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1. Penicillin V ( Veetids), 250mg PO every 8 hours , is prescribed for a child with a respiratory infection. The childs weight is 45 lb.

The safe pediatric dosage is 25 to 50mg/kg per day. The nurse determines that 1. The dose prescribed is too low. 2. The dose prescribes is too high. 3. The dose prescribed is within the safe dosage range. 4. There is not enough information to determine the safe dose. Answer: 3 Rationale: Convert pounds to kilograms by dividing 2.2. 2. A physician has prescribed Phenobarbital sodium (Luminal), 25 mg PO bid, for a child with febrile seizures. The medication labels reads Phenobarbital sodium, 20 mg per 5 ml. A nurse has determined that the dosage prescribed is safe for the child. The nurse prepares to administer how many milliliters per dose to the child? 1. 2 mL 2. 4.5 mL 3. 6.25 mL 4. 7 mL Answer: 3 Rationale: 3. Cloxacillin (Tegopen), 100 mg PO every 8 hours, is prescribed for a child with an elevated temperature who is suspected of having a respiratory tract infection. The child weighs 17 lb. The safe pediatric dosage is 50 mg/kg per day. The nurse determines that 1. The dose prescribed is too low. 2. The dose prescribes is too high. 3. The dose prescribed is within safe. 4. There is not enough information to determine the safe dose. Answer: 3 Rationale: Convert pounds to kilograms by dividing 2.2. 4. Sulfisoxazole (Gantrisin), 1 g PO qid is prescribed for an adolescent with urinary tract infection. The medication label reads 500-mg tablets. A nurse has determined that the dosage

prescribed is safe. The nurse administers how many tablets per dose to the adolescent? 1. 2. 1 tablet 3. 2 tablets 4. 3 tablets Answer: 3 Rationale: Change 1 g to milligrams, knowing that 1000 mg = 1 g. 5. Diphenhyramine hydrochloride (Benadryl), 25 mg PO every 6 hours, is prescribed for a child with an allergic reaction. The child weighs 25 kg. The safe pediatric dosage is 5 mg/kg per day. The nurse determines that 1. The dose prescribed is too low. 2. The dose prescribes is too high. 3. The dose prescribed is within safe. 4. There is not enough information to determine the safe dose. Answer: 3 Rationale: Dosage parameters: 5 mg/kg per day x 25 kg = 125 mg/day Dosage frequency: 25 mg x 4 doses (every 6 hours) = 100 mg/day Dose is within the safe the safe range. 6. Penicillin G (Wycillin), 1,000,000 units 1M (intramuscularly), is prescribed for a child with an infection. The medication label read 1,200,000 units per 2 mL. A nurse determined that the dose prescribed is safe. The nurse prepares to administer how many milliliters per dosew to the child? 1. 0.8 mL 2. 1.2 mL 3. 1.44 mL 4. 1.66 mL 7. Answer: 4 Rationale: 7. Morphine sulfate, 2.5 mg, IV piggyback, is prescribed for a child with cancer. The safe pediatric dose is 0.05 to 0.1 mg/kg per dose. The child weighs 50 kg. The nurse determines that

1. The dose prescribed is too low. 2. The dose prescribes is too high. 3. The dose prescribed is within safe dosage range. 4. There is not enough information to determine the safe dosage range. Answer: 3 Rationale: Dosage parameters: 0.05 mg/kg per dose x 50 kg = 2.5 mg/dose 0.1 mg/kg per dose x 50 kg = 5 mg dose Dosage is within the safe dosage range. 8. Morphine sulfate, 2.5 mg, IV piggyback, in 10 mL of normal saline is prescribed for a child postoperatively. The medication labels reads . The nurse has determined that

the dosage is safe. The nurse prepares to add how many milliliters of morphine sulfate to the 10 mL of normal saline solution? 1. 0.62 mL 2. 0.82 mL 3. 1.35 mL 4. 1.62 mL Answer: 1 Rationale: Convert grains to milligrams: 60 mg = 1 gr

9. A physicians order reads ampicillin (Omnipen), 125 mg IV every 6 hours. The medication label reads 1g and reconstitute with 7.4 mL of bacteriostatic water. A nurse prepares to draw up how many milliliters to adminster one dose? 1. 0.54 mL 2. 0.92 mL 3. 1.1 mL 4. 7.4 mL Answer: 2 Rationale: Convert 1 g to milligrams. In the metric system, to convert larger to samller, multiply by 1000 or move the decimal point three place to the right. 1g = 1000 mg

10. A pediatric client with ventricular septal defect repair is placed on a maintenance dosage of digoxin (lanoxin) elixir. The dosage is 0.07 mg/kg per day, and the clients weight is 7.2 kg. The physician orders the digoxin to be given twice daily. A nurse prepares how much digoxin to administer to the client at each dose? 1. 0.25 mg 2. 0.37 mg 3. 0.5 mg 4. 2.5 mg Answer: 1 Rationale: Calculate the dosage by weight first: 0.7 mg/day x 7.2 kg = 0.5mg/day The physician orders digoxin twice daily, therefore two doses in 24 hours will be administered. 0.50 mg/day 2 doses = 0.25 mg per dose

11. The physician has prescribed Myoflex topical cream for a client with a diagnosis of rheumatism who is complaining of muscular aches. Which of the following information does the nurse provide to the client regarding this medication? 1. Apply a heating pad to the area after applying the medication. 2. The medication acts by decreasing muscle spasms. 3. The medication is prescribed to cause the skin to peel. 4. The medication will act as a local anesthetic Answer: 4 Rationale: Myoflex is one of the many products used for the temporary relief of muscular aches, rheumatism, arthritis, sprains, and neuralgia. These products contain combinations of antiseptics, local anesthetics, analgesics, and counterirritants. 12. An outbreak of pediculosis capitus has occurred at the local school. The school nurse is providing instructions to the mothers of the children attending the school regarding the application of permethrin (Elimite, Nix). The nurse tells the mothers to 1. Apply at bedtime and rinse off in the morning. 2. Apply before washing the hair. 3. Avoid saturating the hair and scalp when applying. 4. Allow to remain on the hair 10 minutes and then rinse with water. Answer: 4

Rationale: The instructions for the use of permethrin include wash, rinse, and towel dry hair; apply sufficient volume to saturate hair and scalp; allow remaining on hair 10 minutes; and then rinsing with water. 13. A client is seen in the clinic for complaints of the skin itchiness that has been persistent over the past several weeks. Following assessment, the client has been determined to have scabies. Lindaine (Kwell) is prescribed. And the nurse provides instructions to the client regarding the use of the medication. The nurse tells the client to 1. Leave the cream on for about 8 to 12 hours and then remove by washing. 2. Apply thick layer of cream to the entire body. 3. Apply the cream for 2 days in a row 4. Apply to the entire body and scalp, excluding the face. Answer: 1 Rationale: Kwell is applied in a thin layer to the entire body below the head. No more than 30 g Should be used. The medication is removed by washing 8 to 12 hours later. In most cases, only one application is required.

14.A Topical corticosteroid is prescribed for the client with dermatitis. The nurse provides instructions to the client regarding the use of the medication. Which of the following, if stated by the client, would indicate a need for further instruction? 1. I need to apply the medication in a thin film 2. I should gently rub the medication into the skin 3. I should place a bandage over the site after applying the medication 4. The medication will help me to relieve the inflammation and itching Answer:3 Clients should be advised not to use occlusive dressing to cover the affected site following the application of the topical corticosteroid, unless the physician specifically prescribed wound coverage. Options 1.2. and 4 are accurate statements related to the use of this medication

15. The nurse is applying a topical corticosteroid to a client with eczema. The nurse would be concerned about the potential for systemic absorption of the medication if the medication were being applied to which of the following body ares? 1. Back 2. Axilla 3. Palms of the hands 4. Soles of the feet Answer: 2 Topical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable, and lower from regions where penetrability is poor

16. Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client knowing that which of the following would indicate the presence of systemic toxicity from this medication? 1. Decreased respirations? 2. Diarrhea 3. Constipation 4. Tinnitus Answer 4 Salicylic acid is absorbed readily through the skin, and systemic toxicity can result. Symptoms include tinnitus, dizziness, hyperpnea, and psychological disturbances. Constipation and diarrhea are not associated with salicylism.

17. The client is diagnosed with herpes simplex type1. The physician prescribes a topical medication for treatment. The nurse anticipates that which of the following medications will be prescribed? 1.Triple antibiotic 2. Acyclovir

3. Mupirocin 4. Masoprocol Answer 2 Acylovir is a topical antiviral agent that inhibits DNA replication in the virus. Acyclovir has activity against herpes simplex types 1 and 2, varicella zoster, Epstein barr virus and cytomegalovirus. Triple antibiotic would not be effective in treating herpes virus

18. The Physician has prescribed coal tar treatments for the client with psoriasis, and the nurse provides information to the client about the treatments. Which Statement made by the client indicates a lack of understanding about the treatements? 1. The medication has unpleasant odor 2. The medication can stain in the skin and hair 3. The medication can cause systemic toxicity 4. The medication can cause phototoxicity Answer 3 Coal tar is used to treat psoriasis and other chronic disorders of the skin. Coal tar suppresses DNA synthesis, mitotic activity and cell proliferation. Coal tar has unpleasant odor, frequently stains the skin and hair, and can cause phototoxicity.Systemic toxicity does not occur.

19. The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied. 1.30minutes to 1 hour before exposure to the sun 2. Immediately before exposure to the sun 3. 15min. before exposure to the sun 4. Immediately before swimming Answer.1

Sunscreens are most effective when applied about 30minutes to 1 hour before exposure to the sun so that they can penetrate the skin. All sunscreens should be reapplied after swimming or sweating.

20. Mafenide is prescribed for the client with a burn injury. When applying the medication, the client complains of local discomfort and burning. Which of the following is the most appropriate nursing action? 1. Discontinue the medication 2. Notify the physician 3. Apply a thinner film than prescribed to the burn site. 4. Inform the client that this is normal. Answer 4 Mafenide is bacteriostatic for gram-negative and gram-positive organisms and is used to treat burns to reduce bacteria present in avascular tissues. The client should be informed that the medication will cause local discomfort and burning

21. The burn client is receiving treatements of topical mafenide to the site of injury. The nurse monitors the client knowing that which f the following indicates that a systemic effect has occurred? 1. Local pain at the burns site. 2. Local rash at the burn site 3. Hyperventilation 4. Elevated blood pressure Answer 3 Mafenide is a carbonic anhydrase inhibitor and can suppress renal excretion of acid, therey causing acidosis. Clients receiving this treatment should be monitored for acidbase imbalance. If acidosis becomes severe, the medication should be discontinues for 1 to 2 days.

22. Sodium hypochlorite is prescribed for a client with a leg wound that is draining purulent material. The home health nurse teaches a family member how to perform these treatments. Which statement if made by the family member indicates a need for further teaching? 1. The solution should not come in contract with normal skin tissue 2. I should rinse the solution off immediately following the irrigation 3. I will soak a sterile dressing with solution and pack it into the wound 4. I will prepare the solution before use Answer. 3 Sodium hypochlorite is a solution that is used for irrigating and cleaning necrotic purulent wounds. Although sodium hypochlorite can be used for packing necrotic wounds, it cannot be used to pack purulent wounds because the solution is inactivated by copious pus. The solution should not come in contact with healing or normal tissue and should be rinsed off immediately if used for irrigation. Solutions are unstable and must be prepared fresh for each use.

23.The nurse has provided instruction to a client regarding the use of tretinoin. Which statement if made by client indicates the need for further instructions? 1. I will wash my hands thoroughly after applying the medication 2. Optimal results will be seen after 6 weeks 3. I must apply a this layer to the skin 4. I will cleanse the skin thoroughly before applying the medication Answer 3 Tretinoin is applied liberally to the skin. The hands are washed thoroughly immediately after applying. Therapeutic results should be seen after to 3 weeks but may not be optimal until after 6 weeks. The skin needs t be cleansed thoroughly before applying the medication

24. Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse would anticipate that which laboratory test will be prescribed?

1. Complete blood count 2. White blood cell count 3. Triglyceride level 4. Platelet count Answer 3 Isotretinoin can elevate triglyceride levels. Blood triglyceride content should be measured before treatement and periodically thereafter until the effect on the triglycerides hae been evaluated.

25.A client with severe acne is seen in the clinic. The physician prescribes isotretinoin. The nurse reviws the clients medication record and would contact the physician if the client I taking which medication? 1.Digoxin 2. Phenytoin 3. VIt A 4. Furosemide Answer 3 Vitamin A, being a relative isotretinoin, can produce generalized intensification of isotretinoin toxicity. Because of the potential for increased toxicity, Vitamin A supplements should be discontinued before isotretinoin therapy.

26. The registered nurse is observing a newly hired nurse perform a dressing change on a client with a leg ulcer. Sutilains is being used to treat the ulcer. Which observation by the registered nurse would indicate an inaccurate action by the newly hired nurse when performing the dressing change? 1. The nurse cleanse the wound with a sterile solution 2. The nurse dries the wound and cover the sutilains application with a dry sterile dressing

3. The nurse moistens the wound with sterile normal saline and then applies the sutilains. 4. The nurse places the sutilains in the refrigerator following use. Answer 2 The wound should be cleansed with a sterile solution before treatment. The nurse then thoroughly moistens the wound with normal saline solution or sterile water, applies a this film of sutilains extendin to inch beyond the area to be debrided, and then applies a lose thin dressing. Ointment should be refrigerated.

27. Dextranomer is prescribed for a client with a decubitus ulcer. The nursing instructor asks the nursing students preparing to perform the treatment about the medication and the procedure. Which statement if made by the student indicates a need for further research? 1 It is effective in we wounds only 2. It should be packed lightly into the wound 3. Maceration of tissue surrounding the wound can occur from the medication 4. The wound bed must be dried thoroughly before applying the medication. Answer 4 Dextranomer is a cleansing rathe than a deriding agent that is effective in wet wounds only. Dextranomer is not packed tightly into the wound because macretion of surrounding tissue may result

28. Fibrinolysin and desoxyribonuclease dry powder is rescribed to treat a skin ulcer, and the nurse is observing a nursing student perform the treatment. The nurse intervenes if the nursing student is observed doing which of the following? 1. Cleans the wound with a sterile solution before applying Elase 2. Prepares the solution just before use 3. Applies a thick layer of medication and covers with a dry sterile dressing 4. Applies a thick layer of medication and covers with a petrolatum gauze. Answer 3

The wound should be cleansed with a sterile solution and gently patted dry/ A thin layer of elase is applied and covered with a petrolatum gauze. If a dry powder is used, for best effects, the solution should be prepared just before use.

29. The clinic nurse is performing an admission assessment on a client. The nurse notes that the client is taking azelaic acid. Because of the medication prescription, The nurse would suspect that the client is being treated for? 1. Herpes simplex 2.Acne 3. Eczema 4. Hair loss Answer 2 Azlaic acid is a topical medication used to treat mild to moderate acne. The acid appears to work by suppressing growth of propinibacterium acnes and by decrasing proliferation of keratinocytes

30. Monoxidil is prescribed for the client to treat hair loss, The client asks the nurse if the hair will continue to grow when the medication is stopped. The most appropriate nursing response is? 1. The hair will continue to grow 2. Newly gained hair is lost in 3 to 4 months 3. It depends on how long you have been taking the Rogaine 4. Im not sure, you need to ask your physician Answer.2 Hair regrowth with the use of Rogaine is most likely to occur when baldness has developed recently and has been limited to a small area. On discontinuation of the medication, newly gained hari is lost in 3 to 4 months, and the natural progression of hair loss resumes,

31. Somatren is administred to a client with pituitary dwarfism. A nurse monitors the client, knowing that the epected therapeutic effect of this medication is to? 1. Promote weigh gain 2. stimulate linear growth 3. Increase bone density 4. Decrease the mobilization of fats. Answer. 2 Somatrem is a growth stimulator used in the long term treatment of growth failure resulting from endogenous growth hormone deficiency

32. Desmopressin acetate is prescribed for the treatement of diabetes insipidus. The nurse administering the medication monitors the client, knowing that the primary action of the medication is to 1. Decrease permeability in the kidney to water 2. Decrease water reabsorption 3. increase renal excretion of water 4. Promote renal conservation of water Answer.4 Desmopressin promotes renal conservation of water. The hormone accomplishes this by acting on the collecting ducts of the kidney to increase their permeability to water which results in increased water reabsoption

33. A nurse is monitoring a client receiving desmopressin acetate for adverse reactions to the medication. Which of the following indicates the presence of an adverse reaction? 1. Increased urination 2. Weight loss

3. Drowsiness 4. Insomnia Answer 3 Water intoxication or hyponatremia is an adverse reaction to desmopressin. Early signs include drowsiness , listlessness, and headache.

34. Vasopressin is prescribed for a client with diabetes insipidus. A nurse is particularly cautious in monitoring the client receiving the medication if the client has which of the following preexisting conditions? 1. Depression 2. Endometriosis 3. Coronary artery disease 4. Pheochromocytoma Answer 3 Because of its powerful vasoconstrictor actions, vasopressin can cause adverse cardiovascular effects. By constricting arteries of the heart, vasopressin can cause angina pectoris and even myocardial infarction, especially if administered to the clients with coronary artery disease

35. A nurse provides instructions to a client who is taking levothyroxin. The nurse tells the client to take the medication 1. With food 2. On an empty stomach 3. At bedtime with a snack 4. At lunchtime Answer 2 Oral doses of levothyroxine should be taken on an empty stomach to enhance absorption.

36, A nurse provides medication instructions to a client who is taking levothyroxin. The nurse instructs the client to notify the physician if which of the following occurs? 1. Cold intolerance 2. Tremors 3. Excessively dry skin 4. Fatigue Answer 2 Excessive doses of levothyroxine can produce signs and symptoms of hyperthyroidism. There include tachycardia, angina, tremors, nervousness, insomnia, hyperthermia, heat intolerance and sweating.

37. A nurse performs an admission assessment on a client who visits a health care clinic for the first time. The client tells the nurse that propylthiouracil is taken daily. The nurse continues to collect data from the client, suspecting that the client has a history of. 1.Cushings syndrome 2. Addisons disease 3. Myxedema 4. Graves disease Answer 4 PTU inhibits thyroid hormone synthesis and is used to treat hyperthyroidism or graves disease. Myxedema indicates hypothyroidism. Cushings syndrome and addisons disease are disorders related to adrenal function

38. A nurse instructing a client regarding intranasal desmopressin. The nurse tells the client that which of the following is a side effect of the medication? 1. Flushed skin

2. Headache 3. Runny nose 4. Vulval pain Answer 3 Demopressin administered by the intranasal route can cause a runny or stuffy nose.

39. A client is receiving somatropin. The nurse monitors which most significant laboratory study during therapy with this medication? 1. Amylase 2. Lipase 3.Blood urea nitrogen 4. Thyroid-stimulating hormone Answer 4 An adverse reaction to somatropin is hypothyroidism. Thyroid function is monitored throughout therapy.

40. A client is scheduled for a subtotal thyroidectomy Strong iodine solution is prescribed. A nurse prepares to administer the medication, knowing that the therapeutic effect of this medication is to 1. Increase thyroid hormone production 2. Suppress thyroid hormone production 3. replace thyroid hormone 4. prevent the oxidation of iodide Answer 2 Lugols solution is administered to hyperthyroid individuals in preparation for thyroidectomy to suppress thyroid function.

41. Strong iodine solution is prescribed for a client with thyrotoxic crisis. The client calls a clinic nurse and complains of a brassy taste and burning sensations in the mouth. The most appropriate instruction to the client is which of the following? 1. Continue with the medication 2. Take half of the prescribed dose for the next 24 hours 3. Stop medication for the next 24 hours and then continue as prescribed 4. stop the medication and notify the physician Answer 4 Chronic ingestion of iodine can produce iodism

42. A nurse provides instructions to a client taking fludrocortisones. The nurse instructs the client to notufy the physician if which of the following occurs? 1. Weigh loss 2. Nausea 3. Swelling of the feet 4. Fatigue Answer 3 Excessive doses of fludrocortisones cause retention of sodium and water and excessive excretion of potassium, resulting in expansion of blood volume, hypertention, cardiac enlargement, edema and hypokalemia.

43. Calcium carbonate is prescribed for a client with hypocalemia. A nurse instructs the client to take the medication. 1. With meal 2. 1hour after meal 3. Just before meals

4. Every 4 hours Answer 2 The client should be instructed to take the medication exactly as prescribed.

44. Calcitriol is prescribed for a client with hypocalemia. A nurse provides dietary instructions to the client. Which of the following food items would the nurse instruct the client to avoid while taking this medication.? 1. Dark green, leafy vegetables 2.Milk 3. Whole-grain cereals 4. Sardines Answer 3 The client who is taking an antihypocalcemic medication should be instructed to avoid eating too much spinach, rhubarb, brain and whole-grain cereal because they decrease calcium absorption.

45. A daily dose of prednisone is prescribed for a client. A nurse provides instructions to the client regarding administration of the medication. The nurse instructs the client that the best time to take this medication is 1. At bedtime 2 At noon 3 Early morning 4 Anytime at the same time each day Answer. 3 Glucocorticoids should be administered before 9am. Administration at this time helps minimize adrenal insufficiency and mimic the burst of glucocorticoids released naturally but the adrenal glands each morning.

46. Prednisone is prescribed for a client with diabetes mellitus who is taking NPH insulin daily. Which of the following prescriptions does the nurse anticipate during therapy with the prednisone? 1 A decreased amount of daily NPH insulin 2 An increased amount of daily NPH insulin 3 n additional dose of prednisone daily 4. The addition of an oral hypoglycemic medication daily Answer 2 Glucocorticoids can elevate blood glucose levels. Clients with diabetes mellitus may need their dosage of insulin or oral hypoglycemic medications increased during glucocorticoid therapy.

47. A nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which of the following actions if performed by the client indicates the need for further teaching 1. Injects air into NPH insulin vial first 2. Injects an amount of air equal to the desired dose of insulin into the vial. 3. Withdraws the NPH insulin first 4. Withdraws the regular insulin first. Answer 3 When preparing a mixture of regular insulin with another insulin preparation, draw the regular insulin into the syringe first. This sequence will avoid contaminating the vial of regular insulin with insulin of another type.

48. A home care nurse visits a client recently diagnosed with diabetes mellitus. The client is taking NH insulin daily. The client asks the nurse how to store the unopened vials of insulin, The nurse tells the client to? 1. Freeze the insulin

2. Refrigerate the insulin 3. Keep the insulin at room temperature 4 Store the insulin in a dark dry place/ Answer 2 Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be frozen

49. Tolbutamine is prescribed for a client with diabetes mellitus. A nurse instructs the client to avoid which of the following while taking this medication. 1 Carbonated beverages 2 Organ meats 3. Alcohol 4. Whole grain cereals Answer 3 When alcohol is combined with tolbutamide, a disulfiram-like reaction may occur. This syndrome includes flushing, palpation, and nausea.

50. Sildenafil citrate is prescribed to treat a client with erectile dysfunction. A nurse reviews the clients medical record and would question the prescription if which of the following is noted in the clients history? 1. Neuralgia 2. Use of nitroglycerin 3. Use of Multivitamins 4. Insomia Answer. 2

Sildenafil citrate enhances the asodilation effect of nitric oxide in the corpus cavernosum of the penis. Thus sustaining an erection. Because of the effect of the medication , it is contraindicated with concurrent use of organic nitrates and nigtroglycerin.

51. The client is receiving propantheline bromide as adjunctive treatment for peptic ulcer disease. The nurse should administer this medication 1. With meals 2 just after meals 3 30mins before meals 4. with antacids Answer 3 Propantheline bromide Is an antimuscarinic anticholinergic medication that decreases gastrointestinal secritions.

52. The client is taking docusate sodium. The nurse monitors for which of the following to determine whether the client is having a therapeutic effect from this medication? 1. absence of abdominal pain 2. hematest negative stools 3. reduction in steatorrhea 4. Regular bowel movements Answer 4 Docusate sodium is a stool softener that promotes absorption of water into the stool, producing a softer consistency of stool. The intended effect is relief or prevention of constipation

53. The client is taking cascara sagrada and develops abdominal craps. The nurse interprets that the client is most likely experiencing

1. A common side effect of this medication 2. Partial bowel obstruction 3. A case of influenza 4. Peptic ulcer disease Answer 1 Cascara sagrada is a laxative that cause nausea and abdominal craps as the most frequent side effects. Other health problems are not determined based on a single symptom

54. The client taking bisacodyl wants to achieve rapid effect from the medication. The nurse then tells the client to take the medication 1. With large meal 2. ON an empty stomach 3 at bedtime 4. With two glasses of juice Answer 2 Mot rapid results from bisacodyl occur when it is taken on an empty stomach.

55. The client who is advised to take senna to treat constipation asks the nurse how this medication works. The nurse would incorporate which of the following when formulating a response? 1. Senna coats the bowel wall and makes it slippery. 2. Senna adds fiber an blk to the stool 3. Senna accumulates water and increases presistalis 4. Senna stimulates the vagus nerve to improve bowel tone Answer 3 Senna works by changing the transport of water and electrolytes in the large intestine, which causes accumulation of water n the mass of stool and increased peristalsis

56. The client has a PRN order for loperamide. The nurse should plan to administer this medication if the client has 1. Hematest positive nasogastric tue drainage 2 Abdominal pain 3 Constipation 4 An episode of diarrhea Answer4 Loperamide is an antidiarrheal agent. Lperamide is used to manage acute diarrhea and also chronic diarrhea in conditions such as inflammatory bowel disease

57. The nurse has given instructions to the client who just received a prescriptions to the client who just received a prescription for diphenoxylate with atropine. The nurse determines that the client understands the use of the medication and its properties if the client states to 1. Stay within the prescribed dose because it can be habit-forming. 2. Take the medication with a bulk-forming laxative. 3 Expect increased salivation while taking the medication 4. Anticipate side effects of nervous system excitability Answer 1 The client should not exceed the recommended dose because it may be habit-forming. The medication is an antidiarrheal and therefore should not be taken with a laxative.

58. The client has been started on psyllium The nurse would teach this client to take this medication with 1.Gelatin, applesauce, or pudding

2. A full glass of liquid, followed by a second 3. A multivitamin and mineral supplement. 4. A dose of an antacid Answer 2 Metamucil is a bulf-forming laxative and should be taken with a full glass of water or juice. Followed by another glass of liquid. This helps to prevent impaction of the medication

59 The nurse teaches the client taking metoclopramide to discontinue the medication immediately and call the physician if which of th following occurs with long-term use? 1. Anxiety or irritability 2.Dry mouth not minimized by the use of sugar free hard candy 3. Excessive drowsiness or excitability 4. Uncontrolled rhythmic movements of the face or limbs Answer. 4 If the client experiences tardive dyskinesia, the client should stop the medication and call the physician. These side effect of this medication. Anxiety, irritability and dry mouth are side effects that are not so harmful to the client.

60. The client just taken a dose of trimethobenzamide. The nurse monitors the client for relief of 1. Nausea and vomiting 2 Abdominal pain 3 Heart burn 4. Constipation Answer 1 Tigan is an antiemetic agent that is used to treat nausea and vomiting

61. The client has a PRN order for ondansetron. The nurse would administer this medication to the postoperative client for relief of 1. Urinary retention 2.Incisional pain 3 Nausea and vomiting 4. Paralytic ileus. Answer 3 Ondansetron is an antiemetic that is used to treat postoperative nausea and vomiting as well as nausea and vomiting associated with chemotherapy.

62.The client has an order to take magnesium citrate to prevent constipation following a barium study of the upper gastrointestinal tract. The nurse plans t administer this medication 1. With a full glass of water 2. With fruit juice only 3 With ice 4 at room temperature Answer 3 Magnesium citrate is available as an oral solution and is used commonly as a laxative in preparation for or following certain studies of the gastrointestinal tract.

63. The nurse is administering a dose of prochlorperazine to a client for nausea and vomiting. The nurse would assess the client for which of the following frequent side effects of this medication? 1. Diarrhea 2. Drooling 3. Excessive lacrimation 4. Blurred vision

Answer 4 The nurse would assess the client for blurred vision as a frequent side effect of prochlorperazine. Other frequent side effects of this phenothiazine-type antiemetic and antipsychotic are dry eyes, dry mouth and constipation.

64. The client has begun medication therapy with pancrelipase. The nurse would evaluate that the medication is having the optimal intended benefit if which of the following effects is observed?

1 Reduction of steatorrhea 2. Absence of abdominal pain 3. Relief of heartburn 4. Weigh loss Answer 1 Pancrease is a pancreatic enzyme used in clients with pancreatitis as a digestive ais. The medication should reduce the amount of fatty stools.

65. A calcium carbonate antacid has been prescribed for client an the nurse provides instructions to the client about the medication. The nurse tells the client that it is best to take the antacid with 1 Milk 2. A vitamin D supplement 3. Yogurt 4. Water Answer 4 Calcium carbonate antacids should not be taken with milk, milk products or foods or supplements high in vitamin D because milk-alkali syndrome can occur.

66. The nurse is giving the client directions for proper use of aluminum hydroxide tablets. The nurse tells the client to. 1. Chew the tablets thoroughly and follow with 4oz of water 2. Swallow the tablets whole with a full glass of water 3. Take the tablets at the same time as other medications 4. Take each dose with a laxative to prevent constipation Answer 1 Aluminum hydroxide tablets should be chewed thoroughly before swallowing. This prevents them from entering the small intestine undissolved.

67. The client with history of duodenal ulcr is taking calcium carbonate chewable tablets. The nurse would evaluate that the client is experiencing optimal effects of the medication if 1. Muscle twitching stops 2. Heartburn is relived 3. Serum calcium levels rise 4. Serum phosphorus levels decrease Answer 2 Calcium carbonate can be used as an antacid for the relief of heartburn and indigestion. Calcium carbonate also can be used as calcium supplement or to bind phosphorus in the gastrointestinal tract with the renal failure.

68. The hospitalized client asks the nurse for sodium bicarbonate to relieve heartburn following a meal. The nurse reviews the clients medical record, knowing that the medications is contraindicated in which of the following conditions? 1. Urinary calculuses 2 Chronic bronchitis

3. Metabolic alkalosis 4. Respiratory acidosis Answer 3 Sodium bicarbonate is an electrolyte modifier and antacid and it would aggravate metabolic alkalosis, which is a difficult acid-base imbalance to correct

69. The client is complaining of gas pains following surgery and requests medication. The nurse elects which of the following medications from the PRN medication list to give to the client? 1. Magnesium hydroxide 2. Droperidol 3 Acetaminophen 4 Simethicone Answer 4 Simethicone is an antiflatulent used to relieve pain caused by excessive gas in the gastrointestinal tract. Magnesium hydroxide is an antacid and laxative.

70 An older client recently has been taking cimetidine. The nurse monitors the client for which of the following most frequent central nervous system side effects of this medication? 1. Confusion 2. Dizziness 3. Tremors 4. Hallucinations Answer 1 Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of these is confusion.

71.A nurse is preparing to administer albuterol to a client. The nurse assesses which of the following parameters before and during therapy? 1.Urine output and blood urea nitrogen 2. Nausea and vomiting 3. Lung sounds and presence of dyspnea 4. Headache and level of consciousness Answer. 3 Albuterol is a bronchodilator of the adrenergic type. The nurse assesses respiratory pattern, lung sounds, pulse and blood pressure before and during therapy.

72. A home care nurse has observed a client self administer a dose of metaproterenol sulfate via metered dose inhaler. Within a short time, the client begins to wheeze loudly. The nurse interprets that this is due to. 1. Insufficient dosage of the medication, which needs to be increased 2.Probable interaction of this medication with an over-the-counter cold remedy. 3. Tolerance to the medication, indicating a need for a stronger type of bronchodilator. 4. Paradoxical bronchospasm, which must be reported to the physician. Answer 4 The client taking adrenergic bronchodilators may experience paradoxical bronchospasm, which is evidenced by the clients wheezing. This occur with excessive use of inhalers

73. A nurse has an order to give a client metaproterenol sulfate, two puffs by metered dose inhaler. The nurse administers the medication by giving the. 1. Beclomethasone first and then the metaproterenol 2. Metaproterenol first and then the beclomethasone

3 Alternating a single puff of each, beginning with the beclomethasone. 4. Alternating a single puff of each, beginning with the metaproterenol. Answer 2 Metaproterenol sulfate is an adrenergic type of bronchodilator. Beclomethasone is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule

74. A client receiving theophylline is due to have a theophylline level drawn. A nurse questions the client to ensure that all the client has no ingested which of the following substances before the blood sample is drawn? 1. Sedatives 2 Narcotics 3. Gkycise 4 Caffeine Answer 4 Theophylline is an xanthine bronchodilators. Before drawing of a serum level of the medication, the client should avoid taking in foods or beverages that contain xanthine, such as colas, coffee or chocholate. Thus the client is told to avoid caffeine intake before the test.

75. A client has begun therapy with oxtriphylline. A nurse plans to teach the client to limit the intake of which of the following while taking this medication 1.Oysters, lobsters and shrimp 2. Coffee, cola, and chocolate 3. Cottage cheese, cream cheese, and diary creamers

4. grapefruit, oranges and pineapple Answer 2 Oxtriphylline is an xanthine bronchodilator. The nurse teaches the client to limit the intake of xanthinecontaining foods while taking this medication.

76. A nurse has administered a dose of salmeterol to a client. The client develops a generalized rash and urticaria, and the eyelids begin to swell. The nurse should 1. Call the physician immediately. 2. Encourage the client. To drink fluids quickly 3. Apply a lanolin-based cream to the rash. 4. Assess the clients vision with a snellen chart. Answer 1 Hypersensitivity reaction can occur in clients taking ephedrine, epinephrine, isoproterenol or salmeterol. Signs and symptoms include rash, uricaria, an swelling of the face, lips or eyelids.

77. A client is receiving acetylcysteine by nebulizer. A nurse should have which of the following items available for possible use after giving this medication? 1. Suction equipment 2. Nasogastric tube 3. Intubation tray 4. Ambu bag Answer 1 Acetylcysteine can be given orally or by a nasogastric tube to treat acetaminophen overdose, or it may be given by inhalation for use as a mucolytic

78. A client has an order to take guaifenesin. A nurse concludes that the client nderstands the most effective use of this medication if the client states to 1. Take the tablet with a full glass of water 2. Take an extra dose if the cough is accompanied by fever 3 Watch irritability as a side effect. 4. Crush the sustained-release tablet if immediate relief is needed Answer 1 Guaifenesin is an expectorant and should be taken with a full glass of water to decrease viscosity f secretions. Sustained-release preparations should not be broken open, crushed or chewed.

79, A nurse is preparing to administer a dose of naloxone hydrochloride intravenously to a client with an intravenous narcotic overdose. The nurse plans to have which of the following available as supportive equipment in case it is needed? 1. Nasogastric tube 2. Paracetesis tray 3. Central line insertion tray 4. Resuscitation equipment Answer 4 The nurse administering naloxone for suspected narcotic overdose should have resuscitation equipment readily available to support naloxone therapy if it is needed. Other adjuncts that may be needed include oxygen, mechanical ventilator, an vasopressors.

80. A nurse teaches a client aout the effects of dipenhydramine hydrochloride, which has been ordered as a cough suppressant. The nurse determines that the client needs further instructions if the client states to.

1. Avoid driving or other activities requiring mental alertness while taking this medication 2. Use sugarless gum. Candy, or rinses to decrease dry mouth 3. Avoid using alcohol while taking this medication 4. Take the medication on an empty stomach Answer 4 Diphenhydramine has several uses, including antihistamine, antitussive, antidyskenetic, and sedative/hypnotic.

81. The client has been prescribed a cough formula containing codeine sulfate. A nurse has given the client instructions for its use. The nurse concludes that eh client understands the instructions if the client verbalizes to self-assess for 1. Excitability 2. Constipation 3 Rapid pulse 4. Excessive urination Answer 2 The client is taught about side effects that could occur with the use of codeine sulfate. The most common side effects include drowsiness, confusion, hypotension, nausea and vomiting and constipation.

82. A cromolyn sodium inhaler is prescribed for a client with allergic asthma. A nurse provides instructions regarding the side effects of this medication. Which of the following undesireable side effects is associated with this medication? 1.Constipation 2. Hypotension 3. Insomnia

4. Bronchospasm Answer 4 The most common undesired side effects associated with inhalation therapy of cromolyn sodium are bronchospasm, cough, nasal congestion, throat irritation, and wheezing.

83. Terbutaline sulfate is for a client with bronchitis. A nurse understands that this medication should be used with caution if which of the following existing medical conditions is present in the client? 1.Hypothyroidism 2. Polycystic disease 3. Osteoarthritis 4. Diabetes mellitus Answer 4 Terbutaline sulfate is contraindicated in clients with hypersensitivity to sympathomimetics and should be used with caution in clients with impared cardiac function, diabetes mellitus, hypertension or hyperthyroidism, and clients with a history of seizures. The medication may increase blood glucose levels.

84. Zafirlukast is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication? 1. Platelet count 2. Complete blood count 3 Liver function tests 4. Neutropil count Answer 3

Zafirlukast is a leukotriene receptors antagonist used in the prophylaxis and long-term treatment of bronchial asthma. Zafirlukast is used with caution in clients with impaired hepatic function. Liver function laboratory test should be performed to obtain a baseline , and the levels thould be monitored during administration of the medications.

85. A client has been taking isoniazid for a month and a half. The client complains to a nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing. 1. Small blood vessel spasm 2. Impaired peripheral circulation 3. Hypercalcemia 4. peripheral neuritis Answer 4 A common side effect of isoniazid is peripheral neuritis. This is manifested by numbness, tingling and paresthesias in the extremeties . This isde effect can be minimized with pyridoxine intake.

86. A client is to begin a 6- month course of therapy with isoniazid. A nurse plans to teach the client to 1. Use alcohol in small amounts only 2 Report yellow eyes or skin immediately 3 Increase intake of swiss or aged cheeses 4 Avoid vitamin supplements during therapy Answer isoniazid is hepatotoxic and therefore the client is taught to report signs and symptoms Of hepatitis immediately. For the same reason, alcohol shouldbe avoided during therapy.

87. A client has been started on long-term therapy with rifampin. A nurse teaches the client that the medication 1.Should be double dosed if one dose is forgotten 2. may be discontinues independently if symptoms are gone in 3 months. 3 Causes orange discoloration of sweat, tears, urine , and feces 4.. Should always be taken with food or antacids Answer 3 Rifampin should be taken exactly as directed. Doses should not be doubled or skipped.

88. A nurse has given a client taking ethambutol information about the medication. The nurse determines that the client states to immediately report. 1. Gastrointestinal side effects. 2. Impaired sense of hearing 3 Orange-rd discoloration of body secretions. 4. Difficulty in discriminating the color red from green Answer 4 Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately.

89, Cycloserine is added to the medication regimen for a client with tuberculosis. Which of the following would the nurse include in the client teaching plan regarding this medication? 1.Take the medication before meals 2. Return to the clinic weekly for serum drug levels

3 It is not necessary to call the physician if a skin rash occurs. 4. It is not necessary to restrict alcohol intake with this medication. Answer 2 Cycloserine is an antibuercular medication that requires weekly serum drug level determinations to monitor for the potential of neurotoxicity.

90. A client with tuberculosis is being started on anti tuberculosis therapy with isoniazid. Before going the client the first dose, a nurse ensures that which of the following baseline studies has been completed? 1 Coagulation times 2. Electrolytes 3. Serum creatinine 4. Liver enzymes Answer. 4 Izoniazid therapy can cause an elevation of hepatic enzymes and hepatitis. Therefore liver enzymes are monitored when therapy is initiated and during the first 3 months of therapy.

91. Trimethoprin-sulfamethoxazole is prescribed to be administered by intravenous infusion to a client with a recurrent urinary tract infection. A nurse would administer this medication 1. Over 60 to 90 mins 2. Over 30 mins 3 Piggybacked into the existing infusion of normal saline and potassium chloride 4. piggybacked into the peripheral line containing total parenteral nutrition Answer 1 Trimethoprin-sulfamethoxazole may be administered by intravenous infusion but should not be mixed with any other medications or solutions

92. Nalidixic acid is prescribed for a client with a urinary tract infection. On review of the client s record , a nurse notes that the client is taking warfarin sodium daily. Which prescription would the nurse anticipate because the client is taking this anticoagulant orally? 1. An increase in the anticoagulation dosage 2. A decrease in the anticoagulation dosage 3. The need to discontinue the anticoagulant 4. The need to administer an alternative medication to treat the urinary tract infection Answer 2 Nalidixic acid can intensify the effects of oral anti coagulants by displacing these agents from binding sites on plasma protein. When an oral anticoagulant is combined with nalidixic acid., a decrease in the anticoagulant dosage may be needed.

93. A nurse is providing discharge instructions to a client receiving sulfisoxazole. Which of the following would be included in the list of instructions? 1 restrict fluid intake 2. maintain a high fluid intake 3 decrease the dosage when symtoms are improving to prevent all allergic response 4. If the urine turn dark brown, call the physician immediately Answer 2 Each dose of sulfisoxazole should be administered with a full glass of water and the client should maintain a high fluid intake.

94. Sulfamethoxazole is prescribed for a client with a urinary tract infection. The client has diabetes mellitus and is receiving tolbutamide. Based on the administration of these two medications in combination,, which of the following would the nurse anticipate might be prescribed? 1. A decreased dosage of the tolbutamide

2 an increased dosage of the tolbutamide 3 a decrease dosage of the sulfamethaxazole 4. an increased dosage of the sulfamethaxozole Answer. 1 Sulfonamides can intensify the effects of warfarin sodium, phenytoin, and orally aministered hypoglycemic such as tolbutamin. When combined with sulfonamides these medications may require a reduction in dosage.

95. Trimethoprin-sulfametoxazole is prescribe for a client. A nurse would instruct the client to report which symptom if it developed during the course of this medication therapy? 1 Headache 2. Nausea 3 Diarrhea 4 Sore throat Answer 4 Clients taking trimethoprim-sulfamethoxazole should be informed about early signs of blood disorders that can occur from this medication. These signs include sore throat,fever, palor , and the client should be instructed to notify the physician if these symptoms occur.

96. Phenazopyridine hydrochloride is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. The nurse teaches the client 1. To Take the medication before meals 2. That a reddish orange discoloration of the urine may occur. 3 To discontinue the medication f a headache occurs

4. To take the medication at bedtime Answer 2 The nurse should instruct the client that a reddish orange discoloration of urine may occur. The nurse also should instruct the client that this discoloration can stain fabric. The medication should be taken after a meals to reduce the possibility of gastrointestinal upset.

97. Bethanechol chloride is prescribed for a client with a urinary retention. Which disorder would be a contraindication to the administration of this medication? 1 Neurogenic atony 2. Urinary strictures 3. Gastroesphageal reflux 4, Gastric atony Answer 2 Bethanechol chloride can be hazardous to clients with urinary tract obstruction or weakness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract could rupture the bladder in clients with these conditions.

98. A nurse who is administering bethanechol chloride is monitoring for acute toxicity associated with the medication. The nurse checks the client for which sign of toxicity? 1. Dry mouth 2. Dry skin 3, Bradycardia 4 Signs of dehydration Answer 3 Toxicity produces manifestations of excessive muscarinic stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia and sever hypotension.

99. Oxybutynin hloride is prescribed for a client with neurogenic bladder. Which sign would indicate a possible toxic effect relate to this medication? 1. Bradycardia 2.Pallor 3 estlessness 4 Drowsiness Answer 3 Toxicity of this medication produces central nervous system excitation, such as nervousness, restlessness, hallucinations, and irritability.

100. Propantheline bromide is prescribed for a client with bladder spasm. Which of the following disorders, if noted in the clients record, would alert a nurse to question the prescription for this medication 1. Glaucoma 2. Hypthyroidism 3 myxedema 4. coronary artery disease Answer 1 Propantheline bromide is contraindicated in clients with narrow-angle glaucoma, obstructive uropathy, gastrointestinal disease, or ulcerative colitis.

101.Following kidney transplant, cyclosporine is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication? 1. Decreased white blood cell count 2 Decreased hemoglobin

3 Elevated blood urea nitrogen 4. Decreased creatinine Answer 3 Nephrotoxicity can occur from the use of cyclosporine. Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen and serum creatinine levels.

102. A nurse is providing dietary instructions to a client who has been prescribed cyclosporine. Which food item would the nurse instruct the client to avoid? 1. Orange juice 2. Grapefruit juice 3. Red meats 4. Green leafy vegetables Answer 2 A compound present in grapefruit juice inhibits metabolism of cyclosporine. As a result, consumption of grapefruit juice can raise cyclosporine levels by 50% to 100% thereby greatly increasing the risk of toxicity.

103. A nurse is caring for a client who will be receiving amphotericin B. The nurse notes that the client is also taking cyclosporine to prevent rejection of a kidney transplant performed 2 years ago. Which prescription would the nurse anticipate to be prescribed for this client during the administration of these medications concurrently? 1. an increased amount of amphotericin B 2. a decreased amount of amphotericin B 3. An incrased amount of cyclosporine 4. a Decreased amount of cyclosporine. Answer 4

Amphotericin B , erythromycin, and ketoconazole can elevate cyclosporine levels. When either of these medications is combined with cyclosporine, the dosage of cyclosporine must be reduced to prevent accumulation to toxic levels.

104. A nurse provides instructions to a client who will be taking cyclosporine oral solution. The nurse tells the client to 1. Dilute the concentrate in a Styrofoam cup before administration 2 avoid diluting the concentrate for administration 3 mix the concentrate with chocolate milk 4 mix the concentrate with grapefruit juice Answer 3 To improve palatability, the client should be taught to mix the concentrated medication solution with chocolate milk or orange juice just before administration. Grapefruit is avoided because it can raise cyclosporine levels.

105 A nurse is monitoring a client receiving cyclosporine. Which sign or symptom would indicate to the nurse that the client is experiencing an adverse effect from this medication? 1. Nausea 2. Alopecia 3. Tremors 4. Hypotension . Answer 3 The most common adverse effect of cyclosporine are nephrotoxcicity , infection,hypertension, tremors, and hirsuitsm.

106. Tacrolimus is prescribed for a client. Which disorder if noted in the clients record, would indicate that the medication needs to be administered with caution?

1.Diabetes insipidus 2. Coronary artery disease 3. Pancreatitis 4. Ulcerative colitis Answer 3 Tacrolimus is used with caution in immunosuppressed clients and in clients with renal, hepatic or pancreatic function impairement.

107. A nurse is reviewing the laboratory results for a client receving tacrolimus. Which laboratory result would indicate to the nurse that the client is experiencing an adverse effect of the medication? 1 White blood cell count of 6000 cells/uL 2 Blood glucose of 200 mg/dL 3 Potassium level of 3.8 mEq/L 4 Platelet count of 300,000 cells/uL Answer 2 Nephrotoxicity is a mjor concern with this medication. Other common reactions include neurotoxicity evidenced by headache, tremor , and vomiting hypertension, hyperkalemia, and hyperglycemia

108 Mycophenolate mofetil is prescribed for a client for prophylaxis of organ rejection following allogenic renaltransplant. Which instruction would a nurse provide to the client regarding administration of this medication? 1. Administer following meals 2. Open the capsule and mix with food for administration 3 Contact the physician if a sore throat occurs 4 Take the medication with a magnesium-type antacid

Answer 3 Mycophenolate mofetil should be administered on an empty stomach. The capsules should not be opened or crushed. The client should contact the physician if unusual bleeding or bruising, sure throat, mouth sores abdominal pain or fever occurs.

109. A client with chronic renal failure is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication? 1. White blood cell count of 6000 cells/uL 2 Hematocrit of 32% 3. Platelet count of 400,000 cells/uL 4 Blood urea nitrogen of 15mg/dL Answer 2 Epoetin alfa is used to reverse anemia associated with chronic renal failure.

110. A nurse is instructing a client to administer epoetin alfa by the subcutaneous route. The nurse tells the client to 1. Shake the bottle before use 2. Freeze the mediation before use 3. Refrigerate the medication 4 Obtain syringes with 1 inch needles from the pharmacy Answer The client should be instructed not to shake the bottle. The medication should be refrigerated at all times. The medication should not be frozen. Syringes with a 5/8 inch needle are used for subcutaneous injection. A 1 -inch needle may be used for intramascular injection.

111. In preparation for cataract surgery the nurse is to administer cyclopentolate eye drops. The nurse administers the eye drops. Knowing that the purpose of this medication is to.

1.Provide lubrication to the operative eye. 2. Produce miosis of the operative eye. 3 Dilate the pupil of the operative eye 4. Constrict the pupil of the operative eye. Answer 3 . Cylopentolate is a rapidly acting mydriatic and cycloplegic medication. Cyclopentolate is effective in 25 to 75mins, and accommodation returns in 6 to 24 hours..

112. The home health nurse visits a client at home and instructs the client on the administration of the prescribed eye drops. Which of the following statements byt eh client indicates a need for further education? 1. I can sit and tilt my head back, pull down on the lower lid, and place the drop in the lower lid 2. I can lie down, pull down on the lower lid and place the drop in the lower lid 3. I can lie down, pull up on the upper lid and place the drop in the lower lid 4. I can lie on my side opposite to the eye I am going to place the drop. Put the drop in the corner of the lid nearest my nose then slowly turn to my other side while blinking. Answer 3 The client can lie down or sit with the head tilted back. The lower lid should be pulled downward with thumb or fingers. The client holds the bottle like a pencil with the tip downward and squeezes the bottle gently allowing 1 drop to fall into the sac.

113. Ear drops prescribed for an infant with otitis media. The most appropriate method to administer the ear drops to the infant is to 1. Pull up and back on the pinna and direct the solution onto the eardrum 2. Pull down and back on the pinna and direct the solution onto the eardrum 3. Pull down and back on the pinna and direct the solution toward the wall of the canal

4. Pull up and back on the ear lobe and direct the solution toward the wall of the canal. Answer 3 In a child younger than 3 years, the pinna is pulled down and straight back. The infant should be turned on the side with the affected ear uppermost.

114. The nurse is providing instructions to a client who will be self-administering eye drops. To minimize the systemic effects that eye drops can produce, the nurse instructs the client 1. Eat before instilling the drops 2 Swallow several times after instilling the drops 3 Blink vigorously to encourage tearing after instilling the drops 4. Occlude the nasolacrimal duct with a finger for several minutes after instilling the drops Answer 4 Applying pressure on the nasolacrimal duct prevents systemic absorption of the medication

115. The client is receiving an eye drop and an eye ointment to the right eye. The nurse would most appropriately 1. Administer the eye drop first, followed by the eye ointment 2. Administered the eye ointment first followed by the eye drop 3 Administered the eye drop, wait 10mins. And administer the eye ointment 4. Administer the eye ointment, wait 10mins, and administer the eyedrop Answer 1 When an eye drop and an eye ointment are scheduled to be administered at the same time, the eye drop is administered first.

116. The nurse is caring for a client with glaucoma. Which of the following medications, if prescribed for the client would the nurse question?

1. Carbachol(Carboptic) 2. Pilocarpine hydrochloride (Isopto Carpine) 3. Pilocarpine nitrate 4 Atropine sulfate (Isopto Atropine) Answer 4 Option 1,2, and 3 are miotic agents used to treat glaucoma Option 4 Is a mydriatic and cycloplegic medication, and its use is contraindicated in clients with glaucoma.

117.A miotic medication has been prescribed for the client with glaucoma. The client asks the nurse about the purpose of the medication. The nurse tlls the client that 1. The medication causes the pupil to constrict and will lower the pressure in the eye 2. The medication will help to dilate the eye to prevent pressure from occurring 3 The medication will relax the muscles of the eyes and prevent blurred vision 4. The medication will help to block the responses that are sent to the muscle in the eye Answer 1 Miotics cause papillary constriction and are used to treat glaucoma. They lower the intraocular pressure, thereby, increasing blood flow to the retina and decreasing retinal damage and loss of vision

118. Pilocarpine hydrochloride is prescribed for the client with glaucoma. Which of the following medications does the nurse plan to have available in the event of systemic toxicity? 1.Naloxone hydrochloride (narcan) 2. Pindolol ( VIsken) 3. Atrpine sulfate 4, Mesoridazine besylate ( Serentil) Answer 3

Systemic, absorption of pilocarpine hydrochloride can produce toxicity and includes manifestations of vertigo, bradycardia, tremors, hypotension, syncope, cardiac dysrhythymias and seizures.

119. Betaxolol hydrochloride (Betoptic) eye drops have been prescribed for the client with glaucoma. Which of the following nursing actions is most appropriate related to monitoring for the side effects of this medication? 1. Monitoring temperature 2. Monitoring Blood pressure 3 Assessing blood glucose level 4, Assessing peripheral pulses Answer 2 Hypotension , dizziness, nausea, diaphoresis , headache fatigue, constipation, and diarrhea are systemic effets of the medication.

120. The nurse prepares the client for an ear irrigation as prescribed by the physician. In performing the procedure the nurse 1. Assist the client to turn his or her head so that the ear to be irrigated is facing upward 2 Warms the irrigating solution to 98 degrees F 3 Directs a slow steady stream of irrigation solution toward the eardrum. 4. Positions the client with the affected side up following the irrigation. Answer 2 Irrigation solutions that are not close to the clients body temperature can be uncomfortable and may cause injury, nausea and vertigo.

121. The nurse is caring for a client in the emergency room diagnosed with Bells palsy. The client has been taking acetaminophen ( Tylenol) and a Tylenol overdose is suspected . The nurse anticipates that the antidote to be prscribed is

1. Auranofin (Ridaura) 2. Fludarabine (Fludara) 3. Acetylcysteine (Mucomyst) 4. Pntostatin (Nipent) Answer 3 The antidote for acetaminophen is acetylcysteine(Mucomyst). The normal therapeutic serum level of acetaminophen is 10 to 20 mcg/ml. A toxic level is greater than 50 mcg/ml, and levels of greater than 200 mcg/ml could indicate hepatotoxicity,

122. The client with trigeminal neuralgia tells the nurse that acetaminophen is taken daily for the relief of generalized discomfort. Which lab value would indicate toxicity associated with the medication. 1. Platelet count of 400,000 cell/uL 2. Direct bilirubin level of 2 mg/dL 3. Prothrombin tie of 12 seconds 4 sodium of 140 mEq/L Answer 2 In adults, overdose of acetaminophen cause liver damage.

123 The client is suspected of having myasthenia gravis. Edrophoium(Tensilon) 2mg is administered intravenously to determine the diagnosis. Which of the following indicates that the client has myasthenia gravis. 1. An increase in muscle strength within 30 to 60 seconds following administration of the medication 2. A decrease in muscle strength within 30 to 60 seconds following administration of the medication 3. Joint pain following administration of the medication 4. Feelings of faintness, dizziness, hypotension, and signs of flushing in the client Answer 1

Edrophonium is a short-acting acetylcholinesterase inhibitor used as a diagnostic agent

124. The client with myasthenia gravis becomes increasingly weaker. The physician prepares to identify whether the client is reacting to an overdose of the medication (cholinergic crisis) or an increasing severity of the disease (myasthenic crisis). An injection of edrophonium (Tensilon) is administered. Which of the following would indicate that the client is in cholinergic crisis? 1. An improvement of the weakness 2. A temporary worsening of the condition 3. No change in the condition 4. Complaints of muscle spasm Answer 2 An Edrophonium injection makes the client in cholinergic crisis temporarily worse This in known as a negative Tensilon test

125. The client with myasthenia gravis verbalizes complaints of feeling much weaker than normal. The physician plans to implement a diagnostic test to determine whether the client is experiencing a mysthenic crisis.The physician administers edrophonium (Tensilon) . Which of the following would indicate that the client is experiencing myasthenic crisis? 1, Increasing weakness 2 No change in the condition 3 A temporary improvement in the condition 4. An increase in muscle spasms Answer3 Edrophonium is administered to determine weather the client is reacting to an ovedose of a medication(cholinergic crisis) or an increasing severity of the disease (myasthenic crisis).

126. Carbidopa-levodopa (Sinemet) is prescribed for the client with Parkinsons disease. The nurse monitors the client for adverse reactions to the medication. Which of the following would indicate that the client is experiencing an adverse reaction? 1. Pruritus 2. Hypertension 3. Tachycardia 4. Imapired voluntary movements Answer 4 Dyskinesia and impaired voluntary movement may occur with high levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia and akinesia ( the temporary muscle weakness that lasts 1 mins to 1 hour, also known as on- off phenomena. )

127. Phenytoin (Dilantin) 100mg PO 3 times daily, has been prescribed for the client for seizur control. The home health nurse visits the client and provides teaching regarding the medication. Which of the following statements, if made by the client, would indicate effective teaching? 1. its okay to break the capsules to make it easier for me to swallow them 2. I will use a soft toothbrush to brush my teeth 3. If I forget to take my medication, I can wait until the next dose and eliminate the dose 4. If my throat becomes sore, its a normal effect of the medication, and its nothing to be concerned about Answer 2 Phenytoin is an anticonvulsant. Gingival hyperplasia, bleeding, swelling, and tenderness of the gums can occur with the use of this medication.

128. The client is taking phenytoin (Dilantin) for seizure control. A serum drug level is drawn, and the nurse reviews the results. Which of the following would indicate a therapeutic serum drug range?

1. 5 to 10 mcg/ml 2 10 to 20 mcg/ml 3 20 to 30 mcg/ml 4 30 to 40 mcg/ml Answer 2 The therapheutic serum drug level range for phanytoin is 10 to 20 mcg/ mL

129. The nurse is preparing an intravenous infusion of phenytoin as prescribed by the physician for the client with seizures. Which of the following solutions will be nurse plan to use to dilute this medication? 1 Lactated Ringers solution 2. 5% dextrose 3 5% dextrose and normal saline 4. Normal saline solution Answer 4 Intravenous infusion of phenytoin should be administered by injection into a large vein. The medication may be diluted in normal saline solution; however, dextrose solution should be avoided because of medication precipitation.

130. The home health nurse visits a client who is taking phenytoin for control of seizures. During the assessment, the nurse notes that the client is taking birth control pills. Which of the following information should the nurse include in the teaching plan? 1. The increased risk of thrombophlebitis while taking phanytoin and birth control pills together 2. The potential decreased effectiveness of the birth control pills while taking phanytoin 3 That the client may stop the medication if it is causing severe gastrointestinal effects 4 That pregnancy should be avoided while taking phanytoin Answer 2

Phnytoin enhances the rate of estrogen metabolism which can decrease the effectiveness of some birth control pills

131. A client with trigeminal neuralgia is being treated with carbamazepine (Tegretol), 400mg PO daily. Which of the following indicates that the client is experiencing an adverse reaction to the medication? 1. White blood cell count, 3000cells u/L 2. Blood urea nitrogen , 15mg /dL 3 Sodium, 140mEq/L 4 Uric acid, 5mg/ dL Answer 1 Adverse effects of carbamazepine appear as blood dysrasias, including aplitic anemia agranulocytosis thrombocytopenia, leukemia, cardiovascular disturbances, thrombophlebitis, dysrhythmias, and dermatological effects.

132. The nurse is caring for a client receiving morphine sulfate 10mg subcutaneously every 4 hours for pain because this medication has been prescribed for this client. Which nursing action would be included in the plan of care? 1. Monitors the clients temp 2. Encourage fluids 3. Maintain the client in a supine position 4 Encourage the client to cough and deep breath Answer 4 Morphine sulfate suppresses the cough reflex. Clients need to be encouraged to cough and deep breath to prevent pneumonia.

133. Meperidine hydrochloride (Demerol) is prescribed for the client with pain. Which of the ff would the nurse monitor for as a side effect of this medication?

1. Hypertension 2. Bradycardia 3. Diarrhea 4. Urinary retention Answer 4 Side effects of this medication include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention

134. The nurse is caring for a client with sever back pain. Codeine sulfate has been prescribed for the client. Which of the following does the nurse specifically include in the plan of care while the client is taking this medication? 1. Monitor for hypertension 2 Monitor fluid balance 3. Monitor bowel activity 4. Monitor peripheral pulses Answer 3 While the client is taking codeine sulfate, the nurse would monitor vital signs and assess for hypotension.

135. Dantrolene (Dantrium) is prescribed for a client with spinal cord injury for discomfort caused by spasticity. Which of the following lab values would the nurse monitor while the client is taking this medication. 1. Sedimenatation rate 2. Whide blood cell count 3. Liver function studies 4. Creatinine

Answer 3 Dantrolene can cause liver damage, and the nurse should monitor the liver fnction studies.

136. The client with epilepsy is taking the prescribed dose of phenytoin(Dilantin) to control seizures. Results of a phenytoin blood level study reveal a level of 35 mcg/mL. Which of the following symptoms would be expected as a result of this laboratory result? 1. No symptoms because this is a normal therapeutic level 2. Slurred speech 3 Tachycardia 4. Nystagmus Answer 2 The therapeutic phenytoin level is 10 to 20 mcg/mL. at greater than 20mcg/ mL involuntary movements of the eyeballs appears

137. Mannitol is prescribed for the client with increased intracranial pressure following a head injury. The nurse prepares to administer the medification knowing that the therapeutic action is to 1. Induce dieresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes 2 Induce dieresis by promoting the reabsorption of sodium and water in the loop of Henle. 3. Prevent the filtration of sodium and water through the kidneys. 4. Prevent the filtration of sodium and potassium through the kidneys. Answer 1 Mannitol is an osmotic diuretic that induces dieresis by raising the osmotic pressure Of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes]

138 Dexamethasone IV is prescribed for the client with cerebral edema. The nurse prepares the medication for administration and plans to 1. Mix the medication in 100Ml Of lactated Ringers solution 2. Mix the medication in 1000mL of 5% dextrose 3. Prepare an undiluted direct injection of the medication. 4. Dilute the medication in lactated Ringers solution and administer as a direct injection. Answer 3 Dexamethasone may be given by direct intravenous injection or intravenous infusion. It may be mix with 0.9% sodium chloride or 5% dextrose

139. The client arrives at the emergency department complaining of back spasm. The Client states I have been taking two to three aspirin every 4 hours for the last week, and it hasnt helped my back. Aspirin intoxication is suspected, and the nurse assesses the client for which of the fllowing 1. Diarrhea 2 Constipation 3. Tinnitus 4. Photosensitivity Answer 3 Mild intoxication with acetylsalicylic acid (aspirin) is called salicylism and is experienced commonly when the daily dosage is more than 4g.

140. client with multiple sclerosis is receiving diazepam (Valium), an centrally acting skeletal muscle relaxant. Which of the following, if noted during assessment of the client, would indicate that the client is experiencing a side effect related to this medication? 1.Headache 2. Increased saliation

3. Urinary retention 4 Drowsiness. Answer 4 In coordination and drowsiness are common side effects resulting from this medication.

141 Allopurinol (Zyloprim) has been prescribed for a client. The nurse prepares to administer this medication , knowing that which of the following information is accurate about this medication? 1. Allopurinol is used for the lysis of thrombin obstructing coronary arteries. 2. Allopurinol prevents calcium ions entry across cells membranes of the cardiac smooth muscle 3 Allopurinol decreases sympathetic outflow from the central nervous system 4. Allopurinol decreases uric acid productions and reduces uric acid concentrations in the serum and urine. Answer 4 Allopurinol is an antigout medication. Allopurinol decrease uric acid production by inhibiting xanthine oxidase, an enzyme, and reduces uric acid concentrations in serum and urine.

142.A community health nurse visits a client at home. The client is taking Allopurinol 400mg PO daily. The nurse instructs the client 1. That the effect of the medication will occur immediately 2. To drink 3000mL of fluid per day. 3. To take the medication on an empty stomach 4. Than if swelling of the lips occurs, this is a normal expected response. Answer 2 Clients taking allopurinol are encouraged to drink 3000mL of fluid daily

143. Colchicine is prescribed for a client with a diagnosis of gout. The nurse reviews the clients record knowing that this medication would be contraindicated in which of the following disorders? 1. Renal failure 2. Hypothyroidism 3. Diabetes mellitus 4. Myxedema Answer 1 Colchicine is contraindicated in clients with severe gastrointestinal, renal, hepatic, or cardiac disorders and in clients with blood dyscrasias.

144 A home health nurse is caring for a client who is taking prbenecid (Benemid). The client has been instructed to restrict the diet to low-purine foods. Which of the following foods would the nurse instruct the client to avoid? 1. Potatoes 2. Ice cream 3Spinach 4 Scallops Answer 4 Uric acid is produced when purine is catabolized. Probenecid is medication used for clients with gout to inhibit the reabsorption of uric acid by the kidney and promote excretion of uric acid in the urine.

145.A physician prescribes auranofin (Ridaura) for a client with rheumatoid arthritis. Which of the following would indicate to the nurse that the client is experiencing toxicity related to the medication? 1. Constipation 2. A metallic taste in the mouth 3. Ringing in the ears

4. Joint pain Answer 2 Auranofin is the one gold preparation that is given orally rather than by injection. Gastrointestinal reactions including diarrhea, abdominal pain, nausea, and loss of appetite are common early in therapy but usually subside in the first 3 months.

146. Alendronate (Fosamax) is prescribed for a client with osteoporosis. The nurse instructs the client to 1. Take the medication at bedtime 2. Take the medication with a full glass of water after rinsing in the morning 3. Take the medication in the morning with breakfast 4. To lie down for 30 minutes after taking the medication. Answer 2 Precautions need to be taken with administration of alendronate to prevent gastrointestinal side effects and increase absorption of the medication.

147. A film-coated form of diflunisal (Dolobid), a non-steroidal anti-inflammatory medication has been prescribed for a client to treat chronic rheumatoid arthritis. The client calls the clinic nurse because of difficulty swallowing the tablets. Which of the following instructions would the nurse provide to the client? 1. Crush the tablets and mix with food 2. Open the tablet and mix the contents with food. 3. Swallow the tablets with large amounts of water or milk 4. Notify the physician for a medication change. Answer 3 Dolobid may be given with water, milk or meals. The tablet should not be crushed or broken open.

148. Baclofen (Lioresal) is prescribed for a client with multiple sclerosis. The nurse monitors the client, knowing that the primary therapeutic effect of this medication is which of the following? 1. Increased muscle tone 2. Decreased muscle spasm 3. Decreased local pain an tenderness 4. Increased range of motion Answer 2 Baclofen is a skeletal muscle relaxant and acts at the spinal cord level to decrease the frequency and amplitude of muscle spasms in clients with spinal cord injuries or debilitating disease such as multiple sclerosis.

149. A nurse is monitoring client receiving baclofen (Lioresal) for side effects related to the medication. Which of the following would indicate that the client is experiencing a side effect? 1. Drowsiness 2. Diarrhea 3. Polyuria 4. Muscular excitability Answer 1 Baclofen is a skeletal muscle relaxant and frequently causes drowsiness, dizziness, weakness, and fatigue.

150. A nurse is providing discharge instructions to a client receiving baclofen. Which of the following would be included in the teaching plan? 1. Restrict fluid intake 2. Avoid the use of alcohol

3. Stop the medication if diarrhea occurs. 4. Notify the physician if fatigue occurs Answer 2 Baclofen is a skeletal muscle relaxant. The client should be cautioned against the use of alcohol and other CNS depressants because baclofen potentiates the depressant activity of these agents.

151. An adult client with muscle spasms is taking an oral maintenance dose of baclofen. Which of the following represents a safe maintenance dose for this medication? 1. 15 mg qid 2. 25 mg qid 3 30mg qid 4 40 mg qid Answer 1 Baclofen is dispensed in tablet of 10 to 20mg for oral use. Dosages are low initially and then are increased gradually. Maintenance doses range from 15 to 20 mg administered 3 to 4 times a day.

152. A client with acute muscle spasms has been taking baclofen(Lioresal). The client calls the clinic nurse fatigue and asks the nurse about discontinuing the medication. Which of the following responses to the client would be most appropriate? 1. It is best that you taper the dose if you intend to stop the medication 2. Weakness and fatigue commonly occur and will diminish with continued medication use 3. It is all right to stop the medication if you think that you can tolerate the muscle spasms 4. You should never stop the medication Answer 2 The client should be instructed that symptoms such as drowsiness, weakness and fatigue are more intense in the early phase of therapy and diminish with continued medication use.

153. Dantrolene sodium (Dantrium) is prescribed for the client experiencing flexor spasms. The nurse monitors the client, knowing that which of the following is the therapeutic action of this medication? 1. Dantrolene acts within the spinal cord to suppress hyperactive reflexes. 2 Dantrolene acts on the central nervous system to suppress spasms 3 Dantrolene acts directly on the skeletal muscle to relieve spasticity. 4. Dantrolene depresses spinal reflexes. Answer 3 Dantrolene (Dantrium) acts directly on skeletal muscle to relieve muscle spasticity

154. A nurse is analyzing the laboratory studies on a client receiving dantrolene sodium (Dantrium). Which of the following laboratory tests would identify and adverse effect associated with the administration of this medication? 1. Blood urea nitrogen 2. Creatinine 3. Liver function tests 4. Platelet count Answer 3 Dose-related liver damage is the most serious adverse effect of dantrolene.

155. A physician is planning to administer a skeletal muscle relaxant to a client with a spinal cord injury. The medication is going to be administered intrathecally. Which of the following medications would the nurse expect? 1. Cyclobenzaprine hydrochloride(Flexeril) 2. Chlorozaxazone (Paraflex) 3. Dantrolene sodium (Dantrium) 4. Baclofen (Lioresal)

Answer 4 Baclofen is the only skeletal muscle relaxant that can be administered intrathecally within the spinal column.

156. A nurse is reviewing the record of a client who has been prescribed baclofen. Which of the following disorders, if noted in the clients history, would alert the nurse to contract the physician? 1. Coronary artery disease 2. Diabetes mellitus 3. Seizure disorders 4. Hyperthyroidism Answer 3 Clients with seizure disorders may have a lowered seizure threshold when baclofen is administered.

157. Cyclobenzaprine hydrochloride is prescribed for a client for muscle spasms. The nurse is reviewing the clients record. Which of the following disorders, if noted in the record, would indicate a need to contact the physician about the administration of this medication? 1.Glaucoma 2. Hypothyroidism 3. Emphysema 4. Diabetes mellitus Answer 1 Because cyclobenzaprine(Flexeril) has anticholinergenic effects, it should be used with caution in clients with a history of urinary rentention, glaucoma , and increased intraocular pressure.

158. A client is to receive a prescription for methocarbamol (Robaxin). The nurse provides instructions to the client about the medication. Which of the following client statements would indicate a need for further education? 1. My urine may turn brown or green 2. If my vision becomes blurred, I dont need to be concerned about it 3 I might get some nasal congestion from this medication 4. This medication is prescribed to help relieve my muscle spasms Answer 2 The client needs to be told that the urine may turn brown, black, or green.

159. A nurse is administering an intravenous dose of methocarbamol (Robaxin) to a client with multiple sclerosis. For which of the following adverse effects would the nurse monitor? 1. Hypertension 2. Tachycardia 3. Rapid pulse 4. Bradycardia Answer 4 Intravenous administration of methacarbamol can cause hypotension and bradycardia. The nurse needs to monitor for these side effects.

160. A nurse is reviewing a physicians orders for an adult client who has been admitted to the hospital following a back injury. Carisoprodol (Soma) is prescribed for the client to relieve the muscle spasms. The physician has prescribed 350mg to be administered 4 times a day. The nurse determines that this dosage is 1.The normal adult dosage. 2. A lower than normal dosage

3. A higher than normal dosage. 4. A dosage requiring further clarification. Answer 1 The normal adult dosage for carisprodol (Soma) is 350 mg PO 3 to 4 times daily.

161. Dapsone (Avlosulfon) is prescribed for a client with acquired immunodeficiency syndrome to treat toxoplasmosis. The nurse reinforces medication instructions and tells the client to. 1. Discontinue the medication if nausea and vomiting develops 2. Plan to take the medication every 6hours around the clock. 3. Contact the physician if fever or a sore throat occurs. 4. Report to the clinic weekly for the injections. Answers 1 Dapsone may be prescribed to treat toxoplasmosis.

162. Pyrimenthamine (Daraprim) has been added to the medication regimen for the client with acquired immunodeficiency syndrome. On review of the clients record, the nurse notes this new prescription and plans care knowing that this has been prescribed to treat 1.Toxoplasmosis 2. Cardiac irregularities 3 Kaposis sarcoma. 4. Nausea and vomiting. Answer 1 Pyrimethamine (Daraprim) is an antimalarial and an antirotozoal medication used to treat toxoplasmosis or Pneumocytis Carinii pneumonia.

163. Saquinavir (Fortovase) is prescribed for the client who is human immunodeficiency virus seropositiv. The nurse reinforces medication instructions and tells the client to 1. Take the medication on an empty stomach 2. Eat low-calorie foods 3. Eat foods that are low in fat 4. Avoid sun exposure Answer 4 Saquinavir is an antiretroviral used with other antiretroviral medications to manage human immunodeficiency virus infection.

164. The clininc is providing medication instructions to a client who will be receiving hydroxychloroquine Sulfate (Plaquenil) to treat systemic lupus erythematosus. The nurse instructs the client about the importance of returning to the clinic in 6 months for which of the following? 1. Dental examination 2. Eye examination 3. Chest radiograph 4. Sigmoidoscopy Answer 2 Ocular toxicity is an adverse reaction to use of hydroxychloroquine sulfate.

165. The client who is human immunodeficiency virus seropositive has been taking Stavudine (d4t,Zerit). The nurse monitors which of the following most closely while the client is taking this medication? 1 Appetite 2 Gait 3. Gastrointestinal function

4. Level of consciousness Answer 2 Stavudine is an antiretroviral used to manage immunodeficiency virus infection in clients who do not respond to or who cannot tolerate convention therapy.

166. The client who is human immunodeficiency virus seropositive has been taking Stavudine (d4t,Zerit). As a component of treatment. The nurse plans to monitor which of the following most closely while the client is taking this medication? 1.Liver function studies 2. Platelet count 3 Red blood cell count 4. Glucose level Answer 1 Zalcitabine is an antiretroviral( Nucleoside reverse transcriptase inhibitor) used to manage human immunodeficiency virus infection with other antiretrovirals.

167. The nurse is assigned to car for a client with cytomegalovirus retinitis and acquired immunodeficiency syndrome who is receiving fasocarnet (Fasocavir). The nurse checks the latest results of which of the following lab studies while the client is taking the medication? 1. Serum albumin 2.Serum creatinine 3 CD4 cell count 4. Lymphocyte count Answer 2

Foscarnet (Foscavir) is toxic to the kidneys. Serum creatinine is monitored before therapy, 2 to 3, times per week during induction therapy, and last weekly during maintenance therapy.

168. The client with acquired immunodeficiency syndrome and Pneumocystitis carinii infection has been receiving pentamidine (Pentam 300). The client dveopls a temp of 101 degrees F. The nurse does further monitoring of the client, knowing that this sign would most likely indicate 1 The dose of the medication is too low. 2. The client is experiencing toxic effects of the medication 3. The client has developed inadequacy of thermoregulation 4 The result of another infection caused by leukopenic effects of the medication. Answer 4 Frequent side effects of this medication include leucopenia, thrombocytopenia, and anemia. The client should be monitored routinely for signs and symptoms of infection.

169. The client with acquired immunodeficiency syndrome has begun therapy with zidovudine (Retrovir, AZT). The nurse carefully monitors which of the following laboratory results during treatment with this medication? 1. Complete Blood count 2.Blood urea nitrogen 3. Blood culture 4 Blood glucose level Answer 1 A common side effect of this medication therapy is agranulocytopenia and anemia. The nurse monitors the complete blood count results for these changes.

170. The nurse is reviewing the results of serum laboratory studies drawn on a client with acquired immunodeficiency syndrome who is receiving didanosine (Videx). The nurse interprets that the client

may have the medication discontinued by the physician if which of the following significantly elevated results is noted? 1. Serum creatinine 2. Serum amylase 3 Blood glucose 4 Serum protein Answer 2 A serum amylase level that is increased 1.5 to 2 times normal may signify pancreatitis in the client with acquired immunodeficiency syndrome and is potentially fatal.

171. A client receiving lithium carbonate (Lithobid ) complains of loose, watery stools, and difficulty walking. The nurse would expect the serum lithium level to be which of the following. 1. 0.7 mEq/L 2. 1 mEq/L 3. 1.3 mEq/L 4. 1.8 mEq/L Answer 4 The therapeutic serum level of lithium is 0.6 to 1.2 mEq/L. A serum lithium level of 1.8 mEq/L indicates moderate toxicity. Serum lithium concentrations of 1.5 to 2.5 mEq/L may produce vomiting, diarrhea, antaxia, incoordination, muscle twitching, and slurred speech.

172 The nurse is teaching a client wh is being started on imipramine hydrochloride(Tofranil) about the medication. The nurse informs the client that the maximum desired effects may 1. Start during the first week of administration 2. Start during the second week of administration

3. Not occur for 2 to 3 weeks of administration. 4. Not occur until after 2 months of administration. Answer 3 The maximum therapeutic effects of imipramine hydrochloride may not occur for 2 to 3 weeks after anti depressant therapy has been initiated

173. A client receiving thioridazine hydrochloride (Mellaril) complains of feeling faint when trying to get out of bed in morning. The nurse recognizes this complaints as a symptom of 1. Pscyhcosmomatic dysrhythmias 2.Cardiac dysrhythmias 3 Respiratory insufficiency 4. Postural hypotension Answer 4 Thioridazine hydrochloride (Mellaril), an antipsychotic can cause postural hypotention. The client needs to be taught to get out of bed slowly and to rise from a sitting position slowly because of this untoward effect related to the medication.

174. The client receiving tryclic antidepressants arrives at the mental health clinic. Which observation would indicate that the client is following the medication plan correctly? 1.Client reports sleeping 12 hours per night and 3 to 4 hours during the day 2. Client arrives at the clinic neat and appropriate in appearance 3. Client reports not going to work for this past week 4. Client complains of not being able to do anything anymore Answer 2

Depressed individuals will sleep for long perioids, are not able to go to work, and feel as if they cannot do anything. Once they have had some therapeutic effect from their medication, they will report resolution of many of these complaints and demonstrate an improvement in their appearance.

175. The nurse is performing a follow-up teaching session with a client discharged 1 month ago. The client is taking fluoxetine (Prozac). What information would be important for the nurse to obtain during this client visit regarding the side effects related to the medication? 1. Problems with excessive sweating 2. Gastrointestinal dysfunctions 3. Cardiovascular symptoms 4. Problems with mouth dryness Answer 2 The most common side effects related to this medication include central nervous system and gastrointestinal system dysnfunction.

176 The client who has been taking busiprone hydrochloride (BuSpar) for 1 month returns to the clinic for a follow-up assessment. The nurse determines that the medication is effective if the absence of which manifestation(S) has occurred? 1. Alcohol withdrawal symptoms 2. Paranoid thought process 3 Rapid heartbeat or anxiety 4. Thought broadcasting or delusions Answer.3 Busipron hydrochloride is not recommended for the treatment of drug or alcohol withdrawal, though disorders, or schizophrenia. Busipron hydrochloride most often is indicated for the treatment of anxiety

177. A client taking lithium carbonate (Eskalith) reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is 2.5 mEq/L The nurse interprets this level as 1. Normal 2. Slightly above normal 3. Excessively below normal 4. Toxic Answer 4 Maintenance serum levels of lithum are 0.6 to 1.2 mEq/L. Symptoms of toxicity begin to appear at levels of 1.5 mEq/L to 2 mEq/L. Lithium toxicity requires immediate medical attention with lavage and possible peritoneal dialysis or hemodialysis.

178. A hospitalized client is prescribed chloral hydrate (Noctec). The nurse includes which action in the plan of care? 1. Monitor apical heart rate every 2 hours 2. Monitor blood pressure every 4 hours 3. Instruct the client to call for ambulation assistance 4. Clear a path to the bathroom at bedtime Answer 3 Chloral hydrate is sedative. This medication does not affect cardiac function.

179. The home health nurse visits the client. The client gives the nurse a bottle of clomipramine hydrochloride (Anafranil). The nurse notes that the medication has not been taken by the client in 2 months. What behaviors observed in the client would validate noncompliance with this medication? 1.Frequent hand washing with hot, soapy water 2. Complaints of hunger fatigue

3. A pulse rate fewer than 60 beats per minute 4. Complaints of insomnia Answer 1 Clomipramine hydrochloride is a tricyclic antidepressant used to treat obsessive compulsive disorder.

180 The mental health clinic nurse is discussing the activities of the past week with a client receiving amitriptyline hydrochloride (Elavil). The nurse evaluates that the medication is most effective for this client if the client reports which of the following? 1. Ability to get to work on time each day 2. Having difficulty concentrating on an activity 3. Sleeping 14 to 16 hours a day 4. Decrease in appetite Answer 1 Amitiriptyline is a tricyclic antidepressant. Depressed individuals sleep for extended periods, have difficulty concentrating. They may also experience increase fatigue, feelings of guilt or worthlessness, loss of interest in activities, and possible suicidal tendencies.

181. The client with schizophrenia has been started on medication therapy with haloperidol (Haldol). The nurse determines that the client is experiencing the intended effects of the medication if which of the following clients behaviors is observed? 1 Decreased appetite and food intake 2 Taking sips of water for dry mouth 3 Presence of a fixed stare 4 Absence of delusional statements Answer 4 Haloperidol (Haldol) is an antipsychotic used to manage psychotic disorder.

182. The hospitalized client has begun taking bupropion ( Wellbutrin) as an antidepressant agent. The nurse monitors this client for which adverse effect that indicates that the client is taking an excessive amount of medication? 1. Dizziness when getting upright 2 Seizure activity 3. Increased weight 4 Constipation Answer 2 The nurse monitors for signs of toxicity. Seizure activity is common in bupropion dosage greater than 450 mg daily. This medication does not cause significant orthostatic blood pressure changes.

183. The client has been started on medication therapy with alprazolam (Xanax). When the nurse teaches the client that the medication should not be discontinued abruptly, the client asks why. The nurse incorporates which of the following in formulating a reply? 1. Rebound central nervous system excitation could occur, causing feelings of restlessness and irritability 2. Abruptly stopping the medication will make the medication much less effective if it must be restarted. 3. The client is likely to become resistant to medication effects. 4. The client is likely to suffer irreversible damage to the kidneys Answer 1 The abrupt withdrawal of alprazolam could result in seizure activity from rebound central nervous system excitation. All clients receiving this medication should be warned of this danger.

184. The clients medication sheet contains an order for sertraline hydrochloride (Zoloft). To ensure safe administration of the medication, the nurse would administer the dose. 1. Evenly spaced around the clock

2. At the same time each evening 3. On an empty stomach 4. As needed when the client complains of depression Answer 2 Sertraline (Zoloft) is classified as an antidepressant sertraline generally is administered once every 24 hours may be administered in the morning or evening, but evening administration may be preferable because drowsiness is a side effect.

185. The client with schizophrenia has been started on medication therapy with clozapine (Clozaril). The nurse assess the results of which laboratory study to monitor for adverse effects from this medication? 1. White blood cell count 2. Platelet count 3. Blood glucose 4. Liver function studies Answer 1 The client taking clozapine may experience agranulocytosis, which is monitored by reviewing the results of the white blood cell count. Treatment is interrupted if the white blood cell count drops below 3000 cells/mm3. Agranulocytosis could be fatal if undetected and untreated

186. A client is scheduled for discharge and will be taking Phenobarbital sodium (Luminal) for an extended period of time. The nurse Would place highest priority on teaching the client which of the following points that directly relates to client safety? 1. Avoid drinking alcohol while taking this medication 2. Take the medication only with meals. 3 Take medication at the same time each day 4. Use a dose container to help prevent missed doses.

Answer 1 Phenobarbital sodium is an anticonvulsant and a hypnotic agent. The client should avoid taking any other central nervous system depressants ( such as alcohol) while taking this medication.

187. The 26-year-old female client with schizophrenia has been prescribed chlorpromazine (Throazine). The client calls for mental health clinic and tells the nurse that her urine has become dark. The client has no other urinary symptoms. The nurse tells the client 1 To increase intake of acid-ash foods and liquids. 2 To seek treatment for urinary tract infection 3. That this is an expected side effect of the medication. 4. That this indicates medication toxicity. Answer 3 Chlorpromazine is an antipsychotic medication. A side effect of this medication is that the color of urine may darken. The client should be aware that this effect is harmless.

188. A client is receiving fluhenazine hydrochloride (Prolixin) daily. The nurse would teach the client to do which of the following to minimize common side effects of this medication? 1. Have the blood pressure checked once a week 2. Monitor the temperature daily 3. Eat snacks at midmorning and at bedtime. 4. Use hard sour candy of sugarless gum. Answer 4 Dry mouth is a common side effect. Frequent mouth rinsing with water, sucking on hard candy, and chewing sugarless gum will alleviate this common side effect. Hypotension and hypertension are rare side effects of fluphenazine. Mild leucopenia may occur but the temperatures does not need to be taken daily. Weigh gain is a common side effect, and frequent snacks will worsen the problem.

189. The nurse is describing the medication side effects to a client who is taking oxazepam (Serax). The nurse incorporates in discussions with the client the need to 1. Take antidiarrheal agents if diarrhea occurs. 2. Rest if the heart begins to beat rapidly 3. Consume a low-fiber diet 4. Increase fluids and bulk in the diet. Answer 4 Oxazepam causes constipation, and the client is instructed to increase fluid intake and bulk (high fiber) in the diet. If the heart begins to beat fast, the physician is notified because this could indicate overdose. Additionally, diarrhea could indicate an incomplete intestinal obstruction and if this occurs , the physician is notified

190. The nurse is administering thioridazine hydrochloride(Mellaril) in oral concentrate form. The nurse prepares this medication by mixing it in which of the following just before giving it to the client? 1. TEA 2 Fruit Juice 3 Pudding 4 Applesauce Answer 2 The oral concentrate form of thioridazine (Mellaril) should be diluted in water or fruit just before administration to the client. The other options are incorrect.