Rationale:

A. A heart rate of 105/min is slightly elevated, but it does not require immediate intervention unless the client is symptomatic or has other concerning signs.

B. Infiltration of the peripheral IV requires immediate intervention, as it can lead to tissue damage and prevent the medication from being effectively delivered. The nurse should stop the infusion, assess the site, and take appropriate action.

C. Increased blood pressure is a common effect of dopamine administration and does not necessarily require urgent intervention unless it becomes critically high or is associated with other adverse symptoms.

D. Occasional PVCs can occur during dopamine infusion and can be monitored unless they become frequent or symptomatic; they typically do not require immediate intervention.

Rationale:

A. Delaying the incident report until the end of the current shift can compromise the timely documentation of the error and any necessary interventions that may arise.

B. While it's important to notify risk management, the priority should be to document the incident immediately after assessing the client to ensure a complete record of the error.

C. Completing the incident report as soon as the assessment is complete is the most appropriate action, allowing for prompt documentation of the error and any potential effects on patient care.

D. Informing the previous nurse is necessary for communication, but it should not delay the completion of the incident report, which is crucial for tracking errors and improving safety protocols.

Rationale:

A. Blurred vision is a common side effect of anticholinergic medications due to their effect on the eye muscles and pupil dilation.

B. Polyuria is not typically associated with anticholinergic medications; these medications may actually lead to urinary retention.

C. A productive cough is not an expected adverse effect of anticholinergic medications; instead, they may cause dry mucous membranes and a dry cough.

D. Tachycardia can occur as anticholinergic medications block the effects of acetylcholine on the heart, leading to increased heart rate.

E. Constipation is a well-known side effect of anticholinergic medications because they reduce gastrointestinal motility.

Rationale:

A. Monitoring alanine aminotransferase is important for liver function, but it is not the priority for a client on captopril.

B. Thyroid-stimulating hormone is not directly impacted by captopril and is not the priority lab value to monitor in this context.

C. Potassium is the priority laboratory value to monitor because captopril, an ACE inhibitor, can lead to hyperkalemia (elevated potassium levels), which can cause serious cardiac complications.

D. While magnesium levels are important to monitor, they are not specifically related to captopril therapy as potassium levels are.

Rationale:

A. The pharmacist typically restocks the medication drawer each day to ensure that medications are available and up-to-date. This is an essential component of the unit-dose medication system.

B. The nursing supervisor does not usually unlock the medication drawer; this is typically done by the nurse in charge or the individual administering the medications.

C. While it is important to limit the number of controlled substances, the medication drawer is usually stocked in a manner that allows for easy access to necessary medications, and there are regulations that govern this process.

D. Opened medications should not necessarily be disposed of at the end of each shift; they may be retained if they are still within their stability period and are properly stored according to protocols.

Rationale:

A. Cataracts are not a contraindication for cholinesterase inhibitors like neostigmine.

B. Hypertension is not a direct contraindication for cholinesterase inhibitor therapy, although caution may be exercised depending on the overall health status of the client.

C. Hypothyroidism is not contraindicated for cholinesterase inhibitors; however, it should be managed appropriately.

D. Peptic ulcer disease is a significant contraindication for cholinesterase inhibitors like neostigmine because these medications can increase gastric secretions and motility, potentially exacerbating ulcer conditions and leading to complications.

Rationale:

A. Furosemide is a diuretic that promotes urine production but is not indicated for treating bladder distention or urinary retention post-surgery.

B. Lorazepam is an anxiolytic medication and does not address urinary retention or bladder distention.

C. Bethanechol is a cholinergic agent that stimulates bladder contraction and is used to treat urinary retention. It helps to facilitate voiding in clients who have difficulty.

D. Atropine is an anticholinergic medication that can actually inhibit bladder contraction, making it inappropriate for this situation.

Rationale:

A. Sargramostim is a granulocyte-macrophage colony-stimulating factor (GM-CSF) used to stimulate the production of white blood cells but is not specifically indicated for anemia.

B. Filgrastim is a granulocyte colony-stimulating factor (G-CSF) that increases white blood cell counts and is not used for treating anemia.

C. Epoetin is an erythropoiesis-stimulating agent that stimulates red blood cell production, making it the appropriate choice for treating chemotherapy-induced anemia.

D. Romiplostim is a thrombopoietin receptor agonist used to treat thrombocytopenia (low platelet count) and is not indicated for anemia.

Rationale:

A. "Cloudy" is not a medication and does not address any adverse effects related to topotecan.

B. Granisetron is an antiemetic medication used to prevent nausea and vomiting, which are common adverse effects of topotecan.

C. Insulin lispro is a rapid-acting insulin used to control blood sugar levels and does not relate to the adverse effects of topotecan.

D. Docusate sodium is a stool softener used to prevent constipation, but it does not specifically address the nausea and vomiting associated with chemotherapy.

E. Prednisone is a corticosteroid that may be used for other indications but is not primarily indicated for treating the nausea and vomiting caused by topotecan.

Rationale:

A. Hydrochlorothiazide does not prevent angiotensin II from binding with receptor sites; this action is typically associated with ACE inhibitors or angiotensin receptor blockers.

B. Hydrochlorothiazide decreases the reabsorption of sodium and water in the distal renal tubule, which leads to increased urine output and decreased blood volume, effectively lowering blood pressure.

C. Hydrochlorothiazide does not block beta receptors; this is the mechanism of action for beta-blockers.

D. Hydrochlorothiazide does not promote the movement of extravascular fluids into the vascular compartment; instead, it reduces blood volume by promoting diuresis.

Rationale:

A. Nitrofurantoin can cause brown-colored urine due to its pigment, and clients should be informed to report this as a common side effect and not a cause for alarm.

B. Nitrofurantoin is an antibiotic used to treat urinary tract infections and does not provide relief for peripheral nerve pain.

C. Nitrofurantoin should not be crushed, as it can affect the medication's absorption and effectiveness.

D. A cough is not a typical side effect of nitrofurantoin; however, if the client develops a cough, it could be a sign of a serious side effect, and they should notify the provider.

Rationale:

A. Educating the client about the consequences of not taking valproic acid is essential to ensure they understand the importance of adherence to the medication regimen.

B. Suggesting that the client take the medication with food can help minimize gastrointestinal side effects such as nausea.

C. Documenting the client's refusal in the medication administration record is a critical step to maintain accurate medical records and to inform other healthcare providers.

D. Offering to administer the medication IM is not appropriate, as valproic acid is typically given orally and not via intramuscular injection.

E. Recommending the client ask the provider about an enteric-coated formulation may provide a more tolerable option to reduce gastrointestinal side effects.

Rationale:

• Administering albuterol first is crucial because it is a bronchodilator that will help open the airways before administering the anti-inflammatory fluticasone.

• The client should rest for 1 minute between puffs of albuterol to allow for the medication to take effect.

• After taking the second puff of albuterol, a longer rest of 5 minutes allows the client to experience the full effects of the bronchodilator.

• Finally, administering fluticasone afterward will help reduce inflammation in the airways, maximizing the benefit of both medications.

Rationale:

A. This statement is incorrect because the client should remove contact lenses before administering brimonidine and wait at least 15 minutes before reinserting them to ensure proper absorption and avoid irritation.

B. While some mild irritation can occur, it is not a desired effect and should not be expected; the nurse should clarify what level of irritation is considered normal.

C. This statement is incorrect as brimonidine is typically a long-term treatment for glaucoma, and clients should not stop using it without consulting their provider.

D. This statement is correct; brimonidine can cause changes in eye color, particularly in individuals with lighter colored eyes, and the client should be informed about this possibility.

Rationale:

A. This statement is incorrect because omeprazole is not an antibiotic and does not kill bacteria; it is a proton pump inhibitor (PPI) that reduces acid production.

B. This statement is incorrect; omeprazole does not neutralize stomach acid, but rather decreases its production.

C. This statement is also incorrect; omeprazole does not coat the stomach lining; it works by inhibiting the proton pumps in the stomach lining to reduce acid secretion.

D. This statement is correct; omeprazole reduces stomach acid production, which is beneficial for managing GERD symptoms.

Rationale:

A. Requesting a serum trough level blood draw for 60 minutes after the completion of the infusion is appropriate for monitoring the therapeutic levels of vancomycin and ensuring it is within the desired range to prevent toxicity.

B. Changing the infusion site after each dose administration is not necessary unless there is an issue such as infiltration or phlebitis; typically, the site can be used for multiple doses if it remains patent and functional.

C. Contacting the provider for prescription clarification is not needed unless there are specific concerns about the medication or the administration protocol; in this case, the order is clear and standard.

D. Requesting a serum peak level to be drawn 30 minutes prior to infusion is incorrect, as the peak level should be drawn 30 minutes after the completion of the infusion, not before the next dose.

Rationale:

A. Diazepam is a benzodiazepine used for anxiety and sedation but is not effective for treating malignant hyperthermia.

B. Dantrolene is the specific antidote for malignant hyperthermia, and the nurse should expect to administer it to help reduce the severe muscle contractions and hypermetabolism associated with this condition.

C. Cyclobenzaprine is a muscle relaxant used for muscle spasms but is not indicated for malignant hyperthermia.

D. Metaxalone is also a muscle relaxant, but like cyclobenzaprine, it is not effective for managing malignant hyperthermia and would not be used in this situation.

Rationale:

A. Terazosin is indicated for the treatment of hypertension as it works by relaxing blood vessels, leading to lower blood pressure.

B. Terazosin is not indicated for heart failure; other medications are typically used to manage this condition.

C. Male pattern baldness is treated with other medications, such as finasteride, rather than terazosin.

D. Terazosin is also indicated for benign prostatic hypertrophy (BPH), as it helps alleviate urinary symptoms associated with this condition by relaxing the smooth muscles in the prostate and bladder neck.

E. Terazosin is not indicated for erectile dysfunction; it is primarily used for hypertension and BPH.

Rationale:

A. Acetylcysteine is not indicated for gastrointestinal bleeding; other treatments are used for that condition.

B. Acute bronchospasm is treated with bronchodilators rather than acetylcysteine.

C. Morphine toxicity requires other interventions, such as opioid antagonists (e.g., naloxone), and acetylcysteine is not effective in this case.

D. Acetylcysteine is specifically indicated for acetaminophen toxicity as it acts as an antidote, replenishing glutathione stores and preventing liver damage from toxic metabolites.

Rationale:

A. Applying a warming blanket is not appropriate, as it may exacerbate the client's reaction to the infusion and is not a standard pre-medication strategy.

B. Infusing amphotericin B deoxycholate over 1 hour is too rapid; it is typically infused over 2-6 hours to minimize adverse effects.

C. Administering diphenhydramine prior to the administration of amphotericin B can help prevent or alleviate infusion-related reactions such as fever and chills, which the client experienced during previous infusions.

D. Monitoring vital signs once per hour following administration is insufficient; vital signs should be monitored more frequently during and immediately after the infusion to promptly detect and address any adverse reactions.

Rationale:

A. Verapamil is a calcium channel blocker that typically decreases heart rate rather than increases it. Therefore, an increased heart rate would not be a therapeutic response to this medication.

B. Verapamil works to lower blood pressure by inhibiting calcium influx into the vascular smooth muscle. An increase in blood pressure would not be an expected therapeutic outcome.

C. While verapamil may help with heart function, the primary therapeutic response is not specifically measured by decreased pulmonary congestion. This outcome may not be directly observable in the early treatment phases post-myocardial infarction.

D. Verapamil is effective in reducing anginal pain by decreasing myocardial oxygen demand through lowering heart rate and contractility. Thus, a decrease in anginal pain would be a direct therapeutic response to the medication.

Rationale:

A. Applying a warming blanket is not appropriate and may worsen the client’s reaction to the infusion. It does not help prevent infusion-related reactions.

B. Infusing amphotericin B deoxycholate over 1 hour is too fast; the medication should be infused over 2-6 hours to reduce the risk of adverse effects.

C. Administering diphenhydramine prior to administration is recommended to help prevent infusion-related reactions, such as fever and chills, which the client experienced during previous infusions.

D. Monitoring vital signs once per hour is inadequate; vital signs should be monitored more frequently during and immediately after the infusion to promptly identify and manage any adverse reactions.

Rationale:

A. Frequent sputum tests may be needed to monitor the effectiveness of isoniazid, particularly in assessing the resolution of tuberculosis infection.

B. Isoniazid is usually prescribed for a minimum of six months for tuberculosis treatment, not just a month. Thus, stopping after one month is incorrect.

C. Antacids containing aluminum should not be taken concurrently with isoniazid, as they can interfere with the absorption of the medication, reducing its effectiveness.

D. Constipation is not a common side effect of isoniazid. The more frequent side effects include peripheral neuropathy and liver toxicity, making this statement incorrect.

Rationale:

A. A respiratory rate of 24/min is elevated and may suggest respiratory distress, but it is not a specific adverse effect of propranolol.

B. An oral temperature of 38.9° C (102° F) indicates fever, which is not a typical adverse effect of propranolol.

C. A blood pressure of 118/78 mm Hg is within normal limits and does not indicate an adverse effect of propranolol, which is often used to manage hypertension.

D. An apical pulse of 50/min indicates bradycardia, a known adverse effect of propranolol, which can occur due to its action on the heart rate.

Rationale:

A. Bradycardia: Albuterol can cause an increase in heart rate (tachycardia) as a common side effect, not a decrease in heart rate, so bradycardia would not be expected.

B. Wheezing: Albuterol is used to relieve wheezing by causing bronchodilation, so continued wheezing after administration would suggest ineffective treatment rather than being an expected finding.

C. Tremors: Tremors are a common side effect of albuterol due to its stimulation of beta-2 receptors in the muscles. This is often seen after nebulizer treatments.

D. Sleepiness: Albuterol generally causes stimulation of the central nervous system, leading to restlessness or nervousness, not sleepiness.