1) A nurse is planning care for a pt who is receiving Mannitol via continuous IV infusion. The nurse should monitor the pt for which of the following
... [Show More] adverse effects.
-Weight loss
Mannitol is an osmotic diuretic used to promote diuresis, decrease intracranial pressure, and improve renal function. An expected therapeutic effect of mannitol is weight loss resulting from diuresis.
-Increased intraocular pressure
An indication for the use of mannitol is increased intraocular pressure. Mannitol decreases the intraocular pressure by creating an osmotic gradient between the intraocular fluid and the plasma.
-Auditory hallucinations
Mannitol has several neurologic adverse effects, including increased intracranial pressure, seizures, confusion, and headaches. However, it does not cause auditory hallucinations.
-Bibasilar crackles = CORRECT ANSWER
Mannitol, an osmotic diuretic, can precipitate heart failure and pulmonary edema. Therefore, the nurse should recognize lung crackles as an indicator of a potential complication and stop the infusion.
2) A nurse is planning to teach about inhalant medications to a pt who has a new diagnosis of exercise induced asthma. Which of the following medications should the nurse plan to instruct the pt to use prior to physical activity?
-Cromolyn = CORRECT ANSWER
Cromolyn sodium stabilizes mast cells, which inhibit the release of histamine and other inflammatory mediators. The client should use cromolyn 10 to 15 min before planning to exercise to prevent bronchospasms.
-Beclomethasone
Beclomethasone is a prophylactic glucocorticoid inhalant medication that suppresses the inflammatory and humoral immune responses. Beclomethasone should be administered with a fixed schedule, not for PRN use before physical exercise.
-Budesonide
Budesonide is a glucocorticoid medication used to treat asthma as a long-term inhaled agent. This medication is administered by inhalation twice daily, not prior to physical activity.
-Tiotropium
Tiotropium is an anticholinergic medication that decreases mucus production and produces bronchodilation. Tiotropium is used for maintenance therapy of bronchospasms and has a duration of 24 hr.
3) A nurse is caring for a pt who has acute acetaminophen toxicity. The nurse should anticipate administering which of the following medications?
-Vitamin K
Vitamin K is used to treat increased warfarin serum levels, indicated by elevated levels of PT/INR.
-Acetylcysteine= CORRECT ANSWER
Acetylcysteine is a specific antidote for acetaminophen toxicity. It can prevent severe injury when given orally or by IV infusion within 8 to 10 hr.
-Benztropine
Benztropine is an anticholinergic medication used to treat adverse effects of Parkinson's disease by reducing rigidity and tremors.
-Physostigmine
Physostigmine is an effective antidote for antimuscarinic poisoning from medications such as atropine, scopolamine, some antihistamines, phenothiazines, and tricyclic antidepressants. It has no effect on acetaminophen toxicity.
4) A nurse is assessing a client who is receiving Epoetin alfa to treat anemia. Which of the following findings should the nurse monitor?
-Paresthesia
Epoetin alfa stimulates the bone marrow to increase production of red blood cells. Adverse effects include neurological manifestations such as seizures, headache, and dizziness. However, epoetin alfa does not cause paresthesia.
-Increased blood pressure = CORRECT ANSWER
The therapeutic effect of epoetin alfa is an increase in hematocrit levels, which can result in an increase in a client's blood pressure. If the client's hematocrit level rises too rapidly, hypertension and seizures can result. The nurse should monitor the client's blood pressure and ensure hypertension is controlled prior to administering the medication.
-Fever
Adverse effects of epoetin alfa include neurological manifestations such as coldness and sweating. However, it does not cause fever.
-Respiratory depression
Heart failure is an adverse effect of epoetin alfa. The nurse should monitor the client's respiratory status and notify the provider if the client develops crackles or rhonchi. However, epoetin alfa does not cause respiratory depression.
5) A nurse is teaching a pt who is to start taking Hydrocodone with Acetaminophen tablets for pain. Which of the following information should the nurse include in the teaching?
-The medication should be taken 1 hr prior to eating.
The client should take hydrocodone and acetaminophen with food or milk to decrease gastric irritation.
-It takes 48 hr for therapeutic effects to occur.
The nurse should instruct the client that they should experience the effects of hydrocodone with acetaminophen within 20 min of administration and that pain relief should last for 4 to 6 hr.
-Tablets should not be crushed or chewed.
The client should avoid crushing, chewing, or breaking the extended release or immediate release hydrocodone tablets to prevent an immediate increase in CNS effects. Hydrocodone with acetaminophen tablets can be crushed if needed.
-Decreased respirations might occur.= CORRECT ANSWER
The nurse should instruct the client that hydrocodone with acetaminophen might cause respiratory depression, which is an adverse effect of the medication. The client should avoid taking over-the-counter medications or newly prescribed medications without consulting their provider to avoid increased respiratory depression.
6) A nurse is caring for a pt who is experiencing acute alcohol withdrawal. For which of the following pt outcomes should the nurse administer Chlordiazepoxide?
-Minimize diaphoresis
The client should take clonidine or a beta-adrenergic blocker, such as atenolol, to minimize autonomic components, such as diaphoresis, during alcohol withdrawal.
-Maintain abstinence
The client should take acamprosate to help maintain abstinence from alcohol by decreasing anxiety and other uncomfortable manifestations.
-Lessen craving
The client should take propranolol to decrease cravings during alcohol withdrawal.
-Prevent delirium tremens = CORRECT ANSWER
The client should take chlordiazepoxide to prevent delirium tremens during acute alcohol withdrawal.
7) A nurse is instructing a pt on the application of Nitroglycerin transdermal patches. Which of the following statements by the pt indicates an understanding of the teaching?
-"I should apply a patch every 5 minutes if I develop chest pain."
Nitroglycerin sublingual tablets are used to treat new onset of angina pain. A client who uses sublingual tablets should place one tablet under their tongue at the onset of angina pain and continue taking a tablet every 5 min for a total of three doses of nitroglycerin. The effects of a nitroglycerin patch will take 30 to 60 min to occur and are not useful to prevent an ongoing angina attack.
-"I will take the patch off right after my evening meal." = CORRECT ANSWER
Clients should remove the patch each evening for a medication free time of 12 to 14 hr before applying a new patch to avoid developing a tolerance to the medication's effects.
-"I will leave the patch off at least 1 day each week."
Nitroglycerin is an antianginal medication that results in dilation of the coronary vessels. Clients should apply the patch daily to sustain prophylaxis.
-"I should discard the used patch by flushing it down the toilet."
Medication remains in the transdermal patch after removing it from the body and must be discarded safely. The nurse should instruct the client to fold the patch ends together with the medication on the inside and place the discarded patch in a closed container so that children and pets cannot gain access to the medication.
8) A nurse is assessing a pt who is taking a Propylthiouracil for the treatment of Grave’s disease. Which of the following findings should the nurse identify as an indication that the medication has been effective?
-Decrease in WBC count
Propylthiouracil is a thyroid hormone antagonist used in the treatment of hyperthyroidism, or thyroid storms. A decreased WBC count is an adverse effect of propylthiouracil, which can cause myelosuppression. Therefore, a decrease in WBC count indicates the medication has not been effective.
-Decrease in amount of time sleeping
Graves' disease, a form of hyperthyroidism, has neurologic manifestations, including insomnia. Therefore, a decrease in the amount of time sleeping indicates the medication has not been effective.
-Increase in appetite
Graves’ disease can result in gastrointestinal manifestations such as increased appetite, weight loss, and increased gastrointestinal motility. Therefore, an increase in appetite indicates the medication has not been effective.
-Increase in ability to focus = CORRECT ANSWER
A client who has Graves' disease can experience psychological manifestations such as difficulty focusing, restlessness, and manic-type behaviors. Propylthiouracil is a thyroid hormone antagonist that decreases the circulating T4 hormone, reducing the manifestations of hyperthyroidism. An increased ability to focus indicates that the medication has been effective.
9) A nurse is caring for a client who recently began taking oral Amoxicillin / Clavulanate and reports urticaria. Which of the following actions should the nurse take?
-Request a change in the type of the antibiotic. = CORRECT ANSWER
Manifestations of urticaria after taking a penicillin-based medication indicate a mild allergic reaction. Therefore, it is appropriate for the nurse to request a change in the type of antibiotic.
-Ask for a change in the route of the administration.
The client is experiencing a mild allergic reaction to the medication. Changing the route of administration puts the client at risk for further manifestations of the allergy.
-Check for pitting edema.
Pitting edema is not an expected manifestation of a mild allergic reaction. The nurse should assess the client's heart rate and pulmonary status when the client is experiencing a mild allergic reaction.
-Check the client's WBC count.
The client is experiencing a mild allergic reaction to the medication and checking the client's WBC count does not indicate why the client is having urticaria.
10) A nurse is reviewing the health history of a client who has Diabetes Mellitus and will begin taking insulin. Which of the following findings should the nurse identify as a factor that might cause the client to have difficulty safely self administering insulin?
-Macular degeneration = CORRECT ANSWER
A client who has macular degeneration loses central vision, making it difficult to accurately draw up insulin for self-administration or dial the insulin pen to the appropriate dosage. The nurse should determine that adaptive equipment is necessary for the client who has macular degeneration.
-Right-sided heart failure
A client who has right-sided heart failure has hypertension and peripheral edema because the right ventricle is unable to completely empty. However, this condition will not affect the client's ability to prepare and administer insulin.
-Hyperlipidemia
A client who has hyperlipidemia has developed an accumulation of plaques and fat within the venous system placing the client at risk for hypertension, stroke, or myocardial infarction. However, this condition will not affect the client's ability to prepare and administer insulin.
-Stage II chronic kidney disease
A client who has diabetes mellitus can also have chronic kidney disease due to changes in the microvasculature caused by hyperglycemia. However, this condition will not affect the client's ability to prepare and administer insulin.
11) A nurse is collecting a med history from a client who has a new prescription for Lithium. The nurse should identify that the client should discontinue which of the following over the counter OTC medications?
-Aspirin
Although most NSAIDs interact with lithium to increase lithium levels, aspirin does not interact with lithium.
-Ibuprofen= CORRECT ANSWER
Most NSAIDs can significantly increase lithium levels. Therefore, the client should not take ibuprofen and lithium concurrently.
-Ranitidine
There are no known medication interactions between ranitidine and lithium.
-Bisacodyl
There are no known medication interactions between bisacodyl and lithium.
12) A nurse is providing teaching to a pt who has a prescription for Ergotamine sublingual to treat migraine headaches. Which of the following info should the nurse include in the instructions?
-"Take one tablet three times a day before meals."
Ergotamine, an alpha-adrenergic blocking medication, is not used prophylactically because this can result in ergotamine dependence.
-"Take one tablet at onset of migraine."= CORRECT ANSWER
The client should take one tablet immediately after the onset of aura or headache.
-"Take up to eight tablets as needed within a 24-hour period."
The client can take up to a maximum of three tablets in a 24-hr period. Excessive dosing can lead to ergotism, which can cause peripheral gangrene due to vasoconstriction and ischemia.
-"Take one tablet every 15 minutes until migraine subsides."
The client can take one sublingual tablet every 30 min for a maximum of three tablets in a 24-hr period to manage a migraine.
13) A nurse on the acute care unit is caring for a pt who is receiving Gentamicin IV. The nurse should report which of the following findings to the provider as an adverse effect of the medication?
-Constipation
Gentamicin, an aminoglycoside used to treat serious infections, can cause several gastrointestinal adverse effects, such as inflammation of the liver and spleen. However, it does not cause constipation.
-Tinnitus= CORRECT ANSWER
Aminoglycosides, such as gentamicin, are ototoxic, which can manifest as tinnitus and deafness. The nurse should monitor the client for high-pitched ringing in the ears and headaches and should notify the provider if these occur.
-Hypoglycemia
Gentamicin, an aminoglycoside used to treat serious infections, can cause alternations in the functions of the liver and spleen. However, pancreatic function, mainly insulin production, is not affected by this medication.
-Joint pain
Aminoglycosides, such as gentamicin, can result in neuromuscular adverse effects such as twitching or flaccid paralysis. However, joint pain is not an adverse effect of gentamicin.
14) A nurse is precepting a newly licensed nurse who is caring for four clients. The nurse should complete an incident report for which of the following actions by the newly licensed nurse?
-Administers isosorbide mononitrate to a client who has BP 82/60 mm Hg = CORRECT ANSWER
Isosorbide mononitrate is a nitrate used for clients with angina. Taking isosorbide mononitrate leads to vasodilation, which can result in hypotension. The nurse should withhold the medication and notify the provider if the client's systolic blood pressure is below the expected reference range of 120/80.
-Administers digoxin to a client who has a heart rate of 92/min
Digoxin is a cardiac glycoside used for clients who have heart failure because it strengthens the contractility of the heart, increasing cardiac output. A slowing of the heart rate is an effect of digoxin, so it should be withheld if the client's heart rate is less than 60/min.
-Administers regular insulin to a client who has a blood glucose of 250 mg/dL
Insulin is a hormone that promotes the uptake of glucose into the cells, thereby decreasing circulating glucose. A blood glucose value of 250 mg/dL is above the expected reference range, so the nurse should administer regular insulin.
-Administers heparin to a client who has an aPTT of 70 seconds
Heparin is an anticoagulant that decreases the coagulability of the blood and is used for clients who have thrombus. Dosing of heparin is dependent upon achieving a therapeutic aPTT level. An aPTT of 70 seconds is within the expected reference range when administering heparin.
15) A nurse is planning to teach about the use of a spacer to a child who has a new prescription for a Fluticasone inhaler to treat chronic asthma. The nurse should include that the spacer decreases the risk for which of the following adverse effects of the med?
-Oral candidiasis = CORRECT ANSWER
Dysphonia and oral candidiasis are adverse effects of inhaled corticosteroids. Using a spacer and rinsing the mouth after inhalation will minimize the amount of medication remaining in the oropharynx, preventing the development of these adverse effects.
-Headache
Fluticasone can cause neurologic adverse effects such as dizziness, fatigue, nervousness, and headaches. However, the use of a spacer will not decrease systemic adverse effects of fluticasone, such as headaches.
-Joint pain
Fluticasone can cause musculoskeletal adverse effects such as bone loss, muscle aches, and joint pain. However, the use of a spacer will not decrease systemic adverse effects of fluticasone, such as joint pain.
-Adrenal suppression
Fluticasone is a glucocorticoid medication that decreases bronchoconstriction. Inhaled glucocorticoids can cause adrenal suppression, although this occurs more often with oral glucocorticoids. The nurse should monitor the client for manifestations of adrenal suppression such as weakness, fatigue, hypotension, and hypoglycemia. However, the use of a spacer will not decrease systemic adverse effects of fluticasone, such as adrenal suppression.
16) A nurse is caring for a pt who is receiving Heparin therapy via continuous infusion to treat a pulmonary embolism. Which of the following findings should the nurse identify as an adverse effect of the med and report to the provider?
-Vomiting
Vomiting is not an expected adverse effect of heparin therapy. The nurse should assess the client for other causes for vomiting.
-Blood in the urine = CORRECT ANSWER
The nurse should report blood in the urine to the provider because this can be a manifestation of heparin toxicity. Other manifestations can include bruising, hematomas, hypotension, and tachycardia.
-Positive Chvostek's sign
A Chvostek's sign is seen in clients who have hypocalcemia or hypomagnesemia.
-Ringing in the ears
Ringing in the ears is not an expected adverse effect of heparin therapy. Aminoglycosides, such as vancomycin, are medications that cause ringing in the ears.
17) A nurse is assessing a client who is taking Amitriptyline for depression. Which of the following findings should the nurse identify as an adverse effect of the medication?
-Tinnitus
Amitriptyline is a tricyclic antidepressant medication that has anticholinergic properties. The nurse should assess for sensory- neurologic adverse effects such as blurred vision or an increased sensitivity to light. However, tinnitus is not an expected finding.
-Urinary frequency
The nurse should assess the client for genitourinary anticholinergic effects such as urinary hesitancy or retention due to the blocking of acetylcholine receptors that cause anticholinergic responses. However, urinary frequency is not an expected finding.
-Dry mouth = CORRECT ANSWER
The nurse should expect the client to have a dry mouth due to the blocking of acetylcholine receptors that cause anticholinergic responses.
-Diarrhea
The nurse should assess the client for gastrointestinal anticholinergic effects such as constipation. However, diarrhea is not an expected finding.
18) A nurse is teaching a client who is starting to take Diltiazem. Which of the following statements should the nurse identify as an indication that the client understands the teaching?
-"I will stop taking the medication if I get dizzy."
Diltiazem is a calcium channel blocker that causes vascular dilation, which can result in orthostatic hypotension. The client should rise slowly when standing and avoid hazardous activities until there is a stabilization of the medication and dizziness no longer occurs.
-"I should not drink orange juice while taking this medication."
The client should not drink grapefruit juice while taking diltiazem because it can interfere with metabolism of the medication by increasing the blood levels of diltiazem and leading to toxicity.
-"I should expect to gain weight while taking this medication."
Diltiazem, a calcium channel blocker, can decrease myocardial contraction, which can lead to heart failure. If the client gains weight or develops shortness of breath, they should notify the provider.
-"I will check my heart rate before I take the medication" = CORRECT ASNWER
Diltiazem, a calcium channel blocker, has cardio-suppressant effects at the SA and AV nodes, which can lead to bradycardia. The client should check their heart rate before taking the medication and notify the provider if it falls below the expected reference range.
19) A nurse is preparing to administer a new prescription of Amoxicillin / Clavulanic to a client. The client tells the nurse that they are allergic to Penicillin. Which of the following actions should the nurse take first?
-Update the client's medical record.
It is important to update the client's medical record to have complete information available; however, the nurse should take another action first.
-Notify the provider.
It is important to notify the provider because the client will need a new prescription; however, the nurse should take another action first.
-Withhold the medication = CORRECT ANSWER
When using the urgent vs nonurgent approach to client care, the nurse should determine that the priority action is to withhold the medication to prevent injury to the client.
-Inform the pharmacist of the client's allergy to penicillin.
It is important to inform the pharmacist of the allergy to promote continuity of care; however, the nurse should take another action first.
20) A nurse is teaching a client who has tuberculosis about the adverse effects of Isoniazid. The nurse should instruct the client to report to the provider which of the following as an adverse effect of the medication?
-Reddish-orange urine
Rifampin, another antituberculosis medication, can cause body fluids to take on a reddish-orange color. However, isoniazid does not alter urine color.
-Photosensitivity
Isoniazid can cause sensory adverse effects including blurred vision and optic neuritis. However, photosensitivity is not an adverse reaction of isoniazid.
-Yellowish skin tones = CORRECT ANSWER
Isoniazid is a hepatotoxic medication that can cause hepatitis. The nurse should instruct the client to monitor for and report signs of hepatitis, such as malaise, nausea, and yellowish skin tones, to the provider.
-Headache
Isoniazid is associated with a number of CNS adverse effects including dizziness, memory impairment, seizures, and psychosis. However, it does not cause headaches.
21) A nurse is providing teaching to a pt who has peptic ulcer disease and is to start a new prescription for Sucralfate. Which of the following actions of Sucralfate should the nurse include in the teaching?
-Decreases stomach acid secretion
Peptic ulcer disease manifests as an erosion of the gastric or duodenal mucosa. The acid production in the stomach causes further irritation and pain. H2 receptor antagonists, such as famotidine, decrease stomach acid secretion.
-Neutralizes acids in the stomach
Acid production in the stomach causes further irritation and pain to a client who has a peptic ulcer. Antacids, such as aluminum hydroxide, neutralize acids in the stomach and prevent pepsin formation, a digestive enzyme that can further damage the eroded epithelium.
-Forms a protective barrier over ulcers = CORRECT ANSWER
Secretions by the parietal and chief cells, hydrochloric acid and pepsin, can further irritate the ulcerated areas. Sucralfate, a mucosal protectant, forms a gel-like substance that coats the ulcer, creating a barrier to hydrochloric acid and pepsin.
-Treats ulcers by eradicating H. pylori
A common cause of peptic ulcers is a bacterial infection with Helicobacter pylori. Treatment of the ulcer includes a combination of antibiotics, such as metronidazole, tetracycline, clarithromycin, or amoxicillin, to eradicate the H. pylori infection.
22) A nurse is preparing to administer 0.9% Sodium Chloride (NaCl) 1,500 mL to infuse over 8hr to a client who is postoperative. The nurse should set the IV pump to deliver how many mL/hr? (Round to nearest whole #. Use a leading zero if it applies. Do not use a trailing zero)
187.5 mL/hr = 188 mL/hr.
The nurse should set the IV pump to deliver 0.9% sodium chloride IV at 188 mL/hr. = CORRECT ANSWER
23) A nurse is assessing a pt 1 hour after administering Morphine for pain. The nurse should identify which of the following findings as the best indication that the Morphine has been effective?
-The client's vital signs are within normal limits.
Vital signs can be within normal limits for clients who have pain.
-The client has not requested additional medication.
Clients often do not request medicine even when they are experiencing pain.
-The client is resting comfortably with eyes closed.
The client might rest with their eyes closed as a method to try to manage pain. However, this does not indicate that the pain is controlled.
-The client rates pain as 3 on a scale from 0 to 10. = CORRECT ANSWER
The client's description of the pain is the most accurate assessment of pain.
24) A nurse is providing follow up care to a client who is taking Lisinopril. Which of the following manifestations should the nurse instruct the client to report as an adverse effect of Lisinopril?
-Drowsiness
Lisinopril is an ACE inhibitor used in the treatment of hypertension, heart failure, and myocardial infarction. Lisinopril can cause a number of neurologic adverse effects including insomnia. However, drowsiness is not an adverse effect of lisinopril.
-Hallucinations
Lisinopril can cause a number of neurologic adverse effects including depression, paresthesia, and stroke. However, hallucinations are not an adverse effect of lisinopril.
-Persistent cough = CORRECT ANSWER
Lisinopril is an ACE inhibitor that can cause a persistent, dry, irritating, nonproductive cough from an excessive buildup of bradykinin. The client should report this adverse effect to the provider.
-Weight gain
Lisinopril can cause a number of gastrointestinal adverse effects including vomiting, anorexia, constipation, pancreatitis, and liver failure. However, lisinopril has not been associated with weight gain.
25) A nurse in an emergency department is caring for a client who has Myasthenia gravis and is in a cholinergic crisis. Which of the following medications should the nurse plan to administer?
-Potassium iodide
Potassium iodide is a thyroid hormone antagonist used in the treatment of radioactive iodine exposure.
-Glucagon
Glucagon is an antihypoglycemic medication used in the treatment of low blood glucose levels.
-Atropine = CORRECT ANSWER
A cholinergic crisis is caused by an excess amount of cholinesterase inhibitor, such as neostigmine. The nurse should plan to administer atropine, an anticholinergic agent, to reverse cholinergic toxicity.
-Protamine
Protamine is a heparin antagonist that is administered to reverse heparin toxicity evidenced by an aPTT greater than 70 seconds. [Show Less]