A diabetic client is prescribed metoclopramide. Which of the following side effects must the nurse teach the client to report immediately to the HCP? -
... [Show More] correct answer 1. Excess blinking of eyes
2. Lip smaking
3. Puffing of cheeks
(Metoclopramide/REGLAN, is prescirbed for the treatment of GERD and delayed gastric emptying and as an antiemetic. It can cause extrapyramidal side effects similar to antipsychotics)
Tardive Dyskinesia symptoms - correct answer caused from: Metoclopramide (Reglan) and antipsychotic drugs
-Protruding and twisting of the tongue
-Lip smacking
-Puffing of cheeks
-Chewing movements
-Frowning or blinking of eyes
-Twisting fingers
-Twisted or rotated neck
An elderly client w/depression, diabetes, and HF has received a new digoxin prescription for daily use. Which client assessment indicates that the nurse should follow up on serum digoxin levels frequently? - correct answer Serum creatinine is 2.3
Creatinine levels - correct answer 0.6-1.3
The home health nurse visits a client w/hand osteoarthritis topical capsaicin for pain relief. Which instruction about capsaicin should the nurse provide the client? - correct answer Apply cream to hands and wait at least 30 minutes before washing them
Commonly used MAOI's - correct answer Isocarboxazid, phenelzine, tranylcypromine
A 21 yo client is being evaluated in the outpatient psychiatric clinic after starting isocarboxazid 2 weeks ago. Which of the clients statements needs to be addressed first? - correct answer "This medication is not working; I am so tired of being depressed"
(MAOI's and other antidepressants are associated w/an increased risk of suicidal ideation during the first few weeks of treatment)
A client w/a brain tumor is admitted for surgery. The HCP prescribes levetiracetam. The client asks why. What is the nurses's response? - correct answer "It prevents seizure development"
(Levetiracetam/KEPPRA is used to treat seizures)
The nurse develops a teaching care plan for the client w/a prescription to change antidepressant medications from imipramine to phenelzine. Which instruction is appropriate to include in the teaching? - correct answer Taper down the imipramine, then discontinue for 2 weeks before starting phenelzine.
(when switching from a tricyclic antidpressant to a MAOI, withdraw gradually w/a drug free period before the new antidepressant is initiated to avoid adverse reactions)
Commonly used Tricyclic antidepressants - correct answer Amitriptyline, Nortriptyline, desipramine, imipramine...also used to treat neuropathic pain
Neuroleptic Malignant Syndrome (NMS) - correct answer -uncommon but life threatening adverse reaction to anti-psychotic medications (haloperidol, fluphenazine). Symptoms are high fever, muscular rigidity, ams, autonomic dysfunction
Treatment is rehydration, cooling body temp and immediate d/c of the medication and notify HCP immediately
The nurse is working in the ER. Which client should the nurse see first? - correct answer Client taking clozapine who has sudden onset of high fever, diaphoresis and change in mental status (Neuroleptic Malignant syndrome)
A client w/active pulmonary TB is prescribed 4-drug therapy ethambutol. The community health nurse instructs the client to notify the HCP immediately if which adverse effect associated with ethambutol occurs? - correct answer Blurred vision
(Ethambutol/MYAMBUTOL, is used in combination w/other antitubercular drugs to treat active TB. The client must have baseline eye examinations during therapy as optic neuritis is a potentially reversible adverse effect)
The nurse teaches the client taking atorvastatin to call the HCP if experiencing which symptom associated w/a serious adverse effect of atorvastatin? - correct answer Muscle aches
(symptom of myopathy)
A client w/seizure activity is receiving a continuous tube feeding via a small bore enteral tube. The nurse prepares to administer phenytoin oral suspension via the enteral route. What is the nurse's priority action before administering this medication? - correct answer Stop the feeding for 1 to 2 hours
(Phenytoin/Dilantin, is an anticonvulsant drug commonly used to treat seizures d/o's. Steady absorption is necessary to maintain a therapeutic dosage range and drug level to control seizure activity)
The clinic nurse evaluates a client's response to levothyroxine after 8 weeks of treatment. What therapeutic responses to the medication should the nurse expect? - correct answer 1. Apical heart rate of 88/min
2. Elevation of mood
3. Improved energy levels
(used to treat hypothyroid. Notify HCP is HR is >100 or if the pt reports c/p, nervousness, or tremors...dose may be too high)
The nurse plans teaching for a client who was newly prescribed levothyroxine sodium after thyroid removal. Which instructions will the nurse include in the teaching plan? - correct answer 1. Notify the HCP if you feel a fluttering or rapid heartbeat
2. You will need to take this medication for the rest of your life
(is safe to take during pregnancy, take first thing in the morning on an empty stomach)
The nurse is caring for a client who started receiving chemotherapy 10 days ago. Today the HCP prescribes Filgrastim. Which of the following is an expected outcome of this medication? - correct answer Increase in neutrophil count
A client is receiving chemotherapy for acute myeloid leukemia. The HCP prescribes allopurinol to prevent tumor lysis syndrome (TLS). Which lab value indicates a therapeutic response to the medication? - correct answer Serum uric acid level of 6.0
(the therapeutic effect of allopurinol is to decrease hyperuricemia caused by TLS. Lab values include rising blood uric acid, potassium and phosphate levels with decreasing calcium levels)
Uric acid levels - correct answer male 4.4-7.6; female 2.3-6.6
Calcium levels - correct answer 8.6-10.2
Phosphate levels - correct answer 2.4-4.4
Potassium levels - correct answer 3.5-5.0
The nurse administers a prescribed oral dose of radioactive iodine (RAI) to a female client w/hyperthyroidism. The nurse should instruct that the client utilize the following home precautions during the first 3-7 days after ingestion? - correct answer 1. Do not use bare hands to handle food that is to be served to others
2. Isolate personal clothing, towels and linens; wash them separately from rest of laundry in the home
3. Use a separate toilet and flush 2-3 times after each use
(Do not breastfeed, avoid being around pregnant mothers, sleep in separate bed)
A client w/a hx of HF calls the clinic and reports a 3lb weight gain over the past 2 days and increased ankle swelling. The nurse reviews the client's medications and anticipates the immediate need for dosage adjustment of which medication? - correct answer Bumetanide (loop diuretic)
Urine specific gravity - correct answer 1.003-1.030
elevated SG=dehydration
Lithium therpeutic index - correct answer 0.6-1.2
>1.5=toxicity
The community health nurse prepares a teaching plan for a client w/latent tuberculosis who is prescribed oral isoniazid (INH). Which instructions should the nurse include? - correct answer 1. Avoid drinking alcohol
2. Report yellowing of skin or sclera
3. Report numbness and tingling of extremities
A nurse is caring for a client w/an exacerbation of COPD and a hx of type 2 diabetes requiring insulin. The client has been prescribed prednisone. The nurse anticipates which need? - correct answer Increasing the insulin dose
(corticosteroids cause hyperglycemia and worsen hypertension)
Ethambutol - correct answer Frequent eye examinations are needed
Phenytoin (Dilantin) therpeutic index - correct answer 10-20
A client w/cancer is to receive a third dose of cisplatin. The client's lab results are shown in the exhibit. Which factor would be important for the nurse to assess before confirming the dose w/the HCP? - correct answer Urine output
(Cisplatin is an antineoplastic med that can cause renal toxicity.)
BUN levels - correct answer 6-20
The hospice nurse is caring for an actively dying client who is unresonsive and has developed a loud rattling sound w/breathing (death rattle) that distresses family members. Which prescription would be the most appropriate to treat this symptoms? - correct answer Atropine sublingual drops
(atropine dries up secretions that cause the rattle noise)
A nurse on the behavioral health unit is reviewing medication prescriptions for 4 clients. Which combination of medications does the nurse question? - correct answer A client w/depression prescribed escitalopram and selegiline
(MAOI's interact w/many meds including many antidepressants)
The nurse administers 8 units of regular insulin at 11:30 am to a client w/type 1 diabetes and serves the client lunch 30 minutes later. The client eats a few bites, becomes nauseated and is unable to finish the meal. When is the client at highest risk for experiencing an insulin-related hypoglycemic reaction - correct answer 2:00pm
(The client is at highest risk for experiencing an insulin-related hypoglycemic reaction when the drug peaks. Regular insulin is short acting and peaks 2-4 hours after administration
Insulin peak times - correct answer -Rapid acting (lispro/humalog, aspart/novolog, glulisine/apidra) 30min-3hours; make sure client eats wiin 15 minutes of administration
-Intermediate acting (NPH) 4 hours
-Detemir-4-9 hours
-Long acting (glargine) no peak
Teratogenic medications - correct answer Phenytoin (dilantin)
Lithium
Valproate
Isotretinoin
Methotrexate
Ace Inhibitors
Warfarin
The nurse provides medication teaching to a client w/primary adrenal insufficiency (Addison's) who is prescribed hydrocortisone 10mg by mouth 3 times/day. Which instructions should be included in the client's teaching plan? - correct answer 1. "Make an appointment w/an optometrist yearly to assess for cataracts"
2. "Report even a low grade fever to the HCP immediately"
3. "Report signs of hyperglycemia including increased urine, hunger and thirst"
Platelet range - correct answer 150,000-400,000
aPTT - correct answer Normal level 25-35 seconds
Therapeutic level 46-70 seconds
INR therapeutic range - correct answer 2-3
The nurse is providing d/c instructions to a client receiving oxybutynin for overactive bladder. Which client statement indicates that further teaching is required? - correct answer "I am looking forward to our summer vacation at the beach"
(anticholinergic medications can lead to hyperthermia d/t constipation, urinary retention, flushing, dry mouth, heat intolerance)
Anticholinergic medications - correct answer atropine=bradyarrythmias
benztropine=parkinsons
ipatropium=bronchospasm
oxybutynin=urinary tract antispasmodics
scopolamine=nausea/vomitting (motion sickness)
propantheline/glycopyrrolate=decrease gastric secretory activity
c/i in clients susceptible to glaucoma or BPH
The home health nurse prepares to give benztropine to a 70yo client w/parkinsons disease. Which client statement is most concerning and would warrant HCP notification? - correct answer "I am going for repeat testing to confirm glaucoma"
(anticholinergic medications are c/i in pt's susceptible to glaucoma or BPH)
The nurse is providing d/c instructions to several clients w/new prescriptions. Which instructions by the nurse are correct in regard to medication administration? - correct answer 1. Avoid salt substitutes when taking valsartan for hypertension
2. When taking ethambutol, notify the HCP of any changes in vision
The HCP has just prescribed tetracycline for an adolescent w/acne vulgaris. The client takes oral contraceptives. The nurse should educate the teen about which topics? - correct answer 1. Not taking tetracycline w/dairy products
2. Using additional contraceptive techniques
3. Using sunblock
4. Take on an empty stomach
5. Take w/a full glass of water
6. Avoid antacids
Calcium channel blockers - correct answer nifedipine; amlodipine; felodipine; nicardipine
-Treat HTN and chronic stable angina.
-Important adverse effects: dizziness; flushing; headache; peripheral edema; constipation
The nurse has provided education for a client newly prescribed alprazolam for generalized anxiety d/o. Which client statement indicates that teaching has been effective? - correct answer "I will take my daily dose at bedtime"
(Benzo's have a sedative effect and should be given at bedtime. They should never be stopped abruptly in long-term users)
A client is receiving scheduled doses of carbidopa-levodopa. The nurse evaluates the medication as having the intended effect if which finding is noted? - correct answer Improvement in spontaneous activity
A nurse teaches a client who is being d/c'd on warfarin for a-fib. Which client statements indicate that teaching has been effective? - correct answer 1. "Antibiotics can affect my INR value"
2. "I will take warfarin at the same time daily."
3. "I will shoot for my INR value to be between 2-3
The nurse is preparing medication for 4 clients on a respiratory medical-surgical unit. Which situation would prompt the nurse to clarify the prescribed treatment w/HCP? - correct answer Client w/bronchospasm who is d/t receive nebulized acetylcysteine
(medication is inhaled to help loosen thick respiratory secretions. Nurses caring for pt's w/reactive airway disease, eg. asthma, who are prescribed acetylcysteine should clarify w/HCP as it may cause or worsen bronchospasm)
The nurse precepts a nursing student caring for a client w/glaucoma and observes the student administer timolol maleate, an opthalmic medication. Which student action indicates that further instruction is needed? - correct answer Removes dried secretions w/moistened sterile gauze pads by wiping from the outer to inner canthus
(client should remove contact lenses; uses aseptic technique; remove dried secretions w/moistened sterile gauze by wiping from inner to outer canthus; place client in supine or sitting w/head tilted back toward side of affected eye; rest hand on clients forehead and hold dropper 1-2cm above conjunctival sac; pull lower lid down gently; instruct client to look upward; then apply pressure to the lacrimal duct for 30-60 seconds)
The nurse reviews an elderly client's medication administration record and identifies which prescriptions as having the potential for injury in the elderly? - correct answer 1. Amitriptyline
2. Chlorpheniramine
3. Lorazepam
(Beers criteria classifies potentially harmful drugs w/the elderly...antipsychotics, anticholinergics, antihistamines, antihypertensives, benzodiaepines, diuretics, opioids, sliding scale insulins)
The nurse is performing d/c teaching for the parents of a 4yo w/HF. Which statement by the parents indicates the need for further teaching r/t the administration of digoxin? - correct answer "We will hold the dose if our child's HR is above 90/min"
(parent teaching for digoxin: hold <90-110 for infants and young children and <70 in older children; do not mix the drug w/food or liquids; if dose is missed do not give extra or increase dose, stay on same schedule; if more than 2 doses missed notify HCP; if child vomits do not give 2nd dose...could indicate toxicity; give water or brush teeth after)
The clinic nurse reviews the medical record of the client who was prescribed etanercept, a tumor necrosis factor (TNF) inhibitor. Which test result is most important for the nurse to check before initiating this treatment? - correct answer Tuberculin skin test (TST)
(major side effects of TNF's include severe infections and bone marrow suppression. TB reactivation is a major concern)
A client has a serum potassium level of 2.8 and the HCP prescribes IV potassium chloride. The nurse administers 10mEq KCL/100 mL5% dextrose in water at 100ml/hr through the client's peripheral IV line sing an infusion pump. Shortly after the initiation of the infusion, the client reports feeling burning and discomfort at the IV site. What is the nurses priority action? - correct answer Slow the rate of the KCL infusion
(It is irritating to the vein but can be administered slowly through a peripheral vein)
A nurse is assessing a client w/type 2 diabetes mellitus who was recently started on pioglitazone. Which client data obtained by the nurse is most important to bring to the attention of the HCP? - correct answer Bilateral pitting edema in ankles
(Thiazolidinediones ((rosiglitazone/avandia, pioglitazone/actos)) increase the risk of cardiovascular events and bladder cancer; similar to metformin)
A client has just been prescribed allopurinol for chronic gout. Which instruction is most important for the nurse to emphasize to the client? - correct answer Take the medication w/a full glass of water and increase fluids during the day.
(increase fluids to help prevent renal stones and promote diuresis and uric acid excretion)
A client w/bronchial asthma and sinusitis has increased wheezing and decreased peak flow readings. During the admission interview, the nurse reconciles the medications and notes that which of the following over the counter medications taken by the client could be contributing to increased asthma symptoms? - correct answer Ibuprofen 400mg orally every 6 hours for pain as needed
(Ibuprofen and aspirin are common OTC anti-inflammatory drugs that can cause bronchospasm in some clients w/asthma
The nurse is caring for a client taking tamoxifen for breast cancer. Which client statement is most concerning and a priority to report to the HCP? - correct answer "My periods have been heavy lately"
(Tamoxifen is associated w/increased risk of endometrial cancer and venous thromboembolism; excessive menstrual bleeding can be a sign of endometrial cancer)
The nurse reviews assigned client's medical and medication administration records. Which prescription should the nurse validate w/the HCP before administering? - correct answer Azathioprine for a client w/Crohn disease who reports fatigue and nausea and has leukopenia
(Azathioprine (Imuran) is an immunosuppressant drug that can cause bone marrow suppression and increase the risk for infection)
The nurse performs medication reconciliation for a 94yo client who has type 2 diabetes, hypothyroidism, and heart failure caused by a previous MI. D/t risks outweighing benefits, the nurse plans to talk w/the HCP about d/c'ing which medication? - correct answer Glyburide 10mg PO/once day
(Beers criteria; glyburide should be avoided d/t potential delayed elimination causing risk for prolonged hypoglycemia)
A client has a follow up checkup in the urology clinic. Six months ago, the client started taking tolterodine. What data collected from the client should the nurse report to the HCP? - correct answer Client excitedly reports being able to go an entire work day w/out having to urinate.
(Tolterodine/Detrol, oxybutynin/ditropan and solifenacin/vesicare are anticholinergic medications; they decrease the urgency and frequency of urination; not urinating the entire day while at work may indicate that the dosage is too high and is causing urinary retention)
A client w/latent TB has been taking oral isoniazid (INH) 300mg daily for 2 months. The client tells the nurse that for the past week she had numbness, a burning sensation and tingling in her hands and feet. Additional intake of which of the following would most likely have prevented this? - correct answer Vitamin B6
(INH interferes w/the action of vitamin B6, resulting in peripheral neuropathy)
The home health hospice nurse visits a client who is newly prescribed extended release oxycodone 40mg orally, scheduled every 12 hours to treat severe chronic cancer pain. Which information is most important to reinforce to the clients caregiver? - correct answer Administer the medication around the clock even if the clock even if the client denies having pain.
(administration twice daily is necessary to maintain a therapeutic level and provide continuous relief as the duration of the analgesic effect is 12 hours)
The nurse administers the prescribed dose of hydromorphone 2mg to a client who is 2 days postoperative from a colostomy. Which assessment finding is most important for the nurse to follow-up? - correct answer Client falls asleep while talking to the nurse
A community health nurse evaluates several clients' vaccination status. Which clients would the nurse recommend receive the influenza vaccine injection? - correct answer 1. 9mo old w/no known medical conditions
2. 5yo w/congenital heart defect
3. 23yo recently dx'd w/HIV
4. 45yo caretaker of elderly patient [Show Less]