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saunders nclex answers from back of each chapter

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Talia Saunders up to chapter 61

Question 1 of 44

1

The nurse is monitoring a client who is receiving oxytocin (Pitocin) to induce labor. Which assessment finding would cause the nurse to immediately DC the medication?

Select one of the following:

  • Fatigue

  • Drowsiness

  • Uterine hyperstimulation

  • Early decelerations of the fetal HR

Explanation

Question 2 of 44

1

A pregnant client is receiving magnesium sulfate for the management of preeclampsia. The nurse determines that the client is experiencing toxicity from the medication if which of the following is noted on assessment?

Select one of the following:

  • Proteinuria of 3+

  • Respirations of 10 breaths/min

  • Presence of deep tendon reflexes

  • Serum magnesium level of 6mEq/L

Explanation

Question 3 of 44

1

The nurse is monitoring a client in preterm labor who is receiving IV magnesium sulfate. The nurse should monitor for which adverse effects of the medication?

Select one of the following:

  • Flushing

  • HTN

  • Increased urine output

  • Depressed respirations

  • Extreme muscle weakness

  • Hyperactive deep tendon reflexes

Explanation

Question 4 of 44

1

The nurse instructor asks a nursing student to describe the procedure for administering erythromycin ointment to the eyes of a newborn. Which student statement indicates that further teaching is needed?

Select one of the following:

  • I will flush the eyes after instilling the ointment

  • I will clean the newborns eyes before instilling the ointment

  • I need to administer the eye ointment within 1 hour after delivery

  • I will instill the eye ointment into each of the newborns conjunctival sacs

Explanation

Question 5 of 44

1

A client in preterm labor (31 weeks) who is dilated to 4 cm has been started on magnesium sulfate and contractions have stopped. If the client's labor can be inhibited for the next 48 hours, the nurse anticipates a prescription for which medication?

Select one of the following:

  • Nalbupine

  • Betamethasone (Celestone)

  • Rh(D) immune globulin (RhoGAM)

  • Dinoprostone (Cervodil vaginal insert)

Explanation

Question 6 of 44

1

Methylgonovine is prescribed for a women to treat postpartum hemorrhage. Before administration of methylergonovine, what is the priority nursing assessment?

Select one of the following:

  • Uterine tone

  • Blood pressure

  • Amount of lochia

  • Deep tendon reflexes

Explanation

Question 7 of 44

1

The nurse is preparing to administer beractant (Survanta) to a premature infant who has respiratory distress syndrome. The nurse plans to administer the medication by which route?

Select one of the following:

  • Inteadermal

  • Intratracheal

  • Subcutaneous

  • Intramuscular

Explanation

Question 8 of 44

1

An ovoid analgesic is administered to a client in labor. The nurse assigned to care for the clinet ensures that which medication is readily available if respiratory depression occurs?

Select one of the following:

  • Naloxone

  • Morphine sulfate

  • Betamethasone (Celestone)

  • Meperidine hydrocholoride (Demerol)

Explanation

Question 9 of 44

1

Rh(D) immune globulin (RhoGAM) is prescribed for a client after delivery and the nurse provides information to the client about the purpose of the medication. The nurse determines that the woman understands the purpose of the women states that it will protect her next baby from which condition?

Select one of the following:

  • Having Rh-positive blood

  • Developing a rubella infection

  • Developing physiological jaundice

  • Being affected by Rh incompatability

Explanation

Question 10 of 44

1

Methylergonovine is prescribed for a client with postpartum hemorrhage. Before administering the medication, the nurse contacts the health care provider who prescribed the medication if which condition is documented in the client's medical history?

Select one of the following:

  • Hypotension

  • Hypothyroidism

  • Diabetes mellitus

  • Peripheral vascular disease

Explanation

Question 11 of 44

1

(Pediatric Medication Administration) The nurse is providing medication instructions to a parent. Which statement by the parent indicates a need for further instruction?

Select one of the following:

  • I should cuddle my child after giving the medication

  • I can give my child a frozen juice bar after he swallows the medication

  • I should mix the medication in the baby food and give it when I feed my child

  • If my child does not like the taste of the medication, I should encourage him to pinch his nose and drink the medication through a straw.

Explanation

Question 12 of 44

1

A health care provider prescription reads "ampicillin sodium 125 mg IV every 6 hours" The medication label reads "1 g and reconstitute with 7.4 mL of bacteriostatic water. The nurse prepares to draw up how many mL to administer 1 dose?

Select one of the following:

  • 1.1 mL

  • 0.54 mL

  • 7.425 mL

  • 0.925 mL

Explanation

Question 13 of 44

1

A pediatric client with ventricular septal defect repair is placed on a maintenance dosage of digoxin (Lanoxin). The dosage is 0.07 mg/kg/day, and the clients weight is 7.2 kg. The health care provider (HCP) prescribes the drug digoxin to be given twice daily. The nurse prepares how much digoxin to administer to the client in each dose?

Select one of the following:

  • 0.5 mg

  • 2.5 mg

  • 0.25 mg

  • 0.37 mg

Explanation

Question 14 of 44

1

Sulfisoxazole (Gantrisin), 1 g orally four times daily is prescribed for an adolescent with a UTI. The medication label reads "500 mg tablets". The nurse has determined that the dosage prescribed is sage. The nurse administers how many tablets per dose to the adolescent?

Select one of the following:

  • 1/2 tablet

  • 1 tablet

  • 2 tablets

  • 3 tablets

Explanation

Question 15 of 44

1

Penicillin G procaine (Wycillin), 1,000,000 units IM, is prescribed for a child with an infection The mediation label reads "1,200,000 units per 2 mL". The nurse has determined that the dose prescribed is safe The nurse administers how many mL per dose to the child?

Select one of the following:

  • 0.8 mL

  • 1.2 mL

  • 1.44 mL

  • 1.66 mL

Explanation

Question 16 of 44

1

The nurse prepares to administer an IM injection to a 4 month old infant. The nurse selects which best site to administer the injection?

Select one of the following:

  • Ventrogluteal

  • Dorsal gluteal

  • Rectus femoris

  • Vastus lateralis

Explanation

Question 17 of 44

1

Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client knowing that which finding indicates the presence of systemic toxicity from this medication?

Select one of the following:

  • Tinnitus

  • Diarrhea

  • Constipation

  • Decreased respiration

Explanation

Question 18 of 44

1

The health education nurse provides instructions to a group of clients regarding measures that will assist in preventing skin cancer. Which instructions should the nurse provide? SATA

Select one of the following:

  • Sunscreen should be reapplied every 8 hours

  • Use sunscreen when participating in outdoor activities

  • Avoid sun exposure in the late afternoon and early evening hours

  • Wear a hat, opaque clothing and sunglasses when in the sun.

  • Examine your body monthly for any lesions that may be suspicious.

Explanation

Question 19 of 44

1

Mafenide acetate (Sulfamylon) is prescribed for a client with a burn injury. When applying the medication, the client complains of local discomfort and burning. The nurse should take which most appropriate action?

Select one of the following:

  • Discontinue the medication

  • Notify the healthcare provider

  • Inform the client that this is expected

  • Apply a thinner film than prescribed to the burn site.

Explanation

Question 20 of 44

1

A burn client is receiving treatments of topical mafenide acetate (Sulfamylon) to the site of injury. Thenruse monitors the client knowing that which findings indicates that a systemic effect has occurred?

Select one of the following:

  • Hyperventilation

  • Local rash at the burn site

  • Elevated blood pressure

  • Local pain at the burn site

Explanation

Question 21 of 44

1

Isotreinoin (Amnesteem or Claravis) is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed?

Select one of the following:

  • Platelet count

  • Triglyceride level

  • CBC

  • WBC count

Explanation

Question 22 of 44

1

A client with severe acne is seen in the clinic and the health care provider (HCP) prescribed isotretinoin (Amnesteem or Claravis). The nurse reviews the clients medical record and would contact the HCP if the client is taking which medication?

Select one of the following:

  • Vitamin A

  • Digoxin (Lanoxin)

  • Furisomide (Lasix)

  • Phenytoin (Dilantin)

Explanation

Question 23 of 44

1

The nurse is applying a topical corticosterioid to a client with eczema. The nurse should monitor for the potential for increased systemic absorption of the medication if the medication were being applied to which body area?

Select one of the following:

  • Back

  • Axilla

  • Soles of the feet

  • Palms of the hands

Explanation

Question 24 of 44

1

The clinic nurse is performing an admission assessment on a client and notes that the client is taking azelaix acid (Azelex). Because of the medication prescription, the nurse would suspect that the client is being treated with which condition?

Select one of the following:

  • Acne

  • Eczema

  • Hair loss

  • Herpes simplex

Explanation

Question 25 of 44

1

Silver sulfadiazine (Sulfadene, Thermazene, SSD cream) is prescribed for a client with a partial thickness burn and the nurse provides teaching about the medication. Which statement made the client indicates for further teaching?

Select one of the following:

  • The medication is an antibacterial

  • The medication will help me heal the burn

  • The medication will permanently stain my skin

  • The medication should be applied directly to the wound

Explanation

Question 26 of 44

1

The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied at which times?

Select one of the following:

  • Immediately before swimming

  • 5 minutes before exposure to the sun

  • Immediately before exposure to the sun

  • At least 30 minutes before exposure to the sun

Explanation

Question 27 of 44

1

Chemotherapy dosage is frequently based on total body surface area (BSA), so it is important for the nurse to perform which assessment before administering chemotherapy?

Select one of the following:

  • Measure the client's abdominal girth

  • Calculate the client's body mass index

  • Ask the client about his or her weight and height

  • Measure the client's current weight and height

Explanation

Question 28 of 44

1

557. A client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed?

Select one of the following:

  • Echocardiography

  • Electrocardiography

  • Cervical radiography

  • Pulmonary function studie

Explanation

Question 29 of 44

1

558. A client with acute myelocytic leukemia is being treated with bisulfate (Myleran, Bisulfex). Which laboratory value would the nurse specifically monitor during treatment with this medication?

Select one of the following:

  • Clotting time

  • Uric acid level

  • Potassium level

  • Blood glucose level

Explanation

Question 30 of 44

1

559. A client with small cell lung cancer is being treated with etoposide (Topsar). The nurse monitors the client during administration, knowing that which adverse effect is specifically associated with this medication?

Select one of the following:

  • Alopecia

  • Chest pain

  • Pulmonary fibrosis

  • Othostatic hypotension

Explanation

Question 31 of 44

1

560. A clinic nurse prepares a teaching plan for clients receiving an antineoplastic medication. When implementing the plan, the nurse should make which statement to the client?

Select one of the following:

  • You can take aspirin (acetylsalicylic acid) as needed for a headache.

  • You can drink beverages containing alcohol win moderate amounts each evening

  • You need to consult with a health care provider (HCP) before receiving immunizations

  • It is fie to receive a flu vaccine at the local health fair without HCP approval because the flu is so contagious.

Explanation

Question 32 of 44

1

561. A client with ovarian cancer is being treated with vincristine (Vincasar). The nurse monitors the client, knowing that which manifestation indicates an adverse effect specific to this medication?

Select one of the following:

  • Diarrhea

  • Hair loss

  • Chest pain

  • Peripheral neutopathy

Explanation

Question 33 of 44

1

562. The nurse is reviewing the H&P examination of a client who will be receiving asparagnase (Elipsar), an antineopastic agent. The nurse contacts the health care provider before administering the mediation if which disorder is documented in the client's history?

Select one of the following:

  • Pancreatitis

  • DM

  • MI

  • COPD

Explanation

Question 34 of 44

1

563. Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. The nurse administering th medication understands that which is the primary action of this medication?

Select one of the following:

  • It increases DNA and RNA synthesis

  • It promotes the biosynthesis of nucleic acid.

  • It increases estrogen concentration and estrogen response

  • It competitively binds to estrogen receptors on tumors and other tissue targets.

Explanation

Question 35 of 44

1

564. A client with metastatic breast CA is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication?

Select one of the following:

  • Glucose level

  • Calcium level

  • Potassium level

  • Prothrombin time

Explanation

Question 36 of 44

1

565. Megestrol acetate (Megase) , an antineoplastic medication is prescribed for a client with metastatic endometrial carcinoma. The nurse reviews the client's history and should contact the health care provider if which diagnosis is documented in the clients health history.

Select one of the following:

  • Gout

  • Asthma

  • Thrombophlebitis

  • Myocardial infarcation

Explanation

Question 37 of 44

1

566. The nurse monitoring the IV infusion of antineoplastic medication. During the infusion , the client complains of pain at the insertion site. On inspection of the site the nurse notes that redness and swelling and that the infusion of the medication has slowed in rate. The nurse suspects extraversion and should take which actions.

Select one of the following:

  • Stop the infusion

  • Notify the health care provider~

  • Prepare to apply ice to the site~

  • Restart the IV at a distal part of the same vein

  • Prepare to administer a prescribed antidote into the site~

  • Increase the flow rate of the solution to flush the skin and subcutaneous tissue. ~

Explanation

Question 38 of 44

1

567. The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the nurse specifically note as a result of the massive cell destruction that occurred from chemotherapy?

Select one of the following:

  • Anemia

  • Decreased platelets

  • Increased uric acid level

  • Decreased leukocyte count

Explanation

Question 39 of 44

1

568. The nurse is providing medication instructions to a client with breast CA who is receiving cycolophosphamide. The nurse should tell the client to take which action?

Select one of the following:

  • Take the medication with food.

  • Increase fluid intake to 2000 to 3000 mL/day.

  • Decrease sodium intake while taking the medication.

  • Increase potassium intake while taking the medication.

Explanation

Question 40 of 44

1

569. A client with non-Hodgkins lymphoma is receiving daunorubicin (DaunoXome). Which finding would indicate to the nurse tha thte client is experiencing an adverse effect related to the medication?

Select one of the following:

  • Fever

  • Sores in the mouth and throat

  • Complaints of nausea and vomiting

  • Crackles on auscultation of the lungs

Explanation

Question 41 of 44

1

570. The nurse is monitoring the laboratory results of a client receiving an antineoplastic medication by IV route. The nurse plans to initiate bleeding precautions if which laboratory result is noted.

Select one of the following:

  • A clotting time of 10 minutes

  • An ammonia level of 20 mcg/dL

  • A platelet count of 50,000 cells mm^2

  • A WBC count of 5000 cells mm^2

Explanation

Question 42 of 44

1

600. The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching?

Select one of the following:

  • Withdraws the NPH insulin first?

  • Withdraws the regular insulin first?

  • Injects air into NPH insulin vial first?

  • Injects an amount of air equal into the desired dose of insulin into each vial?

Explanation

Question 43 of 44

1

601. The home care nurse visits a client recently diagnosed with DM who is taking Humilin NPH daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should tell the client what action?

Select one of the following:

  • Freeze the insulin

  • Refrigerate the insulin

  • Store the insulin in a dark and dry place.

  • Keep the insulin at room temperature.

Explanation

Question 44 of 44

1

602. Glimpiride (Amaryl) is prescribed for a client with DM The nurse instructs the client to avoid consuming which food while taking this medication?

Select one of the following:

  • Alcohol

  • Organ meats

  • Whole grain cereal

  • Carbonated beverages

Explanation