2504_Ch19_711-748.qxd 716 10/28/10 1:11 PM Page 716 MED-SURG SUCCESS MEDICATIONS ADMINISTRATION IN A MEDICAL-SURGICAL SETTING COMPREHENSIVE EXAMINATION The test taker is encouraged to use the guidelines/test-taking hints given previously when taking the following medication test. The test is comprehensive for medications administered in a medical-surgical setting. 1. The client asks the clinic nurse if he should take 2,000 mg of vitamin C a day to prevent getting a cold. On which scientific rationale should the nurse base the response? 1. Vitamin C in this dosage will help cure the common cold. 2. This vitamin must be taken with echinacea to be effective. 3. This dose of vitamin C is not high enough to help prevent colds. 4. Megadoses of vitamin C may cause crystals to form in the urine. 2. The client recently has had a myocardial infarction. Which medications should the nurse anticipate the health-care provider recommending to prevent another heart attack? 1. Vitamin K and a nonsteroidal anti-inflammatory drug. 2. Vitamin E and a daily low-dose aspirin. 3. Vitamin A and an anticoagulant. 4. Vitamin B complex and an iron supplement. 3. The client diagnosed with essential hypertension calls the clinic and tells the nurse she needs something for the flu. Which information should the nurse tell the client? 1. OTC medications for the flu should not be taken because of your hypertension. 2. If OTC medications do not relieve symptoms within three (3) days, contact the HCP. 3. Tell the client to ask the pharmacist to recommend an OTC medication for the flu. 4. Make an appointment for the client to receive the influenza vaccine. 4. Which laboratory test should the nurse monitor for the client receiving the intravenous steroid Solu-Medrol? 1. Potassium level. 2. Sputum culture and sensitivity. 3. Glucose level. 4. Arterial blood gases. 5. The client diagnosed with asthma is prescribed the mast cell inhibitor cromolyn. Which statement by the client indicates the need for further teaching? 1. I will take two puffs of my inhaler before I exercise. 2. I will rinse my mouth with water after taking the medication. 3. After inhaling the medication, I will hold my breath for 10 seconds. 4. When I start to wheeze, I will use my inhaler immediately. 6. The client diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) is receiving the aminoglycoside antibiotic vancomycin. Peak and trough levels are ordered for the dose the nurse is administering. Which priority intervention should the nurse implement? 1. Ask the client if he has had any diarrhea. 2. Monitor the aminoglycoside peak level. 3. Determine if the trough level has been drawn. 4. Check the client s culture and sensitivity report.
7. The nurse is caring for an elderly client who is eight (8) hours postoperative hip replacement and is reporting incisional pain. Which intervention is priority for this client? 1. Assist the client to sit in the bedside chair. 2. Initiate pain medication at the lowest dose. 3. Assess the client s pupil size and accommodation. 4. Monitor the client s urinary output hourly. 8. The client is diagnosed with pernicious anemia. Which health-care provider order should the nurse anticipate in treating this condition? 1. Subcutaneous iron dextran. 2. Intramuscular vitamin B 12. 3. Intravenous folic acid. 4. Oral thiamine medication. 9. The client with type 2 diabetes mellitus is prescribed glyburide (Micronase), a sulfonylurea. Which statement indicates the client understands the medication teaching? 1. I should carry some hard candy when I go walking. 2. I must take my insulin injection every morning. 3. There are no side effects I need to worry about. 4. This medication will make my muscles absorb insulin. 10. The unlicensed assistive personnel (UAP) reports the client s glucometer reading is 380 mg/dl. The client is on regular sliding-scale insulin which reads: CHAPTER 19 PHARMACOLOGY 717 Glucometer Reading Units of Insulin <150 0 151 250 5 251 350 8 351 450 10 451+ Notify the HCP How much insulin should the nurse administer to the client? 11. The nurse administers 18 units of Humulin N, an intermediate-acting insulin, at 1630. Which priority invention should the nurse implement? 1. Monitor the client s hemoglobin A 1c. 2. Make sure the client eats the evening meal. 3. Check the a.c. blood glucometer reading. 4. Ensure the client eats a snack. 12. The nurse is administering the following 1800 medications. Which medication should the nurse question before administering? 1. The sliding-scale insulin to the client who has just been released to have the evening meal. 2. The antibiotic to the client who is one (1) day postoperative exploratory abdominal surgery. 3. Metformin (Glucophage), a biguanide, to the client having a CT scan in the morning. 4. Protonix, a proton pump inhibitor, to the client diagnosed with peptic ulcer disease.
718 MED-SURG SUCCESS 13. The nurse is administering the long-acting insulin glargine (Lantus) to the client at 2200. The nurse asks the charge nurse to check the dosage. Which action should the charge nurse implement? 1. Ask the nurse why the insulin is being given late. 2. Check the MAR versus the dosage in the syringe. 3. Instruct the nurse to complete a medication error form. 4. Have the nurse notify the health-care provider. 14. The nurse is preparing to administer Synthroid, a thyroid hormone replacement, to the client diagnosed with hypothyroidism. Which assessment data would indicate the client is receiving too much medication? 1. Bradypnea and weight gain. 2. Lethargy and hypotension. 3. Irritability and tachycardia. 4. Normothermia and constipation. 15. The client is receiving a continuous intravenous infusion of heparin, an anticoagulant. Based on the most recent laboratory data: PT 13.2 Control: 12.1 INR 1.3 PTT 72 Control: 39 which action should the nurse implement? 1. Continue to monitor the infusion. 2. Prepare to administer protamine sulfate. 3. Have the lab reconfirm the results. 4. Assess the client for bleeding. 16. The elderly client is admitted to the emergency department from a long-term care facility. The client has multiple ecchymotic areas on the body. The client is receiving digoxin, a cardiac glycoside; Lasix, a loop diuretic; Coumadin, an anticoagulant; and Xanax, an antianxiety medication. Which order should the nurse request from the health-care provider? 1. A STAT serum potassium level. 2. An order to admit to the hospital for observation. 3. An order to administer Valium intravenous push. 4. A STAT international normalized ratio (INR). 17. The client with postmenopausal osteoporosis is prescribed the bisphosphonate alendronate (Fosamax). Which discharge instruction should the nurse discuss with the client? 1. The medication must be taken with the breakfast meal only. 2. Remain upright for at least 30 minutes after taking medication. 3. The tablet should be chewed thoroughly before swallowing. 4. Stress the importance of having monthly hormone levels. 18. The nurse is administering a.m. medications. Which medication should the nurse administer first? 1. The daily digoxin to the client diagnosed with congestive heart failure. 2. The loop diuretic to the client with a serum potassium level of 3.1 meq/l. 3. The mucosal barrier Carafate to the client diagnosed with peptic ulcer disease. 4. Solu-Medrol IVP to a client diagnosed with chronic lung disease.
19. The HCP ordered an angiotensin-converting enzyme (ACE) inhibitor for the client diagnosed with a myocardial infarction. Which statement best explains the rationale for administering this medication to this client? 1. It will help prevent the development of congestive heart failure. 2. This medication will help decrease the client s blood pressure. 3. ACE inhibitors increase the contractility of the heart muscle. 4. They will help decrease the development of atherosclerosis. 20. The client is receiving the angiotensin-converting enzyme (ACE) inhibitor enalapril (Vasotec). When would the nurse question administering this medication? 1. The client is not receiving potassium supplements. 2. The client complains of a persistent irritating cough. 3. The blood pressure for two (2) consecutive readings is 110/70. 4. The client s urinary output is 400 ml for the last eight (8) hours. 21. The nurse is preparing to administer the morning dose of digoxin, a cardiac glycoside, to a client diagnosed with congestive heart failure. Which data would indicate the medication is effective? 1. The apical heart rate is 72 beats per minute. 2. The client denies having any anorexia or nausea. 3. The client s blood pressure is 120/80 mm Hg. 4. The client s lungs sounds are clear bilaterally. 22. The client diagnosed with multiple sclerosis (MS) is receiving Lioresal (baclofen), a muscle relaxant. Which information should the nurse teach the client/family? 1. The importance of tapering off medication when discontinuing medication. 2. Baclofen may cause diarrhea, so the client should take antidiarrheal medication. 3. The client should not be allowed to drive alone while taking this medication. 4. The need for follow-up visits to obtain a monthly white blood cell count. 23. The nursing is administering digoxin, a cardiac glycoside, to the client with congestive heart failure. Which interventions should the nurse implement? Select all that apply. 1. Check the apical heart rate for one (1) full minute. 2. Monitor the client s serum sodium level. 3. Teach the client how to take his or her radial pulse. 4. Evaluate the client s serum digoxin level. 5. Assess the client for buffalo hump and moon face. 24. The client s vital signs are T 99.2 F, AP 59, R 20, and BP 108/72. Which medication would the nurse question administering? 1. Theodur, a bronchodilator. 2. Inderal, a beta blocker. 3. Ampicillin, an antibiotic. 4. Cardizem, a calcium channel blocker. 25. The client in end-stage renal disease is a Jehovah s Witness. The HCP orders erythropoietin (Epogen), a biologic response modifier, subcutaneously for anemia. Which action should the nurse take? 1. Question this order because of the client s religion. 2. Encourage the client to talk to his or her minister. 3. Administer the medication subcutaneously as ordered. 4. Obtain the informed consent prior to administering. CHAPTER 19 PHARMACOLOGY 719 26. The elderly male client is admitted for acute severe diverticulitis. He has been taking Xanax, a benzodiazepine, for nervousness three (3) to four (4) times a day PRN for six (6) years. Which intervention should the nurse implement first? 1. Prepare to administer an intravenous antianxiety medication. 2. Notify the HCP to obtain an order for the client s Xanax PRN. 3. Explain Xanax causes addiction and he should quit taking it. 4. Assess for signs/symptoms of medication withdrawal.
720 MED-SURG SUCCESS 27. The nurse is administering an ophthalmic drop to the right eye. Which anatomical location would be correct when administering eyedrops? A D B C 1. A 2. B 3. C 4. D 28. The nurse is administering the loop diuretic furosemide (Lasix) to the client diagnosed with essential hypertension. Which assessment data would warrant the nurse to question administering the medication? 1. The client s potassium level is 4.2 meq/l. 2. The client s urinary output is greater than the intake. 3. The client has tented skin turgor and dry mucous membranes. 4. The client has lost two (2) pounds in the last 24 hours. 29. The client who has had a kidney transplant tells the nurse he has been taking St. John s wort, an herb, for depression. Which action should the nurse take first? 1. Praise the client for taking the initiative to treat the depression. 2. Remain nonjudgmental about the client s alternative treatments. 3. Refer the client to a psychologist for counseling for depression. 4. Instruct the client to quit taking the medication immediately. 30. The nurse is administering an antacid to a client with gastroesophageal reflux disease. Which statement best describes the scientific rationale for administering this medication? 1. This medication will suppress gastric acid secretion. 2. This medication will decrease the gastric ph. 3. This medication will coat the stomach lining. 4. This medication interferes with prostaglandin production. 31. The client is diagnosed with essential hypertension and is receiving a calcium channel blocker. Which assessment data would warrant the nurse holding the client s medication? 1. The client s oral temperature is 102 F. 2. The client complaints of a dry, nonproductive cough. 3. The client s blood pressure reading is 106/76. 4. The client complains of being dizzy when getting out of bed. 32. The client complains of leg cramps at night. Which medication should the nurse anticipate the HCP ordering to help relieve the leg cramps? 1. Quinine, an antimalarial. 2. Soma, a muscle relaxant. 3. Ambien, a sedative-hypnotic. 4. Darvon, an opioid analgesic.
33. The nurse is preparing to administer the initial dose of an antibiotic in the emergency department. Which interventions should the nurse implement? Select all that apply. 1. Assess for drug allergies. 2. Collect needed specimens for culture. 3. Check the client s armband. 4. Ask the client his or her birthday. 5. Draw peak and trough levels. 34. For which client should the nurse question administering the muscarinic cholinergic agonist oxybutynin (Ditropan)? 1. The client diagnosed with overactive bladder. 2. The client diagnosed with type 2 diabetes. 3. The client diagnosed with glaucoma. 4. The client diagnosed with peripheral vascular disease. 35. The nurse is administering a topical ointment to the client s rash on the right leg. Which intervention should the nurse implement first? 1. Don nonsterile gloves. 2. Cleanse the client s right leg. 3. Check the client s armband. 4. Wash the hands for 15 seconds. 36. The client is exhibiting multifocal premature ventricular contractions. Which antidysrhythmic medication should the nurse anticipate the HCP ordering for this dysrhythmia? 1. Adenosine. 2. Epinephrine. 3. Atropine. 4. Lidocaine. 37. The client in the intensive care department is receiving 2 mcg/kg/min of dopamine, an ionotropic vasopressor. Which intervention should the nurse include in the plan of care? 1. Monitor the client s blood pressure every two (2) hours. 2. Assess the client s peripheral pulses every shift. 3. Use a urometer to assess hourly output. 4. Ensure the IV tubing is not exposed to the light. 38. The client is receiving thrombolytic therapy for a diagnosed myocardial infarction (MI). Which assessment data indicate the therapy is successful? 1. The client s ST segment is becoming more depressed. 2. The client is exhibiting reperfusion dysrhythmias. 3. The client s cardiac isoenzyme CK-MB is not elevated. 4. The D-dimer is negative at two (2) hours post-mi. 39. The client with arthritis is self-medicating with aspirin, a nonsteroidal antiinflammatory medication. Which complication should the nurse discuss with the client? 1. Tinnitus. 2. Diarrhea. 3. Tetany. 4. Paresthesia. CHAPTER 19 PHARMACOLOGY 721 40. The client is receiving a loop diuretic for congestive heart failure. Which medication would the nurse expect the client to be receiving while taking this medication? 1. A potassium supplement. 2. A cardiac glycoside. 3. An ACE inhibitor. 4. A potassium cation.
722 MED-SURG SUCCESS 41. The nurse is reviewing laboratory values for the female client diagnosed with cancer. Based on the laboratory report, which biologic response modifier would the nurse anticipate administering to the client? Laboratory Test Client Values Normal Values Red blood cells 4.11 M: 4.7 6.1 ( 10 6 )/mm 3 F: 4.2 5.4 ( 10 6 )/mm 3 Hemoglobin 12.2 M: 13.5 17.5 g/dl F: 11.5 15.5 g/dl Hematocrit 37 M: 40% 52% F: 36% 48% White blood cells 2.0 4.5 11.0 ( 10 3 )/mm 3 Platelets 160 140 400 ( 10 3 )/mm 3 1. Interferon. 2. Neupogen. 3. Neumega. 4. Procrit. 42. The client admitted with pneumonia is taking Imuran, an immunosuppressive agent. Which question should the nurse ask the client regarding this medication? 1. Do you know this medication has to be tapered off when discontinued? 2. Have you been exposed to viral hepatitis B or C recently? 3. Why are you taking this medication, and how long have you taken it? 4. Do you have a lot of allergies or sensitivities to different medications? 43. The elderly client is in a long-term care facility. If the client does not have a daily bowel movement in the morning, he requests a cathartic, bisacodyl (Dulcolax). Which action is most important for the nurse to take? 1. Ensure the client gets a cathartic daily. 2. Discuss the complications of a daily cathartic. 3. Encourage the client to increase fiber in the diet. 4. Refuse to administer the medication to the client. 44. The client received Narcan, a narcotic antagonist, following a colonoscopy. Which action by the nurse has the highest priority? 1. Document the occurrence in the nurse s notes. 2. Prepare to administer narcotic medication IV. 3. Administer oxygen via nasal cannula. 4. Assess the client every 15 to 30 minutes. 45. The client diagnosed with chronic obstructive pulmonary disease is being discharged and is prescribed the steroid prednisone. Which scientific rationale supports why the nurse instructs the client to taper off the medication? 1. The pituitary gland must adjust to the decreasing dose. 2. The beta cells of the pancreas have to start secreting insulin. 3. This will allow the adrenal gland time to start functioning. 4. The thyroid gland will have to start producing cortisol.