HESI - Pharm & Parenteral

Nortriptyline is prescribed for a depressed client. When would the nurse expect a therapeutic response? - 30 minutes to 2 hours - 12 to 24 hours - 1 to 3 days - 2 to 3 weeks

- 2 to 3 weeks As with other tricyclics, optimal therapeutic effects take 2 to 3 weeks to occur. One to 3 days, 12 to 24 hours, and 30 minutes to 2 hours are all too soon to expect a response to nortriptyline.

The nurse is reviewing a newly admitted client's medication administration record (MAR). Which element, if missing, makes the record incomplete? - Height - Allergies - Vital signs - Body weight

- Allergies Allergies should be listed on all MARs to prevent the administration of medications to which the client is allergic. Height, weight, and vital signs are part of the initial health history/physical assessment data.

Which route would the nurse use to administer the chelating agent calcium disodium edetate (EDTA) to a toddler? - Transdermally - Orally with milk - Z-track injection - Intravenous infusion

- Intravenous infusion Calcium EDTA is administered parenterally intramuscularly, intravenously, and subcutaneously; however, the intravenous route permits the most efficient absorption. Chelating agents are not absorbed through the skin. The oral route is contraindicated for calcium EDTA because it results in unabsorbable iron complexes within the lumen of the gastrointestinal tract. The Z-track technique is not necessary if the intramuscular route is ordered by the provider.

A client is scheduled for a craniotomy to remove a brain tumor. To prevent the development of cerebral edema after surgery, the nurse anticipates the use of medications from which class? - Glucocorticoids - Anticholinergics - Anticonvulsants - Antihypertensives

- Glucocorticoids Glucocorticoids are used for their anti-inflammatory action, which decreases the development of cerebral edema. Anticholinergics are not used to prevent cerebral edema. Anticonvulsants prevent seizure activity, not cerebral edema. Antihypertensives control hypertension, not cerebral edema.

Which vitamin is essential for the synthesis of prothrombin by the liver? - B 12 - C - D - K

- K Prothrombin is synthesized in the liver in the presence of vitamin K; vitamin K initiates the vital process of coagulation. Vitamin B 12is needed for hemoglobin synthesis. Vitamin C plays a role in collagen formation. Vitamin D is involved in calcium absorption and metabolism.

A client takes acetaminophen routinely. The nurse will advise the client to avoid which substance? - Alcohol - Caffeine - Diphenhydramine - Ibuprofen

- Alcohol Acetaminophen and alcohol are both hepatotoxic substances. Metabolites of acetaminophen, along with alcohol, can cause irreversible liver damage. Caffeine stimulates the cardiovascular system, not the liver. In addition, caffeine does not interact with acetaminophen. Diphenhydramine may be taken with acetaminophen. Ibuprofen may be taken with acetaminophen.

Which parental statements would the nurse recognize as indicating the need for further education about iron supplements for their preschooler? Select all that apply. One, some, or all responses may be correct. - "We will mix the iron with milk to enhance absorption." - "We will mix the iron with black tea to enhance absorption." - "We will mix the iron with orange juice to enhance absorption." - "We will avoid giving our child green tea because it can decrease absorption." - "We will avoid feeding our child tomatoes because they can decrease absorption."

- "We will mix the iron with milk to enhance absorption." - "We will mix the iron with black tea to enhance absorption." The parental statements that indicate the need for further education include mixing the iron with milk and black tea to enhance absorption. Milk contains phosphorus and black tea contains tannins, both of which decrease the absorption of iron. Orange juice increases the acidity of the stomach, which enhances absorption. Green tea and tomatoes (an oxalate) are avoided because both will decrease the absorption of iron.

A client receiving fluphenazine decanoate develops dystonia early in therapy. Which medication would the nurse anticipate administering to reverse this side effect? - Nafarelin - Fluoxetine - Trandolapril - Benztropine

- Benztropine Dystonia is an extrapyramidal side effect (EPS) of fluphenazine decanoate. The anticholinergic benztropine is used to reverse the signs and symptoms (e.g., oculogyric crisis, torticollis, retrocollis) of dystonia. Nafarelin is a gonadotropin that stimulates the release of luteinizing hormone and follicle-stimulating hormone. Fluoxetine is a selective serotonin reuptake inhibitor antidepressant. Trandolapril is an angiotensin-converting enzyme inhibitor antihypertensive.

Thirty minutes after administering fluphenazine to a client, the nurse notes that the client's jaw is rigid, the client is drooling, and the client's speech is slurred. There are a number of as-needed prescriptions in the client's chart. Which medication will the nurse administer? - Diazepam, 10 mg by mouth - Trihexyphenidyl, 1 mg by mouth - Haloperidol, 2 mg intramuscularly (IM) - Benztropine, 2 mg IM

- Benztropine, 2 mg IM Benztropine is an anticholinergic, antiparkinsonian medication used to treat medication-induced extrapyramidal symptomsassociated with phenothiazine therapy; the IM route will relieve symptoms more rapidly. Haloperidol is also an antipsychotic and may produce parkinsonism, not relieve it. Diazepam is not effective in reducing extrapyramidal side effects. Although trihexyphenidyl is an appropriate medication, swallowing pills may be difficult for the client; the oral medication should not be administered.

A client arrives for an influenza vaccination and reports a low-grade fever with a cough. Which action would the nurse take next? - Administer aspirin with the vaccine. - Check the temperature and current history. - Hold the vaccine and notify the health care provider. - Reschedule administration of the vaccine for the next month.

- Check the temperature and current history. Vaccines may be administered during a mild febrile illness and upper respiratory infection, so the nurse would assess further. Administering aspirin is a dependent function of the nurse and requires a health care provider's prescription. Although holding the vaccine and administering it after the fever and cough are resolved is appropriate, notifying the health care provider is not necessary. Vaccinations should not be delayed unless the illness is moderate to severe.

A client has been prescribed chlorpromazine for the management of positive symptoms of schizophrenia. Which response would the nurse provide when the client reports difficulty sustaining an erection? - Reassuring the client that this side effect will resolve in a few weeks - Consulting with the health care provider regarding alternative medication therapies - Explaining that all conventional antipsychotic medications cause impotence - Providing additional medication education to explain the medication's side effects in detail

- Consulting with the health care provider regarding alternative medication therapies Although erectile dysfunction can result from conventional antipsychotic medication therapy, the provider is often able to prescribe an alternative medication that will help manage the symptoms but is less likely to cause the dysfunction. Education regarding side effects is certainly appropriate, but such information will only confirm that the side effect is not likely to subside with time.

While reviewing the laboratory reports on a client with bipolar disorder, the nurse finds the client's lithium levels are 1.2 mEq/L (1.2 mmol/L). Which nursing intervention would be most appropriate in this client? - Continuing to administer the medication - Administering phenothiazine antipsychotics along with lithium - Notifying the primary health care provider of the lithium levels - Withdrawing the medication by consulting the primary health care provider

- Continuing to administer the medication The normal range of lithium is 0.6-1.2 mEq/L (0.6-1.2 mmol/L). Because the serum lithium level is 1.2 mEq/L (1.2 mmol/L), the nurse would continue administering the medication. Administration of phenothiazine antipsychotics should be avoided because they may cause anticholinergic effects when used with lithium. The primary health care provider does not need to be consulted, and the medication should not be withdrawn.

A client with obsessive-compulsive disorder has an anxiety level that is approaching a panic level, and the client's ritual is interfering with work and daily living. For which selective serotonin reuptake inhibitor (SSRI) would the nurse anticipate preparing a teaching plan? - Haloperidol - Fluvoxamine - Imipramine - Benztropine

- Fluvoxamine Fluvoxamine inhibits central nervous system neuron uptake of serotonin but not norepinephrine. Haloperidol is not an SSRI; it is an antipsychotic that blocks neurotransmission produced by dopamine at synapses. Imipramine is a tricyclic antidepressant, not an SSRI. Benztropine is an antiparkinsonian agent, not an SSRI.

A child is prescribed tetracycline. The nurse understands which possible medication-related reaction is associated with this medication? - Kernicterus - Gray syndrome - Reye syndrome - Staining of teeth

- Staining of teeth Tetracycline causes staining or discoloration of developing teeth in children. Sulfonamides may cause kernicterus in neonates. Chloramphenicol may cause Gray syndrome in infants. Aspirin may cause Reye syndrome in pediatric clients with a history of chickenpox or influenza.

Which side effects are related to oral psoralen in phototherapy? Select all that apply. One, some, or all responses may be correct. - Atrophy - Sunburn - Mucositis - Ocular damage - Persistent pruritus

- Sunburn - Persistent pruritus Oral psoralen is one form of phototherapy used in the treatment of many dermatological conditions. Sunburn and persistent pruritus are side effects of oral psoralen. Atrophy, mucositis, and ocular damage are the adverse reactions of radiation therapy.

Which medication is a teratogen that may cause masculinization of a female fetus? - Lithium - Danazol - Nitrofurantoin - Carbamazepine

- Danazol Danazol is a teratogen that may cause masculinization of a female fetus. Lithium may cause cardiac defects. Nitrofurantoin may cause cleft lips with cleft palates. Carbamazepine may cause neural tube defects.

Tetanus immune globulin is prescribed after a client steps on a rusty nail. Which action would the nurse associate with this medication? - Provides antibodies - Stimulates plasma cells - Produces active immunity - Facilitates long-lasting immunity

- Provides antibodies Tetanus immune globulin provides antibodies, which confer immediate passive immunity. It does not stimulate production of plasma cells, the precursors of antibodies. Passive, not active, immunity occurs. Passive immunity, by definition, is not long lasting.

The nurse is educating a client who is taking clozapine to treat schizophrenia. Which adverse effect of clozapine would the nurse emphasize as being important to report to the health care provider? - A high risk for falls - Inability to sit still - Temperature rise - Tardive dyskinesia

- Temperature rise The nurse would emphasize to the client that it is important to report a rise in body temperature (fever) to the health care provider because clozapine can cause agranulocytosis (diminished immunity), which can promote infection. The inability to sit still (akathisia), tardive dyskinesia (involuntary repetitive body movements), and a higher risk for falls are more common with typical antipsychotics because of extrapyramidal side effects.

The nurse understands which antihypertensive medication is contraindicated in lactating women? - Atenolol - Labetalol - Metoprolol - Propranolol

- Atenolol Atenolol is contraindicated in lactating woman because it enters the breast milk and may cause adverse effects to the neonate. Labetalol and propranolol are safe to administer during lactation. Metoprolol is considered a safe medication to be taken during lactation.

Which nursing assessment is important in determining the causative factors in a client with a history of spontaneous abortions? - Use of sex hormones - Use of contraceptive pills - Presence of heart problems - History of alcohol consumption

- History of alcohol consumption Alcohol consumption during pregnancy may cause fetal abnormalities and increase the risk of spontaneous abortions. The presence of heart problems may not cause spontaneous abortions. The use of sex hormones in pregnancy may cause fetal abnormalities. Contraceptive pills may inhibit the ovulation process, but they rarely affect the embryo.

Which antihistamine is considered safe for a woman who plans to breast-feed? - Sertraline - Loratadine - Clemastine - Bromocriptine

- Loratadine Loratadine does not get excreted in the breast milk. It is a safe medication for a lactating mother to take. Sertraline is an antidepressant that is safe for lactating women. Clemastine and bromocriptine are contraindicated in lactating women.

The medication prescribed for an infant is to be given intramuscularly. Which site will the nurse select for administration of the medication? - Vastus lateralis - Ventrogluteal - Dorsogluteal - Deltoid

- Vastus lateralis Intramuscular injections are given in the vastus lateralis muscle of the thigh in infants. The ventrogluteal site is not used until children have been walking. The dorsogluteal site is considered high risk for damage to the sciatic nerve or a major blood vessel. The deltoid site in the arm has a small muscle mass that limits the amount of medication that can be injected.

A client diagnosed with type 1 diabetes states, "I hate shots. Why can't I take the insulin in tablet form?" Which is the nurse's best response? - "Your diabetic condition is too serious for oral insulin." - "Insulin is poorly absorbed orally, so it is not available in a tablet." - "Insulin by mouth causes a high incidence of allergic and adverse reactions." - "Once your diabetes is controlled, your primary health care provider might consider oral insulin."

- "Insulin is poorly absorbed orally, so it is not available in a tablet." The chemical structure of insulin is altered by gastric secretions, rendering it ineffective. There is no such thing as oral insulin; this comment about the seriousness of the diabetic condition may increase anxiety. There are no data to support the statement regarding allergic or adverse reactions, and insulin is given parenterally, not orally. Insulin is not absorbed but is destroyed by gastric secretions; there is no insulin that is effective if taken by mouth.

For which therapeutic effect will the nurse monitor the client who is prescribed alprazolam? - Pain relief - Decreased anxiety - Reduction in dysrhythmias - Reduced blood pressure

- Decreased anxiety Alprazolam, an anxiolytic, promotes muscle relaxation, reduces anxiety, and facilitates rest. Possible adverse reactions to alprazolam are anger and hostility. Although drowsiness is a side effect of alprazolam caused by depression of central nervous system activity, it is not a hypnotic. Transient hypotension is a side effect of alprazolam, but this is not why it is given to an anxious client.

A client with severe diarrhea is prescribed intravenous fluids, sodium bicarbonate, and an antidiarrheal medication. Which antidiarrheal medication would the nurse anticipate administering? - Psyllium - Bisacodyl - Loperamide - Docusate sodium

- Loperamide Loperamide inhibits peristalsis and prolongs transit time by its effect on the nerves in the muscle wall of the intestines. Bisacodyl is a laxative, not an antidiarrheal; it increases gastrointestinal motility. Psyllium is not an antidiarrheal; it is a bulk laxative that promotes easier expulsion of feces. Docusate sodium corrects constipation, not diarrhea; water and fat are increased in the intestine, permitting easier expulsion of feces.

A client is to take an antipsychotic medication twice a day. Two-thirds of the daily dose is given in the evening and one-third in the morning. Which reason would the nurse give the client as the rationale for this schedule? - To facilitate dreaming - To maintain the daily sleep rhythm - To reduce sedation during the daytime - To decrease assaultiveness in the evening

- To reduce sedation during the daytime Antipsychotic medications tend to make the client listless or drowsy and can interfere with the client's ability to participate in the therapeutic regimen. Antipsychotic medications do not induce rapid eye movement sleep, which is when most dreams occur. Antipsychotic medications do not appreciably affect diurnal rhythms. Assaultiveness is associated with increased anxiety and is unrelated to the time of day.

Carbidopa-levodopa is prescribed for a client with Parkinson's disease. The nurse monitors the client for which side effects of the medication? Select all that apply. One, some, or all responses may be correct. - Vomiting - Involuntary movements - Slow heart rate - Changes in mood - Peripheral edema

- Vomiting - Involuntary movements - Changes in mood Nausea and vomiting may occur, which reflect a central emetic reaction to levodopa. About 80% of clients develop involuntary movements. Changes in affect, mood, and behavior are related to toxic effects of the medication. Tachycardia and palpitations, not bradycardia, occur. Peripheral edema is not a side effect of carbidopa-levodopa.

An adolescent with leukemia is receiving vincristine. The mother reports that the child is complaining of feeling "tingles" all over. Which response by the nurse is mostappropriate regarding the effect of this medication? - "It is a neurological side effect." - "It is caused by an autoimmune reaction." - "The skin becomes sensitive with chemotherapy." - "The central nervous system has become hyperactive."

- "It is a neurological side effect." Neurotoxicity is an anticipated side effect of vincristine sulfate. Some children report it as "tingles" or feeling "funny all over." It is not usually permanent. Vincristine causes leukopenia, which increases susceptibility to infection; it does not cause an autoimmune reaction. Skin sensitivity is not the reason that the child feels tingly. Hyperactivity of the central nervous system is not a factor in the development of this neurological finding.

A client with tuberculosis receives instructions regarding isoniazid (INH) therapy from the assigned nurse. Which client statement indicates a misunderstanding of the content? - "I should take a multivitamin supplement daily." - "I should take the medication 1 hour before eating." - "I should apply sunscreen and wear sun-protective clothing while going outside." - "I should be concerned regarding a potential pregnancy while taking this therapy."

- "I should apply sunscreen and wear sun-protective clothing while going outside." Applying sunscreen needs to be followed up because this is a misconception and needs to be corrected. INH is a first-line medication used in the treatment of tuberculosis. This medication is not a photosensitive medication. All the rest of the statements are accurate. Pregnant women, or women expecting to become pregnant while taking this regimen, are not candidates for participation in this type of therapy. Clients taking INH may have low levels of vitamin B complex; therefore the client should take a daily supplement to prevent peripheral neuropathy. The client should take the medication 1 hour before meals because the presence of food may prevent the absorption of the medication from the gastrointestinal tract.

Which hormone may cause vaginal carcinoma in a female child after birth? - Estrogen - Progesterone - Androgens - Diethylstilbestrol

- Diethylstilbestrol Diethylstilbestrol has a teratogenic effect that may cause vaginal carcinoma in a female child after birth. Progesterone and androgens may cause masculinization of a female fetus. Estrogen may cause congenital defects in the female reproductive system.

A client takes an antipsychotic medication. When assessing the client for signs and symptoms of pseudoparkinsonism, the nurse will be alert for which complication? - Drooling - Blurred vision - Muscle tremors - Photosensitivity

- Muscle tremors Drug-induced pseudoparkinsonism presents with the classic triad of adaptations associated with Parkinson disease: rigidity, slowed movement (bradykinesia), and tremors. The anticholinergic effects of antipsychotic medication cause dry mouth, not drooling. Neither dry mouth nor drooling is related to pseudoparkinsonism. Blurred vision and photosensitivity are side effects of anticholinergic, not antipsychotic, medications.

Which intervention would the nurse implement for a client prescribed haloperidol for schizophrenia? Select all that apply. One, some, or all responses may be correct. - Using the gluteal site only - Administering the medication every 3 months - Shaking the medication vigorously before administering - Using the Z-track method for all irritation medications - When initiating, giving the first two injections using the deltoid site - Monitoring the client for excess sedation for 3 hours postinjection

- Using the Z-track method for all irritation medications Using the Z-track method for all irritation medications decreases injection discomfort by keeping the irritant below the surface of the skin where pain receptors are located. The gluteal or deltoid site may be used with haloperidol. Haloperidol is given every 4 weeks. Olanzapine and paliperidone are shaken vigorously before injection. When initiating paliperidone, the first two injections must be given deltoid. Clients taking olanzapine must be monitored for excess sedation for 3 hours postinjection.

Tissue plasminogen activator (t-PA) is to be administered to a client in the emergency department. Before beginning the infusion, which assessment is the nurse's priority? - Vital signs - Electrocardiogram (ECG) monitoring - Signs of bleeding - Level of chest pain

- Signs of bleeding Assessment for bleeding is a priority because it is a contraindication for administration of thrombolytic agents; administration in the presence of bleeding can cause life-threatening hemorrhage. All the other options are important, but none pose a life-threatening contraindication to tissue plasminogen activator (t-PA) administration.

A client with depression was prescribed fluoxetine and reports restlessness, confusion, an elevated body temperature, and poor concentration. Which intervention would the nurse anticipate preparing for in the treatment of these signs and symptoms? - Withdrawing the medication - Administering isocarboxazid - Reducing the dose of the medication - Informing the client that these are expected side effects

- Withdrawing the medication Restlessness, confusion, poor concentration, and fever are symptoms of serotonin syndrome. The only treatment for serotonin syndrome is discontinuation of the medication. Isocarboxazid is a monoamine oxidase inhibitor that should not be used in a client with serotonin syndrome because it may lead to life-threatening conditions. Reducing the medication dosage may not reverse the symptoms completely. Informing the client that these are expected adverse effects is important, but the medication should be discontinued immediately.

The nurse is reviewing discharge instructions with the parent of an infant with cystic fibrosis. Which statement indicates the parents know how to administer the pancreatic enzyme replacement? - "We should give the medication with feedings." - "We should put crushed enteric-coated pills in the formula." - "We need to give the medication every 6 hours, even during the night." - "We should feed the granules from the capsule in applesauce every morning."

- "We should give the medication with feedings." Pancreatic enzyme replacement is given just before or with every meal to aid digestion. Breaking up and dissolving the medication will hasten its degradation by gastric secretions and interfere with its efficiency. The medication must be given just before or with every meal, not every 6 hours or every morning, to aid digestion.

A client is receiving metoprolol. Which potential effect will the nurse teach the client to expect? - Dizziness with strenuous activity - Acceleration of the heart rate after eating a heavy meal - Flushing sensations after taking the medication - Pounding of the heart

- Dizziness with strenuous activity Because metoprolol competes with catecholamines at beta-adrenergic receptor sites, the expected increase in the heart's rate and contractility in response to exercise does not occur. This, combined with the medication's hypotensive effect, may lead to dizziness. Metoprolol decreases the heart rate. Flushing sensations and pounding of the heart do not represent side effects of metoprolol.

The nurse is caring for a client in labor whose cervix is dilated 6 cm. The client is receiving epidural analgesia. Which common response to regional anesthesia would the nurse anticipate? - Urticaria - Light-headedness - Elevated temperature - Sensation of chilliness

- Light-headedness Light-headedness may indicate hypotension, resulting from the vasodilation commonly associated with epidural analgesia. Urticaria is associated with an allergic response; this is not a common reaction to regional anesthesia. An increase in temperature may be a response to a developing infection or dehydration; these are rare adverse occurrences with regional anesthesia. Feeling chilled is an allergic response, which is not a common reaction to regional anesthesia.

In which week of gestation would the nurse anticipate administering Rho(D) immune globulin to an Rh-negative client? - 12 weeks - 28 weeks - 36 weeks - 40 weeks

- 28 weeks Rho(D) immune globulin (RhoGAM) administered during the 28th week of gestation reduces an active antibody response in an Rh-negative individual exposed to Rh-positive blood. It is difficult to determine whether Rh sensitization has occurred at 12 weeks in pregnancy. RhoGAM is given earlier than 36 weeks in the pregnancy; it is a preventive measure, not a treatment for a woman who is already sensitized. Forty weeks is around the time of birth; if the client has not been sensitized, she will receive RhoGAM within 72 hours of birth.

The parents of a child with juvenile idiopathic arthritis ask the nurse why their child is not receiving steroid therapy when it is so effective for adults with rheumatoid arthritis. Which response by the nurse is most appropriate? - "Steroids could affect growth." - "Body image is adversely affected." - "Steroids could lead to flat emotions." - "Steroids have adverse effects on sexuality."

- "Steroids could affect growth." Preadolescence is a critical period of growth, and steroids could lead to growth retardation. Impaired body image is a result of many variables, not just medications. The most important and most physiologically detrimental reason that steroids are avoided is these medications' effects on growth. Although mood changes have been documented, this is not the reason that steroids are avoided during preadolescence. The effect of steroids on sexuality is unclear.

A breast-feeding mother asks the nurse if the use of herbal medicines will increase breast milk supply. Which nursing response is most appropriate? - "It may be safe if taken with lots of water." - "It does not effectively increase breast milk supply." - "It may cause iron deficiency anemia in the infant." - "You should speak to your health care provider about this."

- "You should speak to your health care provider about this." The use of herbs may increase breast milk supply, but research is limited, so the mother should consult with her health care provider. The herbs are safe for the mother with or without water. However, the priority in this case is to inform the parent of the adverse effects that can result in the infant. Early introduction of solids may increase the risk for iron deficiency anemia in the infant. The herbs increase breast milk supply.

Which is the maximum volume of an intramuscular injection recommended for a preschool-aged child? - 0.5 mL - 1.0 mL - 1.5 mL - 2.0 mL

- 1.0 mL The maximum recommended intramuscular dose in preschoolers should not exceed 1 mL; 0.5 mL is the maximum volume in newborns and infants. School-aged and older children may tolerate 2.0 mL if they have sufficient muscle mass. A volume of 1.5 mL exceeds the maximum intramuscular injection volume in a preschooler.

For the client receiving total parenteral nutrition (TPN), which action will the nurse take to prevent a major complication? - Flush the line if extravasation occurs. - Administer the infusion over 12 to 24 hours. - Change the site every 24 hours. - Discontinue the infusion immediately if elevation of hepatic enzymes occurs.

- Administer the infusion over 12 to 24 hours. TPN should be infused at a slow, constant rate; this will prevent both hyperglycemia and cellular dehydration from too rapid infusion of a hypertonic solution. The intravenous (IV) line should not be flushed if extravasation occurs. Generally, a major vein is selected for administration of TPN; the site is not changed every 24 hours. Abruptly discontinuing the infusion can lead to rebound hypoglycemia; elevation of hepatic enzymes is an anticipated adverse effect in 1% to 2% of clients.

The nurse recognizes which statements are true regarding the pharmacokinetic changes observed in infants? Select all that apply. One, some, or all responses may be correct. - An infant's fat content is higher. - An infant's gastric pH is less acidic. - An infant's gastric emptying is slow. - An infant's first-pass metabolism is slow. - An infant's transdermal absorption is rapid.

- An infant's gastric pH is less acidic. - An infant's gastric emptying is slow. - An infant's first-pass metabolism is slow. Pharmacokinetic changes are observed in infants. An infant's gastric pH is less acidic because the acid-producing cells in the stomach are immature. Gastric emptying is slow due to irregular peristalsis. First-pass metabolism in the liver is slow because the liver is immature and has low levels of microsomal enzymes. An infant's fat content is low because of the high levels of total body water. Transdermal absorption is not affected by age.

Shortly after birth the nurse instills erythromycin ophthalmic ointment in the newborn's eyes. The father asks why an antibiotic is needed. The nurse explains it is routinely administered to prevent which type of infection? - Gonorrhea - Toxoplasmosis - Rubella - Cytomegalovirus

- Gonorrhea The antibiotic ointment is administered prophylactically to prevent the development of ophthalmia neonatorum, which may be contracted during a vaginal birth to a mother with gonorrhea, chlamydia, or both infections. Cytomegalovirus, toxoplasmosis, and rubella are contracted by the fetus in utero during various stages of pregnancy, not during birth. Erythromycin ophthalmic ointment would be an ineffective treatment for these conditions.

Propylthiouracil and potassium iodide are prescribed for the client with hyperthyroidism. Which statement would the nurse include in the client's plan of care? - Administer propylthiouracil and potassium iodide on an empty stomach. - Assess the client for signs of infection and bleeding every shift. - Stop the medications 2 weeks before thyroid surgery. - Discontinue the medications if the heart rate is maintained within the expected range for 48 hours.

- Assess the client for signs of infection and bleeding every shift. Propylthiouracil can cause depression of leukocytes and platelets. This creates an increased bleeding risk. Propylthiouracil and potassium iodide should be given with milk, juice, or food to prevent gastric irritation. Medication therapy decreases the risk of postoperative hemorrhage because this medication regimen decreases the size and vascularity of the thyroid gland. Medication therapy is continued for at least 6 to 8 weeks, even if the client's temperature and pulse return to the expected range.

The nurse is caring for a child receiving furosemide for pulmonary edema. Which nursing intervention(s) would the nurse implement? Select all that apply. One, some, or all responses may be correct. - Checking the child's weight every day - Administering the medication on an empty stomach - Calculating the dose of medication as carefully as possible - Exposing the child to sunlight for increasing periods - Assessing the child regularly to help prevent electrolyte loss

- Checking the child's weight every day - Calculating the dose of medication as carefully as possible - Assessing the child regularly to help prevent electrolyte loss The child's weight should be checked and recorded daily to aid in the assessment of therapeutic and adverse effects. Pediatric doses should be calculated carefully to prevent an accidental overdose. Pediatric clients are at greater risk of electrolyte loss; therefore they require closer and more cautious assessment to help prevent hypertension and stroke. Furosemide may cause stomach upset if it is taken on an empty stomach; the child should be given the medication with food to help prevent gastric upset. A child taking diuretics should not be exposed to sunlight for long periods, because this action may precipitate fluid volume loss and heatstroke.

A client visited the primary health care provider complaining of inflammatory lesions on the face and is diagnosed with an inflammatory disorder of the sebaceous glands. Which medications would the nurse anticipate being prescribed for this client? Select all that apply. One, some, or all responses may be correct. - Bacitracin - Mupirocin - Clindamycin - Erythromycin - Metronidazole

- Clindamycin - Erythromycin Clindamycin and erythromycin are topical antibiotics used in the treatment of acne vulgaris, which occurs due to inflammation of the sebaceous glands. Bacitracin is an over-the-counter topical antibiotic used in the treatment of dermatological problems. Mupirocin is used in the treatment of superficial Staphylococcusinfections such as impetigo. Topical metronidazole is used in the treatment of rosacea and bacterial vaginosis.

A client with osteoarthritis (OA) reports experiencing painful back muscle spasms. Which medication would the nurse administer? - Tramadol - Hyaluronate - Diclofenac epolamine patch - Cyclobenzaprine hydrochloride

- Cyclobenzaprine hydrochloride Cyclobenzaprine hydrochloride is a muscle relaxant administered to relieve painful muscle spasms, especially those resulting from OA of the vertebral column. Although tramadol is a weak opioid medication used to relieve pain in clients with OA, it is not as effective against painful muscle spasms. Hyaluronate is a specific injection for knee and hip pain associated with OA. Clients use the diclofenac epolamine patch to treat signs and symptoms of knee OA.

Which manifestation is an extrapyramidal side effect of chlorpromazine? Select all that apply. One, some, or all responses may be correct. - Drooling - Facial tics - Shuffling gait - Tongue rolling - Restless movements

- Drooling - Facial tics - Shuffling gait - Tongue rolling - Restless movements Extrapyramidal symptoms (EPS) are adverse effects of antipsychotic medications and include drooling, facial tics, shuffling gait, tongue rolling, and restless movements. Parkinsonism symptoms include drooling and a shuffling gait. Tardive dyskinesia can manifest with facial tics and tongue rolling. Akathisia is characterized by restless movements.

A client is prescribed oral disopyramide to manage a ventricular dysrhythmia. Which side effects will the nurse include when teaching the client about this medication? Select all that apply. One, some, or all responses may be correct. - Dry mouth - Rhinorrhea - Constipation - Hyperglycemia - Stress incontinence

- Dry mouth - Constipation Dry mouth occurs because of its anticholinergic properties. Constipation is a side effect of this nonnitrate antidysrhythmic because of its anticholinergic properties. A thin, watery discharge from nose (rhinorrhea) does not occur with this medication because of its anticholinergic properties. Hypoglycemia, not hyperglycemia, may occur. Urinary hesitancy and retention, rather than stress incontinence, occur.

A client with a diagnosis of schizophrenia is discharged from the hospital. At home, the client forgets to take medication, becomes unable to function, and must be rehospitalized. Which medication can prevent this problem when administered on an outpatient basis every 2 to 3 weeks? - Lithium - Diazepam - Fluvoxamine - Fluphenazine

- Fluphenazine Fluphenazine can be given intramuscularly every 2 to 3 weeks to clients who are unreliable about taking oral medications; it allows them to live in the community while keeping the disorder under control. Lithium is a mood-stabilizing medication that is given to clients with bipolar disorder. This medication is not given for schizophrenia. Diazepam is an antianxiety/anticonvulsant/skeletal muscle relaxant that is not given for schizophrenia. Fluvoxamine is a selective serotonin reuptake inhibitor; it is administered for depression, not schizophrenia.

For which medication would the nurse monitor the serum creatinine and blood urea nitrogen (BUN) levels, when administered to a client receiving therapy for extensive burn wounds? - Nitrofurantoin - Mafenide acetate - Silver sulfadiazine - Gentamicin sulfate

- Gentamicin sulfate Gentamicin sulfate may cause nephrotoxicity in the client; therefore the nurse would monitor the client prescribed this medication for serum creatinine and BUN changes. The nurse monitors the client on nitrofurantoin for signs of allergic reactions. Mafenide acetate requires monitoring of blood gases and serum electrolyte levels. In clients who are on silver sulfadiazine, the nurse monitors the wounds for infections.

The nurse is caring for a 60-year-old client diagnosed with dementia. The nurse understands that which antipsychotic medications would be contraindicated for the client? Select all that apply. One, some, or all responses may be correct. - Quetiapine - Haloperidol - Aripiprazole - Risperidone - Chlorpromazine

- Haloperidol - Chlorpromazine First-generation antipsychotic medications such as haloperidol and chlorpromazine are contraindicated because they may increase the risk of mortality when used to treat dementia-related psychosis in older adults. Quetiapine, aripiprazole, and risperidone are second-generation antipsychotic medications that are not contraindicated in older adults suffering from dementia-related psychosis.

A client with a partial occlusion of the left common carotid artery is to be discharged while still receiving warfarin. Which adverse effect will the nurse identify as a reason for the client to seek medical consultation? Select all that apply. One, some, or all responses may be correct. - Hematuria - Hemoptysis - Delayed clotting from minor cuts and scrapes - Bleeding from gums when brushing teeth - Vomiting coffee-ground emesis

- Hematuria - Hemoptysis - Vomiting coffee-ground emesis Warfarin causes an increase in the prothrombin time and International Normalized Ratio (INR) level, leading to an increased risk for bleeding. Any abnormal or prolonged bleeding must be reported, because it may indicate an excessive level of the medication. Common side effects including bruising, delayed clotting and bleeding gums do not require immediate intervention. However, hematuria and hemoptysis are evidence of more serious bleeding and require immediate attention. Coffee-ground emesis is a sign of gastric bleeding.

In which category of fluids would the nurse classify an intravenous solution of 0.45% sodium chloride? - Isotonic - Isomeric - Hypotonic - Hypertonic

- Hypotonic Hypotonic solutions are less concentrated (contain less than 0.85 g of sodium chloride in each 100 mL) than body fluids. Isotonic solutions are those that cause no change in the cellular volume or pressure because their concentration is equivalent to that of body fluid. This relates to two compounds that possess the same molecular formula but that differ in their properties or in the position of atoms in the molecules (isomers). Hypertonic solutions contain more than 0.85 g of solute in each 100 mL.

A blood transfusion is prescribed for a child with acute lymphocytic leukemia (ALL). Which intervention will the nurse implement during the administration of the blood product? - Infuse the blood over no more than 4 hours. -Take the vital signs 3 hours after the transfusion. - Check the vital signs 15 minutes after starting the transfusion. - Have the blood warm at room temperature for 1 hour before administration.

- Infuse the blood over no more than 4 hours. Blood should be administered within 4 hours; the risk for bacterial proliferation increases over time and exposure to room temperature. Taking the vital signs 3 hours after the transfusion is too long to wait; the vital signs should be checked every 5 minutes during the absorption of the first 50 mL of blood and then routinely thereafter (every 15 minutes to 1 hour, depending on hospital policy). Vital signs must be checked every 5 minutes during the administration of the first 50 mL of blood to detect a transfusion reaction. Blood should be used within 30 minutes after its arrival from the blood bank; the risk for bacterial proliferation increases over time and exposure to room temperature.

A child is administered a rotavirus vaccine. Which adverse medication effect would the nurse monitor for? - Intussusception - Encephalopathy - Thrombocytopenia - Guillain-Barré syndrome

- Intussusception In rare cases, rotavirus vaccine causes intussusception, a life-threatening form of bowel obstruction that occurs due to the bowel folding in on itself. The DTaP vaccine causes encephalopathy in rare cases. MMR vaccines induce thrombocytopenia in a few vaccinated clients. Meningococcal conjugate vaccines cause Guillain-Barré syndrome in some children.

To which of these four assigned clients with a mouth infection would the nurse anticipate administering nystatin as an oral suspension? - Trench mouth - Moniliasis - Cold sores - Parotitis

- Moniliasis Moniliasis is a fungal infection caused by Candida albicans. Nystatin is an antifungal medication used to treat fungal infections. Nystatin is the medication used to treat clients with moniliasis. A topical application of antibacterial and mouth irrigations with chlorhexidine treats those clients with trench mouth. Antiviral medications treat clients with cold sores. Adequate fluid intake and antibacterial medications treat clients with parotitis.

The nurse recalls that the blockage of dopamine by antipsychotic medications can cause extrapyramidal side effects such as akathisia. Which client behaviors reflect the presence of akathisia? - Acute muscle spasms and torticollis - Bizarre facial and tongue movements - Motor restlessness, foot tapping, and pacing - Tremor, shuffling gait, drooling, and rigidity

- Motor restlessness, foot tapping, and pacing Motor restlessness, foot tapping, and pacing are signs of akathisia, which is an involuntary movement disorder characterized by an inability to sit still. Muscle spasms and pulling of the head to the side by the neck muscles (torticollis) are related to acute dystonia. Bizarre facial and tongue movements are associated with tardive dyskinesia. A tremor, shuffling gait, drooling, and rigidity are signs of pseudoparkinsonism.

When the client taking haloperidol has a sudden change in health status, the nurse reviews the client's medical record and performs a physical assessment. Which medical emergency would the nurse conclude that the client is experiencing? Chart/Exhibit 1 CLIENT CHART Vital signs Temperature (oral): 105 °F (40.6 °C) Pulse: 128 beats/min Respirations: 26 breaths/min Blood pressure: unstable Physical assessment Diaphoresis Severe muscle rigidity Decreasing level of consciousness Laboratory tests Metabolic acidosis Increased creatine phosphokinase (CPK) - Oculogyric crisis - Serotonin syndrome - Haloperidol toxicity - Neuroleptic malignant syndrome

- Neuroleptic malignant syndrome The data presented are indicative of neuroleptic malignant syndrome, a rare and life-threatening complication of antipsychotic medications such as haloperidol. The medication should be discontinued and supportive care provided. An oculogyric crisis is an extrapyramidal side effect of neuroleptic (not antipsychotic) medications in which there is uncontrolled rolling back of the eyes. This should be treated quickly with an antiparkinsonian agent. Although many of the adaptations presented are associated with serotonin syndrome, the client is not taking a selective serotonin reuptake inhibitor antidepressant or other medications that increase the serotonin level. Haloperidol toxicity is manifested as an increase in the intensity of medication side effects; hyperpyrexia and diaphoresis are not associated with toxicity.

The nurse is teaching a nursing student about tricyclic antidepressant medications. Which statement made by the student indicates the need for further teaching? Select all that apply. One, some, or all responses may be correct. - Nortriptyline is contraindicated in older adult clients. - Desipramine is preferred for use in older adult clients. - Imipramine is used as an adjunct in the treatment of childhood enuresis. - Tricyclic antidepressant medications are prescribed for clients with seizure disorders. - Tricyclic antidepressant medications are contraindicated in clients with a history of seizures.

- Nortriptyline is contraindicated in older adult clients. - Tricyclic antidepressant medications are prescribed for clients with seizure disorders. Nortriptyline is a preferred tricyclic antidepressant that can be administered safely in older adult clients. Antiepileptic medications are prescribed to clients with seizures. Desipramine and nortriptyline are preferred tricyclic antidepressants for use in older adult clients. Childhood enuresis necessitates the administration of imipramine. Clients with epilepsy should not be prescribed tricyclic antidepressants to avoid the risk of medical complications.

Which medication is available in an injectable form? - Pitocin - Meclizine - Misoprostol - Dinoprostone

- Pitocin Pitocin is available in an injectable form. Meclizine and misoprostol are available as oral medications. Dinoprostone is available as a topical gel for self-administration in the vagina.

The nurse evaluates a client's knowledge about protease inhibitors. Which client statement about protease inhibitors is true? - Protease inhibitors prevent viral replication and release of viral particles. - Protease inhibitors prevent the interaction between viral material and the CD4 + T cell. - Protease inhibitors prevent viral and host genetic material integration. - Protease inhibitors prevent the clipping of the viral strands into small functional pieces.

- Protease inhibitors prevent viral replication and release of viral particles. Protease inhibitors act by preventing viral replication and release of viral particles. Nucleoside reverse transcriptase inhibitors (NRTIs) inhibit the transformation of viral single-stranded ribonucleic acid into host double-stranded deoxyribonucleic acid (DNA) by the action of the enzyme reverse transcriptase. Entry inhibitor medications prevent the binding of the virus to the CD4 receptors. Integrase inhibitor medications prevent the integration of viral material into the host's DNA by the action of the enzyme integrase.

Which advice will the nurse give the client to avoid lipodystrophy when self-administering insulin therapy? - Exercise regularly. - Rotate injection sites. - Use the Z-track technique. - Vigorously massage the injection site.

- Rotate injection sites. Fibrous scar tissue can result from the trauma of repeated injections at the same site. Exercise reduces blood glucose but is unrelated to lipodystrophy. Insulin is given subcutaneously; the Z-track technique is used with some intramuscular injections. Gentle pressure applied over the injection site after insulin administration promotes absorption; it should not be vigorously massaged.

A client who takes four 325-mg tablets of buffered aspirin four times a day for severe arthritis complains of dizziness and ringing in the ears. Which complication would the nurse conclude that the client probably is experiencing? - Salicylate toxicity - Allergic reaction - Withdrawal symptoms - Aspirin tolerance

- Salicylate toxicity Aspirin is a salicylate; excessive aspirin ingestion can influence the vestibulocochlear nerve (cranial nerve VIII), causing tinnitus and dizziness. The client is experiencing symptoms of toxicity, not an allergic response. Withdrawal symptoms occur when a medication is no longer being administered. Tolerance describes a condition in which additional medication is needed to achieve an effect; it is not associated with the development of new symptoms.

A client is admitted to the hospital for an adrenalectomy. When teaching the client about the prescribed medications, which advice will the nurse emphasize? - Medication therapy will be given in conjunction with insulin. - Once regulated, the dosage will remain the same for life. - Medications will need to be held for surgery or other invasive procedures. - Salt intake may have to be restricted.

- Salt intake may have to be restricted. Administration of adrenocortical hormones causes sodium retention; dietary intake of salt should be limited. Because pancreatic function is unimpaired, insulin therapy is not indicated. Dosages will likely need to be adjusted over time. The dosage will need to be increased for surgery and severe infections; not doing this can cause a life-threatening crisis.

Which is the nurse's responsibility when a client's labor is being stimulated with an oxytocin? - Checking the fetal heart rate every 2 hours - Flushing the intravenous (IV) tubing if the flow slows - Stopping the infusion if contractions become hypertonic - Decreasing the infusion rate if hypertonic contractions continue for 15 minutes

- Stopping the infusion if contractions become hypertonic Hypertonic contractions of the uterus, if allowed to continue, can lead to nonreassuring fetal signs and uterine rupture; therefore the infusion should be discontinued to stop the hypertonic contractions. The fetal heart rate should be assessed and documented more frequently (continuously or every 15 min) when oxytocin is infusing The IV should be monitored with an automatic pump to ensure a regulated and continuous flow. A delay of 15 minutes can lead to uterine rupture.

A child who has attention-deficit/hyperactivity disorder (ADHD) is prescribed methylphenidate hydrochloride. Which behavior indicates the child needs further treatment? - The child follows instructions given by teachers on a regular basis. - The child remains attentive during long classes while seated at a desk. - The child experiences difficulty keeping school assignments organized. - When instructed to wait, the child sits in one place without complaint.

- The child experiences difficulty keeping school assignments organized. A child with ADHD will have difficulty organizing belongings and tasks. The child who has difficulty organizing school assignments even after treatment with methylphenidate hydrochloride will require further treatment. After successful treatment of ADHD, the child will be able to remain attentive for prolonged periods of time. Successful treatment with methylphenidate hydrochloride makes the child more attentive to instructions. The child with ADHD is hyperactive, so he or she does not stay quiet. If the child is obedient and stays quiet, the treatment has been effective.

A client presents with extensive lesions caused by psoriasis. Which intervention would the nurse anticipate providing teaching on? - Advising sunscreen and special clothing - Topical application of steroids - Potassium permanganate baths - Débridement of necrotic plaques

- Topical application of steroids Steroids are applied locally, and the lesions usually are covered with plastic wrap at night to reverse the inflammatory process. Solar rays may be used for treatment, but other forms of ultraviolet light are preferred. Potassium permanganate is an antiseptic astringent used on infected, draining, or vesicular lesions. The plaques are not necrotic and do not require débriding.

A laboring client receiving epidural anesthesia has a sudden episode of severe nausea, and her skin becomes pale and clammy. Which would be the nurse's immediate action? - Turning the client on her side - Checking the vaginal area for bleeding - Notifying the primary health care provider - Checking the fetal heart rate every 3 minutes

- Turning the client on her side Maternal hypotension is a common complication of epidural anesthesia during labor, and nausea is one of the first clues that it has occurred. Turning the client on her side will keep the uterus from putting pressure on the inferior vena cava, which causes a decrease in blood flow. Checking the vaginal area for bleeding is not an assessment specific to epidural anesthesia; it is part of the general nursing care during labor. If signs and symptoms do not abate after the client is turned on her side, the primary health care provider should be notified. Fetal heart rate monitoring is a continuous process, and the rate should be recorded every 15 minutes; if this monitoring is not being performed, the rate should be checked and recorded every 15 minutes.

Which instructions regarding the use of fluticasone nasal spray are appropriate for client teaching? Select all that apply. One, some, or all responses may be correct. - Use the medication on a regular basis, not PRN. - Clear the nasal passages before using the medication. - Discontinue use of the medication if nasal infection develops. - Remember that driving may be dangerous because of the medication's sedative effect. - Begin taking the medication 2 weeks before pollen season starts, and use it throughout the season.

- Use the medication on a regular basis, not PRN. - Clear the nasal passages before using the medication. - Discontinue use of the medication if nasal infection develops. Fluticasone is a corticosteroid prescribed as a nasal spray in cases of sinusitis and rhinitis. The nurse would instruct the client to use the medication on a regular basis, not as needed, to clear the nasal passages before using the medication, and to discontinue use of the medication if nasal infection develops. Warning the client that driving may be dangerous because of the sedative effect would be beneficial for a client prescribed an antihistamine such as brompheniramine. The nurse should tell a client prescribed a mast cell stabilizer such as cromolyn spray to begin the medication 2 weeks before pollen season starts and to use it throughout the pollen season.