DRUGS, PHARMACOLOGICAL Therapy, IV Therapy

The nurse is evaluating the client's learning about combination chemotherapy. Which statement by the client about reasons for using combination chemotherapy indicates the need for further explanation? a) "Combination chemotherapy is used to destroy cancer cells and treat side effects simultaneously." b) "Combination chemotherapy is used to decrease resistance." c) "Combination chemotherapy is used to interrupt cell growth cycle at different points." d) "Combination chemotherapy is used to minimize the toxicity from using high doses of a single agent."

*A - Combination chemotherapy is used to destroy cancer cells and treat side effects simultaneously.* Combination chemotherapy does not mean two groups of drugs, one to kill the cancer cells and one to treat the adverse effects of the chemotherapy. Combination chemotherapy means that multiple drugs are given to interrupt the cell growth cycle at different points, to decrease resistance to a chemotherapy agent, and to minimize the toxicity associated with use of a high dose of a single agent (i.e., by using multiple agents with different toxicities).

When caring for a client with diabetes insipidus, the nurse expects to administer: a) furosemide. b) 10% dextrose. c) vasopressin. d) regular insulin.

C - vasopressin Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.

The nurse should assess a client taking chlorpropamide for: a) Dumping syndrome. b) Extrapyramidal symptoms. c) Oral candidiasis. d) Hypoglycemia.

D - Hypoglycemia Chlorpropamide is an antidiabetic agent. Clients should be observed for signs and symptoms of hypoglycemia. Other common side effects include anorexia, nausea, vomiting, and heartburn. The drug does not cause dumping syndrome. Extrapyramidal symptoms are not caused by chlorpropamide, and it does not cause oral candidiasis. Ther. Class. antidiabetics Pharm. Class. sulfonylureas

A client is receiving total parenteral nutrition (TPN) solution. The nurse should assess a client's ability to metabolize the TPN solution adequately by monitoring the client for which sign? a) hyperglycemia b) elevated blood urea nitrogen concentration c) hypertension d) tachycardia

A - hyperglycemia During TPN administration, the client should be monitored regularly for hyperglycemia. The client may require small amounts of insulin to improve glucose metabolism. The client should also be observed for signs and symptoms of hypoglycemia, which may occur if the body overproduces insulin in response to a high glucose intake or if too much insulin is administered to help improve glucose metabolism. Tachycardia or hypertension is not indicative of the client's ability to metabolize the solution. An elevated blood urea nitrogen concentration is indicative of renal status and fluid balance.

Nursing responsibilities for the client with a patient-controlled analgesia (PCA) system include: a) instructing the client to continue pressing the system's button whenever pain occurs. b) reassuring the client that pain will be relieved. c) documenting the client's response to pain medication. d) titrating the client's pain medication until the client is free from pain.

C - documenting the client's response to pain medication. It is essential that the nurse document the client's response to pain medication on a routine, systematic basis. Reassuring the client that pain will be relieved is often not realistic. A client who continually presses the PCA button may not be getting adequate pain relief, but through careful assessment and documentation, the effectiveness of pain relief interventions can be evaluated and modified. Pain medication is not titrated until the client is free from pain but rather until an acceptable level of pain management is reached.

Which type of solution raises serum osmolarity and pulls fluid from the intracellular and intrastitial compartments into the intravascular compartment? a) Electrotonic b) Isotonic c) Hypotonic d) Hypertonic

D - Hypertonic The osmolarity of a hypertonic solution is higher than that of serum. A hypertonic solution draws fluid into the intravascular compartment from the intracellular and interstitial compartments. An isotonic solution's osmolarity is about equal to that of serum. It expands the intravascular and interstitial compartments. A hypotonic solution's osmolarity is lower than serum's. A hypotonic solution hydrates the intracellular and interstitial compartments by shifting fluid out of the intravascular compartment. Electrotonic solution is incorrect.

Choice Multiple question - Select all answer choices that apply. When assessing a child receiving tobramycin sulfate, which findings would indicate that the child is experiencing adverse effects? Select all that apply. a) decreased heart rate b) rash c) weight gain d) ringing in the ears e) increased blood pressure f) fever

b• rash d• ringing in the ears f• fever Common adverse effects of tobramycin include nephrotoxicity, ototoxicity, fever, and rash. Hypertension, weight gain, and decreased heart rate are not associated with this drug.

The nurse understands that assessment of blood pressure in clients receiving antipsychotic drugs is important. What is a reason for this assessment? a) It will indicate the need to institute antiparkinsonian drugs. b) Most antipsychotic drugs cause elevated blood pressure. c) Orthostatic hypotension is a common side effect. d) This provides additional support for the client.

c) Orthostatic hypotension is a common side effect. Orthostatic hypotension is common during the first few weeks of treatment with antipsychotic drugs. An elevated blood pressure usually results from MAOI antidepressants. Additional support should be through therapeutic communications. A problem with the blood pressure is not indicative of antiparkinsonian drugs.

The nurse observes a new parent give an oral medication to their 4-month-old infant. The parent instills the medication directly in the back of the infant's throat. Which of the following is the nurse's best action? a) Have the parent lay the infant flat, restraining the arms, while giving the medication b) Praise the parent's technique of giving the medication c) Demonstrate to the parent ways to prop the infant in a sitting position for medication administration d) Instruct the parent to instill a small amount of the medication inside the baby's cheek

*D - Instruct the parent to instill a small amount of the medication inside the baby's cheek* The parent's technique of instilling the medication in the back of the throat is not correct and could cause the infant to choke. The nurse should instruct the parents to instill a small amount at a time inside the infant's cheek. The parent should hold an infant in the bottle-feeding position when administering an oral medication by placing the child's inner arm behind the back, supporting the head in the crook of the elbow, and holding the child's free hand with the hand of the supporting arm. Propping a 4-month-old infant is not appropriate. The infant cannot sit unsupported even in a seated position. Administering medication to an infant lying flat could cause choking and aspiration.

A physician prescribes gentamicin for a client with peritonitis. The client has preexisting impaired vision and hearing. The nurse should: a) Question whether the drug is appropriate for treatment of peritonitis. b) Question the order because gentamicin could cause further visual impairment. c) Give the drug as ordered. d) Question the order because gentamicin could cause further hearing impairment

*D - Question the order because gentamicin could cause further hearing impairment* Aminoglycoside antibiotics can cause damage to the eighth cranial nerve and result in ototoxicity. If the client is already hearing impaired, the nurse should question the order with the physician. Another antibiotic may be able to be substituted that would be safer. Giving the drug as ordered would create an unsafe situation for the client. Gentamicin is an appropriate antibiotic for gram-negative infections such as peritonitis. Gentamicin does not cause visual impairment

In preparing for insertion of a peripheral I.V. catheter, the nurse must select an appropriate site. Which of the following areas should the nurse try first if an appropriate vein is found? a) Inner aspect of the forearm. b) Outer aspect of the forearm. c) Inner aspect of the elbow. d) Back of the hand.

*D - back of hand* When inserting an I.V. catheter needle, the nurse initially uses veins low on the hand or arm if available, unless contraindicated. Should the I.V. fluid infiltrate or the vein become irritated at this insertion site, veins higher on the arm are still available for use. After a vein higher up on the arm has been damaged, veins below it cannot be used.

The husband of a client who was diagnosed 6 years ago with Alzheimer's disease approaches the nurse and says, "I am so excited that my wife is starting to use donepezil for her illness." The nurse should tell the husband: a) effectiveness in the terminal phase of the illness is scientifically proven. b) the adverse effects of the drug are numerous. c) the medication is effective mostly in the early stages of the illness. d) the client will attain a functional level equal to that of 6 years ago.

*C - the medication is effective mostly in the early stages of the illness.* When compared with other similar medications, donepezil (Aricept) has fewer adverse effects. Donepezil is effective primarily in the early stages of the disease. The drug helps to slow the progression of the disease if started in the early stages. After the client has been diagnosed for 6 years, improvement to the level seen 6 years ago is highly unlikely. Data are not available to support the drug's effectiveness for clients in the terminal phase of the disease. Ther. Class. anti-Alzheimers's agents Pharm. Class. cholinergics (cholinesterase inhibitors)

Choice Multiple question - Select all answer choices that apply. A client has developed a hospital-acquired pneumonia. When preparing to administer cephalexin 500 mg, the nurse notices that the pharmacy sent cefazolin. What should the nurse do? Select all that apply. a) Verify the medication order as written by the by the health care provider. (HCP). b) Request that cephalexin be sent promptly. c) Return the cefazolin to the pharmacy. d) Administer the cefazolin. e) Contact the pharmacy and speak to a pharmacist.

- Verify the medication order as written by the by the health care provider. (HCP). -Request that cephalexin be sent promptly. -Return the cefazolin to the pharmacy. -Contact the pharmacy and speak to a pharmacist. One of the "five rights" of drug administration is "right medication." Cefazolin was not the medication prescribed. The pharmacist is the professional resource and serves as a check to ensure that clients receive the right medication. Returning unwanted medications to the pharmacy will decrease the opportunity for a medication error by the nurse who follows the current nurse

A client with schizophrenia who receives fluphenazine develops pseudoparkinsonism and akinesia. What drug should the nurse administer as ordered to minimize this client's extrapyramidal symptoms? a) Benztropine b) Dantrolene c) Clonazepam d) Diazepam

A - Benztropine Benztropine (Cogentin) is an anticholinergic administered to reduce extrapyramidal adverse effects in the client taking antipsychotic drugs. It works by restoring the equilibrium between the neurotransmitters acetylcholine and dopamine in the central nervous system (CNS). Dantrolene, a hydantoin that reduces the catabolic processes, is administered to alleviate the symptoms of neuroleptic malignant syndrome, a potentially fatal adverse effect of antipsychotic drugs. Clonazepam, a benzodiazepine that depresses the CNS, is administered to control seizure activity. Diazepam, a benzodiazepine, is administered to reduce anxiety.

The nurse is teaching a young woman about using oxcarbazepine to control seizures. The nurse determines teaching is effective when the client states: a) "I will use one of the barrier methods of contraception." b) "Since I am 28 years old, I should not delay starting a family." c) "I must weigh myself weekly to check for sudden gain in weight." d) "I will need a higher dose of oral contraceptive when on this drug."

A - I will use one of the barrier methods of contraception. An alternative or additional method of birth control must be used because oxcarbazepine reduces the effectiveness of oral contraceptives. Higher doses of oral contraceptives will not help in achieving this purpose, but the client needs an additional or alternative method of birth control. The client does not need advice about when to start a family. A side effect of oxcarbazepine may be weight gain, but it is typically gradual.

What is the main advantage of using a floor stock system? a) A nurse receives input from the pharmacist. b) A nurse can implement medication orders quickly. c) The system reinforces accurate calculations. d) The system minimizes transcription errors.

B - A nurse can implement medication orders quickly. A floor stock system enables a nurse to implement medication orders quickly. It doesn't allow for pharmacist input, nor does it minimize transcription errors or reinforce accurate calculations.

A client who has been taking flunisolide nasal spray, two inhalations a day, for treatment of asthma has painful, white patches in the mouth. What should the nurse tell the client? a) "This is an anticipated adverse effect of your medication. It should go away in a couple of weeks." b) "You have developed a fungal infection from your medication. It will need to be treated with an antifungal agent." c) "Be sure to brush your teeth and floss daily. Good oral hygiene will treat this problem." d) "You are using your inhaler too much and it has irritated your mouth."

B - You have developed a fungal infection from your medication. It will need to be treated with an antifungal agent. Use of oral inhalant corticosteroids such as flunisolide can lead to the development of oral thrush, a fungal infection. Once developed, thrush must be treated by antifungal therapy; it will not resolve on its own. Fungal infections can develop even without overuse of the corticosteroid inhaler. Although good oral hygiene can help prevent development of a fungal infection, it cannot be used alone to treat the problem.

The nurse is reviewing laboratory reports for a client who is taking allopurinol. Which finding indicates that the drug has had a therapeutic effect? a) increased serum calcium level b) decreased serum uric acid level c) decreased urine alkaline phosphatase level d) increased urine calcium excretion

B - decreased serum uric acid level By inhibiting uric acid synthesis, allopurinol decreases its excretion. The drug's effectiveness is assessed by evaluating for a decreased serum uric acid concentration. Allopurinol does not alter the level of alkaline phosphatase, nor does it affect urine calcium excretion or the serum calcium level Ther. Class. antigout agents antihyperuricemics Pharm. Class. xanthine oxidase inhibitors

A client takes prednisone, as ordered, for rheumatoid arthritis. During follow-up visits, the nurse should assess the client for common adverse reactions to this drug, such as: a) abdominal cramps and diarrhea. b) fluid retention and weight gain. c) anorexia and weight loss. d) tetany and tremors.

B - fluid retention and weight gain Common adverse reactions to prednisone and other steroids include sodium retention, fluid retention, and weight gain. Tetany and tremors are occasional adverse reactions to certain other drugs such as antipsychotics. Anorexia, abdominal cramps, and diarrhea are common adverse reactions to many drugs, but not to steroids.

A client is prescribed alfuzosin for benign prostatic hyperplasia (BPH). What should the nurse teach the client? a) A dry cough is an expected side effect. b) Rise slowly from a supine position. c) Restrict fluid intake while taking this medication. d) Contact the healthcare provider if pulse rate falls below 70/bpm.

B -Rise slowly from a supine position. First-dose phenomenon, which is a severe and sudden drop in blood pressure after the administration of the first dose of an alpha-adrenergic blocker, can cause clients to fall or pass out. All clients must be warned about this adverse effect before they take their first dose of an alpha blocker. Orthostatic hypotension can occur with any dose of an alpha blocker, and clients must be warned to get up slowly from a supine position. The client needs to consult with the healthcare provider if the heart rate falls below 60/bpm. There is no fluid restriction with this medication. A dry cough is a side effect of an ACE inhibitor.

A client has been taking dexamethasone for 2 weeks. The nurse evaluates a client's knowledge as deficient when the client says: a) "When I get a cold, I need to let my health care provider know." b) "If I forget a dose, it is no big deal; I will just take it when I remember it." c) "I need to watch for an allergic reaction when I first start taking this pill." d) "I cannot stop the dexamethasone all at one time."

b) "If I forget a dose, it is no big deal; I will just take it when I remember it." The statement, "If I forget a dose, it is no big deal, I will just take it when I remember it," indicates a knowledge deficit. The nurse should reinforce that the client should take dexamethasone as prescribed and at the same time each day. The drug has to be tapered off and cannot be stopped abruptly. The health care provider (HCP) should be notified when the client is under additional stress (e.g., infection, surgery, illness). The client can have an allergic reaction to inactive ingredients contained in dexamethasone.

A nurse is caring for a client receiving a dopamine receptor agonist for treatment of extrapyramidal symptoms caused by antipsychotic medications. What evaluation would indicate a therapeutic response to this drug? a) Client exhibits bradyphrenia during the nursing assessment. b) Client experiences a decrease in dystonia. c) Client exhibits akathisia only while sitting. d) Client exhibits a shuffling gait with stooped posture.

b) Client experiences a decrease in dystonia. Extrapyramidal effects and antipsychotic-induced muscle rigidity are caused by a low level of dopamine. Dopamine receptor agonists reduce extrapyramidal symptoms such as bradyphrenia or slowed thought processes, akathisia or meaningless movements such as marching in place, or dystonia or abnormal muscle rigidity or movements.

A nurse is caring for a client receiving warfarin therapy following a mechanical valve replacement. The nurse completed the client's prothrombin time and International Normalized Ratio (INR) at 7 a.m. (0700), before the morning meal. The client had an INR reading of 4. The nurse's first priority should be to: a) notify the next shift to hold the daily 5 p.m. dose of warfarin. b) give the client an I.M. vitamin K injection and notify the physician of the results. c) assess the client for bleeding around the gums or in the stool and notify the physician of the laboratory results and most recent administration of warfarin. d) call the physician to request an increase in the warfarin dose.

c) assess the client for bleeding around the gums or in the stool and notify the physician of the laboratory results and most recent administration of warfarin. For a client taking warfarin following a valve replacement, the INR should be between 2 and 3.5. The nurse should notify the physician of an elevated INR level and communicate assessment data regarding possible bleeding. The nurse shouldn't administer medication such as warfarin or vitamin K without a physician's order. The nurse should notify the physician before holding a medication scheduled to be administered during another shift.

A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand? a) 50% dextrose b) Hydrocortisone c) Glucagon d) Epinephrine

*C - Glucagon* During a hypoglycemic reaction, a layperson may administer glucagon, an antihypoglycemic agent, to raise the blood glucose level quickly in a client who can't ingest an oral carbohydrate. Epinephrine isn't a treatment for hypoglycemia. Although 50% dextrose is used to treat hypoglycemia, it must be administered I.V. by a skilled health care professional. Hydrocortisone takes a relatively long time to raise the blood glucose level and therefore isn't effective in reversing hypoglycemia.

A female client is treated for trichomoniasis with metronidazole. The nurse instructs the client that: a) The medication should not alter the color of the urine. b) Her partner does not need treatment. c) She should avoid alcohol during treatment and for 24 hours after completion of the drug. d) She should discontinue oral contraceptive use during this treatment.

*C - She should avoid alcohol during treatment and for 24 hours after completion of the drug* metronidazole (Flagyl) -anti-infectives -antiprotozoals -antiulcer agents Metronidazole can cause a disulfiram-like reaction if it is taken with alcohol. Tachycardia, nausea, vomiting, and other serious interaction effects can occur. Flagyl will make the urine a darker color. Oral contraceptives should never be discontinued with trichomoniasis. The partner also requires treatment to prevent retransmission of infection