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NURSING NCLEX|HSOR Module 8 Pharmacology and Intravenous Therapies

Name: NURSING NCLEX|HSOR Module 8 Pharmacology and Intravenous Therapies
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NURSING NCLEX|HSOR Module 8 Pharmacology and Intravenous Therapies. Module 8 Questions 1. 1.ID: A physician’s prescription reads, “Phenytoin (Dilantin) 0.1 g by mouth twice daily.” The medication label indicates that the bottle contains 100-mg capsules. How many capsules does the nurse prepare for administration of one dose? Correct Correct Responses: "1" Rationale: Convert 0.1 g to milligrams: 1000 mg = 1 g; therefore 0.1 g = 100 mg. Next use the medication formula: <IMG src="/objects/NCLEX/silvestri1e_v1/mod_08/images/exam/M08Q044E" border=0> < IMG src="/objects/NCLEX/silvestri1e_v1/mod_08/images/exam/M08Q044E" border=0> Test-Taking Strategy: First, convert 0.1 g to mg. Next. follow the formula for the calculation of the correct dose. Recheck your work and ensure that the answer makes sense. If you had difficulty with this question, review medication calculation problems. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrat ed Process: Nursing Process/Implementation Content Area: Medication Calculations Refe rence: Potter, P., & Perry, A. (2009). Fundamentals of nursing (7th ed., pp. 695-699). St. Louis: Mosby. Awarded 1.0 out of 1.0 possible points. 2. 2.ID: A client has a prescription for short-term therapy with enoxaparin (Lovenox). The nurse explains to the client that this medication is being prescribed to: A. Prevent pain B. Relieve back spasms C. Increase the client’s energy level D. Reduce the risk of deep vein thrombosis Correct Awarded 1.0 points out of 1.0 possible points. 3. 3.ID: A client receiving parenteral nutrition (PN) requires fat emulsion (lipids), which will be piggybacked to the PN solution. On obtaining a bottle of fat emulsion, the nurse notes that fat globules are floating at the top of the solution. Which of these actions should the nurse take? A. Shaking the bottle vigorously B. Requesting a new bottle from the pharmacy Correct C. Rotating the bottle gently back and forth to mix the globules D. Running the bottle under warm water until the globules disappear Awarded 1.0 points out of 1.0 possible points. 4. 4.ID: Risperidone (Risperdal) is prescribed for a client with a diagnosis of schizophrenia. Which laboratory study does the nurse expect to see among the physician’s prescriptions? A. Platelet count Correct B. Creatinine level C. Sedimentation rate D. Red blood cell count Awarded 1.0 points out of 1.0 possible points. 5. 5.ID: The serum theophylline level of a client who is taking the medication (Theo-24) is 16 mcg/mL. On the basis of this result, the nurse will initially: A. Document the normal value on the chart Correct B. Call the healthcare provider immediately C. Call the rapid response team to help with the emergency D. Call the pharmacy to alert the pharmacist regarding the client’s theophylline level Awarded 1.0 points out of 1.0 possible points. 6. 6.ID: A nurse has obtained a unit of blood from the blood bank and properly checked the blood bag with another nurse. Which of the following parameters does the nurse assess just before hanging the transfusion? A. Skin color B. Vital signs Correct C. Latest platelet count D. Urine output over the last 24 hours Awarded 1.0 points out of 1.0 possible points. 7. 7.ID: At 1300, the nurse is documenting the receipt of a unit of packed blood cells at the hospital blood bank. The nurse calculates that the transfusion must be started by: A. 1315 B. 1330 Correct C. 1345 D. 1400 Awarded 1.0 points out of 1.0 possible points. 8. 8.ID: A nurse hangs a 500-mL bag of intravenous (IV) fluid for an assigned client. One hour later the client complains of chest tightness, is dyspneic and apprehensive, and has an irregular pulse. The IV bag has 100 mL remaining. Which of the following actions should the nurse take first? A. Removing the IV B. Sitting the client up in bed C. Shutting off the IV infusion Correct D. Slowing the rate of infusion Rationale: The client’s symptoms are indicative of speed shock, which results from the rapid infusion of drugs or a bolus infusion. In this case, the nurse would note that 400 mL has infused over 60 minutes. The first action on the part of the nurse is shutting off the IV infusion. Other actions may follow in rapid sequence: The nurse may elevate the head of the bed to aid the client’s breathing and then immediately notify the healthcare provider. Slowing the infusion rate is inappropriate because the client will continue to receive fluid. The IV does not need to be removed. It may be needed to manage the complication. Test-Taking Strategy: Use the process of elimination, focusing on the data in the question. Note the question contains the strategic word “first.” Recognizing the signs of speed shock and recalling the appropriate interventions should also direct you to the option of shutting off the IV infusion. Review the initial nursing actions for speed shock if you had difficulty with this question. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Intravenous Therapy Reference: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: Patient-centered collaborative care (6th ed., p. 230). St. Louis: Saunders. Awarded 1.0 points out of 1.0 possible points. 9. 9.ID: A client taking hydrochlorothiazide reports to the clinic for follow-up blood tests. For which side effect of the medication does the nurse monitor the client’s laboratory results? A. Hypokalemia Correct B. Hypocalcemia C. Hypernatremia D. Hypermagnesemia Awarded 1.0 points out of 1.0 possible points. 10. 10.ID: A nurse is caring for a client with a diagnosis of chronic renal failure who is receiving dialysis. Epoetin alfa (Epogen), to be administered subcutaneously, has been prescribed, and the nurse is drawing the medication from a single-use vial. The nurse should prepare the medication by: A. Shaking the vial before drawing up the medication B. Drawing up the medication and discarding the unused portion Correct C. Obtaining the medication from the medication freezer and allowing it to thaw D. Mixing the medication with 0.1 mL of heparin before administration to prevent clotting Awarded 1.0 points out of 1.0 possible points. 11. 11.ID: A nurse answers a call bell and finds that the parenteral nutrition (PN) solution bag of an assigned client is empty. The new prescription was written for a new bag at the beginning of the shift, but it has not yet arrived from the pharmacy. Which of the following actions should the nurse take first? A. Calling the healthcare provider B. Calling the pharmacy for further instructions C. Hanging a solution of 10% dextrose in water Correct D. Hanging a solution of 5% dextrose in 0.9% sodium chloride Awarded 1.0 points out of 1.0 possible points. 12. 12.ID: Disulfiram (Antabuse) is prescribed for a client. Which questions does the nurse make a priority of asking the client before administering this medication? Select all that apply. A. “When did you have your last full meal?” B. “Do you have a history of diabetes insipidus?” C. “When was your last drink of alcohol?” Correct D. “Do you have a history of thyroid problems?” Correct E. “Do you have a history of cancer in your family?” Rationale: Disulfiram (Antabuse) is used as an adjunct treatment for selected clients with alcoholism who want to remain in a state of enforced sobriety. Clients must abstain from alcohol intake for at least 12 hours before the initial dose of the medication is administered. The most important question is when the client had his last drink of alcohol. The medication is used with caution in clients with diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, nephritis, and hepatic disease. It is also contraindicated in cases of severe heart disease, psychosis, or hypersensitivity to the medication. Test-Taking Strategy: Use the process of elimination. Recalling that the medication is used as an adjunct treatment for selected clients with alcoholism will help direct you to the option in which the client is asked when he consumed his last alcoholic drink. To find the other correct options, it is necessary to know the contraindications to the use of disulfiram. If you are unfamiliar with this medication and its use, review this content. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process/Assessment Awarded 1.0 points out of 1.0 possible points. 13. 13.ID: A client is receiving heparin sodium by way of continuous IV infusion. For which adverse effects of the therapy does the nurse assess the client? Select all that apply. A. Tinnitus B. Tarry stools Correct C. Slowed pulse D. Bleeding from the gums Correct E. Increased blood pressure Awarded 1.0 points out of 1.0 possible points. 14. 14.ID: Cyclophosphamide has been prescribed for a client with a diagnosis of breast cancer, and the nurse is providing instructions to the client. The nurse should tell the client: A. To avoid salt while taking this medication B. That it is best to take the medication with food C. To drink at least 2 glasses of orange juice every day D. To increase fluid intake to 2000 mL to 3000 mL/day Correct Rationale: Hemorrhagic cystitis is a toxic effect of cyclophosphamide. The client must be instructed to drink copious amounts of fluid during administration of this medication. The client should also monitor her urine for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia may also result from the use of the medication; therefore the client would not be encouraged to increase potassium intake (i.e., bananas and orange juice). The client also would not be instructed to alter her sodium intake. Test-Taking Strategy: Knowledge regarding the toxic effects of cyclophosphamide will assist you in answering this question correctly. Correlate cyclophosphamide with hemorrhagic cystitis to direct you to the correct option. If you had difficulty with this question, review the toxic effects associated with this medication. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Teaching and Learning Content Area: Pharmacology Reference: Kee, J., Hayes, E., & McCuistion, L. (2009). Pharmacology: A nursing process approach (6th ed., p. 538, 539). St. Louis: Saunders. Awarded 1.0 points out of 1.0 possible points. 15. 15.ID: A nurse has just hung a transfusion of packed red blood cells and stayed with the client for the appropriate amount of time. Before leaving the room, the nurse tells the client that it is most important to immediately report which specific sign if it occurs? Select all that apply. A. Rash Correct B. Chills Correct C. Fatigue D. Backache Correct E. Tiredness Awarded 1.0 points out of 1.0 possible points. 16. 16.ID: A nurse is assessing a client who is being hospitalized with a diagnosis of pneumonia. The client’s husband tells the nurse that the client is taking donepezil hydrochloride (Aricept). The nurse should ask the husband about the client’s history of which disorder? A. Dementia Correct B. Seizure disorder C. Diabetes mellitus D. Posttraumatic stress disorder Awarded 1.0 points out of 1.0 possible points. 17. 17.ID: Warfarin sodium (Coumadin) has been prescribed, and the nurse teaches the client about the medication. Which statement by the client indicates that further teaching is necessary? A. “I won’t play football anymore.” B. “I won’t take any over-the-counter medications except aspirin.” Correct C. “I’ll use an electric shaver until the doctor stops the Coumadin prescription.” D. “I’ll buy one of those medication alert tags that tells people I’m taking an anticoagulant.” Rationale: No over-the-counter medications of any kind should be ingested by a client taking an anticoagulant. This is especially true of aspirin and aspirin- containing products (because of the potential for bleeding). The other options are correct statements. Strenuous games (e.g., contact sports) that may result in bruising and skin breakdown should be avoided. Electric shavers are less irritating to the skin than razors and less likely to cause skin breakdown. Medication alert tags are recommended in case of emergency. The client should also be taught to carry an identification card listing all medications currently being taken. Test-Taking Strategy: Use the process of elimination, noting the strategic words “further teaching is necessary,” which indicate a negative event query and the need to select the incorrect client statement. Recalling that warfarin sodium (Coumadin) is an anticoagulant and that anticoagulants can cause bleeding will direct you to the correct option. If you had difficulty with this question, review the teaching points for clients on anticoagulants. Level of Cognitive Ability: Evaluating Client Needs: Physiological Integrity Integrated Process: Teaching and Learning Content Area: Pharmacology Reference: Lehne, R. (2010). Pharmacology for nursing care (7th ed., p. 618). St. Louis: Saunders. Awarded 1.0 points out of 1.0 possible points. 18. 18.ID: Carbamazepine (Tegretol) is prescribed for a client with trigeminal neuralgia. Which of the following side effects does the nurse instruct the client to report to the physician? Select all that apply. A. Fever Correct B. Nausea C. Headache D. Sore throat Correct E. Mouth sores Correct Awarded 1.0 points out of 1.0 possible points. 19. 19.ID: A nurse is providing instruction to a client who is taking codeine sulfate for severe back pain. The nurse should tell the client to: A. Decrease fluid intake B. Maintain a high-fiber diet Correct C. Avoid all exercise to help prevent lightheadedness D. Avoid the use of stool softeners to help prevent diarrhea Awarded 1.0 points out of 1.0 possible points. 20. 20.ID: A physician prescribes 1000 mL of 5% dextrose in water to be infused over 8 hours. The drop factor is 15 gtt/mL. At how many drops per minute does the nurse set the flow rate? (Round your answer to the nearest whole number). Incorrect Correct Responses: "31" Rationale: Use the IV flow rate formula: <IMG src="/objects/NCLEX/silvestri1e_v1/mod_08/images/exam/M08Q039E" border=0> < IMG src="/objects/NCLEX/silvestri1e_v1/mod_08/images/exam/M08Q039E" border=0> Test-Taking Strategy: Use the formula for calculating IV flow rates to answer the question. Be careful with the multiplication and division, and remember to convert 8 hours to minutes (8 × 60 = 480) and round your answer to the nearest whole number. Review IV infusion rates if you had difficulty with this question. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrat ed Process: Nursing Awarded 0.0 out of 1.0 possible points. 21. 21.ID: The nurse is preparing to change the solution bag and intravenous tubing of a client receiving parenteral nutrition (PN) through a left subclavian central venous line. Which essential action does the nurse ask the client to perform just before switching the tubing? A. Turn the head to the left B. Turn the head to the right C. Exhale slowly and evenly D. Take a deep breath and hold it Correct Awarded 1.0 points out of 1.0 possible points. 22. 22.ID: A nurse is preparing a plan of care for a pregnant client who will be given oxytocin (Pitocin) to induce labor. Which of the following occurrences does the nurse include in the plan of care as a reason for immediate discontinuation of the oxytocin infusion? A. Uterine atony B. Severe drowsiness C. Uterine hyperstimulation Correct D. Early decelerations of the fetal heart rate Rationale: Oxytocin, a synthetic hormone that stimulates uterine contractions, is a commonly used pharmacological means of inducing labor. One major concern associated with oxytocin is hyperstimulation of uterine contractions. Hyperstimulation of the uterus, which may result in diminished placental perfusion, may cause fetal distress. Therefore an oxytocin infusion must be stopped if there are any signs of uterine hyperstimulation. Early decelerations of the fetal heart rate are a reassuring sign and do not indicate fetal distress. Uterine atony and severe drowsiness are not indications of the need to discontinue the infusion. Test-Taking Strategy: Use the process of elimination. Knowing that induction of labor involves the stimulation of uterine contractions will help you answer this question. Using your knowledge of the effect of uterine contractions on uteroplacental circulation should help you recognize that hyperstimulation of contractions would compromise fetal oxygenation, a primary physiological need. Review the nursing implications associated with the administration of this medication if you had difficulty with this question. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Pharmacology Reference: Kee, J., Hayes, E., & McCuistion, L. (2009). Pharmacology: A nursing process approach (6th ed., p. 849). St. Louis: Saunders. Awarded 1.0 points out of 1.0 possible points. 23. 23.ID: A client is receiving parenteral nutrition (PN) with fat emulsion (lipids) piggybacked to the PN solution. For which signs of an adverse reaction to the fat emulsion should the nurse monitor the client? Select all that apply. A. Chills Correct B. Pallor C. Headache Correct D. Chest and back pain Correct E. Nausea and vomiting Correct F. Subnormal temperature Awarded 1.0 points out of 1.0 possible points. 24. 24.ID: A nurse is providing instructions to a client regarding quinapril hydrochloride (Accupril). The nurse teaches the client: A. To take the medication with meals B. To rise slowly from a lying to a sitting position Correct C. To discontinue the medication if nausea occurs D. That a therapeutic effect will be felt immediately Awarded 1.0 points out of 1.0 possible points. 25. 25.ID: A nurse is caring for a client with histoplasmosis who is receiving intravenous amphotericin B (Fungizone). What should the nurse do while the medication is being administered? A. Monitor the client’s urine output Correct B. Monitor the client for hypothermia C. Check the client’s neurological status D. Check the client’s blood glucose level Rationale: Amphotericin B can produce medication toxicity during administration and exhibit symptoms such as chills, fever, headache, vomiting, and impairment of renal function. The medication is also irritating to the IV site, commonly causing thrombophlebitis. The nurse administering this medication watches for all of these problems. The other options are not specifically related to the administration of this medication. Test-Taking Strategy: Use the process of elimination and your knowledge of this potent medication to answer this question. Recalling that fever and chills may occur will help you eliminate monitoring of the client for hypothermia. To select from the remaining options, recall that the medication can be toxic to the kidneys, which should direct you to the correct option. Review nursing care in regard to the administration of this medication if you had difficulty with this question. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Awarded 1.0 points out of 1.0 possible points. 26. 26.ID: A physician prescribes the administration of parenteral nutrition (PN), to be started at a rate of 50 mL/hr by way of infusion pump through an established subclavian central line. After the first 2 hours of the PN infusion, the client suddenly complains of difficulty breathing and chest pain. The nurse immediately: A. Obtains blood for culture B. Clamps the PN infusion line Correct C. Obtains a sample for blood glucose testing D. Obtains an electrocardiogram (ECG) Rationale: One complication of a subclavian central line is embolism, caused by air or thrombus. Sudden onset of chest pain shortly after the initiation of PN may mean that this complication has developed. The infusion is clamped (the line should not be discontinued, however), the client turned on the left side with the head down, and the physician notified immediately. Depending on agency protocol, the rapid response team would also be called. Blood cultures are not necessary in this situation, because infection is not the concern. Likewise, there is no useful reason for checking the blood glucose level. An ECG may be obtained, but this is not the immediate priority. If the client shows signs of an air embolism, the nurse should examine the catheter to determine whether an open port has allowed air into the circulatory system. Test-Taking Strategy: Note the words “after the first 2 hours” and “immediately.” Focus on the data provided in the question to determine that an embolus has occurred. Eliminate blood cultures and blood glucose testing, which, respectively, relate to infection and hyperglycemia, which is not likely to occur during the first 2 hours of PN administration. To select from the remaining options, focus on the strategic word “immediately”; this will direct you to the correct option. Review the complications of PN and the associated nursing interventions if you had difficulty with this question. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Parenteral Nutrition Reference: Perry, A., & Potter, P. (2010). Clinical nursing skills & techniques (7th ed., p. 850). St. Louis: Mosby. Awarded 1.0 points out of 1.0 possible points. 27. 27.ID: A nurse is reviewing the laboratory results of a client receiving intravenous chemotherapy. Which of the following laboratory findings prompts the nurse to initiate neutropenic precautions? A. A clotting time of 10 minutes B. An ammonia level of 20 mcg/dL C. A platelet count of 100,000 cells/mm3 D. A white blood cell (WBC) count of 2000 cells/mm3 Correct Rationale: The normal WBC count is 4500 to 11,000 cells/mm3. When the WBC count drops, neutropenic precautions — including protective isolation to protect the client from infection — must be implemented. Bleeding precautions must be initiated when the platelet count drops. With bleeding precautions, traumatic procedures such as injections and rectal temperatures are avoided. The normal platelet count is 150,000 to 450,000 cells/mm3. The normal clotting time is 8 to 15 minutes. The normal ammonia value is 10 to 80 mcg/dL. Test-Taking Strategy: Use the process of elimination. Eliminate the options that identify normal laboratory values first. To select from the last two options, correlate a low WBC count with the need for neutropenic precautions and a low platelet count with the need for bleeding precautions. If you had difficulty with this question, review the interventions associated with caring for the client undergoing chemotherapy. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: Patient-centered collaborative care (6th ed., p. 426). St. Louis: Saunders. Awarded 1.0 points out of 1.0 possible points. 28. 28.ID: A client who needs to receive a blood transfusion has experienced a pruritic rash during previous transfusions. The client asks the nurse whether it is safe to receive the transfusion. Which of the following medications does the nurse remember will likely be prescribed before the transfusion? A. Ibuprofen (Motrin) B. Acetaminophen (Tylenol) C. Diphenhydramine (Benadryl) Correct D. Acetylsalicylic acid (ASA, aspirin) Rationale: An urticarial reaction is characterized by a rash accompanied by pruritus. This type of transfusion reaction is prevented by pretreating the client with an antihistamine, such as diphenhydramine. Acetaminophen and acetylsalicylic acid are analgesics; ibuprofen is a nonsteroidal antiinflammatory medication. Test-Taking Strategy: To answer this question correctly, it is necessary to be familiar with this particular type of reaction and the medication that may be used in its prevention. Recalling that diphenhydramine is an antihistamine will direct you to the correct option. Review these medications if you had difficulty with this question. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Blood Administration Reference: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: Patient-centered collaborative care (6th ed., p. 920). St. Louis: Saunders. Awarded 1.0 points out of 1.0 possible points. 29. 29.ID: A nurse is reading the medical record of a client receiving haloperidol (Haldol). The nurse notes that the physician has documented that the client is experiencing signs of akathisia. On the basis of the physician’s note, which clinical manifestation would the nurse expect to find during assessment of the client? A. Motor restlessness Correct B. Puffing of the cheeks C. Puckering of the mouth D. Protrusion of the tongue Awarded 1.0 points out of 1.0 possible points. 30. 30.ID: A client rings the call bell and complains of pain at the site of an IV infusion. The nurse assesses the site and determines that phlebitis has developed. Which of the following actions should the nurse take? Select all that apply. A. Removing the IV catheter at that site Correct B. Applying warm, moist compresses to the IV site Correct C. Notifying the healthcare provider about the finding Correct D. Encouraging the client to scrub the site while in the shower E. Starting a new IV line in a proximal portion of the same vein Awarded 1.0 points out of 1.0 possible points. 31. 31.ID: Packed red blood cells have been prescribed for a client with low hemoglobin and hematocrit values. The nurse takes the client’s temperature orally before hanging the blood transfusion and notes that it is 100.0° F. What should the nurse do next? A. Call the healthcare provider Correct B. Begin the transfusion as prescribed C. Administer an antihistamine and begin the transfusion D. Administer 2 tablets of acetaminophen (Tylenol) and begin the transfusion Rationale: If the client has a temperature of 100.0° F or higher, the unit of blood should not be hung until the physician has been notified and had the opportunity to give further prescriptions. It is likely that the healthcare provider will prescribe the blood to be administered despite the temperature, but it is not within the nurse’s scope of practice to make that determination. Therefore the other options are incorrect. Additionally, medications are not administered to the client without a prescription. Test-Taking Strategy: Use the process of elimination. First eliminate the options that are comparable or alike in that they call for administration of a medication. Choose calling the healthcare provider over beginning the transfusion as prescribed, knowing that an increased temperature is abnormal. Review the procedure for blood transfusions if you had difficulty with this question. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Blood Administration References: Black, J., & Hawks, J. (2009). Medical-surgical nursing: Clinical management for positive outcomes (8th ed., p. 2015). St. Louis: Saunders. Perry, A., & Potter, P. (2010). Clinical nursing skills & techniques (7th ed., p. 791). St. Louis: Mosby. Awarded 1.0 points out of 1.0 possible points. 32. 32.ID: A client who is taking bupropion (Wellbutrin) in an attempt to stop smoking tells a nurse that he has been doubling the daily dose to make it easier to resist smoking. The nurse warns the client that doubling the daily dosage is dangerous. Of which adverse effect of the medication does the nurse warn the client? A. Insomnia B. Seizures Correct C. Weight gain D. Orthostatic hypotension Awarded 1.0 points out of 1.0 possible points. 33. 33.ID: A client with newly diagnosed angina pectoris has taken 2 sublingual nitroglycerin tablets for chest pain. The chest pain is relieved, but the client complains of a headache. The nurse tells the client that: A. This is an indication that the medication should not be used again B. Headache indicates medication tolerance, and the dosage must be increased C. This may be an allergic reaction to the nitroglycerin, and the physician must be notified D. This is an expected side effect of the nitroglycerin, and the client can relieve it by taking acetaminophen (Tylenol) Correct Awarded 1.0 points out of 1.0 possible points. 34. 34.ID: A nurse suspects that a client receiving parenteral nutrition (PN) through a central line has an air embolism. The nurse immediately positions the client on the: A. Left side with the head lower than the feet Correct B. Left side with the head higher than the feet C. Right side with the head lower than the feet D. Right side with the head higher than the feet Awarded 1.0 points out of 1.0 possible points. 35. 35.ID: A client with a thoracic spinal cord injury is receiving dantrolene sodium (Dantrium). Which statement by the client indicates to the nurse that the client is experiencing an undesired effect of the medication? A. “I’m feeling really drowsy.” Correct B. “My legs are very relaxed.” C. “I can’t seem to get enough to eat.” D. “I urinate about the same amount as I always did.” Awarded 1.0 points out of 1.0 possible points. 36. 36.ID: Erythromycin is prescribed for a client with a respiratory tract infection. The nurse provides instructions to the client regarding the administration of the oral medication and tells the client to take the medication: A. With juice B. With a meal C. On an empty stomach Correct D. At bedtime, with a snack Awarded 1.0 points out of 1.0 possible points. 37. 37.ID: A nurse is monitoring a client who is receiving parenteral nutrition (PN). Which of the following signs and symptoms causes the nurse to suspect that the client is experiencing hyperglycemia as a complication? A. Pallor, weak pulse, and anuria B. Nausea, vomiting, and oliguria C. Nausea, thirst, and increased urine output Correct D. Sweating, chills, and decreased urine output Awarded 1.0 points out of 1.0 possible points. 38. 38.ID: A client with tuberculosis is being started on isoniazid (INH), and the nurse stresses the importance of returning to the clinic for follow-up blood testing. Which blood test will be performed? A. Liver enzymes Correct B. Serum creatinine C. Blood urea nitrogen D. Red blood cell count Rationale: INH therapy can increase hepatic enzymes and cause hepatitis. Therefore the client’s liver enzymes are assessed when therapy is initiated and during the first 3 months of therapy. Monitoring may be continued further in the client who is older than 50 or abuses alcohol. The other options are not specifically related to the use of this medication. Test-Taking Strategy: Use the process of elimination. Eliminate blood urea nitrogen and serum creatinine because they are comparable or alike in that they are indicators of renal function. To select from the remaining options, it is necessary to know that this medication can be toxic to the liver. Review the adverse effects of the various antituberculosis medications if you had difficulty with this question. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: Lehne, R. (2010). Pharmacology for nursing care (7th ed., pp. 1043, 1044, 1050). St. Louis: Saunders. Awarded 1.0 points out of 1.0 possible points. 39. 39.ID: Zidovudine (AZT) is prescribed for an adult client with HIV infection. The nurse, while providing instructions to the client, should tell the client: A. That the medication must be taken with milk B. That aspirin can be taken to treat headache C. To discontinue the medication if nausea occurs D. To space the doses evenly around the clock Correct Rationale: The adult dosage of zidovudine is usually 200 mg every 8 hours or 300 mg every 12 hours. The client is instructed to space doses of the medication evenly around the clock. Food or milk does not affect the gastrointestinal absorption of the medication. The client is instructed to continue therapy for the full prescribed duration of treatment. The client is also instructed not to take any medication, including aspirin, without the physician’s approval. Test-Taking Strategy: Use the process of elimination. Knowledge of the basic principles of medication administration will assist you in eliminating the option referring to discontinuation of the medication. To select from the remaining options, recall that this medication is an antiviral, which will direct you to the correct option. Remember that evenly spaced doses are necessary to maintain virustatic concentrations of the medication. Review client teaching points for this medication if you had difficulty with this question. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Teaching and Learning Content Area: Pharmacology Reference: Skidmore-Roth, L. (2009). Mosby’s drug guide for nurses (8th ed., p. 1014). St. Louis: Mosby. Awarded 1.0 points out of 1.0 possible points. 40. 40.ID: A client has a prescription for a unit of packed red blood cells (RBCs). Which of the following IV solutions should the nurse obtain to hang with the blood product at the client’s bedside? A. 0.9% sodium chloride Correct B. Lactated Ringer’s solution (LR) C. 5% dextrose in 0.9% sodium chloride D. 5% dextrose in water in 0.45% sodium chloride Awarded 1.0 points out of 1.0 possible points. 41. 41.ID: A pregnant client is receiving magnesium sulfate for the management of preeclampsia. Which of the following assessment findings indicates to the nurse that the client is experiencing magnesium toxicity? A. Proteinuria of +3 B. Sudden drop in fetal heart rate Correct C. Presence of deep tendon reflexes D. Serum magnesium level of 6 mEq/L Awarded 1.0 points out of 1.0 possible points. 42. 42.ID: A nurse is preparing a plan of care for a client with renal colic who is receiving meperidine hydrochloride (Demerol) for pain. Which side effects does the nurse make a note of needing to be alert to in the plan of care? Select all that apply. A. Hypotension Correct B. Constipation Correct C. Bradycardia D. Urine retention Correct E. Respiratory depression Correct Awarded 1.0 points out of 1.0 possible points. 43. 43.ID: A client is taking a folic acid supplement (Folate). Which of the following laboratory parameters does the nurse use to evaluate the effectiveness of this therapy? Select all that apply. A. Magnesium B. Hemoglobin Correct C. Blood glucose D. Hematocrit Correct E. Alkaline phosphatase Awarded 1.0 points out of 1.0 possible points. 44. 44.ID: A nurse is caring for a group of adult clients on an acute care nursing unit. Which of the following clients does the nurse recognize as the least likely candidate for parenteral nutrition (PN)? A. 61-year-old client with pancreatitis B. 52-year-old client with severe sepsis C. 45-year-old client who has undergone repair of a hiatal hernia Correct D. 24-year-old client with a severe exacerbation of ulcerative colitis Awarded 1.0 points out of 1.0 possible points. 45. 45.ID: A nurse has taught a client who is taking lithium carbonate (Lithobid) about the medication. The nurse determines that the client needs additional teaching if the client states that: A. The medication should be taken with meals B. The lithium blood levels must be monitored very closely C. It is important to decrease fluid intake while taking the medication to avoid nausea Correct D. The physician must be called if excessive diarrhea, vomiting, or diaphoresis occurs Awarded 1.0 points out of 1.0 possible points. 46. 46.ID: At 1600 the nurse checks a client’s parenteral nutrition (PN) infusion bag and finds 1100 mL remaining in the 3000-mL bag. The solution is running at a rate of 100 mL/hr. The bag was hung the previous day at 1800. The nurse plans to change the infusion bag and tubing this evening at: A. 1700 B. 1800 Correct C. 2000 D. 2100 Rationale: The PN solution should be changed every 24 hours as a means of helping prevent infection. Infection is also prevented with the use of aseptic technique during bag and tubing changes. Most agencies recommend that tubing be changed every 24 hours along with the PN infusion bag. Specific agency policies should always be followed. The nurse should also use a filter when administering PN in accordance with hospital protocol. Therefore the remaining options are incorrect. Test-Taking Strategy: Use the process of elimination. Recalling that the infusion bag should be changed every 24 hours will direct you to the correct option. Review the principles of PN administration if you had difficulty with this question. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Parenteral Nutrition References: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: Patient-centered collaborative care (6th ed., p. 1401). St. Louis: Saunders. Awarded 1.0 points out of 1.0 possible points. 47. 47.ID: A client has been taking metoprolol (Lopressor, Toprol-XL). Which of the following findings indicates to the clinic nurse that the medication is effective? A. The client’s ankles are swollen. B. The client’s weight has increased. C. The client’s blood pressure has decreased. Correct D. The client has wheezes in the lower lobes of the lungs. Awarded 1.0 points out of 1.0 possible points. 48. 48.ID: A physician prescribes an intramuscular dose of 200,000 units of penicillin G benzathine (Bicillin) for an adult client. The label on the 10-mL ampule sent from the pharmacy reads, “Penicillin G benzathine (Bicillin), 300,000 units/mL.” How many milliliters of medication does the nurse prepares to ensure administration of the correct dose? (Round your answer to the nearest tenth.) Correct br><IMG src="/objects/NCLEX/silvestri1e_v1/mod_08/images/exam/M08Q040E" border=0> < IMG src="/objects/NCLEX/silvestri1e_v1/mod_08/images/exam/M08Q040E" border=0> Test-Taking Strategy: Follow the formula for the calculation of the correct dose. It is not necessary to perform a conversion in this problem. Recheck your work, ensure that the answer makes sense, and remember to round your answer to the nearest tenth. If you had difficulty with this question, review medication calculation problems. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrat ed Process: Nursing Process/Implementation Content Area: Medication Calculations Refe rence: Potter, P., & Perry, A. (2009). Fundamentals of nursing (7th ed., pp. 695-699). St. Louis: Mosby. Awarded 1.0 out of 1.0 possible points. 49. 49.ID: A nurse is providing dietary instructions to a client taking spironolactone (Aldactone). Which of the following foods does the nurse instruct the client to avoid? Select all that apply. A. Rice B. Cereal C. Carrots D. Bananas Correct E. Citrus fruits Correct Awarded 1.0 points out of 1.0 possible points. 50. 50.ID: A nurse has taught a client taking a methylxanthine bronchodilator about beverages that must be avoided. Which beverage choices by the client indicate to the nurse that the client needs further education? Select all that apply. A. Cocoa Correct B. Coffee Correct C. Lemonade D. Orange juice E. Chocolate milk Correct Awarded 1.0 points out of 1.0 possible points. 51. 51.ID: A client with schizophrenia who has been taking an antipsychotic medication calls the clinic nurse and says, “I need to cancel my appointment with the psychiatrist again, because I still have this awful sore throat. It’s so bad that my mouth has a sore.” How does the nurse respond to the client? A. “I wouldn’t be upset. It happens when you aren’t drinking enough water.” B. “I think you need to come in for blood work today, because this may be a side effect of your medicine.” Correct C. “Do you remember when you started this medication? Your psychiatrist told you how important it is to keep your appointments with him.” D. “You probably have a simple flu, but it might help if you gargle with some antiseptic mouthwash every 2 hours or so and drink plenty of water.” Rationale: Agranulocytosis, an adverse effect of antipsychotic medications, is characterized by a sore throat with mouth sores, fever, and malaise. Any client taking such a medication who complains of flulike symptoms should be evaluated carefully. For this reason, the psychiatrist usually prescribes periodic blood tests while a client is taking antipsychotic medications. The incorrect options ignore the client’s complaints. Test-Taking Strategy: Use the process of elimination and focus on the data in the question. Recalling that antipsychotic medications can cause agranulocytosis will direct you to the correct option. Also note that the correct option is the only one that addresses the client’s complaint. Review the adverse effects of antipsychotic medications if you had difficulty with this question. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental health nursing: A communication approach to evidence-based care (p. 297). St. Louis: Saunders. Awarded 1.0 points out of 1.0 possible points. 52. 52.ID: A physician’s prescription reads, “Clindamycin phosphate (Cleocin Phosphate) 0.3 g in 50 mL NS, to be administered IV over 30 minutes.” The medication label reads, “Clindamycin phosphate (Cleocin Phosphate) 150 mg/mL.” How many milliliters of medication does the nurse prepare to ensure that the correct dose is administered? Correct Correct Responses: "2" Rationale: Convert 0.3 g to milligrams: 1000 mg = 1 g and therefore 0.3 g = 300 mg. Next, use the medication formula: <IMG src="/objects/NCLEX/silvestri1e_v1/mod_08/images/exam/M08Q043E" border=0> < IMG src="/objects/NCLEX/silvestri1e_v1/mod_08/images/exam/M08Q043E" border=0> Test-Taking Strategy: First convert 0.3 gm to mg. Next follow the formula for the calculation of the correct dose. Recheck your work and make sure that the answer makes sense. If you had difficulty with this question, review medication calculation problems. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrat ed Process: Nursing Process/Implementation Content Area: Medication Calculations Refe rence: Potter, P., & Perry, A. (2009). Fundamentals of nursing (7th ed., pp. 695-699). St. Louis: Mosby. Awarded 1.0 out of 1.0 possible points. 53. 53.ID: The nurse determines that the client is exhibiting signs of a hemolytic transfusion reaction while receiving a blood transfusion. Place the actions the nurse should perform in the correct order, with number 1 the first action and number 5 the last action: Correct A. Stopping the infusion of blood B. Hanging an IV bag of normal saline solution (NS) at a keep-vein-open (KVO) rate C. Notifying the healthcare provider D. Obtaining vital signs/oxygen saturation E. Documenting the findings Rationale: If a transfusion reaction is suspected, the transfusion is immediately stopped and NS infused, pending further physician prescriptions. Next, the healthcare provider should be notified. Ensuring patent IV access also helps maintain the client’s intravascular volume. NS is the solution of choice, rather than solutions containing dextrose, because red blood cells do not clump with NS. Vital signs and oxygen saturation are monitored closely. Finally, the nurse documents the findings and the client’s response to the interventions. Test-Taking Strategy: Note that the client is experiencing a having a hemolytic transfusion reaction. The question sets forth the problem; the nurse must determine the order in which interventions should be performed. First, the blood transfusion is stopped and an isotonic solution infused. Next the nurse should notify the healthcare provider, check vital signs and oxygen saturation data, and assess the client closely. Once prescriptions from the healthcare provider have been initiated, the nurse should document the event and client’s response. Review the prioritization of interventions for a transfusion reaction if you had difficulty with the question. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Blood Administration References: Black, J., & Hawks, J. (2009). Medical-surgical nursing: Clinical management for positive outcomes (8th ed., p. 2016). St. Louis: Saunders. Perry, A., & Potter, P. (2010). Clinical nursing skills & techniques (7th ed., p. 789). St. Louis: Mosby. Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., & Camera, I. (2011). Medical- surgical nursing: Assessment and management of clinical problems (8th ed. p. 707). St. Louis: Mosby. Awarded 1.0 points out of 1.0 possible points. 2. 54.ID: A nurse is caring for a client with myasthenia gravis who is exhibiting signs of cholinergic crisis. Which medication does the nurse ensure is available to treat this crisis? A. Atropine sulfate Correct B. Protamine sulfate C. Acetylcysteine (Mucomyst) D. Pyridostigmine bromide (Mestinon) Awarded 1.0 points out of 1.0 possible points. B. 55.ID: A physician prescribes 1000 mL of 5% dextrose in water, to be infused over 24 hours. The drop factor is 60 gtt/mL. At how many drops per minute does the nurse set the flow rate? (Round your answer to the nearest whole number). Correct --> Test-Taking Strategy: Use the formula for calculating IV flow rates to answer the question. Be careful with the multiplication and division, and remember to convert 24 hours to minutes (24 × 60 = 1440) and round your answer to the nearest whole number. Review IV infusion rates if you had difficulty with this question. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrat ed Process: Nursing Process/Implementation Content Area: Intravenous Therapy Referenc e: Potter, P., & Perry, A. (2009). Fundamentals of nursing (7th ed., pp. 1007, 1008). St. Louis: Mosby. Awarded 1.0 out of 1.0 possible points. C. 56.ID: Intravenous tobramycin sulfate (Tobrex) is prescribed for a client with a respiratory tract infection. For which of the following symptoms, indicative of an adverse effect, does the nurse monitor the client? A. Nausea B. Vertigo Correct C. Vomiting D. Hypotension Awarded 1.0 points out of 1.0 possible points. D. 57.ID: A physician’s prescription for an adult client reads, “Potassium chloride 15 mEq by mouth.” The label on the medication bottle reads, “20 mEq potassium chloride/15 mL.” How many milliliters of KCl does the nurse prepare to ensure administration of the correct dose of medication? (Round your answer to the nearest whole number.) Correct Correct Responses: "11" Rationale: Use the medication formula: <IMG src="/objects/NCLEX/silvestri1e_v1/mod_08/images/exam/M08Q041E" border=0> < IMG src="/objects/NCLEX/silvestri1e_v1/mod_08/images/exam/M08Q041E" border=0> Test-Taking Strategy: Follow the formula for calculation of the correct dose. It is not necessary to perform a conversion in this problem. Recheck your work, ensure that the answer makes sense, and remember to round your answer to the nearest tenth. If you had difficulty with this question, review medication calculation problems. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrat ed Process: Nursing Process/Implementation <i Awarded 1.0 out of 1.0 possible points. E. 58.ID: A nurse is changing the central line dressing of a client receiving parenteral nutrition (PN). The nurse notes moisture under the dressing covering the catheter insertion site. What does the nurse assess next? A. Temperature B. Time of the last dressing change C. Expiration date on the infusion bag D. Tightness of the tubing connections Correct Rationale: A loose tubing connection — the most obvious cause of the moisture that could be readily detected and fixed by the nurse — is the first thing the nurse should look for. The client’s temperature would be assessed if the nurse were looking for signs of infection. The expiration date on the infusion bag and the time of the last dressing change are routine observations but have nothing to do with the subject of the question. Test-Taking Strategy: The strategic word in the question is “next.” Also note the relationship between the subject of the question, moisture under the dressing, and tightness of the tubing connections. Review care of the client receiving PN if you had difficulty with this question. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Parenteral Nutrition References: Black, J., & Hawks, J. (2009). Medical-surgical nursing: Clinical management for positive outcomes (8th ed., pp. 584, 588). St. Louis: Saunders. Perry, A., & Potter, P. (2010). Clinical nursing skills & techniques (7th ed., p. 850). St. Louis: Mosby. Awarded 1.0 points out of 1.0 possible points. F. 59.ID: A nurse notes that the site of a client’s peripheral intravenous (IV) catheter is reddened, warm, painful, and slightly edematous near the insertion point of the catheter. On the basis of this assessment, the nurse first: A. Removes the IV catheter Correct B. Slows the rate of infusion C. Notifies the healthcare provider D. Checks for loose catheter connections Rationale: Phlebitis is an inflammatory process in the vein. Phlebitis at an IV site may be indicated by client discomfort at the site or by redness, warmth, and swelling in the area of the catheter. The IV catheter should be removed and a new IV line inserted at a different site. Slowing the rate of infusion and checking for loose catheter connections are not correct responses. The healthcare provider would be notified if phlebitis were to occur, but this is not the initial action. Test-Taking Strategy: Use the process of elimination, focusing on the data in the question. Eliminate slowing the rate of infusion and checking the connection, because they are comparable or alike in that they indicate continuation of IV therapy. Although the healthcare provider would be notified of this occurrence, the word “first” should direct you to select the option of removing the IV catheter. Review the signs of phlebitis and the actions to be taken when it occurs if you had difficulty with this question. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Intravenous Therapy Reference: Ignatavicius,

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nursing nclex|hsor module 8 pharmacology and intravenous therapies module 8 questions 1 1id 383694396 a physician’s prescription

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