PHARMACOLOGY EXAM 2

Question 1

The nurse is caring for a client who is receiving aspirin therapy. Which clinical indicator would be related to this therapy?

A. Urinary calculi
B. Atrophy of the liver
C. Prolonged bleeding time
D. Premature erythrocyte destruction

Answer 1

Prolonged bleeding time

Question 2

A client develops tinnitus. Which of the client’s medications would the nurse suspect is the cause of this new development?
A. Digoxin 0.25 mg, one tablet daily
B. Aspirin 325 mg, two tablets every 4 hours
C. Captopril 25 mg, one tablet three times daily
D. Diphenhydramine 25 mg, one tablet every 4 to 8 hours prn

Answer 2

Aspirin 325 mg, two tablets every 4 hours

Question 3

A client with arthritis takes large doses of aspirin. Which symptom would the nurse include when teaching the client about the clinical manifestations of aspirin toxicity?

A. Feelings of drowsiness
B. Disturbances in hearing
C. Intermittent constipation
D. Metallic taste in the mouth

Answer 3

Disturbances in hearing

Question 4

Which medication would the nurse anticipate the health care provider will prescribe to relieve the pain experienced by a client with rheumatoid arthritis?

A. Aspirin
B. Hydromorphone
C. Meperidine
D. Alprazolam

Answer 4

Aspirin

Question 5

A client who takes four 325-mg tablets of buffered aspirin four times a day for severe arthritis complains of dizziness and ringing in the ears. Which complication would the nurse conclude that the client probably is experiencing?

A. Salicylate toxicity
B. Allergic reaction
C. Withdrawal symptoms
D. Aspirin tolerance

Answer 5

Salicylate toxicity

Question 6

A health care provider prescribes aspirin for a client with severe arthritis. Which advice will the nurse provide to the client?

A. Take the medicine with meals.
B. See a dentist if bleeding gums develop.
C. Switch to acetaminophen if tinnitus occurs.
D. Avoid spicy foods while taking the medication.

Answer 6

Take the medicine with meals.

Question 7

Aspirin is prescribed on a regular schedule for a client with rheumatoid arthritis. The nurse understands that the medication is being used primarily for which property?

A. Analgesic
B. Antipyretic
C. Anti-inflammatory
D. Antiplatelet

Answer 7

Anti-inflammatory

Question 8

A client has been given a prescription for acetylsalicylic acid. The nurse recalls that this medication has which property?

A. Sedative
B. Hypnotic
C. Analgesic
D. Antibiotic

Answer 8

Analgesic

Question 9

A client is admitted to the emergency department with crushing chest pain. A diagnosis of acute coronary syndrome is suspected. Which medication is indicated to prevent progression to a myocardial infarction?

A. Aspirin
B. Atropine
C. Gabapentin
D. Epinephrine

Answer 9

Aspirin

Question 10

The client with chronic arterial insufficiency of the legs refuses the prescribed dose of aspirin (ASA). The client states, ‘My legs are not painful.’ Which action will the nurse take?

A. Explain the reason for the medication and encourage the client to take it.
B. Withhold the medication at this time and return to check with the client again in 30 minutes.
C. Withhold the medication and tell the client to ask for it if the legs become uncomfortable.
D. Request that the client take the medication and explain that it prevents the client from being uncomfortable in the next few hours.

Answer 10

Explain the reason for the medication and encourage the client to take it.

Question 11

A health care provider prescribes aspirin therapy for a client with arthritis. The nurse will advise the client to report which adverse effects? Select all that apply. One, some, or all responses may be correct.

A. Ongoing nausea
B. Constipation
C. Easy bruising
D. Decreased pulse
E. Ringing in the ears

Answer 11

Ongoing nausea
Easy bruising
Ringing in the ears

Question 12

Aspirin is prescribed for a client with rheumatoid arthritis. Which clinical indicators of aspirin toxicity will the nurse teach the client to report? Select all that apply. One, some, or all responses may be correct.

A. Bradycardia
B. Joint pain
C. Blood in the stool
D. Ringing in the ears
E. Increased urine output

Answer 12

Blood in the stool
Ringing in the ears

Question 13

Which would the nurse include in the client’s medication teaching on the administration of aspirin 650 mg every 6 hours as needed for arthritic pain? Select all that apply. One, some, or all responses may be correct.

A. ‘Report persistent abdominal pain.’
B. ‘Do not chew enteric-coated tablets.’
C. ‘Take the aspirin with meals or a snack.’
D. ‘See a dentist if bleeding gums develop.’
E. ‘Switch to acetaminophen if tinnitus occurs.’

Answer 13

‘Report persistent abdominal pain.’

‘Do not chew enteric-coated tablets.’

‘Take the aspirin with meals or a snack.’

Question 14

The nurse is planning care for a toddler who has ingested aspirin. Which assessment warrants close monitoring because an increase would result in further complications?

A. Blood pressure
B. Abdominal girth
C. Body temperature
D. Serum glucose level

Answer 14

Body temperature

Question 15

The nurse is assessing the effectiveness of high dose aspirin therapy for an 88-year-old client with arthritis. The client reports hearing non-stop ringing in the ears. Which action should the nurse implement?

A. Refer the client to an audiologist for evaluation of her hearing.
B. Advise the client that this is a common side effect.
C. Notify the healthcare provider of the finding immediately.
D. Face the client directly and speak in a low, monotone voice.

Answer 15

Notify the healthcare provider of the finding immediately.

Question 16

A client who recently had a heart attack has been prescribed low-dose (81 mg) aspirin at bedtime. The client states “Why am I supposed to take a ‘baby aspirin’ instead of a regular 325 mg tablet?” Which statement represents the nurse’s best response?

A. “Taking a higher dose will affect your hearing.”
B. “The higher dose will cause you to have heartburn.”
C. “Taking 325 mg of aspirin daily will increase your risk of bleeding.”
D. “The higher doses may interfere with your normal sleep patterns.”

Answer 16

“Taking 325 mg of aspirin daily will increase your risk of bleeding.”

Question 17

The nurse is assessing a client with suspected aspirin overdose. Which assessment findings would support this diagnosis? Select all that apply.

A. Respiratory rate of 28
B. Tinnitus
C. Hypoglycemia
D. Jaundice
E. Serum pH 7.31
F. Headache

Answer 17

Respiratory rate of 28
Tinnitus
Serum pH 7.31
Headache

Question 18

A toddler ingested half a bottle of aspirin tablets. Which finding should the nurse expect to see in this child?

A. Dyspnea
B. Hypothermia
C. Edema
D. Epistaxis

Answer 18

Epistaxis

Question 19

The nurse is preparing to administer aspirin 81 mg to a client who had a stroke. The client states, “I do not want to take that.” Which statements should the nurse make to the client? Select all that apply.

A. “If you don’t take aspirin every day, you might die.”
B. “Can you tell me what concerns you have about the aspirin?”
C. “Do you experience any nausea when you take the aspirin?”
D. “Do you take your other medications as prescribed by your provider?”
E. “Would you like to take the aspirin at another time of day?”

Answer 19

“Can you tell me what concerns you have about the aspirin?”

“Do you experience any nausea when you take the aspirin?”

“Do you take your other medications as prescribed by your provider?”

“Would you like to take the aspirin at another time of day?”

Question 20

The nurse is caring for a client that is taking prednisone and aspirin for rheumatoid arthritis. Which action by the nurse is appropriate for this client?

A. Assess the client’s pain level once a shift
B. Monitor the client’s temperature every two hours
C. Test the client’s stool for occult blood
D. Apply a hot pack to a warm, acutely inflamed joint

Answer 20

Test the client’s stool for occult blood

Question 21

A client with a history of heart disease has been prescribed prophylactic aspirin daily. Which action should the nurse implement to help prevent aspirin toxicity?

A. Monitor serum albumin
B. Measure daily protein intake
C. Assess serum potassium level
D. Teach the client that tinnitus is an expected side effect

Answer 21

Monitor serum albumin

Question 22

How would the nurse instruct a client with arthritis to take aspirin when the client states that the aspirin causes stomach irritation?

A. An hour before a meal
B. With food and a full glass of water
C. With sodium bicarbonate
D. At the same time as the other medications

Answer 22

With food and a full glass of water

Question 23

Which medication increases the risk for upper gastrointestinal (GI) bleeding? Select all that apply. One, some, or all responses may be correct.

A. Aspirin
B. Ibuprofen
C. Ciprofloxacin
D. Acetaminophen
E. Methylprednisolone

Answer 23

Aspirin
Ibuprofen
Methylprednisolone

Question 24

When, during the first 24 hours postoperatively, will analgesics be administered to a client who undergoes an abdominal cholecystectomy for gangrene of the gallbladder?

A. If repositioning is ineffective
B. When the pain becomes severe
C. In gradually increasing dosages
D. As prescribed by the health care provider

Answer 24

As prescribed by the health care provider

Question 25

Which action would the nurse take when a client refuses to take deep breaths and cough, saying, "It’s too painful." after an abdominal cholecystectomy? A. Give pain medication regularly as soon as possible. B. Obtain a prescription to increase the client’s pain medication. C. Schedule coughing and deep-breathing exercises after analgesic has taken effect. D. Substitute incentive spirometry for coughing and deep breathing.

Answer 25

Schedule coughing and deep-breathing exercises after analgesic has taken effect.

Question 26

An adolescent is admitted with partial- and full-thickness burns of the arms and upper torso. Which are the primary purposes of administering pain medication via the intravenous route, rather than the intramuscular route? Select all that apply. One, some, or all responses may be correct. A. Adolescents are afraid of injections. B. It decreases the risk of tissue irritation. C. Severe pain is reduced more effectively. D. Impaired peripheral circulation is bypassed. E. It provides for more prolonged relief of pain.

Answer 26

It decreases the risk of tissue irritation. Severe pain is reduced more effectively. Impaired peripheral circulation is bypassed.

Question 27

Which action is the nurse’s responsibility when administering prescribed opioid analgesics? Select all that apply. One, some, or all responses may be correct. A. Count the client’s respirations. B. Document the intensity of the client’s pain. C. Withhold the medication if the client reports pruritus. D. Verify the number of doses in the locked cabinet before administering the prescribed dose. E. Discard the medication in the client’s toilet before leaving the room if the medication is refused.

Answer 27

Count the client’s respirations. Document the intensity of the client’s pain. Verify the number of doses in the locked cabinet before administering the prescribed dose.

Question 28

A pain scale of 1 to 10 is used by the nurse to assess a client’s degree of pain. The client rates the pain as an 8 before receiving an analgesic and a 7 after being medicated. Which conclusion would the nurse make regarding the client’s response to pain medication? A. The client has a low pain tolerance. B. The medication is not adequately effective. C. The medication has sufficiently decreased the pain level. D. The client needs more education about the use of the pain scale.

Answer 28

The medication is not adequately effective.

Question 29

The nurse is caring for a client with deep partial-thickness burns who is receiving an opioid for pain management. Which mode of medication administration is preferred for this client? A. Oral B. Rectal C. Intravenous D. Intramuscular

Answer 29

Intravenous

Question 30

The nurse is preparing an education session for a client prescribed opioids for intractable cancer pain. The nurse should include strategies to help prevent which common side effect associated with long-term use of opioids? A. Sedation. B. Constipation. C. Urinary retention. D. Respiratory depression.

Answer 30

Constipation

Question 31

A staff nurse is assisting a charge nurse with checking controlled substances at the change of shift. The charge nurse is urgently called to a client’s room and has to leave the medication room. Which action will the staff nurse take? A. Continue performing the check while the charge nurse assists the client B. Leave the medication room to find another nurse to assist with the check C. Stop the check and sign out of the medication dispensing system D. Pause the check until the charge nurse returns to the medication room

Answer 31

Stop the check and sign out of the medication dispensing system

Question 32

A nurse is providing care to a client post-cholecystectomy. Which observation indicates the client may require PRN pain medication? A. Slow gait when ambulating to the restroom B. Guarding when the abdomen is palpated C. Muscle tension when repositioning in bed D. Refusal to eat the provided meals

Answer 32

Muscle tension when repositioning in bed

Question 33

The nurse is assessing a client who is taking prescribed opioids for pain. Which finding should indicate to the nurse that the client is having a side effect of the medication? A. Decreased skin turgor B. No bowel movement for four days C. Hypertension D. Increased respiratory effort

Answer 33

No bowel movement for four days

Question 34

A nurse is performing pain assessments on several clients. Which client would benefit the most from the administration of intravenous PRN pain medication? A. A client eating breakfast verbalizing a headache B. A client with a fractured arm pending discharge C. A client post-abdominal surgery sitting in a chair D. A client pending bedside debridement of a wound

Answer 34

A client pending bedside debridement of a wound

Question 35

A client is diagnosed with rheumatoid arthritis (RA). Which types of drugs might the nurse expect to be ordered as a combination drug therapy regimen? Select all that apply. A. Glucocorticoids B. Biological-response modifiers C. Antimicrobial agents D. Diuretics E. Anti-inflammatory drugs

Answer 35

Glucocorticoids Biological-response modifiers Anti-inflammatory drugs

Question 36

The nurse is caring for a client who is actively dying and has been receiving high doses of opioid analgesics. The client has become unresponsive to verbal stimuli. What action should the nurse take? A. Stop giving the analgesic B. Give an extra dose of the analgesic C. Decrease the analgesic dosage by half D. Continue the analgesic at the current dose

Answer 36

Continue the analgesic at the current dose

Question 37

Morphine has been prescribed for a client in a hospice home care program. Which information will the nurse provide regarding this pain management regimen? A. Medication addiction is a concern with this medication. B. Request the medication before the pain becomes severe. C. Dosages of the medication will be given automatically at regular intervals around the clock. D. Intermittent administration of the medication is possible after an intermittent lock is inserted.

Answer 37

Dosages of the medication will be given automatically at regular intervals around the clock.

Question 38

A client, admitted to the cardiac care unit with a myocardial infarction, complains of chest pain. Which intervention will be most effective in relieving the client’s pain? A. Nitroglycerin sublingually B. Oxygen per nasal cannula C. Lidocaine hydrochloride 50-mg intravenous (IV) bolus D. Morphine sulfate 2 mg IV

Answer 38

Morphine sulfate 2 mg IV

Question 39

A client who had a myocardial infarction receives 15 mg of morphine sulfate for chest pain. Fifteen minutes after receiving the medication, the client complains of feeling dizzy. Which action will the nurse take? A. Determine if this is an allergic reaction. B. Elevate the client’s head and keep the extremities warm. C. Place the client in the supine position and take the vital signs. D. Tell the client that this is not a typical sensation after receiving morphine sulfate.

Answer 39

Place the client in the supine position and take the vital signs.

Question 40

A client receives intrathecal morphine to control severe postoperative pain. Which action will the nurse include as part of the client’s initial 24-hour postoperative care plan? A. Monitoring of respiratory rate hourly B. Assessing the client for tachycardia C. Administering naloxone every 3 to 4 hours D. Observing the client for signs of central nervous system (CNS) excitement

Answer 40

Monitoring of respiratory rate hourly

Question 41

Which relationship reflects the relationship of naloxone to morphine sulfate? A. Aspirin to warfarin B. Amoxicillin to infection C. Enoxaparin to dalteparin D. Protamine sulfate to heparin

Answer 41

Protamine sulfate to heparin

Question 42

The nurse is caring for a client hospitalized with a myocardial infarction. Which analgesic is the medication of choice for this client? A. Ketorolac B. Meperidine C. Flurazepam D. Morphine sulfate

Answer 42

Morphine sulfate

Question 43

Which response to morphine would need to be reported immediately to the health care provider? A. Nausea B. Headache C. Drowsiness D. Bradycardia

Answer 43

Bradycardia

Question 44

A client receiving morphine is being monitored by the nurse for adverse effects of the medication. Which clinical findings warrant immediate follow up by the nurse? Select all that apply. One, some, or all responses may be correct. A. Polyuria B. Unconsciousness C. Bradycardia D. Dilated pupils E. Bradypnea

Answer 44

Unconsciousness Bradycardia Bradypnea

Question 45

A health care provider prescribes morphine for a client being treated for myocardial infarction. Which physiological response will occur if the client experiences the intended therapeutic effect of morphine? A. Increased respiratory rate B. Decreased workload of the heart C. Dilation of coronary arteries D. Diminished metabolites within the ischemic heart muscle

Answer 45

Decreased workload of the heart

Question 46

After surgery the client has a prescription for morphine sulfate via intravenous (IV) route every 3 hours as needed for pain. The client’s preoperative blood pressure was 128/76 mm Hg. Postoperative assessments reveal that the client’s blood pressure ranges between 90/60 mm Hg and 100/70 mm Hg. Which action will the nurse take if the client requests medication for pain? A. Administer morphine as prescribed. B. Obtain a prescription for a vasoconstrictor. C. Give half the prescribed amount of morphine. D. Withhold morphine until the blood pressure stabilizes.

Answer 46

Withhold morphine until the blood pressure stabilizes.

Question 47

An adolescent client has orders for morphine sulfate for severe pain and acetaminophen-codeine compound for moderate pain after a spinal fusion. The pain assessment reveals the client is rigid and crying in pain. Which information would influence the nurse’s choice of analgesic? A. One dose of morphine may be given, but the drug should be restricted thereafter because it is addictive. B. Adolescents tend to exaggerate their discomfort, particularly when they are immobilized by surgery or injury. C. Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic. D. The acetaminophen-codeine compound is preferred because morphine can cause respiratory depression or respiratory arrest.

Answer 47

Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic.

Question 48

Which client should the nurse identify as being at highest risk for complications during the use of an opioid analgesic? A. An older client with Type 2 diabetes mellitus. B. A client with chronic rheumatoid arthritis. C. A client with a open compound fracture. D. A young adult with inflammatory bowel disease.

Answer 48

D. A young adult with inflammatory bowel disease.

Question 49

Which medications should the nurse caution the client about taking while receiving an opioid analgesic? A. Antacids. B. Benzodiazepines. C. Antihypertensives. D. Oral antidiabetics.

Answer 49

Benzodiazepines.

Question 50

A nurse is preparing to administer morphine to a client with chronic pain. Which assessment finding would prompt the nurse to withhold the medication? A. Heart rate of 117 beats/min B. Urine output of 35 ml/hr C. Oxygen saturation of 92% D. Respiratory rate of 11 breaths/min

Answer 50

Respiratory rate of 11 breaths/min

Question 51

The nurse is teaching a client who is postoperative cesarean section about prescribing morphine via a patient-controlled device. Which statement should the nurse include in client teaching about the medication? A. It is normal for this medication to cause burning at the IV site B. You will probably experience some itching each time you administer a dose C. Tell your family members to press the administration button if you are feeling tired D. Let a staff member know if you experience any trouble breathing

Answer 51

Let a staff member know if you experience any trouble breathing

Question 52

The nurse is caring for an 81-year-old client with colorectal cancer. Previously, the client's pain was managed with acetaminophen with codeine. However, the client is now experiencing frequent, severe pain and intravenous morphine has been prescribed. What should the nurse recognize about this order? A. Inappropriate due to the potential of respiratory depression B. Inappropriate and demonstrates lack of knowledge related to pain control C. Appropriate despite the risk of diarrhea and abdominal upset D. Appropriate pain management and should be available around the clock

Answer 52

Appropriate pain management and should be available around the clock

Question 53

The nurse is caring for a client with acute pain and realizes a medication error has occurred. The client received twice the ordered dose of morphine an hour ago. Which nursing problem is the priority at this time? A. Chronic pain B. Respiratory depression C. Constipation D. Tolerance

Answer 53

Respiratory depression

Question 54

The nurse is caring for a 1-year-old child after heart surgery. The child weighs 22 pounds (10 kg). The health care provider has given an order for morphine sulfate 4 mg IV every 3 to 4 hours as needed for pain. What should the nurse do next? A. Administer the prescribed dose as ordered. B. Verify that the dose is appropriate for this child. C. Give half of the dose first, wait 30 minutes, then give the other half. D. Check with the pharmacist to clarify the dose.

Answer 54

Verify that the dose is appropriate for this child.

Question 55

A client with a myocardial infarction is admitted to the cardiac intensive care unit. Which pain relief medication would the nurse expect to find on the plan of care for this client? A. Morphine B. Diazepam C. Midazolam D. Oxycodone

Answer 55

Morphine

Question 56

A client in the coronary care unit develops 'viselike' chest pain radiating to the neck. Assessment reveals a blood pressure of 124/64 mm Hg, an irregular apical pulse of 64 beats per minute, and diaphoresis. Cardiac monitoring is instituted, and morphine sulfate 4 mg intravenous (IV) push stat is prescribed. Which intervention is the priority nursing care for this client? A. Relief of pain B. Client teaching C. Cardiac monitoring D. Maintenance of bed rest

Answer 56

Relief of pain

Question 57

A client with a known history of opioid addiction has a surgical repair of multiple stab wounds to the abdomen. After surgery, the client’s pain is not relieved by the prescribed morphine injections. Which phenomenon is the client experiencing when they fail to achieve pain relief? A. Tolerance B. Habituation C. Physical addiction D. Psychological dependence

Answer 57

Tolerance

Question 58

At which time would the nurse plan to administer morphine 2 mg by mouth every 2 hours as needed to a client who has burns on 55% of the body surface and requires dressing changes? A. 15 minutes before the dressing change B. 60 minutes before the dressing change C. Along with a stool softener each time it is administered D. Only if the client rates pain between 8 and 10 on the pain scale

Answer 58

60 minutes before the dressing change

Question 59

Which adverse effect of morphine indicates the need for naloxone administration? A. Blurred vision B. Urinary retention C. Mental confusion D. Respiratory depression

Answer 59

Respiratory depression

Question 60

A client who receives morphine by patient-controlled analgesia has a respiratory rate of 6 breaths/minute. Which intervention is needed? A. Nasotracheal suction B. Mechanical ventilation C. Naloxone administration D. Cardiopulmonary resuscitation

Answer 60

Naloxone administration

Question 61

A client takes morphine sulfate for severe metastatic bone pain. The nurse will assess the client for which adverse effect? A. Diarrhea B. Addiction C. Respiratory depression D. Diuresis

Answer 61

Respiratory depression

Question 62

Which medication would the nurse anticipate will be prescribed to relieve anxiety and apprehension in a client with pulmonary edema? A. Morphine B. Phenobarbital C. Hydroxyzine D. Chloral hydrate

Answer 62

Morphine

Question 63

A terminally ill client is receiving a morphine drip that exceeds the typical recommended dosage. The client’s spouse tells the nurse that the client is again uncomfortable and needs the morphine increased. The prescription states to titrate the morphine to comfort level. Which action will the nurse take? A. Add a placebo to the morphine to appease the spouse. B. Discuss with the spouse the risk for morphine addiction. C. Assess the client’s pain before increasing the dose of morphine. D. Check the client’s heart rate before increasing the morphine to the next level.

Answer 63

Assess the client’s pain before increasing the dose of morphine.

Question 64

Which member of the health care team would the nurse ask to serve as a witness when wasting unused morphine? A. Nursing supervisor B. Licensed practical nurse (LPN) C. Client’s health care provider D. Designated nursing assistant

Answer 64

Licensed practical nurse (LPN)

Question 65

A client has increased intracranial pressure and is unconscious with a heart rate of 60 beats/min, respirations 16 breaths/min, and blood pressure 142/64 mm Hg. The nurse reviews the treatment plan and questions which prescription? A. Mannitol B. Dexamethasone C. Chlorpromazine D. Morphine

Answer 65

Morphine

Question 66

A client who has been diagnosed with a myocardial infarction receives digoxin, fluoxetine, morphine, and docusate sodium. Which medication would the nurse identify as a risk factor for straining due to constipation? A. Digoxin B. Morphine C. Docusate D. Fluoxetine

Answer 66

Morphine

Question 67

A client is admitted to the emergency department after experiencing a seizure. Which action would the nurse take first? A. Ask the emergency provider for a prophylactic anticonvulsant. B. Obtain a history of seizure type and incidence. C. Ask the client to remove any dentures and eyeglasses. D. Observe the client for increased restlessness and agitation.

Answer 67

Obtain a history of seizure type and incidence.

Question 68

Which statement by the nurse reflects teaching for a client recently initiated on anticonvulsants? Select all that apply. One, some, or all responses may be correct. A. 'It is important to take the medication at the same time every day with meals.' B. 'It is important to not drink excessive amounts of caffeine-containing beverages or alcohol.' C. 'Avoid driving or hazardous activities until any side effects such as drowsiness can be determined.' D. 'Some anticonvulsants interfere with vitamin and mineral absorption, so you may need a supplement.' E. 'Oral hygiene, such as gum massage and tooth brushing, is important to combat the gingival hyperplasia that some anticonvulsant medication can cause.'

Answer 68

'It is important to take the medication at the same time every day with meals.' 'It is important to not drink excessive amounts of caffeine-containing beverages or alcohol.' 'Avoid driving or hazardous activities until any side effects such as drowsiness can be determined.' 'Some anticonvulsants interfere with vitamin and mineral absorption, so you may need a supplement.' 'Oral hygiene, such as gum massage and tooth brushing, is important to combat the gingival hyperplasia that some anticonvulsant medication can cause.'

Question 69

Status epilepticus develops in an adolescent with a seizure disorder who is taking antiseizure medication. Which reason would the nurse identify as the most common reason for the development of status epilepticus? A. The provider failed to account for a growth spurt. B. The amount prescribed is insufficient to cover activities. C. The prescribed antiseizure medication probably is not taken consistently. D. The client is prescribed a medication that is ineffective in preventing seizures.

Answer 69

The prescribed antiseizure medication probably is not taken consistently.

Question 70

A client has a tonic-clonic seizure caused by an overdose of aspirin. Which action would the nurse take next? A. Check reflexes every 2 hours. B. Insert a urinary retention catheter. C. Monitor vital signs every 15 minutes. D. Prepare a setup for a central venous pressure (CVP) line.

Answer 70

Monitor vital signs every 15 minutes.

Question 71

During the admission process, the client reports heavy alcohol use for at least one year. What effect does the nurse anticipate the hospitalized client will experience when alcohol consumption stops? A. Bradycardia B. Somnolence C. Withdrawal D. Tachypnea

Answer 71

Withdrawal

Question 72

Which adverse response would a nurse assesses for when carbidopa-levodopa is prescribed for a client with Parkinson disease? Select all that apply. One, some, or all responses may be correct. A. Nausea B. Lethargy C. Bradycardia D. Polycythemia E. Emotional changes

Answer 72

Nausea Emotional changes

Question 73

Carbidopa-levodopa is prescribed for a client with Parkinson's disease. Which instruction will the nurse include when teaching the client about this medication? A. 'Take this medication between meals.' B. 'Blood levels of the medication should be monitored weekly.' C. 'It can cause happy feelings followed by feelings of depression.' D. 'You may experience dizziness when moving from sitting to standing.'

Answer 73

'You may experience dizziness when moving from sitting to standing.'

Question 74

The nurse administers carbidopa-levodopa to a client with Parkinson's disease. Which activity describes the mechanism of action of this medication? A. Increase in acetylcholine production B. Regeneration of injured thalamic cells C. Improvement in myelination of neurons D. Replacement of a neurotransmitter in the brain

Answer 74

Replacement of a neurotransmitter in the brain

Question 75

A client with Parkinson disease is admitted to the hospital. Which medication is prescribed to improve the physical manifestations of Parkinson disease? A. Carbidopa-levodopa B. Isocarboxazid C. Dopamine D. Pyridoxine (vitamin B 6)

Answer 75

Carbidopa-levodopa

Question 76

Which would the nurse include when teaching a client with Parkinson disease about carbidopa-levodopa? A. Multivitamins should be taken daily. B. A high-protein diet should be followed. C. The medication should be taken with meals. D. Alcohol consumption should be in moderation.

Answer 76

The medication should be taken with meals.

Question 77

A client with Parkinson's disease is taking carbidopa-levodopa (Sinemet). Which observation by the nurse would indicate that the desired outcome of the medication is being achieved? A. Decreased blood pressure. B. Lessening of tremors. C. Increased salivation. D. Increased attention span.

Answer 77

Lessening of tremors.

Question 78

A nurse is providing education on the use of carbidopa/levodopa to a client with Parkinson’s disease. What will the nurse include in the teaching? A. This medication will stop the progression of your condition B. Notify your healthcare provider if your urine appears dark C. Eat plenty of whole-grain foods when taking this medication D. Avoid eating meals that are high in protein

Answer 78

Avoid eating meals that are high in protein

Question 79

The nurse is caring for a client with Parkinson's disease. Which finding indicates that the client might be experiencing an adverse side effect from the dopamine-enhancing drugs? A. Urinary retention B. Hallucinations C. Kidney failure D. Hypertensive urgency

Answer 79

Hallucinations

Question 80

Which mechanism of action would the nurse identify for levodopa therapy prescribed to a client diagnosed with Parkinson disease? A. Blocks the effects of acetylcholine B. Increases the production of dopamine C. Restores the dopamine levels in the brain D. Promotes the production of acetylcholine

Answer 80

Restores the dopamine levels in the brain

Question 81

Which symptom of levodopa toxicity will a client taking levodopa be taught as a reason to contact the primary health care provider? A. Nausea B. Dizziness C. Twitching D. Constipation

Answer 81

Twitching

Question 82

The daughter of a client with Alzheimer's disease asks the nurse, "Will the medication my mother is taking cure her dementia?" What is the best response by the nurse? A. "It will help your mother live independently again." B. "It is used to halt the progression of Alzheimer's disease." C. "It will not improve dementia but can help control emotional responses." D. "It will provide a steady improvement in memory."

Answer 82

"It will not improve dementia but can help control emotional responses."

Question 83

The nurse is completing a health history of a client diagnosed with Alzheimer's disease. The nurse reviews a list of the client's medications and supplements routinely taken at home. Which treatment should be a cause for concern by the nurse? A. Donepezil B. Ginkgo biloba C. Omega-3 fatty acids D. Coconut oil

Answer 83

Coconut oil

Question 84

Donepezil is prescribed for a client who has mild dementia of the Alzheimer type. Which information would the nurse include when discussing this medication with the client and family? A. Fluids should be limited to 4 large glasses per day. B. Constipation should be reported to the primary health care provider immediately. C. Blood tests that reflect liver function will be performed routinely. D. The client’s medication dosage may be self-adjusted according to the client’s response.

Answer 84

Blood tests that reflect liver function will be performed routinely.

Question 85

A client with a diagnosis of dementia of the Alzheimer type has been taking donepezil 10 mg/day for 3 months. The client’s partner calls the clinic and reports that the client has increasing restlessness and agitation accompanied by nausea. Which advice would the nurse give the partner? A. Give the medication with food. B. Administer the medication at bedtime. C. Omit 1 dose today and start with a lower dose tomorrow. D. Bring the partner to the clinic for testing and a physical examination.

Answer 85

Bring the partner to the clinic for testing and a physical examination.

Question 86

The nurse teaches a client’s family about the administration of donepezil for treatment of dementia of the Alzheimer type. Which side effect identified by the caregiver indicates to the nurse that further teaching is needed? A. Nausea B. Dizziness C. Headache D. Constipation

Answer 86

Constipation

Question 87

The caregiver of a client with Alzheimer's disease asks the nurse for information about different treatment options that can help with memory or behavior problems. Which of the following responses by the nurse are correct? Select all that apply. A. "Music therapy has been found to help some clients." B. "Ginkgo biloba may help with memory." C. "Acupuncture may be very relaxing." D. "Donepezil (Aricept) may help slow cognitive decline." E. "Garlic may help with this disease."

Answer 87

"Music therapy has been found to help some clients." Ginkgo biloba may help with memory." Donepezil (Aricept) may help slow cognitive decline."

Question 88

The nurse is preparing to administer newly prescribed intravenous phenytoin to a client. When reviewing the client’s medical record, which prescription should the nurse question? A. Continuous infusion of dextrose 5% in 0.9% saline B. NPH insulin 40 units before meals C. Labetalol 100 mg orally twice per day Your Answer D. Ketorolac 15 mg IV push as needed for pain

Answer 88

Continuous infusion of dextrose 5% in 0.9% saline

Question 88

The nursing is preparing to administer phenytoin IV push to a client. The client has dextrose 5% in water infusing continuously. Which action is appropriate? A. Pinch the line above the infusion port during the administration B. Hold the medication and collaborate with the provider prior to administration C. Stop the infusion and flush the port with normal saline prior to administration D. Ask the pharmacy to mix the medication into an IV piggyback (IVPB) infusion

Answer 88

Stop the infusion and flush the port with normal saline prior to administration

Question 88

The nurse is educating a client with seizure disorder about newly prescribed phenytoin. Which statement should the nurse include in the teaching? A. Blood work will be required if you have a seizure while taking this medication B. You will need to have routine visits with a dentist when taking this medication C. It is normal to have a change in your gait when you first start this medication D. Avoid grapefruit juice when taking this medication

Answer 88

You will need to have routine visits with a dentist when taking this medication

Question 88

A nurse is providing care to a client who takes phenytoin for seizure prevention. The latest laboratory report shows a phenytoin level of 32 mcg/mL. Which action does the nurse take next? A. Examine the oral cavity B. Percuss the abdomen C. Check the skin turgor D. Assess the pupillary response

Answer 88

Assess the pupillary response

Question 89

A newly admitted client reports taking phenytoin for several months. Which assessment should the nurse include in the admission report? Select all that apply. A. Report of unsteady gait, rash and diplopia B. Report of any seizure activity C. Serum phenytoin levels D. Report of anorexia, numbness and tingling of the extremities

Answer 89

Report of unsteady gait, rash and diplopia Report of any seizure activity Serum phenytoin levels

Question 89

A nurse is teaching parents of a child recently prescribed the medication phenytoin for seizure control. Which side effect will the nurse include? A. Hypertension B. Insomnia C. Gingival hyperplasia D. Increased appetite

Answer 89

Gingival hyperplasia

Question 89

The nurse is caring for a child diagnosed with seizures. While teaching the family and the child about the medication phenytoin, which concept should the nurse emphasize? A. Omit the medication if the child is seizure-free B. Serve a diet that is high in iron C. A rash is normal with this medication D. Maintain good oral hygiene and dental care

Answer 89

Maintain good oral hygiene and dental care

Question 89

Which instruction about phenytoin will the nurse provide during discharge teaching to a client with epilepsy who is prescribed phenytoin for seizure control? A. "Antiseizure medications will probably be continued for life." B. "Phenytoin prevents any further occurrence of seizures." C. "This medication needs to be taken during periods of emotional stress." D. "Your antiseizure medication usually can be stopped after a year’s absence of seizures."

Answer 89

"Antiseizure medications will probably be continued for life."

Question 90

The nurse teaches the parents of a child prescribed long-term phenytoin therapy about care. Which statement indicates the teaching has been effective? A. 'We give the medication between meals.' B. 'We’ll call the clinic if her urine turns pink.' C. 'She’s eating high-calorie foods, and we encourage fluids, too.' D. 'We’ll have her massage her gums and floss her teeth frequently.'

Answer 90

'We’ll have her massage her gums and floss her teeth frequently.'

Question 90

A school-age child with a seizure disorder is prescribed divalproex/phenytoin. The nurse would include which instruction when teaching the parents about administering this medication? A. 'Crush the tablets and mix them with applesauce.' B. 'Take the child for regularly scheduled blood tests.' C. 'Stop the medication immediately if a rash develops.' D. 'Provide oral hygiene, especially gum massage and flossing.'

Answer 90

'Take the child for regularly scheduled blood tests.'

Question 90

The client with a seizure disorder receives intravenous (IV) phenytoin. The nurse will monitor closely for which condition? A. Cardiac dysrhythmias B. Hypoglycemia C. Polycythemia D. Paradoxical excitation

Answer 90

Cardiac dysrhythmias

Question 90

A client with a seizure disorder will begin taking phenytoin. Which instructions will the nurse give to the client? A. 'Take the medication on an empty stomach.' B. 'Provide meticulous oral hygiene.' C. 'Taper off the medication if seizures are controlled for 3 months.' D. 'Stop taking the medication if you become pregnant.'

Answer 90

'Provide meticulous oral hygiene.'

Question 91

Warfarin is prescribed for the client who takes phenytoin for a seizure disorder. Which medication interaction complicates seizure therapy? A. Warfarin inhibits the metabolism of phenytoin. B. Warfarin decreases phenytoin absorption. C. Phenytoin competes with warfarin for receptor occupation. D. Warfarin promotes excretion of phenytoin.

Answer 91

Warfarin inhibits the metabolism of phenytoin.

Question 92

A client who is receiving phenytoin asks why folic acid was prescribed. Which explanation would the nurse provide? A. Phenytoin inhibits absorption of folate from foods. B. Folic acid potentiates the action of phenytoin. C. Absorption of iron from foods is improved. D. Neuropathy caused by phenytoin is prevented.

Answer 92

Phenytoin inhibits absorption of folate from foods.

Question 93

A client with a seizure disorder is receiving phenytoin and phenobarbital. Which client statement indicates that the instructions regarding the medications are understood? A. 'I will not have any seizures with these medications.' B. 'These medicines must be continued to prevent falls and injury.' C. 'Stopping the medications can cause continuous seizures and I may die.' D. 'By my staying on the medicines I will prevent postseizure confusion.'

Answer 93

'Stopping the medications can cause continuous seizures and I may die.'

Question 93

A client’s phenytoin level is 16 mcg/L. Which action will the nurse take? A. Hold the medication and notify the health care provider. B. Administer the next dose of the medication as prescribed. C. Hold the next dose and then resume administration as prescribed. D. Call the health care provider to obtain a prescription with an increased dose.

Answer 93

Administer the next dose of the medication as prescribed.

Question 93

Which instruction would the nurse provide to parents of a school-age child who has been on long-term phenytoin therapy to prevent side effects? A. Provide good oral hygiene. B. Administer the medication between meals. C. Watch for a reddish-brown discoloration of urine. D. Supplement the diet with high-calorie foods.

Answer 93

Provide good oral hygiene.

Question 94

The nurse educating a client who is postpartum about the use of ibuprofen for uterine cramping. Which statement should the nurse include in the teaching? A. This medication could cause gastrointestinal discomfort B. You may experience decreased vaginal discharge with this medication C. Taking this medication could decrease your breast milk production D. You could experience dizziness while taking this medication

Answer 94

This medication could cause gastrointestinal discomfort

Question 95

A nurse is reviewing prescriptions for a client with a history of rheumatoid arthritis and peptic ulcer disease. The client has prescriptions for ibuprofen and ranitidine. Which action will the nurse perform? A. Clarify the prescription for ibuprofen B. Administer the ibuprofen 30 minutes before the ranitidine C. Hold the ranitidine for 1 hour after meals D. Question the prescription for ranitidine

Answer 95

Clarify the prescription for ibuprofen

Question 96

The mother of a toddler with hemophilia A asks the nurse, 'Can I give my child ibuprofen for fever or pain?' How will the nurse respond? A. 'Ibuprofen is a good choice for fever or pain.' B. 'Give your child acetaminophen. Ibuprofen may cause bleeding.' C. 'No. I’ll explain why your child isn’t allowed pain medications.' D. 'You seem concerned about giving medications to your child.'

Answer 96

'Give your child acetaminophen. Ibuprofen may cause bleeding.'

Question 97

Which life-threatening complication may occur in clients taking high-dose or long-term ibuprofen? A. Anaphylaxis B. Gastrointestinal (GI) bleeding C. Cardiac dysrhythmia D. Disulfiram reaction

Answer 97

Gastrointestinal (GI) bleeding

Question 98

A client with rheumatoid arthritis is to begin taking ibuprofen 800 mg by mouth three times a day. The nurse provides education about the medication’s side effects. The nurse concludes that the teaching was effective when the client makes which statements? Select all that apply. One, some, or all responses may be correct. A. 'I need to report any dark tarry stools.' B. 'I will need to stop taking this medication before any scheduled surgery.' C. 'I should change positions slowly.' D. 'I will take the medication on an empty stomach.' E. 'I need to stop taking low-dose aspirin while I take this medication.'

Answer 98

A. 'I need to report any dark tarry stools.' B. 'I will need to stop taking this medication before any scheduled surgery.'

Question 99

Which therapeutic outcomes are expected after administering ibuprofen? Select all that apply. One, some, or all responses may be correct. A. Diuresis B. Pain relief C. Temperature reduction D. Bronchodilation E. Anticoagulation F. Reduced inflammation

Answer 99

B. Pain relief C. Temperature reduction F. Reduced inflammation

Question 100

The nurse administers acetaminophen to a child who complains of pain after abdominal surgery. The mother asks the nurse why her child isn’t being given ibuprofen. Which response by the nurse is most appropriate? A. 'It could prolong bleeding time.' B. 'It’s contraindicated for young children.' C. 'It can suppress the healing of the incision.' D. 'It becomes ineffective when given for long periods.'

Answer 100

'It could prolong bleeding time.'

Question 101

A nurse is reviewing analgesic prescriptions for a client with a history of liver cirrhosis. The prescriptions state to administer PRN for pain. Which medication is the nurse most likely to administer to this client? A. Fentanyl B. Acetaminophen C. Ibuprofen D. Ketorolac

Answer 101

Fentanyl

Question 102

A nurse has removed a 2 ml vial of fentanyl from the medication dispensing system. After dosage calculations, the nurse determines only 1 ml will be administered to the client. Which action will the nurse perform with the remainder of the medication? A. Request another nurse to witness wasting of the unused medication B. Dispose of the unused medication in the sink C. Store the unused of the medication in the medication cart D. Return the unused medication to the dispensing system

Answer 102

Request another nurse to witness wasting of the unused medication

Question 103

The health care provider writes a new order for a fentanyl patch to manage chronic pain experienced by a client in hospice care. The nurse is teaching the client and family members about the fentanyl patch and knows that teaching was effective when the client makes which of the following statements? Select all that apply. A. "I can soak in a hot tub to help decrease my pain." B. "I should cut up the patch before I throw it away so no one else can use it." C. "It may take up to a half day or longer for the patch to start working, the first time I use it." D. "If my pain is too great while I am on the patch, I can take a supplemental pain medication." E. "I will take the old patch off before I apply the new patch on."

Answer 103

C. "It may take up to a half day or longer for the patch to start working, the first time I use it." D. "If my pain is too great while I am on the patch, I can take a supplemental pain medication." E. "I will take the old patch off before I apply the new patch on."

Question 104

A school-age child with end-stage cancer has a continuous infusion of morphine to manage their pain. Breakthrough pain occurs and a fentanyl 'lollipop' is prescribed. Which instruction would the nurse give the child regarding the use of the lollipop when pain occurs? A. 'Chew it and then swallow every 4 hours.' B. 'Suck on it for half an hour every 6 hours.' C. 'Hold it in your cheek only until the pain is relieved.' D. 'Place it in your mouth and suck on it until it dissolves.'

Answer 104

'Hold it in your cheek only until the pain is relieved.'

Question 105

A health care provider prescribes transdermal fentanyl 25 mcg/h every 72 hours. During the first 24 hours after starting the fentanyl, the nurse recognizes the need to take which action? A. Titrate the dose until pain is tolerable. B. Manage pain with an analgesic by a different route. C. Assess the client for anticholinergic side effects. D. Instruct the client to take the medication with food.

Answer 105

Manage pain with an analgesic by a different route.

Question 106

A client using fentanyl transdermal patches for pain management in late-stage cancer dies. Which action will the hospice nurse take regarding the patch in use at the time of death? A. Tell the family to remove and dispose of the patch. B. Leave the patch in place for the mortician to remove. C. Have the family return the patch to the pharmacy for disposal. D. Remove and dispose of the patch in an appropriate receptacle.

Answer 106

Remove and dispose of the patch in an appropriate receptacle.

Question 107

The nurse understands which anesthetic medication is commonly used for short procedures on pediatric clients? A. Fentanyl B. Morphine C. Meperidine D. Hydromorphone

Answer 107

Fentanyl

Question 108

Which response would the nurse give to a client taking ibuprofen for rheumatoid arthritis who asks the nurse if acetaminophen can be substituted? A. "Yes, both are antipyretics and have the same effect." B. "Acetaminophen irritates the stomach more than ibuprofen does." C. "Acetaminophen is the preferred treatment for rheumatoid arthritis." D. "Ibuprofen has anti-inflammatory properties, and acetaminophen does not."

Answer 108

"Ibuprofen has anti-inflammatory properties, and acetaminophen does not."

Question 109

Which client statement indicates that teaching about acetaminophen is effective? A. "I can drink beer with this but not wine." B. "I need to limit my intake of acetaminophen to 650 mg a day." C. "I should take an emetic if I accidentally overdose on acetaminophen." D. "I have to be careful about which over-the-counter cold preparations I take."

Answer 109

"I have to be careful about which over-the-counter cold preparations I take."

Question 110

Which medication is safest to take for pain in the week before a surgical procedure? A) Naproxen B. Aspirin C. Ketorolac D. Acetaminophen

Answer 110

Acetaminophen

Question 111

A client takes acetaminophen routinely. The nurse will advise the client to avoid which substance? A. Alcohol B. Caffeine C. Diphenhydramine D. Ibuprofen

Answer 111

Alcohol

Question 112

When assessing an adolescent who recently overdosed on acetaminophen (Tylenol), it is most important for the nurse to assess for pain in which area of the body? A. Flank. B. Abdomen. C. Chest. D. Head.

Answer 112

Abdomen

Question 113

A nurse has administered acetaminophen for pain relief to an infant. Based on the client’s development stage, which action is most important to include in the medication administration record? A. The dose administered based on the client weight B. The client pain level after administration of the medication C. The time the dose was administered to the client D. The client vital signs before the medication was administered

Answer 113

The dose administered based on the client weight

Question 114

A client with a history of osteoporosis and vertebral compression has been coming to the clinic more frequently for prescription refills of hydrocodone/acetaminophen. Which inference will the nurse make? A. The half-life of the medication has decreased. B. An idiosyncratic reaction has occurred. C. Higher doses are needed to achieve pain relief. D. An emotional dependence on the medication has developed.

Answer 114

Higher doses are needed to achieve pain relief.

Question 115

In which time frame would the nurse advise a client with a long leg cast for a fractured bone to take the prescribed as-needed oxycodone? A. Just as a last resort B. Before going to sleep C. As the pain becomes intense D. When the discomfort begins

Answer 115

When the discomfort begins

Question 116

A client takes oxycodone every 3 hours for pain after surgery. Which actions would the nurse take before administering each dose of oxycodone? Select all that apply. One, some, or all responses may be correct. A. Count the client’s respiratory rate. B. Examine the client for petechiae. C. Observe the client for movement disorders. D. Ask the client to rate the level of pain. E. Assess the client’s level of consciousness.

Answer 116

A. Count the client’s respiratory rate. D. Ask the client to rate the level of pain. E. Assess the client’s level of consciousness.

Question 117

A hospice client who has severe pain asks for another dose of oxycodone. Which consideration is the nurse’s primary concern when responding to the client’s request? A. Prevent addiction. B. Determine why the medication is needed. C. Provide alternative comfort measures. D. Reduce the client’s pain.

Answer 117

Reduce the client’s pain.

Question 118

A client is prescribed controlled-release oxycodone. Which dosing schedule is best for the nurse to teach the client? A. As needed. B. Every 12 hours. C. Every 24 hours. D. Every 4 to 6 hours.

Answer 118

Every 12 hours.

Question 119

A nurse is evaluating a client who was prescribed 30 mg of codeine after oral surgery. Which assessment finding indicates the expected outcome of the medication? A. Normoactive bowel sounds B. Absence of pain C. Decreased cough reflex D. Normal respiratory rate

Answer 119

Absence of pain

Question 120

A postoperative client has a prescription for acetaminophen with codeine for pain relief. The nurse understands which action to be the primary purpose of this drug combination? A. Enhanced pain relief B. Faster onset of action C. Prevents tolerance D. Minimized side effects

Answer 120

Enhanced pain relief

Question 121

The nurse is providing care for a client after surgery. The client has an order for acetaminophen with codeine. The client asks the nurse what to expect after taking this medication. Which is the best response by the nurse? A. "This combination medication will better help to manage your pain." B. "The combination medication will reduce the chance of addiction." C. "This medication will minimize any side effects from the codeine." D. "This medication combination will allow healing to occur faster."

Answer 121

"This combination medication will better help to manage your pain."

Question 122

A client recovering from hip replacement surgery is taking acetaminophen with codeine every three hours for pain. For which side effect should the nurse monitor the client? A. Constipation B. Wheezing C. Diffuse rash D. Hyperglycemia

Answer 122

Constipation

Question 123

Which medication is indicated for management of clinical manifestations associated with an opioid overdose? A. Naloxone B. Methadone C. Epinephrine D. Amphetamine

Answer 123

Naloxone

Question 124

Which mechanism of action explains why naloxone is administered for a heroin overdose? A. Competition with opioids for occupancy of opioid receptors B. Blunts severity of withdrawal symptoms as heroin wears off C. Accelerated metabolism of heroin and stimulation of respiratory centers D. Stimulation of cortical sites that control consciousness and cardiovascular function

Answer 124

Competition with opioids for occupancy of opioid receptors

Question 125

Naloxone effectively reverses a client’s respiratory depression from an overdose of heroin. Which rationale explains why the nurse will continue to closely monitor this client’s status? A. Naloxone and herioin can cause cardiac depression when combined. B. The medication may cause peripheral neuropathy. C. Symptoms of the heroin overdose may return after the naloxone is metabolized. D. Hyperexcitability and amnesia may cause the client to thrash about and become injured.

Answer 125

Symptoms of the heroin overdose may return after the naloxone is metabolized.

Question 126

The healthcare provider prescribes naloxone (Narcan) for a client in the emergency room. Which assessment data would indicate that the naloxone has been effective? A. A client's statement that the chest pain is better. B. Respiratory rate is 16 breaths/minute. C. Seizure activity has stopped temporarily. D. Pupils are constricted bilaterally.

Answer 126

Respiratory rate is 16 breaths/minute.

Question 127

A child with juvenile idiopathic arthritis is prescribed nonsteroidal anti-inflammatory drug (NSAID) therapy at home. Which important toxic effect of NSAIDs would the nurse include in discharge instructions to the child and family? A. Diarrhea B. Hypothermia C. Blood in the urine D. Increased irritability

Answer 127

Blood in the urine

Question 128

The client is using nonsteroidal anti-inflammatory drugs (NSAIDs) to manage arthritis pain. The nurse should caution the client about which potential side effect? A. Urinary incontinence B. Nystagmus C. Constipation D. Occult bleeding

Answer 128

Occult bleeding

Question 129

The nurse is teaching a group of clients diagnosed with arthritis about the use of non-steroidal anti-inflammatory agents (NSAIDs). In order to minimize side effects of these drugs, which action should the nurse emphasize? A. Eat a diet high in fiber B. Limit foods high in Vitamin K C. Take the medication with food D. Take the drug with an antacid

Answer 129

Take the medication with food

Question 130

A nurse is preparing to administer indomethacin to a client with acute pain. Which medication on the client’s medical record will prompt the nurse to monitor the client more frequently? A. Pantoprazole B. Warfarin C. Simvastatin D. Alprazolam

Answer 130

Warfarin

Question 131

A nurse is assessing a client who takes prescribed oral indomethacin. Which client statement indicates an intended response to the medication? A. My appetite is greater in the mornings B. I am able to rotate my wrists without pain C. I no longer have to urinate in the middle of the night D. My endurance while exercising has improved

Answer 131

I am able to rotate my wrists without pain

Question 132

A nurse is evaluating a client who takes naproxen for pain associated with osteoarthritis. Which documented statement indicates the expected outcome was met? A. Decreased erythema noted to joints B. Muscle strength 3/5 to lower extremities C. Client observed with steady gait upon ambulation D. Deep tendon reflexes +3

Answer 132

Client observed with steady gait upon ambulation

Question 133

The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with osteoarthritis of the hands. The client tells the nurse that the drug does not seem to be effective after three weeks. Which is the best response for the nurse to provide? A. The frequency of the dosing is necessary to increase the effectiveness. B. Therapeutic blood levels of this drug are reached in 4 to 6 weeks. C. Another type of nonsteroidal antiinflammatory drug may be indicated. D. Systemic corticosteroids are the next drugs of choice for pain relief.

Answer 133

Another type of nonsteroidal antiinflammatory drug may be indicated.

Question 134

The nurse is educating a client about newly prescribed alprazolam. Which information should the nurse include in the teaching? A. Tardive dyskinesia is common early in treatment. B. Administration of paroxetine may be needed to prevent adverse effects. C. The use of grapefruit juice should be avoided. D. Hyperactivity is seen with long-term use.

Answer 134

The use of grapefruit juice should be avoided.

Question 135

A client has been taking alprazolam for three days. For which expected effect of the medication should the nurse evaluate the client? A. The client reports sleeping through the night. B. The client reports feeling less depressed. C. The client denies having auditory hallucinations. D. The client denies having suicide ideation.

Answer 135

The client reports sleeping through the night.

Question 136

The nurse is providing discharge education to a client who is prescribed alprazolam for a panic disorder. What concept should the nurse emphasize concerning the drug action? A. Short-term relief can be expected B. The medication acts as a stimulant C. The medication works by suppressing dopamine D. If you miss a dose, double the next scheduled dose

Answer 136

Short-term relief can be expected

Question 137

The nurse is caring for a client who was prescribed alprazolam. When educating the client about the new medication, which intended effect should the nurse include? A. Reduce anxiety and provide a calming effect B. Increase coordination and the ability to concentrate C. Alleviate signs and symptoms of spasticity D. Reduce symptoms of depression

Answer 137

Reduce anxiety and provide a calming effect

Question 138

A client is prescribed the benzodiazepine alprazolam for the management of panic attacks. Which action by the patient makes the nurse confident that the medication information discussed has been understood? A. The client removes the pepperoni from a pizza. B. The client asks for an extra bottle of flavored water to drink with dinner. C. The client requests a prescription for oral contraceptives before being discharged. D. The client states that chewable antacids may be taken to relieve heartburn.

Answer 138

The client requests a prescription for oral contraceptives before being discharged.

Question 139

Which statement about benzodiazepines requires correction? A. They are indicated for ethanol withdrawal. B. These medications increase the activity of gamma-aminobutyric acid. C. Benzodiazepines are the first-line medications used in chronic anxiety disorders. D. These medications depress activity in the brainstem.

Answer 139

These medications increase the activity of gamma-aminobutyric acid.

Question 140

Which manifestation is an adverse effect of intravenous lorazepam? Select all that apply. One, some, or all responses may be correct. A. Amnesia B. Drowsiness C. Sleep driving D. Blurred vision E. Respiratory depression

Answer 140

A. Amnesia B. Drowsiness C. Sleep driving D. Blurred vision E. Respiratory depression

Question 141

A primary health care provider prescribes 0.25 mg of alprazolam by mouth three times a day for a client with anxiety and physical symptoms related to work pressures. Which side effect of this medication will the nurse monitor for in this client? A. Drowsiness B. Bradycardia C. Agranulocytosis D. Tardive dyskinesia

Answer 141

Drowsiness

Question 142

A client has been robbed, beaten, and sexually assaulted. The primary health care provider prescribes 0.25 mg of alprazolam for agitation. Which event would alert the nurse to administer this medication? A. The client’s crying increases. B. The client requests something to calm her. C. The nurse determines a need to reduce her anxiety. D. The primary health care provider is getting ready to perform a vaginal examination.

Answer 142

The client requests something to calm her.

Question 143

The nurse provides care for a client with a long history of alcohol abuse. Which medication would the nurse anticipate will be prescribed for the client to prevent symptoms of withdrawal? A. Lorazepam B. Phenobarbital C. Chlorpromazine D. Disulfiram

Answer 143

Lorazepam

Question 144

A client is prescribed alprazolam. Which action must the nurse include in the client assessment during the initiation of therapy? A. Measure the client’s urine output. B. Examine the client’s pupils daily. C. Check the client’s blood pressure. D. Assess the abdomen for distention.

Answer 144

Check the client’s blood pressure.

Question 145

Which medication would the nurse expect to administer to actively reverse the overdose sedative effects of benzodiazepines? A. Lithium B. Flumazenil C. Methadone D. Chlorpromazine

Answer 145

Flumazenil

Question 146

Which rationale explains why the nurse would question a benzodiazepine prescription for an individual experiencing acute grief? A. The depression is magnified, and the risk of suicide increases. B. Brain activity is suppressed, and the risk of depression increases. C. Lethargy results, and it prevents a return to interpersonal activity. D. The period of denial is extended, and the grieving process is suppressed.

Answer 146

The period of denial is extended, and the grieving process is suppressed.

Question 147

Which finding would the nurse report to the health care provider when caring for a client prescribed temazepam at bedtime? A. Anxiety B. Drowsiness C. Sleep driving D. Morning headache

Answer 147

Sleep driving

Question 148

A client has completed therapy and requests to discontinue treatment with benzodiazepines. Which information would the nurse provide to prevent injury? A. Taper dose over several months. B. Switch to using an antidepressant. C. Refrain from renewing prescription. D. Monitor for signs of increased anxiety.

Answer 148

Taper dose over several months.

Question 149

Which medication would the nurse instruct a client to avoid while taking alprazolam? Select all that apply. One, some, or all responses may be correct. A. Opioids B. Alcohol C. Barbiturates D. Antidepressants E. First-generation antipsychotics

Answer 149

A. Opioids B. Alcohol C. Barbiturates

Question 150

Which medication acts as an antidote to benzodiazepine? A. Zolpidem B. Temazepam C. Suvorexant D. Flumazenil

Answer 150

Flumazenil

Question 151

Which class of medication would the nurse anticipate preparing to administer to a client with alcohol dependence admitted to a detoxification unit? A. Opiate B. Antipsychotic C. Antidepressant D. Benzodiazepine

Answer 151

Benzodiazepine

Question 152

Which medications would the nurse identify as commonly used as an adjunct during conscious sedation for minor surgeries? A. Diazepam B. Midazolam C. Lorazepam D. Clonazepam

Answer 152

Midazolam

Question 153

Which administration guidelines would the nurse follow when administering midazolam to an older client? A. The increments should be smaller, and the rate of injection should be slower. B. The medication should be given as a rapid intravenous push. C. It is important to monitor for spikes in blood pressure elevation during administration. D. During the procedure, the medication should be given as needed for pain management.

Answer 153

The increments should be smaller, and the rate of injection should be slower.

Question 154

Which primary anxiolytic medication would the nurse anticipate developing a teaching plan for when a client with social anxiety disorder has a history of exhibiting an intense, irrational fear of being scrutinized by others? Select all that apply. One, some, or all responses may be correct. A. Sertraline B. Paroxetine C. Alprazolam D. Venlafaxine E. Clonazepam

Answer 154

C. Alprazolam E. Clonazepam

Question 155

Which sedative-hypnotics would the nurse identify as being used to treat insomnia associated with a panic disorder? Select all that apply. One, some, or all responses may be correct. A. Phenelzine B. Paroxetine C. Alprazolam D. Imipramine E. Clonazepam

Answer 155

C. Alprazolam E. Clonazepam

Question 156

Which medication would the nurse anticipate developing a teaching plan for when a client reports becoming panicked and having an irrational fear of talking in public? A. Buspirone B. Alprazolam C. Diazepam D. Lorazepam

Answer 156

Alprazolam

Question 157

Which primary reason identifies why oxazepam is given during detoxification? A. Prevents injury when seizures occur B. Enables the client to sleep better during periods of agitation C. Encourages the client to accept treatment for alcoholism D. Minimizes withdrawal symptoms the client may experience

Answer 157

Minimizes withdrawal symptoms the client may experience

Question 158

Diazepam is administered to the client with status epilepticus. In addition to decreasing central neuronal activity, which effect would the nurse anticipate? A. Relaxing of peripheral muscles B. Decreased heart rate C. Dilation of airways D. Hypertension

Answer 158

Relaxing of peripheral muscles

Question 159

The client wants to know why midazolam will be administered preoperatively. Which reason would the nurse provide? A. It reduces pain. B. It induces sedation. C. It prevents respiratory depression. D. It limits oral secretions.

Answer 159

It induces sedation.

Question 160

A client has a tonic-clonic seizure. The nurse anticipates that the health care provider will prescribe the intravenous administration of which medication? A. Naloxone B. Diazepam C. Epinephrine HCl D. Atropine

Answer 160

Diazepam

Question 161

A client is treated with lorazepam for status epilepticus. Which effect of lorazepam is the reason it is given? A. Decreases anxiety associated with seizures B. Promotes rest after the seizure episode C. Depresses the central nervous system (CNS) D. Provides amnesia for the convulsive episode

Answer 161

Depresses the central nervous system (CNS)

Question 162

For which therapeutic effect will the nurse monitor the client who is prescribed alprazolam? A. Pain relief B. Decreased anxiety C. Reduction in dysrhythmias D. Reduced blood pressure

Answer 162

Decreased anxiety

Question 163

Which concern will the nurse keep in mind when a client has been taking a benzodiazepine? A. Rebound insomnia may occur if the medication is discontinued abruptly. B. Lifelong treatment is often required. C. Higher doses are needed to accommodate physiological changes during pregnancy. D. These medications have both analgesic and antidepressant properties.

Answer 163

Rebound insomnia may occur if the medication is discontinued abruptly.

Question 164

An 18-month-old toddler is being treated with intravenous diazepam every 4 hours for generalized tetanus. Which response to the medication would the nurse anticipate? A. Control of hypertonicity and prevention of seizures B. Control of laryngospasms and neck and jaw rigidity C. Prevention of excess oxygen and caloric expenditure D. Prevention of restlessness and resistance to assisted ventilation

Answer 164

Control of hypertonicity and prevention of seizures

Question 165

The health care provider prescribes alprazolam 5 mg by mouth three times a day for a client with anxiety. Which intervention will the nurse take before administering this prescription? A. Assess the apical pulse. B. Check the blood pressure. C. Encourage the ventilation of feelings. D. Clarify the prescription with the health care provider.

Answer 165

Clarify the prescription with the health care provider.

Question 166

In addition to hydration, parenteral lorazepam is prescribed for a client during alcohol withdrawal delirium. Which primary purpose accurately explains why this medication is given during detoxification? A. To prevent injury when seizures occur B. To enable the client to sleep better during periods of agitation C. To reduce the anxiety tremor state and prevent more serious withdrawal symptoms D. To calm the client and promote acceptance of the treatment plan

Answer 166

To reduce the anxiety tremor state and prevent more serious withdrawal symptoms

Question 167

An antianxiety medication is prescribed for an extremely anxious client. The client states, 'I’m afraid to take this medication because I heard it’s addictive.' Which response by the nurse is most appropriate? A. 'This medication rarely causes dependence when the dosage is controlled.' B. 'You may require increases in your dosage; however, it rarely causes dependence.' C. 'It usually results in psychological but not physiological dependence.' D. 'The medication has the potential for physiological and psychological dependence.'

Answer 167

'The medication has the potential for physiological and psychological dependence.'

Question 168

Which common side effect will the nurse address in the care plan of a client with cancer receiving the plant alkaloid vincristine? A. Color-blindness B. Anuria C. Constipation D. Hyperphosphatemia

Answer 168

Constipation

Question 169

Which toxic effect would a nurse monitor for in a client who is prescribed vincristine? A. Peripheral paresthesia B. Anginal-type chest pain C. Ophthalmic papilledema D. Bilateral crackles in the lung

Answer 169

Peripheral paresthesia

Question 170

Which laboratory test result would alert the nurse that fluid intake would need to be increased in a child receiving vincristine? A. Urine pH of 6 B. Urine specific gravity of 1.020 C. Blood uric acid level of 7.5 mg/dL D. Blood urea nitrogen level of 15 mg/dL

Answer 170

Blood uric acid level of 7.5 mg/dL

Question 171

The nurse is caring for a child who is receiving vincristine. Which body systems are most important for the nurse to assess after medication administration? Select all that apply. One, some, or all responses may be correct. A. Respiratory B. Neurological C. Reproductive D. Hematologic E. Gastrointestinal

Answer 171

B. Neurological D. Hematologic E. Gastrointestinal

Question 172

Which side effect would the nurse assess for in a child receiving vincristine? A. Hemolytic anemia B. Irreversible alopecia C. Hyperglycemia D. Neurological complications

Answer 172

Neurological complications

Question 173

An adolescent with leukemia is receiving vincristine. The mother reports that the child is complaining of feeling 'tingles' all over. Which response by the nurse is most appropriate regarding the effect of this medication? A. 'It is a neurological side effect.' B. 'It is caused by an autoimmune reaction.' C. 'The skin becomes sensitive with chemotherapy.' D. 'The central nervous system has become hyperactive.'

Answer 173

'It is a neurological side effect.'

Question 174

An adolescent who has been prescribed prednisone and vincristine for leukemia tells the nurse that he is constipated. Which reason would the nurse cite as the probable cause of the constipation? A. It is a side effect of the vincristine. B. The spleen is compressing the bowel. C. It is a toxic effect from the prednisone. D. The leukemic mass is obstructing the bowel.

Answer 174

It is a side effect of the vincristine.

Question 175

A school-age child diagnosed with acute lymphocytic leukemia (ALL) becomes constipated after receiving induction therapy with prednisone, vincristine, and asparaginase. Which would the nurse suspect as the cause? A. Diet, which lacks bulk B. Inactivity, which results from illness C. Vincristine, which decreases peristalsis D. Prednisone, which causes gastric irritability

Answer 175

Vincristine, which decreases peristalsis

Question 176

A client with Hodgkin's disease is to receive the cyclic antineoplastic vincristine as part of a therapy protocol. Which mechanism of action would the nurse associate with this medication? A. Arresting mitosis in metaphase B. Inhibiting the synthesis of thymidine C. Alkylating nucleic acids needed for mitosis D. Inactivating DNA while inhibiting RNA synthesis

Answer 176

Arresting mitosis in metaphase

Question 177

To minimize the side effects of the vincristine that a client is receiving, which diet would the nurse advise? A. Low in fat B. High in iron C. High in fluids D. Low in residue

Answer 177

High in fluids

Question 178

A client with leukemia who is receiving vincristine reports lower leg numbness. Which statement about vincristine explains this occurrence? A. Vincristine acts on enlarged lymph nodes in the groin. B. Vincristine affects peripheral vascular circulation. C. Vincristine increases the risk for vascular occlusion. D. Peripheral neuropathies can result from vincristine chemotherapy.

Answer 178

Peripheral neuropathies can result from vincristine chemotherapy.

Question 179

An adolescent is to begin a chemotherapeutic medication regimen. Which side effect of vincristine is most important for the nurse to prepare the adolescent to expect? A. Alopecia B. Constipation C. Loss of appetite D. Peripheral neuropathy

Answer 179

Alopecia

Question 180

A school-age child with leukemia is receiving treatment with vincristine. Which toxic response would the nurse assess the child for? A. Diarrhea B. Alopecia C. Hemorrhagic cystitis D. Peripheral neuropathy

Answer 180

Peripheral neuropathy

Question 181

A nurse is administering vincristine to a client with cancer. The client asks the nurse how the medication works. Which statement by the nurse is appropriate? A. It stops the synthesis of proteins in cancer cells B. It prevents cell division of cancer cells C. It interrupts the S-phase of cancer cell reproduction D. It alters the DNA structure of cancer cells

Answer 181

It prevents cell division of cancer cells

Question 182

The oncology nurse is preparing to administer the initial dose of vincristine to a child diagnosed with acute lymphocytic leukemia. Which interventions should the nurse include in the plan of care? Select all that apply. A. Apply pressure to the injection site if extravasation occurs. B. Monitor liver function tests regularly. C. Monitor for numbness or tingling in the fingers and toes. D. Select the appropriate catheter for intrathecal administration. E. Verify blood return before, during and after intravenous administration.

Answer 182

B. Monitor liver function tests regularly. C. Monitor for numbness or tingling in the fingers and toes. E. Verify blood return before, during and after intravenous administration.

Question 183

A client is receiving ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) therapy for Hodgkin's disease. When the client reports burning and tingling of the feet, which medication would the nurse determine is the likely cause? A. Neurotoxicity caused by vinblastine B. Hypersensitivity caused by dacarbazine C. Endocrine alterations caused by doxorubicin D. Peripheral vasoconstriction caused by bleomycin

Answer 183

Neurotoxicity caused by vinblastine

Question 184

A child receiving methotrexate and undergoing cranial radiation is very weak. The mother asks the nurse if she should give her child vitamins. Which response by the nurse is most appropriate? A. 'That’s an excellent idea. I’ll try to get a prescription for her.' B. 'Unfortunately, vitamins won’t make her feel any better now.' C. 'That won’t be possible. Vitamins interfere with the action of methotrexate.' D. 'After we receive the laboratory reports, your daughter will be getting vitamins.'

Answer 184

'That won’t be possible. Vitamins interfere with the action of methotrexate.'

Question 185

The nurse considers that the safe administration of high-dose methotrexate therapy would include which intervention? A. Maintaining an acidic urine B. Restricting intravenous fluids C. Providing a diet high in folic acid D. Monitoring plasma levels of the medication

Answer 185

Monitoring plasma levels of the medication

Question 186

A client with lymphosarcoma is receiving allopurinol and methotrexate. The nurse can help the client prevent complications related to uric acid nephropathy by administering which medication in relation to which changes in fluid intake? A. Allopurinol and restricting the fluid intake B. Methotrexate and restricting fluid intake C. Allopurinol and encouraging increased fluid intake D. Methotrexate and encouraging increased fluid intake

Answer 186

Allopurinol and encouraging increased fluid intake

Question 187

Leucovorin calcium is prescribed and is to be administered immediately after an infusion of methotrexate. Which result of laboratory testing indicates that leucovorin has been effective? A. Potassium level normalizes B. Folic acid level within normal limits C. Improved white blood cell count D. Decreased methotrexate level

Answer 187

Decreased methotrexate level

Question 188

A client with cancer is receiving leucovorin as part of a chemotherapy protocol. Which purpose does leucovorin serve? A. Potentiating the effect of alkylating agents B. Diminishing toxicity of folic acid antagonists C. Limiting vomiting associated with chemotherapy D. Preventing alopecia

Answer 188

Diminishing toxicity of folic acid antagonists

Question 189

The parent of a toddler taking methotrexate asks the nurse whether the child should be started on vitamin supplements. Which statement by the nurse is appropriate? A. 'That’s a fine suggestion, and I’ll ask for a prescription.' B. 'Vitamin supplements won’t help him feel any better right now.' C. 'He’ll benefit from a vitamin supplement and will be getting it soon.' D. 'Supplements that contain folic acid interfere with the effectiveness of chemotherapy.'

Answer 189

'Supplements that contain folic acid interfere with the effectiveness of chemotherapy.'

Question 190

A nurse is reviewing laboratory data prior to administering methotrexate to a client with breast cancer. Which clinical finding will the nurse report to the healthcare provider before administering the medication? A. ALT of 55 IU/mL B. WBC of 12,000/mm³ C. AST of 34 U/L D. HGB of 11.5 g/dL

Answer 190

ALT of 55 IU/mL

Question 191

A nurse is teaching a parent how to administer oral iron supplements to a 2-year-old child. Which intervention should be included in the teaching? A. Stop the medication if the stools become tarry green B. Add the medicine to a bottle of formula C. Give the medicine with orange juice and through a straw D. Administer the iron with your child's meals

Answer 191

Give the medicine with orange juice and through a straw

Question 192

A client with anemia has a new prescription for ferrous sulfate. When teaching the client about diet and iron supplements, what should the nurse emphasize about taking an iron supplement? A. Lie down for about 10 minutes after taking the pill B. Take the iron tablet with a glass of orange juice C. Take an antacid with the iron supplement to reduce stomach upset D. Take the iron tablet with a glass of low-fat milk

Answer 192

Take the iron tablet with a glass of orange juice

Question 193

The nurse receives an order to administer intravenous (IV) iron sucrose to a client with anemia. Which statement best describes the purpose of administering this medication using the IV route? A. To ensure that the entire dose of medication is given B. To prevent the drug from causing tissue irritation C. To provide more even distribution of the drug D. To enhance absorption of the medication

Answer 193

To prevent the drug from causing tissue irritation

Question 194

A client is being discharged with a prescription for an iron supplement. Which client statement indicates the need for further teaching by the nurse? A. "I will have greenish-black stools from the medication." B. "I will not take antacids with my iron supplement." C. "I will take the iron supplement with a full glass of milk." D. "I will take vitamin C along with the iron supplement."

Answer 194

"I will take the iron supplement with a full glass of milk."

Question 195

A client with severe iron-deficiency anemia is prescribed a parenteral form of iron. Which intervention does the nurse prepare to implement before administering the medication? A. Obtain the client's vital signs. B. Use the Z-track administration method. C. Administer a small test dose. D. Obtain informed consent.

Answer 195

Administer a small test dose.

Question 196

A 3-year-old child is prescribed a liquid iron preparation. The nurse would include which intervention when teaching the parent about the administration of this medication? A. 'Monitor the stools for diarrhea.' B. 'Administer with meals to improve absorption.' C. 'Avoid giving the child orange juice with the iron preparation.' D. 'Have the child drink the diluted iron preparation through a straw.'

Answer 196

'Have the child drink the diluted iron preparation through a straw.'

Question 197

Which information would the nurse include when teaching parents about the side effects of iron supplements? A. The urine may turn red. B. The skin will turn yellow. C. The teeth may become stained. D. The stools will take on a clay color.

Answer 197

The teeth may become stained.

Question 198

Which technique would the nurse use to administer ferrous sulfate to a 12-month-old infant? A. Through a straw B. Crushed in applesauce C. In an intramuscular injection D. Syringe directed toward the back of the mouth

Answer 198

Syringe directed toward the back of the mouth

Question 199

Parents of a child with sickle cell anemia ask about their child taking iron supplements to help treat the anemia. How will the nurse respond? A. Taking supplements will not help with this condition. B. It is advised that iron be taken with orange juice to aid in absorption. C. An over-the-counter multivitamin with iron should meet the needs of the child. D. It is advised that liquid iron supplements be given through a straw to prevent staining the teeth.

Answer 199

Taking supplements will not help with this condition.

Question 200

A client with upper gastrointestinal (GI) bleeding develops mild anemia. Which agent is indicated for treatment of this condition? A. Dextran B. Iron salts C. Vitamin B 12 D. Erythropoietin

Answer 200

Iron salts

Question 201

A client is receiving epoetin for the treatment of anemia associated with chronic renal failure. Which client statement indicates to the nurse that further teaching about this medication is necessary? A. 'I realize it is important to take this medication because it will cure my anemia.' B. 'Because I am at risk for seizures, I need to avoid hazardous activities.' C. 'I recognize that I may still need blood transfusions if my hemoglobin is very low.' D. 'I understand that I will still have to take supplemental iron therapy with this medication.'

Answer 201

'I realize it is important to take this medication because it will cure my anemia.'

Question 202

Which drink would the nurse instruct a client with iron deficiency anemia to choose to drink with the supplement for efficient absorption? A. Water B. Skim milk C. Orange juice D. A strawberry milkshake

Answer 202

Orange juice

Question 203

The nurse would counsel a pregnant client to take her iron supplement at which time of the day for efficient absorption? A. Bedtime B. After lunch C. Dinnertime D. Before breakfast

Answer 203

Before breakfast

Question 204

The nurse instructs a postpartum client on the administration of an iron supplement. Which drink selected by the client indicates the teaching was effective? A. Milk B. Water C. Cream soda D. Cranberry juice

Answer 204

Cranberry juice

Question 205

Which action would the nurse take when administering iron dextran? A. Use a transdermal needle. B. Massage the injection site. C. Use the Z-track method. D. Apply a local anesthetic first.

Answer 205

Use the Z-track method.

Question 206

A 9-month-old infant with iron-deficiency anemia has been getting supplements but shows no improvement. The nurse recognizes which action by the parents as the reason for the lack of improvement? A. Administering iron supplements through a straw B. Administering iron supplements with whole cow’s milk C. Administering iron supplements along with orange juice D. Administering iron supplements at the back of the mouth

Answer 206

Administering iron supplements with whole cow’s milk

Question 207

A child with iron-deficiency anemia is prescribed oral iron therapy. Anticipatory guidance regarding which side effect would the nurse provide? A. Bloody stool B. Orange urine C. Greenish-black stool D. Staining of the mouth

Answer 207

Greenish-black stool

Question 208

Which instructions would the nurse include when teaching parents how to administer liquid iron to their child? Select all that apply. One, some, or all responses may be correct. A. Protect the child from sunlight. B. Administer the medication with food. C. Anticipate that stools tend to be blackish-green. D. Give the medication with a glass of orange juice. E. Have the child drink it through a straw.

Answer 208

Anticipate that stools tend to be blackish-green. Give the medication with a glass of orange juice. Have the child drink it through a straw.

Question 209

Which nursing care will be included for a client who is receiving doxorubicin for acute myelogenous leukemia? A. Increasing citrus foods B. Providing frequent oral hygiene C. Encouraging activity D. Administering medications parenterally

Answer 209

Providing frequent oral hygiene

Question 210

Which clinical finding indicates that doxorubicin toxicity may have occurred? A. Fever B. Blue tinge to the urine C. Alteration in cardiac rhythm D. Increasing anxiety

Answer 210

Alteration in cardiac rhythm

Question 211

A 5-year-old child is receiving dactinomycin and doxorubicin therapy after nephrectomy for Wilms tumor. Which intervention would the nurse include when planning care? A. Adding citrus juices to meals B. Offering warm saline mouthwash C. Scheduling booster immunizations D. Reporting red-orange colored urine

Answer 211

Offering warm saline mouthwash

Question 212

A child with Wilms tumor is prescribed doxorubicin hydrochloride. Which common side effect unique to doxorubicin would the nurse expect to observe in the child? A. Hair loss B. Vomiting C. Red urine D. Stomatitis

Answer 212

Red urine

Question 213

A child is prescribed dactinomycin and doxorubicin therapy after a nephrectomy for Wilms tumor. Which intervention would the nurse include in the plan of care? A. Administering aspirin for pain B. Offering citrus juices with meals C. Ensuring meticulous oral hygiene D. Eliminating spicy foods from the diet

Answer 213

Ensuring meticulous oral hygiene

Question 214

A client receives doxorubicin as part of a chemotherapy protocol. The nurse would assess the client for signs and symptoms of which adverse effect? A. Toxic epidermal necrolysis B. Heart failure C. Pulmonary fibrosis D. Ototoxicity

Answer 214

Heart failure

Question 215

A client is receiving chemotherapy with doxorubicin. Which development will the nurse teach the client to report immediately? A. Nausea B. Sore throat C. Loss of hair D. Constipation

Answer 215

Sore throat

Question 216

A client with stage III Hodgkin's disease is started on a multiple-drug regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine. Why are so many drugs necessary? A. Using smaller doses of several drugs reduces the likelihood of serious side effects. B. Each drug destroys the cancer cell at a different time in the cell cycle. C. Several drugs are used to destroy cells that are not susceptible to radiation therapy. D. Because there are stages of Hodgkin's disease, if one drug is ineffective, another will work.

Answer 216

Each drug destroys the cancer cell at a different time in the cell cycle.

Question 216

A client with Hodgkin's disease adds doxorubicin to current therapy. Which advice will the nurse provide about this medication? A. Cease taking any medication that contains vitamin D. B. Keep the doxorubicin in a dark place protected from light. C. Expect urine to turn red for a few days after taking this medication. D. Take the doxorubicin on an empty stomach with large amounts of fluids.

Answer 216

Expect urine to turn red for a few days after taking this medication.

Question 217

A client receives doxorubicin infusions for treatment of acute lymphocytic leukemia. Which clinical finding indicates that toxicity has occurred? A. Alopecia B. Dyspnea C. Metallic taste to food D. Cardiac rhythm abnormalities

Answer 217

Cardiac rhythm abnormalities

Question 217

A client is receiving doxorubicin as part of a chemotherapy protocol. The nurse will assess the client for which system toxicity? A. Neurotoxicity B. Cardiotoxicity C. Ototoxicity D. Nephrotoxicity

Answer 217

Cardiotoxicity

Question 218

A client diagnosed with breast cancer is prescribed doxorubicin. Which assessment finding would the nurse recognize as a toxic effect of this medication? A. Paralytic ileus B. Red-tinged urine C. Cardiac dysrhythmias D. Increased serum magnesium

Answer 218

Cardiac dysrhythmias

Question 218

A client with adenocarcinoma receives doxorubicin intravenously (IV) to reduce the tumor mass. Which clinical finding indicates that doxorubicin toxicity may have occurred? A. Fever B. Blue tinge to the urine C. Alteration in cardiac rhythm D. Increasing anxiety

Answer 218

Alteration in cardiac rhythm

Question 219

A client receiving doxorubicin (Adriamycin) intravenously (IV) complains of pain at the insertion site, and the nurse notes edema at the site. Which intervention is most important for the nurse to implement? A. Assess for erythema. B. Administer the antidote. C. Apply warm compresses. D. Discontinue the IV fluids.

Answer 219

Discontinue the IV fluids.

Question 219

Which anticipatory guidance would the nurse include when teaching an adolescent about side effects of dactinomycin and doxorubicin therapy? A. Wear a baseball cap. B. Eat three meals daily. C. Avoid dairy products. D. Dress in light clothing.

Answer 219

Wear a baseball cap.

Question 220

A nurse is preparing to administer doxorubicin to a client with bladder carcinoma. How will the nurse prepare this medication? A. While wearing sterile gloves B. In a biological safety cabinet C. Inside a temperature-controlled room D. By withdrawing into a syringe undiluted

Answer 220

In a biological safety cabinet

Question 221

The alkylating agent cyclophosphamide is prescribed for a school-age child with cancer. Which clinical manifestation would the nurse be alert for while the child is receiving this medication? A. Irritability B. Pain with urination C. Unpredictable nausea D. Hyperplasia of the gums

Answer 221

Pain with urination

Question 222

A nurse is preparing to administer reconstituted doxorubicin (Myocet) to a client with thyroid carcinoma. Nuclear medicine calls for the client, and the nurse is unable to administer the medication. Which action should the nurse perform with the medication? A. Save the medication in a syringe with an aluminum needle B. Store the medication in the refrigerator inside the syringe C. Discard the medication in the hazardous waste container D. Add the medication to the intravenous fluids in the client room

Answer 222

Store the medication in the refrigerator inside the syringe

Question 223

Which nursing assessment is most important for a child receiving cyclophosphamide? A. Extent of alopecia B. Changes in appetite C. Hyperplasia of gums D. Daily intake and output

Answer 223

Daily intake and output

Question 224

Which intervention would the nurse include in the plan of care for a client with breast cancer who received doxorubicin and cyclophosphamide 12 days ago and now has a white blood cell (WBC) count of 1.4 cells/mm 3 and reports shortness of breath and activity intolerance? Select all that apply. One, some, or all responses may be correct. A. Use an electric razor when shaving. B. Institute neutropenic precautions. C. Place client on airborne precautions. D. Transfuse two units of packed red blood cells (RBCs). E. Instruct nursing staff to wear a dosimeter badge.

Answer 224

Institute neutropenic precautions.

Question 225

A client is prescribed epoetin injections. To ensure the client’s safety, which laboratory value would the nurse assess before administration? A. Hematocrit B. Platelet count C. Prothrombin time D. Partial thromboplastin time

Answer 225

Hematocrit

Question 226

The nurse is providing teaching to a client who has been prescribed cyclophosphamide for breast cancer treatment. Which of the following statements made by the client would indicate that additional teaching is needed? A. "I will probably need to plan on using a wig to cover my hair loss." B. "I should limit the amount of fluids I drink while taking this medication." C. "I will need to stay away from children when my white blood cell count is low." D. "I may have trouble getting pregnant due to the damaging effects of the medication."

Answer 226

"I should limit the amount of fluids I drink while taking this medication."

Question 227

Which step would the nurse include during the administration of epoetin prescribed to a client with acquired immunodeficiency syndrome (AIDS)? A. Administer the medication via the Z-track technique. B. Shake the vial before withdrawing the solution. C. Obtain the client’s pulse rate before administration. D. Use a syringe that has a 1-inch (2.5-cm), 25-gauge needle.

Answer 227

Use a syringe that has a 1-inch (2.5-cm), 25-gauge needle.

Question 228

The nurse is evaluating the results of treatment with erythropoietin. Which assessment finding indicates an improvement in the underlying condition being treated? A. 2+ pedal pulses B. Decreased pallor C. Decreased jaundice D. 2+ deep tendon reflexes

Answer 228

Decreased pallor

Question 229

Which intervention would the nurse take to improve nutrition after identifying that a client receiving chemotherapy has lost weight? Select all that apply. One, some, or all responses may be correct. A. Provide low-carbohydrate meals. B. Decrease fluid intake at mealtime. C. Encourage the intake of preferred foods. D. Promote the intake of small, frequent meals E. Administer prescribed antiemetics before meals

Answer 229

Encourage the intake of preferred foods. Promote the intake of small, frequent meals Administer prescribed antiemetics before meals

Question 230

Which information will the nurse share about alopecia characteristics to a client who is to receive chemotherapy after surgery for cancer? A. Usually rare B. Not permanent C. Frequently prolonged D. Usually preventable

Answer 230

Not permanent

Question 231

Which benefit is provided by intraarterial chemotherapy for cancer of the liver? A. It reduces systemic toxicity. B. It provides for rapid dilution of chemotherapy. C. The medication bypasses the blood–brain barrier. D. The chemotherapy is delivered to the peritoneal cavity.

Answer 231

It reduces systemic toxicity.

Question 232

Which concept is important to teach a client in relation to why medication cocktails are more effective than a single medication in cancer therapy? A. Medication resistance B. Tumor doubling time C. Cellular growth cycle D. Retained radioactive particles

Answer 232

Cellular growth cycle

Question 233

Which mechanism of action explains the ability of nitrogen mustard to interfere with growth of cancer cells? A. Interference of the cellular protein synthesis B. Inhibition of the synthesis of purine and pyrimidine C. Binding with DNA to interfere with RNA production D. Combining with DNA strands and interfering with cell replication

Answer 233

Combining with DNA strands and interfering with cell replication

Question 234

Which systemic side effect would the nurse monitor for in a client receiving combination chemotherapy for the treatment of metastatic carcinoma? A. Ascites B. Nystagmus C. Leukopenia D. Polycythemia

Answer 234

Leukopenia

Question 235

Which response would the nurse give to a client receiving chemotherapy who develops sores in the mouth and asks the nurse why this happened? A. "The sores occur because of the direct irritating effects of the medication." B. "These tissues are poorly nourished because you have a decreased appetite." C. "The frequently dividing cells of the gastrointestinal tract are damaged by the medication." D. "This side effect occurs because it targets the cells of the gastrointestinal system."

Answer 235

"The frequently dividing cells of the gastrointestinal tract are damaged by the medication."

Question 236

The nurse is assessing a child receiving chemotherapy for treatment of leukemia. Which side effect would the nurse anticipate? A. Epistaxis B. Tachycardia C. Flushed skin D. Increased temperature

Answer 236

Epistaxis

Question 237

The nurse is caring for a child with an exacerbation of leukemia. The nurse would plan to administer the prescribed analgesic for bone pain at which time? A. At scheduled intervals B. When the child asks for it C. When pain becomes severe D. Before the pain becomes severe

Answer 237

At scheduled intervals

Question 238

The nurse observes bloody expectorant after a 4-year-old child with leukemia brushed his or her teeth. Which action should the nurse take next? A. Secure a smaller toothbrush for the child to use. B. Document and report the incident. C. Tell the child to be more careful when brushing the teeth. D. Rinse the child’s mouth with half-strength hydrogen peroxide.

Answer 238

Document and report the incident.

Question 239

Chemotherapy via regional perfusion is the treatment of choice for a client’s malignant sarcoma of the liver. Which reason would the nurse provide to explain to the client why this method of medication administration probably was selected? A. Medication therapy can be continued at home with little difficulty. B. Larger doses of medications can be delivered to the actual site of the tumor. C. Toxic effects of the chemotherapeutic medications are confined to the area of the tumor. D. Combinations of medications are used to attack neoplastic cells at various stages of the cell cycle.

Answer 239

Larger doses of medications can be delivered to the actual site of the tumor.

Question 240

A client develops severe bone marrow suppression related to cancer treatment. Which instruction is important for the nurse to include in the client’s teaching? A. Be prepared to experience alopecia. B. Increase fluids to at least 3 liters per day. C. Use a soft toothbrush for oral hygiene. D. Monitor your intake and output of fluids.

Answer 240

Use a soft toothbrush for oral hygiene.

Question 241

A client is admitted to the hospital with pancytopenia as a result of chemotherapy. Which information will the nurse provide to minimize the risk for complications? A. Avoid activities that risk traumatic injuries and exposure to infection. B. Perform frequent mouth care with a firm toothbrush. C. Increase oral fluid intake to a minimum of 3 L daily. D. Report any unusual muscle cramps or tingling sensations in the extremities.

Answer 241

Avoid activities that risk traumatic injuries and exposure to infection.

Question 242

A client with laryngeal cancer is receiving chemotherapy. Which laboratory report is most important for the nurse to monitor when considering the effects of chemotherapy? A. Platelets B. Hemoglobin level C. Red blood cell count D. White blood cell count

Answer 242

White blood cell count

Question 243

A client with Hodgkin's disease is started on chemotherapy. The nurse teaches the client to notify the health care provider for which adverse response to chemotherapy? A. Hair loss B. Sores in the mouth C. Moderate diarrhea after treatment D. Nausea for 6 hours after treatment

Answer 243

Sores in the mouth

Question 244

A client is diagnosed with multiple myeloma. Which intervention would the nurse expect the plan of care to include? A. Radiotherapy on an outpatient basis B. Human leukocyte interferon therapy C. Surgery to remove the invasive lesions D. Chemotherapy employing a combination of medications

Answer 244

Chemotherapy employing a combination of medications

Question 245

The nurse administers erythropoietin three times a week to a client receiving chemotherapy for cancer. Which client response demonstrates a therapeutic effect? A. Increase in band cells B. Elevated hematocrit C. Normalization of platelets D. Increase in the white blood cell (WBC) count

Answer 245

Elevated hematocrit

Question 246

A client has surgery for the insertion of an implanted infusion port for chemotherapy. How often will the port need to be flushed when not in use? A. Every day B. Once a week C. Every month D. Twice a year

Answer 246

Every month

Question 247

A complete blood count is prescribed before each round of a client’s cancer chemotherapy. Which component of the complete blood count is of greatest concern to the nurse? A. Platelets B. Hematocrit C. Red blood cells (RBCs) D. White blood cells (WBCs)

Answer 247

White blood cells (WBCs)

Question 248

A client with multiple myeloma who is receiving the alkylating agent melphalan returns to the oncology clinic for a follow-up visit. For which adverse effect will the nurse monitor the client? A. Hirsutism B. Leukopenia C. Constipation D. Photosensitivity

Answer 248

Leukopenia

Question 249

A client is scheduled to begin chemotherapy 2 weeks after surgery for colon cancer. Which explanation would the nurse give to explain the delay after surgery? A. Chemotherapy interferes with cell growth and delays wound healing. B. Because chemotherapy causes vomiting, it endangers the integrity of the incisional area. C. Chemotherapy decreases red blood cell production, and the resultant anemia will add to postoperative fatigue. D. Chemotherapy increases edema in areas distal to the incision by blocking lymph channels with destroyed lymphocytes.

Answer 249

Chemotherapy interferes with cell growth and delays wound healing.

Question 250

A client who was admitted with a diagnosis of acute lymphoblastic leukemia is receiving chemotherapy. Which assessment findings would alert the nurse to the possible development of thrombocytopenia? Select all that apply. One, some, or all responses may be correct. A. Fever B. Diarrhea C. Melena D. Hematuria E. Ecchymosis

Answer 250

Melena Hematuria Ecchymosis

Question 251

A client receiving cancer chemotherapy asks the nurse why an antibiotic was prescribed. Which tissue affected by chemotherapy will the nurse consider when formulating a response? A. Liver B. Blood C. Bone marrow D. Lymph nodes

Answer 251

Bone marrow

Question 252

For which side effects will the nurse assess a client with cancer who is being treated with chemotherapeutic agents? Select all that apply. One, some, or all responses may be correct. A. Diarrhea B. Leukocytosis C. Bleeding tendencies D. Lowered sedimentation rate E. Increased hemoglobin levels

Answer 252

Diarrhea Bleeding tendencies

Question 253

A client receiving chemotherapy develops bone marrow suppression. The nurse will monitor for which thrombocytopenic effect? Select all that apply. One, some, or all responses may be correct. A. Deep vein thrombosis B. Melena C. Purpura D. Emboli E. Hematuria

Answer 253

Melena Purpura Hematuria

Question 254

A client is diagnosed at stage IV Hodgkin disease. Which therapy option is indicated? A. Radiation therapy B. Combination chemotherapy C. Radiation with chemotherapy D. Surgical removal of the affected nodes

Answer 254

Combination chemotherapy

Question 255

A client is receiving combination chemotherapy for the treatment of metastatic carcinoma. For which systemic side effect would the nurse monitor the client? A. Ascites B. Nystagmus C. Leukopenia D. Polycythemia

Answer 255

Leukopenia

Question 256

An adolescent is prescribed an antineoplastic agent. Which instruction would the nurse give to the parents before discharge? A. Limit contact with all peers and family members. B. Withhold medications when nausea occurs to prevent vomiting. C. Schedule laboratory blood tests to evaluate response to the medication. D. Return weekly for a bone marrow aspiration to monitor effectiveness of therapy.

Answer 256

Schedule laboratory blood tests to evaluate response to the medication.

Question 257

An adolescent with leukemia is to be given a chemotherapeutic agent. Which time is best for the nurse to administer the prescribed antiemetic? A. As nausea occurs B. An hour before meals C. Just before each meal is eaten D. Before each dose of chemotherapy

Answer 257

Before each dose of chemotherapy

Question 258

The hospice nurse is visiting a client diagnosed with end-stage lung cancer and metastases to the bone. What should the nurse keep in mind when planning for effective pain management? A. High doses of opioid analgesics will be required. B. Pain therapy is based on the client's report of pain. C. Relief of pain will be achieved quickly. D. The client will most likely become addicted.

Answer 258

Pain therapy is based on the client's report of pain.

Question 259

The nurse is developing a plan of care for a client who has developed blisters and sores in the mouth after receiving chemotherapy. Which interventions should the nurse include? Select all that apply. A. Examine your mouth frequently. B. Use strong mouthwashes to kill bacteria. C. Drink 2 or more liters of water per day. D. Suck on ice chips during chemotherapy. E. Visit a dental hygienist weekly. F. Avoid spicy or acidic foods.

Answer 259

Examine your mouth frequently. Drink 2 or more liters of water per day. Suck on ice chips during chemotherapy. Avoid spicy or acidic foods.

Question 260

The nurse is caring for a client who recently received an allogeneic bone marrow transplant for the treatment of leukemia. Which nursing intervention is a priority for this client? A. Provide education on infection prevention in the community B. Assist the client with ambulation every 2 hours C. Monitor the client for signs of infection D. Introduce the client to another bone marrow recipient

Answer 260

Monitor the client for signs of infection

Question 261

Which nursing intervention is a priority for a school-age child with lead poisoning undergoing chelation therapy? A. Scrupulous skin care B. Provision of a high-protein diet C. Careful monitoring of intake and output D. Daily blood sampling for liver function tests

Answer 261

Careful monitoring of intake and output

Question 262

Which nursing action is the priority when administering chelation therapy for a toddler? A. Assessing vital signs B. Monitoring urine output C. Conducting a behavioral assessment D. Providing education to reduce lead exposure

Answer 262

Monitoring urine output

Question 263

Which medications would the nurse plan to use when administering chelation therapy to a toddler-age client to decrease the pain associated with intramuscular administration? Select all that apply. One, some, or all responses may be correct. A. LMX-4 B. Fentanyl C. Procaine D. Ibuprofen E. Acetaminophen

Answer 263

LMX-4 Procaine

Question 264

Which side effect would the nurse anticipate in a child receiving chelation therapy? A. Hypocalcemia B. Hyperkalemia C. Hypoglycemia D. Hypernatremia

Answer 264

Hypocalcemia

Question 265

A child with plumbism is prescribed edetate calcium disodium (calcium EDTA). Which assessment would be the most appropriate for the nurse to conduct before administering EDTA? A. Reviewing laboratory results for hypocalcemia B. Checking for protein in the urine C. Looking for signs of bone marrow depression D. Monitoring for increased intracranial pressure

Answer 265

Checking for protein in the urine

Question 266

A child is treated with succimer for lead poisoning. Which of these assessments is the priority? A. Check the client's serum potassium level. B. Check the client's blood calcium level. C. Test the client's deep tendon reflexes. D. Check the client's complete blood count with differential.

Answer 266

Check the client's complete blood count with differential.

Question 267

A client who is immunosuppressed is receiving filgrastim. When monitoring effectiveness, the nurse will check for an increase in which blood component? A. Platelets B. Erythrocytes C. Lymphocytes D. White blood cells

Answer 267

White blood cells

Question 268

The nurse is reviewing the laboratory results for a client with cancer who is being treated with chemotherapy and recently started prescribed filgrastim. Which laboratory value indicates the treatment is effective? A. Hemoglobin level of 9.8 g/dL B. White blood cell count (WBC) of 5,200/mm3 C. Platelet count of 200,000/mm D. Red blood cell count (RBC) of 4 million/mm

Answer 268

White blood cell count (WBC) of 5,200/mm3