HESI PN PHARMACOLOGY V3 EXAM

HESI PN PHARMACOLOGY V3 EXAM QUESTIONS & ANSWERS WITH RATIONALS (RATED A+) 100% REVIEWED LATEST UPDATE A client with mild parkinsonism is started on oral amantadine (Symmetrel). What statement accurately describes the action of this medication? dopamine in central nervous system is increased A 52-year-old client is admitted to the hospital for possible duodenal ulcers. The healthcare provider prescribes ranitidine hydrochloride (Zantac) 150 mg BID PO. Which data would indicate that this medication is effective? Within 4 hours after meals, the client denies having pain. A 78-year-old client with congestive heart failure receives the cardiac glycoside digoxin (Lanoxin) 0.25 mg PO daily. Which observation by the nurse indicates that the medication has been effective? Clear breath sounds anteriorly and posteriorly Minocycline (Minocin) 50 mg every 8 hours is prescribed for an adolescent girl diagnosed with acne. The nurse discusses self-care with the client while she is taking the medication. Which teaching points should be included in the discussion? (Select all that apply.) Report vaginal itching or discharge. Protect skin from natural and artificial ultraviolet light. Avoid driving until response to medication is known. Use a nonhormonal method of contraception if sexually active. The nurse is assessing a stuporous client in the emergency department who is suspected of overdosing with opioids. Which agent should the nurse prepare to administer if the client becomes comatose? Naloxone hydrochloride (Narcan) The healthcare provider prescribes captopril (Capoten) 37.5 mg. The medication is available in 25 mg tablets. What should the nurse administer? 1 ½ tablets A client who is HIV positive is receiving epoetin (Epogen) for management of anemia secondary to zidovudine (AZT) therapy. Which laboratory finding is most important for the nurse to report to the healthcare provider? Hematocrit (HCT) of 58% A 75-year-old male client taking hydrochlorothiazide (HCTZ) is admitted to the hospital having "palpitations" and "skipped heart beats." What is the most likely cause of these symptoms given the client's medication history? Hypokalemia Which parameter is most important for the nurse to check prior to administering a subcutaneous injection of heparin? A. Heart rate B. Urinary output C. Activated partial thromboplastin time (aPTT) D. Prothrombin time (PT) and international normalized ratio (INR) C. Activated partial thromboplastin time, commonly referred to as aPTT Rationale: The laboratory value that measures heparin's therapeutic anticoagulation time is the aPTT (C). (A) should be checked before the administration of digoxin. (B) is valuable information but not a parameter measured for heparin therapy. (D) is evaluated during anticoagulation therapy using sodium warfarin (Coumadin). A client is prescribed a cholinesterase inhibitor, and a family member asks the nurse how this medication works. Which pharmacophysiologic explanation should the nurse use to describe this class of drug? Improves nerve impulse transmission In developing a nursing care plan for a 9-month-old infant with cystic fibrosis, the nurse writes a nursing diagnosis of Alteration in nutrition: less than body requirements, related to inadequate digestion of nutrients. Which intervention would best meet this child's needs? Give pancrelipase (Cotazym-S) capsule mixed with applesauce before each meal. When providing client teaching about the administration of methylphenidate (Ritalin) to the mother of a child diagnosed with attention-deficit/hyperactive disorder (ADHD), what instruction should the nurse include in the teaching plan? Offer the child the medication before eating breakfast and after eating lunch. Alteration of which laboratory finding represents achievement of a therapeutic goal for heparin administration? Partial thromboplastin time The charge nurse is reviewing the admission history and physical data for four clients newly admitted to the unit. Which client is at greatest risk for adverse reactions to medications? A. 30-year-old man with a fracture B. 7-year-old child with an ear infection C. 75-year-old woman with liver disease D. 50-year-old man with an upper respiratory tract infection A. 75-year-old woman with liver disease Rationale: Impaired hepatic metabolic pathways for drug and chemical degradation place (C) at greatest risk for adverse reactions to medications based on advancing age and liver disease. (A and D) have no predisposing factors, such as genetics, pathophysiologic dysfunction, or drug allergies, that would increase the risk for cumulative toxicity or adverse drug reactions. (B) is at risk for dose-related adverse reactions but is at less risk than (C). The healthcare provider prescribes ipratropium (Atrovent) for a client. An allergic reaction to what other medication would cause the nurse to question the prescription for Atrovent? Atropine sulfate (Atropine) 68-year-old client has been diagnosed with open-angle glaucoma. The healthcare provider prescribes pilocarpine (Isopto Carpine) eye drops. What action of this drug makes it a useful treatment for the client's condition? The outflow of aqueous humor in the eyes is increased. The nurse is preparing to apply a surface anesthetic agent for a client. Which action should the nurse implement to reduce the risk of systemic absorption? A. Apply the anesthetic to mucous membranes. B. Limit the area of application to inflamed areas. C. Avoid abraded skin areas when applying the anesthetic. D. Spread the topical agent over a large surface area. C. Avoid abraded skin areas when applying the anesthetic Rationale: To minimize systemic absorption of topical anesthetics, the anesthetic agent should be applied to the smallest surface area of intact skin (C). Application to the mucous membranes poses the greatest risk (A) of systemic absorption because absorption occurs more readily through mucous membranes than through the skin. Inflamed areas generally have an increased blood supply, which increases the risk of systemic absorption, so (B) should be avoided. A large surface area increases the amount of topical drug that is available for transdermal absorption, so the smallest area should be covered, not (D). The healthcare provider prescribes the anticonvulsant carbamazepine (Tegretol) for a client with a seizure disorder. The nurse should instruct the client to notify the healthcare provider if which condition occurs? Experiences a sore throat chemotherapeutic regimen with doxorubicin HCl (Adriamycin) is being planned for a client recently diagnosed with cancer. What diagnostic test results should the nurse review prior to initiating this treatment? Electrocardiogram (ECG) A client who is HIV positive is receiving combination therapy with the antiviral medication zidovudine (Retrovir). What instruction should the nurse include in this client's teaching plan? Return to the clinic every 2 weeks for blood counts A 67-year-old client is discharged from the hospital with a prescription for digoxin (Lanoxin) 0.25 mg daily. Which instruction should the nurse include in this client's discharge teaching plan? Take and record radial pulse rate daily. Benztropine mesylate (Cogentin) and levodopa (Dopar) are prescribed for a client with Parkinson's disease. After a few days of therapy, the client complains of a "dry mouth" and "dizziness." What response by the nurse would be most appropriate? "Chew gum to relieve the dry mouth and move slowly when assuming a standing position to reduce the dizziness Vancomycin (Vancocin) is prescribed for a client who has a history of endocarditis and is to undergo minor dental surgery. The nurse knows that this drug may be administered PO. Which assessment finding could indicate to the nurse that a client is experiencing an adverse effect of the gastrointestinal stimulant metoclopramide HCl (Reglan)? Demonstrates Parkinson-like symptoms, such as cogwheel rigidity Methylphenidate HCl (Concerta) 18 mg PO is prescribed for daily administration to a 10-year-old child with attention-deficit/hyperactive disorder (ADHD). In preparing a teaching plan for the parents of this newly diagnosed ADHD child, which instruction is most important for the nurse to provide the parents? Administer the medication in the morning before the child goes to school. The nurse is preparing to administer amphotericin B (Fungizone) IV to a client. What laboratory data are most important for the nurse to assess before initiating an IV infusion of this medication? Serum potassium A client with angina pectoris is instructed to take sublingual nitroglycerin tablets PRN for chest pain. Which instruction should the nurse include in the client's teaching plan? A. Take one tablet every 3 minutes, up to five tablets. B. Take one tablet at the onset of angina and stop activity. C. Replace nitroglycerin tablets yearly to maintain freshness. D. Allow 30 minutes for a tablet to provide relief from angina. Take 1 tablet at the onset of angina and stop activity. Rationale: Nitroglycerin tablets should be taken at the onset of angina, and the client should stop activity and rest (B). One tablet can by taken every 5 minutes, up to three doses (A). Nitroglycerin should be replaced every 3 to 6 months, not every 12 months (C). Nitroglycerin should provide relief in 5 minutes, not 30 minutes (D). A client with cancer who has been receiving fentanyl (Duragesic) for several weeks reports to the nurse that the medication is not effectively controlling the pain. Which intervention should the nurse initiate? Notify the healthcare provider of the need to increase the dose A 55-year-old male client was diagnosed with schizophrenia 5 years earlier. He has had numerous hospitalizations since diagnosis because of noncompliance with the prescribed medication regime. Which drug might work best for this particular client? Fluphenazine decanoate (Prolixin decanoate) Prolixin, an antipsychotic drug that can be given IM, has a delayed onset (24 to 96 hours) and a long duration of action (up to 3 or 4 weeks), so would be the drug of choice for a noncompliant psychotic client. In administering the antiinfective agent chloramphenicol (Chloromycetin) IV to a client, the nurse observes the client closely for signs of bone marrow depression. Which laboratory data would be most important for the nurse to monitor? Platelet count The healthcare provider has prescribed a low-molecular-weight heparin, enoxaparin (Lovenox), 30 mg IVP BID for a client following hip replacement. Prior to administering the first dose, which intervention is most important for the nurse to implement? Contact the healthcare provider to clarify the prescription. The nurse has completed diabetic teaching for a client who has been newly diagnosed with diabetes mellitus. Which statement by this client would indicate to the nurse that further teaching is needed? A. "Regular insulin can be stored at room temperature for 30 days." B. "My legs, arms, and abdomen are all good sites to inject my insulin." C. "I will always carry hard candies to treat hypoglycemic reactions." D. "When I exercise, I should plan to increase my insulin dosage." D. When I exercise, I should plan to increase my insulin dosage." Rationale: Exercise helps facilitate the entry of glucose into the cell, so increasing insulin doses with exercise would place the client at high risk for a hypoglycemic reaction (D). (A, B, and C) reflect accurate statements about the use of insulin and management of hypoglycemic reactions. A client with schizophrenia has been taking the antipsychotic agent clozapine (Clozaril) for the past 3 weeks. Which nursing assessment finding would have the greatest implications for this client's care? Low-grade fever The apical heart rate of an infant receiving digoxin (Lanoxin) for congestive heart failure slows to 80 beats/min. What intervention should the nurse implement first? Obtain a serum digoxin level Sinus bradycardia (rate of less than 90 to 110 in an infant) is an indication of digoxin toxicity, so assessment of the client's digoxin level is the highest priority A client with viral influenza is receiving vitamin C 1000 mg PO daily and acetaminophen elixir 650 mg PO every 4 hours PRN. The nurse calls the healthcare provider to report that the client has developed diarrhea. Which change in prescriptions should the nurse anticipate? Decrease the dose of vitamin C. What nursing intervention has the highest priority during IV administration of mechlorethamine HCl (nitrogen mustard) and actinomycin (Actinomycin-D)? Assess for extravasation at the IV site during infusion. client is receiving oral griseofulvin (Grisactin) for a persistent tinea corporis infection. What response by the client indicates an accurate understanding of the drug teaching conducted by the nurse? "I'll wear sunscreen whenever I mow the lawn." A 42-year-old client is admitted to the emergency department after taking an overdose of amitriptyline (Elavil) in a suicide attempt. Which drug should the nurse plan to administer to reverse the cardiac and central nervous system effects of amitriptyline (Elavil)? Physostigmine (Antilirium) The healthcare provider prescribes the H2 antagonist famotidine (Pepcid) 20 mg in the morning and at bedtime. What statement regarding the action of H2 antagonists offers the correct rationale for administering the medication at bedtime? Gastric acid secreted at night is buffered, preventing pepsin formation female client is receiving sulfisoxazole (Gantrisin) for a urinary tract infection. What client teaching should the nurse include? Oral contraceptives may not be effective. Prior to administering a scheduled dose of digoxin (Lanoxin), the nurse reviews the client's current serum digoxin level, which is 1.3 ng/dl. Which action should the nurse implement? A. Administer Digibind to counteract the toxicity. B. Withhold the drug and notify the health care provider immediately. C. Withhold the dose and notify the health care provider during rounds that the dose was held. D. Give the dose of digoxin if the client's heart rate is within a safe range. Give the dose of digoxin if the client's heart rate is within a safe range The client's digoxin level of 1.3 ng/dl is not above the upper range of its therapeutic index (toxic level is greater than 2.0 ng/dl), so the dose should be administered after evaluating the client's heart rate A 19-year-old male client who sustained a severe head injury is intubated and placed on assisted mechanical ventilation. To facilitate optimal ventilation and prevent the client from "fighting" the ventilator, the healthcare provider administers pancuronium bromide (Pavulon) IV with adjunctive narcotic analgesia. What medication should the nurse maintain at the client's bedside? Neostigmine bromide (Prostigmin) The nurse is administering the early morning dose insulin aspart (NovoLog) 5 units subcutaneously to a client with diabetes mellitus type 1. The client's fingerstick serum glucose is 140 mg/dl. Considering the onset of NovoLog, when should the nurse ensure that the client's breakfast is available? 5 minutes after subcutaneous administration Insulin aspart is a very rapidly acting insulin with an onset of 5 to 15 minutes. NovoLog should be administered when the client's tray is available (A). NovoLog peaks in 45 minutes to 1.5 hours (B and C) and has a duration of 3 to 4 hours. What nursing intervention has the highest priority during IV administration of mechlorethamine HCl (nitrogen mustard) and actinomycin (Actinomycin-D)? Assess for extravasation at the IV site during infusion. Mechlorethamine HCl (nitrogen mustard) and actinomycin (Actinomycin-D) are vesicants; therefore, assessment for blister formation and/or tissue sloughing that can occur with leakage of these agents into surrounding subcutaneous tissues is essential to ensure client safety during the IV infusion A client with mild parkinsonism is started on oral amantadine (Symmetrel). What statement accurately describes the action of this medication? Dopamine in the central nervous system is increased The nurse is reviewing a client's laboratory results before a procedure in which a neuromuscular blocking agent is a standing order. Which finding should the nurse report to the healthcare provider? Hypokalemia The nurse is evaluating a client's understanding of the prescribed antilipemic drug lovastatin (Mevacor). Which client statement indicates that further teaching is needed? "I will take the medication every day before breakfast." Which class of antineoplastic chemotherapy agents resembles the essential elements required for DNA and RNA synthesis and inhibits enzymes necessary for cellular function and replication? A. Alkylating agents B. Antimetabolites C. Antitumor antibiotics D. Plant alkaloids B. Antimetabolites Rationale: Antimetabolites (B) exert their action by inhibiting the enzymes necessary for cellular function and replication. (A, C, and D) have a different mechanism of action. Which assessment finding could indicate to the nurse that a client is experiencing an adverse effect of the gastrointestinal stimulant metoclopramide HCl (Reglan)? Demonstrates Parkinson-like symptoms, such as cogwheel rigidity A female client with myasthenia gravis is taking a cholinesterase inhibitor and asks the nurse what can be done to remedy her fatigue and difficulty swallowing. What action should the nurse implement? A. Explore a plan for development of coping strategies for the symptoms with the client. B. Explain to the client that the dosage is too high, so she should skip every other dose of medication. C. Advise the client to contact her health care provider because of the development of tolerance to the medication. D. Develop a teaching plan for the client to self-adjust the dose of medication in response to symptoms. D. Develop a teaching plan for the client to self-adjust the dose of medication in response to symptoms. Rationale: Maintaining optimal dosage for cholinesterase inhibitors can be challenging for clients with myasthenia gravis. Clients should be taught to recognize signs of overmedication and undermedication so that they can modify the dosage themselves (D) based on a prescribed sliding scale. (A, B, and C) do not adequately address the client's concerns. A client who is HIV positive is receiving epoetin (Epogen) for management of anemia secondary to zidovudine (AZT) therapy. Which laboratory finding is most important for the nurse to report to the healthcare provider? Hematocrit (HCT) of 58% A female client who has started taking long-term corticosteroid therapy tells the nurse that she is careful to take her daily dose at bedtime with a snack of crackers and milk. What is the best response by the nurse? Advise the client to take the medication in the morning, rather than at bedtime. A 45-year-old female client is receiving alprazolam (Xanax) for anxiety. Which client behaviors would indicate that the drug is effective? A. Personal hygiene is maintained by the client for the first time in a week. B. The client has an average resting heart rate of 120 beats/min. C. The staff observes the client sitting in the day room reading a book. D. The nurse records that the client lost 2 lb of body weight in the past week. C. The staff observe the client sitting in the day room reading a book. Rationale: The ability to sit and concentrate on reading (C) indicates decreased anxiety. (A, B, and D) are not related to the use of alprazolam (Xanax) for anxiety. 55-year-old male client was diagnosed with schizophrenia 5 years earlier. He has had numerous hospitalizations since diagnosis because of noncompliance with the prescribed medication regime. Which drug might work best for this particular client? Fluphenazine decanoate (Prolixin decanoate) The nurse notes that a client receiving phenytoin (Dilantin) 300 mg PO daily has a serum phenytoin level of 14 mcg/ml. What intervention should the nurse implement? Make sure that the client is performing thorough oral care. therapeutic range for phenytoin is 10 to 20 mcg/ml Amoxicillin 500 mg PO every 8 hours is prescribed for a client with an infection. The drug is available in a suspension of 125 mg/5 ml. How many milliliters should the nurse administer with each dose? 20 A client has a positive skin test for tuberculosis. What prophylactic drug should the nurse expect to administer to this client? Isoniazid (INH) A client with acute lymphocytic leukemia is to begin chemotherapy today. The healthcare provider's prescription specifies that ondansetron (Zofran) is to be administered IV 30 minutes prior to the infusion of cisplatin (Platinol). What is the rationale for administering Zofran prior to the chemotherapy induction? Reduction or elimination of nausea and vomiting When caring for a client on digoxin (Lanoxin) therapy, the nurse knows to be alert for digoxin (Lanoxin) toxicity. Which finding would predispose this client to developing digoxin toxicity? Low serum potassium A client with viral influenza is receiving vitamin C 1000 mg PO daily and acetaminophen elixir 650 mg PO every 4 hours PRN. The nurse calls the healthcare provider to report that the client has developed diarrhea. Which change in prescriptions should the nurse anticipate? Decrease the dose of vitamin C. A 26-year-old primigravida client is experiencing increasing discomfort and anxiety during the active phase of labor. She requests something for pain. Which analgesic should the nurse anticipate administering? A. Butorphanol (Stadol) B. Hydromorphone (Dilaudid) C. Morphine sulfate D. Codeine sulfate A. Butorphanol (Stadol) Rationale: Butorphanol (Stadol) (A) is a mixed agonist-antagonist analgesic resulting in good analgesia but with less respiratory depression, nausea, and vomiting compared with opioid agonist analgesics (B, C, and D). A client receives an antihypertensive agent daily. Which action is most important for the nurse to implement prior to administering the medication? A. Verify the expiration date. B. Obtain the client's blood pressure. C. Determine the client's history of adverse reactions. D. Review the client's medical record for a change in drug route. B. Obtain the client's blood pressure. Rationale: To determine the most accurate response to antihypertensive therapy, baseline blood pressures should be obtained before an antihypertensive drug is administered and should be compared with orthostatic vital signs to determine whether any side effects are occurring (B). Although (A, C, and D) are required nursing actions prior to giving any drug, the therapeutic response should be determined before another dose is administered. An older client who had a colon resection yesterday is receiving a constant dose of meperidine (Demerol) via PCA pump. Which assessment finding is most significant and requires that the nurse intervene? A new hand tremor is noted. Clients receiving disulfiram (Antabuse) for treatment of alcoholism should be cautioned about the importance of avoiding alcohol, particularly during concurrent treatment with cephalosporin antibiotics, because an Antabuse reaction may be initiated. Which symptom would indicate that the client is experiencing a reaction to disulfiram (Antabuse)? Headache female client is receiving sulfisoxazole (Gantrisin) for a urinary tract infection. What instruction should the nurse include in the teaching plan for this client? Avoid cranberry juice while taking this drug. A client who is receiving phenytoin (Dilantin) begins to exhibit nystagmus and diplopia. Which physiologic manifestation is consistent with these findings? Phenytoin toxicity The nurse gives a client NPH insulin 15 units subcutaneously before breakfast (7:30 AM). At what time should the nurse be particularly alert for signs or symptoms of a potential hypoglycemic reaction? 1:30 to 3:30 PM NPH, an intermediate-acting insulin, peaks within 4 and 12 hours after subcutaneous injection, so the most likely time for this client to experience a hypoglycemic reaction is between 1:30 PM and 3:30 PM The nurse is reviewing a client's laboratory results before a procedure in which a neuromuscular blocking agent is a standing order. Which finding should the nurse report to the healthcare provider? Hypokalemia A male client who resides in a long-term care facility has a seizure disorder that has been managed with phenobarbital (Nembutal) for several years. Lately, he has become more difficult to arouse, and frequently tells the nurse that he wants to take a nap. What intervention should the nurse implement? Hold the medication and notify the healthcare provider. The nurse knows that certain antipsychotic drugs cause extrapyramidal symptoms. Which extrapyramidal symptom is a permanent and irreversible adverse effect of long-term phenothiazine administration? Tardive dyskinesia Phenazopyridine (Pyridium) is commonly prescribed for clients with urinary tract infections. What statement should be included by the nurse when teaching clients about the administration of phenazopyridine (Pyridium)? Take this medication with food to decrease gastric irritation. A 46-year-old female client is instructed to take Lugol's solution (strong iodine solution) in preparation for thyroidectomy surgery. Which food should the nurse instruct this client to remove from her diet? Shrimp A client is receiving pyridostigmine bromide (Mestinon) to control the symptoms of myasthenia gravis. Which client behavior would indicate that the drug therapy is effective? Clear speech Clear speech (B) is the result of increased muscle strength. Muscle weakness characteristic of myasthenia gravis often first appears in the muscles of the neck and face. What medication is useful in treating digoxin (Lanoxin) toxicity? Digoxin immune Fab (Digibind) What intervention is most important for a nurse to implement prior to administering atropine PO? Determine the presence of 5 to 35 bowel sounds per minute. The nurse is preparing a child for transport to the operating room for an emergency appendectomy. The anesthesiologist prescribes atropine sulfate (Atropine) IM STAT What is the primary purpose for administering this drug to the child at this time? Decrease the oral secretions A client receives a prescription for theophylline (Theo-Dur) PO to be initiated in the morning. The nurse determines that a theophylline level drawn yesterday was 15 mcg/ml. Based on this information, what should the nurse tell the nurse on the next shift about initiating the new prescription? The theophylline dose can be initiated as planned. The therapeutic range for theophylline is 10 to 20 mcg/ml! A male client who has chronic back pain is on long-term pain medication management and asks the nurse why his pain relief is not as effective as it was 2 months ago. How should the nurse respond? "Pharmacodynamic tolerance requires increased drug levels to achieve the same effect." A child is being treated with mebendazole (Vermox) for pinworms. What type of diet should the mother be instructed to feed the child while receiving this medication? High-fat diet A high-fat diet increases the absorption of mebendazole (Vermox), which boosts the effectiveness of the medication in eliminating the pinworms A client with a dislocated shoulder is being prepared for a closed, manual reduction using conscious sedation. Which medication should the nurse explain as a sedative used during the procedure? Midazolam (Versed) IV During administration of theophylline (Theo-Dur), the nurse should monitor for signs of toxicity. What symptom would cause the nurse to suspect Theo-Dur toxicity? Restlessness The nurse performs a client assessment prior to the administration of a prescribed dose of dipyridamole and aspirin (Aggrenox) PO. The nurse notes that the client's carotid bruit is louder than previously assessed. What action should the nurse implement? Administer the prescribed dose of Aggrenox as scheduled. A client who is experiencing an acute attack of gouty arthritis is prescribed Colchicine USP 1 mg PO daily. Which information is most important for the nurse to provide the client? Report any vomiting to the clinic. An older male client with Tourette syndrome takes haloperidol (Haldol) to control tics and vocalizations. He has become increasingly drowsy over the past 2 days and reports becoming dizzy when changing from a supine to sitting position. What action should the nurse take? Assess for poor skin turgor, sunken eyeballs, and concentrated urine output. Before administering an antiinfective agent to a client with a urinary tract infection, which nursing intervention is most important? Obtain a clean catch urine specimen. The healthcare provider prescribes cisplatin (Platinol) to be administered in 5% dextrose and 0.45% normal saline with mannitol (Osmitrol) added. Which assessment parameters would be most helpful to the nurse in evaluating the effectiveness of the Osmitrol therapy? Urine output To evaluate whether the administration of an antihypertensive medication has caused a therapeutic effect, what action should the nurse implement? Compare the client's blood pressure before and after taking the medication. During therapy with isoniazid (INH), it is most important for the nurse to monitor which lab value closely? Liver enzymes The client receiving isoniazid (INH) is at risk for developing hepatitis; therefore, liver function tests should be monitored carefully during drug therapy In administering the antiinfective agent chloramphenicol (Chloromycetin) IV to a client, the nurse observes the client closely for signs of bone marrow depression. Which laboratory data would be most important for the nurse to monitor? Platelet count The nurse is preparing to administer the disease-modifying antirheumatic drug (DMARD) methotrexate (Rheumatrex) to a client diagnosed with rheumatoid arthritis. Which intervention is most important to implement prior to administering this medication Have another nurse check the prescription. Double-checking the prescription (C) is an important intervention since death can occur from an overdose. This medication is administered weekly and in low doses for rheumatoid arthritis and should not be confused with administration of the drug as a chemotherapeutic agent. Which instruction should the nurse include in the teaching plan for a client who is receiving phenytoin (Dilantin) for seizure control? A.Maintain consistent sodium intake. B. Use sunscreen when outdoors. C. Return for monthly urinalysis. D. Brush and floss teeth daily. D. Brush and floss teeth daily. Rationale: Brushing and flossing the teeth daily prevent gingival hyperplasia (gum disease) that is common with long-term phenytoin (Dilantin) therapy (D). (A, B, and C) are not indicated for client instruction regarding Dilantin. The nurse plans to draw blood samples for the determination of peak and trough levels of gentamicin sulfate (Garamycin) in a client receiving IV doses of this medication. When should the nurse plan to obtain the peak level? A. Thirty minutes after the dose is administered B. Immediately before giving the next dose C. When the next electrolyte levels are drawn D. Sixty minutes after the dose is administered A. Thirty minutes after the dose is administered Peak drug serum levels are achieved 30 minutes after the IV administration of aminoglycosides, so (A) is the optimum time to get a peak level. (B, C, and D) are not appropriate times associated with peak levels for gentamicin. A 4-year-old child is receiving chemotherapy for acute lymphocytic leukemia. Which laboratory result should the nurse examine to assess the child's risk for infection? Neutrophil count Which assessment finding could indicate to the nurse that a client is experiencing an adverse effect of the gastrointestinal stimulant metoclopramide HCl (Reglan)? Demonstrates Parkinson-like symptoms, such as cogwheel rigidity A primigravida at 34 weeks of gestation is admitted to labor and delivery in preterm labor. She is started on a terbutaline sulfate (Brethine) continuous IV infusion via pump. This therapy is ineffective and the baby is delivered vaginally. What complication should the nurse monitor for in this infant during the first few hours after delivery? Hypoglycemia In developing a nursing care plan for a 9-month-old infant with cystic fibrosis, the nurse writes a nursing diagnosis of Alteration in nutrition: less than body requirements, related to inadequate digestion of nutrients. Which intervention would best meet this child's needs? Give pancrelipase (Cotazym-S) capsule mixed with applesauce before each meal. When providing nursing care for a client receiving pyridostigmine bromide (Mestinon) for myasthenia gravis, which nursing intervention has the highest priority? A. Monitor the client frequently for urinary retention. B. Assess respiratory status and breath sounds often. C. Monitor blood pressure each shift to screen for hypertension. D. Administer most medications after meals to decrease gastrointestinal irritation. B. Assess respiratory status and breath sounds often. Rationale: The client should be assessed often for signs of respiratory complications (B). The client with myasthenia gravis is at greatest risk for life-threatening respiratory complications because of the weakness of the diaphragm and ancillary respiratory muscles caused by the disease process. Cholinergic agents used to reduce muscle weakness can also cause hypersalivation, increased respiratory secretions, and possible bronchoconstriction. Although (A, C, and D) reflect helpful interventions, they do not have the priority of (B) in caring for the client with myasthenia gravis. Which question should the nurse ask an older client prior to the initiation of treatment with intravenous infusions of gentamicin sulfate (Garamycin)? "Are you hard of hearing?" Complications of gentamicin sulfate (Garamycin) therapy include ototoxicity, nephrotoxicity, and neurotoxicity. Determining if the client is hard of hearing A client with dysphagia has been diagnosed with duodenal ulcers and is being discharged from the hospital with a prescription for the gastric acid pump inhibitor lansoprazole (Prevacid) 15 mg PO daily. The medication comes in capsule form. What instruction should the nurse include in the discharge teaching plan for this client? Capsule contents can be sprinkled on pudding or applesauce. A 78-year-old client with congestive heart failure receives the cardiac glycoside digoxin (Lanoxin) 0.25 mg PO daily. Which observation by the nurse indicates that the medication has been effective? Clear breath sounds anteriorly and posteriorly During the initial nursing assessment history, a client tells the nurse he is taking tetracycline hydrochloride (Sumycin) for urethritis. What medication taken concurrently with Sumycin could interfere with its absorption? Sucralfate (Carafate) A mother brings her 18-month-old child to the community health center because the child has had "bad diarrhea" for the last 3 days. She states, "I bought some of this liquid at the pharmacy and gave my daughter a half-ounce." The nurse sees the bottle contains loperamide (Imodium AD). What intervention is most important for the nurse to implement initially? Ask the mother when the child last voided. An 83-year-old female client is recovering from a myocardial infarction. The cardiologist prescribes docusate sodium and casanthranol (Peri-Colace) 1 tab PO BID. What therapeutic effect does this medication provide for this client? Maintaining soft stools to prevent straining on defecation A 6-year-old boy is admitted to the emergency department with status epilepticus. His parents report that his seizure disorder has been managed with phenytoin (Dilantin) 50 mg PO BID for the past year. What drug should the nurse plan to administer in the emergency department? Diazepam (Valium) Diazepam (Valium) (B) is the drug of choice for treatment of status epilepticus. (A, C, and D) are used for long-term management of seizure disorders, but are not as useful as in the emergency management of status epilepticus. A client is receiving acyclovir sodium (Zovirax) IV for a severe herpes simplex infection. What intervention should the nurse implement during this drug therapy? Increase daily fluids to 2000 to 4000 ml/day. The healthcare provider prescribes carbamazepine (Tegretol) for a child whose tonic/clonic seizures have been poorly controlled. The nurse informs the mother that the child must have blood tests every week. The mother asks why so many blood tests are necessary. What complication is assessed through frequent lab testing that the nurse should explain to this mother? Myelosuppression A 19-year-old male client who sustained a severe head injury is intubated and placed on assisted mechanical ventilation. To facilitate optimal ventilation and prevent the client from "fighting" the ventilator, the healthcare provider administers pancuronium bromide (Pavulon) IV with adjunctive narcotic analgesia. What medication should the nurse maintain at the client's bedside? Neostigmine bromide (Prostigmin) Which outcome would the nurse expect a client to have who is receiving cyclobenzaprine (Flexeril)? Improved range of motion during physical therapy exercises A client taking linezolid (Zyvox) at home for an infected foot ulcer calls the home care nurse to report the onset of watery diarrhea. What intervention should the nurse implement? Instruct the client to obtain a stool specimen to be taken to the lab for analysis. Which statement indicates that client teaching regarding the administration of the chemotherapeutic agent daunorubicin HCl (Cerubidine) has been effective? A. "I should use an astringent mouthwash after every meal." B. "I will eat high-fiber foods and drink lots of water." C. "I expect my urine to be red for the next few days." D. "I should use sunscreen when I spend time outdoors." C. "I expect my urine to be red for the next few days." Rationale: Daunorubicin HCl (Cerubidine) causes the urine to turn red in color (C). (A) is not recommended. (B and D) are interventions that promote general good health, but are not specific to treatment with Cerubidine. client who is HIV positive is receiving combination therapy with the antiviral medication zidovudine (Retrovir). What instruction should the nurse include in this client's teaching plan? Return to the clinic every 2 weeks for blood counts. A client who is receiving chlorpromazine HCl (Thorazine) to control his psychotic behavior also has a prescription for benztropine (Cogentin). When teaching the client and/or significant others about these medications, what should the nurse explain about the use of benztropine (Cogentin) in the treatment plan for this client? The benztropine (Cogentin) is used to control extrapyramidal symptoms. A psychiatric client is discharged from the hospital with a prescription for haloperidol (Haldol). Which instruction should the nurse include in the discharge teaching plan for this client? A. Take with antacids to reduce gastrointestinal irritation. B. Use sunglasses and sunscreen when outdoors. C. Eat foods low in fiber and salt. D. Count the pulse before each dose. B. Use sunglasses and sunscreen when outdoors. Rationale: Photosensitivity is a common adverse effect of haloperidol (Haldol); therefore, the use of sunglasses and sunscreen (B) should be included in the discharge teaching for this client. (A, C, and D) are not pertinent to client teaching regarding the use of haloperidol (Haldol). A 42-year-old client is admitted to the emergency department after taking an overdose of amitriptyline (Elavil) in a suicide attempt. Which drug should the nurse plan to administer to reverse the cardiac and central nervous system effects of amitriptyline (Elavil)? A. Sodium bicarbonate B. Naloxone (Narcan) C. Phentolamine mesylate (Regitine) D. Atropine sulfate (Atropine) A. Sodium bicarbonate Rationale: Sodium bicarbonate (A) is an effective treatment for an overdose of tricyclic antidepressants such as amitriptyline (Elavil) to reverse QRS prolongation. (B, C, and D) are not the preferred agents for treating this drug overdose. The nurse notes that the hemoglobin of a client receiving darbepoetin alfa ( Aranesp) has increased from 6 g/dl to 10 g/dl over the first 2 weeks of treatment. What action should the nurse take? Notify the healthcare provider of the change in the client's lab values. While an increase in the client's hemoglobin is desired, a rapid increase (more than 1 g/dl in a 2-week period) may lead to hypertension, so the healthcare provider should be notified of this excessive increase A 3-year-old is admitted to the emergency department after ingesting an unknown amount of phenobarbital (Luminal) elixir prescribed for his brother's seizure disorder. What nursing intervention should the nurse implement first? Take the child's vital signs. The healthcare provider prescribes ipratropium (Atrovent) for a client. An allergic reaction to what other medication would cause the nurse to question the prescription for Atrovent? Atropine sulfate (Atropine) A client receiving ephedrine (Ephedrine) nose drops PRN complains of wakefulness. What action should the nurse take to minimize the client's insomnia? Administer the dose a few hours before bedtime. A 2-month-old infant is scheduled to receive the first DPT immunization. What is the preferred injection site to administer this immunization? Vastus lateralis The nurse is assessing a stuporous client in the emergency department who is suspected of overdosing with opioids. Which agent should the nurse prepare to administer if the client becomes comatose?A Naloxone hydrochloride (Narcan) A child with cystic fibrosis is receiving ticarcillin disodium (Ticar) for Pseudomonas pneumonia. What adverse effect should the nurse assess for and report promptly to the healthcare provider? Petechiae A client is receiving antiinfective drug therapy for a postoperative infection. Which complaint should alert the nurse to the possibility that the client has contracted a superinfection? "My mouth feels sore." An older client is receiving a water-soluble drug that is above the average dose for a young adult. Which action should the nurse implement first? Determine the drug's serum levels for toxicity. 75-year-old male client taking hydrochlorothiazide (HCTZ) is admitted to the hospital having "palpitations" and "skipped heart beats." What is the most likely cause of these symptoms given the client's medication history? Hypokalemia A client is taking famotidine (Pepcid). Which client statement should the nurse further assess because it may indicate that the client is experiencing a side effect of this drug? "I seem to be having difficulty thinking clearly." The nurse is preparing a plan of care for a client receiving the glucocorticoid methylprednisolone (Solu-Medrol). Which nursing diagnosis reflects a problem related to this medication that should be included in the care plan? A. Ineffective airway clearance B. Risk for infection C. Deficient fluid volume D. Impaired gas exchange B. Risk for infection Rationale: Corticosteroids depress the immune system, placing the client at risk for infection (B). Although (A, C, and D) reflect diagnostic statements that may be applicable to this client, only (B) is directly related to the administration of this medication. A female client who has started taking long-term corticosteroid therapy tells the nurse that she is careful to take her daily dose at bedtime with a snack of crackers and milk. What is the best response by the nurse? Advise the client to take the medication in the morning, rather than at bedtime. Two hours after taking the first dose of penicillin, a client arrives at the emergency department complaining of feeling ill, exhibiting hives, having difficulty breathing, and exhibiting hypotension. These findings are consistent with which client response that requires immediate action? A severe acute anaphylactic response The nurse is preparing a teaching plan for a client who has received a new prescription for levothyroxine sodium (Synthroid). Which instruction should be included? A. "Take this medication with a high-protein snack at bedtime." B. "You may change at any time to a less expensive generic brand." C. "Take your pulse daily, and if it exceeds 100 beats/min, contact the health care provider." D. "Return to the clinic weekly for serum blood glucose testing." C. "Take your pulse daily, and if it exceeds 100, contact the healthcare provider." Rationale: Levothyroxine sodium (Synthroid) should be withheld if the pulse is over 100 beats/min (C). To prevent insomnia, the daily dose should be taken early in the morning before breakfast, not at bedtime (A). Product brands should not be changed (B) without consulting the health care provider because the intended effects and side effects of different formulations of the medication can vary. The serum glucose level is not affected by thyroid preparations, so (D) is not required. Which class of antineoplastic chemotherapy agents resembles the essential elements required for DNA and RNA synthesis and inhibits enzymes necessary for cellular function and replication? Antimetabolites When developing a written nursing care plan for a client receiving chemotherapy for treatment of cancer, the nurse writes, "Assess each voiding for hematuria." Administration of which type of chemotherapeutic agent would prompt the nurse to add this intervention? Cyclophosphamide (Cytoxan) For which client(s) should the nurse withhold the initial dose of a COX-2 inhibitor until notifying the healthcare provider? (Select all that apply.) An older adult with a history of a skin rash while taking glyburide (DiaBeta) An adolescent with a history of an anaphylactic reaction to penicillin An adolescent at 34 weeks of gestation experiencing 1+ pitting edema A female client is receiving tamoxifen (Nolvadex) following surgery for breast cancer. She reports the onset of hot flashes to the nurse. What intervention should the nurse implement? Instruct the client that hot flashes are a side effect that often occurs with the use of this medication. Which factor is most important to ensure compliance when planning to teach a client about a drug regimen? A. Genetics B. Client age C. Client education D. Absorption rate B. Client education Rationale: The client's educational level (C) is the most important factor when planning teaching to ensure a client's compliance with taking a prescribed drug. (A and D) are physiologic responses that do not relate to a client's compliance. Although maturity level and age (B) contribute to compliance, the client's basic understanding of instructions, which is best indicated by educational level, is more significant. A client receiving a continuous infusion of heparin intravenously starts to hemorrhage from an arterial access site. What medication should the nurse anticipate administering to prevent further heparin-induced hemorrhaging? Protamine sulfate Dopamine (Intropin) 5 mcg/kg/min is prescribed for a client weighing 105 kg. The nurse mixes 400 mg of dopamine in 250 ml D5W for intravenous administration via an infusion pump. What is the hourly rate the nurse should set on the pump? 20 ml/hr 400 mg/250 ml equals 1.6 mg/ml or 1600 mcg/ml. The prescription for 5 mcg/kg/min would result in 31,500 mcg/hr. Delivery of that dose would be achieved by administering 20 ml/hr (D), which would actually deliver 5.07 mcg/kg/min. If CHF was present and the nurse wanted to limit fluid volume, the infusion can be concentrated: 800 mg of dopamine in 250 ml of IV fluid could be administered at 10 ml/hr to deliver the same dose of 5 mcg/kg/min. (A, B, and C) are not accurate hourly rates for this infusion. A lidocaine intravenous infusion at 4 mg/min via infusion pump is prescribed for a client having premature ventricular contractions (PVCs). The available premixed infusion contains 2 mg/ml of D5W. How many ml/hr should the nurse program the pump to deliver to this client? 120 120 ml/hr = 1 ml/2 mg x 4 mg/min x 60 min/hr. A client being treated for an acute myocardial infarction is to receive the tissue plasminogen activator (Alteplase). The nurse would be correct in providing which explanation to the client regarding the purpose of this drug? This drug is a clot buster that dissolves clots within a coronary artery. A client with HIV who was recently diagnosed with tuberculosis (TB) asks the nurse, "Why do I need to take all of these medications for TB?" What information should the nurse provide? A. Antiretroviral medications decrease the efficacy of the TB drugs. B. Multiple drugs prevent the development of resistant organisms. C. Duration of the medication regimen is shortened. D. Potential adverse drug reactions are minimized. B. Multiple drugs prevent the development of resistant organisms. Rationale: A multidrug regimen is prescribed for a client with HIV and TB to prevent the development of resistance of the tubercle bacilli (B). Although antitubercular medications can inhibit some antiretrovirals (A), a multidrug regimen is needed to inhibit the proliferation of the virulent tubercle bacilli. The duration of antitubercular therapy is typically 6 to 9 months and is not shortened (C) by the use of multiple medications. A client who is receiving HIV and TB therapy is at an increased risk of adverse reactions (D) because of the complex medication regimens and complications secondary to immunosuppression. A client experiencing dysrhythmias is given quinidine 200 mg PO every 6 hours. The nurse plans to observe this client for which common side effect associated with the use of this medication? Diarrhea In addition to nitrate therapy, a client is receiving nifedipine (Procardia) 10 mg PO every 6 hours. The nurse should plan to observe for which common side effect of this treatment regimen? Hypotension A 59-year-old client with congestive heart failure is taking furosemide (Lasix) 40 mg twice daily. The nurse plans to monitor this client for development of which complication? Hyponatremia The daughter of a female client with Alzheimer disease reports to the nurse that her mother has recently lost her appetite and refuses to eat. The client recently started taking rivastigmine tartrate (Exelon). What instructions are important for the nurse to provide the client's daughter? The prescriber should be notified about this adverse effect of the medication right away. The nurse working in the community health clinic is assessing risk factors that can decrease medication effectiveness for clients with schizophrenia. Which client behavior is likely to decrease the effectiveness of psychotropic medications? Smokes at least 20 cigarettes daily A client is being discharged with a prescription for sulfasalazine (Azulfidine) to treat ulcerative colitis. Which instruction should the nurse provide to this client prior to discharge? A. Maintain good oral hygiene. B. Take the medication 30 minutes before a meal. C. Discontinue use of the drug gradually. D. Drink eight glasses of fluid a day. D. Drink 8 glasses of fluid a day. Rationale: Adequate hydration is important for all sulfa drugs because they can crystallize in the urine (D). If possible, the drug should be taken after eating to provide longer intestinal transit time (B). (A) is important for other medications, such as phenytoin (Dilantin), because of the incidence of gingival hyperplasia, and (C) is important for steroid administration, but (D) is most important to stress with this client. Daily doses of calcium citrate-malate (Citrucel) and vitamin D are prescribed for a 70-year-old female client. Which instruction should the nurse provide this client regarding taking the prescribed medications? Divide the medication over the course of the day and take it in small doses 1 hour after meals and at bedtime. A female client with trichomoniasis (T. vaginalis) receives a prescription for metronidazole (Flagyl). Which instruction is most important for the nurse to include this client's teaching plan? Avoid alcohol consumption Which physiologic mechanism explains a drug's increased metabolism that is triggered by a disease process? A. Selectivity response B. Pharmacokinetics C. Pharmacodynamics D. Pharmacotherapeutics B. Pharmacokinetics Pharmacokinetics (B) describes the physiologic process of a drug's movement throughout the body and how the drug's interaction is impacted by an underlying disease. Selectivity (A), or a selective drug, is defined as a drug that elicits only the response for which it is given. Pharmacodynamics (C) is the impact of drugs on the body. Pharmacotherapeutics (D) is defined as the use of drugs to diagnose, prevent, or treat disease or prevent pregnancy. Methenamine mandelate (Mandelamine) is prescribed for a client with a urinary tract infection and renal calculi. What finding indicates to the nurse that the medication is effective? Frequency of urinary tract infections decreases. Which assessment datum indicates to the nurse that a dose of granisetron (Kytril) administered IV prior to chemotherapy has had the desired effect? Client denies nausea. The nurse who is working in a men's health clinic is reviewing the medical records of several clients who have received a prescription for sildenafil (Viagra). Which client history data should alert the nurse that close monitoring for adverse effects of Viagra is necessary? Duodenal ulcer prophylaxis with cimetidine (Tagamet) Which instructions should the nurse provide an adolescent female client who is initiating treatment with isotretinoin (Accutane) for acne vulgaris? (Select all that apply.) "Notify the healthcare provider immediately if you think you are pregnant." "If you begin crying more than usual and feel sad, stop the drug and call the healthcare provider." "Before, during, and after therapy, two effective forms of birth control must be used at the same time. " A male client asks the nurse why condoms should not be lubricated with the spermicide nonoxynol-9. Which response is best for the nurse to provide? A. The risk of female infertility and spontaneous abortion is linked with nonoxynol-9. B. Partners can develop intermittent interstitial cystitis if the spermicide is used after the expiration date. C. The spermicide decreases the amount of vaginal and penile sensitivity for up to 8 to 12 hours. D. Nonoxynol-9 provides no protection from STDs and has been linked to the transmission of HIV. D. Nonoxynol-9 provides no protection from STDs and has been linked to the transmission of HIV. Rationale: The use of condoms and a water-based spermicide is recommended because nonoxynol-9 can cause a rash that allows viruses a portal of entry if the condom breaks, which increases the risk of transmission of sexually transmitted diseases (STDs), such as human immunodeficiency virus (HIV) (D), herpes, human papillomavirus (HPV), or hepatitis B virus (HBV). (A and B) are inaccurate. Nonoxynol-9 may cause vaginal irritation, not (C). The healthcare provider prescribes oral contraceptives for a client who wants to prevent pregnancy. Which information is the most important for the nurse to provide this client? Take 1 pill at the same time every day until all the pills are gone. A client with metastatic cancer reports severe, continuous pain. Which route of administration should the nurse use to provide the most effective continuous analgesia? Transdermal The nurse is providing discharge instructions to a client who received a prescription for an antibiotic that is hepatotoxic. Which information should the nurse include in the instructions? Avoid ingesting any alcohol or acetaminophen (Tylenol). Which response best supports the observations the nurse identifies in a client who is experiencing a placebo effect? Psychologic responses to inert medication The placebo effect is a response in the client that is caused by the psychologic impact (D) of taking an inert drug that has no biochemical properties. Placebo effect can be therapeutic, negative, or ineffective, but provides no cure or benefit (A) to the client's progress. The placebo effect may evoke behavioral changes but does not affect neurochemical psychotropic changes (B). Malingering and drugseeking (C) are behaviors that a client exhibits to obtain treatment for nonexistent disorders or to obtain prescription medications. A pediatric client is discharged home with multiple prescriptions for medications. Which information should the nurse provide that is most helpful to the parents when managing the medication regimens? Maintain a drug administration record. A client receives doxacurium (Nuromax), a long-acting, nondepolarizing neuromuscular blocker, during surgical anesthesia. Which client situation should alert the nurse to evaluate the client for a prolonged muscle relaxation response to this medication? Renal insufficiency Doxacurium is eliminated via the kidneys, so a client with renal failure (C) is at risk for prolonged muscle relaxation. Although hepatitis (A) can interfere with this drug's metabolism, it does not place a client at increased risk for prolonged muscle relaxation. (B and D) do not cause prolonged muscle relaxation in a client who receives doxacurium The nurse is preparing to administer a secondary infusion of a dobutamine solution to a client. The nurse notes that the solution is brown in color. Which action should the nurse implement? A. Verify the prescribed dose with the health care provider. B. Discard the solution and reorder from the pharmacy. C. Dilute the solution with more normal saline until it becomes lighter in color. D. Administer the drug if the solution's reconstitution time is less than 24 hours. D. Administer the drug if the solution's reconstitution time is less than 24 hours. Rationale: The color of the dobutamine solution is normal (D), and it should administered within 24 hours after reconstitution, so the time of reconstitution should be verified before administering the solution of medication. (A) is not indicated. (B) is not necessary. Additional dilution of a drug in solution is stated in the manufacturer's reconstitution instructions, but (C) is not needed. Dopamine (Intropin) is administered to a client who is hypotensive. Which finding should the nurse identify as a therapeutic response? A. Gain in weight B. Increase in urine output C. Improved gastric motility D. Decrease in blood pressure B. Increase in urine output Rationale: Intropin activates dopamine receptors in the kidney and dilates blood vessels to improve renal perfusion, so an increase in urine output (B) indicates an increase in glomerular filtration caused by increased arterial blood pressure. (A) is related to fluid retention but is not an indicator of a therapeutic response to dopamine therapy. (C) is not related to the vasopressor effect of dopamine therapy. Dopamine increases cardiac output, which increases a client's blood pressure, not ( D ). A client with diabetes mellitus takes insulin daily and is prescribed propranolol ( Inderal). Which information should the nurse provide this client? Propranolol suppresses a rapid heart rate as a sign of hypoglycemia. A client who arrives in the PACU after surgery is not awake from general anesthesia. What action should the nurse implement first? Review the medication administration record (MAR). The nurse is reviewing prescribed medications with a female client who is preparing for discharge. The client asks the nurse why the oral dose of an opioid analgesic is higher than the intravenous (IV) dose that she received during hospitalization. Which response is best for the nurse to provide "Oral forms of drugs must pass through the liver first, where more of the dose is metabolized." Amoxicillin 500 mg PO every 8 hours is prescribed for a client with an infection. The drug is available in a suspension of 125 mg/5 ml. How many milliliters should the nurse administer with each dose? 20 500 : X = 125 : 5 125 X = 2,500 X = 20 ml (C) During therapy with isoniazid (INH), it is most important for the nurse to monitor which laboratory value closely? A. Liver enzyme levels B. Blood urea nitrogen (BUN) level C. Serum electrolyte levels D. Complete blood count (CBC) A. Liver enzyme levels Rationale: The client receiving isoniazid (INH) is at risk for the development of hepatitis; therefore, liver function test results should be monitored carefully during drug therapy (A). (B, C, and D) are not specific indicators of liver function, so they are not monitored closely during isoniazid (INH) therapy. A client who arrives in the postanesthesia care unit (PACU) after surgery is not awake from general anesthesia. Which action should the nurse implement first? A. Assess for deep tendon reflexes. B. Observe urinary output. C. Review the medication administration record (MAR). D. Administer naloxone (Narcan). C. Review the medication administration record (MAR). Rationale: Most general anesthetics produce cardiovascular and respiratory depression, so a review of the client's MAR identifies all the medications (C) received during surgery and helps the nurse anticipate the client's response and emergence from anesthesia. (A and B) are ongoing postoperative assessments. Based on the medications that the client has received, (D) may need to be administered if indicated by the client's vital signs and delayed spontaneous reactivity. A client with metastatic cancer who has been receiving fentanyl (Duragesic) for several weeks reports to the nurse that the medication is not effectively controlling the pain. Which intervention should the nurse initiate? A. Instruct the client about the indications of opioid dependence. B. Monitor the client for symptoms of opioid withdrawal. C. Notify the health care provider of the need to increase the dose. D. Administer naloxone (Narcan) per PRN protocol for reversal. C. Notify the health care provider of the need to increase the dose. Rationale: Clients can develop a tolerance to the analgesic effect of opioids and may require an increased dose (C) for effective long-term pain relief. The client is not exhibiting indications of dependence (A), withdrawal (B), or toxicity (D). A female client is receiving tamoxifen (Nolvadex) following surgery for breast cancer. She reports the onset of hot flashes to the nurse. Which intervention should the nurse implement? A. Instruct the client that hot flashes are a side effect that often occurs with the use of this medication. B. Encourage the client to verbalize her feelings and fears about the recurrence of her breast cancer. C. Help the client schedule an appointment for evaluation of the need to increase the dose of medication. D. Notify the health care provider that the client needs immediate evaluation for medication toxicity. A. Instruct the client that hot flashes are a side effect that often occurs with the use of this medication. Rationale: Tamoxifen (Nolvadex) is an estrogen receptor blocker used to treat breast carcinoma. Hot flashes are a common side effect (A). If the hot flashes become bothersome, the client can be instructed in measures to reduce the discomfort. Hot flashes are not an indication of (B, C, or D). In addition to nitrate therapy, a client is receiving nifedipine (Procardia), 10 mg PO every 6 hours. The nurse should plan to observe for which common side eff