Establish your study priorities and the goals by

Establish your study priorities and the goals by which to achieve these priorities. Write them out
and review the goals during each of your study periods to ensure focused preparation e ff orts.
Rationale
One side e ff ect of prostaglandin E 2 is bronchoconstriction, which may cause a bronchospasm in a client with
asthma. An albuterol inhaler may be used as needed. Epidural anesthesia is not contraindicated for pregnant
clients with asthma. Intravenous D 5W with piggyback oxytocin is not contraindicated for a pregnant client
with asthma.
Epidural anesthesia
Intravenous D5W with piggyback oxytocin
Prostaglandin E 2 vaginal suppository
Rationale
Preterm labor is often delayed or inhibited by adminstereding tocolytics such as indomethacin. Preterm labor
is delayed so that magensium sulfate for neuroprotection can be admininstered and so that steroid therapy
can be completed. These actions have been shown to prevent morbidity and mortality in the fetus.
Indomethacin should be given for the management of preterm labor. Oxytocin is used to induce labor.
Dinoprostone is also a uterine stimulant administered via the vaginal route; it is not appropriate in this
condition. Methylergonovine is indicated for postpartum uterine atony and hemorrhage.
Dinoprostone
Indomethacin
Methylergonovine
Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong
answer.
Some correct answers were not selected
Rationale
Early side e ff ects of oral contraceptives include bloating, nausea, and breast tenderness. Although they may be
bothersome enough to lead to discontinuation of the contraceptive, these side e ff ects usually subside in
several months. Dizziness is not a common side e ff ect and should be reported to the provider. Contraceptives
have been associated with thrombophlebitis; clinical manifestations of thrombophlebitis include calf
tenderness and redness and heat over the a ff ected area. If the clot travels, it could present as a pulmonary
embolism, so chest pain should be reported as well.
STUDY TIP: An adverse e ff ect is any unexpected or unintended response to a therapeutic dose of a drug. An
adverse e ff ect usually requires changing dosage, stopping the drug, or administering an antidote to terminate
drug action. Adverse e ff ects, sometimes called side e ff ects, fall into two groups: predictable e ff ects occur as
the result of known, dose-related pharmacological e ff ects, whereas unpredictable e ff ects are unrelated to the
drug’s characteristics. Reactions in this second group are often the result of something distinctive to the
individual, such as drug allergies, hypersensitivities, or idiosyncratic reactions. Adverse e ff ects can range in
severity from those that are merely annoying to those that are life threatening.
Chest pain
Bloating
Nausea
Calf tenderness
Breast tenderness
Rationale
Betamethasone enhances fetal lung maturity when administered before a preterm birth. Carboprost
tromethamine is a prostaglandin and nalbuphine HCl is a narcotic antagonist, neither of which is appropriate
for administration in this case. Misoprostol is used for labor induction.
Nalbuphine HCl
Betamethasone
Carboprost tromethamine
Rationale
Maternal hypotension is a common complication of epidural anesthesia during labor, and nausea is one of
the first clues that it has occurred. Turning the client on her side will keep the uterus from putting pressure on
the inferior vena cava, which causes a decrease in blood flow. Checking the vaginal area for bleeding is not an
assessment specific to epidural anesthesia; it is part of the general nursing care during labor. If signs and
symptoms do not abate after the client is turned on her side, the primary health care provider should be
notified. Fetal heart rate monitoring is a continuous process, and the rate should be recorded every 15
minutes; if this monitoring is not being performed, the rate should be checked and recorded every 15
minutes.
Checking the vaginal area for bleeding
Notifying the primary health care provider
Checking the fetal heart rate every 3 minutes
Rationale
The block provides anesthesia to the perineum , after which pain is not felt. Although the bearing-down reflex
is diminished, muscle control is not a ff ected and the client is able to bear down with contractions. The block
results in anesthesia of the perineum, not the cervix or the body of the uterus. The block a ff ects only the
perineum, not the bladder. The block does not influence the decision of whether to have an episiotomy.
Perineal pain will not be felt.
Bladder sensation may be lost.
An episiotomy may not be needed.
The bearing-down reflex will be diminished.
Rationale
Medroxyprogesterone is a long-acting progestin-only contraceptive that is less likely to cause cardiovascular
problems in women who smoke than contraceptives containing estrogen might. Vaginal rings, combined oral
contraceptive pills, and the birth control patch all contain estrogen and are not recommended for women who
smoke.
STUDY TIP: Record the information you find to be most di ffi cult to remember on 3' × 5' cards and carry them
with you in your pocket or purse. When you are waiting in tra ffi c or for an appointment, just pull out the cards
and review again. This 'found' time may add points to your test scores that you have lost in the past.
A vaginal ring
Medroxyprogesterone
Combined oral contraceptive pills
Rationale
Management of di ff erent types of medications can be di ffi cult; nurses need to seek clients’ perspectives,
voices, and needs around medication adherence and management to support identification of strategies that
may help address this issue. Educational sessions and tools or changes in the medication regimen are all
possible strategies that could be implemented after the nurse completes the assessment of parental issues
and concerns.
updates.
Develop new educational tools that clearly demonstrate appropriate administration of di ff erent types
of inhalers.
Conduct focus groups or interviews with parents to obtain their perspectives regarding di ffi culties of
managing their child’s medication regimen.
Discuss possible changes in overall asthma medication regimens with the provider to decrease the
numbers and types of inhalers needed when possible.
Some correct answers were not selected
Rationale
Yellow sclerae are a sign of toxicity that has damaged the liver and necessitates withholding the medication.
Abnormal movements of involuntary muscle groups , particularly of the face, mouth, tongue, fingers, and
toes, can occur after a prolonged period of dopamine blockade. Conversion to an atypical antipsychotic is
warranted. Akathisia and a shu ffl ing gait are common side e ff ects that usually are alleviated by
antiparkinsonian agents. Photosensitivity is an expected side e ff ect of the medication; the medication does not
have to be withheld.
Shu ffl ing gait
Yellow sclerae
Photosensitivity
Involuntary tongue movements
Some correct answers were not selected
Rationale
Suicidal ideation
Di ffi cult urination
Tardive dyskinesia
Transient hypoglycemia
Abnormal vision (e.g., blurred or double vision) is a side e ff ect of venlafaxine. Central nervous system e ff ects
First dose
Second dose
Third dose
Fourth dose
The dosage should be doubled.
The dosage should be cut in half.
The time between doses should be shortened.
The time between doses should be lengthened.
Administer acetaminophen.
Place the child on protective isolation.
Increase the rate of the vancomycin infusion.
Notify the primary health care provider after stopping the infusion.
"I should mix oral medications with food or juice."
"I should use a calibrated medicine spoon or syringe."
"I should start maintaining a medication administration chart."
"I should not readminister any spilled medications to avoid overcompensation."
Tenormin, sertraline
Labetalol, sertraline
Tenormin, sumatriptan
Labetalol, sumatriptan
Assessing the mouth for gingivitis
Checking the pupillary reaction to light
Keeping an accurate intake and output record
Monitoring the child’s complete blood cell counts
Decreased fat content
Increased protein binding
Immature blood-brain barrier
Increased first pass elimination
Decreased glomerular filtration rate
Serum hepatitis
Allergic response
Pulmonary edema
Hemolytic reaction
Administration of one intramuscular microdose (50 mcg) of Rho(D) immune globulin
Administration of one intramuscular standard dose (300 mcg) of Rho(D) immune globulin
A prescription for one subcutaneous standard dose (300 mcg) of Rho(D) immune globulin
A prescription of Rho(D) immune globulin will not be administered because of pregnancy ending
during first trimester
Heparin
Warfarin
Enoxaparin
Clopidogrel
Acetylsalicylic acid
Spinal
General
Epidural
Perineal
Limit her fluid intake.
Strain her urine for calculi.
Monitor her urine output.
Take mineral supplements 2 hours before or after levofloxacin.
Have the client stop taking her medication.
Advise the client to abort the pregnancy.
Have the client continue the asthma treatment.
Have the client reduce the dose of the medication.
"Using a scalp vein improves the absorption rate."
"Inserting the IV in a scalp vein decreases the need for restraints."
"Usually veins in the arm or hand are used, but your baby’s were too small."
"IV solutions are too irritating for the line to be inserted into a vein in the arm or hand."
"Give the next dose immediately."
"Wait 2 hours before giving the medication."
"Skip this dose and give it at the next prescribed time."
"Take the baby’s pulse and give the medication if it’s more than 90 beats/min."
Truncal obesity
Thin extremities
Increased linear growth
Loss of hair on the body
Decreased blood pressure
'Behavioral e ff ects are di ffi cult to observe.'
'Teratogens may not have immediate e ff ects.'
'Animal studies may not be applicable to humans.'
'Controlled experiments can be done in humans.'
Keep the child in side-lying position for 2 to 3 minutes.
Clean the outer ear with a washcloth.
Place the preschooler in a side-lying position.
Straighten the ear canal by pulling the auricle up and out.
Apply gentle massage or pressure to tragus of ear with finger.
Instill prescribed drops while holding the dropper 1 cm above ear
canal.
Adolescents are afraid of injections.
It decreases the risk of tissue irritation.
Severe pain is reduced more e ff ectively.
Impaired peripheral circulation is bypassed.
It provides for more prolonged relief of pain.
'I will take my pill at the same time every day.'
'I can stop the pill and try to get pregnant right away.'
'I may miss two periods and not worry about being pregnant.'
'I am so glad we won’t have to use condoms even if I miss just one pill during the month.'
Proteinuria
Epigastric pain
Loss of patellar reflexes
Urine output of 40 mL/h
Respirations of 10 breaths/min
Rh positive and Coombs positive
Rh negative and Coombs positive
Rh positive and Coombs negative
Rh negative and Coombs negative
Albuterol inhaler
Epidural anesthesia
Intravenous D5W with piggyback oxytocin
Prostaglandin E 2 vaginal suppository
Oxytocin
Dinoprostone
Indomethacin
Methylergonovine
Dizziness
Chest pain
Bloating
Nausea
Calf tenderness
Breast tenderness
Misoprostol
Nalbuphine HCl
Betamethasone
Carboprost tromethamine
Turning the client on her side
Checking the vaginal area for bleeding
Notifying the primary health care provider
Checking the fetal heart rate every 3 minutes
Contractions will decrease.
Perineal pain will not be felt.
Bladder sensation may be lost.
An episiotomy may not be needed.
The bearing-down reflex will be diminished.
A birth control patch
A vaginal ring
Medroxyprogesterone
Combined oral contraceptive pills
Require all parents of children using inhalers to attend educational sessions every 6 months for
updates.
Develop new educational tools that clearly demonstrate appropriate administration of di ff erent types
of inhalers.
Conduct focus groups or interviews with parents to obtain their perspectives regarding di ffi culties of
managing their child’s medication regimen.
Discuss possible changes in overall asthma medication regimens with the provider to decrease the
numbers and types of inhalers needed when possible.
Akathisia
Shu ffl ing gait
Yellow sclerae
Photosensitivity
Involuntary tongue movements
Blurred vision
Suicidal ideation
Di ffi cult urination
Tardive dyskinesia
Transient hypoglycemia

A client is prescribed the benzodiazepine alprazolam for the management of panic attacks.
Which action by the patient makes the nurse confident that the medication information
discussed has been understood?
An agitated, delusional client, who is acting out, is receiving large doses of haloperidol, and
the nurse is concerned because this medication can produce untoward adverse e ff ects.
Which clinical manifestations will alert the nurse to stop the medication immediately?
The nurse teaches a client about the side e ff ects and precautions associated with the
antipsychotic medication haloperidol. Which statement indicates the client has understood
the teaching?
Rationale
Photosensitivity is a side e ff ect of many antipsychotic medications. Diarrhea and vomiting are side e ff ects of
lithium, not haloperidol. Avoiding foods that contain tyramine is a precaution associated with monoamine
oxidase inhibitors, not haloperidol. Adequate fluid intake is a precaution associated with lithium, not
haloperidol.
Which medication-induced physiological alterations may be responsible for the central
nervous system e ff ects of the medication on the neonate?
The primary health care provider suspects agranulocytosis in a client with a history of
bipolar disorder (BPD). Which medication used to treat BPD is responsible for this
condition?
A client is admitted to the acute medical unit for severe amphetamine intoxication. Which
medications are indicated to counteract the e ff ects of stimulant intoxication? Select all that
apply. One, some, or all responses may be correct.
Which vitamin deficiency may occur if cholestyramine, an anion exchange resin, to treat a
client’s persistent diarrhea is needed long-term?
The nurse discusses the implications of diet and fluid intake with a client who is receiving
lithium therapy. Which instruction will the nurse give the client and family about nutrition?
Which rationale will the nurse give for the need to take penicillin G and probenecid for
syphilis?
Which symptom would the nurse expect to decrease in response to corticosteroid therapy
prescribed for a client with multiple sclerosis?
The nurse administers prescribed anxiolytics to clients with severe emotional disorders.
Which outcome is the goal of this treatment?
The nurse is reviewing the data of four clients diagnosed with schizophrenia. Which client
would the nurse identify as being at an increased risk of cardiovascular disease?
Which is the best response by the nurse to a client prescribed phenelzine who makes the
selections listed below for tomorrow’s menu?
Which action would the nurse take to ensure client safety when caring for a client with
human immunodeficiency virus–associated Pneumocystis jiroveci pneumonia that is to
receive pentamidine intravenously daily? Select all that apply. One, some, or all responses
may be correct.
When will the nurse monitor for a potential hypoglycemic reaction after administering daily
regular insulin to a client with type 1 diabetes at 8 AM?
Which intervention is the priority nursing care for a client in the coronary care unit who
develops "viselike" chest pain radiating to the neck with a blood pressure of 124/64 mm Hg,
an irregular apical pulse of 64 beats per minute, and diaphoresis who is prescribed
morphine sulfate 4 mg intravenous (IV) push stat and cardiac monitoring?
Which side e ff ect will the nurse assess for in a client with cancer who is being treated with
chemotherapeutic agents? Select all that apply. One, some, or all responses may be
correct.
Which clinical indicator of aspirin toxicity will the nurse teach the client with rheumatoid
arthritis to report? Select all that apply. One, some, or all responses may be correct.
Which statement made by a client prescribed Isoniazid (INH) as a prophylactic measure due
to having a spouse with active tuberculosis (TB) indicates that there is a need for further
teaching? Select all that apply. One, some, or all responses may be correct.
Which side e ff ect would the nurse anticipate after administering nalbuphine for pain when
providing postoperative care? Select all that apply. One, some, or all responses may be
correct.
Which instruction will the nurse include in the teaching plan for a client who will be taking
simvastatin? Select all that apply. One, some, or all responses may be correct.
Which purpose would the nurse include when explaining why a client with hyperthyroidism
is prescribed potassium iodide solution before a subtotal thyroidectomy is performed?
Which action would the nurse associate with tetanus immune globulin prescribed after a
client steps on a rusty nail?
Which medication is indicated for decreasing the size and vascularity of the thyroid gland
before thyroidectomy?
Which change would the nurse expect to find in a client with left ventricular heart failure
and supraventricular tachycardia when the prescribed digoxin 0.25 mg daily is
therapeutically e ff ective? Select all that apply. One, some, or all responses may be correct.
Which type of toxicity would the nurse suspect in a client who takes daily megadoses of
vitamins and is hospitalized with joint pain, loss of hair, yellow pigmentation of the skin,
and an enlarged liver due to vitamin toxicity?
STUDY TIP:
A client with a history of schizophrenia has recently begun reporting symptoms of
depression and is now prescribed a selective serotonin reuptake inhibitor (SSRI). Which
action is the nurse’s priority i n light of the information in the client’s chart?