NURS 505 (7, 17, 30, 49)

A client has a low white blood cell count and is concerned about acquiring an infection. The client will not sign the informed consent due to a knowledge deficit about the CSF. How should the nurse respond?

"Chemotherapy kills cancer cells as well as good cells needed to prevent and control infection. The cells are called white blood cells that grow in stages but are not effective until the cell is in the adult stage. A colony-stimulating drug acts on these cells to stimulate growth to the mature adult white blood cell stage, so that the cells can go to work to help protect you from infection."

A nurse is providing teaching to a client prescribed midodrine for orthostatic hypotension. Which nursing instruction is very important that the client understands? A)"Midodrine is taken to lower your blood pressure, so you may feel a little light-headed after taking it." B) "Only take midodrine when standing. Taking it while lying down can cause very high blood pressure." C) "Only take midodrine when you have eaten first. It can cause ulcers if taken on an empty stomach." D) "Midodrine is taken for your glaucoma and should be put in your eyes upon waking in the morning."

B) "Only take midodrine when stanind. Taking it while lying down can cause very high blood pressure"

Which would the nurse encourage a client to consume to prevent folic acid anemia? (Select all that apply.) a) Fruits b) Fish c) Broccoli d) Milk e) Liver

C) Broccoli D) milk e) liver Folic acid is found in green leafy vegetables such as broccoli, milk, liver, and eggs. Fruits and fish are not good sources of folic acid.

Adrengeric agonist produce what effects

Decreased bladder tone and broncodilation

Cyanocobalamin is a vitamin B12 in a nasal formulation. True or False

True Vitamin B12 includes hydroxocobalamin (generic), an injectable drug, and cyanocobalamin (Nascobal), a nasal spray.

A nursing instructor is teaching students about the myelin sheath of the central nervous system (CNS). The nurse knows that teaching has been effective when a student identifies which vitamin as necessary for the formation of the myelin sheath in the CNS? a) Vitamin C b) Folic acid c) Vitamin B12 d) Vitamin D

Vitamin B12 Vitamin B12 is necessary for the formation and maintenance of the myelin sheath in the CNS and for the health of RBCs.

A nurse is caring for a client following an organ transplant procedure. The client reports that oral cyclosporine tastes awful and that the client is unable to swallow it. The nurse tells the client that it is possible to make the medication more palatable by mixing it with: a) orange juice. b) grapefruit juice. c) ice cream. d) oatmeal.

a) Orange Juice Cyclosporine may be added to orange juice to make it more palatable. Grapefruit juice should not be used because it affects metabolism of the drug.

The nurse is reviewing the medical record of a client who is taking an alpha- and beta adrenergic agonist. What would be of least concern to the nurse? a) St. John's wort b) Caffeine c) Ma huang d) Over-the-counter (OTC) cold preparations

a) St. John's wort Alpha- and beta-adrenergic agonists interact with caffeine, ma huang, and OTC cold preparations, increasing the risk for hypertension.

A client has been placed on tacrolimus, and the route will be changed from IV to oral prior to discharge home from the hospital. How will this change in administration route affect the client's plan of care? a) The client's dose of tacrolimus will have to be increased. b) The client will receive the drug QID rather than BID. c) The client will have to be monitored more closely for adverse effects. d) The client will have to take tacrolimus concurrently with an antiemetic.

a) The client's dose of tacrolimus will have to be increased. Tacrolimus, like cyclosporine, is not well-absorbed orally, so it is necessary to give higher oral doses than IV doses to obtain similar blood levels. Increased frequency is not necessarily required. Concurrent dosing with an antiemetic is not required. Regardless of the route by which the drug is provided, the client needs to be closely monitored for adverse effects.

Which laboratory assessments are necessary for the nurse to review for a client receiving a filgrastim? Select all that apply. a) WBC b) ANC c) platelets d) sodium e) potassium

a) WBC b) ANC Filgrastim is a colony-stimulating factor (CSF) and acts on the hematopoietic cells to stimulate proliferation, differentiation, and maturation of WBCs. The WBCs and the absolute neutrophil (ANC) are monitored. Therapy is continued until an ANC count of at 10,000/mm3 is achieved. Platelets do not need to be monitored when a client is receiving filgrastim. Sodium and potassium are electrolytes and do not need to monitored with a client receiving filgrastim.

A priority nursing assessment for a client who is to receive an alpha- or beta-adrenergic agonist would be to which action? a) assess heart rate. b) check blood glucose level. c) measure urine output. d)monitor respiratory rate.

a) assess heart rate The client's heart rate must be assessed prior to administration of alpha- and beta-adrenergic agonists. There would some need to check blood glucose, measure urinary output and respiratory although monitored it is not the priority measure.

What would a nurse expect to administer if a client who is receiving isoproterenol develops a severe reaction? a)Beta-adrenergic blockers b)Sympathomimetic agents c)Narcotic antagonist d)Neuromuscular blocking agent

a) beta-adrenergic blockers To counteract the effects of isoproterenol, a beta-specific adrenergic agonist, the nurse would administer a beta-adrenergic blocker.

A nurse would instruct a patient to apply a clonidine patch at which frequency? a) Every 7 days b) Every day c) Every other day d) Every 5 days

a) every 7 days Clonidine transdermal has a duration of action of 7 days, so it needs to be replaced only every week.

A client has been diagnosed with anemia. The nurse knows that erythropoiesis-stimulating agent (ESA) drugs are used to treat anemia associated with certain conditions and treatments. What are expected adverse drug reactions caused by ESAs? (Select all that apply.) a) Hypertension b) Headache c) Rashes d) Fatigue e) Vaginal yeast infection

a) hypertension b) headache c) rashes d) fatigue

Which medication is a synthetic catecholamine prescribed for the treatment of bradycardia? a) isoproterenol b)pseudoephedrine c)ephedrine d) epinephrine

a) isoproterenol Isoproterenol is a synthetic catecholamine that acts on beta1- and beta2-adrenergic receptors to stimulate heart rate. Neither pseudoephedrine, ephedrine, nor epinephrine is synthetic catecholamine.

What second-line vasopressor is likely to be prescribed when norepinephrine proves ineffective at treating hypotension? Select all that apply. a) phenylephrine b)vasopressin c) epinephrine d)phentolamine e) dopamine

a) phenylephrine b) vasopressin c) Epinephrine If hypotension persists despite maximal doses of norepinephrine (or dopamine), second-line vasopressors are epinephrine, phenylephrine, and vasopressin. Phentolamine is used to treat extravasation resulting from the intravenous (IV) administration of norepinephrine.

The nurse is caring for a child who will be receiving a renal transplant and who has been prescribed cyclosporine. When teaching the parents and child about this drug, the nurse should explain what primary rationale for administering this drug? a) Prevention of organ rejection b) Prevention of infection due to immunocompromised status c) Preservation of remaining renal function d) Slowing of metabolic processes postoperatively to prevent an immune response

a) prevention of organ rejection Cyclosporine is used to prevent or suppress rejection in a variety of transplant situations, such as renal transplantation. The drug is an immunosuppressant so it would increase the child's risk for infection. The drug has no effect on renal function or metabolic processes.

A client is receiving anakinra for treatment of rheumatoid arthritis. The client is scheduled to have arthroscopic evaluation of the right knee. What is the priority nursing diagnosis for this client after the procedure? a) Risk for infection b) Risk for injury c) Impaired skin integrity d)Acute pain

a) risk for infection Although all the nursing diagnoses may be appropriate, the priority would be risk for infection because the client is receiving anakinra, which suppresses the immune system and places the client at higher risk for infection following an invasive procedure

A nurse is monitoring the vital signs of a patient who has been administered epinephrine. Which of the readings should nurse report immediately to the primary health care provider? a) Systolic blood pressure below 100 mm Hg b)Temperatures reading of 97.6°F c) Pulse rate of 60 beats per minute d) A diastolic blood pressure of 75 mm Hg

a) systolic blood pressure below 100 mm Hg The nurse must immediately report to the health care provider a fall in systolic blood pressure below 100 mm Hg. Epinephrine should raise the blood pressure, so a continued low systolic pressure indicates the medication has not been effective. A diastolic blood pressure of 75 mm Hg, a pulse rate of 60 beats per minute, and a temperature reading of 97.6°F are normal and need not be reported immediately.

A nurse preparing to teach a client about their newly prescribed cancer treatment should consider addressing which primary reason for non-adherence to the medication regimen? Select all that apply. a) The route of medication administration b) Time constraints and family obligations c) Adverse effects of medications d) The cancer remission rate e)Health care provider attitudes

a) the route of medication administration c) adverse effects of medication Treatment for cancer combines a variety of medications. All of these medications may produce adverse effects so that clients may not feel "better" when taking the drug. The combination of injections and adverse effects may lead to nonadherence to the drugs prescribed. Time constraints, family obligations, cancer remission rate, and health care provider attitude are not as likely to affect adherence to medications.

Prior to beginning therapy with an adrenergic agent, the nurse would expect to obtain what assessments? (Select all that apply.) a) Vital signs b) Urinalysis c) Hearing screen d) Blood glucose e) Arterial blood gases

a) vital signs b) urinalysis d) blood glucose The nurse obtains the client's weight and assesses skin color, temperature, and turgor. Orientation status, reflexes, pulse, blood pressure, respiratory rate, and auscultation of lung sounds are also important to obtain. Required laboratory data include urinalysis, renal function, blood and urine glucose, serum electrolytes, and thyroid function. In addition, an electrocardiogram may be necessary. A hearing screen and arterial blood gases would not be needed.

The nurse has administered a client's prescribed daily dose of filgrastim. When assessing for a therapeutic effect, what laboratory finding should the nurse prioritize? a) White cell differential b) CD4 count c) HIV viral load d) C-reactive protein level

a) white cell differential Filgrastim is given to treat neutropenia; the client's neutrophil level would be revealed in the white cell differential. CD4 and viral load levels are specific to HIV treatment. C-reactive protein levels rise with generalized inflammation, but do not reflect neutrophil levels.

Which adrenergic receptor is responsible for vasodilation of peripheral vessels and bronchodilation? a) β2 receptors b) α2 receptors c) β1 receptors d) α1 receptors

a) β2 receptors Vasodilation of peripheral vessels and bronchodilation are the result of stimulation of β2 receptors.

A nurse is caring for a client who has been receiving an adrenergic medication. Which statement by the client alerts the nurse about an adverse effect of the medication and a reason to call the prescriber? a) "I have a nervous feeling." b) "I feel a "fluttering" feeling in my heart." c) "I am concerned about this hospitalization." d) "I wonder what triggered this allergic reaction?"

b) "I feel a "fluttering" feeling in my heart" Management of the client receiving an adrenergic agent varies and depends on the medication being used, the reason for administration, and the client's response to the drug. Nursing judgment is necessary when reporting adverse reaction. Report adverse effects such as the development of cardiac arrhythmias immediately regardless of the time of day or night. A report of a nervous feeling, or concern about the hospitalization need not be dealt with on an emergent basis. The client is not experiencing an allergic reaction.

An increased dosage of digoxin would be needed if the patient is also taking midodrine. a) True b) False

b) False Midodrine can precipitate increased drug effects of digoxin; this combination should be avoided.

A male client is prescribed interferon. What is his probable diagnosis? a) Hypertension b) Viral hepatitis c) Sepsis d) Bacteremia

b) Viral Hepatitis Interferons are used mainly for viral hepatitis and certain types of cancer.

A nurse is receiving report about a client who had a kidney transplant. Which medications would the nurse expect to suppress organ rejection? (Select all that apply.) a) antibiotics b) corticosteroids c) calcineurin inhibitors d)immunostimulant drugs e)colony-stimulating factors

b) corticosteroids c) calcineurin inhibitors Drugs to suppress immunity in a client who has received a transplant include corticosteroids, clacineurin inhibitors, mTOR inhibitors, IMDH inhibitors, biologics, and monoclonal antibodies. Antibiotics are used for an infection. Immunostimulant drugs are used to stimulate the immune system. Colony-stimulating factors aid in the growth of WBCs that have been destroyed by cancer chemotherapy medications.

A client with an allergy to epoietin alfa should be provided with education regarding the addition of what other medication? a) darbepoetin alfa b) epoetin beta c) filgrastim d) sargramostim

b) epoetin beta Epoetin beta is recommended with an allergy to epoetin alfa. Darbepoetin alfa is similar to epoetin and should not be prescribed. Filgrastim stimulates blood cell production in the bone marrow. Sargramostim stimulates the stem cells from the bone marrow to circulating blood.

Which is an effect of epinephrine? a) Peripheral vasodilation b)Increased heart rate c)Bronchoconstriction d)Decreased blood pressure

b) increased heart rate Epinephrine increases heart rate and acts as a bronchodilator. It has peripheral vasoconstrictive effects and increases blood pressure.

A nurse is providing patient education to a 45-year-old man who is taking cyclosporine (Sandimmune). The nurse will provide the patient with education related to one of the most common and severe adverse effects of cyclosporine, which is: a) hyperthyroidism. b)nephrotoxicity. c) gastritis. d) cardiac effects.

b) nephrotoxicity Nephrotoxicity is one of the most common and severe adverse effects of cyclosporine. The other common and serious adverse effects are hepatotoxicity, malignancies, and neurotoxicity. Gastritis may also occur but would not be considered as severe an adverse effect as nephrotoxicity. The drug is not associated with hyperthyroidism or cardiac effects.

The nurse knows that what is an added benefit of epinephrine in cardiac arrest situations due to asystole or pulseless electrical activity? a) Increases oxygenation to the brain b) Stimulates electrical and mechanical activity c) Reduces seizure activity d)Increases oxygenation to the myocardium

b) stimulates electrical and mechanical activity A benefit of epinephrine in arrest situations due to asystole or pulseless electrical activity is the added ability to stimulate electrical and mechanical activity and produce myocardial contraction.

A client is experiencing shock and is extremely hypotensive. Which would the nurse expect to be the drug most likely to be given? a) Ephedrine b) Epinephrine c) Dopamine d) Dobutamine

c) Dopamine The drug of choice for treating shock is dopamine because it stimulates the heart and blood pressure and also causes a renal and splanchnic arteriole dilation that increases blood flow to the kidney, preventing diminished renal blood supply and possible renal shutdown that can occur with epinephrine or norepinephrine. Ephedrine is used to treat hypotensive episodes, but its use is declining because of the availability of less-toxic drugs with more predictable onset and action. Dobutamine is used to treat congestive heart failure.

Which herbs has been removed from most weight-loss medications due to potential legal liability? a) Gingko b) Ginseng c) Ephedra d) Rose hips

c) Ephedra Ephedra has serious adverse reactions, such as hypertension and irregular heart beat. These side effects have been associated with stroke and heart attacks. The Food and Drug Administration has warnings against taking weight-loss pills that have ephedra in them. Gingko, ginseng, and rose hips have not had these serious side effects.

A client is prescribed iron therapy using iron dextran. The nurse would administer this drug by which route? a) Oral b) Subcutaneous c)Intramuscular d) Intravenous

c) Intramuscular Iron dextran is administered by intramuscular injection using the Z-track technique. Ferrous gluconate, fumarate, and sulfate are administered orally. Iron sucrose and sodium ferric gluconate complex are given intravenously.

To help understand immunostimulant drug therapy, the client has come to the clinic for a class on thrombopoiesis. The nurse explains that the term means the formation of which types of blood cells? a) Red cells b) White cells c) Platelets d) C-reactive protein

c) Platelets Thrombopoiesis is the formation of platelets. Red and white blood cells are not thrombocytes. C-reactive protein is a blood test.

A client is receiving oprelvekin. Which would suggest that the client is experiencing a hypersensitivity reaction? a) Cardiac arrhythmia b) Mental status change c)Chest tightness d) Fever

c) chest tightness Oprelvekin has been associated with severe hypersensitivity reactions, as manifested by chest tightness, difficulty breathing or swallowing, or swelling. Cardiac arrhythmias and mental status changes are adverse effects associated with interleukin therapy and do not suggest hypersensitivity. Fever is associated with the flulike adverse effects of interleukin therapy, not hypersensitivity.

The clinic nurse receives a call from a male client who has been taking interferon alfa for 7 days. The client states that he has become very sad and wonders if life is worth living. What is the best response by the nurse to this client? a) "Don't worry, this medication will make you well again." b) "Wait another 7 days and if you are still feeling sad, call back." c) "Come to the clinic as soon as possible." d) "This is an expected effect. Your depression should lift in another 2 weeks."

c) come to the clinic as soon as possible The client should return to the clinic as soon as possible for reevaluation. If the client is depressed, the medication will need to be stopped because the client can also develop psychiatric symptoms such as hallucinations.

Which assessment finding would indicate to the nurse that the administered isoproterenol is effective? a) Decreased heart rate b)Bronchoconstriction c)Improved cardiac contractility d) Uterine contraction

c) improved cardiac contractility The desired effects of isoproterenol include improved contractility and conductivity, increased heart rate, bronchodilation, relaxation of the uterus, and increased blood flow to skeletal muscles and splanchnic beds.

Which would a nurse identify as the primary issue associated with anemias? a) Defective white blood cells b) Increased plasma proteins c) Ineffective red blood cells d) Lack of vitamin B12

c) ineffective red blood cells Anemias are disorders that involve too few or ineffective RBCs that alter the ability of the blood to carry oxygen. White blood cells are associated with the immune response. Plasma proteins are important in the immune response and blood clotting. Lack of vitamin B12 is associated with a specific type of anemia.

A nurse is caring for a patient who is receiving azathioprine following kidney transplant. For what serious adverse effect should the nurse monitor the patient? a) Respiratory distress b) Mental depression c)Infection d) severe diarrhea

c) infection Azathioprine and other immunosuppressant drugs can increase the risk of infection.

A client is receiving epoetin alfa for anemia. Which adjunctive therapy is imperative with epoetin alfa? a) potassium supplements b)sodium restriction c) iron supplement d) renal dialysis

c) iron supplement When administering darbepoetin and epoetin, an adequate intake of iron is required for drug effectiveness and an iron supplement is usually necessary. It is not necessary to provide the patient with potassium supplements, restrict sodium, or place the patient on renal dialysis.

A nurse is caring for a client with a diagnosis of cancer. The nurse is teaching the client about medications to treat cancer, including erythropoiesis-stimulating agents. Which statement by the client is correct regarding how these medications work? a) "They aid in the growth of WBCs." b) "They normalize RBCs manufacture." c) "They regulate the production of erythrocytes." d)"They are involved in a variety of disease-related regulations."

c) they regulate the production of erythrocytes Erythropoiesis-stimulating agents are glycoproteins that stimulate and regulate the production of erythrocytes. The client is wrong if they state "they aid in the growth of WBCs" or "normalize RBC manufacture." The client is not addressing how the erythropoiesis-stimulating agents work by stating "they are involved in a variety of disease-related regulation."

A client is being treated for asthma. What would the nurse expect to administer? a) Alpha- and beta-adrenergic agonist b) Alpha-specific adrenergic agonist c) Beta-1-specific adrenergic agonist d) Beta-2-specific adrenergic agonist

d) beta-2-specific adrenergic agonist

The nurse knows that which class of drugs prevents epinephrine and norepinephrine from occupying receptor sites on the cell membranes? a) Beta-blocking agonist b)Beta-adrenergic drugs c)Beta-helping drugs d) Beta-adrenergic blocking drugs

d) beta-adrenergic blocking drugs Beta-adrenergic blocking drugs prevent epinephrine and norepinephrine from occupying receptor sites on cell membranes. Beta-adrenergic drugs stimulate epinephrine and norepinephrine release so that they can occupy more of the receptor sites. Beta Blocking agonist cause epinephrine to bind to sites causing airways to open. There is no such thing as beta-helping drugs.