3. Monitor hepatic and liver function studies.4. Administer the medication with an antacid.5. Instruct the client to avoid exposure to thesun.6. Administer the medication on an emptystomach.

2. Instruct the client to avoid alcohol.3. Monitor hepatic and liver function studies.5. Instruct the client to avoid exposure to the sun.Rationale:Ketoconazole is an antifungal medication. It is administered with food (not onan empty stomach) and antacids are avoided for 2 hours after taking themedication to ensure absorption. The medication is hepatotoxic and the nursemonitors liver function studies. The client is instructed to avoid exposure to thesun because the medication increases photosensitivity. The client is alsoinstructed to avoid alcohol. There is no reason for the client to restrict fluidintake. In fact, this could be harmful to the client.

102. 102.) A client with human immunodeficiencyvirus is taking nevirapine (Viramune). Thenurse should monitor for which adverse effectsof the medication? Select all that apply.1. Rash2. Hepatotoxicity3. Hyperglycemia4. Peripheral neuropathy5. Reduced bone mineral density

1. Rash2. HepatotoxicityRationale:Nevirapine (Viramune) is a non-nucleoside reverse transcriptase inhibitors(NRTI) that is used to treat HIV infection. It is used in combination with otherantiretroviral medications to treat HIV. Adverse effects include rash, Stevens-Johnson syndrome, hepatitis, and increased transaminase levels.Hyperglycemia, peripheral neuropathy, and reduced bone density are notadverse effects of this medication.

103. 103.) A nurse is caring for a hospitalizedclient who has been taking clozapine(Clozaril) for the treatment of aschizophrenic disorder. Which laboratorystudy prescribed for the client will thenurse specifically review to monitor for anadverse effect associated with the use ofthis medication?1. Platelet count2. Cholesterol level3. White blood cell count4. Blood urea nitrogen level

3. White blood cell countRationale:Hematological reactions can occur in the client taking clozapine and includeagranulocytosis and mild leukopenia. The white blood cell count should be checkedbefore initiating treatment and should be monitored closely during the use of thismedication. The client should also be monitored for signs indicatingagranulocytosis, which may include sore throat, malaise, and fever. Options 1, 2,and 4 are unrelated to this medication.

104. 104.) Disulfiram (Antabuse) is prescribedfor a client who is seen in the psychiatrichealth care clinic. The nurse is collectingdata on the client and is providinginstructions regarding the use of thismedication. Which is most important forthe nurse to determine beforeadministration of this medication?1. A history of hyperthyroidism2. A history of diabetes insipidus3. When the last full meal was consumed4. When the last alcoholic drink wasconsumed

4. When the last alcoholic drink was consumedRationale:Disulfiram is used as an adjunct treatment for selected clients with chronicalcoholism who want to remain in a state of enforced sobriety. Clients must abstainfrom alcohol intake for at least 12 hours before the initial dose of the medication isadministered. The most important data are to determine when the last alcoholicdrink was consumed. The medication is used with caution in clients with diabetesmellitus, hypothyroidism, epilepsy, cerebral damage, nephritis, and hepatic disease.It is also contraindicated in severe heart disease, psychosis, or hypersensitivityrelated to the medication.

105. 105.) A nurse is collecting data from a clientand the client's spouse reports that theclient is taking donepezil hydrochloride(Aricept). Which disorder would the nursesuspect that this client may have based onthe use of this medication?1. Dementia2. Schizophrenia3. Seizure disorder4. Obsessive-compulsive disorder

1. DementiaRationale:Donepezil hydrochloride is a cholinergic agent used in the treatment of mild tomoderate dementia of the Alzheimer type. It enhances cholinergic functions byincreasing the concentration of acetylcholine. It slows the progression ofAlzheimer's disease. Options 2, 3, and 4 are incorrect.

106. 106.) Fluoxetine (Prozac) is prescribed forthe client. The nurse reinforcesinstructions to the client regarding theadministration of the medication. Whichstatement by the client indicates anunderstanding about administration of themedication?1. "I should take the medication with myevening meal."2. "I should take the medication at noonwith an antacid."3. "I should take the medication in themorning when I first arise."4. "I should take the medication rightbefore bedtime with a snack."

3. "I should take the medication in the morning when I first arise."Rationale:Fluoxetine hydrochloride is administered in the early morning withoutconsideration to meals.*Eliminate options 1, 2, and 4 because they are comparable or alike andindicate taking the medication with an antacid or food.*

107. 107.) A client receiving a tricyclic antidepressant arrivesat the mental health clinic. Which observation indicatesthat the client is correctly following the medication plan?1. Reports not going to work for this past week2. Complains of not being able to "do anything" anymore3. Arrives at the clinic neat and appropriate inappearance4. Reports sleeping 12 hours per night and 3 to 4 hoursduring the day

3. Arrives at the clinic neat and appropriate in appearanceRationale:Depressed individuals will sleep for long periods, are not able to goto work, and feel as if they cannot "do anything." Once they havehad some therapeutic effect from their medication, they will reportresolution of many of these complaints as well as demonstrate animprovement in their appearance.

108. 108.) A nurse is performing a follow-up teaching sessionwith a client discharged 1 month ago who is takingfluoxetine (Prozac). What information would beimportant for the nurse to gather regarding the adverseeffects related to the medication?1. Cardiovascular symptoms2. Gastrointestinal dysfunctions3. Problems with mouth dryness4. Problems with excessive sweating

2. Gastrointestinal dysfunctionsRationale:The most common adverse effects related to fluoxetine includecentral nervous system (CNS) and gastrointestinal (GI) systemdysfunction. This medication affects the GI system by causingnausea and vomiting, cramping, and diarrhea. Options 1, 3, and 4are not adverse effects of this medication.

109. 109.) A client taking buspirone (BuSpar) for 1 monthreturns to the clinic for a follow-up visit. Which of thefollowing would indicate medication effectiveness?1. No rapid heartbeats or anxiety2. No paranoid thought processes3. No thought broadcasting or delusions4. No reports of alcohol withdrawal symptoms

1. No rapid heartbeats or anxietyRationale:Buspirone hydrochloride is not recommended for the treatment ofdrug or alcohol withdrawal, paranoid thought disorders, orschizophrenia (thought broadcasting or delusions). Buspironehydrochloride is most often indicated for the treatment of anxietyand aggression.

110. 110.) A client taking lithium carbonate (Lithobid) reportsvomiting, abdominal pain, diarrhea, blurred vision,tinnitus, and tremors. The lithium level is checked as apart of the routine follow-up and the level is 3.0 mEq/L.The nurse knows that this level is:1. Toxic2. Normal3. Slightly above normal4. Excessively below normal

1. ToxicRationale:The therapeutic serum level of lithium is 0.6 to 1.2 mEq/L. A levelof 3 mEq/L indicates toxicity.

111. 111.) A client arrives at the health care clinic and tells thenurse that he has been doubling his daily dosage ofbupropion hydrochloride (Wellbutrin) to help him getbetter faster. The nurse understands that the client is nowat risk for which of the following?1. Insomnia2. Weight gain3. Seizure activity4. Orthostatic hypotension

3. Seizure activityRationale:Bupropion does not cause significant orthostatic blood pressurechanges. Seizure activity is common in dosages greater than 450mg daily. Bupropion frequently causes a drop in body weight.Insomnia is a side effect, but seizure activity causes a greater clientrisk.

112. 112.) A hospitalized client is started onphenelzine sulfate (Nardil) for the treatmentof depression. The nurse instructs the clientto avoid consuming which foods while takingthis medication? Select all that apply.1. Figs2. Yogurt3. Crackers4. Aged cheese5 Tossed salad6. Oatmeal cookies

1. Figs2. Yogurt4. Aged cheeseRationale:Phenelzine sulfate (Nardil) is a monoamine oxidase inhibitor(MAOI). The clientshould avoid taking in foods that are high in tyramine. Use of these foods couldtrigger a potentially fatal hypertensive crisis. Some foods to avoid include yogurt,aged cheeses, smoked or processed meats, red wines, and fruits such as avocados,raisins, and figs.

113. 113.) A nurse is reinforcing dischargeinstructions to a client receivingsulfisoxazole. Which of the following would beincluded in the plan of care for instructions?1. Maintain a high fluid intake.2. Discontinue the medication when feelingbetter.3. If the urine turns dark brown, call thehealth care provider immediately.4. Decrease the dosage when symptoms areimproving to prevent an allergic response.

1. Maintain a high fluid intake.Rationale:Each dose of sulfisoxazole should be administered with a full glass of water, andthe client should maintain a high fluid intake. The medication is more soluble inalkaline urine. The client should not be instructed to taper or discontinue thedose. Some forms of sulfisoxazole cause the urine to turn dark brown or red. Thisdoes not indicate the need to notify the health care provider.

114. 114.) A postoperative client requestsmedication for flatulence (gas pains). Whichmedication from the following PRN listshould the nurse administer to this client?1. Ondansetron (Zofran)2. Simethicone (Mylicon)3. Acetaminophen (Tylenol)4. Magnesium hydroxide (milk of magnesia,MOM)

2. Simethicone (Mylicon)Rationale:Simethicone is an antiflatulent used in the relief of pain caused by excessive gas inthe gastrointestinal tract. Ondansetron is used to treat postoperative nausea andvomiting. Acetaminophen is a nonopioid analgesic. Magnesium hydroxide is anantacid and laxative.

115. 115.) A client received 20 units of NPH insulinsubcutaneously at 8:00 AM. The nurse shouldcheck the client for a potential hypoglycemicreaction at what time?1. 5:00 PM2. 10:00 AM3. 11:00 AM4. 11:00 PM

1. 5:00 PMRationale:NPH is intermediate-acting insulin. Its onset of action is 1 to 2 hours, it peaksin 4 to 12 hours, and its durat