Medical-Surgical Drugs

Question 1

A client is scheduled to have a thyroidectomy. Which medication does the nurse anticipate the health care provider will prescribe to decrease the size and vascularity of the thyroid gland before surgery?

1 Vasopressin

2 Levothyroxine

3 Propylthiouracil

4 Potassium iodide

Answer 1

Correct 4 Potassium iodide

Potassium iodide adds iodine to the body fluids, exerting negative feedback on the thyroid tissue and decreasing its metabolism and vascularity. Vasopressin is a pituitary hormone. Propylthiouracil interferes with production of thyroid hormone, but causes increased vascularity and size of the thyroid. Levothyroxine is a thyroid hormone that may be administered after a thyroidectomy if the client develops hypothyroidism.

Question 2

The healthcare provider orders intravenous fluids to be infused at 100 mL/hour. The intravenous tubing delivers 15 drops/milliliters. The nurse would infuse the solution at a flow rate of how many drops per minute to ensure that the client receives 100 mL/hour? Record your answer using a whole number. _____ drops/min

Answer 2

The prescribed rate of infusion is 100 ml/hr. The drop factor of the tubing is 15 drops/mL. Use the following formula to determine the flow rate in drops/min.

Question 3

A client has increased intracranial pressure resulting from a traumatic brain injury. Assessment findings indicate that the client is unconscious with vital signs of pulse 60 beats/min, respirations 16 breaths/min, and blood pressure 142/64 mm Hg. The nurse reviews the treatment plan and questions which prescription?

1 Mannitol

2 Dexamethasone

3 Chlorpromazine

4 Morphine

Answer 3

Correct 4 Morphine

Morphine injection is contraindicated for an unconscious, neurologically impaired client because it depresses respirations. Mannitol, an osmotic diuretic, is used to reduce increased intracranial pressure. Dexamethasone, a corticosteroid antiinflammatory agent, is used to help reduce increased intracranial pressure. Chlorpromazine, an antipsychotic/neuroleptic/antiemetic, can be given safely to a neurologically impaired client for restlessness.

Question 4

A client with malabsorption syndrome is admitted to the hospital for medical intervention. A subclavian catheter is inserted, and the client is started on total parenteral nutrition (TPN). What should the nurse teach the client in order to prevent the most common complication of TPN?

1 Avoid disturbing the dressing or getting it wet.

2 Keep the head as still as possible whenever moving.

3 Regulate the flow rate on the infusion pump as necessary.

4 Monitor daily weights at the same time while wearing the same clothing.

Answer 4

Correct 1 Avoid disturbing the dressing or getting it wet.

Disturbing the dressing may expose the area to pathogens. Infection is the most common complication; sterile technique at the catheter insertion site must be maintained. Keeping the head still is not necessary; the catheter is sutured in place, and reasonable movement is permitted. The client should be taught to leave the infusion pump set at the rate prescribed by the healthcare provider and to call the nurse if the alarm rings. Excessive weight gain or loss is not a complication of total parenteral nutrition.

Question 5

A client with arthritis increases the dose of ibuprofen to abate joint discomfort. After several weeks the client becomes increasingly weak. The client is admitted to the hospital and is diagnosed with severe anemia. What findings does the nurse expect to identify when performing an admission assessment? Select all that apply.

1 Melena

Correct2 Tachycardia

3 Constipation

4 Clay-colored stools

5 Painful bowel movements

Answer 5

Correct 1 Melena

Ibuprofen irritates the gastrointestinal (GI) mucosa and can cause mucosal erosion, resulting in bleeding; blood in the stool (melena) occurs as the digestive process acts on the blood in the upper GI tract. Hemoglobin, which carries oxygen to body cells, is decreased with anemia; the heart rate increases as a compensatory response to increase oxygen to body cells. Constipation usually is related to immobility, a low-fiber diet, and inadequate fluid intake, not the data listed in this situation. Clay-colored stools are related to biliary problems, not GI bleeding. Painful bowel movements are related to hemorrhoids, not GI bleeding.

Question 6

A client with heart failure is receiving digoxin and hydrochlorothiazide. The nurse will assess for which signs and symptoms that indicate digoxin toxicity? Select all that apply.

1 Nausea

2 Yellow vision

3 Irregular pulse

4 Increased urine output

5 Heart rate of 64 beats per minute

Answer 6

Correct 1 Nausea

Correct 2 Yellow vision

Correct 3 Irregular pulse

Signs and symptoms of digoxin toxicity include bradycardia, headache, dizziness, confusion, nausea, and visual disturbances (blurred vision or yellow vision). In addition, ECG findings may include heart block, atrial tachycardia with block, or ventricular dysrhythmias, all causing an irregular pulse. Increased urine output is an expected effect of the diuretic furosemide; a pulse rate of 64 beats per minute is an acceptable rate when a client is receiving digoxin.

Question 7

Prednisone, an adrenal steroid, is prescribed for a client with an exacerbation of colitis. When administering the first dose of the medication, what information does the nurse provide to the client?

1 Prednisone protects the client from getting an infection.

2 The medication may cause weight loss by decreasing appetite.

3 Prednisone is not curative, but does cause a suppression of the inflammatory process.

4 The medication is relatively slow in precipitating a response, but is effective in reducing symptoms.

Answer 7

Correct 3 Prednisone is not curative, but does cause a suppression of the inflammatory process.

Prednisone inhibits phagocytosis and suppresses other clinical phenomena of inflammation; this is a symptomatic treatment that is not curative. Prednisone suppresses the immune response, which increases the potential for infection. The appetite is increased with prednisone; weight gain may result from the increased appetite or from fluid retention. Generally the response to prednisone is rapid.

Question 8

A client is to receive metoclopramide intravenously 30 minutes before initiating chemotherapy for cancer of the colon. The nurse explains that metoclopramide is given for what purpose?

1 Stimulate production of gastrointestinal secretions

2 Enhance relaxation of the upper gastrointestinal tract

3 Prolong excretion of the chemotherapeutic medication

4 Increase absorption of the chemotherapeutic medication

Answer 8

Correct 2 Enhance relaxation of the upper gastrointestinal tract

The relaxation effect increases the passage of food through the gastrointestinal tract, limiting reverse peristalsis, gastroesophageal reflux, and vomiting, all of which are precipitated by chemotherapeutic agents. Metoclopramide does not stimulate the production of gastrointestinal secretions. Metoclopramide has no effect on the excretion of chemotherapeutic medications. Metoclopramide has no effect on the absorption of chemotherapeutic medications.

Question 9

A client with type 1 diabetes receives 30 units of NPH insulin at 7 am. At 3:30 pm the client becomes diaphoretic, weak, and pale. What does the nurse determine that these physiologic responses are associated with?

1 Diabetic coma

2 Somogyi effect

3 Diabetic ketoacidosis

4 Hypoglycemic reaction

Answer 9

Correct 4 Hypoglycemic reaction

These are sympathetic nervous system responses to hypoglycemia; the peak action of NPH insulin is 8 to 12 hours after administration, and 8.5 hours have elapsed since it was given. The signs and symptoms of diabetic coma are dry mucous membranes; hot, flushed skin; deep, rapid respirations (Kussmaul breathing); acetone odor to the breath; nausea and vomiting; and, as with hypoglycemia, weakness. The Somogyi effect includes wide swings in blood glucose levels between hyperglycemia and a profound hypoglycemia caused by insulin rebound. Ketoacidosis results from excess use of fats for energy when carbohydrates cannot be used. Lipids are metabolized incompletely, and dehydration, acidosis (both ketotic and lactic), and electrolyte imbalance result. It is not the result of insulin administration.

Question 10

A client who takes daily megadoses of vitamins is hospitalized with joint pain, loss of hair, yellow pigmentation of the skin, and an enlarged liver due to vitamin toxicity. What type of toxicity does the nurse suspect?

1 Retinol (vitamin A)

2 Thiamine (vitamin B1)

3 Pyridoxine (vitamin B6)

4 Ascorbic acid (vitamin C)

Answer 10

Correct 1 Retinol (vitamin A)

These adaptations, as well as anemia, irritability, pruritus, and an enlarged spleen, occur with vitamin A toxicity. Excess thiamine is excreted in the urine and rarely, if ever, causes toxicity; an excessive dose may elicit an allergic reaction in some individuals. Excess vitamin C (ascorbic acid) does not cause these adaptations or toxicity; however, vitamin C may cause diarrhea or renal calculi. Pyridoxine (vitamin B6) is relatively nontoxic, and excess amounts are excreted in the urine.

Question 11

A nurse is preparing to teach a client to apply a nitroglycerin patch as prophylaxis for angina. Which instruction should the nurse include in the teaching plan?

1 Apply the patch on a distal extremity.

2 Remove a previous patch before applying the next one.

3 Massage the area gently after applying the patch to the skin.

4 Apply a warm compress to the site before attaching the patch.

Answer 11

Correct 2 Remove a previous patch before applying the next one.

Removing the previous patch before applying the next patch ensures that the client receives just the prescribed dose. Ideally, a patch should be removed after 12 to 14 hours to avoid the development of tolerance. The patch should be rotated among hair-free and scar-free sites; acceptable sites include chest, upper abdomen, proximal anterior thigh, or upper arm. The patch should be gently pressed against the skin to ensure adherence; it should not be massaged. Applying a warm compress to the site before attaching the patch is unnecessary and can result in an excessive absorption of the medication.

Question 12

A client newly diagnosed with myasthenia gravis is to begin taking pyridostigmine, a cholinesterase inhibitor. Two days later the client develops loose stools and increased salivation. What conclusion does the nurse make about these new developments?

1 Indicative of a myasthenic crisis

2 Cholinergic effects

3 A temporary response

4 Toxic effects of the medication

Answer 12

Correct 2 Cholinergic effects

Because this drug inhibits the destruction of acetylcholine, parasympathetic activity may be increased. The signs do not indicate a myasthenic crisis. Myasthenic crisis is characterized by difficulty breathing or speaking, morning headaches, feeling tired during the daytime, waking up frequently at night, not sleeping well, weak cough with increased secretions (mucus or saliva), an inability to clear secretions, a weak tongue, trouble swallowing or chewing, and weight loss. Side effects are not temporary; they continue as long as the drug is continued. The dosage may be adjusted or an anticholinergic given to limit side effects. Toxicity or cholinergic crisis is manifested by increased muscle weakness, including muscles of respiration.

Question 13

While receiving a blood transfusion, a client develops acute dyspnea, generalized urticaria, a heart rate of 128, and a blood pressure of 70/38. What type of reaction does the nurse conclude that the client probably is experiencing?

1 Panic

2 Pyrogenic

3 Hemolytic

4 Anaphylactic

Anaphylactic reactions result from hypersensitivity to a product in the blood. Signs and symptoms are due to bronchospasm, systemic vasodilation, and compensatory tachycardia. The client may go into life-threatening shock without prompt treatment. Panic reactions (also known as panic attacks) involve high levels of anxiety and may be coupled with autonomic symptoms such as tachycardia. Bacterial pyrogens are present in contaminated blood and can cause a febrile transfusion reaction; signs include fever and chills. Hemolytic reaction results from the incompatibility of a recipient’s antibodies with transfused red blood cells (RBCs); the reactions result from RBC hemolysis, agglutination, and capillary plugging.

Answer 13

Correct 4 Anaphylactic

Anaphylactic reactions result from hypersensitivity to a product in the blood. Signs and symptoms are due to bronchospasm, systemic vasodilation, and compensatory tachycardia. The client may go into life-threatening shock without prompt treatment. Panic reactions (also known as panic attacks) involve high levels of anxiety and may be coupled with autonomic symptoms such as tachycardia. Bacterial pyrogens are present in contaminated blood and can cause a febrile transfusion reaction; signs include fever and chills. Hemolytic reaction results from the incompatibility of a recipient’s antibodies with transfused red blood cells (RBCs); the reactions result from RBC hemolysis, agglutination, and capillary plugging.

Question 14

A client is diagnosed with Crohn disease, and parenteral vitamins are prescribed. The client asks why the vitamins have to be given intravenously (IV) rather than by mouth. What rationales for this route should the nurse include in a response to the question? Select all that apply.

1 More rapid action results.

2 They decrease colon irritability.

3 Oral vitamins are less effective.

4 Intestinal absorption may be inadequate.

5 Allergic responses are less likely to occur.

Absorption through the gastrointestinal (GI) tract is impaired, and parenteral administration goes directly into the intravascular compartment. Disease of the GI tract hampers absorption. Because the mucosa of the intestinal tract is damaged, its ability to absorb vitamins taken orally is greatly impaired. IV vitamins do not decrease colonic irritability. Route of administration does not affect allergic response.

Answer 14

Correct 1 More rapid action results..

Correct 3 Oral vitamins are less effective.

Correct 4 Intestinal absorption may be inadequate.

Absorption through the gastrointestinal (GI) tract is impaired, and parenteral administration goes directly into the intravascular compartment. Disease of the GI tract hampers absorption. Because the mucosa of the intestinal tract is damaged, its ability to absorb vitamins taken orally is greatly impaired. IV vitamins do not decrease colonic irritability. Route of administration does not affect allergic response.

Question 15

Which instructions should the nurse include in the teaching plan for a client who will be taking simvastatin when discharged? Select all that apply.

1 Increase dietary intake of potassium.

2 Avoid prolonged exposure to the sun.

3 Schedule regular ophthalmic examinations.

4 Take the medication at least half an hour before meals.

5 Contact your healthcare provider if skin becomes gray-bronze.

Answer 15

Correct 2 Avoid prolonged exposure to the sun.

Correct 3 Schedule regular ophthalmic examinations.

Correct 5 Contact your healthcare provider if skin becomes gray-bronze.

Simvastatin increases photosensitivity; the client should avoid sun exposure and use sunblock. The client should be monitored for the adverse effects of glaucoma and cataracts. Gray-bronze skin and unexplained muscle pain are signs of rhabdomyolysis. Rhabdomyolysis, a life-threatening response, is the disintegration of muscle associated with myoglobin in the urine. Simvastatin does not affect levels of potassium. The medication is most effective when taken at bedtime because cholesterol synthesis is highest at night.

Question 16

Nitrofurantoin 0.1 g is prescribed for a client with a urinary tract infection. Each tablet contains 50 mg. How many tablets will the nurse administer? Record your answer using a whole number. ___

Answer 16

The prescribed dose is 0.1 g. The available medication are 50 mg tablets. Use the dimensional analysis and/or ratio and proportion methods to determine how many tablets the nurse should administer. For the ratio and proportion method, convert the prescribed dose units to the available dose units.

Question 17

A client with Addison disease is receiving cortisone therapy. What complications does the nurse expect if the client abruptly stops the medication? Select all that apply.

1 Diplopia

2 Dysphagia

Correct3 Tachypnea

4 Bradycardia

5 Hypotension

Answer 17

Correct 5 Hypotension

Tachypnea occurs with addisonian crisis because inadequate circulating corticosteroids cause hypotension, pallor, weakness, tachycardia, and tachypnea. Double vision does not occur with addisonian crisis. Difficulty swallowing does not occur with addisonian crisis. Tachycardia, not bradycardia, occurs with addisonian crisis.

Question 18

A nurse identifies signs of electrolyte depletion in a client with heart failure who is receiving bumetanide and digoxin. What does the nurse determine is the cause of the depletion?

1 Diuretic therapy

2 Sodium restriction

3 Continuous dyspnea

4 Inadequate oral intake

Answer 18

Correct 1 Diuretic therapy

Diuretic therapy that affects the loop of Henle generally involves the use of drugs (e.g., bumetanide) that directly or indirectly increase urinary sodium, chloride, and potassium excretion. Sodium restriction does not necessarily accompany administration of bumetanide. Dyspnea does not directly result in a depletion of electrolytes. Unless otherwise prescribed, oral intake is unaffected.

Question 19

The healthcare provider prescribes cisplatin for a client with metastatic cancer. What will the nurse do to prevent toxic effects?

1 Ask the client’s healthcare provider about prescribing leucovorin.

2 Encourage regular vigorous oral care.

3 Increase hydration to promote diuresis.

4 Assist the client in selecting foods appropriate for a high-protein, low-residue diet.

Answer 19

Correct 3 Increase hydration to promote diuresis.

Cisplatin is nephrotoxic and can cause kidney damage unless the client is adequately hydrated to flush the kidneys. Leucovorin, a form of folic acid, is used to combat toxic effects of methotrexate; cisplatin does not interfere with folic acid metabolism. Gentle, not vigorous, oral care is needed to cleanse the mouth without further aggravating the expected stomatitis. A low-residue diet is unnecessary. Prolonged gastrointestinal irritation is not the major concern; nausea and vomiting last about 24 hours, and although diarrhea may occur and last longer, it is not the primary concern.

Question 20

After receiving streptomycin sulfate for 2 weeks as part of the medical regimen for tuberculosis, the client states, “I feel dizzy and I can’t hear as well as usual.” The nurse withholds the drug and promptly reports the problem to the healthcare provider. Which part of the body does the nurse determine is being affected as indicated by the symptom reported by the client?

1 Pyramidal tracts

2 Cerebellar tissue

3 Peripheral motor end-plates

4 Eighth cranial nerve’s vestibular branch

Answer 20

Correct 4 Eighth cranial nerve’s vestibular branch

Streptomycin sulfate is ototoxic and may cause damage to auditory and vestibular portions of the eighth cranial nerve. Pyramidal tracts, cerebellar tissue, and peripheral motor end-plates are not affected by streptomycin.

Question 21

The postoperative prescriptions for a client who had repair of an inguinal hernia include docusate sodium daily. Before discharge, the nurse instructs the client about what potential side effect?

1 Rectal bleeding

2 Fecal impaction

3 Nausea and vomiting

4 Mild abdominal cramping

Answer 21

Correct 4 Mild abdominal cramping

Mild abdominal cramping is the only side effect of docusate sodium; this emollient laxative permits water and fatty substances to penetrate and mix with fecal material. Rectal bleeding is more likely to occur with a saline-osmotic laxative. Docusate sodium promotes defecation, not constipation. Nausea and vomiting are more likely to occur with a saline-osmotic laxative.

Question 22

The nurse provides discharge teaching to a client with tuberculosis. Which treatment measure does the nurse reinforce as the highest priority?

1 Getting sufficient rest

2 Getting plenty of fresh air

3 Changing the current lifestyle

4 Consistently taking prescribed medication.

Answer 22

Correct 4 Consistently taking prescribed medication

Tubercle bacilli are particularly resistant to treatment and can remain dormant for prolonged periods; medication must be taken consistently as prescribed. Although getting sufficient rest, getting plenty of fresh air, and changing the current lifestyle are important, the microorganisms must be eliminated with medication.

Question 23

A nurse concludes that a client has a hypoglycemic reaction to insulin. Which clinical findings support this conclusion? Select all that apply.

1 Irritability

2 Glycosuria

3 Dry, hot skin

4 Heart palpitations

5 Fruity odor of breath

Answer 23

Correct 1 Irritability

Correct 4 Heart palpitations

Irritability, a neuroglycopenic symptom, occurs when the glucose in the brain declines to a low level. Heart palpitations, a neurogenic symptom, occur when the sympathetic nervous system responds to a rapid decline in blood glucose. Because the blood glucose level is decreased, the renal threshold is not exceeded, and there is no glycosuria. Dry, hot skin is consistent with dehydration, which often is associated with hyperglycemic states. Fruity odor of the breath is associated with hyperglycemia; it is caused by the breakdown of fats as a result of inadequate insulin supply.

Question 24

24. A client with a respiratory infection will be receiving ampicillin 250 mg per percutaneous endoscopic gastrostomy tube every 6 hours. The reconstituted medication suspension contains 125 mg per 5 mL. Which medication cup contains the correct amount of medication for the ordered dose?

Answer 24

Set up the problem and solve. Using the ratio and proportion method:

125 mg : 5 mL = 250 mg : x mL (125)(x) = (5)(250); 125 x = 1250; divide both sides by 125. x = 1250/125 = 10 mL.

Choose the medication cup that is shaded to the 10-mL mark.

Question 25

A nurse adds 20 mEq of potassium chloride to the intravenous solution of a client with diabetic ketoacidosis. What is the primary purpose for administering this drug? 1 Treat hyperpnea 2 Prevent flaccid paralysis Correct3 Replace excessive losses 4 Treat cardiac dysrhythmias A nurse adds 20 mEq of potassium chloride to the intravenous solution of a client with diabetic ketoacidosis. What is the primary purpose for administering this drug? 1 Treat hyperpnea 2 Prevent flaccid paralysis 3 Replace excessive losses 4 Treat cardiac dysrhythmias

Answer 25

Correct 3 Replace excessive losses Once treatment with insulin for diabetic ketoacidosis is begun, potassium ions reenter the cell, causing hypokalemia; therefore potassium, along with the replacement fluids, is needed. Potassium will not correct hyperpnea. Flaccid paralysis does not occur in diabetic ketoacidosis. Considering the relationship between insulin and potassium, treatment with potassium is prophylactic, preventing the development of dysrhythmias.

Question 26

A client with type 2 diabetes is admitted for elective surgery. The health care provider prescribes regular insulin even though oral antidiabetics were adequate before the client's hospitalization. What information does the nurse include when teaching the client about the addition of insulin? 1 "You will need a higher serum glucose level while on bed rest." 2 "The stress of surgery may cause uncontrollable periods of hypoglycemia." 3 "With insulin, dosage can be adjusted to your changing needs during recovery from surgery." 4 "The possibility of surgical complications is greater when a client takes oral hypoglycemics."

Answer 26

Correct 3 "With insulin, dosage can be adjusted to your changing needs during recovery from surgery." There is better control of blood glucose levels with short-acting (regular) insulin. The level of glucose must be maintained as close to normal as possible. The occurrence of acidosis is greater when the client is receiving exogenous insulin. The stress of surgery will precipitate hyperglycemia, which is best controlled with exogenous insulin.

Question 27

27. A client with terminal cancer is to receive 4 mg of hydromorphone intravenously (IV) every 4 hours as needed for severe breakthrough pain. It is supplied at 10 mg/mL. When the client complains of severe pain, how much solution of hydromorphone should the nurse administer? Record your answer using one decimal place and leading zero if applicable. ___ mL

Answer 27

The prescribed dose is 4 mg. The available concentration is 10 mg/mL. Use the dimensional analysis and/or ratio and proportion methods to determine how many milliliters the nurse should administer.

Question 28

The healthcare provider has prescribed enoxaparin 1 mg/kg for a client who had a total knee replacement. The client weighs 187 pounds (85 kg). This medication is available in a concentration of 30 mg/0.3 mL. What dose will the nurse administer in milliliters? 1 0.8 mL 2 0.85 mL 3 0.9 mL 4 0.95 mL

Answer 28

Correct2 0.85 mL The answer is calculated as follows: 1 kg = 2.2 lb (187 divided by 2.2 = 85 kg) 85 mg × 0.3 mL = 25.5 mg/mL25.5 mg divided by 30 = 0.85 mL

Question 29

Neomycin 1 gram is prescribed preoperatively for a client with cancer of the colon. The client asks why this is necessary. How should the nurse respond? 1 "It is used to prevent you from getting a bladder infection before surgery." 2 "It will decrease your kidney function and lessen urine production during surgery." 3 "It will kill the bacteria in your bowel and decrease the risk for infection after surgery." 4 "It is used to alter the body flora, which reduces spread of the tumor to adjacent organs." Neomycin provides preoperative intestinal antisepsis. It

Answer 29

Correct 3 "It will kill the bacteria in your bowel and decrease the risk for infection after surgery." 4 "It is used to alter the body flora, which reduces spread of the tumor to adjacent organs." Neomycin provides preoperative intestinal antisepsis. It is not administered to prevent bladder infection. Nephrotoxicity is an adverse, not a therapeutic, effect. Neomycin will not prevent metastasis of the tumor to other areas.

Question 30

A client who is receiving phenytoin to control a seizure disorder questions the nurse regarding this medication after discharge. How will the nurse respond? 1 "Antiseizure drugs will probably be continued for life." 2 "Phenytoin prevents any further occurrence of seizures." 3 "This drug needs to be taken during periods of emotional stress." 4 "Your antiseizure drug usually can be stopped after a year's absence of seizures."

Answer 30

Correct 1 "Antiseizure drugs will probably be continued for life." Seizure disorders usually are associated with marked changes in the electrical activity of the cerebral cortex, requiring prolonged or lifelong therapy. Seizures may occur despite drug therapy; the dosage may need to be adjusted. A therapeutic blood level must be maintained through consistent administration of the drug irrespective of emotional stress. Absence of seizures will probably result from medication effectiveness rather than from correction of the pathophysiologic condition.

Question 31

A client has been admitted with severe edema and hypertension. Intravenous furosemide has been prescribed. Which subjective clinical manifestations lead the nurse to suspect that the furosemide is infusing too rapidly? Select all that apply. 1 Hunger 2 Tinnitus Correct3 Weakness 4 Leg cramps 5 Excess salivation

Answer 31

Correct 2 Tinnitus Correct3 Weakness Correct 4 Leg cramps Tinnitus is a central nervous system side effect of furosemide. Weakness and leg cramps result from hypokalemia caused by an overload of furosemide. Nausea and anorexia, not hunger, are side effects of dehydration that may occur with an overload of furosemide. Dry mouth, not salivation, results from dehydration caused by an overload of furosemide.

Question 32

A client with hypertensive heart disease, who had an acute episode of heart failure, is to be discharged on a regimen of metoprolol and digoxin. What outcome does the nurse anticipate when metoprolol is administered with digoxin? 1 Headaches 2 Bradycardia 3 Hypertension 4 Junctional tachycardia

Answer 32

Correct 2 Bradycardia Metoprolol and digoxin both exert a negative chronotropic effect, resulting in a decreased heart rate. Metoprolol reduces, not produces, headaches. These drugs may cause hypotension, not hypertension. These drugs may depress nodal conduction; therefore, junctional tachycardia would be less likely to occur.

Question 33

A client has surgery for the insertion of an implanted infusion port for chemotherapy. The client asks, "The doctor said after my chemotherapy is finished, the port will stay in, but it needs to be flushed routinely. How often does this have to be done?" What should the nurse tell the client about how often the port will most likely need to be flushed when not in use? 1 Every day 2 Once a week 3 Every month 4 Twice a year

Answer 33

Correct 3 Every month Once-a-month flushes usually are adequate to keep an implanted infusion port from clotting. Every day or once a week is unnecessary. Twice a year may jeopardize the viability of the port.

Question 34

A client with cancer develops pancytopenia during the course of chemotherapy. The client asks the nurse why this has occurred. What explanation will the nurse provide? 1 Steroid hormones have a depressant effect on the spleen and bone marrow. 2 Lymph node activity is depressed by radiation therapy used before chemotherapy. 3 Noncancerous cells also are susceptible to the effects of chemotherapeutic drugs. 4 Dehydration caused by nausea, vomiting, and diarrhea results in hemoconcentration.

Answer 34

Correct 3 Noncancerous cells also are susceptible to the effects of chemotherapeutic drugs. Chemotherapy destroys erythrocytes, white blood cells, and platelets indiscriminately along with the neoplastic cells because these are all rapidly dividing cells that are vulnerable to the effects of chemotherapy. Stating that steroid hormones have a depressant effect on the spleen and bone marrow is not a true description of the side effects of steroids. Depressed lymph node activity as a result of radiation therapy used before chemotherapy is not the cause for fewer erythrocytes, white blood cells, and platelets. Although it is true that dehydration caused by nausea, vomiting, and diarrhea results in hemoconcentration, this does not explain pancytopenia.

Question 35

A client who is receiving chemotherapy for lung cancer has nausea and vomiting because of the therapy. The client wants to know if it is true that smoking marijuana will help. What is the nurse's best response? 1 "Smoking marijuana is not legal in any state." 2 "Marijuana is effective for nausea and vomiting if it is injected." 3 "Marijuana is not proven to be effective in preventing chemotherapy-induced nausea and vomiting." 4 "Tetrahydrocannabinol is an ingredient in marijuana that decreases nausea and vomiting in some people."

Answer 35

Correct 4 "Tetrahydrocannabinol is an ingredient in marijuana that decreases nausea and vomiting in some people." Tetrahydrocannabinol, an ingredient in marijuana, acts as an antiemetic in some persons and can be absorbed through the gastrointestinal tract or inhaled. The statement "Smoking marijuana is not legal in any state" does not answer the client's question and is inaccurate. Marijuana is not injected. Tetrahydrocannabinol, an ingredient in marijuana, is an effective antiemetic for some clients.

Question 36

A healthcare provider prescribes tissue plasminogen activator (t-PA) to be administered intravenously over 1 hour for a client experiencing a myocardial infarction. What is the nurse’s priority assessment that is specific to this medication’s effect? 1 Respiratory rate 2 Peripheral pulses 3 Level of consciousness 4 Intravenous insertion site

Answer 36

Correct 4 Intravenous insertion site The most common adverse effect of a tissue plasminogen activator is bleeding because of the thrombolytic action of the drug. Sites of invasive procedures, such as IV sites, have an increased tendency to bleed. Although respiratory rate, peripheral pulses, and level of consciousness are important for any client with a decreased cardiac output, they are not specific to the administration of a tissue plasminogen activator.

Question 37

Valsartan, an angiotensin II receptor antagonist, is prescribed for a client. For which possible side effects should the nurse monitor the client? Select all that apply. 1 Constipation 2 Hypokalemia 3 Irregular pulse rate 4 Change in visual acuity 5 Orthostatic hypotension

Answer 37

Correct 3 Irregular pulse rate Correct 5 Orthostatic hypotension Dysrhythmias, including second-degree heart block, are cardiovascular side effects of valsartan. It also may precipitate angina pectoris, myocardial infarction, and brain attack (cerebrovascular accident, CVA). Angiotensin II receptor antagonists, such as valsartan, block vasoconstrictor and aldosterone-producing effects of angiotensin II at receptor sites, including vascular smooth muscle, thus reducing the blood pressure; dizziness, orthostatic hypotension, and excessive hypotension may occur. Diarrhea, not constipation, may occur with valsartan. Hyperkalemia, not hypokalemia, may occur with valsartan. Valsartan does not cause altered visual acuity.

Question 38

The nurse is caring for a client who is scheduled for an electrophysiology study (EPS) because of persistent ventricular tachycardia. Before the procedure the client is to receive a beta-blocker. What client's response during the procedure best indicates that the beta-blocker is working effectively? 1 Decreased anxiety 2 Reduced chest pain 3 Decreased heart rate 4 Increased blood pressure

Answer 38

Correct 3 Decreased heart rate A decreased heart rate or sinus bradycardia is the expected response to a beta-blocker. Beta-blockers inhibit the activity of the sympathetic nervous system and of adrenergic hormones, decreasing the heart rate, conduction velocity, and workload of the heart. A beta-blocker is not an anxiolytic and does not reduce anxiety. A beta-blocker is not an analgesic and does not reduce chest pain. Beta-blockers reduce blood pressure.

Question 39

A blood donor whose blood type is O negative is known as a "universal donor." What does the nurse consider about O negative blood that accounts for this classification? 1 It does not have any of the antigens that can cause a reaction. 2 The donor can donate blood more frequently than other people. 3 More people have this blood type, so it is more universally available. 4 It is more frequently administered when compared with other blood types.

Answer 39

Correct 1 It does not have any of the antigens that can cause a reaction. Type O Rh negative red blood cells will not cause an antigen-antibody reaction in people with O, A, B, AB, Rh-positive, or Rh negative blood; therefore, this type of blood can be administered "universally" to others. However, an exact match of blood type is preferred because there may be other factors in the donor's blood that can cause a reaction. People, regardless of their blood types, can donate blood approximately every 2 months. The availability of blood type does not affect the compatibility of donated blood with a recipient's blood. While it is a common blood type, this is not why people with this type are considered universal donors.

Question 40

10. A client who is postoperative hip replacement is receiving morphine by patient-controlled analgesia and has a respiratory rate of 6 breaths/min. What intervention should the nurse anticipate? 1 Nasotracheal suction 2 Mechanical ventilation 3 Naloxone administration 4 Cardiopulmonary resuscitation

Answer 40

Correct 3 Naloxone administration Naloxone is an opioid antagonist and will reverse respiratory depression caused by opioids. Nasotracheal suction, mechanical ventilation, and cardiopulmonary resuscitation are not needed; naloxone will correct the respiratory depression.

Question 41

A healthcare provider prescribes an intravenous (IV) infusion of ampicillin 375 mg every 6 hours. The drug is supplied as 500 mg of powder in a vial. The directions are to mix the powder with 1.8 mL of diluent, which yields 250 mg/mL. How much prepared solution should the nurse administer? Record your answer using one decimal place. ___ mL The prescribed dose is 375 mg. The available concentration (after reconstitution) is 250 mg/mL. Use the dimensional analysis and/or ratio and proportion methods to determine how many milliliters should be administered.

Answer 41

1.5 mL

Question 42

A nurse reviews a list of medications that have been prescribed for a client. The nurse is aware that it is unsafe to administer which medication as an intravenous (IV) bolus? 1 Saline flush 2 Potassium chloride 3 Naloxone 4 Adenosine

Answer 42

Correct 2 Potassium chloride Potassium chloride given as an IV bolus can cause cardiac arrest. It should never be administered intravenously without being diluted and infused slowly through an IV infusion pump. Saline flush, naloxone, and adenosine are appropriate to be given as an IV bolus undiluted.

Question 43

Parents of a child with sickle cell anemia ask about their child taking iron supplements to help treat the anemia. What would be the best response? 1 Taking supplements will not help with this condition. 2 It is advised that iron be taken with orange juice to aid in absorption. 3 An over-the-counter multivitamin with iron should meet the needs of the child. 4 It is advised that liquid iron supplements be given through a straw to prevent staining the teeth.

Answer 43

Correct 1 Taking supplements will not help with this condition. Taking iron supplements will not help. Sickle cell anemia is not caused by too little iron in the blood; it's caused by not having enough red blood cells. Taking iron supplements could cause harm, because the extra iron builds up in the body and can damage organs. Although iron is better absorbed when taken with orange juice, in the case of sickle cell anemia supplements are not given. Using a straw when giving liquid iron supplements does prevent staining of the teeth; however, giving iron to this child may be detrimental. A multivitamin may be beneficial for this child; however, the addition of iron could build up in the body.

Question 44

A client with a history of cirrhosis of the liver develops heart failure. When ventricular bigeminy develops, the provider orders lidocaine. What alterations in lidocaine dosages does the nurse anticipate? 1 Higher to compensate for the impaired liver function 2 Lower because the drug is metabolized at a diminished rate 3 Reduced because other organs will compensate for the sluggish liver 4 Equal to that needed for other clients to provide a loading dose for the myocardium

Answer 44

Correct 2 Lower because the drug is metabolized at a diminished rate The client has heart failure, which causes liver congestion, further compromising liver function; therefore, less than the usual adult dose will be prescribed because the liver will not be able to break down lidocaine as effectively as necessary. A dose higher to compensate for the impaired liver function increases the concentration of lidocaine in the blood, leading to toxicity. Lidocaine is metabolized by the liver; other organs cannot assist in the process. This may be life threatening because the client cannot metabolize lidocaine at the required rate, and toxicity may result.

Question 45

A client with the diagnosis of primary hypertension is started on a regimen of hydrochlorothiazide. The nurse is providing instructions regarding this medication. What information should the nurse include? 1 A common side effect is decreased sexual libido. 2 One dose should be omitted if dizziness occurs when standing up. 3 The client should adjust the dosage daily based on his blood pressure. 4 An antihypertensive medication will likely be required for the remainder of life.

Answer 45

Correct 4 An antihypertensive medication will likely be required for the remainder of life. If medication is necessary to control primary hypertension, usually it is a lifetime requirement. The client should not adjust the dosage without the healthcare provider's direction. Impotence may occur with some antihypertensive medications but not with hydrochlorothiazide. The drug should not be stopped; orthostatic hypotension can be controlled by a slow change of body position.

Question 46

The nurse is administering lactulose to a client with a history of cirrhosis of the liver. The client asks the nurse why this medication is needed because the client is not constipated. How will the nurse respond? 1 "This medication helps you to stop drinking so much alcohol." 2 "This medication helps you relax and not feel anxious." 3 "This medication helps you lower the high ammonia level caused by your liver disease." 4 "This medication helps you keep your abdomen from being so distended."

Answer 46

Correct 3 "This medication helps you lower the high ammonia level caused by your liver disease." Lactulose is a hyperosmotic laxative and ammonia detoxicant. It decreases serum ammonia concentration by preventing reabsorption of ammonia. Lactulose has been used to lower blood ammonia content in clients with portal hypertension and hepatic encephalopathy secondary to chronic liver disease. Lactulose has no effect on the craving for alcohol or anxiety and is not prescribed to reduce abdominal distension.

Question 47

A nurse is reviewing the history and physicals of several clients from the clinic who are taking rifampin for the treatment of tuberculosis. Which client presents a specific concern for the nurse? 1 45-year-old taking a loop diuretic 2 26-year-old taking oral contraceptives 3 32-year-old taking a proton pump inhibitor 4 72-year-old taking intermediate-acting insulin Rifampin increases metabolism of oral contraceptives, which may result in an unplanned pregnancy. Rifampin does not interact with a loop diuretic, a proton pump inhibitor, or intermediate-acting insulin.

Answer 47

Correct 2 26-year-old taking oral contraceptives Rifampin increases metabolism of oral contraceptives, which may result in an unplanned pregnancy. Rifampin does not interact with a loop diuretic, a proton pump inhibitor, or intermediate-acting insulin.

Question 48

Famotidine 20 mg intravenous piggyback (IVPB) is prescribed for a client with a duodenal ulcer. The medication is diluted in 50 mL of 5% dextrose and is infused over 15 minutes. At what rate should the infusion control device (ICD) be set? Record your answer using a whole number. ___ mL/hr The amount of D5W to be infused is 50 mL. The time of infusion is 15 minutes. The infusion control device requires the rate to be entered in mL/hr. Therefore, the time of infusion must be converted from minutes to hours.

Answer 48

200 mL/hr

Question 49

A client who is receiving a cardiac glycoside, a diuretic, and a vasodilator has been placed on bed rest. The client's apical pulse rate is 44 beats per minute. The nurse concludes that the decreased heart rate most likely is a result of which drug? 1 Diuretic 2 Vasodilator 3 Bed rest regimen 4 Cardiac glycoside

Answer 49

Correct 4 Cardiac glycoside A cardiac glycoside such as digoxin decreases the conduction speed within the myocardium and slows the heart rate. The primary effect of a diuretic is on the kidneys, not the heart; it may reduce the blood pressure, not the heart rate. A vasodilator can cause tachycardia, not bradycardia, which is an adverse effect. A bed rest regimen does not drastically reduce the heart rate.

Question 50

A client with acquired immunodeficiency syndrome (AIDS) is receiving a treatment protocol that includes a protease inhibitor. When assessing the client's response to this drug, which common side effect should the nurse expect? 1 Diarrhea 2 Hypoglycemia 3 Paresthesias of the extremities 4 Seeing yellow halos around lights

Answer 50

Correct 1 Diarrhea Diarrhea, nausea, and vomiting are common side effects; clients should take these medications with a meal or light snack. These drugs may cause hyperglycemia, not hypoglycemia. Circumoral (perioral), not peripheral, paresthesias may occur with protease inhibitors; peripheral paresthesias may occur with nucleoside reverse transcriptase inhibitors. Seeing yellow halos around lights does not occur with protease inhibitors; it may occur with digoxin toxicity.

Question 51

The nurse is caring for an older client who is scheduled for a bronchoscopy. Midazolam has been prescribed for the procedure. What administration guidelines will the nurse follow? 1 Increments should be smaller and rate of injection slower. 2 The medication should be given as a rapid intravenous push. 3 It is important to monitor for spikes in blood pressure elevation during administration. 4 During the procedure, the medication should be given as needed for pain management.

Answer 51

Correct 1 Increments should be smaller and rate of injection slower. In an older client, peak effect may be delayed; increments should be smaller and rate of injection slower. When used for sedation/anxiolysis/amnesia for a procedure, the dosage must be individualized and titrated. Midazolam should always be titrated slowly; administer over at least 2 minutes and allow an additional 2 or more minutes to fully evaluate the sedative effect. Titration to effect with multiple small doses is essential for safe administration. Central nervous system depression is the most serious side effect. A sudden rise in blood pressure shortly after administration has not been evidenced. Midazolam is given for sedation/anxiolysis/amnesia for a procedure.

Question 52

A client is admitted to the intensive care unit with acute pulmonary edema. Which diuretic does the nurse anticipate will be prescribed? 1 Furosemide 2 Chlorothiazide 3 Spironolactone 4 Acetazolamide

Answer 52

Correct 1 Furosemide Furosemide acts on the loop of Henle by increasing the excretion of chloride and sodium, is available for intravenous administration, and is more effective than chlorothiazide, spironolactone, and acetazolamide. Although used in the treatment of edema and hypertension, chlorothiazide is not as efficacious as furosemide. Spironolactone is a potassium-sparing diuretic; it is less efficacious than thiazide diuretics. Acetazolamide is used in the treatment of glaucoma to lower intraocular pressure.

Question 53

A client will be taking nitrofurantoin 50 mg orally every evening at home to manage recurrent urinary tract infections. What instructions should the nurse give to the client? 1 Increase the intake of fluids. 2 Strain the urine for crystals and stones. 3 Stop the drug if urinary output increases. 4 Maintain the exact time schedule for taking the drug.

Answer 53

Correct 1 Increase the intake of fluids. To prevent crystal formation, the client should have sufficient intake to produce 1000 to 1500 mL of urine daily while taking this drug. Straining urine is not indicated when the client is taking a urinary antiinfective. Urinary decrease is of concern because it may indicate renal failure. If fluids are encouraged, the client's output should increase. The drug need not be taken at a strict time daily.

Question 54

A client has been given a prescription for furosemide 40 mg every day in conjunction with digoxin. What would prompt the nurse to ask the provider about potassium supplements? 1 Digoxin causes significant potassium depletion. 2 The liver destroys potassium as digoxin is detoxified. 3 Lasix requires adequate serum potassium to promote diuresis. 4 Digoxin toxicity occurs rapidly in the presence of hypokalemia.

Answer 54

Correct 4 Digoxin toxicity occurs rapidly in the presence of hypokalemia. Furosemide promotes potassium excretion, and low potassium (hypokalemia) increases cardiac excitability. Digoxin is more likely to cause dysrhythmias when potassium is low. Digoxin does not affect potassium excretion. Furosemide causes potassium excretion. Potassium is excreted by the kidneys, not destroyed by the liver. Furosemide causes diuresis and consequent potassium loss regardless of the serum potassium level.

Question 55

A client with human immunodeficiency virus–associated Pneumocystis jiroveci pneumonia is to receive pentamidine intravenously once daily. What should the nurse do to ensure client safety? Select all that apply. 1 Monitor for decreased serum potassium levels. 2 Administer the drug over a period of 30 minutes. 3 Monitor blood pressure for hypertension during therapy. 4 Tell the client to report any evidence of bleeding immediately. 5 Assess blood glucose levels daily and several times after therapy is completed.

Answer 55

Correct4 Tell the client to report any evidence of bleeding immediately. Correct5 Assess blood glucose levels daily and several times after therapy is completed. Any signs of bleeding (e.g., bleeding gums or blood in the urine, stool, or emesis), unusual bruising, or petechiae should be reported to the healthcare provider. Pentamidine may cause hypoglycemia or hyperglycemia even after therapy has been discontinued; therefore blood glucose levels should be monitored. Pentamidine may increase, not decrease, serum potassium levels. Administering the drug over a period of 30 minutes is too quick; the drug should be given over at least 60 minutes. Clients should be monitored closely for sudden, severe hypotension; they should lie flat when receiving the drug.

Question 56

A client with urge incontinence is receiving oxybutynin 30 mg orally. Each tablet contains 5 mg. How many tablets will the nurse administer? Record your answer using a whole number. \_\_\_

Answer 56

6 tablets

Question 57

A client diagnosed with tuberculosis is taking isoniazid. To prevent a food and drug interaction, the nurse should advise the client to avoid which food? 1 Hot dogs 2 Red wine 3 Sour cream 4 Apple juice

Answer 57

Correct 2 Red wine Clients taking isoniazid should avoid foods containing tyramine such as red wine, tuna fish, and hard cheese. Hot dogs, sour cream, and apple juice do not contain tyramine and therefore are not contraindicated.

Question 58

A client is admitted to the hospital with a diagnosis of acute pancreatitis. The health care provider's prescriptions include nothing by mouth and total parenteral nutrition (TPN). The nurse explains that the TPN therapy provides what benefit? 1 Is the easiest method for administering needed nutrition 2 Is the safest method for meeting the client's nutritional requirements 3 Will satisfy the client's hunger without the discomfort associated with eating 4 Will meet the client's nutritional needs without causing the discomfort precipitated by eating

Answer 58

Correct 4 Will meet the client's nutritional needs without causing the discomfort precipitated by eating Providing nutrients by the intravenous route eliminates pancreatic stimulation, therefore reducing the pain experienced with pancreatitis. TPN is used to meet the client's needs, not the nurse's needs. TPN creates many safety risks for the client. Hunger can be experienced with TPN therapy.

Question 59

A client has an order for a sublingual nitroglycerin tablet. The nurse should teach the client to use what technique when self-administering this medication? 1 Place the pill inside the cheek and let it dissolve. 2 Place the pill under the tongue and let it dissolve. 3 Chew the pill thoroughly and then swallow it. 4 Swallow the pill with a full glass of water.

Answer 59

Correct 2 Place the pill under the tongue and let it dissolve. Sublingual medication is placed under the tongue and is quickly absorbed through the mucous membranes into blood. The buccal route requires placing medication between the cheek and gums. Chewing the pill and then swallowing it may be done for oral administration of some large size pills, but not with the sublingual route of administration. Taking the pill with water is required with the PO route of administration of medication, but not with sublingual. In addition, a full glass of water may be an excessive amount of fluid to swallow one pill.

Question 60

A client is scheduled for a bilateral adrenalectomy. Before surgery, steroids are administered to the client. What does the nurse determine is the reason for the steroids? 1 Foster accumulation of glycogen in the liver 2 Increase the inflammatory action to promote scar formation 3 Facilitate urinary excretion of salt and water following surgery 4 Compensate for sudden lack of these hormones following surgery

Answer 60

Correct 4 Compensate for sudden lack of these hormones following surgery Adrenal steroids help an individual adjust to stress. Unless received from external sources, there is no hormone available to cope with surgical stresses after an adrenalectomy. Glucose stores (glycogen) will be used by the body to adapt to surgery. Insulin is the hormone that facilitates conversion of glucose to glycogen. Steroids do not increase inflammatory reactions. Steroids will result in fluid retention, not loss.