A nurse is assigned to perform well-child assessments at a day care center. A staff member interrupts the examinations to ask for assistance. They find a crying 3 year-old child on the floor with mouth wide open and gums bleeding. Two unlabeled open bottles lie nearby. The nurse's first action should be
A) call the poison control center, then 911
B) administer syrup of Ipecac to induce vomiting
C) give the child milk to coat her stomach
D) ask the staff about the contents of the bottles
Review Information: The correct answer is D: ask the staff about the contents of the bottles
The nurse needs to assess what the child ingested before determining the next action. Once the substance is identified, the poison control center and emergency response team should be called.
A client with atrial fibrillation is receiving digoxin (Lanoxin). Which of these assessments is most important for the nurse to perform?
A) Monitor blood pressure every 4 hours
B) Measure apical pulse prior to administration
C) Maintain accurate intake and output records
D) Record an EKG strip after administration
Review Information: The correct answer is B: Measure apical pulse prior to administration
Digitoxin decreases conduction velocity through the AV node and prolongs the refractory period. If the apical heart rate is less than 60 beats/minute, withhold the drug. The apical pulse should be taken with a stethoscope so that there will be no mistake about what the heart rate actually is.
The nurse is administering an intravenous vesicant chemotherapeutic agent to a client. Which assessment would require the nurse's immediate action?
A) Stomatitis lesion in the mouth
B) Severe nausea and vomiting
C) Complaints of pain at site of infusion
D) A rash on the client's extremities
Review Information: The correct answer is C: Complaints of pain at site of infusion
A vesicant is a chemotherapeutic agent capable of causing blistering of tissues and possible tissue necrosis if there is extravasation. These agents are irritants which cause pain along the vein wall, with or without inflammation.
The nurse practicing in a long term care facility recognizes that elderly clients are at greater risk for drug toxicity than younger adults because of which of the following physiological changes of advancing age?
A) Drugs are absorbed more readily from the GI tract
B) Elders have less body water and more fat
C) The elderly have more rapid hepatic metabolism
D) Older people are often malnourished and anemic
Review Information: The correct answer is B: Elders have less body water and more fat
Because elderly persons have decreased lean body tissue/water in which to distribute medications, more drug remains in the circulatory system with potential for drug toxicity. Increased body fat results in greater amounts of fat-soluble drugs being absorbed, leaving less in circulation, thus increasing the duration of action of the drug
The nurse is assessing a client who is on long term glucocorticoid therapy. Which of the following findings would the nurse expect?
A) Buffalo hump
B) Increased muscle mass
C) Peripheral edema
Review Information: The correct answer is A: Buffalo hump
With high doses of glucocorticoid, iatrogenic Cushing''s syndrome develops. The exaggerated physiological action causes abnormal fat distribution which results in a moon-shaped face, a intrascapular pad on the neck (buffalo hump) and truncal obesity with slender limbs.
The health care provider has written "Morphine sulfate 2 mgs IV every 3-4 hours prn for pain" on the chart of a child weighing 22 lb. (10 kg). What is the nurse's initial action?
A) Check with the pharmacist
B) Hold the medication and contact the provider
C) Administer the prescribed dose as ordered
D) Give the dose every 6-8 hours
Review Information: The correct answer is B: Hold the medication and contact the provider
The usual pediatric dose of morphine is 0.1 mg/kg every 3 to 4 hours. At 10 kg, this child typically should receive 1.0 mg every 3 to 4 hours.
A client is ordered atropine to be administered preoperatively. Which physiological effect should the nurse monitor for?
A) Elevate blood pressure
B) Drying up of secretions
C) Reduce heart rate
D) Enhance sedation
Review Information: The correct answer is B: Drying up of secretions
Atropine dries secretions which may get in the way during the operative procedure.
A client is receiving digitalis. The nurse should instruct the client to report which of the following side effects?
A) Nausea, vomiting, fatigue
B) Rash, dyspnea, edema
C) Polyuria, thirst, dry skin
D) Hunger, dizziness, diaphoresis
Review Information: The correct answer is A: Nausea, vomiting, fatigue
Side effects of digitalis toxicity include fatigue, nausea, vomiting, anorexia, and bradycardia. Digitalis inhibits the sodium potassium ATPase, which makes more calcium available for contractile proteins, resulting in increased cardiac output.
A client is receiving dexamethasone (Decadron) therapy. What should the nurse plan to monitor in this client?
A) Urine output every 4 hours
B) Blood glucose levels every 12 hours
C) Neurological signs every 2 hours
D) Oxygen saturation every 8 hours
Review Information: The correct answer is B: Blood glucose levels every 12 hours
The drug Decadron increases glycogenesis. This may lead to hyperglycemia. Therefore the blood sugar level and acetone production must be monitored.
The nurse is caring for a client with schizophrenia who has been treated with quetiapine (Seroquel) for 1 month. Today the client is increasingly agitated and complains of muscle stiffness. Which of these findings should be reported to the health care provider?
A) Elevated temperature and sweating.
B) Decreased pulse and blood pressure.
C) Mental confusion and general weakness.
D) Muscle spasms and seizures.
Review Information: The correct answer is A: Elevated temperature and sweating.
Neuroleptic malignant syndrome (NMS) is a rare disorder that can occur as a side effect of antipsychotic medications. It is characterized by muscular rigidity, tachycardia, hyperthermia, sweating, altered consciousness, autonomic dysfunction, and increase in CPK. This is a life-threatening complication.
A child presents to the Emergency Department with documented acetaminophen poisoning. In order to provide counseling and education for the parents, which principle must the nurse understand?
A) The problem occurs in stages with recovery within 12-24 hours
B) Hepatic problems may occur and may be life-threatening
C) Full and rapid recovery can be expected in most children
D) This poisoning is usually fatal, as no antidote is available
Review Information: The correct answer is B: Hepatic problems may occur and may be life-threatening
Clinical manifestations associated with acetaminophen poisoning occurs in 4 stages. The third stage is hepatic involvement which may last up to 7 days and be permanent. Clients who do not die in the hepatic stage gradually recover.
A client has been receiving dexamethasone (Decadron) for control of cerebral edema. Which of the following assessments would indicate that the treatment is effective?
A) A positive Babinski's reflex
B) Increased response to motor stimuli
C) A widening pulse pressure
D) Temperature of 37 degrees Celsius
Review Information: The correct answer is B: Increased response to motor stimuli
Decadron is a corticosteroid that acts on the cell membrane to decrease inflammatory responses as well as stabilize the blood-brain barrier. Once Decadron reaches a therapeutic level, there should be a decrease in symptomology with improvement in motor skills.
The provider has ordered transdermal nitroglycerin patches for a client. Which of these instructions should be included when teaching a client about how to use the patches?
A) Remove the patch when swimming or bathing
B) Apply the patch to any non-hairy area of the body
C) Apply a second patch with chest pain
D) Remove the patch if ankle edema occurs
Review Information: The correct answer is B: Apply the patch to any non-hairy area of the body
The patch application sites should be rotated.
A newly admitted client has a diagnosis of depression. She complains of “twitching muscles” and a “racing heart”, and states she stopped taking Zoloft a few days ago because it was not helping her depression. Instead, she began to take her partner's Parnate. The nurse should immediately assess for which of these adverse reactions?
A) Pulmonary edema
B) Atrial fibrillation
C) Mental status changes
D) Muscle weakness
Review Information: The correct answer is C: Mental status changes
Use of serotonergic agents may result in Serotonin Syndrome with confusion, nausea, palpitations, increased muscle tone with twitching muscles, and agitation. Serotonin syndrome is most often reported in patients taking 2 or more medications that increase CNS serotonin levels by different mechanisms. The most common drug combinations associated with serotonin syndrome involve the MAOIs, SSRIs, and the tricyclic antidepressants.
A client with bi-polar disorder is taking lithium (Lithane). What should the nurse emphasize when teaching about this medication?
A) Take the medication before meals
B) Maintain adequate daily salt intake
C) Reduce fluid intake to minimize diuresis
D) Use antacids to prevent heartburn
Review Information: The correct answer is B: Maintain adequate daily salt intake
Salt intake affects fluid volume, which can affect lithium (Lithane) levels; therefore, maintaining adequate salt intake is advised.
A client with anemia has a new prescription for ferrous sulfate. In teaching the client about diet and iron supplements, the nurse should emphasize that absorption of iron is enhanced if taken with which substance?
B) Orange juice
C) Low fat milk
D) An antacid
Review Information: The correct answer is B: Orange juice
Ascorbic acid enhances the absorption of iron.
A client with an aplastic sickle cell crisis is receiving a blood transfusion and begins to complain of "feeling hot." Almost immediately, the client begins to wheeze. What is the nurse's first action?
A) Stop the blood infusion
B) Notify the health care provider
C) Take/record vital signs
D) Send blood samples to lab
Review Information: The correct answer is A: Stop the blood infusion
If a reaction of any type is suspected during administration of blood products, stop the infusion immediately, keep the line open with saline, notify the health care provider, monitor vital signs and other changes, and then send a blood sample to the lab.
A client confides in the RN that a friend has told her the medication she takes for depression, Wellbutrin, was taken off the market because it caused seizures. What is an appropriate response by the nurse?
A) "Ask your friend about the source of this information."
B) "Omit the next doses until you talk with the doctor."
C) "There were problems, but the recommended dose is changed."
D) "Your health care provider knows the best drug for your condition."
Review Information: The correct answer is C: "There were problems, but the recommended dose is changed."
Wellbutrin was introduced in the U.S. in 1985 and then withdrawn because of the occurrence of seizures in some patients taking the drug. The drug was reintroduced in 1989 with specific recommendations regarding dose ranges to limit the occurrence of seizures. The risk of seizure appears to be strongly associated with dose.
When providing discharge teaching to a client with asthma, the nurse will warn against the use of which of the following over-the-counter medications?
A) Cortisone ointments for skin rashes
B) Aspirin products for pain relief
C) Cough medications containing guaifenesin
D) Histamine blockers for gastric distress
Review Information: The correct answer is B: Aspirin products for pain relief
Aspirin is known to induce asthma attacks. Aspirin can also cause nasal polyps and rhinitis. Warn individuals with asthma about signs and symptoms resulting from complications due to aspirin ingestion.
The nurse is caring for a client who is receiving procainamide (Pronestyl) intravenously. It is important for the nurse to monitor which of the following parameters?
A) Hourly urinary output
B) Serum potassium levels
* C) Continuous EKG readings
D) Neurological signs
Review Information: The correct answer is C: Continuous EKG readings
Procainamide (Pronestyl) is used to suppress cardiac arrhythmias. When administered intravenously, it must be accompanied by continuous cardiac monitoring by ECG.
The nurse is providing education for a client with newly diagnosed tuberculosis. Which statement should be included in the information that is given to the client?
A) "Isolate yourself from others until you are finished taking your medication."
B) "Follow up with your primary care provider in 3 months."
C) "Continue to take your medications even when you are feeling fine."
D) "Continue to get yearly tuberculin skin tests."
Review Information: The correct answer is C: "Continue to take your medications even when you are feeling fine."
The most important piece of information the tuberculosis client needs is to understand the importance of medication compliance, even if no longer experiencing symptoms. Clients are most infectious early in the course of therapy. The numbers of acid-fast bacilli are greatly reduced as early as 2 weeks after therapy begins.
The nurse is applying silver sulfadiazine (Silvadene) to a child with severe burns to arms and legs. Which side effect should the nurse be monitoring for?
A) Skin discoloration
B) Hardened eschar
C) Increased neutrophils
D) Urine sulfa crystals
Review Information: The correct answer is D: Urine sulfa crystals
Silver sulfadiazine is a broad spectrum anti-microbial, especially effective against pseudomonas. When applied to extensive areas, however, it may cause a transient neutropenia, as well as renal function changes with sulfa crystals production and kernicterus.
The nurse is monitoring a client receiving a thrombolytic agent, alteplase (Activase tissue plasminogen activator), for treatment of a myocardial infarction. What outcome indicates the client is receiving adequate therapy within the first hours of treatment?
A) Absence of a dysrhythmia (or arrhythmia)
B) Blood pressure reduction
C) Cardiac enzymes are within normal limits
D) Return of ST segment to baseline on ECG
Review Information: The correct answer is D: Return of ST segment to baseline on ECG
Improved perfusion should result from this medication, along with the reduction of ST segment elevation.
The provider has ordered daily high doses of aspirin for a client with rheumatoid arthritis. The nurse instructs the client to discontinue the medication and contact the provider if which of the following symptoms occur?
A) Infection of the gums
B) Diarrhea for more than one day
C) Numbness in the lower extremities
D) Ringing in the ears
Review Information: The correct answer is D: Ringing in the ears
Aspirin stimulates the central nervous system which may result in ringing in the ears.
Deglin, J.D. and Vallerand, A.H. (2001). Davis’ drug guide for nurses. (7th edition). Philadelphia: F.A. Davis Company.
Key, J.L. and Hayes, E.R. (2003). Pharmacology, a nursing process approach. (4th edition). Philadelphia: Saunders.
A nurse is caring for a client who is receiving methyldopa hydrochloride (Aldomet) intravenously. Which of the following assessment findings would indicate to the nurse that the client may be having an adverse reaction to the medication?
B) Mood changes
Review Information: The correct answer is B: Mood changes
The nurse should assess the client for alterations in mental status such as mood changes. These symptoms should be reported promptly.
Deglin, J.D. and Vallerand, A.H. (2001). Davis’ drug guide for nurses. (7th edition). Philadelphia: F.A. Davis Company.
Wilson, B.A., Shannon, M.T., and Stang, C.L. (2004). Nurse’s drug guide. Upper Saddle River, New Jersey: Pearson Prentice Hall.
The nurse is teaching a child and the family about the medication phenytoin (Dilantin) prescribed for seizure control. Which of the following side effects is most likely to occur?
C) Gingival hyperplasia
Review Information: The correct answer is C: Gingival hyperplasia
Swollen and tender gums occur often with use of phenytoin. Good oral hygiene and regular visits to the dentist should be emphasized.
The use of atropine for treatment of symptomatic bradycardia is contraindicated for a client with which of the following conditions?
A) Urinary incontinence
C) Increased intracranial pressure
D) Right sided heart failure
Review Information: The correct answer is B: Glaucoma
Atropine is contraindicated in clients with angle-closure glaucoma because it can cause pupillary dilation with an increase in aqueous humor, leading to a resultant increase in optic pressure.
A pregnant woman is hospitalized for treatment of pregnancy induced hypertension (PIH) in the third trimester. She is receiving magnesium sulfate intravenously. The nurse understands that this medication is used mainly for what purpose?
A) Maintain normal blood pressure
B) Prevent convulsive seizures
C) Decrease the respiratory rate
D) Increase uterine blood flow
Review Information: The correct answer is B: Prevent convulsive seizures
Magnesium sulfate is a central nervous system depressant. While it has many systemic effects, it is used in the client with pregnancy induced hypertension (PIH) to prevent seizures.
The nurse is teaching a group of women in a community clinic about prevention of osteoporosis. Which of the following over-the-counter medications should the nurse recognize as having the most elemental calcium per tablet?
A) Calcium chloride
B) Calcium citrate
C) Calcium gluconate
D) Calcium carbonate
Review Information: The correct answer is D: Calcium carbonate
Calcium carbonate contains 400mg of elemental calcium in 1 gram of calcium carbonate.
The nurse is administering diltiazem (Cardizem) to a client. Prior to administration, it is important for the nurse to assess which parameter?
B) Blood pressure
D) Bowel sounds
Review Information: The correct answer is B: Blood pressure
Diltiazem (Cardizem) is a calcium channel blocker that causes systemic vasodilation resulting in decreased blood pressure.
The nurse is instructing a client with moderate persistent asthma on the proper method for using MDIs (multi-dose inhalers). Which medication should be administered first?
C) Mast cell stabilizer
D) Beta agonist
Review Information: The correct answer is D: Beta agonist
The beta-agonist drugs help to relieve bronchospasm by relaxing the smooth muscle of the airway. These drugs should be taken first so that other medications can reach the lungs.
A post-operative client has a prescription for acetaminophen with codeine. What should the nurse recognizes as a primary effect of this combination?
A) Enhanced pain relief
B) Minimized side effects
C) Prevention of drug tolerance
D) Increased onset of action
Review Information: The correct answer is A: Enhanced pain relief
Combination of analgesics with different mechanisms of action can afford greater pain relief.
A client is receiving erythromycin 500mg IV every 6 hours to treat a pneumonia. Which of the following is the most common side effect of the medication?
A) Blurred vision
B) Nausea and vomiting
C) Severe headache
Review Information: The correct answer is B: Nausea and vomiting
Nausea is a common side-effect of erythromycin in both oral and intravenous forms.
The health care provider orders an IV aminophylline infusion at 30 mg/hr. The pharmacy sends a 1,000 ml bag of D5W containing 500 mg of aminophylline. In order to administer 30 mg per hour, the RN will set the infusion rate at:
A) 20 ml per hour
B) 30 ml per hour
C) 50 ml per hour
D) 60 ml per hour
Review Information: The correct answer is D: 60 ml per hour
Using the ratio method to calculate infusion rate: mg to be given (30) : ml to be infused (X) :: mg available (500) : ml of solution (1,000). Solve for X by cross-multiplying: 30 x 1,000 = 500 x X (or cancel), 30,000 = 500 X, X = 30,000/500, X = 60ml per hour.
The nurse is assessing a 7 year-old after several days of treatment for a documented strep throat. Which of the following statements suggests that further teaching is needed?
A) "Sometimes I take my medicine with fruit juice."
B) "My mother makes me take my medicine right after school."
C) "Sometimes I take the pills in the morning and other times at night."
D) "I am feeling much better than I did last week."
Review Information: The correct answer is C: "Sometimes I take the pills in the morning and other times at night."
Inconsistency in taking the prescribed medication indicates more teaching is needed.
The nurse is caring for a 10 year-old client who will be placed on heparin therapy. Which assessment is critical for the nurse to make before initiating therapy
A) Vital signs
C) Lung sounds
D) Skin turgor
Review Information: The correct answer is B: Weight
Check the client''s weight because dosage is calculated on the basis of weight.
In providing care for a client with pain from a sickle cell crisis, which one of the following medication orders for pain control should be questioned by the nurse?
Review Information: The correct answer is A: Demerol
Meperidine is not recommended in clients with sickle cell disease. Normeperidine, a metabolite of meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. Clients with sickle cell disease are particularly at risk for normeperidine-induced seizures.
A 5 year-old has been rushed to the emergency room several hours after acetaminophen poisoning. Which laboratory result should receive attention by the nurse?
A) Sedimentation rate
B) Profile 2
Review Information: The correct answer is C: Bilirubin
Bilirubin, along with liver enzymes ALT and AST, may rise in the second stage (1-3 days) after a significant overdose, indicating cellular necrosis and liver dysfunction. A prolonged prothrombin time may also be found.
An elderly client is on an anticholinergic metered dose inhaler (MDI) for chronic obstructive pulmonary disease. The nurse would suggest a spacer to
A) enhance the administration of the medication
B) increase client compliance
C) improve aerosol delivery in clients who are not able to coordinate the MDI
D) prevent exacerbation of COPD
Review Information: The correct answer is C: improve aerosol delivery in clients who are not able to coordinate the MDI
Spacers improve the medication delivery in clients who are unable to coordinate the movements of administering a dose with an MDI.
The nurse is teaching a parent how to administer oral iron supplements to a 2 year-old child. Which of the following interventions should be included in the teaching?
A) Stop the medication if the stools become tarry green
B) Give the medicine with orange juice and through a straw
C) Add the medicine to a bottle of formula
D) Administer the iron with your child's meals
Review Information: The correct answer is B: Give the medicine with orange juice and through a straw
Absorption of iron is facilitated in an environment rich in Vitamin C. Since liquid iron preparation will stain teeth, a straw is preferred.