BSN HESI 315 Pharmacology Practice Exam Version 6 (New 2026/ 2027 Update) Full Q&A |100% Correct| Grade A-Nightingale

BSN HESI 315 Pharmacology Practice Exam Version 6 (New 2026/ 2027 Update) Full Q&A |100% Correct| Grade A-Nightingale Q. 1. The nurse is administering sodium polystyrene sulfonate to a client in acute kidney injury (AKI). Which laboratory finding indicates that the medication has been effective? Reference Range: Glucose [74 to 106 mg/dL (4.1 to 5.9 mmol/L)] Hemoglobin [14 to 18 g/dL (140 to 180 g/L)] Potassium [3.5 to 5 mEq/L (3.5 to 5 mmol/_)) Glucose [74 to 106 mg/dL (4.1 to 5.9 mmol/L)] Ammonia [10 to 80 g/dL (6 to 47 umol/aL)l A Serum ammonia level of 30 pg/dL (17.62 pmol /dL). B Serum glucose level of 120 mg/dL (c.7 mmol/L). C Serum potassium level of 3.8 mEq/L (3.8 mmol/L). D Hemoglobin level of 13.5 g/dL (135 g/L). ANSWER C. Potassium [3.5 to 5 mEq/L (3.5 to 5 mmol/_)) 3 multiple choice options Q. NGN: The thiazide diuretic works to decrease the client's blood pressure by __________________________. and the angiotensin converting enyzme (ACE) inhibitor works to decrease the client's blood pressure by____________________________________. ANSWER reducing stroke volume reduce stroke volume and systemic vascular resistance Q. 3. The nurse is teaching a client how to use an inhaler device. Which client statement indicates to the nurse that the client understands the instructions? A Caffeinated beverages should be limited to two cups per day. B The inhaler will be used before bed each night. C Rinsing the mouth with water should be done after each use. D To mask taste of the medication, inhaler can be used during meals. ANSWER C Rinsing the mouth with water should be done after each use. Q. The healthcare provider prescribes propylthiouracil (PTU) and Lugol's solution, a strong iodine solution, for a client with hyperthyroidism. How should the nurse schedule the administration of these medications? A Give parental dose once every 24 hours. B offer both drugs together with a meal. C Schedule both medications at bedtime. D Administer iodine one hour before PTU. ANSWER B offer both drugs together with a meal. Q. A client is receiving orlistat as part of a weight management program. Which ongoing assessment should be included in the plan of care to determine the effectiveness of the medication? A Depression screening. B Body mass index (BMI). C Daily calorie count. D Serum protein levels ANSWER B Body mass index (BMI) Q. A client with generalized anxiety disorder (GAD) receives a new prescription for lorazepam. Which statement provided by the client requires additional instruction by the nurse? A Use relaxation technique to reduce excessive anxiety. B Move slowly from a sitting position to a standing position. C Avoid alcohol and other sedatives while taking the medication. D Stop taking the medication if intended effect is not immediate. ANSWER D Stop taking the medication if intended effect is not immediate. Q. A client who is taking an oral contraceptive receives a new prescription for erythromycin. Which instruction should the nurse provide to the client? A Avoid prolonged exposure to direct sunlight. B Use an additional form of contraception. C Take the medications at least 12 hours apart. D Stop the oral contraceptive immediately. ANSWER B Use an additional form of contraception Q. After receiving the third dose of a new oral anticoagulant prescription, an older client develops bleeding and tender gums and has many new bruises. Which action(s) should the nurse implement? Select all that apply. A. Review the most recent coagulation laboratory values. B Complete a medication variance report. C Report findings to healthcare provider. D Obtain a soft bristle toothbrush for client. E Provide a PRN nonsteroidal anti-inflammatory (NSAID) for gum discomfort. ANSWER A Review the most recent coagulation laboratory values. D Obtain a soft bristle toothbrush for client. Q. The nurse is caring for a client who takes methotrexate for rheumatoid arthritis and receives a prescription for adalimumab. Which instructions should the nurse provide the client? A Obtain routine vaccinations as scheduled. B Have a chest x-ray prior to your first dose. C Avoid crowds and people who are sick. D Undergo annual eye examinations. ANSWER C Avoid crowds and people who are sick. Q. The healthcare provider prescribes magnesium sulfate 300 mg/hour IV. The IV bag is contains magnesium sulfate 4 grams in dextrose 5% in water (D,) 500 mL. How many mL/hour should the nurse set the infusion pump? (Enter numerical value only. If rounding is required, round to the nearest tenth.) ANSWER 37.5ml/hr Q. The nurse is assessing a client who was recently diagnosed with Parkinson's disease and is taking carbidopa-levodopa. The client is concerned that the medication is not working. Which intervention should the nurse implement first? A Evaluate the client for signs of dyskinesia. B Determine if the client is taking the medication before meals. C Explore what the client means by the drug "is not working." D Ask if the client's morning voids are dark colored. ANSWER C Explore what the client means by the drug "is not working." Q. A client with peptic ulcer disease receives a new prescription for cimetidine. Which statement provided by the client requires additional instruction by the nurse? A Decrease cigarette use to a pack per day. B Notify the healthcare provider of lethargy. C Take the medication an hour after antacids. D Monitor for any signs of sexual dysfunction. ANSWER A Decrease cigarette use to a pack per day. Q. Which intervention is most important for the nurse to implement for a client with type 2 diabetes mellitus (DM) who is receiving insulin lispro? A Check blood glucose levels every six hours. B Assess for hypoglycemia between meals. C Provide meals at the same time this insulin is given. D Keep an oral liquid or glucose source available. ANSWER C Provide meals at the same time this insulin is given. Q. To control asthma, a client in a residential treatment facility uses a fluticasone propionate and salmeterol discus inhalation system, which provides an inhaled powdered form of these combined medications. Which instruction should the nurse provide to this client's caregivers? A Explain that the client should not use the discus more than twice daily. B Offer the discus to the client for use during an acute asthma attack. C When using the discus, have the client breathe out rapidly into the mouthpiece. D Clients using the discus may experience decreased blood pressure. ANSWER B Offer the discus to the client for use during an acute asthma attack. Q. A client starts a new prescription, oxybutynin, for symptoms of an overactive bladder. The client reports to the nurse the details of training for a half marathon. Which instruction should the nurse emphasize? A Take measures to avoid dehydration and overheating. B Avoid crowds to help prevent acquiring infections. C Wear padding to protect from bruising if a fall occurs. D Keep skin and eyes covered to protect from sun injury. ANSWER A Take measures to avoid dehydration and overheating. Q. A client who is taking furosemide reports experiencing leg cramps, a cough, feeling tired, and palpitations. Which action should the nurse take first? A Apply warm compresses to legs. B Place on cardiac monitoring C Raise the head of the bed. D Monitor intake and output ANSWER B Place on cardiac monitoring Q. A client who received a renal transplant three months ago is readmitted to the acute care unit with signs of graft rejection. While taking the client's history, the nurse determines that the client has been self-administering St. John's Wort, an herbal preparation, on the advice of a friend. Which information is most significant about this finding? A Ingestion diSt. John's Wort can reduce the client's intake of sodium. B Adding the herb can decrease the need for corticosteroids. C St.John's Wort can decrease plasma concentrations of cyclosporine. D The client probably used this herb to treat depression. ANSWER C St.John's Wort can decrease plasma concentrations of cyclosporine. Q. The nurse notes that a client has been receiving hydromorphone every six hours for four days. Which assessment is most important for the nurse to complete? A Auscultate the client's bowel sounds. B Observe for edema around the ankles. C Count the apical and radial pulses simultaneously. D Measure the client's capillary glucose level. ANSWER A Auscultate the client's bowel sounds Q. A client who is newly diagnosed with diabetes insipidus is receiving synthetic vasopressin intravenously. Which side effect of vasopressin reported by the client should the nurse report to the healthcare provider? A Worsening headache. B Low urine specific gravity. C Polydipsia. D Polyuria. ANSWER A Worsening headache. Q. A client with anemia secondary to chronic kidney disease (CKD) started a prescription for epoetin alfa two months ago. Which client finding best indicates that the medication is effective? Reference Range: Hemoglobin [14 to 18 g/dL (140 to 180 g/L)]. A. Reports of increased energy levels and decreased fatigue. B. Takes concurrent iron therapy without adverse effects. C. hemoglobin level increased to 12 g/aL (120 g/-). D. Food diary shows increased consumption of iron-rich foods. ANSWER A. Reports of increased energy levels and decreased fatigue Q. A client receives a prescription for penicillin, 1.2 million units IM. The available vial is labeled, "600,000 units/2 mL." How many mL should the nurse administer? (Enter numeric value only.) ANSWER 4ml Q. A client who is taking dextroamphetamine-amphetamine extended-release tablets for attention deficit hyperactivity disorder (ADHD), reports about having difficulty sleeping at night. Which assessment is most important for the nurse to obtain? A Determine at what time the dose is taken. B Ask about the client's bedtime routine. C Determine daily caffeine intake. D Inquire about perceived anxiety. ANSWER A Determine at what time the dose is taken. NGN: Q. Captopril is an angiotensin converting enzyme inhibitor that works by vasodilation to help lower the blood pressure. ANSWER angiotensin converting enzyme inhibitor vasodilation to help lower the blood pressure. NGN: Which 2 laboratory orders would be most appropriate for this client to complete on their return visit? electrolyte panel kidney function test A client with nasal congestion receives a prescription for phenylephrine (10 mg PO every 4 hours. Which client condition should the nurse report to the healthcare provider before administering the medication? A Bronchitist B Diarrhea C Hypertension D Edema C Hypertension NGN: The nurse is evaluating the client's progress and nursing implementations : decreased flushing and itching regular respirations no chest pain decreased anxiety. NGN: Potential condition: tachydysrhythmias Actions Takes: cardiorespiratory and baseline vital signs Parameters monitor: monitor breath sounds and heart rate and rhythm. A client with chronic lower back pain has been taking ibuprofen PO twice a day for several months. Which assessment is most important for the nurse to complete? A Palpate volume of pedal pulses. B Determine presence of abdominal pain. C Evaluate ongoing sleep patterns. D Assess back pain using numeric scale. B Determine presence of abdominal pain. The nurse administers risedronate to a client with osteoporosis at 0700. The client asks for a glass of milk to drink with the medication. Which action should the nurse take? A Instruct the client that it is necessary to take nothing but water with the medication. B Withhold the medication until the client's breakfast tray is available on the unit. C Assign an unlicensed assistive personnel (UAP) to bring the client a glass of low fat milk. D. Consult with a pharmacist about scheduling the dose one hour after the client eats. D. Consult with a pharmacist about scheduling the dose one hour after the client eats. The nurse is providing medication teaching to a client with bipolar disorder who receives a prescription for lithium carbonate. Which instruction should the nurse emphasize with the client A Keep medication fliers for frequent review and reference. B Report fluctuations in weight to the healthcare provider. C Maintain a fluid intake of 1,500 to 3,000 mL per day. D Avoid taking the medication on an empty stomach. C Maintain a fluid intake of 1,500 to 3,000 mL per day. A client receives a prescription for allopurinol. Which information provided by the client requires additional instruction by the nurse? A Consume 2 liters of water daily. B Reduce caffeine and acidic intake. C Avoid taking on an empty stomach. D Double the dose if a dose is missed. A Consume 2 liters of water daily. The home health nurse observes that a female client is using a topical preparation that contains echinace to treat a canker sore. Her husband expresses concern regarding the effectiveness and safety of using herbs. How should the nurse respond? A Many of the herbal preparations are helpful primarily because of their placebo effect. B Echinacea seems to be useful in the treatment of some infections, such as canker sores. C Topical echinacea is usually used to soothe burns and can cause damage to the skin. D This product is essentially harmless but also is not very beneficial in treating skin infections B Echinacea seems to be useful in the treatment of some infections, such as canker sores. NGN : The nurse is implementing the plan of care: For each body system; A steroid would be used to reduce the inflammation caused by the reaction, monitor the vital signs continuously, Assessing the lung sounds and Providing a calm environment The nurse observes that a client has become lethargic 30 minutes after receiving an opioid injection for pain. Which vital sign should the nurse obtain first? A Respiratory rate. B Blood pressure. C Temperature. D Pulse rate. A Respiratory rate. A client has a new prescription for diclofenac, a nonsteroidal antiinflammatory drug (NSAID). Which information in the client's history is of greatest concern to the nurse in monitoring the client's response to this medication? A Chronic alcoholism. B Migraine headaches. C Osteoarthritis. D Type 2 diabetes mellitus. A Chronic alcoholism. A client has a prescription for heparin, 1,000 units IV STAT. Several pre filled syringes of low molecular weight heparin are available in the client's medication drawer. Which action should the nurse implement? A Request a prescription to change the route of administration and use the available heparin. B Calculate and administer the equivalent dose of the available low molecular weight heparin. C Advise the pharmacy of the need to deliver a vial of heparin to the nursing unit immediately. D Dilute the available heparin in 250 mL of normal saline solution prior to IV administration. C Advise the pharmacy of the need to deliver a vial of heparin to the nursing unit immediately The nurse is assessing the eyes of a client who just received mydriatic eye drops. Which physiological function of the eye will not respond during the therapeutic period after the administration of the eye drops? A Pupillary constriction. B Eye convergence. C Refraction. D Accommodation. A Pupillary constriction. Which action should the nurse implement to assess the effectiveness of amlodipine? A. Measure the client's blood pressure. B A Review the client's intake and output. C Note the client's serum calcium levels. D Monitor the client's serum electrolytes. A. Measure the client's blood pressure. The nurse administers naloxone to a client with opioid-induced respiratory depression. One hour later, a nursing assessment reveals that the client has a respiratory rate of 4 breaths/minute, an oxygen saturation of 75%, and is unable to be aroused. Which action should the nurse implement? A initiate cardiopulmonary resuscitation (CPR). B Determine Glasgow Coma Scale score. C Administer a second dose of naloxone. D Prepare to assist with chest tube insertion. C Administer a second dose of naloxone. The nurse is caring for a client receiving a prescription for sucralfate to treat a peptic ulcer. Which instruction should the nurse provide during discharge education? A Continue with normal dose schedule after missing a dose. B Administer an additional dose if a dose is missed. C Take on an empty stomach at least 1 hour before meals. D Schedule doses with each meal and at bedtime. C Take on an empty stomach at least 1 hour before meals. The nurse is providing discharge instructions to a client who has been prescribed gabapentin 300 mg by-mouth (PO) three times a day for postherpetic neuralgia. Which symptom should the nurse tell the client to report to the healthcare provider? A Gastric irritation. B Sexual dysfunction. C Photosensitivity D Rapid weight gain. D Rapid weight gain. NGN; The nurse would determine what actions to implement in an emergent situation. The client is at immediate risk for developing: anaphylaxis, cardiac arrest, and necrosis A client receives a prescription for ciprofloxacin 400 mg intravenously (IV) every 12 hours to be infused over an hour. The IV bag contains ciprofloxacin 400 mg in dextrose 5% in water (D,W) 200 mL. The nurse should program the infusion pump to deliver how many mL/hr? (Enter numerical value only.) 200ml/hr A client with a fungal infection of the toenail reports to the nurse that the client has been applying an over-the-counter (OTC) triple antibiotic ointment to the infection daily for two weeks without any improvement. Which action should the nurse take? A Advise the client to obtain a prescription-strength formulation of the ointment. B Instruct the client to obtain a prescription for oral terbinafine. C Reassure the client that treatment of fungus infected toenails often takes several months. D Suggest that the client use the ointment twice a day to be more effective. B Instruct the client to obtain a prescription for oral terbinafine. A client with chemotherapy induced nausea receives a prescription for metoclopramide. Which adverse effect is most important for the nurse to report? A Diarrrhea B Involuntary movements. C Nausea D Unusual irritability B Involuntary movements. A client with benign prostatic hyperplasia receives a new prescription of tamsulosin. Which intervention should the nurse perform to monitor for an adverse reaction? A Monitor blood pressure. B Assess urine output. C Perform a bladder scan. D Obtain daily weights. A Monitor blood pressure. The nurse is teaching a client who has been diagnosed with HIV about the antiretroviral medication regimen. Which statement provided by the client requires additional instruction by the nurse? A The viral load can be decreased to an undetectable level. B HIV infection is not cured by the antiretroviral regimen. C Antiretroviral medication prevents the transmission of the virus. D The medications can decrease acquired AIDS related complications. D The medications can decrease acquired AIDS related complications. Which intervention is most important for the nurse to implement for a client with type 2 diabetes mellitus (DM) who is receiving insulin lispro? Provide meals at the same time this insulin is given. The nurse is caring for an adult client who is taking digoxin. Which laboratory value should be reported to the healthcare provider immediately? Reference Range: Sodium [Adult 136 to 145 mEq/L (136 to 145 mmol/L)] Digoxin level [0.8 to 2.0 ng/mL (0.6 to 13 nmol/L)] Potassium (K+) adult: 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L)] Creatinine [0.5 to 1.1 mg/dL (44 to 97 mol/L)] A Sodium level of 135 mEq/L (135 mmol/L). B Potassium level of 3.2 mEq/L (3.2 mmol/L). C Digoxin level of 1.1 ng/mL (1.4 nmol/L). D Creatinine level of 0.8 mg/dL (70.72 pmol/L) B Potassium level of 3.2 mEq/L (3.2 mmol/L). The nurse is reviewing the client's laboratory values. Which serum laboratory value indicates to the nurse that a prescription for atorvastatin is having the desired effect for a client at risk for coronary artery disease? A Prothrombin time (PT). B Creatine phosphokinase (CK). C Low density lipoprotein (LDL). D. High-density lipoprotein (HDL). D. High-density lipoprotein (HDL). Which client should the nurse identify as being at highest risk for complications during the use of an opioid analgesic? A young adult with inflammatory bowel disease. Rationale: The principal indication for opioid use is acute pain, and a client with inflammatory bowel disease is at risk for toxic megacolon or paralytic ileus related to slowed peristalsis, a side effect of morphine. Adverse effects of morphine do not pose as great a risk for clients with diabetes or a fracture as for the client with bowel disease. The healthcare provider prescribes digitalis (Digoxin) for a client diagnosed with heart failure. Which intervention should the nurse implement prior to administering the digoxin? Assess the serum potassium level. Rationale: Hypokalemia (decreased serum potassium) will precipitate digitalis toxicity in persons receiving digoxin. The nurse should monitor the client's serum potassium levels. Blood pressure and respiratory rate will not inform the nurse about potential safety issues with digitalis. A client with hyperlipidemia receives a prescription for niacin (Niaspan). Which client teaching is most important for the nurse to provide? Expected duration of flushing. Rationale: Flushing of the face and neck, lasting up to an hour, is a frequent reason for discontinuing niacin. Inclusion of this effect in client teaching may promote compliance in taking the medication. While nutrition tips and managing pruritis are worthwhile instructions to help clients minimize or cope with normal side effects associated with niacin (Niaspan), flushing is intense and causes the most concern for the client. A client who was prescribed atorvastatin (Lipitor) one month ago calls the triage nurse at the clinic complaining of muscle pain and weakness in his legs. Which statement reflects the correct drug-specific teaching the nurse should provide to this client? Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect. Rationale: Myopathy, suggested by the leg pain and weakness, is a serious, and potentially life-threatening, complication of Lipitor, and should be evaluated immediately by the healthcare provider. An antacid (Maalox) is prescribed for a client with peptic ulcer disease. The nurse knows that the purpose of this medication is to maintain a gastric pH of 3.5 or above. Rationale: The objective of antacids is to neutralize gastric acids and keep pH of 3.5 or above which is necessary for pepsinogen inactivity. Which dosing schedule should the nurse teach the client to observe for a controlled-release oxycodone prescription? Every 12 hours. Rationale: A controlled-release oxycodone provides long-acting analgesia to relieve moderate to severe pain, so a dosing schedule of every 12 hours provides the best around-the-clock pain management. Controlled-release oxycodone is not prescribed for breakthrough pain on a PRN or as needed schedule. Using a schedule of every 4 to 6 hours may jeopardize patient safety due to cumulative effects. A client with osteoarthritis receives a new prescription for celecoxib (Celebrex) orally for symptom management. The nurse notes the client is allergic to sulfa. Which action is most important for the nurse to implement prior to administering the first dose? Notify the healthcare provider. Rationale: Celebrex contains a sulfur molecule, which can lead to an allergic reaction in individuals who are sensitive to sulfonamides, so the healthcare provider should be notified of the client's allergies. The nurse is assessing a client who is experiencing anaphylaxis from an insect sting. Which prescription should the nurse prepare to administer this client? Epinephrine. Rationale: Epinephrine is an adrenergic agent that stimulates beta receptors to increase cardiac automaticity in cardiac arrest and relax bronchospasms in anaphylaxis. On the ither hand, dopamine is a vasopressor used to treat clients with shock. Ephedrine causes peripheral vasoconstriction and is used in the treatment of nasal congestion. Diphenhydramine is an antihistamine decongestant used in the treatment of mild allergic reactions and motion sickness. Epinephrine is the medication of choice in treating anaphylaxis. A client is being treated for osteoporosis with alendronate (Fosamax), and the nurse has completed discharge teaching regarding medication administration. Which morning schedule would indicate to the nurse that the client teaching has been effective? Take medication, go for a 30 minute morning walk, then eat breakfast. Rationale: Alendronate (Fosamax) is best absorbed when taken thirty minutes before eating in the morning. The client should also be advised to remain in an upright position for at least thirty minutes after taking the medication to reduce the risk of esophageal reflux and irritation. After abdominal surgery, a male client is prescribed low molecular weight heparin (LMWH). During administration of the medication, the client asks the nurse why he is receiving this medication. Which is the best response for the nurse to provide? This medication is a blood thinner given to prevent blood clot formation. Rationale: Unfractionated heparin or low molecular weight heparin (LMWH) is an anticoagulant that inhibits thrombin-mediated conversion of fibrinogen to fibrin and is given prophylactically to prevent postoperative venous thrombosis in order to prevent pulmonary embolism or deep vein thrombosis following knee and abdominal surgeries. Which symptoms are serious adverse effects of beta-adrenergic blockers such as propranolol (Inderal)? Wheezing, hypotension, and AV block. Rationale: Wheezing, hypotension, and AV block represents the most serious adverse effects of beta-blocking agents. AV block is generally associated with bradycardia and results in potentially life-threatening decreases in cardiac output. Additionally, wheezing secondary to bronchospasm and hypotension represent life-threatening respiratory and cardiac disorders. Following the administration of sublingual nitroglycerin to a client experiencing an acute anginal attack, which assessment finding indicates to the nurse that the desired effect has been achieved? Client states chest pain is relieved. Rationale: Nitroglycerin reduces myocardial oxygen consumption which decreases ischemia and reduces chest pain. A client is receiving digoxin for the onset of supraventricular tachycardia (SVT). Which laboratory finding should the nurse identify that places this client at risk? Hypokalemia. Rationale: Hypokalemia affects myocardial contractility and places this client at greatest risk for dysrhythmias that may be unresponsive to drug therapy. Although an imbalance of serum sodium and calcium can effect cardiac rhythm, the greatest risk for the client receiving digoxin is low potassium. A client is admitted to the hospital for diagnostic testing for possible myasthenia gravis. The nurse prepares for intravenous administration of edrophonium chloride (Tensilon). What is the expected outcome for this client following administration of this pharmacologic agent? Decreased muscle weakness. Rationale: Administration of edrophonium chloride (Tensilon), a cholinergic agent, will temporarily reduce muscle weakness, the most common complaint of newly-diagnosed clients with myasthenia gravis. This medication is used to diagnose myasthenia gravis due to its short duration of action. This drug would temporarily reverse difficulty in swallowing and respiratory effort. In teaching a client who had a liver transplant about cyclosporine (Sandimmune), the nurse should encourage the client to report which adverse response to the healthcare provider? Presence of hand tremors. Rationale: Neurological complications, such as hand tremors, occur in about 50% of clients taking cyclosporine and should be reported. Although this drug can be nephrotoxic, changes in urine color typically does not occur. Nausea is a common side effects, but is not usually severe. A client has a continuous IV infusion of dopamine (Intropin) and an IV of normal saline at 50 ml/hour. The nurse notes that the client's urinary output has been 20 ml/hour for the last two hours. Which intervention should the nurse initiate? Notify the healthcare provider of the urinary output. Rationale: The main effect of dopamine is adrenergic stimulation used to increase cardiac output, which should also result in increased urinary output. A urinary output of less than 20 ml/hour is oliguria and should be reported to the healthcare provider, so the dose of dopamine can be adjusted. Depending on the current rate of administration, the dose may need to be increased or decreased. Which nursing diagnosis is important to include in the plan of care for a client receiving the angiotensin-2 receptor antagonist irbesartan (Avapro)? Risk for injury. Rationale: Avapro is an antihypertensive agent, which acts by blocking vasoconstrictor effects at various receptor sites. This can cause hypotension and dizziness, placing the client at high risk for injury A medication that is classified as a beta-1 agonist is most commonly prescribed for a client with which condition? Heart failure. Rationale: Beta-1 agonists improve cardiac output by increasing the heart rate and blood pressure and are indicated in heart failure, shock, atrioventricular block dysrhythmias, and cardiac arrest. In contrast, glaucoma is managed using adrenergic agents and beta-adrenergic blocking agents. Beta-1 blocking agents are used in the management of hypertension. Medications that stimulate beta-2 receptors in the bronchi are effective for bronchoconstriction in respiratory disorders, such as asthma. Which method of medication administration provides the client with the greatest first-pass effect? Oral. Rationale: The first-pass effect is a pharmacokinetic phenomenon that is related to the drug's metabolism in the liver. After oral medications are absorbed from the gastrointestinal tract, the drug is carried directly to the liver via the hepatic portal circulation where hepatic inactivation occurs and reduces the bioavailability of the drug. Alternative method of administration, such as sublingual, IV, and subcutaneous routes, avoid this first-pass effect. A female client with rheumatoid arthritis take ibuprofen (Motrin) 600 mg PO 4 times a day. To prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is prescribed. Which information is most important for the nurse to include in client teaching? Use contraception during intercourse. Rationale: Cytotec, a synthetic form of a prostaglandin, is classified as pregnancy Category X and can act as an abortifacient, so the client should be instructed to use contraception during intercourse to prevent loss of an early pregnancy. A common side effect of Cytotec is diarrhea, so constipation prevention strategies are usually not needed. Cytotec and Motrin should be taken together to provide protective properties against gastrointestinal bleeding. The nurse is reviewing the use of the patient-controlled analgesia (PCA) pump with a client in the immediate postoperative period. The client will receive morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes per PCA to total 5 mg IV maximally per hour. What assessment has the highest priority before initiating the PCA pump? The rate and depth of the client's respirations. Rationale A life-threatening side effect of intravenous administration of morphine sulfate, an opiate narcotic, is respiratory depression. Prior to the initiation of the PCA pump, the nurse should assess the client's respirations to obtain a baseline of their respiratory rate and depth. Once the PCA pump is initiated and if the client's respiratory rate falls below 12 breaths per minute, the PCA pump should be stopped and the healthcare provider notified immediately. Which action is most important for the nurse to implement prior to the administration of the antiarrhythmic drug adenosine (Adenocard)? Apply continuous cardiac monitoring. Rationale: Adenosine (Adenocard) is an antiarrhythmic drug used to restore a normal sinus rhythm in clients with rapid supraventricular tachycardia. The client's heart rate should be monitored continuously for the onset of additional arrhythmias while receiving adenosine. A client is receiving methylprednisolone (Solu-Medrol) 40 mg IV daily. The nurse anticipates an increase in which laboratory value as the result of this medication? Serum glucose. Rationale: Solu-Medrol is a corticosteroid with glucocorticoid and mineralocorticoid actions. These effects can lead to hyperglycemia which is reflected as an increase in the serum glucose value. The client taking Solu-Medrol is also at risk for hypocalcemia and hypokalemia which result in a decrease in the serum calcium and serum potassium levels. These medications also alter the some of the body's immune responses by suppressing the migration of white blood cells decreasing inflammation response. 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? Discontinue the IV fluids. Rationale: Doxorubicin is an antineoplastic agent that causes inflammation, blistering, and necrosis of tissue upon extravasation. First, all IV fluids should be discontinued at the site to prevent further tissue damage by the vesicant. A category X drug is prescribed for a young adult female client. Which instruction is most important for the nurse to teach this client? Use a reliable form of birth control. Rationale Drugs classified in the category X place a client who is in the first trimester of pregnancy at risk for teratogenesis, so women in the childbearing years should be counseled to use a reliable form of birth control during drug therapy. If the client is planning to become pregnant, she should be encouraged to discuss plans for pregnancy with the healthcare provider, so a safer alternative prescription can be provided if pregnancy occurs. The nurse is preparing the 0900 dose of losartan (Cozaar), an angiotensin II receptor blocker (ARB), for a client with hypertension and heart failure. The nurse reviews the client's laboratory results and notes that the client's serum potassium level is 5.9 mEq/L. What action should the nurse take first? Withhold the scheduled dose. Rationale The nurse should first withhold the scheduled dose of Cozaar because the client is hyperkalemic (normal range 3.5 to 5 mEq/l). Although hypokalemia is usually associated with diuretic therapy in heart failure, hyperkalemia is associated with several heart failure medications, including ARBs. Because hyperkalemia may lead to cardiac dysrhythmias, the nurse should check the apical pulse for rate and rhythm, and the blood pressure. 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? Lessening of tremors. Rationale Sinemet increases the amount of levodopa to the CNS (dopamine to the brain). Increased amounts of dopamine improve the symptoms of Parkinson's, such as involuntary movements, resting tremors, shuffling gait, etc. Decreased drooling would be a desired effect, not increased salivation. Which medications should the nurse caution the client about taking while receiving an opioid analgesic? Benzodiazepines. Rationale Respiratory depression increases with the concurrent use of opioid analgesics and other central nervous system depressant agents, such as alcohol, barbiturates, and benzodiazepines. Antacids and antidiabetic agents do not interact with opiates to produce adverse effects. Antihypertensives may cause morphine-induced hypotension, but should not be withheld without notifying the healthcare provider. An adult client is given a prescription for a scopolamine patch (Transderm Scop) to prevent motion sickness while on a cruise. Which information should the nurse provide to the client? Apply the patch at least 4 hours prior to departure. Rationale Scopolamine, an anticholinergic agent, is used to prevent motion sickness and has a peak onset in 6 hours, so the client should be instructed to apply the patch at least 4 hours before departure on the cruise ship. The duration of the transdermal patch is 72 hours. Scolopamine blocks muscarinic receptors in the inner ear and to the vomiting center, so the best application site of the patch is behind the ear. Anticholinergic medications are CNS depressants, so the client should be instructed to avoid alcohol while using the patch. A client who has been taking levodopa PO TID to control the symptoms of Parkinson's disease has a new prescription for sustained release levodopa/carbidopa (Sinemet 25/100) PO BID. The client took his levodopa at 0800. Which instruction should the nurse include in the teaching plan for this client? "You can begin taking the Sinemet this evening, but do not take any more levodopa." Rationale Carbidopa significantly reduces the need for levodopa in clients with Parkinson's disease, so the new prescription should not be started until eight hours after the previous dose of levodopa, but can be started the same day. A postoperative client has been receiving a continuous IV infusion of meperidine (Demerol) 35 mg/hr for four days. The client has a PRN prescription for Demerol 100 mg PO q3h. The nurse notes that the client has become increasingly restless, irritable and confused, stating that there are bugs all over the walls. What action should the nurse take first? Decrease the IV infusion rate of the meperidine (Demerol) per protocol. Rationale The client is exhibiting symptoms of Demerol toxicity which is consistent with the large doses of Demerol received over four days. Decreasing the infusion rate of the Demerol as per protocol is the most effective action to immediately decrease the amount of serum Demerol. The next nursing action is for the nurse to notify the healthcare provider. A client with giardiasis is taking metronidazole (Flagyl) 2 grams PO. Which information should the nurse include in the client's instruction? Take the medication with food. Rationale Flagyl, an amoebicide and antibacterial agent, may cause gastric distress, so the client should be instructed to take the medication on a full stomach. Urine may be red-brown or dark from Flagyl, but this side effect is an expectant finding and not necessary to report tot he healthcare provider. Which antidiarrheal agent should be used with caution in clients taking high dosages of aspirin for arthritis? Bismuth subsalicylate (Pepto Bismol). Rationale Bismuth subsalicylate (Pepto Bismol) contains a subsalicylate that increases the potential for salicylate toxicity when used concurrently with aspirin (acetylsalicylic acid, another salicylate preparation). A client asks the nurse if glipizide (Glucotrol) is an oral insulin. Which response should the nurse provide? "No, it is not an oral insulin and can be used only when some beta cell function is present." Rationale An effective oral form of insulin has not yet been developed because when insulin is taken orally, it is destroyed by digestive enzymes. Glipizide (Glucotrol) is an oral hypoglycemic agent that enhances pancreatic production of insulin. Which nursing intervention is most important when caring for a client receiving the antimetabolite cytosine arabinoside (Arc-C) for chemotherapy? Inspect the client's oral mucosa for ulcerations. Rationale Cytosine arabinoside (Arc-C) affects the rapidly growing cells of the body, therefore stomatitis and mucosal ulcerations are key signs of antimetabolite toxicity. Which drug is used as a palliative treatment for a client with tumor-induced spinal cord compression? Dexamethasone (Decadron). Rationale Dexamethasone is a palliative treatment modality to manage symptoms related to compression due to tumor growth ( the focus of this question). Morphine sulphate is an opioid analgesic used in oncology to manage severe or intractable pain. Ibuprofen, a nonsteroidal antiinflammatory drug (NSAID), provides relief for mild to moderate pain, suppression of inflammation, and reduction of fever. Amitriptyline, a tricyclic antidepressant, is often prescribed for pain related to neuropathic origin and provides a reduction in opioid dosage. A client's dose of isosorbide dinitrate (Imdur) is increased from 40 mg to 60 mg PO daily. When the client reports the onset of a headache prior to the next scheduled dose, which action should the nurse implement? Administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol). Rationale Imdur is a nitrate which causes vasodilation. This vasodilation can result in headaches, which can generally be controlled with acetaminophen until the client develops a tolerance to this adverse effect. The nitrate isosorbide dinitrate (Isordil) is prescribed for a client with angina. Which instruction should the nurse include in this client's discharge teaching plan? Do not get up quickly. Always rise slowly. Rationale An expected side effect of nitrates is orthostatic hypotension and the nurse should address how to prevent it--by rising slowly. A client is receiving clonidine (Catapres) 0.1 mg/24hr via transdermal patch. Which assessment finding indicates that the desired effect of the medication has been achieved? Blood pressure has changed from 180/120 to 140/70 mmHg. Rationale Catapres acts as a centrally-acting analgesic and antihypertensive agent. A reduction of the blood pressure to 140/70 mmHg indicates a reduction in hypertension. Dobutamine (Dobutrex) is an emergency drug most commonly prescribed for a client with which condition? Heart failure. Rationale Dobutamine is a beta-1 adrenergic agonist that is indicated for short term use in cardiac decompensation or heart failure related to reduced cardiac contractility due to organic heart disease or cardiac surgical procedures. On the other hand, alpha and beta adrenergic agonists, such as epinephrine and dopamine, are sympathomimetics used in the treatment of shock. Other selective beta-2 adrenergic agonists, such as terbutaline and isoproterenol, are indicated in the treatment of asthma. Although dobutamine improves cardiac output, it is not used to treat hypotension. A client is being treated for hyperthyroidism with propylthiouracil (PTU). The nurse knows that the action of this drug is to inhibit synthesis of T3 and T4 by the thyroid gland Rationale PTU is an adjunct therapy used to control hyperthyroidism by inhibiting production of thyroid hormones. It is often prescribed in preparation for thyroidectomy or radioactive iodine therapy. 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? Abdomen. Rationale Acetaminophen toxicity can result in liver damage; therefore, it is especially important for the nurse to assess for pain in the right upper quadrant of the abdomen, which might indicate liver damage, along with nausea and vomiting. A client has myxedema, which results from a deficiency of thyroid hormone synthesis in adults. The nurse knows that which medication would be contraindicated for this client? Pentobarbital sodium (Nembutal Sodium) for sleep. Rationale Persons with myxedema are dangerously hypersensitive to narcotics, barbiturates and anesthetics. The nurse is teaching a client with cancer about opioid management for intractable pain and tolerance related side effects. The nurse should prepare the client for which side effect that is most likely to persist during long-term use of opioids? Constipation. Rationale The client should be prepared to implement measures for constipation which is the most likely persistent side effect related to opioid use. Tolerance to opiate narcotics is common, and the client may experience less sedation and respiratory depression as analgesic use continues. Opioids increase the tone in the urinary bladder sphincter, which causes retention but may subside. The most likely persistent side effect is constipation. An older client with a decreased percentage of lean body mass is likely to receive a prescription that is adjusted based on which pharmacokinetic process? Distribution. Rationale A decreased lean body mass in an older adult affects the distribution of drugs which affects the pharmacokinetics of drugs. In contrast, decreased gastric pH, delayed gastric emptying, decreased splanchnic blood flow, decreased gastrointestinal absorption surface areas and motility affect absorption in the older adult population. Decreased hepatic blood flow, decreased hepatic mass, and decreased activity of hepatic enzymes affect metabolism in older adults. Decreased renal blood flow, decreased glomerular filtration rate, decreased tubular secretion, and decreased number of nephrons affects elimination in an older adult. A client is receiving ampicillin sodium (Omnipen) for a sinus infection. The nurse should instruct the client to notify the healthcare provider immediately if which symptom occurs? Rash. Rationale Rash is the most common adverse effect of all penicillins, indicating an allergy to the medication which could result in anaphylactic shock, a medical emergency. The nurse is transcribing a new prescription for spironolactone (Aldactone) for a client who receives an angiotensin-converting enzyme (ACE) inhibitor. Which action should the nurse implement? Verify both prescriptions with the healthcare provider. Rationale The concomitant use of an angiotensin-converting enzyme (ACE) inhibitor and a potassium-sparing diuretic such as spironolactone, should be given with caution because the two drugs may interact to cause an elevation in serum potassium levels. Although the client is currently receiving an ACE inhibitor, verifying both prescriptions alerts the healthcare provider about the client's medication regimen and provides the safest action before administering the medication. Upon admission to the emergency center, an adult client with acute status asthmaticus is prescribed this series of medications. In which order should the nurse administer the prescribed medications? (Arrange from first to last.) 1. Albuterol (Proventil) puffs. 2. Salmeterol (Serevent Diskus). 3. Prednisone (Deltasone) orally. 4. Gentamicin (Garamycin) IM. Rationale Status asthmaticus is potentially a life-threatening respiratory event, so albuterol, a beta2 adrenergic agonist and short acting bronchodilator, should be administered by inhalation first to provide rapid and deep topical penetration to relieve bronchospasms, dilate the bronchioles, and increase oxygenation. In stepwise management of persistent asthma, a long-action bronchodilator, such as salmeterol (Serevent Diskus), with a 12-hour duration of action should be given next. Prednisone, an oral corticosteroid, provides prolonged anti-inflammatory effects and should be given after the client's respiratory distress begins to resolves. Gentamicin, an antibiotic, is given deep IM, which can be painful, and may require repositioning the client, so should be last in the sequence. A client with heart failure (HF) is being discharged with a new prescription for the angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten). The nurse's discharge instruction should include reporting which problem to the healthcare provider? Dizziness. Rationale Angiotensin-converting enzyme (ACE) inhibitors are used in HF to reduce afterload by reversing vasoconstriction common in heart failure. This vasodilation can cause hypotension and resultant dizziness. Weight loss is desired if fluid overload is present, and may occur as the result of effective combination drug therapy such as diuretics with ACE inhibitors. It does not reuiqre reporting to the healthcare provider. Unlike ACE inhibitors, diuretics may result in hypokalemia and excessive diuretic administration may result in fluid volume deficit manifested by symptoms of dehydration. A client is taking hydromorphone (Dilaudid) PO q4h at home. Following surgery, Dilaudid IV q4h PRN and butorphanol tartrate (Stadol) IV q4h PRN are prescribed for pain. The client received a dose of the Dilaudid IV four hours ago, and is again requesting pain medication. What intervention should the nurse implement? Administer only the Dilaudid q4h PRN for pain. Rationale Dilaudid is an opioid agonist. Stadol is an opioid agonist-antagonist. Use of an agonist-antagonist for the client who has been receiving opioid agonists may result in abrupt withdrawal symptoms, and should be avoided. A client receiving albuterol (Proventil) tablets complains of nausea every evening with her 9:00 p.m. dose. What action can the nurse take to alleviate this side effect? Administer the dose with a snack. Rationale Administering oral doses of albuterol with food helps minimize GI discomfort. A client with coronary artery disease who is taking digoxin (Lanoxin) receives a new prescription for atorvastatin (Lipitor). Two weeks after initiation of the Lipitor prescription, the nurse assesses the client. Which finding requires the most immediate intervention? Vomiting. Rationale Vomiting, anorexia and abdominal pain are early indications of digitalis toxicity. Since Lipitor increases the risk for digitalis toxicity, this finding requires the most immediate intervention by the nurse. A client with heart failure is prescribed spironolactone (Aldactone). Which information is most important for the nurse to provide to the client about diet modifications? Refrain for eating foods high in potassium. Rationale Spironolactone (Aldactone), an aldosterone antagonist, is a potassium-sparing diuretic, so a diet high in potassium should be avoided, along with table salt substitutes which are generally contain potassium chloride which can lead to hyperkalemia. A peak and trough level must be drawn for a client receiving antibiotic therapy. What is the optimum time for the nurse to obtain the trough level? Immediately before the next antibiotic dose is given. Rationale Trough levels are drawn when the blood level is at its lowest, which is typically just before the next dose is given. Which instruction(s) should the nurse give to a female client who just received a prescription for oral metronidazole (Flagyl) for treatment of trichomonas vaginalis? (Select all that apply.) Increase fluid intake, especially cranberry juice., Avoid drinking alcohol while taking this medication., Use condoms until treatment is completed., Ensure that all sexual partners are treated at the same time Rationale Increased fluid intake and cranberry juice are recommended for prevention and treatment of urinary tract infections, which frequently accompany vaginal infections. It is not necessary to taper use of this drug or to check the blood pressure daily, as this condition is not related to hypertension. Flagyl can cause a disulfiram-like reaction if taken in conjunction with ingestion of alcohol, so the client should be instructed to avoid alcohol. All sexual partners should be treated at the same time and condoms should be used until after treatment is completed to avoid reinfection. In evaluating the effects of lactulose (Cephulac), which outcome would indicate that the drug is performing as intended? Two or three soft stools per day Rationale The medication lactulose can be administered for either chronic constipation or for portal-systemic encephalopathy in clients with hepatic disease. Two to three stools a day indicate that lactulose is performing as intended for chronic constipation. This would also indicate it should be effective for the clients with encephalopathy because the lactulose's action prevents absorption of ammonia in the colon as it increases water absorption and softens the stool. The efficacy of the use for ammonia absorption would have to be verified by a serum ammonia level and observation of clearing of the client's mental status. An adult client has prescriptions for morphine sulfate 2.5 mg IV q6h and ketorolac (Toradol) 30 mg IV q6h. Which action should the nurse implement? Administer both medications according to the prescription. Rationale Morphine and ketorolac (Toradol) can be administered concurrently, and may produce an additive analgesic effect, resulting in the ability to reduce the dose of morphine, as seen in this prescription. Toradol is an antiinflammatory analgesic, and does not have an antagonistic effect with morphine. A 43-year-old female client is receiving thyroid replacement hormone following a thyroidectomy. What adverse effects associated with thyroid hormone toxicity should the nurse instruct the client to report promptly to the healthcare provider? Tachycardia and chest pain. Rationale Thyroid replacement hormone increases the metabolic rate of all tissues, so common signs and symptoms of toxicity include tachycardia and chest pain. Following heparin treatment for a pulmonary embolism, a client is being discharged with a prescription for warfarin (Coumadin). In conducting discharge teaching, the nurse advises the client to have which diagnostic test monitored regularly after discharge? Prothrombin Time (PT/INR). Rationale When used for a client with pulmonary embolus, the therapeutic goal for warfarin therapy is a PT 1 to 2 times greater than the control, or an INR of 2 to 3. A client is admitted to the coronary care unit with a medical diagnosis of acute myocardial infarction. Which medication prescription decreases both preload and afterload? Nitroglycerin. Rationale Nitroglycerin is a nitrate that causes peripheral vasodilation and decreases contractility, thereby decreasing both preload and afterload. The nurse is assessing the effectiveness of high dose aspirin therapy for an 88-year-old client with arthritis. The client reports that she can't hear the nurse's questions because her ears are ringing. What action should the nurse implement? Notify the healthcare provider of this finding immediately. Rationale Tinnitus is an early sign of salicylate toxicity. The healthcare provider should be notified immediately, and the medication discontinued. While taking a nursing history, the client states, "I am allergic to penicillin." What related allergy to another type of antiinfective agent should the nurse ask the client about when taking the nursing history? Cephalosporins. Rationale If a client has a history of being allergic to penicillin (PCN); there is appears to be a cross sensitivity between penicillins and 1st generation cephalosporins. According to research, there appears to be no cross sensitivity between PCN and 3rd or 4th generation cephalosporins. 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? Another type of nonsteroidal antiinflammatory drug may be indicated. Rationale Individual responses to nonsteroidal antiinflammatory drugs are vary from person to person, so another nonsteroidal antiinflammatory drug (NSAID) may be indicated for this particular client. A client with a dysrhythmia is to receive procainamide (Pronestyl) in 4 divided doses over the next 24 hours. What dosing schedule is best for the nurse to implement? q6h. Rationale Pronestyl is a class 1A antidysrhythmic. It should be taken around-the-clock, so that a stable blood level of the drug can be maintained, thereby decreasing the possibility of hypotension (an adverse effect) occurring because of too much of the drug circulating systemically at any particular time of day. Pronestyl may be given with food if GI distress is a problem. Which change in data indicates to the nurse that the desired effect of the angiotensin II receptor antagonist valsartan (Diovan) has been achieved? Blood pressure reduced from 160/90 to 130/80. Rationale Diovan is an angiotensin receptor blocker, prescribed for the treatment of hypertension. The desired effect is a decrease in blood pressure. A client is receiving metoprolol (Lopressor SR, Nu-Metop). What assessment is most important for the nurse to obtain? Blood pressure. Rationale It is most important to monitor the blood pressure of clients taking this medication because metoprolol is an antianginal, antiarrhythmic, antihypertensive agent. The healthcare provider prescribes naloxone (Narcan) for a client in the emergency room. Which assessment data would indicate that the naloxone has been effective? The client's respiratory rate is 16 breaths/minute. Rationale Naloxone (Narcan) is a narcotic antagonist that reverses the respiratory depression effects of opiate overdose, so assessment of a normal respiratory rate would indicate that the respiratory depression has been reversed. The nurse is aware that the older adult client is at an increased risk for surgical complications due to normal physiological functions and comorbidities. Which risk factors place the older adult client at increased risk for surgical complications? Decreased respiratory muscle strength. Upon completing the client's assessment, the nurse determines that the client has which surgical risk factors? (Select all that apply.) metroprolol, poor appetite, diabetes mellitus, albumin 3.0 g/dL (30 g/L) What is the priority preoperative nursing action to prevent postoperative atelectasis? Instruct on incentive spirometer use. Which is the likely reason for the elevated serum creatinine in the absence of kidney disease? Dehydration The nurse is caring for the client who has just been extubated. What should the nurse do first, after the client is extubated? Administer supplemental oxygen. One hour has passed since the client was extubated. Which nursing actions take priority at this time? (Select all that apply.) monitor respiratory rate, assess cardiac rhythm After recovering in the PACU for 2 hours, the client is transferred to the medical intensive care unit (MICU) for observation. Upon transfer to the MICU, the assessment reveals:NeurologicalTemp 97.2°F (36.2°C)Drowsy but easily arousable and oriented x3CardiacHeart Rate 86 beats/minBlood pressure 140/88 mmHgNormal sinus rhythm on the telemetry monitorPulmonaryRespirations 16 breaths/minExtubated 2 hours agoLungs clear bilaterallyCoughs and takes deep breaths with encouragement from nurse.GIBowel sounds active in all quadrantsDenies nauseaBlood glucose 142 mg/dL (7.88 mmol/L)GUIndwelling catheter with 400 mL of clear, amber urineIntegumentarySurgical incision well approximated with staples, no redness notedClient states that pain is 8/10Postoperative OrdersActivity: BedrestDiet: NPO except medicationsMedications:Sodium lactate 100 mL/hourMetoprolol 25 mg by mouth twice daily, first dose statOndansetron 4 mg intravenous push every 4 hours PRN nausea/vomitingAcetaminophen 650 mg by mouth every 4 hours PRN fever/mild painMorphine 1 mg intravenous push every 3 hours severe painMetformin 1000 mg by mouth twice dailyInsulin Lispro per sliding scaleLabs: Complete blood count (CBC) and comprehensive metabolic panel (CMP) in a.m. Based on the nurse's assessment, which is the priority nursing action? administer morphine Based on the healthcare provider's (HCP) prescription, the pharmacy dispenses morphine 4 mg per 1 mL. How many mL should the nurse administer to the client? (Enter numerical value only. If rounding is required, round to the nearest hundredth.) 0.25 Upon reviewing the remaining postoperative orders and comparing with preoperative orders, the nurse realizes that the metformin doses are different. What is the nurse's priority action? Contact the HCP for clarification. The client's spouse inquires about the client's blood sugar because she has never seen it that high, and she reports that the client isn't even eating. What is the nurse's best response? Stress can increase blood sugars. After reviewing the client's assessment data, what is the nurse's priority action? Notify the HCP of the findings. The client's spouse asks why the antibiotic is being delayed to obtain lab tests. What is the nurse's best response? It improves the chance of identifying the bacteria that is making your husband sick. Based on the client's respiratory assessment, which is the priority nursing action? Encourage coughing and deep breathing. After giving report, the nurse transfers client back to the MICU. Which of the client's signs and symptoms cue the MICU nurse to determine if the client continues to have sepsis? (Select all that apply.) hypothermia, altered mental status, tachycardia, leukocytosis, tachypnea Client is increasingly restless overnight, despite antibiotics. He has tachycardia with his heart rate in the 120s. His respiratory rate is 30 breaths/min. The HCP orders arterial blood gases (ABGs). The results are as follows:pH 7.50PaCO2 30 mmHg (3.99 kPa)HCO3 24 mEq/L (mmol/L) The nurse knows that the client is in which acid-base imbalance? Respiratory alkalosis. Which is the primary cause of respiratory alkalosis? Hypoxemia related to acute lung disorders. Before the nurse can notify the HCP of the ABG results, the telemetry monitor starts to alarm. It indicates the client is in ventricular tachycardia. What is the nurse's first action? Assess the client. The nurse goes to the room to assess client. She finds his spouse at the bedside, screaming and crying and saying, that she can't wake him up. Using the American Heart Association's Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) algorithm, what is the nurse's priority action? Assess carotid artery. The nurse assessing the client's carotid artery reports no pulse is found. What is the nurse's priority action? Activate a code. The code team arrives with the crash cart. The carotid artery is reassessed and there is still no pulse. Cardiac leads are placed, compressions are stopped during rhythm assessment and pulseless ventricular tachycardia is confirmed. Compressions were continued during lead placement and immediately re-started post rhythm assessment while the AED charged. Which is the priority nursing action? Shock the client's chest. After shocking the client's chest, what is the nurse's next action? Begin chest compressions. The client remains in pulseless ventricular tachycardia and is unresponsive. The team intubates him and administers the second shock. What medication does the nurse anticipate administering after the second shock? Epinephrine Which is the primary reason for administering epinephrine 1 mg every 3 to 5 minutes during a cardiac arrest? Increases cardiac output. Despite the team's efforts, client remains unresponsive and the telemetry monitor shows asystole. Client's spouse who has been in the room the entire time, asks the team to stop. She cannot bear to see her husband's chest crushed anymore. What is the nurse's next action? Stop coding the client. Thirty minutes after ending the code, client succumbs to his illness. His spouse is crying uncontrollably. She begins to talk about how she is going to have a har