The nurse is educating a client who is newly diagnosed with angina about his newly prescribed nitroglycerin. The nurse understands that teaching is effective when the client makes which statement?
Rationale:
C: I can take up to three tablets, 5 minutes apart, under my tongue as needed for chest pain. This statement reflects the proper use of nitroglycerin, allowing effective relief from angina symptoms while adhering to safe dosing guidelines.
A: It is safe to take one dose of nitroglycerin if I am taking sildenafil. This combination poses serious risks, as both medications can cause dangerous drops in blood pressure.
B: I should chew up three tablets at once, and then call 91-1 if I still have chest pain in 15 minutes. Chewing tablets may hinder absorption, and taking three at once is unsafe.
D: I can keep the pills in a glass cup on my nightstand so I can reach them easily in an emergency. Storing nitroglycerin improperly may diminish its effectiveness, as it should be kept in its original container.
The nurse is caring for a client scheduled to receive cyclopentolate HCl preoperatively. Which finding in the client's history would prompt the nurse to notify the health care provider?
Rationale:
Cardiac dysrhythmias. Cyclopentolate HCl can cause increased heart rate and may exacerbate existing cardiac conditions, prompting the nurse to inform the healthcare provider about the potential for serious complications.
A: osteoporosis. While osteoporosis affects bone health, it does not directly interact with cyclopentolate HCl or significantly impact the medication's safety profile in this context.
B: hypothyroidism. Hypothyroidism does not present a direct contraindication for cyclopentolate HCl administration, as it primarily involves metabolic processes unrelated to the medication's action or side effects.
C: renal insufficiency. Though renal insufficiency can influence drug metabolism, cyclopentolate HCl primarily acts on the eyes, making renal function less critical in this particular medication scenario.
The night nurse is preparing to pull night medications for a client. Levofloxacin is scheduled to be given at 0030. The nurse will give this medication at which time?
Rationale:
The nurse will give this medication at 12:30 a.m. This timing is one hour prior to the scheduled administration of levofloxacin at 0030, aligning with standard practices for medication preparation and administration.
A: 1:30 a.m. This time is one hour after the scheduled medication administration, which does not adhere to the correct timing for giving levofloxacin.
B: 1:30 p.m. This option represents a full 13 hours after the scheduled dose, making it unsuitable for the timely administration of night medications.
C: 11:30 p.m. This time occurs one hour prior to the scheduled dose, meaning it would be premature and not in line with the medication schedule.
E: 12:30 p.m. This choice indicates midday, which is irrelevant and significantly later than the prescribed time for administering levofloxacin during the night shift.
A client diagnosed with bipolar disease is receiving a maintenance dosage of lithium carbonate. His wife calls the community mental health nurse to report that her husband is displaying mild aggression and poor judgment. Which intervention is appropriate?
Rationale:
C: Measure lithium blood level. Monitoring lithium levels is essential, particularly when behavioral changes occur, as they may indicate toxicity or inadequate dosage, necessitating adjustments in treatment to ensure safety and efficacy.
A: Administer an extra dose of lithium carbonate. Increasing the dosage without proper assessment risks toxicity, potentially worsening the client’s condition rather than addressing the underlying issues causing aggression and poor judgment.
B: Take client to the closest emergency department. While urgent care may seem appropriate, immediate hospitalization isn't necessary unless there are severe symptoms, as the situation can often be managed through monitoring.
D: Arrange for hemodialysis. Hemodialysis is unnecessary for mild behavioral changes; it is typically reserved for severe lithium toxicity, indicating a more drastic intervention than what the client's current symptoms warrant.
A client with hypertension asks the nurse to explain how amlodipine besylate (Norvasc) lowers her blood pressure. The nurse gives which explanation to the client?
Rationale:
It prevents calcium from entering the smooth muscle, which relaxes the blood vessels to lower heart rate and blood pressure. Amlodipine besylate is a calcium channel blocker, inhibiting calcium's entry into smooth muscle cells, leading to vasodilation. This action effectively reduces vascular resistance and lowers blood pressure, making it a suitable treatment for hypertension.
B: It is a diuretic that works by removing extra sodium and water from the body through the kidneys, which helps lower blood pressure. Amlodipine is not a diuretic; it does not function by promoting kidney excretion of sodium or water.
C: It causes the body to produce less angiotensin, which allows blood vessels to relax and open up, therefore reducing blood pressure. Amlodipine does not influence angiotensin production; it primarily acts on calcium channels to induce vasodilation.
D: It lowers blood pressure by lowering the heart rate and the workload of the heart, and decreases the amount of blood pumped out of the heart. Amlodipine primarily affects vascular smooth muscle relaxation rather than directly reducing heart rate or altering cardiac output.
The nurse is caring for an elderly client who has been taking cimetidine (Tagamet) for a year. The nurse should monitor for which central nervous system side effects? Select all that apply.
Rationale:
B, C, E.
Cimetidine can lead to central nervous system side effects like agitation, confusion, and disorientation, particularly in the elderly, due to its potential to cross the blood-brain barrier and affect cognitive function.
A: tetany. Tetany is primarily related to calcium imbalance and does not directly correlate with the central nervous system effects associated with cimetidine use.
D: constipation. While cimetidine may cause gastrointestinal issues, constipation is not a central nervous system side effect, thus irrelevant in monitoring cognitive impacts.
The nurse is caring for a client with multiple IV medications. Which of the following drugs are compatible?
Rationale:
D: Furosemide (Lasix) and ondansetron (Zofran) are compatible for intravenous administration, allowing for simultaneous delivery without adverse interactions, thus ensuring effective treatment for the client’s condition.
A: Vancomycin and heparin exhibit compatibility issues, as vancomycin can precipitate when mixed with heparin, potentially leading to compromised treatment efficacy and an increased risk of adverse reactions.
B: Nitroglycerin and dopamine may interact unfavorably, as the combination could lead to alterations in blood pressure and hemodynamic stability, posing risks during concurrent administration in a clinical setting.
C: Sodium bicarbonate and dobutamine are not compatible since sodium bicarbonate can destabilize dobutamine, resulting in decreased drug efficacy and potential complications in patient management when infused together.
The nurse is preparing to administer a calcium channel blocker to a client with hypertension. The nurse understands that the mechanism of action of these drugs is to
Rationale:
Calcium channel blockers cause vasodilation and decrease total peripheral resistance. This mechanism lowers blood pressure by relaxing vascular smooth muscle, enhancing blood flow, and reducing the workload on the heart, making it effective for treating hypertension.
A: cause vasodilation and increase total peripheral resistance. This option contradicts the fundamental action of calcium channel blockers, which specifically aim to reduce resistance rather than increase it.
C: cause vasoconstriction and decrease total peripheral resistance. Vasoconstriction is not a mechanism of calcium channel blockers; these medications focus on relaxation, which leads to a decrease in peripheral resistance.
D: cause vasoconstriction and increase total peripheral resistance. This option misrepresents the action of calcium channel blockers, which promote vasodilation and reduce resistance rather than inducing constriction and increasing it.
The nurse is preparing to administer pilocarpine hydrochloride eye drops to a client with glaucoma. Which is the correct technique to administer eye drops? Select all that apply.
Rationale:
Tilted head positioning (A) helps facilitate proper drop placement, ensuring the medication reaches the eye effectively. Placing drops into the conjunctival sac (C) enhances absorption, while waiting between drops (D) allows the eye to absorb the first dose before administering the next, maximizing therapeutic effects.
B: Pulling the upper lid up and placing drops above the pupil does not ensure the medication enters the eye effectively, potentially leading to waste or improper dosing.
E: Closing the eyes and rubbing may cause discomfort and disrupt the drop distribution, risking inadequate absorption and ineffective treatment for the glaucoma condition.
The nurse is teaching a group of student nurses about drug safety. Keeping in mind Joint Commission guidelines, which of the following does the nurse teach the students? Select all that apply.
Rationale:
Do not abbreviate drug names and use daily instead of QD, Q.D., or q.d. are essential practices that enhance clarity and prevent medication errors, aligning with Joint Commission guidelines for drug safety.
C: Rectum can be abbreviated PR, R, or Per Rec. Abbreviating rectal administration poses significant risks for misinterpretation, compromising patient safety and contravening established guidelines.
D: Use OD to indicate right eye for eye medications. Using OD can lead to confusion with "overdose," which jeopardizes patient safety and violates recommended practices for drug administration clarity.
E: Use the letter u to indicate units, such as with insulin. The letter "u" can be easily misread as a zero or a four, leading to dangerous dosing errors, contrary to safety standards.
The nurse is reviewing a client's morning medication orders. Which of the following orders would prompt the nurse to call the health care provider for order clarification?
Rationale:
B: haloperidol 15 mg IM q4h prn
This order prompts clarification due to the high dosage of haloperidol, which is typically limited to smaller doses in outpatient settings. The frequency and delivery method may also raise safety concerns.
A: famotidine 20 mg PO BID
This order adheres to standard dosing guidelines for famotidine, commonly used for gastric acid conditions, making it a routine and acceptable medication regimen without the need for clarification.
C: lithium carbonate 300 mg PO TID
Lithium carbonate is often prescribed at this dosage and frequency for managing bipolar disorder, aligning with established treatment protocols, thus not warranting any immediate concerns or calls for clarification.
D: amoxicillin 500 mg PO q12h X 7 days
Amoxicillin at this dosage and duration is a typical prescription for bacterial infections, aligning with common therapeutic practices, and does not present any issues that necessitate further inquiry.
The nurse is training persons enrolled at a community center information session on administering naloxone (Narcan) to opioid overdose victims. Which information should the nurse include when teaching this group? Select all that apply.
Rationale:
Naloxone (Narcan) lasts 30 minutes and can be administered by lay persons who have received training. This critical information ensures effective response to opioid overdoses, enabling timely intervention and saving lives.
A: is administered by subcutaneous injection in the abdomen, thigh, or arm. Naloxone is typically administered intranasally or intramuscularly, making this option misleading regarding the correct route of administration.
B: works instantly. While naloxone acts quickly, it does not provide immediate effects; it takes a few minutes to counteract opioid overdoses effectively.
An adolescent client ingests a large number of acetaminophen tablets in an attempt to commit suicide. Which laboratory result is associated with acetaminophen overdose?
Rationale:
Elevated liver enzyme levels are associated with acetaminophen overdose. This occurs due to liver damage from toxic metabolites, leading to a release of enzymes like AST and ALT into the bloodstream.
A: Metabolic alkalosis This condition typically arises from respiratory issues or prolonged vomiting, not from acetaminophen overdose, which primarily affects liver function and does not cause significant acid-base disturbances.
B: Increased blood urea nitrogen level While renal impairment can occur, it is not a primary indicator of acetaminophen overdose. The liver is primarily affected, so BUN levels are less relevant.
C: Decreased hemoglobin and hematocrit These values relate to anemia or blood loss, which are not directly influenced by acetaminophen overdose. The primary concern is liver function rather than blood components.
A client with asthma has orders for terbutaline. Which finding in the medical history would the nurse be most concerned about?
Rationale:
A client with coronary artery disease would be the most concerning finding in the medical history. Terbutaline is a bronchodilator that can stimulate the heart, potentially exacerbating cardiovascular issues in patients with coronary artery disease.
A: diabetes Elevated blood sugar levels could complicate the management of asthma but do not directly interact with terbutaline’s cardiovascular effects, making it less critical than coronary artery disease.
B: migraines While migraines may impact the client’s quality of life, they do not have a direct relationship with the use of terbutaline and its cardiovascular implications.
C: osteoarthritis Osteoarthritis does not significantly influence the use of terbutaline or its associated risks, thus making it a less pressing concern in the context of asthma management.
Which instruction is correct for a client receiving lithium carbonate for bipolar disorder?
Rationale:
C: Drugs containing ibuprofen should be avoided. Lithium carbonate can interact negatively with NSAIDs like ibuprofen, potentially increasing lithium levels and heightening the risk of toxicity, which is crucial for client safety.
A: Breastfeeding may be done. While some medications can be taken during breastfeeding, lithium poses risks that necessitate careful consideration and often contraindicates breastfeeding due to potential infant exposure.
B: Driving or using machinery is acceptable. Lithium carbonate can cause side effects such as dizziness or drowsiness, which may impair coordination and judgment, making driving or operating machinery unsafe.
D: Fluid intake should be limited to eight 8-oz glasses per day. Maintaining adequate hydration is vital for those on lithium, as dehydration can elevate lithium levels and increase toxicity risk; therefore, fluid intake should not be restricted.
The nurse is caring for a client taking sulfonamides to treat a urinary tract infection. Which of the following should the nurse monitor for in this client? Select all that apply.
Rationale:
Fever or sore throat, side effects such as dyspnea, chest pains, chills, and cough, urinary output of 1200 mL daily, and the need to decrease the dosage if the client takes warfarin sodium or phenytoin should all be monitored in this client.
Monitoring for fever or sore throat is crucial as these symptoms may indicate an allergic reaction or serious adverse effects related to sulfonamide use, warranting immediate intervention.
B: Reddish-pink urine This symptom may appear due to other factors unrelated to sulfonamide treatment, such as dietary influences or other medications, thus not specifically requiring monitoring in this context.
C: Side effects such as dyspnea, chest pains, chills, and cough While these symptoms are important to observe, they are encompassed within the broader category of adverse reactions already included in the correct options.
E: The need to decrease the dosage if the client takes warfarin sodium (Coumadin) or phenytoin (Dilantin) While drug interactions are a consideration, monitoring specific symptoms and renal function is more critical for immediate patient safety.
The nurse is preparing to administer furosemide IM to a 6-month-old client with edema. Which location is the preferred injection site for this client?
Rationale:
B: The vastus lateralis is the preferred injection site for infants due to its large muscle mass and distance from major nerves and blood vessels, ensuring safer administration of medications like furosemide.
A: The gluteus medius is not typically used for infants, as this area can be difficult to access and poses a higher risk of injury to nerves.
C: The dorsogluteal site is discouraged in infants due to its proximity to the sciatic nerve, increasing the risk of nerve damage during an injection.
D: The ventrogluteal muscle, while safer than the dorsogluteal, is less accessible in infants, making the vastus lateralis a more suitable choice for intramuscular injections.
The clinic nurse is seeing a client who is taking duloxetine hydrochloride. When updating the client's medical history, for which condition mentioned by the client would the nurse notify the health care provider?
Rationale:
C: uncontrolled narrow-angle glaucoma. Duloxetine hydrochloride can increase intraocular pressure, posing risks for individuals with narrow-angle glaucoma. Therefore, this condition necessitates immediate notification to the healthcare provider for further evaluation.
A: recent worsening of insomnia. While insomnia can be a side effect of duloxetine, it is not an urgent medical concern that requires immediate intervention by the healthcare provider.
B: unplanned weight loss of 6 pounds. Weight loss may be a side effect, but it typically does not warrant urgent action unless accompanied by other concerning symptoms or significant changes in health.
D: removal of a benign skin cancer on the leg. This procedure does not relate to duloxetine's effects or contraindications, making it a non-urgent matter for the healthcare provider's attention.
The nurse is caring for a client who complains of a headache with a pain level of 5 on a scale of 1 to 10. Which PRN pain medication order is most appropriate for the nurse to administer?
Rationale:
Acetaminophen 650 mg PO q6h PRN is the most appropriate choice for managing a headache with a pain level of 5. It effectively alleviates mild to moderate pain without the risks associated with stronger opioids or other medications.
A: morphine 2 mg IV q6h PRN involves an opioid, which is excessive for a moderate headache and poses a risk of dependency and side effects.
B: aspirin 325 mg PO q6h PRN can irritate the stomach and is not first-line for headaches, especially in clients with potential gastrointestinal concerns.
D: nitroglycerin 0.4 mg sublingually every 5 minutes, up to 3 doses over 15 minutes is specifically for angina and does not address headache pain effectively.
The nurse is educating a client about MAOI and diet. Which dietary selection by the client indicates that the nurse's teaching was effective?
Rationale:
A: The egg-white omelet with a cup of yogurt demonstrates effective teaching regarding MAOI dietary restrictions, as it avoids tyramine-rich foods that can interact negatively with the medication.
B: Baked chicken breast with green beans contains nothing harmful; however, it does not specifically highlight the avoidance of tyramine-rich foods which are crucial for MAOI patients.
C: Scrambled eggs with sausage and toast typically includes sausage, which often contains tyramine, posing potential risks to clients taking MAOIs and contradicting dietary guidelines.
D: Hot dog with sauerkraut, beans, and a fruit cup includes sauerkraut, a high-tyramine food that can lead to dangerous interactions with MAOIs, indicating a misunderstanding of dietary restrictions.