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NCLEX pharm guide

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A basic concept of pharmacology that the nurse must understand is how the drug influences cell physiology. What is the term for this concept?
*Pharmacodynamics
-Pharmacodynamics refers to what the drug does to the body; that is, how it influences cellular physiology. Pharmacokinetics is the study of what the body does to the drug. Pharmacotherapeutics refers to the study of the therapeutic use of drugs. Pharmacology is the study of drugs.
Which statement best indicates that the nurse understands the meaning of pharmacokinetics?
*"It explains the distribution of the drug between various body compartments."
-Pharmacokinetics involves the study of how the drug moves through the body, including absorption, distribution, metabolism, and excretion
The pharmacist states that the client's biotransformation of a drug was altered. What does the nurse realize has affected the drug?
*Metabolism
-Metabolism connotes a breakdown of a product. Biotransformation is actually a more accurate term because some drugs are actually changed into an active form in the liver in contrast to being broken down for excretion
The nurse realizes that a drug administered by this route will require the most immediate evaluation of therapeutic effect?
*Intravenous
-Intravenous medications are not altered by first pass effect and enter the system quickly. Oral medications are absorbed in the stomach and small intestine, travel through the portal system, and are metabolized by the liver before they reach general circulation. Subcutaneous medications need to be absorbed into the bloodstream before entering the circulation to exert effect. Topical medications need to be absorbed through the skin before entering the blood stream and exerting an effect.
The nurse reads that the half-life of the medication being administered is 12 hours. What assumption will guide the nurse's care of this client?
*This medication will be 50% eliminated in 12 hours, so the dosing will be spread apart.
-Half-life refers to the time it takes to excrete a drug from the body. Administering the medication every 6 hours would not be appropriate; it would be too soon. Half-life does not refer to onset of action or to the number of doses in 24 hours.
Which nursing intervention will best enhance the absorption of an intramuscular injection?
*Massage the site after injection
-Massaging the site increases circulation to the area and thus increases absorption. Cold will cause vasoconstriction and will not enhance absorption. Administration in the leg and the Z-track method will not enhance absorption
A nurse is administering two highly protein-bound drugs. Which is the safest course of action for the nurse to take?
*Assess the client frequently for the risk of drug-drug interactions.
-When administering two drugs that are protein-bound, one of the drugs will have fewer sites to which to bind and thus more drug available for activity, thereby increasing the risk of toxicity. Food or water will not change the outcome of administration. Hepatic function is a concern at this time.
A client is complaining of pain rated "10" on a scale of 1 to 10. The nurse has several choices of pain medication to administer. Which order is the best for the nurse to administer at this time?
*Morphine sulfate 1 mg IV (intravenous)
-When a drug is administered intravenously, it does not need to be absorbed because it is placed directly into general circulation.
The nurse is administering medications to a client with chronic renal failure. What is a priority action of the nurse?
*Assess the client for toxicity to the medications. T
-The kidneys are responsible for the majority of drug excretion. With excretion impaired, the medication can remain in the system longer and there is more chance for toxicity to develop.
The nurse is monitoring a client's blood pressure an hour after administering an antihypertensive medication. What is the purpose of this monitoring?
*Evaluation of therapeutic effect
-Therapeutic effect occurs after the administration of the medication, and the nurse should assess for expected outcomes.
The nurse understands that there are several mechanisms by which drugs can exert their action on the body, including which mechanisms?
*Interacting with specific receptors, inhibiting the action of a specific enzyme, Altering metabolic chemical processes, Nonspecific binding to a macromolecular receptor
The nurse has administered several oral medications to the client. What factors will influence the absorption of these medications?
*Presence of food in the stomach, pH of the stomach, Form of drug preparation, Pain
-The presence of food in the stomach usually decreases absorption of drugs but may increase absorption for a few specific medications. The pH of the stomach affects absorption of drugs dependent on the pH of the drug. Alkaline drugs are absorbed more readily in an alkaline environment, and acidic drugs are absorbed more readily in an acidic environment. The form of the drug also affects absorption, with liquid drugs being absorbed the fastest and enteric-coated tablets the slowest. Pain can affect absorption by slowing gastric emptying time.
It is important for the nurse to be aware of the four sequential processes of the pharmacokinetic phase. What are these?
Absorption, distribution, metabolism, excretion
It is expected that the nurse will question the health care provider if a drug with a t ½ of >24 hours is ordered to be given more than how often?
Once daily, twice daily.
Which of these statements is correct?
A drug not bound to protein is an active drug
The nurse notices that one of the client's drugs has a low therapeutic index. What is the most important nursing implication of this?
A narrow margin of safety
One of the clients drugs has a potential adverse effect of nephrotoxicity. Which test is most accurate to determine renal function?
Creatinine clearance
The nurse reviews the client's medication regimen, including the interval of drug dosage, which is related to?
Half life
Nursing responsibilities in the assessment phase of the nursing process include which responsibilities?
Identify side effects of drugs that are nonspecific and check peak and trough levels of drugs.
The nurse is preparing to review a client's medication history. Which information is most important when the nurse obtains a medication history from a client?
*Allergies
-Knowledge of allergies is the most important information because the client could have a life-threatening reaction.
The nurse is preparing to administer medications. Which intervention will the nurse include when administering medications to clients?
*Check the client's wristband before administering the medication
-Checking the client's wristband is the most accurate method of determining identity; however, at least two identifiers should always be used. The medication label should be checked three times before administering a medication.
Which activity is the nurse's responsibility during the evaluation phase of drug administration?
*Monitoring the client continuously for therapeutic as well as adverse effects. Ongoing
-monitoring of the client is necessary to evaluate the effect of the drug.
The nurse is developing a nursing care plan for a newly diagnosed adult male client with hypertension who is to begin taking metoprolol/hydrochlorothiazide (Lopressor HCT) 50 to 25 mg daily. The client has many questions about his diagnosis and medication. Which nursing diagnoses would be the highest priority for this client?
Risk for ineffective therapeutic regimen management related to new diagnosis
The nurse is preparing to teach a client newly diagnosed with diabetes mellitus how to inject insulin. Which principle should the nurse include when providing client teaching?
*Include a family member or friend in the teaching process. Provide simple written materials appropriate for individual client. The nurse should provide contact information on how to reach the health care provider.
-The nurse should include a family member or friend in the teaching process.The nurse should be an active, not passive, listener. The nurse should assess readiness to learn before information is presented to the client. The nurse should provide simple written materials appropriate for individual client needs. The nurse should provide teaching in a quiet environment, so that the client can focus on the information. The nurse should provide contact information on how to reach the health care provider in case there are questions or concerns
During a medication review session, a client comments, "I just do not know why I am taking all of these pills". This comment suggests which nursing diagnosis?
Deficient knowledge
The nurse is developing goals in collaboration with the client. Which is the best goal statement?
The client will independently self-administer the prescribed dose of albuterol by the end of the second teaching session
the nurse is aware of the many factors related to effective health teaching about the medication. The most essential component of the teaching plan is to do which?
Establish a trust relationship
a medication health teaching plan is tailored to a specific client. Common topics for health teaching include?
Importance of adherence to the prescribed reginmen, how to administer medications, what side/adverse effects to report to the health care provider.
The client's goals have been met during hospitalization. At the time of discharge, which nursing diagnosis is most probable?
Readiness for enhanced self-care activities
The nurse's rights related to safe medication administration are essential for safe medication administration. Which statements include the nurse's rights?
*The right to a complete and clear order, Correct The right to policies to guide safe medication administration, The right to have the correct drug, route, dose dispensed
-Discussion of the nurse's rights can help to increase safe medication administration. In addition to these three rights, the rights include the right to administer medications safely; the right to identify system problems; and the right to stop, think, and be vigilant when administering medications.
The nurse is reading a medication order and is not sure of the drug name. What action will the nurse perform first?
*Call the health care provider.
-If the nurse cannot understand all components of a drug order, the nurse needs to call the health care provider who wrote the order. If the health care provider is not available, the pharmacist may be able to identify which drug has been prescribed.
The nurse administers a medication that was ordered for a client at 60 mg. The medication's recommended dosage was 10 mg. The client suffers from symptoms of overdose. Who is liable for the medication error?
*All parties involved with administering the medication, including the nurse.
-Nurses are legally liable if they give a prescribed drug and the dosage is incorrect, as are the physician, pharmacist, and hospital. The nurse is the last-line check, and the error should not have happened.
The nurse checks a medication dose that seems high. What is the nurse's best action?
*Call the health care provider.
-The nurse can have others double-check the dosage or the math calculations; however, the nurse should call the health care provider who ordered the medication to report the discrepancies in the dose. Client safety is the primary concern.
A client is scheduled to undergo an upper GI this morning. The client has multiple medications ordered at 9 AM. What is the nurse's best action?
*Withhold the morning medications and document the withholding.
-The client is going for a test this morning, so morning medications would be withheld.
The nurse administered a narcotic medication. What intervention is most important to perform after the medication has been administered?
Document client response to the medication.
The client asks about disposal of medications. What are the nurse's best responses?
"you should mix medications with coffee grounds before disposal" "you should remove identifying information on the original container"
The client is taking duastride (Avodart). Which client comment indicates the need for more education about the drug?
"I prefer to chew the drug before swallowing it"
The nurse educator on the unit receives a list of high-alert drugs. Which strategies are recommended to decrease the risk of errors with these medications?
Limit access to these drugs, use special labels, provide increased information to staff.
The client refuses to take his prescribed medications. Which is the nurse's best response to this client?
Explain the risks of not taking the medications.
What is included in the nurse's role in the development of new and investigational drugs?
Monitoring for and reporting any adverse effects noted during Phase IV studies
The nurse is planning to administer a narcotic to a client for pain control. The medication order expired the day before. What is the nurse's best action?
*Ask the health care provider for a renewal for the medication, but do not administer the medication until the order is renewed.
-The nurse must have a valid order before administration of a medication. The FDA Act does not protect the nurse in the event of an expired medication order. The Durham-Humphrey Amendment distinguishes drugs that should not be refilled without a new prescription, including narcotics. The nurse should not administer a narcotic without a current prescription
The nurse is planning to administer a new medication to a pregnant client. The client is concerned about the effect of the medication on the fetus. What is the nurse's best response?
*"This medication is pregnancy drug category A, which means that there has been no evidence of fetal harm when this drug is administered to pregnant clients."
-Drugs are labeled with pregnancy categories, and category A medications have been proven, through studies, to have no risk to the fetus. Category B indicates that while studies have been conducted on animals, no well-controlled studies on the effects in pregnancy have been conducted, and risk is assumed. Many medications do not harm the fetus and are safe for use during pregnancy. Category X indicates that the medication has been proven to cause harm to the fetus and should not be given to a pregnant client.
A physician has ordered a new medication for a client and states, "The client must take this medication or she will not recover. If she knows about the side effects, she probably will not want to take it." When attempting to administer the medication, the client states "This pill is new. I don't want to take it. What does it do?" What is the nurse's best response?
*To refuse to give the medication unless the client is taught about the medication and its side effects.
-The nurse's code of ethics requires that the nurse respect the rights, dignity, and wishes of clients. It is the nurse's legal responsibility as well as ethical responsibility to make sure the client understands the treatment. The nurse is responsible for teaching the client about medications. Providing limited information or asking the client to take a medication without knowledge is not ethical.
The nurse reads the initials "USP" after a drug name. What is the nurse's best action?
*Proceed with the drug administration procedure.
-Drugs included in the USP-NF have met high standards for therapeutic use, client safety, quality, purity, strength, packaging safety, and dosage form. Drugs that meet these standards have the initials "USP" following their official name, denoting global recognition of high quality. The USP-NF is the official publication for drugs marketed in the United States, so designated by the U.S. Federal Food, Drug, and Cosmetic Act.
The nurse is administering a schedule III controlled substance. What is an essential nursing action?
*Count the available doses of medication before administering and record them. Document the time and date of administration. Countersign all discarded or wasted medication.
-Nursing interventions for controlled substances include accounting for all controlled drugs, keeping a controlled substance record for required information, and countersigning all discarded or wasted medications. In addition, the drugs should be in a locked storage area, with narcotics under double lock. Only authorized persons should have access to keys. The medication should not be kept in the client's drawer. A second nurse does not have to sign the administration record.
Which statement indicates that the nurse understands a principle of caring for clients with drug dependency?
Genetics may play a role in contributing to the cause of substance abuse.
Varenicline (Chantix) is prescribed for a middle-aged client for smoking cessation. What is a priority nursing action for this client?
Tell the client that nausea and vomiting are likely
The nurse is caring for a client with a history of alcoholism who is undergoing long-term alcohol treatment. Which intervention is the highest priority?
*Monitor disulfiram (Antabuse) and ensure client knows that all alcohol must be avoided.
-In addition to cognitive-behavioral therapy, disulfiram (Antabuse) may be ordered because it prevents alcohol consumption by causing an unpleasant reaction if alcohol is taken. Flumazenil (Romazicon) is a benzodiazepine antagonist and is used to treat benzodiazepine overdose. Methadone (Dolophine) is an opioid agonist used during opioid detoxification to decrease symptoms, and is used in long-term management of opioid addiction. Propranolol (Inderal), an adrenergic beta blocker, is indicated in treating elevated blood pressure and tachycardia, which may occur with amphetamine toxicity.
The nurse is caring for a client with a history of secobarbital (Seconal) abuse. The client last took the drug 12 hours ago. Which assessment finding requires immediate action?
Muscle cramps.
The clinic nurse is reviewing medication instructions with a client taking Nicorette gum 2 mg for smoking cessation. Which statement by the client indicates a need for further teaching by the nurse?
*"I can continue to smoke a cigarette once in a while when taking this drug."
-Cigarette smoking while using nicotine-replacement therapy (NRT) agents such as Nicorette gum may cause nicotine overdose. The client should not smoke cigarettes while taking Nicorette gum. NRT should not be used by pregnant or nursing women, so use of birth control is appropriate while taking NRT. Food and drink should be avoided 15 minutes before and during use of Nicorette gum. While the client is chewing the gum, there should be periods of holding the gum between the cheek and teeth.
When caring for a client recovering from an episode of opioid toxicity, the nurse determines that the client has an addiction to the drug based on which finding?
Craving that results in drug seeking behaviors.
While teaching the parents of an adolescent who has been using marijuana, the nurse explains that eh euphoria that results from the use of abused psychoactive substances is believed to be cause by which?
Stimulation of the dopamine pathways in the pleasure areas of the brain.
A client hospitalized with a fractured femur following an automobile accident develops diarrhea and vomiting with abdominal cramps chills with goose bumps, and dilated pupils. The nurse suspects the client is experiencing which reaction.
Opioid withdrawal
Drugs that the nurse would anticipate administering to a client who has been admitted with acute alcohol intoxication include which drugs?
Thiamine, lorazepam (Ativan), intravenous glucose solution.
A client is admitted to the emergency department with acute cocaine toxicity. Which is the most important intervention by the nurse?
To institute cardiac monitoring and obtain frequent blood pressures.
A client scheduled for elective gallbladder surgery is addicted to heroin and is in a methadone treatment program. Postoperatively, the nurse would expect the client's surgical pain to be treated with which measure?
Morphine or other opioids
A nurse observes a colleague taking oral opioids from the medication room at the hospital. Which is the best action by the nurse?
Report the finding to the nursing supervisor to enable the colleagues participation in a diversion program.
A client who smokes tells the nurse that he sees no reason to stop smoking, because it keeps his stress levels down and not everyone who smokes develops lung cancer. What is an appropriate nursing diagnosis for the client?
Ineffective denial related to inability to personalize risk of smoking.
A client is to start a new medication to help with alcohol abuse. The nurse providing medication education about disulfiram (Antabuse) is sure to include which topics in the education plan?
It is important to take this medication every day, better results are experienced when using a support group of family and friends to ensure adherence to the treatment, common food and hygiene products containing alcohol, disulfiram whorks by disrupting the metabolism of alcohol, use of alcohol may cause nausea, vomiting and may even be fatal.
A client in the hospital is experiencing methamphetamine withdrawal. What does the nurse expect the symptoms and treatment to be?
Hypersomnia, irritability; treated by supportive care including pushing food and fluids.
Knowing that the albumin in neonates and infants has a lower binding capacity for medications, the nurse anticipates that the health care provider will order which of the following to minimize the risk of toxicity?
*A decrease in the dosage of drug given
-A lower binding capacity leaves more drug available for action; thus, a lower dose would be required to prevent toxicity. An increase in the drug dose would result in higher risk of toxicity.
What would the nurse teach the client who is lactating to minimize drug effects of medications on the infant?
*"Take your medications immediately after breastfeeding."
-Taking a medication immediately after breastfeeding allows for the maximum amount of time for drug excretion before the next breastfeeding.
The nurse is administering PO medications to a 2-year-old child who is belligerent. What action is the best strategy for the nurse to use?
Ask the parents to assist in calming the child.
A 3-year-old child has been started on a new medication. What is the most important information to convey to the parents?
*"Observe the child for potential adverse effects of the medication."
-Adverse effects of medications can be difficult to discern in young children, especially things such as ringing in the ears, because the child might not be able to communicate well. Parents are in the best position to observe the child and note changes in behaviors that might be related to side effects.
is the excretion of a drug faster or slower for children related to the excretion in adults?
slower
The physiologic changes that normally occur in the older adult have which implication for the nurse, who is assessing drug response in this client population?
*Drug half-life is lengthened.
-Drug half-life is extended secondary to diminished liver and renal function in the older adult. Metabolism is slower, not faster, in the older adult. Drug elimination is also generally slower in the older adult, and protein binding is not more efficient in the older adult.
The nurse administers a medication that has a long half-life to an older adult client. What is a priority action for the nurse?
*Assess the client for potential drug toxicity.
-Because drug absorption is slowed in the older adult, drugs with a longer half-life may increase the potential for toxicity. The nurse should assess the client, and the dose may need to be decreased. The medication should not be halved. This will not affect the half-life.
An older adult client has been having difficulty sleeping. If medications are ordered, what is a primary principle that guides the care of the client?
*The older adult client should be prescribed a drug with a short half-life.
-The older adult client may have difficulty with elimination of drugs, so a drug with a short half-life is preferable. If used correctly, sedative hypnotics are safe for the older adult.
An older adult client has been diagnosed with hypertension. A diuretic has been prescribed. Which assessment finding will most concern the nurse?
*The client's heart rate is irregular
-Diuretics are frequently prescribed for the older adult. They can cause electrolyte imbalances and must be prescribed in smaller doses. An irregular heart rate could be a sign of potassium imbalance.
An older adult client suffered a broken leg and had emergency surgery. The client was prescribed meperidine (Demerol) 50 mg PRN for pain. What is the nurse's most important intervention?
*Calling the health care provider to change the prescription
-Demerol is not a drug that is recommended for the older adult owing to the incidence and risk of confusion and convulsions. Morphine is preferred.
The nurse reviews the clients list of medications with the client. The nurse knows that the 88 year old clients slower absorption of oral medications is primarily because of which phenomenon?
Increased pH of gastric secretions.
A student nurse is studying basic ethical principles that are relevant to research involving human subjects. The nursing instructor asks the student to explain the ethical principle of autonomy. Which statement indicates the student understands the ethical principle of autonomy?
*"The client has the right of self-determination."
-Autonomy is the right of self-determination and is an integral component of respect for person. Generally, a client has the right to refuse any and all treatments, except when the decision poses a threat to others.
The nurse is assessing a client who follows a vegan diet. What assessment is essential for the nurse to make?
*Assess for vitamin B12 deficiency.
-Vegans may be at risk for pernicious anemia, and the levels of vitamin B12 should be assessed.
The nurse is caring for a client who is taking ascorbic acid (vitamin C). The nurse plans to monitor the client for which adverse effect of ascorbic acid?
*Nausea and vomiting and abdominal cramping
-Adverse effects of ascorbic acid (vitamin C) include nausea and vomiting, headache, abdominal cramps, and the development of renal stones
The nurse is reviewing a client's medication history and notes that the client is taking vitamin K. What is essential for the nurse to assess?
*Coagulation studies
-Vitamin K is an essential nutrient for the synthesis of clotting factors. It is also the antidote for warfarin, an oral anticoagulant. The administration of vitamin K enhances the coagulation process, thus minimizing a client's risk for excessive bleeding.
The nurse assesses a client with hyperparathyroidism and notes that the client is to receive a vitamin D supplement. What is essential for the nurse to assess first?
*Calcium levels
-Vitamin D is contraindicated with hypercalcemia, a clinical manifestation of hyperparathyroidism.
The nurse plans to administer iron dextran. Which is the best injection technique?
*Intramuscular injection using the Z-track method
-Iron dextran should be administered deep in a large muscle mass using the Z-track method and a 23-gauge, 1½-inch needle to prevent skin irritation and potential necrosis.
The nurse is reviewing the clients lab test results and current medications. The nurse notes that the clients porthrombin time is prolonged. What vitamin might be contributing to this?
Vitamin E
The PT comes to the office with chief complaint of hair loss and peeling skin. The nurse notes that many vitamins are on the list of meds that the PT reports using to treat liver disease. The PT complaint may be caused by excess of what vitamin?
Vitamin A
The nurse routinely includes health teaching about vitamins to clients. Vitamin D has a major role in which process?
Regulating calcium and phosphorous metabolism
The nurse is doing preconception counseling with the PT. Folic acid is included in the health teaching plan because it is known to prevent CNS anomalies and may offer protection from which disorder?
Colorectal cancer
A prenatal PT tells the nurse that she is not taking vitamins because she heard that "vitamins may cause damage to my baby" what is the best response by the nurse?
"megadoses of vitamins can be harmful in the first trimester"
The client asks the nurse about fat-soluble vitamins. What is the nurses best response?
Fat-soluble vitamins are excreted slowly in the urine
The client complains of night blindness. The nurse correctly recommends which food?
Whole milk and eggs
The alcoholic client has questions about his medications the nurse correctly explains that alcoholism can be associated with deficiency of which vitamin?
B12
The client complains of anorexia, nausea, and vomiting. The clients list of meds includes multiple large doses of vitamins. The nurse notes that the clients complaints may be related to early signs of toxicity of which vitamin?
Vitamin D
A client is admitted to the intensive care unit after a traumatic accident. The client has received 5000 mL of normal saline and has +2 pitting edema and a blood pressure of 90/50 mm/hg. Which IV fluid will the nurse administer?
*Hetastarch (Hespan)
-The client needs to increase intravascular fluid volume. Hetastarch will enable this because it is a colloid that will increase osmotic pull from the extravascular spaces to the intravascular area. 3% saline is also hypertonic, but its use is not preferred secondary to risk of hypernatremia. Ringer's lactate and D5W will not pull fluid into the intravascular space.
What is the priority nursing intervention when administering potassium replacement to the client?
*Administer the medication using an intravenous pump.
-Too rapid an infusion of potassium can cause cardiac dysrhythmias. Therefore, an intravenous infusion pump must always be used. Potassium should not be bolused or pushed. Rapid administration will cause cardiac dysrhythmias. Heat will not aid in the infusion.
The nurse is administering hypertonic saline solution to treat a client with severe hyponatremia. Which nursing intervention is the priority?
*Assess skin for flushing and assess increased thirst.
-Flushed skin and increased thirst are signs and symptoms of hypernatremia.
A client receiving a unit of red blood cells suddenly develops shortness of breath, chills, and fever. What will the nurse do first?
*Discontinue the infusion.
-These are signs and symptoms of a blood transfusion reaction that could escalate to anaphylaxis. Therefore, it is a priority to immediately stop the blood transfusion.
The nurse assesses a client with a potassium level of 3.2 meq/L. Which is the priority intervention?
*Attach telemetry leads for monitoring
-the client is at high risk for cardiac dysrhythmias due to the low potassium level. Oxygen and IV fluids are not a priority, and Kayexalate is not needed for a potassium level of 3.2 meq/L.
the client has been vomiting and has weak, flabby muscles. The clients pulse is irregular. The nurse would correctly suspect what type of imbalance?
Hypokalemia
the client is receiving potassium supplements. What is the most important nursing implication when administering this drug?
It must be diluted.
The client is due to receive kayexalate for complaints of nausea, vomiting, abdominal cramps, short QT interval, weakness, and oliguria. The nurse is away that this drug is used to treat which imbalance?
Severe hyperkalemia
The nurse reviews the clients list of meds and results of lab tests. Which drug type may cause an elevated serum sodium level?
Cortisone preparations.
The clients magnesium level is 2.7 mEq/L. specific health teaching by the nurse for this client should include which suggestion
Avoid selected laxatives and antacids.
The client is receiving fluid replacement. The nurses health teaching with this client includes which suggestions?
Measure weight daily, know that thirst means a mild fluid deficit, monitor fluid intake.
The client gained 10 lbs in 2 days. It is determined that the weight gain is caused by fluid retention. The nurse correctly estimates that the weight gain may be equivalent to how many liters of fluid?
4 liters
the nurse reviews the clients meds as part of the initial interview for admission to the cardiac clinic. Which comment by the client indicates a need for health teaching?
"tetracycline does not affect my meds" "I can take as much calcium as I want"
The nurse is caring for a client receiving total parenteral nutrition (TPN). Which interventions will the nurse include in the client's plan of care?
*Monitor blood glucose levels. Monitor the client for changes in temperature. Monitor intake and output.
-Clients receiving TPN are at risk for hyperglycemia and the glucose should be monitored. The nurse should monitor for temperature changes, as a fever could indicate an infection. Intake and output should be monitored, as the client could experience a fluid volume deficit or excess
The client is receiving a bolus feeding through a gastrostomy tube. The client develops abdominal cramping. What is a priority nursing intervention?
*Stop the bolus feedings and administer feedings with a pump.
-Abdominal cramping is a sign of the feeding not being tolerated. The client may also develop diarrhea and vomiting. The nurse should stop the bolus feeding.
The client receiving enteral feedings has poor skin turgor, and urinary output is 40 mL/hr. What is the nurse's first intervention?
*Assess fluid intake.
-Dehydration can occur if the client does not receive a sufficient amount of fluid with or between feedings.
The client is receiving enteral feedings through a gastrostomy tube at a rate of 100 mL per hour. The nurse assesses the residual volume at 7 AM and finds it to be 80 mL. What is the nurse's primary intervention?
*Stop the feeding for 1 hour and reassess.
-The residual volume should not be greater than 50% of the hourly rate. This indicates that the feeding is not absorbing. The feeding should be stopped for 30 minutes to an hour, and then the residual volume should be reassessed
The nurse determines the clients gastric residual before administering an enteral feeding: the last feeding was 240ml. the client will be discharged on enteral feedings. It is important to include in the health teaching plan that a residual of more than which amount would indicate delayed gastric emptying?
125 ml
It is essential for the client who self-administers the enteral feeding to know that the feeding should be administered at which temp?
room temperature
The nurse reviews the clients plan of care, which includes strategies to prevent which common complication of enteral feedings?
Diarrhea
The client is receiving TPN, health teaching for this client includes the Valsava maneuver, which is done to prevent which condition?
Air embolism
The client has been on TPN for 1 month, and there is an order to discontinue TPN tomorrow. The nurse contracts the health care provider because sudden interruption of TPN therapy may cause which condition?
Hypoglycemia
The nurse prepares to present the Be A.L.E.R.T. campaign to colleagues. Which instructions are important to include?
Wear gloves when handling feeding tube, label enteral equipment, verify that enteral tubing connects formula to feeding tube.
The client receives TPN at home. The visiting nurse assists the family with the care plan, which includes changing the TPN solution and tubing how often?
Every 24 hours
The nurse is caring for a client who is receiving epinephrine (Adrenalin) for treatment of Stokes-Adams syndrome. Which assessment will indicate the client is having the expected therapeutic effect of this medication?
*Increased heart rate and strong pulse
-Epinephrine (Adrenalin) causes sympathomimetic actions, including increased heart rate and contractility.
The client is receiving dopamine at 2 mcg/kg/min. The nurse should monitor for what effect at this dose?
*Urinary output increased to 40 mL/hr
-Dopamine at low doses increases cardiac output and causes increased renal perfusion.
A client with cardiac decompensation is receiving dobutamine as a continuous infusion. The client's blood pressure has increased from 100/80 mm hg to 130/90 mm hg. What is the nurse's primary action?
*Continue to assess hourly blood pressure readings.
-The major therapeutic effect of dobutamine is to increase cardiac output. Cardiac output is reflected in the client's heart rate, blood pressure, and urine output. An increase in the blood pressure is the expected therapeutic effect.
The nurse assesses a client receiving an adrenergic (sympathomimetic) agent. Which finding will most concern the nurse?
*Weak peripheral pulses, decreased heart rate
-Adrenergic agents stimulate the sympathetic nervous system, which increases heart rate (positive chronotropic effect), contractility (positive inotropic effect), and conductivity (positive dromotropic effect). The nurse would be most concerned that the pulses remain weak and heart rate decreased after receiving this drug, as the therapeutic effect is not being achieved.
The client is ordered to receive a sympathomimetic agent. On review of the client's other medications, the nurse finds the client takes an MAO inhibitor daily. What is the nurse's primary action?
*Call the health care provider.
-Adrenergic agents combined with MAO inhibitors can lead to extreme hypertension. The medications cannot be administered together.
The nurse assesses the peripheral intravenous infusion site of a client receiving intravenous dopamine and suspects extravasation. What is the nurse's primary action?
*Stop the infusion.
-The nurse's first action is to stop the infusion. Next, the nurse would infuse Phentolamine (Regitine) into the area to counteract the vasoconstrictive effects of the dopamine.
The nurse is caring for a client with a diagnosis of heart failure and a secondary diagnosis of chronic obstructive pulmonary disease (COPD). The client is ordered a nonselective beta blocker. What is the nurse's primary intervention?
*Call the health care provider to request a different medication.
-Nonselective beta blockers are used to treat supraventricular dysrhythmias secondary to their negative chronotropic effects (decreasing heart rate). They may exacerbate heart failure and COPD. The client could receive a selective beta blocker instead. The nurse should make the health care provider aware of the client's history of respiratory disease.
The nurse is caring for a client who has just been diagnosed with hypertension. The client has received one dose of atenolol (Tenormin). What is the nurse's primary intervention?
*Teach the client about nonselective beta blockers.
-At therapeutic dosages, atenolol selectively blocks only the beta1 receptors in the heart, not the beta2 receptors located in the lungs.
A client has been taking metoprolol (Lopressor) and states to the homecare nurse, "I can't afford this medication any more, and I stopped it yesterday." What is the nurse's primary intervention?
*Assess the client's blood pressure.
-Abrupt withdrawal of a beta-blocking agent can cause rebound hypertension. These drugs should be gradually decreased. The nurse should immediately check the client's blood pressure, and then proceed with teaching and calling the health care provider.
The nurse is caring for a client who is receiving ergotamine tartrate (Ergostat) and who states, "I have no clue what this medication does for me." What is the nurse's most appropriate response?
*"This medication will vasoconstrict blood vessels and help your headaches."
-Ergotamine tartrate (Ergostat) is classified as an ergot alkaloid; it blocks alpha2 receptors, causing vasoconstriction. Ergot alkaloids are useful in treating vascular headaches caused by vasodilation of vessels in the brain.
The nurse is caring for a client who is prescribed propranolol (Inderal). Which assessment finding assists the nurse in determining whether the medication is having a therapeutic effect?
*The client's blood pressure is 130/75 mm Hg.
-Propranolol (Inderal) is nonselective—it blocks both beta1 and beta2 receptors at therapeutic doses. The medication is administered to treat hypertension. The client's blood pressure is within normal limits, which indicates therapeutic effect.
Which is the highest priority potential nursing diagnosis for a client who is starting on metoprolol (Lopressor)?
Decreased cardiac output related to effects of medication
The nurse is preparing to discharge a client who is receiving propranolol (Inderal). Which instruction will the nurse include in the medication teaching plan for this client?
*"If you take your pulse and it is less than 60, hold your medicine and call your health care provider for instructions."
-Propranolol (Inderal), a beta blocker, has negative chronotropic effects and could cause symptomatic bradycardia and/or heart block. The health care provider should be consulted before propranolol is administered to a client with bradycardia (heart rate less than 60 beats/min).
A student nurse is preparing to administer a beta blocker to a client. The nursing instructor asks the student to discuss the indications for beta blockers. The student nurse correctly responds that beta blockers are used to treat which disorders?
*Angina pectoris, Congestive heart failure (CHF), Hypertension.
-Beta blockers are effective in treating hypertension (secondary to negative inotropic effects) and angina pectoris (decreases cardiac workload when decreasing heart rate and contractility). Beta blockade has also been shown to reduce mortality in clients with CHF
for the client taking epinephrine, the nurse realizes there is a possible drug interaction with which drug?
Metoprolol (Lopressor)
the nurse will monitor the client taking albuterol (Proventil) for which condition?
Palpitations
a client is prescribed metoprolol (Lopressor) to treat hypertension. It is important for the nurse to monitor the client for which condition?
Bradycardia
Atenolol (Tenormin) is prescribed for a client. The nurse realizes that this drug is a beta-adrenergic blocker and that this drug classification is contraindicated for clients with which condition?
Cardiac shock
The nurse realizes that beta1 receptor stimulation is differentiated from beta2 stimulation in that stimulation of beta1 receptors leads to which condition?
Increased myocardial contractility
A client is given epinephrine (Adrenalin), an adrenergic agonist (sympathomimetic). The nurse should monitor the client for which condition?
Increased blood pressure
The nurse is administering atenolol (Tenormin) to a client. Which concurrent drug does the nurse expect to most likely cause an interaction?
An NSAID, such as aspirin
The nurse is caring for a client who is taking a cholinergic (parasympathomimetic) drug. Which assessment will indicate that the medication is having a desired effect?
*Increased GI motility
-Cholinergic effects mimic the parasympathetic nervous system (rest and digest) as opposed to the sympathetic nervous system (fight or flight). Increasing GI motility helps the digestive process.
A client is admitted with the diagnosis of glaucoma. What is the best intervention for this client?
*Administer pilocarpine.
-Pilocarpine is a direct-acting cholinergic drug that constricts the pupils of the eyes, thus opening the canal of Schlemm to promote drainage of aqueous humor (fluid). This drug is used to treat glaucoma by relieving fluid (intraocular) pressure in the eye.
The client is prescribed bethanechol. What assessment will assist the nurse in determining if the medication was therapeutic?
*Urinary assessment
-this medication increases the tone of the detrusor urinae muscle and causes the client to void
Which adverse reaction will the nurse monitor in a client taking bethanechol (Urecholine) for treatment of urinary retention?
*Muscle weakness
-Adverse reactions to bethanechol (Urecholine) include abdominal cramps, diarrhea, orthostatic hypotension, bradycardia, and muscle weakness
The nurse administered donepezil (Aricept) to a client. Which finding indicates that the medication is therapeutic?
*The client has increased cognition
-Donepezil (Aricept) is used to treat Alzheimer's disease, a disorder of decreased acetylcholine levels in the brain. It can increase cognition.
A nurse is monitoring a client receiving atropine. Which finding requires the nurse to act?
*Blood pressure 90/40 mm Hg
-Atropine is an anticholinergic agent that blocks the effects of the parasympathetic nervous system, producing sympathetic nervous system effects. Adverse reactions include nasal congestion, tachycardia, hypotension, pupillary dilation, abdominal distention, and palpitations. This blood pressure is low enough that action is required.
A client comes to the emergency department with symptomatic bradycardia. The nurse prepares to administer which dose of atropine intravenously?
*0.5 mg
-The recommended dose of atropine to treat symptomatic bradycardia is 0.5 to 1 mg.
A client is admitted to the emergency department with an expected cholinesterase inhibitor overdose. What is the nurse's primary action?
*Administer anticholinergic medication.
-An anticholinergic can act as an antidote to the toxicity caused by cholinesterase inhibitors and organophosphate ingestion.
The nurse monitors a client taking oxybutynin (Ditropan) for which therapeutic effect?
*Decrease in urinary frequency
-Oxybutynin (Ditropan) blocks the cholinergic receptors in the bladder to decrease urinary frequency and urgency.
The nurse monitors a client prescribed dicyclomine (Bentyl) for which therapeutic effect?
*Decrease in GI motility
-Dicyclomine (Bentyl) is an antispasmodic cholinergic blocker used to decrease GI motility in clients with functional GI disorders such as irritable bowel syndrome.
Which is a priority nursing diagnosis for a client receiving an anticholinergic (parasympatholytic) medication?
*Impaired gas exchange related to thickened respiratory secretions
-Although all of these nursing diagnoses are appropriate, the priority is determined by remembering the ABCs. Anticholinergic drugs decrease respiratory secretions, which could lead to mucous plugs and resultant impaired gas exchange.
A client is receiving bethanechol (Urecholine). The nurse realizes that the action of this drug is to treat?
Urinary retention
The nurse teaches the client receiving atropine to expect which side effect?
Blurred vision
When benztropine (Cogentin) is ordered for a client, the nurse acknowledges tthat this drug is an effective treatment for which condition?
Parkinsonism
Dicyclomine (Bentyl) is an anticholinergic, which the nurse realizes is given to treat which condition?
Irritable bowel syndrome
The nurse realizes that cholinergic agonists mimic which parasympathetic neurotransmitter?
Acetylcholine
The nurse is administering a cholinergic agonist and should know that the expected cholinergic effects include which of the following?
Increased pupil constriction
When the client has a cholinergic overdose, the nurse anticipates administration of which drug as the antidote?
Atropine
What assessment finding indicates that the nonsteroidal antiinflammatory drug has been effective?
*Pain has decreased from "a 6 to a 1" on a scale of 10.
-Prostaglandins are produced in response to activation of the arachidonic acid pathway. Nonsteroidal antiinflammatory drugs (NSAIDs) work by blocking cyclooxygenase (COX), the enzyme responsible for conversion of arachidonic acid into prostaglandins. Decreasing the synthesis of prostaglandins results in decreased pain and inflammation.
The nurse is caring for a client who states, "I can't tolerate aspirin. It makes my stomach hurt." What is the nurse's best response to the client?
*"You can try enteric-coated aspirin."
-Gastric distress is a common problem with uncoated aspirin. Enteric-coated tablets can be used.
A client who is at risk for stroke tells the nurse that the doctor "told me to take aspirin every day." The client states that he is on nabumetone (Relafen) daily for his arthritis, so he does not need to take aspirin daily. What is the nurse's best response to the client?
*"Take an aspirin every day even though you are on Relafen."
-Relafen is a COX-2 inhibitor and does not inhibit platelet aggregation
A client has been taking aspirin for chronic pain. The client states that her pain does not seem to be relieved with 650 mg of aspirin every 4 hours. What is the best instruction for the nurse to give the client?
*"Change to ibuprofen and consult your health care provider."
-If pain persists, the best advice is for the client to switch to another pain reliever, such as ibuprofen.
Which assessment finding in a client taking NSAIDs requires immediate intervention?
*Black, tarry stools
-A major side effect of NSAID therapy is gastrointestinal (GI) distress with potential GI bleeding. Black, tarry stools are indicative of a GI bleed.
Which assessment finding in a client taking acetaminophen (Tylenol) requires immediate intervention?
*Elevated liver enzymes
-Hepatotoxicity is a potential serious side effect of acetaminophen.
A nurse is reviewing a client's admission history. The client has just been prescribed celecoxib (Celebrex) for treatment of arthritis. The nurse plans to contact the health care provider if the client has which condition?
*Anemia
-Celecoxib (Celebrex) is a COX-2 inhibitor that is contraindicated in clients with anemia. Celecoxib can cause an increased risk of gastrointestinal adverse effects, including bleeding.
What is the most important information for the nurse to include in a teaching plan for the client receiving allopurinol (Zyloprim)?
*"Do not take this medication during an acute attack of gout."
-Allopurinol should not be taken during an acute attack because the initial response to allopurinol is an exacerbation of the symptoms. It is used prophylactically to prevent gout and treat hyperuricemia.
Which intervention is most appropriate for a client who needs treatment for acute postoperative pain?
*Administer ketorolac (Toradol) IV every 4 hours PRN
-Ketorolac (Toradol) is the only NSAID that can be administered by injection (intramuscularly or intravenously) and is indicated for short-term use for severe-to-moderate pain.
The nurse plans to include which instructions when teaching a client diagnosed with arthritis about the use of the gold salt auranofin (Ridaura)?
*"It is important to notify the health care provider if you develop sores in your mouth." "Use sunscreen because this drug causes photosensitivity." "It is normal to experience a metallic taste while taking this drug." "Use a soft toothbrush and be sure to floss while taking this drug."
-Gold salts can cause blood dyscrasias (mouth sores can occur secondary to leukopenia) and photosensitivity. A metallic taste is a sign of early drug toxicity and should be reported to the health care provider. Using a soft toothbrush and flossing will help to prevent or control gingivitis and stomatitis. It takes 3 to 4 months, for therapeutic effects to occur. An increase of fluids to 2 to 3 L per day should be encouraged
The nurse understands the difference between COX-1 and COX-2 inhibitors, in that ibuprofen is more likely than celecoxib (Celebrex) to cause which adverse effect?
Peptic ulcers
A nurse is administering gold, a disease-modifying antirheumatic drug, to a client. Which should the nurse monitor carefully?
Blood in urine (hematuria)
When teaching the client who is receiving allopurinol, what should the nurse encourage the client to do?
Have annual eye examinations
A client is admitted to the hospital with an acute gout attack. The nurse expects that which medication will be ordered to treat acute gout?
Colchicine
A client is taking aspirin for arthritis. Which adverse reaction should the nurse teach the client to report to the health care provider?
Tinnitus
The nurse is teaching a client about taking aspirin. Which are important point for the nurse to include?
*Advising client to avoid alcohol while taking aspirin, instructing client to inform dentist of aspirin dosage before any dental work, instructing client to inform surgeon of aspirin dosage before any surgery.
A client is taking infliximab (Remicade) and asks the nurse what side effects/adverse reactions to expect from this drug. The nurse lists which effects?
Fatigue, headache, chest pain, severe infections
The nurse is assessing a client taking morphine sulfate. Which assessment requires immediate action?
*Pinpoint pupils
-Pinpoint pupils might be a sign of morphine overdose or toxicity. The nurse needs to act on this finding immediately. Decreased bowel sounds and constipation are expected. Nausea and delayed gastric emptying are expected side effects of morphine sulfate and do not require immediate action.
A client is admitted for treatment of narcotic addiction. Which intervention is a priority?
*Administer methadone (Dolophine).
-Methadone is a synthetic opioid analgesic with gentler withdrawal symptoms and is the drug of choice for detoxification treatment.
A client has been admitted after overdosing on acetaminophen (Tylenol). The nurse plans to monitor this client for development of which symptom related to the overdose?
*Acute hepatic necrosis
-Acetaminophen (Tylenol) in large doses is extremely hepatotoxic. Clients with normal hepatic function should receive no more than 4000 mg/day.
Which assessment is most important for the nurse to monitor in a client receiving a narcotic analgesic?
*Respiratory rate
-The most serious side effect of narcotic analgesics is respiratory depression.
A client admitted to the hospital with a diagnosis of pneumonia asks the nurse why she is receiving codeine when she does not have any pain. What is the nurse's best response?
*"This medication will help decrease your coughing."
-Codeine provides both analgesic and antitussive therapeutic effects.
In monitoring a client for adverse effects related to morphine sulfate, what is a priority assessment?
*Assess for nausea and vomiting.
-Morphine sulfate can cause nausea and vomiting by stimulating the vomiting center in the brain.
The nurse is preparing to administer an injection of morphine to a client. Assessment notes a respiratory rate of 10 breaths/min. What is the nurse's best action?
*Notify the health care provider and delay drug administration.
-Respiratory depression is a side effect of narcotic analgesia. Therefore, since the client's respiratory rate is below normal, the nurse should withhold the morphine and notify the health care provider.
What will the nurse teach the client to minimize the gastrointestinal (GI) side effects of narcotic analgesics for chronic pain?
*Increase fluid and fiber in the diet.
-Narcotic analgesics decrease intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can prevent this.
What is important for the nurse to teach the client who is prescribed a fentanyl (Duragesic) transdermal delivery system?
*Increase fluid and fiber in the diet.
-Narcotic analgesics decrease intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can prevent this.
What is important for the nurse to teach the client who is prescribed a fentanyl (Duragesic) transdermal delivery system?
*Change the patch every 72 hours.
-The fentanyl (Duragesic) transdermal delivery system is designed to slowly release analgesic over a 72-hour period.
The nurse plans pharmacologic therapy for a client with pain based on what basic principle?
*Pain relief is best obtained by administering analgesics around the clock.
-Studies have demonstrated that analgesics administered around the clock rather than on an as-needed basis provide optimal pain relief.
In developing a plan of care for a client receiving morphine sulfate, which nursing diagnosis is a priority?
*Potential for impaired gas exchange related to respiratory depression
-Using Maslow's hierarchy of needs and the ABCs of prioritization, impaired gas exchange is a priority.
The nurse is teaching a client with decreased hepatic function about taking pain relievers. What is the most important information to teach this client?
*"Take no more than 2 grams a day of acetaminophen."
-The client with decreased hepatic function should decrease the dose of acetaminophen.
A parent enters the emergency department with a child who has taken an unknown amount of liquid acetaminophen. What is the nurse's best action?
*Check serum levels and administer acetylcysteine.
-Serum levels are used to determine a dose of acetylcysteine that will block the acetaminophen.
A client is complaining of severe pain: "10 out of 10." There are several orders for the client's pain medications. Which medication is most appropriate for the nurse to administer at this time?
*IV morphine
-Morphine given PO is metabolized by the liver before it is available to the rest of the body. IV morphine is quicker acting and is not affected by first hepatic pass effect.
A client is who has been taking morphine for pain is assessed by the nurse. The client's respiratory rate is 7 per minute, and her pupils are 1 mm and unreactive. What is the nurse's immediate action?
*Administer naloxone (Narcan).
-Morphine overdose can be indicated by unresponsive, pinpoint pupils and respiratory depression. Rescue breathing, calling anesthesia, or calling a code will not correct the underlying problem.
For the client who is taking acetaminophen (Tylenol). What should the nurse do?
*Monitor routine liver enzymes, encourage the client to check package levels of OTC drugs to avoid overdose, teach the diabetic client to check blood glucose more frequently.
The nurse should know that which drugs are used to treat migraine attacks?
Triptans
The nurse is caring for a client who has been ordered cefazolin sodium (Ancef). Which nursing assessment is the priority?
*History, including allergies
-Antibiotic allergy is one of the most common drug allergies. These allergies also have the potential to cause severe anaphylaxis and death.
A client who is on antibiotic therapy is complaining of pain in the mouth. When instructing a client about antibiotic therapy, the nurse explains that which condition occurs when the normal flora are disturbed during antibiotic therapy?
*Superinfection
-Antibiotic therapy can destroy the normal flora of the body, which typically inhibits the overgrowth of fungi and yeast. When the normal flora are decreased, these organisms can overgrow and cause infections.
While instructing a client about antibiotic therapy, the nurse explains to the client that bacterial resistance to antibiotics can occur when what happens?
*Clients stop taking an antibiotic after they feel better. Environmental dispersion of antibiotic liquid occurs. Antibiotics are prescribed to treat a viral infection.
-Not completing a full course of antibiotic therapy can allow bacteria that are not killed but have been exposed to the antibiotic to adapt their physiology to become resistant to that antibiotic. The same thing can occur when bacteria are exposed to antibiotics in the environment
A client on antibiotic therapy needs peak levels drawn. What is the nurse's best course of action?
*Draw blood 60 minutes after completion of the intravenous antibiotic infusion. -Peak serum drug levels should be drawn 30 to 60 minutes after the medication is infused. Trough levels are drawn just before infusion. The nurse should document the time drug administration is started and completed and the exact time a peak and/or trough level is drawn.
A 22-year-old client is put on amoxicillin. What is the most important intervention for this client?
*Assess if the client is on oral contraceptives.
-This medication may decrease the effectiveness of oral contraceptives. The nurse needs to assess whether or not the client is on oral contraceptives and whether or not the client is sexually active.
A client is receiving amoxicillin (Amoxil). The nurse knows that the action of this drug is by which process?
Inhibition of bacterial cell-wall synthesis
Amoxicillin (Amoxil) is prescribed for a client who has a respiratory infection. The nurse is teaching the client about this medication and realizes that more teaching is needed when the client makes this statement?
"I should not take my medication with food"
A client is prescribed dicloxacillin (Dynapen). The nurse plans to monitor the client for which side effect/adverse reactions?
Hemolytic anemia
A client is taking cefoperazone (Cefobid) the nurse anticipates which appropriate nursing interventions for this med?
Monitoring renal function, liver function, infusing IV medication over 30 minutes and monitoring client for mouth ulcers.
Penicillin G (Pentids) has been prescribed for a client. Which nursing interventions should the nurse include for this client?
Collect C&S prior to first dose, monitor for mouth ulcers, and have epinephrine on hand for a potential severe allergic reaction.
The client taking intravenous gentamicin (Garamycin) has elevated blood urea nitrogen (BUN). What is the nurse's best course of action?
*Hold the medication.
-Gentamicin (Garamycin) has a high potential for nephrotoxicity and is thus contraindicated in clients with elevated renal function tests such as BUN and creatinine. The nurse should hold the medication and call the health care provider.
Discharge teaching by the nurse for a client receiving tetracycline should include what instruction?
*"Use sunscreen and protective clothing when outdoors."
-Photosensitivity is a common side effect of tetracycline. Exposure to the sun can cause severe burns.
The nurse should question the order of tetracycline for which client?
*A 6-year old client with Haemophilus influenza
-Tetracycline is contraindicated in children younger than 8 years because it can cause permanent discoloration of the teeth. Tetracycline is not contraindicated for clients diagnosed with diabetes mellitus or hypertension. Tetracycline is used to treat rickettsiae.
Which client will the nurse assess first?
*The client who is taking vancomycin (Vancocin) with furosemide (Lasix)
-The risk of ototoxicity with vancomycin is increased for clients taking furosemide. The nurse should assess this client first.
A client prescribed azithromycin (Zithromax) expresses concern regarding gastrointestinal upset that she experienced when taking erythromycin. What will the nurse tell this client?
*"This drug is like erythromycin but has less severe gastrointestinal side effects."
-Azithromycin (Zithromax) is one of the newer macrolide antibiotics. It has a longer duration of action as well as fewer and less severe gastrointestinal side effects than erythromycin.
A client is taking azithromycin (Zithromax). The nurse should apply which interventions?
Monitor periodic liver functions test, report any hearing loss, report evidence of superinfection, take oral drug 1 hour before meal or 2 hours after meal, avoid antacid from 2 hours prior to 2 hours after azithromycin admin.
The nurse enters a client's room to find that his heart rate is 120, his BP is 70/50, and his is flushed. Vancomycin (Vancocin) is running IVPB. The nurse interprets this as a severe adverse effect of "red man syndrome" what should the nurse do?
Reduce the infusion to 10 mg/min
The nurse is administering tetracycline (Vibramycin) to a client. Which would be appropriate teaching?
Take sunscreen precautions when at the beach
A client is taking levofloxacin (Levaquin). Then nurse knows that which is true regarding this drug?
Adverse reaction includes dysrhythmias
What should the nurse include when teaching a client about gentamicin (Garamycin)?
Report hearing loss, use sunscreen, monitor for mouth ulcers and vaginitis, increase fluid intake.
The nurse acknowledges which nursing interventions for the client taking ciprofloxacin (Cipro)?
Obtain C&S prior to drug admin, tell client to avoid taking Cipro with antacids, monitor for hearing loss, encourage fluids to prevent crystalluria, infuse IV Cipro over 60 min.
hen planning care for a client receiving a sulfonamide antibiotic, what is a primary intervention?
*Force fluids to at least 3000 mL/day.
-Forcing fluids will help prevent nephrotoxicity associated with sulfonamide antibiotics.
A client with type 2 diabetes mellitus is started on co-trimoxazole (TMP-SMZ). Which nursing intervention is a priority for this client?
*Assess blood sugar.
-Cotrimoxazole increases the hypoglycemic response when taken with sulfonylureas (oral hypoglycemic agents). The nurse should assess blood sugar and determine what oral hypoglycemic the client is taking.
TMP-SMZ (Bactrim, Septra) is ordered for the client and is being administered four times a day. What is the nurse's best action?
*Call the health care provider.
-The half-life of this drug is 8 to 12 hours, and the client should receive it twice a day. The nurse should call the health care provider to clarify this order. The medication should not be scheduled four times a day
A client has been prescribed trimethoprim-sulfamethoxazole. What is the nurse's primary intervention for this client?
*Instruct the client to increase fluids in the diet.
-Increased fluid intake is highly recommended to avoid complications such as crystallization in the urine.
A client has been on sulfonamides repeatedly for recurrent urinary tract infections. The nurse assesses the client in the clinic and finds bruises on her legs and arms. What is the nurse's best action?
*Assess the client's platelet counts.
-Blood disorders such as hemolytic anemia, aplastic anemia, and low white blood cell and platelet counts could result from prolonged use and high dosages. The nurse should assess the client before assuming vitamin K deficiency, potential abuse, or frequent falls.
Sulfasalazine (Azulfidine) has been ordered for a client. The nurse knows that this drug is most effective against which organisms?
Escherichia coli and Clostridium
A client is taking Sulfasalazine (Azulfidine). What should the nurse teach the client to do?
Drink at least 10 full glasses of fluid per day.
The nurse is teaching a client about sulfadiazine (Microsulfon). Which directive should the nurse include in the teaching?
Avoid sulfonamides during the third trimester of pregnancy.
A client is ordered to take trimethoprim-sulfamethoxazole (Bactrim). The nurse knows to expect which common adverse reaction?
Stevens-Johnson syndrome
A client is taking a sulfonamide for an acute urinary tract infection. Which medication does the nurse realize is a short-acting sulfonamide?
Sulfadiazine (Microsulfon)
The nurse is teaching the client about trimethoprim-sulfamethoxazole (Bactrim). Which directives should be included in the teaching?
Report any bruising or bleeding immediately, report any diarrhea or bloody stools promptly, report any fever, rash, or sore throat, and avoid unprotected exposure to sunlight.
What should the nurse teach a client who is taking isoniazid (INH)?
*"Pyridoxine will prevent numbness and tingling that can occur when taking isoniazid."
-Isoniazid (INH) can cause neurotoxicity. Pyridoxine (vitamin B6) is the drug of choice to prevent this adverse reaction.
The nurse is caring for a client who is taking rifampin (Mycobutin) for treatment of Mycobacterium tuberculosis. The client has a heart rate of 90 beats/min, blood pressure of 100/89 mm Hg, and red-orange urine. What is the nurse's best action?
*Document the findings and teach the client.
-Red-orange discoloration of body fluids is a common side effect of rifampin (Mycobutin), but it is not harmful and does not indicate infection.
A client with Mycobacterium tuberculosis is prescribed ethambutol (Myambutol) for long-term use. Which client statement indicates understanding of the instructions?
*"I will need to have my eyes checked regularly while I am taking this drug."
-Ethambutol (Myambutol) can cause optic neuritis. Ophthalmologic examinations should be performed periodically to assess visual acuity.
The client states that she has been prescribed prophylactic medication for tuberculosis for 4 weeks. How should the nurse respond?
*"You should be on the drugs for at least 6 months."
-Between 6 months and 1 year is sufficient time for prevention of active tuberculosis. Because the tuberculosis mycobacterium is slow-growing, shorter lengths of time may not sufficiently eradicate the organism.
A client is diagnosed with an oral candidal infection. Which intervention is best?
*Teach the client how to take nystatin (Mycostatin).
-Nystatin (Mycostatin) is an antifungal ointment that is used for a variety of candidal infections. The client needs to be taught how to "swish and swallow" to treat this infection.
Before administration of intravenous amphotericin B (Fungizone), what will the nurse do?
*Premedicate the client with an antipyretic, antihistamine, and antiemetic as ordered.
-Almost all clients given intravenous amphotericin B (Fungizone) develop fever, chills, nausea and vomiting, and hypotension. Pretreatment with an antipyretic, antihistamine, and antiemetic can minimize or prevent these adverse reactions
The client is receiving intravenous amphotericin. What is the nurse's primary intervention?
*Assess blood urea nitrogen and creatinine.
-Amphotericin B is considered highly toxic and can cause nephrotoxicity and electrolyte imbalance, especially hypokalemia and hypomagnesemia (low serum potassium and magnesium levels). Urinary output, blood urea nitrogen, and serum creatinine levels need to be closely monitored.
Which statement indicates to the nurse that the client understands the medication instructions regarding ketoconazole (Nizoral) for treatment of candidiasis?
*"I need to take this drug with food to minimize gastrointestinal distress."
-Taking this medication with food will help minimize gastrointestinal upset. Ketoconazole (Nizoral) should not be taken with coffee, tea, or acidic fruit juices. Additionally, it needs to be taken at least 2 hours before or after the ingestion of alkaline products or antacids.
When assessing for adverse reactions to Rifamate (combination isoniazid and rifampin), what should the nurse monitor?
*Blood urea nitrogen, Complete blood count, Hemoglobin levels, Liver function tests
-Rifamate (combination isoniazid and rifampin) may cause impairment of liver function as well as hematologic disorders, and serum uric acid levels have been reported along with decreased hemoglobin levels. Elevations in blood urea nitrogen have also been reported
A client is beginning isoniazid and rifampin treatment for tuberculosis. The nurse gives the client which instructions?
Do not skip doses
A client taking isoniazid is worried about the side effects/adverse reactions. The nurse realizes that which is a common adverse reaction?
Hepatotoxicity
The nurse teaches the client taking amphotericin B to report which signs and symptoms to the health care provider?
Blindness
A client with a diagnosis of intestinal amebiasis develops sever nausea, vomiting, fiver, facial flushing, slurred speech, tachycardia, hypotension, and palpitations. A beginning assessment reveals that the client has just had several alcoholic beverages. The nurse should obtain a drug history for which drug?
Metronidazole (Flagyl)
A client has developed vaginal candidiasis. The nurse knows that which medication is appropriate treatment?
Terconazole (Terazol-3)
A client has been diagnosed with tuberculosis and is to begin the antitubercular medications isoniazid, rifampin, and ethambutol. What should the nurse do?
Encourage periodic eye exams, report numbness and tingling of hand or feet, alert client that body fluids may develop a red-orange color, teach client to avoid direct sunlight and use sunblock.
The nurse is obtaining a medication history from an 18-year-old client who has been diagnosed with genital herpes. Which medication is the drug of choice for this client?
*acyclovir (Zovirax)
-Acyclovir (Zovirax) is the drug of choice to treat herpes simplex infections.
What is the primary assessment the nurse should make for a client who is taking ganciclovir sodium (Cytovene)?
*Complete blood count
-Bone marrow suppression is a dose-limiting toxicity of ganciclovir (Cytovene), and a complete blood count should be monitored.
What action will the nurse take to evaluate the effectiveness of antiviral agents administered to treat human immunodeficiency virus infection?
*Viral load
-All antiretroviral agents work to reduce the viral load, which is the number of viral RNA copies per milliliter of blood.
A client who will be traveling to a malaria-infested country is receiving instruction on the prophylactic use of chloroquine (Aralen hydrochloride). What instruction is accurate for this client?
*Start the medication 2 weeks before the trip.
-Treatment for malaria prophylaxis is usually started 2 weeks before travel and continues for 8 weeks after travel is completed.
A client enters the emergency department with suspected influenza. What is most important to determine before starting the client on oseltamivir phosphate (Tamiflu)?
*Length of time since onset of symptoms
-This medication inhibits the replication and spread of influenza if given within 48 hours of symptoms.
A client is diagnosed with HSV-3. The nurse understands that this illness is better known by which name?
shingles in and adult
A client who is taking acyclovir asks the nurse about the drug. Which instruction should the nurse include in client teaching?
Importance of frequent CBC, BUN,and creatinine tests.
A client with a history of malaria, presently being treated with chloroquine, is admitted to the hospital. What should the nurse advise the client to do?
Get frequent hearing checks
Acyclovir (Zovirax) has been ordered for a client with genital herpes. Which nursing interventions are appropriate for this client?
Monitor BUN and creatinine, advise client to maintain adequate fluid intake, teach PT to perform oral hygiene several times a day , monitor clients CBC, especially WBC, platelets, hemoglobin, and hematocrit.
A client is complaining of urinary pain. The client was diagnosed with a urinary tract infection the previous day. What is the nurse's best action?
*Administer phenazopyridine hydrochloride (Pyridium).
-Phenazopyridine (Pyridium) is a urinary analgesic prescribed to relieve the pain associated with urinary tract infections
A client with a history of diabetes mellitus is prescribed nitrofurantoin (Macrodantin) for treatment of a urinary tract infection. Which instruction will the nurse include in the client's teaching plan?
*Urine may turn brown.
-The nurse should instruct the client that the urine may turn a harmless brown color. Fluids should be increased, because this helps minimize gastrointestinal upset. Antacids should be avoided because they interfere with drug absorption. Clients with diabetes mellitus should not use Clinitest for glucose testing because a false-positive result may occur owing to changes in the urine.
A client diagnosed with an atonic bladder and a peptic ulcer is prescribed bethanechol (Urecholine). What is the nurse's best intervention?
*Call the health care provider and hold the medication
-Bethanechol (Urecholine, Duvoid, Urebeth) should not be taken if peptic ulcer is present. Bethanechol can cause epigastric distress, abdominal cramps, nausea, vomiting, diarrhea, and flatulence.
A client complains of "stomach pain" while taking nitrofurantoin. What will the nurse teach the client?
*Eat when taking the medication.
-The drug is usually taken with food to decrease gastrointestinal distress. Antacids decrease the absorption of this medication. Taking the medication on an empty stomach will not help the gastric pain. Discontinuing the medication is not recommended for this side effect.
The nurse is teaching a client who has been prescribed nitrofurantoin. The teaching plan for this client should include which interventions?
*Do not take the medication with an antacid. Shake the suspension well before drinking. Increase fluids while on the medication.
-The medication should not be taken with an antacid, because they interfere with drug absorption. The medication should be shaken well before drinking, and the client should increase fluids to help with nausea. This medication can stain the teeth, so swishing is not recommended. The medication can cause stomach upset and should be taken with food
For the client who is crushing nitrofurantoin (Macrodantin) tablets, what should the nurse teach the client to do?
Rinse the mouth afer oral nitrofurantoin to avoid teeth staining.
The client complains about a burning sensation and pain when urinating. The nurse knows that what drug will help with this pain?
Phenazopyridine (Pyridium)
A client is taking the urinary antiseptic methenamine mandelate (Mandelamine) for a UTI. The nurse realizes that this drug should not be given concurrently with which other drug to avoid potential crystalluria?
Trimethoprim-sulfamethoxazole (Bactrim)
The client is taking tolterodine tartrate (Detrol). The nurse should teach the client to report which condition?
Urinary retention
the nurse is caring for a client taking nitrofurantoin (Macrodantin). Which are appropriate nursing interventions for this client?
Monitor urinary output and urine specific gravity, monitor the client for peripheral neuropathy, inform client that urine may turn a harmless brown color.
The nurse is caring for a client newly diagnosed with human immunodeficiency virus (HIV). The client asks the nurse why he has been put on "so many pills." What is the most important thing for the nurse to tell the client about his therapy?
*"Combination therapy prevents the development of resistant strains of HIV."
-While combination therapy is effective to treat the infection, the therapy also prevents the development of resistant strains of the disease.
The nurse has instructed a client diagnosed with human immunodeficiency virus (HIV) on the use of zidovudine (AZT, Retrovir). Which client statement demonstrates a need for additional teaching?
*"I don't need to use condoms as long as I take my medication as prescribed."
-Antiretroviral agents do not stop the transmission of HIV, and clients need to continue standard precautions.
A client diagnosed with human immunodeficiency virus (HIV) is in her first trimester of pregnancy. Which medication will the nurse teach this client about?
*nevirapine (Viramune)
-Nevirapine (Viramune) may be used as an alternative for women who are pregnant, especially in the first trimester of pregnancy.
A client is receiving HAART. Which outcome indicates a therapeutic response to the medication therapy?
-CD4 T-cell increase
-The expected outcome of HAART is a suppression of HIV RNA levels and CD4 T cell increases in clients.
Which intervention is a priority for a client who is taking HAART?
*Teach adherence to the medication regimen.
-adherence to the regimen is the highest priority.
What information is important to include in follow-up teaching for a client after starting antiretroviral therapy?
*The difference between side effects and new onset of symptoms
-Clients may confuse side effects of therapy with new onset of symptoms
The nurse is preparing to administer vaccines to a young child. What is the nurse's first intervention?
*Ask the caregivers about food allergies and over-the-counter medications.
-Before immunizations are administered, children and their caregivers should be questioned regarding their use of prescription and over-the-counter medications, including herbal preparations, and any food or drug allergies.
Once a child has received a vaccination, what is the nurse's primary action?
*Monitor for possible anaphylaxis.
-Anaphylaxis is a potentially life-threatening adverse reaction to vaccines.
The community health nurse is caring for a client whose daughter has a rash. On assessment, the nurse determines that the child has measles. What is the nurse's best action?
*Report the measles to public health officials.
-Health care providers are responsible for reporting cases of vaccine-preventable diseases to public health officials, who then make weekly reports to the Centers for Disease Control and Prevention. These data identify whether an outbreak is occurring and the impact of immunization policies and procedures.
Which instruction will the nurse include for a client receiving tetanus toxoid?
*Soreness at the injection site is a common reaction.
-Myalgia at the injection site is a common side effect of tetanus toxoid.
An adult client says, "My children need vaccines. Are there any that I need?" What is the nurse's best response?
*"Yes, you need to stay up to date on several vaccines; check with your physician."
-While much emphasis is placed on regularly immunizing infants and children, adult immunizations are frequently overlooked. However, they are equally important to the health and well-being of this population.
61 year old man is to receive zoster vaccine. What is essential for the nurse to discuss with this client?
Confirm that the client has a history of chickenpox.
what are a few live attenuated vaccines?
Intranasal influenza, MMR, Rotavirus.
What should nurses do in order to protect against exposure to chemotherapy drugs when caring for clients receiving intravenous (IV) therapy?
Wear a disposable gown when administering IV chemotherapy.
A client is receiving IV cyclophosphamide (Cytoxan). What nursing intervention is a priority for this client?
*Ensuring that the client is well hydrated
-The client should be well hydrated while taking this drug to prevent hemorrhagic cystitis (bleeding as a result of severe bladder inflammation).
The nurse is completing an admission assessment for a client admitted for chemotherapy. The health care provider has ordered doxorubicin (Adriamycin). The nurse plans to contact the health care provider if the client is taking which supplement?
*Green tea
-Green tea (Camellia sinensis) may enhance antitumor effects of doxorubicin (Adriamycin). Use of green tea should be reported to the health care provider
A client asks "Why am I getting three drugs for my cancer if they all do the same thing?" What is the nurse's best response?
*"Administering more than one drug prevents drug resistance."
-Administering a combination of antineoplastic agents allows for smaller doses of each, which can minimize the severity of side effects and help prevent drug resistance.
The nurse is caring for a client receiving cyclophosphamide (Cytoxan). What is a priority intervention for this client?
*Encourage fluids before, during, and after drug administration
-Clients receiving cyclophosphamide (Cytoxan) should drink at least 2 to 3 L of fluid before, during, and after administration to prevent hemorrhagic cystitis.
A client is nauseated and vomiting after receiving chemotherapy. How will the nurse best intervene?
*Maintain hydration and nutrition and administer antinausea medications.
-It is very important for clients undergoing chemotherapy to maintain adequate nutrition and hydration. Several antiemetic drugs are available that are very successful in controlling this side effect. The client will most likely remain nauseated even without food intake.
The nurse is assessing a client receiving cisplatin (Platinol). What finding requires immediate action by the nurse?
*Increased blood urea nitrogen and creatinine
-Cisplatin (Platinol) is known to be ototoxic, nephrotoxic, neurotoxic, and emetogenic. Increased blood urea nitrogen and creatinine could indicate nephrotoxicity
The nurse is monitoring a client receiving doxorubicin (Adriamycin). What intervention is a priority for this client?
*Administer dexrazoxane (Zinecard).
-Clients receiving doxorubicin need to be monitored for cardiac toxicity. Dexrazoxane (Zinecard) is a cytoprotective (chemoprotective) agent that may be given to help prevent cardiac toxicities associated with doxorubicin administration.
What are some things to watch for when giving a PT Cytoxan?
Cyclophosphamide (Cytoxan) causes bone marrow suppression, which is evidenced by a decrease in red blood cells, white blood cells, and platelets. A thrombocyte count of 8000/mm3 is significantly lower than normal. The chemotherapy should be held.
The nurse is caring for several clients receiving chemotherapy. What client will the nurse assess first?
*The client receiving Mechlorethamine (Mustargen) with pain at the IV insertion site.
-Mechlorethamine (nitrogen mustard, [Mustargen]) is a severe vesicant and can cause tissue necrosis if it infiltrates into the tissues. Pain at the IV site is an indication of possible infiltration and needs to be addressed.
A client is to receive fluorouracil (5-FU, Adrucil) as part of his treatment protocol for colorectal cancer. Which symptoms would be most important for the nurse to report to the physician?
Stomatitis
A nurse is teaching a client about alopecia, which is one of the side effects of the chemotherapy drugs she is to receive. Which statement, made by the client, indicates that she needs additional teaching about alopecia?
"my hair wont grow back after chemotherapy is completed"
A client in the outpatient oncology clinic has developed mucositis after receiving fluorouracil (Adrucil, 5-FU) which statement made by the client indicates the need for additional teaching about mucositis?
I will use a mouthwash with alcohol to get my mouth cleaner"
A client is scheduled to receive high-dose cyclophosphamide (Cytoxan) via IV infusion as treatment for cancer. Which would be most important for the nurse to include when teaching the client about cyclophosphamide (Cytoxan)?
Drink 2 to 3 L of fluid per day
A nurse is administering doxorubicin (Adriamycin) to a client in the outpatient oncology clinic. Which information would be most important for the nurse to include in client teaching?
Report any shortness of breath palpitations, or edema to your doctor.
A client is scheduled to receive vincristine (Oncovin) as part of his chemotherapy protocol. Which nursing action would have the highest priority when providing care for this patient?
Assess for peripheral neuropathy.
Which have been identified as causes of multidrug resistance to chemotherapy?
Cancer cells that are not killed may mutate and become resistant to chemo, some cancer cells may be naturally resistant to chemo, gene amplification can cause overproduction of proteins that make chemo less effective, cancer cells develop the ability to repair damage caused by chemo.
A client is experiencing mucositis (stomatitis) secondary to receiving chemotherapy. Which symptomatic treatments would be appropriate?
Frequent mouth rinse, topical anesthetics, antibiotics.
A client is receiving topotecan (Hycamtin) for treatment of small cell lung cancer. Which assessment finding is a priority for the nurse?
*Peripheral neuropathy
-Peripheral neuropathy, nausea and vomiting, alopecia, constipation, headaches, and stomatitis are adverse effects of the topoisomerase I inhibitor topotecan (Hycamtin).
The nurse is completing an admission assessment for a client diagnosed with non-small cell lung cancer who is prescribed gefitinib (Iressa). The client is currently being treated for a respiratory infection with erythromycin. What is the nurse's initial intervention?
*Contact the health care provider
-Erythromycin inhibits the liver microsomal CYP 34a enzyme, which decreases the rate of metabolism of gefitinib (Iressa). The health care provider will need to make a decision about starting the medication
The nurse admits a client diagnosed with metastatic colorectal cancer. The nurse anticipates that the health care provider will order which medication?
*bortezomib (Velcade)
-Bortezomib (Velcade) is indicated for the treatment of metastatic colorectal cancer
A client is ordered temsirolimus (CCI-779) for treatment of breast cancer. Which teaching is a priority for this client?
*"Do not take this medication with grapefruit juice."
-Temsirolimus (CCI-779) should not be taken with grapefruit juice. Grapefruit juice may alter the exposure of temsirolimus
The nurse works in the oncology clinic and knows that targeted therapies for cancer differ from traditional chemotherapy due to which factor?
They attack and inactivate specific cellular chemicals or structures that are more commonly found in cancer cells than in normal cells.
The client on chemotherapy for breast cancer asks why she is not receiving trastuzumab (Herceptin) like her sister did. What is the nurse's best response?
"your cancer cells do not have the target for trastuzumab"
Which instruction is importat for the nurse to include when teaching the client about imatinib (Gleevec) therapy?
Do not drink grapefruit juice while taking this drug
When administering which class of targeted therapies would the nurse be most alert to a possible infusion reaction?
Monoclonal antibodies
Why should clients taking or receiving targeted therapies for cancer avoid using St. John's wort?
This herbal drug decreases the blood levels of most targeted therapies and reduces there effectiveness.
The nurse prepares to administer aldesleukin (interleukin-2, Proleukin) to a client diagnosed with renal carcinoma. Which assessment indicates a therapeutic effect of this medication?
*Decrease in renal tumor size
-Aldesleukin enhances the immune system by stimulating the production and activity of T-cells and decreases the size of renal cell tumors.
A client is receiving filgrastim (Neupogen). Which assessment finding indicates that the medication has been effective?
*Absence of infection
-Filgrastim (Neupogen) increases the production of white blood cells in the bone marrow. The desired client outcome is that the client will not contract an infection.
Which client should not receive epoetin alfa (EPO, erythropoietin) as ordered?
*The client with uncontrolled hypertension
-Hypertension is a side effect of epoetin alfa (EPO, erythropoietin); hence the drug should not be given to clients with uncontrolled hypertension. Anemia, chronic renal failure, and human immunodeficiency virus or acquired immunodeficiency syndrome are indications for the therapeutic use of epoetin.
A client receiving filgrastim therapy complains of bone pain. What should the nurse do first?
*Administer a nonopioid analgesic.
-Skeletal bone pain is a very consistently observed reaction to the therapy as the bone marrow expands. Nonopioid analgesics generally control the pain.
The client is being seen regularly for treatment of leukemia. The nurse knows that this client has been treated with different biologic response modifiers that function in which way?
Enhancing immune function, WBC production, antigen/antibody reaction.
A client diagnosed with malignant melanoma, a skin cancer, is treated with interferon alfa. Then nurse teaches this client about which side effect of interferon-a that will make the client uncomfortable.
Flulike syndrome
The client has a low platelet count. The nurse reviews the list of meds and is aware that platelet production can be stimulated with which drug?
Epoetin alfa (EPO) Erythropoietin
The nurse is caring for a client who is taking a first-generation antihistamine. What is the most important fact for the nurse to teach the client?
*"Do not drive after taking this medication."
-First-generation antihistamines cause drowsiness.
The nurse is caring for a client in the clinic who states that he is afraid of taking antihistamines because he is a truck driver. What is the best information for the nurse to give this client?
*"You may be able to safely take a second-generation antihistamine."
-Second-generation antihistamines are often called non-sedating antihistamines. These may be safer for the client to take, but the client should still monitor for signs of excessive sedation.
The client tells the nurse that she has a bad cold, is coughing, and feels like she has "stuff" in her lungs. What should the nurse do?
*Administer guaifenesin.
-The client needs an expectorant. This medication will help the client cough the "stuff" out of her lungs.
What is the most important thing for the nurse to teach a client who is switching allergy medications from diphenhydramine (Benadryl) to loratadine (Claritin)?
*This medication has fewer sedative effects.
-Loratadine (Claritin) does not affect the central nervous system and therefore is nonsedating.
A client complains of worsening nasal congestion despite the use of oxymetazoline (Afrin) nasal spray every 2 hours. What is the nurse's best response?
*"Overuse of nasal decongestants results in rebound congestion."
-Oxymetazoline (Afrin) is an effective nasal decongestant, but overuse results in worsening or "rebound" congestion. It should not be used more than every 4 hours. To avoid future rebound congestion with nasal sprays, it is recommended that they be used for no more than 3 to 5 days.
Which statement indicates that the client understands the teaching about beclomethasone diproprionate (Beconase)?
*"This medication will help prevent the inflammatory response of my allergies."
-Beclomethasone diproprionate (Beconase) is a steroid spray administered nasally. It is used to prevent allergy symptoms. Its effect is localized, and therefore the client does not have systemic side effects with normal use and does not have to worry about weaning off the medication as with oral corticosteroids.
A client is prescribed an antitussive medication. What is the most important thing for the nurse to teach the client?
*"This medication may cause drowsiness and dizziness."
-Antitussive medications also affect the CNS, thus causing drowsiness and dizziness.
Which is the best instruction for the nurse to include when teaching a client about the use of expectorants?
*Increase fluid intake in order to decrease viscosity of secretions.
-Expectorant drugs are used to decrease viscosity of secretions and allow them to be more easily expectorated. Increasing fluid intake helps this action.
Client tells the nurse that he has stated to take an OTC antihistamine, diphenhydramine. In teaching him about side effects, what is most important for the nurse to tell the client?
Avoid driving until stabilized on the drug.
The nurse is teaching a client about diphenhydramine (Benadryl). Which are topics to include?
Take med with food to decrease gastric distress. Avoid alcohol and other CNS depressants. Notify the health care provider if confusion of hypotension occurs. Take sugarless candy, gum, or ice chips for temporary relief of dry mouth. Avoid handling dangerous equipment.
The nurse is caring for a client with a theophylline level of 14 mcg/mL. What is the priority nursing intervention?
*Continue to assess the client's oxygenation.
-The therapeutic theophylline level is 10 to 20 mcg/mL. The nurse should continue interventions and monitor oxygenation.
Discharge teaching to a client receiving a beta-agonist bronchodilator should emphasize reporting which side effect?
*Tachycardia
-A beta-agonist bronchodilator stimulates the beta receptors of the sympathetic nervous system, resulting in tachycardia, bronchodilation, hyperglycemia (if severe), and alertness.
The nurse instructs the client to avoid which over-the-counter products when taking theophylline (Theo-Dur)?
*St. John's wort
-St. John's wort has been shown to decrease serum theophylline levels. The other substances do not interact with theophylline.
Monitor client for potential chest pain?
Nonselective adrenergic agonist bronchodilators stimulate beta1 receptors in the heart and beta2 receptors in the lungs. Stimulation of beta1 receptors can increase heart rate and contractility, increasing oxygen demand. This increased oxygen demand may lead to angina or myocardial ischemia in client with coronary artery disease. Cautious use of these agents is indicated if the client has coronary artery disease.
The nurse is instructing a client about the advantages of salmeterol (Serevent) over other beta2 agonists such as albuterol (Proventil). How will the nurse explain to the client the difference in these two medications?
*Salmeterol has a longer duration of action.
-Salmeterol (Serevent) has a longer duration of action, requiring the client to use it only twice a day instead of four times a day with albuterol (Proventil).
Client teaching regarding the use of antileukotriene agents such as zafirlukast (Accolate) should include which statement?
*"This medication will prevent the inflammation that causes your asthma attack."
-Antileukotriene agents block the inflammatory response of leukotrienes and thus the trigger for asthma attacks. Response to these drugs is usually noticed within 1 week. They are not used to treat an acute asthma attack.
A client with a history of asthma is short of breath and says, "I feel like I'm having an asthmatic attack." What is the nurse's best action?
*Administer a beta2 adrenergic agonist
-In an acute asthmatic attack, the short-acting sympathomimetics are the first line of defense.
A client has taken metaproterenol. What is the nurse's priority action?
*Monitor for heart rate >100 beats/min.
-The beta1 properties of this drug can cause increased heart rate and palpitations. The drug should not cause sedation or elevated blood pressure.
A client demonstrates understanding of flunisolide (AeroBid) by saying that he will do what?
*Rinse his mouth with water after each use.
-Flunisolide (AeroBid) is an inhaled corticosteroid. Rinsing the mouth will help prevent oral candidal infections. It is not used to treat an acute asthma attack and should be taken with the client's bronchodilator medications
The nurse is caring for a young child who has been prescribed an inhaler for control of her asthma. The child is having difficulty using the inhaler. What is the nurse's best action?
*Teach the child to use a spacer.
-If a child is unable to use the inhaler, the medication will be trapped in the mouth. Using a spacer helps the medication to be deposited to the lungs.
The nurse is caring for clients on the pulmonary unit. Which client should not receive epinephrine if ordered?
*The client with atrial fibrillation with a rate of 100
-The side effects of epinephrine include tachycardia, dysrhythmias, and palpitations. This client should not receive epinephrine.
The health care provider orders ipratropium bromide (Atrovent), albuterol (Proventil), and beclomethasone (Vanceril) inhalers for a client. What is the nurse's best action?
*Administer the albuterol first, wait 5 minutes, and administer ipratropium bromide, followed by beclomethasone several minutes later.
-Administering the bronchodilator albuterol (Proventil) first allows the other drugs to reach deeper into the lungs as the bronchioles dilate. Anticholinergics such as ipratropium bromide (Atrovent) also help bronchodilate, but to a lesser extent. Corticosteroids such as beclomethasone (Vanceril) do not dilate and are therefore given last.
Which instruction will the nurse include when teaching a client about the proper use of metered-dose inhalers?
*"Hold your breath for 10 seconds if you can after you inhale the medication."
-Holding the breath for 10 seconds allows the medication to be absorbed in the bronchial tree rather than be immediately exhaled.
What will the nurse expect to find that would indicate a therapeutic effect of acetylcysteine (Mucomyst)?
*Liquefying and loosening of bronchial secretions
-Acetylcysteine is a mucolytic drug used to liquefy and loosen bronchial secretions in order to enhance their expectoration.
What is the most important thing for the nurse to teach the client with a history of diabetes and asthma who has started on albuterol PRN?
*Monitor blood glucose levels every 4 hours when taking albuterol.
-Beta2 agonists may increase blood glucose levels. Clients with diabetes should monitor serum glucose levels frequently while taking this medication.
A client is prescribed ipratropium and cromolyn sodium. What will the nurse teach the client?
*"Take the ipratropium at least 5 minutes before the cromolyn."
-When using an anticholinergic in conjunction with an inhaled glucocorticoid or cromolyn, the ipratropium should be used 5 minutes before the steroid. This causes the bronchioles to dilate so the steroid or cromolyn can get deeper into the lungs.
Patient has a blood pressure of 100/50 mm Hg and a heart rate of 110. The client is irritable. What is the best action for the nurse to take?
*Hold the next dose of theophylline.
-The client is displaying adverse reactions to theophylline, and her blood level should be assessed before another dose of the medication. The nurse should hold the medication.
A client is diagnosed with a pulmonary disorder that causes COPD. Lung tissue changes are normally reversible with this condition. The nurse understands that which is the clients most likely diagnosis?
Asthma
A client with COPD has an acute bronchospasm. The nurse knows that which is the best medication for this emergency situation?
Epinephrine (Adrenalin)
A client is taking aminophylline-theophylline ethylendamine (Somophyllin). For what should the nurse monitor the client?
Increased heart rate
a client with COPD is taking a leukotriene antagonist, montelukast (Singulair). The nurse is aware that this medication is given for which purpose?
Maintenance treatment of asthma
A client is to be discharged home with a transdermal nitroglycerin patch. Which instruction will the nurse include in the client's teaching plan?
*"Apply the patch to a nonhairy area of the upper torso or arm."
-A nitroglycerin patch should be applied to a nonhairy area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation. The drug should be continued if headache occurs, as tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain.
A nurse is monitoring a client with angina for therapeutic effects of nitroglycerin. Which assessment finding indicates that the nitroglycerin has been effective?
*Client stating that pain is 0 out of 10
-The client taking nitroglycerin should expect the therapeutic effect of absence of chest pain.
The nurse is monitoring a client during IV nitroglycerin infusion. Which assessment finding will cause the nurse to take action?
*Chest pain
-The client should not continue to have chest pain while on IV nitroglycerin. This would prompt the nurse to intervene. Headache and flushing are common side effects of nitroglycerin.
Which statement made by the client demonstrates a need for further instruction regarding the use of nitroglycerin?
*"I can take up to five tablets at 3-minute intervals for chest pain if necessary."
-Clients are taught to take up to three tablets every 5 minutes. If no relief from chest pain is obtained after one tablets, they should seek medical assistance ASAP then continue with dosage till three are consumed.
Which client assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker?
*Client states that she has no chest pain.
-The workload in the heart should be decreased with the vasodilatation from the calcium channel blocker. With less strain, the client should have fewer incidences of angina as afterload is decreased.
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?
*"This medication will work for 24 hours and you will need to change the patch daily."
-The transdermal patch has a duration of action of 24 hours. Sublingual nitroglycerin is more rapid acting than the transdermal patch. There are other preparations that may be considered stronger because they are higher in dosage. Sublingual and IV preparations are preferred during episodes of chest pain.
What will the nurse instruct the client to do to prevent the development of tolerance to nitroglycerin?
*Apply the nitroglycerin patch for 14 hours and remove it for 10 hours at night.
-Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period each day.
Before the nurse administers isosorbide mononitrate (Imdur), what is a priority nursing assessment?
*Assess blood pressure
-Isosorbide mononitrate (Imdur) is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering.
The client asks the nurse how nitroglycerin should be stored while traveling. What is the nurse's best response?
*"It's best to keep it in its original container away from heat and light."
-Although nitroglycerin needs to be kept in a cool, dry place, it should not be placed in an ice chest where it could freeze. It should also not be locked up and must be kept away from light, not in a clear plastic bag.
Which statement indicates to the nurse that the client understands sublingual nitroglycerin medication instructions?
*"I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."
-Nitroglycerin is a vasodilator and can cause orthostatic hypotension, resulting in dizziness. Three doses can be taken 5 minutes apart. The tablet should be placed under the tongue to dissolve. The medication should be kept in a readily accessible location for immediate use should chest pain occur.
What instruction should the nurse provide to the client who needs to apply nitroglycerin ointment?
*Apply the ointment to a nonhairy part of the upper torso.
-Absorption is best over a nonhairy portion of skin. The upper torso is the preferred site of application. The nurse should wear gloves and squeeze the ointment onto the application patch. The ointment is measured as one straight line on the nitroglycerin paper and is then gently spread around and applied, but not rubbed, into the skin.
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?
*Decrease the intravenous nitroglycerin by 10 mcg/min.
-Nitroglycerin, as a vasodilator, causes a decrease in blood pressure. Because it is short-acting, decreasing the infusion rate will allow the blood pressure to rise. The client should be monitored every 10 minutes while changing the rate of the intravenous nitroglycerin infusion.
The nurse is monitoring a client taking digoxin (Lanoxin) for treatment of heart failure. Which assessment finding indicates a therapeutic effect of the drug?
*Heart rate 58 beats per minute
-Digoxin (Lanoxin) has a negative chronotropic effect (decreased heart rate). The heart rate should become slower and stronger.
A client's serum digoxin level is drawn, and it is 0.4 ng/mL. What is the nurse's priority action?
*Administer ordered dose of digoxin
-Therapeutic serum digoxin levels are 0.5-2 ng/mL. The client should receive the next dose to bring the level into therapeutic range.
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?
*Evaluate digoxin levels.
-Seeing yellow or green halos around lights is a symptom of digoxin toxicity. The nurse should evaluate the client's digoxin levels
Which assessment finding will alert the nurse to suspect early digitalis toxicity?
*Loss of appetite with slight bradycardia
-Early symptoms of digitalis toxicity include anorexia, nausea and vomiting, and bradycardia.
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?
*To administer digoxin immune FAB
-Digoxin immune FAB is indicated for treatment of severe digoxin toxicity as evidenced by a digoxin level of 10 ng/mL and hyperkalemia.
A client is to begin treatment for short-term management of heart failure with milrinone lactate (Primacor). What is the priority nursing action?
*Monitor blood pressure continuously.
-Milrinone lactate (Primacor) is a phosphodiesterase inhibitor administered intravenously for short-term treatment in clients with heart failure not responding adequately to digoxin, diuretics, or other vasodilators. Blood pressure and heart rate should be closely monitored. Digoxin is not administered with the Primacor, but is usually tried before treatment with Primacor
A client is admitted to the emergency department with paroxysmal supraventricular tachycardia. What intervention is the nurse's priority?
*Rapid IV bolus of Adenosine (Adenocard)
-The only therapeutic indication of use for adenosine is the treatment of paroxysmal supraventricular tachycardia. It is administered via rapid IV bolus.
A nurse is caring for a client who has been started on ibutilide (Corvert). Which assessment is a priority for this client?
*ECG
-Ibutilide (Corvert) is specifically indicated for treatment of recent-onset atrial fibrillation and flutter. It is important for the nurse to obtain an ECG to see if the client has converted to sinus rhythm.
What must the nurse monitor when titrating intravenous nitroglycerin for a client?
*Continuous blood pressures, Presence of chest pain.
-Intravenous nitroglycerin can cause hypotension and tachycardia. Relief of chest pain and systolic blood pressure
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?
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?
Increase the serum digoxin sensitivity level
When a client first takes a nitrate, the nurse expects which symptom that often occurs?
Headache
The nurse acknowledges that beta blockers are as effective as antianginals because they do what?
Decrease heart rate and decreases myocardial contractility.
The healthcare provider is planning to discontinue a client's beta blocker. What instructions should the nurse give the client regarding the beta blocker?
The beta blocker should NOT be abruptly stopped; the dose should be tapered down.
Which laboratory value will the nurse report to the health care provider as a potential adverse response to hydrochlorothiazide (HydroDIURIL)?
*Fasting blood glucose level of 140 mg/dL
-Hydrochlorothiazide (HydroDIURIL) can cause hyperglycemia
What is the best information for the nurse to provide to the client who is receiving spironolactone (Aldactone) and furosemide (Lasix) therapy?
*"This combination promotes diuresis but decreases the risk of hypokalemia."
-Spironolactone is a potassium-sparing diuretic; furosemide causes potassium loss. Giving these together minimizes electrolyte imbalance.
What is furosemide (Lasix)?
Furosemide is a potent loop diuretic, resulting in the loss of potassium as well as water, sodium, and chloride. The client needs chloride replacement.
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?
The fact that Lasix has shown efficacy in treating persons with renal insufficiency.
A client taking spironolactone (Aldactone) has been taught about the therapy. Which menu selection indicates that the client understands teaching related to this medication?
*fish
-Spironolactone is a potassium-sparing diuretic that could potentially cause hyperkalemia. Fish is an appropriate dietary choice, because it is low in potassium.
Which client would the nurse need to assess first if the client is receiving mannitol (Osmitrol)?
*A 47-year-old client with anuria
-Mannitol (Osmitrol) is not metabolized but excreted unchanged by the kidneys. Potential water intoxication could occur if mannitol is given to a client with anuria.
A nurse is caring for a client receiving acetazolamide (Diamox). Which assessment finding will require immediate nursing intervention?
*A decrease in arterial pH
-Acetazolamide (Diamox) causes excretion of bicarbonate, which would worsen metabolic acidosis. It is used to treat metabolic alkalosis, edema, seizures, and acute glaucoma.
A client is ordered furosemide (Lasix) to be given via intravenous push. What interventions should the nurse perform?
*Administer at a rate no faster than 20 mg/min. Assess lung sounds before and after administration.Assess blood pressure before and after administration. Maintain accurate intake and output record.
-Furosemide (Lasix) can be infused via intravenous push at the rate of 20 mg/min. Furosemide is a diuretic and will decrease fluid in alveoli, and assessing lung sounds can help to determine therapeutic effect. Blood pressure should decrease with the administration of a diuretic. It is appropriate to monitor before and after administration. It is appropriate to monitor intake and output for a client receiving a diuretic.
A client is prescribed Thalitone (chlorthalidone). What is the most important information the nurse should teach the client?
*"Wear protective clothing and sunscreen while on this medication."
-Adverse effects associated with Thalitone include photosensitivity. The nurse should teach the client to protect himself when out in the sun.
A client with hyperaldosteronism is prescribed spironolactone (Aldactone). What assessment finding would the nurse evaluate as a positive outcome?
*Decreased aldosterone
-Spironolactone (Aldactone) is the direct antagonist for aldosterone
A client with acute pulmonary edema receives furosemide (Lasix). What assessment finding indicates that the intervention is working?
*Lungs clear
-Furosemide (Lasix) is a potent, rapid-acting diuretic that would be the drug of choice to treat acute pulmonary edema
Which assessment indicates a therapeutic effect of mannitol (Osmitrol)?
*Decreased intracranial pressure
-Mannitol (Osmitrol) is an osmotic diuretic that pulls fluid from extravascular spaces into the bloodstream to be excreted in urine. This will decrease intracranial pressure, increase excretion of medications, decrease urine osmolality, and increase serum osmolality.
Which intervention will the nurse perform when monitoring a client receiving triamterene (Dyrenium)?
*Assess potassium levels.
-Triamterene (Dyrenium) is a potassium-sparing diuretic. The nurse should monitor potassium for potential hyperkalemia.
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?
*It causes an alkaline urine, which facilitates the elimination of uric acid.
-Acetazolamide causes increased excretion of bicarbonate, which causes alkaline urine and increased excretion of acidic substances, including uric acid.
A client is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. What type of electrolyte imbalance doe the nurse expect?
Hypokalemia
A client has HF and is prescribed Lasix. The nurse is aware that furosemide (Lasix) is what kind of drug?
High-ceiling (loop) diuretic.
Spironolactone (Aldactone) can cause what condition?
Hyperkalemia
Which statement indicates that the client needs additional instruction about antihypertensive treatment?
*"I will check my blood pressure daily and take my medication when it is over 140/90."
-Antihypertensive medications need to be taken routinely to maintain a normotensive state and prevent occurrence of complications. Many clients do not adhere to this regimen because hypertension itself does not cause symptoms, whereas the medication can cause some untoward effects. Client teaching is essential.
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?
*Call the health care provider to switch the medication.
-Angiotensin-converting enzyme inhibitors prevent the breakdown of bradykinin, frequently causing a nonproductive cough. Angiotensin receptor blocking agents do not block this breakdown, thus minimizing this annoying side effect. The client should be switched to a different medication if the side effect cannot be tolerated.
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?
*spironolactone (Aldactone)
-ACE inhibitors block the conversion of angiotensin I to angiotensin II, thus also blocking the stimulus for aldosterone production. Aldosterone is responsible for potassium excretion—decreased aldosterone can result in increased serum potassium levels. Spironolactone is a potassium sparing diuretic and should not be administered with an ACE inhibitor.
A client is prescribed a noncardioselective beta1 blocker. What nursing intervention is a priority for this client?
*Respiratory assessment
-Non-cardioselective beta blockers can cause bronchospasms, and a respiratory assessment is indicated to check for potential respiratory side effects.
Which client will the nurse assess first?
*The client who has stopped taking a beta blocker due to cost.
-Abrupt discontinuation of the antihypertensive drug may cause rebound hypertension.
The nurse is caring for a client with hypertension who is prescribed Clonidine transdermal preparation. What is the correct information to teach this client?
Get up slowly from a sitting to a standing position.
-This medication can cause dizziness. Client safety is a priority. The patch is left on for 7 days and can be left on while bathing. This medication is often prescribed with other drugs.
The client taking Methyldopa (Aldomet) has elevated liver function tests. What is the nurse's best action?
*Notify the health care provider.
-This drug should not be used in clients with impaired liver function. The nurse should notify the health care provider so that the client can be tapered off the medication. The nurse should not immediately stop this medication as the client could have a hypertensive crisis.
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?
*Determine the client's history.
-The desired therapeutic effect of prazosin may not fully occur for 4 weeks.
A calcium channel blocker has been ordered for a client. Which condition in the client's history is a contraindication to this medication?
*Hypotension
-Calcium channel blockers cause vasodilation and thus a drop in blood pressure. They are contraindicated in the presence of hypotension.
A client who takes clonidine (Catapres) is to be discharged to home. Which instruction will the nurse include when teaching this client?
*"Increasing fluid and fiber in your diet can help prevent the side effect of constipation."
-Constipation is a controllable side effect of clonidine (Catapres).
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?
*To administer phentolamine (Regitine)
-Phentolamine (Regitine) is a potent alpha-blocking agent specifically effective for treatment of hypertension associated with pheochromocytoma. The client's blood pressure is elevated owing to tumor secretion.
Which is a priority nursing diagnosis for a client taking an antihypertensive medication?
*Alteration in cardiac output related to effects on the sympathetic nervous system
-Circulation is always a priority over fatigue, pain, and knowledge deficit.
A client's BP is 145/90. What stage of hypertension is he in?
Stage 1 hypertension
The nurse acknowledges that the first-line drug for mild hypertension(stage 1) is?
Diuretics
The nurse is aware that which group of antihypertensive drugs are less effective in African-american clients?
Beta-Blockers and ACE inhibitors
The nurse knows that which diuretic is most frequently combined with an antihypertensive drug?
Hydrochlorothiazide
The nurse explains that which beta blocker category is preferred for treating hypertension?
Beta-1 blockers
Captopril (Capoten) has been ordered for a client. The nurse teaches the client that ACE inhibitors have which common side effects?
Constant, irritating dry cough
A client is prescribd losartan (Cosaar). The nurse teaches the client that an angiotensin II receptor blocker (ARB's) act by doing what?
Blocking angiotensin II from angiotensin-I 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?
Dizziness, headache, ankle edema
A client is receiving an intravenous heparin drip. Which laboratory value will require immediate action by the nurse?
*Activated partial thromboplastin time (aPTT) of 120 seconds
-This aPTT value is too prolonged. The heparin drip should be shut off for an hour.
A client who has been taking warfarin (Coumadin) is admitted with coffee-ground emesis. What is the nurse's primary action?
*Administer vitamin K.
-Vitamin K is the antagonist for warfarin.
The client has an international normalized ratio (INR) value of 1.5. What action will the nurse take?
*Administer an additional dose of warfarin (Coumadin).
-A therapeutic INR is 2 to 3. The client needs more Coumadin to reach a therapeutic level.
A client is receiving warfarin (Coumadin) for a chronic condition. Which client statement requires immediate action by the nurse?
*"I will increase dark-green, leafy vegetables in my diet."
-Dark green, leafy vegetables are rich in vitamin K, which would antagonize the effects of warfarin. Rather than increase the intake of these, it is important to maintain a consistent daily intake of vitamin K.
A client is taking enoxaparin (Lovenox) daily. Which client statement requires additional monitoring?
*"I take aspirin daily for headaches."
-Aspirin is an antiplatelet medication. A client taking both aspirin and Lovenox could cause excessive bleeding.
The client is receiving tirofiban (Aggrastat). What is an essential nursing intervention for this client?
*Weigh the client before administration
-Tirofiban (Aggrastat) is a glycoprotein IIb/IIIa inhibitor that blocks the enzyme essential for platelet aggregation. This is given to prevent the formation of further clots and is faster acting than warfarin. The medication is administered in mcg per kg of body weight per minute. Weighing the client is essential. Protamine sulfate is the antagonist for heparin.
A nurse is preparing to administer enoxaparin sodium (Lovenox) to a client for prevention of deep vein thrombosis. What is an essential nursing intervention?
*Administer the medication into subcutaneous tissue.
-Enoxaparin (Lovenox) is a low-molecular-weight heparin that is administered subcutaneously.
The client asks what the difference is between dalteparin (Fragmin) and heparin. What is the nurse's best response?
*"Dalteparin is a low-molecular-weight heparin that is more predictable in its effect and has a lower risk of bleeding."
-A low-molecular-weight heparin is more predictable in its effect than regular heparin. Dalteparin (Fragmin) is more expensive than heparin and is dosed based on the client's weight.
A client has been admitted through the emergency department and requires emergency surgery. The client has been receiving heparin. What nursing intervention is essential?
*Administer protamine sulfate.
-Protamine sulfate binds with heparin in the bloodstream to inactivate it and thus reverse its effect.
A client who is taking warfarin (Coumadin) requests an aspirin for headache relief. What is the nurse's best response?
*Teach the client of potential drug interactions with anticoagulants.
-Clients taking an anticoagulant should not use medications that would further increase the risk of bleeding, which includes aspirin as well as ibuprofen. Aspirin should not be administered to the client taking other anticoagulants, unless it is ordered specifically as a low dose daily therapy. Ibuprofen is not the best choice of medication for the client receiving Coumadin. Tylenol (acetaminophen) would be preferred for pain relief.
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?
*"It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic."
-Warfarin works by decreasing the production of clotting factors. However, it takes approximately 3 days for the body to metabolize present clotting factors and thus achieve a therapeutic anticoagulant effect. Because of this, heparin is continued until this is achieved.
The nurse evaluates that the client understood discharge teaching regarding warfarin (Coumadin) based on which statement?
*"I should use a soft toothbrush for dental hygiene."
-This statement is accurate and will reduce the risk of bleeding. Ibuprofen will potentiate bleeding. The client should call the health care provider if experiencing excessive bruising.
What intervention is essential before the nurse administers tenecteplase (TNKase)?
*Perform all necessary venipunctures.
-TNKase is a thrombolytic agent that can interfere with the body's clotting ability. Therefore, all invasive procedures should be completed before administering this drug.
Which nursing diagnosis would be possible for a client receiving intravenous heparin therapy?
*Risk for injury
-The client receiving heparin is at risk for injury secondary to increased risk of bleeding.
Heparin is effective for preventing new clot formation in clients who have which disorders?
Coronary thrombosis, Acute myocardial infarction, DVT, stoke, venous disorders.
The nurse is teaching a client about clopidogrel (Plavix). What is important info to include?
Bleeding may increase when taking aspirin.
A client is being changed from an injectable anticoagulant to an oral anticoagulant. Which anticoagulant does the nurse know is administered orally?
Warfarin (Coumadin)
A client is taking warfarin 5mg/day for atrial fibrillation. The client's international normalized ratio (INR) is 3.8. the nurse would consider the INR to be what?
Elevated
A client is admitted to the ER 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?
Thrombolytic agent
Which statement indicates the client understands discharge instructions regarding cholestyramine (Questran)?
*"I will increase fiber in my diet."
-Cholestyramine can cause constipation; thus, increasing fiber in the diet is appropriate. All other drugs should be taken 1 hour before or 4 hours after cholestyramine to facilitate proper absorption.
The nurse plans which intervention to decrease the flushing reaction of niacin?
*Administer aspirin 30 minutes before nicotinic acid.
- Administration of an antiinflammatory agent such as aspirin has been shown to decrease the flushing reaction associated with niacin. In addition, avoiding hot beverages, such as coffee, when taking niacin may also prevent flushing.
The nurse is reviewing instructions for a client taking an HMG-CoA reductase inhibitor (statin). What information is essential for the nurse to include?
"Take this medication at the same time each day."
A client is prescribed gemfibrozil (Lopid) for treatment of hyperlipidemia type IV. What is important for the nurse to teach the client?
*"You may experience headaches with this medication."
-Side effects of gemfibrozil (Lopid) include headache, fatigue, dizziness, blurred vision, and insomnia
Which statement made by the client indicates understanding about discharge instructions on antihyperlipidemic medications?
*"I will continue my exercise program to help increase my high-density lipoprotein serum levels."
-Antihyperlipidemic medications are an addition to, not a replacement for, the therapeutic regimen used to decrease serum cholesterol levels
A client is prescribed ezetimibe (Zetia). Which assessment finding will require immediate action by the nurse?
*Muscle pain.
-Clients who experience severe muscle pain while taking Ezetimibe (Zetia) need to report the findings right away, as this may be indicative of a serious problem.
A nurse is caring for a client taking cholestyramine (Questran). The client is complaining of constipation. What will the nurse do?
*Have the client increase fluids and fiber in his diet.
-Cholestyramine is an anion exchange resin that binds to bile to form an insoluble complex that is excreted. Constipation can occur and can be treated with conventional therapy, which includes increasing fluid and fiber in the diet.
Which statement indicates to the nurse that the client needs further medication instruction about colestipol (Colestid)?
*"I should stir the powder in as small an amount of fluid as possible to maintain potency of the medication."
-Colestipol (Colestid) is a powder that must be well diluted in fluids before administration to avoid esophageal irritation or obstruction and intestinal obstruction. The powder should not be stirred because it may clump; it should be left to dissolve slowly for a least 1 minute.
Which assessment finding in a client taking an HMG-CoA reductase inhibitor will the nurse act on immediately?
*Elevated liver function tests
-HMG-CoA reductase inhibitors can cause hepatic toxicity; thus it is necessary to monitor liver function tests every 3 months for the first year of treatment. The nurse should act on this finding immediately.
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?
*"These factors may put you at higher risk for myopathy."
-Reported risks for myopathy include an older age and a higher dose. The recommended dose is 40 mg. This client's dose is almost double that value, although still within the approved dosing range for the drug.
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?
*Hepatic disease
-Lovastatin (Mevacor) can cause an increase in liver enzymes and thus should not be used in clients with preexisting liver disease.
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?
*gemfibrozil (Lopid)
-Gemfibrozil (Lopid), a fibric acid derivative, promotes catabolism of triglyceride-rich lipoproteins.
The nurse would question an order for cholestyramine (Questran) if the client has which condition?
*Impaction
-Cholestyramine (Questran) binds with bile in the intestinal tract to form an insoluble complex. It can also bind to other substances and lead to intestinal obstruction
The nurse reviews the history for a client taking atorvastatin (Lipitor). What will the nurse act on immediately?
*Client is on oral contraceptives.
-Atorvastatin (Lipitor) increases the estrogen levels of oral contraceptives. The client's oral contraceptive may need to be altered.
The nurse knows that the client's cholesterol level should be within?
150 to 200 mg/dL
A client is taking lovastatin (Mevacor). Which serum level is most important for the nurse to monitor?
Liver enzymes
The client is taking rosuvastatin (Crestor). What severe skeletal muscle adverse reaction should the nurse observe for?
Rhabdomyolysis
When a client is taking ezetiibe (Zetia), she asks the nurse how it works?
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?
Relaxes the arterial walls within the skeletal muscles, may cause hypotension, chest pain, and palpitations.
Which assessment finding will need intervention and is related to the client's use of aluminum hydroxide (Amphojel)?
*Client has not had a bowel movement in 3 days.
-Aluminum- and calcium-containing antacids cause constipation. The nurse will need to intervene as the client is likely to remain constipated.
Which client needs immediate intervention?
*Client taking magnesium-containing antacids who has renal failure.
-Magnesium-containing antacids can cause hypermagnesemia in clients with chronic renal failure. Aluminum-containing antacids may be used as a phosphate binder in clients with chronic renal failure. Calcium-containing antacids are also appropriate because these clients may be hypocalcemic
What assessment has the highest priority for a client using sodium bicarbonate to treat gastric hyperacidity?
*Assess for metabolic alkalosis.
-Solutions containing sodium bicarbonate (a base) can cause metabolic alkalosis. Serum potassium and serum calcium levels would decrease with alkalosis, not increase.
Which nursing diagnoses is appropriate for a client receiving famotidine (Pepcid)?
*Potential risk for bleeding related to thrombocytopenia
-serious side effect of famotidine (Pepcid) is thrombocytopenia, which is manifested by a decrease in platelet count and an increased risk of bleeding.
Which statement demonstrates to the nurse that the client understands instructions regarding the use of histamine2-receptor antagonists?
*"Smoking decreases the effects of this medication, so I should look into cessation programs."
-Clients taking histamine2-receptor blocking agents should avoid spicy foods, extremes in temperatures, alcohol, and smoking. They should also increase bulk and fluids in their diets to prevent constipation.
A client is prescribed Lorazepam (Ativan) and a glucocorticoid during chemotherapy treatments. What is the nurse's best action?
*Administer the medications and assess the client for relief.
-Drug combination therapy is commonly used to manage chemotherapy-induced nausea and vomiting.
A nurse is caring for a client who is unable to tolerate oral medications. The nurse anticipates that the client may be prescribed which proton pump inhibitor to be administered intravenously?
*pantoprazole (Protonix)
-Pantoprazole (Protonix) is the only proton pump inhibitor that is available for intravenous administration. The other medications in this category may only be administered orally.
Which client statement indicates that further teaching is needed?
*"I will apply the scopolamine patches to rotating sites on my arms."
-Transdermal scopolamine patches should be applied to nonirritated areas behind the ear, not on the arms
The nurse is administering loperamide (Imodium) to a client with diarrhea. What assessment is essential for this client?
*Gastric assessment
-Adverse effects associated with loperamide (Imodium) include central nervous system symptoms such as fatigue and dizziness, epigastric pain, abdominal cramps, nausea, dry mouth, vomiting, and anorexia.
Which outcome assessment is essential to monitor for the client taking diphenoxylate (Lomotil)?
*Decrease in gastric motility
-Diphenoxylate (Lomotil) acts on the smooth muscle of the intestinal tract to inhibit gastrointestinal motility and excessive propulsion of the gastrointestinal tract (peristalsis).
The nurse is planning to administer metoclopramide (Reglan). What is a primary intervention?
*Administer 30 minutes before meals and at bedtime.
-Metoclopramide (Reglan) should be administered 30 minutes before meals and at bedtime. Administering the medication before meals allows time for onset to increase gastrointestinal motility before food ingestion, thus decreasing stomach distention and the resulting nausea and vomiting.
What will the nurse teach the client about the reason for administering multiple medications for relief of nausea and vomiting?
*Combination therapy blocks different vomiting pathways.
-Combining antiemetic agents from various categories allows the blocking of the vomiting center and chemoreceptor trigger zone through different pathways, thus enhancing the antiemetic effect.
In developing a plan of care for a client receiving an antihistamine antiemetic agent, which nursing diagnosis would be of highest priority?
*Fluid volume deficit related to nausea and vomiting
-Although all of the options are appropriate nursing diagnoses, fluid volume deficit is the highest priority because it has the highest associated mortality rate.
What instruction is most important for the nurse to teach a client who is taking an anticholinergic agent to treat nausea and vomiting?
*"Brush your teeth and gargle to help with dryness in your mouth."
-Anticholinergic agents block the parasympathetic nervous system, which causes the body to "rest and digest." Blocking of these effects leads to constipation, urinary retention, and decreased secretions (dry mouth).
A client is prescribed granisetron (Kytril) IV for relief of nausea and vomiting caused by cancer chemotherapy. What intervention is most appropriate for this client?
*Weigh the client before chemotherapy.
-The drug is administered IV at a dose of 10 mcg/kg about 30 minutes before the start of cancer chemotherapy. The client's weight is essential. The medication is administered 30 minutes to 1 hour before cancer chemotherapy
A client is starting cisplatin therapy for cancer. What intervention is appropriate for this client?
*Administer ondansetron HCL (Zofran) 30 minutes before therapy and two doses after therapy.
-Zofran is recommended for treatment of nausea associated with cisplatin therapy.
Before administering a stimulant laxative to a client, which nursing intervention is the priority?
*Evaluate renal function.
-This intervention is essential to predict how the client will handle the therapy.
A client is prescribed scopolamine. What information will the nurse include on the teaching plan for this client?
*"After 3 days, switch patch to alternate ear." "Apply patch 4 hours before effect is desired." "Drowsiness is a concern while on this medication."
-This medication is used for motion sickness and has anticholinergic side effects, including dizziness, drowsiness, dry mouth, and constipation. The client can use it for longer than 3 days, but must switch ears. It should be applied 4 hours before the effect is needed
Common cause of constipation?
Lack of exercise and opioid narcotics
A client has nausea and is taking ondansetron (Zofran). The nurse explains that the action of this drug is what?
Block serotonin receptors in the CTZ
A client who has constipation is prescribed a bisacodyl suppository. The nurse explains that bisacodyl does what?
Acts on smooth intestinal muscle to gently increase peristalsis.
A client is using the scopolamine patch to prevent motion sickness. The nurse teaches the client that which is a common side effect of this drug?
Dry mouth
When metoclopramide (Reglan) is given for nausea, the client is cautioned to avoid which substance?
Alcohol
The nurse is administering opium tincture (paregoric) to a client. Which should be included in the client teaching regarding this medication?
Warn the client to avoid laxative abuse, record the frequency of bowel movements, warn the client against taking sedatives concurrently, encourage the client to increase fluids, instruct the client to avoid this drug if he or she has narrow-angle glaucoma.
A client has just been prescribed aluminum hydroxide (Amphojel, ALternaGEL, Alu-Tab) for peptic ulcer pain. The nurse has provided instructions to the client. Which statement by the client indicates to the nurse that the client understands the instructions?
*"I will drink 2 ounces of water after taking aluminum hydroxide."
-The client should drink 2 ounces of water after taking aluminum hydroxide to ensure the drug reaches the stomach. Aluminum hydroxide should not be taken at mealtime as it slows gastric emptying time. Aluminum hydroxide should not be taken within 1 to 2 hours of other oral medications. The client should contact the health care provider if constipation develops as the antacid may need to be changed
What is a priority nursing intervention when administering ranitidine (Zantac)?
*Administer just before meals.
-Ranitidine (Zantac) should be given just before meals to decrease food-induced acid secretion, or at bedtime.
The health care provider prescribes lansoprazole (Prevacid) to a client. Which assessment indicates to the nurse that the medication has had a therapeutic effect?
*The client has no throat pain.
-Lansoprazole (Prevacid) is a proton pump inhibitor that is effective in suppressing gastric acid secretions. An absence of throat pain would be an indication that the client does not have reflux esophagitis
The nurse is caring for a client who is taking sucralfate (Carafate, Sulcrate) for treatment of a duodenal ulcer. Which assessment requires action by the nurse?
*Absent bowel sounds, hard abdomen
-As sucralfate (Carafate, Sulcrate) is not systemically absorbed, there are few adverse effects. Constipation is an adverse effect of sucralfate.
When administering sucralfate (Carafate) to a client with a nasogastric tube, what is an essential intervention?
*Allow the tablet to dissolve in water before administering.
-It is important to give sucralfate (Carafate) on an empty stomach so that it may dissolve and form a protective barrier over the gastric mucosa. The tablet form will not dissolve in water when crushed; it must be left whole and allowed to dissolve. Crushing the medication so that it will not dissolve could lead to clogging of the nasogastric tube and decreased effectiveness of the drug.
What information should the nurse include in a teaching plan for the client who is prescribed sucralfate (Carafate)?
*"This medication will form a protective barrier over the gastric mucosa."
-Sucralfate (Carafate) affects the gastric mucosa. It forms a pastelike substance in the stomach, which adheres to the gastric lining, protecting against adverse effects related to gastric acid. It also stimulates healing of any ulcerated areas of the gastric mucosa.
The nurse is caring for a client who is experiencing gastric distress from the long-term use of aspirin for treatment of arthritis. What is the best intervention for this client?
*Administer misoprostol. Instruct the client to take omeprazole with the aspirin.
-Misoprostol and omeprazole are each indicated for the prevention of NSAID-induced ulcer. They may be taken during NSAID therapy, including with aspirin.
A client is diagnosed with peptic ulcer disease. The nurse realizes that which factor is a predisposing factor of this condition?
Helicobacter pylori
When a client is given sucralfate (Carafate), the nurse knows that its MOA is what
To combine with protein to form a viscous substance that forms a protective covering of ulcer
A client is taking ranitidine (Zantac). The nurse who is teaching the client about this drug should include which information?
The drug must be administered separate from and antacid by at least 1 hour. Smoking should be avoided, foods high in vitamin B12 should be increased in diet.
When a client complains of pain accompanying a peptic ulcer, why should an antacid be given
Antacids neutralize HCL and reduce pepsin activity.
A client is taking famotidine (Pepcid) to inhibit gastric secretions. What are the side effects of famotidine?
Dizziness, headache, decreased libido
Which intervention is most appropriate for the client with second-degree burns?
*Silver sulfadiazine cream
-Silver sulfadiazine (Silvadene, SSD) is a topical antiinfective agent used to treat and prevent infection in second- and third-degree burns.
A 20-year-old client is starting isotretinoin (Accutane) therapy. What is an essential nursing intervention for this client?
*Perform pregnancy test.
-Isotretinoin (Accutane) is an effective treatment for acne vulgaris. Isotretinoin must not be used during pregnancy because of teratogenic effects. Every female client should have a pregnancy test before beginning therapy to ensure that the client is not pregnant.
A client is prescribed calcipotriene (Dovonex) for treatment of psoriasis. Which assessment finding requires immediate intervention by the nurse?
*Calcium 12 mg/dL
-A serious adverse effect of calcipotriene (Dovonex) is hypercalcemia and hypercalciuria.
Before applying povidone-iodine (Betadine) to a client's skin, what is a primary nursing intervention?
*Ask client if he or she has any allergies.
-Seafood can be rich in iodine, and thus a client allergic to seafood has a high risk for being allergic to povidone-iodine (Betadine).
A client is prescribed isotretinoin (Accutane). What is the most important instruction to teach the client before beginning this medication?
*Call the health care provider if you have muscle weakness.
-Muscle weakness may be a sign of severe adverse reaction.
The nurse reviews the clients list of meds and recalls that the purpose of keratolytic agents is to remove what?
A horny layer of epidermis
Nursing implications for health teaching with clients taking isotretinoin include which implications?
Avoid sunlight, monitor CBC, glucose and lipids and do not breastfeed or give blood.
What treatment are used when alopecia occurs?
-2% minoxidil (Rogaine) solution for men and women.
- Finasteride (Propecia) is an oral drug used for male baldness (1mg tablet)
The client has second and third -degree burns over 25% of his body. Mafenide acetate has been ordered. What acid-base imbalance can result from its use?
Metabolic acidosis, Respiratory alkalosis
The nurse reviews the client's medication history. Based on the clients prolonged use of glucocorticoids, what does the assessment include?
Thinning of the skin, Purpura
A 20 year old woman comes to the clinic for follow-up related to isotretinoin use. The nurse reviews the iPLEDGE program, which includes which important information?
That a negative pregnancy test is required before each monthly refill, and review of iPLEDGE material
The school nurse prepares a program for junior high school students on sun safety. What is important information to include?
sunscreen products should contain information about UVA and UVB SPF protection. UVB radiation is greatest between 10am and 4pm. SPF should be at least 15 in sunscreen products.
Which client is most likely to be treated with somatrem (Protropin)?
*A 7-year-old diagnosed with growth hormone deficiency
-For this medication to be used, the client has to be diagnosed with a growth hormone deficiency, and the epiphyses must not be fused, so the child needs to be young. Severe respiratory conditions, Prader-Willi syndrome, and age of 17 years are contraindications to this medication.
Which nursing diagnosis is the highest priority for a client receiving desmopressin?
*Potential for fluid volume excess
-Desmopressin (DDAVP) is a form of antidiuretic hormone, which increases sodium and water retention, leading to an alteration in fluid volume
When teaching a client regarding the correct administration of desmopressin, the nurse will include which instruction?
*"Rotate nostrils daily to prevent irritation."
-Because it is administered intranasally, it can be irritating; thus nostrils should be rotated. Desmopressin (DDAVP) works to decrease urine output; thus the client would retain fluid and gain weight. This drug should be taken at night if used to treat nocturnal enuresis.
Which assessment finding indicates to the nurse that vasopressin has been effective?
*Increased urine specific gravity
-Vasopressin (Pitressin) causes decreased water excretion in the renal tubule, thus increasing urine specific gravity. It is used to treat diabetes insipidus, which presents with a low urine specific gravity.
The nurse admitting a client with acromegaly anticipates administering which medications?
*octreotide (Sandostatin)
-Octreotide (Sandostatin) suppresses growth hormone, which causes acromegaly.
After administering corticotropin, what assessments are priorities for the nurse?
*Changes in vision, Glucose levels, Intake and output, Serum sodium levels.
-Corticotropin (Acthar, ACTH) can cause cataracts and glaucoma, so the nurse needs to monitor for changes in vision. Corticotropin stimulates the release of adrenal hormones, which can lead to sodium and fluid retention as well as hyperglycemia. Corticotropin can cause sodium and fluid retention, so that intake and output should be monitored. Serum sodium levels should be monitored, as sodium retention can be a result of corticotropin administration
Which client statement demonstrates understanding of the nurse's teaching for levothyroxine (Synthroid)?
*"I will take this medication first thing in the morning."
-Levothyroxine (Synthroid) increases basal metabolism and thus wakefulness. It should be taken first thing in the morning. The client should not increase the dose. The medication is absorbed best on an empty stomach. Depending on the symptoms, some symptoms may take weeks to improve
The nurse is caring for a client who has just started taking levothyroxine (Synthroid). What assessment finding is a priority for the nurse to address?
*Irritability
-Irritability is a symptom of hyperthyroidism. This could be a sign that the medication dose is too high. A lowered heart rate, weight gain, and intolerance to cold could be symptoms of hypothyroidism and are expected in this client
The nurse is caring for a client who is taking levothyroxine (Synthroid) and warfarin. What intervention is a priority for the nurse?
*Monitor the client for increased risk of bleeding.
-Levothyroxine (Synthroid) can compete with protein-binding sites of warfarin, allowing more warfarin to be unbound or free, thus increasing the effects of warfarin and the risk of bleeding.
A client receiving propylthiouracil asks the nurse how this medication will help relieve symptoms. Which statement is the nurse's best response?
*"This medication inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal."
-Propylthiouracil (PTU) is an antithyroid medication used to treat hyperthyroidism. It works by inhibiting the synthesis of new thyroid hormone. It does not inactivate hormone already present.
Which statement indicates that the client understands teaching about radioactive iodine therapy?
*"This drug will be taken up by the thyroid gland and destroy the cells to reduce my hyperthyroidism."
-Radioactive iodine is an antithyroid medication that is administered orally for one or two doses only. It concentrates in the thyroid gland, enabling the radiation to destroy the hyperplastic cells. Taking this medication will not expose the client's family to radiation. The drug will decrease heat intolerance and weight loss
Which plan is best for the client beginning prednisone therapy?
*Take the medication with food to diminish the risk of gastric irritation.
-Glucocorticoids can cause gastric distress and should be administered with food. The normal circadian secretion of the adrenal cortex is early morning to wake the person up, not early evening. These medications should be tapered off slowly to prevent adrenal crisis. The client takes the medication daily.
A client asks the nurse to explain the action of glucocorticoids. Which statement is the nurse's best response?
*"Glucocorticoids influence carbohydrate, lipid, and protein metabolism."
-Glucocorticoids play a major role in carbohydrate, lipid, and protein metabolism within the body. They are produced in increasing amounts during stress. They increase sodium and glucose levels and suppress the immune system.
Which client should the nurse assess first, before administering glucocorticoid therapy as ordered?
*The client with uncontrolled diabetes mellitus
-A common side effect of steroid therapy is hyperglycemia. The client with uncontrolled diabetes mellitus could suffer a severe hyperglycemic episode. The risks and benefits should be considered.
When assessing for potential side effects of fludrocortisone (Florinef), what is a priority for the nurse to monitor?
*Serum potassium levels for hypokalemia
-Fludrocortisone (Florinef) has mineralocorticoid properties, resulting in sodium and fluid retention along with potassium excretion.
Discharge teaching for a client receiving glucocorticoids should include the preferred use of which over-the-counter medication for pain management?
*Acetaminophen
-Acetaminophen (Tylenol) does not cause gastric distress as do aspirin, ibuprofen, naproxen sodium, and glucocorticoids.
The nurse would question an order for aminoglutethimide for a client with which medical condition?
*Addison's disease
-Aminoglutethimide (Cytadren) suppresses the adrenal cortex. Addison's disease presents with decreased adrenal secretion; thus the nurse would not want to exacerbate this by administering aminoglutethimide.
A client is receiving growth hormone drug somatrem (Protropin). The nurse understands that the action of this drug is do what?
To stimulate growth in long bones at epiphyseal plates
a client is taking levothyroxine (Synthroid). For which adverse effect would the nurse monitor the client?
Tachycardia, hypertension, palpitations
a client has just begun taking dihydrotachysterol (DHT). What is a nursing implication of this drug?
To monitor weekly calcium levels.
A client is given corticotropin (Acthar) the nurse knows to monitor the client for which condition?
Weight gain
A nurse is administering prednisone (Deltasone) to a client newly admitted to the hospital who is taking multiple other drugs. The nurse should consider which drug interactions with prednisone?
Potassium-wasting diuretics increase potassium loss resulting in hypokalemia. The risk of GI bleeding and ulcerations increases when taken with aspirin and other NSAIDS. The action of prednisone is decreased with taken with phenytoin (Dillantin) as phenytoin increases glucocorticoid metabolism. The risk of dysrhythmias and digitalis toxicity increases when taken with cardiac glycosides. The dosage of anitdiabetic agents may need to be increased when taken concurrently with glucocorticoids.
The nurse is administering vasopressin (Pitressin) to a client. The nurse realizes that nursing implications for this drug would include which implication?
Monitor the client for decreased BP. Monitor the client pulse for increase HR.
A client with type 1 diabetes mellitus has been ordered insulin aspart (NovoLog) 10 units at 7:00 AM. What nursing intervention will the nurse perform after administering this medication?
*Make sure the client eats breakfast.
-Insulin aspart (NovoLog) is a rapid-acting insulin that acts in 15 minutes or less. It is imperative that the client eat as it starts to work. The client should have had a fingerstick blood sugar test done before receiving the medication. This medication is given subcutaneously.
The client newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine (Lantus). What information is essential for the nurse to teach this client?
*"This medication has a duration of action of 24 hours."
-Insulin glargine (Lantus) has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas. This medication cannot be mixed with other insulins and is not a short-acting insulin. The client may need to receive this medication for a long time.
The nurse is monitoring the client receiving an IV infusion of insulin. What intervention is essential for this client?
*Make sure the pump is set to the correct rate.
-Rapid-acting insulins and some regular insulins may be used for intravenous therapy. The IV must be run on a pump for accuracy. the client should not receive D5W.
The nurse is teaching the client how to administer insulin. What information is essential to include in the plan?
*"For the most consistent absorption, inject the insulin into the abdomen."
-The abdomen has the most consistent absorption because the blood flow to the subcutaneous tissue typically is not as affected by muscular movements as it could be in the arm or thigh. Insulin can be administered in the arm. The client should be instructed not to inject over an exercising muscle. Most insulins can be mixed, except for Lantus.
The nurse administers NPH insulin at 8 AM. What intervention is essential for the nurse to perform?
*Make sure client eats by 5 PM.
-NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia. The client needs to eat by 5 PM.
Which statement indicates that the client needs additional teaching on oral hypoglycemic agents?
*"I will take the medication only when I need it."
-Oral hypoglycemic agents must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes.
What is the most important information for the nurse to teach the client who has been prescribed an alpha-glucosidase inhibitor?
*"This medication will delay the absorption of carbohydrates from the intestine."
-Alpha-glucosidase is an enzyme necessary for the absorption of glucose from the GI tract. Inhibiting this enzyme inhibits glucose absorption, delaying rises in postprandial serum glucose levels.
The client with type 1 diabetes mellitus asks "Why can't I take a sulfonylurea like my friend who has diabetes?" What is the nurse's best response?
*"Sulfonylurea increases beta-cell stimulation to secrete insulin, and with your type of diabetes, the beta cells do not contain insulin. This medication will not work for you."
-Sulfonylurea agents reduce serum glucose levels by increasing beta-cell stimulation for insulin release, decreasing hepatic glucose production, and increasing insulin sensitivity. It is administered for type 2 diabetes mellitus, but will not be effective in type 1.
The nurse is teaching a client who has been prescribed repaglinide. What information is the most important for the nurse to include in the teaching plan?
*You will need to be sure you eat as soon as you take this medication."
-Repaglinide (Prandin) is known as the "Humalog of oral hypoglycemic agents." The drug's very fast onset of action allows clients to take the drug with meals and skip a dose when they skip a meal. Prandin interacts with beta-adrenergic blockers as well as other medications. Hypoglycemia is a side effect of this medication, and there are many other possible side effects of this medication.
The nurse is teaching a client with type 1 diabetes and hypertension. The client currently takes insulin and Inderal. What is the most important information for the nurse to teach this client?
*"Check your blood glucose four times a day."
-Propranolol (Inderal) is a beta blocker that may cause an increased risk for clients taking insulin to develop unrecognized hypoglycemia. Beta-adrenergic blockers block the initial sympathetic response to hypoglycemia; therefore the client will not exhibit the initial symptoms of nervousness, diaphoresis, and sweating that typically alert the client to the onset of hypoglycemia, allowing the hypoglycemia to progress to the neuroglycopenic stage. The client should check his blood glucose levels frequently.
How will the nurse teach the client to mix her insulins when administering 30 units regular insulin and 70 units NPH insulin in the morning?
*Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin.
-Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could cause an alteration in the onset of action of the regular insulin. The medications do not have to be in separate syringes and can be administered together. Z-track is an IM technique.
The nurse would include which statement when teaching a client about insulin glargine?
*"You cannot mix this insulin with any other insulin in the same syringe."
-Insulin glargine is a long-acting insulin with a duration of action up to 24 hours. It should not be mixed with any other insulins
The client states that he typically takes his glipizide with food. What is the nurse's best intervention?
*Inform the client that it is better to take the medication 30 minutes before a meal.
-Food inhibits the absorption of glipizide, the only sulfonylurea agent that should be given 30 minutes before a meal. The medication is not to be taken after a meal.
The nurse finds a client with type 1 diabetes mellitus unresponsive, cold, and clammy. What is the nurse's best action?
*Administer glucagon
-Glucagon stimulates glycogenolysis, raising serum glucose levels. The client is showing signs of hypoglycemia.
A client is to receive insulin before breakfast, and the time of breakfast tray delivery is variable. The nurse knows that which insulin should not be administered until the breakfast tray has arrived and the client is ready to eat?
Lispro (Humalog)
Client is receiving a daily dose of Humulin N insulin at 7:30AM. The nurse expects the peak effect of this drug to occur at which time?
5:00PM
When the client is prescribed glipizide (Glucotrol), the nurse knows that which side effects/adverse effects may be expected?
Tachycardia, visual disterbances, and hunger
A nurse who is teaching a client how to recognize symptoms of hypoglycemia should include which symptoms in the teaching?
Headache, nervousness, sweating
The labor and delivery nurse is preparing to administer butorphanol tartrate(Stadol) to a client in labor. Which nursing interventions are appropriate when administering butorphanol tartrate?
*Keep bedrails up when the client is nonambulatory. Monitor fetal heart rate tracing throughout drug administration
-should be given deep IM or IV, not subcutaneously. Butorphanol tartrate should be given if respirations are greater than 12 breaths/min because this drug can cause respiratory depression. The antidote naloxone (Narcan) should be kept readily available, not atropine.
The postpartum nurse is caring for a client who received a saddle block during delivery. The client is experiencing a resistant postdural headache. What is the nurse's best intervention?
*Give the client caffeine.
-Caffeine constricts the cerebral vasculature and is indicated for treatment for resistant postdural headache. Atropine sulfate is indicated for the treatment of bradycardia and is the antidote for overdose of cholinergic drugs or for cholinesterase poisoning. Elevating the head of the bed is likely to make the headache worse.
The labor and delivery nurse is caring for a client in labor who is receiving a lumbar epidural for pain management. The client develops hypotension. What is the nurse's initial action?
*Place the client on her left side.
-Place the client on her left side because this prevents aortocaval compression and facilitates placental perfusion before the client is rapidly bolused with a crystalloid IV solution.
The obstetrics nurse reviews a postpartum client's history. The client is prescribed ergonovine maleate for control of postpartum hemorrhage. What nursing intervention is essential for the client receiving this medication?
*Assess for signs and symptoms of clots.
-Clients who receive this drug are at high risk for clot formation and hypercoagulability.
A pregnant client has been ordered oxytocin. What is the nurse's primary intervention for this client?
*Monitor the client's blood pressure frequently.
-Hypertensive episodes can occur with oxytocin use.
The client is to have a lumbar epidural anesthesia. Before the anesthesiologist administers the epidural, what should the nurse administer as the priority nursing intervention?
A bolus of 500 to 1000 mL of crystalloid IV solution.
Which client statement indicates to the nurse that the client understands the discharge instructions regarding alendronate (Fosamax)?
*"I will take the medication on an empty stomach and not lie down for 30 minutes."
-Alendronate (Fosamax) can cause erosive esophagitis. To prevent this side effect, it is important to take the medication first thing in the morning on an empty stomach without any other medications and to maintain an upright position for 30 minutes. These actions facilitate rapid absorption and prevent reflux into the esophagus.
Which statement indicates that the client understands the benefit of continuous administration of progestin with an estrogen regimen?
*"Endometrial cancer risk can be reduced with this regimen."
-Estrogen, given alone, has been associated with an increased risk of endometrial hyperplasia, which can lead to endometrial cancer. Progestin reduces the incidence of endometrial hyperplasia.
The nurse is assessing a client who is prescribed estrogen replacement therapy. A history of which condition would be a contraindication to this therapy?
*Deep vein thrombosis
-Increased coagulation and risk of deep vein thrombosis are side effects of hormone replacement therapy. A previous history would put the client at increased risk.
A client is taking the oral contraceptive Ortho Tri-Cyclen, has developed an infection, and is prescribed tetracycline. What information is essential for the nurse to teach the client?
*"Use an additional form of contraception while on these medications."
-Tetracycline interacts with oral contraceptives and decreases their effectiveness. An additional form of contraception is needed while taking tetracycline
The nurse is instructing a client on the use of the contraceptive NuvaRing. Which of the following information will the nurse include in the client's teaching plan?
*The client should insert the ring during the first 5 days of the menstrual cycle.
-NuvaRing should be inserted the first 5 days of the menstrual cycle. Backup contraception is recommended during the first 7 days after the first ring is placed, until hormones have had the opportunity to reach an appropriate level. NuvaRing does not cause diarrhea and does not protect against STIs, including human immunodeficiency virus.
The nurse is preparing a teaching plan for oral contraceptive use. Which factors must be included?
Report ACHES symptoms, COCs use will not protect from STIs, the pills should be taken at the same time every day.
The client asks the nurse about the indications for hormone therapy. Which is an indication of hormone therapy?
Relief of hot flashes
The client is interested in the routes of administrating of hormone therapy. which are routes for the admin of hormone therapy?
oral tablets, vaginal ring, transdermal products.
The nurse is caring for a client receiving androgen therapy. The nurse understands that androgen therapy is indicated for which conditions?
*Constitutional growth delay. Endometriosis. Refractory anemias.
-Androgen therapy is indicated for the treatment of constitutional growth delay, endometriosis, refractory anemias, advanced breast cancer in women, hypogonadism, angioneurotic edema, and tissue wasting associated with severe or chronic illness.
The nurse is planning to administer vardenafil (Levitra) to a client with a history of past myocardial infarction (MI). What intervention should the nurse perform first?
*Perform a thorough history, including medication
-This medication is safe for clients with a past history of MI; however, it is contraindicated with nitrate use. The nurse's primary responsibility is to assess medications the client is receiving prior to administration.
The nurse is caring for a client receiving testosterone therapy. Which assessment finding will the nurse intervene for immediately?
*Pitting edema
-Pitting edema is a sign of sodium and water retention and is an adverse reaction of administration of testosterone. Abdominal pain, nausea, and dizziness are side effects, but do not require immediate attention.
The nurse assesses a client before the administration of medications. The client's serum potassium level is 5.5 meq/L. The client is due to receive testosterone. What is the nurse's first intervention?
*Hold the testosterone.
-Testosterone can cause increased serum potassium levels. As this is an increased potassium level, the nurse would first hold this medication.
A client receiving finasteride (Proscar) has increased hair growth. What is the nurse's primary action?
*Continue to assess.
-Increased hair growth is a therapeutic effect of this medication. The nurse should continue to assess.
A client who has been taking sildenafil (Viagra) has developed angina. The physician has ordered isosorbide mononitrate (Imdur). What is the nurse's primary intervention?
*Hold the sildenafil.
-When taken in conjunction with nitroglycerin, sildenafil (Viagra) can cause severe hypotension unresponsive to treatment. The client should not take these medications together.
A client has been prescribed nitroprusside (Nipride) for treatment of a hypertensive emergency. Which interventions will the nurse include when administering nitroprusside?
*Closely monitor the client's blood pressure. Monitor the client's thiocyanate levels. Do not mix nitroprusside with other drugs or solutions.
-Nipride will lower the client's blood pressure owing to vasodilation. Thiocyanate toxicity is an adverse reaction, and levels should be monitored. To prevent drug interactions, nitroprusside should not be mixed with other drugs or solutions. The mixture should not be vigorously shaken. The solution should not be warmed. The medication should not be administered IV push
A client is receiving mannitol (Osmitrol) for treatment of cerebral edema. The nurse assesses a heart rate of 110 beats per minute and rhonchi throughout the lung fields, and the client complains of blurred vision. What will the nurse do?
*Stop the infusion and call the health care provider.
-Pulmonary congestion, tachycardia, and blurred vision are symptoms of adverse effects of mannitol. The nurse should stop the infusion. Coughing and deep breathing will not assist the client.
The nurse is administering nitroglycerin at 10 mcg per minute. The client continues to complain of chest pain. What is the nurse's primary action?
*Increase the infusion by 5 mcg per minute.
-A continuous infusion is started for the client with chest pain at a rate of 10 to 20 mcg/min and increased by 5 to 10 mcg/min based on the client's symptoms. The client would have had an ECG at the beginning of the episode. The infusion should not be stopped.
The nurse administers atropine 0.3mg IV to a 50 year old man with a heart rate of 45, and the clients HR decreased to 38. What is the most likely explanation?
The ordered dose was to low.
A 75 year old woman with a hip fracture received morphine 3 mg IV 20 minutes ago. The client's son runs to the nurses' station and says that is mother is no longer responding to him. What actions should be taken?
Asses the client, call for additional assistance, support breathing with bag-valve-mask and prepare to administer naloxone (Narcan).
The nurse is caring for a 19 year old woman with a closed head injury. Her intracranial pressure is 35 (normal is 5-15). Her serum osmolality is 330. The nurse should anticipate which action?
Withholding mannitol at this time but taking other measures to reduce intracranial pressure.
A dopamine infusion was started in a client's antecubital vein during resuscitation after a cardiac arrest. The electronic infusion device is now sounding an alert for an occlusion. What is the most important immediate concern for the nurse?
An interruption in the infusion can produce hypotension in the client.
Adenosine is ordered for a client in the ER. Immediately after intravenous administration, the nurse observes a short period of a systole on the cardiac monitor that resolves spontaneously. What is the most appropriate initial action for the nurse?
Closely observe the client and the cardiac monitor.
a client is having an anaphylactic reaction during infusion of an IV antibiotic with hives and bronchospasm. What should the nurse administer?
Epinephrine
a 45 year old woman has been reportedly taking Xanax for a severe anxiety disorder following her mothers death. She was brought to the ER because she became unresponsive. What should the nurse anticipate administering?
Flumazenil (benzodiazepine receptor antagonist)
a 25 year old woman was admitted to the ER after a successful prehospital resuscitation from cardiac arrest owing to an asthma attack. On arrival, her pulse oximeter reading is 85%. Given her conditions, what is the most important initial medication to administer as ordered?
Oxygen
the nurse practitioner orders epinephrine 0.3 mg IM for a severe allergic reaction to a bee sting in an adult. Which concentration of epinephrine should the nurse select to administer this particular dose?
1:1000
Why would administering a drug as an enteric-coated product be beneficial?
Enteric-coated drugs resist disintegration in the gastric acid of the stomach. Disintegration occurs when the drug reaches the alkaline environment of the small intestine. Drugs that are inactivated by the acid environment of the stomach, those drugs that are irritating or increase the acidity of the stomach, and those products requiring delayed release are often administered in an enteric-coated formulation.
Why is it important to understand the half-life of a drug?
The half-life of a drug is the time it takes for half of the drug concentration to be eliminated from the body. With drugs that have very long half-lives, there is a possibility of accumulation, and toxicity may occur. Drugs with long half-lives may only need to be dosed daily, whereas those with short half-lives will need to be administered more frequently. The two commonly used macrolide antibiotics erythromycin and azithromycin (Zithromax) are an example. For therapeutic levels to be reached with erythromycin, dosing every 6 hours is required for a period of 7 to 10 days. The same therapeutic levels and response are achieved with azithromycin dosed once daily for only 5 days.
What are the seven items that should be addressed when the nurse educates the client about the use of a medication?
1)Name of the drug (including brand and generic names)
2) Reason for taking the drug
3) Dosage
4) Specific times to take the drug
5) What specific things should or should not be done while taking the medication; for example, tablets may or may not be crushed or chewed, or may or may not be taken with food
6)Possible side effects of medication
7) Possible adverse effects of medication; when to notify health care provider
What are the Five-Plus-Five Rights of drug administration?
1.The right client
2. The right drug
3. The right dose
4. The right time
5. The right route
Experience indicates that five additional rights are essential to professional nursing practice:
1. The right assessment
2. The right documentation
3. The client's right to education
4. The right evaluation
5. The client's right to refuse the medication
What are the five schedules of controlled substances and what differentiates them?
The Controlled Substance Act of 1970 was designed to remedy the escalating problem of drug abuse. It established five classes, or schedules, of drugs according to abuse liability. The schedules are I, II, III, IV, and V. Schedule I drugs are not approved for medical use (e.g., heroin); schedule II through V drugs have accepted medical uses. The schedule the drug is assigned is based on abuse potential. The dependency decreases as one moves through the schedules, with schedule V drugs having only limited abuse potential. Morphine is an example of a schedule II drug. Codeine-containing cough preparations are an example of a schedule V drug.
What are the four classifications of intravenous solutions?
1) Crystalloids—include dextrose, saline, and lactated Ringers solution. This group of solutions is for replacement and maintenance fluid therapy.
2) Colloids—are volume expanders that include dextran solutions, amino acids, hetastarch, and Plasmanate.
3) Blood and blood products—are whole blood, packed red blood cells (PRBCs), plasma, and albumin.
4) Lipids—are administered as a fat emulsion and are usually indicated when intravenous therapy lasts longer than 5 days. They are important in balancing the clients nutritional needs.
How much fluid should I use to flush an enteral feeding tube?
Enteral feeding tubes should be flushed with 30 ml of water before and after intermittent feedings; with continuous feedings, 30 ml every 4 hours; with medications, 30 ml before and after administration. The nurse should review the literature on all medications administered via the feeding tube because many commercially available products are not recommended to be given via feeding tubes.
Why should a patient with a penicillin allergy NOT be prescribed a cephalosporin?
It has been documented that a small percentage (<5%) of patients with an allergy to penicillin will also be allergic to cephalosporins. Careful evaluation and a detailed history of any previous penicillin allergic reactions should be taken. Many times a patient reports side effects such as upset stomach or diarrhea as an allergy to a medication.
Why is a low-molecular-weight heparin product preferred for a patient who will require home therapy following hip, knee, or abdominal surgery?
Low-molecular-weight heparins (LMWHs) produce more stable responses at recommended doses, therefore not requiring frequent laboratory monitoring. These products are also effective in once or twice daily dosages because of a half-life two to four times longer than that of heparin, and they come conveniently packaged in syringes with needles already attached. Heparin must be administered in the hospital because of a higher risk of bleeding and the need for frequent laboratory monitoring for dosage adjustment.
What is the goal of therapy when treating a patient for hypercholesterolemia?
The desired lipid level profile is as follows: cholesterol less than 200 mg/dl; triglycerides less than 150 mg/dl; low-density lipoprotein less than 100 mg/dl; and high-density lipoprotein greater than 60 mg/dl. The clients lipid levels should be monitored every 6 to 8 weeks for the first 6 months after any statin therapy and then every 3 to 6 months. Client should be advised to fast for 12 to 14 hours before the lipid levels are obtained.
When should patients be instructed to take antacids for optimal effect?
The ideal dosing interval for antacids is 1 and 3 hours after meals (maximum acid secretion occurs after eating) and at bedtime. Antacids taken on an empty stomach are effective for 30 to 60 minutes before passing into the duodenum. Chewable tablets should be followed by water. Liquid antacids should also be taken with water (2 to 4 oz) to ensure that the drug reaches the stomach; however, no more than 4 oz of water should be taken because water quickens gastric emptying time.
A client was prescribed an antibiotic for an upper respiratory tract infection, and the client states that he/she feels cured after 5 days. What should you tell the client?
If the drug is taken only for several days, drug resistance to that antibiotic may occur in the future. The infection may still be present even though the patient still feels better. The patient should be instructed to take the medication for the prescribed time unless an allergic reaction occurs.
What are the new guidelines for defining hypertension?
1) Normal blood pressure is less than 120/80 mm Hg.
2) Prehypertension is the second category, with a systolic blood pressure (SBP) of 120-139 mm Hg and a diastolic blood pressure (DBP) of 80 to 89 mm Hg. 3) Stage 1 hypertension is 140/90 to 159/99 mm Hg, and
4) stage 2 hypertension is greater than 160/100 mm Hg.
Why has metformin (Glucophage) become so popular as an oral antidiabetic agent?
Metformin is effective; however, when combined with a sulfonylurea, the drug is useful in cases in which the client is resistant to oral antidiabetics (oral hypoglycemics). It does not produce hypoglycemia or hyperglycemia. Metformin acts by decreasing hepatic production of glucose from stored glycogen as well as by increasing insulin receptor sensitivity and peripheral glucose reuptake at the cellular level.
How should insulin be stored?
Unopened insulin vials are refrigerated until needed. Once an insulin vial has been opened, it may be kept (1) at room temperature for 1 month or (2) in the refrigerator for 3 months. Insulin is less irritating to the tissues when injected at room temperature. Insulin vials should not be put in the freezer. In addition, insulin vials should not be placed in direct sunlight or in a high-temperature area. Prefilled syringes should be stored in the refrigerator and used within 1 to 2 weeks. Opened insulin vials lose their strength after approximately 3 months.
Why is the use of isotretinoin so highly controlled?
Isotretinoin (Accutane), a derivative of vitamin A, is used for severe cystic acne. Monitoring of complete blood cell count (CBC), glucose and lipid levels, and urinalysis on a regular basis is important. Isotretinoin must not be used during pregnancy; its pregnancy risk category is X. Based on this drugs teratogenicity, a System to Manage Isotretinoin-Related Teratogenicity (SMART) has been implemented, with the purpose that no woman will be pregnant when treatment is initiated and no woman will become pregnant while taking this drug or for at least 1 month after completing treatment with the drug. Female clients must receive warnings of teratogenicity both orally and in writing. Two negative pregnancy tests are required before starting the drug and one negative test before each monthly refill. Two effective methods of contraception are required 1 month before starting the drug, throughout the duration of the drug, and 1 month after terminating the drug. (Exceptions are total abstinence from intercourse or following hysterectomy.) The client must review iPLEDGE educational materials on a variety of topics, including reasons for contraception when using a drug known to be teratogenic. A signed patient information/informed consent is also required.
Should ipecac syrup be immediately given to all patients who ingest toxic amounts of medications or other substances?
No. Vomiting should not be induced if caustic substances, such as ammonia, chlorine bleach, lye, toilet cleaners, or battery acid, have been ingested. Regurgitating these substances can cause additional injury to the esophagus. To prevent aspiration, vomiting should also be avoided if petroleum distillates are ingested; these include gasoline, kerosene, paint thinners, and lighter fluid. Activated charcoal is given when emesis is contraindicated.
Why are alpha-receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors less effective in the African American population?
This racial group is susceptible to low-renin hypertension; therefore they do not respond well to beta-blockers and ACE inhibitors. The antihypertensive drugs that are effective for African Americans are the alpha1 blockers and calcium channel blockers (calcium blockers). African American clients do respond to diuretics as the initial monotherapy for controlling hypertension. White clients usually have high-renin hypertension and respond well to all antihypertensive agents.
How do diuretics lower blood pressure?
Diuretics have an antihypertensive effect by promoting sodium and water loss by blocking sodium and chloride reabsorption. This causes a decrease in fluid volume and lowering of blood pressure. In addition, with fluid loss, edema (fluid retention in body tissues) should decrease. When sodium is retained, water is also retained in the body and the blood pressure increases.
Why is furosemide called a high-ceiling diuretic?
The loop, or high-ceiling, diuretics act on the thick ascending loop of Henle by inhibiting chloride transport of sodium into the circulation (inhibits passive reabsorption of sodium). The effects of loop diuretics are dose related (i.e., increasing the dose increases the effect and response of the drug). This response is called high-ceiling.
Why are inhaled steroids NOT recommended for acute asthmatic episodes?
Inhaled glucocorticoids are not helpful in treating a severe asthmatic attack, because it may take 1 to 4 weeks for an inhaled steroid to reach its full effect. When maintained on inhaled glucocorticoids, asthmatic clients demonstrate an improvement in symptoms and a decrease in asthma attacks.
Why is it important to advise the patient to limit the use of nasal decongestant sprays and drops?
Use of nasal decongestants longer than 5 days could result in rebound nasal congestion. Instead of the nasal membranes constricting, vasodilation occurs, causing increased stuffy nose and nasal congestion. The nurse should emphasize the importance of limiting the use of nasal sprays and drops.
Why did you pass pharmacy?
Because your are flipping awesome... and studied this long ass mother Fer... Merry Christmas everyone :)