A nurse is caring for a client who is to receive treatment for opiod use disorder. Which of the following medications should the nurse expect to administer?
A. Bupropion
B. Disulfiram
C. Modafinil
D. Methadone | D. Methadone
Rationale:
The nurse should expect to administer methadone for treatment of opioid use disorder. Methadone can be administered for withdrawal and to assist with maintenance and suppressive therapy.
The nurse should administer modafinil to assist with the fatigue and prolonged sleep from methamphetamine withdrawal.
The nurse should administer disulfiram as an aversion therapy to assist with maintaining abstinence from alcohol.
The nurse should administer bupropion to assist the client with smoking cessation. |
A nurse is caring for a client on a medical-surgical unit.
Nurses' Notes: Yesterday:Client was admitted 1 week ago with a Crohn's disease exacerbation. A central venous access device (CVAD) was placed in the client's right subclavian vein. Total parental nutrition (TPN) and lipids initiated 3 days ago. The client is NPO. The client reports abdominal pain as 5 on a scale of 0 to 10. Bowel sounds are hyperactive and lower right quadrant is tender to palpation. Today:The 24-hr bag of TPN infusion was complete 1 hr ago, pharmacy notified and waiting for a new bag. CVAD dressing is clean, dry, and intact. CVAD is difficult to flush. The client reports abdominal pain as 4 on a scale of 0 to 10 and chills.
Vital Signs:
Yesterday:
Oral temperature 36.6° C (97.9° F)
Pulse 80/min
Respiratory rate 16/min
Blood pressure 105/78 mm Hg
Oxygen saturation 99% on room air
Today:
Oral temperature 37.4° C (99.4° F)
Pu | The nurse should first address the client's Glucose level, followed by the client's CVAD.
Rationale:
When analyzing cues, the nurse should identify that the client is developing hypoglycemia and experiencing a complication with the central venous line (CVL). Hypoglycemia can occur if the TPN is stopped abruptly. A CVAD can become occluded or infected. Findings of a CVL complication can include difficulty flushing, pain while flushing, fever, or chills. |
A nurse is preparing to administer hydrochlorothiazide (HCTZ) to a client. Which of the following actions should the nurse take prior to administering the medication?
A. Ask the client to drink 8 oz of water.
B. Review the client's most recent Hgb level.
C. Obtain the client's blood pressure.
D. Determine if the client is allergic to NSAIDs. | C. Obtain the client's blood pressure.
Rationale:
HCTZ is a thiazide diuretic administered to promote urine output and reduce blood pressure and edema. The nurse should obtain the client's blood pressure prior to administration of the medication.
HCTZ is a thiazide diuretic administered to promote urine output and reduce blood pressure and edema. The client does not need to drink 8 oz of water prior to taking the medication.
HCTZ does not affect Hgb levels. The nurse should monitor the client's electrolytes, especially potassium, before and periodically while the client is taking this medication.
The nurse should assess the client for an allergy to sulfonamides due to the potential of cross-sensitivity with HCTZ. NSAIDs can decrease the effectiveness of HCTZ. |
A nurse is planning care for a client who is receiving mannitol via continuous IV infusion. Which of the following adverse effects should the nurse monitor the client for?
A. Weight loss
B. Increased intraocular pressure
C. Auditory hallucinations
D. Bibasilar crackles | D. Bibasilar crackles
Rationale:
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.
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.
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.
Mannitol has several neurologic adverse effects, including increased intracranial pressure, seizures, confusion, and headaches. However, it does not cause auditory hallucinations. |
A nurse is caring for a client who is taking nitroglycerin for angina and reports feeling faint when standing up. Which of the following actions should the nurse take?
A. Inform the client that feeling faint is caused by rapid constriction of the blood vessels in the legs.
B. Assist the client into bed, elevate the lower extremities, and check their blood pressure.
C. Request a prescription for dobutamine from the client's provider.
D. Check the client's blood pressure while they're still standing. | B. Assist the client into bed, elevate the lower extremities, and check their blood pressure.
Rationale:
The nurse should first assist the client into bed to prevent injuries from a fall. The nurse should elevate the client's legs on pillows to enhance venous return from the lower extremities. The nurse should then check the client's blood pressure.
Orthostatic, or postural, hypotension is caused by vasodilation of the blood vessels of the lower extremities, which allows pooling of blood. This pooling leads to manifestations such as dizziness, light headedness, or feeling faint. Nitroglycerin causes vasodilation.
Dobutamine is an adrenergic agonist medication used in the treatment of heart failure or cardiogenic shock. It is not used in the treatment of orthostatic hypotension.
To assess for orthostatic hypotension, the nurse should have the client lie supine for at least 5 minutes, then check their blood pressure. The nurse should then have the client sit up and recheck the blood pressure. Last, the client should stand up and the nurse should measure the blood pressure. |
A nurse is preparing medication instructions for a client who is receiving end-of-life care and their family. The client has a prescription for fentanyl patches. Which of the following information regarding the manifestations and use of fentanyl should the nurse include in the instructions?
A. Respiratory depression as a result of fentanyl use will cause a need for an at-home nefazodone prescription.
B. Removing the patch will immediately reverse any adverse effects of fentanyl.
C. An increase in urinary output should be expected.
D. Taking a stool softener daily will be needed. | D. Taking a stool softener daily will be needed.
Rationale:
Constipation is an adverse effect of opioid use. Stool softeners can decrease the severity of this adverse effect.
Urinary retention is an adverse effect of opioids, including fentanyl.
After removing the patch, the effects will persist for several hours due to the absorption of the residual medication on the skin.
Naloxone may be prescribed for the reversal of severe respiratory depression, not nefazodone, an atypical antidepressant. |
A nurse is providing teaching to a client who has a gastric ulcer and a new prescription for famotidine.
Which of the following instructions should the nurse include?
A. "Take the medication on an empty stomach for full effectiveness."
B. "You may discontinue this medication when stomach discomfort subsides."
C. "Report yellowing of the skin."
D. "You will be taking this medication for 2 weeks." | C. "Report yellowing of the skin."
Rationale:
Famotidine can be hepatotoxic and cause jaundice. The nurse should instruct the client to monitor for and report yellowing of the skin or eyes to the provider.
The client can take famotidine with or without food because food does not affect the medication's effectiveness.
For clients who have a gastric ulcer, famotidine is prescribed to inhibit gastric secretion and must be taken for the full course of therapy to be effective.
The client who has a gastric ulcer will be prescribed famotidine for a minimum of 6 weeks and typically no longer than a year for treatment. |
A nurse is providing discharge teaching about handling medication to a client who is to continue taking oral transmucosal fentanyl raspberry-flavored lozenges on a stick. Which of the following information should the nurse include in the teaching?
A. Chew on the medication stick to release the medication.
B. Leave the medication stick in one location of the mouth until melted.
C. Allow the medication 1 hr for analgesia effects to begin.
D. Store unused medication sticks in a storage container. | D. Store unused medication sticks in a storage container.
Rationale:
The nurse should instruct the client to store unused, used, or partially used medication sticks in the safe storage container that comes in the kit when the medication is initially prescribed.
The nurse should instruct the client to expect the medication's analgesia effects to begin within 10 to 15 min.
The nurse should instruct the client to periodically move the medication stick to a different location in the mouth for best absorption.
The nurse should instruct the client to place the fentanyl stick between their cheek and lower gum and actively suck it for increased absorption of the medication. |
A nurse is preparing to administer a scheduled antibiotic at 0800 to a client and discovers the antibiotic is not present in the client's medication drawer. The nurse should identify that administration of the medication can occur at which of the following time periods without requiring an incident report?
A. 1000
B. 0900
C. 0830
D. 1200 | C. 0830
Rationale:
The nurse should identify that an antibiotic can be administered 30 min before or after the scheduled time to maintain therapeutic blood levels without requiring an incident report.
The nurse should identify that administering an antibiotic 4 hr after the scheduled time is too late and requires filing an incident report.
The nurse should identify that administering an antibiotic 1 hr after the scheduled time is too late and requires filing an incident report.
The nurse should identify that administering an antibiotic 2 hr after the scheduled time is too late and requires filing an incident report. |
A nurse is caring for a client who is receiving filgrastim. Which of the following findings should the nurse document to indicate the effectiveness of the therapy?
A. Increased RBC count
B. Increased neutrophil count
C. Decreased prothrombin time
D. Decreased triglycerides | B. Increased neutrophil count
Rationale:
Filgrastim stimulates the bone marrow to produce neutrophils. For clients receiving chemotherapy, the risk of infection is minimized.
Filgrastim stimulates the bone marrow to produce neutrophils and has no effect on a client's RBC count.
Prothrombin time measures the effectiveness of warfarin therapy. Filgrastim therapy does not cause a decrease in prothrombin time.
Triglycerides are a form of lipids found in the blood stream. Increased levels are associated with an increased risk for heart disease. Decreased levels can occur in clients who have malnutrition or malabsorption disorders. Filgrastim is used to treat chemotherapy-induced neutropenia and has no effect on a client's triglyceride levels. |
A nurse is teaching a client who has a new prescription for docusate sodium about the medication's mechanism of action. Which of the following information should the nurse include in the teaching?
A. Docusate sodium reduces the surface tension of the stools to change their consistency.
B. Docusate sodium causes rectal contractions.
C. Docusate sodium acts as a fiber agent, increasing bulk in the intestines.
D. Docusate sodium stimulates the motility of the intestines. | A. Docusate sodium reduces the surface tension of the stools to change their consistency.
Rationale:
Docusate sodium is a surfactant that softens stool by reducing surface tension, allowing water to penetrate the stool more easily.
Osmotic laxatives, such as glycerin suppositories, act by lubricating the lower colon and initiating reflex contractions of the rectum.
Bulk-forming laxatives, such as methylcellulose, mimic the action of dietary fiber, forming a viscous compound that softens the fecal mass and increases its bulk, which stimulates peristalsis.
Stimulant laxatives, such as bisacodyl, stimulate the intestinal wall to cause peristalsis by pulling water into the intestines. |
A nurse is providing teaching to a client who has peptic ulcer disease and is to start a new prescription for sucralfate. Which of the following information should the nurse include in the teaching?
A. Decreases stomach acid secretion
B. Neutralizes acids in the stomach
C. Forms a protective barrier over ulcers
D. Treats ulcers by eradicating H. pylori | C. Forms a protective barrier over ulcers
Rationale: 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.
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.
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.
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. |
A nurse is preparing to administer amoxicillin 250 mg PO to a school-age child. The amount available is amoxicillin oral suspension 200mg/5 mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.) | Answer: 6.3mL
Rationale: Step 1: What is the unit of measurement the nurse should calculate? mL Step 2: What is the dose the nurse should administer? Dose to administer = Desired 250 mg Step 3: What is the dose available? Dose available = Have 200 mg Step 4: Should the nurse convert the units of measurement? No
Step 5: What is the quantity of the dose available? 5 mL Step 6: Set up an equation and solve for X. HaveDesired = QuantityX
200 mg250 mg = 5 mLX mL, X mL = 6.25
Step 7: Round if necessary. 6.25 mL = 6.3 mL Step 8: Determine whether the amount to administer makes sense. If there are 200 mg/5 mL and the prescription reads 250 mg, it makes sense to administer 6.3 mL. The nurse should administer amoxicillin 6.3 mL PO
Follow these steps for the Desired Over Have method of calculation:
Step 1: What is the unit of measurement the nurse should calculate? mL. Step 2: What is the dose the nurse should administer? Dose to administer = Desired 250 mg. Step 3: What is the dose available? Dose available = Have 200 mg. Step 4: Should the nurse convert the units of measurement? No. Step 5: What is the quantity of the dose available? 5 mL. Step 6: Set up an equation and solve for X.
HaveDesired = QuantityX, 200 mg250 mg = 5 mLX mL, X mL = 6.25
Step 7: Round if necessary. 6.25 mL = 6.3 mL. Step 8: Determine whether the amount to administer makes sense. If there are 200 mg/5 mL and the prescription reads 250 mg, it makes sense to administer 6.3 mL. The nurse should administer amoxicillin 6.3 mL PO. Follow these steps for the Dimensional Analysis method of calculation: Step 1: What is the unit of measurement the nurse should calculate? (Place the unit of measure being calculated on the left side of the equation.) X mL =. Step 2: Determine the ratio that contains the same unit as the unit being calculated. (Place the ratio on the right side |
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?
A. Potassium iodide
B. Glucagon
C. Atropine
D. Protamine | C. Atropine
Rationale:
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.
Potassium iodide is a thyroid hormone antagonist used in the treatment of radioactive iodine exposure.
Glucagon is an antihypoglycemic medication used in the treatment of low blood glucose levels.
Protamine is a heparin antagonist that is administered to reverse heparin toxicity evidenced by an aPTT greater than 70 seconds. |
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?
A."I will stop taking the medication if I get dizzy."
B."I should not drink orange juice while taking this medication."
C."I should expect to gain weight while taking this medication."
D."I will check my heart rate before I take the medication." | D."I will check my heart rate before I take the medication."
Rationale:
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.
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.
The client should not drink grapefruit juice while taking diltiazem because it can interfere with metabolism of the medication, increasing the blood levels of diltiazem and leading to toxicity.
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. |
A nurse is caring for a client who has a new prescription for spironolactone. Which of the following laboratory results should the nurse monitor while the client is taking this medication?
A. Potassium level
B. WBC count
C. Protein level
D. Adrenocorticotropic hormone level | A. Potassium level
Rationale: The nurse should monitor the client's potassium level as spironolactone is a potassium sparing diuretic that can cause hyperkalemia. The client's potassium level should be obtained and monitored within 1 week of beginning spironolactone, with any increase in dosage, and periodically throughout therapy. Additional laboratory results to monitor include sodium, uric acid, glucose, and renal function tests. The nurse does not need to monitor the client's white blood cell count as spironolactone does not affect white blood cells. Spironolactone is a potassium sparing diuretic that can cause hyperkalemia. Potassium level should be obtained and monitored within 1 week of initiation of therapy, with any increase in dosage, and periodically throughout therapy. Additional laboratory results to monitor include sodium, uric acid, glucose, and renal function tests. The nurse does not need to monitor the client's protein level as spironolactone does not affect protein. Spironolactone is a potassium sparing diuretic that can cause hyperkalemia. Potassium level should be obtained and monitored within 1 week of initiation of therapy, with any increase in dosage, and periodically throughout therapy. Additional laboratory results to monitor include sodium, uric acid, glucose, and renal function tests. The nurse does not need to monitor the client's adrenocorticotropic hormone level as spironolactone does not affect this hormone. Spironolactone is a potassium sparing diuretic that can cause hyperkalemia. Potassium level should be obtained and monitored within 1 week of initiation of therapy, with any increase in dosage, and periodically throughout therapy. Additional laboratory results to monitor include sodium, uric acid, glucose, and renal function tests. |
A nurse at an urgent care clinic is collecting a history from a client who has a urinary tract infection. The nurse anticipates a prescription for ciprofloxacin. The nurse should identify that which of the following client statements indicates a contraindication for administering this medication?
A. "I have tendonitis, so I haven't been able to exercise."
B. "I take a stool softener for chronic constipation."
C. "I take medicine for my thyroid."
D. "I am allergic to sulfa." | A. "I have tendonitis, so I haven't been able to exercise."
Rationale:
The nurse should identify tendonitis as a contraindication for taking ciprofloxacin due to the risk of tendon rupture.
Ciprofloxacin is not contraindicated for the client who takes a stool softener for chronic constipation. Diarrhea is an adverse effect of the medication.
Ciprofloxacin does not affect thyroid function and is not contraindicated for the client who takes thyroid medication.
Ciprofloxacin does not affect thyroid function and is not contraindicated for the client who takes thyroid medication. |
A nurse is reviewing the medication list of a client who wants to begin taking oral contraceptives. Which of the following client medications should the nurse identify will interfere with the effectiveness of an oral contraceptive?
A. Sumatriptan
B. Carbamazepine
C. Atenolol
D. Glipizide | B. Carbamazepine
Rationale:
Carbamazepine causes an accelerated inactivation of oral contraceptives because of its action on hepatic medication-metabolizing enzymes.
There is no medication interaction between oral contraceptives and sumatriptan, which is a medication to treat migraines.
There is no medication interaction between oral contraceptives and atenolol, a beta blocker.
There is no medication interaction between oral contraceptives and glipizide, an antidiabetic medication. |
A nurse is providing teaching to a client who is to begin taking oxybutynin for urinary incontinence. Which of the following adverse effects should the nurse include in the teaching? (Select all that apply.)
A. Dry mouth
B. Tinnitus
C. Blurred Vision
D. Bradycardia
E. Dry eyes | A. Dry mouth
C. Blurred Vision
E. Dry eyes
Rationale:
-Dry mouth is correct. Oxybutynin is an anticholinergic agent that can cause dry mouth.
-Tinnitus is incorrect. Oxybutynin can cause several sensory adverse effects including increased intraocular pressure. The nurse should instruct the client to report eye pain, seeing colored halos around lights, and a decreased ability to perceive light changes. However, tinnitus is not an adverse effect associated with oxybutynin administration.
-Blurred vision is correct. Oxybutynin is an anticholinergic agent that can cause blurred vision due to an increase in intraocular pressure.
-Bradycardia is incorrect. Oxybutynin can cause several cardiovascular adverse effects such as a prolongation of the QT interval, palpitations, hypertension, and tachycardia.
-Dry eyes is correct. Oxybutynin is an anticholinergic agent that can cause dry eyes and mydriasis, or pupil dilation. |
A nurse is caring for a client who has a magnesium level of 3.1 mEq/L (1.3 to 2.1 mEq/L). The nurse should expect to administer which of the following medications?
A. Magnesium gluconate
B. Cinacalcet
C. Calcium gluconate
D. Regular insulin | C. Calcium gluconate
Rationale:
The nurse should expect to administer IV calcium gluconate to the client and prepare to provide ventilatory support. This client is at risk for respiratory depression and cardiac dysrhythmias because a magnesium level of 3.1 mEq/L is above the expected reference range of 1.3 to 2.1 mEq/L.
Regular insulin is administered to treat hyperkalemia.
A magnesium level of 3.1 mEq/L is above the expected reference range of 1.3 to 2.1 mEq/L. Magnesium gluconate is administered to treat hypomagnesemia.
Cinacalcet is administered to treat hypercalcemia. |
A nurse contacts a clinet's provider on the telephone to obtain a prescription for pain medication. Which of the following actions should the nurse take?
A. Write the order on a prescription pad designated for the client's provider.
B. Have the provider spell out the unfamiliar medication names.
C. Read the prescription back to the provider using abbreviations.
D. Consult with a second nurse for any questions regarding dosage. | B. Have the provider spell out the unfamiliar medication names.
Rationale:
The nurse should ask the provider to spell out the name of the medication if the stated name is one the nurse is not familiar with.
The nurse should write the order on the provider's order form in the client's medical record or place the order into the computer on the provider's order form according to facility policy.
The nurse should read the prescription back to the provider using words in place of abbreviations to reduce the risk of error. The nurse should ask the provider to acknowledge that the prescription is correct after having it read back.
The nurse should consult the provider about any questions concerning the prescription. |
A nurse is assessing a client 1 hr after administering morphine for pain. Which of the following findings should the nurse identify as the best indication that the morphine has been effective?
A. The client's vital signs are within normal limits.
B. The client has not requested additional medication.
C. The client is resting comfortably with eyes closed.
D. The client rates pain as 3 on a scale of 0 to 10. | D. The client rates pain as 3 on a scale of 0 to 10.
Rationale:
The client's description of the pain is the most accurate assessment of pain.
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.
Clients often do not request medicine even when they are experiencing pain.
Vital signs can be within normal limits for clients who have pain. |
A nurse in a provider's office is assessing a client who has been taking aspirin daily for the past year. For which of the following findings should the nurse immediately notify the provider?
A. Hyperventilation
B. Heartburn
C. Anorexia
D. Swollen ankles | A. Hyperventilation
Rationale:
When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is hyperventilation. This finding indicates the client might have acute salicylate poisoning, which causes respiratory alkalosis in the early stages.
Heartburn is nonurgent because the client who is taking aspirin can experience gastrointestinal distress. Therefore, there is another finding that is the nurse's priority.
Anorexia is nonurgent because the client who is taking aspirin can experience a decrease in appetite. Therefore, there is another finding that is the nurse's priority.
Swollen ankles are nonurgent because the client who is taking aspirin can experience sodium and fluid retention. Therefore, there is another finding that is the nurse's priority. |
A nurse is teaching a client who has insomnia about zolpidem. The nurse should identify that which if the following client statements indicates an understanding of the teaching?
A. "I will need to get laboratory testing prior to a refill of this medication."
B. "I will use this medication for a short period of time."
C. "I will need to take this medication for 1 week before results are seen."
D. "I will need to change the medications to prevent building up a tolerance." | B. "I will use this medication for a short period of time."
Rationale:
Zolpidem is used for short-term treatment of insomnia. Therefore, the provider should reassess the client before refilling the prescription.
Laboratory testing is not needed when taking this medication for sleep.
The client who takes zolpidem should experience improved sleep within 2 days of starting this medication.
The client who takes zolpidem should not build up a tolerance to the medication with short-term use. |
A nurse is assessing a client who is receiving epoetin alfa to treat anemia.
Which of the following findings should the nurse monitor?
A. Paresthesia
B. Increased blood pressure
C. Fever
D. Respiratory depression | B. Increased blood pressure
Rationale: 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.
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.
Adverse effects of epoetin alfa include neurological manifestations, such as coldness and sweating. However, it does not cause fever.
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. |
A nurse is assessing a client who has schizophrenia and is taking haloperidol. The nurse should report which of the following findings to the provider as a manifestation of neuroleptic malignant syndrome (NMS)?
A. Temperature of 39.7° C (103.5° F)
B. Urinary retention
C. Heart rate 56/min
D. Muscle flaccidity | A. Temperature of
39.7° C (103.5° F)
Rationale:
The nurse should report fever to the provider as an indication of NMS, an acute life-threatening emergency. Other manifestations can include respiratory distress, diaphoresis, and either hypertension or hypotension.
The nurse should report incontinence as a manifestation of NMS.
The nurse should report tachycardia as a manifestation of NMS.
The nurse should report severe muscle rigidity as a manifestation of NMS. |
A nurse is planning to teach about inhalant medications to a client who has recent diagnosis of exercise-induced asthma. Which of the following medications should the nurse plan to include in the teaching for the client to use prior to physical activity?
A. Cromolyn
B. Beclomethasone
C. Budesonide
D. Tiotropium | A. Cromolyn
Rationale:
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 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 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 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. |
A nurse is preparing to administer dextrose 5% in water (D5W) 400 mL IV to infuse over 1 hr. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero). | 100 gtt/min Rationale: Follow these steps to calculate the infusion rate using the Ratio and Proportion or Desired Over Have method of calculation: Step 1: What is the unit of measurement the nurse should calculate? gtt/min. Step 2: What is the volume the nurse should infuse? 400 mL Step 3: What is the total infusion time? 1 hr. Step 4: Should the nurse convert the units of measurement? Yes (hr ? min) 1 hr = 60 min. Step 5: Set up an equation and solve for X.
Volume (mL)X gtt/min = × Drop factor (gtt/mL)Time (min)
400 mL15 gttX gtt/min = × 60 min1 mL, X gtt/min = 100 gtt/min
Step 6: Round if necessary. Step 7: Determine whether the amount ot administer makes sense. If the prescription reads D5W 400 mL IV to infuse over 60 min with a drop factor of 15 gtt/mL, it makes sense to administer 100 gtt/min. The nurse should set the manual IV infusion to deliver D5W IV at 100 gtt/min. Follow these steps to calculate the infusion rate using the Dimensional Analysis method of calculation: Step 1: What is the unit of measurement the nurse should calculate? (Place the unit of measure being calculated on the left side of the equation.) X gtt/min = . Step 2: Determine the ratio that contains the same unit as the unit being calculated. (Place the ratio on the right side of the equation, ensuring that the unit in the numerator matches the unit being calculated.)
15 gttX gtt/min = 1 mL. Step 3: Place any remaining ratios that are relevant to the item on the right side of the equation, along with any needed conversion factors, to cancel out unwanted units of measurement. 15 gtt400 mLX gtt/min = × 1 mL60 min
Step 4: Solve for X. X gtt/min = 100 gtt/min. Step 5: Round if necessary. Step 6: Determine whether the amount ot administer makes sense. If the prescription reads D5W 400 mL IV to infuse over 60 min with a drop factor of 15 gtt/mL, it ma |
A nurse is instructing a client on the application of nitroglycerin transdermal patches. Which of the following statements by the client indicates an understanding of the teaching?
A. "I should apply a patch every 5 minutes if I develop chest pain."
B. "I will take the patch off right after my evening meal."
C. "I will leave the patch off at least 1 day each week."
D. "I should discard the used patch by flushing it down the toilet." | B. "I will take the patch off right after my evening meal."
Rationale: 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.
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.
Nitroglycerin is an antianginal medication that results in dilation of the coronary vessels. Clients should apply the patch daily to sustain prophylaxis.
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. |
A nurse is providing teaching to a client who has depression and a new prescription for fluoxetine. Which of the following statements by the client indicates an understanding of the teaching?
A. "I should start to feel better within 24 hours of starting this medication."
B. "I will be sure to follow a strict diet to avoid foods with tyramine."
C. "I will continue to take St. John's Wort to increase the effects of the medication."
D."I should take acetaminophen instead of ibuprofen for my headaches while taking this medication." | D."I should take acetaminophen instead of ibuprofen for my headaches while taking this medication."
Rationale:
Fluoxetine suppresses platelet aggregation, which increases the risk of bleeding when used concurrently with NSAIDs and anticoagulants. Therefore, clients who are taking fluoxetine should take acetaminophen for headaches or pain, since acetaminophen does not suppress platelet aggregation.
Concurrent use of St. John's Wort and fluoxetine can increase the client's risk for serotonin syndrome, a potentially life-threatening complication. Manifestations of serotonin syndrome include confusion, hallucinations, hyperreflexia, excessive sweating, and fever.
Clients taking fluoxetine, a selective serotonin reuptake inhibitor, are not required to restrict their dietary intake of tyramine. A client who is taking an MAOI, such as selegiline, should avoid products containing tyramine.
The nurse should inform the client that the therapeutic levels of fluoxetine can take between 1 and 4 weeks to achieve desired effects. The client should take the medication as prescribed and use other strategies to manage depression in the interim. |