Test 1
1. The nurse is educating a client who will be discharged home with a prescription for an enteric-coated tablet. Which statement made by the client indicates understanding of the teaching?
a. “I may crush the tablet and put it in applesauce to improve absorption.”
b. “I should consume acidic foods to enhance absorption of this medication.”
c. “I should expect a delay in onset of the drug’s effects after taking the tablet.”
d. “I should take this medication with high-fat foods to improve its action.”
The nurse is caring for a client experiencing acute toxicity from an overdose of acetaminophen. The nurse should prepare to administer which medication to the client?
a. Flumazenil
b. Acetylcysteine
c. Atropine
d. Vitamin K
b. Acetylcysteine is the antidote for acetaminophen. It converts the toxic metabolite to a nontoxic form. Flumazenil is the antidote for benzodiazepine receptor agonists. Atropine is the antidote for muscarinic poisoning. Vitamin K is the antidote for warfarin overdose. 297
A client complains of a dry, nagging cough for several days. Which medication would best treat this symptom?
a. Nasal decongestant
b. Expectorant
c. Antitussive
d. Mucolytic
c. An antitussive works on the cough-control center in the brain to suppress the cough reflex. These medications are useful for treating a dry/nagging cough. Expectorants and mucolytics are useful for a productive cough with secretions. A nasal decongestant is useful for nasal congestion/runny nose.
A client is taking metformin daily. Which should the nurse monitor to evaluate the effectiveness of this medication?
a. Blood glucose
b. BUN and Creatinine
c. Urine specific gravity
d. T3, T4, and TSH
a. Metformin is an oral antidiabetic agent. The nurse should monitor the client’s blood sugar to evaluate the effectiveness of the medication.
Convert 25.5 mg to g.
0.0255 g
3. When the nurse administers a drug to a client, the nurse explains it will take about 3 hours for the drug to reach its highest concentration in the bloodstream. What is the nurse referring to?
a. Onset of the drug
b. Drug’s peak
c. Duration of action
d. Steady state
B. A drug’s peak occurs when it reaches its highest concentration in the blood.
The nurse is administering methylphenidate to a client eating breakfast. Which item on the client’s tray should cause the nurse to be concerned?
a. Coffee
b. Milk
c. Protein shake
d. Orange juice
a. Food interactions related to methylphenidate include caffeine, chocolate, tea, and cola.
The nurse is preparing to administer digoxin to a client. The client reports nausea, vomiting, and visual halos around objects. The nurse notes a respiratory rate of 18 breaths per minute, a heart rate of 52 beats per minute, and a blood pressure of 120/78 mm Hg. What should the nurse do next?
a. Reassure the client that these are common side effects.
b. Administer the next dose as ordered since these are mild side effects.
c. Hold the dose and notify the provider of possible digoxin toxicity.
d. Request an order for an antiemetic and an analgesic medication.
c. Nausea, vomiting, and headache are common signs of digoxin toxicity as is a heart rate less than 60 beats per minute. Patients will also sometimes present with visual illusions, such as colored halos around objectives. The nurse should hold the dose and notify the provider.
The nurse is reviewing morning labs of a client taking furosemide. Which lab result should prompt the nurse to hold the furosemide and contact the healthcare provider?
a. Potassium 3.2 mEq/L
b. Sodium 137 mEq/L
c. Calcium 9.2 mg/dL
d. Magnesium 2.0 mg/dL
a. Furosemide is a potassium wasting diuretic. A potassium of 3.2 is hypokalemic and should prompt the nurse to hold the furosemide and contact the healthcare provider. All other results are WNL.
Convert the following: 30 mL is equivalent to how many tbs?
2 tbs
2. A nurse prepares to administer medications to a client. The nurse asks the client their name and date of birth, and then checks the drug, dose, route, and time. What is the reason for the nurse’s actions?
a. Adequate information is provided to the client.
b. Cost-effective use of medications.
c. Informed consent for drug administration is obtained.
d. Safe administration of medications.
D. The “Six Rights” ensure that the nurse has considered all of the details of safe medication administration. The “Six Rights” include verifying: (1) the right patient; (2) the right drug; (3) the right dose; (4) the right route; (5) the right time, and (6) the right documentation
The nurse is caring for a client receiving morphine sulfate. The nurse assesses the client’s intake and output at the end of the day and notes 400 mL urine output for the entire 24 hour period. Which action should the nurse take?
a. Notify the healthcare provider immediately
b. Bladder scan the client
c. Insert an indwelling foley catheter
d. Encourage the client to increase oral intake
b. Morphine sulfate may cause urinary retention. An output of 400 ml in 24 hours is decreased. The nurse should bladder scan the client to determine if the client is retaining urine.
he nurse is caring for a client taking lisinopril. The client asks for help ordering meals. Which item ordered by the client should prompt the nurse to be concerned?
a. Chocolate cake
b. Salt substitute
c. Milk
d. Spinach
b. A client taking Lisinopril will retain potassium. Caution should be taken when using salt substitutes as many contain potassium, and may result in high potassium levels.
The nurse is caring for a client with a prescription for phenzaopyradine. Which side effect should the nurse expect related to this medication?
a. Orange colored urine
b. Urinary hesitancy
c. Incontinence
d. Ototoxicity
a. Phenzaopyradine is used to treat side effects of a urinary tract infection such as pain, burning, urgency, and frequency. It can cause a red-orange discoloration of urine/body fluids.
If the nurse starts a 100 mL IV infusion at 1423, what time will it be completed if it runs at a rate of 25 mL/hr?
1823
The nurse is preparing to administer the first dose of digoxin to a client. The first dose ordered is much higher than the ordered maintenance dose. The nurse understands which of the following to be the reason the first dose is higher?
a. Digoxin requires a loading dose.
b. Digoxin has a high potency.
c. Digoxin has a long duration of action.
d. Digoxin has a short half-life.
a. The reason the first dose is higher than the ordered maintenance dose is because a loading dose is required. This is performed to more quickly reach steady state for a drug with a long half-life. The loading dose is not given due to first-pass metabolism or duration of action.
The nurse is caring for a client who has developed Stevens-Johnson syndrome. The nurse should recognize this as an adverse effect to which medication?
a. Phenytoin
b. Acetaminophen
c. Fluphenazine
d. Methylphenidate
a. Stevens-Johnson syndrome is an adverse reaction of Phenytoin.
The nurse is caring for a client taking metoprolol. In caring for this client, which action by the nurse is a priority?
a. Implement bleeding precautions
b. Administer medication with food
c. Monitor electrolyte levels
d. Implement fall precautions
d. Metoprolol is used to treat hypertension, angina, and heart failure. This medication may cause fatigue, dizziness, drowsiness, and hypotension. The nurse should implement fall precautions.
The nurse is educating a client who has been prescribed psyllium to treat constipation. What information should the nurse include in the teaching?
a. The importance of consuming adequate amounts of water
b. The need to monitor for systemic side effects
c. The onset of action of 30 to 60 minutes after administration
d. The need to use the dry form of psyllium to prevent cramping
a. Insufficient fluid intake can cause the drug to solidify in the gastrointestinal tract and place the patient at risk for GI obstruction, thus counseling on ingestion of adequate amounts of water is important. Psyllium is not systemically absorbed, so it does not have systemic side effects. Onset of action for psyllium is between 10 and 24 hours. All forms of bulk forming laxatives can contribute to GI side effects such as cramping.
A client is to receive 500 mL of 0.45%NS IV over 3 hours. Using a 15 gtt/mL set, what gtt/min flow rate will the nurse use to administer the IV? (Round answer to nearest whole number.)
42 gtt/min
The nurse is preparing to administer a drug that is eliminated through the kidneys. The nurse reviews the client’s chart and notes that the client has increased serum creatinine and blood urea nitrogen and a low estimated glomerular filtration rate. Which action by the nurse is appropriate?
a. Administer the drug as ordered.
b. Anticipate a shorter than usual half-life of the drug.
c. Expect decreased drug effects when the drug is given.
d. Verify that the dose ordered is appropriate based on the patient’s kidney function.
d. Increased creatinine and BUN and a low eGFR indicate impaired kidney function, so a drug that is eliminated through the kidneys can accumulate leading to toxicity. The nurse should verify that the ordered dose is appropriate based on the patient’s kidney function, and if not, discuss a lower dose or alternative medication with the provider. The drug will have a longer half-life and will exhibit increased effects with decreased kidney function.
The nurse is caring for a client taking fluphenazine. Upon assessing the client, the nurse notes a shuffling gait, stooped posture, and tremors at rest. How should the nurse document these findings?
a. Pseudoparkinsonism
b. Akathisia
c. Acute dystonia
d. Tardive dyskinesia
a. Clients taking fluphenazine can experience extrapyramidal syndrome, such as pseudoparkinsonism. Clinical manifestations include stooped posture, shuffling gait, rigidity, bradykinesia, tremors at rest, and pill-rolling motion of the hand. 256
The nurse is preparing to administer an ACE inhibitor to a client being treated for hypertension. The client started the ACE inhibitor the day prior. The nurse notes peripheral edema and swelling of the client’s lips. The client’s blood pressure is 160/80 mm Hg and the heart rate is 76 beats per minute. Which action should the nurse take?
a. Hold the dose and notify the provider of a hypersensitivity reaction.
b. Request an order for serum electrolytes and renal function tests.
c. Administer the dose and observe carefully for hypotension.
d. Notify the provider and request an order for a diuretic medication.
a. The patient has signs of angioedema, which indicates a hypersensitivity reaction. The nurse should hold the dose and notify the provider. Giving the dose will make the reaction more serious. These are not signs of edema, so a diuretic is not indicated. Electrolytes and renal function tests are not indicated.
A client in the intensive care unit is found to have increased intracranial pressure. The nurse contacts the healthcare provider to request a prescription for a diuretic that will quickly reduce the cerebral edema in this client. Which diuretic should the nurse anticipate the provider to order?
a. Mannitol
b. Furosemide
c. Hydrochlorothiazide
d. Spironolactone
a. Mannitol is an osmotic diuretic used to treat increased intracranial pressure. This medication works fast and is good in emergent situations.
The nurse is working the 2300 to 0700 shift. During this time, a client voided twice, 300 mL and 450 mL, and drank half of his 900 mL water pitcher plus a 12 oz soft drink. There was 50 mL drainage from the jackson pratt drain during the night. Calculate the client’s total I & O for this shift. Is there a surplus or deficit? How much?
intake: 810
output: 800
surplus
10