Which change in data indicates to the nurse that the desired
effect of the angiotensin II receptor antagonist valsartan
(Diovan) has been achieved?
A) Dependent edema reduced from +3 to +1.
B) Serum HDL increased from 35 to 55 mg/dl.
C) Pulse rate reduced from 150 to 90 beats/minute.
D) Blood pressure reduced from 160/90 to 130/80.
- Correct Answer - D) 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 (D). (A, B, and C) do not
describe effects of Diovan.
A client is receiving digoxin for the onset of supraventricular
tachycardia (SVT). Which laboratory findings should the nurse
identify that places this client at risk?
A) Hypokalemia.
B) Hyponatremia.
C) Hypercalcemia.
D) Low uric acid levels.
,- Correct Answer - A) Hypokalemia.
Rationale: Hypokalemia affects myocardial contractility, so (A)
places this client at greatest risk for dysrhythmias that may be
unresponsive to drug therapy. Although an imbalance of serum
electrolytes, (B and C), can effect cardiac rhythm, the greatest
risk for the client receiving digoxin is (A). (D) does not cause
any interactions related to digoxin therapy for supraventricular
tachycardia (SVT).
Which dosing schedule should the nurse teach the client to
observe for a controlled-release oxycodone prescription?
A) As needed.
B) Every 12 hours.
C) Every 24 hours.
D) Every 4 to 6 hours. - Correct Answer - B) 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 (B) provides the best
around-the-clock pain management. Controlled-release
oxycodone is not prescribed for breakthrough pain on a PRN or
as needed schedule (A). (C) is inadequate for continuous pain
management. Using a schedule of every 4 to 6 hours (D) may
jeopardize patient safety due to cumulative effects.
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?
A) Administer a PRN dose of the PO meperidine (Demerol).
B) Administer naloxone (Narcan) IV per PRN protocol.
C) Decrease the IV infusion rate of the meperidine (Demerol)
per protocol.
D) Notify the healthcare provider of the client's confusion and
hallucinations.
- Correct Answer - C) 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 dose of Demerol
received over four days. (C) is the most effective action to
immediately decrease the amount of serum Demerol. (A) will
increase the toxic level of medication in the bloodstream.
Naloxone (B) is an opioid antagonist that is used during an
opioid overdose, but it is not beneficial during Demerol toxicity
and can precipitate seizures. The healthcare provider should be
notified (D), but that is not the initial action the nurse should
take; first the amount of drug infusing should be decreased.
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?
A) Take medication, go for a 30 minute morning walk, then eat
breakfast.
, B) Take medication, rest in bed for 30 minutes, eat breakfast,
go for morning walk.
C) Take medication with breakfast, then take a 30 minute
morning walk.
D) Go for a 30 minute morning walk, eat breakfast, then take
medication.
- Correct Answer - A) 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. (A) is the best schedule
to meet these needs. (B, C, and D) do not meet these criteria.
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?
A) Changes in urine color.
B) Presence of hand tremors.
C) Increasing body hirsutism.
D) Nausea and vomiting.
- Correct Answer - B) Presence of hand tremors.
Rationale: Neurological complications, such as hand tremors
(B), occur in about 50% of clients taking cyclosporine and
should be reported. Although this drug can be nephrotoxic, (A)
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