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Page 1 Aclient has been prescribed metoclopramide. Which of the following should the nurse include inclient education regarding this medication ?Select one: a. Notify your provider if you experience restlessness or spasms of the face or neck. An adverse effect of Reglan is extrapyramidal symptoms. The client should stop the medication and notify the provider if these occur. b. This medication can cause urinary frequency. c. Decrease your fluid intake while taking this medication. d. This medication can cause insomnia. A52-year-old client with a history of angina has been prescribed transdermal nitroglycerin. Which of the following adverse effects is notseen with this therapy? Select one: a. Headache b. Orthostatic hypotension c. Tolerance d. Productive cough Correct -—Nitroglycerin therapy does not directly have an effect lung function. Physiologically, vasodilation should effect capillary perfusion and decrease lung secretions. Anurse is caring fora client prescribed montelukast. Which of the following should the nurse include in teaching related to this medication ?Select one: a. Advise client to take the medication once daily at bedtime. Clients should take montelukast once daily at bedtime. [Date] 4] Page 2 b. If the client forgets to take the medication for a few days he can double up on doses to catchup. c.Avoid dairy products while taking this medication. d. This medication is for acute management of asthma Anurse is caring fora client prescribed ferrous sulfate for the treatment of anemia. Which of thefollowing instructions should be included in client teaching about this medication? Select one: a. Take the medication on an empty stomach to maximize absorption. The nurse should instruct the clients to take iron on an empty stomach, such as 1 hrbefore meals to maximize absorption. Stomach acid increases absorption. If Gl adverse effects occur, the client can take with food toincrease adherence to therapy even though absorption is also Page 4 d. Aclient with glaucoma. Correct— benzodiazepines can increase intraocular pressure due to the pupil-dilating effects of the Medication. Aclient has been prescribed lisinopril. Which of the following medication interactions should thenurse instruct this client about? Select one: a. Escitalopram b. Potassium supplements Correct. Potassium supplements and potassium-sparing diuretics increase the risk of hyperkalemia in clients taking ACE inhibitors such as lisinopril. Clients should only take potassium supplements if prescribed by the provider. Clients should also avoid salt substitutes that contain potassium. Page 5 c. Magnesium supplements d. Ciprofloxacin Aclient has been prescribed vasopressin for the treatment of diabetes insipidus. Whats the expected pharmacological action of this medication? a. To stimulate the pancreas to secrete insulin. b. Toincrease blood pressure. c. Toslowthe absorption of glucose in the intestine. d. Toincrease reabsorption of water in the renal tubules. The expected pharmacological action is to promote reabsorption of water within thekidney Anurse is caring for a client receiving a dopamine infusion via a peripheral IV. Which of the following actions should the nurse take if the IV site appears infiltrated? Select one: a. Apply a warm compress to the site. b. Apply acold compress to the site. c. Slow the infusion and continue to monitor the site. d. Stop the infusion. Correct. If infiltration is suspected, the infusion should be stopped. Necrosis can occur from extravasation of high doses of dopamine. Extravasation can be treated with local injection of an alpha- adrenergic blocking agent, such as Phentolamine. Anurseis caring for a client newly prescribed doxazosin mesylate. Which of the following instructions should the nurse include in client education regarding taking the first dose of this medication? Select one: a. There is no need to avoid normal activities. Page 7 b. "I should take the medication ona full stomach." c. "| should take the medication in the morning to prevent insomnia." Synthroid shouldbe taken once in the morning to preventinsomnia. d."| should take the medication in divided doses to ensure therapeutic drug levels.” A55-year-old client has levothyroxine ordered. Which of the below past medical history concerns may contraindicate with her medication management of hypothyroidism?Select one: a. Peripheral Vascular Disease b. Osteoporosis Correct: There is an increased risk for fractures, especially in older adults. c. Asthma d. Scleroderma Anurse is preparing to administer an intramuscular injection to an adult client. Atwhat angle should the nurse administer the medication using the ventrogluteal site?Select one: a.a45 degree angle b. A90 degree angle IM injections should be administered at a 90 degree angle. c.a75degree angle d.a60 degree angle Anurse has just administered a wrong medication to a client. Which of the following actions should the nurse take next? Select one: a. Report error tothe provider. Correct. The nurse should acknowledge the error and report it to the provider for further orders. The nurse should also monitor the client for adverse effects. b. No action is needed. c. Complete an institutional incident report. Page 8 d. Inform the client that the wrong medication was given. A45-year-old client is taking methylprednisolone. What pharmacological action should the nurseexpect with this therapy? Select one: a. Suppression of airway mucus production. Correct—Corticosteroids, suchas methylprednisolone (Solu-Medrol) will suppress airway mucus production. b. Suppression of candidiasis. c. Fortification of bones. d. Suppression of beta receptors. Page 10 following medication classifications? . Nitrates . sulfa-based medications antilipemic agents proton pumpinhibitors . -Anurse in an emergency department is caring for a client who has anew prescription for acetylcysteine. For which of the following conditions should the nurse expect to administer this medication? . Gastrointestinal bleed acute bronchospasm morphine toxicity acetaminophen toxicity [Date] | 10 | Page 11 Anurseis caring for a client prescribed the HMG CoAreductase inhibitor, atorvastatin. Which ofthe following should be monitored while this medication is prescribed?Select one: a. Hearing screenings b. Visual acuity screenings c. Renalfunction tests d. Liver function tests Correct. Statins (HMG CoAreductase inhibitors) like atorvastatin (Lipitor) can cause hepatotoxicity. Prior to initiating therapy the client's baseline liver function should be determined then liverfunction tests should be checked after 12 weeks of therapy and then every 6 months. The nurse should advise the client to observe forsymptoms of liver dysfunction (anorexia, vomiting, nausea, jaundice) and to notify the provider if these occur. Anurseis caring fora client prescribed hydromorphone for severe pain. The client's respiratoryrate has decreased from 16 breaths per minute to 6. Which if the following medications should the nurse prepare to administer?Select one: a. Naloxone Correct. This client is experiencing respiratory depression likely related to over administration of hydromorphone (Dilaudid). Naloxone (Narcan) and nalmefene (Revex) are opioid antagonists used toreverse an overdose of opioids. Page 13 has formed a precipitate. The first step is to observe the characteristics of the regular and NPH insulin to determine whether they are safe to use. * Roll NPH vial between palms of hands: Because NPH insulin is a suspension, the particles must be evenly dispersed by rolling the vial gently between the palms of the hands. This should be done gently because vigorous mixing may cause the solution to become frothy and cause inaccurate dosing. If granules or clumps are present after mixing, discard the solution. This should be done prior to withdrawing the solution intothe syringe. Page 14 ¢ Inject air into NPH insulin vial: This creates a pressure in the vial for accuracy in measuring the amount prescribed. ¢ Inject air into regular insulin vial: The amount of air injected into the vial of short-acting insulin is equal to the amount to be administered. ¢ Withdraw short-acting insulin into syringe: When the prescription requires the administration of two types of insulin, it is preferable to mix the solutions into one syringe if they are compatible to prevent the client from receiving two injections. Of the longer-acting insulin available, only NPHinsulinis mixed with short-acting insulin. Whentwo insulins are to be mixed, withdraw the short-acting insulin first to avoid contaminating the stock vial with NPH insulin. ¢ Add intermediate insulin to syringe: The mixture is stable for 28 days. Aclientis prescribed propranolol. Which of the following client history findings would require thenurse to clarify this medication prescription ?Select one: a. Tachydysrhythmias b. Asthma Correct. Clients with asthma should avoid Beta2 Blockade agents suchas propranolol. Bronchoconstriction can occur. Clients with asthma should be administered a beta‘ selective agent. c. Hypertension d. Urolithiasis Which of the following are contraindications to aspirin therapy? Select all that apply. Select one or more: a. Coronary artery disease b. Deep vein thrombus c. Thrombocytopenia Correct. Aspirin is contraindicated in clients with bleeding [Date] Page 16 clean gloves when touching blood, body fluid, secretions, excretions, most mucous membranes, nonintact skin, and contaminated items or surfaces. Lubricate index finger is correct. The rounded end of the suppository is lubricated witha sterile water-soluble lubricating jelly. Use a rectal applicator for insertion is incorrect. The nurse should administer the suppositorywith the dominant index finger, which is lubricated. The nurse should not use an applicator toinsert a suppository. Pasition client supine with knees bentis incorrect. To avoid the rupturing the rectum, the clientispositioned on the left lateral side. Insert suppository just beyond internal sphincter is correct. The nurse should gently retract the buttocks with the nondominant hand. Insert the suppository gently throughthe anus, past the internal sphincter, and against the rectal wall. Following the administration of the medication, the nurse should apply gentle pressure to hold the buttocks together momentarily if needed to keep medication in place. Anurse is providing care to a client with staphylococcus epidermidis, who is prescribed vancomycin. Identify the adverse effect associate with this antibiotic therapy?Select one: a. Infusion reaction Correct — Red Man Syndrome or an infusion reaction that results in rashes, flushing, tachycardia and hypotension can occur as an adverse reaction. For this reason, vancomycin should be administered over a 60 minute period. b. Immunosuppression c. Hepatotoxicity d. Constipation Anurse is preparing to administer a measles, mumps, and rubella vaccine (MMR) to an adult client. Which of the following is a [Date] | 16 | Page 17 contraindication to this vaccine?Select one: a. The possibility of overseas travel in the next month b. Client allergy to strawberries c. The possibility of pregnancy within 4weeks Pregnancy or the possibility of pregnancy with 4 weeks is a contraindication to the MMR vaccine. d. Client history of genital herpes Disulfiram is taken by a client daily for abstinence maintenance. What is an adverse effect ofthis therapy? Page 19 STEP 6: Setup an equation and solve for X.Desired x Quantity/Have =X 2mgx1mL/10mg=XmL 0.2mL=X STEP 7: Roundif necessary. STEP 8: Reassess to determine whether the amount to administer makes sense. If there are 10mg/mL and the prescription reads 2 mg, it makes sense to administer 0.2 mL. The nurse shouldadminister morphine sulfate 0. 2 mLIV bolus. Dimensional Analysis STEP 1: Whatis the unit of measurement the nurse should calculate? mL STEP 2: Whatis the quantity of the dose available? 1 mL Page 20 STEP 3: Whatis the dose available? Dose available = Have 10 mg STEP 4: Whatis the dose the nurse should administer? Dose to administer= Desired 2 mg STEP 5: Should the nurse convert the units of measurement? No STEP 6: Set up an equation and solve for X. X= Quantity/Have x Conversion (Have)/Conversion (Desired) x Desired/X mL = 1mL/10 mg x2 mg/ X=0.2 STEP 7: Roundif necessary. STEP 8: Reassess to determine whether the amount to administer makes sense. If there are 10mg/mL and the prescription reads 2 mg, it makes sense to administer 0.2 mL. The nurse shouldadminister morphine sulfate 0.2 mL IV bolus. -Anurse is monitoring a client who received an excessive dose of morphine. Which of the following adverse effects should the nurse identify as the priority? -nausea andvomiting -urinary retention -decreased respirations -increased drowsiness -Anurse is caring fora client who has a prescription for a hypotonic IV fluid. Which of the following solutions should the nurse expect to administer? 0.45% sodium chloride 0.9% sodium chloride 3% sodium chloride Lactated ringers [Date] 
