Intravenous heparin therapy is prescribed for a client. While implementing this prescription, a nurse ensures while implementing this prescription, that which of the following medications is available on the nursing unit?

a. Protamine sulfate
b. Potassium chloride
c. Aminocaproic acid (amicar)
d. Vitamin K

a. Protamine Sulfate
Rationale: The antidote to heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrahge should occur. Vitamin K is an antidote for warfarin sodium. Amniocaproic acid is the antidote for thrombolytic therapy. Potassium chloride is administered for a potassium diet.
1) After a period of of unsuccessful treatment with elavil (amitriptyline), a woman diagnosed with depression is switched to Parnate (tranylcypromine). Which statement by the client indicates the client understands the side effects of Parnate?

a. “I need to increase my intake of sodium”
b. “I must refrain from strenuous exercise”
c. “I must refrain from eating aged cheese or yeast products”
d. “I should decrease my intake of foods containing sugar”
c.“I must refrain from eating aged cheese or yeast products”-
Rationale: Parnate is a MAO inhibitor. Patients taking MAO inhibitors should avoid tyramine-rich foods which cause a negative reaction when mixed.
1) The client with Type 1 diabetes mellitus is taught to take the isophane insulin suspension NPH (Humulin N) at 5 pm each day. The client should be instructed that the GREATEST risk of hypoglycemia will occur at about what time?

a. 11 am shortly before lunch
b. 1 pm, shortly after lunch
c. 6 pm, shortly after dinner
d. 1 am, while sleeping
d. 1am, while sleeping

Rationale: NPH insulin/Humulin N is an intermediate insulin which peaks in 6-8 hours. Therefore, the client is at greatest risk at 1 am while sleeping. In order to help prevent this hypoglycemic episode, the client should eat a bedtime snack.
A client with allergic rhinitis is instructed on the correct technique for using an intranasal inhaler. Which of the following statements would demonstrate to the nurse that the client understands the instructions?

A. "I should limit the use of the inhaler to early morning and bedtime use"
B."It is important to not shake the canister because that can damage the spray device."
C. "I should hold one nostril closed while I insert the spray into the other nostril"
D. "The inhaler tip is inserted into the nostril and pointed towards the inside nostril wall."
C. "I should hold one nostril closed while I insert the spray into the other nostril"

Rationale: When using an intranasal inhaler, it is important to close off one nostril while inhaling to ensure the best inhalation of the spray. Use of the inhaler is not limited to mornings and bedtime. The canister should be shaken immiediately before use. The inhaler tip should be inserted into the nostril and pointed toward the outside nostril wall to maximize inhalation of the medication.
A client with diverticular disease is receiving psyllium hydrophillic mucilloid (Metamucil). The drug has been effective when the client tells the nurse that he:

A. Passes stool without cramping
B. No longer has diarrhea
C. Is not as anxious as he once was
D. Does not expel gas like he used to
A. Passes stool without cramping

Rationale: Diverticular disease is treated with a high fiber diet and bulk laxatives such as Metamucil. Bulk laxatives and fiber decrease the intraluminal pressure and make it easier for stool to pass through the colon.
A client with atrial fibrilation is receiving a continuous heparin infusion at 1000 units/hr. The nurse would determine that the client is receiving a therapeutic effect based on which of the following results?

a. Prothrombin time of 12.5 sec
b. activated partial thromboplastin time of 60 seconds
c. activated partial thromboplastin time of 28 seconds
d. activated partial thrombin time longer than 120 seconds
d. Activated partial thrombin time longer than 120 seconds
Rationale: PT is used to assess response to warfarin (Coumadin) therapy. Normal activated partial thromboplastin time should be 1.5-2.5 times normal value.
2) The client states to the nurse, “I take citalopram (Celexa) 40 mg every day like my physician prescribed. I have also been taking St. John’s wort 750 mg daily for the past 2 weeks”. Which of the following indicate that the client is developing serotonin syndrome? Select all that apply.

1. confusion 2. restlessness 3. constipation 4. diaphoresis 5. ataxia

Rationale: Serotonin syndrome includes mental status changes such as confusion, restlessness or agitation, headache, diaphoresis, ataxia, myoclonus, shivering, tremor, diarrhea, nausea, abdominal cramps and hyperreflexia. Constipation is not associated with it.
2) A client has recently been diagnosed with type 2 diabetes mellitus and is to take tolbutamide (orinase). When teaching the client about the drug, the nurse explains that tolbutamide is believed to lower the blood glucose level by which of the following actions?

a. Potentiating that action of insulin
b. Lowering the renal threshold of glucose
c. Stimulating insulin release from functioning beta cells in the pancreas
d. Combining with glucose to render it inert.
c. Stimulating insulin release from functioning beta cells in the pancreas.

Rationale: Tolbutamide is from the sulfonylurea group lower blood glucose by stimulating already functioning Beta cells in the pancreas to release insulin. In addition, these agents increase the number of insulin receptors in the body.
A nurse is teaching a client about taking antihistamines. Which of the following instructions should the nurse include in the teaching plan? Select all that apply.

A. Operating machinery and driving may be dangerous when taking antihistamines.
B. Continue taking antihistamines even if nasal infection develops.
C. The effect of antihistamines is not felt until a day later.
D. Do not use alcohol with antihistamines
E. Increase fluid intake to 2,000ml/day

Rationale: Antihistamines have an anticholinergic action and a drying effect. They reduce nasal, salivary, and lacrimal gland hypersecretions (runny nose, tearing, and itchy eyes). An adverse effect is drowsiness, so operating machinery and driving are not recommended. There is also an additive depressant effect when alcohol is combined with antihistamines, so alcohol should be avoided during use. The client should ensure adequate fluid intake of atleast 8 glasses per day due to the drying effect of this drug.
A client with peptic ulcer disease is taking ranitidine (Zantac). What is the expected outcome of this drug?

A. Heal the ulcer
B. Protect the ulcer surface from acids
C. Reduce acid concentration
D. Limit gastric acid secretion
D. Limit gastric acid secretion

Rationale: Ranitidine is a Histamine-2 receptor antagonist, meaning that is reduces gastric acid secretion. Anti-secretory or proton-pump inhibitors such as Prilosec, help ulcers heal quickly in 4-8 weeks. Cytoprotective drugs such as Carafate protect the ulcer surface against acid, bile and pepsin. Antacids are responsible for reducing acid concentration and helping to reduce symptoms.
A 66-year-old client complaining of not feeling well is seen in a clinic. The client is taking several meds for the control of heart disease and hypertension. These medications include atenolol, digoxin, and chlorothiazide. A tentative diagnosis of digoxin toxicity is made. Which of the following assessment data would support this diagnosis?

a. Dypsnea, edema, and palpitations
b. Chest pain, hypotension, and paresthesia
c. Double vision, loss of appetite, and nausea
d. Constipation, dry mouth, and sleep disorder

c. Double vision, loss of appetite, and nausea
Rationale: These are early signs of toxicity. Additional signs of toxicity are bradycardia, difficulty reading, other visual alterations such as green and yellow vision or seeing spots or halos, confusion, vomiting, diarrhea, and decreased libido and impotence.
3) Which of the following comments indicates that a client understands the nurse’s teaching about sertraline (Zoloft)?

a. “Zoloft will probably cause me to gain weight”
b. “This medication can cause delayed ejaculations”
c. “Dry mouth is a permanent side effect of Zoloft”
d. “I can take my medicine with St. John’s wort”
b. “This medication can cause delayed ejaculations”

Rationale: Sertraline is an SSRI which can cause decreased libido and sexual dysfunction. SSRI’s do not cause weight gain, but can cause decreased appetite and weight loss. Dry mouth is a possible side effect, but is temporary. St. John’s wort should not be taken with SSRI's because it can cause serotonin syndrome.
A client with Graves disease is treated with radioactive iodine (RAI) in the form f sodium iodide. 131I. Which of the following statements by the nurse will explain to the client how the drug works?

a. “The radioactive iodine stabilizes the thyroid hormone levels before a thyroidectomy.”
b. “The radioactive iodine reduces uptake of thyroxine and thereby improves your condition”
c. “The radioactive iodine lowers the levels of thyroid hormones by slowing your body’s
production of them”
d. “The radioactive iodine destroys thyroid tissue so that the thyroid hormones are no longer produced.”
d. “The radioactive iodine destroys thyroid tissue so that the thyroid hormones are no longer produced.”
Rationale: RAI is frequently given to patients with Graves disease, it is described as a “medical thyroidectomy” as it is given in lieu of surgery. It is frequently given in the elderly.
The nurse should include which of the following instructions when developing a teaching plan for a client who is receiving Isoniazid (INH) and Rifampin (Rifamate) for treatment of tuberculosis?

A. Take the medication with antacids
B. Double the dosage if a drug dose is missed
C. Increase intake of dairy products
D. Limit alcohol intake
D. Limit alcohol intake

Rationale: INH and Rifamate are hepatotoxic drugs. The client should be warned to limit the intake of alcohol during drug therapy. These drugs should be taken on an empty stomach. If antacids are needed for GI distress, they should be taken 1 hour before or 2 hours after drug administration. The client should not double the dose due to potential toxicity. Clients taking these drugs should avoid foods rich in tyramine, such as cheese and dairy products, to avoid development of hypertension.
The physician prescribes metoclopramide hydrochloride (Reglan) for the client with a hiatal hernia. The nurse plans to instruct the client that this drug is used in hiatal hernia therapy to accomplish which of the following objectives?

A. Increase tone of the esophageal sphincter
B. Neutralize gastric secretions
C. Delay gastric emptying
D. Reduce secretion of gastric juices
A.Increase tone of the esophageal sphincter

Rationale: Reglan increases esophageal sphincter tone and facilitates gastric emptying: both actions reduce the incidence of reflux. Other drugs, such an antacids or histamine receptor antagonists may also be prescribed to help control reflux and esophagitis, and to decrease or neutralize secretions.
4. A client is being treated with procainamide (Procanbid) for a cardiac dysrhytmia. Following intravenous administration of the medication, the client complains of dizziness. What interventions should the nurse take first?

a. Administer prescribed nitroglycerin tablets
b. Measure the heart rate on the rhythm strip
c. Obtain a 12-lead electrocardiogram immediately
d. Auscultate the client’s apical pulse and obtain a blood pressure
d. Signs of toxicity from procainamide include confusion, dizziness, drowsiness, decreased urination, nausea, vomiting and tachydysrhythmias. If the client complains of dizziness, the nurse should assess the vital signs first.
4) The client with acute mania is prescribed 600 mg of lithium (lithium carbonate) PO TID. The physician also orders 5 mg of haloperidol (Haldol) PO at bedtime. Which action should the nurse take?

a. administer the medication as ordered
b. question the physician about the order
c. Administer the haldol, but not the lithium
d. Consult with the nursing supervisor before administering the medication
a. administer the medication as ordered

Rationale: Administer the medication as ordered. Lithium has lag time response of 1-2 weeks. Haldol is prescribed temporarily to produce a neuroleptic effect until the Lithium starts to produce a clinical response. Haldol is usually discontinued when the Lithium starts to take effect
The client with Addison’s disease is taking glucocorticoids at home. Which of the following statements indicates that the client understands how to take the medication?

a. “Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage”.
b. “My need for glucocorticoids will stabilize and I will be able to take a predetermined dose once a day.”
c. “Glucocorticoids are cumulative, so I will take a dose every third day”
d. “I must take a dose every 6 hours to ensure consistent blood levels of glucocorticoids”
a. “Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage”
Rationale: The need for glucocorticoids changes with circumstances. The basal dose given is determined at discharge, but the dose covers only normal daily needs and does not include additional stressors. The client needs to be the manager of the medication schedule and have the knowledge of the signs and symptoms of excessive and insufficient dosages. Needs for glucocorticoids fluctuate and the client must be able to manage according to their needs.
A client is prescribed metaproterenol (Alupent) via a metered-dose inhaler, two puffs every 4 hours. The nurse instructs the client to report adverse effects. Which of the following are potential adverse effects of metaproterenol?

A. Irregular heartbeat
B. Constipation
C. Pedal edema
D. Decreased pulse rate
A. Irregular heartbeat

Rationale: Irregular heartbeats should be reported promptly to the PCP. Metaproterenol (Alupent) may cause irregular heartbeat, tachycardia, or anginal pain because it has an adrenergic effect on beta-adrengergic receptors in the heart. This adverse effect should be immediately reported to a provider. This medication is not recommended for use in clients with known cardiac disorders. Metaproterenol does not cause constipation, pedal edema, or bradycardia.
The physician prescribes sulfasalazine (Azulfidine) for the client with ulcerative colitis to continue taking at home. Which instruction should the nurse give the client about taking his medication?

A. Avoid taking it with food
B. Take the total dose at bedtime
C. Take it with a full glass of water (240ml)
D. Stop taking it if urine turns orangey-yellow
C. Take it with a full glass of water (240ml)

Rationale: Adequate fluid intake of at least 8 glasses a day prevents crystalluria and stone formation during sulfasalazine therapy. Sulfasalazine can cause GI distress and is best taken after meals and in equal doses. Orange-yellow urine is a natural effect of this medication.
5. A nurse is monitoring a client who is taking propanolol (Inderal). Which assessment data would indicate a potential serious complication associated with propranolol?

a. The development of complaints of insomnia
b. The development of audible expiratory wheezes
c. A baseline blood pressure of 150/80 mmHg followed by a blood pressure of 138/72
d. A baseline resting heart rate of 88 beats/min followed by a resting heart rate of 72/beats/min after two doses of the medication
b. The development of audible expiratory wheezes
Rationale: Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. Beta blockers may induce this reaction, particularly in clients with COPD, or asthma. Normal decreases in BP and HR are expected. Insomnia is a frequent mild side effect and should be monitored.
5) A young adult client diagnosed with bipolar disorder has been managing the disorder effectively with medication and treatment for several years. The client suddenly becomes manic. The nurse reviews the client’s medication record. Which of the following medications may have contributed to the development of his manic state?

a. Elavil (amitriptyline) 50 mg PO daily at bedtime
b. Prednisone 20 mg PO daily
c. BuSpar (buspirone) 5 mg PO TID
d. Neurotonin (gabapentin)- 300 mg PO TID
b. Prednisone.
Rationale: The use of steroids can initiate a manic state in a bipolar client even if well controlled on medications. The other medications would decrease the client's depression, mood swings, and anxiety, making him calmer rather than more agitated.
5) Which of the following therapeutic classes of drugs is used to treat tachycardia and angina in a client with pheochromocytoma?

a. Angiotensin- converting enzymes (ACE inhibitors)
b. Calcium channel blockers
c. Beta blockers
d. Diuretics
c. Beta blockers-
Rationale: A beta blocker is administered to block the cardiac-stimulating effects of epinephrine. ACE inhibitors and calcium channel blockers do not block sympathetic activity like beta blockers do and diuretics decrease fluid volume and peripheral resistance, not sympathetic activity.
The nurse administers theophylline (Theo-Dur) to a client. To evaluate the effectiveness of this medication, which of the following drug actions should the nurse anticipate?

A. Suppression of the client's respiratory infection
B. Decrease in bronchial secretions
C. Relaxation of bronchial smooth muscle
D. Thinning of tenacious, purulent sputum
C. Relaxation of bronchial smooth muscle.

Rationale: Theophylline (Theo-Dur) is a bronchodilator that is administered to relax the airways and decrease dyspnea in patients with COPD. It is not used to treat infections and does not have an effect on secretions.
Bethanechol (Urecholine) has been ordered for a client with gastroesophageal reflux disease (GERD). The nurse should assess the client for which of the following adverse effects.

A. Constipation
B. Urinary urgency
C. Hypertension
D. Dry oral mucosa
B. Urinary urgency

Rationale: Bethanecol (Urecholine), a cholinergic drug, may be used in GERD to increase lower esophageal sphincter pressure and facilitate gastric emptying. Cholinergic adverse effects may include urinary urgency, diarrhea, abdominal cramping, hypotension, and increased salivation.
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