pharm exam #5 prepu
A client who has been prescribed bethanechol asks a nurse to explain how the drug works. What would be a correct response?
"Bethanechol is a direct-acting cholinergic drug that causes contraction of the smooth muscles of the bladder and passage of urine."
A 42-year-old client is experiencing chemotherapy-induced thrombocytopenia. The nurse is providing information to the client regarding the medication oprelvekin. Which information would the nurse include in the explanation?
"Chemotherapy has caused you to have a low platelet count, which puts you at risk for bleeding. Oprelvekin is used to increase platelet production to decrease the risk."
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."
The nurse is educating a client who has been prescribed atropine, an anticholinergic drug. Which instructions should the nurse provide to the client?
"Do not drive or operate machinery."
The health care provider has ordered scopolamine transdermally for motion sickness. Which statement by the client, prescribed transdermal scopolamine, indicates an understanding of the medication's administration guideline?
"I will change the patch every 3 days."
A nurse is discharging a client who was hospitalized for severe urinary retention. The client has a prescription for Duvoid. Which statements would indicate the client has understood instructions on urinary retention and taking Duvoid?
"I will keep track of how much fluid I drink and how much urine I void."
A client with asthma will soon begin treatment with atropine as an adjunct to a normal drug regimen. What teaching point should the nurse include in client education related to this new aspect of drug treatment?
"It's possible that your eyes will take longer to adjust to bright lights."
A nurse is talking to a client about their ability for micturition. Which statements would indicate the client understands what the nurse is talking about?
"Sometimes my bladder feels full and I can't pee."
A 72-year-old client has been diagnosed with iron deficiency anemia. The client comes to the clinic for the nurse to teach the recommended way to take the iron supplement. Which of the following information would the nurse include in the client's teaching plan?
"Take this drug with water on an empty stomach."
A client is undergoing chemotherapy for vulvar cancer. The client had a friend who died after treatment, which has caused severe anxiety and fear; the client is constantly tired and sees this as an indication she won't survive. The nurse knows that the client is scheduled for immunostimulant drug therapy to support the hematopoietic system. The nurse would include which statement to explain the action of drug?
"Taking immunostimulants to stimulate the production of blood cells will help you feel better."
The nurse is caring for a 30-year-old woman who came to her gynecologist today to receive a Gardasil injection, stating that she believes that she may have genital warts. What should the nurse teach this client?
"The drug is only effective if administered before exposure to human papillomavirus (HPV)."
The nurse is preparing to administer oprelvekin to a client diagnosed with a chemotherapy-induced bleeding disorder. The nurse is explaining to the client the reason for administering this drug? Which explanation is best?
"The drug is used to increase platelet count during chemotherapy."
The nurse is caring for a client in the immediate postoperative period following cardiac transplantation. The client is receiving mycophenolate IV. What should the nurse teach the client regarding drug therapy? Select all that apply.
"The drug will be given orally as soon as possible." "It's important to avoid people with contagious diseases." "Ask a pharmacist about drug-drug interactions before taking any over-the-counter (OTC) drug once you're discharged." "Never miss a dose of medication."
The nurse learns that a client in a clinic is taking folic acid to treat an associated anemia. The client decided to go on a fasting diet for the last two weeks to lose weight before her daughter's wedding. How would the nurse explain the importance of staying on the diet that the provider prescribed last month?
"The prescribed diet and drug are necessary to correct anemia associated with folic acid deficiency."
The parents of a two month-old infant have brought their child in to the clinic for the first scheduled immunizations. The parents appear anxious and the child's father says, "We keep hearing about the link between vaccinations and autism. Is there a risk that it could happen to our child?"
"There's been shown to be no genuine link between children receiving vaccinations and developing autism."
The nurse is teaching a client about macrocytic anemia. Which of the following information would the nurse include in the teaching plan?
"This is an anemia that results from the abnormal formation of erythrocytes."
A client is reading something about his medication on the Internet and asks the nurse what synergistic means. What would be a correct response by the nurse?
"This occurs when two drugs are taken together and the effect is greater than the two drugs taken separately."
A primiparous woman tells the nurse that she and her partner are highly reluctant to have their infant vaccinated, stating, "We've read that vaccines can potentially cause a lot of harm, so we're not sure we want to take that risk." How should the nurse respond to this family's concerns?
"Vaccinations are not without some risks, but these are far exceeded by the potential benefits."
The nurse is working with the parents of an infant and has initiated a dialogue about immunizations. The infant's parent states, "We're not comfortable with immunizations because of the safety issue." What is the nurse's best response?
"What are some of the safety risks that most concern you?"
The nurse is preparing to administer a dose of the human papillomavirus vaccine to a middle school student. What assessment question should the nurse prioritize when interacting with the student?
"What's your understanding of why you're getting this vaccination?"
After a client age 65 years diagnosed with vitamin B12 deficiency learns about the use of the vitamin, she asks the nurse what caused her B12 deficiency anemia. Which of the following statements would the nurse use when teaching the client about vitamin B12?
"You have a deficiency because you are on a strict vegan diet."
A client prescribed prednisone 40 mg daily should be provided what information about immunizations by the nurse?
"You should wait at least 3 months after chemotherapy to obtain a live vaccine immunization."
For the first time, a 10 year-old female has received an IM injection of Gardasil. What follow-up education should the nurse provide?
"You'll have to get another shot in around 2 months."
The nurse is administering colony-stimulating factors to an older adult client after chemotherapy. The nurse should explain to the client that this medication is being administered for which reason?
"Your body is going to have trouble fighting off infections on it's own. This medication will help with that."
After teaching a group of nursing students about the effects of the parasympathetic nervous system, the instructor determines the need for additional teaching when the students identify which of the following?
-slowing of peristalsis
What is the recommended dosage for atropine for a client with a bradyarrhythmia?
0.4-0.6 mg
A physician has prescribed 5mg IV of edrophonium to a client with myasthenia gravis. The available dose is 4 mL/40 mg. How much of edrophonium should the nurse administer the client?
0.5 mL
A mother brings her 18-month-old into the clinic for a well-baby check-up. A nurse will administer measles, mumps, and rubella vaccine (MMR) to the 18-month-old. What dosage will the nurse administer?
0.5 mL IM
The nurse should be prepared to administer an infant's first dose of polio vaccine at what age?
2 months
If a nurse is administering immune globulin to a client in the health care provider's office, the nurse would monitor the client for hypersensitivity reactions for how long after administering the drug?
30 minutes
A client is receiving propantheline as adjunctive therapy for peptic ulcers. The nurse instructs the client to take the medication at which time?
30 minutes before meals
A nurse caring for a client receiving bethanechol for urinary retention should advise the client that voiding usually occurs how long after oral administration?
30 to 90 minutes
A client bitten by a copperhead snake will benefit the most if the antivenin is administered within how long after exposure?
4 hours
What client would be most likely to benefit from the administration of epoetin alfa?
A client with hemorrhage after abdominal surgery
A client with chronic arthritis is taking a corticosteroid medication. The client has been given a prescription of a cholinergic medication to treat urinary retention. The nurse knows that the two medications will have what effect?
A decreased effect of the cholinergic drug
A nurse has administered a drug that will have a therapeutic effect on the client's parasympathetic nervous system. The nurse understands the drug will primarily affect what neurotransmitter?
Acetylcholine
A hospitalized client is about to receive immunological therapy and asks the nurse to explain the difference between passive and active immunity. In order to provide complete information, the nurse knows to include which information during the teaching session?
Active immunity occurs when a client receives a killed or weakened antigen that stimulates antibodies. These antibodies fight the antigen (for example, chickenpox vaccine).
A 40-year-old, diagnosed with myasthenia gravis (MG), is scheduled to begin treatment with oral neostigmine. When providing relevant health education, the nurse should emphasize that successful control of MG symptoms will primarily depend on what personal behavior?
Adhering strictly to the prescribed administration schedule
A client has presented to the emergency department with a puncture wound suffered a few hours ago while demolishing an old house. The nurse's assessment reveals that the client is not in acute distress. The client's immunization status is unknown. What intervention should the nurse prioritize?
Administering tetanus immune globulin as prescribed
A 78-year-old client is about to begin home care and has been prescribed an anticholinergic. What should the home care nurse explain to the client and her family about this medication?
All the above
Decreased acetylcholine levels are characteristic of:
Alzheimer's disease.
A client is brought to the emergency department after being bitten by a snake. The nurse asks the client to carefully describe the snake that bit them. The nurse would ask this question for which reason?
Antivenin is very specific with regard to the venoms it can treat.
The nurse is discussing adverse reactions involving the cardiovascular system after administration of oprelvekin. The nurse would include which reactions in the client teaching plan?
Arrhythmia
The administration of immunizations to a client is a form of what type of immunity?
Artificial active immunity
The nurse is caring for a client who has a diagnosis of chronic hepatitis B infection and has been prescribed an immune stimulant. After teaching the client about the treatment plan, how should the nurse evaluate the effectiveness of teaching?
Ask the client to describe specific measures to avoid adverse effects.
A 4-year-old girl is brought to the emergency department by her mother. The mother reports the child has been vomiting, The nurse notes the child's face is flushed and is diaphoretic. The mother thinks the child may have swallowed carbachol drops. A diagnosis of cholinergic poisoning is made. Which drug would be administered?
Atropine
A child is brought to the emergency department after ingesting his grandfather's Duvoid medication. The nurse knows what medication is an antidote for Duvoid?
Atropine
A client being treated for myasthenia gravis is receiving neostigmine. When the client's pulse drops to 50 after the administration, which medication should be administered to treat the bradycardia?
Atropine
A client experiences an overdose of a cholinergic drug. Which medication would the nurse anticipate that the client will receive as a reversal agent?
Atropine
The client is taking digitalis and has not been monitoring pulse rate. The client presents to the emergency department via ambulance experiencing digitalis toxicity and symptomatic bradycardia. The nurse knows that which medication may be administered to treat bradycardia?
Atropine
The health care provider is preparing to administer edrophonium to confirm myasthenia gravis in a 47-year-old male client. What other drug must be available when edrophonium is administered?
Atropine
Which agent would be used to counteract a severe reaction occurring with the use of neostigmine?
Atropine
Which would be important to perform for a client who has received an anticholinergic agent? (Select all that apply.)
Auscultating bowel sounds Monitoring urine output Monitoring heart rate
An adult client with a recent history of visual disturbances and dysphagia has just been diagnosed with myasthenia gravis. The nurse should recognize that this client's health problem is ultimately attributable to what pathophysiologic process?
Autoimmune destruction of acetylcholine receptors
An adult client being treated for breast cancer inquired about required vaccinations. What information should the nurse provide to this client?
Avoid all live vaccines.
A client comes to the clinic to learn about pernicious anemia. What would the nurse include in the lesson plan?
Avoid contact with infectious disease.
Which would the nurse include in a teaching plan for a client who is prescribed an anticholinergic agent?
Avoiding activities that require alertness
A female client 50 years of age has a history of an allergy to cyanocobalamin. Based on the history, the nurse knows which of the following vitamins is contraindicated?
B12
A nurse is reviewing the medication history of several clients. One of the clients is receiving a direct-acting cholinergic drug. The nurse would most likely identify which drug?
Bethanechol
The client has been diagnosed with urinary retention. The nurse expects the client to receive which medication for this condition?
Bethanechol
The client is receiving a cholinergic agonist. Which assessment finding in a client warrants immediate action by the nurse?
Blood pressure decreased from 110/90 mm Hg to 80/50 mm Hg
A male client, age 75, is started on flavoxate . What adverse effect should the client be made aware of?
Blurred vision
Which effects does the nurse expect a client to exhibit from parasympathetic stimulation?
Bradycardia
When describing the contraindications associated with direct-acting cholinergic agents to a group of students, what would an instructor include? (Select all that apply.)
Bradycardia Peptic ulcer disease Asthma Bladder obstruction
A client has undergone organ transplant and fears that she will die of a virus infection because of the postoperative anti-rejection drug therapy. The nurse should provide what information to the client about anti-rejection treatment?
CMV-IGIV is routinely administered for prevention of cytomegalovirus after organ transplant.
The nurse is preparing to administer a vaccine to a newborn. What action would the nurse take prior to administering the vaccine?
Check the infant's temperature.
The nurse educator is teaching a class of students about the actions and uses of colony stimulating factor. The nurse should inform students CSF is indicated for what secondary problem related to cancer treatment?
Chemotherapy-induced neutropenia
An order for a PCR confirms that for a client that the painful rash on her trunk is caused by herpes zoster (shingles). The nurse explains that the painful rash is called shingles and is caused later in life by which of the following infections?
Chickenpox
The nurse is caring for a client with glaucoma and is aware that which category of preanesthetic medication is contraindicated in this client?
Cholinergic blocking
Administration of which classes of medications can decrease secretions of the upper respiratory tract?
Cholinergic blocking drug
A middle-aged client has been admitted to the outpatient treatment unit of the hospital for an edrophonium test. Shortly after the administration of the medication, the client reports that the muscle strength is significantly weaker than before the test. The nurse who is participating in the test should recognize that this finding is suggestive of what diagnosis?
Cholinergic crisis
A client has atony of the smooth muscle of the gastrointestinal tract. Which type of medication will be administered to increase smooth muscle strength?
Cholinergic drugs
A 32-year-old breast-feeding mother has been diagnosed with closed-angle glaucoma and is receiving cholinergic therapy. She does not have a history of asthma, cardiovascular disease, or biliary disorder. What is the most important factor that the nurse would consider during ongoing assessment of the therapy?
Cholinergic stimulation in her infant
A client is scheduled to receive an immunization. In which client may the administration of a live vaccine be contraindicated?
Client taking steroid therapy
They provide the person with active immunity.
Client taking steroid therapy
The nurse is addressing with a nursing student the types of treatments to expect when caring for a client with chronic kidney disease. Which of the following would the nurse include in the lesson plan?
Colony stimulating factors are one type of immunostimulant that can boost the diminished cell count caused by chronic kidney failure.
Routine immunization can help reduce the spread of disease. Which of the following is a strategy that is used to promote routine immunization?
Combining vaccines so that only one injection is required
The critical care nurse is providing care for a client whose heart rate has dropped to 29 beats/min. The care provider has prescribed atropine 0.5 mg IV. What is the nurse's best action?
Confirm the client's identity, administer the drug, and monitor closely.
A client with a neurogenic bladder secondary to a spinal tumor has been taking bethanechol. When the nurse finds the client anxious, diaphoretic, and visibly flushed, what action should the nurse take to best assure the client's safety?
Contact the health care provider as the client may be experiencing a cholinergic crisis.
The client is to receive an IV cholinergic medication. When the nurse administers the drug what reaction will the nurse anticipate?
Decrease in heart rate
The client has been prescribed a cholinergic medication. Which nursing diagnosis is common for clients taking a cholinergic medication?
Diarrhea related to medication side effect
A client is experiencing symptoms of a hyperactive bowel. Which agent would the nurse expect to be ordered?
Dicyclomine
The nurse would closely monitor a client for signs and symptoms of toxicity of which medication if the client is also prescribed a cholinergic blocking drug?
Digoxin
Which signs may be observed by the nurse in a client receiving an underdosage of ambenonium for myasthenia gravis?
Drooping of the eyelids
After teaching a female client who is prescribed a scopolamine patch, the nurse determines that the teaching was successful when the client states that she will change the patch in which time frame?
Every 3 days
A nurse is assessing a client prior to giving a cholinergic drug for myasthenia gravis. Which symptoms would cause the nurse to withhold the medication and call the provider? Select all that apply.
Excessive salivation Severe abdominal cramping Clenching of the jaw
An adult client received the annual influenza vaccine yesterday afternoon and has now presented back to the clinic reporting malaise. The client's oral temperature is 37.4°C (99.3°F). What is the nurse's best action?
Explain that vaccines often cause a mild immune response and have the client self-monitor
The nurse is aware that cholinergic blocking agents will be used preoperatively for what type of anesthesia?
General
Clients with what disorder should not be given anticholinergic drugs?
Glaucoma
The client is scheduled for surgery in two hours. The physician orders preoperative administration of glycopyrrolate and meperidine. These drugs might be contraindicated for the client if the client had what disorder?
Glaucoma
A nurse would be alert for which risk if a client was receiving a cholinergic drug and then was ordered to receive another cholinergic drug?
Greater risk for toxicity
The nurse is teaching a course to students about immunologic agents. In order for the students to understand active immunity, the nurse explains that there are agents that provide active immunity. Which is an active immunity agent?
Haemophilus influenzae type B conjugate
A client is receiving omalizumab to treat allergic asthma, which is not relieved by inhaled corticosteroids. Which nursing intervention is appropriate with each dose administration of omalizumab?
Have epinephrine available during administration.
A nurse educator is teaching nursing students about the administration colony-stimulating factors. Teaching is effective when the students identify the need to assess for which adverse reaction related to this drug?
Hypertension
The nurse understands that older clients taking anticholinergic drugs are more likely to have all of the following symptoms EXCEPT:
Hypertension.
A nurse is receiving post-exposure prophylaxis for hepatitis B. What would the nurse most likely receive?
Immune globulin
The nurse is caring for a 16-year-old client who just received a kidney transplant. Which of the following passive immunity agents would the nurse include in the family teaching session regarding prevention of organ rejection?
Immune globulins
A nurse is caring for a client with a nursing diagnosis of Imbalanced Nutrition: Less Than Body Requirements related to iron deficiency. Which instructions should the nurse offer the client when providing care?
Increase intake of lean red meats.
A client with myasthenia gravis has received ambenonium (Mytelase). What is the therapeutic response the nurse expects to assess?
Increased muscle strength
The client is receiving Bethanechol for bladder atony. What assessment findings indicate the effect of this medication?
Increased urinary output
The nurse administers a drug that will increase micturition. What should the nurse assess for a therapeutic effect?
Increased voiding
A group of nursing students are presenting information on the hepatitis B vaccine. What would the students prepare to tell others about the recommended population?
Infants and people at high risk for contracting the disease
A 70-year-old client is taking a cholinergic blocking drug. The family has noticed the client is a confused, excited, and not voiding normally. What would be the appropriate action by the nurse in this situation?
Instruct the client's family to withhold the next dose and the nurse will contact the prescribing provider.
The nurse is providing education to clients who are required to take B12 due to deficiency anemia. The nurse should discuss the role of which body substance responsible for absorption of this vitamin?
Intrinsic factor
Which agent would the nurse expect to be prescribed for a client with seasonal rhinitis?
Ipratropium
A client with myasthenia gravis is experiencing rhinorrhea. Which of medication should not be administered to the client?
Ipratropium (Atrovent)
A student nurse is preparing to administer an oral iron supplement to a client diagnosed with iron deficiency anemia. The supervising nurse should question the student regarding which interaction caused when iron and antibiotics are used together for treatment?
Iron causes a decreased gastrointestinal absorption of the antibiotic.
A client is administered atropine to increase the heart rate. What is the action of atropine?
It blocks the parasympathetic vagal stimulation.
A client is ordered to receive cyclosporine intravenously, and the nurse has explained the need for frequent blood work. This blood work is required because of what characteristic of cyclosporine?
It has a narrow therapeutic range.
A client diagnosed with anemia asks what the cause of anemia is. Which is the nurse's best response?
It is caused by a decrease in the number of RBCs.
A young mother asks the clinic nurse about the "chickenpox" vaccine. The mother states that she and her husband have both had chickenpox, but that she wants to protect her child if she can. What should the nurse tell the mother about the recommendation for the chickenpox vaccine?
It is recommended for all children who have not been exposed to the varicella virus.
An infant is being administered an immunization. Which statement provides an accurate description of an immunization?
It is the administration of an antigen for an antibody response.
A nursing student is trying to remember what the parasympathetic branch of the autonomic nervous system does. The nurse would provide which of the following statements as the best reminder?
It is the rest-and-digest response."
A nurse is teaching a client about an iron supplement. Which should be included in the teaching a client about this medication?
It should be taken on an empty stomach.
A client is prescribed filgrastim. Which is the nurse's <b>best</b> explanation of how this drug works?
It stimulates growth and production of WBCs to fight off infection.
A client diagnosed with myasthenia gravis is administered a cholinergic drug named neostigmine. How does this drug produce its therapeutic effect?
It stimulates the parasympathetic nervous system.
A client has been prescribed an anticholinergic medication. What instructions should the nurse provide related to safety when outside in hot weather?
Keep well hydrated
The nurse educator is teaching students regarding different types of immunostimulant drugs. When discussing lab values associated with the administration of these drugs, which cell counts should the nurse tell the students to expect?
Low platelet and low white blood cell count.
When teaching new parents about the benefits of adhering to the recommended vaccination schedule for their infant, the nurse should cite protection against which diseases? Select all that apply.
Measles Varicella Poliomyelitis Hepatitis B
An employee of a long-term care facility has been administered the hepatitis B series prior to beginning employment. How should the employee's therapeutic response to the vaccination be best assessed?
Measure the employee's serum antibody levels.
The nurse is teaching a client about megaloblastic anemia. What information would the nurse include in the teaching plan?
Megaloblastic anemia is characterized by large immature erythrocytes, due to folic acid deficiency.
A nurse administers carbachol eye drops to a client. What would indicate that the drug is effective?
Miosis
A client is being treated for malignant melanoma and has been prescribed interferon alfa-2b. The client has complex medical history and the medication regimen includes aspirin, furosemide, bisoprolol and levothyroxine. When planning the client's care, what should the nurse prioritize?
Monitor the client's response to the medication and assess for adverse effects.
After administering a cholinergic blocking drug to a client, the client reports some blurred vision. The nurse observes that the client's pupils are dilated. The nurse documents this finding as which adverse effects?
Mydriasis
The stimulation of which receptors in the parasympathetic nervous system stimulates skeletal muscle?
Nicotinic receptors
An elderly woman is given scopolamine while on a cruise. She becomes very agitated and confused and is taken to the sick-bay of the ship. The nurse knows that which is a likely reason for these symptoms?
Older clients have a greater chance of adverse reactions to cholinergic blocking drugs.
Which of the following is an anticholinergic drug that may be used in the treatment of overactive bladder?
Oxybutynin
The nursing instructor is discussing cholinergic drugs. The nursing students understand what system is acted upon by this family of drugs?
Parasympathetic nervous system
A nursing student is preparing to administer the drug bethanechol to a client with urinary retention. After researching the drug's actions and uses, the student demonstrates understanding of the drug by identifying it as which type of medication? Select all that apply.
Parasympathomimetic drug Cholinergic drug
When discussing vaccines in class, a student asks the instructor what an antitoxin is? What is an example of an antitoxin?
Passive immunity
A client who is receiving an immune suppressant has been admitted to the hospital unit. What action should the nurse prioritize?
Place the client on protective isolation.
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?
Platelets
The nurse is providing care for a client whose current medications include tacrolimus. The nurse should anticipate that this client is likely to be taking what medication concurrently?
Prednisone
An older adult client has experienced a sharp decline in her mobility and quality of life due to severe rheumatoid arthritis. As a result, the health care provider has recently prescribed abatacept. This fusion protein inhibitor will achieve a therapeutic effect by what means?
Preventing the activation of T cells
Anticholinergics have varied effects on the body. What is one of those effects?
Preventing vagal stimulation
The nurse is reviewing laboratory values of client who has a respiratory illness. Which cells supply oxygen to the tissues?
RBCs
The school nurse is participating in a program to immunize students against human papillomavirus (HPV). What benefit should the nurse describe to students and their families?
Reduced risk for cervical cancer
A client is prescribed glycopyrrolate preoperatively. The nurse integrates understanding of the drug's action, explaining that this drug will help achieve which effect?
Reduction of oral secretions
A client comes to the clinic for follow-up for a diagnosis of hypertension. During the intake history, the nurse finds that the client is scheduled for epoetin alfa therapy. Which action will the nurse take?
Report any rise in the blood pressure of 20 mm Hg or more in the systolic or diastolic to the primary care provider.
A nurse is participating in an influenza vaccination clinic on a college campus. What action will best prepare the nurse for this role?
Review the procedure for intramuscular injection
A client is to begin treatment for rheumatoid arthritis with infliximab. What potential risk should the nurse identify as being associated with this drug?
Risk for infection
A client has received a rubella immunization. The client was unaware that she was pregnant. What risk is associated with the administration of the rubella immunization in this client?
Risk of birth defects
A client is scheduled to receive immunization with a live vaccine. The nurse would hold the vaccine and contact the health care provider when noticing what information in the client record?
Steroid therapy
A 27-year-old male is taking an anticholinergic drug as adjunctive therapy to treat his peptic ulcer disease. The client comes to the clinic and tells the nurse that he "feels his heart beating." What adverse effect is the client experiencing from the anticholinergic medication?
Tachycardia
What are important precautions a nurse should teach a client receiving an immunosuppressant? (Select all that apply.)
Take precautions to avoid getting pregnant. Keep follow-up appointments for laboratory assessments. Avoid crowds.
A 45-year-old female client is being seen at the oncology clinic for a two-year follow up for cancer. Within the past two days, the client was exposed to hepatitis A and requests immune globulin prophylaxis. The nurse checks the electronic health record and discovers the client has had extensive immunosuppressive drug therapy in the past. The nurse knows that the client's history guides the nurse to take which of the following actions?
Teach the client that the administration of immune globulin is contraindicated for clients with a history of immunosuppressive drug therapy and leukemia.
A client on the transplant unit is taking cyclosporine after receiving a liver transplant 4 days earlier. A coworker of the client has come for a visit and is apologetic because of a cough and runny nose. What is the nurse's best action?
Teach the visitor about the client's risk for infection and ask the visitor to return after becoming healthy.
The nurse is assessing a client who received pyridostigmine (Mestinon). What assessment indicates a potential side effect?
The client has a heart rate of 120 beats/minute.
A client has come to the clinic requesting a hepatitis A and B vaccination before leaving on a tropical vacation. After assessing the client, the nurse should prioritize what finding to communicate to the provider?
The client takes corticosteroids to treat rheumatoid arthritis
A 65-year-old client has come to the clinic after receiving the shingles vaccine two weeks ago. The client asks the nurse how long the immunity will last. The nurse would include which information in the explanation?
The varicella virus (shingles) vaccine protects the recipient for several years or for life.
A 72-year-old female client has come to the primary care provider's office asking for the varicella virus vaccine to prevent shingles. The nurse knows that the vaccine can only be administrated to people who have never had herpes zoster before for which reason?
The varicella virus vaccine contains the live, attenuated varicella virus that causes a mild form of the infection, producing immunity against the virus.
The perioperative nurse is caring for a surgical client whose anesthesiologist has just administered atropine. When assessing the client, what finding should the nurse interpret as achieving the desired effect?
There is no evidence of excessive oral or bronchial secretions.
The nurse is assigned to perform telephone triage for the clinic and receives a call from a young parent whose 6-month-old baby received their third diphtheria-pertussis-tetanus immunization that morning. The parent reports the baby's temperature is 99.8° axillary, the site of injection is "a little red," and the baby is irritable. After checking the standing orders provided by the pediatrician, what teaching would the nurse provide this parent? Select all that apply.
These are common adverse effects reported after immunizations." "Apply a warm moist compress to the baby's leg." "Symptoms should subside within 2 to 3 days."
A student asks the pharmacology instructor to explain the action of anticholinergic agents. What would be the instructor's best response?
They act to block the effects of the parasympathetic nervous system.
Which best reflects the action of direct acting cholinergic agonists?
They occupy receptor sites for acetylcholine.
A nurse is teaching a group of clients about immunizations . What benefit of immunization should the nurse describe?
They provide the person with active immunity.
The nurse administered neostigmine to a client with myasthenia gravis. The nurse is doubling the dose that the client was taking at home. Three hours later, the nurse is assessing the client and notes the following symptoms: nausea with vomiting, diarrhea, and sweating. What does the nurse interpret these symptoms to be?
This is cholinergic crisis, and the provider needs to be notified immediately.
The nurse is preparing a client for pacemaker surgery. The health care provider orders atropine to be given 30 minutes before the client is taken to the operating room. The nurse knows this medication is ordered for what reason?
To dry up respiratory secretions to prevent aspiration during surgery
The client is ordered bethanechol subcutaneously. After giving the client the injection of bethanechol, the nurse should make sure that what is available?
Urinal, bed pan, and call light
A nurse is reviewing laboratory values of a client who has a urinary tract infection. Which cells protect the body from microorganisms?
WBCs
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?
White cell differential
When providing a health promotion presentation to a group of seniors, how often should the nurse instruct the senior group to obtain influenza vaccines?
Yearly
For the first time, a 10 year-old female has received an IM injection of Gardasil. What follow-up education should the nurse provide?
You'll have to get another shot in around 2 months."
The infection control nurse is assessing the immunization status of many of the hospital's current clients. For what client would vaccination most likely be contraindicated?
a client who takes immunosuppressants post-renal transplant
A client asks what neutropenia is. Which is the nurse's best response?
a condition when the neutrophil level is very low
Which statement best describes the recommended vaccination schedule for a 63-year-old client?
a tetanus-diphtheria booster every 10 years, annual influenza vaccine, and a one-time administration of pneumococcal vaccine at 65 years of age
A client receives an immunization. The nurse interprets this as providing the client with which type of immunity?
artificially acquired active immunity
The nurse has just administered the measles, mumps, and rubella vaccine to a female client. The nurse instructs the woman to avoid becoming pregnant for how long?
at least 3 months
A 78-year-old client is admitted to the Emergency Department (ED) and is diagnosed with bradycardia. The client tells the nurse that the client is taking donepezil (Aricept), a cholinergic agent, for Alzheimer's disease. The nurse knows that the drug of choice for bradycardia is:
atropine.
The nurse is assessing a client during a home health visit. The client asks how interferon works. The nurse should inform the client that interferon works by:
controlling cellular proteins.
What is the primary goal for prescribing an anticholinergic agent for a preoperative client?
decrease respiratory secretions
A client is diagnosed with anemia. The nurse understands that anemia can result in which effect?
decreased platelet production
While preparing a client for an eye examination, the nurse explains that the eyedrops, an ophthalmic anticholinergic preparation, will cause what pupil reaction?
dilatation
A client who is going on a cruise is concerned about motion sickness and sees the health care provider, who prescribes scopolamine. The nurse informs the client that using scopolamine may cause the client to experience:
drowsiness.
The nurse prepares to administer a preoperative anticholinergic to a client. What is a desired effect based upon the characteristics of the prescribed medication?
dry mucous membranes
A client suffering from anemia resulting from chronic kidney disease might be treated with which drugs?
epoetin alfa
A client about to receive an injection of influenza vaccination should be informed of the possibility of experiencing which short-term adverse effect? Select all that apply.
erythema at the injection site low-grade fever muscle aches malaise
A nurse is describing the process by which the body is stimulated to make more of a specific type of blood cells. The nurse is describing which process?
hematopoiesis
What client assessment finding will have the greatest effect on the half-life of methotrexate therapy?
history of chronic renal impairment
A nurse is writing a plan of care for a client who has been prescribed bethanechol. What outcome should the nurse include in the care plan?
improved bladder function
What specific effect is expected of acetylcholinesterase inhibitor drugs like neostigmine? Select all that apply.
increased tone of gastrointestinal (GI) smooth muscle increased relaxation of sphincters increased salivary gland secretions decreased heart rate
How does bethanechol affect bladder emptying?
increasing the muscle tone of the detrusor muscle
A client develops neutropenia secondary to chemotherapy. The nurse would identify that this client is at risk for which complication?
infection
A nurse is educating a group of nursing students about the different types of vaccines. Which should the nurse mention as a killed virus vaccine?
influenza vaccine
When educating clients on the immune system, the nurse identifies which white blood cells to be involved in cell-mediated immunity (CMI) along with T lymphocytes?
macrophages
The nurse administers a dose of carbachol to an ophthalmologic client. When assessing this client, the nurse would expect to see effects arising from stimulation of what receptors?
muscarinic
The nurse is caring for a client who has indirect-acting cholinergic agonists prescribed to treat myasthenia gravis. When administering this classification of drug, the nurse should assess the client for what sign of a potential toxic effect?
muscle weakness
A 71-year-old client has sought care due to recent bradycardia, and the nurse's initial assessment reveals a heart rate of 42 beats/min. Upon reviewing the client's health history, the nurse also learns that the client has comorbidities of myasthenia gravis and type 1 diabetes. What aspect of this client's health status would contraindicate the safe use of an anticholinergic?
myasthenia gravis
The administration of immune globulins or antivenins to a client is a form of what type of immunity?
passive immunity
Oprelvekin is a drug that stimulates the process of making which blood cells?
platelets
A group of students are reviewing class material about immunizations and vaccines. The students demonstrate understanding of the topic when they state that immunizations and vaccines:
provide the person with active immunity.
While being intubated, a client with a head injury experienced bradycardia. Atropine was consequently administered. What assessment should be postponed until all atropine is excreted and no longer exerting an effect?
pupil response
A client with a history of multiple drug allergies is scheduled to receive a vaccination against chickenpox. Which would the nurse expect to be completed before the vaccine is administered?
skin test
A middle-aged client is being treated for myasthenia gravis with neostigmine. What change in the client's health status would warrant immediate medical follow-up?
sudden muscle weakness
Which intervention regarding the oral administration of mycophenolate should the nurse encourage the client to implement to minimize the risk of undesired effects?
taking the pills on an empty stomach
When describing cell-mediated immunity, a nurse would explain that this type of immunity depends on which response or action?
the action of T lymphocytes
Mycophenolate mofetil is being considered in the treatment of a 39-year-old female transplant recipient. Before the initiation of therapy, the nurse must assess the client for what information to ensure safety?
the fact that the client is not pregnant
A client has been newly diagnosed with myasthenia gravis. What education should the nurse provide the client and family?
the signs and symptoms of a medication overdose
The nurse is educating a client who has just been prescribed bethanechol. The nurse has taught the client to take the medication on an empty stomach. What is the rationale for the nurse's instruction?
to decrease nausea and vomiting
After reviewing information about the use of epoetin alfa (Epogen), the nurse demonstrates understanding of the information by identifying that this drug is contraindicated in clients with which medical conditions?
uncontrolled hypertension
Cholinergic drugs are contraindicated in all situations except in clients with:
urinary retention or postoperative abdominal distention due to paralytic ileus.
