Angelite Nurses

Source: Saunders Q&A Review 3rd edition

1. A client with myasthenia gravis reports the occurrence of difficulty

chewing. The physician prescribes pyridostigmine bromide (Mestinon)

to increase muscle strength for this activity. The nurse instructs the

client to take the medication at what time, in relation to meals?

a. after dinner daily when most fatigued

b. before breakfast daily

c. as soon as arising in the morning

d. thirty minutes before each meal

Pyridostigmine is a cholinergic medication used to increase muscle strength

for the client with myasthenia gravis. For the client who has difficulty

chewing, the medication should be administered 30 minutes before meals to

enhance the client’s ability to eat.

2. A client is advised to take senna (Senokot) for the treatment of

constipation asks the nurse how this medication works. The nurse

responds knowing that it:

a. accumulates water in the stool and increases peristalsis

b. stimulates the vagus nerve

c. coats the bowel wall

d. adds fiber and bulk to the stool

Senna works by changing the transport of water and electrolytes in the large

intestine, which causes the accumulation of water in the mass of stool and

increased peristalsis.

3. A client is receiving heparin sodium by continuous intravenous

infusion. The nurse monitors the client for which adverse effect of this

therapy?

a. decreased blood pressure

b. increased pulse rate

c. ecchymoses

d. tinnitus

Heparin sodium is an anticoagulant. The client who receives heparin sodium

is at risk for bleeding. The nurse monitors for signs of bleeding, which

includes bleeding from the gums, ecchymoses on the skin, cloudy or pink-

tinged urine, tarry stools, and body fluids that test positive for occult blood.

4. A client is being treated for acute congestive heart failure (CHF) and

the client’s vital signs are as follows: BP 85/50 mm Hg; pulse, 96

bpm; respirations, 26 cpm. The physician prescribes digoxin (Lanoxin).

To evaluate a therapeutic effectiveness of this medication, the nurse

would expect which of the following changes in the client’s vital signs?

a. BP 85/50 mm Hg, pulse 60 bpm, respirations 26 cpm

b. BP 98/60 mm Hg, pulse 80 bpm, respirations 24 cpm

c. BP 130/70 mm Hg, pulse 104 bpm, respirations 20 cpm

d. BP 110/40 mm Hg, 110 bpm, respirations 20 cpm

The main function of digoxin is inotropic. It produces increased myocardial

contractility that is associated with an increased cardiac output. This causes a

rise in the BP in a client with CHF. Digoxin also has a negative chronotropic

effect (decreases heart rate) and will therefore cause a slowing of the heart

rate. As cardiac output improves, there should be an improvement in

respirations as well.

5. Diazepam (Valium) is prescribed for a client with anxiety. The nurse

instructs the client to expect which side effect?

a. incoordination

b. cough

c. tinnitus

d. hypertension

Valium, a benzodiazepine, can cause motor incoordination and ataxia and

safety precautions should be instituted for clients taking this medication.

6. A client receives oxytocin (Pitocin) to induce labor. During the

administration of the oxytocin, it is most important for the nurse to

monitor:

a. urinary output

b. fetal heart rate

c. central venous pressure

d. maternal blood glucose

Pitocin produces uterine contractions. Uterine contractions can cause fetal

anoxia. The nurse monitors the fetal heart rate and notifies the physician of

any significant changes.

7. A clinic nurse is performing assessment on a client who is being seen

in the clinic for the first time. When asking about the client’s

medication history, the client tells the nurse that he takes nateglinide

(Starlix). The nurse then questions the client about the presence of

which disorder that is treated with this medication?

a. hypothyroidism

b. insomnia

c. type 2 diabetes mellitus

d. renal failure

Nateglinide (Starlix) is an antidiabetic medication used to treat type 2

diabetes mellitus in clients whose disease cannot be adequately controlled

with diet and exercise. It stimulates the release of insulin from beta cells of

the pancreas by depolarizing beta cells, leading to an opening of calcium

channels. Resulting calcium influx induces insulin secretion.

8. A client who is taking rifampin (Rifadin) as part of the medication

regimen for the treatment of tuberculosis calls the clinic nurse and

reports that her urine is a red-orange color. The nurse tells the client

to:

a. come to the clinic to provide a urine sample

b. stop the medication until further instructions are given by the

physician

c. take the medication dose with an antacid to prevent this adverse

effect

d. expect a red-orange color in urine, feces, sweat, sputum,

and tears as a harmless side effect

Rifampin (Rifadin) is an antitubercular medication used in conjunction with at

least one other antitubercular agent for initial treatment or retreatment of

tuberculosis. Urine, feces, sputum, sweat, and tears may become red-orange

in color. The client should also be told that soft contact lenses may become

permanently stained as a result of this harmless side effect. There is no

useful reason for the client to provide a urine sample. The client is not told to

stop a medication. Antacids are not usually taken with a medication because

of interactive effects.

9. A nurse is caring for a client with a tracheostomy that has been

diagnosed with a respiratory infection. The client is receiving

vancomycin hydrochloride (Vancocin) 500 mg intravenously every 12

hours. Which of the following would indicate to the nurse that the

client is experiencing an adverse effect of the medication?

a. decreased hearing acuity

b. photophobia

c. hypotension

d. bradycardia

Vancomycin hydrochloride (Vancocin) is an antibiotic. Adverse and toxic

effects include nephrotoxicity characterized by a change in the amount or

frequency of urination, anorexia, nausea, vomiting, and increased thirst;

ototoxicity characterized by hearing loss due to damage to the auditory

branch of the eight cranial nerve; and red-neck syndrome from too rapid

injection of the medication characterized by chills, fever, fast heartbeat,

nausea, vomiting, itching, rash and redness on the face, neck, arms, and

back. When this medication is administered to a client, nursing

responsibilities include monitoring renal function laboratory results, intake

and output, and hearing acuity.

10. A nurse is caring for a client with a diagnosis of metastatic breast

carcinoma who is receiving tamoxifen citrate (Nolvadex) 10 mg orally

twice daily. Which of the following would indicate to the nurse that the

client is experiencing a side effect related to the medication?

a. hypetension

b. diarrhea

c. nose bleeds

d. vaginal bleeding

Tamoxifen citrate is an antineoplastic medication that competes with

estradiol for binding to estrogen in tissues containing high concentration of

receptors such as the breasts, uterus, and vagina. Frequent side effects

include hot flashes, nausea, vomiting, vaginal bleeding or discharge, pruritus,

and skin rash. Adverse or toxic effects include retinopathy, corneal opacity,

and decreased visual acuity.

11. A client has just been given a prescription for diphenoxylate with

atropine (Lomotil). The nurse teaches the client which of the following

about the use of this medication?

a. drooling may occur while taking this medication

b. irritability may occur while taking this medication

c. this medication contains a habit-forming ingredient

d. take the medication with a laxative of choice

Diphenoxylate with atropine (Lomotil) is an antidiarrheal. The client should

not exceed the recommended dose of this medication because it may be

habit-forming. Since this medication is an antidiarrheal, it should not be

taken with a laxative. Side effects of the medication include dry mouth and

drowsiness.

12. A nurse is gathering data from client about the client’s medication

history and notes that the client is taking tolterodine tartrate (Detrol

LA). The nurse determines that the client is taking the medication to

treat which disorder?

a. glaucoma

b. renal insufficiency

c. pyloric stenosis

d. urinary frequency and urgency

Tolterodine tartrate is an antispasmodic used to treat overactive bladder and

symptoms of urinary frequency, urgency, or urge incontinence. It is

contraindicated in urinary retention and uncontrolled narrow-angle glaucoma.

It is used with caution in renal function impairment, bladder outflow

obstruction, and gastrointestinal obstructive disease such as pyloric stenosis.

13. A client has an order to receive psyllium (Metamucil) daily. The nurse

administers this medication with:

a. a multivitamin and mineral supplement

b. a dose of an antacid

c. applesauce

d. eight ounces of liquid

Metamucil is a bulk-forming laxative. It should be taken with a full glass of

water or juice, and followed by another glass of liquid. This will help prevent

impaction of the medication in the stomach or small intestine. The other

options are incorrect.

14. A nurse is teaching a client taking cyclosporine (Sandimmune) after

renal transplant about medication information. The nurse tells the

client to be especially alert for:

a. signs of infection

b. hypotension

c. weight loss

d. hair loss

Cyclosporine is an immunosuppressant medication used to prevent transplant

rejection. The client should be especially alert for signs and symptoms of

infection while taking this medication, and report them to the physician if

experienced. The client is also taught about other side effects of the

medication, including hypertension, increased facial hair, tremors, gingival

hyperplasia, and gastrointestinal complaints.

15. A nurse reinforces dietary instruction for the client receiving

spironolactone (Aldactone). Which food would the nurse instruct the

client to avoid while taking this medication?

a. crackers

b. shrimp

c. apricots

d. popcorn

Aldactone is a potassium-sparing diuretic and the client needs to avoid foods

high in potassium, such as whole grain cereals, legumes, meat, bananas,

apricots, orange juice, potatoes, and raisins. Option c provides the highest

source of potassium and should be avoided.

16. Oral lactulose (Chronulac) is prescribed for the client with a hepatic

disorder and the nurse provides instructions to the client regarding this

medication. Which statement by the client indicates a need for further

instructions?

a. “I need to take the medication with water’”

b. “I need to increase fluid intake while taking the medication”

c. “I need to increase fiber in the diet”

d. “I need to notify the physician of nausea occurs”

Lactulose retains ammonia in the colon, promotes increased peristalsis and

bowel evacuation, expelling ammonia from the colon. It should be taken with

water or juice to aid in softening the stool. An increased fluid intake and a

high-fiber diet will promote defecation. If nausea occurs, the client should be

instructed to drink cola, eat unsalted crackers, or dry toast. It is not

necessary to notify the physician.

17. A home care nurse provides instructions to a client taking digoxin

(Lanoxin) 0.25 mg daily. Which statement by the client indcates a

need for further instructions?

a. “I will take my prescribed antacid if I become nauseated”

b. “It is important to have my blood drawn when prescribed”

c. “I will check my pulse before I take my medication”

d. “I will carry a medication identification card with me”

Digoxin is an antidysrhythmic. The most common early manifestations of

toxicity are gastrointestinal (GI) disturbances such as anorexia, nausea, and

vomiting. If these manifestations occur, the physician needs to be notified.

Digoxin blood levels need to be obtained as prescribed to monitor for

therapeutic plasma levels (0.5 to 2.0 ng/mL). The client is instructed to take

the pulse, hold the medication if the pulse is below 60 beats per minute, and

notify the physician. The client is instructed to wear or carry an ID bracelet

or card.

18. A client with anxiety disorder is taking buspirone (BuSpar) and tells

the nurse that it is difficult to swallow the tablets. The nurse tells the

client to:

a. dissolve the tablet in a cup of coffee

b. crush the tablet before taking it

c. call the physician for a change in medication

d. mix the tablet uncrushed in custard

Buspirone (BuSpar) may be administered without regard to meals and the

tablets may be crushed. It is premature to advise the client to call the

physician for a change in medication without first trying alternative

interventions. Mixing the tablet uncrushed in custard will not ensure ease in swallowing. Dissolving the tablet in a cup of coffee is not the best instruction

to provide to the client because this measure may not ensure that the client

will receive the entire dose.

19. A nurse is caring for a child with CHF provides instructions to the

parents regarding the administration of digoxin (Lanoxin). Which

statement by the mother indicates a need for further instructions?

a. “If my child vomits after I give the medication, I will not repeat

the dose”

b. “I will check my child’s pulse before giving the medication”

c. “I will check the dose of the medication with my husband before I

give the medication”

d. “I will mix the medication with food”

The medication should not be mixed with food or formula because this

method would not ensure that the child receives the entire dose of

medication. Options a, b, and c are correct. Additionally, if a dose is missed

and is not identified until 4 or more hours later, that dose is not

administered. If more than one consecutive dose is missed, the physician

needs to be notified

20. A nurse provides instructions to a client who will begin an oral

contraceptives. Which statement by the client indicates the need for

further instructions?

a. “I will take one pill daily at the same time every day”

b. “I will not need to use an additional birth control method

once I start these pills”

c. “If I miss a pill I need to take it as soon as I remember”

d. “If I miss two pills I will take them both as soon as I remember

and I will take two pills the next day also”

The client needs to be instructed to use a second birth control method during

the first pill cycle. Options a, b, and c are correct. Additionally, the client

needs to be instructed that if she misses three pills, she will need to

discontinue use for that cycle and use another birth control method.

21. A nurse provides instructions to a client taking clorazepate (Tranxene)

for management of an anxiety disorder. The nurse tells the client that:

a. drowsiness is a side effect that usually disappears with

continued therapy

b. if dizziness occurs, call the physician

c. smoking increases the effectiveness of the medication

d. if gastrointestinal disturbances occur, discontinue the medication

Drowsiness occurs as a side effect and usually disappears with continued

therapy. The client should be instructed that if dizziness occurs to change

positions slowly from lying to sitting, before standing. Smoking reduces

medication effectiveness. Gastrointestinal disturbances can occur as an

occasional side effect and the medication can be given with food if this

occurs.

22. A client with Parkinson’s disease has begun therapy with levodopa (L-

dopa). The nurse determines that the client understands the action of

the medication if the client verbalizes that results may not be apparent

for:

a. 24 hours

b. Two to three days

c. One week

d. Two to three weeks

Signs and symptoms of Parkinson’s disease usually begin to resolve within 2

to 3 weeks of starting therapy, although in some clients marked

improvement may not be seen for up to 6 months. Clients need to

understand this concept to aid in compliance with medication therapy.

23. A nurse in a physician’s office is reviewing the results of a client’s

phenytoin (Dilantin) level drawn that morning. The nurse determines

that the client has a therapeutic drug level if the client’s result was:

a. 3 mcg/ml

b. 8 mcg/ml

c. 15 mcg/ml

d. 24mcg/ml

The therapeutic range for serum phenytoin levels is 10 to 20 mcg/mL in

clients with normal serum albumin levels and renal function. A level below

this range indicates that the client is not receiving sufficient medication, and

is at risk for seizure activity. In this case, the medication dose should be

adjusted upward. A level above this range indicates that the client is entering

the toxic range and is at risk for toxic side effects of the medication. In this

case, the dose should be adjusted downward.

24. A nurse is caring for a client with a genitourinary tract infection

receiving amoxicillin (Augmentin) 500 mg every 8 hours. Which of the

following would indicate to the nurse that the client is experiencing an

adverse effect related to the medication?

a. hypertension

b. nausea

c. headache

d. watery diarrhea

Amoxicillin is a penicillin. Adverse effects include superinfection, such as

potentially fatal antibiotic-associated colitis, that results from altered

bacterial balance. Symptoms include abdominal cramps, severe watery

diarrhea, and fever. Frequent side effects of the medication include

gastrointestinal disturbances (mild diarrhea, nausea, vomiting), headache,

and oral or vaginal candidiasis.

25. A nurse is caring for a client with glaucoma who receives a daily dose

of acetazolamide (Diamox). Which of the following would indicate to

the nurse that the client is experiencing an adverse effect of the

medication?

a. constipation

b. difficulty swallowing

c. dark-colored urine and stools

d. irritability

Acetazolamide (Diamox) is a carbonic anhydrase inhibitor. Nephrotoxicity

and hepatotoxicity can occur and is manifested by dark-colored urine and

stools, pain in the lower back, jaundice, dysuria, crystalluria, and renal colic

and calculi. Bone marrow depression may also occur.

26. A nurse is caring for a client with a diagnosis of meningitis who is

receiving amphotericin B (Fungizone) intravenously. Which of the

following would indicate to the nurse that the client is experiencing an

adverse effect related to the medication?

a. nausea

b. decreased urinary output

c. muscle weakness

d. confusion

Amphotericin B is an antifungal medication. Adverse effects include

nephrotoxicity evidenced by a decrease in urinary output and the nurse

needs to monitor fluid balance and renal function tests for potential signs of

this adverse effect. Cardiovascular toxicity, evidenced by hypotension and

ventricular fibrillation, can occur but is rare. Anaphylactic reactions are also

rare. Vision and hearing alterations, seizures, hepatic failure and coagulation

defects may also occur.

27. A nurse has formulated a nursing diagnosis of Disturbed Body Image

for a client who is taking spironolactone (Aldactone). The nurse based

this diagnosis on assessment of which side effect of the medication?

a. edema

b. weight gain

c. excitability

d. decreased libido

Spironolactone (Aldactone) is a potassium-sparing diuretic. The nurse should

be alert to the fact that the client taking spironolactone may experience body

image changes due to threatened sexual identity. These body image changes

are related to decreased libido, gynecomastia in males, and hirsutism in

females. Since the medication is a diuretic, edema and weight gain should

not occur. Excitability is not associated with the use of this medication;

rather, drowsiness may occur.

28. A nurse is caring for the client with a history of mild heart failure who

is receiving diltiazem hydrochloride (Cardizem) for hypertension. The

nurse would assess the client for:

a. bradycardia

b. wheezing

c. peripheral edema and weight gain

d. apical pulse rate lower than baseline

Calcium channel blocking agents, such as diltiazem hydrochloride

(Cardizem), are used cautiously in clients with conditions that could be

worsened by the medication. These conditions include aortic stenosis,

bradycardia, heart failure, acute myocardial infarction, and hypotension. The

nurse would assess for signs and symptoms that indicate worsening of these

underlying disorders. In this question, the nurse assesses for signs and

symptoms indicating heart failure.

29. The wound of a client with an extensive burn injury is being treated

with the application of silver sulfadiazine (Silvadene). Which symptom

would indicate to the nurse that the client is experiencing a side effect

related to systemic absorption?

a. pain at the wound site

b. burning and itching at the wound site

c. a localized rash

d. photosensitivity

Silver sulfadiazine (Silvadene) is a cream used for extensive burn wounds.

Significant systemic absorption may occur if applied to extensive burns. Side

effects of the medication include pain, burning, itching and a localized rash.

Systemic side effects include anorexia, nausea, vomiting, headache,

diarrhea, dizziness, photosensitivity, and joint pain.

30. A nurse is caring for a client with a diagnosis of rheumatoid arthritis

who is receiving sulindac (Clinoril) 150 mg po twice daily. Which

finding would indicate to the nurse that the client is experiencing a

side effect related to the medication?

a. diarrhea

b. photophobia

c. fever

d. tingling in the extremities

Sulindac (Clinoril) is a nonsteroidal antiinflammatory medication (NSAID).

Frequent side effects include gastrointestinal (GI) disturbances including

constipation or diarrhea, indigestion, and nausea. Dermatitis, a rash,

dizziness, and a headache are also frequent side effects.

31. The nurse notes that the client is receiving filgrastim (Neupogen). The

nurse checks which of the following to determine medication

effectiveness?

a. neutrophil count

b. platelet count

c. blood urea nitrogen

d. creatinine level

Filgrastim is a biologic modifier that stimulates production, maturation, and

activation of neutrophils. Therefore the nurse would monitor the client’s

neutrophil count. The platelet count measures the amount of platelets; a

decreased level places the client at risk for bleeding. The blood urea nitrogen

and creatinine level measures renal function.

32. A nurse is monitoring a client who is taking fluphenazine decanoate

(Prolixin) for signs of leucopenia. Which finding indicates a sign of this

blood dyscrasia?

a. blurred vision

b. constipation

c. sore throat

d. dry mouth

Blood dyscrasias can occur as an adverse effect of fluphenazine decanoate.

Leukopenia is indicative of a low white blood cell count and places the client

at risk for infection. The nurse would monitor the client for signs of infection

such as a sore mouth, gums, or throat. Blurred vision, dry mouth, and

constipation are occasional side effects of the medication but are not

indicative of leukopenia.

33. A nurse is administering amphotericin B (Fungizone) to a client

intravenously to treat a fungal infection. The nurse monitors the result

of which electrolyte study during therapy with this medication?

a. sodium

b. potassium

c. calcium

d. chloride

Life-threatening hypokalemia can occur with the administration of

amphotericin B. Therefore, the nurse monitors the results of serum

potassium levels, which should be prescribed at least biweekly during

therapy. Magnesium levels should also be monitored.

34. A clinic nurse asks a client with diabetes mellitus being seen in the

clinic for the first time to list the medications that she is taking. Which

combination of medications taken by the client should the nurse report

to the physician?

a. Acetohexamide (Dymelor) and trimethoprim-

sulfamethoxazole (Bactrim)

b. Chlorpropamide (Diabenase) and amitriptyline (Elavil)

c. Glyburide (DiaBeta) and Lanoxin (Digoxin)

d. Tolbutamide (Orinase) and amoxicillin (Amoxil)

Sulfonylureas are hypoglycemic agents that lower the blood glucose.

Acetohexamide (Dymelor), chlorpropamide (Diabinese), glyburide (DiaBeta),

and tolbutamide (Orinase) are sulfonylureas. If a sulfonylureas is

administered with a sulfonamide (option a), increased glycemic effects can

occur.

35. A nurse is caring for a client receiving streptogramin (Synercid) by

intravenous intermittent infusion for the treatment of a bone infection

develops diarrhea. Which nursing action would the nurse implement?

a. administer an antidiarrheal agent

b. notify the physician

c. discontinue the medication

d. monitor the client’s temperature

Synercid is an antimicrobial agent. One adverse effect of the medication is

superinfection, including antibiotic-associated colitis, which may result from

bacterial imbalance. If the client develops diarrhea, the medication should be

withheld, and the physician is notified. The nurse would not discontinue the

medication. The nurse would not administer an antidiarrheal unless

specifically prescribed by the physician.

36. A client has been taking fosinopril (Monopril) for 2 months. The nurse

determines that the client is having the intended effects of therapy if

the nurse notes which of the following?

a. lowered BP

b. lowered pulse rate

c. increased WBC

d. increased monocyte count

Monopril is an angiotensin-converting enzyme (ACE) inhibitor that lowers

blood pressure. It can cause tachycardia as a side effect of therapy, making

option b incorrect. Other side effects of the medication are neutropenia and

agranulocytopenia, making options c and d incorrect.

37. A client is taking labetalol (Normodyne). The nurse monitors the client

for which frequent side effect of the medication?

a. tachycardia

b. impotence

c. increased energy level

d. night blindness

Impotence is a common side effect of labetalol and may be distressing to the

client. Other side effects of this medication are bradycardia, weakness, and

fatigue. Night blindness is unrelated to this medication, although this

medication can cause blurred vision and dry eyes.

38. An older client has been using cascara sagrada on a long-term basis.

The nurse determines that which laboratory result is a result of the

side effects of this medication?

a. sodium 135 mEq/L

b. sodium 145 mEq/L

c. potassium 3.1 mEq/L

d. potassium 5.0 mEq/L

Hypokalemia can result from long-term use of casanthrol (cascara sagrada),

which is a laxative. The medication stimulates peristalsis and alters fluid and

electrolyte transport, thus helping fluid to accumulate in the colon. The

normal range for potassium is 3.5 to 5.1 mEq/L. The normal range for

sodium is 135 to 145 mEq/L.

39. A client has an order to begin short-term therapy with enoxaparin

(Lovenox). The nurse explains to the client that this medication is

being ordered to:

a. dissolve urinary calculi

b. reduce the risk of deep vein thrombosis

c. relieve migraine headaches

d. stop progression of multiple sclerosis

Enoxaparin is an anticoagulant that is administered to prevent deep vein

thrombosis and thromboembolism in selected clients at risk. It is not used to

treat urinary calculi, migraine headaches, or multiple sclerosis.

40. Quinidine gluconate (Dura Quin) is prescribed for a client. The nurse

reviews the client’s medical record, knowing that which of the following

is a contraindication in the use of this medication?

a. complete atrioventricular (AV) block

b. muscle weakness

c. asthma

d. infection

Quinidine gluconate is an antidysrhythmic medication used as prophylactic

therapy to maintain normal sinus rhythm after conversion of atrial fibrillation

and/or atrial flutter. It is contraindicated in complete AV block,

intraventricular conduction defects, abnormal impulses and rhythms caused

by escape mechanisms, and in myasthenia gravis. It is used with caution in

clients with preexisting asthma, muscle weakness, infection with fever, and

hepatic or renal insufficiency.

41. A client has been taking benzonatate (Tessalon) as ordered. The

nurse tells the client that this medication should do which of the

following?

a. take away nausea and vomiting

b. calm the persistent cough

c. decrease anxiety level

d. increase comfort level

Benzonatate is a locally acting antitussive. Its effectiveness is measured by

the degree to which it decreases the intensity and frequency of cough,

without eliminating the cough reflex.

42. Auranofin (Ridaura) is prescribed for a client with rheumatoid

arthritis, and the nurse monitors the client for signs of an adverse

effect related to the medication. Which of the following indicates an

adverse effect?

a. nausea

b. diarrhea

c. anorexia

d. proteinuria

Auranofin (Ridaura) is a gold preparation that is used as an antirheumatic.

Gold toxicity is an adverse effect and is evidenced by decreased hemoglobin,

leukopenia, reduced granulocyte counts, proteinuria, hematuria, stomatitis,

glomerulonephritis, nephrotic syndrome, or cholestatic jaundice. Anorexia,

nausea, and diarrhea are frequent side effects of the medication.

43. A nurse is providing instructions to a client regarding quinapril

hydrochloride (Accupril). The nurse tells the client:

a. to take the medication with food only

b. to rise slowly from a lying to a sitting position

c. to discontinue the medication if nausea occurs

d. that a therapeutic effect will be noted immediately

Accupril is an angiotensin-converting enzyme (ACE) inhibitor. It is used in the

treatment of hypertension. The client should be instructed to rise slowly from

a lying to sitting position and to permit the legs to dangle from the bed

momentarily before standing to reduce the hypotensive effect. The

medication does not need to be taken with meals. It may be given without

regard to food. If nausea occurs, the client should be instructed to take a

noncola carbonated beverage and salted crackers or dry toast. A full

therapeutic effect may be noted in 1 to 2 weeks.

44. A female client tells the clinic nurse that her skin is very dry and

irritated. Which product would the nurse suggest that the client apply

to the dry skin?

a. glycerin emollient

b. aspercreame

c. myoflex

d. acetic acid solution

Glycerin is an emollient that is used for dry, cracked, and irritated skin.

Aspercreame and Myoflex are used to treat muscular aches. Acetic acid

solution is used for irrigating, cleansing, and packing wounds infected by

Pseudomonas aeruginosa.

45. A client with advanced cirrhosis of the liver is not tolerating protein

well, as eveidenced by abnormal laboratory values. The nurse

anticipates that which of the following medications will be prescribed

for the client?

a. lactulose (Chronulac)

b. ethacrynic acid (Edecrin)

c. folic acid (Folvite)

d. thiamine (Vitamin B1)

The client with cirrhosis has impaired ability to metabolize protein because of

liver dysfunction. Administration of lactulose aids in the clearance of

ammonia via the gastrointestinal (GI) tract. Ethacrynic acid is a diuretic. Folic

acid and thiamine are vitamins, which may be used in clients with liver

disease as supplemental therapy.

46. A nurse is planning dietary counseling for the client taking triamterene

(Dyrenium). The nurse plans to include which of the following in a list

of foods that are acceptable?

a. baked potato

b. bananas

c. oranges

d. pears canned in water

Triamterene is a potassium-sparing diuretic, and clients taking this

medication should be cautioned against eating foods that are high in

potassium, including many vegetables, fruits, and fresh meats. Because

potassium is very water-soluble, foods that are prepared in water are often

lower in potassium.

47. A client is taking famotidine (Pepcid) asks the home care nurse what

would be the best medication to take for a headache. The nurse tells

the client that it would be best to take:

a. aspirin (acetylsalicylic acid, ASA)

b. ibuprofen (Motrin)

c. acetaminophen (Tylenol)

d. naproxen (Naprosyn)

The client is taking famotidine, a histamine receptor antagonist. This implies

that the client has a disorder characterized by gastrointestinal (GI) irritation.

The only medication of the ones listed in the options that is not irritating to

the GI tract is acetaminophen. The other medications could aggravate an

already existing GI problem.

48. A nurse has taught a client taking a xanthine bronchodilator about

beverages to avoid. The nurse determines that the client understands

the information if the client chooses which of the following beverages

from the dietary menu?

a. chocolate milk

b. cranberry juice

c. coffee

d. cola

Cola, coffee, and chocolate contain xanthine and should be avoided by the

client taking a xanthine bronchodilator. This could lead to an increased

incidence of cardiovascular and central nervous system side effects that can

occur with the use of these types of bronchodilators.

49. A client with histoplasmosis has an order for ketoconazole (Nizoral).

The nurse teaches the client to do which of the following while taking

this medication?

a. take the medication on an empty stomach

b. take the medication with an antacid

c. avoid exposure to sunlight

d. limit alcohol to 2 ounces per day

The client should be taught that ketoconazole is an antifungal medication. It

should be taken with food or milk. Antacids should be avoided for 2 hours

after it is taken because gastric acid is needed to activate the medication.

The client should avoid concurrent use of alcohol, because the medication is

hepatotoxic. The client should also avoid exposure to sunlight, because the

medication increases photosensitivity.

50. A nurse is preparing the client’s morning NPH insulin dose and notices

a clumpy precipitate inside the insulin vial. The nurse should:

a. draw up and administer the dose

b. shake the vial in an attempt to disperse the clumps

c. draw the dose from a new vial

d. warm the bottle under running water to dissolve the clump

The nurse should always inspect the vial of insulin before use for solution

changes that may signify loss of potency. NPH insulin is normally uniformly

cloudy. Clumping, frosting, and precipitates are signs of insulin damage. In

this situation, because potency is questionable, it is safer to discard the vial

and draw up the dose from a new vial.