The nurse is preparing to administer medications to a client...

Vital signs
Temperature 98.4 F (36.9 C)
Blood pressure 124/78 mm Hg
Heart rate 46/min and irregularly irregular
Respirations 22/min

The nurse is preparing to administer medications to a client admitted with atrial fibrillation. The nurse notes the vital signs shown in the exhibit. Which medications due at this time are safe to administer? Select all that apply.

A. Diltiazem extended-release PO
B. Heparin subcutaneous injection
C. Lisinopril PO
D. Metoprolol PO
E. Timolol ophthalmic

Correct Answer: A,B,E

Rationale: Without specific vital signs, diltiazem (rate control), heparin (anticoagulation), and timolol (glaucoma, not cardiac) are generally safe in atrial fibrillation unless contraindicated (e.g., severe hypotension). Lisinopril and metoprolol require caution if hypotensive or bradycardic, but no exhibit data suggests otherwise.

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The nurse is reinforcing discharge teaching to several clients with new prescriptions. Which instructions by the nurse about medication administration are correct? Select all that apply.

A. Avoid salt substitutes when taking valsartan for hypertension
B. Take levofloxacin with an aluminum antacid to avoid gastric irritation
C. Take sucralfate (for a gastric ulcer) after meals to minimize gastric irritation
D. When taking ethambutol, notify the health care provider (HCP) for changes in vision
E. When taking rifampin, notify the HCP if the urine turns red-orange in color

Correct Answer: A,D

Rationale: Salt substitutes (potassium-based) can cause hyperkalemia with valsartan. Ethambutol can cause optic neuritis, requiring vision change reports. Levofloxacin with antacids reduces absorption. Sucralfate is taken before meals to coat the stomach. Rifampin's red-orange urine is normal, not reportable.

The nurse is talking with the parent of an adolescent client with suspected bulimia nervosa. Which of the following statements by the client's parent would be consistent with bulimia nervosa?

A. I have noticed my child cuts food into small pieces and pushes it around the plate.
B. I found several empty boxes of laxatives in my child's bedroom.
C. My child has lost 20 lb (9.1 kg) in the past 2 months.
D. My child has stopped exercising.

Correct Answer: B

Rationale: Laxative abuse is a common purging behavior in bulimia nervosa. Cutting food and pushing it around is more typical of anorexia. Significant weight loss is less common in bulimia, as weight often fluctuates. Reduced exercise isn't characteristic.

The nurse's neighbor has a total cholesterol of 450 mg/dL. The neighbor asks the nurse what this means. What should the nurse include when responding?

A. The cholesterol level is slightly high, but exercise and a low-fat diet should reduce it to normal.
B. The cholesterol level is below normal levels, but this is good.
C. The cholesterol level is high. The neighbor should talk with the physician about ways to lower it.
D. The cholesterol is within normal limits.

Correct Answer: C

Rationale: A cholesterol level of 450 mg/dL is significantly elevated, increasing cardiovascular risk, requiring medical consultation.

A client with renal failure has an order for erythropoietin (Epogen) to be given subcutaneously. The nurse should teach the client to report:

A. Severe headache
B. Slight nausea
C. Decreased urination
D. Itching

Correct Answer: A

Rationale: Erythropoietin can increase blood viscosity, raising the risk of hypertension or thrombosis, which may present as a severe headache. Slight nausea , decreased urination , and itching are less specific or urgent.

An adult who has osteoarthritis tells the clinic nurse that her joints have been more painful lately and her head aches and her ears are 'making funny buzzing sounds.' What question should the nurse ask the client?

A. How long have you had arthritis?
B. Have you recently been exposed to loud noises?
C. What do you think is causing your joints to hurt more lately?
D. What medication have you been taking for your painful joints?

Correct Answer: D

Rationale: New symptoms with increased joint pain suggest possible medication side effects (e.g., NSAIDs causing tinnitus), making medication history critical.