Which statement is an advantage to administering a histamine 2 blocker rather than an antacid to a client diagnosed with GERD?
1. Antacids are more potent than H2 blockers.
2. H2 blockers have more side effects than antacids.
3. H2 blockers are less expensive than antacids.
4. H2 blockers require less frequent dosing than antacids.
4. H2 blockers require less frequent administration than antacids, which require regular administration, seven or more times a day, for therapeutic effects. The fewer times a client is expected to take a medication, the more likely the client is to comply with a medication regimen.
The client diagnosed with AIDS has a pruritic rash with pinkish-red macules. Which medication should the nurse suspect is causing the rash?
Trimethoprim-sulfamethoxazole
Nelfinavir
Efavirenz
Zidovudine
1. An antibiotic trimethoprim-sulfamethoxazole (Bactrim) sulfa allergy with this type of rash develops in up to 60% of clients diagnosed with AIDS.
The client diagnosed with late-stage Alzheimer’s disease is agitated and having delusions. Which medication should the nurse anticipate the HCP prescribing?
Donepezil
Haloperidol
Fluoxetine
Amitriptyline
2. Delusions and agitation respond to antipsychotic medications. Haloperidol (Haldol), an antipsychotic medication, has been used and has proven to be effective in treating these symptoms, so the nurse should anticipate this prescription.
The nurse is caring for a client diagnosed with partial onset seizures related to epilepsy. The HCP has prescribed brivaracetam. Which should the nurse discuss with the client?
1. “Be sure to see the dentist regularly because the medication can cause gingival hyperplasia.”
2. “Regular laboratory work must be obtained to monitor the levels of the drug.”
3. “Do not drive or operate heavy machinery until the HCP determines it is safe to do so.”
4. “You should take baths only.”
3. Brivaracetam (Briviact) has a side effect of causing drowsiness, as do most other anticonvulsant medications. It is prescribed for partial onset seizures related to epilepsy.
The client diagnosed with paranoid schizophrenia has been taking chlorpromazine. The client tells the psychiatric clinic nurse that they have frequent joint pain and stiffness and get a rash when in the sun. Which statement is the nurse’s best response?
1. “This is part of your illness and will go away if you ignore it.”
2. “What have your voices said about the aches, pains, and rash?”
3. “Don’t take your medication today and come in to see the HCP.”
4. “This is a reaction to medications, and you can no longer take medications.”
3. This is the best response by the nurse. These are symptoms of drug-induced SLE. The nurse should make sure the HCP sees the client.
The nurse is discharging a client diagnosed with GERD. Which information should the nurse include in the teaching?
1. “There are no complications of GERD as long as you take the medications.”
2. “Notify the HCP if the medication does not resolve the symptoms.”
3. “Immediately after a meal, lie down for at least 45 minutes.”
4. “If any discomfort is noted, take an NSAID for the pain.”
2. The client should always be informed of what symptoms to report to the HCP.
The client diagnosed with end-stage liver failure is taking lactulose. Which statement indicates the client needs more teaching concerning this medication?
1. “I will notify my doctor if I have any watery diarrhea.”
2. “If I get nauseated, I will quit taking the lactulose.”
3. “I will take my lactulose with fruit juice.”
4. “I should have two or three soft stools a day.”
2. Lactulose (Cephulac) is an osmotic laxative that functions as an ammonia detoxicant. Although the drug may cause nausea, the client should keep taking it to decrease the ammonia level. The nurse should instruct the client to take the medication with crackers or a soft drink, which may reduce nausea. This statement indicates the client does not understand the medication teaching and needs more instruction.
The client is admitted into the ED reporting profuse salivation, excessive tearing, and diarrhea. The client tells the nurse about currently camping and living off the land. Which medication should the nurse anticipate administering?
1. Atropine
2. Diphenhydramine
3. Magnesium and aluminum hydroxide
4. Pantoprazole
1. The client reports living off the land, and the symptoms reported are clinical manifestations of muscarinic poisoning from eating wild mushrooms. Therefore, the nurse should anticipate administering the antidote atropine, a muscarinic agonist.
2. An antihistamine, diphenhydramine (Benadryl), would be prescribed for an allergic reaction, not for muscarinic poisoning.
The clinic nurse is assessing a client 3 weeks after a suicide attempt. The client was prescribed sertraline. Which behavior indicates the medication is effective?
1. The client sleeps 14 to 16 hours a day.
2. The client has lost 3 pounds.
3. The client regrets the suicide attempt.
4. The client has started a new job.
4. Setting new goals and priorities, such as getting a job, indicates the client may no longer be depressed, and sertraline (Zoloft), an SSRI, is effective.
The client has a severe anaphylactic reaction to insect bites. Which priority discharge intervention should the nurse discuss with the client?
1. “Wear an insect repellent on exposed skin.”
2. “Keep prescribed antihistamines with you.”
3. “Have an epinephrine auto-injector available at all times.”
4. “Wear a medication alert identification bracelet.”
3. Clients with documented severe anaphylaxis should carry an epinephrine auto-injector (EpiPen), a prescribed injectable device containing epinephrine that the client can administer to themselves in case of an insect bite. This will save the client’s life; therefore, this is the priority intervention.
The client is diagnosed with a Helicobacter pylori (H. pylori) infection and peptic ulcer disease (PUD). Which discharge instructions should the nurse teach?
Select all that apply.
1. Discuss placing the head of the bed on blocks to prevent reflux.
2. Teach never to use NSAIDs again.
3. Encourage the client to quit smoking cigarettes.
4. Instruct the client to eat a soft, bland diet.
5. Take the combination of medications for 14 days as directed.
3. Smoking decreases prostaglandin production and results in decreased protection of the mucosal lining. Smoking should be stopped.
H. pylori is a bacterial infection that is treated with a combination of medications. At least two antibiotics and an antisecretory medication will be ordered. As with all antibiotic prescriptions, the client should be taught to take all medications as ordered. Resistant strains of H. pylori are being documented in clients not compliant with the treatment program.
The client is prescribed senna glycoside for constipation. The client calls the clinic and reports yellow-green feces. Which intervention should the clinic nurse implement?
1. Have the client come to the clinic immediately.
2. Explain that this is a common side effect of senna glycoside.
3. Instruct the client to get a stool specimen to bring to the clinic.
4. Determine if the client has eaten any type of yellow or green food.
2. Senna (Senokot) is a stimulant laxative. Senna (Senokot, Ex-Lax, and Agoral) may cause a yellow or yellow-green cast to feces. It may also cause a red-pink discoloration of alkaline urine or yellow-brown color in acid urine. The nurse should teach the client about this when the medication is prescribed.
The client diagnosed with epilepsy is seen in the clinic and has a serum phenytoin level of 5.4 mcg/dL. Which intervention should the nurse implement?
1. Request that the laboratory verify the results of the test.
2. Ask the client when the dose was taken last.
3. Instruct the client not to take the phenytoin for 2 days.
4. Discuss the need to increase the dose of the medication.
2. This level is below the therapeutic range of 10 to 20 mcg/dL; therefore, the nurse should determine if the client is taking the medication as directed.
The client diagnosed with panic disorder is taking a phenelzine. Which statement by the client warrants immediate intervention?
1. “I am very careful about what I eat.”
2. “I have been taking dextromethorphan for my cough.”
3. “I took two acetaminophen for my headache.”
4. “I only drink one cup of coffee a day.”
2. Dextromethorphan (Robitussin) interacts with MAOIs to produce hypertension, fever, and coma. This statement warrants intervention.
The nurse is administering a dose of an IV antibiotic to the client. Twenty minutes into the infusion the client reports shortness of breath, itching, and difficulty swallowing. Which intervention should the nurse implement first?
1. Prepare to administer subcutaneous epinephrine.
2. Discontinue the client’s IV antibiotic.
3. Assess the client’s apical pulse and blood pressure.
4. Administer 10 L of oxygen via nasal cannula.
The nurse should realize that the client is having an allergic reaction to the IV antibiotic and immediately discontinue the medication. This is the nurse’s first intervention.
The 80-year-old client diagnosed with diverticulosis is prescribed docusate sodium. Which assessment data indicates the medication is effective?
1. The client has a bowel movement within 8 hours.
2. The client has soft, brown stools.
3. The client has a soft, nontender abdomen.
4. The client has bowel sounds in all four quadrants.
2. Docusate calcium (Colace) is a stool softener. If the client has soft brown stools, the medication is effective.
The registered nurse (RN) and unlicensed assistive personnel (UAP) are caring for the client receiving TPN at 70 mL/hr. Which task is most appropriate for the RN to delegate to the UAP?
1. Instruct the UAP to weigh the client.
2. Ask the UAP to change the subclavian dressing.
3. Tell the UAP to assist the client with feeding.
4. Request the UAP to assess the client’s bowel sounds.
1. The UAP can weigh the client because this task is not assessing, teaching, evaluating, or administering medications.
The client is prescribed meclizine HCL for vertigo. Which statement by the client warrants intervention by the nurse?
1. “I have had someone drive my car because I have been getting dizzy.”
2. “I will tell my HCPs about taking this medication.”
3. “I usually have one or two glasses of wine with my evening meal.”
4. “I will chew sugarless gum or suck on hard candy if my mouth is dry.”
3. The client should avoid other central nervous system depressants, including alcohol. Therefore, this statement requires intervention and further teaching by the nurse.
The client is brought to the ED by a friend. The client is hypervigilant, has not slept in 3 days, has dilated pupils, has an apical pulse of 118 bpm, and has a runny nose. Which substance should the nurse suspect the client is abusing?
Cannabis
Heroin
Cocaine
Alcohol
3. Hypervigilance, insomnia, dilated pupils, and a runny nose are clinical manifestations of cocaine abuse.
The client diagnosed with RA is prescribed prednisone for an acute episode of pain. The client asks the nurse, “Because it helps the pain so much, why can’t I be on this forever?” Which statement is the nurse’s best response?
“The medication will cause you to have a buffalo hump or moon face.”
“The medication has long-term side effects, such as osteoporosis.”
“If you continue taking the medication, it may cause an Addisonian crisis.”
“There are other medications that can be prescribed to help the pain.”
2. Prednisone, a glucocorticoid, has serious long-term side effects that can lead to possible life-threatening complications; therefore, the client cannot take prednisone forever.
The client diagnosed with end-stage liver failure has an elevated ammonia level. The HCP prescribes lactulose. Which intervention should the nurse implement to determine the effectiveness of the medication?
1. Monitor the client’s intake and output.
2. Assess the client’s neurological status.
3. Measure the client’s abdominal girth.
4. Document the number of bowel movements
2. Lactulose (Cephulac) is an osmotic laxative that functions as an ammonia detoxicant. An elevated ammonia level affects the client’s neurological status. Lactulose is prescribed to remove ammonia through the intestinal tract. Assessing the client’s neurological status will determine the medication’s effectiveness.
The nurse is assessing the pain level of a postoperative abdominal surgery client. The client reports “mild” abdominal pain rated a “4” on a scale of 1–10. Which medication should the nurse prepare to administer?
1. Oxycodone PO
2. Acetaminophen PO
3. Morphine sulfate IVP
4. Ondansetron IVP
1. Oxycodone (Percodan), a narcotic analgesic, is an oral medication and appropriate for mild to moderate pain.
The client diagnosed with MS tells the nurse, “I have problems having regular bowel movements.” Which statement indicates the client needs more medication teaching?
1. “I am taking a stimulant laxative tablet every day.”
2. “I am taking a fiber laxative daily.”
3. “I take a stool softener at bedtime.”
4. “I keep a glass of water with me at all times.”
1. Bisacodyl (Dulcolax) is a stimulant laxative and should not be taken every day because it will cause a decrease in bowel tone. The client diagnosed with MS already has difficulty with bowel tone.
Which statement best supports the scientific rationale for pharmacologic treatment in clients diagnosed with substance abuse?
1. Medications allow the clients to take a medication legally for their problem.
2. Medications permit safe withdrawal and help prevent relapse.
3. Medications will prevent all side effects of substance abuse withdrawal.
4. Medications allow the clients to have a psychological reason to quit the substance abuse.
2. The two primary purposes for prescribing medication for clients addicted to alcohol, sedatives or hypnotics, and benzodiazepines are to permit safe withdrawal from the substance and to prevent relapse into addiction again.
The client recently diagnosed with RA is prescribed 4 grams of aspirin daily. Which statement indicates the client needs more teaching concerning the medication?
1. “I will decrease my dose for a few days if my ears start ringing.”
2. “I should take my aspirin with meals, food, milk, or antacids.”
3. “I need to take the entire aspirin dose at night before going to bed.”
4. “If I have any stomach upset, I will take enteric-coated aspirin.”
3. The aspirin should be taken in divided doses (three to four 325-mg tablets four times a day). This statement indicates the client needs more teaching.