A nurse is conducting medication reconciliation for a client who is newly admitted to the
facility. Which of the following actions should the nurse take first? - Answer Ask the
client which herbal supplements he takes.
When using the nursing process, the first action the nurse should take is to assess the
client by completing a comprehensive review of prescribed and over-the-counter
medications, as well as herbal and nutritional supplements the client takes. The nurse
should obtain a comprehensive list in order to identify duplications as well as any
possible contraindications or interactions between medications.
A nurse is preparing to administer the first dose of clarithromycin to a client who has
pneumonia. For which of the following adverse reactions should the nurse monitor? -
Answer Diarrhea
Clarithromycin can cause pseudomembranous colitis, an adverse effect of the
medication, which is characterized by frequent, loose stools. The nurse should monitor
for and report the development of diarrhea in the client to the provider.
A nurse is admitting a client who has a history of type 2 diabetes mellitus following a CT
scan with contrast to diagnose the presence of renal calculi. The nurse should expect to
withhold which of the following of the client's home medications? - Answer Metformin
Metformin is a biguanide that is used in the management of type 2 diabetes mellitus. It
is contraindicated for the client for 48 hr following the administration of contrast media to
prevent the development of acute kidney injury. The nurse should expect that the
provider will withhold the metformin and prescribe another medication, such as insulin,
to provide glucose control in the interim.
A nurse is preparing to administer bumetanide to a client who has heart failure. For
which of the following findings should the nurse withhold the medication and contact the
provider? - Answer BP 84/50 mm Hg
Bumetanide is a loop diuretic that acts to decrease circulating fluid volume. It is useful in
the treatment of pulmonary edema and heart failure. The nurse should monitor the
client's BP and, if the client is hypotensive, the nurse should withhold the medication
and notify the provider.
A nurse is admitting a client who has pneumonia and is reviewing the client's medication
prescriptions. The nurse should identify which of the following medications as the
priority to administer? - Answer Clarithromycin
The client who presents with community-acquired pneumonia should receive antibiotic
treatment within the first 6 hr of admission. This limits complications such as sepsis and
mortality. The greatest risk to this client is injury from infection. Therefore, the priority
medication for the nurse to administer is the clarithromycin.