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1,995 terms

bstrandable NCLEX Pharmacology 2 of 5

Combination of sets from all over quizlet, containing practice questions and study cards for NCLEX preparation on the topic of pharmacology
STUDY
PLAY
1 tsp to ml
5 ml
tbsp to ml
15 ml
1 oz to ml
30 ml
1 cup (8 oz) to ml
240 ml
1 soda (12 oz) to ml
360 ml
1 pint to ml
480 ml
1 quart to ml
960 ml
1 mg to ng
1000 ng
1g to mg
1000 mg
1 gr to mg
60 mg
1 kg to lb
2.2 lb
1 L to kg
1 kg
Andrenergics Med Names
Norepinephrine, Dopamine, Epinephrine, Dobutamine
Andrenergics Actions
Stimulates Beta-2 Receptors in Lungs (causes brochdilation)
Andrenergics Uses
COPD, Cardiac Arrest
Andrenergics Side Effects
Dysrhythmias, Tremors, Anticholinergic Effects (dry mouth, urinary retention)
Andrenergics Nursing Considerations
Monitor B/P, Monitor Peripheral Pluses, Check Output
Antianxiety Med Names
Librium, Xanax, Ativan, Vistaril, Equanil
Antianxiety Actions
affect neurotransmitters (CNS depressent)
Antianxiety Uses
anxiety disorders, manic episodes, panic attacks
Antianxiety Side Effects
Sedatiosn, confustion, hepatic dysfunction
Benzodiazepines
-pams
Antianxiety Nursing Considerations
Potential for addiction/overdose, Avoid Alcohol, Monitor LFT
Antacids Med Names
MOM, Maalox, Amphojel
Antacids Action
neutralize gastric acids
Antacids Uses
peptic ulcer, indigestion, reflex esophagitis
Antacids Side Effects
constipation, diarrhea, acid rebound
Antacids Nursing Consideration
Interferes with absorption of antibiotics, iron preps, INH, oral contraceptives
Monitor bowel functions
Antidysrhythmics Med Names
Atropine, Lidocaine, Pronestyl, Quinidine, Isuprel
Antidysrhythmics Action
interfere with electrical exciablility of heart
Antidysrhythmics Uses
A-Fib and flutter, tachycardia, PVCs
Antidysrhythmics Side Effects
Lightheadedness, hypotension, bradycardia, urnary retention
Antidysrhythmics Nursing Consideration
Monitor VS and Cardiac Rhythm
Beta Blockers
-lol
can cause bronchspasms
airway is a consideration
Antibiotics General
Allergies, Super Infections, Organ Toxicity
Antibiotics Teaching
Take until gone
Do culture and sensitivity first
Encourage fluids
Check expiration date
Antibiotics: Aminoglycosides Med Names
Gentamycin, Neomycin, Streptomycin, Tobramycin
Antibiotics: Aminoglycosides Action
inhibits protein synthesis in gram-negative bacteria
Antibiotics: Aminoglycosides Uses
Pseudomonas, E. coli
Antibiotics: Aminoglycosides Side Effects
ototoxicity, nephrotoxicty, nausea, vomiting, diarrhea
Antibiotics: Aminoglycosides Nursing Considerations
Checking 8th cranial nerve (hearing)
Check Renal Function (BUN)
Take for 7-10 days
Encourage Fluids (3,000ml/day when pushing)
Antibiotics: Cephalosporins Med Names
Ceclor, Ancef, Keflex, Rocephin, Mefoxin
Antibiotics: Cephalosporins Actions
inhibits synthesis of bacterial cell wall
Antibiotics: Cephalosporins Uses
tonsillitis, otitis media, peri-operative prophylaxis, meningitis
Antibiotics: Cephalosporins Side Effects
Bone Marrow Depression, Superinfections, Rash
Antibiotics: Cephalosporins Nursing Consideration
Take w food
Cross allergy with PCN
Avoid alcohol
Obtain Culture and Sensitivity before first dose
Antibiotics: Aminoglycosides
-mycin
Antibiotics: Cephalosporins
Ceph-, Cef, Kef
Antibiotics: Fluoroquinolones Med Names
Cipro
Antibiotics: Fluoroquinolones Actions
interferes with DNA replication in gram-negative bacteria
Antibiotics: Fluoroquinolones Uses
E. coli, Pseudomonas, S. aureus
Antibiotics: Fluoroquinolones Side Effects
diarrhea, decreased WBC and hematocrit, elevated liver enzymes (AST ALT), elevated alkaline phosphatase
Antibiotics: Fluoroquinolones Nursing Consideration
Culture and Sensity before starting therapy
Encourage Fluids (3000ml.day)
Take 1 h before or 2 h after meals
Antibiotics: Macrolide Med Names
erthromycin, Cleocin (clindamycin)
Antibiotics: Macrolide Actions
binds to cell membrane and changes protein function
Antibiotics: Macrolide Uses
acute infections, acne, URI, prophylaxis before dental procedures if allergic to PCN
Antibiotics: Macrolide Side Effects
diarrhea, confusion, hepatotoxicity, superinfections
Antibiotics: Macrolide Nursing Consderations
Take 1 h before or 2-3 h after meals
Monitor LFT
Take w full glass of water
Antibiotics: Penicillins Med Names
amoxicillin, ampicillin, augmentin
Antibiotics: Penicillins Actions
inhibits synthesis of cell wall
Antibiotics: Penicillins Uses
moderate to severe infections, syphilis, gonococcus infections, Lyme disease
Antibiotics: Penicillins Side Effect
stomatitis, diarrhea, allergic reactions, renal and hepatic changes
Antibiotics: Penicillins Nursing Considerations
Check for hypersensitivity
Give 1-2 h before or 2-3 h after meals
Cross allergy to cephalosporins
Antibiotics: Sulfonamides Med Names
Gantrisin, Bactrim, Azulfidine
Antibiotics: Sulfonamides Actions
anatgonize essential component of folic acid synthesis
Antibiotics: Sulfonamides Uses
ulcerative colitis, Crohn's, otitis media, UTIs
Antibiotics: Sulfonamides Side Effects
peripheral neuropathy, crystalluria, photosensitivity, GI upset, stomatitis
Antibiotics: Sulfonamides Nursing Considerations
Take with meals
Encourage fluids
Good mouth care
Antibiotics: Tetracyclines Med Names
Vibramycin, Panmycin
Antibiotics: Tetracyclines Actions
inhibits protein syntheis
Antibiotics: Tetracyclines Uses
infections, acne, prophylaxis for ophthalmia neonatorum
Antibiotics: Tetracyclines Side Effects
discoloration of primary teeth if taken by the mother during pregnancy, glossitis, rash, phototoxic reaction
Antibiotics: Tetracyclines Nursing Consideration
Take 1 h before or 2-3 after meals
Do not take antacid, mile, iron
SUNBLOCK - avoid sunlight
Monitor renal function
Note Expiration Date - Toxic after date
Furadantin (nitrofurantoin) Uses
UTIs
Furadantin (nitrofurantoin) Side Effects
asthma attacks, diarrhea
Furadantin (nitrofurantoin) Nursing Considerations
Anti-infective
Give w food or milk
Monitor pulmonary status
Take w/ cranberry juice
Pyridium Uses
UTIs
Pyridium Side Effects
Headache, Vertigo, Changes urine orange
Pyridium Nursing Considerations
Taken with meals
Urinary tract analgesic
Anti Impotence (Erectile Dysfunction) Med Names
Viagra, Levitra, Cialis
Anti Impotence Side Effects
headaches, hypotension, priapism
Anti Impotence Contraindications
nitrates, alpha blockers
Anti Impotence Nursing Considerations
can not take with grapefruit juice
call PCP if erection lasting longer than 4 h
Anticholinergics Med Names
Pro-Banthine, Atropine, Scopace
Anticholinergics Actions
dilates pupil, causes bronchodialtion adn decreased secreations, decreases mobility and GI secreations
Anticholinergics Uses
opthalmic exam, motion sickness, pre-operative
Anticholinergics Side Effects
blurred vision, dry mouth, urinary retention, change in heart rate
Anticholinergics Nursing Considerations
Monitor output
Contraindicated with glaucoma
Give 30 min before meals, at bedtime or 2 hours after meals
Anticoagulant Coumadin Action
interferes with synthesis of vitamin 5-dependent clotting factors
Anticoagulant Heparin Action
blocks conversion of prothrobin to thrombin
Anticoagulant Heparin Uses
pulmonary embolism, venous thrombosis, prophylaxis after acute MI
Anticoagulant Heparin Side Effect
hematuria, tissue irritation
Anticoagulant Heparin Nursing Considerations
Monitor clotting time or PTT
Normal 20-45 sec
Therapeutic level 1.5-2.5 times control
Antagonist- protmaine sulfate
Give SC or IV - Do NOT aspirate or Massage!
Anticoagulant Coumadin Uses
pulmonary embolism, venous thrombosis, prophylaxis after acute MI
Anticoagulant Coumadin Side Effects
Hemorrhage, alopecia
Anticoagulant Coumadin Nursing Considerations
Monitor PT
Normal 9-12 sec
Therapeutic level 1.5 times control
Antagonist- Vit K
Monitor for bleeding
Give PO
Anticonvulsants Med Names
Dilantin, Luminal, Depakote, Tegretol, Klonopin
Anticonvulsants Actions
decreases flow of calcium and sodium across neuronal membranes
Anticonvulsants Uses
seizures
Anticonvulsants Side Effects
Respiratory depression, aplastic anemia, gingival hypertrophy, ataxia
Anticonvulsants Nursing Considerations
Don't d/c abruptly
Monitor I&O
Caution with use of meds that lower seizure thresholds (ex. MOAIs, antipyscotic)
No alcohol
Urine is pink/reddish
Dilantin - Anticonvulsant
Don't give too fast - cardiac arrest
NEVER mix with another med
Urine Pink
Mag Sulfate - Anticonvulsant
Common given in OB
Deep Tendon Reflexes be evaluated
SE: Resp Arrest
Depakote - Anticonvulsant
No carbonated beverages
Antidepressants: MAOIs Med Names
Marplan, Parnate, Nardil
Antidepressants: MAOIs Action
causes increased concentration of neurotransmitters
Antidepressants: MAOIs Uses
depression, chronic pain
Antidepressants: MAOIs Side Effects
hypertensive crisis when taken with tyramine-containing foods (cheese, liver, beer, wine), photosensitivity
Antidepressants: MAOIs Nursing Considerations
Avoid foods containing tyramine
Monitor Output
Takes 4 wks to work
Do not take with cold medications or CNS stimulates
Antidepressants: SSRIs Med Names
Paxil, Prozac, Zoloft
Antidepressants: SSRIs Actions
inhibits CNS uptake of serotonin
Antidepressants: SSRIs Uses
depression, obsessive compulsive disorders, bulimia
Antidepressants: SSRIs Side Effects
Anxiety, gi upset, change in appetite and bowel function, urinary retention
Antidepressants: SSRIs Nursing Considerations
suicide precautions
takes 4 weeks to fully work
take in am
turn urine pink
Hypertensive Crisis
Severe Headache
Palpitations
Diaphoretic
Stiff Neck
Antidepressants: Tricyclics Med Names
Elavil, Tofranil, Norpamin
Antidepressants: Tricyclics Actions
inhibits reuptake of neurotransmitters
Antidepressants: Tricyclics Uses
depression, sleep apnea
Antidepressants: Tricyclics Side Effects
sedation, anticholinergic effect, confusion, postural hypotension, urinary retention
Antidepressants: Tricyclics Nursing Considerations
Monitor for suicide
takes 2-6 weeks to work
take at bedtime
monitor vital signs
position slowly
wean off medication
no alcohol
no sun- use sunscreen
Antidepressants: Heterocyclics Med Names
Wellbutrin, Desyrel
Antidepressants: Heterocyclics Uses
depression and smoking cessation
Antidepressants: Heterocyclics Side Effects
Wellbutrin: agitation
Desyrel: sedation
Antidepressants: Heterocyclics Nursing Considerations
avoid alcohol
CNS depressants
wean off slowly
Insulin: Fast Acting Names
Regular - can be given IV or Pump
Humulin R
Insulin: Fast Acting Onset
.5-1h
Insulin: Fast Acting Peak
2-4h
Insulin: Fast Acting Duration
6-8h
Insulin: Intermediate Acting Names
NPH
Humulin N
Insulin: Intermediate Acting Onset
2h
Insulin: Intermediate Acting Peak
6-12h
Insulin: Intermediate Acting Duration
18-26h
Insulin: Slow Acting Names
Ultralente
Humulin U
Insulin: Slow Acting Onset
4h
Insulin: Slow Acting Peak
8-20h
Insulin: Slow Acting Duration
24-36h
Insulin: Combination Names
Humulin 70/30
Insulin: Combination Onset
.5h
Insulin: Combination Peak
2-12h
Insulin: Combination Duration
24h
Antidiabetic Agents: Med Names
Diabinese, Orinase, Dymelor, Micronase
Antidiabetic Agents: Actions
Stimulates insulin release from beta cells in pancreas
Antidiabetic Agents: Uses
Type 2 diabetes
Antidiabetic Agents: Side Effects
Hypoglycemia, allergic skin reactions, GI upset
Antidiabetic Agents: Nursing Considerations
take before breakfast
Monitor glucose levels
avoid alcohol
Hypoglycemic Agent: Med Name
GlacGen (glucagon)
Hypoglycemic Agent: Action
stimulates liver to change glycogen to glucose
Hypoglycemic Agent: Uses
Hypoglycemia
Hypoglycemic Agent: Side Effects
hypotension, bronchospasms
Hypoglycemic Agent: Nursing Considerations
May repeat in 15 min
Give carbs orally to prevent secondary hypoglycemic reactions
Antidiarrheals: Med Names
Kaopectate, Lomotil, Imodium, Paregoric
Antidiarrheals: Actions
slows peristalsis, increases tone of sphincters
Antidiarrheals: Uses
diarrhea
Antidiarrheals: Side Effects
constipation, anticholinergic effects
Antidiarrheals: Nursing Considerations
do not use with abdominal pain
monitor for urinary retention
give 2h before or 3h after other medications
Antiemetics: Med Names
Tigan, Compazine, Reglan, Antivert, Dramine
Antidiarrheals: Action
increases GI motility, blocks effect of dopamine in chemoreceptor trigger zone
Antidiarrheals: Uses
vomiting
Antidiarrheals: Side Effects
sedation, anticholinergic effects
Antidiarrheals: Nursing Considerations
Use before chemo
When used with viral infections may cause Rye's syndrome
Antifungals: Med Names
Amphotericin B, Nystatin
Antifungals: Action
impairs cell membrane
Antifungals: Uses
candidiasis, oral thrush, histoplasmosis
Antifungals: Side Effects
hepatotoxicity, throbocytopenia, leukopenia, hemorrhage, pruritus
Antifungals: Nursing Considerations
Give w food
monitor liver function
good oral hygiene
Antigout Agents: Med Names
Colchicine, Probenecid, Allopurinol
Antigout Agents: Actions
decreases production and resorption of uric acid
Antigout Agents: Uses
Gout
Antigout Agents: Side Effects
agranulocytosis, GI upset, renal calculi
Antigout Agents: Nursing Consideration
monitor kidney stones
Give w milk, food, antacids
Antihistamines: Med Names
Chlor-Trimeton, Benadryl, Phenergan
Antihistamines: Action
block effects of histamine
Antihistamines: Uses
allergic rhinitis, allergic reactions to blood
Antihistamines: Side Effects
drowsiness, dry mouth, photosensitivity, bronchospasm
Antihistamines: Nursing Considerations
give w food
use sunscreen
avoid alcohol
assess respirations
Antihyperlipidemic: Med Names
Questran, Lipitor
Antihyperlipidemic: Actions
inhibits cholesterol and triglyceride synthesis
Antihyperlipidemic: Uses
elevated cholesterol, reduce incidence of cardiovascular disease
Antihyperlipidemic: Side Effects
constipation, fat-soluble, vitamin deficiency
Antihyperlipidemic: Nursing Considerations
Take at bedtime or 30 mins after meals
Administer 1 h before or 4-6h after other meds
Antihypertensives: Ace Inhibitors Med Names
-pril (think arteries)
Antihypertensives: Ace Inhibitors Actions
blocks ACE in lungs
Antihypertensives: Ace Inhibitors Uses
hypertension, CHF
Antihypertensives: Ace Inhibitors Side Effects
GI upset, orthostatic hypotension, dizziness
Antihypertensives: Ace Inhibitors Nursing Considerations
give 1 hour before meals, or 3 hrs after
Change positioning slowly
Monitor VS
Antihypertensives: Beta Blockers Med Names
-lol (beats)
Antihypertensives: Beta Blockers Actions
blocks beta-adrenergic receptors
Antihypertensives: Beta Blockers Uses
hypertension, angina, SVT
Antihypertensives: Beta Blockers Side Effects
changes in HR, hypotension, bronchospasms
Antihypertensives: Beta Blockers Nursing Considerations
Masks signs of shock and hypoglycemia
Take with meals
Do not dc abruptly
Antihypertensives: Calcium Channel Blockers Med Names
-pine, Cardizem
Antihypertensives: Calcium Channel Blockers Actions
inhibits movement of calcium across cell membrane
Antihypertensives: Calcium Channel Blockers Uses
angina, hypertension, interstitial cystitis
Antihypertensives: Calcium Channel Blockers Side Effects
hypotension, renal failure, angioedema
Antihypertensives: Calcium Channel Blockers Nursing Considerations
monitor vs
caution position change
monitor edema (face swelling, SOB)
Antihypertensives: Angiotensin II Receptor Blockers Med Names
-sartan
Antihypertensives: Angiotensin II Receptor Blockers Action
blocks vasoconstriction and aldosterone effects of aniotensin II
Antihypertensives: Angiotensin II Receptor Blockers Uses
Hypertension, heart failure, MI, diabetic neuropathy, stroke prevention
Antihypertensives: Angiotensin II Receptor Blockers Side Effects
Hypotension, dizziness, GI distress
Antihypertensives: Angiotensin II Receptor Blockers Nursing Considerations
monitor vs
do not chew or divide sustained release tablets
Antihypertensives: Alpha 1 Adrenergic Blockers Med Names
-osin
Antihypertensives: Alpha 1 Adrenergic Blockers Actions
Selective blockade of alpha-1 reception in peripheral blood vessels
Antihypertensives: Alpha 1 Adrenergic Blockers Uses
hypertension, benign prostatic hypertrophy, reflex tachycardia
Antihypertensives: Alpha 1 Adrenergic Blockers Side Effects
reflex tachycardia, orthostac hypotension, nasal congestion
Antihypertensives: Alpha 1 Adrenergic Blockers Nursing Considerations
administer first dose bedtime to avoid fainting
Monitor BUN, weight and edema
Change position slowly
Bipolar Disorder: Med Names
Lithium (salt), Tegretol (mood stablizer), Depakote (mood stablizer)
Bipolar Disorder: Action
reduces catecholamine release
Bipolar Disorder: Uses
Manic episodes
Bipolar Disorder: Side Effects
GI upset, tremors, polydipsia, polyuria
Bipolar Disorder: Nursing Considerations
monitor serum levels
give with meals
increase fluid intake
Antineoplastic: Alkylating Agents Med Names
Cisplatin, Myleran, Cytoxan
Antineoplastic: Alkylating Agents Action
interferes with rapidly reproducing DNA
Antineoplastic: Alkylating Agents Uses
leukemia, multiple myeloma
Antineoplastic: Alkylating Agents Side Effects
hepatotoxicity, bone marrow suppression
Antineoplastic: Alkylating Agents Nurisng Considerations
Checking hematopoietic function
Force fluids
Good mouth care
Antineoplastic: Antimetabolites Med Names
5-FU, Methotrexate
Antineoplastic: Antimetabolites Actions
inhibits DNA polymerase
Antineoplastic: Antimetabolites Uses
acute lymphatic leukemia, cancer of colon, breast, pancreas
Antineoplastic: Antimetabolites Side Effects
nausea, vomiting, oral ulcerations, bone marrow suppression, alopecia
Antineoplastic: Antimetabolites Nursing Consideration
Monitor hematopoietic function
Good mouth care
Discuss body image changes
Antineoplastic: Antitumor Med Names
Adriamycin, Bleomycin, Actinomycin D
Antineoplastic: Antitumor Action
interferes with DNA and RNA sythesis
Antineoplastic: Antitumor Uses
cancer
Antineoplastic: Antitumor Side Effects
bone marrow suppression, alopecia, stomatitis
Antineoplastic: Antitumor Nursing Considerations
Monitor VS
Give antiemetic before administration
Antineoplastic: Hormonal Agents Med Names
Nolvadex, Testosterone
Antineoplastic: Hormonal Agents Actions
changes hormone input into sensitive cells
Antineoplastic: Hormonal Agents Uses
Cancer
Antineoplastic: Hormonal Agents Side Effects
leukopenia, bone pain, hypercalcemia
Antineoplastic: Hormonal Agents Nursing Considerations
Check CBC
Monitor serum calcium
Antineoplastic: Vinca Alkaloids Med Names
Velban (vinblastine), Oncovin (vincristine)
Antineoplastic: Vinca Alkaloids Action
interferes with cell division
Antineoplastic: Vinca Alkaloids Uses
cancer
Antineoplastic: Vinca Alkaloids Side Effects
stomatitis, alopecia, loss of deep tendon reflexes, bone marrow suppression
Antineoplastic: Vinca Alkaloids Nursing Considerations
Give antiemetic before administration
Check reflexes
Given with Zyloprim to decrease uric acid
Antiparkinson Agents Med Names
(-dopa) Artane, Cogentin, L-Dopa, Parlodel, Sinemet
Antiparkinson Agents Actions
converted to dopamine, stimulates postoynaptic dopamine receptors
Antiparkinson Agents Uses
Parkinson's Disease
Antiparkinson Agents Side Effects
dizziness, ataxia, atropine like effects
Antiparkinson Agents Nursing Consideration
Monitor for urinary retention
Large doeses of Vit B6 reverse effects
Avoid use of CNS depressants
Antiplatelet Agents Med Names
Aspirin, Persantine, Plavix
Antiplatelet Agents Actions
interferes with platelet aggregation
Antiplatelet Agents Uses
venous thrombosis, PE
Antiplatelet Agents Side Effects
hemorrhage, throbocytopenia
Antiplatelet Agents Nursing Considerations
Check for signs of bleeding
Give with food or milk
Antipsychotic Agents Med Names
Thorazine-low, Trilafon-medium, Haldol-high
Antipsychotic Agents Actions
blocks dopamine receptors in basal ganglia
Antipsychotic Agents Uses
acute and chronic psychoses
Antipsychotic Agents Side Effects
akathisia, dyskinesia, dystonia, parkinson's syndrome, tardive dyskinesias, leukpenia
Antipsychotic Agents Nruisng Considerations
Check CBC
Monitor VS
Avoid alcohol and caffeine
Atypical Antipsychotic Agents Med Names
Clozaril, Risperdal
Atypical Antipsychotic Agents Actions
interferes with binding of dopamine in the brain
Atypical Antipsychotic Agents Uses
Acute and chronic psychoses
Atypical Antipsychotic Agents Side Effects
extrapyramidal, anticholinergic, sedatives, ortho hypotension
Atypical Antipsychotic Agents Nursing Considerations
Monitor Blood Work
Chang position slowly
Use sunscreen
Monitor VS - Airway
Antipyretic Med Name
Tylenol
Antipyretic Action
antiprostaglandin activity in hypothalamus
Antipyretic Uses
fever
Antipyretic Side Effects
GI irritation, Liver dysfuction
Antipyretic Nursing Considerations
Monitor LFT & ALT
Aspirin contraindicated under 21 yo due to risk of Reye's syndrome
Antithyroid Agents Med Names
Tapazole, SSKI
Antithyroid Agents Action
reduce vasularity of thyroid, inbibits release of thyroid into circulation
Antithyroid Agents Uses
Hyperthroidism, myxedema
Antithyroid Agents Side Effects
leukopenia, rash, thrombocytopenia
Antithyroid Agents Nursing Considerations
Bitter Taste
May cause burning in mouth
Give with meals
Check CBC
Thyroid Replacement Agents Med Names
Synthroid, Cytomel
Thyroid Replacement Agents Action
increases metabolic rate
Thyroid Replacement Agents Uses
hypothyroidism, Graves' disease
Thyroid Replacement Agents Side Effects
nervousness, tachycardia, weight loss
Thyroid Replacement Agents Nursing Consideration
Monitor weight
Take in am
Monitor pulse and BP
Enhances antideppresants and anticouglant stronger
Decreases insulin and digoxin
Antitubercular Agents Med Names
First Line -INH, Rifampin, Ethambutol, Streptomycin
Second Line - PAS, PZA
Antitubercular Agents Action
inhibits cell and protein synthesis
Antitubercular Agents Uses
TB, to prevent disease in person exposed to organism
Antitubercular Agents Side Effects
hepatitis, peripheral neuritis
Antitubercular Agents Nursing Considerations
Check LFT
Vit B6 given for peripheral neuritis
Used in combination
Antitussive Agents Med Names
Benylin DM, Robitussin
Antitussive Agents Actions
suppress cough reflex by inhibiting cough reflex in medulla, decrease viscosity of secretions
Antitussive Agents Uses
coughs due to URI, COPD
Antitussive Agents Side Effects
bradycardia, respiratory depression, drowsiness, dizziness, anticholinergic effects
Antitussive Agents Nursing Considerations
Monitor Cough
Avoid alcohol
Antivirals Med Names
Zovirax, AZT, Videx, Famvir, Cytovene
Antivirals Action
inhibits DNA and RNA relpications
Antivirals Uses
recurrent HSV, HIV infections
Antivirals Side Effects
headache, dizziness, GI symptoms
Antivirals Nursing Considerations
Encourage fluids
Not a cure, but relieves symptoms
Attention Disorder Agents Med Names
Ritalin, Dexedrine
Attention Disorder Agents Action
increases level of catecholamines
Attention Disorder Agents Uses
ADD, narcolepsy
Attention Disorder Agents Side Effects
restlessness, insomnia, tachycardia, palitations
Attention Disorder Agents Nursing Consideration
Monitor growth rate
Monitor liver enzymes
Give in am
Bone-Reabsorption Inhibitors: Biophosphonates Med Names
Alendronate (fosamax), Risedronate (actonel), Ibandronate (boniva)
Bone-Reabsorption Inhibitors: Biophosphonates Action
inhibits resorption of bone
Bone-Reabsorption Inhibitors: Biophosphonates Uses
osteoprosis, paget's disease
Bone-Reabsorption Inhibitors: Biophosphonates Side Effects
esophagitis, arthralgia
Bronchodilators Med Names
Aminophylline, Brethine, Atrovent, Proventil, Primatene mist
Bronchodilators Action
decreases activity of phosphodiesterase
Bronchodilators Uses
COPD, preterm labor
Bronchodilators Side Effects
tachycardia, dysrhythmias, palpitations, anticholinergic effects
Bronchodilators Nursing Considerations
Monitor BP and HR
When used with steroid inhaler, use bronchodilater first
May aggravate diabetes
Carbonic Anhydrase Inhibitors Med Names
Diamox
Carbonic Anhydrase Inhibitors Action
decreases production of aqueous humor in ciliary body
Carbonic Anhydrase Inhibitors Uses
open-angle glaucoma
Carbonic Anhydrase Inhibitors Side Effects
blurred vision, lethargy, depression
Carbonic Anhydrase Inhibitors Nursing Considerations
Monitor for systemic effects
Cardiac Glycosides Med Names
Lanoxin (digoxin)
Cardiac Glycosides Action
increases force of myocardial contraction, slows rate
Cardiac Glycosides Uses
left-sided HF
Cardiac Glycosides Side Effects
bradycardia, nausea, vomiting, visual disturbances
Cardiac Glycosides Nursing Consideration
Take apical pulse
Notify physician if adult <60, child <90-110
Monitor potassium level (3.5-5)
Digoxin Therapeutic Levels
0.5-2
Digoxin Antidote
Digibind
Cytoprotective Agents Med Names
Carafate
Cytoprotective Agents Action
forms a barrier on ulcer surface
Cytoprotective Agents Uses
duodenal ulcer
Cytoprotective Agents Side Effects
constipation, vertigo
Cytoprotective Agents Nursing Considerations
Take 1h before food
Give 2h becofe or after other meds
Diuretics Med Names
HydroDIURIL, Aldactone, Lasix, Mannitol
Diuretics Actions
inhibits reabsorption of sodium and water, blocks effects of aldosterone
Diuretics Uses
CHF, renal disease
Diuretics Side Effects
dizziness, orth hypotension, leukopenia
Diuretics Nursing Considerations
Take with food or milk
Take in am
Monitor fluid and electrolytes
Electrolytes Med Names
Os-Cal, Slow Mag, K-Dur, Sodium Chloride
Electrolytes Actions
replaces needed electrolytes
Electrolytes Uses
fluid and electrolyte imbalances, osteoporosis
Electrolytes Side Effects
electrolyte imbalances
Electrolytes Nursing Considerations
Monitor fluid and electrolyte levels
Iron Preparations Med Names
Feosol (ferrous sulfate) Imferon
Iron Preparations Actions
increase availability of iron for hemoglobin
Iron Preparations Uses
iron-deficiency anemia
Iron Preparations Side Effects
constipation, dark stools, tachycardia
Iron Preparations Nursing Considerations
Take on empty stomach
Vit C increases absorption
Monitor Hct and Hgb
Glucocorticoids Med Names
Solu-Cortef (hydrocortisone) Decadron, Prednisone
Glucocorticoids Action
stimulates formation of glucose, alters immune response
Glucocorticoids Uses
Addison's disease, Crohn's disease, COPD, leukemias
Glucocorticoids Side Effects
susceptible to infection and masks infection, insomnia, hypoglycemia, hypokalemia, psychoses, depression, stunted growth
Glucocorticoids Nursing Considerations
Monitor fluid and electrolyte balance
Don't dc abruptly
Monitor for signs of infection
Immunosuppressants Med Names
Sandimmune (cyclosporine)
Immunosuppressants Action
prevents production of T cells and their response to interleukin-2
Immunosuppressants Uses
prevents rejection for transplanted organs
Immunosuppressants Side Effects
hepatotxicity, nephrotoxicity, leukonpenia, thrombovytopenia
Immunosuppressants Nursing Considerations
Take once daily in am
Used with adrenal corticosteroids
Monitor renal and liver function tests
Take w milk or juice
Stay away from sick ppl
Good Handwashing
Laxatives/Stool Softeners Med Names
Cascara, Dulcolax, Colace, MOM
Laxatives/Stool Softeners Action
absorb water increasing bulk, lubricate surface of stool, stimulate peristalsis
Laxatives/Stool Softeners Uses
constipation, preparation for sx and procedures
Laxatives/Stool Softeners Side Effects
diarrhea, dependence, abdominal cramps, hypermagnesemia
Laxatives/Stool Softeners Nursing Considerations
Contraindicated w symptoms of acute abd
Monitor fluid and electrolytes
Chronic uses may cause hypokalemia
Encourage fluid
Narcotics Med Names
Morphione, Codeine, Demerol, Dilaudid, Precodan (oxycodone)
Narcotics Action
acts on CNS receptor cells
Narcotics Uses
moderate to severe pain, preoperative, postoperative
Narcotics Side Effects
dizziness, sedation, respiratory depression, hypotension, constipation
Narcotics Nursing Considerations
Safety precautions
Avoid alcohol
Monitor VS
Narcan
Antianginals Med Names
Nitro, Isordil
Antianginals Action
relaxes smooth muscle, decreases venous return
Antianginals Uses
angina, peri-operative hypoertension, HF
Antianginals Side Effects
hypotension, tachycardia, headache, dizziness
Antianginals Nursing Considerations
Check expiration date
Teach when to take medication
May take q 5 min x 3 doses
Wet with saliva and place under tongue
NSAIDS Med Names
Motrin, Indocin, Naprosyn
NSAIDS Action
inhibits prostaglandin synthesis
NSAIDS Uses
arthritis, mild to moderate pain, fever
NSAIDS Side Effects
GI upset, dizziness, headaches, bleeding, fluid retention
NSAIDS Nursing Considerations
Take w food or after meals
Monitor liver and renal functions
Use cautiously with aspirin allergy
Check for bleeding
Thrombolytics Med Names
Strepokinase, Urokinase, Tissue Plasminogen Activator (TPA)
Thrombolytics Action
dissolves or lyses blood clots
Thrombolytics Uses
acute pulmonary emboli, thrombosis, MI
Thrombolytics Side Effects
Bleeding, bradycardia, dysrhythmias
Thrombolytics Nursing Considerations
Monitor for bleeding
Have amino caproic acid available - Antidote
Check pulse, color, sensation of extremities
Monitor EKG
H2-Receptor Blockers Med Names
Tagamet, Zantac
H2-Receptor Blockers Action
inhibits action of histamine and gastric acid secretions
H2-Receptor Blockers Uses
ulcers, gastroesophageal reflux
H2-Receptor Blockers Side Effects
dizziness, confustion, hypotension, impotence
H2-Receptor Blockers Nursing Considerations
Take w meals and hs
Smoking decreases effectiveness
Monitor LFT and CBC
-"dipine"
Ca Channel blockers
HTN
angina
dysrhythmias
-"afil"
erectile dysfunction
-"caine"
anesthetics
-"pril"
ACE inhibitor
HTN
CHF
-"pam", -"lam"
benzodiazepine
anxiety
sedative
anti-convulsent
-"statin"
antilipemic
lower chol.
lower triglycerides
take in the evening
-"asone, -"solone"
corticosteroid
suppress inflammation
-"alol"
Beta blocker
angina
HTN
Adverse Effects (4 Bs)
B- bradycardia
B- BP decreased
B- BG masked
B- Bronchoconstriction
-"cillin"
penicillin
-"ide"
Oral hypolglycemic
-"prazole"
PPI
suppress gastric acid
antiulcer
don't give w/ food, 1-2 hrs between meals
-"vir"
antiviral
HIV
-"ase" -"plase"
thrombolytic
dissolve clots
-"azine"
antiemetic
-"phylline"
Bronchodilator
-"arin"
anticoagulant
-"tidine"
Histamine H2 receptor agonist
suppress secretion of gastric acid
GERD
antiulcer
-"zine"
antihistamine
-"cycline"
antibiotic
-"mycin"
aminoglycoside
-"floxacin"
antibiotic
-"tyline"
Tricyclic antidepressents
-"pram", -"ine"
SSRIs
-"nitr"
Nitrates
angina
vasodilation
-"sulf"
sulfonamides
suppress bacterial growth
-"zide"
thiazide diuretics
HTN
Pulm. edema
-"thy"
thyroid hormones
take in the AM
-"line"
bronchodilators
COPD
bronchospasms
-"terol"
Beta 2 agonist
bronchodilator
sympathomimetic
-"pium"
anticholinergic
bronchodilator
-"phylline"
methylxanthines
bronchodilator
-"lukast"
leukotrenes
anti-inflammatory
-"crome"
Mast Cells stabilizers
anit-inflammatory
Vasoconstrictors
Ex. epinephrine, ephedrine, isoprote
N- nervousness
A- anxious
S- BG increased
C- cardiac arrest
A- allergic reaction
R- resp broncodilator
-"barbitol"
barbituates
CNS depressant, long acting
Norepinephrine (levofed)
given as last effort of saving life
S- stimulation of alpa/beta receptors
H- hypovolemia must be corrected prior to administration
O- output, increases urinary output
C- Constricts blood vessels
K- Keep eye on patient (monitor every 5-15 min)
Dopamine
vasoconstrictor
1st line of drug in sever hypotension
-"sartan"
ARBs
Angiotensin II receptor Blockers
CHF
HTN
blocks aldosterone
avoid suanas, hot tubs
take at same time everyday
N-acetylcysteine (mucomyst)
acetaminophen antidote
physostigmine
anticholinergics antidote
chelation therapy
arsenic antidote
lead antidote
mercury antidote
flumazenil (mucomyst)
acetaminophen antidote
glucagon (high dose)
Beta blocker antidote
glucagon, CaChl, Ca gluconate
Ca Channel blockers antidote
atropine
cholinergic antidote
amyl nitrate, Na thiosulfate
cyanide antidote
digibind
digoxin antidote
protamine sulfate
anoxoparin (lovenox) antidote
heparin
ethanol
ethylene glycol antidote
glucagon
hypoglycemic agents antidote
deferoxamine mesylate
iron antidote
Ca gluconate
Mg Sulfate antidote
atropine sulfate
mushrooms, muscarinic antidote
nerve gas antidote
naloxone
opiod (morphine, codeine) antidote
antivenin, polyvalent
snake bite antidote
antivenin, equine
black widow antidote
Na bicarbonate
TCAs antidote
phytonadione (Vit K)
warfarin antidote
TPN
RN Resp:
check BG every 4hrs
high risk for infection
dressing change 48-72hrs
IV tubing/fluid change every 24hrs
substitute with 10% DW
Cardiac glycosides
digoxin
Heart failure, AFib
adverse reaction:
Halos
anorexia
N/V
Hold if HR <60 adult, <70 child, <90 infant
lispro (Humalog)
rapid acting insulin
onset <15 min.
regular (Humalin R)
short-acting
onset 0.5-1hr
only one given via IV
Clear
NPH (Humalin N)
Intermediate
Onset 1-2 hrs
Cloudy
I Glargine (Lantus)
Long Acting
Onset 1 hr
give at bedtime
don't mix with other insulin
-"zocin"
peripherally acting anti-adrenergic
HTN
take at bedtime
Antihypertensives
Take med at same time every day
avoid saunas, hot tubs
Captopril
take 1hr before meals
ACE-I
stop diuretic 24-48 hrs prior to taking ACE-I
monitor K levels
A- angioedema (treat with epinephrine)
C- dry persistent cough
E- electrolyte imbalance
Ca Channel Blocker
caution w/ PT taking digoxin/beta-blockers
don't consume grapefruit juice
IV give over 2-3 minutes
Beta Blockers
do not give in same line with furosemide
Digoxin toxicity
Dc Dig and K sparring diuretics
Treat dysrhythmias with phenytoin
Bradycardia with atropine
Niratetes
life threatening if taken with Viagra
headache
keep in dark container
replace every 6 months
may be used 5-10min before exercise
Adenosine (Adenocard)
antidysrhythmic
slows conduction time through AV node
rapid IVP 1-2 sec
Amiodarone (Cordorone)
antidysrhythmic
prolongs repolarization
relaxes smooth muscle
Atropine
antidysrhythmic
increases firing of SA node & conduction through AV node
Centrally acting alpha 2 agonist
Clonidine, Guanfacine, Methyldopa
works in the brain to reduce peripheral vascular resistance
black sore tongue
leukopenia
take at bedtime
Statins
multiple drug interactions
can prolong bleeding in patients taking coumadin
Cholesterol absorption inhibitor
Ezetimibe
take 1hr before or 4hrs after another antilipemic
SSRIs (ZLPP)
Zoloft-elderly
Lexapro-
Paxil-not for elderly
Prozac-children
antidepressant
bruxism
restless leg syndrome
SNRIs
Cymbalta
caution with children and adolescents
may cause suicidality
decrease libido
TCAs
severe case of depression
Elavil
anticholinergic effects
decrease libido
MAOIs
N-nardil
P-parmate-
M-marplan
avoid foods with high tyramine
serotonin syndrome
fever,
muscle stiffness
ALOC
hallucinations
Ferrous Sulfate
Iron supplement
do not take with food, milk, antacid
take with VitC
High fiber diet to decrease constipation
M.U.C.H.
Ca Channel blockers
M-meal, give with meal
U- Under 100 systolic BP, hold
C- Ca++, needs to be monitored
H- HTN, used for HTN
-"mide"
loop diuretic
High K diet
-"zides"
thiazide diuretics
-"tone"
K+ sparring diuretics
Mannitol
osmotic diuretic
ICP
Watch for headache
Desmporessin (DDAVP)
used for DI
reabsorbs of H2O in kidneys
watch for fluid overload
Ace Inhibitors
"PRIL" Captopril, Enalapril, Afosiopril

Antihypertensive. Blocks ACE in lungs from converting angiotensin I to angiotensin II (powerful vasoconstrictor). Decreases BP, Decreased Aldosterone secretions, Sodium and fluid loss.

Check BP before giving (hypotension)

*Orthostatic Hypotension
Beta Blockers
*** DO NOT give with ASTHMA, BRONCHIAL CONSTRICTIVE DISEASE!!!***

"LOL" Antenolol, metoprolol. labetolol

Antihypertensive. Blocks beta-adrenergic receptors in heart, decreases excitability of the heart, reduces caridac workload and O2 consumption. Lowers BP.

Check BP before giving (hypotension)

*Orthostatic Hypotension

* Do not D/C abruptly (2wks)

*Blocks normal signs of Hypoglycemia (sweating, tachycardia). Monitor Blood glucose!!
Calcium Channel Blocker
"CA" Calan, Procardia, Cardizem

Slow the HR and decrease BP (check HR and BP before). Inhibits mvmt of Calcium ions across membrane or cardiac and arterial muscle cells. Results in slowed impulse conduction, depression of myocardial constractility, dilation of coroanry arteries.

SE: Constipation

Procardia sometimes causes peripheral edema
Diuretics
K+ and NA+ follows the walter --> electrolytes imbalances
Potassium Chloride
Check labs before giving, Never give IV PUSH

Give with FOOD (GI distresss))

Extreme caution if pt. receiving potassium-sparing diuretic.

NOT for pts with RENAL DISEASE.
Morphine
IV for chest pain
Check Respirations
Narcan
Counteracts Morphine - opioid narcotics.
Atopine (Caridiac Use)
Tx Heart Blocks (increase HR)

4D's:
Dry Mouth, Dry Stool, Dilated Pupils, Dilated Bladder (urinary retention)
Digitalis
Strengthens cardiac muscle contraction
Antiarrhythmic

CANT MIX WITH ANYTHING

TOXICITY:
Pulse (slows - Check Apical Pulse before giving)
Photosensitivity
Puke (vomiting, nausea)
Yellow-Green Halos
Light Flashes
Lidocaine
Decrease cardiac irritability
Titate IV
Use with V. TACH
Nitro
Vasodilator
Angina (1 tab 3x, 5 min apart)
Keep med dry, cool, only effective for 6 mo. (Tingling under tongue = good)

ORTHOSTATIC HYPOTENSION
Aminophylline
Bronchodilator - Decreases SOB

Therapeutic levels 10-20 mcg/dl
TOXIC > 20

CANT MIX WITH ANYTHING
Amphotericin B
Antifungal
IVPB SLOW - 2+ hrs
Hydrate pt - very toxic to kidneys, monitor BUN.
Check Hearing
Check K+ levels.
Aminoglycosides
Gentamycin, Kanamycin sulfate, Neomycin sulate, Steptomycin Sulfate

OTOTOXICITY
KIDNEY DAMAGE
Bronchodilators
Epinephrine (adrenalin)

Careful with Cardiac Pts
Anticoagulants
Heparin (Antecdote - Protamine Sulfate)

Coumadin (Antecdote - Vit K.)

Bleeding precautions

PPT - Heparin
PT/INR - Coumadin
Anticholinergics
Atropine

GI - Slows motility, spasm
Eyes - Dilates pupils DO NOT GIVE TO GLAUCOME PTS
Heart - Increase HR
Resp - bronchodilator (Atrovent)
Cancer Drugs
Wear gloves, mask when preparing or giving. Can be absorbed throught skin
Sulfa Drugs
Drink lots of fluids
Can cause blood dyscrasias - REPORT SORE THROAT, RASH IMMEDIATELY.

UTI (Bactrim, sulfisoxazole)
Ulcerative colitis (Sulfasalazine)
Urinary Antispasmodics
Pyridium (cystitis) - Orange/Red urine
Penicillines
Take all 10 days
Cortisone (Steroids)
Wt gain, Na+ retention, K+ Loss

NEVER STOP SUDDENLY
Dilantin
Anti-convolsant

Therapeutic level 10-20 (same as amminophylline)
Toxicity > 20
Causes hyperplasia of gums - bleeding gums
Give extra VIT. D
Tylenol
Bad for Liver - DO NOT GIVE TO ALCOHOLICS
Premarin
1. Hormone Replacement - Estrogen
Tx Menopause Sxs
SD - Vascular Headaches
Periods continue

2. Prempro (comination estrogen and progesteron)
No periods
Allupurinol (Zyloprim)
G - Gulp 3L fluid per day
O - (NO) Organ Meats
U - Output up to 2 L/day
T - Teach
Miotics
CONSTRICT (Pilo-Carpine)
For glaucoma - increased outflow of aqueaous humor
Mydriatics
DILATES (Atropine)
Dont use in pts with gaucoma (build up IOP)
Antacids
Aluminum - Constipation
Magnesium - Diarrhea
Lithium
Bipolar Disorder
Decrease Na+ (risk of toxicity)
Increase Na+ levels (causes sodium diuresis)
Toxic Level > 2 mEq/L
Librium and Valume
To prevent DT's in acute alcohol withdrwal
Can produce physical dependency.
Direct - Acting Vasodilator
Hydralazine (apresoline)

Relaxes smooth muscle of blood vessels, lowing peripheral esistance.

Teach pt to check pulse d/t change in C.O.
If HR <60 Contact physician.
Psychomotor symptoms
Anticholinergic effects are common adverse effects of antidepressants such as imipramine (Tofranil). These effects may include:
a. Psychomotor symptoms
b. Tachycardia, hypertension, and increase in respiratory rate
c. Tardive dyskinesias
d. Blurred vision, dry mouth, and constipation
TCA antidepressants
Psychomotor symptoms, tachycardia, hypertension, increase in respiratory rate, and tardive dyskinesias are potential adverse effects of ______?
Decrease drug dependence and assess status
The parents of a patient receiving methylphenidate (Ritalin) express concern that the health care provider has suggested the child have a "holiday" from the drug. The nurse explains that the drug-free holiday is designed to:
a. Reduce the risk of drug toxicity
b. Allow the child's "normal" behavior to return
c. Decrease drug dependence and assess status
d. Prevent hypertensive crisis
drug holiday
The ____ is to decrease the risk of dependence and to evaluate behavior.
An increased susceptibility to infections
A 17-year-old male has started valproic acid (Depakene) for treatment of bipolar disorder. While he is taking this drug, he should be carefully monitored for:
a. Unusual abdominal pain, especially in the upper quadrant areas
b. An increased susceptibility to infections
c. Lethargy or confusion
d. Unusual bleeding or bruising
St. John's wort
Taking ____ with an MAOI could result in hypertensive crisis; patients should always consult with their health care provider before taking any medications or OTC drugs/herbal remedies.
Read labels of food and over-the-counter drugs.
Which of the following would be a priority component of the teaching plan for a patient prescribed * phenelzine (Nardil) for treatment of depression?
a. Headache may occur.
b. Hyperglycemia may occur.
c. Read labels of food and over-the-counter drugs.
d. Monitor blood pressure for hypotension.
MAOI
Nardil is an ____. This class of drugs has many drug and food interactions that may cause a hypertensive crisis.
A month or longer
A patient experiencing moderate depression is placed on sertraline (Zoloft). The nurse should counsel the patient to expect full effects from the drug in:
a. 2-3 days
b. 1 week
c. A month or longer
d. Within 24 hours after starting the drug
SSRIs
Antidepressant drugs such as the ____ may not have full effects for a month or longer but some improvement in mood and depression should be noticeable after beginning therapy. DRUG OF CHOICE for depression.
depression
Lack of energy, sleep disturbances, abnormal eating patterns
( OVER EATING) Feelings of despair, guilt, hopelessness
Most common mental health disorder of elderly adults. Is associated w/ dysfunction of neurotransmitters in the brain connected with cognition and emotion.
Postpartum Depression
Intense mood changes associated with hormonal changes
BIPOLAR DISORDER
once known as Manic depression- Shift from emotions of extreme depression to extreme rage & agitation.
suicidal ideation
Always ask pt about this before giving antidepressant. Children at greatest risk for this.
Seasonal Affective Disorder (SAD)
Enhanced release of melatonin due to lower light levels
Give Ritalin in the morning. do not give Ritalin after 4pm.
Do not give Ritalin after ?
SSRIs
1st line of defense against depression
lithium (Eskalith)
Medication use for Mania symptoms of bipolar
Lithium
Must have salt or it will cause retention of this drug? patients should not avoid salt when taking this drug because it reduces its effects. salt is needed.
electroconvulsive therapy (ECT)
therapy for *severely depressed patients in which a brief electric current is sent through the brain. serious complications are seizure activity and anesthesia
TCAs
Block or inhibit the reuptake of NE and serotonin (or 5-HT) Are less dangerous than MAOI's. Sedation is a reported complaint at beginning of therapy.
repetitive transcranial magnetic stimulation (rTMS)
this treatment requires surgical implant of device. somatic treatment
black box warning
2004 FDA issued this. To be included at beginning of drug package inserts and drug information sheets. These warnings apply especially to children, who are at greater risk for suicidal ideation.
TCA's
atypical use of ____ is for the treatment of enuresis (bed wetting)
Clomipramine (Anafranil)
are used to treat obsessive compulsive behavior. (OCD)
paroxetine, Paxil
Antidepressant. Weight gain. pack it on ____
Zoloft
Selective serotonin reuptake inhibitor (SSRI) drug.can reduce your sex drive. its been nicknamed "so soft".
venlafaxine, Effexor
SNRI. an atypical antidepressant; off labeled use for hot flashes associated with menopause.
SSRI
These should not be started within 14 days of taking MAOI. use with a MAOI can cause serotonin sydrome (autonomic hyperactivity, hyperthermia, rigidity, diaphoresis, and neuroleptic malignant syndrome, hypertensive crisis.
Serotonin syndrome
may occur when taking another drug that affects reuptake of serotonin, causing sertonin to accumulate in the body. Can also be caused from SSRI with MAOI. Symptoms include confusion, anxiety, restlessness, hyperpyrexia, ataxia.
Tyramine
rich in wines and cheese, yogart, beef or chicken liver; these foods are contraindicated in patients on MAO inhibitors
Diarrhea and ataxia
Hypotension and edema
Slurred speech and muscle weakness
Which of the following symptoms would indicate to the
nurse that a patient is experiencing lithium toxicity? (Select
all that apply.)
1. Diarrhea and ataxia
2. Hypotension and edema
3. Hypertension and dehydration
4. Increased appetite, increased energy, and memory loss
5. Slurred speech and muscle weakness
lithium toxicity
dehydration can lead to?
b. 0.5 to 2.0 ng/mL
A newly admitted client takes digoxin 0.25 mg/day. The nurse knows that which is the serum therapeutic range for digoxin?

a. 0.1 to 1.5 ng/mL
b. 0.5 to 2.0 ng/mL
c. 1.0 to 2.5 ng/mL
d. 2.0 to 4.0 ng/mL
a. It is in the high (elevated) range.
The client's serum digoxin level is 3.0 ng/mL. What does the nurse know about this serum digoxin level?

a. It is in the high (elevated) range.
b. It is in the low (decreased) range.
c. It is within the normal range.
d. It is in the low average range.
d. Pulse below 60 beats/min and irregular rate
The nurse is assessing the client for possible evidence of digitalis toxicity. The nurse acknowledges that which is included in the signs and symptoms for digitalis toxicity?

a. Pulse (heart) rate of 100 beats/min
b. Pulse of 72 with an irregular rate
c. Pulse greater than 60 beats/min and irregular rate
d. Pulse below 60 beats/min and irregular rate
a. Increase the serum digoxin sensitivity level
The client is also taking a diuretic that decreases her potassium level. The nurse expects that a low potassium level (hypokalemia) could have what effect on the digoxin?

a. Increase the serum digoxin sensitivity level
b. Decrease the serum digoxin sensitivity level
c. Not have any effect on the serum digoxin sensitivity level
d. Cause a low average serum digoxin sensitivity level
b. Headaches
When a client first takes a nitrate, the nurse expects which symptom that often occurs?

a. Nausea and vomiting
b. Headaches
c. Stomach cramps
d. Irregular pulse rate
c. Decrease heart rate and decrease myocardial contractility.
The nurse acknowledges that beta blockers are as effective as antianginals because they do what?

a. Increase oxygen to the systemic circulation.
b. Maintain heart rate and blood pressure.
c. Decrease heart rate and decrease myocardial contractility.
d. Decrease heart rate and increase myocardial contractility.
b. The beta blocker should NOT be abruptly stopped; the dose should be tapered down.
The health care provider is planning to discontinue a client's beta blocker. What instruction should the nurse give the client regarding the beta blocker?

a. The beta blocker should be abruptly stopped when another cardiac drug is prescribed.
b. The beta blocker should NOT be abruptly stopped; the dose should be tapered down.
c. The beta blocker dose should be maintained while taking another antianginal drug.
d. Half the beta blocker dose should be taken for the next several weeks.
c. To block the beta1-adrenergic receptors in the cardiac tissues
The beta blocker acebutolol (Sectral) is prescribed for dysrhythmias. The nurse knows that what is the primary purpose of the drug?

a. To increase the beta1 and beta2 receptors in the cardiac tissues
b. To increase the flow of oxygen to the cardiac tissues
c. To block the beta1-adrenergic receptors in the cardiac tissues
d. To block the beta2-adrenergic receptors in the cardiac tissues
a. "Apply the patch to a nonhairy area of the upper torso or arm."
A client is to be discharged home with a transdermal nitroglycerin patch. Which instruction will the nurse include in the client's teaching plan?

a. "Apply the patch to a nonhairy area of the upper torso or arm."
b. "Apply the patch to the same site each day."
c. "If you have a headache, remove the patch for 4 hours and then reapply."
d. "If you have chest pain, apply a second patch next to the first patch."
d. Client stating that pain is 0 out of 10
A nurse is monitoring a client with angina for therapeutic effects of nitroglycerin. Which assessment finding indicates that the nitroglycerin has been effective?

a. Blood pressure 120/80 mm Hg
b. Heart rate 70 beats per minute
c. ECG without evidence of ST changes
d. Client stating that pain is 0 out of 10
d. Chest pain
The nurse is monitoring a client during IV nitroglycerin infusion. Which assessment finding will cause the nurse to take action?

a. Blood pressure 110/90 mm Hg
b. Flushing
c. Headache
d. Chest pain
d. "I can take up to five tablets at 3-minute intervals for chest pain if necessary."
Which statement made by the client demonstrates a need for further instruction regarding the use of nitroglycerin?

a. "If I get a headache, I should keep taking nitroglycerin and use Tylenol for pain relief."
b. "I should keep my nitroglycerin in a cool, dry place."
c. "I should change positions slowly to avoid getting dizzy."
d. "I can take up to five tablets at 3-minute intervals for chest pain if necessary."
a. Client states that she has no chest pain.
Which client assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker?

a. Client states that she has no chest pain.
b. Client states that the swelling in her feet is reduced.
c. Client states the she does not feel dizzy.
d. Client states that she feels stronger.
d. "This medication will work for 24 hours and you will need to change the patch daily."
What statement is the most important for the nurse to include in the teaching plan for a client who has started on a transdermal nitroglycerin patch?

a. "This medication works faster than sublingual nitroglycerin works."
b. "This medication is the strongest of any nitroglycerin preparation available."
c. "This medication should be used only when you are experiencing chest pain."
d. "This medication will work for 24 hours and you will need to change the patch daily."
c. Apply the nitroglycerin patch for 14 hours and remove it for 10 hours at night.
What will the nurse instruct the client to do to prevent the development of tolerance to nitroglycerin?

a. Apply the nitroglycerin patch every other day.
b. Switch to sublingual nitroglycerin when the client's systolic blood pressure elevates to more than 140 mm Hg.
c. Apply the nitroglycerin patch for 14 hours and remove it for 10 hours at night.
d. Use the nitroglycerin patch for acute episodes of angina only.
c. Assess blood pressure.
Before the nurse administers isosorbide mononitrate (Imdur), what is a priority nursing assessment?

a. Assess serum electrolytes.
b. Measure blood urea nitrogen and creatinine.
c. Assess blood pressure.
d. Monitor level of consciousness.
b. "It's best to keep it in its original container away from heat and light."
The client asks the nurse how nitroglycerin should be stored while traveling. What is the nurse's best response?

a. "You can protect it from heat by placing the bottle in an ice chest."
b. "It's best to keep it in its original container away from heat and light."
c. "You can put a few tablets in a resealable bag and carry it in your pocket."
d. "It's best to lock them in the glove compartment to keep them away from heat and light."
d. "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."
Which statement indicates to the nurse that the client understands sublingual nitroglycerin medication instructions?

a. "I will take up to five doses every 3 minutes for chest pain."
b. "I can chew the tablet for the quickest effect."
c. "I will keep the tablets locked in a safe place until I need them."
d. "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."
b. Apply the ointment to a nonhairy part of the upper torso.
What instruction should the nurse provide to the client who needs to apply nitroglycerin ointment?

a. Use the fingers to spread the ointment evenly over a 3-inch area.
b. Apply the ointment to a nonhairy part of the upper torso.
c. Massage the ointment into the skin.
d. Cover the application paper with ointment before use.
b. Decrease the intravenous nitroglycerin by 10 mcg/min.
A client receiving intravenous nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's priority action?

a. Assess the client's lung sounds.
b. Decrease the intravenous nitroglycerin by 10 mcg/min.
c. Stop the nitroglycerin infusion for 1 hour, and then restart.
d. Recheck the client's vital signs in 15 minutes but continue the infusion.
b. Heart rate 58 beats per minute
The nurse is monitoring a client taking digoxin (Lanoxin) for treatment of heart failure. Which assessment finding indicates a therapeutic effect of the drug?

a. Heart rate 110 beats per minute
b. Heart rate 58 beats per minute
c. Urinary output 40 mL/hr
d. Blood pressure 90/50 mm Hg
a. Administer ordered dose of digoxin.
A client's serum digoxin level is drawn, and it is 0.4 ng/mL. What is the nurse's priority action?

a. Administer ordered dose of digoxin.
b. Hold future digoxin doses.
c. Administer potassium.
d. Call the health care provider.
a. Evaluate digoxin levels.
A client is taking digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 40 mg. When the nurse enters the room, the client states, "There are yellow halos around the lights." Which action will the nurse take?

a. Evaluate digoxin levels.
b. Withhold the furosemide
c. Administer potassium.
d. Document the findings and reassess in 1 hour.
a. Loss of appetite with slight bradycardia
Which assessment finding will alert the nurse to suspect early digitalis toxicity?

a. Loss of appetite with slight bradycardia
b. Blood pressure 90/60 mm Hg
c. Heart rate 110 beats per minute
d. Confusion and diarrhea
b. To administer digoxin immune FAB
The nurse reviews a client's laboratory values and finds a digoxin level of 10 ng/mL and a serum potassium level of 5.9 mEq/L. What is the nurse's primary intervention?

a. To administer atropine
b. To administer digoxin immune FAB
c. To administer epinephrine
d. To administer Kayexalate
c. Monitor blood pressure continuously.
A client is to begin treatment for short-term management of heart failure with milrinone lactate (Primacor). What is the priority nursing action?

a. Administer digoxin via IV infusion with the Primacor.
b. Administer Lasix (furosemide) via IV infusion after the Primacor.
c. Monitor blood pressure continuously.
d. Maintain an infusion of lactated Ringers with Primacor infusion.
c. Continue to monitor the client.
A client's recently drawn serum lidocaine drug level is 3.0 mcg/mL. What is the nurse's priority intervention?

a. Increase the lidocaine infusion.
b. Decrease the lidocaine infusion.
c. Continue to monitor the client.
d. Stop the IV drip for 1 hour.
c. Rapid IV bolus of Adenosine (Adenocard)
A client is admitted to the emergency department with paroxysmal supraventricular tachycardia. What intervention is the nurse's priority?

a. Administration of digoxin IV push
b. Administration of oxygen, 2 lpm
c. Rapid IV bolus of Adenosine (Adenocard)
d. Instructing client to "bear down"
c. ECG
A nurse is caring for a client who has been started on ibutilide (Corvert). Which assessment is a priority for this client?

a. Blood pressure measurement
b. BUN and creatinine
c. ECG
d. Lung sounds
b. Crackles in the lungs
Which assessment finding will alert the nurse to possible toxic effects of amiodarone?

a. Heart rate 100 beats per minute
b. Crackles in the lungs
c. Elevated blood urea nitrogen
d. Decreased hemoglobin
b. Continuous blood pressures
d. Presence of chest pain
What must the nurse monitor when titrating intravenous nitroglycerin for a client? (Select all that apply.)

a. Continuous oxygen saturation
b. Continuous blood pressures
c. Hourly ECGs
d. Presence of chest pain
e. Serum nitroglycerin levels
f. Visual acuity
b. Hypokalemia
A client is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. What type of electrolyte imbalance does the nurse expect to occur?

a. Hypocalcemia
b. Hypokalemia
c. Hyperkalemia
d. Hypermagnesemia
c. Hydrochlorothiazide
What would cause the same client's electrolyte imbalance?

a. High dose of digoxin
b. Digoxin taken daily
c. Hydrochlorothiazide
d. Low dose of hydrochlorothiaizde
d. Serum glucose (sugar)
A nurse teaching a client who has diabetes mellitus and is taking hydrochlorothiazide 50 mg/day. The teaching should include the importance of monitoring which levels?

a. Hemoglobin and hematocrit
b. Blood urea nitrogen (BUN)
c. Arterial blood gases
d. Serum glucose (sugar)
c. High-ceiling (loop) diuretic
A client has heart failure and is prescribed Lasix. The nurse is aware that furosemide (Lasix) is what kind of drug?

a. Thiazide diuretic
b. Osmotic diuretic
c. High-ceiling (loop) diuretic
d. Potassium-sparing diuretic
a. Hypokalemia
The nurse acknowledges that which condition could occur when taking furosemide?

a. Hypokalemia
b. Hyperkalemia
c. Hypoglycemia
d. Hypermagnesemia
b. To increase the serum potassium level
For the client taking a diuretic, a combination such as triamterene and hydrochlorothiazide may be prescribed. The nurse realizes that this combination is ordered for which purpose?

a. To decrease the serum potassium level
b. To increase the serum potassium level
c. To decrease the glucose level
d. To increase the glucose level
b. Hyperkalemia
The client has been receiving spironolactone (Aldactone) 50 mg/day for heart failure. The nurse should closely monitor the client for which condition?

a. Hypokalemia
b. Hyperkalemia
c. Hypoglycemia
d. Hypermagnesemia
a. Have the client lie down when taking a nitroglycerin sublingual tablet.
b. Teach client to repeat taking a tablet in 5 minutes if chest pain persists.
e. Warn client against ingesting alcohol while taking nitroglycerin.
A client who has angina is prescribed nitroglycerin. The nurse reviews which appropriate nursing interventions for nitroglycerin (Select all that apply.)

a. Have the client lie down when taking a nitroglycerin sublingual tablet.
b. Teach client to repeat taking a tablet in 5 minutes if chest pain persists.
c. Apply Transderm-Nitro patch to a hairy area to protect skin from burning.
d. Call the health care provider after taking 5 tablets if chest pain persists.
e. Warn client against ingesting alcohol while taking nitroglycerin.
b. Fasting blood glucose level of 140 mg/dL
Which laboratory value will the nurse report to the health care provider as a potential adverse response to hydrochlorothiazide (HydroDIURIL)?

a. Sodium level of 140 mEq/L
b. Fasting blood glucose level of 140 mg/dL
c. Calcium level of 9 mg/dL
d. Chloride level of 100 mEq/L
b. "This combination promotes diuresis but decreases the risk of hypokalemia."
What is the best information for the nurse to provide to the client who is receiving spironolactone (Aldactone) and furosemide (Lasix) therapy?

a. "Moderate doses of two different diuretics are more effective than a large dose of one."
b. "This combination promotes diuresis but decreases the risk of hypokalemia."
c. "This combination prevents dehydration and hypovolemia."
d. "Using two drugs increases the osmolality of plasma and the glomerular filtration rate."
c. Administer 2 mEq potassium chloride per kilogram per day IV.
The nurse is assessing a client who is taking furosemide (Lasix). The client's potassium level is 3.4 mEq/L, chloride is 90 mmol/L, and sodium is 140 mEq/L. What is the nurse's primary intervention?

a. Mix 40 mEq of potassium in 250 mL D5W and infuse rapidly.
b. Administer Kayexalate.
c. Administer 2 mEq potassium chloride per kilogram per day IV.
d. Administer PhosLo, two tablets three times per day.
c. The fact that Lasix has shown efficacy in treating persons with renal insufficiency.
A nurse admits a client diagnosed with pneumonia. The client has a history of chronic renal insufficiency, and the health care provider orders furosemide (Lasix) 40 mg twice a day. What is most important to include in the teaching plan for this client?

a. That the medication will have to be monitored very carefully owing to the client's diagnosis of pneumonia.
b. The fact that Lasix has been proven to decrease symptoms with pneumonia.
c. The fact that Lasix has shown efficacy in treating persons with renal insufficiency.
d. That the medication will need to be given at a higher than normal dose owing to the client's medical problems.
c. Fish
A client taking spironolactone (Aldactone) has been taught about the therapy. Which menu selection indicates that the client understands teaching related to this medication?

a. Apricots
b. Bananas
c. Fish
d. Strawberries
c. A 47-year-old client with anuria
Which client would the nurse need to assess first if the client is receiving mannitol (Osmitrol)?

a. A 67-year-old client with type 1 diabetes mellitus
b. A 21-year-old client with a head injury
c. A 47-year-old client with anuria
d. A 55-year-old client receiving cisplatin to treat ovarian cancer
c. A decrease in arterial pH
A nurse is caring for a client receiving acetazolamide (Diamox). Which assessment finding will require immediate nursing intervention?

a. A decrease in bicarbonate level
b. An increase in urinary output
c. A decrease in arterial pH
d. An increase in PaO2
b. Assess lung sounds before and after administration.
c. Assess blood pressure before and after administration.
d. Maintain accurate intake and output record.
A client is ordered furosemide (Lasix) to be given via intravenous push. What interventions should the nurse perform? (Select all that apply.)

a. Administer at a rate no faster than 20 mg/min.
b. Assess lung sounds before and after administration.
c. Assess blood pressure before and after administration.
d. Maintain accurate intake and output record.
e. Monitor ECG continuously.
f. Insert an arterial line for continuous blood pressure monitoring.
d. "Wear protective clothing and sunscreen while on this medication."
A client is prescribed Thalitone (chlorthalidone). What is the most important information the nurse should teach the client?

a. "Do not drink more than 10 ounces of fluid a day while on this medication."
b. "Take this medication on an empty stomach."
c. "Take this medication before bed each night."
d. "Wear protective clothing and sunscreen while on this medication."
c. Decreased aldosterone
A client with hyperaldosteronism is prescribed spironolactone (Aldactone). What assessment finding would the nurse evaluate as a positive outcome?

a. Decreased potassium level
b. Decreased crackles in the lung bases
c. Decreased aldosterone
d. Decreased ankle edema
c. Lungs clear.
A client with acute pulmonary edema receives furosemide (Lasix). What assessment finding indicates that the intervention is working?

a. Potassium level decreased from 4.5 to 3.5 mEq/L.
b. Crackles auscultated in the bases.
c. Lungs clear.
d. Output 30 mL/hr.
a. Decreased intracranial pressure
Which assessment indicates a therapeutic effect of mannitol (Osmitrol)?

a. Decreased intracranial pressure
b. Decreased potassium
c. Increased urine osmolality
d. Decreased serum osmolality
c. Assess potassium levels.
Which intervention will the nurse perform when monitoring a client receiving triamterene (Dyrenium)?

a. Assess urinary output hourly.
b. Monitor for side effect of hypoglycemia.
c. Assess potassium levels.
d. Monitor for Hypernatremia.
a. It causes an alkaline urine, which facilitates the elimination of uric acid.
The client asks the nurse why the health care provider prescribed acetazolamide (Diamox), a diuretic, to treat gout. What is the nurse's best response?

a. It causes an alkaline urine, which facilitates the elimination of uric acid.
b. It increases alkalinity of urine, thus decreasing the formation of uric acid.
c. It causes an acid urine, which facilitates the elimination of uric acid.
d. It decreases alkalinity of urine, thus decreasing the formation of uric acid.
c. Stage 1 hypertension
A client's blood pressure (BP) is 145/90. According to the guidelines for determining hypertension, the nurse realizes that the client's BP is at which stage?

a. Normal
b. Prehypertension
c. Stage 1 hypertension
d. Stage 2 hypertension
a. Diuretic
The nurse acknowledges that the first-line drug for treating this client's blood pressure might be which drug?

a. Diuretic
b. Alpha blocker
c. ACE inhibitor
d. Alpha/beta blocker
c. Beta blockers and ACE inhibitors
The nurse is aware that which group(s) of antihypertensive drugs are less effective in African-American clients?

a. Diuretics
b. Calcium channel blockers and vasodilators
c. Beta blockers and ACE inhibitors
d. Alpha blockers
b. hydrochlorothiazide
The nurse knows that which diuretic is most frequently combined with an antihypertensive drug?

a. chlorthalidone
b. hydrochlorothiazide
c. bendroflumethiazide
d. potassium-sparing diuretic
a. Beta1 blocker
The nurse explains that which beta blocker category is preferred for treating hypertension?

a. Beta1 blocker
b. Beta2 blocker
c. Beta1 and beta2 blockers
d. Beta2 and beta3 blockers
d. Constant, irritating cough
Captopril (Capoten) has been ordered for a client. The nurse teaches the client that ACE inhibitors have which common side effects?

a. Nausea and vomiting
b. Dizziness and headaches
c. Upset stomach
d. Constant, irritating cough
b. Blocking angiotensin II from AT1 receptors
A client is prescribed losartan (Cozaar). The nurse teaches the client that an angiotensin II receptor blocker (ARB) acts by doing what?

a. Inhibiting angiotensin-converting enzyme
b. Blocking angiotensin II from AT1 receptors
c. Preventing the release of angiotensin I
d. Promoting the release of aldosterone
b. Dizziness
c. Headache
e. Ankle edema
During an admission assessment, the client states that she takes amlodipine (Norvasc). The nurse wishes to determine whether or not the client has any common side effects of a calcium channel blocker. The nurse asks the client if she has which signs and symptoms? (Select all that apply.)

a. Insomnia
b. Dizziness
c. Headache
d. Angioedema
e. Ankle edema
f. Hacking cough
a. "I will check my blood pressure daily and take my medication when it is over 140/90."
Which statement indicates that the client needs additional instruction about antihypertensive treatment?

a. "I will check my blood pressure daily and take my medication when it is over 140/90."
b. "I will include rest periods during the day to help me tolerate the fatigue my medicine may cause."
c. "I will change my position slowly to prevent feeling dizzy."
d. "I will not mow my lawn until I see how this medication makes me feel."
a. Call the health care provider to switch the medication.
A nurse is caring for a client who is taking an angiotensin-converting enzyme inhibitor and develops a dry, nonproductive cough. What is the nurse's priority action?

a. Call the health care provider to switch the medication.
b. Assess the client for other symptoms of upper respiratory infection.
c. Instruct the client to take antitussive medication until the symptoms subside.
d. Tell the client that the cough will subside in a few days.
d. spironolactone (Aldactone)
The nurse is reviewing a medication history on a client taking an ACE inhibitor. The nurse plans to contact the health care provider if the client is also taking which medication?

a. docusate sodium (Colace)
b. furosemide (Lasix)
c. morphine sulfate
d. spironolactone (Aldactone)
b. Respiratory assessment
A client is prescribed a noncardioselective beta1 blocker. What nursing intervention is a priority for this client?

a. Assessment of blood glucose levels
b. Respiratory assessment
c. Orthostatic blood pressure assessment
d. Teaching about potential tachycardia
c. The client who has stopped taking a beta blocker due to cost.
Which client will the nurse assess first?

a. The client who has been on beta blockers for 1 day.
b. The client who is on a beta blocker and a thiazide diuretic.
c. The client who has stopped taking a beta blocker due to cost.
d. The client who is taking a beta blocker and Lasix (furosemide).
d. Get up slowly from a sitting to a standing position.
The nurse is caring for a client with hypertension who is prescribed Clonidine transdermal preparation. What is the correct information to teach this client?

a. Change the patch daily at the same time.
b. Remove the patch before taking a shower or bath.
c. Do not take other antihypertensive medications while on this patch.
d. Get up slowly from a sitting to a standing position.
b. Notify the health care provider.
The client taking Methyldopa (Aldomet) has elevated liver function tests. What is the nurse's best action?

a. Document the finding and continue care.
b. Notify the health care provider.
c. Immediately stop the medication.
d. Change the client's diet.
c. Determine the client's history.
A client taking prazosin has a blood pressure of 140/90. The client is complaining of swollen feet. What is the nurse's best action?

a. Hold the medication.
b. Call the health care provider.
c. Determine the client's history.
d. Weigh the client.
c. Hypotension
A calcium channel blocker has been ordered for a client. Which condition in the client's history is a contraindication to this medication?

a. Hypokalemia
b. Dysrhythmias
c. Hypotension
d. Increased intracranial pressure
b. "Increasing fluid and fiber in your diet can help prevent the side effect of constipation."
A client who takes clonidine (Catapres) is to be discharged to home. Which instruction will the nurse include when teaching this client?

a. "Your blood pressure should be checked by a health care provider at least once a year."
b. "Increasing fluid and fiber in your diet can help prevent the side effect of constipation."
c. "Intense exercise or prolonged standing is not a problem with clonidine as it can be with other antihypertensive agents."
d. "If you are having difficulty with the common side effect of drooling, notify your health care provider so your dosage can be adjusted."
c. To administer phentolamine (Regitine)
During assessment of a client diagnosed with pheochromocytoma, the nurse auscultates a blood pressure of 210/110 mm Hg. What is the nurse's best action?

a. To ask the client to lie down and rest
b. To assess the client?s dietary intake of sodium and fluid
c. To administer phentolamine (Regitine)
d. To administer nitroprusside (Nipride)
a. Alteration in cardiac output related to effects on the sympathetic nervous system
Which is a priority nursing diagnosis for a client taking an antihypertensive medication?

a. Alteration in cardiac output related to effects on the sympathetic nervous system
b. Knowledge deficit related to medication regimen
c. Fatigue related to side effects of medication
d. Alteration in comfort related to nonproductive cough
a. Coronary thrombosis
b. Acute myocardial infarction
c. Deep vein thrombosis (DVT)
d. Cerebrovascular accident (CVA) (stroke)
e. Venous disorders
When a newly admitted client is placed on heparin, the nurse acknowledges that heparin is effective for preventing new clot formation in clients who have which disorder(s)? (Select all that apply.)

a. Coronary thrombosis
b. Acute myocardial infarction
c. Deep vein thrombosis (DVT)
d. Cerebrovascular accident (CVA) (stroke)
e. Venous disorders
a. protamine sulfate
A client who received heparin begins to bleed, and the physician calls for the antidote. The nurse knows that which is the antidote for heparin?

a. protamine sulfate
b. vitamin K
c. aminocaproic acid
d. vitamin C
a. A longer half-life than heparin
A client is prescribed enoxaparin (Lovenox). The nurse knows that low-molecular-weight heparin (LMWH) has what kind of half-life?

a. A longer half-life than heparin
b. A shorter half-life than heparin
c. The same half-life as heparin
d. A four-times shorter half-life than heparin
c. Bleeding may increase when taken with aspirin.
The nurse is teaching a client about clopidogrel (Plavix). What is important information to include?

a. Constipation may occur.
b. Hypotension may occur.
c. Bleeding may increase when taken with aspirin.
d. Normal dose is 25 mg tablet per day.
d. Subcutaneously
A client is prescribed dalteparin (Fragmin). LMWH is administered via which route?

a. Intravenously
b. Intramuscularly
c. Intradermally
d. Subcutaneously
b. warfarin (Coumadin)
A client is being changed from an injectable anticoagulant to an oral anticoagulant. Which anticoagulant does the nurse realize is administered orally?

a. enoxaparin sodium (Lovenox)
b. warfarin (Coumadin)
c. bivalirudin (Angiomax)
d. lepirudin (Refludan)
b. Elevated INR range
A client is taking warfarin 5 mg/day for atrial fibrillation. The client's international normalized ration (INR) is 3.8. The nurse would consider the INR to be what?

a. Within normal range
b. Elevated INR range
c. Low INR range
d. Low average INR range
d. To suppress platelet aggregation
Cilostazol (Pletal) is being prescribed for a client with coronary artery disease. The nurse knows that which is the major purpose for antiplatelet drug therapy?

a. To dissolve the blood clot
b. To decrease tissue necrosis
c. To inhibit hepatic synthesis of vitamin K
d. To suppress platelet aggregation
b. abciximab (ReoPro)
A client is to undergo a coronary angioplasty. The nurse acknowledges that which drug is used primarily for preventing reocclusion of coronary arteries following a coronary angioplasty?

a. clopidogrel (Plavix)
b. abciximab (ReoPro)
c. warfarin (Coumadin)
d. streptokinase
c. Thrombolytic agent
A client is admitted to the emergency department with an acute myocardial infarction. Which drug category does the nurse expect to be given to the client early for the prevention of tissue necrosis following blood clot blockage in a coronary or cerebral artery?

a. Anticoagulant agent
b. Antiplatelet agent
c. Thrombolytic agent
d. Low-molecular-weight heparin (LMWH)
b. Activated partial thromboplastin time (aPTT) of 120 seconds
A client is receiving an intravenous heparin drip. Which laboratory value will require immediate action by the nurse?

a. Platelet count of 150,000
b. Activated partial thromboplastin time (aPTT) of 120 seconds
c. INR of 1.0
d. Blood urea nitrogen (BUN) level of 12 mg/dL
b. Administer vitamin K.
A client who has been taking warfarin (Coumadin) is admitted with coffee-ground emesis. What is the nurse's primary action?

a. Administer vitamin E.
b. Administer vitamin K.
c. Administer protamine sulfate.
d. Administer calcium gluconate.
a. Administer an additional dose of warfarin (Coumadin).
The client has an international normalized ratio (INR) value of 1.5. What action will the nurse take?

a. Administer an additional dose of warfarin (Coumadin).
b. Hold the next dose of warfarin (Coumadin).
c. Increase the heparin drip rate.
d. Administer protamine sulfate.
c. "I will increase dark-green, leafy vegetables in my diet."
A client is receiving warfarin (Coumadin) for a chronic condition. Which client statement requires immediate action by the nurse?

a. "I will avoid contact sports."
b. "I will take my medication in the early evening each day."
c. "I will increase dark-green, leafy vegetables in my diet."
d. "I will contact my health care provider if I develop excessive bruising."
a. "I take aspirin daily for headaches."
A client is taking enoxaparin (Lovenox) daily. Which client statement requires additional monitoring?

a. "I take aspirin daily for headaches."
b. "I take ibuprofen (Motrin) at least once a week for joint pain."
c. "Whenever I have a fever, I take acetaminophen (Tylenol)."
d. "I take my medicine first thing in the morning."
b. Weigh the client before administration.
The client is receiving tirofiban (Aggrastat). What is an essential nursing intervention for this client?

a. Have protamine sulfate available in case of an overdose.
b. Weigh the client before administration.
c. Have vitamin K available in case of an overdose.
d. Assess intake and output.
c. Administer the medication into subcutaneous tissue.
A nurse is preparing to administer enoxaparin sodium (Lovenox) to a client for prevention of deep vein thrombosis. What is an essential nursing intervention?

a. Draw up the medication in a syringe with a 22-gauge, 1-½ inch needle.
b. Utilize the Z-track method to inject the medication.
c. Administer the medication into subcutaneous tissue.
d. Rub the administration site after injecting.
b. "Dalteparin is a low-molecular-weight heparin that is more predictable in its effect and has a lower risk of bleeding."
The client asks what the difference is between dalteparin (Fragmin) and heparin. What is the nurse's best response?

a. "There is no real difference. Dalteparin is preferred because it is less expensive."
b. "Dalteparin is a low-molecular-weight heparin that is more predictable in its effect and has a lower risk of bleeding."
c. "I'm not sure why some health care providers choose dalteparin and some heparin. You should ask your doctor."
d. "The only difference is that heparin dosing is based on the client's weight."
b. Administer protamine sulfate.
A client has been admitted through the emergency department and requires emergency surgery. The client has been receiving heparin. What nursing intervention is essential?

a. Teach the client about the phenytoin.
b. Administer protamine sulfate.
c. Assess the INR before surgery.
d. Administer vitamin K.
a. Assess for reperfusion dysrhythmias.
What nursing intervention is essential for the client receiving alteplase?

a. Assess for reperfusion dysrhythmias.
b. Monitor liver enzymes.
c. Administer vitamin K if bruising is observed.
d. Monitor blood pressure and stop the medication if blood pressure drops below 110 systolic.
b. Teach the client of potential drug interactions with anticoagulants.
A client who is taking warfarin (Coumadin) requests an aspirin for headache relief. What is the nurse's best response?

a. Administer 650 mg of acetylsalicylic acid (ASA) and reassess pain in 30 minutes.
b. Teach the client of potential drug interactions with anticoagulants.
c. Explain to the client that ASA is contraindicated and administer ibuprofen as ordered.
d. Explain that the headache is an expected side effect and will subside shortly.
b. "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic."
A client is started on warfarin (Coumadin) therapy while still receiving intravenous heparin. The client questions the nurse about the risk for bleeding. How should the nurse respond?

a. "Your concern is valid. I will call the doctor to discontinue the heparin."
b. "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic."
c. "Because of your valve replacement, it is especially important for you to be anticoagulated. The heparin and warfarin together are more effective than one alone."
d. "Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications."
d. "I should use a soft toothbrush for dental hygiene."
The nurse evaluates that the client understood discharge teaching regarding warfarin (Coumadin) based on which statement?

a. "I will double my dose if I forget to take it the day before."
b. "I should keep taking ibuprofen for my arthritis."
c. "I should decrease the dose if I start bruising easily."
d. "I should use a soft toothbrush for dental hygiene."
a. Perform all necessary venipunctures.
What intervention is essential before the nurse administers tenecteplase (TNKase)?

a. Perform all necessary venipunctures.
b. Administer aminocaproic acid (Amicar).
c. Have the client void.
d. Assess for allergies to iodine.
c. Risk for injury
Which nursing diagnosis would be possible for a client receiving intravenous heparin therapy?

a. Potential for fluid volume excess
b. Potential for pain
c. Risk for injury
d. Potential for body image disturbance
c. Hyperlipidemia
A client has a serum cholesterol level of 265 mg/dL, triglyceride level of 235 mg/dL, and LDL of 180 mg/dL. What do these serum levels indicate?

a. Hypolipidemia
b. Normolipidemia
c. Hyperlipidemia
d. Alipidemia
a. 150 to 200 mg/dL
The nurse knows that the client's cholesterol level should be within which range?

a. 150 to 200 mg/dL
b. 200 to 225 mg/dL
c. 225 to 250 mg/dL
d. Greater than 250 mg/dL
b. It is the desired level of HDL.
A client's high-density lipoprotein (HDL) is 60 mg/dL. What does the nurse acknowledge concerning this level?

a. It is lower than the desired level of HDL.
b. It is the desired level of HDL.
c. It is higher than the desired level of HDL.
d. It is a much lower HDL level than desired.
b. homocysteine
The nurse realizes that which is the laboratory test ordered to determine the presence of the amino acid that can contribute to cardiovascular disease and stroke?

a. antidiuretic hormone
b. homocysteine
c. ceruloplasmin
d. cryoglobulin
d. Liver enzymes
A client is taking lovastatin (Mevacor). Which serum level is most important for the nurse to monitor?

a. Blood urea nitrogen
b. Complete blood count
c. Cardiac enzymes
d. Liver enzymes
b. Rhabdomyolysis
The client is taking rosuvastatin (Crestor). What severe skeletal muscle adverse reaction should the nurse observe for?

a. Myasthenia gravis
b. Rhabdomyolysis
c. Dyskinesia
d. Agranulocytosis
a. Inhibits absorption of dietary cholesterol in the intestines.
When a client is taking ezetimibe (Zetia), she asks the nurse how it works. The nurse should explain that Zetia does what?

a. Inhibits absorption of dietary cholesterol in the intestines.
b. Binds with bile acids in the intestines to reduce LDL levels.
c. Inhibits HMG-CoA reductase, which is necessary for cholesterol production in the liver.
d. Forms insoluble complexes and reduces circulating cholesterol in blood.
a. Relaxes the arterial walls within the skeletal muscles
b. May cause hypotension, chest pain, and palpitations
A client is diagnosed with peripheral arterial disease (PAD). He is prescribed isoxsuprine (Vasodilan). The nurse acknowledges that isoxsuprine does what? (Select all that apply.)

a. Relaxes the arterial walls within the skeletal muscles
b. May cause hypotension, chest pain, and palpitations
c. Increases the rigidity of arteriosclerotic blood vessels
d. May increase intermittent claudication
e. May lead to hypertension and bradycardia
f. Commonly causes an adverse effect of rhabdomyolysis
b. "I will increase fiber in my diet."
Which statement indicates the client understands discharge instructions regarding cholestyramine (Questran)?

a. "I will take Questran 1 hour before my other medications."
b. "I will increase fiber in my diet."
c. "I will weigh myself weekly."
d. "I will have my blood pressure checked weekly."
b. Administer aspirin 30 minutes before nicotinic acid.
The nurse plans which intervention to decrease the flushing reaction of niacin?

a. Administer niacin with an antacid.
b. Administer aspirin 30 minutes before nicotinic acid.
c. Administer diphenhydramine hydrochloride (Benadryl) with niacin.
d. Apply cold compresses to the head and neck.
b. "Take this medication at the same time each day."
The nurse is reviewing instructions for a client taking an HMG-CoA reductase inhibitor (statin). What information is essential for the nurse to include?

a. "Take this medication on an empty stomach."
b. "Take this medication at the same time each day."
c. "Take this medication with breakfast."
d. "Take this medication with an antacid."
b. "You may experience headaches with this medication."
A client is prescribed gemfibrozil (Lopid) for treatment of hyperlipidemia type IV. What is important for the nurse to teach the client?

a. "Take aspirin before the medication if you experience facial flushing."
b. "You may experience headaches with this medication."
c. "You will need to have weekly blood drawn to assess for hyperkalemia."
d. "Cholesterol levels will need to be assessed daily for one week."
d. "I will continue my exercise program to help increase my high-density lipoprotein serum levels."
Which statement made by the client indicates understanding about discharge instructions on antihyperlipidemic medications?

a. "Antihyperlipidemic medications will replace the other interventions I have been doing to try to decrease my cholesterol."
b. "It is important to double my dose if I miss one in order to maintain therapeutic blood levels."
c. "I will stop taking the medication if it causes nausea and vomiting."
d. "I will continue my exercise program to help increase my high-density lipoprotein serum levels."
c. Muscle pain.
A client is prescribed ezetimibe (Zetia). Which assessment finding will require immediate action by the nurse?

a. Headache.
b. Slight nausea.
c. Muscle pain.
d. Fatigue.
c. Have the client increase fluids and fiber in his diet.
A nurse is caring for a client taking cholestyramine (Questran). The client is complaining of constipation. What will the nurse do?

a. Call the health care provider to change the medication.
b. Tell the client to skip a dose of the medication.
c. Have the client increase fluids and fiber in his diet.
d. Administer an enema to the client.
d. "I should stir the powder in as small an amount of fluid as possible to maintain potency of the medication."
Which statement indicates to the nurse that the client needs further medication instruction about colestipol (Colestid)?

a. "The medication may cause constipation, so I will increase fluid and fiber in my diet."
b. "I should take this medication 1 hour after or 4 hours before my other medications."
c. "I might need to take fat-soluble vitamins to supplement my diet."
d. "I should stir the powder in as small an amount of fluid as possible to maintain potency of the medication."
b. Elevated liver function tests
Which assessment finding in a client taking an HMG-CoA reductase inhibitor will the nurse act on immediately?

a. Decreased hemoglobin
b. Elevated liver function tests
c. Elevated HDL
d. Elevated LDL
b. "These factors may put you at higher risk for myopathy."
A 70-year-old client who is taking several cardiac antidysrhythmic medications has been prescribed simvastatin (Zocor) 80 mg/day. What is essential information for the nurse to teach the client?

a. "This dose may lower your cholesterol too much."
b. "These factors may put you at higher risk for myopathy."
c. "You should not take this drug with cardiac medications."
d. "This combination will cause you to have nausea and vomiting."
b. Hepatic disease
A client diagnosed with hypercholesterolemia is prescribed lovastatin (Mevacor). The nurse is reviewing the client's history and would contact the health care provider about which of these conditions in the client's history?

a. Chronic pulmonary disease
b. Hepatic disease
c. Leukemia
d. Renal disease
c. gemfibrozil (Lopid)
A nurse is caring for a client with elevated triglyceride levels who is unresponsive to HMG-CoA reductase inhibitors. What medication will the nurse administer?

a. cholestyramine (Questran)
b. colestipol (Colestid)
c. gemfibrozil (Lopid)
d. simvastatin (Zocor)
a. Impaction
The nurse would question an order for cholestyramine (Questran) if the client has which condition?

a. Impaction
b. Glaucoma
c. Hepatic disease
d. Renal disease
c. Client is on oral contraceptives.
The nurse reviews the history for a client taking atorvastatin (Lipitor). What will the nurse act on immediately?

a. Client takes medications with grape juice.
b. Client takes herbal therapy including kava kava.
c. Client is on oral contraceptives.
d. Client was started on penicillin for a respiratory infection.
Erythropoietin regulates the process of red blood cell formation. The nurse understands that this mechanism is activated by a reduction of oxygen reaching the:
Kidneys.
A client with a diagnosis of cancer is receiving epoetin alfa (Epogen, Procrit) as part of the treatment regimen. The nurse evaluates the effectiveness of this drug by:
Monitoring the hematocrit and hemoglobin levels.
The nursing care plan for a client receiving epoetin alfa (Epogen, Procrit) should include careful monitoring for symptoms of:
Angina, or a change in level of consciousness.
The nurse administers filgrastim (Neupogen) to the client. The nurse explains that this drug is used in the treatment of:
Neutropenia, or neutropenia secondary to chemotherapy.
The client receiving filgrastim (Neupogen) should be monitored for common adverse effects, which include:
Hypertension and skeletal pain.
Prior to the administration of sargramostim (Leukine), the nurse should assess:
CBC.
The client receiving chemotherapy is prescribed oprelvekin (Neumega) as part of the treatment regimen. The nurse explains that the function of this drug is to:
Stimulate platelet production.
The nurse teaches the client and caregivers to immediately report to the health care provider which of the following symptoms of adverse reaction to oprelvekin (Neumega)?
Cough; difficulty breathing
The nurse explains to the client that the development of pernicious anemia is caused by:
Blood Loss
The nurse prepares nutritional teaching for a group of clients. The nurse recognizes that the client most at risk for ____________ anemia is the client diagnosed with Insufficient Dietary Intake.
Folate-deficiency
The client experiences shock following a spinal cord injury. This type of shock is classified as:
Neurogenic.
The client in shock is prescribed an infusion of lactated Ringer's solution. The nurse recognizes that the function of this fluid in the treatment of shock is to:
Replace fluid, and promote urine output.
Nursing assessment of a client receiving serum albumin for treatment of shock should include:
Assessing lung sounds.
Teaching for a client receiving plasma protein fraction (Plasmanate) should include reporting which of the following possible adverse reactions?
Anaphylactic reaction
The nurse should closely monitor the client receiving Dextran 70 (Macrodex) for:
Bleeding
Which of the following requires intervention by the nurse caring for a client receiving Phenylephrine (Neosynephrine)?
Decreased urinary output
Dobutamine (Dobutrex) is used to treat a client experiencing cardiogenic shock. Nursing intervention includes:
Monitoring for cardiac dysrhythmias.
The nurse weighs the client receiving dobutamine (Dobutrex) therapy daily. The rationale for this is to:
Determine drug dosage.
. The client care plan of a client receiving dopamine should include having phentolamine (Regitine) available for use. The purpose of this drug is to:
Prevent necrosis if the IV extravasates.
. The nurse evaluates the effectiveness of client education as it relates to anaphylaxis therapy. Which of the following might indicate that teaching was successful? (Select all that apply.)
"I will carry an EpiPen to administer when I experience a hypersensitivity episode to peanuts."
"I will seek emergency medical attention immediately if a single auto-injection of epinephrine fails to bring relief."
An elderly patient diagnosed with iron-deficency anemia will be taking ferrous sulfate (feosol, others) orally. the nurse will teach required administration guidlines to the patient including (select all that apply)
Take the tablets on an empty stomach if possible
increase fluid intake and increase dietary fiber while taking this medication
if liquid prepartions are used, dilute with water or juice and sip through a straw placed in back of the mouth.
To best monitor for therapeutic effects from filgrastim (Neupogen) should include:
Frequent observations for infection
The patient in hypovolemic shock is prescribed an infusion of lactated Ringers's The nurse recognizes the function of this fluid in the treatment of shock is to (select all that apply)
Replace fluid and promote urine output
Draw water into cells
Maintain vascular volume
The nurse evaluates the effectiveness of dapamine therapy for a patient in shock. Which of the following may indicate the treatment is successful (select all that apply)
Improved urine output and Increased blood pressure
A patient is recieving a cyrstalloid infusion (lactated ringer;s) for treatement of hypovolemic shock . Because of concerns for fluid volume overload, the nurse will frequently monitor (select all that apply)
Breath sounds, daily weight, level of consciousness.
Your patient has been switched from valproic acid (Depakote) to gabepentin (Neurontin). Which of the following is a false statement?

a. Gabapentin (Neurontin) is also used for bipolar disorder therapy
b. Gabapentin (Neurontin) requires more frequent hepatic monitoring
c. Gabapentin (Neurontin) is also used for migraine therapy
d. Gabapentin (Neurontin) should not be given concurrently with antacids containing magnesium
b. Gabapentin (Neurontin) requires more frequent hepatic monitoring
In the administration of a drug such as levothyroxine (Synthroid), the nurse should teach the client:

A) That therapy typically lasts about 6 months.
B) That weekly laboratory tests for T4 levels will be required.
C) To report weight loss, anxiety, insomnia, and palpitations.
D) That the drug may be taken every other day if diarrhea occurs.
C) To report weight loss, anxiety, insomnia, and palpitations.
A patient with hyperthyroidism is taking propylthiouracil (PTU). The nurse will monitor the patient for:

A) gingival hyperplasia and lycopenemia.
B) dyspnea and a dry cough.
C) blurred vision and nystagmus.
D) fever and sore throat.
D) fever and sore throat.
A type I diabetic patient comes to the clinic for a follow-up appointment. The patient is taking NPH insulin, 30 units every day. A nurse notes that the patient is also taking metoprolol (Lopressor). What education should the nurse provide to the patient?

A) "You need to increase your insulin to allow for the agonist effects of metoprolol."
B) "Metoprolol may potentiate the effects of the insulin, so the dose should be reduced."
C) "Metoprolol has no effects on diabetes mellitus or on your insulin requirements."
D) "Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely."
D) "Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely."
A physician has prescribed propylthiouracil (PTU) for a client with hyperthyroidism and the nurse develops a plan of care for the client. A priority nursing assessment to be included in the plan regarding this medication is to assess for:

a) relief of pain
b) signs of renal toxicity
c) signs and symptoms of hyperglycemia
d) signs and symptoms of hypothyroidism
d) signs and symptoms of hypothyroidism


Excessive dosing with propylthiouracil (PTU) may convert the client from a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. Temporary administration of thyroid hormone may be required. Propylthiouracil is not used for pain and does not cause hyperglycemia or renal toxicity.
A physician prescribes levothyroxine sodium (Synthroid), 0.15 mg orally daily, for a client with hypothyroidism. The nurse will prepare to administer this medication:

a) in the morning to prevent insomnia
b) only when the client complains of fatigue and cold intolerance
c) at various times during the day to prevent tolerance from occurring
d) three times daily in equal doses of 0.5 mg each to ensure consistent serum drug levels
a) in the morning to prevent insomnia


Levothyroxine (Synthroid) is a synthetic thyroid hormone that increases cellular metabolism. Levothyroxine should be given in the morning in a single dose to prevent insomnia and should be given at the same time each day to maintain an adequate drug level. Therefore, options B, C, and D are incorrect.
A nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which of the following, if exhibited in the client, would indicate hyperglycemia and warrant physician notification?

a) polyuria
b) diaphoresis
c) hypertension
d) increased pulse rate
a) polyuria

Classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia. Options B, C, and D are not signs of hyperglycemia.
Myxedema, which includes fatigue, general weakness, and muscle cramps, is a symptom of which endocrine disorder treated with levothyroxine (Synthroid)?

a. Hyperthyroidism
b. Hypothyroidism
c. Cushing's syndrome
d. Addison's disease
b. Hypothyroidism
Which disease is characterized by increased body metabolism, tachycardia, increased body temperature, and anxiety, and treated with Prophylthiouracil (PTU)?

a.) Hashimoto's thyroiditis
b.) Graves' disease
c.) Addison's disease
d.) Cushing's syndrome
b.) Graves' disease
In the administration of hydrocortisone (Aeroseb-HC, Alphadern, Cetacort), it is vital that the nurse recognize that this drug might mask which symptoms?

a.) Signs and symptoms of infection
b.) Signs and symptoms of heart failure
c.) Hearing loss
d.) Skin infections
a.) Signs and symptoms of infection
When hydrocortisone use is discontinued, the nurse must recognize the possibility of what side effect, if this drug is stopped abruptly?

a.) Development of myxedema
b.) Circulatory collapse
c.) Development of Cushing's syndrome
d.) Development of diabetes insipidus
b.) Circulatory collapse
A client who is taking levothyroxine (Synthroid) begins to develop weight loss, diarrhea, and intolerance. The nurse should be aware that this might be an indication of what hormonal condition?

a.) Addison's disease
b.) Hyperthyroidism
c.) Cushing's syndrome
d.) Development of acromegaly
b.) Hyperthyroidism
Which organ is destroyed when administering radioactive I-131?

a.) Pituitary gland
b.) Adrenals
c.) Parathyroid
d.) Hypothalamus
radioactive I-131 destroys the thyroid because the thyroid cells are the only cells in the body that can take up iodine
Of what precautions should a client receiving radioactive iodine-131 be made aware?

a.) Drink plenty of fluids, especially those high in calcium.

b.) Avoid close contact with children or pregnant women for one week after administration of drug.

c.) Be aware of the symptoms of tachycardia, increased metabolic rate, and anxiety.

d.) Wear a mask if around children or pregnant women.
b.) Avoid close contact with children or pregnant women for one week after administration of drug.
In the administration of a drug such as levothyroxine (Synthroid), the nurse must teach the client: (Select all that apply.)

a.) Therapy could take three weeks or longer.

b.) Periodic lab tests for T4 levels are required.

c.) Report weight loss, anxiety, insomnia, and palpitations.

d.) Jaundice
Therapy could take three weeks or longer.

Periodic lab tests for T4 levels are required.

Report weight loss, anxiety, insomnia, and palpitations.

A,B,C
21. The client scheduled for electroconvulsive therapy tells the nurse, "I'm so afraid. What will happen to me during the treatment?" Which of the following statements is most therapeutic for the nurse to make?

A. "You will be given medicine to relax you during the treatment."

B. "The treatment will produce a controlled grand mal seizure."

C.
The treatment might produce nausea and headache.

d. You can expect to be sleepy and confused for a time after the treatment.
A.

The patient will receive medication that relaxes skeletal muscles and produces mild sedation.
Which information should be given to the client taking phenytoin (Dilantin)?

A. Taking the medication with meals will increase its effectiveness.

B. The medication can cause sleep disturbances

C. More frequent dental appointments will be needed for special gum care.

D. The medication decreases the effects of oral contra- ceptives.
C. More frequent dental appointments will be needed for special gum care.

Gingival hyperplasia is a side effect of phenytoin. The client will need more frequent dental visits.

Answers A, B, and D do not apply to the medication; therefore, they are incorrect.
36. The nurse is teaching the client with insulin-dependent diabetes the signs of hypoglycemia. Which of the following signs is associ- ated with hypoglycemia?

A. Tremulousness
B. Slow pulse
C. Nausea
D. Flushed skin
Answer A is correct.

Tremulousness (a state of trembling or quivering) is an early sign of hypoglycemia.

Answers B,C, and D are incorrect because they are symptoms of hyperglycemia.
A patient taking Dilantin (phenytoin) for a seizure disorder is experiencing breakthrough seizures. A blood sample is taken to determine the serum drug level. Which of the following would indicate a sub-therapeutic level?

A. 15 mcg/mL.
B. 4 mcg/mL.
C. 10 mcg/dL.
D. 5 mcg/dL.
B. 4 mcg/mL.

The therapeutic serum level for Dilantin is 10 - 20 mcg/mL. A level of 4 mcg/mL is sub-therapeutic and may be caused by patient non-compliance or increased metabolism of the drug. A leve of 15 mcg/mL is therapeutic. Choices C and D are expressed in mcg/dL, which is the incorrect unit of measurement.
A patient arrives at the emergency department complaining of back pain. He reports taking at least 3 acetaminophen tablets every three hours for the past week without relief. Which of the following symptoms suggests acetaminophen toxicity?

A. Tinnitus.
B. Diarrhea.
C. Hypertension.
D. Hepatic damage.
Answer: D

Acetaminophen in even modestly large doses can cause serious liver damage that may result in death. Immediate evaluation of liver function is indicated with consideration of N-acetylcysteine administration as an antidote. Tinnitus is associated with ASPIRIN overdose, not acetaminophen. Diarrhea and hypertension are not associated with acetaminophen.
A nurse is caring for a cancer patient receiving subcutaneous morphine sulfate for pain. Which of the following nursing actions is most important in the care of this patient?

A. Monitor urine output.
B. Monitor respiratory rate.
C. Monitor heart rate.
D. Monitor temperature.
Answer: B

Morphine sulfate can suppress respiration and respiratory reflexes, such as cough. Patients should be monitored regularly for these effects to avoid respiratory compromise. Morphine sulfate does not significantly affect urine output, heart rate, or body temperature.
18. A nurse is administering blood to a patient who has a low hemoglobin count. The patient asks how long to RBC's last in my body? The correct response is.

A. The life span of RBC is 45 days.
B. The life span of RBC is 60 days.
C. The life span of RBC is 90 days.
D. The life span of RBC is 120 days.
D. The life span of RBC is 120 days.
A client has been newly diagnosed with hypothyroidism and will take levothyroxine (Synthroid) 50 mcg/day by mouth. As part of the teaching plan, the nurse emphasizes that this medication:

A) Should be taken in the morning
B) May decrease the client's energy level
C) Must be stored in a dark container
D) Will decrease the client's heart rate
A) Should be taken in the morning
Your patient is taking valproic acid (Depakote). Which of the following is a false statement?

a. Valproic acid requires hepatic monitoring
b. Valproic acid has the lowest seizure relapse rate when discontinued
c. Valproic acid is also used in migraine therapy
d. Valproic acid is also used in bipolar disorder therapy
b. Valproic acid has the lowest seizure relapse rate when discontinued
Your patient has been switched from valproic acid (Depakote) to gabepentin (Neurontin). Which of the following is a false statement?

a. Gabapentin (Neurontin) is also used for bipolar disorder therapy
b. Gabapentin (Neurontin) requires more frequent hepatic monitoring
c. Gabapentin (Neurontin) is also used for migraine therapy
d. Gabapentin (Neurontin) should not be given concurrently with antacids containing magnesium
b. Gabapentin (Neurontin) requires more frequent hepatic monitoring
Your patient has been stabilized taking only primidone (Mysoline). Which drug besides primidone may be assayed during his stay in the hospital to monitor his therapy?

a. pentobarbital
b. phenobarbital
c. valproic acid
d. phenytoin
b. phenobarbital
Fosphenytoin (Cerebyx)

a. is a controversial agent for depression
b. is used to control tremors due to Parkinsonism
c. can be administered intravenously
d. is ineffective after 5 days of therapy
c. can be administered intravenously
Antidote for warfarin overdose

a. protamine zinc insulin
b. protamine sulfate
c. vitamin K
d. warfarin
c. vitamin K
Antidote for heparin overdose
a. protamine sulfate
b. vitamin K
c. vitamin E
d. cyanocobolamine
a. protamine sulfate
Antiplatelet agents include all of the following except

a. acetylsalicylic acid
b. acetaminophen
c. ticlopidine (Ticlid)
d. dipyridamole (Persantine)
b. acetaminophen
A classic drug interaction, greatly involving an increased bleeding time, involves warfarin and

a. vitamin B-6
b. acetaminophen
c. acetylsalicylic acid
d. all of the above
c. acetylsalicylic acid
A young woman makes an appointment to see a physician at the clinic. She complains of tiredness, weight gain, muscle aches and pains, and constipation. The physician will likely order:

1. T3 and T4 serum level laboratory tests.
2. glucose tolerance test.
3. cerebral computed tomography (CT) scan.
4. adrenocortical stimulating test.
1. T3 and T4 serum level laboratory tests.

These complaints are strongly suggestive of thyroid disorder; T3 and T4 laboratory tests are the most useful diagnostic tests.
The patient asks about his lab test, which showed a high level of TSH and a low level of T4. You explain:

1. "It means that you have an inconsistency in your thyroid tests, and you will need more testing."
2. "I am sorry. You will have to ask your doctor about your lab results. We are not allowed to discuss them."
3. "The TSH is sending a message to your thyroid gland to increase production, but your thyroid isn't doing that."
4. "That means that you will have to go on hormone therapy for the rest of your life."
3. "The TSH is sending a message to your thyroid gland to increase production, but your thyroid isn't doing that."

The test determines if the problem is in the pituitary or in the thyroid. In this case the high TSH is coming from the pituitary as it should but the thyroid is not responding.
The nurse instructs the patient is scheduled to have a radioactive iodine uptake test to:

1. watch for any signs of bleeding or swelling from the biopsy site.
2. avoid contact with others until notified otherwise.
3. wash hands with soap and water after each urination for 24 hours after the test.
4. this test demonstrates the effectiveness of the pituitary gland on the thyroid gland.
3. wash hands with soap and water after each urination for 24 hours after the test.

Radiation dose is small and will not harm others.
The patient, newly diagnosed with hypothyroidism, seems very anxious to begin her drug regimen. The nurse's instructions include:

1. "Be certain that no dose is skipped."
2. "If a dose is skipped one day, double the dose the next day."
3. "Know the signs and symptoms of hyperthyroidism."
4. "You will be able to notice the benefits of thyroid replacement therapy right away."
3. "Know the signs and symptoms of hyperthyroidism."


Her enthusiasm may lead her to overdose on the thyroid replacement pills. She needs to be aware of the proper prescription and the reasons for following the prescribed dosage.
Mr. Jessie Ray, a newly admitted patient, has a seizure disorder which is being treated with medication. Which of the following drugs would the nurse question if ordered for him?

A. Phenobarbitol, 150 mg hs
B. Amitriptylene (Elavil), 10 mg QID.
C. Valproic acid (Depakote), 150 mg BID
D. Phenytoin (Dilantin), 100 mg TID
B.

Elavil is an antidepressant that lowers the seizure threshold, so would not be appropriate for this patient. The other medications are anti-seizure drugs.
11. A nurse is preparing the client's morning NPH insulin dose and notices a clumpy precipitate inside the insulin vial. The nurse should:

A. draw up and administer the dose
B. shake the vial in an attempt to disperse the clumps
C. draw the dose from a new vial
D. warm the bottle under running water to dissolve the clump
C.

The nurse should always inspect the vial of insulin before use for solution changes that may signify loss of potency. NPH insulin is normally uniformly cloudy. Clumping, frosting, and precipitates are signs of insulin damage. In this situation, because potency is questionable, it is safer to discard the vial and draw up the dose from a new vial.
A patient who has type 2 diabetes has a glycated hemoglobin (HbA1c) result of 10%. A nurse should make which of these changes to the nursing care plan?

A) Refer to a diabetic educator, there is poor glycemic control.
B) Glycemic control is adequate, no changes are needed.
C) Hypoglycemia is a risk, teach the patient the symptoms.
D) Instruct the patient to limit activity and weekly exercise.
A) Refer to a diabetic educator, there is poor glycemic control.
Which of these instructions should the nurse provide when teaching a patient to mix regular insulin and NPH insulin in the same syringe?

A) Draw up the clear regular insulin first, followed by the cloudy NPH insulin.
B) It is not necessary to rotate the NPH insulin vial when it is mixed with regular insulin.
C) The order of drawing up insulin does not matter as long as the insulin is refrigerated.
D) Rotate each day subcutaneous injection sites among the arm, thigh, and abdomen.
A) Draw up the clear regular insulin first, followed by the cloudy NPH insulin.

To ensure a consistent response, only NPH insulin is appropriate for mixing with a short-acting insulin. Unopened vials of insulin should be refrigerated; current vials can be kept at room temperature for up to 1 month. Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could alter the pharmacokinetics of subsequent doses taken out of the regular insulin vial. NPH insulin is a cloudy solution, and it should always be gently rotated to evenly disperse the particles before loading the syringe. Subcutaneous injections should be made using one region of the body (e.g., the abdomen or thigh) and rotated within that region for 1 month.
NPH INSULIN
intermediate acting insulin
A patient is scheduled to start taking insulin glargine (Lantus). On the care plan a nurse should include which of these outcomes related to the therapeutic effects of the medication?

A) Blood glucose control for 24 hours
B) Mealtime coverage of blood glucose
C) Less frequent blood glucose monitoring
D) Peak effect achieved in 2 to 4 hours
A) Blood glucose control for 24 hours


Insulin glargine is administered as a once-daily subcutaneous injection for patients who have type 1 diabetes. It is used for basal insulin coverage, not mealtime coverage. It has a prolonged duration up to 24 hours with no peaks. Blood glucose monitoring is still an essential component to achieve tight glycemic control.
At 5 PM a patient who is taking NPH insulin develops hunger, shakiness, and sweating. A nurse assesses the medication administration record (MAR) and should recognize that the patient's symptoms are related to an injection of NPH insulin at which of these times?

A) 2 AM
B) 8 AM
C) 1 PM
D) 3 PM
A) 2 AM

The patient is exhibiting symptoms of hypoglycemia at 5 PM. NPH has a peak action of 8 to 10 hours after administration. Based on the duration of action of NPH insulin, the patient's hypoglycemic symptoms are from the 8 AM injection of NPH insulin. An injection of NPH insulin at 2 AM, 1 PM, or 3 PM would not cause hypoglycemic symptoms based on the average duration of action from NPH insulin.
A teaching plan for a patient who is taking lispro (Humalog) should include which of these instructions by the nurse?

A) "Inject this insulin with your first bite of food because it is very fast acting."
B) "The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack."
C) "This insulin needs to be mixed with regular insulin to enhance the effects."
D) "To achieve tight glycemic control, this is the only type of insulin you'll need."
A) "Inject this insulin with your first bite of food because it is very fast acting."


Lispro is a rapid-acting insulin and has an onset of 15 to 30 minutes with a peak action of about 2 hours, not 8 to 10 hours. Because of its rapid onset, it is administered immediately before a meal or with meals to control blood glucose rise after meals. Lispro insulin must be combined with intermediate- or long-acting insulin not regular insulin, which is also a short-duration insulin, for glucose control between meals and at night. To achieve tight glycemic control, patients must combine different types of insulin based on duration of action.
A patient who is newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse explains that normal insulin has which of these actions in the body?

A) Stimulates the pancreas to reabsorb glucose
B) Promotes synthesis of amino acids into glucose
C) Stimulates the liver to convert glycogen to glucose
D) Promotes the passage of glucose into cells for energy
D) Promotes the passage of glucose into cells for energy

Insulin is a hormone that promotes the passage of glucose into cells, where it is metabolized for energy. Insulin does not stimulate the pancreas to reabsorb glucose or synthesize amino acids into glucose. It does not stimulate the liver to convert glycogen into glucose.
A patient is taking glipizide (Glucotrol) and a beta-adrenergic medication. A nurse is teaching hypoglycemia awareness and should tell the patient that which of these symptoms may not occur?

A) Vomiting
B) Muscle cramps
C) Tachycardia
D) Chills
C) Tachycardia

Glipizide is a sulfonylurea oral hypoglycemic medication that acts to promote insulin release from the pancreas. Beta-adrenergic blockers can mask early signs of sympathetic system responses (most importantly, tachycardia) to hypoglycemia, which is the most common adverse effect of glipizide. Vomiting, muscle cramps, and chills are not symptoms of activation of the sympathetic nervous system that arise when glucose levels fall.
A nurse assesses a patient who is taking pramlintide (Symlin) with mealtime insulin. Which of these findings should require immediate follow-up by the nurse?

A) Skin rash
B) Sweating
C) Itching
D) Pedal edema
B) Sweating

Pramlintide is a new type of antidiabetic medication that is used as a supplement to mealtime insulin in type 1 and 2 diabetes. Hypoglycemia, which is manifested by sweating, tremors, and tachycardia, is the adverse reaction of most concern. Skin rash, itching, and edema are not adverse effects of pramlintide.
Which of these characteristics should a nurse associate with a patient who has type 2 diabetes? (Select all that apply.)

A) Exercise and diet may be sufficient treatment
B) Is often obese with difficulty managing weight
C) Prone to ketosis and ketoacidosis complications
D) Genetics and strong familial links are causal factors
E) Insulin resistance and inappropriate secretion
A
B
D
E
A nurse caring for a patient who has diabetic ketoacidosis recognizes which of these characteristics in the patient? (Select all that apply.)

A) Occurs mainly in type 2 diabetes patients
B) Altered fat metabolism leading to ketones
C) Arterial blood pH of 7.35 to 7.45
D) Sudden onset, triggered by acute illness
E) Plasma osmolality of 300 to 320 milliosmoles/L
B
D
E
A postoperative patient has an epidural infusion of morphine sulfate (Astramorph). The patient's respiratory rate declines to 8 breaths/min. Which medication would the nurse anticipate administering?

A) Naloxone (Narcan)
B) Acetylcysteine (Mucomyst)
C) Methylprednisolone (Solu-Medrol)
D) Protamine sulfate
A) Naloxone (Narcan)

Naloxone is a narcotic antagonist that can reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.
The nurse is planning care for a patient receiving morphine sulfate (Duramorph) by means of a patient-controlled analgesia (PCA) pump. Which intervention may be required because of a potential adverse effect of this drug?

A) Administer cough suppressant.
B) Insert Foley catheter.
C) Administer antidiarrheal.
D) Monitor liver function tests.
B) Insert Foley catheter.

Morphine can cause urinary hesitancy and urinary retention. If bladder distention or the inability to void is noted, the prescriber should be notified. Urinary catheterization may be required. Morphine acts as a cough suppressant and an antidiarrheal, so neither of those drugs would need to be administered to counteract an adverse effect of morphine. Liver toxicity is not a common adverse effect of morphine.
A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse, "Why am I receiving codeine? I don't have any pain." The nurse's response is based on the knowledge that codeine also has which effect?

A) Immunostimulant
B) Antitussive
C) Expectorant
D) Immunosuppressant
B) Antitussive

Codeine provides both analgesic and antitussive therapeutic effects.
A patient takes oxycodone (OxyContin), 40 mg PO twice daily, for the management of chronic pain. Which intervention should be added to the plan of care to minimize the gastrointestinal adverse effects?

A) Take an antacid with each dose.
B) Eat foods high in lactobacilli.
C) Take the medication on an empty stomach.
D) Increase fluid and fiber in the diet.
D) Increase fluid and fiber in the diet.

Narcotic analgesics reduce intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can help manage this adverse effect.
OxyContin
Oxycodone, Narcotic pain reliever, analgesic
Which agent below is most likely to cause serious respiratory depression as a potential adverse reaction?

A) Morphine (Duramorph)
B) Pentazocine (Talwin)
C) Hydrocodone (Lortab)
D) Nalmefene (Revex)
A) Morphine (Duramorph)

Morphine is a strong opioid agonist and as such has the highest likelihood of respiratory depression. Pentazocine, a partial agonist, and hydrocodone, a moderate to strong agonist, may cause respiratory depression but not as often and serious as morphine. Nalmefene is an opioid antagonist and would be used to reverse respiratory depression with opioids.
The nurse is working on a postoperative unit where pain management is part of routine care. Which statement below is the most helpful in guiding clinical practice in this setting?

A) At least 30% of the U.S. population is prone to drug addiction and abuse.
B) The development of opioid dependence is rare when opioids are used for acute pain.
C) Morphine is a common drug of abuse in the general population.
D) The use of PRN (as needed) dosing provides the most consistent pain relief without risk of addiction.
B) The development of opioid dependence is rare when opioids are used for acute pain.
A nurse administers naloxone (Narcan) to a postoperative patient experiencing respiratory sedation. What undesirable effect would the nurse anticipate after giving this medication?

A) Drowsiness
B) Tics and tremors
C) Increased pain
D) Nausea and vomiting
C) Increased pain

Naloxone is a medication that reverses the effects of narcotics. Although the patient's respiratory status will improve after the administration of naloxone, pain will be more acute.
The client informs the nurse that he has experienced pain in the lower extremities for the past eight months. The nurse recognizes that this pain is classified as:


a.) Moderate.
b.) Severe.
c.) Acute.
d.) Chronic.
d.) Chronic.

Chronic pain persists longer than six months.
A client who incurred an arm injury describes his pain as "sharp and localized to the lower arm." The nurse recognizes that this type of pain would be relieved best by administration of which type of medication?

a.) Muscle relaxant
b.) Acetaminophen
c.) Narcotic analgesics
d.) Ice packs
c.) Narcotic analgesics

Injury to tissues produces nociceptor pain, which usually responds to conventional analgesic pain medications such as opiates or NSAIDS.
The nurse teaches the client relaxation techniques and guided imagery as an adjunct to medication for treatment of pain. The nurse explains that the major benefit of these techniques is that they:

a.) Are less costly.
b.) Allow lower doses of drugs with fewer side effects.
c.) Can be used at home or in any environment.
d.) Do not require self-injection.
b.) Allow lower doses of drugs with fewer side effects.

When used concurrently with medication, non-pharmacologic techniques can allow for lower doses, and possibly fewer drug-related adverse effects. The other options also are advantages to guided imagery and relaxation, but not the major one.
The nurse recognizes that opioid analgesics exert their action by interacting with a variety of opioid receptors. Drugs such as morphine act by activating
Mu and kappa
The client admitted with hepatitis B is prescribed Vicodin tabs 2 for treatment of pain. The appropriate nursing action is to:


a.) Administer the drug as ordered.
b.) Administer one tablet only.
c.) Question the physician about the order.
d.) Hold the drug until the physician arrives.
c.) Question the physician about the order.

Vicodin is a combination drug of hydrocodone and acetaminophen. Acetaminophen can be hepatotoxic, and is contraindicated in liver disease.
The nurse administers morphine sulfate 4 mg IV to a client for treatment of severe pain. Which of the following assessments requires immediate nursing interventions?

a.) Blood pressure 110/70
b.) The client is drowsy.
c.) Pain is unrelieved in 15 minutes.
d.) Respiratory rate 10/minute
d.) Respiratory rate 10/minute

Opioids activate mu and kappa receptors that can cause profound respiratory depression. Respiratory rate should remain above 12. The BP is not significantly low. Drowsiness is an expected effect of morphine. Unrelieved pain warrants further assessment, but not as immediately as do decreased respirations.
Nursing intervention for a client receiving opioid analgesics over an extended period of time should include:

a.) Referring the client to a drug treatment center.
b.) Encouraging increased fluids and fiber in the diet.
c.) Monitoring for G.I. bleeding.
d.0 Teaching the client to take her own blood pressure.
b.) Encouraging increased fluids and fiber in the diet.

Opioids suppress intestinal contractility, increase anal sphincter tone, and inhibit fluids into the intestines, which can lead to constipation. There is nothing to indicate the drug is related to addiction problems. Opioids do not cause GI bleeding.
Naloxone (Narcan) is administered to a client with severe respiratory depression and suspected drug overdose. After 20 minutes, the client remains unresponsive. The most likely explanation for this is:


a.) The client did not use an opioid drug.
b.) The dose of naloxone was inadequate.
c.) The client is resistant to this drug.
d.) The drug overdose is irreversible.
a.) The client did not use an opioid drug.

If opioid antagonists (Naloxone) fail to reverse symptoms of respiratory depression quickly, the overdose was likely due to a non-opioid substance.
Celecoxib (Celebrex) is added to the treatment regimen of a client with arthritis. The nurse explains that the major advantage of this drug is:


a.) The drug is less expensive.
b.) The drug has no known side effects.
c.) The drug has anti-inflammatory properties.
d.) The drug's effectiveness is the same as opioids.
c.) The drug has anti-inflammatory properties.

Celecoxib (Celebrex) has anti-inflammatory properties. It is not less expensive, has many side effects, and is less potent than opioids.
The client is prescribed ketorolac tromethamine (Toradol) for treatment of pain following a surgical procedure. The nurse should question which of the following drug orders?

a.) Toradol 10 mg p.o. b.i.d.
b.) Toradol 20 mg p.o. b.i.d
c.) Toradol 5 mg p.o. t.i.d.
d.) Toradol 20 mg p.o q.i.d
b.) Toradol 20 mg p.o. b.i.d

The maximum daily dose of Toradol is 40 mg.
Blood sugar is well controlled when Hemoglobin A1C is:

a. Below 7%
b. Between 12%-15%
c. Less than 180 mg/dL
d. Between 90 and 130 mg/dL
a. Below 7%

A1c measures the percentage of hemoglobin that is glycated and determines average blood glucose during the two to three months prior to testing. Used as a diagnostic tool, A1C levels of 6.5% or higher on two tests indicate diabetes. A1C of 6% to 6.5% is considered prediabetes.
Untreated hyperglycemia may lead to all of the following complications except:

a. Hyperosmolar syndrome
b Vitiligo
c. Diabetic ketoacidosis
d. Coma
B.

Excessively high blood sugar or prolonged hyperglycemia can cause diabetic ketoacidosis, the condition in which the body breaks down fat for energy and ketones spill into the urine. Diabetic hyperosmolar syndrome occurs when blood sugar is excessively high and available insulin is ineffective. In this case, the body cannot use glucose or fat for energy and glucose is excreted in the urine. Without immediate medical attention, both conditions may result in coma or death.
Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver?

a. Sulfonylureas
b. Meglitinides
c. Biguanides
d. Alpha-glucosidase inhibitors
c. Biguanides

Biguanides, such as metformin, lower blood glucose by reducing the amount of glucose produced by the liver.

Sulfonylureas and Meglitinides stimulate the beta cells of the pancreas to produce more insulin.

Alpha-glucosidase inhibitors block the breakdown of starches and some sugars, which helps to reduce blood glucose levels
The benefits of using an insulin pump include all of the following except:

a. By continuously providing insulin they eliminate the need for injections of insulin
b. They simplify management of blood sugar and often improve A1C
c. They enable exercise without compensatory carbohydrate consumption
d. They help with weight loss
d. They help with weight loss

Using an insulin pump has many advantages, including fewer dramatic swings in blood glucose levels, increased flexibility about diet, and improved accuracy of insulin doses and delivery; however, the use of an insulin pump has been associated with weight gain.
Which of the following regimens offers the best blood glucose control for persons with type 1 diabetes?

a. A single anti-diabetes drugs
b. Once daily insulin injections
c. A combination of oral anti-diabetic medications
d. Three or four injections per day of different types of insulin.
D. Three or four injections per day of different types of insulin.

Because persons with type 1 diabetes do not produce insulin, they require insulin and cannot be treated with oral anti-diabetic drugs.

Several injections of insulin per day, calibrated to respond to measured blood glucose levels, offer the best blood glucose control and may prevent or postpone the retinal, renal, and neurological complications of diabetes.
A patient has just been diagnosed with diabetes mellitus. His doctor has requested glucagon for emergency use at home. The nurse instructs the patient that the purpose of this drug is to treat:

A. Hyperglycemia from insufficient insulin injection.
B. Hyperglycemia from eating a large meal.
C. Hypoglycemia from insulin overdose.
D. Lipohypertrophy from inadequate insulin absorption.
C. Hypoglycemia from insulin overdose.

Glucagon is for emergency use for insulin overdose. The patient will usually arouse within 20 minutes if unconscious.

The family should also be instructed how to use the glucagon injection as well.
Which of the following statements from a newly diagnosed client with diabetes indicates more instruction is needed?

A.) i need to check my feet daily for sores
B.) i need to store my insulin in the refrigerator
C.) i can use my plastic insulin syringe more than once
D.) i need to see my doctor for follow up exams
B.) i need to store my insulin in the refrigerator


Insulin only needs to be stored in the refrigerator if it wont be used within 6 weeks, after being opened. It should be at room temperature when given to decrease pain and prevent lipodystrophy.
Following heparin treatment for a pulmonary embolism, a client is being discharged with a prescription for warfarin (Coumadin). In conducting discharge teaching, the nurse advises the client to have which diagnostic test monitored regularly after discharge?

A) Perfusion scan
B) Prothrombin Time (PT/INR)
C) Activated partial thromboplastin (APTT)
D) Serum Coumadin level (SCL
B) Prothrombin Time (PT/INR)
The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with osteoarthritis of the hands. The client tells the nurse that the drug does not seem to be effective after three weeks. Which is the best response for the nurse to provide?

A) The frequency of the dosing is necessary to increase the effectiveness.

B) Therapeutic blood levels of this drug are reached in 4 to 6 weeks.

C) Another type of nonsteroidal antiinflammatory drug may be indicated.

D) Systemic corticosteroids are the next drugs of choice for pain relief
C) Another type of nonsteroidal antiinflammatory drug may be indicated.
The nurse instructs a patient about how insulin affects blood glucose. Arrange the events in sequence.

1. Beta cells are stimulated to release insulin.
2. Glucose enters the bloodstream.
3. Glycogen is converted to glucose by alpha cells (glycogenesis).
4. Glycogen is stored in the liver.
5. Insulin transports glucose to muscle cells.
2
1
5
4
3
The teaching plan for a diabetic is focused on smoking cessation and control of hypertension for the avoidance of microvascular complications, such as (select all that apply):

1. macular degeneration.
2. end-stage renal disease (ESRD).
3. coronary artery disease (CAD).
4. peripheral vascular disease (PVD).
5. cerebrovascular accident (CVA).
ANS: 1, 2
Macular degeneration and ESRD are both microvascular complications. CAD, PVD, and CVA are all macrovascular complications.
The patient has been admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNKS). Her blood glucose level is very high (880 mg/dL on admission). The physician believes that her condition is to the result of large amounts of glucose solutions administered intravenously during kidney dialysis. The nurse would anticipate that the patient would exhibit:

1. a fruity breath and high level of
ketones in her urine.
2. severe dehydration and hypernatremia caused by the hyperglycemia.
3. exactly the same symptoms and signs as diabetic ketoacidosis.
4. Kussmaul's respirations, nausea, and vomiting.
2. severe dehydration and hypernatremia caused by the hyperglycemia.

IV solutions containing glucose will bypass the digestive system, so there is no trigger for the pancreas to release insulin, but there is just enough insulin to prevent the breakdown of fatty acids and the formation of ketones.
The nurse giving Humulin R 20 U at 7 AM is aware that this drug will peak in:

1. 15 minutes.
2. 30 minutes.
3. 1 hour.
4. 2 hours.
Humulin R has its onset in about 15 minutes, but its peak is in 2 hours.
When the Type 1 diabetic patient asks why his 7 AM insulin has been changed from NPH insulin to 70/30 premixed insulin, the nurse explains that 70/30 insulin:
1. is absorbed more rapidly into the bloodstream.
2. has no peak action time and lasts all day.
3. makes insulin administration easier and safer.
4. give a bolus of rapid-acting insulin to prevent hyperglycemia after breakfast.

the morning meal.
4. give a bolus of rapid-acting insulin to prevent hyperglycemia after breakfast.



70/30 insulin is 30% rapid-acting and 70% intermediate-acting insulin. The rapid action of the 7 AM premixed insulin prevents hyperglycemia after the morning meal.
The type 1 diabetic patient has an insulin order for NPH insulin, 35 U, to be given at 7 AM. The patient is also NPO for laboratory work that will not be drawn until 10 AM. The nurse
should:

1. give the insulin as ordered.
2. give the insulin with a small snack.
3. inform the charge nurse.
4. hold the insulin until after the blood draw.
4. hold the insulin until after the blood


Holding the insulin for the NPO order is appropriate. The patient will not be getting food until after the blood draw, so will not need the insulin until then. Giving the insulin as ordered will create a possibility of hypoglycemia before the blood is drawn. Giving a snack to a patient who is NPO is inappropriate.
A patient has come to the doctor's office after finding out that her blood glucose level was 135 mg/dL. She states that she had not eaten before the test and was told to come and see her doctor. She asks you if she has
diabetes. The nurse responds:

1. "Having a fasting serum glucose that high certainly indicates diabetes."
2. "That test indicates that we need to do more tests that are specific for diabetes."
3. "How do you feel? Do you have any other signs of diabetes?"
4. "Do you have a family history of diabetes, stroke, or heart disease? We need to know before making a diagnosis."
2. "That test indicates that we need to do more tests that are specific for diabetes

The nurse needs to answer the patient's question in a way that gives information and is not misleading. Although 135 is high, there may be a nonpathologic explanation. More tests should be done to evaluate the patient.
A patient has come into the emergency room with her friend. Her friend states that she had been acting very strangely and confused. The friend states that the patient has diabetes and takes insulin. The nurse knows that signs and symptoms of hypoglycemia include:

1. slow pulse rate and low blood pressure.
2. irritability, anxiety, confusion, and dizziness.
3. flushing, anger, and forgetfulness.
4. sleepiness, edema, and sluggishness.
2. irritability, anxiety, confusion, and dizziness

When blood sugar levels fall, hormones are activated to increase serum glucose. One of the hormones is epinephrine, which causes these symptoms.
The nurse is drawing up a teaching plan for a patient who has type 1 diabetes. The doctor has ordered two types of insulin, 10 U of regular insulin and 35 U of NPH insulin. The proper procedure is to:

1. draw up the insulins in two separate syringes so that there can be no confusion.

2. draw up the regular insulin before drawing up the NPH insulin.

3. inject air into the NPH insulin, draw it up to 35 U, then inject air into the clear regular insulin and withdraw to 45 U.

4. inject 35 U air into the NPH insulin, inject 10 U air into the regular insulin, withdraw 10 U of the regular insulin, and withdraw 35 U of the NPH insulin.
4. inject 35 U air into the NPH insulin, inject 10 U air into the regular insulin, withdraw 10 U of the regular insulin, and withdraw 35 U of the NPH insulin.


When drawing up two insulins, the vials are injected with air and the regular insulin is drawn first. This slow and time-consuming activity has been greatly reduced with the advent of premixed insulins.
The home health nurse is assessing a type 1 diabetic patient who has been controlled for 6 months. The nurse is surprised and concerned about a blood glucose reading of 52. This episode of hypoglycemia is probably caused by the patient's having:

1. taken a new form of birth control pill this morning.
2. used large amounts of sugar substitute in her tea this morning.
3. had a 2-hour long exercise class at the spa this morning.
4. underdosed herself with insulin this morning.
ANS: 3
Excessive exercise used up the glucose that was made available by the insulin taken by the patient. The patient now has too much insulin for the available glucose and has become hypoglycemic.
The patient with type 2 diabetes shows a blood sugar reading of 72 at 6 AM. Based on the reading of 72, the nurse should:

1. notify the charge nurse of the reading.
2. give regular insulin per sliding scale.
3. give him cup of milk.
4. administer the oral hyperglycemic tablet.
ANS: 3 milk

The patient is hypoglycemic and needs an immediate source of glucose, such as milk or orange juice. The oral hyperglycemic agent will not work quickly enough. Notifying the charge nurse can be done later. Giving insulin per sliding scale would lower the blood sugar level.
When the type 2 diabetic patient says, "Why in the world are they looking at my hemoglobin? I thought my problem was with my blood sugar." The nurse responds that the level of hemoglobin A1c:

1. shows how a high glucose level can cause a significant drop in the hemoglobin level.
2. shows what the glucose level has done for the last 3 months.
3. indicates a true picture of the patient's nutritional state.
4. reflects the effect of high glucose levels on the ability to produce red blood cells.
ANS: 2

By analyzing the amount of glucose bound to the hemoglobin, the level of blood glucose can be evaluated for the last 3 months, because the glucose stays bound to the hemoglobin for the life of the red blood cell (RBC).
When a newly diagnosed type 2 diabetes mellitus patient asks the nurse why she has to take a pill instead of insulin, you reply that in type 2 diabetes, the body makes insulin but:

1. overweight and underactive people simply cannot use the insulin produced.
2. metabolism is slowed in some people so they have to take a pill to speed up their metabolism.
3. sometimes the autoimmune system works against the action of the insulin.
4. the cells become resistant to the action of insulin. Pills are given to increase the sensitivity.
ANS: 4

Type 2 diabetes mellitus is a disease in which the cells become resistant to the action of insulin and the blood glucose level rises. Oral hyperglycemic agents make the cells more sensitive.
The nurse is caring for a patient whose seizures are characterized by a 10- to 30-second loss of consciousness with mild symmetric eye blinking. Which seizure type does this most closely illustrate?

A) Tonic-clonic
B) Absence
C) Atonic
D) Myoclonic
B) Absence


This scenario accurately describes absence seizures.

Tonic-clonic seizures present with convulsions and muscle rigidity followed by muscle jerks. Patients may experience urinary incontinence and loss of consciousness.

Atonic seizures cause sudden loss of muscle tone.

Myoclonic seizures present with sudden muscle contractions that last but a second.
The nurse is teaching a patient who is newly diagnosed with epilepsy about her disease. Which statement made by the nurse best describes the goals of
antiepilepsy medication therapy?

A) "With proper treatment we can completely eliminate your seizures."

B) "Our goal is to reduce your seizures to an extent that helps you live a normal life."

C) "Epilepsy medication does not reduce seizures in most patients."

D) "These drugs will help control your seizures until you have surgery."
B) "Our goal is to reduce your seizures to an extent that helps you live a normal life."

Epilepsy is treated successfully with medication in a majority of patients. However, the dosages needed to completely eliminate seizures may cause intolerable side effects. Neurosurgery is indicated only for patients in whom medication therapy is unsuccessful.
The nurse is assessing a patient receiving valproic acid (Depakene) for potential adverse effects associated with this drug. Which item represents the most common problem with this drug?

A) Increased risk for infection
B) Reddened, swollen gums
C) Nausea, vomiting, and indigestion
D) Central nervous system depression
D) Central nervous system depression

Valproic acid is generally well tolerated.
It does not cause hematologic effects resulting in increased risk for infection nor does it cause gingival hyperplasia.

It causes minimal sedation.

Gastrointestinal effects, which include nausea, vomiting, and indigestion, are the most common problems but tend to subside with use and can be lessened by giving with food.
The nurse is preparing to give ethosuximide (Zarontin). The nurse understands that this drug is only indicated for which seizure type?

A) Tonic-clonic
B) Absence
C) Simple partial
D) Complex partial
B) Absence

Absence seizures are the only indication for ethosuximide. The drug effectively eliminates absence seizures in approximately 60% of patients and effectively controls 80% to 90% of cases.
The nurse is conducting discharge teaching related to a new prescription for phenytoin (Dilantin). Which statements are appropriate to include in the teaching for this patient and his family? Select all that apply.

A) "Be sure to call the clinic if you or your family notice increased anxiety or agitation."

B) "You may have some mild sedation. Do not drive until you know how this drug will affect you."

C) "This drug may cause easy bruising. If you notice this, call the clinic immediately."

D) "It is very important to have good oral hygiene and visit your dentist regularly."

E) "You may continue to have wine with your evening meals but only in moderation."
A, B, D

Patients receiving an antiepileptic drug are at increased risk for suicidal thoughts and behavior beginning early in their treatment. The U.S. Food and Drug Administration (FDA) advises that patients, families, and caregivers be informed of the signs that may precede suicidal behavior and be encouraged to report these immediately. Mild sedation can occur in patients taking phenytoin even at therapeutic levels.

Carbamazepine(Tegretol), not phenytoin, increases the risk for hematologic effects, such as easy bruising.

Phenytoin causes gingival hyperplasia in about 20% of patients who take it. Dental hygiene is important.

Patients receiving phenytoin should avoid alcohol and other central nervous system depressants because they have an additive depressant effect.
The nurse receives a lab report indicating that the phenytoin (Dilantin) level for the patient she saw in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate?

A) Continue as planned since the level is within normal limits.
B) Tell the patient to hold today's dose and return to the clinic.
C) Consult the prescriber to recommend an increased dose.
D) Have the patient call 911 and meet the patient in the emergency department.
A) Continue as planned since the level is within normal limits
1. Which of the following statements made by a client taking phenytoin indicates understanding of the nurse's teaching?

A. "I will increase the dose if my seizures don't stop."
B. "I don't need to contact my health care provider before taking an over-the-counter cold remedy."
C. "I will take good care of my teeth and see my dentist regularly."
D. "I cannot take this drug with food."
C. "I will take good care of my teeth and see my dentist regularly."
A 20-year-old client presents to the clinic with complaints of breast tenderness, nausea, vomiting, and absence of menses for 2 months. She has a history of a seizure disorder well controlled with carbamazepine (Tegretol). She tells the nurse that she has been taking her oral contraceptives as directed, but she wonders if she might be pregnant. The nurse's best response to her concern should be which of the following?

A. "You can't be pregnant if you have been taking your oral contraceptives correctly."
B. "Carbamazepine can decrease the effectiveness of oral contraceptive drugs, so we need to do a pregnancy test."
C. "There is no need to worry. Oral contraceptives are very effective."
D. "Taking antiseizure drugs with oral contraceptives significantly decreases your risk of getting pregnant."
B. "Carbamazepine can decrease the effectiveness of oral contraceptive drugs, so we need to do a pregnancy test.
A client in the trauma ICU is experiencing deep, throbbing pain. The nurse will provide medication for this pain because:


A.) The pain is being transmitted over C fibers and the enkephalins will not be
effective to control the pain.

B.) The pain is being transmitted over A beta fibers and beta-endorphins will not be effective to control the pain.

c.) The pain is being transmitted over delta fibers and dynorphins will not be effective to control the pain.

d.) The pain is being transmitted over A beta fibers and the dynophins will not be effective to control the pain.
A.) The pain is being transmitted over C fibers and the enkephalins will not be
effective to control the pain.
A client in the ICU tells the nurse he is experiencing severe pain. Prior to administering a narcotic analgesic to this client, the nurse will conduct a pain assessment to include:

a.) Pain
b.) Nociception
c.) Pain behaviors
d.) Suffering
c.) pain behavior

There is a theory that addresses pain as having four facets: nociception, pain, suffering, and pain behaviors. Of these four facets, only the fourth, pain behavior, can be observed. This nurse will only be able to assess the client's pain behavior in the pain assessment.
A client in the ICU who sustained a traumatic abdominal injury 1 week ago continues to complain of severe pain. The nurse notes his vital signs are normal. Which of the following would be appropriate for the nurse to do?



a.) Encourage early return to ambulation.
b.) Offer nonnarcotic analgesics for pain.
c.) Utilize distraction
d.) Provide the client with pain medication.
D.) Provide the client with pain medication.
The nurse is creating a pain management plan for a client with a previous history of substance abuse. Which of the following should be included in this plan?

a.) Ask the physician to prescribe short-acting analgesics.
b.) Ask the physician to prescribe a medication similar to the one the client abused.
c.) Ask the physician to prescribe all analgesics for the oral route.
d.) Keep a dose of Narcan at the bedside.
C.) Ask the physician to prescribe all analgesics for the oral route.

Extended-release and long-acting analgesics are recommended for clients with a history of abuse.
Specific interventions should avoid analgesics similar to the abused drug, utilize long-acting analgesics, avoid Narcan, and administer medications through the oral route.
The safest narcotic choice for an elderly client with acute pain is:


a. Meperidine (Demerol).
b. Oxycodone.
c. Fentanyl transdermal patch.
d. Morphine sulfate.
d. Morphine sulfate.

Rationale: Morphine is the "gold standard" of narcotics for acute pain. The other choices are incorrect.
An elderly client had abdominal surgery six hours earlier. When the nurse asks the client about pain, the client responds that there is none. The best intervention on the part of the nurse is:

a. Administer a PRN dose of IV pain medication as ordered.
b. Assist the client into a sitting position in preparation for ambulation.
c. Question the client further about discomfort to assess the meaning of pain.
d. Assess the abdominal dressing and consult the surgeon about findings.
c. Question the client further about discomfort to assess the meaning of pain.
A resident of the nursing home has quite severe arthritis. When administering an analgesic to this elderly resident, the nurse should:


a. Give the medication before the activity session in the day room.
b. Give the medication when the resident states the pain is at 6 or higher on a 1-10 pain scale.
c. Give the pain medication at mealtime.
d. Make sure that the medication is not a narcotic.
a. Give the medication before the activity session in the day room.
Two days after surgery, an elderly client refuses a PRN dose of analgesic dose for fear of becoming "hooked." The nurse should respond by stating that:


a. It is impossible to become hooked on PRN narcotics.
b. Short-term use of narcotics is not likely to cause a person to become dependent on them.
c. Side effects that occur in the elderly mean that medications will be discontinued as soon as possible.
d. The elderly are least likely to become dependent on narcotics.
b. Short-term use of narcotics is not likely to cause a person to become dependent on them.
When an elderly client with cancer experiences "breakthrough pain," the nurse should expect that pharmacological treatment will include:


a. Initiation of a placebo after every third dose of narcotic.
b. More aggressive chemotherapy.
c. Giving narcotics every hour.
d. Increasing the dose of the narcotic.
d. Increasing the dose of the narcotic.
A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what "type 2" means in relation to diabetes. The nurse explains to the patient that type 2 diabetes differs from type 1 diabetes primarily in that with type 2 diabetes

a. the patient is totally dependent on an outside source of insulin.
b. there is decreased insulin secretion and cellular resistance to insulin that is produced.
c. the immune system destroys the pancreatic insulin-producing cells.
d. the insulin precursor that is secreted by the pancreas is not activated by the liver.
B

Rationale: In type 2 diabetes, the pancreas produces insulin, but the insulin is insufficient for the body's needs or the cells do not respond to the insulin appropriately. The other information describes the physiology of type 1 diabetes.
A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dl (6.7 mmol/L). The nurse will plan to teach the patient about

a. use of low doses of regular insulin.
b. self-monitoring of blood glucose.
c. oral hypoglycemic medications.
d. maintenance of a healthy weight.
D

Rationale: The patient's impaired fasting glucose indicates prediabetes and the patient should be counseled about lifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or the oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.
When assessing the patient experiencing the onset of symptoms of type 1 diabetes, which question should the nurse ask?

a. "Have you lost any weight lately?"
b. "Do you crave fluids containing sugar?"
c. "How long have you felt anorexic?"
d. "Is your urine unusually dark-colored?"
A
Rationale: Weight loss occurs because the body is no longer able to absorb glucose and starts to break down protein and fat for energy. The patient is thirsty but does not necessarily crave sugar- containing fluids. Increased appetite is a classic symptom of type 1 diabetes. With the classic symptom of polyuria, urine will be very dilute.
During a clinic visit 3 months following a diagnosis of type 2 diabetes, the patient reports following a reduced-calorie diet. The patient has not lost any weight and did not bring the glucose-monitoring record. The nurse will plan to obtain a(n)

a. fasting blood glucose level.
b. urine dipstick for glucose.
c. glycosylated hemoglobin level.
d. oral glucose tolerance test.
C


Rationale: The glycosylated hemoglobin (Hb A1C) test shows the overall control of glucose over 90 to 120 days.

A fasting blood level indicates only the glucose level at one time.

Urine glucose testing is not an accurate reflection of blood glucose level and does not reflect the glucose over a prolonged time.

Oral glucose tolerance testing is done to diagnose diabetes, but is not used for monitoring glucose control once diabetes has been diagnosed.
A college student who has type 1 diabetes normally walks each evening as part of an exercise regimen. The student now plans to take a swimming class every day at 1:00 PM. The clinic nurse teaches the patient to

a. delay eating the noon meal until after the swimming class.
b. increase the morning dose of neutral protamine Hagedorn (NPH) insulin on days of the swimming class.
c. time the morning insulin injection so that the peak occurs while swimming.
d. check glucose level before, during, and after swimming.
D
Rationale: The change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully to determine the need for changes in diet and insulin administration. Because exercise tends to decrease blood glucose, patients are advised to eat before exercising. Increasing the morning NPH or timing the insulin to peak during exercise may lead to hypoglycemia, especially with the increased exercise.
Alprazolam (Xanax)
Indication: anxiety, panic disorders, anxiety caused by depression
Class: benzodiazapien
Labs: hematocrit may decrease, renal function, liver function
Side effects: dizziness, drowsiness, depression, dependance
Precuations: monitor risk to fall, monitor drowsiness, monitor anxiety Reversal: Flumanizil
Amitriptyline (Elvail)
Indication: depression
Class: antidepressant
Labs: liver, WBC, glucose
Side effects: suicide, arrythmias, hypotension, blurred vision, lethargy, dry mouth
Precuations: monitor BP and pulse before and after dose, monitor for suicide
Amoxicillin/clvulanate (Augmentin)
Indication: infection
Class: anti-infective
Labs: liver
Side effects: seizure, diarrhea, rash, C-Diff
Precuations: assess vital signs, appearance of any infection, monitor bowel function, monitor for signs of anaphlaxis
Betamethasone (Celestone)
Indication: asthma, neoplastic disease, renal disease, respiratory disease, pre-term labor at 36wk Class: gluccocorticoid
Labs: WBC, glucose (increase), Na (increase), potassium(decrease)
Side effects: depression, euphoria, decreased healing, hypertension
Precuations: rinse mouth if inhaled, monitor condition used for
Bumetanide (Bumes)
Indication: fluid retention, high blood pressure, heart failure
Class: loop diuretic
Labs: Na, K, Mg, renal, liver
Side effects: dehydration, low K, low Na, metabolic alkalosis, muscle cramps
Precuations: fluid status, lung sounds, location of edema, monitor BP and pulse, monitor for tinnitus
Bupropion (Wellbutrin)
Indication: depression, quit smoking aid Class: antidepressant
Labs: liver, renal
Side effects: seizure, suicide, agitation, headache, tremor, N/V
Precuations: mental status, mood changes
Calcitriol (Rocaltrol)
Indication: low blood calcium due to kidney dialysis, osteoporosis, hyperparathyroidism
Class: Vitamin D
Labs: Mg, Ca, phosphate
Side effects: pancreatitis, dizziness, malasia
Precuations: toxicity is hypocalcaemia assess for N/V, weakness, constipation, headache, bone pain, metallic taste, cardiac arrythmias
Reversal: low Ca diet, stop drug
Ceftazidime
Indication: pseudomonas, netropenia
Class: anti-infective broad spectrum
Labs: liver, WBC
Side effects: seizure, C-Diff, rash, diarrhea, N/V, anaphylaxis
Precuations: monitor for anaphylaxis, bowel function, assess infection, obtain culture
Cephalonia (Keflex)
Indication: UTI, sore throat, e-coli, pneumonia, wounds
Class: anti-infective
Labs: liver, WBC
Side effects: seizure, C-Diff, rash, diarrhea, N/V, anaphylaxis
Precuations: monitor for anaphylaxis, bowel function, assess infection, obtain culture
Ciprofloxacin
Indication: UTI, gonorrhea, sinus infection, e-coli
Class: anti-infective
Labs: liver, WBC, glucose, cholesterol, Ca
Side effects: seizure, C-Diff, rash, diarrhea, N/V, anaphylaxis, arrythmias, hyperglycemia
Precuations: monitor for anaphylaxis, bowel function, assess infection, obtain culture
Clonazepam
Indication: seizures, panic disorders, anxiety
Class: benzodiazepine
Labs: CBC, liver
Side effects: suicide, mood changes, lethargy, ataxia
Precuations: monitor levels, suicide, monitor and record seizure activity
Reversal: Flumanazil
Cyclobenzaprine (Flexrol)
Indication: acute painful muscle spasms Class: muscle relaxant
Labs: N/A
Side effects: dizziness, drowsiness
Precautions: monitor pain and ROM
Diazepam (Valium)
Indication: anxiety, conscious sedation, seizures, alcohol withdrawl
Class: benzodiazepines
Labs: hepatic, renal, CMB
Side effects: dizziness, lethargy, drowsiness
Precautions: monitor vitals, physical dependence for long term use, assess mental status, assess pt with alcohol withdrawl for symptoms
Reversal: Flumazenil
Enalapril (Vasotec)
Indication: CHF, lower blood pressure, improve CO
Class: ACE inhibitor
Labs: BUN, Cr, Na, hepatic, urine output
Side effects: hypotension, cough, dizziness
Precautions: monitor blood pressure and pulse, monitor weight, monitor for fluid overload, monitor for cough
Erythromycin
Indication: infection, if penicillin can't be used
Class: anti-infective
Labs: hepatic
Side effects: prolonged QRS, arrythmias, N/V, itching
Precautions: monitor infection, culture and sensitivity
Famotidine (Pepcid)
Indication: ulcers, GERD
Class: H2 blockers
Labs: CBC
Side effects: confusion, arrythmias
Precautions: assess for epigastria or abdominal pain, frank occult blood, gastric aspirate, or emesis
Fluconazole
Indication: UTI, yeast infection
Class: antifungal
Labs: liver, renal
Side effects: hypokalemia, hepatotoxicity
Precautions: assess infection, renal dysfunction need dose adjustment
Fluoxetine (Prozac)
Indication: depression, panic disorder, OCD
Class: antidepressant
Labs: CBC, hepatic, renal
Side effects: seizures, suicidal thoughts, headache, insomnia, diarrhea, sweating
Precautions: suicide, mood changes, changes in mental status (serotonin syndrome)
Furosemide (Lasix)
Indication: edema caused by HF, liver disease, or renal failure, hypertension
Class: loop diuretic
Labs: Na, K, glucose, renal, Mg
Side effects: tinnitus, hypokalemia, low mag, hypovolemia, hyponatremia, dehydration, hyperglycemia
Precautions: monitor fluid status, weight, I/O, lung sounds, BP, pulse
Gentamicin
Indication: staph infections
Class: amino glycoside, anti-infective
Labs: renal, hepatic, calcium, gent levels Side effects: ototoxicity, nephrotoxicity
Precautions: infection monitor, test hearing, monitor I/O, monitor neurological function
Levels: Peak 30 min after dose, troph right before next dose
Haloperidol (Haldol)
Indication: schizophrenia, chronic psychotic disorders, manic episodes Class: anti-psychotic
Labs: CBC, liver, WBC
Side effects: seizures, blurred vision, constipation, hypotension, respiratory depression, confusion
Precautions: monitor mental status, monitor BP, make sure meds are taken, monitor for fever/respiratory distress/tachycardia/hypotension and report immediately
Lisinopril
Indication: CHF, lower blood pressure, improve CO
Class: ACE inhibitor
Labs: BUN, Cr, Na, hepatic, urine output
Side effects: hypotension, cough, dizziness
Precautions: monitor blood pressure and pulse, monitor weight, monitor for fluid overload, monitor for cough
Atrovant (Ipratropium Bromide)
Indication: COPD, cold, cough, allergies
Class: bronchodialator
Labs: N/A
Side Effects: headache, palpitations
Precautions: monitor respiratory status
Ativan (Lorazepam)
Indication: anxiety, preoperative sedation, seizures
Class: benzodiazepine
Labs: renal, hepatic, hematological
Side Effects: drowsiness, apnea, cardiac arrest, dependence, tolerance
Precautions: assess mental status, assess seizures, monitor for dependence/tolerance
Ketoalac
Indication: short term management not to exceed 5 days
Class: NSAID
Labs: hepatic, bleeding time, BUN, Cr, K
Side Effects: drowsiness, anaphylaxis, GI bleeding, asthma, renal toxicity
Precautions: rhinitis, asthma, and aspirin allergy increase risk for hypersensitivity, assess pain
Hesperidins (Dmerol)
Indication: moderate to severe pain
Class: opiod
Labs: N/A
Side Effects: seizure, confusion, hypotension, anaphylaxis, respiratory depression
Precautions: assess pain, monitor vitals, monitor bowel function
Reversal: Narcan
Metoprolol (Lopressor)
Indication: angina, hypertension, prevention and decreased mortality of MI
Class: beta blocker
Labs: glucose, hepatic, K, cholesterol, uric acid
Side Effects: fatigue, weakness, bradycardia, hypotension, pulmonary edema
Precautions: hold for pulse less than 60 and BP less than 100, monitor I/O, assess angina, do not stop all at once
Nystatin
Indication: skin fungus infections
Class: antifungal
Labs: N/A
Side Effects: burning, itching
Precautions: inspect affected area
Oxybutyn
Indication: Neurogenic bladder, increase bladder capacity
Class: anticholinergic
Labs: N/A
Side Effects: drowsiness, constipation, urinary retention
Precautions: monitor voiding pattern, assess for bladder distention
Oxymetholone
Indication: anemia
Class: androgen (increase production of erythropoietin)
Labs: hepatic
Side Effects: acne, allergic reaction, depression, mood changes, anxiety
Precautions: do not take if pregnant
Dilantin
Indication: prevention of seizures
Class: anti-arrhythmic
Labs: CBC, Ca, albumin, hepatic
Side Effects: ataxia, suicide, anemia, hypotension, rash
Precautions: monitor for mood changes, assess for hypersensitivity, oral hygiene, monitor seizures, monitor vitals Always monitor levels
Prazepam
Indication: anxiety, conscious sedation, seizures, alcohol withdrawl
Class: benzodiazepines
Labs: hepatic, renal, CMB
Side effects: dizziness, lethargy, drowsiness
Precautions: monitor vitals, physical dependence for long term use, assess mental status, assess pt with alcohol withdrawl fo symptoms
Reversal: Flumazenil
Promethazine
Indication: vomiting and nausea
Class: anti-metic
Labs: glucose
Side Effects: confusion, sedation, bradycardia
Precautions: monitor vitals, monitor N/V
Propoxyphene
Indication: pain
Class: opiod
Labs: hepatic, amylase, lipase
Side Effects: dizziness, weakness, nausea, hypotension
Precautions: monitor pain, vitals, bowel function
Reversal: Narcan
Sudafed
Indication: nasal congestion
Class: adrenergic
Labs: N/A
Side Effects: seizure, anxiety, palpitations, anorexia, dizziness
Precautions: assess congestion, monitor pulse, adequate fluid intake
Temazepam
Indication: insomnia
Class: benzodiazepien
Labs: hepatic, renal, CBC
Side effects: dizziness, lethargy, drowsiness, suicidal thoughts, behavioral changes
Precautions: monitor vitals, physical dependence for long term use, assess mental status, assess pt with alcohol withdrawl fo symptoms
Reversal: Flumazenil
Tolnaftate
Indication: fungal skin infection
Class: antifungal topical
Labs: N/A
Side Effects: rash
Precautions: N/A
Vancomycin
Indication: super bugs
Class: anti-infective
Labs: renal, CBC, levels in blood
Side Effects: nephrotoxicity, ototoxicity, anaphylaxis, hypotension
Precautions: monitor urinary output and color, monitor hearing, monitor vitals, monitor infection
Seroquel
Indication: schizophrenia, depressive episodes
Class: antipsychotic
Labs: anemia labs, WBC, hepatic, blood glucose, cholesterol
Side Effects: seizure, dizziness, weight gain, palpitations, hyperglycemia
Precautions: mental status monitor, monitor BMI/weight, monitor BP, make sure med is taken
Remeron
Indication: major depression
Class: anti-depressant
Labs: CBC, hepatic
Side Effects: drowsiness, constipation, weight gain
Precautions: assess mental status, monitor weight, monitor for seizures
Klonipin
Indication: seizures, panic disorders
Class: anticonvulsant, benzo
Labs: hepatic, renal, CBC
Side effects: dizziness, lethargy, drowsiness, suicidal thoughts, behavioral changes
Precautions: monitor vitals, physical dependence, monitor seizures, for long term use, assess mental status,
Reversal: Flumazenil
Doxorubicin (Adiamycin)
Indication: in combination treatment for tumors
Class: cancer drug
Labs: CBC, platelets, WBC, renal, hepatic, uric acid
Side Effects: red color urine, diarrhea, alopecia, vomiting, anemia, leucopenia, thrombocytopenia
Precautions: monitor vitals, monitor for bone marrow depression, monitor for bleeding, monitor I/O, monitor for signs of toxicity (ST depression, tachycardia, dyspnea), monitor injection site
Albuterol
Indications: used as a bronchodialator to control and prevent reversible air way obstruction caused by asthma or COPDClass-Therapeutic: bronchodialators
Lab to monitor: Serum Potassium levels
Assessments: lung sounds, pulse, BP before administration and during peak
If have sputum note color, consistency, and amount
Observe for any wheezing
Monitor pulmonary function tests before intiating and periodically through therapy
Side effects: Paradoxacal bronchospams
Chest pain, paplpatations, tremor
Concurrent with other adrenergic agents
Cardiovascular effects increase with pateints on tricyclic antidepressants
May decrease serum digoxin can also cause hypokalemia which can lead to digoxin toxicity
Caffeine may increase adverse effects
Precautions/Special considerations: extended release tablets should be swallowed whole not crushed
Shake inhaler well and allow 1 minute between each puff
Ceftriazone (Rocephin)
Indications: treatment for skin infection, urinary infections, respiratory tract infections, meningitis, septicemia, intra abdominal infections, otitis media, lyme disease
Class-Therapeutic: anti-infectives
Lab to monitor: may increase serum AST, ALT, LDH, BUN, and creatine
Monitor WBC
Assessments: assess infection
Monitor for any signs of anaphylaxis
Monitor injection sight
Monitor bowel function
Side effects: seizures, C-Diff, Steven Johnson Syndrome (skin condition), anaphylaxis, serum sickness
Can cause disulfiram reaction
Use of loop diuretics or nephrotoxic agents may increase risk of nephrotoxicity
Precautions/Special considerations: use cautiously if patient has renal impairment
Do not use if have an allergy to cephlasporins or penicillins
Should not be administered with Ca containing solutions
Reconsiture IM dose with sterile water for injection or 0.9% NaCl
Inject deep into a well develop muscle mass, massage well
Levofloxacin (Levaquin)
Indications: treatment of the following bacterial infections: urinary tract, gonorrhea, gynecological infections, respiratory tract, skin, bone/joint, GI, post exposure treatment
Class-Therapeutic: anti-infectives
Lab to monitor: liver function tests
Monitor AST, ALT, bilirubin
Monitor serum glucose
Monitor prothrombin time
Assessments: observe for S/S anaphylaxis
Monitor bowel function
Assess infection
Side effects: seizures, arrhythmias, C-Diff, hepatotoxicity, anaphylaxis, Steven-Johnson Syndrome
Decreased absorption if used with antacids
Probenecid decrease renal elimination
Risk for tendon rupture if used with steroids
Prolong QT interval
V-tach/V-fib
Precautions/Special considerations: dosing changes in renal impaired patients
Use cautiously with CNS disorders
Can be administered with disregards to food
Discard unused IV solution
Diluted solution is stable for 72 hours room temp and 14 days refrigerated
Must measure QT interval prior to giving
Heparin
Dilution: undiluted
Continuous: 25,000 units with 250-500 ml of 0.9% NaCl or D5W
Rate: over at least 1 min
Continuous: adjust to maintain therapeutic aPTT, infuse approx 1,000 units/hr
Concentration: varies
Continuous: 50-100 units/ml
Compatibility: y-site many
Action: potentiates the inhibitory effect of ant thrombin. In low doses prevents the conversion of prothrombin to thrombin. Higher doses neutralize thrombin.
Indications: prophylaxis and treatment for various thromboembolic disorders.
Class-Therapeutic: anticoagulant
Class-Pharmalogic: antithrombotics
Heparin
Lab to monitor: monitor aPTT and hematocrit periodically during therapy
Monitor platelet count 2-3 days throughout therapy
Monitor potassium, AST, ALT
Assessments:
Assess for signs of bleeding and hemorrhage
Assess for evidence of additional thrombus
Monitor for hypersensitivity reaction
If sub-cut assess injection sight for hematomas, ecchymosed, or inflammation
To prevent clot formation in intermittent infusion inject heparin dilute solution after each medication injection
Specific patient teaching:
Advise patient to report any signs of unusual bleeding or bruising
Instruct patient not to take medications containing aspirin or NSAIDs while on heparin
During therapy should use soft tooth brushes and electric razors avoiding things that can causes injury
Patient should carry a medical card saying they take heparin
Heparin
Side effects: bleeding, anemia, thrombocytopenia, alopecia, hypersensitivity
Risk of bleeding increases with the use of drugs that affect platelet function like Aspirin, NSAID, and some penicillins
Concurrent use of thrombolytics increase risk of bleeding
Digoxin may decrease effects Precautions/Special considerations:
When intermittent IV therapy is used draw aPTT levels 30 min before each dose and during therapy if continuous monitor every 4 hours. For subcut draw blood 4-6 hr after injection
Do not confuse hepatin sodium injection vials with heparing flush vials
Inform other health care providers that patient is on heparin
Reversal: protamine sulfate
Warfarin
Action: interferes with hepatic synthesis of vitamin K dependant clotting factors to prevent thromembolic events, extrinsic pathway
Indications: prophylaxis and treatment of venous thrombis, pulmonary embolism, a-fib, and management of MI.
Class-Therapeutic: anticoagulants
Class-Pharmalogic: coumarins
Warfarin
Lab to monitor:
Monitor PT, INR, and clotting factors want PT 1.3-1.5 and INR 2.5-3.0
Monitor hepatic function and CBC
Monitor stool and urine for occult blood
Assessments:
Assess for signs of bleeding and hemorrhage
Monitor Blood Pressure
Geri: patients over 60 exhibit greater than expected PT/INR response monitor for side effects at lower therapeutic range Specific patient teaching:
Take medication as directed take missed dose as soon as remembered do not double doses
Limit intake of food high in vitamin K
Report any symptoms of unusual bleeding or bruising, tarry stools, pain, temperature change in area of the body
Don't drink alcohol
Carry card stating take this medication
Emphasize the importance of frequent lab test to monitor coagulation factor
Lisinopril
Indication: management of hypertension and CHF
Class: ACE
Lab to monitor:
Monitor BUN, creatine, and electrolyte levels, (K)
Monitor Na levels
Monitor CBC periodically hematocrit or hemoglobin may decrease
Monitor AST, ALT, serum bilirubin, uric acid, glucose
Assess urine protein
Assessments:
Monitor BP and pulse frequently during therapy
Assess for angioedema (dyspnea, facial swelling)
Monitor weight
Monitor for signs of hypotension
Side effects: cough, hypotension, taste disturbance, agranuloctes, angioedema
Excessive hypotension may occur with the use of other anti-hypertensives and diuretics
Response decrease with the use of NSAID
Risk of hyperkalemia with use of potassium supplements or angiogenesis II receptor antagonists
Precautions/Special considerations:
Initiate therapy at 5mg/day for those on diuretics
Initial therapy at 2.5 mg/day for patients with hyponatremia
For patients with difficulty swallowing pharamcists may compound oral suspension
Atrovastatin (Lipitor)
Indication: primary prevention to decrease risk MI/Stroke, lowers cholesterol
Class: lipid lowering agent
Lab to monitor: serum cholesterol, triglycerides, liver function tests, if develop muscle tenderness monitor CK levels if > 10 D/C therapy
Specific patient teaching:
Instruct to take as directed
Ingest no more than 200 ml/day of grapefruit juice
Advise of diet restriction
Notify health care professional if unexplained muscle pain, tenderness, or weakness occurs accompanied by fevers
Emphasize importance of follow up care
Side effects: dizziness, headache, rhinitis, chest pain, abdominal cramps, constipation, heartburn, rhabdomyolisis, rashes, RUQ pain - liver
Drug-Drug: Risk of sympathy increase with use of amiodarone, niacin, nelfinavir
Increase levels of hormonal contraceptives
Increase bleeding risk with Warfarin
Levels may be increased with use of Erythromycin
Grape fruit may increase blood levels
Precautions/Special considerations:
Obtain dietary history in regards to fat particularly
Administer with food
May be administered at any time
Avoid large amounts of grapefruit
Monitor for rhabdo and upper right quadrant pain
Amiodarone
Indication: arrhythmias, tachycardia, ventricular fibrillation, cardiopulomanry resuscitation
Rate: Direct -- push, 300mg first does then 150mg next dose
Intermittent -- over 10 min
Continuous --- 1 mg/min for first 6 hr then decrease to 0.5mg/min
Concentration: direct ---- 50 mg/ml
Intermittent ---- 1.5mg/ml
Continuous ---- 1.8 mg/ml
Amiodarone
Lab to monitor: liver and thyroid functions before and every 6 months during therapy
Monitor AST, ALT, and alkane phosphatase
Side effects: ARD, pulmonary fibrosis, CHF, bradycardia, dizziness, headache, neuropathy, tremor, ataxia, photosensitivity, hypotension, N/V, constipation
Drug-Drug: Macrolides, antifungal increase risk of QT prolongation
Increase levels of class I antiarrythmics
Increase activity of Warfarin
Increase risk of bradyarrhythmias, sinus arrest, or AV heart block with beta blockers of calcium channel blockers
Precautions/Special considerations:
Monitor ECG continuously
Assess for signs of pulmonary toxicity (crackles, decreased breath sounds, friction rub, fatigue)
Assess for s/s of ARDS (dyspnea, rales/crackles bilaterally)
Monitor B/P
Opthalmic exams should be performed before and during therapy
May be administered with food and in divided doses if GI irritation occurs
Clopidogrel (Plavix)
Indication: reduction of atherosclerosis events
Class: anti-platelet
Lab to monitor:
Bleeding time
CBC
Platelet count
Bilirubin, hepatic enzymes, cholesterol, non protein nitrogen, uric acid (may increase)
Side effects: depression, cough, GI bleeding, Neutropenia, fever, chest pain, hypertension, edema
Drug-Drug: Aspirin, heparin, warfarin may increase bleeding risks
NSAID may decrease absorption
Omeprazole or fluvoxamine may decrease effects
Precautions/Special considerations:
Assess for symptoms of stroke, MI, vascular disease during therapy
Monitor for signs of thrombocytopenia, anemia, renal dysfunction, fever
D/C 5-7 days before surgery
Salicylism signs
tinnitus
dizziness
hyperpnea
psychological disturbances
Mafenide acetate (Sulfamylon) needs to be monitored for what systemic effect?
hyperventilation

-d/c med for 1-2 days
Isotretinoin (Accutane) needs to be monitored for____ levels bc it can elevate _______ levels.
triglyceride
Bleomycin is an antineoplastic med that can cause interstitial pneumonitis which can progress to_____ thus monitor ____ function studies as well as hematological, hepatic, & renal function tests.
pulmonary fibrosis; pulmonary
Busulfan is given to a pt w/ acute myelocytic leukemia; what needs to be monitored?
uric acid level
Hyperuricemia can produce
uric acid
nephropathy
renal stones
acute renal failure
main SE of etoposide (Toposar) given to pt w/ small cell lung cancer
orthostatic hypotension
Major SE of Vincristine (Oncovin, Vincasar) given to pt w/ ovarian cancer
peripheral neuropathy
Asparaginase (Elspar), an antineoplastic med is contraindicated for pts w/
hypersensitivity
pancreatitis
hx of pancreatitis
what tests need to be done w/ Asparaginase (Elspar), an antineoplastic med
pancreatic function tests
signs of pancreatitis
n/v
abdominal pain
during treatment of Tamoxifen given to breast cancer pt, monitior what
calcium
cholesterol
triglceride levels
CBC
platelet
during treatment of Tamoxifen given to breast cancer pt, watch for
hypercalcemia
signs of hypercalcemia
increased urine volume
excessive thirst
n/v
constipation
hypotonicity of muscles
deep bone pain
flank pain
Megestrol acetate (Megace), an antineoplastic med is used w/ caution in pts w/
thrombophlebitis
what is common following treatment for leukemias & lymphomas bc chemotherapy results in massive cell kill
hyperuricemia or increased uric acid level
Cyclophosphamide for breast cancer needs to be monitored for
hematuria
adverse effect of Cyclophosphamide for breast cancer
Hemorrhagic cystitis
Glimepiride (Amaryl) and alcohol can cause what reaction
disulfiram like reaction
disulfiram reaction
flushing
palpitations
nausea
Exenatide (Byetta) is an incretin mimetic used only for
DM type 2
Desmopressin acetate is prescribed for diabetes insipidus what is the therapeutic response of the med?
decreased urinary output
adverse result of Desmopressin acetate
water intoxication aka overhydration
hyponatremia
earl signs of water intoxification (overhydration, hyponatremia)
drowsiness
listelessness
headache
all signs of water intoxification (overhydration, hyponatremia)
drowsiness
listelessness
headache
decreased urination
rapid weight gain
confusion
seizures
coma
Levothyroxine (Synthroid) needs to be taken
on an empty stomach
Excessive doses of levothyroxine (Synthroid) produce signs of
hyperthyroidism
Hyperthyoidism signs
tachycardia
chest pain
tremors
nervousness
insomnia
hyperthermia
heat intolerance
sweating
Hypothyroidism signs
fatigue
cold intolerance
excessively dry skin
Propylthiouracil (PTU) is used to treat
hyperthyroidism or Grave's disease
Myexdema indicates
hypothyroidism
best time to take corticosteroids
before 9 am or early morning
glucocorticoids elevate
blood glucose levels
pts w/ DM taking insulin or oral hypoglycemics and taking glucocorticoid therapy will need
their insulin or oral hypoglycemic meds increased
common SE of Metformin is
diarrhea
Repaglinife (Prandin) common SE
hypoglycemia
pt w/ Crohn's disease takes infliximab (Remicade) how can the RN determine the effectiveness of treatment?
check frequency & consistency of bowel movements which inflammation in the colon will reduce thus reducing diarrhea
loperamide hydrochloride (Imodium) is used to treat
diarrhea
Cimetidine, histamine (H2) receptor antagonist, most common SE in older/elderly pt
confusion
Sucralfate (Carafate), gastric protectant, should be given
one hour before meals & at bedtime;

time is given to allow a protective coating over the ulcer before food intake stimulates gastric acid production & mechanical irritation
Misoprostol, gastric protectant, is given specifically to pts who use what drugs chronically?
NSAIDS
what is included in the triple therapy for Helicobacter pylori infection
2 antibacterial drugs & a proton pump inhibitor like Esomeprazole (Nexium)
Metoclopramide (Reglan) is an antiemetic as well as a GI stimulant; bc it is a GI stimulant , this med is not given to pts w/
GI obstruction
hemorrhage
perforation
Cholestyramine (Questran) is a bile acid sequestrant used to lower the cholestrol level and pt compliance is low due to
poor taste and patability
H2 receptor antagonists suppress secretion of GI acid, alleviate symptoms of heartburn and assist in preventing complications of peptic ulcer disease.

These meds have an ending of
"tidine"
Proton pump inhibitors have an ending of
"prazole"
Guaifenesin (Mucinex) needs to be monitored for _____ that lasts longer than 1 week or is accompanied by fever, rash, sore throat, persistent headache; notify MD
cough
The uses of Diphenhydramine (Benadryl)
antihistamine
antitussive (cough suppressant)
antidyskinetic
sedative-hypnotic
Cromolyn sodium (Intal) is an inhaled nonsteroidal antiallerg agent & mast cell stabilizer; what is the major adverse effect?
Bronchospasm
Cough
Nasal congestion
throat irritation
wheezing
Terbutaline is a bronchodilator and is used w/ caution in
impaired cardiac function
DM
HTN
Hyperthryroidism
Hx of seizures
Zafirlukast (Accolate) is a leukotriene receptor antagonists used in prophylaxis and long term treatment of bronchial asthma; what lab test is done before admin?
Liver function tests
common SE of INH
peripheral neuritis
peripheral neuritis signs
numbness
tingling
paresthesias in extremities
SE of peripheral neuritis from INH can be minimized w/
vitamin B6
INH is hepatotoxic; what are signs of hepatitis
yellow skin
yellow sclera
What is important to know about pt taking Rifampin (Ridadin) long term?
causes orange discoloration of sweat, tears, urine, feces.
Ethambutol (Myambutol) causes optic neuritis which does what
decreases visual acuity & the ability to discriminate between the colors red and green.
Streptomycin -major thing to look for?
impaired sense of hearing
before starting INH, the nurse gathers a baseline of what lab?
liver enzyme levels
Theophylline is a methylxanthine bronchodilator and needs to limit xanthine containing foods like
coffee
cola
chocolate
Omalizumab is an anti-inflammatory used for long term control of asthma;

what major reaction can occur w/ admin of this med?
anaphylactic reactions
therapeutic Digoxin (Lanoxin) level
0.5-2 ng/mL
Procainamide (Procanbid) given for cardiac dysrhythmia;

what are signs of toxicity of Procainamide (Procanbid)?
confusion
dizziness
drowsiness
decreased urination
n/v
tachydysrhythmias
Propranolol (Inderal) major adverse reaction?
Bronchospasm
What manifestation in a COPD or asthma pt taking Propanolol (Inderal), a beta blocker, show that they have bronchospasm?
audible expiratory wheezes
major complication of thrombolytic med?
hemorrhage
Before giving a thiazide diuretic like hydrochlorothiazide ask if they are allergic to?
sulfa
Pts taking a thiazide diuretic like hydrochlorothiazide are at risk for
hypokalemia
hyperglycemia
hypercalcemia
hyperlipidemia
hyperuricemia
Cholestyramine (Questran) & ________ (Niacin) need to be avoided
nicotinic acid
how can flushing that is caused by Nicotinic acid (Niacin) given for hyperlipidemia be prevented?
Aspirin or NSAID like Ibuprofen (Motrin) taken 30 min before med
early signs of Digoxin toxicity
double vision
loss of appetite or anorexia
nausea/ vomiting
diarrhea
all signs of digoxin toxicity, a cardiac glycoside
double vision
loss of appetite
nausea
bradycardia
difficulty reading
green or yellow vision
seeing spots
halos
confusion
vomiting
diarrhea
decreased libido
impotence
common SE of Bumetanide (Bumex)
hypotension; thus monitor BP
antidote for heparin
protamine sulfate
antidote for Coumadin
vitamin K
antidote for aminocaproic acid
thrombolytic therapy
what is given for potassium deficit
potassium chloride
Thrombolytic therapy is contraindicated in what conditions
risk of uncontrolled bleeding
severe uncontrolled HTN
before intiating thrombolytic therapy an important vital signs is
blood pressure
What is the effect of Nalidixic acid (Neg gram) and warfarin sodium (Coumadin)?
Nalidixic acid intensifies the effects of the oral anticoagulant.
W/ Nalidixic acid, Coumadin should be
decreased
Sulfisoxazole needs to be given w/
full glass of water
Trimethoprim- sulfamethoxazole (Bactrim) ; most important thing to look for
blood disorders
early signs of blood disorders
sore throat
fever
pallor
Bethanechol chloride (Urecholine) can be hazardous to pts w/
urinary tract obstruction
weakness of the bladder wall

bc elevation of pressure within the urinary tract could rupture the bladder in pts w/ these conditions
Overdose (toxicity) of bethanechol chloride manifestations
excessive muscarinic stimulation :
-salivation
- sweating
- involuntary urination
- defecation
- bradycardia
- severe hypotension
treatment of Bethanechol chloride (Urecholine)
atropine sulfate subc or IV
excessive muscarinic stimulation signs
-salivation
- sweating
- involuntary urination
- defecation
- bradycardia
- severe hypotension
Overdose (Toxicity) of oxybutnin chloride
Hypotension or Hypertension
Confusion
Tachycardia
Flushed or red face
Signs of Resp Depression
CNS excitation like
-nervousness
-hallucinations
-irritability
Cyclosporine (Sandimmune) given after kidney transplantation needs to be monitored for nephrotoxicity;

what labs are monitored for signs of nephrotoxicity?
Elevated blood urea nitrogen
Elevated creatinine levels
Tacrolimus (Prograf) is used in caution in pts w/
immunosuppressed
renal function impairment
hepatic function impairment
pancreatic function impairment
Therapeutic effect of Epoetin alfa (Epogen, Procrit) ??

Epoetin alfa is used to reverse anemia associated w/ chronic renal failure
hematocrit between 30-33%
With high Carbidopa-levodopa (Sinemet) levels what can occur?
Dyskinesia and impaired voluntary movement
Phenytoin and birth control pills: what do you need to know?
Phenytoin can decrease the effectiveness of birth control pills
antidote for acetaminophen (Tylenol)
acetylcysteine (Mucomyst)
normal acetaminophen (Tyelnol) therapeutic serum level
10-20 mcg/mL
What is the gold preparation used to treat rheumatoid arthritis?
Auranofin (Ridaura)
normal direct bilirubin level
0-0.3 mg/dL
normal platelet count
150,000 - 400,000 mm
normal prothrombin time
10-13 seconds
phenytoin therapeutic level
10-20 mcg/mL
phenytoin level of 20 mcg/mL or higher the pt will show signs of
nystagmus (involuntar movements of the eyeballs)
phenytoin level of 30 mcg/mL or higher the pt will show signs of
ataxia & slurred speech
Mild intoxication w/ acetylsalicylic acid (aspirin) is called salicylism and is experienced when daily dose is higher than
4 g or 4000 mg
what is the systemic manifestation in a pt w/ salicylism
hyperventilation
what is the major adverse effects of carbamazepine (Tegretol)
blood dyscrasias
what do blood dyscrasias include?
aplastic anemia
agranulocytosis
thrombocytopenia
thrombophlebitis
dysrhythmias
dermatological effects
antacids are given
after meals
oral steroids are given
with meals to decrease GI irritation
cholinergic crisis when there is
an overdose of Edrophoium (Tensilon) med
A pt w/ Myasthenia gravis becomes increasingly weaker and is given Edrophonium (Tensilon) and the symptoms improve.. what crisis is this?
Myasthenic crisis
Major SE of Etabercept (Enbrel) for rheumatoid arthritis
infection & pancytopenia; monitor WBC counts & platelets
most important nursing intervention for Allopurinol (Zyloprim)
drink 3000 mL of fluid daily
Colchicine given for gout is used w/ caution in pts w/
old age
debilitated pts
pts w/ cardiac disease
renal disease
GI disease
Major adverse effect of Alendronate (Fosamax)
esophageal irritation
Major teaching w/ Alendronate (Fosamax)
Do not eat or drink anything for 30 min after meds; do not lie down; take med w/ full glass of water after rising in the morning
Dantrolene sodium (Dantrium) major adverse effect
liver damage; thus monitor liver function tests
Cyclobenzaprine hydrochloride (Flexeril) for muscle spasms has anticholinergic effects and is used in caution w/
urinary retention
glaucoma
increased intraocular pressure
IV admin of Methocarbarnol (Robaxin) for multiple sclerosis can cause
hypotension
bradycardia
Major adverse effect of Clozapine (Clozaril)
agranulocytosis

monitor WBC count

treatment is stopped if WBC under 3000
Tardive dyskinesia signs
uncontrollable involuntar movements of the body & extremities, particulary the tongue
Parkinsonism signs
tremors
mask-like facies
rigidity
shuffling gait
hypertensive crisis signs
hypertension
occipital headache
readiating frontanlly
neck stiffness
soreness
n/v
MAOI major adverse effect
hypertensive crisis
neuroliptic malignant syndrome
Dyspnea or tachypnea
tachycardia
irregular pulse rate
fever
BP changes
increased sweating
loss of bladder control
skeletal muscle rigidty
neuroliptic malignant syndrome occurs in what meds
antipsychotic
SE of Fluoxetine (Prozac)
CNS and GI dysfunction
maintenance serum levels of lithium are
0.6- 1.2 mEq/L
Clomipramine (Anafranil) is a tricyclic antidepressant used for
OCD
Bupropion (Wellbutrin) causes toxicity when levels are greater than 450 mg/day; what do you need to look for when looking for toxicity
seizure activity
Phenelzine (Nardil) is a Monoamine oxidase inhibitor (MAOI) what type of foods need to be avoided bc it can cause hypertensive crisis?
Tyramine like yogurt, aged cheeses, smoked or processed meats, red wines, and fruits like avocados, raisins, or figs
Warfarin (Coumadin) & Levothyroxine (Synthroid) what dose needs to be changed when in use with the other?
Decrease the Warfarin (Coumadin) dose

bc Levothyroxine (Synthroid) enhances the effects of Warfarin ( Coumadin)
an insulin vile in current use can be kept at room temp for
1 month
most common SE of metformin (Glucophage) is
GI disturbances like
- decreased appetite or anorexia
-nausea
-diarrhea
Desmopressin is an ANTI-diuretic hormone used in treatment of diabetes insipidus; it causes
water reabsorption
Sulfonlureas
promote insulin secretion by the pancreas and may increase tissue response to insulin
Biguanides
decrease glucose production by the liver
Alpha glucosidease inhibitors
inhibit carbohydrate digestion
Thiazolidinediones
decrease insulin resistance
Isoproterenol hydrochloride is a adrenergic bronchodilator ; what are the SE
tachycardia
hypertension
chest pain
dysrhythmias
nervousness
restlessness
headache
increased pulse
increased BP
Bethanechol chloride (Urecholine ) can cause nausea & vomiting when should the pt take the med
2 hours after meals
Fludrocortisone acetate (Florinef Acetate) is given for Addison's disease; what is the primary action
enhances the REABSORPTION of sodium & chloride ions in the distal tubules of the kidney

** promotes water retention
Succimer (Chemet) given for lead poisoning

specifically for Chelatin therapy,what needs to be monitored and what lab?
renal function bc med is excreted by kidneys

monitor BUN level
Ribavirin given to a HOSPITALIZED child w/ respiratory syncytial virus (RSV) cannot be given orally, intramuscularly or subc, how is it given?
hood
face mask
oxygen tent
for child w/ HIV who have a positive Mantoux test result, what is the minimum months of treatment?
12 months
Corticosteroid therapy can cause
calcium depletion
potassium depletion
sodium retention
glucose intolerance
increased blood glucose levels
What should the nurse do innitially if there are crystal formations in the mannitol solution?
Place the vial in warm water

**bc it will quickly dissolve if the container is placed in warm water then cooled to body temp before admin
What should the nurse do if after placing the mannitol w/ crystal formation does not dissolve in warm water?
return to pharm; do not use
Ataxia from ototoxicity reflects damage from what cranial nerve
eighth
Lindane is prescribed for scabies; what preexisiting condition is high risk for adverse effect of seizures?
seizure hx
What med is used to treat known or suspected ethylene glycol (antifreeze) intoxication?
Fomepizole (Antizol)
Fomepizole (Antizol) given for treatment of known or suspected ethylene glycol (antifreeze) intoxication;

The RN recieves the med and it has solidified, what to do?
run the vial under warm water
Fomepizole (Antizol) given for treatment of known or suspected ethylene glycol (antifreeze) intoxication is given w/ what type of IV fluid over a 30 min period?
isotonic

0.9% Normal saline

5% dextrose in water
Irbesartan (Avapro) given for Hypertension is what type of med?
Angiotension II type 1 receptor antagonist
what is used to treat a bladder spasm after prostatectomy?
Antispasmodic meds like

Belladonna & opium (B&O) suppository

OR

propantheline bromide (Pro-Banthine)
Epoetin alfa (epogen, procrit) given to treat anemia in renal failure can be given IV or
subcutaneously
what gauge is used for heparin or enoxaparin subc?
25-27
what size needle is used for heparin or enoxaparin subc?
5/8 inch
"pril" is the ending for drugs that are
ACE inhibitors
serious SE of ACE inhibitor drugs
hypotension

monitor BP
when are thrombolytics like streptokinase most effective?
within 4-6 hours after onset of symptoms
What is the antidote for Warfarin (Coumadin)?
Phytonadione a.k.a Vitamin K
Ticlopidine (Ticlid) is an antiplatelet med given to prevent thrombotic stroke

what is the major adverse effect of Ticlopidine (Ticlid)?
neutropenia
neutropenia
abnormally small number of MATURE white blood cells
A pt given Ticlopidine (Ticlid) needs to be monitored for neutropenia development thus a nurse should monitor
CBC count
Before giving Ticlopidine (Ticlid) what baseline labs does a RN need?
CBC count
Ticlopidine (Ticlid) can cause GI SE and should be given
with meals
neutropenia is aka?
agranulocytosis
pt taking Ticlopidine (Ticlid) will often develop neutropenia within
first 3 months of therapy
Phenobarbital sodium (Luminal) is both a
barbiturate & antiseizure med
Dantrolene sodium (Dantrium) given for spasticity, what is the oral maintenance dosage?
100 mg two to four times daily
a pt being changed from oral to inhalation glucocorticoids could experience signs of
adrenal insufficiency
adrenal insufficiency signs
anorexia
nausea
weakness
fatigue
hypotension
hypoglycemia
signs of opiod withdrawl
increased temp
increased BP
abdominal cramping
vomiting
restlessness
Food can hamper absorption w/ Norfloxacin (Noroxin) given for UTI, when should it be given?
1 hour before meals
OR 2 hours after meals
Nitrofurantoin (macrodantin) given for acute UTI , what is the adult dosage
50 mg every 6 hours
Nitrofurantoin (macrodantin) given for acute UTI , what is the adult dosage for prophylaxis or recurrent UTI?
50-100m mg at bedtime
Nalidixic acid (Neg Gram) given for UTI , what are normal adult dosage for this med?
1 g four times daily for a period of 1 week.
normal adult dosage for Bethanechol chloride (Urecholine) for post-op bladder spasm
10-50 mg three to four times a day
the injectable form of Bethanechol chloride (Urecholine) is given
subc
most significant adverse effect of Epoetin alfa (Epogen, Procrit) is?
Hypertension
Epoetin alfa (Epogen, Procrit) can show a therapeutic effect in
increase in hematocrit will show in 2 weeks after therapy
Aluminum hydroxide (Amphojel), an antacid, is given
w/ meals
Major SE of Aluminum hydroxide (Amphojel), an antacid, is
constipation
Ferrous sulfate (Feosol) is an iron supplement used to treat anemia what is the common SE?
constipation
what opioid analgesic is given to pts SPECIFICALLY after craniotomy & why?
Codeine sulfate

bc it does not alter respirations or mask neurological signs as do other opioids
what is given first: eye drops or eye ointment?
eye drops
Itraconazole (Sporanox) given for fungal infection of the hands needs to be monitored for what adverse effect?
Hepatitis
signs of hepatitis
urine becomes very dark in color
anorexia
abdominal pain
unusual tiredness
weakness
jaundice develops
Kanamycin sulfate (Kantrex) given for respiratory tract infection, what are the adverse reactions?
nephrotoxicity
irreversible ototoxicity
neurotoxicity
nephrotoxicity
increased BUN
increased creatinine
phentoin (Dilantin) is hung with what IV solution?
0.9% sodium chloride (NS)
SE of Meperidine hydrochloride are
respiratory depression
orthostatic hypotension
tachycardia
drowsiness
mental clouding
constipation
urinary retention
what diet is prescribed to prevent constipation?
high fiber diet & stool softners & increase fluid intake
Dantrolene (Dantrium) is a skeletal muscle relaxant and can cause
liver damage; thus monitor liver function studies
Dexamethasone (Decadron) is mixed with what IV solution?
50-100 mL of 0.9% sodium chloride (NS) OR
5% dextrose in water
most important teaching of tetracycline intake
stains teeth; use straw
important teaching of Allopuinol (Zyloprim) intake
encourage 3000 mL to prevent formations of crytsals in urine
Probenecid given for gout to inhibit reabsorption of uric acid by the kidney and promote excretion of uric acid needs to avoid what type of food intake?
High purine foods like
- organ meats
-sardines
-scallops
-anchovies
-broth
-mincemeat
-herring
-shrimp
-gravy
-yeast
Auranofin (Ridaura) is a gold preparation that is given orally for rheumatoid arthritis,

what are the early signs & symptoms of toxic reaction of Auranofin (Ridaura) ?
rash
purple blotches
pruritus
mouth lesions
metallic taste in mouth
Ibuprofen (Motrin) given to an older adult w/ rheumatoid arthritis or osteoarthritis , what is the normal oral dose?
400-800 mg three or four times a day

1200-3200 mg/day
Baclofen (Lioresal) is a skeletal muscle relaxant and decreases muscle spasms in pts w/ spinal cord
a skeletal muscle relaxant and decreases muscle spasms in pts w/ spinal cord
major SE of Baclofen (Lioresal)
urinary retention
Major adverse effect of Asparaginase (Elspar), an antineoplastic med
prolonged blood clotting times
How do you apply Crotamiton (Eurax) used for scabies?
-Massage the med into the skin from the chin downward.

-apply a second application in 24 hours

-followed by a cleansing bath 48 hours after the second applications

-if needed treatment can be repeated in 7 days
Teaching about Metronidazole (Flagl)
darkening of the urine may occur and is harmless
signs of developing pancreatitis
increased serum amylase
increased serum triglycerides
decreased serum calcium
nausea
vomiting
abdominal pain radiating to the back
what major disease can develop due to toxicity of Didanosine (Videx) ?
pancreatitis
Adverse effect w/ Zalcitabine
peripheral neuropathy
Amphotericin B (Fungizone) major adverse reaction
renal impairment

monitor kidney function; watch for elevated serum creatinine
If the serum creatinine level rises above ____ mg/dL, the dose of Amphotericin B (Fungizone) should be reduced
3.5 mg/dL
w/ Bleomycin, it is a priority to assess lung sound and pulmonary function studies bc
pneumonitis can manifest leasing to severe pulmonary fibrosis
Vincristine (Oncovin), anticancer med, major adverse effect?
peripheral neuropathy like weakness and sensory loss in the legs

-decreased refleces
-weakness
-paresthesia
-sensory loss
If GI systems occur Oral erythromycin can be given w/meals but it is BEST given
empty stomach w/ full glass of water
Azithromycin (Zithromax) given for chlamydial infection is given
1 hour before meals or 2 hours after
Bethanechol chloride (Urecholine) is a direct acting muscarinic agonists (cholinergic medication) and can cause
hypotension
vasodilation
bradycardia
excess salivation
increased secretion of gastric acid
abdominal cramps
diarrhea
what is the antidote for bethanechol chloride (Urecholine); a med that causes a cholinergic reaction
atropine sulfate
Atropine sulfate causes mydriasis and cycloplegia and is contraindicated in
narrow angle glaucoma
mydriasis
dilation of the pupils
cycloplegia
relaxation of the ciliary muscles
What is the antidote in a cholinergic crisis?
Atropine sulfate
When performing a Tensilon test, the RN obtains Edrophonium (Tensilon) and what antidote?
Atropine sulfate
Prazosin hydrochloride is an ANTI-hypertensive med , what manifestation determines a benefit of therapy
decreased BP
Clonidine is an ANTI-hypertensive med that is applied to a hairless intact skin area of the upper arm or torso and changed?
every 7 days
Phenytoin (Dilantin) therapeutic serum level
10-20 mcg/mL
IV admin of phenytoin (Dilantin) is performed slowly and no faster than
50 mg/min

**bc rapid admin can cause cardiovascular collapse
Before giving Valproic acid (Depakene), look at what results first?
liver function tests
Before giving Carbamazepine (Tegretol), look at what lab results first?
CBC count

**bc leukopenia, anemia, thrombocytopenia can occur
Dantrolene sodium (Dantrium) major adverse effect?
hepatotoxic
signs of liver dysfunction
jaundice
abdominal pain
malaise
Protamine sulfate is the antidote for
heparin
what is the antidote for heparin?
Protamine sulfate
Atropine sulfate is what type of med
anticholinergic
Ergotamine tartrate (Cafergot) is used
to stop an ongoing migraine attack
OR treat cluster headaches
Spironolactone (Aldactone) is what type of diuretic?
k sparing diuretic
main adverse effect of Spironolactone (Aldactone), a diuretic
Hyperkalemia
Moexipril, an ACE inhibitor, is given
1 hour before meals
What 2 ACE inhibitors are given 1 hour before meals?
Moexipril (Univasc) & Captopril (Capoten)
Major adverse effect w/ Potassium iodide solution (Lugol's solution)?
Iodism
signs of Iodism
brassy taste
burning sensation in the mouth
soreness of the gums & teeth
if signs of Iodism occur when taking potassium iodide solution (Lugol's solution), what should the nurse instruct the pt to do?
report symptom to MD
Abacavir is used to treat
HIV infection
A newly admitted client takes digoxin 0.25 mg/day. The nurse knows that which is the serum therapeutic range for digoxin?
a. 0.1 to 1.5 ng/mL
b. 0.5 to 2.0 ng/mL
c. 1.0 to 2.5 ng/mL
d. 2.0 to 4.0 ng/mL
b. 0.5 to 2.0 ng/mL
The client's serum digoxin level is 3.0 ng/mL. What does the nurse know about this serum digoxin level?
a. It is in the high (elevated) range.
b. It is in the low (decreased) range.
c. It is within the normal range.
d. It is in the low average range.
a. It is in the high (elevated) range.
The nurse is assessing the client for possible evidence of digitalis toxicity. The nurse acknowledges that which is included in the signs and symptoms for digitalis toxicity?
a. Pulse (heart) rate of 100 beats/min
b. Pulse of 72 with an irregular rate
c. Pulse greater than 60 beats/min and irregular rate
d. Pulse below 60 beats/min and irregular rate
d. Pulse below 60 beats/min and irregular rate
The client is also taking a diuretic that decreases her potassium level. The nurse expects that a low potassium level (hypokalemia) could have what effect on the digoxin?
a. Increase the serum digoxin sensitivity level
b. Decrease the serum digoxin sensitivity level
c. Not have any effect on the serum digoxin sensitivity level
d. Cause a low average serum digoxin sensitivity level
a. Increase the serum digoxin sensitivity level
When a client first takes a nitrate, the nurse expects which symptom that often occurs?
a. Nausea and vomiting
b. Headaches
c. Stomach cramps
d. Irregular pulse rate
b. Headaches
The nurse acknowledges that beta blockers are as effective as antianginals because they do what?
a. Increase oxygen to the systemic circulation.
b. Maintain heart rate and blood pressure.
c. Decrease heart rate and decrease myocardial contractility.
d. Decrease heart rate and increase myocardial contractility.
c. Decrease heart rate and decrease myocardial contractility.
The health care provider is planning to discontinue a client's beta blocker. What instruction should the nurse give the client regarding the beta blocker?
a. The beta blocker should be abruptly stopped when another cardiac drug is prescribed.
b. The beta blocker should NOT be abruptly stopped; the dose should be tapered down.
c. The beta blocker dose should be maintained while taking another antianginal drug.
d. Half the beta blocker dose should be taken for the next several weeks.
b. The beta blocker should NOT be abruptly stopped; the dose should be tapered down.
The beta blocker acebutolol (Sectral) is prescribed for dysrhythmias. The nurse knows that what is the primary purpose of the drug?
a. To increase the beta1 and beta2 receptors in the cardiac tissues
b. To increase the flow of oxygen to the cardiac tissues
c. To block the beta1-adrenergic receptors in the cardiac tissues
d. To block the beta2-adrenergic receptors in the cardiac tissues
c. To block the beta1-adrenergic receptors in the cardiac tissues
A client is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. What type of electrolyte imbalance does the nurse expect to occur?
a. Hypocalcemia
b. Hypokalemia
c. Hyperkalemia
d. Hypermagnesemia
b. Hypokalemia
What would cause the same client's electrolyte imbalance?
a. High dose of digoxin
b. Digoxin taken daily
c. Hydrochlorothiazide
d. Low dose of hydrochlorothiazide
c. Hydrochlorothiazide
A nurse is teaching a client who has diabetes mellitus and is taking hydrochlorothiazide 50 mg/day. The teaching should include the importance of monitoring which levels?
a. Hemoglobin and hematocrit
b. Blood urea nitrogen (BUN)
c. Arterial blood gases
d. Serum glucose (sugar)
d. Serum glucose (sugar)
A client has heart failure and is prescribed Lasix. The nurse is aware that furosemide (Lasix) is what kind of drug?
a. Thiazide diuretic
b. Osmotic diuretic
c. High-ceiling (loop) diuretic
d. Potassium-sparing diuretic
c. High-ceiling (loop) diuretic
The nurse acknowledges that which condition could occur when taking furosemide?
a. Hypokalemia
b. Hyperkalemia
c. Hypoglycemia
d. Hypermagnesemia
a. Hypokalemia
For the client taking a diuretic, a combination such as triamterene and hydrochlorothiazide may be prescribed. The nurse realizes that this combination is ordered for which purpose?
a. To decrease the serum potassium level
b. To increase the serum potassium level
c. To decrease the glucose level
d. To increase the glucose level
b. To increase the serum potassium level
The client has been receiving spironolactone (Aldactone) 50 mg/day for heart failure. The nurse should closely monitor the client for which condition?
a. Hypokalemia
b. Hyperkalemia
c. Hypoglycemia
d. Hypermagnesemia
b. Hyperkalemia
A client who has angina is prescribed nitroglycerin. The nurse reviews which appropriate nursing interventions for nitroglycerin? (Select all that apply.)
a. Have client lie down when taking a nitroglycerin sublingual tablet.
b. Teach client to repeat taking a tablet in 5 minutes if chest pain persists.
c. Apply Transderm-Nitro patch to a hairy area to protect skin from burning.
d. Call the health care provider after taking 5 tablets if chest pain persists.
e. Warn client against ingesting alcohol while taking nitroglycerin.
a. Have client lie down when taking a nitroglycerin sublingual tablet.
b. Teach client to repeat taking a tablet in 5 minutes if chest pain persists.
e. Warn client against ingesting alcohol while taking nitroglycerin.
A client's blood pressure (BP) is 145/90. According to the guidelines for determining hypertension, the nurse realizes that the client's BP is at which stage?
a. Normal
b. Prehypertension
c. Stage 1 hypertension
d. Stage 2 hypertension
c. Stage 1 hypertension
The nurse acknowledges that the first-line drug for treating this client's blood pressure might be which drug?
a. Diuretic
b. Alpha blocker
c. ACE inhibitor
d. Alpha/beta blocker
a. Diuretic
The nurse is aware that which group(s) of antihypertensive drugs are less effective in African-American clients?
a. Diuretics
b. Calcium channel blockers and vasodilators
c. Beta blockers and ACE inhibitors
d. Alpha blockers
c. Beta blockers and ACE inhibitors
The nurse knows that which diuretic is most frequently combined with an antihypertensive drug?
a. chlorthalidone
b. hydrochlorothiazide
c. bendroflumethiazide
d. potassium-sparing diuretic
b. hydrochlorothiazide
The nurse explains that which beta blocker category is preferred for treating hypertension?
a. Beta1 blocker
b. Beta2 blocker
c. Beta1 and beta2 blockers
d. Beta2 and beta3 blockers
a. Beta1 blocker
Captopril (Capoten) has been ordered for a client. The nurse teaches the client that ACE inhibitors have which common side effects?
a. Nausea and vomiting
b. Dizziness and headaches
c. Upset stomach
d. Constant, irritating cough
d. Constant, irritating cough
A client is prescribed losartan (Cozaar). The nurse teaches the client that an angiotensin II receptor blocker (ARB) acts by doing what?
a. Inhibiting angiotensin-converting enzyme
b. Blocking angiotensin II from AT1 receptors
c. Preventing the release of angiotensin I
d. Promoting the release of aldosterone
b. Blocking angiotensin II from AT1 receptors
During an admission assessment, the client states that she takes amlodipine (Norvasc). The nurse wishes to determine whether or not the client has any common side effects of a calcium channel blocker. The nurse asks the client if she has which signs and symptoms? (Select all that apply.)
a. Insomnia
b. Dizziness
c. Headache
d. Angioedema
e. Ankle edema
f. Hacking cough
b. Dizziness
c. Headache
e. Ankle edema
When a newly admitted client is placed on heparin, the nurse acknowledges that heparin is effective for preventing new clot formation in clients who have which disorder(s)? (Select all that apply.)
a. Coronary thrombosis
b. Acute myocardial infarction
c. Deep vein thrombosis (DVT)
d. Cerebrovascular accident (CVA) (stroke)
e. Venous disorders
a. Coronary thrombosis
b. Acute myocardial infarction
c. Deep vein thrombosis (DVT)
d. Cerebrovascular accident (CVA) (stroke)
e. Venous disorders
A client who received heparin begins to bleed, and the physician calls for the antidote. The nurse knows that which is the antidote for heparin?
a. protamine sulfate
b. vitamin K
c. aminocaproic acid
d. vitamin C
a. protamine sulfate
A client is prescribed enoxaparin (Lovenox). The nurse knows that low-molecular-weight heparin (LMWH) has what kind of half-life?
a. A longer half-life than heparin
b. A shorter half-life than heparin
c. The same half-life as heparin
d. A four-times shorter half-life than heparin
a. A longer half-life than heparin
The nurse is teaching a client about clopidogrel (Plavix). What is important information to include?
a. Constipation may occur.
b. Hypotension may occur.
c. Bleeding may increase when taken with aspirin.
d. Normal dose is 25 mg tablet per day.
c. Bleeding may increase when taken with aspirin.
A client is prescribed dalteparin (Fragmin). LMWH is administered via which route?
a. Intravenously
b. Intramuscularly
c. Intradermally
d. Subcutaneously
d. Subcutaneously
A client is being changed from an injectable anticoagulant to an oral anticoagulant. Which anticoagulant does the nurse realize is administered orally?
a. enoxaparin sodium (Lovenox)
b. warfarin (Coumadin)
c. bivalirudin (Angiomax)
d. lepirudin (Refludan)
b. warfarin (Coumadin)
A client is taking warfarin 5 mg/day for atrial fibrillation. The client's international normalized ratio (INR) is 3.8. The nurse would consider the INR to be what?
a. Within normal range
b. Elevated INR range
c. Low INR range
d. Low average INR range
b. Elevated INR range
Cilostazol (Pletal) is being prescribed for a client with coronary artery disease. The nurse knows that which is the major purpose for antiplatelet drug therapy?
a. To dissolve the blood clot
b. To decrease tissue necrosis
c. To inhibit hepatic synthesis of vitamin K
d. To suppress platelet aggregation
d. To suppress platelet aggregation
A client is to undergo a coronary angioplasty. The nurse acknowledges that which drug is used primarily for preventing reocclusion of coronary arteries following a coronary angioplasty?
a. clopidogrel (Plavix)
b. abciximab (ReoPro)
c. warfarin (Coumadin)
d. streptokinase
b. abciximab (ReoPro)
A client is admitted to the emergency department with an acute myocardial infarction. Which drug category does the nurse expect to be given to the client early for the prevention of tissue necrosis following blood clot blockage in a coronary or cerebral artery?
a. Anticoagulant agent
b. Antiplatelet agent
c. Thrombolytic agent
d. Low-molecular-weight heparin (LMWH)
c. Thrombolytic agent
A client has a serum cholesterol level of 265 mg/dL, triglyceride level of 235 mg/dL, and LDL of 180 mg/dL. What do these serum levels indicate?
a. Hypolipidemia
b. Normolipidemia
c. Hyperlipidemia
d. Alipidemia
c. Hyperlipidemia
The nurse knows that the client's cholesterol level should be within which range?
a. 150 to 200 mg/dL
b. 200 to 225 mg/dL
c. 225 to 250 mg/dL
d. Greater than 250 mg/dL
a. 150 to 200 mg/dL
A client's high-density lipoprotein (HDL) is 60 mg/dL. What does the nurse acknowledge concerning this level?
a. It is lower than the desired level of HDL.
b. It is the desired level of HDL.
c. It is higher than the desired level of HDL.
d. It is a much lower HDL level than desired.
b. It is the desired level of HDL.
The nurse realizes that which is the laboratory test ordered to determine the presence of the amino acid that can contribute to cardiovascular disease and stroke?
a. antidiuretic hormone
b. homocysteine
c. ceruloplasmin
d. cryoglobulin
b. homocysteine
A client is taking lovastatin (Mevacor). Which serum level is most important for the nurse to monitor?
a. Blood urea nitrogen
b. Complete blood count
c. Cardiac enzymes
d. Liver enzymes
d. Liver enzymes
The client is taking rosuvastatin (Crestor). What severe skeletal muscle adverse reaction should the nurse observe for?
a. Myasthenia gravis
b. Rhabdomyolysis
c. Dyskinesia
d. Agranulocytosis
b. Rhabdomyolysis
When a client is taking ezetimibe (Zetia), she asks the nurse how it works. The nurse should explain that Zetia does what?
a. Inhibits absorption of dietary cholesterol in the intestines.
b. Binds with bile acids in the intestines to reduce LDL levels.
c. Inhibits HMG-CoA reductase, which is necessary for cholesterol production in liver.
d. Forms insoluble complexes and and reduces circulating cholesterol in blood.
a. Inhibits absorption of dietary cholesterol in the intestines.
A client is diagnosed with peripheral arterial disease (PAD). He is prescribed isoxsuprine (Vasodilan). The nurse acknowledges that isoxsuprine does what? (Select all that apply.)
a. Relaxes the arterial walls within the skeletal muscles
b. May cause hypotension, chest pain, and palpitations
c. Increases the rigidity of arteriosclerotic blood vessels
d. May increase intermittent claudication
e. May lead to hypertension and bradycardia
f. Commonly causes an adverse effect of rhabdomyolysis
a. Relaxes the arterial walls within the skeletal muscles
b. May cause hypotension, chest pain, and palpitations
What are the symptoms of a panic attack?
Crying, flushed face, trembling hands, diaphoretic, trouble breathing, heart is fluttering, feels as if going crazy, increased HR, BP, and respirations.
What should be done immediately for someone experiencing a panic attack?
Reassure them that they are safe and that you'll stay with them until their symptoms resolve (most last for 10 mins although they can last for than an hour). Reassure them that symptoms won't harm them. COACH them to take slow deep breaths, inhaling through nose and exhaling gently through her mouth with pursed lips. Relaxation techniques will calm their body and mind, easing their symptoms.
Should an LPN be assigned to a person experiencing a panic attack?
NO!!!
What drug might be given to a person experiencing a panic attack? Teaching?
Paxil. The pt should be taught that they shouldnt drive the 1st time they take it, it takes 2 weeks to work, and stress reduction techniques to use until medicine kicks in.
What is behavior modification? What should you reward with? What should you not reward with?
It is changing behaviors by reward the good and ignoring the bad. You should reward with your time (story,play). You should not reward with food.
What is milieu therapy?
Use the environment/peer pressure to change a person's behaviors. Patients develop the rules/punishments. (A controlling nurse for this type of therapy isn't appropriate).
What is agoraphobia?
A fear of open spaces or leaving their home. They fail to interact with others and are never w/o symptoms.
How do you know therapy for agoraphobia is working?
They are out shopping or initiating conversation!
What should you do with someone who is admitted with obsessive compulsive disorder?
Ask what makes them anxious. Don't interfere with rituals unless harming themselves or others. and interact in a positive way if need to influence.
What should you do with an obsessive compulsive patient who is wringing their hands for hours and they are beginning to bleed?
Give him lotion instead of asking him to stop the ritual.
What is an obsession? EX?
It is a thought. EX: "I'm so bad, I made a mistake", feeling like someone close to you might die, or you might be harmed.
What is a compulsion? EX?
It is an action in response to an obsession. EX: Washing hands repetitively, counting things, rechecking things 20 times.
What is characteristic of a patient with PTSD?
Tense, HYPERVIGILANT, depressed, or emotionally distant. They may also suddenly believe that a traumatic event is recurring (a flashback) or experience survival guilt, intrusive memories, or psychic numbing.
What should you do immediately for someone experience a PTSD episode?
Reassure the pt that they are safe before he injures himself, you, or others. First try to orient them to their surroundings. Explain who you are, and tell them you're going to turn the lights on so that they can see they are in a hospital and not a jungle/etc.
What would be appropriate treatment/coping for PTSD?
Valerian root can help with symptoms (takes 1 1/2 weeks to kick in) and avoiding triggers (stress) can help prevent episodes (not watching army movies).
What characteristics are present with anorexia nervosa?
INTENSE FEAR OF BECOMING FAT, WEIGHT DECREASE BY AT LEAST 25% FROM ORIGINAL BODY WT, body image disturbance (draw fat person even though skinny), no known physical illness, absence of periods, fine hair (lanugo), excessive exercising, cook a lot but don't eat any, low self-esteem, and may think they don't have a problem.
What is the main concern with anorexia nervosa?
F&E imbalance and muscle weakness.
What should you do on admission for a person with anorexia nervosa?
Have them sign a contract to eat and retain fluid. Weigh each morning after void.
When would you be extremely concerned about a person with anorexia nervosa?
IF THEY BEGIN TO PURGE ALSO!
What is characteristic of bulimia?
RECURRENT BINGE EATING, awareness of abnormal eating pattern, fear of not being able to stop eating voluntarily, depressed mood following binges, laxative misuse, calloused knuckles, and rotten teeth.
What is characteristic of PICA?
PERSISTENT EATING OF NON-NUTRITIVE SUBSTANCES X 1 MONTH, infants (paint, plaster, cloth), older kids (bugs, rocks, sand), adults (chalk, starch, paper). STASH= Stuff is hidden, Things (hair, clay, starch), All non-food items, Sick-don't digest (iron deficiency and impaction are most common), and Have e.coli-ileus.
What is a concern for pregnant women with PICA?
Iron deficiency anemia (ALL AGE GROUPS). Tx= foods high in iron (legumes, veggies, raisins). Give with vitamin C to help absorb.
What is Dysthmia?
Chronic depression that is less severe than major depression and can occur at all ages.
What is the medical treatment for depression?
Meds (MAOIs, Tricyclics) and ECT
What is ECT? What are interventions that are carried out for someone undergoing ECT?
Electroconvulsive therapy: planned controlled seizures to assist depression. The pt should be NPO, atropine to dry secretions (drooling) but not for a glaucoma patient, sleep 5-6 hours afterwards, and may have some memory loss. A Float nurse would be assigned to this patient.
Who is at risk for suicide as a result of depression? Evaluate risk?
SUBSTANCE ABUSERS, PEOPLE WHO LIVE ALONE, adolescents and elderly, recent crisis, chronic illness, previous attempts, identity crisis, hallucinating (voices telling them to harm themselves). (Use Sad Persons Scale to Evaluate).
What interventions should be implemented for someone at risk for suicide?
Safety Precautions: Remove harmful objects, Close observation, 1 on 1, and Written contract.
What types of meaningful socialization would be good for a depressed patient?
NO GROUP ACTIVITIES bc they hate to be in groups. NO competitive activities bc may decrease self esteem more. They will do better with puzzles, music, or activities/hobbies of their choice. These should help increase their self esteem.
What are the two drugs to know for depression?
MAOIs and Tricyclics
What's important to know about MAOIs?
NO Foods with tyramine should be consumed during therapy and for 2 weeks after treatment is discontinued. May cause hypotension.
What is important to know about Tricyclics?
It takes 2-4 weeks before the drug effects kick in so teach relaxation techniques to utilize in the meantime. SE= Dry mouth, constipation (give med before bed, increase fluids, and high fiber diet (NO COLACE!!)). May also cause hypotension.
What are the two components of bipolar disorder?
Manic and Depressive
What is characteristic of the manic phase of bipolar disorder?
Onset is prior to age 30, Mood (ELEVATED, expansive, and irritable), Speech (loud, rapid, running, rhyming, clanging, vulgar), ? WEIGHT LOSS, GRANDIOSE (think they are GOD or can fly), DISTRACTED, HYPERACTIVE, delusions, decreased need for sleep, inappropriate, flight of ideas, begins suddenly and escalates over days.
What interventions would be appropriate for a manic patient?
Lithium (.6-1.2), NO GROUPS, high protein/calorie diet to help increase wt (mobile food is impt and NO Caffeine), Treadmill=good activity bc helps with energy (NO PUZZLES), place the patient in a private room or with another manic pt, and make sure to meet their physical needs (hygiene).
What is characteristic of the depressive part of bipolar disorder?
Previous manic episodes, Mood: dysphoric, depressive, and despairing), decrease interest in pleasure, negative views, fatigue, decreased appetite, constipation, insomnia, libido, suicidal preoccupation, and agitation or movement retardation.
What is the normal lithium level?
0.6-1.2
What factors increase retained lithium?
Diarrhea, diuretics or dehydration, low salt diets, or high fevers/strenuous exercise.
What factors decrease the amount of lithium through enhanced excretion?
High salt intake, high intake of sodium bicarbonate, and pregnancy.
What is important to remember with patients on lithium?
HIKE= Hydration. If have diarrhea could be from elevated lithium level from dehydration as a result of hiking.
What is an appropriate snack for someone on lithium who is going hiking?
Lemonade is good bc they need hydration but can't have caffeine. (No tea, coffee, etc.)
What are the 5 stages of grieving?
Denial, Anger, Bargaining, Depression, and Acceptance.
If a patient in the hospital is talking about good memories from their life time what should be done?
Hospice should be called at this time.
If a psych nurse floated to a cancer unit what type of patient should she receive?
A person who is in the acceptance stage of their disease.
What is juvenile schizophrenia/autism?
When a person has ritualistic behaviors so everyone must follow the plan of care. They self stimulate and don't like loud noises. To relax an autistic child try to de-pressure the situation.
Who is a good roommate for an autistic child?
A person in a coma.
What is characteristic of schizophrenia?
Loss of boundaries, inability to trust, withdrawn or peculiar behavior, indifferent/aloof, love/hate feelings, personality changes, confused chaotic thoughts, retreat to fantasy world, auditory hallucinations and delusions, hypersensitivity to sound & smell, difficulty relating to others, negativism, religiosity, lack of social awareness, and disorganized.
How would someone describe a schizophrenic?
Weird, strange, and different.
What is an important thing that needs to be done with schizophrenics and why?
SET LIMITS with them because otherwise they won't manage their hygiene properly. (Poor hygiene skills). They may also break rules or be unintentionally rude (inform them of the mistake and help them regain control).
What are hallucinations? Ex?
Sensory impressions without external stimuli. Ex: Detox= seeing pink elephants (absolutely not there but seeing).
What are illusions? Ex?
Real stimuli that has been misinterpreted. Ex: Thinking that someone waving at you is trying to stab you (see person just misinterpret).
What is a delusion? Ex?
A false fixed belief. Ex: I am dating Madonna and she's waiting for me in a hotel room!
What are paranoid delusions?
The person thinks that someone is out to harm him/her.
What is the response to someone experiencing a paranoid delusion?
Acknowledge what the person says but don't agree. Hone in on their feelings ("it must be very frightening"= EMPATHY)
What are typical types of delusions that are less frightening than paranoid delusions?
Grandiose and religious
What are the guidelines for maintaining a therapeutic relationship with a schizophrenic patient?
Accept them as they are, monitor of hallucination/ delusions, assess their safety, give appropriate feedback on how interpret communication, SET LIMITS, and encourage them to learn about their mental illness.
What is associative looseness? Ex?
It means a persons one thought isn't connected to the next thought. Ex: Blue lights, I go round and round, the grass is green.
What is a neologism? Ex?
A word or phrase the patient constructs that's meaningless to everyone else. Ex: I bessaton the coaglese and vergified the rest.
What is clang association? Ex?
A meaningless use of rhyming words. Ex: I read the bed and said the head then led Ted to the dead.
What is word salad? Ex?
A mix of words or phrases that have no meaning to the listener. Ex: Animals, fast, food, family, working, birds, loving, the net.
What is the best way to respond to a patient who is using neologisms, clang association, or word salad?
Honesty is the best response. If you don't understand then tell them you don't understand but you'd like to help.
What is echolalia? Ex?
Repeating exactly what someone else said to you. Ex: "It's time for your shower", "It's time for your shower".
If a person has a delusion of being GOD, should you challenge them and tell them that he is not GOD he is Joe, etc.?
NO. Challenging a firmly fixed delusion serves no therapeutic purpose, but it could antagonize the patient.
What are 6 common side effects of antipsychotics?
Extrapyramidal sx, orthostatic hypotension, constipation, urinary retention, confusion, sexual dysfunction.
What are extrapyramidal sx?
Parkinson's like symptoms (tremors, drooling, etc.)
What is dystonia?
Face spasms, or awkward twisting of the head/body.
What is tardive dyskinesia?
Irreversible/permanent sticking out of the tongue, lip smacking, or leaning tree syndrome.
What are antipsychotics that commonly cause the 6 side effects listed previously?
LoxaPINE, clozaPINE/ Risperidone, Haldol/Haloperidol, Phenothiazine (DRUG CLASS)- ThroaZINE, Prolixin, ChlorpromaZINE, CompaZINE.
What are the S&S of neuroleptic malignant syndrome?
Diaphoresis, incoherent speech, disorientation, muscle rigidity, fever (101), hypertension, tachycardia, incontinence, tremor, increased salivation, and increased respirations. (present after receiving an antipsychotic medication).
What is neuroleptic malignant syndrome?
It is a rare but potentially fatal adverse reaction to antipsychotic medications that leads to autonomic dysfunction.
What must you do immediately if someone is presenting with neuroleptic malignant syndrome?
Page the house physician and hold all antipsychotic meds. Provide 1 on 1 observation. Closely monitor vital signs, establish IV access for fluids or give oral fluids. Adminsiter an antipyretic because he/she is at risk for SEIZURES d/t hyperthermia (TEMPERATURE REGULATION BLANKET).
When should you take off a cooling blanket on someone with a fever?
When their temperature reaches 101 bc they will continue to decrease after removal.
What is characteristic of antisocial behavior?
They are like the troll under the bridge. They are unreliable, self-centered, poor judgement, conflicts with society, LACK OF REMORSE (love em and leave em), MANIPULATIVE, blames others, and splits the staff.
What interventions are used for someone with antisocial behavior?
ASSIGN THE MOST SKILLED NURSE TO THIS MANIPULATIVE PATIENT (no float nurse), set firm consistent limits, explain consequences of breaking rules, work consistently with staff to prevent splitting, and give positive feedback for appropriate behavior.
How do you know when the treatment for an antisocial person has been effective?
They show remorse for taking advantage of others.
What is the difference between borderline personality disorder and antisocial behavior?
Borderline PD patients hurt/abuse themselves.
What are the S&S of alcohol withdrawal and when do they usually begin?
They usually begin 3 to 36 hours after the last drink. The patient may present with tremulousness, motor hyperactivity, anxiety, and hyperalertness, irritability, agitation, diaphoresis, tachycardia, hypertension, pounding HA, abdominal cramping, anorexia, nausea, vomiting, or diarrhea. A tonic-clonic (Grand Mal) seizure is a common but serious complication also.
What are the S&S of delerium tremens?
Hyperthermia (105), disorientation, delusions, paranoia, and frightening visual and tactile hallucinations. (tachycardia, tachypnea, hypertension, dilated pupils, and diaphoresis).
What are alcohol dependent patients with a thiamine deficiency at risk for?
WERNICKE-KORSAKOFF SYNDROME (WERNIKE'S ENCEPHALOPATHY AND KORSAKOFF PSYCHOSIS) AN IRREVERSIBLE DEGENERATIVE BRAIN DISORDER.
What should you give to a patient experiencing alcohol withdrawal to prevent seizures?
Magnesium sulfate IV
After a patient is discharged following an alcohol withdrawal episode and wants to stop drinking what is a good drug for him/her?
Antabuse- must be committed to not drinking or get severely sick. After the drug is d/c it is in the body for another 2 weeks.
What treatment should you implement for delirium tremens?
Administer D5 1/2 NS at 100cc/hr, now adding thiamine 100 mg, folate 1 mg, and multivitamins to the IV fluids once daily. (the B vitamins help with red blood cell formation and thiamine helps prevent wernicke-korsakoff syndrome). Place them in a quiet/private room, leaving the light on at all times, and side rails up on bed. Administering a sedative (chlordiazepoxide or benzodiazepines) will help to calm the patient down.
What are the signs and symptoms of a cocaine/crack user?
DILATED PUPILS, TACHYCARDIA, ELEVATED BP (HEART BLOWS UP!), nose bleeds, nasal congestion, sniffing, impaired movement, seizures, insomnia, and anorexia. (OVERDOSE= TACHYCARDIA AND INCREASED BP).
What are the signs of opiate overdose?
RESPIRATORY DEPRESSION --> respiratory arrest, circulatory depression, and unconsciousness-->death
What are the S&S of amphetamine overdose?
RAPID RESPIRATIONS, restlessness, tremor, confusion, hallucinations, and panic.
What is the difference between onset and duration of delirium and dementia?
Delirium is acute onset and duration is days to weeks. Dementia is an insidious onset and the duration is months to years.
1. Walter, teenage patient is admitted to the hospital because of acetaminophen (Tylenol) overdose. Overdoses of acetaminophen can precipitate life-threatening abnormalities in which of the following organs?
a. Lungs
b. Liver
c. Kidney
d. Adrenal Glands
1.Answer B. Acetaminophen is extensively metabolized by pathways in the liver. Toxic doses of acetaminophen deplete hepatic glutathione, resulting in accumulation of the intermediate agent, quinine, which leads to hepatic necrosis. Prolonged use of acetaminophen may result in an increased risk of renal dysfunction, but a single overdose does not precipitate life-threatening problems in the respiratory system, renal system, or adrenal glands.
2. A contraindication for topical corticosteroid usage in a male patient with atopic dermatitis (eczema) is:
a. Parasite infection.
b. Viral infection.
c. Bacterial infection.
d. Spirochete infection.
2.Answer B. Topical agents produce a localized, rather than systemic effect. When treating atopic dermatitis with a steroidal preparation, the site is vulnerable to invasion by organisms. Viruses, such as herpes simplex or varicella-zoster, present a risk of disseminated infection. Educate the patient using topical corticosteroids to avoid crowds or people known to have infections and to report even minor signs of an infection. Topical corticosteroid usage results in little danger of concurrent infection with these agents.
3. In infants and children, the side effects of first generation over-the-counter (OTC) antihistamines, such as diphenhydramine (Benadryl) and hydroxyzine (Atarax) include:
a. Reye's syndrome.
b. Cholinergic effects.
c. Paradoxical CNS stimulation.
d. Nausea and diarrhea.
3.Answer C. Typically, first generation OTC antihistamines have a sedating effect because of passage into the CNS. However, in some individuals, especially infants and children, paradoxical CNS stimulation occurs and is manifested by excitement, euphoria, restlessness, and confusion. For this reason, use of first generation OTC antihistamines has declined, and second generation product usage has increased. Reye's syndrome is a systemic response to a virus. First generation OTC antihistamines do not exhibit a cholinergic effect. Nausea and diarrhea are uncommon when first generation OTC antihistamines are taken.
4. Reye's syndrome, a potentially fatal illness associated with liver failure and encephalopathy is associated with the administration of which over-the-counter (OTC) medication?
a. acetaminophen (Tylenol)
b. ibuprofen (Motrin)
c. aspirin
d. brompheniramine/psudoephedrine (Dimetapp)
4.Answer C. Virus-infected children who are given aspirin to manage pain, fever, and inflammation are at an increased risk of developing Reye's syndrome. Use of acetaminophen has not been associated with Reye's syndrome and can be safely given to patients with fever due to viral illnesses. Ibuprofen adverse effects include GI irritation and bleeding, and in toxic doses, both renal and hepatic failure are reported. However, ibuprofen has not been associated with the onset of Reye's disease. Brompheniramine/psudoephedrine contains a first generation OTC antihistamine and a decongestant. Neither agent has been associated with the development of Reye's syndrome.
5. The nurse is aware that the patients who are allergic to intravenous contrast media are usually also allergic to which of the following products?
a. Eggs
b. Shellfish
c. Soy
d. acidic fruits
5.Answer B. Some types of contrast media contain iodine as an ingredient. Shellfish also contain significant amounts of iodine. Therefore, a patient who is allergic to iodine will exhibit an allergic response to both iodine containing contrast media and shellfish. These products do not contain iodine.
6. A 13-month-old child recently arrived in the United States from a foreign country with his parents and needs childhood immunizations. His mother reports that he is allergic to eggs. Upon further questioning, you determine that the allergy to eggs is anaphylaxis. Which of the following vaccines should he not receive?
a. Hepatitis B
b. inactivated polio
c. diphtheria, acellular pertussis, tetanus (DTaP)
d. mumps, measles, rubella (MMR)
6.Answer D. The measles portion of the MMR vaccine is grown in chick embryo cells. The current MMR vaccine does not contain a significant amount of egg proteins, and even children with dramatic egg allergies are extremely unlikely to have an anaphylactic reaction. However, patients that do respond to egg contact with anaphylaxis should be in a medically controlled setting where full resuscitation efforts can be administered if anaphylaxis results. The vaccines in options a,b and c do not contain egg protein.
7. The cell and Coombs classification system categorizes allergic reactions and is useful in describing and classifying patient reactions to drugs. Type I reactions are immediate hypersensitivity reactions and are mediated by:
a. immunoglobulin E (IgE).
b. immunoglobulin G (IgG).
c. immunoglobulin A (IgA).
d. immunoglobulin M (IgM).
7.Answer A. IgE, the least common serum immunoglobulin (Ig) binds very tightly to receptors on basophils and mast cells and is involved in allergic reactions. Binding of the allergen to the IgE on the cells results in the release of various pharmacological mediators that result in allergic symptoms. IgG is the major Ig (75 percent of serum Ig is IgG). Most versatile Ig because it is capable of carrying out all of the functions of Ig molecules. IgG is the only class of Ig that crosses the placenta. It is an opsonin, a substance that enhances phagocytosis. IgA, the second most common serum Ig is found in secretions (tears, saliva, colostrum, and mucus). It is important in local (mucosal) immunity. IgM, the third most common serum Ig, is the first Ig to be made by the fetus and the first Ig to be made by a virgin B cell when it is stimulated by antigen. IgM antibodies are very efficient in leading to the lysis of microorganisms.
8. Drugs can cause adverse events in a patient. Bone marrow toxicity is one of the most frequent types of drug-induced toxicity. The most serious form of bone marrow toxicity is:
a. aplastic anemia.
b. thrombocytosis.
c. leukocytosis.
d. granulocytosis.
8.Answer A. Aplastic anemia is the result of a hypersensitivity reaction and is often irreversible. It leads to pancytopenia, a severe decrease in all cell types: red blood cells, white blood cells, and platelets. A reduced number of red blood cells causes hemoglobin to drop. A reduced number of white blood cells make the patient susceptible to infection. And, a reduced number of platelets cause the blood not to clot as easily. Treatment for mild cases is supportive. Transfusions may be necessary. Severe cases require a bone marrow transplant. Option 2 is an elevated platelet count. Option 3 is an elevated white count. Option 4 is an elevated granulocyte count. A granulocyte is a type of white blood cell.
9. Serious adverse effects of oral contraceptives include:
a. Increase in skin oil followed by acne.
b. Headache and dizziness.
c. Early or mid-cycle bleeding.
d. Thromboembolic complications.
9.Answer D. Oral contraceptives have been associated with an increased risk of stroke, myocardial infarction, and deep vein thrombosis. These risks are increased in women who smoke. Increased skin oil and acne are effects of progestin excess. Headache and dizziness are effects of estrogen excess. Early or mid-cycle bleeding are effects of estrogen deficiency.
10. The most serious adverse effect of Alprostadil (Prostin VR pediatric injection) administration in neonates is:
a. Apnea.
b. Bleeding tendencies.
c. Hypotension.
d. Pyrexia.
10.Answer A. All items are adverse reactions of the drug. However, apnea appearing during the first hour of drug infusion occurs in 10-12 percent of neonates with congenital heart defects. Clinicians deciding to utilize alprostadil must be prepared to intubate and mechanically ventilate the infant. Careful monitoring for apnea or respiratory depression is mandatory. In some institutions, elective intubation occurs prior to initiation of the medication.
11. Mandy, a patient calls the clinic today because he is taking atrovastatin (Lipitor) to treat his high cholesterol and is having pain in both of his legs. You instruct him to:
a. Stop taking the drug and make an appointment to be seen next week.
b. Continue taking the drug and make an appointment to be seen next week.
c. Stop taking the drug and come to the clinic to be seen today.
d. Walk for at least 30 minutes and call if symptoms continue.
11.Answer C. Muscle aches, soreness, and weakness may be early signs of myopathy such as rhabdomyolysis associated with the HMG-CoA reducatase class of antilipemic agents. This patient will need an immediate evaluation to rule out myopathy. Additional doses may exacerbate the problem. Exercise will not reverse myopathy and delays diagnosis.
12. Which of the following adverse effects is associated with levothyroxine (Synthroid) therapy?
a. Tachycardia
b. Bradycardia
c. Hypotension
d. Constipation
12.Answer A. Levothyroxine, especially in higher doses, can induce hyperthyroid-like symptoms including tachycardia. An agent that increases the basal metabolic rate would not be expected to induce a slow heart rate. Hypotension would be a side effect of bradycardia. Constipation is a symptom of hypothyroid disease.
13. Which of the following adverse effects is specific to the biguanide diabetic drug metformin (Glucophage) therapy?
a. Hypoglycemia
b. GI distress
c. Lactic acidosis
d. Somulence
13.Answer C. Lactic acidosis is the most dangerous adverse effect of metformin administration with death resulting in approximately 50 percent of individuals who develop lactic acidosis while on this drug. Metformin does not induce insulin production; thus, administration does not result in hypoglycemic events. Some nausea, vomiting, and diarrhea may develop but is usually not severe. NVD is not specific for metformin. Metformin does not induce sleepiness.
14. The most serious adverse effect of tricyclic antidepressant (TCA) overdose is:
a. Seizures.
b. Hyperpyrexia.
c. Metabolic acidosis.
d. Cardiac arrhythmias.
14.Answer D. Excessive ingestion of TCAs result in life-threatening wide QRS complex tachycardia. TCA overdose can induce seizures, but they are typically not life-threatening. TCAs do not cause an elevation in body temperature. TCAs do not cause metabolic acidosis.
15. The nurse is aware that the following solutions is routinely used to flush an IV device before and after the administration of blood to a patient is:
a. 0.9 percent sodium chloride
b. 5 percent dextrose in water solution
c. Sterile water
d. Heparin sodium
15.Answer A. 0.9 percent sodium chloride is normal saline. This solution has the same osmolarity as blood. Its use prevents red cell lysis. The solutions given in options 2 and 3 are hypotonic solutions and can cause red cell lysis. The solution in option 4 may anticoagulate the patient and result in bleeding.
16. Cris asks the nurse whether all donor blood products are cross-matched with the recipient to prevent a transfusion reaction. Which of the following always require cross-matching?
a. packed red blood cells
b. platelets
c. plasma
d. granulocytes
16.Answer A. Red blood cells contain antigens and antibodies that must be matched between donor and recipient. The blood products in options 2-4 do not contain red cells. Thus, they require no cross-match.
17. A month after receiving a blood transfusion an immunocompromised male patient develops fever, liver abnormalities, a rash, and diarrhea. The nurse would suspect this patient has:
a. Nothing related to the blood transfusion.
b. Graft-versus-host disease (GVHD).
c. Myelosuppression.
d. An allergic response to a recent medication.
17.Answer B. GVHD occurs when white blood cells in donor blood attack the tissues of an immunocompromised recipient. This process can occur within a month of the transfusion. Options 1 and 4 may be a thought, but the nurse must remember that immunocompromised transfusion recipients are at risk for GVHD.
18. Jonas comes into the local blood donation center. He says he is here to donate platelets only today. The nurse knows this process is called:
a. Directed donation.
b. Autologous donation.
c. Allogenic donation.
d. Apheresis.
18.Answer D. The process of apheresis involves removal of whole blood from a donor. Within an instrument that is essentially designed as a centrifuge, the components of whole blood are separated. One of the separated portions is then withdrawn, and the remaining components are retransfused into the donor. Directed donation is collected from a blood donor other than the recipient, but the donor is known to the recipient and is usually a family member or friend. Autologous donation is the collection and reinfusion of the patient's own blood. Allogenic donation is collected from a blood donor other than the recipient.
19. Nurse Bryan knows that the age group that uses the most units of blood and blood products is:
a. Premature infants.
b. Children ages 1-20 years.
c. Adults ages 21-64 years.
d. The elderly above age 65 years.
19.Answer D. People older than 65 years use 43 percent of donated blood. This number is expected to increase as the population ages.
20. A child is admitted with a serious infection. After two days of antibiotics, he is severely neutropenic. The physician orders granulocyte transfusions for the next four days. The mother asks the nurse why? The nurse responds:
a. "This is the only treatment left to offer the child."
b. "This therapy is fast and reliable in treating infections in children."
c. "The physician will have to explain his rationale to you."
d. "Granulocyte transfusions replenish the low white blood cells until the body can produce its own."
20.Answer D. Granulocyte (neutrophil) replacement therapy is given until the patient's blood values are normal and he is able to fight the infection himself. Options 1 and 3 are not therapeutic responses. The treatment in option 2 takes days and is not always able to prevent morbidity and mortality.
21. A neighbor tells nurse Maureen he has to have surgery and is reluctant to have any blood product transfusions because of a fear of contracting an infection. He asks the nurse what are his options. The nurse teaches the person that the safest blood product is:
a. An allogenic product.
b. A directed donation product.
c. An autologous product.
d. A cross-matched product.
21.Answer C. This process is the collection and reinfusion of the patient's own blood. It is recommended by the American Medical Association's Council on Scientific Affairs as the safest product since it eliminates recipient incompatibility and infection. The product in option 1 is collected from a blood donor other than the recipient. The process in option 2 is also collected from a blood donor other than the recipient, but the donor is known to the recipient and is usually a family member or friend. Cross-matching significantly enhances compatibility. It does not detect infection.
22. A severely immunocompromised female patient requires a blood transfusion. To prevent GVHD, the physician will order:
a. Diphenhydramine hydrochloride (Benadryl).
b. The transfusion to be administered slowly over several hours.
c. Irradiation of the donor blood.
d. Acetaminophen (Tylenol).
22.Answer C. This process eliminates white blood cell functioning, thus, preventing GVHD. Diphenhydramine HCl is an antihistamine. It's use prior to a blood transfusion decreases the likelihood of a transfusion reaction. Option 2 will not prevent GVHD. Use of acetaminophen prevents and treats the common side effects of blood administration caused by the presence of white blood cells in the transfusion product: fever, headache, and chills.
23. Louie who is to receive a blood transfusion asks the nurse what is the most common type of infection he could receive from the transfusion. The nurse teaches him that approximately 1 in 250,000 patients contract:
a. Human immunodeficiency disease (HIV).
b. Hepatitis C infection.
c. Hepatitis B infection.
d. West Nile viral disease.
23.Answer C. Hepatitis B is the most common infection spread via blood transfusion. Donors are screened by a questionnaire that includes symptoms. The donated blood is also tested for infection. The risk of infection with the agents in options 2 and 3 has decreased to approximately 1 in 2 million secondary to donor questioning and donor blood testing. The incidence of West Nile viral transmission is unknown, but donor infection is still relatively rare.
24. A male patient with blood type AB, Rh factor positive needs a blood transfusion. The Transfusion Service (blood bank) sends type O, Rh factor negative blood to the unit for the nurse to infuse into this patient. The nurse knows that:
a. This donor blood is incompatible with the patient's blood.
b. Premedicating the patient with diphenhydramine hydrochloride (Benadryl) and acetaminophen (Tylenol) will prevent any transfusion reactions or side effects.
c. This is a compatible match.
d. The patient is at minimal risk receiving this product since it is the first time he has been transfused with type O, Rh negative blood.
24.Answer C. Type O, Rh negative blood has none of the major antigens and is safely administered to patients of all blood types. It is also known as the universal donor. Premedicating with these agents will not prevent a major transfusion reaction if the blood type and Rh factors of the donor blood are incompatible with the recipient's blood.
25. Dr. Rodriguez orders 250 milliliters of packed red blood cells (RBC) for a patient. This therapy is administered for treatment of:
a. Thrombocytopenia.
b. Anemia.
c. Leukopenia.
d. Hypoalbuminemia.
25.Answer B. A red blood cell transfusion is used to correct anemia in patients in which the low red blood cell count must be rapidly corrected. RBC transfusion will not correct a low platelet count. RBC transfusion will not correct a low white blood cell count. Packed RBCs contain very little plasma and, thus, only a small amount of albumin. This amount will not correct low albumin levels.
26. A female patient needs a whole blood transfusion. In order for transfusion services (the blood bank) to prepare the correct product a sample of the patient's blood must be obtained for:
a. A complete blood count and differential.
b. A blood type and cross-match.
c. A blood culture and sensitivity.
d. A blood type and antibody screen.
26.Answer B. This is needed to utilize the correct type of donor blood and to match the donor product with the patient. Incompatible matches would result in severe adverse events and possible death. The tests in options 1 and 3 are unnecessary. The test in option 4 is utilized to determine the patient's blood type and presence of antibodies to blood antigens. It does not determine donor blood compatibility with the patient.
27. A male patient needs to receive a unit of whole blood. What type of intravenous (IV) device should the nurse consider starting?
a. A small catheter to decrease patient discomfort
b. The type of IV device the patient has had in the past, which worked well
c. A large bore catheter
d. The type of device the physician prefers
27.Answer C. Large bore catheters prevent damage to blood components and are less likely to develop clotting problems than a small bore catheter. The nurse should determine the correct device without asking the patient what type has been used before or asking the physician which type he prefers and start the IV.
28. Dr. Smith orders a gram of human salt poor albumin product for a patient. The product is available in a 50 milliliter vial with a concentration of 25 percent. What dosage will the nurse administer?
a. The nurse should use the entire 50 milliliter vial.
b. The nurse should determine the volume to administer from the physician.
c. This concentration of product should not be used.
d. The nurse will administer 4 milliliters.
28.Answer D. A 25 percent solution contains one quarter of a gram per milliliter. Thus, the nurse will administer 4 milliliters to provide a complete gram of albumin. The volume in option 1 would provide 12.5 grams of albumin. The nurse should determine the volume. It is unnecessary to seek the answer from the physician. A 25 percent solution is an acceptable product and can safely be used.
29. Central venous access devices (CVADs) are frequently utilized to administer chemotherapy. What is a distinct advantage of using the CVAD for chemotherapeutic agent administration?
a. CVADs are less expensive than a peripheral IV.
b. Once a week administration is possible.
c. Caustic agents in small veins can be avoided.
d. The patient or his family can administer the drug at home.
29.Answer C. Many chemotherapeutic drugs are vesicants (highly active corrosive materials that can produce tissue damage even in low concentrations). Extravasations of a vesicant can result in significant tissue necrosis. Administration into a large vein is optimal. CVADs are more expensive than a peripheral IV. Dosing depends on the drug. IV chemotherapeutic agents are not administered at home. They are given in an outpatient or clinic setting if not given during hospitalization.
30. A female patient's central venous access device (CVAD) becomes infected. Why would the physician order antibiotics to be given through the line rather than through a peripheral IV line?
a. To prevent infiltration of the peripheral line
b. To reduce the pain and discomfort associated with antibiotic administration in a small vein
c. To lessen the chance of an allergic reaction to the antibiotic
d. To attempt to sterilize the catheter and prevent having to remove it
30.Answer D. Microorganisms that infect CVADs are often coagulase-negative staphylococci, which can be eliminated by antibiotic administration through the catheter. If unsuccessful in eliminating the microorganism, the CVAD must be removed. CVAD use lessens the need for peripheral IV lines and, thus, the risk of infiltration. In this case however, the antibiotics are given to eradicate microorganisms from the CVAD. CVAD use has this effect, but in this case, the antibiotics are given through the CVAD to eliminate the infective agent. The third option would not occur
1. An infection in a central venous access device is not eliminated by giving antibiotics through the catheter. How would bacterial glycocalyx contribute to this?
a. It protects the bacteria from antibiotic and immunologic destruction.
b. Glycocalyx neutralizes the antibiotic rendering it ineffective.
c. It competes with the antibiotic for binding sites on the microbe.
d. Glycocalyx provides nutrients for microbial growth.
1.Answer C. Glycocalyx is a viscous polysaccharide or polypeptide slime that covers microbes. It enhances adherence to surfaces, resists phagocytic engulfment by the white blood cells, and prevents antibiotics from contacting the microbe. Glycocalyx does not have the effects in options B-D.
2. Central venous access devices are beneficial in pediatric therapy because:
a. They don't frighten children.
b. Use of the arms is not restricted.
c. They cannot be dislodged.
d. They are difficult to see.
2.Answer B. The child can move his extremities and function in a normal fashion. This lessens stress associated with position restriction and promotes normal activity. Fear may not be eliminated. All lines can be dislodged. Even small catheters can be readily seen.
3. How can central venous access devices (CVADs) be of value in a patient receiving chemotherapy who has stomatitis and severe diarrhea?
a. The chemotherapy can be rapidly completed allowing the stomatitis and diarrhea to resolve.
b. Crystalloid can be administered to prevent dehydration.
c. Concentrated hyperalimentation fluid can be administered through the CVAD.
d. The chemotherapy dose can be reduced.
3.Answer C. In patients unable to take oral nutrition, parenteral hyperalimentation is an option for providing nutritional support. High concentrations of dextrose, protein, minerals, vitamins, and trace elements can be provided. Dosing is not affected with options a and d. Crystalloid can provide free water but has very little nutritional benefits. Hyperalimentation can provide free water and considerable nutritional benefits.
4. Some central venous access devices (CVAD) have more than one lumen. These multi lumen catheters:
a. Have an increased risk of infiltration.
b. Only work a short while because the small bore clots off.
c. Are beneficial to patient care but are prohibitively expensive.
d. Allow different medications or solutions to be administered simultaneously.
4.Answer D. A multilumen catheter contains separate ports and means to administer agents. An agent infusing in one port cannot mix with an agent infusing into another port. Thus, agents that would be incompatible if given together can be given in separate ports simultaneously.
5. Some institutions will not infuse a fat emulsion, such as Intralipid, into central venous access devices (CVAD) because:
a. Lipid residue may accumulate in the CVAD and occlude the catheter.
b. If the catheter clogs, there is no treatment other than removal and replacement.
c. Lipids are necessary only in the most extreme cases to prevent essential fatty acid (EFA) deficiency.
d. Fat emulsions are very caustic.
5.Answer A. Occlusion occurs with slow infusion rates and concurrent administration of some medications. Lipid occlusions may be treated with 70 percent ethanol or with 0.1 mmol/mL NaOH. Lipids provide essential fatty acids. It is recommended that approximately 4 percent of daily calories be EFAs. A deficiency can quickly develop. Daily essential fatty acids are necessary for constant prostaglandin production. Lipids are almost isotonic with blood.
6. A male patient needs a percutaneously inserted central catheter (PICC) for prolonged IV therapy. He knows it can be inserted without going to the operating room. He mentions that, "at least the doctor won't be wearing surgical garb, will he?" How will the nurse answer the patient?
a. "You are correct. It is a minor procedure performed on the unit and does not necessitate surgical attire."
b. "To decrease the risk of infection, the doctor inserting the PICC will wear a cap, mask, and sterile gown and gloves."
c. "It depends on the doctor's preference."
d. "Most doctors only wear sterile gloves, not a cap, mask, or sterile gown."
6.Answer C. Strict aseptic technique including the use of cap, mask, and sterile gown and gloves is require when placing a central venous line including a PICC. Options A, B, and D are incorrect statements. They increase the risk of infection.
7. A male patient is to receive a percutaneously inserted central catheter (PICC). He asks the nurse whether the insertion will hurt. How will the nurse reply?
a. "You will have general anesthesia so you won't feel anything."
b. "It will be inserted rapidly, and any discomfort is fleeting."
c. "The insertion site will be anesthetized. Threading the catheter through the vein is not painful."
d. "You will receive sedation prior to the procedure."
7.Answer C. Pain related to PICC insertion occurs with puncture of the skin. When inserting PICC lines, the insertion site is anesthetized so no pain is felt. The patient will not receive general anesthesia or sedation. Statement 2 is false. Unnecessary pain should be prevented.
8. What volume of air can safely be infused into a patient with a central venous access device (CVAD)?
a. It is dependent on the patient's weight and height.
b. Air entering the patient through a CVAD will follow circulation to the lungs where it will be absorbed and cause no problems.
c. It is dependent on comorbidities such as asthma or chronic obstructive lung disease.
d. None.
8.Answer B. Any air entering the right heart can lead to a pulmonary embolus. All air should be purged from central venous lines none should enter the patient.
9. Kent a new staff nurse asks her preceptor nurse how to obtain a blood sample from a patient with a portacath device. The preceptor nurse teaches the new staff nurse:
a. The sample will be withdrawn into a syringe attached to the portacath needle and then placed into a vacutainer.
b. Portacath devices are not used to obtain blood samples because of the risk of clot formation.
c. The vacutainer will be attached to the portacath needle to obtain a direct sample.
d. Any needle and syringe may be utilized to obtain the sample.
9.Answer A. A special portacath needle is used to access the portacath device. A syringe is attached and the sample is obtained. One of the primary reasons for insertion of a portacath device is the need for frequent or long-term blood sampling. A vacutainer will exert too much suction on the central line resulting in collapse of the line. Only special portacath needles should be used to access the portacath device.
10. What is the purpose of "tunneling" (inserting the catheter 2-4 inches under the skin) when the surgeon inserts a Hickman central catheter device? Tunneling:
a. Increases the patient's comfort level.
b. Decreases the risk of infection.
c. Prevents the patient's clothes from having contact with the catheter
d. Makes the catheter less visible to other people.
10.Answer B. The actual access to the subclavian vein is still just under the clavicle, but by tunneling the distal portion of the catheter several inches under the skin the risk of migratory infection is reduces compared to a catheter that enters the subclavian vein directly and is not tunneled. The catheter is tunneled to prevent infection.
11. The primary complication of a central venous access device (CVAD) is:
a. Thrombus formation in the vein.
b. Pain and discomfort.
c. Infection.
d. Occlusion of the catheter as the result of an intra-lumen clot.
11.Answer C. A foreign body in a blood vessel increases the risk of infection. Catheters that come outside the body have an even higher risk of infection. Most infections are caused by skin bacteria. Other infective organisms include yeasts and fungi. Options 1 and 4 are complications of a CVAD but are not the primary problem. Once placed, these lines do not cause pain and discomfort.
12. Nurse Blessy is doing some patient education related to a patient's central venous access device. Which of the following statements will the nurse make to the patient?
a. "These type of devices are essentially risk free."
b. "These devices seldom work for more than a week or two necessitating replacement."
c. "The dressing should only the changed by your doctor."
d. "Heparin in instilled into the lumen of the catheter to decrease the risk of clotting."
12.Answer D. A solution containing heparin is used to reduce catheter clotting and maintain patency. The concentration of heparin used depends on the patient's age, comorbidities, and the frequency of catheter access/flushing. Although patients have few complications, the device is not risk free. Patients may develop infection, catheter clots, vascular obstruction, pneumothorax, hemothorax, or mechanical problems (catheter breakage). Strict adherence to protocol enhances the longevity of central access devices. They routinely last weeks to months and sometimes years. The patient will be taught how to perform dressing changes at home.
13. The chemotherapeutic DNA alkylating agents such as nitrogen mustards are effective because they:
a. Cross-link DNA strands with covalent bonds between alkyl groups on the drug and guanine bases on DNA.
b. Have few, if any, side effects.
c. Are used to treat multiple types of cancer.
d. Are cell cycle-specific agents.
13.Answer A. Alkylating agents are highly reactive chemicals that introduce alkyl radicals into biologically active molecules and thereby prevent their proper functioning, replication, and transcription. Alkylating agents have numerous side effects including alopecia, nausea, vomiting, and myelosuppression. Nitrogen mustards have a broad spectrum of activity against chronic lymphocytic leukemia, non-Hodgkin's lymphoma, and breast and ovarian cancer, but they are effective chemotherapeutic agents because of DNA cross-linkage. Alkylating agents are noncell cycle-specific agents.
14. Hormonal agents are used to treat some cancers. An example would be:
a. Thyroxine to treat thyroid cancer.
b. ACTH to treat adrenal carcinoma.
c. Estrogen antagonists to treat breast cancer.
d. Glucagon to treat pancreatic carcinoma.
14.Answer C. Estrogen antagonists are used to treat estrogen hormone-dependent cancer, such as breast carcinoma. A well-known estrogen antagonist used in breast cancer therapy is tamoxifen (Nolvadex). This drug, in combination with surgery and other chemotherapeutic drugs reduces breast cancer recurrence by 30 percent. Estrogen antagonists can also be administered to prevent breast cancer in women who have a strong family history of the disease. Thyroxine is a natural thyroid hormone. It does not treat thyroid cancer. ACTH is an anterior pituitary hormone, which stimulates the adrenal glands to release glucocorticoids. It does not treat adrenal cancer. Glucagon is a pancreatic alpha cell hormone, which stimulates glycogenolysis and gluconeogenesis. It does not treat pancreatic cancer.
15. Chemotherapeutic agents often produce a certain degree of myelosuppression including leukopenia. Leukopenia does not present immediately but is delayed several days to weeks because:
a. The patient's hemoglobin and hematocrit are normal.
b. Red blood cells are affected first.
c. Folic acid levels are normal.
d. The current white cell count is not affected by chemotherapy.
15.Answer D. The time required to clear circulating cells before the effect that chemotherapeutic drugs have on precursor cell maturation in the bone marrow becomes evident. Leukopenia is an abnormally low white blood cell count. Answers A-C pertain to red blood cells.
16. Currently, there is no way to prevent myelosuppression. However, there are medications available to elicit a more rapid bone marrow recovery. An example is:
a. Epoetin alfa (Epogen, Procrit).
b. Glucagon.
c. Fenofibrate (Tricor).
d. Lamotrigine (Lamictal).
16.Answer A. Epoetin alfa (Epogen, Procrit) is a recombinant form of endogenous erythropoietin, a hematopoietic growth factor normally produced by the kidney that is used to induce red blood cell production in the bone marrow and reduce the need for blood transfusion. Glucagon is a pancreatic alpha cell hormone, which cause glycogenolysis and gluconeogenesis. Fenofibrate (Tricor) is an antihyperlipidemic agent that lowers plasma triglycerides. Lamotrigine (Lamictal) is an anticonvulsant.
17. Estrogen antagonists are used to treat estrogen hormone-dependent cancer, such as breast carcinoma. Androgen antagonists block testosterone stimulation of androgen-dependent cancers. An example of an androgen-dependent cancer would be:
a. Prostate cancer.
b. Thyroid cancer.
c. Renal carcinoma.
d. neuroblastoma.
17.Answer A. Prostate tissue is stimulated by androgens and suppressed by estrogens. Androgen antagonists will block testosterone stimulation of prostate carcinoma cells. The types of cancer in options 2-4 are not androgen dependent.
18. Serotonin release stimulates vomiting following chemotherapy. Therefore, serotonin antagonists are effective in preventing and treating nausea and vomiting related to chemotherapy. An example of an effective serotonin antagonist antiemetic is:
a. ondansetron (Zofran).
b. fluoxetine (Prozac).
c. paroxetine (Paxil).
d. sertraline (Zoloft).
18.Answer A. Chemotherapy often induces vomiting centrally by stimulating the chemoreceptor trigger zone (CTZ) and peripherally by stimulating visceral afferent nerves in the GI tract. Ondansetron (Zofran) is a serotonin antagonist that bocks the effects of serotonin and prevents and treats nausea and vomiting. It is especially useful in single-day highly emetogenic cancer chemotherapy (for example, cisplatin). The agents in options 2-4 are selective serotonin reuptake inhibitors. They increase the available levels of serotonin.
19. Methotrexate, the most widely used antimetabolite in cancer chemotherapy does not penetrate the central nervous system (CNS). To treat CNS disease this drug must be administered:
a. Intravenously.
b. Subcutaneously.
c. Intrathecally.
d. By inhalation.
19.Answer C. With intrathecal administration chemotherapy is injected through the theca of the spinal cord and into the subarachnoid space entering into the cerebrospinal fluid surrounding the brain and spinal cord. The methods in options A, B, and D are ineffective because the medication cannot enter the CNS.
20. Methotrexate is a folate antagonist. It inhibits enzymes required for DNA base synthesis. To prevent harm to normal cells, a fully activated form of folic acid known as leucovorin (folinic acid citrovorum factor) can be administered. Administration of leucovorin is known as:
a. Induction therapy.
b. Consolidation therapy.
c. Pulse therapy.
d. Rescue therapy.
20.Answer B. Leucovorin is used to save or "rescue" normal cells from the damaging effects of chemotherapy allowing them to survive while the cancer cells die. Therapy to rapidly reduce the number of cancerous cells is the induction phase. Consolidation therapy seeks to complete or extend the initial remission and often uses a different combination of drugs than that used for induction. Chemotherapy is often administered in intermittent courses called pulse therapy. Pulse therapy allows the bone marrow to recover function before another course of chemotherapy is given.
21. A male Patient is undergoing chemotherapy may also be given the drug allopurinol (Zyloprim, Aloprim). Allopurinol inhibits the synthesis of uric acid. Concomitant administration of allopurinol prevents:
a. Myelosuppression.
b. Gout and hyperuricemia.
c. Pancytopenia.
d. Cancer cell growth and replication
21.Answer B. Prevent uric acid nephropathy, uric acid lithiasis, and gout during cancer therapy since chemotherapy causes the rapid destruction of cancer cells leading to excessive purine catabolism and uric acid formation. Allopurinol can induce myelosuppression and pancytopenia. Allopurinol does not have this function.
22. Superficial bladder cancer can be treated by direct instillation of the antineoplastic antibiotic agent mitomycin (Mutamycin). This process is termed:
a. Intraventricular administration.
b. Intravesical administration.
c. Intravascular administration.
d. Intrathecal administration.
22.Answer B. Medications administered intravesically are instilled into the bladder. Intraventricular administration involves the ventricles of the brain. Intravascular administration involves blood vessels. Intrathecal administration involves the fluid surrounding the brain and spinal cord.
23. The most common dose-limiting toxicity of chemotherapy is:
a. Nausea and vomiting.
b. Bloody stools.
c. Myelosuppression.
d. Inability to ingest food orally due to stomatitis and mucositis.
23.Answer C. The overall goal of cancer chemotherapy is to give a dose large enough to be lethal to the cancer cells, but small enough to be tolerable for normal cells. Unfortunately, some normal cells are affected including the bone marrow. Myelosuppression limits the body's ability to prevent and fight infection, produce platelets for clotting, and manufacture red blood cells for oxygen portage. Even though the effects in options a, b, and d are uncomfortable and distressing to the patient, they do not have the potential for lethal outcomes that myelosuppression has.
24. Chemotherapy induces vomiting by:
a. Stimulating neuroreceptors in the medulla.
b. Inhibiting the release of catecholamines.
c. Autonomic instability.
d. Irritating the gastric mucosa.
24.Answer A. Vomiting (emesis) is initiated by a nucleus of cells located in the medulla called the vomiting center. This center coordinates a complex series of events involving pharyngeal, gastrointestinal, and abdominal wall contractions that lead to expulsion of gastric contents. Catecholamine inhibition does not induce vomiting. Chemotherapy does not induce vomiting from autonomic instability. Chemotherapy, especially oral agents, may have an irritating effect on the gastric mucosa, which could result in afferent messages to the solitary tract nucleus, but these pathways do not project to the vomiting center.
25. Myeloablation using chemotherapeutic agents is useful in cancer treatment because:
a. It destroys the myelocytes (muscle cells).
b. It reduces the size of the cancer tumor.
c. After surgery, it reduces the amount of chemotherapy needed.
d. It destroys the bone marrow prior to transplant.
25.Answer A. Myelo comes from the Greek word myelos, which means marrow. Ablation comes from the Latin word ablatio, which means removal. Thus, myeloablative chemotherapeurtic agents destroy the bone marrow. This procedure destroys normal bone marrow as well as the cancerous marrow. The patient's bone marrow will be replaced with a bone marrow transplant. Myelocytes are not muscle cells Tumors are solid masses typically located in organs. Surgery may be performed to reduce tumor burden and require less chemotherapy afterward.
26. Anticipatory nausea and vomiting associated with chemotherapy occurs:
a. Within the first 24 hours after chemotherapy.
b. 1-5 days after chemotherapy.
c. Before chemotherapy administration.
d. While chemotherapy is being administered.
26.Answer C. Nausea and vomiting (N&V) are common side effects of chemotherapy. Some patients are able to trigger these events prior to actually receiving chemotherapy by anticipating, or expecting, to have these effects. N&V occurring post-chemotherapeutic administration is not an anticipatory event but rather an effect of the drug. N&V occurring during the administration of chemotherapy is an effect of the drug.
27. Medications bound to protein have the following effect:
a. Enhancement of drug availability.
b. Rapid distribution of the drug to receptor sites.
c. The more drug bound to protein, the less available for desired effect.
d. Increased metabolism of the drug by the liver.
27.Answer C. Only an unbound drug can be distributed to active receptor sites. Therefore, the more of a drug that is bound to protein, the less it is available for the desired drug effect. Less drug is available if bound to protein. Distribution to receptor sites is irrelevant since the drug bound to protein cannot bind with a receptor site. Metabolism would not be increased. The liver will first have to remove the drug from the protein molecule before metabolism can occur. The protein is then free to return to circulation and be used again.
28. Some drugs are excreted into bile and delivered to the intestines. Prior to elimination from the body, the drug may be absorbed. This process is known as:
a. Hepatic clearance.
b. Total clearance.
c. Enterohepatic cycling.
d. First-pass effect.
28.Answer C. Drugs and drug metabolites with molecular weights higher than 300 may be excreted via the bile, stored in the gallbladder, delivered to the intestines by the bile duct, and then reabsorbed into the circulation. This process reduces the elimination of drugs and prolongs their half-life and duration of action in the body. Hepatic clearance is the amount of drug eliminated by the liver. Total clearance is the sum of all types of clearance including renal, hepatic, and respiratory. First-pass effect is the amount of drug absorbed from the GI tract and then metabolized by the liver thus, reducing the amount of drug making it into circulation.
29. An adult patient has been taking a drug (Drug A) that is highly metabolized by the cytochrome p-450 system. He has been on this medication for 6 months. At this time, he is started on a second medication (Drug B) that is an inducer of the cytochrome p-450 system. You should monitor this patient for:
a. Increased therapeutic effects of Drug A.
b. Increased adverse effects of Drug B.
c. Decreased therapeutic effects of Drug A.
d. Decreased therapeutic effects of Drug B.
29.Answer C. Drug B will induce the cytochrome p-450 enzyme system of the liver thus, increasing the metabolism of Drug A. Therefore, Drug A will be broken down faster and exert decreased therapeutic effects. Drug A will be metabolized faster, thus reducing, not increasing its therapeutic effect. Inducing the cytochrome p-450 system will not increase the adverse effects of Drug B. Drug B induces the cytochrome p-450 system but is not metabolized faster. Thus, the therapeutic effects of Drug B will not be decreased.
30. Epinephrine is administered to a female patient. The nurse should expect this agent to rapidly affect:
a. Adrenergic receptors.
b. Muscarinic receptors.
c. Cholinergic receptors.
d. Nicotinic receptors.
30.Answer A. Epinephrine (adrenaline) rapidly affects both alpha and beta adrenergic receptors eliciting a sympathetic (fight or flight) response. Muscarinic receptors are cholinergic receptors and are primarily located at parasympathetic junctions. Cholinergic receptors respond to acetylcholine stimulation. Cholinergic receptors include muscarinic and nicotinic receptors. Nicotinic receptors are cholinergic receptors activated by nicotine and found in autonomic ganglia and somatic neuromuscular junctions.
1. The nursery nurse is putting erythromycin ointment in the newborn's eyes to prevent infection. She places it in the following area of the eye:
a. under the eyelid
b. on the cornea.
c. in the lower conjunctival sac
d. by the optic disc.
1. C. The ointment is placed in the lower conjunctival sac so it will not scratch the eye itself and will get well distributed.
2. The physician orders penicillin for a patient with streptococcal pharyngitis. The nurse administers the drug as ordered, and the patient has an allergic reaction. The nurse checks the medication order sheet and finds that the patient is allergic to penicillin. Legal responsibility for the error is:
a. only the nurse's—she should have checked the allergies before administering the medication.
b. only the physician's—she gave the order, the nurse is obligated to follow it.
c. only the pharmacist's—he should alert the floor to possible allergic reactions.
d. the pharmacist, physician, and nurse are all liable for the mistake
2. D. The physician, nurse, and pharmacist all are licensed professionals and share responsibility for errors.
3. James Perez, a nurse on a geriatric floor, is administering a dose of digoxin to one of his patients. The woman asks why she takes a different pill than her niece, who also has heart trouble. James replies that as people get older, liver and kidney function decline, and if the dose is as high as her niece's, the drug will tend to:
a. have a shorter half-life.
b. accumulate.
c. have decreased distribution.
d. have increased absorption.
3. B. The decreased circulation to the kidney and reduced liver function tend to allow drugs to accumulate and have toxic effects.
4. The nurse is administering Augmentin to her patient with a sinus infection. Which is the best way for her to insure that she is giving it to the right patient?
a. Call the patient by name
b. Read the name of the patient on the patient's door
c. Check the patient's wristband
d. Check the patient's room number on the unit census list
4. C. The correct way to identify a patient before giving a medication is to check the name on the medication administration record with the patient's identification band. The nurse should also ask the patient to state their name. The name on the door or the census list are not sufficient proof of identification. Calling the patient by name is not as effective as having the patient state their name patients may not hear well or understand what the nurse is saying, and may respond to a name which is not their own.
5. The most important instructions a nurse can give a patient regarding the use of the antibiotic Ampicillin prescribed for her are to
a. call the physician if she has any breathing difficulties.
b. take it with meals so it doesn't cause an upset stomach.
c. take all of the medication prescribed even if the symptoms stop sooner.
d. not share the pills with anyone else.
5. C. Frequently patients do not complete an entire course of antibiotic therapy, and the bacteria are not destroyed.
6. Mr. Jessie Ray, a newly admitted patient, has a seizure disorder which is being treated with medication. Which of the following drugs would the nurse question if ordered for him?
a. Phenobarbitol, 150 mg hs
b. Amitriptylene (Elavil), 10 mg QID.
c. Valproic acid (Depakote), 150 mg BID
d. Phenytoin (Dilantin), 100 mg TID
6. B. Elavil is an antidepressant that lowers the seizure threshold, so would not be appropriate for this patient. The other medications are anti-seizure drugs.
7. Mrs. Jane Gately has been dealing with uterine cancer for several months. Pain management is the primary focus of her current admission to your oncology unit. Her vital signs on admission are BP 110/64, pulse 78, respirations 18, and temperature 99.2 F. Morphine sulfate 6mg IV, q 4 hours, prn has been ordered. During your assessment after lunch, your findings are: BP 92/60, pulse 66, respirations 10, and temperature 98.8. Mrs. Gately is crying and tells you she is still experiencing severe pain. Your action should be to
a. give her the next ordered dose of MS.
b. give her a back rub, put on some light music, and dim the lights in the room.
c. report your findings to the RN, requesting an alternate medication order be obtained from the physician.
d. call her daughter to come and sit with her.
7. C. Morphine sulfate depresses the respiratory center. When the rate is less than 10, the MD should be notified.
8. When counseling a patient who is starting to take MAO (monoamine oxidase) inhibitors such as Nardil for depression, it is essential that they be warned not to eat foods containing tyramine, such as:
a. Roquefort, cheddar, or Camembert cheese.
b. grape juice, orange juice, or raisins.
c. onions, garlic, or scallions.
d. ground beef, turkey, or pork.
8. A. Monoamine oxidase inhibitors react with foods high in the amino acid tyramine to cause dangerously high blood pressure. Aged cheeses are all high in this amino acid the other foods are not.
9. The physician orders an intramuscular injection of Demerol for the postoperativepatient's pain. When preparing to draw up the medication, the nurse is careful to remove the correct vial from the narcotics cabinet. It is labeled
a. simethicone.
b. albuterol.
c. meperidine.
d. ibuprofen.
9. C. The generic name for Demerol is meperidine.
10. The nurse is administering an antibiotic to her pediatric patient. She checks the patient's armband and verifies the correct medication by checking the physician's order, medication kardex, and vial. Which of the following is not considered one of the five "rights" of drug administration?
a. Right dose
b. Right route
c. Right frequency
d. Right time
10. C. The five rights of medication administration are right drug, right dose, right route, right time, right patient. Frequency is not included.
11. A nurse is preparing the client's morning NPH insulin dose and notices a clumpy precipitate inside the insulin vial. The nurse should:
a. draw up and administer the dose
b. shake the vial in an attempt to disperse the clumps
c. draw the dose from a new vial
d. warm the bottle under running water to dissolve the clump
11. C. The nurse should always inspect the vial of insulin before use for solution changes that may signify loss of potency. NPH insulin is normally uniformly cloudy. Clumping, frosting, and precipitates are signs of insulin damage. In this situation, because potency is questionable, it is safer to discard the vial and draw up the dose from a new vial.
12. A client with histoplasmosis has an order for ketoconazole (Nizoral). The nurse teaches the client to do which of the following while taking this medication?
a. take the medication on an empty stomach
b. take the medication with an antacid
c. avoid exposure to sunlight
d. limit alcohol to 2 ounces per day
12. C. The client should be taught that ketoconazole is an antifungal medication. It should be taken with food or milk. Antacids should be avoided for 2 hours after it is taken because gastric acid is needed to activate the medication. The client should avoid concurrent use of alcohol, because the medication is hepatotoxic. The client should also avoid exposure to sunlight, because the medication increases photosensitivity.
13. A nurse has taught a client taking a xanthine bronchodilator about beverages to avoid. The nurse determines that the client understands the information if the client chooses which of the following beverages from the dietary menu?
a. chocolate milk
b. cranberry juice
c. coffee
d. cola
13. B. Cola, coffee, and chocolate contain xanthine and should be avoided by the client taking a xanthine bronchodilator. This could lead to an increased incidence of cardiovascular and central nervous system side effects that can occur with the use of these types of bronchodilators.
14. A client is taking famotidine (Pepcid) asks the home care nurse what would be the best medication to take for a headache. The nurse tells the client that it would be best to take:
a. aspirin (acetylsalicylic acid, ASA)
b. ibuprofen (Motrin)
c. acetaminophen (Tylenol)
d. naproxen (Naprosyn)
14. C. The client is taking famotidine, a histamine receptor antagonist. This implies that the client has a disorder characterized by gastrointestinal (GI) irritation. The only medication of the ones listed in the options that is not irritating to the GI tract is acetaminophen. The other medications could aggravate an already existing GI problem.
15. A nurse is planning dietary counseling for the client taking triamterene (Dyrenium). The nurse plans to include which of the following in a list of foods that are acceptable?
a. baked potato
b. bananas
c. oranges
d. pears canned in water
15. D. Triamterene is a potassium-sparing diuretic, and clients taking this medication should be cautioned against eating foods that are high in potassium, including many vegetables, fruits, and fresh meats. Because potassium is very water-soluble, foods that are prepared in water are often lower in potassium.
16. A client with advanced cirrhosis of the liver is not tolerating protein well, as eveidenced by abnormal laboratory values. The nurse anticipates that which of the following medications will be prescribed for the client?
a. lactulose (Chronulac)
b. ethacrynic acid (Edecrin)
c. folic acid (Folvite)
d. thiamine (Vitamin B1)
16. A. The client with cirrhosis has impaired ability to metabolize protein because of liver dysfunction. Administration of lactulose aids in the clearance of ammonia via the gastrointestinal (GI) tract. Ethacrynic acid is a diuretic. Folic acid and thiamine are vitamins, which may be used in clients with liver disease as supplemental therapy.
17. A female client tells the clinic nurse that her skin is very dry and irritated. Which product would the nurse suggest that the client apply to the dry skin?
a. glycerin emollient
b. aspercreame
c. myoflex
d. acetic acid solution
17. A. Glycerin is an emollient that is used for dry, cracked, and irritated skin. Aspercreame and Myoflex are used to treat muscular aches. Acetic acid solution is used for irrigating, cleansing, and packing wounds infected by Pseudomonas aeruginosa.
18. A nurse is providing instructions to a client regarding quinapril hydrochloride (Accupril). The nurse tells the client:
a. to take the medication with food only
b. to rise slowly from a lying to a sitting position
c. to discontinue the medication if nausea occurs
d. that a therapeutic effect will be noted immediately
18. B. Accupril is an angiotensin-converting enzyme (ACE) inhibitor. It is used in the treatment of hypertension. The client should be instructed to rise slowly from a lying to sitting position and to permit the legs to dangle from the bed momentarily before standing to reduce the hypotensive effect. The medication does not need to be taken with meals. It may be given without regard to food. If nausea occurs, the client should be instructed to take a noncola carbonated beverage and salted crackers or dry toast. A full therapeutic effect may be noted in 1 to 2 weeks.
19. Auranofin (Ridaura) is prescribed for a client with rheumatoid arthritis, and the nurse monitors the client for signs of an adverse effect related to the medication. Which of the following indicates an adverse effect?
a. nausea
b. diarrhea
c. anorexia
d. proteinuria
19. D. Auranofin (Ridaura) is a gold preparation that is used as an antirheumatic. Gold toxicity is an adverse effect and is evidenced by decreased hemoglobin, leukopenia, reduced granulocyte counts, proteinuria, hematuria, stomatitis, glomerulonephritis, nephrotic syndrome, or cholestatic jaundice. Anorexia, nausea, and diarrhea are frequent side effects of the medication.
20. A client has been taking benzonatate (Tessalon) as ordered. The nurse tells the client that this medication should do which of the following?
a. take away nausea and vomiting
b. calm the persistent cough
c. decrease anxiety level
d. increase comfort level
20. B. Benzonatate is a locally acting antitussive. Its effectiveness is measured by the degree to which it decreases the intensity and frequency of cough, without eliminating the cough reflex
1. The physician orders penicillin for a patient with streptococcal pharyngitis. The nurse administers the drug as ordered, and the patient has an allergic reaction. The nurse checks the medication order sheet and finds that the patient is allergic to penicillin. Legal responsibility for the error is
1) only the nurse's—she should have checked the allergies before administering the medication.
2) only the physician's—she gave the order, the nurse is obligated to follow it.
3) only the pharmacist's—he should alert the floor to possible allergic reactions.
4) the pharmacist, physician, and nurse are all liable for the mistake.
The correct answer is (4).
The physician, nurse, and pharmacist all are licensed professionals and share responsibility for errors.
2. The nurse is administering Augmentin to her patient with a sinus infection. Which is the best way for her to insure that she is giving it to the right patient?
1) Call the patient by name
2) Read the name of the patient on the patient's door
3) Check the patient's wristband
4) Check the patient's room number on the unit census list.
The correct answer is (3).
The correct way to identify a patient before giving a medication is to check the name on the medication administration record with the patient's identification band. The nurse should also ask the patient to state their name. The name on the door or the census list are not sufficient proof of identification. Calling the patient by name is not as effective as having the patient state their name patients may not hear well or understand what the nurse is saying, and may respond to a name which is not their own.
3. Tom R., a newly admitted patient, has a seizure disorder which is being treated with medication. Which of the following drugs would the nurse question if ordered for him?
1) Phenobarbitol, 150 mg hs
2) Amitriptylene (Elavil), 10 mg QID.
3) Valproic acid (Depakote), 150 mg BID
4) Phenytoin (Dilantin), 100 mg TID
The correct answer is (2).
Elavil is an antidepressant that lowers the seizure threshold, so would not be appropriate for this patient. The other medications are anti-seizure drugs.
4. When counseling a patient who is starting to take MAO (monoamineoxidase) inhibitors such as Nardil for depression, it is essential that they be warned not to eat foods containing tyramine, such as
1) Roquefort, cheddar, or Camembert cheese.
2) grape juice, orange juice, or raisins.
3) onions, garlic, or scallions.
4) ground beef, turkey, or pork.
The correct answer is (1).
Monoamine oxidase inhibitors react with foods high in the amino acid tyramine to cause dangerously high blood pressure. Aged cheeses are all high in this amino acid the other foods are not.
5. The nurse is administering an antibiotic to her pediatric patient. She checks the patient's armband and verifies the correct medication by checking the physician's order, medication kardex, and vial. Which of the following is not considered one of the five "rights" of drug administration?
1) Right dose
2) Right route
3) Right frequency
4) Right time
The correct answer is (3).
The five rights of medication administration are right drug, right dose, right route, right time, right patient. Frequency is not included.
6. The physician orders an intramuscular injection of Demerol for the post-operative patient's pain. When preparing to draw up the medication, the nurse is careful to remove the correct vial from the narcotics cabinet. It is labeled
1) simethicone.
2) albuterol.
3) meperidine.
4) ibuprofen.
The correct answer is (3).
The generic name for Demerol is meperidine.
7. Mrs. Garvey has been dealing with uterine cancer for several months. Pain management is the primary focus of her current admission to your oncology unit. Her vital signs on admission are BP 110/64, pulse 78, respirations 18,and temperature 99.2 F. Morphine sulfate 6mg IV, q 4 hours, prn has been ordered. During your assessment after lunch, your findings are: BP 92/60,pulse 66, respirations 10, and temperature 98.8. Mrs. Garvey is crying and tells you she is still experiencing severe pain. Your action should be to
1) give her the next ordered dose of MS.
2) give her a back rub, put on some light music, and dim the lights in the room.
3) report your findings to the RN, requesting an alternate medication order be obtained from the physician.
4) call her daughter to come and sit with her.
The correct answer is (3).
Morphine sulfate depresses the respiratory center. When the rate is less than 10, the MD should be notified.
8. The most important instructions a nurse can give a patient regarding the use of the antibiotic Ampicillian prescribed for her are to
1) call the physician if she has any breathing difficulties.
2) take it with meals so it doesn't cause an upset stomach.
3) take all of the medication prescribed even if the symptoms stop sooner.
4) not share the pills with anyone else.
The correct answer is (3).
Frequently patients do not complete an entire course of antibiotic therapy, and the bacteria are not destroyed.
9. Frank Jones, a nurse on a geriatric floor, is administering a dose of digoxin to one of his patients. The woman asks why she takes a different pill than her niece, who also has heart trouble. Frank replies that as people get older, liver and kidney function decline, and if the dose is as high as her niece's, the drug will tend to
1) have a shorter half-life.
2) accumulate.
3) have decreased distribution.
4) have increased absorption.
The correct answer is (2).
The decreased circulation to the kidney and reduced liver function tend to allow drugs to accumulate and have toxic effects.
10. The nursery nurse is putting erythromycin ointment in the newborn's eyes to prevent infection. She places it in the following area of the eye:
1) under the eyelid.
2) on the cornea.
3) in the lower conjunctival sac.
4) by the optic disc.
The correct answer is (3).
The ointment is placed in the lower conjunctival sac so it will not scratch the eye itself and will get well distributed.
The nurse's understanding of the clotting mechanism is important in administering anticoagulant drugs. the nurse understands that which of the following clotting factors are formed after injury to the vessels?
1. Fibrin, vitamin K
2. Thromboplastin, fibrinogen
3. Prothrombin, thrombin
4. Thrombin, fibrin
4. Thrombin, fibrin
The patient receiving heparin therapy asks how the "blood thinner" works. The best response by the nurse would be:
1. "heparin makes the blood less thick"
2. "heparin does not thin the blood but prevents clots from forming as easily in the blood vessels"
3. "heparin decreases the number of platelets so that blood clots more slowly"
4. "heparin dissolves the clot"
2. "heparin does not thin the blood but prevents clots form forming as easily in the blood vessels"
Nursing interventions for a patient receiving enoxaparin (Lovenox) may include: (Select all that apply)
1. teaching the patient or family to give subcutaneous injections at home
2. teaching the patient or family not take any OTC drugs without first consulting with the health care provider
3. teaching the patient to observe for unexplained bleeding such as pink, red, or dark brown urine or blood gums
4. teaching the patient to monitor for the development of DVT
5. teaching the importance of drinking grapefruit juice daily
1. teaching the patient or family to give subcutaneous injections at home
2. teaching the patient or family not take any OTC drugs without first consulting with the health care provider
3. teaching the patient to observe for unexplained bleeding such as pink, red, or dark brown urine or blood gums
4. teaching the patient to monitor for the development of DVT
The nurse receives the patient's lab values throughout warfarin drug therapy. The expected therapeutic level is:
1. aPTT of three to four times the normal control value
2. aPTT one to two times the patient's baseline level
3. aPT one to two times the patient's last result
4. aPT one and half to two and half times the control value.
4. aPT one and half to two and half times the control values.

Rationale: aPT is the coagulation study that monitors oral anticoagulant use, such as warfarin. As a result of one and half to two and half times the control value indicates adquate anticoagulation.

aPTT is the coagulation study that monitors heparin use.

aPT level of one would indicate a less than therapeutic level of anticoagulation.
A patient is receiving a thrombolytic agent, alteplase (Activase), follwing an acute myocardial infraction. Which condition is most likely attributed to thrombolytic therapy with this agent?
1. Skin rash with urticaria
2. Wheezing with labored respirations
3. Brusing and epistaxis
4. Temperature elevation of 100.8F
3. Bruising and epistaxis

Rationale: Thrombolytic agents dissolve existing clots rapidly and continue to have effects for 2 to 4 days. All forms of bleeding must be monitored and reported immediately. Skin rash with urticara, wheezing with labored respirations, and temperature elevation of 100.8F are not symptoms of adverse effects directly attributed to thrombolytic therapy.
A patient has started clopidogrel (Plavix) after experiencing a TIA (transient ischemic attack). The desired therapeutic effects of this drug will be:
1. anti-inflammatory and antipyretic effects
2. to reduce the risk of a stroke from a blood clot
3. analgesic as well as clot-dissolving effects
4. to stop clots from becoming emboli.
2. to reduce the risk of a stroke from a blood clot

Rationale: Antiplatelet drugs such as clopidogerel are given to inhibit platelet aggreagtion and thus reduce the risk of thrombus formation. Antiplatelet drugs do no exert antiinflammatory, antipyretic or analgesic effects. The antiplatelet and anticoagulant drugs do not prevent emboli formation. Thrombolytics dissolve existing blood clots.
1) A nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13 mg/dL. Which medication should the nurse prepare to administer as prescribed to the client?
1. Calcium chloride
2. Calcium gluconate
3. Calcitonin (Miacalcin)
4. Large doses of vitamin D
3. Calcitonin (Miacalcin)
Rationale:
The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing hypercalcemia. Calcium gluconate and calcium chloride are medications used for the treatment of tetany, which occurs as a result of acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided. Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration.
2.) Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia. The nurse instructs the mother to administer the iron with which best food item?
1. Milk
2. Water
3. Apple juice
4. Orange juice
4. Orange juice
Rationale:
Vitamin C increases the absorption of iron by the body. The mother should be instructed to administer the medication with a citrus fruit or a juice that is high in vitamin C. Milk may affect absorption of the iron. Water will not assist in absorption. Orange juice contains a greater amount of vitamin C than apple juice.
3.) Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which of the following would indicate the presence of systemic toxicity from this medication?
1. Tinnitus
2. Diarrhea
3. Constipation
4. Decreased respirations
1. Tinnitus
Rationale:
Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can result. Symptoms include tinnitus, dizziness, hyperpnea, and psychological disturbances. Constipation and diarrhea are not associated with salicylism.
4.) The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied:
1. Immediately before swimming
2. 15 minutes before exposure to the sun
3. Immediately before exposure to the sun
4. At least 30 minutes before exposure to the sun
4. At least 30 minutes before exposure to the sun
Rationale:
Sunscreens are most effective when applied at least 30 minutes before exposure to the sun so that they can penetrate the skin. All sunscreens should be reapplied after swimming or sweating.
5.) Mafenide acetate (Sulfamylon) is prescribed for the client with a burn injury. When applying the medication, the client complains of local discomfort and burning. Which of the following is the most appropriate nursing action?
1. Notifying the registered nurse
2. Discontinuing the medication
3. Informing the client that this is normal
4. Applying a thinner film than prescribed to the burn site
3. Informing the client that this is normal
Rationale:
Mafenide acetate is bacteriostatic for gram-negative and gram-positive organisms and is used to treat burns to reduce bacteria present in avascular tissues. The client should be informed that the medication will cause local discomfort and burning and that this is a normal reaction; therefore options 1, 2, and 4 are incorrect
6.) The burn client is receiving treatments of topical mafenide acetate (Sulfamylon) to the site of injury. The nurse monitors the client, knowing that which of the following indicates that a systemic effect has occurred?
1.Hyperventilation
2.Elevated blood pressure
3.Local pain at the burn site
4.Local rash at the burn site
1.Hyperventilation
Rationale:
Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal excretion of acid, thereby causing acidosis. Clients receiving this treatment should be monitored for signs of an acid-base imbalance (hyperventilation). If this occurs, the medication should be discontinued for 1 to 2 days. Options 3 and 4 describe local rather than systemic effects. An elevated blood pressure may be expected from the pain that occurs with a burn injury.
7.) Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed?
1. Platelet count
2. Triglyceride level
3. Complete blood count
4. White blood cell count
2. Triglyceride level
Rationale:
Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before treatment and periodically thereafter until the effect on the triglycerides has been evaluated. Options 1, 3, and 4 do not need to be monitored specifically during this treatment.
8.) A client with severe acne is seen in the clinic and the health care provider (HCP) prescribes isotretinoin. The nurse reviews the client's medication record and would contact the (HCP) if the client is taking which medication?
1. Vitamin A
2. Digoxin (Lanoxin)
3. Furosemide (Lasix)
4. Phenytoin (Dilantin)
1. Vitamin A
Rationale:
Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements should be discontinued before isotretinoin therapy. Options 2, 3, and 4 are not contraindicated with the use of isotretinoin.
9.) The nurse is applying a topical corticosteroid to a client with eczema. The nurse would monitor for the potential for increased systemic absorption of the medication if the medication were being applied to which of the following body areas?
1. Back
2. Axilla
3. Soles of the feet
4. Palms of the hands
2. Axilla
Rationale:
Topical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions in which permeability is poor (back, palms, soles).
10.) The clinic nurse is performing an admission assessment on a client. The nurse notes that the client is taking azelaic acid (Azelex). Because of the medication prescription, the nurse would suspect that the client is being treated for:
1. Acne
2. Eczema
3. Hair loss
4. Herpes simplex
1. Acne
Rationale:
Azelaic acid is a topical medication used to treat mild to moderate acne. The acid appears to work by suppressing the growth of Propionibacterium acnes and decreasing the proliferation of keratinocytes. Options 2, 3, and 4 are incorrect.
11.) The health care provider has prescribed silver sulfadiazine (Silvadene) for the client with a partial-thickness burn, which has cultured positive for gram-negative bacteria. The nurse is reinforcing information to the client about the medication. Which statement made by the client indicates a lack of understanding about the treatments?
1. "The medication is an antibacterial."
2. "The medication will help heal the burn."
3. "The medication will permanently stain my skin."
4. "The medication should be applied directly to the wound."
3. "The medication will permanently stain my skin."
Rationale:
Silver sulfadiazine (Silvadene) is an antibacterial that has a broad spectrum of activity against gram-negative bacteria, gram-positive bacteria, and yeast. It is applied directly to the wound to assist in healing. It does not stain the skin.
12.) A nurse is caring for a client who is receiving an intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. During an inspection of the site, the nurse notes redness and swelling and that the rate of infusion of the medication has slowed. The nurse should take which appropriate action?
1. Notify the registered nurse.
2. Administer pain medication to reduce the discomfort.
3. Apply ice and maintain the infusion rate, as prescribed.
4. Elevate the extremity of the IV site, and slow the infusion.
1. Notify the registered nurse.
Rationale:
When antineoplastic medications (Chemotheraputic Agents) are administered via IV, great care must be taken to prevent the medication from escaping into the tissues surrounding the injection site, because pain, tissue damage, and necrosis can result. The nurse monitors for signs of extravasation, such as redness or swelling at the insertion site and a decreased infusion rate. If extravasation occurs, the registered nurse needs to be notified; he or she will then contact the health care provider.
13.) The client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed?
1. Echocardiography
2. Electrocardiography
3. Cervical radiography
4. Pulmonary function studies
4. Pulmonary function studies
Rationale:
Bleomycin is an antineoplastic medication (Chemotheraputic Agents) that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to the specific use of this medication.
14.) The client with acute myelocytic leukemia is being treated with busulfan (Myleran). Which laboratory value would the nurse specifically monitor during treatment with this medication?
1. Clotting time
2. Uric acid level
3. Potassium level
4. Blood glucose level
2. Uric acid level
Rationale:
Busulfan (Myleran) can cause an increase in the uric acid level. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute renal failure. Options 1, 3, and 4 are not specifically related to this medication.
15.) The client with small cell lung cancer is being treated with etoposide (VePesid). The nurse who is assisting in caring for the client during its administration understands that which side effect is specifically associated with this medication?
1. Alopecia
2. Chest pain
3. Pulmonary fibrosis
4. Orthostatic hypotension
4. Orthostatic hypotension
Rationale:
A side effect specific to etoposide is orthostatic hypotension. The client's blood pressure is monitored during the infusion. Hair loss occurs with nearly all the antineoplastic medications. Chest pain and pulmonary fibrosis are unrelated to this medication.
16.) The clinic nurse is reviewing a teaching plan for the client receiving an antineoplastic medication. When implementing the plan, the nurse tells the client:
1. To take aspirin (acetylsalicylic acid) as needed for headache
2. Drink beverages containing alcohol in moderate amounts each evening
3. Consult with health care providers (HCPs) before receiving immunizations
4. That it is not necessary to consult HCPs before receiving a flu vaccine at the local health fair
3. Consult with health care providers (HCPs) before receiving immunizations
Rationale:
Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without a HCP's approval. Clients also need to avoid contact with individuals who have recently received a live virus vaccine. Clients need to avoid aspirin and aspirin-containing products to minimize the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity and side effects.
17.) The client with ovarian cancer is being treated with vincristine (Oncovin). The nurse monitors the client, knowing that which of the following indicates a side effect specific to this medication?
1. Diarrhea
2. Hair loss
3. Chest pain
4. Numbness and tingling in the fingers and toes
4. Numbness and tingling in the fingers and toes
Rationale:
A side effect specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation rather than diarrhea is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all the antineoplastic medications. Chest pain is unrelated to this medication.
18.) The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse consults with the registered nurse regarding the administration of the medication if which of the following is documented in the client's history?
1. Pancreatitis
2. Diabetes mellitus
3. Myocardial infarction
4. Chronic obstructive pulmonary disease
1. Pancreatitis
Rationale:
Asparaginase (Elspar) is contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between administration of the doses. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. The conditions noted in options 2, 3, and 4 are not contraindicated with this medication.
19.) Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse understands that the primary action of this medication is to:
1. Increase DNA and RNA synthesis.
2. Promote the biosynthesis of nucleic acids.
3. Increase estrogen concentration and estrogen response.
4. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors.
4. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors.
Rationale:
Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy. Tamoxifen reduces DNA synthesis and estrogen response.
20.) The client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication?
1. Glucose level
2. Calcium level
3. Potassium level
4. Prothrombin time
2. Calcium level
Rationale:
Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium levels should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain.
21.) A nurse is assisting with caring for a client with cancer who is receiving cisplatin. Select the adverse effects that the nurse monitors for that are associated with this medication. Select all that apply.
1. Tinnitus
2. Ototoxicity
3. Hyperkalemia
4. Hypercalcemia
5. Nephrotoxicity
6. Hypomagnesemia
1. Tinnitus
2. Ototoxicity
5. Nephrotoxicity
6. Hypomagnesemia
Rationale:
Cisplatin is an alkylating medication. Alkylating medications are cell cycle phase-nonspecific medications that affect the synthesis of DNA by causing the cross-linking of DNA to inhibit cell reproduction. Cisplatin may cause ototoxicity, tinnitus, hypokalemia, hypocalcemia, hypomagnesemia, and nephrotoxicity. Amifostine (Ethyol) may be administered before cisplatin to reduce the potential for renal toxicity.
22.) A nurse is caring for a client after thyroidectomy and notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed to:
1. Treat thyroid storm.
2. Prevent cardiac irritability.
3. Treat hypocalcemic tetany.
4. Stimulate the release of parathyroid hormone.
3. Treat hypocalcemic tetany.
Rationale:
Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed or injured during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes or muscle spasms or twitching, the health care provider is notified immediately. Calcium gluconate should be kept at the bedside.
23.) A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which information should the nurse teach when carrying out plans for discharge?
1. Keep insulin vials refrigerated at all times.
2. Rotate the insulin injection sites systematically.
3. Increase the amount of insulin before unusual exercise.
4. Monitor the urine acetone level to determine the insulin dosage.
2. Rotate the insulin injection sites systematically.
Rationale:
Insulin dosages should not be adjusted or increased before unusual exercise. If acetone is found in the urine, it may possibly indicate the need for additional insulin. To minimize the discomfort associated with insulin injections, the insulin should be administered at room temperature. Injection sites should be systematically rotated from one area to another. The client should be instructed to give injections in one area, about 1 inch apart, until the whole area has been used and then to change to another site. This prevents dramatic changes in daily insulin absorption.
24.) A nurse is reinforcing teaching for a client regarding how to mix regular insulin and NPH insulin in the same syringe. Which of the following actions, if performed by the client, indicates the need for further teaching?
1. Withdraws the NPH insulin first
2. Withdraws the regular insulin first
3. Injects air into NPH insulin vial first
4. Injects an amount of air equal to the desired dose of insulin into the vial
1. Withdraws the NPH insulin first
Rationale:
When preparing a mixture of regular insulin with another insulin preparation, the regular insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of regular insulin with insulin of another type. Options 2, 3, and 4 identify the correct actions for preparing NPH and regular insulin.
25.) A home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse tells the client to:
1. Freeze the insulin.
2. Refrigerate the insulin.
3. Store the insulin in a dark, dry place.
4. Keep the insulin at room temperature.
2. Refrigerate the insulin.
Rationale:
Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be frozen. When stored unopened under refrigeration, insulin can be used up to the expiration date on the vial. Options 1, 3, and 4 are incorrect.
26.) Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. A nurse reinforces instructions for the client and tells the client to avoid which of the following while taking this medication?
1. Alcohol
2. Organ meats
3. Whole-grain cereals
4. Carbonated beverages
1. Alcohol
Rationale:
When alcohol is combined with glimepiride (Amaryl), a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol consumption while taking this medication. The items in options 2, 3, and 4 do not need to be avoided.
27.) Sildenafil (Viagra) is prescribed to treat a client with erectile dysfunction. A nurse reviews the client's medical record and would question the prescription if which of the following is noted in the client's history?
1. Neuralgia
2. Insomnia
3. Use of nitroglycerin
4. Use of multivitamins
3. Use of nitroglycerin
Rationale:
Sildenafil (Viagra) enhances the vasodilating effect of nitric oxide in the corpus cavernosum of the penis, thus sustaining an erection. Because of the effect of the medication, it is contraindicated with concurrent use of organic nitrates and nitroglycerin. Sildenafil is not contraindicated with the use of vitamins. Neuralgia and insomnia are side effects of the medication.
28.) The health care provider (HCP) prescribes exenatide (Byetta) for a client with type 1 diabetes mellitus who takes insulin. The nurse knows that which of the following is the appropriate intervention?
1. The medication is administered within 60 minutes before the morning and evening meal.
2. The medication is withheld and the HCP is called to question the prescription for the client.
3. The client is monitored for gastrointestinal side effects after administration of the medication.
4. The insulin is withdrawn from the Penlet into an insulin syringe to prepare for administration.
2. The medication is withheld and the HCP is called to question the prescription for the client.
Rationale:
Exenatide (Byetta) is an incretin mimetic used for type 2 diabetes mellitus only. It is not recommended for clients taking insulin. Hence, the nurse should hold the medication and question the HCP regarding this prescription. Although options 1 and 3 are correct statements about the medication, in this situation the medication should not be administered. The medication is packaged in prefilled pens ready for injection without the need for drawing it up into another syringe.
29.) A client is taking Humulin NPH insulin daily every morning. The nurse reinforces instructions for the client and tells the client that the most likely time for a hypoglycemic reaction to occur is:
1. 2 to 4 hours after administration
2. 4 to 12 hours after administration
3. 16 to 18 hours after administration
4. 18 to 24 hours after administration
2. 4 to 12 hours after administration
Rationale:
Humulin NPH is an intermediate-acting insulin. The onset of action is 1.5 hours, it peaks in 4 to 12 hours, and its duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.
30.) A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia?
1. Prednisone
2. Phenelzine (Nardil)
3. Atenolol (Tenormin)
4. Allopurinol (Zyloprim)
1. Prednisone
Rationale:
Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 2, a monoamine oxidase inhibitor, and option 3, a β-blocker, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.
31.) A community health nurse visits a client at home. Prednisone 10 mg orally daily has been prescribed for the client and the nurse reinforces teaching for the client about the medication. Which statement, if made by the client, indicates that further teaching is necessary?
1. "I can take aspirin or my antihistamine if I need it."
2. "I need to take the medication every day at the same time."
3. "I need to avoid coffee, tea, cola, and chocolate in my diet."
4. "If I gain more than 5 pounds a week, I will call my doctor."
1. "I can take aspirin or my antihistamine if I need it."
Rationale:
Aspirin and other over-the-counter medications should not be taken unless the client consults with the health care provider (HCP). The client needs to take the medication at the same time every day and should be instructed not to stop the medication. A slight weight gain as a result of an improved appetite is expected, but after the dosage is stabilized, a weight gain of 5 lb or more weekly should be reported to the HCP. Caffeine-containing foods and fluids need to be avoided because they may contribute to steroid-ulcer development.
32.) Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response?
1. Decreased urinary output
2. Decreased blood pressure
3. Decreased peripheral edema
4. Decreased blood glucose level
1. Decreased urinary output
Rationale:
Desmopressin promotes renal conservation of water. The hormone carries out this action by acting on the collecting ducts of the kidney to increase their permeability to water, which results in increased water reabsorption. The therapeutic effect of this medication would be manifested by a decreased urine output. Options 2, 3, and 4 are unrelated to the effects of this medication.
33.) The home health care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client is prescribed repaglinide (Prandin) and metformin (Glucophage) and asks the nurse to explain these medications. The nurse should reinforce which instructions to the client? Select all that apply.
1. Diarrhea can occur secondary to the metformin.
2. The repaglinide is not taken if a meal is skipped.
3. The repaglinide is taken 30 minutes before eating.
4. Candy or another simple sugar is carried and used to treat mild hypoglycemia episodes.
5. Metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide.
6. Muscle pain is an expected side effect of metformin and may be treated with acetaminophen (Tylenol).
1. Diarrhea can occur secondary to the metformin.
2. The repaglinide is not taken if a meal is skipped.
3. The repaglinide is taken 30 minutes before eating.
4. Candy or another simple sugar is carried and used to treat mild hypoglycemia episodes.
Rationale:
Repaglinide is a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin secretion that should be taken before meals, and that should be withheld if the client does not eat. Hypoglycemia is a side effect of repaglinide and the client should always be prepared by carrying a simple sugar with her or him at all times. Metformin is an oral hypoglycemic given in combination with repaglinide and works by decreasing hepatic glucose production. A common side effect of metformin is diarrhea. Muscle pain may occur as an adverse effect from metformin but it might signify a more serious condition that warrants health care provider notification, not the use of acetaminophen.
34.) A client with Crohn's disease is scheduled to receive an infusion of infliximab (Remicade). The nurse assisting in caring for the client should take which action to monitor the effectiveness of treatment?
1. Monitoring the leukocyte count for 2 days after the infusion
2. Checking the frequency and consistency of bowel movements
3. Checking serum liver enzyme levels before and after the infusion
4. Carrying out a Hematest on gastric fluids after the infusion is completed
2. Checking the frequency and consistency of bowel movements
Rationale:
The principal manifestations of Crohn's disease are diarrhea and abdominal pain. Infliximab (Remicade) is an immunomodulator that reduces the degree of inflammation in the colon, thereby reducing the diarrhea. Options 1, 3, and 4 are unrelated to this medication.
35.) The client has a PRN prescription for loperamide hydrochloride (Imodium). The nurse understands that this medication is used for which condition?
1. Constipation
2. Abdominal pain
3. An episode of diarrhea
4. Hematest-positive nasogastric tube drainage
3. An episode of diarrhea
Rationale:
Loperamide is an antidiarrheal agent. It is used to manage acute and also chronic diarrhea in conditions such as inflammatory bowel disease. Loperamide also can be used to reduce the volume of drainage from an ileostomy. It is not used for the conditions in options 1, 2, and 4.
36.) The client has a PRN prescription for ondansetron (Zofran). For which condition should this medication be administered to the postoperative client?
1. Paralytic ileus
2. Incisional pain
3. Urinary retention
4. Nausea and vomiting
4. Nausea and vomiting
Rationale:
Ondansetron is an antiemetic used to treat postoperative nausea and vomiting, as well as nausea and vomiting associated with chemotherapy. The other options are incorrect.
37.) The client has begun medication therapy with pancrelipase (Pancrease MT). The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed?
1. Weight loss
2. Relief of heartburn
3. Reduction of steatorrhea
4. Absence of abdominal pain
3. Reduction of steatorrhea
Rationale:
Pancrelipase (Pancrease MT) is a pancreatic enzyme used in clients with pancreatitis as a digestive aid. The medication should reduce the amount of fatty stools (steatorrhea). Another intended effect could be improved nutritional status. It is not used to treat abdominal pain or heartburn. Its use could result in weight gain but should not result in weight loss if it is aiding in digestion.
38.) An older client recently has been taking cimetidine (Tagamet). The nurse monitors the client for which most frequent central nervous system side effect of this medication?
1. Tremors
2. Dizziness
3. Confusion
4. Hallucinations
3. Confusion
Rationale:
Cimetidine is a histamine 2 (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations.
39.) The client with a gastric ulcer has a prescription for sucralfate (Carafate), 1 g by mouth four times daily. The nurse schedules the medication for which times?
1. With meals and at bedtime
2. Every 6 hours around the clock
3. One hour after meals and at bedtime
4. One hour before meals and at bedtime
4. One hour before meals and at bedtime
Rationale:
Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation. The other options are incorrect.
40.) The client who chronically uses nonsteroidal anti-inflammatory drugs has been taking misoprostol (Cytotec). The nurse determines that the medication is having the intended therapeutic effect if which of the following is noted?
1. Resolved diarrhea
2. Relief of epigastric pain
3. Decreased platelet count
4. Decreased white blood cell count
2. Relief of epigastric pain
Rationale:
The client who chronically uses nonsteroidal anti-inflammatory drugs (NSAIDs) is prone to gastric mucosal injury. Misoprostol is a gastric protectant and is given specifically to prevent this occurrence. Diarrhea can be a side effect of the medication, but is not an intended effect. Options 3 and 4 are incorrect.
41.) The client has been taking omeprazole (Prilosec) for 4 weeks. The ambulatory care nurse evaluates that the client is receiving optimal intended effect of the medication if the client reports the absence of which symptom?
1. Diarrhea
2. Heartburn
3. Flatulence
4. Constipation
2. Heartburn
Rationale:
Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called heartburn by clients. Omeprazole is not used to treat the conditions identified in options 1, 3, and 4.
42.) A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is reinforcing teaching for the client about the medications prescribed, including clarithromycin (Biaxin), esomeprazole (Nexium), and amoxicillin (Amoxil). Which statement by the client indicates the best understanding of the medication regimen?
1. "My ulcer will heal because these medications will kill the bacteria."
2. "These medications are only taken when I have pain from my ulcer."
3. "The medications will kill the bacteria and stop the acid production."
4. "These medications will coat the ulcer and decrease the acid production in my stomach."
3. "The medications will kill the bacteria and stop the acid production."
Rationale:
Triple therapy for Helicobacter pylori infection usually includes two antibacterial drugs and a proton pump inhibitor. Clarithromycin and amoxicillin are antibacterials. Esomeprazole is a proton pump inhibitor. These medications will kill the bacteria and decrease acid production.
43.) A histamine (H2)-receptor antagonist will be prescribed for a client. The nurse understands that which medications are H2-receptor antagonists? Select all that apply.
1. Nizatidine (Axid)
2. Ranitidine (Zantac)
3. Famotidine (Pepcid)
4. Cimetidine (Tagamet)
5. Esomeprazole (Nexium)
6. Lansoprazole (Prevacid)
1. Nizatidine (Axid)
2. Ranitidine (Zantac)
3. Famotidine (Pepcid)
4. Cimetidine (Tagamet)
Rationale:
H2-receptor antagonists suppress secretion of gastric acid, alleviate symptoms of heartburn, and assist in preventing complications of peptic ulcer disease. These medications also suppress gastric acid secretions and are used in active ulcer disease, erosive esophagitis, and pathological hypersecretory conditions. The other medications listed are proton pump inhibitors.
H2-receptor antagonists medication names end with -dine.
Proton pump inhibitors medication names end with -zole.
44.) A client is receiving acetylcysteine (Mucomyst), 20% solution diluted in 0.9% normal saline by nebulizer. The nurse should have which item available for possible use after giving this medication?
1. Ambu bag
2. Intubation tray
3. Nasogastric tube
4. Suction equipment
4. Suction equipment
Rationale:
Acetylcysteine can be given orally or by nasogastric tube to treat acetaminophen overdose, or it may be given by inhalation for use as a mucolytic. The nurse administering this medication as a mucolytic should have suction equipment available in case the client cannot manage to clear the increased volume of liquefied secretions.
45.) A client has a prescription to take guaifenesin (Humibid) every 4 hours, as needed. The nurse determines that the client understands the most effective use of this medication if the client states that he or she will:
1. Watch for irritability as a side effect.
2. Take the tablet with a full glass of water.
3. Take an extra dose if the cough is accompanied by fever.
4. Crush the sustained-release tablet if immediate relief is needed.
2. Take the tablet with a full glass of water.
Rationale:
Guaifenesin is an expectorant. It should be taken with a full glass of water to decrease viscosity of secretions. Sustained-release preparations should not be broken open, crushed, or chewed. The medication may occasionally cause dizziness, headache, or drowsiness as side effects. The client should contact the health care provider if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache.
46.) A postoperative client has received a dose of naloxone hydrochloride for respiratory depression shortly after transfer to the nursing unit from the postanesthesia care unit. After administration of the medication, the nurse checks the client for:
1. Pupillary changes
2. Scattered lung wheezes
3. Sudden increase in pain
4. Sudden episodes of diarrhea
3. Sudden increase in pain
Rationale:
Naloxone hydrochloride is an antidote to opioids and may also be given to the postoperative client to treat respiratory depression. When given to the postoperative client for respiratory depression, it may also reverse the effects of analgesics. Therefore, the nurse must check the client for a sudden increase in the level of pain experienced. Options 1, 2, and 4 are not associated with this medication.
47.) A client has been taking isoniazid (INH) for 2 months. The client complains to a nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing:
1. Hypercalcemia
2. Peripheral neuritis
3. Small blood vessel spasm
4. Impaired peripheral circulation
2. Peripheral neuritis
Rationale:
A common side effect of the TB drug INH is peripheral neuritis. This is manifested by numbness, tingling, and paresthesias in the extremities. This side effect can be minimized by pyridoxine (vitamin B6) intake. Options 1, 3, and 4 are incorrect.
48.) A client is to begin a 6-month course of therapy with isoniazid (INH). A nurse plans to teach the client to:
1. Drink alcohol in small amounts only.
2. Report yellow eyes or skin immediately.
3. Increase intake of Swiss or aged cheeses.
4. Avoid vitamin supplements during therapy.
2. Report yellow eyes or skin immediately.
Rationale:
INH is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately (which include yellow skin and sclera). For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of INH therapy for TB.
49.) A client has been started on long-term therapy with rifampin (Rifadin). A nurse teaches the client that the medication:
1. Should always be taken with food or antacids
2. Should be double-dosed if one dose is forgotten
3. Causes orange discoloration of sweat, tears, urine, and feces
4. May be discontinued independently if symptoms are gone in 3 months
3. Causes orange discoloration of sweat, tears, urine, and feces
Rationale:
Rifampin should be taken exactly as directed as part of TB therapy. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a health care provider. The medication should be administered on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin causes orange-red discoloration of body secretions and will permanently stain soft contact lenses.
50.) A nurse has given a client taking ethambutol (Myambutol) information about the medication. The nurse determines that the client understands the instructions if the client states that he or she will immediately report:
1. Impaired sense of hearing
2. Problems with visual acuity
3. Gastrointestinal (GI) side effects
4. Orange-red discoloration of body secretions
2. Problems with visual acuity
Rationale:
Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client is also taught to take the medication with food if GI upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin (Rifadin).
51.) Cycloserine (Seromycin) is added to the medication regimen for a client with tuberculosis. Which of the following would the nurse include in the client-teaching plan regarding this medication?
1. To take the medication before meals
2. To return to the clinic weekly for serum drug-level testing
3. It is not necessary to call the health care provider (HCP) if a skin rash occurs.
4. It is not necessary to restrict alcohol intake with this medication.
2. To return to the clinic weekly for serum drug-level testing
Rationale:
Cycloserine (Seromycin) is an antitubercular medication that requires weekly serum drug level determinations to monitor for the potential of neurotoxicity. Serum drug levels lower than 30 mcg/mL reduce the incidence of neurotoxicity. The medication must be taken after meals to prevent gastrointestinal irritation. The client must be instructed to notify the HCP if a skin rash or signs of central nervous system toxicity are noted. Alcohol must be avoided because it increases the risk of seizure activity.
52.) A client with tuberculosis is being started on antituberculosis therapy with isoniazid (INH). Before giving the client the first dose, a nurse ensures that which of the following baseline studies has been completed?
1. Electrolyte levels
2. Coagulation times
3. Liver enzyme levels
4. Serum creatinine level
3. Liver enzyme levels
Rationale:
INH therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is greater than age 50 or abuses alcohol.
53.) Rifabutin (Mycobutin) is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. The nurse monitors for which side effects of the medication? Select all that apply.
1. Signs of hepatitis
2. Flu-like syndrome
3. Low neutrophil count
4. Vitamin B6 deficiency
5. Ocular pain or blurred vision
6. Tingling and numbness of the fingers
1. Signs of hepatitis
2. Flu-like syndrome
3. Low neutrophil count
5. Ocular pain or blurred vision
Rationale:
Rifabutin (Mycobutin) may be prescribed for a client with active MAC disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis. Side effects include rash, gastrointestinal disturbances, neutropenia (low neutrophil count), red-orange body secretions, uveitis (blurred vision and eye pain), myositis, arthralgia, hepatitis, chest pain with dyspnea, and flu-like syndrome. Vitamin B6 deficiency and numbness and tingling in the extremities are associated with the use of isoniazid (INH). Ethambutol (Myambutol) also causes peripheral neuritis.
54.) A nurse reinforces discharge instructions to a postoperative client who is taking warfarin sodium (Coumadin). Which statement, if made by the client, reflects the need for further teaching?
1. "I will take my pills every day at the same time."
2. "I will be certain to avoid alcohol consumption."
3. "I have already called my family to pick up a Medic-Alert bracelet."
4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated."
4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated."
Rationale:
Ecotrin is an aspirin-containing product and should be avoided. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking prescribed medication at the same time each day increases client compliance. The Medic-Alert bracelet provides health care personnel emergency information.
55.) A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3.0 mEq/L and is complaining of anorexia. A health care provider prescribes a digoxin level to rule out digoxin toxicity. A nurse checks the results, knowing that which of the following is the therapeutic serum level (range) for digoxin?
1. 3 to 5 ng/mL
2. 0.5 to 2 ng/mL
3. 1.2 to 2.8 ng/mL
4. 3.5 to 5.5 ng/mL
2.) 0.5 to 2 ng/mL
Rationale:
Therapeutic levels for digoxin range from 0.5 to 2 ng/mL. Therefore, options 1, 3, and 4 are incorrect.
56.) Heparin sodium is prescribed for the client. The nurse expects that the health care provider will prescribe which of the following to monitor for a therapeutic effect of the medication?
1. Hematocrit level
2. Hemoglobin level
3. Prothrombin time (PT)
4. Activated partial thromboplastin time (aPTT)
4. Activated partial thromboplastin time (aPTT)
Rationale:
The PT will assess for the therapeutic effect of warfarin sodium (Coumadin) and the aPTT will assess the therapeutic effect of heparin sodium. Heparin sodium doses are determined based on these laboratory results. The hemoglobin and hematocrit values assess red blood cell concentrations.
57.) A nurse is monitoring a client who is taking propranolol (Inderal LA). Which data collection finding would indicate a potential serious complication associated with propranolol?
1. The development of complaints of insomnia
2. The development of audible expiratory wheezes
3. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after two doses of the medication
4. A baseline resting heart rate of 88 beats/min followed by a resting heart rate of 72 beats/min after two doses of the medication
2. The development of audible expiratory wheezes
Rationale:
Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. β-Blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored.
58.) Isosorbide mononitrate (Imdur) is prescribed for a client with angina pectoris. The client tells the nurse that the medication is causing a chronic headache. The nurse appropriately suggests that the client:
1. Cut the dose in half.
2. Discontinue the medication.
3. Take the medication with food.
4. Contact the health care provider (HCP).
3. Take the medication with food.
Rationale:
Isosorbide mononitrate is an antianginal medication. Headache is a frequent side effect of isosorbide mononitrate and usually disappears during continued therapy. If a headache occurs during therapy, the client should be instructed to take the medication with food or meals. It is not necessary to contact the HCP unless the headaches persist with therapy. It is not appropriate to instruct the client to discontinue therapy or adjust the dosages.
59.) A client is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase (Activase, tPA). Which action is a priority nursing intervention?
1. Monitor for renal failure.
2. Monitor psychosocial status.
3. Monitor for signs of bleeding.
4. Have heparin sodium available.
3. Monitor for signs of bleeding.
Rationale:
Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychosocial status are important but are not the most critical interventions. Heparin is given after thrombolytic therapy, but the question is not asking about follow-up medications.
60.) A nurse is planning to administer hydrochlorothiazide (HydroDIURIL) to a client. The nurse understands that which of the following are concerns related to the administration of this medication?
1. Hypouricemia, hyperkalemia
2. Increased risk of osteoporosis
3. Hypokalemia, hyperglycemia, sulfa allergy
4. Hyperkalemia, hypoglycemia, penicillin allergy
3. Hypokalemia, hyperglycemia, sulfa allergy
Rationale:
Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.
61.) A home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine (Questran). Which of the following statements, if made by the client, indicates the need for further education?
1. "Constipation and bloating might be a problem."
2. "I'll continue to watch my diet and reduce my fats."
3. "Walking a mile each day will help the whole process."
4. "I'll continue my nicotinic acid from the health food store."
4. "I'll continue my nicotinic acid from the health food store."
Rationale:
Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid-lowering medications also can cause liver abnormalities, so a combination of nicotinic acid and cholestyramine resin is to be avoided. Constipation and bloating are the two most common side effects. Walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels.
62.) A client is on nicotinic acid (niacin) for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client would indicate an understanding of the instructions?
1. "It is not necessary to avoid the use of alcohol."
2. "The medication should be taken with meals to decrease flushing."
3. "Clay-colored stools are a common side effect and should not be of concern."
4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing."
4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing."
Rationale:
Flushing is a side effect of this medication. Aspirin or a nonsteroidal anti-inflammatory drug can be taken 30 minutes before taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this side effect. The medication should be taken with meals, this will decrease gastrointestinal upset. Taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be immediately reported to the health care provider (HCP).
63.) A client with coronary artery disease complains of substernal chest pain. After checking the client's heart rate and blood pressure, a nurse administers nitroglycerin, 0.4 mg, sublingually. After 5 minutes, the client states, "My chest still hurts." Select the appropriate actions that the nurse should take. Select all that apply.
1. Call a code blue.
2. Contact the registered nurse.
3. Contact the client's family.
4. Assess the client's pain level.
5. Check the client's blood pressure.
6. Administer a second nitroglycerin, 0.4 mg, sublingually.
2. Contact the registered nurse.
4. Assess the client's pain level.
5. Check the client's blood pressure.
6. Administer a second nitroglycerin, 0.4 mg, sublingually.
Rationale:
The usual guideline for administering nitroglycerin tablets for a hospitalized client with chest pain is to administer one tablet every 5 minutes PRN for chest pain, for a total dose of three tablets. The registered nurse should be notified of the client's condition, who will then notify the health care provider as appropriate. Because the client is still complaining of chest pain, the nurse would administer a second nitroglycerin tablet. The nurse would assess the client's pain level and check the client's blood pressure before administering each nitroglycerin dose. There are no data in the question that indicate the need to call a code blue. In addition, it is not necessary to contact the client's family unless the client has requested this.
64.) Nalidixic acid (NegGram) is prescribed for a client with a urinary tract infection. On review of the client's record, the nurse notes that the client is taking warfarin sodium (Coumadin) daily. Which prescription should the nurse anticipate for this client?
1. Discontinuation of warfarin sodium (Coumadin)
2. A decrease in the warfarin sodium (Coumadin) dosage
3. An increase in the warfarin sodium (Coumadin) dosage
4. A decrease in the usual dose of nalidixic acid (NegGram)
2. A decrease in the warfarin sodium (Coumadin) dosage
Rationale:
Nalidixic acid can intensify the effects of oral anticoagulants by displacing these agents from binding sites on plasma protein. When an oral anticoagulant is combined with nalidixic acid, a decrease in the anticoagulant dosage may be needed.
65.) A nurse is reinforcing discharge instructions to a client receiving sulfisoxazole. Which of the following should be included in the list of instructions?
1. Restrict fluid intake.
2. Maintain a high fluid intake.
3. If the urine turns dark brown, call the health care provider (HCP) immediately.
4. Decrease the dosage when symptoms are improving to prevent an allergic response.
2. Maintain a high fluid intake.
Rationale:
Each dose of sulfisoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Some forms of sulfisoxazole cause urine to turn dark brown or red. This does not indicate the need to notify the HCP.
66.) Trimethoprim-sulfamethoxazole (TMP-SMZ) is prescribed for a client. A nurse should instruct the client to report which symptom if it developed during the course of this medication therapy?
1. Nausea
2. Diarrhea
3. Headache
4. Sore throat
4. Sore throat
Rationale:
Clients taking trimethoprim-sulfamethoxazole (TMP-SMZ) should be informed about early signs of blood disorders that can occur from this medication. These include sore throat, fever, and pallor, and the client should be instructed to notify the health care provider if these symptoms occur. The other options do not require health care provider notification.
67.) Phenazopyridine hydrochloride (Pyridium) is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. The nurse reinforces to the client:
1. To take the medication at bedtime
2. To take the medication before meals
3. To discontinue the medication if a headache occurs
4. That a reddish orange discoloration of the urine may occur
4. That a reddish orange discoloration of the urine may occur
Rationale:
The nurse should instruct the client that a reddish-orange discoloration of urine may occur. The nurse also should instruct the client that this discoloration can stain fabric. The medication should be taken after meals to reduce the possibility of gastrointestinal upset. A headache is an occasional side effect of the medication and does not warrant discontinuation of the medication.
68.) Bethanechol chloride (Urecholine) is prescribed for a client with urinary retention. Which disorder would be a contraindication to the administration of this medication?
1. Gastric atony
2. Urinary strictures
3. Neurogenic atony
4. Gastroesophageal reflux
2. Urinary strictures
Rationale:
Bethanechol chloride (Urecholine) can be harmful to clients with urinary tract obstruction or weakness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract could rupture the bladder in clients with these conditions.
69.) A nurse who is administering bethanechol chloride (Urecholine) is monitoring for acute toxicity associated with the medication. The nurse checks the client for which sign of toxicity?
1. Dry skin
2. Dry mouth
3. Bradycardia
4. Signs of dehydration
3. Bradycardia
Rationale:
Toxicity (overdose) produces manifestations of excessive muscarinic stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension. Treatment includes supportive measures and the administration of atropine sulfate subcutaneously or intravenously.
70.) Oxybutynin chloride (Ditropan XL) is prescribed for a client with neurogenic bladder. Which sign would indicate a possible toxic effect related to this medication?
1. Pallor
2. Drowsiness
3. Bradycardia
4. Restlessness
4. Restlessness
Rationale:
Toxicity (overdosage) of this medication produces central nervous system excitation, such as nervousness, restlessness, hallucinations, and irritability. Other signs of toxicity include hypotension or hypertension, confusion, tachycardia, flushed or red face, and signs of respiratory depression. Drowsiness is a frequent side effect of the medication but does not indicate overdosage.
71.) After kidney transplantation, cyclosporine (Sand immune) is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication?
1. Decreased creatinine level
2. Decreased hemoglobin level
3. Elevated blood urea nitrogen level
4. Decreased white blood cell count
3. Elevated blood urea nitrogen level
Rationale:
Nephrotoxicity can occur from the use of cyclosporine (Sandimmune). Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen (BUN) and serum creatinine levels. Cyclosporine is an immunosuppressant but does not depress the bone marrow.
72.) Cinoxacin (Cinobac), a urinary antiseptic, is prescribed for the client. The nurse reviews the client's medical record and should contact the health care provider (HCP) regarding which documented finding to verify the prescription? Refer to chart.
1. Renal insufficiency
2. Chest x-ray: normal
3. Blood glucose, 102 mg/dL
4. Folic acid (vitamin B6) 0.5 mg, orally daily
1. Renal insufficiency
Rationale:
Cinoxacin should be administered with caution in clients with renal impairment. The dosage should be reduced, and failure to do so could result in accumulation of cinoxacin to toxic levels. Therefore the nurse would verify the prescription if the client had a documented history of renal insufficiency. The laboratory and diagnostic test results are normal findings. Folic acid (vitamin B6) may be prescribed for a client with renal insufficiency to prevent anemia.
73.) A client with myasthenia gravis is suspected of having cholinergic crisis. Which of the following indicate that this crisis exists?
1. Ataxia
2. Mouth sores
3. Hypotension
4. Hypertension
4. Hypertension
Rationale:
Cholinergic crisis occurs as a result of an overdose of medication. Indications of cholinergic crisis include gastrointestinal disturbances, nausea, vomiting, diarrhea, abdominal cramps, increased salivation and tearing, miosis, hypertension, sweating, and increased bronchial secretions.
74.) A client with myasthenia gravis is receiving pyridostigmine (Mestinon). The nurse monitors for signs and symptoms of cholinergic crisis caused by overdose of the medication. The nurse checks the medication supply to ensure that which medication is available for administration if a cholinergic crisis occurs?
1. Vitamin K
2. Atropine sulfate
3. Protamine sulfate
4. Acetylcysteine (Mucomyst)
2. Atropine sulfate
Rationale:
The antidote for cholinergic crisis is atropine sulfate. Vitamin K is the antidote for warfarin (Coumadin). Protamine sulfate is the antidote for heparin, and acetylcysteine (Mucomyst) is the antidote for acetaminophen (Tylenol).
75.) A client with myasthenia gravis becomes increasingly weak. The health care provider prepares to identify whether the client is reacting to an overdose of the medication (cholinergic crisis) or increasing severity of the disease (myasthenic crisis). An injection of edrophonium (Enlon) is administered. Which of the following indicates that the client is in cholinergic crisis?
1. No change in the condition
2. Complaints of muscle spasms
3. An improvement of the weakness
4. A temporary worsening of the condition
4. A temporary worsening of the condition
Rationale:
An edrophonium (Enlon) injection, a cholinergic drug, makes the client in cholinergic crisis temporarily worse. This is known as a negative test. An improvement of weakness would occur if the client were experiencing myasthenia gravis. Options 1 and 2 would not occur in either crisis.
76.) Carbidopa-levodopa (Sinemet) is prescribed for a client with Parkinson's disease, and the nurse monitors the client for adverse reactions to the medication. Which of the following indicates that the client is experiencing an adverse reaction?
1. Pruritus
2. Tachycardia
3. Hypertension
4. Impaired voluntary movements
4. Impaired voluntary movements
Rationale:
Dyskinesia and impaired voluntary movement may occur with high levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia (the temporary muscle weakness that lasts 1 minute to 1 hour, also known as the "on-off phenomenon") are frequent side effects of the medication.
77.) Phenytoin (Dilantin), 100 mg orally three times daily, has been prescribed for a client for seizure control. The nurse reinforces instructions regarding the medication to the client. Which statement by the client indicates an understanding of the instructions?
1. "I will use a soft toothbrush to brush my teeth."
2. "It's all right to break the capsules to make it easier for me to swallow them."
3. "If I forget to take my medication, I can wait until the next dose and eliminate that dose."
4. "If my throat becomes sore, it's a normal effect of the medication and it's nothing to be concerned about."
1. "I will use a soft toothbrush to brush my teeth."
Rationale:
Phenytoin (Dilantin) is an anticonvulsant. Gingival hyperplasia, bleeding, swelling, and tenderness of the gums can occur with the use of this medication. The client needs to be taught good oral hygiene, gum massage, and the need for regular dentist visits. The client should not skip medication doses, because this could precipitate a seizure. Capsules should not be chewed or broken and they must be swallowed. The client needs to be instructed to report a sore throat, fever, glandular swelling, or any skin reaction, because this indicates hematological toxicity.
78.) A client is taking phenytoin (Dilantin) for seizure control and a sample for a serum drug level is drawn. Which of the following indicates a therapeutic serum drug range?
1. 5 to 10 mcg/mL
2. 10 to 20 mcg/mL
3. 20 to 30 mcg/mL
4. 30 to 40 mcg/mL
2. 10 to 20 mcg/mL
Rationale:
The therapeutic serum drug level range for phenytoin (Dilantin) is 10 to 20 mcg/mL.
* A helpful hint may be to remember that the theophylline therapeutic range and the acetaminophen (Tylenol) therapeutic range are the same as the phenytoin (Dilantin) therapeutic range.*
79.) Ibuprofen (Advil) is prescribed for a client. The nurse tells the client to take the medication:
1. With 8 oz of milk
2. In the morning after arising
3. 60 minutes before breakfast
4. At bedtime on an empty stomach
1. With 8 oz of milk
Rationale:
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs should be given with milk or food to prevent gastrointestinal irritation. Options 2, 3, and 4 are incorrect.
80.) A nurse is caring for a client who is taking phenytoin (Dilantin) for control of seizures. During data collection, the nurse notes that the client is taking birth control pills. Which of the following information should the nurse provide to the client?
1. Pregnancy should be avoided while taking phenytoin (Dilantin).
2. The client may stop taking the phenytoin (Dilantin) if it is causing severe gastrointestinal effects.
3. The potential for decreased effectiveness of the birth control pills exists while taking phenytoin (Dilantin).
4. The increased risk of thrombophlebitis exists while taking phenytoin (Dilantin) and birth control pills together.
3. The potential for decreased effectiveness of the birth control pills exists while taking phenytoin (Dilantin).
Rationale:
Phenytoin (Dilantin) enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. Options 1, 2, are 4 are not accurate.
81.) A client with trigeminal neuralgia is being treated with carbamazepine (Tegretol). Which laboratory result would indicate that the client is experiencing an adverse reaction to the medication?
1. Sodium level, 140 mEq/L
2. Uric acid level, 5.0 mg/dL
3. White blood cell count, 3000 cells/mm3
4. Blood urea nitrogen (BUN) level, 15 mg/dL
3. White blood cell count, 3000 cells/mm3
Rationale:
Adverse effects of carbamazepine (Tegretol) appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia, cardiovascular disturbances, thrombophlebitis, dysrhythmias, and dermatological effects. Options 1, 2, and 4 identify normal laboratory values.
82.) A client is receiving meperidine hydrochloride (Demerol) for pain. Which of the following are side effects of this medication. Select all that apply.
1. Diarrhea
2. Tremors
3. Drowsiness
4. Hypotension
5. Urinary frequency
6. Increased respiratory rate
2. Tremors
3. Drowsiness
4. Hypotension
Rationale:
Meperidine hydrochloride is an opioid analgesic. Side effects include respiratory depression, drowsiness, hypotension, constipation, urinary retention, nausea, vomiting, and tremors.
83.) The client has been on treatment for rheumatoid arthritis for 3 weeks. During the administration of etanercept (Enbrel), it is most important for the nurse to check:
1. The injection site for itching and edema
2. The white blood cell counts and platelet counts
3. Whether the client is experiencing fatigue and joint pain
4. A metallic taste in the mouth, with a loss of appetite
2. The white blood cell counts and platelet counts
Rationale:
Infection and pancytopenia are side effects of etanercept (Enbrel). Laboratory studies are performed before and during drug treatment. The appearance of abnormal white blood cell counts and abnormal platelet counts can alert the nurse to a potentially life-threatening infection. Injection site itching is a common occurrence following administration. A metallic taste with loss of appetite are not common signs of side effects of this medication.
84.) Baclofen (Lioresal) is prescribed for the client with multiple sclerosis. The nurse assists in planning care, knowing that the primary therapeutic effect of this medication is which of the following?
1. Increased muscle tone
2. Decreased muscle spasms
3. Increased range of motion
4. Decreased local pain and tenderness
2. Decreased muscle spasms
Rationale:
Baclofen is a skeletal muscle relaxant and central nervous system depressant and acts at the spinal cord level to decrease the frequency and amplitude of muscle spasms in clients with spinal cord injuries or diseases and in clients with multiple sclerosis. Options 1, 3, and 4 are incorrect.
85.) A nurse is monitoring a client receiving baclofen (Lioresal) for side effects related to the medication. Which of the following would indicate that the client is experiencing a side effect?
1. Polyuria
2. Diarrhea
3. Drowsiness
4. Muscular excitability
3. Drowsiness
Rationale:
Baclofen is a central nervous system (CNS) depressant and frequently causes drowsiness, dizziness, weakness, and fatigue. It can also cause nausea, constipation, and urinary retention. Clients should be warned about the possible reactions. Options 1, 2, and 4 are not side effects.
86.) A nurse is reinforcing discharge instructions to a client receiving baclofen (Lioresal). Which of the following would the nurse include in the instructions?
1. Restrict fluid intake.
2. Avoid the use of alcohol.
3. Stop the medication if diarrhea occurs.
4. Notify the health care provider if fatigue occurs.
2. Avoid the use of alcohol.
Rationale:
Baclofen is a central nervous system (CNS) depressant. The client should be cautioned against the use of alcohol and other CNS depressants, because baclofen potentiates the depressant activity of these agents. Constipation rather than diarrhea is an adverse effect of baclofen. It is not necessary to restrict fluids, but the client should be warned that urinary retention can occur. Fatigue is related to a CNS effect that is most intense during the early phase of therapy and diminishes with continued medication use. It is not necessary that the client notify the health care provider if fatigue occurs.
87.) A client with acute muscle spasms has been taking baclofen (Lioresal). The client calls the clinic nurse because of continuous feelings of weakness and fatigue and asks the nurse about discontinuing the medication. The nurse should make which appropriate response to the client?
1. "You should never stop the medication."
2. "It is best that you taper the dose if you intend to stop the medication."
3. "It is okay to stop the medication if you think that you can tolerate the muscle spasms."
4. "Weakness and fatigue commonly occur and will diminish with continued medication use."
4. "Weakness and fatigue commonly occur and will diminish with continued medication use."
Rationale:
The client should be instructed that symptoms such as drowsiness, weakness, and fatigue are more intense in the early phase of therapy and diminish with continued medication use. The client should be instructed never to withdraw or stop the medication abruptly, because abrupt withdrawal can cause visual hallucinations, paranoid ideation, and seizures. It is best for the nurse to inform the client that these symptoms will subside and encourage the client to continue the use of the medication.
88.) Dantrolene sodium (Dantrium) is prescribed for a client experiencing flexor spasms, and the client asks the nurse about the action of the medication. The nurse responds, knowing that the therapeutic action of this medication is which of the following?
1. Depresses spinal reflexes
2. Acts directly on the skeletal muscle to relieve spasticity
3. Acts within the spinal cord to suppress hyperactive reflexes
4. Acts on the central nervous system (CNS) to suppress spasms
2. Acts directly on the skeletal muscle to relieve spasticity
Rationale:
Dantrium acts directly on skeletal muscle to relieve muscle spasticity. The primary action is the suppression of calcium release from the sarcoplasmic reticulum. This in turn decreases the ability of the skeletal muscle to contract.
*Options 1, 3, and 4 are all comparable or alike in that they address CNS suppression and the depression of reflexes. Therefore, eliminate these options.*
89.) A nurse is reviewing the laboratory studies on a client receiving dantrolene sodium (Dantrium). Which laboratory test would identify an adverse effect associated with the administration of this medication?
1. Creatinine
2. Liver function tests
3. Blood urea nitrogen
4. Hematological function tests
2. Liver function tests
Rationale:
Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, liver function tests should be performed before treatment and periodically throughout the treatment course. It is administered in the lowest effective dosage for the shortest time necessary.
*Eliminate options 1 and 3 because these tests both assess kidney function.*
90.) A nurse is reviewing the record of a client who has been prescribed baclofen (Lioresal). Which of the following disorders, if noted in the client's history, would alert the nurse to contact the health care provider?
1. Seizure disorders
2. Hyperthyroidism
3. Diabetes mellitus
4. Coronary artery disease
1. Seizure disorders
Rationale:
Clients with seizure disorders may have a lowered seizure threshold when baclofen is administered. Concurrent therapy may require an increase in the anticonvulsive medication. The disorders in options 2, 3, and 4 are not a concern when the client is taking baclofen.
91.) Cyclobenzaprine (Flexeril) is prescribed for a client to treat muscle spasms, and the nurse is reviewing the client's record. Which of the following disorders, if noted in the client's record, would indicate a need to contact the health care provider regarding the administration of this medication?
1. Glaucoma
2. Emphysema
3. Hyperthyroidism
4. Diabetes mellitus
1. Glaucoma
Rationale:
Because this medication has anticholinergic effects, it should be used with caution in clients with a history of urinary retention, angle-closure glaucoma, and increased intraocular pressure. Cyclobenzaprine hydrochloride should be used only for short-term 2- to 3-week therapy.
92.) In monitoring a client's response to disease-modifying antirheumatic drugs (DMARDs), which findings would the nurse interpret as acceptable responses? Select all that apply.
1. Symptom control during periods of emotional stress
2. Normal white blood cell counts, platelet, and neutrophil counts
3. Radiological findings that show nonprogression of joint degeneration
4. An increased range of motion in the affected joints 3 months into therapy
5. Inflammation and irritation at the injection site 3 days after injection is given
6. A low-grade temperature upon rising in the morning that remains throughout the day
1. Symptom control during periods of emotional stress
2. Normal white blood cell counts, platelet, and neutrophil counts
3. Radiological findings that show nonprogression of joint degeneration
4. An increased range of motion in the affected joints 3 months into therapy
Rationale:
Because emotional stress frequently exacerbates the symptoms of rheumatoid arthritis, the absence of symptoms is a positive finding. DMARDs are given to slow progression of joint degeneration. In addition, the improvement in the range of motion after 3 months of therapy with normal blood work is a positive finding. Temperature elevation and inflammation and irritation at the medication injection site could indicate signs of infection.
93.) The client who is human immunodeficiency virus seropositive has been taking stavudine (d4t, Zerit). The nurse monitors which of the following most closely while the client is taking this medication?
1. Gait
2. Appetite
3. Level of consciousness
4. Hemoglobin and hematocrit blood levels
1. Gait
Rationale:
Stavudine (d4t, Zerit) is an antiretroviral used to manage human immunodeficiency virus infection in clients who do not respond to or who cannot tolerate conventional therapy. The medication can cause peripheral neuropathy, and the nurse should monitor the client's gait closely and ask the client about paresthesia. Options 2, 3, and 4 are unrelated to the use of the medication.
94.) The client with acquired immunodeficiency syndrome has begun therapy with zidovudine (Retrovir, Azidothymidine, AZT, ZDV). The nurse carefully monitors which of the following laboratory results during treatment with this medication?
1. Blood culture
2. Blood glucose level
3. Blood urea nitrogen
4. Complete blood count
4. Complete blood count
Rationale:
A common side effect of therapy with zidovudine is leukopenia and anemia. The nurse monitors the complete blood count results for these changes. Options 1, 2, and 3 are unrelated to the use of this medication.
95.) The nurse is reviewing the results of serum laboratory studies drawn on a client with acquired immunodeficiency syndrome who is receiving didanosine (Videx). The nurse interprets that the client may have the medication discontinued by the health care provider if which of the following significantly elevated results is noted?
1. Serum protein
2. Blood glucose
3. Serum amylase
4. Serum creatinine
3. Serum amylase
Rationale:
Didanosine (Videx) can cause pancreatitis. A serum amylase level that is increased 1.5 to 2 times normal may signify pancreatitis in the client with acquired immunodeficiency syndrome and is potentially fatal. The medication may have to be discontinued. The medication is also hepatotoxic and can result in liver failure.
96.) The nurse is caring for a postrenal transplant client taking cyclosporine (Sandimmune, Gengraf, Neoral). The nurse notes an increase in one of the client's vital signs, and the client is complaining of a headache. What is the vital sign that is most likely increased?
1. Pulse
2. Respirations
3. Blood pressure
4. Pulse oximetry
3. Blood pressure
Rationale:
Hypertension can occur in a client taking cyclosporine (Sandimmune, Gengraf, Neoral), and because this client is also complaining of a headache, the blood pressure is the vital sign to be monitoring most closely. Other adverse effects include infection, nephrotoxicity, and hirsutism. Options 1, 2, and 4 are unrelated to the use of this medication.
97.) Amikacin (Amikin) is prescribed for a client with a bacterial infection. The client is instructed to contact the health care provider (HCP) immediately if which of the following occurs?
1. Nausea
2. Lethargy
3. Hearing loss
4. Muscle aches
3. Hearing loss
Rationale:
Amikacin (Amikin) is an aminoglycoside. Adverse effects of aminoglycosides include ototoxicity (hearing problems), confusion, disorientation, gastrointestinal irritation, palpitations, blood pressure changes, nephrotoxicity, and hypersensitivity. The nurse instructs the client to report hearing loss to the HCP immediately. Lethargy and muscle aches are not associated with the use of this medication. It is not necessary to contact the HCP immediately if nausea occurs. If nausea persists or results in vomiting, the HCP should be notified.
*(most aminoglycoside medication names end in the letters -cin)*
98.) The nurse is assigned to care for a client with cytomegalovirus retinitis and acquired immunodeficiency syndrome who is receiving foscarnet. The nurse should check the latest results of which of the following laboratory studies while the client is taking this medication?
1. CD4 cell count
2. Serum albumin
3. Serum creatinine
4. Lymphocyte count
3. Serum creatinine
Rationale:
Foscarnet is toxic to the kidneys. Serum creatinine is monitored before therapy, two to three times per week during induction therapy, and at least weekly during maintenance therapy. Foscarnet may also cause decreased levels of calcium, magnesium, phosphorus, and potassium. Thus these levels are also measured with the same frequency.
99.) The client with acquired immunodeficiency syndrome and Pneumocystis jiroveci infection has been receiving pentamidine isethionate (Pentam 300). The client develops a temperature of 101° F. The nurse does further monitoring of the client, knowing that this sign would most likely indicate:
1. The dose of the medication is too low.
2. The client is experiencing toxic effects of the medication.
3. The client has developed inadequacy of thermoregulation.
4. The result of another infection caused by leukopenic effects of the medication.
4. The result of another infection caused by leukopenic effects of the medication.
Rationale:
Frequent side effects of this medication include leukopenia, thrombocytopenia, and anemia. The client should be monitored routinely for signs and symptoms of infection. Options 1, 2, and 3 are inaccurate interpretations.
100.) Saquinavir (Invirase) is prescribed for the client who is human immunodeficiency virus seropositive. The nurse reinforces medication instructions and tells the client to:
1. Avoid sun exposure.
2. Eat low-calorie foods.
3. Eat foods that are low in fat.
4. Take the medication on an empty stomach.
1. Avoid sun exposure.
Rationale:
Saquinavir (Invirase) is an antiretroviral (protease inhibitor) used with other antiretroviral medications to manage human immunodeficiency virus infection. Saquinavir is administered with meals and is best absorbed if the client consumes high-calorie, high-fat meals. Saquinavir can cause photosensitivity, and the nurse should instruct the client to avoid sun exposure.
101.) Ketoconazole is prescribed for a client with a diagnosis of candidiasis. Select the interventions that the nurse includes when administering this medication. Select all that apply.
1. Restrict fluid intake.
2. Instruct the client to avoid alcohol.
3. Monitor hepatic and liver function studies.
4. Administer the medication with an antacid.
5. Instruct the client to avoid exposure to the sun.
6. Administer the medication on an empty stomach.
2. Instruct the client to avoid alcohol.
3. Monitor hepatic and liver function studies.
5. Instruct the client to avoid exposure to the sun.
Rationale:
Ketoconazole is an antifungal medication. It is administered with food (not on an empty stomach) and antacids are avoided for 2 hours after taking the medication to ensure absorption. The medication is hepatotoxic and the nurse monitors liver function studies. The client is instructed to avoid exposure to the sun because the medication increases photosensitivity. The client is also instructed to avoid alcohol. There is no reason for the client to restrict fluid intake. In fact, this could be harmful to the client.
102.) A client with human immunodeficiency virus is taking nevirapine (Viramune). The nurse should monitor for which adverse effects of the medication? Select all that apply.
1. Rash
2. Hepatotoxicity
3. Hyperglycemia
4. Peripheral neuropathy
5. Reduced bone mineral density
1. Rash
2. Hepatotoxicity
Rationale:
Nevirapine (Viramune) is a non-nucleoside reverse transcriptase inhibitors (NRTI) that is used to treat HIV infection. It is used in combination with other antiretroviral medications to treat HIV. Adverse effects include rash, Stevens-Johnson syndrome, hepatitis, and increased transaminase levels. Hyperglycemia, peripheral neuropathy, and reduced bone density are not adverse effects of this medication.
103.) A nurse is caring for a hospitalized client who has been taking clozapine (Clozaril) for the treatment of a schizophrenic disorder. Which laboratory study prescribed for the client will the nurse specifically review to monitor for an adverse effect associated with the use of this medication?
1. Platelet count
2. Cholesterol level
3. White blood cell count
4. Blood urea nitrogen level
3. White blood cell count
Rationale:
Hematological reactions can occur in the client taking clozapine and include agranulocytosis and mild leukopenia. The white blood cell count should be checked before initiating treatment and should be monitored closely during the use of this medication. The client should also be monitored for signs indicating agranulocytosis, which may include sore throat, malaise, and fever. Options 1, 2, and 4 are unrelated to this medication.
104.) Disulfiram (Antabuse) is prescribed for a client who is seen in the psychiatric health care clinic. The nurse is collecting data on the client and is providing instructions regarding the use of this medication. Which is most important for the nurse to determine before administration of this medication?
1. A history of hyperthyroidism
2. A history of diabetes insipidus
3. When the last full meal was consumed
4. When the last alcoholic drink was consumed
4. When the last alcoholic drink was consumed
Rationale:
Disulfiram is used as an adjunct treatment for selected clients with chronic alcoholism who want to remain in a state of enforced sobriety. Clients must abstain from alcohol intake for at least 12 hours before the initial dose of the medication is administered. The most important data are to determine when the last alcoholic drink was consumed. The medication is used with caution in clients with diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, nephritis, and hepatic disease. It is also contraindicated in severe heart disease, psychosis, or hypersensitivity related to the medication.
105.) A nurse is collecting data from a client and the client's spouse reports that the client is taking donepezil hydrochloride (Aricept). Which disorder would the nurse suspect that this client may have based on the use of this medication?
1. Dementia
2. Schizophrenia
3. Seizure disorder
4. Obsessive-compuls