NCLEX pharm guide

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A basic concept of pharmacology that the nurse must understand is how the drug influences cell physiology. What is the term for this concept?

*Pharmacodynamics
-Pharmacodynamics refers to what the drug does to the body; that is, how it influences cellular physiology. Pharmacokinetics is the study of what the body does to the drug. Pharmacotherapeutics refers to the study of the therapeutic use of drugs. Pharmacology is the study of drugs.

Which statement best indicates that the nurse understands the meaning of pharmacokinetics?

*"It explains the distribution of the drug between various body compartments."
-Pharmacokinetics involves the study of how the drug moves through the body, including absorption, distribution, metabolism, and excretion

The pharmacist states that the client's biotransformation of a drug was altered. What does the nurse realize has affected the drug?

*Metabolism
-Metabolism connotes a breakdown of a product. Biotransformation is actually a more accurate term because some drugs are actually changed into an active form in the liver in contrast to being broken down for excretion

The nurse realizes that a drug administered by this route will require the most immediate evaluation of therapeutic effect?

*Intravenous
-Intravenous medications are not altered by first pass effect and enter the system quickly. Oral medications are absorbed in the stomach and small intestine, travel through the portal system, and are metabolized by the liver before they reach general circulation. Subcutaneous medications need to be absorbed into the bloodstream before entering the circulation to exert effect. Topical medications need to be absorbed through the skin before entering the blood stream and exerting an effect.

The nurse reads that the half-life of the medication being administered is 12 hours. What assumption will guide the nurse's care of this client?

*This medication will be 50% eliminated in 12 hours, so the dosing will be spread apart.
-Half-life refers to the time it takes to excrete a drug from the body. Administering the medication every 6 hours would not be appropriate; it would be too soon. Half-life does not refer to onset of action or to the number of doses in 24 hours.

Which nursing intervention will best enhance the absorption of an intramuscular injection?

*Massage the site after injection
-Massaging the site increases circulation to the area and thus increases absorption. Cold will cause vasoconstriction and will not enhance absorption. Administration in the leg and the Z-track method will not enhance absorption

A nurse is administering two highly protein-bound drugs. Which is the safest course of action for the nurse to take?

*Assess the client frequently for the risk of drug-drug interactions.
-When administering two drugs that are protein-bound, one of the drugs will have fewer sites to which to bind and thus more drug available for activity, thereby increasing the risk of toxicity. Food or water will not change the outcome of administration. Hepatic function is a concern at this time.

A client is complaining of pain rated "10" on a scale of 1 to 10. The nurse has several choices of pain medication to administer. Which order is the best for the nurse to administer at this time?

*Morphine sulfate 1 mg IV (intravenous)
-When a drug is administered intravenously, it does not need to be absorbed because it is placed directly into general circulation.

The nurse is administering medications to a client with chronic renal failure. What is a priority action of the nurse?

*Assess the client for toxicity to the medications. T
-The kidneys are responsible for the majority of drug excretion. With excretion impaired, the medication can remain in the system longer and there is more chance for toxicity to develop.

The nurse is monitoring a client's blood pressure an hour after administering an antihypertensive medication. What is the purpose of this monitoring?

*Evaluation of therapeutic effect
-Therapeutic effect occurs after the administration of the medication, and the nurse should assess for expected outcomes.

The nurse understands that there are several mechanisms by which drugs can exert their action on the body, including which mechanisms?

*Interacting with specific receptors, inhibiting the action of a specific enzyme, Altering metabolic chemical processes, Nonspecific binding to a macromolecular receptor

The nurse has administered several oral medications to the client. What factors will influence the absorption of these medications?

*Presence of food in the stomach, pH of the stomach, Form of drug preparation, Pain
-The presence of food in the stomach usually decreases absorption of drugs but may increase absorption for a few specific medications. The pH of the stomach affects absorption of drugs dependent on the pH of the drug. Alkaline drugs are absorbed more readily in an alkaline environment, and acidic drugs are absorbed more readily in an acidic environment. The form of the drug also affects absorption, with liquid drugs being absorbed the fastest and enteric-coated tablets the slowest. Pain can affect absorption by slowing gastric emptying time.

It is important for the nurse to be aware of the four sequential processes of the pharmacokinetic phase. What are these?

Absorption, distribution, metabolism, excretion

It is expected that the nurse will question the health care provider if a drug with a t ½ of >24 hours is ordered to be given more than how often?

Once daily, twice daily.

Which of these statements is correct?

A drug not bound to protein is an active drug

The nurse notices that one of the client's drugs has a low therapeutic index. What is the most important nursing implication of this?

A narrow margin of safety

One of the clients drugs has a potential adverse effect of nephrotoxicity. Which test is most accurate to determine renal function?

Creatinine clearance

The nurse reviews the client's medication regimen, including the interval of drug dosage, which is related to?

Half life

Nursing responsibilities in the assessment phase of the nursing process include which responsibilities?

Identify side effects of drugs that are nonspecific and check peak and trough levels of drugs.

The nurse is preparing to review a client's medication history. Which information is most important when the nurse obtains a medication history from a client?

*Allergies
-Knowledge of allergies is the most important information because the client could have a life-threatening reaction.

The nurse is preparing to administer medications. Which intervention will the nurse include when administering medications to clients?

*Check the client's wristband before administering the medication
-Checking the client's wristband is the most accurate method of determining identity; however, at least two identifiers should always be used. The medication label should be checked three times before administering a medication.

Which activity is the nurse's responsibility during the evaluation phase of drug administration?

*Monitoring the client continuously for therapeutic as well as adverse effects. Ongoing
-monitoring of the client is necessary to evaluate the effect of the drug.

The nurse is developing a nursing care plan for a newly diagnosed adult male client with hypertension who is to begin taking metoprolol/hydrochlorothiazide (Lopressor HCT) 50 to 25 mg daily. The client has many questions about his diagnosis and medication. Which nursing diagnoses would be the highest priority for this client?

Risk for ineffective therapeutic regimen management related to new diagnosis

The nurse is preparing to teach a client newly diagnosed with diabetes mellitus how to inject insulin. Which principle should the nurse include when providing client teaching?

*Include a family member or friend in the teaching process. Provide simple written materials appropriate for individual client. The nurse should provide contact information on how to reach the health care provider.
-The nurse should include a family member or friend in the teaching process.The nurse should be an active, not passive, listener. The nurse should assess readiness to learn before information is presented to the client. The nurse should provide simple written materials appropriate for individual client needs. The nurse should provide teaching in a quiet environment, so that the client can focus on the information. The nurse should provide contact information on how to reach the health care provider in case there are questions or concerns

During a medication review session, a client comments, "I just do not know why I am taking all of these pills". This comment suggests which nursing diagnosis?

Deficient knowledge

The nurse is developing goals in collaboration with the client. Which is the best goal statement?

The client will independently self-administer the prescribed dose of albuterol by the end of the second teaching session

the nurse is aware of the many factors related to effective health teaching about the medication. The most essential component of the teaching plan is to do which?

Establish a trust relationship

a medication health teaching plan is tailored to a specific client. Common topics for health teaching include?

Importance of adherence to the prescribed reginmen, how to administer medications, what side/adverse effects to report to the health care provider.

The client's goals have been met during hospitalization. At the time of discharge, which nursing diagnosis is most probable?

Readiness for enhanced self-care activities

The nurse's rights related to safe medication administration are essential for safe medication administration. Which statements include the nurse's rights?

*The right to a complete and clear order, Correct The right to policies to guide safe medication administration, The right to have the correct drug, route, dose dispensed
-Discussion of the nurse's rights can help to increase safe medication administration. In addition to these three rights, the rights include the right to administer medications safely; the right to identify system problems; and the right to stop, think, and be vigilant when administering medications.

The nurse is reading a medication order and is not sure of the drug name. What action will the nurse perform first?

*Call the health care provider.
-If the nurse cannot understand all components of a drug order, the nurse needs to call the health care provider who wrote the order. If the health care provider is not available, the pharmacist may be able to identify which drug has been prescribed.

The nurse administers a medication that was ordered for a client at 60 mg. The medication's recommended dosage was 10 mg. The client suffers from symptoms of overdose. Who is liable for the medication error?

*All parties involved with administering the medication, including the nurse.
-Nurses are legally liable if they give a prescribed drug and the dosage is incorrect, as are the physician, pharmacist, and hospital. The nurse is the last-line check, and the error should not have happened.

The nurse checks a medication dose that seems high. What is the nurse's best action?

*Call the health care provider.
-The nurse can have others double-check the dosage or the math calculations; however, the nurse should call the health care provider who ordered the medication to report the discrepancies in the dose. Client safety is the primary concern.

A client is scheduled to undergo an upper GI this morning. The client has multiple medications ordered at 9 AM. What is the nurse's best action?

*Withhold the morning medications and document the withholding.
-The client is going for a test this morning, so morning medications would be withheld.

The nurse administered a narcotic medication. What intervention is most important to perform after the medication has been administered?

Document client response to the medication.

The client asks about disposal of medications. What are the nurse's best responses?

"you should mix medications with coffee grounds before disposal" "you should remove identifying information on the original container"

The client is taking duastride (Avodart). Which client comment indicates the need for more education about the drug?

"I prefer to chew the drug before swallowing it"

The nurse educator on the unit receives a list of high-alert drugs. Which strategies are recommended to decrease the risk of errors with these medications?

Limit access to these drugs, use special labels, provide increased information to staff.

The client refuses to take his prescribed medications. Which is the nurse's best response to this client?

Explain the risks of not taking the medications.

What is included in the nurse's role in the development of new and investigational drugs?

Monitoring for and reporting any adverse effects noted during Phase IV studies

The nurse is planning to administer a narcotic to a client for pain control. The medication order expired the day before. What is the nurse's best action?

*Ask the health care provider for a renewal for the medication, but do not administer the medication until the order is renewed.
-The nurse must have a valid order before administration of a medication. The FDA Act does not protect the nurse in the event of an expired medication order. The Durham-Humphrey Amendment distinguishes drugs that should not be refilled without a new prescription, including narcotics. The nurse should not administer a narcotic without a current prescription

The nurse is planning to administer a new medication to a pregnant client. The client is concerned about the effect of the medication on the fetus. What is the nurse's best response?

*"This medication is pregnancy drug category A, which means that there has been no evidence of fetal harm when this drug is administered to pregnant clients."
-Drugs are labeled with pregnancy categories, and category A medications have been proven, through studies, to have no risk to the fetus. Category B indicates that while studies have been conducted on animals, no well-controlled studies on the effects in pregnancy have been conducted, and risk is assumed. Many medications do not harm the fetus and are safe for use during pregnancy. Category X indicates that the medication has been proven to cause harm to the fetus and should not be given to a pregnant client.

A physician has ordered a new medication for a client and states, "The client must take this medication or she will not recover. If she knows about the side effects, she probably will not want to take it." When attempting to administer the medication, the client states "This pill is new. I don't want to take it. What does it do?" What is the nurse's best response?

*To refuse to give the medication unless the client is taught about the medication and its side effects.
-The nurse's code of ethics requires that the nurse respect the rights, dignity, and wishes of clients. It is the nurse's legal responsibility as well as ethical responsibility to make sure the client understands the treatment. The nurse is responsible for teaching the client about medications. Providing limited information or asking the client to take a medication without knowledge is not ethical.

The nurse reads the initials "USP" after a drug name. What is the nurse's best action?

*Proceed with the drug administration procedure.
-Drugs included in the USP-NF have met high standards for therapeutic use, client safety, quality, purity, strength, packaging safety, and dosage form. Drugs that meet these standards have the initials "USP" following their official name, denoting global recognition of high quality. The USP-NF is the official publication for drugs marketed in the United States, so designated by the U.S. Federal Food, Drug, and Cosmetic Act.

The nurse is administering a schedule III controlled substance. What is an essential nursing action?

*Count the available doses of medication before administering and record them. Document the time and date of administration. Countersign all discarded or wasted medication.
-Nursing interventions for controlled substances include accounting for all controlled drugs, keeping a controlled substance record for required information, and countersigning all discarded or wasted medications. In addition, the drugs should be in a locked storage area, with narcotics under double lock. Only authorized persons should have access to keys. The medication should not be kept in the client's drawer. A second nurse does not have to sign the administration record.

Which statement indicates that the nurse understands a principle of caring for clients with drug dependency?

Genetics may play a role in contributing to the cause of substance abuse.

Varenicline (Chantix) is prescribed for a middle-aged client for smoking cessation. What is a priority nursing action for this client?

Tell the client that nausea and vomiting are likely

The nurse is caring for a client with a history of alcoholism who is undergoing long-term alcohol treatment. Which intervention is the highest priority?

*Monitor disulfiram (Antabuse) and ensure client knows that all alcohol must be avoided.
-In addition to cognitive-behavioral therapy, disulfiram (Antabuse) may be ordered because it prevents alcohol consumption by causing an unpleasant reaction if alcohol is taken. Flumazenil (Romazicon) is a benzodiazepine antagonist and is used to treat benzodiazepine overdose. Methadone (Dolophine) is an opioid agonist used during opioid detoxification to decrease symptoms, and is used in long-term management of opioid addiction. Propranolol (Inderal), an adrenergic beta blocker, is indicated in treating elevated blood pressure and tachycardia, which may occur with amphetamine toxicity.

The nurse is caring for a client with a history of secobarbital (Seconal) abuse. The client last took the drug 12 hours ago. Which assessment finding requires immediate action?

Muscle cramps.

The clinic nurse is reviewing medication instructions with a client taking Nicorette gum 2 mg for smoking cessation. Which statement by the client indicates a need for further teaching by the nurse?

*"I can continue to smoke a cigarette once in a while when taking this drug."
-Cigarette smoking while using nicotine-replacement therapy (NRT) agents such as Nicorette gum may cause nicotine overdose. The client should not smoke cigarettes while taking Nicorette gum. NRT should not be used by pregnant or nursing women, so use of birth control is appropriate while taking NRT. Food and drink should be avoided 15 minutes before and during use of Nicorette gum. While the client is chewing the gum, there should be periods of holding the gum between the cheek and teeth.

When caring for a client recovering from an episode of opioid toxicity, the nurse determines that the client has an addiction to the drug based on which finding?

Craving that results in drug seeking behaviors.

While teaching the parents of an adolescent who has been using marijuana, the nurse explains that eh euphoria that results from the use of abused psychoactive substances is believed to be cause by which?

Stimulation of the dopamine pathways in the pleasure areas of the brain.

A client hospitalized with a fractured femur following an automobile accident develops diarrhea and vomiting with abdominal cramps chills with goose bumps, and dilated pupils. The nurse suspects the client is experiencing which reaction.

Opioid withdrawal

Drugs that the nurse would anticipate administering to a client who has been admitted with acute alcohol intoxication include which drugs?

Thiamine, lorazepam (Ativan), intravenous glucose solution.

A client is admitted to the emergency department with acute cocaine toxicity. Which is the most important intervention by the nurse?

To institute cardiac monitoring and obtain frequent blood pressures.

A client scheduled for elective gallbladder surgery is addicted to heroin and is in a methadone treatment program. Postoperatively, the nurse would expect the client's surgical pain to be treated with which measure?

Morphine or other opioids

A nurse observes a colleague taking oral opioids from the medication room at the hospital. Which is the best action by the nurse?

Report the finding to the nursing supervisor to enable the colleagues participation in a diversion program.

A client who smokes tells the nurse that he sees no reason to stop smoking, because it keeps his stress levels down and not everyone who smokes develops lung cancer. What is an appropriate nursing diagnosis for the client?

Ineffective denial related to inability to personalize risk of smoking.

A client is to start a new medication to help with alcohol abuse. The nurse providing medication education about disulfiram (Antabuse) is sure to include which topics in the education plan?

It is important to take this medication every day, better results are experienced when using a support group of family and friends to ensure adherence to the treatment, common food and hygiene products containing alcohol, disulfiram whorks by disrupting the metabolism of alcohol, use of alcohol may cause nausea, vomiting and may even be fatal.

A client in the hospital is experiencing methamphetamine withdrawal. What does the nurse expect the symptoms and treatment to be?

Hypersomnia, irritability; treated by supportive care including pushing food and fluids.

Knowing that the albumin in neonates and infants has a lower binding capacity for medications, the nurse anticipates that the health care provider will order which of the following to minimize the risk of toxicity?

*A decrease in the dosage of drug given
-A lower binding capacity leaves more drug available for action; thus, a lower dose would be required to prevent toxicity. An increase in the drug dose would result in higher risk of toxicity.

What would the nurse teach the client who is lactating to minimize drug effects of medications on the infant?

*"Take your medications immediately after breastfeeding."
-Taking a medication immediately after breastfeeding allows for the maximum amount of time for drug excretion before the next breastfeeding.

The nurse is administering PO medications to a 2-year-old child who is belligerent. What action is the best strategy for the nurse to use?

Ask the parents to assist in calming the child.

A 3-year-old child has been started on a new medication. What is the most important information to convey to the parents?

*"Observe the child for potential adverse effects of the medication."
-Adverse effects of medications can be difficult to discern in young children, especially things such as ringing in the ears, because the child might not be able to communicate well. Parents are in the best position to observe the child and note changes in behaviors that might be related to side effects.

is the excretion of a drug faster or slower for children related to the excretion in adults?

slower

The physiologic changes that normally occur in the older adult have which implication for the nurse, who is assessing drug response in this client population?

*Drug half-life is lengthened.
-Drug half-life is extended secondary to diminished liver and renal function in the older adult. Metabolism is slower, not faster, in the older adult. Drug elimination is also generally slower in the older adult, and protein binding is not more efficient in the older adult.

The nurse administers a medication that has a long half-life to an older adult client. What is a priority action for the nurse?

*Assess the client for potential drug toxicity.
-Because drug absorption is slowed in the older adult, drugs with a longer half-life may increase the potential for toxicity. The nurse should assess the client, and the dose may need to be decreased. The medication should not be halved. This will not affect the half-life.

An older adult client has been having difficulty sleeping. If medications are ordered, what is a primary principle that guides the care of the client?

*The older adult client should be prescribed a drug with a short half-life.
-The older adult client may have difficulty with elimination of drugs, so a drug with a short half-life is preferable. If used correctly, sedative hypnotics are safe for the older adult.

An older adult client has been diagnosed with hypertension. A diuretic has been prescribed. Which assessment finding will most concern the nurse?

*The client's heart rate is irregular
-Diuretics are frequently prescribed for the older adult. They can cause electrolyte imbalances and must be prescribed in smaller doses. An irregular heart rate could be a sign of potassium imbalance.

An older adult client suffered a broken leg and had emergency surgery. The client was prescribed meperidine (Demerol) 50 mg PRN for pain. What is the nurse's most important intervention?

*Calling the health care provider to change the prescription
-Demerol is not a drug that is recommended for the older adult owing to the incidence and risk of confusion and convulsions. Morphine is preferred.

The nurse reviews the clients list of medications with the client. The nurse knows that the 88 year old clients slower absorption of oral medications is primarily because of which phenomenon?

Increased pH of gastric secretions.

A student nurse is studying basic ethical principles that are relevant to research involving human subjects. The nursing instructor asks the student to explain the ethical principle of autonomy. Which statement indicates the student understands the ethical principle of autonomy?

*"The client has the right of self-determination."
-Autonomy is the right of self-determination and is an integral component of respect for person. Generally, a client has the right to refuse any and all treatments, except when the decision poses a threat to others.

The nurse is assessing a client who follows a vegan diet. What assessment is essential for the nurse to make?

*Assess for vitamin B12 deficiency.
-Vegans may be at risk for pernicious anemia, and the levels of vitamin B12 should be assessed.

The nurse is caring for a client who is taking ascorbic acid (vitamin C). The nurse plans to monitor the client for which adverse effect of ascorbic acid?

*Nausea and vomiting and abdominal cramping
-Adverse effects of ascorbic acid (vitamin C) include nausea and vomiting, headache, abdominal cramps, and the development of renal stones

The nurse is reviewing a client's medication history and notes that the client is taking vitamin K. What is essential for the nurse to assess?

*Coagulation studies
-Vitamin K is an essential nutrient for the synthesis of clotting factors. It is also the antidote for warfarin, an oral anticoagulant. The administration of vitamin K enhances the coagulation process, thus minimizing a client's risk for excessive bleeding.

The nurse assesses a client with hyperparathyroidism and notes that the client is to receive a vitamin D supplement. What is essential for the nurse to assess first?

*Calcium levels
-Vitamin D is contraindicated with hypercalcemia, a clinical manifestation of hyperparathyroidism.

The nurse plans to administer iron dextran. Which is the best injection technique?

*Intramuscular injection using the Z-track method
-Iron dextran should be administered deep in a large muscle mass using the Z-track method and a 23-gauge, 1½-inch needle to prevent skin irritation and potential necrosis.

The nurse is reviewing the clients lab test results and current medications. The nurse notes that the clients porthrombin time is prolonged. What vitamin might be contributing to this?

Vitamin E

The PT comes to the office with chief complaint of hair loss and peeling skin. The nurse notes that many vitamins are on the list of meds that the PT reports using to treat liver disease. The PT complaint may be caused by excess of what vitamin?

Vitamin A

The nurse routinely includes health teaching about vitamins to clients. Vitamin D has a major role in which process?

Regulating calcium and phosphorous metabolism

The nurse is doing preconception counseling with the PT. Folic acid is included in the health teaching plan because it is known to prevent CNS anomalies and may offer protection from which disorder?

Colorectal cancer

A prenatal PT tells the nurse that she is not taking vitamins because she heard that "vitamins may cause damage to my baby" what is the best response by the nurse?

"megadoses of vitamins can be harmful in the first trimester"

The client asks the nurse about fat-soluble vitamins. What is the nurses best response?

Fat-soluble vitamins are excreted slowly in the urine

The client complains of night blindness. The nurse correctly recommends which food?

Whole milk and eggs

The alcoholic client has questions about his medications the nurse correctly explains that alcoholism can be associated with deficiency of which vitamin?

B12

The client complains of anorexia, nausea, and vomiting. The clients list of meds includes multiple large doses of vitamins. The nurse notes that the clients complaints may be related to early signs of toxicity of which vitamin?

Vitamin D

A client is admitted to the intensive care unit after a traumatic accident. The client has received 5000 mL of normal saline and has +2 pitting edema and a blood pressure of 90/50 mm/hg. Which IV fluid will the nurse administer?

*Hetastarch (Hespan)
-The client needs to increase intravascular fluid volume. Hetastarch will enable this because it is a colloid that will increase osmotic pull from the extravascular spaces to the intravascular area. 3% saline is also hypertonic, but its use is not preferred secondary to risk of hypernatremia. Ringer's lactate and D5W will not pull fluid into the intravascular space.

What is the priority nursing intervention when administering potassium replacement to the client?

*Administer the medication using an intravenous pump.
-Too rapid an infusion of potassium can cause cardiac dysrhythmias. Therefore, an intravenous infusion pump must always be used. Potassium should not be bolused or pushed. Rapid administration will cause cardiac dysrhythmias. Heat will not aid in the infusion.

The nurse is administering hypertonic saline solution to treat a client with severe hyponatremia. Which nursing intervention is the priority?

*Assess skin for flushing and assess increased thirst.
-Flushed skin and increased thirst are signs and symptoms of hypernatremia.

A client receiving a unit of red blood cells suddenly develops shortness of breath, chills, and fever. What will the nurse do first?

*Discontinue the infusion.
-These are signs and symptoms of a blood transfusion reaction that could escalate to anaphylaxis. Therefore, it is a priority to immediately stop the blood transfusion.

The nurse assesses a client with a potassium level of 3.2 meq/L. Which is the priority intervention?

*Attach telemetry leads for monitoring
-the client is at high risk for cardiac dysrhythmias due to the low potassium level. Oxygen and IV fluids are not a priority, and Kayexalate is not needed for a potassium level of 3.2 meq/L.

the client has been vomiting and has weak, flabby muscles. The clients pulse is irregular. The nurse would correctly suspect what type of imbalance?

Hypokalemia

the client is receiving potassium supplements. What is the most important nursing implication when administering this drug?

It must be diluted.

The client is due to receive kayexalate for complaints of nausea, vomiting, abdominal cramps, short QT interval, weakness, and oliguria. The nurse is away that this drug is used to treat which imbalance?

Severe hyperkalemia

The nurse reviews the clients list of meds and results of lab tests. Which drug type may cause an elevated serum sodium level?

Cortisone preparations.

The clients magnesium level is 2.7 mEq/L. specific health teaching by the nurse for this client should include which suggestion

Avoid selected laxatives and antacids.

The client is receiving fluid replacement. The nurses health teaching with this client includes which suggestions?

Measure weight daily, know that thirst means a mild fluid deficit, monitor fluid intake.

The client gained 10 lbs in 2 days. It is determined that the weight gain is caused by fluid retention. The nurse correctly estimates that the weight gain may be equivalent to how many liters of fluid?

4 liters

the nurse reviews the clients meds as part of the initial interview for admission to the cardiac clinic. Which comment by the client indicates a need for health teaching?

"tetracycline does not affect my meds" "I can take as much calcium as I want"

The nurse is caring for a client receiving total parenteral nutrition (TPN). Which interventions will the nurse include in the client's plan of care?

*Monitor blood glucose levels. Monitor the client for changes in temperature. Monitor intake and output.
-Clients receiving TPN are at risk for hyperglycemia and the glucose should be monitored. The nurse should monitor for temperature changes, as a fever could indicate an infection. Intake and output should be monitored, as the client could experience a fluid volume deficit or excess

The client is receiving a bolus feeding through a gastrostomy tube. The client develops abdominal cramping. What is a priority nursing intervention?

*Stop the bolus feedings and administer feedings with a pump.
-Abdominal cramping is a sign of the feeding not being tolerated. The client may also develop diarrhea and vomiting. The nurse should stop the bolus feeding.

The client receiving enteral feedings has poor skin turgor, and urinary output is 40 mL/hr. What is the nurse's first intervention?

*Assess fluid intake.
-Dehydration can occur if the client does not receive a sufficient amount of fluid with or between feedings.

The client is receiving enteral feedings through a gastrostomy tube at a rate of 100 mL per hour. The nurse assesses the residual volume at 7 AM and finds it to be 80 mL. What is the nurse's primary intervention?

*Stop the feeding for 1 hour and reassess.
-The residual volume should not be greater than 50% of the hourly rate. This indicates that the feeding is not absorbing. The feeding should be stopped for 30 minutes to an hour, and then the residual volume should be reassessed

The nurse determines the clients gastric residual before administering an enteral feeding: the last feeding was 240ml. the client will be discharged on enteral feedings. It is important to include in the health teaching plan that a residual of more than which amount would indicate delayed gastric emptying?

125 ml

It is essential for the client who self-administers the enteral feeding to know that the feeding should be administered at which temp?

room temperature

The nurse reviews the clients plan of care, which includes strategies to prevent which common complication of enteral feedings?

Diarrhea

The client is receiving TPN, health teaching for this client includes the Valsava maneuver, which is done to prevent which condition?

Air embolism

The client has been on TPN for 1 month, and there is an order to discontinue TPN tomorrow. The nurse contracts the health care provider because sudden interruption of TPN therapy may cause which condition?

Hypoglycemia

The nurse prepares to present the Be A.L.E.R.T. campaign to colleagues. Which instructions are important to include?

Wear gloves when handling feeding tube, label enteral equipment, verify that enteral tubing connects formula to feeding tube.

The client receives TPN at home. The visiting nurse assists the family with the care plan, which includes changing the TPN solution and tubing how often?

Every 24 hours

The nurse is caring for a client who is receiving epinephrine (Adrenalin) for treatment of Stokes-Adams syndrome. Which assessment will indicate the client is having the expected therapeutic effect of this medication?

*Increased heart rate and strong pulse
-Epinephrine (Adrenalin) causes sympathomimetic actions, including increased heart rate and contractility.

The client is receiving dopamine at 2 mcg/kg/min. The nurse should monitor for what effect at this dose?

*Urinary output increased to 40 mL/hr
-Dopamine at low doses increases cardiac output and causes increased renal perfusion.

A client with cardiac decompensation is receiving dobutamine as a continuous infusion. The client's blood pressure has increased from 100/80 mm hg to 130/90 mm hg. What is the nurse's primary action?

*Continue to assess hourly blood pressure readings.
-The major therapeutic effect of dobutamine is to increase cardiac output. Cardiac output is reflected in the client's heart rate, blood pressure, and urine output. An increase in the blood pressure is the expected therapeutic effect.

The nurse assesses a client receiving an adrenergic (sympathomimetic) agent. Which finding will most concern the nurse?

*Weak peripheral pulses, decreased heart rate
-Adrenergic agents stimulate the sympathetic nervous system, which increases heart rate (positive chronotropic effect), contractility (positive inotropic effect), and conductivity (positive dromotropic effect). The nurse would be most concerned that the pulses remain weak and heart rate decreased after receiving this drug, as the therapeutic effect is not being achieved.

The client is ordered to receive a sympathomimetic agent. On review of the client's other medications, the nurse finds the client takes an MAO inhibitor daily. What is the nurse's primary action?

*Call the health care provider.
-Adrenergic agents combined with MAO inhibitors can lead to extreme hypertension. The medications cannot be administered together.

The nurse assesses the peripheral intravenous infusion site of a client receiving intravenous dopamine and suspects extravasation. What is the nurse's primary action?

*Stop the infusion.
-The nurse's first action is to stop the infusion. Next, the nurse would infuse Phentolamine (Regitine) into the area to counteract the vasoconstrictive effects of the dopamine.

The nurse is caring for a client with a diagnosis of heart failure and a secondary diagnosis of chronic obstructive pulmonary disease (COPD). The client is ordered a nonselective beta blocker. What is the nurse's primary intervention?

*Call the health care provider to request a different medication.
-Nonselective beta blockers are used to treat supraventricular dysrhythmias secondary to their negative chronotropic effects (decreasing heart rate). They may exacerbate heart failure and COPD. The client could receive a selective beta blocker instead. The nurse should make the health care provider aware of the client's history of respiratory disease.

The nurse is caring for a client who has just been diagnosed with hypertension. The client has received one dose of atenolol (Tenormin). What is the nurse's primary intervention?

*Teach the client about nonselective beta blockers.
-At therapeutic dosages, atenolol selectively blocks only the beta1 receptors in the heart, not the beta2 receptors located in the lungs.

A client has been taking metoprolol (Lopressor) and states to the homecare nurse, "I can't afford this medication any more, and I stopped it yesterday." What is the nurse's primary intervention?

*Assess the client's blood pressure.
-Abrupt withdrawal of a beta-blocking agent can cause rebound hypertension. These drugs should be gradually decreased. The nurse should immediately check the client's blood pressure, and then proceed with teaching and calling the health care provider.

The nurse is caring for a client who is receiving ergotamine tartrate (Ergostat) and who states, "I have no clue what this medication does for me." What is the nurse's most appropriate response?

*"This medication will vasoconstrict blood vessels and help your headaches."
-Ergotamine tartrate (Ergostat) is classified as an ergot alkaloid; it blocks alpha2 receptors, causing vasoconstriction. Ergot alkaloids are useful in treating vascular headaches caused by vasodilation of vessels in the brain.

The nurse is caring for a client who is prescribed propranolol (Inderal). Which assessment finding assists the nurse in determining whether the medication is having a therapeutic effect?

*The client's blood pressure is 130/75 mm Hg.
-Propranolol (Inderal) is nonselective—it blocks both beta1 and beta2 receptors at therapeutic doses. The medication is administered to treat hypertension. The client's blood pressure is within normal limits, which indicates therapeutic effect.

Which is the highest priority potential nursing diagnosis for a client who is starting on metoprolol (Lopressor)?

Decreased cardiac output related to effects of medication

The nurse is preparing to discharge a client who is receiving propranolol (Inderal). Which instruction will the nurse include in the medication teaching plan for this client?

*"If you take your pulse and it is less than 60, hold your medicine and call your health care provider for instructions."
-Propranolol (Inderal), a beta blocker, has negative chronotropic effects and could cause symptomatic bradycardia and/or heart block. The health care provider should be consulted before propranolol is administered to a client with bradycardia (heart rate less than 60 beats/min).

A student nurse is preparing to administer a beta blocker to a client. The nursing instructor asks the student to discuss the indications for beta blockers. The student nurse correctly responds that beta blockers are used to treat which disorders?

*Angina pectoris, Congestive heart failure (CHF), Hypertension.
-Beta blockers are effective in treating hypertension (secondary to negative inotropic effects) and angina pectoris (decreases cardiac workload when decreasing heart rate and contractility). Beta blockade has also been shown to reduce mortality in clients with CHF

for the client taking epinephrine, the nurse realizes there is a possible drug interaction with which drug?

Metoprolol (Lopressor)

the nurse will monitor the client taking albuterol (Proventil) for which condition?

Palpitations

a client is prescribed metoprolol (Lopressor) to treat hypertension. It is important for the nurse to monitor the client for which condition?

Bradycardia

Atenolol (Tenormin) is prescribed for a client. The nurse realizes that this drug is a beta-adrenergic blocker and that this drug classification is contraindicated for clients with which condition?

Cardiac shock

The nurse realizes that beta1 receptor stimulation is differentiated from beta2 stimulation in that stimulation of beta1 receptors leads to which condition?

Increased myocardial contractility

A client is given epinephrine (Adrenalin), an adrenergic agonist (sympathomimetic). The nurse should monitor the client for which condition?

Increased blood pressure

The nurse is administering atenolol (Tenormin) to a client. Which concurrent drug does the nurse expect to most likely cause an interaction?

An NSAID, such as aspirin

The nurse is caring for a client who is taking a cholinergic (parasympathomimetic) drug. Which assessment will indicate that the medication is having a desired effect?

*Increased GI motility
-Cholinergic effects mimic the parasympathetic nervous system (rest and digest) as opposed to the sympathetic nervous system (fight or flight). Increasing GI motility helps the digestive process.

A client is admitted with the diagnosis of glaucoma. What is the best intervention for this client?

*Administer pilocarpine.
-Pilocarpine is a direct-acting cholinergic drug that constricts the pupils of the eyes, thus opening the canal of Schlemm to promote drainage of aqueous humor (fluid). This drug is used to treat glaucoma by relieving fluid (intraocular) pressure in the eye.

The client is prescribed bethanechol. What assessment will assist the nurse in determining if the medication was therapeutic?

*Urinary assessment
-this medication increases the tone of the detrusor urinae muscle and causes the client to void

Which adverse reaction will the nurse monitor in a client taking bethanechol (Urecholine) for treatment of urinary retention?

*Muscle weakness
-Adverse reactions to bethanechol (Urecholine) include abdominal cramps, diarrhea, orthostatic hypotension, bradycardia, and muscle weakness

The nurse administered donepezil (Aricept) to a client. Which finding indicates that the medication is therapeutic?

*The client has increased cognition
-Donepezil (Aricept) is used to treat Alzheimer's disease, a disorder of decreased acetylcholine levels in the brain. It can increase cognition.

A nurse is monitoring a client receiving atropine. Which finding requires the nurse to act?

*Blood pressure 90/40 mm Hg
-Atropine is an anticholinergic agent that blocks the effects of the parasympathetic nervous system, producing sympathetic nervous system effects. Adverse reactions include nasal congestion, tachycardia, hypotension, pupillary dilation, abdominal distention, and palpitations. This blood pressure is low enough that action is required.

A client comes to the emergency department with symptomatic bradycardia. The nurse prepares to administer which dose of atropine intravenously?

*0.5 mg
-The recommended dose of atropine to treat symptomatic bradycardia is 0.5 to 1 mg.

A client is admitted to the emergency department with an expected cholinesterase inhibitor overdose. What is the nurse's primary action?

*Administer anticholinergic medication.
-An anticholinergic can act as an antidote to the toxicity caused by cholinesterase inhibitors and organophosphate ingestion.

The nurse monitors a client taking oxybutynin (Ditropan) for which therapeutic effect?

*Decrease in urinary frequency
-Oxybutynin (Ditropan) blocks the cholinergic receptors in the bladder to decrease urinary frequency and urgency.

The nurse monitors a client prescribed dicyclomine (Bentyl) for which therapeutic effect?

*Decrease in GI motility
-Dicyclomine (Bentyl) is an antispasmodic cholinergic blocker used to decrease GI motility in clients with functional GI disorders such as irritable bowel syndrome.

Which is a priority nursing diagnosis for a client receiving an anticholinergic (parasympatholytic) medication?

*Impaired gas exchange related to thickened respiratory secretions
-Although all of these nursing diagnoses are appropriate, the priority is determined by remembering the ABCs. Anticholinergic drugs decrease respiratory secretions, which could lead to mucous plugs and resultant impaired gas exchange.

A client is receiving bethanechol (Urecholine). The nurse realizes that the action of this drug is to treat?

Urinary retention

The nurse teaches the client receiving atropine to expect which side effect?

Blurred vision

When benztropine (Cogentin) is ordered for a client, the nurse acknowledges tthat this drug is an effective treatment for which condition?

Parkinsonism

Dicyclomine (Bentyl) is an anticholinergic, which the nurse realizes is given to treat which condition?

Irritable bowel syndrome

The nurse realizes that cholinergic agonists mimic which parasympathetic neurotransmitter?

Acetylcholine

The nurse is administering a cholinergic agonist and should know that the expected cholinergic effects include which of the following?

Increased pupil constriction

When the client has a cholinergic overdose, the nurse anticipates administration of which drug as the antidote?

Atropine

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