ATI Pharmacology Practice Questions Hematologic, Cardiovascular, Pain and Inflammation,100% CORRECT

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ATI Pharmacology Practice Questions Hematologic, Cardiovascular, Pain and Inflammation 1) A nurse is reinforcing teaching for a client who has angina pectoris and a new prescription to apply a ni... troglycerin transdermal patch daily at home. Which of the following instructions should the nurse give the client? ANSWERS - Multiple Choice 1) Fold used patch with medication area to the inside and discard in a closed receptacle. Answer Rationale: It is important to prevent pets, children, and others in the client’s home from coming into contact with the medication on the nitroglycerin patch. Therefore, the client should be instructed to fold the patch in half with the medication area to the inside and to discard the patch in a closed receptacle rather than in an open trash can. INCORRECT 2) Put a second patch in place if angina pain occurs. Answer Rationale: Nitroglycerin transdermal patches are designed for prophylaxis of angina pain and are not to be used to stop an existing angina attack. Adding a second patch is not appropriate and could cause adverse effects, such as hypotension. The client should discuss strategies for treating an angina attack with the provider. INCORRECT 3) Keep a nitroglycerin patch in place 24 hr per day. Answer Rationale: Since clients can develop tolerance to nitroglycerin, the transdermal patch should be removed after 12 to 14 hr each day, and the client should have 10 to 12 hr of time without a patch during the evening and nighttime hours. INCORRECT 4) Shave excess hair from skin before applying a nitroglycerin patch. Answer Rationale: The client should be instructed to apply the patch to a different hairless area each day. If it is necessary to apply the patch to an area with hair, the hair should be clipped, not shaved, to avoid irritation to the skin. 2) A nurse is caring for a client who has a deep vein thrombosis, who received IV heparin for the past 5 days, and now has a new prescription for oral warfarin in addition to the heparin. The client asks the nurse if both medications are necessary. Which of the following is an appropriate response by the nurse? ANSWERS - Multiple Choice INCORRECT 1) "Heparin enhances the effects of the warfarin." Answer Rationale: Neither medication enhances the effects of the other. INCORRECT 2) "I will ask the charge nurse to call your provider and get an explanation." Answer Rationale: The charge nurse does not need to call the provider for an explanation at this time. INCORRECT 3) "Both heparin and warfarin work together to dissolve the clots." Answer Rationale: Neither heparin nor warfarin dissolves clots that have already formed. 4) "Heparin will be continued until the warfarin reaches a therapeutic level." Answer Rationale: Heparin and warfarin are both anticoagulants that decrease the clotting ability of the blood and help prevent thrombosis formation in the blood vessels. However, they work in different ways to achieve therapeutic coagulation and must be given together until therapeutic levels of anticoagulation can be achieved by warfarin alone, which usually takes about 3 days. Oral warfarin therapy may continue for several months following discharge. 3) A nurse in a provider’s office is reviewing the laboratory results of four clients who take digoxin. Which of the following clients is at risk for developing digoxin toxicity? ANSWERS - Multiple Choice INCORRECT 1) A client who takes glyburide for type 2 diabetes mellitus Answer Rationale: Glyburide is an oral antidiabetic medication to treat type 2 diabetes mellitus. Altered glucose levels have no effect on digoxin toxicity. 2) A client who take furosemide for hypertension Answer Rationale: Loop diuretics such as furosemide can cause hypokalemia, which greatly increases the risk of digoxin toxicity. INCORRECT 3) A client who takes ranitidine to reduce gastric acid secretion Answer Rationale: Ranitidine can reduce the absorption of some medications such as cefuroxime and ketoconazole, but it does not increase the risk for digoxin toxicity. INCORRECT 4) A client who takes azelastine for allergic rhinitis Answer Rationale: Azelastine can cause central nervous system depression, but it does not increase the risk for digoxin toxicity. 4) A nurse is caring for a client who is postoperative and receiving fentanyl via patient controlled analgesia. The client has a prescription for naloxone. The nurse understands that the purpose of naloxone is which of the following? ANSWERS - Multiple Choice INCORRECT 1) To suppress respiratory secretions Answer Rationale: Atropine suppresses respiratory secretions. 2) Block the effects of opioids on the central nervous system Answer Rationale: Naloxone is a narcotic antagonist that combines competitively with opiate receptors and blocks or reverses the action of narcotic analgesics. By blocking the effects of narcotics on the central nervous system (CNS), it prevents CNS and respiratory depression. INCORRECT 3) To treat nausea Answer Rationale: Ondansetron is used to treat postoperative nausea. INCORRECT 4) To treat urinary retention Answer Rationale: Bethanechol is used to treat postpartum and postoperative urinary retention. 5) A nurse is caring for a client who has thrombophlebitis and is receiving a continuous infusion of heparin. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse make? ANSWERS - Multiple Choice INCORRECT 1) "It usually takes at least 2 to 3 days for heparin to dissolve a clot." Answer Rationale: Heparin does not dissolve established clots. Thrombolytic medications such as alteplase dissolve established clots. INCORRECT 2) "The time it takes heparin to dissolve clots varies between clients." Answer Rationale: Heparin does not dissolve established clots. Thrombolytic medications such as alteplase dissolve established clots. 3) "Heparin prevents new clots from forming rather than dissolving established clots." Answer Rationale: Heparin is an anticoagulant that prevents the formation of new clots by blocking the conversion of prothrombin to thrombin and fibrinogen to fibrin. It does not dissolve established clots. INCORRECT 4) "The time it takes for heparin to dissolve a clot depends on the size of the clot." Answer Rationale: Heparin does not dissolve established clots. Thrombolytic medications such as alteplase dissolve established clots. 6) A nurse is collecting data from a client prior to administering nifedipine. For which of the following findings should the nurse contact the provider? ANSWERS - Multiple Choice 1) Peripheral edema of the ankles Answer Rationale: Peripheral edema can occur due to the vasodilation principles of nifedipine. The nurse should monitor for edema of the feet and ankles and notify the provider if this occurs. INCORRECT 2) BP of 148/94 mm Hg Answer Rationale: The nurse should administer nifedipine to treat essential hypertension. The goal is to reduce the BP value below 140/90 mm Hg. The nurse does not need to contact the provider for this measurement. INCORRECT 3) Heart rate of 66/min Answer Rationale: Nifedipine will increase heart rate and can result in reflex tachycardia. A heart rate of 66/min is within the expected reference range. The nurse does not need to contact the provider for this measurement. INCORRECT 4) Increased alkaline phosphatase level Answer Rationale: Nifedipine can result in mild to moderate increases of alkaline phosphatase, CPK, LDH, AST and ALT levels. 7) A nurse is reinforcing teaching with a client who is to start taking enteric-coated naproxen for rheumatoid arthritis. Which of the following client statements by the client indicates a need for further teaching? ANSWERS - Multiple Choice INCORRECT 1) "I am taking this type of medication so it dissolves in my intestine, not my stomach." Answer Rationale: Naproxen tablets have an enteric coating that prevents them from dissolving in the stomach. Instead, the tablets pass into the intestine where they dissolve and the client absorbs it. This prevents gastric irritation. 2) "It's okay to crush a tablet as long as I make sure it dissolves completely in water before swallowing it." Answer Rationale: The client should not crush an enteric-coated tablet, because this will interfere with the coating and allow the medication to dissolve in the stomach, resulting in gastric irritation. INCORRECT 3) "I can take these pills with my meals." Answer Rationale: The client can take the medication with meals to decease gastrointestinal distress. INCORRECT 4) "I might not get relief from my pain for 3 to 4 weeks." Answer Rationale: It is important for the client to understand that she might not get experience the therapeutic effect for 3 to 4 weeks and to continue taking the medication. 8) A nurse is collecting data from a client prior to the administration of digoxin. Which of the following findings should the nurse report to the provider? ANSWERS - Multiple Choice INCORRECT 1) BP of 132/82 mm Hg Answer Rationale: This BP reading is within the expected reference range. The nurse does not need to report this finding to the provider. 2) Potassium level of 3.0 mEq/L Answer Rationale: The nurse should report a potassium level of 3.0 mEq/L to the provider. This finding is an indication of hypokalemia, which can lead to cardiac dysrhythmias, the most serious adverse effect of digoxin. INCORRECT 3) Digoxin level of 1.2 ng/mL Answer Rationale: A digoxin level of 1.2 ng/mL is within the expected reference range. The nurse does not need to report this finding to the provider. INCORRECT 4) Heart rate of 66/min Answer Rationale: The nurse should withhold the medication and notify the provider if the heart rate is below 60/min. The nurse does not need to report this finding to the provider. 9) A nurse is collecting data from a client who has hypertension and a prescription for propranolol. A history of which of the following conditions should be reported to the provider? ANSWERS - Multiple Choice INCORRECT 1) Migraine Answer Rationale: The use of propranolol is not contraindicated for a client who has a history of migraines. INCORRECT 2) Glaucoma Answer Rationale: Beta-blockers, such as propranolol, can be safely used by a client who has glaucoma. INCORRECT 3) Depression Answer Rationale: Depression is not a contraindication for the use of propranolol, a beta-blocker. 4) Heart failure Answer Rationale: Propranolol is used with caution in clients who have heart failure due to the depressive effect on myocardial contractility; therefore, the nurse should report this finding to the provider. 10) A nurse is preparing to administer heparin intravenously to a client. Which of the following actions should the nurse take? ANSWERS - Multiple Choice 1) Obtain an infusion pump to regulate the continuous flow of the medication. Answer Rationale: Because of the risk for bleeding, an infusion pump must be used to prevent overdosage and its rate must be checked every 30 to 60 min. INCORRECT 2) Verify that a dose of vitamin K is available as an antidote. Answer Rationale: Protamine zinc is the antidote for heparin, not vitamin K. INCORRECT 3) Insert an indwelling catheter to monitor closely the client’s urine output. Answer Rationale: Heparin is an anticoagulant that has no effect on urine output. INCORRECT 4) Schedule the client’s prothrombin time (PT) to be drawn at regular intervals. Answer Rationale: The activated partial thromboplastin time (aPTT), not the PT, is measured to determine the effectiveness of a heparin drip. 11) A nurse is caring for a client who is taking celecoxib daily. The nurse should identify that a history of which of the following disorders indicates a need for this type of medication? ANSWERS - Multiple Choice INCORRECT 1) Depression Answer Rationale: Celecoxib is not indicated for the treatment of depression. 2) Osteoarthritis Answer Rationale: Celecoxib is a nonsteroidal anti-inflammatory, cyclooxygenase-2 (COX-2) inhibitor used to relieve the pain and inflammation caused by rheumatoid arthritis and osteoarthritis in adults. INCORRECT 3) Infection Answer Rationale: Celecoxib is not indicated for the treatment of infection. INCORRECT 4) Seizures Answer Rationale: Celecoxib is not indicated for the treatment of seizures. 12) A nurse is caring for a client who has a prescription for clopidogrel. Which of the following actions should the nurse plan to take? ANSWERS - Multiple Choice 1) Monitor the client for black, tarry stools. Answer Rationale: Clopidogrel is an antithrombotic and antiplatelet medication; therefore, it poses a risk of serious bleeding. The nurse should monitor for signs of bleeding such as black, tarry stools and report these findings to the provider. INCORRECT 2) Initiate contact precautions. Answer Rationale: Contact precautions protect staff from acquiring an illness that spreads by direct contact, such as a methicillin- resistant Staphylococcus aureus infection. INCORRECT 3) Administer the medication with each meal. Answer Rationale: The nurse should administer clopidogrel once daily, with or without food. INCORRECT 4) Have suction equipment at the bedside. Answer Rationale: The nurse should have suction equipment at the bedside for a client who requires seizure precautions; however, this is not necessary for a client who is receiving this medication and is not otherwise at an increased risk for aspiration. 13) A nurse is caring for an older adult client who is 5 days postoperative following a total hip arthroplasty and is receiving meperidine for pain. While the nurse is taking morning vital signs, the client begins to experience a seizure. Which of the following should the nurse recognize as the possible cause for this seizure? ANSWERS - Multiple Choice INCORRECT 1) Antagonistic effect Answer Rationale: An antagonistic effect is a drug-drug interaction that results in the decreased effectiveness of one or both of the medications given. 2) Cumulative effect Answer Rationale: A cumulative effect occurs with repeated doses of a medication are given and the rate of administration exceeds the rate of metabolism or excretion. Due to older adults decreased kidney function, meperidine can quickly reach a toxic level when given over several days, which can cause seizures. INCORRECT 3) Synergistic effect Answer Rationale: A synergistic effect is a drug-drug interaction that results in an increased effectiveness of one or both of the medications given. INCORRECT 4) Teratogenic effect Answer Rationale: A teratogenic effect is one that results in the congenital defect of a fetus during pregnancy when the mother is exposed to certain medications and chemicals. 14) A nurse is reinforcing discharge teaching with a client who has hyperlipidemia and a prescription for niacin. Which of the following statements should the nurse include in the teaching? ANSWERS - Multiple Choice INCORRECT 1) "Take this medication 30 min before you eat breakfast." Answer Rationale: The nurse should instruct the client to take niacin with meals to avoid gastrointestinal upset. 2) "You might experience flushing of the face after taking this mediation." Answer Rationale: The nurse should advise the client that niacin causes flushing of the face, neck, and ears in most clients within the first 2 hr of taking the medication. INCORRECT 3) "Your blood work will be monitored weekly for the first 3 months of treatment." Answer Rationale: The nurse should instruct the client that blood lipid levels will be monitored monthly early in the course of treatment and will continue to be monitored every 3 to 6 months thereafter. INCORRECT 4) "Store this medication in your refrigerator in a dark container." Answer Rationale: The nurse should instruct the client to store the medication at room temperature in a light and moisture-proof container. 15) A nurse caring for a client who has a new prescription for atenolol. For which of the following adverse effects should the nurse monitor the client? ANSWERS - Multiple Choice INCORRECT 1) Neutropenia Answer Rationale: Neutropenia and risk for infection are not adverse effects of atenolol. 2) Bradycardia Answer Rationale: Atenolol, a beta adrenergic blocker, is used to treat hypertension and stable angina pectoris. This medication slows the pulse rate due to blockage of cardiac beta 1 receptors. The nurse should monitor for bradycardia in clients who are prescribed atenolol and other beta adrenergic blockers. INCORRECT 3) Hypokalemia Answer Rationale: Hypokalemia is not an adverse effect of atenolol. INCORRECT 4) Anemia Answer Rationale: Anemia is not an adverse effect of atenolol. 16) A nurse is reinforcing teaching with a client who has a prescription for simvastatin. Which of the following instructions should the nurse provide? ANSWERS - Multiple Choice INCORRECT 1) Follow each tablet with an antacid tablet. Answer Rationale: Simvastatin does not cause GI upset as an adverse effect and therefore does not require a follow-up antacid medication INCORRECT 2) Swallow the tablet with a glass of grapefruit juice. Answer Rationale: Statins have potential adverse effects when taken with grapefruit juice. 3) Take the medication in the evening hours. Answer Rationale: Statins are most effective if taken at bedtime or with the evening meal because this is when the peak production of cholesterol takes place. INCORRECT 4) Have a meal or a snack when taking the medication. Answer Rationale: Lovastatin can be taken with the evening meal; however, simvastatin can be taken without regard to meals. 17) A nurse is caring for a client who has a new prescription for warfarin. The nurse should use the results of which of the following diagnostic tests to monitor the effect of this therapy? ANSWERS - Multiple Choice 1) Prothrombin time (PT) Answer Rationale: The PT, reported as an INR, is used to monitor warfarin therapy. INCORRECT 2) Platelet count Answer Rationale: The platelet count is used to monitor for adverse effects of cancer chemotherapy. Warfarin does not affect the platelet count. INCORRECT 3) White blood cell count (WBC) Answer Rationale: The WBC is used to monitor antibiotic therapy for a client who has a bacterial infection. INCORRECT 4) Activated partial thromboplastin time (aPTT) Answer Rationale: The aPTT is used to monitor heparin therapy. 18) A nurse is collecting data for a client who has been receiving parenteral morphine 10 mg every 4 hr for the past week due to a serious traumatic injury to the pelvis and lower extremities. The client is awake and alert but states that the morphine no longer seems to be relieving her severe pain. Which of the following phenomena should the nurse realize the client is experiencing? ANSWERS - Multiple Choice 1) Opioid tolerance Answer Rationale: Opioid tolerance, as well as physical dependence, occurs over time when morphine is administered regularly for longer than 1 to 2 weeks. Tolerance occurs when a larger dose of opioid is required to relieve pain that was previously relieved by a smaller dose. For a client who has severe, ongoing pain, the dosage of morphine may need to be increased to control pain adequately. INCORRECT 2) Opioid addiction Answer Rationale: Opioid addiction is a rare phenomenon that means the client is experiencing a psychological craving for morphine despite a decreased need for the opioid. The client who has sustained a severe traumatic injury and has ongoing acute pain requires continued opioid treatment. Addiction is not an issue at this time. Fear of addiction might cause a nurse to administer less pain medication than the client requires and might cause the client to refuse needed pain relief. INCORRECT 3) Opioid toxicity Answer Rationale: Manifestations of opioid toxicity include decreased respiratory rate and sedation. There is no data to show that toxicity is being experienced by this client. In addition, a client who is experiencing severe pain is unlikely to experience opioid toxicity. INCORRECT 4) Opioid withdrawal Answer Rationale: Manifestations of opioid withdrawal include abdominal cramping, muscle pain, tremor, and irritability. A client who is administered morphine every 4 hours should not have manifestations of opioid withdrawal and there is no data to show that these manifestations are present. 19) A nurse is reviewing the morning laboratory results of electrolytes for four clients who are receiving digoxin. Which of the following clients should the nurse identify as being at risk for developing digoxin toxicity? ANSWERS - Multiple Choice 1) A client taking furosemide for chronic hypertension Answer Rationale: Loop diuretics, such as furosemide, might cause hypokalemia, which greatly increases the risk of digoxin toxicity. INCORRECT 2) A client taking chlorpropamide for type 2 diabetes mellitus Answer Rationale: Chlorpropamide is an oral hypoglycemic agent. Altered glucose levels have no effect on digoxin toxicity. INCORRECT 3) A client taking aluminum hydroxide for gastric upset Answer Rationale: Aluminum hydroxide and other antacids can decrease the absorption of digoxin, as well as other medications, if given concurrently. Digoxin toxicity is associated with an increased digoxin level rather than a decreased one. INCORRECT 4) A client taking a potassium supplement twice a day Answer Rationale: Hypokalemia, not hyperkalemia, is associated with an increased risk for digoxin toxicity. 20) A nurse is reinforcing teaching for a client who has a new prescription for sublingual nitroglycerin. Which of the following instructions should the nurse include? ANSWERS - Multiple Choice INCORRECT 1) "You may take up to five nitroglycerin sublingual tablets at 3 min intervals if chest pain occurs." Answer Rationale: The client should be instructed to take no more than a total of three sublingual nitroglycerin 5 min apart, if necessary, in a 15 min time period. INCORRECT 2) "If you experience a headache after taking nitroglycerin, stop taking the medication and notify your provider immediately." Answer Rationale: Up to half of clients who take nitroglycerin experience a headache following administration, especially during the first few weeks the medication is used. The client should not stop taking the medication and does not need to notify the provider if a headache occurs. The client should ask the provider about an appropriate analgesic to take if a headache occurs. INCORRECT 3) "You should keep an emergency supply of nitroglycerin tablets in a plastic container with other medications for each day." Answer Rationale: Nitroglycerin tablets should be kept in their original container with the top tightly closed and protected from moisture, light and heat. The client should be taught to discard outdated nitroglycerin and make sure to refill the prescription if the expiration date on the container has been reached. 4) "If your mouth is dry, take a sip of water before putting the tablet under your tongue.” Answer Rationale: Nitroglycerin tablets require moisture to dissolve completely. The client should be taught to take a sip of water before putting the tablet under the tongue if the mouth is very dry. 21) A nurse is reinforcing teaching with a young adult female client who has been prescribed lisinopril. Which of the following instructions should the nurse plan to include? (Select all that apply.) ANSWERS - Multiple Response 1) "Report the development of a persistent dry cough." 2) "Monitor your blood pressure on a regular basis." 3) "Notify your doctor immediately if you become pregnant." INCORRECT 4) "Your cholesterol levels should be monitored monthly while taking this medication." INCORRECT 5) "Make sure your diet contains a lot of potassium-rich foods." Answer Rationale: Report the development of a persistent dry cough is correct. The development of a chronic dry cough is a common problem with the use of ACE inhibitors and is believed to be related to the accumulation of bradykinin. It is important that all clients be instructed to report the development of this side effect. Monitor your blood pressure on a regular basis is correct. Hypotension is a common side effect of lisinopril, so the client should be instructed in how to monitor their blood pressure on a regular basis. Notify your doctor immediately if you become pregnant is correct. Lisinopril is a known teratogenic agent and may cause serious harm to a developing fetus; therefore, lisinopril should not be taken by a woman who is pregnant or lactating. Your cholesterol levels should be monitored monthly while taking this medication is incorrect. Lisinopril does not affect cholesterol. The WBC should be monitored frequently during the first 6 months of therapy to check for neutropenia. Make sure your diet contains a lot of potassium-rich foods is incorrect. Lisinopril does not cause potassium depletion, so the client does not need to ensure the diet includes potassium-rich foods. 22) A nurse is reinforcing teaching for the parent of a toddler who has iron deficiency anemia and a new prescription for liquid iron solution. Which of the following instructions by the nurse is the priority? ANSWERS - Multiple Choice INCORRECT 1) Rinse the child's mouth after administration of iron. Answer Rationale: Rinsing the child's mouth with water after administration can help prevent staining the child's teeth; however, another option is the priority. INCORRECT 2) Dilute the iron solution with fruit juice. Answer Rationale: Diluting the iron solution with juice or water can help prevent staining the child's teeth and might help in increasing absorption of iron; however, another option is the priority. INCORRECT 3) Increase the child's consumption of iron-rich foods. Answer Rationale: Reinforcing teaching about ways to increasing the child's consumption of iron-rich foods can help treat iron deficiency and prevent its recurrence; however, another option is the priority. 4) Keep the iron solution stored in a locked cupboard. Answer Rationale: The greatest risk to this client is injury from iron toxicity which can be fatal in young children; therefore, the priority instruction the nurse should give is to keep the iron solution stored in a locked cupboard. The nurse should also instruct the parent to keep the medication in a child-proof container. 23) A nurse is collecting data from a female client who has osteoarthritis and reports she is thinking about taking aspirin for pain control. Which of the following data in the client's history should the nurse realize might be a contraindication to taking aspirin and should be reported to the provider? ANSWERS - Multiple Choice INCORRECT 1) Report of recent migraine headaches Answer Rationale: Migraine headaches are not a contraindication to the use of aspirin. 2) History of vitamin K deficiency Answer Rationale: Aspirin inhibits platelet aggregation and should not be taken by clients who have bleeding disorders, such as a history of vitamin K deficiency. Vitamin K must be present in order to synthesize several clotting factors and a deficiency of the vitamin causes bleeding tendencies. The nurse should report a history of vitamin K deficiency to the provider. INCORRECT 3) Current diagnosis of glaucoma Answer Rationale: Glaucoma is not a contraindication to the use of aspirin. INCORRECT 4) Prior reports of amenorrhea Answer Rationale: Amenorrhea is not a contraindication to the use of aspirin. 24) A nurse is reinforcing teaching for a client who has a new prescription for warfarin. Which of the following information should the nurse include? ANSWERS - Multiple Choice INCORRECT 1) Mild nosebleeds are common during initial treatment. Answer Rationale: Warfarin, an anticoagulant, increases the client's risk for bleeding. The nurse should instruct the client to stop the medication and notify the provider if bleeding occurs. 2) The client should use an electric razor while on this medication. Answer Rationale: Warfarin, an anticoagulant, increases the client's risk for bleeding. The nurse should teach the client safety measure, such as using an electric razor, to decrease the risk for injury and bleeding. INCORRECT 3) If he misses a dose, he should double the dose at the next scheduled time. Answer Rationale: Warfarin, an anticoagulant, should be taken at the same time each day and the client should not adjust the dose. Doubling a dose increases the client's risk for bleeding. INCORRECT 4) Warfarin increases the risk for deep vein thrombosis. Answer Rationale: Warfarin, an anticoagulant, is a medication for the prophylaxis and treatment of deep vein thrombosis. 25) A nurse is assisting in the education of a group of clients about the contraindications of warfarin therapy. Which of the following statements is appropriate to include in the instructions? ANSWERS - Multiple Choice INCORRECT 1) "Clients who have diabetes mellitus type 1 should not take warfarin." Answer Rationale: Diabetes mellitus is not a contraindication for warfarin therapy. INCORRECT 2) "Clients who have rheumatoid arthritis should not take warfarin." Answer Rationale: Rheumatoid arthritis is not a contraindication for warfarin therapy. 3) "Clients who are pregnant should not take warfarin." Answer Rationale: Warfarin therapy is contraindicated in the pregnant client because it crosses the placenta and places the fetus at risk. Warfarin is a pregnancy category X medication. INCORRECT 4) "Clients who have hypertension should not take warfarin." Answer Rationale: Hypertension is not a contraindication for warfarin therapy. 26) A nurse is reinforcing teaching for a client who has rheumatoid arthritis and a new prescription for aspirin 650 mg orally every 6 hr. The nurse should instruct the client to monitor for which of the following adverse effects of aspirin therapy? ANSWERS - Multiple Choice INCORRECT 1) Constipation Answer Rationale: Aspirin can cause diarrhea. Constipation is not an adverse effect of aspirin therapy. 2) Bleeding Answer Rationale: Aspirin can cause bleeding, tinnitus, gastric ulceration, nausea, and heartburn. Aspirin inhibits platelet aggregation and prolongs bleeding time. The client should be instructed to report blood in the stool, urine, or in emesis, and should also report unusual bruising or bleeding gums. INCORRECT 3) Blurred vision Answer Rationale: Aspirin can cause tinnitus and hearing loss. Blurred vision is not an adverse effect of aspirin therapy. INCORRECT 4) Insomnia Answer Rationale: Aspirin can cause dizziness and drowsiness. Insomnia is not an adverse effect of aspirin therapy. 27) A nurse is collecting data from an older adult client who has been taking digoxin for the past several months. For which of the following manifestations of digoxin toxicity should the nurse monitor? ANSWERS - Multiple Choice 1) Anorexia Answer Rationale: Clients who take digoxin are at risk for toxicity due to the medication’s narrow therapeutic range. Anorexia, nausea, and vomiting are some of the early manifestations of digoxin toxicity in adults. In children, cardiac dysrhythmias are often the first manifestation of digoxin toxicity. INCORRECT 2) Ataxia Answer Rationale: Weakness is a manifestation of digoxin toxicity; however, ataxia, a lack of muscle coordination, is not present with digoxin toxicity. INCORRECT 3) Hearing deficits Answer Rationale: Digoxin toxicity causes halos around lights, yellow vision, and blurred vision; however, hearing deficits are not a manifestation of digoxin toxicity. INCORRECT 4) Jaundice Answer Rationale: Jaundice is a sign of sulfonylurea toxicity in older adults; however, jaundice is not a manifestation of digoxin toxicity. 28) A nurse is reinforcing teaching with a client who has increased cholesterol levels and a new prescription for colestipol granules 15 gm PO twice daily. The nurse should identify that which of the following statements by the client indicates an understanding of colestipol administration? ANSWERS - Multiple Choice INCORRECT 1) "I will take the granules along with my other medications in the morning and evening." Answer Rationale: The client should take other medication 1 hr before or 4 hr after colestipol, as colestipol decreases absorption of other medications. 2) "I can mix the granules with applesauce and take the mixture with a spoon." Answer Rationale: Colestipol granules can be mixed with a liquid, such as water, carbonated beverages, or soup. The granules can also be mixed with crushed fruit or a fruit sauce, such as applesauce, before swallowing them. This decreases the risk for irritation to the esophagus. INCORRECT 3) "I should check my blood sugar before meals while taking colestipol." Answer Rationale: Clients taking colestipol should have periodic monitoring of cholesterol levels and serum electrolytes, but colestipol does not cause changes in blood glucose levels. INCORRECT 4) "I need to mix the granules with a clear liquid and stir the solution until it becomes clear." Answer Rationale: If mixed with a clear liquid, colestipol mixture will remain cloudy because it is not a water-soluble solution. The client does not need to mix the granules with a clear liquid. 29) A nurse is caring for a postoperative client who is receiving fentanyl. Which of the following medications should the nurse plan to administer to the client if manifestations of fentanyl toxicity occur? ANSWERS - Multiple Choice INCORRECT 1) Protamine Answer Rationale: Protamine reverses the effects of heparin, not fentanyl. INCORRECT 2) Flumazenil Answer Rationale: Flumazenil, a benzodiazepine antagonist, reverses the sedative effects of benzodiazepines. It does not reverse the effects of fentanyl. INCORRECT 3) Atropine Answer Rationale: Atropine, an anticholinergic drug, treats bradycardia. It does not reverse the effects of fentanyl. 4) Naloxone Answer Rationale: Fentanyl is an opioid analgesic. The nurse should have the opioid reversal agent naloxone and resuscitation equipment available in the event that the client develops manifestations of opioid toxicity such as sedation. 30) A nurse is preparing to administer heparin subcutaneously to a client. Which of the following is an appropriate action by the nurse? ANSWERS - Multiple Choice INCORRECT 1) Use a 22-gauge needle to inject the medication. Answer Rationale: The nurse should use a small 25-gauge needle when administering a deep subcutaneous injection. INCORRECT 2) Use a 1-inch needle to inject the medication. Answer Rationale: The nurse should use a short needle, ½- to 5/8-inch, when administering a deep subcutaneous injection. 3) Inject the medication into the abdomen above the level of the iliac crest. Answer Rationale: The nurse should inject the medication into the abdomen above the level of the iliac crest, at least 2 inches from the umbilicus. INCORRECT 4) Massage the injection site after administration of the medication. Answer Rationale: The nurse should apply firm pressure without massage to the site for 1 to 2 min after administration. Massaging the area after injecting heparin can cause bleeding. 31) A nurse administered nitroglycerin sublingually to a client who has angina pectoris and experienced chest pain. The client states that his chest pain is relieved but now he has a headache. Which of the following responses by the nurse is appropriate? ANSWERS - Multiple Choice INCORRECT 1) "It sounds as if you are allergic to this medication." Answer Rationale: Allergic reactions typically manifest as itching and a rash. Severe reactions can include laryngeal edema and bronchospasm. 2) "A headache is a common adverse effect of this medication, but it will probably occur less often over time." Answer Rationale: The vasodilation nitroglycerin induces increases blood flow to the head and typically results in a headache. INCORRECT 3) "A headache indicates tolerance to the medication." Answer Rationale: With tolerance, the client needs more of the medication to achieve a therapeutic response. A headache is not a sign of this phenomenon. INCORRECT 4) "Your headache is probably a result of anxiety about the chest pain." Answer Rationale: The nurse has no reliable data for determining that anxiety produced the client’s headache. 32) A nurse is reinforcing teaching with a client who has a new prescription for transdermal nitroglycerin for angina pectoris. Which of the following instructions should the nurse include? ANSWERS - Multiple Choice INCORRECT 1) Apply a new patch each day. Answer Rationale: The client should apply a new transdermal patch at the same time each day. 2) Leave the patch in place for 24 hr. Answer Rationale: The client should remove the patch after 10 to 12 hr to prevent the client developing a tolerance to the medication. INCORRECT 3) Shave excessive hair before applying the patch to the chest. Answer Rationale: The client should remove excess hair by clip prior to applying the patch. INCORRECT 4) Apply the patch to a different site once a week. Answer Rationale: To reduce the risk of skin irritation, the client should change the application site every time he applies a patch. 33) A nurse is preparing to administer diphenhydramine to a client who is to receive a blood transfusion. The nurse should explain that the purpose of diphenhydramine is to prevent which of the following manifestations of a transfusion reaction? ANSWERS - Multiple Choice 1) Urticaria Answer Rationale: Antihistamines such as diphenhydramine are administered prior to blood administration to prevent mild allergic reactions such as itching, flushing, and hives. INCORRECT 2) Fever Answer Rationale: Fever is a manifestation of a nonhemolytic transfusion reaction, which is caused by antibodies to the donor’s WBCs. Leucocyte-poor blood products can be used for clients who have a history of nonhemolytic transfusion reactions. INCORRECT 3) Dyspnea Answer Rationale: Dyspnea, cough, headache, and distended neck veins are manifestations of fluid overload. The nurse should ensure that the rate of the transfusion is based on the client’s size and overall condition. INCORRECT 4) Low-back pain Answer Rationale: Low-back pain is a clinical manifestation of an acute hemolytic reaction. The nurse should ensure that strict compliance with the agency procedures throughout the blood transfusion process to prevent administration of the wrong unit of blood to the client. 34) A nurse is collecting data from a client who is postoperative from a mastectomy and was administered hydromorphone 1 hr ago. The nurse should identify that which of the following findings is an adverse effect of this medication? ANSWERS - Multiple Choice 1) Vomiting Answer Rationale: An adverse effect of opioid analgesics, which includes hydromorphone, is nausea and vomiting. The nurse can reduce the emetic effects of this medication by having the client lie still or administering an antiemetic medication prior to the administration of an opioid analgesic. INCORRECT 2) Diarrhea Answer Rationale: Opioid analgesics such as hydromorphone cause constipation. Paregoric is an opioid that is used to treat diarrhea. INCORRECT 3) Tremors Answer Rationale: Tremors are an adverse effect of the opioid antagonist naloxone. INCORRECT 4) Cough Answer Rationale: Hydromorphone is an antitussive and is used to treat cough. 35) A nurse is reinforcing discharge teaching with a client who is postoperative following hip arthroplasty and is to continue use of enoxaparin at home. Which of the following statements by the client indicates an understanding of the teaching? ANSWERS - Multiple Choice INCORRECT 1) "I will return to the clinic for laboratory testing weekly." Answer Rationale: Enoxaparin does not require weekly laboratory testing. The nurse should instruct the client to notify the provide4r if manifestations of bleeding occur, such as bruising or epistaxis. INCORRECT 2) "I will avoid eating foods that are high in vitamin K, such as broccoli and spinach." Answer Rationale: The nurse should instruct the client that no dietary changes are required while taking enoxaparin. 3) "I will need to give myself an injection in my abdomen twice a day." Answer Rationale: Enoxaparin is an anticoagulant used to prevent deep vein thrombosis after orthopedic and other types of surgery. It is administered only by the subcutaneous route and its duration of action is 12 hr. It is considered safe to allow the client to self-administer this medication. INCORRECT 4) "I will need to take this medication for two weeks." Answer Rationale: The recommendation for treatment with enoxaparin after hip arthroplasty is 7 to 10 days. 36) A nurse is caring for a client who has thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin’s effects? ANSWERS - Multiple Choice INCORRECT 1) Vitamin K Answer Rationale: Vitamin K reverses the effects of warfarin, not heparin, by promoting the synthesis of coagulation factors. 2) Protamine sulfate Answer Rationale: Protamine sulfate reverses the effects of heparin by binding with heparin to form a heparin-protamine complex that has no anticoagulant properties. INCORRECT 3) Acetylcysteine Answer Rationale: Acetylcysteine reduces the risk of hepatotoxicity after acetaminophen overdose. It does not reverse the effects of heparin toxicity. INCORRECT 4) Deferoxamine Answer Rationale: Deferoxamine binds to iron to reduce iron toxicity from supplemental iron therapy. It does not reverse the effects of heparin toxicity. 37) A nurse is reinforcing teaching with a client who uses a nitroglycerine patch to treat angina. The client now has a new prescription for nitroglycerin sublingual tablets. Which of the following instructions should the nurse include? ANSWERS - Multiple Choice INCORRECT 1) Swallow the tablet whole with an 8 oz glass of water. Answer Rationale: The client should place the tablet under his tongue and allow it to dissolve. INCORRECT 2) Store the medication in a pill box at the bedside. Answer Rationale: To promote chemical stability, the client should store the medication in a room with low moisture and in its original container. 3) Take the medication at the first indication of chest pain. Answer Rationale: The client should take nitroglycerin as soon as he feels pain, pressure, or tightness in his chest and not wait until his chest pain is severe. INCORRECT 4) Remove the nitroglycerine patch before taking the sublingual tablet. Answer Rationale: The client can take a sublingual tablet without removing the nitroglycerine patch. 38) A nurse is preparing to administer digoxin to a client who has heart failure. For which of the following findings should the nurse withhold the medication and report to the provider? ANSWERS - Multiple Choice INCORRECT 1) Heart rate 66/min Answer Rationale: Digoxin is a cardiac glycoside, which increases the force of ventricular contraction and thus increases cardiac output. This action reverses the manifestations of heart failure, resulting in decreased heart size, decreased heart rate, decreased vascular constriction, and reversal of water retention. 2) Report of blurred vision Answer Rationale: The nurse should monitor the client for cardiac and noncardiac adverse effects that can indicate toxicity. Nausea, vomiting, anorexia, fatigue and visual disturbances, such as blurred vision can be early indicators of toxicity. The nurse should withhold the medication and contact the provider. INCORRECT 3) Urine output 35 mL/hr Answer Rationale: The nurse should expect adequate urine output because digoxin increases renal blood flow, which increases urine production and output. A urine output of 35 mL/hr is within the expected reference range. INCORRECT 4) Serum potassium 4.8 mEq/L Answer Rationale: A serum potassium level of 4.8 mEq/L is within the expected reference range. Digoxin increases myocardial contractility by inhibiting the enzyme sodium, potassium-ATPase. Potassium and digoxin compete for the binding sites on this enzyme, so if serum potassium levels are low, more digoxin can bind to the enzyme and have a greater effect on the heart. To prevent cardiotoxicity, the nurse should monitor the client’s serum potassium level to ensure it is within the expected reference range. 39) A nurse is administering meperidine 100 mg IM for a client who is admitted with a pelvic fracture. Following the injection, which of the following data is the priority for the nurse to check? ANSWERS - Multiple Choice INCORRECT 1) Apical pulse rate Answer Rationale: Meperidine might affect the client’s apical pulse rate; however, it is not the priority data for the nurse to check. INCORRECT 2) Blood pressure Answer Rationale: Meperidine might lower the client’s blood pressure; however, it is not the priority data for the nurse to check. INCORRECT 3) Level of consciousness Answer Rationale: Meperidine might affect the client’s level of consciousness by causing sedation; however, it is not the priority data for the nurse to check. 4) Respiratory rate Answer Rationale: Meperidine, an opioid, can cause respiratory depression. The nurse should apply the ABC priority-setting framework. This framework emphasizes the basic core of human functioning—having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body’s organs via the blood. An alteration in any of these can indicate a threat to life, and is therefore the nurse’s priority concern. When applying the ABC priority setting framework, airway is always the highest priority because the airway must be clear and open for oxygen exchange to occur. Breathing is the second-highest priority in the ABC priority setting framework because adequate ventilator effort is essential in order for oxygen exchange to occur. Circulation is the third-highest priority in the ABC priority setting framework because delivery of oxygen to critical organs only occurs if the heart and blood vessels are capable of efficiently carrying oxygen to them. 40) A nurse is caring for a client who is taking furosemide. For which of the following adverse effects should the nurse monitor? ANSWERS - Multiple Choice INCORRECT 1) Hypervolemia Answer Rationale: A client who is taking furosemide can develop hypovolemia because the medication is a high-ceiling loop diuretic that results in excessive sodium, chloride, and water loss. The nurse should monitor for dry mouth, thirst, and decreased urine output, which indicate dehydration. INCORRECT 2) Hypertension Answer Rationale: A client who is taking furosemide can develop hypotension, resulting from loss of blood volume and venous smooth muscle relaxation, which decreases venous return to the heart. The nurse should monitor for dizziness, lightheadedness, and fainting. 3) Hypokalemia Answer Rationale: A client who is taking furosemide can develop hypokalemia because the medication is a high-ceiling loop diuretic that promotes secretion of potassium in the distal nephron. The nurse should monitor for muscle weakness, decreased bowel sounds, abdominal distention, and constipation. INCORRECT 4) Hypoglycemia Answer Rationale: A client who is taking furosemide can develop hyperglycemia, resulting from decreased insulin release, glycogen synthesis, and increased glycogenolysis. 41) A nurse is caring for a client who has been taking warfarin and has a prothrombin time of 30 seconds. Which of the following medications should the nurse anticipate the provider to prescribe? ANSWERS - Multiple Choice 1) Vitamin K Answer Rationale: A prothrombin time of 30 seconds indicates the clotting time is prolonged and bleeding could occur. Vitamin K injection antagonizes the actions of warfarin and serves as an antidote to the medication; therefore, the nurse should anticipate the provider will prescribe vitamin K. INCORRECT 2) Heparin Answer Rationale: Heparin is an anticoagulant and should not be administered to a client who has an increased prothrombin time of 30 sec. INCORRECT 3) Prednisone Answer Rationale: The nurse should anticipate a prescription for prednisone for a client who has an inflammatory condition. A prolonged prothrombin time is not an indication of an inflammatory response. INCORRECT 4) Ferrous sulfate Answer Rationale: The nurse should anticipate a prescription for ferrous sulfate for a client who has iron-deficiency anemia. There is no indication this client is anemic. 42) A nurse is collecting data from a client who is to start taking digoxin for heart failure. The nurse should instruct the client to avoid taking which of the following herbal supplements? ANSWERS - Multiple Choice INCORRECT 1) Feverfew Answer Rationale: There are no interactions between feverfew and digoxin. 2) St. John’s wort Answer Rationale: Taking St. John’s wort concurrently with digoxin can increase excretion of the medication and thus decrease its effectiveness. INCORRECT 3) Echinacea Answer Rationale: There are no interactions between echinacea and digoxin. INCORRECT 4) Valerian Answer Rationale: There are no interactions between valerian and digoxin. 43) A nurse is reinforcing discharge teaching with a client who has pulmonary edema and is about to start taking furosemide. Which of the following instructions should the nurse include? ANSWERS - Multiple Choice INCORRECT 1) Take aspirin for headaches. Answer Rationale: The client should avoid aspirin and other NSAIDs because they can blunt the diuretic effects of furosemide. 2) Eat foods that contain plenty of potassium. Answer Rationale: Furosemide, a high-ceiling (loop) diuretic, can cause potassium loss. To prevent this, the client should add potassium-rich foods to his diet such as bananas and avocados. INCORRECT 3) Expect some swelling in the hands and feet. Answer Rationale: Furosemide is a loop diuretic that blocks the reabsorption of sodium and chloride, which in turn prevents reabsorption of water and promotes the excretion of these electrolytes and water. Therefore, the client should expect decreased swelling in the hands and feet. INCORRECT 4) Take the medication at bedtime. Answer Rationale: The client should take furosemide early in the day so that the medication’s action will not disturb his sleep. 44) A nurse is preparing to administer digoxin to a client who has heart failure. Before administering this medication, which of the following actions should the nurse take? ANSWERS - Multiple Choice INCORRECT 1) Offer the client a light snack. Answer Rationale: The client can take the medication with or without food, although giving it immediately after food can delay absorption slightly. INCORRECT 2) Check the client’s blood pressure. Answer Rationale: It is not necessary to check the client’s blood pressure immediately before dosing, although the nurse should check the client’s blood pressure routinely to monitor for worsening of heart failure. 3) Measure the client’s apical pulse. Answer Rationale: Digoxin decreases the heart rate, so the nurse should count the apical pulse for at least 1 min before administering it. The nurse should withhold the medication if the client’s heart rate is below designated parameters such as 50 to 60/min. INCORRECT 4) Weigh the client. Answer Rationale: It is not necessary to weigh the client immediately before dosing, although the nurse should weigh the client daily to monitor for worsening of heart failure. 45) A nurse is reinforcing teaching to a client who is to start using a nitroglycerine transdermal unit for angina. Which of the following instructions should the nurse include? ANSWERS - Multiple Choice INCORRECT 1) Cut the patches in half to save money. Answer Rationale: The client should never alter the size of the transdermal unit, because this will alter the amount of medication he will receive. 2) Remove the patch each evening to have 10 hr without medication. Answer Rationale: The client should remove the patch each evening to allow for 10 to 12 hr of medication free time. This will help prevent tolerance to the medication. INCORRECT 3) Apply an additional patch during an angina attack. Answer Rationale: Clients should use a transdermal delivery system for long-term management of angina and not as a rescue medication. INCORRECT 4) Remove the patch if you develop a headache. Answer Rationale: Headaches are a common adverse effect of nitroglycerin and usually decrease in intensity with time. The nurse can recommend the client use an over-the-counter mild analgesic such as aspirin or acetaminophen to manage pain. If the headaches persist, the client should report this finding to the provider, who might lower the dosage. 46) A nurse is talking with a client who is about to start taking nitroglycerin oral, sustained-release capsules. Which of the following instructions should the nurse include? ANSWERS - Multiple Choice INCORRECT 1) Take 1 capsule at the onset of anginal pain. Answer Rationale: The client should take nitroglycerin oral, sustained-release capsules to prevent angina attacks from occurring. INCORRECT 2) Stop taking the medication if you develop headaches. Answer Rationale: Abruptly discontinuing the use of long-acting nitroglycerin capsules can cause vasospasm. The nurse should inform the client that headaches will lessen with time but he can take an over-the-counter mild analgesic such as aspirin or acetaminophen to manage pain. If the headaches persist, the client should report this finding to the provider who may lower the dosage. INCORRECT 3) Take the medication with meals. Answer Rationale: The client should take the medication on an empty stomach with 240 mL (8 oz) of water. 4) Swallow the capsules whole. Answer Rationale: The client should swallow the capsules whole and not chew, crush them, or place them under the tongue because this will interfere with the sustained release effect of the medication. 47) A nurse is assisting with the care of a client who is receiving heparin by IV infusion. Which of the following medications should the nurse have available in the event of an overdose? ANSWERS - Multiple Choice INCORRECT 1) Ferrous sulfate Answer Rationale: The nurse should administer ferrous sulfate to a client who has anemia. INCORRECT 2) Glucagon Answer Rationale: The nurse should have glucagon available when caring for clients who have diabetes mellitus. The nurse should administer glucagon to a client who has hypoglycemia because it promotes the breakdown of glycogen to glucose in the liver and rapidly increases the blood glucose level. 3) Protamine Answer Rationale: Protamine combines with heparin to form a stable compound, which then neutralizes the anticoagulant effect of heparin. INCORRECT 4) Vitamin K Answer Rationale: Vitamin K reverses the effects of warfarin, not heparin. 48) A nurse is reinforcing teaching with a client who is about to start taking captopril to treat hypertension. Which of the following instructions should the nurse include to help the client manage this medication’s adverse effects? ANSWERS - Multiple Choice INCORRECT 1) Use salt substitutes while taking this medication. Answer Rationale: Captopril, an ACE inhibitor, can cause hyperkalemia due to potassium retention by the kidney. The client should avoid salt substitutes, as most of them are high in potassium. 2) Take the medication on an empty stomach. Answer Rationale: The client should take captopril on an empty stomach because food reduces the medication’s absorption by 30 - 40%. INCORRECT 3) Expect a dry cough when taking this medication. Answer Rationale: Captopril can result in a dry, persistent cough from bradykinin buildup. This can lead to excessive vasodilation and hypotension. The client should report this finding and the provider will most likely discontinue the medication. INCORRECT 4) Expect to gain weight while taking this medication. Answer Rationale: Captopril is more likely to cause weight loss than weight gain. 49) A nurse is reinforcing teaching with a client who has hypertension and a new prescription for verapamil. The nurse should instruct the client to avoid taking this medication with which of the following foods? ANSWERS - Multiple Choice INCORRECT 1) Milk Answer Rationale: The nurse should instruct the client to take verapamil with food to reduce gastric irritation. Milk has no known effect on the metabolism of verapamil; therefore, the client can take verapamil with milk. INCORRECT 2) Orange juice Answer Rationale: The nurse should instruct the client to take verapamil with food to reduce gastric irritation. Orange juice has no known effect on the metabolism of verapamil; therefore, the client can take verapamil with orange juice. INCORRECT 3) Cranberry juice Answer Rationale: The nurse should instruct the client to take verapamil with food to reduce gastric irritation. Cranberry juice has no known effect on the metabolism of verapamil; therefore, the client can take verapamil with cranberry juice. 4) Grapefruit juice Answer Rationale: The nurse should instruct the client to avoid taking verapamil with grapefruit juice. Grapefruit juice can inhibit the metabolism of verapamil, a calcium channel blocker, and cause an increase in verapamil blood level. This excess amount of medication can cause severe hypotension and cardiotoxicity. 50) A nurse is reinforcing teaching with a client who has a new prescription for sublingual nitroglycerine. Which of the following instructions should the nurse include in the teaching? ANSWERS - Multiple Choice INCORRECT 1) Administer up to four tablets over 10 min. Answer Rationale: The nurse should instruct the client to take one tablet every 5 minutes until pain is relieved, and up to three tablets in 15 minutes, to prevent toxicity. 2) Lie down upon onset of chest pain. Answer Rationale: The nurse should instruct the client to lie down upon the onset of chest pain to prevent hypotension and reduce oxygen demand. INCORRECT 3) Store the tablets in the refrigerator. Answer Rationale: The nurse should instruct the client to store the tablets in the original container at room temperature to maintain effectiveness. INCORRECT 4) Swallow the tablets whole. Answer Rationale: The nurse should instruct the client to place the tablet under his tongue and allow it to dissolve completely to maximize effectiveness. 51) A nurse is caring for a client who is receiving warfarin therapy to prevent a deep vein thrombosis. Which of the following medications should the nurse have available in the event of an overdose? ANSWERS - Multiple Choice INCORRECT 1) Epinephrine Answer Rationale: The nurse should recognize that epinephrine is given to treat anaphylaxis. It does not reverse warfarin overdose. INCORRECT 2) Atropine Answer Rationale: The nurse should recognize that atropine is given to treat bradycardia. It does not reverse warfarin overdose. INCORRECT 3) Protamine Answer Rationale: The nurse should recognize that protamine is given to reverse the effects of heparin. It does not reverse warfarin overdose. 4) Vitamin K Answer Rationale: The nurse should have available vitamin K available to reverse the effects of warfarin in the event of an overdose. 52) A nurse is reinforcing teaching with a newly licensed nurse about caring for a client who has a prescription for enoxaparin. Which of the following instructions should the nurse include in the teaching? ANSWERS - Multiple Choice INCORRECT 1) Administer the medication into a large muscle. Answer Rationale: The nurse should instruct the new nurse to administer enoxaparin subcutaneously into the client’s abdomen. 2) Have protamine available in case of overdose. Answer Rationale: The nurse should instruct the new nurse to have protamine available to reverse the effects of enoxaparin in case of toxicity and bleeding. INCORRECT 3) Expel air bubble prior to administration of prefilled medication. Answer Rationale: The nurse should instruct the new nurse to administer the prefilled medication with the air bubble to ensure all of the medication is given with the injection. INCORRECT 4) Monitor the client’s potassium level. Answer Rationale: The nurse should instruct the new nurse to monitor the client’s platelet count. Enoxaparin is a low molecular weight heparin that inhibits thrombus and clot formation. It can cause thrombocytopenia and bleeding. It does not affect potassium level. 53) A nurse is assisting in the plan of care for a client who is receiving digoxin to treat heart failure. Which of the following actions should the nurse plan to take? ANSWERS - Multiple Choice INCORRECT 1) Withhold the medication if the client’s heart rate is above 100/min. Answer Rationale: The nurse should withhold the medication if the client’s heart rate is below 60/min because digoxin can cause bradycardia and other dysrhythmias. INCORRECT 2) Instruct the client to eat foods that are low in potassium. Answer Rationale: The client should eat foods high in potassium to prevent hypokalemia, which increases the risk of digoxin toxicity. INCORRECT 3) Measure the client’s apical pulse rate for 30 seconds before administration. Answer Rationale: The nurse should measure the apical pulse rate for 1 min to obtain an accurate reading. 4) Monitor the client for nausea, vomiting, and anorexia. Answer Rationale: Loss of appetite, nausea, vomiting, and blurred or yellow vision are manifestations of digoxin toxicity. Digoxin toxicity can cause cardiac dysrhythmias and should be reported immediately. 54) A nurse is reinforcing teaching a client who has a new prescription for transdermal nitroglycerin to treat angina pectoris. The nurse should include which of the following instructions in the teaching? (Select all that apply.) ANSWERS - Multiple Response 1) Apply the patch to a hairless area. 2) Apply a new patch each morning. 3) Remove the patch for 10 to 12 hr daily. INCORRECT 4) Apply a new patch to the same site each time. INCORRECT 5) Apply a new patch at the onset of anginal pain. Answer Rationale: Apply the patch to a hairless area is correct. Hair can interfere with the adhesion of the patch.Apply a new patch each morning is correct. Therapeutic preventive effects of transdermal nitroglycerin patches begin 30 to 60 min after application and last up to 14 hr. Remove the patch for 10 to 12 hr daily is correct. Removing the patches for 10 to 12 hr each day helps prevent tolerance to the drug. Apply a new patch to the same site each time is incorrect. The patch application site should be rotated to prevent skin irritation. Apply a new patch at the onset of anginal pain is incorrect. Nitroglycerin patches prevent angina attacks. They do not treat angina attacks. Sublingual nitroglycerine can be taken with the transdermal patch for angina. 55) A nurse is collecting data on a client who has a prescription for morphine. The nurse should recognize that which of the following data is a priority to obtain before administering this medication? ANSWERS - Multiple Choice INCORRECT 1) Blood pressure Answer Rationale: The nurse should check the client’s blood pressure because morphine can cause postural hypotension, but another action is the priority. INCORRECT 2) Apical heart rate Answer Rationale: The nurse should check the client’s apical heart rate because morphine can cause bradycardia, but another action is the priority. 3) Respiratory rate Answer Rationale: The priority action the nurse should take when using the airway, breathing, and circulation (ABC) approach to client care is to evaluate the client’s respirations. The respiratory rate is a priority because opioid analgesics such as morphine can cause respiratory depression. INCORRECT 4) Temperature Answer Rationale: The nurse should check the client’s temperature because morphine can cause hypothermia, but another action is the priority. 56) A nurse is reinforcing teaching with a client who has angina pectoris about starting therapy with nitroglycerin sublingual tablets. Which of the following statements by the client indicates an understanding of the teaching? ANSWERS - Multiple Choice INCORRECT 1) "I will take the first tablet when the pain becomes severe." Answer Rationale: The client should take the first nitroglycerin tablet at the onset of pain to provide immediate vasodilation. If pain is not relieved in 5 min, the client should call 911. INCORRECT 2) "I will take no more than four tablets in 10 min." Answer Rationale: The client should take no more than three tablets in 15 min to prevent toxicity. INCORRECT 3) "I will chew the tablet before swallowing." Answer Rationale: The client should place the sublingual nitroglycerine under his tongue for rapid absorption. 4) "I'll dial 911 if one tablet does not relieve my pain." Answer Rationale: The client should dial 911 if one tablet does not relieve the client’s pain after 5 min in order to receive immediate medical attention. 57) A nurse is collecting data from a client who has a prosthetic aortic valve and takes warfarin daily at bedtime. Which of the following data is the priority finding for the nurse to report to the provider? ANSWERS - Multiple Choice INCORRECT 1) The client keeps a small supply of vitamin K tablets on hand for emergency use. Answer Rationale: Clients might be advised by their provider to keep a supply of vitamin K tablets on hand for emergency use. The client should notify the provider if bleeding occurs and should be taught not take the vitamin K unless advised specifically by the provider. The nurse should notify the provider about the supply of vitamin K; however, this is not the priority finding to report. INCORRECT 2) The client consistently eats fish for dinner twice weekly. Answer Rationale: Fish contains vitamin K, which can decrease the effectiveness of warfarin. However, consistent eating of foods containing vitamin K is not a problem. A sudden increase of foods high in vitamin K might affect INR. The nurse should report the client’s dietary practice to the provider; however, this is not the priority finding to report. INCORRECT 3) The client sprinkles flaxseeds on breakfast food every day. Answer Rationale: The nurse should be aware that flaxseed does not specifically interact with warfarin. Like other medications, prescribed or nonprescribed, the provider should be notified of its use; however, it is not the priority to report. 4) The client uses garlic as a daily dietary supplement. Answer Rationale: The nurse should be aware that the use of garlic as a dietary supplement might potentiate the action of warfarin and may cause bleeding. Therefore, use of garlic is the finding to report to the provider. The nurse should apply the safety and risk reduction priority-setting framework. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow’s hierarchy of needs, the ABC priority setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. 58) A nurse is preparing to administer digoxin to a client who has left-sided heart failure. Which of the following clinical manifestations should the nurse expect to see in this client? (Select all that apply.) ANSWERS - Multiple Response 1) Dyspnea INCORRECT 2) Gastrointestinal bloating INCORRECT 3) Jugular vein distention 4) Orthopnea 5) Tachycardia Answer Rationale: Dyspnea is correct. Dyspnea is a clinical manifestation of left-sided heart failure. Gastrointestinal bloating is incorrect. Gastrointestinal bloating is a clinical manifestation of right-sided heart failure. Jugular vein distention is incorrect. Jugular vein distention is a clinical manifestation of right-sided heart failure. Orthopnea is correct. Orthopnea is a clinical manifestation of left-sided heart failure. Tachycardia is correct. Tachycardia is a clinical manifestation of left-sided heart failure. 59) A nurse is preparing to administer potassium chloride to a client who has a potassium level of 5.8 mEq/L. Which of the following actions should the nurse take? ANSWERS - Multiple Choice INCORRECT 1) Give the medication as prescribed. Answer Rationale: A potassium level of 5.8 mEq/L is above the expected reference range and therefore the nurse should not give the potassium chloride at this time. INCORRECT 2) Hold the medication until the client has his evening meal. Answer Rationale: A potassium level of 5.8 mEq/L is above the expected reference range. This medication should be held until the client is not in a state of hyperkalemia. 3) Inform the provider of the client’s potassium level. Answer Rationale: The nurse should notify the provider and inform her of the client's potassium level. INCORRECT 4) Obtain a prescription to increase the dosage of the medication. Answer Rationale: A potassium level of 5.8 mEq/L is above the expected reference range, so the nurse would not need to obtain a prescription to increase the current dose. 60) A nurse is caring for a client who has heart failure and is taking furosemide. For which of the following findings should the nurse withhold the medication? ANSWERS - Multiple Choice INCORRECT 1) Crackles in bases of lungs Answer Rationale: Left-sided heart failure can result in crackles in lung bases from the back up of blood in the pulmonary system. Clients can benefit from furosemide, a loop diuretic that promotes reabsorption of water and promotes excretion, thus ridding the body of excess fluid. INCORRECT 2) Peripheral edema Answer Rationale: Right-sided heart failure can result in peripheral edema, jugular vein distention, anorexia, and nausea. Furosemide can promote fluid excretion and relieve these signs and symptoms of heart failure. INCORRECT 3) Ascites Answer Rationale: Right-sided heart failure can result in ascites, abdominal distention, and liver and spleen enlargement and tenderness. Furosemide can promote fluid excretion and relieve these signs and symptoms of heart failure. 4) Potassium 2.8 mEq/L Answer Rationale: Furosemide promotes the excretion of potassium. A potassium level of 2.8 indicates hypokalemia, which places the client at risk for cardiac dysrhythmias and possibly death. The nurse should withhold the medication and contact the provider. 61) A nurse is caring for a client who has hypertension and is to start taking atenolol. The nurse should instruct the client to monitor for which of the following findings as an adverse effect of this medication? ANSWERS - Multiple Choice 1) Bradycardia Answer Rationale: Atenolol is a beta-adrenergic blocking agent, which slows the heart rate and can lead to bradycardia. The nurse should instruct the client to check his heart rate before each dose and to notify the provider if the rate is below his usual rate. INCORRECT 2) Headache Answer Rationale: Headache is not an adverse effect of atenolol. Clients can use atenolol to prevent migraine headaches. INCORRECT 3) Cough Answer Rationale: Clients who take an ACE inhibitor are at risk for a dry, persistent cough. Clients who develop a cough while taking an ACE inhibitor should notify the provider, who will most likely discontinue the medication. INCORRECT 4) Constipation Answer Rationale: Clients who take atenolol are more likely to have nausea, vomiting, and diarrhea. 62) A nurse in an urgent care center is collecting data from a client who reports taking an excessive amount of aspirin. Which of the following findings should the nurse identify as an indication of salicylism? ANSWERS - Multiple Choice 1) Tinnitus Answer Rationale: A client can develop salicylism when aspirin levels exceed therapeutic levels. Clinical manifestations include tinnitus, sweating, headache, dizziness, and hyperventilation. INCORRECT 2) Joint pain Answer Rationale: Aspirin is an anti-inflammatory agent that can treat joint pain. INCORRECT 3) Diuresis Answer Rationale: Aspirin can result in acute, reversible renal impairment which can lead to decreased urine output, weight gain, and increased serum creatinine and BUN levels. INCORRECT 4) Respiratory depression Answer Rationale: High doses of aspirin lead to stimulation of the respiratory center in the brain. 63) A nurse in an urgent care center is collecting data from a client who reports taking an excessive amount of acetaminophen. Which of the following findings should the nurse identify as an indication of acute acetaminophen toxicity? ANSWERS - Multiple Choice INCORRECT 1) Elevated WBC count Answer Rationale: A client who has acute acetaminophen toxicity is more likely to have neutropenia; diarrhea is more likely than constipation. INCORRECT 2) Orange-red tinged urine Answer Rationale: A client who is taking rifampin can have orange-red tinged urine, feces, saliva, sputum and tears. A client who has acute acetaminophen toxicity can develop liver failure, which can lead to jaundice. INCORRECT 3) Tinnitus Answer Rationale: A client who has aspirin toxicity is more likely to have tinnitus. 4) Vomiting Answer Rationale: With acute acetaminophen toxicity, the client is at serious risk for hepatic necrosis. Early signs include nausea, vomiting, abdominal distress, diarrhea, and sweating. 64) A nurse is reinforcing teaching with a client who is to start taking atorvastatin. The nurse should instruct the client that she will need which of the following baseline examinations prior to starting therapy? ANSWERS - Multiple Choice 1) Liver function tests Answer Rationale: Statins such as atorvastatin can cause liver damage and liver disease is a contraindication for taking the medication. The client should have baseline liver function testing before beginning therapy, then every 1 to 2 months, at 6 and 12 weeks, and then periodically throughout therapy. INCORRECT 2) Vision testing Answer Rationale: The client should have periodic eye exams while taking atorvastatin to monitor for blurred vision and opacities. INCORRECT 3) Papanicolaou test Answer Rationale: A Papanicolaou test screens for cervical cancer. Atorvastatin is not known to affect the female reproductive system. However, it can cause impotence in males. INCORRECT 4) Dental examination Answer Rationale: Adverse effects of atorvastatin do not include gum disease. 65) A nurse is reinforcing teaching with a group of nurses about the administration of nitroglycerin. Which of the following routes of administration provides the most rapid onset for the client? ANSWERS - Multiple Choice INCORRECT 1) Transdermal patch Answer Rationale: The client who receives a transdermal patch of nitroglycerin will have an onset of 30 min to 60 min. Therefore, the nurse should use another route for a more rapid effect. 2) Sublingual Answer Rationale: The client who receives sublingual nitroglycerin will have an onset of 1 to 3 min. Therefore, the nurse should use this route for nitroglycerin administration for the most rapid onset for the client. Absorption through the sublingual route is brisk because the medication goes through the oral mucosa directly into the bloodstream. INCORRECT 3) Suspended release Answer Rationale: The client who receives suspended release nitroglycerin will have an onset of 20 to 45 min. Therefore, the nurse should use another route for a more rapid effect. INCORRECT 4) Topical ointment Answer Rationale: The client who receives topical nitroglycerin ointment will have an onset of 30 to 60 min. Therefore, the nurse should use another route for a more rapid effect. 66) A nurse is reviewing the medication record of a client who has heart failure and has a potassium level of 2.4 mEq/L. The nurse should identify which of the following medications as a possible cause of the client's potassium level? ANSWERS - Multiple Choice 1) Furosemide Answer Rationale: Furosemide is a high-ceiling loop diuretic that inhibits the reabsorption of sodium and chloride and results in diuresis. Potassium is lost through excretion in the distal nephrons when the client receives this medication. This laboratory result is interpreted as hypokalemia, which is an adverse effect associated with the administration of furosemide. INCORRECT 2) Nitroglycerin Answer Rationale: Nitroglycerin is a vasodilator medication used to treat angina. Therefore, a potassium level of 2.4 mEq/L is not an adverse effect of nitroglycerin. INCORRECT 3) Metoprolol Answer Rationale: Metoprolol is a beta-blocker medication that slows the heart rate and improves contractility of the heart muscle. Therefore, a potassium level of 2.4 mEq/L is not an adverse effect of metoprolol. INCORRECT 4) Spironolactone Answer Rationale: Spironolactone is a potassium sparing diuretic medication. Therefore, a potassium level of 2.4 mEq/L is not an adverse effect of spironolactone. 67) A nurse is caring for a client who has a prescription for digoxin 0.25 mg PO daily for heart failure. The client's current vital signs are: BP 144/96, heart rate 54/min, respirations 18/min, and temperature 37° C (98.6° F). Which of the following actions should the nurse take? ANSWERS - Multiple Choice INCORRECT 1) Administer digoxin 0.125 mg. Answer Rationale: The nurse should not administer a reduced dose of digoxin as the heart rate is less than 60/min. The nurse should not administer a different dose than prescribed without a written prescription from the provider. INCORRECT 2) Administer digoxin 0.25 mg. Answer Rationale: The nurse should not administer the prescribed dose of digoxin as the heart rate is less than 60/min. INCORRECT 3) Withhold the digoxin dose for elevated BP. Answer Rationale: The nurse should not withhold the prescribed dose of digoxin for elevated BP. However, if the heart rate is less than 60/min, the nurse should withhold the medication. 4) Withhold the digoxin dose for decreased heart rate. Answer Rationale: The nurse should withhold the prescribed dose of digoxin as the heart rate is less than 60/min. The nurse should immediately notify the provider. 68) A nurse is reinforcing teaching with a client who is taking ibuprofen to treat chronic hip pain. Which of the following instructions should the nurse include in the teaching? ANSWERS - Multiple Choice INCORRECT 1) "Limit your intake of alcohol to one glass of wine each evening." Answer Rationale: The nurse should instruct the client to avoid alcohol intake to reduce the risk of gastric ulceration and hemorrhage. 2) "Have regular eye exams done while taking this medication." Answer Rationale: The nurse should instruct the client to have regular vision and hearing examinations due to the potential adverse effects of ibuprofen. INCORRECT 3) "Expect to experience an increase in weight while taking this mediation." Answer Rationale: The nurse should instruct the client to report increased weight or edema to the provider, as these signs can indicate nephrotoxicity. INCORRECT 4) "Take this medication 2 hours prior to taking an antacid medication." Answer Rationale: The nurse should instruct the client to take ibuprofen with an antacid to decrease GI symptoms. 69) A nurse is collecting data from a client prior to administering atenolol. For which of the following findings should the nurse withhold the medication? ANSWERS - Multiple Choice 1) Heart rate 50/min Answer Rationale: Atenolol is a beta-blocker and is used in the treatment of hypertension and angina, and following a myocardial infarction. This medication works by slowing the heart rate, decreasing the speed of electrical impulses through the atrioventricular node, and decreasing the force of contraction. The nurse should check the client’s heart rate prior to administering a beta-blocker. If the client’s heart rate is less than 60/min, the nurse should hold the medication and contact the provider. INCORRECT 2) Oxygen saturation 95% Answer Rationale: Atenolol is a beta-blocking medication and affects heart rate and blood pressure but does not impact respiratory status. An oxygen saturation of 95% is within the expected reference range, and the nurse should not withhold the mediation. INCORRECT 3) Respiratory rate 18/min Answer Rationale: Atenolol is a beta-blocker and is used to treat hypertension. This medication will decrease BP and HR but does not affect the respiratory rate. This would not be a finding to withhold the medication. INCORRECT 4) Blood pressure 160/94 mm Hg Answer Rationale: Atenolol is a beta-blocker and is used in the treatment of hypertension and angina, and following a myocardial infarction. The nurse should monitor the client’s blood pressure when receiving a beta-blocker. This client is experiencing hypertension, so there is no reason to hold the medication. 70) A nurse is caring for an older adult client who has a prescription for captopril. For which of the following possible adverse effects should the nurse instruct the client to notify the provider immediately? ANSWERS - Multiple Choice INCORRECT 1) Metallic taste Answer Rationale: The nurse should inform the client that taste impairment, including a metallic or salty taste, sometimes occurs when starting captopril, but that it should go away within the first few months. The client does not need to notify the provider immediately about this finding. INCORRECT 2) Headache Answer Rationale: Headache is not an adverse effect of captopril. 3) Sore throat Answer Rationale: A sore throat, fever, easy bruising, and bleeding are manifestations of neutropenia, which is a serious adverse effect of captopril and other angiotensin-converting enzyme inhibitors (ACE inhibitors). The nurse should inform the client to notify the provider immediately if any of these manifestations occur. INCORRECT 4) Stuffy nasal passages Answer Rationale: Stuffy nasal passages are not an adverse effect of captopril. 71) A nurse is caring for a client who has a prescription for metoprolol. The nurse measures the client’s vital signs and notes that the client’s apical heart rate is 49/min. The nurse should prepare to administer which of the following medications? ANSWERS - Multiple Choice INCORRECT 1) Digoxin Answer Rationale: Digoxin decreases heart rate, so the nurse should not administer the digoxin to this client. 2) Atropine Answer Rationale: Atropine is a muscarinic agonist and it is used to treat bradycardia. INCORRECT 3) Bethanechol Answer Rationale: Bethanechol causes bradycardia, so the nurse should not administer bethanechol to this client. INCORRECT 4) Neostigmine Answer Rationale: Neostigmine causes bradycardia, so the nurse should not administer neostigmine to this client. 72) A nurse is caring for a client whose serum potassium level is 5.3 mEq/L. The nurse should anticipate a prescription for which of the following medications? ANSWERS - Multiple Choice INCORRECT 1) Potassium chloride Answer Rationale: A serum potassium level of 5.3 mEq/L is above the expected reference range. The nurse should not anticipate the administration of potassium chloride, because it is used to treat hypokalemia. INCORRECT 2) Acetylcysteine Answer Rationale: Acetylcysteine is an antidote used to treat acetaminophen poisoning. 3) Sodium polystyrene Answer Rationale: In addition to calcium gluconate, glucose and insulin, sodium polystyrene is administered orally or rectally to absorb excess potassium. INCORRECT 4) Potassium iodide Answer Rationale: A serum potassium level of 5.3 mEq/L is above the expected reference range. The nurse should not anticipate the administration of potassium iodide, because it is used to treat hypokalemia. 73) A nurse is reinforcing teaching with a client who is to start taking bumetanide. Which of the following instructions should the nurse include in the teaching? ANSWERS - Multiple Choice 1) "Report changes in hearing." Answer Rationale: Bumetanide is a high-ceiling loop diuretic that promotes diuresis by inhibiting sodium and chloride reabsorption in the loop of Henle. An adverse effect of high-ceiling loop diuretics is ototoxicity; therefore, the nurse should instruct clients to notify the prescriber if they develop ear discomfort, ringing or buzzing in the ears or a hearing deficit. INCORRECT 2) "Avoid foods high in potassium." Answer Rationale: Bumetanide promotes secretion of potassium in the distal nephron; therefore, the client should consume foods in high in potassium, such as raisins, tomato juice, bananas, and potatoes to minimize the risk for hypokalemia. The nurse should instruct the client to monitor and report signs and symptoms of hypokalemia, such as irregular heart rate, muscle weakness, diarrhea, irritability, confusion, paresthesias, and numbness in extremities. INCORRECT 3) "Take the medication daily at bedtime." Answer Rationale: Bumetanide is a high-ceiling loop diuretic. Clients should take bumetanide once daily in the morning because the medication increases urine volume and frequency of voiding. INCORRECT 4) "Limit your fluid intake to no more than 1.5 liters a day." Answer Rationale: Loss of sodium, chloride, and water can cause severe dehydration. Signs of dehydration include dry mouth, unusual thirst, and oliguria. Clients should consume 2 to 3 L of fluid per day to prevent dehydration. 74) A nurse is reinforcing teaching with a client who has hypertension and is taking propranolol. Which of the following statements by the client indicates an understanding of the teaching? ANSWERS - Multiple Choice INCORRECT 1) "I should weigh myself on the same day once a week." Answer Rationale: The nurse should instruct the client to obtain weight daily and report a weight gain of greater than 5 pounds. INCORRECT 2) "I will not take my medicine if my heart rate is greater than 70/min." Answer Rationale: The nurse should instruct the client to withhold the medication for a heart rate less than 50 and to notify the provider. 3) "I will sit on the side of the bed before I stand up." Answer Rationale: The nurse should instruct the client to change positions slowly to prevent fainting and to sit or lie down for signs of hypotension such as light-headedness or dizziness. INCORRECT 4) "I should expect to develop a slight cough while taking this medication." Answer Rationale: The client should instruct the client to report signs of heart failure such as shortness of breath, night coughs, or selling of the extremities to the provider immediately. 75) A nurse is caring for a client who reports daily use of acetaminophen to manage mild knee pain. Which of the following statements by the client should the nurse investigate further? ANSWERS - Multiple Choice INCORRECT 1) "I have a glass of wine before bedtime each evening." Answer Rationale: The client who consumes 3 or more drinks per day of alcohol should consume no more than 2,000 mg of acetaminophen a day. This client’s practices are safely within the guidelines. INCORRECT 2) "I have my blood checked often due to the heparin I am taking." Answer Rationale: Clients taking heparin should not take other medications that depress platelet function, such as aspirin. Acetaminophen does not suppress platelet aggregation and is not be contraindicated in clients taking heparin. INCORRECT 3) "I take two regular-strength tablets in the morning and two in the evening.” Answer Rationale: A regular-strength tablet of acetaminophen contains 325 mg. Four tablets a day would equal 1,300 mg and is less than the recommended maximum of 4,000 mg/day. This daily dose should not be a concern to the nurse. 4) "I take over-the-counter cold medicine for my sinus congestion." Answer Rationale: The nurse should advise the client to consult with his provider before taking any over-the-counter cold preparations, as many of them contain acetaminophen and could lead to an overdosing of the medication. 76) A nurse is reviewing laboratory data from a client who has pulmonary embolism and is receiving IV heparin. Which of the following findings should the nurse report to the provider? ANSWERS - Multiple Choice INCORRECT 1) Hematocrit 45% Answer Rationale: Hematocrit (Hct) is the percentage of packed red blood cells per deciliter of blood. A hematocrit of 45% is within the expected reference range, and the nurse does not need to report this to the provider. INCORRECT 2) Partial thromboplastin time (PTT) 55 seconds Answer Rationale: The partial thromboplastin time (PTT) assesses the clotting time. Heparin therapy often is monitored with a PTT test. The desired therapeutic range for anticoagulation is between 1.5-2 times the normal value. A PTT of 55 seconds is within the expected reference range, and the nurse does not need to report this to the provider. INCORRECT 3) White blood cell count 8,000/mm3 Answer Rationale: A white blood cell count (WBC) with differential often is obtained when a client is suspected of having an infection. This test measures five types of leukocytes: neutrophils, lymphocytes, monocytes, eosinophils, and basophils. This finding is within the expected reference range, and the nurse does not need to report this to the provider. 4) Platelets 74,000/mm3 Answer Rationale: Heparin-induced thrombocytopenia is a disorder characterized by low platelet counts and is an adverse effect of heparin that causes the activation of platelets, resulting in widespread clot formation and depletion of platelets. A platelet count of 74,000/mm3 is below the expected reference range. The nurse should notify the provider and discontinue the heparin. 77) A nurse is reinforcing teaching with a client who has hyperlipidemia and is taking atorvastatin daily. Which of the following statements by the client indicates understanding? ANSWERS - Multiple Choice 1) "I will notify my provider if my arms feel weak." Answer Rationale: Atorvastatin is an HMG-CoA reductase inhibitor. It is in a class of medications more commonly known as statins, which are the most effective medications in lowering LDL and total cholesterol. Two serious adverse effects of statins are hepatotoxicity and myopathy. The nurse should instruct the client to report any onset of muscle weakness or aches to the provider due to the possibility of myopathy. INCORRECT 2) "I must take this medication without food." Answer Rationale: Statins usually are prescribed for once-daily dosing and are best taken in the evening, either with the evening meal or at bedtime. They may be taken with or without food. INCORRECT 3) "It is best if I take this medication in the morning." Answer Rationale: Statins are best taken late in the day because endogenous cholesterol synthesis increases during the night, and these medications have their greatest impact at this time. INCORRECT 4) "It is not necessary to have any routine lab tests done." Answer Rationale: One serious adverse effect of statins is hepatotoxicity. Clients taking statins should have their liver enzymes assessed before treatment and every 3 to 6 months thereafter. They should also have their cholesterol levels monitored to evaluate the effects of treatment. 78) A nurse is collecting data from a client who has heart failure, prior to the administration of furosemide. For which of the following findings should the nurse withhold the medication? ANSWERS - Multiple Choice 1) Blood pressure of 80/40 mm/Hg Answer Rationale: Hypotension is an adverse effect of furosemide. The nurse should withhold the medication and notify the provider for a client who is hypotensive. INCORRECT 2) Serum potassium level of 4.8 mEq/L Answer Rationale: Hypokalemia is an adverse effect of furosemide. A serum potassium level of 4.8 mEq/L is within the expected reference range, so the nurse does not need to withhold the medication. INCORRECT 3) Oxygen saturation of 95% Answer Rationale: An oxygen saturation of 95% is within the expected reference range and does not require the nurse to withhold the medication. INCORRECT 4) Serum sodium level of 140 mEq/L Answer Rationale: Hyponatremia is an adverse effect of furosemide. A serum sodium level of 140 mEq/L is within the expected reference range, so the nurse does not need to withhold the medication. 79) A nurse is reinforcing medication instructions with a group of clients. Which of the following statements by a client indicates a need for further clarification? ANSWERS - Multiple Choice INCORRECT 1) "I will take ibuprofen for arthritis." Answer Rationale: Ibuprofen is classified as a nonsteroidal anti-inflammatory (NSAID), and it is used for chronic, symptomatic rheumatoid arthritis and osteoarthritis, as well as mild to moderate pain, and reduction of fever. Ibuprofen decreases inflammation caused by arthritis. INCORRECT 2) "I will take morphine sulfate during sickle cell crisis." Answer Rationale: Morphine sulfate is an opiate narcotic used for the symptomatic relief of severe, acute, and chronic pain. A client in sickle cell crisis experiences severe pain and hypoxia due to sickling of red blood cells and would benefit from morphine sulfate. INCORRECT 3) "I will take propranolol to manage high blood pressure." Answer Rationale: Propranolol hydrochloride is classified as a beta-blocker and can be used in the management of cardiac arrhythmias, myocardial infarction, anesthesia, angina pectoris, and hypertension. Propranolol hydrochloride typically is used in conjunction with another antihypertensive to control blood pressure. 4) "I will take aspirin to relieve the ringing in my ears." Answer Rationale: The nurse should inform the client that ringing in the ears is a manifestation of salicysm, an adverse effect of aspirin therapy. 80) A nurse is reinforcing teaching with a client who has a prescription for lisinopril. Which of the following statements indicates an understanding of the teaching? ANSWERS - Multiple Choice INCORRECT 1) "I can expect my voice to be hoarse while taking this medication." Answer Rationale: The nurse should instruct the client to immediately report to the provider manifestations such as hoarseness, swelling of the face, or trouble breathing, as these can indicate a life-threatening hypersensitivity reaction. INCORRECT 2) "I should use salt substitutes while taking this medication." Answer Rationale: Lisinopril can increase potassium levels. The nurse should instruct the client to avoid the use of potassium- containing salt substitutes and monitor potassium levels closely for hyperkalemia. INCORRECT 3) "I should check my pulse before each dose of this medication." Answer Rationale: Lisinopril is an ACE inhibitor and will lower the client’s blood pressure; however, it is not necessary for the client to check her pulse rate prior to taking this medication. 4) "I will contact my provider if I become pregnant while taking this medication." Answer Rationale: The nurse should instruct the client to notify the provider if pregnancy occurs while taking lisinopril. This medication can cause fetal injury including fetal death if taken in the second or third trimester. If a client becomes pregnant, the ACE inhibitor should be withdrawn. 81) A nurse on a telemetry unit is reviewing laboratory results for a client who has atrial fibrillation and is taking warfarin. Which of the following laboratory values should the nurse report to the provider? ANSWERS - Multiple Choice 1) PT 45 seconds Answer Rationale: The expected reference range for PT is 11 to 12.5 seconds. During therapy, the nurse should expect to see the values increase 1.5 to 2.5 times the baseline. Therefore, the nurse should withhold the warfarin and notify the provider. INCORRECT 2) Hgb 16 g/dL Answer Rationale: The expected range for Hgb in males is 14 to 18 g/dL and in females is 12 to 16 g/dL. A level of 16 g/dL is within the expected range for both males and females. INCORRECT 3) aPTT 36 seconds Answer Rationale: The expected reference range for aPTT is 30 to 40 seconds, with some variations among laboratories. INCORRECT 4) Platelets 190,000/mm3 Answer Rationale: The expected reference range for platelets is 150,000 to 400,000/mm3. 82) A nurse is reinforcing teaching with a client who is to start subcutaneous heparin. Which of the following information should the nurse include in the teaching? ANSWERS - Multiple Choice 1) Use a soft bristle toothbrush. Answer Rationale: To decrease the risk of bleeding gums, the client should use a soft bristle toothbrush. INCORRECT 2) Inject the medication deep into the thigh muscle. Answer Rationale: The medication should be injected into the layer of fat beneath the skin’s surface. INCORRECT 3) Expect stools to become black and tarry. Answer Rationale: Stools that are black and tarry can be a manifestation of a gastrointestinal bleed and should be reported to the provider. INCORRECT 4) Easy bruising indicates the medication is effective. Answer Rationale: Bruising can be a manifestation of bleeding and should be reported to the provider. 83) A nurse is reviewing the medical record of a client who has a new prescription for morphine. Which of the following findings should the nurse identify as a contraindication to this medication? ANSWERS - Multiple Choice INCORRECT 1) The client recently had a myocardial infarction (MI). Answer Rationale: Morphine sulfate is routinely used in clients who have an MI to decrease oxygen demand and the workload on the heart. A history of recent MI is not a contraindication to the administration of morphine. INCORRECT 2) The client is 24-hr postoperative following hip arthroplasty. Answer Rationale: Morphine sulfate is used for preoperative and postoperative pain. INCORRECT 3) The client has a history of seizures. Answer Rationale: A history of seizures is not a contraindication to the administration of morphine. 4) The client has a paralytic ileus. Answer Rationale: Morphine is contraindicated in clients who have a paralytic ileus. 84) A nurse is reinforcing teaching with a client who has a new prescription for codeine. Which of the following information should the nurse include in the teaching? ANSWERS - Multiple Choice INCORRECT 1) Take on an empty stomach to prevent nausea. Answer Rationale: Nausea and vomiting are common adverse effects that can be minimized by taking the medication with food or milk. INCORRECT 2) Limit alcohol intake to 12 oz daily. Answer Rationale: Codeine causes CNS depression. Therefore, other CNS depressants such as alcohol should be avoided. INCORRECT 3) Diarrhea is an expected adverse effect. Answer Rationale: Codeine is an opioid analgesic that can cause constipation. 4) Change positions slowly. Answer Rationale: Codeine is an opioid analgesic that causes CNS depression and orthostatic hypotension. The client should change positions slowly to avoid the risk of falls. 85) A nurse is planning to administer digoxin to a client who has heart failure. Which of the following laboratory results is the priority for the nurse to review prior to administering the medication? ANSWERS - Multiple Choice 1) Potassium level Answer Rationale: Digoxin is a cardiac glycoside medication used to improve myocardial contractility, increasing stroke volume and cardiac output in a client who has heart failure. During therapy, the nurse should closely monitor the client’s potassium level as hypokalemia increases the risk of digitalis toxicity and cardiac arrhythmias. INCORRECT 2) Hemoglobin level Answer Rationale: Digoxin is a cardiac glycoside used to increase the force of myocardial contraction and decrease heart rate. The client’s hemoglobin level should be monitored, but there is another lab value that is the priority. INCORRECT 3) Creatinine Answer Rationale: Creatinine is monitored to identify renal impairment and indicate the glomerular filtration rate. Digoxin is a cardiac glycoside used to increase cardiac output in a client who has heart failure. The client’s creatinine level should be monitored, but there is another lab value that is the priority. INCORRECT 4) Blood urea nitrogen Answer Rationale: Blood urea nitrogen (BUN) is formed in the liver as a metabolite of protein. BUN increases with compromised kidney filtration, high-protein diet, fever, and dehydration. BUN and creatinine levels are monitored together when caring for a client who has renal insufficiency or failure. The client’s BUN level should be monitored, but there is another lab value that is the priority. 86) A nurse is talking with a client who says she knows someone who takes metoprolol for blood pressure and asks if the medication would be appropriate for her as well. Which of the following data from the client’s medical record should the nurse identify as a contraindication to metoprolol? ANSWERS - Multiple Choice INCORRECT 1) Diet-controlled diabetes mellitus Type 2 Answer Rationale: Metoprolol can mask the manifestations of hypoglycemia for clients who have diabetes mellitus. The nurse should implement close monitoring when administering metoprolol to clients who have this condition; however, this is not a contraindication to administration. 2) A history of sinus bradycardia Answer Rationale: Metoprolol can cause bradycardia, dysrhythmias, and AV block. The nurse should recognize the medication is contraindicated for clients who have sinus bradycardia, sick sinus syndrome, or 2nd or 3rd degree heart block. INCORRECT 3) A concurrent prescription for tadalafil Answer Rationale: Metoprolol does not interact with tadalafil. INCORRECT 4) Recently treated bilateral pneumonia Answer Rationale: Metoprolol can cause bronchospasm. The nurse should implement close monitoring when administering it to clients who have obstructive lung disease; however, this is not a contraindication. 87) A nurse observes a newly licensed nurse administer enoxaparin subcutaneously using a pre-filled syringe. Which of the following indicates appropriate medication administration? ANSWERS - Multiple Choice INCORRECT 1) Inserting the needle into the tissue using a 30-degree angle Answer Rationale: The newly licensed nurse should use a 45- to 90-degree angle for a subcutaneous injection, depending on the amount of fatty tissue at the injection site. INCORRECT 2) Transferring the medication into a U-100 insulin syringe for injection Answer Rationale: The nurse should not attempt to transfer the medication. If a multidose vial of enoxaparin is available, the appropriate dose can be retrieved and administered using a tuberculin syringe. INCORRECT 3) Removing the air bubble from the prefilled syringe prior to administration Answer Rationale: The newly licensed nurse should not remove the air bubble from the prefilled syringe priori to administration. 4) Administering the injection 6.35 cm (2.5 in) from the umbilicus Answer Rationale: The newly licensed nurse should administer enoxaparin at least 5.008 cm (2 in) from the umbilicus. 88) A nurse is reviewing the medical record of a client who has been taking simvastatin for 9 months. The client has an alanine aminotransferase (ALT) 120 units/L and aspartate aminotransferase (AST) 100 units/L. Which of the following data from the client’s dietary history should the nurse report to the provider? ANSWERS - Multiple Choice INCORRECT 1) The client drinks milk when taking the medication. Answer Rationale: Consuming dairy products does not affect the effectiveness of simvastatin. 2) The client drinks grapefruit juice every evening. Answer Rationale: Grapefruit inhibits the drug-metabolizing enzyme CYP3A4. Clients taking statin medications and consuming grapefruit juice can experience medication toxicity, leading to headache, gastrointestinal disturbances, and damage to the muscles and liver. The nurse should report this finding to the provider to prevent further harm to the client. INCORRECT 3) The client eats spinach salad daily. Answer Rationale: Foods high in Vitamin K, such as green leafy vegetables, do not affect the effectiveness of simvastatin. INCORRECT 4) The client consumes a diet high in gluten. Answer Rationale: Consuming a high gluten diet does not affect the effectiveness of simvastatin. 89) A nurse is reinforcing teaching about transdermal nitroglycerin paste with a client. Which of the following client statements indicates understanding of the teaching? ANSWERS - Multiple Choice INCORRECT 1) "I should apply some paste under my tongue if I experience angina." Answer Rationale: The client should not use transdermal paste sublingually to treat angina, since the absorption rate and dosage differs from the sublingual tablets. INCORRECT 2) "I should rub the paste into my skin thoroughly." Answer Rationale: The client should apply nitroglycerin paste to the skin surface without rubbing and cover it with plastic wrap or provided papers. 3) "I should get up slowly when I stand or get out of bed." Answer Rationale: Nitroglycerin can cause orthostatic hypotension. The nurse should instruct the client to change positions slowly, and rest her feet on the floor for a few minutes before standing up. INCORRECT 4) "I should stop taking this medication if I experience headaches." Answer Rationale: The nurse should instruct the client that a headache is a common adverse effect once therapy is initiated, and that clients usually experience them less once tolerance to the medication develops. The client can take nonopioid pain relievers to treat the headache. 90) A nurse is reinforcing teaching with a client who is taking hydrochlorothiazide. Which of the following information should the nurse include in the teaching? ANSWERS - Multiple Choice INCORRECT 1) Take the medication at bedtime. Answer Rationale: Hydrochlorothiazide is a diuretic that will increase urinary output. The client should take the medication in the morning to avoid nocturia. 2) Increase daily intake of foods high in potassium. Answer Rationale: Hydrochlorothiazide increases the excretion of potassium, which can lead to hypokalemia. The client should eat plenty of foods that are high in potassium, such as bananas. INCORRECT 3) Take the medication on an empty stomach. Answer Rationale: Hydrochlorothiazide should be taken with food or milk to decrease gastrointestinal upset. INCORRECT 4) Muscle weakness is an expected adverse effect. Answer Rationale: Muscle weakness can indicate hypokalemia and should be reported to the provider. 91) A nurse is collecting data from a client who is receiving clopidogrel following the placement of a cardiac stent. Which of the following findings should the nurse identify as an adverse effect of this medication? ANSWERS - Multiple Choice INCORRECT 1) Constipation Answer Rationale: Clopidogrel is more likely to cause diarrhea than constipation. INCORRECT 2) Hypotension Answer Rationale: Clopidogrel is more likely to cause hypertension than hypotension. 3) Black stools Answer Rationale: Clopidogrel helps prevent stent closure, but can cause gastrointestinal bleeding, with manifestations such as black, tarry stools, coffee-ground emesis, and easy bruising. The nurse should notify the provider immediately of any of these findings. INCORRECT 4) Hypothermia Answer Rationale: Clopidogrel is more likely to cause fever than hypothermia. 92) A nurse is collecting data from a client who is postoperative and receiving IV morphine 1 mg every 10 min via PCA. For which of the following manifestations should the nurse withhold the morphine? ANSWERS - Multiple Choice INCORRECT 1) The client is drowsy and responds to verbal stimuli by answering questions. Answer Rationale: A client who is receiving IV morphine but is drowsy and responds to verbal stimuli by answering questions is not experiencing a severe adverse effect of morphine. 2) The client's respiratory rate is 9/min. Answer Rationale: The nurse should withhold the opioid and notify the provider for a respiratory rate that is less than 12/min in a client receiving morphine. Respiratory depression can lead to severe hypoxia and death if further opioids are administered. INCORRECT 3) The client reports a pain level of 4 on a scale of 0 to 10. Answer Rationale: A client evaluation of pain as 4 on a numeric scale of 0 to 10 is not a reason to withhold an opioid. INCORRECT 4) The client's urinary catheter output was 30 mL during the past hour. Answer Rationale: An hourly urinary output of 30 mL is adequate and is not a reason to withhold an opioid. 93) A group of nurses are discussing the difference of an agonist verses an antagonist. Which of the following medications may the nurse select as an agonist? ANSWERS - Multiple Choice INCORRECT 1) Flumazenil (Romazicon) Answer Rationale: The nurse should not select flumazenil which is a benzodiazepine antagonist, not an agonist. INCORRECT 2) Diphenhydramine hydrochloride (Benadryl) Answer Rationale: The nurse should not select diphenhydramine hydrochloride which is a cholinergic antagonist, not an agonist. 3) Dobutamine hydrochloride (Dobutrex) Answer Rationale: The nurse should select dobutamine hydrochloride which is an adrenergic agonist that mimics the receptors it binds to. INCORRECT 4) Naloxone hydrochloride (Narcan) Answer Rationale: The nurse should not select naloxone hydrochloride which is an opiate antagonist, not an agonist. [Show More]

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