A nurse is caring for a 74-yr-old client w/ chronic open-angle glaucoma. After the nurse administers pilocarpine, the client reports blurred vision. Which nursing action is most appropriate?
a) Holding the next dose & notifying the physician
b) Treating the client for an allergic reaction
c) Suggesting that the client put on his glasses
d) Explaining that this is an expected adverse effect
d) Pilocarpine, a miotic drug used to treat glaucoma, achieves its effect by constricting the pupil. Blurred vision lasting 1-2 hrs after instilling the eydrops is an expected adverse effect. The client may also note difficulty adapting to the dark. B/c blurred vision is an expected adverse effect, the drug doesn't need to be withheld nor does the physician need to be notified. Likewise, the client doesn't need to be treated for an allergic reaction. Wearing glasses won't alter his temporary adverse effect.
A nurse is assessing a 38-year-old client diagnosed w/ multiple sclerosis. Which symptom should the nurse expect to find?
a) vision changes
b) absent deep tendon reflexes
c) tremors at rest
d) flaccid muscles
a) Vision changes such as diplopia, nystagmus, and blurred vision, are symptoms of multiple sclerosis. Deep tendon reflexes may be increased or hyperactive - not absent. Babinski's sign may be positive. Tremors at rest aren't characteristic of multiple sclerosis; however, intentional tremors, or those occuring w/ purposeful voluntary movement, are common in clients w/ multiple sclerosis. Affected muscles are spastic, rather than flaccid
A nurse must plan care for a 28-yr-old client hospitalized w/ a diagnosis of myasthenia gravis. Which times are most appropriate for procedures and care to be completed?
a) All at one time, to provide a longer rest period
b) Before meals, to stimulate his appetite
c) In the morning, w/ frequent rest periods
d) Before bedtime, to promote rest
c) Myasthenia gravis is characterized by extreme muscle weakness, which generally worsens after effort & improves w/ rest. Procedures should be spaced to allow for rest in between. Procedures should be avoided before meals, or the client may be too exhausted to eat. Procedures should also be avoided at bedtime to avoid overstimulation.
After suffering an acute myocardial infarction (MI), a client w/ a history of type 1 diabetes is prescribed metoprolol (Lopressor) I.V. Which nursing interventions are associated w/ I.V. metoprolol administration? Select all that apply.
a) Monitor glucose level closely
b) Monitor the client for heart block & bradycardia
c) Monitor bp closely
d) Mix the drug in 50 ml of dextrose 5% in water and infuse over 30 mins.
e) Know that the drug isn't compatible w/ morphine
a,b,c - Metoprolol masks the common signs of hypoglycemia; therefore, glucose level should be monitored closely in diabetics. Monitor the client for the development of heart block or bradycardia. When used to treat an MI, metoprolol is contraindicated in clients w/ heart rates less than 45 beats/min & any degree of heart block. Monitor bp frequently; metoprolol masks common signs & symptoms of shock, such as decreased bp. Give the drug undiluted by direct injection. Although mixing w/ other drugs should be avoided, studies have shown metoprolol is compatible when mixed w/ meperidine hydrochloride or morphine sulfate, or when administered w/ alteplase influsion at a Y-site connection
The nurse prepares to administer a dose of which of the following medications to a client who has a diagnosis of Parkinson's disease?
1) Levodopa (L-Dopa)
2) Mitotane (Lysodren)
3) Mannitol (Osmitrol)
4) Vancomycin (Vancocin)
Levodopa. Destruction of the neurons of the basal ganglia in Parkinson's disease results in decreased muscle tone resulting in mask-like facial expression and a monotone speech pattern. Levodopa restores dopamine, the neurotransmitter secreted by the basal ganglia. Mitotane is administered for cancer of the hypothalamus. Mannitol is utilized to reduce the fluid accumulation that causes increased intracranial pressure. Vancomycin is administered to treat infections caused by a staphylococcus microorganism
The family member/caregiver of a client receiving donepezil (Aricept) for Alzheimer's disease (AD) asks the nurse, "Is the brain of a person w/ this diease different from those who do not have a problem?" Which of the following responses is most appropriate?
1) "The ventricles are narrower in the client w/ Alzheimer's disease."
2) "The number of senile plaques are the same for most populations."
3) "Neurofibrillary tangles are more prominent in the client w/ Alzheimer's disease."
4) "Vascular regeneration is more prominent in the client w/ Alzheimer's disease."
Neurofibrillary tangles are more prominent in the client w/ Alzheimer's disease. Neurofibrils are the tiny fibrils that extend every direction in the cytoplasm of the nerve cell body. The neurofibrillary tangles in the brain are a classic finding on the autopsies of clients w/ AD. The alterations in the brain associated w/ aging are accelerated in the client w/ AD. The ventricles are wider, not narrower, in the client w/ AD. The number of plaques are greater in the client w/ AD. Vascular degeneration rather than regeneration occurs in the client w/ AD.
A family member who takes diazepam (Valium) for anxiety is concerned about the administration of diazepam 10 mg IV to a relative having frequent tonic-clonic seizures that last 10 mins. The nurse provides which of the following explanations?
1) "The drug inhibits the irregular firing across the nerves in the brain."
2) "The drug relaxes peripheral muscles at the spinal level."
3) "The drug reduces the anxiety related to seizure activity."
4) "The drug provides amnesia of the seizure episode."
2) The drug relaxes peripheral muscles at the spinal level. B/c diazepam relaxes smooth muscles at the spinal level as well as in the brain stem at the reticular formation level, it is an effective anticonvulsant to treat status epilepticus. The statement in option 1 is the physiologic process occurring w/ the ingestion of most anticonvulsant drugs, but this is not how diazepam reduces seizure activing. Since the level of consciousness is reduced during seizures, perception of a threate would be imperceptible (option 3). Amnesia is commonly associated w/ seizures w/o the introduction of a drug (option 4)
The nurse concludes that the client has adequate knowledge of the side effects of phenobarbital sodium (Luminal) when the client states, "I should call the doctor if I develop:"
1) "Loss of appetite or persistent fatigue."
2) "Anal itching or dizziness when I stand up."
3) "Diarrhea or a rash on the upper part of my body."
4) "Decreased tolerance to common foods or constipation."
Loss of appetite or persistent fatigue. Phenobarbital depresses the CNS, particularly the motor cortex, producing side effects such as lethargy, loss of appetite, depression, and vertigo (option 1). Side effects associated w/ phenobarbital do not include anal itching or dizziness upon standing, diarrhea or upper body rash, or decreased tolerance to common foods and constipation (options 2,3, &4)
If a client is taking methylphenidate (Ritalin) displays which of the following, the nurse would lok for a cause that is unrelated to drug therapy?
Fever. Fever isn't a side effect of methylphenidate (option 2). B/c methylphenidate is a CNS stimulate, insomnia, nervousness, and palpitations are common side effects (options 1,3, &4)
The nurse teaches a client that a predicted outcome of phenytoin (Dilantin) is that it:
1) Produces an antispasmodic action on voluntary muscles
2) Prevents depression of the CNS
3) Controls nerve impulses originating in the motor cortex
4) Alters the permeability of the cell membrane to potassium
Controls nerve impulses originating in the motor cortex. The primary action of phenytoin is to reduce voltage, frequency, and spread of electrical discharges within the motor cortex resulting in inhibition of seizure activity (option 3). Phenytoin does not act directly on voluntary muscles, prevent CNS depression, or change permeability of cell membranes (options 1, 2 & 4)
Two weeks after teaching a client about benztropine (Cogentin), the nurse schedules a second teaching session after hearing the client make which of the following statements?
1) "I may crush the tablets to make them easier to take."
2) "I should avoid driving until I know how this med will affect me."
3) "It is acceptable to use alcohol-based over-the-counter cold medications."
4) "I should never discontinue the medication abruptly."
"It is acceptable to use alcohol-based over-the-counter cold medications." over-the-counter medications containing alcohol (another CNS depressant) are contraindicated unless ordered by the prescriber (option 3). The tablets may be crushed and ingested w/o adverse effects (option 1). Sedation is a common side effect of the drug (option 2). Withdrawal from the drug should be gradual (option 4).
The nurse performs discharge planning for a client taking donepezil hydrochloride (Aricept) while the family members are present. Which of the following should be included in the plan of care?
1) The drug remains in the body for a short period
2) If insomnia develops, contact the home health nurse
3) Antiasthmatic meds may be administered w/ this drug
4) Measure pulse and report tachycardia
If insomnia develops, contact the home health nurse. Insomnia is a common side effect of Aricept (option 2). The drug has a half-life of 70 hours (option 1). B/c the drug may cause dyspnea, it is contraindicated in clients who have chronic respiratory disorders (option 3). The drug may have vagotonic effects resulting in bradycardia (option 4).
To determine the effectiveness of tacrine (Cognex) prescribed for a client diagnosed w/ moderate Alzheimer's disease, the nurse evaluates for which of the following?
1) Reduction in occurrent of seizures
2) Increased participation in family activities
3) Decrease in signs/symptoms of clinical depression
4) Reduction in disturbed throught processes
Reduction in disturbed throught processes. Tacrine should result in an increase in organization of the client's thought patterns (option 4). Seizures are more commonly associated w/ advanced disease. The drug does not reduce seizure activity (option 1). B/c damage to cholinergic neurons is permanent and cells are lost, improvement s not likely to occur (option 2). Clinical depression may occur resulting from the client's recognition of altered mental function, but this is not viewed as a hallmark of Alzheimer's (option 3).
If a client w/ Alzheimer's disease were receiving tacrine (Cognex), the nurse would include which of the following in client assessment?
1) Monitor for diarrhea and vomiting
2) Monitor for dyspnea on exertion
3) Monitor for signs/symptoms of hyperthyroidism
4) Monitor for signs/symptoms of sexual dysfunction
Monitor for diarrhea and vomiting. B/c tacrine is a parasympathomimetic, stimulation of the GI tract is likely to occur resulting in diarrhea and vomiting (option 1). There are no known respiratory alterations associated w/ tacrine (option 2). There are no known influences on thyroid function (option 3). It may be difficult to separate altered cognitive functioning and altered sexual fuctioning (option 4)
A client w/ migrane headaches is scheduled to take amitriptyline hydrochloride (Elavil). The nurse explains that which over-the-counter medication may intensify the actions of amitriptyline?
1) Acetaminophen (Tylenol)
2) Aspirin (ASA)
3) Diphenhydramine (Benadryl)
4) Cimetidine (Tagamet HB)
Cimetidine (Tagamet HB). Cimetidine may incrase the levels of Elavil in the blood causing seizures, tachycardia, hypertension, or toxicity (4). When administering acetaminophen, the nurse should monitor for overlapping drug interactions that involve hepatotoxicity (1). When administering aspirin, the nurse should monitor for overlapping drug interactions that involve increased rish of GI bleeding (2). When administering Benadryl, the nurse should monitor for overlapping drug interactions that involve drowsiness, tachycardia, and cardiovascular collapse (3)
When administering anticholinergic drugs to a client w/ Parkinson's disease, the nurse is least likely to teach the client which of the following?
1) Rinse w/ warm water to decrease sensation of dry mouth
2) Take laxative of choice for constipation
3) Report immediate heart rate <60 beats/min
4) Urinary retention or hesitancy are possible side effects
Report immediate heart rate <60 beats/min. Tachycardia is more likely to occur than bradycardia (3). B/c anticholinergic drugs reduce secretory functions as well as functions of anal and urethral sphincters, dry mouth, constipation, and urinary retention or hesitancy are all possible side effects of anticholergic medications (options 1, 2, &4)
The client is receiving phenytoin (Dilantin) asks the nurse why the doctor prescribed folic acid w/ this medicaiton. The nurse's response is based on which of the following?
1) Phenytoin (Dilantin) increases the effects of folic acid
2) Folic acid content in most foods is inadequate
3) Folic acid prevents gingival hyperplasia
4) Phenytoin inhibits the absorption of folic acid in foods
Phenytoin inhibits the absorption of folic acids in foods. Phenytoin inhibits folic acid absorption and potentiates the effects of folic acid antagonists (4). Dilantin may interfere w/ RBC production. Folic acid stimulates the production of RBCs (1). A balanced diet provides an adequate level of folic acid (2). Massage the gums is most appropriate intervention in preventing gingival hyperplasia (3)
Because a client is taking warfarin (Coumadin) and has a new prescription for phenobarbital, the home health nurse does which of the following?
1) Request assessment of WBC as soon as possible
2) Monitor client very closely for bronchospasms
3) Instruct client not to fill prescription until health care provider can be consulted
4) Review current prothrombin time and international normalized ratio
Instruct client not to fill prescription until health care provider can be consulted. Barbiturates may decrease absorption and increase metabolism of oral anticoagulants resulting in decreased effect of the drug (3). Agranulocytosis is a side effect of phenobarbital but not warfarin (1). Bronchospasms are a side effect of heparin but not of warfarin or phenobarbital (2). The nurse does not need to be aware of the current status of lab tests.
The nurse is managing the care of a group of post-op clients. If morphine sulfate (MS) is prescribed for these clients, the nurse is most likely to contact the prescriber about which of the following clients?
1) Client w/ psoriasis on hands and trunk
2) Postop client w/ history of drug addiction
3) Client receiving cimetidine (Tagamet)
4) Postop client w/ a seizure disorder
Postop client w/ a seizure disorder. Morphine may induce seizures in clients w/ a seizure disorder. Therefore, the client w/ a history of seizures is at risk for increased seizure activity. This is especially true w/ the addition of the stress of surgery (4). There is no evidence that a client w/ psoriasis is at greater risk while taking morphine (1). With a history of drug addiction, a postop client may require additional medication. The history of drug addiction is more easily managed than a client w/ uncontrolled seizures (2). Cimetidine and morphine have no known overlapping characteristics (3).
When caring for a client receiving phenytoin (Dilantin), the nurse emphasizes meticulous oral hygiene to the client, stating that phenytoin has which of the following effects on oral tissue?
1) "It causes hyperplasia of the gums."
2) "It increases alkalinity of the oral secretions."
3) "It destroys tooth enamel."
4) "It increases bacterial growth at the gum lines."
"It causes hyperplasia of the gums." Gingival hyperplasia is an adverse effect of long-term phenytoin (Dilantin) therapy. Maintaining therapeutic blood levels, gum massages, and meticulous oral hygiene can decrease the incidence of hyperplasia (1). Phenytoin does not alkalinize oral secretions or destroy tooth enamel (2&3). Phenytoin does not increase bacterial growth at gum lines (4).
A nurse is assigned to several clients w/ neurological disorders. The nurse plans to interact more w/ which of the following clients?
1) Client on the third day of therapy w/ phenytoin (Dilantin) 100 mg TID for seizures
2) Client in the fourth day following a stroke in the right hemisphere w/ left-sided paralysis
3) Client 24 hours post op for ventriculoarterial shunt to manage hydrocephalus
4) Client w/ fever of unknown origin of 102.8F by tympanic membrane
Client w/ fever of unknown origin of 102.8F by tympanic membrane. Since the fever is very high and of an unknown origin, this client will need to be monitored closely. The client status is potentially more unstable than the other clients (4). After 3 days of treatment w/ phenytoin, drug adjustmnts would have to be made and the client should exhibit some degree of stability (1). A client may have another stroke within 72 hours after the first one, but after 4 days, the client's status is usually stable and more predictable than on admission (2). Post-op management of shunts includes monitoring for increased intracranial prssure. The clinical picture is marginally predictable (3)
A 62-yr-old female client newly diagnosed w/ idiopathic seizures is taking carbamazepine (Tegretold). The nurse provides which of the following instructions to the client?
1) Initially, the drug may cause drowsiness
2) Do not abruptly discontinue ingesting the drug
3) Schedule a bone density examine periodically
4) Avoid ingesting this drug w/ over counter drugs w/o talking w/ the prescriber
Schedule a bone density examine periodically. Research has shown that women experience a decrease in bone density when taking this anticonvulsant drug for a long period of time. This client is particularly at risk (3). Drowsiness could occur at any time w/ this client, not just at the start of therapy (1). The abrupt withdrawl will result in the return of the seizures w/ greater frequency and can occur in any client (2). Anticonvulsant drugs have an extensive degree of significant drug interactions. This does not apply solely to this client (4)
The nurse on a large med-surg unit administered 3 doses of diazepam (Valium) 10 mg IV at 15-min intervals to a client experiencing status epilepticus. After the seizure acitivity ceases, the nurse adds which intervention to the care plan?
1) Perform oropharyngeal suctioning every 2-3 hours
2) Reposition the client every 2-4 hours
3) Teach the family members at the bedside about the side effects of the drug
4) Monitor for drug side effects for the next 4-5 hours.
Teach family members at the bedside about the side effects of the drug. Diazepam is a benzodiazepine and CNS depressant. B/c diazepam has a half-life of 20-50 hrs, a risk of life-threatening side effects such as cardiovascular collapse and laryngospasms exist. Family members at the bedside need to be aware of the signs/symptoms of the side effects (4). A 4-5 hour interval of assessment is insufficient when compared to the half-life of the drug (4). Unless the client demonstrates impaired airway clarance, suction would not be necessary (1). Re-positioning the client is routin nursing care, but not unique to administration of this drug (2)
A client w/ a history of migraine headaches arrives at the ER w/ a severe headache. In additon to an analgesic, the nurse is most likely to administer which drug?
1) Verapamil HCL (Isoptin)
2) Propranolol (Inderal)
3) Ergotamine tartrate (Ergomar)
4) Phenytoin (Dilantin
Ergotamine tartrate (Ergomar). Ergotamine is used to abort migrane headaches. It is not recommended for prophylaxis b/c of side effects such as gangrene of the nose, seizures, nausea/vomiting and many others (3). Calcium channel blockers become effective several weeks after the therapy begins (1). Beta blockers are used prophylactically (2). Phenytoin is an antiepileptic drug that is not used to treat migraine headaches (4)
A client recently diagnosed w/ Parkinson's disease is taking levodopa (Dopar). The nurse adds which expected outcome of the drug therapy to the care plan?
1) Decreased levels of epinephrine and increased levels of acetylcholine
2) Establish balance b/t levels of serotonin and levels of endorphins
3) Establish balance b/t dopaminergic and cholinergic activities
4) Increased levels of bradykinin and prostaglandins
Establish balance b/t dopaminergic and cholinergic activities. Dopamine is inhibitory and acetylcholine is excitatory. Balance b/t the 2 results in smooth and deliberate movement. In Parkinson's Disease, there is a dopamine deficit, which results in dysrhythmic, non-deliberate movements. Levodopa re-establishes the dopamine levels that result in smooth rhythmic movements (3). The goal is to establish a balance b/t the chemicals (1). Serotonin controls mood and sleep. Endorphins (neuromodulators) are responsible for pain relief (2). The presence of bradykinin results in dilation of the arteries in the kidneys. Angiotensin II increases systemic blood pressure and has no effect on mobility.
The nurse is planning to adminster meds to several clients w/ neurological alterations Which one of the clients should receive meds first?
1) Closed head trauma: bolus of mannitol (Osmitrol) IV 2 mg/kg
2) Onset of migraine headache an hour ago: ergotamine (Ergotrate) 2mg SL
3) Occasional petit mal seizure: carbamazepine (Tegretold) 200 mg PO
4) 2 cm brain tumor in left temporal lobe: codeine sulfate (generic) 30 mg PO
Closed head trauma: bolus of mannitol (Osmitrol) IV 2 mg/kg. Mannitol should be adminstered first b/c of the threat of increased intracranial pressure (1). Ergotamine is administered for immediate relief headaches, but this problem is not life-threatening (2). Carbamazepine is commonly administered for petit mal seizures. Clients generally stare into space and are not at risk as clients w/ increased intracranial pressure (3). The functions of the temporal lobe are primarily auditory (4)
A client had surgery for a herniated lumbar disk at the L4 level 2 days ago. The prescribed meds included morphine sulfate (Morphine) 10-15 mg IV prn, Loratab 2.5/500 (hydrocodone 2.5 mg/Tylenol 500 mg 1 q4 hrs, and cyclobenzaprine (Flexeril) 10 mg PO TID. The nurse anticipates that the client will utilize which pain management protocol after discharge to home?
1) Morphine administered before the client ambulates
2) Cyclobenzaprine will be administered PRN at home
3) Loratab should be administered at the same time as the cyclobenzaprine
4) Schedule all 3 meds so that the overlapping actions and side effects do not occur.
Cyclobenzaprine will be administered PRN at home. To prevent muscle spasms, cyclobenzaprine is often continued on a regular schedule at home (2). Morphine sulfate is discontinued as soon as the client is able ingest adequate fluids and take oral meds (1). To prevent excessive drowsiness, the client should note the time intervals in which the drugs are administered. However, the primary goal to provide relaxed muscles so that physical therapy can be performed (3). Morphine sulfate will not be prescribed for home use; the goal is to help client manage pain w/ oral meds (4)
A client was recently diagnosed w/ a tonic-clonic seizure disorder and started on antiepileptic drug therapy. The nurse should give priority to which of the following nursing diagnoses?
1) Impaired mobility
2) Deficient knowledge
3) Ineffective coping
4) Impaired gas exchange
Deficient knowledge. Since the meds change the electrical activity in the brain to a more regular pattern (whcih results in reduced seizure activity), taking the med appropriately is paramount to managing the seizure disorder (2). Unless another health problem exists, clients w/ seizures do not have difficulty w/ mobility (1). B/c of the limitations imposed by the disease, clients often have difficulty coping w/ changes in lifestyle and self-image. If clients can control the seizure w/ meds, the increased predictability will add stability to their lives (3). B/c many antiepileptics have aplastic anemia as a side effect, the client would be at risk for bleeding and decreased oxygenation. The client is not at any special respiratory risk (4)
The nurse prepares to administer which of the following prescribed meds to a client diagnosed w/ Huntington's disease?
1) Thiothixene HCL (Navane)
2) Phenytoin (Dilantin)
3) Amphetamine sulfate (Adderall) 10 mg PO q6 hours
4) Dantrolene sodium (Dantrium) 25 mg/day PO
Thiothixene HCL (Navane). B/c dopamine plays a role in kinetics, blocking the dopamine receptors decreases the choreiform movements associated w/ Huntington's disease (1). Phenytoin decreases irregular firing in the brain resulting in decreased irreguar movement, but doesn't affect dopamine levels in the brain (2). Amphetamine sulfate exerts a paradoxical sedative effect in children, but increases stimulation in adults. It is commonly used for narcolepsy (3). Dantrolene is used for involuntary spasms but Huntington movements are not spastic, they are choreiform (4)
The father of a student takes phenytoin (Dilantin) 100 mg BID PO dailty. After the student makes which of the following statements, the school nurse contacts the father immediately?
1) "My daddy bleeds or buises real easy."
2) "My daddy sleeps all the time."
3) "My daddy is sick to his stomach a lot."
4) "After my daddy started taking the med, his hair fell out."
"My daddy bleeds or bruises real easy." Aplastic anemia is a side effect of phenytoin. Drowsiness is a common side effect and can be significant if the father attempts activities that can place him in danger. Aplastic anemia that could result in hemorrhage related to decreased platelets is of more significance (2). The most common GI disturbance includes gingival hyperplasia (3). Alopecia is a side effect of the drug, but not as significant as the threat imposed by aplastic anemia or agranulocytosis (4).
A client recently diagnosed w/ partial occlusion of the left common carotid artery has been taking phenytoin (Dilantin) for 10 yrs. When performing the initial assessment in the preoperative period, the nurse gives priority to which of the following items?
1) Obtain history of seizure activity and response to therapy
2) Place an airway, suction equipment, and restraints at the bedside
3) Ask client to remove any dentures
4) Observe client for increased restlessness and agitation
Obtain history of seizure activity and response to therapy. Phenytoin (Dilantin) is most effective in controlling tonic-clonic seizures. In order to provide safe, effective care, the nurse needs to know about past seizure activity or the degree of seizure control. Assessment is required first. Common practices of seizure management do not include airway placement or the placement of restraints (2). The nurse has no data to indicate that dentures need to be removed (3). Until an asessment is conducted, the nurse does not know whether the client experiences a prodromal phase before a seizure occurs (4)
Because a client scheduled for an arteriogram of the heart is taking pehnytoin (Dilantin), the nurse should apply which of the following principles?
1) Maintain phenytoin (Dilantin) therapeutic dose levels
2) Administer phenytoin (Dilantin) as soon as procedure is complete
3) Give phenytoin (Dilantin) after procedure to prevent negative interaction with the dye
4) Administer drug w/ 30 mL of water immediately before procedure
Maintain phenytoin (Dilantin) therapeutic dose levels. A steady state of Dilantin requires at least 7-10 days. Interruption of dosage can decrease the steady state resulting in the return of the seizures (1). Since the client may have to wait for the appointed time as well as the time required for the procedure, this would risk interruption of the steady state (2). There is no evidence of an existing negative interaction b/t the 2 drugs (3). To prevent the risk of aspiration, the client should remain NPO before the precedure (4).