Complex Care

A nurse is caring for a client who has nausea and a prescription for metoclopramide intermittent IV bolus every 4hr as needed. The client asks the nurse how metoclopramide will relieve her nausea. Which of the following explanations should the nurse provide? a. "The medication relieves nausea by promoting gastric emptying." b. "The medication works by decreasing gastric acid secretions." c. "The medication relieves nausea by slowing peristalsis." d. "The medication works by relaxing gastric muscles."

a. "The medication relieves nausea by promoting gastric emptying." Rationale: Reglan is a gastrointestinal stimulant used to relieve nausea, vomiting, heartburn, stomach pain, bloating, and a persistent feeling of fullness after meals. Reglan works by promoting gastric emptying.

Which of the following are included in the care of a patient with an abdominal aortic aneurysm that measures 4.2 cm? SELECT ALL THAT APPLY a. Educate the patient about the need to monitor the growth of the aneurysm with imaging every 12 months b. Initiate or maintain the patient on medications that control blood pressure c. Initiate or maintain the patient on medications that control cholesterol levels d. Initiate or maintain the patient on blood thinners e. Strongly recommend smoking cessation

▸ a. Educate the patient about the need to monitor the growth of the aneurysm with imaging every 12 months ▸ b. Initiate or maintain the patient on medications that control cholesterol levels ‣ c. Initiate or maintain the patient on medications that control cholesterol levels

A nurse is caring for a child who is allergic to penicillin. The nurse should verify which of the following prescriptions with the provider? a. Amoxicillin-clavulanate b. Gentamicin c. Erythromycin d. Amphotericin B

a. Amoxicillin-clavulanate Rationale: Penicillin is the most common medication allergy. Clients who are allergic to one penicillin medication should be considered allergic to all penicillins, which would include amoxicillin-clavulanate. Reactions may mild or life-threatening. Gentamicin is an aminoglycoside, which is often used to treat gram-negative bacilli. Aminoglycosides can be administered to clients who have a penicillin allergy. Erythromycin is a macrolide, which is a broad-spectrum antibiotic used for gram-positive and gram-negative organisms causing skin and respiratory infections. This medication can be administered to a client who has a penicillin allergy as a safe alternative. Amphotericin B is an anti-fungal agent useful in treating vaginal and oral candidiasis, ringworm, and histoplasmosis. This medication can be administered to a client who has a penicillin allergy.

A nurse in a provider's clinic is assessing a client who has cancer and a prescription for methotrexate PO. Which of the following actions should the nurse take when the client reports bleeding gums? a. Explain to the client that this is an expected adverse effect. b. Check the value of the client's current platelet count. c. Instruct the client to use an electric toothbrush. d. Have the client make an appointment to see the dentist.

a. Explain to the client that this is an expected adverse effect. Rationale: The nurse should recognize that the bleeding is likely due to the adverse effect of the chemotherapy and needs to be evaluated further. Bleeding gums is a sign of thrombocytopenia(decreased platelet count) secondary to bone marrow suppression, which can be life-threatening in a client who is receiving chemotherapy.

A nurse in a provider's clinic is caring for a client who reports erectile dysfunction and requests a prescription for sildenafil. Which of the following medications currently prescribed for the client is a contraindication to taking sildenafil? a. Isosorbide b. Metronidazole c. Prednisone d. Phenytoin

a. Isosorbide Rationale: Clients who are on nitrates including isosorbide and nitroglycerin preparations cannot take sildenafil, because of the serious medication interaction. There is the possibility of sudden death due to hypotension.

A nurse is taking a health history of a client who reports occasionally taking several over-the-counter medications, including an H2 receptor antagonist (H2RA). Which of the following outcomes indicates the H2RA is therapeutic? a. Relief of heartburn b. Cessation of diarrhea c. Passage of flatus d. Absence of constipation

a. Relief of heartburn Histamine2 receptor antagonists are used to treat duodenal ulcers and prevent their return. In over-the-counter strengths, these medications, such as cimetidine and ranitidine, are used to relieve or prevent heartburn, acid indigestion, and sour stomach.

A nurse is teaching a client who has asthma about how to use an albuterol inhaler. Which of the following actions by the client indicates an understanding of the teaching? a. The client holds his breath for 10 seconds after inhaling the medication b. The client takes a quick inhalation while releasing the medication from the inhaler. c. The client exhales as the medication is released from the inhaler. d. The client waits 10 min between inhalations

a. The client holds his breath for 10 seconds after inhaling the medication The medication should be retained in the lungs for a minimum of 10 seconds so the maximum amount of the dosage can be delivered properly to the airways. To use the inhaler, the client exhales normally just prior to releasing the medication, inhales deeply as the medication is released, then holds the medication in the lungs for approximately 10 seconds prior to exhaling.

A nurse is caring for a client who has poison ivy and is prescribed diphenhydramine. Which of the following instructions should the nurse give regarding the adverse effect of dry mouth associated with diphenhydramine? Administer the medication with food." b. "Chew on sugarless gum or suck on hard, sour candies." "Place a humidifier at your bedside every evening." "Discontinue the medication and notify your provider."

b. "Chew on sugarless gum or suck on hard, sour candies." Rationale: Clients who report dry mouth can get the most effective relief by sucking on hard candies(especially the sour varieties that stimulate salivation), chewing gum, or rinsing the mouthfrequently. It is the local effect of these actions that provides comfort to the client.

A nurse is caring for a client who is taking naproxen following an exacerbation of rheumatoid arthritis. Which of the following statements by the client requires further discussion by the nurse? a. "I signed up for a swimming class." b. "I've been taking an antacid to help with indigestion." c. "I've lost 2 pounds since my appointment 2 weeks ago." d. "The naproxen is easier to take when I crush it and put it in applesauce."

b. "I've been taking an antacid to help with indigestion." NSAIDs, like naproxen, can cause serious adverse gastrointestinal reactions such as ulceration, bleeding, and perforation. Warning manifestations such as nausea or vomiting, gastrointestinal burning, and blood in the stool reported by the client require further investigation by the nurse.The client might be taking an antacid because he is experiencing one or more of these manifestations.

A nurse is caring for four clients. After administering morning medications, she realizes that the nifedipine prescribed for one client was inadvertently administered to another client. Which of the following actions should the nurse take first? a. Notify the client's provider. b. Check the client's vital signs. c. Fill out an occurrence form. d. Administer the medication to the correct client.

b. Check the client's vital signs. The first action the nurse should take using the nursing process is to assess the client. The nurse should know that the action of nifedipine is to lower blood pressure. Immediately upon realizing the error, the nurse should check the client's vital signs (especially the client's blood pressure) to ensure that the client is not hypotensive as a result. Only after ensuring that the client is safe and has stable vital signs should the nurse take other actions.

A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin? a. Hemoglobin (Hgb) b. Prothrombin time (PT) c. Bleeding time d. Activated partial thromboplastin time (aPTT)

b. Prothrombin time (PT) This test is used to monitor warfarin therapy. For a client receiving full anticoagulant therapy, the PT should typically be approximately two to three times the normal value, depending on the indication for therapeutic anticoagulation.

A nurse is caring for a client who has acute respiratory distress syndrome (ARDS), and requires mechanical ventilation. The client receives a prescription for pancuronium. The nurse recognizes that this medication is for which of the following purposes? a. Decrease chest wall compliance b. Suppress respiratory effort c. Induce sedation d. Decrease respiratory secretions

b. Suppress respiratory effort Rationale: Neuromuscular blocking agents, such as pancuronium, induce paralysis and suppress the client's respiratory efforts to the point of apnea, allowing the mechanical ventilator to take over the work of breathing for the client. This therapy is especially helpful for a client who has ARDSand poor lung compliance.

A nurse is providing teaching for a client who has anemia and a new prescription for ferrous sulfate liquid. Which of the following instructions should the nurse provide? a. Take the medication on an empty stomach to decrease gastrointestinal irritation. b. Take the medication with orange juice to enhance absorption. c. Take the medication with milk. d. Rinse the mouth before taking the iron

b. Take the medication with orange juice to enhance absorption. Ascorbic acid (vitamin C), which is found in orange juice, will enhance the absorption of iron and increase its bioavailability. This will also help to decrease the gastrointestinal side effects of iron.

A nurse at an ophthalmology clinic is providing teaching to a client who has open angle glaucoma and a new prescription for timolol eye drops. Which of the following instructions should the nurse provide? a. The medication is to be applied when the client is experiencing eye pain b. The medication will be used until the client's intraocular pressure returns to normal. c. The medication should be applied on a regular schedule for the rest of the client's life. d. The medication is to be used for approximately 10 days, followed by a gradual tapering off.

b. The medication will be used until the client's intraocular pressure returns to normal. Medications prescribed for open angle glaucoma are intended to enhance aqueous outflow, or decrease its production, or both. The client must continue the eye drops on an uninterrupted basis for life to maintain intraocular pressure at an acceptable level.

A nurse is caring for a client who has a new prescription for ferrous sulfate tablets twice daily for iron-deficiency anemia. The client asks the nurse why the provider instructed that she take the ferrous sulfate between meals.Which of the following responses should the nurse make? a. Taking the medication between meals will help you avoid becoming constipated." b. "Taking the medication with food increases the risk of esophagitis." c. "Taking the medication between meals will help you absorb the medication more efficiently." d. "The medication can cause nausea if taken with food."

c. "Taking the medication between meals will help you absorb the medication more efficiently." Rationale: Ferrous sulfate provides the iron needed by the body to produce red blood cells. Taking iron supplements between meals helps to increase the bioavailability of the iron.

A nurse on an oncology unit is preparing to administer doxorubicin to a client who has breast cancer. Prior to beginning the infusion, the nurse verifies the client's current cumulative lifetime dose of the medication. For which of the following reasons is this verification necessary? a. An excess amount of doxorubicin can lead to myelosuppression b. Exceeding the lifetime cumulative dose limit of doxorubicin might cause extravasation. c. An excess amount of doxorubicin can lead to cardiomyopathy d. Exceeding the lifetime cumulative dose limit of doxorubicin might produce red tinged urine and sweat.

c. An excess amount of doxorubicin can lead to cardiomyopathy Doxorubicin is an antineoplastic antibiotic used in the treatment of various cancers. Irreversible cardiomyopathy with congestive heart failure can result from repeated doses of doxorubicin, and prolonged use can also cause severe heart damage, even years after the client has stopped taking it. The maximum cumulative dose a client should receive is 550 mg/m2 or 450 mg/m2with a history of radiation to the mediastinum.

A nurse is providing teaching to a client who has emphysema and a new prescription for theophylline. Which of the following instructions should the nurse provide? a. Consume a high-protein diet. b. Administer the medication with food. c. Avoid caffeine while taking this medication. d. Increase fluids to 1L/per day.

c. Avoid caffeine while taking this medication. The nurse should instruct the client that caffeine should be avoided while taking theophylline, as it can increase central nervous system stimulation.

A nurse is caring for a client who has an infection and a prescription for gentamicin intermittent IV bolus every 8 hr.A peak and trough is required with the next dose. Which of the following actions should the nurse take to obtain an accurate gentamicin serum level? a. Draw a trough level at 0900 and a peak level at 2100. b. Draw a peak level 90 min prior to administering the medication and a trough level 90 min after the dose. c. Draw a trough level immediately prior to administering the medication and a peak level 30 min after the dose. d. Draw a peak level at 0900 and a trough level at 2100.

c. Draw a trough level immediately prior to administering the medication and a peak level 30 min after the dose. Rationale: Timing of the peak and trough is based on the pharmacokinetics of absorption and the half-life of the medication. The trough level is the lowest serum level after pharmacokinetic effects have taken place. For divided doses, correct timing for the trough is just before administering the next dose. The peak is the highest serum level of the medication; if this level is too low, thenthe medication will not be effective. Correct timing for the peak is between 30 and 60 min afterthe dose has finished infusing.

A nurse is caring for a client who has a bacterial infection and is receiving gentamicin. Which of the following actions should the nurse take to minimize the risk of an adverse effect of the medication? a. Limit the client's fluid intake. b. Instruct the client to report agitation. c. Monitor the serum medication levels. d. Administer the medicine with food..

c. Monitor the serum medication levels. Rationale: A disadvantage of gentamicin, an aminoglycoside, is the association with nephrotoxicity and ototoxicity, both of which are a result of elevated trough levels. Monitoring the serum medication levels is an important action to minimize the risk of an adverse effect of gentamicin.

A nurse is caring for a client who has heart failure and a prescription for digoxin. Which of the following statements by the client indicates an adverse effect of the medication? a. "I can walk a mile a day." b. "I've had a backache for several days." c. "I am urinating more frequently." d. "I feel nauseated and have no appetite."

d. "I feel nauseated and have no appetite." Rationale: Anorexia, nausea, vomiting, and abdominal discomfort are early signs of digoxin toxicity.

A nurse is caring for a client who has developed gout. Which of the following medications should the nurseprepare to administer? Zolpidem Alprazolam Spironolactone Correct! Allopurinol

d. Allopurinol Rationale: Allopurinol is a xanthene oxidase inhibitor that reduces uric acid synthesis. The medication isprescribed to treat gout.

A nurse is reviewing the medical record of a client who has been on levothyroxine for several months. Which of the following findings indicates a therapeutic response to the medication? Decrease in level of thyroxine (T4) Increase in weight Increase in hr of sleep per night Correct! Decrease in level of thyroid stimulating hormone (TSH).

d. Decrease in level of thyroid stimulating hormone (TSH). In hypothyroidism, the nonfunctioning thyroid gland is unable to respond to the TSH, and noendogenous thyroid hormones are released. This results in an elevation of the TSH level as theanterior pituitary continues to release the TSH to stimulate the thyroid gland. Administration ofexogenous thyroid hormones, such as levothyroxine, turns off this feedback loop, which resultsin a decreased level of TSH.