1 When caring for a client receiving warfarin sodium (Coumadin), which lab test would the nurse monitor

to determine
therapeutic response to the drug?

a. Coagulation time

b. Partial thromboplastin time

c. Prothrombin time

d. Bleeding time

Prothrombin time. -Coumadin is ordered daily, based on the client''s prothrombin time (PT). This test evaluates the
adequacy of the extrinsic system and common pathway in the clotting cascade; Coumadin affects the Vitamin K
dependent clotting factors.
2A client has been receiving total parenteral nutrition (TPN) for several days. The central venous catheter (CVP)
became dislodged and the nurse notes that the clients I.V. has not been running for several hours. The nurse would
monitor which of the following complications related to the stopped infusion?

a. Hyperkalemia

b. Sepsis

c. Hypoglycemia

d. Hypocalcemia

3The client’s body has adjusted to higher blood glucose levels as a result of receiving TPN with high dextrose
concentrations. Abruptly stopping the TPN can result in hypoglycemia. The other options are incorrect.
Systematic rotation of injection sites within an anatomic area is recommended to prevent:

a. Dawn phenomenon

b. Insulin lipodystrophy

c. Somogyi effect

d. Insulin resistance

Insulin lipodystrophy refers to a localized reaction in the form of either lipoatrophy or lipohypertrophy, occurring at the
site of insulin injections. Lipoatrophy is a loss of subcutaneous fat and appears as a slight dimpling or more serious
pitting of subcutaneous fat. Lipohypertrophy is the development of fatty masses at the injection site because of
repeated use of that injection site. If insulin is injected to the scarred areas, absorption may be delayed. This is the
reason why rotating injection sites are so important.
Insulin resistance - has been defined as a daily insulin requirement of 200 units or more
Dawn phenomenon - a cause of morning hyperglycemia where there is relatively normal blood glucose until about
3am when the level begins to rise
Somogyi effect- also a cause of morning hyperglycemia where there is a normal or elevated blood glucose, a
decrease at 2am to hypoglycemic levels and a subsequent increase caused by the production of counterregulatory
hormones.
4.Lala, a 23-year-old nursing student, went to the clinic to have a Hepatitis B vaccine. The nurse attendant knows that
she will administer the vaccine in the:

a. Vastus Lateralis site

b. Deltoid site

c. Dorsogluteal site

d. Ventrogluteal site

The deltoid site / muscle is found on the lateral aspect of the upper arm. It is not often used for intramuscular
injections because it is relatively small and very close to the radial nerve. It is sometimes considered for adults
because of the rapid absorption from the deltoid area but no more than 1 ml of the solution can be administered. This
site is the recommended site for the administration of Hepatitis B vaccine in adults.
is instructing the client on how to use a metered dose inhaler. The nurse determines that the client understands her
instructions when she observed the client doing the following?

a. Exhaling immediately after the puff

b. Administering 2 puffs in rapid order between breaths

c. Holding the inhaler 1-2 inches away from open mouth

d. Not shaking the canister before the puffs

The client should be instructed to hold the inhaler one to two inches away from open mouth or put the mouthpiece far
enough into the mouth with its opening toward the throat, hold the breath for 10 seconds, slowly exhale through
pursed lips and wait 2 minutes between puffs. The client should be instructed to shake the canister before the puff
vigorously for 3-5 seconds to mix the medication evenly.
The nurse is preparing to discharge a child who has rheumatic fever. Which of the following medications is prescribed
to prevent recurrence of rheumatic fever?
.

a. Anti-inflammatory medications

b. Antibiotics

c. Glucocorticoids

d. Digoxin (Lanoxin)

Because the child with rheumatic fever is at risk for a recurrence, especially if the condition is complicated by carditis,
long-term antibiotic therapy is necessary into adulthood, maybe even for life. Digoxin may be prescribed to treat heart
failure but it doesn't prevent the recurrence of rheumatic fever. Corticosteroids and anti-inflammatory medications
reduce inflammation in rheumatic fever but won't prevent a recurrence.
The physician orders pilocarpine (Pilocar) eye drops for a client. The nurse’s knows that Pilocar is prescribed
primarily for the treatment of:

a. Cataracts
 b. Retinal detachment

c. Open-angle glaucoma

d. Macular degeneration

Pilocar is a miotic used for open-angle glaucoma. It causes constriction of the iris sphincter muscles, resulting in
miosis. This opens the channels for the drainage of aqueous humor.
The nurse prepares to administer medication by the buccal route. Where should the nurse place this medication?

a. In the client's conjunctival sac

b. On the client's skin

c. Under the client's tongue

d. Between the client's cheek and gums

The nurse should place medication administered by the buccal route in the client's upper or lower buccal pouch,
between the cheek and gum. A topical medication is applied on the client's skin; a sublingual medication, under the
tongue; and an eye (ocular) medication, in the conjunctival sac.
The physician orders an I.V. infusion at 125 ml/hour for a client. To determine the I.V. drip rate, the nurse must know
the drip factor, which is:

a. The number of drops per hour to be infused

b. The number of milliliters in one drop

c. The number of drops in one milliliter

d. The number of drops per minute to be infused

The drip factor is the number of drops in one milliliter, not the number of milliliters in one drop. The drip rate refers to
the number of drops infused per minute. The flow rate is the number of milliliters, not the number of drops, infused
per hour.
A client with a severe brain injury receives IV mannitol and corticosteroids in the emergency department. The desired
effect of this treatment is to:

a. Reduce cerebral edema

b. Improve renal function

c. Promote cerebral vasodilation

d. Prevent central nervous system infection

Mannitol is an osmotic diuretic and used specifically for reducing cerebral edema. Corticosteroids posses anti-
inflammatory action.
Improve renal function – is incorrect because these drugs do not affect renal function.
Promote cerebral vasodilation – is incorrect because these drugs do not affect cerebral blood vessels. Cerebral
vasodilation would only increase intracranial pressure.
Prevent central nervous system infection – is incorrect because these drugs do not prevent infection. Instead,
steroids masks the signs of infection and depress the immune system.

After a client receives an I.M. injection, he complains of burning pain at the injection site. Which nursing action would
be the best to take at this time?

a. Apply a warm compress to dilate the blood vessels.

b. Apply a cold compress to decrease swelling.

c. Massage the area to promote absorption of the drug.

d. Instruct the client to tighten his gluteal muscles to promote better absorption.

Applying heat increases blood flow to the area, which, in turn, increases the absorption of the medication. Cold
decreases the pain but allows the medication to stay in the muscle longer. Massage is a good intervention, but
applying a warm compress is better. Tightening the gluteal muscles may cause additional burning if the drug irritates
muscular tissues.
The physician has ordered to administer a hypotonic intravenous solution to a client with cellular dehydration. The
nurse would expect to which of the following fluids to be administered?

a. 0.9% Normal Saline solution

b. 0.45% sodium chloride

c. 5% dextrose in normal saline

d. Lactated Ringer’s solution

The solution of 0.45% normal saline is a hypotonic solution that draws fluid from the vascular compartment into the
cells. The other options are isotonic (Lactated Ringer’s solution and b0.9% Normal Saline solution) and
hypertonic (5% dextrose in normal saline).
Which of the following findings contraindicate the use of haloperidol (Haldol) and warrant withholding the dose?

a. Drowsiness, lethargy, and inactivity

b. Rash, blood dyscrasias, severe depression

c. Dry mouth, nasal congestion, and blurred vision

d. Hyperglycemia, weight gain, and edema

Rash, blood dyscrasias, severe depression. Rash and blood dyscrasias are side effects of anti-psychotic drugs. A
history of severe depression is a contraindication to the use of neuroleptics.
The 6-month-old client with a ventral septal defect is receiving Digitalis for regulation of his heart rate. Which finding
should be reported to the doctor?
 a. Respiratory rate of 30 breaths per minute

b. Blood glucose of 110mg/dL

c. Blood pressure of 126/80

d. Heart rate of 60 bpm

A heart rate of 60 in the infant should be reported immediately. The dose should be held if the heart rate is below
100bpm. The blood glucose, blood pressure, and respirations are within normal limits; thus answers Blood pressure
of 126/80 , Blood glucose of 110mg/dL , and Respiratory rate of 30 breaths per minute are incorrect.
The physician orders ear drops for a 3-year-old child with otitis media. The nurse watches the child’s parent
administer the ear drops. Which of the following observations, if made by the nurse, would require an intervention?

a. The parent warms the medication to room temperature before instilling the ear drops.

b. The parent places a cotton ball in the child’s ear after instilling the ear drops.

c. The parent has the child lie down before instilling the ear drops.

d. The parent pulls the auricle of the child’s ear up and back to instill the ear drops.
The auricle of the ear should be pulled down and back to straighten the canal of a young child.
Option (The parent has the child lie down before instilling the ear drops), (The parent warms the medication to room
temperature before instilling the ear drops), and (The parent places a cotton ball in the child’s ear after instilling
the ear drops) – are correct procedures for ear instillation.
The physician prescribes 250 mg of a drug. The available drug vial reads 500 mg/ml. How much of the drug should
the nurse give?

a. ½ ml

b. 1 ml

c. ¼ ml

d. 2 ml

The nurse should give ½ ml of the drug. The dosage is calculated as follows:
250 mg/X = 500 mg/1 ml
500X = 250
X = ½ ml
The nurse is preparing an IM injection of vistaril which is irritating to the subcutaneous tissue. To prevent staining of
the medication and irritation to the tissues, it is best to take which of the following action?

a. Use the Z-track technique

 b. Apply ice to the injection site

c. Administer at a 45-degree angle

d. Use a small gauge needle

You received the medication order of:

Aminocaproic Acid (Amicar) 1.5 g STAT and repeat in 1 hour.
Available: 500 mg
How many tablet(s) should you give?

a. 1

b. 3

c. 4

d. 2

1.5 grams = 1500 mg / 500 mg = 3 tablets

Nurse Paloma is about to administer 25 mg of promethazine (Phenergan) intramuscularly to a client weighing 180
lbs. Nurse Paloma knows that this medication should be given into a large and well-developed muscle mass. The
preferred site of injection for this client would be which of the following?

a. Dorsogluteal muscle

b. Deltoid muscle

c. Ventrogluteal

d. Vastus lateralis

For an adult with a well-developed muscle mass, the preferred IM injection site for the medications requiring a large
muscle mass is the ventrogluteal. The vastus lateralis muscle is the preferred IM injection site for children under 7
months of age. The other options are incorrect.
The nurse is caring for a client who admits to a 15-year history of gastric ulcers. The nurse instructs the client to take
which of the following drugs for minor aches and pains?

a. Ibuprofen

b. Plain aspirin

c. Buffered aspirin

d. Acetaminophen
Acetaminophen (Tylenol) which is an analgesic/antipyretic has no adverse effect on the gastric mucosa and produces
no ulcerative effects when administered for pain. Aspirin is associated with the development of gastric ulcers. Non
steroidal anti inflammatory drugs (NSAIDS) such as Ibuprofen may cause gastric ulceration.

The nurse is setting an infusion pump to deliver 4 mcg/kg/min of a medication to a patient who weighs 50 kg. How
many micrograms should the patient receive in one hour?

a. 20,000

b. 1200

c. 200

d. 12,000
To calculate the dose multiply 50 kg times 4 mcg. This equals 200 mcg/min. Then multiply this by 60 to calculate
what the patient would receive in 1 hour. 200 x 60 = 12,000.
A nurse teaches a client about the effects of diphenhydramine (Benadryl), which has been ordered as a cough
suppressant. The nurse determines that the client needs further instructions if the client states that he or she will:

a. Use sugarless gum, candy, or oral rinses to decrease dry mouth

b. Take the medication on an empty stomach

c. Avoid driving or other activities requiring mental alertness while taking this medication

d. Avoid using alcohol while taking this medication

Diphenhdyramine (Benadryl) has several uses, including antihistamine, antitussive, antidyskinetic, and sedative-
hypnotic. Instructions for use include to take with food or milk to decrease gastrointestinal upset and to use oral
rinses or sugarless gum or hard candy to minimize dry mouth. Because the medication causes drowsiness, the client
should avoid use of alcohol or central nervous system depressants, operating a car, or engaging in other activities
requiring mental awareness during use.
Nurse Kim is administering meperidine (Demerol) IM, aspirates and finds blood in the syringe prior to injecting the
medication. Which of the following actions by Nurse Kim would be appropriate?

a. Continue to administer the medication because the needle has hit a capillary and would not be an
intravenous medication

b. Withdraw the needle, cleanse the needle and the new injection site with alcohol and administer the
medication again

c. Withdraw the needle, discard the medication and begin again with the medication administration
d. The nurse should continue to administer the medication because it is compatible with blood and would not
present a harmful effect

If blood returns while aspirating during an IM injection, the nurse should discontinue, withdraw, discard the medication
and prepare a new injection. Blood indicates that the needle has entered a blood vessel and the medication injected
into the bloodstream may be dangerous.
Why would the nurse be interested in a client's dietary history when administering drugs?

a. Vegetarian diets can cause more adverse drug reactions than diets containing meat
 b. High-sodium diets can increase the half-life of some drugs

c. Dietary intake can alter the effectiveness of some drugs

d. The number of calories consumed can alter a drug's metabolism

Dietary intake can alter the effectiveness of some drugs; for example, certain antibiotics are bound and made
ineffective by dairy products. A vegetarian diet doesn't cause more adverse drug reactions than does a diet
containing meat. Although excessive calories may alter the distribution of a drug, caloric intake doesn't affect a drug's
metabolism. Dietary intake, including sodium, doesn't affect the half-life of any drug.
The nurse is assessing the client’s I.V. and she observes that the area is swollen, pale, cool and causes the
client discomfort. The nurse suspects that which of the following problem is present?

a. Infection

b. Infiltration

c. Phlebitis

d. Air embolism

Infiltration is the leakage of fluids into the surrounding tissues resulting in edema in the insertion site, blanching and
the coolness of skin around the site. The other options are incorrect.
26 The nurse is caring for a client with myasthenia gravis. Who has become progressively weaker. Edrophonium
chloride (Tensilon) has been prescribed for which of the following purposes?

a. Increase skeletal muscle relaxation

b. Decrease difficulty of breathing

c. Differentiate between a cholinergic crisis and a myasthenic crisis

d. Treat the client’s muscle weakness

Edrophonium chloride (Tensilon) is used to differentiate between a cholinergic crisis and a myasthenic crisis. If the
client is experiencing a cholinergic crisis, Edrophonium (Tensilon) will result in an increased muscle weakness. If a
client is experiencing a myasthenic crisis, Edrophonium (Tensilon) will result in an improvement of the client’s
clinical manifestations.
Question 27
The nurse has an order to administer iron dextran, (InFeD) 50 mg I.M. injection. When carrying out this order, the
nurse should:

a. Use the Z-track technique

b. Insert the needle at a 45-degree angle

c. Pull the skin laterally toward the injection site

 d. Wipe the needle immediately after injection

Iron dextran is an iron preparation given using the Z-track technique to prevent leakage into the subcutaneous tissue
and staining of the skin. When giving an I.M. injection using the Z-track technique, the nurse pulls the skin laterally
away from the injection site to seal the drug in the muscle, inserts the needle at a 90-degree angle, waits 10 seconds
after injecting the medication to ensure drug dispersion, and then simultaneously withdraws the needle and releases
the skin to seal the needle track. Wiping the needle immediately after injection poses the risk of a needle stick.
Question 28
One drug can have as many as four kinds of names. Which name describes the constituents of the drug precisely?

a. Generic name

b. Chemical name

c. Brand name

d. Official name

The chemical name describes the composition of the drug. The generic name is given before the drug becomes
official while the official name is the name under which the drug is listed in the official publications. And lastly, the
brand name or the trademark name is the name given by the drug manufacturer.

Question 29
The nurse should expect which of the following medications to be prescribed for a client just diagnosed with
rheumatoid arthritis?

a. Calcium gluconate

b. Tylox (Tylenol with codeine)

c. Acetylsalicylic acid (Aspirin)

d. Sodium fluoride

Treatment for rheumatoid arthritis usually starts with salicylates. The goal of treatment is to relieve swelling, pain,
stiffness, and inflammation.
Calcium gluconate – used to maintain and replace calcium with hypocalcemia and hypoparathyroidism.
Sodium fluoride – is a supplement used to catalyze bone remineralization.
Tylox (Tylenol with codeine) – is not an anti-inflammatory medication. It is an analgesic and antipyretic.
Question 30
You received the medication order of:
Allopurinol (Zyloprim) 150 mg, po, qid.
Available: 300mg
How many tablet(s) should you give per dose?

a. 1/2

b. 1
 c. 1 1/2

d. 2

Required/Available x 1 tablet = x
150mg / 300 mg x 1 tablet = ½ tablet
Question 31
The nurse evaluates that the medication teaching is effective when the client with gastritis states that ranitidine
(Zantac):

a. Increases pepsin levels

b. Changes hormonal levels

c. Decreases pH levels

d. Decreases gastric acid levels

Ranitidine (Zantac) is a histamine 2 receptor antagonist which suppresses gastric acid secretion. Changing hormonal
levels is not a primary action of ranitidine. Cimetidine (Tagamet) suppresses pepsin production. Zantac also reduces
hydrogen ion concentration which will increase pH levels.

Question 32
the medication order of:
Digoxin 0.25 mg, po, STAT.
Available: 0.125 mg
How many tablet(s) are equivalent to Digoxin 0.25 mg?

a. 1

b. 4

c. 3

d. 2
0.250 mg / 0.125 mg x 1 tablet = 2 tablets

Question 33
A client with a large goiter is scheduled for a subtotal thyroidectomy to treat thyrotoxicosis. Which of the following is
the drug given before the procedure in conjunction with an anti-thyroid agent?

a. Lugol’s solution

b. Calcium gluconate

c. Levothyroxine

d. All of the above

Iodine (Lugols’s solution or potassium iodide) may be prescribed in an effort to reduce blood loss and create a
euthyroid state. Compounds such as potassium iodide and Lugol’s solution may be used in conjunction with an
antithyroid agent to prepare the client with hyperthyroidism for surgery. These agents reduce the activity of the thyroid
hormone and the vascularity of the thyroid gland making the surgical procedure safer.

.Question 34
taking phenytoin (Dilantin) for seizure control. A sample is drawn to determine the serum drug level, and the nurse
reviews the results. Which of the following would indicate a therapeutic serum drug range?

a. 30 to 40 mcg/mL

b. 20 to 30 mcg/mL

c. 10 to 20 mcg/mL

d. 5 to 10 mcg/mL

The therapeutic serum drug level range for phenytoin is 10 to 20 mcg/mL.

Question 35
The nurse is reconstituting a powdered medication in a vial. After adding the solution to the powder, the nurse should:

a. Stir the liquid with a sterile applicator

b. Shake the vial vigorously

c. Roll the vial gently between the palms

d. Invert the vial and let it stand for 2 to 3 minutes

Rolling the vial gently between the palms produces heat, which helps dissolve the medication. Stirring the medication
with a sterile applicator isn't accepted practice. Inverting the vial wouldn't help dissolve the medication. Shaking the
vial vigorously could cause the medication to break down, altering its action.
Question 36
Nurse Paloma is administering a client’s dose of sublingual nitroglycerin. The client asks the nurse why it is
administered sublingually rather than orally. Which of the following is the best response of Nurse Paloma?

a. “Sublingual provides a sustained release of the medication”

b. “It is absorbed more rapidly when swallowed than sublingually”

c. “The absorption rates are the same so it does not matter”

d. “It is absorbed more rapidly sublingually than when swallowed”

The thin layer of epithelium and the vast network of capillaries under the tongue enhance sublingual absorption. This
medication dissolves rapidly and is absorbed immediately. The other options are incorrect.

Question 37
What is the best way for the nurse to improve client compliance with the prescribed medication schedule?
 a. Give all instructions at least three times

b. Change the administration schedule to longer intervals

c. Devise the simplest medication schedule possible

d. Encourage the client to hire a visiting nurse

To improve client compliance, nurses should simplify the medication schedule. Compliance drops sharply when more
than three medications are prescribed; geriatric clients tend to use more than one medication concurrently. It's too
costly and impractical to hire a visiting nurse in most instances. Although instructions may need to be repeated, giving
all instructions at least three times doesn't necessarily ensure compliance. Moreover, a physician, not the nurse, must
decide how often a medication should be given.
Question 38
mg of Lasix (furosemide) PO at 10 AM. Which would be essential for the nurse to include at the change of shift
report?
Choose one answer.

a. The client lost 2 pounds in 24 hours

b. The client’s potassium level is 4 mEq/liter.

c. The client’s urine output was 1500 cc in 5 hours

d. The client is to receive another dose of Lasix at 10 PM

The client’s urine output was 1500 cc in 5 hours. Although all of these may be correct information to include in
report, the essential piece would be the urine output.
Question 39
Which type of solution raises serum osmolarity and pulls fluid from the intracellular and intrastitial compartments into
the intravascular compartment?

a. Hypertonic

b. Isotonic

c. Electrotonic

d. Hypotonic

A hypertonic solution has an osmolarity higher than that of serum. It draws fluid into the intravascular compartment
from the intracellular and interstitial compartments. An isotonic solution has an osmolarity about equal to that of
serum. It expands the intravascular and interstitial compartments. A hypotonic solution has an osmolarity lower than
serum. It shifts fluid out of the intravascular compartment, hydrating the intracellular and interstitial compartments.
Electrotonic solution is incorrect.
Question 40
The client admitted with angina is given a prescription for nitroglycerine. The client should be instructed to:

a. Crush the medication and take with water

 b. Replenish his supply every 3 months

c. Take one every 15 minutes if pain occurs

d. Leave the medication in the brown bottle

Nitroglycerine should be kept in a brown bottle (or even a special air- and water-tight, solid or plated silver or gold
container) because of its instability and tendency to become less potent when exposed to air, light, or water. The
supply should be replenished every 6 months, not 3 months, and one tablet should be taken every 5 minutes until
pain subsides, so answers (Replenish his supply every 3 months) and (Take one every 15 minutes if pain occurs) are
incorrect. If the pain does not subside, the client should report to the emergency room. The medication should be
taken sublingually and should not be crushed, as stated in answer (Crush the medication and take with water).
Question 41
Jenrick, a 2-year-old child, has been diagnosed with conjunctivitis. The nurse is to administer optic drops QID. The
nurse should drop the medication into the:

a. Lower conjunctival sac

b. Sclera by the inner canthus

c. Sclera by the outer canthus

d. Center of the cornea

The optic drops/medication are always placed in the lower conjunctival sac to prevent damage to the cornea and to
facilitate coating the eye with the medication. The other options are incorrect.
Question 42
Medication order: Augmentin 0.5 g, po, q8h.
Available: Augmentin 250 mg.
How many tablet(s) should you give per dose?

a. 1/2

b. 1

c. 2

d. 4

Order is .5 g / Available .25g x 1 = 2 tablets

Question 43
A nurse is caring for a client with a history of GI bleeding, sickle cell disease, and a platelet count of 22,000/μl. The
client is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hour. The client complains of
severe bone pain and is scheduled to receive a dose of morphine sulfate. In administering the medication, the nurse
should avoid which route?

a. I.M

b. Oral
 c. Subcutaneous (S.C.)

d. I.V.

With a platelet count of 22,000/μl, the client bleeds easily. Therefore, the nurse should avoid using the I.M. route
because the area is highly vascular and can bleed readily when penetrated by a needle. The bleeding can be difficult
to stop. The client already has an I.V. access, so it would be the best route, especially because I.V. morphine is
effective almost immediately. Oral and S.C. routes are preferred over I.M., but they're less effective for acute pain
management than I.V
Question 44
hepatic encephalopathy 1 week after portal caval shunt surgery. Her physician prescribes neomycin (Neo-Tabs), 4 g
by mouth daily in four divided doses. Her husband asks how neomycin decreases his wife's serum ammonia
concentration. How should the nurse respond?

a. It binds with ammonia in the GI tract

b. It decreases the number of ammonia-producing bacteria in the GI tract

c. It acidifies the colon and traps ammonia in the GI tract

d. It increases the growth of such bacteria as Escherichia coli

Neomycin lowers the blood ammonia level by reducing the number of ammonia-producing bacteria in the GI tract.
The drug also exerts its antibacterial activity directly on the ribosomes of susceptible organisms, among them E. coli,
by inhibiting protein synthesis via direct action on ribosomal subunits. When these bacteria are present, they convert
urea to ammonia. Neomycin is bactericidal in high concentrations and bacteriostatic in low concentrations. Thus, it
doesn't trap or bind with ammonia in the GI tract.
Question45
For intramuscular injections, several factors indicate the size and length of the needle to be used such as:
1. The age of the client
2. The type of solution
3. The amount of adipose tissue covering the muscle
4. The muscle

a. 1, 2, 3

b. none of the above

c. 2, 3, 4

d. all of the above

Question 46
an elderly client how to use MDI's (multi-dose inhalers). The nurse is concerned that the client is unable to coordinate
the release of the medication with the inhalation phase. What is the nurse's best recommendation to improve delivery
of the medication?

a. Adding a spacer device to the MDI canister

 b. Request a visiting nurse to follow the client at home

c. Asking a family member to assist the client with the MDI

d. Nebulized treatments for home care

Adding a spacer device to the MDI canister. If the client is not using the MDI properly, the medication can get trapped
in the upper airway, resulting in dry mouth and throat irritation. Using a spacer will allow more drug to be deposited in
the lungs and less in the mouth. It is especially useful in the elderly because it allows more time to inhale and
requires less eye-hand coordination.
Question 47
What type of drug interaction occurs when two drugs produces the same effect?
.

a. Synergistic effect

b. Additive effect

c. Increased absorption

d. Decreased effect

Potentiation (potentiating or synergistic effect) occurs when two drugs that produce the same effect are given
together. One drug enhances the effect of another drug, resulting in greater effect of both drugs.

Question 48
The physician orders nitroglycerin, 5 mg by mouth twice a day, for a client. The drug is dispensed in 2.5-mg tablets.
How many tablets will the nurse administer with each dose?

a. Two

b. Six

c. Four

d. Eight

The nurse will administer two tablets with each dose. Using the ratio method, the equation to solve for X is: 5 mg : X
tab :: 2.5 mg : 1 tab. Solving for X determines the quantity of the dosage form (two tablets, in this example).
Question 49
Allopurinol (Zyloprim) is prescribed for a client and the nurse provides medication instructions to the client. The nurse
instructs the client:

a. To take the medication on an empty stomach.

b. That the effect of the medication will occur immediately.

c. That if swelling of the lips occurs, this is a normal expected response.

d. To drink 3,000ml of fluid a day

Clients taking allopurinol are encouraged to drink 3,000 ml of fluid a day. A full therapeutic effect ma take 1 week or
longer. Allopurinol is to be given with or immediately after, meals or milk. A client who develops a rash, irritation of the
eyes, or swelling of the lips or mouth should contact the physician because this may indicate hypersensitivity.
Question 50
The nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of
800 mg/dl. Which solution is the most appropriate at the beginning of therapy?

a. 100 U of NPH insulin in dextrose 5% in water

b. 100 U of regular insulin in normal saline solution

c. 100 U of regular insulin in dextrose 5% in water

d. 100 U of neutral protamine Hagedorn (NPH) insulin in normal saline solution

Only short-acting regular insulin is used in continuous insulin infusions. Insulin is added to normal saline solution and
administered until blood glucose levels fall. Further along in the therapy, a dextrose solution is administered to
prevent hypoglycemia.