HESI Pharm
What are the clinical indicators that a nurse expects when an intravenous (IV) line has infiltrated?
Pallor, Edema, Decreased glow rate
A nurse is reviewing a plan of care for a client who was admitted with dehydration as a result of prolonged watery diarrhea. Which prescription should the nurse question?
Parenteral albumin (Albuminar)
A local anesthetic (pudendal block) is administered to a client as second-stage labor begins. For what side effect does the nurse monitor for the client?
Decreased blood pressure
What therapeutic effect does the nurse expect to identify when mannitol is administered parenterally to a client with cerebral edema?
Decreased intracranial pressure
A client with rheumatoid arthritis has been taking a steroid medication for the past year. For which complication of prolonged use of this medication should the nurse assess the client?
Decreased white blood cells
A pregnant client at 30 weeks' gestation begins to experience contractions every 5 to 7 minutes. She is admitted with a diagnosis of preterm labor. Although the client is being given tocolytic therapy her cervix continues to dilate, and it is determined that a preterm birth is inevitable. Which medication does the nurse expect the health care provider to prescribe?
Dexamethasone
Amlodipine (Norvasc) is prescribed for a client with hypertension. Which response to the medication should the nurse instruct the client to report to the health care provider?
Difficulty breathing
A nurse needs to administer fluid in a severely burned child of 2 years, but the peripheral vein is obscured. Which other route should the nurse use?
Intraosseous
A client is prescribed dinoprostone for the termination of a pregnancy. What is the route of administration of the drug?
Intravaginal route
A nurse concludes that a client has a hypoglycemic reaction to insulin. Which clinical findings support this conclusion?
Irritability, Heart palpitations
A client with psychosis is receiving olanzapine. What special information about this drug does the nurse recall?
It dissolves instantly after oral administration.
Which teratogenic effect is seen due to lithium?
Ebstein anomaly (cardiac defects)
A client with myasthenia gravis who is taking a cholinesterase inhibitor is admitted to the emergency department in crisis. Which medication does the nurse anticipate the provider to prescribe in order to differentiate between myasthenic crisis and cholinergic crisis?
Edrophonium chloride (Tensilon)
A family member of a client with a hemorrhagic stroke asks about anticoagulant therapy. The nurse explains what about anticoagulant therapy for the client?
It is contraindicated because it will increase bleeding
The nurse concludes that a client with glaucoma needs education when the client makes which statement?
It is dangerous for me to use sedatives
A 7-year-old child who is taking medication to prevent seizures has been seizure free for 2 years. The child's parents ask a nurse, "How much longer will my child need to take the medication?" What is the best response by the nurse?
It is important that the medications be gradually decreased."
A client in her 30th week of gestation is in preterm labor, and the practitioner prescribes betamethasone (Celestone). The client asks the nurse why she is being given this drug. As a basis for the response the nurse takes what into consideration?
It promotes neonatal pulmonary maturity
A client newly diagnosed with type 2 diabetes is receiving glyburide (Micronase) and asks the nurse how this drug works. How should the nurse respond?
It stimulates the pancreas to produce insulin
A woman who is Rh negative has a spontaneous abortion at the end of the second trimester, and the primary healthcare provider prescribes Rho(D) immune globulin. The client asks the nurse, "Why do I need this drug?" What should the nurse consider before answering the client's question?
It will prevent the woman from producing antibodies.
An agitated, acting-out, delusional patient is receiving large doses of haloperidol (Haldol), and the nurse is concerned because this drug can produce untoward side effects. Which clinical manifestations should alert the nurse to stop the drug immediately?
Jaundice, Tachycardia
A client is diagnosed with tuberculosis associated with human immunodeficiency virus (HIV) infection. What crucial laboratory test results should the nurse review before antitubercular pharmacotherapy is started?
LFTs
A client starting her second trimester asks a nurse in the prenatal clinic whether she can safely take an over-the-counter (OTC) medicine now that she is past the first 3 months of pregnancy. The nurse explains why she should consult with her health care provider before taking any oral medications. What physiological alteration associated with pregnancy may change the client's response to medication?
Longer gastrointestinal emptying time
What is an important nursing intervention when a client is receiving intravenous (IV) magnesium sulfate for preeclampsia?
Maintaining a quiet, darkened environment
A client with schizophrenia is started on an antipsychotic/neuroleptic medication. The nurse explains to a family member that this drug primarily is used to do what?
Make the client more receptive to psychotherapy
The postoperative prescriptions for a client who had repair of an inguinal hernia include docusate sodium (Colace) daily. Before discharge, what does the nurse teach the client that an intermittent side effect of this medication may be?
Mild abdominal cramping
A client with a history of type 1 diabetes is diagnosed with heart failure. Digoxin (Lanoxin) is prescribed. What should the nurse do when administering the medication?
Monitor the client for atrial fibrillation and first-degree heart block
A woman who is infertile is diagnosed with primary ovarian failure. Which fertility drug regimen may be prescribed to treat infertility?
Estrogens and progestins
A client with diabetes asks how exercise will affect insulin and dietary needs. How should the nurse respond?
Exercise increases the need for carbohydrates and decreases the need for insulin."
A 12-year-old child with cystic fibrosis is to receive four pancrelipase capsules five times a day. The nurse explains that the medication should be taken with meals and snacks to accomplish which goal?
Facilitate nutrient utilization
A nurse is reviewing the admission laboratory report of an infant with severe gastroenteritis. The serum potassium is 3 mEq/L. Potassium chloride 20 mEq/L is prescribed to be added to the infant's intravenous (IV) line. What should the nurse do next?
Find out when the infant last had a wet diaper
A client is receiving furosemide (Lasix). For which sign of hypokalemia should the nurse monitor the client?
Flabby muscles
Which medication should the nurse anticipate will be prescribed to relieve anxiety and apprehension in a client with pulmonary edema?
Morphine
A primary healthcare provider prescribes carbamazepine for a client. The nurse teaches the client about effects of the drug that should be reported to the primary healthcare provider. Which effects does the nurse include?
Nausea and vomiting, Unusual bleeding or bruising
A healthcare provider prescribes aspirin therapy for a client with arthritis, and the nurse provides teaching about the undesirable side effects of this medication. What responses should the client identify as reasons to notify the healthcare provider?
Nausea, Easy bruising, Ringing in the ears
A client with heart failure is receiving digoxin and hydrochlorothiazide. The nurse will assess for which signs and symptoms that indicate digoxin toxicity?
Nausea, Yellow Vision, Irregular Pulse
Which tocolytic agent can be used safely without combining with other agents to inhibit labor and maintain a pregnancy?
Nifedipine
The health care provider prescribes propylthiouracil (PTU) for a client with the diagnosis of Graves' disease. What should the nurse teach the client when discussing the self-administration of this medication?
Observe for signs of infection
A nurse teaches dietary guidelines to a client who will be receiving tranylcypromine sulfate (Parnate), a monoamine oxidase inhibitor (MAOI). The client compiles a list of foods to avoid. Which foods included on the list indicate that the teaching has been effective?
Pepperoni pizza, Bologna sandwich
A nurse is caring for an adolescent in labor an hour after she was admitted to the birthing unit. The adolescent is anxious and tense. She cries during contractions and asks the nurse for epidural anesthesia. The nurse obtains the adolescent's current vital signs and reviews her history and admission information. What nursing interventions are essential before epidural anesthesia is administered?
Performing a baseline vaginal examination, Telling the adolescent what to expect with each procedure, Identifying risk factors that contraindicate epidural anesthesia
A client with a large fetus is to have a pudendal block during the second stage of labor. What does the nurse plan to instruct the client about the effectiveness of the block?
Perineal pain will not be felt, The bearing-down reflex will be diminished
A client is receiving total parenteral nutrition. Which clinical finding will the nurse determine is the result of hyperglycemia due to the TPN?
Polyuria
What dietary choices should the nurse instruct the client taking spironolactone to avoid increasing?
Potatoes, Cantaloupe
A client with mild Alzheimer disease has been taking galantamine, and the primary healthcare provider prescribes paroxetine for depression. For what effect will a nurse assess the client when these medications are taken concurrently?
Additive
A client has acute tubulointerstitial renal disease and is experiencing fluid and electrolyte imbalances. The client is confused and complains of nausea and muscle weakness. What does the nurse anticipate will be prescribed to help correct the electrolyte imbalance associated with this diagnosis?
Administer a cation-exchange resin.
A client with severe preeclampsia is admitted to the high-risk unit, and the nurse preceptor starts an intravenous (IV) infusion of magnesium sulfate. What explanation does the preceptor give the student to explain how magnesium sulfate treats the client's condition?
"It blocks neuromuscular transmissions."
After receiving levothyroxine (Synthroid) for 3 months for congenital hypothyroidism an infant is brought to the pediatric clinic for a checkup. What statement by the infant's mother indicates that the drug is effective?
"My baby's stools are soft.
The parents of a school-aged child with cystic fibrosis tell the nurse that they have changed to natural pancreatic enzymes because of money issues. What is an appropriate response by the nurse?
"Natural enzymes are not as effective as the brand-name product."
A client with type 2 diabetes is taking one oral hypoglycemic tablet daily. The client asks whether an extra pill should be taken before exercise. What is the best response by the nurse?
"No, but you should observe for signs of hypoglycemia while exercising."
Which drug does a nurse anticipate may be prescribed to produce diuresis and inhibit formation of aqueous humor for a client with glaucoma?
AcetaZOLAMIDE (Diamox)
An adolescent with a major depressive disorder is prescribed venlafaxine (Effexor). What signs or symptoms related to the medication should the nurse communicate immediately to the prescribing provider?
Blurred vision, Suicidal ideation, Difficult urination
A postmenopausal woman has been administered raloxifene for osteoporosis. Which parameter should be assessed to ensure the efficacy of the drug and thus its continuation of use?
Bone density
A 1-year-old infant is in the pediatric unit for management of AIDS. One of the medications that has been prescribed for the child is zidovudine. What clinical finding indicates to the nurse that the infant is experiencing life-threatening zidovudine toxicity?
Bruises on the limbs and trunk
A client who had a tonic-clonic seizure of unknown etiology is to begin taking phenytoin (Dilantin). Which instruction should the nurse reinforce with the client?
Brush the teeth and gums three times daily
An estrogen-progestin oral contraceptive is prescribed for a client. Which adverse effects should the nurse teach the client to report to the health care provider?
Chest pain, Breast soreness, Calf tenderness
The nurse is monitoring a client who is having a third transfusion of packed red blood cells. Which of these may be evident if the client is experiencing a febrile transfusion reaction?
Chills, Hypotension, Tachycardia
Which conditions may result in the decreased effectiveness of estrogen therapy?
Habit of smoking, Use of anticoagulants
A nurse is caring for a client who is receiving IV magnesium sulfate for preeclampsia. At 37 weeks' gestation she gives birth to an infant weighing 4 lb. What clinical finding in the newborn may indicate magnesium sulfate toxicity?
Hypotonia
A client with rheumatoid arthritis is to begin taking ibuprofen 800 mg by mouth three times a day. The nurse provides education about the medication's side effects. The nurse concludes that the teaching was effective when the client makes which statement?
I need to have my blood work checked periodically.
A client with a history of alcoholism is found to have Wernicke encephalopathy associated with Korsakoff syndrome. What does the nurse anticipate will be prescribed?
Intramuscular injections of thiamine
Which of the following drugs used to treat cardiac dysrhythmias does not cause the potential side effect of fatigue?
Propafenone, Warfarin
A client with gastroesophageal reflux disease (GERD) receives a prescription for an H2 receptor antagonist. Which medications are within the classification of an H2 receptor antagonist?
Ranitidine, Famotadine, Nizatidine
A client is diagnosed with Parkinson disease and receives a prescription for levodopa therapy. The nurse concludes that the medication is appropriate for this client because it does what?
Restores the dopamine levels in the brain
Before the administration of Rho(D) immune globulin (RhoGAM) the nurse reviews the laboratory data of a pregnant client. Which blood type and Coombs test result must a pregnant woman have to receive RhoGAM after giving birth?
Rh-negative and Coombs negative
A client with stage III-B Hodgkin disease is started on chemotherapy. The nurse teaches the client to notify the health care provider to seek treatment for which response to chemotherapy?
Sores in mouth
A health care provider prescribes bisacodyl (Dulcolax) for a client with cardiac disease. The nurse explains to the client that this drug acts by doing what?
Stimulating peristalsis
A client is started on fluphenazine decanoate. What does the nurse emphasize when teaching the client about taking this medication?
Sunscreen should be used for outdoor activities
A client is discharged with a prescription for sustained-release nitroglycerin. What should the nurse teach the client about sustained-release nitroglycerin?
Swallow the capsule whole
A nurse is caring for a client who is addicted to opioids and who has undergone major surgery. The client is receiving methadone. What is the purpose of this medication?
Switches the user from illicit opioid use to use of a legal drug
A client says, "I take baking soda in water when I get heartburn." The nurse suggests an antacid containing aluminum and magnesium hydroxide instead of baking soda. What is the advantage these antacids have over baking soda?
There is no direct effect on the systemic acid-base balance when taken as directed.
A client with gastric ulcer disease asks the nurse why the health care provider has prescribed metronidazole. What purpose does the nurse provide?
To treat Helicobacter pylori infection
A client with schizophrenia is receiving intramuscular injections of fluphenazine decanoate. After therapy is initiated, dystonia develops. What clinical manifestations does the nurse document during the assessment?
Torticollis, Oculogyric crisis
A nurse concludes that the simvastatin (Zocor) being administered to a client is effective. A decrease in what clinical finding supports this conclusion?
Triglycerides
A nurse is caring for a client who is being given intravenous magnesium sulfate to treat preeclampsia. Which adverse side effect alerts the nurse to notify the health care provider?
Urine output of less than 100 mL in 4 hours
What complication should a nurse be alert for in a client receiving an oxytocin (Pitocin) infusion to induce labor?
Uterine tetany
A client who is taking an oral contraceptive calls the nurse with concerns about side effects of the medication. Which adverse effect of this medication should alert the nurse to inform the client to immediately stop the contraceptive and contact the health care provider?
Visual disturbances, Persistant headaches
A client is taking an antithyroid medication for hyperthyroidism. The nurse provides education about serious health problems that may develop if the medication is not effective and tachycardia continues. The nurse instructs the client to seek medical attention immediately if any of the problems occur. Which should be included in the teaching?
Weight gain, Pedal edema
A client is receiving furosemide (Lasix) to relieve edema. The nurse should monitor the client for which responses? Select all that apply.
Weight loss, Excessive loss of potassium ions
A client who has schizophrenia is receiving a phenothiazine antipsychotic medication. Which serious client responses to the medication will the nurse immediately report to the primary healthcare provider?
Yellow sclerae, Involuntary tongue movements
A client with schizophrenia is actively psychotic, and a new medication regimen is prescribed. A student nurse asks the nurse, "Which of the medications will be the most helpful against the psychotic signs and symptoms?" What response should the nurse give?
Ziprasidone (Geodon)
A client at 31 weeks' gestation is admitted in preterm labor. She asks the nurse whether there is any medication that can stop the contractions. What is the nurse's response?
"A beta-adrenergic."
A client develops a seizure disorder as a result of a traumatic fall. When the client returns to the clinic for a routine visit, the client states, "I have not had a seizure in two years. When can I stop taking my anti-seizure medications?" What is the nurse's best response?
"A gradual reduction in seizure medication may be considered."
Allopurinol (Zyloprim) is prescribed for a 6-year-old child undergoing chemotherapy regimen for cancer of the bone. When given the medication, the child asks, "Why do I have to take this pill?" What is the best response by the nurse?
"Because with the other medicines it helps you get rid of the things that are making you sick."
Sublingual nitroglycerin is prescribed for a client with a history of a myocardial infarction and atrial tachycardia. The nurse instructs the client about the prophylactic use of these tablets. What is the statement by the client that indicates the teaching was effective?
"I should take one tablet before attempting to climb two flights of stairs."
A nurse at a women's health clinic confirms that client teaching regarding the use of an oral contraceptive is understood when the client makes which statement?
"I will put a baby's picture on my bathroom mirror so I'll see it every morning
The nurse provides discharge medication education to a client who has been switched from a prescription for heparin to a prescription for warfarin sodium (Coumadin). The nurse concludes that the teaching was effective when the client states what?
"I will take acetaminophen (Tylenol) for my occasional headaches."
After 18 months of unsuccessful attempts at conception by a client, primary infertility related to anovulatory cycles is diagnosed. Clomiphene citrate (Clomid) is prescribed. The nurse concludes that the client understands the teaching about the correct time to take the clomiphene when the she makes which statement?
"I'll start the pills on the fifth day of my cycle."
A client who has been taking ibuprofen for rheumatoid arthritis asks the nurse if acetaminophen can be substituted instead. What is the appropriate nursing response?
"Ibuprofen has antiinflammatory properties and acetaminophen does not."
Famotidine (Pepcid) is prescribed for a client with peptic ulcer disease. The client asks the nurse what this medication does. How does the nurse respond?
"It inhibits gastric acid secretion."
The health care provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. What teaching will the nurse provide the client regarding this medication?
"This medication interferes with the synthesis of thyroid hormone."
A client with systemic lupus erythematosus (SLE) is at 39 weeks gestation. What does the nurse anticipate regarding this client?
A need to discontinue the client's salicylate therapy
The nurse knows that when a magnesium sulfate infusion is given to a client with preeclampsia, it can build to a toxic level. Which assessment finding should prompt the nurse to withhold the medication and notify the primary healthcare provider?
Absence of deep tendon reflexes
Which medications are associated commonly with upper gastrointestinal (GI) bleeding?
Aspirin, Ibuprofen, Methylpredisolone
A client receiving fluphenazine decanoate develops dystonia early during therapy. What medication does the nurse expect to be prescribed to reverse this side effect?
Benztropine
A pregnant client with severe preeclampsia is receiving IV magnesium sulfate. What should the nurse keep at the bedside to prepare for the possibility of magnesium sulfate toxicity?
Calcium gluconate
A woman who underwent infertility treatment is pregnant with twins. Which drug might have been responsible?
Clomiphene
Which drug should be used with caution when a client has a history of peptic ulcers and is diagnosed with hypersensitivity?
Dexamethasone
Several hours after administering insulin, the nurse is assessing a client for an adverse response to the insulin. Which client responses are indicative of a hypoglycemic reaction?
Diaphoresis, Tremors, Confusion
A practical nurse teaches a client with rheumatoid arthritis about precautions to be taken during the intake of methotrexate. Which statements made by the client indicates effective learning?
Drink lots of water, Avoid becoming pregnant
A health care provider has prescribed isoniazid (Laniazid) for a client. Which instruction should the nurse give the client about this medication?
Drinking alcohol daily can cause drug-induced hepatitis
A client is admitted to the hospital with a diagnosis of acute salmonellosis. What does the nurse expect the health care provider to prescribe?
Electrolytes
A client with a mental illness reports weakness and fatigue. During assessment, the primary health-care provider notes hoarseness, esophagitis, dental erosion, and palate lacerations. The nurse should plan on reinforcing instructions provided for which medication?
Fluoxetine
Sildenafil (Viagra) is prescribed for a man with erectile dysfunction. A nurse teaches the client about common side effects of this drug.
Flushing, Headache, Dyspepsia
A client is admitted to the psychiatric hospital with a diagnosis of obsessive-compulsive disorder. The client's anxiety level is approaching a panic level, and the client's ritual is interfering with work and daily living. Which selective serotonin reuptake inhibitor (SSRI) should the nurse anticipate that the health care provider may prescribe?
Fluvoxamine (Luvox)
A 3-year-old child is to receive a liquid iron preparation. What should the nurse teach the mother regarding this medication?
Have the child drink the diluted iron preparation through a straw.
A nurse is caring for a client recently diagnosed with type 1 diabetes. When assessing the client for an insulin reaction, what will the nurse look for?
Headache, Diaphoresis, Nervousness
A nurse is teaching a female client about using oral contraceptives and when to report complications. What clinical findings should alert the client to stop taking the contraceptive and notify the health care provider immediately?
Headaches, Visual Disturbances
A young adult client with schizophrenia is prescribed haloperidol. When the nurse administers the medication, the client asks, "What's this for?" The nurse responds that the medication has which effect?
Helps the client relax and think more clearly
A nurse is caring for a client who is scheduled for a bilateral adrenalectomy. Which medication should the nurse expect to be prescribed for this client on the day of surgery and in the immediate postoperative period?
Hydrocortisone succinate
An adolescent with type 1 diabetes who is admitted to the hospital with a blood glucose level of 700 mg/dL. A continuous insulin infusion is started. What complication should the nurse make a priority of detecting while the adolescent is receiving the infusion?
Hypokalemia
The nurse is caring for a client who is receiving therapy for vitamin B12 deficiency. Which finding indicates that the therapy is having the desired effect?
Improved hemoglobin and hematocrit levels
Steroid therapy is prescribed for a client with an exacerbation of ulcerative colitis. The nurse evaluates that teaching is effective when the client identifies which times for the medication schedule?
In the early morning with food
The nurse reinforces instructions about how to use a nebulizer to a client with chronic obstructive pulmonary disease (COPD). The nurse concludes that additional teaching is needed when the client does what?
Inhales with the lips tightly sealed around the mouthpiece of the nebulizer
Which insulin should the nurse prepare for the emergency treatment of ketoacidosis?
Insulin aspart (NovoLog)
A client is scheduled to begin chemotherapy two weeks after the client had surgery for colon cancer. The nurse explains to the client that the delay in instituting drug therapy is planned because the chemotherapy does what?
Interferes with cell growth and delays wound healing
A client in preterm labor is to receive a tocolytic medication, and bedrest is prescribed. Which position should the nurse suggest that the client maintain while on bedrest?
Lateral
A client with schizophrenia is prescribed antipsychotic medication. During the follow-up visit, the primary health-care provider (PHP) administers parenteral diphenhydramine to the client. Which symptom required the administration of parenteral diphenhydramine by the PHP?
Lip smacking and tongue protrusion
A health care provider prescribes furosemide (Lasix) for a client with hypervolemia. The nurse recalls that furosemide exerts its effects in what part of the renal system?
Loop of Henle
An infertile client is found to have a hormonal deficiency at the pituitary level. Which fertility drug may be prescribed to treat infertility?
Menotropin
A school-aged child with a seizure disorder has been taking carbamazepine (Tegretol) for 3 years. What nursing intervention is most important at this time?
Monitoring the child's complete blood cell counts
Which medication does the nurse anticipate will be prescribed to relieve anxiety and apprehension in a client with pulmonary edema?
Morphine
The alkylating agent cyclophosphamide (Cytoxan) is prescribed for a school-aged child with cancer. What is the most important sign or symptom for the nurse to be alert for while the child is receiving this medication?
Pain with urination
The health care provider prescribes donepezil (Aricept) 5 mg by mouth once a day for a client exhibiting initial signs of dementia of the Alzheimer type. The client is already taking digoxin (Lanoxin) 0.125 mg in the morning and alprazolam (Xanax) 0.5 mg twice a day. What should the nurse teach the client's spouse to do?
Prefill a weekly drug box with the medications for the spouse to self-administer
A woman is exposed to indomethacin during the third trimester of pregnancy. Which teratogenic effect of the medication is expected in the newborn?
Premature closure of the ductus arteriosus
A 5-month-old infant experiences severe diarrhea and is given intravenous (IV) fluids. What is the most important reason for the nurse to closely monitor the IV flow rate?
Prevention of cardiac overload
Immediately after a client has completed the third stage of labor, the nurse adds the prescribed 10 units of oxytocin to the intravenous line. What is the desired response to this medication?
Prevention of the occurrence of profuse bleeding after placental separation
A nurse is couseling a pregnant client with sickle cell anemia about the importance of taking supplemental folic acid. How does folic acid help this client?
Promotes production of hemoglobin
A nurse is caring for a client whose laboratory values indicate the presence of hyponatremia. For which risk factors should the nurse assess the client that most likely may have caused the hyponatremia?
Rapid IV infusion of 5% dextrose in water, Diaphoresis
A female client has severe cramping, pain, backache, and a migraine headache that presents with anxiety and mood swings. Which medication does the nurse think will be prescribed first to reduce the symptoms?
Sertraline
Which medication is effective in treating eating disorders?
Sertraline
A client with type 1 diabetes comes to the clinic because of concerns regarding erratic control of blood glucose with the prescribed insulin therapy. The client has been experiencing a sudden fall in the blood glucose level, followed by a sudden episode of hyperglycemia. Which complication of insulin therapy should the nurse conclude that the client is experiencing?
Somogyi effect
Ten minutes after the initiation of a blood transfusion, a client reports lumbar pain. What is the next nursing action?
Stop the transfusion
A client with a history of tuberculosis reports difficulty hearing. Which medication should the nurse consider is related to this response?
Streptomycin
A newborn who is receiving drug therapy for an infection has developed jaundice. The newborn has poor sucking and extreme sleepiness. Which drug may be responsible for the newborn's condition?
Sulfonamide
On reviewing the medical history, the nurse finds that the client is prescribed mycophenolate mofetil for late graft loss. Which other medications could also be co-administered?
Tacrolimus, Cyclosporine
A client has been taking levothyroxine (Synthroid) for hypothyroidism for three weeks. The nurse suspects that a decrease in dosage is needed when the client exhibits which clinical manifestations?
Tremors, Heat intolerance
A nurse administers trimethoprim-sulfamethoxazole (Bactrim) to a client diagnosed with a urinary tract infection. What should the nurse monitor to determine the therapeutic effectiveness of the drug?
WBC
Warfarin is prescribed for the client who takes phenytoin for a seizure disorder. Why must the nurse observe the client closely during the initial days of treatment with warfarin?
Warfarin affects the metabolism of phenytoin.
A client in labor is receiving an oxytocin (Pitocin) infusion. For which adverse reaction resulting from prolonged administration should the nurse monitor the client?
Water intoxication
A client with tuberculosis asks the nurse why vitamin B 6 is given with isoniazid. What explanation should the nurse provide?
"Isoniazid interferes with the synthesis of this vitamin."
On the psychiatric unit a client has been receiving high doses of haloperidol for 2 weeks. The client says, "I just can't sit still, and I feel jittery." Which side effect does the nurse suspect that the client is experiencing?
Akathisia
Which instructions should the nurse include in the teaching plan for a client with hyperlipidemia who is being discharged with a prescription for cholestyramine (Questran)?
"Increase your intake of fiber and fluid."
A client receives information about rifampin for tuberculosis. Which statements indicate that the client understands this information?
"This drug may be hard on my liver so I must avoid alcoholic drinks while taking it.", "This drug may reduce the effectiveness of the oral contraceptive I am taking.", "My health care provider must be called immediately if my eyes and skin become yellow."
A nurse is caring for a client who is scheduled to undergo radiation therapy as a palliative treatment for advanced-stage breast cancer. A family member asks the nurse, "What is the expected outcome of the therapy?" Which is the most appropriate response by the nurse?
"This therapy will reduce the pain caused by local recurrence and metastasis."
A nurse prepares to administer vitamin K to a newborn. What rationale explains why newborns are deficient in this vitamin?
A newborn's intestinal tract does not synthesize it for several days after birth.
A 30-year-old gravida 1 para 0 experienced a miscarriage at 10 weeks gestation. She is Rh negative. In light of this information, what does the nurse expect regarding Rho(D) immune globulin?
A prescription for one intramuscular microdose (50 mcg) of Rho(D) immune globulin
A client with a recent history of sinusitis develops meningitis and demonstrates a positive Brudzinski sign. What is the priority nursing care?
Administering prescribed antibiotics
A client with burns is to receive the exposure method of treatment with application of mafenide twice a day. With this type of treatment the nurse plans to do what?
Administer prescribed pain medication
A client with a long history of alcohol abuse develops acute pancreatitis. What should be done to best prevent stimulation of the pancreas?
Administer the histamine H2-receptor antagonist as prescribed.
A 7-year-old child contracts a urinary tract infection. A sulfonamide preparation is prescribed. What is the prioritynursing responsibility when the nurse is administering this drug?
Administering the drug at the prescribed times
Akathisia
An extrapyramidal side effect of typical antipsychotics, is motor restlessness. The client is unable to sit or stand still and feels the need to move, pace, rock, swing the legs, or tap the feet. The condition occurs within 5 to 90 days of the initiation of therapy.
Despite receiving 2900 mL intake for two days, the client's urine output has progressively diminished. The nurse identifies that the urinary output is less than 40 mL/hr over the past three hours. What action should the nurse take?
Assess breath sounds and obtain vital signs
A client is receiving morphine sulfate for severe metastatic bone pain. What should the nurse do to prevent complications from a common, serious side effect of morphine?
Assess for altered breathing patterns
A client in preterm labor is receiving subcutaneous terbutaline (Brethine) tocolytic therapy. Which nursing action is the most important during the initial administration of this medication?
Assessing the client's pulse rate continuously
The nurse finds that a child has inattention, hyperactivity, and impulsivity upon assessment. Which medication would be beneficial for the child?
Atomoxetine
A healthcare provider prescribes tolterodine for a client with an overactive bladder. What is most important for the nurse to teach the client to do?
Avoid activities requiring alertness until the response to medication is known.
A client reports fatigue and dyspnea and appears pale. The nurse questions the client about medications currently being taken. In light of the symptoms, which medication causes the nurse to be most concerned?
Methyldopa
A client with phosphate-based urinary calculi asks why aluminum hydroxide gel has been prescribed. The nurse explains that the medication decreases serum phosphorus by which action?
Binding with phosphorus in the intestine
When a client has gluteal edema, why should the nurse avoid using the gluteus maximus muscle for administration of intramuscular medications?
Blood supply is insufficient for adequate absorption
Upon assessment, the primary healthcare provider finds that the client is experiencing weight gain as well as elevated lipid and blood glucose levels. Which drugs in the client's prescription list are most likely to cause these metabolic side effects?
Clozapine, Olanzapine
A client who takes high-dose aspirin for arthritis has an acute episode of right ventricular heart failure. The healthcare provider prescribes furosemide and lowers the client's usual dosage of aspirin. The client asks the nurse the reason for the lower dose. On what principle does the nurse base a response?
Competition for renal excretion sites by the drugs causes increased serum levels of aspirin.
A client is diagnosed with myasthenia gravis, and the anticholinesterase medication pyridostigmine is prescribed. When teaching the client about this medication, the nurse explains that the desired effect is to increase what?
Contraction of skeletal muscles
While assessing a client with adrenal gland hypofunction receiving drug therapy, the nurse finds that the client has a round face, has experienced rapid weight gain, and has swelling in the body. Which medication change should the nurse expect the primary healthcare provider to make?
Dose adjustment of hydrocortisone
A nurse is administering hydroxyzine (Vistaril) to a client. For which common side effects of this drug should the nurse monitor the client?
Drowsiness and dry mouth
A client is scheduled for a 6-week electroconvulsive therapy (ECT) treatment program. What intervention is important during the course of treatment?
Elimination of benzodiazepines for nighttime sedation
The nurse is caring for a child with a very low platelet count related to chemotherapy. The nurse should monitor this child's urine for the presence of what?
Erythrocytes
Bupropion has a unique side effect not shared by most other drugs of its class. The nurse will assess the client for which unique possible side effect of this drug?
Generalized seizures
A client is admitted to the hospital with a diagnosis of an exacerbation of asthma. What should the nurse plan to do to best help this client?
Give prescribed drugs to promote bronchiolar dilation.
A client is started on tetracycline antibiotic therapy. What should the nurse do when administering this drug?
Give the medication an hour before milk products are ingested.
A 29-week-pregnant woman is found to have uterine contractions. Which medication does the primary healthcare provider prescribe?
Indomethacin
A nurse assesses a primigravida who has been in labor for 5 hours. The fetal heart rate tracing is reassuring. Contractions, which are of mild intensity, are lasting 30 seconds and are 3 to 5 minutes apart. An oxytocin infusion is prescribed. What is the priority nursing intervention at this time?
Infusing oxytocin by piggybacking into the primary line
The nurse prepares an intravenous solution of lactated Ringer solution to replace the T-tube output of a client who had a cholecystectomy and common bile duct exploration. Which condition will improve if the administration of lactated Ringer solution is effective?
Metabolic acidosis
A client with newly diagnosed hyperthyroidism is treated with propylthiouracil, an antithyroid drug, along with potassium iodide. What should the nurse take into consideration when caring for the client?
Monitoring for signs of infection or bleeding is necessary.
A client with schizophrenia who has type II (negative) symptoms is prescribed risperidone (Risperdal). Which outcomes indicate that the medication has minimized these symptoms? Select all that apply.
More interest is shown in unit activities, The client performs activities of daily living independently
A 5-year-old child is receiving dactinomycin (Cosmegen) and doxorubicin therapy after nephrectomy for Wilms tumor. What intervention should the nurse include when planning care?
Offering warm saline mouthwash
A woman has been administered prostaglandin E2 as a part of a treatment to induce labor. Which factor determines if an infusion with oxytocin should be continued?
One contraction every three minutes
What are the desired outcomes that the nurse expects when administering a nonsteroidal antiinflammatory drug (NSAID)?
Pain Reliefe, Antipyresis, Reduced Inflammation
The alkylating agent cyclophosphamide is prescribed for a school-aged child with cancer. What is the most important sign or symptom for the nurse to be alert for while the child is receiving this medication?
Pain with urination
A nurse is teaching a prenatal class about the types of pain blocks that provide perineal anesthesia during labor. Which type of pain block should the nurse include in the discussion that will provide perineal anesthesia but allow the client to feel contractions and push during the second stage of labor?
Pudendal
A client is diagnosed with acute lymphoid leukemia and is receiving chemotherapy. The nurse should monitor what thrombocytopenic side effects of chemotherapy?
Purpura, Hematuria, Melena
A hospitalized client is receiving pyridostigmine for control of myasthenia gravis. In the middle of the night, the nurse finds the client weak and barely able to move. Which additional clinical findings support the conclusion that these responses are related to pyridostigmine?
Respiratory depression, Decreased bp, High-pitched gurgling bowel sounds
A neuromuscular blocking agent is administered to a client before electroconvulsive therapy. At this time, what should the nurse monitor the client for?
Respiratory difficulties
A client diagnosed with Paget's disease is prescribed zoledronic acid. Which assessments should be performed before initiating therapy?
Serum Creatinine, Dental Exam
A nurse administers the prescribed regular insulin to a client in diabetic ketoacidosis. In addition, an intravenous (IV) solution with potassium is prescribed even though the serum potassium level is within normal limits. What does the nurse recognize as the reason for potassium administration?
Serum potassium levels will decrease as potassium ions shift from the extracellular fluid to the intracellular fluid compartment.
Olanzapine (Zyprexa) is prescribed for a client with bipolar disorder, manic episode. What cautionary advice should the nurse give the client?
Sit up slowly
A client's cells are deprived of oxygen during a cardiac arrest. What medication should the nurse be prepared to administer?
Sodium bicarbonate
Which medication requires the nurse to monitor the client for signs of hyperkalemia?
Spironolactone
A health care provider prescribes steroid therapy for a four-year-old child who has nephrotic syndrome. What goal of this treatment does the nurse explain to the child's parents?
Stimulates diuresis
Which cardiovascular adverse effect is associated with the use of clomiphene?
Tachycardia
Which topical immunomodulator is used to treat a client with atopic dermatitis?
Tacrolimus
A client with schizophrenia is taking benztropine in conjunction with an antipsychotic. The client tells a nurse, "Sometimes I forget to take the benztropine." What will the nurse teach the client to do if this happens again?
Take a dose as soon as possible, up to 2 hours before the next dose.
A healthcare provider prescribes lithium carbonate for a client with bipolar disorder, depressive episode. What instructions will the nurse include when teaching the client about lithium?
Take with food, It make take several weeks for benefits to occur, Do not restrict your dietary sodium
A client with depression is to be given fluoxetine (Prozac). What precaution should the nurse consider when initiating treatment with this drug?
The blood level may not be sufficient to cause noticeable improvement for 2 to 4 weeks.
In which clinical situation would cervical ripening drugs be prescribed to pregnant women?
The cervical status indicates a Bishop score of 6.
Permethrin 1% lotion (Nix) is prescribed for a 5-year-old child with pediculosis capitis (head lice). What instruction should the nurse include while teaching the parents about treating the head lice?
The child's hair must be combed with a fine-toothed comb to remove nits.
What intrauterine medication exposure may lead to the child being born with a cleft lip?
The mother was on nitrofurantoin therapy.
A client who had a myocardial infarction receives a prescription for a beta-blocker and a nitroglycerin patch. The nurse determines that the purpose of the nitroglycerin patch is to decrease what?
The preload of the heart, thereby reducing the cardiac workload.
A client diagnosed with gastroesophageal reflux disease (GERD) is being treated with antacid therapy. When teaching the client about the therapy, the nurse reinforces what about antacid tablets?
They are known to interfere with the absorption of other drugs.
What is the planned effect of naloxone when it is administered for a heroin overdose?
To compete with opioids for receptors that control respiration
A nurse is planning to administer a prescribed intravenous (IV) solution that contains potassium chloride. What assessment should be brought to the health care provider's attention before administration via the IV line?
Urinary output of 200 mL during the previous 8 hours
What potentially dangerous adverse effect of an intravenous titrated drip of lidocaine should the nurse immediately report to the healthcare provider?
Tremors
A child who has been undergoing prolonged steroid therapy takes on a cushingoid appearance. What will the nursing evaluation probably reveal?
Trunkal Obesity, Thin Extremeties
What is the most appropriate time for the nurse to administer an intravenous opioid analgesic to a client in active labor?
When a contraction starts
A nurse is caring for a primigravida during labor. At 7 cm of dilation a prescribed pain medication is administered. Which medication requires monitoring of the newborn for the side effect of respiratory depression?
Butorphanol
A client asks the nurse what she should do if she forgets to take her contraceptive pill one day. How should the nurse respond?
"On the next day take one pill in the morning and one before bedtime."
A client who is addicted to opioids undergoes emergency surgery. During the postoperative period the health care provider decreases the previously prescribed methadone dosage. For what clinical manifestations should the nurse monitor the client?
Agitation and attempts to escape from the hospital
Which nursing interventions would help to ensure the safe administration of antiepileptics to children?
Avoid carbonated beverages while taking valproic acid, Use a graduated device to deliver an oral dose, Encourage the wearing of a medical alert bracelet, Maintain a record of symptoms of seizures before, during, and after treatment with anti-epileptics
Loratadine 10 mg by mouth once a day in the morning is prescribed for a 15-year-old girl with seasonal allergies. The girl tells the school nurse that she is concerned that she will be sleepy for a quiz the next day. How should the nurse respond?
By explaining that this medication rarely causes drowsiness
A client with heart failure is digitalized (given a loading dose of digoxin) and placed on a maintenance dose of digoxin 0.25 mg by mouth daily. What responses does the nurse expect the client to exhibit when a therapeutic effect of digoxin is achieved?
Diuresis and decreased pulse rate
Imipramine, 75 mg three times per day, is prescribed for a client. What nursing action is appropriate when this medication is being administered?
Having the client checked for increased intraocular pressure and teaching about symptoms of glaucoma
What antidote to the side effects of terbutaline (Brethine) should a nurse have available?
Propranolol (Inderal)
A client begins fighting and biting other clients. The practitioner prescribes a stat injection of haloperidol (Haldol). How should the nurse implement this prescription?
Quickly, with an attitude of concern
A health care provider in the emergency department identifies that a client is in mild hypovolemic shock. Which type of drug should the nurse anticipate will be prescribed?
Sympathomimetic
A client has been taking prescribed risperidone (Risperdal) 3 mg twice a day for the past 8 days. A friend brings the client to the outpatient clinic. The client reports tremors, shortness of breath, a fever, and sweating. What should the nurse do?
Take the client's vital signs and arrange for immediate transfer to a hospital
A pregnant client states to the nurse, "I have been advised to take an over-the-counter medication for the flu. The drug label says it is a category B drug." How should the nurse respond to these statements?
This drug does not show risks to an animal fetus so you can safely take it while pregnant.
A nurse is caring for several clients who have severe psychiatric disorders. What is the major reason a health care provider prescribes an antipsychotic medication for these clients?
To reduce the positive symptoms of psychosis
A 63-year-old woman with the diagnosis of estrogen-receptor positive cancer of the breast undergoes lumpectomy and radiation therapy, and tamoxifen (Nolvadex) is prescribed. The client asks the nurse how long she will have to take the medication. How does the nurse respond?
You'll need to take it for 5 years, after which it will be discontinued
